The orbitozygomatic area occupies a key anatomic position in midface, is prone to injury, and plays a prominent role in facial aesthetics. So the facial appearance including orbital shape can be altered by complications of orbitozygomatic fractures. Most possible initial complications include blindness, hyphema, retinal detatchment, and paralysis or entrapment of extraocular muscles. Long term sequelaes include infraorbital nerve dysfunction, loss of malar projection, enophthalmos, and dystopia. Accurate anatomic reduction and rigid fixation is essential for management of orbitozygomatic fractures to minimize those late sequelaes. Conventional fixation devices to fix displaced fracture of facial bone are interosseous wire and miniplate. But interosseous wirings are unstable for primary bone healing and time consuming. Miniplates have great deal in rigid fixation but their high profile and palpability are the main complaints in many patients, especially in orbital rim area. In this article, we reviewed the 30 cases of zygomamaxilla complex fractures with orbital rim fracture fixed with microplates, and discussed the stability of microplate and superiorities in final aesthetics result. The use of microplates in these area permits enough stability of fracture segment with ease of procedures and superiorities in final results without any palpability.
Blindness ; Enophthalmos ; Esthetics ; Facial Bones ; Humans ; Hyphema ; Muscles ; Orbit* ; Paralysis ; Retinaldehyde

No abstract available.

Any types of burn injury that involve more than deep dermis often require reconstructive treatment. In gluteal region, V-Y fasciocutaneous advancement flap is frequently used to cover the defect. However, in case of large burn wounds, this kind of flap cannot provide adequate coverage because of the lack of normal surrounding tissues. We suggest V-Y adipofascial flap using the surrounding superficially damaged tissue. We present the case of a patient who was referred for full-thickness burn on gluteal region. We performed serial debridement and applied vacuum-assisted closure device to defective area as wound preparation for coverage. When healthy granulation tissue grew adequately, we covered the defect with surrounding V-Y adipofascial flap and the raw surface of the flap was then covered with split-thickness skin graft. We think the use of subcutaneous fat as an adipofascial flap to cover the deeper defect adjacent to the flap is an excellent alternative especially in huge defect with uneven depth varying from subcutaneous fat to bone exposure in terms of minimal donor site morbidity and reliability of the flap. Even if the flap was not intact, it was reuse of the adjacent tissue of the injured area, so it is relatively safe and applicable.
Burns* ; Buttocks* ; Debridement ; Dermis ; Granulation Tissue ; Humans ; Negative-Pressure Wound Therapy ; Skin* ; Subcutaneous Fat ; Tissue Donors ; Transplants* ; Wounds and Injuries

The third crus of the antihelix is a very rare anomaly that is characterized by an abnormal elevation of cartilage extending from antihelx to helix. that results in an additional prominence with varying degrees of an helical deformity. In this report, an unusual a 16-years- old male case of a third and fourth crus of the antihelix accompanying constricted helical deformity on upper pole is presented and the surgical correction of the deformity is described. A curvilinear incision is made on the posterior surface of the ear and the skin flap was reflected. In order to correct deformity of the helix and make the scapha concave, a series of additional scoring were made into the extra crus cartilage, and the cartilage was sutured by a few horizontal mattress sutures. For structural support, Medpor was placed on the scapha. Through-and-through mattress sutures are tied over a bolster of gauze for 2 weeks to eliminate dead space and to accentuate the helical sulcus. During the 9 month follow-up, the result was satisfactory.
Cartilage ; Congenital Abnormalities* ; Ear ; Follow-Up Studies ; Humans ; Male ; Skin ; Sutures

