PURPOSE: After exposure of fracture site, the proximal segment must be reduced to their preinjury position for open reduction of fractured mandibular condyle. We examined the use of inter-maxillary fixation screws or titanium screws tied with stainless steel wire to assist in positioning of proximal segment. Since it enables to make a relatively small preauricular incision by not disturbing the operative field like Moule pin, we can reduce the danger of injury to the facial nerve. METHODS: A preauricular approach was used for exposure, reduction, and rigid fixation in 4 cases of mandibular condylar fractures. Inter-maxillary fixation screws or titanium screws tied with stainless steel wire were used to assist in aligning proximal segment. The joints were submitted to functional exercises and postoperative radiologic and clinical follow-ups were performed. RESULTS: No facial nerve lesions were found in all 4 cases. Radiologic follow-up showed correct reduction and fixation in all 4 cases. Clinical follow-up showed an initial limitation, but normal morbility of the condyle was achieved within 4 months after the operation, with a maximum mouth opening of 34.1+/-5.2 mm after 12 months. There found no occlusal disturbances, no trismus, no lateral deviations of the mandible. CONCLUSION: By using Inter-maxillary fixation screws tied with stainless steel wire, it was shown that reducing the proximal segment to their preinjury position is easy to perform and it enables us to make a minimal dissection below preauricular skin incision to avoid facial nerve injury.
Exercise ; Facial Nerve ; Facial Nerve Injuries ; Follow-Up Studies ; Joints ; Mandible ; Mandibular Condyle* ; Mouth ; Skin ; Stainless Steel ; Titanium ; Trismus

In 1912, Crouzon described a syndrome compromising the triad of cranial deformity, facial deformity, and exorbitism. Crouzon's syndrome occurs in 1 in 25,000 live births and follows an autosomal dominant mode of transmission. However 30 to 60% of cases are sporadic and represent fresh mutations. The 27-year-old female patient we report here has family history of two cases of Crouzon's syndrome. The patient had mild nasal obstruction and rhinorrhea, which didn't make the surgery absolutely contraindicated. The Monobloc advancement-Le Fort III osteotomy for midfacial advancement and the lamellar split osteotomy of supraobital bandeau for orbitofrontal advancement- were performed. After 8~12 weeks of patient follow up, CSF rhinorrhea was observed and infection was suspected. The primary focus of infection was supposed to be preexisting sinusitis of the patient. The infection didn't spread intracranially, which was contributed by intact inner table of cranium owing to the lamellar split osteotomy. In conclusion, 1) The importance of irradication of preexisting nasal / perinasal infection such as sinusitis cannot be emphasized too much, 2) How to obliterate the dead space between the inner and outer table, and 3) In terms of infection, at least, lamellar split osteotomy can be regarded superior to classical osteotomy, since inner table serves as a barrier of ascending infection.
Adult ; Congenital Abnormalities ; Female ; Follow-Up Studies ; Humans ; Live Birth ; Nasal Obstruction ; Osteomyelitis* ; Osteotomy ; Sinusitis ; Skull

A 64-year-old man was treated with sunitinib as a first-line therapy for metastatic renal cell carcinoma. He was given oral sunitinib in cycles of 50 mg once daily for 2 weeks followed by a week off. During the 5th week of treatment right upper quadrant pain developed, but this resolved spontaneously during the 6th week (off treatment). However, on the 8th week of treatment, he was admitted to hospital because the acute right upper quadrant pain recurred with nausea, vomiting, and fever. Acute acalculous cholecystitis was then diagnosed by ultrasonography and CT. In addition, his laboratory findings indicated disseminated intravascular coagulation. Accordingly, sunitinib therapy was discontinued and broad-spectrum antibiotics initiated. He subsequently recovered after emergent percutaneous cholecystostomy. His Naranjo Adverse Drug Reaction Probability Scale score was 7, indicaing a probable association of the event with sunitinib. Suspicion of sunitinib-related acute cholecystitis is required, because, although uncommon, it can be life-threatening.
Acalculous Cholecystitis ; Anti-Bacterial Agents ; Carcinoma, Renal Cell ; Cholecystitis, Acute ; Cholecystostomy ; Disseminated Intravascular Coagulation ; Drug-Related Side Effects and Adverse Reactions ; Fever ; Humans ; Middle Aged ; Nausea ; Ultrasonography ; Vomiting

