Immunocompetent Young Patient Presenting with Unilateral Lip Abscess Due to Peeling Exfoliated Lip Skin.

Lip abscess is a rare condition encountered in clinical practice. Generally, it may be due to an infective agent, such as virus, bacteria, entering through a skin wound, or it can be seen through hematogenous spread when there is a serious underlying condition such as a general condition disorder or immunodeficiency. It requires rapid diagnosis and treatment as it may cause significant complications in terms of localization and lymphovascular drainage. In this case report, an 18-year-old male patient with unilateral lip abscess that regressed rapidly with external drainage and antibiotic therapy is presented with imaging and clinical-laboratory findings.

The Use of Spreader Grafts in Revision Septoplasty.

INTRODUCTION: Persistent nasal obstruction at internal nasal valve was a common problem seen after septoplasty and submucous resection, the 2 methods used for surgical treatment for deviation of nasal septum during the first half of twentieth century. The authors performed cartilage-grafting technique and retrospectively analyzed the patients after 12 months with Nasal Obstruction and Septoplasty Effectiveness scale to emphasize persistent nasal obstruction. METHODS: In this study, 115 (65 male, 50 female) patients operated between 2008 and 2013 who underwent revision septoplasty and complaints were evaluated with Nasal Obstruction and Septoplasty Effectiveness scale. The surgical technique was used in 32 (27.8%) of the patients "open" and in 83 (72.2%) "closed" approach. Wilcoxon sign test is used for the statistical analysis. Postoperative values were statistically significant compared with preoperative ones (P <0.05). DISCUSSION: Septoplasty and submucous resection described by Cottle and Killian are similar techniques, but a septoplasty often includes less cartilage resection and septal cartilage modification or placement of a cartilage graft instead of resection. Most important disadvantage of these techniques is to be deficient in the correction of the caudal and/or dorsal deviations. In authors' experience these classical septoplasty techniques are not suitable for columellar and dorsal deviations and especially in revision surgery an internal nasal valve correction with cartilage grafts is a necessary alternative technique.

Utility of Cartilage Grafts Wrapped With Amniotic Membrane in Dorsal Nasal Augmentation.

OBJECTIVES: The success of rhinoplasty may be compromised with postoperative problems like rough and rigid nasal dorsum. Biological grafts or alloplastic materials are required to hurdle and correct nasal dorsal deformities and also irregularities. The purpose of this experimental study was to compare pure cartilage graft, cartilage graft wrapped in amniotic membrane, and diced cartilage grafts wrapped in amniotic membrane for soft tissue augmentation. METHODS: All grafts were transplanted through a subcutaneous tunnel created in the nasal dorsum of 18 rats, 6 in each group. After 3 months follow-up, the histopathological changes in all groups were evaluated by light microscopy and volumetric measurements. RESULTS: With regard to cartilage viability, cartilage wrapped in amniotic membrane had a higher success rate than pure cartilage graft. Also, a further increased success rate was found in the diced group. CONCLUSIONS: In the soft tissue augmentation after rhinoplasty surgery, especially diced cartilage wrapped in amniotic membrane keeps the graft viable and adjoined.

The effect of duration of merocel in glove finger with tetracaine solution on septoplasty morbidity.

OBJECTIVE: We aimed to decrease the postseptoplasty morbidities depending on nasal packing by using Merocel within glove finger moistened with tetracaine 0.25% solution. STUDY DESIGN: The study was designed as a randomized prospective study. SETTING: A university hospital in Turkey. SUBJECTS AND METHODS: Our study consisted of 80 patients who underwent septoplasty. The Merocel nasal tampon within glove finger was inserted after surgery in the study group and removed after 24 or 48 hours. Merocel was moistened with tetracaine 0.25% solution after insertion into the nasal cavity and just before removal. The morbidities and normal breathing time were recorded and compared with those of the control group. RESULTS: The postseptoplasty morbidities were significantly decreased in the study group compared with those in the control group. The morbidities were also improved after removal of tampons after 24 hours compared with 48 hours. However, the normal breathing time was prolonged when the nasal tampons were removed after 24 hours. CONCLUSIONS: The glove finger provides comfortable removal of nasal packing. The Merocel tampons might be safely removed just after 24 hours postoperatively without any complication.

