Fibular Bone Graft for Nasal Septal Reconstruction: A Case Report.

Although various techniques have been described for treatment of severe nose deformities, these problems have high revision rates. Conventional nasal septal surgery may not be adequate for all cases. A 21-year-old male patient with nose deformity underwent a nasal surgery. Patient had both functional and aesthetic nasal problems. Rigid fibular bone graft was used for corrective nasal surgery. Duration of the operation was three hours. Patient recovered without problems. Aesthetic and functional results of the operation were acceptable. Fibular bone graft may offer a long lasting support in treatment of severe nose deformity.

The Effect of Nasal Obstruction after Different Nasal Surgeries Using Acoustic Rhinometry and Nasal Obstruction Symptom Evaluation Scale.

BACKGROUND: The efficiency of nasal surgeries can be determined by objective or subjective methods. We have assessed the effect of nasal obstruction after different nasal surgeries using Acoustic Rhinometry (AR) and Nasal Obstruction Symptom Evaluation (NOSE) Scale. METHODS: Between May 2011 and May 2012, 40 young adult patients and 10 healthy volunteers as control group who referred to Otorhinolaryngology Clinic in Eskisehir Military Hospital due to nasal obstruction were enrolled. Depending on operation, patients were divided into four equal groups. Group 1: Septoplasty, Group 2: Septoplasty with sprader graft, Group 3: Septorinoplasty and Group 4: Septorhinoplasty with spreader graft. The patients completed NOSE scale, 1 week before and 1 month after the surgery and AR measurements. RESULTS: There were a significant improvement in mean NOSE scores of patients and statistical difference was found between pre and post-operational values for each group. There was a statistically significant change of the mean minimal cross section areas (MCA) of the deviated side of nasal passages measured by AR between pre and postoperative period. CONCLUSION: In patients with nasal obstruction, functional nasal surgeries which were performed after appropriate medical examination and with right operation methods had a positive impact on quality of life and patient satisfaction. We observed that nasal findings were correlated with NOSE scores and MCA values. So, we suggest that NOSE scale and AR to be used for evaluation of the efficiency of functional nasal surgeries.

Atypical Location of a Bartholin Cyst in Adolescence.

BACKGROUND: Cystic lesions associated with the blockage of Bartholin gland ducts are frequently seen, but occurrence outside the normal vestibular localization is quite rare. CASE: A 16-year-old patient presented with a localized cystic lump approximately 4 cm in size on one of her labia minora. After an excision, she was diagnosed with an atypically localized Bartholin cyst. SUMMARY AND CONCLUSION: It is very difficult to make an early diagnosis for an atypically localized Bartholin cystic lesion in adolescence; it can be diagnosed only after a pathological examination. In the differential diagnosis of a vulvar lump, an atypically localized Bartholin cyst should also be considered as a possibility.

A New Reduction Mastopexy Design for Young Women: Snowman Pattern.

BACKGROUND: Many young women are satisfied with their large breasts but suffer from sagging due to heaviness. In this article; we present a novel modification of vertical scar breast reduction based on a special indication. METHODS: From January 2006 to May 2012, twenty five individual patients underwent operation using modified technique with superior pedicle and vertical scar. Young women between ages 25-35 years with voluminous breasts who requested mastopexy rather than reduction were selected for the surgery. RESULTS: The mean patient age was 30 years and body mass index (BMI) was 27.8±1.07 kg/m(2). Mean nipple transposition was 6.5 cm. Mean weight for resected tissue was 415 g for left and 419 g for right breast. Mean operative time was 125 minutes. Patients were followed up for 9-22 months. No serious complications encountered in consecutive patient series. The only complication was permanent wrinkling probably due to vertical closure in 5 of 25 patients which did not resolve during the follow-up period. CONCLUSION: We recommend that the Snowman design is a useful tool for superior pedicle breast reduction technique providing good projection and a short scar in selected patients.

Freestyle Perforator-Based Fasciocutaneous Flap Reconstruction in Nicolau Syndrome-Related Tissue Necrosis.

