Takatoshi Yotsuyanagi

Sapporo Medical University, Sapporo, Hokkaidō, Japan

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Publications (97)132.23 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: To clarify the relationship between mandibular ramus height and function of masticatory muscles in patients with hemifacial microsomia. Design: Retrospective study of imaging and physiological data. Setting: Images and physiological data were obtained from the records of Sapporo Medical University Hospital. Patients: A total of 29 patients with hemifacial microsomia who showed Pruzansky grades I, II deformity. Main outcome measures: Mandibular ramus height and masticatory muscle volume were evaluated with multi-detector row computed tomography. The electromyographic value was measured by the K7 Evaluation System. The hemifacial microsomia patients were classified into three groups based on the mandibular ramus height ratio of the affected and unaffected sides: group 0, >1.00; group 1, 1.00 to 0.85; group 2, <0.85. The Tukey-Kramer method and Games-Howell method were used to determine correlations between parameters. Results: Decreased mandibular ramus height was significantly correlated with both reduced electromyographic values of the masseter muscle (P < .05) and the amount of mandibular lateral deviation at the time of maximum opening (P < .05) on the affected side. These differences were prominent in unilateral hemifacial microsomia patients classified as group 2. Conclusions: Decreased mandibular ramus height may cause dysfunction of the masseter muscles but not the temporal muscle on the affected side in patients with hemifacial microsomia.
    No preview · Article · Jan 2016 · The Cleft Palate-Craniofacial Journal
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    ABSTRACT: It has been suggested that there is a close association of abnormality in auricular muscles with various congenital auricular deformities. However, there has been no investigation to determine what muscles are involved and how they affect the deformity. The authors examined abnormalities of auricular muscles for patients with various auricular deformities. The authors examined 77 auricles of 62 patients with congenital auricular deformities, including cryptotia, Stahl's ear, prominent ear, lop ear, and others. The superior and posterior auricular muscles from the extrinsic auricular muscle group and the auricular oblique and transverse muscles from the auricular intrinsic muscle group were investigated. The authors found characteristic features of the abnormality of the muscle for each auricular deformity. In nearly all cases of cryptotia, abnormality was found in the superior auricular, auricular oblique, and auricular transverse muscles. Abnormal insertion was found mainly in the superior auricular muscle and was the main cause of cryptotia. In Stahl's ear, the major abnormality was abnormal insertion of the auricular transverse muscle, which creates an abnormal cartilaginous prominence in the scapha. The abnormality in cases of prominent ear was clearly limited mostly to the auricular transverse muscle and, in some cases, to the posterior auricular muscle. In lop ear, abnormality was mostly found in the auricular transverse muscle, with elongation, and in the superior auricular or auricular oblique muscle in some cases. There is a tendency for a specific muscle abnormality to be found in each deformity. It is important to identify the abnormal muscle and correct the abnormality during the operation.
    No preview · Article · Jul 2015 · Plastic and Reconstructive Surgery
  • K. Yamashita · T. Yotsuyanagi · A. Kitada · A. Gonda · A. Sugai · M. Yamauchi · T. Saito
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    ABSTRACT: We retrospectively reviewed 30 cases of orbital tumors in patients who underwent surgery in our department between October 2009 and June 2012. The mean age of onset was 51 years, and 15 patients were aged more than 50 years. There were no differences in tumor incidence by sex. The majority of tumors (25 cases, 83 %) were unilateral, and no difference in laterality was found. Regarding the location in the orbit, 19 cases (63 %) occurred in the lacrimal gland area. The tumor types included 21 (70 %) benign tumors and 9 (30 %) malignant tumors. The most frequently encountered tumors (8 cases, 27 %) were IgG4-related diseases, and 7 of the 9 malignant tumors (23 %) were malignant lymphomas. The present series demonstrated a higher incidence of IgG4-related disease in orbital tumors than the previous reports in Japan, which described the majority of tumors as idiopathic orbital inflammation or pleomorphic adenoma. Therefore, appropriate clinical inspection and treatment are needed instead of immediate surgical resection.
