Following the development of the morphological sciences, the brain has been first anatomically an... more Following the development of the morphological sciences, the brain has been first anatomically and histologically evaluated. With the new technology, important information about physiology was obtained after CT, MR, and PET. The insula discovered by Johann Christian Reil protected the mystery until recent days. The main purpose of this book chapter is to gather information about the histology and development of the insula and to elaborate on its morphological concepts. Understanding the various pathologies and surgical procedures being performed in this area is useful for clinical and basic scientists.
The human insula is regarded as the hidden fifth lobe, and as a result, macroscopic features incl... more The human insula is regarded as the hidden fifth lobe, and as a result, macroscopic features including vascularity of the insula are neglected in undergraduate and even in postgraduate medical education. The vasculature of the insula is of interest to many medical professionals interested in neuroanatomy, neuroimaging, neurosurgery, etc. The vascularity of the insula affects its functionality, and its vessels are associated with many diseases, such as strokes, infarcts, arteriovenous malformations, varices and tumours of insula. The middle cerebral artery is the main blood supply of the insula. Cortical branches of the middle cerebral artery lie over the insula and provide short, middle, and long perforating arteries. Insuloopercular and terminal insular arteries have been discussed and depicted. Arteries of the insula are presented herein.
Abstract Introduction: In recent years, “endoscopic thyroidectomy” methods have shown rapid progr... more Abstract Introduction: In recent years, “endoscopic thyroidectomy” methods have shown rapid progress. Among these techniques, transoral endoscopic thyroidectomy, vestibular approach (TOETVA) is app...
Background The number of TOETVA surgeries has increased worldwide but the anatomical passage of t... more Background The number of TOETVA surgeries has increased worldwide but the anatomical passage of trocars is not clearly defined. We aimed to define detailed surgical anatomical passage of the trocars in cadavers. The incisions in oral vestibule, anatomical pathways of trocars, affected mimetic muscles, neurovascular relations of trocars and histological correlation of surgical anatomy were investigated. Methods Four cadavers and 6 six patient oral vestibules were used. The locations of optimised vestibular incisions were measured photogrammetrically. Initial steps of TOETVA surgery were performed on cadavers according to those optimal incisions. TOETVA preformed cadavers dissected to determine anatomical passages of the trocars. Afterwards, flap of lower lip and chin were zoned by software appropriate to the trocars routes. Histological analyses of the zones were made in correlation with dissections. Results Mimetic muscles associated with median (MT) and lateral trocars (LT) are orbicularis oris, mentalis, depressor anguli oris, depressor labii inferioris and platysma muscles. Trocars affect mimetic muscles in the perioral, chin and submental regions in different ways. The risk of mental nerve injury by MT is low. LT pass through the DLI muscle. The transmission of LT to the subplatysmal plane in the submental regions can be in two different ways. The arterial injury risk is higher with LT than the MT. Conclusions The surgical anatomy of the perioral, chin and submental regions for the initial TOETVA steps has been defined. Detailed surgical anatomical passages of the MT and LT were determined. Anatomical pattern to reach subplatysmal plane are presented. Mimetic muscles effected by trocars were determined. Endocrine surgeons should know the anatomical passage of TOETVA trocars.
Lateral supraorbital approach is a simpler and quicker method than pterional approach. It provide... more Lateral supraorbital approach is a simpler and quicker method than pterional approach. It provides a more anterior projection when compared to the pterional approach. There are some minor differences of the modified lateral supraorbital approach when compared to lateral supraorbital approach. It is directed more subfrontally and anterior than the pterional and lateral supraorbital approach. We used modified lateral supraorbital approach in 100 cases between 2012 and 2015 in Medical Park İzmir Hospital/Turkey. The assessed data were as follows: age, gender, Glasgow coma scale at admission, the localization of pathology, the condition of surgical obliteration for aneurysm, excision grade for meningioma, length of stay in the hospital and Glasgow outcoma scale at discharge. Of all patients, 58 (58%) were men and 42 (42%) were women. Our cases were anterior communicating artery aneurysms (41 cases), tuberculum sella and medial sphenoid wing meningiomas (22 cases), middle cerebral artery...
Surgical and radiologic anatomy : SRA, Jan 11, 2017
10% Formalin (F10)-fixed cadavers have disadvantages such as disturbing smell, mucosal irritation... more 10% Formalin (F10)-fixed cadavers have disadvantages such as disturbing smell, mucosal irritation, discoloration and rigidity. We aimed to determine a suitable, simple and cost-effective embalming method that preserves color, texture, pliability and flexibility of the tissues for a long time without a disturbing smell and mucosal irritation. The embalmed cadavers were expected to be durable against environmental effects, utilizable for multiple and repetitive surgical trainings and instrumentations. Eight male (six intact, two autopsied bodies) and four female (three intact and one imported trunk) human cadavers were preserved with modified Larssen solution (MLS). Preserved bodies were kept in the deep freezers at -18/-20 °C. Bodies were allowed to thaw at room temperature 3 days prior to use. They were used in postgraduate hands-on courses for several medical disciplines. Each course lasted at least 1 day and during this period the bodies were stayed at room temperature. Assessment...
