• Radiation Oncology Journal
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• v.20 no.2
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• pp.139-146
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• 2002

Purpose : This study evaluated the treatment outcomes, patterns of failure, and treatment related complications of primary lymphoma patients who received definitive radiation therapy. Materials and Methods : A retrospective analysis was undertaken for 31 patients with primary orbital lymphoma at the Asan Medical Center between February 1991 and April 2001. There were 18 males and 13 females with ages ranging from 3 to 73 years (median, 44 years). The involved sites were 9 conjunctivae, 12 eyelids and 10 other orbits. The histological types were 28 MALT lymphomas (low-grade B-cell lymphoma of mucosa-associated lymphoid tissue type), 1 diffuse large B-cell lymphoma, 1 anaplastic large cell lymphoma and 1 lymphoblastic lymphoma. The Ann Arbor stages were all IE $(100\%)$. Ann Arbor stage III or IV patients were excluded from this study, Bilateral orbital involvement occurred in 6 cases. Radiation therapy was given with one anterior port of high energy electrons $(6\~16\;MeV)$ for the lesions located at the anterior structures like the conjunctivae or eyelids. Lesions with a posterior extension or other orbital lesions were treated with 4 or 6 MeV photons with appropriately arranged portals. In particular, lens blocks composed of lead alloy were used in conjunctival or eyelid lesions. Twelve patients received chemotherapy. The median follow-up period was 53 months. Results : The 5-year overall, cause-specific, and disease-free survival was $91\%,\;96\%,\;and\;80\%$, respectively. The complete response rate 6 months after radiation therapy was $100\%$. Local recurrences were observed in 2 patients at 16 and 18 months after completion of radiation treatment. They were salvaged with additional radiation therapy. Two patients developed distant metastases. A MALT lymphoma patient with a lung relapse was successfully salvaged with radiotherapy, but the other lymphoblastic lymphoma patient with bone marrow relapse expired. There were no severe complications but 5 patients developed radiation-induced cataracts and 2 patients developed dry eye. Conclusion : Most primary orbital lymphomas consisted of MALT lymphomas. Radiation therapy was a successful treatment modality for orbital lymphoma without any severe complications. In cases of local relapses, radiation therapy is also a very successful salvage treatment modality.

• Archives of Craniofacial Surgery
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• v.19 no.2
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• pp.135-138
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• 2018

Parry-Romberg syndrome is a rare neurocutaneous syndrome characterized by progressive shrinkage and degeneration of the tissues usually on only one side of the face. It is usually difficult to restore the facial contour due to skin tightness. In this case report, we report a forehead reconstruction with custom-made three-dimensional (3D) titanium implant of a Parry-Romberg syndrome patient who was treated with multiple fat grafts but had limited effect. A 36-year-old man presented with hemifacial atrophy. The disease progressed from 5 to 16 years old. The patient had alopecia on frontal scalp and received a surgery using tissue expander. The alopecia lesion was covered by expanded scalp flap done 22 years ago. Also, he was treated with fat grafts on depressed forehead 17 years ago. However, it did not work sufficiently, and there was noted depressed forehead. We planned to make 3D titanium implant to cover the depressed area (from the superior orbital rim to the vertex). During the operation, we confirmed that the custom-made 3D implant accurately fit for the depressed area without any dead spaces. Previously depressed forehead and glabella were elevated, and the forehead contour was improved cosmetically. A custom-made 3D titanium implant is widely used for skull reconstruction and bring good results. In our case, the depressed forehead of a Parry-Romberg syndrome patient was improved by a 3D titanium implant.

• Archives of Plastic Surgery
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• v.33 no.4
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• pp.499-502
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• 2006