PURPOSE: Recently, the incidence of malignant melanoma has been steadily increasing. Malignant melanoma is already known to have poorer prognosis than other primary skin cancers. Despite the poor prognosis, it is relatively less known to the public so that a number of patients visit hospital carrying advanced stage tumor. Yet, extensive study about malignant melanoma is currently insufficient, and specific guidelines and statistical figures in Korea are almost inexistent. Therefore, authors reviewed patients with malignant melanoma who have visited our hospital for last 14 years. METHODS: Between January 1994 and January 2008, 62 patients were diagnosed with malignant melanoma at our hospital. A retrospective study was performed with data from patients' charts and biopsy results. Annual incidence, mean age of onset, gender, tumor location, tumor thickness, pathologic ulceration, clinicopathologic subtype, and clinical AJCC stage were evaluated. Analysis of factors associated with survival were performed using the Cox proportional hazard model. Kaplan-Meier method was used to generate survival curves. RESULTS: Clinicopathologic features of 62 patients (32 male, 30 female) with average age of 57 years were evaluated. Most lesions were found in lower limb, and the most common subtype was acral lentiginous melanoma. We could also find that age, tumor thickness, and clinical stage were the only significant prognostic factors. CONCLUSION: Clinicopathologic features of malignant melanoma were analyzed in this study, but the result is not ready to be generalized because of the limited number of cases. Further study must be performed to report clinical guidelines for prognosis and treatment for malignant melanoma patients in Korea.
Age of Onset ; Biopsy ; Humans ; Incidence ; Korea ; Lifting ; Lower Extremity ; Male ; Melanoma ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Skin Neoplasms ; Survival Rate ; Ulcer

PURPOSE: To re-evaluate additional clinical significance of the apparent diffusion coefficient (ADC) map in the inference of infarction stage, authors studied the evolution patterns of the DWI and the ADC map of the brain infarction. MATERIALS AND METHODS: In 127 patients with cerebral infarctions, including follow-up checks, 199 studies were performed. They were classified as hourly (117 studies)-, daily (108 studies)-, weekly (62 studies)-based groups. The signal intensity (SI) was measured at the core of the infarction and contralateral area with ROI of 0.3 cm2 or more on the images of the DWI and the ADC map, and calculated the ratios of SI and ADC value of the infarction area / contralateral normal area, and compared the patterns of the change according to the evolution. RESULTS: Infarction was detected as early as 1 hour after the attack, and the ratio of SI in the DWI became over than 2 after 12 hours, which showed a plateau until the 6th day. Thereafter, it decreased slowly to 1 on the 30th day, and changed to lower SI than the surrounding brain. The ratio in the ADC map became 0.46 in 24 hours after the attack, and increased slowly to 1 in the 15th day. Thereafter, it became a higher value than the surrounding brain. Overall, the ratio in the ADC map changed earlier than in the DWI, and the ratio curves showed inverse pattern each other according to the evolution of the infarction. CONCLUSION: The evolution patterns of infarction on the ADC map showed an inverse curve of DWI curve, which means that the ADC value is accurately predictable from DWI, and the ADC map joined with the DWI seems helpful in the determination of subacute infarction between 15 to 30 days.
Brain Infarction* ; Brain* ; Cerebral Infarction ; Diffusion ; Follow-Up Studies ; Humans ; Infarction

Intracranial squamous cell carcinoma is extremely rare, with most of the cases arising from malignant transformation of an epidermoid or a dermoid cyst. The patient presented with facial weakness. Initial magnetic resonance imaging revealed a mass in the right cerebellopontine angle. A subtotal resection was performed via right retrosigmoid suboccipital approach. Histopathological findings were consistent with an epidermoid tumor. Five months later, the patient underwent gamma knife radiosurgery due to highly probable recurrent epidermoid tumor. Two years after, the patient's neurological deficit had been newly developed, and follow-up magnetic resonance imaging demonstrated a large contrast-enhancing tumor in the left cerebellopontine angle, which compressed the brainstem. After resection of the tumor, histopathological examinations revealed a squamous cell carcinoma probably arising from an underlying epidermoid cyst. We report a case of an epidermoid tumor in the cerebellopontine angle that transformed into a squamous cell carcinoma.
Brain Stem ; Carcinoma, Squamous Cell ; Cerebellopontine Angle ; Dermoid Cyst ; Epidermal Cyst ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Radiosurgery

