• Archives of Plastic Surgery
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• v.40 no.4
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• pp.380-386
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• 2013

Background Xanthelasma palpebrarum (XP) is a benign disorder manifesting as yellowish cholesterol-laden plaques on the eyelids. This paper presents the outcomes in patients with XP who have undergone surgical excision as the main modality of treatment. Methods A retrospective review of patients who received surgery for xanthelasma palpebrarum from March 2007 to March 2011 was conducted. Patients were classified into four grades according to the location and extent of the lesion, with grade I being the mildest and grade IV being the most diffuse. Simple excision was performed in grade I and II lesions, while local flaps and skin grafts were performed in the more advanced grades. Results Ninety-five cases from March 2007 to March 2011 were included in this study. 66 cases (70%), were treated by simple excision. Twenty-four cases (25%) and 5 cases (5%) were treated by simple excision in combination with or without local flaps and skin grafts. In approximately 1/4 of the patients, orbicularis oris muscle involvement was observed. 4 patients (4.2%) developed scar contracture postoperatively, which required a secondary procedure. Recurrence was reported in 3 patients (3.1%). Otherwise. There were no other reports of major complications or disfigurement. Conclusions We found that for lesions involving the deep dermis and/or muscle, surgical excision was the most appropriate therapeutic option.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.43 no.4
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• pp.262-266
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• 2017

Hemangioma is the most common benign tumor of a vascular origin, and is characterized by the abnormal proliferation of blood vessels. Intramuscular hemangioma (IMH) usually involves the skeletal muscles of the trunk or limbs, but rarely occurs in the head and neck region. This case report presents a patient with IMH showing multiple phleboliths in the buccal cheek. A 13-year-old boy was referred for the evaluation and management of painful swelling of the left cheek that had gradually increased in size over a 6 year duration. The examination revealed a palpable firm mass. Reddish-blue buccal mucosa color was observed with an aciniform shape. Preoperative magnetic resonance imaging (MRI) showed a vascular tumor in the left side adjacent to the buccinator and depressor orbicularis oris muscles. Surgical resection under general anesthesia was performed via the intraoral approach. The mass and phleboliths were extracted successfully. A histopathological examination confirmed the diagnosis of IMH. In conclusion, clinicians should be aware of the possibility of IMH in cases of a palpable mass with multiple nodules deep within the muscle in the buccal cheek. Among the several diagnostic tools, MRI provides essential information on the extent and surrounding anatomy of IMH.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.29 no.5
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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.

• Archives of Craniofacial Surgery
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• v.20 no.4
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• pp.255-259
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• 2019

Craniofacial cleft is a rare disease, and has multiple variations with a wide spectrum of severity. Among several classification systems of craniofacial clefts, the Tessier classification is the most widely used because of its simplicity and treatment-oriented approach. We report the case of a Tessier number 3 cleft with wide soft tissue and skeletal defect that resulted in direct communication among the orbital, maxillary sinus, nasal, and oral cavities. We performed soft tissue reconstruction using the straight-line advanced release technique that was devised for unilateral cleft lip repair. The extension of the lateral mucosal and medial mucosal flaps, the turn over flap from the outward turning lower eyelid, and wide dissection around the orbicularis oris muscle enabled successful soft tissue reconstruction without complications. Through this case, we have proved that the straight-line advanced release technique can be applied to severe craniofacial cleft repair as well as unilateral cleft lip repair.

• Korean Journal of Veterinary Research
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• v.26 no.1
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• pp.1-9
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• 1986

This study was carried out to investigate the branch and distribution of Nervus facialis of the Korean native goat. The observation was made by dissection of embalmed cadavers of ten Korean native goats. The results were as follows; 1. N. facialis arose from the ventrolateral surface of the medulla oblongata. 2. In the facial canal, N. facialis gave off N. petrosus major, N. stapedius and Chorda tympani. 1) N. petrosus major arose from Ganglion geniculi, passed through the pterygoid canal and terminated in Ganglion pterygopalatinum. 2) Chorda tympani joined N. lingualis at the lateral surface of the internal pterygoid muscle. 3. At the exit of the stylomastoid foramen, N. facialis gave off N. caudalis auricularis, Ramus auricularis internus, Ramus stylohyoideus and Ramus digastricus. 1) N. caudalis auricularis arose by two branches in 6 cases and by a single branch in 4 cases. N. caudalis auricularis gave off branches to the caudoauricuIar muscles and the internal surface of the conchal cavity. 2) Ramus auricularis internus arose by a single branch except in 2 cases in which it arose in common with N. caudalis auricularis. It penetrated the caudolateral surface of the tragus and distributed in the skin of the scapha. 3) Ramus stylohyoideus and Ramus digastricus arose separately from N. facialis. 4. In the deep surface of the parotid gland, N. facialis divided into N. auriculopalpebralis, Ramus buccalis dorsalis and Ramus buccalis ventralis. In 6 cases, N. facialis gave off Ramus buccalis ventralis and then divided into N. auriculopalpebralis and Ramus buccalis dorsalis. In 3 cases, N. facialis trifurcated into Ramus buccalis ventralis, Ramus buccalis dorsalis and N. auriculopalpebralis. In one case, N. facialis gave off N. auriculopalpebralis and then divided into Ramus buccalis dorsalis and Ramus buccalis ventralis. 1) Ramus buccalis ventralis ran along the ventral border of the masseter muscle and distributed to the buccinator and depressor labii inferioris muscles. Ramus buccalis ventralis communicated with a branch of Ramus buccalis dorsalis and N. buccalis. In 2 cases, it also communicated with N. mylohyoideus. 2) Ramus buccalis dorsalis communicated with Ramus transverses faciei, N. buccalis, N. infraorbitalis and a branch of Ramus buccalis ventralis. Ramus buccalis dorsalis distributed to the orbicularis oris, caninus, depressor labii inferioris, levator labii superioris, buccinator, malaris, nasolabialis and zygomaticus muscles. 3) N. auriculopalpebralis gave off Rami auriculares rostrales, which supplied the zygomaticoauricularis muscle, the frontoscutularis muscle and the skin of the base of the ear. N. auriculopalpebralis then continued as Ramus zygomaticus, which innervated the frontal muscle, the lateral surface of the base of the horn, the orbicularis oculi muscle and the adjacent skin of the orbit. N. auriculopalpebralis communicated with Nn. auriculares rostrales and Ramus zygomaticotemporalis. In 7 cases, it also communicated with N. infratrochlearis.

