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Öğe Topographical Anatomy of the Superficial Temporal Artery(Turkish Neurosurgical Soc, 2023) Güler, Tuğba Morali; Comert, Ayhan; Güngör, Yiğit; Güner, Yahya Efe; Sayacı, Yağız Emre; Korkmaz, Ali Can; Cömert, ElaAIM: 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.Öğe The superiority of Dexpanthenol or Vaseline as excipient in nasal formulations(Verduci Publisher, 2022) Develioglu, O. N.; Dilber, M.; Muluk, Nuray Bayar; Sezer, C. Vejselova; Kutlu, H. Mehtap; Topsakal, V.; Cingi, C.OBJECTIVE: Dexpanthenol is an ingredient in multiple topical pharmaceutical preparations thanks to its high penetration and localized concentration. It is included in many ointments or lotions for dermatological use, assisting in healing and reducing pruritus. Vaseline is a synthetic product obtained by distilling crude oil. It is commercially available in several grades. The study presented here examined how topically applied agents (dexpanthenol or vaseline) affect nasal epithelial cells in culture. In particular, the study aimed to identify any alterations to epithelial cells which might indicate toxicity. MATERIALS AND METHODS: The nasal epithelial cells used were sourced from mucosal tissue fragments left over the following septorhinoplasty on five patients not suffering from rhinosinusitis. The first step was to dissect the mucosal fragments into smaller pieces on a sterilized Petri dish. These fragments were then placed into the DMEM-F12 cell culture medium, which had been freshly prepared. The dexpanthenol and vaseline were diluted in dimethylsulfoxide (DMSO) to a concentration of 5 mg/ mL. The cells in the wells were exposed to varying concentrations of dexpanthenol or vaseline. The actual concentration of the test reagent to which the epithelial cells were exposed ranged from 0.15 mg/mL to 5 mg/mL. The exposure period was 24 hours. The cells were finally examined using a Leica SP5II confocal microscope. The features sought were DNA fragmentation, condensation of the nuclei, changes in the outer membrane, or cytoskeletal abnormality. RESULTS: The viability of the cultured nasal epithelial cells was unaltered by a 24-hour exposure to dexpanthenol, nor was the cellular proliferation rate affected at the level of statistical significance. There was evidence of a cytotoxic effect from exposing nasal epithelial cells to vaseline in liquid form for 24 hours. There was a reduction in cellular viability in the plates where the highest dose of vaseline (5 mg/mL) was used. Cellular viability was not affected significantly at any of the doses below 5 mg/mL. CONCLUSIONS: The absence of cytotoxic effects from the application of dexpanthenol to the nasal mucosa indicates that this agent may be safely used within the nose. The cytotoxic effects of liquid vaseline observed in this trial (condensed nuclear chromatin, loss of cellular volume) indicate that this agent may be harmful when used intranasally. For patients who require nasal packing due to nose bleeds or following endoscopic sinus surgical procedures, dexpanthenol should be preferred to vaseline from the point of view of maximizing healing of a nasal injury.Öğe The Relationship between Sphenoid Sinus, Carotid Canal, and Optical Canal in Paranasal Sinus Computed Tomography in Children(Thieme Medical Publ Inc, 2023) Tursun, Serkan; Muluk, Nuray Bayar; İnal, Mikail; Goncuoğlu, Alper; Şencan, ZiyaObjectives The authors examined the structural differences in the paranasal sinus region at sphenoid sinus in the pediatric population. Methods Paranasal sinus computed tomography (PNSCT) images of 86 pediatric subjects (30 males, 56 females) were included. In 13 to 15 years of age group ( n =34) and >= 16 years of age group ( n =52), sphenoid sinus pneumatization (SSP), optic canal and carotid canal classifications and dehiscence evaluation were performed. Results In both sexes, type 1 and type 2 SS pneumatization were observed more frequently on both the right and left sides. On the right side, type 2> type 1; on the left side type 1> type 2 optic canals were detected in both gender. Type 3 optic canals were detected in 8.8 to 14.7% of the 13 to 15 years of age group; and 11.5 to 