• Archives of Craniofacial Surgery
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• v.19 no.1
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• pp.41-47
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• 2018

Background: The number of surgical risks recalled by a patient after surgery can be used as a parameter for assessing how well the patient has understood the informed consent process. No study has investigated the usefulness of a self-developed mobile application in the traditional informed consent process in patients with a nasal bone fracture. This study aimed to investigate whether delivery of information, such as surgical risks, through a mobile application is more effective than delivery of information through only verbal means and a paper. Methods: This prospective, randomized study included 60 patients with a nasal bone fracture. The experimental group (n=30) received preoperative explanation with the traditional informed consent process in addition to a mobile application, while the control group (n=30) received preoperative explanation with only the traditional informed consent process. Four weeks after surgery, the number of recalled surgical risks was compared for analysis. The following six surgical risks were explained: pain, bleeding, nasal deformity, numbness, nasal obstruction, and nasal cartilage necrosis. Results: The mean number of recalled surgical risks among all patients was $1.58{\pm}0.56$. The most frequently recalled surgical risk was nasal deformity in both groups. The mean number of recalled surgical risks was $1.72{\pm}0.52$ in the experimental group and $1.49{\pm}0.57$ in the control group. There was a significant association between mobile application use and the mean number of recalled surgical risks (p=0.047). Age, sex, and the level of education were not significantly associated with the mean number of recalled surgical risks. Conclusion: This study found that a mobile application could contribute to the efficient delivery of information during the informed consent process. With further improvement, it could be used in other plastic surgeries and other surgeries, and such an application can potentially be used for explaining risks as well as delivering other types of information.

• Archives of Craniofacial Surgery
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• v.18 no.2
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• pp.92-96
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• 2017

Background: All nasal bone fractures have the potential for worsening of olfactory function. However, few studies have studied the olfactory outcomes following reduction of nasal bone fractures. This study evaluates posttraumatic olfactory dysfunction in patients with nasal bone fracture before and after closed reduction. Methods: A prospective study was conducted for all patients presenting with nasal bone fracture (n=97). Each patient consenting to the study underwent the Korean version of Sniffin' Sticks test (KVSS II) before operation and at 6 month after closed reduction. The nasal fractures were divided according to the nasal bone fracture classification by Haug and Prather (Types I-IV). The olfactory scores were compared across fracture types and between preoperative and postoperative settings. Results: Olfactory dysfunction was frequent after nasal fracture (45/97, 46.4%). Our olfactory assessment using the KVSS II test revealed that fracture reduction was not associated with improvements in the mean test score in Type I or Type II fractures. More specifically, the mean posttraumatic Threshold, discrimination and identification score decreased from 28.8 points prior to operation to 23.1 point at 6 months for Type II fracture with septal fracture. Conclusion: Our study has revealed two alarming trends regarding post-nasal fracture olfactory dysfunction. First, our study demonstrated that almost half (46.4%) of nasal fracture patients experience posttraumatic olfactory dysfunction. Second, closed reduction of these fractures does not lead to improvements olfaction at 6 months, which suggest that olfactory dysfunction is probably due to factors other than the fracture itself. The association should be further explored between injuries that lead to nasal fracture and the mechanism behind posttraumatic olfactory dysfunction.

• 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 Craniofacial Surgery
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• v.18 no.2
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• pp.97-104
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• 2017

Background: Nasal bone fracture is one of the most common facial bone fracture types, and the surgical results exert a strong influence on the facial contour and patient satisfaction. Preventing secondary deformity and restoring the original bone state are the major goals of surgeons managing nasal bone fracture patients. In this study, a treatment algorithm was established by applying the modified open reduction technique and postoperative care for several years. Methods: This article is a retrospective chart review of 417 patients who had been received surgical treatment from 2014 to 2015. Using prepared questionnaires and visual analogue scale, several components (postoperative nasal contour; degree of pain; minor complications like dry mouth, sleep disturbance, swallowing difficulty, conversation difficulty, and headache; and degree of patient satisfaction) were evaluated. Results: The average scores for the postoperative nasal contour given by three experts, and the degree of patient satisfaction, were within the "satisfied" (4) to "very satisfied" (5) range (4.5, 4.6, 4.5, and 4.2, respectively). The postoperative degree of pain was sufficiently low that the patients needed only the minimum dose of painkiller. The scores for the minor complications (dry mouth, sleep disturbance, swallowing difficulty, conversation difficulty, headache) were relatively low (36.4, 40.8, 65.2, 32.3, and 34 out of the maximum score of 100, respectively). Conclusion: Satisfactory results were obtained through the algorithm-oriented management of nasal bone fracture. The degree of postoperative pain and minor complications were considerably low, and the degree of satisfaction with the nasal contour was high.

