Yazar "Yilmaz, Beyhan" seçeneğine göre listele
Listeleniyor 1 - 17 / 17
Sayfa Başına Sonuç
Sıralama seçenekleri
Öğe An Analysis on Aerodynamic and Acoustic Changes After Thyroidectomy(Int College Of Surgeons, 2016) Yilmaz, Beyhan; Bakir, Salih; Yilmaz, Edip Erdal; Senhul, Engin; Uslukaya, Omer; Gul, Aylin; Ozkurt, Fazil EmreThe purpose of this study was to investigate the aerodynamic and acoustic changes after thyroidectomy without laryngeal nerve injury by using objective methods. Voice samples of sustained /alpha/ recorded from 44 adults preoperatively and nearly 1 week and 3 months after thyroidectomy were analyzed for mean vocal fundamental frequency (Mean Fo, Hz), maximum fundamental frequency (Max Fo, Hz), minimum fundamental frequency (Min Fo, Hz), jitter, shimmer, glottal to noise excitation ratio (GNE), irregularity, noise, overall severity, S time, Z time, S/Z ratio, and maximum phonation time (MPT). Voice samples were analyzed using the lingWAVES software. The comparisons of preoperative and early and late postoperative acoustic parameters revealed significant differences in Mean F0, Max F0, MPT, and S Time between the early and late postoperative periods. The voice changes after thyroidectomy were not affected by age, sex, or surgical procedure, but they differed between the benign and malignant nature of the tumor. Patients with malignant tumors showed a greater decrease in Mean F0 and Max F0 compared with the patients with benign tumors, and this difference was statistically significant. Voice changes may occur after thyroidectomy even in the patients with no evidence of laryngeal nerve damage, and these changes can be assessed with objective measurement methods. This information should be explained to the patients during the preoperative counseling, and proper informed consent is ethically and legally required for all planned thyroidectomies.Öğe Cultural adaptation of an olfactory test: the odour in bottle test (vol 52, pg 172, 2014)(Int Rhinologic Soc, 2014) Gul, Aylin; Akdag, Mehmet; Ozkurt, Fazil Emre; Yilmaz, Beyhan; Sengul, Engin; Bakir, Salih; Topcu, Ismail[Abstract Not Available]Öğe Does Short Term Usage of Fresh Pomegranate Juice (FPJ) Protect Cochlear Hair Cells after Cisplatin-Based Chemo-Irradiation?(Aves, 2014) Akdag, Mehmet; Dasdag, Suleyman; Alabalik, Ulas; Yilmaz, Beyhan; Altas, Sevcan; Zincircioglu, Seyit Burhanedtin; Gul, AylinOBJECTIVE: The aim of this study was to investigate the protective effect of short-term usage of fresh pomegranate juice (FPJ) on ototoxicity after cisplatin-based chemo-irradiation. MATERIALS and METHODS: The study was carried out on 56 adult Wistar Albino rats, which were divided into 8 groups (n: 7 for each group). The first group was accepted as the sham control group. However, rats in the seven experimental groups were treated with FPJ; cisplatin; irradiation; irradiation plus FPJ; cisplatin plus FPJ; both cisplatin and irradiation; and combined use of cisplatin, irradiation, and FPJ, respectively. Ototoxicity was evaluated by Distortion Product Otoacoustic Emissions (DPOA), histopathology, and paracochlear protein carbonyl content. RESULTS: The results of the study showed that cisplatin, irradiation, and both cisplatin and irradiation treatments affected hair cells dramatically. However, the results of cisplatin plus FPJ and combined use of cisplatin, irradiation, and FPJ indicated that FPJ plays an important role in protecting hair cells in the inner ear. Additionally, the findings of signal-noise ratio and protein carbonyl values also supported the results stated above. CONCLUSION: Fresh pomegranate juice treatment can be a supportive agent to reduce hair cell injury in the inner ear of patient treated by cisplatin, radiotherapy, or cisplatin-based chemo-irradiation. However, more performance is necessary for further studies, especially on long-term treatment with FPJ.