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Combined mandibular angle resection with angle-splitting ostectomy (ASO) is more effective than conventional simple or multistaged ostectomy. Removal of the outer cortex of the mandibular body by ASO lessens the protuberance of the masseter muscle. In this study, the anatomy of the mandibular canals in seven human cadavers was studied in detail, and a guideline for ASO and mandibular angle ostectomy was set up so as to avoid injury to the inferior alveolar nerve. The most vulnerable area of the inferior alveolar nerve is the line from the gonion (G) to the junction (O) of the intersecting vertical line along the anterior border of the ramus and the horizontal line on the alveolar crest because of the thin anterior distance (AD) between the buccal surface of the mandible and the outer wall of the mandibular canal. The resection line should not be above 17.5 mm at the GO line to ensure a safe inferior distance, the distance between the inferior border of the mandible and the floor of the mandibular canal (21.6 +/- 4.1 mm). The body of the mandible was less vulnerable to injury to the inferior alveolar nerve in ASO because of the relatively thicker AD at the second molar (8.3 mm) and first molar (6.8 mm). Pilot surgery was performed in five cadavers. The lateral cortex was safely split off, avoiding injury to the inferior alveolar nerve, and angle ostectomy was then done. This method was applied in two clinical cases without any complications. The "split ostectomy of mandibular body and angle reduction" is a new and safe method of avoiding the injury to the inferior alveolar nerve.

Xanthelasma palpebrarum is the most common cutaneous xanthoma. It is most often around the medial side of the eyelids, and typically presents in middle-aged and older adults [1]. A case of bilateral extensive xanthelasma palpebrarum that involves the entire upper and lower eyelids, resembling a pair of circles, has not been reported. A 53-year-old female visited our department complaining of bilateral circular yellowish skin lesions around the upper and lower eyelids (Fig. 1). The lesions started to appear one year prior to admission at the medial aspect of the upper and lower eyelids and spread to the lateral sides. The patient complained that she felt inconvenienced or that opening her eyelids felt somewhat heavy and worried about the cosmetic appearance. Based on the clinical manifestation alone, the diagnosis of xanthelasma palpebrarum could be made. The patient was otherwise healthy, and her medical history was noncontributory. She had no history of using medication for hyperlipidemia or cardiovascular disease. Her parents had no history of xanthelasma palpebrarum. She had seven siblings. No one in her family had used medication for cardiovascular diseases such as hypertension, hyperlipidemia, or diabetes. Among them, only one sister had experienced xanthelasma palpebrarum, which had been limited to the medial side of the upper eyelid, and she had been treated with laser ablation in a local dermatology clinic. Fig. 1 Preoperative view. A 53-year-old female presented bilateral circular yellowish skin lesions around the upper and lower eyelids. On physical examination, the yellowish flat lesions involved both the upper and lower eyelids, resembling a pair of circles. The lesions of the medial side of both of the upper eyelids were especially large and the other sides were linear and curved. The sizes (horizontal length × largest longitudinal height) were: 35×8 mm (right upper eyelid); 40×9 mm (left upper eyelid); 30×5 mm (right lower eyelid); and 50×5 mm (left lower eyelid). There was no limitation of the extraocular muscle movement. Laboratory tests were evaluated before surgery. The total cholesterol, high-density lipoprotein cholesterol, and triglyceride levels were 255 mg/dL (range, 120 to 220 mg/dL), 52 mg/dL (range, 35 to 88 mg/dL), and 109 mg/dL (

A prominent mandibular angle is considered to be unattractive in Asian countries because it gives the face a square and muscular appearance. Successful correction by angle ostectomy has been reported, but one of the serious complications of angle reduction ostectomy is fracture of the mandibular condyle. If the ostectomy line is misdirected vertically, the condyle may be fractured. The authors experienced two cases of condylar fracture during angle reduction. Case 1 was a pulled-out condylar fracture, where an L-shaped miniplate was then attached by external approach, and intermaxillary fixation (IMF) with arch bar was used on postoperative day 14. With release of the IMF, a systematic approach for a jaw-opening exercise was begun. On postoperative day 21, the elastics were placed to assist in guiding protrusion of the mandible anteriorly 24 hours a day. After postoperative day 28, it was possible to completely abandon daytime elastic fixation. The exercise was modified to lateral movement. Case 2 was green-stick condylar fracture, with the IMF with arch bar applied on postoperative day 10. After releasing the IMF, the exercise involved the daily use of several tongue blades, and range of motion increased by wedging additional blades until postoperative day 21. More aggressive stretching was continued with 22 blades on postoperative day 28. On the removal of the arch bar, the occlusion was stable and followed by more aggressive stretching and physical therapy. Both cases were successfully restored and had good results. The authors believe the exercise protocols and algorithms they used may serve as a standard procedure of treatment in condylar fracture caused by angle ostectomy.

