Traditional wire fixation for zygomaticomaxillary complex fracture (ZMC fracture) using Kirshner wire and soft wire became obsolete following the advent of the plate fixation technique. Titanium plates, the gold standard treatment for facial fractures, have the advantages of strength and handling; however, they remain permanently in the body as foreign materials. On the other hand, absorbable materials are useful for spontaneous resolution and do not require additional surgery for removal. However, absorbable plates may result in insufficient fixation for unstable ZMC fractures due to insufficient strength and stiffness. We performed hybrid fixation using absorbable plates and transmalar Kirschner wire for unstable ZMC fractures, and examined 53 patients (38 with absorbable plate fixation and 15 with hybrid fixation) . A preoperative diagnosis of unstable ZMC fracture is important for hybrid fixation. Three situations should be evaluated: deviation of zygomatic frontal sutures, multiple fractures of the zygomatic arch, and comminuted condition at the plate fixation point. Hybrid fixation using traditional transmalar wire in combination with absorbable plates is useful for unstable ZMC fractures as it provides additional fixation and facilitates the procedure.

　　The swinging eyelid approach (SEA) is an orbital approach that combines the transconjunctival approach with lateral canthotomy and cantholysis. We report its functionality and frequent use due to its wide operative field and inconspicuous scarring compared with other approaches. In this study, we quantitatively evaluated the postoperative ocular symptoms in a patient with zygomatic fractures treated by SEA. The average score of the questionnaire for ocular symptoms was 79/100 points, and both patient satisfaction and doctor evaluation were good (4.1 and 4.3, respectively) . No correlation was observed between the ocular symptoms and the doctor evaluation. Moreover, this study revealed that patient satisfaction cannot be obtained if the eye health is impaired.

　　Zygomatic fracture is one of the major types of facial fracture. Its causes include traffic accidents, reported to be the most frequent cause in previous studies, falls, and sports. However, the causes depend on social background and change over time. We retrospectively reviewed recent cases of zygomatic fracture (375 cases) at our institution between 2013 and 2019 focusing on the causes of injury. We also compared our results with previous reports using residual analysis. The most frequent cause was falls (144 cases, 38.4%) , followed by traffic accidents (110 cases, 29.3%) and sports (55 cases, 14.7%) . The rate of sports was high among younger patients, whereas that of falls was high among elderly patients. Compared with previous reports, the rate of traffic accidents decreased and the rate of falls increased, reflecting the social changes in our country such as the aging society and improved safety of automobiles.

　　Sebaceous nevus (SN) is usually resected at an early age to avoid malignant transformation with age. However, some patients with SN on the head develop cicatricial alopecia after resection and require scar revision. We retrospectively analyzed 86 patients (43 men and 43 women, 13.6±14.1 years old) who underwent surgical resection of SN between 2004 and 2018 focusing on scar revision. The operative method was simple resection in 67 patients, local flap in 7, and two-stage resection with tissue expander (TE) in 12. The average width of resection was 14.4 mm for simple resection, 19.1 mm with a local flap, and 27.4 mm with a TE, and the differences were significant. Ten patients (11.6%) required scar revision for postoperative cicatricial alopecia, with a significant difference among the surgical groups; simple resection 11.9% (8/67 patients) , local flap 28.6% (2/7 patients) , and TE 0% (0/12 patients) (P=0.02) . Although resection with a TE requires two operations, it is an efficient method to prevent cicatricial alopecia of the scalp, especially in patients with wide SN lesions.

　　Young bone is elastic and is prone to greenstick fractures. We retrospectively evaluated 72 cases of fracture in patients younger than 18 years old. Examination items were compared among the following groups: baby (0-3 years old) , infant (4-6 years old) , elementary school lower grade (7-9 years old) , elementary school upper grade (10-12 years old) , junior high school student (13-15 years old) , and high school student (16-18 years old) . The number of cases increased with age, but the rate of surgery was unchanged (20-33%) . CT findings of inferior rectus muscle swelling or missing rectus sign may be good predictors of prolonged diplopia after surgical repair.

　　Nasal bone fractures are the most common fractures caused by facial trauma. Recently, the usefulness of ultrasonography for intraoperative evaluation during nasal bone fracture reduction was reported. Although its safety, non-invasive nature, and capability of repeated use are advantages, the technique is hindered by its complicated operation and large device size. We evaluated the usefulness of the portable echo Venue 40^® for nasal bone fracture reduction and report our experience. Between November 2017 and December 2018, 19 patients with nasal bone fractures underwent closed reduction at our institution using this device. We were able to detect the fracture sites and achieve accurate results using real-time ultrasonography. The Venue 40^® is superior to other ultrasonographic devices in terms of operability and mobility, can be easily used by both operators and other medical staff, and can be used at the bedside and outpatient clinic, in addition to the operating room. Therefore, it may be useful for evaluating nasal bone fractures.

　　Introduction: Alloplastic implants are commonly used for reconstruction of orbital wall defects. Post-operative complications include hemorrhage, infections, and the formation of periprosthetic orbital cysts, which can lead to removal of the implant. We consider it necessary to strategically remove the cyst wall and add a counterpore in the maxillary sinus to prevent recurrence of the cyst.
　　Case description: We report the case of a patient who suddenly developed a periprosthetic multi-row columnar epithelial cyst 12 years after initial orbital floor reconstruction using a silicone sheet implant. Although the implant was immediately removed and the cyst was extirpated, followed by complete clinical recovery, the cyst redeveloped one year after surgery. We extirpated the cyst again and no further complications were noted at the 2-year follow-up.
　　Conclusion: This report emphasizes that periprosthetic orbital cysts can develop years after the initial repair. Awareness of this rare complication enables prompt diagnosis, reducing the risk of permanent damage to the orbit. Complete extirpation of the cyst and removal of the implant are necessary to relieve the symptoms and prevent recurrence of the cyst. In the case of incomplete removal of the cyst, it is essential to create a drainage pathway into the maxillary sinus to prevent further damage as much as possible.

　　Neonatal oropharyngeal teratoma (=epignathus) is a markedly rare congenital malformation, with an incidence of 1 in 35,000-200,000 live births. Regarding deformities associated with this tumor, cleft palate is common. We report a rare case of epignathus in a male newborn with a huge oral mass protruding through a cleft in the hard palate.
　　For the large defect of the palate after surgical excision of the tumor, soft and hard palate closure were performed at 2 years and 11 months, and 5 years and 4 months, respectively. As a result, language development is age-appropriate and velopharyngeal insufficiency is mild, but the patient was able to produce monophonic words approximately 4 years after the second surgery. There is no malocclusion or rhinorrhea on ingestion at 9 years of age.
　　The two-stage operation resulted in insufficient velopharyngeal closure function in many reports; however, language training resulted in good language performance equivalent to that after the one-stage operation.
　　This report describes our procedure and postoperative course.

　　First branchial cleft anomalies are rare in clinical settings, and account for 1 to 8% of all branchial abnormalities. They are due to incomplete fusion of the ventral portion of the first and second brachial arches. Malformation can develop in any part of the external auditory canal to the mandibular angle, including the parotid gland area. As the fistula tract is located close to the facial nerve originating in the second brachial arch, it is important to preserve the facial nerve during surgery. However, the relationship between the lesion and the facial nerve varies. Thus, it is difficult to predict this relationship when making the preoperative diagnosis.
　　We were able to dissect the lesion safely using the facial nerve monitor that is usually employed in parotidectomy.