BACKGROUND: Orthognathic surgery is required in 25% to 35% of patients with a cleft lip and palate, for whom functional recovery and aesthetic improvement after surgery are important. The aim of this study was to examine maxillary and mandibular changes, along with concomitant soft tissue changes, in cleft patients who underwent LeFort I osteotomy and sagittal split ramus osteotomy (two-jaw surgery). METHODS: Twenty-eight cleft patients who underwent two-jaw surgery between August 2008 and November 2013 were included. Cephalometric analysis was conducted before and after surgery. Preoperative and postoperative measurements of the bone and soft tissue were compared. RESULTS: The mean horizontal advancement of the maxilla (point A) was 6.12 mm, while that of the mandible (point B) was -5.19 mm. The mean point A-nasion-point B angle was -4.1degrees before surgery, and increased to 2.5degrees after surgery. The mean nasolabial angle was 72.7degrees before surgery, and increased to 88.7degrees after surgery. The mean minimal distance between Rickett's E-line and the upper lip was 6.52 mm before surgery and 1.81 mm after surgery. The ratio of soft tissue change to bone change was 0.55 between point A and point A' and 0.93 between point B and point B'. CONCLUSIONS: Patients with cleft lip and palate who underwent two-jaw surgery showed optimal soft tissue changes. The position of the soft tissue (point A') was shifted by a distance equal to 55% of the change in the maxillary bone. Therefore, bone surgery without soft tissue correction can achieve good aesthetic results.
Cleft Lip ; Humans ; Lip ; Mandible ; Maxilla ; Orthognathic Surgery ; Osteotomy ; Osteotomy, Le Fort ; Osteotomy, Sagittal Split Ramus ; Palate

BACKGROUND: Various techniques for lengthening short columellae have been used for bilateral cleft nose repair. However, previous methods have not yielded satisfactory results. We performed a full-thickness skin graft to lengthen short columellae during secondary cleft nose repair in adult patients. METHODS: Ten bilateral cleft lip and nose patients underwent secondary cheiloplasty with open rhinoplasty between July 2008 and August 2014. The patients underwent a full-thickness skin graft on the medial crura to elongate the columella. The average age of the patients at the time of surgery was 22.2 years. Nasal profiles were evaluated before and after the operation using the photogrammetric method. RESULTS: The nasal profiles were improved in all patients, and all skin grafts were well taken, with the exception of one patient. Columellar height, nostril height, and columella-lip angle increased, and nasal width decreased significantly. The ratios of columellar height to nasal height, columellar height to nasal width, and nasal height to nasal width increased to a statistically significant extent. CONCLUSIONS: Columella lengthening with a full-thickness skin graft is a simple and effective method for the repair of severely short columellae in bilateral cleft nose patients. We had satisfactory outcomes, with good color matching and aesthetically pleasing contours.
Adult ; Cleft Lip* ; Humans ; Nose* ; Rhinoplasty ; Skin Transplantation ; Skin* ; Transplants*

PURPOSE: Laparoscopy-assisted distal gastrectomy for early gastric cancer has gained acceptance and popularity worldwide. However, laparoscopy-assisted distal gastrectomy for advanced gastric cancer is still controversial. Therefore, we propose this prospective randomized controlled multi-center trial in order to evaluate the safety and feasibility of laparoscopy assisted D2-gastrectomy for advanced stage gastric cancer. MATERIALS AND METHODS: Patients undergoing distal gastrectomy for advanced gastric cancer staged cT2/3/4 cN0/1/2/3a cM0 by endoscopy and computed tomography are eligible for enrollment after giving their informed consent. Patients will be randomized either to laparoscopy-assisted distal gastrectomy or open distal gastrectomy. Sample size calculation revealed that 102 patients are to be included per treatment arm. The primary endpoint is the non-compliance rate of D2 dissection; relevant secondary endpoints are three-year disease free survival, surgical and postoperative complications, hospital stay and unanimity rate of D2 dissection evaluated by reviewing the intraoperative video documentation. DISCUSSION: Oncologic safety is the major concern regarding laparoscopy-assisted distal gastrectomy for advanced gastric cancer. Therefore, the non-compliance rate of clearing the N2 area was chosen as the most important parameter for the technical feasibility of the laparoscopic procedure. Furthermore, surgical quality will be carefully reviewed, that is, three independent experts will review the video records and score with a check list. For a long-term result, disease free survival is considered a secondary endpoint for this trial. This study will offer promising evidence of the feasibility and safety of Laparoscopy-assisted distal gastrectomy for advanced gastric cancer.Trial Registration: NCT01088204 (international), NCCCTS-09-448 (Korea).
Arm ; Disease-Free Survival ; Endoscopy ; Gastrectomy ; Humans ; Informed Consent ; Laparoscopy ; Length of Stay ; Lymph Node Excision ; Lymph Nodes ; Postoperative Complications ; Prospective Studies ; Sample Size ; Stomach Neoplasms

