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Objective:Bone grafts and even bone substitutes do not meet all of the requirements of bony reconstructions. The aim of this study was to generate bone tissue from autologous adipose tissue-derived mesenchymal stem cells (ATDMSCs) and decellularised bone allografts.Methods:A 1.5 cm bone defect developed in the middle third of the rabbit’s ulna. Reconstructions were carried out using miniplate and screws and interpositional autogenous bone grafts according to the designs of the groups: (1) No touch, (2) cryopreserved, (3) decellularised and (4) ATDMSCs-implanted decellularised bones. Before implantation, ATDMSCs in the last group were labelled with Q-dot and identified microscopically.Results:Graft recovery and irregular callus formation were observed in the first, second and forth groups. In the first group, the organisation of Haversian systems, the structure of the lacunae and the presence of canaliculi ossiums were observed; in the second group, approximately 40% of the Haversian canals contained blood vessels, and canaliculi ossiums in the form of thin filaments were found in 90% of the microscopically examined areas; in the third group, most Haversian canals were empty, most osteocyte canals were devoid of cells, and canaliculi ossiums were absent; in the fourth group, some of the Haversian canals contained blood vessels, and there were partly lacunae containing cells due to decellularisation, whereas in approximately 50% of the examined microscope areas, the presence of canaliculi ossiums with evidence of mesenchymal stem cells differentiated into osteocytes was demonstrated by Q-dot traced cells.Conclusion:In this study, the establishment of a proper niche environment for adipose-derived mesenchymal cells promotes their development into osteogenic cells.

Objective Describe the first hybrid global simulation-based comprehensive cleft care workshop, evaluate impact on participants, and compare experiences based on in-person versus virtual attendance. Design Cross-sectional survey-based evaluation. Setting International comprehensive cleft care workshop. Participants Total of 489 participants. Interventions Three-day simulation-based hybrid comprehensive cleft care workshop. Main Outcome Measures Participant demographic data, perceived barriers and interventions needed for global comprehensive cleft care delivery, participant workshop satisfaction, and perceived short-term impact on practice stratified by in-person versus virtual attendance. Results The workshop included 489 participants from 5 continents. The response rate was 39.9%. Participants perceived financial factors (30.3%) the most significant barrier and improvement in training (39.8%) as the most important intervention to overcome barriers facing cleft care delivery in low to middle-income countries. All participants reported a high level of satisfaction with the workshop and a strong positive perceived short-term impact on their practice. Importantly, while this was true for both in-person and virtual attendees, in-person attendees reported a significantly higher satisfaction with the workshop (28.63 ± 3.08 vs 27.63 ± 3.93; P = .04) and perceived impact on their clinical practice (22.37 ± 3.42 vs 21.02 ± 3.45 P = .01). Conclusion Hybrid simulation-based educational comprehensive cleft care workshops are overall well received by participants and have a positive perceived impact on their clinical practices. In-person attendance is associated with significantly higher satisfaction and perceived impact on practice. Considering that financial and health constraints may limit live meeting attendance, future efforts will focus on making in-person and virtual attendance more comparable.

Introduction: Prolonged inflammation after tracheal injury invariably results in a degree of stenosis. The topical application of platelet-rich plasma (PRP) and human amniotic fluid-derived cell culture medium (ACCM) have been shown to promote wound healing. The effects of PRP and amniotic cell culture medium (Gibco AmnioMAX - II ) were investigated in a rat model through morphometric, histological, and biochemical parameters. Material & Methods: Thirty-two male Sprague Dawley rats were included in the study: 4 rats provided for the preparation of PRP. Three groups of 7 rats were divided into PRP and ACCM groups, a control and a sham group respectively. A transverse incision on the ventral aspect of the third trachea spanning half of the tracheal circumference was performed. The incision was repaired with 7/0 polypropylene in the sham group. In the control group, 0.5 ml saline solution was applied on to the repaired injury site. In the other two groups, 0.5 mL PRP or ACCM were applied topically on the tracheal repair. Tissue samples were harvested 30 days after surgery for morphometric measurements and biochemical analyses for oxidative stress markers, IL-1beta, IL-6, and VEGF. Connective tissue thickness was evaluated histologically. Statistical analysis included the Mann-Whitney U and Kruskal Wallis tests. Results: A notable difference was detected (P = 0,025) in cartilage segment length measurements of the trachea between the ACCM group and the sham and control groups (P < 0.03). A significant difference was found in the analysis of TAS, TOS, and OSI values between the study groups and the control and sham groups (P < 0.005). There were also differences in IL1-beta and IL-6 levels between ACCM and PRP groups (P < 0.05). For the same parameters, the differences were significant between the PRP and, sham and control groups (P = 0,004 and P = 0,002 respectively), and between the ACCM and, sham and control groups (P = 0,003 and P = 0,002 respectively). VEGF values demonstrated a significant difference between the PRP and sham group (P = 0,002), and between ACCM and sham/control groups (p=0,002 for both), the highest VEGF value was in ACCM group while the lowest value was in the sham group. In the histological assessment of connective tissue, a significant difference was observed between ACCM and the other groups. Conclusion: Amniotic fluid-derived cell culture medium shows less oxidative stress status than the other applications. ACCM is more effective on inflammatory and angiogenetic processes. Connective tissue thickness results were consistent with those biochemical and morphologic results. Additionally, a significant difference was observed in histological data between ACCM and PRP. Overall, ACCM proved to be efficient on tracheal healing. These effects can be attributed to the abundance of growth factors in both PRP and amniotic fluid-derived cell culture medium (ACCM).

Objective The surgical flap delaying has been shown to be effective in preventing partial flap loss or in preparing larger flaps. However, there is no gold standard flap delay method in the literature. In this study, the authors aimed to compare 3 types of surgical delay methods to determine which model would increase more flap survival. The authors also investigated the effect of delay methods on circulating mononuclear leukocytes as a parameter of DNA damage. Methods Twenty-four Sprague-Dawley male rats were divided into 4 groups. All subjects had a 10 × 3 cm modified McFarlane flap. Surface area measurements, biopsies, and blood samples were taken on the day of sacrification; 7th day for the control group and 14th day for delay groups. Results Between incisional surgery delay groups, a significant difference was found in necrosis and apoptosis in the bipedicled group, and only necrosis in the tripedicled group compared to the control. In terms of DNA damage, it was found higher in all experimental groups than in the control group. Conclusions Both incisional surgical delay procedures' results were meaningfully effective when only incisions were made without the elevation of flaps. In conclusion, bipedicled incisional surgical delay seems to be the most effective method in McFarlane experimental flap model whereas two-staged surgeries may increase the risk of systemic toxicity.

