Pollybeak deformity in rhinoplasty: prevention and treatment.

OBJECTIVE: Patients with pollybeak deformity who underwent rhinoplasty were analyzed retrospectively and across centers to identify their primary risk factors, preventative measures, and treatment modalities. PATIENTS AND METHODS: The retrospective data of 100 pollybeak deformity cases (61 males and 39 females) were enrolled in our study. The causes leading to pollybeak deformity were evaluated and classified as (1) Over-resected bony dorsum, (2) Excessive supra tip scarring, and (3) Inefficient tip support causing an under-projected tip. The treatments applied to patients with pollybeak deformity were retrospectively evaluated and classified as (1) Triamcinolone acetonide injections (one or two injections), (2) Filler injection over the bony dorsum to balance, (3) Using a graft to achieve the desired nose shape, (4) Trimming down the excessive supra tip soft tissue and/or tip cartilage, and (5) Enforcing the tip support. RESULTS: Our results showed that the major cause of pollybeak deformity was excessive supra-tip scarring (48%). The other reasons are inefficient tip support, causing an under-projected tip (28%), and over-resected bony dorsum (24%). The modalities for the treatment of pollybeak deformity were (1) Trimming down the excessive supra tip soft tissue and/or tip cartilage (30%), (2) Triamcinolone acetonide injections (one or two injections) (28%), or (3) Enforcing the tip support (28%), (4) Using a graft to achieve the desired nose shape (14%) and (5) Filler injection over the bony dorsum to balance (6%). In some patients, more than one treatment modality was applied. Triamcinolone acetonide or filler injections were the non-surgical therapies for pollybeak deformities. CONCLUSIONS: We concluded that excessive supra-tip scarring is not directly related to a surgical error but rather depends on the patient and tissue healing. Care should be taken to avoid over-resecting the bony dorsum. Tip support should be provided to prevent inefficient tip support from causing an under-projected tip. However, efforts should be made to minimize supra-tip dead space and possibly proceeding pollybeak formation through proper bandaging.

The comparison of 1-year results for mini and wide-size cap grafts applied to nasal tips.

OBJECTIVE: In the present study, we evaluated patient satisfaction with cap grafts by Rhinoplasty Outcomes Evaluation (ROE) scores. Mini cap and wide cap grafts were applied. PATIENTS AND METHODS: A total of 80 patients who underwent a rhinoplasty operation with cap graft application to the tip region were included in the study. According to the cap graft size, there were two groups: Group 1 consisted of 40 patients with cap graft size ≤7 cm (mini cap group). Group 2 comprised 40 patients with cap grafts ≥8 cm (wide cap group). Patients in groups 1 and 2 underwent evaluations based on the following criteria at preoperative, postoperative-1st month, and postoperative-1st year intervals: (1) Rhinoplasty Outcomes Evaluation Questionnaire (ROE), (2) tip projection (cm), (3) nasal dorsum length (cm), (4) tip projection ratio (Goode), (5) nasofrontal angle, and (6) nasolabial angle. RESULTS: Postoperative 1st-month and 1st-year ROE scores of the wide cap group were significantly higher than those in the mini cap group (p<0.05). Preoperative tip projection ratio (Goode) values of the wide cap group were considerably higher than those in the mini cap group (p<0.05). There were no significant differences between tip projection, nasal dorsum length, nasofrontal angle, and nasolabial angle values of the mini cap and wide cap groups (p>0.05). Correlation tests showed that as preoperative ROE scores decreased, postoperative-1st month and 1st-year ROE scores increased (p<0.05). Postoperative 1st-month and postoperative 1st-year's ROE scores increased together (p<0.05). In the wide cap group, postoperative 1st-month and postoperative 1st-year's ROE scores increased compared to the mini cap group (p<0.05). As postoperative 1st-year nasolabial angle values increased, postoperative 1st-year ROE scores also increased (p<0.05). CONCLUSIONS: We found that patients who received wide-cap rhinoplasty had increased postoperative ROE scores and higher satisfaction rates during the first month and first year. Postoperative higher nasolabial angle values were related to higher ROE scores and patient satisfaction in the postoperative 1st year.

