Does inferior turbinate outfracture provide additional benefit when combined with inferior turbinate radiofrequency ablation?

PURPOSE: To evaluate, both subjectively and objectively, whether turbinate outfracture provides any additional benefit in the treatment of inferior turbinate hypertrophy when combined with radiofrequency ablation. METHODS: The study was conducted on 58 patients diagnosed with inferior turbinate hypertrophy. The patients were randomly divided into two groups according to the treatment they receive. Group A consisted of patients undergoing radiofrequency ablation and Group B included patients undergoing turbinate outfracture in combination with radiofrequency ablation. For the purposes of objective evaluation, all patients underwent acoustic rhinometry and anterior rhinomanometry preoperatively and at 6 months postoperatively. In addition, for subjective evaluation, the patients completed the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire. Postoperative changes in objective and subjective parameters in both groups versus the preoperative period and their differences were compared statistically. RESULTS: In Group A, mean postoperative minimal cross-sectional area (MCA) and nasal volume (NV) values and NOSE scores were significantly greater compared to those obtained in the preoperative period. Similarly, Group B showed significantly greater mean postoperative MCA, NV and NOSE score values compared to the preoperative period. In Group A and B, mean postoperative total nasal resistance (TNR) value was significantly lower in comparison to the preoperative period. The differences in mean preoperative and postoperative MCA, NV, TNR and NOSE scores were significantly greater in Group B versus Group A. CONCLUSION: The addition of turbinate outfracture to inferior turbinate radiofrequency ablation treatment provides both objective and subjective benefits in the resolution of nasal obstruction.

Impact of Nasal Trauma on Olfactory Function.

OBJECTIVE: To determine the impact of nasal trauma with and without the potential to produce nasal fracture on the olfactory function. STUDY DESIGN: A descriptive analytical study. PLACE AND DURATION OF STUDY: Ear, Nose, Throat Clinic, Ankara Numune Training and Research Hospital, Ankara from October 2018 to June 2019. METHODOLOGY: The study included patients with nasal trauma and control subjects. The patients with nasal trauma were divided into two groups as fracture group (Group F, n=83) and non-fracture group (Group Non-F, n=30). The Group F was further divided into two subgroups according the presence as septal fracture as Group SF (patients with septal fracture) and Group Non-SF (patients with non-septal fracture). The smell functions of all participants were evaluated using the Sniffin' Sticks test. The odour scores of Group F and Group Non-F were compared versus control group, using the independent sample t-test or Mann-Whitney U-test. Percentage of patients with olfactory dysfunction was compared between Group F and Group Non-F and between Group SF and Group Non-SF using the Chi-square test. RESULTS: There were a total of 113 participants with mean age of 35.64±10.44 years. The median TDI score of Group F was significantly lower in comparison to control group, no significant difference was found between Group Non-F and control group in terms of median TDI score. There was a significant difference between Group F and Group Non-F in terms of the percentage of patients with olfactory dysfunction. No significant difference was found between Group F and Group Non-F with respect to the percentage of patients with olfactory dysfunction. CONCLUSION: Nasal trauma can lead to olfactory dysfunction only if it has the potential to produce a nasal fracture. Key Words: Smell disorders, Nasal bone, Bone fractures, Trauma.

Does the Change in the Indications of Endoscopic Sinonasal Surgery Continue? Data between 1994-2018.

OBJECTIVE: Endoscopic sinonasal surgery (ESS) has changing over the years in parallel with the developments in endoscopy devices, video-imaging techniques, and surgical instruments. In the present study we investigated whether the indications of patients who underwent surgery over a period of 25 years have accommodated to these changes. METHODS: We retrospectively evaluated 1173 patients who underwent surgery in our clinic from 1994 through 2007, and 954 patients who underwent surgery from 2008 through 2018. The patients were divided into three groups as follows: chronic rhinosinusitis with polyps (CRSwNP), chronic rhinosinusitis without polyps (CRSsNP), and others. The changes in the indications during the first 14 years and the following 11 years were compared, and the results were statistically evaluated. RESULTS: A significant decrease was observed in the number of patients who underwent surgery following the diagnosis of CRSsNP (p<0.001). In addition, a statistically significant increase was found in CRSwNP (p<0.001) and other (p<0.001) indications. CONCLUSION: When ESS indications identified in our clinic were reviewed, it was observed that the increasing trend in CRSwNP rate in the first 14 years continued, there was a significant increase in non-CRS indications in the last 11 years, and there has been an increase in patients with fungal sinusitis, especially in this group.

