Mustafa Tercan

Craniofacial Anthropometry in a Turkish Population

OBJECTIVE To present norms and demonstrate the anthropometric variations in fronto-occipital circumference, inner and outer canthal distances, near and distant [far] anatomical interpupillary distance, canthal index, and circumference-interorbital index across age and sex in urban Turkish subjects. PARTICIPANTS Three thousand four hundred forty-eight subjects (1852 male, 1596 female) aged 7 to 40 years were included in this study. METHODS Three age groups were studied: children aged 7 to 15 years, young adults aged 16 to 25 years, and adults aged 26 to 40 years. Mean values for each measured parameter were determined at each age between 7 and 25 years. Subjects were also divided into nine age subgroups to observe the change of each parameter with advancing age. RESULTS The fronto-occipital circumference and outer canthal distance of males was significantly (p <.001) wider than females in all age groups. The near and distant interpupillary distances of male subjects were, on average, wider than the female subjects with greater differences with advancing age. Across all subjects aged 7 to 40 years, the mean of all measured parameters and calculated indexes of men and boys was significantly different from girls and women (p <.001). The mean for interpupillary distances in our study in both sexes were found to be similar to Arabian, Hong Kong, and British children; larger than those of Chinese, Black, Indian, and Caucasians; and smaller than those of Mexican children and a mixed European population. CONCLUSION This study clearly shows the anthropometric variation for fronto-occipital circumference, inner canthal distance, outer canthal distance, near and distant interpupillary distance, canthal index, and circumference-interorbital index with age. These developmental data and the normal values of these measurements in healthy subjects are useful for dysmorphologists in the early identification of some craniofacial syndromes, hyper- and hypotelorism, and congenital or posttraumatic telecanthus and of planning surgical intervention. We suggest that the comparison of craniofacial dimensions of a patient must be performed with normal standards specific for age as well as sex and race.

Comparative study of the effect of ultrasound and electrostimulation on bone healing in rats.

This study was performed to compare the effects of direct current with ultrasound on fracture healing. Thirty-two rats were subjected to the experiment. Each rats right legs were used as the experimental sample, and their left legs were used as the control. Four groups were formed, each consisting of 16 ultrasound, 16 electrostimulation, 16 ultrasound control, and 16 electrostimulation control animals. Fibular osteotome was applied to the rats under anesthesia. In the electrostimulation and electrostimulation control groups, a stainless steel cathode electrode was installed in the fractured side. In the electrostimulation group, 10 microA of direct current for 30 min, using a semi-invasive method, was given one day after fracture, for 15 days. On the control side, the aforementioned protocol was followed but sham treated. The ultrasound group was treated with 0.1 W/cm2 ultrasound for 2 min every second day for 6 days after fracture (4 times). Rats were killed on the 7th and 14th days to investigate the macroscopic, radiologic, and histopathologic parameters of fracture healing. There was a difference (P < 0.05) between the electrostimulation and the electrostimulation control groups on the 7th day. There was a difference (P < 0.05) between the ultrasound and ultrasound control groups on the 14th day. After statistical evaluation of the experimental results, it was found that in both the ultrasound and the electrostimulation groups, the fracture healing had been accelerated more so than in the control groups. There was no observed statistical difference between ultrasound and electrostimulation effects.

Eicosanoids and inflammatory cells in frostbitten tissue: prostacyclin, thromboxane, polymorphonuclear leukocytes, and mast cells.

