The traditional aesthetic blepharoplasty has limitations in correcting the heaviness and bulkiness of the lateral orbital region. These limitation is due to presence of sub-orbicularis oculus fat(SOOF) which is defined as that layer of fibrofatty soft tissue deep to the orbicularis oculus muscle, superficial to orbital septum and orbital rim, and extending medially from supraorbital nerve and laterally to varying distance over the lateral upper orbit. Therefore authors performed resections of the SOOF in conjunction with aesthetic blepharoplasty in 15 patients, who visited the clinic with complaints of thickness and heaviness over their lateral eyebrow, often accompanied by tired or sad-looking appearance. We believe that in these patients the heaviness. bulkiness and fullness in the lateral upper orbital region were corrected effectively and smoothly in aesthetical aspect. No patients developed postoperative hematoma, dry eye syndrome, lacrimal gland injury and significant paralysis of the orbicularis oculus of corrugator muscle. Our department performed the SOOF resection to those who had bulkiness and heaviness in lateral upper orbital region. From this experience, the SOOF resection would appear to be a useful adjunct to standard blepharoplasty technique in selected patients. Since we achieved a satisfactory result aesthetically through this method on patients who showed proper indications, we are recording the indications, operative techniques and complications in addition to review of reference.
Blepharoplasty* ; Dry Eye Syndromes ; Eyebrows ; Hematoma ; Humans ; Lacrimal Apparatus ; Orbit ; Paralysis

The surgical treatment of long duration lagaphthalmos was traditionally conducted using the Gillies (1934) method of temporal muscle transfer. This method has been effective in cases of simultaneous lagaphthalmos in the upper eyelid and ectropion in the lower eyelid. In the past, we treated 18 leprosy patients who suffered complications of ptosis in the upper eyelid and ectropion in the lower eyelid after the application of the Gillies method. To treat these complications, we removed the fascia strips emplaced during temporal muscle transfer from the upper and lower eyelid. Thereafter, we implanted a 1.0 gram gold plate in the upper eyelid and either a conchal cartilage graft. In the treatment of Lagaphthalmos over the past seven years, we have applied gold plate lid loading in 120 cases. However, in five of these cases, patients suffered from exposure of the gold plate due to paralytic orbicularis oculi muscle tearing. Recently, to correct this, we covered the gold plate with AlloDerm tissue to protect and support the muscle. In the treatment of ectropion over the last six years, we have had over 30 cases of cartilage grafts (over 35mm in length and 5mm in breadth) in the lower eyelid. However, the end of the cartilage graft would warp and create new partial ectropion several months later. Because of this, we shifted from cartilage to AlloDerm. We applied 40mm (length) and 7mm (breadth) to the lower border of the tarsus and fixed at each end with medial and canthal ligament. From 1997 to 2002, in the Institute of Leprosy Research, we operated on 25 patients suffering from Lagaphthalmos and Ectropion using a newer treatment to correct ectropion more effectively. The levator muscle of the upper eyelid loses the funtion of its antagonistic muscle, namely the orbicularis oculi due to facial nerve palsy, and results in retraction of the upper eyelid. To correct upper eyelid retraction, we severed the levator and muller muscle from the superior tarsal border and discontinued the use of gold lid loading which is visually evident. This method does not result in ptosis and the eye is more normal in appearance.
Ankle ; Cartilage ; Ectropion ; Eyelids* ; Facial Nerve ; Fascia ; Humans ; Leprosy ; Ligaments ; Paralysis ; Temporal Muscle ; Transplants