The levels of advanced oxidation protein products in patients with obstructive sleep apnea syndrome.

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is characterized by repeated episodes of complete or partial obstructions of the upper airway during sleep, frequently followed by transient hypoxemia. Advanced oxidation protein products (AOPP) are a family of oxidized protein products, and oxidative stress has a substantial role in the morbidity of OSAS. AIMS: The aim of this study was to investigate the serum levels of advanced oxidation protein products (AOPP) as a marker of oxidative stress, and their correlation with polysomnographic parameters in patients with obstructive sleep apnea syndrome (OSAS). Additionally, we investigated the effect of positive airway pressure (PAP) treatment on serum AOPP values and compared the levels before and after the treatment. METHODS: The study enrolled a total of 125 subjects including 59 patients with severe OSAS, 34 patients with moderate OSAS, 32 patients with mild OSAS, and 40 healthy controls. Mean AOPP values were compared between OSAS groups and control groups. Correlations between AOPP and polysomnographic parameters were investigated. Mean AOPP values before and after 6-month PAP therapy were compared. RESULTS: Significantly elevated AOPP levels were found in severe and moderate OSAS groups in comparison with mild OSAS and control groups. AOPP was directly correlated with apnea-hypopnea index, percentage of total time spent with oxygen saturation below 90%, oxygen desaturation index, maximum obstructive apnea duration, arousal index, and number of obstructive apneas accompanying bradycardia but inversely correlated with average SPO2 (%), minimum SPO2, and percentage of non-REM stage 3 sleep. There was no statistically significant difference between AOPP values before and after PAP therapy. CONCLUSIONS: AOPP, which is an oxidative stress marker, was found to be high in OSAS patients. Especially, high levels in moderate and severe OSAS patients may be an indicator of increased morbidity. After 6 months of PAP treatment, there was no statistically significant change in these levels.

Is Nasal Septum Deviation Severity a Significant Factor on Voice in Patients Undergoing Septoplasty?

OBJECTIVE: To determine whether septoplasty is an effective factor on the voice in patients with varying degrees of nasal septum deviation. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Ankara Numune Training and Research Hospital, Ear Nose Throat Clinic, Ankara, Turkey, from November 2018 to March 2019. METHODOLOGY: A total of 69 patients formed groups I, II and III. Groups I, II and III consisted of patients with mild, moderate and severe nasal deviation, respectively. All patients underwent septoplasty under general anesthesia. Subjective and objective voice analyses were performed for each patient preoperatively and at the postoperative third month. RESULTS: There was no statistical difference between the mean pre- and postoperative voice handicap index-30 (VHI-30) scores in group I and group II. Postoperative mean VHI-30 scores were significantly lower in group III. In groups I and II, the differences between the mean pre- and postoperative fundamental frequency (F0), frequency perturbation (jitter), amplitude perturbation (shimmer) and noise-to-harmonics ratio (NHR) values were not statistically significant. While the differences between the mean preoperative and postoperative F0, jitter and NHR values in group III were not statistically significant, mean postoperative shimmer value was lower than preoperative one with significantly difference. CONCLUSION: Septoplasty affects the voice positively in patients having severe septum deviation.

Evaluation of olfactory function in patients with obstructive sleep apnea syndrome.

