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    Expansion sphincter pharyngoplasty: analyzing the technique based on anatomy
    (SPRINGER, 2021) Comert, Ela; Comert, Ayhan; Sencan, Ziya
    Purpose The purpose of this study is to evaluate the effect of the different surgical techniques of expansion sphincter pharyngoplasty (ESP) on the dimensions of the oropharyngeal airway. Methods The techniques that were evaluated included the preservation and transection of the palatopharyngeus (PP) and superior pharyngeal constrictor (SPC) muscle attachment and transposition of the PP muscle to the hamulus of the medial pterygoid plate and the palatal musculature. Surgical techniques were applied in twenty half heads. Results The preservation of the PP-SPC attachment inhibited the transposition of the PP muscle to the hamulus and resulted in comparable enlargement in the medial-lateral dimension in the oropharyngeal airway when the PP muscle was transposed to the palatal musculature. After transection of the PP-SPC attachment, significant enlargement was observed in anterior-posterior and medial-lateral directions in the oropharyngeal airway when the PP muscle was transposed both to the hamulus and the palatal musculature. The distances measured after both the transposition techniques were similar. Conclusion The present study is a basic study demonstrating how different techniques of ESP affect the position of the soft palate. The PP-SPC attachment can be transected in the patients with anterior-posterior palatal and lateral wall collapse to pull the soft palate anteriorly in addition to prevent the lateral wall collapse. The PP-SPC attachment can be preserved in the patients with only lateral wall collapse. Nevertheless, the clinical consequences of these static changes need to be evaluated in clinical studies.
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    Jugular Bulb Anatomy for Lateral Skull Base Approaches
    (Lippincott Williams & Wilkins, 2018) Comert, Ela; Kilic, Caner; Comert, Ayhan
    Background: This study was designed to define the detailed anatomical relations of the jugular bulb with the facial nerve, sigmoid sinus, otic capsule, and internal acoustic canal allowing the safe management of the jugular bulb. Methods: Thirty-five formalin-perfused cadaveric temporal bones that had well mastoid and petrous pneumatization without any neurovascular variations on computed tomography scan were selected for the study. The bones were dissected via translabyrinthine approach. Results: The dome of the jugular bulb was located under the facial nerve in 21 of the cases (60%), in the mastoid cavity in 8 of the cases (22.9%), and in the tympanic cavity in 6 of the cases (17.1%). Significant difference was observed only between the temporal bones in which the dome of the jugular bulb was located in the mastoid cavity and under the facial nerve with regard to the mastoid cortex-lateral semicircular canal measurement (P = 0.04). Conclusion: Because of the high variability of the position of the dome of the jugular bulb, the precise knowledge of the relations of the jugular bulb and the preoperative radiologic verification of possible variations are essential to avoid the problems associated with its position and to decide the approach individually.
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    Maxilla allograft for transplantation - An anatomical study
    (Lippincott Williams & Wilkins, 2008) Yazici, Ilker; Cavusoglu, Tarik; Comert, Ayhan; Vargel, Ibrahim; Cavusoglu, Mehtap; Tekdemir, Ibrahim; Siemionow, Maria
    Introduction: The aim of this study is to present an anatomic study and a dissection technique to, prepare maxilla graft for transplantation. Methods: Six fixed adult human cadavers were used for dissection of the maxilla grafts. Retrospective reviews of archives of 10 MRI and 5 angiographies of the maxillary region were performed to demonstrate the vascular and soft tissue anatomy of this area. Results: We have harvested maxilla graft as a single unit (larger type of Le Fort II) based on arterial and venous pedicle ready for transplantation. MRI evaluation revealed the vascular structures in the masticatory space and its anterior pterygomaxillary extension. Angiographic observations have demonstrated the arterial blood supply of the maxillary region, which lies within the pterygomaxillary region that we have included in the graft. Conclusions: We are presenting a method for harvesting of the maxilla graft, with vascular supply based on certain anatomic landmarks.
