Naci Celik

Management of frontoethmoidal (sincipital) encephalocele.

Frontoethmoidal encephaloceles are congenital malformations that cause complex deformities in the frontal, orbital, and nasal regions. As the term implies, with frontoethmoidal encephaloceles, intracranial material has herniated through the dural and skull defect. In this report, 21 patients with frontoethmoidal encephalocele operated by a craniofacial team are presented, and accompanying anomalies, results, and complications are discussed.

Prophylactic use of ondansetron for emesis after craniofacial operations in children.

Children who undergo craniofacial operations are especially at risk of postoperative nausea and vomiting. These operations are more complex than the craniotomies for resective procedures. Postoperative vomiting is a common occurrence that can delay recovery and result in cerebrospinal fluid leak and fistula formation in these patients. Ondansetron, a selective serotonergic antagonist, is effective in reducing postoperative nausea and vomiting in several high-risk populations. In a randomized, double-blind, placebo-controlled study, the authors compared the prophylactic use of intravenous ondansetron 0.15 mg/kg with induction of anesthesia versus a placebo of normal saline 0.3 ml/kg with induction. A second dose was given 8 hours after the first dose. After surgery, episodes of vomiting were recorded separately in 0 to 2 hours, 2 to 6 hours, 6 to 12 hours, 12 to 24 hours, and 24 to 48 hours. Postoperative vomiting is significantly reduced in the ondansetron group compared with the placebo group (P = 0.000258). Ondansetron is effective in the prevention of postoperative vomiting in the pediatric population undergoing craniofacial operations.

Van der Woude syndrome

Van der Woude syndrome (VWS) is an autosomal dominant craniofacial syndrome with variable expression characterised by congenital pits and sinuses in the lower lip together with cleft lip, or palate, or both. We report a case of VWS, which occurred as a new mutation, and review previous reports.

Comparing the osteogenic capacities of bone substitutes: hydroxyapatite, high-density porous polyethylene, and bone collagen: a biochemical and histological analysis.

Several inorganic materials have been shown previously to hold some osteogenic capacity. The purpose of this study is to compare the bone-forming abilities of hydroxyapatite ceramic, high-density porous polyethylene, and bone collagen within the periosteal island flap of rabbit tibia using histological and biochemical analysis. With this goal, four discrete experimental groups were formed, each comprising 22 New Zealand male rabbits. A sac was created on each rabbit tibial periosteum flap in each of the groups, and each of the previously mentioned materials was placed within this sac separately. One of these groups was thought as a control group without any material being placed inside the periosteal sac. Biopsies were taken at weeks 1, 2, 4, and 8 for biochemical analysis and at weeks 2 and 8 for histological evaluation. Neo-osteogenesis was evaluated quantitatively by determination of alkaline phosphatase and osteocalcin levels biochemically as well as by the percentage of new bone formation inside the periosteal sac histologically. Results show statistically that the osteogenic effect of high-density porous polyethylene is greater than that of the other materials used in this study (P < 0.05).

Congenital infiltrating lipomatosis of the face.

Congenital infiltrating lipomatosis of the face is a rare clinical entity. Since it was first described by Slavin and colleagues in 1989, only a few cases have been reported in the literature. A 6-year-old girl with congenital infiltrating lipomatosis of the right side of the face is presented, and treatment modalities are discussed.

Transsacral usage of a pure Island TRAM flap for a large sacral defect : A case report

A pedicled transverse rectus abdominis musculocutaneous (TRAM) flap was used to reconstruct a large sacral defect retroperitoneally. Muscle and superiorly located skin were elevated on the deep inferior epigastric pedicle. The flap was transposed retroperitoneally from the abdominal wall to the sacral region of the patient. The selection criteria for this particular flap are discussed and compared with other reconstructive choices.

The role of periosteum and different dissection types on callus formation: quantitative analyses with scintigraphy in a rabbit mandible model.

&NA; In this experimental study, the effects of different dissection types and the role of the periosteum on callus formation were investigated. Forty‐five rabbits were divided into three groups of 15 rabbits. In the first group, a classic subperiosteal dissection was performed to reach the mandible. In the second group, the dissection was done extraperiosteally between the periosteum and the muscle. In the third group, the periosteum at the osteotomy line was stripped out bilaterally both on the lingual and the buccal sides (1.5 cm wide on each side). In all groups, linear vertical osteotomy was performed using an oscillating saw, and fracture fragments were fixed with surgical wire. The animals were evaluated using biomechanical (traction test), histological, and scintigraphic methods. The most durable callus in the traction test and, scintigraphically, the most rapid remodeling were seen in the second group. The histological study performed during week 3 revealed immature callus formation in the first and second groups, and no such formation in the third group. At week 8 the callus was mature in the first two groups and in the third group it was seen but not mature. Bilkay U, Çelik N, Bilkay Ü, Görken C, Alper M, Songür E, Çağdaş A. The role of periosteum and different dissection types on callus formation: quantitative analyses with scintigraphy in a rabbit mandible model. Ann Plast Surg 2000;45:48‐53

Complications in craniofacial surgery: the Turkish experience.

The records of 71 patients who underwent 75 consecutive craniofacial procedures involving a transcranial component have been analyzed retrospectively to assess the incidence and type of complications encountered during the 14-year period of 1985 to 1998 at Ege University Hospital, Department of Plastic and Reconstructive Surgery. The results were compared with those of similar reports from other craniofacial centers. Operations were classified into six groups according to their type to evaluate effectively their complication rates. Complications were also graded in terms of their severity. Serious complications were seen in 12 patients (16.8%), whereas life-threatening complications were seen in 6 patients (8, 4). The mortality rate was 2.7%. It is determined that complication incidence was notably higher in the group that underwent monobloc frontofacial advancement. A decrease in the rate of serious complications occurred with increased experience with the surgery. The results of our study indicate that although craniofacial surgery carries an inherent risk for significant complications, the risk can be minimized and the rate of mortality and major complications kept to an acceptable level by a careful and experienced craniofacial team.