• Archives of Craniofacial Surgery
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• v.18 no.1
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• pp.16-20
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• 2017

Background: Pyogenic granuloma (PG) is a benign vascular lesion of the mucosa and skin. Recent studies of the epidemiology of PG are rare. We aimed to retrospectively analyze characteristics of PG cases in South Korea. Methods: We reviewed the medical records of 155 patients treated for PG between March 2005 and May 2014. The male-to-female ratio was 1:1.2 (70 males, 85 females). The mean age of patients was 35.3 years. Results: A high occurrence was observed in the first and third decades in males, and the fourth to fifth decades in females. There was a statistically significant difference between genders according to age group (p<0.05). The average lesion diameter was $0.84{\pm}0.46cm$ (long axis). The most frequently involved site was the face (n=47). Bleeding was the primary complication (n=41). PG was mostly treated with excisional biopsy (n=74). The recurrence rate was 7.7% (n=12). Conclusion: We concluded that most common site of PG was the face, the age of female with PG is higher than previous studies, and finger is associated with trauma more than other sites. The most recent epidemiological information on PG of this study will support the treatment and diagnosis of PG and future research objectives.

• Archives of Craniofacial Surgery
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• v.21 no.1
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• pp.27-34
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• 2020

Background: Free-flap reconstruction for recurrent head and neck cancer may be challenging depending on the previous treatments, those are, chemotherapy, radiotherapy, and surgery, including neck dissection or free tissue transfer. Specifically, the previous treatment could compromise the neck vessels, thereby making free-flap reconstruction more difficult. This study aimed to investigate the correlation between previous treatments and vascular compromise of the free flap. Methods: In this retrospective study, 124 free-flap reconstructions in 116 patients for recurrent head and neck cancer between 1993 and 2017 were investigated. The demographic characteristics, previous treatments, flap choices, infections, recipient vessels, and vascular crises were evaluated. Results: Of the 124 reconstruction cases, 10 had vascular crises. There were six revisions, totaling six flap failures. The success rate of free-flap reconstruction for recurrent cancer was 95.2%, which significantly differed from that for primary cancer (98.8%, p= 0.006). Moreover, in the recurrent cancer group, no correlation was found between previous treatments and vascular crises (p> 0.05). Increased rates of contralateral or uncommon anastomoses were found following neck dissection (p< 0.05). Conclusion: Previous neck dissection or radiotherapy could lead to scarring and tissue damage, which could in turn make microvascular reconstruction more challenging; however, the effect was not definite in this study. Approximately 60% of patients with previous neck dissection had compromised ipsilateral recipient vessels, which resulted in contralateral or uncommon anastomoses. In this study, free-flap reconstruction seems to be quite safe and preferable in patients with recurrent head and neck cancer based on the overall survival rate.

• Archives of Craniofacial Surgery
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• v.21 no.4
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• pp.237-243
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• 2020

Background: The scalp is an important functional and aesthetic structure that protects the cranial bone. Due to its inelastic characteristics, soft-tissue defects of the scalp make reconstruction surgery difficult. This study aims to provide an improved scalp reconstruction decision making algorithm for surgeons. Methods: This study examined patients who underwent scalp reconstruction within the last 10 years. The study evaluated several factors that surgeons use to select a given reconstruction method such as etiology, defect location, size, depth, and complications. An algorithmic approach was then suggested based on an analysis of these factors. Results: Ninety-four patients were selected in total and 98 cases, including revision surgery, were performed for scalp reconstruction. Scalp reconstruction was performed by primary closure (36.73%), skin graft (27.55%), local flap (17.34%), pedicled regional flap (15.30%), and free flap (3.06%). The ratio of primary closure to more complex procedure on loose scalps (51.11%) was significantly higher than on tight scalps (24.52%) (p=0.011). The choice of scalp reconstruction method was affected significantly by the defect size (R=0.479, p<0.001) and depth (p<0.001). There were five major complications which were three cases of flap necrosis and two cases of skin necrosis. Hematoma was the most common of the 29 minor complications reported, followed by skin necrosis. Conclusion: There are multiple factors affecting the choice of scalp reconstruction method. We suggest an algorithm based on 10 years of experience that will help surgeons establish successful surgical management for their patients.

