Nuket Gocmen-Mas

Anatomic evaluation of maxillary sinus septa: surgery and radiology.

The anatomical structure of the maxillary sinus is fundamental to maxillofacial surgery. The presence of septa, located at the inner surface of the maxillary sinus, increases the risk of sinus membrane perforation during sinus elevation for dental implant surgery. The aim of this study was to evaluate the anatomy of maxillary sinus septa.Data in this study was obtained from a total of 205 cases. One hundred and seventy‐seven patients were partially edentulous (PE) whereas 28 patients had no teeth. Dental computerized tomography (dental CT) was used in the assessment of 410 sinus segments (205 left and 205 right segments). The prevalence of sinus segments with septa was found to be 145/410. Septa were detected in 91 of the 177 PE cases. There were a total of 26 septa in 18 of the 28 completely edentulous (CE) cases. A total of 165 septa were detected in these segments. The prevalence of septa was 46.4% (26/56) in the CE, and 39.2% (139/354) in the PE segments. Thirty septa were found in the anterior, 110 in the middle and 25 in the posterior region. All detected septa were located mediolateral direction. Their relative position: lateral, middle or medial were also noted. The height measurements of the septa varied amongst the different positions. In view of the fact that septa of various heights and courses can develop in all parts of the maxillary sinus, timely and adequate assessment of the inner aspect of the maxillary sinus is essential to avoid complications during sinus augmentation procedures. Clin. Anat. 22:563–570, 2009.

Ocular and periocular injuries associated with an isolated orbital fracture depending on a blunt cranial trauma: Anatomical and surgical aspects☆

The anatomical location of fractures following blunt cranio-orbital trauma is important for neurosurgeons and maxillofacial surgeons. In this study, 588 cranio-orbital fractures following blunt trauma were evaluated retrospectively with regard to the anatomical site and surgical treatment. Orbital cranial nerve injuries and the outcomes of the medical and/or surgical treatment are described. Distribution of the zygomatic complex and orbital fractures were as follows: zygomatic complex fractures (n:304), isolated orbital fractures (n:58), complex comminuted fractures (n:226). In 58 cases, 69 orbit fractures were found (11 bilateral and 47 unilateral fractures). The lateral wall was the most frequent fracture (n:63). The least frequent fracture was the roof of the orbit (n:11). The accompanying lesions were as follows: 89.65% of cases were associated with periorbital haematoma (n:52), 13.79% of cases with retrobulbar haemorrhage (n:8), 96.55% cases with periorbital soft tissue oedema (n:56), 53.45% cases with pneumocephalus (n:31), 8.62% cases with intra-parenchymal contusion (n:5), 6.89% cases with enophthalmia (n:4), 5.17% of cases with rhinorrhoea (n: 3), 5.17% cases with optic bulb injury and adnexial trauma (n:3), 32.76% cases with intra-orbital emphysema (n:19), and 20.69% with vision dysfunctions (n:12), of whom 2 had no optic nerve injury.

Evaluation of Lumbar Vertebral Body and Disc: A Stereological Morphometric Study

El acceso anterior a las vertebras L1-L5 y espacios entre los discos puede ser tecnicamente dificil, con frecuencia requiere la participacion de un cirujano para una exposicion adecuada. La tecnica se utiliza para la extirpacion de la lesion, corpectomia, la reconstruccion del cuerpo vertebral con jaulas, realineamiento y / o placas o tornillos. Para un enfoque exitoso anterior y un diseno adecuado instrumental a traves de tornillo, un acabado conocimiento sobre la morfometria del cuerpo de las vertebras lumbares y de los espacios entre los discos y la evaluacion volumetrica son necesarias para el neurocirujano. El objetivo fue la evaluacion morfometrica y volumetrica de los cuerpos lumbares y los discos, para contribuir al abordaje seguro durante la cirugia. Se evaluo en 25 sujetos adultos, diestros, sin antecedentes de fracturas vertebrales y de enfermedad degenerativa espinal, el cuerpo vertebral y la morfometria del disco mediante estereologia con RM. La forma de las vertebras, el indice de concavidad y la definicion de las medidas volumetricas de los cuerpos L1-L5. Ademas, se midieron los parametros morfometricos como longitud, altura, ancho del cuerpo vertebral. Se efectuo un analisis morfometrico y volumetrico de loss cortes axiales y sagitales de los discos entre L1 y L5. Como era de esperar, las dimensiones promedio de las vertebras en los hombres fueron mayores que en las mujeres, pero la mayoria de ellos no son estadisticamente significativas. Solo tres dimensiones, la diferencia promedio entre la altura anterior y central de las vertebras L3, L4 y L5 mostraron diferencias estadisticamente significativas, indicando menor altura central tanto en los hombres como en las mujeres. Los diametros transversal y anteroposterior del cuerpo vertebral, la altura del disco intervertebral y el volumen no mostraron dimorfismo sexual (p>0,05). Sin embargo, aumentaron la altura del disco intervertebral y el volumen de L1 a L5 (p<0,01). Los indices de concavidad, de todas las vertebras lumbares, para ambos sexos, no diferian estadisticamente. El metodo es importante para el neurocirujano, para estimar el tamano y cantidad del implante y su aplicacion en las cirugias de descompresion.

