Computed Tomography and Magnetic Resonance Imaging for Congenital Hearing Loss: A Retrospective Study.

OBJECTIVE: The aim of this study is to evaluate the relationship between the cochlear nerve and the anatomical structures of the cochlea and internal acoustic canal in patients with congenital hearing loss. MATERIALS AND METHODS: Temporal tomography and magnetic resonance images of 44 patients (88 ears) with non-syndromic congenital hearing loss were retrospectively analyzed between 2018 and 2021. Patients were divided into 2 groups according to cochlear nerve hypoplasia. Cochlear nerve canal width, cochlear basal/ middle turn widths, and internal auditory canal widths were examined. RESULTS: Cochlear nerve hypoplasia was detected in 18.2% (n=16) of the patients and all of the patients with cochlear nerve hypoplasia had severe hearing loss. A statistically significant difference was found between the structures' widths in patients with and without cochlear nerve hypoplasia, in cochlear nerve canal and coronal width of the internal auditory canal. When stenosis is accepted as <1.4 mm for cochlear nerve canal and <3.80 mm for coronal width of the internal auditory canal, cochlear nerve hypoplasia differs statistically between the groups in measurements (respectively; P < .001, P=.018). CONCLUSIONS: In patients with sensorineural hearing loss, cochlear nerve hypoplasia may accompany. Anatomical structures are important in predicting cochlear nerve hypoplasia from temporal computed tomography. Cochlear nerve hypoplasia should be suspected if the cochlear nerve canal and coronal width of the internal auditory canal are less than 1.4 mm and 3.8 mm, respectively, on temporal computed tomography.

Benefits of Combined Surgical Techniques in Otoplasty.

OBJECTIVE: Prominent ear deformity is one of the aesthetic problems that should be treated due to the psychosocial problems it causes. We aimed to present our results in which we used the combination of Mustarde suture to create an antihelix, conchal resection, and concomastoid suture combination to reduce conchal excess in the light of literature. MATERIALS AND METHODS: A total of 28 cases in which the same otoplasty method was used in 2 separate centers between 2014 and 2020 were included in the study. Elliptic skin excision, antihelix reconstruction with Mustarde suture, and in cases with large conchal cartilage, cartilage excision and reconstruction with concomastoid suture were performed in all of our cases. After the skin was closed, a bandage was applied to the ear. RESULTS: In the early postoperative period, hematoma developed in 4 cases. There was superficial erosion of the skin in 4 cases. In the late period, hypertrophic scar developed in both ears and resolved with medical treatment. There was minimal asymmetry in 4 cases, but intervention was not required in cases with asymmetry. Skin necrosis, infection, and visible cartilage irregularity on the anterior side were not observed in any case. CONCLUSION: The aim of otoplasty is to create symmetrical ears with smooth contours, so combined techniques should be used instead of a single technique. In otoplasty, we used Mustarde suture to create antihelix, conchal resection, and concomastoid suture combination to reduce cavum. Our results were satisfactory.

Predictive role of trigeminal ganglion ischemia on scalp survival affected by temporal artery diameters: The first experimental study.

Scalp arteries are mainly innervated by trigeminal, facial, and vagal nerves. The ischemic neurodegeneration of the trigeminal ganglion can impede scalp circulation via vasospasm-creating effects. This study was designed to investigate whether there is any link between the vasospasm index of deep temporal arteries and ischemic neuron densities of the trigeminal ganglion after subarachnoid hemorrhage. The study subjects included five normal control rabbits, six sham rabbits, and nine rabbits chosen from a formerly established experimental subarachnoid hemorrhage group created by cisternal homologous blood injection (0.75 mL). These rabbits, all male, were followed up for 3 weeks. The trigeminal ganglion and deep temporal artery vasospasm indexes were examined by stereological methods. Ischemic neuron densities of the trigeminal ganglion and vasospasm index values of deep temporal arteries were compared statistically. Postmortem examinations showed important vasospasms of deep temporal arteries, foramen magnum herniations, and neurodegeneration of the trigeminal ganglion. The mean vasospasm index values and degenerated neuron densities of the trigeminal ganglion were determined as 1.03 ± 0.13 and 10 ± 3/mm3 (p > 0.5) in the control group, 1.21 ± 0.18 and 35 ± 9/mm3 in the sham group (p < 0.005 for sham vs. control), and 2.54 ± 0.84 and 698 ± 134/mm3 in the experimental group (p < 0.0005 for sham vs. control and p < 0.00001 for study vs. control). There was an inverse relationship between the vasospasm index values and the degenerated neuronal density of the trigeminal ganglion. The high degenerated neuron density in the trigeminal ganglion had a facilitative effect on temporal artery vasospasm. Trigeminal ganglion neurodegeneration may promote temporal artery vasospasms after subarachnoid hemorrhage, which has not been previously mentioned in the literature.