17.3% of >= 16 years of age group. Type 4 optic canals were detected in 2.9% of the 13 to 15 years of age group and 1.9% of the >= 16 years of age group bilaterally. Optic canal dehiscence was detected in 26.5% of the 13 to 15 years of age group and 17.3% of the >= 16 years of age group. Type 1 and type 2 carotid canals are most common in children, the percentages for type 3 carotid canals were 1.8 to 3.6% in children. Conclusion In pneumatized SS, optic canal classifications got increased values which showed protrusion into the sphenoid sinus wall. Therefore, in children, the surgeons must be very careful for optic canal being nearer to the sphenoid sinus walls.Öğe The Nose as a Route for Therapy: Part 1. Pharmacotherapy(Frontiers Media Sa, 2021) Cingi, Cemal; Muluk, Nuray Bayar; Mitsias, Dimitrios I.; Papadopoulos, Nikolaos G.; Klimek, Ludger; Laulajainen-Hongisto, Anu; Hytonen, MaijaThis article reviews nasal structure and function in the light of intranasal pharmacotherapy. The nose provides an accessible, fast route for local treatment of nose and sinus diseases, with lower doses than are necessary systemically and few adverse effects. It can also be used for other medications as it has sufficient surface area protected from local damage by mucociliary clearance, absence of digestive enzymes, responsive blood flow, and provides a rapid route to the central nervous system.Öğe The intranasal trigeminal system: roles in rhinitis (allergic and non-allergic)(Verduci Publisher, 2022) Ulusoy, S.; Muluk, Nuray Bayar; Scadding, G. K.; Passali, G. S.; Dilber, M.; Gevaert, P.; Passali, D.The aim of this paper is to review intranasal trigeminal system and associated reflexes. The literature survey was performed on PubMed, ProQuest Central database of Kirikkale University and Google Scholar. The intranasal trigeminal system and associated reflexes play an important role in humans in both health and disease, including in rhinitis of non-allergic and mixed type. The intranasal trigeminal nerve provides sensory perception to the lining of the nose, supplying information on how patent the nasal airway is and responding to various chemical signals. The reflexes known to exist within the intranasal trigeminal system are nasobronchial reflex, trigemino-cardiac reflex, nasogastric reflex, and nasal cycle. The intranasal trigeminal system and its reflexes play a vital role in normal human physiology. Alterations in how this system operates may underlie multiple forms of rhinitis and more research is needed to fully understand the mechanisms involved.Öğe The important adjacent structures for anterior ethmoidal artery in FESS: Anterior ethmoidal artery canal angle, supraorbital ethmoid cells and Keros classification(Elsevier Sci Ltd, 2022) Özdemir, Adnan; Muluk, Nuray BayarObjectives: This study investigated the visualization of the anterior ethmoidal artery (AEA) as notch, canal and sulcus, its relationship between supraorbital ethmoid cells (SOECs) and the Keros classification of the olfactory fossa on paranasal sinus computerized tomography (PNSCT). Methods: In this retrospective study, the paranasal sinus computerized tomography (PNsCT) images of 204 patients (103 males and 101 females) were analyzed. AEA canal, notch and sulcus, SOECs, the distance between AEA notch and ethmoid roof, AEA canal angle and Keros classification of the olfactory fossa were evaluated. Results: AEA notch in all patients and AEA canal (37.6 to 45.6%) and AEA sulcus (53.5 to 61.2%) were visualized. In the AEC canal and sulcus visualized patients, the Keros classification revealed higher. AEA notch and ethmoid roof distance increased in patients with higher Keros types. The presence of SOECs was significantly higher in males (41.7%) than females (19.8%) on the left side. There was a positive correlation between SOEC presence and Keros classification. In patients with SOEC, bilateral AEA canal and sulcus visualized more; and bilateral AEA notch and ethmoid roof distance increased. On the right side, the AEA canal angle of the males was significantly higher than that of the females. In patients with SOEC, the left AEA canal angle also increased. Conclusion: When detected SOECs and higher Keros types, the AEA was detected away from the skull base, AEA notch-ethmoid roof distance increased; and the AEA canal angle increased. To avoid intracranial penetrations, PNSCT should be evaluated carefully during the preoperative period.