Greeting from Professor｜Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, The University of Tokyo

Professor and Chair, Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, The University of Tokyo. ：Mutsumi Okazaki, M.D., Ph.D.

Mutsumi Okazaki, M.D., Ph.D.

　　Professor and Chair, Department of Plastic and Reconstructive Surgery,
　Graduate School of Medicine, The University of Tokyo.

【Profile】

1990 　Graduated from The University of Tokyo, School of Medicine.
2000 　Chief, Department of Plastic Surgery, Asahi General Hospital.
2002　 Staff Surgeon, Department of Plastic and Reconstructive Surgery,
　　　The University of Tokyo Hospital.
2006 　Associate professor, Department of Plastic Surgery, Kyorin University.
2009 　Professor and Chair, Department of Plastic and Reconstructive Surgery,
　　　Graduate School of Science, Tokyo Medical and Dental University.
2017 　Professor and Chair, Department of Plastic and Reconstructive Surgery,
　　　Graduate School of Medicine, The University of Tokyo.

・International Associate Editor, Plastic and Reconstructive Surgery®
・International Associate Editor, PRS Global Open.

【Field of expertise】

・Reconstruction of facial deformity and dysfunction
・Reanimation of facial paralysis
・Microsurgery

【Reanimation of Facial Paralysis】

　　At Plastic and Reconstructive Surgery in The University of Tokyo Hospital, we perform surgical operations that are highly satisfying for patients using our ideas and ingenious and dexterous techniques, and had published the achievements obtained for the benefit of the world. Here we present our surgical treatments of facial nerve paralysis

　　1. Reconstructive operations around the eyes using eyeblink evaluation as an indicator A patient with facial nerve paralysis suffers in two ways: eyelid opening difficulty occurs due to upper eyelid ptosis caused by frontalis muscle paralysis, and eyelid closure disorder also results from orbicularis oculi muscle paralysis. Regarding eyelid closure disorder, until now, the ability to intentionally close the eyelid has been used as an indicator.

　　However, symptoms that trouble patients are related to eyeblink, such as corneal inflammation and dryness or pain in the eyes. Therefore, in 2016, our division introduced an eyeblink evaluation using a high-speed camera. An eyeblink test is conducted on patients with facial nerve paralysis, with several tens of thousands of frames analyzed with each test. Based on the analysis results, a reconstructive procedure for the area around the eyes that best suits each patient is determined, as well as the appropriate amount of correction (Figure 1).

Eyeblink evaluation using a high-speed camera

　　2. Reconstruction of laughing and eyelid closing functions using multi-split vascularized nerve and muscle Patients with facial nerve paralysis tend to avoid laughing as much as possible because facial asymmetry becomes conspicuous when laughing due to the mouth being pulled to the opposite side, caused by impaired muscle movement involved in the process. From the viewpoint of QOL, restoring the ability of patients to laugh by reconstructing movement affected by paralysis is a highly significant achievement. Nerve and muscle transplantation has been conducted using microscopic microvascular anastomosis. As the power source for muscle power movement, either 1) a facial nerve on the opposite side or 2) the masseteric nerve on the same side has been used. While 1) has the benefit of enabling unintentional spontaneous laughing, movement was occasionally weak. Similarly, while 2) enabled intentional and strong movement, unintentional spontaneous laughing is difficult, and therefore patients had to artificially make laughing motions through initiating biting movement. The technique required for 2) is easier, making this procedure still the more popular choice in many countries, particularly Europe and the U.S. The procedure for 1), which is more difficult, is performed at five to ten facilities across Japan. Both 1) and 2) have their respective strengths and weaknesses, with the selection for one or the other largely depending on the skill level of the surgeon. Our division has devised and published a hybrid method that splits into two a single muscle supplied by a pair of artery and vein, and sutures the nerve of the respective muscle to the facial nerve of the healthy side and to the masseter nerve of the affected side1) 2) (Figure 2). This method combines the strengths of both procedures above, enabling the patient both to laugh spontaneously as well as artificially, with a level of surgical intervention that is mostly equivalent to 1) or 2). We have also devised a procedure that further advances the technique above by splitting the muscle into three, and transplanting them while suturing the respective nerves to different nerves, thereby achieving intentional eyelid closing function in addition to the above (Figure 3).

　　3. More complex reconstruction of facial features and functional disorders Major deformation of the face may result in patients with bone or soft tissue defects in addition to facial nerve paralysis, due to tumor resection or traumatic injury. For such patients, we perform surgery to transplant vascularized bones and adipose tissue at the same time as muscle (Figure 4). Simultaneous implementation of such a complex procedure reduces the required number of surgical operation sessions, thereby relieving burden to the patient, and also supporting faster rehabilitation.

