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ABSTRACT: BACKGROUND:: Although craniofacial asymmetry is frequently involved in the congenital muscular torticollis (CMT) patients, it has not been evaluated appropriately. Little is still known concerning the severity and change of craniofacial asymmetry with aging. The authors analyzed preoperative craniofacial asymmetry objectively and confirmed the relationship between craniofacial asymmetry and aging in CMT patients who received surgical release. METHODS:: The authors retrospectively measured preoperative craniofacial asymmetry using the cranial-vault-asymmetry-index (CVAI) and intercommissural angle (ICA) and reviewed preoperative rotational and flexional deficit of neck movement for 123 CMT patients who underwent surgical release at Ajou Medical Center, from February 2007 to February 2011. The relationships between CVAI, ICA, rotational deficit, flexional deficit, and age were analyzed. Mean values of dependent variables were compared between the age groups, after grouping the patients by age. RESULTS:: Mean age at operation was 82.5 months (range, 5-498 months). Seventy-one percent (n=87) of patients had a significant cranial asymmetry and eighty-seven percent (n=107) had a significant facial asymmetry. In correlation analysis, ICA increased proportionally to age (r=0.334, p=0.000), especially under 3 years (r=0.42, p =0.001). CVAI was unrelated to age, rotational and flexional deficit. Rotational deficit decreased proportionally to age (r=-0.229, p=0.032). By ANOVA test, ICA and rotational deficit between the age groups were statistically significantly different (p<0.05). CONCLUSIONS:: In CMT, facial asymmetry is progressive if the contracted SCM muscle is not released although cranial asymmetry is already determined younger than 6 months old. Early correction of torticollis should be considered to prevent progression of facial asymmetry in CMT patients. CLINICAL QUESTION /LEVEL OF EVIDENCE:: Therapeutic, III.
Plastic and reconstructive surgery 04/2013; · 2.74 Impact Factor
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ABSTRACT: Wide excision of cancer arising from the tonsillar fossa and soft palate has several functional sequelae (e.g., speech, swallowing, chewing, and breathing) that require surgical restoration of the pharyngeo-palatal structure and optimal velopharyngeal function. For this purpose, several kinds of surgical procedures have been introduced. Our method to reconstruct the tonsillar fossa and soft palate entails folding the flaps and reconstructions at the same time as the oral and nasal planes, with some modifications.Patient 1 was a 64-year-old man with left soft palate cancer. After wide excision of the tumor, the defect size of the nasal floor was 3 × 3 cm, and that of soft palate and tonsillar fossa was 8 × 5 cm. Patient 2 was a 49-year-old man with left tonsil cancer. The defect size of the nasal floor was 3 × 3 cm, and that of left lateral wall of the tonsillar fossa was 8 × 3 cm. For reconstruction of oral, nasal, and tonsillar plane, we designed the flap fit to the defect site, especially cutting of the edge of the square plane of the flap to a round shape.Both patients achieved good functional recovery without surgical complications. The average speech intelligibility score in the 2 patients was 10. Swallowing functional score was 4 in both patients. Creative reconstruction with modified radial forearm free flap for tonsillar and soft palate area makes it possible to restore velopharyngeal function to levels close to the preoperative condition.
The Journal of craniofacial surgery 03/2013; 24(2):458-60. · 0.81 Impact Factor
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ABSTRACT: Paraganglioma is a neuroendocrine neoplasm that may develop at various body sites, including the head, neck, thorax, and abdomen. Approximately 85% of paragangliomas develop on the abdomen, 12% develop on the chest, and only 3% develop on the head and neck. These tumors are found in locations that parallel the sympathetic chain ganglion in the thoracolumbar regions and parasympathetic nervous system in craniosacral regions, and all head and neck paragangliomas arise from the parasympathetic nervous system. Although the skin has a rich neural network, it is devoid of ganglia. There has been only 1 report of a paraganglioma on the scalp of a child. We describe a 3-year-old child with a primary cutaneous paraganglioma of the vertex scalp and review the literature on paragangliomas.
