Modified Lengthening Temporalis Myoplasty Involving an Extended Lazy-S Incision to Avoid Facial Scar Formation.

BACKGROUND: Lengthening temporalis myoplasty is a faster and less invasive alternative to free muscle transfer for smile reconstruction. However, it requires a nasolabial fold incision, which leaves a midfacial scar. Based on esthetic considerations, a modified approach, involving an extended lazy-S (parotidectomy) incision instead of a nasolabial fold incision, was developed. METHODS: A cadaveric study involving 10 hemifaces was conducted. From February 2013 to March 2016, the modified lengthening temporalis myoplasty procedure was employed in 10 patients. The results were graded from 1 (poor) to 5 (excellent) according to the Terzis grading system. The excursion of the oral commissure was also measured. RESULTS: The extended lazy-S incision provides easy and safe access to the coronoid process and good visibility. The patients' mean age was 56.5 years, and the mean duration of the postoperative follow-up period was 22.2 months. The patients' underlying conditions included acoustic neuroma (n = 2), Bell palsy (n = 3), congenital conditions (n = 2), brain infarction (n = 1), Ramsay Hunt syndrome (n = 1), and malignant parotid lymphoma (n = 1). One patient suffered a surgical site infection, which was successfully treated with irrigation. All the patients achieved improvements in smile symmetry: 2, 5, and 3 patients obtained excellent, good, and moderate results, respectively. The excursion of the oral commissure ranged from 5 to 10 mm. CONCLUSION: The modified lengthening temporalis myoplasty procedure provides satisfactory functional outcomes without causing significant complications. It does not leave a facial scar and is a preferable option, especially for young and female patients, and patients who have undergone ablative surgery involving the parotid region.

Surgery Requiring Detailed Preoperative Simulation and Scar De-epithelialization to Repair Severe Postoperative Scarring from Gastroschisis.

We present the case of a patient with severe postoperative scarring from surgical treatment for gastroschisis, with the intestine located immediately under the dermal scar. Although many patients are unsatisfied with the results of scar repair treatment, few reports exist regarding severe or difficult cases involving the surgical repair of postoperative scar contracture. We achieved an excellent result via simulation involving graph paper drawings that were generated using computed tomography images as a reference, followed by dermal scar deepithelialization. The strategy described here may be useful for other cases of severe postoperative scar contracture after primary surgery for gastroschisis.

Modified Dufourmentel flap with superior pedicle: a useful technique for sacrococcygeal pilonidal sinus.

PURPOSE: In order to prevent postoperative infection and recurrence of sacrococcygeal pilonidal sinus, the authors developed a modified Dufourmentel flap, involving the superior pedicles, and designed a descriptive prospective study to evaluate its efficiency. METHODS: Between July 2007 and March 2014, 16 patients with sacrococcygeal pilonidal sinus were treated with an irregular quadrilateral excision and reconstruction by a modified Dufourmentel flap with superior pedicle. The duration of wound healing, presence of wound complications and permanent hypoesthesia, and recurrence rates were recorded and assessed. RESULTS: None of the patients developed flap necrosis or wound infection postoperatively. The duration of wound healing was 7.2 ± 2.9 (range = 6-15) days. Wound dehiscence was demonstrated in only one patient (6.3%). The mean follow-up period was 4 years and 2 months (range = 4 months-8 years and 8 months), whereby no permanent hypoesthesia or recurrence was detected. CONCLUSION: The modified Dufourmentel flap with superior pedicle can be safely used as a treatment of sacrococcygeal pilonidal sinus, with excellent results.

Microsurgical Training using Reusable Human Vessels from Discarded Tissues in Lymph Node Dissection.

The use of human vessels at the beginning of microsurgery training is highly recommended. But vessels with the appropriate length for training are not often obtained. Whether these vessels may be reused for training has not been reported. Accordingly, we harvested vessels from discarded tissues in lymph node dissection and demonstrated that vascular anastomosis training using the same human vessels several times is possible by placing the vessels in a freezer and defrosting them with hot water. Vascular walls can be stored for microsurgical training until about 4 years after harvest, as shown in the gross appearance and histologic findings of our preserved vessels. We recommend the technique presented here for the longterm reuse of human vessels for microsurgery training that closely resembles real procedures.

Usefulness of an Osteotomy Template for Skull Tumorectomy and Simultaneous Skull Reconstruction.

