• 대한두개안면성형외과학회지
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• 제17권2호
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• pp.63-67
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• 2016

Background: The subciliary approach is commonly used for reconstruction of orbital wall or zygomaticomaxillary fractures. However, this approach is associated with postoperative complications, especially lower eyelid malposition. We report the experience of managing postoperative lower eyelid malposition with triamcinolone acetonide. Methods: A retrospective review was performed for all traumatic facial fractures requiring surgery via the subciliary approach at Chosun University Hospital in 2014. For each patient meeting inclusion criteria, the medical chart was reviewed for demographic information and postoperative course, including the presence of postoperative eyelid malposition or scleral show. Results: The review identified 189 cases in which the subciliary approach was used, and postoperative lower eyelid malposition was found in 7 cases (3.7%). For these 7 patients, the mean therapeutic period (interval to correction of the malposition) was 10.5 weeks (range, 8 to 14 weeks). On average, patients received 3 injections of triamcinolone. In all cases, degrees of the malposition were improved, and none of the patients required an operative intervention to correct the malposition. Conclusion: Triamcinolone injection is an appropriate treatment modality for lower eyelid malposition after subciliary approach. Treatment duration is relatively short, requiring fewer than 4 outpatient clinic visits, with relatively earlier recovery compared to conservative "wait-and-see" management.

• Archives of Plastic Surgery
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• 제45권2호
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• pp.135-139
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• 2018

Background Static reconstruction surgery that tightens the tension of the inferior tarsus, thereby raising the lax lower eyelid, is a common treatment for paralytic ectropion of the lower eyelid. We present one such operative procedure, in which an orbicularis oculi muscle flap was used. Methods The surgical technique involves partial resection of the tarsus and the skin, as well as a superior-based orbicularis oculi muscle flap that is sutured to the firm tissue present on the Whitnall tubercle. The muscle flap is approximately 7 mm in width and 15 mm in length, with a superior pedicle that is attached to the tarsus at the medial point of the resected tarsus. The procedure results in contact between the ocular surface and the lower eyelid. Results The procedure was performed in 11 patients with lower eyelid ectropion due to facial paralysis. Ten cases showed a favorable outcome following surgery, with stable results seen over an average follow-up period of 4.5 years. In one case, recurrence of ectropion was observed 2 months after surgery due to an insufficient correction, and the patient required repeat surgery. Conclusions The orbicularis oculi muscle flap was an effective means of suspension and was able to maintain long-term traction tension. This procedure can therefore be considered a favorable treatment option for lower eyelid ectropion due to facial paralysis.

• Archives of Plastic Surgery
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• 제34권6호
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• pp.724-728
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• 2007

Purpose: The objective of this study is to prevent postoperative lower eyelid retraction and scleral show. There are several approaches for orbital rim reconstruction. But these techniques are sometimes difficult to perform, and have some merits and faults. Maybe most common unwanted and unpleasant result that we have experienced by subciliary incision preseptal approach is the lower eyelid retraction and the scleral show. Therefore, I want to find out the causes and the solutions for such complication. We must know the mechanics for those unpleasant result first of all. Methods: We conducted a comparison of postoperative photographs between retroseptal approach group and preseptal approach group, both with subciliary incision. In experimental retroseptal group, incision was applied at subciliary region. After elevating skin flap to preserve pretarsal muscle, not with muscle flap elevation, but direct oblique incision through the muscle, retroseptal dissection was applied to the ROOF and the septum. Fixating fracture line, periosteal and septal repair was followed by skin repair. The light compressive dressings and protection were kept in place for 7 days. The effectiveness of this operative method was made comparison with control group which the preseptal approach was applied to, by postoperative 2nd week and 2nd month. Results: Author's technique had been used in 20 patients and control group was composed of 50 patients over 19months period. There were better results in experimental group than in control group and all of experimental group had no complaint about the lower eyelid retraction and the scleral show. Conclusion: It must be known about the reason of the lower eyelid retraction and the scleral show induced by subciliary and preseptal approach. Mechanically it can be easily proved. And the solution maybe will be easier if we get more information about the mechanics. I recommend the retroseptal subciliary approach

• 대한두개안면성형외과학회지
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• 제18권4호
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• pp.249-254
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• 2017

