• 대한두개안면성형외과학회지
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• 제22권4호
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• pp.209-213
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• 2021

Primary palatoplasty for cleft palate places patients at high risk for scarring, altered vascularity, and persistent tension. Palatal fistulas are a challenging complication of primary palatoplasty that typically form around the hard palate-soft palate junction. Repairing palatal fistulas, particularly wide fistulas, is extremely difficult because there are not many choices for closure. However, a few techniques are commonly used to close the remaining fistula after primary palatoplasty. Herein, we report the revision of a palatal fistula using a pedicled buccal fat pad and palatal lengthening with a buccinator myomucosal flap and sphincter pharyngoplasty to treat a patient with a wide palatal fistula. Tension-free closure of the palatal fistula was achieved, as well as velopharyngeal insufficiency (VPI) correction. This surgical method enhanced healing, minimized palatal contracture and shortening, and reduced the risk of infection. The palate healed with mucosalization at 2 weeks, and no complications were noted after 4 years of follow-up. Therefore, these flaps should be considered as an option for closure of large oronasal fistulas and VPI correction in young patients with wide palatal defects and VPI.

• Archives of Plastic Surgery
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• 제50권2호
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• pp.177-181
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• 2023

Digital extensor hypoplasia (DEH) is a rare malformation that presents with loss of active finger extension at the metacarpophalangeal (MCP) joints. Descriptions of optimal treatment and outcomes in this population are sparse. We describe successful operative treatment of a child with DEH involving the extensor digitorum communis, extensor digiti minimi, and the extensor indicis proprius tendons. The 5-year-old male patient was referred for severe limitation on bilateral finger extension since birth. He had been previously diagnosed with arthrogryposis and managed conservatively. Due to lack of improvement, magnetic resonance imaging was done evidencing hypoplasia/aplasia of the extensor tendons. The patient underwent successful tendon transfers using extensor carpi radialis longus to the common extensor tendons, and one hand required an additional tenolysis procedure. 2 years postoperatively, his MCP position and finger extension are markedly improved, and he is able to grip objects without limitation or difficulty. The patient returned to full activity without restriction.

• 대한두개안면성형외과학회지
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• 제17권2호
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• pp.82-85
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• 2016

We report two cases of cleidocranial dysplasia, which was managed without significant craniofacial osteotomy. A mother and daughter, both of normal intelligence, presented with central forehead depression, mid-face hypoplasia, and blepharoptosis. The fact that they have an identically deformed face implied a genetic basis. In both patients, radiologic evaluation revealed the underdeveloped maxilla, persistent fontanelle opening, and cleidal aplasia. Clinical findings and radiologic studies were consistent with the diagnosis of cleidocranial dysplasia. Both patients underwent forehead plasty via bicoronal approach, augmentation rhinoplasty using tip plasty, and epicanthoplasty. In addition, the mother underwent malar augmentation using Medpor implantation and reduction genioplasty. The patients did not experience any postoperative complication and remained satisfied with the operation at 6-year follow-up.

• 대한두개안면성형외과학회지
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• 제22권3호
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• pp.161-163
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• 2021

The soft tissue triangle is an easily recognizable subunit of the nose. Therefore, deformities in this region resulting from trauma or complications after cosmetic surgery can have serious cosmetic impacts. Various reconstruction choices exist for deformities such as depression of the soft triangle but choosing the most appropriate treatment in each case remains a challenge. In the case described herein, a patient underwent augmentation rhinoplasty with a silastic implant and experienced implant exposure in the soft triangle area. After implant removal, the patient complained of depression in this area. The authors effectively solved this problem through a de-epithelialized composite tissue graft. In this report, we present this case and review similar cases of reconstruction of the soft triangle.

• 대한기계학회논문집A
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• 제35권10호
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• pp.1329-1335
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• 2011

본 논문에서는 3 차원 유한요소 한계해석을 기반으로 하여 인장하중, 굽힘 모멘트 및 내압이 작용하는 원주방향 경사관통균열을 갖는 배관의 소성한계 하중값을 제안하였다. 본 연구에서 수행된 유한요소 모델 및 해석 방법은 이상화된 관통균열을 갖는 배관의 소성한계 하중값을 구하기 위한 기존의 이론식과의 비교를 통해 타당성을 입증하였다. 또한, 경사균열이 소성한계 하중값에 미치는 영향을 정량화하기 위하여 대규모의 3 차원 유한요소 해석을 통해 이상화된 관통균열 배관의 소성한계 하중값으로부터 경사관통균열 배관의 소성한계 하중값을 구할 수 있는 새로운 경사균열 보정계수를 제안하고자 한다. 본 논문의 결과인 경사균열 보정계수들은 각 하중조건 및 실제 조건의 형상들에 대해 표 형식으로 나타내었다.

