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Öğe Biocompatibility of vitallium as ossicular reconstruction material in the middle ear: experimental animal study(TAYLOR & FRANCIS AS, 2005) Ulku, CH; Avunduk, MC; Uyar, Y; Arbag, HConclusion. Although long-term data will be necessary for confirmation, the result of this preliminary study indicates that vitallium may be a good alternative material for ossicular replacement prostheses in the middle ear. Objectives. To investigate the biocompatibility of vitallium (Co-Cr-Mo) as ossicular reconstruction material in the rabbit middle ear, and to compare the results with those obtained with titanium, well known as a highly biocompatible material, and non-implanted control groups. Material and methods. Eighteen female New Zealand White rabbits were anesthetized. The tympanomeatal flap was elevated and 12 vitallium and 12 titanium implants were placed in the bulla away from the ossicles in 24 middle ears. Six rabbits were used as non-implanted controls. All animals were sacrificed under general anesthesia on the 180th day after implantation. The temporal bones were removed, fixed in 10% buffered paraformaldehyde and decalcified for a week in EDTA. Tissue samples were then prepared using an Autotechnicon and embedded in paraffin. Sections (30-mum thick) were cut with a microtome, stained with hematoxylin-eosin, von Gieson's stain and fibroblast growth factor (FGF) and examined under a light microscope. The numbers of lymphocytes, collagen fibers and FGF-positive cells were determined in all three groups. Results. There was no significant difference in the numbers of collagen fibers between the groups (P > 0.05). No significant differences were found in the numbers of lymphocytes and FGF-positive cells between the titanium and vitallium groups (p > 0.05). The differences in the numbers of lymphocytes and FGF-positive cells between the control and other groups were found to be significant (p < 0.05).Öğe Glomangioma of the middle ear(TAYLOR & FRANCIS LTD, 2004) Uyar, Y; Ulku, CH; Koral, H; Avunduk, MC; Atici, SSA 62-year-old female was admitted to our clinic in October 1999 with a 6-year history of hearing loss, tinnitus and otorrhea in the right ear. Physical examination showed a polypoid mass arising from the right middle ear and extending into the external auditory canal. Serohemorrhagic otorrhea was also observed. Serious hemorrhage occurred while taking a biopsy. The histopathologic diagnosis was a glomangioma. MRI demonstrated a hypervascular mass (10x15 mm(2)) completely filling the right middle ear. Preoperative embolization of the ascending pharyngeal artery was carried out. The tumor was completely resected via a transmastoid approach. No complications were observed postoperatively. At the most recent follow-up examination, 72 months after the operation, no sign of disease was present. The modified radical mastoidectomy approach used in this case proved to be a safe and efficacious method for removing the glomangioma.Öğe Iatrogenic epidermal inclusion cyst of the parapharyngeal space: Unusual complication of ear surgery(THIEME MEDICAL PUBL INC, 2004) Ulku, CH; Uyar, Y; Kocaogullar, Y; Avunduk, MCA 46-year-old man presented with a 12-month history of a slow-growing mass at the right anterior temporal and superior parotid region. He had a history of chronic otitis media and had undergone a modified radical mastoidectomy for cholesteatoma 5 years earlier. Physical examination revealed a sinus tract and diffuse soft tissue mass measuring 4 cm in diameter spread throughout the region of the right anterior temporal and superior parotid areas. Magnetic resonance imaging (MRI) showed three separate masses, including contrast material in the right superior parotid region and lateral skull base. The patient underwent a preauricular infratemporal approach. Six months later, a sinus tract recurred at the inferior border of the right zygomatic arch. MRI showed multiple masses in the right prestyloid parapharyngeal space, which were resected through a transparotid approach. The histopathologic diagnosis was an epidermal inclusion cyst (EIC). One year after the operation the patient was in good health and there was no sign of disease. EICs are rare tumors that are seen when epidermal elements are included in the dermis, which can follow trauma. EICs are unusual in the parapharyngeal space. Thus, until they become clinically observable, primary benign growths may not be recognized in this region. EICs must be considered in the differential diagnosis of growths in the parapharyngeal space, particularly among patients with a prior history of tympanomastoid surgery on the tumor side.