• Korean Journal of Bronchoesophagology
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• v.4 no.1
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• pp.117-121
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• 1998

Relapsing polychondritis is a rare disesase involving any cartilaginous structure of entire body and is characterized by recurrent episode of inflammation and degeneration of cartilage and most commonly involve ear, nose, larynx, trachea, ribs, Eustachian tube, etc. Its signs and symptoms are recurrent swelling of auricle, saddle nose deformity, polyarthralgia, hoarseness and dyspnea, audiovestibular disturbance and cardiovascular abnormality, etc. Characteristic histologic findings are loss of normal basophilic staining of cartilage, perichondrial inflammatory infiltration with plamsa cells, lymphocytes and neutrophils, and finality, destruction of cartilage and replacement with scar tissue. Our case had saddle nose deformity, arthralgia, tracheal collapse, hearig loss and positive histologic finding but no auricular perichnodritis. Her major problem was airway. obstruction due to tracheal collapse. This case was diagnosed with relapsing polychondritis according to the Damiani's criteria. This case indicates that any patients complaining of airway obstruction have to be examined systemically.

• Archives of Plastic Surgery
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• v.39 no.6
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• pp.601-605
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• 2012

Background Cryptotia is a congenital ear deformity in which the upper pole appears buried beneath the mastoid skin. Cryptotia is a common auricular malformation among Asians. The aim of this paper is to examine the surgical techniques for and complications of 34 cryptotic patients. Methods Surgery was performed for 34 cryptotic deformities (January 2005 to January 2012). Twenty-two patients (64.7%) were classified as having type I cryptotia, and 12 patients (37.5%) type II cryptotia. Among the type I cryptotia patients, 8 patients had mild deformity and 14 severe deformity. Among the type II cryptotia patients, 10 patients had mild deformity and 2 severe deformity. Results The mild deformities were corrected via Z-plasty, V-Y plasty, full-thickness skin graft, and transposition flap, while the severe deformities were corrected via cartilage graft or Medporfor the spread of cartilage adhesion of antihelix. There were two cases of reinvagination in the autologous cartilage graft group. Implant exposure occurred with Medpor (two cases). There were two cases of hypertrophic scar on the previous surgical wound with Medpor. There were no complications in the 18 patients who had mild deformities. Conclusions The type I cryptotia patients had more severe deformities than the type II cryptotia patients. As most of the type II cryptotia patients had only mild deformities, their deformities were corrected without using autologous conchal cartilage graft or Medpor, except for two patients. Through more case analyses, researchers should make an effort to identify methods for recurrence and prevention of complication.

• Archives of Plastic Surgery
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• v.33 no.4
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• pp.499-502
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• 2006

Purpose: Grave's disease is an autoimmune disease with chronic and systemic features. It affects the orbital fat and muscle bringing about defect in extrinsic eye motility, diplopia, optic nerve defect and lid retraction. In patients with lagopthalmos and resulting facial deformity, treatment can be done by rectus muscle recession or filling with various material. Autogenous auricular cartilage graft is often used and synthetic material such as synthetic acellular dermis, polyethylene meshs are also used for filling of the depressed area. Nevertheless, autogenous auricular cartilage grafts are difficult to utilize and synthetic materials sometimes result in protrusion or infection. Therefore, hard palate mucosa was considered as an alternative. We report two cases of patients with lower eyelid retraction corrected with autogenous hard palate mucosa. Methods: We performed this operation in two patients of Graves' ophthalmopathy. The capsulopalpebral fascia was incised and elevated through an incision on the conjunctiva. Then, the harvested hard palate mucosa was sutured to the inferior border of the tarsus and covered with the conjunctiva. Results: The lower eyelid retraction was corrected successfully. No hypertrophy or deformation of the transplanted hard palate mucosa was noted 6 months after the surgery. Conclusions: From the results above, we may conclude that the hard palate mucosa serves as an ideal spacer for the curvature and the inner lining in lower lid retraction. Hard palate mucosa is as sturdy as the autogenous cartilage but is much easier to utilize. It can be also used for lid retraction after lower lid aesthetic surgeries or traumas.

