It has recently been noted that some patients who complain of blepharoptosis actually have blepharospasm. However, to the best of my knowledge, no study has yet examined the involvement of blepharospasm in blepharoptosis. The author retrospectively reviewed patients who expressed dissatisfaction with blepharoptosis surgery on a patient-satisfaction survey, and examined the involvement of blepharospasm in these patients. Two out of 10 patients who were dissatisfied with blepharoptosis surgery showed photophobia and increased contraction of the facial muscles, and seemed to have had blepharospasm before surgery. The author also prospectively examined patients who visited his clinic for blepharoptosis, and tested whether the patients had blepharospasm. Among the 75 patients who requested blepharoptosis treatment, 11 were diagnosed with mild blepharospasm, and 2 with severe blepharospasm. The two severe cases were treated with botulinum toxin, rather than with surgery. Some patients who have blepharospasm believe that they have blepharoptosis, and request blepharoptosis treatment at clinics. We should be aware of the potential involvement of blepharospasm in our clinical experience of patients with blepharoptosis.

  An arteriovenous fistula is an abnormal short-circuit between arteriovenous vessels that does not involve capillaries. Acquired arteriovenous fistulas are caused by traumatic injuries such as puncture wounds and contusions, and sometimes by medical procedures. Traumatic arteriovenous fistulas occurring in the facial area have been reported infrequently, and supratrochlear arteriovenous fistulas are also extremely rare. We encountered a case of supratrochlear arteriovenous fistula. The arteriovenous fistula was located in the external carotid artery system and clustered in the frontal, lateral orbital, and temporal regions, being consistent with the site of trauma. Therefore, arteriovenous fistulas should be suspected when a mass with pulsation that disappears with pressure is found at a trauma site.
  In this case, the surgical approach was the first choice because the arteriovenous fistula was relatively superficial and tumor diameter was small. Embolization may be an option despite the risk of blindness associated with ocular artery embolization.

  We report the case of an 89-year-old woman who had macrocheilia including arteriovenous malformation (AVM) of the lower lip (Schöbinger stage III).
  She was referred to our department because of swelling and hemorrhagic ulcer of the lower lip. Pulsation and thrill were not felt on palpation of the lip.
  The lesion was preoperatively diagnosed as AVM by ultrasonography, CT, and MRI. We planned to perform preoperative embolization immediately before partial resection in a hybrid operating room. Based on angiographic classifications, we could choose an effective approach for embolization. After that, AVM was reduced with little hemorrhage.
  The post-operative course was favorable. There was no trismus or difficulty closing the mouth. The patient tolerated oral ingestion very well. There was no recurrence of symptoms about 6 months after surgery.
  For AVM, it is desirable to perform partial resection immediately after embolization to promote hemostatic efficacy and minimize any spread of inflammation caused by the embolizing material. Because of the patient's advanced age, it was considered important to complete the treatment in one session, so embolization and partial resection were performed simultaneously. The hybrid operating room was very useful to carry out both embolization and partial resection in a single treatment.