[An Adult Case of Difficult Intubation Caused by Late Complications of Radiotherapy for Pediatric Neck Malignancy, as well as a Later Laryngeal Elevation Surgery].

We present a case of a 32-year-old female who underwent endoscopic sinus surgery under general anesthesia. She had been diagnosed as rhabdomyosarcoma of her neck at 5 years of age, and received tumor resection and chemoradiotherapy. Afterwards, she was suffering from dysphagia as a late complication of radiotherapy. She received laryngeal elevation surgery at 24 years of age, in order to improve swallowing disturbance. With rapid induction of anesthesia, she was easily ventilated with mask and bag. However, it was difficult to visualize her vocal cord with various intubating apparatus, because of her mandible hypoplasia, small oral cavity, and laryngeal elevation. After all, we were able to intubate her trachea using Pentax Airway-scope® (AWS) with a Pediatric-type INTLOCK Blade™ (ITL-P). Radiotherapy for head and neck malignancy at childhood causes various late complications, leading to difficult intubation. Meanwhile, laryngeal elevation surgery for dysphagia anatomically makes intubation more difficult An adult who has such past history should be expected as an extremely difficult intubation case, and we must be prepared with various intubating apparatus including AWS with ITL-P.

A technique for auricular keloid core excision using a skin biopsy punch.

BACKGROUND: Keloids of the auricular region, resulting from ear piercing or external injury, are a common cosmetic problem. Surgical treatment followed by conservative management often is needed. The "hollowing out method for keloids of the auricle" retains the skin over the keloid lesion to minimize tension on the wound. This is considered to be the appropriate surgical treatment method, but skill is required to remove the keloid and retain the skin with a uniform thickness and appropriate form. MATERIAL AND METHODS: Four patients with auricle keloids were included in this study. All the patients were females between the ages of 18 and 29 years (average age, 24.8 years). Keloid core excision using a skin biopsy punch with the patient under local anesthesia was performed for all the patients. RESULTS: Use of a skin biopsy punch resulted in a shorter operating time without causing ear deformity. CONCLUSION: The authors report a technique for keloid core excision using a skin biopsy punch and believe it is a useful method LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.springer.com/00266.

Lipoma with bone and cartilage components in the left axilla of a middle-aged woman.

UNLABELLED: Lipoma is the most common type of benign soft tissue tumor. However, lipoma containing bone or cartilage is very rare, especially a tumor containing both of these components. We encountered a 59-year-old woman who had a benign lipoma of the infraspinatus muscle that contained both osseous and chondral components. Histopathological examination revealed the presence of chondral and osseous elements mixed with mature adipose tissue. To the best of our knowledge, there has never been a report of benign lipoma containing osteochondral tissue at this location. Therefore, we report the first case of an axillary lipoma with bone and cartilage components. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article.

Dye laser photodynamic therapy for Bowen's disease in a patient with epidermodysplasia verruciformis.

Epidermodysplasia verruciformis (EV) is a rare heritable skin disease that results in unusual susceptibility to infection with specific types of human papillomavirus (HPV). Here we report a 53-year-old man with EV who developed Bowen's disease on his lower eyelid and the chest. Mutation analysis of EVER1 gene revealed homozygous splice acceptor site mutation (IVS8-2, A > T). In this patient, HPV3, HPV14, and HPV38 had been identified from the skin lesions. The Bowen's skin lesion on the left lower eye-lid was treated by photodynamic therapy (PDT) using 5-aminolevulinic acid (ALA) and pulsed dye laser (PDL). After two rounds of the PDT treatment, the skin lesion disappeared and a skin biopsy confirmed the efficacy of the treatment. This method was simple, less invasive than other treatments, and achieved a satisfactory cosmetic result.

Two cases of steatocystoma simplex in infants.

Steatocystoma simplex is a rare benign cutaneous cyst that is thought to be a circumscribed malformation arising from the pilosebaceous duct junction. Reports describing steatocystoma simplex are scarce and many issues remain to be clarified, including frequency and age distribution. Steatocystoma simplex is generally considered to be a solitary, non-inherited tumor arising in adults; there have been no previous reports of steatocystoma simplex in infants. We encountered two cases of steatocystoma simplex arising on the head in infants less than 2 years old. Herein we discuss the clinical and pathological characteristics of these cases.