• Archives of Plastic Surgery
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• v.37 no.3
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• pp.289-292
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• 2010

Purpose: Mycobacterium abscessus belongs to the group of rapid-growing atypical mycobacterium. The organism is ubiquitous and is found in soil, dust, and water. Although it rarely causes disease in humans, Mycobacterium abscessus has been associated with soft tissue infection. To the best of our knowledge, this is the first case report of facial soft tissue Mycobacterium abscessus infection in a healthy child in Korea. Methods: A 12-year-old girl presented with an erythematous skin lesion with serous discharge on her chin, which had been present for 3 weeks. On her history, she had a laceration wound on her chin at public bath and the lesion was repaired at emergency department immediately. Although conventional soft tissue infecton treatment, her lesion remains unhealed state and had serous discharge for 2 months. Moreover, we found a 1 cm sized nodular mass on her chin. Therefore we performed excision operation and referred the specimen to the laboratory for microbial and histopathologic study. Results: Pathology report confirmed the mass was enlarged lymph node with chronic necrotizing granulomatous inflammation with central microabscess. Non-Tuberculous mycobacterium identification test through tissue specimen resulted Mycobacterium abscessus. We prescribed clarithromycin for three weeks by oral administration as well as performed wound debridement and mass excision via previous wound. This way, her lesion appeared to be complete healing with minimal scarring. There were no evidence of inflammation sign or palpable mass. Conclusion: Although the prevalence is rare, Mycobacterium abscessus infections of soft tissue should be considered even in a healthy child with a lesion caused by trauma or which fails to respond to conventional treatment.

• Archives of Craniofacial Surgery
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• v.18 no.1
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• pp.37-43
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• 2017

Background: Skin cancer is the most common type of cancer. Of the 4 million skin lesions excised annually worldwide, approximately 2 million are considered cancerous. In this study, we aimed to describe a regional experience with skin cancers treated by a single senior surgeon and to provide a treatment algorithm. Methods: The medical records of 176 patients with head and neck non-melanocytic skin cancer (NMSC) who were treated by a single surgeon at our institution between January 2010 and May 2016 were retrospectively reviewed, and their data (age, sex, pathological type, tumor location/size, treatment modality) were analyzed. Patients with cutaneous squamous cell carcinoma (cSCC) who were classified as a high-risk group for nodal metastasis underwent sentinel node mapping according to the National Comprehensive Cancer Network guidelines. Results: Among the patients with NMSC who were treated during this period, basal cell carcinoma (BCC; n=102, 57.9%) was the most common pathological type, followed by cSCC (n=66, 37.5%). Most lesions were treated by complete excision, with tumor-free surgical margins determined via frozen section pathology. Thirty-one patients with high-metastasis-risk cSCC underwent sentinel node mapping, and 17 (54.8%) exhibited radiologically positive sentinel nodes. Although these nodes were pathologically negative for metastasis, 2 patients (6.5%) later developed lymph node metastases. Conclusion: In our experience, BCC treatment should comprise wide excision with tumor-free surgical margins and proper reconstruction. In contrast, patients with cSCC should undergo lymphoscintigraphy, as nodal metastases are a possibility. Proper diagnosis and treatment could reduce the undesirably high morbidity and mortality rates.

• Journal of Korean Dental Science
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• v.7 no.1
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• pp.38-42
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• 2014

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is defined as exposed necrotic bone without evidence of healing for at least 8 weeks in the maxillofacial area in a patient with history of bisphosphonate use. Obtaining complete coverage of the hard tissue by soft tissue in BRONJ patients is especially important. Therefore, managing the mucosa is one of the key factors in a successful outcome, but this is especially hard to achieve in BRONJ patients. Various applications of buccal fat pad in oral reconstruction-including the closure of surgical defects following tumor excision, repair of surgical defects following the excision of leukoplakia and submucous fibrosis, closure of primary and secondary palatal clefts, coverage of maxillary and mandibular bone grafts, and lining of sinus surface of maxillary sinus bone graft in sinus lift procedures for maxillary augmentation-have been studied. Eliminating all potential sites of infection and post-operative infection control is crucial in BRONJ. We present a case using the buccal fat pad pedicle for a stage 3 BRONJ defect. Uneventful total epithelialization of the buccal fat pad regardless of size was noted. In summary, the buccal fat pad has versatile application and various recipient sites for surgical utilization. It is an easy technique, with promising overall success rates. With careful selection and handling, buccal fat graft can resolve problems with soft tissue coverage in stage 2 or 3 BRONJ patients.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.27 no.5
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• pp.478-481
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• 2005

