Modification of the position of the angulus oris with a rotation flap and a YV flap in lip reconstruction.

Functionally, the lip serves to prevent food and drink from spilling out of the beginning of the gastrointestinal tract, and it is also used for vocalization. In addition, the lip has cosmetic importance as part of the face involved in making expressions, and in many cultures, it is considered to be sexually appealing. The results of lip reconstruction procedures must therefore be both functionally and cosmetically satisfactory. When the orbicularis oris muscle and oral mucosa are excised, functional reconstruction is prioritized. In contrast, if there are no functional problems, cosmetic reconstruction is the main focus. This case involved the reconstruction of a right upper lip defect caused by a dog bite. When the skin defect was covered with a local flap, the right angulus oris shifted medially, so we incorporated a YV flap at the right angulus oris to modify its position and allow for a cosmetically satisfactory result. We believe that this method can be used not only for cases in which asymmetry of the angulus oris is expected to occur at the time of lip reconstruction, but also for cases in which it has already occurred in the initial operation.

Efficacy of seasonal allergic rhinitis using an 810 nm diode laser system.

BACKGROUND AND AIMS: Allergic rhinitis annually reach epidemic proportions in Japan. Approximately 30 to 40% of the population suffers from allergic rhinitis during the spring season. Symptoms comprise rhinorrhea, nasal congestion, and sneezing accompanied by irritation and itching of the eyes. The Ohshiro Clinic started using the conventional Nd:YAG laser for the treatment of allergic rhinitis in 1993, and from 2005 we started using a diode laser-pumped Nd:YAG laser. From 2010, we adopted a novel 810 nm diode laser, and the present retrospective study examined the efficacy rate of the treatment of allergic rhinitis in the 2018 season with this system, compared with a previous study in 2011. We aimed to confirm the degree of improvement for each symptom to evaluate effectiveness of the diode laser treatment. SUBJECTS AND METHODS: Between January 8, 2018 and April 30, 2018, a large number of patients consulted our clinic with the major complaint of seasonal allergic rhinitis. They underwent a blood test, and the antigen-specific serum IgE antibody titers were measured for a definitive diagnosis of cedar pollinosis. A total of 211 target patients were treated during the trial period. The average age of the target group was 36.3 years, 134 males, and 77 females. The target patients were treated with lower nasal turbinate mucosal irradiation using a diode laser (ADL-20, Asuka Medical) delivering 810 nm at 7.5 W, with a total energy per treatment of 240 J/cm2. We adopted a five-step evaluation in accordance with the Japanese Guidelines for Allergic Rhinitis 2014 for the symptoms of rhinorrhea, sneezing and nasal obstruction. We assessed the degree of improvement in the severity of these symptoms following diode laser treatment from baseline to one month after treatment, in addition to assessing patient satisfaction with the degree of improvement in their quality of life (QOL). RESULTS: The 211 patients positive for cedar pollinosis by the antigen-specific serum IgE antibody tests were broken down by month by number and by improvement, no change or exacerbation as follows. January, 18 patients: 33.4%, 44.4% and 22.2%, respectively. February, 29: 10.4%, 44.4% and 22.2%, respectively. March, 146: 60.3%, 31.5% and 8.2%, respectively. April, 18: 77.8%, 16.7% and 5.5%, respectively. The monthly respective improvement, no change or worse patient QOL as percentages were as follows: January: 16.7%, 44.4% and 38.9%. February: 17.3%, 13.8% and 68.9%. March: 61.6%, 29.5% and 8.9%. April: 94.4%, 0.0% and 5.6%. The values for prevention of exacerbation versus exacerbation for each month were: January, 77.8% vs 22.2%; February, 41.4% vs 58.6%; March, 91.8% vs 8.2%; and April, 94.4% vs 5.6%. The mean efficacy rate for the trial period in the present study was therefore 52.6% which compared very favorably with the mean efficacy rate in the 2011 study of 53.4%. CONCLUSIONS: The results showed that the 810 nm diode laser offered a safe and effective solution for the uncomfortable symptoms of allergic rhinitis and could be well applied during the season of Japanese cedar pollen dispersion. Furthermore, a tendency towards high efficacy was demonstrated for laser treatment in class 6 cedar pollinosis patients, based on the specific IgE antibody test.

