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Çiçek F, Kurtoğlu Olgunus Z, Koç T. The effect of hallux valgus on the anatomy of the nerves around the first metatarsal bone. Surg Radiol Anat 2024; 46:433-441. [PMID: 38492026 DOI: 10.1007/s00276-024-03318-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 01/31/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVE To identify the variations in the location of the nerves that may be at risk in hallux valgus (HV) surgery, and to reveal whether these nerves are affected by the anatomical changes associated with HV. METHOD In the formalin fixed, 46 lower extremities (19 female, 27 male) (9 normal, 14 mild HV, 21 moderate/severe HV), extensor hallucis longus tendon (EHL), deep plantar artery, medial dorsal cutaneous (MDCN), deep fibular (DFN), common plantar digital (CPDN) and proper plantar digital (PPDN) nerves were examined. The branches of MDCN extending to the medial side of foot were recorded in three segments. The positional topography of nerves according to EHL were analyzed on 360° circle and clock models. RESULTS Sex-related differences observed in some parameters in direct measurements were not found in the clock model comparisons. In advanced HV angles (> 20°), DFN was closer to EHL in the distal part of the metatarsal bone, while there was no difference in the proximal. The intersection of the medial branch of the MDCN with the EHL was more proximal in HV cases than in normal feet. The location of the nerves in the clock pattern did not change in HV. Of the nerve branches reaching the medial side of the foot, 65.2% were in Part I, 71.7% in Part II, and 4.3% in Part III. CONCLUSION Sex differences in the distance of the nerves to the EHL disappeared when the size effect of the cross-section of the first metatarsal bone region was eliminated with the clock model. Only in advanced HVA (>20°) (not in mild HV), the DFN being closer to the EHL distally and the intersection of the medial branch of the MDCN with the EHL in HV being more proximal than in normal can be interpreted as specific reflections of HV progress. The variations we revealed in the number of branches reaching the inside of the foot may explain the diversity of neuromas or nerve injuries associated with HV surgery.
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Affiliation(s)
- Fatih Çiçek
- Department of Anatomy, Faculty of Medicine, Niğde Ömer Halisdemir University, Niğde, Turkey
| | | | - Turan Koç
- Department of Anatomy, Faculty of Medicine, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey
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Mert A, Çınaroğlu S, Aydın M, Çiçek F, Ceranoğlu FG. Comparison of stiffness, elasticity and resilience values of ACL with autografts used instead of ACL in terms of texture analysis. Heliyon 2024; 10:e25588. [PMID: 38356561 PMCID: PMC10864985 DOI: 10.1016/j.heliyon.2024.e25588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/30/2024] [Accepted: 01/30/2024] [Indexed: 02/16/2024] Open
Abstract
Background Anterior cruciate ligament (ACL) ruptures are one of the most extensively studied injuries in the field of orthopedics, but despite the extensive research, graft selection for ACL reconstruction remains a matter of debate. The present study aims to evaluate the stiffness and elasticity of native ACLs using texture profile analysis and compare results with those of autografts used in ACL reconstruction. Methods Included in the study were dissected 12 cadavers from which grafts were recovered. The graft characteristics, such as stiffness, elasticity and resilience, were measured using a TA.XT Plus Texture Analyzer. Findings Among the grafts studied, Achilles' tendon graft (0.70; 0.64) had the highest resilience in both males and females, while the greatest elasticity was identified in the patellar tendon graft (Male: 93 %; Female: 94 %) in all subjects. The highest stiffness value in males was recorded for the quadriceps tendon graft (2928.76 N), while the highest stiffness value in females was recorded for Achilles' tendon graft (2204.61 N). Interpretation According to the study data, the autografts that may be considered as an alternative to ACL were, listed in order of strength from high to low, the quadriceps, Achilles', patella and hamstring tendons in men, and the Achilles', quadriceps, patellar and hamstring tendons in women. It is worthy of note that the hamstring tendon graft, which is the most frequently preferred autograft in ACL reconstruction, was found to be the lowest in all parameters in both groups.
