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Sun Goo KIM ; Tae Min YI ; Yu Jin KIM ; Se Il LEE

Journal of the Korean Cleft Palate-Craniofacial Association.2011;12(1):71-74.

PURPOSE: Sarcoidosis is a systemic noncaseating granulomatous disease of an unknown origin, and can involve any organ including the skin. The infiltration of sarcoid granuloma in an old cutaneous scar is an uncommon cutaneous manifestation of sarcoidosis. This paper reports a 35-year old female who presented with cutanesous nodules in previous facial scars. METHODS: A 35-year-old female presented with cutaneous nodules for 2 months in previous scars of the forehead and lower lip that she had acquired in the childhood. An excisional biopsy of the lower lip mass, serologic examinations and radiologic studies were performed. RESULTS: The excisional biopsy revealed noncaseating granulomas consistent with sarcoidosis. Chest CT revealed both hilar and paratracheal lymphadenopathy with nodular densities in both lung fields. Routine laboratory tests, serologic tests, serum angiotensin converting enzyme level, sputum for acid-fast bacilli, ophthalmoscopic examination, TB-PCR and NTM-PCR showed normal findings. Therefore, the patient was diagnosed with sarcoidosis. The patient refused fiberoptic bronchoscopy and medication with oral steroid. Currently, the clinical manifestation and progress are being monitored closely, and treatment is expected to start with oral steroid according to the progress. CONCLUSION: For the proper management of cutaneous sarcoidosis, particularly scar sarcoidosis, plastic surgeons should be aware of the many clinical and histopathological features of sarcoidosis and recommend a systemic evaluation for early diagnosis and proper treatment.
Adult ; Biopsy ; Bronchoscopy ; Cicatrix ; Early Diagnosis ; Female ; Forehead ; Granuloma ; Humans ; Lip ; Lung ; Lymphatic Diseases ; Peptidyl-Dipeptidase A ; Sarcoidosis ; Serologic Tests ; Skin ; Sputum ; Thorax

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A Case Report of a Giant Epidermal Nevus on the Scalp.

In Ho BAE ; Seok Chan EUN ; Rong Min BAEK

Journal of the Korean Cleft Palate-Craniofacial Association.2011;12(1):67-70.

PURPOSE: Epidermal nevi are hamartomas of the skin with multiple clinical variants. Normally, epidermal nevi present at an early age, are found on the head and neck area, and have a female predominance. Only very rarely do epidermal nevi have an adult onset. Most lesions are small and giant Epidermal nevi (> 5 cm at its greatest diameter) are quite rare. Huge verrucous plaque was observed on the scalp of a 70-year-old man. He had been reclusive for a long time, and this problem might have played a crucial role in the development of the giant epidermal nevi. METHODS: A punch biopsy and MRI imaging were performed. The huge mass was resected. A local flap and split thickness skin graft was used for reconstruction. RESULTS: The histology examination revealed the characteristic findings of epidermal nevus. Postoperatively, the patient did not suffer from complications or recurrence. CONCLUSION: A rare case of a huge epidermal nevus on the scalp of an elderly man was treated with a surgical excision. This is the oldest patient reported with an adult onset epidermal nevus in Korea.
Adult ; Aged ; Biopsy ; Female ; Hamartoma ; Head ; Humans ; Korea ; Neck ; Nevus ; Scalp ; Skin ; Transplants

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A Case Report of Cranial Fasciitis in an Adolescent Male.

Sin Young KIM ; Young Joon JUN ; Young Jin KIM ; Byung Chul SEO

Journal of the Korean Cleft Palate-Craniofacial Association.2011;12(1):63-66.

