Soo Hyang Lee

Analysis of 809 Facial Bone Fractures in a Pediatric and Adolescent Population

Background Facial fractures are infrequent in children and adolescents and have different clinical features from those in adults. The low incidence in children and adolescents reflects the flexibility and underdevelopment of their facial skeletons, as well as their more protected environments. Only a few reports have reviewed such patients in Korea. The authors performed a retrospective study to analyze the characteristics of facial fractures in the Korean pediatric population. Methods We conducted a retrospective review on a series of 741 patients, aged <18 years, with facial fractures who had been treated at our hospital between 2006 and 2010. The following parameters were evaluated: age, sex, cause, location and type of fractures, associated injuries, treatment and complications. Results A total of 741 consecutive patients met the inclusion criteria. The ratio of boys to girls was 5.7:1. Facial fractures most commonly occurred in patients between 13 and 15 years of age (36.3%). The most common causes of injury was violence. The nasal fracture was the most common type of fracture (69%) and the blowout fracture was the second most common (20%). Associated injuries occurred in 156 patients (21%). Conclusions The incidence of pediatric facial fractures caused by violence is high in Korea. Our results show that as age increases, etiological factors and fracture patterns gradually shift towards those found in adults. This study provides an overview of facial fractures in these age groups that helps illustrate the trends and characteristics of the fractures and may be helpful in further evaluation and management.

Attractive Composite Faces of Different Races

Existing evidence suggests that the standards of facial attractiveness are similar across genders and cultures [1]. Researchers have reported that the computer-generated, mathematical average of a series of faces was rated more favorably than the individual faces [2]. On the other hand, although some controversy exists regarding the significance of the average and attractive faces, Perrett et al. [3] have insisted that highly attractive facial configurations are not an average. Many authors have reported that the average faces are different from attractive faces and that attractive faces differ considerably according to race [4–8]. I agree with the opinion that the average face is not an attractive face and that the most attractive face is the average of attractive faces. Recently, although some scholars have attempted to unify facial beauty using the concept of the golden proportion, Holland [9, 10] proved that a phi mask, namely, the divine proportion or golden ratio, did not appear to describe the ‘‘ideal’’ face shape and showed the many limitations of traditional morphometrics in research on the attractiveness of faces. Because I absolutely agree with him, I introduced examples of attractive composite faces from different races in the follow-up article that I submitted [11]. The composite faces in Fig. 1 that exemplify attractive faces of different races were generated using the same computerized morphing systems reported in my previous article [11]. Each example of an attractive face has different characteristics with respect to the average face of its own race. The Japanese composite face is a relatively long face with slightly slanted eyes, sharp chin, and chubby cheeks. The Chinese attractive face has a relatively narrow cheek, slim and thin face, and lantern jaw. The Caucasian attractive face has a somewhat masculine appearance. This face has a narrow palpebral height, angulated and squareshaped mandible, protruding cheek, and fuller lips compared with the average Caucasian face. The example of an African face has a narrower nose, smaller and more acute eyes, smaller upper lip, and slender chin compared with the ordinary African face. Although these composite faces are not the standard or most ideal attractive faces, and although many biases occurred during the process of photographic sampling, I regard these as good examples for understanding prior and current configurations, balance, harmony, or the secret of attractive faces of different races. I insist that the concept of facial beauty is not a fixed one and that it is constantly evolving with time [5]. Therefore, the stereotyped concept of facial beauty must change. Our society is eventually conforming to a single standard, but I do value ethnic and cultural diversity. We must understand cultural diversity and try to respect the beauty of other human races. I think the beauty concept of other races shows some differences from ours. I expect these photographs to be used to understand the aesthetic preference of different races. S. C. Rhee (&) S. H. Lee Department of Plastic and Reconstructive Surgery, Ilsan Paik Hospital, Inje University, #2240, Daehwa-Dong, Ilsan Seo-Gu, Goyang City, Kyounggi-Do 411-706, Republic of Korea e-mail: rheesc@paik.ac.kr

Comparison of the Multidetector-row Computed Tomographic Angiography Axial and Coronal Planes' Usefulness for Detecting Thoracodorsal Artery Perforators.