The Journal of craniofacial surgery 07/2012; 23(4):e338-40. · 0.81 Impact Factor
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ABSTRACT: Radiofrequency coagulation was introduced to reduce the volume of masseter muscle. Radiofrequency procedure causes focal necrosis in masseter muscles, which leads to muscle hypoplasia and a slender lower face. We present a case of a 24-year-old woman who underwent radiofrequency coagulation to reduce masseter muscles. The patient experienced progressive erythematous swelling and noticed the mass around the right cheek 5 days after the procedure. On radiologic evaluation, a round cavity of 4-cm diameter containing air and fluid was observed. Incision and drainage was performed, and antibiotics were administrated intravenously. Blood-tinged purulent fluid was obtained, which was subsequently found to have a high amylase level. The swelling subsided, and there is no relapse up to 6 months after drainage. There are several complications of radiofrequency coagulation reported such as mucoserous fluid collections, late bleeding, infections, long-lasting pain, Stensen duct injury, facial nerve injuries, and limitation of temporomandibular joint movement. A well-designed operation plan and skilled technique are required to avoid these complications.
The Journal of craniofacial surgery 05/2012; 23(3):e261-2. · 0.81 Impact Factor
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ABSTRACT: Poststernotomy mediastinitis is a rare, but life-threatening complication, thus early diagnosis and proper management is essential for poststernotomy mediastinitis. The main treatment for mediastinitis is aggressive debridement. Several options exist for reconstruction of defects after debridement. The efficacy of immediate debridement and reconstruction with a pectoralis major muscle flap designed for the defect immediately after the diagnosis of poststernotomy mediastinitis is demonstrated.
Between September 2009 and June 2011, 6 patients were referred to the Department of Plastic and Reconstructive Surgery and the Department of Thoracic and Cardiovascular Surgery of Ajou University Hospital for poststernotomy mediastinitis. All of the patients underwent extensive debridement and reconstruction with pectoralis major muscle flaps, advanced based on the pedicle of the thoracoacromial artery as soon as possible following diagnosis. A retrospective review of the 6 cases was performed to evaluate infection control, postoperative morbidity, and mortality.
All patients had complete wound closures and reduced severity of infections based on the erythrocyte sedimentation rate and C-reactive protein levels and a reduction in poststernal fluid collection on computed tomography an average of 6 days postoperatively. A lack of growth of organisms in the wound culture was demonstrated after 3 weeks. There were no major wound morbidities, such as hematomas, but one minor complication required a skin graft caused by skin flap necrosis. No patient expired after definitive surgery.
Immediate debridement and reconstruction using a pectoralis major muscle flap is a safe technique for managing infections associated with poststernotomy mediastinitis, and is associated with minimal morbidity and mortality.
Archives of plastic surgery. 01/2012; 39(1):36-41.
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ABSTRACT: Recurrent laryngeal nerve paralysis is the most common and serious complication after thyroid cancer surgery. The objective of this study was to report the advantages of the vein wrapping technique for nerve reconstruction in patients with thyroid cancer invading the recurrent laryngeal nerve and its effects on postoperative phonatory function. The subjects were three patients who underwent resection of the recurrent laryngeal nerve during surgical extirpation of papillary thyroid cancer. Free ansa cervicalis nerve graft or direct neurorrhaphy with a vein wrapping technique was used to facilitate nerve regeneration, protect the anastomosed nerve site mechanically, and prevent neuroma formation. One-year postoperative laryngoscopic examination revealed good vocal cord mobility. Maximum phonation time (19.5 ± 0.3 sec) was longer than a previously-reported value in conventional reconstruction patients (18.8 ± 6.6 sec). The present phonation efficiency index (7.88 ± 0.78) was higher than that previously calculated in conventional reconstruction (7.59 ± 2.82). The mean value of the Voice Handicap Index-10 was 6, which was within the normal range. This study demonstrates improvement in phonation indices measured 1 year after recurrent laryngeal nerve reconstruction. Our results confirm that the vein wrapping technique has theoretical advantages and could be favored over conventional reconstruction techniques for invenerate nerve injuries.
Archives of plastic surgery. 01/2012; 39(1):71-5.
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ABSTRACT: Blepharoplasty remains one of the most frequent operations in Asia. The most common complaint of Asian patients is a limitation of eye opening, and a substantial proportion of patients have puffy eyelids, supratarsal folds in the upper eyelid, and a narrow palpebral fissure, thus exhibiting a tired and sleepy appearance. To correct these features, an accurate understanding of upper eyelid anatomy is essential, especially concerning the levator aponeurosis, orbital fat, and orbital septum.
