Seong Pin Jeon

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.

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.

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

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New nasal fracture classification for patients with silicone implants.

Abstract Aesthetic nasal augmentation has increased in popularity among Asian populations, and nasal bone fracture is the most common type of facial bone fracture. In Asia, the frequency of nasal bone fractures is also increasing among patients who have undergone silicone augmentation rhinoplasty. The increasing prevalence of this injury presents a challenge to the surgeon. Thirty-six patients who had previously undergone augmentation rhinoplasty with silicone implant presented with nasal bone fracture from June 2007 through December 2011. The patients were grouped into three categories: patients with fractures in the high level (type I), patients with fractures in the low level (type II), and patients with fractures throughout the entire nasal bone, from base to top (type III). The largest group comprised patients with type I fractures (n = 24, 67%), followed by type II (n = 4, 11%), and Type III (n = 8, 22%) fractures. Symptoms and surgical outcomes for nasal bone fractures may be different in patients with silicone implants. A novel classification system for nasal bone fractures is required, as is a new approach to diagnosis and treatment.

Stafne Bone Cavity of the Mandible

Stafne bone cavity is a rare mandibular defect that was first reported by Edward C. Stafne in 1942. It commonly presents with a well-demarcated, asymptomatic, unilateral radiolucency that indicates lingual invagination of the cortical bone. A 52-year-old female patient who with nasal bone fracture, visited the hospital. During facial bone computed tomography (CT) for facial area evaluation, a well-shaped cystic lesion was accidentally detected on the right side of the mandible. Compared to the left side, no swelling or deformity was observed in the right side of the oral lesion, and no signs of deformity caused by mucosal inflammation. 3D CT scans, and mandible series x-rays were performed, which showed a well-ossified radiolucent oval lesion. Axial CT image revealed a cortical defect containing soft tissue lesion, which has similar density as the submandibular gland on the lingual surface of the mandible. The fact that Stafne cavity is completely surrounded by the bone is the evidence to support the hypothesis that embryonic salivary gland is entrapped by the bone. In most cases, Stafne bone cavity does not require surgical treatment. We believe that the mechanical pressure from the salivary gland could have caused the defect.

Usefulness of indirect open reduction via a transconjunctival approach for the treatment of nasal bone fracture associated with orbital blowout fracture

Background Nasal fracture and orbital blowout fracture often occur concurrently in cases of midface blunt trauma. Generally, these multiple fractures treatment is surgery, and typically, the nasal bone and orbit are operated on separately. However, we have found that utilizing a transconjunctival approach in patients with concurrent nasal bone fracture and orbital blowout fracture is a useful method. Methods The participants in the present study included 33 patients who visited the Plastic Surgery outpatient department between March 2014 and March 2017 and underwent surgery for nasal fracture and orbital blowout fracture. We assessed patients’ and doctors’ satisfaction with surgical outcomes after indirect open reduction via a transconjunctival approach for the treatment of nasal bone fracture with associated orbital blowout fracture. Results According to the satisfaction scores, both patients and doctors were satisfied with transconjunctival approach. Conclusion We presented here that our method enables simultaneous operation of nasal fracture accompanied by orbital blowout fracture, rather than treating the two fractures separately, and it allows precise reduction of the nasal fracture by direct visualization of the fracture site without any additional incisions or difficult surgical techniques. Also, by preventing the use of excessive force during reduction, this method can minimize damage to the nasal mucosa, thereby reducing the incidence of nasal bleeding.