We present hybrid reconstruction of distal lateral -through-and-through- nasal defects (skin, cartilage, and mucosa) due to resection of tumor and/or infection. Retrospective descriptive study. The study was performed in multicenter clinics between July 2011 and September 2016. 13 patients with full thickness distal nasal defects secondary to tumor and/or infection were included. Defects included dorsal and/or caudal septum, upper lateral cartilage, or inner/outer nasal valve. Caudal-based turn-in flaps were planned and used to repair inner lining of nasal cavity. Conchal and septal cartilages were used as cartilage grafts. Skin defects were reconstructed with lateral nasal artery perforator flaps. All flaps healed uneventfully, without flap loss. Nasal passage collapse, adhesion, or difficulty in breathing were not seen. No hematoma, infection, and deformity at cartilage graft donor areas was observed. During nasal reconstruction, it is mandatory to consider 3D complex and functional structure of nose. The repair of skin defects may not be enough for functional restoration. We believe that single step reconstruction of full thickness nasal defects through hybrid reconstruction may lead to anticipated successful results.

The aim of this letter is to present the surgical experience obtained from a patient, in whom the proximal segment was better manipulated for precise alignment after application of the intermaxillary fixation screw.

Fibrous dysplasia (FD) is a developmental bone disorder caused by the hamartamatous proliferation of bone-forming cells. A 29-year-old male patient with diagnosis of FD was admitted to our clinic with the symptoms of severe craniomaxillofacial involvement of FD beginning from last year. Neurological examination revealed diplopia, horizontal nystagmus, conductive hearing loss, and partial vision loss. In his medical history, it was reported that he had undergone intramedullary nailing operation in his left femur due to a pathological fracture approximately 8 years ago in the orthopedics clinic of our institution. The patient underwent 3 consecutive surgeries by our plastic and neurosurgical team. The patient was followed-up in the neuro-intensive care unit between the surgical sessions and 1 week after the last operation. Afterwards, he was transferred to the neurosurgical department. No postoperative complication was detected. The preoperative signs were recovered. During his 6th month follow-up control-visit, all his preoperative symptoms were improved. In addition, the patient was satisfied with his postoperative cosmetic improvement. In conclusion, virtual surgical planning and intraoperative surgical navigation systems can make the challenging cases possible to operate with increasing the safety margin of the surgical procedures for polyostotic FD.

Massive intraosseous vascular malformations, a relatively rare entity in the vascular malformation spectrum, deserves attention as involving the membranous bones of the craniofacial skeleton and may lead to severe life-threatening hemorrhages and even death. The main aim of this study was to summarize the 25 years of clinical experience with these vascular malformation osseous patients, focus on the molecular and genetic aspect of the clinical entity, and to emphasize the certain challenging conditions in the treatment of these patients. All the patients appeared to be unaffected at birth, whereas initial symptoms occasionally began with painless swelling in the mandible in early childhood. The disease was progressive in behavior especially in the pubertal ages and was specifically involving the maxilla and mandible of the craniofacial skeleton in all the patients. Calvarium and cranial base were the second most common involved regions among these patients (62.5%). Clavicular (50%), costal (25%), and vertebral (25%) involvements were also a significant manifestation of the disease. Tissue samples obtained from the affected individuals and the blood samples from their families were matched, revealing a loss of function mutation in the ELMO-2 gene of chromosome 20 leading to developmental abnormality of the vascular structures via RAC1 signaling and leading to abnormally enlarged vessels in the intraosseus portion of the membranous bone. Immunohistochemical staining revealed positive CD31 and smooth muscle actin staining but negative proliferation and maturity markers such as Ki-67, desmin, h-caldesmon, and myofibroblast-like desmin. The follow-up of 3 of 5 patients ended up with mortality (60%). vascular malformation osseous is intraosseous vascular malformation with aggressive biological behavior associated with ELMO-2 gene mutation. Further studies for obtaining prenatal diagnosis and achievement of gene therapy should take place. As the disease rapidly progresses as the affected individual grows, surgical interventions should be taken into consideration before the initiation of complications.

BACKGROUND In underdeveloped countries one-stage definitive repair of cleft lip and palate is considered for late-presenting patients. MATERIALS AND METHODS A total of 25 patients with unoperated cleft lip and palate more than 2 years of age were enrolled in this study for one-stage simultaneous repair of cleft lip and palate. According to Veau-Wardill-Kilner push-back technique, 2 flap palatoplasties were performed for palatal repairs; all of the lips were repaired with the Millard II rotation-advancement technique. RESULTS The authors experienced no perioperative or postoperative life-threatening complications. With respect to the registered operation periods, longer times were required to perform these double operations, but this elongation is shorter than the sum of the periods if the 2 operations had been performed separately. Although the authors were unable to evaluate the late postoperative results because the authors could not follow-up the patients after they were discharged the day after surgery, the early results related to the success of the operation without any surgical complication were prone to meet the parents' and patients' expectations. DISCUSSION The authors presented their experiences with many volunteer cleft lip and palate trips to third world countries; however the structure of this article is not a new hypothesis and data based to support a scientific study, but observations are objective to get a conclusion. To perform one-stage definitive repair of the cleft lip and palate in late-presented patients was the reality that they had only 1 chance to undergo these operations. According to the terms and conditions of this challenging operation, one-stage simultaneous repair of cleft lip and palate is a more demanding and time-consuming procedure than is isolated cleft lip repair or cleft palate repair. Although technically challenging, single-stage repair of the whole deformity in late-presenting patients is a feasible, reliable, successful, and safe procedure in authors' experience.

