Objective:To explore the surgical methods and treatment outcomes of nasal endoscopic surgery for nasal deformity secondary to unilateral cleft lip and palate, combined with nasal septal deviation, using nasal septal cartilage and bone.Methods:Eleven patients who underwent surgical treatment for unilateral cleft lip and palate secondary to nasal deformity in the Department of Otorhinolaryngology, Head and Neck Surgery, Linyi People′s Hospital, Shandong Second Medical University, from March 2021 to March 2023, were retrospectively analyzed. The cohort included 8 males and 3 females, aged (22.0±8.4) years (range: 17 to 35 years). Preoperatively, all of them underwent CT scanning and three-dimensional reconstruction of the nasal bones and sinuses to evaluate the size of the nasal septal cartilage and the design of the material to be taken, and to assess the degree of nasal deformity. During the operation, an open “V”-shaped incision was made through the nasal columella, and part of the septal bone and cartilage were removed under direct nasal endoscopic visualization. The septal cartilage and bony structures were used to correct the nasal deformity, and a nasal brace was used as an intraoperative support for the reconstruction of the nasal cartilage, which was then worn for 1 month after the operation to maintain a stable nasal shape. A visual analog scale (VAS) was used before and after surgery to assess the patient′s satisfaction with the nasal shape and the degree of nasal ventilation. Corresponding data on both sides of the external nose were measured, including nasal tip height, nostril height, nostril width, nasal base width, and nasal columella inclination, to assess the symmetry of the external nose objectively. SPSS 22.0 software was used for statistical analysis to evaluate the surgical results.Results:The surgical incisions of all 11 patients healed at stage Ⅰ. At 6-24 months of postoperative follow-up, nasal symmetry was restored, and the nostrils were equal in size. The difference in symmetry indexes before and after the surgery was statistically significant. The t value for nasal tip height, the nostril height, the nostril width, the nasal base width, and the nasal columellar inclination were 4.21, 2.26, 3.38, 3.65, and 2.36, respectively (all P<0.05). Postoperative incision scarring was not obvious, and patients were satisfied with the nasal appearance [VAS score (9.14±0.48) points vs (3.45±1.23) points, t=14.29, P<0.001], and nasal ventilation was significantly improved [VAS score (9.32±1.24) points vs (4.61±0.85) points, t=10.39, P<0.001]. Conclusion:Nasal endoscopic surgery using septal cartilage and bone to treat nasal deformity secondary to unilateral cleft lip and palate, combined with deviated septum, can simultaneously improve the patients′ nasal shape and nasal ventilation, yielding good clinical outcomes.

Objective:To investigate and analyze the surgical method and therapeutic effect of removing benign masses between the nasal radix and eyebrow via a V-shaped cosmetic incision approach through the columella with the assistance of nasal endoscopy.Methods:The data of patients who underwent surgical treatment from May 2020 to August 2023 at the Department of Otorhinolaryngology, Head and Neck Surgery, Linyi People’s Hospital were retrospectively analyzed, because of a mass involving the radix of the nose and the interbrow area. Preoperative CT examination of the nose was performed to clarify the nature, size, and level of the mass, and a V-shaped incision was made in the middle and lower third of the nasal columella, with subcutaneous tunnels along the dorsal median line of the nose, and the mass was excised with the aid of nasal endoscopy. Postoperative follow-up was performed for recurrence of swelling, diplopia, ocular dyskinesia, frontal-facial numbness, and recovery of the operative area; patients were evaluated by visual analogue scoring (VAS) to assess satisfaction with the appearance of the incorporeal scar (0~10 points, higher scores indicate higher satisfaction).Results:A total of 4 patients were included, with an average age of 18.5 years (15-21 years). All 4 patients had complete resection of the tumor through the columellar V-shaped incision approach, and the surgical incisions were all healed by primary intention. Postoperative pathology suggested epidermoid cysts in 1 case, lipoma in 1 case, sebaceous cysts in 1 case, and osteomas in 1 case. Postoperative follow-up ranged from 6 to 24 months, with an average follow-up of 12 months, with no recurrence of the mass, no depression at the radix of the nose and between the eyebrows, and no noticeable scar at the columella. The patients were satisfied with the appearance of the incision scar with a VAS score of 10 points.Conclusion:Nasal endoscopic transnasal columella approach to excision of benign tumors at the root of the nose and between the eyebrows has the advantages of small skin incision and hidden scarring, and has good treatment effect.

