Details of a Researcher - Sakamoto, Yoshiaki

Papers - Sakamoto, Yoshiaki

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Influence of Lip Revision Surgery on Facial Growth in Patients with A Cleft Lip

Kamata M., Sakamoto Y., Ogata H., Sakamoto T., Ishii T., Kishi K.

Journal of Craniofacial Surgery (Journal of Craniofacial Surgery) 34 ( 4 ) 1203 - 1206 2023.06

ISSN 10492275

Although patients with cleft lip and palate often present with poor maxillary growth because of intrinsic and iatrogenic factors, the surgical influence of lip revision surgery, palatal fistula repair, and pharyngeal flap procedures remains uncertain in contrast to that of primary cleft lip repair and palatoplasty. Therefore, this study aimed to reveal factors inhibiting maxillary growth and inducing later orthognathic surgery. A retrospective analysis was conducted on the data of patients with cleft lip and palate who underwent a series of treatments at Keio University Hospital from 1990 to 2000. We collected data on patient sex, cleft type, number and timing of lip revision surgery, the incidence of palatal fistulae, history of pharyngeal flap procedures, and timing of a repeat bone graft, and reviewed whether these patients underwent orthognathic surgery later in life. Multivariate analysis was conducted using binary logistic regression to extract factors affecting later orthognathic surgery. A total of 52 patients were included in this study. Results showed that revision surgery conducted more than twice was the highest statistically significant predictor of later orthognathic surgery in patients with a cleft lip and palate (P<0.05, odds ratio=43.3), followed by palatal fistula occurrence after cleft palate repair (P<0.05, odds ratio=22.3). Therefore, primary surgical procedure is most important for these patients.

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An Elderly Patient with Crouzon Syndrome Treated with Monobloc Distraction

Nakao K., Sakamoto Y., Miwa T., Wakabayashi K., Ishii T., Kishi K.

Journal of Craniofacial Surgery (Journal of Craniofacial Surgery) 33 ( 8 ) E871 - E874 2022.11

ISSN 10492275

Monobloc advancement by distraction osteogenesis is the treatment of choice in patients with syndromic craniosynostosis. This procedure is usually performed at 18 to 24 months/5 to 10 years of age. Herein, we present the case of a male patient with Crouzon syndrome who underwent monobloc advancement at the age of 62 years. Although the patient lived a normal life (employed, married, and being a father of a daughter), he visited our hospital for surgical improvement in facial esthetics. The patient underwent monobloc advancement by distraction osteogenesis. He was satisfied with the postoperative esthetic improvement and did not experience any major complications. This case highlights the fact that patients with syndromic craniosynostosis desire esthetic improvement and suggests that multidisciplinary treatment involving both the neuro and plastic surgeons is important in such cases.

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Application of Deep Learning Techniques for Automated Diagnosis of Non-Syndromic Craniosynostosis Using Skull

Mizutani K., Miwa T., Sakamoto Y., Toda M.

Journal of Craniofacial Surgery (Journal of Craniofacial Surgery) 33 ( 6 ) 1843 - 1846 2022.09

ISSN 10492275

Abstract Non-syndromic craniosynostosis (NSCS) is a disease, in which a single cranial bone suture is prematurely fused. The early intervention of the disease is associated with a favorable outcome at a later age, so appropriate screening of NSCS is essential for its clinical management. The present study aims to develop a classification and detection system of NSCS using skull X-ray images and a convolutional neural network (CNN) deep learning framework. A total of 56 NSCS cases (scaphocephaly [n = 17], trigonocephaly [n = 28], anterior plagiocephaly [n = 8], and posterior plagiocephaly [n = 3]) and 25 healthy control infants were included in the study. All the cases underwent skull X-rays and computed tomography scan for diagnosis in our institution. The lateral views obtained from the patients were retrospectively examined using a CNN framework. Our CNN model classified the 4 NSCS types and control with high accuracy (100%). All the cases were correctly classified. The proposed CNN model may offer a safe and high-sensitivity screening of NSCS and facilitate early diagnosis of the disease and better neurocognitive outcome for patients.

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Factors Affecting Optic Nerve Damage in le Fort III Osteotomy: A Retrospective Study

Noto M., Sakahara D., Sakamoto Y., Imai K.

Journal of Craniofacial Surgery (Journal of Craniofacial Surgery) 33 ( 6 ) 1865 - 1868 2022.09

ISSN 10492275

The causes of visual impairment following Le Fort osteotomy for syndromic craniosynostosis have not been completely elucidated. The authors investigated the potential causes and means of prevention of optic nerve damage, with particular emphasis on intraoperative blood transfusion volume and operating time. This retrospective study evaluated patients who underwent Le Fort III osteotomy for syndromic craniosynostosis between 2000 and 2020. Data on pupillary reflex, pupil size, operating time, blood transfusion, age at time of surgery, sex, and syndrome type were obtained from medical records. Univariate analysis and multivariate analysis with the level of statistical significance set at P<0.05. For the 86 patients included, the mean values of operating time, amount of blood transfusion based on body weight, amount of blood transfusion per body weight per hour, and age were 6.0 hours (range: 3.5-12.3 h), 30.5 mL/kg (range: 0-322 mL/kg), 5.14 mL/kg/h (range: 0-35.7 mL/kg/h), and 10.0 years (range: 4-38 y), respectively. Crouzon, Apert, and Pfeiffer syndromes were observed in 49, 29, and 8 patients, respectively. Abnormal pupillary findings were observed in 27 patients of whom 25 showed no abnormalities in subsequent visual function and 2 developed blindness. Abnormal pupillary findings correlated with the amount of blood transfused per body weight (P=0.0082) and amount of blood transfused per body weight per hour (P=0.0052). As demonstrated in this study, increased intraoperative bleeding and amount of blood transfused were associated with optic nerve damage, particularly during acute bleeding. Prompt inspection of the pupils following surgery is therefore warranted.

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The role of surgeon's learning on the outcomes of alveolar bone graft for cleft repair

Sakamoto Y., Ogata H., Miyamoto J., Kishi K.

