A new concept for mandible reconstruction after oncological resection: Multisegment virtual surgical planning.

PURPOSE: Virtual surgical planning (VSP) is good for three dimensional reconstructions in maxillofacial surgery, but it is not problem-free completely especially when the resection margins cannot be affirmed in preoperative period. We aimed to obtain an ideal reconstruction with elaborating VSP to be prepared for adverse conditions during surgery and to proceed the oncological resections step- by- step with A, B, and C resection planes. PATIENTS AND METHODS: Four patients undergoing multisegment VSP for the primary mandible malignancies were included in the study. The first resection margin was detected as plan A in VSP, and plans of B and C were also prepared considering the tumor- positive result of intraoperative frozen section procedure. RESULTS: Following the tumor resection, margins were extended to the plan B in two patients, and plan C in one patient in accordance with the results of the frozen section procedure.Histogram comparison of the localizations of osteotomies in mandible and fibula, and positions of the implants were calculated at a confidence level of 95 % (p > 0.95) and mean difference was found -0.55 mm, while standard deviation was 1.76 mm. CONCLUSION: Multisegment virtual surgical planning seems to achieve the optimal reconstruction with the staged resection preventing redundant removal of tumor- free structures like bone and teeth.

Original Location of Congenital Nasal Sinus "Midcolumella": A Modified Inverted V Incision Technique.

Among the rare congenital malformations, congenital nasal sinuses with blind end are extremely unusual. To the best of our knowledge, a sinus located in the midcolumellar region has not been reported yet. Since there is no consensus about the treatment of midcolumellar sinus, to manage the case as individually as possible was our priority. Considering the patient's age, aesthetic concerns, and requirement of septorhinoplasty in the future, the known inverted V incision was modified to provide surgical excision without any extra scar in the midcolumellar line. This report emphasizes a patient-specific treatment of a 15-year-old female patient presented for congenital sinus in the midcolumellar area. Supplementary Information: The online version contains supplementary material available at 10.1007/s12663-023-02032-0.

The Impact of Age on Anthropometric Changes Following Rhinoplasty.

Background: There are several factors affecting the results of rhinoplasty, and the predictability of outcomes still remains insufficient. Objective: To associate the rhinoplasty results with patients' age by anthropometric measurements. Methods: Retrospective chart review of patients undergoing rhinoplasty who were divided into decades of age. Anthropometric measurements were carried out using Rhinobase® Software. Wilcoxon t test was used for the postoperative 3 months and 2 years analysis. p values of <0.05 were considered statistically significant. Results: A total of 243 patients (median age: 37.1; M:F = 68:175) were included in the study: group I (19-29 years) n: 80; group II (30-39 years) n:71; group III (40-49 years) n: 48; and group IV (50-61 years) n: 44. In group IV, the highest value of difference (Δ) was seen in the midfacial height with the number of 5.5 ± 1.1 (mm) (<0.001). The values of nasal length, tip projection, and midfacial height parameters showed significant differences in both group III and group IV. Conclusions: Unfavorable age-related changes in long-term postoperative period following rhinoplasty can occur in patients above 40 years of age.

The effect of dobutamine treatment on salvage of digital replantation and revascularization.

