BACKGROUND: The purpose of this study was to compare postoperative morbidities and functional outcomes of pectoralis major myocutaneous (PMMC) flap and cutaneous free flap reconstruction approaches in hypopharyngeal squamous cell carcinoma patients. METHODS: We retrospectively reviewed records from 99 patients who underwent hypopharyngeal reconstruction with a cutaneous free flap (n=85) or PMMC flap (n=14) between 1995 and 2013. Morbidity was classified into hospitalization, medical, or flap-related complications. Functional outcomes were classified into oral re-alimentation and decannulation time. RESULTS: The overall flap-related complication rate was higher in the PMMC flap group (n=8, 57.1%; P=0.019), but the medical morbidity rate was higher in the cutaneous free flap group (n=68, 80%; P=0.006). The rate of pneumonia was higher in the cutaneous free flap group (n=48, 56.5%; P=0.020). Pulmonary premorbidity was the variable most significantly associated with pneumonia (odds ratio=3.012, P=0.012). There was no statistically significant difference in oral re-alimentation and decannulation time between the two groups. CONCLUSIONS: Although the functional superiority of free flaps has been reported in many studies, our results do not support this hypothesis. One limitation of our study is the relatively smaller flap size and fewer PMMC flap cases compared with the cutaneous free flap group. The low postoperative medical morbidity incidence rate in the PMMC flap group was clinically significant; however, the free flap group had more flap-related complications. Thus, PMMC flaps should be considered a viable option, especially for patients with pulmonary premorbidities.
Carcinoma, Squamous Cell* ; Free Tissue Flaps* ; Hospitalization ; Humans ; Hypopharynx ; Incidence ; Pneumonia ; Postoperative Complications ; Retrospective Studies

Background: The primary objectives of mandibular surgery are to achieve optimal occlusion, low sensory disturbance, and adequate fixation with early movement. In-depth knowledge of the mandibular structure is required to achieve these goals. This study used computed tomography (CT) to evaluate the mandibular cortical thickness and cancellous space according to age and sex. Methods: We enrolled 230 consecutive patients, aged 20 to 50 years, who underwent CT scanning. The cortex and cancellous space centered around the inferior alveolar nerve (IAN) canal were measured at two specific locations: the lingula and second molar region. Statistical analysis of differences according to increasing age and sex was performed. Results: The t-test revealed that the cancellous space and cortical thickness differed significantly with respect to the threshold of 35 years of age. Both cortical thickness and cancellous space in the molar region were negatively correlated with age. Meanwhile, both cortical thickness and cancellous space in the lingula region showed a positive correlation with age. With respect to sex, significant differences in the cancellous space at the molar region and the cortical thickness at the lingula were observed. However, no further statistically significant differences were observed in other variables with respect to sex. The sum of each measurement on the mandibular body reflected the safe distance from the surface of the outer cortex to the IAN canal. The safe distances also showed statistically significant differences between those above and below 35 years of age. Conclusion Knowledge of the anatomical structure of the mandible and of changes in bone structure is crucial to ensure optimal surgical outcomes and avoid damage to the IAN. CT examination is useful to identify changes in the bone structure, and these should be taken into account in the planning of surgery for older patients.

Epidermal cyst is a benign lesion which is commonly encountered in practice, and malignant transformation of it is rare. There are few case reports in the literature about malignant transformation of an epidermal cyst into a squamous cell carcinoma. We present a case of squamous cell carcinoma arising from a 3-year epidermal cyst in the right temporal area of a 68-year-old man. The epidermal cyst was initially identified as a spot and treated with laser therapy. However, it recurred, leading to three surgical interventions at a different surgical clinic. Despite these procedures, the cyst persisted, leading to presenting to our department of plastic and reconstructive surgery. He presented with a 2.5cm sized subcutaneous mass with skin ulcerative lesion. After excision, histopathological examination confirmed squamous cell carcinoma from a ruptured epidermal cyst, with clear resection margins. This case underscores the importance of routine histological examinations in excision of epidermal cysts.

Epidermal cyst is a benign lesion which is commonly encountered in practice, and malignant transformation of it is rare. There are few case reports in the literature about malignant transformation of an epidermal cyst into a squamous cell carcinoma. We present a case of squamous cell carcinoma arising from a 3-year epidermal cyst in the right temporal area of a 68-year-old man. The epidermal cyst was initially identified as a spot and treated with laser therapy. However, it recurred, leading to three surgical interventions at a different surgical clinic. Despite these procedures, the cyst persisted, leading to presenting to our department of plastic and reconstructive surgery. He presented with a 2.5cm sized subcutaneous mass with skin ulcerative lesion. After excision, histopathological examination confirmed squamous cell carcinoma from a ruptured epidermal cyst, with clear resection margins. This case underscores the importance of routine histological examinations in excision of epidermal cysts.

