Seok Joo Kang

Severe visual loss and cerebral infarction after injection of hyaluronic acid gel.

We report a case of a 23-year-old man with cerebral infarction and permanent visual loss after injection of a hyaluronic acid gel filler for augmentation rhinoplasty. The patient was admitted to the hospital with complaints of loss of vision in the right eye, facial paralysis on the right side, and paralysis of the left limbs with severe pain during augmentation rhinoplasty with filler injection. Brain magnetic resonance imaging and computed tomography showed ophthalmic artery obstruction and right middle cerebral artery infarction. Acute thrombolysis was performed to treat the infarction; however, the patients condition did not improve. Intracerebral hemorrhage in the right temporal/frontal/occipital/parietal lobe, subarachnoid hemorrhage, and midline shifting were observed on brain computed tomography after 24 hours after thrombolysis. Emergency decompressive craniectomy was performed. After the surgery, the patient continued to experience drowsiness, with no improvement in visual loss and motor weakness. Three months later, he could walk with cane. This case indicates that surgeons who administer filler injections should be familiar with the possibility of accidental intravascular injection and should explain the adverse effects of fillers to patients before surgery.

Surgical treatment of periorbital foreign body.

We present the rare case of a violence-related accident involving a periorbital foreign body and surgical treatment. A 43-year-old man was brought to the hospital with a foreign body lodged in his left eyelid. A ballpoint pen penetrated the upper lid and orbital floor and reached the maxillary sinus.The spring of the ballpoint pen was observed in the radiograph, but the other parts of the ballpoint pen were not seen.The ballpoint pen was retrieved along the path of insertion. The fractured part of the orbital floor was slightly enlarged with a drill to allow visual access during surgery. Plastic pieces and the spring of the pen were removed under endoscopy inside the maxillary sinus. The inferior orbital wall was successfully reconstructed and there were no postoperative complications.The unique features of this case include the nature of the foreign body and its trajectory; removal was particularly challenging because the foreign body was not clearly visible in the radiograph.

Surgical management of recurrent squamoid eccrine ductal carcinoma of the scalp.

Squamoid eccrine ductal carcinoma (SEDC) is an exceedingly rare tumor that shows both squamous differentiation and adnexal ductal differentiation. As our review of the literature revealed, only a total of 7 cases were reported to date. We report an additional case of SEDC occurring on the scalp of a 53-year-old man. Despite complete excision by conventional technique with clear margin, the lesion recurred within a 3-month period, with regional lymph node metastasis. The tumor was completely removed, and the large scalp defect was reconstructed by using scalp rotation flap. We present a case of recurrent SEDC on the scalp, and we surgically resected this tumor. In addition, the large scalp defect was reconstructed successfully with scalp flap, and no recurrence has been observed in the patients postoperative follow-ups.

A Novel and Easy Approach for Contouring Surgery in Patients With Craniofacial Fibrous Dysplasia.

Although the bone-shaving procedure is the optimal alternative treatment of craniofacial fibrous dysplasia affecting the maxilla and zygoma, it is difficult to determine the appropriate amount of bone to be removed. The authors therefore developed a novel method for bone shaving using three-dimensional printing technology on computed tomography (CT) scans and screws as a guide. In our method, we implanted screws of predetermined lengths into surgical sites and then performed a burring within the visual field. By using screws, the exact amount of bone could be removed, as determined preoperatively. Thus, the operation time was shorted and the method was less effort intensive. Moreover, this procedure had reduced risk of radiation exposure owing to frequent use of CT, and had a low cost. This simple new method is more precise and effective, and shows satisfactory cosmetic outcomes than those with current bone-shaving practices.

Proposed Method for Closed Reduction of Impacted Nasal Bone Fractures Using a Kirschner Wire and a C-Arm

PURPOSE Closed reduction is commonly used for the treatment of nasal bone fractures. If the fracture is impacted, accurate reduction is difficult. Therefore open reduction is often required. MATERIALS AND METHODS Between January 2010 and December 2011, we used a Kirschner wire and a C-arm intraoperatively for accurate closed reduction of impacted nasal bone fractures. RESULTS During the follow-up period of 4 weeks to 6 months, all patients had satisfactory cosmetic results. CONCLUSIONS The effectiveness of open reduction was obtained without noticeable scarring with our method of closed reduction using a Kirschner wire and a C-arm.

Rapidly growing eccrine porocarcinoma of the face in a pregnant woman.

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Platysma Flap with Z-Plasty for Correction of Post-Thyroidectomy Swallowing Deformity

Background Recently, the number of thyroid surgery cases has been increasing; consequently, the number of patients who visit plastic surgery departments with a chief complaint of swallowing deformity has also increased. We performed a scar correction technique on post-thyroidectomy swallowing deformity via platysma flap with Z-plasty and obtained satisfactory aesthetic and functional outcomes. Methods The authors performed operations upon 18 patients who presented a definitive retraction on the swallowing mechanism as an objective sign of swallowing deformity, or throat or neck discomfort on swallowing mechanism such as sensation of throat traction as a subjective sign after thyoridectomy from January 2009 till June 2012. The scar tissue that adhered to the subcutaneous tissue layer was completely excised. A platysma flap as mobile interference was applied to remove the continuity of the scar adhesion, and additionally, Z-plasty for prevention of midline platysma banding was performed. Results The follow-up results of the 18 patients indicated that the definitive retraction on the swallowing mechanism was completely removed. Throat or neck discomfort on the swallowing mechanism such as sensation of throat traction also was alleviated in all 18 patients. When preoperative and postoperative Vancouver scar scales were compared to each other, the scale had decreased significantly after surgery (P<0.05). Conclusions Our simple surgical method involved the formation of a platysma flap with Z-plasty as mobile interference for the correction of post-thyroidectomy swallowing deformity. This method resulted in aesthetically and functionally satisfying outcomes.