Transient diplopia, blepharoptosis, or both conditions are rare postoperative complications of blepharoplasty performed with the patient under local anesthesia. It has been hypothesized that some cases of postoperative diplopia and blepharoptosis could be attributed to the myotoxic effects of local anesthetics to the extraocular muscles and the levator muscle or to the neurotoxic effects of lidocaine. In 30 cadavers, the superior division of the oculomotor nerve was severed en bloc 1.5 cm anterior to the annulus of Zinn with the levator palpebrae superioris (LPS) and the superior rectus muscles. These muscles were detached from their origins, and their attachments to the scleral and tarsal plates were divided respectively. The specimens were treated in guanidine–hydrochloride and Alizarin Red solution, and were dissected under an operating microscope. The nerve branches of the superior division of the oculomotor nerve innervated the proximal third (type I) in 2 of 30 LPS muscles (6.7%), in 8 of 30 muscles (26.7%) extended to the middle third (type II), and reached the distal third (type III) in 20 of 30 muscles (66.7%). The terminal branches ran through the medial third (type IIIa) in 6 of 20 type III LPS muscles (30%), the central third (type IIIb) in 8 muscles(40%), and the lateral third (type IIIc) in 6 muscles (30%). The oculomotor nerve ends that extend forward to the distal third of the LPS muscle (type III) are exposed and vulnerable to local anesthetics and may be numbed during blepharoplasty. If this is so, postoperative blepharoptosis may be caused by transient paralysis of the LPS muscle, and great care should be taken during the injection of local anesthetics near the LPS. Hwang K, Lee DK, Chung IH, Lee SI. Patterns of oculomotor nerve distribution to the levator palpebrae superioris muscle, and correlation to temporary ptosis after blepharoplasty. Ann Plast Surg 2001;47:381–384

This study aimed to investigate pertinent arterial supplies of masseter muscle to prevent fatal hemorrhage in resection of masseter muscle and/or mandibular angle ostectomy. Fifty-three postmortem cadavers of Koreans were used for the work. Color latex was injected into the arteries to outline 17 of 53 specimens. We found that an artery branches off the external carotid artery and enters the masseter muscle at the midpoint of its posterior margin 31 mm above the gonion. We termed this the middle masseteric artery. The middle masseteric artery is divided into superficial and deep branches. The deep branch of the middle masseteric artery travels deep in the muscle close the periosteum of the mandible in 94% of cases. The average diameter is 1.23 +/- 0.26 mm. A small artery with 1.23-mm diameter is enough to cause massive bleeding if severed. The deep branch of the middle masseteric artery is vulnerable in such procedures as resection of the masseter muscle and/or ramus and angle of the mandible.

Ectropion or scleral show resulting from weakness of the lower eyelids is not uncommon after lower blepharoplasty or midface lift via blepharoplasty incision. Denervation of the pretarsal orbicularis oculi muscle (OOM) attributes to such complications. The authors analyzed 102 patients who underwent midface lift via lower blepharoplasty incision for the past 3 years and investigated the motor nerve innervation of the lower OOM in 20 cadavers. They encountered two cases of ectropion attributed to the denervation of the pretarsal OOM: one with dry-eye syndrome and scleral show, and the other with a "polar bear-like appearance" (i.e., outer eversion of the lower eyelid). All pretarsal and preseptal OOMs were innervated by five to seven terminal twigs of the zygomatic branches of the facial nerve that approached the muscle at a right angle. The medial portion of the lower OOM was innervated by one to two terminal twigs of the buccal branch, and the middle portion was innervated with two to three twigs of the zygomatic branch. The lateral portion was supplied by the uppermost zygomatic branch, which split into two to four twigs. The mean horizontal distance between the lateral canthus and the zygomatic branch was 2.31 +/- 0.29 cm (range, 1.7-2.7 cm) and the vertical distance was 1.20 +/- 0.20 cm (range, 0.8-1.5 cm). The critical zone was a circle with 0.5-cm radius, and its center was located 2.5 cm inferolaterally (30 deg) from the lateral canthus. It is very important to understand the motor nerve innervation of the lower eyelid and the "critical zone" to avoid postoperative ectropion or weakness of the lower eyelid resulting from paralysis of the pretarsal or preseptal OOM.

