Journal of the Japan Society of Cranio-Maxillo-Facial Surgery
Online ISSN : 2433-7838
Print ISSN : 0914-594X
Volume 36, Issue 4
Displaying 1-9 of 9 articles from this issue
Feature Article : How I Do It
  • Hiroshi FURUKAWA, Tsuneo YASUMURA, Mami TANAKA, Yasutaka UMEMOTO, Taku ...
    2020Volume 36Issue 4 Pages 149-153
    Published: 2020
    Released on J-STAGE: December 25, 2020
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      Network-like reconstruction is surgical rehabilitation for incomplete facial palsy, and includes end-to-side for neural signal augmentation and neural supercharge, which originated from nerve crossovers. Numerous motor nerves, such as the hypoglossal, spinal accessory, and masseteric branch of the trigeminal nerve, were reported as neural sources of nerve crossovers for facial palsy, but the hypoglossal nerve is the most commonly used. The history of hypoglossal crossover is reviewed in this article. The superiority of the hypoglossal nerve as a neural source of nerve crossovers and network-like reconstruction for facial palsy is due to the following points : 1)the centers of the movements of the face and tongue overlap in the cortex 2)hypoglossal and reticular interneurons may be involved in oro-facial coordination, and 3)central reorganization of the blink reflex is induced because of central nerve plasticity. Further review to compare the hypoglossal nerve with other available cranial nerve transfers, such as the masseter nerve, is warranted.

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  • Masato KUROKAWA
    2020Volume 36Issue 4 Pages 154-160
    Published: 2020
    Released on J-STAGE: December 25, 2020
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    Supplementary material

      Although there are many reduction methods for zygomatic fractures, we performed reduction using a maxillary sinus balloon. Using upper gingivobuccal sulcus incisions, a Foley catheter was inserted into the maxillary sinus from the fractured line and the balloon was expanded. The zygomatic bone was reduced in the anatomical position by stress from the maxillary sinus. The reduction position can be assessed using ultrasonography intraoperatively.
      The advantages of this method are the avoidance of facial incision, possibility of repositioning the zygomatico-maxillary bone with minimal exposure, reduced vice damage, and shortened surgery time. This method is indicated for type III, IV, and some type VI fractures according to Knight and North, but this method is not indicated if there is large displacement in the frontozygomatic suture. During fixation with absorbable plates after reduction, it is important to pay attention that the fixed portion is accurate in order to prevent postoperative relapse.

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Original Article
  • Yu HOSOKAWA, Jiro IIMURA, Shinya TSUMIYAMA, Takeshi MIYAWAKI
    2020Volume 36Issue 4 Pages 161-167
    Published: 2020
    Released on J-STAGE: December 25, 2020
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      Nasal obstruction causes not only respiratory disorders, but also sleep disorders, reduced work efficiency, and significantly impairs the quality of life (QOL). Nasal septal deviation is one cause of nasal obstruction. Conventional surgical treatment for nasal septum deformity is endoscopic septoplasty. However, caudal and dorsal deviation may be challenging to treat. Open septorhinoplasty (OSRP)is useful for severe caudal and dorsal septal deviation with L-strut deformity.
      This study evaluated the effects of OSRP on nasal obstruction and the QOL. We compared changes in perioperative rhinomanometry and a QOL questionnaire survey. The risk factors for improvement of nasal obstruction before OSRP were also examined.
      On perioperative rhinomanometry, the average of the convex side of the nasal cavity improved from 1.832 Pa/cm3/s to 0.491 Pa/cm3/s (p<0.001)and the bilateral side improved from 0.561 Pa/cm3/s to 0.258 Pa/cm3/s (p=0.001). The average perioperative score of the QOL questionnaire also significantly improved. Patients with low resistance on preoperative bilateral rhinomanometry were less likely to exhibit improvement in nasal obstruction by OSRP (p=0.046.).
      OSRP was highly effective in improving nasal obstruction and the QOL in severe nasal deviation with L-strut deformity. Cooperation between the otolaryngologist and plastic surgeon enabled surgery on the entire nasal septum, leading to favorable results. Patients with nasal obstruction and low resistance on preoperative bilateral rhinomanometry may have nasal valve obstruction or psychosomatic nasal disorder, and poor improvement of postoperative nasal obstruction by OSRP.

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  • Eri TAKESHITA, Hitoshi NEMOTO, Yotaro TSUNODA, Ushio HANAI, Tadashi AK ...
    2020Volume 36Issue 4 Pages 168-175
    Published: 2020
    Released on J-STAGE: December 25, 2020
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      Insufficient surgery for zygomaticomaxillary complex (ZMC)fractures leads to a markedly disfigured facial appearance and dysfunction.
      However, intraoperative 3D imaging of ZMC fractures using intraoperative cone-beam computed tomography (CBCT)may improve outcomes with satisfactory midface symmetry.
      The aim of this study was to compare the surgical results for ZMC fractures between with and without intraoperative 3D imaging.
      A total of 23 patients with unilateral ZMC fractures at our hospital between April 2017 and January 2019 were enrolled in this retrospective study. The primary outcome measurement was the absolute bilateral difference in the ZMC height and projection on multi-detector CT (MDCT)measurement within 14 days after surgery.
      The patients group with intraoperative 3D imaging (n=9)had a more symmetrical position of bilateral ZMCs than the control group (n=14). Three patients underwent additional reduction of the zygoma following intraoperative 3D imaging.
      Intraoperative 3D imaging is an effective tool for the surgical management of ZMC fractures.