Lumbar vertebra morphometry and stereological assesment of intervertebral space volumetry: a methodological study.

The use of technology in the treatment of degenerative spinal diseases has undergone rapid clinical and scientific development. It has been extensively studied in combination with various techniques for spinal stabilization from both the anterior and posterior approach. Minimally invasive and instrumental approach via posterior fixation is increasingly being used for the treatment of adult degenerative disc disease, stenosis, and deformity of the lumbar vertebrae. Posterior access to the lumbar disc spaces for posterolateral fusion scan has been technically challenging, frequently requiring the use of an approach surgery for adequate exposure. For successful surgery and suitable instrumental design, adequate anatomical knowledge of the lumbar vertebra is also needed. Anatomic features of lumbar vertebrae are of importance for posterior screw fixation technique. The morphometry of L1-L5 has been studied to facilitate the safe application of pedicle screws. Thus, we aimed to evaluate the morphometric landmarks of lumbar vertebrae such as pedicle, vertebral body, vertebral foramen, intervertebral space height and volume for safe surgical intervention using a posterior fixation approach to offer anatomical supports for lumbar discectomy, stenosis and cases of deformity. The features of the L1-L5 vertebral body, the detailed morphometric parameters of lumbar vertebrae and the intervertebral space were analyzed using computerized tomography scan, magnetic resonance imaging and also dry lumbar vertebrae. Additionally, intervertebral space volumes were measured using stereological methods to ensure safe surgical intervention.

Evaluation of Cerebellar and Cerebral Volume in Migraine with Aura: A Stereological Study

Migraine is associated with an increased risk of deep white matter lesions and subclinical posterior circulation infarcts. A significant association between deep white matter hyperintensities and cerebral atrophy is true for various neurological diseases; it was not specifically proven in migraine. The aim of this study was to evaluate the cerebellar and cerebral volume and volume ratios for cerebellum using the Cavalieri principle. We also aimed to examine whether migraine with aura causes cerebellar and cerebral atrophy. Twenty three right-handed patients with migraine with aura diagnosed by means of the International Headache Society criteria and 24 age-matched subjects whose only health problem was headache due to rhinosinusitis and tension type headache were included in the study. Measurements of the cerebellar and cerebral volumes as well as cerebellar/cerebral volume ratios were made using Cavalieri’s principle by utilizing the point-counting methods. There were no significant differences between the volumes of cerebrum, cerebellum, and the ratio of cerebellum to cerebrum for males (p = 0.05, p = 0.10, and p = 0.64, respectively) and for females (p = 0.18, p = 0.89, and p = 0.24, respectively). Our results suggest that patients with migraine with aura do not have a significant difference in cerebellar and cerebral volumes and cerebellar/cerebral volume ratios compared to the non-migraine group.

Evaluation of Cerebellar Asymmetry in Alzheimer's Disease: A Stereological Study

Objectives: Alzheimer’s disease (AD) is the most common cause of dementia and, as previous studies have indicated, degenerative changes in the cerebellum occur in AD. It is well known that the cerebellum does not have a symmetric morphology and some pathological disorders, such as schizophrenia, epilepsy, autism and alcoholism, can cause asymmetrical changes in the cerebellum. In this study, we aimed to evaluate whether or not patients with AD show cerebellar asymmetry. We also intended to depict the probable volumetric asymmetry by using a stereological technique. Materials and Methods: The study evaluated the volu- metric measurements of each cerebellar hemisphere by applying a stereological method to MR images. This age- and gender-matched study was composed of 15 patients with probable AD and 14 healthy subjects (controls). MR images were analyzed by using the point-counting approach, holding to Cavalieri’s principle. Results: Although there was significant cerebellar atrophy in AD patients, the study showed no statistically significant cerebellar asymmetry according to age and gender, both in the study and control groups (p > 0.05). Conclusions: There was no difference in cerebellar asymmetry associated with age and gender between the AD patients and control subjects. The stereological evaluation of cerebellar asymmetry correlating with gender is of importance to both clinicians and anatomists. The technique is simple, inexpensive, reliable and unbiased.

