Hakan Şirinoğlu

A New Option for the Reconstruction of Orbital Floor Defects: The Olecranon Bone Graft.

BackgroundOrbital floor fractures are one of the most commonly encountered maxillofacial fractures due to its weak anatomic structure. Autogenous bone is a commonly used option for the reconstruction of orbital floor defects by many authors and institutions. This article introduces the olecranon bone graft as a new option for orbital floor reconstruction. MethodsThe study is based on the analysis of 13 patients with orbital floor fracture operated on by using the olecranon bone graft. The mean age of the patients was 34 years 6 months. The physical examination of 5 (38.5%) patients revealed diplopia, 3 (23%) patients gaze restriction, 3 (23%) patients infraorbital nerve paresthesia, and 7 (53.8%) patients enophthalmos with various degrees. The mean defect size was 21.15 × 14.08 mm and the mean defect field was 2.98 cm2. All patients were operated on under general anesthesia and the orbital floor defect was exposed subperiosteally. The olecranon bone graft was harvested in 10 cases using a 3-cm incision over the olecranon and in 3 cases using the bone biopsy trephine and placed to the orbital floor defect after shaping with cottle cartilage crusher. Both clinical and radiological follow-up examinations were carried out in the postoperative period. ResultsThe mean follow-up period of the patients was 7.92 months. The mean size of the grafts was 24.85 × 17.54 mL. The mean field of the grafts was 4.26 cm2. Among the 7 patients who had enophthalmos before the surgery, complete resolution was observed in 6 (85.7%) patients and in the remaining 1 (14.3%) patient, the degree of enophthalmos was found to be significantly reduced at the postoperative sixth month examination. All patients with preoperative diplopia and gaze restriction showed complete healing in the postoperative period. Eleven (84.6%) patients showed mild pain at the olecranon donor area with complete relief in the postoperative 3 days and the remaining 2 (15.4%) patients had moderate pain sensation which completely passed away at the postoperative fifth day. ConclusionsThe olecranon bone graft is a suitable autogenous option for orbital floor reconstruction due to its considerable strength and molding capacity with low rates of complications and donor area morbidity.

Comparison of bone prefabrication with vascularized periosteal flaps, hydroxyapatite, and bioactive glass in rats.

BACKGROUND Periosteal flaps possess osteoprogenitor cells and an osteoinductive potential that can be further augmented by combination with a biodegradable scaffold; therefore, various osteoconductive and osteostimulative biomaterials are frequently combined with periosteal flaps in studies of bone prefabrication. An experimental study was designed to determine and compare the contribution of bioactive glass and hydroxyapatite to osteoneogenesis in rats when combined with a periosteal flap. MATERIALS AND METHODS In 60 Sprague Dawley rats, saphenous artery periosto-fasciocutaneous island flaps were transposed to abdomen. In group 1, the flap was left alone, in group 2, an empty artificial pocket made of Gore-Tex (W. L. Gore & Associates, Inc.; Flagstaff, AZ) was sutured onto the periosteal layer, and in groups 3 and 4, the pocket was filled with bioactive glass and hydroxyapatite, respectively. Following sampling for histological analysis, a 4-point scoring system was used to grade inflammatory cell infiltration, osteogenesis, angiogenesis, and cell migration into the bioactive material. RESULTS The combination of the periosteal flap with any of the bioactive materials resulted in significantly higher percentages of animals exhibiting osteogenesis (80% in hydroxyapatite group and 93.3% in the bioactive glass group; p = 0.0000528) and angiogenesis. Comparison of the bioactive material groups revealed that a significantly higher proportion of animals in the bioactive glass group exhibited moderate or severe inflammation (80 vs. 20%; p = 0.002814). CONCLUSION Periosteal flaps prefabricated with hydroxyapatite or bioactive glass in rats exhibit osteogenic capacities that are not dependent on direct bone contact or proximity to vascular bony tissue. The innate capacity of the periosteal flap when utilized alone for osteoneogenesis was found to be rather insufficient.

Benign Chondroid Syringoma: Atypical Presentation of a Rare Eccrine Tumor

Chondroid syringoma is a rare eccrine tumor that is often benign but has the potential for malignant transformation and distant metastasis. Histopathological analysis may not be definitive, and any patient with atypical features, an accelerated clinical course, or high suspicion for malignant transformation is a candidate for immediate surgical intervention and close follow-up. The purpose of this article is to review the clinical features of this rare tumor with a special emphasis on its atypical presentation.