Öğe Increased expression of epidermal growth factor receptors in the tracheal epithelia after topical mitomycin-C in rabbits(ELSEVIER SCI LTD, 2005) Arbag, H; Avunduk, MC; Ozer, B; Ozturk, K; Ulku, CHThe aim is to examine histopathological changes and expression of epidermal growth factor receptor (EGFR) in tracheal epithelia caused by application of topical mitomycin-C (MMC) in rabbit model after the tracheotomy procedure. The conventional tracheotomy was performed in 16 rabbits. They were randomly divided into two equal groups. The first group was applied MMC at a concentration of 0.4 mg/ml around tracheotomy for 5 min, and the other group was not taken a treatment as a control. The animals were sacrificed at the end of 4 weeks. Their tracheas were evaluated with H&E and Masson's trichrome histochemically, and with antiepidermal growth factor receptor immunohistochemically. Results showed that there was no significant difference between MMC and control group for inflammatory cells (P = 0.09). The numbers of fibroblasts and subepithelial tissue thickness in the group exposed to MMC were significantly lower than the control group (P < 0.05). In contrast, the percentage of EGFR in the application of MMC group was significantly higher than the control croup (P < 0.05). The application of topical MMC on airway epithelia after tracheotomy showed significant elevation in the levels of epithelial EGFR expression compared to controls in a rabbit model. The activation of epithelial EGFR may facilitate epithelial healing, but further studies are needed to assess the effect of topical MMC on respiratory epithelia. (c) 2004 Elsevier Ireland Ltd. All rights reserved.Öğe Management of lipomas arising from deep lobe of the parotid gland(ELSEVIER SCI LTD, 2005) Ulku, CH; Uyar, Y; Unaldi, DObjectives: We would like to present our experience in management of lipomas arising in the deep lobe of the parotid gland, which were diagnosed and operated in our clinic from the point of complication/morbidity, and recurrence, in line with the literature. Material and methods: Five patients with lipoma found in the deep lobe of the parotid gland, diagnosed and treated at our clinic in the 12-year period between March 1992 and March 2004, were included in this study. Limits of the tumors were determined by computed tomography (CT), and/or magnetic resonance imaging (MRI). Preoperative fine needle aspiration biopsy (FNAB) was also performed. Through a classic parotidectomy incision, the parotid gland was exposed, Full exposure of he facial nerve and. its branches, was performed. The removal of deep lobe parotid lipomas was achieved by enucleation in all cases. Postoperative complication/morbidity and recurrence were evaluated. Results: The most common symptom was an otherwise asymptomatic mass on the parotid region and/or upper lateral neck. One of five patients was presented with medial displacement of the lateral pharyngeal wall, and tonsil as the additional physical finding. Preoperative radiologic evaluation results revealed that CT and/or MRI scans accurately localized 100% of the tumors in relation to the deep lobe of the,A parotid gland. FNAB did not enable us to make a diagnosis of lipoma in four of the cases. Total resection was achieved in all cases. Temporary facial nerve paralysis, due to the dissection of the facial nerve, did not occur in any cases. There was no recurrence of the tumors after a mean follow-up of 60 months. Conclusion: Assessment of the exact location of the tumor is an important consideration for selection of the appropriate surgical approach. Different from lipomas found in other locations, those observed in the parotid gland cannot be easily resected by simple dissection. Resection of these tumors requires full exposure of the facial nerve. (c) 2004 Elsevier Ireland Ltd. All rights reserved.Öğe A modified technique to bypass the maxillary artery to supraclinoid internal carotid artery by using radial artery graft: an anatomical study(HEADLEY BROTHERS LTD, 2005) Arbag, H; Ustun, ME; Buyukmumcu, M; Cicekcibasi, AE; Ulku, CHObjective: This study aims to examine the use of a radial artery graft for bypass of the maxillary artery (MA) to the supraclinoid internal carotid artery (ICA) in treating ICA occlusions. Study design and setting: This method was carried out on five adult cadaver sides. The MA was reached 1-2 cm inferior to the crista infratemporalis, following a frontotemporal craniotomy and a zygomatic arch osteotomy. Extradurally 2-3 cm lateral to the foramen rotundum, a hole was drilled in the sphenoid bone with a 4 mm tipped drill. A radial artery graft was