Late oropharyngeal functional outcomes of suicidal maxillofacial gunshot wounds.

PURPOSE: The aim of this study was to evaluate the long-term aesthetic and functional results of suicidal gunshot injuries using objective methods to identify the residual problems after one-stage reconstruction. METHODS: Twenty male patients with gunshot injuries resulting from suicide attempts who were treated in the Department of Plastic and Reconstructive Surgery at Gulhane Military Medical Academy were included in the study. The control group was composed of 10 male volunteers. The reconstructions of all involved structures were performed within 1-3 days of the injury. The patients were evaluated both aesthetically and functionally. The Body Satisfaction Scale was used for evaluation of aesthetic appearances of the facial structures. To evaluate swallowing, videofluoroscopy, cine-magnetic resonance imaging, submental electromyography, Functional Endoscopic Evaluation of Swallowing, and submental ultrasound were performed. Perceptual speech analysis was used for speech evaluation. RESULTS: The Body Satisfaction Scale score was statistically higher in the control group than in patients with both ongoing and completed reconstructions (P < 0.05). Swallowing disturbances and their frequencies were higher in the study group than in the control group. The most frequently observed swallowing disturbance was stasis in the sinuses. The laryngeal elevation and geometric angle of the epiglottis in the study group were statistically lower than in the control group (P < 0.05). The mean amplitude of contraction of submental muscles was lower in the study group than in the control group (P < 0.05). The Multidimensional Voice Program showed statistically significant differences between the treatment and control groups (P < 0.01). CONCLUSION: Objective assessment methods enabled us to retrospectively evaluate the treatment and identify the specific problem underlying functional and aesthetic morbidities.

Osteoid osteoma treated with radiofrequency ablation.

Purpose. Our aim is to evaluate the results of treatment with computed tomography (CT) guided percutaneous radiofrequency ablation for osteoid osteomas which were localized in a difficult area for operation. Materials and Methods. Glenoid, distal tibia, humerus shaft, proximal humerus, and in third finger of the hand proximal phalanx were involved in one patient. Proximal femur was involved in three patients, distal femur was involved in three patients, and proximal tibia was involved in two patients. 9 males and 4 females were aged 4 to 34 years (mean age: 18.5 years). All patients had pain and were evaluated with X-rays, CT, bone scintigraphy, and MRI. In all patients, RF ablation was performed with local anesthesia. The lesion heated to 90°C for 6 minutes. Results. All of the patients achieved complete pain relief after ablation and were fully weight bearing without any support. In all patients, there was soft tissue edema after the procedure. During follow-up, all patients were free from the pain and there was no sign about the tumor. There was no other complication after the process. Conclusion. CT guided RFA is a minimally invasive, safe, and cost-effective treatment for osteoid osteoma placed in difficult area for surgery.

New morphometric findings in adhesive otitis media: petroclival angle and eustachian tube-tympanic cavity ventilation angle.

OBJECTIVE: Observations during adhesive otitis media (OM) surgery led us to consider that morphometric variations might cause formation of the middle ear cavity with smaller bony boundaries during developmental process. Among the various factors mentioned in the literature, we thought that angle of the petrous bone relative to the midsagittal line and the eustachian tube-tympanic cavity ventilation angle might be factors in the course of adhesive otitis media. METHODS: Axial computerized tomography scans from 14 patients with adhesive OM and 19 cases (control group) with normal middle ear-tympanic membrane were retrospectively examined in terms of petroclival angle and eustachian tube-tympanic cavity ventilation angle. Measurements of these two angles were compared between the two groups. A correlation was also investigated between these two angles. RESULTS: The petroclival angle (54.5 degrees vs 62.3 degrees) and the eustachian tube-tympanic cavity ventilation angle (156 degrees vs 162.6 degrees) in the adhesive OM group were narrower than those of controls (p<0.01). The correlation analysis showed that there was a strong association between two angles (r, 0.803; p<0.01). CONCLUSIONS: More medially positioning of the petrous bone and acutely angled-eustachian tube-tympanic cavity ventilation axis were observed in this study. It would be reasonable to conclude that these findings might take part in development of adhesive OM. We should also admit that these results do not decline the previous theories that account for development of the adhesive otitis media.

Closure of the defect resulting from caudal regression syndrome with duplicated rectum.

Caudal regression syndrome covers a range of congenital malformations that range from simple anal atresia to absence of sacral, lumbar, and possibly lower thoracic, vertebrae. To the best of our knowledge, this is the first case of caudal regression syndrome combined with rectal duplication. We present a case and describe our technique of reconstruction.

CT angiographic demonstration of a mesenteric vessel "whirlpool" in intestinal malrotation and midgut volvulus: a case report.

Although the color Doppler ultrasonography diagnosis of intestinal malrotation with midgut volvulus, based on the typical "whirlpool" appearance of the mesenteric vascular structures is well-defined in the peer-reviewed literature, the combination of both the angiographic illustration of these findings and the contemporary state-of-the-art imaging techniques is lacking. We report the digital subtraction angiography and multidetector computed tomography angiography findings of a 37-year-old male with intestinal malrotation.

Effect of hyperbaric oxygen on flow-mediated vasodilation: an ultrasound study.