Clinical and stereologic evaluation of osteochondroma

Osteochondroma is a benign tumor that is unusual in the maxillofacial region. Anatomy of the region, especially the mandible, is important for surgical intervention for the condylar osteochondroma. The present case report describes evaluation of condylar hyperplasia with emphasis on the advantages and disadvantages of sterolithographic solid model and stereologic techniques for preoperative surgical planning, operation time, and prognosis. Condylar osteochondoma was diagnosed by panoramic radiograph and 3-dimensional computerized tomography (3DCT) as well as histopathologic analysis in a male patient. Before surgery, a stereolithographic model was created and stereologic method was used based upon 3DCT.

Effect of ligamenta flava hypertrophy on lumbar disc herniation with contralateral symptoms and signs: a clinical and morphometric study

Introduction The purpose of this study was to determine whether ligamentum flavum hypertrophy among disc herniated patients causes contralateral pain symptoms. For this reason we measured the thickness of the ligament in disc herniated patients with ipsilateral or contralateral symptoms. Material and methods Two hundred disc herniated patients with ipsilateral symptoms as group I were compared with five disc herniated patients with only contralateral symptoms as group II. Ligamenta flava thicknesses and spinal canal diameters of both groups were measured on magnetic resonance imaging (MRI) with a micro-caliper. Results Both groups underwent surgery only on the disc herniated side. The total thicknesses of the ligamenta flava in group II was thicker than in group I. There was no spinal stenosis in either group and no significance difference between the groups. Statistically significant differences were found for both ipsilateral and contralateral thickness of the ligament flava in both groups. We also compared thickness of the ligamenta flava for each level of disc herniation in group I; ligamenta flava hypertrophy was more common at L3-L4 and L4-L5 levels of vertebrae in females. Conclusions Aetiology of contralateral sciatica among disc herniated patients may be related to hypertrophy of the ligamenta flava, especially on the opposite side. Surgical approaches of the disc herniated side alone may be sufficient for a good outcome.

Multiple Abnormal Unerupted Mandibular Permanent Molar Teeth: A Case Report

Los molares permanentes anormales no erupcionados multiples, ademas de otras anomalias del desarrollo de los dientes, desde hace tiempo han recibido atencion de anatomistas y cirujanos maxilofaciales. Este articulo presenta un caso clinico de un paciente masculino de 23 anos de edad, que fue admitido en el Departamento de Cirugia Maxilofacial de la Facultad de Odontologia de la Escuela de Medicina Gulhane, con una historia de seis meses de dolor, en la posicion de descanso y durante la masticacion, asi como dolor en su cuerpo mandibular derecho. Fue encontrada la impactacion que resulta de la falla en la erupcion y la dislocacion de la anatomia normal del desarrollo en tres molares mandibulares. En el examen extraoral fue definida asimetria facial del lado derecho. El diagnostico de molares mandibulares anormales no erupcionados multiples fue confirmado por radiografia panoramica e imagenes de tomografia 3D. El diente invertido no erupcionado fue el tercer molar que se encontro en la base de la mandibula en el lado derecho. En el otro lado, el primer molar se posiciono sobre la base de la mandibula distoangularmente. El segundo molar se encontro verticalmente en medio del cuerpo mandibular izquierdo. Tambien, el tercer molar erupciono mesioangularmente. La longitud del arco fue evaluada por el cirujano oral. La distancia mesio-distal entre los dientes fue suficiente. Las causas de impactacion de los dientes permanentes podrian haber sido influenciadas por los factores locales, tales como la retencion prolongada de dientes deciduos o germenes dentales malposicionados, pero no fueron provocados por deficiencia de longitud del arco y dientes supernumerarios. Anomalias tales como las reportadas en el presente caso, son importantes en la cirugia maxilofacial.

Morphometrical aspect on angular branch of facial artery.

AbstractAnatomic variability and anastomosis of the angular artery of the facial artery with the other arteries are important for both anatomists and surgeons. In particular, the angular artery is a significant landmark in dacryocystorhinostomy. Because of variations on anatomy of the angular artery, there are limited numbers of anatomic studies on the flaps of facial region. Hence, the aim of the cadaveric study was to evaluate the anatomic features of the angular artery in detail to help surgical procedures.The artery was represented under ×4 loop magnification in 32 sides of 16 formalin-fixed adult cadavers. The angular arterys position, diameter, and branch patterns relevant to the nose arterial supply were evaluated. The facial artery ended symmetrically in 10 (62.5%) of the cadavers. The facial artery was terminated as angular artery in all of the cases. The types of the angular artery were as follows: classical angular type in 8 cases (25.0%), nasal type in15 cases (46.9%), alar type in 4 cases (12.5%), and labial type in 5 cases (15.6%) on the facial halves. We studied the topographic anatomic features of the angular artery for increasing reliability of the flaps on the region. The angular arterial anatomic details are critical and essential for surgical cosmetic and functional results.