• 대한의사협회지
• /
• 제61권12호
• /
• pp.740-748
• /
• 2018

Posttraumatic facial deformities (PTFDs) are very difficult to correct, and if they do occur, their impact can be devastating. It may sometimes be impossible for patients to return to normal life. The aim of surgical treatment is to restore the deformed bone structure and soft tissue to create symmetry between the affected side and the opposite side. In the process of managing PTFD, correcting enophthalmos is one of the most challenging aspects for surgeons because of difficulties in overcoming the scar tissue and danger of injuring to the optic nerve. In this article, surgical options for reconstruction of the medial wall, floor, lateral wall, and roof of the orbit are described. To optimize aesthetic improvement, additional cosmetic procedures such as facial contouring surgery, blepharoplasty and rhinoplasty can be used. Plastic surgeons should join emergency trauma teams to implement an overall treatment plan containing rational strategies to avoid or minimize PTFD.

• Archives of Plastic Surgery
• /
• 제37권3호
• /
• pp.265-270
• /
• 2010

Purpose: Most of the bilateral structures in our body are not perfectly balanced, such that one side is preferred than the other or it has physiological superiority. Eyes also have an imbalance; the eye with sensory and motional superiority compared to the other is called dominant eye. Authors of this study focused on analyzing the correlation between the dominant eye and levator palpebrae superioris muscle. Methods: The subject of this study was 42 patients with no ptosis and with no past history of blepharoplasty. Hand dominance was identified through questionnaire and dominant eye was identified by hole-in-the-card dominance test (Dolman's test) in all patients. The function of levator palpebrae superioris muscle was measured by MLD (marginal limbal distance). During the measuring procedure, frontalis muscle was not inhibited to avoid the eyelid skin hooding. Results: Out of 42 patients, 27 patients (64.3%) were right ocular dominant, 15 patients (35.7%) were left ocular dominant, 36 patients (85.7%) were right hand dominant and 4 patients (9.5%) were left hand dominant. Out of 27 right ocular dominant patients, right MLD was larger than the left in 26 patients (96.3%). It was larger in average of 0.47 mm (p<0.001) in 27 right ocular dominant patients. Also, left MLD was larger than the right in 11 patients (73.3%) out of 15 left ocular dominant patients. It was larger in average of 0.57 mm (p=0.003) in 27 left ocular dominant patients. MLD on the side of the dominant eye was larger in average of 0.50 mm (p<0.001) than the MLD of non-dominant eye side. Right MLD was larger than the left in average of 0.28mm (p=0.010) in right hand dominant patients, and left MLD was larger than the right in average of 1.15 mm (p=0.025) in left hand dominant patients. Conclusion: The function of levator palpebrae muscle differs in right and left, and the difference correlates with the dominant eye. Also, the function of levator palpebrae muscle is stronger in the dominant eye. We were able to present statistical evidence regarding the difference of the function in right and left levator palpebrae muscle. This may be a factor worth consideration in terms of balancing the eyes during the blepharoplasty.

• Archives of Plastic Surgery
• /
• 제42권2호
• /
• pp.214-217
• /
• 2015

Blepharoptosis is a common indication for surgery in plastic surgery units, yet its possible underlying pathology frequently remains unidentified. A 52-year-old man with a 20-year history of progressive bilateral ptosis (right>left) presented with recurrent ptosis of both eyes; he had undergone an operation on the levator aponeurosis 12 years prior. Due to the suspicion of an underlying disease, he was evaluated further. Chronic progressive external ophthalmoplegia in transition to the more severe syndromic variant Kearns-Sayre syndrome, a mitochondrial disorder causing myopathy, was diagnosed. The patient was treated with coenzyme Q10, and he underwent ptosis surgery on both eyes. This case illustrates a potentially multi-systemic disease that was diagnosed by a further evaluation of a common symptom, in this case worsening blepharoptosis. Awareness of myopathic symptoms is necessary to prevent overlooking serious yet improvable conditions.