PURPOSE: One of the most common causes of a failure after replantation and revascularization surgeries is 'no reflow' from proximal artery that occurs, especially following crush and avulsion injuries. In this study, we aimed to evaluate the effect of dobutamine treatment on salvage of replanted and revascularized digits. METHODS: The patients with no reflow phenomenon detected in the salvage operations of replanted/revascularized digits between the years 2017 and 2020 were included in the study. Dobutamine treatment was infused at a rate of 4 µg·kg-1·min-1 intraoperatively and of 2 µg·kg-1 min-1 postoperatively. Demographic data (age, sex), digit survival rate, ischemia time, and level of injury were retrospectively analysed. Pre-infusion, intraoperative and postoperative values of cardiac index (CI), mean arterial pressure (MAP), and heart rate (HR) were recorded. RESULTS: The phenomenon of 'no reflow' was encountered in 35 digits of 22 patients who underwent salvage surgery due to vascular compromise. The survival rate in the revascularization group was 75%, while it was 42.1% in the replanted digits. Metaphysis level of proximal phalanx was the most common localization for 'no reflow' phenomenon. The least values of CI, MAP and HR to obtain sufficient perfusion in salvaged digits were as follows: 4.2 l.min-1.m-2, 76 mm Hg, and 83 beat·min-1, respectively. CONCLUSIONS: It was demonstrated that dobutamine infusion at a rate of 4 µg·kg-1·min-1 intraoperatively and at 2 µg·kg-1·min-1 postoperatively has favorable effects on the vascular compromise derived from no reflow of proximal artery.

Gracilis Muscle Interposition to Fill the Perianal Dead Space May Decrease Hospital Length of Stay in Fournier's Gangrene.

PURPOSE: The treatment of Fournier's gangrene (FG) includes aggressive debridement of the affected necrotic area, broad-spectrum antibiotic therapy, and reconstructive procedures, respectively. One of the main reasons of unfavorable outcomes in FG surgery is that the dead space occurs in the perianal region because of destruction of fascias and soft tissues. In this study, we aimed to evaluate the results of gracilis muscle flap transposition to fill the FG-associated perianal dead spaces. METHODS: Patients treated for FG-associated dead spaces in their perianal region between the years 2017 and 2021 were included in the study. The patients who underwent the pedicled gracilis muscle flap surgery were included in group 1, whereas group 2 consisted of the patients with no additional surgical procedure for dead spaces but only the reconstruction of the soft tissue defects. Demographic data (age, sex), comorbid diseases, localization and length of perianal dead space, and management method for the soft tissue defects and complications were noted. The length of hospital stay and discharge day after surgery were also recorded. RESULTS: In group 1, the mean duration of hospital stay was 23.5 ± 5.0 (range, 14-48) days, whereas the mean period between the surgery and discharge was 5.1 ± 2.2 (range, 3-12) days. These numbers were 31 ± 8.3 (range, 19-58) days and 12.7 ± 6.1 (range, 7-22) days in group 2, respectively. Statistical comparison of the periods between the surgery and discharge was found to be significantly different ( P = 0.022). The duration of hospital stay was also shorter in the patients with gracilis muscle flap ( P = 0.039). CONCLUSIONS: Perianal dead spaces accompanying many of the patients with FG provide appropriate conditions for bacterial colonization. Filling these pouches by the gracilis muscle flap prevented the progression of infection and enabled the patients to return to their normal life earlier.

The Impact of Wearing a Face Mask during the COVID-19 Pandemic on Temporomandibular Joint: A Radiological and Questionnaire Assessment.

Aim Several health problems have been reported to be triggered or facilitated by prolonged mask usage during the coronavirus disease 2019 (COVID-19) pandemic. While wearing a face mask, people tend to push their jaws forward and downward in a repetitive manner to hold their masks in the right position; these jaw motions may induce temporomandibular joint disorder (TMD). In this study, we aimed to investigate these repetitive jaw movements while wearing face masks and their effects on TMD. Patients and Methods Patients who applied with TMD signs between June 2020 and May 2021 were evaluated prospectively. A survey using a questionnaire was conducted to define patients with TMD that caused only by mask-related repetitive jaw movements. Demographic data (age and gender), mean duration of daily mask usage, mask type, and magnetic resonance imaging results were recorded. Results Prolonged daily mask usage (≥8 hours/day) was significantly higher in patients with mask-related habits (group a) with a rate of 40.4% ( p ≈ 0.001). Also, in this group, the disc displacement with reduction rate (54.6%) was higher compared with other groups ( p ≈ 0.010). On the contrary, patients with no underlying risk factor (group c) showed an unexpected high osteoarthritis rate ( p ≈ 0.029). Conclusions In this study, we demonstrate that correcting the position of a face mask by repetitive jaw movements can increase the occurrence of TMD. Informing individuals wearing face masks about the risk of TMD and the importance of choosing the appropriate mask size according to the face shape are important issues to be addressed in the near future.