Nasal bone fractures are often accompanied by septal fractures or deformity. Posttraumatic nasal deformity is usually caused by septal fractures. Submucosal resection and septoplasty are commonly used surgical techniques for the correction of septal deviation. However, septal perforation or saddle nose deformity is a known complication of submucosal resection. Hence, we chose to perform septoplasty, which is a less invasive procedure, as the primary treatment for nasal bone fractures accompanied by septal fractures. During septoplasty, we used a bioabsorbable mesh as an internal splint. We used the endonasal approach and inserted the mesh bilaterally between the mucoperichondrial flap and the septal cartilage. The treatment outcomes were evaluated by computed tomography (CT) and the nasal obstruction symptom evaluation (NOSE) scale. The CT scans demonstrated a significant improvement in the septal deviation postoperatively. The symptomatic improvement rated by the NOSE scale was greater at 1 month and 6 months after surgery compared to the preoperative status. There were no cases of extrusion or infection of the implant. In cases of moderate or severe septal deviation without dislocation from the vomerine groove on the CT scan, our technique should be considered one of the treatments of choice.
Absorbable Implants ; Cartilage ; Congenital Abnormalities ; Dislocations ; Nasal Bone ; Nasal Obstruction ; Nasal Septum ; Nose ; Splints ; Symptom Assessment

Nasal bone fractures are often accompanied by septal fractures or deformity. Posttraumatic nasal deformity is usually caused by septal fractures. Submucosal resection and septoplasty are commonly used surgical techniques for the correction of septal deviation. However, septal perforation or saddle nose deformity is a known complication of submucosal resection. Hence, we chose to perform septoplasty, which is a less invasive procedure, as the primary treatment for nasal bone fractures accompanied by septal fractures. During septoplasty, we used a bioabsorbable mesh as an internal splint. We used the endonasal approach and inserted the mesh bilaterally between the mucoperichondrial flap and the septal cartilage. The treatment outcomes were evaluated by computed tomography (CT) and the nasal obstruction symptom evaluation (NOSE) scale. The CT scans demonstrated a significant improvement in the septal deviation postoperatively. The symptomatic improvement rated by the NOSE scale was greater at 1 month and 6 months after surgery compared to the preoperative status. There were no cases of extrusion or infection of the implant. In cases of moderate or severe septal deviation without dislocation from the vomerine groove on the CT scan, our technique should be considered one of the treatments of choice.
Absorbable Implants ; Cartilage ; Congenital Abnormalities ; Dislocations ; Nasal Bone ; Nasal Obstruction ; Nasal Septum ; Nose ; Splints ; Symptom Assessment

PURPOSE: The congenital epulis is a rare, benign tumor. It can protrude out of the newborn's mouth to prevent normal closure of the mouth and it can interfere with respiration or feeding. METHODS: An 11-day old female neonate presented with a 1.5x1.5x2.3cm sized mass in the gingival and anterior alveolar ridge of the mandible. We performed a simple excision. RESULTS: In our case, histologically, there was no pseudoepitheliomatous hyperplasia. The staining for S-100 protein, and actin was negative. After 8 months, the patient had normal teeth eruption and no recurrence of the tumor. CONCLUSION: With early detection and appropriate treatment, we were able to help the baby avoid developing any dyspnea. Nursing was possible after the mass had been removed.
Actins ; Alveolar Process ; Dyspnea ; Female ; Gingival Neoplasms ; Humans ; Hyperplasia ; Infant, Newborn ; Mandible ; Mouth ; Recurrence ; Respiration ; S100 Proteins ; Tooth

BACKGROUND: We wanted to explore performing hepatic arterial reconstruction in living donor liver transplantation (LDLT) using right lobe liver grafts and cadaveric liver transplantation (CLT) in a single center. METHODS: Thirty five LDLTs were performed from April 2005 to August 2009. The back wall support suture without twisting was used in most cases. A single RHA was anastomosed to the RHA in 24 patients, to the proper HA in 2 patients, to the RAHA in 4 patients, to the LHA in 2 patients and to an aberrant RHA arising from the SMA in 3 patients. The diameter of the donor RHA was between 1.5 mm and 3.0 mm (mean: 2.5 mm). In the 34 patients who underwent CLT, most of the arterial anastomoses were usually performed using two cuffs at the recipient HA and the GDA bifurcation and a branching point on the donor CHA with running and intermittent stay suture. RESULTS: The total incidence of HA complication was 4.34% (3/69): 1 HAT (2.85%) occurred in a case of LDLT and 2 HAS (5.88%) occurred in a case of CLT. HAT occurred in 1 recipient on the 1st day following LDLT and 2 HAS occurred in CLT recipients at one and two months, respectively, following LDLT. CONCLUSIONS: HA complications occurred as a mild type of late complication and these complications might not be fatal in CLT. A low incidence of HAT can be achieved with using non-twisting method-guided microsurgical techniques for creating hepatic arterial anastomosis in LDLT. When early HAT occurs, early surgical reconstruction is mandatory for preventing the loss of the graft. Back wall sutures with only single needle suture might be a feasible method for HA microsurgical reconstruction.
Arterial Occlusive Diseases ; Cadaver ; Hepatic Artery ; Humans ; Incidence ; Liver ; Liver Transplantation ; Living Donors ; Needles ; Running ; Sutures ; Thrombosis ; Tissue Donors ; Transplants

