• Maxillofacial Plastic and Reconstructive Surgery
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• 제14권3호
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• pp.217-227
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• 1992

The purpose of this paper is to investigate changes in soft tissue in 22 patients treated by vertical ramus osteotomy and sagittal split ramus osteotomy for the correction of mandibular prognathism. 22 individuals, 12 males and 10 females, were selected from the patients with mandibular prognathism at the Department of Oral and Maxillofacial Surgery, Colledge of Dentistry, Kyung Hee University. Patient were analyzed with cephalogram taken 1 week before and at least 6 weeks after surgery under the same condition. Measurements were made constructed hard tissue and sop tissue points located on each before-and-after film tracing. Comparision were made of these figures to estimate the amount that the soft tissue followed the hard tissue structures in each surgical procedure : ratio of sop and hard tissue changes were formulated. The results were as follows. 1. The horizontal changes of Pogs and Bs as a ratio of the horizontal changes of Pog and B point were 1.02 and 1.16 respectively. 2. One millimeter of posterior changes at Pog resulted in 0.86mm of posterior change at Li and 0.09mm of posterior change at Ls. The greatest amount of sop tissue change occurred at Pogs, with substantially less posterior displacement at Bs, even less at Li and at least at Ls. 3. The ratio of LI to Li was 1:0.81 and the ratio of LI to Ls was not significant.(1 : 0.17) 4. The ULA(Cm-Sn-Ls) and the relative lower lip projection (LLP) was incnease4 but the relative upper lip projection (ULP) was slightly decreased 5. The angular change of the upper lip inclined angle (Ls-Sn/ANS-PNS) and lower lip inclined angle(Li-Pogs/Me-Go) expressed as a ratio of the posterior change of Pog were 0.57 and 0.20 respectively. 6. The ratio of the lower anterior facial height change of the soft tissue(Sn-Mes) to the hard tissue(ANS-Gn) were 0.78 and and the ratio of vertical height changes of the hard tissue and sop tissue to the posterior change of the Pog were 0.18 and 0.19 respectively. 7. The sop tissue angular change of facial convexity(G-Sn-Pogs) expressed as a ratio of the angular change of the hard tissue angle of facial convexity(N-A-Pog) was 1.24.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제30권6호
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• pp.567-571
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• 2008

Purpose: The purpose was to assess the usefulness of midazolam in patients undergoing minor oral surgery under conscious sedation. Materials and methods: Bispectral index was examined in 20 patients receiving oral minor surgery with conscious sedation supplemented with local anesthesia. All patients included were ASA I and had no contraindications to the study medications. The patients were escorted to the day surgery operation room where, before the commencement of the sedation and surgical procedures, routine monitoring was applied, including the noninvasive monitoring of arterial blood pressure, arterial oxygen saturation, and 3-lead electrocardiogram (Electrocardiogram). Bispectral index electrodes were applied on the frontotemporal region after cleansing the skin with alcohol. Bispectral index was calculated with the Electrocardiogram monitor (A-2000; Aspect Co.). Midazolam was then titrated (initially 3mg wait 2min and 2mg). Vital sign and Bispectral index checked every 5 minute until the end of the procedure. The results were then compared. Results: The Bispectral index index values throughout the sedation study period alter many level. The index was dropped at 5 minutes after administration, but raised at injection and odontomy procedure. During the operation, mean Bispectral index index was higher than conscious sedation index range($60{\sim}80$). The amnesic effect was shown 17 cases out of 20 cases(85%). Conclusion: Conscious sedation technique using midazolma is a safe and effective method of controlling behavior in oral and maxillofacial surgery.