PURPOSE: Cranial fasciitis is a rare type of benign tumor that occurs mostly in children younger than 6 years. It arises from the deep fascia, periosteum, or fibromembranous layer that covers fontanelles. The etiology is unknown, although prior trauma has been postulated to be an underlying cause. There is a 2:1 male predominance. Despite its rapid growth, this tumor has a benign clinical course and can be cured by total excision. METHODS: A 16-year-old male presented with a 3 cm-sized palpable mass in the left lateral eyebrow region that he first noticed 4 months before presentation. The mass had grown rapidly since it was first noticed. Preoperative brain computed tomography showed a well-demarcated mass approximately 3 cm in size extending from the subcutaneous layer to the periosteum. Preoperatively, the presumed diagnosis was a dermoid cyst. An operation was performed with the patient under general anesthesia. The subcutaneous mass was completely excised by periosteal dissection. RESULTS: Histological diagnosis revealed the presence of cranial fasciitis. After 20 months of follow-up, there have been neither complications nor evidence of local recurrence besed on clinical examination. CONCLUSION: Although cranial fasciitis is quite rare, it should be considered in the differential diagnosis for lytic skull lesions in patient whose clinical presentation suggests this possibility. This condition could be occasionally mistaken for malignant or locally aggressive lesions. To prevent local recurrence, curettage of the underlying bone is recommended for patients with bone involvement.
Adolescent ; Anesthesia, General ; Brain ; Child ; Curettage ; Dermoid Cyst ; Diagnosis, Differential ; Eyebrows ; Fascia ; Fasciitis ; Follow-Up Studies ; Humans ; Male ; Periosteum ; Recurrence ; Skull

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A New Method to Conceal Cleft Lip Scar: Follicular Unit Hair Graft.

Ki Il UHM ; Jong In SHIN

Journal of the Korean Cleft Palate-Craniofacial Association.2002;3(1):37-40.

In cleft lip surgery, the scar on lip is minimized with trials but visible in some cases. The causes of visible scar after cheiloplasty include; (1) Mature scar is whitish, so the scar is more visible in Orientals with dark skin color than in Caucasians. (2) Mature scar on lip is conspicuous because it is whitish, so distinguished from hairy skin especially in mustached men. To solve this problem, authors used hair transplantation techniques. Hair transplantation techniques have been used for the treatment of alopecia in the main. The techniques include scalp composite graft technique such as strip graft, square graft and punch graft, but this may have a shortcoming such as unnatural, cobble-stone appearance. Moreover, this is not appropriate to use for the correction of long, slender scar of post-cheiloplasty state. So, authors used another hair transplantation technique, individual hair graft. A donor ellipse of scalp was harvested from the occipital area. The scalp was splitted into many single hair grafts carefully not to hurt hair follicles with No. 11 blade. The grafts were transplanted to the scar using Choi hair transplanter. Between February, 1996 to June, 2001, 8 cleft lip patients underwent individual hair graft and satisfactory results were obtained to conceal cleft lip scar. Hair grafts were well taken. When we splitted a scalp ellipse into many single hair grafts, we removed dermis from hair follicles delicately. So we obtained natural appearance and avoided unnatural, cobble-stone appearance. We didn't observe transient hair loss. So, authors conclude that individual hair graft technique is a new method to conceal cleft lip scar.
Alopecia ; Cicatrix* ; Cleft Lip* ; Dermis ; Hair Follicle ; Hair* ; Humans ; Lip ; Male ; Scalp ; Skin ; Tissue Donors ; Transplants*

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Correction of Cleft Lip Nasal Deformity using Refined Reverse-U Incision and V-Y Plasty.

Jong Hyup LEE ; Jae Woo PARK ; Byung Chae CHO ; Bong Soo BAIK

Journal of the Korean Cleft Palate-Craniofacial Association.2002;3(1):28-36.

Forty-five patients with cleft lip nasal deformities were operated on between September 1997 and December 1999. Thirty-five were followed up. Among them, 31 patients had unilateral cleft lip nasal deformities and 4 had bilateral cleft lip nasal deformities. The age range of the patients was from 3 to 56 years old. Reverse-U incision and V-Y plasty were used in 20 patients with mild to moderate unilateral cleft lip nasal deformities. An open rhinoplasty incision combined with the reverse-U incision and V-Y plasty was used in 11 patients with severe unilateral cleft lip nasal deformities. Bilateral reverse-U incisions and transcolumella incisions were used in 4 patients with bilateral cleft lip nasal deformities. After advancement of the mucochondrial flap, alar transfixion sutures were performed to make firm contact between the nasal skin and the redraped reverse- U flap. Ancillary procedures included correction of the laterally displaced alar base, lip scar revision, cartilage graft for tip augmentation, iliac bone graft for correcting hypoplasia of the maxilla or an alveolar cleft, corrective rhinoplasty, and composite graft for columella lengthening. A self-made nasal retainer was applied for 6 months in all patients to maintain the corrected contour of the nostril. The follow-up period ranged from 11 to 26 months, with an average of 18 months. Final results were evaluated based on the degree of symmetry of both nostrils, conditions of the redraped alar-columella web, and exposure of the nostril. Good results were obtained in 29 patients where alar-columella web deformities were either absent or minimal and a satisfactory symmetry of the nostrils was acquired. Four patients showed fair results, and 2 poor. In conclusion, these results suggest that the reverse-U incision and V-Y plasty are useful methods for creating a symmetry of the nostrils in cases of cleft lip nasal deformities in Orientals. In addition, this technique provides ample advancement and repositioning of the mucochondrial flap and simultaneous correction of the nasal vestibular web.
Cartilage ; Cicatrix ; Cleft Lip* ; Congenital Abnormalities* ; Follow-Up Studies ; Humans ; Lip ; Maxilla ; Middle Aged ; Rhinoplasty ; Skin ; Sutures ; Transplants

