• Title/Summary/Keyword: surgical exposure

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Head and Neck Squamous Cell Carcinoma - Comparative Evaluation of Pathological Parameters in Young and Old Patients

  • Naz, Samreen;Salah, Kanwal;Khurshid, Amna;Hashmi, Atif Ali;Faridi, Naveen
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.9
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    • pp.4061-4063
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    • 2015
  • Background: To evaluate pathological features of head and neck squamous cell carcinoma (HNSCC) and to compare these pathological features in patients younger and older than 40 years. Materials and Methods: All resection specimens of HNSCC between 2010 and 2013 evaluated. Tumor characteristics - grade, location (site) cervical node status, alongwith presence or absence of extranodal extension, lymphovascular invasion, gender and age - were extracted from surgical pathology reports. Results: Among these n=19 patients (21.8%) were 40 years or younger and n=68 patients (78.2%) were above 40 years of age. The mean age was 34 (20-40 years) in the younger group and 56 (42-86) in the older group. The most common location of HNSCC in both groups was the oral cavity. The analysis of histopathological features including grade of tumor, tumor size, extranodal extension and comparison between two groups do not show any significant difference. Conclusions: There are no specific pathological characteristics of HNSCC in young patients. An interesting observation is that exposure to expected risk factors is similar in both groups, in younger patients they have less time to act and yet tumors are the same in terms of tumor size, lymph node status and lymphovascular invasion. Therefore further research is recommended to look for potentiating factors.

Modified Approach in Reduction Malarplasty for Repositioning and Fixation (광대뼈 축소술에 있어서 재배치와 고정)

  • Hwang, So-Min;Song, Jennifer Kim;Baek, Se-Min;Baek, Rong-Min
    • Archives of Plastic Surgery
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    • v.38 no.3
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    • pp.273-278
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    • 2011
  • Purpose: It has always been an aspiration for Asians to look more balanced and feminine, considering their facial features regarding relatively flat midface with marked prominences of the zygoma. Many studies have been dealt in this subject. However, the authors would like to emphasize the concept and introduce the technique of repositioning of the malar complex to a cosmetically beneficial point and stationing it on proper position by fixation on zygoma body and arch. Methods: From January 1998 to December 2007, this method was performed in 50 patients of mild to moderate prominence and malposition of the malar complex. A simplified technique of lateral orbital osteotomy and oblique osteotomy on zygomatic arch through intraoral and preauricular incision was developed. Then, liberal malar complex can be moved to a supero-posterior direction and repositioned to a more cosmetically beneficial point. To maintain the stationed position and to protect from vector affected by the attached masticating muscle to zygomatc bone, fixation was done on both zygoma body and arch. Results: We have obtained satisfactory results using this procedure without any observable complications. The advantages of this procedure are proper exposure, inconspicuous scar, safe, more natural contour, improved stability, and shorter healing time. Conclusion: The authors suggest that reduction malarplasty should be approached with underlying concept of repositioning and fixation. In mild moderate malar prominent cases, our technique will provide with maintenance of aesthetic concept, equal to the malar reduction performed under coronal approach and provide with more natural facial contour with stability even with less invasive surgical approach.

Low Cardiac Output after Division of the Left Superior Vena Cava during a Norwood Operation for Hypoplastic Left Heart Syndrome in a Patient with Coronary Sinus Orifice Atresia -A case report- (관상정맥동 유입부 폐쇄를 동반한 좌심형성부전 증후군 환자의 Norwood 수술 중 좌상대정맥 절단 후 발생한 저박출증 - 1예 보고 -)

  • Choi, Eun-Seok;Kim, Woong-Han;Park, Sung-Joon;Kwak, Jae-Gun;Seo, Jeong-Wook
    • Journal of Chest Surgery
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    • v.43 no.2
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    • pp.161-163
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    • 2010
  • A 12-day-old female baby underwent a Norwood procedure for hypoplastic left heart syndrome. The left superior vena cava (LSVC), which was found incidentally during the operation, was divided to facilitate surgical exposure. After the operation, she developed signs of low cardiac output and died 7 hours afterward. Autopsy findings showed that the coronary sinus was atretic at the orifice without unroofing into both atria, rendering the LSVC the sole route of coronary sinus drainage. In patients with incidentally-found LSVC during surgery, special care should be taken to leave the LSVC intact because the LSVC may be the exclusive drainage vein of the coronary venous system.