　　4. Treatment of viral facial nerve palsy sequelae Viruses make up a large share with regard to the causes of facial nerve palsy. Owing to multidisciplinary drug treatment in Otorhinolaryngology, severe sequelae have become rarer in recent years. However, it is easy to imagine the extreme stress to patients resulting from sequelae to the face, as it is one of the most conspicuous parts of the body. Typical sequelae include: weak facial movement even though the face is pulled relatively strongly while the affected side is at rest (contracture type); synkinetic movement that is different from that intended (the corner of the mouth is pulled sideways, even though the patient wants to close his/her eyelid; the eye closes when the patient moves his/her mouth: synkinesis); and a drooping eyebrow resulting in a drooping eyelid that hinders the patient’s vision despite the patient being mostly recovered. We provide tailor-made treatments for each patient while listening to their complaints. At The University of Tokyo Hospital, a cooperative structure has been established with the Otorhinolaryngology Department. Once otorhinolaryngologic treatment has been completed, the patient is transferred to Reconstructive Surgery. We support enhanced QOL of patients by seamlessly taking over the treatment process, even if sequelae endure. If you are seeking medical advice concerning facial deformation or movement disorder (facial nerve palsy): See the details regarding symptoms and treatment by visiting https://www.h.u-tokyo.ac.jp/english/centers-services/clinical-divisions/plastic/index.html. Requests for consultation and inquiries concerning hospital visits from patients with facial nerve palsy are accepted at the e-mail address below: utokyoprs-office@umin.ac.jp.

(REFERENCES)

1. Okazaki M, Tanaka K, Uemura N, Usami S, Homma T, Okubo A, Hamanaga M, Mori H. One-Stage Dual Latissimus Dorsi Muscle Flap Transfer with a Pair of Vascular Anastomoses and Double Nerve Suturing for Long-Standing Facial Paralysis. J Plast Reconstr Aesthet Surg. 2015; 68: e113-9.

2. Homma T, Okazaki M, Tanaka K, Uemura N. Simultaneous Surgical Treatment for Smile Dysfunction and Lagophthalmos Involving a Dual Latissimus Dorsi Flap. Plast Reconstr Surg Glob Open. 25; 5: e1370, 2017.

【Selected Publications】

・Hidaka T, Kurita M, Ogawa K, Tomioka Y, Okazaki M. Application of Artificial Intelligence for Real-time Facial Asymmetry Analysis. Plast Reconstr Surg. 2020 (Online ahead of print).

・Mito D, Kurita M, Miyamoto S, Okazaki M. Miniaturization of Indocyanine Green Fluorescence Imaging Device Using a Smartphone.Plast Reconstr Surg. 145:230e-232e, 2020.

・Higashino T, Okazaki M, Mori H, Yamaguchi K, Akita K. Microanatomy of Sensory Nerves in the Upper Eyelid: A Cadaveric Anatomical Study. Plast Reconstr Surg. 142: 345-353, 2018.

・Tanaka K, Yano T, Homma T, Tsunoda A, Aoyagi M, Kishimoto S, Okazaki M. A new method for selecting auricle positions in skull base reconstruction for temporal bone cancer. Laryngoscope. 2018 [Epub ahead of print].

・Usami S, Okazaki M. Fingertip reconstruction with a posterior interosseous artery perforator flap: A minimally invasive procedure for donor and recipient sites. J Plast Reconstr Aesthet Surg. 2017; 70: 166-172.

・Homma T, Okazaki M, Tanaka K, Uemura N. Simultaneous Surgical Treatment for Smile Dysfunction and Lagophthalmos Involving a Dual Latissimus Dorsi Flap. Plast Reconstr Surg Glob Open. 25; 5: e1370, 2017.

・Okazaki M. Aging and Melanocytes Stimulating Cytokine Expressed by Keratinocyte and Fibroblast. Textbook of Aging Skin, Second Edition, Miranda A. Farage, Kenneth W. Miller and Howard I. Maibach eds. Springer Berlin Heidelberg, 415-422, 2016.

・Uemura N, Okazaki M, Mori H. Anatomical and histological study to determine the border of sole skin Surg Radiol Anat. 2016;38:767-73.

・Okazaki M, Tanaka K, Uemura N, Usami S, Homma T, Okubo A, Hamanaga M, Mori H. One-Stage Dual Latissimus Dorsi Muscle Flap Transfer with a Pair of Vascular Anastomoses and Double Nerve Suturing for Long-Standing Facial Paralysis. J Plast Reconstr Aesthet Surg. 2015; 68:e113-9.

