No abstract available.
Congenital Abnormalities*

Augmentation rhinoplasty is one of the most popular aesthetic procedures in Asians. Numerous alloplastic implants have been used, however alloplastic implants may cause many problems in nasal and perinasal areas because of thin soft tissue cover. For these reasons, an ideal implant should be nonpalpable, readily exchangeable and biocompatible. Among these alloplastic implants, Gore-Tex(R) is a polymer of carbon bound to fluorine composed of solid nodes connected by very fine fibers. It has been reported that this material become permeated and surrounded by mature connective tissue, forming a strong supporting envelop for the material, yet the implant is easily removed because of limited tissue ingrowth. Since it's development, Gore-Tex(R) has found many applications in the field of facial plastic and reconstructive surgery. From November, 2001 to December, 2002, Gore-Tex(R) implants were removed from 17 patients due to several problems such as; decreased dorsal height, tip deformity, chronic inflammation. The implants were very hard to remove and coinciding injury of the surrounding tissue were inevitable. An analysis of the length and thickness changes in these removed implants was made. The results showed, decrease in length and thickness with a volume loss averaging, 46.3% in 45x4.0mm implants, 49.3% in 50x5.0mm implants. In view of the experiences of 17 cases of Gore-Tex(R) implants in rhinoplasty, we have concluded that Gore-Tex(R) implants were structurally unstable, fibrovascular tissue ingrowth into pores were minimal, the implants were very hard to remove and the implants caused a postoperative volume reduction. Therefore, Gore-Tex(R) use in augmentation rhinoplasty should be approached with caution.
Asian Continental Ancestry Group ; Carbon ; Congenital Abnormalities ; Connective Tissue ; Fluorine ; Humans ; Inflammation ; Plastics ; Polymers ; Polytetrafluoroethylene* ; Rhinoplasty*

PURPOSE: Torus palatinus is a bony prominence at the middle of the hard palate. The size varies from barely discernible to very large, from flat to lobular. This oral exostosis is not a disease or a sign of disease, but if large, may be a problem. So, we present the clinical and histopathologic features and applied therapy and provide a comprehensive review of the rare case of the symptomatic exostoses. METHODS: A 37-year-old woman had slowly growing exophytic nodular mass of the bone that arises the midline suture of the hard palate. The patient was concerned about discomfort associated with movement of her tongue and about frequent irritation of the palatal mucosa during mastification of the hard food. The patient had a large, unilobulated torus palatinus. It extended from the area adjacent to the canine to a point beyond the junction with the soft palate. The mass was oblong in shape, measuring about 3cm long, 2cm wide, and 0.8cm in height. RESULTS: Before surgical intervention a CT was obtained for the sake of estimating the thickness of the bone between the exostoses and the maxillary antrum and floor of the nose. The surgical procedure was performed with the patient under general anesthesia. Removal of the exostosis was performed after midline mucoperiosteal incision with osteotome and diamond burr. Histologic finding revealed decalcified dense bony tissue, the presence of lacunae, and normal osteocytes. CONCLUSION: Surgical removal is recommended when one or more of the following condition exist: interference with the construction of prosthesis, interference with oral function, irritation or pathology of the overlying tissue, inability of the patient to maintain proper oral hygiene, and fear of malignancy or other psychologic trauma. We report a rare case of the torus arising in hard palate with symptoms.
Adult ; Anesthesia, General ; Diamond ; Exostoses ; Female ; Floors and Floorcoverings ; Humans ; Hyperostosis ; Maxillary Sinus ; Mucous Membrane ; Nose ; Oral Hygiene ; Osteocytes ; Palate ; Palate, Hard ; Palate, Soft ; Prostheses and Implants ; Sutures ; Tongue

The reconstruction of hypopharynx after ablation of carcinoma is quite challengeable to plastic surgeons and requires the recovery of anatomic continuity and its own function such as swallowing and speech. Various surgical methods have been evolved through the years from local flap to microvascular free flap. The latter, obviously has improved the surgical outcome playing a main role in reconstruction of hypopharynx and universally been divided into visceral free transfer and fasciocutaneous free flap. Though lots of surgical options are reported depending on the shape and size of defect, patient's desires or surgeon's empirical background, no general agreement about the reconstruction of hypopharynx exists because the advantage of the one flap can be a disadvantage of the other and vice versa. The fasciocutaneous free flaps were used for reconstruction of hypopharynx in 18 patients, radial forearm free flap for 14 and anterolateral thigh perforator flap for 4 patients, respectively and indicated following that the first is the patients have partial defect that retain the remnant mucosa more than 50% of hypopharyngeal circumference. the second indication is the patient with previous abdominal operation and the third is the patient with risk of long ischemic time of transferred bowel. the last cases is the elderly patient with other comorbid condition even though the remnant mucosa are less than 50% of hypopharyngeal circumference. We have designed the flap to have a sufficient lumen of neohypopharyngeal diameter more than 4cm and the cephalic margin of hypopharynx be wider than caudal one, like a funnel shape, to eliminate the size discrepancy between the pharyngeal and esophageal lumen. The small triangular flap extension was designed in the caudal margin to prevent the distal enteric anastomosis site from the stricture, making the circumference of distal margin to be enlarged. In this paper, we contemplate our speculation for use of fasciocutaneous free flap for reconstruction of hypopharynx with surgical finesse to get a fine surgical outcome.
Aged ; Constriction, Pathologic ; Deglutition ; Forearm* ; Free Tissue Flaps* ; Humans ; Hypopharynx ; Mucous Membrane ; Perforator Flap ; Thigh*

