• Archives of Plastic Surgery
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• 제40권4호
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• pp.380-386
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• 2013

Background Xanthelasma palpebrarum (XP) is a benign disorder manifesting as yellowish cholesterol-laden plaques on the eyelids. This paper presents the outcomes in patients with XP who have undergone surgical excision as the main modality of treatment. Methods A retrospective review of patients who received surgery for xanthelasma palpebrarum from March 2007 to March 2011 was conducted. Patients were classified into four grades according to the location and extent of the lesion, with grade I being the mildest and grade IV being the most diffuse. Simple excision was performed in grade I and II lesions, while local flaps and skin grafts were performed in the more advanced grades. Results Ninety-five cases from March 2007 to March 2011 were included in this study. 66 cases (70%), were treated by simple excision. Twenty-four cases (25%) and 5 cases (5%) were treated by simple excision in combination with or without local flaps and skin grafts. In approximately 1/4 of the patients, orbicularis oris muscle involvement was observed. 4 patients (4.2%) developed scar contracture postoperatively, which required a secondary procedure. Recurrence was reported in 3 patients (3.1%). Otherwise. There were no other reports of major complications or disfigurement. Conclusions We found that for lesions involving the deep dermis and/or muscle, surgical excision was the most appropriate therapeutic option.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제43권4호
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• pp.262-266
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• 2017

Hemangioma is the most common benign tumor of a vascular origin, and is characterized by the abnormal proliferation of blood vessels. Intramuscular hemangioma (IMH) usually involves the skeletal muscles of the trunk or limbs, but rarely occurs in the head and neck region. This case report presents a patient with IMH showing multiple phleboliths in the buccal cheek. A 13-year-old boy was referred for the evaluation and management of painful swelling of the left cheek that had gradually increased in size over a 6 year duration. The examination revealed a palpable firm mass. Reddish-blue buccal mucosa color was observed with an aciniform shape. Preoperative magnetic resonance imaging (MRI) showed a vascular tumor in the left side adjacent to the buccinator and depressor orbicularis oris muscles. Surgical resection under general anesthesia was performed via the intraoral approach. The mass and phleboliths were extracted successfully. A histopathological examination confirmed the diagnosis of IMH. In conclusion, clinicians should be aware of the possibility of IMH in cases of a palpable mass with multiple nodules deep within the muscle in the buccal cheek. Among the several diagnostic tools, MRI provides essential information on the extent and surrounding anatomy of IMH.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제29권5호
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• pp.422-428
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• 2007

The columella, nasal tip, lip relationship in the secondary bilateral cleft deformity remains an enigma and a great challenge for the cleft surgeon. A subset of patients with bilateral cleft lip still require columellar lengthening and nasal correction, despite the advances in preoperative orthopedics and primary nasal corrections. An approach to correct this deformity is described. This consists of 1) lengthening the columella, 2) open rhinoplasty, allowing definitive repositioning of lower lateral cartilages, ear cartilage grafting to the tip and columella when necessary, 3) nasal mucosal advancement, 4) alar base narrowing and 5) reconstruction of the orbicularis oris as required. In surgical repair of the cleft lip nose, the timing of the operation(during lip closure, before or after the puberty growth sput), and the operative technique play a key role in the final result. In this study, 13 cleft lip patients who had undergone a secondary cheilorhinoplasty at the Department of Oral and Maxillofacial Surgery, Pusan National University Hospital were evaluated to check the proper time and method of the operation.

