Background and Design.- The nasal tip tends to rotate inferiorly during smiling, columella folded in width and the central upper lip moves superiorly. One of the most important factors that cause smiling deformity is hyperactivity of depressor septi muscle. Materials and Methods.- Between January 2000 and December 2002, depressor septi muscle was cut during standard rhinoplasty procedure in sixteen cases. Fourteen cases were female, other 2 were male. The age of cases was between 18 and 42 (mean age was 27). Depressor septi muscles were cut and inferior ends were sutured together in anterior and inferior position of anterio nasal spine. All patients were satisfied with aesthetic results. This procedure prevented the rotation of the nasal tip inferiorly. We have not seen any wound problem or shortening of frenulum. Results.- We conclude that the cutting of the depressor septi nasi muscle created a wider nasolabial angle. This procedure prevents to the forces that draws nasal tip inferiorly in mild smiling deformity.

Bu i,:a~mada biri ayak bilegi m:dialinde, digeri pretibial bolgenin 1/3 distal lasmmda ~ak doku derekti olan 2 bastada, minOr vaskiiler pedikiilleri iizerine bazirlanan lasmi soleus kas flebi uygulamalan s~tur. Olgulardan birinde erken donemle deri grefl:inde 1asmi kayip o~ ve tekrar gre~tir. Olgularm gei,: donem takiplerinde herhangi bir komplikasyon g0zlem~tir.

The facial wrinkles, hyperpigmentation and post-acne scars are the most common causes of facial rejuvenation. Facial rejuvenation can be done with dermabrasion, laser or chemical peeling. Thirty-eight cases were included in this study. Between September 1999 and January 2004, full face Er: YAG laser was performed in 28 cases and dermabrasion was performed in 10 cases. Mean age of cases was 32 ± 2.3 ( 6 - 49 ). Twenty-six cases were female, other 12 were male. Laser treatment was performed due to facial wrinkles in 18 cases which had Fitzpatrick skin type between II and V, due to acne scars in 14 cases and in 6 cases had hiperpigmentation areas on their faces. Er: YAG laser was used with a 2,5 mm handpiece at the setting of 8-20 J / cm2 . Dermabrasion was performed with motor or sterilized sandpaper. Although the results of Er: YAG application were satisfied in cases with fine wrinkles in lighter type skin, it was not effective in cases that had deep wrinkles and post-acne scars. Hyperpigmented skins which were treated Er: YAG laser have been shown some recurrence. We concluded that dermabrasion was more effective tool for surgeons in facial rejuvenation, because depth of skin abrasion was easily controlled. Benlier E, Top H, Aygıt C. A.