    No preview · Article · Jul 2015
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    ABSTRACT: Background: Facial asymmetry, which is often due to asymmetry of the mandible, is a naturally occurring phenomenon in patients with hemifacial microsomia (HFM). Only a few attempts have been made to develop specific quantitative diagnostic criteria for the mandibular asymmetry of HFM. This pilot study was designed to determine the soft-tissue and skeletal characteristics of patients perceived to have HFM and the factors affecting objective assessment of mandibular asymmetry. Methods: Frontal facial photographs and frontal cephalograms of twelve patients who had HFM with mandibular asymmetry were analyzed. Landmarks and reference lines were determined on the basis of frontal photographs and cephalographic analysis. Linear measurements of the right and left sides were performed to assess the degree of asymmetry of the mandible. The differences between the affected side and the unaffected side were calculated and analyzed statistically. Results: Significant differences were found for linear measurements of the gonion distance (GoD), full marginal distance (FMD), external marginal distance (EMD), and gonion-menton distance (Go-MeD) in the hard tissue and sFMD, sEMD, sGo-MeD in the soft tissue but not for the gonion distance in soft tissue (sGoD). The differences in sEMD and EMD were significantly correlated, and represented a valid factor affecting the mandibular asymmetry in soft and hard tissues. Conclusions: The results of this study suggest that appropriate measurements affecting the outline of the mandible such as sEMD and EMD taken from frontal facial photographs and frontal cephalograms provide a useful, objective means of assessing mandibular asymmetry for patients with HFM.
    No preview · Article · May 2015
  • M. Yamauchi · T. Yotsuyanagi · T. Saito · K. Yamashita · A. Sugai · A. Gonda · A. Kitada · R. Ozawa
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    ABSTRACT: Local flaps from surrounding tissues are both functionally and cosmetically better for reconstructing external nasal defects as compared to skin grafts and distant flaps. In the case of local flaps, the concept of the aesthetic subunit principle is important. This principle enables matching the shape of the defect or flaps to the subunits, to the greatest extent possible, and provides various advantages such as an inconspicuous scar or easy construction of a three-dimensional structure. However, the subunit principle that has been reported does not always match with all cases. Hence, we should consider the appropriate subunits depending on each case. The typical local flaps used for nasal defects are the nasolabial flap for defects of the ala, and the forehead flap or dorsal nasal flap for defects of the nasal tip and dorsum. Moreover, relatively large nasal defects that extend over several subunits have been frequently reconstructed using a forehead flap and distant flap. However, it is possible achieve restoration using local flaps from surrounding tissues by dividing the large defect for each subunit and combining several local flaps together.
    No preview · Article · May 2015
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    ABSTRACT: Here, we introduce our recent operative technique for ear elevation that results in (1) minimal morbidity for patients, (2) symmetric appearance, (3) clearer 3-dimensional structure with a deep concha, (4) good aesthetic appearance by hiding the grafted area behind the ear, and (5) maintenance of deep temporoauricular sulcus and angle. After a skin incision, the ear is elevated with temporoparietal fascia underlying the cartilage. On the conchal area, undermining is performed just below the skin so that the deep concavity can be maintained. Scalp and neck skin behind the ear is undermined subcutaneously and lifted up cranially to hide the entire area of grafted skin behind the ear. The postauricular surface is covered by full-thickness skin from the lower abdomen. A protective splint is applied for 3 months while sleeping. A total of 137 ears in 121 patients were corrected with our technique and followed up for at least 3 years. All of the scar tissue could be hidden behind the ear, an aesthetically excellent result. Our technique made it possible to acquire an excellent and symmetrical shape of the ear. The important points in our procedure are as follows: (1) subcutaneous posterior undermining to enlarge the conchal cavity, (2) careful arrangement of the temporoauricular angle and auriculo-earlobe angle, (3) reduction in the area of temporally grafted skin to hide all scars behind the ear, and (4) protection of the ear to maintain the shape using a postoperative splint.
    Full-text · Article · Sep 2014
  • A. Kita · T. Yotsuyanagi · T. Saito · K. Yamashita · M. Yamauchi · M. Kayama · T. Yamada · A. Kitada
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    ABSTRACT: The auricle is easily damaged because it is made up of soft tissue and protrudes from the temporal region. The helix is particularly vulnerable to external injuries such as burns or frostbites. Despite these risks, life saving treatments are usually prioritized, and have thus resulted in unfarorable aesthetic outcomes of the auricle owing to delayed reconstruction treatment. Herein, we report a case of frostbite injury to the auricle due to an ice pack placed during therapeutic hypothermia in an intensive care unit after a traffic accident. About one-third of the helix was lost even after careful conservative treatment, and the marginal skin had markedly thinned. The patient also complained of pain in the auricle. Seven months later, the helix was reconstructed using a retroauricular flap. There were no complications during the healing process. The pain reduced, and the shape the auricle was restored.
