• Maxillofacial Plastic and Reconstructive Surgery
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• v.15 no.2
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• pp.100-104
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• 1993

Carotid-cavernous sinus fistula(CCSF) is an abnormal arterio-venous communication between the cavernous sinus and the internal carotid artery. It is usually caused by craniofacial trauma and a very rarely encountered complication, but it may also occur spontaneously. The most common cause of traumatic CCSF is blunt trauma, which usually associated with a skull base, frontal or midfacial fracture. The common clinical feature of CCSF are orbital bruit, headache, exophthalmos, chemosis, diplopia, visual disturbance and others. This dramatic ocular-orbital symptoms are principally due to orbital venous hypertension. The symptoms occured within a few hours to a maximum of a year after injury, usually within several weeks. The patient, 33-year-old female, developed a carotid-cavernous sinus fistula after only minimal closed trauma We present a rare case of CCSF associated facial bone fracture that was successfully treated by detachable balloon embolization with a review of the literature.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.32 no.1
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• pp.62-67
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• 2010

The spreading pathways which is the cause of infection on head and neck area are submandibular space, masticatory space, parapharyngeal space, retropharyngeal space, carotid sheath and mediastinum, etc. If spread to parapharyngeal area involving airway, such infection can be life-threatening by airway obstruction, or can cause vascular injury followed by hemorrhage, nerve injuries. Also, if spread to superficially, necrotizing fasciitis and many complications may occur including gangrene of skin. The key to successful treatment of infection on head and neck area is recognition of spreading pathways, early diagnosis and following therapeutic management. Our department present two cases, one is infection progressed superficially to suprasternal space, another is spreading deep according to parapharyngeal space, subclavian space and carotid sheath followed by airway obstruction, and obtained significant results with surgical incision and drainage, administration of selected antibiotics, continuous post-operative treatment. We report these 2 cases with literatures review.

• Journal of Chest Surgery
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• v.30 no.7
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• pp.729-732
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• 1997

A case of chest wall malignant peripheral nerve sheath tumor(MPNST) was reported in the U.S.A by Mark and coworkers6)(1991), but none in korea. MPNST accounts for approximately 10% of all soft tissue sarcoma, mostly in patients between 20 and 50 years of age. MPNST arises in association with a major nerve trunk, including the sciatic nerve, brachial plexus, and sacral plexus and the most common anatomical site is the proximal portion of the upper and lower extremity and trunk. Surgical treatment is local excision of mass in low grade sarcoma but unblock resection is necessary in high grade sarcoma. We experienced multiple huge low grade MPNST on left chest wall of a 50 years old man. The tumor and invalved chest wall were removed, and the chest wall defect(15$\times$8 cm) was reconstructed with Teflon. Postoperative course was unevenful.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.11 no.2
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• pp.81-86
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• 1989

Tumors originated from peripheral nerve tissues are neurofibroma, neurilemoma, plexiform neurofibroma, malignant schwannoma, and granular cell tumor. Neurofibromas seem to occur in two forms : The first one is circumscribed solitary neurofibroma and the second group is neurofibromatosis or Von Recklinghausen's disease, which is a congenital and familial disease, presenting abnormalities of the skin, nerve system, bones and soft tissue. A solitary neurofibroma is a benign, relatively circumscribed, noncapsulated tumor which often presents in the skin and subcutaneous tissue as a soft sessile or pedunculated mass. It may occur anywhere in the head and neck, but the common site of the occurrence is the tongue, buccal mucosa, palate in frequency. Since solitary neurofibroma is a relatively radioresistant and its recurrence rate seem to be low, the treatment of choice is surgical excision. The author would like to present a case of unusually large solitary neurofibroma occured in the chin, which was successfully treated with surgical excision and reconstructed using deltopectoral flap and tongue flap.

