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Metastatic Squamous Cell Carcinoma of the Lower Lip: Analysis of the 5-Year Survival Rate.

Tommaso AGOSTINI ; Giuseppe SPINELLI ; Francesco ARCURI ; Raffaella PERELLO

Archives of Craniofacial Surgery.2017;18(2):105-111. doi:10.7181/acfs.2017.18.2.105

OBJECTIVES: The author analyse the impact of extracapsular lymph node spread and bone engagement in the ipsilateral neck of patients suffering squamous cell carcinoma (SCC) of the lower lip. METHODS: The data of 56 neck dissections performed in patients suffering SCC of the lower lip between January 2000 and December 2008 were retrospectively analysed. Statistical analysis was performed with the Kaplan-Meier life table method, and the survival rate was investigated with the log rank statistic and significance test. The values were considered statistically significant at p<0.05. RESULTS: Nine patients took advantage from simultaneous treatment of tumor and prophylactic neck dissection (level I-III), reaching 100% survival rate. Patients suffering metastasized disease, who received radical neck dissection at the time of tumor treatment, presented 83.3% survival rate. Patients who underwent previous surgery and radiotherapy presented worse prognosis although radical neck dissection in case of extra-capsular spread only (24.7%) and osseous engagement (22.2%). CONCLUSION: Prophylactic neck dissection (level I–III) is recommended in T3–T4 N0 SCC. Simultaneous treatment of tumor and cervical lymph nodes provides a better prognosis as respect to delayed nodal management. Extra-capsular spread with or without bone engagement represents independent risk factor responsible for high mortality rate of SCC of the lower lip.
Carcinoma, Squamous Cell* ; Epithelial Cells* ; Humans ; Life Tables ; Lip* ; Lymph Nodes ; Mortality ; Neck ; Neck Dissection ; Prognosis ; Radiotherapy ; Retrospective Studies ; Risk Factors ; Survival Rate*

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The Algorithm-Oriented Management of Nasal Bone Fracture according to Stranc's Classification System.

Ki Sung PARK ; Seung Soo KIM ; Wu Seop LEE ; Wan Suk YANG

Archives of Craniofacial Surgery.2017;18(2):97-104. doi:10.7181/acfs.2017.18.2.97

BACKGROUND: Nasal bone fracture is one of the most common facial bone fracture types, and the surgical results exert a strong influence on the facial contour and patient satisfaction. Preventing secondary deformity and restoring the original bone state are the major goals of surgeons managing nasal bone fracture patients. In this study, a treatment algorithm was established by applying the modified open reduction technique and postoperative care for several years. METHODS: This article is a retrospective chart review of 417 patients who had been received surgical treatment from 2014 to 2015. Using prepared questionnaires and visual analogue scale, several components (postoperative nasal contour; degree of pain; minor complications like dry mouth, sleep disturbance, swallowing difficulty, conversation difficulty, and headache; and degree of patient satisfaction) were evaluated. RESULTS: The average scores for the postoperative nasal contour given by three experts, and the degree of patient satisfaction, were within the “satisfied” (4) to “very satisfied” (5) range (4.5, 4.6, 4.5, and 4.2, respectively). The postoperative degree of pain was sufficiently low that the patients needed only the minimum dose of painkiller. The scores for the minor complications (dry mouth, sleep disturbance, swallowing difficulty, conversation difficulty, headache) were relatively low (36.4, 40.8, 65.2, 32.3, and 34 out of the maximum score of 100, respectively). CONCLUSION: Satisfactory results were obtained through the algorithm-oriented management of nasal bone fracture. The degree of postoperative pain and minor complications were considerably low, and the degree of satisfaction with the nasal contour was high.
Classification* ; Congenital Abnormalities ; Deglutition ; Facial Bones ; Headache ; Humans ; Mouth ; Nasal Bone* ; Pain, Postoperative ; Patient Satisfaction ; Postoperative Care ; Retrospective Studies ; Surgeons

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Olfactory Dysfunction in Nasal Bone Fracture.

