Comparing the effectiveness of "plasma knife" tonsillectomy with two well-established tonsillectomy techniques: cold dissection and bipolar electrocautery. A prospective randomized study.

OBJECTIVE: To evaluate the effectiveness of a new device "plasma knife" for tonsillectomy by comparing to two well-established tonsillectomy techniques: cold dissection, and bipolar electrocautery. METHODS: A prospective, randomized study conducted on 110 patients undergoing tonsillectomy. Subjects were randomized to plasma knife (PKT), cold dissection (CDT) and bipolar electrocautery (BET) groups. Operative time, intraoperative blood loss and postoperative complications were recorded. Pain/discomfort level of patients and healing time of the tonsillar fossae were assessed postoperatively. Data were recorded and statistically analyzed. RESULTS: Operative time with plasma knife and bipolar electrocautery were associated with a significant decrease in operative time compared to cold dissection (p<0.05). Intraoperative blood loss was significantly decreased with plasma knife, compared to cold dissection and bipolar electrocautery (p<0.05). Less postoperative pain was observed with plasma knife compared to bipolar electrocautery but more postoperative pain was observed with both compared to CDT (p<0.05). Postoperative healing time was longer with plasma knife and bipolar electrocautery, compared to cold dissection (p<0.05). CONCLUSION: Plasma knife is a useful and safe device in tonsillectomy. Its use reduces intraoperative blood loss and provides a fast tonsillectomy with acceptable morbidity.

Multilateral scrutiny of the Gülhane mastoidectomy.

This study has been conducted in order to analyze the outcomes of a previously described technique for chronic otitis media surgery: the improved radical mastoidectomy with flap (formerly IRMF), which consisted of improved radical mastoidectomy (formerly IRM), inferiorly based fascioperiosteal flap and large meatoconchoplasty (Kahramanyol, Ear Nose Throat J 71:70-77, 1992; Kahramanyol et al., Ear Nose Throat J 79:524-526, 2000). The technique is hereafter referred as the Gülhane mastoidectomy. During a period of 22 consecutive years, 255 patients have been operated on and treated utilizing the technique mentioned above. Despite extensive otologic destruction and concomitant severe complications, the technique rendered impressive outcomes: the cavities became smaller over time and remained healthy, providing good life quality for the patients. Cholesteatoma recurrence was observed in but one patient. The outcomes confirm the value and usefulness of the technique.

Lobular capillary haemangioma of the middle turbinate.

Lobular capillary haemangioma (LCH) is a benign, vascular lesion of unknown origin. It usually affects skin and mucous membranes of the oral cavity. It rarely occurs in the nose. Microtrauma and hormonal factors are considered in the aetiology. The most frequently seen symptoms of nasal LCH are epistaxis and nasal obstruction. LCH can be pedinculated or wide based. Its size ranges from several millimetres to centimetres. LCH cases secondary to postoperative use of nasal packs have been reported. Here we present an LCH which was located on the middle turbinate and occurred after the usage of nasal packing. It is known that the nose is a rare location for LCH but middle turbinate location has not been described so far in the literature. LCH should be considered in the differential diagnosis of all endonasal masses with bleeding.

Association between adenoidal-nasopharyngeal ratio and right ventricular diastolic functions in children with adenoid hypertrophy causing upper airway obstruction.

OBJECTIVE: Adenoid hypertrophy causing upper airway obstruction can cause cardiovascular complications, including pulmonary hypertension and right heart failure in children. Adenoidal-nasopharyngeal ratio (ANR) is a practical, non-invasive and reliable method to evaluate adenoid enlargement. Our aim was to evaluate a possible association between ANR and echocardiographic parameters of right ventricle. METHODS: Twenty-one children who were affected by upper respiratory obstruction symptoms due to adenoid hypertrophy were included in this study (male/female: 12/9; mean age was 6.0 +/- 1.5 years). ANRs were calculated as the ratio of adenoidal depths to the nasopharyngeal depths on lateral cephalometric radiographs. Pulmonary arterial pressures, right ventricular diastolic filling parameters (peak E, peak A, E/A ratio), right ventricular end-diastolic diameters, and left ventricular ejection fractions were measured using echocardiography both preoperatively and also 3 months after the operation. RESULTS: Preoperative pulmonary arterial pressure, E/A ratio, right ventricular end-diastolic diameter, and left ventricular ejection fraction values were 23.10 +/-3.43 mmHg, 1.01 +/- 0.20, 1.95 +/- 0.16 cm, and 69.43 +/- 3.68%, respectively. Postoperative pulmonary arterial pressure, E/A ratio, right ventricular end-diastolic diameter, and left ventricular ejection fraction values were 16.94 +/- 1.45 mmHg, 1.24 +/- 0.14, 1.72 +/- 0.15 cm, and 69.77 +/- 2.17%, respectively. There were significant differences between preoperative and postoperative pulmonary arterial pressures, E/A ratios, and right ventricular end-diastolic diameters (p < 0.01 for each), while left ventricular ejection fraction values did not significantly change after the operation (p > 0.05). There was a negative correlation between E/A ratio and ANR-Ba (p < 0.05, r = -0.44). CONCLUSION: ANR can give information about the right ventricular functions in children with enlarged adenoids causing obstructive symptoms.

Comparison of cardiac function and valvular damage in children with and without adenotonsillar hypertrophy.