• 대한두개안면성형외과학회지
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• 제9권2호
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• pp.85-89
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• 2008

Purpose: Unicoronal synostosis is the craniofacial anomaly caused by premature fusion of unilateral coronal suture. Ipsilateral flattening of the frontal and parietal bones, temporal retrusion with elevation and recession of the supraorbital rim are main clinical features. Compensatory contralateral frontal bossing and deviation of the nasal root and/or chin can also occur. There is a controversy about techniques for surgical correction, however, bilateral approach technique is more effective for correction of deformity. Methods: A 4-year-old patient with unicoronal synostosis had undergone unilateral suturectomy at 28-month-old but fronto-facial deformity had remained and aggravated as she grew older. She had both fronto-facial and endocranial asymmetry. We performed coronal cranial approach and fully exposed affected cranium including supraorbital rim. Anterior 2/3 calvarial reconstruction with bilateral frontal bone osteotomy and fronto-orbital bandeau advancement was performed. Results: Fronto-facial symmetry including fronto-orbital contour, nasal devation was improved. Endocranial twisting was also improved from $158^{\circ}$ to $162^{\circ}$ in CSO(crista gallisella turcica-opisthion) degree. There was no postoperative complications and no need for revision, and facial asymmetry improved at the period of 2 years of follow-up. Conclusion: Bilateral approach with fronto-orbital bandeau remodeling in surgery of unicoronal synostosis looked superior to unilateral approach in achieving better symmetry and preventing recurrence of asymmetry. Remodeling surgery should be tried in patients even at an older age to correct fronto-facial asymmetry.

• 대한두개안면성형외과학회지
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• 제20권6호
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• pp.361-369
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• 2019

Background: Trauma is one of the most common causes of enophthalmos, and post-traumatic enophthalmos primarily results from an increased volume of the bony orbit. We achieved good long-term results by simultaneously using an anatomical absorbable implant and iliac bone graft to correct post-traumatic enophthalmos. Methods: From January 2012 to December 2016, we performed operations on seven patients with post-traumatic enophthalmos. In all seven cases, reduction surgery for the initial trauma was performed at our hospital. Hertel exophthalmometry, clinical photography, three-dimensional computed tomography (3D-CT), and orbital volume measurements using software to calculate the specific volume captured on 3D-CT (ITK-SNAP, Insight Toolkit-SNAP) were performed preoperatively and postoperatively. Results: Patients were evaluated based on exophthalmometry, clinical photographs, 3D-CT, and orbital volume measured by the ITK-SNAP program at 5 days and 1 year postoperatively, and all factors improved significantly compared with the preoperative baseline. Complications such as hematoma or extraocular muscle limitation were absent, and the corrected orbital volume was well maintained at the 1-year follow-up visit. Conclusion: We present a method to correct enophthalmos by reconstructing the orbital wall using an anatomical absorbable implant and a simultaneous autologous iliac bone graft. All cases showed satisfactory results for enophthalmos correction. We suggest this method as a good option for the correction of post-traumatic enophthalmos.

• 대한두개안면성형외과학회지
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• 제22권4호
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• pp.193-198
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• 2021

Background: Nasal bone fractures are frequently encountered in clinical practice. Although fracture reduction is simple and correction requires a short operative time, low patient satisfaction and relatively high complication rates remain issues for many surgeons. These challenges may result from inaccuracies in fracture recognition and assessment or inappropriate surgical planning. Findings from immediate postoperative computed tomography (CT) scans and those performed at 4 to 6 weeks postoperatively were compared to evaluate the accuracy and outcomes of nasal fracture reduction. Methods: This retrospective study included patients diagnosed with nasal bone fractures at our department who underwent closed reduction surgery. Patients who did not undergo additional CT scans were excluded from the study. Clinical examinations, patient records, and radiographic images were evaluated in 20 patients with nasal bone fractures. Results: CT findings from immediately after surgery and a 1month follow-up were compared in 20 patients. Satisfactory nasal projection and aesthetically acceptable results were observed in patients with accurate correction or mild overcorrection, while undercorrection was associated with unfavorable results. Conclusion: Closed reduction surgery for correcting nasal bone fractures usually provides acceptable outcomes with relatively few complications. If available, immediate postoperative CT scans are recommended to guide surgeons in the choice of whether to perform secondary adjustments if the initial results are unsatisfactory. Based on photogrammetric data, nasal bone reduction with accurate correction or mild overcorrection achieved acceptable and stable outcomes at 1 month postoperatively. Therefore, when upward dislocation is observed on postoperative CT, one can simply observe without a subsequent intervention.

• Archives of Plastic Surgery
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• 제43권3호
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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.

• 대한두개안면성형외과학회지
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• 제21권2호
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• pp.92-98
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• 2020

Background: Posttraumatic acquired facial deformities require surgical treatment, with options including scar revision, fat grafts, implant insertion, and flap coverage. However, each technique has specific advantages and disadvantages. Methods: From 2016 to 2018, 13 patients (eight with scar contracture and five with a depressed scar) were treated using dermofat grafts from the groin. The harvested dermofat was then inserted into the undermined dead space after the contracture was released, and a bolster suture was done for fixation considering the patient's contour and asymmetry. A modified version of the Vancouver Scar Scale and satisfaction survey were used to compare deformity improvements before and after surgery. Results: In most cases, effective volume correction and an aesthetically satisfactory contour were maintained well after dermofat grafting, without any major complications. In some cases, however, lipolysis proceeded rapidly when inflammation and infection were not completely eliminated. A significant difference was found in the modified Vancouver Scar Scale before and after surgery, with a p-value of 0.001. The average score on the satisfaction survey was 17.07 out of 20 points. Conclusion: A dermofat graft with the groin as the donor site can be considered as an effective surgical option that is the simplest and most cost-effective method for the treatment of acquired facial deformities with scar contracture.