Sug Won KIM ; Beom PARK ; Tae Geun LEE ; Ji Ye KIM

Archives of Craniofacial Surgery.2017;18(2):92-96. doi:10.7181/acfs.2017.18.2.92

BACKGROUND: All nasal bone fractures have the potential for worsening of olfactory function. However, few studies have studied the olfactory outcomes following reduction of nasal bone fractures. This study evaluates posttraumatic olfactory dysfunction in patients with nasal bone fracture before and after closed reduction. METHODS: A prospective study was conducted for all patients presenting with nasal bone fracture (n=97). Each patient consenting to the study underwent the Korean version of Sniffin' Sticks test (KVSS II) before operation and at 6 month after closed reduction. The nasal fractures were divided according to the nasal bone fracture classification by Haug and Prather (Types I–IV). The olfactory scores were compared across fracture types and between preoperative and postoperative settings. RESULTS: Olfactory dysfunction was frequent after nasal fracture (45/97, 46.4%). Our olfactory assessment using the KVSS II test revealed that fracture reduction was not associated with improvements in the mean test score in Type I or Type II fractures. More specifically, the mean posttraumatic Threshold, discrimination and identification score decreased from 28.8 points prior to operation to 23.1 point at 6 months for Type II fracture with septal fracture. CONCLUSION: Our study has revealed two alarming trends regarding post-nasal fracture olfactory dysfunction. First, our study demonstrated that almost half (46.4%) of nasal fracture patients experience posttraumatic olfactory dysfunction. Second, closed reduction of these fractures does not lead to improvements olfaction at 6 months, which suggest that olfactory dysfunction is probably due to factors other than the fracture itself. The association should be further explored between injuries that lead to nasal fracture and the mechanism behind posttraumatic olfactory dysfunction.
Classification ; Discrimination (Psychology) ; Humans ; Nasal Bone* ; Olfactory Nerve ; Prospective Studies ; Skull Fractures ; Smell

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A Statistical Analysis of Superior Orbital Fissure Width in Korean Adults using Computed Tomography Scans.

Yongsik PARK ; Youngjoon KIM

Archives of Craniofacial Surgery.2017;18(2):89-91. doi:10.7181/acfs.2017.18.2.89

BACKGROUND: The superior orbital fissure is a small area that connects the middle cranial fossa and the orbit. Many studies have measured the size of the superior orbital fissure. However, there is no standard value for the size of the superior orbital fissure. Therefore, we conducted this study to provide the average size of the superior orbital fissure in Korean adults. METHODS: We measured the widths of the superior orbital fissures of 142 patients using computed tomography scans. Because the width of the superior orbital fissure varies at different locations, we measured the superior orbital fissure width at the level of the optic canal. RESULTS: In the males, the width of the superior orbital fissure on both sides was 3.79±0.93 mm, and these values were 3.79±0.96 mm for the left side and 3.783±0.92 mm for the right side. In the females, the widths of the superior orbital fissures were 3.62±1.35 mm on the left side, 3.69±1.18 mm on the right side, and 3.65±1.26 mm across both sides. CONCLUSION: There were no significant differences between the males and females or between the left and right sides. The present study suggests that we may accept the hypothesis that a congenitally narrow superior orbital fissure may be a risk factor for the superior orbital fissure syndrome. Surgeons should take precaution with patients who have narrow superior orbital fissures during the perioperative period.
Adult* ; Cranial Fossa, Middle ; Cranial Nerves ; Female ; Humans ; Male ; Orbit* ; Perioperative Period ; Risk Factors ; Surgeons ; Tomography, X-Ray Computed

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The Efficacy of Coblator in Turbinoplasty.