• Archives of Plastic Surgery
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• v.38 no.4
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• pp.451-457
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• 2011

Purpose: As a central feature of the face, the nose has considerable significance in appearance and expression. Reconstruction of full thickness defects of the nasal ala has always been a challenge because of the 3-dimensional structure. For reconstruction of post burn defects of ala, skin graft, local or pedicled flap and composite graft are optionally available. We have reconstructed the ala defects using adiposocutaneous graft and observed the outcome. Methods: From March 2003 to December 2010, 19 cases in 11 patients with scar contracture and defect on ala portion were performed operation using adiposocutaneous graft. As a donor site, we used the inguinal crease and posterior auricular area and the donor site was primarily closed. We made incision through the superior rim of ala and released fully. A graft is applied to recipient site with larger size than recipient volume. Results: The mean age of the patient was 38.6 years (16~51), males are seven patients and females are four patients. The operation was performed bilaterally in 5 patients and unilaterally in 6 patients. Composite grafts were harvested from inguinal area in 13 cases and posterior auricular area in 6 cases. In one case, we did 4 times of operation to get enough volume. All the grafts were well taken. The mean size of the graft was 3.63 $cm^2$. Conclusion: For reconstruction of post burn defects of ala, it's not easy to use local flap or pedicled flap because of hardness and fibrosis of surrounding tissue. So, we choose adiposocutaneous graft for ala deformity reconstruction, got satisfactory outcome in color matching and texture.

• Archives of Plastic Surgery
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• v.36 no.1
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• pp.118-121
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• 2009

Purpose: Constricted ear, which is named by Tanzer includes lop ear, cup ear, and sort of prominent ear. It has classified three groups by Tanzer, especially grou I and IIA have been corrected by banner flap, Musgrave's technique, tumbling concha - cartilage flap, reversed banner flap and others. However, these techniques were too invasive for correcting mild degree of deformity. Therefore, we corrected the ear with mattress suture which is simple and less invasive. Method: The operations were done against 5 patients from 2005 March to 2008 April. All the cases were unilateral ears with constriction included helix and scaphoid fossa without difference in length between both ears. Though a posterior auricular skin incision, the folded cartilage is exposed and two parallel incisions on superior crus were made. After mattress suturing in cartilage, the superior crus of antihelix was formed and its force enables the folded portion to be in a normal anatomic position. Result: All of 5 patients got satisfactory results. There were no complications like hematoma or skin necrosis, and no recurrence during follow - up period(the average period was 9 months). And we couldn't recognize the difference between height of both auricles. Conclusion: Mattress suture is simple, less invasive, and suitable on correcting mild deformity of constricted ear with better result, so here we suggest the method.

• Clinical and Experimental Pediatrics
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• v.59 no.sup1
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• pp.10-13
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• 2016

Chromosome 11q13 deletion syndrome has been previously reported as either otodental syndrome or oculo-oto-dental syndrome. The otodental syndrome is characterized by dental abnormalities and high-frequency sensorineural hearing loss, and by ocular coloboma in some cases. The underlying genetic defect causing otodental syndrome is a hemizygous microdeletion involving the FGF3 gene on chromosome 11q13.3. Recently, a new form of severe deafness, microtia (small ear) and small teeth, without the appearance of eye abnormalities, was also reported. In this report, we describe a 1-year-old girl presenting with ptosis of the left upper eyelid, right auricular deformity, high-arched palate, delayed dentition, simian line on the right hand, microcephaly, and developmental delay. In this patient, we identified a deletion in the chromosome 11q13.2-q13.3 (2.75 Mb) region by using an array-comparative genomic hybridization analysis. The deletion in chromosome 11q13 results in a syndrome characterized by variable clinical manifestations. Some of these manifestations involve craniofacial dysmorphology and require a functional workup for hearing, ophthalmic examinations, and long-term dental care.

• Archives of Plastic Surgery
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• v.33 no.1
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• pp.53-60
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• 2006

The current authors performed two-stage ear reconstruction of microtia using autogenous costal cartilage combined with canaloplasty of the acoustic meatus in a team approach. In the first stage, lobule transposition, fabrication of the cartilage framework, and implantation of the framework were peformed. In the second stage, elevation of the auricle, cartilage graft for posterior auricular sulcus, coverage with the mastoid fascia flap and skin graft, and concha excavation were performed. The canaloplasty was combined simultaneously in patients with radiologic and audiometric evidence of cochlear function in the second stage. A total of 36 consecutive patients with congenital microtia were treated from 1998 to 2003. Among them, 27 patients(male: 18, female: 9) ranging from 7 to 43 years old were combined with canaloplasty. The follow-up period was one year to 5 years. Thirteen patients exhibited improved hearing over 30 dB PTA(pure tone average), 9 patients below 30 dB, and 5 patients with no improvement. Complications related to the canaloplasty were chronic drainages of the auditory meatus and meatal stenosis. Lobule type deformity combined with the canaloplasty showed higher complications than concha type. Therefore, in the lobule type, meticulous manipulation is necessary to reduce complications after the canaloplasty.