Local allergic rhinitis - a narrative review.

This narrative review aims to provide an up-to-date definition of local allergic rhinitis (LAR), its classification, mechanisms, comorbidities, recommendations for diagnosis and treatment, and define needs in this area. Both 'PubMed' and 'Science Direct' literature was reviewed systematically, and a manual search for studies not previously encountered in the databases was also carried out. Published studies were identified in PubMed covering the period from 1947 to 2022. The following keyword search strategy was used: (local allergic rhinitis* OR entopy* OR local Immunoglobulin E * OR nasal specific Immunoglobulin E). LAR involves Type 2 nasal inflammation with local IgE and cannot be diagnosed by systemic methods, such as skin prick or blood IgE tests. A nasal allergen challenge is necessary for diagnosis. LAR can respond to usual AR treatments, including allergen specific immunotherapy (AIT). LAR is a novel entity that requires additional investigation in terms of prevalence, proper diagnosis, treatment, and prognosis. The target outcomes and possible benefits of this review are to achieve a consensus for the study and diagnosis of LAR and increase interest in this area.

Applied surgical methods and outcomes in crooked nose rhinoplasty.

OBJECTIVE: In this retrospective and multicentric study, we investigated applied surgical methods in rhinoplasty for crooked nose deformity. PATIENTS AND METHODS: The retrospective data for 300 crooked nose deformity cases (191 males and 109 females) were used in our study. Classification of the initial deformities was performed as (1) I-shaped crooked nose deformity, (2) C-shaped crooked nose deformity, (3) Reverse C-shaped crooked nose deformity, and (4) S-shaped crooked nose deformity. As an operation technique, L-strut septoplasty was performed. The applied surgical methods in rhinoplasty to correct the crooked nose are evaluated and classified. RESULTS: Our results showed that initial deformities in crooked nose patients were I-shaped crooked nose deformity (34%), C-shaped crooked nose deformity (28%), Reverse C-shaped crooked nose deformity (21.3%), and S-shaped crooked nose deformity (16.7%). L-strut septoplasty was performed, and the results of the applied methods to correct the crooked nose were evaluated and classified. It was noticed that more than one procedure was applied to each case: (1) double-side lateral osteotomy (86.6%), (2) wedge bone resection on one side of the osteotomy (7.3%), (3) single-side lateral osteotomy (6%), (4) symmetric spreader grafts (56%), (5) asymmetric spreader grafts (10.6%), (6) shaving of the transverse wing of dorsal septum (8%), (7) correction of deviated dorsal septum (16.3%), (8) displaced anterior nasal spine (12.6%), (9) clocking suture (dorsal septal rotation suture) (9%), (10) dorsal septal scoring and splinting graft (8.3%), and equalizing lateral cruses (12.6%). CONCLUSIONS: I-shaped and C-shaped crooked nose deformities were mainly detected in crooked nose deformity patients. Correcting the crooked nose, double-side lateral osteotomy, and symmetric spreader grafts were the most applied techniques to correct the crooked nose. Other rhinoplasty techniques were also applied to these patients; more than one technique was needed.

Caudal septal extension grafts: conchal cartilage or PDS foil-empowered nasal cartilage.

