Nobukazu Shirai

Intraoral reconstruction with innervated forearm flap: A comparison of sensibility and reinnervation in innervated versus noninnervated forearm flap

OBJECTIVE To evaluate the cutaneous sensibility and sensory reinnervation in patients who underwent intraoral reconstruction with an innervated or noninnervated forearm flap. STUDY DESIGN Results of the use of innervated forearm flaps in oral reconstruction was compared with the use of noninnervated flaps. The evaluation of sensibility and reinnervation comprised clinical sensibility tests and immunohistochemical investigation of postoperative biopsy specimens against S-100 and neurofilament. RESULTS The innervated flaps (4 patients) provided earlier and qualitatively better recovery of sensation than the noninnervated flaps (9 patients). Immunohistochemical investigation revealed the existence of a larger number of regularly arranged sensory nerve fibers in the cutaneous tissue of the innervated flaps than in the noninnervated flaps. Examination with an electron microscope found the structure of these nerve fibers to be well preserved in the innervated flaps, whereas nerve fibers in the noninnervated flaps were degenerative. CONCLUSION These findings suggest (1) that the innervated flaps are superior to the noninnervated flaps not only for the repair of defects but also for the restoration of function and (2) that the innervated flaps contribute to the improvement of the quality of life for patients.

Symmetrical lipomatosis of the tongue presenting as macroglossia, report of two cases

Symmetrical lipomatosis in the oral cavity is extremely rare. Two cases of symmetrical lipomatosis presenting as macroglossia are presented. Glossectomy was performed in order to reduce the size of the tongue and for diagnosis. Because of their multiplicity, non-encapsulation and invasiveness, the lesions were diagnosed histopathologically as symmetrical lipomatosis.

Full-thickness reconstruction of cheek defect involving oral commissure with forearm tendinocutaneous flap

An 82-year-old man underwent full-thickness reconstruction of the cheek for a defect of the oral commissure resulting from a T3N1M0 squamous cell carcinoma. He had previously had both radiotherapy and chemotherapy. A tendinocutaneous flap from the forearm incorporating palmaris longus was used for static reconstruction. The vermilion was then reconstructed with rotation flaps from the contralateral vermilion. Oral function was restored, and he had no problems with drooling or speech.

Reliability of internal jugular vein in oral microvascular reconstruction.

OBJECTIVE The purpose of this study was to review the reliability of the internal jugular vein when used as a recipient vein in oral microvascular reconstruction. STUDY DESIGN A retrospective study was done of 36 consecutive cases in which microvascular reconstruction was accomplished with a free flap using the internal jugular vein in an end-to-side fashion. The postoperative patency of 25 internal jugular veins used as recipient veins was examined by postcontrast computed tomography scanning. RESULTS The overall flap success rate was 97%. Venous thromboses occurred in 2 cases. A common venous thrombosis occurred in one case, but the flap survived after re-anastomosis. In another case, internal jugular vein thrombosis occurred at 5 days of anastomosis, and the flap could not be salvaged by exploratory surgery. All other cases were completely uneventful. All internal jugular veins assessed on postcontrast computed tomography scans were patent at 51 to 107 days after surgery (mean, 89 days). CONCLUSION Internal jugular vein, if available, is reliable when used as a recipient vein in oral microvascular reconstruction. However, it is not necessarily flawless.

Unique inflammatory features noted in intraorally transferred skin flapsCorrelation with Candida albicans infection

OBJECTIVE The purpose of this study was to evaluate how well intraorally transferred skin flaps endure their new surroundings. STUDY DESIGN Biopsy specimens were taken from 20 patients who had undergone microsurgical reconstruction and as pretransferred skin from 5 of these patients at the time of surgery. The study used immunohistochemistry for immunocompetent cells, differentiation markers for the epidermis and desmosomal proteins, and immunoelectron microscopy for desmosomal protein, in addition to routine histologic examination, including Sudan IV, periodic acid Schiff, and Grocott stains. We also measured the thickness of the epidermis and stratum corneum. Oral swabs from the skin flaps were examined for the presence of yeasts, particularly Candida albicans, by means of a culture method. RESULTS According to the results of periodic acid-Schiff and Grocott staining, 20 cases were divided into 2 groups: fungal element-positive cases (n = 15) and fungal element-negative cases (n = 5). All swabs from the former were positive for Candida albicans. In these fungus-positive cases, histopathologic evaluation revealed marked diminution of stratum corneum and pronounced epidermal hyperplasia. Immunohistochemistry demonstrated the dermal infiltration of numerous immunocompetent cells-CD4+, CD8+, CD20+, CD68+, neutrophil elastase+, and HLA-DR+ cells-and the scarce infiltration of IgA+ and IgG+ cells. There were scattered CD1a+, CD4+, CD8+, and HLA-DR+ cells and elastase+ neutrophils in the epidermis. Expression of cytokeratin subtypes (10, 14, 16, and 19), involucrin, and tenascin showed the characteristic features of epidermal proliferation. Enumeration of Ki-67+ keratinocytes showed an increase, indicating epidermal proliferation. Expression of desmoglein 1 and desmocollin 1 in the epidermal keratinocytes was decreased in comparison with that in the pretransferred skin. Immunoelectron microscopy for desmoglein 1 confirmed the reduced immunoreactive deposits along the desmosomal plaques. In the fungus-negative cases, all such changes were a great deal milder. CONCLUSIONS Taken together, our results demonstrate that most intraorally transferred flaps are affected by an inflammatory process that is induced by the influence of the wet oral environment. They present psoriasiform tissue reactions characterized by epidermal hyperproliferation that are mostly due to Candida albicans infection.

Differential expression of cornified cell envelope precursors in normal skin, intraorally transplanted skin and normal oral mucosa

Summary Background Skin flaps have routinely been used as substitutes for oral mucosa after extensive resection of oral tissues. However, it remains unknown how the transplanted skin flaps perform as a host defence in the new environment of the oral cavity.