This study aimed to clarify the relation between the anatomical variations of the pterygomaxillary region and fracture of the pterygoid plate during Le Fort I osteotomy. We present a secure method to separate maxillary tuberosities from pterygoid plates without injuring the pterygoid plates. Thirty specimens of hemisection of Korean skulls were used for the study. The maxilla was sectioned transversely on the floor of the pyriform aperture and posteriorly to the lateral pterygoid plate with a mechanical saw. The section was 5 to 6 mm above the tooth roots. The pterygomaxillary junction was separated with a curved osteotome in two steps: initially with light tapping of the shallow groove 2 to 3 mm anterior to the pterygomaxillary fissure at a half right angle and then changing the course of forceful tapping to more than 60 degrees. The maxillary tuberosity separated from the medial and lateral pterygoid plates during the procedure was grouped into the "disjunction group" (24 of 30, 80%) and the pterygoid plates fractured were grouped into the "fracture group" (6 of 30, 20%). The thickness of the pterygomaxillary region (T) was significantly greater in the disjunction group than in the fracture group (P = 0.034). The concavity of the pterygomaxillary fissure (C) was significantly deeper in the disjunction group than in the fracture group (P = 0.020). There was no significant difference of width of the pterygomaxillary fissure between the disjunction group and the fracture group (P = 0.169). The thin pterygomaxillary region and less concave pterygomaxillary fissure on the preoperative computed tomography scan draw precautionary attention to vulnerable pterygoid plates fractured in the procedure of Le Fort I osteotomy.

We propose a novel simulation method for modeling the game of golf using SystemC, a system description language that allows modeling of a concurrent system's behavior. Utilizing the proposed simulator, we compare different outing formats of golf, namely, regular and shotgun, in terms of playing time. Our simulation results reveal that the shotgun format can take longer than the regular format if the number of groups in a golf course exceeds 33 for the scenario we tested, confirming the belief that the shotgun format can take longer than the regular format. We also justify our simulation by comparing the simulation and analytical results.

The authors report a case of uncommon neurilemmoma on the tip of the tongue. A 23-year-old Korean man presented with a mass on the tip of the tongue, which was noted first 3 years before, when it was a small nodule. The mass had been growing slowly. Physical examination revealed a firm, not-tender, oval, elevated, protruded, red mass on the right side tip of the tongue. It measured 2 x 2 cm. The lesion was well capsulated and separated easily. A complete excision was done, and the wound was closed primarily. Histopathologic examination revealed an encapsulated spindle cell tumor, of which two types of the tissue were clear. A small and slow-growing mass in the tongue with positive history of tongue bite is first suggestive of neurilemmoma, as well as neurofibroma, lingual cyst, and minor salivary gland tumor.

An 18-year-old man had a melanocytic nevus on the chin that had been treated with three different lasers at a private clinic for 2.5 years. This lesion was excised and sent to a pathologist. The initial histological diagnosis was reported as compound nevus coexistent with changes suspicious of malignant melanoma. The reevaluation of histology together with the clinical information that the lesion had been pretreated with laser resulted in a revised diagnosis of pseudomelanoma. It is important to be aware of this benign pseudomelanoma, which can arise as a complication of laser therapy, to avoid subjecting patients to unnecessary surgical procedures or other forms of adjuvant treatment.

We report on a case of leakage and migration to the upper abdomen of an unknown injected material that was used for breast augmentation. It was revealed to be prolamin by Fourier transform infrared (FTIR) analysis and pyrolysis gas chromatography/mass spectrometry (PY-GC/MS). A 35-year-old woman who had undergone mammary augmentation by transaxillary injection 8 years previously presented with a decreased size of her left breast and a palpable mass in the left upper quadrant (LUQ). Mammogram and ultrasonography showed multiple dense masses and several hypoechoic areas, respectively. Abdominal ultrasound showed a hypoechoic lesion between the subcutaneous layer and the abdominal wall muscles. When the left breast and the lump in the LUQ were explored, 90 and 160 cc of yellow, sticky, granular gel gushed out. FTIR analysis and PY-GC/MS were used to investigate the component of the removed gel. When this gel was analyzed by FTIR with the transmittance mode, intensity bands appeared at 3295.2 (NH2), 2927.2 (CH), 1650 (C=C), 1544.6 (C–C), and 1403.1 (C–N) cm−1. The result showed a 93.84% match with purified zein, a 91.19% match with zein from corn, and a 90.27% match with poly(N-methyl acrylamide). FTIR with the attenuated total reflectance (ATR) mode revealed that the gel matched with wheat gluten flour. Based on the result of PY-GC/MS, the gel was suspected to be protein. This is the first such report on performing chemical analysis of a leaked injected gel from human breast implantation. The removed gel from the breast augmentation was revealed to be prolamin, which is a cereal seed storage protein. We think FTIR might be a useful tool for analyzing and confirming extracted materials that were previously injected to the body.