Retrospective Study on Laser Treatment of Oral Vascular Lesions Using the "Leopard Technique": The Multiple Spot Irradiation Technique with a Single-Pulsed Wave.

OBJECTIVE: This study aimed to retrospectively evaluate the efficacy and safety of laser treatment of oral vascular lesions using the multiple spot irradiation technique with a single-pulsed wave. BACKGROUND DATA: In laser therapy for vascular lesions, heat accumulation induced by excessive irradiation can cause adverse events postoperatively, including ulcer formation, resultant scarring, and severe pain. To prevent heat accumulation and side effects, we have applied a multiple pulsed spot irradiation technique, the so-called "leopard technique" (LT) to oral vascular lesions. This approach was originally proposed for laser treatment of nevi. It can avoid thermal concentration at the same spot and spare the epithelium, which promotes smooth healing. The goal of the study was to evaluate this procedure and treatment outcomes. PATIENTS AND METHODS: The subjects were 46 patients with 47 oral vascular lesions treated with the LT using a Nd:YAG laser (1064 nm), including 24 thick lesions treated using a combination of the LT and intralesional photocoagulation. RESULTS: All treatment outcomes were satisfactory without serious complications such as deep ulcer formation, scarring, bleeding, or severe swelling. CONCLUSIONS: Laser therapy with the LT is a promising less-invasive treatment for oral vascular lesions.

Usefulness of picosecond pulse alexandrite laser treatment for nevus of Ota.

BACKGROUND AND AIMS: Recently, novel picosecond pulse duration lasers (ps-lasers) have been developed for the treatment of multicolored and recalcitrant tattoos, and safety and efficacy have been reported. We therefore hypothesized that ps-lasers could be an alternative treatment for dermal pigmented lesions. We performed a retrospective review to evaluate the efficacy and safety of the ps-laser for nevus of Ota. SUBJECTS AND METHODS: A retrospective photographic review of 15 patients with nevus of Ota was performed (ages from 10 months to 65 yr). The patients were treated in the Ohshiro Clinic with a picosecond-domain 755 nm alexandrite laser (ps-Alex laser) from June 2015 to August 2017. Improvement was evaluated as the percentage of pigmentation clearance comparing the baseline findings with those at 3 months after the final treatment using a four category grading scale: Poor, 0-24%; Fair, 25-49%; Good, 50-74%; and Excellent 75-100% improvement. Adverse events were also assessed. RESULTS: All patients obtained clinical improvement ranging from fair to excellent. All 5 patients whose primary treatment was the ps-Alex laser obtained excellent in 2-3 treatment sessions (average 2.5 sessions), and the average total treatment span was 10.0 months. Treatment with the ps-Alex laser caused transient hyperpigmentation followed by improvement to complete resolution at 3 months of follow-up. CONCLUSIONS: Our results suggest that 755 nm ps laser treatment is efficacious for the treatment of nevus of Ota with minimum adverse events.

Type 2 Minocycline-induced hyperpigmentation successfully treated with the novel 755 nm picosecond alexandrite laser - a case report.

BACKGROUND AND AIM: Minocycline therapy for acne vulgaris is associated with the occasional induction of various types of unsightly and often persistent hyperpigmentation, which is frequently resistant to hydroquinone treatment. Pigment-specific lasers have achieved some success with multiple treatment sessions. Recently, the picosecond domain 755 nm alexandrite laser (ps-Alex) has attracted attention in tattoo removal. The present study reports on the successful treatment, in a single ps-Alex session, of minocycline-associated pigmentation. SUBJECT AND METHOD: Subsequent to a course of minocycline, a 28-year-old Asian female developed persistent type 2 minocycline-related pigmentation on the bilateral lower extremities which was recalcitrant to hydroquinone treatment. The patient had a test treatment on a small area with a Q-switched ruby laser and the ps-Alex, following which the ps-Alex was selected for the actual treatment (spot size, 2 mm; fluence, 6.37 J/cm2; pulsewidth, 750 ps) on one leg first, followed later by the contralateral leg. RESULTS: Rapid clearance of the pigmentation was noted after a single ps-Alex session on both limbs without prolonged post-inflammatory hyperpigmentation (PIH). At one year post-treatment, clearance had been maintained. CONCLUSIONS: Our results in this single case strongly suggest that the novel 755-nm ps-Alex laser is both safe and very effective for the treatment of type 2 minocycline-induced hyperpigmentation even in PIH-prone type IV Asian skin. Further trials with larger patient populations are warranted to confirm this optimistic result.