Ossifying fibroma is a rare, benign, fibro-osseous tumor of mesenchymal origin. It develops mainly in the mandible, where it is usually slow growing and asymptomatic, whereas in the maxilla and paranasal sinus, it is more aggressive. The vast majority are located in the posterior region of the mandible; however, ossifying fibroma involving the maxillary sinus is uncommon. It may reach a very large size and cause facial asymmetry. It shows a female predilection, and most cases are seen in the third and fourth decades of life. Radiographically, ossifying fibroma is radiolucent or radiopaque depending on the amount of calcification. Histologically, the tumor consists of a cementum-like or bony mass. Ossifying fibroma shares many histopathologic features with fibrous dysplasia. Their radiographic features may help to separate these entities when pathological differentiation is uncertain. It is important to differentiate ossifying fibroma from fibrous dysplasia. The treatment of ossifying fibroma involves its complete removal using curettage, enucleation, excision, or en bloc resection. This case report presents an unusual case of ossifying fibroma of the maxillary sinus. We describe a Caldwell-Luc operation with a lateral window approach for excision of an ossifying fibroma of the maxillary sinus.

• Advances in Traditional Medicine
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• v.7 no.3
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• pp.254-260
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• 2007

Alstonia scholaris (Family: Apocynaceae) has been indicated for the treatment of various diseases, one among which is wound healing. The purpose of this study is to investigate the wound healing effect and antioxidant role of Alstonia scholaris leaves in animal models. The ethanol and aqueous extracts of Alstonia scholaris (EEAS, AEAS respectively) were tested against excision, incision and dead space wound models to evaluate the wound healing activity. In excision wound model, treatment was continued till the complete healing of wound, in incision and dead space wound models, the treatment was continued for 10 days. For topical application, 5% w/w ointment of EEAS and AEAS were prepared in 2% sodium alginate. For oral administration, EEAS was suspended in distilled water using Tween 80 and AEAS was dissolved in distilled water. The wound healing was assessed by the rate of wound contraction, period of epithelialisation, skin breaking strength, granulation strength, dry granulation tissue weight, hydroxyproline, collagen and histopathology of granulation tissue. Malondialdehyde level was also estimated to evaluate the extent of lipid peroxidation. AEAS and EEAS significantly promoted wound healing activity in all the wound models studied. Increase in the rate of wound contraction, skin breaking strength, granulation strength, dry granulation tissue weight, hydroxyproline and collagen, decrease in the period for epithelialisation and increased collagenation in histopathological section were observed with EEAS and AEAS treated groups. EEAS and AEAS also significantly decreased the levels of lipid peroxidation. The present study is suggestive that EEAS and AEAS promote wound healing activity.

• Archives of Plastic Surgery
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• v.34 no.3
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• pp.399-402
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• 2007

Purpose: Arteriovenous fistula is one of high flow vascular malformations. Recently, arteriovenous fistula has been regarded as one of the type of arteriovenous malformations. The patients were diagnosed as arteriovenous malformation Schobinger clinical stage II. Even though arteriovenous fistula rarely occurs on head and neck, treatment of that is difficult due to frequent recurrence. In treating the arteriovenous fistula, chemical embolization, surgical excision and other treatment modalities were used, but the results were not satisfactory. The authors experienced three cases of arteriovenous fistula and treated them with surgical excision. Methods: In cases, warmth, enlargement, pulsation, thrill, and bruit were found. For the accurate evaluation before the operation, angiography and MRI were checked in advance. Incision was made on the site of pulsation. The artery and vein connected to the arteriovenous fistula were dissected widely, individually ligated, and divided. And then the entire mass was totally removed. Results: All surgical sites were healed well without complications and there was no evidence of recurrence in all cases up to for 2 years of follow-up examination. Conclusion: The arteriovenous fistula on face is a very rare disease and has difficulties in treatment. The authors experienced three cases of arteriovenous fistula with complete surgical removal and no recurrence was found in all cases.

• Advances in pediatric surgery
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• v.14 no.2
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• pp.153-163
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• 2008

Inflammatory myofibroblastic tumor (IMT) is a rare reactive lesion characterized by the feature of myofibroblasts and a mixed inflammatory infiltrate that rarely undergoes malignant transformation. Extrapulmonary IMTs in children have been described involving the mesentery, omentum, retroperitoneum, abdominal soft tissues, liver, bladder, mediastinum, head and neck, extremity, appendix, and kidney. Medical records of children treated with abdominal IMT between 1985 and 2005 were reviewed retrospectively. Seven children were treated for IMT with the mean age of 3 y 2 m (range, 1 y 1 m to 14 y). Tumors were located in transverse mesocolon (n=2), omentum (n=1), porta hepatis (n=2), complex site (antrum, duodenum, common bile duct, porta hepatis) (n=2). The symptoms included abdominal mass, fever, jaundice, abdominal pain and anemia. The masses were excised totally in transverse mesocolon, omentum IMT and there is no evidence of recurrence (follow-up periods: 6 y 8 m, 8 y 9 m, 4 y 10 m). In porta hepatis IMT, liver transplantations were performed and there is no evidence of recurrence (follow period: 6 y 8 m, 8 y 7 m). In one case of complex site IMT, partial excision of mass was performed and he still survived with no change of the residual tumor during follow-up period. The other one of complex site IMT denied further treatment after the biopsy. In conclusion, complete surgical excision including liver transplantation and close follow-up are mandatory for the abdominal IMT in child.

