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Background: The inferior temporal septum (ITS) is a fibrous adhesion between the superficial temporal fascia and the superficial layer of the deep temporal fascia. This study identified detailed the anatomical relationship between the ITS and the temporal branch of the facial nerve (TBFN) for facial nerve preservation during temple interventions., Methods: Among 33 Korean cadavers, 43 sides of TBFNs in temporal regions were dissected after identifying the ITS between the superficial temporal fascia and superficial layer of the deep temporal fascia through blunt dissection. The topography of the ITS and TBFN were investigated with reference to several facial landmarks. Regional relationships with the ITS and TBFN within the temporal fascial layers were histologically defined from five specimens., Results: At the level of the inferior orbital margin by the tragion, the mean distances from the lateral canthus to the anterior and posterior branches of the TBFN were 5 and 6.2 cm, respectively. At the lateral canthus level, the mean distance from the lateral canthus to the posterior branch of the TBFN was similar to that to the ITS, at 5.5 cm. At the superior orbital margin level, the posterior branch of the TBFN ran cranial to the ITS adjacent to the frontotemporal region. The TBFN ran through the subsuperficial temporal fascia layer and the nerve fibers located cranially, and within the ITS meshwork in the upper temporal compartment., Conclusion: The area of caution during superficial temporal fascia interventions related to the TBFN was clearly identified in the upper temporal compartment, which is known to lack important structures., (Copyright © 2023 by the American Society of Plastic Surgeons.)

Purpose: Nerve conduction study (NCS) is essential for subclassifying Guillain-Barré syndrome (GBS). It is well known that the GBS subclassification can change through serial NCSs. However, the usefulness of serial NCSs is debatable, especially in patients with early stage GBS., Methods: Follow-up NCS data within 3 weeks (early followed NCS, EFN) and within 3 to 10 weeks (late-followed NCS, LFN) were collected from 60 patients with GBS who underwent their first NCS (FN) within 10 days after symptom onset. Each NCS was classified into five subtypes (normal, demyelinating, axonal, inexcitable, and equivocal), according to Hadden's and Rajabally's criteria. We analyzed the frequency of significant changes in classification (SCCs) comprising electrodiagnostic aggravation and subtype shifts between demyelinating and axonal types according to follow-up timing., Results: Between FN and EFN, 33.3% of patients with Hadden's criteria and 18.3% with Rajabally's criteria showed SCCs. Between FN and LFN, 23.3% of patients with Hadden's criteria and 21.7% with Rajabally's criteria showed SCCs, of which 71.4% (Hadden's criteria) and 46.2% (Rajabally's criteria) already showed SCCs from the EFN. The conditions of delayed SCCs between EFN and LFN were very early FN, mild symptoms at the FN, or persistent electrophysiological deterioration 3 weeks after symptom onset., Conclusions: A substantial proportion of patients with GBS showed significant changes in neurophysiological classification at the early stage. Serial NCS may be helpful for precise neurophysiological classification. This study suggests that follow-up NCSs should be performed within 3 weeks of symptom onset in patients with GBS in whom FN was performed within 10 days of symptom onset., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2022 by the American Clinical Neurophysiology Society.)

Background: Deep circumflex iliac artery osteocutaneous flap transfer has frequently been applied to large defects in the maxillary and mandible regions, but the use rate has decreased gradually because of the complicated anatomy of the deep circumflex iliac artery. This study investigated the comprehensive anatomy of the deep circumflex iliac artery in relation to flap surgery with the aim of providing navigational guidelines for safe deep circumflex iliac artery harvesting., Methods: Sixty-two sides of the hemi-abdominal wall were dissected in fixed Korean cadavers. Several dimensions of the deep circumflex iliac artery and its positional relationships with surgical landmarks were measured, and the patterns of the arterial supply and anastomosis were identified., Results: The mean distance between the anterior superior iliac spine and the lateral border of the femoral artery was 57.5 mm. The deep circumflex iliac artery generally originated almost at the same level as the inguinal ligament, and its highest level was 14.8 mm superior to that ligament. Emerging points of the ascending branch were observed both medial and lateral to the anterior superior iliac spine, but no transverse branch pierced the transversus abdominis muscle medial to the anterior superior iliac spine., Conclusions: The incision line for safe deep circumflex iliac artery harvesting was parallel and 2 cm superior to the inguinal ligament and 6 cm from the anterior superior iliac spine. This position of the safe incision line can be easily determined using the thumb. Sex differences in the incidence of the deep circumflex iliac artery originating above or below the inguinal ligament will be another useful guide for easily detecting the deep circumflex iliac artery.