• 대한두개안면성형외과학회지
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• 제20권4호
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• pp.255-259
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• 2019

Craniofacial cleft is a rare disease, and has multiple variations with a wide spectrum of severity. Among several classification systems of craniofacial clefts, the Tessier classification is the most widely used because of its simplicity and treatment-oriented approach. We report the case of a Tessier number 3 cleft with wide soft tissue and skeletal defect that resulted in direct communication among the orbital, maxillary sinus, nasal, and oral cavities. We performed soft tissue reconstruction using the straight-line advanced release technique that was devised for unilateral cleft lip repair. The extension of the lateral mucosal and medial mucosal flaps, the turn over flap from the outward turning lower eyelid, and wide dissection around the orbicularis oris muscle enabled successful soft tissue reconstruction without complications. Through this case, we have proved that the straight-line advanced release technique can be applied to severe craniofacial cleft repair as well as unilateral cleft lip repair.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제50권4호
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• pp.222-226
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• 2024

The upper lip is a functionally and aesthetically important area of the face. Therefore, reconstruction of an upper lip defect needs sufficient consideration to ensure functional and aesthetic recovery. Several methods, such as wedge resection, rotation flaps, advancement flaps, and myomucosal advancement flaps, have been used to reconstruct vermilion defects. However, it is challenging to reconstruct a vermilion defect because of the possibility of residual asymmetry or scars and restrictions to normal lip movement after the reconstruction. We present the case of a 51-year-old female that had an upper lip vermilion defect caused by a dog bite. The lip defect was reconstructed using a mucosal V-Y advancement flap. This mucosal flap was based on the orbicularis oris muscle with a branch of the superior labial artery to ensure sufficient blood supply. Therefore, flap survival was excellent, and there was no constriction of the flaps. Moreover, the color and contour were matched to the adjacent lip tissue, and re-establishment of the white roll and adequate lip volume were achieved. This mucosal V-Y advancement flap technique represents a reliable method to repair mucosal defects without vascular compromise of the flap.

• 대한수의학회지
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• 제26권1호
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• pp.1-9
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• 1986

This study was carried out to investigate the branch and distribution of Nervus facialis of the Korean native goat. The observation was made by dissection of embalmed cadavers of ten Korean native goats. The results were as follows; 1. N. facialis arose from the ventrolateral surface of the medulla oblongata. 2. In the facial canal, N. facialis gave off N. petrosus major, N. stapedius and Chorda tympani. 1) N. petrosus major arose from Ganglion geniculi, passed through the pterygoid canal and terminated in Ganglion pterygopalatinum. 2) Chorda tympani joined N. lingualis at the lateral surface of the internal pterygoid muscle. 3. At the exit of the stylomastoid foramen, N. facialis gave off N. caudalis auricularis, Ramus auricularis internus, Ramus stylohyoideus and Ramus digastricus. 1) N. caudalis auricularis arose by two branches in 6 cases and by a single branch in 4 cases. N. caudalis auricularis gave off branches to the caudoauricuIar muscles and the internal surface of the conchal cavity. 2) Ramus auricularis internus arose by a single branch except in 2 cases in which it arose in common with N. caudalis auricularis. It penetrated the caudolateral surface of the tragus and distributed in the skin of the scapha. 3) Ramus stylohyoideus and Ramus digastricus arose separately from N. facialis. 4. In the deep surface of the parotid gland, N. facialis divided into N. auriculopalpebralis, Ramus buccalis dorsalis and Ramus buccalis ventralis. In 6 cases, N. facialis gave off Ramus buccalis ventralis and then divided into N. auriculopalpebralis and Ramus buccalis dorsalis. In 3 cases, N. facialis trifurcated into Ramus buccalis ventralis, Ramus buccalis dorsalis and N. auriculopalpebralis. In one case, N. facialis gave off N. auriculopalpebralis and then divided into Ramus buccalis dorsalis and Ramus buccalis ventralis. 1) Ramus buccalis ventralis ran along the ventral border of the masseter muscle and distributed to the buccinator and depressor labii inferioris muscles. Ramus buccalis ventralis communicated with a branch of Ramus buccalis dorsalis and N. buccalis. In 2 cases, it also communicated with N. mylohyoideus. 2) Ramus buccalis dorsalis communicated with Ramus transverses faciei, N. buccalis, N. infraorbitalis and a branch of Ramus buccalis ventralis. Ramus buccalis dorsalis distributed to the orbicularis oris, caninus, depressor labii inferioris, levator labii superioris, buccinator, malaris, nasolabialis and zygomaticus muscles. 3) N. auriculopalpebralis gave off Rami auriculares rostrales, which supplied the zygomaticoauricularis muscle, the frontoscutularis muscle and the skin of the base of the ear. N. auriculopalpebralis then continued as Ramus zygomaticus, which innervated the frontal muscle, the lateral surface of the base of the horn, the orbicularis oculi muscle and the adjacent skin of the orbit. N. auriculopalpebralis communicated with Nn. auriculares rostrales and Ramus zygomaticotemporalis. In 7 cases, it also communicated with N. infratrochlearis.