• Journal of Oral Medicine and Pain
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• v.34 no.3
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• pp.317-324
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• 2009

This study aimed to assess stiffness and elasticity of the masticatory muscle in the patients with the masticatory muscle pain using a tactile sensor and to investigate whether the masticatory muscle pain affects the facial expression muscles. From those who visited Department of Oral Medicine in Dankook University Dental Hospital, 27 patients presenting with unilateral muscle pain and tenderness in the masseter muscle (Ms) were selected (mean age: $36.4{\pm}13.8$ years). Exclusion criterion was those who also had temporomandibular joint (TMJ) disorders or any neurological pain. Muscle stiffness and elasticity for the muscles of mastication and facial expression was investigated with the tactile sensor (Venustron, Axiom Co., JAPAN) and the muscles measured were the Ms, anterior temporal muscle (Ta), frontalis (Fr), inferior orbicularis oculi (Ooci), zygomaticus major (Zm), superior and inferior orbicularis oris (Oors, Oori) and mentalis (Mn). t-tests was used to compare side difference in muscle stiffness and elasticity. Side differences were also compared between diagnostic groups (local muscle soreness (LMS) vs myofascial pain syndrome (MPS) and between acute (< 6M) and chronic ($\geq$ 6M) groups. This study showed that Ms and Zm at affected side exhibited significantly increased stiffness and decreased elasticity as compared to the unaffected side.(p<0.05) There was no significant difference between local muscle soreness and myofascial pain syndrome groups and between acute and chronic groups. The results of this study suggests that masticatory muscle pain in Ms can affect muscle stiffness and elasticity not only for Ms but also for Zm, the facial expression muscle.

• The Journal of Korean Medicine
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• v.23 no.1
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• pp.100-111
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• 2002

Objectives : In order to obtain the clinical type of facial palsy sequelae and try to make the treatment protocols for each, I observed patients who visited Gunpo-Wonkwang oriental medicine center with Bell’s palsy sequelae that were treated over three months. Methods : I make the value standard of muscle paralysis, contraction, synkinesis and acquired the results as follows. Results and Conclusions : 1. The distribution of age and sex was as follows : females of 41-50 years were the most common demographic, females of 51-60 years and males of 31-40 years were the second, males of 51-60 years were the third, females of 21-30 years and males of over 60 years were the fourth, and males of 41-50 years were the fifth. 2. The distributions of period of disease were as follows : 3-6 months was the most, 12-18 months was the second, 6-12 months and over 24 months was the third, and 18-24 months was the fourth. 3. The sequelae distributions of disease were as follows. In the group of 3-6 months, 12 persons (80%) showed palsy and atrophy, 10 persons (66.6%) showed synkinetics. In the group of over 6 months, all patients showed muscle palsy, muscle atrophy and synkinetics. All groups showed lower sensitivity of muscles, but the group of 18-24 months and the group of over 24 months showed more. Tinnitus was shown by the groups of 12-18 months and 3-6 months. Facial muscle pain was shown by the group of3-6 months only, Crocodile's tear was shown by the groups of 18-24 months and over 24 months. 4. The total palsy rates of sequela patients and palsy rates by muscle for disease period were as follows. The total palsy rate was 27.94%; the palsy rates for the group of 6-12 months and the group of over 24 months was lower than the total palsy rate. The rates of the groups of 3-6, 12-18, 18-24 months were higher than the total palsy rate. The palsy rate of zygomatic minor, levator labii superior muscle was higher than the total palsy rate for all groups. 5. Synkinetics manifestation rates by disease period were as follows. Total synkinetics manifestation rate was 73.81 %; the manifestation rate of the group of 6-12 months was lower than total synkinetics manifestation rate. For the groups of 12-18, 18-24, and over 24 months it was more than the total synkinetics manifestation rate. The group of over 24 months, total synkinetics induced by orbicularis oculi muscle and orbicularis oris muscle. 6. Facial muscle atrophy rates by disease period were as follows. Total atrophy rate was 5.26%; in the groups of 6-12, 18-24, over 24 months, the atrophy rates were higher than the total atrophy rate. The groups of 3-6 and 12-18 months showed lower than the total atrophy rates, while the atrophy of the levator palpebrae superioris muscle and levator palpebrae inferioris muscle was higher than in other groups.