Journal of Plastic, Reconstructive and Aesthetic Surgery (Journal of Plastic, Reconstructive and Aesthetic Surgery) 75 ( 6 ) 1937 - 1941 2022.06

ISSN 17486815

Background and purpose: Teaching cleft repair in the operating room may not sufficiently prepare craniofacial residents to perform the procedure self-reliantly. This study aimed to assess the influence of surgeons’ experience level on the operative time and graft survival ratio after alveolar bone grafts for cleft repair. Subjects and methods: This was a retrospective review of 100 consecutive alveolar bone graft patients treated for unilateral alveolar cleft by one craniofacial surgeon between 2012 and 2019. An alveolar bone graft from the iliac bone was performed using the lateral sliding flap. Sex, age, cleft width, cleft defect volume, and operative time were recorded, and the 1-year postoperative graft survival ratio was calculated. Multiple regression analysis was performed to identify factors that affect the operative time and survival ratio. Results: Factors affecting the operative time were the experience level of the surgeon and the presence of a cleft palate. Factors affecting the graft survival ratio were the cleft defect volume and experience level of the surgeon. In cleft lip and alveolus, the survival ratio was constant, and the operative time stabilised after approximately 20 cases. In cleft lip and palate, more experience was required to master the technique, and the operative time and survival ratio were stabilised only after approximately 40 cases. Conclusion: Surgeons’ experience level influenced the outcomes of alveolar bone grafting. Although surgical training is currently undergoing a paradigm shift from on-the-job training to simulation-based training, clinical experience is critical to be self-sufficient.

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The Learning Curve of a Craniofacial Surgeon: A Retrospective Study of 100 Consecutive Cases

Sakamoto Y., Miwa T.

Journal of Craniofacial Surgery (Journal of Craniofacial Surgery) 33 ( 3 ) 794 - 796 2022.05

ISSN 10492275

Mastering the techniques of craniofacial surgery is difficult owing to the small number of cases and the special skills required. To improve the outcomes of craniofacial surgery in Japan, the authors charted the progress of a craniofacial surgeon by reviewing the results for the 100 consecutive craniosynostosis cases, in which the authors performed fronto-orbital advancement (FOA). in this study, all FOA surgeries were performed by the first author beginning in 2012. The number of FOA surgeries previously performed by the surgeon at the time of the current surgery served as an indicator of his level of experience; the cases were grouped in 5 consecutive sets of 20. The preparation time before the operation, the operative time, and the amount of bleeding were retrospectively investigated. The operative and preparation times decreased as the surgeon's experience increased until a plateau was reached after 41 to 60 surgeries. Increases in operative time also corresponded to decreases in the amount of bleeding. Everyone has a learning curve, including surgeons performing craniofacial surgeries. Surgery is not performed by the surgeon alone. Reductions in preparation time, operative time, and the time needed to leave the operation room after the completion of the surgery were attributed to better collaborations with nurses and anesthesiologists. Hence, the growth of the team is very important to the success of the craniofacial surgeon and ensures safe and effective treatment of the patient.

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The fascial structure of the breast: New findings on the anatomy of the inframammary fold

Takaya K., Sakamoto Y., Imanishi N., Kishi K.

Journal of Plastic, Reconstructive and Aesthetic Surgery (Journal of Plastic, Reconstructive and Aesthetic Surgery) 75 ( 5 ) 1632 - 1638 2022.05

ISSN 17486815

The inframammary fold defines the shape and structure of the breast, especially in women. As the inframammary fold is placed between the fifth and sixth ribs, the ligaments or fascia are thought to attach from these ribs. However, the previous literature on what structures constitute the inframammary fold does not provide sufficient knowledge for reconstructing the natural form of the fold. This study aimed to clarify the structure that involves the inframammary fold. Ten sides of five formalin-fixed, adult Asian cadaveric breasts were studied. Upon dissection of the breast, including the ribs, the fat lobules were removed while preserving the septal structures under the microscope. The fascial structures were observed grossly and radiographically. A multilayered fascial structure was noted from the dermis near the inframammary fold, anchored to the deep fascia of the pectoralis major muscle mainly at the height of the fourth rib and partially of the fifth rib, from the outside of the nipple to the linea axillaris media, where the fold could be clearly observed. Additionally, the fat lobules around the inframammary fold were subdivided by thin septa closer to the dermis, and they fused posteriorly and upward to form this fascial structure. The inframammary fold was not formed by an adhesion directly under the sixth rib, but by the skin “hanging” from the height of the fourth and fifth ribs due to the multilayered fascial structure that repeatedly fused and dissociated and the changes in the size of the fat lobules. This new anatomical finding may help in inframammary fold reconstruction.

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Transient central diabetes insipidus after cranioplasty for craniosynostosis in an infant with septo-optic dysplasia

Fukuyama T., Sato T., Nakano S., Tomita K., Sakamoto Y., Miwa T., Hamada J., Futagawa N., Hasegawa K., Ishii T., Hasegawa T.

Clinical Pediatric Endocrinology (Clinical Pediatric Endocrinology) 31 ( 1 ) 50 - 53 2022

ISSN 09185739

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Bioabsorbable System-Related Subcutaneous Swelling after Craniofacial Surgery

Sakamoto Y., Miwa T., Toda M., Kishi K.

Journal of Craniofacial Surgery (Journal of Craniofacial Surgery) 32 ( 8 ) E816 - E818 2021.11

ISSN 10492275

Background: Bioabsorbable systems have been commonly used in pediatric patients for primary cranioplasty and other related surgeries. However, subcutaneous swelling, a unique complication related to bioabsorbable osteosynthesis, is a concern. Differences in the incidence of subcutaneous swelling, depending on the bioabsorbable material used to construct the plate, are still unknown. Methods: The authors retrospectively reviewed all incidences of subcutaneous swelling related to resorbable systems used during primary cranioplasty for patients with craniosynostosis at their hospital between 2014 and 2018 during a 12-month follow-up period. Furthermore, the authors reviewed all published English-language articles (since 1995) on subcutaneous swelling in bioabsorbable systems used for craniosynostosis. Results: The most common resorbable systems used in the literature were divided into 2 groups: mixtures of poly D-lactic acid and polyglycolic acid, and mixtures of poly D- and L-lactic acid. In patients for whom poly D-lactic acid and polyglycolic acid were used, the incidence of subcutaneous swelling during resorption was 0% to 4.2% between 3 and 9 months of follow-up. In patients for whom poly D- and L-lactic acid was used, subcutaneous swelling during resorption occurred in 5% to 16.7% of these patients between 6 and 12 months of follow-up. All cases resolved spontaneously after complete absorption of the plate. Conclusions: It was difficult to determine which system had the lowest incidence of subcutaneous swelling. The thickness of each resorbable system and the thickness of the infants’ scalps were different in each study. However, subcutaneous swelling occurred in every resorbable system. Therefore, preoperative counseling and careful follow-up are necessary.

