Idiopathic Palatal Fistula of the Left Soft Palate.

Palatal fistulas, often congenital or trauma-induced, are occasionally encountered in the field of plastic surgery. We report a case of a non-medial 3 mm soft palate fistula in a 43-year-old woman, with no apparent trigger or history of local trauma or infection. The fistula, extending 2 cm toward the lateral pharyngeal wall, was surgically removed under general anesthesia as it was impacting the patient's quality of life. The lumen was stained, and the fistula was removed in one mass. The excised tissue was covered with stratified squamous epithelium and was surrounded by adherent tonsil tissue. No recurrence was observed postoperatively. Despite an initial suspicion of a congenital cause, the fistula's lateral extension and histology suggested a possible origin from the second pharyngeal pouch. To date, there are no reports of fistulas opening on the soft palate. Therefore, this presents an exceptionally rare instance of a soft palate fistula.

Successful management of a mediastinum abscess with sternum destruction caused by MSSA bloodstream infection.

BACKGROUND: Multiple deep organ abscesses associated with Staphylococcus aureus bloodstream infection (SAB) have a high mortality rate, requiring rapid removal or drainage of infective foci with long-term appropriate antimicrobial therapy. Cases in which infective foci cannot be completely removed are challenging for their management. CASE PRESENTATION: A 77-year-old man developed multiple deep organ abscesses associated with SAB. The left anterior chest subcutaneous abscess continued into the right anterior mediastinum and had extensively destroyed the sternum. Necrotizing fasciitis was observed in the bilateral feet. The anterior mediastinum abscess was drained percutaneously, and the chest wall abscess was incised cautiously without causing an external pneumothorax. On the next day, right-sided pyothorax had developed, requiring pleural drainage. On the third day, debridement of anterior chest wall abscess followed by concurrent thoracoscopic pleural curettage and debridement of bilateral feet were performed. Thorough sternal debridement was not performed, considering the risk of respiratory failure due to the sternal defects. On the 24th day, sternum debridement and incisional drainage of sciatic rectus fossa abscess, which had been present since the time of admission, were performed to control persistent infection. The caudal half of the sternal body was resected, leaving the costal cartilage attachments. The general condition further improved without postoperative respiratory failure after the second surgery, leading to a transfer to the general ward on the 43rd day. CONCLUSIONS: We successfully treated the severe multiple deep organ abscesses, including a mediastinum abscess with sternum destruction, by repeated removal of the infective foci while avoiding respiratory failure due to excessive debridement of the anterior chest wall, including the sternum.

Efficacy of seasonal allergic rhinitis using an 810 nm diode laser system.

BACKGROUND AND AIMS: Allergic rhinitis annually reach epidemic proportions in Japan. Approximately 30 to 40% of the population suffers from allergic rhinitis during the spring season. Symptoms comprise rhinorrhea, nasal congestion, and sneezing accompanied by irritation and itching of the eyes. The Ohshiro Clinic started using the conventional Nd:YAG laser for the treatment of allergic rhinitis in 1993, and from 2005 we started using a diode laser-pumped Nd:YAG laser. From 2010, we adopted a novel 810 nm diode laser, and the present retrospective study examined the efficacy rate of the treatment of allergic rhinitis in the 2018 season with this system, compared with a previous study in 2011. We aimed to confirm the degree of improvement for each symptom to evaluate effectiveness of the diode laser treatment. SUBJECTS AND METHODS: Between January 8, 2018 and April 30, 2018, a large number of patients consulted our clinic with the major complaint of seasonal allergic rhinitis. They underwent a blood test, and the antigen-specific serum IgE antibody titers were measured for a definitive diagnosis of cedar pollinosis. A total of 211 target patients were treated during the trial period. The average age of the target group was 36.3 years, 134 males, and 77 females. The target patients were treated with lower nasal turbinate mucosal irradiation using a diode laser (ADL-20, Asuka Medical) delivering 810 nm at 7.5 W, with a total energy per treatment of 240 J/cm2. We adopted a five-step evaluation in accordance with the Japanese Guidelines for Allergic Rhinitis 2014 for the symptoms of rhinorrhea, sneezing and nasal obstruction. We assessed the degree of improvement in the severity of these symptoms following diode laser treatment from baseline to one month after treatment, in addition to assessing patient satisfaction with the degree of improvement in their quality of life (QOL). RESULTS: The 211 patients positive for cedar pollinosis by the antigen-specific serum IgE antibody tests were broken down by month by number and by improvement, no change or exacerbation as follows. January, 18 patients: 33.4%, 44.4% and 22.2%, respectively. February, 29: 10.4%, 44.4% and 22.2%, respectively. March, 146: 60.3%, 31.5% and 8.2%, respectively. April, 18: 77.8%, 16.7% and 5.5%, respectively. The monthly respective improvement, no change or worse patient QOL as percentages were as follows: January: 16.7%, 44.4% and 38.9%. February: 17.3%, 13.8% and 68.9%. March: 61.6%, 29.5% and 8.9%. April: 94.4%, 0.0% and 5.6%. The values for prevention of exacerbation versus exacerbation for each month were: January, 77.8% vs 22.2%; February, 41.4% vs 58.6%; March, 91.8% vs 8.2%; and April, 94.4% vs 5.6%. The mean efficacy rate for the trial period in the present study was therefore 52.6% which compared very favorably with the mean efficacy rate in the 2011 study of 53.4%. CONCLUSIONS: The results showed that the 810 nm diode laser offered a safe and effective solution for the uncomfortable symptoms of allergic rhinitis and could be well applied during the season of Japanese cedar pollen dispersion. Furthermore, a tendency towards high efficacy was demonstrated for laser treatment in class 6 cedar pollinosis patients, based on the specific IgE antibody test.

