• Maxillofacial Plastic and Reconstructive Surgery
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• 제15권1호
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• pp.1-6
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• 1993

The maxillary squamous cell carcinoma is major part of maxillary malignant tumor. The treatment of maxillary malignancy tumor is the maxillectomy in combination with radiation therapy and chemorherapy. When tumor invasion is occured to the orbit, orbital exenteration is required. But if the periosteum of the orbital floor is intact, the orbit can be preserved. There are many orbital floor reconstruction materials for the prevention of ptosis of the orbital content. The patients on this paper were diagnosised as squamous cell carcinoma on maxilla, we performed the partial maxillectomy including the orbital floor, and we used temporalis muscle-coronoid process flap for the reconstruction of the orbital floor after partial maxillectomy and obtained good esthetic and functional results, as followed. 1. We obtained sufficient flap width for defect of orbital floor. 2. It permits good blood supply and no necessary other donor site. 3. It gives a solid base for the support the globe and the orbital floor. 4. It gives minimal postoperative morphorogical defect and functional disturbance.

• 대한두개안면성형외과학회지
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• 제22권5호
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• pp.232-238
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• 2021

Background: Galeal or temporalis muscle flaps have been traditionally used to reconstruct skull base defects after tumor removal. Unfortunately, these flaps do not provide sufficient vascularized tissue for a dural seal in extensive defects. This study describes the successful coverage of large skull base defects using anterolateral thigh (ALT) free flaps. Methods: This retrospective study included five patients who underwent skull base surgery between June 2018 and June 2021. Reconstruction was performed using an ALT free flap to cover defects that included the intracranial space and extended to the frontal sinus and cribriform plate. Results: There were no major complications, such as ascending infections or cerebrospinal leakage. Postoperative magnetic resonance imaging showed that the flaps were well-maintained in all patients. Conclusion: Successful reconstruction was performed using ALT free flaps for large anterior skull base defects. In conclusion, the ALT free flap is an effective option for preventing communication between the nasal cavity and the intracranial space.

• 대한두개안면성형외과학회지
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• 제10권1호
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• pp.49-54
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• 2009

상악골 악성종양의 경우 적출 후 골편들을 이식해 상악동 전체를 재건하는 경우는 재발이 많아 잘 시행하지 않는다. 이러한 이유로 안와하연의 재건을 통해 안구 및 안면윤곽만을 재건하는데, 저자들이 시행한 혈행화된 부분 두께의 골이식(vascularized split thickeness calvarium)은 술기방법에 있어 골피판이 혈관경에서 쉽게 분리되는 성질이 있어 시행에 주의가 필요하고 혈관경을 포함한 temporalis muscle이 부피감을 주므로 미용상 불리한 점이 있는 반면에 골편의 높은 생존율이 보장된다는 장점과 공여부의 합병증이 적다는 장점을 가진다. 또한 술후 복시 현상이나 안구함몰이 관찰되지 않았다는 점이 합리적인 술기임을 지지해준다. 따라서 측두동맥 및 정맥을 혈관경으로 하는 혈행화된 두정골 부분층 이식술은 안와하벽을 재건하는데 있어 안전하게 시행가능 한 술기였음을 보고하는 바이다.

• Archives of Plastic Surgery
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• 제41권6호
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• pp.716-721
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• 2014

Background The aim of this study was to review the recipient vessels used in our cases of facial reanimation with free functional muscle transfer and to identify patient variables that may predict when the facial vessels are absent. From this we present a protocol for vessel selection in cases when the facial artery and/or vein are absent. Methods Patients were identified from November 2006 to October 2013. Data was collected on patient demographics, facial palsy aetiology, history of previous facial surgery/trauma and flap/recipient vessels used. A standard operative approach was adopted and performed by a single surgeon. Results Eighty-seven eligible patients were identified for inclusion amongst which 98 hemifaces were operated upon. The facial artery and vein were the most commonly used recipient vessels (90% and 83% of patients, respectively). Commonly used alternative vessels were the transverse facial vein and superficial temporal artery. Those with congenital facial palsy were significantly more likely to lack a suitable facial vein (P=0.03) and those with a history of previous facial surgery or trauma were significantly more likely to have an absent facial artery and vein (P<0.05). Conclusions Our algorithm can help to guide vessel selection cases of facial reanimation with free functional muscle transfer. Amongst patients with congenital facial palsy or in those with a previous history of facial surgery or trauma, the facial vessels are more likely to be absent and so the surgeon should then look towards the transverse facial vein and superficial temporal artery as alternative recipient structures.

