Yakup Cil

Long-term outcomes of ultra-thin porous polyethylene implants used for reconstruction of orbital floor defects.

Purpose:The objective of this article is to present the long-term outcomes of ultra-thin polyethylene implants used for orbital floor reconstruction in facial trauma patients. Materials and Methods:From 1998 to 2004, 38 patients underwent orbital floor reconstruction with porous polyethylene implants with a mean follow-up of 4 years. A subciliary incision and preexisting facial wounds or scars were used. The boundaries of the maxillofacial injury and the orbital volumes of both orbits were assessed by computed tomography images obtained pre- and postoperatively. In all patients, ultra-thin porous polyethylene implants in various sizes were used to reconstruct the orbital floor defect. Results:None of the patients needed removal of the implants during the follow-up. The volume increase of the traumatized orbits ranged from 0.04 to 6.18 (average 3.12 ± 1.48) mL compared with the intact orbit (P < 0.01). This difference was not significant postoperatively (P > 0.01). Postoperative ectropion in three cases was corrected under local anesthesia. Persistence of complications were as follows: enophthalmos, 3 in 28; diplopia, 1 in 16; dystopia, 1 in 4; and infraorbital nerve hypoesthesia, 3 in 31. One patient underwent late enucleation of the globe because of initial penetrating trauma. Conclusions:We recommend the use of ultra-thin porous polyethylene implants in the reconstruction of the orbital floor defects in facial trauma patients. The implants are durable in the long-term and mimic the anatomy of the thin orbital floor and avoid the morbidity of autogenous bone grafts.

The crooked nose: the use of medial iliac crest bone graft as a supporting framework.

The crooked nose is one that the vertical axis of the nose inclines from the midline. As a rule, a major septal deformity almost always accompanies to impairing breathing and aesthetic appearance. To achieve total straightening of the crooked nose, the septum must become the target of the treatment. To prevent redeviation, we used rigid bone grafts instead of flexible and relatively weak cartilage to maintain the support of the corrected deformity. Between February 2005 and July 2007, 9 patients (all male) with crooked noses underwent corrective surgery. The mean age of the patients was 21 years (range, 19-23 years). The source of the bone graft was medial side of iliac crest in all patients. The mean follow-up was 18 months, ranging from 10 to 26 months. All patients had both functional and cosmetic problems. Mean operation time was 4 hours. Airway patency was improved in all cases. The grafts did not shift in any case and did not develop unsightly irregularities over time. Absorption of the grafts was not seen in the follow-up. There were no cases of extrusion or infection. No donor site complication occurred. None of the patient required secondary surgery. A residual deviation can be obvious despite all attempts, which has no deleterious effect on patient satisfaction. This article introduces a novel technique for the correction of the crooked nose.

Squamous cell carcinoma arising in the giant cutaneous horns accompanied with renal cell carcinoma

An 85-year-old man who presented with two giant cutaneous horns on his lower lip underwent an explorative laparotomy because of a left renal tumor and gall bladder stones. The cutaneous horns on the lower lip were excised at the same session. Histology revealed a renal cell carcinoma and minimally invasive squamous cell carcinoma at the base of the giant cutaneous horns. We present this case showing the simultaneous occurrence of squamous cell carcinoma at the base of a giant lower lip cutaneous horn and a renal cell carcinoma of the L kidney.

Assessment of distraction regenerate using quantitative bone scintigraphy.

In this study, we examined whether quantitative bone scintigraphy can be used to assess new bone formation following distraction osteogenesis (DO). A vertical osteotomy was performed on the right hemimandible of male Sprague-Dawley rats, and a custom-made distraction device was applied. Following the gradual distraction, rats were divided into 2 subgroups, the second and fourth week. Cephalograms were taken and scintigraphic and histomorphometric analysis was performed at the second and fourth week. Scintigraphic findings showed good correlation with histomorphometric results. Results were compared with sham-operated (skin and muscle incision and placement of pin but no osteotomy) and acute distraction (5-mm acute distraction) groups. Scintigraphic mean uptake ratios were significantly higher in the gradual distraction group compared with the sham-operated and acute distraction groups. Quantitative bone scintigraphy is a promising method for the assessment of DO and consolidation. It could offer objective qualitative and quantitative data for the noninvasive evaluation of bony regenerate.

