• Archives of Craniofacial Surgery
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• v.13 no.2
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• pp.143-146
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• 2012

Purpose: The typical reconstructive option for the nasal tip is paramedian forehead flap. However, the forehead flap is too bulky for nasal tip reconstruction and does not look natural, and therefore, secondary operations for debulking are required. Methods: We treated a 46-year-old woman who suffered from a nose tip soft tissue defect using a modified paramedian forehead flap. The flap was elevated from the hair line of the forehead and had 3-layered structure. The distal part included skin and subcutaneous tissue, the middle part included frontalis muscle, and the proximal part had periosteum. Results: The nasal tip was not bulky and looked natural in terms of height, shape, and had 3-dimensional structure without debulking procedure. The patient was satisfied with the outcome. Conclusion: The authors' modified paramedian forehead flap may be a useful option for the treatment of nasal tip, columella, and alar defects. With these modifications, the paramedian forehead flap can provide an aesthetically acceptable nasal tip appearance without debulking.

• Archives of Craniofacial Surgery
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• v.18 no.2
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• pp.132-136
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• 2017

Frey's syndrome and infra-auricular depressed deformities are the ones of the most common complications that can occur after total parotidectomy. We report 1 case of pleomorphic adenoma occurred in the deep lobe that obtained good results from using acellular dermal matrix (ADM) after total parotidectomy. A 24-year-old man visited the hospital with oval shape mass in right mandibular angle which of 4 cm in size was found in the deep lobe of right parotid gland from Magnetic resonance imaging scanning and a pleomorphic adenoma was suspected. A total parotidectomy was performed while preserving the facial nerve. The material known as ADM were placed in the depressed part from where the mass was removed, and the site was sutured. The surgery site was healed well without any complications such as Frey's syndrome or infra-auricular depressed deformities. The pathological result was confirmed as pleomorphic adenoma. In addition to these advantages, it does not have little potential of deformation by the gravity after the surgery, and there is no restraint on circulation, which makes fabrication free and each deformation into various shapes can be described as another advantage of the reconstruction using the ADM.

• Archives of Craniofacial Surgery
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• v.19 no.1
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• pp.79-82
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• 2018

Formation of an ideally-shaped tragus remains one of the most challenging issues during staged tragus reconstruction in microtia patients. The authors describe a new method used to treat a unique case of concha-type microtia in which the 10-year-old male patient had only a portion of pre-existing cartilage at the tragus site. An anomalous skin lump was also present. During the initial stages of the reconstruction, the two-stage Nagata method was used for surgical correction of the microtia. An autologous rib cartilage graft was used to form the ear framework. A temporoparietal fascia flap was also constructed. Remnant skin tags and anomalous cartilage that accompany microtia are usually removed during microtia repair. However, the cartilage and skin lump were preserved during the reconstruction. The skin lump was later used to form a vascularized chondrocutaneous island flap that supplemented the portion of cartilage during tragus formation. The result was a new tragus that was satisfactorily improved in both size and shape. Patients with concha-type microtia may benefit from the use of this new method for tragus formation.

• Archives of Craniofacial Surgery
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• v.17 no.2
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• pp.77-81
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• 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.

• The korean journal of orthodontics
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• v.18 no.1 s.25
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• pp.141-154
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• 1988

This study was designed to investigate the difference between craniofacial characteristics of the normal occlusion and those of Class II Div. 1 malocclusion. The sample was divided into 2 groups, the 50 subjects of Normal occlusion, the 50 subjects of Class II Div. 1 malocclusion in both sexes. Both groups aged from 11 to 14 years. The results of this study were as follows; 1. No significant difference was observed in cranial base shape between both groups, but anterior cranial base size of Class II Div. 1 malocclusion group was larger than that of normal group. 2. No significant difference in antero-posterior position of Maxilla to cranial base was founded between both groups. 3. No difference in Mandibular shapes and Mandibular plane angles to the cranial base was observed between Class II Div. 1 malocclusion and normal occlusion, but Mandibular position in Class II Div. 1 malocclusion was posterior to that of normal group. 4. Antero-posterior relationship of Maxilla and Mandible was significant difference between both groups, but vertical relationship of those was no difference. 5. Maxillary incisor position to cranial base of Class II Div. 1 malocclusion was anteior to normal occlusion, and Maxillary posterior teeth was posterior. Mandibular incisor and mandibular posterior teeth position was no difference. 6. Upper and lower lip position to esthetic line of Class II Div. 1 malocclusion was anterior to normal occlusion.

• Archives of Craniofacial Surgery
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• v.20 no.1
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• pp.31-36
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• 2019

Background: After closed reduction, patients are sometimes concerned that their external nasal shapes have changed. The aim of this study was to investigate and explain changes in nasal shape after surgery through objective photogrammetric anthropometry measurements taken through three-dimensional (3D) reformed computed tomography (CT) images. Methods: Our study included 100 Korean patients who underwent closed reduction of isolated nasal bone fracture from January 2016 to June 2017. Using the ruler tool in Adobe Photoshop CS3, we measured preoperative and postoperative nasal base heights, long nostril axis lengths, both nasal alar angles, and amount of nasal deviation through the 3D reformation of soft tissue via CT scans. We then compared the dimension of nose. Results: The amount of postoperative correction for nasal base height was 1.192 mm. The differences in nostril length between each side were found to be 0.333 mm preoperatively and 0.323 mm postoperatively. The differences in the nasal alar angle between each side was $1.382^{\circ}$ preoperatively and $1.043^{\circ}$ postoperatively. The amount of nasal deviation was found to be 5.248 mm preoperatively and 1.024 mm in postoperatively. Conclusion: After the reduction of nasal bone fractures, changes in nasal dimensions were noticeable in terms of nasal deviation but less significant in nasal tips, except for changes in nasal alar angles, which were notable.

