• Archives of Plastic Surgery
• /
• 제39권3호
• /
• pp.190-197
• /
• 2012

Background : This article presents long-term outcomes after correcting secondary bilateral cleft lip nasal deformities using a refined reverse-U incision and V-Y plasty or in combination with a composite graft in order to elongate the short columella. Methods : A total of forty-six patients underwent surgery between September 1996 and December 2008. The age of the patients ranged from 3 to 19 years of age. A bilateral reverse-U incision and V-Y plasty were used in 24 patients. A composite graft from the helical root was combined with a bilateral reverse-U incision in the 22 patients who possessed a severely shortened columella. The follow-up period ranged between 2 and 10 years. Results : A total of 32 patients out of 46 were evaluated postoperatively. The average columella length was significantly improved from an average of 3.7 mm preoperatively to 8.5 mm postoperatively. The average ratio of the columella height to the alar base width was 0.18 preoperatively and 0.29 postoperatively. The postoperative basal and lateral views revealed a better shape of the nostrils and columella. The elongated columella, combined with a composite graft, presented good maintenance of the corrected position with no growth disturbance. A composite graft showed color mismatching in several patients. Twenty-six patients demonstrated no alar-columella web deformity and satisfactory symmetry of the nostrils. Four patients experienced a drooping and overhanging of the corrected alar-columella web. Conclusions : A bilateral reverse-U incision with V-Y plasty or in combination with a composite graft was effective in correcting secondary bilateral cleft lip nasal deformity.

• Archives of Plastic Surgery
• /
• 제37권4호
• /
• pp.427-432
• /
• 2010

Purpose: The purpose of this study is to estimate muscle defect by ultrasonography in the patients with secondary deformities of the lip. We investigated the association between the muscle defect in the repaired cleft lip and the philtral appearance not only at resting state but also maximal puckering. Methods: From December 2006 to November 2007, 52 children were evaluated after primary or secondary cheiloplasty. Digital photographs were taken both from the front and both three quarter views in repose and at maximal pucker. Video clips were also taken in repose and at maximal pucker. A panel of four, scored the philtral ridge and dimple seen on these photographs and videos by using two visual analog scales. Eminence of the philtral ridge was scored by a 5 point grading scale, from "conspicuous groove" to "normal philtral ridge" and the philtral dimple was scored by 3 point grading scale, from "no dimple" to "prominent dimple". Ultrasound images of the upper lip were made using a linear array transducer at the resting position of the lip and evaluated by a single radiologist. Results: The philtral ridge eminence scored $2.79{\pm}0.54$ and $1.40{\pm}0.53$ at resting and maximal pucker, correlating with "flat" and "conspicous groove". The philtral dimpling scored $1.44{\pm}0.53$ and $2.27{\pm}0.66$ at resting and maximal pucker, correlating with "no dimple" and "slight dimple". Ultrasound imaging showed the average muscle dehiscence to be $3.78{\pm}2.14$ mm at resting position. Correlation between the muscle defect in ultrasound imaging and philtral ridge eminence at rest was statistically significant (p<0.050), but was not significant (p=0.756) at maximal pucker using Spearman's rank correlation. Correlation between the muscle defect in ultrasound imaging and philtral dimpling was not statistically significant both at rest (p=0.920) and at maximal pucker (p=0.815) using Spearman's rank correlation. Conclusion: Quantitative assessment of the muscle defect using ultrasonography correlates with the static philtral appearance, but does not correlate with the dynamic appearance. Also, the size of the muscle defect does not show any correlation with the philtral dimpling. Our findings reveal that ultrasound imaging partially reflect static appearance of philtrum but cannot reflect dynamic appearance and suggest the need for further research to evaluate dynamic appearance.

• 대한물리치료과학회지
• /
• 제9권3호
• /
• pp.97-106
• /
• 2002

Purpose. This study was tried to compare the effect of the change in postural deviation caused by the pain side Subjects and Methods. Inpatients and outpatients (n=71) were selected from I hospital who have a musculoskeletal low back pain and shoulder pain without any history of the central nervous system (CNS) lesions, orthopaedic problems of the both lower extremities, or the vestibular and the visual default. For the control group, normal and healthy subjects (n=30) were selected without any history of weight bearing disorders. the weight bearing was rated by the computerized force plate. Results. 1) Postural deviation was not significant difference between patients and control group(p<0.01). But postural deviation in patients was more pronounced than control group. 2) There was significant difference of postural deviation between in patients according to the pain side(p<0.01). When the pain side was on the left side, postural deviation tended to the right. When the pain side was on the right side and vertebral body, postural deviation tended to the left. 3) There was no significant difference of postural deviation between regional pain in shoulder and regional pain in low back(p<0.01). Discussions and Conclusion. As a result, the pain, for sure, affected the good posture and its keeping process directly or/and indirectly. Therefore, as the postural deviation increases, the additional energy consumption increased by the works of the muscles to keep the good posture. Preponderated postural deviation, furthermore, could load too much to the musculoskeletal system, leading to increase the pain. The postural deviation, a result of the pain, can cause a secondary deformity of the distal area as a compensatory reaction, and this compensation actually become a cause of the musculoskeletal symptom back in a cycle. Therefore, the appropriate treatment of the musculoskeletal problem and the education of the posture correction should be given to decrease the pain, preventing the secondary deformities, and increasing muscle energy efficiency of the posture remaining muscles.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• 제32권4호
• /
• pp.287-294
• /
• 2006