Journal of Brachial Plexus and Peripheral Nerve Injury, 2017
This review summarizes the role of melatonin (MLT) in defense against toxic-free radicals and its... more This review summarizes the role of melatonin (MLT) in defense against toxic-free radicals and its novel effects in the development of the nervous system, and the effect of endogenously produced and exogenously administered MLT in reducing the degree of tissue and nerve injuries. MLT was recently reported to be an effective free radical scavenger and antioxidant. Since endogenous MLT levels fall significantly in senility, these findings imply that the loss of this antioxidant could contribute to the incidence or severity of some age-related neurodegenerative diseases. Considering the high efficacy of MLT in overcoming much of the injury not only to the peripheral nerve but also to other organs, clinical trials for this purpose should be seriously considered.
Background: The exposure of the round window (RW) through the facial recess (FR) is sometimes par... more Background: The exposure of the round window (RW) through the facial recess (FR) is sometimes partial. The anatomic variations that alter RW exposure during cochleostomy have not been clearly defined to date. Aims: The aim of this study was to assess the best FR position in which to achieve the widest exposure of the RW niche and to define the topographic relationship between two other important anatomical structures, the facial nerve (FN) and the chorda tympani (CT). Study Design: Cadaver study. Methods: Twenty-four temporal bones were included in the study. Anterior and posterior epitympanectomy and posterior tympanotomy were performed after mastoidectomy. Bone was removed until the FN and CT were skeletonized and the CT branching point was visible. Two pictures were taken. The first was taken when the facial recess was at its widest exposure, while the second was taken when the RW niche was maximally exposed through the facial recess. Various measurements were taken. Results: The RW niche was totally visible in 19 temporal bones (79.2%). The RW was partially visible in the remaining five bones (20.8%). The unexposed part of the RW lay posteromedial to the FN in these five bones. While the branching point of the CT could be visualized in all cases at the widest exposure of RW, the part of the FN distal to the branching point was hidden in eight subjects (33.3%) under the posterior wall of the external ear canal. Conclusions: The RW niche was totally visible in most of the temporal bones. The RW lay posteromedial to the FN in some cases and total exposure was impossible.
We present a cadaveric dissection study to investigate the anatomic feasibility of penile transpl... more We present a cadaveric dissection study to investigate the anatomic feasibility of penile transplantation. Seventeen male cadavers were dissected to reveal detailed anatomy of the dorsal neurovascular structures including dorsal arteries, superficial and deep dorsal veins, and dorsal nerves of the penis. Dorsal artery diameters showed a significant decrease from proximal to distal shaft. Dominance was observed in one side. Deep dorsal vein showed a straight course and less decrease in diameter compared to artery. Dorsal nerves showed proximal branching pattern. In a possible penile transplantation, level of harvest should be determined according to the patient and the defect, where a transgender patient will receive a total allograft and a male patient with a proximal penile defect will receive a partial shaft allograft. We designed an algorithm for different levels of penile defect and described the technique for harvest of partial and total penile transplants.
Orbital floor fractures are one of the most commonly encountered maxillofacial fractures due to t... more Orbital floor fractures are one of the most commonly encountered maxillofacial fractures due to their weak anatomical structure. Restoration of the orbital floor following a traumatic injury or a tumor surgery is often difficult due to inadequate visibility and lack of knowledge on its anatomical details. The aim of this study is to investigate the locations of the inferior orbital fissure (IOF), infraorbital groove (G), and infraorbital foramen (Fo) and their relationship with the orbital floor using a software. Measurements from the inferior orbital rim (IOR) using the Fo, the IOF, G, and the optic canal (OC) were calculated in 268 orbits as reference points. The surgical landmarks from the G and the OC, the G and the IOF, the G and the intersection point were measured as 31.6 ± 6, 12.9 ± 4, and 12 ± 5 mm, respectively. The mean distances between the G and the IOR, the Fo and the IOF, and the Fo and the OC were found as 8.3 ± 2.1, 28.7 ± 3.5, and 53.6 ± 5.9 mm, respectively. The mean angles were calculated as OC-IOF-G 68.1° ± 16.4°; intersection-G-IOF as 61.4° ± 15.8°; IOF-OC-G as 19° ± 5.5°; OC-G-intersection as 31.5° ± 11.9°, G-intersection-OC as 129.5°, IOF-intersection-G as 50.5°. Furthermore, variable bony changes on the orbital floor which may lead to the differences at intersection point of the G and Fo were determined. In 28 specimens (20.9 %), unilateral accessory Fo (AcFo) was present. In 27 specimens, AcFo was situated supermaedially (96.4 %) on the main aperture. In one specimen, two intraorbital canals and Fo emerged from different points and coursed into different apertures. The measured mean distances of the AcFo-IOR and the AcFo-Fo were as 7 ± 2 and 7.3 ± 3.2 mm, respectively. The primary principle in the oculoplastic treatment of orbital floor reconstructions must be repositioning the herniated orbital aperture by maintaining the infraorbital artery and the nerve in the orbital floor. The IOF and the G were recommended as the more reliable oculoplastic surgical landmarks for identifying the orbital floor. To avoid pinching of the orbital floor structures, the triangle (IS-G-IOF) should be equilateral with an exigence of a 70° angle within it. Among each distance of the intersection-IOF, IOF-G, G-intersection should be equal. With the help of certain software, this study made possible to investigate the variability of the orbital floor structures, observe the variety in measurements and calculate the parameters which are crucial in implementing personalized reconstruction and implanting support.
