These approaches are easy to perform and will lead to better cosmetic results in clinical settings.

The aim of the authors’ study is to show their surgical results in orbital decompression using different endonasal endoscopic techniques. These approaches are according to the degree of proptosis and the presence or not of sight threatening.

The authors performed 31 orbital decompressions on 20 Graves orbitopathy patients. Average age at surgery was 52 years. There were 5 males and 15 females. Five patients were diagnosed as having severe or for sight-threatening Graves orbitopathy. These included 3 men and 2 women having an average age of 54 years old. Minimum postsurgical follow-up was 12 months in all patients.

Orbital decompression was performed in 15 patients for proptosis and in 5 patients for urgent sight threat. Thirteen orbits showed mild proptosis and 18 orbits presented moderate proptosis. In patients without sight threatening reduction of proptosis had a mean value of 2.8 mm as determined by exophtalmometry, being 3.3 mm when measured on magnetic resonance imaging. The mean millimeter in mile Level V.Controversy remains whether to perform a pharyngeal flap simultaneously with a tonsillectomy in patients with velopharyngeal insufficiency. The aim of this study is to revisit the speech outcomes and complications associated with the combined superiorly based pharyngeal flap and tonsillectomy procedure, while comparing pain outcomes. We hypothesize that the combined procedure will improve speech outcomes with minimal complications, but patients will experience more pain in the combined procedure.A 5-year retrospective review of registry data from Boys Town National Research Hospital was conducted from 2014 to 2019. Data collection included age, surgeries performed, length of stay, pain medication administration occurrences, immediate postoperative complications, postoperative speech outcomes specifically related to articulation (audible nasal airway emissions) and resonance (hypernasality).Eighty-eight patients had a superiorly based pharyngeal flap over this 5-year period. Eighteen patients (20%) had a simultaneous procedure performed. 1-NM-PP1 clinical trial There were no patients who had immediate postoperative complications such as upper airway obstruction or bleeding complications that necessitated a reoperation. One of the patients had a pharyngeal flap dehiscence that required a revision pharyngeal flap in the combined group. Nasal airway emissions and hypernasality were eliminated in 58.3% and 75%of the combined patients, respectively. The total number of narcotic administration occurrences were significantly higher in the combined group than the pharyngeal flap only group (9.0 versus 7.0; P = 0.03).A number of velopharyngeal patients will present with hypertrophied tonsils. We believe that it is safe and beneficial to perform the combined procedure in the same setting.Facial trauma can pose challenging reconstructive obstacles in both maintaining tissue viability and restoring aesthetic appearance. Medicinal leech therapy can help to promote vascular decompression in the setting of venous congestion. A retrospective chart review was conducted to identify patients who underwent medicinal leech therapy following venous stasis secondary to repair of a complex facial laceration. Three patients were identified; 2 suffered auricular avulsion, while 1 suffered a lip avulsion. All patients suffered from venous congestion and underwent medicinal leech therapy for 48 to 72 hours with reduction of edema and stasis. Decompression was successfully achieved with no further sequelae on last follow-up. Medicinal leech therapy is an adequate treatment for venous congestion following traumatic soft-tissue repair of the face. The authors advocate for the utilization of medicinal leeches to combat venous congestion after repair, particularly when arterial inflow remains intact.Over the last 10 years there has been an explosion in the number of minimally invasive procedures that patients undertake with increasing uses of botulinum neurotoxin type A for off label indications. One area of expansion over the past several years is the “Lip Flip” which involves injection of botulinum neurotoxin type A along the vermillion border to improve lip contour, eversion and fullness. While techniques and results for “gummy smile” and perioral vertical rhytids have been previously reported, minimal literature exists on this new trend, including whether such increased interest truly exists. Therefore, the authors aim to explore whether there is a rising trend regarding “lip flip” and report on clinical results from patients treated in our practice.Craniofacial harpoon injuries are extremely rare, especially when caused by attempted suicide. The approach to surgical removal becomes dependent on the characteristics of the device, with or without barbs on the spear, and its path, which presents with significant changes between accidents and suicide attempts. This report presents the successful treatment carried out in a dramatic case of harpoon suicide attempt. The approaches to complete and cautious removal of the spear from the occipital region, reconstruction of the orbital cavity, evisceration of the left eyeball due to amaurosis and psychiatric follow-up were successful, which allowed the restoration of the patient’s physical and mental health.

Giant congenital nevi (GCN), defined as abnormal collections of melanocytes with a diameter greater than 20 cm, occur in 1 in 20,000 births. The lifetime risk of malignant transformation in GCN is reported between 5% and 20% and most commonly occurs in the first 3 to 5 years of life. This article reviews the risk factors of malignant transformation and highlights the diagnostic challenges of malignant melanoma in the pediatric population utilizing a clinical report of a patient with GCN.

A male patient with giant congenital nevus of the scalp with over 20 satellite nevi was evaluated at the authors’ institution at 1 week of life. Beginning at 9 months of age, he underwent serial excision of GCN and satellite lesions. Initial pathology showed compound congenital melanocytic nevus. Subsequent pathology on serial excisions demonstrated compound nevus with clonal expansion of pigmented epithelioid melanocytoma (PEM). He then underwent complete excision of GCN. Pathology demonstrated malignant melanoma that was confirmed by consensus review with outside institutions.