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Background and Aim: Selecting the optimum nasal passage for nasotracheal intubation is quite important in the maxillofacial surgeries for the success of intubation and the reduction of potential complications such as nasal mucosal laceration, epistaxis, avulsion of the inferior and middle turbinates, and septal laceration. Materials and Methods: The present study evaluates standard panoramic radiographs (PR) and posteroanterior cephalometric radiographs (PACR) to determine the optimal nasal passage for nasotracheal intubation and compares the results with those of routine anesthesiological occlusion and spatula tests (ST). The results of occlusion tests (OT), ST, and radiological assessments of 60 patients prior to nasotracheal intubation were compared with the nasal endoscopic assessment results, and complications were evaluated. Results: There was no significant association between the OT and nasal endoscopy results (P = 0.075). A significant association was found between the ST and nasal endoscopy results (P = 0.000), and between the radiological assessments and the nasal endoscopy results (P = 0.000). Compatibility with nasal endoscopy was 54% when the occlusion and ST were evaluated together, 75% when the OT and radiological assessments were evaluated together, and 86% when the ST and radiological assessments were evaluated together. The highest level of compatibility was 92% when all the tests were evaluated together. Conclusion: The simple tests alone were found to be inadequate for the selection of the optimal nasal passage. Evaluation of PR and PACR, which are commonly used in maxillofacial surgeries, together with simple anesthesiological examination tests would increase nasotracheal intubation success and decrease complications.

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Maxillary sinus septa increase the risk of membrane perforation during sinus floor elevation and grafting operations. This study was designed to evaluate the prevalence, morphology, localisation, aetiology, and orientation of maxillary sinus septa in dentate, completely edentulous, and partially edentulous sinus regions using cone beam computed tomography (CBCT), and possible patient-related factors were also assessed. Data from 300 patients (600 sinuses), 160 women and 140 men, with a mean (SD) age of 50.72 (13.99) years (range 20-83), who were undergoing treatment planning for implant-supported restorations in posterior maxillae, were analysed from reformatted CBCT scans. Sinus septa were detected in 132 (44%) patients. A total of 208 septa were found, and 187 (31.17%) single maxillary sinuses presented septa in 600 sinuses. Unilateral septa were found in 77 patients (58.3%) and bilateral septa in 55 patients (41.7%). Out of the 208 septa, 42 (20.19%) were in the anterior third, 124 (59.62%) were in the middle third, and 42 (20.19%) were in the posterior third. Further, 106 (50.96%) septa were in completely edentulous regions, 64 (30.77%) were in partially edentulous regions, and 38 (18.27%) were in dentate regions. The prevalence of septa was significantly higher in the middle third area of the completely edentulous sinus regions. The mean (SD) height of septa was 6.34 (3.05) mm, and the mean orientation was buccopalatal in 204 patients (98.08%). Maxillary sinus septa are common anatomical structures. To avoid possible complications during sinus augmentation, a detailed radiographic identification of anatomical structures in maxillary sinuses is needed.

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Bifid condyle is a rare entity with a difficult diagnosis and usually identified as an incidental finding on routine radiographic examination. The etiology is not well known, possible causes may be developmental, traumatic, vascular, abnormal muscle pulling, nutritional, endocrinal, teratogenic, and infections. The orientation of the condylar heads can behelpful for the etiological diagnosis.This case report describes a 56-year-old woman who suffered from a unilateral, progressively increasing, radiating pain which intensified with the movement of the mandible and includes information about the diagnosis, management, radiographic and three-dimensional model features and review of the literature.