• Archives of Plastic Surgery
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• v.43 no.6
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• pp.512-517
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• 2016

Background Studies of the ear-molding technique have emphasized the importance of initiating molding early to achieve the best results. In the present study, we describe the immediate effects and long-term outcomes of this technique, focusing on children who were older than the ideal age of treatment initiation. Methods Patients who visited our institution from July 2014 to November 2015 were included. Medical charts were reviewed to collect data on demographics, the duration of treatment, the types of deformities, and the manner of recognition of the deformity and referral to our institution. Parents were surveyed to assess the degree of improvement, the level of procedural discomfort at the end of treatment, any changes in the shape of the molded auricle, and overall satisfaction 12 months after their last follow-up visits. Results A review of 28 ears in 18 patients was conducted, including the following types of deformities: constricted ear (64.2%), Stahl ear (21.4%), prominent ear (7.1%), and cryptotia (7.1%). The average score for the degree of improvement, rated on a 5-point scale (1, very poor; 5, excellent), was 3.5 at the end of treatment, with a score of 2.6 for procedural discomfort (1, very mild; 5, very severe). After 12 months, the shapes of all ears were well maintained. The average overall satisfaction score was 3.6 (1, very dissatisfied; 5, very satisfied). Conclusions We had reasonable outcomes in older patients. After 1 year of follow-up, these outcomes were well maintained. Patients past the ideal age at presentation can still be candidates for the molding technique.

• Archives of Plastic Surgery
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• v.36 no.6
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• pp.788-791
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• 2009

Purpose: Reconstruction of full - thickness defects of the nasal ala has always been a challenge. Local flaps can be used easily, and good result can be achieved when it is indicated. But local flaps often result in facial scars and bulky ala that require secondary revisions. Composite auricular chondrocutaneous graft may matches nasal alae well in terms of contour, color and texture, however, the size of composite graft is limited. We performed free vascularized helical root flaps for reconstruction of nasal ala. Methods: Bilateral ala were excised and the defects were reconstructed with a chondrocutaneous free helical root flap. Each side of ala was reconstructed in 3 months interval. Superficial temporal vessels of vascularized helical root flap were anastomosed to facial vessels. Great saphenous vein was used for interpositional vascular graft. Results: Flaps were survived successfully. The contour, texture and color match were satisfactory. Functional problem of nasal obstruction caused by scar stenosis of nostrils was also resolved. Conclusion: The free vascularized helical root flap is a reliable method in reconstruction of nasal alar defects. The donor deformity was minimal.

• Journal of Chest Surgery
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• v.13 no.1
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• pp.77-81
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• 1980

We present one case of 26-year-old male having saddle block combined with mitral valvular disease [NYHA Class IV] with auricular fibrillation. The most common cause of emboli is atrial fibrillation. The clinical manifestations of saddle emboli are relatively slow due to development of collateral circulation and large size of lumen of the aorta. The 5month duration of saddle emboli in this case led to severe atrophic changes, coldness, peripheral cyanosis on the both lower extremities, and flexion deformity on the knee and ankle joint of the left lower extremity. We planned staged operation for the saddle block and for mitral stenoinsufficiency and tricuspid insufficiency, because of poor general condition of the patient. The thromboembolectomy of aortic bifurcation was performed through the transabdominal approach without trial of Fogarthy catheter embolectomy, because of expectation of the secondary inflammatory changes of the vessel wall and thrombi which was 3 cm X 1 cm X 0.5 cm in size with irregular surfaced solid in consistency. 1 month later, after thromboembolectomy, mitral valve replacement and tricuspid annuloplasty were performed, with successful early operative result. During operation organized thrombi [1 cm X 0.5 cm] in the left auricle was removed. We wonder if simple management using Fogarthy catheter might be possible to remove the thromboemboli instead of thromboembolectomy by aortotomy in this case.