Context: The extravasation of the chemotherapeutic agents is not an unusual phenomenon. Necrosis of the skin and underlying structures has been reported, depending on the cytotoxicity of the extravasating drug. Despite the presence of some antidotes, such wounds tend to enlarge with time and are likely to resist the treatment. Aims: The objective of this study was to investigate the efficacy of negative pressure wound therapy (NPWT) on extravasation ulcers. Settings and Design: Animals were separated into two groups; conventional dressing group and NPWT group. Materials and Methods: Extravasation necrosis was established by intradermal doxorubicin injection. Following the debridement of the necrotic areas, one group of animals was treated with the conventional dressing while NPWT was applied to the other group. The wound areas were measured, and then biopsies were taken on the 3rd, 7th and 14th days after the debridement. Statistical Analysis Used: SPSS 11.5 for Windows was used. Two-way ANOVA test was used to compare wound areas between groups. Willcoxon sign test with Bonferroni correction was used to compare histological scores between groups. Chi-square test with Bonferroni correction was used to compare histological scores within the group between the days. Results: There is no significant difference in terms of inflammatory cell count, neovascularisation, granulation tissue formation between the groups. Contrary to these results wound areas at the end of the treatment were smaller in the NPWT group compared with the dressing group. Conclusion: There is the superiority of NPWT over conventional dressing in chemotherapeutic extravasation wounds as well as the wound area is concerned, but it is not proven histologically.

BACKGROUND AND OBJECTIVE The growth of maxillary sinus is closely connected to the development of facial structures. However, its definition and reference standards on fetal magnetic resonance imaging (MRI) have not been analyzed so far. In this study, the objectives were to define and evaluate the fetal maxillary sinus (fMS) formation with MRI. METHODS We reviewed T2-weighted coronal MRI images of 75 fetuses. The MRI features, time of appearance, and boundaries of fMS were defined. Craniocaudal and transverse diameters of both maxillary sinuses and bone biparietal diameters were measured and statistically evaluated. RESULTS In 150 fMS site analysis, 91 fMSs were identified. The fMSs were visualized as a hyperintense structures on T2-weighted image above the tooth bud. It first appeared at the 22nd gestational week, and in 4% (3/75) of fetuses, there was unilateral development. Mean craniocaudal length was 2.84 mm (1.1-4.8 mm), and mean transverse diameter was 2.67 mm (1.5-4.2 mm). CONCLUSIONS Magnetic resonance imaging features of fMS that should be sought for the assessment of craniofacial anatomy are identified in this study. Fetal maxillary sinuses can be observed as hyperintense structures on T2-weighted MRI images starting from 22 weeks of gestation. The growth of fMS follows a predictable course throughout gestation; however, the dimensions are larger than the previously reported ex vivo series.

WOS: 000295398700059 PubMed: 21959441 Hemangiomas (proliferating endothelial tumors) are the most common benign tumors of infancy. Most often hemangiomas are self-regressing lesions without any treatment. Approximately 10% of hemangiomas cause complications such as major ulceration/destruction, distortion of involved tissues, and obstruction of a vital structure. When the situation becomes complicated, there are different treatment alternatives, ranging from systemic or local corticosteroid use to surgery. Sclerotherapy using intralesional polidocanol (Aethoxysklerol) injection may be used before surgery to decrease blood loss or when a vital structure of the face is in danger because of sudden increase in size of a surrounding hemangioma. Before any kind of treatment for both hemangiomas and vascular malformations, pre-operative diagnosis and anatomic position of the lesion must be documented thoroughly. With the help of magnetic resonance imaging, tridimensional vascular pattern of such lesions can be shown successfully. We used three-dimensional contrast-enhanced time-resolved magnetic resonance angiography to detect the changes of lesions for 2 children who have large hemangiomas on their faces, before and after sclerotherapy with polidocanol injection. The findings of three-dimensional magnetic resonance imaging studies help to better assess the success rate of treatment not only for us as the physicians but also for the parents of these children who cannot understand anything with standard two-dimensional radiologic imaging.

Aim: The aim of this study was to compare the clinical facial soft tissue measurements with the measurements of facial plaster cast, three-dimensional scanned facial plaster cast, 3-dimensional digital photogrammetrical images, and three-dimensional laser scanner images. Materials and Methods: Three-dimensional facial images of 15 adults were obtained with stereophotogrammetry and a three-dimensional laser scanner. Facial models of subjects were obtained using silicone impression and were scanned. Landmarks were marked on the subjects and plaster casts, digitized on three-dimensional models, and measured in Mimics 12.0 software (Materialise's Interactive Medical Image Control System, Leuven, Belgium). Results: No statistically significant differences were found between all three-dimensional measurement methods in mouth width, philtrum median height, and nasal width. Comparison of clinical measurements with facial plaster cast measurements revealed that philtral width, nasal tip protrusion, and right lip and nostril heights were wider and longer in clinical measurements than in facial plaster cast measurements. Comparison of clinical measurements to the laser scanned and stereophotogrammetric model measurements revealed that philtrum lateral and lip heights and philtral width were significantly different between methods. When laser scanned and stereophotogrammetric measurements were compared, significant differences were observed in lip and nostril heights. Conclusions: Facial impression may be problematic owing to the depression caused by the impression material especially on the tip of the nose. Laser scanning is not sensitive enough to visualize the deeper indentations such as nostrils. Stereophotogrammetry is promising for three-dimensional facial measurements and even will be better when color identification between mucocutaneous junctions of the lip region is achieved. Copyright © 2010 by Mutaz B. Habal, MD.

Objective : The aim of this study was to develop an internal distractor to release a drug to the distraction site during the distraction process and to investigate whether intermittent bone morphogenetic protein 2 (BMP-2)-containing chitosan hydrogel infusion will improve radiologic and histologic parameters of distraction osteogenesis (DO) when compared with control groups. Materials and methods : Experimental groups were control group (n = 6), 2-microg single-dose BMP-2-chitosan hydrogel-infused group (n = 6), and 2-microg intermittent BMP-2-containing chitosan hydrogel-infused group (n = 6). In intermittent BMP-infused group, certain amount of BMP-2 loaded chitosan hydrogel injected into the distraction gap for controlled BMP release from the chitosan with every turning of the geared rod of the distractor. Radiologic and histologic evaluation methods have been conducted. Conclusion : The results of the analysis demonstrated that the newly developed distractor effectively stabilized the DO site while allowing intermittent BMP-chitosan infusion. Application of a BMP-2-chitosan hydrogel infusion to the distraction zone facilitates ossification. Intermittent infusion of BMP-2-containing chitosan hydrogel by use of a developed internal distractor increases ossification even more at the site of DO.