PURPOSE: To investigate the pathophysiological mechanisms underlying the effects of obstructive sleep apnea syndrome (OSAS) on olfactory functions. METHODS: Study subjects consisted of patients with newly diagnosed OSAS divided by polysomnography into subgroups of mild, moderate, and severe disease. Subjects identified as not having OSAS served as controls. All subjects were subjected to the Sniffin' Sticks test to evaluate olfactory functions. Control subjects and subgroups with OSAS were compared for sleep characteristics and olfactory scores. In the patient group, correlations were investigated between olfactory scores and polysomnographic parameters. RESULTS: Of 99 subjects (64 men), there were 20 controls, 23 with mild OSAS, 25 moderate, and 31 severe. There was a decreasing trend from the control group towards the severe subgroup in mean odor threshold, odor discrimination, odor identification, and threshold-discriminationidentification (TDI) scores. In the patient group, there was a strong inverse correlation between AHI and TDI scores (r = - 0.62, p < 0.001). Arousal index and TDI scores had a strong negative correlation (r = - 0.81, p < 0.001). There was a weak positive correlation between the minimum SPO2% and TDI scores (r = 0.34, p = 0.002) and a weak negative correlation between TST <90% and TDI scores (r = - 0.24, p = 0.027). CONCLUSION: The finding that arousal index showed a stronger correlation with odor scores than with hypoxemia-related parameters suggests that sleep fragmentation may be a more prominent mechanism underlying the pathophysiology of olfactory malfunction in patients with OSAS.

Is Adenotonsillar Size a Significant Factor on Voice in Children Undergoing Adenotonsillectomy?

OBJECTIVE: To determine whether adenotonsillar size is a significant determinant of voice in children who have undergone adenotonsillectomy. STUDY DESIGN: Prospective cohort study. PLACE AND DURATION OF STUDY: Ear Nose Throat Clinic, Ankara Numune Training and Research Hospital, Ankara, Turkey, from July 2017 to June 2018. METHODOLOGY: A total of 57 patients, who have been diagnosed with chronic adenotonsillitis and operated for obstruction or infection, were included in the study. Patients were divided into two groups according to their palatine tonsil sizes. Each patient performed voice analysis preoperatively and one month postoperatively, recruiting both objective and subjective methods. F0, jitter % and shimmer % values were assessed with objective methods; while subjective methods evaluated pediatric voice handicap index (pVHI) scores. Pre- and post-operative F0, jitter % and shimmer % values and pVHI scores from each study group were compared. RESULTS: In each study group, pre- and post-operative F0, jitter % and shimmer % values were found to be similar. In Group A, postoperative pVHI scores were found to be significantly reduced (p<0.001). In Group B, however, pre- and postoperatively assessed pVHI scores were similar. CONCLUSION: Adenotonsillar hypertrophy in children, who underwent adenotonsillectomy, seems to be an important and positively effecting factor on the subjective, but not the objective, parameters of voice.

Does Tonsillectomy Affect Voice in Early or Late Postoperative Periods in Adults?

OBJECTIVE: The aim of our study was to investigate the short- and long-term effects of tonsillectomy on voice performance in adults. STUDY DESIGN: Prospective cohort study. MATERIALS AND METHODS: This study was conducted between January 2013 and June 2015. A total of 26 adults who had tonsillectomy due to chronic tonsillitis or recurrent acute tonsillitis were included in the study. The voice performances of the participants were analyzed with objective and subjective methods before surgery, and 1 and 3 months after surgery. An acoustic voice analysis (fundamental frequency [F0], jitter %, shimmer %) was performed for objective analysis, and Voice Handicap Index survey was used for subjective analysis of the voice. Preoperative F0, jitter %, shimmer %, and Voice Handicap Index values were compared with the values obtained 1 and 3 months after surgery. RESULTS: Impairment of voice performance was determined when preoperative and postoperative first month F0, jitter %, and shimmer % values were compared. Three months after surgery, those values were found similar to the preoperative values. CONCLUSION: Tonsillectomy affects voice performance negatively in adults in short term; however, it does not affect voice performance in long term after surgery.

New Predictive Parameters of Bell's Palsy: Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio.

BACKGROUND: Bell's palsy is the most frequent cause of unilateral facial paralysis. Inflammation is thought to play an important role in the pathogenesis of Bell's palsy. AIMS: Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are simple and inexpensive tests which are indicative of inflammation and can be calculated by all physicians. The aim of this study was to reveal correlations of Bell's palsy and degree of paralysis with NLR and PLR. STUDY DESIGN: Case-control study. METHODS: The retrospective study was performed January 2010 and December 2013. Ninety-nine patients diagnosed as Bell's palsy were included in the Bell's palsy group and ninety-nine healthy individuals with the same demographic characteristics as the Bell's palsy group were included in the control group. As a result of analyses, NLR and PLR were calculated. RESULTS: The mean NLR was 4.37 in the Bell's palsy group and 1.89 in the control group with a statistically significant difference (p<0.001). The mean PLR was 137.5 in the Bell's palsy group and 113.75 in the control group with a statistically significant difference (p=0.008). No statistically significant relation was detected between the degree of facial paralysis and NLR and PLR. CONCLUSION: The NLR and the PLR were significantly higher in patients with Bell's palsy. This is the first study to reveal a relation between Bell's palsy and PLR. NLR and PLR can be used as auxiliary parameters in the diagnosis of Bell's palsy.