Conservative costal cartilage harvest for revision septorhinoplasty.

OBJECTIVE: We present our experience with a conservative costal harvesting to be used for patients undergoing secondary septorhinoplasty. METHODS: Sixty-five patients who underwent revision septorhinoplasty requiring autogenous costal cartilage harvest performed by the senior author from 2005 to 2011 have been included in this retrospective study. Assessment of the outcomes includes harvesting time, incision size, availability of graft material, and postoperative complications. RESULTS: The mean operation time was 25 minutes. The incisions varied from 3 to 4 cm. Sufficient cartilage volume was harvested for the targeted purpose in all cases. No wound infection developed. One patient had pleural damage, and no more major complications were noted. The patients suffered from mild pain. Postoperative scar was minimal. No deformity was observed in the donor site on postoperative analysis. CONCLUSIONS: The described technique is very safe and minimizes donor-site morbidity. In addition, it allows the acquisition of nonepithelialized dermal graft and muscle fascia for soft tissue reconstruction.

Voice and speech changes in various phases of menstrual cycle.

BACKGROUND: The reproductive system in females undergoes a regular cyclic change known as the menstrual cycle. Laryngeal changes are evident and fluctuate systematically during the reproductive years with the menstrual cycle. The impact of estrogens in concert with progesterone produces the characteristics of the female voice, with a fundamental frequency (F(0)) higher than that of male. OBJECTIVE: To characterize changes in voice and speech in adolescent females in different phases of the menstrual cycle--during menstruation, after menstruation, mid-menstrual cycle, and premenstruation. MATERIALS AND METHODS: Sixteen adult females who were nonusers of oral contraceptives participated in a cross-sectional study of menstrual cycle influences on voicing and speaking tasks. Acoustic analysis (F(0), intensity, perturbation measurements [jitter and shimmer], and harmonic-to-noise ratio), maximum phonation time (MPT), s/z ratio, and perceptual assessments (grade [G], roughness [R], breathiness [B], asthenia [A], and strain [S] [GRBAS] and Voice Handicap Index-10 [VHI-10]) scales were performed during all phases. RESULTS: None of the acoustic analysis parameters and MPT and s/z ratio measurements revealed statistically significant difference (P > 0.05). Perceptual voice assessment scales either clinician based or patients self-evaluated showed significant differences among phases (P < 0.05). CONCLUSIONS: The objective voice analysis methods, such as acoustic analysis, MPT, and s/z ratio, determined no difference; however, the subjective voice analysis methods, such as clinician-based perceptual assessment (GRBAS) and patients self-evaluation (VHI-10) scales, demonstrated significant changes during different phases of menstrual cycle.

Septorhinoplasty with spreader grafts enhances perceived voice quality without affecting acoustic characteristics.

OBJECTIVE: To identify the effect of septorhinoplasty with spreader grafts on patients' perception of voice and to measure formant frequencies that may be responsible for perceived changes in voice quality. METHODS: A total of 20 patients who underwent septorhinoplasty and had spreader grafts placed during the operations were included. All subjects were tested within the week before surgery and 1-3 months postoperatively by means of perceptual assessment (Voice Handicap Index-10 [VHI-10] and self-assessment of hypo/hypernasality), acoustic analysis, and formant frequency analysis. RESULTS: The mean of VHI-10 score was decreased from 9.44±6.1 to 5.1±3.94 postoperatively (P=0.03). Fifteen patients (75%) perceived their voices to be hyponasal before surgery, but only three perceived the hyponasality to persist after surgery (P<0.001). No patient perceived the voice to be hypernasal either before or after surgery. Fifteen patients (75%) perceived their overall voice quality to be improved, whereas five patients perceived no change. None of the patients perceived their voice to be worse after surgery. There were no significant differences between pre- and postoperative acoustic analysis and formant frequency analysis (P>0.05). CONCLUSION: Septorhinoplasty with spreader grafts significantly improved patients' perception of voice; however, acoustic analysis and formant frequency analysis of nasalized vowels did not reveal any significant differences after the operation.

