Objective: To examine morphological changes of the lip and nose during resting and lip protrusion in patients with unilateral cleft lip.

Methods: A total of 41 patients with unilateral cleft lip who underwent primary lip repair were included in the study population. The distortion of the lip and nose was measured and evaluated using photographs of the preoperative and postoperative resting lips and the postoperative protruding lips.

Results: The position of the labial commissure on the affected side was cranially deviated before lip repair, and the deviation remained after surgery. The degree of cranial deviation was increased by lip protrusion. The position of the alar base on the affected side was caudally deviated before lip repair and improved after surgery; however, it was displaced cranially by lip protrusion. Horizontal displacement of the lip and nose was improved after surgery, and there was no change during lip protrusion.

Conclusions: The characteristic facial distortion in patients with unilateral cleft lip were confirmed. Patients with cleft lip had distortions in the labial commissure and the nose. One of the important future challenges in cleft lip treatment is to focus on changes caused by muscle movement and provide natural and symmetrical facial expressions.

Objectives: To present a new protocol for closure of cocaine fistulae using a combination of palatal flap delay and facial artery musculomucosal flap demonstrating its reliability for closing these challenging defects and its advantages compared to the other used techniques such as turned over palatal, tongue, temporalis muscle, and radial forearm free flaps.

Methods: Eight patients presenting with oronasal communication who admitted sniffing cocaine were treated using palatal flap delay in combination with facial artery musculomucosal flap after quitting cocaine abuse. All cases were followed up for a period of 12-18 months where healing pattern, signs and symptoms of breakdown, recurrence, or residual fistulae in addition to patient satisfaction using a visual analog scale were evaluated.

Results: All eight patients showed a very good healing pattern without any signs and symptoms of breakdown, recurrence, or residual fistulae. VAS assessment for patient satisfaction where 10 being the most satisfied showed that four patients reported score 10, three reported score 9, and one reported score 8.

Conclusions: The combination of palatal flap delay and FAMM flap is very reliable for cocaine fistulae closure.

Important factors that affect the initial repair of complete bilateral cleft lip (CBCL) include not only the width of the cleft but also the distance between the premaxilla and alveolar bone. We report a case of a patient with CBCL in whom favorable morphological and aesthetical results were achieved by surgical premaxillary setback. The patient was a 5-month-old boy with CBCL, who had a severely protruding premaxilla. Despite repeated lip adhesion before lip closure surgery, wound dehiscence occurred, and therefore, we performed premaxillary setback with vomerine ostectomy. The bone was removed posterior to the vomero-premaxillary suture, and the premaxilla was indirectly stabilized by bilateral mucosal bridging. The procedure for the vomer worked well, and his premaxilla was moved back enough to undergo surgery. The premaxillary setback is thought to be a reasonable option to treat CBCL in patients with a protruding premaxilla. The subsequent long-term follow-up of the midfacial development of these patients is necessary.

Trichilemmal cysts are the most common benign subcutaneous cysts on the scalp. Approximately 90% of trichilemmal cysts appear on the scalp and have trichilemmal keratinization without a granular layer visible on pathological examination. In addition, proliferating trichilemmal tumors, which occur in 2% of trichilemmal cysts, show local recurrence and ulceration, making them highly locally aggressive and requiring careful differentiation. We report the case of a 56-year-old man with a giant trichilemmal cyst on his forehead. After computed tomography and magnetic resonance imaging, a subcutaneous cyst was suspected and excised, and a pathological diagnosis of trichilemmal cyst was established. This was a rare case as the trichilemmal cyst was not located on the scalp, the most common site, but on the forehead area, and it was exceedingly large, with a maximum diameter of 9 cm.

