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

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

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

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

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

Lymphangioma is a rare, benign, and hamartomatous tumor of the lymphatic vessels that shows a marked predilection for the head and neck region. When this tumor occurs on the tongue or mouth floor or in the deep neck space, blockage of the efferent lymphatic vessels can result in secondary macroglossia. We report here two patients who showed unusual macroglossia from birth. Initially, there was no noticeable cervical or mandibular swelling. However, mandibular swellings were noted during follow-up examinations, which led to MRI scans on the two infant patients at 5 months and 5 weeks of age, respectively. Subsequently, both patients were diagnosed with lymphangioma or lymphangiohemangioma in the deep neck space.
Follow-Up Studies ; Head ; Humans ; Infant ; Lymphangioma ; Lymphatic Vessels ; Macroglossia ; Magnetic Resonance Imaging ; Mouth Floor ; Neck ; Parturition ; Tongue

Eighty-three cases with severe blepharoptosis were treated by the superiorly based muscle flaps around eye including orbicularis oculi muscle, frontalis muscle, levator muscle. The selection of the muscle flaps were done in accordance with the levator function of patients. The orbicularis oculi muscle flap technique in 32 patients who have 2-5 mm levator function, 21 cases of the interdigitated orbicularis oculi-frontalis muscle flap for 1-3 mm levator function, frontalis muscle flap technique for less than 2 mm levator function, 22 cases of levator muscle resection for 2-8 mm levator function, 7 cases of levator plication for 5-9 mm levator function. The majority of patients recorded as satisfactory results. There has been no complete failure but there were 14 cases of undercorrection, 4 cases of overcorrection, 2 cases of exposure keratitis, 3 cases of corneal erosion, 2 cases of sensory loss, hematoma loss of wrinkle and a few cases of eyelid deformity such as notching, entropion, fading or unnatural fold. The orbicularis oculi muscle technique or the interdigitated orbicularis oculi-frontalis muscle flap technique offers several advantages over conventional frontalis muscle flap technique such as being a simple with a good operative field, single incision or supratarsal fold, no depression on the forehead, no risk of neurovascular injury and relatively easy technique with less complication. The levator resection or levator plication could offer good results by careful selection of patients. In conclusion, we would like to say that the interdigitated frontalis orbicularis oculi muscle flap technique is best in cases with less than 2 mm levator function, orbicularis oculi muscle flap technique in 2-4 mm levator function, levator resection in 4-8 mm levator function, levator plication in more that 8 mm levator function.
Blepharoptosis* ; Congenital Abnormalities ; Depression ; Entropion ; Eyelids ; Forehead ; Hematoma ; Humans ; Keratitis

The size of the cisterna magna is still detatable. Robertson13) stated that the cisterna magna varies greatly in capacity and described the large cisterna magna as a separate entity. He also found that in most cases the cisterna magna extended approximately 2.5cm above the foramen magnum and was usually 5mm deep with a variable width. Liliequist8) proposed a mean heigh of 28mm for the normal cisterna magna with a wide variation of 15 to 60mm, and a depth of 6mm at the foramen magnum with a variation of 2 to 10mm:however, he did not quote measurements for the width. Gonsette, et al.5) reported 28 cases of enlarged cisterna magna diagnosed by ventriculography and coined the phrase "mega grande citerne" or mega cisterna magna. All of these cases, however, had symptoms of posterior fossa disease. Our study of the syndrome of the mega cisterna magna without specific syndrome is presented nystagmus, transient syncope in the first & third cases were operated under suboccipital craniectomy and was confimed the large cisterna magna. This paper presents the clinical diagnosis with vertebral angiogrraphy, pneumoencephalography and computed tomography.
Cisterna Magna* ; Diagnosis ; Foramen Magnum ; Numismatics ; Pneumoencephalography ; Syncope

PURPOSE: For proper operation of the Seoul Emergency Medical Service Information Center, We analyzed the contents of the phone-calls made to the center. METHODS: We retrospectively analyzed phone calls made to the center from Jul. 1 to Sep. 30, 2001. RESULTS: The total number of phone calls made to the center during the above-mentioned period was 42,143, and the average number of calls was 458.1+/-32.3 per day. Most calls came between 09:00 and 12:00 (85 calls, 18.6%), and hours with the fewest calls were from 03:00 to 06:00 (18 calls, 3.9%). The average length of the calls was 2 minutes 38 seconds. Most callers(25,454 calls, 60.4%) asked questions about a disease or first aid which were considered as non-urgent, and 9,586 (22.7%) asked for simple advice about a hospital or a clinic and also considered as non-urgent. There were 885 (2.1%) calls that were considered as emergent situations and there were 1,686 cases (6.7%) connected to the Rescue system 1-1-9 for the rapid evacuation. CONCLUSION: The results show that the Seoul Emergency Medical Information Center does not perform the proper functions that it should in emergent situations.
Emergencies* ; Emergency Medical Services* ; First Aid ; Information Centers* ; Retrospective Studies ; Seoul*

PURPOSE: To evaluate the efficacy of color Doppler ultrasound (US) in the diagnosis of gestational trophoblastic neoplasia (GTN). MATERIALS AND METHODS: Intralesional color flows and resistive index (RI) on color Doppler US were prospectively analyzed in 21 consecutive suspected GTN cases. RI of the intralesional artery was investigated on the basis of the presence or absence of mass and metastasis. Correlation between RI of intralesional artery and urinary beta-hCG was also investigated. RESULTS: Intralesional color flows were identified in 15 patients with GTN. On operation, intralesional color flows were observed in one of two patients in whom the presence of completely necrotic tissue was confirmed. Intralesional color flows, however, were not detected in four patients who were proved not to be GTN sufferers. Sensitivity, specificity, accuracy, positive and negative predictive values, and accuracy were 100%, 83%, 95%, 94% and 100%, respectively. Significant correlation between RI of the intralesional artery and urinary beta-hCG was not established(p=0.49, r=0.19). RI of this artery was not substantially different between groups with and without mass, and between groups with and without metastasis(p=0.32, p=0.82). CONCLUSION: The current study demonstrates that color Doppler US is a sensitive and useful method for the diagnosis of GTN.
Arteries ; Diagnosis ; Gestational Trophoblastic Disease* ; Humans ; Neoplasm Metastasis ; Prospective Studies ; Sensitivity and Specificity ; Ultrasonography*