・Mori H, Uemura N, Okazaki M. Nipple reconstruction with banked costal cartilage after vertical-type skin-sparing mastectomy and deep inferior epigastric artery perforator flap. Breast Cancer 2015; 22: 95-97.

・Wakimura Y, Wang W, Itoh S, Okazaki M, Takakuda K. An experimental study to bridge a nerve gap with a decellularized allogeneic nerve. Plast Reconstr Surg. 2015; 136: 319e-27e.

・Tanaka K, Okazaki M, Yano T, Miyashita H, Homma T, Tomita M. Quantitative evaluation of blood perfusion to nerves included in the anterolateral thigh flap using indocyanine green fluorescence angiography: a different contrast pattern between the vastus lateralis motor nerve and femoral cutaneous nerve. J Reconstr Microsurg. 2015; 31: 163-70.

・Tanaka K, Okazaki M, Yano T, Akiyama M, Mori H. Volumetric changes in transplanted vascularized fat flaps after ischemic or congestive stresses and their relationship to capillary density in a Zucker fatty rat model. Microsurg. 2015; 35: 653-61.

・Yano T, Okazaki M, Yamaguchi K, Akita K. Anatomy of the middle temporal vein: implications for skull-base and craniofacial reconstruction using free flaps. Plast Reconstr Surg. 2014; 134: 92e-101e.

・Okazaki M. Functional and esthetic reconstruction of the defects following the hemiglossectomy in patients with oropharyngeal cancer. Head and Neck Cancer (ISBN978-953-51-0236-6) Mark Agulnik ed., pp337-348 INTEC, Croatia, 2012.

・Yano T, Okazaki M, Tanaka K, Iida H, Aoyagi M, Kishimoto S. A new concept for classifying skull-base defects for reconstructive surgery. J Neurol Surg B Skull Base. 2012; 73: 125-31.

・Kurita M, Okazaki M, Kaminishi-Tanikawa A, Niikura M, Takushima A, Harii K. Differential expression of wound fibrotic factors between facial and trunk dermal fibroblasts. Connect Tissue Res 2012; 53: 349-54.

・Okazaki M, Miyamoto S. Low skin paddle pedicled latissimus dorsi flap with vascular supercharging: Possibility of complete survival of larger and/or more distal flap. Plast Reconstr Surg, 2011; 128 : 568e-9e

・Kurita M, Okazaki M, Fujino T, Takushima A, Harii K. Cyclic stretch induces upregulation of endothelin-1 with keratinocytes in vitro: Possible role in mechanical stress-induced hyperpigmentation. Biochem Biophys Res Commun. 2011; 409: 103-7.

・Kurita M, Okazaki M, Ozaki M, Tanaka Y, Tsuji N, Takushima A, Harii K. Patient satisfaction after open reduction and internal fixation of zygomatic bone fractures. J Craniofac Surg. 2010; 21: 45-49.

・Okazaki M, Ueda K, Sasaki K, Shiraishi T, Kurita M, Harii K. Expanded narrow subcutaneous-pedicled island forehead flap for reconstruction of the forehead. Ann Plast Surg, 2009; 63: 167-70.

・Takushima A, Harii K, Okazaki M, Ohura N, Asato H. Availability of latissimus dorsi minigraft in smile reconstruction for incomplete facial paralysis: quantitative assessment based on the optical flow method. Plast Reconstr Surg. 2009; 123: 1198-208.

・Okazaki M, Asato H, Okochi M, Suga H, Kinoshita M. Shortcut vascular augmented long rectus abdominis musculocutaneous flap transfer using intercostal perforator for complex oro-pharyngo-cutaneous defects. Plast Reconstr Surg, 2008; 121: 220e-221e.

・Miyamoto S, Okazaki M, Ohura N, Shiraishi T, Takushima A, Harii K. Comparative study of different combinations of microvascular anastomoses in a rat model: end-to-end, end-to-side, and flow-through anastomosis. Plast Reconstr Surg, 2008; 122: 449-55.

・Miyamoto S, Okazaki M, Takushima A, Shiraishi T, Omori M, Harii K. Versatility of a posterior-wall-first anastomotic technique using a short-thread double-needle microsuture for atherosclerotic arterial anastomosis. Microsurg. 2008; 28: 505-8.

・Okazaki M, Asato H, Takushima A, Sarukawa S, Nakatsuka T, Yamada A, Harii K. Analysis of salvage treatments following failure of the free flap transfer due to vascular thrombosis in reconstruction for head and neck cancer. Plast Reconstr Surg, 2007; 119: 1223-1232.