It is clear that the importance of the ethmoidal foramen (EF) is based on its vascular contents. ... more It is clear that the importance of the ethmoidal foramen (EF) is based on its vascular contents. The frontoethmoidal suture (FS) line is recommended as more reliable navigational landmark for identifying the EF. The vertical orientation between the EF and the FS line was studied in 188 orbits using a computer software program. 146 anterior EFs (77.7 %) and 42 anterior EFs (22.3 %) were situated in the FS line as intrasutural and extrasutural, respectively. 146 posterior EFs (77.25 %) and 8 posterior EFs (4.25 %) were presented as intrasutural and extrasutural, respectively. Although accessory EFs were detected in 25.5 % specimen exhibited an extrasutural location. Majority of the EFs (1-4 EFs) were situated on the FS line. The mean distances from the FS and the anterior EF, the posterior EF and the accessory EF were measured as 2.1 ± 0.5, 2.0 ± 1.5 and 2.3 ± 1.2 mm, respectively. The range of the distances from the FS to the anterior EF, posterior EF and accessory EF were -1.2 to 3.32 , -1.02 to 5.76 and -1.1 to 3.65 mm, respectively. The ranges of EF changed within 1-6 mm. As the FS is not a single point, it is more suitable to make the incision 7 mm above the suture line. The data from this study to help the orbital surgeons explain and avoid unexpected hemorrhage during the orbital procedures such as posttraumatic orbital reconstruction, orbital tumor resections, anterior skull base reconstruction, and orbital decompression surgery.
European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, Jan 4, 2014
Typically, the medial orbital wall contains an anterior ethmoidal foramen (EF) and a posterior EF... more Typically, the medial orbital wall contains an anterior ethmoidal foramen (EF) and a posterior EF, but may also have multiple EFs transmitting the arteries and nerves between the orbit and the anterior cranial fossa. The aim of this study is to determine a patient-friendly landmark of the medial orbital wall and to specify a precise location of the ethmoidal foramens (EF) in order to standardize certain anatomical marks as safe ethmoidal arteries. Orientation points on the anterior ethmoidal foramen (AEF), posterior ethmoidal foramen (PEF) and middle ethmoidal foramen (MEF) were investigated in 262 orbits. Using a software program, distances between each foramen and the midpoint of the anterior lacrimal crest (ALC), the optic canal (OC), and some important angles were measured. The EFs were identified as single in 0.8 %, double in 73.7 %, triple 24,4 % and quadruple in 1.1 % specimens. The mean distances between ALC and AEF, ALC and PEF and ALC and MEF were 27.7, 10.6, and 12.95 mm,...
Palsy of the lingual nerve (LN) during third molar extractions, ramus osteotomies, anesthetic inj... more Palsy of the lingual nerve (LN) during third molar extractions, ramus osteotomies, anesthetic injections, procedures of orthognathic, preprosthetic, and periodontal surgery are important complications reported with varying frequency. The purpose of this study is to present quantitative data describing the position and shape of the LN in the third molar area. In the course of dissection, the LN was noted, as well as the furcation pattern, position, course, and anatomic relations under 2.5X loupe magnification in 21 adult male human cadavers. The distance of the junction of the LN and the chorda tympani from the foramen ovale was measured as average 15.1 +/- 5.8mm. The 4 furcation patterns of the LN and the inferior alveolar nerve (IAN) were observed based on their relative positions. Bifurcation of them above the level of the mandibular notch (type I) was observed in 66.7% of the specimens. The horizontal distance of the LN from the lingual plate of the mandible was greater in this s...
