SummaryBackground: Currently, endoscopic endonasal reduction and transcaruncular reduction are frequently used as surgical treatments for medial orbital wall fractures. However, these two surgical techniques have not been comprehensively compared using objective criteria. Therefore, the results of these two techniques were compared retrospectively using eight objective criteria in patients with medial orbital wall fracture. Methods:This study included 48 medial orbital wall fracture patients treated from June 1993 to July 2006: 29 had endoscopic endonasal reduction, and 19 had transcaruncular reduction. Computed tomographic scans, double vision field testing for diplopia using Goldmann perimetry, and Hertel's exophthalmometer were done pre-and post-surgery. Results:The average follow-up period was 70.8 months. Among patients with pure medial orbital wall fractures, the average reduction rate was 89.2% for the endoscopic endonasal reduction group and 90.7% for the transcaruncular reduction group. One case in the endoscopic endonasal reduction group had a more than 2 mm enophthalmos after surgery. The diplopia correction rate was 1.8% in the endoscopic endonasal reduction group and 2.7% in the transcaruncular reduction group. None of the above differences were statistically significant. However, among patients with pure medial orbital wall fractures, compared to the trancaruncular reduction group, the average operation time, the average hospital stay, and the average cost were significantly greater in the endoscopic endonasal reduction group. Conclusions:The two surgical methods had a similar effectiveness; however, transcaruncular reduction appeared to be more advantageous with respect to the operation time, the length of hospital stay and cost. BACKGROUNDMedial orbital wall fractures occur in the most fragile area, the lamina papyracea, and are caused by blunt periorbital trauma. In contrast to inferior orbital wall fractures, the clinical symptoms of medial orbital wall fractures are minor, even in cases with displacement. Thus, medial orbital wall fractures may be left ignored and untreated. In fact, while the incidence of these fractures is high, the diagnostic rate is low. Since these fractures are associated with large defects, medial orbital wall fractures can cause late enophthalmos. If surgery is not performed at the appropriate time, noticeable enophthalmos can develop. Hence, aggressive diagnosis and surgical correction are desirable for medial orbital wall fracture patients.

In the 1990s, skin island flaps supplied by the vascular axis of sensitive superficial nerves, like the sural and saphenous nerves, were introduced. Flaps supplied by the superficial peroneal nerve accessory artery (SPNAA), however, are still not commonly used. The aim of this study is to understand the anatomical structure of the SPNAA and its perforators in the anterior intermuscular septum, and to utilize SPNAA perforator flaps in the clinic.We dissected sixteen cadavers and assessed the location and number of the SPNAA, its perforators, and the septocutaneous perforators originating from the anterior tibial artery. A SPNAA perforator flap was applied to twelve patients, the free flap was applied to eleven patients, and the pedicled flap was applied to one patient.SPNAA varied from 7 to 16 cm in length with an average of 4.5 perforators to supply lateral aspect. An average of 3.13 septocutaneous perforators originated from the anterior tibial artery. The mean size of the SPNAA perforator flaps was 65.5 cm 2 . The complete follow-up period was 3-20 months. Although one flap was lost as a result of arterial thrombosis, the procedure was successful in the remaining eleven patients. In addition, reduced flap thickness made them more aesthetically appealing.SPNAA perforator flaps could be an excellent alternative to perforator flaps that use the lower leg as a donor site.

We reported previously that the activity of the large-conductance calciumactivated potassium channels (BK Ca channel) could be strongly potentiated by certain derivatives of benzofuroindole scaffold when treated from extracellular side of the membrane (Gormemis et al., 2005; Ha et al., 2006). In order to localize the receptor site on the BK Ca channel, we surveyed the effects of CTBIC, the most potent benzofuroindole compound, on various K þ channels. While the compound increase the activity of voltage-gated K þ channels, K V 1.5 and HERG, CTBIC did not affect the activity of inward rectifier K þ channel, Kir3.1, significantly. Intriguingly enough, the same compound greatly decreased the activity of SK2, a different subclass of Ca 2þ -activated K þ channel. In addition, the affinity of charybdotoxin, a peptide pore-blocker, was reduced by the co-treatment with CTBIC, whereas that of tetraethylammonium, a small pore-blocking quaternary ammonium, was not altered. Guided by these results, we performed mutagenesis studies on the outer vestibule of the BK Ca channel to localize the residues that affect the binding of CTBIC. We identified three residues in the loop that connects with the pore-forming region of the channel, which was strongly affected by alanine substitution. Our results suggest that the turret region of the BK Ca channel may play a critical role in the modulation of the channel activity and may thus represent a therapeutic target site of K þ channels.

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