Öğe Effect of caffeic acid phenethyl ester on myringosclerosis development in the tympanic membrane of rat(Springer, 2015) Kinis, Vefa; Ozbay, Musa; Alabalik, Ulas; Gul, Aylin; Yilmaz, Beyhan; Ozkurt, Fazi Emre; Sengul, EnginMyringosclerosis is hyalinization and calcification of certain areas of the tympanic membrane, especially the fibrous lamina propria layer and appears as white sclerotic lesions. Ventilation tube insertion is one of the most performed operations in the pediatric otorhinolaryngology practice to treat chronic otitis media with effusion. Myringosclerosis is a very common sequela of ventilation tube insertion. In this experimental study, our aim was to show the histopathological effects of caffeic acid phenethyl ester on myringosclerosis development in rat tympanic membrane after myringotomy. The rats were randomly categorized into four experimental groups including the comparison group (n = 4), non-treated group (n = 7), the saline (control) group (n = 7), the caffeic acid phenethyl ester group (n = 7). Non-treated group did not receive any treatment for 15 days. Saline (2.5 mL/kg, intraperitoneal) was administered to the third group once a day for 15 days. Fourth group received caffeic acid phenethyl ester intraperitoneally once a day at a dose of 10 mu mol/kg for 15 days. Myringotomy was performed on the right tympanic membrane of all rats except comparison group using a sterile pick with the help of an operating microscope. Histopathological examination of myringosclerosis formation was done by a pathologist under light microscope. In histopathological analysis of groups, the severity of inflammation was milder in caffeic acid phenethyl ester group compared to non-treated and saline groups (p < 0.05). There was less myringosclerotic plaques in caffeic acid phenethyl ester group than in non-treated and saline groups (p < 0.05). TM thickness measurements were very close to each other in non-treated and saline groups. The tympanic membrane thickness of caffeic acid phenethyl ester group was much thinner than the other two groups (p < 0.05). Caffeic acid phenethyl ester decreases inflammation severity and the formation of myringosclerotic plaques. These two effects resulted in thinner tympanic membranes of rats which were treated with caffeic acid phenethyl ester. As a result, caffeic acid phenethyl ester has potential preventive effects on myringosclerosis development after myringotomy and ventilation tube insertion.Öğe Effects of caffeic acid phenethyl ester on wound healing of nasal mucosa in the rat: an experimental study(W B Saunders Co-Elsevier Inc, 2014) Kinis, Vefa; Ozbay, Musa; Akdag, Mehmet; Alabalik, Ulas; Gul, Aylin; Yilmaz, Beyhan; Ozkan, HakanPurpose: Wound healing of the nasal mucosa is a highly complex process that restores the anatomical and functional integrity of tissue that has been exposed to trauma. In this experimental study, our aim was to use histopathological examination to investigate the effects of caffeic acid phenethyl ester on the wound healing of rat nasal mucosa after mechanical trauma. Materials and methods: The rats were randomly divided into 3 experimental groups: a non-treated group (n = 7), a control saline group (n = 7) and a caffeic acid phenethyl ester group (n = 7). The non-treated group received no treatment for 15 days. The second group was administered saline (2.5 mL/kg, intraperitoneal) once a day for 15 days. The third group received caffeic acid phenethyl ester intraperitoneally at a dose of 10 mu mol/kg once a day for 15 days. At the beginning of the study, unilateral mechanical nasal trauma was induced on the right nasal mucosa of all rats in the three groups using a brushing technique. Samples were stained using hematoxylin and eosin solution and were examined by a pathologist using a light microscope. Results: The severity of inflammation was milder in the caffeic acid phenethyl ester group compared with that in the non-treated and saline groups (P < 0.05). The subepithelial thickness index was lower in the experimental group (P < 0.05). Goblet cell and ciliated cell loss was substantially reduced in the experimental group compared with the non-treated and saline groups (P <0.05). Conclusions: Caffeic acid phenethyl ester decreases inflammation and the loss of goblet cells and ciliated cells. Therefore, caffeic acid phenethyl ester has potential beneficial effects on the wound healing of nasal mucosa in the rat. (C) 2014 Elsevier Inc. All rights reserved.