• Archives of Craniofacial Surgery
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• v.10 no.1
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• pp.44-48
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• 2009

Purpose: The treatment of arteriovenous malformation (AVM) of the face remains a difficult challenge in plastic surgery. Incomplete resection resulting in uncontrolled bleeding, postoperative enlargement of the remaining malformation, and a poor functional and cosmetic result could be the problems confronted by the surgeons. Methods: A 37 year-old male with large arteriovenous malformation in face treated with preoperative superselective transarterial embolization and free flap transfer. The size of the defect was $13{\times}9cm$. Sclerotheraphy without resection were performed several times but the results were unsatisfactory. Resection was performed the next day of embolization. We were able to repair with the thoracodorsal artery perforator free flap. And facial muscle reconstruction performed by simultaneous muscle and nerve transfer. Results: During the follow-up period 8 months the patient regained an acceptable cosmetic appearance. And he has shown no reexpansion of the malformation. Conclusion: The thoracodorsal artery perforator free flap could be a good choice for the reconstruction for massive defects of the face. A huge arteriovenous malformation could be safely removed and successfully reconstructed by the complete embolization, wide excision and coverage with a well vascularized tissue.

• Archives of Craniofacial Surgery
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• v.12 no.1
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• pp.43-47
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• 2011

Purpose: Romberg's disease manifests as progressive hemifacial atrophy of the skin, soft tissue and bone, which usually begins in the first or second decade of life. When present, atrophy may originate from the cutaneous stigmata and may become so sharply delimited by the midline. Methods: A 10-year-old girl, who had suffered from right mandibular area atrophy for 3 years, visited us and was diagnosed with Romberg's disease. The depressed lesion of the face was augmented successfully using a deepithelialized groin free flap. The superficial circumflex iliac vessels were used as the donor pedicle and the facial artery and vein were used as the recipient vessels. Results: After surgery, the flap survived well and she was satisfied with the result. Although there are various methods of facial augmentation using free flaps, this flap has some advantages. First, there is a considerable amount of fat tissue components for augmentation. Second, flap elevation with thinning is possible. Third, the donor site can be hidden. Conclusion: The groin dermo-fat free flap is a good method for the facial augmentation of Romberg's disease.

• Journal of Korean Neurosurgical Society
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• v.40 no.4
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• pp.277-280
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• 2006

Extracerebral cavernous hemangiomas are rare vascular tumors that are very difficult to remove because of severe intraoperative bleeding. We report a case of 57-year-old male with extracerebral cavernous hemangioma with review of 126 cases in the literature. Patient presented with blurred vision, diplopia, numbness on the left side of his face. Magnetic resonance imaging revealed a well defined mass of $3{\times}4{\times}3cm$ size with heterogenous iso-or hypointensity on T1-weighted image showing strong homogenous contrast enhancement and marked hyperintensity on T2-weighted image. Digital subtraction angiography[DSA] revealed a faint tumor blush by feeders from the left internal carotid artery[ICA] and left external carotid artery[ECA] in the delayed phase. Even with profuse intratumoral bleeding, near total removal was achieved. In addition to preoperative neurologic deficits such as ophthalmoplegia, facial numbness in the V1-2 dermatomes, ptosis appeared postoperatively.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.22 no.2
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• pp.243-248
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• 2000

Carotid cavernous sinus fistula(CCSF) is an abnormal communication at the base of the skull between the internal carotid artery and the cavernous sinus. Fistula is almost associated with extensive facial trauma as a result of direct or indirect forces. Most fistulas of traumatic origin develop as a result of fractures through the base of the skull, which cause the laceration of the internal carotid artery near the cavernous sinus. The signs and symptoms of CCSF are pulsating exophthalmosis, orbital headache, pain, orbital or frontal bruit, loss of visual acuity, diplopia and ophthalmoplegia. Angiography reveals a definite CCSF and a detachable balloon embolization is known to be the treatment of choice. Even though carotid cavernous sinus fistula is an uncommon complication after orthognathic surgery, several cases of CCSF due to congenital anomalies, pre-existing aneurysms and abnormally thickened maxillary posterior wall have been reported in the literature. We have experienced a case of CCSF after Le Fort I osteotomy for maxillary advancement in skeletal class III patient and the cause, pathogenesis, diagnosis and treatment of this case.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.33 no.6
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• pp.525-528
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• 2011

A deep circumflex iliac artery (DCIA) flap is usually used for reconstruction in oral and maxillo-facial surgery department since introduced by O'Brien in 1975. Various flap designs are possible for osteomusculocutaneous, musculocutaneous, musculosseous and vascularized bone types. Iliac crest shape is similar to contour of mandible. Moreover, though a fibular flap has only 15~20 mm of cutting plane width, a DCIA flap contains much more bone amount, making this a similar reconstruction compare with normal mandible. A 68 year-old male with squamous cell carcinoma on the anterior floor of the mouth had an impression with T2N0Mx and the treatment procedure was DCIA reconstruction after wide resection and marginal mandibulectomy, with both supraomohyoid neck dissection. We present an experience of DCIA flap for reconstruction with a literature review.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.31 no.6
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• pp.526-530
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• 2009