Purpose: Grave's disease is an autoimmune disease with chronic and systemic features. It affects the orbital fat and muscle bringing about defect in extrinsic eye motility, diplopia, optic nerve defect and lid retraction. In patients with lagopthalmos and resulting facial deformity, treatment can be done by rectus muscle recession or filling with various material. Autogenous auricular cartilage graft is often used and synthetic material such as synthetic acellular dermis, polyethylene meshs are also used for filling of the depressed area. Nevertheless, autogenous auricular cartilage grafts are difficult to utilize and synthetic materials sometimes result in protrusion or infection. Therefore, hard palate mucosa was considered as an alternative. We report two cases of patients with lower eyelid retraction corrected with autogenous hard palate mucosa. Methods: We performed this operation in two patients of Graves' ophthalmopathy. The capsulopalpebral fascia was incised and elevated through an incision on the conjunctiva. Then, the harvested hard palate mucosa was sutured to the inferior border of the tarsus and covered with the conjunctiva. Results: The lower eyelid retraction was corrected successfully. No hypertrophy or deformation of the transplanted hard palate mucosa was noted 6 months after the surgery. Conclusions: From the results above, we may conclude that the hard palate mucosa serves as an ideal spacer for the curvature and the inner lining in lower lid retraction. Hard palate mucosa is as sturdy as the autogenous cartilage but is much easier to utilize. It can be also used for lid retraction after lower lid aesthetic surgeries or traumas.

• Archives of Plastic Surgery
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• v.43 no.4
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• pp.344-351
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• 2016

Background Xeroderma pigmentosum (XP) is an autosomal recessive disorder characterized by xerosis, ultraviolet light sensitivity, and cutaneous dyspigmentation. Due to defects in their DNA repair mechanism, genetic mutations and carcinogenesis inevitably occurs in almost all patients. In these patients, reconstruction of cutaneous malignancies in the head and neck area is associated with some challenges such as likelihood of recurrence and an aggressive clinical course. The aim of this study is to discuss the therapeutic options and challenges commonly seen during the course of treatment. Methods Between 2005 and 2015, 11 XP patients with head and neck cutaneous malignancies were included in this study. Demographic data and treatment options of the patients were evaluated. Results The mean age of the patients was 32 years (range, 10-43) (4 males, 7 females). The most common tumor type and location were squamous cell carcinoma (6 patients) and the orbital region (4 patients), respectively. Free tissue transfer was the most commonly performed surgical intervention (4 patients). The average number of surgical procedures was 5.5 (range, 1-25). Six patients were siblings with each other, 5 patients had local recurrences, and one patient was lost to follow-up. Conclusions Although genetic components of the disease have been elucidated, there is no definitive treatment algorithm. Early surgical intervention and close follow-up are the gold standard modalities due to the tendency toward rapid tumor growth and possible recurrence. Treatment must be individualized for each patient. In addition, the psychological aspect of the disease is an important issue for both patients and families.

• Parasites, Hosts and Diseases
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• v.49 no.1
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• pp.91-94
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• 2011

We report 2 cases of Thelazia rhodesii infection in the African buffaloes, Syncerus caffer, in Zambia. African buffalo calves were captured from the livestock and wildlife interface area of the Kafue basin in the dry season of August 2005 for the purpose to translocate to game ranches. At capture, calves (n = 48) were examined for the presence of eye infections by gently manipulating the orbital membranes to check for eye-worms in the conjunctival sacs and corneal surfaces. Two (4.3%) were infected and the mean infection burden per infected eye was 5.3 worms (n=3). The mean length of the worms was 16.4 mm (95% CI; 14.7-18.2 mm) and the diameter 0.41 mm (95% CI; 0.38-0.45 mm). The surface cuticle was made of transverse striations which gave the worms a characteristic serrated appearance. Although the calves showed signs of kerato-conjunctivitis, the major pathological change observed was corneal opacity. The calves were kept in quarantine and were examined thrice at 30 days interval. At each interval, they were treated with 200 ${\mu}g/kg$ ivermectin, and then translocated to game ranches. Given that the disease has been reported in cattle and Kafue lechwe (Kobus lechwe kafuensis) in the area, there is a need for a comprehensive study which aims at determining the disease dynamics and transmission patterns of thelaziasis between wildlife and livestock in the Kafue basin.

• The Korean Journal of Nuclear Medicine
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• v.22 no.1
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• pp.27-31
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• 1988

In Graves' disease, changes in orbital tissue and structure are casued by inflammatory infiltation, which induces increase of capillary permeability and breakdown of blood-tissue barriers. Using the uptake of $^{99m}Tc-DTPA$ in inflammatory lesion, Eye/Brain radioactivity ratios in brain scintigraphy were evaluated in 15 normal controls and 40 Graves' patients. The results were as follows; 1) Eye/Brain radioactivity ratio was significantly higher in Graves' ophthalmopthy group than in control group (p < 0.005). 2) In Graves' ophthalmopathy, Eye/Brain radioactivity ratio was significantly higher in active (progressive) group than in inactive (non-progressive) group (p < 0.05). 3) There was no correlation between class of ATA classification of Graves' ophthalmopathy and Eye/Brain radioactivity ratio. 4) There was no correlation between Eye/Brain radioactivity ratio and serum activity of TBII. In conclusion, Eye/Brain radioactivity ratio using $^{99m}Tc-DTPA$ brain scintigraphy may be useful to determine the activity of Graves' ophthalmopathy and whether treatment of Graves' ophthalmopathy is necessary or not.

