• 대한두개안면성형외과학회지
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• 제18권2호
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• pp.82-88
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• 2017

Background: Turbinate hypertrophy is one of the common causes of chronic nasal obstruction. In principle, therapeutic guidelines recommend medical treatment. Failure to treat turbinate thickening despite drug therapy may indicate the need for surgery. The main aim of this study was to determine the effect of radiofrequency surgery, among various other surgical procedures, on people with both nasal septal deviation and turbinate hypertrophy. Methods: Among people with nasal deviation who visited the subject hospital between July 2008 to July 2014, 21 people with nasal septal deviation and severe turbinate hypertrophy before their surgery had undergone septoplasty with turbinoplasty using radiofrequency combined with septoplasty. The degree of the turbinate's hypertrophy was appraised in all the patients before and after the surgery using the rhinoscopy, and acoustic rhinometry was objectively carried out. The subjective effect of the turbinoplasty using radiofrequency was explored through the visual analog scale (VAS) score. Results: The degree of contraction of the nasal mucosa after the rhinoscopy changed from Grades 3 and 4 (100%) to Grades 1 and 2 (95.2%) and Grades 3 (4.8%). The minimal cross-sectional area significantly increased from $0.44{\pm}0.07$ to $0.70{\pm}0.07cm^2$ (p<0.05). The nasal cavity volume increased from $4.79{\pm}0.49$ to $6.76{\pm}0.55cm^2$ (p<0.05). The subjective symptoms evaluated with VAS score a year after the surgery significantly improved (p<0.05). Conclusion: Turbinoplasty using Coblator with septoplasty is an effective treatment method because it expands nasal cavity, has a low incidence of complications, subjectively improves symptoms, and has short treatment duration.

• 대한두개안면성형외과학회지
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• 제19권1호
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• pp.3-12
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• 2018

Background: Millard's rotation-advancement repair, which is used by many surgeons, can make a natural philtral column, but most surgeons use a modification of the rotation-advancement flap. The purpose of this article is to introduce a modification utilized by the authors and to provide detailed surgical procedure. Methods: We retrospectively reviewed 82 patients' medical records and presented surgical technique and outcomes. The main features of the authors' strategy are emphasizing horizontal length of the lip, orbicularis oris muscle duplication for improving the definition of the philtral column, overcorrection of domal portion than the non-cleft side in order to compensate for the recurrence during growth. Two judges rated two times the appearance of the patients' nose and lip using Asher-McDade aesthetic index. Intra- and interobserver reliabilities were determined using Cohen's kappa statistics. Results: All patients recovered eventually after surgery; however, two patients have a minor complications (wound infection in one patient, wound disruption due to trauma in the other patient). The improvement of the aesthetic results can be achieved with this modified Millard technique. Total mean scores of the Asher-McDade index was 2.08, fair to good appearance. The intraobserver reliabilities were substantial to almost perfect agreement and the interobserver reliabilities were moderate to almost perfect agreement. Conclusion: We modified Millard method for repair of complete unilateral cleft lip. The surgical outcomes were favorable in long-term follow-up. We hope our technique will serve as a guide for those new to the procedure.

• 대한두개안면성형외과학회지
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• 제19권1호
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• pp.13-19
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• 2018

Background: $Abb{\acute{e}}$ flap technique is one of the most challenging operations to correct horizontal deficiencies in secondary cleft lip deformity. Since its first introduction, the operative method was dynamically modified from simple variation to complete conceptual change, but conventional $Abb{\acute{e}}$ flap has many drawbacks in esthetic and functional aspect. Our purpose was reconstructing the symmetry of Cupid's bow and central vermilion tubercle with minimal sequalae. Methods: From 2008 to 2016, this technique was applied to 16 secondary cleft lip patients who had total or more than 60% of unilateral deficiency of Cupid's bow and central lip or tubercle pouting deficiency. A quadrangular-shaped flap was transferred from vermilion including skin and white line of central or contralateral lower lip. Pedicle division and insetting were made at 9 (unilateral) or 10 (bilateral) days after transfer. Secondary lip revision was done with open rhinoplasty after wound maturation. Results: Overall satisfaction was high with modified technique. Scar was minimally noticeable on both upper and lower lip especially. Balanced Cupid's bow and symmetric vermilion tubercle were made with relatively small size of flap compared to conventional $Abb{\acute{e}}$ flap. An accompanying benefit was reduced ectropion of lower lip, which made balanced upper and lower lip protrusion with more favorable profile. Conclusion: A new modified $Abb{\acute{e}}$ flap technique showed great satisfaction. It is worth considering in secondary cleft lip patient who has central lip shortage and asymmetry of upper lip vermilion border line. Our technique is one of the substitutes for correction of horizontal and central lip deficiency with asymmetric Cupid's bow.