[New predictive parameters of nasal polyposis: neutrophil to lymphocyte ratio and platelet to lymphocyte ratio]. / Nazal polipte yeni öngörücü parametreler: Nötrofil lenfosit orani ve trombosit lenfosit orani.

OBJECTIVES: This study aims to investigate the correlations between nasal polyposis (NP) and NP density with neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR). PATIENTS AND METHODS: The study included 105 patients (72 males, 33 females; mean age 41.33±12.85 years; range 16 to 63 years) diagnosed as NP (NP group) and 83 healthy individuals (54 males, 29 females; mean age 44.01±8.50 years; range 18 to 62 years) (control group). Nasal polyposis density score was calculated with preoperative Lund-Mackay computed tomography grading system. Neutrophil to lymphocyte and PLR ratio values of NP and control groups were calculated and statistically compared. Neutrophil to lymphocyte and PLR values were statistically compared in terms of NP density in the NP group. RESULTS: Mean NLR value was 2.26 in the NP group and 1.75 in the control group with a statistically significant difference (p=0.001). Mean PLR value was 120.79 in the NP group and 109.84 in the control group with a statistically insignificant difference (p=0.073). CONCLUSION: Neutrophil to lymphocyte ratio value may be used as a novel marker that is easily administered in patients with nasal polyps and obtained with low-cost tests. New studies with larger patient series are needed for the value of PLR.

Evaluation of autoinflammatory disease genes in nasal polyposis.

BACKGROUND/AIM: To investigate cold-induced autoinflammatory syndrome 1 (CIAS 1) gene polymorphisms that cause autoinflammatory diseases in patients with nasal polyposis (NP). MATERIALS AND METHODS: The study included 30 patients diagnosed with NP and 30 healthy age-matched individuals as a control group. CIAS1 polymorphisms were assessed by DNA sequence analysis. Patients with nasal polyps and the control group were compared in terms of gene polymorphisms. Each of the 8 polymorphisms of the CIAS1 gene was analyzed separately in the patient group. RESULTS: The most frequently observed polymorphisms in the patient group were c.732G > A in 83%, c.663C > T in 23%, and c.1308C > A in 23% of the patients. c.732G > A polymorphism was evaluated separately. Guanine was transformed to adenine at the 732nd nucleotide position of the CIAS1 gene in the cDNA of chromosome 1. CONCLUSION: The CIAS1 gene c.732G > A polymorphism was thought to be responsible for an increase in disease susceptibility. The frequency of the "A" allele is higher in the patient group compared to the control group. Autoinflammatory diseases seem like a candidate to be one of these factors. This is the first report to define the role of autoinflammatory diseases among these factors.

The effect of obstructive sleep apnea syndrome and continuous positive airway pressure treatment on voice performance.

OBJECTIVE: Obstructive sleep apnea syndrome (OSAS) may affect voice performance due to alterations that occur in the upper respiratory tract. The aim of the study was to assess the effect of OSAS and continuous positive airway pressure (CPAP) treatment on voice performance. MATERIALS AND METHODS: Twenty-seven patients with moderate to severe OSAS (apnea-hypopnea index ≥15/h) who underwent polysomnographic examination and 28 age- and gender-matched normal control subjects were enrolled in the study. The patients and the control subjects completed Voice Handicap Index (VHI) questionnaires, and their acoustic voice analyses were performed. Fundamental frequency (F0), jitter %, and shimmer % parameters were statistically compared. Acoustic analyses were performed again 1 month after regular CPAP use in OSAS patients, and the parameters before and after the treatment were compared. RESULTS: F0 was 160.82 Hz, jitter was 0.70%, shimmer was 1.05%, and VHI was 1.18 in the control group. In OSAS patients before CPAP treatment, F0 was 157.04 Hz, jitter was 0.82%, shimmer was 1.33%, and VHI was 13.11. These results showed that shimmer and VHI parameters were significantly worse in OSAS patients. After CPAP treatment, F0 was 169.19 Hz, jitter was 0.62%, shimmer was 0.93% and VHI was 5.00. The differences were statistically significant in all parameters. CONCLUSION: The acoustic parameters of OSAS patients differed from those of the normal control subjects. The patients' voice performance improved after a regular use of CPAP treatment for 1 month.