The actual pathology of the Nicolau syndrome (NS) is still unknown. It is thought to involve direct vascular damage and vasospasm. Many NS cases were reported in the literature but a treatment protocol is still not established. However, after demarcation of the necrotic tissue, surgical intervention is mandatory. Five NS cases with extensive tissue necrosis on the upper lateral gluteal region were analyzed retrospectively. Operative technique was described in details for freestyle perforator-based fasciocutaneous flaps from the gluteal region to reconstruct defects of NS-related tissue necrosis. Freestyle perforator-based fasciocutaneous flaps were used for defect closure in all patients. All flaps survived totally. No complications occurred during the follow-up period. Although rare, NS is a serious complication of inadvertent intramuscular injections. Prevention is the best treatment. However, in case of large-tissue necrosis, freestyle perforator-based fasciocutaneous flaps harvested from the gluteal region is a satisfactory option for reconstruction.

An analysis of 45 patients with pure nasal fractures.

BACKGROUND: Nasal fracture is generally encountered alone or in combination with other serious injuries. The objective of this study was to analyze patients who had pure nasal fracture. METHODS: Forty-five records from patients with pure nasal fracture treated in the hospital between 7 October 2005 and 14 December 2011 were included. The following nasal fracture criteria were evaluated: age at the time of nasal trauma, gender, accident type, use of alcohol, findings of the physical examination, treatment time after the nasal fracture, and year and seasonal distribution. RESULTS: The age ranged from 6-32 years, with a mean age of 21 years. The most frequent reasons of the injury were violence 60% (27 cases) followed by falling 31% (14 cases), accidents 4.5% (2 cases) and sport injuries 4.5% (2 cases). The most frequent findings were tenderness in 71.1% (32 cases), followed by swelling in 51.1% (23 cases), nasal deviation in 42.2% (19 cases), and epistaxis in 15.6% (7 cases). Nasal bone fracture was diagnosed exactly by standard X-ray films in 91.1% (41 cases). CONCLUSION: In this study; pure nasal bone fractures occurred primarily among men under 25 years of age, and fights were found to be the main etiologic factor.

Primary intraosseous cavernous hemangioma of the toe.

Intraosseous cavernous hemangioma is an uncommon benign vascular tumor. A 21-year-old man presented with a small painless swelling of the left foot's long toe. X-ray examination showed an outgrowing bony lesion that has cortical continuity in the tip of the long toe's distal phalanx lateral aspect. Preoperative examination yielded no final diagnosis. En bloc resection was performed. The histological diagnosis was intraosseous cavernous hemangioma. To the best of our knowledge, this case is a first report of primary intraosseous cavernous hemangioma of the toe.

Radial bone graft usage for nasal septal reconstruction.

BACKGROUND: Although various techniques have been described for correction of crooked and saddle nose deformities, these problems are challenging with high recurrence and revision rates. Conventional septal surgery may not be adequate for nose reconstruction in crooked and saddle nose deformities. MATERIALS AND METHODS: Between December 2005 and October 2009, six patients with crooked nose and five patients with saddle nose deformities underwent corrective surgery in our clinic. All patients were male, and the mean age was 21 years (range, 19-23 years). We used rigid radial bone graft to prevent redeviation and recurrence following corrective nasal septal surgery. RESULTS: The mean follow-up period was 28 months, ranging from 18 to 46 months. Mean operation time was 4 hours (3-4.5). All patients healed uneventfully. None of the patients required secondary surgery. CONCLUSIONS: We believe that radial bone grafts offer a long lasting support in treatment of challenging cases with crooked and saddle nose deformities.

A new perforator flap from distal medial arm: a cadaveric study.

