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An Experimental Study of Bone Distraction in Rabbit Skull.

Min Sung TAK ; Ho Sung SHIN ; Sang Gue KANG ; Yong Bae KIM ; Young Mann LEE ; Sang Bak SIM ; Jong Whan KIM

Journal of the Korean Cleft Palate-Craniofacial Association.2001;2(1):35-41.

The epiopathogenesis of craniosynostosis remains obscure. According to the studies involved, the conditions observed at birth are very different. In case that a deformity is obvious or the risk of brain compression is possible, strip craniectomy, frontal bone advancement and cranial vault remodeling methods are used. These direct reshaping or remodeling methods are time consuming and require greater use of physical resources and still are not uniformly successful in making skull shape to normal. Distraction of the cranial bone has been studied to solve this problem. This study subsequently included 30 white rabbits aged about 25 weeks. The rabbits were divided in three groups. In group I, a 0.25mm distraction was done every other day after 3 day latency period. In group II, there was a 7 day latency period with the same rate of distraction as in group I. There was a 3 day latency period with a 0.5mm distraction every other day in group III. The contralateral side underwent a sham operation as a control group. During distraction and after consolidation periods, histologic and ultrastructural studies were carried out. And a serial radiologic study was done. As a result, group I and group II showed successful distraction osteogenesis, and we demonstrated the biological and mechanical factor associated with distraction osteogenesis. In group I, despite the short latency period, there was successful bone regeneration. Group III, it also showed successful ossification. During the distraction period, there was a remarkable increase of TGF-beta1 in both groups, especially in periosteum osteoid and newly developed connective tissue. In conclusion, we have demonstrated a useful model of distraction osteogenesis in rabbit skulls, and attempted to evaluate associated biological and mechanical factors.
Bone Regeneration ; Brain ; Congenital Abnormalities ; Connective Tissue ; Craniosynostoses ; Frontal Bone ; Latency Period (Psychology) ; Osteogenesis, Distraction ; Parturition ; Periosteum ; Rabbits ; Skull* ; Transforming Growth Factor beta1

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Comparative study of the Effectiviness Among the four Types of Induced Hypotensive Anesthetic Methods in Maxillofacial Reconstructive Surgery.

Rong Min BAEK ; Byung Ha YUN ; Mun Chul KIM

Journal of the Korean Cleft Palate-Craniofacial Association.2001;2(1):30-34.

In the maxillofacial surgery, close care is mandatory during operation and anesthesia. The surgical field is limited since most procedure is done through the mouth. In this situation, airway management and blood pressure controls are keystone. So, the induced hypotensive anesthesia is essential to the maxillofacial surgery for bleeding control and accurate operation. One hundred and ninety-eight cases of maxillofacial surgery was carried out under induced hypotensive anesthesia from 1991 to 1999. Authors divided them into 4 groups based on the anesthetic protocol. In group 1(n = 43) inhalation anesthetics(enflurane, halothane) and sodium nitroprussde(SNP) were used; in group 2(n = 99) inhalation anesthetics(enflurane), SNP and labetalol were used; In group 3(n = 27) inhalation anesthetics(enflurane) and labetalol were used; In group 4(n = 29) total intravenous anesthesia(propofol, fentanyl, midazolam) was applied with SNP, and esmolol(or labetalol). The patient records were retrospectively studied during the operation and anesthesia, including degree of fluctuation in the mean arterial blood pressure, amounts of the blood loss and transfusion during the operation, complications, and the period of hospitalization. Mean operation time of 4 groups decreased in order. The blood pressure was controllable without reflex tachycardia in beta-blocker using groups. Amount and incidence of transfusion was smaller in total intravenous anesthesia group. However there were no significant differences in total admission days and ICU stay periods between 4 groups.
Airway Management ; Anesthesia ; Anesthesia, Intravenous ; Arterial Pressure ; Blood Pressure ; Fentanyl ; Hemorrhage ; Hospitalization ; Humans ; Incidence ; Inhalation ; Labetalol ; Mouth ; Reflex ; Retrospective Studies ; Sodium ; Surgery, Oral ; Tachycardia

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Auricular Reconstruction with Autogenous Rib Cartilage Graft using Tissue Expander after Canaloplasty in Microtia.

Jin Soo LEE ; Sukwha KIM ; Chin Whan KIM ; Chul Gyoo PARK ; Yoonho LEE

Journal of the Korean Cleft Palate-Craniofacial Association.2001;2(1):25-29.

