Use of the facial dismasking flap approach for surgical treatment of a multifocal craniofacial abscess

The decision of which surgical approach to use for the treatment of a multifocal craniofacial abscess is still a controversial matter. A failure to control disease progress in the craniofacial region can potentially put the patient's life at risk. Therefore, understanding the various ways to approach the craniofacial region helps surgeons to obtain satisfactory results in such cases. In this report, we describe a patient who visited the emergency department with a large swelling in his right cheek. A blood test and computed tomography revealed odontogenic maxillary sinusitis. The patient developed sepsis due to a progressive multifocal abscess. An abscess was seen in the temporal muscle, infratemporal fossa, and interorbital region. To control this multifocal abscess, we used the facial dismasking flap (FDF) approach. After debridement using the FDF approach, we succeeded in obtaining sufficient drainage of the abscess, and the patient recovered from sepsis. The advantages of the FDF approach are that it provides a wide surgical field, extending from the parietal region to the mid-facial region, and that it leaves no aesthetically displeasing scars on the face. The FDF approach may be one of the best options to approach multifocal abscesses in the craniofacial region.

Successful peritoneovenous shunt in a case of refractory ascites with multiple liver matastases from breast cancer

<b>Purpose</b>: Refractory ascites is one of common symptoms in patients with breast cancer. <b>Case report</b>: A woman in her fifties was admitted with massive ascites and was diagnosed with advanced breast cancer with multiple liver metastases. Diuretics, hormonal therapy, and chemotherapy could not control the ascites. Therefore, we implanted a peritoneovenous shunt to continue the cancer treatment with good quality of life. Despite the liver metastases had progressed during subsequent chemotherapies, no ascites had been detected for 8 months. <b>Conclusion</b>: We believe that peritoneovenous shunt can be an effective treatment that support anticancer therapy and palliative care in patients with cancer accompanied by intractable ascites.

Mohs' paste successfully controlled intractable bleeding from local recurrence in rectal cancer

A man in his seventies sustained continuous bleeding from local recurrence at the residual rectal stump after Hartmann's surgery for rectal cancer. This patient declined chemotherapy and radiation therapy and conventional local anti-hemorrhagic treatments had not been effective. To assess the risk of Mohs' paste application to the rectal recurrence area, we checked the anatomical structures surrounding the application site by a CT study. In addition, two reasons we evaluated this Mohs' paste treatment to the rectal recurrence would be very safe were as follows: 1. A small amount of Mohs' paste was needed for the small rectal bleeding site. 2. Mohs' paste would not be applied to the rectum used for stoma. To avoid applying Mohs' paste to the neighbouring normal structures, a gauze coated with Mohs' paste was inserted into the rectum and placed only on the local recurrence site. Petroleum jelly was applied to the surface of normal rectal mucosa to prevent fixation. Bleeding and malodorous effusion decreased significantly without side effects such as pain, bleeding, or ulceration. Thereafter, additional fixation was not necessary. When all the other antihemorrhagic modalities are not available, Mohs' paste could be used for bleeding or an effusion from non-superficial tumors after a thorough risk assessment on this treatment.