[Show abstract][Hide abstract] ABSTRACT: The degree to which the jejunum can reach upward is a significant consideration in cervical oesophagus reconstruction with vascularised free jejunum transfer using the thoracoacrominal vessels as recipient vessels. The present study aims to elucidate this issue.
In 30 fresh cadavers, the thoracoacrominal vessels were dissected, and the jejunums were harvested, carrying the second branches of the superior mesenteric arteries and veins as their pedicles. After the mesenteric vessels were anastomosed to the thoracoacrominal vessels, the jejunums were advanced to their maximum upward degree, and the positions of the oral ends were evaluated referring to the hyoid bone. The evaluation was performed under three conditions. In the first condition, the jejunums were simply advanced. In the second condition, tension of the mesenteriums was reduced by incising their serosa. In the third condition, mesenterial incision was also performed, and the anastomosed pedicles were placed under the clavicles.
The jejunums can reach superior to the hyoid bone by 2.1 ± 1.5 SD cm for males and by 1.9 ± 1.5 SD for females. By incising the mesenteric serosa, these distances can be extended by about 2 cm for males and 1 cm for females. Further extension of 2 cm can be obtained for both sexes by placing the pedicle under the clavicle.
With patients whose neck regions lack vessels available for vascular anastomosis, the thoracoacrominal vessels are used in free jejunum transfer for cervical oesophagus reconstruction. The findings of the present study are useful in planning this type of reconstruction.
No preview · Article · Sep 2011 · Journal of Plastic Reconstructive & Aesthetic Surgery
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: As the antihelix is created in the operation for prominent ear, the helix often presents irregularities. This biomechanical study aims to elucidate effective techniques to prevent these irregularities. METHODS: Finite element models were produced simulating 10 prominent ears. The scaphas of the 10 models were thinned to simulate scoring or abrasion of the cartilage. The thinning was conducted in four fashions. In the first group, no thinning was conducted (Non-Scoring Models); in the second group, the upper half of the scapha was thinned (Upper-Scoring Models); in the third group, the lower half of the scapha was thinned (Lower-Scoring Models); in the fourth group, the whole scapha was thinned (Whole-Scoring Models). Mattress sutures were applied to create the antihelix to simulate Mustarde's in-suture technique. Thereafter, transformation of the helix's contour was evaluated. RESULTS: Irregularity developed on the upper region of the helix with Non-Scoring and Lower-Scoring Models; the degree of the upper-region's irregularity was reduced with Upper-Scoring Models and Whole-Scoring Models. Although the edge of the helix moved in the posterior-medial direction with other type models, it moved in the anterior direction with Whole-Scoring Models. CONCLUSION: Irregularity of the upper region of the helix can be prevented by performing scoring or abrasion of the upper part of the scapha. The prominence of the helix and width of the auricle are adjustable by varying the areas of the scapha receiving scoring or abrasion. These findings are useful in improving operative outcomes in the treatment of prominent ears.
No preview · Article · Aug 2011 · Journal of cranio-maxillo-facial surgery: official publication of the European Association for Cranio-Maxillo-Facial Surgery
[Show abstract][Hide abstract] ABSTRACT: This report addresses a pitfall of decompression for severe exophthalmos. In mild cases, removal of the orbital floor is an effective treatment, but in severe cases, the results of this approach are sometimes unsatisfactory, and only decompression is necessary. In these cases, orbital decompression in 3 areas including the medial wall, the lateral wall, and the orbital floor is usually performed. A 5.0-mm mean reduction in exophthalmos is observed, but more reduction is difficult to achieve.We considered the possibility that removal of the posterior wall of the maxillary sinus is critically important to achieving greater recovery. It is proposed that this technique is effective in creating about 10 mm of improvement for severe exophthalmos.
No preview · Article · Jul 2011 · The Journal of craniofacial surgery
[Show abstract][Hide abstract] ABSTRACT: This report describes a pitfall of reconstruction for severe enophthalmos after time has passed following traumatic injury. In severe cases, hypoglobus may be refractory to reconstructive surgery. The posterior wall of the maxillary sinus is sometimes implicated in severe enophthalmos. Thus, we considered that reconstruction of this posterior wall is critical for improvement in hypoglobus. In addition, a satisfactory contour and improvement in hypoglobus were maintained postoperatively.
No preview · Article · Jul 2011 · The Journal of craniofacial surgery
[Show abstract][Hide abstract] ABSTRACT: Although hemangioma is a common soft tissue tumor, in the oral and maxillofacial region, hemangioma of bone is very rare, especially in a zygoma. A 47-year-old woman was admitted complaining of a hard mass in the zygomatic region, which had first been noticed 1 year previously. Plain roentgenograms revealed a well-marked spoke-wheel trabeculation diverging from the center of the mass. CT scans demonstrated the same findings. From the excision biopsy, the lesion was suspected to be cavenous hemangioma with malignant hemangioendothelioma. We performed complete excision and reconstructed the full-thickness defect of the zygomatic bone with an artificial bone made ahead of operation and calcium phosphate cement. The implant, maintained at 7 months, continued to have a successful outcome. It is useful in zygomatic bone reconstruction because of shortening of operation time and control of bleeding, conditioning the figure side.
[Show abstract][Hide abstract] ABSTRACT: The present paper introduces a rare case of congenital unilateral hypoplasia of the nose. A 29-year-old woman consulted the authors' institute complaining of asymmetric appearance of the nose. Besides the external nose, the nasal cavity and paranasal sinuses were also involved in the deformity; computerised tomography scanning revealed complete absence of the right nasal cavity and right maxillary sinus. The nasal septum, left nasal cavity, and left maxillary sinus were not impaired. The asymmetry of the nose was corrected using local flaps. Since the patient did not have major functional disturbances, correction was not performed for the absence of the right nasal cavity and the right paranasal sinuses. Aetiology and treatment for congenital hypoplasia of the nose are discussed in the present paper.
No preview · Article · Jul 2008 · Journal of Plastic Reconstructive & Aesthetic Surgery
[Show abstract][Hide abstract] ABSTRACT: Large, full-thickness defects are often produced in the lower lip particularly after malignant tumor resection. Various reconstruction techniques to treat an extensive defect of the lower lip have been proposed in the past, but they have their advantages and disadvantages, and few have proved satisfactory in terms of function and cosmetic appearance. Here, we report a new technique for reconstruction of the lower lip that we have proposed (Fusuma sliding flap). With this technique, skin for the defect site comes from a laterally designed quadrilateral flap of the same width, and mucosa for the defect site comes from a V-Y advancement mucosal flap expanded 5 mm cranially; these flaps are then slid to the midline, filling the defect. Vermilion is reconstructed by covering the expanded and attached mucosa, and the flap donor site is closed by a V-Y advancement flap of the nasolabial fold. Since this technique allows nerve preservation, can reconstruct the natural continuity of muscle, and produces no distortion of the corner of the mouth, it allows satisfactory reconstruction of motor and sensory function. In addition, the suture line follows RSTL, so the procedure is also superior in terms of the cosmetic appearance it provides.