PURPOSE: The purpose of this study is to describe the usefulness of intraoperative mobile CT scans in the reduction of zygomatic arch fracture. Method: Two patients with zygomatic arch fractures were selected who were indications of closed reduction by Gilles' approach. After the reduction was done in the operating room with zygomatic arch elevator, intraoperative CT scan was done to check the extent of reduction. Additional reduction was performed according to the obtained images from the intraoperative mobile CT scan. Examination of the preoperative CT, intraoperative CT after the reduction, and postoperative plain X-ray films were done for documentation and analysis. RESULTS: Reduction was carried out successfully to the patients without any complications. Both patients were satisfied with the postoperative cosmetic and functional outcome. Revisional surgery was not necessary during the 6 months follow up. CONCLUSION: The advantage of this method is that it is easier to obtain three dimensional relationships of the fracture site. Furthermore, the operator is less exposed to radiation hazards compared to other methods that obtain intraoperative images such as the C-arm. In conclusion, intraoperative mobile CT scan can be a useful surgical aid in the reduction of zygomatic arch fractures.
Cosmetics ; Elevators and Escalators ; Humans ; Imidazoles ; Nitro Compounds ; Operating Rooms ; X-Ray Film ; Zygoma

We present our experience with calvarial bone framework insertion through an intraoral approach for a patient who was at risk for columellar necrosis due to a previous open rhinoplasty. A 58-year-old woman exhibited severe columellar contracture, so that the columellar tissue was too fragile to be touched. We could not incise the columella and insert a new nasal implant through the bilateral rim incision. Moreover, the patient had septal cartilage perforation and collapse. The patient needed columellar support as well as nasal dorsum reconstruction. The authors decided to graft an autogenous L-strut bone framework through an intraoral approach. Two pieces of 5-cm × 1-cm sized split calvarial bone were harvested and trimmed to fit the width and length of the nasal dorsum and columella. The right-angle-shaped bone framework was made with an absorbable plate and screws. Through a gingivobuccal incision, the bone framework graft was inserted and the graft was fixed with absorbable screws. The patient did not experience complications such as skin necrosis or inflammation. A bone framework grafted through an intraoral approach can be a good choice for patients who have experienced scar contracture in the columella, septal cartilage perforation, and collapse.
Cartilage ; Cicatrix* ; Contracture* ; Female ; Humans ; Inflammation ; Middle Aged ; Necrosis ; Oral Surgical Procedures ; Rhinoplasty ; Skin ; Transplants*

PURPOSE: Tyrophagus putrescentiae (Tyr p) is known as the third most common mite following Dermatophagoides pteronyssinus (Der p) and Dermatophagoides farina (Der f) in Korea. And it is an important allergen in allergic diseases, but there have been no reports on its sensitization rate in Korean children. The aim of this study was to evaluate its sensitization rate and the relationship between Tyr p and other parameters related to allergy. METHODS: This study included 662 allergic patients who visited the allergy clinic of Severance Children's Hospital between 2005 and 2008. Patients consisted of 472 asthmatic children, 102 patients with allergic rhinitis, 59 patients with atopic dermatitis, 7 patients with chronic urticaria and 22 patients with other diseases. Skin prick tests with 32 common allergens and measurements of peripheral blood eosinophil counts, serum total IgE level and eosinophil cationic protein were performed in subjects. RESULTS: Of the 662 patients, 592 (89.4%) showed positive responses to more than one allergen. The number of patients sensitized to Tyr p was 129 (19.5%). The wheal size induced by Tyr p was positively related to age (r=0.102 P=0.009) as well as the wheal size induced by house dust (r=0.298 P<0.001), Der p (r=0.272, P<0.001) and Der f (r=0.272, P<0.001). The wheal size induced by Tyr p was also positively related to serum total eosinophil counts (r=0.101,P=0.015) and IgE (r=0.153, P<0.001) and number of positive skin prick test (r=0.272, P<0.001). CONCLUSION: Sensitization to Tyr p is prevalent in children with allergic disease. Therefore, this result should be considered when evaluating allergic children. Further studies are needed to elucidate the clinical significance of sensitization to Tyr p.
Allergens ; Child ; Dermatitis, Atopic ; Dermatophagoides pteronyssinus ; Dust ; Eosinophil Cationic Protein ; Eosinophils ; Humans ; Hypersensitivity ; Immunoglobulin E ; Korea ; Mites ; Prevalence ; Pyroglyphidae ; Rhinitis ; Rhinitis, Allergic, Perennial ; Skin ; Urticaria