OBJECTIVE: The purpose of this study was to investigate the effect of hyperbaric oxygen (HBO) treatment on flow-mediated vasodilation (FMD) by ultrasound examination. METHODS: We studied 14 young patients without cardiovascular problems who underwent HBO treatment. The indications for HBO treatment were osteomyelitis (n = 8), Crohn disease (n = 2), perianal abscesses (n = 2), lingual artery embolization (n = 1), and aseptic necrosis (n = 1). The ultrasound evaluation for FMD was performed before HBO treatment, after 1 session of HBO treatment, and after 10 sessions of HBO treatment. The right brachial artery FMD response was evaluated by the mean of the baseline right brachial artery diameter, absolute change in the diameter before and after cuff inflation/deflation, and percent change in the diameter. RESULTS: Statistical analysis showed a significant change in the preinflation right brachial artery diameter before (mean +/- SD, 3.6 +/- 0.54 mm) and after (3.76 +/- 0.56 mm) 10 sessions of HBO treatment (P < .05). The absolute changes in the right brachial artery diameter before and after cuff inflation/deflation (0.36 +/- 0.2 mm before HBO treatment, 0.37 +/- 0.22 mm after 1 session of HBO treatment, and 0.38 +/- 0.21 mm after 10 sessions) and percent change in FMD (10% +/- 5.8% before HBO treatment, 10.6% +/- 7.5% after 1 session of HBO treatment, and 10.6% +/- 7.7% after 10 sessions) after induction of a hyperemic response by cuff inflation were not statistically significant (P > .05). CONCLUSIONS: Hyperbaric oxygen treatment did not have an immediate effect on FMD (absolute change in the right brachial artery diameter after cuff inflation/deflation); however, the right brachial artery diameter increased after 10 sessions of HBO treatment. This may suggest chronic stress on the vascular endothelium after HBO.

Imaging of porous polyethylene implant by using multidetector spiral computed tomography.

The porous polyethylene implant (Medpor; Porex Surgical, Inc., Newnan, GA) is one of the most usable implants in clinical practice. Because it is radiolucent on both direct radiography and conventional computed tomography, visualization of the implant becomes an important issue. In this clinical study, availability of multidetector spiral computed tomography for visualization of the implant was evaluated. The technique was used in 15 patients who had Medpor reconstructions on their faces, including frontal (seven), malar (five), and mandibular (five) regions. A 16-channel multislice computed tomography scanner was used in spiral scanning mode. Sagittal, coronal, and transverse multiplanar reformation and volume-rendered images were reformatted using a PC-based three-dimensional reconstruction program (Extended Brilliance Workspace, Release 1.0.1.1, Philips Medical Systems, Amsterdam, The Netherlands). The three-dimensional images along the course of the implant were additionally reformatted. Window width and level were adjusted for viewing the bone as respective values of 1100 HU and 450 HU in contrast to the values of 800 HU and 200 HU, respectively, for the implant. The detailed contour of the implants could be easily traced on the multidetector computed tomographic images, including either the concave or convex areas. The calcifications and cystic formations around the implants and the spatial relationship between the defects and the implants were also shown. We believe that the present multidetector computed tomographic technique offers direct visualization of the Medpor implant in the body. It has many advantages over the current magnetic resonance imaging techniques that need tissue in growth for visualization.

Right renal vein aplasia associated with diverted renal venous drainage through lower pole.

We report a unique anomalous renal venous drainage on a 25-year-old man who had congenital absence of the right renal vein and an aberrant venous drainage through the lower pole of the kidney into the inferior vena cava. To our knowledge, this anomaly has not been previously reported in the peer-reviewed literature. State-of-the-art imaging findings are presented.

A new composite flap: rectus abdominis muscle flap harvested with pubic bone segment--anatomic considerations.

The aim of this study was to incorporate a segment of pubic bone to rectus abdominis muscle (RAM). Eight RAM flaps from four fresh cadavers were used. During surgical dissection, utmost care was paid to enclose the areolar tissue between the main deep inferior epigastric (DIE) vessels and the pubic bone. A bone segment, 1.5 x 5 cm in dimension with an intact periosteum, was included with the RAM. Surgical dissections revealed two major vascular branches. The first branch arising from the DIE artery (DIEA) at a distance of 5.2 +/- 1.4 cm from the origin gave rise to two consistent subbranches. The second major branch originated from the DIEA at a distance of 8.4 +/- 1.8 cm from the origin. The first branch gave off two subbranches. The second subbranch coursed anteromedially and nourished the periosteum of the pubic bone. Microangiography showed a similar branching pattern of the vessels that create two significant networks. The X-rays confirmed a rich vascular network around the periosteum of the pubic bone. This wealthy nourishment of the pubic periosteum comes mainly from the perpendicular descending branches. In conclusion, a vascularized part of pubic bone can be incorporated to the RAM flap by preserving the delicate vascular network between the DIE vessels and the pubic periosteum.

Situs inversus totalis with accompanying craniodiaphysial dysplasia: a new syndrome?

A 20-year-old man with craniofacial anomalies of craniodiaphysial dysplasia (CDD), facial paralysis, mental retardation, and situs inversus totalis is described. Similar features except situs inversus totalis are also present in two of his sisters. The authors believe this to be the first reported case of CDD with accompanying situs inversus totalis.