Comparison of Resorbable and Nonresorbable Membrane for Guided Bone Regeneration in Implant Dehiscence Defects (매식체 주위 열개형 골 결손부의 골 재생시 흡수성 막과 비흡수성 막의 비교)

  • Kwon, Tae-Hoon;Chung, Chin-Hyung;Yim, Sung-Bin
    • Journal of Periodontal and Implant Science
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    • v.30 no.2
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    • pp.323-335
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    • 2000
  • The purpose of this study was to examine the frequency of dehiscence bone defect on peri-implant and to compare the difference between resorbable membrane and nonresorbable membrane in bone regeneration on peri-implant. Amomg the patients, 22 patientswho have recieved an implant surgery at the department of Periodontics in Dankook University Dental Hospital showed implant exposure due to the dehiscence defect and 27 implants of these 22 patients were the target of the treatment. $Gore-Tex^{(R)}$ and $Bio-mesh^{(R)}$ were applied to the patients and treated them with antibiotics for five days both preoperatively and postoperatively. Reentry period was 26 weeks on average in maxilla and 14 weeks on average in mandible. The results were as follows : 1. Dehiscence bone defect frequently appeared in premolar in mandible and anterior teeth in maxilla respectively. 2. Among 27 cases, 2 membrane exposures were observed and in these two cases, regenerated area was decreased. 3. In non-resorbable membrane, bone surface area $9.25{\pm}4.84$ preoperatively and significantly increased to $11.48{\pm}7.52$ postoperatively.(P<0.05) 4. In resorbable membrane, bone surface area was $14.80{\pm}8.25$ preoperatively and meaningfully widened to $17.61{\pm}10.67$ postoperatively.(P<0.05) 5 . The increase of bone surface area in non-resorbable membrane was $2.23{\pm}3.38$ and the increase of bone surface area in resorbable membrane was $2.80{\pm}3.00$ ;therefore, there was no significant difference between these two membranes(P<0.05). This study implies that the surgical method using DFDB and membrane on peri-implant bone defect is effective in bone regeneration regardless the kind of the membrane, and a similar result was shown when a resorbable membrane was used.

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Wound Infection of Spinal Cord Stimulator: A Case Report (척수 신경 자극기 삽입부 감염의 치험례)

  • Kim, Jong-Sok;Oh, Deuk-Young;Seo, Je-Won;Lee, Jung-Ho;Rhie, Jong-Won;Ahn, Sang-Tae
    • Archives of Plastic Surgery
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    • v.37 no.1
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    • pp.71-74
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    • 2010
  • Purpose: Nowadays spinal cord stimulator is frequently used for the patients diagnosed as complex regional pain syndrome. The lead is placed above the spinal cord and connected to the stimulation generator, which is mostly placed in the subcutaneous layer of the abdomen. When the complication occurs in the generator inserted site, such as infection or generator exposure, replacement of the new generator to another site or pocket of the abdomen would be the classical choice. The objective of our study is to present our experience of the effective replacement of the existing stimulation generator from subcutaneous layer to another layer in same site after the wound infection at inexpensive cost and avoidance of new scar formation. Methods: A 50-year-old man who was diagnosed as complex regional pain syndrome after traffic accident received spinal cord stimulator, Synergy$^{(R)}$ (Medtronic, Minneapolis, USA) insertion 1 month ago by anesthetist. The patient was referred to our department for wound infection management. The patient was presented with erythema, swelling, thick discharge and wound disruption in the left upper quadrant of the abdomen. After surgical debridement of the capsule, the existing generator replacement beneath the anterior layer of rectus sheath was performed after sterilization by alcohol. Results: Patient's postoperative course was uneventful without any complication and had no evidence of infection for 3 months follow-up period. Conclusion: Replacement of existing spinal cord stimulation generator after sterilization between the anterior layer of rectus sheath and rectus abdominis muscle in the abdomen will be an alternative treatment in wound infection of stimulator generator.

