Konjenital Kolumella Yokluğunun Bilateral İnternal Nazal Cilt Flepleri ve Kıkırdak Grefti ile Rekonstrüksiyonu

Giriş ve Amaç: Nasal kolümellanın konjenital aplazisi oldukça nadir görülen bir anomalidir. Deformite, kolümellanın burun ucundan filtrum tabanına kadar, alar kartilajları da içerecek şekilde izole yokluğu ile karakterizedir. Nazal kolümellanın konjenital aplazisinde septum, burun ve üst dudak gibi çevre yapılar normaldir. Olgu ve Yöntem: 26 yaşında bayan hasta, solunum güçlüğü ve burun ucu projeksiyon yetersizliği şikayetleri ile kliniğimize başvurdu. Hikâyede kolümellanın doğumda yokluğu öğrenildi. Özgeçmişinde hastanın halasında da aynı patolojinin varlığı saptandı. Fizik muayenede burun ucunun superior filtral sınıra adhezyonu ve nazal dorsal çizgide septumun kaudal sınırından burun ucuna kadar uzanan şiddetli depresyon izlendi. Rekonstrüksiyon bilateral internal nazal vestibüler deri flepleri ve alar konkal kartilaj greftleri kullanılarak yapıldı. Postoperatif flep kaybı ve yara iyileşme problemi görülmedi. 6 aylık takipte ameliyatta sağlanan burun ucu projeksiyonu postoperatif dönemde de yumuşak doku kontraksiyonu veya kartilaj rezorpsiyonu gelişmeksizin korunduğu gözlendi. Sonuç: Kolumellar defektlerin rekonstrüksiyonunda kullanılabilecek sayısız teknik olmasına rağmen her birinin kendi avantaj ve dezavantajları vardır. Bu nedenle kolümellar defektlerin cerrahi tedavisi hastaya özel olmalıdır. Kolümella rekonstrüksiyonunda internal nasal vestibüler flep kullanımı flep donör alanında görülebilen nebbe olmaması ve iyi doku uyumu nedeniyle avantajlıdır

Reliability of Measurements on Plaster and Digital Models of Patients with a Cleft Lip and Palate

Objective:The purpose of this study was to determine (1) the more and less reliable measurements/methods and (2) the influence of knowledge and skill on the inter- examiner, intra-examiner, and inter-method reliability of nasolabial measurements on plaster casts and three dimensional (3D) stereophotogrammetric images of casts in infants with an unrepaired unilateral cleft lip and palate (UUCLP).Methods:Preoperative extraoral plaster casts from 42 patients with UUCLP were measured with a digital caliper, and the image acquisition of casts was performed with the 3dMDface stereophotogrammetry system (3dMD, Atlanta, GA). Two examiners (one postgraduate student, one lecturer) evaluated 19 nasolabial measurements in two separate sessions.Results:Intra-rater, inter-rater, and inter-method reliability was lower in measurements of nasal, philtral, and nasal floor width. Almost all of the interclass correlation coefficients (ICC) for measurements performed by the lecturer were above 0.75, whereas the intra-examiner reliability of some measurements performed by the postgraduate student showed low ICC (<0.75).Conclusion:Measurements of curving slopes, such as nasal width, of small dimensions, such as nostril floor width, and deformity-affected anatomic parts, such as philtrum width, presented a low reliability. Measurements on 3D images showed a higher reliability compared to plaster model measurements performed by the postgraduate student. Therefore, it may be recommended to use 3D digital images of infants with CLP for nasolabial measurements especially if performed in postgraduate settings

Reconstruction of mandibular defects using autografts combined with demineralized bone matrix and cancellous allograft

WOS: 000243853800018PubMed: 17251844Facial bone defects can be managed by a variety of means, such as inlay or onlay applied nonvascularized bone grafts, local pedicled/distal free osteocutaneous/osseous flaps or distraction osteogenesis. Although each method has its own advantages and drawbacks, the indications of using these methods may overlap in certain clinical situations. The use of nonvascularized bone grafts, conceptually and technically simple method, relies on creeping substitution of applied graft with regenerating new bone. However, using vascularized osteocutaneous free flaps provide not only plenty of bony tissue for reconstruction, but also soft tissue coverage over the reconstructed bony segment. Furthermore, bone healing in vascularized osteocutaneous free flaps resembles as the physiologic fracture healing. In selected cases with enough soft tissue coverage over the defective bony segment, on the other hand, using larger nonvascularized bone grafts with osteoinductive growth factors may decrease the risk of graft failure while avoiding the drawbacks of the free tissue transfer. Here we present our results of three cases with facial bone defects, to which nonvascularized iliac bone grafts and demineralized bone matrix with cancellous allograft (Orthoblast II (TM)) as a source of BMP were used together for mandibular reconstruction