Recently, the anterolateral thigh(ALT) flap, based on the septocutaneous vessels or musculocutaneous perforators from the descending branch of the lateral circumflex femoral artery has gained popularity in head and neck soft-tissue reconstruction. It has some advantages in free-flap surgery with respect to the radial forearm free flap, such as low donor site morbidity, availability of different tissues with large amounts of skin, adaptability as a sensate or flow-through flap (with the possibility of harvesting a long pedicle with a suitable vessel diameter). Moreover, the thickness of the flap is adjustable until the subdermal fat level, allowing it to be used as a thin or ultrathin flap. This clinical cases are ALT free flap reconstructions without functional impairment of the donor limbs (transitory and permanent) based on anastomosis with superficial temporal arteries and veins in patient of huge resection defect on face, lip and tongue.

• Journal of Oral Medicine and Pain
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• v.45 no.2
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• pp.44-47
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• 2020

The case of pseudo-aneurysm of internal maxillary artery (IMA) in oral and maxillofacial region is known to be very rare. The etiology of this case was regarded as IMA injury by radiofrequency ablation (RFA) and such incidence was not reported previously. One case of false aneurysm in the IMA was referred from local dental clinic to our department. Left facial swelling was observed with severe trismus immediately after radiofrequency procedure for masseteric nerve block in local dental clinic. Despite of medication and surgical intervention, the swelling did not subside and there was massive bleeding and pulsation on one of the follow ups. The traumatic vascular disorder was suspected and finally diagnosed with angiography and treated by embolization procedure. RFA targeting masseteric nerve or trigeminal ganglion may cause traumatic injury to adjacent anatomic structures such as IMA, resulting in pseudo-aneurysm. Clinicians must be aware of potential damages of RFA. Angiography enables the solid diagnosis for pseudo-aneurysm, and selective embolization can be optimum treatment method.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.45 no.6
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• pp.364-368
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• 2019

A Le Fort I osteotomy is a common procedure for correcting dental and facial deformities in orthognathic surgery. In rare cases, a delayed hemorrhage can occur as early as several hours or up to 12 weeks, postoperatively. The most frequently involved blood vessels in a delayed hemorrhage are the descending palatine artery, the internal maxillary artery, and the pterygoid venous plexus of veins. Intraoral bleeding accompanied by severe epistaxis in these cases makes it difficult to locate the precise bleeding focus. Eventual uncontrolled bleeding would require Merocel packing or surgical intervention. In general, a severe late postoperative hemorrhage is most effectively managed by angiography and embolization. Herein we describe a delayed hemorrhage case in which the cause was not evident on angiography. We were able to detect the bleeding point through an endoscopic nasal approach and treat it using direct cauterization.

• Archives of Reconstructive Microsurgery
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• v.14 no.2
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• pp.112-116
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• 2005

The auricle is easy to be amputated in the face due to its protruding position. When facial parts are amputated, the mechanism of injury usually involves some form of avulsion, which damages these fragile vessels over a distance and renders them unsuitable for anastomosis. Replantation of the ear remains a challenging problem because of the tiny vessels and the paucity of adequate veins for anastomosis. Reattachment as a composite graft of the total or subtotal amputated ear is unreliable. Microsurgical replantation can be performed in a minority of cases because of technical difficulties and long operation time. In this article, the authors report two case of a successful ear replantation of completely amputated auricle. Only one artery and one vein were anastomosed in first case. In the other case one artery was anastomosed without vein. Instead of venous repair, multiple incision was done with leech application therapy. and the outcome was successful. In spite of the technical difficulties and long operation time, microsurgical replantation of amputated ear is better than other reconstructive method or reattachment without microsurgery.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.35 no.3
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• pp.174-177
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• 2013

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a disease characterized by jaw necrosis and delayed wound healing in patients who had received bisphosphonates. Buccal fat pad (BFP) can be used as a pedicled flap in the posterior region of the oral cavity. BFP pedicle flap needs simple surgical technique and it shows less donor site morbidity and aesthetic problem than other vascularized flap. BFP pedicled flap was fed by 3 arteries-facial, internal maxillary, and transverse facial artery. Osteomyelitis was generally related with poor blood supply. Thus, rich blood supply of BFP pedicle flap can have a potential advantage to BRONJ patients. In this case report, we presented 3 BRONJ patients treated by BFP pedicle flap after sequestrectomy.