• Archives of Plastic Surgery
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• 제38권6호
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• pp.747-754
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• 2011

Purpose: The Abbe flap procedure has been used to correct disharmony of the upper and lower lips as well as for making a philtrum for patients with secondary cleft lip deformities. But the Abbe flap procedure adds two scars in addition to the prior operative scar on the upper lip. This study was conducted to determine the treatment outcomes of esthetic subunit excision of the scar on the philtrum and Abbe flap coverage for correction of cleft lip deformities with photogrammetric analysis. Methods: This study investigated a total of 11 patients with cleft lip deformities who underwent scar excision with Abbe flap coverage, and the patients were followed up for at least 6 months. Under general anesthesia, a mushroom-shaped Abbe flap was drawn on the lower lip with a width of 8 mm and a height 1~2 mm longer than that of the philtral midline. The epidermis and dermis of the scar on the upper lip were excised. In the cases with alar base depression, the orbicularis oris muscle was split vertically and transposed to the alar base. The Abbe flap was harvested as a pedicled flap containing a small amount of muscle and this was rotated 180-degree to be inserted into the upper lip. Mucosa, muscle, subcutaneous tissue and skin were closed in layers. The flap was divided at the 7~14 postoperative day. The postoperative outcomes were evaluated by using photogrammetric analysis. Three indices were measured from the standard clinical photographs taken before and after the surgery. For anthroposcopic assessment, observers described the postoperative outcomes using an ordinary scale method. Results: The postoperative values obtained in the photogrammetric analysis showed improvement as compared with the preoperative ones. Improved anthroposcopic outcomes were also noted. Conclusion: Scar excision and Abbe flap coverage were proven to be effective in improving protrusion and the height of the upper lip, the scar of the upper lip and the symmetry of Cupid's bow and the philtral column, as well as formation of the philtral dimple.

• Archives of Plastic Surgery
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• 제37권4호
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• pp.400-408
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• 2010

Purpose: Complete septal extension grafts have been widely used in rhinoplasty for effective projection of the short retruded columella in Asian patients. Autologous septal cartilages and porous high-density polyethylene sheets are frequently used as septal extension grafts. This study was conducted to compare the postoperative results of porous polyethylene sheets and septal cartilages used for correction of unilateral cleft lip nasal deformities by using photogrammetric analysis. Methods: This study investigated a total of 49 patients with cleft lip nasal deformities who underwent corrective surgery, and were followed up for at least 6 months. Septal cartilages were used in 39 patients, and porous polyethylene sheets were used in 10 patients. In all patients, through the open rhinoplasty, complete septal extension grafts were sutured to the caudal margin of the septal cartilage, and the alar cartilage was sutured with suspension. The cleft side alar cartilage was overcorrected by approximately 3 - 5 mm. Postoperative outcomes were evaluated by using photogrammetric analysis. Five indices and 4 angles were measured on their photographs taken before and after the surgery. In patients with unilateral cleft lip nasal deformities, symmetry was also evaluated by means of columellar length index. Results: The postoperative values obtained in photogrammetric analysis showed improvements in comparison with the preoperative ones. The polyethylene group produced more improved outcomes than the septal cartilage group but also resulted in more complications at the same time. Conclusion: The results of this study indicates that complete septal extension grafts are efficient for the correction of unilateral cleft lip nasal deformities. However, since postoperative complications occur more frequently in the polyethylene group than in the septal cartilage group, caution is advised in using porous high-density polyethylene sheets in patients with cleft lip nasal deformities.

