The platysma musculocutaneous (PLM) flap was first applied to intraoral reconstructions in 1987, and cervival island flap in 1950. These flaps are not only an alternative to microvascular flaps but they also an excellent reconstructive choice especially in cases where free tissue transfer cannot be carried out. The platysma muscle should be considered fasciocutaneous rather than musculocutaneous. Therefore, the PLM flap should be usually be elevated with the deep adipofascial tissue under the platysma. Flap survival is threatened if elevated without the adipofascial tissue under the muscle as with a usual musculocutaneous flap. The purpose of this review is to indicate basic technique, surgical planning, pitfalls and various risks for PLM flap and cervical island flap elevation.
It is neck dissection is essential in order to control the oral cancer. Although there are many excellent surgical manual, these of all are written from the standpoint of operator. The role of assistant required to perform a good operation is described.
We report describe our experience with the case of a deep aberration caused by a needle piercing the dorsal region of the tongue, followed by the development of an abscess in the tongue and mouth floor. The patient was 36-year-old man who visited our department for swelling of the tongue as a chief complaint. On clinical examination, the tongue and mouth floor were prominently swollen, with respiratory discomfort. On computed tomography, we recognized a needle-shaped radiopacity, which appeared to be a piercing insert needle extending from the deep region of the tongue median toward the sublingual region. There was also stenosis of the upper respiratory tract. The patient was given a diagnosis of an abscess of the tongue and oral floor due to accidental insertion of a piercing needle in the tongue. After securing the airway by executing a tracheostomy, we removed the foreign objects, incised the abscess, and administered antimicrobial therapy. These treatments were so effective that the inflammation subsided day by day, and the patient was discharged from the hospital 14 days after admission. As of 1 year 6 months postoperatively, the inflammation has not recurred.
We report a case of oral, pharyngeal, esophageal, and gastric ulcer in patient with Waldenström macroglobulinemia（ WM） in a 64-year-old woman in whom remission was induced by the administration of rituximab 6 months previously. She consulted our hospital because of ulcer formation in the right side of the floor of the mouth. A biopsy specimen showed inflammation. Five days later, the patient had a fever of 39℃, and the ulcer extended to the tongue and the left side of the floor of the mouth. Blood examination demonstrated delayed-onset neutropenia after treatment with rituximab. Although the symptoms were improved by antibacterial therapy, the ulcer with fever recurred 4 months later. The ulcer was observed not only in the mouth, but also in the pharynx, esophagus, and stomach. Since neutropenia continued and CD19, a monoclonal B cell antibody, was 0％ , the patient received both G-CSF and an antibacterial drug. In addition, a proton pump inhibitor was given. These treatments led to improvement of the ulcer. The fact that severe delayed-onset neutropenia was induced by rituximab in the patient suggested that infection with endogenous microbial flora caused the ulcer in the mouth, pharynx, esophagus, and stomach. On the other hand, in the stomach with few endogenous microbial flora, the lack of the regulatory B cells apparently inhibited IL-10 production. Consequently, the activation of macrophages and neutrophils may have caused the ulcer formation.
Migration of teeth or implants into the maxillary sinus has been reported, but migration of teeth into the ethmoid sinus is a rare event. We report the case of migration of a tooth into the ethmoid sinus. A 53-year-old man was referred to our hospital for the removal of a root of a tooth that had migrated into the maxillary sinus. A maxillary antrostomy was performed under general anesthesia, but the foreign body could not be identified in the maxillary sinus. Preoperative radiographs and computed tomography （CT） showed a foreign body in the maxillary sinus 2 weeks before the operation. Postoperative CT images revealed that the foreign body was located in the ethmoid sinus. Endoscopic surgery was then performed under general anesthesia by a otolaryngologist, and the tooth root was safely removed. This case highlights the importance of reimaging just before operation in patients with paranasal sinus foreign bodies. In addition, we should refrain from easy irrigation of the sinuses. It was also suggested that endoscopic examination is useful for finding paranasal sinus foreign bodies.