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    Microsurgical training model for lymphaticovenous anastomosis in rat
    (Wiley-Blackwell, 2012) Yazici, Ilker; Cavusoglu, Tarik; Karakaya, Esen Ibrahim; Comert, Ayhan; Siemionow, Maria
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    Surgical anatomy of the transcanal infracochlear approach
    (Springer, 2022) Comert, Ela; Comert, Ayhan
    Purpose The objective of this study is to describe the detailed surgical anatomy of the infracochlear approach to prevent complications and to compare the postauricular transcanal microscopic and endoscopic approaches to reach the petrous apex. Methods Cadaver heads were dissected using a binocular surgical microscope, endoscopes, and an electric drill. The dimensions of the access field that could be reached and manipulated with surgical instruments and straight drill via postauricular transcanal microscopic and endoscopic approaches were evaluated. Results Both postauricular microscopic and transcanal endoscopic approaches were considered to be inapplicable in cases with a tympanic cavity located jugular bulb closer than 3 mm to the cochlea. This relationship was seen in 3 (9%) sides of the cadavers. In 4 specimens (12%), a cochlear aqueduct with an open lumen was detected. Both postauricular microscopic and transcanal endoscopic approaches reached a nearly identic dissection area. Detailed anatomy of the approach and measurements about the topography of the third portion of the facial nerve from the tympanic cavity were presented. Conclusion Both traditional microscopic postauricular and endoscopic transcanal approaches provided comparable access areas to the inferior petrous apex with wide exposure, and radiologic measurements were compatible. A tympanic cavity located jugular bulb in close relation with cochlea was the only instance that restricted the applicability of this technique.
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    Topographical Anatomy of the Superficial Temporal Artery
    (Turkish Neurosurgical Soc, 2023) Guler, Tugba Morali; Comert, Ayhan; Gungor, Yigit; Guner, Yahya Efe; Sayaci, Yagiz Emre; Korkmaz, Ali Can; Comert, Ela
    AIM: To describe in detail the gross anatomy of the superficial temporal artery (STA), its course and branches, its relationships with the branches of the facial nerve, and certain anatomical and surgical landmarks to preserve these structures in daily neurosurgical practice, and to use the STA during revascularization surgery.MATERIAL and METHODS: This cadaveric study was conducted on 16 cadaver heads bilaterally, in which 32 silicon/latex-injected STAs were dissected using a microdissection technique in a neuroanatomy laboratory. The distances between the facial nerve, tragus, STA, superficial temporal vein (STV), and imaginary lines created between important anatomical landmarks were measured. The curvilinear lengths of STA and STV were also measured.RESULTS: The average distances of the most posteriorly located branch of the facial nerve to the frontal region and the tragus at the midpoint of zygoma in the horizontal plane, at the superior border of the zygoma and at the level of the superior border of the parotid gland, were measured as 25.39, 29.84, and 15.56 mm, respectively. The average distance directly measured between the tragus and STA was 39.29 mm, and that between the tragus and STV was 20.26 mm. The average curvilinear lengths of the frontal and parietal branches of STA were 97.63 and 96.45 mm, respectively.CONCLUSION: Understanding the clinical anatomy of the STA and its branches and its relationships with other structures is of critical importance for a successful and noncomplicated surgery. Our findings will be useful not only for surgical approaches such as pterional craniotomy and orbitozygomatic approaches but also for cerebral revascularization.
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    Use of Triangulation Method in End-to-Side Arterial Microvascular Anastomosis
    (Lippincott Williams & Wilkins, 2009) Yazici, Ilker; Cavusoglu, Tarik; Comert, Ayhan; Vural, Altughan Cahit
    In this article, we present the use of triangulation for end-to-si I de microvascular arterial anastomosis. The classic end-to-side anastomosis starts by putting 2 Sutures 180 degrees apart to the lateral arteriotomy aperture that is parallel to the longitudinal axis. We are performing triangulation in end-to-side microvascular artery anastomoses by putting 3 Stay Sutures, securing 2 of them to visualize vascular lumen and reduce the risk of passing suture from the back wall. We have been using this method for the last 5 years and found that triangulation seems to be a safer technique to teach and practice end-to-side microvascular anastomosis.