Background: Lower lip reconstruction following cancer resection includes a variety of clinical an... more Background: Lower lip reconstruction following cancer resection includes a variety of clinical and microsurgical options. Objective: We have developed a myocutaneous flap for full thickness reconstruction with a functioning muscle. Technique: In all patients, the submandibular artery was outlined using computerized tomographic angiography and Doppler. The flap was designed after resection. The first lobe was designed to fill the defect and was outlined 90 from the defect margin, with the submandibular artery in the center of the flap. A second lobe was then outlined 90 from the first lobe. The flap was raised along with the platysma muscle and artery, with the first lobe rotated to the lip and the second lobe inset into the first lobe site, permitting neck closure without skin redundancy. Results: From January to May 2012, 17 patients were treated with this flap, and all flaps survived. All of the patients had oral continence at sixteen months, and electromyography documented platysma function. Conclusion: The flap provides single-stage lower lip reconstruction with functional muscle.
Turkiye Klinikleri Journal of Medical Sciences, 2010
oth the extensor digitorum indicis (ED-indicis) and the extensor indicis proprius (EIP) muscles, ... more oth the extensor digitorum indicis (ED-indicis) and the extensor indicis proprius (EIP) muscles, together or individually, produce the extension of the index finger joints. 1-4 The independent ability to extend the index finger is thought to be caused by the independent function of the EIP tendon and the lack of a juncturae tethering the ED-indicis to the extensor pollicis. 5,6
Türk Üroloji Dergisi/Turkish Journal of Urology, 2012
Objective: The aim of our study was to describe the external anatomical landmarks and angles as a... more Objective: The aim of our study was to describe the external anatomical landmarks and angles as a training guide for urologists in the performance of percutaneous nephrolithotomy (PCNL) in the prone position. Materials and Methods: Between 2006 and 2008, 50 patients (including 10 resident cases) undergoing PCNL met the study criteria. The inclusion criteria consisted of patients with renal stones scheduled for a lower calyceal puncture PCNL where the number of attempts to access the calyx ≤ 3, and clear urine was seen draining from the needle. The exclusion criteria consisted of previous ipsilateral kidney surgery, severe hydronephrosis, anomalies of the renal or skeletal systems, BMI>30 kg/m 2 , upper/middle calyceal puncture and age ≤18. Several anatomical landmarks and angles were measured, recorded and analyzed. Results: The mean length of (Pi) was 10.1±1.7 cm (range 7-14), (Pe) was 9.9±1.7 cm (range 6-13), (a) was 11.2±2.8 cm (range 5.5-17), (b) was 5.3±2.3 cm (range 1.5-11 cm), (x) was 5.1±1.9 cm (range 1-8), (x1) was 3.3±1.7 cm (range 1.5-8.2), (y) was 7.1±1.7 cm (range 3.3-11.6), (y1) was 3.8±1.6 cm (range 1-9) and (t) was 4.9±1.7 cm (range 3-9). The mean angle for (a) was 49±13º (range 30-70º), (b) was 41±13º (range 20-70º) and (g) was 61±13º (range 28-80º). In resident cases, the median number of attempts was 1 (range 1-3), the median overall time for successful access was 7.25 minutes (range 2-12) and the median fl uoroscopy time was 62.5 seconds (range 30-150). Conclusion: A knowledge of these anatomical landmarks and angles may increase the capacity of urologists to repetitively perform the precise task of percutaneous access of the lower calyceal during PCNL.
The superior thyroid artery (STA) is the dominant arterial supply of the thyroid gland, upper lar... more The superior thyroid artery (STA) is the dominant arterial supply of the thyroid gland, upper larynx and the neck region. The knowledge of variations in possible patterns of origin, courses, and branching pattern of the STA is also important for surgical procedures in the neck region, such as emergency cricothyroidotomy, radical neck dissection, catheterization, reconstruction of aneurysm and carotid endarterectomy. The surgical anatomy of the STA was studied in 20 adult Anatolian preserved cadavers between the age of 40 and 70 years. The outer diameter of the STA origin was observed to be 3.53 ± 1.17 mm. The location of the origin of the STA according to the carotid bifurcation was evaluated as above (25%), below (35%) and at the same level (40%). The distribution patterns of the STA were classified into six types depending on the branching pattern. The outer diameter of the infrahyoid branch, superior laryngeal artery, sternocleidomastoid artery and cricothyroid branch at their origins were observed to be 1.13 ± 0.14, 1.42 ± 0.47, 1.54 ± 0.96 and 1.30 ± 0.41 mm, respectively. Typical and variant glandular branching patterns were observed in 85 and 15% of the specimens, respectively. The outer diameters of anterior, anteromedial, anterolateral and posterior glandular branches were measured as 2.05 ± 0.46, 1.41 ± 0.43, 1.51 ± 0.41 and 1.73 ± 0.53 mm, respectively. It is necessary to understand the surgical anatomy of the STA to carry out successful radical neck dissection and to minimize postoperative complications in a bloodless surgical field.
navigational landmarks for identifying the cOF. Hence, the transversal and vertical orientation o... more navigational landmarks for identifying the cOF. Hence, the transversal and vertical orientation of the cOF should be mastered by the surgeons reconstructing the anterior base of the skull and the orbit.