We reviewed the potential benefits of conchal cartilage or Polydioxanone (PDS) foil-empowered nasal cartilage as caudal septal extension grafts (CSEGs). Research methods included searching online databases such as Google, Google Scholar, PubMed, and Proquest Central at Kirikkale University. Use terms like "caudal septal extension grafts," "septal extension grafts," "conchal cartilage," and "PDS foil-empowered nasal cartilage" to find related articles. Due to the anchoring of the lower alar cartilage to the nasal septum, the results of a CSEG rhinoplasty are relatively stable over the long term. They can be adjusted independently by the rhinoplasty surgeon. Over time, the skin and soft tissue envelope contract and a downward force for these grafts develops. It allows for independent regulation of projection and rotation, unlike conventional columellar strut procedures and lateral crural steal techniques. Inadequate cartilage may need conchal or costal cartilage, depending on the application and the need for projection and counter rotation. Costal cartilage transplant outperformed conchal cartilage graft in a rabbit model regarding tip projection and angle relapse rate. Three-patient case series show that PDS foil-enhanced nasal cartilage led to septal cartilage loss. However, other research draws a different result, finding that PDS foil-enhanced nasal cartilage prevented growth inhibition in the developing nasal septum following septoplasty, and reduced late problems in animals. The caudal septal extension grafts should prioritize septum cartilage if it is readily available, of adequate size, and with sufficient strength. If this is not possible, PDS foil-enhanced nasal cartilage fragments or conchal cartilage could be used as a backup. PDS foil will maintain the integrity and stability of the implanted cartilage. Due to its strength, stability, and convenient location, conchal cartilage will serve as the second donor site.

Effects of ceramide C2 application on human laryngeal carcinoma cells: a cell culture study.

OBJECTIVE: In the present study, we investigated the effects of Ceramide C2 application on human laryngeal carcinoma cells. MATERIALS AND METHODS: Human larynx epidermoid carcinoma HEp-2 (ATCC® CCL-23™) cells were purchased from the American Type Culture Collection (ATCC, USA). Human larynx epidermoid carcinoma HEp-2 cells were cultured in complete Dulbecco's Modified Eagle's Medium (DMEM) supplemented with fetal bovine serum (FBS) (10%) and penicillin/streptomycin (1%) in a CO2 (5%) incubator under standard cell culture conditions. Ceramide C2 was prepared, and further dilutions ranging from 3.13 to 100 µM were prepared in a fresh culture medium. Cells on 96 well plates were exposed to the prepared concentrations of ceramide C2 for 24 and 48 hours. Cytotoxicity evaluation was performed by MTT. Apoptosis profiles of HEp-2 cells were detected by annexin-V analysis. The activated caspases 3/7 on HEp-2 cells after ceramide C2 exposure were evaluated with flow cytometric analysis. The morphological changes on HEp-2 cells caused by ceramide C2 were evaluated by staining with phalloidine and acridine orange via confocal microscopy. For the Wound Healing Assay, HEp-2 cells were cultured in 6 well-plates until they became confluent. RESULTS: MTT cytotoxicity test findings revealed that the viability of human laryngeal carcinoma cells decreased with the increased application of ceramide C2 for 24 hours compared to untreated (control) cells. The highest growth inhibition by ceramide C2 for short-term application for 24 hours was detected at the highest concentration of ceramide C2 (100 µM). Annexin-V findings showed that 98.97 of HEp-2 cells were alive, and 1.63% were detected as early apoptosis for the control group. The results showed that ceramide C2 triggered apoptosis on HEp-2 cells with a percentage of total apoptotic cells of 61,40 compared to untreated HEp-2 cells. Cysteine proteases (caspases) 3/7 activation percentages of HEp-2 cells exposed to ceramide C2 for 24 hours were compared to control cells, and the morphology of HEp-2 cells was changed with clear apoptotic signs that underlined the cytotoxicity and pro-apoptotic activity of ceramide C2. Scratch Assay assessed the migration capability of HEp-2 cells before and after the exposure to ceramide C2. It showed that ceramide C2 reduced human laryngeal carcinoma cells' migration capability and proliferation for 24 hours. CONCLUSIONS: Based on all study findings, it can be considered that short-chain ceramide C2 exerted cytotoxicity on human laryngeal carcinoma cells in a dose and time-dependent manner and reduced the viability via inducing caspase-dependent apoptosis. The overall effect might be derived from the elevated intracellular ceramide levels by the exogenous application of ceramide C2. Consequently, it was concluded that ceramide C2 has good potential to cause cytotoxicity and apoptosis in human laryngeal carcinoma cells and, after deeper in vitro and in vivo investigations, can be a good candidate for designing anti-cancer drugs with high efficiency.

