The effect of the Botulinum toxin-A on craniofacial development: an experimental study.

In this study, we developed a novel experimental model to evaluate muscular action on bone formation and remodeling by the help of Botulinum toxin-A (BTX). Forty-nine 15-day-old male Wistar rats were put into 4 groups randomly. Group 1 was the control group. BTX 0.4 IU (0.05 mL) was injected into the right masseter muscle in group 2 and into right temporalis muscle in group 3. The same volume of sterile saline was given into the both above-mentioned muscles in group 4. At the end of the fourth month, all animals were killed. Histology and weight of the masseter and temporalis muscles were studied. Thirty different osteometric measurements were also taken from skulls. Significant atrophy in BTX injected muscles was observed in groups 2 and 3. In group 4 (saline injection), only few osteometric measurements were significantly reduced, indicating the effect of the injection itself. Both groups 2 and 3 have apparent decrease in nasal bone, premaxilla, maxilla, and zygomatic dimensions on the injected side. When masseter group was compared with control and saline groups, no significant difference was found in skull base dimensions and mandibular length. In contrast, temporal group has also shown significant decrease in skull base dimensions. Our conclusions are as follows: (1) With this model, it is possible to study muscular action on bone formation and modeling without any surgical intervention, that is, by avoiding surgical artifacts, such as scar and contracture; (2) denervation of the skeletal muscles with BTX during the growing phase does effect bone development in a negative way; (3) pediatric use of the BTX deserves reevaluation under the light of these findings.

An unusual case of lymphedema tarda.

BACKGROUND: Lymphedema is the result of the equilibrium between the load to be cleared and the transport capacity of the clearing system. Lymphedema may be classified as primary or secondary, based on the underlying etiology. Primary lymphedema is an unusual disorder characterized by inadequate lymphatic drainage. Lymphedema tarda is a rare form of primary lymphedema. CASE REPORT: The case of lymphedema tarda documented here was chronic, progressive, and resistant to medical therapy and recurred several times after previous operations. CONCLUSIONS: We performed two-staged operations and we recommend that the staged excisional procedures offers reliable long-term improvement and minimizes postoperative complications in chronic advanced lymphedema.

Hemangioma of the nasal bone: a case report.

Hemangiomas of the bone account for 0.7% of all bone tumors. The craniofacial region is a rare site of involvement, with the mandible, zygoma, and maxilla being the most frequently affected areas. Hemangioma of the nasal bone is very rare. A 60-year-old male patient presented with complaints of difficult breathing through the nasal airway and a slowly growing hard mass at the nasion with a history of 10 years. Computed tomography demonstrated a round mass involving the left nasal bone with submucosal extension. An en bloc excision of the mass and its extension was performed. Histopathological examination showed two neighboring tumors, cavernous hemangioma of the bone and arteriovenous malformation of the nasal mucosa. During a-year follow-up, the patient had no complaints and the functional and cosmetic results were excellent.

Evaluation by scintigraphy of hindlimb ischemia in a rat model.

The subject of ischemia-reperfusion has commonly been studied in rat hindlimb models. Unfortunately, in these experiments, the ischemia procedures lack standardization. For this reason, the authors evaluated the reliability of rat ischemia models described in the literature using scintigraphy. The study comprised six groups. Each consisted of ten male Wistar rats; five of them underwent methoxy-isobutyl-isonitrile (MIBI) scintigraphy, which is specific for muscle, and the others underwent methylene diphosphanate (MDP) scintigraphy, which is specific for bone. In Group 1, only the iliac artery was ligated; in Group 2, the iliac artery and its branches, except for the superficial epigastric artery, were ligated; in Group 3, the iliac artery and vein were ligated; in Group 4, the iliac artery and all branches, including the superficial epigastric artery, were ligated; in Group 5, in addition to ligation of the iliac artery and its branches, the skin was incised circumferentially around the pelvic girdle; in Group 6, a tourniquet was applied to the limb at the pelvic level. After 2-hr warm ischemia, a radioactive tracer was injected intravenously. In the MIBI group, images were taken at the twentieth minute and second hour after injection, and in the MDP group, at the fifth minute and third hour after injection. The radioactivity in both hind limbs of the animal was measured, and the ratio of the control to the ischemic limb was calculated. In the first five groups, there was no necrosis in the ischemic limb at the end of 2 weeks. The measured radioactivity in the ischemic limb was lower than that of the control limb in all groups. The ratio of activity obtained from the control limb to that of the ischemic limb in the tourniquet group was significantly higher, compared to other groups in both MIBI and MDP evaluations (p < 0.005). Significant ischemia was also seen in the skin incision group (Group 5). A low-flow state was observed in the ischemic limb in Groups 1-4 using both scintigraphic modalities. The tourniquet method (Group 6) provided almost complete limb ischemia, compared to other arterial ligation methods, and it is practical to use for complete ischemia when studying the physiology of replantation or free flaps.