• Journal of Korean Dental Science
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• v.13 no.1
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• pp.11-20
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• 2020

Purpose: This study sought to identify differences in hard and soft tissue chin profile changes in skeletal Class III patients after bimaxillary surgery, with or without advancement genioplasty. Materials and Methods: The retrospective study was conducted based on cephalometric analysis of skeletal and soft tissue variables. Lateral cephalograms taken at 3 different time points were utilized: pre-operation (T0), immediately post-operation (T1), and at least 6 months (11.0±2.6 months) post-operation (T2). The 2 groups were matched for sample size (n=20 each). Data were analyzed using independent t-tests with Bonferroni correction. Result: Group N (bimaxillary surgery alone) and Group G (bimaxillary surgery with an advancement genioplasty by horizontal sliding osteotomy) did not differ significantly in terms of demographic characteristics. The soft tissue chin thickness of Group G increased more after surgery, followed by a greater decrease during the postoperative period, and was eventually not significantly different from Group N at T2. On the other hand, the mentolabial sulcus depth of Group G (5.5±1.3 mm) was significantly greater than that of Group N (4.4±0.9 mm) (P=0.006) at T2. Conclusion: Although Group G showed a statistically significantly greater decrease in soft tissue chin thickness during the postoperative period, there were no significant intergroup differences in the chin profile for at least 6 months after the surgery, except for the mentolabial sulcus depth, which was greater in Group G than in Group N.

• Archives of Craniofacial Surgery
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• v.14 no.1
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• pp.1-10
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• 2013

Background: Recently, substances from seaweeds have been widely used in hair growth solutions, and have been proven to be effective. Seaweeds have been documented to possess hair growth activity; however, no report on the effect of seaweed on hair regeneration has been issued to date. In this study, we investigated which exact substance of hair tonic made by JW-bio and our institute shows effects on hair growth by studying the mechanisms of candidate substances. Methods: The study was conducted to investigate the hair restoring effect of domestic natural substances; we categorized the candidate substances as seaweed, cereal, and herbal medicine. Five experimental groups were included in the study as follows: a saline group, a 50% ethanol group, seaweed group, a cereal group, and a herbal medicine group. Results: Three extracts (seaweed, cereal, and herbal medicine) were administered to C57BL/6 mice for two weeks after depilation. Depilated areas were found to be completely covered with fully grown hair, and the hair re-growth score was highest in the seaweed group. Using a hair analysis system, hair characteristics were measured in all groups on days 10 and 14 after depilation. The width and length of hair follicles were largest in the seaweed group. Groups treated with seaweed showed significantly increased gene expression of insulin-like growth factor-1. Groups treated with all the three extracts showed decreased expression of transforming growth factor-${\beta}1$. Conclusion: Findings from our study suggest that seaweeds possess hair-growth effects and may be useful for the treatment of alopecia in the future.

• Archives of Craniofacial Surgery
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• v.20 no.6
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• pp.354-360
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• 2019

Background: Keloids are benign fibro-proliferative lesion, related to excessive inflammatory reactions in certain anatomical areas, including the auricles. Their specific etiology remains unclear; nonetheless they exhibit tumor-like characteristics of significant recurrence and cause emotional distress, even with various treatment strategies. We applied intermittent magnetic pressure therapy on ear keloids in combination with surgical excision, and present its effectiveness herein. Methods: Ear keloid patients were treated with surgical excision followed by magnetic pressure therapy. The keloid tissues underwent excision and keloid marginal flaps were utilized for wound closure. Intermittent magnetic pressure therapy was applied 2 weeks after the surgical procedure. The pressure therapy consisted of a 3-hour application and 2-hour resting protocol (9 hr/day), and lasted for 6 months. The results were analyzed 6 months after the therapeutic procedures, using the scar assessment scale. Results: Twenty-two ear keloids from 20 patients were finally reviewed. Among the keloids that completed the therapeutic course, 20 ear keloids out of 22 in total (90.9%) were successfully eradicated. Two patients (2 keloids) exhibited slight under-correction. Postoperative complications such as wound dehiscence or surgical site infection were not noted. The scar assessment scale demonstrated a significant improvement in each index. The intermittent pressure therapy led to patient compliance, and avoided pressure-related pain and discomfort. Conclusion: Excision followed by intermittent pressure application using a magnet successfully reduced the burden of fibro-proliferative keloids, and had good patient compliance. The role of intermittent pressure application and resting should be studied with regard to keloid tissue remodeling.

• Archives of Craniofacial Surgery
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• v.15 no.3
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• pp.117-120
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• 2014

Background: Lipomas can be categorized into deep and superficial lipomas according to anatomical depth. Many cases of forehead lipomas are reported to be deep to the muscle layer. We analyze ultrasound in delineating depth of forehead lipomas. Methods: A retrospective review was performed for all patients who underwent excision of forehead lipomas between January 2008 and March 2013 and for whom preoperative ultrasound study was available. Sensitivity and specificity of ultrasound imaging was evalauted against depth finding at the time of surgical excision. Results: The review identified 42 patients who met the inclusion criteria. Preoperative ultrasound reading was 18 as deep lipomas and 24 as superficial. However, intraoperative finding revealed 2 of the 18 deep lipomas to be superficial and 13 of the 24 superficial lipomas to be deep lipomas. Overall, ultrasonography turned out to be 69% (29/42) accurate in correctly delineating superficial versus deep lipomas. Conclusion: Lipomas of the forehead tend to be located in deeper tissue plane compared to lipomas found elsewhere in the body. Preoperative ultrasonography of lipomas can be helpful, but was not accurate in identifying the depth of forehead lipomas in our patient population. Even if a forehead lipoma is found to be superficial on ultrasound, operative planning should include the possibility of deep lipomas.

