Therapeutic failure and eventual solution for skin necrosis and exposed tendon of the dorsum of the foot: A case report.

For the treatment of skin necrosis with exposed tendons in rheumatoid arthritis (RA) foot, we should perform microvascular free flap surgery at an early stage without conservative treatment considering the increased risk of infection and the decreased physical activity.

Primary Palatoplasty for Unilateral Cleft Lip and Palate Using Mucosal Grafts and Flaps.

The mucosal graft and flaps method (MG method) is a palatoplasty technique that was developed for the purpose of improving maxillary growth in patients with cleft palate. In the MG method, full-thickness buccal mucosa is grafted onto the raw surface created by pushback palatoplasty. The method is unlikely to result in severe scarring and has a favorable effect on maxillary growth. In addition, it is unlikely to result in oronasal fistula and provides good speech results. Overall, postive long-term treatment results have been obtained. Although the MG method is technically difficult and requires a lengthy surgery, the technique is considered to be effective for palate closure in terms of speech and maxillary growth.

Segmental distraction osteogenesis with modified LeFort II osteotomy for a patient with craniosynostosis.

In this article, we report successful orthodontic treatment combined with segmental distraction osteogenesis after a modified LeFort II osteotomy in a patient with craniosynostosis. An 8-year-old boy diagnosed with craniosynostosis had a dished-in face, an anterior crossbite, and a skeletal Class III jaw relationship because of midfacial hypoplasia. At the age of 13 years 6 months, the maxillary second and mandibular first premolars were extracted, and leveling and alignment of both arches was started with preadjusted edgewise appliances. At age 14 years 11 months, the patient had a modified LeFort II osteotomy, and the maxillary segment was advanced 7 mm and fixed to the zygomatic bone. At the same time, segmental distraction osteogenesis was started with a rigid external distraction system, and the nasal segment was advanced for 20 days at a rate of 1.0 mm per day. The total active treatment period was 40 months. As a result of the modified segmental distraction osteogenesis, significant improvement of his severe midfacial hypoplasia was achieved without excessive advancement of the maxillary dentition. Both the facial profile and the occlusion were stable after 1 year of retention. However, the nasal segment relapsed 1.4 mm during the 1.5 years after the segmental distraction osteogenesis. Evaluation of the stability and retention suggests that some overcorrection in midfacial advancement is recommended.

Primary alveolar bone grafting and gingivoperiosteoplasty or gingivomucoperiosteal flap at the time of 1-stage repair of unilateral cleft lip and palate.

It takes quite a long time to finish treating patients with cleft lip and palate. Usually, lip closure, palate repair, secondary alveolar bone grafting, and secondary repair of lip/nose have been given to patients at appropriate time according to their growth. However, these series of surgical interventions impose a considerable burden on the patients and their families. As for palate repair, it is considered that the earlier the better for the sake of speech, but it should be delayed to approximately 1(1/2) years of age for maxillary growth. However, we have developed a palate repair technique that will hardly result in marked maxillary growth impairment by modifying the Furlow method, so we have become able to perform palate repair between 3 and 10 months after birth. Accordingly, we can perform lip and palate repair simultaneously, which have been performed separately. As we have developed a 1-stage repair of cleft lip and palate including primary alveolar bone grafting from nasal concha and/or hard plate and gingivoperiosteoplasty or gingivomucoperiosteal flap, we report on our technique and treatment outcome.

Successful thoracoscopic debridement of descending necrotizing mediastinitis.

Descending necrotizing mediastinitis results from odontogenic, deep neck infection that spreads along fascial planes into the mediastinum. Although the optimal surgical approach remains controversial, nearly half of the cases require mediastinal debridement by thoracotomy. We report a case of successful thoracoscopic debridement for descending necrotizing mediastinitis due to odontogenic infection that failed to be drained by transcervical approach. Because of less invasiveness as compared with standard thoracotomy, the thoracoscopic approach should be used as early as possible in case of unsuccessful transcervical approach.