• Archives of Plastic Surgery
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• v.46 no.5
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• pp.421-425
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• 2019

Background The endoscopic transnasal approach is widely used for reconstructing the medial orbital wall by filling it with a silicone sheet or Merocel, but this technique has the disadvantage of retaining the packing for a long time. To overcome this drawback, a method of positioning an absorbable plate in the orbit has been introduced, but there is a risk of defect recurrence after the plate is absorbed. Here, the authors report the results of a novel surgical technique of placing a nonabsorbable titanium mesh with porous polyethylene into the orbit through the endoscopic transnasal approach. Methods Fourteen patients underwent surgery using the endoscopic transnasal approach. Preoperative computed tomography (CT) was used to calculate the size of the bone defect due to the fracture, and the titanium mesh was designed to be shorter than the anteroposterior length of the defect and longer than its height. The titanium mesh was inserted into the orbit under an endoscopic view. The authors then confirmed that the titanium mesh supported the orbital contents by pressing the eyeball and finished the operation. Immediately after surgery, CT results were evaluated. Results Postoperative CT scans confirmed that the titanium mesh was well-inserted and in the correct position. All patients were discharged without any complications. Conclusions We obtained satisfactory results by inserting a titanium mesh with porous polyethylene into the orbit via the transnasal approach endoscopically.

• Archives of Plastic Surgery
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• v.35 no.5
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• pp.560-564
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• 2008

Purpose: Because of traffic accidents and many criminal violences, the incidence of facial trauma has been increasing not only in adults but also in children. We planed this study to introduce our experience about pediatric blow out fracture and provide more information. Methods: We made retrospective study in 76 children with blow out fracture from January 2001 to September 2005 by retrospective chart review including detailed preoperative and postoperative evaluations, age, sex, cause, symptom and sign, and their post-operative complications. Results: Among our patients, 69 were male and 7 were female. The ages ranged from 7 to 18 years, which shows the greatest incidence of blow out fracture. Physical violence(46%) was the most common cause in this group and was followed by vehicle accident(28%), and fall down accident(17%). Left side(64%) showed slightly more incidence than right side(36%), but there were no statistical importance. Ecchymosis(88%) was the most common symptom and followed by periorbital swelling(68%) and diplopia(30%). 30 patients was diagnosed with another facial bone fracture and nasal bone(51%) was the most common associated facial bone fracture. Fourty four Patients(60%) got an orbital wall reconstruction in 7 days after trauma. After the operation, only 3 patients(4%) suffered from diplopia postoperative 3 month, and resolved in 4 years. Conclusion: The incidence of blow out fracture in children has been increasing every year, and violence has become more important etiology of pediatric blow out fracture and public and private education institutions were the most common place that blow out fracture originated. Accurate diagnosis and careful treatment plans are important in pediatric blow out fracture.

• Archives of Plastic Surgery
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• v.33 no.5
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• pp.659-662
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• 2006

Purpose: Alloplastic implants, such as methylmethacrylate, Teflon, silicone, Supramid are commonly used to cover the floor defect and to prevent reherniation of the displaced orbital tissue in orbital floor fracture. Silicone implant has been used for reconstruction of orbital wall defects because of pliability, advantage of carving and chemically inert nature. However, silicone implant also has complications including infection, extrusion, pain, dystopia and tissue reaction. Cyst formation around the silicone implant is a very rare complication. According to many reports, cysts around alloplastic implant in an orbital area are mostly hemorrhagic cysts consisted of blood breakdown product with fibrous capsule cell in histologic examination. Methods: The authors report atypical case and successful treatment of intraorbital hemorrhagic cyst around silicone implant of a 37-year-old male patient. Results: Preoperative symptoms of diplopia, exophthalmos, proptosis, vertical dystopia and ectropion of lower eyelid were resolved after surgical removal of implants with surrounding capsule. Conclusion: Clinical suspicion of plastic surgeon is important in diagnosis of intraorbital cyst of patients who have history of silicone implantation and computed tomography is the standard tool of diagnosis. During the operation, caution must be taken on delivering the whole capsule of intraorbital cyst along with silicone implant to prevent recurrence of the cyst.