BACKGROUND: In this study, a new fasciocutaneous perforator flap raised from inner medial surface of the distal medial arm has been described for soft tissue coverage. METHODS: The blood supply of this flap comes directly from the distal brachial artery. Fourteen limbs of 7 formalinized cadavers were dissected to study the origin and the course of perforator vessel. RESULTS: The average size of the flap was 10.7 cm × 5.6 cm in the distal medial arm region. The constant main perforator was measured within a circle of 2.76-cm diameter, the center of which was 11.5 cm above and 1.3 cm medial to the medial epicondyle of humerus. The mean length and diameter of the distal brachial perforator artery were 3.3 cm and 0.95 mm, respectively. CONCLUSION: We think that this flap may be a useful option for the reconstruction of soft tissue defect of elbow.

Distally based venous flap: a new technique for the correction of syndactyly without skin graft in adult patients.

Skin grafts and local flaps are conventional methods for repairing simple syndactyly. Skin grafts usually leave unsightly appearance and contracture formation. In this study, unipedicled distally based venous flap were raised from third or fourth metacarpal area of the hand for syndactyly treatment. The distally based venous flap was to provide skin coverage to one side of the finger, in order to avoid complications arising from using skin graft. Nine patients' syndactylies (5 simple incomplete and 4 simple complete syndactyly) were treated using this method. The mean follow-up period of the flaps was 14 months, ranging from 12 to 16 months. Mild edema and venous congestion occurred in all flaps. Superficial necrosis involving two flaps did not affect flap survival. All flaps survived completely. In this article, we have described a new surgical technique for the correction of syndactyly in a single surgical procedure that utilizes a distally based venous flap to provide skin coverage without skin graft.

Distally based venous flap for proximal phalangeal soft tissue burn defect and web space burn contracture.

Flap choices for the coverage of the proximal phalangeal soft tissue defects of the finger and web space burn contractures are limited. A unipedicled distally based venous flap was raised from the third or fourth metacarpal area of the hand for proximal phalangeal soft tissue defects of the finger and web space burn contracture. For clinical use, we operated seven male patients using this venous flap. Superficial necrosis involving two flaps did not interfere with flap survival. Mild edema and venous congestion occurred in all flaps. All flaps survived completely. The mean follow-up period of the flaps was 6 months, ranging from 3 to 14 months. A well-planned distally based venous flap is an useful option for the coverage of the proximal phalangeal soft tissue burn defects of the finger and web space burn contracture of the hand.

The crooked nose: the use of medial iliac crest bone graft as a supporting framework.

The crooked nose is one that the vertical axis of the nose inclines from the midline. As a rule, a major septal deformity almost always accompanies to impairing breathing and aesthetic appearance. To achieve total straightening of the crooked nose, the septum must become the target of the treatment. To prevent redeviation, we used rigid bone grafts instead of flexible and relatively weak cartilage to maintain the support of the corrected deformity. Between February 2005 and July 2007, 9 patients (all male) with crooked noses underwent corrective surgery. The mean age of the patients was 21 years (range, 19-23 years). The source of the bone graft was medial side of iliac crest in all patients. The mean follow-up was 18 months, ranging from 10 to 26 months. All patients had both functional and cosmetic problems. Mean operation time was 4 hours. Airway patency was improved in all cases. The grafts did not shift in any case and did not develop unsightly irregularities over time. Absorption of the grafts was not seen in the follow-up. There were no cases of extrusion or infection. No donor site complication occurred. None of the patient required secondary surgery. A residual deviation can be obvious despite all attempts, which has no deleterious effect on patient satisfaction. This article introduces a novel technique for the correction of the crooked nose.

Frontal parosteal lipoma.

Parosteal lipoma of the head and neck is very rare, and there is no reported case of parosteal lipoma in the frontal region. We present the case of frontal parosteal lipoma in a 20-year-old man who was referred for a forehead mass causing a cosmetic problem. Computed tomography revealed an osseous projection with cortical irregularity and soft tissue enlargement. Excision of the lesion revealed a 7 x 4.5-cm lobulated, encapsulated, yellow tan mass. Histopathologic examination revealed mature adipose tissue, and pathologic diagnosis of lipoma was made. Here, we present the first case of parosteal lipoma in the frontal region.