Jianbin Chen

Management of cystic lymphangioma in the head and neck region: endoscopic cautery and postoperative intratumoral negative pressure.

Cystic lymphangiomas of the head and neck are very common and cannot be completely removed by surgical excision because of frequent complications. In this article, we report on 28 cases of huge cystic lymphangiomas in the head and neck region, which were treated successfully by endoscopic cautery in combination with postoperative intratumoral negative pressure. The cysts were 11 to 20 cm in diameter as diagnosed by ultrasonography and computed tomography scan. The 45-degree × 4-mm endoscopes were placed into the cysts through 1- to 2 cm-long hidden incisions to visualize the lymphangiomas, which were under the blue translucent mucous membranes. We cauterized the walls of the tumor cavities with 6% to 10% iodine twice and used topical negative-pressure therapy for 7 to 10 days after suture of the small incisions. This endoscopic approach can be successfully and safely performed by an experienced surgeon who complies with oncologic principles.

Inversion of the flap at the lower ear and restoration of the flap at postauricular skin for reconstruction of the earlobe.

AbstractWe describe a technique for reconstruction of the earlobe. This technique is to reconstruct the earlobe by inversing the flap at the lower ear and restoring the flap at postauricular skin. Although there are many procedures that aim to reconstruct the earlobe naturally, the aesthetic results of using our method are better because the scar tissue that remains behind the ear is hidden.

Treating kaposiform hemangioendothelioma with Kasabach-Merritt phenomenon by intralesional injection of absolute ethanol.

Purpose Kasabach-Merritt phenomenon (KMP) is characterized by thrombocytopenia, microangiopathic hemolytic anemia, consumptive coagulopathy, and an enlarging vascular lesion. It is a rare and life-threatening disease of vascular tumor. The purpose of this study was to assess the effectiveness of absolute ethanol in the treatment of KMP. Methods We treated 8 pediatric patients with KMP by using absolute ethanol injections, whose cases failed previously when applied steroid therapy. We reviewed the clinical and laboratory data of these 8 cases at Nanjing Children’s Hospital in China. Results Eight pediatric patients (5 female and 3 male) showed tumor regression after treatments. Core needle biopsy had been performed on the 8 patients, and the results included 7 kaposiform hemangioendotheliomas and one tufted angioma. All patients had an increase in platelet count. All coagulopathies were corrected. Complications included one patient with flush on face, one patient with needle scars, and one patient with a small area of local tissue necrosis. Conclusion Absolute ethanol therapy presents a safe option in the treatment of KMP. Treatment-associated complications seemed to be reversible and acceptable by severity levels. Direct intralesional injection of absolute ethanol provides a simple and reliable alternative treatment for KMP among infants and may be used as the second-line therapy.

Reconstruction of sternal cleft and aplasia cutis with a Medpor and a rectus abdominis musculocutaneous flap.

Superior sternal cleft is a rare congenital malformation that may represent a challenge for plastic surgeons. We describe a 1-day-old neonate. She was noted to have superior sternal cleft associated with aplasia cutis ahead the sternum. Three days after birth, she successfully underwent primary repair using a Medpor and a rectus abdominis musculocutaneous flap. This is a novel concept of successfully constructing the sternal cleft associated with aplasia cutis.

Correction of craniosynostosis using modified spring-assisted surgery.

BackgroundThe use of springs in craniofacial surgery was originated at Sahlgrenska University Hospital in 1997 as a way of remodeling the cranial vault postoperatively. After a decade of development, spring technology has been improved to a greater extent. However, there still exist some problems, such as the poor consistency of steel wire stretches, the wrong position of steel wire, the problem of increasing the elasticity of springs, and so on. MethodWe have designed a spring device for external uses. This device is composed of 3 parts. The first part is the outside of the spring ring. This ring is the same as the internal spring, only a little bigger. The second part is a small U-shaped hook, which is made of titanium plates and linked to the skull portion. The U-shaped hook is approximately 1 cm long and 1 cm wide. The hang is approximately 1 cm long and 0.6 cm wide. The U-shaped level length is 1 cm, but the level width should be equal to or bigger than the thickness of the skull. The third part is a steel wire, which is placed at 1 end of hook. We first conduct a strip craniotomy, then put 2 hooks at the bone ends and, after that, fix hooks on the skull. Finally, we pull the steel wire of the hook end out of the scalp, connect it with the external spring, and draw out the external spring. We performed 24 craniofacial spring placement procedures for 12 patients with craniosynostosis. ResultsWe used 6 springs for 3 patients who had anterior plagiocephaly, 12 springs for 6 patients who had scaphocephaly, and 3 springs for another patient who had metopic synostosis and holoprosencephaly. We also used 3 springs for 2 patients who had metopic synostosis. The 12 patients have not required further surgeries so far, and there were no major complications. Spring dislodgement had not caused any complication in early cases. We could easily change the position of the spring rings from outside the scalp, regularly correct the elasticity of the spring rings, and replace spring rings to increase the traction. The head shapes of the 12 children have been improved significantly to use external spring rings. ConclusionsThis therapeutic modality in craniofacial surgery has allowed minimization of the extent of surgery without compromising clinical outcomes. The authors have shown that the use of external spring techniques is safe and, in selected situations, offer significant advantages over other methods of treatment. It makes up for a number of shortcomings of internal springs.