Along with aural atresia, abnormalities of the middle ear and external ear canal can impede the audition of the developing infant. In cases of bilateral atresia when bone-conduction aids fail to adequately restore impaired hearing, unilateral canal reconstruction may be required at a very early age to enable proper speech and language development. We are often confronted by cases in which canaloplasty has previously been performed by ENT surgeons, leaving auricular canals of various locations and sizes in addition to scars. In such cases, it can be difficult to prepare a skin flap sufficient in size to cover the cartilagenous framework for auricular reconstruction. Scar tissues with relatively poor vascularity induced by a prior incision and elevation of the soft tissue may compromise the ultimate result of auricular reconstruction. To obtain the sufficient, thin, pliable and well vascularized skin, we used tissue expansion at the first stage of the auricle reconstruction in microtia patients who previously received canaloplaty. From December, 1988 to February, 1999, we attempted tissue expansion using volume 35cc, cresent- type inflatable silicone expanders(SebbinR) in 12 patients who previously received canaloplasty. Ear frameworks were prepared using autologous rib cartilage. The expanded skin provided sufficient, thin, pliable, and well vascularized skin for easy draping and better contouring. The reconstructed auricle was satisfactory in both color and texture and had nearly normal sensation. No resorption of the inserted rib cartilage has been observed from 7 months to 9 years and 9 months after the operation.
Cartilage* ; Cicatrix ; Ear ; Ear Canal ; Ear, Middle ; Hearing ; Humans ; Infant ; Language Development ; Ribs* ; Sensation ; Silicones ; Skin ; Tissue Expansion ; Tissue Expansion Devices* ; Transplants*

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Correction of Vertical Excess of the Lower Face.

Jong Lim PARK ; Chul Gyoo PARK

Journal of the Korean Cleft Palate-Craniofacial Association.2001;2(1):19-24.

Since Wilmar first described term "Long face", various methods have been performed to enhance features of the patients with vertical excess of face, but Kawamoto established that the sole method to correct these deformities is to shorten the height of maxilla by LeFort I osteotomy. Features of the lower long facial pattern, conveniently called "Long face syndrome", "Horse face" has following characteristics; 1) Disproportionally elingated lower half of the face. 2) Widely separated lip and visible anterior teeth. 3) Hyperactivity of mentalis muscle. 4) The smile is typically "Gummy" 5)On profile, convex dorsum of nose, and receded double bump appearance of chin. 6) Tendency of class II malocclusion. From May, 1994 to April, 1999 we have treated 6 cases of vertical maxillary excess, "Long face syndrome" patient using maxillary LeFort I osteotomy and ancillary mandibular surgery. Sometimes there were combined bimaxillary prognathi and hemifacial hypertrophies. Age varied from 22 to 31(mean 23) and follow-up period varied from 6 months to 3 years(mean 1 year). Vertical shortening, rotation of the maxilla and combined mandibular adjustment surgery resulted in good facial harmony improvement of characteristics above and satisfaction of the patient with long face syndrome.
Chin ; Congenital Abnormalities ; Follow-Up Studies ; Humans ; Hypertrophy ; Lip ; Malocclusion ; Maxilla ; Nose ; Osteotomy ; Tooth

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A Correction Of Unilateral Cleft Lip Nose Deformity using Porous High-density Polyethylene Columellar Strut.

Kihwan HAN ; Byungju PARK ; Daegu SON

Journal of the Korean Cleft Palate-Craniofacial Association.2001;2(1):11-18.