Öğe The Evaluation of the Cochlear Aqueduct and Internal Acoustic Canal in Patients with Unilateral Subjective Tinnitus and Normal Hearing(Aves, 2023) Yılmazsoy, Yunus; Muluk, Nuray Bayar; Özdemir, Adnan; Şencan, ZiyaObjective: We investigated the relationship between idiopathic subjective tinnitus and internal acoustic canal, cochlear aqueduct, vestibule, and lateral semicircular canal measurements by temporal magnetic resonance imaging. Methods: In this retrospective study, temporal magnetic resonance imaging sections of 25 patients (8 males and 17 females) with unilateral tinnitus and normal hearing were included. The internal acoustic canal, cochlear aqueduct, vestibule, and lateral semicircular canal measurements and internal acoustic canal and cochlear aqueduct shape classification were determined in the ipsilateral tinnitus side and contralateral non-tinnitus side. Results: The cochlear aqueduct length and width and internal acoustic canal opening width, length, width, and area of the ipsilateral tinnitus side were not different from the contralateral side. Similarly, the vestibule area and lateral semicircular canal height and width values were not different between the ipsilateral tinnitus side and the contralateral side. The main cochlear aqueduct type was type 2 in both ipsilateral and contralateral sides. For the internal acoustic canal types, cylindrical and funnel shapes were the most common types for the ipsilateral tinnitus side and contralateral side. There were positive correlations between the internal acoustic canal and vestibule areas; cochlear aqueduct length and internal acoustic canal areas; cochlear aqueduct width and width of the lateral semicircular canal; internal acoustic canal area and length and cochlear aqueduct length; internal acoustic canal opening width and height of the lateral semicircular canal; and width of the lateral semicircular canal dimensions. In older patients, the ipsilateral internal acoustic canal area was found to be smaller. Conclusions: In idiopathic subjective tinnitus, there were no important pathologies detected in the internal acoustic canal, cochlear aqueduct, vestibule area, and lateral semicircular canal. We concluded that there are no statistically significant morphometric differences compared to the healthy side in the internal acoustic canal, cochlear aqueduct, vestibule, and lateral semicircular canal areas detected by temporal magnetic resonance imaging in patients with unilateral subjective tinnitus and normal hearing.Öğe The efficacy of adenotonsillectomy on oxidative stress evaluated by thiol/disulfide balance(Wiley, 2021) Tursun, Serkan; Şimşek, Gökçe; Muluk, Nuray Bayar; Taş, Mustafa Burak; Erel, ÖzcanBackground Oxidative stress plays a role in the pathogenesis of many chronic diseases. Upper airway obstruction has been identified as a risk factor for increased oxidative stress-related disorders such as obstructive sleep apnea. The effect of adenotonsillar hypertrophy, which may result in a narrowing of the upper airways, on oxidative stress can be a valuable subject of research. This study aimed to investigate the efficacy of adenotonsillectomy on oxidative stress evaluated using the thiol / disulfide balance. Methods Thirty children who underwent adenotonsillectomy and 30 healthy controls, all aged from 3 to 18 years, were included in the study. Blood samples were taken preoperatively and 3 months postoperatively in the study group; in the control group, baseline blood samples were taken and samples were again taken 3 months later. Thiol / disulfide homeostasis items were analyzed. Antioxidant markers were native thiol, total thiol, and native / total thiol. Oxidative stress markers were disulfide, disulfide / native thiol, and disulfide / total thiol. Results At the preoperative period, oxidative stress parameters of thiol / disulfide homeostasis were higher in the study group than in the control group (P < 0.05) and antioxidant activity parameters were lower than in