No abstract available.
Joints* ; Range of Motion, Articular* ; Spine*

Management of the bulbous nasal tip with inadequate projection and drooping is challenging aesthetic plastic surgery. The bulbous nasal tip is influenced by several factors; 1) thick, non-elastic oily skin, 2) soft tissue bulkiness due to supratip fibrous fatty tissue, and 3) a wide intercrural angle or increased interdormal distance. Another common factor among caucasians, hypertrophic alar cartilage, is seen less in orientals. These variable factors can be corrected with various surgical maneuvers for proper tip projection and refined alar shape. All these procedures are performed through open rhinoplasty incision. The fibromuscular fatty tissue on the nasal tip is resected with subdermal tangential excision without violating the detmal blood supply. The proximal part of the lateral crus, dome and the part of medial crus which was isolated from the skin and nasal mucosa are replaced and plicated in midline in the role of a new columellar strut and skeletal support. If more skeletal supports are desired, the new columellar is reinforced with a silicone strut and conchal cartilage onlay grafts are applied. And for lengthening of the columella, a V-Y advancement incision on the columellar base with open rhinoplasty is applied. The pressure splint on the upper third of the columella and nasal tip is applied on the 7th postoperative day and maintained for two months. All procedures are focused on the preservation of catilaginous integrity and in providing skeletal support. We performed nasal tip plasty on the bulbous nasal tip and its simple technique and predictability resulted in improved nasal tip projection and contour.
Adipose Tissue ; Cartilage ; Inlays ; Nasal Mucosa ; Rhinoplasty ; Silicones ; Skin ; Splints ; Surgery, Plastic ; Transplants

Deformities of the leg and ankle may result from growth abnormalities of the tibia and fibula. The appearance of the secondary ossification center and growth plate closure of the tibial and fibular epiphyses, and the pattern of closure of the epiphyses, were observed in a different age. Normal radiographs were reviewed in one hundred and fifty patients at age from two days after birth to 20 years, who were injured on the contralateral leg, at Wonju Medical College, Yonsei University from Feb., 1980 to May, 1984. The results were as follows: 1. The time of the appearance of secondary ossification center and the closure of growth plates; The proximal tibial epiphysis usually forms secondary ossification center at birth to second postnatal months, the physeal closure occurs from 13 year and 11 months to 18 year 3 months in male, from 13 year 4 months to 15 year 5 months in female. The secondary ossification center of the distal tibial epiphysis appears from 8th postnatal months to one year, and physeal closure occurs from 15 years to 17 year and 4 months in male, from 15 year 2 months to 16 year 8 months in female. The secondary ossification center of the tibial tuberosity appears from 9 year 3month to 12 year 2 months, and closure occurs from 16 year 3 months to 18 year 7 months inmale, from 14 year 10 months to 19 year 1 months in female. The proximal fibular epiphysis forms secondary ossification center from 2 year 5 months to 5 year 4 months, closure occurs from 15year 8 months to 17 year 4 months in male, from 14 year 9 months to 16 year 9 months in female. The secondary ossification center of the distal fibular epiphysis appears from 2 year 5 months to 3rd years, and closure occurs from 13 year 11 months to 17 year 6 months in male, from 13 year 4 months to 16 year 7 months in female. 2. The growth and the pattern of the closure of growth plates of the tibia; The proximal tibial epiphysis is elliptic for the first 3 years of life. The epiphysis is slightly conical centrally as it extends toward the tibial spines, and becomes more prominent from 8 years to adolescence. The closure of the proximal tibial growth plate occurs initially along the anteromedial aspect of the tibia and tibial tuberosity during 12 years and proceeds posterolaterally. Complete closure of the proximal tibial physis occurs about from 13 years to 18 years. The secondary ossification center of the distal tibial epiphysis is oval in shape initially, becomes thicken medially by 3rd year of life, then the tibial plafond is valgoid, and becomes horizontal at age 10 approximately. The distal epiphysis of tibia unites first at about 13 years, starting centrally and proceeding toward anteromedial portion. And the posterolateral portion unites finally by about 15 to 17 years. The tibial tuberosity develops a secondary ossification center by 7 to 9 years, usually in the most distal region, and gradually elongates and extends toward the secondary ossification center of the proximal tibia.From about 12 years, the tuberosity epiphyseal center fuses with the proximal tibial center, and the fusion with the tibial metaphysis extends distally, the tuberosity physis closes completely from about 15 to 19 years. 3. The growth and development of the tibia, fibula and ankle; The growth of the proximal tibial and the distal fibular epiphyses play an important role of the growth rate in lower extremities unber ten years. The distal tibial growth plate inclines laterally and distally prior to the first year of life, the inclination is on the decrease and it finally horizontal at about 12 years. The distal tibia talus angle is about 90° prior to the age one year, becomes mildly valgoid by 12 years.
Adolescent ; Ankle ; Congenital Abnormalities ; Epiphyses ; Female ; Fibula ; Gangwon-do ; Growth and Development ; Growth Plate ; Humans ; Leg ; Lower Extremity ; Male ; Parturition ; Spine ; Talus ; Tibia