Following the development of the morphological sciences, the brain has been first anatomically an... more Following the development of the morphological sciences, the brain has been first anatomically and histologically evaluated. With the new technology, important information about physiology was obtained after CT, MR, and PET. The insula discovered by Johann Christian Reil protected the mystery until recent days. The main purpose of this book chapter is to gather information about the histology and development of the insula and to elaborate on its morphological concepts. Understanding the various pathologies and surgical procedures being performed in this area is useful for clinical and basic scientists.
The human insula is regarded as the hidden fifth lobe, and as a result, macroscopic features incl... more The human insula is regarded as the hidden fifth lobe, and as a result, macroscopic features including vascularity of the insula are neglected in undergraduate and even in postgraduate medical education. The vasculature of the insula is of interest to many medical professionals interested in neuroanatomy, neuroimaging, neurosurgery, etc. The vascularity of the insula affects its functionality, and its vessels are associated with many diseases, such as strokes, infarcts, arteriovenous malformations, varices and tumours of insula. The middle cerebral artery is the main blood supply of the insula. Cortical branches of the middle cerebral artery lie over the insula and provide short, middle, and long perforating arteries. Insuloopercular and terminal insular arteries have been discussed and depicted. Arteries of the insula are presented herein.
Abstract Introduction: In recent years, “endoscopic thyroidectomy” methods have shown rapid progr... more Abstract Introduction: In recent years, “endoscopic thyroidectomy” methods have shown rapid progress. Among these techniques, transoral endoscopic thyroidectomy, vestibular approach (TOETVA) is app...
Background The number of TOETVA surgeries has increased worldwide but the anatomical passage of t... more Background The number of TOETVA surgeries has increased worldwide but the anatomical passage of trocars is not clearly defined. We aimed to define detailed surgical anatomical passage of the trocars in cadavers. The incisions in oral vestibule, anatomical pathways of trocars, affected mimetic muscles, neurovascular relations of trocars and histological correlation of surgical anatomy were investigated. Methods Four cadavers and 6 six patient oral vestibules were used. The locations of optimised vestibular incisions were measured photogrammetrically. Initial steps of TOETVA surgery were performed on cadavers according to those optimal incisions. TOETVA preformed cadavers dissected to determine anatomical passages of the trocars. Afterwards, flap of lower lip and chin were zoned by software appropriate to the trocars routes. Histological analyses of the zones were made in correlation with dissections. Results Mimetic muscles associated with median (MT) and lateral trocars (LT) are orbicularis oris, mentalis, depressor anguli oris, depressor labii inferioris and platysma muscles. Trocars affect mimetic muscles in the perioral, chin and submental regions in different ways. The risk of mental nerve injury by MT is low. LT pass through the DLI muscle. The transmission of LT to the subplatysmal plane in the submental regions can be in two different ways. The arterial injury risk is higher with LT than the MT. Conclusions The surgical anatomy of the perioral, chin and submental regions for the initial TOETVA steps has been defined. Detailed surgical anatomical passages of the MT and LT were determined. Anatomical pattern to reach subplatysmal plane are presented. Mimetic muscles effected by trocars were determined. Endocrine surgeons should know the anatomical passage of TOETVA trocars.
Lateral supraorbital approach is a simpler and quicker method than pterional approach. It provide... more Lateral supraorbital approach is a simpler and quicker method than pterional approach. It provides a more anterior projection when compared to the pterional approach. There are some minor differences of the modified lateral supraorbital approach when compared to lateral supraorbital approach. It is directed more subfrontally and anterior than the pterional and lateral supraorbital approach. We used modified lateral supraorbital approach in 100 cases between 2012 and 2015 in Medical Park İzmir Hospital/Turkey. The assessed data were as follows: age, gender, Glasgow coma scale at admission, the localization of pathology, the condition of surgical obliteration for aneurysm, excision grade for meningioma, length of stay in the hospital and Glasgow outcoma scale at discharge. Of all patients, 58 (58%) were men and 42 (42%) were women. Our cases were anterior communicating artery aneurysms (41 cases), tuberculum sella and medial sphenoid wing meningiomas (22 cases), middle cerebral artery...
Surgical and radiologic anatomy : SRA, Jan 11, 2017
10% Formalin (F10)-fixed cadavers have disadvantages such as disturbing smell, mucosal irritation... more 10% Formalin (F10)-fixed cadavers have disadvantages such as disturbing smell, mucosal irritation, discoloration and rigidity. We aimed to determine a suitable, simple and cost-effective embalming method that preserves color, texture, pliability and flexibility of the tissues for a long time without a disturbing smell and mucosal irritation. The embalmed cadavers were expected to be durable against environmental effects, utilizable for multiple and repetitive surgical trainings and instrumentations. Eight male (six intact, two autopsied bodies) and four female (three intact and one imported trunk) human cadavers were preserved with modified Larssen solution (MLS). Preserved bodies were kept in the deep freezers at -18/-20 °C. Bodies were allowed to thaw at room temperature 3 days prior to use. They were used in postgraduate hands-on courses for several medical disciplines. Each course lasted at least 1 day and during this period the bodies were stayed at room temperature. Assessment...