In adult congenital muscular torticollis (CMT) patients, physical therapy is not as effective because the development of sternocleidomastoid muscle (SCM) muscle is complete. While surgical release can address CMT in adult patients, the risk of general anesthesia and visible postoperative scar is a concern, expecially in patients with mild symptoms. In this paper, we report our experience in treating such patients with minimal-incision myotomy under local anesthesia. A review was performed for all adult patients who had undergone the simple myotomy procedure. Surgical indication was reserved for patients with mild fibrotic band in the SCM muscle with minimal lengthdiscrepancybetween the muscles. All patients had recognizable head tiltand palpation of fibrotic band on affected side of the neck. Surgical details are described in the main body of text. Three female patients had undergone the procedure. Torticollis was resolve in all patients with complete restoration of ranage of motion. There were no postoperative complications, and patient satisfaction was high. We have reported three cases of mild CMT in adult female patients, who had undergone minimal-incision myotomy under local anesthesia. Outcomes were satisafactory with no morbidity to report. With careful patient selection, this method offers an alternate treatment option for adult CMT patients with mild symptoms.
Adult* ; Anesthesia, General ; Anesthesia, Local* ; Cicatrix ; Female ; Head ; Humans ; Muscles ; Neck ; Palpation ; Patient Satisfaction ; Patient Selection ; Postoperative Complications ; Torticollis*

BACKGROUND: Preauricular sinuses represent a common congenital abnormality in children. Classically, a preauricular sinus manifests as a small opening, usually near the anterior limb of ascending helix. The difficulty in the surgical treatment of preauricular sinus is the high recurrence rate. The aim of this article is to review the outcomes of preauricular sinus and to introduce our surgical technique and its prognosis. METHODS: A single-institutional retrospective review was performed for all patients who had undergone excision of congenital periauricular sinus between October 2007 and April 2014. Medical records were reviewed for demographic information, wound complication, and recurrence rate. The sinus tract was visualized with the aid of preoperative dye instillation and intraoperative probe insertion. The skin next to the sinus opening was incised elliptically, and the tract itself was dissected medially to the end of the sinus tract and posteriorly to the cartilage of the ascending helix. RESULTS: The review identified 44 patients for a total of 57 preauricular sinus tracts. The mean age at time of operation was 16.3 years with a range from 9 months to 65 years. Unilateral preauricular sinus tract was present in 31 patients (11 right and 20 left preauricular tract), and 13 patients had bilateral sinus tract. None of the patients had experienced wound issues postoperative, and there were no recurrent sinus tract formation or infection. CONCLUSION: Using a combination of dye instillation, probe insertion, and modified dissection, we were able to achieve a recurrence free series of preauricular sinus tract excision among a heterogenous group of patients. A large patient series is necessary to replicate the results of this study.
Cartilage ; Child ; Congenital Abnormalities ; Extremities ; Follow-Up Studies ; Humans ; Medical Records ; Prognosis ; Recurrence ; Retrospective Studies ; Skin ; Wounds and Injuries

Coil migration into the parent artery during endovascular coil embolization is a rare, but life-threatening complication, which can induce thromboembolism and result in poor outcome. A 63-year-old man was referred to Chonbuk National University Hospital emergency center due to migration of a coil for a left middle cerebral artery bifurcation unruptured aneurysm. We performed an emergency craniectomy to remove the coil migrated to the distal M2 branch and thrombus, and aneurysmal neck clipping for his aneurysm. Fortunately, at the six month follow-up, the patient did not show any noticeable neurological sequela. In case of parent artery occlusion due to coil migration an immediate recanalization should be performed by a neurovascular specialist who can provide both surgical treatment and endovascular management in order to prevent severe sequela or even death.
Aneurysm ; Arteries ; Embolization, Therapeutic* ; Emergencies ; Follow-Up Studies ; Humans ; Infarction, Middle Cerebral Artery* ; Jeollabuk-do ; Middle Aged ; Middle Cerebral Artery ; Neck ; Neurosurgical Procedures ; Parents ; Specialization ; Thromboembolism ; Thrombosis