• Archives of Plastic Surgery
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• 제49권2호
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• pp.195-199
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• 2022

Nasolacrimal duct (NLD) damage is associated in the majority of type II and III naso-orbito-ethmoid (NOE) fractures. Our study aims to investigate the efficacy and safety of prophylactic NLD intubation in the setting of facial fractures, by comparing incidence of postoperative epiphora and wound infection. A retrospective matched control study was conducted on all patients with surgically treated facial fractures from 2008 to 2013 (n=280) (IRB ref number: DSRB 2013/01198). Patients with the following fracture types were included: NOE (n=16), frontal sinus (n=2), Le Fort II/III (n=8), and > 1 type (n=48). All patients in this study were included with the intention to treat. The study group comprised patients who were intubated, while the control group patients were not intubated. Each group had 37 patients matched for age, gender, fracture type, and injury type. A single oculoplastic surgeon skilled in lacrimal surgery performed the procedure for all intubated patients. Patients with more severe and complex facial fractures were intubated with bicanalicular Crawford stents. Postoperative epiphora and infective complications (both facial wound and dacryocystitis) were assessed at 1, 3, 6, and 12 months. There was no significant difference in incidence of either postoperative epiphora (p=0.152) or wound infection (p=0.556) comparing both groups. Reduced incidence of postoperative epiphora in the study group is statistically not significant and does not support the need for prophylactic intubation. If radiographic evidence of NLD disruption or regurgitation seen on syringing on the NLD intraoperatively is present, intubation is safe and efficacious only if performed by an expert.

• Archives of Plastic Surgery
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• 제46권6호
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• pp.511-517
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• 2019

Background Cleft treatment is frequently performed in Indonesia, mostly in charity missions, but without a postoperative protocol it is difficult to establish the risks and complications of cleft treatment. The present study was designed to give an overview of current cleft lip and palate treatment strategies in Indonesia and to assess the complication rates during and after surgery. Methods This prospective study evaluated anesthetic, intraoperative surgical, and short-term postoperative complications in patients undergoing primary, secondary, or corrective surgery for cleft lip and palate deformities. The population consisted of 98 non-syndromic cleft patients. The main anesthetic complication that occurred during general anesthesia was high blood pressure, whereas the main intraoperative surgical complication was excessive bleeding and the main early postoperative complication was extremely poor wound hygiene. Results In this study, there were no cases of perioperative or postoperative mortality. However, in 23 (23.4%) of the 98 operations performed, at least one perioperative complication related to anesthesia occurred. The intraoperative and early postoperative complications following cleft lip and/or palate were assessed. There was a significant difference in the complication rate between procedure types (χ²=0.02; P<0.05). However, no relationship was found between perioperative complications related to anesthesia and the occurrence of postoperative complications (χ²=1.00; P>0.05). Nonetheless, a significant difference was found between procedure types regarding perioperative complications and the occurrence of postoperative complications (χ²=0.031; P<0.05). Conclusions Further evaluation of these outcomes would help direct patient management toward decreasing the complication rate.

• Archives of Plastic Surgery
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• 제32권1호
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• pp.12-18
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• 2005

The Transverse rectus abdominis musculocutaneous (TRAM) flap has been commonly used for autologous breast reconstruction. Despite these clinical usefulness, the TRAM flap is prone to partial flap or fat necrosis in especially pedicled flap. To improve flap survival, the surgical delay procedures and pharmacological treatments have been developed. In many studies for the pharmacological treatment, Lipo-$PGE_1$ has demonstrated a marked ability to improve flap survival and it's effect has been proved similar to surgical delay procedure. The purpose of this study is to determine the most effective route of Lipo-$PGE_1$ administration as a pharmacological treatment in TRAM flap of the rat. Fifty male Sprague-Dawley rats weighing 300-350 gm were divided into five groups, One week before flap elevation, Lipo-$PGE_1$($2{\mu}g/kg$) was injected three times in a week and than the left inferior epigastric vessel based TRAM flap ($5.0{\times}3.0cm$) elevated; group I: no procedure before flap elevation; group II: intraperitoneal injection; group III: intravenous injection; group IV: subcutaneous injection; group V: topical application. A flap was assessed at postoperative 7 days by comparison of flap survival rate, vessel counts(H-E stain), and vascular endothelial growth factor(VEGF) protein expressed by Western blot. The results demonstrated that the mean percentages of the flap survival area in group III were significantly higher than that of any other group(p<0.05). The vessel counts of all experimental groups were statistically higher than that of control group(p<0.05). Only in group III, the VEGF protein expression was increased significantly than control group and there are no difference in other experimental groups. In conclusion, the intravenous administration of the Lipo-$PGE_1$ is the most effective on flap survival, and the VEGF induced by Lipo-$PGE_1$ has some positive effects on new vessel formation and flap survival.

