Background: Telementoring is the technology for providing surgical instruction from a remote place via a network. To demonstrate the use of telementoring in craniofacial surgery, Skype and a mixed reality device HoloLens were adopted, and 3-layer facial models had been developed. Methods: A resident in hospital A used the model surgery under remote guidance by a mentor surgeon in hospital B 4 times on different dates. The straight-line between hospitals A and B is 250 km. The mentor gave the resident guidance via Skype and HoloLens, communicating by voice, and video of the surgical field, and providing reference data. Results: There was no delay in voice communication and a delay of <0.5 seconds in the video. The resident was able to confirm the main landmarks of the surgical field and to grasp the situation without problems. The mentor could send appropriate instructions by voice, could point out a specific part by telestration function, and could draw lines on the 2-dimentional images pasted on the operator's field of vision. Discussion: With the use of HoloLens, Skype, and the 3-layer models, it was possible to demonstrate telementoring. The risk of personal information leakage due to data interception seems to be very low because its data communication is encrypted with advanced encryption standard. Conclusion: This telementoring system has various advantages and many improvable aspects in the field of craniofacial surgery.

Summary:Reconstruction with the use of local flaps always involves 3 dimensional movements. It is difficult to predict with 3D complex forms stereoscopic changes after local flap operations on the face. We have made 3-dimensional computer-assisted 2-layered elastic models of the face. The surface layer of the model can be detached from the inner layer. By observing the surface model after simulation surgery, it becomes possible to note the distortions caused by the flaps and to determine the tension of each stitch during suturing of the flap. For the simulation surgery, we used our model for a 73-year-old woman with basal cell carcinoma of the nose, selecting the best of several candidate flaps. The time of removal of the stitches could be delayed at the places with high tension. By using these separable 2-layered models of the face, we can choose the best reconstruction method. The actual operation can be performed smoothly, and the best time to remove the stitches can be determined.

Background: Molding helmet therapy is used routinely for moderate to severe deformational plagiocephaly. However, there have been few reports of its use for deformational brachycephaly (DB). The incidence and severity of DB are high in the Asian population, including Japanese people, but there are no reports of treatment for severe cases. The current study showed significant improvement even in severe DB with various deformities. The difference in improvement according to the morphologic classification was investigated. Methods: The study included 47 patients treated with helmet therapy for DB with a cephalic index of greater than 100%. Three-dimensional head scans were used for classification and measurement. DB was classified into four types according to the position of the eurion and the presence of deformational plagiocephaly. The therapeutic effect was determined by changes in cephalic index and cranial asymmetry. Results: Patients exhibited a mean change of 8.0% in cephalic index and 6.4 mm in cranial asymmetry. An older age at initiation was associated with less change in both cephalic index and cranial asymmetry. A significant difference in the amount of cephalic index change was observed depending on the position of the eurion when the starting age was 6 months or older (P < 0.05). Conclusions: Molding helmet therapy for severe DB results in significant morphological improvement. However, depending on the position of the eurion, the effect of treatment may be decreased if it is started too late. It is necessary to understand the difference in improvement depending on the morphology and to ensure early intervention. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.