Unilateral Palatal Hypoplasia: A Case Report With a Long-Term Follow-Up.

Isolated unilateral palatal hypoplasia is an extremely rare congenital disorder that usually causes velopharyngeal incompetence. We herein report a case with isolated unilateral palatal hypoplasia that was treated and followed up over nine years. No hypernasality or articulation errors were observed through the postoperative period. Here the intraoperative and postoperative findings are described.

A case of occipital spindle cell lipoma: a case report.

Spindle cell lipoma (SCL) is a subtype of lipoma first defined by Enzinger; it accounts for ~1.5% of all fatty tumors. Most cases occur in the posterior neck and shoulders of middle-aged men and rarely in women or the occiput. A 41-year-old woman presented to us with complaints of a mass on her left occiput which had slowly grown in size over six years. We excised the tumor, and pathological findings confirmed the diagnosis of SCL. There was no recurrence one year after the surgery.

A solitary giant neurofibroma of the left thigh: a case report.

A neurofibroma not associated with neurofibromatosis type 1 is termed solitary neurofibroma. A solitary giant neurofibroma of the thigh is an extremely rare tumor. A 44-year-old woman presented to us with a well-defined swelling on her left thigh for 10 years. On the basis of magnetic resonance image finding, we diagnosed the tumor as a neurofibroma. We excised the tumor and the pathological findings established the diagnosis of neurofibroma. There was no recurrence 8-months after surgery.

A New Technique of Unilateral Cleft Lip Repair with Scarless Cupid's Bow Peaks.

BACKGROUND: A novel technique for primary unilateral cleft lip repair with scarless Cupid's bow peaks is described. This technique focuses on the curvature of the Cupid's bow and the preservation of the minute three-dimensional structure around the cleft-side peak of the Cupid's bow, such as the cutaneous roll and white skin roll. This technique has been used in 50 consecutive unilateral cleft lip repairs by a single surgeon. METHODS: The flap from the lateral lip is expanded into a three-stair flap, including a lateral white lip flap, a cutaneous roll flap, and a quadrangular mucovermilion flap as partial flaps. The cleft-side peak of the Cupid's bow is made to form a curved peak with the cutaneous roll. The suture lines pass through the lip columellar crease, philtrum ridge, and upper lip groove. These lines are stepwise, just like W-plasty, and do not cross the peak of the Cupid's bow. Measurements were obtained from three-dimensional photographs, and a visual assessment was performed by standard photographs taken 1 year or later postoperatively with no additional surgery, except for palatoplasty. RESULTS: The Noordhoff point was kept as the peak of the Cupid's bow with no scar. The three-dimensional structure, including the cutaneous roll around the cleft-side peak of the Cupid's bow, was well maintained. CONCLUSION: The present technique allows for the fashioning of a reliable intended peak of the Cupid's bow without scarring on its point and preserves the three-dimensional structure, including the cutaneous roll.

Simple and efficient method for consecutive inactivation-cryopreservation of porcine skin grafts.

We previously reported that inactivation treatment by high hydrostatic pressurization (HHP) has potential utility as a novel skin regeneration therapy for various skin tumors. In this study, we evaluated whether glycerol-cryopreservation could be applied in order to preserve inactivated skin by HHP using a porcine model. Twenty full-thickness skin grafts (1.5 × 1.5 cm) were prepared from a minipig. The skin samples were inactivated by the HHP in normal saline or glycerol/fructose solution, followed by cryopreservation for 5 weeks at - 80 °C in each same solution. Another 10 grafts immediately after inactivation were prepared as non-cryopreserved controls. Nine grafts in each group were randomly implanted on the fascia of a host pig and removed at 1, 4 and 11 weeks after grafting. All grafts showed engraftment macroscopically. Hematoxylin eosin staining showed the cellular components in all areas of the dermis at 4 and 11 weeks after grafting, and immunohistochemical staining for CD31 showed the presence of capillaries in the grafts in all groups. The surface and cross-sectional areas of grafts in the normal saline solution cryopreserved group decreased between 1 and 11 weeks, whereas these areas in the glycerol cryopreserved group did not decrease significantly. Glycerol cryopreservation may therefore be a simple and efficient method for preserving porcine skin inactivated by HHP.