This article describes a simple, new surgical technique to provide a complete two-layer closure of palatal defect resulting from a surgical complication of trans palatal resection of skull base chordoma. The nasal layer was reconstructed with triangular shape oral mucoperiosteal turn over hinge flap based on anterior margin of palatal defect and rectangular shaped lateral nasal mucosal hinge flaps. The oral layer was reconstructed with conventional pushback V-Y advancement 2-flaps palatoplasty. Each layer of the flaps were secured with two key mattress suture for flap coaptation. This technique has some advantages: simple, short operation time, one-stage procedure, no need of osteotomy. It can close small- to medium-sized palatal defect of palate or wide cleft palate and can prevent common complication of oronasal fistula, which could be caused by tension.

The problem of RNA genomes packaged inside spherical viruses is studied. The viral capsid is modeled as a hollowed sphere. The attraction between RNA molecules and the inner viral capsid is assumed to be non-specific and occurs at the inner capsid surface only. For small capsid attraction, it is found that monomer concentration of RNA molecules is maximum at the center of the capsid to maximize their configurational entropy. For stronger capsid attraction, RNA concentration peaks at some distance near the capsid. In the latter case, the competition between the branching of RNA secondary struture and its adsorption to the inner capsid results in the formation of a dense layer of RNA near capsid surface. The layer thickness is a slowly varying (logarithmic) function of the capsid inner radius. Consequently, for immediate strength of RNA-capsid interaction, the amount of RNA packaged inside a virus is proportional to the capsid {\em area} (or the number of proteins) instead of its volume. The numerical profiles describe reasonably well the experimentally observed RNA nucleotide concentration profiles of various viruses., Comment: 5 pages, 2 figures. Abstract, introduction rewritten. Comparison to actual virus profiles added. Submitted to PRL

The authors report two cases of blepharoptosis caused by compression of the levator muscle by fractured orbital roof fragment; both were improved by surgical treatments. In one case, because neurosurgeons were concerned with the contusional hemorrhage of the right frontal lobe during the early admission period, they missed the orbital roof fracture. The patient underwent surgery on the 18th post-trauma day. In the other case, the early diagnosis was made, and the surgical treatment were performed on the 10th post-trauma day. The authors think if the blepharoptosis is not improved in several days and the fractured fragment is suspected to compress the levator in computed tomography scan, surgical decompression is necessary and should be performed as soon as possible.

Plump and muscular calves, a so-called radish-like leg, embarrass young women and cause a feeling of inferiority in Korea. Damage to motor nerves innervating a muscle makes the muscle paralyzed and dystrophic, with loss of muscle volume. The authors studied the morphometry of the motor branches of the tibial nerve innervating the gastrocnemius and soleus muscle and sensory medial sural cutaneous nerve in popliteal fossa. Dissection and exploration of the tibial nerve were performed in the popliteal fossae of 70 legs (of 18 males and 17 females) of embalmed Korean cadavers. The main branch of the tibial nerve innervating medial and lateral gastrocnemius muscle originated 3 cm above and below the popliteal crease. The medial gastrocnemius muscle had an additional nerve (49%). The medial sural cutaneous nerve came off the nerve into the medial gastrocnemius muscle (30%) and diverged 5.5 mm from the tibial nerve. The nerve into the soleus muscle originated from the nerve innervating the lateral gastrocnemius muscle (30%) and was 12.3 mm away from it. Surgeons should keep in mind that the medial sural cutaneous nerve originates from the nerve to medial gastrocnemius in 30% and the nerve to soleus muscle originates from the nerve to lateral gastrocnemius in 30%.