Objective:To explore the surgical methods and treatment outcomes of nasal endoscopic surgery for nasal deformity secondary to unilateral cleft lip and palate, combined with nasal septal deviation, using nasal septal cartilage and bone.Methods:Eleven patients who underwent surgical treatment for unilateral cleft lip and palate secondary to nasal deformity in the Department of Otorhinolaryngology, Head and Neck Surgery, Linyi People′s Hospital, Shandong Second Medical University, from March 2021 to March 2023, were retrospectively analyzed. The cohort included 8 males and 3 females, aged (22.0±8.4) years (range: 17 to 35 years). Preoperatively, all of them underwent CT scanning and three-dimensional reconstruction of the nasal bones and sinuses to evaluate the size of the nasal septal cartilage and the design of the material to be taken, and to assess the degree of nasal deformity. During the operation, an open “V”-shaped incision was made through the nasal columella, and part of the septal bone and cartilage were removed under direct nasal endoscopic visualization. The septal cartilage and bony structures were used to correct the nasal deformity, and a nasal brace was used as an intraoperative support for the reconstruction of the nasal cartilage, which was then worn for 1 month after the operation to maintain a stable nasal shape. A visual analog scale (VAS) was used before and after surgery to assess the patient′s satisfaction with the nasal shape and the degree of nasal ventilation. Corresponding data on both sides of the external nose were measured, including nasal tip height, nostril height, nostril width, nasal base width, and nasal columella inclination, to assess the symmetry of the external nose objectively. SPSS 22.0 software was used for statistical analysis to evaluate the surgical results.Results:The surgical incisions of all 11 patients healed at stage Ⅰ. At 6-24 months of postoperative follow-up, nasal symmetry was restored, and the nostrils were equal in size. The difference in symmetry indexes before and after the surgery was statistically significant. The t value for nasal tip height, the nostril height, the nostril width, the nasal base width, and the nasal columellar inclination were 4.21, 2.26, 3.38, 3.65, and 2.36, respectively (all P<0.05). Postoperative incision scarring was not obvious, and patients were satisfied with the nasal appearance [VAS score (9.14±0.48) points vs (3.45±1.23) points, t=14.29, P<0.001], and nasal ventilation was significantly improved [VAS score (9.32±1.24) points vs (4.61±0.85) points, t=10.39, P<0.001]. Conclusion:Nasal endoscopic surgery using septal cartilage and bone to treat nasal deformity secondary to unilateral cleft lip and palate, combined with deviated septum, can simultaneously improve the patients′ nasal shape and nasal ventilation, yielding good clinical outcomes.

Objective:To investigate and analyze the surgical method and therapeutic effect of removing benign masses between the nasal radix and eyebrow via a V-shaped cosmetic incision approach through the columella with the assistance of nasal endoscopy.Methods:The data of patients who underwent surgical treatment from May 2020 to August 2023 at the Department of Otorhinolaryngology, Head and Neck Surgery, Linyi People’s Hospital were retrospectively analyzed, because of a mass involving the radix of the nose and the interbrow area. Preoperative CT examination of the nose was performed to clarify the nature, size, and level of the mass, and a V-shaped incision was made in the middle and lower third of the nasal columella, with subcutaneous tunnels along the dorsal median line of the nose, and the mass was excised with the aid of nasal endoscopy. Postoperative follow-up was performed for recurrence of swelling, diplopia, ocular dyskinesia, frontal-facial numbness, and recovery of the operative area; patients were evaluated by visual analogue scoring (VAS) to assess satisfaction with the appearance of the incorporeal scar (0~10 points, higher scores indicate higher satisfaction).Results:A total of 4 patients were included, with an average age of 18.5 years (15-21 years). All 4 patients had complete resection of the tumor through the columellar V-shaped incision approach, and the surgical incisions were all healed by primary intention. Postoperative pathology suggested epidermoid cysts in 1 case, lipoma in 1 case, sebaceous cysts in 1 case, and osteomas in 1 case. Postoperative follow-up ranged from 6 to 24 months, with an average follow-up of 12 months, with no recurrence of the mass, no depression at the radix of the nose and between the eyebrows, and no noticeable scar at the columella. The patients were satisfied with the appearance of the incision scar with a VAS score of 10 points.Conclusion:Nasal endoscopic transnasal columella approach to excision of benign tumors at the root of the nose and between the eyebrows has the advantages of small skin incision and hidden scarring, and has good treatment effect.

