Sebahattin Kandal

Reconstruction of Traumatic Orbital Floor Fractures With Resorbable Mesh Plate

Various materials such as autogenous bone, cartilage and alloplastic implants have been used to reconstruct orbital floor fractures. A new material is needed because of disadvantages of nonresorbable alloplastic materials and difficulties in harvesting autogenous tissues. In this study safety and value of the use of resorbable mesh plate in the treatment of orbital floor fractures are discussed. Between 2002 and 2004 a total of 17 maxillofacial trauma patients complicated with orbital floor fractures were treated with resorbable mesh plate through subciliary or transconjunctival incisions. Pure blow-out fractures were determined in 6 patients and 11 patients had accompanying maxillofacial fractures. Resorbable plate was easily shaped to fit to the orbital floor by cutting with scissors. Patients were evaluated clinically and with computed tomography scans preoperatively and at 3-, 6- and 12-month intervals postoperatively. Twelve patients had preoperative enophthalmos. Two patients had diplopia that was corrected postoperatively. In all 17 cases there was no evidence of infection, diplopia and gaze restriction postoperatively. Scleral show appeared in three patients by the second postoperative week but resolved totally within 3 to 6 weeks except one patient. In this patient anterior displacement of mesh was evident which caused ectropion and enophthalmos and required re-operation. No any other mesh related problems were seen at 15 months mean follow-up time. The advantage of the resorbable mesh system in orbital floor fracture is the maintenance of orbital contents against herniation forces during the initial phase of healing and then complete resorption through natural processes after its support is no longer needed. Our experience represents that resorbable mesh is a safe and effective material for reconstruction of the selected, non-extensive orbital floor fractures.

Odontogenic keratocyst: an unusual location and review of the literature.

Odontogenic keratocyst is an epithelial developmental odontogenic cyst most commonly occurring in the jaws. It comprises approximately 11% of all cysts of the jaws. It has an aggressive behavior including high rates of recurrence, rapid growth, and extension into adjacent tissues. Odontogenic keratocyst is commonly found in the mandible with a predilection for angle and ascending ramus of the mandible. We document a case of odontogenic keratocyst that is unusually originated from the temporomandibular joint and we review the existing literature concerning odontogenic keratocyst. As far we know this is the first case of the odontogenic keratocyst originating from the temporomandibular joint in the English-written literature.

Upper lateral cartilage fold-in flap: a combined spreader and/or splay graft effect without cartilage grafts.

Dorsal hump reduction almost always breaks the internal nasal valve and nasal obstruction is likely to occur postoperatively, unless reconstructed. One hundred eighty patients were operated using both open and closed rhinoplasty approaches. Upper lateral cartilages were meticulously separated from their junction with septum. Following bony and septal cartilaginous hump removal, upper lateral cartilages were folded inward. Either transcartilaginous horizontal mattress/simple sutures or perichondrial sutures were used depending of the desired width of the middle vault and the necessity for a splay-graft effect. In 7 patients unilateral, and in 1 patient bilateral, nasal synechia occurred and they were all treated under local anesthesia. All patients but 9 stated significantly improved nasal breathing. There was no inverted-V deformity or middle-vault narrowing observed. This technique is simple and physiologic, might be applicable for almost all primary rhinoplasty patients. Although it is possible with closed rhinoplasty approaches, it is easier with an open approach.

Suction-Assisted Lipectomy for Treatment of Lower-Extremity Lymphedema

Lymphedema typically occurs on the extremities and affects millions of people throughout the world. Although currently there is no single treatment proven effective for lymphedema in every patient, suction-assisted lipectomy has been shown to be effective in some patients. Suction-assisted lipectomy offers patients with lower-extremity lymphedema a less invasive, less morbid surgical option compared with traditional excisional techniques. In this article we present a case of lymphedema reduction with suction-assisted lipectomy in a patient with bilateral lower-extremity lymphedema.

Thoracodorsal Artery Perforator Flap: A Versatile Alternative for Various Soft Tissue Defects

Thoracodorsal artery perforator (TDAP) flap is a relatively new member of the perforator flap family. The objective of this study is to describe the use of pedicled and free TDAP flaps for various soft tissue defects. Fifteen patients underwent soft tissue reconstruction using 16 TDAP flaps. Twelve pedicled flaps were used for axillary, breast, and shoulder regions. Four free flaps were used for cheek, popliteal, hand, and foot reconstruction. The flaps were harvested based on the perforators, which were preoperatively located at or close to a point 8 cm below the posterior axillary fold and 2 cm behind the lateral border of the latissimus dorsi muscle. Early, late, major, and minor complications were documented. In 13 of the 16 flaps, perforators from the thoracodorsal artery were found in the circle 3 cm in diameter, centered on the anatomic landmark. Three other perforators were found outside this circle. One flap loss was considered the only major complication. Minor complications occurred in 12.5% of flaps. Although the vascular anatomy can be variable, free and pedicled TDAP flap is a versatile option in soft tissue reconstruction.