Purpose: The aim of the study was to elucidate the positional relationship of the ethmoidal foramens (EFs) with reference to the nasion to facilitate prediction of the exact location of EFs, the optic canal (OC), and the frontoethmoidal suture (FS), and thereby avoid complications during complex surgery involving the medial wall of the orbit., Materials and Methods: One hundred two intact orbits of 57 embalmed cadavers were dissected in this observational anatomic study. Nasion' (N') was defined as the intersection point of the medial orbit margin with the horizontal line through the nasion, and this was used as a reference point. N'-OC was defined as the straight line joining N' and OC. The locations of the anterior ethmoidal foramen (AEF), posterior ethmoidal foramen (PEF), and OC were determined with reference to N'. The vertical distances from N'-OC to EFs and to FS were also determined., Results: The N'-AEF, AEF-PEF, and PEF-OC distances were 18.4, 15.3, and 8.3 mm, respectively. Vertically, AEF and PEF were situated at 0.2 mm below and 0.4 mm above N'-OC, respectively. At the same reference points, N'-OC was situated at 0.4 and 0.6 mm above FS, respectively., Conclusions: N', AEF, PEF, and OC were considered to be situated on the same straight line, and N'-OC could be regarded as coinciding with FS. This means that N' is an easily identifiable and reliable landmark for identifying EFs, OC, and FS. Our navigational parameters with reference to N' will help surgeons to enhance the safety of orbital surgery.

Background and Purpose: Fluid-attenuated inversion recovery vascular hyperintensities (FVHs) are seen in some cases with cerebral hemodynamic impairment and collateral flow. Because the worst outcomes of patients with borderzone infarcts were mainly correlated with impaired hemodynamics, the presence of FVH might provide another clue for predicting the prognosis of patients with borderzone infarcts., Methods: We reviewed 1377 consecutive patients with ischemic stroke. Cortical borderzone (CBZ) and internal borderzone infarcts were selected based on diffusion-weighted imaging. FVHs were defined as tubular- or serpentine-shaped hyperintensities in the subarachnoid space. We investigated the clinical significance of FVHs in borderzone-infarcted patients., Results: Among 87 patients with borderzone infarcts, the presence of FVH was observed in 30 (34.5%). We identified 62 patients with CBZ infarcts and 25 patients with internal borderzone infarcts. In the cases with CBZ infarcts, the initial National Institutes of Health Stroke Scale scores and the portions of nonfavorable outcome at 3 months in the FVH(+) group were significantly higher than in the FVH(-) group (P<0.05 and P<0.001, respectively). Unlike the cases with CBZ infarcts, there were no significant differences of these clinical features between the FVH(+) group and the FVH(-) group in the patients with internal borderzone infarcts., Conclusions: The findings of FVH are associated with relatively severe clinical presentation and nonfavorable prognosis in patients with CBZ infarcts, but not in patients with internal borderzone infarcts. The presence of FVH may help to identify CBZ-infarcted patients who require close observation and hemodynamic control., (© 2016 American Heart Association, Inc.)

Objective: To categorize a syndrome manifesting as prominent acute bulbar palsy (ABP) without limb motor weakness as a variant form of Guillain-Barré syndrome (GBS) and differentiate it from Miller Fisher syndrome (MFS) and pharyngeal-cervical-brachial (PCB) variants., Methods: We analyzed cases of ABP without limb motor weakness based on a dataset containing clinical information and the results of antiganglioside antibodies assays for acute immune-mediated neuropathies., Results: Eleven cases with an age at onset ranging from 18 to 65 years (mean 33.8 years) were identified as ABP-plus syndrome. All of the enrolled cases manifested with ABP as the predominant symptom, and with no limb weakness. The following features accompanied ABP in order of decreasing frequency: ophthalmoplegia (n = 9, 82%), ataxia (n = 9, 82%), and facial palsy (n = 6, 55%). An enzyme-linked immunosorbent assay study disclosed that immunoglobulin G (IgG) anti-GT1a antibodies were the most frequent (n = 11), followed by IgG anti-GQ1b antibodies (n = 6)., Conclusions: We propose that ABP-plus syndrome without neck or limb weakness is a variant of GBS that is distinct from the MFS and PCB variants. The presence of IgG anti-GT1a antibodies can explain the relationships between the distinct clinical characteristics and the underlying pathomechanisms., (© 2015 American Academy of Neurology.)

