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Lupus erythematosus profundus (LEP), is a rare form of, chronic cutaneous LE, also called lupus erythematosus panniculitis. LEP is characterized by subcutaneous fatty tissue involvement spesifically in patients with LE. Before systemic LE was diagnosed, very few reports reported the presence of lesions of lupus erythematosus profundus. The rare manifestations of the disease are remarkable with the unusual features of the cases. A 43-year-old female patient diagnosed with bilateral periorbital LEP was presented and the literature was reviewed. Significant clinical improvement was achieved in the patient who was given systemic hydroxychloroquine and topical pimecrolimus therapy. This report suggests that asymptomatic periorbital erythema and edema may develop as a manifestation of LEP.

The umbilicus is a very important component of the abdominal region; therefore, loss of the umbilicus for any reason is a challenging problem. The goal of aesthetically pleasing umbilical reconstruction is to create a neoumbilicus with sufficient depth and good morphology, with natural-looking appearance and minimal scarring.

Objectives The central giant-cell reparative granuloma has been defined as a localized benign but sometimes aggressive osteolytic proliferation consisting of fibrous tissue with hemorrhage and hemosiderin deposits, presence of osteoclast-like giant cells and reactive bone formation. It is a benign lesion usually appears as solitary, multilocular, radiolucencies, located in the mandible and maxilla. Multiple CGCRGs of the jaw bones is very rare and, if it occurs, it is usually associated with hyperparathyroidism in majority of the cases .This report presents an unusual case of a 12-year-old girl who has idiopatic, bilateral giant cell granulomas of the angulus mandible. Methods A 12 year-old girl was admitted to our department with complain of swelling on both right and left side of her lower jaw. There was no history of trauma, dental problem or neck infection. Blood chemistry, including calcium, alkaline phosphatase and inorganic phosphorus was normal. Patient had not family history, clinical apperiance like cherubism or noonan sydrome and systemic anomalies. MRI showed, in right ramus mandible, 37 × mm × 35 mm × 28 mm size mass and in lenf ramus mandible, an expansile, 30 mm 38 mm × 12 mm size mass. The patient underwent surgical curettage of the lesion through an intraoral approach under general anesthesia. Result The histopathologic examination of the lesion was reported as ‘giant cell reparative granuloma. Conclusion Our patient had multiple CGCRG in her jaw. In literature there is several reports about multiple CGCRG but unlike of that report our patient had no syndromes like Cherubism, Noonan syndrome, neurofibromatosis type-1 and systemic disease like hyperparathyroidism ,fibrous dysplasia. So we define this case as Idiopatic bilaterally central giant cell reparative granuloma of jaw.

Since its introduction in 1895, augmentation mammaplasty has gained widespread acceptance. The choice of breast augmentation procedure is determined almost entirely by three variables: the selection of incision location, the pocket plane for implant placement (either subpectoral or completely subglandular), and the appropriate implant. The current study evaluated 210 cases of augmentation mammaplasty retrospectively. A capsular contracture rate of 8% was found. Rupture and gel bleeding were observed in eight cases (4%). For various reasons, such as capsular contracture or implant rupture, the prostheses were renewed once in 16 patients (8%) and twice in 5 patients (2%). Submammary incision was used in 42 cases (20%). The patients in 23 cases responded that they had implant folds or edges they could feel (11%). Only 4 of these 23 patients stated that feeling the edge of the implant was a concern for them. Of the 210 augmented breasts, 5 had diminished sensation postoperatively (2%), as interpreted by the patient.

Velopharyngeal insufficiency may persist after primary repair of the palate. This insufficiency causes a speech deficit. Although there are many treatment alternatives, the most effective treatment of velopharyngeal insufficiency remains controversial.The authors performed Furlow palatoplasty in patients older than 3 years who had undergone primary palatoplasty with the Veau-Wardill-Kilner technique. Speech was assessed by a speech therapist before and after the operation. Velopharyngeal closure and velum motion were recorded using a video nasendoscope before and also 12 months after the operation. Any increase in velum length was measured.After Furlow palatoplasty, 10 of 27 patients (37 percent) made complete recovery and 12 (44 percent) made substantial recovery from hypernasal resonance, but five (18.5 percent) showed no improvement. Regarding nasal emission, 16 of 27 patients (59.3 percent) made complete and eight (29.6 percent) made substantial recovery, but there was no change in three (11 percent). Five of 27 patients (18.5 percent) achieved complete intelligibility and 18 of 27 (66.7 percent) improved intelligibility, but four (14.8 percent) did not show any improvement in intelligibility. Articulation improved considerably in 17 of 27 (63 percent). The overall rate of surgical success and near misses who benefited from the surgery was 18 of 27 (67 percent), and a positive correlation between surgical success and articulation and intelligibility was noticed. Video nasendoscopy showed complete velopharyngeal closure in 15 of 27 patients (56 percent). The mean velar length increased by 44 percent. After secondary Furlow palatoplasty, patients with small gaps benefited more.The results suggest that Furlow palatoplasty performed in later years improves not only speech but also velopharyngeal closure by reorienting the levator veli palatini muscle and augmenting the velum.

