Access to the craniofacial skeleton and skull base requires osteotomies. An adequate exposure of neoplasms occupying the skull base and the oral cavity and oropharynx, especially retromolar trigone, is very important for precise tumor ablation. The demonstration by Tessier of the capacity for large segments of bone to survive removal and replacement has enabled skull base tumor surgery to grow into a subspeciality. Through the refined craniofacial exposure osteotomies, the surgery is safer, the operation shorter, and the result better both oncologically and reconstructively. We experienced 24 cases of exposure osteotomies consisting of 12 cases transzygomatic approaches, 1 case tranglabellar osteotomy, 1 case lateral transmaxillary approach, 1 case Le Fort II & midline splitting, and 9 cases mandibulotomy. There was no significant complication except a local wound infection in transzygomatic approach and one case of minimal malocclusion after parasymphyseal mandibulotomy. The orthotopic bone graft and the rigid fixation enables the postoperative morbidity to decrease. It seems that the previously inaccessible craniofacial tumors can be treated through the various exposure osteotomies.
Malocclusion ; Mouth ; Oropharynx ; Osteotomy* ; Skeleton ; Skull Base ; Transplants ; Wound Infection

No abstract available.
Free Tissue Flaps* ; Head* ; Neck*

No abstract available.
Adenocarcinoma* ; Estrogens*

Bony defect is one of the most common problems in craniomaxillofacial surgery. Although aurogenous bone graft is the best choice for the treatment of bone defect, it provides many problems such as donor site morbidity, irregular absorption, and limited amount of harvest. To overcome the shortcomings of autogenous bone graft many bone substitutes have been introduced. The ideal bone substitution is to have characteristics such as cheap, easy to obtain, rapid fusion to recipient bone, hard structure, long maintenance of shape and volume, low infection rate, and low exposure rate. Among those bone substitutes which have been widely used we chose lyophilized cartilage allograft because of low antigenecity, low resorption rate, easiness of carving and ling term preservation. From August 1993 to August 1997, 66 patients had been performed craniomaxillofacial reconstruction with lyophilized cartilage allograft. Orbital wall reconstruction and correction of enophthalmos were 24, correction of cleft lip and nose deformity were 19, temporal augmentations were 7, and others 16. Complications such as infection, exposure were not common. And partially removed cartilage was proved some calcification. Radiologic follow-up presented well positioned lyophilized cartilage allograft. Two radiologic works revealed haziness of bone density at the site of cartilage allograft. This suggests the ossification of lyophilized cartilage allograft. Together with liw infection rate, low exposure rate, and good framework for osteoconduction, lyophilized cartilage allograft are regarded as one of the good bone substitutes.
Absorption ; Allografts* ; Bone Density ; Bone Regeneration ; Bone Substitutes ; Cartilage* ; Cleft Lip ; Congenital Abnormalities ; Enophthalmos ; Follow-Up Studies ; Humans ; Nose ; Orbit ; Tissue Donors ; Transplants

BACKGROUND: The photsensitizing effect of quinolones has been recognized since their introdulation as an antibacterial agents. Recently several new second eneration antibacterial agents of this pharmacological class have become available for therapy, and are gaining increasing impotance. OBJECTIVE: To reveal the phototoxic potentials of some new quinolones by photohemolysis test, estimation of fluorescenc spectra, and Candida albicans test. METHODS: Nalidixic acid and four second-generation quinolones(ciprofloxacin, enoxacini, norfloxacin, and ofloxacitid were examined by fluorescence spertra which measured t.he phototoxc potentials by photochemial instability, photohemolsis test for the phototoxic properties against cell membranes and Candida tlbicans test for phototoxic properties against DNA. RESULTS: All drugs showed a fluorescence spectra within 360 nm to 450 nm, and in the photohemolysis test, all studied drug except ofloxacin got above 5% hemolytic value, and all drugs showed clear zone. in Candida albicans test after 48hours. CONCLUSION: These results suggested that all tested drugs were photochemically unstable. According to the mechanisris of cellular phototoxicity, ciprofloxacin, enoxacin, and norfloxacin was phtototoxic to nucleus and cell membrane, whereas ofloxacin was phototoxic to nucleus only.
Anti-Bacterial Agents* ; Candida ; Candida albicans ; Cell Membrane ; Ciprofloxacin ; Dermatitis, Phototoxic ; DNA ; Enoxacin ; Fluorescence ; Nalidixic Acid ; Norfloxacin ; Ofloxacin ; Quinolones