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Affiliation(s)
- Ahmet Mert
- Department of Orthopedics and Traumatology, Faculty of Medicine, Niğde Ömer Halisdemir University, TR-51240, Niğde, Turkey
| | - Selim Çınaroğlu
- Department of Anatomy, Faculty of Medicine, Niğde Ömer Halisdemir University, TR-51240, Niğde, Turkey
| | - Murat Aydın
- Department of Orthopedics and Traumatology, Faculty of Medicine, Niğde Ömer Halisdemir University, TR-51240, Niğde, Turkey
| | - Fatih Çiçek
- Department of Anatomy, Faculty of Medicine, Niğde Ömer Halisdemir University, TR-51240, Niğde, Turkey
| | - Faruk Gazi Ceranoğlu
- Department of Anatomy, Faculty of Medicine, Niğde Ömer Halisdemir University, TR-51240, Niğde, Turkey
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Çiçek F, Çınaroğlu S, Ceranoğlu FG, Küçük E, Zor KR. Evaluation of nerve innervation distribution of orbicularis oculi muscle for botulinum neurotoxin application using Sihler's method. Ann Anat 2024; 251:152165. [PMID: 37804929 DOI: 10.1016/j.aanat.2023.152165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/21/2023] [Accepted: 10/02/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND Blepharospasm is the involuntary and forced closure of the eyelids due to spasm-like contraction of the orbicularis oculi muscle around the eye. The study aimed to reveal the nerve innervation of the orbicularis oculi muscle for Botulinum neurotoxin (BoNT) treatment of blepharospasm by Sihler's staining technique. METHODS This study used six cephalus (12 orbicularis oculi muscles) with an average age of 69,6 (62-88) years. Then, the orbicularis oculi muscles were removed by dissection, and Sihler's staining technique was applied to the muscles. The limit for dissection of the muscle is the orbital opening level, where the nerves enter the muscle, and the muscle attaches to the bone. RESULTS In the region above the palpebral fissure, the nerves entering the muscle were densely located in the superolateral quadrant between 9 and 12 o'clock in the right eye and between 12 and 3 o'clock in the left eye. In the region under the palpebral fissure, the nerves' density in the orbicularis oculi muscle was higher between 4 and 7 o'clock in the right eye and between 5 and 8 o'clock in the left eye. CONCLUSION This study unveiled the nerve branches associated with the orbicularis oculi muscle. It pinpointed precise crossing points of these nerve branches, which can be targeted for applying BoNT in treating blepharospasm. Consequently, by utilizing minimal BoNT, it is anticipated that the quantity of toxin administered will decrease, leading to more efficient outcomes and reduced expenses. Furthermore, this approach can aid in averting potential undesired complications during BoNT administration.
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Affiliation(s)
- Fatih Çiçek
- Department of Anatomy, Faculty of Medicine, Niğde Ömer Halisdemir University, TR-51240 Niğde, Turkiye.
| | - Selim Çınaroğlu
- Department of Anatomy, Faculty of Medicine, Niğde Ömer Halisdemir University, TR-51240 Niğde, Turkiye
| | - Faruk Gazi Ceranoğlu
- Department of Anatomy, Faculty of Medicine, Niğde Ömer Halisdemir University, TR-51240 Niğde, Turkiye
| | - Erkut Küçük
- Department of Ophthalmology, Faculty of Medicine, Niğde Ömer Halisdemir University, TR-51240 Niğde, Turkiye
| | - Kürşad Ramazan Zor
- Department of Ophthalmology, Faculty of Medicine, Niğde Ömer Halisdemir University, TR-51240 Niğde, Turkiye
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Çiçek F, Koç T, Olgunus ZK. Connection between medial dorsal cutaneous nerve and saphenous nerve: case report. Surg Radiol Anat 2023; 45:1233-1237. [PMID: 37528298 DOI: 10.1007/s00276-023-03214-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/19/2023] [Indexed: 08/03/2023]
Abstract
PURPOSE There are no data on the connection of the saphenous nerve (SN), located on the medial side of the foot, with the terminal branches of the superficial fibular nerve. The aim of this study is to reveal the variation that surgeons should pay attention to for anesthesia applied in foot surgeries. METHODS In this study, the left foot of a 70-year-old female cadaver fixed with formalin was dissected. The distance to the medial malleolus and the incision line was recorded using digital caliper to determine the reference points in the resulting variation. RESULTS It was observed that a branch from the SN, which arose from the SN and proceeded anteriorly to the upper part of the medial malleolus and continued towards the dorsum of the foot, hooked with a branch from the medial dorsal cutaneous nerve (MDCN). The branches arising from this hook were distributed on the medial edge of the foot up to the proximal metatarsophalangeal joint I. The distance of this nerve connection to the medial malleolus is 91.14 mm, and the distance to the incision line is 15.76 mm. CONCLUSIONS It is suggested that the case presented as an unusual SN variation, which may affect the success of local anesthesia in invasive procedures to the medial part of the foot and could be considered in the evaluation of sensory loss after anteromedial surgical approach to the ankle, should be included in the classification of the cutaneous innervation pattern of the foot.
