The Impact of Scroll Ligament Preservation on Nasal Airway Patency in Rhinoplasty: An Objective Study with Rhinomanometry and Acoustic Rhinometry.

BACKGROUND: Rhinoplasty is a critical surgical intervention aimed at enhancing nasal form and function. However, traditional approaches often compromise the integrity of nasal scroll ligaments, vital for the functionality of the internal nasal valve, leading to potential postoperative nasal dysfunction. Despite the importance of scroll ligaments in maintaining nasal structure and function, the literature lacks objective, quantifiable evidence of their role. This study sought to objectively compare nasal functionality and anatomy between patients undergoing rhinoplasty with bilateral preservation of scroll ligaments and those with bilateral sacrifice of these ligaments, employing computerized rhinomanometric and acoustic rhinometric measurements as evaluative tools. METHODS: This retrospective, double-blind study was conducted at Tekirdag Namik Kemal University's Plastic Reconstructive and Aesthetic Surgery and Ear, Nose, and Throat Clinics. The study population comprised patients who underwent rhinoplasty between May 1, 2018, and October 1, 2019. Patients were rigorously selected based on their medical history, including previous nasal surgeries, aesthetic dissatisfaction, and minimal nasal septum deviation. They were then categorized into two distinct groups: one undergoing rhinoplasty with an emphasis on preserving the scroll ligaments (n = 31) and the other where these ligaments were intentionally sacrificed (n = 30). A comprehensive analysis involving preoperative and six-month postoperative computerized rhinomanometry and acoustic rhinometry measurements was conducted to assess the surgical impact on nasal functionality and structure. The statistical comparison focused on evaluating the changes in air pressure and airflow rates, aiming to delineate the functional outcomes attributable to the differing surgical techniques. RESULTS: Our findings reveal a stark contrast in postoperative nasal functionality between the two groups. In the group with preserved scroll ligaments, there was a significant improvement in postoperative computerized rhinomanometric measurements, indicating enhanced nasal airflow and reduced airway resistance. Conversely, the group with sacrificed scroll ligaments exhibited deteriorated postoperative outcomes, with increased nasal airway resistance and decreased airflow. These differences underscore the pivotal role of scroll ligaments in maintaining nasal airway patency and functionality. CONCLUSION: The study unequivocally demonstrates that the preservation of scroll ligaments during rhinoplasty significantly benefits nasal airway function, as evidenced by improved postoperative rhinomanometry and acoustic rhinometry measurements. This objective data provide a compelling argument for the functional importance of scroll ligaments, advocating for surgical techniques that prioritize their preservation. By highlighting the positive correlation between ligament preservation and enhanced nasal functionality, this research contributes valuable insights into rhinoplasty practices, suggesting a paradigm shift towards approaches that safeguard nasal structural integrity for optimal functional outcomes. LEVEL OF EVIDENCE IV: This 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 www.springer.com/00266 .

Congenital three generation wide familial non-syndromic polydactyly.

Polydactyly is typically observed as isolated and sporadic occurrences, although familial cases do exist, albeit with lower frequency, manifesting in various inheritance patterns. In around 30% of polydactyly cases, there exists a familial history, suggesting the probable involvement of a single gene. Given its potential for hereditary transmission, thorough investigation of the patients' parents, first-degree relatives, grandparents, and even great-grandparents for similar disorders becomes imperative. In our clinic, we conducted an analysis focusing on patients presenting with foot polydactyly, along with occurrences of polydactyly among their first- and second-degree relatives spanning two to three generations of family history. The study encompassed three patients and their respective families, including a pair of siblings. We speculate that the inheritance type in our cases was autosomal dominant. Among our patients, one presented with central polydactyly, while the remaining patients and all familial cases displayed postaxial polydactyly. In terms of morphologic classification, one patient had a Y-shaped metatarsal, another had a T-shaped metatarsal, and the third patient exhibited a duplicated ray-shaped anomaly. In our review of the literature, we haven't come across a case spanning three generations like the ones we encountered. Additionally, the presence of a transverse accessory extensor tendon between both extensor tendons in cases with T- and Y-shaped metatarsals intrigued us from an anatomical perspective. Our goal is to present these rare cases of congenital familial polydactyly spanning three generations, highlighting the anatomical variations observed and aiming to contribute to the existing body of literature on the subject.