Journal of Brachial Plexus and Peripheral Nerve Injury, 2017
This review summarizes the role of melatonin (MLT) in defense against toxic-free radicals and its... more This review summarizes the role of melatonin (MLT) in defense against toxic-free radicals and its novel effects in the development of the nervous system, and the effect of endogenously produced and exogenously administered MLT in reducing the degree of tissue and nerve injuries. MLT was recently reported to be an effective free radical scavenger and antioxidant. Since endogenous MLT levels fall significantly in senility, these findings imply that the loss of this antioxidant could contribute to the incidence or severity of some age-related neurodegenerative diseases. Considering the high efficacy of MLT in overcoming much of the injury not only to the peripheral nerve but also to other organs, clinical trials for this purpose should be seriously considered.
Background: The exposure of the round window (RW) through the facial recess (FR) is sometimes par... more Background: The exposure of the round window (RW) through the facial recess (FR) is sometimes partial. The anatomic variations that alter RW exposure during cochleostomy have not been clearly defined to date. Aims: The aim of this study was to assess the best FR position in which to achieve the widest exposure of the RW niche and to define the topographic relationship between two other important anatomical structures, the facial nerve (FN) and the chorda tympani (CT). Study Design: Cadaver study. Methods: Twenty-four temporal bones were included in the study. Anterior and posterior epitympanectomy and posterior tympanotomy were performed after mastoidectomy. Bone was removed until the FN and CT were skeletonized and the CT branching point was visible. Two pictures were taken. The first was taken when the facial recess was at its widest exposure, while the second was taken when the RW niche was maximally exposed through the facial recess. Various measurements were taken. Results: The RW niche was totally visible in 19 temporal bones (79.2%). The RW was partially visible in the remaining five bones (20.8%). The unexposed part of the RW lay posteromedial to the FN in these five bones. While the branching point of the CT could be visualized in all cases at the widest exposure of RW, the part of the FN distal to the branching point was hidden in eight subjects (33.3%) under the posterior wall of the external ear canal. Conclusions: The RW niche was totally visible in most of the temporal bones. The RW lay posteromedial to the FN in some cases and total exposure was impossible.
We present a cadaveric dissection study to investigate the anatomic feasibility of penile transpl... more We present a cadaveric dissection study to investigate the anatomic feasibility of penile transplantation. Seventeen male cadavers were dissected to reveal detailed anatomy of the dorsal neurovascular structures including dorsal arteries, superficial and deep dorsal veins, and dorsal nerves of the penis. Dorsal artery diameters showed a significant decrease from proximal to distal shaft. Dominance was observed in one side. Deep dorsal vein showed a straight course and less decrease in diameter compared to artery. Dorsal nerves showed proximal branching pattern. In a possible penile transplantation, level of harvest should be determined according to the patient and the defect, where a transgender patient will receive a total allograft and a male patient with a proximal penile defect will receive a partial shaft allograft. We designed an algorithm for different levels of penile defect and described the technique for harvest of partial and total penile transplants.
Orbital floor fractures are one of the most commonly encountered maxillofacial fractures due to t... more Orbital floor fractures are one of the most commonly encountered maxillofacial fractures due to their weak anatomical structure. Restoration of the orbital floor following a traumatic injury or a tumor surgery is often difficult due to inadequate visibility and lack of knowledge on its anatomical details. The aim of this study is to investigate the locations of the inferior orbital fissure (IOF), infraorbital groove (G), and infraorbital foramen (Fo) and their relationship with the orbital floor using a software. Measurements from the inferior orbital rim (IOR) using the Fo, the IOF, G, and the optic canal (OC) were calculated in 268 orbits as reference points. The surgical landmarks from the G and the OC, the G and the IOF, the G and the intersection point were measured as 31.6 ± 6, 12.9 ± 4, and 12 ± 5 mm, respectively. The mean distances between the G and the IOR, the Fo and the IOF, and the Fo and the OC were found as 8.3 ± 2.1, 28.7 ± 3.5, and 53.6 ± 5.9 mm, respectively. The mean angles were calculated as OC-IOF-G 68.1° ± 16.4°; intersection-G-IOF as 61.4° ± 15.8°; IOF-OC-G as 19° ± 5.5°; OC-G-intersection as 31.5° ± 11.9°, G-intersection-OC as 129.5°, IOF-intersection-G as 50.5°. Furthermore, variable bony changes on the orbital floor which may lead to the differences at intersection point of the G and Fo were determined. In 28 specimens (20.9 %), unilateral accessory Fo (AcFo) was present. In 27 specimens, AcFo was situated supermaedially (96.4 %) on the main aperture. In one specimen, two intraorbital canals and Fo emerged from different points and coursed into different apertures. The measured mean distances of the AcFo-IOR and the AcFo-Fo were as 7 ± 2 and 7.3 ± 3.2 mm, respectively. The primary principle in the oculoplastic treatment of orbital floor reconstructions must be repositioning the herniated orbital aperture by maintaining the infraorbital artery and the nerve in the orbital floor. The IOF and the G were recommended as the more reliable oculoplastic surgical landmarks for identifying the orbital floor. To avoid pinching of the orbital floor structures, the triangle (IS-G-IOF) should be equilateral with an exigence of a 70° angle within it. Among each distance of the intersection-IOF, IOF-G, G-intersection should be equal. With the help of certain software, this study made possible to investigate the variability of the orbital floor structures, observe the variety in measurements and calculate the parameters which are crucial in implementing personalized reconstruction and implanting support.
