• Maxillofacial Plastic and Reconstructive Surgery
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• v.30 no.3
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• pp.283-291
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• 2008

The malar mound defines the contour of the lateral face between the inferior orbital rim and the mandible, and hypoplasia or asymmetry of this region is readily noticeable. A flat, hypoplastic malar eminence can make the face blunt and wearisome, which contributes to a premature aged appearance. Patients with congenital or traumatic flattening of the malar eminence can obtain esthetic improvement with implants. Indications for placement of malar implants to improve the appearance of subtle flattening or to enhance the esthetic harmony of a patient's face have been suggested in several studies. Many augmentation materials, such as silicone, proplast, polyamide, and porous polyethylene implants have been used. Many methods of localization have been described, the key to proper placement of the implants lies in a through understanding of the esthetics of the malar mound. From August 2001 to June 2007, 12 patients with malar depression who visited the Department of Oral and Maxillofacial Surgery, Chonnam National University Hospital were treated by augmentation malarplasty with Porous polyethylene. The location and amount of augmentation are determined by preoperative interview, physical examinations, facial models and radiographic findings. 12 patients were satisfied with the results of augmentation malarplasty and severe complications were not occurred.

• Archives of Craniofacial Surgery
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• v.18 no.2
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• pp.76-81
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• 2017

Background: A transcaruncular approach is typically used for reconstructions of medial wall fractures. However, others reported that a transconjunctival approach was conducive for securing an adequate surgical field of view. In this study, we aimed to examine the extent of repair of medial wall fracture via a transconjunctival approach. Methods: We retrospectively reviewed the medical records of 50 patients diagnosed as having medial wall fracture via preoperative computed tomography and who underwent surgery between March 2011 and February 2014. The fracture location was defined by dividing each of the anterior-posterior and superior-inferior distances into three compartments. Results: A transcaruncular approach was used in 7 patients, while the transconjunctival approach was performed in the remaining 43 patients. The transconjunctival approach enabled a relatively broad range of repair that partially included the front and back of the medial wall, and was successful in 86% of the entire study population. Conclusion: It is known that more than 50% of total cases of the medial wall fracture occur mainly in the middle-middle portion, a majority of which can be reconstructed via a transconjunctival approach. We used a transconjunctival approach in identifying the location of the fracture on image scans except for cases including the fracture of the superior portion in patients with medial wall fracture. If it is possible to identify the location of the fracture, a transconjunctival approach would be an useful method for the reconstruction in that it causes no damages to the lacrimal system and is useful in confirming the overall status of the floor.

• Archives of Plastic Surgery
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• v.45 no.3
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• pp.222-228
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• 2018

Background The most common surgical treatment for paralytic lagophthalmos is the placement of a weight implant in the upper eyelid; however, this technique confers the risks of implant visibility, implant extrusion, and entropion. In this study, we present a new technique of placing platinum weight implants between the levator aponeurosis and inner septum to decrease such complications. Methods A total of 37 patients with paralytic lagophthalmos were treated between March 2014 and January 2017 with platinum weight placement (mean follow-up, 520.1 days). After dissecting through the orbicularis oculi muscle, the tarsal plate and levator aponeurosis were exposed. The platinum weights (1.0-1.4 g) were fixed to the upper margin of the tarsal plate and placed underneath the orbital septum. Results Five patients could partially close their eye after surgery. The average distance between the upper eyelid and the lower eyelid when the eyes were closed was 1.12 mm. The rest of the patients were able to close their eye completely. Three patients patient developed allergic conjunctivitis after platinum weight insertion, which was managed with medication. None of the patients complained of discomfort in the upper eyelid after surgery. Visibility or extrusion of the implant were observed in three patients. Conclusions Postseptal weight placement is a safe and reproducible method in both primary and secondary upper eyelid surgery for patients with paralytic lagophthalmos. It is a feasible method for preventing implant visibility, implant exposure, and entropion. Moreover, platinum is a better implant material than gold because of its smaller size and greater thinness.

• Archives of Craniofacial Surgery
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• v.19 no.2
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• pp.114-119
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• 2018

Background: The ideal absorbable plating system should provide sufficient rigidity and then be absorbed within a timely manner. The Resorb-X has been recently developed as a plating system with a mixture ratio of 50:50 poly(D, L-lactide). Methods: We present seven of 121 patients who experienced delayed degradation with this absorbable plate. One hundred twenty-one patients with facial bone fracture underwent surgical treatment from March 2011 to March 2015, and rigid fixation was achieved with the Resorb-X. Results: Of 121 patients, seven (5.8%) developed complications at the surgical sites. Six of 102 cases underwent fixation of the infraorbital rim and one of 73 underwent fixation of the frontozygomatic buttress; the other sites of fixation did not develop delayed degradation. Foreign body granuloma developed at the earliest by postoperative 20 months and at the latest by postoperative 28 months (average, 23.5 months). Conclusion: We observed that the use of absorbable plates in incision sites or areas with thin skin can increase the possibility of delayed degradation. When performing surgery in these areas, the normal skin above the fixed location should be covered sufficiently.