• Archives of Craniofacial Surgery
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• v.18 no.2
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• pp.82-88
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• 2017

Background: Turbinate hypertrophy is one of the common causes of chronic nasal obstruction. In principle, therapeutic guidelines recommend medical treatment. Failure to treat turbinate thickening despite drug therapy may indicate the need for surgery. The main aim of this study was to determine the effect of radiofrequency surgery, among various other surgical procedures, on people with both nasal septal deviation and turbinate hypertrophy. Methods: Among people with nasal deviation who visited the subject hospital between July 2008 to July 2014, 21 people with nasal septal deviation and severe turbinate hypertrophy before their surgery had undergone septoplasty with turbinoplasty using radiofrequency combined with septoplasty. The degree of the turbinate's hypertrophy was appraised in all the patients before and after the surgery using the rhinoscopy, and acoustic rhinometry was objectively carried out. The subjective effect of the turbinoplasty using radiofrequency was explored through the visual analog scale (VAS) score. Results: The degree of contraction of the nasal mucosa after the rhinoscopy changed from Grades 3 and 4 (100%) to Grades 1 and 2 (95.2%) and Grades 3 (4.8%). The minimal cross-sectional area significantly increased from $0.44{\pm}0.07$ to $0.70{\pm}0.07cm^2$ (p<0.05). The nasal cavity volume increased from $4.79{\pm}0.49$ to $6.76{\pm}0.55cm^2$ (p<0.05). The subjective symptoms evaluated with VAS score a year after the surgery significantly improved (p<0.05). Conclusion: Turbinoplasty using Coblator with septoplasty is an effective treatment method because it expands nasal cavity, has a low incidence of complications, subjectively improves symptoms, and has short treatment duration.

• Archives of Craniofacial Surgery
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• v.18 no.2
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• pp.105-111
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• 2017

Background: The author analyse the impact of extracapsular lymph node spread and bone engagement in the ipsilateral neck of patients suffering squamous cell carcinoma (SCC) of the lower lip. Methods: The data of 56 neck dissections performed in patients suffering SCC of the lower lip between January 2000 and December 2008 were retrospectively analysed. Statistical analysis was performed with the Kaplan-Meier life table method, and the survival rate was investigated with the log rank statistic and significance test. The values were considered statistically significant at p<0.05. Results: Nine patients took advantage from simultaneous treatment of tumor and prophylactic neck dissection (level I-III), reaching 100% survival rate. Patients suffering metastasized disease, who received radical neck dissection at the time of tumor treatment, presented 83.3% survival rate. Patients who underwent previous surgery and radiotherapy presented worse prognosis although radical neck dissection in case of extra-capsular spread only (24.7%) and osseous engagement (22.2%). Conclusion: Prophylactic neck dissection (level I-III) is recommended in T3-T4 N0 SCC. Simultaneous treatment of tumor and cervical lymph nodes provides a better prognosis as respect to delayed nodal management. Extra-capsular spread with or without bone engagement represents independent risk factor responsible for high mortality rate of SCC of the lower lip.

• Archives of Craniofacial Surgery
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• v.18 no.2
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• pp.141-144
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• 2017

An odontogenic cutaneous fistula is a pathological communication between the outer skin surface of the face and the oral cavity. Facial cutaneous fistula is a complication of odontogenic infection that is often misdiagnosed with skin infection. We report a rare case, which was diagnosed as basal cell carcinoma based on the biopsy of skin lesions in the patient who had been diagnosed with odontogenic cutaneous fistula. A 64-year-old male patient presented with a cutaneous odontogenic fistula. The patient had undergone surgical extraction of fistula tract and loose tooth before dermatology or plastic surgery consultation. With the biopsy and computed tomography, it was confirmed that fistula and basal cell carcinoma. However, the connection between the fistula and skin cancer was not clear. Positron emission tomography-computed tomography scan was performed and was not detected as other local or distant metastasis. After that, wide excision of the skin lesion was performed. Although skin cancer is not commonly observed, it is necessary to rule out this disease entity by performing biopsy of skin lesions.