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The Abbe Island Flap for the Correction of Cleft Lip Deformity.

Kihwan HAN ; Hunyji KIM ; Joongjae LIM

Journal of the Korean Cleft Palate-Craniofacial Association.2002;3(1):21-27.

The tissue deficiency in the upper lip after cleft lip repair produces a tight lip, and an Abbe flap procedure is indicated. In order to increase the mobility of the pedicle and decrease the distortion of the lips at transfer, a procedure has been developed in which the pedicle is cut all around soft tissue leaving only a inferior labial artery. Therefore, the Abbe flap which is an arterial flap has been converted to an island flap. The authors performed 15 cases(14 men and 1 woman) of the correction of a tight lip in cleft lip deformities between 1986 and 2000. The patient ranged in age from 18 years to 33 years at the time of surgery, with a mean age of 24.4 years. From 1 to 14 years(mean, 9.7 years) postoperatively, the patients were evaluated by the photogrammetric analysis using preoperative and postoperative photograph, and the ordinary scale method. By the photogrammetric analysis, the upper vermilion contour index and the lip protrusion index were measured. The upper vermilion contour index is the percentage of the surface distance of the upper vermilion ridge to the mouth width. The lip protrusion index is the percentage of the labiale superius-tragion to the labiale inferius-tragion. One represented the correction of the horizontal deficiency in the upper lip, and the other showed the protrusion of the upper lip in relation th the lower lip. By the ordinary scale method, "excellent" aesthetic results were noted. In conclusion, the Abbe island flap provides maximal flexibility without reducing its viability and an accurate adaptation in the defect of the upper lip can be made. The upper vermilion contour index and the lip protrusion index represent objectively the effects of the Abbe island flap.
Arteries ; Cleft Lip* ; Congenital Abnormalities* ; Humans ; Lip ; Male ; Mouth ; Pliability

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Development and Clinical Application of Critical Pathway for Cleft Lip and Palate.

Jae Ha HWANG ; Kwang Seog KIM ; Dae Young KIM ; Sam Yong LEE ; Bek Hyun CHO ; Kwang Suk KIM ; Ji Hee CHEONG

Journal of the Korean Cleft Palate-Craniofacial Association.2002;3(1):15-20.

Objectives of this study is to determine the effect of a critical pathway on hospital stays and outcomes after cleft lip and palate repair. During a period of eleven months from March 2000 to January 2001, twenty six cases to applied by critical pathway for cleft lip and palate were followed up. Comparisions were made between the precritical pathway and postcritical pathway groups. The results of this study showed that expenses of treatment for cleft lip and palate was reduced to 20%, 30% respectively, after critical pathway. After critical pathway, hospital stays for cleft lip and palate was reduced to from 7 days to 4 days, from 9 days to 6 days, respectively. Postoperative complications was not increased. Patient satisfactions was increased because of the detailed explanations and reduced hospital stays. Conclusively, significant decreases in length of hospital stay are seen, and cost reductions can be realized after critical pathway.
Cleft Lip* ; Critical Pathways* ; Humans ; Length of Stay ; Palate* ; Postoperative Complications

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Correction of Maxillary Arch of Cleft Lip and Palate Patient using Active Stabilized Extraoral Apparatus.

Youngsuk CHOI ; Kun HWANG ; Jungsin PARK ; Seil LEE

Journal of the Korean Cleft Palate-Craniofacial Association.2002;3(1):11-14.