A custom-made distraction device for experimental mandibular distraction osteogenesis.

Abstract:Distraction osteogenesis has recently become popular in craniofacial reconstruction, after it was first described for long bones. Despite the widespread clinical use of this technique, currently, lack of an ideal experimental model for small animals hampers investigations focused on its molecular basis, which warrants further elucidation. The authors developed a new device for distraction of the rat mandible and, to asses its effectiveness, practiced on 30 animals assigned to either an acute 3-mm distraction group (n = 7) or a gradual distraction group (0.25 mm twice a day for 6 days; n = 23). The authors applied the devices to a localization that allowed them to perform the ostomies posterior to the molar teeth. Because of a U-shaped plate that the authors used for posterior pin fixation, their device maintained its stability until the end of the study, despite the delicate anatomy of the bone at the posterior part of the mandible. Additionally, the authors described a practical and easy method of transient mandibular stabilization method that facilitates the manipulations while the mouth is open for safer airway control during surgery. This new nutrition technique with enteral feeding solution solved the problem of progressive weight loss after surgery. Application of the device was easy and practical, without demanding complex manipulations. The authors did not observe any device dislodgement or a high rate of accidental fractures during the manipulations. They demonstrated that the device works properly and is able to create ossified regenerate bones that fill the entire distraction gap, which can be used for various investigations during distraction osteogenesis.

Distally based venous flap for proximal phalangeal soft tissue burn defect and web space burn contracture.

Flap choices for the coverage of the proximal phalangeal soft tissue defects of the finger and web space burn contractures are limited. A unipedicled distally based venous flap was raised from the third or fourth metacarpal area of the hand for proximal phalangeal soft tissue defects of the finger and web space burn contracture. For clinical use, we operated seven male patients using this venous flap. Superficial necrosis involving two flaps did not interfere with flap survival. Mild edema and venous congestion occurred in all flaps. All flaps survived completely. The mean follow-up period of the flaps was 6 months, ranging from 3 to 14 months. A well-planned distally based venous flap is an useful option for the coverage of the proximal phalangeal soft tissue burn defects of the finger and web space burn contracture of the hand.

Radial bone graft usage for nasal septal reconstruction

Background: Although various techniques have been described for correction of crooked and saddle nose deformities, these problems are challenging with high recurrence and revision rates. Conventional septal surgery may not be adequate for nose reconstruction in crooked and saddle nose deformities. Materials and Methods: Between December 2005 and October 2009, six patients with crooked nose and five patients with saddle nose deformities underwent corrective surgery in our clinic. All patients were male, and the mean age was 21 years (range, 19-23 years). We used rigid radial bone graft to prevent redeviation and recurrence following corrective nasal septal surgery. Results: The mean follow-up period was 28 months, ranging from 18 to 46 months. Mean operation time was 4 hours (3-4.5). All patients healed uneventfully. None of the patients required secondary surgery. Conclusions: We believe that radial bone grafts offer a long lasting support in treatment of challenging cases with crooked and saddle nose deformities.

Railway graft for internal nasal valve reconstruction

BackgroundAlthough many methods have been proposed to restore the internal nasal valve (INV) such as suture techniques, various grafts, upper lateral cartilage folding techniques, and combined techniques, the most popular and effective one remains spreader grafts. The aim of the present study is to propose a new graft design for INV reconstruction and to test the reliability and feasibility of the technique.MethodsThirty-two primary septorhinoplasty patients divided in three groups underwent surgery with railway, spreader, and no graft techniques. The functional results were evaluated with the Nasal Obstruction Evaluation Scale (NOSE) scores subjectively.ResultsSignificant improvements were observed comparing preoperative and postoperative NOSE scores in railway and spreader grafts groups. However, there was no significant difference in NOSE scores between those groups of patients.ConclusionsRailway graft is an effective method that can be recommended if septal cartilage is limited for reconstruction of INV.Level of Evidence: Level IV, therapeutic study.