It is clear that the importance of the ethmoidal foramen (EF) is based on its vascular contents. ... more It is clear that the importance of the ethmoidal foramen (EF) is based on its vascular contents. The frontoethmoidal suture (FS) line is recommended as more reliable navigational landmark for identifying the EF. The vertical orientation between the EF and the FS line was studied in 188 orbits using a computer software program. 146 anterior EFs (77.7 %) and 42 anterior EFs (22.3 %) were situated in the FS line as intrasutural and extrasutural, respectively. 146 posterior EFs (77.25 %) and 8 posterior EFs (4.25 %) were presented as intrasutural and extrasutural, respectively. Although accessory EFs were detected in 25.5 % specimen exhibited an extrasutural location. Majority of the EFs (1-4 EFs) were situated on the FS line. The mean distances from the FS and the anterior EF, the posterior EF and the accessory EF were measured as 2.1 ± 0.5, 2.0 ± 1.5 and 2.3 ± 1.2 mm, respectively. The range of the distances from the FS to the anterior EF, posterior EF and accessory EF were -1.2 to 3.32 , -1.02 to 5.76 and -1.1 to 3.65 mm, respectively. The ranges of EF changed within 1-6 mm. As the FS is not a single point, it is more suitable to make the incision 7 mm above the suture line. The data from this study to help the orbital surgeons explain and avoid unexpected hemorrhage during the orbital procedures such as posttraumatic orbital reconstruction, orbital tumor resections, anterior skull base reconstruction, and orbital decompression surgery.
European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, Jan 4, 2014
Typically, the medial orbital wall contains an anterior ethmoidal foramen (EF) and a posterior EF... more Typically, the medial orbital wall contains an anterior ethmoidal foramen (EF) and a posterior EF, but may also have multiple EFs transmitting the arteries and nerves between the orbit and the anterior cranial fossa. The aim of this study is to determine a patient-friendly landmark of the medial orbital wall and to specify a precise location of the ethmoidal foramens (EF) in order to standardize certain anatomical marks as safe ethmoidal arteries. Orientation points on the anterior ethmoidal foramen (AEF), posterior ethmoidal foramen (PEF) and middle ethmoidal foramen (MEF) were investigated in 262 orbits. Using a software program, distances between each foramen and the midpoint of the anterior lacrimal crest (ALC), the optic canal (OC), and some important angles were measured. The EFs were identified as single in 0.8 %, double in 73.7 %, triple 24,4 % and quadruple in 1.1 % specimens. The mean distances between ALC and AEF, ALC and PEF and ALC and MEF were 27.7, 10.6, and 12.95 mm,...
Palsy of the lingual nerve (LN) during third molar extractions, ramus osteotomies, anesthetic inj... more Palsy of the lingual nerve (LN) during third molar extractions, ramus osteotomies, anesthetic injections, procedures of orthognathic, preprosthetic, and periodontal surgery are important complications reported with varying frequency. The purpose of this study is to present quantitative data describing the position and shape of the LN in the third molar area. In the course of dissection, the LN was noted, as well as the furcation pattern, position, course, and anatomic relations under 2.5X loupe magnification in 21 adult male human cadavers. The distance of the junction of the LN and the chorda tympani from the foramen ovale was measured as average 15.1 +/- 5.8mm. The 4 furcation patterns of the LN and the inferior alveolar nerve (IAN) were observed based on their relative positions. Bifurcation of them above the level of the mandibular notch (type I) was observed in 66.7% of the specimens. The horizontal distance of the LN from the lingual plate of the mandible was greater in this s...
