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하성윤,강진성,한기환 大韓成形外科學會 1996 Archives of Plastic Surgery Vol.23 No.3
The ability to judge soft tissue changes of the nose and to predict how they will respond to changes of the underlying structure, may be the surgeon's greatest asset in achieving consistently good results in a wide range of augmentation rhinoplasty. This retrospective study was undertaken to investigate soft tissue thickness changes and soft tissue response rates following the augmentation rhinoplasty. Forty patients having augmentation rhinoplasty with the authors' prefabricated custom made soft silicone implants, with a mean follow-up time of 25 months, were included in this study. The tracings of the outline of preoperative cephaloxerograms were superimposed on the postoperative ones, and the thicknesses of preoperative and postoperative soft tissue and implant thicknesses were measured. Preoperatively, the soft tissue was thickest over the zone 1 (nasion) and zone 2 (sellion or median), and was a similar thickness over the other zones. The soft tissue thickness became thicker over nasion, sellion, proximal bridge, and rhinon and became thinner over the zone 6 (nasal tip) and the zone 7 (lobule) following augmentation. The soft tissue response rate to the nasal implant was measured in eight different zones: 82.0 percent and 69.0 percent at zones 6 and 7, and approximately 100 percent at zones 3, 4, and 5. In short, the nasal tip and lobule had the lowest soft tissue response rate to the implant and became thinner following augmentation rhinoplasty. We recommend that augmentation rhinoplasty using custom made silicone implants having their nasal tips covered with autogenous or allogeneic tissues is not only an effective way to overcome the lowest response rate to the implant and postoperative thinning over the nasal tip but is also helpful in preventing the extrusion of the implant.
가토의 두개안면골봉합선의 견고한 고정이 골성장에 미치는 영향
하성윤,한기환,강진성 大韓成形外科學會 1998 Archives of Plastic Surgery Vol.25 No.7
Plate and screw fixation has had a profound effect on the recent development of craniofacial surgery. Rigid fixation of the facial skeleton by using plate and screw has become routine in adults, many craniofacial surgeons have expanded its use to the pediatric patient. The effects of microplate and screw fixation on subsequent craniofacial growth, however, have not been qualified in infancy and childhood. Sixty white male rabbits, 4 weeks old and weighing 400 gm, were divided into 5 groups. Each group contains 12 rabbits. Group 1 was control and group 2 was sham. They operated periosteal elevation to the right of the midline over the nasal and frontal bone. Group 3: 2-hole microplate and screws were placed in the right nasofrontal suture. Group 4: 2-hole microplate and screws were placed in the right nasomaxillary suture. Group 5: microplates and screws were placed in the right nasofrontal and nasomaxillary suture. All rabbits were killed at 18 weeks postoperatively. We analyzed the changes in morphology to the result of differences in growth between the operated and unoperated group by direct osteometry on dry skull preparations, and the structures of the constrained suture were analysed under light microscopy. Periosteal elevation alone (sham group) showed no discenible change in the shape of craniofacial bone except localized periosteal thickening. Nasofrontal suture plating showed periosteal thickening and bony resorption around the plate, nasal flattening of plated side, an increase in the width of the nasal bone on the plated side, a slight nasal deviation (mean 2.0 degrees) to the plated side, and frontal displacement of microplate and screws. Nasomaxillary suture plating showed periosteal thickening and bony resorption around the plate, nasal flattening of plated side, a decrease in the width of the nasal bone on the plated side, and nasal displacement of microplate and screws. Nasofrontal and nasomaxillary suture plating showed periosteal thickening and bony resorption around the plate, nasal depression of plated side, a decrease in the width of the nasal bone on the plated side, a significant nasal deviation (mean 5.2 degrees) to the plated side, and frontal and nasal displacement of microplates and screws. The findings of this study show that the use of microplate and screw fixation of the growing craniofacial skeleton in the rabbit model leads to little evidence of localized growth retardation. But their use in the pediatric population should be viewed cautiously, because secondary growth disturbances can be produced with the use of these fixation devices. Careful observation of early and late growth is mandatory when microplates are used in the pediatric patient. It is recommended that the plates and screws are removed as soon as possible their bony union.