Keun Cheol LEE ; Jeong Min CHO ; Seok Kwun KIM ; Kwang Ryeol LIM ; Sang Yun LEE ; Su Seong PARK

Archives of Craniofacial Surgery.2017;18(2):82-88. doi:10.7181/acfs.2017.18.2.82

BACKGROUND: Turbinate hypertrophy is one of the common causes of chronic nasal obstruction. In principle, therapeutic guidelines recommend medical treatment. Failure to treat turbinate thickening despite drug therapy may indicate the need for surgery. The main aim of this study was to determine the effect of radiofrequency surgery, among various other surgical procedures, on people with both nasal septal deviation and turbinate hypertrophy. METHODS: Among people with nasal deviation who visited the subject hospital between July 2008 to July 2014, 21 people with nasal septal deviation and severe turbinate hypertrophy before their surgery had undergone septoplasty with turbinoplasty using radiofrequency combined with septoplasty. The degree of the turbinate's hypertrophy was appraised in all the patients before and after the surgery using the rhinoscopy, and acoustic rhinometry was objectively carried out. The subjective effect of the turbinoplasty using radiofrequency was explored through the visual analog scale (VAS) score. RESULTS: The degree of contraction of the nasal mucosa after the rhinoscopy changed from Grades 3 and 4 (100%) to Grades 1 and 2 (95.2%) and Grades 3 (4.8%). The minimal cross-sectional area significantly increased from 0.44±0.07 to 0.70±0.07 cm² (p<0.05). The nasal cavity volume increased from 4.79±0.49 to 6.76±0.55 cm² (p<0.05). The subjective symptoms evaluated with VAS score a year after the surgery significantly improved (p<0.05). CONCLUSION: Turbinoplasty using Coblator with septoplasty is an effective treatment method because it expands nasal cavity, has a low incidence of complications, subjectively improves symptoms, and has short treatment duration.
Drug Therapy ; Humans ; Hypertrophy ; Incidence ; Methods ; Nasal Cavity ; Nasal Mucosa ; Nasal Obstruction ; Rhinometry, Acoustic ; Rhinoplasty ; Turbinates ; Visual Analog Scale

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Usefulness of a Transconjunctival Approach in the Reconstruction of the Medial Blow-Out Wall Fracture.

Chi An LEE ; Hook SUN ; Ji Young YUN

Archives of Craniofacial Surgery.2017;18(2):76-81. doi:10.7181/acfs.2017.18.2.76

BACKGROUND: A transcaruncular approach is typically used for reconstructions of medial wall fractures. However, others reported that a transconjunctival approach was conducive for securing an adequate surgical field of view. In this study, we aimed to examine the extent of repair of medial wall fracture via a transconjunctival approach. METHODS: We retrospectively reviewed the medical records of 50 patients diagnosed as having medial wall fracture via preoperative computed tomography and who underwent surgery between March 2011 and February 2014. The fracture location was defined by dividing each of the anterior-posterior and superior-inferior distances into three compartments. RESULTS: A transcaruncular approach was used in 7 patients, while the transconjunctival approach was performed in the remaining 43 patients. The transconjunctival approach enabled a relatively broad range of repair that partially included the front and back of the medial wall, and was successful in 86% of the entire study population. CONCLUSION: It is known that more than 50% of total cases of the medial wall fracture occur mainly in the middle-middle portion, a majority of which can be reconstructed via a transconjunctival approach. We used a transconjunctival approach in identifying the location of the fracture on image scans except for cases including the fracture of the superior portion in patients with medial wall fracture. If it is possible to identify the location of the fracture, a transconjunctival approach would be an useful method for the reconstruction in that it causes no damages to the lacrimal system and is useful in confirming the overall status of the floor.
Humans ; Medical Records ; Methods ; Ophthalmologic Surgical Procedures ; Orbital Fractures ; Orbital Implants ; Reconstructive Surgical Procedures ; Retrospective Studies

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Treatment of Mandibular Angle Fractures.

Jung Ho LEE

Archives of Craniofacial Surgery.2017;18(2):73-75. doi:10.7181/acfs.2017.18.2.73

The management of mandibular angle fractures is often challenging and results in the highest complication rate among fractures of the mandible. In addition, the optimal treatment modality for angle fractures remains controversial. Traditional treatment protocols for angle fractures have involved rigid fixation with intraoperative maxillomandibular fixation (MMF) to ensure absolute stability. However, more recently, non-compression miniplates have gained in popularity and the use of absolute intraoperative MMF as an adjunct to internal fixation has become controversial. In this article, the history of, and current trends in, the treatment of mandibular angle fractures will be briefly reviewed. In addition, issues regarding the management of the third molar tooth will be discussed.
Clinical Protocols ; Fracture Fixation, Internal ; Jaw Fixation Techniques ; Mandible ; Mandibular Fractures ; Molar, Third ; Tooth

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Nodular Fasciitis of the Periorbital Area.