Microscopic bilateral posterior cordotomy in severe obstructive sleep apnea syndrome with bilateral vocal cord paralysis.

BACKGROUND: Vocal cord paralysis is a rare cause of obstructive sleep apnea syndrome (OSAS). Recurrent laryngeal nerve injury after thyroid gland surgery is one of the leading causes of acquired vocal cord paralysis. REPORT: A 46-year-old woman with OSAS due to bilateral abductor vocal cord paralysis was presented. She had thyroidectomy 30 years ago and had a weak, breathy voice. She had been referred with a history of high-pitched snoring, apnea witnessed by her spouse, and excessive daytime sleepiness for the last 5 years. Full-night polysomnography revealed that her apnea-hypopnea index was 72/h and minimal oxygen saturation level was 81%. There was no REM and deep sleep periods. Ear-nose-throat consultation offered an endoscopic bilateral posterior cordotomy operation via microscopic suspension laryngoscopy (MLS) as a treatment option. CONCLUSIONS: Instead of using a nasal positive airway pressure (nCPAP) device, she was treated surgically. Her OSAS resolved completely within 5 months of the surgery. Her phonation was preserved, and symptoms such as snoring and hypersomnolance disappeared. In OSAS patients with bilateral vocal cord paralysis, MLS-associated bilateral posterior cordotomy can be a choice of treatment as an alternative to nCPAP application.

[Reduction of the inferior turbinates with a microdebrider]. / Alt konkanin mikrodebrider ile redüksiyonu.

OBJECTIVES: We evaluated the results of submucosal microdebrider turbinate reduction in patients with inferior turbinate hypertrophy. PATIENTS AND METHODS: The study included 503 patients (190 females, 313 males; mean age 28 years; range 18-68 years) who underwent turbinate reduction by a microdebrider for inferior turbinate hypertrophy. The inferior turbinates were examined by anterior rhinoscopy and nasal endoscopy before and three weeks after surgery and their size was graded from I to III. Preoperatively, 384 patients had grade II, 119 patients had grade III inferior turbinates. Of the study group, 116 patients completed a follow-up of two years. RESULTS: At three weeks after surgery, none of the patients had grade III turbinates; 435 patients and 68 patients were evaluated as grade I and II, respectively. At the end of two years, none had grade III turbinates; 76 patients were grade I, 40 patients were grade II. Complaints of nasal obstruction disappeared in three weeks in 95% of patients and it did not recur in all 116 patients at the end of two years. In the early postoperative period, crusting was not observed and recovery was quick. The most common complication was mucosal tears (n=114, 22.6%). Bleeding was seen in only one patient (0.2%). CONCLUSION: Submucosal microdebrider turbinate reduction is a safe alternative procedure and provides rapid healing with low complication rates, especially postoperative crusting.

Combined use of histopathology with touch smear cytology in biopsies of the larynx.

The aim of this prospective study is to evaluate the effectiveness of combined use of histopathology with cytology in biopsies of the larynx. Biopsies taken for this purpose are studied by using two different methods and the results are evaluated. One hundred and thirty-five patients with suspected malignant laryngeal lesions were examined by direct microlaryngoscopy for primary diagnosis. Each lesion was biopsied first. Subsequently touch smear cytology was obtained from the biopsies. In all cases, cytologic slides (one or two per biopsy) were screened and compared to corresponding biopsies. Lesions were categorized as benign, laryngeal intraepithelial neoplasia and malignant. Results obtained were compared with surgical samples obtained from patients who have undergone surgery. In other cases, where surgery was not applied, results of the follow-up were evaluated. In larynx biopsies the results for histopathology were as follows: sensitivity 93.9%, specificity 100% and accuracy 96.3%. The results for cytology were as follows: sensitivity 82.5%, specificity 94.5% and accuracy 87.4%. A comparison of cytologic evaluation versus histopathologic evaluation in laryngeal biopsies reveals that histopathology is superior. According to the study results, in 88.9% (120/135) of the cases the agreement between cytological and histopathological results was found. In two other cases (1.5%) cytologic evaluation contributed to the histopathologic diagnosis.

