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Summary:. Lymphedema is characterized by the abnormal accumulation of lymphatic fluid in the skin and subcutaneous tissue owing to impaired lymph flow. This condition may be primary or secondary to other diseases. Most lymphedema occurs in the lower extremities, which greatly interferes with the activities of the patients, especially walking. Further, it may affect the psychological condition of patients. In Indonesia, several patients with severe lymphedema have visited our clinic. In our center, lymphography is not available. However, as our center is a provincial referral hospital, many patients with lymphedema present with severe conditions. Nonoperative and operative treatment is available, including lymphovenous anastomosis. Herein, we present the rare case of a 33-year-old man with severe lymphedema in his left leg for the past 7 years. The patient was diagnosed with stage III secondary lymphedema of the left lower extremity and underwent lymphaticovenular anastomosis using a modification of the Seki method (Seki 2015). Five large lymphatic vessels were identified using methylene blue, and a transverse incision was made approximately 2–3 cm from the skin to the fatty tissue under the superficial fascia. Lymphaticovenular anastomosis was performed using a microscope. On postoperative day 1, the edema in the leg shrank significantly, and 6 months after surgery, the patient’s foot size began normalizing. The patient could wear pants and became more confident.

A cauliflower ear is an auricular deformity characterized by thickened soft tissue and cartilage. A subperichondrial hematoma or fluid collection causes this malformation. As a result of being cut off from the perichondrium blood supply, the ear cartilage becomes ischemic, developing scar tissue, fibrous tissue, new cartilage overgrowth, or necrosis beneath the skin, resulting in a permanent alteration in the shape of the external ear resembling that of a cauliflower. To properly fix defects, the surgeon must grasp ear anatomy and be familiar with a variety of reconstructive alternatives. It requires meticulous attention, due to the intricate design of the ear. Simple and complex techniques for treating cauliflower ears have been developed. However, in severe cases, simple techniques are often insufficient. As a result, complex techniques such as replacement with an auricular prosthesis or implant or autogenous costal cartilage framework were developed. We present a case of a 25-year-old man who experienced a severe cauliflower ear as a result of an infection during adolescence. The patient was concerned about the shape of his ear and was depressed. Ear reconstruction was accomplished using the costal cartilage framework engraved according to a three-dimensional cutting guide for surgical planning. Costal cartilage is chosen to provide a framework for reconstruction as it is strong and rigid, and its curved shape is similar to that of the external ear. There were no complications after surgery. The ear projection and shape have performed admirably. The patient was pleased with the outcome and felt more confident after surgery.

Summary:. Malocclusion is an abnormal relationship between the teeth of the upper and lower jaws, with irregular tooth position, including crossbite and underbite. Malocclusion can occur in the form of crooked, protruding, or crowded teeth, affecting appearance, pronunciation, and mastication. Many factors lead to malocclusions, such as heredity, growth disturbance, and bad habits. Many Indonesians undergo orthodontic treatment to improve both function and appearance. The large demand for orthodontic treatment is due to increasing public knowledge about the impact of untreated malocclusion and the rising standard of living. We present a severe and rare case of malocclusion in Indonesia. A 20-year-old man presented with bilateral mandibular condylar hyperplasia and Angle’s class III malocclusion. A multidisciplinary team, including plastic and oral surgeons, orthodontists, and psychologists, was created to address this problem. The first surgical procedure was chosen to achieve correction in the shortest possible time. Le Fort I osteotomy and mandibular bilateral sagittal split and anterior subapical osteotomies using Kole’s procedure were performed. The patient underwent preoperative and postoperative examinations. After surgery, the occlusion was corrected and facial symmetry significantly improved.