ABSTRACT
Background@#Fibrous dysplasia (FD) is a localized bone disorder in which fibro-osseous tissue replaces the normal bone structure. Patients with craniofacial FD often present with gradual swelling, deformity, and compromised vision or hearing. We previously introduced “the core extirpation method,” a novel surgical technique that is minimally invasive like traditional bone shaving but has longer-lasting effects. This study presents the long-term outcomes of our core extirpation method. @*Methods@#We conducted a retrospective analysis of patients who underwent core extirpation for FD of the zygomaticomaxillary region from 2012 through 2021. Computed tomography (CT) scans were performed 6 to 12 months before the operation, immediately before and after the operation, and during follow-up visits. We performed all operations using the upper gingivobuccal approach, and we extirpated the core of the lesion while preserving the cortical structures of the zygoma and the maxilla to maintain symmetrical facial contour. @*Results@#In 12 patients with lesions in the growth phase, anteroposterior/mediolateral (AP/ML) length discrepancies and the volume increased between preoperative and immediate postoperative CT scans. All patients’ immediate postoperative AP/ML discrepancies were stable up to 12–17 months postoperatively. Postoperative volume showed continuous lesion growth; the median volume growth rate was 0.61 cc per month. @*Conclusion@#In this article, we present our experiences managing FD using the minimally invasive core extirpation technique, which entails small expected blood loss and can be performed as day surgery. It provides similar cosmetic outcomes as traditional bone shaving but with longer-lasting results. Although there are some limitations with the study’s retrospective nature and small sample size, our 4-year follow-up results show promising results of the core extirpation method in well-indicated patients.
ABSTRACT
Performing a concurrent gynecologic operation and mastectomy with immediate breast reconstruction using a free transverse rectus abdominis myocutaneous flap may increase the risk of complications such as umbilical necrosis due to vascular compromise. Imaging studies such as preoperative computed tomography angiography and intraoperative indocyanine green testing can provide information regarding the umbilical blood supply, facilitating decision-making for pedicle selection. Therefore, in situations where a coordinated operation is unavoidable, a thorough preoperative and intraoperative evaluation of the umbilical blood supply is recommended to avoid complications.
ABSTRACT
Reduction mammoplasty is a popular operation worldwide. Early complications include bleeding, wound dehiscence, and nipple-areolar complex (NAC) ischemia. Although uncommon, NAC ischemia can lead to necrosis of the NAC. NAC congestion is usually recognized intraoperatively or within a few hours of the operation. A 21-year-old woman with severe macromastia received bilateral reduction mammoplasty using a Wise-pattern reduction with a superomedial pedicle. NAC congestion of the left breast was identified 40 hours after the operation. Delayed venous congestion of the NAC after reduction mammoplasty has not been previously reported; in this case, delayed congestion may have been caused by partial venous obstruction aggravated by the progression of tissue edema near the pedicle. Through use of the delayed suture technique, application of nitroglycerin cream, intravenous administration of prostaglandin E1, and use of a portable negative-pressure wound therapy device, the patient’s NAC was salvaged with satisfactory nipple projection and minimal scarring.
ABSTRACT
Orthognathic surgeries often utilize rigid fixation for stabilization of the osteotomy site. The longterm fate of rigid fixations is still under investigation, and whether they should be routinely removed is under debate despite their low complication rates. Here, we report a case where a 26-year-old man suffered high-velocity trauma to his face 7 years after a two-jaw surgery. Computed tomography examination revealed a zygomaticomaxillary complex fracture, and open reduction and internal fixation was performed along with anterior maxillary wall reconstruction using absorbable mesh. Intraoperative examination revealed a broken L-shaped titanium plate near the fracture site with multiple bony fragments near each titanium screw. The rigid titanium system may have caused comminution of the fracture pattern, worsening the severity of the fracture.