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My Hopes for 2015: Letter from the President of Korean Cleft Palate-Craniofacial Association.

Jeong Yeol YANG

Archives of Craniofacial Surgery.2015;16(1):47-47. doi:10.7181/acfs.2015.16.1.47

No abstract available.
Hope*

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Microcystic Adnexal Carcinoma Misdiagnosed as Desmoplastic Trichoepithelioma on Preoperative Biopsy.

Sung Hoon KOH ; Kwang Rae KANG ; Ji Hoon YANG ; Sung Won JUNG ; Hyuck Jae LEE

Archives of Craniofacial Surgery.2015;16(1):43-46. doi:10.7181/acfs.2015.16.1.43

Microcystic adnexal carcinoma is a rare type of tumor, with about 300 cases reported globally. Due to its similar histology with other tumors, it is occasionally misdiagnosed as desmoplastic trichoepithelioma, basal cell carcinoma, syringoma, and so on. We present a patient with a mass on the perioral area who was preoperatively diagnosed with trichoepithelioma. Microcystic adnexal carcinoma was diagnosed after excisional biopsy and a wide excision. Defects were reconstructed with a mucosal advancement flap. There was no recurrence and there were no significant complications during the 18-month follow-up period. Because superficial punch biopsy has limitations in width and depth, surgeons should always consider the possibility of malignancy of a mass even if a biopsy shows a benign result.
Biopsy* ; Carcinoma, Basal Cell ; Diagnostic Errors ; Follow-Up Studies ; Humans ; Recurrence ; Skin Neoplasms ; Syringoma

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Actinomycosis and Sialolithiasis in Submandibular Gland.

Jin Seok KANG ; Hwan Jun CHOI ; Min Sung TAK

Archives of Craniofacial Surgery.2015;16(1):39-42. doi:10.7181/acfs.2015.16.1.39

Actinomycosis is a subacute or chronic suppurative infection caused by Actinomyces species, which are anaerobic Gram-positive bacteria that normally colonize the human mouth and digestive and urogenital tracts. Cervicofacial actinomycosis is the most frequent clinical form of actinomycosis, and is associated with odontogenic infection. Characterized by an abscess and mandibular involvement with or without fistula, but the cervicofacial form of actinomycosis is often misdiagnosed because the presentation is not specific and because it can mimic numerous infectious and non-infectious diseases, including malignant tumors. We report a rare case of actinomycosis infection with coexisting submandibular sialolithiasis. The patient presented with a 1x1 cm abscess-like lesion below the lower lip. Punch biopsy of the lesion revealed atypical squamous cell proliferation with infiltrative growth, suggestive of squamous cell carcinoma. The patient underwent wide excision of this lesion, where the lesion was found to be an abscess formation with multiple submandibular sialolithiases. The surgical specimen was found to contain Actinomyces without any evidence of a malignant process. We assumed that associated predisposing factors such as poor oral hygiene may have caused a dehydrated condition of the oral cavity, leading to coexistence of actinomycosis and sialolithiasis.
Abscess ; Actinomyces ; Actinomycosis* ; Actinomycosis, Cervicofacial ; Biopsy ; Carcinoma, Squamous Cell ; Causality ; Cell Proliferation ; Colon ; Fistula ; Gram-Positive Bacteria ; Humans ; Lip ; Mouth ; Oral Hygiene ; Salivary Gland Calculi* ; Submandibular Gland*

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Delayed Orbital Hemorrhage around Alloplastic Implants after Blowout Fracture Reduction.

Yong Ah RYU ; Jae Beom PARK ; Hyun Woo KYUNG ; Seung Han SONG ; Nak Heon KANG

Archives of Craniofacial Surgery.2015;16(1):35-38. doi:10.7181/acfs.2015.16.1.35

Alloplastic implants have been used to repair orbital wall fractures in most cases. Orbital hemorrhage is a rare complication of these implants and has been reported rarely in Korea. The purpose of this article is to report a late complication case focusing on their etiology and management. A 20-year-old male patient underwent open reduction with Medpor (porous polyethylene) insertion for bilateral orbital floor fractures. The initial symptom occurred with proptosis in the right side as well as vertical dystopia, which had started 4 days earlier, 8 months after surgery. Any trauma history after the surgery was not present. We performed an exploration and removal of hematoma with Medpor titanium meshed alloplastic implant. A case of delayed orbital hematoma following alloplastic implant insertion was identified. It occurred within the pseudocapsule of the implant. One week after surgery, overall symptoms improved successfully, and no complications were reported during the 11-month follow-up period. Although rare, orbital hemorrhage is a potential complication of alloplastic orbital floor implants, which may present many years after surgery. As in the case presented, delayed hematoma should be included in the differential diagnosis of late proptosis or orbital dystopia.
Diagnosis, Differential ; Exophthalmos ; Follow-Up Studies ; Hematoma ; Hemorrhage* ; Humans ; Korea ; Male ; Orbit* ; Titanium ; Young Adult

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Complex Correction of Complete Cleft Lip with Severe Prominent Premaxilla using Lip Adhesion and Nasoalveolar Molding Device.

