Turkiye Klinikleri Journal of Ophthalmology

.: ORIGINAL RESEARCH
Prognosis and Cost Effectiveness of the Monocanalicular Intubation with Re-Sterilized Silicone Tubes in Canalicular Lacerations: Observational Case Series
Kanalikül Laserasyonlarında Tekrar Sterilize Edilmiş Silikon Tüpler ile Yapılan Monokanaliküler Entübasyonun Prognozu ve Maliyet Etkinliği: Gözlemsel Olgu Serisi
Ali Altan Ertan BOZa , Kadriye DEMİR BONCUKÇUa , Eda GÜMRÜKÇÜOĞLUa , Nilgün ÖZKAN AKSOYa
aSakarya University Faculty of Medicine, Department of Ophthalmology, Sakarya, Türkiye
Turkiye Klinikleri J Ophthalmol. 2024;33(3):156-62
doi: 10.5336/ophthal.2023-100707
Article Language: EN
Full Text
ABSTRACT
 Objective: Canalicular lacerations are usually treated with monocanalicular or bicanalicular silicon stent intubation. This study aimed to report the prognosis and cost-effectiveness of monocanalicular intubation using re-sterilized silicone tubes for canalicular lacerations. Material and Methods: Patient demographics, surgery timing, surgical time, postoperative treatment, follow-up, timing of the silicon tube removal, and postoperative lacrimal patency (anatomical success) and subjective epiphora (functional success) were investigated. Five-centimeter silicone tubes remaining from dacryocystorhinostomy surgery, re-sterilized with ethylene oxide, were used. The silicone tube was left approximately 1.5 centimeters beyond the lacrimal punctum to avoid corneal contact. The free end of the tube was sutured to the skin and orbicularis muscle, positioning it downward. Anatomical success was determined with the lacrimal irrigation test upon removal, and functional success was assessed using the Munk score. Results: Twenty-seven patients with an average age of 47.5 years and a mean follow-up of 7.6 months were included. Canalicular reconstruction was performed within 24 hours of injury, with an average surgical time of 24.7 minutes. No intraoperative complications, ocular surface irritation, stent migration, spontaneous stent loss, or infection were observed. Granuloma formation occurred in one (3.7%) patient, and medial ectropion of the lower eyelid in one (3.7%) patient. Anatomical success was 100%, and functional success was 96.2%. Conclusion: Repairing lacerated canaliculi with re-sterilized silicon tubes was successful and cost-effective. This technique avoids manipulation of the uninjured canaliculus, making tube insertion and removal straightforward. Its significant advantage is the lack of additional costs or instruments, valuable during limited instrument availability, such as the COVID-19 pandemic.

Keywords: Monocanalicular intubation; re-sterilized silicon tube; epiphora; lacrimal irrigation; Munk score
ÖZET
 Amaç: Kanaliküler laserasyonlar genellikle monokanaliküler veya bikanaliküler silikon tüp entübasyonu ile tedavi edilir. Bu çalışmada, kanalikül laserasyonlarının tedavisinde tekrar sterilize edilmiş silikon tüpler kullanılarak yapılan monokanaliküler entübasyonun prognozu ve maliyet etkinliğinin araştırılması amaçlandı. Gereç ve Yöntemler: Hasta demografisi, cerrahi zamanlaması, ameliyat süresi, ameliyat sonrası tedavi, takip süresi, silikon tüp çıkarılma zamanı ve postoperatif lakrimal geçiş (anatomik başarı) ve subjektif epifora (fonksiyonel başarı) araştırıldı. Dakriyosistorinostomi ameliyatından kalan beş santimetrelik silikon tüpler etilen oksit ile tekrar sterilize edilerek kullanıldı. Korneal teması önlemek için silikon tüp lakrimal punktumdan itibaren yaklaşık 1.5 santimetre uzun bırakıldı. Tüpün serbest ucu cilde ve orbiküler kasa sütüre edilerek aşağı yönde konumlandırıldı. Anatomik başarı, tüp çıkarıldığında lakrimal irrigasyon testi ile, fonksiyonel başarı ise Munk skoru ile değerlendirildi. Bulgular: Yaş ortalaması 47.5 yıl olan ve ortalama 7.6 aylık takip süresi olan 27 hasta çalışmaya dahil edildi. Kanaliküler rekonstrüksiyon, yaralanmadan sonraki 24 saat içinde gerçekleştirildi ve ortalama cerrahi süresi 24.7 dakika idi. Ameliyat sırasında komplikasyon, oküler yüzey irritasyonu, stent göçü, spontan stent kaybı veya enfeksiyon gözlemlenmedi. Bir (%3.7) hastada granüloma oluşumu ve bir (%3.7) hastada alt göz kapağının medial ektropiyonu gözlendi. Anatomik başarı %100 ve fonksiyonel başarı %96.2 olarak bulundu. Sonuç: Tekrar sterilize edilmiş silikon tüplerle kanaliküler laserasyonlarının onarımı hem başarılı hem de maliyet etkin bulundu. Bu teknikte, sağlam kanalikülün manipülasyonu gerekmemektedir ve silikon tüp yerleştirme ve çıkarma işlemleri nispeten basittir. Tekniğimizin en önemli avantajı, ek maliyet ve donanım gerektirmemesidir, bu da COVID-19 pandemisi gibi enstrüman bulunabilirliğinin sınırlı olduğu dönemlerde özellikle değerlidir.