Mammoplasty Using Modified Superomedial Pedicle Technique in Severely Macromastia and Ptotic Breasts.

Mammoplasty is a surgery commonly used for macromastia. Many mammoplasty techniques are described, all with their specific pros and cons. However, the concern to avoid serious complications sometimes takes precedence, and the ideal result cannot be. For macromastia and severely ptotic breasts, usually the free nipple-areolar complex (NAC) mammoplasty technique is implemented. The results, however, may only be completely satisfactory regarding cosmetics. Loss of NAC, poor appearance, flabbiness, flattening, and ptosis are among the disadvantages of this technique. This study aimed to present the results of mammoplasty employing the superomedial pedicle technique without interrupting a macromastia central base with a pedicle length of 8 to 18 cm. According to the literature, many plastic surgeons recommend the free NAC rather than the pedicle technique because of the high complication rates in mammoplasties planned for highly ptotic breasts and macromastia. On the other hand, many free NAC techniques and their modifications with pedicle mammoplasty are described. The general conviction is that a standard method, protocol, or technique good for all patients does not exist. Our results are more acceptable both cosmetically and physiologically. Therefore, the superomedial pedicle technique can be modified to achieve ideal results where free NAC mammoplasty is considered for severe macromastia and ptotic patients. This combined method contributes to the viability of NAC by increasing blood supply to breast tissue and providing an ideal breast appearance.

Electric scooters as a silent source of danger in increasing use among young people: a single-center in-depth accident analysis.

BACKGROUND: The reasons for the increase in accidents involving shared stand-up e-scooters in recent years may be the wide-spread use of e-scooters among young people, especially in metropolitan areas with heavy traffic, non-compliance with traffic rules, and insufficient legal regulations. In this study, we analyzed in detail the typical features of rider-sharing e-scooter-related injuries brought to the emergency department of our hospital in the light of current literature. METHODS: The clinical and accident characteristics of 60 patients with surgical requirements who were brought to the emergency department of our hospital due to e-scooter-related accidents between 2020 and 2020 were analyzed using statistical methods ret-rospectively. RESULTS: The majority of the victims were university students and the number of victims of the male gender was slightly higher and the mean age was 25.3±13.0 years. Most e-scooter accidents occur on weekdays. Most of the e-scooter-related accidents happen on weekdays and are non-collision type accidents. The majority of e-scooter-related accident victims were in the minor trauma group (injury severity score <9), predominantly had extremity and soft-tissue injuries and needed radiological examination (44 patients, 73.3%), and only eight victims (13.3%) required surgical operation and also all of the e-scooter victims were discharged fully healed. CONCLUSION: Among the more common collision-free e-scooter-related accidents that have a lower trauma severity score or cause minor soft-tissue injury, mono-trauma occurs more commonly than multisystem trauma; likewise, radius and nasal-weighted monofractures occur more commonly than multiple fractures, according to this study. Besides, effective measures and legal regulations should be put in place to prevent e-scooter-related accidents.

Bilobed Flap for Reconstruction of a Large Keratoacanthoma of the Thumb.

We present the bilobed flap principle which can be used to reconstruct of large defects located on the dorsum of the thumb. The flap provides similar texture, colour and thickness as adjacent hand skin. The final results were excellent both functionally and cosmetically.

Recurrent Merkel cell carcinoma of the gluteal region: A case report.

Merkel cell carcinoma (MCC) is a rare malignant tumor of the skin. The development of MCC on non-sun-exposed skin is extremely rare, with few cases reported in the literature. The present authors aimed to highlight the characteristic features and treatment options of this tumor. The present authors present a 50-year-old man who developed MCC on the left gluteal region (non-sun-exposed skin). After surgery with clear margins, adjuvant radiotherapy was given. Three months after radiotherapy, lymphatic recurrence was observed and he was treated with chemotherapy. On follow-up, systemic metastases were found and palliative treatment was planned.

