From May 1988 to January 1997 authors had experienced 13 cases of recurred blepharoptosis. Previous operative procedures were frontalis muscle suspension in 10 cases and levator resection in 3 cases. Follow up period ranged from 11 months to 9 years. We have treated recurred blepharoptosis using frontalis myofascial flap, orbicularis oculi muscle flap and levator resection in accordance with the postoperative levator function and degree of ptosis of patient and considering previous operative technique. The results were that 12 patients have gained the levator excursion over 7 mm and reduced the height difference between both palpebral fissures less than 2 mm after reoperation (good in 6 cases and satisfactory in 6 cases). From these results we might conclude that the frontalis myofascial flap technique is a good secondary blepharoptosis operation for patient with less than 2 mm of levator function, orbicularis oculimuscle flap technique with 2-4 mm of levator function, levator resection with over than 4 mm of levator function. The expert technique and experience are also important factor for the treatment of recurred blepharoptosis.
Blepharoptosis* ; Follow-Up Studies ; Humans ; Reoperation ; Surgical Procedures, Operative

Twenty-five Le Fort fractures accompanying palatal fracture or malocculsion had been studied from October 1990 to May 1997. The patients were analyzed on the basis of classification causes, operative procedure treatment of fracture, status of malocclusion and complication. The most common cause of fracture was a traffic accident and diagnosis was performed by history, physical examination, reontgenogram, and computed tomography. The follow-up period ranged from 5 months to 5 years, averaging 17 months. Internal fixations with plates and screws were performed in 22 cases and external fixations with halo apparatus were used in 3 cases. Intermaxillary fixations with arch bar were applied during the preoperative and postoperative period in all cases. In 6 cases of Le Fort fractures, acylic splints were applied. In 3 cases of palatal fractures, transverse wiring of the palatal arch were also used. Overall 19 of 25 patients were satisfied with the results. Six patients complained about depression of the midface because of undercorrection 4 patients had persisting hypoesthesia of the infraorbital nerve for more than 6 months postoperative. In summary, the dental plast and acrylic splint are very helpful in correcting malocclusion in severe maxillary fractures. Also, in cases of palatal fracture, it is important to minimize maloccusion by rigid fixation or transverse wiring of the palatal arch.
Accidents, Traffic ; Classification ; Depression ; Diagnosis ; Follow-Up Studies ; Humans ; Hypesthesia ; Malocclusion* ; Maxillary Fractures* ; Physical Examination ; Postoperative Period ; Splints ; Surgical Procedures, Operative

Endoscopic technique have become very popular in plastic and reconstructive surgery. They have provided advantages over previously closed techniques by minimizing scars, soft tissue manipulation and access with excellent visualization and magnification. More than twenty cases of facial bone surgery were performed over the past 3 years by endoscopic assistance. Our series consist of 3 cases of frontal bone contouring, 1 zygoma contouring, 3 fracture of zygoma, 9 fracture of orbit, 4 rhinoplasty for deviated nose. To accomplish this technique, a rigid 4 mm, 30 degree down angled endoscope was used. The frontal bone or zygomatic arch is approached endoscopically through two or three small incisions on the temporoparietal scalp. All endoscopic instrument are then manipulated through these incisions. The approach for zygoma complex, maxilla and mandible needs intraoral incision. Recontouring by a power bur and osteotomy using a small saw are done with endoscopic visual assistance. Rigid fixation requires an additional small incision over the plate for trocar method. The other technique was same with routine standard rhinoplasty procedures. The duration of follow-up ranged 3 months to 27 months. The postoperative course were satisfactory with fewer complication than conventional technique. The extra-time need for the endoscopic procedures was about 1 hour Endoscopically assisted facial bone recontouring, osteotomy and plate fixation can be performed with adequate visualization and direct manipulation of all facial bone. Complications usually associated with extensive incisions and pool visualization may be avoided. This technique may prove to be ideal for aesthetic surgery for facia skeleton with smaller scars and less morbidity.
Cicatrix ; Endoscopes ; Facial Bones ; Follow-Up Studies ; Frontal Bone ; Mandible ; Maxilla ; Nose ; Orbit ; Osteotomy ; Plastics ; Rhinoplasty ; Scalp ; Skeleton ; Surgical Instruments ; Zygoma