• Archives of Plastic Surgery
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• v.37 no.4
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• pp.504-508
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• 2010

Purpose: Traumatic telecanthus can result from nasoethmoid-orbital fractures. Repair of the medial canthal tendon (MCT) using transnasal wiring is regarded as a choice of method to treat telecanthus, however, is often complicated by incomplete anchoring and drift of canthus, extrusion of wire, in-fracture of orbital bone, and eye damage. The authors introduced oblique transnasal wiring method through the Hiraga's epicanthopalsty incision instead of well-known classical bicoronal approach. Methods: Five patients with traumatic telecanthus were treated with this method. Though the Hiraga's epicanthoplasty incision, we could approach the operative field; the medial orbital wall and detached MCT. Oblique transnasal wiring was performed as following steps. After slit skin incision on the contralateral nasal recession area, drill holes were made from this point to the superior and posterior point of lacrimal sac of deformed eye. A 2-0 wire was double-passed through the holes and MCT. Traction was applied to ensure pulling the MCT and the wires were twisted in the contralateral nose, securing the MCT in the correct position. Results: All patients except 1 person showed improvement and rapid recovery. On average each canthus was moved 5.6 mm medially. In all cases, there were no eyelashes disappear, lacrimal canaliculitis, lacrimal duct injury, or infections. Conclusion: The Hiraga's epicanthoplasty incision could give sufficient operative field to reattach the MCT in traumatic telecanthus patients. And the oblique transnasal wiring technique is effective for the Asians who have flat nose and exophthalmic eye. The authors conclude that this technique could be a simple, safe and scarless method to correct traumatic telecanthus.

• Journal of Korean Neurosurgical Society
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• v.59 no.3
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• pp.310-313
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• 2016

Intracranial tuberculous subdural empyema (ITSE) is extremely rare. To our knowledge, only four cases of microbiologically confirmed ITSE have been reported in the English literature to date. Most cases have arisen in patients with pulmonary tuberculosis regardless of trauma. A 46-year-old man presented to the emergency department after a fall. On arrival, he complained of pain in his head, face, chest and left arm. He was alert and oriented. An initial neurological examination was normal. Radiologic evaluation revealed multiple fractures of his skull, ribs, left scapula and radius. Though he had suffered extensive skull fractures of his cranium, maxilla, zygoma and orbital wall, the sustained cerebral contusion and hemorrhage were mild. Eighteen days later, he suddenly experienced a general tonic-clonic seizure. Radiologic evaluation revealed a subdural empyema in the left occipital area that was not present on admission. We performed a craniotomy, and the empyema was completely removed. Microbiological examination identified Mycobacterium tuberculosis (M.tuberculosis). After eighteen months of anti-tuberculous treatment, the empyema disappeared completely. This case demonstrates that tuberculosis can induce empyema in patients with skull fractures. Thus, we recommend that M. tuberculosis should be considered as the probable pathogen in cases with posttraumatic empyema.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.41 no.6
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• pp.306-316
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• 2015

Objectives: The facial bones are the most noticeable area in the human body, and facial injuries can cause significant functional, aesthetic, and psychological complications. Continuous study of the patterns of facial bone fractures and changes in trends is helpful in the prevention and treatment of maxillofacial fractures. The purpose of the current clinico-statistical study is to investigate the pattern of facial fractures over a 4-year period. Materials and Methods: A retrospective analysis of 1,824 fracture sites was carried out in 1,284 patients admitted to SMG-SNU Boramae Medical Center for facial bone fracture from January 2010 to December 2013. We evaluated the distributions of age/gender/season, fracture site, cause of injury, duration from injury to treatment, hospitalization period, and postoperative complications. Results: The ratio of men to women was 3.2:1. Most fractures occurred in individuals aged between teens to 40s and were most prevalent at the middle and end of the month. Fractures occurred in the nasal bone (65.0%), orbital wall (29.2%), maxillary wall (15.3%), zygomatic arch (13.2%), zygomaticomaxillary complex (9.8%), mandibular symphysis (6.5%), mandibular angle (5.9%), mandibular condyle (4.9%), and mandibular body (1.9%). The most common etiologies were fall (32.5%) and assault (26.0%). The average duration of injury to treatment was 6 days, and the average hospitalization period was 5 days. Eighteen postoperative complications were observed in 17 patients, mainly infection and malocclusion in the mandible. Conclusion: This study reflects the tendency for trauma in the Seoul metropolitan region because it analyzes all facial fracture patients who visited our hospital regardless of the specific department. Distinctively, in this study, midfacial fractures had a much higher incidence than mandible fractures.