Anahtar Kelimeler: Monokanaliküler entübasyon; tekrar sterilize edilmiş silikon tüp; epifora; lakrimal irrigasyon; Munk skoru
REFERENCES:
  1. Jordan DR, Gilberg S, Mawn LA. The round-tipped, eyed pigtail probe for canalicular intubation: a review of 228 patients. Ophthalmic Plast Reconstr Surg. 2008;24(3):176-80. [Crossref]  [PubMed] 
  2. Jordan DR, Mawn L. Repair of canalicular lacerations. Am J Ophthalmol. 2008;146(5):792-3; author reply 793. [Crossref]  [PubMed] 
  3. Tavakoli M, Karimi S, Behdad B, Dizani S, Salour H. Traumatic canalicular laceration repair with a new monocanalicular silicone tube. Ophthalmic Plast Reconstr Surg. 2017;33(1):27-30. [Crossref]  [PubMed] 
  4. Murchison AP, Bilyk JR. Canalicular laceration repair: an analysis of variables affecting success. Ophthalmic Plast Reconstr Surg. 2014;30(5):410-4. [Crossref]  [PubMed] 
  5. Nam SM. Microscope-assisted reconstruction of canalicular laceration using Mini-Monoka. J Craniofac Surg. 2013;24(6):2056-8. [Crossref]  [PubMed] 
  6. Zhang W, Zhang D, Han P, Liang X, Zhang W, Feng F, et al. A novel monocanalicular silicone intubation technique for canalicular laceration repair. J Plast Reconstr Aesthet Surg. 2021;74(8):1848-53. [Crossref]  [PubMed] 
  7. Gupta VP, Gupta P, Gupta R. Repair of canalicular lacerations using monostent and Mini-Monoka stent. Ann Plast Surg. 2011;66(2):216. [Crossref]  [PubMed] 
  8. Bi Y, Sui G, Zhou Q, Heindl LM, Bock F, Sun X, et al. Two-step retrograde closed stenting: a novel method for treating canalicular lacerations in Chinese patients. Eye (Lond). 2013;27(11):1275-80. [Crossref]  [PubMed]  [PMC] 
  9. Balaji SM. Management of nasolacrimal duct injuries in mid-facial advancement. Ann Maxillofac Surg. 2015;5(1):93-5. [Crossref]  [PubMed]  [PMC] 
  10. Munk PL, Lin DT, Morris DC. Epiphora: treatment by means of dacryocystoplasty with balloon dilation of the nasolacrimal drainage apparatus. Radiology. 1990;177(3):687-90. [Crossref]  [PubMed] 
  11. Lee H, Ahn J, Lee TE, Lee JM, Shin H, Chi M, et al. Clinical characteristics and treatment of blow-out fracture accompanied by canalicular laceration. J Craniofac Surg. 2012;23(5):1399-403. [Crossref]  [PubMed] 
  12. Men CJ, Ko AC, Ediriwickrema LS, Liu CY, Kikkawa DO, Korn BS. Canalicular laceration repair using a self-retaining, bicanalicular, hydrophilic nasolacrimal stent. Orbit. 2021;40(3):239-42. [Crossref]  [PubMed] 
  13. Naik MN, Kelapure A, Rath S, Honavar SG. Management of canalicular lacerations: epidemiological aspects and experience with Mini-Monoka monocanalicular stent. Am J Ophthalmol. 2008;145(2):375-80. [Crossref]  [PubMed] 
  14. Shah SM, Shah MA, Shah PD, Patel KB. Successful repair of injury to the eyelid, lacrimal passage, and extraocular muscle. GMS Ophthalmol Cases. 2016;6:Doc04. [PubMed]  [PMC] 
  15. Iñiguez-Soto M, Espinosa-Noguera J, Dávila-Camargo A, Nava-Castañeda A. Anatomical and Functional Success Analysis of Lacrimal Canalicular Lacerations Repaired with Bicanalicular Stents in a Tertiary Referral Teaching Center in Mexico. Nepal J Ophthalmol. 2021;13(24):118-27. [Crossref]  [PubMed] 
  16. Wladis EJ, Aakalu VK, Tao JP, Sobel RK, Freitag SK, Foster JA, et al. Monocanalicular Stents in Eyelid Lacerations: A Report by the American Academy of Ophthalmology. Ophthalmology. 2019;126(9):1324-9. [Crossref]  [PubMed] 
  17. Mangan MS, Turan SG, Ocak SY. Pediatric canalicular laceration repair using the Mini Monoka versus Masterka monocanalicular stent. Arq Bras Oftalmol. 2023;86(1):46-51. [PubMed] 
  18. Bai F, Tao H, Zhang Y, Wang P, Han C, Huang YF, et al. Old canalicular laceration repair: a retrospective study of the curative effects and prognostic factors. Int J Ophthalmol. 2017;10(6):902-7. [PubMed]  [PMC] 
  19. Alam MS, Mehta NS, Mukherjee B. Anatomical and functional outcomes of canalicular laceration repair with self retaining mini-MONOKA stent. Saudi J Ophthalmol. 2017;31(3):135-9. [Crossref]  [PubMed]  [PMC] 