Interdisciplinary treatment of a patient with bilateral cleft lip and palate and congenitally missing and transposed teeth

2014 IEEE Global Communications Conference, GLOBECOM 2014 -- 8 December 2014 through 12 December 2014 -- 110905The comprehensive treatment of a patient with cleft lip and palate requires an interdisciplinary approach for functional and esthetic outcomes. A 20-year-old woman with bilateral cleft lip and palate had a chief complaint of unesthetic appearance of her teeth and the presence of oronasal fistulae. Her clinical and radiographic evaluation showed a dolichofacial growth pattern, a Class II skeletal relationship with retroclined maxillary central incisors, 5 mm of negative overjet, maxillary constriction, maxillary and mandibular crowding, congenitally missing maxillary right incisors and left lateral incisor, and a transposed maxillary left canine. Her treatment plan included the extraction of 3 premolars, maxillary expansion, segmental maxillary osteotomy, repair of the oronasal fistulae, rhinoplasty, periodontal surgery, and prosthodontic rehabilitation. To obtain a better occlusion and reduce the dimensions of the fistulae, orthognathic surgery comprising linear and rotational movements of the maxillary segments (premaxilla, right and left maxillary alveolar segments) in all 3 axes was planned by performing 3-dimensional virtual surgery on 3-dimensional computerized tomography. At the end of the interdisciplinary treatment, a functional occlusion, a harmonious profile, and patient satisfaction were achieved. Posttreatment records after 1 year showed stable results

Results of botilinum toxin: An application to blepharospasm in Schwartz-Jampel syndrome

WOS: 000239535700008PubMed: 16877909Schwartz-Jampel syndrome (SJS) is a rare congenital disorder of continuous myotonia, causing visual and eyelid problems such as blepharospasm, acquired ptosis, and blepharophimosis. We report the management of blepharospasm in two sisters with Schwartz-Jampel syndrome with application of botilinum toxin type A (BTX-A), as an alternative to the surgical treatments, such as orbicularis oculi myectomy, levator aponeurosis resection, and lateral canthopexy as described in the literature. Three consequent doses of commercially available BTX-A (Botox(R)-Allergan, Inc. 100 u/via) were injected to orbicularis oculi muscle in two sisters with Schwartz-Jampel syndrome. At the least, the authors waited for a six-month interval to prevent development of sensitivity to BTX-A in patients. No significant improvement was observed after the injection of first dose of BTX-A, with the total dose of 25 units of BTX-A to each orbicularis oculi muscle of the eyes. The muscle tone weakened after the second dose, which was the twice as such of the first applied total dose (50 units of BTX-A to each orbicularis oculi muscle of the eyes) and significant functional and cosmetic improvements were achieved after injection of the third dose, in which the total applied dose was the same as the one applied in second dose. The blepharospasm and eyelid alterations caused by Schwartz-Jampel syndrome should be treated to provide functional and cosmetic improvements. Application of BTX-A to orbicularis oculi muscle for the treatment of blepharospasm could be considered as an alternative to levator resection, and lateral canthopexy in Schwartz-Jampel syndrome

Repeated tissue expansions on solit-thickness skin graft in a patient with neurocutaneous syndrome

WOS: 000246986300040PubMed: 17538342Soft tissue expansion is a mechanical process that increases the surface area of local tissue available for reconstructive procedures. In most cases, adjacent tissue that matches the recipient site in color, texture, and hair-bearing quality is preferred for tissue expansion. In this particular case with neurocutaneous syndrome, the defects that resulted from removal of parts of a giant hairy nevus overlying the latissimus dorsi muscle bilaterally were grafted with a split-thickness skin graft. Two expanders were then placed under the latissimus dorsi muscles. After full expansion of the grafted area, some part of the remaining nevus surrounding the grafted area was removed and the defects were covered with the expanded skin graft obtained after deflation of the expanders. The expanders placed under the latissimus dorsi muscle in the first operation were reused in the second operation to obtain a second expansion of the skin graft. After the second expansion of the skin graft, the expanders were deflated and another portion of the remaining nevus surrounding the grafted area was removed. The resulting defects were again covered with the excess expanded skin graft. Although repeated expansion of the skin graft is a time-consuming and laborious process, it eliminates the need for taking repeated skin grafts; it decreases skin graft donor site morbidity; it decreases possible infectious complications of tissue expansion by decreasing the number of surgical interventions to the expander pocket; and it increases the aesthetic outcome by keeping all the surgical scars around the grafted Area without extending them into healthy surrounding skin

Deepithelialization Of Breast In Reduction Mammoplasty Using Cable Tie As Breast Tourniquet

PubMe

Management of a Neonate with a Rare Congenital Palatosubglossal Synechia in Pierre Robin Sequence