Skin and soft tissue infection (SSTI) is common and important infectious disease. This work represents an update to 2012 Korean guideline for SSTI. The present guideline was developed by the adaptation method. This clinical guideline provides recommendations for the diagnosis and management of SSTI, including impetigo/ecthyma, purulent skin and soft tissue infection, erysipelas and cellulitis, necrotizing fasciitis, pyomyositis, clostridial myonecrosis, and human/animal bite. This guideline targets community-acquired skin and soft tissue infection occurring among adult patients aged 16 years and older. Diabetic foot infection, surgery-related infection, and infections in immunocompromised patients were not included in this guideline.
Adult ; Cellulitis ; Communicable Diseases ; Diabetic Foot ; Diagnosis ; Erysipelas ; Fasciitis ; Fasciitis, Necrotizing ; Humans ; Immunocompromised Host ; Impetigo ; Methods ; Pyomyositis ; Skin* ; Soft Tissue Infections*

PURPOSE: Retronychia is the embedding of the nail into proximal nail fold. Retronychia starts with disruption of the longitudinal growth of the nail. With the growth of a new nail, the old one is pushed upwards and backwards. This leads to embedding of the top nail into the ventral aspect of the proximal nail fold and results with chronic paronychia. We present a case of retronychia that was rarely reported in the literature. METHODS: A 46-year old female presented with a 3-month history of painful right first, 2nd, 3rd toenail changes. Although she was initially treated with broad spectrum antibiotics, she did not response to therapy. Later, she presented to our department because of progressively worsening pain that impaired her walking. Physical examination revealed with proximal nail fold erythema, painful swelling, yellowish nail discoloration, and distal onycholysis. Bacterial and fungus culture showed no organism. Treatment was surgical nail avulsion under local anesthesia. RESULTS: The postoperative course was uneventful. 10 months later, the patient had a normal growing nail and was free of symptoms. CONCLUSION: We report a case of retronychia on toenail. Retronychia is a proximal nail plate ingrowth into the proximal nail fold which is associated with multiple generations of nail plate misaligned beneath the proximal nail. Management consisted of simple avulsion of superimposed nail. Retronychia is suspected with a persistent paronychia, particularly in the setting of trauma. Avulsion of the top nail confirms the diagnosis and may be curative if the underlying nail appears healthy.
Anesthesia, Local ; Anti-Bacterial Agents ; Erythema ; Family Characteristics ; Female ; Fungi ; Humans ; Nails ; Onycholysis ; Paronychia ; Physical Examination ; Walking

PURPOSE: In treatment of facial bone fracture, occurred in children, we generally use wires, miniplate, absorbable plate or their combination. These foreign bodies can be palpable, and sometimes may cause infections, and need reoperation for removing. When bone fragments are multiple, small or thin, they are hard to handle and make accurate reduction of all fragments. In these cases, a biodegradable tissue adhesive, Histoacryl(R) (n-butyl-2-cyanoacrylate), can be used as fixation technique for small, multiple, and thin fracture fragments. METHODS: 3 years old and 6 years old children, who has comminuted fracture on frontal sinus, we used Histoacryl(R) for fixation of multiple bone fragments. After approaching by coronal incision, we pulled out all bone fragments and reconstructed bone fragments by Histoacryl(R) and fixed those on frontal sinus by absorbable plates. RESULTS: Photographs and 3-dimensional CT obtained preoperatively and postoperatively. And we compared them each other in terms of accuracy of reconstructed bony contour. We could reconstruct almost all bone fragments easily along 3-dimensional structure and get excellent aesthetic results. There was no complication such as infection. CONCLUSION: In treatment of comminuted facial bone fracture, occurred in children, Histoacryl(R) is an excellent method for accurate reconstruction in small and thin bone fragments which cannot be fixed by wire, miniplate or absorbable plate without complication.
Child ; Enbucrilate ; Facial Bones ; Foreign Bodies ; Fractures, Comminuted ; Frontal Sinus ; Humans ; Reoperation ; Tissue Adhesives

