Clinical success of mandibular distraction for obstructive sleep apnea resulting from micrognathia in 10 consecutive Japanese young children.

In recent years, obstructive sleep apnea has gained attention as one of the causes of sudden death in young children. There have been some reports, mainly from the United States and Europe, that mandibular distraction osteogenesis is effective as a treatment for obstructive sleep apnea syndrome caused by micrognathia in young children. However, there has not been any report yet in Japan. In this study, we performed mandibular distraction osteogenesis using internal devices in 10 young children with obstructive sleep apnea. To enable distraction to be performed smoothly without any difficulties, we modified a surgical procedure by adding an osteotomy of the coronoid process to a vertical ramus osteotomy. Postoperative evaluations using cephalograms and polysomnography were performed, and great improvements were observed. As a result, all patients either avoided or were weaned from tracheostomy, and very good results were obtained similar to those in reports from the United States and Europe. We report our experience in Japan.

Sinus pericranii associated with craniosynostosis.

Sinus pericranii is a vascular tumor of the head having communication with the dural venous system. The tumor enlarges with increased intracranial pressure when the patient is in the lateral recumbent position. Since Stromeyer used the term "sinus pericranii" in his report in 1850, approximately 170 cases have been reported. However, relatively few cases of sinus pericranii have been reported in association with craniosynostosis or by plastic surgeons. In this study, we report seven cases of sinus pericranii associated with craniosynostosis. There were two patients with Apert syndrome, two with Crouzon syndrome, two with oxycephaly, and one with trigonocephaly. The sites of occurrence were the parietal region in six patients and the frontal region in one patient. In either type of case, the tumor was clinically a soft subcutaneous mass of the head. The clinical characteristics of the tumor were its disappearance when the patient was in a sitting position and its appearance when the patient was in a recumbent position or crying. The patients were preoperatively diagnosed with sinus pericranii from imaging test findings, such as from magnetic resonance imaging and aforementioned clinical findings. In all cases, treatment for sinus pericranii was performed during the surgery for craniosynostosis. For patients with lesions in either site, we did not perform craniotomy, and we used a minimally invasive method of tumor excision and resection of the sites of communication using electrocoagulation. Perioperatively, heavy hemorrhage was not observed, and, postoperatively, no recurrence has been observed in any patient. In this study, we examine the etiology, diagnosis, and treatment of sinus pericranii, in particular for patients with craniosynostosis.

Basal cell carcinoma with sebaceous differentiation.

Some authors have used sebaceous epithelioma as a synonym for basal cell carcinoma (BCC) with sebaceous differentiation. However, our review of the literature revealed that definite cases of BCC with sebaceous differentiation that provide adequate clinical and histopathologic information are scarce. We present the case of a 72-year-old woman with a pigmented nodular lesion on her right ala nasi region, clinically diagnosed as pigmented BCC. Histopathologically, this nodular lesion, which was completely excised, showed typical features of BCC. It was noteworthy that within one aggregation of the presented BCC, tiny and small duct-like structures lined by cornified layers with a crenulated inner surface were seen. Vacuolated cells were scattered within a few aggregations, and they had foamy, bubbly cytoplasm and starry nuclei. The vacuolated cells were immunohistochemically positive for epithelial membrane antigen (EMA). These histopathologic findings demonstrated unquestionable sebaceous differentiation in this BCC, namely BCC with sebaceous differentiation, which should be distinguishable from both sebaceoma and sebaceous carcinoma. The small duct-like structures lined by eosinophilic cuticle, indicating apocrine differentiation, were also observed in this BCC.

Composite Z plasty for cicatricial ectropion of Tessier III cleft.

Tessier III clefts represent one of the most difficult and challenging malformations of the face to repair. Ectropion caused by a Tessier III cleft may be secondary to a vertical loss of both the anterior and posterior lamellae of the lower eyelids.A composite Z plasty to treat recurrence of cicatricial ectropion of the lower eyelids in Tessier III cleft is described. This is not only a technically easy and effective surgical method but also has a short operation time. To the best of the authors' knowledge, this is the first report of the application of a composite Z plasty in the successful treatment of ectropion.

Three-dimensional cranial expansion using distraction osteogenesis for oxycephaly.

Oxycephaly is associated with raised intracranial pressure as a result of the fusion of multiple cranial sutures. We have performed an effective and less invasive cranial expansion by means of three-dimensional cranial distraction for the treatment of oxycephaly with suspicion of increased intracranial pressure. We describe two oxycephaly cases and the surgical technique of three-dimensional cranial expansion using distraction osteogenesis.

Intramuscular benign lipoma of the temporalis muscle.

An intramuscular lipoma within the musculature of the head and neck is unusual. Most of them are infiltrating lipomas, and we know of no description of a well-circumscribed lipoma of the temporalis muscle. We present a 64-year-old woman who had a non-pulsatile, soft, mobile mass in the right temporal fossa. The lesion 11 x 8 x 3 cm in size was diagnosed using magnetic resonance imaging, it was resected, and she has recovered well with a good cosmetic result.

Staged cranial reconstruction after epidural abscess associated with dural substitute exposure.

UNLABELLED: Cadaveric dura mater was widely used for a long time but has recently been associated with the transmission of Creutzfelt-Jakob disease. Expanded polytetrafluoethylene sheet has been suggested as a suitable alternative in Japan. Recently epidural abscesses associated with exposure to Expanded polytetrafluoethylene have been on the increase in Japan. We experienced one case of staged cranial reconstruction for chronic ulcer of the head associated with MRSA epidural abscess. SURGICAL TECHNIQUE: the exposed expanded polytetrafluoethylene must be completely removed along with the skin. Reconstruction of dura mater should be made watertight with the application of autologous free fascia lata collected from the paralyzed thigh. Autologous free fascia lata is reconstructed with the rectus abdominis muscle so that there is no dead space remaining. Calvarial bone should be reconstructed in a separate operation as at a second stage.

Different types of arteriovenous anastomoses between femoral artery and vein distal to the island groin flap.

An experimental study was done in rats in which the animals were randomly divided into four groups. Each group included bilateral standard island groin flaps. The right side flap was used as control. On the left side, after elevation of the flap, different types of arteriovenous connections were constructed distal to the pedicle between the femoral artery and vein. The connection type was a type-C (end-to-end) anastomosis in Group 1; a type-X (side-to-side) anastomosis in Group 2; a type-T a (artery-end-to-vein-side) anastomosis in Group 3; and a type-Tv (vein-end-to-artery-side) anastomosis in Group 4. Flow values in the flaps were measured externally and repeatedly using a laser Doppler flowmeter. Extremity changes, signs of congestive heart failure, flap weights (measured at the end of the study), thrombosis at the anastomosis or distal to it, edema in the flaps, subcutaneous venous stasis, and aneurysm formation in the anastomoses were observed. Histopathologic evaluations were also done. Only the side-to-side anastomosis group showed any aneurysm formation in the distal vein, as well as extremity changes and signs of congestive heart failure in some of the animals. Only the artery-end-to-vein-side group showed distal thromboembolism in some animals. All flaps survived, but there was prominent edema in the flaps of Group 2 and Group 4 animals in decreasing order. All the study flaps demonstrated subcutaneous venous stasis and capsule formation. The authors concluded that although any arteriovenous communication located distal to the pedicle of an island skin flap that connects the arterial to the venous system, bypassing microcirculation, may have some beneficial effects, it is not devoid of some possibly hazardous developments, including edema formation and venous stasis.