BACKGROUND: Simultaneous tumor resection and cranioplasty with hydroxyapatite osteosynthesis are sometimes necessary in patients of skull neoplasms or skull-invasive tumors. However, the disadvantage of simultaneous surgery is that mismatches often occur between the skull defect and the hydroxyapatite implant. To solve this problem, the authors developed a customized template for designing the craniotomy line. METHODS: Before each operation, the craniotomy design was discussed with a neurosurgeon. Based on the discussion, 2 hydroxyapatite implants were customized for each patient on the basis of models prepared using computed tomography data. The first implant was an onlay template for the preoperative cranium, which was customized for designing the osteotomy line. The other implant was used for the skull defect. Using the template, the osteotomy line was drawn along the template edge, osteotomy was performed along this line, and the implant was placed in the skull defect. RESULTS: This technique was performed in 3 patients. No implant or defect trimming was required in any patient, good cosmetic outcomes were noted in all patients, and no complications occurred. CONCLUSION: Use of predesigned hydroxyapatite templates for craniotomy during simultaneous skull tumor resection and cranioplasty has some clinical advantages: the precise craniotomy line can be designed, the implant and skull defect fit better and show effective osteoconduction, trimming of the implant or defect is minimized, and the operation time is shortened.

A rare case of a broken dental bur perforating the medial orbital wall without damaging the eye.

Rotating instruments used in the fields of dentistry and oral surgery operate at high speeds. Therefore, if small particles are projected and strike the orbit, injuries of varying severity can occur. We report here a case in which a broken dental bur pierced into the orbit. The bur fortunately did not damage the eyeball and stopped after penetration of the medial orbital wall. The subject was a 27-year-old dental assistant and not wearing protective eyewear. A foreign body had penetrated the medial wall of the right orbit and the tip had reached the ethmoid sinus. The medial orbital wall was exposed subperiosteally after dissection of the medial canthal ligament, and the foreign body was removed. Although the importance of protective eyewear had been advocated, eye protection compliance differed by region and dental personnel. Eye protection use needs to increase in not only dentists but also other dental personnel.

Basic fibroblast growth factor for treatment of onychomadesis with delayed regrowth of the nail.

Onychomadesis usually arises from an inflammation of the paronychium or as a result of blisters and hemorrhaging under a nail that has been struck or compressed. No documented interactions between basic fibroblast growth factor (bFGF) and onychomadesis have hitherto been reported. This case report describes a 25-year-old woman with onychomadesis following infection of the ingrown nail of her left thumb. After ten months of observation with no treatment showed no regrowth of her left thumbnail, the external use of bFGF and antibiotic ointment was started. One month later, nail regrowth was observed up to the halfway point of the nail bed, and after treatment for three months, the regrown nail reached the top of the nail bed. Both thumbnails now looked identical. This case suggests that external use of bFGF can promote nail regrowth in cases of onychomadesis with delayed regrowth of the nail.

A 25-year review of cases with submucous cleft palate.

OBJECTIVES: To evaluate the effect of diagnostic and operative time on velopharyngeal closure in submucosal cleft palate (SMCP). METHODS: SMCP patients treated at the Keio University School of Medicine from 1986 to 2011 were enrolled as subjects. Clinical data were obtained, including patient sex, age at diagnosis, and operative age, occasion of diagnosis, accompanying deformities, speech test results before and 6 months after palatoplasty, and pharyngeal flap usage after palatoplasty. RESULTS: Data were available for 16 patients, with a mean diagnostic age of 51.1 months (range: 0-132 months). The clinical presentations were bifid uvula in 4 patients and speech dysfunction in 11. The cases suspected from bifid uvula were diagnosed significantly earlier than those with speech dysfunction (19.5 versus 56.8 months, p<0.01). Velopharyngeal closure was improved in 6 cases, and the average age of these patients at surgery was significantly lower than that of the other patients (46.7 versus 79.8 months, p<0.05). A pharyngeal flap was performed in 7 cases (43.8%). The pharyngeal flap usage rate in cleft palate patients other than those with SMCP was significantly lower than that of SMCP patients (3.5% versus 43.8%, p<0.01). CONCLUSIONS: Early discovery and surgical correction is vital for improving postoperative speech outcomes in SMCP patients. This requires educating physicians about SMCP and future studies regarding simple and effective SMCP screening methods.

Surgical treatment of severe blepharoptosis and facial palsy caused by oculopharyngodistal myopathy.

Oculopharyngodistal myopathy is an extremely rare disease characterised by slowly progressive blepharoptosis, facial and bulbar muscle weakness and distal leg myopathy. We report the case of a 72-year-old woman with severe bilateral blepharoptosis and facial palsy caused by oculopharyngodistal myopathy that was present for more than 29 years. The condition was successfully treated by simple surgical intervention.