Long-term Follow-up of Secondary Reconstruction of Facial Paralysis and Depressive Deformities After Subtotal Temporal Bone Resection.

Subtotal temporal bone resection (STBR) frequently results in facial paralysis and depression, making reconstruction challenging due to significant tissue loss. This study aimed to evaluate the effectiveness of a procedure designed for simultaneous smile and soft tissue reconstruction after STBR. The authors included 3 patients who underwent latissimus dorsi (LD) neuromuscular flap combined with adipose flap transfer after STBR at the Tokyo Medical and Dental University Hospital between 2010 and 2016. Among these patients, 2 had facial vessels unsuitable for anastomosis due to prior neck dissection, and their masseteric nerves were unavailable for neurorrhaphy due to STBR. The thoracodorsal nerve was coaptated to the contralateral facial nerve in all patients and to the ipsilateral masseter nerve in one patient. Follow-up periods ranged from 7 to 13 years, with all patients achieving spontaneous smiles within 12 months post-surgery. Although depressive deformities improved, long-term follow-up revealed buccal muscle bulging due to unstable LD muscle fixation from a zygomatic arch defect caused by STBR. Revision surgeries, including muscle refixation with a tensor fasciae lata graft, muscle reduction, eyebrow lifting, blepharoplasty, and adipose tissue repositioning, were performed as needed. Ultimately, all patients achieved satisfactory facial contours and spontaneous smiles. This study demonstrates that free LD muscle with adipose flap transfer is effective for post-STBR reconstruction. However, detailed surgical planning and multistage reconstruction are often necessary due to the complexities involved.

Epicutaneously sensitized food-induced anaphylaxis is ameliorated with "oral tolerance" to antigen.

Food allergy is an antigen-specific immunological adverse reaction after exposure to a given food. Multiple clinical studies showed that oral immunotherapy (OIT) is effective for the prevention and treatment for food allergy that is developed in infants and children. However, the effectiveness of OIT for epicutaneously sensitized food allergy remains unclear. Previously, we established a mouse model of epicutaneous-sensitized food allergy. In this model, systemic allergic reaction including intestinal and skin symptoms, such as anaphylaxis, was observed. We treated this model with OIT in two ways (OIT before sensitization or OIT during the sensitization phase) and evaluated the preventive effect of both methods. OIT before sensitization significantly ameliorated mast cell degranulation in sensitized skin, but there was no decrease in rectal temperatures or in mast cell degranulation in the jejunum. However, OIT administered during the sensitization phase significantly ameliorated the decrease in rectal temperature and mast cell degranulation in the skin and jejunum. OIT before sensitization increased the regulatory T cells in mesenteric lymph node (MLN), but not in the spleen, and it reduced antigen-specific IgG, but not IgE, production compared with the non-OIT control. However, OIT during sensitization caused a greater increase in regulatory T cells in both the MLN and spleen and reduced antigen-specific IgE and IgG generation compared with the non-OIT control group. Thus, OIT during the sensitization phase was effective for the prevention of epicutaneous-sensitized food allergy.