Background During the planning of a thoracodorsal artery perforator (TDAP) free flap, preoperative multidetector-row computed tomographic (MDCT) angiography is valuable for predicting the locations of perforators. However, CT-based perforator mapping of the thoracodorsal artery is not easy because of its small diameter. Thus, we evaluated 1-mm-thick MDCT images in multiple planes to search for reliable perforators accurately. Methods Between July 2010 and October 2011, 19 consecutive patients (13 males, 6 females) who underwent MDCT prior to TDAP free flap operations were enrolled in this study. Patients ranged in age from 10 to 75 years (mean, 39.3 years). MDCT images were acquired at a thickness of 1 mm in the axial, coronal, and sagittal planes. Results The thoracodorsal artery perforators were detected in all 19 cases. The reliable perforators originating from the descending branch were found in 14 cases, of which 6 had transverse branches. The former were well identified in the coronal view, and the latter in the axial view. The location of the most reliable perforators on MDCT images corresponded well with the surgical findings. Conclusions Though MDCT has been widely used in performing the abdominal perforator free flap for detecting reliable perforating vessels, it is not popular in the TDAP free flap. The results of this study suggest that multiple planes of MDCT may increase the probability of detecting the most reliable perforators, along with decreasing the probability of missing available vessels.

Pyogenic Granuloma: A Retrospective Analysis of Cases Treated Over a 10-Year

Background Pyogenic granuloma (PG) is a benign vascular lesion of the mucosa and skin. Recent studies of the epidemiology of PG are rare. We aimed to retrospectively analyze characteristics of PG cases in South Korea. Methods We reviewed the medical records of 155 patients treated for PG between March 2005 and May 2014. The male-to-female ratio was 1:1.2 (70 males, 85 females). The mean age of patients was 35.3 years. Results A high occurrence was observed in the first and third decades in males, and the fourth to fifth decades in females. There was a statistically significant difference between genders according to age group (p<0.05). The average lesion diameter was 0.84±0.46 cm (long axis). The most frequently involved site was the face (n=47). Bleeding was the primary complication (n=41). PG was mostly treated with excisional biopsy (n=74). The recurrence rate was 7.7% (n=12). Conclusion We concluded that most common site of PG was the face, the age of female with PG is higher than previous studies, and finger is associated with trauma more than other sites. The most recent epidemiological information on PG of this study will support the treatment and diagnosis of PG and future research objectives.

Reconstruction of severe medial orbital wall fractures using titanium mesh plates by the pericaruncular approach

Abstract Medial orbital wall fractures can cause severe aesthetic and functional complications, if not treated properly. The aim of this study was to prospectively evaluate the use of titanium mesh plates inserted through the pericaruncular approach for the treatment of medial orbital wall fractures. Between 1 July 2010 and 1 January 2013, a total of 17 patients with large medial orbital wall defects were treated. All of the large bony defects were treated using titanium mesh plates inserted through the pericaruncular approach. All patients had anatomically correct orbital wall reconstruction as accessed by immediate postoperative computed tomography scan. One patient with large bony defects presented with diplopia after the primary procedure. Re-operation was needed for correction. After surgery, the diplopia was corrected. In all patients, postoperative morbidity was minimal and cosmetic results were excellent. Titanium mesh may be a valuable material for the reconstruction of severe medial orbital wall defects. Its advantages include excellent structural support, shorter operative time, and ease of being moulded into the desired shape. The pericaruncular approach may allow for or give direct access to the medial orbital wall and orbital apex without any cutaneous incision or disruption of the medial canthal ligament, and insertion of titanium mesh plates is possible under direct vision. It is proposed that this technique could be advantageous in the reconstruction of severe medial orbital wall fractures.