&NA; The pathophysiology of cold injury is still controversial. An inflammatory process has been implicated as the underlying mechanism and certain anti‐inflammatory substances such as ibuprofen and acetylsalicylic acid have been used in the clinical treatment of frostbite injury. It has been postulated that the progressive ischemic necrosis is secondary to excessive thromboxane A2 production, which upsets the normal balance between prostacyclin (prostaglandin I2) and thromboxane A2. It was aimed to clarify the pathophysiology of cold injury in this study. Twenty‐one New Zealand White rabbits, each weighing 1.2 to 2.9 kg, were divided into control (n = 10) and frostbitten (n = 11) groups the randomly. The rabbit ears in the frostbitten group were subjected to cold injury, and the levels of thromboxane A2 (as thromboxane B2) and of prostaglandin I2 (as 6‐keto‐prostaglandin F1&agr;) and the number of inflammatory cells (polymorphonuclear leukocytes and mast cells) were measured in normal and frostbitten skin of rabbit ears. The levels of 6‐keto prostaglandin F1&agr; and thromboxane B2, the stable metabolites of prostaglandin I2 and thromboxane A2, respectively, were increased in a statistically significant way (p < 0.002) by frostbite injury; however, thromboxane B2 increased more than 6‐keto prostaglandin F1&agr;. Polymorphonuclear leukocytes and mast cells, absent in normal skin, were present in the frostbitten skin. There was a statistically significant (p < 0.01) correlation between the time a rabbit ear was maintained at below ‐ 10°C and skin survival and between the weights of rabbits and skin survival (p < 0.024). All these findings suggest that inflammation is involved in frostbite injury; a decrease in prostaglandin I2/thromboxane A2 ratio could be one of the factors leading to necrosis; the bigger the animal, the better its ability to counter frostbite. (Plast. Reconstr. Surg. 101: 1881, 1998.)

The Effects of Exogenous Melatonin on Peripheral Nerve Regeneration and Collagen Formation in Rats

BACKGROUND Peripheral nerve damage that requires surgical repair does not result in complete recovery because of collagen scar formation, ischemia, free oxygen radical damage, and other factors. To date, the best treatment method has not yet been determined. In this study, we designed an experimental peripheral nerve injury model, and researched the possible effects of melatonin hormone, based on evidence of its strong antioxidant and cell-protective effects via mimicking the effects of calcium channel blockers. MATERIALS AND METHODS We randomized 24 healthy female albino rats into three groups: the pinealectomy group, melatonin group, and control group. In the pinealectomy group, craniotomy, pinealectomy, sciatic nerve transection, and coaptation were performed, and 0.9% NaCl was injected intraperitoneally. In the melatonin group, craniotomy (without pinealectomy), sciatic nerve dissection, and coaptation were performed, and melatonin was injected intraperitoneally, instead of NaCl. In the control group, craniotomy (without pinealectomy), sciatic nerve dissection and coaptation, and intraperitoneal NaCl injection were performed. In each group, nerve recovery was evaluated histologically, functionally, and electrophysiologically. Functional and electrophysiologic evaluations were conducted before surgery and at 4 and 12 wk. RESULTS At 4 wk, no significant difference was observed between the groups. However, at 12 wk, significant electrophysiologic and functional improvement was observed only in the melatonin group. CONCLUSIONS Melatonin seems to have a beneficial effect on nerve recovery. However, this effect is not effective at physiologic doses. Future comparative studies with melatonin versus other nerve-regenerating agents are necessary to determine the clinical utility of melatonin hormone.

Versatility of botulinum toxin: a use in stabilization of pedicled muscle flaps.

Background: In this study, botulinum toxin A was used to secure the stabilization of muscle flaps without denervation atrophy. Methods: Thirty adult female Wistar rats were divided into a control group (group I, n = 10), a denervation group (group II, n = 10), and a botulinum toxin A group (group III, n = 10). In all of the groups, pedicled pectoralis major muscle flaps were elevated from the sternal attachment on the right side. In the second group, muscle flaps were denervated by transsecting the pectoralis major nerve after flap elevation; in the third group, botulinum toxin A (1.4 U of Dysport; Ipsen, Maidenhead, United Kingdom) was injected into the prepared muscle flap before flap replacement. The distance between the medial side of the muscle and the midline was measured at 4 weeks. Histopathological examination was performed 10 weeks after the first operation. The diameter of the muscle fibers was measured, and the degree of atrophy in the muscle flaps was evaluated in all groups. Results: Mean distances from the midline were statistically significantly different in all of the groups (p = 0.000, p < 0.01). There was a significant difference in muscle fiber diameter among the groups (p = 0.000, p < 0.01). Temporary denervation by botulinum toxin A and irreversible denervation with transsection of the motor nerve caused the reduced diameters of the muscle fibers. In addition, moderate to severe muscle atrophy in group II and mild to moderate muscle atrophy in group III were observed. Conclusions: In the pedicled muscle flaps, botulinum toxin A can be used easily and reliably for stabilization. It was concluded that detachment of the muscle flap might be prevented and operative morbidity decreased using this method.