OBJECTIVE: Comparison of cardiac function in children with and without adenotonsillar hypertrophy. METHODS: We examined 28 pediatric patients with adenotonsillar hypertrophy mean aged 7.3+/-2.9 years comprised of 14 females and 14 males (group I). The control group were chosen from 35 healthy sex and age matched children mean aged 7.37+/-2.7 years (group II). Both groups were examined by an otorhinolaryngologist and adenotonsillar hypertrophy was diagnosed with nasal endoscopic method or lateral neck X-ray. All the patients in group I underwent adenotonsillectomy. Cardiologic and echocardiographic examinations were performed in both groups. Echocardiographic examination was done twice in group I (preoperative and postoperative first month) however in group II only once. Preoperative findings of group I compared with the findings of group II. Preoperative and postoperative echocardiographic findings were also compared within group I. The chi-square test and the independent paired-sample t-test were used for statistical analysis. RESULTS: The tricuspid end-diastolic time was the only significant difference in echocardiographic findings between the two groups (104.8+/-28.8 ms versus for 86.4+/-17.32 ms p<0.05). There was no statistical difference between preoperative and postoperative echocardiographic findings in group I. Brady-tachyarrhythmia was detected on electrocardiography - performed with 24h ambulatory electrocardiography - in one patient. To our surprise, in group I five patients had cardiac valve damage: mitral and/or aortic valve insufficiency. These findings were interpreted as silent carditis. CONCLUSION: There was no significant difference in right ventricular function between the children with and without adenotonsillar hypertrophy. Whereas, there was shortening of tricuspid end-diastolic time in group I. However, five patients having adenotonsillar hypertrophy developed a cardiac dysfunction which was not observed in the control group. Therefore, we assumed a correlation between adenotonsillar hypertrophy and possible silent carditis following frequent tonsillitis.

PFAPA syndrome: a rare cause of periodic fever.

PFAPA syndrome (periodic fever, aphthous stomatitis, pharyngitis, adenopathy) is characterized by abrupt onset of fever, malaise, aphthous stomatitis, tonsillitis, pharyngitis and cervical adenopathy. The age of onset of the disease is four years, with a range of 6 months to 7 years. The syndrome is sporadic and nonhereditary. Long-term sequelae do not develop. A nine- year-old boy presented with sore throat, fever and oral aphthae. After taking a throat culture, he was prescribed oral antipyretic and was called for a follow-up visit the next day. As the culture result was negative, he was given a single dose prednisolone with the suspected diagnosis of PFAPA. Twenty-four hours later his temperature was 36.8 degrees C, with all his complaints regressed. Twenty-two days later the patient was again admitted to our hospital with the same complaints. Again, single dose oral prednisolone was given after a throat culture. On the next day the patient was free of all symptoms and the culture was again normal. To our knowledge this is the first PFAPA case report from Turkey in the literature.

The relationship between the concha bullosa, nasal septal deviation and sinusitis.

OBJECTIVES: To evaluate the possible relationship between concha bullosa, nasal septal deviation and sinusitis. PATIENTS AND METHODS: Paranasal sinus computed tomography scans of patients suffering from rhinosinusitis were examined. Fifty-four patients with concha bullosa were included in the study. The relationship between concha bullosa, nasal septal deviation and sinusitis was investigated. RESULTS: A statistically significant relationship between unilateral concha bullosa and nasal septal deviation was found (p < 0.01). The relationships of unilateral and bilateral concha bullosa with sinusitis, and bilateral concha bullosa with nasal septal deviation were not statistically significant (p > 0.05). CONCLUSION: In order to define the relation between the concha bullosa, nasal septal deviation and sinusitis, more detailed investigations are needed.

Maxillary sinus hypoplasia.

Maxillary sinus hypoplasia (MSH) is an uncommonly encountered condition by otolaryngologists. The computerized tomography (CT) scans provide valuable data about the anatomic details of the paranasal sinuses. MSH may be misdiagnosed as an infection or a neoplasm of the maxillary sinuses. Variations of the other paranasal structures, especially the uncinate process associated with MSH were defined. MSH shows three distinct hypoplasia patterns. Type I MSH characteristics are mild hypoplasia of the maxillary sinus, normal uncinate process and a well-developed infundibular passage. Significant hypoplasia of the maxillary sinus, hypoplastic or absent uncinate process and absent or pathologic infundibular passage are seen in Type II MSH. Type III MSH is characterized by the absence of an uncinate process and cleft-like maxillary sinus hypoplasia. In this study a series of 18 patients with MSH were presented. Twelve cases of unilateral and 6 cases of bilateral maxillary antrum hypoplasia were evaluated and 13 MSH type I, 7 MSH type II and 4 MSH type III were detected. Three ethmomaxillary sinuses, an overpneumatized posterior ethmoid cell into the orbit and the maxillary sinus were determined. Our series showed that the uncinate process anomalies related to MSH may lead to inadvertent orbital complications and therefore should be kept in mind.

[Approaches to twisted noses and results of treatment]. / Carpik burunlara yaklasim ve sonuçlarimiz.

OBJECTIVES: The aim of this study was to address the multiplicity of surgical techniques and pitfalls in the treatment of twisted noses. PATIENTS AND METHODS: Fifty-nine patients (43 males, 16 females; mean age 27 years; range 17 to 47 years) with vertical axis deviation of the nose were surgically treated. Thirty patients had C-type and 29 patients had I-type twisted noses. Deviation angles were measured before nd at least six months after the operation. Correction of deviations was graded according to the ideal angular values and the two groups were compared. RESULTS: Significant correction was achieved in both types of twisted noses (p < 0.01). The results of the I-twisted noses were significantly closer to the ideal angles compared to those of the C-twisted noses (p < 0.05). Three patients underwent revision surgery. CONCLUSION: To correct functional and aesthetic problems in twisted noses, an external approach can be employed to straighten the nose by releasing, mobilizing, aligning and reinforcing the nasal anatomic structures. Cartilage grafts may be used to camouflage persistent deformities. C-twisted noses require more experience in, and familiarization with, a large number of surgical techniques.