• Archives of Craniofacial Surgery
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• v.17 no.2
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• pp.77-81
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• 2016

Background: Asymmetry of the infraorbital rim can be caused by trauma, congenital or acquired disease, or insufficient reduction during a previous operation. Such asymmetry needs to be corrected because the shape of the infraorbital rim or midfacial skeleton defines the overall midfacial contour. Methods: The study included 5 cases of retruded infraorbital rim. All of the patient underwent restoration of the deficient volume using polyethylene implants between June 2005 and June 2011. The infraorbital rim was accessed through a subciliary approach, and the implants were placed in subperiosteal space. Surgical outcomes were evaluated using preoperative and postoperative computed tomography studies. Results: Implant based augmentation was associated with a mean projection of 4.6 mm enhancement. No postoperative complications were noted during the 30-month follow-up period. Conclusion: Because of the safeness, short recovery time, effectiveness, reliability, and potential application to a wide range of facial disproportion problems, this surgical technique can be applied to midfacial retrusion from a variety of etiologies, such as fracture involving infraorbital rim, congenital midfacial hypoplasia, lid malposition after blepharoplasty, and skeletal changes due to aging.

• 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.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.30 no.1
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• pp.69-73
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• 2004

Mucormycosis is an acute opportunistic infection caused by a saprophytic fungus found in soil, decaying fruits and vegetables. Numerous predisposing risk factors are associated with mucormycosis, although most cases have been reported in poorly controlled diabetics or in patients with hematologic malignant conditions. Throughout the history of mucormycosis, from the first case in humans reported in 1885 by Paltauf, through publication by Gregory et al of the first observation of rhino-orbital cerebral mucormycosis in 1943, to the report by Harris in 1955 of the first known survivor, little has changed in the diagnosis and outcome of this disease. Without treatment, the patient may die after an interval ranging from a few days to a few weeks. Regulation of diabetes mellitus and a decrease in the dose of immunosuppressive drugs facilitate the treatment of Mucormycosis. Extensive debridement of craniofacial lesions appears to be very important. intravenous amphotericin B is clearly of value. This is a case report of a patient with mucormycosis in maxilla. He was an uncontrolled DM patient, and for the treatment of intravenous amphotericin B and sequestrectomy were applied.

• Archives of Plastic Surgery
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• v.35 no.3
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• pp.321-324
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• 2008

Purpose: Lymphoma originated from mucosa associated lymphoid tissue(MALT) is most common in gastrointestinal system, and rarely found in salivary gland, thyroid, bronchus or orbit. We experienced a case of MALT lymphoma which was originated from conjunctiva and involving lower eyelid without metastasis. Methods: A 40-year-old man suffered palpable mass on right lower eyelid without pain. Orbital computed tomographic and ultrasonographic findings showed a conical mass($1.9{\times}1.2{\times}0.9cm$ size) inside lower eyelid. The mass was completely excised under local anesthesia and histopathological examination was followed. Results: Microscopic finding showed a multiple follicular colonization. In the follicle, small lymphocytes and plasma cells differentiated to centrocyte-like cell, monocyte B cell, plasma cell were diffusely infiltrated. Immunophenotyping was preformed on fixed section. The majority of the small cells were immunoreactive for the B cell marker CD20. Based on the typical histological findings supported by immunostaining, the mass was defined as MALT lymphoma. After excision, SPECT, abdominal CT was carried out and there were no evidence of extraorbital disease. Conclusion: Biopsy and pathological examination should be performed in patients who complain palpable mass on lower eyelid because of possibility of MALT lymphoma. Although MALT lymphoma is rarely metastasized, it is necessary to evaluate the extraorbital involvement using SPECT or other radiologic exams. For detecting extraorbital involvement, periodic follow-up examination is need.