    No preview · Article · Jul 2014
  • A. Suzuki · T. Yotsuyanagi · A. Gonda · A. Sugai · A. Imai · M. Yamauchi · K. Yamashita · T. Saito
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    ABSTRACT: Complete auricular defects are usually reconstructed by local flaps from the periauricular regions or skin grafts. However, in cases of larger scars including the anterior and posterior regions of the auricle, these methods cannot be applied, and reconstruction becomes challenging. Herein, we describe a reconstruction method using a costal cartilage graft and expanded skin flaps. With this method, we could reduce the scar size and satisfactorily reconstruct the auricle at the same time. When reconstruction of large-sized defects on the face, including the auricle is needed, our method may be useful.
    No preview · Article · Jun 2014
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    Ken Yamashita · Takatoshi Yotsuyanagi · Makoto Yamauchi · David M Young
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    ABSTRACT: Background: As the elderly population continues to expand, it becomes increasingly important to develop treatments to improve wound healing in the elderly. One problem limiting the research is the lack of appropriate animal models for wound healing in elderly patients. We hypothesized that the Klotho mouse of premature aging is a suitable animal model to shed light on many of the biological processes involved in aging skin. Methods: Klotho mice (kl/kl), Klotho-heterozygous mice (kl/+), and wild-type mice (+/+) were wounded, and the area of the wound was measured every 3 days until the wound was healed. To compare the klotho phenotype with wild-type mice, wounds were also harvested at 4 and 7 days after wounding. For histological examination, paraffin-embedded sections were stained with hematoxylin and eosin and Masson trichrome. Collagen expression in the wound was also studied by analyzing messenger RNA using real-time polymerase chain reaction. Results: Klotho mice showed a significantly slower rate of wound closure compared with Klotho-heterozygous mice and wild-type mice. Histology showed substantial less healing and collagen deposition in the wounds of the Klotho mice. The expression of collagen messenger RNA in Klotho mice was also less than that in heterozygous and wild-type mice. The Klotho mice exhibited significant phenotypic similarities with aged skin, such as atrophy and delayed wound healing. Conclusion: These preliminary data suggest that the Klotho mouse may be a model to further investigate wound healing in the elderly.
    Full-text · Article · Jan 2014

  • No preview · Article · Jan 2014 · Modern Plastic Surgery
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    ABSTRACT: Recently, auriculoplasty with costal cartilage grafting has been successfully used for correcting microtia and creating a clearly refined contour and a natural appearance of the ear. However, several important problems remain unsolved in these techniques. The authors describe an improved technique for harvesting costal cartilage with minimal morbidity and a new procedure for fabricating a cartilage frame that ensures a refined shape and rigid structure of the constructed ear. Costal cartilage is harvested directly with a chisel. This technique enables some of the cartilage at the chest wall to remain intact. The base frame is fabricated by two cartilage blocks partly overlapped on the area of the antihelix. The thickness in the overlapping area emphasizes the contour between the antihelix and the helical crus. To prevent absorption of the cartilage, helical and antihelical parts are created using the outer rigid layer of the harvested cartilage and are covered as much as possible by perichondrium. A total of 137 ears in 121 patients were corrected with the authors' technique and followed up for at least 3 years. Almost all of the patients could walk within 2 days after the operation. The structure and contour of the constructed ear were well maintained. Attention should be given not only to successful outcomes of construction of the ear but also to minimal morbidity for the patients. Our technique made it possible to construct a cosmetically refined ear that could be maintained for a long period and minimize the pain and deformity of the donor's chest. Therapeutic, IV.
    No preview · Article · Jan 2014 · Plastic and Reconstructive Surgery
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    ABSTRACT: Keloids are benign dermal fibrotic tumors arising during the wound healing process. The mechanisms of keloid formation and development still remain unknown, and no effective treatment is available. Resveratrol, a dietary compound, has anticancer properties and, from recent studies, it has been suggested that resveratrol may have an antifibrogenic effect on organs such as the liver and kidney. Based on this idea, we investigated its effect on the regulation of extracellular matrix expression, proliferation, and apoptosis of keloid fibroblasts. Type I collagen, α-smooth muscle actin, and heat shock protein 47 expression decreased in resveratrol-treated keloid fibroblasts in a dose-dependent manner. In addition, resveratrol diminished transforming growth factor-β1 production by keloid fibroblasts. We also demonstrated that it suppressed their proliferation and induced apoptosis of the fibroblasts. Conversely, resveratrol did not decrease type I collagen, α-smooth muscle actin, and heat shock protein 47 mRNA expression in normal skin fibroblasts and barely suppressed cell proliferation. Our data indicate that resveratrol may have an antifibrogenic effect on keloid fibroblasts without any adversely effects on normal skin fibroblasts, suggesting the potential application of resveratrol for the treatment of keloids.