the control group (P < 0.05). Three months postoperatively, oxidative stress parameters were lower than in the control group (P < 0.05), and antioxidant parameters were no different from those in the control group (P > 0.05). In the adenotonsillectomy group considered separately, oxidative stress markers of disulfide and disulfide / native thiol decreased (P < 0.05) and antioxidant markers of native thiol and total thiol increased in the postoperative measurements (P < 0.05). Conclusions Oxidative stress related to adenotonsillar hypertrophy decreased after adenotonsillectomy. The antioxidant parameters of the thiol homeostasis increased after adenotonsillectomy. We concluded that adenotonsillectomy operations should be planned and applied timeously to prevent the adverse effects of adenotonsillar hypertrophies on thiol homeostasis.Öğe The Contribution of Fillers Used in the Correction of Malar Depression to Visual Quality and Quality of Life(Sage Publications Inc, 2024) Oğuz, Oğuzhan; Muluk, Nuray Bayar; Öztürk, Zeynel; Yağcı, Tarık; Cingi, CemalObjectives: This study aims to investigate the contributions of the filler procedure performed in the malar region to the patient's appearance as visual quality and quality of life. Methods: A total of 72 patients who underwent a malar filler procedure between March 2022 and March 2023 were included in the study. Each patient received a 2 cc injection of hyaluronic acid filler, with 1 cc administered on the right and 1 cc on the left. Photos before the malar filler procedure and photos taken in the first month after the procedure for individuals included in the study were independently evaluated by 2 physicians. Change criteria were rated on a scale of 1 to 5 as follows: (1) no change, (2) slight change, (3) moderate change, (4) significant change, and (5) very significant change. The satisfaction of the patients related to the malar filler procedure was evaluated by a Visual Analogue Scale (VAS) scale of 1 to 10 (0 showing no satisfaction, 10 showing maximum satisfaction). Results: Physicians evaluated the visual appearance of the patients as a very significant change in all patients (100%). Of the 72 patients, 66 (91.6%) expressed satisfaction with the procedure, while 6 (8.4%) found the treatment insufficient and requested further interventions. Conclusion: Hyaluronic acid fillers applied to the malar region caused patient satisfaction in 91.6%. However, a few patients requested further interventions. Patients' requests for unnecessary operations should be noted and treated with caution since they may lead doctors in the wrong direction.Öğe Temporal CT Evaluation of the Relationships between Basic Anatomical Structures and the Round Window: Importance for the Cochlear Implant Surgery(Thieme Medical Publ Inc, 2024) Asal, Nese; Muluk, Nuray Bayar; Sarıkaya, Pelin Zeynep BekinObjectives In the present study, we investigated the round window (RW) and neighboring anatomical structures using temporal computed tomography (CT) which are important for cochlear implant (CI) electrodes. Methods In this retrospective study, the temporal CT images of 112 adult patients (45 males and 67 females) were evaluated. We classified mastoid pneumatization, and measured RW diameter, RW-carotid canal (CC) distance, RW-facial nerve mastoid segment (FNMS) distance, RW-pyramidal eminence distance, RW-jugular bulb (JB) distance, and RW-internal acoustic canal (IAC) distance. Additionally, RW-cochlea angle and RW-facial nerve angle were also measured. Results RW diameters in males were significantly higher than those in females bilaterally ( p < 0.05). RW-CC distance and RW-JB distance were both smaller than 10mm. RW-IAC distance was 2.54 to 2.68mm, and RW-FNMS distance was 4.20 to 4.40mm. RW-cochlea angle ranged from 39.62 to 41.91degrees and RW-FN angle ranged from 17.28 to 18.40degrees. Males showed better mastoid pneumatization values ( p < 0.05). In higher RW diameters, RW-JB distance decreased, and in pneumatized mastoids, RW-JB distance increased. RW-JB distance and RW-CC distance were detected to increase together ( p < 0.05). Conclusion RW is crucial anatomic structure for CI surgeries. RW diameters are between 1.21 and 1.35mm and lower in the females. Males exhibited better mastoid pneumatization values than the females, and CC and JB distances from RW were farther in well-pneumatized mastoids. Future studies should include comprehensive clinical and surgical findings.