The secondary correction of cleft lip nasal deformity (CLND) presents difficult surgical problems. Characteristically, nostrils are asymmetric. The present study was aimed to examine and compare the effect of Straith's alar web Z-plasty, Millard's alar web Z-plasty, alar web excision, and lateral V-Y advancement of the alar base for augmentation of the nostril with or without lengthening the columella in CLND. The subjects were 28 patients with unilateral cleft lip, who had secondary nostril correction. The nostril correction methods were Straith's alar web Z-plasty, Millard's alar web Z-plasty, alar web excision, and lateral V-Y advancement of the alar base. Facial photographs were taken before and 20 days after the operation. By using Adobe photoshop, the columella length and the nostril width were measured from the facial frontal photograph and Worm's eye view. The degree of improvement was calculated and statistically analyzed. The degree of improvement of the columella length using Straith's alar web Z-plasty was 70.20%. And then Millard's alar web Z-plasty was 55.01%, alar web excision was 39.93%, and lateral V-Y advancement of the alar base was 16.38% in order. The degree of improvement of the nostril size using lateral V-Y advancement of the alar base was 55.26%. And then alar web excision was 52.72%, Millard's alar web Z-plasty was 34.86%, and Straith's alar web Z-plasty was 16.06% in order. Straith's alar web Z-plasty and Millard's alar web Z-plasty resulted in elongation of the columella, equalization of asymmetrical nostril, and enlargement of small nostrils. Alar web excision enlarged nostrils and restored symmetry. Lateral VY advancement of the alar base increased nostril width and enlarged nostrils. These results indicate that the correction of nostrils improve the shape and the symmetry of the nostrils in CLND.

• 대한전기학회:학술대회논문집
• /
• 대한전기학회 2004년도 학술대회 논문집 정보 및 제어부문
• /
• pp.3-5
• /
• 2004

Cleft lip is one of the most common congenital deformities in craniofacial region. Despite the many reports on the outcome of various surgical techniques from individual medical centers, the evaluation of the outcome is based on the subjective observation because of lack of the objective evaluation system. Therefore, a new technique of objective and scientific evaluation for the nasal deformity of secondary cleft lip and nose deformity is critical to improve the management of the cleft patients including the decision of optimal age of operation and surgical technique as veil as evaluation of the outcome. In this study, a new method was proposed to evaluate the nasal deformity using nostril angle, distance, and area of patient images. The images were also evaluated by three expert plastic surgeons, and put into scale of 5 percentile. Measurement results were compared between the each category and the surgeon's evaluation, and coefficients of each category were statistically tested. As a result, The normalized overlap area of right and left nostrils and distance ratio between two centers of nostrils showed high coefficient with evaluations of plastic surgeons.

• Journal of Chest Surgery
• /
• 제20권1호
• /
• pp.161-170
• /
• 1987

Fifty-nine cases of congenital chest wall defects experienced in the department of thoracic surgery of Seoul National University Hospital were analyzed and the relevant literatures were reviewed. They are 52 cases of funnel chest, 3 cases of pigeon breast, one case of superior sternal fissure, one case of costochondral incurvation, one case of Cantrell`s pentalogy, and one case of Poland`s syndrome. Funnel chest affected males more frequently than females by 44 to 8. All of the funnel deformities were corrected by Ravitch operation or its modification except one which was the first case of this series and was corrected by a sterno-turnover. Two cases required a mechanical ventilation for 3 days and 5 days respectively. Four minor complications which were two cases of skin wound infection and 2 cases of fluid accumulation were noted. Skin would infection was repaired by a secondary closure and fluid accumulation was treated by aspiration only. The result are all excellent without recurrence or reoperation. In 3 cases of pigeon breast, they were treated by subperichondrial resection of all of the involved costal cartilages and shortening their course with reefing sutures in the perichondrium with excellent result. The superior sternal fissure which was combined by a ventricular septal defect was treated by a simple wire closure with a good result. The costochondral incurvation was corrected by subperichondrial resection of deformed cartilages and a rib graft removed from the contralateral normal side. The Poland syndrome and the Cantrell`s pentalogy was already presented previously.

