Fibrous dysplasia is a nonneoplastic developmental disease of osseous tissue. It is a lesion of unknown etiology, uncertain pathogenesis, and diverse histopathology. In this series of 16 patients with fibrous dysplasia of the craniomaxillofacial bones, the disease was generally monostotic and most commonly maxillary in location. Two patients demonstrated typical symptoms of the McCune Albright syndrome. Marked deformity or functional disturbances were the major indications for treatment. Total excision of the involved bone was the most successful form of treatment but produced the greatest functional and cosmetic deficits and long-term postoperative complications. A conservative therapeutic approach with a modest reduction in the bulk of these lesions may be sufficient to relieve signs and symptoms effectively. Periodic follow-up is indicated to detect recurrences or malignant changes in the early stages.

Epidermoid carcinoma in nonhealing scar tissue, known as Marjolin's ulcer, is not uncommon and is thought to behave in a more aggressive fashion than those from other causes. Between 1982 and 1997, 56 patients with Marjolin's ulcer were treated at our center, Ege University Medical School, Izmir, Turkey. All lesions were secondary to various kinds of burns. Forty of these patients could be followed up 5 years or more. These 40 patients' medical records were reviewed retrospectively.

All suspected congenital abnormalities of the nose require further evaluation. The nasal dermoid sinus cyst (NDSC) is one of the many midline nasal masses that often pose diagnostic and treatment dilemmas for the plastic and reconstructive surgeon. NDSCs are distinct from other facial dermoids in their potential for involving deeper contiguous structures, and intracranial extension. Accurate diagnosis and effective treatment are essential to avoid craniofacial skeletal deformation, cyst rupture, and infection that could cause cutaneous, ocular, or intracranial complications. A comprehensive discussion of the embryogenesis, pathogenesis, diagnosis, and surgical management of the NDSC is presented to delineate the role of open rhinoplasty in optimizing the management of this congenital nasal deformity.

Currently, the free fibular flap is well accepted as the first choice for mandibular reconstruction. Achieving functional results in pediatric patients requires a different approach than that employed for mature patients. Because the pediatric craniofacial skeleton continues to grow, reconstruction is more challenging, and the long-term results can be different from those of adult patients. In this study, we sought to measure flap growth objectively in our series. Ten pediatric patients who underwent reconstruction with free fibular flaps were retrospectively reviewed. Flap growth was evaluated by comparing the intraoperative photographs with photographs of the control panoramic mandibular radiographs taken using photo-anthropometric techniques. The measurements were converted to proportionality indices (PI), and these indices were compared. Subsequent complications and functional results were also evaluated. The mean patient age was 11.8 years, and the mean follow up was 57.7 months. The mean preoperative PI value was 10.74  ±  2.47. The mean postoperative PI value was 12.52  ±  2.34. The mean difference between the preoperative and postoperative PI values was -1.78 ± 0.53. These photo-anthropometric data clearly illustrated the growth of the fibular flaps (P = 0.001). None of these patients exhibited nonunion of the fractures; however, one patient experienced a delayed union, one had chronic temporomandibular joint pain, and one had chronic temporomandibular joint luxation. In two patients, the inter-incisive measurements were below the third percentile, and two additional patients had grade 2 eating abilities, which can be regarded as poor. All of the patients had symmetric mandibular contours. Free fibular flaps continue to grow in pediatric patients. This flap is a "workhorse" flap in children because it adapts to the craniofacial skeleton via its ability to grow, and this ability results in subsequent good cosmetic and functional results.

Gardner syndrome, a variant of familial adenomatous polyposis, is an autosomal dominant disease characterized by gastrointestinal polyps that develop in the colon as well as in the stomach and upper intestine (duodenum), multiple osteomas, and skin and soft tissue tumors. Cutaneous findings include epidermoid cysts, desmoid tumors, and other benign tumors. Polyps have a 100% risk of undergoing malignant transformation; consequently, early identification and therapy of the disease are critical. Osteoma is a benign neoplasm of bone tissue that is characterized by slow continuous growth and is the most common accompanying bone lesion seen in Gardner syndrome. The authors report a case of Gardner syndrome that was operated on because of the mandibular osteoma.

The formation of neoplastic changes in the scar tissue of chronically ulcerating wounds is a well-known process. This condition is most commonly seen after the postburn scars, but it may be seen after many kinds of scars. The term "Marjolin's ulcer" is used to describe this type of carcinoma. Although many different cell types can be seen in these lesions, the most commonly seen is squamous cell carcinoma. Squamous cell carcinomas resulting from the Marjolin's ulcer have a much greater tendency to metastasize than squamous cell carcinomas resulting from the other causes. Confusion continues about the precise pathophysiology of this lesion and the clinical behavior of this neoplasm, and the mortality and morbidity rates are also conflicting. As would be expected, there is a wide variety of suggested treatment protocols for this disease. This article, through case reports and review of the literature, offers criteria for the treatment of the Marjolin's ulcers that arise on the scalp, which is an uncommon site.

Despite the success with transverse rectus abdominis musculocutaneous (TRAM) flap breast reconstruction, ischemia-related complications, including fat necrosis and partial flap loss, continue to occur in 5 to 28 percent of reported series. The associated vascular problems of the TRAM flap stimulated several authors to study the effect of surgical delay, aiming to improve the viability of the flap. The present study investigated the potential effect of human vascular endothelial growth factor (hVEGF) in the induction of angiogenesis in the TRAM flap model and compared its effect with the surgical delay model. The rat model was used to demonstrate the effect of VEGF angiogenesis. Thirty male Sprague-Dawley rats were individually assigned to one of six groups (n = 5 in each group). One control group and five delay groups were established. A variety of flap delay techniques were used to increase the viable surface area of the flap. The flap mean viable surface area for the control group was 50 percent. The surgical delay group (group 2) had a mean viability of 83 percent. The group with the highest percentage of viable flap surface area was group 3, in which both surgical delay and intramuscular injection of VEGF were used (96.6 percent mean flap viability). The mean viable flap surface area in groups 4 (surgical delay and intraarterial VEGF), 5 (intramuscular VEGF), and 6 (intraarterial VEGF) were 90.6 percent, 87 percent, 90.6 percent, respectively. Statistically significant differences were obtained in all groups in comparison to the control group (p < 0.05). No significant differences were seen among the five treatment groups, however. The findings reported in the present study indicate that the use of VEGF to improve the viability of the TRAM flap proved to be beneficial and statistically significant in comparison to the control group.

Penoscrotal avulsion injuries are rare surgical emergencies. The best treatment for penile avulsions is split skin graft, although late results of split-grafted scrotal avulsions are not superior. Scrotal skin avulsions require additional judgment for the treatment, because there are several available treatment options. Scrotal skin remnants must be used to cover whenever possible.