Ercan Akbay

Reconstruction of isolated mandibular bone defects with non-vascularized corticocancellous bone autograft and graft viability

OBJECTIVE The aim of this study is to discuss the use of non-vascularized bone grafts in mandibular reconstruction and their viability. METHODS In this study, 11 patients with mandibular defect treated by surgery using non-vascularized bone grafts between 2011 and 2012 were reviewed. All patients underwent preoperative and postoperative 3-dimensional computerized tomography scan for surgical planning and evaluation of success after surgery. Grafts were used for defects caused by mandible tumors in 2 patients and firearm injuries in 9 patients. Reconstruction was achieved by using various non-vascularized bones, including iliac crest, fibula and scapula. To improve graft supply, periosteum of the grafts was spared and multiple bores were created on the graft during surgery by drilling. At the postoperative period, Dextran 70 and Bencyclane Hydrogen Fumarate was given in order to enhance micro-circulation. On the postoperative day 5, 15 and 30, Tc-99m methylenediphosphonate scintigraph, blood-pool single photon emission computed tomography and its bone phase were performed in order to assess viability of bone grafts greater than 3cm. RESULTS Mean age was 32. 27±13.33 (min=10-max=56). Of the 11 patients, 10 (90. 9%) were men and 1 (9. 1%) was woman. Mandibular defects were at right corpus in 3 patients; at right ramus and angulus in 1 patient; at left corpus in 1 patient; at left ramus and angulus in 1 patient; at left ramus, angulus and corpus in 1 patient; left parasymphysis in 1 patient; at bilateral corpus in 1 patient; at symphysis in 1 patient and at whole segment from right corpus to left one in 1 patient. The following grafts were used: iliac crest grafts in 9 cases, scapula graft in 1 case and fibula graft in 1 case. The smallest graft used was 1×2cm in size, while the greatest, single piece graft was 7cm in size. The greatest multi-piece graft was a fibula graft of 14cm in length. All grafts with a size of 3 and 7cm had been supplied at the end of first month. No bone resorption or donor site morbidity was observed in any patient. CONCLUSION Non-vascular bone grafts can be successfully used in isolated bone defects of mandible in case of appropriate graft selection for fitting anatomical region. A single piece iliac crest grafts up to 7cm can be revascularized in long-term.

The relationship between posterior septum deviation and depth of maxillopalatal arch

OBJECTIVE To investigate the relationship between depth of maxillopalatal arch and deviation of posterior septum. METHODS This study is based on paranasal sinus CT (PNSCT) scan in the coronal plane evaluation, and sinus paranasal scans were obtained from the database. One-hundred and fifty PNSCT scans were randomly chosen among the PNSCT scans which belong to adult (18 and older) patients. All scans were divided to three different groups. The first group constituted by those patients who had more convex deviation. The second group had those patients with either crest or spur deviations. The last group (control group) had no septum deviation. The data collected from each group were statistically compared. EXCLUSION CRITERIA CT imaging which has a chronic sinusitis, nasal cavity mass, and nasal polyps. MAIN OUTCOME MEASURES angle and distance measures were taken on maxillopalatal arch and posterior nasal septum. RESULTS Strongly positive correlation between posterior septum deviation and depth of maxillopalatal arch was determined (r=0.479, p=0.001). CONCLUSION These findings suggest that posterior septum deviations are considered as a result of increase in maxillopalatal depth.

[An unusual Wohlfahrtia magnifica myiasis case localized in cutaneous and subcutaneous tissues in a patient with head-neck cancer].

Auricular tumors constitute 6% of all head-neck tumors. Malignant tumors of the auricula are generally squamous or basal cell carcinomas. Myiasis rarely occurs in healthy individuals. In general, it is a parasite that is seen in patients with mental retardation or psychiatric disorders, elderly individuals, those with poor self-care and hygiene, and those with immune system disorders. In humans, it is mainly seen in tropical and subtropical regions; however, in rare instances, it may be seen in other regions of the world. In the literature, there are limited numbers of myiasis cases reported from Turkey. In this study, we aimed to present a myiasis case (Wohlfahrtia magnifica) involving cutaneous and subcutaneous tissues with an underlying head-neck cancer, which, to the best of our knowledge, has not been reported before in the literature.