Is There a Relationship Between Epitaxis and Anatomical Variations?

OBJECTIVE: The aim of our study is to introduce the relationship between epistaxis and anatomical variations and present the current treatment approach. MATERIALS AND METHODS: Forty-five patients (28 males and 17 females) that presented to otorhinolaryngology clinics at Mengucek Gazi Training and Research Hospital with pre-diagnosed epistaxis between October 2018 and April 2019 were included in the study. Age, sex and structural causes and anatomical localization of epistaxis in patients were analysed. RESULTS: The median age of the patients was 42, ranging from 20 to 60 years. Focus of bleeding was observed on the right in 16 cases (35.5%), left in 14 cases (31.1%) and bilateral in nasal cavity in 15 cases (33.3%). Bleeding was from the anterior septum in front of the maxillary ostium line. Anatomical variations were seen in 31 patients (68.8%) (septal deviation in 12, septal perforation in two, and concha hypertrophy in 17). CONCLUSION: Epistaxis is one of the most common ear, nose, and throat emergencies. Etiological reasons must be analysed for the treatment to be effective.

Evaluation of the Effect of Bosentan-Mediated Endothelin Receptor Blockade on Flap Survival in Rats: An Experimental Study.

Local skin flaps are important tools for performing plastic surgery. Skin flaps are used for closure of defects after tumor excision or in tissue losses after trauma. However, problems associated with these flaps are commonly encountered, particularly in areas of marginal necrosis. Bosentan is a vasodilator that exerts its effect through endothelin receptor blockade, and has been shown to prevent ischemic tissue damage. However, no reports have addressed the effect of bosentan on skin flaps. The aim of the study was to investigate the effects of bosentan, which may be applied clinically to promote survival of ischemic skin flaps. A modified McFarlane flap was elevated in the dorsum of 20 Albino Wistar rats with a width-to-length ratio of 3 to 10 cm, respectively, with the caudal base. Perioperatively, 0.9% of physiologic NaCl and injectable distilled water of identical volume were injected into rats in Group 1 (n = 10), and 5 mg/kg bosentan was injected intraperitoneally into rats in Group 2 (n = 10). All of the rats were followed up for 7 days postoperatively. The surviving parts of the flaps were measured at the end of day 7. Acute and chronic inflammation, amount of granulation tissue, fibroblast maturation, amount of collagen, and amounts of reepithelialization and neovascularization present in the ischemic zones of the distal parts of the flaps were evaluated histopathologically, and results were compared statistically. The mean flap survivals were 61.1% in Group 1 and 91.1% in Group 2; the percentage of the surviving flap area in Group 2 was higher than that in Group 1 (p < 0.005). In both groups, there was significantly less acute inflammation in the ischemic zones in Group 2 than in Group 1 (p < 0.005). No significant difference was found in the amounts of chronic inflammation and granulation tissue between the two groups (p > 0.005). Fibroblast maturation, amount of collagen, and amounts of reepithelialization and neovascularization investigated in Group 2 were statistically significantly higher than those in Group 1 (p < 0.005). We believe that bosentan may be used prophylactically to increase survival in risky skin flaps because it decreases ischemic necrosis distal to skin flaps, thus exerting favorable effects on flap survival.

A fast, easy circumcision procedure combining a CO2 laser and cyanoacrylate adhesive: a non-randomized comparative trial.

