Donghyeok Shin

Secondary Cleft Nasal Deformity Correction Using Bioabsorbable Mesh.

Introduction:Septorhinoplasty in cleft patients is relatively difficult to perform and the outcomes are often unsatisfactory owing to weakness of the cartilage. Therefore, providing support to the cartilage is necessary. The authors used bioabsorbable mesh as a spreader or batten graft to support the septum in cleft patients those with weak cartilages. The purpose of this study was to evaluate the efficacy of bioabsorbable mesh when performing septorhinoplasty in cleft patients. Methods:Between 2009 and 2013, 34 patients with cleft lip and nose underwent open septorhinoplasty by using bioabsorbable mesh at the Konkuk University Medical Center. The authors determined the nasolabial angle, Goode ratio, alar base-nasal tip-columellar base angle, and columellar axis angle and performed a panel evaluation. Results:In all, 29 of the 34 patients were included; 5 patients were excluded as lost to follow-up. The nasolabial angle increased from 85.69° to 91.62° (P = 0.0032), and the mean Goode ratio increased from 0.51 to 0.55, which was approximately the ideal value (P = 0.0017). The alar base-nasal tip-columellar base angle decreased from 36.28 to 31.74 (P < 0.0001). The columellar axis angle increased from 82.36 to 86.90 (P < 0.0001). Discussion:As bioabsorbable mesh can provide strong support, results in good esthetic outcomes, and causes minimal complications, it can be used in septorhinoplasty for cleft patients.

Maxillary Distraction Osteogenesis Using a Rigid External Distractor: Which Clinical Factors Are Related With Relapse?

Introduction:Maxillary distraction osteogenesis is a reliable treatment for cleft lip and palate with midfacial retrusion. The purpose of this study was to evaluate the results of long-term follow-up in patients with cleft lip and palate after maxillary distraction osteogenesis and to find clinical factors related to relapse. From February 2002 to June 2008, 21 patients with severe class III malocclusion were treated at our hospital. We performed distraction osteotomy with a rigid external distractor device. The distraction length was more than 15 mm in all patients. Methods:Preoperative and postoperative lateral cephalometric radiographs were used for analysis. The sella-nasion-subnasale, sella-nasion-supramentale, and point-A-point-B-nasion (sella-nasion-subnasale–sella-nasion-supramentale) angles were recorded. The timelines for follow-up were preoperatively, after distraction, after consolidation, at 3 years, and once fully grown (5- to 8-year follow-ups). A comparative analysis of clinical factors was performed for the relapsing and nonrelapsing groups. Results:Of the 21 patients, 14 had relapsed. The mean age in the relapsing group was 9.1 years (7 boys and 7 girls) with 9 patients with unilateral cleft palate and 5 c bilateral cleft palate. The mean age in the nonrelapsing group was 11.7 years (4 boys and 3 girls) with 5 patients with unilateral cleft palate and 2 patients with bilateral cleft palate. Discussion:Despite greater anterior overcorrection, relapse occurred owing to scar tissue retraction and mandibular compensatory hypertrophy. The results suggest that the younger the patient, the more likely relapse will occur.

The effect of the dental root on single mandibular bone fractures

Background This study was conducted to determine the effect of the distributional relationship between dental roots and the mandibular bone on single mandibular bone fractures, which are common craniofacial fractures. Methods This was a retrospective, single-center study in Seoul, Korea. Patients with single mandibular fractures in the symphysis, parasymphysis, body, and angle area, with tooth structure involvement were included. The control group included patients with simple, bone-level lacerations without fractures. In total, 94 patients (72 males and 22 females) were included in the treatment group, and 125 (71 males and 54 females) were included in the control group. The height of the mandibular bone and the dental root were measured with panoramic radiography. The central incisor represented the symphysis area, the canine represented the parasymphysis area, the first molar represented the body area, and the second molar represented the angle area. Results In the treatment group, symphysis fractures occurred in 16 patients (17%), parasymphysis fractures in 36 patients (38%), body fractures in 17 patients (18%), and angle fractures in 25 patients (27%). The ratios of the dental roots to the total height of the mandibular bone in the treatment group were 30.35%, 39.75%, 39.53%, and 36.27% for symphysis, parasymphysis, body, and angle areas, respectively, whereas in the control group, they were 27.73%, 39.70%, 36.76%, and 35.48%. The ratios of the treatment group were significantly higher than those of the control group. Conclusion The results show that the higher ratio of the dental root to the height of the mandibular bone increases the fracture risk.