Determination of hearing levels in patients with Familial Mediterranean Fever

OBJECTIVE Familial Mediterranean Fever is the most common congenital, periodic fever condition that affects over 100,000 people worldwide. In the literature, there is limited number of studies about hearing levels in children with Familial Mediterranean Fever. In the present study, we aimed to investigate hearing levels and cochlear functions by using Distortion product Otoacoustic Emission and High Frequency Audiometry (250-20,000 Hz) in pediatric patients with Familial Mediterranean Fever. METHODS The study included 62 children with Familial Mediterranean Fever and 27 healthy children with similar age and gender. After otoscopic examination, both groups underwent audiological evaluation including High Frequency Audiometry (250-20,000 Hz) and Distortion product Otoacoustic Emissions. The results obtained were assessed among groups. In addition, these results were compared regarding colchicine use, age at the onset of disease and duration of the diseases in the Familial Mediterranean Fever group. RESULTS Of the Familial Mediterranean Fever patients, 93.5% were on colchicine therapy and mean duration of colchicine use was 19.9 ± 13.9 months. The mean age at diagnosis was 6.57 ± 2.86 years (min-max: 2-14) and mean duration of disease was 23 ± 17 months (min-max: 6-84). Pure tone audiometry values, and hearing levels between 9000 and 20,000 Hz were similar and within normal range in both groups. The Distortion product Otoacoustic Emissions responses at the frequencies of 1020, 2040, 3000, 4080 and 5040 Hz were similar for both groups. CONCLUSION To the best of our knowledge, this is the first study evaluating hearing levels at the frequencies of 18k Hz and 20k Hz in children with Familial Mediterranean Fever in the literature. In children with Familial Mediterranean Fever, Pure tone audiometry values, hearing values obtained at all frequencies from 250 to 20,000 Hz, and Distortion product Otoacoustic Emissions levels were within normal range. Furthermore, hearing levels were found to be similar to those in healthy children.

Pseudoaneurysm of the carotid arterial system.

Abstract Pseudoaneurysms of internal, external, and common carotid arteries are seen rarely. Blunt traumas caused by automobile accidents are the prior reasons to this. Central venous catheterization, ballistic trauma, cystic medial necrosis, fibromuscular dysplasia, atherosclerosis, and other inflammatory processes are some other potential reasons for pseudoaneurysm. In contrast to true aneurysms, it does not contain 3-layer structure with adventitia, media, and intima sublayers in its wall. The wall contains coagulum and fibrous capsules. Clinically, after trauma, it presents itself as swelling after days to weeks of damage to vascular walls. Because it causes morbidity and mortality when it is ruptured, It should be treated via surgical or vascular intervention.

Treatment of displaced mandibular condylar fracture with botulinum toxin A

The aim of this case report is to discuss the effect on condylar reduction of botulinum toxin A treatment used in a child with displaced fracture at condylar neck of mandible. A 3-years old boy was admitted to our clinic for incomplete fracture of mandibular symphysis and displaced condylar fracture at the left side. An asymmetrical occlusal splint with intermaxillary fixation was used instead of open reduction and internal fixation because of incomplete fracture of symphysis and possible complications of condyle surgery. However, it was observed that condylar angulation persisted despite this procedure. Thus, botulinum toxin A was administered to masseter, temporalis and pterygoideus medialis muscles. At the end of first month, it was seen that mandibular condyle was almost completely recovered and that fusion was achieved. In conclusion, Botulinum A toxin injection aiming the suppression of masticatory muscle strength facilitates the reduction in the conservative management of displaced condyle in pediatric patients.

Perioperative difficulties and early postoperative complications of transoral approach in mouth base surgery.

