Browsing by Author "Ozucer, Berke"

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    Contralateral Depressor Labii Inferioris Chemodenervation for Congenital Unilateral Lower Lip Palsy
    (2020) Cam, Osman Halit; Ozucer, Berke; 32487835
    Introduction: Congenital unilateral lower lip palsy - also known as asymmetric crying facies - is isolated asymmetry of the lower lip unilaterally. It is characterized by isolated lower lip asymmetry during smiling and speech. Although etiology is unknown, depressor labii inferioris (DLI) weakness is hold responsible. Aim: Purpose of this study was to evaluate the effectiveness of contralateral depressor labii inferioris botulinum toxin injection on patients' concern levels and patient satisfaction. Ten units of botulinum toxin A injection was carried out to the healthy contralateral side. Methodology: Eleven patients were treated. Patients' pretreatment and posttreatment concern regarding asymmetry during speech and smiling was evaluated with a questionnaire. Patients' perception of treatment satisfaction was also evaluated with a questionnaire. Results: Mean score related to concern about asymmetric appearance during smiling decreased from 1.6 +/- 0.8 to 0.5 +/- 0.5. Mean score related to concern about asymmetric appearance during speech decreased from 1.6 +/- 0.5 to 0.4 +/- 0.5. Eleven out of 11 patients reported improvement with speech whereas 10 out of 11 patients reported improvement with smiling. No weakness about oral competence was reported. Conclusion: Most congenital unilateral lower lip palsy patients are concerned regarding their asymmetric appearance while smiling or speaking. Chemodenervation of the contralateral DLI muscle reduces concern levels and has high patient satisfaction. Chemodenervation of the contralateral healthy DLI muscle is a valid, practical treatment option.
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    Effect of Distal Masseter to Facial Nerve Transfer in Paralytic Patients with Preserved Facial Nerve Continuity on Improving Scaled Measurement of Improvement in Lip Excursion (SMILE): A Vectoral Analysis
    (2020) Ozucer, Berke; Cam, Osman Halit; 33554200
    Objective: Distal masseter-to-facial neurorrhaphy is an option to improve smile excursion in facial paralysis patients in the early period without truncating the facial nerve truncus and by ensuring the continuity of the facial nerve. This study aimed to study the effect of distal masseter-to-facial neurorrhaphy on smile excursion. Methods: Charts of eight patients were retrospectively examined. Screenshots showing the best possible smiles were taken from preoperative videos. Screenshots were taken from postoperative videos showing the best combination of a natural smile on the healthy side and a smile with clenched teeth on the paralytic side. Emotrics and Photoshop software were used for computing vertical, horizontal, and overall excursion from facial landmarks. Scaled measurements of improvement in lip excursion and lip angle was evaluated. Symmetry was evaluated by accepting the healthy side as 100 percent, and the paralytic side was calculated as a percentage of the healthy side. Results: Five patients had total facial paralysis and three had facial paresis. Mean postoperative follow-up period was 15.0 +/- 10.2 months. The average interval between facial denervation and nerve repair was 14.0 +/- 4.1 months (range, 11-23). All neurorrhaphies were coapted end-to-end to either the zygomatic or the buccal branch without an interposition graft. Mean postoperative initial movement occurred at 95.5 +/- 20.5 days (range, 72-138). Paralytic side to healthy side horizontal excursion changed from preoperative 72.5 +/- 17.4% to postoperative 93.4 +/- 6.9%. Vertical excursion changed from preoperative 38.4 +/- 24.6% to postoperative 89.3 +/- 11.8%. Overall excursion changed from preoperative 68.4 +/- 19.6% to postoperative 92.9 +/- 10.4%. Paralytic side to healthy side mean lip angle changed from 64.7% preoperative to 95.2% postoperatively. All changes were statistically significant (p<0.05). Conclusion: Facial paralysis patients with an asymmetric smile benefit from distal masseter-to-facial nerve transfer and it improves smile excursion dramatically. This effect was especially prominent in the vertical component of the smiling vector.
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    The Effectiveness of Asymmetric Dorsal Preservation for Correction of I-Shaped Crooked Nose Deformity in Comparison to Conventional Technique
    (2020) Ozucer, Berke; Cam, Osman Halit; 0000-0002-2785-4474; 32392429; AAP-1533-2020
    Importance: Using asymmetric dorsal preservation (ADP) (pushdown technique for deviated side and letdown technique to the contralateral nondeviated side) is an alternative surgical method to correct osseocartilaginous deviation in crooked nose deformity. Objective: Aim of this study was to evaluate whether ADP rhinoplasty is a good method to address I-shaped crookedness in comparison with conventional midvault deconstructing/reconstructing rhinoplasty. Design, Setting, and Participants: This study was conducted between June 2017 and August 2019. Twenty-two consecutive patients' I-shaped crookedness was addressed with either ADP (n = 10) or conventional midvault techniques (n = 12). Patients were followed up at least for 6 months. Main Outcomes and Measures: Pre- and postoperative frontal photographs and digital screen protractor was utilized for measurement of crookedness in a single-blinded manner. Surgical success were calculated and compared. Results: In ADP group, mean angle of deviation was 10.2 +/- 3.7 degrees and 0.5 +/- 1.0 degrees pre- and postoperatively, respectively. In control group, mean angle of deviation was 9.5 +/- 1.8 degrees and 0.3 +/- 0.9 degrees pre- and postoperatively, respectively. Change in angle was statistically significant for both groups. Postoperative calculated mean success rate was 96.3 +/- 7.9% and 97.5 +/- 8.5% for dorsal preservation and control group, respectively. Eight out of 10 patients in dorsal preservation group and 11 out of 12 patients in the control group achieved the ideal angle of 0 degrees, hence had 100% postoperative surgical success. Conclusions and Relevance: Utilization of dorsal preservation principles for correction of I-shaped crookedness presents as a promising and practical surgical alternative approach that should be in every rhinoplasty surgeon's armamentarium.
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    Surgical Approach to the Thick Nasolabial Folds, Jowls and Heavy Neck-How to Approach and Suspend the Facial Ligaments
    (2018) Cakmak, Ozcan; Emre, Ismet Emrah; Ozucer, Berke; 29409105
    Patients with thick skin typically present with a redundant, baggy, lax skin envelope together with prominent nasolabial folds, jowls, and a heavy neck. Durable and natural-appearing rejuvenation is not possible unless the deformities are addressed adequately and harmoniously in these patients. Traditional superficial musculoaponeurotic system techniques do not include surgical release of the zygomatic cutaneous ligaments and repositioning of descendent malar fat pad, and may lead to an unbalanced, unnatural appearance and the lateral sweep phenomenon. Additional attempts to improve unopposed nasolabial folds such as fat grafting to malar region are more likely to result with a "stuffed" look, far from a natural and rejuvenated appearance, and must therefore be avoided. The facelift techniques including true release of the anchoring ligaments of the midface and allowing adequate repositioning of saggy tissues are ideal for these patients to obtain harmonious, natural result. Despite the extensive dissections, maximal release, and maximal lateral pull, additional maneuvers, e.g., platysmaplasty, subplatysmal fat removal, or partial resection of submandibular glands may be required for satisfying result in patients with heavy neck. In this article, the authors outline the relevant anatomy of the facial retaining ligaments and their implications to surgical management of patients with heavy skin are discussed.