Jin-Soo Lim

Ankyloglossia correction: Z-plasty combined with genioglossus myotomy.

AbstractAnkyloglossia or tongue-tie is a disease in which the tongue has a mobility disorder because the lingual frenulum is short and tight, and as a result, the tongue tip is tied up. It may be asymptomatic or may cause various problems such as articulation disorder. Surgical treatment is required in many of the patients, and conventional methods release only the mucosal layer of the frenulum. However, conventional method alone is not as effective; therefore, the authors studied the addition of a partial myotomy of the genioglossus muscle along with mucosal layer release for treatment.The authors performed the surgery on 106 patients from 2005 to 2010, and during the surgery, the mucosal layer was released through Z-plasty after myotomy was performed on the contracted genioglossus muscle.During the follow-up, none of the patients showed signs and symptoms of tongue mobility impairment or articulation disorder caused by the partial myotomy of the genioglossus muscle, and a satisfactory outcome was obtained in achieving mobility of the tongue tip.Because tongue mobility disorder in ankyloglossia is accompanied by the contracture and shortening of the genioglossus muscle, an improved outcome is expected in the projection and mobility of the tongue tip from the combined application of conventional Z-plasty and genioglossus muscle release.

Automated Transformation of Template-Based Web Applications into Single-Page Applications

In a template-based web application (TWA), a template is used as a common structure or layout to dynamically generate web pages. The consistent structure helps users easily obtain information. However, TWAs still have an interaction problem: whenever a user clicks a hyperlink or submits a form, a new page is loaded. Therefore, we need to reduce communication between a browser and a server by avoiding loading the same template twice. This paper proposes a technique of transforming a Java-based TWA into a single-page application (SPA) with partial page refreshes. An Eclipse plugin is also presented for automatic reengineering of TWAs. Our technique is applied to typical TWAs and discussed with respect to quality attributes such as performance, bookmarkability, and backward navigation.

A simple and easy surgical technique for open reduction of orbital wall fractures using a silicone sheet

The purpose of orbital wall fracture surgery is to reduce the herniated orbital contents into the orbital cavity and restore the fracture site. When approaching the orbital wall in blow-out fracture surgery, soft tissue is often an obstacle to a clear view of the fractured site. Although soft tissue can be moved aside using a retractor, there are many difficulties, including obscuration of the operative field by soft tissue and even soft tissue sandwiched between the fracture site and the orbital implant due to soft tissue mobility. Thus, the authors introduce a useful method utilizing a silicone sheet(BioPlexus Corporation, Ventura, CA, USA) in blow-out fractures. We performed surgery in a total of 381 patients with isolated orbital wall fractures between January 2007 and December 2012. All of the operations were performed by a single surgeon, Lim JS. All medical records were reviewed retrospectively through electronic medical records, and the study was approved by the Institutional Review Board of St. Vincent’s Hospital. The silicone sheet used in the surgery had a thickness of 0.062” and was prepared aseptically. The surgical procedure was performed under general anesthesia in all cases. The site of the fractured orbital walls was reached through a standard subciliary or transcaruncle method according to the site of fracture. After visualization of the fracture site, the soft tissue herniated through the fracture site was reduced into the orbital cavity. A sterilized silicone sheet was trimmed into a circular shape slightly larger than the fractured orbital wall and inserted temporarily between the orbital wall and the soft tissue, including the periosteum (Figure 1). Since the silicone sheet held the orbital soft tissue contents in place, the operator could simply insert a retractor between the silicone sheet and fracture site to visualize the fracture site, thus

Leiomyosarcoma of the Face

Leiomyosarcoma is a rare form of soft tissue neoplasm, with only 1% to 5% occurring in the head and neck region. Current recommended treatment suggests surgical excision with a wide lateral margin, but no definite guidelines regarding excisional margin have been established yet. Recently, complete excision with a narrow surgical margin has been recommended, and the authors present a case of cutaneous leiomyosarcoma on the face that was successfully managed by complete removal with a narrow excisional margin. A 74-year-old woman presented with a 3 cm sized, rapidly growing cutaneous mass on her right preauricular area. Preoperative biopsy of the skin lesion suggested a cutaneous leiomyosarcoma. The authors performed complete surgical excision with a 1 cm lateral margin, and the resulting skin defect was repaired with bilateral V-Y advancement local flaps. Histopathology and immunohistochemistry evaluation confirmed a moderately differentiated cutaneous leiomyosarcoma, with negative margin involvement. The patient refused of any additional treatment, but showed no locoregional recurrence during the 1.5 years of postoperative follow-up period. With a regular postoperative follow-up, cutaneous leiomyosarcomas may be successfully treated with a narrow surgical margin.

A Simple and Reproducible Surgical Technique for the Management of Preauricular Sinuses

Preauricular sinus is a relatively common congenital anomaly that mainly exists on the anterior aspect of the anterior limb of the ascending helix. Although many surgical techniques have been developed, extirpation of the sinus is not easy because of the ramifications of the sinus, remnants of the sinus wall, and infection with or without formation of abscesses, which can all lead to disease recurrence. In our institution, we have surgically treated a total of 141 cases of congenital preauricular sinuses. Instead of using the conventional lacrimal probe and methylene blue method, we used a gentian violet–soaked Cottonoid, which has antibacterial effects against the main pathogen responsible for causing infection of the preauricular sinus. Results have been very favorable, with a zero recurrence rate. We present here a simple and reproducible surgical technique using a gentian violet–soaked Cottonoid that even beginning surgeons can easily follow.

Jeopardized Digital Circulation From a Closed Phalangeal Fracture

Closed phalangeal fractures that accompany concomitant vascular injuries are not common. The mechanism of such vessel injuries vary, from direct vascular trauma by fractured bone segment, increased compartmental pressure or unintentional vascular traction during reduction procedures. Acute digital ischemia requires appropriate surgical intervention(s) to minimize complications. The authors present a case of a closed phalangeal fracture with concomitant digital artery injury, and a brief review of the related literature.

Follicular hybrid cyst on the cheek: A combination of infundibular, isthmic, and pilomatrical differentiation

A hybrid cyst is a rare condition which includes any type of cyst arising from the various parts of the pilosebaceous unit. We report a case of hybrid cyst with infundibular, isthmic, and pilomatrical differentiation. A 12-year-old boy presented with a mass on the right cheek. The physical examination revealed an oval-shaped, dark-gray protruding mass with dimensions of 0.9 cm×0.6 cm that was non-tender to palpation. The mass was totally excised. The diagnosis of a hybrid cyst was confirmed by histological evaluation. It was a well-encapsulated mass and showed combined histologic features of infundibular, isthmus, and pilomatrical differentiation. The hybrid cyst is a follicular cyst that includes two or more components of a cystic lesion arising from the pilosebaceous unit. Occasionally, there have been reports of hybrid cysts consisting of two components in differentiation, but those showing more than two components of differentiation have been extremely rare. The pathogenesis of this unusual disease is not yet known.