ObjectiveThe aim of this study was to discuss perioperative difficulties and temporary or permanent complications that can be seen at early postoperative period in cases undergoing transoral surgical approach for disorders of mouth base. Study DesignThe study included 19 patients undergoing transoral surgical approach between September 2011 and January 2013 who were retrospectively evaluated. Exclusion criteria were patients with malign submandibular gland tumor or other suspected tumors at mouth base, those with a benign solid mass larger than 10 × 10 cm, and those who did not accept the transoral approach. ResultsMean age was 28.47 ± 17.89 years (range, 8–76 years) in 19 patients included (9 male and 10 female subjects). Of these, submandibular gland excision was performed in 9 cases, whereas thyroglossal duct cyst excision was performed in 3 (2 transfrenulum approach and 1 lateral lingual approach), lymphangioma excision in 1, diagnostic lymph node excision at the posterior of submandibular gland in 3 cases, and dermoid cyst excision (2 with midline and 1 with left submandibular localization) in 3 cases. Perioperative difficulties included dissection problems due to adhesion, partial adhesion between Wharton canal and lingual nerve, fragmented dissection of the gland, capsule rupture of submandibular adenoma, and facial artery rupture. While visualization of surgical field and retraction of mouth base muscles are an important issue in midline approaches, resection of hyoid bone corpus is challenging in lateral approaches. Early postoperative complications included edema at mouth base, lingual ecchymosis, and postoperative temporary abnormal tongue sensation. ConclusionsTransoral mouth base surgery is a safe approach in selected patients. Permanent injuries of neural structures are rarely encountered, which is considered as a concern by head and neck surgeons. Temporary complications are at a level that can be tolerated by patients.

The Effect of Passive and Active Smoking on Nasal Mucociliary Clerarance Time

Aim: The aim of this study was to investigate the effect of passive and active smoking on NMC by comparing the results of age and sex matched healthy individuals, passive and active smokers. Material and Method: A total of 75 subjects met the criteria and were divided into three groups: control group (nonsmokers, group 1, n =25), passive smokers group(group 2, n =25), active smokers group (group 3, n =25). NMC of these subjects were measured and compared. Moreover, the amount of cigarette consumption of active smokers group were calculated as package to year and the correlation between NMC and the amount of cigarette consumption. in active smokers group were evaluated. Results: The mean NMC in passive smokers group and active smokers group were significantly longer than the control group (p=0,0001) The comparison of NMC values between the passive smokers group and the active smokers group revealed no statistically significant dif ferences (p≥0,05). There was positive correlation between the increase in NMC and amount of cigarette consumption in the active smokers group ( p=0,0001,r=0.433). Discussion: Both active and passive smoking prolonged nasal mucociliary clearance time when they were compared with healthy controls. Tobacco exposure is associated diseases such as asthma, chronic rhinosinusitis, and lower airway infections. It may be related to the direct effect of prolonged NMC.

Effect of carboxyhemoglobin on postoperative complications and pain in pediatric tonsillectomy patients

Carbon monoxide (CO) is a product of burning solid fuel in stoves and smoking. Exposure to CO may provoke postoperative complications. Furthermore, there appears to be an association between COHb concentrations and pain. We thus tested the primary hypothesis that children with high preoperative carboxyhemoglobin (COHb) concentrations have more postoperative complications and pain after tonsillectomies, and secondarily that high‐COHb concentrations are associated with more pain and analgesic use.

Thyroid gland papillary microcarcinomas diagnosed by extraglandular mass findings

Thyroid papillary microcarcinomas not only present with neck lympathic metastasis but also may occur in thyroglossal cysts or ectopic thyroid glands. The aim of this case report is to discuss two cases of thyroid papillary carcinomas with no mass detectable by thyroid gland ultrasonography but diagnosed with the biopsy of cervical lymphatic metastasis and occurred in ground of lateral sided thyroglossal cyst. It must be kept in mind that, in cervical metastasis and even laterally sided cystic masses, these symptoms may be associated with thyroid papillary carcinoma.