Primary cutaneous adenoid cystic carcinoma on the lower leg.

Primary cutaneous adenoid cystic carcinoma (PCACC) is a very rare malignant tumor. Here a case of PCACC on the left lower leg with metastasis to the inguinal lymph node. The tumor resection and the inguinal lymph node dissection were performed under general anesthesia, and the defect was covered with free meshed skin graft. No complication or recurrence has occurred after the surgery.

Reconstruction of Medial Canthal Tendon Using Novel Suture Anchoring System: A Case Report.

For medial canthal tendon reattachment, many kinds of surgical technique have previously been reported. They are complicated and generally require technical skill and prolonged operating times. We, for the first time, describe a novel device, the Caraji Anchor Suture System, used for reattaching the medial canthal tendon to the medial orbital wall after removal of squamous cell carcinoma. The medial canthal tendon was excellently fixed with this rapid and simple method. No complications, such as local infection or exposure, have occurred up to the present. This technique appears to be safe, fast, and effective for reconstruction of the medial canthus after tendon avulsion or loss from excision of cutaneous carcinoma in plastic and reconstructive surgery.

Giant Nevus Lipomatosus Cutaneous Superficialis on the Buttock.

Nevus lipomatosus cutaneous superficialis is a benign hamartoma characterized by the presence of mature ectopic adipocytes in the dermis. Here, we report a case of giant nevus lipomatosus cutaneous superficialis, measuring 24 × 14 cm in diameter, on the buttock. The tumor was resected, and the cutaneous defect was closed with a rotation flap under general anesthesia. No complication or recurrence occurred after surgery. Giant nevus lipomatosus cutaneous superficialis is very rare, and repair of the skin defect required plastic and reconstructive surgery.

The Visualization of the Functional Role of the Depressor Septi Nasi Muscle by Ultrasound.

Supplemental Digital Content is available in the text.

The Visualization of the Functional Structure of the Crossing Fibers of the Orbicularis Oris Muscle Using Ultrasound.

Supplemental Digital Content is available in the text.

A Quadrangular Flap Technique for Vermilion Repair in Unilateral Cleft Lip.

In unilateral cleft lip repair, the vermilion triangular flap technique reported by Noordhoff1 and its modification are widely accepted for the augmentation of the vermilion height on the medial side of the cleft; however, these techniques do not focus on the deformity of the labial tubercle. In this article, we herein report a modified technique for vermilion repair that is focused on the labial tubercle. The muco-vermilion quadrangular flap was elevated from the lateral lip to augment the labial tubercle. As a result, the amount of labial tubercle is appropriate. Fifty-three consecutive unilateral cleft lip repairs were performed. In most cases, the amount of the labial tubercle was appropriate, and the curvature of free margin was preferable. The technique could reduce the number of scars on the vermilion by placing some of the suture lines on the oral surface and enabled the augmentation of the labial tubercle. In conclusion, the quadrangular flap can be considered an ideal flap for the construction of the vermilion.

Patient With Cleft Maxillary Hypoplasia Who Underwent Distraction Osteogenesis and Conservative Therapies to Postoperative Velopharyngeal Insufficiency.

The authors performed distraction osteogenesis using The Maxillary Distractor System (SYNTHES) to maxillary hypoplasia patient with cleft lip palate, and consequently improved the aesthetic complexion of the patient. Velopharyngeal insufficiency developed after bone elongation; the authors improved the insufficiency with conservative therapies such as articulatory training using the bulb attached palatal lift prosthesis. The authors were successful and accepted postoperative speech outcome.

Exploration of the wound healing effect of topical administration of nicotine in combination with collagen scaffold in a rabbit model.