• Journal of Oral Medicine and Pain
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• 제34권3호
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• pp.317-324
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• 2009

저작근장애 환자의 근육 평가를 위해 촉진과 압력통각역치가 주로 이용되어 왔으나, 본 연구는 근육의 경도와 탄성도을 정량적으로 측정할 수 있는 촉각센서를 이용하여 저작근을 평가하고, 저작근장애가 안면표정근에 영향을 미칠 수 있는지 조사하고자 하였다. 연구 대상은 단국대학교 치과병원 구강내과를 내원한 환자 중 편측 교근에 통증과 압통이 있는 저작근장애 환자 27명으로서 평균연령 $36.4{\pm}13.8$세였다. 근통 외에 턱관절의 이상이나 다른 통증 질환을 함께 가진 환자는 제외하였다. 촉각센서는 Venustron(Axiom Co., JAPAN)을 사용하여 전측두근, 교근, 전두근, 하안륜근, 대관골근, 상하구륜근, 이근에 대한 경도와 탄성도를 측정하였다. 이환측과 비이환측의 근육 경도와 탄성도를 비교하였으며 진단에 따라 국소근동통군과 근막동통군으로 분류하여 비교하였고, 6개월을 기준으로 급성군과 만성군으로 나누어 비교하였다. 편측 저작근장애가 있는 환자의 이환측과 비이환측을 비교했을 때 이환측의 교근과 대관골근에서 근육 경도가 유의성 있게 증가하였고 탄성도는 유의성 있게 감소하였다(p<0.05). 급성군과 만성군, 국소근동통군과 근막동통군 사이에는 유의한 차이없이 이환측 교근과 대관골근에서 경도가 증가하고 탄성도는 감소하였다. 이상의 결과는 교근에 발생한 저작근통은 교근 뿐아니라 안면표정근인 대관골근의 탄성도과 경도에도 영향을 줄 수 있음을 보여준다.

• 대한한의학회지
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• 제23권1호
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• pp.100-111
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• 2002

Objectives : In order to obtain the clinical type of facial palsy sequelae and try to make the treatment protocols for each, I observed patients who visited Gunpo-Wonkwang oriental medicine center with Bell’s palsy sequelae that were treated over three months. Methods : I make the value standard of muscle paralysis, contraction, synkinesis and acquired the results as follows. Results and Conclusions : 1. The distribution of age and sex was as follows : females of 41-50 years were the most common demographic, females of 51-60 years and males of 31-40 years were the second, males of 51-60 years were the third, females of 21-30 years and males of over 60 years were the fourth, and males of 41-50 years were the fifth. 2. The distributions of period of disease were as follows : 3-6 months was the most, 12-18 months was the second, 6-12 months and over 24 months was the third, and 18-24 months was the fourth. 3. The sequelae distributions of disease were as follows. In the group of 3-6 months, 12 persons (80%) showed palsy and atrophy, 10 persons (66.6%) showed synkinetics. In the group of over 6 months, all patients showed muscle palsy, muscle atrophy and synkinetics. All groups showed lower sensitivity of muscles, but the group of 18-24 months and the group of over 24 months showed more. Tinnitus was shown by the groups of 12-18 months and 3-6 months. Facial muscle pain was shown by the group of3-6 months only, Crocodile's tear was shown by the groups of 18-24 months and over 24 months. 4. The total palsy rates of sequela patients and palsy rates by muscle for disease period were as follows. The total palsy rate was 27.94%; the palsy rates for the group of 6-12 months and the group of over 24 months was lower than the total palsy rate. The rates of the groups of 3-6, 12-18, 18-24 months were higher than the total palsy rate. The palsy rate of zygomatic minor, levator labii superior muscle was higher than the total palsy rate for all groups. 5. Synkinetics manifestation rates by disease period were as follows. Total synkinetics manifestation rate was 73.81 %; the manifestation rate of the group of 6-12 months was lower than total synkinetics manifestation rate. For the groups of 12-18, 18-24, and over 24 months it was more than the total synkinetics manifestation rate. The group of over 24 months, total synkinetics induced by orbicularis oculi muscle and orbicularis oris muscle. 6. Facial muscle atrophy rates by disease period were as follows. Total atrophy rate was 5.26%; in the groups of 6-12, 18-24, over 24 months, the atrophy rates were higher than the total atrophy rate. The groups of 3-6 and 12-18 months showed lower than the total atrophy rates, while the atrophy of the levator palpebrae superioris muscle and levator palpebrae inferioris muscle was higher than in other groups.