• Journal of Veterinary Clinics
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• v.39 no.5
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• pp.246-252
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• 2022

Multilobular osteochondrosarcoma (MLO) reportedly has a good prognosis after complete resection. This study reports the successful treatment of MLO in two dogs using 3-dimensional (3D) printing technology. A nine-year-old castrated male Maltese (Case 1) and a five-year-old castrated male poodle (Case 2) both presented with a mass in the skull. Diagnostic imaging revealed a cranial mass arising from the cranio-orbital and parieto-occipital bones. The masses were resected using 3D-printed osteotomy guides, and the resulting defects were reconstructed using 3D-printed patient-specific implants. Histopathological results confirmed the resection of MLOs with clean margins. Patients routinely recover from surgery without complications. To date, the two patients remain alive without clinical signs of tumor recurrence at 20 and 12 months postoperatively, respectively. In the management of MLO in dogs, 3D printing technology can allow accurate tumor resection, reduced surgical time, and successful reconstruction of large defects.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.30 no.4
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• pp.301-307
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• 2004

The flap considered at first for the reconstruction of large maxillary defect, especially mid-face defect, is scapular free flap, because it provides ample composite tissue which can be designed 3-dimensionally for orbital, facial and oral reconstruction. In case of maxillary defect involving hard palate, however, this flap has some limitations. First, its bulk prevents oral function and physio-anatomic reconstruction of nasal and oral cavity. Second, mobility and thickness of cutaneous paddle covering the alveolar area reduce retention of tissue-supported denture and give rise to peri-implantitis when implant is installed. Third, lateral border of scapula that is to reconstruct maxillary arch and hold implants is straight, not U-shaped maxillary arch form. To overcome these problems, new concept of step prefabrication technique was provided to a 27-year-old male patient who had been suffering from a complete hard palate and maxillary alveolar ridge defect. In the first stage, scapular osteomuscular flap was elevated, tailored to fit the maxillary defect, particulated autologous bone was placed subperiosteally to simulate U-shaped alveolar process, and then wrapped up with split thickness skin graft(STSG, 0.3mm thickness). Two months later, thus prefabricated new flap was elevated and microtransferred to the palato-maxillary defect. After 6 months, 10 implant fixtures were installed along the reconstructed maxillary alveolus, with following final prosthetic rehabilitation. The procedure was very successful and patient is enjoying normal rigid diet and speech.

• The Korean Journal of Nuclear Medicine
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• v.33 no.6
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• pp.475-483
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• 1999

Purpose: Complete fibrovascular ingrowth within the hydroxyapatite ocular implant is necessary for peg drilling which is performed to Prevent infection and to provide motility to the ocular prosthesis. We compared planar bone scintigraphy and SPECT for the evaluation of the vascularization within hydroxyapatite ocular implants. Materials and Methods: Seventeen patients (M:F: 12:5, mean age; $50.4{\pm}17.5$ years) who had received a coralline hydroxyapatite ocular implant after enucleation surgery were enrolled. Patients underwent Tc-99m MDP planar bone and SPECT imaging by dual head gamma camera after their implant surgery (interval: $197{\pm}81$ days). Uptake on planar and SPECT images was graded visually as less than (grade 1), equal to (grade 2), and greater than (grade 3) nasal bridge activity. Quantitative ratio of implanted to non-implanted intraorbital activity was also measured. Vascularization within hydroxyapatite implants was confirmed by slit lamp examination and ocular movement. Results: All but three patients were considered to be vascularized within hydroxyapatite implants. In visual analysis of planar image and SPECT, grade 1 was noted in 9/18 (50%) and 6/18 (33%), respectively. Grade 2 pattern was 7/18 (39%) and 4/18 (22%), and grade 3 pattern was 2/18 (11%) and 8/18 (44%) respectively. When grade 2 or 3 was considered to be positive for vascularization, the sensitivity of planar and SPECT imaging were 60% (9/15) and 80% (12/15), respectively. In 3 patients with incomplete vascularization, both planar and SPECT showed grade 1 uptake The orbital activity ratios on planar imaging were not significantly different between complete and incomplete vascularization ($1.96{\pm}0.87$ vs $1.17{\pm}0.08$, p>0.05), however, it was significantly higher on SPECT in patients with complete vascularization ($8.44{\pm}5.45$ vs $2.20{\pm}0.87$, p<0.05). Conclusion: In the assessment of fibrovascular ingrowth within ocular implants by Tc-99m MDP bone scintigraphy, SPECT image appears to be more effective than planar scintigraphy.

• Archives of Craniofacial Surgery
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• v.17 no.3
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• pp.135-139
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• 2016

Background: The ultimate goal of craniofacial reconstructive surgery is to achieve the most complete restoration of facial functions. A bioabsorbable fixation system which does not need secondary operation for implant removal has been developed in the last decade. The purpose of this study is to share the experience of authors and to demonstrate the efficacy of bioabsorbable mesh in a variety of craniofacial trauma operations. Methods: Between October 2008 and February 2015, bioabsorbable meshes were used to reconstruct various types of craniofacial bone fractures in 611 patients. Any displaced bone fragments were detached from the fracture site and fixed to the mesh. The resulting bone-mesh complex was designed and molded into an appropriate shape by the immersion in warm saline. The mesh was molded once again under simultaneous warm saline irrigation and suction. Results: In all patients, contour deformities were restored completely, and bone segments were fixed properly. The authors found that the bioabsorbable mesh provided rigid fixation without any evidence of integrity loss on postoperative computed tomography scans. Conclusion: Because bioabsorbable meshes are more flexible than bioabsorbable plates, they can be molded and could easily reconstruct the facial bone in three dimensions. Additionally, it is easy to attach bone fragments to the mesh. Bioabsorbable mesh and screws is effective and can be easily applied for fixation in various craniofacial trauma reconstructive scenarios.