• Advances in pediatric surgery
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• v.8 no.2
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• pp.95-100
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• 2002

Lymphangiomas or cystic hygromas are quite commonly seen in children. During a 22-year period, from January 1980 to December 2001, 117 patients with lymphangioma were treated and followed in the Department of Pediatric Surgery at Hanyang University Hospital. The male-to-female ratio was 1.9:1(77:40) with a male preponderance. As for the age incidence at time of diagnosis, 10(8.5 %) patients were noted under 1 month of age, 37(31.6%) were between 1 month and 1 year of age, 12(10.3%) between 1 and 2 years of age, so 59(50.4%) were under 2 years of age. Sixty one (52.1%) lymphangioma-cases were located in the neck, including one case at the nape. Axilla was the second in frequency and the rest were scattered at various sites. The intrascrotal lymphangioma is very rare but we have experienced one case of primary intrascrotal lymphangioma. Eighteen (15.4%) cases were located in the intraabdominal area, 10 in the mesentery, 2 in the greater omentum and 6 in the retroperitoneum. The chief complaints of intraabdominal lymphangioma were abdominal pain, intestinal obstruction, inguinal hernia, palpable mass, and/or abdominal distension. Among 77 histologically proven cases, 14 cases were cavernous lymphangiomas and the rest were cystic lymphangiomas. Bleeding in the lymphangioma was noted in 20(17.1%) cases of all. As for the treatment, a complete excision was performed in 77(65.8%) patients and $AgNO_3$ sclerotherapy after incomplete excision was performed in 23(19.7%). Picibanil (OK-432) sclerotherapy was performed in 17(14.5%) patients. Recurrence rate was 7.7 % and mortality occurred in one case who had a large neck lymphangioma extending into the mediastinum.

• Tuberculosis and Respiratory Diseases
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• v.48 no.1
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• pp.91-95
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• 2000

Mucous gland adenoma of the bronchus is a rare benign tumor arising from the bronchial mucous gland. It accounts for less than 0.5% of all lung tumors. In adults, tracheal tumors are most often malignant. Among benign tumors arising in the trachea, mucous gland adenoma of the trachea is extremely rare. First case was reported by Ferguson and Cleeland in 1988, as "Mucous gland adenoma of the trachea". Microscopic study shows it to arise from normal submucosal mucous glands forming glandular or tubular structures composed of mucous secreting cells. Common symptoms were cough, hemoptysis, recurrent and protracted pneumonia, shortness of breath, and wheeze. Duration of symptoms before diagnosis varied from a few weeks to 10 years with prolonged symptoms being usual. Management of these tumors should be complete excision, including pulmonary resection because two instances of recurrence after local excision have been reported.

• Korean Journal of Bronchoesophagology
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• v.14 no.2
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• pp.31-37
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• 2008

Background and Objectives: In most cases of benign neck cysts, surgical excision has been considered as treatment of choice. However, sometimes complete excision is very difficult, and recurrences has been occured due to insufficient surgery frequently. In this point of view, non-surgical treatment has been attempted with sclerosing agents such as picibanil(OK-432). In this study, we evaluated the efficacy of picibanil sclerotherapy for benign neck cysts. Materials and methods: We retrospectively reviewed 53 patients(27 males, 26 females) who had undergone sclerotherapy with picibanil for benign neck cysts such as ranula, lymphangioma, thyroglossal duct cyst and branchial cyst. Information was gathered with respected to age, sex, number of injections, side effect and outcome of treatment. All patients were treated with intralesional aspiration of cystic contents and injection of picibanil, and followed on neck ultrasonography or neck CT. Results: 53 patients received sonoguided sclerotherapy using picibanil(OK-432). 31 patients(41.3%) showed total shrinkage, near total shrinkage(more than 90% of volume) in 7 patients(9.3%), marked shrinkage(more than 70%) in 5 patients(6.6%) and partial shrinkage(less than 70%) in 17 patients. 15 patients(20%) reaveled no response and 8 patients showed recurrences with repeated sclerotherapy. The side effects of therapy were observed by symptoms such as fever, localized pain and odynophagia. However, these complications disappeared after several days in all cases. Conclusions: We recognized that picibanil(OK-432) sclerotherapy for benign neck cyst is a safe and effective procedures as a primary treatment before considering surgery.