Intracranial lipoma is a rare disease, accounting for 0.46%-1.0% of all intracranial tumors. It typically develops in the pericallosal cistern, but rarely in the cerebellopontine angle. Intracranial lipoma associated with subcutaneous scalp lipoma is markedly rare and no case of cerebellopontine angle lipoma has been reported. We report a case of occipital subcutaneous lipoma associated with cerebellopontine angle lipoma. A 4-month-old male infant was admitted to our hospital because of an occipital subcutaneous mass with little hair on its surface. No seizures or neurological abnormalities were noted. Magnetic resonance imaging revealed a cerebellopontine angle lipoma extending to the subcutaneous lipoma. Resection of only the extracranial subcutaneous lipoma was performed for aesthetic reasons. The subcutaneous lipoma was connected to the intracranial space through a small hole in the occipital area. In the year following surgery, he remained asymptomatic and the occipital scar healed well. Magnetic resonance imaging should be considered for infants with subcutaneous scalp lipoma to check for a possible intracranial component, which is important when considering surgical procedures.
Autologous bone grafting is considered the first option of choice for cranial reconstruction or cranioplasty. However, in recent years, several types of bone substitutes and high-quality synthetic materials have become available as alternatives. We used a custom-made cranial implant “CT-Bone”, fabricated by a 3D inkjet printer using alpha-tricalcium phosphate（alpha-TCP), to repair a full thickness defect of the frontal bone after venous malformation resection in a 56-year-old female. Although there are previous reports on using CT-bone for hemifacial microsomia, its utilization in calvarial bone reconstruction has not been reported. In particular, reconstruction of forehead defects with exposed bone requires achieving an aesthetic outcome. Therefore, we report our experience of obtaining a satisfactory outcome using CT-Bone in cranioplasty and discuss its possible limitations along with a review of the relevant literature.
Depressed scars and tracheal tugging that cause skin traction during swallowing without tracheocutaneous fistulae following tracheostomy can pose a serious problem. We report the cases of two patients with a depressed scar and tracheal tugging. The first case was that of a 12-year-old boy with Pierre Robin sequence. The scar and surrounding skin were de-epithelialized, and a dermal fat flap was elevated, overlapped, and sutured to the depression. Thereafter, the bilateral sternohyoid muscles were sutured in the midline. The second case was that of a 51-year-old woman. The recess was filled with a dermal fat flap, and the left sternohyoid muscle and medial sternal head of the right sternocleidomastoid muscle were sutured in the midline. Postoperative recurrence was not observed in either patient. There are several reports on the treatment of tracheocutaneous fistulas after tracheostomy；however, few discussed the treatment of depressed deformities and tracheal tugging. Grafting of a dermal fat flap, artificial dermis, or allogenic dura, and shifting of the strap muscles to improve the depressed shape and prevent reattachment of the skin to the trachea yield good results. Future studies are necessary to provide more treatment options.
Sebaceous carcinoma is a malignant tumor that differentiates into sebaceous cells and is most common in the upper eyelid. The myotarsocutaneous flap（MTC flap）is a useful reconstruction method；however, there are several methods for pedicle selection, reduction of flap tension, and dealing with mucosal defects. It is necessary to understand the characteristics of each procedure. In this case, an MTC flap was used for full-thickness reconstruction of an upper eyelid defect after resection of a sebaceous carcinoma. The defect width of the upper eyelid was 48% of the entire eyelid width. The levator palpebra muscle and conjunctiva were elevated as the pedicle of the MTC flap. At the external canthus, the conjunctiva and upper crus of the external canthal tendon were dissected to advance the flap. The functional and cosmetic results were both satisfactory. At the end of the operation, the conjunctival defect was 6 mm in width；however, it healed naturally.
Facial herpes zoster occurs by reactivation of latent varicella-zoster virus, manifesting as eruptions, blisters, and first division trigeminal neuralgia. A 74-year-old male was treated for facial herpes zoster complicated by skin ulceration. Due to pain and stenosis of the nasal cavity after wound closure, full-thickness resection of the left alar was performed. Considering the size of the defect involving the surrounding tissues, nasolabial hinge and median forehead flaps were used for reconstruction in combination with an auricular cartilage graft. The advantages of this method are the restoration of the nostril shape and retention of the nasal cavity. The surrounding scar tissue was not used for external reconstruction and flap circulation, and the esthetic outcome was satisfactory. Alar reconstruction requires consideration of the primary cause and the condition of the surrounding tissue.