[Sphenoid sinus agenesis]. / Sfenoid sinüs yoklugu.

Agenesis of paranasal sinuses is an uncommon finding mainly seen in the frontal and maxillary sinuses. Agenesis of sphenoid sinuses is an extremely rare condition. In this article, we present an 18-year-old female patient suffering from headache and nasal obstruction without any skeletal or cranial anomalies. Axial, coronal and sagittal computed tomography revealed absent sphenoid sinuses. Surgeons should be aware of sphenoid sinus agenesis, when transsphenoidal hypophysectomy and endoscopic sinus surgery are scheduled, in particular.

Ossicular reconstruction for incus long-process defects: bone cement or partial ossicular replacement prosthesis.

OBJECTIVE: The objective of this study was to compare hearing results in patients undergoing ossiculoplasty with bone cement (BC) vs partial ossicular replacement prosthesis (PORP) in cases of incudostapedial discontinuity during tympanoplasty surgeries. STUDY DESIGN: Case series with chart review. SETTING: Tertiary referral center. SUBJECTS: A total of 44 patients with incudostapedial discontinuity, 21 operated on with BC and 23 operated on with PORP, were enrolled in this study. METHODS: Preoperative and postoperative audiograms at 12 months were evaluated. Pure-tone averages and air-bone gaps (ABGs) were calculated according to the guidelines. RESULTS: The ABG was 26.61 dB preoperatively and 9.76 dB postoperatively in the BC group. The hearing gain in ABG was statistically significant (P = .0001). The preoperative and postoperative ABGs in the PORP group were 29.48 and 8.89 dB, respectively. The hearing gain in ABG was statistically significant (P = .0001). When the groups were compared for mean gains in the ABG, the difference was not statistically significant (P = .192). The postoperative ABG of less than 20 dB was achieved by 90.4% in the BC group and 86.9% in the PORP group. This difference was not statistically significant (P = .745). No adverse reactions or complications were observed. CONCLUSIONS: Both BC and PORP are reliable and efficient methods for the repair of incudostapedial joint defects. There is no difference between these 2 methods, based on the hearing results. Additional research is necessary to determine the maximum incudostapedial defect length suitable for bone cement repair.

Evaluation of tissue response to Gore-Tex (expanded polytetrafluoroethylene) implantation.

OBJECTIVE/HYPOTHESIS: The aim of this study was to assess the tissue response to Gore-Tex (expanded polytetrafluoroethylene) in rats and compare the results of surgical placement modalities. STUDY DESIGN: Prospective animal study. MATERIALS AND METHODS: Experiments were performed in 18 young Sprague-Dawley rats that were divided into 3 groups. Gore-Tex patches were implanted subcutaneously over the periosteum in the first group and under the periosteum in the other groups. Gore-Tex was immersed in an antibiotic-containing solution in the third group. All animals were killed 4 weeks after the procedure. The tissue samples were stained with hematoxylin and eosin stain and evaluated using a light microscope. RESULTS: The Gore-Tex patches were displaced and not observed at the originally implanted sites in the first group. The Gore-Tex patches were observed at the originally implanted sites in the other groups. In group 1, edema and inflammation were prominent. In the second group, ossification was detected in 5 rats and foreign-body reaction and edema were identified in 1 rat. In the third group, all of the rats were found to have developed ossification, but no inflammatory reactions were observed. CONCLUSIONS: The results suggest that implanting synthetic graft materials immersed in an antibiotic solution at the subperiosteal plane provides better stabilization and low complication rates.

Levels of reactive oxygen species in rat tympanic membranes after incisional versus radiofrequency myringotomy.