Ameloblastic carcinoma (AC) is an aggressive malignant epithelial odontogenic tumor. It may appear de novo or originate from a pre-existing ameloblastoma or odontogenic cyst. To our knowledge, an AC that originates from the anterior skull base has not been reported before in the English literature. We report a case of an AC that originated from the anterior skull base and invaded the dura of the anterior fossa and discuss its clinical course and treatment.

The most frequently used method in two-stage reconstruction of a tendon is the placement of a silicone rod, forming a canal where the tendon can glide easily, that is subsequently replaced with a tendon graft. However, there is a disadvantage in that the formation of a qualified gliding canal requires at least three months after the placement of the silicone rod. In the present report, the authors evaluated the effects of tetracycline on the time period required for the formation of a qualified gliding canal in rats after the placement of a silicone rod. Tetracycline was administered through an 18 gauge needle inserted into the silicone rod in the test side (right) and saline solution was administered in the same fashion to the control side (left) in each rat. Histopathological and macroscopic examinations at weeks 1, 2, 3, 4 and 8 after the operation showed that a significantly thicker and more mature sheath was formed after two weeks in the sides that had been treated with tetracycline.La méthode la plus utilisée pour reconstruire un tendon en deux étapes consiste à installer une tige de silicone, formant un espace sur lequel le tendon peut glisser facilement, remplacé plus tard par une greffe de tendon. Cependant, il existe un inconvénient, car il faut au moins trois mois après l’installation de la tige de silicone pour qu’un espace de glissement acceptable se forme. Dans le présent rapport, les auteurs ont évalué les effets de la tétracycline sur la période nécessaire pour former un espace de glissement acceptable chez des rats après l’installation d’une tige de silicone. La tétracycline a été administrée au moyen d’une aiguille de calibre 18 insérée dans la tige de silicone du côté à l’essai (à droite), et une solution saline a été injectée de la même façon dans la tige témoin (à gauche) de chaque rat. Les examens histopathologique et macroscopique aux semaines 1, 2, 3, 4 et 8 après l’intervention ont révélé qu’au bout de deux semaines, une gaine beaucoup plus épaisse et plus mature s’était formée du côté traité à la tétracycline.

Various techniques are being used to perform reduction mammaplasty. One of the most widely used techniques is the inferior pedicle technique. To our knowledge, there are not many studies on long-term changes in areola-to-fold distance, distribution of pedicle length, and its importance. Therefore, in this study, breast volume, suprasternal notch-to-nipple distance, and nipple-to-inframammary fold distance were analyzed and the movement range of the nipple-areola complex was determined. In addition, the degree of benefit derived from the technique and the degree of long-term ptosis were investigated. The desired transposition of the nipple can be achieved by the inferior pedicle technique. The most serious complication of reduction mammaplasty is impairment of the blood supply to the nipple. However, the inferior pedicle technique has a slight possibility of causing the above complications. The most important criterion in deciding whether to perform free nipple technique or inferior pedicle technique is the pedicle length. This is a detailed study on the pedicle length and its statistical analysis.

Temporomandibular joints (TMJ) are negatively affected by trauma and disuse. In this prospective study, 103 patients with mandibular fractures were evaluated for the influence of trauma and maxillomandibular fixation on the TMJ. A total of 54 patients were treated by maxillomandibular fixation and 49 by titanium miniplate fixation. Those patients with condylar fractures and multiple mandibular fractures and malocclusion at presentation were not included in the study. The control group consisted of 44 randomly-selected healthy people with no past history of mandibular fracture or symptoms referable to the TMJ. Trauma was a major factor leading to TMJ dysfunction and maxillomandibular fixation increased the incidence and severity of TMJ dysfunction.

background. Success of skin grafts depends on sufficient immobilization and early intervention for hematoma, seroma, or infection. objective. To stabilize and cover skin grafts with a tie-over technique using translucent silicone gel sheet. methods. Twenty-seven skin defects were resurfaced with skin grafts. A sterile silicone gel sheet was placed over the skin graft. Gel was fixed to the wound edges with skin staplers. results. All grafts healed without any complication. conclusion. Using silicone gel sheeting on 27 skin grafts, we found that it is an effective method for stabilization and allows direct visualization of the graft in order to inspect hematoma-like complications.

