In posterior cranial vault distraction（PCVD）, it is necessary to accurately determine the direction of the venous sinus. A three-dimensional fluoroscopic composite image was created from the venous cava by MRI and the cranial bone on CT using SYNAPSE VINCENT^®. Four patients who underwent PCVD for craniosynostosis at our hospital between 2019 and 2020 were analyzed. As a measurement of the accuracy of the composite image, the distance from the intersection of the suture lines during the operation to the lower edge of the osteotomy（λ-A）and the distance from the intersection of the suture lines on postoperative CT to the lower edge of the osteotomy（λ-B）were measured. The average of the difference（A-B）was 0.5 mm. As a measurement of the accuracy of setting the cutting line, the average distance between the lower edge of the osteotomy line and the upper edge of the sinus was 9.4 mm. The three-dimensional fluoroscopic composite image was an accurate indicator. The setting of the bone-cutting line was appropriate. If images of different modalities are synthesized and examined, three-dimensional fluoroscopic composite images are considered a useful method in PCVD.

　　Aplasia cutis congenita of the scalp is a relatively rare disease. Bleeding from the superior sagittal sinus and intracranial infection indicate fatal complications. We report a case of aplasia cutis congenita of the scalp with a large cranial bone defect. A girl weighing 1484 g was born by cesarean section at 35 weeks of gestation due to severe fatal growth retardation. Aplasia cutis congenita consisted of a large scalp defect measuring 8.0 × 6.0 cm at the parietal region and 2.0 × 2.0 cm at the occipital region involving the full thickness of the cranium. Conservative treatment was performed and the skin defect was covered with white petrolatum and film to protect from drying after spraying basic fibroblast growth factor. The wound was fully epithelialized within 12 weeks. The scalp defects were treated by conservative methods without major complications. We describe the course of treatment in detail.

　　A 76-year-old man visited our emergency room following a fall that also bruised his right eye. He had been taking antiplatelet medication. He exhibited decreased visual acuity, increased intraocular pressure, and restricted movement of his right eye. Simple computed tomography (CT) demonstrated no obvious fracture or pneumocephalus. However, a convex lens-shaped hyper-absorption area was observed along the right supraorbital wall. These findings led us to a diagnosis of orbital subperiosteal hematoma. An emergency incision was made in the right eyebrow region three hours after injury under local anesthesia to drain the hematoma. A Penrose drain was inserted to preserve his vision and the patient was admitted to the hospital. After 36 hours, hemostasis was performed under general anesthesia due to hypotension caused by excessive bleeding. Intraoperative findings included spinal fluid leak, a linear fracture line on the supraorbital wall, and bleeding from the same site, which was cauterized. The patient recovered uneventfully and was discharged on the 3rd day of illness. Draining a hematoma under local anesthesia may help preserve vision. However, if the bleeding point cannot be identified, the possibility of hemostasis under general anesthesia, including frontal craniotomy, should be considered.

　　Le Fort type I osteotomy is a surgery to improve facial appearance and occlusion by moving the maxilla. There are few complications of Le Fort type I osteotomy, but the morphology of the external nose may change with the movement of the maxillary bone. In addition, nasal septal deviation may occur due to maxillary bone movement, resulting in nasal obstruction. We report a case of nasal septum surgery using the hemitransfixion approach for nasal obstruction symptoms after Le Fort type I osteotomy. The patient was a 52-year-old female who underwent Le Fort type I osteotomy approximately 10 years ago and developed nasal obstruction symptoms afterwards. The nasal septum surgery was performed with a hemitransfixion approach because she had caudal nasal deviation and postoperative nasal obstruction symptoms improved. After Le Fort type I osteotomy, L-strut deviation is more likely than physiological nasal septum deviation, and nasal septum surgery using the hemitransfixion approach is effective.

　　Nasal obstruction, in which resistance of nasal breathing increases, directly affects the patient’s quality of life. In some cases of anatomical deformity, the nasal airway itself should be surgically corrected. We report a case of severe nasal obstruction with traumatic saddle nose deformity and nasal valve narrowing due to scar contracture. The saddle nose deformity was compounded by bony nasal vault disruption and marked contracture of the nasal lining after major septal collapse. The nasal bony vault was adjusted and reinforced with an iliac bone graft, and bilateral nasolabial flaps were transferred to the defect after contracture release. We evaluated nasal obstruction objectively and subjectively using acoustic rhinometry and the Nasal Obstruction Symptom Evaluation Scale respectively. These scores demonstrated significant improvement after surgery and the patient was highly satisfied. Surgery for external nasal deformity with airway obstruction requires preoperative assessment of the nasal vault and valve.

　　Foreign bodies such as toothbrushes or chopsticks are not uncommon in children. Many of these injuries are minor and resolve without sequelae, but some can lead to serious complications, such as pneumomediastinum or severe infections, and may require intubation if there is a risk of upper airway obstruction. Velopharyngeal insufficiency due to injuries of the soft palate has been reported to result in speech impairment, even in cases where a favorable prognosis was predicted. Possible complications vary depending on the type of foreign body involved and penetration depth into the tissues. We discuss a very rare case of injury caused by a fork extending from the palate to the posterior wall of the nasopharynx and a case of velar trauma due to hyperbaric water flow.