    No preview · Article · Jul 2013 · Wound Repair and Regeneration
  • T. Suda · T. Yotsuyanagi · K. Ikeda · T. Saito · K. Yamashita · T. Yamada · S. Katou · A. Gonda
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    ABSTRACT: For plasty of mild congenital auricular deformities, conchal cartilage graft is the most useful technique. Conchal cartilage graft is indicated for a case in which the deformity is severe but not accompanied with hypoplasia, or the deformity is localized partially in helix and scapha accompanied with mild hypoplasia. In these cases, removal of the deformed cartilage and grafting of the conchal cartilage with ideal shape can achieve a natural shape. It is better to overlap the cartilages because it increases the strength of the auricle and prevents postoperative distortion. Indication of the costal cartilage graft is different between adult and child patients. In adult patients, a costal cartilage graft is useful for enlarging the size for various cases accompanied with mild hypoplasia, as costal cartilage has sufficient size and strength. On the other hand, deformed auricular cartilage should be largely removed because it is difficult to correct the deformed cartilage by incision or suture material. In a child patient, the grafted conchal cartilage sometimes has insufficient size and strength to acquire the effect of enlargement of the size or maintaining the shape of the auricle. On the other hand, the deformed cartilage has elasticity, which is easy to correct by overlapping the cartilage without removal of the deformed cartilage. For cases with severe hypoplasia, we should select carefully from conchal cartilage graft and costal cartilage graft.
    No preview · Article · Jun 2013
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    ABSTRACT: Z-plasty is one of the most widely employed techniques in plastic surgery and mainly serves the following purposes: elongation along the axis of the scar, dispersal of the scar followed by breaking up the straight-line scar and realigning the scar within the lines of minimal tension. It is useful especially to release linear-scar contracture, yet difficult for wide scars. This report describes a novel technique to release contracture effectively for any wide scars using a new design called double combined Z-plasty. The design is simple. The main limb is set to incise the wide scar, and this main limb is shared as a peripheral limb by two other Z-plasty designs. From the main limb, each central limb is designed along the margin of the scar in the opposite direction. The main and central limbs have 90° between them. Other peripheral limbs are then designed facing laterally to the intact skin to make 60° for the central limb. After skin incision, two triangular intact skin flaps could be inserted into the wide scar from both sides, making it possible to release contracture. We performed this technique on eight patients. All wounds healed well and scar contracture was satisfactorily released. This procedure is very useful for wide-scar contracture, compared to conventional Z-plasty.
    No preview · Article · Feb 2013 · Journal of Plastic Reconstructive & Aesthetic Surgery
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    ABSTRACT: Microtia is thought to have a multifactorial inheritance, but several investigators disagree. Here we report our survey of the hereditary factors and possible causes. We conducted a questionnaire survey of 428 patients with microtia who were being treated at two hospitals from September 2006 to September 2008. We recorded their age, sex, affected side, duration of gestation, birth weight, age of parents at patients' birth, accompanying malformations, number of siblings, familial occurrence, smoking habit of parents, and medication/disorders of mother during pregnancy, and analysed the results. There were preponderances of male (61%), unilateral (90%) and right-sided disease (59%). Other than the first and second branchial arch syndrome, microtia is often accompanied by other congenital deformities, in particular congenital heart disease; cleft lip, or palate, or both; vertebral defects; and anomalies of extremities. The occurrence in first-degree relatives was 2%. Most maternal disorders and medication taken during pregnancy were common and there was no clear link. Statistically, there was a tendency to low birth weight and high maternal age, but it is not possible to identify these as a specific cause of microtia. Multifactorial inheritance is unlikely to be the cause of microtia as there was only one finding in agreement with its widely accepted characteristics. However, we cannot completely discount it as there were too few cases in some groups to make a judgement.