• Archives of Plastic Surgery
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• 제32권2호
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• pp.205-213
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• 2005

There are several characteristics of the nose of orientals. The dorsum of nose is flat and low, the skin is thick with severe tension, the nasal tip is bulbous, the nostril is wide, and the projection of the nose is limited due to a poorly developed alar cartilage with a short columella. In order to improve these untoward characteristics of the nose of Orientals aesthetically, plain augmentation of the dorsum and tip-plasty with conventional methods has been performed by many plastic surgeons. However these conventional rhinoplasty is not enough to obtain satisfactory results when transforming into a more beautiful and aesthetically charming appearance. In order to produce the optimal nasal shape and profile, it is extremely important to consider the aesthetic surgical factors, which are; the position of the nasion, the optimal nasolabial angle(95-100 degree in Orientals), the natural exposure of infra-tip lobule with and columella, the position of the tip defining point in harmony with the dorsal profile and the smooth and natural silhouette of the lateral nasal profile as it descends into the inferior portion of the nose. From April, 2003 to August, 2004, a total of 52 patients underwent open rhinoplasty, adhering to the strict aesthetic principles considered and described priorly. Surgical approach was done through a transcolumella incision and an alar rim incision. The nasal dorsum was augmented with a silicone implant and the shape of the columella and the nasolabial angle were finessed with a silicone strut implant which was placed in between the medial crurae in a manner of a non-visible graft. The nasal tip was corrected by alar cartilage suture technique and onlay graft of shield shaped Alloderm and Gore-Tex. Author obtained the optimal nasal shape and profile aesthetically, and the results, considered satisfactory in all patients without any complications, are as follows; 1. the average increase in nasal length was 2.5 mm, 2. the average decrease in nasal width was 2.1 mm, 3. the average increase in nasal tip projection was 3.2 mm, 4. the changes of nasolabial angles were from 85.5 degree to 94.7 degree, 5. the changes of the angle between the long axis of the external naris was from 101.3 degree to 89.5 degree. In conclusion, this surgical procedure is an effective, reliable and a valuable method in improving the nasal shape, tip projection, nasolabial angle and especially, the lateral facial profile of Orientals aesthetically.

• Archives of Reconstructive Microsurgery
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• 제15권2호
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• pp.65-69
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• 2006

Purpose: We performed vastus lateralis (VL) muslce or myocutaneous flap for close of the trochanteric skin defect usually happened in paraplegia and report our 6 cases. Materials and Methods: Between March 2004 and August 2005 we performed 4 cases of VL muscule flap with skin graft and 2 cases of VL myocutaneous flap for close of the trochanteric skin defect in 6 paraplegia patients. There were 5 men and 1 woman and mean age was 52.2 years and mean diameters of skin defect was $8.3{\times}8.3\;cm$. The mean follow up period was 18 months. The survival of flap, complications, healing time and patient's satisfaction were evaluated. Results: All flaps were survived except 1 case of margin necrosis. In 2 cases, blood-serous discharges were continued after operation which might be due to dead space and treated with $2{\sim}3$ times debridement and delayed close. Mean time to heal the skin defect was 7.6 weeks. No infection and recurrence in follow up periods. Cosmetic results judged by patients are that 3 cases are good and 3 cases are fair. Conclusion: VL muscle and myocutaneous flap is good treatment method among the numerous methods in treatment-failed cases of trochanteric skin defects of paraplegia patients. This surgical procedure is simple, constant blood supply, good pliability, cosmetic results and also appliable to other skin defect of pelvis girdle like sacrum and ischium.