Preventive effect of intravesical ozone supplementation on n-methyl-n-nitrosourea-induced non-muscle invasive bladder cancer in male rats.

Although non-muscle invasive bladder cancer (NMIBC) is widely seen in men, most laboratory studies of new intravesical therapies to prevent NMIBC have been conducted on female animals. In addition, ozone (O3) has been shown to be a beneficial agent as an intravesical application in the treatment of various disorders. In the current study, we evaluated the immunohistopathological and oxidative-antioxidative effects of intravesical O3 treatment on n-methyl-n-nitrosourea (MNU)-induced NMIBC. Male Wistar-Albino rats (n=51) were divided into four groups: sham (n=6), O3 only (n=15), MNU only (n=15), and MNU+O3 (n=15). The MNU-only and MNU+O3 groups received MNU, and the O3-only group received saline every other week for 10 weeks. The MNU-only group received 1 ml saline in place of O3 treatment, whereas the O3-only and MNU+O3 groups were treated with 1 ml 25 µg/ml O3 between the 7th and 12th weeks. Rat bladders were collected in the 15th week for immunohistopathology and oxidant-antioxidant quantitation. Oxidant-antioxidant parameters were determined by ELISA. Although all surviving rats in the MNU-only group had preneoplastic (4/11, 36.4%) or neoplastic changes (7/11, 63.6%), a completely normal urothelium was observed in 2 rats (2/12, 16.7%) in the MNU+O3-group (P=0.478). More high-grade lesions were observed in the MNU-only group (4/11, 36.4%) than in the MNU+O3 group (1/12, 8.3%) (P=0.120). All oxidant-antioxidant parameters significantly increased (P<0.05) in the O3-only group compared with the sham group. However, only antioxidant superoxide dismutase was remarkably higher (178.9%, P=0.060) in the MNU+O3 group compared with the MNU-only group. This is the first methodologically and pathologically well-described male rat orthotopic bladder carcinogenesis model with intravesical MNU and administration of O3 in NMIBC.

Interobserver variability in Gleason histological grading of prostate cancer.

OBJECTIVE: The aims of this study were to evaluate the reproducibility of the Gleason grading system and to compare its interobserver variability with the novel Gleason grade grouping proposal using a large sample volume. MATERIALS AND METHODS: In total, 407 pathology slides of prostate needle biopsies from 34 consecutive patients with prostate cancer were re-evaluated. The International Society of Urological Pathology 2005 modified Gleason grading system with Epstein's modification was used. Two pathologists, blind to each other and to the initial pathology report, performed the pathological evaluation. To determine interobserver concordance, the kappa (κ) coefficient test was used. RESULTS: Pathologist 1 and pathologist 2 detected a tumor in 202 and 231 cores, respectively (p < 0.001). The two pathologists disagreed on the presence of a tumor in 31 cores. Of these 31 cores, 74% (n = 23/31) were Gleason pattern 3. The mean length of the cancer foci in these 31 disputed cores was 1.54 ± 0.8 mm. Concordance rates between the two observers for primary and secondary Gleason patterns were 63.96% (κ = 0.34) and 63.45% (κ = 0.37), respectively. Concordance with respect to the Gleason sum was 57.9% (κ = 0.43). When the Gleason scores were classified into the novel Gleason grade grouping, concordance was found to be 51.7% (κ = 0.39). CONCLUSIONS: The agreement between observers on the Gleason sum was moderate. The novel Gleason grade grouping did not improve interobserver agreement. Further studies are needed to confirm these results on interobserver variability.

What is the impact of electromagnetic waves on epileptic seizures?