Endovascular repair of inflammatory aortic aneurysms has been reported as an alternative to open surgical treatment. In selective cases, adjunctive bypass surgery may be required to provide an adequate landing zone. We report a case of endovascular repair of an inflammatory aortic aneurysm in a patient with Behcet's disease using a carotid-carotid bypass graft to provide an adequate landing zone. A 45-yr-old man with a voice change was referred to our hospital with the diagnosis of saccular aneurysm of the distal aortic arch resulting from vasculitis. Computed tomography showed a thoracic aortic aneurysm with thrombosis. Right to left carotid-carotid bypass grafting was performed. After 8 days, the patient underwent an endovascular stent graft placement distal to the origin of the innominate artery. The patient was discharged with medication and without postoperative complications after 5 days. Hybrid endovascular treatment may be suitable a complementary modality for repairing inflammatory aortic aneurysms.
Aortic Aneurysm, Thoracic/complications/radiography/*surgery ; Behcet Syndrome/*complications/surgery ; Blood Vessel Prosthesis Implantation/*methods ; Carotid Arteries/physiopathology/*surgery ; Coronary Artery Bypass ; Endovascular Procedures ; Humans ; Male ; Middle Aged ; Stents ; Thrombosis/complications ; Tomography Scanners, X-Ray Computed ; Vasculitis/complications

PURPOSE: Failure of hemodialysis access is the main medical problem in chronic renal failure patients. This resulted from complications such as thrombosis, infection, pseudoaneurysm, steal syndrome and so on. This study was undertaken in an attempt to describe the clinical characteristics and significances of dialysis failure due to iatrogenic fistula between prosthetic graft and native vein at puncture site. METHODS: During 5 years between Feb. 2005 and Feb. 2009, five Iatrogenic fistulas were identified in a retrospective review of 133 patients performed 220 times fistulography due to dialysis failure in PTFE (polytetrafluoroethylene) graft. RESULTS: Overall incidence is 3.8 % in PTFE graft cases. Mean age is 50 (28~75) years, male to female ratio 2:3. Median 1st patency period is 20 months (6~36). All iatrogenic fistula is usually located in not venous but arterial limb of forearm loop, combined with the stenosis in venous limb and anastomosis site. More than 70% venous anastmotic stenosis in 4 cases (80%) and diffuse stenosis of venous limb in 3 cases (60%), revised concomitantly either by patch angioplasty or ballooning. Medial follow-up period is 8 months (5~12), graft occlusion occurred in one case. CONCLUSION: All iatrogenic fistula usually occurs in not venous but arterial limb of forearm loop graft. Most iatrogenic fistula is combined with the stenosis in venous limb and anastomosis sites, must be revised concomitantly either by patch angioplasty or ballooning. Close assessment to superficial vein and graft is needed for early detection. Fistulography is the most useful diagnostic tool. Careful cannulation method is required to prevent the occurrence of iatrogenic fistula in chronic renal failure patients.
Aneurysm, False ; Angioplasty ; Catheterization ; Constriction, Pathologic ; Dialysis ; Extremities ; Female ; Fistula ; Follow-Up Studies ; Forearm ; Humans ; Incidence ; Kidney Failure, Chronic ; Male ; Polytetrafluoroethylene ; Punctures ; Renal Dialysis ; Retrospective Studies ; Thrombosis ; Transplants ; Veins

Saphena varix is very rare disease that characterized by isolated distention of the saphenous vein below the sapheno-femoral junction. Saphena varix must be differentiated from other medical problems that can cause a groin mass. A 49-year-old man presented with a palpable mass on the right upper thigh and he'd had the mass for 6 months. There was no history of trauma, and the mass was especially noticeable when he was standing. On the physical examination, a 5 cm-sized soft, nontender, compressible mass was detected at the right upper medial thigh near the femoral foramen. Doppler sonography showed a saccular venous dilatation of the great saphenous vein just below the saphenofemoral junction. On computed tomography, there were superficially dilated veins in the right thigh and calf, a focal saccular aneurysm at the proximal segment of the right greater saphenous vein and no evidence of deep vein thrombosis. Aneurymal excision and stripping of the greater saphenous vein were performed. No complication was observed at the 2 week follow-up.
Aneurysm ; Dilatation ; Follow-Up Studies ; Groin ; Hernia, Femoral ; Humans ; Middle Aged ; Physical Examination ; Rare Diseases ; Saphenous Vein ; Thigh ; Varicose Veins ; Veins ; Venous Thrombosis