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Ultraviyole isinlarina maruz kalan ciltte olusan kirisikliklar ve pigmentasyon artislari ile gecirilmis akne nedbeleri yuz cildi yenilemeyi gerektiren sebeplerdendir. Yuz cildi yenilenmesinde dermabrazyon, lazer ve kimyasal asitle soyma islemleri kullanilir. Bu calismada Er: YAG lazer kullanarak sagaltimi amacladigimiz 28 olgu ile dermabrazyon uyguladigimiz 10 olguyu gozden ge- cirerek alinan sonuclarin etkinligini sorguladik. Eylul 1999 tarihinden Ocak 2004 tarihine kadar gecen surede 28 olguya tum yuze lazer uygulamasi, 10 olguya ise dermabrazyon uygulamasi yapildi. Yas ortalamasi 32 ± 2.3 ( 6 - 49 ) olan olgularin 26'si kadin 12'si erkekti. Cilt tiplemesi Fitzpatrick tip II ile V arasina uyan olgularin 18'i yuzde mevcut kirisikliklar nedeniyle, 14'u gecirilmis akneler sonucu kalan nedbe cukurlari nedeniyle ve 6 olgu ise hiperpigmente alanlar nedeniyle yuz cildi yenilenmesine alindi. Kullanilan lazer cihazi Er: YAG lazer olup 8-20 j / cm2 arasinda degisen guclerde ve 2,5 mm nokta boyutu ile uygulandi. Dermabrazyon uygulamasi mekanik olarak motorla veya steril edilmis su zimparasi ile uygulandi. Acik tenli ve ince kirisikliklara sahip olgularda Er: YAG lazer uygulamasi tatmin ediciydi. Ancak derin kirisiklik ve cukur seklinde akne nedbelerinde Er: YAG lazer uygulamasi memnun edici sonuclar vermedi. Derin akne nedbelerinde dermabrazyonun daha etkili ve guvenilir bir uygu- lama oldugu kanaatine vardik. Anahtar Kelimeler: Yuz dermatozlari; kozmatik teknik; dermabrazyon; Er: YAG Lazer Cerrahpasa Tip Derg 2006; 37: 5 - 9 Er: YAG Laser and Dermabrasion Treatment in Facial Rejuvenation Abstract The facial wrinkles, hyperpigmentation and post-acne scars are the most common causes of facial rejuvenation. Facial rejuvenation can be done with dermabrasion, laser or chemical peeling. Thirty-eight cases were included in this study. Between September 1999 and January 2004, full face Er: YAG laser was performed in 28 cases and dermabrasion was performed in 10 cases. Mean age of cases was 32 ± 2.3 ( 6 - 49 ). Twenty-six cases were female, other 12 were male. Laser treatment was performed due to facial wrinkles in 18 cases which had Fitzpatrick skin type between II and V, due to acne scars in 14 cases and in 6 cases had hiperpigmentation areas on their faces. Er: YAG laser was used with a 2,5 mm handpiece at the setting of 8-20 J / cm2. Dermabrasion was performed with motor or sterilized sandpaper. Although the results of Er: YAG application were satisfied in cases with fine wrinkles in lighter type skin, it was not effective in cases that had deep wrinkles and post-acne scars. Hyperpigmented skins which were treated Er: YAG laser have been shown some recurrence. We concluded that dermabrasion was more effective tool for surgeons in facial rejuvenation, because depth of skin abrasion was easily controlled. Benlier E, Top H, Aygit C. A. Key Words: Facial dermatoses; cosmetic techniques; dermabrasion; Er: YAG Laser Cerrahpasa J Med 2006; 37: 5 - 9

Purpose: Despite adequate treatment, enophthalmos due to intraconjunctival corticosteroid injection and enlargement of the bony orbit after trauma remains a frequent complication. The use of alloplastic material in addressing this problem is restricted because it may result in allergic reactions and is not cost-effective. The use of retro-orbital intraconal injection is the most effective method for maximum augmentation. An inexpensive and minimally invasive alternative that also allows for reoperation when needed would be a preferred intervention.Materials and Methods: We used 24 white rabbits (New Zealand) in our study. The animals were divided into 2 groups: a fat group and a saline solution group. The first group was subjected to retrobulbar fat injection, and the second group underwent physiologic saline solution injection. The volume of the retrobulbar area was measured and statistically evaluated both before and after the injections. Sonographically measured retrobulbar volumes were then statistically analyzed.Results: When the saline solution and fat groups were compared, no significant difference was observed between the preinjection volumes of the orbits. However, after injection, there was a significant difference between volumes. A statistically significant difference was shown between retroorbital volumes calculated before the injection in the fat group and volumes calculated immediately after injection and in the following 4 months (right retro-orbital volume of 1.291 cm(3) +/- 0.031 cm(3) before injection and 2.656 cm(3) +/- 0.040 cm(3) in the fourth month, P < .05).Conclusions: Volume augmentation by fat injection is superior to complicated surgical methods because of the advantages of decreased morbidity, rapid rehabilitation, and ease of reinjection. Using fat tissue as a filling material is more reliable, easier, and cheaper in comparison to other implantable materials. (C) 2012 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 70:242-250,2012

Objectives: Arginase activity and ornithine concentration have been shown to be elevated in experimentally-induced benign tumors in mice. The aim of the study is to investigate arginase activity and ornithine concentration in human benign and malignant skin tumors and to evaluate their role for prognosis of skin tumors.Patients and Methods: We have investigated arginase activity and ornithine concentration in supernatant of homogenates of benign tumors (nevus) of the skin from 13 patients and of malignant tumors (squamous cell or basal cell carcinomas) from 29 patients. Total arginase activity, ornithine and total protein concentration in supernatant were determined by the methods of Geyer, Chinard and Lowry, respectively.Results: Arginase activity (p=0.006) and ornithine concentration (p=0.007) in nevus were significantly higher than in adjacent normal tissue. There was no significant difference between their levels in basal cell carcinoma and in nevus (p>0.05). There was no significant difference between ornithine concentration in squamous cell carcinoma and in nevus (p>0.05). However, arginase activity in this carcinoma was significantly higher than in nevus (p=0.018).Conclusion: The significant difference between tissue arginase activities in squamous cell carcinoma and in nevus indicates that determination of arginase activity could be useful for prognosis of skin tumors.