Pain Control for Hydrofluoric Acid Chemical Burn Using EMLA® creams (EMLA® 연고를 이용한 불산 화학 화상의 통증 조절)

  • Choi, Hwan Jun;Song, Jin Woo;Choi, Chang Yong
    • Archives of Plastic Surgery
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    • v.36 no.1
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    • pp.113-117
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    • 2009
  • Purpose: Although Hydrofluoric acid(HF) is not a strong acid when compared to other hydrogen halides, it is a feared corrosive and is particularly dangerous at higher concentrations. HF burns are characterized by symptoms, often delayed and localized with diluted HF solutions, to include erythema, edema and severe pain. Pain, a well known symptom following exposure to calcium binding. And, EMLA$^{(R)}$ cream is a topical formulation based upon the eutectic mixture of lidocaine and prilocaine and is used in clinical settings to provide pain relief undergoing superficial surgical procedures. The aim of this study is to evaluate effects of EMLA$^{(R)}$ cream, pain - control dressing on the treatment for HF injury wound. Methods: From June 2007 to June 2008, this study was carried out with 10 patients who had HF partial thickness burns. We were applied topically EMLA$^{(R)}$ cream to injured wound with vaseline gauze and 10% calcium gluconate wet gauze dressings. As a principle, in the emergency treatment, partial or complete removal of the bullae along with copious washing with normal saline was done, depending on the degree of HF invasion of the distal digital extremities. The effect of dressing was investigated by visual analogue pain scale. Results: We therefore reviewed 10 cases of HF - induced pain and pain relief treatment principle. The 10 cases who came to the hospital nearly immediately after the injury healed completely without sequelae and EMLA$^{(R)}$ related complications. Conclusion: Proper initial treatment of HF burns are important, if not promptly recognized and properly treated, for produce serious injury. Topical EMLA$^{(R)}$ cream remain a powerful, new advancement for minimizing HF - related pain during dressing procedures. When used appropriately, topical EMLA$^{(R)}$ cream can provide a safe and effective alternative to other forms of HF - pain control treatment.

Temple and Postauricular Dissection in Face and Neck Lift Surgery

  • Lee, Joo Heon;Oh, Tae Suk;Park, Sung Wan;Kim, Jae Hoon;Tansatit, Tanvaa
    • Archives of Plastic Surgery
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    • v.44 no.4
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    • pp.261-265
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    • 2017
  • Periauricular paresthesia may afflict patients for a significant amount of time after facelift surgery. When performing face and neck lift surgery, temple and posterior auricular flap dissection is undertaken directly over the auriculotemporal, great auricular, and lesser occipital nerve territory, leading to potential damage to the nerve. The auriculotemporal nerve remains under the thin outer superficial fascia just below the subfollicular level in the prehelical area. To prevent damage to the auriculotemporal nerve and to protect the temporal hair follicle, the dissection plane should be kept just above the thin fascia covering the auriculotemporal nerve. Around the McKinney point, the adipose tissue covering the deep fascia is apt to be elevated from the deep fascia due to its denser fascial relationship with the skin, which leaves the great auricular nerve open to exposure. In order to prevent damage to the posterior branches of the great auricular nerve, the skin flap at the posterior auricular sulcus should be elevated above the auricularis posterior muscle. Fixating the superficial muscular aponeurotic system flap deeper and higher to the tympano-parotid fascia is recommended in order to avoid compromising the lobular branch of the great auricular nerve. The lesser occipital nerve (C2, C3) travels superficially at a proximal and variable level that makes it vulnerable to compromise in the mastoid dissection. Leaving the adipose tissue at the level of the deep fascia puts the branches of the great auricular nerve and lesser occipital nerve at less risk, and has been confirmed not to compromise either tissue perfusion or hair follicles.