Development of the human face begins in the fourth week of gestation, as a series of several complicated and well-organized sequential intrauterine events, disruption of which causes some sort of facial dismorhogenesis. Oral synechiae is a rare congenital anomaly usually recognized at birth secondary to airway or nutritional compromise. They help to understand the intrauterine developmental steps of the facial region. In this particular case with congenital palatosubglossal synechia, anterior soft palate of the patient with Pierre Robin sequence was repaired with the oral mucosal flap elevated from the floor of the mouth by using the synechial band as the pedicle of the flap

Effect of slow-release 5-fluorouracil on capsule formation around silicone breast implants: An experimental study with mice

WOS: 000251090700009PubMed: 17578639Background: Capsule formation around breast implants, development of tendon adhesions after tendon repair, intestinal brits after laparatomies, hypertrophic scars in skin incisions all are the results of excessive collagen synthesis to the extracellular matrix by fibroblasts. Any intervention that leads to cessation of collagen synthesis in these clinical situations may help to prevent these untoward results of wound healing. Although 5-fluorouracil (5-FU) is used mainly as a cytotoxic drug in chemotherapy protocols, it decreases cellular metabolism and blocks protein synthesis only at lower concentrations. Findings have shown that 5-FU downregulates fibroblast proliferation and differentiation in vitro. It has been used to treat fibroproliferative disorders of the eye and skin and is thought to inhibit thymidylate synthetase, blocking DNA replication. Methods: This study used five treatment groups: (1) gelatin only, (2) silicone only, (3) silicone + gelatin, (4) silicone + gelatin containing 1 mg of 5-FU, and (5) silicone + gelatin containing 5 mg of 5-FU. The release kinetics of 5-FU from gelatin have been investigated by means of ultraviolet spectrophotometric analysis. Specimens were obtained on postoperative day 30. Gross evaluation and histopathologic examination were conducted for capsule formation and the development of inflammation. Results: The silicone group had the most prominent capsule formation among all the groups. The gelatin group was second, and the silicone + gelatin group was third. As compared with the other groups, the 5-FU-containing groups had the least capsule formation. The 5-mg 5-FU-containing group had the most inflammation. The silicone + gelatin group was second in inflammation. Although the silicone, gelatin, and 1-mg 5-FU-containing groups had the same means, the results of the silicone group showed the most divergent data within the group. Conclusions: Because 5-FU loaded to a gelatin carrier for its slow release seems to prevent capsule formation around silicone blocks, it may be used to prevent capsule formation around silicone breast implants

Effect of Use of Slow Release of Bone Morphogenetic Protein-2 and Transforming Growth Factor-Beta-2 in a Chitosan Gel Matrix on Cranial Bone Graft Survival in Experimental Cranial Critical Size Defect Model

Sargon, Mustafa Fevzi/0000-0001-6360-6008; KORKUSUZ, PETEK/0000-0002-7553-3915WOS: 000275061800020PubMed: 20179488Bone grafts, used for providing structural integrity of cranial vault remodeling, could not always integrate with the remaining bone structures. All efforts are focused on increasing incorporation of the applied bone grafts. Allografts were covered by chitosan so that slow release of bone morphogenetic protein-2 (BMP-2) and Transforming growth factor-beta-2 (TGF-beta-2) was achieved. Two hundred forty Wistar-Albino rats were distributed equally in 8 study groups. Study groups were designed as; defect group, autograft group, allograft group, chitosan group, allograft + chitosan, TGF-beta-2 group, BMP-2 group, and TGF-Beta-2 + BMP-2 group. Bone biopsies were obtained at second, eight, and 14th weeks. Bone regeneration was evaluated by morphologic studies detecting histologic bone healing and radiologic studies detecting bone density. Histologic findings were evaluated in 2 categories; tissue response to the implant and defect healing. Additionally, scanning electron microscopy for detailed morphologic evaluation was done. Bone density of the applied scaffold and the parietal bone at the same computed tomography section were measured in Hounsfield scale and this ratio was used for densitometry evaluations. Kruskal-Wallis test was used to analyze difference among groups according to the histologic and radiologic data. Pairwise comparisons were done using Mann-Whitney U test with Bonferroni correction. P < 0.05 was considered significant. In the morphologic studies, bone regeneration in BMP-2 group was found to be compatible with bone regeneration in gold standard autograft group and even better than it within 15 days. Chitosan is a biocompatible material. TGF-Beta-2 alone is not effective enough in bone regeneration; BMP-2 alone has a positive effect in every step of bone regeneration. Combining TGF-Beta-2 with BMP-2 does not lead to a better bone regeneration than using BMP-2 alone. A synergistic effect is not obtained by using these 2 factors together