The purpose of this study was to research regeneration and growing properties of an immature rat ear cartilage and its adjacent tissue after a thermal injury. Fifteen 30-day-old male Sprague-Dawley rats were used. Burn wounds were created by applying a heated plaque. All the rats, based on their tissue sampling day, were placed in two groups for histopathologic evaluation. In group I (n = 5), the burned right auricles were amputated on the first day,and the left auricles were amputated as a control at the same time. In group II (n = 10), the burned right auricles were amputated on the 30th day, and the left auricles were amputated as a control at the same time. Epithelization of skin was completed in period ranging between 12 and 15 days in all burned ears. The skin appendages were few throughout the affected area.Chondroid tissue regenerated from perichondrium and increased capillary vessels were observed.On the first day of the burn injury, electron microscopic findings were karyopyknosis, karyorrhexis, and karyolysis of the nucleus, and there were also signs of necrosis. New chondroblasts were formed around the collagen fibrils in the scar tissue on the 30th day. CD-31 immunohistochemical staining showed increased capillary vessels in the burned ear. The peripheral nerve fibers decreased and regenerative signs of nerves were shown with the use of S-100 immunohistochemical staining. Differentiation of chondroblasts to chondrocytes occurs in the burned immature ear, and new cartilage tissue regenerates from perichondrium. In addition, regenerative signs of nerves appear.

It has been reported that sialic acid containing oligosaccharides play an important rolein the adhesion between cancer cells and endothelial cells and metastatic potential of tumorcells is proportional to cell surface sialylation. In the present study, we investigatedwhether there is a change in serum total and lipid bound sialic acid levels of patientswith benign and non-melanom malignant skin tumors and, evaluated whether the measurementof sialic acid levels may be useful clinically in distinguishing patients with benignskin tumors from those with non-melanom malignant skin tumors. In this study, 27patients with malignant skin tumors (16 men, age 50.78 ± 12.46 years), 39 patients withbenign skin tumors (17 men, age 48.59 ± 16.23 years) were included. Serum total andlipid bound sialic acid determination was performed by the thiobarbituric acid methoddescribed by Warren and, the resorsinol method described by Katopodis, respectively.Student’s T test and Z test were used to analyze the results. The mean serum total andlipid bound sialic acid levels were found to be 63.01 ± 11.89 mg/dl and 15.77 ± 2.44mg/dl, respectively in patients with benign skin tumors; and 65.95 ± 7.30 mg/dl and16.70 ± 3.80 mg/dl, respectively in patients with non-melanom malignant skin tumors.Serum total sialic acid and lipid bound sialic acid of patients with benign skin tumorswere not different from those of patients with non-melanom malignant skin tumors. Thepercentage of lipid bound sialic acid was found to be 25.3 in patients with non-melanommalignant skin tumors, 25 in patients with benign skin tumors. There was no significantdifference between the value of lipid bound sialic acid percentage in these groups. Ourfinding that there is no significant difference between serum total and lipid-bound sialicacid levels of patients with non melanom malignant skin tumors which are not able tometastase and patients with benign skin tumors supports the studies reporting that sialicacids play an important role in metastases.