A rare complication after septoplasty procedure in a misdiagnosed submucous cleft palate case: Palatal fistula

Nasal septoplasty is a common and low-risk procedure performed very frequently in plastic surgery as well as in otorhinolaryngology. The development of a palatal perforation following a nasal septoplasty procedure is a very rare event with only a few cases reported in the literature. A patient with palatal fistula formation after septoplasty procedure is presented here, who was later on diagnosed with submucous cleft palate during the repair of the palatal fistula.

The lever technique for the external reduction of temporomandibular joint dislocation

Temporomandibular joint (TMJ) dislocation usually occurs due to large bites, yawning, laughing, neuromuscular diseases, dental operations or intubation in sporadic, recurrent or chronic recurrent fashion. In the acute period, closed reduction maneuvers with the support of a muscle relaxant medication are usually useful for the treatment. In classical closed reduction maneuvers, the displaced condyle head is moved backward and downward along the articular eminence of temporal bone and returned back into the glenoid fossa. Most of these methods are performed with an intraoral approach by placing both thumbs over the third molar teeth in both sides and pulling the angles of mandible downwards using the remaining four fingers to overcome tractional forces of masticatory muscles. This article presents a new technique used for the closed reduction of TMJ dislocations extraorally which offers both the physician and the patient an easier and safer reduction. Twenty-nine patients; twenty-one with unilateral TMJ dislocation and the remaining eight with bilateral dislocation were included to the study. The mean patient age was 32,6 years in a range of twenty-four to forty-four and twenty patients were female while nine of them were male. The etiologic reasons of the TMJ dislocations were yawning while asleep in fourteen patients, followed by large bites in six patients, dental operations of third molars in five patients and laughing in three patients. All patients had severe pain at the effected TMJ and periauricular region and were unable to close their mouth while patients with unilateral dislocation experienced also latherognathia. In all patients, plain radiographs of the head and TMJ were taken both for the confirmation of the dislocation and evaluation of the pericondyler bone deposition of the patient.

Microvascular anastomosis using Ankaferd blood stopper: demonstration of long-term histopathologic effects on vascular tissue.

Ankaferd blood stopper (ABS) (Ankaferd Ilaç Kozmetik A.Ş., Turkey) is a medicinal plant extract, which is used in Turkish traditional medicine as a haemostatic agent. The aim of this study was to investigate the haemostatic effect of ABS in preventing microvascular leakage on an anastomosis site and to look into its long-term impact on vascular tissue. Twenty-one Wistar albino rats were randomly divided into three groups. The animals in the second and third groups were pretreated with acetylsalicylic acid. All of the right femoral arteries were divided and anastomosed in an end-to-end fashion. Following microvascular anastomosis, saline-soaked gauze tampons were applied in the first and second groups. In the third group, ABS-soaked tampons were applied to the anastomosis sites. The mean bleeding time of group 3 was significantly shorter than group 2 and group 1. Three weeks after the operation, there were aneurysms on all of the anastomosis sites in group 3 and none of the anastomoses were patent. Histologic examination demonstrated increased inflammatory cell infiltration, tunica media degeneration and contraction of tunica intima in group 3. This is the first study reporting the long-term effects of ABS on microvascular anastomosis. Contrary to previously reported studies, this agent is not appropriate for use on injured or anastomosed vessels.

The effects of the centrifugation speed on the survival of autogenous fat grafts in a rat model

Abstract Purpose The most important problem in fat transplantation is the durability, which is closely associated with the applied technique. This study includes the comparison of different centrifugation speeds on the survival of autogenous fat grafts in rats. Materials and methods Forty-nine Sprague-Dawley rats were divided into seven groups and the left inguinal fat pad was extracted and re-implanted under the scalp after performing appropriate preparation processes. In the first group the fatty tissue was re-implanted in en-bloc fashion and in the second group it was re-implanted after trimming. After trimming, centrifugation with a G-force of 111.8 (1000 rpm) was performed in the third group, 447.2 (2000 rpm) in the fourth group, 1006.2 (3000 rpm) in the fifth group, 1788.8 (4000 rpm) in the sixth group, and 2795 (5000 rpm) in the seventh group for 4 minutes. The fat grafts were taken after 3 months and histopathological and statistical evaluations were performed. Results The rate of viable fat grafts was significantly higher in the 4th and 5th groups comparing to the first three groups. Total weight and volume amounts of the 4th and 5th groups were also significantly higher comparing to the first three groups. Conclusion Maximal long-term durability and fat cell viability results were obtained in the groups with 2000 rpm or 447.2 G-force/4 minutes and 3000 rpm or 1006.2 G-force/4 minutes centrifugation speed, indicating that 4 minutes centrifugation with an average G-force of 698.75 or 2500 rpm provides the best results for the survival of autogenous fat grafts.