Successful survival and growth of autogenous cartilage graft has been well proved in the experimental studies of Dupertuis and Peer. However, it is still unknown whether multilayer cartilage graft has the same survival and growth as a single-layer graft. The authors studied any difference of survival and growth rate between single and multilayer cartilage grafts in rabbits. Single, double, and triple layers of autogenous cartilage grafts were inserted into three separate pockets in a single rabbit ear. The three grafts were left in place for 6 months. They performed this procedures in 10 rabbit ears. Proliferating activity of chondrocytes was measured with a method of proliferating cell nuclear antigen immunolabeling. The authors found that there were more proliferating cell nuclear antigen-positive cartilage cells in the graft than in the host bed, but no difference in weight and thickness of the graft among the three groups.

Roberts-SC phocomelia syndrome (RS) is an autosomal recessive disorder of symmetric limb defects, craniofacial abnormalities, pre- and postnatal growth retardation, and mental retardation. Patients with RS have been reported to have premature separation of heterochromatin of many chromosomes and abnormalities in the cell-division cycle. No case has been reported who had normal intelligence and normal cell division with typical clinical features of the RS. We report a case of a six-year-old male of clinical and radiologic findings of typical RS with normal cell division and normal intelligence. Although he showed growth retardation, his intelligence was normal. Van Den Berg and Francke later reported that 79 out of 100 cases of Roberts syndrome had premature cell separation (PCS). We think that this case may demonstrate severe expression of the Roberts syndrome even though PCS is not exhibited. The limb involvement of this case was symmetrical, and he showed phocomelia of upper limbs, equinus valgus deformity of ankle, aplasia of fibula, and shortness of fifth toes while his hands and feet were normal with 5 rays each. Craniofacial abnormalities of this case were typical; he showed scaphocephaly, mild hypertelorism, mandibular hypoplasia, dysplastic helix of ear, narrowing of external auditory canal, and cleft palate with wide gap. This report supports the theory that normal intelligence can make social-personal adjustment possible even if all of the stigmata of Roberts syndrome is present.

Our exploration disclosed 17 (40%) stranded muscles of 42 hemifacial specimens of Korean cadavers. We name this distinct muscle "Orbitozygomatic Muscle (OZM)" that is either an aberrant orbicularis oculi muscle or a separate muscle. A triangular space bounded superiorly by the lowest edge of the orbicularis oculi muscle (OOM), laterally by Zygomaticus Minor, and inferiorly by OMZ gives way to neurovascular bundle and suborbicularis oculi fat pad (SOOF).

The authors report a typical case of tenosynovial giant cell tumor of the right middle finger of a 31-year-old man. Histologically, this tumor is characterized by a discrete proliferation of rounded synovial-like cells accompanied by a variable number of multinucleated giant cells, inflammatory cells, and xanthoma cells. Clinicopathologically, this tumor is a benign lesion that nonetheless possesses a capacity for local recurrence. Local excision with a small cuff of normal tissue is the treatment of choice in this tumor.

The iliac bone is one of the most common donor sites for bone graft. Despite such potential and clinical usefulness, the anthropometric data on the iliac bone are lacking. The purpose of this study is to construct a thickness map that provides the mean iliac bone thickness of its various points and their differences. We studied 58 hip bones (from 23 males and 35 females) from Korean adults. We measured the iliac bone thickness at 26 points, which were positioned at regular intervals on each given iliac bone, using a Techlock GM 21 caliper gauge. The mean thickness of each measuring point of the male and the female, and of the right and the left, was compared with each other through paired t-test; the measurements did not differ significantly. From the anteriorposterior perspective, the region between anterior superior iliac spine (ASIS) and iliac tubercle was relatively thick. However, it became progressively thinner before it reached the sacroiliac articulation. It became thicker again toward the posterior superior iliac spine (PSIS), the thickest area. From the superoinferior perspective of superior iliac crest and inferior acetabulum, the thickness became inferiorly thinner in the anterior part between ASIS and iliac tuberosity. However, in the posterior part between the sacroiliac joint and PSIS, there was no significant difference of thickness. We hope that our thickness map can serve as a practical guide to the choice of an ideal site of the iliac bone for bone graft to obtain desired thickness.

www.kcpca.or.kr ISSN 2287-1152 76 Copyright © 2012 The Korean Cleft Palate-Craniofacial Association This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/ licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 두피에 발생한 거대 피지샘 상피종 1례