Reconstruction of Abdominal Wall of a Chronically Infected Postoperative Wound with a Rectus Abdominis Myofascial Splitting Flap

Background If a chronically infected abdominal wound develops, complications such as peritonitis and an abdominal wall defect could occur. This could prolong the patients hospital stay and increase the possibility of re-operation or another infection as well. For this reason, a solution for infection control is necessary. In this study, surgery using a rectus abdominis muscle myofascial splitting flap was performed on an abdominal wall defect. Methods From 2009 to 2012, 5 patients who underwent surgery due to ovarian rupture, cesarean section, or uterine myoma were chosen. In each case, during the first week after operation, the wound showed signs of infection. Surgery was chosen because the wounds did not resolve with dressing. Debridement was performed along the previous operation wound and dissection of the skin was performed to separate the skin and subcutaneous tissue from the attenuated rectus muscle and Scarpas fascial layers. Once the anterior rectus sheath and muscle were adequately mobilized, the fascia and muscle flap were advanced medially so that the skin defect could be covered for reconstruction. Results Upon 3-week follow-up after a rectus abdominis myofascial splitting flap operation, no major complication occurred. In addition, all of the patients showed satisfaction in terms of function and esthetics at 3 to 6 months post-surgery. Conclusions Using a rectus abdominis myofascial splitting flap has many esthetic and functional benefits over previous methods of abdominal defect treatment, and notably, it enabled infection control by reconstruction using muscle.

Pediatric lipoma of the buccal fat pad.

excised. No complications or recurrence occurred. Histopathological examination revealed that the cystic wall consisted of respiratory epithelium with chronically inflamed granulation tissue and keratin. Postoperative control after 6 months, the patient had no complaints. Submucous resection is a simple procedure, with satisfactory results, and an often used procedure to solve the problem of nasal obstruction. The usual complications of nasal septal surgery are septal hematoma, infection, septal perforation, and external nasal deformity. Nasal septal cyst is a rare complication seen after submucous resection of the nasal septum. Nasal septal cyst, as a complication of septoplasty, has been reported in only 3 cases before. The exact cause of the cyst is not known, but the most acceptable theory is development of an inclusion cyst, entrapment of free nasal mucosal remnants or inward folding of incised septal mucosa in the submucosal space. Allergic rhinitis is a possible ethiological agent, and some authors postulate that allergic rhinitis is a reasonable cause. Postoperative traumatic nasal packing may be a reason for nasal septal cyst. In the other cases, there were reported postoperative several nasal packing in 2 of 3 cases, so it seems to be an acceptable theory. However, in our case, there was no complication after surgery, and the nasal packing had no problems, seen by endoscopic examination after removal. There were no complications after the surgery, except the cyst formation. In our case, it is difficult to say the exact cause of this complication, so the most reasonable cause is the inclusion of the mucosa in the submucosal space. The differential diagnosis of a nasal septal cyst includes hematoma and abscess of the nasal septum, and congenital midline masses, such as nasal dermoid cysts, meningoencephaloceles, and gliomas. Therefore, preoperative assessment with CT and MRI is mandatory to ascertain the possibility of intracranial involvement, as well as to evaluate bony erosion and nature of contents within the mass. Lateral rhinotomy, open rhinoplasty, or endoscopic surgery can be used as a treatment model. Metin Ibrahimov, MD, Mehmet Yilmaz, MD, Ferit Akil, MD, Ozge Tarhan, MD, Nihat Kaya, MD, Ozcan Ozturk, MD Istanbul University Istanbul, Turkey metinibrahimov@gmail.com

Surgical treatment of enophthalmos using an endoscope and T-shaped porous polyethylene fabricated with a mirror image.

Enophthalmos is corrected mostly through reducing the enlarged orbit volume by identifying intact bone edges and spanning the defect with an implant or autogenous graft. Predicting the amount of volume which must be added to correct enophthalmos is not easy using this method, and the outcome may be unsatisfactory. In this study, the authors examined 9 patients in whom enophthalmos was caused by a defect or inadequate surgery of the orbital medial wall. The authors designed an adequately shaped implant by using the mirror image obtained before surgery, and prepared a T-shaped Medpor for each patient in order to maintain the accurate contour of the medial wall and to decrease the enlarged orbital volume. During the surgery, the T-shaped Medpor was inserted while monitoring the posterior portion of the orbital wall. Satisfactory results were obtained for all the patients. Although the new method of implant design developed by the authors in this study is limited to the reconstruction of the medial wall, it is considered useful for the surgical treatment of posttraumatic enophthalmos because it takes into account both the contour and volume of the orbital wall.