Bin Na SEO ; Su Han PARK ; Jeong Yeol YANG ; Kyung Min SON ; Ji Seon CHEON

Archives of Craniofacial Surgery.2015;16(1):31-34. doi:10.7181/acfs.2015.16.1.31

Nasoalveolar molding (NAM) device is an effective treatment for protruding maxilla in infants with cleft palate. However, only a few studies have investigated the effect of NAM devices on the treatment of protruding maxilla in infants with cleft lip only. We have designed a combination treatment using NAM devices prior to cheiloplasy for cleft lip-only patients with severe anterior protrusion of the premaxilla. Three cleft lip-only infants with 1-cm or more of premaxilla protrusion were included. Definitive cheiloplasty was performed at 6 months of age without any preoperative correction in infant 1. Cheiloplasty was performed in conjunction with the use of NAM device and lip adhesion in infants 2 and 3. Postoperative columella length and anterior-posterior dimension of the protruding premaxilla were compared amongst the infants. We were able to obtain satisfactory postoperative columella length and general nasal appearance.
Cleft Lip* ; Cleft Palate ; Fungi* ; Humans ; Infant ; Lip* ; Maxilla ; Orthodontic Appliances

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Application of Hand Towel Drape over Dingman Mouth Gag.

Kyeong Beom CHOI ; Myong Chul PARK

Archives of Craniofacial Surgery.2015;16(1):29-30. doi:10.7181/acfs.2015.16.1.29

In cleft palate surgery, the environment is especially critical when suturing. Encum-bered, obstructive space in the environment can hinder a suture while using the Dingman mouth gag. We introduced a novel but simple draping technique. A simple hand towel is placed over the gag. A hole is cut out in the middle according to each patient's mouth. After making the hole, the hand towel is soaked in water and gently squeezed. Then the towel is properly placed over the Dingman mouth gag. Dripping water on the hand towel during the suture helps keep it in place. Using this draping technique, we cut 14 minutes of operation time compared to the average operation time of the past 2 years. There were several disadvantages in previous draping method. First, long suture material may easily get caught. Second, the operation field can easily be contaminated. Third, focusing on the operation becomes difficult due to the obstruction. This draping technique can compensate for the disadvantages of the previous Dingman mouth gag.
Cleft Palate ; Hand* ; Mouth* ; Oral Surgical Procedures ; Surgical Drapes ; Sutures ; Water

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Simple Aesthetic Correction for Patients with Acute Auriculocephalic Angle.

Byung Mi LEE ; Seok Joo KANG ; Hook SUN

Archives of Craniofacial Surgery.2015;16(1):24-28. doi:10.7181/acfs.2015.16.1.24

BACKGROUND: Acute auriculocephalic angle refers to an ear with helix that is spaced closely to the cranium. An increasing number of patients with acute auriculocephalic angle wish to undergo corrective operation for aesthetic purposes. However, there is a paucity of data regarding acute auriculocephalic angle. This paper proposes a treatment protocol for patients with acute auriculocephalic angle. METHODS: We performed a retrospective analysis of patients undergoing acute auriculocephalic angle (4 patients, 6 ears). Patient records were reviewed for demographic data as well as auricular measurements at preoperative, immediate postoperative and final follow-up evaluations. RESULTS: All of the patients were men with a mean age of 36.5 years (range, 23-52 years). The mean follow-up period was 47.5 months (range, 28-60 months). Postoperative auriculocephalic angle was close to the normal auriculocephalic angle (25degrees-30degrees) without notable scars. Moreover, the patients had minimal contractions of the skin flaps without any hematoma or relapse. CONCLUSION: We propose the following three treatment protocols for patients with acute auriculocephalic angle: the posterior auricular muscle should be sufficiently released, the mastoid area should be augmented using implants, the skin should be repositioned with a superior auricular flap.
Cicatrix ; Clinical Protocols ; Ear ; Follow-Up Studies ; Hematoma ; Humans ; Male ; Mastoid ; Recurrence ; Retrospective Studies ; Skin ; Skull ; Surgical Flaps

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Transfacial Surgical Approaches to Secure Wide Exposure of the Skull Base.