Öğe The effects of oral isotretinoin (13-Cis retinoic acid) on the inner ear: A prospective clinical study(Canadian Soc Clinical Investigation, 2014) Akdag, Mehmet; Akkurt, Zeynep M.; Gul, Aylin; Ucmak, Derya; Yilmaz, Beyhan; Sengul, Engin; Topcu, IsmailPurpose: The purpose of this study was to investigate the effect of oral isotretinoin, a drug used in the treatment of acne vulgaris, on hearing function determined by serial audiology examinations. Methods: Forty patients with acne vulgaris were included in this study. Nine patients were excluded from the study because of inconsistent follow-up. The hearing of each participant was tested with pure tone audiometry and transient evoked autoacoustic emissions before and two and four weeks after treatment with isotretinoin (0.3-0.6 mg/kg/day) in the remaining 31 patients (62 ears). Results: Th e di ff erences between the mean values of the pre- treatment and post-treatment pure tone hearing thresholds at 1000, 2000, 4000 and 6000 Hz frequencies were statistically signi fi cant (p< 0.05), but there was no signi fi cant di ff erence between the pretreatment and post- treatment values at 250 and 500 Hz frequencies (p> 0.05). The difference between the pre-treatment and post-treatment signal-noise ratio values of the transient evoked autoacoustic emissions was not significantly different (p> 0.05). Conclusion: Our results suggest that the use of isotretinoin may cause bilateral hearing threshold changes. Further animal and human studies are required to investigate and characterize isotretinoin- induced neurophysiological alterations in hearing.Öğe THE EFFICACY OF DOPPLER ULTRASOUND ON CHRONIC SUPPURATIVE OTITIS MEDIA(Carbone Editore, 2015) Gul, Aylin; Akdag, Mehmet; Ozkurt, Fazil Emre; Aguloglu, Bulent; Ozkan, Hakan; Akturk, Adem; Yilmaz, BeyhanAims: The diagnostic techniques used in the diagnosis of lateral sinus thrombosis are invasive and pose a risk of stroke. For this reason, we aimed to evaluate the efficiency of Doppler ultrasonography, a simple, fast, and non-invasive technique in this field. Materials and methods: Patients presenting at our clinic with one-sided, chronic suppurative otitis media were included in the study. Internal jugular vein and internal carotid artery Doppler tests were conducted on the patients. The healthy ears of the patients were used as the control group. The values were compared statistically. Results: A total of 40 patients were included in the study 17 male (42.5%) and 23 female (57.5%). Seventeen patients had suppurative otitis media with cholesteatoma, and 23 patients had suppurative otitis media without cholesteatoma. According to Doppler ultrasonography parameters, no statistically significant differences were observed. However, when the chronic suppurative otitis media patients were compared to those without cholesteatoma, the internal jugular vein diameter was found to be reduced significantly in the group with cholesteatoma (p=0.047). Conclusion: The results of our study suggest that Doppler ultrasonography can be considered as a useful, fast, easy, and non-invasive method in the prognosis of cases with suspected lateral sinus thrombosis.Öğe Efficacy of N-Acetylcysteine on Wound Healing of Nasal Mucosa(Lippincott Williams & Wilkins, 2015) Yilmaz, Beyhan; Turkcu, Gul; Sengul, Engin; Gul, Aylin; Ozkurt, Fazil Emre; Akdag, MehmetPostoperative nasal mucosa healing is a highly complex and organized process, and the success rates of endoscopic sinus surgery and septoplasty surgeries are closely associated with the postoperative wound healing processes. In this experimental study, the authors' aim was to use histopathologic examination to investigate the effects of N-Acetylcysteine (NAC) on the wound healing of rat nasal mucosa after mechanical trauma. Twenty-one Sprague-Dawley rats were randomly divided into 3 groups: the nontreated group (N = 7), the control saline group (N = 7), and the NAC group (N = 7). No treatment was given to the nontreated group for 15 days. The control saline group received intraperitoneal injection of saline (2.5 mL/kg, intraperitoneal) for 15 days and the NAC group was intraperitoneally injected with NAC at a dose of 300 mg/kg/day for 15 days. At the beginning of the study, unilateral mechanical nasal trauma was induced with an interdental brush inserted through the right nostril in all rats. Samples were stained using hematoxylin and eosin solution, and were examined by a pathologist using a light microscope. The severity of inflammation was milder in the NAC group compared with that in the nontreated and saline groups (P < 0.05). The subepithelial thickness index was lower in the experimental group (P < 0.05). Goblet cell loss was reduced in the experimental group compared with the nontreated and saline groups (P < 0.05). NAC decreases inflammation and goblet cell loss. Therefore, NAC has potential beneficial effects on the wound healing of nasal mucosa in rats.Öğe Is Middle Ear Pressure Effected by Nasal Packings after Septoplasty?