OBJECTIVE: A close relationship between reactive oxygen species (ROS) and myringosclerosis, which is a common complication of myringotomy, was recently reported. The objective of this study was to measure ROS levels directly in rat tympanic membranes using luminol-aided chemiluminescence (CL) in order to compare the levels of ROS after incisional and radiofrequency (RF) myringotomy. METHODS: Fifteen Sprague-Dawley rats were separated into three groups of five animals each. Bilateral myringotomies were made using an appropriate myringotomy lancet in Group 1 and RF in Group 2. Group 3 served as the control group with no myringotomy. Twenty-four hours after the procedure, all tympanic membranes were inspected with an otomicroscope and then excised for the measurement of ROS using luminol-aided CL. RESULTS: The mean ROS level in Group 1 was significantly higher than that in Groups 2 and 3 (p<0.05 for both). The difference in mean ROS level between Groups 2 and 3 was not significant (p>0.05). Otomicroscopy revealed increased vascularity and vessel dilation in all tympanic membranes that underwent myringotomy. Vascular dilation was observed in the annular region in the vessels that passed along the long arm of the malleus, in addition to the vessels feeding the anterior and posterior tympanomalleolar folds. CONCLUSIONS: Although the relationship between ROS and the development of myringosclerosis after myringotomy has been demonstrated, the present study is the first to compare incisional and RF myringotomy based on the measurement of ROS levels. Our results indicate that the increase in ROS due to myringotomy was greater following incisional myringotomy than RF myringotomy.

Importance of placing Gore-Tex in the subperiosteal plane for augmentation rhinoplasty.

OBJECTIVE: The purpose of this study was to present the placement technique of Gore-Tex implants for nasal augmentation. METHODS: The study group comprised 32 patients of various nasal deformities who underwent consecutive rhinoplasty via open approach with Gore-Tex implant material for dorsal augmentation. A pocket is made subperiostally at the nasal dorsum. The implant is rinsed in antibiotic solution and placed in position. Complications due to Gore-Tex were observed during the follow-up period. RESULTS: There were 12 men and 20 women. The mean age was 28.4 years. There were 9 primary rhinoplasty and 23 revision rhinoplasty. Patients were followed up postoperatively for 12 to 24 months. During the postoperative follow-up period, no complications were encountered in this series of patients. The implants were stable and immobile under the skin. CONCLUSIONS: In the cases of nasal dorsum augmentation, Gore-Tex can be a suitable graft material. We recommend implanting graft materials at subperiosteal plane to provide better stabilization and low complication rates.

Effect of topical use of mitomycin C and 5-fluorouracil on the closure time of myringotomies created by radiofrequency unit.

CONCLUSION: Both mitomycin C (MC) and 5-fluorouracil (5-FU) had a significant effect in prolonging the patency rate of radiofrequency myringotomy. OBJECTIVE: To compare the effect of topical use of MC and 5-FU on the closure time of myringotomies created by a radiofrequency unit. MATERIALS AND METHODS: Myringotomies were performed using a radiofrequency unit on 80 tympanic membranes of 40 rats. Rats were divided into two study groups and one control group. MC (0.4 mg/ml) and 5-FU (50 mg/ml) pledgets were applied topically in the right ears (study groups, 20 ears each) for 10 min and saline pledgets in the left ears (control group, 40 ears). Animals were monitored using otomicroscopy weekly and patency rates were recorded until myringotomy closure. RESULTS: The mean patency times were 4.85 weeks for the MC group and 3.90 weeks for the 5-FU group. The mean patency rate for the control side was 1.30 weeks. The log-rank test revealed both study groups to have a significantly longer patency time than the control group (p<0.0001). Although the patency rate was found to be higher in the MC-treated group than the 5-FU-treated group, this difference was not statistically significant (p>0.05).

Effect of the use of dry (rigid) or wet (soft) temporal fascia graft on tympanoplasty.

OBJECTIVE: The aim of this study was to research the advantages and disadvantages of using a wet or dry temporalis fascia graft in myringoplasty surgery. STUDY DESIGN: Randomized prospective study. SETTING: Teaching and research hospital. METHODS: Dry graft was used in 210 cases, and wet graft was used in 174 cases in 384 patients who underwent tympanoplasty. OUTCOMES MEASURES: (1) Rate of primary closure of perforation, (2) rate of recurrent and residual perforation, (3) difference in hearing improvement between the two groups, (4) total operation time and graft placement time, and (5) histologic properties of wet and dry fascia grafts. RESULTS: The success rate was 91.4% (159 of 174) in the wet graft group and 88.6% (186 of 210) in the dry graft group. There were no differences between groups regarding recurrent disease, residual disease, and postoperative hearing results (p > .05). The mean operation time and graft placement time were shorter in group 2 (wet graft), and this difference was found to be statistically significant (p < .01). Histologically, the number of fibroblast nuclei was higher in group 2 (wet graft), and this was statistically significant (p < .01). CONCLUSION: The temporal fascia graft has a high success rate regardless of its use, either wet or dry. Using wet grafts can shorten the operation time and result in a high number of fibroblast nuclei histologically.