Correlation between vessel diameters of superficial and deep inferior epigastric systems: Doppler ultrasound assessment

BACKGROUND The deep inferior epigastric artery perforator (DIEAP) flap is a technically demanding procedure and the dissection is directly influenced by the size of the perforator vessels. There is a common belief that the size of the superficial inferior epigastric vein (SIEV) is inversely proportional to the perforators from the deep inferior epigastric system. To investigate the validity of this hypothesis, we evaluated and compared the diameters of the SIEV and deep inferior epigastric perforator vessels (DIEP-A and DIEP-V). METHODS Between 2004 and 2006, 50 patients scheduled for breast reconstruction with autologous tissue were evaluated with colour Doppler ultrasound to determine the diameters of SIEV and DIE perforator vessels. The correlation between SIEV and ipsilateral DIEP-V, the correlation between DIE perforator vessels on each side and the impact of body mass index were assessed. Results were analysed statistically to compare the diameter of the SIEV with the largest perforator on the same side and the largest perforators on the contralateral side. Additionally, partial correlation coefficients were calculated to assess if there is an inverse correlation between SIEV and DIE perforators. RESULTS Diameters of SIEV ranged from 0.50 to 4.06 mm. DIEP-A ranged from 1.00 to 3.49 mm, while DIEP-V ranged from 0.50 to 4.32 mm. There was a slightly inverse correlation between the size of SIEV and DIEP-V, but this was not statistically significant. However, the correlation between SIEVs on both sides was statistically significant. There was also a strong correlation between the size of DIEP-A and DIEP-V on the same side as well as the size of those on the contralateral side. However, the largest artery and vein matched only in 50% of perforator bundles on the right and 62% on the left side. In addition, the vessel diameters increased as the body mass index increased; however, this finding was significant only for perforator veins. CONCLUSION The inverse correlation between the size of SIEV and DIEP-V was not significant. If SIEV and DIE perforator vessels are large on one side, they are also large on the other side. In addition, the larger the artery, the larger is the vein on the same perforator. However, the largest arteries and veins are not necessarily on the same perforator bundle.

Giant neurothekeoma in the forearm of an infant

Neurothekeomas are benign tumours of nerve sheath origin. Neurothekeomas present most commonly on the head and neck and upper extremities. These are usually small, slow growing tumours. Most patients with neurothekeoma are young women. We describe a 1-year-old infant with a large and extensive neurothekeoma in the upper extremity. We believe that our patient is one of the youngest cases and the tumour is probably the largest and most extensive neurothekeoma reported in the literature.

Effects of Rat Bone Marrow-Derived Mesenchymal Stem Cells and Demineralized Bone Matrix on Cranial Bone Healing.

BackgroundStudies in tissue engineering about mesenchymal stem cells (MSCs) provide promising results for bone regeneration. The aim of this study was to evaluate the effects of rat bone marrow–derived MSCs (rMSCs) alone and when combined with demineralized bone matrix (DBM) on critical-sized cranial defects of rats. MethodsTen rats were used to obtain allogeneic rMSCs. Forty rats were separated equally into 4 groups. A full-thickness circular bone defect was created in the frontal bone of the rats. Group 1 was an operative control group. In group 2 DBM, in group 3 rMSCs, and in group 4 DBM combined with rMSCs were applied into the defects. Bone regeneration was evaluated by computed tomographic analysis and immunohistochemistry. ResultsIn radiological evaluation, the percentage of area healed in group 3 at the 12th week was statistically significantly greater than in group 1. In group 3 and group 4, distributed healing patterns were observed more than in group 2 and in group 1. Immunohistochemical evaluation revealed that group 4 had the best osteoinductive potential. Osteoinductive potential of group 3 was similar to group 2 and was better than group 1. ConclusionsAllogeneic rMSC applications have created a statistically significant radiologic reduction of the bone defect areas at the end of the 12 weeks. The MSC applications have also increased the bone density and changed the healing patterns. Combined use of the DBM and rMSCs has created more osteoinductive responses. This combination can provide better results in craniofacial bone reconstruction.

Reconstruction of cranial bone defects using Struthio camelus eggshell.

Background: There are many synthetic materials for the treatment of bone defects, which have their own advantages and disadvantages. We aimed to compare the efficacy of ostrich eggshell, which is cheap and easily available, and demineralized bone matrix in healing of cranial bone defects. Methods: A full-thickness circular bone defect was created in the frontal bone of 40 Wistar rats. Group 1 was the operative control group. In group 2, demineralized bone matrix applied into the defects; in group 3, Struthio camelus (ostrich) eggshell implants (OSIs) were applied into the defects; and in group 4, ostrich eggshell powders were applied into the defects. Computed tomographic analysis was performed to evaluate the healing of bone defects, the bone density, the OSI area measurements, and the OSI volume and density. At the end of the 24th week, all rats were killed. New bone formation, infection, resorption, and tissue reactions were evaluated. Results: Ostrich eggshell implants were slightly resorbed, integrated with bone, stable, and supplied good cranial completeness. Ostrich eggshell powders were totally resorbed at the sixth month. There were no significant differences between control and ostrich eggshell groups in new bone formation. Conclusions: Ostrich eggshell did not seem to be an osteoproductive material, but it has some important advantages as an implant. Ostrich eggshell has a strong structure, is cheap, is shaped easily, and does not cause tissue reaction or infection. Ostrich eggshell could be a good alternative graft material for craniomaxillofacial procedures. Further studies are required to find out the potential use of the ostrich eggshell in craniomaxillofacial reconstructions.

P93: Upper Lateral Cartilage Fold-In Flap: A Combined Spreader and/or Splay Graft Effect without Cartilage Grafts

Upper lateral cartilages are attached to the septum in an obtuse angle forming a ‘T’ shape. Dorsal hump reduction during rhinoplasty almost always breaks this connection and can create both functional and aesthetic problems if performed incorrectly. The main objective in reconstruction of the internal nasal valve is to provide support and stiffness to open up the internal nasal valve angle and to reestablish a stiff or resistant nasal side wall that does not bow inward.