Simultaneous Development of Three Different Neoplasms of Trichilemmoma, Desmoplastic Trichilemmoma and Basal Cell Carcinoma Arising from Nevus Sebaceus

Nevus sebaceus is a hamartoma of the sebaceous gland that occurs congenitally, from which various secondary tumors can arise with a prevalence of 5%–6%. Benign neoplasms commonly arise from nevus sebaceous, but they have a very low malignant potential. Two neoplasms may occasionally arise within the same lesion, but it is rare for three or more neoplasms to occur in a nevus sebaceus simultaneously. A 61-year-old male patient was admitted to our hospital for a 4 cm×2.5 cm growing tumor in a verrucous form arising within a periauricular nevus sebaceus in the post auricle of the left ear that had developed 30 years earlier. The nodule was diagnosed as 3 different types of tumors: trichilemmoma, desmoplastic trichilemmoma, and basal cell carcinoma. To our knowledge, this is the first report of the coexistence of three different tumors arising from nevus sebaceous. It contain malignant neoplasm also. Surgeons should be aware of the need for close monitoring and early complete surgical excision of sebaceous nevus in order to improve patient outcomes.

Transient Anisocoria during Medial Blowout Fracture Surgery

Transient anisocoria is rare during blowout fracture reconstruction. We report a case of transient anisocoria occurring during medial blowout fracture reconstruction and review the relevant literature. A 54-year-old woman was struck in the face and was admitted for a medial blowout fracture of the left eye. During the operation, persistent bleeding occurred. To control this bleeding, a 1% lidocaine solution with 1:200,000 epinephrine was applied to the orbital wall with cotton pledgets. In total, 40 mL of local anesthetic was used for the duration of the operation. After approximately three hours of the surgery, the ipsilateral pupil was observed to be dilated, with sluggish response to light. By 3 hours after the operation, the mydriasis had resolved with normal light reflex. In conclusion, neurological and ophthalmologic evaluation must be performed prior to blowout fracture surgery. Preoperative ophthalmic evaluation is simple and essential in ruling out any preexisting neurologic condition. Moreover, surgeons must be aware of the fact that excessive injection of lidocaine with epinephrine for hemostasis during orbital wall surgery can result in intraoperative anisocoria. Anisocoria-related situations must be addressed in a proficient manner through sufficient understanding of the mechanism controlling the pupillary response to various stimuli.