Burn, a common injury in daily life, is a potential risk factor for severe sequelae in people, particularly children. Preventing unexpected burn injuries is of the utmost importance. This study examined the current status of pediatric burns in our institute. One hundred children who received intensive therapy in Kyushu University Hospital were analyzed regarding the causes, sites, severity, treatments, and outcomes of burns between 2004 and 2021. The mean patient age was 2.4 years (range: 0-15), and 90% of patients were 6 years old or younger. The mean percent total body surface area was 12.7%. All patients had second- or third-degree burns. The most common cause was scalding (93%), and among them, hot water burns, and kettle burns were predominant in 49.5% and 24.7% of children, respectively. The seasonal fluctuations of occurrence were not remarkable. Basic fibroblast growth factor spray with wet dressing was used, but hypertrophic scars arose in 39 patients. The mean duration of hospitalization was 18.9 ± 18.2 days. This study revealed that more than 90% of pediatric burns were caused by hot liquids, thereby highlighting the importance of educational activities for parents to prevent and reduce pediatric burns because most scalding burns can be avoided with caution.

Background: Although several studies have investigated the accuracy of clinical diagnoses of skin tumors, specific ways to improve diagnostic accuracy have not been identified. This study investigated factors that influence the accuracy of clinical skin tumor diagnostic methods and discusses strategies to improve accuracy.

Methods: Study 1 retrospectively analyzed 657 skin tumors excised at our hospital between March 2001 and March 2011. Data were extracted from surgical records to establish a diagnostic template for further research. Study 2 prospectively applied this template to aid clinical diagnosis at four facilities between April 2011 and March 2013. The clinical diagnoses were compared with the histological ones and the concordance was determined.

Results: A total of 448 and 209 benign and malignant tumors, respectively, were included in Study 1. The overall diagnostic accuracy was 79.0%. In Study 2, 310 patients were clinically diagnosed using a standardized template, which did not affect the diagnostic accuracy. Age, sex, duration of disease, tumor size and location, skin tone, mobility, stiffness, and years of diagnostic experience did not significantly affect diagnostic accuracy. A high proportion of pathologically malignant tumors were clinically misdiagnosed as benign (16/22; 72%). Other clinical examinations were performed in only 35 cases.

Conclusions: Auxiliary diagnostic tools such as dermoscopy and biopsies should be used to accurately diagnose malignant tumors.

Objectives: Photogrammetry is a method of producing three-dimensional (3D) data from multiple photographs and videos. The purpose of this study was to evaluate the reliability of 3D hand models constructed using photogrammetry.

Methods: The angles of the distal (DIP) and proximal (PIP) interphalangeal joints of the author's index finger were measured using a protractor goniometer. Five different blocks were used to stabilize the angles of the fingers. We collected 50 photographs and one video. Digital 3D models of the hand were constructed using 3DF Zephyr photogrammetry software. The angles of the DIP and PIP joints of the model were measured in virtual space. The angles obtained via the two methods were subjected to correlation analysis.

Results: Eighty values (40 joints of 20 fingers; goniometer/3D model) were obtained. The maximum value obtained was 84° and the minimum was 33°. The average time required to take the original photographs of the model was 3 minutes, and that for the videos was 51 seconds. The average time required to construct a 3D image was 12 minutes. The greatest difference between the methods was 9° and the mean difference was 0.2°. The intraclass correlation coefficient (2,1) was 0.971.

Conclusions: A high level of agreement was found between these angles. A 3D hand model constructed using photogrammetry is reproducible.

Monitoring blood flow in a buried flap is often challenging. In cases of free jejunal transfer, although exteriorization of a minor jejunal segment has become the standard method, there remain issues such as intestinal fluid management, the need for separation of the monitored jejunum, and high false positive rates. In this study, we performed monitoring using handheld ultrasound (Vscan Extend™; GE Healthcare, Japan) in four patients who had undergone free jejunal transfer between August 2022 and December 2022. The blood flow in the anastomosed vessels and the peristalsis of the jejunum were observed in all patients. There were no cases of reoperation due to early failure such as thrombosis of vascular anastomosis or vessel spasm. The handheld ultrasound made it possible to adequately evaluate both the blood flow in the anastomosed vessels and the peristalsis of the transplanted jejunum. Handheld ultrasound can be useful for monitoring blood flow in a buried flap.