Thyroid dysfunction after combined therapy for laryngeal cancer: a prospective study.

OBJECTIVE: The purpose of this study was to assess the incidence of the thyroid dysfunction in a group of patients treated with laryngectomy and radiotherapy for larynx cancer and to analyze the risk factors related to the development of hypothyroidism. STUDY DESIGN: This was a prospective study conducted in a tertiary center hospital. SUBJECTS AND METHODS: Thyroid function tests have been applied to 75 patients treated with surgery and radiotherapy preoperatively, before radiotherapy, and postoperatively. Risk factors have been analyzed by carrying out a multivariate analysis. RESULTS: All the patients were men with the mean age of 59.4 and an average follow-up of 28.6 months. The incidence of hypothyroidism was 49.3 percent. The average time to detection of hypothyroidism was 6 months after the completion of treatment. Radiotherapy dose, type of laryngectomy, extent of neck dissection, implementation of thyroid lobectomy, and presence of thyroiditis in specimens were risk factors for thyroid dysfunction. CONCLUSIONS: It is important to check the thyroid function periodically in these patients especially with risk factor to obtain early diagnosis and appropriate treatment.

Ototoxic effect of topical ciclopirox as an antimycotic preparation.

OBJECTIVE: To evaluate the ototoxicity of ciclopirox-containing solution as an otologic preparation for the treatment of otomycosis. BACKGROUND: Ciclopirox is a synthetic antimycotic agent available in a variety of formulations to treat superficial fungal infections. Ciclopirox has demonstrated both fungicidal and fungistatic activity in vitro against a broad spectrum of pathogenic fungi. It also possesses a broad-spectrum antibacterial properties, anti-inflammatory, and antiedema effect. The ototoxic effect of ciclopirox-containing solutions has not been known, so the current study was designed to observe the ototoxic effect of this solution experimentally. MATERIALS AND METHODS: Experiments were performed in 22 young male albino guinea pigs (weight, 450-550 g). The 10 animals in the experimental group received ciclopirox solution, and the control group was divided into two groups of six animals each. The first group received saline solution (negative control) and the second received gentamicin (40 mg/mL; ototoxic control). Under general anesthesia, pretreatment auditory brainstem responses (ABRs) from the right ears were obtained from the animals in all groups. The right tympanic membranes were totally perforated, and a small piece of Gelfoam was applied to the middle ear directly to the round window membrane. Ear solutions were applied through transcanal approach to the middle ear twice a day in 2 weeks. Twenty-two animals of perforated tympanic membrane were observed during a 2-week period. Posttreatment ABRs were obtained in all groups in a week after the last administration. RESULTS: Baseline ABR results were normal in right ears of all animals tested. Animals undergoing placement of Gelfoam with either ciclopirox solution or saline in the middle ear showed no changes in the ABR threshold. The gentamicin group showed a significant change in the ABR threshold. CONCLUSION: In the guinea pig, when applied topically to the middle ear, ciclopirox does not cause a reduction in the ABR threshold. Because its safety has not yet been confirmed in patients, caution should be observed when prescribing this agent.

Assessment of long- and short-term neurotoxic effects of glass ionomer bone cement by electromyography and histopathologic examination: experimental study.

OBJECTIVE: The objective of this study was to investigate the possible neurotoxic effects of bone cement on the peripheral nerves. STUDY DESIGN: Experimental study. SETTING: Teaching and research hospital. METHODS: Twenty New Zealand rabbits were included in this study. The sciatic nerves of both legs of the 10 rabbits were exposed surgically under general anesthesia and closed primarily without any intervention and constituted the control group (group 1). Following surgical exploration, glass ionomer cement (GIC) was applied to the left sciatic nerves of the 10 rabbits for 10 seconds and then aspirated (group 2). GIC material was also applied to the right sciatic nerves of these rabbits but without aspiration (group 3). OUTCOME MEASURES: All rabbits were sacrificed at the end of 8 weeks postoperatively following electromyographic investigation. The sections were stained with hematoxylin-eosin and Immune Olig 2 staining technique for histopathologic examination under light microscopy. RESULTS: There was no statistically significant difference in distal latency, which indicates the conduction speed of the nerve, between all groups by electromyography. Histopathologic examination of all specimens revealed no demyelinization or axonal degeneration, and all had an intact myelin structure. There was no statistically significant difference in inflammation of the specimens between groups. (p>.05). CONCLUSION: GIC has no neurotoxic effects on the nerves in short- and long-term applications.