Prognostic effect of hyperbaric oxygen therapy starting time for sudden sensorineural hearing loss.

Sudden sensorineural hearing loss is one of the otological emergencies whose pathogenesis is uncertain and associated with total or partial loss of hearing function. The aim of this study was to investigate whether the hyperbaric oxygen therapy starting time affects the management of sudden sensorineural hearing loss. Fifty-nine patients with sudden sensorineural hearing loss admitted to our clinic between 2008 and 2012 were retrospectively included in this study. All patients received hyperbaric oxygen therapy. In addition, each patient received intravenous piracetam and 37 patients received steroid therapy. Hyperbaric oxygen therapy was initiated between 1 and 7 days with 20 patients determined as Group A, between 8 and 14 days with 25 patients determined as Group B and between 15 and 28 days with 14 patients determined as Group C. Hearing gains of these three groups were statistically evaluated. Each of them showed statistically significant improvement. Lowest hearing gain was observed in Group C and the gain of this group was statistically less than the other two groups. There was no significant difference between the hearing gains of the Group A and Group B. Starting hyperbaric oxygen therapy in patients with sudden sensorineural hearing loss within the first 14 days has positive effect on the prognosis of the disease.

The correlation between clinical prediagnosis and pathology results in the diagnosis of neck masses.

The importance of clinical assessment and its contribution to the diagnosis of neck masses was investigated in patients presenting with a neck mass. In our study, we collected the medical history of a total of 127 patients, including 66 males and 61 females, who presented with a neck mass. Physical exams, endoscopic examinations, laboratory tests, a variety of imaging studies, and fine-needle aspiration biopsies were performed. The relationship between age, duration and location of the neck mass, FNAB results, and definitive histopathological diagnosis were investigated as well as the correlation between the consensus diagnosis reached after the evaluation of the medical history, physical examination and imaging studies, and definitive histopathological diagnosis. A strong and positive relationship (p < 0.01) was found between patients' ages and the definitive diagnosis established by histopathological examination. There was no statistically significant relationship (p > 0.05) between the duration and location of the neck mass and definitive diagnosis established by histopathological examination. And no statistically significant relationship (p > 0.05) was found between FNAB results and definitive histopathological diagnosis. Although no statistically significant relationship was found between the characteristics of neck masses and age, duration and location of masses and FNAB results, there was a statistically significant correlation between the pre-diagnosis estimated by ENT specialists and definitive diagnosis established by histopathological examination. A strong and positive relationship (p < 0.01) was found between clinical pre-diagnosis and definitive diagnosis established by histopathological examination. In patients presenting with a neck mass, the diagnosis should be made based on the medical history, physical examination, radiologic imaging and FNAB results, treatment decisions should be based on those findings.

Intranasal angiofibrolipoma.

Angiofibrolipoma is a rarely seen histopathological variant of lipoma. It is seldom in the head and neck region. Clinically, it shows macroscopic similarity with lipoma. In this article, we report a 65-year-old male case who presented with left-sided nasal obstruction. After complete removal of the tumor, histopathological diagnosis was reported as angiofibrolipoma. To the best of our knowledge, this is the first case report of an angiofibrolipoma of the nose in the literature.

[Cervical lymphadenopathy: progressive transformation of germinal centers]. / Boyunda lenfadenopati: Germinal merkezlerin progresif transformasyonu.

Enlarged lymph node in the head and neck region is a common reason for referral to ear nose throat specialists. In the differential diagnosis of chronic lymphadenopathies, infection, lymphoproliferative disorders and progressive transformation of germinal centers should be considered. In this article, we report two cases of progressive transformation of germinal centers in the neck.

The clinical efficiency of positive airway pressure treatment.