Although the use of rigid fixation of bony segments in orthognathic surgery has become a standard of care, the question remains, 'With use of rigid fixation has stability of common orthognathic surgical procedures improved?' Because of the problems with various methods of osteosynthesis for the osteotomies commonly used in orthognathic surgery, we have developed our own way of semirigid fixation method to stabilize the osteotomized fragments for bone healing with enough flexibility to avoid the problems arising from absolute rigid fixation. The purpose of this article is to review the existing data to determine whether our method of semirigid fixation yields enough short-term and long-term stability after orthognathic surgery procedures. The study was designed as a retrospective trial. A total of 23 patients with double jaw surgery and 12 patients with mandibular set back surgery were reviewed. Preoperative lateral cephalometric radiographs obtained 1 month before the surgery, early postoperative cephalometric radiographs obtained after intermaxillary fixation was opened and late postoperative cephalometric radiographs were evaluated. Pog-McNamara vertical (mm) was used to measure the anteroposterior movement of mandible. Facial axis (degrees) was used to measure the vertical movement of the anterior part of the mandible. A-McNamara vertical (mm) was used to measure the anteroposterior movement of maxilla. Maxillary height (degrees) was used to measure rotational movement of the osteotomized maxillary segment in vertical dimension. The raw data obtained from cephalometric analysis were evaluated by using the computerized statistical program SPSS version 11.5 for Windows. The differences in linear and angular measurements between time intervals were tested for statistical significance, using repeated measures analysis of variance. A value of P < 0.05 was considered significant. None of the patients had infection at maxillary osteotomy side. Unilateral local infection at osteotomy side was seen in only one patient after double jaw surgery. Condylar malpositioning was not observed in any of the patients. Although postoperative maxillaomandibular fixation with elastics was applied routinely to all patients for 15 days, none of the patients had complaint related with temporomandibular joint discomfort, such as pain, restricted joint motion, etc. There is significant difference in anteroposterior movement of mandible in all time intervals. In terms of facial axis, the differences at T1 and T2 and at T2 and T3 are significant, while the difference at T1 and T3 is not significant. There is significant difference in anteroposterior movement of maxilla in all time intervals. In terms of maxillary height, the differences at T1 and T2 and at T2 and T3 are significant, while the difference at T1 and T3 is not significant. Method of semirigid fixation with 2 plates for maxillary fixation and 2 screws for mandibular fixation provide enough stability after LeFort I and bilateral sagittal split osteotomy procedures where mainly anteroposterior linear displacements were performed. There was no significant clinical short-term or long-term relapse. Stability in rotational movements needs to be further evaluated.

Thromboangiitis obliterans is a segmental inflammatory disease of the small- and medium-sized vessels mainly affecting the extremities. Although there are numerous reports concerning the treatment of these debilitating, chronic ulcers, such as skin grafting, local flaps, and free flaps, this report is the first published case of a patient with Buerger's disease, successfully managed with vacuum-assisted closure (VAC) application. This therapy decreases the period of hospital stay and increases patient comfort between dressings. Further clinical studies are needed to demonstrate the effectiveness and safety of VAC therapy in treatment of ulcers due to different kinds of vasculitis.

Goldenhar syndrome is a well-known developmental anomaly of the maxillofacial skeleton and hemifacial soft tissue. Maxillofacial anomalies of that syndrome can be managed by a variety of means such as inlay- or onlay-applied nonvascularized bone grafts, vascularized osteocutaneous/osseous flaps, or distraction osteogenesis. Vascularized full-thickness calvarial bone grafting is an important option for mandibular reconstruction for cases in which, for one reason or another, other techniques are not available, not applicable, or have failed. A mandibular defect of a 6-year-old boy presenting with bilateral preauricular skin tags, right microtia, right mandibular hypoplasia (with missing right condylar head and ascending ramus of the mandible) was reconstructed with right vascularized full-thickness calvarial bone grafting. Preoperative three-dimensional computed tomographic scans were used to acquire the stereolithographic biomodeling of the patient for assessing the amount of bone defect and precise planning of the surgery. Panoramic, anteroposterior, and lateral cephalograms and three-dimensional computed tomographic scans were obtained before and after the surgery and in the follow-up period for the evaluation of amount of relapse in the follow-up period. Clinical follow up and bone scintigraphy were used to assess the viability of transferred vascularized calvarial bone graft in the postoperative period. Plain radiographic evaluation with anteroposterior radiographs showed that mandibular symmetry increased and normooclusive closure of incisive teeth was achieved after surgery and retained in the postoperative period. Radiographs taken 1 year after surgery demonstrated that there was a slight relapse (1 mm) to the right side in the mandible when the results were compared with early postoperative ones. Postoperative three-dimensional computed tomographic evaluation of bony structures 3 months after operation showed that the transferred bone retained its volume. Sequential bone scintigraphies, performed to assess the vascularity of the grafts 1 week, 1 month, and 1 year after the operation, demonstrated the viability of transferred vascularized bone graft. The temporalis muscle osteofascial flap is a reliable method for mandibular reconstruction. It lessens the operative time, lessens surgical team labor, minimizes postoperative morbidity and discomfort, minimizes the hospital stay period, and minimizes financial expenses without renouncing the bone-healing capacity and increases aesthetic outcome by camouflaging the donor site scar in scalp and minimizing the facial scarring.

Çalışmada 21 yazar bulunmaktadır. Bu yazarlardan sadece Bursa Uludağ Üniversitesi mensuplarının girişleri yapılmıştır. Vascular malformations are non-neoplastic expansions of blood vessels that arise due to errors during angiogenesis. They are a heterogeneous group of sporadic or inherited vascular disorders characterized by localized lesions of arteriovenous, capillary, or lymphatic origin. Vascular malformations that occur inside bone tissue are rare. Herein, we report loss-of-function mutations in ELMO2 (which translates extracellular signals into cellular movements) that are causative for autosomal-recessive intraosseous vascular malformation (VMOS) in five different families. Individuals with VMOS suffer from life-threatening progressive expansion of the jaw, craniofacial, and other intramembranous bones caused by malformed blood vessels that lack a mature vascular smooth muscle layer. Analysis of primary fibroblasts from an affected individual showed that absence of ELMO2 correlated with a significant downregulation of binding partner DOCK1, resulting in deficient RAC1-dependent cell migration. Unexpectedly, elmo2-knockout zebrafish appeared phenotypically normal, suggesting that there might be human-specific ELMO2 requirements in bone vasculature homeostasis or genetic compensation by related genes. Comparative phylogenetic analysis indicated that elmo2 originated upon the appearance of intramembranous bones and the jaw in ancestral vertebrates, implying that elmo2 might have been involved in the evolution of these novel traits. The present findings highlight the necessity of ELMO2 for maintaining vascular integrity, specifically in intramembranous bones. CRANIRARE consortium - R07197KS Strategic Positioning Fund for Genetic Orphan Diseases Agency for Science Technology & Research (A*STAR) Hacettepe Üniversitesi- 00-02-101-009 / 03-D07-101-001

