• Archives of Craniofacial Surgery
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• v.22 no.4
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• pp.193-198
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• 2021

Background: Nasal bone fractures are frequently encountered in clinical practice. Although fracture reduction is simple and correction requires a short operative time, low patient satisfaction and relatively high complication rates remain issues for many surgeons. These challenges may result from inaccuracies in fracture recognition and assessment or inappropriate surgical planning. Findings from immediate postoperative computed tomography (CT) scans and those performed at 4 to 6 weeks postoperatively were compared to evaluate the accuracy and outcomes of nasal fracture reduction. Methods: This retrospective study included patients diagnosed with nasal bone fractures at our department who underwent closed reduction surgery. Patients who did not undergo additional CT scans were excluded from the study. Clinical examinations, patient records, and radiographic images were evaluated in 20 patients with nasal bone fractures. Results: CT findings from immediately after surgery and a 1month follow-up were compared in 20 patients. Satisfactory nasal projection and aesthetically acceptable results were observed in patients with accurate correction or mild overcorrection, while undercorrection was associated with unfavorable results. Conclusion: Closed reduction surgery for correcting nasal bone fractures usually provides acceptable outcomes with relatively few complications. If available, immediate postoperative CT scans are recommended to guide surgeons in the choice of whether to perform secondary adjustments if the initial results are unsatisfactory. Based on photogrammetric data, nasal bone reduction with accurate correction or mild overcorrection achieved acceptable and stable outcomes at 1 month postoperatively. Therefore, when upward dislocation is observed on postoperative CT, one can simply observe without a subsequent intervention.

• Archives of Craniofacial Surgery
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• v.23 no.3
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• pp.119-124
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• 2022

Background: Many severe nasal bone fractures present with septal fractures, causing postoperative septal deviation and negatively affecting the patients' quality of life. However, when a septal fracture is absent, it is difficult to predict whether surgical correction can help minimize nasal septal deviation postoperatively. This study determined whether performing closed reduction on even mildly displaced nasal bone fracture could deter the outcome of septal deviation. Methods: We retrospectively reviewed the data of 116 patients aged 21-72 years who presented at the outpatient clinic and emergency room with fractures of nasal bones only without any involvement of the septum from January 2014 to December 2020. Patients were classified into three fracture type groups: A (unilateral), B (bilateral), and C (comminuted with depression). The degree of septal deviation was calculated by measuring the angle between the apex of the most prominent point and the crista galli in the coronal view on computed tomography images. The difference between the angles of the initial septal deviation and that of the follow-up was calculated and expressed as delta (Δ). Results: Closed reduction tended to decrease the postoperative septal deviation in all fracture types, but the values were significantly meaningful only in type A and B fractures. In the surgical group, with type A as the baseline, type B showed a significantly larger Δ value, but type C was not significantly different, although type C showed a smaller Δ value. In the conservative group, with type A as the baseline, the other fracture types presented significantly lower Δ values. Conclusion: For all fracture types, closed reduction significantly decreased the extent to which the nasal septum likely deviated. Therefore, when a patient is reluctant to undergo closed reduction, physicians should address the possible outcomes and prognosis of untreated nasal bone fractures.

• Archives of Craniofacial Surgery
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• v.23 no.4
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• pp.163-170
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• 2022

Background: Personal mobility devices (PMDs) have become an increasingly popular transport modality globally. With increasing social interest in and demand for PMDs, the number of individuals visiting emergency departments with PMD-related injuries has also increased annually. This study aimed to evaluate injury patterns and treatment costs for patients treated in the department of plastic surgery in a trauma center. Methods: In this retrospective study, data concerning patients with PMD-related injuries from January 2017 to December 2021 were reviewed. The data retrieved included age, sex, alcohol consumption, helmet use, the type of impact, onset of injury, place of first visit, type of injury, admission status, operation status, and treatment cost. Multiple linear regression analysis was performed to determine the effects of various factors on cost. Results: Data were collected from 93 patients. Until 2019, the annual number of PMD-related accidents was less than 10; however, this number increased sharply in 2020. The average cost of hospitalization was USD 7,698 whereas the average cost of non-hospitalization was USD 631. Only fractures had a significant association with total cost in linear regression analysis (p< 0.001). Conclusion: The prevalence of PMD use and related injuries requiring plastic surgery during the study period showed significant health and financial costs both to the patients involved and to society. This cost could be reduced through stricter regulations concerning PMD use, advocating the use of protective gear, and promoting greater awareness of safety measures and of the consequences of PMD-related accidents.