New technique for correcting mild types of cryptotia: elevate cavum conchae cartilage and suture to cranial periosteum.

Abstract We have developed a new technique for the treatment of mild types of cryptotia in which the cavum conchae cartilage was pulled superiorly and sutured it to the temporal bone to the temporal parietal junction periosteum securely. Then, the stitches for bolster fixation were inserted parallel to the auricular temporal sulcus and temporarily left untied. Our technique is easy to use and secures a firm bolster fixation, and the scar is hidden. We recommend it for the treatment of mild types of cryptotia.

Kasabach-Merritt syndrome with partial resection of tumor, reduction of tumor blood, and vincristine chemotherapy.

Kasabach-Merritt syndrome is a life-threatening and localized consumptive coagulopathy and characterized by profound thrombocytopenia and microangiopathic anemia. The huge tumor is the major cause of rapid platelet destruction, so we supposed that the reduction of tumor could reduce the platelet destruction and improve the clinical condition. In our cases, the vascular tumor occupied one of the extremities, head or face; however, removal of the whole tumor will result in the amputation of this extremity or the destruction of the face, and partial removal of the tumor and a U-shape suture to reduce tumor blood supply will be suitable. The wound could be repaired with skin graft or flaps. Vincristine chemotherapy after operation is necessary to prevent the enlargement of the remaining tumor.

Kasabach-Merritt syndrome: case reports of successful treatment with partial tumor resection and vincristine chemotherapy.

Kasabach-Merritt syndrome is a life-threatening and localized consumption coagulopathy, characterized with profound thrombocytopenia and microangiopathic anemia. The huge tumor is the major cause of rapid platelet destruction, so we supposed the reduction of tumor size could reduce the platelet destruction and improve the clinical condition. In our cases, the vascular tumor occupied one of the extremities, or the head or face. However, removal of the whole tumor would have resulted in the amputation of this extremity or the destruction of the face, and partial tumor removal was suitable. The wound could be repaired with skin graft. Vincristine chemotherapy after the operation was necessary to prevent the enlargement of the remaining tumor. Two cases which were ineffectively treated by other means were treated in this way.

Piezosurgical Suturectomy and Sutural Distraction Osteogenesis for the Treatment of Unilateral Coronal Synostosis.

Summary: Different surgical procedures are used for the treatment of synostosis. Among them, suturectomy and sutural distraction osteogenesis (SDO) are suitable for young infant patients. In this report, we present the case of a young infant patient with a clear synostosis of the left coronal suture, which was treated by piezoelectric suturectomy combined with SDO and 2 internal distractors. One-year follow-up showed good results. Thirty-six months after surgery, normal skull growth and shape were observed by 3D computed tomographic examination. No infection, bleeding, fistula, and other complications were observed. The results suggested that the treatment of unilateral coronal synostosis in young infant patient by piezosurgical suturectomy and SDO is to be preferred because of its simplicity and relatively minimal invasiveness.

Treatment of orbital hypertelorism using inverted U-shaped osteotomy.

AbstractThe objective of this article was to explore the effect of correction orbital hypertelorism using inverted U-shaped osteotomy by combined intracranial-extracranial approach. Eleven cases of severe orbital hypertelorism were performed. The measurement of interorbital and intercanthal distance was studied preoperatively and postoperatively by 3-dimensional computed tomography. The interorbital distance of the 11 patients are significantly decreased .The intercanthal distance decreased from 6.7 and 4.8 cm to 5.0 and 3.8 cm, respectively. The inverted U-shaped osteotomy technique may be an effective and safe technique for the stability of the corrected orbital framework and the prevention of recurrence in severe cases of orbital hypertelorism. Moreover, this method has little trauma compared with box osteotomy technique.