The effect of a gap concept on peripheral nerve recovery in modified epineurial neurorrhaphy: An experimental study in rats.

BACKGROUND: Several factors such as surgical approach that only consider topographic anatomy; inadequate fascicular alignment, extraepineurial sprouting in the repair zone; contact of axons with the suture area are the disadvantages of epineurial neurorrhaphy. Accordingly, axonal mismatch, neuroma, and unfavorable nerve recovery become inevitable. Neurotropism is the theory clarifying appropriate matching of the nerve fibers independently without needing surgical approach. The studies comparing the primary nerve repair with the nerve defects bridged in different ways demonstrated better outcomes of nerve recovery in the groups with a nerve gap. In this study, we aimed to demonstrate the effects of the gap concept in primary nerve repair bridged by own epineurium. We hypothesized that this technique will provide better results in terms of peripheral nerve recovery and will significantly eliminate the occurrence of a neuroma, which is quite possible in epineurial neurorrhaphy. MATERIALS AND METHODS: A total of 35 Wistar female rats weighing 200 ~ 250 g were randomly divided into five groups each with seven rats. Sham controls constituted Group 1, while the rats with epineural neurorrhaphy were included in Group 2. The remaining three groups were the study groups. In Group 3, after the sciatic nerve transection, epineurium of the distal segment was sleeved and preserved. A 2-mm axonal segment was removed from the epineurium free distal ending and no any procedure was applied to the proximal ending of the transected sciatic nerve. Epineuriums of the both sides were approximated and repaired. In Group 4, a 2-mm axonal segment was removed from the proximal ending of the sciatic nerve after preservation of epineurium and no any procedure was applied to the distal part of sciatic nerve. Epineuriums of the both sides were approximated and repaired. In addition, in Group 5, after epineuriums were sleeved in the both distal and proximal stumps, a 1-mm nerve segment was removed from both endings and epineuriums were repaired in the middle bridging a 2-mm axonal gap again. After a 3 months follow-up period Sciatic Functional Index (SFI) was measured by walking track analysis; the area under the evoked compound muscle action potential (CMAP) and latency periods were calculated via electromyographic (EMG) analysis; and histopathological evaluation were performed to compare the parameters of edema, fibrosis, inflammation, vascularization, axonal degeneration, axonal density, myelination, disorganization, and neuroma occurrence. Vascular structures and nerve fibers were counted at ×200 magnification: +1, +2, and +3 indicated the presence of 0-15, 16-30, and >30 structures, respectively. For uncountable parameters (edema, disorganization, myelination, fibrosis, and inflammation): +1 indicated mild, +2 indicated moderate, and +3 indicated severe. RESULTS: The differences between the groups with axonal gap repair and epineural neurorrhaphy were not significant regarding to SFI. The areas under CMAP were as follows: 27.9 ± 5.9 (Δ = 12.1%) in Group 1; 16.5 ± 5.5 (Δ = 6.3%) in Group 2; 14.1 ± 6.2 (Δ = 4.8%) in group 3; 13.8 ± 2.3 (Δ = 9.2%) in Group 4, and 22.5 ± 18.3 (Δ = 2.2%) in Group 5. Group 5 (1 mm gap in the distal +1 mm gap in the proximal segments) had a significantly better result in terms of the area under CMAP with the value of 22.5 ± 18.3 m/Mv (p = .031). Axonal density was 0.9 ± 0.6 (Δ = 2.2%) in Group 2, 2.4 ± 0.3 (Δ = 5.1%) in Group 3, 2.8 ± 0.1 (Δ = 7.7%) in Group 4, and 2.8 ± 0.2 (Δ = 4.8%) in Group 5. Myelination was 1.1 ± 0.5 (Δ = 3.4%) in group 2, 2.2 ± 0.2 (Δ = 6.7%) in group 3, 2.4 ± 0.4 (Δ = 6.0%) in Group 4, and 2.7 ± 0.3 (Δ = 4.6%) in Group 5. Disorganization was 2.3 ± 0.4 (Δ = 4.1%) in Group 2, 1.2 ± 0.2 (Δ = 7.7%) in Group 3, 1.3 ± 0.2 (Δ = 6.5%) in Group 4, and 1 ± 0.3 (Δ = 5.9%) in Group 5. And, neuroma occurrence was found 2.2 ± 0.6 (Δ = 2.8%) in Group 2 and 0.3 ± 0.2 (Δ = 0.1%) in Group 4 while neuroma was not encountered in Group 3 and Group 5. Comparison between the epineurial neurorrhaphy group and the groups with axonal defect revealed the statistically significant results in the factors of axonal density (p = .001), myelination (p = .028), disorganization (p = .016) and neuroma (p = .001). CONCLUSIONS: Creating axonal gap bridged by own epineurium showed favorable results comparing with epineurial neurorrhaphy. Resection of a 1 mm axonal segment from the proximal and distal stumps following the epineurial sleeve procedure and performing the epineurium- only repair can facilitate the nerve regeneration. The feasibility of the described technique has been demonstrated in a small rat model and must be further validated in larger animals before clinical testing.

