Deep Neck Contouring With a Focus on Submandibular Gland Vascularity: A Cadaver Study.

BACKGROUND: Opening the neck through a submental incision allows accurate management of deep neck structures and results in exceptional neck contours. OBJECTIVES: The authors aimed to evaluate the distribution of deep neck structures and investigate the detailed vascular anatomy of the submandibular gland. METHODS: A total of 26 fresh frozen cadaver heads (15 female, 11 male) were utilized. The authors evaluated the weights of the excised tissues simulating cosmetic resections, including subcutaneous fat, subplatysmal fat, the anterior belly of the digastric muscle, and submandibular glands. The vascular supply of the submandibular gland and intracapsular vessel diameters were also investigated. RESULTS: Whereas female cadavers had greater mean tissue weight removed from the supraplatysmal plane (mean 20.9 g, 56.6%) than the subplatysmal plane (16 g, 43.4%), male cadavers had higher mean tissue weight removed from the subplatysmal plane (10.5 g, 60.7%) than the supraplatysmal plane (mean 6.8 g, 39.3%). The mean subcutaneous (6.8 g) and subplatysmal (6.4 g) fat weights were almost equal in male cadavers; mean subcutaneous fat weight (20.9 g) was 3 times higher than subplatysmal fat weight (6.8 g) in female cadavers. There was a statistically significant relationship between body mass index and fat removed. The intraglandular vessel diameters increased as resections approached the main feeding vessels located posterosuperior (facial artery) and anterosuperior (submental artery) to the submandibular gland. CONCLUSIONS: The results suggest that to achieve exceptional neck contour the structures deep to the platysma often need to be addressed. The submandibular gland reduction can be safely performed with comprehensive understanding of its vascular anatomy.

Mechanical comparison of standard interlocking, clawed, and expandable wedge locked nail fixations: An experimental and numerical study.

INTRODUCTION: Intramedullary nailing has been used as a standard in the treatment of the long bone fractures with its clinical and mechanical advantages. However, using distal locking screws has been associated with longer operative times, higher radiation exposure rates, and complications like breakages of distal screw or nail at the screw hole level. Therefore, attempts to eliminate distal locking screws has been always present for intramedullary nail fixation. With a similar purpose, the present study has been carried out to compare mechanical behaviors of intramedullary nail fixations with different distal locking elements. MATERIALS AND METHODS: In this study, mechanical behaviors of standard interlocking and clawed nail fixations were compared experimentally in the first part. Six fourth generation Sawbones femurs, which have a simulated subtrochanteric fracture, were divided equally and were fixed with standard interlocking and clawed nails. During axial compression tests, experimental strain measurements were taken from all fixations. After validation of numerical models with using experimental strains and stiffnesses, mechanical behaviors of standard interlocking, clawed, and wedge locked nail fixations were compared numerically under axial compression loads. In numerical comparison, the stress-strain distributions were evaluated. RESULTS: Experimental results showed that although that there was no significant difference in stiffnesses, standard nail fixation bore two times higher loads than clawed nail fixations. Under loading, decrease in the distance between fracture surfaces was approximately seven times higher in the clawed nail fixation when compared to standard nail fixations. Numerical results showed that wedge locked nail fixation provided equivalent mechanical behavior to standard interlocking nail. DISCUSSION: In experiments of clawed nail fixation, the high decrease in the distance between fracture surfaces was evidence of the slippage of nail in the medullary canal. For a safe fixation, claws should be deployed when they are completely in contact with the cortical bone, they should be stuck into the bone in a fair amount, and the deployment in the distal third of the femur should be avoided. According to experimentally validated numerical analyses, wedge locked nail fixation may be an alternative for standard interlocking nail fixation if experimental studies support the present results.

A bioartificial rat heart tissue: Perfusion decellularization and characterization.

Despite remarkable advancement in the past decades, heart-related defects are still prone to progress irreversibly and can eventually lead to heart failure. A personalized extracellular matrix-based bioartificial heart created by allografts/xenografts emerges as an alternative as it can retain the original three-dimensional architecture combined with a preserved natural heart extracellular matrix. This study aimed at developing a procedure for decellularizing heart tissue harvested from rats and evaluating decellularization efficiency in terms of residual nuclear content and structural properties. Tissue sections showed no or little visible cell nuclei in decellularized heart, whereas the native heart showed dense cellularity. In addition, there was no significant variation in the alignment of muscle fibers upon decellularization. Furthermore, no significant difference was detected between native and decellularized hearts in terms of fiber diameter. Our findings demonstrate that fiber alignment and diameter can serve as additional parameters in the characterization of biological heart scaffolds as these provide valuable input for evaluating structural preservation of decellularized heart. The bioartificial scaffold formed here can be functionalized with patient's own material and utilized in regenerative engineering.