Morphology of the gluteal region in the female population 5 to 83 years of age.

This study evaluated the development of gluteal region morphology in the female population 5 to 83 years of age. For the study, 132 female subjects were placed into four groups: prepubertal (ages 5 to 8 years; n = 10), pubertal (ages 9 to 14 years; n = 38) postpubertal (ages 15 to 41 years; n = 34), and menopausal-postmenopausal (older than 42 years; n = 29). The age, weight, and height of the subjects were routinely recorded, and body mass index was estimated. In addition, 11 measurements were performed on the gluteal region. The data were analyzed by Pearson and Spearmen correlation analyses using SSPS 11.0 for Windows. In the prepubertal group, the intergluteal sulcus and infragluteal sulci did not actively change. Weight gain was the major factor influencing the shape of the gluteal region, whereas age had no effect. In the puberty group, the gluteal region expanded in all directions. During this period, it was difficult to determine any specific relation between measurements because of significant correlation involving all parameters. However, it should be mentioned that among the four groups, only in pubertal group did age significantly affect the shape of the gluteal region. In other three groups, weight seemed to be a major determinant. In the pospubertal and menopausal-postmenopausal groups, the buttocks sagged with weight gain, contrary to the belief that this happens with aging. This causes movement of the infragluteal sulci in downward and lateral directions as well as lengthening of intergluteal sulcus. Although the gluteal shape is open to the effects of demographic factors such as ethnicity, feeding habits, and lifestyle, according to these findings, it might be advised that in the assessment of the gluteal region morphology, it would be better to consider its dynamic nature. Reshaping its only one part, which can be devastating unless the whole gluteal region and upper limb are addressed.

The place of fine-needle aspiration in the preoperative diagnosis of the congenital sublingual teratoid cyst.

The term "teratoid cyst" was first used by Meyer in his classification of dysontogenetic cysts of the cervicofacial region, which was based on the type of germinative layers included in the cyst wall. Sublingual location of a dermoid cyst is not common, with an incidence of 1.6%. The teratoid cyst is the least common, accounting for 1.8% of sublingual dermoid cysts, and such lesions are extremely rare in infancy. In our case, a 7-mo-old male infant was referred with a sublingual mass. Ultrasonography yielded a cystic mass with internal echoes but no specific diagnosis. The smears obtained from fine-needle aspiration (FNA) displayed sheets of large, benign-appearing, anucleated and nucleated squamous cells. There were a number of neutrophils, which had no significant importance. No atypical cells were observed. According to the clinical picture and FNA findings, it appeared to be a cystic structure of keratogenous origin and could have been any type of dermoid cyst. The cyst was excised completely by the oral approach. On histopathological examination, the presence of skin appendages along with mature cartilage and respiratory epithelium confirmed the final diagnosis of a teratoid cyst. In conclusion, although FNA is not comparable with computed tomography (CT) and magnetic resonance imaging (MRI), it might be valuable for the diagnosis of lesions occurring in this anatomical location. It is safe, cost-effective, and reliable. FNA is not only able to help selecting the most appropriate surgical method, but also be used as a therapeutic modality in some emergencies or during surgery.

Complications of minor cutaneous surgery in patients under anticoagulant treatment.

Anticoagulant use is common in the elderly population. The role of these medications in the postoperative period is not well defined. We designed a prospective study to evaluate the incidence of postoperative complications in patients taking aspirin and warfarin. A prospective study was performed on 102 patients undergoing minor cutaneous plastic surgery. The number of subjects using regular aspirin, warfarin, and that of the patients with no anticoagulant medication were 37, 21, and 44, respectively. Complications were defined as minor, moderate, or major based on predetermined criteria. Of patients taking warfarin, 57% had some complication, significantly more than complications in the control group. The number of major complications in the warfarin group was significantly higher than those of the control and aspirin groups (p = 0.02). Also, the total number of complications in the warfarin group was significantly higher than the control group, but there was no significant difference between aspirin and control groups (p > 0.05). Cutaneous surgery in patients who receive warfarin is associated with a risk of major complication, but this risk does not exist in the patients receiving chronic aspirin treatment.