• Archives of Craniofacial Surgery
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• v.9 no.2
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• pp.85-89
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• 2008

Purpose: Unicoronal synostosis is the craniofacial anomaly caused by premature fusion of unilateral coronal suture. Ipsilateral flattening of the frontal and parietal bones, temporal retrusion with elevation and recession of the supraorbital rim are main clinical features. Compensatory contralateral frontal bossing and deviation of the nasal root and/or chin can also occur. There is a controversy about techniques for surgical correction, however, bilateral approach technique is more effective for correction of deformity. Methods: A 4-year-old patient with unicoronal synostosis had undergone unilateral suturectomy at 28-month-old but fronto-facial deformity had remained and aggravated as she grew older. She had both fronto-facial and endocranial asymmetry. We performed coronal cranial approach and fully exposed affected cranium including supraorbital rim. Anterior 2/3 calvarial reconstruction with bilateral frontal bone osteotomy and fronto-orbital bandeau advancement was performed. Results: Fronto-facial symmetry including fronto-orbital contour, nasal devation was improved. Endocranial twisting was also improved from $158^{\circ}$ to $162^{\circ}$ in CSO(crista gallisella turcica-opisthion) degree. There was no postoperative complications and no need for revision, and facial asymmetry improved at the period of 2 years of follow-up. Conclusion: Bilateral approach with fronto-orbital bandeau remodeling in surgery of unicoronal synostosis looked superior to unilateral approach in achieving better symmetry and preventing recurrence of asymmetry. Remodeling surgery should be tried in patients even at an older age to correct fronto-facial asymmetry.

• Archives of Craniofacial Surgery
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• v.21 no.4
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• pp.237-243
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• 2020

Background: The scalp is an important functional and aesthetic structure that protects the cranial bone. Due to its inelastic characteristics, soft-tissue defects of the scalp make reconstruction surgery difficult. This study aims to provide an improved scalp reconstruction decision making algorithm for surgeons. Methods: This study examined patients who underwent scalp reconstruction within the last 10 years. The study evaluated several factors that surgeons use to select a given reconstruction method such as etiology, defect location, size, depth, and complications. An algorithmic approach was then suggested based on an analysis of these factors. Results: Ninety-four patients were selected in total and 98 cases, including revision surgery, were performed for scalp reconstruction. Scalp reconstruction was performed by primary closure (36.73%), skin graft (27.55%), local flap (17.34%), pedicled regional flap (15.30%), and free flap (3.06%). The ratio of primary closure to more complex procedure on loose scalps (51.11%) was significantly higher than on tight scalps (24.52%) (p=0.011). The choice of scalp reconstruction method was affected significantly by the defect size (R=0.479, p<0.001) and depth (p<0.001). There were five major complications which were three cases of flap necrosis and two cases of skin necrosis. Hematoma was the most common of the 29 minor complications reported, followed by skin necrosis. Conclusion: There are multiple factors affecting the choice of scalp reconstruction method. We suggest an algorithm based on 10 years of experience that will help surgeons establish successful surgical management for their patients.

• Molecules and Cells
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• v.37 no.12
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• pp.907-911
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• 2014

The function of reactive oxygen species (ROS) as second messengers in cell differentiation has been demonstrated only for a limited number of cell types. Here, we used a well-established protocol for BMP2-induced neuronal differentiation of neural crest stem cells (NCSCs) to examine the function of BMP2-induced ROS during the process. We first show that BMP2 indeed induces ROS generation in NCSCs and that blocking ROS generation by pretreatment of cells with diphenyleneiodonium (DPI) as NADPH oxidase (Nox) inhibitor inhibits neuronal differentiation. Among the ROS-generating Nox isozymes, only Nox4 was expressed at a detectable level in NCSCs. Nox4 appears to be critical for survival of NCSCs at least in vitro as down-regulation by RNA interference led to apoptotic response from NCSCs. Interestingly, development of neural crest-derived peripheral neural structures in Nox4-/- mouse appears to be grossly normal, although Nox4-/- embryos were born at a sub-Mendelian ratio and showed delayed over-all development. Specifically, cranial and dorsal root ganglia, derived from NCSCs, were clearly present in Nox4-/- embryo at embryonic days (E) 9.5 and 10.5. These results suggest that Nox4-mediated ROS generation likely plays important role in fate determination and differentiation of NCSCs, but other Nox isozymes play redundant function during embryogenesis.

