Arman Cagdas

Nasal dermoid sinus cysts and the role of open rhinoplasty.

All suspected congenital abnormalities of the nose require further evaluation. The nasal dermoid sinus cyst (NDSC) is one of the many midline nasal masses that often pose diagnostic and treatment dilemmas for the plastic and reconstructive surgeon. NDSCs are distinct from other facial dermoids in their potential for involving deeper contiguous structures, and intracranial extension. Accurate diagnosis and effective treatment are essential to avoid craniofacial skeletal deformation, cyst rupture, and infection that could cause cutaneous, ocular, or intracranial complications. A comprehensive discussion of the embryogenesis, pathogenesis, diagnosis, and surgical management of the NDSC is presented to delineate the role of open rhinoplasty in optimizing the management of this congenital nasal deformity.

Benign giant schwannoma located in the upper arm.

A 72-year-old-female presented with a giant schwannoma on the medial side of her right upper arm. Ultrasonographic and magnetic resonance imaging examinations showed that it was almost a totally cystic lesion. It was initially misdiagnosed as a hydatid cyst. After excision of the tumor, histopathological examination revealed that it was a schwannoma composed of two types of regions known as Antoni A and B regions. The tumor was 15 x 8 x 7 cm in size. There were no neurological sequelae after the operation. This is probably the biggest schwannoma of the upper extremity reported.

Late results of split-grafted penoscrotal avulsion injuries

Penoscrotal avulsion injuries are rare surgical emergencies. The best treatment for penile avulsions is split skin graft, although late results of split-grafted scrotal avulsions are not superior. Scrotal skin avulsions require additional judgment for the treatment, because there are several available treatment options. Scrotal skin remnants must be used to cover whenever possible.

Van der Woude syndrome

Van der Woude syndrome (VWS) is an autosomal dominant craniofacial syndrome with variable expression characterised by congenital pits and sinuses in the lower lip together with cleft lip, or palate, or both. We report a case of VWS, which occurred as a new mutation, and review previous reports.

Reconstruction of congenital absent columella.

A case of congenital absence of the nasal columella accompanying a facial hemangioma is presented. The nose is an important aesthetic unit of the face, and its projection is mainly supported by the columella. The etiology of the absent columella is unclear, and the clinical feature is rare. Reconstruction of the columella remains a challenging problem in plastic surgery, and numerous techniques have been described. The authors discuss several techniques aimed at the correction of the problem and describe a method of reconstruction of the absent nasal columella that was used in the case reported.

Comparing the osteogenic capacities of bone substitutes: hydroxyapatite, high-density porous polyethylene, and bone collagen: a biochemical and histological analysis.

Several inorganic materials have been shown previously to hold some osteogenic capacity. The purpose of this study is to compare the bone-forming abilities of hydroxyapatite ceramic, high-density porous polyethylene, and bone collagen within the periosteal island flap of rabbit tibia using histological and biochemical analysis. With this goal, four discrete experimental groups were formed, each comprising 22 New Zealand male rabbits. A sac was created on each rabbit tibial periosteum flap in each of the groups, and each of the previously mentioned materials was placed within this sac separately. One of these groups was thought as a control group without any material being placed inside the periosteal sac. Biopsies were taken at weeks 1, 2, 4, and 8 for biochemical analysis and at weeks 2 and 8 for histological evaluation. Neo-osteogenesis was evaluated quantitatively by determination of alkaline phosphatase and osteocalcin levels biochemically as well as by the percentage of new bone formation inside the periosteal sac histologically. Results show statistically that the osteogenic effect of high-density porous polyethylene is greater than that of the other materials used in this study (P < 0.05).

Facial Cleft No. 30

Midline clefts of the lower lip, mandible, tongue, and neck are rare congenital deformities and are classified as facial cleft no. 30 by Tessier. This is a report of a patient who presented with congenital fibrotic neck cord but no lower lip cleft, which has been the most frequently observed pathognomonic sign of this anomaly. The patient was treated initially for thyroglossal remnant. In the patients who present with a fibrotic cord located at the cervical midline without a lower lip cleft, the diagnosis of facial cleft no. 30 should be kept in mind.

The role of periosteum and different dissection types on callus formation: quantitative analyses with scintigraphy in a rabbit mandible model.

&NA; In this experimental study, the effects of different dissection types and the role of the periosteum on callus formation were investigated. Forty‐five rabbits were divided into three groups of 15 rabbits. In the first group, a classic subperiosteal dissection was performed to reach the mandible. In the second group, the dissection was done extraperiosteally between the periosteum and the muscle. In the third group, the periosteum at the osteotomy line was stripped out bilaterally both on the lingual and the buccal sides (1.5 cm wide on each side). In all groups, linear vertical osteotomy was performed using an oscillating saw, and fracture fragments were fixed with surgical wire. The animals were evaluated using biomechanical (traction test), histological, and scintigraphic methods. The most durable callus in the traction test and, scintigraphically, the most rapid remodeling were seen in the second group. The histological study performed during week 3 revealed immature callus formation in the first and second groups, and no such formation in the third group. At week 8 the callus was mature in the first two groups and in the third group it was seen but not mature. Bilkay U, Çelik N, Bilkay Ü, Görken C, Alper M, Songür E, Çağdaş A. The role of periosteum and different dissection types on callus formation: quantitative analyses with scintigraphy in a rabbit mandible model. Ann Plast Surg 2000;45:48‐53

Mechanisms of viability in rabbit flank venous flaps

Venous flaps may become more versatile in reconstruction and offer different opportunities to reconstructive surgeons if the mechanisms of their viability is clarified. In this study, axial pattern flank flaps in rabbits were converted into venous flaps by dividing the cutaneous pedicles and ligating the artery. Fluorescein and radioactive tracer studies were performed to elucidate the mechanisms of possible circulation. It is hypothesized that the venous flaps do not have a capillary circulation, but veins transport the fluid out, which is drawn into the capillaries from the interstitium, and that the nutrients and oxygen for flap viability diffuse from the wound bed. Venous drainage plays an important role by draining the metabolites away until revascularization offers a more direct supply.