Assessment of the Relationship Between Clinicophysiologic and Magnetic Resonance Imaging Findings of the Temporomandibular Disorder Patients.

Temporomandibular joint disorders (TMJDs) are a complex group of disorders that comprise dysfunctions of the temporomandibular joint (TMJ). In this study, we analyzed the objective and subjective findings of the TMJD patients by using Helkimo anamnesis (Ai) and clinical dysfunction (Di) indices, and tried to document a relation between these findings and magnetic resonance imaging (MRI) results.Ninety-eight patients who were admitted to our clinic were included in the study. The clinical evaluation was performed by using Ai, an 8-question-survey based on the objective symptoms of patients; Di, concluded as the score of 5 objective measurements of physical examination. The morphology of the TMJ was evaluated by MRI, and the findings were analyzed and statistically compared with respect to the Di.The most commonly seen symptoms were noise during mandibular movement (58%), pain around the joint (42.5%), and pain with mandibular movements (40%). Seventeen patients (17.3%) were Di0, 47 (48%) were DiI, 24 (24.5%) were DiII, and 10 (10.2%) were DiIII. Thirty-seven patients (37.8%) had abnormal MRI findings, whereas 61 patients (62.2%) had normal MRI. The most commonly encountered pathology was anterior disc displacement with reduction, which was reported in 15 patients. Increased TMJ Di, which points a more progressed TMJD, was found to be significantly related with the pathological MRI findings (P < 0.05).MRI is especially effective in particularly those with high Di; therefore, the results of the study may give a prospect in which types of patients does MRI give a valuable data toward diagnosis, in which stages of the TMJD should we expect pathological findings, and thereby preventing unnecessary use of MRI in patients with symptoms of TMJD.

Optimal treatment of zygomatic fractures: a single-center study results.

OBJECTIVES: This study aims to investigate the epidemiological and operative characteristics of patients undergoing surgery for zygomatic fractures. PATIENTS AND METHODS: Between May 2008 and October 2013, a total of 121 patients (98 males, 23 females; mean age 27 years; range, 9 to 63 years) who were operated for zygomatic fractures in our clinic were retrospectively analyzed. Age and sex of the patients, symptoms, fracture and incision sites, length of hospital stay, plate type, treatment options, and complications were recorded. RESULTS: Assault was the leading cause of trauma (39%), followed by traffic accidents (24%). The most common symptom or clinical sign was the periorbital ecchymosis/hematoma. Conservative treatment was applied in 14 patients (12%). Surgery was performed with a closed reduction in 17 patients (14%) and open reduction in 90 patients (74%). The most common fracture site was the infraorbital rim in 76 patients (62.8%). A total of 48% patients had three-site, 35% had two-site and 12% had one-site of fixations. The major material used for the orbital floor reconstruction was porous polyethylene in 43.7% patients. CONCLUSION: Our study results show that surgery is required in the majority of the patients with zygomatic fractures. However, further large studies are required to determine many parameters such as incision sites, plate locations, and the material to be used in orbital floor reconstruction.

Five-Years Trigger Finger Due to Partial Flexor Tendon Laceration in a Child.

Trigger finger (TF) is a condition that affects quality of life and one of the most common causes of hand pain and disability. TF is characterized by catching, snapping or locking of the involved finger flexor tendon, associated with pain. TF in the children occurs rarely than in adults and partial tendon laceration is an uncommon cause of TF in the children. Thus, our aim in this study to define TF due to partial flexor tendon laceration in a child.

A New Paradigm for Surgical Management of Congenital Triple Lobe Type Cleft.

Congenital earlobe clefts (CELC) may be annoying for the plastic surgeons. Many classifications and techniques were described for CELC. The previously described techniques are useful in some conditions, but not proper in all. We present a simple, effective method for a rare CELC 'triple lobe' in this article.

The Use of Dermabrasion to Achieve Natural-Looking Areolas Following Breast Reduction or Mastopexy: A Study of 23 Patients.

BACKGROUND: Although obtaining symmetrical breasts with good projection and a correctly positioned nipple-areola complex are the main objectives after breast reduction (BR) or mastopexy (MP), the importance of areola esthetics should not be underestimated. In this study, the authors discuss the use of dermabrasion for another purpose, which is to achieve a more natural areola with a smooth, natural border and depigmentation. METHODS: Twenty-three patients who had undergone BR surgery (18) or MP (5) between 2012 and 2014 were included in the study. The mean age of the participants was 25.5 (range 19-43). Dermabrasion of the areola was performed using a diamond-type fraise to obtain a smooth transition from the border of the areola to the depigmented areola zones. RESULTS: The patients were followed up for 15 months on average (range 12-18 months). In a survey administered 1 year after surgery, the patients were asked to score their new areola on a scale of 0-10. The mean score was 8.6 (range 4-10). Three patients were re-operated due to the persistence of the sharp border due to insufficient dermabrasion. One patient had a hypertrophic scar and another had hyperpigmentation. CONCLUSIONS: Satisfactory and a more natural areola can be obtained using dermabrasion with few complications in BR or MP patients. Therefore, this technique may be considered a complementary procedure for motivated and voluntary patients ready to accept the disadvantages of a secondary procedure.