• Archives of Craniofacial Surgery
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• v.13 no.1
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• pp.22-28
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• 2012

Purpose: In accordance to an increased interest in facial appearance and the popularization of computed tomography scanning, the number of diagnosis and treatment of blowout fractures has been increased. The purpose of this article is to review pure blowout fracture surgery through transconjunctival incision focusing on complications and their management. Methods: In this retrospective study, 583 patients, who had been treated for pure blowout fracture through transconjunctival incision from 2000 to 2009, were evaluated. Their hospital records were reviewed according to their sex, age, fracture site, preoperative presentations, time interval between trauma and surgery, and postoperative complications. Results: According to postoperative follow-up results, there were early complications that included wound dehiscence and infection (0.2%), hematoma (insomuch as extraocular movement is limited) (0.7%), lacriminal duct injury (0.5%), and periorbital nerve injury (0.7%). In addition, there were late complications that lasted more than 6 months, that included persistent diplopia (1.7%), extraocular movement limitation (0.9%), enophthalmos (1.0%), periorbital sensation abnormalities (1.0%), and entropion (0.5%). Conclusion: We propose the following guidelines for prevention of postoperative complications: layer by layer closure; bleeding control with the epinephrine gauzes, Tachocomb, and Tisseel; conjunctival incision 2 to 3 mm away from punctum; avoidance of excessive traction; performing surgical decompression and high dose corticosteroid therapy upon confirmation of nerve injury; atraumatic dissection and insertion of Medpor Barrier implant after securing a clear view of posterior ledge; using Medpor block stacking technique and BioSorb FX screw fixation; performing a complete resection of the anterior ethmoidal nerve during medial wall dissection; and making an incision 2 to 3 mm below the tarsal plate.

• Archives of Craniofacial Surgery
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• v.23 no.4
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• pp.171-177
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• 2022

Background: The treatment of zygoma complex fractures is of crucial importance in the field of plastic surgery. However, surgical methods to correct zygoma complex fractures, including the number of fixation sites, differ among operators. Although several studies have compared two-point and three-point fixation, no comparative research has yet been conducted on one-point versus two-point fixation using computed tomography scans of surgical results. Therefore, the present study aimed to address this gap in the literature by comparing surgical results between one-point and two-point fixation procedures. Methods: In this study, we randomly selected patients to undergo surgery using one of two surgical methods. We analyzed patients with unilateral zygoma complex fractures unaccompanied by other fractures according to whether they underwent one-point fixation of the zygomaticomaxillary buttress or two-point fixation of the zygomaticomaxillary buttress and the zygomaticofrontal suture. We then made measurements at three points-the zygomaticofrontal suture, inferior orbital wall, and malar height-using 3-month postoperative computed tomography images and performed statistical analyses to compare the results of the two methods. Results: All three measurements (zygomaticofrontal suture, inferior orbital wall, and malar height) showed significant differences (p< 0.05) between one-point and two-point fixation. Highly significant differences were found for the zygomaticofrontal suture and malar height parameters. The difference in the inferior wall measurements was less meaningful, even though it also reached statistical significance. Conclusion: Using three parameters in a statistical analysis of imaging findings, this study demonstrated significant differences in treatment outcomes according to the number of fixations. The results indicate that bone alignment and continuity can be achieved to a greater extent by two-point fixation instead of one-point fixation.

• Archives of Plastic Surgery
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• v.34 no.4
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• pp.524-527
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• 2007

Purpose: Globe displacement due to a blowout fracture is a rare clinical phenomenon. The authors present reduction of a globe displacement to the maxillary sinus due to trauma suffered in a fall and the reconstruction of a large defect left in the medial and inferior orbit. Methods: A 39-year-old male patient was unable to open his left eye after being struck on the periorbital area by a metal edge. Laceration was not noted in that area but we were unable to observe the intraorbital globe. A facial computed tomography (CT) scan showed that the globe was displaced through the maxillary sinus. A transconjunctival approach was used to access the infraorbital margin and the globe entrapped in the inferior margin of the orbit was successfully reduced. A large defect in the medial and inferior orbit was reconstructed using a graft from the iliac bone. Results: In 5 months after the operation, no atrophy of the globe was seen. Both sides retained a similar shape. A satisfactory functionality outcome in terms of improved extraocular muscle movement, and a satisfactory aesthetical outcome were achieved. Conclusion: The authors report the reduction of a globe displaced to the maxillary sinus following a fall and the reconstruction of the large defect left in the medial and inferior orbit.

• The Journal of the Korean dental association
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• v.54 no.10
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• pp.811-819
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• 2016

Panfacial fracture is extremely difficult to manage facial injuries but concomitant injuries and severe complications including facial esthetic and functional problems can make it harder. Thorough evaluation and closed co-work with other specialists is needed when reduction and fixation cannot be achieved quickly. Emergency bony support and soft tissue key suture provide the patients with airway integrity, hard and soft tissue vitality. A systemic treatment plan must be made by 3D CT image. This plan include airway management for surgery, sequence of reduction and fixation, approach method, soft tissue resuspension and reconstruction of lost tissue like inferior orbital wall, zygomaic buttress and soft tissue. From known to unknown structures, accurate reduction and fixation will provide proper occlusion, facial projection, width, hight and function. Consideration about facial retaining ligaments must be given to prevent soft tissue sagging.