• Archives of Craniofacial Surgery
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• v.18 no.3
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• pp.155-161
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• 2017

Background: Because of the relatively similar size of organs to human and the physiological and structural similarities, the use of porcine as xenograft donors is progressing very actively. In this study, we analyzed the characteristics of porcine ear cartilage and evaluated its suitability as graft material in reconstructive and cosmetic surgery. Methods: The auricular cartilage was harvested from two pigs, and subjected to histological examination by immunohistochemical staining. To determine the collagen content, samples were treated with collagenase and weight changes were measured. After sterilization by irradiation, the samples were grafted into rats and stained with Hematoxylin and Eosin and Masson Trichrome to observe inflammation and xenograft rejection. Results: In IHC staining, extracellular matrices were mainly stained with type II collagen (20.69%), keratin sulfate (10.20%), chondroitin sulfate (2.62%), and hyaluronic acid (0.84%). After collagenase treatment, the weight decreased by 68.3%, indicating that about 70% of the porcine ear cartilage was composed of collagen. Upon xenograft of the sterilized cartilages in rats, inflammatory cells were observed for up to 2 months. However, they gradually decreased, and inflammation and reject-response were rarely observed at 5 months. Conclusion: The porcine ear cartilage was covered with perichondrium and cellular constituents were found to be composed of chondrocytes and chondroblasts. In addition, the extracellular matrices were mainly composed of collagen. Upon xenograft of irradiated cartilage into rats, there was no specific inflammatory reaction around the transplanted cartilage. These findings suggest that porcine ear cartilage could be a useful alternative implant material for human cosmetic surgery.

• Archives of Craniofacial Surgery
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• v.19 no.3
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• pp.175-180
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• 2018

Background: The facial bone has a complex structure compared to other bones, and various types of fractures can occur due to its characteristics. Among them, in comminuted fractures of anterior maxillary wall, multiple depressed and impacted bony segments cannot be reduced easily when performing internal fixation using plates and screws or wires, and inadequate restoration leads to a range of complications. This paper introduces an alternative technique using a resorbable mesh with fibrin glue to restore comminuted fractures of anterior maxillary wall. Methods: Thirteen patients were diagnosed with comminuted fractures of anterior maxillary wall between March 2017 and February 2018 in the authors' hospital. All patients with comminuted fractures of anterior maxillary wall underwent restoration using resorbable mesh with fibrin glue. The patients' demographics, causes of facial trauma, mean operation time, length of hospital stay, follow-up period, and complications were recorded. Results: No major complications and only one hypoesthesia of the skin area was noted. Three months after surgery, the hypoesthesia recovered completely. After surgery (mean, 3.9 months; range, 2-12 months), computed tomography showed that the bone fragments in all patients were fixed successfully in their anatomical places. Conclusion: In comminuted fractures of anterior maxillary wall, the use of a resorbable mesh with fibrin glue can be an advantageous and effective method for a successful restoration without complications.

• Archives of Craniofacial Surgery
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• v.12 no.1
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• pp.6-11
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• 2011

Purpose: The cephalic index (CI) is used to classify the head and every race has its unique characteristics. Previous studies published in Korea were limited to demonstrating the periodical change of the CI. This study was done to determine the CI change in 0 to 20 year-old Koreans by sex and age. Methods: The measurement was done on 1,222 Koreans ranging from 0 to 20 years of age, randomly selected from 2,156 who were diagnosed with simple concussion, had no other diseases or anomalies, and took cephalographs from January, 2000 to July, 2008. The files were obtained from $Marosis^{(R)}$ and then photogrammetry was done by $Photoshop^{(R)}$. To standardize the cephalograph, the Frankfort horizontal line was selected as the reference line on lateral view and the line connecting both lateral-orbitales on AP view. The maximal length was obtained from the lateral cephalograph and the maximal breadth from the AP cephalograph. Results: The CI showed no difference by sex (p=0.4848). The CI and age showed negative correlation (p<0.0001). Analyzed separately by the male and the female, the CI showed statistical significance in the male (p<0.0001), but not in the female (p=0.4741) group. Comparing the CI above the age of 11, the CI of the female became greater than that of the male. Conclusion: This study contributes to the standardization of CI measurement and the authors were able to obtain the average CI by age. We concluded that the CI decreased according to age and most Koreans belonged to barchycephalic or hyperbrachycephalic.