Objective:To implement evidence-based nursing practices for gastrointestinal function recovery in postoperative patients with gynecologic malignancies, develop review indicators based on the best available evidence, analyze their obstructive and facilitating factors, and provide references for applying evidence in clinical practice.Methods:Based on the 6S Pyramid Model, a comprehensive computer-based search was conducted across Chinese and international databases for evidence related to gastrointestinal function recovery in patients with gynecologic malignancies. The search included clinical decisions, guidelines, evidence summaries, systematic reviews, expert consensus, and randomized controlled trials up to July 10, 2023. The knowledge-to-action framework (KTA) was used to systematically retrieve, evaluate, and summarize the best evidence to develop an evidence-based nursing review plan for postoperative gastrointestinal function recovery in gynecologic malignancy patients. A baseline review was conducted, and influencing factors were analyzed to formulate action strategies.Results:A total of 16 articles were included, and 17 review indicators were developed. One indicator had an execution rate of 100%, one indicator had an execution rate of 95%, and the remaining 15 indicators had execution rates between 0 and 60%. Obstructive factors included ingrained previous work patterns, lack of awareness regarding evidence translation, increased clinical workload leading to resistance among medical staff, lack of necessary systems, processes, and equipment for practice change, and poor communication between multidisciplinary teams. Facilitating factors included Qilu Hospital of Shandong University (Qingdao) being an evidence-based nursing evidence application base in Shandong Province, with the Department being a key discipline in the hospital and having the necessary talent for practice change. In addition, the Department had high cooperation among medical staff and strong leadership with a focus on evidence-based clinical translation.Conclusions:There is a significant gap between clinical practice and best evidence in the gastrointestinal function recovery of postoperative patients with gynecologic malignancies. Precisely analyzing obstructive and facilitating factors and developing scientific action strategies are essential for driving effective evidence translation.

Objective:To explore the causal relationship between blood metabolites and keloids.Methods:The study was a two-sample bidirectional Mendelian randomization (MR) analysis-based study. Data on blood metabolites were collected from 7 824 adult volunteers and 8 299 participants, alongside information related to 481 912 keloid patients obtained from the genome-wide association studies (GWAS) database. Single nucleotide polymorphisms (SNPs) significantly associated with blood metabolites and keloids were screened for inclusion as instrumental variables in the MR analysis by setting a significance threshold of P<1.0×10 -5, chain imbalance analysis [ r2=0.001, kilobase pairs (kb)=10 000)], and the F statistic ( F≥10). Five methods of MR analysis were employed: inverse variance weighting (IVW) as the primary method, and MR-Egger regression, weighted median, simple modeling, and weighted modeling as auxiliary methods. These analyses aimed to determine the causal relationship between blood metabolites (exposure factors) and keloids (outcome variables). Sensitivity analyses were performed on eligible blood metabolite SNPs to assess the reliability and stability of the findings. Heterogeneity was assessed by Cochran Q-test and MR-Egger regression test. MR Egger intercept test was utilized to rule out horizontal pleiotropy, while the leave-one-out test determined whether the presence of a single SNP significantly affected the results of the MR analyses. The MR-PRESSO method was used to identify outliers among SNPs, which were corrected by false discovery rate (FDR) (FDR<0.2) to control the false positive rate. Reverse MR analysis was performed with keloid as the exposure factor, using the blood metabolites identified in the previous MR analysis as outcome variables for effect and sensitivity analyses. The data were analyzed using R version 4.3.2 and the TwoSampleMR package, with the causal effect values of the MR analysis expressed as odds ratio ( OR) and 95% confidence intervals ( CI). A P-value <0.05 was considered statistically significant, indicating substantial evidence of a potential causal effect. Forest plots, funnel plots, and scatter plots were constructed