Aydın Turan

Efficacy of dexamethasone with controlled hypotension on intraoperative bleeding, postoperative oedema and ecchymosis in rhinoplasty

PURPOSE The aim of this retrospective study was to evaluate the efficacy of dexamethasone with controlled hypotension on intraoperative bleeding and postoperative morbidity in rhinoplasty. MATERIALS AND METHODS Sixty rhinoplasty patients required hump resection and lateral osteotomy were included in this study. The patients were randomized into four groups. In group I (n=15), a single dose of 10mg/kg dexamethasone was intravenously administered at the beginning of the operation. In group II (n=15), the patients were given 2 doses of 10mg/kg intravenously dexamethasone at the beginning of the operation, and 24 hours after the operation. In group III (n=15), 3 doses of 10mg/kg intravenously dexamethasone were given at the beginning of the operation, before osteotomy and 24 hours after the operation. Group IV (n=15) was assigned as control group and the patients were neither administered dexamethasone nor applied hypotension. All cases in groups I, II and III were operated under controlled hypotension. Systolic arterial pressure was aimed to keep between 65 and 75 mmHg for controlled hypotensive anaesthesia. Controlled hypotension was achieved by a remifentanil infusion of 0.1-0.5 microg/kg/min, following a bolus of 1 microg/kg. Degree of eyelid oedema and periorbital soft-tissue ecchymosis was evaluated separately using a scale of 0-4. Intraoperative blood loss was recorded for each patient. Patients were evaluated at 24 hours and postoperative days 2, 5, 7, and 10. RESULTS In groups I, II and III, intraoperative bleeding was more decreased and the operation time was significantly shorter compared with control group (P<0.001). Eyelid oedema and periorbital ecchymosis were significantly decreased in groups I, II and III at the following postoperative 7 and 10 days (P<0.001). There was statistically significant difference between group III and other groups at the postoperative 5 and 7 days in lower eyelid oedema (P<0.001), upper and lower eyelid ecchymosis (P<0.001 and 0.004, respectively). There were no postoperative complications with using steroid in any of the groups. CONCLUSION Three doses of dexamethasone with controlled hypotension considerably reduced postoperative morbidities of rhinoplasty with osteotomy as well as intraoperative bleeding. Thus, in group III receiving 3 doses of steroid, when compared to other groups, more uneventful postoperative period were provided for surgeon and the patients.

Digital anthropometric shape analysis of 110 rhinoplasty patients in the Black Sea Region in Turkey

PURPOSE The aim of the study was to describe the average values of the nasal anthropometric measurements by using the landmark-based geometric morphometric technique in young male patients who applied for rhinoplasty in the Black Sea Region in Turkey. MATERIALS AND METHODS The study group consisted of 110 healthy male patients all were born in the Black Sea Region, Turkey. The landmark-based geometric morphometric technique was used to analyze the nasal shapes as described in the literature. The mean age was 29 years (ranging from 23 to 35). All patients underwent primary rhinoplasty in our clinic between 2006 and 2011 years. All data were obtained from standardized digital photographic images. Anterior and worms eye view photos of the patients were analyzed by using standard anthropometric measurement methods. RESULTS The mean total length and nasal bridge length of the noses were 58.90 and 57.35 mm, respectively. The mean nasal bridge width and the morphologic nose width were 32.65 and 35.50mm, respectively. The average width of the anatomic nose was 26.25 mm. The mean length and width of the ala were 22.72 and 4.73 mm, respectively. The mean length and width of the columella were 11.35 and 5.20mm, respectively. The mean frontonasal angle was 137.88° and the mean nasolabial angle was 87.34°. CONCLUSION Black Sea nose was characterized by being considerably longer than average in nasal length and columellar height. Also nasolabial angle was found to be more acute than average when compared to other noses.

Scapular Bone Grafts: Good Options for Craniofacial Defects?

