Midfacial degloving is an excellent technique for entering the deeper parts of the midfacial region, particularly the nasal and paranasal cavities, the epipharynx and the base of the skull. This approach consists of a bilateral sublabial incision and rhinoplastic release of the nasal soft tissue, exposing the whole bony midf ace without external skin incisions. We reported two cases of the tumor resected by midfacial degloving technique ; a case of juvenile nasopharyngeal angiof ibroma extending to the pterygomaxillary space (Chandler's stage III) and a case of maxillary large schwannoma extending to the infratemporal fossa. The cosmetic results have been excellent. The approach is ideal for children, adolescents and women with a benign tumor of the deep midfacial region.

View full abstract

To clarify the major points of head and neck reconstruction by microvascular free flap, we reviewed the complications in 78 cases of which 34 were rectus abdominis myocutaneous flaps, 28 were radial forearm flaps, 15 were free jejunal flaps and 1 scapular osteo-cutaneous flap. The analysis about post-operative complications at the recipient site was mainly performed from the point of view of the history of previous surgery and/or radiotherapy. There were 5 cases (6.4%) with major complications which required surgical repair. Out of the 5 cases, there were 3 cases with total free flap necrosis and 2 cases with abdominal complications in relation to harvesting free jejunum. The necrosis was mainly due to the plan of microvascular anastomosis and not the relationship of previous surgery and radiotherapy. It was thought to be resolved by improvement in the skill of the microvascular surgeon. There were 28 cases (35.9%) with minor complications which did not require surgical repair. Out of the 28 cases, there were 17 cases with wound infection including fistula formation, 3 cases with partial flap necrosis, and 4 cases with fluid collection. The wound infection was found to be more frequent in cases which received radical radiotherapy over 45 Gy, than in those who received pre-operative radiotherapy around 40 Gy. Careful examination was necessary to identify any wound infections for the post-operative management of free flap reconstruction in the case with radical radiotherapy.

View full abstract

Paragangliomas, uncommon tumors in the head and neck region, are especially rare in the nasal cavity. The authors have experienced a case of nonchromaffin paraganglioma in the nasal cavity. To our knowledge, this case report is the 3rd in Japan and there have been seventeen reported cases in the literature. The patient, a 16-year-old man, had complained of left recurrent epistaxis since December 1994 and was referred to our hospital in May 1995. On physical examination, a polyp-like mass was noted on the anterior surface of the left middle turbinate.
The mass had a rich capillary network and tended to bleed easily. Paranasal sinuses x-rays were normal, except a tumor-like shadow found in the left nasal cavity. Computed tomography demonstrated a small mass in the left nasal cavity and marked contrast enhancement. After external carotid angiography and embolization, a surgical operation was done. Histopathological diagnosis of paraganglioma was made because of the typical finding of “Zellballen” pattern.
Paraganglioma is a benign tumor but has the potential of local recurrence, lymph node metastasis and distant metastasis, so it requires a long-term follow-up.

View full abstract

A case of traumatic lagophthalmos due to partial eyelids skin and orbicularis oculi muscle defect was reported. The weakness of contraction force of defective orbicularis muscle caused the lagophthalmos in this 18-year old man. Because lagopthalmos and deformity of the eyelid caused a keretopathy, this condition had to be eliminated quickly. Then we performed Gillies-Andersen procedure (temporalis muscle transfer) to enhance the eyelid closure. This procedure effectively resolved the deformity and incomplete closure of the eyelid. The post-operative outcome was satisfactory without complications. The temporalis muscle transfer is considered to be a reliable procedure in selected cases of traumatic lagophthalmos.

View full abstract