It is difficult to treat the complete cleft lip because of wide cleft and malaligned alveolar process, outward rotation of greater(medial) alveolar segment, and severe nasal deformity. Lip adhesion without presurgical orthopedic appliance was performed on 8 consecutive infants with unilateral complete cleft of the primary palate before denfinitive lip repair with Millard I procedure. Among 8 patients, 6 patients had complete unilateral cleft lip with alveolar cleft only and 2 patients were accompanied with complete cleft palate. All patients had more than a 10-mm-wide lip cleft with alveolar arch discrepancy. Lip adhesions were performed at 1-2 months of age and definitive repair was done at 5-6 months of age. Lip adhesions were performed by Randall's method and cheiloplasty was done by Millard I technique. Satisfactory results of lip and nose were obtained aesthetically in 8 cases after an average follow-up of 32 months. The vertical height of the medial and lateral lip segment were a symmetric appearance, while the vermilion tubercle, philtrum, and Cupid's bow were natural. Disadvantages included increased operating time and the sacrifice of same-lip tissue. In conclusion, preliminary lip adhesion can have better functional, esthetic and emotional results since the disadvantages are minor compared to the advantages.
Alveolar Process ; Cleft Lip* ; Cleft Palate ; Congenital Abnormalities ; Follow-Up Studies ; Humans ; Infant ; Lip* ; Nose ; Orthopedics ; Palate

Marcus Gunn described for the first time a syndrome consisting of unilateral, congenital ptosis and rapid, exaggerated elevation of the ptotic eyelid on movement of the mandible to the contralateral side. The clinical findings and management of 2 patients with Marcus Gunn phenomenon had been reviewed. Preoperative measurement of ptotic amount, levator function by Berke's method, and marginal limbal distance were evaluated. The amount winking of the upper eyelid on primary gaze was graded on as scale from I to III. The operation was performed two patients under local anesthesia, one by unilateral levator resection, one by orbicularis oculi muscle flap. As a result, the correction of blepharoptosis was possible without severe complications. However, moderate degree of jaw-winking, slight undercorrection, transient lagophthalmos was inevitable. The management of patients with Marcus Gunn phenomenon is a challenging endeavor. Therefore, a comprehensive medical and ophthalmological evaluation of the patient and a detailed history are mandatory before undertaking the successful treatment of patients with this syndrome
Anesthesia, Local ; Blepharoptosis ; Blinking ; Eyelids ; Humans ; Mandible ; Mortuary Practice

The current model of compact bone is that of a system of Haversian (longitudinal) canals connected by Volkmann's (transverse) canals. Models based on either histology or microcomputed tomography do not accurately represent the morphologic detail and microstructure of this system, especially that of the canal networks and their spatial relationships. The aim of the present study was to demonstrate the morphologic pattern and network of the Haversian system and to compare endosteal and periosteal sides in rats using three-dimensional (3D) reconstruction. Ten Sprague-Dawley rats aged 8-10 weeks were used. The femurs were harvested from each rat and fixed, decalcified with 10% EDTA-2Na, serially sectioned at a thickness of 5 microm, and then stained with hematoxylin and eosin. The serial sections were reconstructed three-dimensionally using Reconstruct software. The Haversian canals in the endosteal region were found to be large, highly interconnected, irregular, and close to neighboring canals. In contrast, the canals in the periosteal region were straight and small. This combined application of 3D reconstruction and histology examinations to the Haversian system has confirmed its microstructure, showing a branched network pattern on the endosteal side but not on the periosteal side.
Animals ; Eosine Yellowish-(YS) ; Femur ; Haversian System* ; Hematoxylin ; Rats* ; Rats, Sprague-Dawley ; X-Ray Microtomography