to visualize the results of the MR analysis and sensitivity analyses. Results:A total of 1 400 blood metabolites with 34 843 SNPs were obtained from the GWAS database, all of which support the hypothesis that genetic variants were closely associated with exposure factors. Additionally, 24 197 210 SNPs were obtained from the keloid dataset. The IVW analysis revealed that one blood metabolite, succinyl taurine (16∶1n-7) with 28 SNPs, was linked to keloid disease, demonstrating a causal relationship (O R=1.13, 95% CI 1.06-1.19, P<0.001, FDR=0.07). Further analyses using the MR-Egger regression method ( OR=1.11, 95% CI 1.04-1.19, P=0.005), the weighted median method ( OR=1.11, 95% CI 1.02-1.20, P=0.014) and weighted modeling method ( OR=1.12, 95% CI 1.04-1.20, P=0.004) also indicated that succinyl taurine (16∶1n-7) was a risk factor for keloid disease. However, the results from the simple modeling method only showed that the causal relationship between succinyl taurine (16∶1n-7) and keloid disease was not significant ( OR=1.10, 95% CI 0.85-1.41, P=0.485). MR overall analysis showed a significant positive causal relationship between succinyl taurine (16∶1n-7) and keloid, suggesting that elevated levels of succinyl taurine (16∶1n-7) were associated with an increased risk of keloid disease. The Cochran Q-test ( Q=26.98, P=0.465), MR-Egger regression test ( Q=26.65, P=0.428), MR-Egger intercept test ( P=0.574), and MR-PRESSO composite test ( P=0.569) indicated no heterogeneity or horizontal pleiotropy among SNPs ( P>0.05). The leave-one-out test confirmed that individual SNPs did not have a significant effect on the overall results, indicating the reliability and stability of the findings. The inverse MR analysis suggested that there was no causal relationship between keloid on succinyl taurine (16∶1n-7) (IVW: OR=0.98, 95% CI 0.93-1.04, P=0.490). Conclusion:There is a significant positive causal relationship between the blood metabolite succinyl taurine (16∶1n-7) and keloids, and succinyl taurine (16∶1n-7) is a risk factor for keloid disease.

Objective:To explore the causal relationship between blood metabolites and keloids.Methods:The study was a two-sample bidirectional Mendelian randomization (MR) analysis-based study. Blood metabolites of 7 824 adult volunteers and 8 299 participants and data related to 481 912 keloid patients were obtained from the genome-wide association studies (GWAS) Catalog database. Single nucleotide polymorphisms (SNPs) significantly associated with blood metabolites and keloids were screened for inclusion as instrumental variables in the MR analysis by setting a significance threshold of P<1.0×10 -5, chain imbalance analysis [ r2 = 0.001, kilobase pairs (kb) = 10, 000)], and the F statistic ( F≥10) . Five method of MR analysis, i.e., inverse variance weighting (IVW) as the main method and MR-Egger regression, weighted median, simple modeling, and weighted modeling as auxiliary method, were used to analyze the causal relationship between blood metabolites (exposure factors) and keloids (outcome variables) . Sensitivity analyses were performed on eligible blood metabolite SNPs to assess the reliability and stability of the findings: heterogeneity was assessed by Cochran Q-test and MR-Egger regression test, MR Egger intercept test to rule out horizontal pleiotropy, leave-one-out test to determine if the presence of a single SNP significantly affected the result of the MR analyses, MR-PRESSO method was used to test for outliers of SNPs, which were corrected by false discovery rate (FDR) (FDR <0.2) to control the false positive rate. Reverse MR analysis was performed with keloid as the exposure factor, and blood metabolites screened by the aforementioned MR analysis were used as outcome variables for effect analysis and sensitivity analysis. The data were analyzed using R 4.3.2 software and the TwoSampleMR program package therein, and the causal effect values of the MR analysis were expressed as the ratio ( OR) and 95% CI, with P<0.05 being considered as a statistically significant difference, i. e., the evidence of a potential causal effect was substantial. Forest plots, funnel plots, and scatter plots were constructed to visualize the result of MR analysis and sensitivity analysis. Results:A total of 1 400 blood metabolites with 34 843 SNPs were obtained from the GWAS Catalog database, all of which were consistent with the hypothesis that genetic variants are closely associated with exposure factors; a total of 24 197 210 SNPs were obtained from the keloid dataset. IVW analysis revealed that