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BACKGROUND AND AIM: Postoperative pain is well known and usually disturbing complication of surgery. Inflammation plays an important role in the development and progression of postoperative pain. We aimed to investigate possible relationship between preoperatively measured neutrophil-lymphocyte ratio (NLR) - as an inflammation marker - and postoperative analgesic demand in patients underwent orthognathic surgery. MATERIALS AND METHODS: We retrospectively investigated medical and anesthesia records of 177 patients underwent orthognathic surgery. Demographical data, preoperative NLR, type of surgery, modified Mallampati score, difficulty degree of intubation, duration of surgery, and postoperative analgesic (tenoxicam - as the first drug of choice, paracetamol, tramadol, or pethidine) usage were recorded. A cutoff value of NLR ≥2 was determined for inflammation threshold. Two groups (Group 1 NLR ≥2, Group 2 NLR <2) were compared for analgesic doses, numbers of patients needed analgesic treatment, and other parameters. RESULTS: Mean administered tenoxicam dose was significantly higher in Group 1 than in Group 2 (P < 0.0001). Further, ratio of patients treated with tenoxicam in Group 1 was significantly higher than that in Group 2 (χ2 = 4.779, P = 0.029). CONCLUSIONS: Preoperatively measured NLR may help to predict postoperative analgesic demand in patients undergoing orthognathic surgery, and thus sufficient postoperative pain control can be achieved with various preventive treatments taken at the perioperative period such as preemptive analgesia, local anesthetic administration at the end of surgery, or early administration of analgesics.

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OBJECTIVE: The aim of this study was to evaluate the mechanical behavior of different rigid fixation methods in mandibular angle fractures. MATERIALS AND METHODS: Three different three-dimensional finite element models of the mandible were developed to simulate the biomechanical responses of titanium plates and screws. The fracture lines were fixed with double 4-hole straight, 4-hole square, and 5-hole Y plates with monocortical screws. 150 N incisal occlusal loads were simulated on the models. The commercial ANSYS software was utilized to calculate the Von Mises stresses on fixative appliances. RESULTS: The highest Von Mises stress values were observed in the Y plate, whereas the lowest stress values have been found in the square plate. CONCLUSIONS: The use of square plate led to better stability and lower mechanical stresses than other techniques.

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OBJECTIVE: The aim of the study was to evaluate the mechanical behavior of three different fixation methods used in the bilateral sagittal split ramus osteotomy. MATERIALS AND METHODS: Three different three-dimensional finite element models were created, each corresponding to three different fixation methods. The mandibles were fixed with double straight 4-hole, square 4-hole, and 5-hole Y plates. 150 N incisal occlusal loads were simulated on the distal segments. ANSYS software ((v 10; ANSYS Inc., Canonsburg, PA) was used to calculate the Von Mises stresses on fixative appliances. RESULTS: The highest Von Mises stress values were found in Y plate. The lowest values were isolated in double straight plate group. CONCLUSIONS: It was concluded that the use of double 4-hole straight plates provided the sufficient stability on the osteotomy site when compared with the other rigid fixation methods used in this study.

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PURPOSE: In the current study we aim to investigate the effects of vitamin C and profol on red blood cell deformability in diabetic rats. MATERIALS AND METHODS: Twenty- eight Wistar Albino rats were included in the study after streptozocin (60 mg/kg) treatment for 4 weeks of observation for diabetes presence. Twenty-eight rats were allocated to 4 groups. In group DP (n = 7) 150 mg.kg-1 of propofol was injected intraperitoneally. In group DP-vit C (n = 7) rats 100 mg/kg of vitamin C (Ascorbic acid, Redoxon® 1000 mg/5 mL - Roche) were applied one hour before administrating 150 mg.kg-1 of propofol, while rats in control group (n = 7), and diabetic control group (n = 7) received intraperitoneally physiological saline. Deformability measurements were achieved by using erythrocyte suspensions with hematocrit level of 5 % in PBS buffer. RESULTS: Erythrocyte deformability was significantly higher in diabetic control group than in control and vitamin C plus propofol groups (p = 0.00, p = 0.025, respectively). Erythrocyte deformability indexes were found similar in control group and vitamin C plus propofol group (p = 0.949). Relative resistance was increased in diabetic rat model. CONCLUSIONS: Erythrocyte deformability was damaged in rats with diabetes. This injury might lead to further problems in microcirculation. Application of propofol did not alter red cell deformability in diabetic rats. Vitamin C supplementation seems to reverse those negative effects and variations in erythrocyte deformability (Fig. 2, Ref. 57).