• Archives of Craniofacial Surgery
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• v.23 no.6
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• pp.256-261
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• 2022

Background: Treating panfacial fractures (PFFs) can be extremely difficult even for experienced surgeons. Although several authors have attempted to systemize the surgical approach, performing surgery by applying a unidirectional sequence is much more difficult in practice. The purpose of this study was to review the literature on PFF surgery sequence and to understand how different surgical specialists-plastic reconstructive surgery (PRS) and oral maxillofacial surgery (OMS)-chose sequence and review PFFs fixation sequence in clinical cases. Methods: The PubMed and Google Scholar databases were scoured for publications published up until May 2020. Data extracted from the studies using standard templates included fracture part, fixation sequence, originating specialist, and the countries. Bibliographic details like author and year of publication were also extracted. Also, we reviewed the data for PFFs patients in the Trauma Registry System of Dankook University Hospital from 2011 to 2021. Results: In total, 240 articles were identified. This study comprised 22 studies after screening and full-text analysis. Sixteen studies (12 OMS specialists and 4 PRS specialists) used a "bottom-top" approach, whereas three studies (1 OMS specialist and 2 PRS specialists) used a "top-bottom" method. However, three studies (only OMS specialists) reported on both sequences. In our hospital, there were a total of 124 patients with PFF who were treated during 2011 to 2021; 64 (51.6%) were in upper-middle parts, 52 (41.9%) were in mid-lower parts, and eight (6.5%) were in three parts. Conclusion: Bottom-top sequencing was mainly used in OMS specialists, and top-bottom sequencing was used at a similar rate by two specialists in literature review. In our experience, however, it was hard to consistently implement unidirectional sequence suggested by a literature review. We realigned the reliable and stable buttresses first with tailoring individually for each patient, rather than proceeding in the unidirectional sequence like bottom-top or top-bottom.

• Archives of Craniofacial Surgery
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• v.24 no.2
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• pp.52-58
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• 2023

Background: Complex orbital fractures are impure orbital fractures because they involve the orbital walls and mid-facial bones. The author reported an orbital wall restoration technique in which the primary orbital wall fragments were restored to their prior position in complex orbital fractures in 2020. As a follow-up to a previous preliminary study, this study retrospectively reviewed the surgical results of complex orbital wall fractures over a 4-year period and compared the surgical outcomes by dividing them into groups with and without balloon restoration. Methods: Data of 939 patients with facial bone fractures between August 2018 and August 2022 were reviewed. Of these, 154 had complex orbital fractures. Among them, 44 and 110 underwent reduction with and without the balloon technique respectively. Pre- and postoperative Naugle exophthalmometer (Good-Lite Co.) scales were evaluated. The orbital volume and orbital volume ratio were calculated from preoperative and 6 months postoperative computed tomography images. Results: Among 154 patients with complex orbital fractures, 44 patients underwent restoration with the balloon technique, and 110 patients underwent restoration without it. The Naugle scale did not differ significantly between the two groups, but the orbital volume ratio significantly decreased by 3.32% and 2.39% in groups with and without the balloon technique and the difference in OVR was significantly greater in patients in the balloon restoration group compared with the control group. Postoperative balloon rupture occurred in six out of 44 cases (13.64%). None of the six patients with balloon rupture showed significant enophthalmos at 6 months of follow-up. Conclusion: The balloon rupture rate was 13.64% (6/44 cases) with marginal screw fixation, blunt screws, and extra protection with a resorbable foam dressing. Furthermore, we restored the orbital wall with primary orbital fragments using balloon support in complex orbital wall fractures.

• Archives of Craniofacial Surgery
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• v.24 no.3
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• pp.117-123
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• 2023

Background: Midfacial fractures frequently involve the maxillary sinus, leading to maxillary sinus pathology. We aimed to examine the incidence and contributing factors of maxillary sinus pathology in patients who underwent open reduction and internal fixation (ORIF) for midfacial fractures. Methods: A retrospective analysis was conducted on patients who underwent ORIF for midfacial fractures at our department over the past 10 years. The incidence of maxillary sinus pathology was identified clinically and/or by computed tomography findings. Factors that significantly influenced the groups with and without maxillary sinus pathology were examined. Results: The incidence of maxillary sinus pathology in patients who underwent ORIF for midfacial fractures was found to be 11.27%, with sinusitis being the most common pathology. Maxillary sinus pathology was significantly associated with the presence of a blowout fracture involving both the medial and the inferior orbital walls. Factors such as sex, age, diabetes mellitus, hypertension, smoking, inflammatory disease, follow-up period, use of absorbable plates, and use of titanium plates did not have a significant impact on the development of maxillary sinus pathology. Conclusion: The incidence of maxillary sinus pathology in patients who underwent ORIF for midfacial fractures was relatively low, and in most cases, it resolved without the need for specific treatment. Consequently, there may not be a significant need for concern regarding postoperative maxillary sinus pathology.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.32 no.3
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• pp.241-249
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• 2006