Foot ischemia after a free fibula flap harvest: immediate salvage with an interpositional sapheneous vein graft.

The most dreaded major donor-site complication of free fibula flap is a foot ischemia, which is fortunately rare. Various authors have discussed the efficacy of the use of preoperative imaging methods including color Doppler, magnetic resonance angiography, and conventional angiography. A 25-year-old man presented with a 10-cm mandibular defect after a facial gunshot injury. Lower extremity color Doppler revealed triphasic peroneal, tibialis anterior, and posterior artery flows. A fibula osteocutaneous flap was harvested, and the mandible was reconstructed. However, the suture sites at the donor site began to demonstrate signs of necrosis, abscess formation, and widespread cellulitis beginning from postoperative day 9. Angiogram of the lower extremity on the 13th day demonstrated no flow in the right posterior tibial artery distal to the popliteal artery, whereas the anterior tibial artery had weak flow with collateral filling distally. An emergency bypass with a saphenous vein graft between the popliteal artery and the distal posterior tibial artery was performed. Repeated debridements, local wound care, and vacuum-assisted closure were applied. A skin graft was placed eventually. The extremity healed without severe functional disability. In conclusion, although the arterial anatomy is completely normal in preoperative evaluation, vascular complications may still ocur at the donor fibula free flap site. In addition, emergency cardiovascular bypass surgery, as we experienced, may be necessary for limb perfusion.

The free-nipple breast-reduction technique performed with transfer of the nipple-areola complex over the superior or superomedial pedicles.

BACKGROUND: Although the free-nipple breast-reduction technique is essentially an amputation, achieving aesthetic results still is important. The authors present their technique for free nipple-areola complex (NAC) transfer over the superomedial or superior pedicle full-thickness flaps in patients for whom a free-nipple technique is inevitable due to certain risk factors. METHODS: The study included 25 patients who underwent surgery with the aforementioned method for addressing severe gigantomastia. The patients had a mean age of 43 years (range 34-59 years) and a mean body mass index (BMI) of 35.8 kg/m(2) (range 28-42 kg/m(2)). During the operation, the NAC was elevated as a full-thickness skin graft, then transposed to the superior or superomedial pedicles, which had been planned previously. The subsequent stages of the operation thus became a Wise-pattern breast reduction. RESULTS: The mean resection per breast was 1,815 g (range 1,620-2,410 g). Breast projection, shape, and areolar pigmentation were assessed during the follow-up visit. One patient experienced a partial loss of the NAC graft, which healed secondarily, and three patients experienced a patchy hypopigmentation of the NAC. Breast projection and conical structure were observed to be preserved during the follow-up period. CONCLUSIONS: The modified free-nipple technique aimed to convert the reduction procedure to a technique similar to pedicle methods, yielding successful results during the early phases. The full-thickness flap constructed in this way provides more fullness and a maximum contribution to projection in patients who will inevitably undergo breast reduction with the free-nipple method. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Is there a profit to use the lateral antebrachial cutaneous nerve as a graft source in digital nerve reconstruction?

BACKGROUND: The digital nerves are commonly injured in emergency hand surgery practice. Lateral antebrachial nerve is of the autologous graft options available in forearm for digital nerve reconstruction. In this report, we aimed the evaluation of this nerve as an autologous nerve source for digital nerve repair. PATIENTS AND METHODS: The overall sensorial results of the lateral antebrachial cutaneous nerve grafting and associated donor site morbidity in neglected digital nerve injuries of 15 patients in Zones 1 and 2 were evaluated Average length of the harvested lateral antebrachial cutaneous nerve grafts was 1.81 cm (0.75-3 cm.). RESULTS: Patients have been followed up for 20.7 months in average (range: 9.3-41 months). According to Highet and Sander criteria modified by Mackinnon and Dellon, nine patients were graded as S4, whereas six patients had S3+ values. According to modified ASSH guidelines for stratification of static 2PD results, excellent results were obtained in five patients, good results were achieved in eight patients and moderate results were obtained in two patients. Both the donor and recipient sites were evaluated with Semmes-Weinstein monofilament tests where satisfactory results have been obtained. Only two patients reported minimal cold intolerance at the donor site apart from the mild hypoesthesia noted at the anterolateral aspect of the middle forearm. CONCLUSION: Quite favorable clinical results with minimal donor site sensorial deficiency, anatomical and histomorphological similarity and being available in close location to surgical area brings up a matter to utilization of LABCN for digital nerve reconstruction.

Large hydatid cyst of the maxillozygomatic region.

Hydatid cyst is a zoonotic infection caused by Echinococcus granulosus. Majorly affected body regions are the liver and the lungs. However, rare localizations of the neck region, mastoids, parotid glands, orbita, and the mandible have been reported in literature. In this case, we report a large hydatid cyst of the maxillozygomatic region presenting as a slowly growing mass.