Picosecond pulse duration laser treatment for dermal melanocytosis in Asians : A retrospective review.

Background and aims: Recently novel picosecond duration lasers (ps-lasers) have been developed for the treatment of multicolored and recalcitrant tattoos, and safety and efficacy have been reported. We therefore hypothesized that the ps-laser could be an alternative treatment for dermal pigmented lesions and performed a retrospective review to evaluate the efficacy and safety of the ps-laser. Subjects and methods: A retrospective photographic review of 10 patients with dermal pigmented lesions was performed (ages from 4 months to 52 yr), 6 nevus of Ota, 3 ectopic Mongolian spots and 1 Mongolian spots. The patients were treated in the Ohshiro Clinic with picosecond 755 nm alexandrite laser (ps-Alex laser) and picosecond 1064 nm Nd:YAG laser (ps-Nd:YAG laser) from April 2014 to December 2015 (ps-Alex laser, 7 patients; ps-Nd:YAG laser, 3 patients, 1 to 3 treatment sessions). Improvement was evaluated as percentage of pigmentation clearance comparing the baseline findings with those at 3 months after the final treatment using a five category grading scale: Poor, 0-24%; Fair, 25-49%; Good, 50-74%; Excellent, 75-94%; and Complete, 95-100% improvement. Adverse events were also assessed. Results: All ten patients obtained clinical improvement ranging from fair to excellent. Treatment with the ps-Alex laser caused transient hyperpigmentation followed by improvement to complete resolution at 3 months follow-up. The ps-Nd:YAG laser caused severe transient erythema and swelling but no post-inflammatory hyperpigmentation. Conclusions: Our results suggest that the 755 nm and 1064 nm ps-lasers are efficacious for the treatment of dermal pigment lesions, with minimum adverse events.

Investigation regarding prevention of insufficiency fractures in children with severe cerebral palsy by Light-Emitting Diode (LED) irradiation.

Bone metabolism in children with severe fractures was examined, risk factors for fractures were characterized, and effects of LED (light-emitting diode) irradiation on the risk factors for fractures were investigated. Since insufficiency fracture in children with severe cerebral palsy can be caused without obvious external force in daily care, it is sometimes handled as a medical accident and can lead to a lawsuit. It is very important to explain the possibility of an insufficiency fracture to guardians before a fracture is caused. However, risk factors for fractures in bone metabolism has not been well investigated and preventive treatment of fractures have also not been established. Risk factors in bone metabolism were investigated in 14 cases of insufficiency fracture in children with severe cerebral palsy accompanied by akathisia in this study. Fractures were likely caused around 8 years old when children grew rapidly, and either IGF-1 or BAP showed low values in all cases. A group with LED irradiation consisting of 25 cases indicated a normal value of IGF-1 related to bone growth, BAP related to bone density and NTX/Cr. A case irradiated to LED for more than one month clearly showed normal bone metabolism compared with the change within a non irradiated group after one year. LED irradiation increased bone density and femur cortical bone thickness, and improved bone age. Adequate effects were not seen in two children at 14 years of age. The commercially available LED light bulbs that we used have a peak at 446-477 nm in the blue wave length, but also have second peaks at 574 nm in green, at 590 nm in yellow, and even 612 nm in orange and 660 nm in red are included. Although it is thought that such a variety of wave lengths might have a good influence on bone metabolism; exposure time and distance, number of regions, and time period irradiated to LED are important factors, since the LED power density is low (0.9 mW/m(2) with a 30 cm distance). Our results suggest that LED irradiation can be a phototherapy to activate human homeostasis.

Treatment strategies for large oral venous malformations using intralesional laser photocoagulation.

