• Archives of Plastic Surgery
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• v.37 no.4
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• pp.499-530
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• 2010

Purpose: Lateral osteotomy is an essential step in the correction of nasal bony asymmetry. Direct visualization allows accurate repositioning of the nasal bones compared to blind techniques, which require precision and manual dexterity. We propose direct visualization procedures in open corrective rhinoplasty. Methods: The technique was used on 16 patients. All patients underwent open rhinoplasty with a columellar incision. The marginal incisions were extended on either side to allow access to the piriform aperture. A double hook was used to caudally retract the lower lateral cartilages and the fibrous connections between the upper and lower lateral cartilages were released until the piriform aperture was visualized. Through the incision, lateral osteotomy was performed using a reciprocating saw at that time with direct visualization. Additional procedures including augmentation rhinoplasty, hump resection, septoplasty and tip plasty were performed simultaneously. Results: This method provided excellent exposure to the lateral nasal bones and allowed the lateral osteotomy to be carried out precisely using the reciprocating saw. Conclusion: This extended open rhinoplasty method is suitable for most individuals, allowing a wide surgical field.

• Archives of Plastic Surgery
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• v.37 no.4
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• pp.492-495
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• 2010

Purpose: Facial tumor excision is a common cause of lower eyelid defect in old patients. Many methods have been introduced for the reconstruction of lower eyelid. However, conventional surgical method can cause various complications like scar, ectropion and unnatural color matching. Thus, we introduce a simple and aesthetically acceptable method for the reconstruction of lower eyelid defect. Methods: Three elderly patients with skin cancer in the unilateral lower eyelid were operated by the new method. Following a wide excision of skin cancer, subcilliary incision of lower blepharoplasty was carried out. Elevated skin flap of lower eyelid was redrapped for the correction of defect and the remnant skin from lateral portion of lower eyelid was used for full thickness skin graft (FTSG) to correct the remaining defect. Results: All grafts survived and color match of the graft was excellent without ectropion. Furthermore, wrinkles of the lower eyelid were improved after the blepharoplasty. Conclusion: Lower eyelid defect resulting from wide excision of malignant tumor in old patients could be reconstructed successfully by modifying the conventional lower eyelid blepharoplasty along with FTSG using the remnant skin.

• Archives of Plastic Surgery
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• v.51 no.1
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• pp.67-71
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• 2024

Clavicle fractures are frequent injuries accounting for approximately 4% of all fractures in adults with about 35% occurring in the shoulder region among which midshaft fractures are the most common (>66%). Nonsurgical management is the treatment of choice for most clavicle fractures; however, poor functional and aesthetic outcomes may result from nonunion, symptomatic malunion, and aesthetic impairment which are the most common complications. A young woman was referred to our clinic for a "Step Deformity" resulting after primary, nonsurgical treatment of a midshaft clavicle fracture. Residual deformity was corrected with a novel simple and little invasive approach. Midshaft clavicle fractures typically only require conservative nonsurgical treatment, nevertheless suboptimal outcomes may occur. Selective osteotomies and fixation are deemed too invasive when only cosmetic impairment of the clavicle contour is present without any functional or sensitive damage and most patients are discouraged from undergoing surgery. Thus far, no specific focus on this topic, nor exploration of possible correction can be found in the published literature. These residual deformities may be very noticeable sometimes and cause psychological distress and social life impairment. Despite no related functional impairment, this deformity should still be addressed, to improve patients' quality of life.

• Archives of Plastic Surgery
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• v.38 no.6
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• pp.747-754
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• 2011

Purpose: The Abbe flap procedure has been used to correct disharmony of the upper and lower lips as well as for making a philtrum for patients with secondary cleft lip deformities. But the Abbe flap procedure adds two scars in addition to the prior operative scar on the upper lip. This study was conducted to determine the treatment outcomes of esthetic subunit excision of the scar on the philtrum and Abbe flap coverage for correction of cleft lip deformities with photogrammetric analysis. Methods: This study investigated a total of 11 patients with cleft lip deformities who underwent scar excision with Abbe flap coverage, and the patients were followed up for at least 6 months. Under general anesthesia, a mushroom-shaped Abbe flap was drawn on the lower lip with a width of 8 mm and a height 1~2 mm longer than that of the philtral midline. The epidermis and dermis of the scar on the upper lip were excised. In the cases with alar base depression, the orbicularis oris muscle was split vertically and transposed to the alar base. The Abbe flap was harvested as a pedicled flap containing a small amount of muscle and this was rotated 180-degree to be inserted into the upper lip. Mucosa, muscle, subcutaneous tissue and skin were closed in layers. The flap was divided at the 7~14 postoperative day. The postoperative outcomes were evaluated by using photogrammetric analysis. Three indices were measured from the standard clinical photographs taken before and after the surgery. For anthroposcopic assessment, observers described the postoperative outcomes using an ordinary scale method. Results: The postoperative values obtained in the photogrammetric analysis showed improvement as compared with the preoperative ones. Improved anthroposcopic outcomes were also noted. Conclusion: Scar excision and Abbe flap coverage were proven to be effective in improving protrusion and the height of the upper lip, the scar of the upper lip and the symmetry of Cupid's bow and the philtral column, as well as formation of the philtral dimple.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.35 no.4
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• pp.256-259
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• 2013

Botulinum toxin type A (BTX-A) inhibits muscle contraction, which leads to reversible muscle atrophy and paralysis. Therefore, BTX-A injection can be an effective treatment of facial asymmetry that originated from the uncoordinated muscle movement. A 52-year-old patient was referred from another hospital for the correction of post-traumatic sequelae. The patient had prominent scar in the mandibular symphysis area with asymmetric lower lip movement. The reason for this asymmetric lower lip movement was due to damage in the lower lip depressor muscle. After the injection of BTX-A on the lower lip depressors, asymmetric lip movement has been improved.