Epidermal cyst is a benign lesion which is commonly encountered in practice, and malignant transformation of it is rare. There are few case reports in the literature about malignant transformation of an epidermal cyst into a squamous cell carcinoma. We present a case of squamous cell carcinoma arising from a 3-year epidermal cyst in the right temporal area of a 68-year-old man. The epidermal cyst was initially identified as a spot and treated with laser therapy. However, it recurred, leading to three surgical interventions at a different surgical clinic. Despite these procedures, the cyst persisted, leading to presenting to our department of plastic and reconstructive surgery. He presented with a 2.5cm sized subcutaneous mass with skin ulcerative lesion. After excision, histopathological examination confirmed squamous cell carcinoma from a ruptured epidermal cyst, with clear resection margins. This case underscores the importance of routine histological examinations in excision of epidermal cysts.

Epidermal cyst is a benign lesion which is commonly encountered in practice, and malignant transformation of it is rare. There are few case reports in the literature about malignant transformation of an epidermal cyst into a squamous cell carcinoma. We present a case of squamous cell carcinoma arising from a 3-year epidermal cyst in the right temporal area of a 68-year-old man. The epidermal cyst was initially identified as a spot and treated with laser therapy. However, it recurred, leading to three surgical interventions at a different surgical clinic. Despite these procedures, the cyst persisted, leading to presenting to our department of plastic and reconstructive surgery. He presented with a 2.5cm sized subcutaneous mass with skin ulcerative lesion. After excision, histopathological examination confirmed squamous cell carcinoma from a ruptured epidermal cyst, with clear resection margins. This case underscores the importance of routine histological examinations in excision of epidermal cysts.

Because facial nerve injuries affect the quality of life, leaving them untreated can have devastating effects. The number of patients with traumatic and iatrogenic facial nerve paralysis is considerably high. Early detection and prompt treatment during the acute injury phase are crucial, and immediate surgical treatment should be considered when complete facial nerve injury is suspected. Symptom underestimation by patients and clinical misdiagnosis may delay surgical intervention, which may negatively affect outcomes and in some cases, impair the recovery of the injured facial nerve. Here, we report two cases of facial nerve injury that were treated with nerve grafts during the subacute phase. In both cases, subacute facial nerve grafting achieved significant improvements. These cases highlight surgical intervention in the subacute phase using nerve grafts as an appropriate treatment for facial nerve injuries.

A 76-year-old woman, initially thought to have a simple abscess on her right upper eyelid, presented to our department of plastic and reconstructive surgery. Enhanced three-dimensional facial computed tomography (CT) revealed an abscess on the right upper lid, with a pyomucocele present in the right frontal sinus, accompanied by bone erosion in the superior wall of the right orbit. Based on the results of the CT scan, we diagnosed an atypical Pott’s puffy tumor (PPT) with an abscess on the upper lid originating from the frontal sinusitis. First, surgical incision and drainage were performed in our department, and a percutaneous vacuum drain was placed. To provide a more definitive treatment, endoscopic sinus surgery (ESS) was subsequently performed by otorhinolaryngologists. The patient was discharged without any complications 5 days after ESS. At a 1-year follow-up, no recurrence or notable neurological symptoms were observed. In the case we observed, the patient presented with an upper eyelid abscess and cellulitis, indicating possible orbital involvement. For such patients, a CT scan is necessary. Given the possibility of PPT, it is critical to perform a comprehensive differential diagnosis rather than defaulting to a straightforward approach involving abscess treatment.

The incidence of high-pressure injection injuries is increasing with the development of industry and use of injectors. Although high-pressure injection injuries are relatively rare, they commonly lead to complications such as skin necrosis, infection, and amputation. Moreover, the initial presentation is prone to be underestimated because of the small entry point at the patient’s first encounter in emergency care. A prompt surgical intervention is required, with appropriate and rapid initial treatments, including broad-spectrum antibiotics and tetanus toxoid. The surgical treatment involves wide debridement for foreign material removal and subsequent reconstruction. In this case report, we present three cases we encountered and the ensuing complications. All three patients who received the same treatments are discussed in detail.

Myxoma is a locally invasive neoplasm usually involving the jaw bones, typically occurs between the second and fourth decades. This tumor may comprise 3%-6% of odontogenic tumors. Myxomas of the soft tissue of the face are very rare. We present an unusual case of myxofibroma occurring in a 13-year-old man involving the soft tissue of the face. It congenitally occurred and was a 1 cm sized, ovoid in shape, swelling located on the glabella without any symptoms. An excisional biopsy was performed. A well encapsulated ovoid mass was attached to the corrugator supercilli muscle below the frontalis muscle. It was measured 1.1 x 1 x 0.8 cm and completely excised. Histological examination revealed myxofibroma showing stellate and spinde-shaped cells throughout myxoid ground substance. The unusual features of this case are the site of the tumor, which was localized to the non-tooth bearing area of the mandible and its congenital occurrence history.