• Archives of Plastic Surgery
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• 제36권1호
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• pp.66-74
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• 2009

Purpose: The importance of the deformities in alar - columellar complex has been underestimated in Asian ethnic groups for the last decades. Fortunately, with increasing familiarity of the open rhinoplasty techniques, the anatomic details of the nasal tip have been pointed up. Definitely, having an interest and demand for improving the sub - normal relationship between the alar rim and columella are indebted for such growing of knowledge about nasal tip anatomy. However, it is true that any single procedure is not settled as versatile and fully confident modality to correct the retracted notching of the alar rim. With this article, I should like to propose another useful option for treating retracted ala. Methods: The author has tried to correct alar rim retraction by means of: (1) Triangular onlay septal cartilage graft on the lower lateral cartilage with the medial end fixed to the anterior surface of the lateral crus(Alar extension graft), (2) Inserting lateral end of the alar extension graft to the vestibular skin pocket in the form of a finger - in - groove, (3) using the vestibular skin in the form of an advancement flap, and (4) using the soft shield graft to prevent possible visible step - off of the alar margin. Results: The author applied an alar extension graft to 16 patients in order to correct a retracted ala for the last 27 months (August, 2003 - October, 2005). The distances from alar rim to long axis of nostril were improved to be within 2 mm in all of the cases, and also the shape of the alar rim changed to a round form. Nostril asymmetry (6%) in one case, temporary palpable step - off (18%) in three cases, temporary visible step - off (6%) in one case, and temporary paresthesia of the tip (25%) in four cases were observed. Conclusion: The alar extension graft is simple and efficacious. It does not need donor sites other than the operative field, and its results are predictable. In particular, since it may give structural intensity to a weak lower lateral cartilage, it may be preferentially used for the correction of a retracted ala that arises from hypoplastic lower lateral cartilage. Moreover intensified lower lateral cartilage also improves the esthetic shape of lobule.

• Archives of Plastic Surgery
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• 제47권4호
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• pp.310-316
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• 2020

Background To produce patient-specific nasal implants, it is necessary to harvest and grow autologous cartilage. It is crucial to the proliferation and growth of these cells for scaffolds similar to the extracellular matrix to be prepared. The pore size of the scaffold is critical to cell growth and interaction. Thus, the goal of this study was to determine the optimal pore size for the growth of chondrocytes and fibroblasts. Methods Porous disc-shaped scaffolds with 100-, 200-, 300-, and 400-㎛ pores were produced using polycaprolactone (PCL). Chondrocytes and fibroblasts were cultured after seeding the scaffolds with these cells, and morphologic evaluation was performed on days 2, 14, 28, and 56 after cell seeding. On each of those days, the number of viable cells was evaluated quantitatively using an MTT assay. Results The number of cells had moderately increased by day 28. This increase was noteworthy for the 300- and 400-㎛ pore sizes for fibroblasts; otherwise, no remarkable difference was observed at any size except the 100-㎛ pore size for chondrocytes. By day 56, the number of cells was observed to increase with pore size, and the number of chondrocytes had markedly increased at the 400-㎛ pore size. The findings of the morphologic evaluation were consistent with those of the quantitative evaluation. Conclusions Experiments using disc-type PCL scaffolds showed (via both morphologic and quantitative analysis) that chondrocytes and fibroblasts proliferated most extensively at the 400-㎛ pore size in 56 days of culture.

• Archives of Plastic Surgery
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• 제39권3호
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• pp.190-197
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• 2012

Background : This article presents long-term outcomes after correcting secondary bilateral cleft lip nasal deformities using a refined reverse-U incision and V-Y plasty or in combination with a composite graft in order to elongate the short columella. Methods : A total of forty-six patients underwent surgery between September 1996 and December 2008. The age of the patients ranged from 3 to 19 years of age. A bilateral reverse-U incision and V-Y plasty were used in 24 patients. A composite graft from the helical root was combined with a bilateral reverse-U incision in the 22 patients who possessed a severely shortened columella. The follow-up period ranged between 2 and 10 years. Results : A total of 32 patients out of 46 were evaluated postoperatively. The average columella length was significantly improved from an average of 3.7 mm preoperatively to 8.5 mm postoperatively. The average ratio of the columella height to the alar base width was 0.18 preoperatively and 0.29 postoperatively. The postoperative basal and lateral views revealed a better shape of the nostrils and columella. The elongated columella, combined with a composite graft, presented good maintenance of the corrected position with no growth disturbance. A composite graft showed color mismatching in several patients. Twenty-six patients demonstrated no alar-columella web deformity and satisfactory symmetry of the nostrils. Four patients experienced a drooping and overhanging of the corrected alar-columella web. Conclusions : A bilateral reverse-U incision with V-Y plasty or in combination with a composite graft was effective in correcting secondary bilateral cleft lip nasal deformity.