• Archives of Plastic Surgery
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• v.36 no.3
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• pp.322-326
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• 2009

Purpose: Severe type of inverted nipple (cannot be pulled out above the areola plane by manipulation, grade III) usually cannot be corrected by a relatively simple purse - string suture technique. Most patients want to avoid visible scars. To treat the severe case and avoid visible stigma, we introduce this invisible dermal flap method. Methods: This new surgical procedure makes bilateral incisions on the sidewall of nipple and dissections vertically to free the ducts from the contracted tissues. After dissection, the tunnel is formed. We insert "dermal flaps" into the tunnel underneath nipple base. Then through - and - through sutures are performed vertically (6 o'clock and 12 o'clock positions) and the purse - string suture is added with 4 - 0 nylon. Results: We had treated 35 primary inverted nipples (grade III) in 27 patients and 13 recurrent nipples in 7 cases. The results were excellent in 45 nipples (93.7%). All but 3 recurred cases was fully or very satisfied with the results. Conclusion: This technique is effective for the correction of severe inverted nipples and recurrent cases. We can avoid the visible scars on the areola surface.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.23 no.4
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• pp.366-375
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• 2001

Bone shaving for surgical correction is general method in facial asymmetrical patient with fibrous dysplasia. Therefore, decision of bone shaving amount on the preoperative planning is very difficult for improvement of ideal occlusal relationship and harmonious face. Preoperative planning of facial asymmetry with fibrous dysplasia is generally confirmed by the simulation surgery based on evaluation of clinical examination, radiographic analysis and analysis of facial study model. However, the accurate postoperative results can not be predicted by this method. By using the computed tomography based RP(rapid prototyping) model, simulation of facial skeleton can be duplicated and 3-dimensional simmulation surgery can be perfomed. After fabrication of postoperative study model by preoperactive bone shaving, preoperative and postoperactive surgical index was made by omnivaccum and clear acrylic resin. Amount of bone shaving is confirmed by superimposition of surgical index at the operation. We performed the surgical correction of facial asymmetry patients with fibrous dysplasia using surgical index and prototyping model and obtained the favorable results.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.41
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• pp.21.1-21.3
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• 2019

Background: Treatment planning the correction of a transverse maxillary occlusal plane cant often involves a degree of qualitative "eyeballing", with the attendant possibility of error in the estimated judgement. A simple chair side technique permits quantification of the extent of asymmetry and thereby quantitative measurements for the correction of the occlusal plane cant. Methods: A measuring instrument may be constructed by soldering the edge of a stainless steel dental ruler at 90° to the flat surface of a similar ruler. With the patient either standing in natural head position, or alternatively seated upright in the dental chair, and a dental photographic retractor in situ, the flat under-surface of the horizontal part of this measuring instrument is placed on a unilateral segment of a bilateral structure, e.g. the higher maxillary canine orthodontic bracket hook. The vertical ruler is held next to the contralateral canine tooth, and the vertical distance measured directly from the canine bracket to the flat under-surface of the horizontal part of the measuring instrument. Results: This vertical distance quantifies the overall extent of movement required to level the maxillary occlusal plane. Conclusions: This measuring instrument and simple chair side technique helps to quantify the overall extent of surgical levelling required and may be a useful additional technique in our clinical diagnostic armamentarium.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.34 no.5
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• pp.343-348
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• 2012

Treatment of hemifacial atrophy is a challenge for oral & maxillofacial surgeons. The surgical approach basically focused on skeletal correction so that the overlying soft tissues can be improved by the osseous change of the skeleton. However, the treatment ends up with insufficient soft tissue mophology in most cases even after skeletal correction. Therefore comprehensive hard and soft tissue reconstruction is needed for treating the hemifacial atrophy. In this case report, we experienced a successful result after combined orthognathic and microvascular adipofascial flap reconstruction for hemifacial atrophy patient.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.35 no.3
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• pp.184-188
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• 2013

Post-traumatic enophthalmos is a relatively common problem following orbitozygomatic fractures. Bony-volume expansion and soft tissue atrophy are considered the main etiological causes of this condition. Enophthalmos is corrected mostly through reducing the enlarged orbit volume. Autogenous graft and various alloplastic materials are used for this purpose. Porous polyethylene is highly biocompatible, durable, and remarkably stable. Also, the titanium plate embedded in a porous polyethylene sheet provides radiographic visibility and increased sheet strength and contour retention. We present experiences of titanium reinforced porous polyethylene for correction of the traumatic enophthalmos with literature review.