Omer Faruk Kocak

Use of rotation flap in repair of cleft palate and velopharyngeal insufficiency.

Although cleft palate anomaly is frequent, the criterion standards in surgical treatment have not been determined yet. There are a few techniques described for cleft palate repair owing to the limited tissue in the palatal mucosa, the rigid structure of the palatal mucosa, and the limited vascularity of the hard palate. In this study, a novel cleft palate repair technique based on separating the soft palate from the hard palate as a musculomucosal flap and using it as a rotation flap has been described. The operation is evaluated individually for each anomaly because variations occur in the surgical technique according to the extension of the cleft toward the teeth in the palate. This operation was performed on a total of 28 patients (17 girls and 11 boys) aged between 1.5 and 16 years and presented to our clinic. Patients were assessed for speech analysis outcomes, tympanogram values, hearing functions, magnitude of palatal lengthening during the operation, and rate of fistulae. Statistically significant differences in values of the speech analysis and the audiometric assessment were determined between before and 6 months after surgery. Complete recovery of otitis was observed 1 month after surgery without another treatment in 9 (42.8%) of 21 patients who were detected to have serous otitis media preoperatively. Tension-free closure, lower risk of fistula, good restoration of velopharyngeal functions, ability to be performed on all types of cleft palate, ability to provide a good intraoperative exposure, and being a single stage seem to be the most important advantages of this technique.

Comparison of the Fistula Risk Associated With Rotation Palatoplasty and Conventional Palatoplasty for Cleft Palate Repair

Objectives The aims of the cleft palate repair techniques are to reduce the velopharyngeal insufficiency risk and oronasal fistula development to minimal levels without affecting the maxillofacial development. In this article, we present a retrospective study comparing the conventional palatoplasty techniques with the new technique of rotation palatoplasty for the risk of development of oronasal fistula. Materials and Methods Of the 100 patients who were operated on because of cleft palate between the years 2002 and 2008, 12 patients had Furlow palatoplasty, and 88 patients received the Veau-Wardill-Kilner (V–Y pushback) operation (group C). A total of 67 patients who were operated on between 2008 and 2011 had rotation palatoplasty (group R). Results One hundred patients were men, and 67 were women. Among all the patient groups, 22.8% were classified as Veau 1, 24.6% were classified as Veau 2, 37.1% were classified as Veau 3, and 15.6% were classified as Veau 4. The rate of fistula was found to be 17.7% in all patients. Fistula development was found in 6% of the patients in group R (4/67) and in 18% of the patients in group C (18/100). The difference between group R and group C regarding the number of patients who developed fistula was statistically significant (P = 0.011). Conclusions The Veau classification of the cleft palate affects the risk of fistula development, and the risk for fistula after rotation palatoplasty is lower than that associated with the V–Y pushback technique.

An Ideal Flap Alternative for Closure of Myelomeningocele Defects: Dorsal Intercostal Artery Perforator Flap.

Background:Dorsal intercostal artery perforator (DICAP) flap is an ideal flap to be used for posterior trunk defects since it leads to lower donor-site morbidity and shorter operative times, offers easy surgical planning, and uses a reliable and easily identifiable artery. Materials and Methods:The study retrospectively reviewed 52 patients with meningomyelocele defects that were closed with DICAP flap between January 2007 and May 2015. Surgical Technique:Each of the 4th to 12th posterior intercostal arteries can be used as dorsal perforators. The dominant direct cutaneous perforators derive from the 4th, 5th, 6th, 10th, and 11th posterior intercostal arteries. These perforators are located 5 cm medial to the spinous processes of the thoracic vertebrae and can be easily identified. Conclusion:Dorsal intercostal artery perforator flap is a reliable flap alternative for the defects seen in neonates, including myelomeningocele, oncologic resections, burn defects, and radiation burns since it is a thin flap and offers easy surgical planning and shorter operative times.

Congenital Lateral Cleft Palate of Unknown Etiology.

The term cleft palate (CP) refers to midline defects extending from the prealveolar ark to the uvula, and these defects present with varying degrees. CP may be complete, incomplete, unilateral, bilateral, or submucosal. It is often observed with cleft lip (CL). In various studies, the incidence of isolated CP has been reported as 1.3 to 25.3 per 1000 births. As a result of deterioration of the anatomical structure of the palate, illnesses such as regurgitation, respiratory tract infections, otitis, and speech disorders may occur. These defects are often observed in the midline and are rarely laterally localized. Cleft palates with lateral localization are outside the natural midline cleft closure line and cause clinical complaints similar to other types of CP. Two cases of laterally localized CP have previously been published in the literature. The case presented here is the third known case to be reported.

A new alternative flap in the closure of meningomyelocele defects: modified S flaps

Neural tube defects occur within the first four weeks of gestation and can be seen in a variable range from anencephaly to spina bifida. The most common form of spina bifida is meningomyelocele. Its etiology is multifactorial including genetic, geographical, and ethnic factors, low socioeconomic status, and folic acid deficiency (2). The incidence of neural tube defects has been reported as one per 1,000 live births (3).