Introduction There is still no consensus on the ideal material to be used in craniofacial defects. Autogenous bone grafts are mostly preferred owing to their use with fewer complications. The aim of this study was to evaluate whether the scapular bone graft can be used with equal or more advantages to other bone graft resources in orbital, maxillary sinus front wall, and frontal bone defects. Patients and Methods Twenty-four orbital, maxillary sinus front wall, and frontal bone defects were reconstructed with scapular bone grafts. Sixteen patients presented with complicated orbital fractures, 5 patients presented with isolated orbital floor fractures, and 3 patients presented with frontal bone fractures. The grafts were radiologically evaluated 1 day, 6 months, and 12 months postoperatively by 3-dimensional computed tomography scan. Results All orbital, maxillary sinus front wall, and frontal bone defects were reconstructed successfully with scapular bone grafts. Clinical evaluation of the patients at 6 to 24 months of follow-up was considered satisfactory. Minimal donor site morbidity was observed. Scapular bone grafts adapted nicely to the recipient area, and bony union was complete as demonstrated by 3-dimensional computed tomography scans. Conclusions Reconstruction of orbital, maxillary sinus front wall, and frontal bone defects with scapular bone grafts is an easy and safe procedure with minimal donor site morbidity. Scapular bone graft is a good reconstructive option for orbital, maxillary sinus front wall, and frontal bone defects.

The use of single rhomboid flap in reconstruction of microstomia

Microstomia is a term used to describe a small oral aperture.Perioral cicatricialcontracturesoccurringafterperioralsurgery,genetic disorders, burn and injuries are the main causes ofmicrostomia. Maintaining adequate oral aperture is essentialfor the function of speech, nutritional needs, dental hygiene,facial expression and social interaction [1]. The cause andseverity of the condition can influence the model of treatmentThe goals of microstomia repair include the reconstructionof orbicularis sphincter for adequate lip functioning, obtaininglip symmetry and good cosmesis. A number of methods havebeen described in the literature addressing the treatmentof microstomia.Weherebypresentamethodwhich,tothebestof our knowledge, has not been described before.

The use of temporalis muscle graft, fresh and cryopreserved amniotic membrane in preventing temporomandibular joint ankylosis after discectomy in rabbits

PURPOSE The aim of the study was to evaluate the efficacy of temporalis muscle-fascia graft, fresh and cryopreserved human amniotic membrane as an interpositional material in preventing temporomandibular joint ankylosis in a rabbit model. MATERIALS AND METHODS In this experimental study, 21 New Zealand white rabbits were used. The condyle and the joint disc were removed to induce ankylosis in left TMJs. Reconstruction was immediately performed with temporalis muscle-fascia graft (tMFG) in group I (n = 7), fresh human amniotic membrane (fHAM) in group II (n = 7) and cryopreserved human amniotic membrane (cHAM) in group III (n = 7). All rabbits were sacrificed at 3 months after the operation. The comparison was made among three groups by means of vertical mouth opening and weight measurements, radiologic and histologic findings obtained before and after surgery. RESULTS In all rabbits, there was no statistically significant difference in the jaw movements and weight among groups at commencement and 3 months after surgery. The condylar surfaces were more irregular in HAM groups. There were mild osteophyte formations, sclerosis, fibrosis and calcification around the condyle in all groups however the joint gap was more preserved in group I. All interpositional materials were also seen to be partially present in the joint gap at 3 months. Ankylosis was not seen in the joint gap in any group. CONCLUSION With the results of this study it was concluded that interpositional arthroplasty with HAM and tMFG have an almost similar effect in preventing TMJ ankylosis after discectomy in the rabbit model.

Acute closed radial nerve injury

We present a 45-year-old patient who had acute radial nerve palsy following a blunt trauma without any fracture or dislocation. He was injured by strucking in a combat three months ago. The patient has been followed by application of a long-arm plaster cast before referred to our clinic. Preoperative electromyoneurography and magnetic resonance imaging (MRI) indicated that there was a radial nerve injury on humeral groove. The British Medical Research Council (MRC) grade was 2/5 on his wrist preoperatively. The patient underwent an operation under general anesthesia. It was seen to be a second-degree nerve injury. The patient has subsequently regained full movement on his wrist and finger extension in six months. We suggest that a detailed clinical and electrodiagnostical evaluation is necessary in patients who have radial nerve injury when deciding the treatment, conservative or surgical.

Reverse Superior Labial Artery Flap in Reconstruction of Nose and Medial Cheek Large Defects: Reply.