• 대한두개안면성형외과학회지
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• 제17권1호
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• pp.35-38
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• 2016

Chondroid synringoma (CS), pleomorphic adenoma of skin, is a benign tumor found in the head and neck region. CS was first reported in 1859 by Billorth for the salivary gland tumor. The usual presentation is an slowly growing, asymptomatic mass. A 53-year-old female with a history of chondroid synringoma had presented with multiple firm, nodular masses found in the left nostril area. The lesion had been excised 8 years prior and was diagnosed histopathologically, but had gradually recurred. Excision of the mass located in subcutaneous layer revealed four whitish, firm tumors surrounded with capsular tissue. Neither recurrence nor complications occurred during the 18 months follow-up period. In the head and neck region, chondroid syringoma should always be considered in differential diagnosis of soft tissue masses despite its rare incidence. For that reason, excisional biopsy with clear margin is the optimal diagnostic as well as therapeutic choice. We report a case of recurred chondroid syringoma on the nose in female patient.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제38권
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• pp.21.1-21.6
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• 2016

Background: The Le Fort I osteotomy is one of the most widely used and useful procedure to correct the dentofacial deformities of the midface. The changes of the maxilla position affect to overlying soft tissue including the nasal structure. Postoperative nasal septum deviation is a rare and unpredicted outcome after the surgery. There are only a few reports reporting the management of this complication. Case Presentation: In our department, three cases of the postoperative nasal septum deviation after the Le Fort I osteotomy had been experienced. Via limited intraoral circumvestibular incision, anterior maxilla, the nasal floor, and the anterior aspect of the septum were exposed. The cartilaginous part of the nasal septum was resected and repositioned to the midline and the anterior nasal spine was recontoured. Alar cinch suture performed again to prevent the sides of nostrils from flaring outwards. After the procedure, nasal septum deviation was corrected and the esthetic outcomes were favorable. Conclusion: Careful extubation, intraoperative management of nasal septum, and meticulous examination of preexisting nasal septum deviation is important to avoid postoperative nasal septum deviation. If it existed after the maxillary osteotomy, septum repositioning technique of the current report can successfully correct the postoperative septal deviation.

• Archives of Reconstructive Microsurgery
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• 제6권1호
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• pp.103-110
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• 1997

Since R.Y. Song(1982) has reported anatomic studies about septocutaneous perforator flap, various experiences especially on thigh flaps pedicled on septocutaneous artery were reported. Baek(1983) reported an anatomic study through the cadavers dissections on medial, lateral thigh area and provided the first new cutaneous free flap of thigh for clinical use. Song, et a1.(1984) reported anterolateral thigh free flap, Koshima, et al.(1989) reported pedicle variations and its versatile clinical usages. According to their reports, accessory branches of lateral femoral circumflex artery are placed in comparatively constant location and proved to be the effective pedicle of this flap. The advantages of anterolateral thigh free flap are 1) comparatively thin 2) can obtain sufficiently large flap 3) can contain cutaneous nerve 4) can be easy to approach anatomically because pedicle is located in comparatively constant position 5) minimal donor site morbidity. We report the experience of 10 cases of anterolateral thigh free flap coverage for soft tissue defects: 4 cases of soft tissue defects on foot area, 2 cases of soft tissue defects on hand, 3 cases of partial tongue defects owing to tongue cancer ablation, and 1 case of soft tissue defect on nasal alar.

• 대한두개안면성형외과학회지
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• 제13권2호
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• pp.143-146
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• 2012

Purpose: The typical reconstructive option for the nasal tip is paramedian forehead flap. However, the forehead flap is too bulky for nasal tip reconstruction and does not look natural, and therefore, secondary operations for debulking are required. Methods: We treated a 46-year-old woman who suffered from a nose tip soft tissue defect using a modified paramedian forehead flap. The flap was elevated from the hair line of the forehead and had 3-layered structure. The distal part included skin and subcutaneous tissue, the middle part included frontalis muscle, and the proximal part had periosteum. Results: The nasal tip was not bulky and looked natural in terms of height, shape, and had 3-dimensional structure without debulking procedure. The patient was satisfied with the outcome. Conclusion: The authors' modified paramedian forehead flap may be a useful option for the treatment of nasal tip, columella, and alar defects. With these modifications, the paramedian forehead flap can provide an aesthetically acceptable nasal tip appearance without debulking.