WOS: 000243853800018 PubMed: 17251844 Facial bone defects can be managed by a variety of means, such as inlay or onlay applied nonvascularized bone grafts, local pedicled/distal free osteocutaneous/osseous flaps or distraction osteogenesis. Although each method has its own advantages and drawbacks, the indications of using these methods may overlap in certain clinical situations. The use of nonvascularized bone grafts, conceptually and technically simple method, relies on creeping substitution of applied graft with regenerating new bone. However, using vascularized osteocutaneous free flaps provide not only plenty of bony tissue for reconstruction, but also soft tissue coverage over the reconstructed bony segment. Furthermore, bone healing in vascularized osteocutaneous free flaps resembles as the physiologic fracture healing. In selected cases with enough soft tissue coverage over the defective bony segment, on the other hand, using larger nonvascularized bone grafts with osteoinductive growth factors may decrease the risk of graft failure while avoiding the drawbacks of the free tissue transfer. Here we present our results of three cases with facial bone defects, to which nonvascularized iliac bone grafts and demineralized bone matrix with cancellous allograft (Orthoblast II (TM)) as a source of BMP were used together for mandibular reconstruction.

Guneren, Ethem/0000-0002-5981-7010; Kaplan, Suleyman/0000-0003-1477-5002 WOS: 000367303900001 PubMed: 26710017 Background: The aim of this study was to generate skin tissue using adipose tissue-derived mesenchymal stem cells. Methods: Thirty Wistar albino rats were used. A 2-cm-diameter full-thickness skin defect on the back of each rat was formed. A secondary wound healing model was constituted in group 1, fibrin matrix only was applied in group 2, a keratinocyte-coated fibrin matrix was applied in group 3, an adipose tissue-derived mesenchymal stem cell-seeded fibrin matrix was applied in group 4, and a keratinocyte-coated and adipose tissue-derived mesenchymal stem cell-seeded fibrin matrix was applied to the defects in group 5. Results: A similar form of wound healing, with contraction from the edges and ulceration at the center, was observed in groups 1, 2, and 3. The wound contraction was reduced in group 4, and the epidermis was creeping from the surrounding tissue but with some ulcerations in the central part of the wounds. In group 5, the defect area was almost totally epithelialized, with minimal wound contraction. By microscopic analysis, significant increases in the collagen volume ratios and vascular volume ratios were determined in groups 4 and 5. From the fluorescent micrographs, fibroblastic differentiation and extracellular matrix synthesis, endothelial differentiation of stem cells, and neoangiogenesis and epithelium derived from marked keratinocytes were observed in group 5. Conclusion: Formation of the adipose tissue-derived mesenchymal stem cell-seeded and keratinocyte-coated autologous fibrin scaffold leads to significant skin replacement. Turkish Ministry of Science and Technology (SanTez Code)Ministry of Science, Industry & Technology - Turkey [01101.STZ.2011-2] This study was supported by a grant from the Turkish Ministry of Science and Technology (SanTez Code; 01101.STZ.2011-2).

Goldenhar syndrome is a well-known developmental anomaly of maxillofacial skeleton and hemi-facial soft tissue, was later included to a broader classification called oculo-ariculo-vertebral spectrum. Here we report a patient presenting goldenhar syndrome with accessory auricula, defined as polyotia, coloboma and bifid tongue.

Penile girth enhancement is a controversial subject but demands for enhancement are increasing steadily. Although various fillers have been widely used for soft tissue augmentation, there is no reliable material for this particular situation. Here we report a case of an acute hypersensitivity reaction in a man after his first self-injection of a filler material, which, he claimed, was hyaluronic acid gel for penile girth enhancement and glans penis augmentation.

Epidermoid cyst located in cranium is uncommon and usually diagnosed with a growing mass leading to symptoms. Asymptomatic intradiploic epidermoid cyst has not been reported yet. In this study, incidental diagnosis of asymptomatic cyst and potential impact of that cyst on surgical planning of a patient with craniosynostosis are presented.

Despite the fact that cyanoacrylates, a group of rapidly polymerizing adhesives, are used widely in general surgery, neuroradiology, otolaryngology, and plastic surgery, scientific data on histopathological changes resulting from the deposition of -butyl-2-cyanoacrylate (NBCA), a new-generation cyanoacrylate derivative, in human tissues is based largely on experimental observations in animals and sporadic postmortem studies in humans. The authors report the consecutive pathological findings of a patient who underwent surgery for facial hemangioma after percutaneous injection of NBCA for devascularization of a lesion, and underwent additional surgery 1 and 6 months after the initial operation for the removal of the residual NBCA cast from the injection site. Acute inflammatory findings after injection of NBCA and the development of a chronic granulomatous foreign body reaction support the histological findings of experimental animal studies and postmortem examinations on humans. Additionally, their findings support the proposed hypothetical sequence of events for the recanalization of cyanoacrylate-embolized vascular structures.

Complications of rhytidectomy, technically one of the most challenging operations of the aesthetic surgery, have been widely reported in the literature and nerve injuries are one of these possible complications during facial rejuvenation surgery. Beside the injuries of motor branches of the facial nerve, complaints of numbness and development of neuromas due to sensorial nerve injuries were reported in the literature. In this particular reported case, however, complaints of a 52-year-old woman, presented with diffuse intractable pain in her left cheek radiating to the neck and behind the ear after facial rejuvenation surgery, improved dramatically by use of gabapentine. Although there was no apparent neuroma formation on her neck, MRI findings are inconclusive and she had not responded to injection of local anesthetics at all.