The Supracondylar fracture of the humerus is the most common elbow fracture in children. In general, accurate anatomic reductio, the least regional trauma as possible and the maintenance of the reduction are necessary to obtain excellent results. Lateral and posterior approach is commonly used method for the treatment of supracondylar fracture of the humerus in children. But lateral and posterior approach has some troubles in reduction of fracture and Kirschner wire fixation. From March 1988 to February 1993, seventeen supracondylar fractures of the humerus were treated by means of medial approach and followed from 8 monts to 13 months with an average 10 months. There were some advantages in medial approach. Reduction was easy and ulnar nerve was not damaged by medial approach at insertion of Kirschner wire and no more another incision. The results obtained are as follows. Postoperative vascular impairment or Volkmann's ischemia was not complicated and neurologic deficits accompanied with injury were all recovered completely. According to Mitchell and Adams' criteria, all had satisfactory results.
Child ; Elbow ; Humans ; Humerus ; Ischemia ; Methods ; Neurologic Manifestations ; Ulnar Nerve

No abstract available.

No abstract available.
Child* ; Hip* ; Humans ; Osteoma, Osteoid*

We experienced a case of congenital goiter with congenital hypothyroidism in 45 day-old male, who complained of respiratory difficulty and anterior neck mass. After admission, he was diagnosed congenital hypothyroidism by the clinical manifestations and laboratory tests including biochemistry, radioimmunoassay, radioisotope study, perchlorate discharge test, and bone radiography. We obtained positive finding at the perchlorate discharge test and found that his congenital goiter with congenital hypothyroidism was manifested by organification defect. We started treatment with L-thyroxine orally at 6th hospital day. The case was presented with brief review of literatures.
Biochemistry ; Congenital Hypothyroidism* ; Goiter* ; Humans ; Male ; Neck ; Radiography ; Radioimmunoassay ; Thyroxine

Porencephaly is relatively rare condition defined by an defect or a defect or cavity in the cerebrum owing to a developmental malformation or to a destructive lesion. Fory-five porencephaly patients diagnosed by Brain CT were clinically analyzed and the following results were obtained. 1) By the age group presenting initial symptoms, the peak incidence was from 1 month to below 3 years old. 2) In initial symptoms, seizure, spastic weakness, headache were showed in order of frequency. But 7 cases (15.5%) were asymptomatic. 3) The latency of diagnosis after presenting initial symptoms from the symptom onset time to 10 years. 4) The subsequent symptoms were as follows: spastic weakness, speech disturbance, gait disturbance, mental retardation, sensory loss and seizure showed independently or combined. 5) As etiologic factor, 21 cases (46.7%) were congenital, 16 cases (35.5%) were post-traumatic or post-operative and 8 cases (17.8%) were perinatal. 6) The prognosis was seen various from mild to severe. Out of 45 cases, 29 cases (64.4%) were no complications. But the prognosis in patients with post-traumatic or postoperative etiological factors was poor. With the advent of brain CT and the resultant capability of detecting structural defect and cerebral lesions responsible for epilepsy or focal neurologic signs, porencephaly was seen to be readily recongizable by CT examination. Since porencephaly is a significant contributor to the spectrum of CNS lesion and benign condition, ist recognition is important in determining prognosis and therapy.
Brain ; Cerebrum ; Child, Preschool ; Diagnosis ; Epilepsy ; Gait ; Headache ; Humans ; Incidence ; Intellectual Disability ; Muscle Spasticity ; Neurologic Manifestations ; Prognosis ; Seizures