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Early Fat Grafting for Augmentation in Craniofacial Microsomia

Sakamoto Y., Arnaud E.

Journal of Craniofacial Surgery (Journal of Craniofacial Surgery) 32 ( 7 ) E615 - E616 2021.10

ISSN 10492275

Patients with craniofacial microsomia often require multiple surgical interventions to address both hard and soft tissue defects. For improvement of soft tissue defects, microvascular free tissue transfers have been widely performed after puberty. To camouflage facial asymmetry, early fat grafting was performed on five six-month-old patients, and acceptable outcomes were obtained without overcorrection. This result suggests that early fat grafting in craniofacial microsomia is useful to camouflage asymmetrical facial contours.

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Clinical Features of Bilambdoid and Sagittal Synostosis (BLSS): A Retrospective Multicenter Study in Japan

Tamada I., Hikosaka M., Sakamoto Y., Tsuda K., Ihara S., Kaneko T., Kishi K.

Journal of Craniofacial Surgery (Journal of Craniofacial Surgery) 32 ( 6 ) 2134 - 2138 2021.09

ISSN 10492275

Bilambdoid and sagittal synostosis (BLSS), a rare form of multisutural craniosynostosis, is sometimes known as the Mercedes-Benz syndrome due to the appearance of the fused sagittal and bilateral lambdoid sutures. Although previous studies have described some of its clinical features, the pathology of this disease is not yet fully understood. Moreover, it has been pointed out that BLSS is more common among individuals of Hispanic ethnicity, but its incidence in Asia remains unclear. In the present study, BLSS cases in Japan were analyzed to determine the characteristics of the condition in Japan. Three hospitals in Tokyo participated in the present study. Patients with BLSS who underwent cranial remodeling were included. Data on patient demographics, clinical symptoms, status of the cranial sutures, morphological subclassification, surgical procedures, developmental status, and genetic mutations were analyzed. In total, 22 patients met the enrollment criteria and were included, indicating a higher incidence of BLSS in Japan than in other nations reported in previous studies. In terms of morphological subclassification, there were 15 brachycephalic, 4 dolichocephalic, and 3 normocephalic. For the initial cranial procedure, 7 patients underwent a single-stage cranioplasty, 13 underwent a posterior distraction, and 2 underwent lateral expansion. Patients with a normocephalic cranial morphology tended to undergo surgery at an older age than patients with the other two types. Appropriate timing for surgery is important for healthy development; hence, surgeons should remember that BLSS can lead to "balanced dysmorphism" that may have led to a delay in diagnosis due to its normal-looking morphology.

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Outcomes of the Nuss procedure for pectus excavatum in adults

Sakamoto Y., Yokoyama Y., Nagasao T., Yamada Y., Yamada M., Jinzaki M., Kishi K.

Journal of Plastic, Reconstructive and Aesthetic Surgery (Journal of Plastic, Reconstructive and Aesthetic Surgery) 74 ( 9 ) 2279 - 2282 2021.09

ISSN 17486815

Limited data exist with regard to the outcome of the Nuss procedure for pectus excavatum repair in adults. Here, we analysed changes in lung capacity and thoracic morphology based on computed tomography (CT) imaging in adults with pectus excavatum before surgery, during bar insertion and after bar removal. Patients who underwent the Nuss procedure for pectus excavatum after the age of 20 were included in this study. Chest CT scans of the included participants were taken before the Nuss procedure, immediately before removal of the pectus bar and 6 months after removal of the pectus bar. Lung capacity and thoracic morphology measurements were made from the CT scans. Six patients aged 24–43 years were included in this study. After the Nuss procedure, lung capacity was decreased in all patients. Although the pectus bar was removed, lung capacity had not significantly increased and was almost the same volume as before the Nuss procedure. After the Nuss procedure, the funnel chest shape had improved in all cases, patients’ thoracic spine had also moved forward as the thorax moved forward and patients’ stoop had improved. Despite a lack of change in lung capacity, surgical modification should be considered to reduce stress on the thoracic spine and in turn, reduce pain in patients with pectus excavatum. However, further long-term observation seems necessary.

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Reconstruction of Combined Orbital Floor and Medial Wall Fractures Using Custom-Made Titanium Alloy Implant

Kitabata R., Uno K., Sakamoto Y.

Journal of Craniofacial Surgery (Journal of Craniofacial Surgery) 32 ( 4 ) E388 - E389 2021.06

ISSN 10492275

The reconstruction of combined orbital floor and medial wall fractures is challenging due to the surgical approach and implant stability. A 0.5 mm thickness rigidity custom made titanium alley implant was created by 3-dimensional printing with electron-beam additive manufacturing. The implant was designed to cover the entire surface of the inferomedial orbit based on the flipped the contralateral orbit images. Although the cost was expensive, the use of three-dimensional printed implants for extensive orbital wall fractures was useful for decreasing operative time, and can be accessed with a limited surgical approach with a precise fit.

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Assessment of long-term quality of life in patients with syndromic craniosynostosis

Sakamoto Y., Takenouchi T., Miwa T., Kishi K.

Journal of Plastic, Reconstructive and Aesthetic Surgery (Journal of Plastic, Reconstructive and Aesthetic Surgery) 74 ( 2 ) 336 - 340 2021.02

ISSN 17486815

Several studies have analyzed the long-term stability of cranioplasty and midface distraction in patients with craniosynostosis; however, few studies have investigated long-term quality of life (QOL) and complications in adults with syndromic craniosynostosis. This study aimed to investigate the QOL (social, physical, and psychosocial) of patients with adult syndromic craniosynostosis. Patients aged ≥20 years with syndromic craniosynostosis, who were surgically treated at a single craniofacial institution, were included in this study. We investigated everyday inconvenience (using the World Health Organization Disability Assessment Schedule questionnaire), any ongoing treatment, marital status, and number of children. Totally, 18 patients aged 22–48 years (mean: 31.4 ± 9.2 years) answered the questionnaire (Crouzon syndrome, 9; Apert syndrome, 5; Pfeiffer syndrome, 4). Of these, only one Crouzon syndrome patient was married; she was also the only one with a child. Apert syndrome patients were found to have difficulty in understanding, communication, and self-care because of their mental retardation and hand and foot handicaps; however, their participation in society was the most aggressive. In contrast, Crouzon syndrome patients had especially poor participation in society. In all patients, any ongoing hospital treatment was due to ophthalmological conditions. Crouzon syndrome patients have extremely poor QOL; the absence of mental retardation and hand and foot handicaps forces them to live in mainstream society, for which they are emotionally ill-equipped. It is necessary to treat these patients without any residual deformity to provide psychological support and to create an accepting society.