Nicotine has been reported to prolong the wound healing; however, we showed that the topical application of 10(-4) M nicotine promoted murine wound healing. The objective of this study was to explore the wound healing effects of nicotine in combination with collagen scaffold using skin defects in rabbit. Three full-thickness skin defects 8 mm in diameter were made on the rabbit auricle. Artificial dermis was applied to the defects, and 10 µl of nicotine solution (10(-5), 10(-4), and10(-3) M), bFGF solution (0.5 µg/10 µl), and both bFGF and 10(-4) M nicotine solutions were injected into the artificial dermis once daily for 7 days. Rabbits were sacrificed on day 10, 15, or 20, and the wound healing process was evaluated. bFGF was superior in the formation of the dermis-like tissue and capillaries. In nicotine groups, the epithelial length and the dermis-like tissue formations in the 10(-4) M group were superior, in contrast, those were inhibited in the 10(-3) M group. The synergistic effect of bFGF and 10(-4) M nicotine was not confirmed. This study suggests that the topical application of 10(-4) M nicotine promoted wound healing in rabbit, but the effect was not apparent compared with murine models.

Conchal Cartilage Graft for Correction of Bilateral Cleft Lip Nasal Deformities during Childhood.

BACKGROUND: Various methods for primary repair of bilateral cleft lip have been developed, but they often produce inadequate results, such as an upturned nose or a short columella. We perform primary lip repair with muscle reconstruction to correct depression of the nasal floor and inferoposterior displacement of the alar base. Then, open rhinoplasty to project the nasal tip is performed during childhood. This article describes the methods and results of open rhinoplasty for bilateral cleft lip patients. METHODS: Open rhinoplasty with a modified forked flap is performed. The harvested conchal cartilage is grafted as a strut to strengthen and extend the septum. The lower lateral cartilages are sutured to the grafted cartilage and fixed in the correct position. Before skin closure, the tips of the 2 V flaps of the forked flap and the reverse V-flap between the forked flap are trimmed. Three trapezoidal flaps are sutured to the base of the columella. Thirty patients with bilateral cleft lip nasal deformities have undergone surgery. The operative results of 15 of 30 patients were evaluated photogrammetrically. RESULTS: The nose was refined and more projected. The nasolabial angle and the nasal tip projection were improved. The reformed configuration was well maintained for many years. Photogrammetric analysis demonstrated increases in both the nasal height-to-width ratio and the nostril height-to-width ratio and a decrease in the nasolabial angle. CONCLUSIONS: Open rhinoplasty during childhood using 3 trapezoidal flaps and conchal cartilage graft improves bilateral cleft lip nasal deformities effectively.

Open rhinoplasty using conchal cartilage during childhood to correct unilateral cleft-lip nasal deformities.

BACKGROUND: Although many articles have investigated the optimal method for the primary correction of nasal deformities during unilateral cleft lip repair, residual nasal deformities often remain. Such residual deformities are commonly corrected around the age of 5. We have started performing two-stage nasal repair operations for unilateral cleft lip patients. During the first stage, the nasal floor is elevated, and the alar base is brought into the correct position by muscle reconstruction during primary lip repair. During the second stage, the slanting nasal apex and drooping alar rim are corrected at pre-school age. This article describes the methods and results of second-stage open rhinoplasty. METHODS: Open rhinoplasty is performed. The conchal cartilage is harvested and used as a strut to strengthen and extend the septum. The lower lateral cartilages are sutured to the grafted cartilage and fixed in the correct position. The operative results of 38 patients were evaluated photogrammetrically. The nasal height, nostril height and the columella angle on a basilar view of the nose were measured. RESULTS: In most patients, the nose was refined and became less distorted. Poorly projecting nasal tips and drooping alar rims were corrected. The reformed configuration was relatively well maintained for many years. Photogrammetric analysis demonstrated increases in both the nasal height to nasal width ratio and the nostril height to nostril width ratio, and improvement of the columella angle. CONCLUSION: Performing open rhinoplasty using conchal cartilage during childhood effectively improves unilateral cleft-lip nasal deformities.