The calculated electrophysiological parameters, such as terminal latency index (TLI), residual latency, modified F ratio, and F-wave inversion, have been investigated as a diagnostic tool for detection of early stage of carpal tunnel syndrome (CTS) in the literature. However, the correlation of these calculated electrophysiological parameters with the clinical severity of CTS has not been reported. The aim of this study was to determine the correlation of the calculated electrophysiological parameters and clinical severity in patients with CTS. A retrospective study was performed with 212 hands of 106 CTS patients. The CTS hands were classified as asymptomatic, mild, moderate, and severe according to the clinical severity. The distal motor latency and distal motor conduction velocity of median nerve, minimal F-wave latency of median and ulnar nerves, and sensory nerve conduction velocity in the finger-wrist and palm-wrist segment of median nerve (SNCV f-w and SNCV p-w) were obtained in a conventional nerve conduction study. The TLI, residual latency, and modified F ratio of the median nerve and the difference of minimal F-wave latencies between the median and ulnar nerves (F-diff M-U) were calculated. The distal motor latency, residual latency, and F-diff M-U were significantly increased according to the clinical severity of CTS. The motor conduction velocity, SNCV p-w, SNCV f-w, TLI, and modified F ratio were significantly decreased according to the clinical severity of CTS. In analyses of variance and Kruskal-Wallis test, we used the Scheffe test as a post-hoc comparison analysis. The TLI, F-diff M-U, and SNCV f-w showed a significant difference among all groups of each CTS severity. The sensitivity, specificity, and cut-off value of TLI, F-diff M-U, and SNCV f-w between asymptomatic and mild, mild and moderate, and moderate and severe CTS groups were calculated by using receiver operating characteristic curve analysis. The cut-off values of TLI, F-diff M-U, and SNCV f-w between the asymptomatic and mild CTS groups were, respectively, 0.33 millisecond, 0.3 millisecond, and 40 cm/second. The cut-off values of TLI, F-diff M-U, and SNCV f-w between mild and moderate were, respectively, 0.27 millisecond, 2.3 milliseconds, and 34.8 cm/second. The cut-off values of TLI, F-diff M-U, and SNCV f-w between moderate and severe CTS groups were, respectively, 0.20 millisecond, 4.2 milliseconds, and 26.4 cm/second. We found that calculated electrophysiological parameters of conventional nerve conduction study could be a good indicator to determine the severity of CTS.

Isolated rotational vertigo is most often associated with disorders of the semicircular canals, vestibular nerve, brainstem, or cerebellum but rarely observed following a supratentorial stroke. A 64-year-old man developed sudden onset of vertigo and horizontal right-beating nystagmus with a torsional component in primary and eccentric gazes, unsteady gait, and axial lateropulsion to the right side. Magnetic resonance imaging demonstrated an infarction in the posterior limb of left internal capsule, an unusual cause of the patient's signs and symptoms.

It is well known that facial beauty is dictated by facial type, and harmony between the eyes, nose, and mouth. Furthermore, facial impression is judged according to the overall facial contour and the relationship between the facial structures. The aims of the present study were to determine the optimal criteria for the assessment of gathering or separation of the facial structures and to define standardized ratios for centralization or decentralization of the facial structures.Four different lengths were measured, and 2 indexes were calculated from standardized photographs of 551 volunteers. Centralization and decentralization were assessed using the width index (interpupillary distance / facial width) and height index (eyes-mouth distance / facial height). The mean ranges of the width index and height index were 42.0 to 45.0 and 36.0 to 39.0, respectively. The width index did not differ with sex, but males had more decentralized faces, and females had more centralized faces, vertically. The incidence rate of decentralized faces among the men was 30.3%, and that of centralized faces among the women was 25.2%.The mean ranges in width and height indexes have been determined in a Korean population. Faces with width and height index scores under and over the median ranges are determined to be "centralized" and "decentralized," respectively.

Objectives: For the pediatric population, upper reference limits (URLs) for aminotransferase levels have not been established. The prevalence of high aminotransferase levels provides important information regarding the burden of liver disease in the current childhood obesity endemic., Methods: We set the URL of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) for participants ages 10 to 19 years (n = 2746) from the 2007 to 2009 Korea National Health and Nutrition Examination Survey at the 97.5th percentile of that population who were determined to be at low risk for liver disease (n = 1717; low risk was defined as testing negative for hepatitis B virus surface antigens, the absence of alcohol use disorder, having normal body mass index, and having normal lipid or carbohydrate metabolism)., Results: The URLs for ALT were 33 IU/L for boys and 25 IU/L for girls, and the corresponding limits for AST were 33 IU/L for boys and 28 IU/L for girls. The weighted prevalence of elevated ALT levels was 6.5% in the sample, 8.2% in boys and 4.5% in girls. The prevalence of elevated AST levels was 3.9% and had no sex differences. We also found that elevated ALT levels are associated with male sex, older age, obesity, and presence of abnormal lipid levels. Having elevated AST levels is associated with obesity, younger age, and exhibiting laboratory indicators of abnormal lipid metabolism., Conclusions: Aminotransferase URLs are being established for the first time, and our results may be useful in determining a baseline level for monitoring the secular trends of liver disease in future studies of adolescent populations.