Öğe Surgical anatomy of the transcanal infracochlear approach(Springer, 2022) Cömert, Ela; Cömert, AyhanPurpose 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.Öğe Supraorbital ethmoid cells (SOECs), anterior ethmoid artery notch and ethmoid roof relation in PNSCT(Elsevier Sci Ltd, 2023) Özdemir, Adnan; Muluk, Nuray Bayar; Sarıkaya, Pelin Zeynep Bekin; Yılmazsoy, YunusObjectives: We investigated supraorbital ethmoid cell (SOEC) presence and types in paranasal sinus computed tomography (PNSCT).Methods: The PNSCT images of 188 adult patients (93 males and 95 females) were evaluated as SOEC group (n = 87 sides), and non-SOEC group (n = 289 sides, control). In both groups, anterior ethmoid artery (AEA) notch-ethmoid roof distance and presence of AEA canal were evaluated. In the SOEC group, SOEC types (type 1 to 3) and SOEC angle are also examined.Results: SOEC was detected in 87 sides (23.13 %). SOEC type 2 was the most detected type (71.3 %). AEA notch-ethmoid roof distance of the SOEC group was significantly higher than those in the non-SOEC group. AEA notch-ethmoid roof distance of the SOEC Type 3 group was significantly higher than SOEC Type 2 group. AEA notch-ethmoid roof distance was 3.74 +/- 1.81 mm in the SOEC group and 0.68 +/- 1.16 mm in the non-SOEC group. When SOEC types were considered, this distance was 5.29 +/- 2.66 mm in type 3, 3.35 +/- 1.35 mm in type 2 and 3.48 +/- 0.92 mm in type 1. In higher SOEC types, SOEC angle; and AEA notch-ethmoid roof distance increased.Conclusion: In more pneumatized SOEC presence, SOEC angle increase, and AEA notch-ethmoid roof distance increases, AEA runs inferiorly in the ethmoid cells and freely below the skull base; and is more susceptible to injury. The surgeons should be more careful not to damage AEA in the FESS when detecting well-pneumatized SOECs (SOEC Type 3).Öğe Smell Regions in Patients with Vitamin D Deficiency: An MRI Evaluation(Thieme Medical Publ Inc, 2021) Şencan, Ziya; Bayar Muluk, Nuray; Şahan, Mehmet HamdiObjectives We investigated the effects of vitamin D deficiency in the peripheral and central smell regions by magnetic resonance imaging (MRI). Methods This retrospective study included 29 patients (12 males, 17 females) with 25-dihydroxy vitamin D3 [25(OH)(2)D-3] deficiency (group 1) and 34 subjects without 25 (OH)(2)D-3 deficiency (14 males, 20 females) (group 2). Using cranial MRIs, the peripheral (olfactory bulb [OB] volume and olfactory sulcus [OS] depth) and central (insular gyrus and corpus amygdala) smell regions were evaluated. Results The OB volume and OS depth values of the 25(OH)(2)D-3 deficiency group were significantly lower than those of the control group (p<0.05). For the central smell regions, the insular gyrus and corpus amygdala areas of the 25(OH)(2)D-3 deficiency group were nonsignificantly lower than those in the control group (p>0.05). There were positive correlations between OB volumes, OS depths, and insular gyrus and corpus amygdala areas bilaterally in the 25(OH)(2)D-3 deficiency group separately and in all subjects (groups 1 and 2) (p<0.05). In the 25(OH)(2)D-3 deficiency group, as the 25(OH)(2)D-3 values became lower, the insular gyrus area values decreased bilaterally (p<0.05). In females, the corpus amygdala area values were lower than in males (p<0.05). Conclusion Since vitamin D3 deficiency affected the peripheral and central smell regions negatively, we recommend evaluating patients' vitamin D levels as a health policy to prevent vitamin D3 deficiency-related cranial smell region problems. Moreover, sunlight exposure is very important to increase vitamin D levels, and the public should be informed about this topic.