This study aimed to elucidate the vasodilatory effects and cytotoxicity of various vasodilators used as antispasmodic agents during microsurgical anastomosis. Rat smooth muscle cells (RSMCs) and human coronary artery endothelial cells (HCAECs) were used to investigate the physiological concentrations and cytotoxicity of various vasodilators (lidocaine, papaverine, nitroglycerin, phentolamine, and orciprenaline). Using a wire myograph system, we determined the vasodilatory effects of each drug in rat abdominal aortic sections at the concentration resulting in maximal vasodilation as well as at the surrounding concentrations 10 min after administration. Maximal vasodilation effect 10 min after administration was achieved at the following concentrations: lidocaine, 35 mM; papaverine, 0.18 mM; nitroglycerin, 0.022 mM; phentolamine, 0.11 mM; olprinone, 0.004 mM. The IC₅₀ for lidocaine, papaverine, and nitroglycerin was measured in rat abdominal aortic sections, as well as in RSMCs after 30 min and in HCAECs after 10 min. Phentolamine and olprinone showed no cytotoxicity towards RSMCs or HCAECs. The concentrations of the various drugs required to achieve vasodilation were lower than the reported clinical concentrations. Lidocaine, papaverine, and nitroglycerin showed cytotoxicity, even at lower concentrations than those reported clinically. Phentolamine and olprinone show antispasmodic effects without cytotoxicity, making them useful candidates for local administration as antispasmodics.

Pachydermodactyly (PDD), meaning “thick skin finger” in Greek, is a rare, noninflammatory, benign, superficial fibromatosis. We report the case of PDD in a 15-year-old boy who visited our clinic because of asymptomatic swelling of the proximal interphalangeal (PIP) joints on the third finger of both left and right hands. Physical examination revealed thickening of the skin in the radial and ulnar aspects of the PIP joints of his third finger of both hands without functional limitation or neurological symptoms. He had a habit of biting his swelling fingers, and he belonged to a basketball club at his junior high school. He had no medical history. Plain radiographs and magnetic resonance imaging of both hands showed only soft tissue thickening outside of the radial and ulnar collateral ligament of the bilateral third PIP joint. The lesions were suggestive of PDD. Surgical resection was performed via a midaxial incision and a Z-plasty to confirm the diagnosis and improve the aesthetic appearance of his hands. Histopathological examination of the lesions was compatible with PDD. After surgery on the left hand, the patient underwent the same surgery on the right hand. No recurrence or complications were observed at the one-year follow-up after surgical intervention. Thus, surgery for PDD via a midaxial incision may be a good treatment option for patients who wish to rectify the appearance of their digital deformity.

Introduction: Arteriovenous malformations (AVMs) of facial bones are rare conditions. These lesions can cause aesthetic challenges, pain, impact on gums and teeth, facial asymmetry, and life-threatening bleeding. Presentation of the case: This report described a case involving the resection of AVMs within the maxilla following preoperative embolization and sclerotherapy by using an ultrasonic bone aspirator (Sonopet®, Stryker, Kalamazoo, MI, USA) and a radiofrequency bipolar sealer (Aquamantys™, Medtronic, Minneapolis, MN, USA). The AVMs and deformed bone were resected en bloc through repeated cutting and hemostasis, preserving the maxillary crown and maintaining the maxillary structure by treating only the affected bone. Discussion: Reducing inflow during surgery and controlling intraoperative bleeding requires thorough planning. Preoperative embolization and sclerotherapy can reduce inflow to the tumor, and appropriate surgical devices enable the resection of arteriovenous malformations within the maxilla. Conclusion: The method presented in this report is a viable treatment option because it allows for selective bone removal, thus leading to the preservation of crowns and maxillary contour. Highlights:

In cases of lacrimal gland carcinoma requiring surgical excision of the orbital contents, skull base, and surrounding bones, definitive blockage of the cranial cavity and reconstruction of the anterior skull base with irradiation-acceptable tissue (for possible subsequent radiotherapy) is necessary. However, considerations for quality of life, including cosmetic aspects, such as artificial eye placement and contour morphology, make reconstruction challenging. In three cases of advanced lacrimal gland carcinoma, we performed a reconstruction surgery following an en bloc resection of the orbital contents and lateral orbital bones. A rectus abdominis flap was used, considering both function and morphology. This flap, characterized by reliable anatomical structure and good blood flow, adequately filled the three-dimensional dead space. In our case, the flap fully survived, and no complications such as cerebrospinal fluid leakage or meningitis were observed. Six months after surgery, the flap volume was 31.7-73.3% of its initial size. Considering potential flap shrinkage in the future, it was deemed beneficial to use a slightly excessive volume.