Baek-kyu Kim

Nasalance scores for normal Korean-speaking adults and children

There are numerous nasometric studies to date, including normative nasalance scores for various languages as well as nasometric differences in age, gender, race and region except the Korean language. In this regard, we sought to establish normative nasalance scores for Koreans. We created speech samples based on the everyday use of phonemes in the Korean language which were syntactically simple for children. In addition, we analysed nasometric features based on age and gender and confirmed test-retest reliability. The study included 108 children (54 girls and 54 boys, aged 7-11 years) and 108 adults (54 women and 54 men, aged 18-29 years) with normal articulation, resonance, voice and hearing. Nasometer II 6400 was used to measure the nasalance scores. The subjects read or repeated three speech stimuli, each consisting of 33, 36 and 24 syllables: (1) an oral passage devoid of nasal consonants, (2) an oro-nasal passage and (3) nasal sentences. For each stimulus, mean nasalance scores were obtained and gender or age dependence was analysed, using two-way analyses of variance. The mean nasalance scores for the oral passage, oro-nasal passage and nasal sentences were 11.69% (standard deviation (SD) 3.68), 34.04% (SD 4.88) and 63.72% (SD 6.07), respectively. Female speakers exhibited significantly higher nasalance scores than male speakers on the oro-nasal passage (p = 0.000) and nasal sentences (p = 0.004). Children exhibited significantly higher nasalance scores than adults on nasal sentences (p = 0.000). The nasalance scores in children and females were a little higher. Korean normative data will provide reference information in the evaluation and treatment of resonance problems.

Three-dimensional assessment of zygomatic malunion using computed tomography in patients with cheek ptosis caused by reduction malarplasty

BACKGROUND Reduction malarplasty is one of the most popular aesthetic surgical procedures for reshaping facial contour in oriental people. Especially for those who have a wide midface and a prominent zygoma. Although malunion and cheek ptosis are known as major complications in reduction malarplasty, but there have been few reports about their causes and patterns. The authors experienced many revision reduction malarplasty using the coronal approach to correct cheek ptosis with malunion and were able to categorize the types of malunion by analyzing 3-dimensional CT imaging prior to revision surgery. METHODS A total of 24 patients underwent revision reduction malarplasty with the coronal approach to correct the unfavorable result after primary malarplasty. Most patients complained of various degrees of cheek ptosis associated with malunion. In all cases, the status of zygomatic malunion was evaluated through 3D CT imaging. The operative procedures during revision surgery including repositioning of the inferolaterally displaced malar complex to the appropriate position and obtaining bone-to-bone contact with rigid fixation. If bony absorption at non-union margin was found during the operation, bihalved calvarial bone was grafted into the bony gap. Midface and forehead lifts were also performed when indicated. RESULTS The types of zygomatic malunion could be categorized into four patterns according to the shape of displacement. The degree of displacement was relevant to the condition of the fixation in all cases. The higher the grade of malunion was evaluated in 3D CT imaging, the more difficult procedures it required during revision surgery. The postoperative results in all cases were satisfactory without any complications. CONCLUSIONS In reduction malarplasty, inappropriate fixation and the ignorance of repositioning vector can lead to cheek ptosis and malunion by the action of masseter muscle. The malunion types apprehended by the preoperative 3D CT scanning enabled precise operative planning before revision surgery. In all grades of zygomatic malunion with cheek ptosis, revision reduction malarplasty with coronal approach was a very useful solution because it offers a wide surgical field, enables accurate repositioning along with firm fixation and easily allows simultaneous midface lift.

Narrowing and Lengthening Genioplasty with Pedicled Bone Graft in Contouring of the Short and Wide Lower Face

BackgroundA short and wide lower face is perceived as unattractive and masculine. Simply contouring the mandibular body and angle is insufficient to make the lower face with short and wide features slimmer and more feminine. In many cases, vertical elongation of the chin together with a bone graft is necessary. This can cause infection, donor-site morbidity and height loss by resorption of the grafted bone. To prevent this problem, the authors performed a pedicled interpositional graft with the discarded bone from narrowing genioplasty, and the results were aesthetically satisfactory.MethodsFrom March 2010 to September 2011, 32 patients who received chin narrowing and vertical lengthening surgery at the authors’ clinic were included in this study. For all the patients, the remnant mandibular bone at the stepoff from the site of the genioplasty to the mandibular angle was reduced concurrently.ResultsNo complications occurred, and all the patients were satisfied with their postoperative results.ConclusionHarmonizing the vertical length and transverse width of the chin is essential to acquiring more favorable results in mandibular contouring. The authors recommend pedicled interpositional bone grafting in narrowing genioplasty as a safe and useful method for aesthetic chin lengthening.Level of Evidence IVThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Use of various free flaps in progressive hemifacial atrophy.