• Archives of Plastic Surgery
• /
• 제37권5호
• /
• pp.561-564
• /
• 2010

Purpose: According to the data presented by ministry of justice, a number of foreign workers in Korea is approximately 700 thousands and among them 22 thousands are illegal workers. We would like to provide the basic information the foreign workers by analyzing clinical contents. Methods: 1456 patients who visited the hospital were reviewed by nationality, medical department, gender and age. 62 patients have visited plastic surgery department and they were additionally reviewed by diagnosis, chief complant and operation. Results: Mongolians were 388 cases (26.7%), followed by Chineses with 452 cases (31.1%). General surgery had 264 visits (18.1%) followed by internal medicine with 388 visits (26.6%). In gender grouping, 781 patients were males and 675 patients were females. Hand, face and extremity injuries were common in plastic surgery field but many foreign worker patients also wanted to take aesthetic surgery such as scar revision, blepharoplasty and augmentation rhinoplasty. Conclusion: It has been twenty years since foreign workers have come to the Korean society. In the past foreign workers were mostly neglected. However with the vast improvement in labor and welfare related services, demands for plastic surgery, especially aesthetic surgery are increasing among foreign workers. Therefore plastic surgeons' continuous interest in foreign workers is required.

• 대한두개안면성형외과학회지
• /
• 제17권4호
• /
• pp.206-210
• /
• 2016

Background: Zygoma is a major buttress of the midfacial skeleton, which is frequently injured because of its prominent location. Zygoma fractures are classified according to Knight and North based on the direction of anatomic displacement and the pattern created by the fracture. In zygomaticomaxillary complex (ZMC) fracture many incisions (lateral eyebrow, lateral upper blepharoplasty, transconjunctival, subciliary, subtarsal, intraoral, direct percutaneous approach) are useful. We reviewed various approaches for the treatment of ZMC fractures and discussed about incisions and fixation methods. Methods: A retrospective review was conducted of patients with ZMC fracture at a single institution from January 2005 to December 2014. Patients with single zygomatic arch fracture were excluded. Results: The identified 694 patients who were admitted for zygomatic fractures from which 192 patients with simple arch fractures were excluded. The remaining 502 patients consisted of 439 males and 63 females, and total 532 zygomatic bone was operated. Orbital fracture was the most common associated fracture. According to the Knight and North classification the most frequent fracture was Group IV. Most fractures were fixated at two points (73%). Conclusion: We reviewed our cases over 10 years according to fracture type and fixation methods. In conclusion, minimal incision, familiar approach and fixation methods of the surgeon are recommended.

• 대한두개안면성형외과학회지
• /
• 제17권2호
• /
• pp.77-81
• /
• 2016

Background: Asymmetry of the infraorbital rim can be caused by trauma, congenital or acquired disease, or insufficient reduction during a previous operation. Such asymmetry needs to be corrected because the shape of the infraorbital rim or midfacial skeleton defines the overall midfacial contour. Methods: The study included 5 cases of retruded infraorbital rim. All of the patient underwent restoration of the deficient volume using polyethylene implants between June 2005 and June 2011. The infraorbital rim was accessed through a subciliary approach, and the implants were placed in subperiosteal space. Surgical outcomes were evaluated using preoperative and postoperative computed tomography studies. Results: Implant based augmentation was associated with a mean projection of 4.6 mm enhancement. No postoperative complications were noted during the 30-month follow-up period. Conclusion: Because of the safeness, short recovery time, effectiveness, reliability, and potential application to a wide range of facial disproportion problems, this surgical technique can be applied to midfacial retrusion from a variety of etiologies, such as fracture involving infraorbital rim, congenital midfacial hypoplasia, lid malposition after blepharoplasty, and skeletal changes due to aging.

• 대한두개안면성형외과학회지
• /
• 제20권1호
• /
• pp.3-9
• /
• 2019

Facial nerve palsy has an effect on a person's well-being functionally and psychologically. Therefore, comprehensive patient management is essential. One of the most common uncomfortable and potentially debilitating features is associated with the incapacity for eye closure. Restoration of eye closure is a key consideration during the surgical management of facial palsy. In this article, we introduce simple surgical methods-which are relatively easy to learn and involve the upper and lower eyelids-for achieving eye closure. Correcting upper eyelid function involves facilitating the component of eye closure that is in the same direction as gravity and is, therefore, less complicated and favorable outcomes than correction of lower lid. Aesthetic aspects should be considered to correct the asymmetry caused by facial palsy. Lower eyelid function involves a force that opposes gravity for eye closure, which makes correction of lower eyelid ectropion more challenging than surgery for the upper eyelid, particularly in terms of effecting a sustained correction. Initially, proper ophthalmic evaluation is required, including identifying the chronicity and severity of ectropion. Also, it is important to determine whether or not lateral canthoplasty is necessary. The lateral tarsal strip procedure is commonly used for lower lid correction. However, effective lower lid correction can be achieved with better cosmesis when extensive supporting techniques are applied, including those involving cheek tissue.