Öğe Role of Microplastics in Chronic Rhinosinusitis Without Nasal Polyps(Wiley, 2024) Taş, Burak Mustafa; Tuna, Ayşegül; Kankılıç, Gökben Başaran; Koçak, Furkan Melih; Sencan, Ziya; Cömert, Ela; Bayar Muluk, NurayObjective: We aimed to examine the relationship between chronic rhinosinusitis without nasal polyps and microplastics. Methods: A total of 80 patients participated in this prospectively planned study. The patients were divided into two groups. Group 1 had 50 patients with chronic rhinosinusitis without nasal polyps, whereas Group 2 had 30 healthy volunteers. The age and gender of the participants were noted. Nose Obstruction Symptom Evaluation questionnaire was applied to the patients. The patients performed nasal lavage with saline. Microplastics were examined in the collected nasal lavage fluids, and their numbers were noted. The groups were compared on these values. Results: The mean age was 38.06 +/- 14.15 years in the chronic rhinosinusitis group without nasal polyps and 33.60 +/- 11.68 years in the control group. There was no significant difference between the groups in terms of age and gender. There was a significant difference in the number of microplastics between the chronic rhinosinusitis group without nasal polyps and the control group (p < 0.001). Microplastics were detected in all participants. Conclusions: We found more microplastics in patients with chronic rhinosinusitis without nasal polyps. According to this result, we can say that there may be a relationship between chronic rhinosinusitis and microplastics.Öğe Radiological Evaluation of the Effect of Laryngopharyngeal Reflux on the Thickness of Inferior Turbinate, Maxillary Sinus Mucosa and Nasal Septal Body(Springer India, 2024) Taş, Burak Mustafa; Sarıkaya, Pelin Zeynep Bekin; Şencan, Ziya; Cömert, Ela; Muluk, Nuray BayarBackground We investigated the relationship between Laryngopharyngeal Reflux (LPR) and maxillary sinus mucosal thickness (MSMT), inferior turbinate mucosal thickness (ITMT), inferior turbinate width (ITW) and nasal septal body thickness (NSBT), which can be signs of chronic rhinosinusitis and allergic rhinitis.Methods The study, which included 87 patients, was designed as two groups. While 42 of the patients were included in the Laryngopharyngeal Reflux group, 45 were included in the control group. Age and gender information of the patients were noted. MSMT, ITMT, ITW and NSBT values were measured in patients who had Paranasal Sinus Computed Tomography. MSMT, ITMT and ITW were measured as right and left. Both groups were evaluated in terms of these values.Results Right ITMT, bilateral ITW and MSMT values were found to be significantly higher in the LPR group than in the control group (p < 0.05). MSMT values were higher in males (p < 0.05). The left-ITT and NSBT values were not significantly different between the LPR group and the control group, but both values were higher in the LPR group than in the control group (p > 0.05). In the LPR group, there were positive correlations between ITMT and ITW values of the right side; and left side separately (p < 0.05).Conclusion It has been shown that Laryngopharyngeal Reflux increases maxillary sinus mucosal thickness, inferior turbinate thickness and width, and nasal septal body thickness, which can be signs of chronic rhinosinusitis and allergic rhinitis. The negative effects of LPR on nasal and paranasal mucosa and structures were demonstrated in this study.Öğe Pronator quadratus musculo-osseous free flap for wide hard palatal defect reconstruction: An anatomical study(Elsevier Sci Ltd, 2023) Iğde, Murat; Salman, Necati; Güngör, Yiğit; Yılmaz, Mehmet; Cömert, Ela; Sağlam, Murat Enes; Baykara, YiğitWide hard palate defects include congenital and acquired defects that are six square centimeters or larger in size. Obturator prostheses and autologous soft tissue transfers have been used to reconstruct palatal defects. This study aims to repair wide, hard palatal defects by using a pronator quadratus musculo-osseous free flap to achieve subtotal reconstruction. Seventeen formalin-fixed cadavers were dissected. Free musculo-osseous pronator quadratus flaps were prepared after a 12 cm curvilinear volar skin incision. Standard 30 x 23 mm (690 & PLUSMN; 52.12 mm2) hard palate defects were made by chisels and saws. A subcutaneous tunnel was created between the mandibular edge cross point of the facial vessels and the retromolar trigone through the subcutaneous to the superficial musculoaponeurotic system by dissection. Area measurements