BACKGROUND: The effects of electromagnetic waves (EMWs) on humans and their relationship with various disorders have been investigated. We aimed to investigate the effects of exposure to different frequencies of EMWs in various durations in a mouse epilepsy model induced by pentylenetetrazole (PTZ). MATERIAL AND METHODS: A total of 180 4-week-old male mice weighing 25-30 g were used in this study. Each experimental group consisted of 10 mice. They were exposed to 900, 700, 500, 300, and 100 MHz EMWs for 20 hours, 12 hours and 2 hours. Following electromagnetic radiation exposure, 60 mg/kg of PTZ was injected intraperitoneally to all mice. Each control was also injected with PTZ without any exposure to EMW. The latency of initial seizure and most severe seizure onset were compared with controls. RESULTS: The shortest initial seizure latency was noted in the 12-hour group, followed by the 700 MHz. The mean initial seizure latencies in the 2-hour EMW exposed group was significantly shorter compared to that in the 12- and 20-hour groups. There was no significant difference between 12- and 20-hour EMW exposed groups. There was a significant difference between control and 2- and 10-hour EMW exposed groups. No statistically significant differences were noted in mean latencies of the most severe seizure latency, following 20-, 12-, and 2- hour EMW exposed groups and control groups. CONCLUSIONS: Our findings suggest that acute exposure to EMW may facilitate epileptic seizures, which may be independent of EMW exposure time. This information might be important for patients with epilepsy. Further studies are needed.

Does radial artery harvesting for coronary revascularization cause neurological injury in the forearm and hand?

OBJECTIVE: Radial artery (RA) is now used widely as a conduit of choice in coronary artery bypass grafting. Although RA removal is considered safe in the presence of adequate collateral arterial supply, there is still a considerable suspicion on the functional status of the forearm and hand. However, a neurological dysfunction may occur owing to either surgical trauma or ischemic neuropathy. This study was aimed to investigate the functional outcome of the donor forearm nerves of the patients who underwent coronary artery bypass grafting surgery with RA conduits. METHODS: A consecutive series of 50 patients who underwent coronary artery bypass graft surgery with one or two RA grafts were investigated in the study. Motor and sensory functions of donor forearm nerves were measured by ENMG studies, pre- and postoperatively at the third week and sixth month of the operation. The conduction velocities, distal latencies and amplitudes of action potentials for motor and sensorial conductions of radial, ulnar and median nerves were measured in each ENMG examination. Neurologic status of the donor forearm and hand was assessed by the same neurologist who performed a detailed neurologic physical examination and ENMG studies. Results were statistically compared using one-way ANOVA test. RESULTS: The incidence of any neurologic symptoms was 32% in early postoperative period. All reported neurologic complaints were associated with sensory conduction deceleration in ENMG investigations of related nerves. In postoperative assessment, median nerve sensory-motor, and ulnar nerve motor conduction records were slightly lower than the preoperative values, but no statistical difference was observed. Pre- and postoperative radial nerve motor and sensory conduction records were statistically similar (P>0.05). CONCLUSIONS: We advocate that removal of RA does not lead to any major neurologic hand complications in the presence of adequate collateral arterial blood supply. ENMG studies confirmed minimal conduction alterations with no statistical significance, even if neurologic symptoms were stated.

The pterion in Turkish male skulls.

This study was conducted to determine the location and type of pterion in Turkish males. The importance of the pterion is its relation to the middle meningeal artery, Broca's motor speech area on the left side, and surgical interventions relating to pathologies of the sphenoid ridge and optic canal. Specific measurements were taken on both sides of 26 Turkish human male skulls, none of which showed any obvious pathology or trauma. The sphenoparietal type of pterion was the most common (96% right side, 79% left side), followed by the frontotemporal (4% right side, 17% left side), and finally the epipteric type (4% left side only). The distances on the right and left sides respectively from the center of the pterion to the frontozygomatic suture were 3.30+/-0.40 cm and 3.44+/-0.39 cm, to the zygomatic arch 4.05+/-0.39 cm and 3.85+/-0.25 cm, to the optic canal 4.39+/-0.40 cm and 4.36+/-0.40 cm, and to the sphenoid ridge 1.40+/-0.33 cm and 1.48+/-0.32 cm. The thickness of the skull at the center of the pterion was 0.41+/-0.14 cm and 0.39+/-0.12 cm on the right and left sides respectively. These findings should be of use in surgical approaches and interventions via the pterion.