Management of Descending Necrotizing Mediastinitis with Thoracoscopy (흉강경을 이용한 하행 괴사성 종격동염의 치료)

  • Lee, Sung-Ho;Sun, Kyung;Kim, Kwang-Taik
    • Journal of Chest Surgery
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    • v.35 no.2
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    • pp.161-165
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    • 2002
  • Descending necrotizing mediastinitis is a life-threatening infection originating in the head or the neck and descends into the mediastinum. Even in the era of antibiotics, mortality rate has been reported to be 25 ∼ 40%. Prompt diagnosis and treatment is mandatory for delayed diagnosis and inappropriate drainage of the mediastinum are the main causes of high mortality Surgical management ranges from cervical drainage to routin thoracotomy:however, the optimal management still needs to be defined particularly in respect to effective mediastinal drainage. Although posterolateral thoracotomy incision has been considered as a standard approach, potential disadvantages including postoperative pain, risk of wound complication and delayed recovery remain to be concerned. Thoracoscopic approach is an attractive treatment modality as it can provide an excellent exposure with minimal incision and can complete drainage from the mediastinum and the neck in one-staged manner We describe here two cases of descending necrotizing mediastinitis successfully managed by thoracoscopic drainage.

Effect of poly(lactide-co-glycolide) (PLGA) on bone regeneration in rabbit calvaria (토끼 두개골 결손부의 골재생에 대한 poly(lactide-co-glycolide) (PLGA) 의 영향)

  • Park, Jae-Young;Hwang, Woo-Jin;Jeong, Seong-Nyum;Kim, Yun-Sang;Pi, Sung-Hee;You, Hyung-Keun;Shin, Hyung-Shik
    • Journal of Periodontal and Implant Science
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    • v.39 no.2
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    • pp.167-176
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    • 2009
  • Purpose: The purpose of this study is to histologically and histomorphometrically evaluate the effect of PLGA on bone regeneration compared with bone graft material. Methods: The experimental study was conducted in 10 rabbits with 2 different healing periods of 2 and 4 weeks. Following surgical exposure of the calvarium, 4 circular bone defects with a diameter of 4.6mm were formed. Rabbits were divided into control group, test groups I, and II. 10 defects assigned to the test group Ⅰ were grafted with Nu-oss and other 10 defects assigned to the test group II were grafted with PLGA. The rest of the defects were in the negative control group. At 2nd and 4th week after surgery, 10 rabbits were sacrificed through intracardiac perfusion and then specimens were obtained. Histological analysis was performed following staining with trichorme and transversal sectioning of the calvarial bone. Results: A group which used PLGA showed tissue reactions characterized by severe inflammation, rather than distinctive new bone formation. Conclusions: The present experimental investigations have failed to prove any beneficial effects of PLGA. PLGA used in this study exhibited foreign body reactions and a less favorable pattern of new bone formation in comparison to control group. Conclusion: PLGA did not function as scaffold. Further investigations of many types of micro PLGA that could improve its potential in GBR procedures are needed.

Ovariectomy of Fibroma in Paint Horse by Using the Diagonal Paramedian Approach (Diagonal paramedian approach법을 이용한 말에서 난소 제거술)

  • Kwon, Do-Yeon;Jo, Young-Jae;Choi, Gui-Cheol;Cho, Gil-Jae
    • Journal of Veterinary Clinics
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    • v.26 no.3
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    • pp.282-285
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    • 2009
  • A 10-year-old Paint horse was presented with gradual changes in behavior, characterized as stallion-like including aggressiveness towards people and other horse. The abnormal right ovary was detected via transrectal ultrasonography and rectal palpation. A complete blood count and biochemical panel values were within reference ranges. The hormone analysis revealed increased testosterone 46.00 pg/mL and inhibin 0.856 ng/mL, and progesterone concentration consistent with absence of luteal tissue 1.2 ng/mL more than normal values. The purpose of the study reported was to describe a ovariectomy of enlarged ovary by using the diagonal paramedian approach. This method is useful to minimize surgical exposure and hemorrhage. This ovary was confirmed fibroma by histological examination post operation. Behavior problems and the hormone values were alleviated after surgery, and clinical signs of complication were not showed.