BACKGROUND: Circumcision is performed as a routine operation in many countries, more commonly for religious and cultural reasons than for indicated conditions, such as phimosis and balanitis. There are many techniques available, and recently electrocautery and both Nd:YAG and CO2 lasers, instead of blades, have been used for skin and mucosal incisions. However, the infection risk in circumcisions performed using a CO2 laser was 10% higher. There are also reports of sutureless procedures using cyanoacrylate, but these have higher risks of hematoma and hemorrhage. We combined a CO2 laser and cyanoacrylate to shorten the operation time and to decrease bleeding complications. MATERIALS AND METHODS: Circumcisions were performed under general anesthesia with CO2 laser and cyanoacrylate combination in 75 6-9-year-old boys between May 2013 and August 2014 only for religious reasons. As a control, we compared them retrospectively with 75 age-matched patients who were circumcised using the conventional guillotine method in our clinic. RESULTS: No hematomas, bleeding, or wound infections were observed. One wound dehiscence (1.33%) occurred during the early postoperative period and healed without any additional procedures. The median operating time was 7 (range 6-9) minutes. The conventional guillotine group comprised one hematoma (1.3%), two wound dehiscences (2.6%), and two hemorrhages (2.6%), and the median operating time was 22 (range 20-26) minutes. The difference in surgical time was significant (p<0.001), with no significant difference in the rate of complications between the two groups. CONCLUSION: The combined CO2 laser and cyanoacrylate procedure not only decreased the operating time markedly, but also eliminated the disadvantages associated with each individual procedure alone.

Effects of ozone gas on skin flaps viability in rats: an experimental study.

BACKGROUND: The main purpose of this study was to assess the effects of ozone gas on the viability of flaps for reconstruction and to determine the optimum application method. The antioxidant, immunomodulatory, and reperfusion effects of ozone gas have been previously assessed, and successful results have been reported. However, only one study has investigated the effect of ozone gas on flap viability. In the present study, it was hypothesised that the antioxidant and reperfusion effects of ozone gas would enhance flap viability. METHODS: Forty female Wistar rats were randomly divided into four groups of 10 rats each. A cranial-based, 3 × 11 cm modified McFarlane flap including the panniculus carnosus was raised from the dorsum of a rat and re-sutured to its own bed using 3/0 sharp propylene. Group 1 (n = 10): no pharmacological agent was used after the operation. Group 2 (n = 10): vegetable (olive) oil group; vegetable-oil-impregnated gauze was used as a dressing for 7 days. Group 3 (n = 10): Vegetable (olive) oil with ozone peroxide group; vegetable oil with ozone peroxide-impregnated gauze was used as a dressing for 7 days. Group 4 (n = 10): Hemo-ozone therapy group; hemo-ozone therapy was applied rectally once every day for 7 days. All rats were sacrificed at the end of week 1 and assessed macroscopically and histopathologically. RESULTS: The proportion of substantive necrosis was less in group 4 than in the other three groups. Survival area ratios were better in groups 2 and 3 than in group 1; however, there was no significant difference between groups 2 and 3. No significant differences in the histopathological scores were observed among the groups. CONCLUSION: Ozone gas enhanced flap viability. No differences in flap viability were observed between the vegetable oil and vegetable oil with ozone peroxide groups. The greatest benefit ratios were found in the hemo-ozone therapy group.

A cause of severe thigh injury: Battery explosion.

INTRODUCTION: In parallel with technological improvements, humankind encounter with equipments/devices transforming chemical energy to electrical energy. Especially automobile batteries, watch and mobile phone batteries are the most encountered ones. In the literature, there are mainly facial burn cases due to mobile phone battery explosion. On the other hand very few examples of serious lower limb. injury is present. PRESENTATION OF CASE: 12-year-old female patient referred to emergency room with skin and soft tissue injuries on bilateral anteromedial thigh area as a result of battery explosion. The widest axis of skin defect was approximately 16 × 8 cm on the right side, and 17 × 4 cm on the left side. In addition, there were tattooing caused by chemical injury and multiple pin-point like lesions extending to dermal level on anterior region of thigh. Chemically dirty and necrotized dermal and subdermal tissues were debrided and foreign materials were removed from regions with multiple tattooing. Left thigh was closed primarily. In order to close the defect on right anterior thigh, skin flap from right medial thigh is advanced in Y-V fashion. DISCUSSION: Battery explosion causing lower extremity tissue defect is a type of injury that is rarely seen in the literature. Regardless of battery size and energy level, they should be considered as potential explosive material and protector masks, clothing should be worn during contact with this type of material.

