No abstract

Since congenital curved nail of the fourth toe (CNFT) was reported by Iwasawa et al in 1991, there have been only 19 cases of CNFT in 6 reports, which were from Japan and Taiwan. We performed surgery on 4 patients with CNFT and report here good results. There has been no previous detailed report on surgical treatment for this condition. This report will describe the treatment, mainly the surgical procedure.

In scalp and cranial surgeries, it had been conventional to shave hair for surgical manipulations and prevention of infection. In recent years, it has been conventional to perform surgeries with minimal hair shaving. Such a method has been found to have a low risk of infection, and it takes into account esthetic considerations for patients. However, since long hair can become a hindrance to surgery, it is essential to preoperatively manage such hair and maintain a clear operating field. In this study, we braided patients' long hair to obtain a good operating field during scalp or cranial surgery. The advantages of our method are that it can be performed easily in a short period of time, does not require special instruments, and does not damage hair because rubber bands are used minimally. It is a useful method that minimizes shaving of long-haired patients for surgeries of the head and reduces cumbersome steps.

Treacher Collins syndrome is a disorder characterized by various congenital soft tissue anomalies involving hypoplasia of the zygoma, maxilla, and mandible. A variety of treatments have been reported to date. These treatments can be classified into 2 major types. The first type involves osteotomy for hard tissue such as the zygoma and mandible. The second type involves plastic surgery using bone grafting in the malar region and soft tissue repair of eyelid deformities. We devised a new treatment to comprehensively correct hard and soft tissue deformities in the upper half of the face of Treacher Collins patients. The aim was to "change facial features and make it difficult to tell that the patients have this disorder." This innovative treatment strategy consists of 3 stages: (1) placement of dermal fat graft from the lower eyelid to the malar subcutaneous area, (2) custom-made synthetic zygomatic bone grafting, and (3) Z-plasty flap transposition from the upper to the lower eyelid and superior repositioning and fixation of the lateral canthal tendon using a Mitek anchor system. This method was used on 4 patients with Treacher Collins syndrome who had moderate to severe hypoplasia of the zygomas and the lower eyelids. Facial features of these patients were markedly improved and very good results were obtained. There were no major complications intraoperatively or postoperatively in any of the patients during the series of treatments. In synthetic bone grafting in the second stage, the implant in some patients was in the way of the infraorbital nerve. Thus, the nerve was detached and then sutured under the microscope. Postoperatively, patients had almost full restoration of sensory nerve torpor within 5 to 6 months. We devised a 3-stage treatment to "change facial features" of patients with hypoplasia of the upper half of the face due to Treacher Collins syndrome. The treatment protocol provided a very effective way to treat deformities of the upper half of the face in patients with Treacher Collins syndrome.

A 6-year-old girl with Poland syndrome was diagnosed with loss of hard and soft tissue on her affected chest. She required chest reconstruction to protect her thorax and improve her developmental delay. We applied a titanium device used for children with funnel chest to her, resulting in good shape. By using this device, we avoided sacrificing healthy rib and muscle; she could save the tissue for secondary surgery in puberty. The device made it possible to support the growth of her thoracic frame and has kept it in good shape. Also, 66 months after removing the device, her chest contour has been maintained. We evaluated the change of her chest frame by comparing the preoperative and postoperative CT index and found the result quite an improvement. We suggest that our technique would be easy, of low invasiveness, and safe for treatment of thoracic deformity in school age.