• 한국기계가공학회지
• /
• 제20권9호
• /
• pp.97-103
• /
• 2021

In this paper, an omni wheel-based electric wheelchair is proposed that can achieve safe and convenient movement and can improve the convenience of living for mobility-impaired people who cannot move on their own. Generally, mobility-impaired people are afflicted with physical health issues such as pain and secondary body deformities because they often remain seated in wheelchairs for long periods of time. Hence, an electric wheelchair is required whose posture can be changed and whose size can be adjusted according to the user's body type. Such a wheelchair should also facilitate easy change of direction (even in a narrow space) for convenient movement. In this paper, an electric wheelchair featuring omni wheels is proposed that allows posture transformation and facilitates movement in a narrow space. It is believed that the proposed wheelchair can aid in enhancing the convenience of living for mobility-impaired people.

• 대한화상학회지
• /
• 제24권2호
• /
• pp.46-49
• /
• 2021

An anatomically normal first web space is essential for optimal prehensile movements of the thumb and hand. A 28-year-old woman presented with severe scarring and contractures of the first web space of both hands, following a flame burn injury sustained 25 years prior to presentation. First web space contracture may occur secondary to severe injuries, burns (as observed in our patient), or congenital hand anomalies. A significant amount of additional skin is required to release a severe first web space contracture. Reconstruction of wide areas of contractures using only local flaps is challenging. Among other free flaps used in clinical practice, the thinned lateral arm free flap provides flexible vascularized tissue for reconstruction of the skin after severe first web space contracture release. Reconstruction using lateral arm free flaps facilitated thumb abduction and opposition (which were initially difficult) and improved hand function in our patient.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제29권1호
• /
• pp.55-62
• /
• 2007

구순열의 일차 수술 또는 이차 수술 후에 발생하는 상순의 지나친 긴장은 상하순 간의 부조화, 상악열성장, 골격성 III급 부정교합 등 안모추형을 초래한다. 상순의 긴장이 매우 심한 경우에는 하순의 여유 있는 조직을 이용하여 상순을 수정하는 Abbe 피판을 고려할 수 있다. 상순의 긴장이 큐피드궁의 2/3 이상의 조직 손실을 동반할 경우 Abbe 피판의 적응증이 된다. Abbe 피판은 상순과 하순의 반흔, 색상의 부조화, 그리고 상순의 불완전한 운동을 초래하는 단점을 가진다. 그러므로 Abbe 피판은 신중하게 사용되어야 한다. 우리는 편측성 구순열 1예와 양측성 구순열 3예에서 상순의 과도한 긴장과 큐피드궁의 조직 결핍 그리고 비변형이 심한 이차성 구순열비변형을 교정하기 위해 세 가지 형태의 Abbe 피판을 이용한 이차 교정술을 경험하였다. Abbe 피판수술을 시행한 결과 상순의 반흔과 긴장이 해소되고 큐피드궁이 재건되고 비주의 길이가 증가되어 이차 구순열비변형을 교정할 수 있었다. Abbe 피판은 신중을 기해 적용한다면 구순열 수술 후에 발생되는 상순의 수평적 긴장감이나 편평함을 해결하는 데 유용한 술식임을 알 수 있었다.

• Journal of Korean Neurosurgical Society
• /
• 제30권11호
• /
• pp.1271-1277
• /
• 2001

Objectives : Since vertebroplasty has been introduced, we performed short segment pedicle screw fixation with augmented intra-operative vertebroplasty in patients with unstable thoraco-lumbar fracture. Our intentions are to demonstrate the efficacy and indication of this new technique compare to conventional methods. Material and Methods : The surgery comprised of pedicle screw fixations on one level above and below the fracture site, and the fractured level itself, if pedicle is intact, and intra-operative vertebroplasty under the fluoroscopic guide with in-situ postero-lateral bone graft. Also, in cases of bone apposition, we removed those with small impactor through a transfascetal route. During the last 2 years, we performed in seven(7) unstable thoraco-lumbar fracture patients who consisted of two different characteristics, those four(4) with primary or secondary osteoporosis and three(3) of young and very healthy. All patients were followed clinically by A.S.I.A. score and radiography. Results : Mean follow up period was 14 months. We observed well decompressed state via transfascetal route in cases of bone fragments apposition and no hardware pullout in osteoporotic cases, no poly-methyl-methacrylate (PMMA) leakage through the fracture sites into the spinal canal, and no kyphotic deformities in both cases during follow-up periods. All patients demonstrated solid bony fusion except one following osteoporotic compression fracture on other sites. Conclusions : In the management of unstable thoraco-lumbar fracture, we believe that this short segment pedicle screw fixation with augmented intra-operative vertebroplasty reduce the total length or levels of pedicle screw fixation without post-operative kyphotic deformity.