• Archives of Plastic Surgery
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• 제45권3호
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• pp.271-274
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• 2018

The decision of which surgical approach to use for the treatment of a multifocal craniofacial abscess is still a controversial matter. A failure to control disease progress in the craniofacial region can potentially put the patient's life at risk. Therefore, understanding the various ways to approach the craniofacial region helps surgeons to obtain satisfactory results in such cases. In this report, we describe a patient who visited the emergency department with a large swelling in his right cheek. A blood test and computed tomography revealed odontogenic maxillary sinusitis. The patient developed sepsis due to a progressive multifocal abscess. An abscess was seen in the temporal muscle, infratemporal fossa, and interorbital region. To control this multifocal abscess, we used the facial dismasking flap (FDF) approach. After debridement using the FDF approach, we succeeded in obtaining sufficient drainage of the abscess, and the patient recovered from sepsis. The advantages of the FDF approach are that it provides a wide surgical field, extending from the parietal region to the mid-facial region, and that it leaves no aesthetically displeasing scars on the face. The FDF approach may be one of the best options to approach multifocal abscesses in the craniofacial region.

• Archives of Plastic Surgery
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• 제34권2호
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• pp.250-257
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• 2007

Purpose: Aging changes of midface include drooping of lower lid, wrinkles of malar area, orbitomalar groove and deepening of nasolabial fold from drooping of malar fat pad. Improvement of lower lid can be achieved through lower blepharoplasty, but improvement of cheek can not be gained. Superficial subciliary cheek lift(by Moelleken, 1996) is a method that lifts malar fat pad through extended subciliary incision. We obtained simultaneous improvement of lower lid, malar wrinkles and orbitomalar groove with modification of this technique. Methods: From December 2003 to January 2006, we performed this method on 21 patients among volunteers for lower blepharoplasty who wanted to correct orbitomalar groove and malar wrinkles. Under local anesthesia, lateral extension of subciliary incision is done 1cm from the lateral orbital rim. Skin-muscle flap is elevated, and dealing of orbital fat and septum is the same as with ordinary lower blepharoplasty. After downward subcutaneous dissection through extended incision, exposing the upper 1/3 level of malar fat pad, superolateral fixation is done to superior deep temporal fascia. Excision of the upper part of fat pad is performed, if needed. After excision of overlapped skin-muscle flap, skin closure is done. Results: We obtained satisfactory results with this simple method for improvement of orbitomalar groove and malar wrinkles among patients for lower blepharoplasty. During a follow-up period of 5 months on the average, no revision was performed. Conclusion: Under local anesthesia, lower blepharoplasty and improvement of orbitomalar groove and malar wrinkles can be achieved at the same time. It is good for patients who do not want conventional midface-lifting. But surgeons should select patients and perform cautiously for it may leave a scar of the extended incision that require over 2 months for maturation and it is insufficient for improvement of nasolabial fold compared to conventional mid face-lifts.

• Archives of Plastic Surgery
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• 제44권4호
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• pp.261-265
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• 2017

Periauricular paresthesia may afflict patients for a significant amount of time after facelift surgery. When performing face and neck lift surgery, temple and posterior auricular flap dissection is undertaken directly over the auriculotemporal, great auricular, and lesser occipital nerve territory, leading to potential damage to the nerve. The auriculotemporal nerve remains under the thin outer superficial fascia just below the subfollicular level in the prehelical area. To prevent damage to the auriculotemporal nerve and to protect the temporal hair follicle, the dissection plane should be kept just above the thin fascia covering the auriculotemporal nerve. Around the McKinney point, the adipose tissue covering the deep fascia is apt to be elevated from the deep fascia due to its denser fascial relationship with the skin, which leaves the great auricular nerve open to exposure. In order to prevent damage to the posterior branches of the great auricular nerve, the skin flap at the posterior auricular sulcus should be elevated above the auricularis posterior muscle. Fixating the superficial muscular aponeurotic system flap deeper and higher to the tympano-parotid fascia is recommended in order to avoid compromising the lobular branch of the great auricular nerve. The lesser occipital nerve (C2, C3) travels superficially at a proximal and variable level that makes it vulnerable to compromise in the mastoid dissection. Leaving the adipose tissue at the level of the deep fascia puts the branches of the great auricular nerve and lesser occipital nerve at less risk, and has been confirmed not to compromise either tissue perfusion or hair follicles.