Traditional open rhinoplasty leaves a scar on the columella. No one can say that this scar is invisible. It is less noticeable in Caucasian patients but it is a problem in non-Caucasian patients like in our country. To avoid such a scar and still obtain a wide exposure of the nasal framework, the bilateral paramarginal incisions close to the columella were extended down to the nasal floors. The lower lateral cartilages forming the nasal tip could then be delivered out through one of the nostrils. An exposure similar to the traditional open rhinoplasty was then achieved. The technique has been used in 23 patients with satisfactory results. In conclusion, the open rhinoplasty without transcolumellar incision can replace the traditional transcolumellar open rhinoplasty technique in selected patients.

Extremity contractures are one of the most common deformities faced by the reconstructive surgeon. Major deformities with ankylosis of the related joint have to be managed by both soft tissue and bone operations. Contractures existing for a long period of time cannot be brought into anatomic position easily because of shortened tendons, nerves, and vessels or ankylosed joints. Although tendons can be lengthened in one operation, this is not the case for neural and vascular structures. The authors use external fixators associated with soft tissue procedures to gradually correct major foot dorsiflexion contractures.

Background. Squamous cell carcinoma (SCC) accounts for a large proportion of nonmelanoma skin cancers. It may appear mainly on the skin and the mucous membranes; however, it may also appear on any part of the body. The tumor originates from atypical keratinocytes. This tumor, which can be locally destructive, has a metastasis rate of 5% to 10%. Objective. To present a patient with disseminated primary SCC of the skin. Methods. In this report, we present a unique case of disseminated SCC that is thought to be primary. As far as we know, the patient neither had any syndrome or a disease predisposing to SCC nor was exposed to toxic substances or ionized radiation. The disease progressed in a very short period. To our knowledge, there has not so far been a case of disseminated primary SCC. The patient was inoperable when he presented to our clinic. Results. Chemotherapy was instituted in the Department of Medical Oncology; unfortunately, the patient died while on the therapy. Conclusion. An original case of disseminated SCC of the skin is presented.

Currently, both autogenous and nonautogenous materials are used to treat contour deformities. Autogenous grafts are preferable to nonautogenous grafts because they cause less reaction and are both inexpensive and easy to obtain. Currently, however, no consensus exists on an ideal autogenous graft. As autogenous materials, dermal grafts can be obtained from scar tissue, allowing simultaneous revision of scars, quicker vascularization than with other autogenous tissues, and a very short immobilization for their stabilization (i.e., they interact with surrounding tissues). The operation can be performed with the patient under local anesthesia, providing regular contours easily. Alternative techniques are needed to increase the viability and mass effects of autogenous grafts in the long term. With this as the objective, folded dermal grafts were used to increase the mass effects of dermal grafts. The current study compared long-term histopathologic and structural changes in unfolded and folded dermal autogenous grafts used for correction of soft tissue contour deformities. Thicknesses and histopathologic changes of the unfolded and folded dermal autogenous grafts were evaluated 6 and 12 months after placement of the grafts in the abdomens of 10 rabbits. Both the authors’ observations and histopathologic examinations showed that the folded dermis caused a more severe granulomatous reaction and fibrosis. Graft thicknesses considerably increased in the first 6 months, but then almost leveled off in the following months. Increased fibrosis in the folded grafts had a masslike effect, which was preserved in the long term, suggesting that folded dermal grafts can be used clinically.

The deviated nose is a particular challenge because both functional and aesthetic problems must be addressed. A most important challenge is resection of the hump. The nasal bones often are asymmetric in deviated noses. Several methods have been used for resection of the hump. Using the authors' method, it is possible to calculate the extent of hump resection. Clinical analysis of the nasal deviation is performed preoperatively. Digital photographs are taken, and all the landmarks are marked on the life-size photo prints. Planning begins on the deviated side. The ideal dorsal line is drawn, and the extent of hump resection is planned according to the preoperative measurements. Measurements on the deviated side are applied to the other side using the medial canthi and the most prominent part of the alar creases as landmarks. Classical methods emphasize the importance of the chisel position during hump removal. According to the classical approach, the chisel should be positioned lower on the deviated side to resect more bone. However, there is no method for calculating how the chisel should be positioned exactly during hump resection. Therefore, a precise plan has been devised to leave symmetric nasal bones after hump resection. The authors have applied this method in eight cases, achieving satisfactory results.