After a strip of orbicularis oculi muscle was removed through usual transcutaneous blepharoplasty incision, we excised the submuscular soft tissue to expose the fusion line of the septum and the levator aponeurosis. Blunt dissection was carried out between the levator aponeurosis and the orbital fat. During dissection, a three-dimensional fibrous web connecting the orbital fat and levator aponeurosis, and continuing to just behind the Whitnall ligament, was observed in all patients. All of the connections with these fibrous bands were resected during the procedure using a Steven scissors while controlling bleeding. After this dissection, we reevaluated the degree of blepharoptosis in the upright position and checked the function of the levator palpebral muscle. We observed that mild and subclinical blepharoptosis was corrected without manipulation of the levator aponeurosis or the Müller muscle.
Of the 32 patients evaluated, 22 were women and 10 were men. All of our patients had mild or subclinical blepharoptosis (<2 mm). The levator function was excellent or good in all patients. Most of these patients (29/32, 87.5%) were satisfied with the outcome after this operation.
The authors found that fibrous web bands between levator aponeurosis and orbital fat limit movement of the levator aponeurosis, which is a cause of eye opening limitation. In the current study, subclinical and mild blepharoptoses were corrected by releasing these fibrous bands without manipulating the levator aponeurosis or the Müller muscle. This method has been shown to be highly effective in correcting mild ptosis and can be applied during most surgical blepharoptosis techniques.
The Journal of craniofacial surgery 01/2012; 23(1):e52-5. · 0.81 Impact Factor
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ABSTRACT: Skeletal muscle differentiation is regulated by transcription factors, including members of the myogenic regulatory factor (MRF) family and many signaling pathways. The JAK1 and JAK2 pathways are known to each have different effects on myoblast proliferation and differentiation; however, the role of JAK3 in myoblast differentiation remains unclear. In this study, we investigated the effect of JAK3 inhibition on myogenic differentiation in the C2C12 mouse myoblast cell line. During myogenic differentiation, treatment with the JAK3 inhibitor WHIp154 significantly increased the number of MHC-positive multinucleated myotubes and the expressions of myosin heavy chain (MHC), myogenin (MGN), MyoD, and myogenic enhancer factor 2 (MEF2). Knockdown of the JAK3 gene using siJAK3 also significantly increased MHC, MGN and MyoD mRNA expressions as well as insulin-like growth factor-II (IGF-II) gene expression. During differentiation, JAK3 was initially activated and later decreased. Differentiation decreased STAT1, which was further decreased by WHIp154. In contrast, STAT3 gradually was elevated during differentiation, and was increased by JAK3 inhibition. Moreover, we found that up-regulation of AKT activity and down-regulation of ERK activity cooperated to accelerate myogenic differentiation. Taken together, these data indicate that JAK3 inhibition potently facilitates myoblast differentiation through antagonistic STAT1/STAT3 activities. Additionally, JAK3 inhibition induced precocious differentiation and played important roles for terminal differentiation, including fusion, which is involved with regulation of AKT and ERK pathways.
Cellular signalling 11/2011; 24(3):742-9. · 4.09 Impact Factor
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ABSTRACT: Blepharoplasty remains one of the most popular surgical procedures in Asia. The most common patient complaint leading to a blepharoplasty is limited eye opening causing a narrowing of the palpebral fissure. The typical Asian eye is characterized by puffiness, lack of a supratarsal fold in the upper eyelid, and a narrow palpebral fissure, exhibiting a tired and sleepy appearance. Almost all such patients believe that a simple double-eyelid operation is able to make the eye look bigger with eversion of the eyelashes into a more charming configuration. Some of these patients actually have mild to moderate blepharoptosis, which can present both functional and aesthetic problems. Numerous surgical procedures have been developed to correct ptosis because proper correction can be difficult to achieve. The authors found abnormal lateral deviation of the levator aponeurosis in patients with blepharoptosis and suggest that this abnormality is a major cause of blepharoptosis, particularly in Asians. The authors assessed the effectiveness of a levator aponeurosis medial repositioning technique rather than levator resection or levator plication for mild or moderate ptosis. No disadvantage was attributed to this technique when it was used to correct 87 patients with mild ptosis. Eighty of the 87 patients achieved a good result with the first operation. Undercorrection was observed in 6 patients, and a hematoma was corrected in 1 patient. However, no other major complications related to the technique were encountered. Herein the authors describe their operative technique and present the long-term follow-up results. The authors propose that anatomic repositioning of a laterally deviated levator aponeurosis using the described repositioning technique is highly effective for correcting mild ptosis and can be applied during most surgical blepharoptosis procedures in Asian patients.