Midline Mandibular Cleft Treatment.

ABSTRACT: Tessier 30 cleft is a more rare anomaly comparing the other clefts and has variable clinical presentations. According to the literature, there were only 66 cases with Tessier 30 cleft reported since 2007. Furthermore, because of the rarity and variable clinical presentation of this condition, there is no consensus on the mode of management and timing of surgical procedures. In this case, we demonstrated the earlier treatment method of a newborn case with Tessier 30 cleft.

Comparison of Maxillofacial Fractures Between Pedestrians and Passengers in Road Traffic Accidents.

PURPOSE: Road traffic accidents remain as the most common cause of maxillofacial injuries in developed countries. To the best of our knowledge, comparative analysis of fracture localizations and injury types of injured pedestrians and passengers is seldom performed. Thus, this study aimed to compare maxillofacial injuries between pedestrians and passengers injured in road traffic accidents in terms of demographic characteristics of the patients, localization of fractures, and treatment. MATERIALS AND METHODS: The study population was composed of patients who underwent surgery for maxillofacial fractures resulting from road traffic accidents. They were divided into the pedestrian group and passenger group. Demographic data, fracture sites, and treatment methods were investigated retrospectively. RESULTS: Most of the patients were 20 to 30 years of age. Isolated mandible fractures occurred in 55.71% of the pedestrian group and 43.78% of the passenger group. Panfacial fractures were observed in 5.71% (n = 8) of the patients in the pedestrian group compared with 14.28% (n = 21) in the passenger group. CONCLUSIONS: Based on the injury pattern and mechanism of in-vehicle accidents, fractures tend to be located in the middle and upper facial bones rather than in the mandible. Thus, careful management in triage is important, as each group has specific injury patterns. Patients with panfacial fractures require meticulous management because they are at risk for high-energy injury and comorbidities.

Evaluation of the effect of hyperbaric oxygen therapy on hypertrophic scar formation in a rabbit ear model: An experimental study.

Hypertrophic scar is a disease with complicated treatment methods. Although there are numerous studies in the literature definitive therapy has not been reported yet. In this study, we aimed to evaluate the short and long-term effects of HBOT on hypertrophic scar formation in a rabbit ear model. A total of 20 male New Zealand rabbits weighing 2.1 to 2.4 kg were used in this study. The rabbits in group 2 were exposed to hyperbaric oxygen treatment for 7 days starting from the first day following biopsy punch, while no extra treatment was applied to the rabbits in group 1. Macroscopic scar thickness, histopathological parameters and HI were assessed in both of the 30th day and 60th day scars. Scar thickness was found significantly less in the scars of the rabbits exposed to HBOT (P < .05). And less dermal hypertrophy was also found in HI results of group 2.(P ≈ .022) There were differences between groups in terms of inflammation, vascularization and density of collagen fibrils. HBOT applied for 7 days from the first day of wound formation has both short and long-term effects on the triggering factors of hypertrophic scar, especially on inflammation.