(Aves, 2015) Sereflican, Murat; Yurttas, Veysel; Oral, Mesut; Yilmaz, Beyhan; Dagli, MuharremOBJECTIVE: To investigate the effects of different types of nasal packings on middle ear pressure in patients undergoing septoplasty. MATERIALS and METHODS: Sixty patients who were suffering from nasal obstruction and who had to undergo septoplasty because of nasal septal deviation were included in the study. After the septoplasty, Merocel packings and internal nasal splints were intraoperatively applied in thirty patients each. Middle ear pressure was evaluated by tympanometry. Tympanometric peak pressures were used for this aim. Acoustic impedance measurements were performed in both ears, and the average values of the two ears were calculated. Tympanometric measurements were performed for patients during the preoperative period and on the 2nd and 5th postoperative days. RESULTS: There were 30 (5 females, 25 males; average age 23 years) patients in the internal nasal splint group and 30 (8 females, 22 males; average age 26 years) patients in the anterior Merocel packing group. When the values obtained by acoustic impedancemetry before the operation and on the postoperative 5th day were compared, there was no statistically significant difference between the groups. The middle ear pressure significantly decreased in the anterior Merocel packing group compared with that in the internal nasal splint group. The intragroup comparison of the acoustic impedance measurements of the internal nasal splint group revealed no significant difference between the preoperative acoustic impedance values and the values obtained on the postoperative 2nd day. CONCLUSION: Cannulated silicone intranasal splints are better in terms of patient comfort after an intranasal surgery without effecting eustachian tube function.Öğe Managment of orbital complications of sinusitis(Consel Brasil Oftalmologia, 2014) Ozkurt, Fazil Emre; Ozkurt, Zeynep Gursel; Gul, Aylin; Akdag, Mehmet; Sengul, Engin; Yilmaz, Beyhan; Yuksel, HarunPurpose: We reported on the clinical approaches of ophthalmology and otorhinolaryngology departments in the treatment of the orbital complications of sinusitis. We also included an in-depth literature review. Methods: We retrospectively reviewed the medical files of 51 patients from January 2008 to January 2014. The records were evaluated for age, gender, type of orbital complications, symptoms, predisposing factors, imaging studies, medical and surgical management, culture results, and follow-up information. SPSS version 15.0 software (Statistical Analysis, The Statistical Package for Social Sciences Inc, Chicago, IL) was used for the statistical analysis. Results: Fifty-one patients met the criteria, with available medical records, for the study (29 male, 22 female). Thirty-two (62.7%) were diagnosed with preseptal cellulitis and 19 (37.3%) with postseptal cellulitis. After a detailed evaluation, 15 were diagnosed with a subperiosteal abscess (SPA), and 4 were diagnosed with orbital cellulitis. The age and gender was similar for the two groups. Five patients with medial SPA were treated with endoscopic sinus surgery, one patient with inferior SPA was treated with external surgery, and six patients with other localizations were treated with a combination of endoscopic sinus surgery and external surgery. All patients presented with periorbital erythema and edema. The length of hospitalization and duration of symptoms were similar in both groups. Visual acuity was between 1/10 to 10/10 (mean 7/10) and statistically significant for preseptal and postseptal cellulitis groups (p<0.001). All patients received intravenous antibiotics upon the first day of admission. Conclusion: Orbital complications of acute sinusitis required intensive follow-up and a multidisciplinary approach. A contrast-enhanced paranasal sinus computerized tomography (CT) scan can detect the extent of the infection. An initial trial of intravenosus (IV) antibiotics may be appropriate when close monitoring is possible. Surgery may be indicated when there has been no improvement within 48 hours of intravenous treatment, loss of visual acuity (under 8/10), and a non-medial abscess.