• Journal of Electrodiagnosis and Neuromuscular Diseases
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• v.20 no.2
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• pp.84-90
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• 2018

Objective: To assess the correlation between surface electromyography (SEMG) and conventional EMG in patients with facial nerve palsy. Additionally, compare the discomfort and the time required by the patients in two methods. Method: 36 patients with facial palsy were given nerve conduction studies (NCS) via conventional EMG. Then, the peak root mean square (RMS) values were obtained from the SEMG. We also recorded visual analogue scale (VAS), House-Brackmann scale, and the time required for the examination. Results: Pearson's correlation coefficient between the amplitude loss ratio of the RMS values obtained by SEMG compared to the unaffected side (RSEMG) and the amplitude loss ratio of CMAP amplitudes compared to the unaffected side (RCMAP) was 0.567 at the frontalis, 0.456 at the orbicularis oculi, 0.393 at the nasalis, and 0.437 at the orbicularis oris. An increase in RSEMG is positively correlated with an increase in RCMAP. The mean VAS score with conventional EMG was $3.55{\pm}1.42$, whereas that experienced when using SEMG was $0.11{\pm}0.52$ and the mean time required for conventional EMG was $610{\pm}103.84$ seconds, while that required for SEMG was $420{\pm}86.32$ seconds. Conclusion: This study demonstrated a significant positive correlation between facial muscle activities as measured by SEMG and conventional EMG in patients with facial nerve palsy. SEMG has the benefits of being more comfortable and faster when diagnosing facial palsy.

• Archives of Plastic Surgery
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• v.43 no.3
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• pp.242-247
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• 2016

Background Median cleft lip is a rare anomaly consisting of a midline vertical cleft through the upper lip. It can also involve the premaxillary bone, the nasal septum, and the central nervous system. In our current report, we present the clinical features of 6 patients with a median cleft lip and their surgical management according to the accompanying anomalies. Methods From December 2010 to January 2014, 6 patients with a median cleft lip were reviewed. Five of these cases underwent surgical correction; alveolar bone grafting was performed in a patient with a median alveolar cleft. The surgical technique included inverted-U excision of the upper lip and repair of the orbicularis oris muscle. The mean follow-up period was 20.4 months (range, 7.4-44.0 months). Results The study patients presented various anomalous features. Five patients received surgical correction, 4 with repair of the median cleft lip, and one with iliac bone grafting for median alveolar cleft. A patient with basal sphenoethmoidal meningocele was managed with transoral endoscopic surgery for repair of the meningocele. Successful surgical repair was achieved in all cases with no postoperative complications. Conclusions Relatively mild forms of median cleft lip can be corrected with inverted-U excision with good aesthetic outcomes. In addition, there is a broad spectrum of clinical features and various anomalies, such as nasal deformity, alveolar cleft, and short upper frenulum, which require close evaluation. The timing of the operation should be decided considering the presence of other anomalies that can threaten patient survival.

• Korean Journal of Cleft Lip And Palate
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• v.15 no.1
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• pp.21-28
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• 2012

Unilateral cleft lip is not a simple and independent problem in all aspects. nasal deformity results from the cleft lip, maxillary hypoplasia, and abnormal muscular pull on the nasal structures, including abnormal muscular tension on the alar base and abnormal position of the orbicularis oris muscle. Its gross and histopathologic characteristics include widening of the alar base, a midline deviation of the columella and septum to the noncleft side, dorsal displacement of the dome, lateral rotation of medial crura, buckling of the alar cartilage, and underdevelopment of the pyriform aperture. Since Dr. Millard first presented his method for repair of the unilateral cleft lip and nasal deformity in 1955, no other technique has gained as much popularity as the rotation-advancement principle. Principles established more than 50 years ago and techniques are evolving continuously. Unlike earlier procedures, this repair gives the surgeon the opportunity to manipulate the individual cleft elements through various modifications while maintaining Millard's original surgical and anatomical goals. Although this strategy is applied worldwide, successful execution is variable and highly operator dependent. Millard and many other surgeons have made technical variations to adjust the procedure to each specific patient, to address some of its faults, and to gain new advantages. We will review the Mulliken's modifications that Dr. Millard made to his original rotation-advancement principle and inform cases applied modifying the rotation-advancement principle.