FIGURE 1. Left: defect in the right nasal sidewall after squamous cell carcinoma excision; reconstruction with a V-Y advancement angular artery perforator based flap was planned. Middle: intraoperative view of the perforator vessels dissected (artery and vein are clearly identifiable); the flap was islanded on the dissected pedicle with preservation of the underlying mimic musculature and advanced without tension to the recipient site. Right: no vascular complications were registered and the patient was satisfied of the aesthetic result as shown in the 12-month postoperative follow-up. W e read with great interest the article by Turan and colleagues in which they describe the use of the reverse superior labial artery flap for reconstruction of nasal and medial cheek defects.We congratulate the authors for the introduction of such an interesting surgical technique and for the aesthetically pleasant results provided; nevertheless, we believe that some additional considerations on this topic should be made. The authors describe the use of an axial flap harvested around the corner of the mouth and based on the reverse flow from the ipsilateral super labial artery. In the surgical technique, they explain that the facial artery, the inferior labial artery, and the lateral nasal artery are progressively ligated and that risorius, zygomaticus major, and orbicularis oris muscles are divided to include the pedicle in the flap and achieve the desired arc of rotation. Even if the authors do not report functional sequelae associated with the procedure, as a matter of fact, a significant local morbidity is created to reconstruct small to moderate size defects in the nasal and perinasal subunits. In the last decade, the introduction of free style perforator flaps has revolutionized the approach to soft tissues reconstruction allowing us to harvest pure adipocutaneous flaps with preservation of the underlying muscles, nerves and source vessels, thus resulting in superior aesthetic and functional results with minimal morbidity for the patients. The same concept has been subsequently applied to facial reconstruction, and the use of free style perforator flaps of the facial angiosome, based on known perforator vessels originating from facial and angular arteries, has been popularized for reconstruction of perioral, perinasal, and nasal defects. Unfortunately, the authors do not make mention of this alternative and less morbid approach when reviewing the current avalaible reconstructive options in the discussion paragraph. The free style concept is particularly useful in nasal and perinasal reconstruction because of the significant soft tissue laxity observed in the nasolabial and perioral regions and the abundant vascularization of the facial integument. Starting from 1 side of the defect, preferably using an easier lateral approach, it

Alternative nipple suspension technique in the treatment of inverted nipple: reverse s-shaped design.

The primary aim in the treatment of inverted nipple is to achieve a satisfactory and permanent projection of the nipple. The drawbacks of reported techniques include sensory disturbance of the nipple, marked scarring of the nipple and areola, destruction of breast function and incomplete correction. In the present study, the authors introduced a new modification of using two opposite nipple-based areolar dermal flap in the treatment of grades 2 and 3 inverted nipple cases. Nipple-based areolar flaps designed at 3 o’clock and 9 o’clock were raised by two linear incisions and the tip of each flap was sutured on the base of the nipple close to the base itself in a reverse S shape at 6 and 12 o’clock. Successful outcome was obtained due to a strongly suspending effect of the design of the flaps. The mean follow-up period was 6 months. The patients were satisfied with the result and the scars were minimal. The authors recommend the use of the technique that is a simple, reliable and with minimal scars for correcting grades 2 and 3 inverted nipples.

The Use of a Nasolabial Island Flap in Vestibulo‑sulcoplasty in a Patient with Recurrent Depressed Scar on the Modiolus

A 56-year-old woman with a recurrent depressed scar of the commissure, treated with a nasolabial island flap, is presented. On examination, the scar was located on the right modiolus involving the right upper gingivobuccal sulcus. A history of recurrent canine abscess was obtained. After excision of the scar and release of the vestibular fold, reconstruction of the defect was performed with a nasolabial island flap from the same side. The postoperative course was uneventful, with a good aesthetic and functional outcome.

Use of a Urogel Reservoir as a Closed-Suction Drain: Letter to the Editor

drainage systems such as closed-suction drainage or Penrose drain are usually used to prevent accumulation of fluid or blood after surgery.1,2 There have been various reports in the literature on innovative drainage systems which are alternatives for closed-suction drains.2,3 This paper describes an easy method that can be used as a continuous suction drainage system for especially small surgical wounds, making use of a sterile feeding tube and a sterile urogel reservoir.