Vertical and horizontal neoclassical facial canons in Turkish young adults.

Four vertical and three horizontal measurements were taken to assess the validity of neoclassical facial canons in 500 (272 female, 228 male) healthy, young adults between the ages of 18 and 25 years from Turkey and to compare them with a different population. The measurements were made by a millimetric compass. The special head height was longer than the special face height in the majority of our group (women/men: 97.8%/91.7%). The three-section facial profile canon was equal in only one male subject (women/men: 0/0.4%). Faces with four equal profile sections were not seen in either of the sexes. The nose length was longer than the ear length in the minority of our population (women/men: 1.5%/1.3%). The intercanthal distance was shorter than the nose width and left eye fissure length in the majority of our subjects (women/men: 50.4%/78.9% and 50.0%/52.2% respectively). The mouth width was greater than 1.5 times the nose width in the majority of this study (women/men: 66.9% vs 49.1%).

Measurements of soft tissue orbits in Turkish young adults.

The present study was undertaken to determine the normal values of the intercanthal distance, biocular distance, interpupillary distance and palpebral fissure length and height for the Turkish population. These measurements were taken from 500 (272 females, 228 males) healthy young adults aged 18-25 years. The measurements were made with a millimetric compass. The mean values of intercanthal distance, biocular distance, interpupillary distance, right palpebral fissure length and palpebral fissure height were 30.7+/-3.0 mm, 95.9+/-6.0 mm, 63.9+/-3.6 mm, 32.6+/-2.4 mm and 10.3+/-1.6 mm respectively in males. In females the equivalent values were 30.0+/-2.6 mm, 92.0+/-5.4 mm, 60.8+/-3.2 mm, 31.0+/-2.4 mm and 10.4+/-1.5 mm respectively.

Morphometric measurements from various reference points in the orbit of male Caucasians.

The aim of this study was to determine the morphometric variations from various reference points to decrease risks in orbital surgery. Sixty-two orbits obtained from 31 skulls of male adult Caucasians were measured with a millimetric compass. On the medial orbital wall, the midpoint of the anterior lacrimal crest was the reference point; from this point we measured distances of 23.9+/-3.3 mm, 35.6+/-2.3 mm, 41.7+/-3.1 mm and 6.9+/-1.5 mm respectively to the anterior ethmoidal foramen, posterior ethmoidal foramen, midpoint of the medial aspect of the optic canal and posterior lacrimal crest. On the same wall, distances from the plane of the anterior and posterior ethmoidal foramina to the ethmoido-maxillary suture and distance from the posterior ethmoidal foramen to the anterior ethmoidal foramen and midpoint of the medial margin of the optic canal were 14.9+/-2.3 mm, 9.8+/-2.9 mm and 6.8+/-2.2 mm respectively. On the inferior orbital wall, the main reference point was the infraorbital foramen, and from this point to the midpoints of the lateral margin of the fossa for the lacrimal gland, inferior orbital fissure, inferior orbital rim and inferior aspect of the optic canal was 23.8+/-7.2 mm, 31.9+/-3.9 mm, 6.7+/-1.9 mm and 50.3+/-3.2 mm respectively. On the superior orbital wall, the distances from the supraorbital foramen to the midpoints of the superior orbital fissure, fossa for the lacrimal gland and superior aspect of the optic canal were 45.7+/-3.6 mm, 26.0+/-2.5 mm and 45.3+/-3.2 mm respectively. Furthermore, on the same wall, the distance from the posterior ethmoidal foramen to the midpoint of the superior orbital fissure was 14.6+/-2.8 mm. Finally, on the lateral orbital wall the frontozygomatic suture was the reference point. From this point distances to the midpoints of the fossa for the lacrimal gland, superior orbital fissure, lateral aspect of the optic canal and inferior orbital fissure were 17.5+/-2.1 mm, 37.7+/-3.6 mm, 44.9+/-2.5 mm and 33.4+/-3.1 mm respectively.