Purpose For the reconstruction of craniofacial deformities, the distraction osteogenesis is an useful method which can make new soft tissues as well as new bone. Although the distraction osteogenesis is an effective procedure in quantitative aspects, the new bone formed by this procedure can be coarse in qualitive aspects sometimes. Materials and methods Twelve rabbits, weighing about 2 kg, were included and the prefabricated distraction device were used. After a latency period of 5 days, in the experimental group (n=6), the mandible was distracted at the rate of 1.0 mm/day for 2 days and then compressed with 1.0 mm for the next 3rd day, therefore distracted totally to a length of 1.0 mm for 3 days. This procedure was repeated 5 times and, as a result, the experimental group was distracted to a length of 5.0 mm for 15 days finally. In the control group (n=6), the mandible was distracted totally to a length of 5.0 mm at the rate of 1 mm/day. At 2 weeks and 8 weeks of consolidation in the control group, 3 rabbits in each group were sacrificed and their biopsy specimens from the distracted mandible were taken. Results All animals showed the mandibular elongation clinically and radiographically. Histologically, many blood vessels, osteoblasts and immature bones formed by osteoid deposition were observed in the experimental group at 2 weeks. At 8 weeks, the bony trabeculae were thicker than the ones in the control group and were composed of lamella bones and woven bones in the experimental group. On histomorphometric analysis, the bone deposition area of the distracted site was broader in the experimental group $(273.8{\pm}115.7\;cm^2)$ than the one in the control group $(199.4{\pm}101.4\;cm^2)$. Futhermore, the modified rate of bone deposition area was higher in the experimental group (48${\pm}$20%) than the one in the control group (35${\pm}$18%). However, these data showed no significant differences statistically. Conclusion These results suggest that the distraction osteogenesis by using an alternating distraction/compression protocols is an effective method for increasing new bone formation in distracted areas.

• Journal of the korean academy of Pediatric Dentistry
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• v.30 no.2
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• pp.217-228
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• 2003

Co-ordinate growth of the brain and skull is achieved through a series of tissue interactions between the developing brain, the growing bones of the skull and the sutures that unite the bones. Craniosynostosis, the premature fusion of cranial sutures, presumably involves disturbance of these interactions. Bmp2, one of bone morphogenetic proteins (Bmps), is involved in the regulation of the shapes of individual bones and the relative proportions of the skeleton. Mutations in the homeobox gene Msx2, known as a downstream gene of Bmp, cause Boston-type human craniosynostosis. The phenotype of Dlx5 homozygote mutant mouse presents craniofacial abnormalities including a delayed ossification of calvarial bone. These facts suggest important roles of Bmp2, Msx2 and Dlx5 genes in the cranial bone growth and suture morphogenesis. To elucidate the function of these molecules in the early morphogenesis of mouse cranial sutures, we first analyzed by in situ hybridization the expression of Bmp2(E15-18), Msx2 and Dlx5 genes in the developing sagittal suture of calvaria during the embryonic stage. Bmp2 mRNA was intensely expressed in the osteogenic fronts and also at the low level in the periosteum of parietal bones during embryonic stage, Msx2 mRNA was intensely expressed in the sutural mesenchyme and mildly expressed in the dura mater during the embryonic stage. Dlx5 mRNA was intensely expressed osteogenic fronts and parietal bones. To further examine the role of Bmp signaling in cranial suture, we did in vitro experiments in E15.5 mouse calvarial explants. Interestingly, implantation of Bmp2-soaked beads onto the osteogenic fronts after 48 hours organ culture resulted in the increase of the tissue thickness and cell number around Bmp2 beads, compared to BSA control beads. In addition Bmp2 induced etopic expressions of Msx2 and Dlx5 genes. On the other hand, overexpression of FGF2 did not induce the expression of Msx2 and Dlx5. Taken together, these data indicate that Bmp2 signaling molecule has a important role in regulating the cranial bone growth and early morphogenesis of cranial suture. We also suggest that Bmp signaling is involved in all the stages of osteogenesis of cranial bones and the maintenance of cranial suture by regulating Msx2 and Dlx5 genes, and that Msx2 and Dlx5 genes are specific transcription factors of Bmp signaling pathway.

• Journal of Dental Rehabilitation and Applied Science
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• v.23 no.4
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• pp.373-384
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• 2007

The purpose of this study was to analyse the stress distribution on the craniofacial suture and cranium after application of RME. Twelve years and six months old boy and twenty years old adult male were chosen for taking computed-tomography for FEM. From DICOM visual information, it was processed by 3-dimensional image construction program Mimics 10.01. Hounsfield unit(HU) which shows gray scale of CT image is picked for revealing mechanical properties of each model. The models have been accomplished with various range of physical properties. After applying 5.0 mm expansion, the maxillary complex model was obeserved for analyzing displacement and stress distribution of the model. The amount of transverse expansion of child and adult maxilla is different according to its location. It appears that it decreases gradually with the distance from separation site. In child, maximum compressive stress located broad area in zygomatic buttress department and the ends of frontal process of maxilla, pterygoid plate, and bones surrounding orbit. However, in adult maximum compressive stress was located smaller area and the stres was higher than child.

• Journal of Korean Foot and Ankle Society
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• v.24 no.3
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• pp.120-123
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• 2020

Heterotopic ossification is the formation of extra-skeletal bone in the muscle and soft tissues, and an osteoma is a benign bone-forming tumor composed of compact or mature trabecular bone limited almost exclusively to the craniofacial bones. This paper reports an extremely rare case of heterotopic ossification mimicking an osteoma that occurred independently at the plantar side of the medial sesamoid bone. The patient was a 46-year-old male with a three-month history of pain and a hard mass on the plantar aspect of the left forefoot sole. After excising the lesion, the patient's symptoms were relieved, and no pain or complications occurred. This paper discusses this exceedingly rare case of heterotopic ossification around the medial sesamoid bone with a review of the relevant literature.