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The Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) is widely used to predict surgical complications affecting various organs. However, there are few reports about objective evaluation methods for head and neck surgery. In this study, we retrospectively examined the association between POSSUM score and actual surgical complications of head and neck reconstruction surgery. In total, 711 patients who underwent head and neck reconstruction after cancer extirpation between January 2007 and January 2015 were studied. The predicted risk of complications was calculated using the POSSUM score and compared with the actual rate of perioperative complications. Perioperative complications occurred in 178 (25%) patients, comprising systemic complications in 52 (7%) patients, surgical site infection of the head and neck area in 78 (11%) patients and failure of the free flap in 55 (8.8%) patients. When patients were divided into a perioperative complication group and a no-complication group, a significant difference between the two groups was observed in the predicted postoperative rate calculated from the POSSUM score (p < .0001, odds ratio 1.03, 95% confidence interval = 1.02-1.04). Furthermore, the cutoff value of the POSSUM score calculated from the receiver operating characteristic curve using Youden's index was 43.0%. POSSUM is a useful risk indicator for head and neck reconstruction surgery. It is possible to objectively calculate the prediction level using a standard assessment method without adding burden to any medical facility. Therefore, patients may be considered at high risk for perioperative complications when the POSSUM score is 43.0% or higher.

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要旨 われわれは，苺状血管腫に対してダイレーザー照射を第１選択として早期治療を行ってきた．今回，治療開始時の 年齢が 1 歳未満，1 歳以上 2 歳未満，2 歳以上の 3 群を局面型，腫瘤型に分け、治療効果を比較検討した結果，全ての 群で縮緬じわが消失し，1 歳未満の群では腫瘤型でも平坦化する傾向がみられた．瘢痕形成等の合併症はなく，未治 療群と比較して明らかに良好な成績を得た。また、低出生体重児では苺状血管腫が多く見られるが、今回 7 症例で早 期治療を行い，腫瘤型では隆起の改善を認め，治療に対する良好な結果を得た． キーワード：苺状血管腫，ダイレーザー，早期治療，低出生体重児 AbstractEarly dye laser treatment for strawberry marks has been our first choice. Patients are classified by age of first treatment for three groups (under 1 year, between 1 and 2 years, above 2 years) and by appearances for two groups (plaque type and tumor type). The results of laser treatment in each groups was compared. In most cases the wrinkles on the surface disappeared. In cases under 1 year old the height of the mass tended to become flat though they were of the tumor type. Our cases showed no conspicuous scar formation, clearly differing from cases without dye laser treatment. Strawberry marks are common in premature babies and seven cases were treated. Flattening was observed in tumor type and good results were obtained in the majority of cases. 〒 113 − 8677 東京都文京区本駒込 3 丁目 18 番 22 号 TEL: 03 − 3823 − 2101 (代) FAX: 03 − 3823 − 5433 (3-18-22,

Acquired choanal atresia is a rare complication of pharyngeal surgical interventions. Here, we report the case of a 72-year-old woman who was treated in our institution for acquired choanal atresia after failed previous treatments. We have excised the obstructing fibrotic scar tissue and then reconstructed the area using a mucosal local flap and free radial forearm flap transfer. Choanal stenosis caused by abnormal granulation was identified in the months after surgery; however, this was treated with endoscopic dilatation and steroid injections in the outpatient setting. No restenosis was identified 1 year after the operation. Postoperative evaluation of speech was satisfactory. Free flap transfer could be an option for refractory choanal atresia, and endoscopic dilatation with local steroid injections may be an effective method to treat postoperative restenosis.