of the pedicle and palate defects were performed by the ImageJ program (National Institutes of Health, Bethesda, MD, USA) on drawings over an acetate layer of materials. Mandibular distances of gonion-facial vessel cross point (a), goniongnathion (m), and facial vessels' cross point-retromolar entrance point (h) were measured. Ratios of h/m and a/m were calculated. The mean pronator quadratus area was 2349.39 & PLUSMN; 444.05 mm2, and the arterial pedicle pronator quadratus diameter was 2.32 & PLUSMN; 0.34 mm. The mean pedicle length of the pronator quadratus was 117.13 & PLUSMN; 8.10 mm. Study results showed that musculo-osseous pronator quadratus flaps' bone and muscle parts perfectly fit on the defects in all cadavers. Pronator quadratus musculo-osseous flap is a feasible surgical option for wide, hard palatal defect reconstruction strategies.& COPY; 2023 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.Öğe Preventive Measures for Safer Orthognathic Surgery: Key Points(Sage Publications Inc, 2024) İşçi, Kemal Devrim; Muluk, Nuray Bayar; Güngör, Enes; Cingi, CemalObjectives: The aim of this article is to review safer orthognathic surgery. Methods: The literature survey was performed in PubMed, EBSCO, UpToDate, ProQuest Central databases of K & imath;r & imath;kkale University, and Google and Google Scholar databases. Results: Patients with dentofacial skeletal defects may benefit from orthognathic surgery, which entails surgically modifying parts of the facial skeleton to restore the right anatomic and functional relationship. Careful investigation of the soft tissue via clinical examination and supporting pictures, evaluation of the structure via standardized radiographs, and evaluation of the dental via study dental casts are all necessary to successfully correct maxillofacial abnormalities. Orthognathic surgery can involve either the maxilla, the mandible, or both. Improving the dynamics of nasal airflow may necessitate simultaneous intranasal surgery consisting of septoplasty and reduction of the inferior turbinate. In some patients, a genioplasty and neck liposuction may be recommended to enhance the final result. Le Fort I osteotomy, Le Fort II osteotomy, Le Fort III osteotomy, maxillary segmental osteotomies, sagittal split osteotomy of the mandibular ramus, vertical Ramal osteotomy, inverted L and C osteotomies, and mandibular body segmental osteotomies are all examples of well-established osteotomies that can be used to reposition facial skeletal elements and redefine the face. Conclusion: Preventative strategies for risk-free orthognathic surgery include maintaining blood flow, shielding teeth, bone, and neurovascular systems, and bolstering the patient's diet.Öğe Preoperative computer imaging before augmentation rhinoplasty(Verduci Publisher, 2023) Cingi, Can Cemal; Muluk, Nuray Bayar; Cingi, Can CemalOBJECTIVE: In the present study, we investigated the efficacy of morphing technology via Adobe PhotoShop program and its liquefy effect in patients planned to undergo augmentation rhinoplasty. PATIENTS AND METHODS: The retrospective data for 100 consecutive augmentation rhinoplasty cases (64 females and 36 males) were enrolled in our study. Preoperative computer imaging (PCI) steps, a stepwise systematic guide for image editing, including (1) augmenting the dorsum, (2) lengthening the nose, (3) adjusting the tip projection, (4) perfection of the nasal dorsum and (5) exaggerating the tip projection and/or the dorsal augmentation were applied to the patients. After performing the PCI before augmentation rhinoplasty, the patients were allowed to see the options for the final appearance of their noses. Therefore, PCI helped them to decide on their operations. RESULTS: After applying CS-PCI before augmentation rhinoplasty, 71 patients (71%) accepted Step-4, and 19 (19%) accepted Step-3. Furthermore, six patients (6%) requested additional changes during their operational planning. In 95% of the cases, the authors achieved the results agreed upon based on the preoperative simulation. CONCLUSIONS: By PCI involving five steps for augmentation rhinoplasty, the patients were allowed to see the options for the final appearance of their noses. Therefore, PCI helped them to decide on their operations. With the help of morphing technology (2D), it is possible to increase interpersonal communication effectively.