Superficial Subcutaneous Leiomyosarcoma on the Face of a Pediatric Patient

Leiomyosarcomas (LMSs) are rare malignant tumors of the smooth muscles, and superficial LMS is a type of LMS that develops on the skin. Superficial LMS of the head is exceedingly rare and represents only 1%-5% of all superficial LMS cases [1]. LMSs are classified as cutaneous or subcutaneous depending on the primary site of origin. A primary cutaneous LMS derives from the erector muscles of the hair and sweat glands in the dermis. Subcutaneous LMS is considered to arise from the muscular coat of a vessel [2]. It mostly develops in people in the age group of 40-60 years and is twice more likely to occur in women than in men. The most common sites of LMS development are the legs (50%-75%), followed by the arms (20%-30%), trunk (10%-15%), and face (1%-5%) [3]. We report a case of LMS in a 13-year-old boy. LMS developed on the face of the child. A case like this has thus far not been reported internationally, and the present study contributes to the knowledge on LMS disease characteristics. A 13-year-old boy was admitted because of a protruding and painless mass on his right jaw. The tumor size had been increasing for 10 months, and the lesion was approximately 20 mm in diameter at the time of admission (Fig. 1). There were no palpable cervical lymph nodes. Fig. 1 A preoperative photograph of the patient showing a 30-mm-sized tumor under the right jaw. A solitary oval-shaped mass with increased contrast and measuring 28 mm×18 mm was observed at the superficial masseter muscle and the mandibular ramus during preoperative contrast-enhanced computed tomography (Fig. 2). At first, hemangioma was suspected. Accordingly, a catheter was placed in the right external carotid artery through the right femoral artery, and embolization through the facial artery was performed using Gelfoam. However, instead of decreasing, the tumor size gradually increased during the 2 months of postoperative follow-up. Fig. 2 A preoperative computed tomography scan showing a hypervascular mass with increased contrast. Under general anesthesia, a pale, yellowish mass, measuring 33 mm×23 mm×20 mm, on the subcutaneous layer was resected via an intraoral incision (Fig. 3). On the postoperative biopsy, LMS involving adipose and vascular tissues accompanied by dystrophic calcification and a mitotic count of 3/10 high-power fields was observed (Figs. 4, ​,55). Fig. 3 An oval-shaped mass was revealed via an intraoral incision. Fig. 4 High-power microscopic examination revealed atypical spindle cell proliferation with a long fascicular or short bundle pattern. The red arrow denotes atypical mitosis (H&E, ×400). Fig. 5 Immunohistochemically, desmin staining (desmin immunohistochemistry, ×200) was positive. Low-power microscopic examination revealed a hypercellular solid mass without necrosis or hemorrhage and composed of spindle cells. The lesion infiltrated to the adipose tissue, probably the subcutaneous fat layer. The high-power view showed cellular atypism with frequent mitotic figures (at least one/high-power field) (Fig. 4). Immunohistochemically, desmin and actin were positive, but CD34 or cytokeratin was negative (Fig. 5). SYT/SS18 fluorescence in situ hybridization revealed no t(X;18)(p11.2;q11.2) translocation. Therefore, the pathologic diagnosis was LMS. LMSs are classified as cutaneous or subcutaneous depending on the primary site of origin. Cutaneous forms, which arise from the arrector pili muscles of the hair follicles or the dartos muscles of the genital skin, are associated with epidermal changes, such as ulceration, umbilication, and discoloration. Subcutaneous forms, which arise from the smooth muscle lining of arterioles and veins in the subcutaneous tissue, are not associated with surface changes and usually grow relatively fast [2]. Differentiation into one of these two subtypes is not always straightforward because the local growth of tumors of either type may involve invasion of the dermal and subdermal layers. However, differentiating between cutaneous and subcutaneous LMSs is important because they have different prognoses. Cutaneous LMSs have a local recurrence rate of 14%-50%, but the potential for distant metastasis is very low. In contrast, subcutaneous LMSs recur locally in 40%-60% of cases and metastasize in 20%-60% of cases [2]. The present case was determined to belong to the subcutaneous type. Clinically, the tumor did not protrude out of the skin, and no epidermal changes such as ulceration were observed. This is significant because it is difficult to identify and diagnose subcutaneous-type tumors if there are symptoms indicative of a cutaneous type. LMS is extremely rare in patients below the age of 15 years. A literature search revealed a single study by Bernstein and Roenigk [4], who reported two pediatric patients with LMS localized on the shoulder or the scalp. There is no report of LMS of the lower jaw in a pediatric patient. Although a 30-mm solitary mass with increased contrast was found on computed tomography at the time of the initial hospital admission, the correct diagnosis was delayed due to the lack of knowledge on LMS. Pain is the most common symptom of LMS, occurring in 80%-95% of patients. Pruritus, burning, and bleeding are also common [2]. In our patient, no such symptoms were observed before the histological diagnosis was established, and no physical trauma was detected. Histologically, superficial cutaneous LMSs are characterized by poorly circumscribed fascicles of spindle-shaped cells in the dermis. The tumor is highly cellular, with elongated, blunt-tipped nuclei. LMSs are characterized by co-expression of vimentin, desmin, and muscle-specific actin [2]. The recommended treatment for superficial LMS is wide local excision with a 20- to 50-mm lateral margin [5]. Routine lymphadenectomy is not indicated unless the lymph node disease is evident. There is no evidence to support the use of chemotherapy in the treatment of these tumors [1,2]. Here, we report a case of a 30-mm LMS that developed on the jaw of a pediatric patient. As this is an extremely rare facial tumor, it is difficult to diagnose in the absence of obvious symptoms. It is particularly important to differentiate a tumor of the subcutaneous type, which is not manifested by changes on the surface of the skin such as protrusion or ulceration, from a hemangioma or lymphoma. An incorrect or delayed diagnosis may lead to increased tumor size, invasion to proximal tissues, or remote metastasis. Therefore, we need to consider the possibility of LMS during the diagnosis of a facial tumor in children. We hope that this study provides useful information for clinicians and researchers investigating the biological characteristics of superficial LMS.