Yoon Jae LEE ; Sue Min KIM ; Jung Ho LEE ; Young Joon JUN ; Young Jin KIM ; Jeana KIM

Archives of Craniofacial Surgery.2014;15(1):43-46. doi:10.7181/acfs.2014.15.1.43

Nodular fasciitis is a reactive, non-neoplastic lesion that is most commonly found in the subcutaneous or superficial fascia of the extremities and trunk. Head and neck lesions are relatively uncommon and reports vary from 7% to 15% depending on the authors. Nodular fasciitis grows quickly, and shows a pleomorphic spindle cell pattern with increased mitotic activity. Such factors lead to cases where the lesion is mistaken for a malignancy such as fibrosarcoma and the case may end up with unnecessarily aggressive treatments. The intent of this paper is to report a relatively rare case of nodular fasciitis occurring in the periorbital area and also to highlight the importance of accurate diagnosis and non-aggressive management of this benign lesion.
Diagnosis ; Extremities ; Fasciitis* ; Fibrosarcoma ; Head ; Neck ; Subcutaneous Tissue

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Ganglion Cyst of the Sternoclavicular Joint in an Adult.

Nam Gyun KIM ; Yun Sub LIM ; Jae Hoon CHOI ; Jun Sik KIM ; Kyung Suk LEE

Archives of Craniofacial Surgery.2014;15(1):40-42. doi:10.7181/acfs.2014.15.1.40

Ganglion cysts are most common on the dorsum of the hand or wrist, but they can occur in any part of the body. There have been few papers reporting ganglion cysts originating from the sternoclavicular joint, with most of these cases developing in children. A 76-year-old woman was referred to our department because of a painless mass over the right sternoclavicular joint. The mass was excised along with the portion of the sternoclavicular joint capsule surrounding the stalk. Histopathologic examination showed the cyst wall to be composed of compressed collagen fibers without evidence of an epithelial or synovial lining, which was consistent with ganglion cyst. To our knowledge, this is the first report of such a cyst in an adult. We consider this to be a useful report for surgeons that treat mass lesions occurring in almost any part of the body surface.
Adult* ; Aged ; Child ; Collagen ; Female ; Ganglion Cysts* ; Hand ; Humans ; Joint Capsule ; Sternoclavicular Joint* ; Wrist

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Leiomyosarcoma of the Face.

Young Il KO ; Jin Soo LIM ; Ki Taik HAN ; Min Cheol KIM

Archives of Craniofacial Surgery.2014;15(1):36-39. doi:10.7181/acfs.2014.15.1.36

Leiomyosarcoma is a rare form of soft tissue neoplasm, with only 1% to 5% occurring in the head and neck region. Current recommended treatment suggests surgical excision with a wide lateral margin, but no definite guidelines regarding excisional margin have been established yet. Recently, complete excision with a narrow surgical margin has been recommended, and the authors present a case of cutaneous leiomyosarcoma on the face that was successfully managed by complete removal with a narrow excisional margin. A 74-year-old woman presented with a 3 cm sized, rapidly growing cutaneous mass on her right preauricular area. Preoperative biopsy of the skin lesion suggested a cutaneous leiomyosarcoma. The authors performed complete surgical excision with a 1 cm lateral margin, and the resulting skin defect was repaired with bilateral V-Y advancement local flaps. Histopathology and immunohistochemistry evaluation confirmed a moderately differentiated cutaneous leiomyosarcoma, with negative margin involvement. The patient refused of any additional treatment, but showed no locoregional recurrence during the 1.5 years of postoperative follow-up period. With a regular postoperative follow-up, cutaneous leiomyosarcomas may be successfully treated with a narrow surgical margin.
Aged ; Biopsy ; Female ; Follow-Up Studies ; Head ; Humans ; Immunohistochemistry ; Leiomyosarcoma* ; Neck ; Recurrence ; Skin ; Soft Tissue Neoplasms

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