Tolga Eryilmaz

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.

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.

Sliding alar cartilage (SAC) flap: a new technique for nasal tip surgery.

Congenital anatomic deformities or acquired weakness of the lateral crura of the lower lateral cartilages after rhinoplasty could cause alar rim deformities. As lower lateral cartilages are the structural cornerstone of the ala and tip support, deformities and weakness of the alar cartilages might lead to both functional and esthetic problems. In this article, we are introducing sliding alar cartilage flap as a new technique to reshape and support nasal tip.One hundred sixty consecutive patients between 18 and 55 years of age (mean age: 27.51) were included in the study between January 2007 and May 2008. Of the total number of patients 60 were male and 100 of them were female. None of the patients had rhinoplasty procedure including lower lateral cartilage excision previously.Sliding alar cartilage technique was used in an open rhinoplasty approach to shape the nasal tip in all patients. This technique necessitates about 2 to 3 minutes for suturing and undermining the alar cartilages. The follow-up period was between 4 and 18 months. In no patients any revision related to the sliding alar cartilage technique was required. Revision was applied in 3 patients due to thick nasal tip skin and in one patient due to unpleasant columellar scar.In this article, we are presenting the “sliding alar cartilage flap” as a new technique for creating natural looking nasal tip. This technique shapes and supports nasal tip by spontaneous sliding of the cephalic portion of the lower lateral cartilage beneath the caudal alar cartilage, with minimal manipulation, without any cartilage resection, or cartilage grafting.

Management of cranial bone defects: a reconstructive algorithm according to defect size.

Introduction Reconstruction of cranial bone defects is one of the most challenging problems in reconstructive surgery. The timing of reconstruction, the location of the defect, the materials to be used, and the medical history of the patient are parameters that have been mostly discussed in the literature. To the best of our knowledge, there has not been any published classification for the cranial bone defect reconstruction according to defect size. Materials and Methods Twelve patients underwent reconstruction of cranial vault defects. Cranial bone defects were classified into 3 groups according to the size of the defect. The small-sized group included the defects smaller than 25 cm2, the medium-sized group included the defects between 25 to 200 cm2, and the large-sized group included the defects larger than 200 cm2. The small-sized defects were reconstructed with split calvarial graft, demineralized bone matrix, or hydroxyapatite cement; the medium-sized defects were reconstructed with split calvarial graft or allogenic bone graft; and the large-sized defects were reconstructed with methyl methacrylate, autoclaved bone, or porous polyethylene. Results Two patients needed revision for irregularities with demineralized bone matrix. Other patients had no skull defects or irregularities for which revision was suggested. Conclusions We believe that the size of the defect is important for the reconstruction of cranial vault defects and that using a standard algorithm can increase the success rate.

A challenging problem that concerns the aesthetic surgeon: postoperative nausea and vomiting.

Postoperative nausea and vomiting (PONV) are among the most common adverse events in the postoperative period. This is especially disastrous in aesthetic surgery; it may cause hematoma, wound dehiscence, and patient dissatisfaction. The purpose of this study was to evaluate the incidence of PONV after aesthetic surgery procedures, and to determine the risk factors for PONV. Two hundred and twelve patients undergoing the most common aesthetic surgical procedures were included into this study. Female gender, surgical site, and history of PONV were found to be significant risk factors, however, postoperative opiate use and history of motion sickness were not found to be significant risk factors for PONV. Those undergoing trunk surgery procedures appeared to be at higher risk than were those undergoing head and neck surgery procedures. Also, ondansetron was found to be more affective than metoclopramide. Risk factors for PONV must be questioned preoperatively. Patients with risk factors are good candidates for prophylaxis. As a result of the effective prevention of PONV, postoperative patient comfort and satisfaction should be more improved.

Treatment of hyperdynamic nasal tip ptosis in open rhinoplasty: using the anatomic relationship between the depressor septi nasi muscle and the dermocartilaginous ligament.

BackgroundSmiling causes a deformity in some rhinoplasty patients that includes drooping of the nasal tip, elevation and shortening of the upper lip, and increased maxillary gingival show. The depressor septi muscle leads this deformity. The dermocartilaginous ligament originates from the fascia of the upper third of the nose and extends down to the medial crus, merging into the depressor septi muscle.MethodsIn this study, 100 primary rhinoplasty patients were studied for hyperdynamic nasal tip ptosis. Of these patients, 36 had hyperdynamic nasal tip ptosis due to hyperactive depressor septi nasi muscle. The dermocartilaginous ligament was used as a guide to reach the depressor septi muscle in open rhinoplasty. Muscle excision was performed just below the footplates of the medial crura. A strong columellar strut graft was placed between the medial crura to avoid narrowing of the columellar width resulting from tissue excision and to withstand activation of depressor septi muscle remnants.ResultsNo complications such as infection or hematoma occurred in the early postoperative period. The technique corrected the hyperdynamic nasal tip ptosis, increased upper lip length, and decreased gingival show when patients smiled. There was no narrowing of the columellar width. No depression in the columellar–labial junction due to distal resection of the depressor septi muscle was observed.ConclusionThe dermocartilaginous ligament can be used as a reliable guide to reach the depressor septi muscle in open rhinoplasty. Therefore, the hyperactive depressor septi muscle can be definitively identified and treated without an intraoral approach.Level of Evidence IVThis 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 at www.springer.com/00266.