• Archives of Plastic Surgery
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• 제36권2호
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• pp.200-204
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• 2009

Purpose: The epicanthal fold is a unique finding in the medial canthal area of many Asians. Various methods have been developed to eliminate this fold. However, excessive and prominent scarring in the medial canthal and nasal area and recurrence restricted application of epicanthoplasty. The authors performed a epicanthoplasty using Y-V advancement flap method in order to obliterate the epicanthal fold without making incisions in the nasal area and as a result, to avoid postoperative scarring. Methods: Sixty one patients underwent epicanthal fold correction using Y-V advancement flap method from July 1999 to February 2005. There were 4 males and 57 females with ages ranging from 9 to 60 years. The epicanthoplasty was performed combined with double eyelid operation, ptosis correction, augmentation rhinoplasty, nasal alar reduction, and nasal tip-plasty. Results: There were few complications in our studies, and most of the patients were satisfied with the results. Conclusion: Remarkable advantages of our Y-V advancement flap epicanthoplasty are as follows: 1) minimal postoperative scarring in the medial canthal area, 2) application of modified double eyelid operation, 3) wider opening of the medial palpebral fissure, 4 the correction of entropion or epiblepharon, 5) no recurrence.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제31권1호
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• pp.74-81
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• 2005

Midfacial degloving approach는 중안면부에 대한 접근시 비교적 광범위한 수술시야의 확보가 가능하고, 술 후 중안모에 반흔을 남기지 않는 심미적 장점이 있다. 특히 중안면부의 광범 위한 골절과 비골 복합 골절을 동반한 중안면부 골절 수복에 이용되어 골절부에 대한 적절한 시야 확보로 정확한 관혈적 정복술이 가능하며 필요시에는 자가 늑골 등을 이용한 비 성형술이 가능하다는 장점이 있다. 이에 저자 등은 중안면부 복합골절의 치료시 midfacial degloving approach을 통해 중안면골의 관혈적 정복술 및 비 재건술을 시행한 증례에 대하여 문헌 고찰과 함께 보고하는 바이다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제31권4호
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• pp.342-349
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• 2005

심미적인 이유를 포함한 여러 가지 원인에 의한 안검성형술을 저자등이 사용한 방법, 안검성형술을 받고자 하는 동기, 합병증 등을 보고하며 국내의 턱얼굴외과의사들의 새로운 진료 영역으로의 안면부 연조직미용수술에 관한 관심과 노력을 기대한다.

• 대한두개안면성형외과학회지
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• 제12권2호
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• pp.102-106
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• 2011

Purpose: It is accepted universally that correction of the cleft lip nasal deformity requires multiple stages of surgery. Following primary lip repair in infancy or early childhood, secondary surgery to improve the deformity of the lip and nose is frequently necessary. A suitable surgical procedure to correct the accompanying deformity, such as cleft palate and alveolus, must be carried out at an appropriate age. In developing countries, it is common for patients with cleft lip nasal deformity to present severe secondary deformities in adolescence, because of poor follow-up and inappropriate surgery. Methods: The first patient was a 12 year old Mongolian boy. He presented prominent lip scar, short lip, wide columella, asymmetric nostril, palatal fistula, cleft alveolus, and velopharyngeal incompetence. He underwent cheilorhinoplasty, transpositional flap, alveoloplasty by iliac bone graft, and sphincter pharyngoplasty. On follow-up, a bilateral maxillary hypoplasia and a class III malocclusion developed. He underwent LeFort I osteotomy and maxillary advancement at the age of 16 years. The second patient was an 18 year old Eastern Russian girl. She presented with a deviated nose, right alar base depression, short lip, protrusion on vermilion, large palatal fistula, and severe VPI due to short palate. She underwent the combined procedure of cheilorhinoplasty, corrective rhinoplasty, tongue flap for palatal fistula, and superiorly based pharyngeal flap. And the tongue flap was detached at postoperative 3 weeks. Results: The overall results have been extremely pleasing and satisfactory to patients. There were no postoperative complications. Conclusion: We discovered the one stage operation for radical correction was sufficient procedure to provide excellent clinical outcomes in patients with severe cleft lip nose deformity.