Large ulceration of the oropharynx induced by methotrexate-associated lymphoproliferative disorders.

We present a case of a 67-year-old Japanese man with a serious oropharyngeal ulceration that at first seemed to be destructive malignant lymphoma or oropharyngeal carcinoma. We suspected methotrexate (MTX)-associated lymphoproliferative disorder (LPD) induced by MTX treatment for rheumatoid arthritis (RA). About 3 weeks after simple discontinuation of MTX, complete regression of the disease was observed, confirming our diagnosis.

[Double anterior (anterolateral and anteromedial) thigh flaps for reconstruction of head and neck defects].

Although the anterolateral and anteromedial thigh flaps have such disadvantages as anatomical variations in the lateral circumflex femoral system and its cutaneous perforators, they have a sufficient number of cutaneous perforators on the anterior aspect of the thigh in many cases, meaning double anterior thigh flaps can be elevated from the ipsilateral thigh. We report 8 cases in which single-pedicle double anterior thigh flaps were transferred for reconstruction of head and neck defects following resection of head and neck tumors from January 1995 to March 2001 at Okayama Saiseikai General Hospital. Eight double anterior thigh flaps were classified into the following 3 types by perforator derivation: Type I flaps consisting of double anterolateral thigh flaps with a single vascular source were elevated in 4 cases. Type II flaps consisting of anterolateral thigh flap and anteromedial thigh flap supplied by separate branches from a single vascular source were elevated in 2 cases. Type III flaps, in which two anterior thigh flaps were harvested separately and constructed into a single flap with microvascular anastomosis, were elevated in 2 cases. Double anterior thigh flaps were combined with vascularized bone, and 2 flaps supplied by independent long vascular pedicles from a single vascular source could be 3-dimensionally arranged. All flaps completely survived in 7 cases and functionally and aesthetically acceptable results were obtained except in 1 case whose flap was lost to major necrosis after infection. We concluded that the single-pedicle double-flap technique using anterior thigh flaps is useful in 3-dimensional reconstruction of massive complex head and neck defects since sufficient tissue implant with preserved blood flow and free flap arrangement is made available.

The potential of a plastination specimen for temporal bone surgery.

OBJECTIVE: The benefits of plastination specimens in temporal bone surgery (TBS) were evaluated. METHODS: A formalin-preserved human temporal bone was drilled and dissected with the middle cranial fossa approach or the translabyrinthine (or transcochlear) approach. The specimen was thereafter subjected to silicon impregnation. RESULTS: The flexibility of the dura mater after plastination was maintained, and not only bony structures such as the auditory ossicles and semicircular canals but also soft tissues such as the facial nerve, internal carotid artery and the sinus attached to the dura mater were easily discriminated. CONCLUSION: The technique furnishes a persistently dry, odorless and durable specimen that allows handling and may serve as the most ideal specimen for anatomical learning of various approaches of TBS.