The quantitative effect of botulinum toxin A over brow height.

IntroductionBotulinum toxin type A (BTX-A) is currently used in temporal brow lifting. Reducing the activity of the superolateral portion of orbicularis oculi muscle causes lateral brow elevation. The objective of this study was to determine the quantitative brow elevation after paralysis of the superolateral portion of orbicularis oculi muscle. Material and MethodsThis study includes 10 female patients. Six units of BTX-A were injected into the superolateral portion of the orbicularis oculi in a serial manner into 3 points, below the lateral half of the brow at each side. Bilateral measurements were obtained by using calipers, immediately before and 2 weeks after the treatment. The medial canthus to the medial brow margin (AB), the lateral brow margin to the lateral canthus (CD), the medial brow margin to the lateral brow margin (BC), the brow apex to upper lid margin at the level of the lateral limbus (EF), the brow apex to the medial brow margin (EB), the brow apex to the lateral brow margin (EC), and upper eyelid margin to lower eyelid margin at the level of the pupil (GH), were measured. ResultsThere were no statistically significant differences found between pretreatment and posttreatment left and right measurements. There were statistically significant increases in CD, EF, and GH measurements, which are point out brow elevation. There were no statistically significant differences found in other measurements. ConclusionsSame doses of BTX-A application did not disrupt symmetry. Applications of 6U BTX-A to the superolateral portion of orbicularis oculi provide brow elevation and increased interpalbebral distance and upper eyelid distance. Our study has confirmed that BTX-A treatment of superolateral portion of the orbicularis oculi muscle produces quantitative temporal brow elevation.

Feasibility of demineralized bone matrix for craniomaxillofacial contour restoration.

Demineralized bone matrix (DBM) could be a good alternative for craniomaxillofacial contour restoration, especially in perialar, malar, temporal, and frontal regions. In this study, the histologic behavior of DBM was investigated in different tissue planes to determine its proper application plane for restoration of craniomaxillofacial contour deformities and defects. Forty Wistar rats were divided into 6 groups: (1) 0.3 mL of 0.9% saline was injected into the subperiosteal plane of the cranium, (2) 0.3 mL of DBM was implanted into the subperiosteal plane of the cranium, (3) 0.3 mL of 0.9% saline was injected into the subdermal plane on the left inguinal region, (4) 0.3 mL of DBM was implanted into the subdermal plane on the right inguinal region, (5) 0.3 mL of 0.9% saline was injected between the left external and internal oblique muscles, and (6) 0.3 mL of DBM was implanted between the right external and internal oblique muscles. At the 8th week half of the rats and at 16th week the remaining rats were killed in each group, and tissue samples were harvested. Histological and immunohistochemical evaluation revealed new bone tissue and bone marrow formation in all planes that DBM was given. Demineralized bone matrix can provide satisfactory results in craniomaxillofacial contour deformities including forehead, temporal, and malar augmentations, as well as mental and perialar augmentations and saddle nose corrections, with supraperiosteal or deep subcutaneous applications. However, superficial applications must be avoided because of the possibility of palpation, because it induces hard bone tissue formation in all tissue planes.

Facial resurfacing with a monoblock full-thickness skin graft after multiple malignant melanomas excision in xeroderma pigmentosum.

Abstract Xeroderma pigmentosum is an autosomal recessive disease, characterized by vulnerability of the skin to solar radiation. Increase in sunlight-induced cancer is a direct consequence of an increase in mutated cells of the skin of patients with xeroderma pigmentosum. There is no specific technique for facial resurfacing in patients with xeroderma pigmentosum. In this article, a patient with xeroderma pigmentosum with multiple malignant melanomas on her face and radical excision of total facial skin followed by facial resurfacing with monoblock full-thickness skin graft from the abdomen is presented.

Finger Tip Defect After Cryotherapy

Warts are common, benign skin lesions that are usually self-limiting. They are cutaneous manifestations of human papillomavirus and can grow anywhere on the skin but usually occur on the hands and feet. The treatment of warts is challenging for physicians. Many local treatments are used for warts, but none of them has been proven effective in every patient. Cryotherapy is one of the most common preferred methods. In this article, a case with a finger tip defect that developed after cryotherapy is presented.