The influence of hemostatic materials in split thickness calvarial bone defects was evaluated in 24 white rabbit models. The rabbits were divided in 4 groups. In the group A, Surgicel(R) was inserted into the 2x2cm sized left calvarial defects. In the group B, Gelfoam(R) was inserted and in group C, Bonewax(R) was inserted and in group D, Collagen bloc was inserted. The contralateral side underwent sham operation as the control group. After 4 and 8 weeks, radiological findings, histopathological findings and immunohistopathological findings were studied to find development of trabeculae, appearance of osteoblast, calcification and increased expression of TGF-beta. As a result, osteoid and osteoblast were richly found in Surgicel(R), Gelfoam(R), Collagen bloc inserted groups. In Bonewax(R) inserted group, bone regeneration was delayed and foreign body reaction was seen in 4 weeks and it reduced in 8 weeks. The TGF-beta was darkly stained in periosteum, connective tissue and periphery of bone defect. From this result it would be concluded as follows. Surgicel(R), Gelfoam(R) and Collagen bloc effects positively on bone healing with marked increasing of osteoid, osteoblasts and rapid bone remodeling. Bonewax(R) prolongs bone healing with increasing foreign body reaction. Bone regeneration was confirmed with increased expression of TGF-beta in Surgicel(R), Gelform(R) and Collagen bloc applied groups especially in periosteum and ends of bone defects. It suggests that bone regeneration was originated from these areas.
Bone Regeneration ; Bone Remodeling ; Collagen ; Connective Tissue ; Foreign-Body Reaction ; Osteoblasts ; Osteogenesis* ; Periosteum ; Rabbits ; Transforming Growth Factor beta

The goals of reconstruction of orbital blowout fracture are to restore continuity, to provide support of orbital contents and to prevent functional and anatomic defects. Various materials such as autogenous and alloplastic implants have been used to reconstruct the defect of orbital wall fracture. Autogenous implants such as bone and cartilage have the advantages of excellent biocompatibility and low rates of infection. On the other hand, they have the disadvantage of donor site morbidity. Alloplastic implants have potential risk of tissue inflammation and migration within orbit or anterior to the skin although they are easy to use without any disadvantages of donor site morbidity. To cover these disadvantages of various materials, we used the resorbable materials in mesh form(Biosorb FX(R)) in orbital wall reconstruction. Seventeen patients with blowout fracture defect were operated with 0.8mm thickness resorbable material in mesh form and fourteen of them were followed-up (Minimum, 9 months; maximum, 30 months). The results were satisfactory in most cases. Some of them showed minor problems for a short time; One patient had persistent 2mm enophthalmos, but no further surgical correction was required. Transient diplopia in four patients disappeared in two weeks. Lower eyelid swelling in two patients lasted for more than two weeks, but no inflammation, migration or extrusion of implants were observed. Resorbable materials allow initial sufficient stability and are gradually resorbed through the physiologic process. So no permanent implants that might affect facial growth, create interference with radiologic imaging, or be susceptible to infection and extrusion remain. Resorbable mesh plates we used are made of copolymers of Dextro(D)-polylactic acid and Levo(L)-polylactic in 30: 70 ratio. They were well tolerated by tissue, giving adequate support to healing of bone defect. During the follow-up period(mean 14 months), no significant problems were observed.
Cartilage ; Diplopia ; Enophthalmos ; Eyelids ; Follow-Up Studies ; Hand ; Humans ; Inflammation ; Orbit* ; Polymers* ; Skin ; Tissue Donors

PURPOSE: Nerve sheath myxoma is a rare cutaneous neoplasm originating from the peripheral nerve sheath and divided into three groups : myxoid, cellular and mixed type. There is a controversy on it's origin whether schwannian cell or perineurial differentiation, or anything else. Myxoid nerve sheath myxoma is asymptomatic, soft, papule or nodule in middle-age adults. We report a case of myxoid nerve sheath myxoma on the fingertip. METHODS: A 53-year-old woman presented with a painful, 0.4 x 0.4 x 0.6 cm sized, corn shaped nodule on the left 3rd fingertip. We put into surgical excision and studied it by histopathologically and specific immnohistochemical stain. RESULTS: The tumor has well defined nodules separated by thin fibrous connective tissue with abundant myxoid stroma and were positively stainded for S-100 protein, NSE and GFAP. After surgical treatment it was healed without recurrence. CONCLUSION: Nerve sheath myxoma is rare neoplasm and located mainly on face, but very rarely on the fingertip. We report a case of painful myxoid nerve sheath myxoma located on the 3rd fingertip.
Adult ; Connective Tissue ; Female ; Humans ; Middle Aged ; Neurothekeoma ; Peripheral Nerves ; S100 Proteins ; Zea mays