Even though many surgical techniques have been reported to correct the unilateral cleft lip nose deformity, it is very difficult to achieve optimal results. The authors used the porous high-density polyethylene(Medpor(R)) sheet as a columellar strut for alar cartilage repositioning and the triangular transposition flap based on the superior columella for correction of excess skin of alar web. A silicone implant was used for nasal dorsal augmentation. Additional techniques including segmental resection of the excessive alar cartilage on the normal side, freeing of the septal cartilage from the vomer, the nasal osteotomies, a Z-plasty on the afftected plica vestibularis, alar advancement of denuded alar base flap or an interalar cinch, and subcutaneous reduction of the external lateral triangle were also used to repair individual differences of the nasal deformities. Twenty-four patients (11 females and 13 males; mean age, 24 years) were included in this study. From six to thirty-four months(mean fifteen months) postoperatively, the patients were evaluated by the ordinary scale method and the anthropometric analysis using preoperative and postoperative nasal cast models. The analysis of the result was conducted by Paired samples T test. All the patients showed uneventful healing except three cases of columellar strut protrusion. By the ordinary scale method, "good" aesthetic results were noted. By the postoperative anthropometric analysis, the alar length of the normal side, the columellar length and the tip projection of both normal and affected sides were significantly increased. The nostril floor width of the affected side and the nose width were significantly decreased. In conclusion, this technique is valuable in the correction of unilateral cleft lip nasal deformity. But in cases of severe deformity, residual septal deviation, those who have received the operation several times, the porous high-density polyethylene sheet must be used carefully because of the protrusion.
Cartilage ; Cleft Lip* ; Congenital Abnormalities* ; Female ; Humans ; Individuality ; Male ; Nose* ; Osteotomy ; Polyethylene* ; Silicones ; Skin ; Vomer

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Repair of Complete Cleft Palate by Modified 2-Flap Palatoplasty.

Kyung Suck KOH ; June kyu KIM

Journal of the Korean Cleft Palate-Craniofacial Association.2001;2(1):7-10.

The goal of palatoplasty is focused on two points. One is to close the palatal defect completely and the other is to create velopharyngeal system for normal speech production. After palatoplasty, scaring of palatal bare area is an important factor contributing to maxillofacial growth aberration. Bardach reported that most palatal clefts could be closed without bare bone by using the two-flap palatoplasty. On the basis of clinical experiences of the two-flap palatoplasty, authors made the lateral incision on the noncleft side to decrease the chance of bony exposure. From November 2000 to January 2001, nine children with complete cleft palate underwent two-flap palatoplasty without lateral incision on noncleft side (modified two-flap palatoplasty). Mean age at cleft repair was 11.2 months, and mean follow-up period was 2.9 months. Incision was performed on the medial edges of both side and the alveolar ridge of the cleft side. After elevation, the mucoperiosteal flaps of both sides were rotated downward. The palatal gap was simply closed without tension. Palatal fistula did not occur, and there was no postoperative bleeding. Modified two-flap palatoplasty method can be suggested to reduce the bare bone exposure, scarring and resultant growth disturbance. However, more in-depth study by long term follow-up is needed to evaluate growth pattern and speech evaluation.
Alveolar Process ; Child ; Cicatrix ; Cleft Palate* ; Fistula ; Follow-Up Studies ; Hemorrhage ; Humans

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Classification and Operation of Microform Cleft Lip.

Byung Hoon CHA ; Si Hyun PARK ; Joo Heon KIM ; Jeong Tae KIM ; Seok Kwun KIM

Journal of the Korean Cleft Palate-Craniofacial Association.2001;2(1):1-6.

Microform cleft lip is a mild expression of cleft lip. Downward depression of the nostril rim, skin striae of the upper lip, notching of the Cupid`s bow, and deformity of the vermilion border are characteristic findings. The definition is very important to aid in selection of the operative methods. Based on our operative experiences of cleft lip, we classified microform cleft lip according to our new definition.. According to author`s classification, class I(1 case) has cleft lip nose deformity without lip deformity or with slight short lip of cleft side, class IIa(5 cases) has minimal lip deformity with blurring of cupid`s bow, vermilion notching, and skin striae with intact of orbicularis oris muscle, class IIb(12 cases) has discontinuity of the orbicularis oris muscle, class III(5 cases) has mild lip nose deformity with discontinuity of orbicularis oris muscle including Cupid`s bow deviation. In class IIb and class III, reconstruction of orbicularis oris muscle is important and we repaired it with radical operation by rotation-advancement method. A total of 23 microform cleft lip result was reviewed. We treated the clefts following the above principles according to the classification and obtained satisfactory results.
Classification* ; Cleft Lip* ; Congenital Abnormalities ; Depression ; Lip ; Microfilming* ; Nose ; Skin

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A Case of Dermoid Cyst in Temporal Fossa.

Hak Sung LEE ; Matthew Seung CHOI ; Hee Chang AHN ; Jang Hyun LEE

Journal of the Korean Cleft Palate-Craniofacial Association.2010;11(1):65-68.