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BACKGROUND: Lornoxicam and iv paracetamol are commonly preferred to be used for postoperative analgesia. Although Aspirin is a well known non-steroid anti-inflammatory drug that decreases the erythrocyte deformability, there is no study comparing lornoxicam and iv paracetamol regarding their effects on erythrocyte deformability recorded in literature. The aim of this study was to compare the effects of lornoxicam and IV paracetamol on blood perfusion and erythrocyte deformability on rats. METHODS: Twenty male Wistar Albino rats were randomly divided into three groups as Lornoxicam group (Group L), IV paracetamol group (Group P), and control group (Group C). Intraperitoneal administrations were done in all groups except Group C. Liver and renal blood flows were conducted by laser Doppler and euthanasia was performed via intraabdominal blood uptake. Erythrocyte deformability was measured using a constant flow filtrometer system. RESULTS: Lornoxicam increased the relative resistance which shows the erythrocyte deformability in rats (p<0.05). The comparison of Groups C and P revealed no statistically different results (p=0.731) while Group L revealed statistically higher results than Group C (p=0.022). No statistically significant differences were found between groups L and P (p=0.073). Liver and renal blood flow values in Group L were just numerically decreased not statistically whilst no statistically significant difference was found between the three groups. CONCLUSIONS: Lornoxicam have lead to functional disorders related to tissue perfusion as a result of both decreased blood flow and erythrocyte deformability (Fig. 3, Ref. 21). Full Text in PDF www.elis.sk.

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The aim of this study was to investigate and compare changes in the nasomaxillary complex substructures following orthopaedic rapid maxillary expansion (RME) and surgically assisted RME (SARME). 10 patients received RME, 10 patients received SARME, and 10 patients served as an untreated control group. Lateral and posteroanterior cephalograms were obtained for each individual at pre-expansion/pre-control (T1) and post-expansion/post-control (T2). Descriptive parameters and transversal measurements on maxillo-mandibular dentoalveolar structures and skeletal bases, right and left nasal cavity angles (NC/Lom/VL and CN/Lom/VL, respectively), total nasal cavity angle (NC/Lom/CN), nasal cavity width (NC-CN) and nasal septum angle (sn/Lom/VL) were also calculated. Paired t-tests were used to evaluate changes within groups following treatment/control. Analysis of variance (ANOVA) and Duncan's tests were used to compare changes between groups. With the exception of nasal septum deviation, all nasal parameters significantly increased following RME and SARME. The increases in the SARME group were greater than in the other groups, but no statistically significant differences were recorded between the RME and SARME groups. Neither RME nor SARME created positional changes in the nasal septum.

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Having studied the effect of maxillary advancement and maxillary impaction in parts 1 and 2 of this research, the purpose of this study was to investigate the biomechanical behavior of different fixation models in inferiorly and anteriorly repositioned maxilla following Le Fort I osteotomy. Two separate three-dimensional finite element models, simulating the inferiorly advanced maxilla at Le Fort I level, were used to compare 2- and 4-plate fixation. Model INF-2 resulted in 247,897 elements and 53,247 nodes and INF-4 consisted of 273,130 elements and 59,917 nodes. The stresses occurring in and around the bone and plate-screw complex were computed. The highest Von Mises stresses on the plates and maximum principal stresses on the bones were found in INF-2, especially under horizontal and oblique loads, when compared with INF-4. The present biomechanical study shows that the traditionally used 4-plate fixation technique, following Le Fort I inferior and anterior repositioning surgery, without bone grafting, provides fewer stress fields on the maxillary bones and fixation materials.