Öğe Bromelain: a candidate to enhance wound healing after endonasal surgeries(Verduci Publisher, 2023) Esen, E.; Muluk, Nuray Bayar; Sezer, C. Vejselova; Kutlu, H. M.; Cingi, C.OBJECTIVE: In the present study, we investigated the topical bromelain's cytotoxic effects on mouse fibroblast NIH/3T3 cells via cell culture study. MATERIALS AND METHODS: In this cell culture study, Dulbecco's Modified Eagle Medium ( DMEM) with fetal bovine serum (FBS, 10%) and penicillin/streptomycin (1%) was used as a cell growth medium for NIH/3T3 mouse fibroblast cells. MTT test was performed in 96-well plates seeded with NIH/3T3 cells 5x103/ well and under standard cell culture conditions. Bromelain doses of 3.13 to 100 mu M were administered to the wells and incubated for 24, 48, and 72 hours in the same cell culture conditions. For Confocal microscopic evaluation, NIH/3T3 cells were plated on cover slips in 6-well plates (105 cells/ well) and treated with 100 mu M concentration of bromelain for 24 h. Untreated cells were used as controls. RESULTS: M TT r esults s howed t hat b romelain is not cytotoxic on mouse fibroblast NIH/3T3 cells. All three incubation times of 24, 48, and 72 hours bromelain initiated cell growth. A statistically significant rise in cell growth was detected in the only applied highest dose of 100 mu M bromelain for all incubation times except for 24 hours. The nontoxic effect was further investigated by using confocal microscopy by applying the highest bromelain dose of 100 mu M to NIH/3T3 mouse fibroblast cells. Confocal micrographs showed that bromelain did not change the morphology of mouse fibroblast cells at the incubation time of 24h. In untreated cells and bromelain-treated cells, the nucleus of NIH/ 3T3 cells was undamaged and compact, and the cytoskeleton was fusiform and non-fragmented. CONCLUSIONS: Bromelain is not cytotoxic on mouse fibroblast NIH/ 3T3 cells and enhances cell growth. If clinical trials will confirm this, it is possible that bromelain will be used topically in humans to enhance wound healing, in rhinosinusitis and chronic rhinosinusitis with nasal polyps and endonasal surgeries due to its anti-inflammatory effects.Öğe Biologics in allergic rhinitis(Verduci Publisher, 2023) Muluk, Nuray Bayar; Cingi, C.This paper aims to review biologics in allergic rhinitis (AR). Biologic agents of Omalizumab, Dupilumab, Mepolizumab, Reslizumab, and Benralizumab are reviewed in detail. The search is performed in Pubmed, Google, Google Scholar and EBSCO Academic Search Ultimate (EKUAL) database of Kirikkale University Library from 2021 to 2000, and randomized and/or placebo-controlled studies, review papers, meta-analysis, and reports are taken into consideration. The search was performed with the keywords of allergic rhinitis, biologics, biologic agents, Omalizumab, Dupilumab, Mepolizumab, Reslizumab, Benralizumab, Anti IgE, Anti-IL-4/IL-13, Anti IL-5. Search is also performed in the U.S. Food and Drug Administration (FDA) and European Medicines Agency (EMA) web systems. Biological agents such as monoclonal antibodies (MAb) in treatment are called biological therapy or biotherapy. Omalizumab is a humanized Anti-Ig Emonoclonal antibody. Omalizumab treatment improved the Daily Nasal Rescue Medication Score (DNSSS) and decreased the use of antiallergic drugs in seasonal and perennial AR and rhino-conjunctivitis. Omalizumab is also used in specific immunotherapy patients with allergic rhinitis and reduced allergic reactions associated with allergen immunotherapy, such as anaphylaxis. Dupilumab is an Anti-IL-4/IL-13 biologic agent. Dupilumab treatment significantly improved sino-nasal Outcome Test (SNOT-22) total scores in perennial allergic rhinitis. Anti-IL-5 monoclonal antibodies of Mepolizumab, Reslizumab Benralizumab reduce the number of eosinophils in the blood and tissue, corticosteroid addiction and asthma attacks are reduced, and their use in the treatment of severe eosinophilic asthma has been approved. Biologics, especially Omalizumab, and Dupilumab, may be used more in allergic rhinitis.