• Archives of Plastic Surgery
• /
• 제34권6호
• /
• pp.777-784
• /
• 2007

Purpose: For a minor degree of mandibular prognathism, mandibular anterior segmental osteotomy (ASO), usually extracting the bilateral premolars, has been performed frequently to correct malocclusion of the anterior teeth. Preoperative planning using cephalometry and a dental model is very important for such a orthognathic surgery. Depending on the specific preoperative mock surgery with the dental model, ASO, with ipsilateral unitooth extraction, is defined to be feasible and performed for ten patients. The comparisons of its preoperative and postoperative analysis of clinical photographs, dental casts, and lateral cephalograms, for soft tissue profiles, skeletal and dental relationships are described in the following, and its clinical applications are noted. Methods: From March 1, 2004, to March 31, 2006, We performed 10 mandibular ASO by extraction of ipsilateral unitooth to improve their lower facial profiles and the lip relationships. Patient age ranged from 19 to 33 years, with a mean age of 25.6 years. Two were males and eight were females. Results: All patients were satisfied with aesthetic and occlusal changes postoperatively. Significant and persistent decrease in the SNB and interincisal angle were observed in the postoperative cephalometries. The soft tissue profiles also were improved and near Ricketts's esthetic line. Other combined procedures include nine genioplasties, two rhinoplasties, and one blepharoplasty. One patient complained of transient unilateral inferior mental nerve paresthesia. There were no other significant complications or relapses throughout the follow-up period(6-20 months). Conclusion: Mandibular ASO, extracting the ipsilateral unitooth, was performed for ten patients to correct mild mandibular prognathism. The amount of setback of the mandibular anterior portion was 2 to 3 mm, and satisfactory results were obtained combined with genioplasties.

• 대한두개안면성형외과학회지
• /
• 제11권1호
• /
• pp.41-44
• /
• 2010

Purpose: The epicanthus is a specific feature in Asian. Many techniques have been described to eliminate the epicanthal fold: resection of glabellar skin, resection of medial canthal skin, V-Y advancement, V-W technique, modified Z-plasty, multiple Z-plasties, and others. The authors observed postoperative epiphora after correction of epicanthal fold by periciliary skin flap without damaging lacrimal duct. Methods: A 19-year-old woman underwent non-incisional blepharoplasty, septorhinoplasty, and periciliary epicanthoplasty. On her history, she didn't have any symptom of epiphora preoperatively. And there was no specific complaint of epiphora during the postoperative two weeks. However epiphora got worse from one month after the surgery. She was out of this country, so the patient re-visited the clinic on the postoperative six months for this on-going symptom. On an ophthalmologic examination, patient's lacrimal duct and sac was intact but both lacrimal puncta of the patient were covered with a thin membrane. This membrane was punctuated by a 25 gauge needle and dilated with a standard dilator. Results: After ophthalmologic treatment, no recurrence was observed during five weeks of follow-up periods. Conclusion: Both lacrimal puncta of the patient were only covered with membranes. And we could not confirm the direct relationship between periciliary epicanthoplasty and postoperative epiphora. The probable factors will be a predisposing narrowed punctum, post operative peri-punctal edema and decrease in muscular function of orbicularis oculi.

• Archives of Plastic Surgery
• /
• 제45권6호
• /
• pp.525-533
• /
• 2018

Background Patients with ectropion experience devastating symptoms. Therefore, the prevention and management of this condition are of utmost importance. To treat ectropion, it is important to perform medial and lateral canthopexy in an effective way. In this study, we propose a comprehensive algorithm for the prevention and management of ectropion based on a new classification of ectropion according to its signs and causes. Methods Canthopexy was performed in 68 cases according to the proposed algorithm, which starts with a categorization of the types of ectropion and ends with the recommended operative technique. To assess the results, we reviewed clinical preoperative and postoperative photographs. To evaluate improvements in patients' symptoms, we conducted a survey with responses scored on a Likert scale. Results None of the patients had scleral show postoperatively. The average patient satisfaction score was satisfied or higher for all symptoms, and the most improved symptom was aesthetic appearance. No major complications were reported. Conclusions For the comprehensive management of ectropion, it is crucial to consider both treatment and prevention. Through the simple surgical algorithm proposed in this study, both medically acceptable results and high levels of patient satisfaction were achieved without significant postoperative complications. We recommend using this algorithm for the comprehensive management of ectropion.