2014 IEEE Global Communications Conference, GLOBECOM 2014 -- 8 December 2014 through 12 December 2014 -- 110905 The comprehensive treatment of a patient with cleft lip and palate requires an interdisciplinary approach for functional and esthetic outcomes. A 20-year-old woman with bilateral cleft lip and palate had a chief complaint of unesthetic appearance of her teeth and the presence of oronasal fistulae. Her clinical and radiographic evaluation showed a dolichofacial growth pattern, a Class II skeletal relationship with retroclined maxillary central incisors, 5 mm of negative overjet, maxillary constriction, maxillary and mandibular crowding, congenitally missing maxillary right incisors and left lateral incisor, and a transposed maxillary left canine. Her treatment plan included the extraction of 3 premolars, maxillary expansion, segmental maxillary osteotomy, repair of the oronasal fistulae, rhinoplasty, periodontal surgery, and prosthodontic rehabilitation. To obtain a better occlusion and reduce the dimensions of the fistulae, orthognathic surgery comprising linear and rotational movements of the maxillary segments (premaxilla, right and left maxillary alveolar segments) in all 3 axes was planned by performing 3-dimensional virtual surgery on 3-dimensional computerized tomography. At the end of the interdisciplinary treatment, a functional occlusion, a harmonious profile, and patient satisfaction were achieved. Posttreatment records after 1 year showed stable results.

The vascularized iliac osteocutaneous flap has been used successfully for jaw reconstruction. To obtain a better contour of the reconstructed area in large upper and lower jaw resections, the transferred bone actually needs to be osteotomized. Single closing-wedge osteotomy of the iliac flap for mandibular reconstruction has been previously described. In this article, the modified multiple osteotomized perforator-based versatile free iliac osteocutaneous flap is described. Eleven cases were enrolled. Seven patients had wide anterior mandibular resections due to oral cavity and mandibular tumors; 3 patients had a defect due to explosive injury and 1 patient had complicated orbitomaxillary defect due to blast injury. Skin paddle was based on the perforators. In 8 patients, the bony segment was divided into 3 segments by 2 osteotomies, whereas in 2 patients the bony segment was divided into 4 segments by 3 osteotomies. In 10 cases, the flap was used for anterior mandibular defects, whereas in 1 case the flap was customized to fit an L-shaped defect at the naso-orbito-maxillary region. The overall flap success rate was 100%. No resorption or morbidity related to the osteotomy of the bony segments was observed. The size of perforator skin paddle was 6 to 8 × 15 to 18 cm. Physical and radiologic examinations showed proper bone healing without any additional complications. The modified multiple osteotomized free osteocutaneous iliac flap can provide a safe and versatile bony segment to be arranged and adapted to reconstruct complex mandibular and maxillofacial defects.

OBJECTIVE The aim of the study is to investigate the effectiveness of the controlled slow-release granulocyte-monocyte colony-stimulating factor (GM-CSF) system in burn wound healing. MATERIAL AND METHODS In vivo effect of controlled slow-release GM-CSF from chitosan gel on burn wound healing was evaluated on 18 Wistar-Albino rats, weighing between 250 and 300 g. They were randomly divided into 3 groups; (1) burned only group (n = 6), (2) burned + chitosan group (n = 6), (3) burned + chitosan + GM-CSF group (n = 6). Wound area was measured macroscopically. Hematoxylin and eosin and Masson's trichrome stained sections were evaluated for wound healing and tissue response to the polymer. RESULTS The best healing process was observed with the controlled slow-release GM-CSF-applied group (group 3) in which the wound area was significantly narrowed. CONCLUSION The study demonstrated the positive contribution of the single-dose controlled slow-release GM-CSF from chitosan gel on burn wound healing.

Introduction Hypercoagulable state is a complex condition with an abnormal propensity for thrombosis. The consequences of it due to thrombosis of veins and arteries are the most common cause of sickness. Aim The present study is a report of a case describing penis necrosis after circumcision and evaluation of hypercoagulable state as a reason of it. Methods Nine-year-old boy referred from another hospital with the sequelae of the penile ischemia with discoloration of the penis after traditional circumcision. Results The ischemic event developed 3 weeks after circumcision. Priapism that was treated with needed glandulocavernous shunt initially developed following circumcision. All values of routine blood count and blood biochemical analysis were within normal limits. Further, hematologic studies revealed that there might be a hypercoagulable state as a result of lower protein S level. Conclusion Circumcision is a common procedure frequently performed in many communities around the world. Although it is seen as an easy procedure and performed even by unauthorized medical stuff, it is not complication-free. Severe penile necrosis after circumcision should be treated on an individual basis, necessitating different techniques. Hypercoagulable state should be concerned and evaluated in such a complication. In short, circumcision has to be done by specialists who can handle such serious complications.

Sargon, Mustafa Fevzi/0000-0001-6360-6008; KORKUSUZ, PETEK/0000-0002-7553-3915 WOS: 000275061800020 PubMed: 20179488 Bone grafts, used for providing structural integrity of cranial vault remodeling, could not always integrate with the remaining bone structures. All efforts are focused on increasing incorporation of the applied bone grafts. Allografts were covered by chitosan so that slow release of bone morphogenetic protein-2 (BMP-2) and Transforming growth factor-beta-2 (TGF-beta-2) was achieved. Two hundred forty Wistar-Albino rats were distributed equally in 8 study groups. Study groups were designed as; defect group, autograft group, allograft group, chitosan group, allograft + chitosan, TGF-beta-2 group, BMP-2 group, and TGF-Beta-2 + BMP-2 group. Bone biopsies were obtained at second, eight, and 14th weeks. Bone regeneration was evaluated by morphologic studies detecting histologic bone healing and radiologic studies detecting bone density. Histologic findings were evaluated in 2 categories; tissue response to the implant and defect healing. Additionally, scanning electron microscopy for detailed morphologic evaluation was done. Bone density of the applied scaffold and the parietal bone at the same computed tomography section were measured in Hounsfield scale and this ratio was used for densitometry evaluations. Kruskal-Wallis test was used to analyze difference among groups according to the histologic and radiologic data. Pairwise comparisons were done using Mann-Whitney U test with Bonferroni correction. P < 0.05 was considered significant. In the morphologic studies, bone regeneration in BMP-2 group was found to be compatible with bone regeneration in gold standard autograft group and even better than it within 15 days. Chitosan is a biocompatible material. TGF-Beta-2 alone is not effective enough in bone regeneration; BMP-2 alone has a positive effect in every step of bone regeneration. Combining TGF-Beta-2 with BMP-2 does not lead to a better bone regeneration than using BMP-2 alone. A synergistic effect is not obtained by using these 2 factors together.

