Tarik Cavusoglu

Maxilla Allograft for Transplantation : An Anatomical Study

Introduction:The aim of this study is to present an anatomic study and a dissection technique to prepare maxilla graft for transplantation. Methods:Six fixed adult human cadavers were used for dissection of the maxilla grafts. Retrospective reviews of archives of 10 MRI and 5 angiographies of the maxillary region were performed to demonstrate the vascular and soft tissue anatomy of this area. Results:We have harvested maxilla graft as a single unit (larger type of Le Fort II) based on arterial and venous pedicle ready for transplantation. MRI evaluation revealed the vascular structures in the masticatory space and its anterior pterygomaxillary extension. Angiographic observations have demonstrated the arterial blood supply of the maxillary region, which lies within the pterygomaxillary region that we have included in the graft. Conclusions:We are presenting a method for harvesting of the maxilla graft, with vascular supply based on certain anatomic landmarks.

A 6-month in vivo study of polymer/mesenchymal stem cell constructs for cranial defects

Two biodegradable polymers, poly(L-lactide) and poly(ε-caprolactone) were blended (50/50) and used to produce polymeric scaffolds by the dual porogen approach using a salt leaching technique to create pores within the matrix, while supercritical-CO 2 treatment was used to enhance the interconnectivity and to remove impurities from synthesis steps. The scaffolds were highly porous (porosity >90%) with interconnected pore morphologies. These biodegradable scaffolds were evaluated in Sprague Dawley rats for osteoconductive properties over a 6-month period. Bone specimens were analyzed after 1, 3, and 6 months, for bone healing and tissue response. The cortical bone remodeling by controlled osteoblastic and osteoclastic activities as well as the bone marrow elements recovery were semi-quantitatively examined for each group. Excellent integration and biocompatibility behavior was observed in all groups. No adverse tissue responses were observed.

Reconstruction of Orbital Floor Fractures Using Autologous Nasal Septal Bone Graft

We describe herein a new technique for reconstruction of the orbital floor, using autologous nasal septal bone and report the surgical results achieved in maxillofacial trauma patients.Prior to its clinical surgical application, a cadaver practice was carried out on 5 formalin-fixed adult human cadavers to establish the feasibility and efficacy of the method. Fifteen patients with orbital floor fractures, operated between 2005 and 2008, using this technique, were included in the current study.Cadaveric practice revealed that an adequate and appropriate size of septal bone graft can be harvested for reconstruction of the orbital floor. All patients except one had satisfactory clinical and radiologic late results. One patient experienced persistent enophthalmos, possibly due to delayed repair and associated displaced zygomatic bone fracture.Autologous nasal septal bone as an orbital floor bone graft has many advantages, including low donor site morbidity, adequacy and appropriateness of size, and similarity of its bicortical morphology and histologic nature compared with the orbital floor bone. Our clinical results strongly support that this technique can become a satisfactory alternative to existing reconstruction methods.

Auricular cartilage repair using cryogel scaffolds loaded with BMP‐7‐expressing primary chondrocytes

The loss of cartilage tissue due to trauma, tumour surgery or congenital defects, such as microtia and anotia, is one of the major concerns in head and neck surgery. Recently tissue‐engineering approaches, including gene delivery, have been proposed for the regeneration of cartilage tissue. In this study, primary chondrocytes were genetically modified with plasmid‐encoding bone morphogenetic protein‐7 (BMP‐7) via the commercially available non‐viral Turbofect vector, with the aim of bringing ex vivo transfected chondrocytes to resynthesize BMP‐7 in vitro as they would in vivo. Genetically modified cells were implanted into gelatin–oxidized dextran scaffolds and cartilage tissue formation was investigated in 15 × 15 mm auricular cartilage defects in vivo in 48 New Zealand (NZ) white rabbits for 4 months. The results were evaluated via histology and early gene expression. Early gene expression results indicated a strong effect of exogenous BMP‐7 on matrix synthesis and chondrocyte growth. In addition, histological analysis results exhibited significantly better cartilage healing with BMP‐7‐modified (transfected) cells than in the non‐modified (non‐transfected) group and as well as the control. Copyright

A rare complication of nasotracheal intubation: accidental middle turbinectomy.

In this paper, we are presenting a rare case of accidental middle turbinectomy, a complication of nasotracheal intubation. We have reviewed the literature and addressed important parameters on nasotracheal intubation to avoid damage to the turbinates and its possible serious complications.

