No abstract

BackgroundThe nasal septal cartilage is often used as a donor graft in rhinoplasty operations but can vary widely in size across the patient population. As such, preoperative estimation of the cartilaginous area is important for patient counseling as well as operating planning. We aim to estimate septal cartilage area by using facial computed tomography (CT) studies.MethodsThe study was performed using facial CT images taken from 200 patients between January 2012 to July 2015. Using the mid-sagittal image, the boundary of cartilaginous septum was delineated from soft tissue using the mean difference in signal intensity (or brightness). The area within this boundary was calculated. The calculated area for septal cartilage was then compared across age groups and sexes.ResultsOverall, the mean area of nasal septal cartilage was 8.18 cm2 with the maximum of 12.42 cm2 and the minimum of 4.89 cm2. The cartilage areas were measured to be larger in men than in women (p<0.05). The area decreased with advancing age (p<0.05).ConclusionMeasuring the size of septal cartilage using brightness difference is more precise and reliable than previously reported methods. This method can be utilized as the standard for prevention of postoperative complication.

BackgroundMost nasal bone fractures are corrected using non-invasive methods. Often, patients are dissatisfied with surgical outcomes following such closed approach. In this study, we compare surgical outcomes following blind closed reduction to that of ultrasound-guided reduction.MethodsA single-institutional prospective study was performed for all nasal fracture patients (n=28) presenting between May 2013 and November 2013. Upon research consent, patients were randomly assigned to either the control group (n=14, blind reduction) or the experimental group (n=14, ultrasound-guided reduction). Surgical outcomes were evaluated using preoperative and 3-month postoperative X-ray images by two independent surgeons. Patient satisfaction was evaluated using a questionnaire survey.ResultsThe experimental group consisted of 4 patients with Plane I fracture and 10 patients with Plane II fracture. The control group consisted of 3 patients with Plane I fracture and 11 patients with Plane II fracture. The mean surgical outcomes score and the mean patient dissatisfaction score were found not to differ between the experimental and the control group in Plane I fracture (p=0.755, 0.578, respectively). In a subgroup analysis consisting of Plane II fractures only, surgeons graded outcomes for ultrasound-guided reduction higher than that for the control group (p=0.007). Likewise, among the Plane II fracture patients, those who underwent ultrasound-guided reduction were less dissatisfied than those who underwent blind reduction (p=0.043).ConclusionOur study result suggests that ultrasound-guided closed reduction is superior to blind closed reduction in those patients with Plane II nasal fractures.

BackgroundLobular keloid appears to be a consequence of hypertrophic inflammation secondary to ear piercings performed under unsterile conditions. We wish to understand the pathogenesis of lobular keloids and report operative outcomes with a literature review.MethodsA retrospective review identified 40 cases of lobular keloids between January, 2005 and December, 2010. Patient records were reviewed for preclinical factors such as presence of inflammation after ear piercing prior to keloid development, surgical management, and histopathologic correlation to recurrence.ResultsThe operation had been performed by surgical core extirpation or simple excision, postoperative lobular compression, and scar ointments. Perivascular infiltration was noted in intra- and extra-keloid tissue in 70% of patients. The postoperative recurrence rate was 10%, and most of the patients satisfied with treatment outcomes.ConclusionHistological perivascular inflammation is a prominent feature of lobular keloids. Proper surgical treatment, adjuvant treatments, and persistent follow-up observation were sufficient in maintaining a relatively low rates of recurrence.

No abstract

BackgroundAsymmetry of the infraorbital rim can be caused by trauma, congenital or acquired disease, or insufficient reduction during a previous operation. Such asymmetry needs to be corrected because the shape of the infraorbital rim or midfacial skeleton defines the overall midfacial contour.MethodsThe study included 5 cases of retruded infraorbital rim. All of the patient underwent restoration of the deficient volume using polyethylene implants between June 2005 and June 2011. The infraorbital rim was accessed through a subciliary approach, and the implants were placed in subperiosteal space. Surgical outcomes were evaluated using preoperative and postoperative computed tomography studies.ResultsImplant based augmentation was associated with a mean projection of 4.6 mm enhancement. No postoperative complications were noted during the 30-month follow-up period.ConclusionBecause of the safeness, short recovery time, effectiveness, reliability, and potential application to a wide range of facial disproportion problems, this surgical technique can be applied to midfacial retrusion from a variety of etiologies, such as fracture involving infraorbital rim, congenital midfacial hypoplasia, lid malposition after blepharoplasty, and skeletal changes due to aging.

No abstract

Background Many studies about the levator aponeurosis complex of the blepharoptosis have already been presented. However, the studies about the changes of the levator aponeurosis are relatively insufficient. So, this study was performed to observe histological changes of levator aponeurosis that arise depending on the severity of blepharoptosis and the age. Methods Twenty patients who have undergone surgical treatment for blepharoptosis from 2013 to 2014 were analyzed in this study. Patients were categorized mild or severe group according to the severity of blepharoptosis, and the age. Through the blepharoplasty incision, we harvested the specimens of the levator aponeurosis on the upper border of tarsal plate. After staining the specimens with the Verhoeff-van Gieson technique, the changes of elastin was analyzed in a histopathological manner. Results Light microscopy of the levator aponeurosis stained positively for elastic fibers using the Verhoeff-van Gieson technique. Elastic fibers appear to have direct connections with the collagen fiber of the levator aponeurosis. The amount of the elastin was decreased in the old age group. And the amount of elastin was decreased markedly in severe blepharoptosis group. Conclusions The elastin of the levator aponeurosis was decreased in old age and elastin tended to decreased markedly in severe levator function group. The levator aponeurosis plays a greater role in the eyelid ptosis. Therefore, knowledge about the histologic changes of the levator aponeurosis may give more help us to understand the high recurrence rate of the blepharoptosis in old age. Also, considering this information, will be helpful to the blepharoptosis surgery.