・Okazaki M, Asato H, Takushima A, Sarukawa S, Okochi M, Harii K. Reconstruction with rectus abdominis myocutaneous flap for total glossectomy with laryngectomy. J Reconstr Microsurgery 2007; 23: 243-249.

・Okazaki M, Asato H, Okochi M, Suga H. One-segment double vascular pedicled free jejunum transfer for the reconstruction of pharyngoesophageal defects. J Reconstr Microsurgery 2007; 23: 213-218.

・Ueda K, Kajikawa A, Suzuki Y, Okazaki M, Nakagawa M, Iida S. Blood gas analysis of the jejunum in the supercharge technique: to what degree does circulation improve? Plast Reconstr Surg. 2007; 119:1745-50.

・Okazaki M, Asato H, Takushima A, Nakatsuka T, Sarukawa S, Inoue K, Harii K, Sugawara Y, Makuuchi M. Hepatic artery reconstruction with double-needle micro-suture in living donor liver transplantation. Liver Transpl, 2006; 12: 46-50.

・Takushima A, Harii K, Asato H, Momosawa A, Okazaki M. One-stage reconstruction of facial paralysis associated with skin/soft tissue defects using latissimus dorsi compound flap. J Plast Reconstr Aesthetic Surg 2006; 59: 465-473.

・Hasegawa H, Okazaki M, Sasaki K. Restoration of the thumb abduction damaged by electrical burn using free dorsalis pedis flap with the extensor hallucis brevis tendon. J Reconstr Microsurgery 2006; 22: 33-36.

・Okazaki M, Asato H, Sarukawa S, Takushima A, Nakatsuka T, Harii K. Availability of end-to-side arterial anastomosis to the external carotid artery using short-thread double-needle micro-suture in free-flap transfer for head and neck reconstruction. Ann Plast Surg, 2006; 56: 171-175.

・Okazaki M, Hasegawa H, Kano M, Kurashina R. A different method of fingertip reconstruction with the thenar flap. Plast Reconstr Surg 2005; 115: 885-888.

・Okazaki M, Asato H, Takushima A, Nakatsuka T, Ueda K, Harii K. Secondary reconstruction of failed esophageal reconstruction. Ann Plast Surg 2005; 54: 530-537.

・Okazaki M, Yoshimura K, Uchida G, Harii K. Correlation between age and the secretions of melanocyte-stimulating cytokines in cultured keratinocytes and fibroblasts. Br J Dermatol 2005; 153 (s3): 23-29.

・Okazaki M, Asato H, Sarukawa S, Okochi M. A revised method for pharyngeal reconstruction using free jejunal transfer. Ann Plast Surg 2005; 55: 643-647.

・Okazaki M, Yoshimura K, Fujiwara H, Suzuki Y, Harii K. Induction of hard keratin in non-nail-matrical keratinocytes by nail-matrical fibroblasts through epithelial-mesenchymal interaction. Plast Reconstr Surg 2003; 111: 286-290.

・Okazaki M, Yoshimura K, Suzuki Y, Uchida G, Kitano Y, Harii K, Imokawa G. Epidermal hyperpigmentation mechanisms in Café-au-lait macules of Neurofibromatosis type-I (von Recklinghausen’s disease) may be associated with dermal fibroblast-derived stem cell factor and hepatocyte growth factor. Br J Dermatol 2003; 148: 689-697.

・Okazaki M, Ohmori K, Akizuki T. Long-term follow-up of nasomaxillary epithelial inlay skin graft for the saddle nose. Plast Reconstr Surg 2003; 112: 64-70.

・Okazaki M, Yoshimura K, Suzuki S, Harii K. Effects of subepithelial fibroblasts on epithelial differentiation in human skin and oral mucosa: Heterotypically recombined organotypic culture model. Plast Reconstr Surg 2003; 112: 784-792.

・Okazaki M, Yoshimura K, Uchida G, Harii K. Elevated expression of Hepatocyte and Keratinocyte Growth Factor in cultured buccal-mucosa-derived fibroblasts compared with normal-skin-derived fibroblasts. J Dermatol Sci 2002; 30: 108-115.

・Okazaki M, Ueda K, Niu A, Momosawa A. Free lateral supramalleolar flap transfer as a small and thin flap. Ann Plast Surg 2002; 49: 133-137.

・Okazaki M, Akizuki T, Ohmori K. Medial canthoplasty with Mitek Anchor System. Ann Plast Surg 1997; 38: 124-128.