Microstomia is one of the most distressing results of burn. In this article, two cases presenting with microstomia following burn injury were revealed. In these patients, perioral and commisure defects due to burn were severe. The commissuroplasties were performed with a composite graft harvested and reshaped from the ear lobule. The oral aperture was evaluated before and after the operation and the patients were followed-up for two years. As a result, the opening was nearly normal without the help of a splint. Functional recovery were satisfactory as the incidence of drooling disappeared. Both patients were satisfied with the end results since their quality of life increased significantly.

WOS: 000231783000017, PubMed: 16174509

Nasal augmentation required following a trauma or a rhinoplasty operation poses a challenging problem to many plastic surgeons. Currently, allografts and autologous tissues are used for nasal augmentation; however, an ideal technique has not yet been described. Although preferred for augmentation of different parts of the body, pure dermal graft use has not been described for nasal augmentation. The authors performed nasal augmentation using a dermal graft in 90 patients in their hospital between 1994 and 2000, and they followed up the patients for 6 months to 8 years. In this article, the early and late results of dermal grafts for nasal augmentation are presented, and their advantages and disadvantages are discussed with a review of the literature. It was concluded that the easily obtained dermal graft could be an appropriate alternative in nasal augmentation, though it has not been used widely for this purpose.

WOS: 000220062700057, PubMed: 14504551

Reshaping and preserving the new shape of cartilage grafts is important for reconstruction of congenital or acquired deformities. In this in vivo study the authors investigated the effect of the Er:YAG laser on cartilage reshaping in comparison with scalpel stripping. The study consisted of two groups (N = 9). After measuring the angle between two margins of the ear, the cartilage in the right ear in rabbits was reshaped using the Er:YAG laser in group I, and scalpel incisions were used to reshape the left-ear cartilage in group II rabbits. Changes in the shape of the ears were evaluated at 10 days, and 1 and 6 months. The laser-reshaped ears were flattened and preserved the new flattened shape at the end of 6 months. The ultrastructural changes in the cartilage were evaluated based on the results from histopathological examination and electron microscopy. The authors conclude that cartilage can be reshaped using the Er:YAG laser. The mechanical effect of laser ablation and the thermal effect of laser radiation caused ultrastructural changes in the cartilage tissue, resulting in permanent changes in cartilage shape.

We present our experience with nasal grafts over 20 years. The nose, located centrally, always plays a key role in facial aesthetics. Public recognition of this makes rhinoplasty the most popular operation. From the traditional aesthetic point of view, propogated by the media, the nose must be narrow and straight and have correct nasolabial and forehead angles. It is the desire of every surgeon to obtain permanent and satisfactory cosmetic results. However, it is not always possible to obtain good cosmetic appearance using conventional methods when the nose is small or large, when the columella is short, or when the skin is thick. Mostly, nasal tip projection cannot be achieved. In the present article, we report our experiences in primary asthetic rhinoplasty using cartilaginous grafts obtained from septum, costa, and ear as umbrella grafts of columella type.

In the past decade, the number of patients demanding rhinoplasty has increased, and this has increased the use of grafts. Although different materials are used as grafts, cartilage is the most popular one. In secondary rhinoplasties the need for cartilage is very frequent. The most suitable cartilage grafts are the ones extracted during primary rhinoplasty. These grafts are disposed of after the operation and in a secondary operation, grafts are obtained from a new donor site. In our department, the surplus cartilages obtained during primary rhinoplasties of the patients who are thought to be probable secondary rhinoplasty candidates are stored in a postauricular pocket after their volumes are measured and marked down. In the secondary operations the volume of the grafts are measured again and the grafts are used. We have found out that there is no significant difference between the initial and secondary volumes of lower lateral cartilages (3.6% of initial volume is lost), but the difference between the initial and secondary volumes of septal cartilages is significant (6.9% of initial volume is lost), and the stored cartilages are sufficient qualitatively and quantitatively for the secondary rhinoplasties.

After palatoplasty operations, we are faced with a palatal fistula rate of 30% repair which is one of the most difficult tasks in Plastic Surgery. Placement of a biological material between the two anatomic layers of the palate was performed to reduce the rate of fistula formation. Commercially available “fascia lata” homograft was used in order to decrease the time of operation and avoid donor site morbidity. This method has reduced the rate of palatal fistulae to 8.3%.

The SMAS was described more than 25 years ago, yet its full potential in face-lift surgery has become appreciated only more recently. A reappraisal of the various aspects of SMAS surgery is now appropriate. These include aspects of its release from the deep fascia, the several considerations underlying the vectors of flap redistribution, and the rationale underlying the methods of flap fixation. These are unique, compared with the traditional considerations in subcutaneous face lifts and en bloc subperiosteal lifts.