Background: Lower eyelid incisions are widely used for the orbital approach in periorbital trauma and aesthetic surgery. In general, the subciliary approach is known to cause disposition of the lower eyelid by scarring the anterior lamella in some cases. On the other hand, many surgeons believe that a transconjunctival approach usually does not result in such complications and is a reliable method. We measured positional changes in the lower eyelid in blowout fracture repair since entropion is one of the most serious complications of the transconjunctival orbital approach. Methods: To measure the positional changes in the lower eyelids, we analyzed preoperative and postoperative photographs over various time intervals. In the analysis of the photographs, marginal reflex distance 2 ($MRD_2$) and eyelash angle were used as an index of eyelid position. Statistical analyses were performed to identify the significance in the positional changes. All patients underwent orbital reconstruction through a transconjunctival incision by a single plastic surgeon. Results: In 42 blowout fracture patients, there was no statistical significant difference in the MRD2 and eyelash angle. Furthermore, there were no clinical complications, such as infection, hematoma, bleeding, or implant protrusion, during the follow-up periods. Conclusion: The advantages of the transconjunctival approach for orbital access include minimal scarring and a lower risk of eyelid displacement compared with other approaches. Based on these results, we recommend the transconjunctival approach for orbital exposure as a safe and reliable method.

• 대한두개안면성형외과학회지
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• 제17권4호
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• pp.190-197
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• 2016

Background: The cheek rotation flap has sufficient blood flow and large flap size and it is also flexible and easy to manipulate. It has been used for reconstruction of defects on cheek, lower eyelid, or medial and lateral canthus. For the large defects on central nose, paramedian forehead flap has been used, but patients were reluctant despite the remaining same skin tone on damaged area because of remaining scars on forehead. However, the cheek flap is cosmetically superior as it uses the adjacent large flap. Thus, the study aims to demonstrate its versatility with clinical practices. Methods: This is retrospective case study on 38 patients who removed facial masses and reconstructed by the cheek rotation flap from 2008 to 2015. It consists of defects on cheek (16), lower eyelid (12), nose (3), medial canthus (3), lateral canthus (2), and preauricle (2). Buccal mucosa was used for the reconstruction of eyelid conjunctiva, and skin graft was processed for nasal mucosa reconstruction. Results: The average defect size was $6.4cm^2$, and the average flap size was $47.3cm^2$. Every flap recovered without complications such as abnormal slant, entropion or ectropion in lower eyelid, but revision surgery required in three cases of nasal side wall reconstruction due to the occurrence of dog ear on nasolabial sulcus. Conclusion: The cheek rotation flap can be applicable instead of paramedian forehead flap for the large nasal sidewall defect reconstruction as well as former medial and lateral canthal defect reconstruction.

• Archives of Plastic Surgery
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• 제48권1호
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• pp.80-83
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• 2021

Eye socket contracture is a well-known late complication of enucleation surgery, and the additional insult of radiotherapy at an early age causes even further fibrosis and scarring of the socket. Management of the contracted socket is challenging, and several methods have been proposed. We report a case of eye socket contracture after enucleation and radiotherapy in which multiple reconstructive procedures failed. The recurrent contracture caused difficulty in housing and retaining the eye prosthesis. We reconstructed the lower eyelid with a facial artery myomucosal flap and nasolabial flap, and the upper eyelid with a Fricke flap following reconstruction of the orbital rims (supraorbital and infraorbital rims with a calvarial bone graft, and further augmentation of the infraorbital rim with a rib bone graft). Cosmesis post-reconstruction was acceptable and the prosthesis was retained very well.

• 대한두개안면성형외과학회지
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• 제22권4호
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• pp.204-208
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• 2021

Sebaceous carcinoma is a malignant neoplasm that usually arises in the sebaceous glands of the eyelids. Its pathogenesis is unknown; however, irradiation history, immunosuppression, and use of diuretics are known risk factors. The mainstay of treatment for sebaceous carcinoma of the eyelid is wide surgical resection with a safety margin of 5 to 6 mm, which often results in full-thickness defects. The reconstruction of a full-thickness defect of the eyelid should be approached using a three-lamella method: a mucosal component replacing the conjunctiva, a cartilage component for the tarsal plate, and a flap or skin graft for the skin of the eyelid. In this case, a full-thickness defect of the upper eyelid was reconstructed after tumor removal using a combination of a nasal septum chondromucosal composite graft and a forehead transposition flap, also known as a "Fricke flap." The flap was designed to include a line of the eyebrow on the lower margin of the flap to replace the eyelash removed during tumor excision. The wound healed completely, without any early or late complications, and the outcome was satisfactory.