one blood metabolite, succinyl taurine (16 ∶ 1n-7), had 28 SNPs with keloid with a causal relationship ( OR=1.13, 95% CI 1.06-1.19, P<0.001, FDR=0.070) ; MR-Egger regression method ( OR = 1.11, 95% CI 1.04-1.19, P=0.005), weighted median method ( OR = 1.11, 95% CI 1.02-1.20, P=0.014) and weighted modeling method ( OR=1.12, 95% CI 1.04 to 1.20, P=0.004) analyses also showed that succinyl taurine (16 ∶ 1n-7) was a risk factor for keloid disease; the result of the simple modeling method only showed that the causal relationship between succinyl taurine (16 ∶ 1n-7) and keloid disease was not significant ( OR=1.10, 95% CI 0.85-1.41, P=0.485) . MR overall analysis showed a significant positive causal relationship between succinyl taurine (16 ∶ 1n-7) and keloid, i.e., elevated levels of succinyl taurine (16 ∶ 1n-7) were associated with an increased risk of keloid disease. Cochran Q-test ( Q = 26.98, P=0.465), MR-Egger regression test ( Q = 26.65, P = 0.428), MR-Egger intercept test ( P = 0.574), and MR-PRESSO composite test ( P=0.569) showed that there was no heterogeneity and horizontal pleiotropy among SNPs ( P>0.05) ; the leave-one-out test confirmed that individual SNPs did not have a significant effect on the overall result, indicating that the result had reliability and stability. The inverse MR analysis suggested that there was no causal relationship between keloid on succinyl taurine (16 ∶ 1n-7) (IVW: OR=0.98, 95% CI 0.93-1.04, P=0.490) . Conclusions:There is a significant positive causal relationship between the blood metabolite succinyl taurine (16 ∶ 1n-7) and keloids, and succinyl taurine (16 ∶ 1n-7) is a risk factor for keloid disease.

Objective:To explore the causal relationship between blood metabolites and keloids.Methods:The study was a two-sample bidirectional Mendelian randomization (MR) analysis-based study. Blood metabolites of 7 824 adult volunteers and 8 299 participants and data related to 481 912 keloid patients were obtained from the genome-wide association studies (GWAS) Catalog database. Single nucleotide polymorphisms (SNPs) significantly associated with blood metabolites and keloids were screened for inclusion as instrumental variables in the MR analysis by setting a significance threshold of P<1.0×10 -5, chain imbalance analysis [ r2 = 0.001, kilobase pairs (kb) = 10, 000)], and the F statistic ( F≥10) . Five method of MR analysis, i.e., inverse variance weighting (IVW) as the main method and MR-Egger regression, weighted median, simple modeling, and weighted modeling as auxiliary method, were used to analyze the causal relationship between blood metabolites (exposure factors) and keloids (outcome variables) . Sensitivity analyses were performed on eligible blood metabolite SNPs to assess the reliability and stability of the findings: heterogeneity was assessed by Cochran Q-test and MR-Egger regression test, MR Egger intercept test to rule out horizontal pleiotropy, leave-one-out test to determine if the presence of a single SNP significantly affected the result of the MR analyses, MR-PRESSO method was used to test for outliers of SNPs, which were corrected by false discovery rate (FDR) (FDR <0.2) to control the false positive rate. Reverse MR analysis was performed with keloid as the exposure factor, and blood metabolites screened by the aforementioned MR analysis were used as outcome variables for effect analysis and sensitivity analysis. The data were analyzed using R 4.3.2 software and the TwoSampleMR program package therein, and the causal effect values of the MR analysis were expressed as the ratio ( OR) and 95% CI, with P<0.05 being considered as a statistically significant difference, i. e., the evidence of a potential causal effect was substantial. Forest plots, funnel plots, and scatter plots were constructed to visualize the result of MR analysis and sensitivity analysis. Results:A total of 1 400 blood metabolites with 34 843 SNPs were obtained from the GWAS Catalog database, all of which were consistent with the hypothesis that genetic variants are closely associated with exposure factors; a total of 24 197 210 SNPs were obtained from the keloid dataset. IVW analysis revealed that one blood metabolite, succinyl taurine (16 ∶ 1n-7), had 28 SNPs with keloid with a causal relationship ( OR=1.13, 95% CI 1.06-1.19, P<0.001, FDR=0.070) ; MR-Egger regression method ( OR = 1.11, 95% CI 1.04-1.19, P=0.005), weighted median method ( OR = 1.11, 95% CI 1.02-1.20, P=0.014) and weighted modeling method ( OR=1.12, 95% CI 1.04 to 1.20, P=0.004) analyses also showed that succinyl taurine (16 ∶ 