PURPOSE: Dermoid cysts are benign neoplasms that are derived from both ectoderm and mesoderm. Approximately 7 percent of all dermoid cysts occur in the head and neck, as most common sites are the lateral ends of the eyebrows, the midline in the nasal root and neck. Rarely they can be found in the frontal sinus, temporal bone, maxilla and the floor of the mouth. Dermoid cysts in the temporal fossa are extremely rare. We experienced a characteristic dermoid cyst that occupied the temporal fossa. METHODS: A 16-year-old man had a progressive enlarging mass on the left eyebrow. Computerized tomographic scan showed a bulging mass in the temporal fossa, and it had the density similar to that of fat. The size of the mass was 3x3x2cm, and it was composed of high density of fat with clear margin. There was no bony invasion, but the mass was fixed on bone. RESULTS: We performed the surgery through coronal incision under general anesthesia. Because the mass was closely connected with temporal fat pads, we removed this mass with some portion of temporal fat pads, avoiding damage to the facial nerve. The postoperative course was ordinary without complication. CONCLUSION: The reports about dermoid cyst on the temporal fossa is uncommon. However, if there is a mass in the temporal fossa which has the density similar to that of fat in CT scan, we should consider the possibility of dermoid cyst. We suggest that excision through coronal incision with bewaring temporal fat pad can induce good result.
Adipose Tissue ; Adolescent ; Anesthesia, General ; Dermoid Cyst ; Ectoderm ; Eyebrows ; Facial Nerve ; Floors and Floorcoverings ; Frontal Sinus ; Head ; Humans ; Maxilla ; Mesoderm ; Mouth ; Neck ; Temporal Bone

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Intravenous Pyogenic Granuloma in Sentinel Vein: A Case Report.

Ki Yong HONG ; Eui Cheol JEONG ; Xianghua MIN ; Kyung Won MINN ; Young Jik LEE

Journal of the Korean Cleft Palate-Craniofacial Association.2010;11(1):62-64.

PURPOSE: Lobular capillary hemangioma is a vascular tumor that commonly occurs as a cutaneous lesion. Intravenous pyogenic granuloma is a rare form of lobular capillary hemangioma that usually occurs in the veins of the neck and the upper extremities. METHODS: A 41-year-old man presented with 3 months history of nodules on the left temporal area and these lesions were clinically mistaken for a typical lipoma or epidermal cyst, but the nodules appeared unusually vascular with sentinel veins on excision. RESULTS: On the histopathologic examination, the excised tissue was observed as an intraluminal polypoid mass, which was attached to the vein via a fibrovascular stalk and capillaries in a loose edematous fibromyxoid stroma, and so the lesions were confirmed to be intravenous pyogenic granuloma. At 6 months after excision, there has been no recurrence and the patient is asymptomatic. CONCLUSION: Intravenous pyogenic granuloma is a rare variant of lobular capillary hemangioma. This article describes the surgical and histopathological findings of treating pyrogenic granuloma.
Adult ; Capillaries ; Epidermal Cyst ; Granuloma ; Granuloma, Pyogenic ; Humans ; Lipoma ; Neck ; Nitriles ; Pyrethrins ; Recurrence ; Upper Extremity ; Veins

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Sebaceous Carcinoma Treated with Various Flaps in Head and Facial Regions.

Da Arm KIM ; Yong Ah RYU ; Nak Heon KANG ; Sang Ha OH

Journal of the Korean Cleft Palate-Craniofacial Association.2010;11(1):58-61.

PURPOSE: Sebaceous carcinoma is a rare malignant tumor that occurs mostly in head and neck regions. Early diagnosis and treatment are necessary because it tends to be locally aggressive and goes through distal metastasis with fast progression. This study presents reliable surgical methods for sebaceous carcinoma in head and neck regions. METHODS: Three patients were included in this study. First, a 61-year-old woman visited the hospital with a yellow-colored, slowly growing mass on the left ala. A 54-year-old woman had a brown-colored mass on her right preauricle. Last case was a 62-year-old man who had a yellow-colored mass on his scalp. CT scan and punch biopsy were done. All cases were diagnosed as sebaceous carcinoma. The lesions were resected with 10 mm safety margin and various regional flaps were used for reconstruction. RESULTS: Histological examination revealed sebaceous differentiation and local invasions. Postoperatively, all patients did not suffer from complication and no recurrence was found. CONCLUSION: We recommend early wide excision with an enough safety margin, and a regional flap as a treatment of sebaceous carcinoma.
Biopsy ; Early Diagnosis ; Female ; Head ; Humans ; Middle Aged ; Neck ; Neoplasm Metastasis ; Recurrence ; Scalp

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