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Gorham-Stout disease with parietal bone osteolysis: a case series and review of literature

Takaya K., Sakamoto Y., Miwa T., Yoshida K., Kishi K.

British Journal of Neurosurgery (British Journal of Neurosurgery) 35 ( 1 ) 27 - 31 2021

ISSN 02688697

Background: Gorham-Stout disease (GSD) is a rare and idiopathic bone disorder, characterized by massive osteolysis. To date, there is no established treatment strategy for GSD. We empirically treated two patients, who had presented to us with cranial lesions of GSD. Here, we propose a novel algorithm for the management of Gorham’s disease based on our experience and review the literature published to date. Methods: We reviewed all existing literature on GSD describing the pathophysiology and suggested treatment methods, up to 2018. Results: We found 13 papers with 14 reported cases; an inclusion of our two cases brings the total count up to just 16 recorded cases of GSD involving the skull. Of these, the base of the skull was affected in eight cases, while the remaining eight cases showed cranial involvement. The patients with skull-base involvement were managed conservatively, using medications or radiotherapy. The patients with cranial osteolysis were managed surgically, with an excision of the osteolytic portion, followed by cranioplasty. Of the latter group, the pericranium was not removed in one patient, in whom a very slight progression of the osteolytic process was later observed. Conclusions: The pathogenesis of GSD remains poorly understood. Further study is required to determine an optimum management strategy. A long-term follow-up will also be necessary to establish the effectiveness of the treatment process. The untreated patients show a progressive resorption of the affected bones of the skull. A painful, vanishing skull deformity is an alarming sign of GSD. Early diagnosis and treatment are necessary to arrest disease progression and to prevent complications.

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Beware of Optical Illusion of the Alar Base in Unilateral Cleft Lip Nasal Deformity

Sakamoto Y., Miyamoyo J., Kishi K.

Plastic and Reconstructive Surgery - Global Open (Plastic and Reconstructive Surgery - Global Open) 2021

Background: It is generally accepted that the alar base on the cleft side in the cleft lip nose is displaced outward and downward; therefore, it is rotated inward and upward in almost all procedures for cleft lip closure. However, nostril narrowing and collapse of the lower lateral cartilage on the cleft side are sometimes experienced. In this retrospective study, we investigated whether the preoperative alar base on the cleft side is displaced outward and downward. Methods: This was a retrospective evaluation using preoperative frontal images obtained from patients with unilateral cleft lip (n = 245). The midcolumellar and subalare points were placed, and each ratio was analyzed and compared to those of age-matched controls (n = 40). Results: The subalare on the noncleft side and subnasale were displaced upward and outward. In contrast, the subalare on the cleft side was displaced downward and inward. The displacement of the subalare was greater on the noncleft than on the cleft side. There were no significant differences between male and female patients and between the left and right sides. Among the complete cleft lip and palate, incomplete cleft lip and palate, complete cleft lip and alveolus, incomplete cleft lip and alveolus, and microform cleft lip groups, the complete cleft lip and palate group showed the greatest displacement. Conclusion: The cleft alar base appeared to shift outward and downward because of an optical illusion, but in fact, both alar bases shifted; the alar base on the cleft side was displaced inward and downward, and the alar base on the noncleft side was displaced outward and upward.

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Posterior distraction first or fronto-orbital advancement first for severe syndromic craniosynostosis

Iida C., Sakamoto Y., Miwa T., Yoshida K., Kishi K.

Journal of Craniofacial Surgery (Journal of Craniofacial Surgery) 30 ( 1 ) 47 - 49 2019.01

ISSN 10492275

Copyright © 2018 by Mutaz B. Habal, MD Purpose: Posterior calvarial vault expansion using distraction osteogenesis is performed for syndromic craniosynostosis as the first choice. This procedure allows far greater intracranial volume than fronto-orbital advancement (FOA). This study aimed to determine the most suitable timing of posterior distraction or FOA to sufficiently increase the intracranial volume and remodel the skull shape. Patients and Methods: From 2014 to 2017, the authors performed posterior distraction in 13 patients with syndromic craniosynostosis. Data on premature suture fusion, age at first visit, age at surgery, skull thickness, and complications were collected. Results: Five patients underwent posterior distraction at approximately 12 months of age and had no complications, including cerebrospinal fluid leakage or gull wing deformity. However, during the waiting period for the operation, the skull deformity continues to extend upward (turribrachycephaly). To prevent progress of the skull deformity, the authors performed the operation at approximately 6 months of age in 7 patients. However, in 3 of 7 patients whose lambdoid sutures were opening, gull wing deformity occurred. From these results, in a patient with severe Beare-Stevenson syndrome, the authors performed FOA first at 5 months of age, followed by posterior distraction at 12 months of age, and achieved favorable results. Conclusions: Treatment patterns are patient specific and should be tailored to premature suture fusion, specific skull deformity, and required intracranial volume of each patient.

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Multi-stage preparation for the repair of complicated skull defects

Sakamoto Y., Arnaud E.

Neurologia Medico-Chirurgica (Neurologia Medico-Chirurgica) 59 ( 5 ) 172 - 175 2019

ISSN 04708105

© 2019 by The Japan Neurosurgical Society. Cranioplasty following decompressive craniectomy is highly associated with complications. Methods for avoiding these complications have been well-documented; however, approaching reconstruction through the previous incision, especially if it was on or very near the bone defect, can sometimes lead to wound dehiscence and infection, with exposure of the artificial bone. For such complicated cases, we propose a multi-staged preparation that includes creating a delayed skin flap for the actual skull reconstruction. Flap was elevated in three stages, with 4 week intervals between each stage to allow for adequate blood supply. Cranioplasty using custom-made implants was then performed. Four patients (age range, 10-25 years) were prepared for skull reconstruction using this technique. During follow-up period for 12 months, no complications, including infections, exposure of the artificial bone, or flap necrosis, were observed. Despite the multiple stages required, we consider that our technique makes a significant contribution to the literature because it suggests a technique for cranioplasty following decompressive craniectomy that may avoid many of the complications following such cranioplasty using current methods.

