Hiroshi Nishioka

OBJECTIVES: External nasal deformity in patients with cleft lip and palate causes both functional and aesthetic problems. Corrective rhinoplasty using a reverse U-shaped incision and suturing of the alar cartilage is not always successful. Therefore, we compared the use of a newer septal extension graft technique with the conventional suture technique to determine an effective surgical method for improving nasal tip morphology. METHODS: We compared the outcomes of the conventional reverse U-shaped incision technique with the septal extension graft in 12 patients undergoing secondary cleft rhinoplasty (6 in each group). Ten plastic surgeons evaluated 6-month postoperative photographs using six criteria: nasal tip shape (frontal, lateral, and basal views), left-right asymmetry (frontal and basal views), and overall improvement. Each item was rated on a 4-point scale (1=poor, 4=excellent). Mann-Whitney U tests were used to assess statistical significance. RESULTS: The septal extension graft group showed significantly better nasal tip morphology in the frontal and basal views (P<0.001) and in the lateral view (P=0.007). However, there were no significant differences in symmetry improvement between the two techniques for the front (P=0.685) and bottom (P=0.602) views. CONCLUSIONS: Corrective rhinoplasty using a septal extension graft can significantly improve nasal tip morphology in cleft lip cases compared with the reverse U-shaped incision and alar cartilage suturing technique. However, decreased mobility of the nasal tip was noted. Further improvement is needed in terms of patient-reported satisfaction and postoperative stability.

BACKGROUND: Exoscope-assisted digital imaging allows continuous real-time visualization of the surgical site on a large 3D monitor. We evaluated its usefulness in orbital fracture reduction surgery, a procedure with a narrow and deep operative field that restricts direct visibility for the operating surgeon. METHODS: This retrospective cohort study included all patients who underwent orbital floor fracture reduction with an absorbable plate via a subciliary approach at our institution from January 2022 to December 2024. ORBEYE 3D exoscope system (Olympus, Tokyo, Japan) was used in all cases when available, as the device was shared among several departments in our institution. Surgeries performed with and without the ORBEYE exoscope were compared for the following preoperative variables: (i) years since the surgeon's graduation and (ii) days from injury to surgery, and outcome variables including (iii) operative time, (iv) blood loss, and (v) absorbable plate size. Surgeons also completed a questionnaire regarding their experience with ORBEYE. RESULTS: Eleven patients underwent conventional surgery, and 10 underwent ORBEYE-assisted surgery. ORBEYE-assisted surgery resulted in a significantly shorter operative time, while no significant differences were observed in other preoperative or outcome variables. The involved surgeons reported reduced physical strain, particularly in the neck, as well as improved collaboration and education. Despite some disadvantages, all surgeons expressed a positive attitude toward continued ORBEYE use. CONCLUSIONS: ORBEYE-assisted surgery offers significant advantages in orbital floor fracture reduction, including reduced operative time, improved ergonomics, and enhanced teamwork and education. Its drawbacks are relatively minor, and broader adoption in plastic surgery should be considered.

BACKGROUND: Lymphatic vessels support wound recovery and absorb excess fluid. Blepharoplasty involves excess tissue excision, and this study investigated the relationship between lymph vessel density in excised tissue and the postoperative course. METHODS: Forty eyelids from 21 patients with blepharoptosis who underwent blepharoplasty were included. Each resected excess tissue sample was divided into 4 parts by 3 parasagittal cuts-medial, central, and lateral. The area percentages occupied by lymphatic vessels and elastic fibers in the inner tissue between skin and muscle, exposed by these cuts, were determined histologically. The wound-healing process was assessed at 2 weeks and 1, 3, and 6 months postoperatively, using a visual analog scale (VAS) to estimate edema and the Vancouver Scar Scale (VSS) for scar assessment. RESULTS: With increasing age, the area percentage of lymphatic vessels declined significantly (r = -0.581, p < 0.001), while an increase in solar elastosis was observed. The percentage of lymphatic vessels was highest on the medial side of the eyelid (p < 0.05), where their relative distribution to the "shallow layer" close to the skin was also the highest (p < 0.01). Independent of age, the VSS values at 2 weeks and 1 month postoperatively were significantly lower in patients with a higher area percentage of lymphatic vessels (2 weeks: p < 0.05; 1 month: p < 0.01). CONCLUSIONS: In patients undergoing blepharoplasty, the percentage of lymphatic vessels in the upper eyelid tissue decreased with advancing age. Higher proportions of lymphatic vessels were associated with improved wound-healing outcomes.