• Archives of Plastic Surgery
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• 제43권2호
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• pp.181-188
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• 2016

Background Major problems with cervicoplasty by direct skin excision include the subjective nature of skin markings preoperatively and the confusing array of procedures offered. This technique incorporates curved incisions, resulting in a wave-like scar, which is why the procedure is called a "wave-plasty". Methods This prospective study includes 37 patients who underwent wave-plasty procedures from 2004 to 2015. Skin pinching technique was used to mark the anterior neck preoperatively in a reproducible fashion. Intra-operatively, redundant skin was excised, along with excess fat when necessary, and closed to form a wave-shaped scar. Patients were asked to follow up at 1 week, 6 weeks, and 6 months after surgery. Results The mean operation time was 70.8 minutes. The majority (81.3%) was satisfied with their progress. On a scale of 1 to 10 (1 being the worst, and 10 being the best), the scars were objectively graded on average 5.5 when viewed from the front and 7.3 when seen from the side 6 months after surgery. Complications consisted of one partial wound dehiscence (2.3%), one incidence of hypertrophic scarring (2.3%), and two cases of under-resection requiring revision (5.4%). Conclusions In select patients, surgical rejuvenation of the neck may be obtained through wave-like incisions to remove redundant cervical skin when other options are not available. The technique is reproducible, easily teachable and carries low morbidity and high patient satisfaction in carefully chosen patients.

• Journal of Chest Surgery
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• 제30권3호
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• pp.348-348
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• 1997

48세 남자 환자의 전종격동을 깊게 침범하며 흉골에서 발생한 거대한 연골육종을 치료하였다. 환자는 흉골의 연골육종과 주변의 정상변연 4cm을 포함하여 광범 위 절제술을 받았으며 그 종양 자체 는 양측의 쇄골과제 1,2,3늑연골을 포함하는 15× 16X10cm크기였다. 종양의 광범위 절제술후 남은 결손 부위는 매우 컸으며 흉벽 재건술을 Marled mesh와 methylmethacrylate와 wire steels로 겹싸는 sandwich식의 방법으로 시행하였고 연부조직의 재건술 또한 대흉근을 이용한 근피 판 치환술을 시행하 였다. 그러나 환자는 수술후 결핵성 종격동염이 발생되었고 다량의 농이 배출되었다. 재수술은 흉벽 재건술시의 사용되었던 이물질 모두를 제거하고 괴사성 조직의 소파술과 배농술을 시행하였다. 환자는 1 년간 항결핵제요법을 시행하였으며 완치되었기에 문헌고찰과 보고하는 바이다.

• Journal of Chest Surgery
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• 제30권3호
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• pp.248-252
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• 1997

48세 남자 환자의 전종격동을 깊게 침범하며 흉골에서 발생한 거대한 연골육종을 치료하였다. 환자는 흉골의 연골육종과 주변의 정상변연 4cm을 포함하여 광범 위 절제술을 받았으며 그 종양 자체 는 양측의 쇄골과제 1,2,3늑연골을 포함하는 15$\times$ 16X10cm크기였다. 종양의 광범위 절제술후 남은 결손 부위는 매우 컸으며 흉벽 재건술을 Marled mesh와 methylmethacrylate와 wire steels로 겹싸는 sandwich식의 방법으로 시행하였고 연부조직의 재건술 또한 대흉근을 이용한 근피 판 치환술을 시행하 였다. 그러나 환자는 수술후 결핵성 종격동염이 발생되었고 다량의 농이 배출되었다. 재수술은 흉벽 재건술시의 사용되었던 이물질 모두를 제거하고 괴사성 조직의 소파술과 배농술을 시행하였다. 환자는 1 년간 항결핵제요법을 시행하였으며 완치되었기에 문헌고찰과 보고하는 바이다.