• 대한치과교정학회지
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• 제50권4호
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• pp.249-257
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• 2020

Objective: To evaluate the changes in the nose in three dimensions after Le Fort I osteotomy in patients with skeletal Class III malocclusion. Methods: The subjects were 40 adult patients (20 females and 20 males; mean age, 20.3 ± 3.0 years; range, 17.0 to 31.1 years) who underwent one-piece Le Fort I osteotomy with maxillary advancement and impaction treatment for maxillary hypoplasia. The mean maxillary advancement was 4.56 ± 1.34 mm, and the mean maxillary impaction was 2.03 ± 1.04 mm. Stereophotogrammetry was used to acquire three-dimensional images before and at least 6 months after surgery. Results: Alare (Al) and alare curvature (Ac) points had moved vertically and anterolaterally postoperatively. A significant increase was observed in the nasal ala width and alar base width, and no changes were noted in the columellar length, nasolabial angle, and nasal area. There was a significant relationship between maxillary impaction and nasal ala width and horizontal and sagittal positions of the bilateral Al and Ac. The only relationship found was between maxillary advancement and postoperative sagittal location of the subnasale and pronasale. Conclusions: Nasal soft tissues were highly affected by the vertical movement of the maxilla; however, the soft tissue responses were individual-dependent.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제13권1호
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• pp.100-103
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• 1991

하악골 전돌증 환자의 악교정 수술시 비익기저부가 좁고, 발육부진을 보일경우 수술의 심미적 효과를 증진시키기 위한 부가적 방법으로서의, 하악골의 후방 이동술과 함께 비익기저부의 증강술을 고려할 수 있다. 이물성형 재료에 의한 증강술은 자가골 이식골에 비하여 술후 체적변화가 적고 안정성을 보이며, 간편하게 시술될 수 있다는 장점을 가진다. 저자등은 하악골 전돌증 및 비익기저부의 발육부전을 보이는 환자의 악교정예에서 하악골 후방이동술과 더불어 부가적인 비익기저부 증강술을 시행하여 술후 15 개월이 경과된 현재 좋은 결과를 보이고 있으므로 이에 보고하는 바이다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제29권5호
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• pp.422-428
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• 2007

The columella, nasal tip, lip relationship in the secondary bilateral cleft deformity remains an enigma and a great challenge for the cleft surgeon. A subset of patients with bilateral cleft lip still require columellar lengthening and nasal correction, despite the advances in preoperative orthopedics and primary nasal corrections. An approach to correct this deformity is described. This consists of 1) lengthening the columella, 2) open rhinoplasty, allowing definitive repositioning of lower lateral cartilages, ear cartilage grafting to the tip and columella when necessary, 3) nasal mucosal advancement, 4) alar base narrowing and 5) reconstruction of the orbicularis oris as required. In surgical repair of the cleft lip nose, the timing of the operation(during lip closure, before or after the puberty growth sput), and the operative technique play a key role in the final result. In this study, 13 cleft lip patients who had undergone a secondary cheilorhinoplasty at the Department of Oral and Maxillofacial Surgery, Pusan National University Hospital were evaluated to check the proper time and method of the operation.

• 임상이비인후과
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• 제29권2호
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• pp.269-275
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• 2018

Nasal valve compromise (NVC) is a distinct cause of symptomatic nasal obstruction, yet there are several ambiguities surrounding the diagnosis and management of this disease. Understanding of nasal valve anatomy with critical assessment of the site of obstruction is essential to effective nasal valve management. Technique selection should be individualized to the type of valve dysfunction. This case report presents a 56 year old man with nasal valve dysfunction due to narrow middle vault, concave lower lateral cartilage and swollen septal body which was diagnosed by various techniques including navigation system and treated by spreader graft, alar batten graft and reduction of septal body.