Autogenous Fat Grafting for Mild-to-Moderate Postoperative Temporal Hollowing after Decompressive Craniectomy: 1-Year Follow-Up

Background Temporal hollowing is inevitable after decompressive craniectomy. This complication affects self-perception and quality of life, and various techniques and materials have therefore been used to restore patients’ confidence. Autologous fat grafting in postoperative scar tissue has been considered challenging because of the hostile tissue environment. However, in this study, we demonstrate that autologous fat grafting can be a simple and safe treatment of choice, even for postoperative depressed temporal scar tissue. Methods Autologous fat grafting was performed in 13 patients from 2011 to 2016. Fat was harvested according to Coleman’s strategy, using a tumescent technique. Patient-reported outcomes were collected preoperatively and at 1-month and 1-year follow-ups. Photographs were taken at each visit. Results The thighs were the donor site in all cases for the first procedure. The median final volume of harvested fat was 29.4 mL (interquartile range [IQR], 24.0–32.8 mL). The median final volume of fat transferred into the temporal area was 4.9 mL on the right side (IQR, 2.5–7.1 mL) and 4.6 mL on the left side (IQR, 3.7–5.9 mL). There were no major complications. The patient-reported outcomes showed significantly improved self-perceptions at 1 month and at 1 year. Conclusions Despite concerns about the survival of grafted fat in scar tissue, we advise autologous fat grafting for patients with temporal hollowing resulting from a previous craniectomy.

Formation of the Philtral Column Using a Dermal Graft in Secondary Unilateral Cleft Lip

Introduction: The philtral column has an important aesthetic significance and is especially important in patients with cleft lip. If the integrity of the philtrum cannot be preserved in patients of unilateral clefts, these patients will have profound abnormalities in their facial musculature. The purpose of this study was to analyze the effects of dermal grafting on the philtral column in patients with a unilateral alveolar cleft. Methods: The authors retrospectively studied dermal grafts performed in Konkuk University Medical Center between January 2009 and January 2015. A total of 26 patients with unilateral cleft lip were included in this study; the authors measured philtral symmetry based on differences in convexity and angle using clinical photos. Additionally, panel evaluation was performed. Results: Of 26 patients enrolled, 21 completed follow-up and had adequate photographs. Five patients who were lost to follow-up were excluded. The difference in convexity decreased from 0.25 to 0.15 (P < 0.005) and the difference in angle decreased from 10.76 to 6.43 (P < 0.005). The panel evaluation indicated that patient appearances were significantly improved (P < 0.001). Discussion: In patients with secondary cleft lip deformity of the philtral depression, the authors’ procedure may augment the thickness of the philtral ridge and have positive aesthetic outcomes.

Alveolar Bone Grafting Changes the Inclination of Teeth and Affects Malocclusion in Patients With Unilateral Alveolar Cleft

Introduction: Alveolar bone grafting not only stabilizes the alveolar arch, but also provides positive aesthetic outcomes. However, there have been no reports about the inclinations of the incisor and canine or the change in occlusion after alveolar bone grafting. Therefore, the purpose of this study is to analyze the effects of alveolar bone grafting on tooth angles and changes in occlusion in patients with a unilateral alveolar cleft, using three-dimensional computed tomography. Methods: The authors retrospectively studied alveolar bone grafts performed in Konkuk University Medical Center between January 2008 and January 2013. A total of 40 patients with unilateral alveolar cleft were included in this study; the authors measured the changes in tooth angles and changes in anterior and molar occlusion before and after bone grafting. Results: Of the 40 patients enrolled, 21 completed follow-up and had adequate computed tomography imaging studies. Ten patients who were lost during the follow-up period, and 9 with inadequate images, were excluded. The anterior occlusion increased from −2.21 to 0.19 mm (P < 0.0001) and the molar occlusion increased from 0.75 to 2.10 (P < 0.0001). The dental angle decreased from 25.23° to 15.32° (P = 0.001). Discussion: Alveolar bone grafting provides support to the tooth root and changes the inclination of the tooth, resulting in changes in occlusion and positive aesthetic outcomes.