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Foreign-body reaction to bioabsorbable plate and screw in craniofacial surgery

Kamata M., Sakamoto Y., Kishi K.

Journal of Craniofacial Surgery (Journal of Craniofacial Surgery) 30 ( 1 ) E34 - E36 2019

ISSN 10492275

Copyright © 2018 by Mutaz B. Habal, MD Hydroxyapatite and poly-L-lactide plates are often used for maxillofacial surgery. These plates take 3 to 4 years to resorb completely, leading to the possibility of a foreign-body reaction. A 20-year-old woman who developed a foreign-body reaction to the plates was reported. Based on review of the relevant literature, foreign-body reactions have often been reported with this plate. Long-term follow-up is warranted to evaluate patients using this plate in maxillofacial surgery.

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Assessment of Bioabsorbable Hydroxyapatite for Secondary Bone Grafting in Unilateral Alveolar Clefts

Sakamoto Y., Sakamoto T., Ishii T., Kishi K.

Cleft Palate-Craniofacial Journal (Cleft Palate-Craniofacial Journal) 57 ( 1 ) 114 - 117 2019

ISSN 10556656

© 2019, American Cleft Palate-Craniofacial Association. Purpose: To evaluate the utility and efficacy of bioabsorbable hydroxyapatite and collagen complex (HA/Col) for secondary bone grafting in unilateral alveolar clefts. Patients and Methods: Between 2015 and 2016, 21 patients with unilateral cleft lips and alveolar clefts were enrolled. In group I, a cancellous iliac bone graft was placed at the alveolar cleft (6 males, 5 females). In group II, a bioabsorbable HA/Col was placed at the alveolar cleft (4 males, 7 females). Results: The groups did not differ in age, cleft volume, or surgical duration. There was a significant difference in intraoperative blood loss between the 2 groups (6.7 ± 1.89 mL in group II vs 38.8 ± 9.73 mL in group I [P <.01]). The use of patient-controlled intravenous analgesia was also significantly lower in group II than in group I (2.2 ± 1.9 times vs 12.2 ± 4.4 times [P <.01]). Only 1 female in group II who had maxillary sinusitis did not achieve osteosynthesis. With the exception of this patient, the 12-month bone volumes in groups I and II were 0.567 ± 0.066 and 0.596 ± 0.073 mL, respectively, without significant difference (P =.18). Conclusion: Compared with an autogenous bone, bioabsorbable HA/Col significantly reduces postoperative pain. In addition, the use of HA/Col alone produced the same result as an autologous bone and is effective in filling the alveolar cleft.

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Assessment of bioabsorbable hydroxyapatite for cranial defect in children

Sakamoto Y., Miwa T., Yoshida K., Kishi K.

Journal of Craniofacial Surgery (Journal of Craniofacial Surgery) 30 ( 1 ) E58 - E60 2019

ISSN 10492275

Copyright © 2018 by Mutaz B. Habal, MD Purpose: To evaluate the utility and efficacy of bioabsorbable hydroxyapatite and collagen complex (HA/Col) for cranioplasty repair of cranial bone defects in children. Methods: Two patients (a 6-year-old male and 11-year-old female) with Treacher Collins syndrome received zygoma and orbital floor reconstruction using a full thickness of parietal bone. The bone grafts were taken from each patient’s parietal cranium. The right parietal cranial defect was repaired with autologous bone dust, and the left side was repaired with HA/Col in each patient. Computed tomography scans were taken immediately after and at 12 months following surgery. The osteosynthesis areas and thicknesses were measured using computer-aided engineering. Results: Both patients experienced no complications, including infection. In the 6- and 11-year-old patients, the extent of osteosynthesis for HA/Col was 92.2% and 89.4%, respectively; and for the autologous bone dust was 78.5% and 53.2%, respectively. Because of the small sample size, a significant difference could not be calculated; however, the percentage of osteosynthesis for HA/Col was higher than for the autologous bone dust. Conclusion: This study showed that HA/Col can be effectively used in cranial defects and can be considered an alternative graft material for cranial reconstruction.

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An internal distraction device for midface distraction osteogenesis: The NAVID system type Z'gok

Sakamoto Y., Sakamoto T., Ishii T., Kishi K.

Journal of Plastic, Reconstructive and Aesthetic Surgery (Journal of Plastic, Reconstructive and Aesthetic Surgery) 2019

ISSN 17486815

© 2019 Elsevier Ltd Midface advancement with distraction osteogenesis is more routinely used for faciocraniosynostosis. Distraction devices are generally classified into external and internal types. Compared with external distractors, internal distractors are smaller and better tolerated, but their removal is complicated. Here, we introduce a refined internal distraction device and describe its applicability. Unlike the previous anterior fixation plate that utilises screws, the refined internal distraction (type Z'gok) has 3 claws. This anterior point of the distractor is positioned behind the malar eminence, or the lateral orbital wall. Eight patients with syndromic craniosynostosis underwent midface distraction osteogenesis using the type Z'gok between 2016 and 2017 (Z'gok group). Twelve patients were treated using conventional internal distractors (control group). Patient age ranged from 6 to 21 years. Among them, 4 patients underwent Le Fort III distraction osteogenesis, while the others underwent Le Fort IV distraction osteogenesis. The operative time to remove the distractors in the Z'gok group was 65 ± 18 min, shorter than 89 ± 12 min in the control group. The blood loss per kilogram of body weight in the Z'gok and control groups was 3.6 ± 3.3 mL/kg and 4.7 ± 1.7 mL/kg, respectively. In conclusion, the type Z'gok is a reliable and effective internal distractor for midface distraction osteogenesis.

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Complications of craniofacial surgery using the ultrasonic-assisted pinned resorbable system: A prospective report with a minimum follow-up of 30 months

Nakajima Y., Sakamoto Y., Miwa T., Yoshida K., Kishi K.