Type 2 Minocycline-induced hyperpigmentation successfully treated with the novel 755 nm picosecond alexandrite laser - a case report.

BACKGROUND AND AIM: Minocycline therapy for acne vulgaris is associated with the occasional induction of various types of unsightly and often persistent hyperpigmentation, which is frequently resistant to hydroquinone treatment. Pigment-specific lasers have achieved some success with multiple treatment sessions. Recently, the picosecond domain 755 nm alexandrite laser (ps-Alex) has attracted attention in tattoo removal. The present study reports on the successful treatment, in a single ps-Alex session, of minocycline-associated pigmentation. SUBJECT AND METHOD: Subsequent to a course of minocycline, a 28-year-old Asian female developed persistent type 2 minocycline-related pigmentation on the bilateral lower extremities which was recalcitrant to hydroquinone treatment. The patient had a test treatment on a small area with a Q-switched ruby laser and the ps-Alex, following which the ps-Alex was selected for the actual treatment (spot size, 2 mm; fluence, 6.37 J/cm2; pulsewidth, 750 ps) on one leg first, followed later by the contralateral leg. RESULTS: Rapid clearance of the pigmentation was noted after a single ps-Alex session on both limbs without prolonged post-inflammatory hyperpigmentation (PIH). At one year post-treatment, clearance had been maintained. CONCLUSIONS: Our results in this single case strongly suggest that the novel 755-nm ps-Alex laser is both safe and very effective for the treatment of type 2 minocycline-induced hyperpigmentation even in PIH-prone type IV Asian skin. Further trials with larger patient populations are warranted to confirm this optimistic result.

Combined usage of hydroxyapatite and cross-finger flap for fingertip reconstruction.

Reconstruction for fingertip defects categorized as Type 3 and Type 4 in Allen's classification is challenging, because surgeons need to reconstruct not only the pulp but also great parts of the distal phalangeal bone. This paper introduces an original technique for the reconstruction of defects of these types. The defects of seven fingers (two small fingers and five index fingers) of seven patients (three males and four females; aged 14-44 years) were repaired. After the fingertip is divided in a fish-mouth fashion to expose the stump of the distal phalangeal bone, a curved block of hydroxyapatite is grafted to fill the phalangeal defect and straighten the nail bed. A rectangular flap is raised from the dorsal side of the neighbouring finger in the region between the PIP and DIP joints. Then the fish-mouth region carrying the grafted hydroxyapatite is covered with the rectangular flap to reconstruct the pulp. The rectangular cross-finger flap is separated 3-4 weeks postoperatively. In all seven cases, the flap survived completely. Infection developed in no case. In all cases, aesthetic appearance of the pulp and nail presented improvement, satisfying the patients. Combined usage of hydroxyapatite and a cross-finger flap from the neighbouring finger is an effective method for the reconstruction of type 3 and type 4 defects in Allen's classification.

3-D analysis of dislocation in zygoma fractures.

OBJECTIVE: When fractured, zygomas rotate and dislocate. The present study quantitatively elucidates the pattern of the rotation. METHODS: 50 patients with tri-pod-type zygoma fractures were involved in this study. After defining a 3-dimensional coordinate system--consisting of the M-L axis (the axis directed from the medial to lateral side of the skull), I-S axis (directed from the inferior to superior side), and P-A axis (directed from the posterior to anterior side), the degree with which the fractured zygomas rotated around each of these axes was measured using 3-dimensional graphic software. Thereafter, the tendency of the rotation was compared between the three rotational axes. RESULTS: Rotation around the I-S axis was the most frequent with a 96% incidence, followed by a substantial margin by rotation around the M-L axis with a 26% incidence; rotation around the P-A axis was rare, with an incidence of 10%. Furthermore, the degree of P-A axis rotation was minor compared to I-S and M-L axis rotations. CONCLUSION: The main factor of zygoma dislocation in zygoma fracture is rotation around the I-S axis. This finding is helpful for effective performance to reposition fractured zygomas.

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.