日本頭蓋顎顔面外科学会誌
Online ISSN : 2433-7838
Print ISSN : 0914-594X
36 巻, 1 号
選択された号の論文の6件中1~6を表示しています
原著
  • 林 明照, 王子 富登, 荻野 晶弘, 岡田 恵美, 大西 清
    2020 年 36 巻 1 号 p. 1-9
    発行日: 2020年
    公開日: 2020/03/25
    ジャーナル 認証あり

      Facial reanimation in patients with established facial paralysis remains challenging for reconstructive surgeons, and unfavorable results cannot be prevented to a certain extent. Unfavorable functional and aesthetic results can impair the quality of life. When options in which the contralateral facial nerve is used, such as one-stage or two-stage free muscle transfer, a natural spontaneous smile (truly spontaneous smile) can be achieved. On the other hand, when options in which a nerve other than the contralateral facial nerve is used, such as free muscle transfer with coaptation to the masseter nerve and lengthening temporalis myoplasty, the majority of patients can achieve a spontaneous smile innervated by the trigeminal nerve, i.e., without biting. The awareness of all possible adverse effects characteristic to each reconstructive option is the key to avoiding them, and understanding the consequences of unsuccessful reconstruction provides the foundation for satisfactory planning and personalized approaches to revise the result.

症例
  • 梅林 佳緒里, 玉田 一敬, 井原 哲, 津田 恭治, 青木 麻利江, 鈴木 彩馨, 大滝 真梨香
    2020 年 36 巻 1 号 p. 10-16
    発行日: 2020年
    公開日: 2020/03/25
    ジャーナル 認証あり

      Background:Ping-pong fractures are indentations of the relatively soft skull of newborns or infants and are usually treated by neurosurgeons. However, plastic surgeons may also be involved in their management to improve the resultant cranial shape. We retrospectively reviewed cases of surgically treated ping-pong fractures at our hospital.
      Methods:From the hospital database, patients with ping-pong fractures were extracted from among those who underwent surgery for a depressed skull fracture between 2011 and 2017.
      Results:There were ten cases of surgery for depressed skull fractures, including three cases for ping-pong fractures. The patients in all three cases were less than 6 months old and had no combined intracranial injury. Surgery was performed after observing the patients’ general condition. All fractures were successfully repositioned.
      Discussion:It is unclear whether ping-pong fractures should be observed until natural healing occurs or be treated early using non-invasive methods. Surgery was required in the present cases because natural healing failed to occur during the observation period.
      Conclusion:Although ping-pong fractures are a relatively rare type of head injury, plastic surgeons should be familiar with their incidence, etiology, and surgical indications. Surgical intervention should be carefully considered as a treatment option in each case.

  • 木下 直志, 安楽 邦明
    2020 年 36 巻 1 号 p. 17-23
    発行日: 2020年
    公開日: 2020/03/25
    ジャーナル 認証あり

      Defects involving one-third or more of the lower eyelid require reconstruction for eyelid function.
      Several cases of reconstruction of the lower eyelid have been previously reported.
      Grafts obtained from the hard palate mucosa or chondromucosal grafts from the nasal septum are commonly used to line the inner layer of the lower eyelid.
      We treated 6 patients who underwent lower eyelid reconstruction using an auricular cartilage graft and cheek flap.
      The transferred cartilage was exposed in front of the eye-ball for several weeks; however, neither eye pain nor lacrimation developed in any patient. The exposed cartilage was covered by a mucous membrane within a month in all patients, and no eyelid or ear deformities were noted. No recurrence was observed and the quality of life was improved in all patients.
      Auricular cartilage is a useful graft material because it can be easily harvested and large-sized grafts can be obtained.
      We achieved rigid fixation of the lower eyelid and prevented postoperative ectropion.
      Rigid fixation of an auricular cartilage graft and cheek flap is useful to maintain visual function and restore contour defects of the eyelids.

  • 原 幸司, 今井 啓道, 村木 健二, 佐藤 顕光, 館 正弘
    2020 年 36 巻 1 号 p. 24-29
    発行日: 2020年
    公開日: 2020/03/25
    ジャーナル 認証あり

      Meningiomas are a common histological type of brain tumor, but they are rarely found as primary extracranial tumors without intracranial lesions. A 62-year-old woman developed primary extracranial meningioma in the frontal sinus and subcutaneous forehead. Her prior ENT suspected frontal sinusitis and administered treatment, but no improvement was observed. They biopsied the lesion and diagnosed it as meningiothelial meningioma. The patient was then referred to the neurosurgery department at our hospital for evaluation of intracranial lesions. As there was no intracranial tumor, neurosurgery doctors followed up with MRI once a year. During the 4 years of follow up, the forehead protrusion gradually increased in size. Neurosurgery doctors referred her to us to improve her appearance. However, it was almost impossible to remove all of the tumor because infiltration had spread to the skin and skull base. Therefore, we resected the subcutaneous part of the tumor to improve her appearance. After the resection, her appearance improved and no re-growth of the tumor has been observed. However, careful long-term follow-up is necessary.

  • 藤澤 大輔, 朝戸 裕貴, 長谷川 弘毅, 田中 克典, 糸数 哲郎, 古謝 靜男
    2020 年 36 巻 1 号 p. 30-35
    発行日: 2020年
    公開日: 2020/03/25
    ジャーナル 認証あり

      Accessory parotid gland tumors are relatively rare and the histopathological types vary. We report a 41-year-old woman with mucoepidermoid carcinoma that developed in the accessory parotid gland. Both CT and MRI demonstrated a solid and smooth 20-mm tumor lying on the masseter muscle, but it was not adjacent to the parotid gland. The tumor was surgically removed via the standard extended pre-auricular approach, and mucoepidermoid carcinoma low-grade malignancy was diagnosed by histopathology. The buccal branches of the facial nerve and the parotid duct were sacrificed in the secondary surgery. Multiple additional resections were performed because of multiple recurrence. In the 4th surgery, the defect was reconstructed using a free rectus abdominis musculocutaneous flap and intercostal nerve transplantation.
      As the incidence of malignant tumors of the accessory parotid gland is higher than that of the parotid gland, the possibility of malignancy should be considered. The patient has remained free of recurrence during two years of follow-up.

  • 岡本 年弘, 稲田 享希子
    2020 年 36 巻 1 号 p. 36-41
    発行日: 2020年
    公開日: 2020/03/25
    ジャーナル 認証あり

      Case 1 is a 34-year-old woman. According to her, she received hyaluronic acid injections for cheek augmentation at a clinic several years ago. She visited our department because induration, pressure and discomfort gradually developed at the injection site. Extirpation of the foreign substance was performed orally and percutaneously. At 10 months after the operation, her subjective and objective symptoms had improved.
      Case 2 is a 39-year-old woman. Approximately 15 years ago, filler was injected into her nose root for nose augmentation at a clinic. Approximately 2 months prior to consultation, she developed noticeable protrusion of the nasal root area. Diagnosed as foreign body granuloma, we performed extirpation surgery twice percutaneously. She was satisfied with the excellent result.
      There are many reports about complications, such as redness, swelling, induration and scarring, among patients who receive fillers. Such fillers are classified into absorbable and non- absorbable, and our cases may have involved fillers containing non-absorbable materials. Non-absorbable fillers have a high rate of complications, and once they develop, treatment is difficult, and post-operative deformity and scarring are unavoidable. Non-absorbable fillers should be injected into the face with caution and long-term follow-up is necessary.

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