Shinya Yoshimoto

Diagnostic criteria for Werner syndrome based on Japanese nationwide epidemiological survey

Aim:u2003 Werner syndrome (WS) is an autosomal recessive disorder of progeroid symptoms and signs. It is caused by mutations in the WRN gene, which encodes a RecQ DNA helicase. The aim of this study was to revise the diagnostic criteria for Japanese Werner syndrome.

Surgical treatment of facial fracture by using unsintered hydroxyapatite particles/poly l-lactide composite device (OSTEOTRANS MX®): A clinical study on 17 cases

BACKGROUNDnIn Japan we currently use absorption properties for facial fractures. OSTEOTRANS MX(®) (Takiron co., ltd, Japan) is an absorption device, which is called Super FIXSORB MX(®) in Japan. This absorbable osteosynthetic device constitutes unsintered hydroxyapatite particles/poly l-lactide (u-HA/PLLA) composites. This study focuses on reporting clinical cases of using OSTEOTRANS MX(®).nnnMATERIALS AND METHODSnSeventeen patients (16 men and 1 woman) aged 10-80 years (mean: 39.9 years, SD: ±20.7) with 86 fracture sites were treated. In all cases we used 1.0xa0mm plates and 5xa0mm or 7xa0mm screws. The postoperative observation period was 6-60 months (mean: 21.8 months, SD: ±14.5).nnnRESULTSnThe fracture site recovered in all cases. Complications included one bone excess on the forehead and one foreign-body reaction on the frontozygomatic suture, but the fracture sites were recovered and had no problems. In the case with the longest observation time 60 months, the plate was almost fully absorbed. However, in other cases the plate was not fully absorbed because of a shorter observation time.nnnCONCLUSIONnOSTEOTRANS MX(®) is a useful device because of its suitable intensity, thinness, radiopaque, and few complications. A longer observation time is required for a plate to be absorbed completely.

Difference in nasolabial features between awake and asleep infants with unilateral cleft lip: Anthropometric measurements using three-dimensional stereophotogrammetry

PURPOSEnCleft lip repair is performed in the supine position, tilting the head back under general anesthesia. However, postoperative results are evaluated in the upright position while patients are awake. The purpose of this study was to anthropometrically assess whether nasolabial features of infants with unilateral cleft lip are influenced by posture and anesthesia.nnnMATERIAL AND METHODSnThree-dimensional facial images in a preoperative upright position and operating supine position under general anesthesia were captured from 51 consecutive infants with unilateral cleft lip. Twenty-four indirect anthropometric measurements (11 for the nose and 13 for the lip elements) were considered on each infant.nnnRESULTSnIn the supine position under general anesthesia, alar surface distance was significantly shorter (pxa0<xa00.001). Regarding lip measurements, medial lip height of the cleft side and philtrum height were significantly smaller (pxa0<xa00.05 and pxa0<xa00.05, respectively), whereas vermilion height was greater (pxa0<xa00.01). In addition, the cleft width and lip width were significantly broader (pxa0<xa00.001 and pxa0<xa00.001, respectively) after general anesthesia.nnnCONCLUSIONSnSeveral nasolabial alteration patterns are found after general anesthesia that are presumably attributable to cessation of nasal breathing and the action of muscle relaxation. Surgeons should take these nasolabial changes into account during preoperative planning and postoperative assessment.

Difference in nasolabial features between awake and asleep infants with bilateral cleft lip: Anthropometric measurements using three-dimensional stereophotogrammetry

BackgroundFacial soft tissue anthropometric values change according to a patient’s body position. We compared the facial soft tissue shape between the upright and the supine operative positions in infants with bilateral cleft lip.MethodsTwenty-five infants with bilateral cleft lip were photographed in two different positions. Twenty-three anthropometric landmarks were selected and used for the analysis. Wilcoxon signed rank test was used for comparing the obtained values.ResultsLip width was significantly broader (3.0xa0mm in average, pxa0<xa00.01) in the supine operative position, whereas no significant differences were found in both lip length and height between the two positions. The cleft width was significantly broader (1.18xa0mm, pxa0<xa00.05) after setting the operative position. No significant changes were observed for the nose elements.ConclusionsThe lip and the cleft width became broader, while the nose elements did not change after setting the operative position. We believe these changes are due to the effects of both gravity and the relaxation of the musculature under general anesthesia. This data could be useful in providing more complete information for surgeons planning bilateral cleft lip treatment.Level of Evidence: Level IV, diagnostic study.

Natural mastopexy repositioning based on age-related mean breast shape

BACKGROUNDnThe most important element during breast reconstruction preoperative planning is determining the new position and shape of the breast. A youthful breast with no signs of ptosis may not necessarily be the ideal breast for women of all ages. However, indicators have not been established on how breasts should be positioned depending on age. We investigated and reported on the proper positioning of the breasts based on age during breast reconstruction using mean age-based data from three-dimensional (3D) modeling.nnnMETHODSnWe photographed 110 breast cancer patients using a compact 3D scanner and calculated the measured means. Data were grouped according to age group. Three-dimensional simulation images from all patients were reconstructed from the data. Breasts from all age groups were divided into healthy and affected breasts. For each measured value, the means of the two groups were compared.nnnRESULTSnThere were no major differences in the mean values in the 30s, 40s, and 50s age groups. Major changes were noted in the 60s age group compared with the 30s, 40s, and 50s age groups. There were no statistically significant differences between healthy and affected breasts.nnnCONCLUSIONSnThis is the first study to use a 3D method to calculate the means based on age group. This study showed that particular attention should be paid to age-related changes during breast reconstruction surgeries for women aged ≥60 years. We believe that the method used in our study on mean breast shape based on age group can be used as a reference or indicator to ensure that the reconstruction of natural breasts befits the age of the patient.

Static reconstruction of malar region in facial paralysis: a new alternative technique for plasty of symmetric mouth appearance.

Abstract Static suspension using fascia lata graft is used as a reconstructive procedure against drooping of the mouth corner for treating longstanding facial paralysis. Although it achieves symmetry at rest, movement of the mouth corner at mouth opening is restricted to some extent because it is fixed with fascia lata to the immovable temporal fascia, the parotid fascia, or bones. This was overcome by suspending the mouth corner to the mandibular coronoid process with fascia lata, which enabled a shift of the mouth corner with mouth opening and closure. The nine patients discussed in this study were operated on since 1994 for longstanding facial paralysis and followed-up for over 1.5 years. As in conventional static suspension, the fascia lata was harvested and split into two bands. Next, one semi-oval fascial loop was inserted around the paralysed part of the mouth and tied with another fascial band at the mouth corner, which was looped to the mandibular coronoid process. The suspended fascia lata graft was relaxed with anteroinferior movement of the coronoid process at mouth opening, enabling the mouth corner to shift inferiorly. The mouth corner returned to its original position at mouth closure, and the nasolabial fold deepened during mastication. No limitation in mouth opening was observed. Suspension of the mouth corner to the mandibular coronoid process provided a dynamic element, thereby restoring a near-normal shift. The procedure is considered as an alternative for reconstructing the malar region of patients with facial paralysis and in whom dynamic reconstruction is not indicated.