• Archives of Plastic Surgery
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• v.40 no.6
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• pp.735-741
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• 2013

Background The prosthetic dura is an essential element in the protection of the cranial parenchyma and prevention of cerebrospinal fluid leakage. Although prosthetic dura are widely used in neurosurgery, they occasionally provoke infection, which can be a major concern after neurosurgical treatment. However, removal of the prosthetic dura carries a risk of brain parenchyma injury and cerebrospinal fluid leakage. The salvage of infected prosthetic dural material has not been adequately addressed in the literature. In this study, we demonstrate the value of the combination of a meticulous surgical debridement of necrotic tissue and simultaneous muscle free flap for intractable postoperative epidural abscess without removal of the infected prosthetic dura. Methods Between 2010 and 2012, we reviewed the data of 11 patients with persistent infection on the prosthetic dura. The epidural infections each occurred after a neurosurgical procedure, and there was soft tissue necrosis with the disclosure of the underlying prosthetic dura and dead bone around the scalp wound. To salvage the infected prosthetic dura, meticulous debridement and a muscle free flap were performed. Results All 11 patients experienced complete recovery from the complicated wound problem without the need for further surgical intervention. No signs of prosthetic dural infection were observed during the mean follow-up period of 11 months. Conclusions The combination of a meticulous surgical debridement and coverage with a muscle free flap is an effective treatment for salvage of infected prosthetic dura.

• Journal of Veterinary Clinics
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• v.31 no.1
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• pp.54-56
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• 2014

A 9-year-old Korean native cattle was referred with chief complaint of left hind limb lameness during 2 months. He could not bear a weight on the left hind limb. On palpation, the stifle joint was swollen and mild fever was felt. In X-ray images, increased joint fluid, subchondral bone erosions, osteophyte formation along the trochlear ridge, and changes in the shape of the infrapatellar fat pad were shown. Cranial displacement of the tibia and intercondylar eminence could be seen. Based on the history, physical examination and radiographic findings, the bull was diagnosed as anterior cruciate ligament rupture. Because he could not participate in further bullfighting competition anymore, we indicated the slaughter as soon as possible.

• The Journal of the Korean bone and joint tumor society
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• v.11 no.1
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• pp.105-109
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• 2005

This journal reports three cases diagnosed with schwannomatosis in which no clinical symptoms of type 2 neurofibromatosis. The chief complain was pain. In adolescence and adult group, all masses were found. The locations were brachial plexus, popliteal fossa and hand. No hearing impairment, vertigo, tinnitus and visual disturbance was observed in any of the case. Family history was negative. In all cases, there was no evidence of vestibular schwannoma on cranial MRI imaging study. In all cases, Tinel sign was positive. Pathologic diagnosis was positive for schwannoma. Further study and case collection is needed to idenity the clinical manifestation, clinical course and genetic characteristic of schwannomatosis.

• Biomedical Science Letters
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• v.11 no.3
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• pp.355-363
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• 2005

This study aimed to investigate the cerebroprotective effect of vascular endothelial growth factor (VEGF) on permanent focal cerebral ischemia in Sprague-Dawley rats. Right middle cerebral artery (MCA) was occluded for 6 and 24 hours by an intraluminal monofilament technique. An open cranial window was made on the right parietal bone for determination of continuous changes in regional cerebral blood flow (rCBF) by laser-Doppler flowmetry. The infarct size was morphometrically determined using the 2,3,5-triphenyltetrazolium chloride technique. Brain edema was determined by measuring brain water content. In normal rats, rCBF was significantly increased by intravenous infusion of VEGF for 10 minutes. The VEGF-induced increase in rCBF was significantly inhibited by pretreatment with suramin, a heparin-binding growth factor inhibitor as well as $N^{\omega}-nitro-L-arginine$, a nitric oxide synthase inhibitor. In focal cerebral ischemic rats, the amplitude of decrease in rCBF during ischemic period was significantly less in VEGF-treated group, compared with that in vehicle-treated group. The cerebral infarct size was reduced by VEGF in a dose-dependent manner. The brain edema formation was dose-dependently reduced by VEGF in 24-hour MCA occlusion group but not in 6-hour MCA occlusion group. It is suggested that VEGF not only improves the rCBF during cerebral ischemic period but also reduces the brain edema formation, and thereby exert a protective effect on focal cerebral ischemia in rats.