The effect of low molecular weight heparin on salvaging the zone of stasis in an experimental burn model

Background/aim: Multiple zones of injuries are formed after burns, consisting of a zone of coagulative necrosis, a zone of hyperemia, and a zone of stasis, in which progressive microcirculatory thrombosis leads to degeneration and deepening of the wound. We used an experimental rat comb burn model to test the hypothesis that use of low molecular weight heparin (LMWH) may save the zone of stasis. Materials and methods: Adult female rats were randomly divided two groups: the LMWH group (n = 8) rats received subcutaneous LMWH injections, while the saline group (n = 8) rats were injected with the same volume of saline solution by the same route. The zone of stasis was evaluated macroscopically and histologically, and functional capillary density was evaluated. Results: Histological assessments revealed higher macrophage numbers and PML density, fibroblast proliferation, and angiogenesis in the LMWH group than in the saline group. Functional capillary density measurement in the stasis zones revealed no significant difference between the two groups in the first 4 days, although a significant difference in favor of the LMW group was observed in the last 3 days. Conclusion: The results of this experimental study show that LMWH is effective in saving the zone of stasis.

An evaluation of five different dressing materials on split-thickness skin graft donor site and full-thickness cutaneous wounds: an experimental study.

The objective of this study was to investigate the healing effect of five different products on split-thickness skin graft (STSG) donor sites and full-thickness cutaneous wounds (FTCWs) using an occlusive dressing model. Six groups were included: 1 control and 5 experimental groups, with a total of 24 rats, using an occlusive dressing model. STSG donor sites and FTCWs were established in two separate areas, to the right and left on the animals' backs. Wound sites were dressed with one of the following materials: fine mesh gauze, microporous polysaccharide hemosphere (MPH), clinoptilolite, alginate, hydrogel or biosynthetic wound dressing (Biobran(®) ). These materials were compared in terms of healing rate, healing quality and histopathological findings. Occlusive dressings were applied to each wound on days 0, 3, 5, 7, 10 and 14. Area measurements were taken using images of each dressing. The alginate and clinoptilolite groups gave the best healing rate results for both STSG donor sites (P = 0·003) and FTCWs (P = 0·003). MPH came third in each group. The alginate group produced better results in terms of healing quality criteria, followed by hydrogel, MPH, clinoptilolite and Biobran(®) , in that order. Statistically significant results were obtained in all groups compared to the control group (P < 0·0007). Rapid and good healing quality for both the STSG donor sites and FTCWs were obtained with alginate. Healing with clinoptilolite and MPH was rapid, but poor quality, while slower but good healing quality was obtained with hydrogel. Slower and worse quality healing was obtained with Biobran(®) .

Effects of lidocaine plus epinephrine and prilocaine on autologous fat graft survival.

Although fat grafting is frequently used in plastic surgery practice, debate about the viability of the graft still persists owing to its questionable long-term success. The ultimate aim is to obtain long-term graft viability. Vascularization of the graft is essential for this purpose. The effects of 2 different local anesthetic preparations frequently used during harvesting of fat grafts on long-term graft survival were compared with angiogenesis and volumetric measurements. Twenty-four male Wistar rats were divided into 3 groups. The inguinal region was selected as the fat graft donor site. The first group was injected with isotonic saline, the second was injected with lidocaine plus epinephrine, and the third was injected with prilocaine. Fat grafts were implanted into the dorsal regions of rats, and volumetric measurements were performed initially and on days 30 and 180 at which microvascular angiogenesis were also analyzed. Microvascular angiogenesis was assessed both with the reverse transcription-polymerase chain reaction and immunohistochemistry through determination of vessels stained with factor VIII. No significant difference was obtained between the 3 groups in graft volume or microvascular angiogenesis at any stage of the study. Results from this experimental study indicate that there is no negative effect of lidocaine plus epinephrine or prilocaine on microangiogenesis and the survival of fat grafts.

Giant cementoblastoma of the impacted mandibular incisor.

The cementoblastoma is a relatively rare type of all odontogenic tumors. The incisor and impacted or unerupted tooth involvement by a cementoblastoma is extremely rare. We present a case report of a giant cementoblastoma that involved an impacted mandibular incisor.