Autologous Tissue Graft in Revision Medial Epicanthoplasty Using Subciliary Fat and Orbicularis Oculi Muscle

Abstract The medial epicanthal fold is one of the racial anatomic characteristics of Asians. As medial epicanthoplasty has become one of the most common cosmetic surgeries among Asians, the need for revision of overcorrected medial epicanthus also increased. In revision medial epicanthoplasty, an autologous tissue graft to the subcutaneous plane is used to reduce postoperative scar. Medial epicanthoplasty, using V–Y advancement and rotation flap, was performed in 93 patients (revision medial epicanthoplasty with autologous tissue graft, 60 patients; revision medial epicanthoplasty only, 33 patients). A V–Y and rotation flap was designed to cover the overexposed lacrimal lake. A small amount of fat tissue and orbicularis oculi muscle were harvested from the upper eyelid through the double-fold line and grafted to the subcutaneous space of the medial epicanthal area. We evaluated the patients’ satisfaction with the overall outcome and scar. The mean intercanthal distance increased from 32.3 mm before surgery to 34.6 mm after surgery. Satisfaction with the scar and overall outcome was higher in the patient group who underwent medial epicanthoplasty with autologous tissue graft. No complication was observed in the autologous tissue graft group, whereas 1 patient who underwent medial epicanthoplasty without autologous tissue graft showed recurrence of the medial epicanthal fold, 5 months after surgery. Medial epicanthoplasty with autologous tissue graft is a simple and reliable method to repair the overcorrected medial epicanthus that can efficiently increase the intercanthal distance and prevent scar contracture.

A Mobile Application for Wound Assessment and Treatment: Findings of a User Trial.

The D+Wound Solution is a mobile phone application (app) that assists users in the assessment and treatment of the wound. The app has 6 components for assessment: need for debridement, infection control, revascularization, and exudate control; whether it is chronic; and finally, the top surface of the skin. These components are named D.I.R.E.C.T. The app makes you review these components as an algorithm to provide a reasonable solution for dressing. It is designed to understand the status of the wound and provide a practical treatment idea for wound care providers. A total of 118 nurses were divided into 2 groups, designated as experienced and less-experienced groups, and surveyed. Both groups found the app to be helpful in making a treatment plan. However, the less-experienced group found it to be significantly more useful in assessing the wound (P = .026) but difficult to understand the logic. The experienced group found the logic to be significantly easier to understand (P = .018) and had significantly higher similarities (P = .015) in treatment protocols compared with the less-experienced group. We may conclude that this app has a logical algorithm resembling experienced wound caregivers and is more useful in the less-experienced group.

Anatomical characteristics of the nasal cartilages for successful rhinoplasty in Koreans.

BackgroundsThe aims of the present study were to determine the exact level of separation of the upper lateral cartilage from the septal cartilage, and to classify the patterns of connection between the upper lateral cartilage and the lower lateral cartilage. MethodsWe dissected and photographed 60 sides of noses; 18 specimens were sectioned and stained with Masson’s trichrome. ResultsThe mean length of the connection between the upper lateral cartilage and septal cartilage was 16.1 mm. The mean level for separation of the upper lateral cartilage was 7.5 mm from the nasal bone. The pattern of connection between the upper lateral cartilage and lower lateral cartilage could be classified into five types: disconnection, end-to-end, overlap, scroll, and reverse scroll. ConclusionsThe results of the present study will be helpful for surgical procedures such as nasal hump reduction and nasal cartilage work and also provide information for the anthropometric study of the nose.