Arteriography and Histopathology of Vascular Beds in Traumatically Amputated Fingers.

BACKGROUND: The success of replantation following traumatic amputation is determined by the quality of the vascular anastomoses. The purpose of this study was to assess the vascularity of injured arteries from traumatically amputated digits using arteriographic and histopathological analysis. METHODS: 25 amputated digits were included in the study. Crush and avulsion injuries were evaluated according to the Venkatramani classification. The amputated arteries were dissected under a microscope, and the arterial route determined with a transducer. Arteriography using fluoroscopy was evaluated by a radiologist. The area thought to be damaged was dissected and 2-mm slices taken for histopathological examination, and scored using the parameters of fibrin accumulation, oedema, separation, and bleeding. RESULTS: Arterial flow was observed in 6 of 7 in the avulsion group. In the crush group, arterial flow was observed in 11 of 16 cases. On histopathological examination in all cases there were 2 or more findings of either oedema, fibrin formation, bleeding or hernia. These findings were more common in the crush group then the avulsion group. CONCLUSIONS: The intravascular introduction of radio contrast agents to amputated digit prior to replantation may give further information particularly in avulsion amputations.

New Entity of Skull Lesions due to Birth Trauma: Kanat (Wing) Fractures.

AIM: To discuss a special type of skull lesion detected after delivery. We reviewed our experience on scalp swelling in term neonates to further investigate the relationship between cranial injuries and labor process. MATERIAL AND METHODS: A total of 55 newborns with scalp swellings were assessed with medical records retrospectively between January 2007-July 2017. A radiologist and a pediatric neurosurgeon re-analyzed all skull X-ray images via picture archiving and communication system of the hospital. RESULTS: A special type of skull fracture, called Kanat (wing) fracture, was detected. The fractures appeared unique, were located in the midline parietal bone, and were difficult to detect by X-ray. Kanat fractures accounted for 12.7% of the 55 cases (n=7). Patients without (group-1) and patients with (group-2) Kanat fractures were compared based on the head circumference of the newborns (p=0.881), fetal birth weight (p=0.20), maternal age (p=0.04), duration of second stage of labor (p=0.217), maternal body mass index (p=0.278), total labor time (p=0.922) and parity (p=0.375). No statistically significant difference between the two groups was determined for the compared parameters. CONCLUSION: The present study is the first research describing and discussing the possible effects of maternal, fetal and delivery characteristics on Kanat fractures. Designing clinical and experimental researches to enhance awareness and acknowledgement of skull injuries and labor process could improve the clinical outcome of the newborns.

A comparison of basilar artery diameters measured by T2WI and TOF MR angiography.

PURPOSE: The purpose of our study is to compare basilar artery diameters (BAD) measured by T2WI to diameters measured by TOF MR angiography (MRA). By doing this, we hope to understand how compatible these two methodologies are with each other. METHODS: We used data from 100 patients (59 females, 41 males) who underwent a session of both T2W MRI and TOF MRA at the same time (ages between 18 and 83). We measured BAD by both T2WI and TOF MRA in three different levels. We then compared these diameters measured by two different methodologies to each other. RESULTS: In an area between the vertebrobasilar junction and posterior cerebral artery, all data measured by T2WI and TOF MRA in three different levels were analyzed. Average diameters measured by T2WI and TOF MRA turned out to be 79.5% correlated with each other. As a result of our mathematical model that we came up with through regression analysis, we calculated that measurements taken by T2WI on mid-pontine levels could predict TOF MRA measures with 78.3% accuracy. In T2WI and TOF MRA, average diameters measured were 2.982 ± 0.4717 and 3.205 ± 0.4281 mm, respectively. Statistical analyses showed that images measured by T2W series were significantly smaller than those measured by TOF MRA (p < 0.05). CONCLUSION: Our study showed that BAD measured by T2WI were smaller than those measured by TOF MRA. We think that it will be beneficial to refer our results to avoid T2WI and TOF MRA mismatch when evaluating BAD.

Descriptive Analysis of Sphenovomerine Suture and Its Importance in Neurosurgery.