A fast, easy circumcision procedure combining a CO2 laser and cyanoacrylate adhesive: a non-randomized comparative trial

ABSTRACT Background Circumcision is performed as a routine operation in many countries, more commonly for religious and cultural reasons than for indicated conditions, such as phimosis and balanitis. There are many techniques available, and recently electrocautery and both Nd:YAG and CO2 lasers, instead of blades, have been used for skin and mucosal incisions. However, the infection risk in circumcisions performed using a CO2 laser was 10% higher. There are also reports of sutureless procedures using cyanoacrylate, but these have higher risks of hematoma and hemorrhage. We combined a CO2 laser and cyanoacrylate to shorten the operation time and to decrease bleeding complications. Materials and Methods : Circumcisions were performed under general anesthesia with CO2 laser and cyanoacrylate combination in 75 6–9-year-old boys between May 2013 and August 2014 only for religious reasons. As a control, we compared them retrospectively with 75 age-matched patients who were circumcised using the conventional guillotine method in our clinic. Results No hematomas, bleeding, or wound infections were observed. One wound dehiscence (1.33%) occurred during the early postoperative period and healed without any additional procedures. The median operating time was 7 (range 6–9) minutes. The conventional guillotine group comprised one hematoma (1.3%), two wound dehiscences (2.6%), and two hemorrhages (2.6%), and the median operating time was 22 (range 20–26) minutes. The difference in surgical time was significant (p<0.001), with no significant difference in the rate of complications between the two groups. Conclusion The combined CO2 laser and cyanoacrylate procedure not only decreased the operating time markedly, but also eliminated the disadvantages associated with each individual procedure alone.

TG (Tri-Goniometry) technique: Obtaining perfect angles in Z-plasty planning with a simple ruler.

The Z-plasty is used frequently in hand surgery to release post-burn scar contractures. Correct angles and equalization of each limb are the most important parts of the Z-plasty technique. A simple ruler is enough for equalization of limb but a goniometer is needed for accuracy and equalization of angles. Classically, angles of 30°, 45°, 60°, 75°, and 90° are used. These angles are important when elongating a contracture line or decreasing tension. Our method uses only trigonometry coefficients and a simple ruler, which is easily obtained and sterilized, enabling surgeons to perform all types of Z-plasty perfectly without measuring angles using a goniometer.

Application of N-Butyl Cyanoacrylate to Split-Thickness Skin Grafts in Rats: An Experimental Study.

Skin grafts are a standard option for closing skin defects that cannot be closed primarily. A split -thickness skin graft entirely transfers the epidermis and a part of the dermal layer to the wound site. Using conventional techniques, the skin graft is fixed to the wound using sutures and kept closed for 3 to 7 days with a pressed bolster dressing. Continued care includes applying routine graft dressings after the bolster dressing has been removed. The use of fibrin glue and cyanoacrylate derivatives-which shortens the duration of surgery and improves graft fixation to the recipient bed-has become widespread. However, applying fibrin glue during skin graft surgery is limited because there are considerable disadvantages in terms of preparation and cost. Many studies have been conducted on the use of cyanoacrylate derivatives during skin grafting; however, few reports have investigated the effects of cyanoacrylate derivatives on skin graft survival and related histopathologic changes.In this study, the authors used n-butyl cyanoacrylate to prepare split-thickness skin grafts that were subsequently applied to Wistar albino rats, and the authors evaluated the results both histopathologically and macroscopically. The authors also statistically analyzed the effects of graft fixation according to surgical duration. The findings of authors suggest that n-butyl cyanoacrylate can be safely applied during split-thickness skin graft surgery because it significantly reduces surgical duration, demonstrates substantial advantages in terms of graft fixation and monitoring, and, most importantly, demonstrates no notable disadvantages in comparison with conventional methods.

Fast and Painless Skin Tag Excision with Ethyl Chloride.

Skin tags (acrochordon) are skin colored or hyperpigmented, usually pedunculated benign skin lesions and often occur on the neck, axilla, and groin regions. It is difficult choice to excise these multiple, widespread, and pedinculated lesions with or without local anesthesia. One option is to infiltrate local anesthesia to every single skin tag, while cutting pedicle with single move is another option. However, both of these options are painful to some degree. We routinely use ethyl chloride spray anesthesia for skin tag excision with micro-scissor and micro-forceps. We received positive feedback from patients, who underwent skin tag excision before with conventional techniques. They declare that ethyl chloride procedure is more comfortable and painless.