Daichi Morioka

Primary repair in adult patients with untreated cleft lip-cleft palate.

Background: The authors have volunteered their services as plastic surgeons in several countries, such as Nepal and Cambodia. In these programs, the authors saw many adults with cleft lips or palates who could not have primary repair at the proper time. The purpose of this report is to discuss the primary repair of untreated cleft lips or palates in adult patients. Methods: Subjects were older than 17 years. In Nepal, primary repairs were performed in 129 adults with untreated clefts over the past 11 years. Unilateral cleft lips were repaired by rotation advancement with the small triangular flap method or the straight method with a small triangular flap. Bilateral clefts were repaired using a one-stage repair method. Cleft palates were repaired by a mucoperiosteal push-back or Furlow technique. Results: Differences between primary cleft repair for infants and for adults were as follows: (1) in adults, aggressive correction was possible, as maxillary growth was not a consideration; (2) correction of the anterior part of the nasal deformity was more difficult than in infants, as adults showed less elasticity and a more severe deformity of the nasal cartilages; (3) simultaneous palatoplasty should be chosen judiciously, as it is more invasive and results in higher morbidity; and (4) cheiloplasty under local anesthesia can reduce cost, time, and manpower. Conclusions: These observations should be useful for the local and foreign surgeons who treat clefts in developing regions.

Aesthetic and Plastic Surgery for Trichorhinophalangeal Syndrome

Abstract. Trichorhinophalangeal syndrome is an autosomal dominant disorder characterized by a number of clinical features including short stature, sparse scalp hair, a pear-shaped bulbous nose, upper lip deformity, protruding ears, mandibular hypoplasia, and cone-shaped epiphyses of the phalanges. The syndrome has three subgroups: types I, II, and III. Although a few authors have pointed out the importance of aesthetic and plastic surgery in this syndrome, it has attracted relatively little attention. This review of the literature indicates that many patients have had various surgical corrections for associated abnormalities, including otoplasty and rhinoplasty. Unlike aesthetic or plastic corrections in other well-known congenital disorders, most corrections in trichorhinophalangeal syndrome have been performed prior to a diagnosis of the syndrome. Accurate identification of this syndrome is important to provide appropriate aesthetic treatments. Careful evaluation of patients is required when they present for surgery or aesthetic counseling, because they may have a variety of occult associations such as recurrent respiratory tract infections and urogenital anomalies.

Nasolabial Growth in Individuals With Unilateral Cleft Lip and Palate: A Preliminary Study of Longitudinal Observation Using Three-Dimensional Stereophotogrammetry

Abstract There are limited numbers of studies comparing the preoperative and postoperative facial features of infants with unilateral cleft lip and palate (UCLP) using three-dimensional (3D) stereophotogrammetry. The authors attempted an anthropometric analysis of nasolabial asymmetry 1 year after primary lip repair using a handheld 3D imaging system. Five different nasolabial dimensions in 24 infants with UCLP were measured using 3D images captured during primary lip repair and again, 1 year after the repair. The nasal and upper-lip elements of the cleft side were significantly changed after primary lip repair, and nasolabial asymmetry was anthropometrically improved. This is a preliminary longitudinal observation of nasolabial growth in individuals with UCLP using 3D stereophotogrammetric technique. The authors would like to follow these children until adulthood, capturing 3D images at every intervention.

Clinical features of axillary osmidrosis: A retrospective chart review of 723 Japanese patients

Axillary osmidrosis often disturbs a persons social life, particularly in Asian countries. However, the clinical aspects of this condition have not been well documented in the English‐language published work. This study aimed to provide information on the features of axillary osmidrosis, with a particular focus on sex differences. A retrospective review was made of the charts for 723 Japanese patients (492 female, 231 male). The mean age at initial presentation (29.1 years) was nearly the same for males and females. Almost all patients (96.1%) had wet earwax, which was extremely high compared to its frequency in the general Japanese population. An association with hyperhidrosis was seen in 61.8% of these patients. Subjective odor levels in female patients were significantly lower than those in males (P < 0.001). A positive family history was more frequent for females than for males (P < 0.001), and prior treatment history was also more frequent for females than for males (P < 0.015). Most patients (86.6%) had received some treatments in our clinic. There were significantly fewer females who underwent surgical treatments compared to males (P = 0.026), as females preferred less invasive techniques (P < 0.001). Several features, including male/female ratios, and associations of wet earwax and hyperhidrosis, corresponded to previously reported data on axillary osmidrosis. Female patients were more concerned with axillary odor than males, and females had a tendency for polysurgery.