Nicolau syndrome is rare cutaneous adverse reaction following injection of various drugs. The disease has been associated with almost all classes of medications, such as nonsteroidal anti-inflammatory drugs, local anesthetics, corticosteroids, antibiotics, vitamin B complexes, antihistamines, and vaccines. The most severe cases of this complication occur after injection of nonsteroidal anti-inflammatory drugs. Subcutaneous injection is an important factor in the pathogenesis of the syndrome. We report a case of Nicolau syndrome resulting from intramuscular injection of diclofenac and discuss some precautions to prevent this complication.

Treatment of large soft tissue vascular lesions, one of the greatest challenges facing plastic surgeons, is patient specific in almost all cases, and preoperative angiographic evaluation and embolization of these lesions are standards of care. The aim of this study was to evaluate the usefulness of 3-dimensional demonstration and volumetric assessment of soft tissue vascular lesions both in the treatment of these lesions with curettage and in the participation of the patients to the decision-making process of the disease. Five patients with vascular malformation of the head and neck regions were included to this prospective trial. All patients were evaluated with preoperative angiography, and selective embolizations of the soft tissue vascular lesions were done in the same session by the same interventional radiologists. The amount of embolic agent injected was determined according to the size and vascularization of the lesions. Surgery was done by curettage of the embolized lesions 7 to 10 days after the embolization procedure. The raw data obtained from preoperative and postoperative high-resolution computed tomographic scans of the patients were processed with a Mimics 9.22 Software (Materialise's Interactive Medical Image Control System, Leuven, Belgium). Volume and surface area of the injected embolic agent were assessed. Statistical analysis was performed using the software package SPSS 10.0 for Windows (SPSS Inc, Chicago, IL). Wilcoxon signed rank test was used to compare the measurements of the volume and the surface area of injected sclerosing agent preoperatively and postoperatively. There were no complications related to either the preoperative angiography or embolization procedure. All the patients emphasized (assessed) that the 3-dimensional demonstration of the lesions and their relation with other anatomic structures helped them to understand the extent of their pathology and aim of the proposed treatment. The difference between the volumetric measurements before and after the treatment was found statistically significant. Treatment of large soft tissue vascular lesions with curettage after embolization has acceptable cosmetic results. Although it is not possible to remove all of the sclerosing agent from its injection site with this technique, a significant amount of it can be removed, and the 3-dimensional vascular architecture of the lesion is disturbed. Reactive chronic inflammation against the remaining sclerosing agent and the intralesional scarring caused by curettage lead to further improvement. Using 3-dimensional imaging modalities helps patients and/or their relatives to understand their disease and participate in the decision-making process.

Collapse of maxillofacial skeletal structures after trauma results in inadequate anteroposterior projection and increase in facial width with deformed facial aesthetics and various functional problems. After successful use of rigid external distractor for treatment of congenital facial hypoplasia, they have been used for treating more complex craniofacial anomalies. Six patients with posttraumatic orbitozygomaticomaxillary deformity were managed with intraoperative and/or postoperative use of rigid external distractor device. All the patients maintained the early postoperative aesthetic and functional results in their follow-up period. All patients that the device kept applied in postoperative period tolerated the device. There were no complications related to use of rigid external distractor. Rigid external distractor device is a useful instrument in management of traumatic facial deformities and can be used (1) in controlled traction for reduction of impacted bony segments, (2) as external fixator to decrease the number of plates for fixation, (3) to overcome the soft tissue tension over bony structures to enable the use of smaller screw-plate systems, and (4) for fine adjustment of bony segments after operation depending on the needs of the case demonstrated with postoperative control computed tomographies.

Stereolithographic (medical rapid prototyping) biomodeling allows three-dimensional computed tomography to be used to generate solid plastic replicas of anatomic structures. Reports in the literature suggest that such biomodels may have a use in maxillofacial surgery, craniofacial surgery, orthopedics, neurosurgery, otology, vascular, and nasal research. A prospective trial to assess the usefulness of biomodeling in orthognathic surgery has been performed. In 12 patients with mandibular prognathism and/or maxillary retrusion, in addition to routine preoperative cephalometric analysis, preoperative high-resolution (cutting slice thickness of 1 mm) three-dimensional computed tomography scan of the patients was obtained. Raw data obtained from computed tomography scanning was processed with a Mimics 9.22 Software (Materialise's Interactive Medical Image Control System, Belgium). Fabrication of three-dimensional medical models was obtained through a process called powder depositional modeling by use of a Spectrum Z 510 3D Color Printer (Z Corporation, Burlington, MA). Alveolar arches of the maxilla and mandibula of the models were replaced with orthodontic dental cast models. Temporomandibular joints of the models were fixed with Kirschner wire. Maxillary and mandibular bony segments were mobilized according to preoperative orthodontic planning done by analysis of cephalometric plain radiographs. The relation between proximal and distal mandibular segments after bilateral sagittal split osteotomies were evaluated on models preoperatively. The same surgeon had a role in both model cutting preoperatively and as an instructor preoperatively. The same bony relation was observed both in preoperative modelsand in the perioperative surgical field in all patients. Condylar malpositioning was not observed in any of the patients. Studying preoperative planned movements of osteotomized bone segments and observing relations of osteotomized segments of mandibula and maxilla in orthognathic surgery increased the intraoperative accuracy. Limitations of this technology were manufacturing time and cost.

For better evaluation of long-term results of orthognathic surgery, movements of osteotomized maxillary and mandibular segments should be documented both in x-, y-, and z-axes and in terms of kind of movement (either linear or rotational movements). Lateral cephalometric, anteroposterior cephalometric, and submentovertex radiographs of 14 patients, treated with combined orthodontic and surgical treatment for skeletal class III malocclusion, were reevaluated retrospectively to demonstrate the applicability and usefulness of defined parameters in four maxillary and five mandibular movements. There was no clinically significant relapse in the follow-up period of 6 months in any of the patients. Differences between preoperative and postoperative measurements to demonstrate the linear movement in the z-axis, rotational movements in the x-axis and y-axis of the maxilla, and the linear movement in the z-axis of the mandibula were found to be statistically significant. Differences between early postoperative and late postoperative measurements to demonstrate rotational movement in the y-axis of the maxilla and rotational movement in the y-axis of the mandibula were found to be statistically significant. In this article, the possible tridimensional movements and cephalometric measurements of osteotomized bony segments after LeFort I and sagittal split osteotomy surgery were defined for better evaluation and follow up of the postoperative results.