We aimed to investigate the questionable effect of linear polarized polychromatic light on burn wound healing in rats. Two deep second-degree burn wounds on the backside of each of 21 Sprague-Dawley rats were created with a standard burning procedure by applying a heated plaque. Burned regions located right dorsolaterally and classified as group I lesions were treated with linear polarized polychromatic light + open dressing + antibacterial pomade, whereas group II lesions were located left dorsolaterally and treated with only open dressing + antibacterial pomade. Macroscopic evaluation was performed for determination of the completed wound closure rate, measurement of burn wound area, and investigation of macroscopic edema, hyperemia, and epithelialization. Histopathological evaluation included monitoring of epithelialization, vascularization, origination of granulation tissue, inflammatory cell response, and total histopathological score on days 7, 14, and 21 after burn creation. Macroscopic evaluation revealed more obvious epithelialization in group I lesions between days 6 and 15. The number of completely closed wounds was higher in group I than in group II on days 16 and 21. The average area of burn wounds was lower from day 5, hyperemia was less on days 2 to 17, and edema was less from day 4 to day 13 in group I lesions. Histopathological evaluation revealed a higher rate of epithelialization on day 7 and higher vascularization occurrence on day 21 in group I lesions. Linear polarized polychromatic light seems to be effective in the treatment of burn wounds and in the promotion of healing. This may be related to linear polarized polychromatic light stimulation of epithelialization and vascularization.

BACKGROUND:Reconstruction of facial skin defects requires good-quality skin cover to satisfy aesthetic expectations of patient, especially when the skin defect is on the uncovered area of the face. Limitations in the available local tissue and donor-site morbidity restrict the options.OBJECTIVE:In an effort to solve these problems, we have begun to use a subcutaneous pedicled retroauricular reverse-flow flap.METHODS:Between January 1997 and December 2005, reverse-flow subcutaneous pedicled retroauricular island flap was used to cover facial defects in 12 patients who underwent surgical excision of skin tumor. The patients ranged in age from 44 to 81 years with a mean age of 58 years.RESULTS:Only one case experienced a superficial necrosis in the distal one-quarter part of the flap. The functional and aesthetic results were satisfactory for both patients and surgeons, and no tumor recurrence was observed during the 12 to 28 months (mean, 18.8 months) follow-up period.CONCLUSIONS:This flap can be used reliably for the reconstruction of facial skin defects of small and medium size. The preference of frontal branch pedicled flap enables more distal facial area defects to be covered, such as dorsal nasal, nasolabial, and upper lip, than flaps based on parietal branch.

The long nose with a “plunging” tip is a deformity that involves an inferiorly rotated nasal tip, leading to an increase in the length of the nose. The anatomic basis of the long nose with a plunging tip may be divided into two types. Type 1 presents a normal alar–cartilage complex inferiorly displaced by a long nasal septum and long upper lateral cartilages. Type 2 is caused by a dislocation of the alar cartilages downward from the aponeurotic attachments to the septal angle. During the study period, the authors identified 60 patients with long noses and plunging tips. For 22 patients with type 1 long noses, the high septal incision technique was used in 12 cases and the step technique in 10 cases. The invagination procedure alone was used for 22 of 38 patients with type 2 plunging noses. Also, an extension graft with the invagination procedure was used for 6 patients, and a columellar strut graft was used for 10 patients. A high septal incision increased tip rotation without significantly changing the amount of tip projection. However, the step procedure, the invagination technique alone, septal extension graft with the invagination technique, and columellar strut grafts increased nasal tip rotation and projection. During the study period, 38 patients were identified as having a smiling deformity, which was improved using the authors’ modification procedure. On the basis of the results, the authors recommend that the appropriate treatment for each patient with a long nose and a plunging tip must be determined by preoperative and intraoperative examination findings with the patient at rest and while smiling.

The facial wrinkles, hyperpigmentation and post-acne scars are the most common causes of facial rejuvenation. Facial rejuvenation can be done with dermabrasion, laser or chemical peeling. Thirty-eight cases were included in this study. Between September 1999 and January 2004, full face Er: YAG laser was performed in 28 cases and dermabrasion was performed in 10 cases. Mean age of cases was 32 ± 2.3 ( 6 - 49 ). Twenty-six cases were female, other 12 were male. Laser treatment was performed due to facial wrinkles in 18 cases which had Fitzpatrick skin type between II and V, due to acne scars in 14 cases and in 6 cases had hiperpigmentation areas on their faces. Er: YAG laser was used with a 2,5 mm handpiece at the setting of 8-20 J / cm2. Dermabrasion was performed with motor or sterilized sandpaper. Although the results of Er: YAG application were satisfied in cases with fine wrinkles in lighter type skin, it was not effective in cases that had deep wrinkles and post-acne scars. Hyperpigmented skins which were treated Er: YAG laser have been shown some recurrence. We concluded that dermabrasion was more effective tool for surgeons in facial rejuvenation, because depth of skin abrasion was easily controlled. Benlier E, Top H, Aygit C. A.

