A survey of public attitudes toward uterus transplantation, surrogacy, and adoption in Japan.

This study aimed to evaluate the attitudes of male and female members of the public toward uterus transplantation (UTx), surrogacy, and adoption in Japan via a web-based survey. One thousand six hundred participants were recruited with equal segregation of age (20s, 30s, 40s, and 50s) and gender. We assessed the association between ethical view and gender, age, infertility, and the knowledge level of UTx, using a questionnaire. The findings were as follows. First, 36.5% and 31.0% of respondents agreed that UTx and gestational surrogacy should be approved, respectively. Second, the respondents would potentially choose to receive UTx (34.4%), gestational surrogacy (31.9%), and adoption (40.3%), if they or their partners experienced absolute uterine factor infertility. Third, 10.1%, 5.8%, and 14.3% of the respondents chose UTx, gestational surrogacy, and adoption as the most favorable option, respectively. Fourth, if their daughters suffered from absolute uterine factor infertility, 32.3% of female respondents might want to be donors, and 36.7% of male respondents might ask their wives to be donors. These data were affected by age, gender, infertility, or the knowledge level of UTx. UTx was a more acceptable option than gestational surrogacy and adoption. The effects of gender, age, infertility, and the level of knowledge of UTx are important in understanding the attitude toward UTx. On the other hand, there were concerns about the safety of UTx for recipients, donors, and babies. It is important to continue to understand public attitudes to inform the development and safety of UTx, which will enhance the discussion on the ethical consensus on UTx.

Occlusal difficulties after simultaneous mandibular and maxillary distraction in an adult case of hemifacial microsomia.

A 23-year-old woman with hemifacial microsomia type IIB was treated by simultaneous mandibular and maxillary distraction. During the course of the distraction, cephalometric analysis showed that the maxilla was not moving downward and that the upper edge of the mandibular condyle was moving upward into the space between the condyle and the glenoid fossa. This phenomenon could lead to early consolidation of the osteotomized maxilla, resulting in malposition and occlusal difficulties. This is thought to be a problem unique to bimaxillary distraction of hemifacial microsomia type IIB with severe hypoplasia of the mandibular ramus and space between the condyle and the glenoid fossa. Surgeons should be alerted to this risk and prepared to address it when performing this procedure.

Intracranial hemorrhage resulting from skull base fracture as a complication of Le Fort III osteotomy.

Various complications of Le Fort osteotomies have been reported. We describe a lethal complication of Le Fort III osteotomy we encountered in a 9-year-old boy with Crouzon syndrome. A standard Le Fort III osteotomy, including pterygomaxillary dysjunction with a curved osteotome and down-fracture manipulation, was performed uneventfully. When the intraoral buccal wound was closed after fixation of the external midface distraction devices, we discovered hemorrhage originating from the right posterior maxillary region. Although it was stopped with pressure on the osteotomized maxilla, the volume of intraoperative blood loss was nearly 2,000 ml. During the observation period in the intensive care unit, the patient suffered brain death, and he died 3 months later. A computed tomography scan obtained the day after surgery revealed vigorous subarachnoid and intraventricular hemorrhage and transverse fracture of the middle cranial fossa. This skull base fracture was believed to result from intraoperative maneuvers, including the pterygomaxillary dysjunction and down-fracture manipulation. We emphasize the risk of intracranial hemorrhage with Le Fort osteotomy and advise discussing this risk with patients and family members during preoperative consultations.

Sclerotherapy of hemangioma with late involution.

BACKGROUND: Most cutaneous hemangiomas involute spontaneously. However, the lesion existing on the face poses a cosmetic problem during the waiting period for involution. METHODS: Hemangioma showing late involution was treated by local injection of monoethanolamine oleate solution. RESULTS: The lesion flattened and was excised serially. CONCLUSION: Sclerotherapy with monoethanolamine oleate can shorten the waiting period for involution and can decrease the risk of psychosocial trauma. Moreover, it provides good preparation for further surgery. Such sclerotherapy is effective in the treatment of hemangioma with late involution.

Segmental distraction of the midface in a patient with Crouzon syndrome.

We treated midface hypoplasia in a 20-year-old woman with Crouzon syndrome using a rigid external distraction device. The patient showed severe exophthalmos and maxillary retrusion, although relatively good occlusion had been achieved by long-term orthodontic procedures. We considered that our patient's particular condition could not be resolved by the usual Le Fort III osteotomy/midface distraction procedure, so we devised a segmental approach. The midface, mobilized by Le Fort III osteotomy, was divided into two segments by Le Fort I osteotomy; each fragment was connected to the rigid external distraction device to be distracted separately. Distraction was begun after 1 day at 1 mm/day. The upper and lower segments were distracted over 17 and 12 days, respectively. The patient's occlusion was fully corrected, and her facial contour was significantly improved. After 3 weeks of consolidation, we removed the distraction device. The clinical course was without complication, and no relapse was observed on the cephalogram or computed tomography scan obtained 1 year after the procedure. Our modified technique was helpful in increasing the usefulness of the external distraction system and in refining the midface distraction procedure.

Correction of a deformed thumb by distraction of the phalanx.

We used distraction osteogenesis to correct six deformed thumbs in four patients ranging in age from 4 to 7 years. Two of the patients had Apert syndrome (syndromic craniosynostosis with symmetrical syndactyly) and two had polydactyly. We used a small fixator with a ball joint and successfully corrected the angular deformity after lengthening the proximal phalanx by distraction. This single inclusive procedure was extremely useful. We found the optimal distraction regimen for the digital phalanx was a one day waiting period and lengthening at 1 mm/day. The mean healing indexes were 37.2 days/cm (range 24.2 to 41.5) in those with Apert syndrome and 64.3 days/cm in those with polydactyly (62.5 and 66.0). Our results suggest that osteogenesis at the distraction site may be quicker in patients with Apert syndrome than in those with polydactyly.