Facilitated Tissue Expansion With Topical Estriol

Tissue expansion is a helpful technique in reconstructive plastic surgery. Unfortunately, tissue expansion still needs to be improved. Twenty-four male Wistar rats were used to evaluate the effect of estriol on tissue expansion. The agents hyaluronidase, estriol, and base cream (as a control) were applied topically to separate animal groups for 5 weeks, and their effects were studied on tissue expansion. Both hyaluronidase (p < 0.05) and estriol (p < 0.001) enhanced the rate of expansion when compared with control animals. Estriol was more effective than hyaluronidase (p < 0.05). Breaking strengths were measured in the estriol and the control groups. Breaking strength was not evaluated in the hyaluronidase group because of the necrotic changes seen at the end of the fifth week. The breaking strength was higher in the control group than in the estriol group (p < 0.05). The authors suggest that topical estriol be used as an adjunctive agent to facilitate tissue expansion.

Importance of hereditary factors in synchronous development of Basal cell carcinoma in two albino brothers: case report.

Oculocutaneous albinism is an autosomal recessive disease associated with hypomelanosis of the skin, hair, and eyes. Squamous cell carcinoma is the most common malignant neoplasm in this group. Those affected in the tropical populations have higher rates of metastatic lesions. Basal cell carcinoma (BCC) is the most common human cancer. Its incidence is steadily increasing. The etiology of BCC of the skin is characterized by a complex interaction of environmental, genetic, and lifestyle factors. The results of family and genetic studies provide support for the role of genetic factors in BCC, but most cases of BCC of the skin appear to be sporadic, and possible gene-environment interactions remain unknown. We have reported 2 brothers who have albinism and synchronous developed BCC on their trunk region. Unlike most of the albino patients, our cases have BCC instead of squamous cell carcinoma. Development of the same malignancy in the same life period at the similar localizations reminds the importance of genetic predisposition.

The Use of Z-Plasty in the Treatment of Vaginal Septum

A transverse vaginal septum is probably less common than congenital absence of the vagina and uterus. It has been diagnosed in newborns, infants, and older adolescent girls. Transverse vaginal septum varies in thickness and can be located at almost any level in the vagina but most often is located in the upper vagina. It is associated with few urologic or other anomalies and can lead to serious problems and symptoms. The diagnosis is made by clinical findings and radiologic evaluation. The treatment consists of simple excision, Z-plasty techniques, and various flaps. Two cases of transverse vaginal septum are reported here. In case 1 it is located in the upper vagina; in case 2, in the lower vagina. To eliminate the septum, Z-plasty was used to minimize the raw surface of the vagina. The remaining part of the raw surface in case 1 was covered with split thickness skin graft with fibrin glue.

Use of Gracilis Musculocutaneous Flap in the Treatment of Complex Rectovaginal Fistula with Rectal Incontinence: A Case Report

Occult sphincter injuries are quite common in normal vaginal delivery. These injuries may be symptomatic, especially in older patients. Rectal continence and function are disturbed when the complex rectovaginal fistula develops. Because of high recurrence rate in the treatment of complex rectovaginal fistula, a vascularized tissue transfer is required, especially in postmenopausal women. The authors report a case of complex rectovaginal fistula together with sphincter incontinence treated by gracilis musculocutaneous flap at the same time.