Primary intraosseous cavernous hemangioma of the toe

Intraosseous cavernous hemangioma is an uncommon benign vascular tumor. A 21-year-old man presented with a small painless swelling of the left foot’s long toe. X-ray examination showed an outgrowing bony lesion that has cortical continuity in the tip of the long toe’s distal phalanx lateral aspect. Preoperative examination yielded no final diagnosis. En bloc resection was performed. The histological diagnosis was intraosseous cavernous hemangioma. To the best of our knowledge, this case is a first report of primary intraosseous cavernous hemangioma of the toe.

Supraorbital Rim Contour Restoration with Porous Polyethylene Implant via Preexisting Scar

Isolated anterior wall fractures with displaced fragments require surgical correction to restore normal forehead contour. The anterior wall is returned to its anatomic position and stabilized with either suture, wire, or metal or resorbable plates, according to the surgeons desire and the patients age.1 Treatment principles are emerging from published studies.2 Many cases with solitary depressed anterior wall fractures require anterior wall restoration to obtain aesthetically acceptable contours.3 We present a 40-year-old man who had left supraorbital rim depression caused by blunt trauma 1 year previously. Anterior wall fracture of the left frontal sinus was evaluated with computed tomography (CT; Fig. ​Fig.1).1). He was treated by porous polyethylene Medpor (Porex Surgical, Inc., College Park, GA) sheet implant (1.5 mm thick; 50 mm wide × 76 mm long) via supraorbital preexisting scar to avoid coronal incision (Fig. 1). In the standard treatment modality of frontal sinus fractures, repair is best performed by way of a coronal approach, which offers excellent access.3 The patient did not want a coronal incision for the contour restoration surgery with implant. The patient did not want to autolog bone graft for restoration of the supraorbital rim contour due to the graft donor site morbidity. He was treated by porous polyethylene implant. The porous polyethylene implants have biomaterial properties favorable for facial skeletal contour restoration.4,5 The frontal bar depression was accessed by way of preexisting scar (Fig. 1). First, the scar was removed and the subperiosteal space was entered along the supraorbital rim after incision of the periosteum medially (Fig. 1). Supraorbital soft tissues and neurovascular pedicles were carefully lifted out of the depression area. The porous polyethylene sheet implant overlapped the defect of depression edges. The implant was shaped to bridge the defect and was inserted below the periosteum without any fixation with screws or sutures (Fig. 1). Before implantation, the implant was soaked in antibiotic solution containing 1 g ceftriaxone. Oral first-generation cephalosporin was given every 12 hours for 5 days postoperatively. A compressive garment was used to stabilize the polyethylene implant for 1 week postoperatively. No infection was seen in the early or late postoperative period. At 12-month follow-up, the patient did not complain of any disturbance (Fig. 2). We have experienced these rules in our case: Figure 1 Left supraorbital rim depression (top, left). Preexisting scar on the left supraorbital rim (top, right). Preoperative computed tomography (bottom, left). Medpor sheet implant was inserted the subperiosteal ... Figure 2 Late postoperative view of frontal area. Preexisting scar on the supraorbital area should not be exposed to protect the neurovascular bundle, which is important. If access via the preexisting scar is used for contour restoration, preoperative CT evaluation must be precise to calculate the contour of the defect for the alloplastic material. A compressive garment must be used to stabilize the polyethylene implant for 1 week if rigid fixation material is not used to stabilize the alloplastic material. If the surgeon follows these rules, the surgical approach is less invasive and the operation can be performed without problems in selected cases.