Journal of Plastic, Reconstructive and Aesthetic Surgery (Journal of Plastic, Reconstructive and Aesthetic Surgery) 2019

ISSN 17486815

© 2019 Elsevier Ltd Several resorbable fixation systems are used for osteosynthesis in craniofacial surgery. Recently, ultrasonic-assisted pinned resorbable systems have been introduced; however, few studies have described the associated complications during the long-term follow-up until complete resorption. In this study, we investigated the complications of craniofacial surgery using the ultrasonic-assisted pinned resorbable system with a follow-up of at least 30 months. Among patients who underwent craniofacial surgery using a commercially available ultrasonic-assisted pinned resorbable system between 2014 and 2016, those with follow-up visits for at least 30 months were included in this study. We investigated the development of complications such as local infection, exposure of the device, and reoperation related to the implant. Twenty-four patients aged 6 months to 69.4 years (median: 3.5 years) were followed up for more than 30 months. None of the patients required reoperation regardless of implants. Further, no infection or device exposure was seen among all patients. However, two patients aged 6 and 22 months who underwent cranioplasty for craniosynostosis and another patient aged 148 months who underwent cranioplasty for cranial defect exhibited plate-related bulging in the scalp during the course of resorption between 7 and 12 months of follow-up. The bulges were characterized by swelling without pain or redness and resolved spontaneously within 18 months of follow-up, which was considered to occur after complete absorption of the plate. In conclusion, subcutaneous swelling is related to resorbable plates and has a benign clinical course. We recommend that patients be informed of this phenomenon preoperatively to relieve their anxiety.

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Ablepharon and craniosynostosis in a patient with a localized TWIST1 basic domain substitution

Takenouchi T., Sakamoto Y., Sato H., Suzuki H., Uehara T., Ohsone Y., Kosaki K.

American Journal of Medical Genetics, Part A (American Journal of Medical Genetics, Part A) 176 ( 12 ) 2777 - 2780 2018.12

ISSN 15524825

© 2018 Wiley Periodicals, Inc. The TWIST family is a group of highly conserved basic helix–loop–helix transcription factors. In humans, TWIST1 haploinsufficiency causes Saethre–Chotzen syndrome, which is characterized by craniosynostosis. Heterozygous localized TWIST1 and TWIST2 basic domain substitutions exert antimorphic effects to cause Sweeney–Cox syndrome, Barber–Say syndrome, and ablepharon-macrostomia syndrome, respectively. Sweeney–Cox syndrome, Barber–Say syndrome, and ablepharon-macrostomia syndrome share the facial features of ablepharon, hypertelorism, underdevelopment of the eyelids, and cheek pads adjacent to the corners of the mouth. Existence of phenotypic overlap between Saethre–Chotzen syndrome and Sweeney–Cox syndrome remains unknown. Herein, we document a male infant with the distinctive facial features of ablepharon, hypertelorism, cheek pads adjacent to the corners of the mouth, and bilateral coronal suture craniosynostosis who had a de novo heterozygous mutation in the basic domain of TWIST1, that is, c.351C>G p.Glu117Asp. The pathogenicity of this variant was supported by in silico and in vivo evidence. Our review showed that Sweeney–Cox syndrome appears to share many characteristics with Barber–Say syndrome and ablepharon-macrostomia syndrome except for craniosynostosis, which is a cardinal feature of Saethre–Chotzen syndrome. An amino acid substitution from Glu117 to Asp, both of which are the sole members of negatively charged amino acids, resulted in a prototypic Sweeney–Cox syndrome phenotype. This suggests that any amino acid substitutions at Glu117 would likely lead to the Sweeney–Cox syndrome phenotype or lethality. The present observation suggests that a localized TWIST1 basic domain substitution, that is, p.Glu117Asp, in TWIST1 may exert a mild antimorphic effect similar to that of haploinsufficiency, leading to craniosynostosis and ablepharon.

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Haploinsufficiency of NCOR1 associated with autism spectrum disorder, scoliosis, and abnormal palatogenesis

Sakaguchi Y., Uehara T., Suzuki H., Sakamoto Y., Fujiwara M., Kosaki K., Takenouchi T.

American Journal of Medical Genetics, Part A (American Journal of Medical Genetics, Part A) 176 ( 11 ) 2466 - 2469 2018.11

ISSN 15524825

© 2018 Wiley Periodicals, Inc. NCOR1 (nuclear receptor corepressor 1) is a transcriptional coregulatory protein that regulates the balance between histone acetylation and histone deacetylation. NCOR1 is listed as one of the 3,230 dose-sensitive genes which very rarely show truncating mutations in the pediatric population without severe diseases, even in a heterozygous state. In a large cohort study of intellectual disability/autism spectrum disorder, splicing mutations were identified in two individuals, however, the truncating effects of these splicing mutations have not been examined at the transcription level. We describe a 3-year-old girl who had behavior consistent with autism spectrum disorder, a bifid uvula, and early-onset scoliosis. Trio exome analysis showed a de novo heterozygous mutation at the splice donor site in exon 19 of NCOR1, c.2182 + 1G > T (NM_00190440.1). Reverse transcription polymerase chain reaction assay confirmed that the splicing mutation results in skipping of exon 19, a shift in the reading frame and then to nonsense-mediated mRNA decay. This patient represents the first patient who has had unequivocal documentation of haploinsufficient for the NCOR1 gene. Based on our observations, we conclude that NCOR1 is indeed a human disease-causing gene. We further suggest that bifid uvula, a micro form of cleft palate, may well be causally related to de novo NCOR1 haploinsufficiency, in that a previously reported deletion mapping study of atypical Smith-Magenis syndrome patients with large deletions and cleft palate identified that NCOR1, the only loss-of-function-intolerant gene within the region, is located in the smallest region of overlap.

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Surgical Simulation and Custom-Made Implant for Cranial Fibrous Dysplasia

Sakamoto Y., Miwa T., Yoshida K., Kishi K.

Journal of Craniofacial Surgery (Journal of Craniofacial Surgery) 29 ( 5 ) 1352 - 1353 2018.07

ISSN 10492275

Copyright © 2018 by Mutaz B. Habal, MD. Background: The management of fronto-orbital fibrous dysplasia involves total excision of the dysplastic bone and bone reconstruction using implants. Custom-made implants are used to achieve good contouring. However, the remnant defect after excising the lesion often does not match the implant. Methods: To design the craniotomy line, a template was prepared by preoperative computed surgical simulation. The template was overlaid on the preoperative cranium, such that its inner surface fits exactly with the cranial surface. After excising the lesion by performing osteotomy, the implant was placed in the defect and fixed. Both template and implant were made of hydroxyapatite. Results: The authors treated 4 patients, with fibrous dysplasia involving the fronto-facial region by using the template. Intraoperative trimming of the implant or bone defect was not required in 2 patients, while the third patient required mild trimming. They did not have any complications and obtained good contouring. Conclusion: The hydroxyapatite templates reduced the surgical time by determining the precise craniotomy line preoperatively, thus avoiding needless trimming of the implant and bone defect. Therefore, they can enhance the efficacy of treatment for fronto-orbital fibrous dysplasia lesion.