Clear cell sarcoma

Malignant melanoma (MM) of soft tissue, also called clear cell sarcoma (CCS) of tendons and aponeuroses, derives from the neural crest. CCS is similar morphologically to MM but has no precursor skin lesion, and instead, has a characteristic chromosomal translocation. Prognosis is related to the tumor size. Early recognition and initial radical surgery is the key to a favorable outcome. The tumor has to be differentiated from other benign and malignant lesions of the soft tissues, such as fibrosarcoma. The demonstration of melanin and a positive immunohistochemical reaction for S-100 protein and HMB-45 can assist in the differential diagnosis. We report the case of a 58-year-old woman with CCS arising from the soft tissue of her little finger.

Stem cell suspension injected HEMA-lactate-dextran cryogels for regeneration of critical sized bone defects

Abstract HEMA-Lactate-Dextran cryogel scaffolds were produced by cryogelation. Mesencyhmal stem cells (MSC) were isolated from rat bone marrow. Critical sized cranial bone defects were created in rat cranium. Stem cells were injected inside the macropores of the cryogel scaffolds prepared from HEMA-Lactate-Dextran possessing the same dimensions with the defect and placed in the cranial bone. The cryogels placed in the defect without stem cells served as control. After selected time intervals the experimental sites were removed from the animals and new bone formation and tissue integration were investigated by histological analysis. The in vivo results exhibited osseous tissue integration within the implant and mineralized functionally stable bone restoration of the cranial defects. Tissue formation started in the macrospores of the scaffold starting from periphery to the center. A significant ingrowth of connective tissue cells and new blood vessels allowed new bone formation. Histological data demonstrated that new bone per total defect area ratio, were not significantly different in “scaffold-stem cells” group compared to that of “scaffold only” group on all time points. However, the blood vessel density was significantly higher in “scaffold-stem cells” group comparing to that of the “scaffold only” group on day 30. “Scaffold-stem cells” given group gave better tissue response score when compared to “scaffold only” group on day 180.

Cranial bone regeneration via BMP-2 encoding mesenchymal stem cells

Abstract Cranial bone repair and regeneration via tissue engineering principles has attracted a great deal of interest from researchers during last decade. Here, within this study, 6 mm critical-sized bone defect regeneration via genetically modified mesenchymal stem cells (MSC) were monitored up to 4 months. Cranial bone repair and new bone formations were evaluated by histological staining and real time PCR analysis in five different groups including autograft and bone morphogenetic protein-2 (BMP-2) transfected MSC groups. Results presented here indicate a proper cranial regeneration in autograft groups and a prospering regeneration for hBMP-2 encoding mesenchymal stem cells.

Simultaneous Open Rhinoplasty and Alar Base Excision for Secondary Cases

Background: Simultaneous open rhinoplasty and alar base excision are a very safe procedure for protecting the vascular supply of the nasal dip and the columellar skin in primary cases when surgical dissection is performed below the musculoaponeurotic layer of the nose. Major arteries of the external nose lie above the musculoaponeurotic layer. However, secondary cases may pose increased risks to the blood supply of the nasal tip and columella skin because of the decreased vascular supply and increased scar tissue from the previous rhinoplasty. We studied our secondary cases of simultaneous open rhinoplasty and alar base excision, to assess the real risk for necrosis of the nasal tip and columellar skin.Methods: A total of 12 secondary patients (6 men and 6 women) underwent simultaneous open rhinoplasty and alar base excision in the past 3 years. Their average age was 27 years (range, 21–35 years). The average follow-up period was 15 months (range, 1–35 moths). A modified grading system, originally described by Bafaqeeh and Al-Qattan, was used for assessment of the blood supply in the nasal tip and the columellar skin.Results:Satisfactory results were obtained for our patients, with the exception of one case. Grade 3 vascular compromise to the nasal tip and the columella was observed in one case, but the patient healed well with wound care treatment.Conclusion:Simultaneous alar base excision and open rhinoplasty can be performed safely in secondary cases. However some surgical maneuvers such as subcutaneous pocket preparation for the tip graft in closed rhinoplasty and subdermal defatting in the first rhinoplasty as well as previous scarring on the nasal lobule can disrupt the vascular supply of the nasal tip and columella skin. Under these conditions, alar base excision should be deferred and then performed as an isolated excision procedure.

Simultaneous reconstruction of medial canthal area and both eyelids with a single transverse split forehead island flap.

In this report, we are presenting a case in which we have split the paramedian forehead flap, thus providing 2 axially perfused skin flaps for simultaneous reconstruction of the upper and lower lid structures after resection of basal cell carcinoma from the left medial canthal area. We found that split forehead flap seems to be a favorable option for simultaneous reconstruction of the upper and lower eyelid defects by enabling nicely vascularized and abundant amount of regional skin.