The Journal of craniofacial surgery 11/2011; 22(6):2284-7. · 0.81 Impact Factor
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ABSTRACT: Superficial parotidectomy is a well-established treatment for the early stages of tumors involving the parotid gland. However, there are 3 problems with traditional superficial parotidectomies: (1) cosmetic problems, such as scars, especially around the neck; (2) depressed deformities; and (3) Frey syndrome. A superficial parotidectomy via a modified face-lift incision with dermofat graft provides a solution for these problems and should be considered as an alternative technique in select patients.
The Journal of craniofacial surgery 05/2011; 22(3):1021-3. · 0.81 Impact Factor
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ABSTRACT: A 49-year-old man was presented for evaluation of a painless mass on his right posterior neck. The mass had gradually enlarged for a 25-year period without inflammation or rupture. On physical examination, a round, nontender, soft-tissue mass, 8 cm in diameter, was noted on the right posterior neck. The neck is a common site of epidermoid cysts, but a mass more than 5 cm in diameter is rare. A contrast-enhanced neck computed tomographic (CT) scan revealed a 7.6 × 6.5 × 5.7 cm unilocular hypodense mass adjacent to the posterior neck muscles.The mass was completely excised under general anesthesia. A histopathologic examination of the excised specimen resulted in a diagnosis of an epidermoid cyst. The patient was discharged from the hospital on the third postoperative day. There were no recurrences in a 2-year follow-up period.
The Journal of craniofacial surgery 05/2011; 22(3):1142-4. · 0.81 Impact Factor
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ABSTRACT: A square mandible is considered unattractive in Asia; as a result, mandibular reduction is the most common type of operation performed. The authors review the importance of mandibular tubercles in the lower margin of the parasymphysis area and introduce their resection techniques and results.
From April of 2005 to September of 2009, 178 patients underwent tubercle resection in the parasymphyseal area. The procedures used were as follows: mandibular angle reduction in 139, genioplasty in 39, and mandibular angle reduction with simultaneous malar reduction in 58 patients. In the chin area, horizontal osteotomy was performed in 35 patients to reduce chin length. Other patients underwent mandibular tubercle resection and burring.
With the exception of one patient who developed hyperesthesia in the left lower lip 2 years after the procedure, all patients achieved satisfactory aesthetic results after mandibular tubercle resection and concurrent mandibular reduction.
The authors consider mandibular tubercle resection, either as a single procedure or combined with mandible reduction, essential for patients who require a slimmer, more feminine lower face.
Plastic and reconstructive surgery 05/2011; 127(5):2076-82. · 2.74 Impact Factor
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ABSTRACT: Autologous fat grafting to the breast for breast reconstruction and cosmetic breast augmentation has gained much attention recently. However, its efficacy and the severities of its associated complications are of concern. The authors experienced one case of multiple breast abscesses after augmentation mammoplasty by autologous fat grafting.
A 42-year-old woman presented to the authors' emergency department reporting tenderness, swelling, and a sensation of heat in both breasts. The patient had undergone augmentation mammoplasty by autologous fat grafting 7 days previously. Abscess formation was suspected based on the patient's history, physical examination, laboratory findings, and image study.
Incision and drainage were performed immediately with the patient under general anesthesia, and 500 ml of a foul, brown, turbid, purulent fluid containing necrotic fat debris was drained from each breast. Empiric antibiotics were started on the first hospital day, and betadine and saline-irrigation were administered daily for 2 weeks. Incisions were closed on hospital day 19 when laboratory data and local infection signs had improved. At the patient's 9-month follow-up assessment, breast contours were found to be well preserved, and scarring was minimal.
Immediate complications such as edema, hematoma, and infection require serious consideration after autologous fat grafting in the breast. In particular, infection probably is the most serious complication because the volume of the fat injected is large and can induce systemic infections such as sepsis and distort the contours of the breast. To avoid such infections, systemic and multicenter studies are required to determine how fat grafting should be performed to minimize the risks of fat necrosis and infection.
Aesthetic Plastic Surgery 11/2010; 35(4):641-5. · 1.41 Impact Factor
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ABSTRACT: The Charles procedure for late-stage lower limb lymphoedema (LLL) is often criticized for its unpredictable and poor results. We have adopted a systematic approach to optimize outcome of patients treated with this excisional surgery.
From June 2004 to March 2009 we performed the Charles procedure on 1 lower limb of 19 women and 8 men with late-stage LLL. Mean age and follow-up was 48 (range, 16.5-77.8) years and 21.6 (range, 1.5-48) months, respectively.
Average inpatient stay was 27 (range, 11-54) days. After discharge, 16 (59.3%) patients underwent further minor surgery. The most frequent complication was a single, short episode of cellulitis, affecting 5 (18.5%) patients. Self-reported mobility was either the same or improved at 6 months, and appearance of their limbs satisfactory.