OBJECTIVES: The aim of this study was to evaluate the clinical efficiency and compliance of positive airway pressure (PAP) treatment. MATERIALS AND METHODS: This study was conducted on moderate-severe obstructive sleep apnea syndrome (OSAS) patients who admitted to Ankara Numune Hospital Sleep Center between 2008 and 2012. Seventy-five patients with moderate-severe OSAS who were using PAP treatment regularly were enrolled in the study. Patient's usage data, Epworth sleepiness scale (ESS) scores, and the differences in complaints of OSAS were recorded. RESULTS: The overall complaints were improved when compared to pretreatment period. Particularly there was improvement in apnea, snoring, excessive daytime sleepiness, fatigue, and sleep quality. CONCLUSION: PAP is effective in reducing symptoms in people with moderate and severe OSAS. To inform the patients with details and the creation of strategies for close followup are necessary for improving the compliance of the patients. TRIAL REGISTRATION NUMBER: ACTRN12613000373774.

Investigation of lateral pharyngeal walls in OSAS.

The aim of this study is to investigate the relationship between the site of obstruction detected on Müller's maneuver and the polysomnography findings in patients with obstructive sleep apnea syndrome. This study is a prospective cohort study in a setting of Tertiary referral center. The study was performed on 87 patients (59 males and 28 females) with a mean age of 50 ± 10.34 years (range 20-83 years) who presented with the complaints of snoring, apnea, witnessed apnea and daytime sleepiness. The height and body weight of the enrolled patients were measured and the body mass indexes were calculated. The obstruction degrees of the soft palate and lateral pharyngeal walls at the level of the soft palate and the obstruction degrees of the tongue base and lateral pharyngeal walls at the level of the tongue base were determined using the Müller's maneuver. All patients underwent whole-night polysomnography at our hospital's Sleep Center. The apnea-hypopnea index values of the patients increased as their ages and body mass index values increased. There was a highly statistically significant correlation between apnea-hypopnea index and the obstruction degree of the lateral pharyngeal walls at the level of the tongue base on Müller's maneuver (p < 0.01). We found that the apnea-hypopnea index increased as the obstruction degree of the lateral pharyngeal walls increased on Müller's maneuver. In patients with obstructive sleep apnea syndrome, a high apnea-hypopnea index can be predicted if the obstruction degree of the lateral pharyngeal walls is high at the level of the tongue base on Müller's maneuver.

The importance of carotid-cochlear interval in the etiology of hearing loss.

Carotid-cochlear interval (CCI) is the minimal distance between petrous segment of internal carotid artery (ICA) and basal turn of cochlea. Pulsations of the ICA might create fluid pressure changes and direct stimulation of hair cells on the basilar membrane of basal turn of cochlea which is responsible for mid-tone frequencies. The purpose of this study was to investigate whether CCI has a role in the etiology of mid-tone hearing loss and to obtain reference measurements of CCI on MRI. A total of 117 subjects were consecutively enrolled into this retrospective study during a 4 month period. All examinations were performed on a 1.5 T MRI system. The images were transferred to the workstation and reformatted. The CCI was measured on reformatted 3D FIESTA images. The audiologic findings were correlated. We reviewed the temporal MRI studies of 90 consecutive patients [M/F: 48/42, Mean age 45.6 ± 16.6 (10-78)]. As a total 180 sides were evaluated. The CCI ranged from 0 to 9 mm. The CCI didn't exhibit a significant association with subject age or gender. There were no significant differences between readers or sides. There were statistically significant correlation between CCI and level of frequency and degree of hearing loss (p = 0.004 and p = 0.002). The knowledge of CCI is essential prior to otosurgical procedures. There was linear correlation among CCI and level of frequency and degree of hearing loss. CCI of the group including all types of middle frequency hearing loss was longer compared to the normal group.

Giant pleomorphic adenoma of the parotid gland.

Pleomorphic adenomas are the most common benign tumors of the salivary glands. These adenomas generally present without pain and are slowly enlarged. However, they can reach enormous sizes, because they are often neglected by the patient and due to late diagnosis and intervention because of fear of surgery or sociocultural factors. This may lead to functional, aesthetic and social problems. In this article, we present a 55-year-old female patient with a giant pleomorphic adenoma in size of 15x15x20 cm, who presented with the complaint of a mass enlarged and swollen for 20 years in her left neck and face and underwent a successful surgery.