• Archives of Craniofacial Surgery
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• v.20 no.3
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• pp.164-169
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• 2019

Background: The conventional surgical method for reconstructing orbital floor fractures involves restoration of orbital continuity by covering an onlay with a thin material under the periorbital region. However, in large orbital floor fractures, the implant after inserting is often dislocated, leading to malposition. This study aimed to propose a novel implanting method and compare it with existing methods. Methods: Among patients who underwent surgery for large orbital floor fractures, 24 who underwent the conventional onlay implanting method were compared with 21 who underwent the novel ${\gamma}$ implanting method that two implant sheets were stacked and bent to resemble the shape of the Greek alphabet ${\gamma}$. When inserting a ${\gamma}$-shaped implant, the posterior ledge of the orbital floor was placed between the two sheets and the bottom sheet was impacted onto the posterior wall of the maxilla to play a fixative role while the top sheet was placed above the residual orbital floor to support orbital contents. Wilcoxon signed-rank test and Mann-Whitney U test were used for data analyses. Results: Compared to the conventional onlay method, the gamma method resulted in better restoration of orbital contents, better improvement of enophthalmos, and fewer revision surgeries. Conclusion: Achieving good surgical outcomes for extended orbital floor fractures is known to be difficult. However, better surgical outcomes could be obtained by using the novel implantation method of impacting a ${\gamma}$-shaped porous polyethylene posteriorly.

• Archives of Craniofacial Surgery
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• v.22 no.1
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• pp.66-70
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• 2021

Isolated head and neck metastasis of renal cell carcinoma (RCC) is relatively rare and metastasis to the temple area is very rare. Here, we present the case of a 51-year-old man who was diagnosed with RCC 2 years earlier and had a contralateral metastatic temple area lesion. The patient who was diagnosed with renal cell cancer and underwent a nephrectomy 2 years ago was referred to the plastic surgery department for a temple mass on the contralateral side. In the operative field, the mass was located in the temporalis muscle with a red-to-purple protruding shape. Biopsy of the mass revealed a metastatic RCC lesion. Computed tomography imaging showed a lobulated, contoured enhancing lesion. Positron emission tomography/computed tomography imaging showed high-fluorodeoxyglucose uptake in the right temporalis muscle. The patient underwent wide excision of the metastatic RCC including the temporalis muscle at the plastic surgery department. Skeletal muscle metastasis of head and neck lesions is extremely rare in RCC. Isolated contralateral temporalis muscle metastasis in RCC has not been previously reported in the literature. If a patient has a history of malignant cancer, plastic surgeons should always consider metastatic lesions of head and neck tumors. Because of its high metastatic ability and poor prognosis, it is very important to keep this case in mind.

• Archives of Craniofacial Surgery
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• v.23 no.5
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• pp.211-219
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• 2022

Background: Correction of secondary cleft nose deformity is one of the most important portions in the management of cleft lip patients. Various techniques have been introduced to achieve adequate shape, balance, and symmetry of anatomical landmarks. None of these methods can claim to universally solve all aspects of the problems encountered in secondary cleft deformity surgery. Some authors overlook the aspect of functional rehabilitation with regard to nasal respiratory pathway problems, which is present in over 90% of the patients. This study aimed to evaluate the aesthetic and functional improvements of the authors' non-destructive technique. Methods: With over 15 years of experience, open rhinoplasty was performed, which included total remodeling of the deformed lower lateral cartilage using several suture fixation techniques without any graft or implantation with septo-turbinoplasty. A total of 150 questionnaires were sent by e-mail, but 55 completed questionnaires were returned. Surgical outcomes were evaluated using questionnaire responses, and outcomes were divided into five categories each for esthetic and functional analyses. Results: The satisfaction rate ranged from 75 % to 98%, which means "more or less," "very much," and "absolutely yes" in the esthetic and functional viewpoints. Conclusion: The results of this study strongly recommend performing the suture fixation technique and functional rehabilitation simultaneously for cleft lip/nose correction.

• Archives of Craniofacial Surgery
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• v.24 no.4
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• pp.198-201
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• 2023

Maintaining the patency of the external auditory canal (EAC) during reconstruction is important because of its physiological role in hearing and immunological protective functions. The curved shape of the EAC presents a challenge when performing a skin graft. One of the key points for a successful skin graft is to ensure compression on the wound bed, and many novel methods, including prefabricated ear molds, have been reported for this purpose. In this study, we present a case of a skin graft performed to reconstruct a skin defect following excision of actinic keratosis in the EAC, using the cover of an ear thermometer probe as a mold for the graft to match the curvature of the EAC. This is an economical and practical method for secure compression dressing of a skin graft in the EAC.