The Charles procedure is an effective treatment for selected patients and by applying our systematic approach, a positive outcome can be achieved.
Annals of plastic surgery 10/2010; 66(4):393-402. · 1.29 Impact Factor
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ABSTRACT: A 38-year-old woman presented with a tender mass with mild erythematous change above the left eyebrow area. She had received curettage in another clinic after a diagnosis of infected epidermal cyst 5 years previously. On examination, a round, irregular scar and a mass of 1-cm diameter associated with mild erythematous region were observed above the right eyebrow.Exploration disclosed a 1-cm neuroma with mild adhesion to a branch of the supraorbital nerve. The neuroma was completely removed. However, although partial transection of the supraorbital nerve was performed during surgery, the nerve was not repaired. The open wound was repaired securely. A histopathologic examination of the resected specimen resulted in a diagnosis of traumatic neuroma. The patient had no forehead numbness before or after surgery.
The Journal of craniofacial surgery 11/2009; 20(6):2243-5. · 0.81 Impact Factor
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ABSTRACT: Congenital muscular torticollis (CMT) is caused by shortening of the sternocleidomastoid (SCM) muscle, which may lead to neck movement limitation and craniofacial deformity. The authors retrospectively reviewed clinical experiences of CMT at their hospital from February 2007 to June 2008. During the study period, 20 CMT patients underwent complete tight fibrous band release and resection. Mean patient age was 47.6 months at operation. Eighteen of the 20 patients started a programme of physical therapy preoperatively. All patients received well-controlled postoperative physical therapy and wore a soft neck collar to correct head position for at least 3 months. At 3 months postoperatively, passive ranges of neck motion were determined, and compared with those of uninvolved sides. Eighteen patients showed a full range of motion of neck rotation and lateral flexion, but one patient showed a 10 degrees limitation in lateral flexion, and another showed 10 degrees limitations of neck rotation and lateral flexion. The authors recommended that the described operative technique involving complete fibrous band release and resection, combined with intensive postoperative physical therapy and application of a soft neck collar, provides good functional and cosmetic results.
Journal of Plastic Reconstructive & Aesthetic Surgery 07/2009; 63(6):947-53. · 1.49 Impact Factor
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ABSTRACT: While infantile haemangiomas are the most common tumours of childhood, rare congenital haemangiomas grow to maximum size at birth and then spontaneously and rapidly regress (rapidly involuting congenital haemangiomas). However, certain congenital haemangiomas, described recently as 'non-involuting congenital haemangiomas', evolve differently and do not regress. There are several options regarding the treatment of infantile haemangiomas, but few reports have addressed the treatments of non-involuting congenital haemangiomas, though a small number have recommended surgical excision. However, the treatments of non-involuting congenital haemangiomas with multiple epidermal cysts have not been investigated. Epidermal cysts can cause recurrent infection, and we suspect that recurrent ulceration might cause the implantation of epidermal cells into the dermis, and result in the development of multiple epidermal cysts. Currently, epidermal cysts are treated by surgical excision, which should reduce complication rates. Herein, we report our experience of treating repeatedly infected non-involuting congenital haemangioma with multiple epidermal cysts.
Journal of Plastic Reconstructive & Aesthetic Surgery 05/2009; 63(1):e19-22. · 1.49 Impact Factor
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ABSTRACT: In this study, we propose a precise 3D lug pose detection sensor for automatic robot welding of a lug to a huge steel plate used in shipbuilding, where the lug is a handle to carry the huge steel plate. The proposed sensor consists of a camera and four laser line diodes, and its design parameters are determined by analyzing its detectable range and resolution. For the lug pose acquisition, four laser lines are projected on both lug and plate, and the projected lines are detected by the camera. For robust detection of the projected lines against the illumination change, the vertical threshold, thinning, Hough transform and separated Hough transform algorithms are successively applied to the camera image. The lug pose acquisition is carried out by two stages: the top view alignment and the side view alignment. The top view alignment is to detect the coarse lug pose relatively far from the lug, and the side view alignment is to detect the fine lug pose close to the lug. After the top view alignment, the robot is controlled to move close to the side of the lug for the side view alignment. By this way, the precise 3D lug pose can be obtained. Finally, experiments with the sensor prototype are carried out to verify the feasibility and effectiveness of the proposed sensor.
Sensors 01/2009; 9(9):7550-65. · 1.74 Impact Factor
