okumoto takayuki

Nasal growth after cleft lip surgery with or without primary nasal repair was evaluated using lateral cephalograms. In 14 patients who underwent simultaneous nasal repair with primary cleft lip repair and 12 patients without simultaneous nasal repair, lateral cephalograms were obtained at 5 and 10 years of age. Lateral cephalograms of normal Japanese children were used as a control. At 5 years of age, there were significant differences in the nasal height and columellar angle among the three groups. Children without simultaneous nasal repair had shorter noses with more upward tilt of the columella compared with the controls, while children with simultaneous nasal repair had much shorter noses and more upward tilt than those without repair. At 10 years of age, the children without simultaneous nasal repair showed no differences from the control group, while those with simultaneous repair still had shorter noses and more upward tilt of the columella. These findings suggest that performing nasal repair at the same time as primary cleft lip surgery has an adverse influence on the subsequent growth of the nose. (C) 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

患者は47歳女性,多発性硬化症による第4胸椎以下の神経障害があり,数年前より車椅子生活であった。2011年3月より左坐骨結節部に褥瘡が生じたが放置していた。3月下旬より38度台の発熱が生じ,解熱しないため,当科を受診した。初診時,左坐骨結節部の褥瘡部に壊死組織を認め,CTでは左臀部から左下腿にかけて皮下深部組織内にガス像を認めガス壊疸と診断した。創部からの細菌培養ではEnterococccus avium,Lactbacillus spが検出された。抗生剤の全身投与を開始したが,第3病日に意識障害を来したため,第4病日に広範囲にデブリードマンを行い,感染の沈静化を得ることができ救命することができた。デブリードマン部の欠損は,複数回の植皮術を行い上皮化した。坐骨部褥瘡は,各種外用剤による保存的治療,局所陰圧閉鎖療法(VAC療法)を約5ヵ月間にわたり試みるも治癒しなかった。そのため左坐骨突出部の削除を含めたデブリードマンと大臀筋皮弁形成術を行うことで退院が可能となった。(著者抄録)

Myoepithelioma is a rare, benign salivary neoplasm, most frequently located in the salivary gland extrasalivary cases most commonly occur in the palate. This tumor is prone to recurrence. We present a case of recurrent myoepithelioma in the nasal cavity with a palatal fistula treated both by a palatal approach and a piriform apertural approach. The combination of these approaches widens the surgical space, allowing removal of the mass. It is important not only to excise the mass but also to allow for reconstruction.

Preaxial prehallux is a rare clinical manifestation among patients with polydactyly. Few cases arising from tarsal bones have been reported. We present a case of a true prehallux occurring in a patient with a bilateral complete cleft lip, palate, and alveolus.

A mobile eye socket is generally reconstructed by inserting an implant into the scleral pocket immediately after bulbar exenteration, or by attaching the extra-ocular muscles to the implanted artificial eyeball immediately after enucleation. However, exposure of the implanted material and other problems can occur. We achieved satisfactory reconstruction of a mobile eye socket by using an autogenous cartilage graft and a pericranial flap in a patient with long-standing anophthalmia due to enucleation. This case is presented with a review of the relevant literature. (C) 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

A 35-year-old man suffered from electrical injury with a direct current of 440-V voltage while engineering work. Electric current spots were observed on forehead and right buttock. (The electric current was suggested to have traveled from forehead to buttock.) Debridement and suture without graft could be performed for the right buttock burn, on the other hand the forehead burn injury necrotized to periosteum and needed to be reconstructed by the radial forearm free flap. Also, a 63 year-old man suffered from electrical injury with an alternative current of 200-V voltage while engineering work. He was injured with both hands, neck and chest when he used the industrial tool. The neck and chest were epithelized by conservative treatment, but the both hands required Thiersch's skin graft. The serious complications such as arrhythmia or the renal failure were not found with two cases either. The appropriate management and the cooperation with each medical department are required in order that electrical injury can cause systemic complications as well as skin.