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Influence of backscatter radiation on cranial bone fixation devices

Sakamoto Y., Koike N., Takei H., Ohno M., Shigematsu N., Kishi K.

Journal of Craniofacial Surgery (Journal of Craniofacial Surgery) 29 ( 4 ) 1094 - 1096 2018.06

ISSN 10492275

© 2018 by Mutaz B. Habal, MD. Postoperative radiation can cause ulcer formation, leading to the denudation of skin over alloplastic materials. The influence of backscatter radiation from fixation devices has not been investigated. The aim of this study is to evaluate backscatter dose variations for different cranial bone fixation devices in an experimental model designed to simulate postoperative radiotherapy. The authors assessed the radiation backscatter doses associated with resorbable (PLLA-PGA) and titanium plates. The samples were irradiated with 6 and 10 MV photon beams from a linear accelerator. Measurements were obtained using an ionization chamber and radiochromic films cut from the same batch. As a result, the backscatter radiation of water and PLLA-PGA proportionally decreased as the depth increased. However, the backscatter radiation of the titanium plate increased just above the plate. This depth lies in the region of the scalp. Each material showed a dose of radioactivity that was higher at 10 MV than that at 6 MV. These devices showed a significant difference, which suggested that these materials amplified the dose compared with water at 6 MV. In conclusion, it is supposed that PLLA-PGA should be used to fix the cranium to decrease the potential for radiation ulcers.

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A giant osteoma of the ethmoid sinus

Ishii T., Sakamoto Y., Miwa T., Yoshida K., Kishi K.

Journal of Craniofacial Surgery (Journal of Craniofacial Surgery) 29 ( 3 ) 661 - 662 2018.05

ISSN 10492275

Copyright © 2017 by Mutaz B. Habal, MD. Osteomas are slow-growing, benign bony tumors. Most are asymptomatic. Paranasal sinus osteoma in the pediatric population is rare; hence, there are few reports of symptomatic osteomas. The authors report the case of a giant ethmoid sinus osteoma in an 11-year-old girl who presented with diplopia and proptosis. Total excision and reconstruction of the medial orbital wall were performed via a coronal approach. The postoperative period was uneventful, the child’s vision improved, and a good cosmetic result was obtained.

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The guiding lateral Z osteotomy for the correction of vertical orbital dystopia

Kohno H., Sakamoto Y., Miwa T., Yoshida K., Kishi K.

Journal of Craniofacial Surgery (Journal of Craniofacial Surgery) 29 ( 3 ) e325 - e327 2018.05

ISSN 10492275

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Fate of the three embryonic dural sinuses in infants: the primitive tentorial sinus, occipital sinus, and falcine sinus

Mizutani K., Miwa T., Akiyama T., Sakamoto Y., Fujiwara H., Yoshida K.

Neuroradiology (Neuroradiology) 60 ( 3 ) 325 - 333 2018.03

ISSN 00283940

© 2018, Springer-Verlag GmbH Germany, part of Springer Nature. Purpose: The primitive tentorial, occipital, and falcine sinuses are thought to attain the adult pattern or regress between the fetal stage and adulthood. The anatomy of these three primitive dural sinuses has seldom been studied in the infant population, and it remains unclear when these dural sinuses reach the adult condition. Using computed tomography digital subtraction venography (CT-DSV), we analyzed the anatomy of these embryonic dural sinuses in infants. Methods: We included 13 infants who underwent CT-DSV prior to neurosurgery and 35 cases with unruptured cerebral aneurysms as normal adult controls. Three embryonic dural sinuses, i.e., the primitive tentorial, occipital, and falcine sinuses, were retrospectively analyzed in CT-DSV images of infants and adults. We also analyzed the drainage patterns of the superficial middle cerebral vein (SMCV), determined by the connection between the primitive tentorial sinus and the cavernous sinus. Results: The primitive tentorial, occipital, and falcine sinuses were present in 15.4%, 46.2%, and none of the infants, respectively, and in 10.0, 8.6, and 2.9% of the adults, respectively. The difference in SMCV draining pattern between infants and adults was insignificant. The incidence of the occipital sinus was significantly higher in infants than in adults. Conclusions: The connection between the primitive tentorial sinus and the cavernous sinus appears to be established before birth. The occipital sinus is formed at the embryonic stage and mostly regresses after infancy. The falcine sinus is usually obliterated prenatally. Our findings form the basis for interventions by pediatric interventional neuroradiologists and neurosurgeons.

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Biomechanical analysis of likelihood of optic canal damage in peri-orbital fracture

Nagasao T., Morotomi T., Kuriyama M., Tamai M., Sakamoto Y., Takano N.

Computer Assisted Surgery (Computer Assisted Surgery) 23 ( 1 ) 1 - 7 2018.01

© 2018 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. Purpose: Detection of optic canal fractures is often difficult because of the subtleness of the fracture. If we could clarify impact on which region around the orbit is likely to accompany the fracture of the optic canal, the knowledge should be useful to make early diagnosis of optic canal fractures. The present study was conducted to elucidate this issue. Methods: Ten finite element models were produced simulating the skulls of ten humans (8 males and 2 females; 43.8 ± 10.2 y/o). The peri-orbital area of each of the ten models was divided into eight regions in a clockwise fashion per 45 degrees. These regions were defined as Superior-Medial (0–45 degrees), Medial-Superior (45–90 degrees), Medial-Inferior (90 to 135 degrees), Inferior-Medial (135 to 180 degrees), Inferior-Lateral (180–225 degrees), Lateral-Inferior (225 to 270 degrees), Lateral-Superior (270–315 degrees), and Superior-Lateral regions (315–360 degrees), respectively. Dynamic simulation of applying traumatic energy on each of these regions was conducted. Resultant fracture patterns were evaluated using finite element analyses. Thereafter, frequencies of fracture involvement of the optic canal were evaluated for each of the eight regions. Results: The involvement of the optic canal was most frequent for the Superior-Medial region (7/10), followed by the Medial-Superior region (5/10). Conclusion: Optic canal fracture is likely to occur when the area between the supra-orbital notch and the medial canthus are strongly impacted. When evident fracture or serious damage of soft tissue is observed in this area, occurrence of optic canal fracture should be suspected.

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Optimal Conditions for Absorbable Fixation of Hydroxyapatite Ceramic Implants

Sakamoto Y., Kishi K.