ObjectiveRomberg disease is an uncommon condition manifested by progressive hemifacial atrophy of the skin, soft tissue, and bone. Facial asymmetry with soft tissue deficiency in Romberg disease causes a significant disability affecting the social life and can bring about many psychological problems. MethodsThe aim of surgical treatment is cosmetic amelioration of the defect. Several conventional reconstructive procedures have been used for correcting facial asymmetry. They include fat injections, dermal fat grafts, filler injections, cartilage and bone grafts, and pedicled and free flaps. We report our experiences with 11 patients involving 11 free flaps with a minimum 1-year follow-up. All patients were classified as having moderate to severe atrophy. The average age at disease onset was 4.5 years; the average duration of atrophy was 5.2 years. No patients were operated on with a quiescent interval of less than 1 year. The average age at operation was 20.1 years, ranging from 10 to 55 years. Reconstruction was performed using 4 groin dermofat free flaps, 4 latissimus dorsi muscle free flaps, and 3 other perforator flaps. To achieve the finest symmetrical and aesthetic results, several ancillary procedures were performed in 4 patients. These procedures included Le Fort I leveling osteotomy, sagittal split ramus osteotomy, reduction malarplasty and angle plasty, rib and calvarial bone graft, correction of alopecia, and additional fat graft. ResultsAll patients were satisfied with the results. ConclusionsWe believe that a free flap transfer is the requisite treatment modality for severe degree of facial asymmetry in Romberg disease.

The Classification and Prognosis of Periocular Complications Related to Blindness following Cosmetic Filler Injection.

Summary: Common side effects during hyaluronic acid filler injections are typically mild and reversible, but several reports of blindness have received attention. The present study focused on orbital symptoms combined with blindness, aiming to classify affected patients and predict their disease course and prognosis. From September of 2012 to August of 2015, nine patients with vision loss after filler injection were retrospectively reviewed. Ptosis, ophthalmoplegia, and enophthalmos were recorded over a 6-month follow-up, and patients were classified into four types according to periocular symptom manifestation. Two patients were categorized as type I (blindness without ptosis or ophthalmoplegia), two patients as type II (blindness and ptosis without ophthalmoplegia), two patients as type III (blindness and ophthalmoplegia without ptosis), and three patients as type IV (blindness with ptosis and ophthalmoplegia). The present study includes previously unpublished information about orbital symptom manifestations and prognosis combined with blindness caused by retinal artery occlusion after cosmetic filler injection. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

Lateral Crural Reinforcement in Secondary Cleft Lip Nasal Deformity Through a Combined Lateral Crural Turn-over Flap and Strut Graft.

Background Secondary cleft lip nasal deformity is a complex deformity, and the variety of recommended techniques used to correct this deformity attests to it. Much of the nasal deformity can be attributed to an abnormal lower lateral cartilage. This study presents our experience with applying a lateral crural turnover flap with a sandwiched strut graft in adjunct with other procedures to correct unilateral secondary cleft lip nasal deformity. Methods A retrospective review was conducted of 20 cases of unilateral cleft lip patients undergoing secondary rhinoplasty with lateral crural turnover flap with strut graft. Nostril base augmentation, columellar strut, suture techniques, and alar base reduction were performed as needed. Anthropometric analysis and subjective grading of the postoperative results were performed to evaluate the effect of the procedure on nostril symmetry. Results At long-term follow-up of 1 year, the symmetry for cleft side and noncleft side nostril height, width, and angulation of long axis of nostril improved after surgery. Subjective evaluation revealed improved results for all patients. Conclusions The lateral crural turnover flap with sandwiched strut graft is a useful technique for reinforcing, repositioning, and reshaping the lower lateral cartilage in cleft lip patients with hyperconcave lateral crus and hypoplastic pyriform margin. Combined with other techniques, the nostril is increased in height, decreased in width, and thus satisfactory symmetry is obtained.