Although various non-invasive procedures have been proposed to determine the optimal level of amputation of limbs in patients who have vascular disease, currently there are no consistent criteria that can be applied before surgery. The purpose of this study was to determine whether 99mTc-sestamibi imaging can accurately predict the healing of amputation sites.

A diagnosis of an aesthetic smiling deformity, which is functional rather than anatomic, is essential for provision of the best treatment in rhinoplasty. Smiling deformity consists of three elements: (a) the nasal tip tending to retrodisplace and rotate inferiorly; (b) the lower part of the upper lip moving superiorly; and (c) a horizontal groove occurring in the midphiltral area. An active depressor septi and orbicularis muscle can accentuate a drooping nasal tip and shorten the upper lip during smiling. Downward movement of the nasal tip and a sharper nasolabial angle usually are aesthetically unpleasant. Dur- ing the study period (January 2000 to January 2004), the authors identified 38 patients with smiling deformities, 16 of whom underwent dissection and transposition of the paired depressor septi during rhinoplasty. The remaining 22 pa- tients experienced hyperactivity of both the depressor septi and orbicularis muscles, as diagnosed by a descending nasal tip and a shortened upper lip at animation. These patients underwent a modification of the depressor septi and or- bicularis muscles. No relapse was evident up to 2 years postoperatively. Repositioning of the depressor septi nasi muscle improved only mild cases. However, modification of the orbicularis and depressor septi muscles was a valuable adjunct to rhinoplasty for moderate and severe forms of smiling deformity. The new approach for smiling deformity provided an aesthetically pleasant appearance for the pa- tient both at rest and when smiling.

Salivary duct carcinomas of parotid gland are rare, as are the skin metastases from them. Four cases are reported with metastases to the skin. We present an additional case, with Subcutaneous metastases of the back and leg. To our knowledge, this is the first case reported in the literature in which the nodule on an extremity was the metastasis of a salivary duct carcinoma of parotid gland.

The usual method to prefabricate a bone flap is to harvest a nonvascularized bone graft and to implant the artery and vein bundle between segments of bone graft. The basic problem of this method is sacrificing an artery for prefabrication. Another method for creating flap donor sites without using an artery is venous flap prefabrication. There are a few articles describing bone flap prefabrication, and these include implantation of both artery and vein as a vascular bundle. Also, there is no experimental study in the literature using a vein or an arterialized vein pedicle for bone flap prefabrication. As an experimental model for bone flap prefabrication, the rabbit ear vascular model was chosen. For the experiments 3 groups were formed. Each group contained 5 rabbits. In the first experimental group a vein was implanted between the halves of bone graft. In the second experimental group an arterialized vein was implanted between the halves of bone graft. To compare the viability of the bone graft of the 2 prefabrication groups, a bone graft was implanted into the subcutaneous pocket of the posterior auricular area in the third group. The authors examined 5 rabbits in each group by microangiography at the end of 6 weeks except for group 3. On microangiographic analysis, groups 1 and 2 showed patency of the vascular pedicle. There was no difference between these 2 groups from the point of view of vascular patency and bone appearance. Bone scintigraphy was performed for 5 rabbits in each group. On bone scintigraphic scans, the bone component of the flaps was visualized in groups 1 and 2, but not in group 3. A quantitative analysis of images was performed by drawing symmetric spherical regions of interest (ROIs) over both the implanted area and cranial bone. The uptake ratios were computed by dividing the mean counts in the implanted ROI by mean counts in the cranial bone ROI. The mean value was 0.86 +/- 0.02 in group 1 and 0.86 +/- 0.04 in group 2. A statistically significant uptake difference was not seen between venous and arterialized venous groups (P < 0.01). Histologic examination was performed all rabbits in each group, and demonstrated that the bony component was viable, showing osteocytes containing lacunae, osteoblasts along bony trabeculae, and vascular channels in groups 1 and 2. In group 3, the bony architecture of the graft was still apparent, but all bone within it was dead. There were no significant microangiographic, histologic, and scintigraphic differences between the 2 experimental methods.