• Archives of Craniofacial Surgery
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• v.18 no.2
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• pp.89-91
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• 2017

Background: The superior orbital fissure is a small area that connects the middle cranial fossa and the orbit. Many studies have measured the size of the superior orbital fissure. However, there is no standard value for the size of the superior orbital fissure. Therefore, we conducted this study to provide the average size of the superior orbital fissure in Korean adults. Methods: We measured the widths of the superior orbital fissures of 142 patients using computed tomography scans. Because the width of the superior orbital fissure varies at different locations, we measured the superior orbital fissure width at the level of the optic canal. Results: In the males, the width of the superior orbital fissure on both sides was $3.79{\pm}0.93mm$, and these values were $3.79{\pm}0.96mm$ for the left side and $3.783{\pm}0.92mm$ for the right side. In the females, the widths of the superior orbital fissures were $3.62{\pm}1.35mm$ on the left side, $3.69{\pm}1.18mm$ on the right side, and $3.65{\pm}1.26mm$ across both sides. Conclusion: There were no significant differences between the males and females or between the left and right sides. The present study suggests that we may accept the hypothesis that a congenitally narrow superior orbital fissure may be a risk factor for the superior orbital fissure syndrome. Surgeons should take precaution with patients who have narrow superior orbital fissures during the perioperative period.

• Archives of Craniofacial Surgery
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• v.19 no.1
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• pp.35-40
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• 2018

Background: When a skin defect occurs, clinicians must work to restore the original skin quality as soon as possible. Accordingly, an artificial dermis can be used to supplement the wound and prevent severe scar contracture formation. The Terudermis is an artificial dermis that is simple and easy to use. We investigated the effectiveness of the Terudermis in the treatment of facial skin defects by analyzing previous relevant cases treated in our institution. Methods: We retrospectively examined 143 patients who were treated with the Terudermis graft in facial skin defect at Dong Kang General Hospital in 2015 and 2016. The patients' age, sex and location, wound size, complications were analyzed. In addition, the patients were asked to complete a self-satisfaction questionnaire after 18 months from the completion of treatment. The results were compared with that of autologous full-thickness skin graft (FTSG) and split-thickness skin graft (STSG) patients in same period. Results: The mean self-satisfaction scores evaluated by patients were $4.1{\pm}1.0$, $4.0{\pm}1.3$ and $3.5{\pm}1.8$ for the Terudermis graft, FTSG and STSG patients, respectively. With respect to complications, there were fewer incidences of hematoma, partial skin loss and complete skin loss in the Terudermis graft patients. Conclusion: In the present study, the Terudermis, when used to treat post-traumatic facial skin defects, is a good alternative option to obtain satisfactory aesthetic outcomes. Also, the Terudermis grafting is a simple and easy treatment method to perform.

• Archives of Craniofacial Surgery
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• v.19 no.1
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• pp.3-12
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• 2018

Background: Millard's rotation-advancement repair, which is used by many surgeons, can make a natural philtral column, but most surgeons use a modification of the rotation-advancement flap. The purpose of this article is to introduce a modification utilized by the authors and to provide detailed surgical procedure. Methods: We retrospectively reviewed 82 patients' medical records and presented surgical technique and outcomes. The main features of the authors' strategy are emphasizing horizontal length of the lip, orbicularis oris muscle duplication for improving the definition of the philtral column, overcorrection of domal portion than the non-cleft side in order to compensate for the recurrence during growth. Two judges rated two times the appearance of the patients' nose and lip using Asher-McDade aesthetic index. Intra- and interobserver reliabilities were determined using Cohen's kappa statistics. Results: All patients recovered eventually after surgery; however, two patients have a minor complications (wound infection in one patient, wound disruption due to trauma in the other patient). The improvement of the aesthetic results can be achieved with this modified Millard technique. Total mean scores of the Asher-McDade index was 2.08, fair to good appearance. The intraobserver reliabilities were substantial to almost perfect agreement and the interobserver reliabilities were moderate to almost perfect agreement. Conclusion: We modified Millard method for repair of complete unilateral cleft lip. The surgical outcomes were favorable in long-term follow-up. We hope our technique will serve as a guide for those new to the procedure.