Ethyl Alcohol Versus Botulinum Toxin A: A Comparative Study of the Visual and Histopathological Outcomes in the Rabbit Anterior Auricular Muscle Model.

BACKGROUND: Botulinum toxin has long been known for its paralytic effects at the neuromuscular junction. Although it has been widely used for vascular and nervous tissues, there has been no study of the aesthetic effects of the application of ethanol to muscle tissues to date. OBJECTIVE: The authors aimed to demonstrate the effects of the application of ethanol to muscle tissues after an intramuscular injection and to compare the effects of botulinum toxin A (BTA) and ethanol. METHODS AND MATERIALS: A total of 28 rabbits were divided into 4 groups (n = 7 each). Botulinum toxin A (5 units) and different concentrations of ethanol (5 cc) were injected into the left and right anterior auricular muscles of all rabbits, respectively. Ear ptosis was assessed, and histopathological examination was performed after all rabbits were euthanized in the eighth week. RESULTS: Muscle function was affected earlier in ethanol-treated ears than in botulinum-treated ears; however, the ptotic effect lasted for a significantly shorter duration in ethanol-injected ears than in BTA-applied ears. CONCLUSION: Ethanol can block muscle function reversibly and can serve as an alternative to BTA, particularly when rapid results are desirable.

Effects of aspiration time on immediate viability of adipocyte cell in ultrasound-assisted liposuction (UAL) and in traditional suction-assisted lipectomy (SAL).

We aimed to determine the effect of aspiration periods following liposuction procedure on vascular structures, fibrocollagenous tissues and viability of adipose cells at different minutes, respectively in UAL and SAL. Abdominoplasty materials were divided into two equal parts from middle following excusion during the operations. Traditional SAL was performed to the right part of the abdominoplasty materials therewithal. Each side of the material was then divided into five parts enumarated from one to five and aspiration procedure time for each area was defined according to this ranking. The aspiration periods for each area were as follows: the transition intervals of 30 seconds between each zone were calculated as preoperative preparation time for surgical equipment in every area, and for discharging the lipoaspirates from collecting container. Red blood cell amount, a rate of degeneration in vasculary tissues, adipocyte cell amount with nuclear conformation, a rate of septal structure loss in fibroblast cells and septal fibroblast amount were the histopatological parametres of the study which observed and analysed by the pathologists. Based on the results of statistically analysis we proved that obtaining more surviving fat graft is possible by keeping aspiration period less than 2 minute in operation zone. In case of elongation of stated period clinical accomplishment of fat graft application reduces due to the downward of viable adipocyte cell amount and accelerating injury on tissues. Consequently, keeping the aspiration duration less than two minutes in planned liposuction area in both liposuction methods is favourable for providing maximum viable autologous fat graft.

A Different Stabilization Technique of Autogenous Cartilage Grafts in Saddle Nose Deformity: Prevention Warping and Resorption.

BACKGROUND: Saddle nose deformity (SND) is a collapse of the cartilage and bone structures forming the dorsal projection of the nose. After the use of autologous cartilage in the treatment of SND, resorption and warping continue to be a problem. METHODS: This study presents results from 11 patients with SND types III and IV from 2005 to 2017 treated with autologous cartilage fixed with microplates and microscrews. The patients were monitored for at least 1 year. Resorption and warping were measured using postoperative photographs of the patients in the 3rd and 12th months after treatment. RESULTS: No signs of resorption or warping were noted in the patients. CONCLUSIONS: Our findings indicate autologous cartilage use with microplates and microscrews is a viable, long-term treatment option for patients with SND types III and IV.