Comparison of Enalapril, Candesartan and Intralesional Triamcinolone in Reducing Hypertrophic Scar Development: An Experimental Study

BackgroundThe purpose of this study was to compare the effects of oral enalapril, an angiotensin-converting enzyme inhibitor (ACE-I), oral candesartan, an angiotensin receptor blocker (ARB), and intralesional corticosteroid treatments in reducing scar formation.MethodsTwenty male rabbits were divided into five study groups: A (sham), B (control), C (ACE-I), D (ARB) and E (intralesional corticosteroid). The rabbit ear hypertrophic scar model was used. The hypertrophic scars were photographed and analyzed with the program ImageJ quantitatively to determine the degree of collagen fibers. The scar elevation index (SEI) was calculated at the end of the 40th day. Tissue samples were stained with hematoxylin and eosin and Masson’s trichrome and examined under light microscopy for the determination of fibroblast number, epithelization, vascularization, inflammation and fibrosis.ResultsThe SEI was the highest in the control group with the highest number of fibroblasts under the epithelium. In the steroid group, the SEI was significantly lower than both the ACE-I (p: 0.02) and ARB (p: 0.001) groups. The density of type 1 collagen fibers was the lowest in the control group, whereas type 3 collagen fibers were highest in that group. The ACE-I and ARB groups were similar regarding densities of type 1 and type 3 collagen fibers. The density of type 1 collagen fibers was the highest in the steroid group, whereas the density of type 3 collagen fibers was the lowest in that group.ConclusionsEnalapril, candesartan and intralesional steroid therapies were all effective in reducing scar tissue development; however, enalapril and steroid groups revealed better results.No Level AssignedThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Mean Platelet Volume, Red Cell Distribution Width, and Neutrophil-to-Lymphocyte Ratio Before and After Surgery in Patients With Carotid Body Tumors

Objective: Carotid body tumors (CBTs) are rare hypervascular benign tumors that originate from the paraganglia at the carotid bifurcation. The red cell distribution width (RDW), neutrophil-to-lymphocyte ratio (NLR), and mean platelet volume (MPV) may serve as markers in inflammatory, cardiovascular, and neoplastic diseases. However, their prognostic value in CBTs is unknown. The purpose of this study was to assess the leukocyte count, MPV, RDW, and NLR before and after surgery in patients with CBTs. Methods: This retrospective trial included data from 80 patients with CBTs and 65 age-matched healthy controls. The leukocyte, neutrophil, lymphocyte and platelet counts, RDW, and MPV were extracted and NLR was calculated from the complete blood count results of participants. Results: The leukocyte and neutrophil counts as well as RDW levels were significantly increased in patients with CBTs compared with healthy controls (P = 0.005, P = 0.003, and P = 0.026; respectively). Patients with CBTs had lower lymphocytes counts (P = 0.241) and higher NLRs (P = 0.054); however, the difference was statistically insignificant. Moreover, no statistically significant difference was detected between groups in terms of platelet counts and MPV levels. Furthermore, the leukocyte count, platelet numbers, MPV, RDW, and NLR levels in patients with CBTs were not statistically significant after surgery (all; P > 0.05). Conclusion: This is the first study that documents the increased RDW levels and leukocyte count in patients with CBTs. The combined use of RDW and the leukocyte count along with other clinical assessments can be used as a biomarker for CBTs. Further clinical trials with larger cases series are required to determine the actual predictive roles of these systemic biomarkers.

The acute effects of thymoquinone on acute peripheral nerve injury: an experimental study

BACKGROUND The purpose of this study was to evaluate the acute effects of thymoquinone (TQ) on acute nerve injury. METHODS A rat model of crush injury of the sciatic nerve was used. Animals were divided into 3 groups: control, trauma, and TQ treatment groups (n=6 per group). Seven days after injury, sciatic nerve specimens were obtained from the site of the injury and analyzed histologically and stereologically. Axon diameter, myelin thickness, and axon density were measured. RESULTS There were no significant differences in axon diameter, myelin thickness, or axon density among groups. CONCLUSION TQ has no acute therapeutic effect on acute nerve injury.

Effects of ozone pretreatment on viability of random pattern skin flaps in rats

Abstract Background: Medical ozone is a chemical agent that consists of three oxygen atoms and has antioxidant, angiogenic and vasodilator effects. This study evaluated the effects of medical ozone pre-treatment on flap survival. Materials and methods: Rats were divided into four groups of 10 rats each and a 9 × 3 cm McFarlane flap was used. Sham group: Neither surgical nor ozone pretreatment was used. Control group: No pretreatment was used after surgery. Preoperative ozone group: Preoperative 1 mg/kg ozone was given intraperitoneally for 7 days. No pretreatment was used after surgery. Postoperative ozone Group: Postoperative 1 mg/kg ozone was given intraperitoneally for 7 days. After postoperative 1 week, all groups were evaluated by surface area measurement, histopathology and electron microscopy. Results: With the experimental McFarlane flap model, the experimental groups had better surface area measurements, along with histopathological and electron microscopic results when compared with the control group. Conclusion: Medical ozone had positive effects on flap survival due to its antioxidant, angiogenic and vasodilator qualities.

Comparison of the effect of the rotation palatoplasty and V–Y pushback palatoplasty techniques on palate elongation with magnetic resonance imaging

Most surgical techniques used in cleft palate repair require the extension of the palate to the pharynx. However, no adequate information exists regarding the extent to which this elongation obtained during operation continues in late postoperative period. In this study, we compared and measured palate elongation in patients with a cleft palate who underwent a V-Y pushback or rotation palatoplasty, by means of magnetic resonance images obtained before and 1 year after surgery. The hard palate, soft palate, and total palate lengths were measured for all of the patients, and the velopharyngeal opening area width was calculated. In patients who underwent the V-Y pushback technique (n=13), the total palate and soft palate lengths were shortened by an average of 0.10 and 0.14cm after surgery, respectively. However, the hard palate length was elongated by an average of 0.13cm. In the rotation palatoplasty group (n=13), the total palate, hard palate, and soft palate lengths were elongated by 0.57, 0.10, and 0.49cm, respectively. The velopharyngeal opening was narrowed by 0.06cm(2) using the V-Y pushback technique and by 0.29cm(2) using the rotational palatoplasty. This study demonstrated that the palate does not elongate during the V-Y pushback technique, as expected. However, rotational palatoplasty elongates the soft palate.