We report two treatment strategies using intralesional laser photocoagulation (ILP) for large venous malformations (VMs) in the oral cavity. ILP is considered to be an effective technique for massive vascular lesion. The satisfactory results could have been obtained, since we started ILP for the treatment of large VMs. Recently, to improve the safety, reliability, and effectiveness of the treatment, we developed modifications of ILP that include a combination of ILP and transmucosal irradiation; and compartmentalization and serial step irradiation. In the former, ILP is performed for a deep layer lesion and transmucosal irradiation with multiple spots fashioned using a single pulse is added for the superficial layer in the same session, to increase the efficacy of regression. In the latter, the lesion is divided by virtual compartment and each area will be sequentially treated by ILP. The irradiated area and total energy in a session should be limited to avoid severe reactions and excessive thermal destruction of surrounding tissue. All treatment outcomes by each technique were satisfactory without serious complications, such as deep ulcer formation, bleeding, or severe swelling developing obstruction. Both treatment strategies improve the safety, reliability, and effectiveness of ILP and make the method less traumatic for patients.

Correct calibration procedure for the Q-switched ruby laser and checking the treatment irradiation pattern.

BACKGROUND AND AIMS: There are many Q-switched lasers. The Q-switched ruby laser is the one most popularly used in dermatology, aesthetic surgery and plastic surgery, to remove pigmented lesions or tattoos. Correct and regular calibration of such a system is essential. However, some clinics fail to perform this with the excuse of having no measuring instrument (MI) in their offices or treatment rooms in some of their hospitals or clinics, or even the case of well-known medical universities in Japan. The present article explains the precise calibration procedure and beam pattern checking for the Q-switched ruby systems in the first author's clinic. RATIONALE: In the case of treatment with a medical laser, the calibration and the irradiated pattern (IP) check of the laser being used for treatment are the most important factors for treatment efficacy and safety. If these factors change, the treatment result could be different from that expected. Such kind of data are not acceptable as scientific information for a presentation or published paper. With such unreliable results and incorrect beam pattern, replicating such a study would be impossible Regular calibration check: In our clinic, we have 2 Q-switched ruby laser systems. On a daily basis, the beam patterns, both the optical axis of the beam and its treatment footprint, are checked on dedicated printed sheets and footprint paper, respectively, at the beginning of the day and after the last procedure. Every two weeks we calibrate our systems in-house using a precise MI. Every six months we calibrate the systems in-house with the MI, and then we send the systems back to the manufacturers for calibration. Once every year, we have our MI calibrated by an accredited facility in Japan. In this way, we are not only ensuring accurate and safe treatment for our patients, but we are also producing accurate system and treatment data which can be replicated by others, the basis of evidence-based medicine.

Laser scar management technique.

BACKGROUND AND AIMS: Scars are common and cause functional problems and psychological morbidity. Recent advances in optical technologies have produced various laser systems capable of revising the appearance of scars from various etiologies to optimize their appearance. METHODS: Laser treatment can commence as early as the time of the initial injury and as late as several years after the injury. Several optical technologies are currently available and combined laser/light treatments are required for treatment of scars. Since 2006, we have set up a scar management department in our clinic and more than 2000 patients have been treated by our combined laser irradiation techniques. Herein, we review several available light technologies for treatment of surgical, traumatic, and inflammatory scars, and discuss our combined laser treatment of scars, based upon our clinical experience. RESULTS AND CONCLUSIONS: Because scars have a variety of potential aetiologies and take a number of forms, no single approach can consistenty provide good scar treatment and management. The combination of laser and devices is essential, the choice of wavelength and approach being dictated by each patient as an individual.

Comparative Study Between Pre-Seasonal and Intra-Seasonal Treatment of Allergic Rhinitis Using a New 808NM Diode Laser System.

BACKGROUND AND AIMS: Allergic rhinitis annually reaches epidemic proportions in Japan, and represents a major problem. The application of the CO2 laser in the treatment of allergic rhinitis was first successfully reported in 1982, but CO2 laser ablation is associated with side effects. The Ohshiro Clinic started using the conventional Nd: YAG laser for the treatment of allergic rhinitis in 1993, and from 2005 we started using a diode laser-pumped Nd: YAG laser with efficacy and safety at least equal to the others. Even more recently, we have adopted a novel 808 nm diode laser, and the present retrospective study examined the difference in of the efficacy rate between the pre-seasonal and intra-seasonal treatment of allergic rhinitis with this system. SUBJECTS AND METHODS: One thousand, two hundred and ten patients primarily presented to the Ohshiro Clinic with allergic rhinitis during the period from December 2010 to April 2011, of whom 531 were selected for blood tests to identify 13 kinds of Japanese allergens including cedar pollen. In the 2010-2011 season, huge clouds of cedar pollen appeared from February 26(th). The subjects were therefore divided into two groups depending on the treatment period, namely the pre-seasonal and intra-seasonal groups, December 1(st), 2010 to February 25(th), 2011 and February 26(th) to April 6(th) 2011, respectively. All patients were treated with the new 808 nm diode laser system. RESULTS: A high success rate was achieved in both groups, with no significant difference seen regarding the symptoms of rhinorrhea, obstruction, sneezing, quality of life (QOL) or severity. CONCLUSIONS: The 808 nm diode laser offers an excellent solution for the uncomfortable symptoms of allergic rhinitis, and could be equally well applied before or during the Japanese cedar pollen dispersed season.