We observed a case of sebaceous epithelioma associated with a nevus sebaceus in a 25-year-old male. The tumor was bean-sized, dome-shaped nodule on the slightly yellowish plaque of nevus sebaceus. Histopathological finding shows undifferentiated cells which are arranged in a palisade fashion at the periphery of a cell mass and a fairly large number of transitional cells and groups of mature sebaeeous cells.
Adult ; Carcinoma* ; Humans ; Male ; Nevus* ; Nevus, Sebaceous of Jadassohn*

Human untreated costal cartilage was compared with lyophilized human costal cartilage which was treated with defatting solution for 48 hours and freeze drying for 72 hours (-70degree C, 10??bar) on the tendency of distortion. All cartilages, which were taken from six cadavers, were carved 5x5x30mm in size on principle of the balanced cross section. Their distortions were evaluated by two methods at intervals of one week, one month, three months, six months after experiment. At first, the degree of distortion was grossly graded with four steps: grade O; no distortion / grade I; minimal distortion / grade II; moderate distortion / grade III; severe distortion. Second method is measurement and quantification of distortion in the horizontal and vertical plane of cartilage.Untreated cartilage is shown to be an unsatisfactory material, with only three(12%) of the 25 cartilages being cosmetically acceptable(grade 0 and 1) after 6 months. In lyophilized cartilage, 18(94%) of the 19 cartilages were cosmetically acceptable(grade 0 and 1) at 6 months. This figure is highly significant(p<0.01). In another method, distortion in the horizontal(h) and vertical (v) planes of cartilage were measured, and mean values of ???? were calculated. In untreated group, the mean values of ???? were 0.82 at 1 week, 0.91 at 1 month, 1.13 at 3 months, and 1.31 at 6 months. In lyophilized group, the mean values were 0.27 at 1 week, 0.29 at 1 month, 0.40 at 3 months and 0.47 at 6 months. All values were statistically significant(p<0.01).
Cadaver ; Cartilage* ; Freeze Drying ; Humans

No abstract available.
Skull Base* ; Skull*

Epiblepharon is frequently encountered n oriental eyelid, especially in children. It is characterized by a horizontal fold of redundant skin and abundant orbicularis muscle near lid margin, which the lashes vertically, or posteriorly towards the eye. Surgical therapy of epiblepharon in correcting the trichiasis includes lid bracing sutures, burried sutures, skin resection, a Hotz procedure or its modification, and a Jones procedure. In our opinion, these procedures are not sufficient, because these procedures will not correct the epicanthal folds. Epicanthal folds have been a one of the characteristics of Asian over 50 percents of population in Japan and South Korea, and it either reduce the aesthetic result of the double-eyelid procedure or make the correction of the entropion and epiblepharon difficult. Although many surgical procedures are available to eliminate epicanthal folds, scarring on the medial canthus is in still and obstacle for surgeons to overcome. From January of 1998 to October of 1998, we used half z-plasty procedures in 5 cases to correct epicanthal folds in epiblepharon. There were few complications in our series. We believe that half z-plasty can get a good result in the correction of epibolepharon and oriental epicanthal folds.
Asian Continental Ancestry Group ; Braces ; Child ; Cicatrix ; Entropion ; Eyelids ; Humans ; Japan ; Korea ; Skin ; Sutures ; Trichiasis

We studied two hundread cases of replantations-61 cases of major limb replantation and 139 cases of finger replantation. 53 of 179 patients had multiple amputation. The most common cause of amputation was cutting-machine injury and the next one was belt and roller injury. The patients were followed than 6 months, ranging 6 months to 5 years and 10 months, averaging 36 months. The success rate of replantation is 86.9%(53/61) in the amputated limbs and 80.6%(112/139) in the amputated digits. Main causes of failure were tissue crushing, vessel thrombosis, long ischemic time, and amputation wound infection. Common complications were infection (25 cases), delayed union(7 cases), nonunion(2 cases), bleeding tendency and hematoma formation due to systemic heparinization(5 cases). We used Seddon's classification to assess the recovery of the nerve function of the replanted limbs and digits. 84.6 % of success cases of limb replantation presented the excellent result in the motor fuction recovery and 89.1% also presented the excellent sensory recovery. 89.8% of the success cases of the digit replantation showed the excellent result in the sensory recovery. The factors influencing the functional recovery of the replantation surgery were mechanism of injury, ischemic time, surgical technique, numbers of anastomosed vessels, ratio between anastomosed artery and vein, and wound infection. This analysis demonstrated that strict selection of the indication or the replantation is the first step in the limb and digit replantation surgery.
Amputation ; Arteries ; Classification ; Extremities ; Fingers ; Hematoma ; Hemorrhage ; Humans ; Operative Time ; Replantation ; Thrombosis ; Veins ; Wound Infection