• Archives of Plastic Surgery
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• 제33권5호
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• pp.531-535
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• 2006

Purpose: To report our experience of retro-angular flap for reconstruction of the midface defect. The midface, including nose, lower eyelid, and intercanthal area, is the very prominent area of face. Also midface is more vulnerable to trauma and skin cancer and defect of mid face of highly perceptible. Reconstruction of mid face is difficult because of complexity of anatomy and functions. Following factors should be considered in reconstructive prcedure of midface. First, multiple procedure may need for complete the reconstruction of mid face defect. Second, secondary reconstructive surgeries such as flap rotation or skin graft may need for donor site morbidity. Third, the color, texture and thickness of the skin used are not always complacency. Methods: 8 cases of the midface defects (3 cases of lower eyelid, 1 case of intercanthal area, and 4 cases of nose) from skin cancer were reconstructed with retroangular flap from March 2004 to August 2005. Results: Satisfactory result were obtained in color, texture and donor site scar. There was no major complication such as wound disruption, hematoma, and atrophy of flap. But partial necrosis of flap and bulkiness were observed one case in each. Retroangular flap is simple procedure that can be preceded in one stage under local anesthesia closing primary wound closure. It will leave less visible donor scar, acceptable color, texture and thickness of the skin. Conclusions: The retro-angular flap could be suggested as a safe and effective method for midface reconstruction.

• 대한두경부종양학회지
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• 제39권1호
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• pp.41-44
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• 2023

Mucinous Eccrine carcinoma (MEC) is a rare malignant tumor related to the eccrine sweat gland and is commonly located on the face, especially around the eyelids and scalp. Most of these tumors are diagnosed at age 40's to 60's and exhibit a wide variety of patterns in addition to the general appearance previously reported. MEC is difficult to diagnose clinically, but can be diagnosed by accompanying biopsy. We present the case of a 75-year-old man who complained of a gradually growing Left lower lid tumor of duration one year. Initially, the tumor was mistaken for an epidermal cyst and treated by surgical resection. However, biopsy findings resulted in a diagnosis of Mucinous Eccrine carcinoma. Therefore, we performed wide excision and flap reconstruction surgery. In a one year follow-up examination, the patient achieved successful functional and aesthetic results without regional or distant metastasis and recurrence.

• 대한두경부종양학회지
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• 제1권1호
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• pp.35-61
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• 1985

The surgical treatment of advanced carcinomas and some benign tumors having clinically malignant behaviors of the head and neck region often require extensive resection, necessitating large flaps for reconstruction. Since the original upper arm flap was described by Tagliacozzi in 1597, a variety of technique such as random pattern local flap, axial flap, distant flap, scalping flap, myocutaneous flap, free flap etc. have been proposed for reconstruction of head, face and neck defects. Reconstruction of the facial defects usually require the use of distant tissue. Traditionally, nasal reconstruction has been carried out with a variety of forehead flaps. In recent years, there has been more acceptance of immediate repairs following the removal of these tumors. As a result, patients are more willing to undergo these extensive resections to improve their chances of cure, with the reasonable expectation that an immediate reconstruction will provide an adequate cosmetic result. Authors experienced 13 cases of head and neck tumor during last three and half years that required wide excision and immediate reconstruction with various flaps, not with primary closure or simple skin graft. We present our experience with varied flaps for reconstruction after wide resection of head and neck tumors 3 cases of defect of dorsum of nose or medial canthus with island forehead flaps, lower eyelid defect with cheek flap, cheek defect with Limberg flap, orbital floor defect with Temporalis muscle flap, lateral neck defects with Pectoralis major myocutaneous flap or Latissimus dorsi myocutaneous free flap, subtotal nose defect with scalping flap, wide forehead defect with Dorsalis pedis free flap and 3 cases of mandibular defect or mandibular defect combined with lower lip defect were reconstructed with free vascularized iliac bone graft or free vascularized iliac bone graft concomitantly combined with free groin flap pedicled on deep circumflex iliac vessels We obtained satisfactory results coincided wi th goal of treatment of head and neck tumors, MAXIMAL CURE RATE with MINIMAL MORBIDITY, OPTIMAL FUNCTION, and an APPEARANCE as close to normal as possible.