• Archives of Plastic Surgery
• /
• v.37 no.4
• /
• pp.499-530
• /
• 2010

Purpose: Lateral osteotomy is an essential step in the correction of nasal bony asymmetry. Direct visualization allows accurate repositioning of the nasal bones compared to blind techniques, which require precision and manual dexterity. We propose direct visualization procedures in open corrective rhinoplasty. Methods: The technique was used on 16 patients. All patients underwent open rhinoplasty with a columellar incision. The marginal incisions were extended on either side to allow access to the piriform aperture. A double hook was used to caudally retract the lower lateral cartilages and the fibrous connections between the upper and lower lateral cartilages were released until the piriform aperture was visualized. Through the incision, lateral osteotomy was performed using a reciprocating saw at that time with direct visualization. Additional procedures including augmentation rhinoplasty, hump resection, septoplasty and tip plasty were performed simultaneously. Results: This method provided excellent exposure to the lateral nasal bones and allowed the lateral osteotomy to be carried out precisely using the reciprocating saw. Conclusion: This extended open rhinoplasty method is suitable for most individuals, allowing a wide surgical field.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.20 no.2
• /
• pp.91-96
• /
• 1998

Surgical resection of tumors in the maxillofacial region sometimes results in extended defects of soft and hard tissue that frequently causes aesthetic, functional and especially mental damages. It is essential for patients with such facial defects to reduce the scar and maxillofacial asymmetry. To attain esthetic facial appearance after hemimaxillectomy, we devise a new design, so called 'IOIO Incision' (InfraOrbital-IntraOral incision). The new approach is established on infraorbital region to expose maxillofacial skeleton in aspect of face. And the other incision is designed on intraoral region. The IOIO incision provide excellent aesthetic result after hemimaxillectomy, because of reduced minimal facial scar contraction. Maxillofacial surgeons are used to designing Weber-Fergusson incision in resection of maxillofacial tumors, but disadvantages of the incision were large scar and asymmetry of face. To improve theses problem, we attempted IOIO Incision.. For correct osteotomy of posterolateral wall of maxillary sinus, 1. Fenestra formation on zygomatic body for easily access of reciprocating saw to posterolateral wall of maxillary sinus. 2. To achieve better visual field in posterolateral aspect of maxilla, fat tissue is removed from infratemporal fossa. This new, versatile procedure can be used for benign and malignant lesions of the maxillary area. We introduce cases with review of literatures.

• Archives of Plastic Surgery
• /
• v.40 no.3
• /
• pp.251-255
• /
• 2013

We present a case of a 57-year-old male patient who presented with squamous cell carcinoma on his mouth floor with cervical and mandibular metastases. Wide glossectomy with intergonial mandibular ostectomy, and sequential reconstruction using fibular osteomyocutaneous free flap were planned. When the anastomosis between the peroneal artery of the fibular free flap and the right lingual artery was performed, no venous flow was observed at the vena comitans. Then re-anastomosis followed by topical application of papaverine and lidocaine was attempted. However, the blood supply was not recovered. Warm saline irrigation over 30 minutes was also useless. Microvascular thromboses of donor vessels were clinically suspected, so a solution of 100,000 units of urokinase was infused once through a 26-gauge angiocatheter inserted into the recipient artery just at the arterial anastomotic site, until the solution gushed out through the flap vena comitans. Immediately after the application of urokinase, arterial flow and venous return were restored. There were no complications during the follow-up period of 11 months. We believe that vibrating injuries from the reciprocating saw during osteotomies and flap insetting might be the cause of microvascular thromboses. The use of urokinase may provide a viable option for the treatment of suspicious intraoperative arterial thrombosis.