Mustafa Keskin

Allogenous Cartilage Graft Versus Autogenous Cartilage Graft in Augmentation Rhinoplasty: A Decade of Clinical Experience

Cartilage grafts have great value in augmentation rhinoplasty. For most surgeons, an autogenous cartilage graft is the first choice in rhinoplasty because of its resistance to infection and resorption. On the other hand, an allogenous cartilage graft might be preferred over an autogenous graft to avoid additional morbidity and lengthened operating time. Allogenous cartilage grafts not only have the advantage of averting donor site morbidity but also are resistant to infection, resembling autogenous cartilage grafts. The authors present their experience with 41 patients who underwent augmentation rhinoplasty using 22 autogenous and 19 allogenous cartilage grafts between June 1994 and August 2004. For evaluation of adequate augmentation rates, photographic analyses were performed on preoperative, early postoperative, and late postoperative photographs from all the patients. To assess patient satisfaction, the Facial Appearance Sorting Test (FAST) was applied preoperatively and late postoperatively in both groups. These results were compared, and it was concluded that in terms of resorption, there was no difference in the early and late postoperative follow-up data between allogenous and autogenous cartilage grafts. Evaluation of the preoperative and early postoperative photographic outcomes showed statistically significant differences with respect to adequate augmentation rates between the two groups. The FAST scores showed statistically significant differences between preoperative and late postoperative outcomes. There were no infections in the two groups of patients.

Simultaneous occurrence of facial fibrous dysplasia and ameloblastoma

BACKGROUND Both fibrous dysplasia (FD) and ameloblastoma are benign but locally aggressive tumours of the craniofacial region. In this case report, we present the unique synchronous occurrence of these two tumours in the facial skeleton. CASE REPORT A 16-year-old woman presented with complaints of swelling of the upper right face and at the inferior border of the mandible. She was diagnosed as FD of the maxilla, temporal bone and sphenoid sinus together with ameloblastoma of the mandible after surgery and histopathological evaluation. CONCLUSION The case that we present here is unique in that two separate pathological conditions, FD of the upper face, and ameloblastoma of the mandible coexisted. Although cases of synchronous or metachronous occurrence of FD and ameloblastoma with other pathology have been previously described, this to our knowledge, is the first reported case of true coexistence of FD and ameloblastoma.

Squamous Cell Carcinoma on Cutaneous Leishmaniasis Lesion

Squamous cell carcinoma (SCC) is the second most common malignancy that originates from the keratinizing or spindle cell layer of the epithelium. The etiology of SCC is multifactorial. These factors include exposure to ultraviolet, ionizing radiation and chemicals and chronic wounds. Chronic wounds, including unhealed burn scars, fistula tracts, pressure sores, and draining osteomyelitis areas, are important factors in development of SCC. Infections are also a cause of chronic wounds.

Implant-retained nasal prosthesis

Malignant tumors of the nose occasionally require rhinectomy. Facial defects can cause not only functional problems but also some serious physchological problems that could cause the individual to avoid social contact. In view of this, the first aim of maxillofacial rehabilitation should be solving esthetic problems. Implant retained prostheses can give good esthetic results. Predictable biomechanical retention of nasal prostheses can be achieved using osseointegrated implants and intra-oral and craniofacial implants have been used previously. These prostheses are tissue compatible, simple in design and easy to place, can be worn independently of spectacles and in the majority of cases can be provided soon after surgical excision. In this case report, a nasal prosthesis was fabricated for a patient who lost his nose due to the basal cell carcinoma. Extra-oral implants and magnet retention for the proper connection of the nasal prosthesis were used. This prosthesis was acceptable for the patient because of excellent support, retentive abilities and the patient′s appearance.

Lower eyelid reconstruction with tarsoconjunctival flap in a xeroderma pigmentosum patient

Xeroderma pigmentosum is an autosomal recessive genetic disorder of DNA repair in which the ability to repair damage caused by ultraviolet light is deficient. This disorder leads to multiple basal cell carcinomas and other skin malignancies at a young age. The eye is the second most commonly affected organ. We present a case of xeroderma pigmentosum with basal cell carcinoma totally infiltrating the lower eyelid. The reconstruction after excision has been planned with a tarsoconjunctival flap (modified Hughes procedure). This procedure had evolved over the years since it had been first described by Hughes. Some important modifications have led the flap to be used with much success. Our aim is to show that the tarsoconjunctival flap is a reliable option in the reconstruction of total lower eyelid defects, with good functional and esthetic outcomes.

The extended uses of Foley catheter in plastic surgery

I enjoyed the note by Dr. A. Nirale: “Anatomy of an internet consultation” in the December issue. The ideas put up by the author are great. I would like to comment on the safety tips on page 197. The tip number 5 is a good tip but it should be expanded. Any comments if adverse and not complementing the “other” surgeon should be kept strictly to the second opinion surgeon. We often say things about other persons result which comes back to hound us. In this environment of malpractice cases filed for trivial causes, it is best not to comment about results as seen in photographs or in person.

Surgical correction of ptosis in chronic progressive external opthalmoplegia

Chronic progressive external opthalmoplegia (CPEO) is a neuromyopathic disorder characterized by progressive weakness of the extraocular and levator muscles, which causes blepharoptosis. Ocular motility is impaired. It is usually bilateral and symmetrical. Lagophthalmos and ectropion are frequent because the orbicularis oculi muscle is commonly involved [1]. Other clinical findings are poor Bell’s phenomenon and poor lid closure. CPEO tends to begin in young adulthood. Mitochondrial DNA mutations are increasingly being recognized as the etiology for CPEO [2]. Meticulous clinical examination in all cases of ptosis is necessary to identify CPEO as the underlying cause. We present a case of blepharoptosis with CPEO diagnosed as mitochondrial myopathy and the clinical features and the strategies for the surgical treatment of ptosis in this rare syndrome are reviewed. Case report

Is it a chemical burn or an irritant contact dermatitis

A 67-year-old female patient boiled daisy flower seeds and applied the poultice after it had cooled down over the knee region to relieve pain. When she removed the dressing 36 h later, she discovered that there was an extensive redness with some blisters over the area of application. The redness and blisters spread to the leg over time (Figure 1). When the patient was admitted to the clinic, the affected area was irrigated with saline solution, dressed with clorhexidyne tulle grasses and antibiotic ointment. She was started on antihistaminic medication for 10 days. On the first day, pheniramine hydrogen maleate (50 mg per day) was given parenterally; then, 25 mg per day was given orally for 9 days. In her detailed history, it was learned that the cause of the patient’s knee pain was due to her rheumatismal joint disease. She had no personal or family history of atopy. The patient had used this poultice for the first time and had followed some traditional practice and knowledge without prescription. She received the diagnosis of an irritant contact dermatitis by the dermatologist. After 15 days of wound care, the lesion was totally epithelised without any residual defect (Figure 2). One year later, the burned area healed well with minor hyperpigmentation. The

Compartmentalization of inoperable high-flow vascular malformation

A high-flow vascular malformation of the face is a rare entity, and it can cause severe disfigurement and can even be potentially fatal as a result of massive hemorrhage. The authors describe a high-flow vascular malformation case that was successfully treated by compartmentalization and sclerotherapy with polidocanol. Two weeks later, the necrotic tissues were debrided and the resulting defect was covered with a skin graft. The resulting aesthetic outcome was more than anticipated by the patient. With this technique, it was possible to treat what was considered an untreatable vascular malformation using a standard technique.