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Affiliation(s)
- Fatih Çiçek
- Department of Anatomy, School of Medicine, Niğde Ömer Halisdemir University, Niğde, Türkiye.
| | - Turan Koç
- Department of Anatomy, School of Medicine, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Türkiye
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Çiçek F, Köle MT. Evaluation of the Impact of Serum Vitamin D Levels on the Scoring Atopic Dermatitis Index in Pediatric Atopic Dermatitis. Children (Basel) 2023; 10:1522. [PMID: 37761483 PMCID: PMC10529228 DOI: 10.3390/children10091522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023]
Abstract
Atopic dermatitis (AD) is a chronic and recurrent inflammatory skin condition characterized by itching, eczematous plaques, and dry skin. Despite ongoing research, its exact cause remains elusive. In this study, we aimed to explore the factors that influence the severity of AD in children and assess the relationship between serum vitamin D levels and the disease's severity. We enrolled 96 AD patients in our investigation, evaluated their clinical condition using the Scoring Atopic Dermatitis (SCORAD) index, and compared them to a group of 90 healthy controls. Our analysis revealed that serum vitamin D levels and eosinophil counts significantly impacted the SCORAD index (p < 0.001). According to standardized regression coefficients, for each incremental unit in serum vitamin D levels, the SCORAD index exhibited a decrease of 0.449 units. Similarly, a one-unit increase in eosinophil count resulted in a 0.009 unit increase in the SCORAD index. It is worth noting that the influence of serum vitamin D levels on disease severity surpasses that of eosinophil counts and atopic conditions. In our patient cohort, we uncovered a negative correlation (r = -0.419, p < 0.001) between serum vitamin D levels and the SCORAD index. Our findings suggest that low serum vitamin D levels may have a more substantial impact on AD severity than atopic conditions and eosinophilia. Furthermore, we observed a negative association between the severity of AD and serum 25(OH)D3 levels.
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Affiliation(s)
- Fatih Çiçek
- Department of Pediatric Allergy and Immunology, Kartal Dr. Lütfi Kırdar City Hospital, University of Health Sciences, Istanbul 34870, Turkey
| | - Mehmet Tolga Köle
- Department of Pediatrics, Kartal Dr. Lütfi Kırdar City Hospital, University of Health Sciences, Istanbul 34870, Turkey;
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Mert A, Cinaroglu S, Keleş H, Aydin M, Çiçek F. Evaluation of Autografts Used in Anterior Cruciate Ligament Reconstruction in Terms of Tensile Strength. Cureus 2023; 15:e39927. [PMID: 37409216 PMCID: PMC10318378 DOI: 10.7759/cureus.39927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2023] [Indexed: 07/07/2023] Open
Abstract
Introduction Anterior cruciate ligament (ACL) injuries increase the likelihood of chronic knee problems in later years, including early onset osteoarthritis. Therefore, ACL treatment is important in preventing knee problems from developing. The treatment of choice for ACL tears is surgery (ACL reconstruction), and the most popular tendons for ACL reconstruction are the patellar tendon, hamstring tendon (semitendinosus and gracilis tendons), and bone-patellar tendon-bone. The present study compares the tensile strength of autografts used in ACL reconstruction to identify the optimum autograft for ACL in terms of mechanical properties. Methods Cadavers were dissected, and the Achilles tendons, quadriceps tendons, hamstring tendons (semitendinosus and gracilis tendons), patellar tendon grafts, and ACLs were harvested. Tensile tests of each tendon graft were performed using a Shimadzu Autograph AG-IS 100 kN tester (Shimadzu, Kyoto, Japan). Results The mean difference in tensile strength between ACL and other grafts was lowest for the quadriceps in both males and females (p ˂ 0.001), meaning that ACL and quadriceps grafts are more compatible than other tendon grafts in terms of tensile strength. Conclusion The present study found the lowest mean difference in tensile strength to be between the ACL and the quadriceps tendon, suggesting that the use of the quadriceps tendon in ACL reconstruction will yield more positive outcomes.
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Affiliation(s)
- Ahmet Mert
- Department of Orthopedics and Traumatology, Niğde Ömer Halisdemir University Faculty of Medicine, Niğde, TUR
| | - Selim Cinaroglu
- Department of Anatomy, Niğde Ömer Halisdemir University Faculty of Medicine, Niğde, TUR
| | - Hacı Keleş
- Department of Anatomy, Niğde Ömer Halisdemir University Faculty of Medicine, Niğde, TUR
| | - Murat Aydin
- Department of Orthopedics and Traumatology, Niğde Ömer Halisdemir University Faculty of Medicine, Niğde, TUR
| | - Fatih Çiçek
- Department of Anatomy, Niğde Ömer Halisdemir University Faculty of Medicine, Niğde, TUR
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