Background: Lower lip reconstruction following cancer resection includes a variety of clinical an... more Background: Lower lip reconstruction following cancer resection includes a variety of clinical and microsurgical options. Objective: We have developed a myocutaneous flap for full thickness reconstruction with a functioning muscle. Technique: In all patients, the submandibular artery was outlined using computerized tomographic angiography and Doppler. The flap was designed after resection. The first lobe was designed to fill the defect and was outlined 90 from the defect margin, with the submandibular artery in the center of the flap. A second lobe was then outlined 90 from the first lobe. The flap was raised along with the platysma muscle and artery, with the first lobe rotated to the lip and the second lobe inset into the first lobe site, permitting neck closure without skin redundancy. Results: From January to May 2012, 17 patients were treated with this flap, and all flaps survived. All of the patients had oral continence at sixteen months, and electromyography documented platysma function. Conclusion: The flap provides single-stage lower lip reconstruction with functional muscle.
Turkiye Klinikleri Journal of Medical Sciences, 2010
oth the extensor digitorum indicis (ED-indicis) and the extensor indicis proprius (EIP) muscles, ... more oth the extensor digitorum indicis (ED-indicis) and the extensor indicis proprius (EIP) muscles, together or individually, produce the extension of the index finger joints. 1-4 The independent ability to extend the index finger is thought to be caused by the independent function of the EIP tendon and the lack of a juncturae tethering the ED-indicis to the extensor pollicis. 5,6
Türk Üroloji Dergisi/Turkish Journal of Urology, 2012
Objective: The aim of our study was to describe the external anatomical landmarks and angles as a... more Objective: The aim of our study was to describe the external anatomical landmarks and angles as a training guide for urologists in the performance of percutaneous nephrolithotomy (PCNL) in the prone position. Materials and Methods: Between 2006 and 2008, 50 patients (including 10 resident cases) undergoing PCNL met the study criteria. The inclusion criteria consisted of patients with renal stones scheduled for a lower calyceal puncture PCNL where the number of attempts to access the calyx ≤ 3, and clear urine was seen draining from the needle. The exclusion criteria consisted of previous ipsilateral kidney surgery, severe hydronephrosis, anomalies of the renal or skeletal systems, BMI>30 kg/m 2 , upper/middle calyceal puncture and age ≤18. Several anatomical landmarks and angles were measured, recorded and analyzed. Results: The mean length of (Pi) was 10.1±1.7 cm (range 7-14), (Pe) was 9.9±1.7 cm (range 6-13), (a) was 11.2±2.8 cm (range 5.5-17), (b) was 5.3±2.3 cm (range 1.5-11 cm), (x) was 5.1±1.9 cm (range 1-8), (x1) was 3.3±1.7 cm (range 1.5-8.2), (y) was 7.1±1.7 cm (range 3.3-11.6), (y1) was 3.8±1.6 cm (range 1-9) and (t) was 4.9±1.7 cm (range 3-9). The mean angle for (a) was 49±13º (range 30-70º), (b) was 41±13º (range 20-70º) and (g) was 61±13º (range 28-80º). In resident cases, the median number of attempts was 1 (range 1-3), the median overall time for successful access was 7.25 minutes (range 2-12) and the median fl uoroscopy time was 62.5 seconds (range 30-150). Conclusion: A knowledge of these anatomical landmarks and angles may increase the capacity of urologists to repetitively perform the precise task of percutaneous access of the lower calyceal during PCNL.
The superior thyroid artery (STA) is the dominant arterial supply of the thyroid gland, upper lar... more The superior thyroid artery (STA) is the dominant arterial supply of the thyroid gland, upper larynx and the neck region. The knowledge of variations in possible patterns of origin, courses, and branching pattern of the STA is also important for surgical procedures in the neck region, such as emergency cricothyroidotomy, radical neck dissection, catheterization, reconstruction of aneurysm and carotid endarterectomy. The surgical anatomy of the STA was studied in 20 adult Anatolian preserved cadavers between the age of 40 and 70 years. The outer diameter of the STA origin was observed to be 3.53 ± 1.17 mm. The location of the origin of the STA according to the carotid bifurcation was evaluated as above (25%), below (35%) and at the same level (40%). The distribution patterns of the STA were classified into six types depending on the branching pattern. The outer diameter of the infrahyoid branch, superior laryngeal artery, sternocleidomastoid artery and cricothyroid branch at their origins were observed to be 1.13 ± 0.14, 1.42 ± 0.47, 1.54 ± 0.96 and 1.30 ± 0.41 mm, respectively. Typical and variant glandular branching patterns were observed in 85 and 15% of the specimens, respectively. The outer diameters of anterior, anteromedial, anterolateral and posterior glandular branches were measured as 2.05 ± 0.46, 1.41 ± 0.43, 1.51 ± 0.41 and 1.73 ± 0.53 mm, respectively. It is necessary to understand the surgical anatomy of the STA to carry out successful radical neck dissection and to minimize postoperative complications in a bloodless surgical field.
navigational landmarks for identifying the cOF. Hence, the transversal and vertical orientation o... more navigational landmarks for identifying the cOF. Hence, the transversal and vertical orientation of the cOF should be mastered by the surgeons reconstructing the anterior base of the skull and the orbit.
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