Journal of Craniofacial Surgery (Journal of Craniofacial Surgery) 29 ( 1 ) 248 - 250 2018.01

ISSN 10492275

© Copyright 2017 by Mutaz B. Habal, MD. Synthetic hydroxyapatite (HAP) implants are common in craniofacial surgery; the major problem with HAP implants is fixation instability. An ultrasound-assisted pinned resorbable fixation system has recently been introduced. The authors hypothesized that this resorbable system could be used to fix HAP implants. The authors evaluated the optimal HAP porosity and resorbable pin using the pull-out test and microscopic analysis. Hydroxyapatite blocks were synthesized with 0% (dense type), 35% (fine pore type), and 50% (large pore type) porosity. Bioabsorbable pins of 4 sizes were tested: diameters of 1.6 or 2.1mm and lengths of 4 or 7mm. Among the 1.6mm diameter pins, the 7-mm length pins showed higher pull-out strength (large pore, 6.5±1.2 kgf; fine pore, 4.1±0.7 kgf; dense, 2.4±0.4 kgf) than the 4-mm length pins (large pore, 2.1±1.0 kgf; fine pore, 1.3±0.4 kgf; dense, 1.5±0.9 kgf) with all 3 HAP types (P<0.01). Among 2.1-mm diameter pins, all were removed from the large and fine pore HAP types without any resistance. Only three of seven 2.1×7mm pins inserted into the dense type HAP showed pull-out strength (3.9±2.1 kgf). Among all conditions, the 7-mm length, 1.6-mm diameter pin in large pore type HAP showed the highest pull-out strength. Microscopically, the large pore type HAP showed the liquefying pin flowing into the large pore adjacent to the pilot hole. By contrast, the fine pore and dense pore types of HAP did not allow flow, and the pins did not change in structure 3-dimensionally. The authors found that pull-out strength depends on HAP porosity, and pin length and diameter.

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A Family with Craniofrontonasal Syndrome: The First Report of Familial Cases of Craniofrontonasal Syndrome with Bilateral Cleft Lip and Palate

Inoue Y., Sakamoto Y., Sugimoto M., Inagaki H., Boda H., Miyata M., Kato H., Kurahashi H., Okumoto T.

Cleft Palate-Craniofacial Journal (Cleft Palate-Craniofacial Journal) 2018

ISSN 10556656

© 2018 American Cleft Palate-Craniofacial Association. Craniofrontonasal syndrome (CFNS) is a very rare genetic disorder, the common physical malformations of which include coronal synostosis, widely spaced eyes, clefting of the nasal tip, and various skeletal anomalies. Mutations of EFNB1, which encodes a member of the ephrin family of transmembrane ligands for Eph receptor tyrosine kinases, is the cause of CFNS. Although familial CFNS cases have been reported, no studies in the literature describe familial cases of CFNS expressing bilateral cleft lip and palate. Here, we describe a Japanese family with three cases of CFNS expressing bilateral cleft lip and palate.

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A Pitfall of Reconstruction for Severe Enophthalmos: Role of the Posterior Wall of the Maxillary Sinus (Part 2)

Sakamoto Y, Nakajima H, Tamada I, Kasai, S, Kishi K

Journal of Craniofacial Surgery 22 ( 4 ) 1351-1353 2011

Research paper (scientific journal), Single Work, Accepted

The "crossbeam technique": a technique for taking bone grafts from the ilium

Sakamoto Y, Nakajima H, Tamada I, Kishi K

Journal of Plastic Reconstructive and Aesthetic Surgery 64 ( 3 ) 82e-83e 2011

Research paper (scientific journal), Single Work, Accepted

Dynamic total skull remodeling by a combination of morcellation craniotomy with distraction osteogenesis; the MoD procedure.

Nakajima H, Sakamoto Y, Tamada I, Ohara H, Kishi K

Journal of Craniofacial Surgery 22 ( 4 ) 1240-1246 2011

Research paper (scientific journal), Single Work, Accepted

A Pitfall of Decompression for Severe Exophthalmos: Role of the Posterior Wall of the Maxillary Sinus (Part 1)

Sakamoto Y, Nakajima H, Tamada I, Kasai, S, Kishi K

Journal of Craniofacial Surgery 22 ( 4 ) 1348-1350 2011

Research paper (scientific journal), Single Work, Accepted

A Backflip Flap: A New Surgical Correction for Severe Cicatricial Entropion.

Sakamoto Y, Nakajima H, Tamada I, Uchikawa Y, Kishi K

Plastic and Reconstructive Surgery 126 ( 4 ) 179e-180e 2010

Research paper (scientific journal), Single Work, Accepted

巨大あるいは余剰皮膚が多い臍ヘルニアに対する臍形成術の工夫

Sakamoto Yoshiaki

小児外科 42 ( 5 ) 527-531 2010

Research paper (scientific journal), Joint Work, Accepted

Umbilical shape by age and growth: A Japanese study

Sakamoto Y, Hirobe S, Kamagata S, Hayashi Y.

Plastic and Reconstructive surgery 126 ( 2 ) 97e-98e 2010

Research paper (scientific journal), Joint Work, Accepted

The management of craniofacial hyperostosis in Proteus syndrome

Sakamoto Y, Nakajima H, Kishi K, Shimizu R, Nakajima T

Journal of Craniofacial Surgery 21 ( 2 ) 414-418 2010

Research paper (scientific journal), Single Work, Accepted

A Rare Case of Proboscis Lateralis with Median Cleft Lip

Sakamoto Y, Nakajima T, Miyamoto J

Cleft Palate and Craniomaxillofacial Surgery 47 ( 5 ) 553-556 2010

Research paper (scientific journal), Single Work, Accepted

A New Surgical Correction of Cryptotia with Superior Auricular Myocutaneous Flap

Sakamoto Y, Nakajima H, Kishi K, Imanishi N

Journal of Plastic Reconstructive and Aesthetic Surgery 63 ( 12 ) 1995-2000 2010

Research paper (scientific journal), Single Work, Accepted

幼児胸壁過誤腫の1例

Sakamoto Yoshiaki

日本小児外科学会誌 45 ( 4 ) 733-738 2009

Research paper (scientific journal), Joint Work, Accepted

頬骨海綿状血管腫の1例

Sakamoto Yoshiaki

形成外科 52 ( 8 ) 959-966 2009

Research paper (scientific journal), Joint Work, Accepted

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