No abstract available.
Humans

The use of diversion in conjunction with pyeloplasty has been a matter of continuous debate for a number of years. A retrospective analysis of 20 cases with ureteropelvic junction obstruction which had pyeloplasty with or without diversion was done to evaluate the value of urinary diversion. The postoperative symptomatic and radiologic results were improved in 9(75%) of 12 patients with nephrostomy catheter and/or ureteral stent and in 7(87.5%) of 8 patients without nephrostomy catheter and ureteral stent (p>0.05). One patient with ureteral stent developed persistent hemorrhage and persistent urine leakage occurred in one patient with nephrostomy catheter and ureteral stent and one patient without diversion. In conclusion, nephrostomy catheter and ureteral stent appear to be unnecessary in the routine repair of primary uncomplicated ureteropelvic junction obstruction, if urologist strictly adhered to technical details.
Catheters ; Hemorrhage ; Humans ; Retrospective Studies ; Stents ; Ureter ; Urinary Diversion

Until now, surgical treatment of bile duct carcinoma has been unsatisfactory. There have been few reports dealing with the clinical significance of epidermal growth factor receptor(EGFR) and c-erbB-2 in bile duct cancer. To evaluate epidermal growth factor receptor(EGFR) and c-erbB-2 protein as a marker for prognosis, we analyzed the data and outcome of 32 cases of extrahepatic bile duct carcinoma immunohistologically, as well as clinicopathologically. The expressions of EGFR and c-erbB-2 showed in 71.9%(23/32) and 34.4%(11/32), respectively. The expression of EGFR was closely associated with the expression of c-erbB-2 (p<0.05). The expression rate of EGFR was significantly higher in well-differentiated cancer than in poorly-differentiated cancer (p<0.05), but was not related to stage, or lymph node metastasis. The expression of c-erbB-2 was not related to stage, lymph node metastasis, and differentiation. The expressions of EGFR and c-erbB-2 did not correlate with survival. In conclusion, the expression of EGFR or c-erbB-2 may be used as a tumor marker, but not as a prognostic factor in extrahepatic bile duct cancer.
Bile Duct Neoplasms ; Bile Ducts ; Bile Ducts, Extrahepatic* ; Epidermal Growth Factor ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis ; Receptor, erbB-2

PURPOSE: Percutaneous needle aspiration biopsy under the imaging guidance in the diagnosis of intrathoracic diseases has become a standard practice. Core tissue obtained by automated gun biopsy(AGB) is believed to be more diagnostic than materials from fine needle aspiration(FNA) by many cytopathologists. The authors evauated the role of automated gun biopsy in localized pulmonary lesions with respect to the its accuracy and complications. MATERIALS AND METHODS: We performed 107 percutaneous biopsies in localized pulmonary lesions under fluoroscopic guidance among 107 patients:AGB using 18G or 20G was done in 81 patients, and both AGB and FNA was done in 26 patients. RESULTS: Biopsy samples sufficient for histologic diagnosis were obtained in 94(87.9%) of 107 patients, AG8 in 73(90.1%) of 81 patients and AGB and FNA in 21(80.8%) of 26 patients. 11 of 13 negative results were due to inadeguate specimen size for the histologic diagnosis or were composed of necrotic areas, and 2 of 13 negative results were obtained through nontarget tissue. 10 patients developed pneumothorax and 4 of them required chest tube insertion. Minimal hemoptysis was found in 3 patients. CONCLUSION: Percutaneous automated gun biopsy under fluoroscopic guidance was easy and simple method of obtaining specimens of good quality and quantity. It may be an useful procedure in the diagnosis of localized pulmonary lesions.
Biopsy* ; Biopsy, Needle ; Chest Tubes ; Diagnosis ; Hemoptysis ; Humans ; Needles ; Pneumothorax