• Biomedical Science Letters
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• v.11 no.2
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• pp.201-209
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• 2005

This study aimed to investigate the cerebroprotective effect of nociceptin on transient focal cerebral ischemia in Sprague-Dawley rats by determining the changes in regional cerebral blood flow (rCBF) and the infarct size. Right middle cerebral artery (MCA) was occluded for 2 hours, and thereafter was followed by reperfusion by an intraluminal monofilament technique. An open cranial window was made on the right parietal bone for determination of continuous changes in rCBF by laser-Doppler flowmetry. The infarct size was morphometrically determined using the 2,3,5-triphenyltetrazolium chloride technique. In normal rats, nociceptin ($0.01\~100\;nmol/kg$, Lv.) increased rCBF and decreased cerebral arterial resistance in a dose-dependent manner. Systemic arterial blood pressure was little affected by nociceptin at the doses of 0.01 and 0.1nmol/kg, but dose-dependently reduced at the doses of 1 nmol/kg or more. In transient cerebral ischemic rats, nociceptin ($0.01\~0.1$ nmol/kg, i.p.) significantly attenuated the postischemic cerebral hyperemia, and progressively increased rCBF. The improving effect of nociceptin on the postischemic rCBF response was markedly blocked by pretreatment with $[Nphe^1]nociceptin(1-13)NH_2$ (1 nmol/kg, i.p.), a selective nociceptin receptor antagonist, but not by naloxone ($3{\mu}mol/kg$, i.p.), a selective opioid receptor antagonist. The cerebral infarct size was significantly reduced by nociceptin ($0.01\~0.1$ nmol/kg) administered i.p. 5 min after MCA occlusion in transient cerebral ischemia of 2-hour MCA occlusion and 22-hour reperfusiion. It is suggested that nociceptin improves the postischemic cerebral hemodynamics and thereby has a cerebroprotective effect in transient focal cerebral ischemia.

• Journal of Veterinary Clinics
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• v.18 no.3
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• pp.243-248
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• 2001

Radiographic findings of degenerative joint disease (DJD) in the coxofemoral joints were studied in 108 dogs referred to Veterinary Medical Teaching Hospital, College of Veterinary Medicine, Seoul National University. Radiographic findings were identified with a extended ventrodorsal projection. Clinical signs such as pain in the affected joint, exercise intolerance, lameness, crepitation on flexion and extension of the joint and decreased range of motion, were shown in 40% and radiographic changes of bilateral coxofemoral joints were identified in 69% of a group of dogs. There are no sex predilections. Thirty-seven dogs were diagnosed as canine hip dysplasia (CHD; 10 cases), avascular necrosis of the femoral head (Legg-Calves-Perthes disease [LCPD]; 12 cases), fracture of the acetabulum (1 case), luxation(10 cases) and subluxation (15 cases), however, luxation and subluxation were identified in 11 dogs affected with CHD and LCPD. Causes of DJD in others (71case) were not identified. Radio-graphic findings identified included osteophyte formation at the attachment of the joint capsule (70%), sclerosis of the subchondral bone of the cranial acetabular edge (47%), remodeling of the femoral head (34%), thickening of the femoral neck(31%), perichondral osteophyte formation (31%), joint laxity (30%) and so on. All of the dogs diagnosed as CHD were large breed such as Retriever, Germain Shepherd, and Weimaraner and their age was under 1 year. This condition occurred bilaterally in 70% of affected animals. Dogs diagnosed as LCPD were young (under 1 year), small breed dogs. The incidence of LCPD is greater in Yorkshire Terrier, Miniature Pinscher and Poodle. This condition occurred unilaterally in 67% of affected animals. Clinical signs of dogs with unknown cause were shown in 15% and this condition occurred bilaterally in 75% of affected animals. Radiographic findings varied with patient's age and breed, however, the most common finding was osteophyte formation at the attachment of the joint capsule.

• Archives of Plastic Surgery
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• v.34 no.2
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• pp.186-190
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• 2007

Purpose: Plate systems have been used for osteosynthesis of cranial and oromaxillofacial fracture. However, there is no consensus on the need for routine removal of plate and the question about indications of removal. Therefore, we present the retrospective study to clarify the indications and consensus of removal. Methods: The medical records of patients who were treated with rigid internal fixation using plates after craniofacial trauma were reviewed. Study variables included age, gender, type of fracture, type of plate, seniority of the operator, causes of removal, and time between insertion and removal. All results amendable to statistics were analyzed using SPSS 10.0 to determine which set of variables might affect the fate of the plates. Results: For a period of 10 years (March 1, 1994 through July 31, 2004), total of 41 plates(6.7%) were removed among 609 plates inserted into 419 patients; 27 plates were removed from 15 patients for infection, which is the most common cause of removal accounting for 65.8%. Mean time between insertion and removal is 35.2 months and mean age is 41.4 years. Most plates were removed from combined fracture(14.92%) and facial fracture(8.47%) and these were statistically significant. The age, gender, seniority of the operator and other variables were not statistically associated with plate removal. Conclusion: This retrospective study shows that routine removal does not appear to be clinically indicated due to respectively low removal rate and that the commonest indications for removal were infection.