Orbital hypertelorism is defined as an abnormally wide bony interorbital distance. The aims of surgery are both correction of ocular dystopia and cosmetic reconstruction of the nasal crest. Marked improvement of visual function, especially binocular vision, by surgery is not expected. Here we report that surgical treatment unexpectedly resulted in a significant visual improvement for a 13-year-old boy with orbital hypertelorism who also had bilateral cleft lip and palate. (C) 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Cranium bifidum is a congenital anomaly caused by abnormal development of the cephalic neural tube. We report two cases of cranium bifidum occultum with defects of both the frontal bone and anterior cranial base accompanied by infection and enlargement of frontonasal dermoid cysts. Surgery successfully interrupted the communication between the intracranial space and nasal cavity by inserting a pericranial flap after removal of the dermoid cysts. (C) 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

We studied the effect and validity of medical intervention for submucous cleft palate (SMCP) in our center retrospectively.<br>Object: Fifty SMCP cases were referred to our center between April 1992 and December 2008. Of these SMCP cases, 36 were examined, and 14 with complications which affected operation and speech therapy were excluded.<br>Method: SMCP is defined as a congenital deformity in which there is imperfect muscle union across the velum, if they do not satisfy the Calnan's triad. Their gender, age at first visit, chief complaint, complications, Calnan's triad, length and mobility of soft palate, and medical interventions (operation and speech therapy) were investigated.<br>Results: There were 17 males and 19 females, and the age at first visit varied from 8 days to 6 years and 3 months. Chief complaints were morphologic defects such as cleft in 21 cases and functional disability such as speech disturbance in 15. Complications were found in 22 cases; chief complications were as below: mental retardation in 11 cases, 22 q 11.2 deletion syndrome in 4, first and second branchial arch syndrome in 4 (2 cases with auditory imperfections), and Robin's sequence in 3 (combined OSAS in one). Clinical symptoms were: imperfect muscle union across the velum in 36 cases, uvula bifida in 28, deficiency in the bone of the posterior edge of the hard palate in 22, and all of the Calnan's triad in 20. Eighteen cases showed short palate, and palatal lift was poor in 14 cases. Operation was necessary in 19 cases. In 17 cases without surgery, 12 required speech therapy. The effects of speech therapy were: improvement in 10 cases and slight improvement in 2. Satisfactory speech was acquired before starting school, excluding a case speech therapy was started after 5 years. In the operated cases, palatoplasty was performed. In one case, a pharyngeal flap was combined. In 15 cases speech therapy was necessary. The effect of medical intervention was: improvement in 12 cases, slight improvement in one, and no change in 2. For the 2 no-change cases, a PLP was applied in one, and a pharyngeal flap was applied additionally in the other. In 15 cases with surgery, excluding the 2 no-change cases and 2 cases operated after 5 years, satisfactory speech was acquired before starting school.<br>Conclusion: Excluding the 2 cases in which the speech evaluation after primary operation showed no change, the other cases could acquire satisfactory speech before starting school, provided medical intervention was started within 5 years. We conclude that the medical intervention in our center is appropriate.

A clinico-statistical investigation was conducted with 1112 cleft lip and/or palate patients (excluded 18 cases in which data were inadequate) in the Cleft Lip and Palate Center, Fujita Health University Hospital, since its foundation in April 1992.<br>The results were as follows:<br>1) Primary cases were 1073, secondary cases were 39, and average number of patients registered per year was 75.5 from 1993 to 2006.<br>2) The distribution by cleft type was: 368 cases (33.1%) with unilateral CL (A) P, 279 cases (25.1%) with unilateral CL (A), 275 cases (24.7%) with CP, 157 cases (14.1%) with bilateral CL (A) P, 26 cases (2.3%) with bilateral CL (A), and 7 cases (0.6%) with others.<br>3) The average number of operations per year from 1993 to 2006 was as follows: chelioplasty (primary lip operation) 61.7, palatoplasty (one stage operation for CP) 13.1, palatoplasty (soft palate in two stage operation) 26.5, palatoplasty (hard palate in two stage operation) 23.4, secondary alveolar bone graft 17.8, and secondary operation for velopharyngeal incompetence 3.<br>4) The number of patients registered for speech evaluation and training was 741 until June 2007.