Öğe Paraoxonase Activity and Oxidative Status in Patients with Tinnitus(Korean Audiological Soc, 2016) Koc, Sema; Akyuz, Servet; Somuk, Battal Tahsin; Soyalic, Harun; Yilmaz, Beyhan; Taskin, Abdullah; Bilinc, HasanBackground and Objectives: The aim of this study was to investigate serum paraoxanase-1 (PON) activity, total oxidant status (TOS), total antioxidant status (TAS), and the oxidative stress index (OSI) in tinnitus; and to compare the results with data from healthy subjects. Subjects and Methods: A total of 114 subjects-54 patients with tinnitus and 60 healthy controls were enrolled in this study. Serum PON activity, TOS, TAS, and OSI levels were measured. Results: In the tinnitus group, TAS, and PON were significantly lower than in the control group (p<0.001). However, the TOS, and OSI levels were significantly higher in the tinnitus group than in the control group (p<0.001). Conclusions: According to the data obtained from the present study, patients with tinnitus were exposed to potent oxidative stress. Oxidative stress may be the key contributing factor to the pathogenesis of tinnitus.Öğe Patients With Congenital Choanal Atresia Treated by Transnasal Endoscopic Surgery(Lippincott Williams & Wilkins, 2014) Kinis, Vefa; Ozbay, Musa; Akdag, Mehmet; Cetin, Muzeyyen; Gul, Aylin; Yilmaz, Beyhan; Sengul, EnginCongenital choanal atresia (CCA) is defined as a congenital failure in the development of communication between the nasal cavity and nasopharynx in newborns. It is the most common congenital anomaly of nose. Most of the patients presented with unilateral CCA. Neonates with bilateral CCA have severe respiratory distress after birth. Airway control with orotracheal intubation should be done immediately to save the life of neonate with bilateral CCA. After airway control, surgery should be performed as soon as possible. The aim of surgery is to create a patent nasal passage and to prevent restenosis with minimal morbidity. Transnasal endoscopic surgery of CCA has become the most popular treatment method. The retrospective review of 33 patients with CCA was presented in this study. The patients who were diagnosed at the neonate period and operated on in 6 months after birth were grouped as I (neonate). The patients who were diagnosed 6 months after birth were grouped as II (child-young adult). All patients were treated by transnasal endoscopic surgery. Stent were put in all patients to prevent restenosis. Although the restenosis rate was higher in group I (53.8%) than in group II (23.1%), it did not cause a statistically significant difference. Overall success rate of our surgical approach was 61.5%. Despite the surgical developments and many treatment modalities, restenosis is still the most challenging problem in CCA.Öğe The Protective Effect of Intratympanic Dexamethasone on Streptomycin Ototoxicity in Rats(Sage Publications Inc, 2017) Gul, Aylin; Sengul, Engin; Yilmaz, Beyhan; Ozkurt, Fazil Emre; Akdag, Mehmet; Keles, Aysenur; Topcu, IsmailThe purpose of this experimental study was to investigate the protective role of intratympanically administered dexamethasone on the inner ears of rats that were exposed to streptomycin ototoxicity. Twenty-four adult Wistar albino rats were separated into 4 groups: Group 1 (only streptomycin), Group 2 (only intratympanic dexamethasone), Group 3 (streptomycin and intratympanic dexamethasone), and Group 4 (streptomycin and intratympanic saline). All rats were evaluated with distortion product otoacoustic emissions (DPOAE) tests before the start of treatment and on the day it ended. On the 45th day, after the final DPOAE tests, animals of all groups were sacrificed under general anesthesia. The differences between the amplitudes of DPOAE results were determined, and hearing results were statistically analyzed. Also, the cochleas of each rat were histopathologically evaluated under a light microscope with hematoxylin and eosin staining. In the intratympanic dexamethasone group it was observed that cochlear hair cells were mostly protected. No significant difference was seen between the DPOAE results before and after treatment (p > 0.05). On the other hand, loss was observed in the hearing functions and hair cells of the rats that received streptomycin and streptomycin plus intratympanic saline (p < 0.05). In the streptomycin plus intratympanic dexamethasone group, the cochlear hair cells were partially protected. A significant difference was observed when the DPOAE results (DP-grams) of the streptomycin plus intratypmanic dexamethasone group were compared to those of the streptomycin plus intratympanic saline group (p < 0.05). After the experimental study, ototoxic effects of the administration of streptomycin and intratympanic dexamethasone were observed on the rats' cochlear hair cells. We conclude that intratympanic dexamethasone has protective effects against this cochlear damage in rats.