A useful option to obtain maximal foreign body removal and better prognosis in high pressure injection injuries: Negative pressure wound therapy with instillation

High pressure injection injuries to the hand are quite rare and they should be evaluated as a surgical emergency. Delay in the diagnosis and treatment usually occur if high pressure injection injuries does not present with an emergent clinical situation such as compartment syndrome. The prognosis depends on the features and the volume of the injected substance but it should be stated that amputation rates up to 48% were reported in previous publications. All foreign substances should be removed and copious irrigation in conjunction with debridement of all necrotic tissues should be performed. We present a useful technique including the utilization of vacuum therapy to remove maximum possible foreign body after adequate debridement as a preliminary study. Five patients with high pressure dye injection injuries treated between years 2011e2014 were presented in the paper (Table 1). The average age of the patients was 35,8 and the entry wounds of two patients were located in the palmar area, three patients in the volar surface of the fingers. In all patients, immediate debridement was performed and negative pressure wound therapy (NPWT) with instillation (wound irrigation) was applied to the open wound area with a mean pressure of 50 mmHg initially to prevent any possible obstruction of neurovascular bundles and circulatory problems. The pressure was increased to 75 mmHg in the postoperative first day, 100 mmHg in the postoperative second day and 125 mmHd in the postoperative third day. If no sign of circulation problems were encountered, NPWTwas continued with 125 mmHg pressure for the remaining days of the treatment. The extremity was

A new role for hygienic pad in the laboratory settings

To the Editor, To diminish the heat loss during the surgical intervention to the laboratory rat, usually an underpad or a clean towel is placed under the rat, which can also absorb the blood and the irrigation fluids, keeping the operative field clean. But a towel and similar cotton containing products become wet in a short time and soak the rat as well, resulting in a significant heat loss after a while. To overcome this problem, a hygienic pad can be used as an alternative to the towel. Sanitary pad has the advantage of maintaining a dry contact surface with the animal while absorbing the fluids reaching on top of it. It can be easily attached to the rat board with help of the adhesive tapes on the wings at each side. In contrast to the traditional bed underpad, the width of the hygienic pad is quite similar to the transverse diameter of the rats’ abdomen, thus the remaining part of the rat board is left visible for easy access, where push pins are placed for fixation of the limbs and tail to the board and retractors are fastened for better visualization of the surgical field (Fig. 1). The maintenance of the rats’ body temperature is an important issue, which directly affects the perioperative and immediately postoperative morbidity as well as mortality. Hygienic pad is a cheap and versatile method for working with laboratory animals, which efficiently keeps a dry surgical field and prevents heat loss.

Facial Artery Perforator and Depressor Anguli Oris Muscle Chimeric Flap: A New Design of an Old Flap.

BackgroundThe aim of this study was to investigate the reliability and outcomes of the facial artery perforator and separately elevated depressor anguli oris (DAO) muscle chimeric flap for the reconstruction of partial or total lower lip defects. MethodsEleven patients with malignant skin tumors located at the lower lip were operated between 2013 and 2015. After the excision of the tumor with adequate clear margins using margin controlled excision technique, an appropriate flap fitting to the resultant defect based on the perforators of the facial artery and DAO muscle was prepared and placed into the defect. The DAO muscle activity was tested with electromyography in the postoperative first year examination. ResultsBesides 1 patient with transient venous insufficiency, all the flaps healed well without a partial or total flap loss. The mean follow-up period was 10 months. No new primary tumor or recurrence was observed. Although in 1 patient, transient asymmetric smiling and mild drooling was observed, the overall oral competence results were found to be quite satisfactory. The electromyography evaluation of DAO muscle of 5 patients who reached the postoperative first year examination showed action potential results in normal limits with a slight decrease. All patients were satisfied with the final esthetic and functional result. ConclusionsThe facial artery perforator and depressor angel oris muscle chimeric flap is a valuable option for reconstruction of lower lip defects providing esthetically and functionally good results.