• Archives of Craniofacial Surgery
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• v.13 no.1
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• pp.41-45
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• 2012

Purpose: Fibular osteocutaneous free flap is the procedure of choice for mandibular reconstruction. However, the anatomic consistency and the reliability of the skin paddle have been considered to be questionable and the utilization of the fibular osteocutaneous free flap can be challenging for the inexperienced surgeon. Preoperative computed tomography (CT) angiography can support revolutionary help with the operator design of the fibular osteocutaneous flap. The purpose of this article is to share the valuable experience of support with preoperative CT angiography. Methods: Three consecutive patients, who needed mandibular reconstruction, were treated with fibular osteocutaneous free flap. Each of the patients had undergone lower extremity CT angiography before the surgery. The CT angiographies were scrupulously investigated to calculate the locations and the tracts of the peroneal artery perforators. We compared the findings of the CT angiography with those of the real operation. Results: The information about the perforators was sufficiently matched with the findings of the operation. With the use of preoperative CT angiography, we were able to achieve confident performance during operation, shortening of operation time, and fine outcomes with a no flap failure. Conclusion: The CT angiography of lower extremity can provide reliable information of the perforators of the fibular osteocutaneous free flap.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.21 no.1
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• pp.69-73
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• 1999

Toxic shock syndrome is an acute disease involving multiple organs. I described here a case of TSS associated with intranasal packing. Four major criteria, which are involvement of multiple organ systems, fever, hypotension or shock, and rash with subsequent desquamation should be fulfilled for the diagnosis. The exact pathogenesis is not well understood, however it is thought to be due to the effects of an enterotoxin produced by certain strains of staphylococcus aureus.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.17 no.3
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• pp.289-295
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• 1995

Malignant fibrous histiocytoma rarely occurs in the jaws. Although the histogenesis of this tumor remains controversal, it is best regarded as a primitive and pleomorphic nature reflected by collagen production and occasional phagocytosis. It is common for metastatic foci to appear in lung and regional lymph node. There are variable treatments such as radiotherapy, surgical excision or combination therapy of surgical excision, chemotherapy and radiotherapy. With the review of literatures, the authors report the clinical study of two cases of malignant fibrous histiocytoma of the jaw.

• Korean Journal of Head & Neck Oncology
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• v.6 no.2
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• pp.79-84
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• 1990

This paper is a review of our experience with radical resection for cancer of the oral cavity with particular emphasis upon the value of myocutaneous(i.e., musculocutanous) flaps employed in the surgical reconstruction in patient survival. During the past 15 years, 98 patients underwent resection of cancer arising in the oral cavity and oropharynx. Of these, 14 had composite resections in which the mandible was not sectioned, and 4 underwent en bloc resections without neck dissections in the face of post-radiation recurrence. When these excluded, 84 patients who underwent COMMANDO procedures with or without myocutaneous flaps were suitable for analysis of recurrence and survival according to the various surgical technics employed. 1) According to the surgical technic, there were 24 standard COMMANDO procedures in whom no regional or myocutanous flap was used; 12 patients who underwent reconstruction employing a forehead flap; 19 patients in whom a posterior cervical 'nape' flap was employed; 27 patients who underwent myocutaneous or osteo-myocutaneous flap repair; and two patients who had double flap repair. 2) The uncorrected two-year disease free survival was 41% for standard COMMANDOs, 17% for forehead flap COMMANDOs; 35% for nape flap COMMANDOs; and 35% for myocutaneous flap COMMANDO procedures. 3) The two-year disease-free survival by Stage was 100% in Stage I, 45% in Stage II, 41% in Stage III, and 18% in Stage IV. 4) When myocutanous flaps cases were compared with Group I, comprised of matched historical controls including both Standard COMMANDOs and those who had undergone regional flap repairs(that is, forehead and nape flap COMMANDOs)there was no difference, both groups showing a 40% 2-year disease-free survival. 5) When musculocutanous flap cases were compared with Goup II, which was composed of matched historical controis limited to patients who had undergone regional flap repairs(that is, forehead and nape flap cases only)there was no difference, both groups showing a 27% 2-year desease-free survival. 6) When musculocutanous flap cases were compared with Group III, composed of patients who had undergone classic COMMANDO procedures without any sort of flap repair, there was a striking difference; the patients undergoing MC flap repair showed 50% 2-year disease-free survival, whereas the classic COMMANDO cases showed a 25% survival free of disease. 7) Locoregional recurrence was also evaluated in the four categories; for standard COMMANDO cases it was 25%, for nape flap cases 26% ; for forehead flap cases, 33%, and for the musculocutaneous flap cases, the lowest recurrence rate, 22%. These results are of particular significance in view of the fact that the proportion of advanced cases(Stage III and IV)in each category was 67% of standard cases, 79% of nape flap patients, 100% of forehead flap cases, and 96% of musculocutaneous flap cases.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.22 no.4
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• pp.373-382
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• 2000