Öğe Radiologic and Surgical Findings in Chronic Suppurative Otitis Media(Lippincott Williams & Wilkins, 2014) Gul, Aylin; Akdag, Mehmet; Kinis, Vefa; Yilmaz, Beyhan; Sengul, Engin; Teke, Memik; Meric, FarukOur aim in this study was to evaluate the efficiency of preoperative temporal bone computed tomography (CT) in detecting pathologic conditions in patients with chronic suppurative otitis media (CSOM). The intraoperative findings and temporal bone CT results of 350 patients who were diagnosed with CSOM between September 1, 2010, and June 1, 2013, were compared. Comparison parameters were as follows: the presence of cholesteatoma, erosion of the outer ear bone canal, erosion of the middle ear chain, erosion of the dural plate, erosion of the lateral semicircular canal, erosion of the sigmoid sinus wall, and dehiscence of the facial canal. The contribution of CT was limited in showing the outer ear canal destruction, dural plate destruction, facial canal destruction, lateral semicircular canal destruction, and destruction of the sigmoid sinus wall. However, CTwas more sensitive in detecting cholesteatoma and erosion of the ossicular chain. These results indicate that preoperative CT of patients with CSOM serves as an important guide for otolaryngologists, although there are limitations in the evaluation of the CT results.Öğe A rare sublingual cyst in an infant: oral heterotopic gastrointestinal cyst(Turkish J Pediatrics, 2014) Kinis, Vefa; Alabalik, Ulas; Aguloglu, Bulent; Ozbay, Musa; Yilmaz, Beyhan; Topcu, IsmailOral heterotopic gastrointestinal cyst is rarely seen in the oral cavity. The tongue and floor of the mouth are the most commonly affected sites. These cysts may cause feeding and respiration problems, especially in newborns and infants. A benign mass was considered according to the physical examination and ultrasonography findings. We treated the patient with simple excision. We present a three-month-old female infant who was referred to us with a cystic mass in the sublingual region.Öğe The role of human papilloma virus and herpes viruses in the etiology of nasal polyposis(Tubitak Scientific & Technological Research Council Turkey, 2016) Kocoglu, Mucahide Esra; Mengeloglu, Firat Zafer; Apuhan, Tayfun; Ozsoy, Seyda; Yilmaz, BeyhanBackround/aim: The aim of this study was to investigate the etiological role of human papilloma virus (HPV), herpes simplex virus (HSV), varicella-zoster virus (VZV), Epstein-Barr virus (EBV), cytomegalovirus (CMV), and human herpes virus-6 (HHV-6) and -7 (HHV-7) in the occurrence of nasal polyposis. Materials and methods: Nasal polyp samples from 30 patients with nasal polyposis and normal nasal mucosa from 10 patients without nasal polyps were obtained. DNA was extracted from tissues. Real-time polymerase chain reaction was performed for all runs. Results: No HSV-1, HSV-2, or VZV was detected in the samples. Among the patient samples, EBV and HHV-7 DNA were detected in 18 (60%), HHV-6 was detected in 20 (66.7%), and HPV was detected in 4 (13.3%) samples. Among the controls, CMV DNA was positive in one (10%). EBV was positive in 5 (50%), HHV-6 and HHV-7 were positive in 7 (70%), and HPV was positive in 2 (20%) samples. No significant difference was found among the groups with any test in terms of positivity. Conclusion: The association of Herpesviridae and HPV with the pathogenesis of nasal polyps was investigated in this study and no relationship was found. Thus, these viruses do not play a significant role in the formation of nasal polyps.Öğe Titanium Implant Medialization Laryngoplasty Application in the Case of a Silicone and Gore-Tex Extrusion(Derman Medical Publ, 2014) Bakir, Salih; Akdag, Mehmet; Gul, Aylin; Yilmaz, Beyhan; Sengul, EnginThough the surgical technique of medialization laryngoplasty (ML) has been standardized today, the ideal implant has not been well-defined yet. Various non-absorbable materials such as autogenous cartilage, silicone, hydroxylapatite, Goretex, and titanium have been used for ML Titanium implant ML is a new technique and any complication has not been reported so far. Core-tex and silicone implants have been used more longer and both of them are accepted safe and easy to handle materials. Extrusion of Gore-ten or silicone material after ML has been rarely reported. We present a case of a 38-year-old man with history of silicone and then Gore-tex implant extrusion after ML Titanium implant was performed on the patient. Although rare, the possibility of silicone and Gore-ten extrusion after MT operation must not be ignored. Titanium implant may be a good alternative in such cases.