• 대한근전도전기진단의학회지
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• 제20권2호
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• pp.84-90
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• 2018

Objective: To assess the correlation between surface electromyography (SEMG) and conventional EMG in patients with facial nerve palsy. Additionally, compare the discomfort and the time required by the patients in two methods. Method: 36 patients with facial palsy were given nerve conduction studies (NCS) via conventional EMG. Then, the peak root mean square (RMS) values were obtained from the SEMG. We also recorded visual analogue scale (VAS), House-Brackmann scale, and the time required for the examination. Results: Pearson's correlation coefficient between the amplitude loss ratio of the RMS values obtained by SEMG compared to the unaffected side (RSEMG) and the amplitude loss ratio of CMAP amplitudes compared to the unaffected side (RCMAP) was 0.567 at the frontalis, 0.456 at the orbicularis oculi, 0.393 at the nasalis, and 0.437 at the orbicularis oris. An increase in RSEMG is positively correlated with an increase in RCMAP. The mean VAS score with conventional EMG was $3.55{\pm}1.42$, whereas that experienced when using SEMG was $0.11{\pm}0.52$ and the mean time required for conventional EMG was $610{\pm}103.84$ seconds, while that required for SEMG was $420{\pm}86.32$ seconds. Conclusion: This study demonstrated a significant positive correlation between facial muscle activities as measured by SEMG and conventional EMG in patients with facial nerve palsy. SEMG has the benefits of being more comfortable and faster when diagnosing facial palsy.

• Archives of Plastic Surgery
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• 제43권3호
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• pp.242-247
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• 2016

Background Median cleft lip is a rare anomaly consisting of a midline vertical cleft through the upper lip. It can also involve the premaxillary bone, the nasal septum, and the central nervous system. In our current report, we present the clinical features of 6 patients with a median cleft lip and their surgical management according to the accompanying anomalies. Methods From December 2010 to January 2014, 6 patients with a median cleft lip were reviewed. Five of these cases underwent surgical correction; alveolar bone grafting was performed in a patient with a median alveolar cleft. The surgical technique included inverted-U excision of the upper lip and repair of the orbicularis oris muscle. The mean follow-up period was 20.4 months (range, 7.4-44.0 months). Results The study patients presented various anomalous features. Five patients received surgical correction, 4 with repair of the median cleft lip, and one with iliac bone grafting for median alveolar cleft. A patient with basal sphenoethmoidal meningocele was managed with transoral endoscopic surgery for repair of the meningocele. Successful surgical repair was achieved in all cases with no postoperative complications. Conclusions Relatively mild forms of median cleft lip can be corrected with inverted-U excision with good aesthetic outcomes. In addition, there is a broad spectrum of clinical features and various anomalies, such as nasal deformity, alveolar cleft, and short upper frenulum, which require close evaluation. The timing of the operation should be decided considering the presence of other anomalies that can threaten patient survival.