Dynamic Reconstruction Using Bilateral Lengthening Temporalis Myoplasty for Facial Palsies in Patients with Hereditary Skin Laxity.

Hereditary skin laxity is a rare condition, some cases of which are also referred to as cutis laxa, and those involving facial skin are considered a target for treatment by plastic surgery as patients present with an aged face, which can reduce their quality of life. In some of these patients, the facial nerve and muscles may be affected, and cause weakness of mimetic muscles. We performed one-stage bilateral lengthening temporalis myoplasty reanimation, followed by lower facial contouring with partial lower lip excision and hammock-shaped fascia grafting in two patients with hereditary facial skin laxity coexisting with facial palsy. The patient was a 63-year-old woman with hereditary gelsolin amyloidosis and a 64-year-old man who was diagnosed with oculopharyngeal muscular dystrophy. Postoperatively, a symmetrical facial contour was achieved in repose, and smiling with and without biting was possible. To our knowledge, there are no reports of dynamic smile reconstruction for facial weakness in patients with hereditary facial skin laxity. Although these patients may experience progressive loss of function of the trigeminal nerve and its innervating muscles, the static suspension effect of lengthening temporalis myoplasty can be expected to continue even if the temporal muscles lose their function in the future. We believe that, with careful patient selection, dynamic reconstruction is an option for progressive facial paralysis. In this article, we present the chronological history of two patients who underwent multiple plastic surgery procedures and discuss the importance of the role of plastic surgery in improving the quality of life under these conditions.

Comorbidity Between Crowned Dens Syndrome and Primary Hyperparathyroidism.

Primary hyperparathyroidism (PHPT) is characterized by various symptoms, including malaise, psychiatric symptoms, and hypertension. When hypercalcemia is accompanied by PHPT, it may cause pathologic fractures or lethargy. Additionally, PHPT can be complicated by crowned dens syndrome (CDS). We present a case of a 72-year-old female. She had begun experiencing low back pain during movement five days before. The symptoms progressed and the patient was unable to move. Based on the imaging, blood tests, and clinical findings, the patient was diagnosed with PHPT complicated with CDS. Therefore, it is important to perform a careful physical examination of the neck and cervical spine computed tomography in patients with PHPT. Moreover, measuring calcium levels in patients with CDS may lead to early detection of PHPT.