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The aim of the second part of this study was to evaluate the mechanical behaviour of 2- versus 4-plate fixation and bony structures after Le Fort I impaction surgeries using three-dimensional finite element analysis (3D-FEA). Two 3D-FEA models were created to fixate the impacted maxilla at the Le Fort I level as 2-plate fixation at the piriform rims (IMP-2 model) and 4-plate fixation at the zygomatic buttresses and piriform rims (IMP-4 model). The IMP-2 model contained 225664 elements and 48754 nodes and the IMP-4 model consisted of 245929 elements and 53670 nodes. The stresses in each maxillary model were computed. The models were loaded on one side, at the molar-premolar region, in vertical, horizontal and oblique directions to reflect the chewing process. It was concluded that the use of 4-plate fixation following Le Fort I advancement surgery provides fewer stress fields on the maxillary bones and fixation materials than 2-plate fixation from a mechanical point of view.

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The study aimed to calculate the location and intensity of the maximum stress fields on the fixation plates and surrounding maxilla following Le Fort I osteotomies after advancement procedures using three-dimensional finite element analysis. The models were generated using skull CT scan data. Le Fort I osteotomy simulations were made and two separate impacted maxillary models were designed. The ADV-2 model has 2 plate fixations bilaterally at the piriform rims, the ADV-4 model has 4 plate fixations at the zygomatic buttresses and piriform rims. The stress fields on bone, plate and screws were computed for each model. Posterior occlusal loads were simulated on one side in the molar-premolar region, in all three directions, reflecting the chewing forces. The increased locations of highest Von Mises stresses on the plates and highest maximum principle stresses on the bones were determined in ADV-2 models especially under horizontal and oblique loads when compared with ADV-4 models. Evaluation of the highest Von Mises stress values and maximum principal stress revealed that oblique load in the ADV-2 model received the highest values. 4-plate fixation following Le Fort I advancement surgery exerts less stress on the maxillary bones and fixation materials than 2-plate fixation.

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Haemangiopericytoma is an aggressive vascular tumour with a high propensity for recurrence and metastasis. It typically occurs in the soft tissues of the extremities and trunk, and is rarely seen in the oral cavity. A case of haemangiopericytoma of the hard palate is presented. A 48-year-old woman presented with a gradually enlarging mass on the left side of her hard palate for 3 months. CT scans revealed a mass on the left side of the hard palate which extended to the nasal cavity and left maxillary sinus by causing erosion in the bones. Due to the possibility of local recurrence and occasional metastasis, a wide local excision was performed. There was no recurrence over 1 year's follow up.

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Earrings are very popular jewelry and ear piercing is performed in very young children. Complications that have been reported in the literature are mainly dermatologic, ranging from embedded foreign body to pressure sores in the post-auricular region. During panoramic radiographic evaluation, precise examination of this area can be used to determine the presence of foreign bodies. In this case, a patient referred to our clinic with panoramic film for an impacted third molar who was not aware of an earring clip impacted in her ear lobe is presented.

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Visual evoked potentials (VEP) and auditory evoked potentials (AEP) were studied together with the EEG, in 15 hydrocephalic children who had been shunted previously, and in a control group of 10 normal children. From the control group normal VEP's, AEP's and EEG's were obtained. In all 15 hydrocephalic children the EEG was abnormal. AEP's were normal in 9 and abnormal in 6 cases. VEP's were normal in 7 and abnormal in 8 cases. Only 4 patients showed both abnormal VEP's and AEP's. No relation could be demonstrated between the severity of EEG disturbances and evoked response abnormalities.

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Twenty-one children with brain-stem glioma are discussed. Sixteen received radiotherapy and five were too sick to be irradiated. The mean survival was 3.4 weeks for the non-irradiated group and 8.7 months for the treated group, two of the latter being still alive five and ten months after diagnosis. From the literature and our cases the effect of radiotherapy in brain-stem glioma in childhood is not clear. Differences in patient-selection criteria and the mode and doses of irradiation between the reported series may account for the divergent results, but in our cases radiotherapy did not prolong survival as significantly as compared with the reported series. Elevated intracranial pressure is not rare in patients with a brain-stem glioma, as may be concluded from the present series and from the literature.

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