Individual genetic susceptibilities to cancers may result from several factors including differences in xenobiotics metabolism to chemical carcinogens, DNA repair, altered oncogenes and suppressor genes, and environmental carcinogen exposures. Among them, genetic polymorphisms of metabolizing enzymes to chemical carcinogens have been recognized as a major important host factors in human cancers. They have two main types of enzymes: the phase I cytochrome P-450 mediating enzymes (CYPs) and phase II conjugating enzymes. The purpose of this study is to determine the frequencies of genotypes of phase I (CYP1A1 and CYP2E1) and phase II (NAT2) metabolizing enzymes in healthy control and head and neck cancer patients of Korean and to identify the relative high risk genotypes of these metabolizing enzymes to head and neck cancer in Korean. The author has analyzed 132 head and neck cancer patients and 113 healthy controls using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The results were as following; 1. The frequencies of genotypes of CYP1A1, CYP2E1 and NAT2 in healthy control were as following; CYP1A1 exon 7 polymorphism; Ile/Ile: Ile/Val: Val/Val = 59.3%: 36.3%: 4.4% CYP2E1 Pst I polymorphism, C1/C1: C1/C2: C2/C2 = 61.1%: 32.1%: 6.2% NAT2 polymorphism; F/F: F/S: S/S = 43.4%: 48.7%: 8.0% 2. In analysis of phase I enzyme, Val/Val genotype in CYP1A1 exon 7 polymorphism and C2/C2 genotype in CYP2E1 Pst I polymorphism were associated with relative high risks to head and neck cancers (Odds' ratio: 2.09 and 1.37, respectively). 3. Among the genotypes of NAT2 enzyme polymorphism, S/S genotype of NAT2 enzyme had 1.03 times of relative risk to head and neck cancers. 4. In combined genotyping of CYP1A1, CYP2E1, and NAT2 enzymes polymorphisms, the patients with Val/Val and C1/C1, C2/C2 and fast acetylator, and Val/Val and fast acetylator had higher relative risks than the patients with each baseline of combined genotypes (Odds' ratio: 2.82, 1.98 and 2.1, respectively). These results suggest the combined genotypes of Val/Val and C1/C1, C2/C2 and fast acetylator, and Val/Val and fast acetylator were more susceptible to head and neck cancers in Korean. And genotyping of metabolizing enzymes could be useful for predicting individual susceptibility to head and neck cancer.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.13 no.1
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• pp.63-68
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• 1991

The author has arrived at the following result after having carried out multilateral study based on a total of 282 maxillofacial fracture patients who have receive treatment at the Euijeongbu general hospital and Shinchun general hospital in the northern district of Kyunggido from march 1988 to august 1990. 1. Sex distribution of Mx. facial fx. patient was higher in male by 4.6:1 and was predominant in the 3rd decade with 40.4% followed in decreasing order by the 2nd decade and the 4th. 2. A majority were in the Mn. with 40.2% followed in decreasing order by zygoma. nasal bone and maxilla. 3. For the sex distribution according to anatomy, make to female ratio was 6.2:1 in the mandible, followed in decreasing order by zygoma, and nasal bone with predominance in male. 4. Car accident with 42.8% was the most common cause of fx. followed in decreasing order by violence, workmen's accident, and fall down. 5. The involvement of other trauma areas are head. 79.0%, abdomen-thorax, and the extremities in decreasing order. 6. In the mandibular fx. a majority were in the symphysis with 73.9% followed in decreasing order by angle, Condyle, and body. 7. Maxillary fx. of the type LeFort II was estimated to be 41.2% 8. Fracture in the zygoma including zygomatic arch was estimated to be 72.5%