Surgery for pathologic hip fracture poses significant challenges regarding the fixation of fracture and management of the original tumor lesion. An extensive destruction of the femoral neck and intertrochanteric region by benign or malignant lesions complicated by a pathological fracture generally necessitates total hip arthroplasty; however, in adolescents and young adults, preservation of the hip is preferable. We present a 14-year-old female patient, who sustained a pathological intertrochanteric fracture through a pre-existing aneurysmal bone cyst. Several operative interventions with internal fixation and bone graft were unsuccessful, and combined nonunion and progression of osteolysis around the compression hip screw eventually caused femoral head collapse, mimicking osteonecrosis. Hip preservation and resolution of the original tumor were achieved by free vascularized fibular graft.
Adolescent ; Aneurysm ; Arthroplasty, Replacement, Hip ; Bone Cysts ; Female ; Femur Neck ; Fractures, Spontaneous ; Head* ; Hip ; Humans ; Osteolysis ; Osteonecrosis ; Transplants* ; Young Adult

The treatment of fingertip amputation is difficult and controversial. Although the microsurgery has been accepted as a procedure of choice, in distal location, however, both reattachment of amputated portion as a composite graft and microvascular anastomosis are prone to failure. The fact that microscopic reconstruction of vessels is safer means of replacing amputated digits, makes considerably smaller the need to use the technique of composite graft nowadays. Nevertheless, there still remains a group of distal digital amputations which cannot be replaced by microsurgical procedure and the composite grafting is the only way of achieving a full length digit with a normal nail complex. Nowadays, it is generally accepted that replacement should be made as early as possible for the prevention of bacterial and proteolytic activity. However, if the replacement is made so quickly that bleeding doesn't stop, there is a layer of clot blocking adhesion between the two surfaces, and the union will not be achieved. We report a new strategy: the tie-over dressing ensures not only fixation, but also hemostasis, and the drainage application is used to drain retained blood, so composite graft doesn't need to be delayed until the bleeding stops. We achieved good results by using this new technique.
Amputation* ; Bandages* ; Drainage ; Hemorrhage ; Hemostasis ; Microsurgery ; Transplants*

The scabies mite is an ectoparasite, which is able to infest humans. The incidence of scabies decreased during the past 20 years in Korea. However, the incidence is likely to increase again, and may be delayed or missed diagnosis recently. Its clinical presentation is typical, although in a host with compromised immune system, like the mentally retarded and elderly patients, the clinical presentation may be altered. Because a delay in diagnosis may induce rapid spread of the scabies mite, immediate diagnosis and treatment are necessary. We report two cases of scabies in elderly patients from different nursing homes. These patients were transferred to our center for treatment of pneumonia and chronic renal disease. They revealed pruritus and skin rashes after the treatment of further underlying diseases. We consulted to a dermatologist because of worsening symptoms, despite an application of medication with antihistamine and topical steroid, scabies was diagnosed. The symptom improved with topical 1% gamma-benzene hexachloride, an effective scabies drug. We suggest that geriatrists should suspect scabies who presents with pruritus that is persistent or resistant to conventional treatment, especially patients transferred from nursing homes.
Aged ; Chronic Disease ; Exanthema ; Humans ; Immune System ; Immunocompromised Host ; Incidence ; Korea ; Lindane ; Mentally Disabled Persons ; Mites ; Nursing Homes ; Pneumonia ; Pruritus ; Renal Insufficiency, Chronic ; Scabies

PURPOSE: This study examined the clinical outcomes of comminuted intraarticular distal radius fractures treated by an anatomical reduction using a brick-work technique. MATERIALS AND METHODS: Seventeen patients with AO/OTA type 23-C3 distal radius fractures were enrolled in this study. An anatomical reduction of the articular surface was achieved using a brick-work technique through the dorsal approach and dorsal plates were used for fixation. The postoperative functional results were assessed with the range of motion of the wrist and the modified Mayo wrist score (MMWS). In addition, the radial length, radial inclination, volar tilt, and Lidstrom score were evaluated from the radiology results. The mean postoperative follow-up period was 13.6 months. RESULTS: All patients showed bony union and the mean range of motion of the injured wrists was 94% (92% to 95%) of the uninjured side. The mean MMWS was 85.3, and the functional results were excellent in 12 patients, good in 4, and fair in one at the final follow-up. Based on the final radiographic measurements, the radial length, volar tilt, and radial inclination were 11.4 mm (10.0 to 13.5 mm), 6.6° (−1.8° to 9.2°), and 21.3° (20.1° to 25.7°), respectively. The radiologic results according to the Lidstrom score were excellent in 14 patients and good in three. CONCLUSION: An anatomical reduction with the brick-work technique is relatively easy, results in a reproducible clinical outcome, and could be a safe and effective treatment option for severe comminuted intraarticular distal radius fractures that are not amenable to volar plate fixation.
Follow-Up Studies ; Humans ; Radius Fractures ; Radius ; Range of Motion, Articular ; Wrist