Atypical penetrating laryngeal trauma: a bullet in the larynx.

Penetrating laryngeal traumas due to gunshot wounds are rare cases. These cases are generally encountered during wars. Here, we report a 40-year-old man who presented with a gunshot wound in his neck. Physical and radiological examination revealed a foreign body in the larynx. A piece of bullet was extracted from the right supraglottic part of his larynx via direct laryngoscopy under general anesthesia. The patient had a good recovery without any symptom postoperatively. Early recognition and accurate management of penetrating laryngeal traumas are essential. Establishing a patent airway and a good quality of voice are important aims for long-term results.

The use of expanded polytetrafluoroethylene (Gore-Tex) in rhinoplasty.

BACKGROUND: Septal cartilage still is the most appropriate graft material used in rhinoplasty. In traumatic or revision cases, septal cartilage can be insufficient, and the need for an implant material emerges. In this study, the safety and efficacy of polytetrafluoroethylene (Gore-Tex) used as an implant material in nasal dorsal augmentation were assessed. METHODS: This study retrospectively reviewed 74 patients who underwent nasal dorsal augmentation with Gore-Tex. Of the 74 patients who underwent rhinoplasty with Gore-Tex for dorsal augmentation from February 1999 to January 2006, 46 (62.2%) represented primary cases and 28 (37.8%) represented revision cases. The patients were followed from 5 to 62 months (average, 28 months) and questioned about cosmetic and functional outcomes. The results were assessed according to patients' charts as well as preoperative and postoperative photographic documentation. RESULTS: There were no complications such as infections, foreign body reaction, extrusions, resorption, or migration, and all the patients were satisfied with their results. Only one case of soft tissue reaction was observed, which lasted for 3 weeks postoperatively. CONCLUSIONS: Biocompatibility, ease of use, lack of extrusion or resorption, and low rate of infection make Gore-Tex a good alternative to autogenous tissue. However, long-term success and complication rates still are lacking, and large numbers of patients with longer follow-up periods are required.

Ototoxic effect of Burow solution applied to the guinea pig middle ear.

OBJECTIVE: To analyze the ototoxicity of Burow solution as an otologic preparation. BACKGROUND: Burow solution has been used for years in the treatment of acute or chronic otitis externa and chronic suppurative otitis media. This acidic solution has antibacterial and antiedematous properties. Ototoxic effect of Burow solution has not been known, so the current study was designed to observe the ototoxic effect of Burow solution experimentally. MATERIALS AND METHODS: Experiments were performed in 32 young, male albino guinea pigs (weight, 450-550 g). Twenty animals in the experimental group were divided into 2 groups of 10 animals each. The first group received 13% Burow solution (13% aluminum subacetate), and the second received 4% Burow solution (4% aluminum subacetate). Twelve animals in the control group were divided into 2 groups of 6 animals each. The first group received gentamicin (40 mg/mL; ototoxic control), and the second received saline solution (negative control). Under general anesthesia, pretreatment auditory brainstem responses (ABRs) from the right ear were obtained from the animals in all groups. The right tympanic membranes were widely perforated, and a small piece of Gelfoam was applied to the middle ear. Ear solutions at concentrations of 0.1 mL were applied through transcanal approach to the middle ear twice a day in 10 days. Under general anesthesia, the Gelfoam was removed from the right middle ear, and posttreatment ABRs were obtained 14 days later after the initial time in all groups. RESULTS: Baseline ABR results were normal in right ears of all animals tested. Animals undergoing placement of Gelfoam with either 13% Burow solution, 4% Burow solution, or saline in the middle ear showed no changes in ABR threshold. The gentamicin group showed significant change in the ABR threshold. CONCLUSION: Burow solution was considered to be an effective and safe otologic preparation.