PURPOSE: Articulation of rostrum of sphenoid bone with alae of vomer forms a schindylesis type of joint. The circumference of this joint, called sphenovomerine suture (SVS), is very important in establishing a reliable surgical field in the endoscopic transsphenoidal pituitary surgery. Because of its vital role in endoscopic transsphenoidal pituitary surgery, this radio-anatomical study was designed to establish the morphological properties of SVS. METHODS: In this study, the authors examined SVS in 235 patients (121 females and 114 males) on the computed tomography images of the paranasal sinus and made 4 measurements to describe SVS. RESULTS: The mean distance between superior margin of the upper labial philtrum and top of SVS was 6.66 ±â€Š0.43 cm for females and 7.44 ±â€Š0.54 cm for males. The distance between the top of SVS and dorsum sellae was 3.08 ±â€Š0.33 cm for females and 3.19 ±â€Š0.32 cm for males, the alae of vomer angle in the upper surface was 74.22 ±â€Š20.06° for females and 74.23 ±â€Š19.68° for males. The distance between the most lateral points of 2 alae of vomer was 0.99 ±â€Š0.17 and 1.01 ±â€Š0.19 cm for females and males, respectively. CONCLUSIONS: For an easy and successful operation, removal of the SVS is very important as it will provide a better view of the sellar base and make the management of the surgical instruments easier in the wider safe surgical field thus created.

Extralaryngeal division of the recurrent laryngeal nerve: a new description for the inferior laryngeal nerve.

Extralaryngeal division of the recurrent laryngeal nerve was contradictory in the literature. We aimed to investigate extralaryngeal division of the nerve, and also propose a new description for the inferior laryngeal nerve. Sixty specimens (120 sides) were examined for this project, including 41 men and 19 women cadavers between the ages of 40 and 89 years at death. In one right side, terminal segment of the nerve gave off many small branches surrounding the inferior thyroid artery then reaching the larynx, trachea, thyroid gland and esophagus. In eight sides, terminal segment of the nerve had no extralaryngeal division and entered the larynx as a single trunk. In 110 sides, the nerve had extralaryngeal division. One hundred and three nerves had two laryngeal and one to three extralaryngeal branches. Two types were described in this group. In type I (66 nerves), both branches arose from the same level of nerve. Type I had two subtypes: type Ia, the origin of the branches was just below the inferior constrictor muscle; type Ib, the origin of the branches was 15-35 mm below the muscle. In type II (37 nerves), the laryngeal branches arose just 3-5 mm above the extralaryngeal branches. We observed that the laryngeal and extralaryngeal branches arose generally from the same point of the recurrent laryngeal nerve. The inferior laryngeal nerve is thus very short, or even nonexistent. Therefore, we suggest that if the term "superior laryngeal nerve" is a given, standard, and accepted term, then the term "inferior laryngeal nerve" should also be accepted instead of the term "recurrent laryngeal nerve."

Light and scanning electron microscopic examination of hair in Griscelli syndrome.

Griscelli syndrome is a rare disease characterized by pigment dilution, partial albinism, variable cellular immunodeficiency, and an acute phase of uncontrolled T-lymphocyte, and macrophage activation. Griscelli et al described this syndrome in 1978. Since then, only in approximately 60 cases have been reported, most from the Turkish, and Mediterranean population. In microscopic examination, silvery gray hair with large, clumped melanosomes on the hair shaft is the diagnostic finding. Here, we present scanning electron microscopic study of hair in 2 cases of Griscelli syndrome, where the hair showed normal cuticular pattern but nodular structures were present as an abnormal findings.

Scanning electron microscopic observation of the brown tumor of the head of mandible.

Brown tumors are tumor-like, expansile osteolytic lesions of bone which are seen in both primary and secondary hyperparathyroidism. They generally resolve after surgical treatment of the parathyroid adenoma. Here, we report a case of brown tumor of the mandible of a cadaver with its scanning electron microscopic observation and review of literature.

Double-orifice mitral valve and an associated malformation: secundum atrial septal defect.

The authors report a case of double-orifice mitral valve (DOMV) which showed mitral stenosis and mild insufficiency. An associated anomaly was secundum atrial septal defect. DOMV is an unusual congenital heart defect. The occurrence of this anomaly with or without secundum atrial septal defect is very rare. More often it is associated with other congenital malformations arising from atrioventricular canal defects. There may be no haemodynamic consequences but mitral insufficiency and/or stenosis may complicate this malformation. Treatment can be summarised as abstention, surgical repair or valve replacement.