    No preview · Article · Sep 2012 · Journal of Plastic Surgery and Hand Surgery
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    ABSTRACT: For the reconstruction of facial defects, the retroauricular flap is generally used. However, this flap has disadvantages, such as venous return disturbance and reddish skin colour peculiar to the retroauricular region. Here, we report the reverse superficial temporal artery (STA) flap, elevated from the preauricular region. In our method, the flap is retrogradely elevated including the STA under the skin island in the preauricular region and the temporoparietal fascia around the superficial temporal vessels in the temporal region. The donor site is closed primarily or by the retroauricular flap. Five cases with a pedicled flap and one case with a free flap were treated using our method. In one case, a minor congestion of the flap occurred postoperatively, and temporary facial nerve palsy in another case. In all cases, the results were cosmetically good, and the scar at the donor site was inconspicuous. As compared to the retroauricular flap, our method is easier to perform and the flap has a reliable blood circulation. Moreover, it can be used with both a pedicled and a free flap, leaving an inconspicuous scar at the donor site, and a colour match without reddish skin. Therefore, when considering reconstruction of small-sized defects on the face, our method is more useful than the retroauricular flap.
    No preview · Article · Feb 2012 · Journal of Plastic Reconstructive & Aesthetic Surgery
  • Kanae Ikeda · Takatoshi Yotsuyanagi · Koshiro Arai · Tetsuya Suda · Tamotsu Saito · Kyori Ezoe
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    ABSTRACT: Buerger disease is a limb-threatening condition occurring in young smokers, and its treatment has been a challenging problem, although a large number of medical and surgical options have been suggested. Combined surgery for revascularization and free-tissue transfer for Buerger disease is an aggressive and attractive option. This complex surgery enables successful treatment of tissue loss caused by ischemia. We performed revascularization and free-tissue transfer to the critically ischemic limb in a patient with Buerger disease. In this case, the procedure is attempted to salvage a limb from amputation.
    No preview · Article · Jan 2012 · Annals of Vascular Surgery
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    ABSTRACT: Purpura fulminans (PF) is a rare syndrome of intravascular thrombosis and haemorrhagic infarction of the skin. The initial symptom of PF is peripheral purpura which progresses to necrosis very rapidly. The prognosis of PF is poor, and the mortality is reported to be around 40%. Even if the patient survives, the patient may require amputation or reconstruction for limbs and facial necrosis. A 48-year-old male suffered from PF following a left cerebellopontine angle tumour excision. His nose and upper lip fell into necrosis afterwards. We performed nose and upper lip reconstruction at 8 months after the onset. We used a forehead flap for the nasal reconstruction and a free forearm flap for the lining. His upper lip was reconstructed with bilateral nasolabial orbicularis oris myocutaneous flaps. The colour and texture match of the reconstructed nose and lip is good. He could open his mouth wide enough and close completely. Facial reconstruction after PF is very difficult, because the patient has extensive scarring around the defect and there is little intact facial tissue. However, we performed a facial reconstruction using local flaps as much as possible, and obtained good results.
    No preview · Article · Jul 2011 · Journal of Plastic Reconstructive & Aesthetic Surgery
  • Koshiro Arai · Ken Yamashita · Tetsuya Suda · Kanae Ikeda · Makoto Yamauchi · Takatoshi Yotsuyanagi

    No preview · Article · Jul 2011 · Journal of Plastic Reconstructive & Aesthetic Surgery
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    ABSTRACT: Mozart ear is a congenital auricular deformity, which is mainly characterized by a bulging appearance of the anterosuperior portion of the auricle, a convexly protruded cavum conchae, and a slit-like narrowing of the orifice of the external auditory meatus. It is said to be uncommon, and because no one has yet fully described neither the disease nor the treatment, the concept of Mozart ear has not been unified. This report describes a case of a 13-year-old girl presented with an unusual congenital deformity which showed the features of Mozart ear. It is an extremely rare deformity that only about 4 clinical cases have been reported in medical literature thereby a treatment method has not been fully discussed. For surgical correction of our cases, we excised deformed conchal cartilage, turned it over, regrafted, and maintained a cosmetically positive result. We also reviewed and described the origin, current concept, and treatment method of Mozart ear.
    No preview · Article · May 2011 · Annals of plastic surgery

Publication Stats

891 Citations
132.23 Total Impact Points


  • 2005-2015
    • Sapporo Medical University
      • Division of Plastic and Reconstructive Surgery
      Sapporo, Hokkaidō, Japan
  • 1996-2004
    • Hirosaki University
      • • Department of Plastic and Reconstructive Surgery
      • • School of Medicine
      Khirosaki, Aomori Prefecture, Japan