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Case Report
  • Toshiro IMAI, Yoshimichi IMAI, Kenji MURAKI, Akimitsu SATOU, Masahiro ...
    2020Volume 36Issue 4 Pages 176-182
    Published: 2020
    Released on J-STAGE: December 25, 2020
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      Combined orbital floor and medial wall fractures can be technically challenging to repair, especially when the “bony buttress,” which is a bony septum between the ethmoid and the maxillary sinus, collapses. Recently, several studies reported the usefulness of new artificial materials to treat these complex orbital fractures, but no consensus on the appropriate treatment has been reached. This was a case series of eight consecutive patients with combined orbital floor and medial wall fractures reconstructed using several materials employing a combined transcaruncular-transconjunctival approach. As a result, diplopia resolved in six of eight patients and enophthalmos was corrected within 2 mm from the healthy side in all patients. We report our cases of combined orbital floor and medial wall fractures, and provide a literature review.

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  • Chihiro TERAMURA, Tsutomu HOMMA, Hiroki MORI, Mutsumi OKAZAKI
    2020Volume 36Issue 4 Pages 183-187
    Published: 2020
    Released on J-STAGE: December 25, 2020
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      We report a case of nasolacrimal duct obstruction due to dacryolithiasis and dacryocystitis induced by instillation that was successfully managed by dacryocystorhinostomy. A 79-year-old female patient had a 6-year history of dry eyes and 16-year history of Behçet’s disease-related uveitis, which were both treated using eye drops. Many instillations were used during the 16 years of treatment and 5 were used long-term (more than 3 years). Of the 5 drugs, rebamipide was used during the development and exacerbation of dacryolithiasis and dacryocystitis. Infrared spectroscopy confirmed rebamipide in the dacryolith in this case. Lacrimal duct obstruction and dacryocystitis were previously reported as adverse effects of rebamipide instillation. In order to prevent the exacerbation of nasolacrimal duct obstruction, it is important to know the correct usage and unfavorable effects of topical ocular medications, and to recognize the initial symptoms of dacryocystitis.

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  • Akinori IWAKAMI, Takeshi KAN, Hiroyuki SONEDA, Norio FUKUDA
    2020Volume 36Issue 4 Pages 188-193
    Published: 2020
    Released on J-STAGE: December 25, 2020
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      Adenoid cystic carcinoma (ACC)is a malignant epithelial tumor of the salivary glands. Sinonasal ACC accounts for 10 to 25% of all head and neck ACCs. However, ACC of the frontal sinus is rare.
      We present the case of a 76-year-old man with ACC of the frontal sinus. MRI for the follow-up of cerebral infarction demonstrated a mass lesion in the frontal sinus. Endoscopic biopsy revealed that the mass was ACC. Extensive resection and free flap reconstruction were planned. The tumor was resected via combined cranial and endoscopic approaches. The skull base and the bilateral medial orbital walls were reconstructed using an anteriolateral thigh flap including vastus lateralis muscle. The dura mater was reconstructed with fascia lata. He had no evidence of recurrence during the follow-up period.
      There is no established treatment for ACC of the frontal sinus due to its rarity. The local recurrence rate is high; therefore, complete resection is necessary. An anteriolateral thigh flap is useful for complex skull base reconstruction because it is thin, flexible, and can be elevated with fat, muscle, and fascia.

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  • Shotaro SUZUKI, Satoshi TAKAGI, Takako FUJITA, Shinichi HIROSE, Hiroyu ...
    2020Volume 36Issue 4 Pages 194-201
    Published: 2020
    Released on J-STAGE: December 25, 2020
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      For non-syndromic craniosynostosis, surgical treatment is selected in the following cases : 1)the intracranial cavity is relatively narrow, and intracranial hypertension symptoms and mental development disorders are expected or 2)the skull and orbital morphology are significantly deformed due to craniosynostosis. In these cases, surgery is often performed by the age of 1-2 years.
      We report the case of a 10-year-old girl with craniosynostosis. She had no head deformities or symptoms during infancy. However, she visited the hospital with the chief complaint of chronic headache after reaching school-age, and was diagnosed with craniosynostosis with intracranial hypertension. We performed cranioplasty (multi-directional cranial distraction osteogenesis)to increase her cranial volume. Her postoperative course was good and her chronic headache improved.
      Similar to this patient, some patients with non-syndromic craniosynostosis may live to an old age without being diagnosed because of the absence of symptoms. However, there are no effective screening tests at present and a diagnosis can only be established after symptoms appear. Simple screening tests for non-syndromic craniosynostosis need to be developed, and it is essential that the patients undergo early detection, treatment, and separation of cranial sutures.

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  • Shogo IWAMOTO, Rintaro ASAI, Yosio AIDA, Akiyoshi KAJIKAWA
    2020Volume 36Issue 4 Pages 202-207
    Published: 2020
    Released on J-STAGE: December 25, 2020
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      Aneurysms of the superficial temporal artery (STA)are rare and are usually associated with head trauma. We report a markedly rare case of a spontaneous true aneurysm of the STA with no associated head trauma. A 65-year-old man presented with an asymptomatic, pulsatile, 24×20-mm forehead mass that gradually increased in size. He had no history of head trauma. The aneurysm was discovered upon evaluation via ultrasonography and computed tomographic angiography. Ligation and resection were performed under general anesthesia. Pathological examination revealed a true aneurysm due to arteriosclerosis. The pathology, etiology, and treatment of this spontaneous true aneurysm of the STA are discussed in this paper.

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