For the reconstruction of large scalp and middle facial defects using free flaps, there are several options for the recipient vessels. Among them, the superficial temporal vessels are proximate to the defect. However, the reliability of these vessels remains controversial. In this report, we retrospectively investigated the recipient vessels and postoperative outcomes of 25 patients who underwent microsurgical scalp or middle facial reconstruction. Among these 25 patients, the reconstructed sites were: the scalp in 12, eyelid in 4, orbit in 3, and upper jaw and cheek in 6. Superficial temporal vessels were selected in 17, facial vessels in 2, occipital vessels in 2, and cervical vessels in 4 patients. In 17 patients in whom superficial temporal vessels were used as the recipient vessels, there were 1 cases of vein thrombosis, 2 case of insufficient caliber of the vein, and 1 case of arterial thrombosis. All of these patients required re-anastomosis to cervical vessels. On the other hand, there were no complications among the recipient vessels for which cervical vessels were used. Our study suggests that it is necessary to plan preoperatively for the option of anastomosing to cervical vessels.

　　We used THERMAL GIPS^®, which can be easily molded after being softened with boiling water, for external fixation after reduction of nasal fractures, and examined its usefulness.
　　In 21 cases of fresh nasal fractures, 14 cases using THERMAL GIPS^® and 7 cases using Denver Splint^® were compared. On the day after surgery and one week after surgery, the presence of gaps between the skin and the gips was evaluated, and patients were asked and surveyed about the feeling of wearing and the ease of self-fitting.
　　A gap between the skin and the gips was not observed in all patients in the THERMAL GIPS^® group on the day after the operation, but a slight gap was observed in 4 in the Denver Splint^® group. One week after the operation, the THERMAL GIPS^® group had 9 patients with no gap and 5 with a slight gap, whereas the Denver Splint^® group had 5 patients with a slight gap and 2 with a noticeable gap. THERMAL GIPS^® was rated higher in the interview survey regarding the feeling of wearing and the ease of self-fitting.
　　THERMAL GIPS^® are highly moldable, and can be processed and adapted three-dimensionally to complicated surface shapes, and even inexperienced doctors can make fine adjustments repeatedly. Furthermore, their cost is low, making them useful as an external fixing material after reduction of a nasal fracture.

　　The deep circumflex iliac artery (DCIA) osteocutaneous flap is a useful osteocutaneous flap for reconstruction of large defects of the maxilla and mandible. However, the bulkiness of the soft tissue due to inclusion of the abdominal muscle cuff and the complex anatomy of the DCIA makes surgeons hesitant to harvest DCIA osteocutaneous flaps. We report 5 cases of DCIA perforator flaps with iliac crests and internal oblique muscles for reconstruction of the maxillary and mandibular regions. We detected cutaneous perforators in the area of the upper iliac crest by handheld Doppler in all cases. However, we found feeding vessels of the skin paddle from arteries other than the DCIA in 2 cases (one from the lumbar artery and the other from the superficial circumflex iliac artery). We describe the challenges of using DCIA perforator flaps for reconstruction. We also advocate the use of preoperative CT angiography after administration of sublingual nitroglycerin in order to assess the relationship of source arteries with their perforators.

　　Based on our studies, there are many cases in which patients with cleft lip age, and the thickness of their vermillion and height of their philtrum ridge decrease after the primary surgery because a cleft lip is accompanied by a soft tissue defect. These defects must be fixed through secondary revision surgery. This surgery consists of a local flap and tissue transplantation surgery. At our hospital, we performed dermal fat grafting for the defects and costal cartilage grafting for simultaneous rhinoplasty on 5 of 24 patients. The dermal fat grafting produced good visible results even though the technique that we used was simple. In conclusion, this technique is effective for fixing relatively small defects.

　　Methods of reconstructing small skin defects resulting from procedures, such as the removal of a facial cutaneous tumor, include primary closure, local flaps, and skin grafts. Depending on the extent and location of the skin defect, it is often difficult to decide whether to perform primary closure or to use a local flap. As the local flap is usually designed before the skin incision is made, it is frequently larger than required and unnatural postoperative scarring develops. In cosmetic reconstruction, it is important not only to cover the skin defect, but also to reconstruct its color, texture, and shape, and the relaxed skin tension line (RSTL) must also be considered. Designing the local flap only after the skin defect has been sutured as far as possible is advantageous in that a longer portion can coincide with the RSTL, a smaller skin flap can be used, and sutures can be placed unaltered.

　　Submental intubation is used in patients with maxillofacial trauma to enable free intraoperative access to the dental occlusion and nasolabial complex. Orthognathic surgery is usually performed with nasotracheal intubation to prevent the tube from interfering with occlusion.
　　We used submental intubation in 2 cases of orthognathic surgery in which nasotracheal intubation was impossible. One patient was a 17-year-old male with maxillary hypoplasia associated with left cleft lip and palate. He had a pharyngeal flap precluding nasal tube placement. The other patient was 18-year-old female with facial hamartoma and jaw deformity. The hamartoma obstructed her nasal cavity.
　　The surgery proceeded uneventfully and there were no complications. Submental intubation is a useful method not only for patients with maxillofacial trauma, but also in selected cases of orthognathic surgery.

　　Amyloidosis is a disease that is characterized by amyloid deposits in specific organs or throughout the body, resulting in organ disorders. In the field of ophthalmology, amyloidosis causes deposits in the cornea or the vitreous body; however, amyloid deposits in the lacrimal gland are rare. We describe the case of a 76-year-old Japanese woman with localized amyloidosis in the lacrimal gland. The mass was located in the deep part of the orbit. Removal of intraorbital masses is a delicate procedure because the anatomical structure of the orbit is complicated. Considering the esthetic outcome and operability, we selected a coronal incision and lateral approach by osteotomy, and performed surgical simulation from the skin incision to the osteotomy using a three-dimensional（3D）3-layer elastic model of the face that we designed to determine the development range, osteotomy range, and surgicalapproach. Moreover, we report the usefulness of the simulation using the 3D 3-layer elastic model of the face.