Superficial parotidectomy is a well-established treatment for the early stages of tumors involving the parotid gland. However, there are 3 problems with traditional superficial parotidectomies: (1) cosmetic problems, such as scars, especially around the neck; (2) depressed deformities; and (3) Frey syndrome. A superficial parotidectomy via a modified face-lift incision with dermofat graft provides a solution for these problems and should be considered as an alternative technique in select patients.Key Words: Superficial parotidectomy, modified face-lift incision, dermofat graft, Frey syndrome (J Craniofac Surg 2011;22: 1021Y1023) S uperficial parotidectomy is a well-established treatment for earlystage tumors involving the parotid. The traditional superficial parotidectomy, however, leaves obvious cervical scars. Although a face-lift incision may improve the postoperative appearance by concealing the wounds, a face-lift incision without reconstruction of the hollow parotid bed does not prevent depressed deformities or the Frey syndrome.1,2 Many methods, such as the superficial musculoaponeurotic system (SMAS) advancement flap, fascia lata flap, and sternocleidomastoid (SCM) muscle flap, have been attempted to overcome these problems. 3Y7 However, because these procedures use the tissues around the wound, they have the disadvantage of causing donor-site morbidity. We report a patient with an early-stage tumor of the parotid gland for which we used a dermofat graft after a superficial parotidectomy via a modified facelift incision. CLINICAL REPORTA 15-year-old girl sought evaluation at the hospital for a palpable right parotid gland mass (23.3 Â 22.6 mm). She met the criteria of a clinically discrete parotid gland mass and was immediately transferred to the OtolaryngologyYHead and Neck Surgery Department of Ajou University Hospital. A computed tomogram scan was obtained to establish an accurate diagnosis and identify the exact site of the tumor (Figs. 1 and 2).The surgery was performed with the patient in the supine position under general anesthesia. The following procedures were performed by a plastic and reconstructive surgeon, with the patient's head tilted 45 degrees and the ipsilateral buttock was tilted 30 degrees in the sagittal plane. A temporal incision was made from the projected point at the beginning of the hairline to the junction of the ear and temporal skin. The incision was continued along the junction of the ear and cheek and was extended distally around the origin of the earlobe to the retroauricular fold. The occipital incision was extended horizontally into the hairy scalp for the huge mass. The next step was to elevate the flap superficial to the parotidomasseteric fascia. During the dissection, the great auricular nerve was identified and preserved.A superficial parotidectomy was performed by the otolaryngologyYhead and neck surgeon. The mastoid insertion site and anterior border of the SCM muscle were identified, and the posterior belly of the digastrics muscle was exposed. In the...

Background Autologous fat grafting to the breast for breast reconstruction and cosmetic breast augmentation has gained much attention recently. However, its efficacy and the severities of its associated complications are of concern. The authors experienced one case of multiple breast abscesses after augmentation mammoplasty by autologous fat grafting. Methods A 42-year-old woman presented to the authors' emergency department reporting tenderness, swelling, and a sensation of heat in both breasts. The patient had undergone augmentation mammoplasty by autologous fat grafting 7 days previously. Abscess formation was suspected based on the patient's history, physical examination, laboratory findings, and image study. Results Incision and drainage were performed immediately with the patient under general anesthesia, and 500 ml of a foul, brown, turbid, purulent fluid containing necrotic fat debris was drained from each breast. Empiric antibiotics were started on the first hospital day, and betadine and saline-irrigation were administered daily for 2 weeks. Incisions were closed on hospital day 19 when laboratory data and local infection signs had improved. At the patient's 9-month follow-up assessment, breast contours were found to be well preserved, and scarring was minimal. Conclusion Immediate complications such as edema, hematoma, and infection require serious consideration after autologous fat grafting in the breast. In particular, infection probably is the most serious complication because the volume of the fat injected is large and can induce systemic infections such as sepsis and distort the contours of the breast. To avoid such infections, systemic and multicenter studies are required to determine how fat grafting should be performed to minimize the risks of fat necrosis and infection.

Recurrent laryngeal nerve paralysis is the most common and serious complication after thyroid cancer surgery. The objective of this study was to report the advantages of the vein wrapping technique for nerve reconstruction in patients with thyroid cancer invading the recurrent laryngeal nerve and its effects on postoperative phonatory function. The subjects were three patients who underwent resection of the recurrent laryngeal nerve during surgical extirpation of papillary thyroid cancer. Free ansa cervicalis nerve graft or direct neurorrhaphy with a vein wrapping technique was used to facilitate nerve regeneration, protect the anastomosed nerve site mechanically, and prevent neuroma formation. One-year postoperative laryngoscopic examination revealed good vocal cord mobility. Maximum phonation time (19.5 ± 0.3 sec) was longer than a previously-reported value in conventional reconstruction patients (18.8 ± 6.6 sec). The present phonation efficiency index (7.88 ± 0.78) was higher than that previously calculated in conventional reconstruction (7.59 ± 2.82). The mean value of the Voice Handicap Index-10 was 6, which was within the normal range. This study demonstrates improvement in phonation indices measured 1 year after recurrent laryngeal nerve reconstruction. Our results confirm that the vein wrapping technique has theoretical advantages and could be favored over conventional reconstruction techniques for invenerate nerve injuries.

A 44-year-old man presented with a 5-year history of localized pain on his back, and a 1.5-cm round, touch-induced painful mass was palpated. A subsequent diagnostic evaluation revealed the presence of a glomus tumor. Glomus tumors are rare, benign, small vascular tumors, which originate from glomus bodies present in the reticular dermis. Glomus tumors constitute less than 2.0% of all primary soft tissue tumors, approximately 80% of the lesions are located in the upper extremity, and more than 75% are subungually located. However, many locations have been reported in the literature. Nevertheless, to the best of our knowledge, this glomus tumor that occurred on the back is very rare.

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