passed through the hole to the inside of the dura. Before giving the infraorbital artery branch, the MA was dissected from the surrounding tissue and transected. The proximal end of the graft was anastomosed end-to-end with the MA and the distal end of the graft end-to-side with the supraclinoid ICA. Results: The mean calibre of the MA was 2.6 +/- 0.3 mm. The mean calibre of the proximal end of the radial artery graft was 2.5 +/- 0.25 mm and the distal end was 2.35 +/- 0.2 mm. The mean length of the radial artery graft was 4.0 +/- 0.5cm. Conclusion: This study suggested that the cases with ICA occlusion, which require high blood flow, may be treated as an alternative to current bypass methods requiring long vein grafts.Öğe Parapharyngeal lipoma extending to skull base: A case report and review of the literature(THIEME MEDICAL PUBL INC, 2004) Ulku, CH; Uyar, YLipomas in the head and neck region usually occur in the immediate subcutaneous tissue. They are extremely rare in the parapharyngeal space. A rare case of aright parapharyngeal space lipoma extending to skull base in an 18-year-old male is reported. The literature is reviewed and the characteristics of disease are discussed.Öğe Radial artery graft for bypass of the maxillary to proximal posterior cerebral artery: An anatomical and technical study(TAYLOR & FRANCIS AS, 2004) Ulku, CH; Ustun, ME; Buyukmumcu, M; Cicekcibasi, AE; Ziylan, TObjective-To examine the use of a radial artery graft for bypass of the maxillary artery (MA) to proximal posterior cerebral artery (PCA) as an alternative to the external carotid artery (ECA) to PCA anastomosis used in posterior circulation bypass surgery. Materials and Methods-The method was applied to five adult cadaver sides bilaterally. The MA was easily found 1-2 cm beneath the infratemporal crest after a frontotemporal craniotomy and a zygomatic arch osteotomy. Extradurally, 2-3 cm posterolateral to the foramen rotundum, a hole was drilled in the sphenoid bone with a 4-mm tipped drill. After sylvian fissure, the interpedincular and ambient cisternae were opened and the P2 segment of the PCA appeared. The graft was passed through the hole and dura to reach the P2 segment. Proximal to the infraorbital artery branch, the MA was freed from the surrounding tissue and transected. The proximal side of the radial artery graft was anastomosed end-to-end with the MA and the distal side was anastomosed end-to-side with the P2 segment of the PCA. Results-The average diameter of the MA proximal to the infraorbital artery branch was 2.6+/-0.3 mm. The average diameter of the P2 was 2.2+/-0.2 mm. The average length of the graft was 47+/-5.2 mm. Conclusion-As MA to proximal PCA bypass uses a short radial graft and as the calibers of the MA and PCA are >2 mm such a bypass may provide sufficient blood flow and represents a reasonable alternative to "ECA to PCA'' bypass.Öğe Saphenous vein graft for bypass of the external carotid artery to supraclinoid internal carotid artery using a modified technique: An anatomical and technical study(TAYLOR & FRANCIS AS, 2004) Ulku, CH; Ustun, ME; Buyukmumcu, M; Cicekcibasi, AE; Uyar, YObjective - To investigate the use of a saphenous vein graft for bypass of the external carotid artery (ECA) to supraclinoid internal carotid artery (ICA) when the proximal middle cerebral artery (MCA) is not suitable for a bypass procedure. Material and Methods - Five adult cadaver sides were used. Dissection required a frontotemporal craniotomy and a zygomatic arch osteotomy, with a hole being opened 2 - 3 mm lateral to the foramen rotundum extradurally. The ECA was found easily via a second incision in the cervical region. The ophthalmic segment of the ICA was exposed by removal of the anterior clinoid process intradurally. After the dura over the hole was opened, the 7 - 8-cm long bypass graft was passed just behind the mandibula and through the hole inside the dura to reach the ICA. The ECA was then transected proximal to the occipital artery (OA) branch and the distal side of the vein graft was anastomosed end-to-end with the ECA and end-to-side with the supraclinoid ICA. Results - The mean diameter of the ECA proximal to the OA was 3.75 +/- 0.4 mm ( range 3.35 - 4.15 mm) and that of the supraclinoid ICA was 3.4 +/- 0.5 mm ( range 2.9 - 3.9 mm). The mean length of the venous graft was 7.5 +/- 0.5 cm ( range 7 - 8 cm). Conclusion - When high blood flow is needed and the proximal MCA is not suitable for a bypass, the bypass described herein may be an alternative to a superficial temporal to MCA bypass as well as to extracranial carotid artery to MCA or ICA bypasses, which both need long vein grafts.