Sin Rak KIM ; Jung Woo LEE ; Yea Sik HAN ; Han Kyu KIM

Archives of Craniofacial Surgery.2015;16(1):17-23. doi:10.7181/acfs.2015.16.1.17

BACKGROUND: Treatment of skull base tumors is challenging due to limited access and presence of important neurovascular structures nearby. The success of a complete tumor resection depends on the extent of tumor exposure and secure field of view. While these tumors are often removed by transcranial endoscopic access, transfacial approach is sometimes required depending on the location and size of the tumor. This study describes various transfacial approaches in patients undergoing skull base tumor resection. METHODS: From March to November 2013, 15 patients underwent skull base tumor resection via transfacial accesses at a tertiary institution. Data were reviewed for patient demographics, type of access used, completeness of tumor resection, surgical outcome, and postoperative complications. RESULTS: Two clivus tumor patients underwent transmaxillary approach; three tuberculum- sellae and suprasellar-hypothalamus tumor patients underwent transbasal approach; three clinoid and retrobulbar intraconal orbital tumor patients underwent orbitozygomatic approach; and seven petroclival-area, pons, cavernous sinus, and lateral-sphenoid-wing tumor patients underwent zygomatic approach. In all cases, the upper and lower margins of the tumor were visible. Complete tumor removal consisted of 10 cases, and partial tumor removal in 5. There were no immediate major complications observed for the transfacial portion of the operations. The overall cosmetic results were satisfactory. CONCLUSION: Plastic surgeons can use various transfacial approaches according to the location and size of skull base tumors to secure a sufficient field of view for neurosurgeons.
Cavernous Sinus ; Cranial Fossa, Posterior ; Demography ; Humans ; Orbit ; Pons ; Postoperative Complications ; Skull Base*

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Skull Reconstruction with Custom Made Three-Dimensional Titanium Implant.

Hyung Rok CHO ; Tae Suk ROH ; Kyu Won SHIM ; Yong Oock KIM ; Dae Hyun LEW ; In Sik YUN

Archives of Craniofacial Surgery.2015;16(1):11-16. doi:10.7181/acfs.2015.16.1.11

BACKGROUND: Source material used to fill calvarial defects includes autologous bones and synthetic alternatives. While autologous bone is preferable to synthetic material, autologous reconstruction is not always feasible due to defect size, unacceptable donor-site morbidity, and other issues. Today, advanced three-dimensional (3D) printing techniques allow for fabrication of titanium implants customized to the exact need of individual patients with calvarial defects. In this report, we present three cases of calvarial reconstructions using 3D-printed porous titanium implants. METHODS: From 2013 through 2014, three calvarial defects were repaired using custommade 3D porous titanium implants. The defects were due either to traumatic subdural hematoma or to meningioma and were located in parieto-occipital, fronto-temporo-parietal, and parieto-temporal areas. The implants were prepared using individual 3D computed tomography (CT) data, Mimics software, and an electron beam melting machine. For each patient, several designs of the implant were evaluated against 3D-printed skull models. All three cases had a custom-made 3D porous titanium implant laid on the defect and rigid fixation was done with 8 mm screws. RESULTS: The custom-made 3D implants fit each patient's skull defect precisely without any dead space. The operative site healed without any specific complications. Postoperative CTs revealed the implants to be in correct position. CONCLUSION: An autologous graft is not a feasible option in the reconstruction of large calvarial defects. Ideally, synthetic materials for calvarial reconstruction should be easily applicable, durable, and strong. In these aspects, a 3D titanium implant can be an optimal source material in calvarial reconstruction.
Freezing ; Hematoma, Subdural ; Humans ; Meningioma ; Skull* ; Titanium* ; Transplants

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Analysis of Facial Asymmetry.

Kang Young CHOI

Archives of Craniofacial Surgery.2015;16(1):1-10. doi:10.7181/acfs.2015.16.1.1

Facial symmetry is an important component of attractiveness. However, functional symmetry is favorable to aesthetic symmetry. In addition, fluctuating asymmetry is more natural and common, even if patients find such asymmetry to be noticeable. However, fluctuating asymmetry remains difficult to define. Several studies have shown that a certain level of asymmetry could generate an unfavorable image. A natural profile is favorable to perfect mirror-image profile, and images with canting and differences less than 3degrees-4degrees and 3-4 mm, respectively, are generally not recognized as asymmetry. In this study, a questionnaire survey among 434 medical students was used to evaluate photos of Asian women. The students preferred original images over mirror images. Facial asymmetry was noticed when the canting and difference were more than 3degrees and 3 mm, respectively. When a certain level of asymmetry is recognizable, correcting it can help to improve social life and human relationships. Prior to any operation, the anatomical component for noticeable asymmetry should be understood, which can be divided into hard tissues and soft tissue. For diagnosis, two-and three-dimensional (3D) photogrammetry and radiometry are used, including photography, laser scanner, cephalometry, and 3D computed tomography.
Asian Continental Ancestry Group ; Cephalometry ; Diagnosis ; Facial Asymmetry* ; Female ; Humans ; Imaging, Three-Dimensional ; Photogrammetry ; Photography ; Radiometry ; Students, Medical ; Surveys and Questionnaires

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