  20. Tsai MJ, Lin IW, Lee SS, Lai CS. Stitch guide technique for bicanalicular nasal intubation in single canalicular laceration reconstruction. Kaohsiung J Med Sci. 2018;34(9):529-34. [Crossref]  [PubMed] 
  21. Han S, Wang T, Jia J, Sun S, Fan Y. Bicanalicular lacerations: clinical characteristics and surgical outcomes with a new bicanalicular silicone stent. J Craniofac Surg. 2019;30(7):2261-4. [Crossref]  [PubMed] 
  22. Leibovitch I, Kakizaki H, Prabhakaran V, Selva D. Canalicular lacerations: repair with the Mini-Monoka® monocanalicular intubation stent. Ophthalmic Surg Lasers Imaging. 2010;41(4):472-7. [Crossref]  [PubMed] 
  23. Kim T, Yeo CH, Chung KJ, Lee JH, Kim YH. Repair of lower canalicular laceration using the mini-monoka stent: primary and revisional repairs. J Craniofac Surg. 2018;29(4):949-52. [Crossref]  [PubMed] 
  24. Conlon MR, Smith KD, Cadera W, Shum D, Allen LH. An animal model studying reconstruction techniques and histopathological changes in repair of canalicular lacerations. Can J Ophthalmol. 1994;29(1):3-8. [PubMed] 
  25. Shi W, Fan X. Incidence of postoperative obstruction at different sites of lacrimal canalicular injury. Plast Reconstr Surg. 2012;129(4):731e-3e. [Crossref]  [PubMed] 
  26. Fayet B, Racy E, Ruban JM, Katowitz J. Pushed monocanalicular intubation. Pitfalls, deleterious side effects, and complications. J Fr Ophtalmol. 2011;34(9):597-607. [Crossref]  [PubMed] 
  27. Anastas CN, Potts MJ, Raiter J. Mini Monoka silicone monocanalicular lacrimal stents: Subjective and objective outcomes. Orbit. 2001;20(3):189-200. [Crossref]  [PubMed] 
  28. Eo S, Park J, Cho S, Azari KK. Microsurgical reconstruction for canalicular laceration using Monostent and Mini-Monoka. Ann Plast Surg. 2010;64(4):421-7. [Crossref]  [PubMed] 
  29. Raj A, Thakur S, Arya KS, Kesarwani P, Sinha U. Canalicular lacerations in a tertiary eye hospital: our experience with monocanalicular stents. Rom J Ophthalmol. 2020;64(2):146-52. [Crossref]  [PubMed]  [PMC] 
  30. Aytoğan H, Karadeniz Uğurlu Ş. Evaluation of anatomical and functional outcomes in patients undergoing repair of traumatic canalicular laceration. Ulus Travma Acil Cerrahi Derg. 2017;23(1):66-71. [Crossref]  [PubMed] 
  31. Fayet B, Katowitz WR, Racy E, Ruban JM, Katowitz JA. Pushed monocanalicular intubation: an alternative stenting system for the management of congenital nasolacrimal duct obstructions. J AAPOS. 2012;16(5):468-72. [Crossref]  [PubMed] 
  32. Rajabi MT, Zavarzadeh N, Mahmoudi A, Johari MK, Hosseini SS, Abrishami Y, et al. Bicanalicular versus monocanalicular intubation after failed probing in congenital nasolacrimal duct obstruction. Int J Ophthalmol. 2016;9(10):1466-70. [PubMed]  [PMC] 
  33. Fayet BE, Katowitz WR, Racy E, Ruban JM, Katowitz JA. An update to monocanalicular stent surgery. Int J Ophthalmol. 2016;9(5):797-8. [PubMed]  [PMC] 

.: Up To Date

.: Process List

Login

 Forgot your password?

 New Registration  

Contact

Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.

.: Address

Turkocagi Caddesi No:30 06520 Balgat / ANKARA
Phone: +90 312 286 56 56
Fax: +90 312 220 04 70
E-mail: info@turkiyeklinikleri.com

.: Manuscript Editing Department

Phone: +90 312 286 56 56/ 2
E-mail: yaziisleri@turkiyeklinikleri.com

.: English Language Redaction

Phone: +90 312 286 56 56/ 145
E-mail: tkyayindestek@turkiyeklinikleri.com

.: Marketing Sales-Project Department

Phone: +90 312 286 56 56/ 142
E-mail: reklam@turkiyeklinikleri.com

.: Subscription and Public Relations Department

Phone: +90 312 286 56 56/ 118
E-mail: abone@turkiyeklinikleri.com

.: Customer Services

Phone: +90 312 286 56 56/ 118
E-mail: satisdestek@turkiyeklinikleri.com

1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com