Augmentation Genioplasty Using Double Folded Dermal Graft.

Introduction:The chin is a very important aesthetic subunit of the face. The diverse materials and methods for chin augmentation can be classified according to autologous tissues and artificial ones. Among them, reports on the effectiveness of dermal graft for chin augmentation are scarce. The authors report on our new techniques and surgical results regarding chin augmentation using a dermal graft. Patients and Methods:From July 2010 to January 2013, the authors performed supraperiosteal chin augmentation using a double folded dermal graft for 58 patients (15 men and 43 women; range of age: 20–45, average was 29.4). Periodic sonography was performed routinely to measure the change of thickness of the dermal graft (preoperative, postoperatively 1, 6, and 12 months). Results:Thickness of the survived dermal graft was 8.33 ± 1.21 mm and 7.99 ± 1.19 mm at postoperative 6 and 12 months separately. Statistics showed that the average resorption rate was 32.17% (SD = 10.99) at postoperative 6 months and 34.93% (SD = 10.74) at postoperative 12 months. Of 56 patients 54 (2 patients were excluded from the study) did not request additional surgery during the 3-year follow-up period and showed a high level of satisfaction with the surgical results. Conclusions:The authors consider that our unique design and surgical techniques of double folded dermal graft have many advantages and provide consistent evidence-based results to meet patients’ desire for a natural appearance after chin augmentation, particularly patients who refuse to get artificial implants.

Trichoblastic Carcinoma Arising from a Nevus Sebaceous

Nevus sebaceous is a hamartoma of the cutaneous structures that often presents at birth and typically involves the face and scalp. Nevus sebaceous is frequently complicated by the development of a variety of other benign or malignant neoplasms. The most frequently reported benign neoplasms are trichoblastoma and syringocystadenoma papilliferum. Malignant tumors are much less frequently observed in association with nevus sebaceous and include basal cell carcinoma, squamous cell carcinoma, sebaceous carcinoma, and others [1]. However, no previous reports have described trichoblastic carcinoma occurring secondarily to nevus sebaceous. We report a case of malignant trichoblastoma that arose from nevus sebaceous of the scalp in a 38-year-old woman.

A Comparison Between K-Wire Splinting and Intranasal Gauze Packing in Nasal Bone Fracture.

Background:The aim of this study was to compare the outcomes between Kirschner wire (K-wire) splinting and intranasal packing. Methods:The authors performed a retrospective and comparative analysis of subjective patient discomfort and objective postoperative computed tomography (CT) imaging after closed reduction for treating type II and type III nasal bone fractures from April 2010 to April 2013 in 2 groups, 1 with K-wire splinting and 1 with intranasal packing. Results:Complaints of nasal obstruction, dry mouth, loss of appetite, and sleep disturbance were significantly less in K-wire group. Mean scores for concerns about aesthetics/postoperative asymmetry did not differ significantly between groups. There was no significant difference in accuracy of reduction and support provided to the reduced nasal bones between groups. Conclusions:The K-wire fixation can be considered a reliable and useful immobilization method for treating type II and type III nasal bone fractures.

Traumatic Carotid-Cavernous Sinus Fistula in a Patient with Facial Bone Fractures

Carotid-cavernous sinus fistulas (CCFs) are abnormal connections between the cavernous sinus and the carotid arterial system (the internal carotid artery, external carotid artery, or both). CCFs may be classified as spontaneous or acquired and as direct (high blood flow) or dural (low blood flow) [1]. Direct CCFs represent 70% to 90% of all CCFs, and mostly result from head trauma, especially basal skull fractures [2]. Patients with CCFs may present with signs and symptoms such as conjunctival chemosis, decreased vision, proptosis, diplopia, orbital pain, audible bruits, headache, and blindness [2,3]. In this report, we present the case of a 49-year-old man with a CCF and ophthalmic symptoms, resulting from a left zygomaticomaxillary complex fracture.