1n-7) was a risk factor for keloid disease; the result of the simple modeling method only showed that the causal relationship between succinyl taurine (16 ∶ 1n-7) and keloid disease was not significant ( OR=1.10, 95% CI 0.85-1.41, P=0.485) . MR overall analysis showed a significant positive causal relationship between succinyl taurine (16 ∶ 1n-7) and keloid, i.e., elevated levels of succinyl taurine (16 ∶ 1n-7) were associated with an increased risk of keloid disease. Cochran Q-test ( Q = 26.98, P=0.465), MR-Egger regression test ( Q = 26.65, P = 0.428), MR-Egger intercept test ( P = 0.574), and MR-PRESSO composite test ( P=0.569) showed that there was no heterogeneity and horizontal pleiotropy among SNPs ( P>0.05) ; the leave-one-out test confirmed that individual SNPs did not have a significant effect on the overall result, indicating that the result had reliability and stability. The inverse MR analysis suggested that there was no causal relationship between keloid on succinyl taurine (16 ∶ 1n-7) (IVW: OR=0.98, 95% CI 0.93-1.04, P=0.490) . Conclusions:There is a significant positive causal relationship between the blood metabolite succinyl taurine (16 ∶ 1n-7) and keloids, and succinyl taurine (16 ∶ 1n-7) is a risk factor for keloid disease.

Objective:To investigate the application of retroauricular groove incision in the resection of benign tumors in the deep lobe of parotid.Methods:From January 2017 to January 2022, 19 patients (11 males and 8 females, age ranged from 17 to 69 years, with a median age of 48) with benign tumor in the deep lobe of parotid gland underwent parotidectomy through retroauricular sulcus incision in Linyi People′s Hospital. Among them, 17 cases with tumor diameter≤4.0 cm underwent simple retroauricular groove incision, and 2 cases were dumbbell type with tumor diameter>4.0 cm on the medial side of mandible protruding into the parapharyngeal space, in which the deep lobe and tumor of parotid gland were resected through retroauricular sulcus incision combined with intraoral incision.Results:Tumors were completely removed through retroauricular sulcus incision in 17 cases, and dumbbell type tumors were removed through retroauricular sulcus incision combined with intraoral incision in 2 cases. Postoperative pathological examinations showed pleomorphic adenoma in 13 cases, basal cell adenoma in 4 cases and Warthin′s tumor in 2 cases. Temporary mandibular marginal branch paralysis occurred in 2 patients and returned to normal 3 weeks after operation. All incisions healed in Phase I. By following-up of 1-5 years with a median follow-up time of 3.1 years, none of the patients had Frey syndrome, salivary fistula, other complications and tumor recurrence. The patients and their families were satisfied with the postoperative facial appearances.Conclusion:The retroauricular groove approach can not only preserve the function of parotid superficial lobe and facial nerve, but also has less trauma, less tissue defect and hidden scar. As the advantages of less complication, low recurrence rate and good cosmetic effect, the incision is worthy of clinical application.

Objective:To investigate the application of retroauricular sulcus incision in surgery for benign tumor in superficial lobe of parotid gland.Methods:A total of 20 patients were reviewed who underwent the resection of benign tumor in the superficial lobe of parotid gland with retroauricular sulcus incision at the Department of Otorhinolaryngology, the Linyi City People Hospital between May 2015 and March 2017. There were 12 males and 8 females with an age range of 12-66 years old, including 15 cases with mixed tumor and 5 cases with adenolymphoma. Surgical procedure included facial never dissection from the main trunk to facial never cervical trunk, temporal trunk and peripheral branches. After resection of tumor and superficial lobe of parotid gland, and sternocleidomastoid muscle flap was used to fill the defect in parotid area. All patients were postoperatively followed up after surgery.Results:Surgeries were successfully operated in all patients. Follow-up for 2 years showed there was no presence of recurrence, salivary fistula, Frey syndrome, scar affecting facial appearance, or significant deformity in the surgical area.Conclusion:Surgery for superficial lobe of parotid gland and facial nerve dissection through retroauricular sulcus incision have some advantages such as incision concealment, simple procedure for facial nerve dissection, simultaneous repair of tissue defects with sternocleidomastoid muscle flap, and less complications.