Self-mutilation by a Patient with Borderline Personality Disorder

Abstract We present an unusual insatiable aesthetic/plastic surgery patient with borderline personality disorder (BPD) who removed her upper eyelids by herself after we rejected her request for revision blepharoplasty. This impulsive self-injury was attributed to anxiety from what the patient considered to be abandonment by the surgeon. Even after the eyelid defects were successfully treated, the patient requested several other revisions, including tattoo removal. Compared with other mental disorders, including body dysmorphic disorder, preoccupation with appearance in BPD is less profound and shifts from one body part to another. In an aesthetic and plastic surgery practice, a different psychiatric approach should be used for individuals with BPD, and the proper timing for a psychiatric referral should be established.Level of Evidence VThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Chronic expanding hematoma, ruptured through the skin 53 years after buttock contusion.

INTRODUCTION Chronic expanding hematoma is a relatively rare complication of soft tissue trauma and often clinically mistaken for a malignant neoplasm. PRESENTATION OF CASE A 71-year-old female presented with a chronic expanding hematoma that ruptured through the buttock skin 53 years after the original contusion. The diagnosis of CEH was made based on the results of the biopsy, physical examination, and CT. The tumor was completely excised, and the defect was covered with a rhomboid flap. DISCUSSION There are no reports of lesions rupturing through the skin. Almost all instances of chronic expanding hematoma previously reported in the English literature have a history ranging from 1 month to 20 years. There is a report of a thorax CEH that ruptured into the lung parenchyma after 24 years, so it is conceivable that other subcutaneous CEHs could break through the skin several decades after their inception. CONCLUSION Once this lesion has ruptured, its differentiation from other entities becomes more complicated.

Cervical necrotizing fasciitis with upper trunk extension

Abstract A 49-year-old patient presented with an unusual case of cervical necrotizing fasciitis that extended subacutely to the upper trunk. The source of the infection was unknown. The patient had a markedly protracted course and had severe complications, including pneumonia, septic shock, and disseminated intravascular coagulation. Following surgical debridement, split thickness skin grafting was performed from the neck to the anterior chest wall; a subcutaneous area on the back was debrided, the skin was not affected and the area healed like a bipedicled flap. This paper also focuses on the importance of intense supportive care and the clinical utility of intravenous human immunoglobulin.

Antitragicus muscle resection: A key to correction of prominent lobules

The antitragicus muscle arises from the outer part of the antitragicus cartilage, and inserts into the helical tail and antihelix. Overdevelopment or malpositioning of the antitragicus muscle exerts an anterior pull on the helical tail, and it can cause prominent lobules. We attempted prominent lobule correction using antitragicus muscle resection and helical tail setback in combination with a Mustarde or Furnas suture technique. Seventeen children with prominent lobules underwent this technique, and all had satisfactory outcomes. Resection of the antitragicus muscle is minimally invasive and easy to perform. This procedure is a key to successful lobular setback.

Rectus sheath hematoma presenting as a gradually enlarging abdominal mass

We report two unusual cases of rectus sheath hematoma. This condition usually presents with acute onset and is generally treated through the general surgery or emergency service department. However, if the hematoma grows slowly it may be diagnosed as an abdominal tumor and the patient may then be referred to the plastic surgery department.

Chronic Expanding Hematoma Following Abdominoplasty

AbstractChronic expanding hematoma (CEH) is a relatively rare complication of trauma or surgery. We report a patient with CEH as a late complication of abdominoplasty. A 58-year-old woman underwent conventional abdominoplasty and thereafter refused to use a compression binder, citing discomfort. One month postoperatively, she presented with a gradually enlarging, painful abdominal mass. The results of ultrasonography and computed tomography were highly suspicious for CEH. The lesion was completely removed, together with surrounding fibrous tissue. Histopathology revealed a chronic hemorrhage collection with a fibrous capsule, consistent with CEH. This condition as a late complication of abdominoplasty has not previously been reported in the literature. However, an online medical consultation site features several abdominoplasty patients asking about persistent hematomas that sound suspicious for CEH. CEH might be underdiagnosed by surgeons. Although a postoperative binder may increase the risk of skin necrosis and deep vein thrombosis, appropriate compression treatment is necessary to prevent hematoma formation. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.