Bone Metabolism in Cerebral Palsy and the Effect of Light-Emitting Diode (LED) Irradiation.

In recent years, through the availability of examination by bone metabolism markers, diagnosis and treatment for osteoporosis in elderly people has been greatly advanced. However, bone metabolism in cases of cerebral palsy has not been fully examined. Though children with cerebral palsy tend to be susceptible to insufficiency fractures, a method of treatment for insufficiency fractures has not been established. In the longitudinal progress of bone metabolism, although there was a difference depending on the severity, reduced bone resorption tended to be mild but osteo-genesis tended to decrease in the severe cases. Osteogenesis and bone resorption markers decreased at around ages 8 and 15. The bone resorption marker maintained mild advancement after age 15. With LED irradiation, all of IGF-1, ucOC, osteogenic marker; BAP, and urinary bone resorption marker; NTx/Cr showed a tendency to normalize. In particular, IGF-1, BAP, and NTx/Cr increased significantly one month after irradiation, compared to the non-irradiation group. Bone density assessed by the DIP method showed no apparent change in the short term either. Irradiation by a commercial LED light bulb indicated a possible positive effect on bone metabolism for children with severe cerebral palsy.

Histological responses of cutaneous vascular lesions following photodynamic therapy with talaporfin sodium: a chicken comb model.

BACKGROUND: Mono-L-aspartyl chlorin e6 (Talaporfin sodium) is a novel photosensitizer, and is currently being used in photodynamic therapy for various malignant tumors in combination with irradiation with a 664 nm laser. An interesting characteristic of Talaporfin sodium is that the skin photosensitivity after injection of this agent disappears faster than any other existing photosensitizers. This study examined the vascular events that occurred postirradiation in the chicken comb as a capillary malformation model after photosensitization with Talaporfin sodium. MATERIALS AND METHODS: A single intravenous bolus injections of Talaporfin sodium was administered to the chickens, and a 1 cm diameter area of the comb of each animal was irradiated with a 664 nm visible red laser. The gross changes in the chicken combs were recorded for 7-14 days after photodynamic therapy. For the histological examination, HE, PTAH and Azan stained sections were analyzed. RESULTS: All treated chicken combs had blanched after photodynamic therapy. Microscopy demonstrated an absence of erythrocytes and the vessel lumina were obliterated, leaving the normal overlying epidermis completely intact. Concomitantly with selective destruction of the capillaries in the target area, moderate invasion of inflammatory cells and a slight increase in the stroma were observed. CONCLUSIONS: In the chicken comb model, photodynamic therapy with Talaporfin sodium effectively achieved selective destruction of the microvasculature while leaving the epidermis intact. Our results strongly suggest that photodynamic therapy with Talaporfin sodium could be a feasible method to treat dermal hypervascular lesions.

Reconstruction of the levator function and conjunctiva using an inferiorly based orbital septal flap for subtotal full-thickness defects of the upper eyelid: two cases of ocular sebaceous carcinoma.

Without using the lower eyelid, functional reconstruction of the tarsoconjunctival layer is challenging for subtotal full-thickness defects of the upper eyelid. In 2 cases of ocular sebaceous carcinoma, the levator function and conjunctiva were reconstructed using the inferiorly based orbital septal flap and conchal cartilage graft. The raw surface of the orbital septal flap was epithelialized within 14 days postoperatively. The new upper eyelid with a stable lid margin could open and close properly. Our surgical procedures may be available in the case that the lower eyelid is not usable.