WOS: 000251090700009 PubMed: 17578639 Background: Capsule formation around breast implants, development of tendon adhesions after tendon repair, intestinal brits after laparatomies, hypertrophic scars in skin incisions all are the results of excessive collagen synthesis to the extracellular matrix by fibroblasts. Any intervention that leads to cessation of collagen synthesis in these clinical situations may help to prevent these untoward results of wound healing. Although 5-fluorouracil (5-FU) is used mainly as a cytotoxic drug in chemotherapy protocols, it decreases cellular metabolism and blocks protein synthesis only at lower concentrations. Findings have shown that 5-FU downregulates fibroblast proliferation and differentiation in vitro. It has been used to treat fibroproliferative disorders of the eye and skin and is thought to inhibit thymidylate synthetase, blocking DNA replication. Methods: This study used five treatment groups: (1) gelatin only, (2) silicone only, (3) silicone + gelatin, (4) silicone + gelatin containing 1 mg of 5-FU, and (5) silicone + gelatin containing 5 mg of 5-FU. The release kinetics of 5-FU from gelatin have been investigated by means of ultraviolet spectrophotometric analysis. Specimens were obtained on postoperative day 30. Gross evaluation and histopathologic examination were conducted for capsule formation and the development of inflammation. Results: The silicone group had the most prominent capsule formation among all the groups. The gelatin group was second, and the silicone + gelatin group was third. As compared with the other groups, the 5-FU-containing groups had the least capsule formation. The 5-mg 5-FU-containing group had the most inflammation. The silicone + gelatin group was second in inflammation. Although the silicone, gelatin, and 1-mg 5-FU-containing groups had the same means, the results of the silicone group showed the most divergent data within the group. Conclusions: Because 5-FU loaded to a gelatin carrier for its slow release seems to prevent capsule formation around silicone blocks, it may be used to prevent capsule formation around silicone breast implants.

Background: The topic of condylar injury in adults has generated more discussion and controversy than any other in the field of maxillofacial trauma. The treatment of condylar fractures in adults is still a highly debated theme. Methods: Patients with unilateral subcondylar or condylar neck fractures of the mandibula without any significant angulation of the condylar head were managed with closed-treatment protocol. Closed treatment was applied through the injection of 100 units of botulinum toxin A, diluted to a concentration of 20 IU/mL, into the muscles of mastication of the fractured side. Masseter and anterior fibers of temporalis muscles were reached through percutaneous extraoral route and 30 IU of the toxin was injected to each muscle. Additional 40 IU of the toxin was injected around the fractured bone fragments through transmucosal intraoral route to paralyze medial and lateral pterygoid muscles as much as possible. An asymmetric occlusal splint was applied for maxillomandibular fixation to restore the vertical height for 10 days. Functional therapy with intermaxillary guiding elastics was advocated for 2 months. Results: There were no complications related to either toxin injections or splint application procedures. The toxin was effective on all occasions. Fractured condylar process and ramus of the mandibula were in good approximation and remained in reduced positions. None of the patients had any occlusal disturbance, mandibular asymmetry, or joint dysfunction in the follow-up period. Conclusions: We believe that modification of treatment options concerning the clinical situation of the patients is the best method for condylar injury. The purpose of this study is to present and discuss the results achieved in closed treatment of a selected group of patients with mandibular condylar fractures to whom botulinum toxin A was injected to relieve the spasm of muscles of mastication, along with special splint application.

Fractures of the frontal sinus are a relatively common injury presenting to trauma units that deal with craniofacial injuries. Approximately one third of frontal sinus fractures affect the anterior wall alone, with two thirds involving the anterior wall, posterior wall, or frontonasal duct. Isolated posterior wall defects are exceedingly rare. Frontal sinus fracture management is still controversial and involves preserving function when feasible or obliterating the sinus and duct, depending on the fracture pattern. In the standard treatment modality of frontal sinus fractures, repair is best performed by way of a coronal approach, which offers excellent access. Most of the frontal sinus fractures deserve this attentive surgical manipulation to prevent late sequelae of infection or mucocele formation. In this article, we present a case of isolated depressed anterior wall fracture of the frontal sinus that was treated by closed reduction to avoid coronal incision. Anterior wall fracture of the right frontal sinus was diagnosed with preoperative evaluation of three-dimensional CT of a 34-year-old male patient with maxillofacial trauma. The anterior wall fracture was reduced by traction of two percutaneously applied screws to the depressed fragments. Accurate reduction was obtained, and neither recurrent displacement nor infection was observed during the follow-up period of 3 months. The screws were removed in the clinical setting without difficulty. Although percutaneous reduction of noncomminuted anterior wall frontal sinus fractures has limited indications, it has its own advantages over open techniques. This method is a less-invasive technique and can be performed without problem in selected cases. Our technique is not suitable for complex fractures of the frontal sinus.

The standard treatment modality of zygomatic fractures is open reduction and rigid fixation of the fractured segments. Although most of the zygomatic fractures deserve this attentive surgical manipulation to prevent late residual asymmetry, minimally depressed noncomminuted zygomatic fractures can be reduced and fixed percutaneously. Percutaneous intervention causes minimal scarring and morbidity than open techniques and it is possible to align fragments precisely by using high-quality three-dimensional computed tomography (3-D CT) imaging. Six patients with noncomminuted fractures of the zygomaticomaxillary skeleton were evaluated with plain radiographs of facial bones, axial, coronal and 3-D CT. Reduction of the displaced bone segments were achieved by traction of percutaneously applied screw. Either reduced segments were not fixated at all or one of the two new fixation techniques, described in detail in the article, were used for stabilization of reduced segments. In all patients, accurate reduction was obtained. None of the patients showed any recurrent displacement or infection during the follow-up period of six months. The screws were removed in the clinical settings without difficulty. Although percutaneous reduction and external fixation of noncomminuted zygomatic fractures has limited indications, it has its own advantages over open techniques. This method is a less invasive technique and can be performed without any problem in selected cases. Our technique is not suitable for complex zygomatic and periorbital fractures.