Presurgical maxillary orthodontics during neonatal period has been advocated to facilitate cleft lip and/or palate cases through correcting widened alveolar bone and twisting or bending protruded premaxilla. This may improve post-orthodontic surgical lip repair procedure. Premaxilla cannot be moved into the correct position by a passive acrylic appliance alone. Therefore active acrylic appliance may be necessary and force vector, amount and stability of appliance are mandatory. Because neonatal infant still doesn't have a fully grown face, there may be some limitations to apply proper active force to the patient. The authors devised a new active stabilized extraoral appliance which provided stable extraoral force in the cleft lip and/or palate patients. We applied our new device to 2 infants with unilateral and bilateral cleft lip and palate. Stability of extraoral part has been increased by elastic rubber band, and the intraoral part is firmly connected to extraoral part. By using this device, the gap has decreased from 11.5mm to 6.5mm between right and left alveolar ridge in 1-month infant with unilateral case after 7 weeks. In 2-month infant with bilateral cleft, the length between premaxilla and alveolar ridge decreased from 6.5mm to 2.0mm after 4 weeks. We think our intraoral active stabilized orthodontic appliance could be widly used in cleft patients to put their maxillary segments to desirable position. This procedure makes the cleft lip surgery easier, with less tension.
Alveolar Process ; Cleft Lip* ; Cleft Palate ; Humans ; Infant ; Lip ; Orthodontic Appliances ; Orthodontics ; Palate* ; Rubber

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Surgical Correction of Microform Cleft Lip by Small Triangular Flap.

Bek Hyun CHO ; Ji Hee CHEONG ; Suk Joon OH

Journal of the Korean Cleft Palate-Craniofacial Association.2002;3(1):6-10.

Cleft lip is one of the most common major facial malformation. The defect of the midline tissue on the upper lip is due to failure of the contact and fusion between mesenchymal tissues of the lip. Microform cleft lip is defined as the cleft of the lip with the minor degree of the deformity on the lip and the nose. The hallmarks of the microform cleft lip are a small notching of the vermilion, a vertical congenital fibrous band extending from the vermilion to the nostril floor, and a displaced alar cartilage on the cleft side. The surgical methods of microform cleft lip include Rose-Thomson straight line closure and Millard Rotation- advancement repair. Although those methods repaired the functional impairment effectively, they failed to achieve the cosmetic improvement because of the long incision scar on the upper lip. The authors applied Tennison's small triangular flap to the microform cleft lips of the 10 patients from July 1998 to January 2001. We excised the scar on the notch of the vermilion with minimal incision using Tennison's small triangular flap and repaired the discontinuity of orbicularis oris musculture. The asymmetric nostrils were also corrected appropriately. We followed up each case with constant intervals and could get good results esthetically without shortening of the upper lip and the contracture of the scar band.
Cartilage ; Cicatrix ; Cleft Lip* ; Congenital Abnormalities ; Contracture ; Humans ; Lip ; Microfilming* ; Nose

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Preoperative Nasal Molding and Unilateral Cleft Lip Repair By Mohler'S Technique.

So Young LIM ; Bomjoon HA ; Kap Sung OH ; Soon Man KWON ; Won Sok HYON

Journal of the Korean Cleft Palate-Craniofacial Association.2002;3(1):1-5.

Various techniques of unilateral cleft lip repair are being developed. Nowadays, rotation-advancement flap technique is most widely used for the repair of unilateral cleft lip. This procedure places a premium on the conservation of tissue and preservation of natural landmarks. Millard's technique however occasionally can produce a scar that crosses the philtrum obliquely in the upper third of the philtral unit. In Mohler's technique, the marking of the medial segment has been altered in uppermost portion by utilizing tissue from the columellar base. That is to say, cutback on columellar tissue is utilized at approximately 90 degrees. After full-thickness release of the medial lip segment, the C flap is advanced into donor defect of the columellar base and is also used to lengthen the shortened columella. This results in the placement of a scar that will simulate the mirror image of the non-involved phitral column. And another advantage of this technique is the possibility of primary nasal correction including wide dissection of alar cartilage through cutback incision on columellar base without need of additional incision for nasal dissection. In addition, preoperative nasal molding was performed with a special NAM(nasoalveolar molding) appliance by orthodontist during preoperative period. The authors performed 27 cases of the correction of the unilateral cleft lip using this technique between July 2000 and December 2001. All the patients showed satisfactory results by achieving enough rotation of medial lip segment without scar that crosses the philtral column and satisfactory correction of primary nasal deformity.
Cartilage ; Cicatrix ; Cleft Lip* ; Congenital Abnormalities ; Fungi* ; Humans ; Lip ; Preoperative Period ; Tissue Donors

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