Soft tissue response of the larynx to silicone, Gore-Tex, and irradiated cartilage implants.

OBJECTIVE: The aim of the study is to compare the efficiency of three different materials (Silicone, Gore-Tex, and irradiated cartilage) used in medialization laryngoplasty. Local tissue reaction to implants in laryngeal skeleton has been examined for this purpose. STUDY DESIGN AND METHODS: In this prospective study, New Zealand rabbits were used. Different materials have been implanted in the paraglottic space of both sides of the larynx to enable a better comparison of the different materials used. Limited medialization was applied. Special care has been taken not to narrow the airway and cause breathing problems. The reaction of the tissue in this region against the materials used has been studied. Each material was implanted 14 times in total. The rabbits were killed 6 months after the implementation to study their larynx. For each material, the fibrous capsule formation, histiocyte infiltration, foreign body giant cell infiltration, eosinophil infiltration, neutrophil infiltration, and lymphoplasmacytic infiltration levels were investigated histologically. RESULTS: Best fibrous capsule formation has been observed around silicone. Allergic reactions and inflammatory responses were minimal for this material. Fibrous capsule formation was more limited with Gore-Tex. Some degree of chronic inflammatory response (in few cases) has been observed against this material. Severe allergic response was observed against irradiated cartilage, and the implant material was resorbed completely in most cases. CONCLUSION: According to histopathologic results of this study (tissue compatibility of three materials), silicone is the most suited material among the study materials for medialization. Gore-Tex can also be used for this purpose. Irradiated cartilage, on the other hand, appears not to be a suitable material for medialization laryngoplasty.

Skin metastasis: an unusual localization from laryngeal carcinoma.

Skin metastasis from laryngeal carcinoma is rare and indicates a poor prognosis. A case of laryngeal carcinoma with unusual metastasis to the skin of the hand is reported. The patient underwent total laryngectomy, left radical neck dissection, and right functional neck dissection. After the operation, the patient received radiotherapy. In the postoperative 18th month, a mass was observed in the left hand. It was found to be a metastatic tumor from laryngeal carcinoma, histopathologically as well as immunohistochemically. Metastatic potential in malignant neoplasms is generally correlated with reduced cellular adhesiveness. We investigated the expression of the vascular endothelial growth factor (VEGF), matrix metalloproteinase-9 (MMP-9), and E-cadherin. Interestingly, the immunohistochemical expression characteristics of such an aggressive tumor were not positive.

Use of polyethylene terephthalate and expanded-polytetrafluoroethylene in medialization laryngoplasty.

Various materials have been used up to the present time in vocal fold augmentation. Although silicon has been the most frequently employed, the surgical difficulties encountered in shaping, positioning and placing this material have led to a search for a more easily applicable material. In our study, we investigated the local tissue reaction to implants in the laryngeal skeleton of 10 New Zealand rabbits in which we performed medialization laryngoplasty employing polyethylene terephthalate (PETP=Dacron) and expanded polytetrafluoroethylene (e-PTFE=Gore-Tex). When the local host tissue reaction to PETP and e-PTFE were compared, PETP was found to cause significant foreign body giant cell and histiocyte infiltration localized around fibres of the implant. The greater irregularity of the fibrous capsule formed in response to PETP and the density of foreign body giant cells around the PETP fibres suggested that resorption of the implant with time would decrease the degree of medialization.