A Novel Method for Lower Blepharoplasty: Repositioning of the Orbital Septum Using Inverted T-Shaped Plication

Background Numerous techniques have been used for lower blepharoplasty. The techniques can be classified into four principles: excision of excess fat, septal reset, orbital fat repositioning, and reinforcement of the attenuated orbital septum. Objectives We modified the conventional approach of septal reinforcement to utilize an inverted T-shaped plication with preservation of the orbital fat, repositioning the septum below the arcus marginalis to refine tear-trough deformity. Methods From April 2010 to September 2015, 93 individuals underwent bilateral lower blepharoplasty. Retrospective chart reviews were performed, and the results and complications during the follow-up period were recorded and photographed. Results The patients comprised 76 women and 17 men. Thirteen, 33, and 47 patients exhibited mild, moderate, and severe fat herniation, respectively, accompanied by tear-trough deformity. A total of 70 and 23 patients underwent lower blepharoplasty via subciliary and transconjunctival approaches, respectively. We performed inverted T-shaped plication of the orbital septum in mild and moderate cases and X-shaped plication in severe cases, and in moderate and severe cases, we performed septal repositioning simultaneously. The mean follow-up period was 25 months. When immediate mild lid retraction or lid malposition was observed, it recovered without specific treatment within 1 to 2 weeks. No permanent lid malposition or ectropion was observed in any of the patients. Conclusions Septal plication with inverted T-shape or X-shape can minimize the downward forces that affect postoperative eyelid malposition and ectropion. Further, these procedures provide sufficiently strong reinforcement of the orbital septum to restore infraorbital fat herniation. Level of Evidence 4

Clinical Significance of the Levator Veli Palatini Muscle in Velocardiofacial Syndrome Patients: Implications in Velopharyngeal Incompetence and Pharyngeal Flap Surgery

Background: Anatomical variation and deficits of velocardiofacial syndrome patients are related to unsatisfactory treatment results in surgical correction of speech abnormalities. The main purpose of the article is to investigate the clinical significance of thinned levator veli palatini muscle in VCFS patients. Methods: The authors reviewed medical records of all children with velocardiofacial syndrome who received pharyngeal flap surgery between March 2007 and September 2015. Data including thickness of levator veli palatini in magnetic resonance examination; preoperative velopharyngeal gap size from nasoendoscopy; and preoperative and postoperative speech outcomes were collected. Results: Total of 36 velocardiofacial syndrome patients with preoperative objective data and postoperative speech outcomes were identified. Preoperative velopharyngeal gap showed significant correlation with thickness of levator veli palatini (correlation coefficient: 0.297/0.397, P = .02/.03) and gap size showed correlation with postoperative speech improvement (0.347/0.413, P = .04/.02). However, muscle thickness showed no correlation with speech outcomes (0.046/0.037, P = .77/.86). Conclusion: Thinned levator veli palatini muscle in velocardiofacial syndrome patients are related to widened velopharyngeal gap and production of hypernasal speech, and can give negative impact on postoperative surgical outcome of pharyngeal flap surgery.

The Reduction Malarplasty with Coronal Approach

1. Flat and wide midface makes requests for malar reduction quite common in the East Asian population. 2. Reduction malarplasty using the coronal approach makes up for the shortcomings of the intraoral approach. 3. The coronal approach consists of medial and lateral osteotomy, repositioning of the malar complex, and rigid bony fixation. 4. To avoid facial nerve injury and temporal hollowing, temporal dissection is performed in the plane just beneath the temporoparietal fascia. 5. The coronal approach is an efficient method to produce symmetric results with adequate reduction and rigid fixation.

Reconstruction of the Maxillofacial Defect afterExtensive Resection of the Giant Ameloblastoma UsingOsteocutaneous Fibular Free Flap

Ameloblastoma of the jaws is a benign odontogenic lesion, commonly encountered in the maxillofacial area, in which the mandible is more frequently involved than the maxilla. It is locally invasive with complex clinical and radiographic presentation. Ameloblastoma is a slow-growing, silent, and painless tumor with marginal influences on functions, which is sometimes incidentally detected during regular dental check-up [1,2]. Nonetheless, patients who present late to hospital may have giant tumors that cause unaesthetic deformity of the face, and affect other functions, i.e. eating, mastication, deglutition, and speech. Radical tumor resection leaves large and multi-component defects involving skin, bone or mucosa, making facial reconstruction a challenging task. Here, we present our experience with 2 cases of giant maxillofacial ameloblastoma. The resulting large facial defects after removal of the entire tumors were successfully reconstructed using an osteocutaneous fibular free flap.