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.

Concurrent medullary and papillary carcinoma of thyroid.

Simultaneous occurrence of papillary thyroid carcinoma (PTC) and medullary thyroid carcinoma (MTC) in the same thyroid gland is a rare condition. These tumors derive from different cells; PTC originates from follicular cells whereas MTC originates from parafollicular cells. Because of this, the treatment of these tumors also differs. This article describes two rare cases of the simultaneous occurrence of MTC and PTC in the thyroid gland.

Mucociliary transport and histopathological changes in rotation flaps of the nasal mucosa.

Normal mucociliary transport in the mucoperichondrium of the nasal septum is from a distal (anterior) to proximal (posterior) direction. This study was to determine the direction of mucociliary transport and histopathological changes in nasal mucosal rotation flaps when their transport directions were anatomically reversed. Thirty-two rabbits were divided into four groups. Surgical septal rotational flaps were prepared in the experimental groups. Group I was the control group. The distal aspect of the flap was sutured through a large septal window to the other side of the nasal septum, thus changing the direction of the flap. Evaluation was performed 1 week, 1 month and 9 months later with each of these groups named as groups II, III, and IV, respectively. The rate and direction of the mucociliary transport was determined and histopathological investigations were performed from the flaps. The direction of mucociliary transport was observed to continue as distal to proximal direction in the rotated segments. The mucociliary transport rate was found to be decreased in group II, nearly normal in group III, and in normal limits in group IV after surgery. Intense inflammation and decreased number of cilia were present in group II. The inflammation was milder in group III and the epithelium was found to be nearly normal in group IV. The originally programmed direction of mucociliary transport in the nasal rotation flaps is maintained and is not altered or reprogrammed. Histopathological changes revert back to normal from an inflammatory state to reach pre-surgical status over time.

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.

Efficacy of dexpanthenol for pediatric post-tonsillectomy pain and wound healing.

OBJECTIVES: We evaluated the efficacy of dexpanthenol in managing pediatric post-tonsillectomy pain and wound healing and sought to discover which of two surgical tonsillectomy techniques provides better healing and less postoperative pain. METHODS: One hundred twenty patients who underwent tonsillectomy were equally randomized to thermal welding and cold dissection groups. Dexpanthenol pastilles were given to half of each group. Postoperative throat pain was determined with a visual analog scale on the 1st, 3th, 7th, and 14th days, and mucosal healing patterns were assessed on the 7th and 14th days. RESULTS: Regardless of surgical technique, post-tonsillectomy throat pain was significantly less in the dexpanthenol groups than in the placebo groups (p < 0.05), and tonsillar wound healing was significantly better in the dexpanthenol groups than in the placebo groups (p < 0.05). When a comparison was made with regard to surgical technique, wound healing was significantly better in the cold dissection group (p < 0.05), whereas postoperative throat pain was less in the thermal welding group (p < 0.05). CONCLUSIONS: Postoperative administration of dexpanthenol significantly accelerates the wound healing process and decreases tonsillectomy-related pain complaints.

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.

Does cooling the tonsillar fossae during thermal welding tonsillectomy have an effect on postoperative pain and healing?

The objective of this study was to evaluate the effect of cooling the tonsillar fossa during thermal welding tonsillectomy on pain and wound healing. Prospective, blinded, clinical study was conducted. 30 patients who underwent tonsillectomy by thermal welding were evaluated. When one of the tonsillar fossa was cooled by isotonic fluid, the other has left untreated. Postoperative pain and mucosal healing pattern were assessed. Data were recorded and statistically analyzed. Healing process of the cooled down tonsillar fossae were significantly better on the 7th and 14th postoperative day (p < 0.01). Control tonsillar fossae had significantly higher pain scores on the 3rd, 7th and 14th postoperative day (p < 0.05). Administration of isotonic fluid, during thermal welding tonsillectomy for cooling tonsillar fossae, accelerates wound-healing process significantly and decreases tonsillectomy related pain complaints post-operatively.

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.

Endoscopic orbital decompression of an isolated medial orbital wall fracture: a case report.

Motor vehicle and bicycle accidents are the most common causes of blunt head trauma. Other common etiologies are falls, physical violence, and sports accidents. Blunt trauma toward the superior orbital rim, lateral orbital rim, frontal region, and cranium may lead to intraorbital hematoma. A fracture following the blunt head trauma may form a one-way valve, which leads to orbital emphysema and a more pronounced increase in orbital pressure. Increased tissue pressure in an enclosed space will eventually lead to an inevitable decrease in tissue perfusion. It is important to treat the patient within the first 48 hours following the trauma, which is accepted as the "critical period." In this report we present a case involving a 42-year-old man who was admitted to our clinic with left periorbital pain, edema, proptosis, and blurred vision after experiencing physical violence. The medical history and physical examination findings, along with imaging studies and a description of the endoscopic orbital decompression procedure within the first 24 hours, are reported.

Thermal welding vs. cold knife tonsillectomy: a comparison of voice and speech.

OBJECTIVE: To compare acoustic, aerodynamic and perceptual voice and speech parameters in thermal welding system tonsillectomy and cold knife tonsillectomy patients in order to determine the impact of operation technique on voice and speech. METHODS: Thirty tonsillectomy patients (22 children, 8 adults) participated in this study. The preferred technique was cold knife tonsillectomy in 15 patients and thermal welding system tonsillectomy in the remaining 15 patients. One week before and 1 month after surgery the following parameters were estimated: average of fundamental frequency, Jitter, Shimmer, harmonic to noise ratio, formant frequency analyses of sustained vowels. Perceptual speech analysis and aerodynamic measurements (maximum phonation time and s/z ratio) were also conducted. RESULTS: There was no significant difference in any of the parameters between cold knife tonsillectomy and thermal welding system tonsillectomy groups (p>0.05). When the groups were contrasted among themselves with regards to preoperative and postoperative rates, fundamental frequency was found to be significantly decreased after tonsillectomy in both of the groups (p<0.001). First formant for the vowel /a/ in the cold knife tonsillectomy group and for the vowel /i/ in the thermal welding system tonsillectomy group, second formant for the vowel /u/ in the thermal welding system tonsillectomy group and third formant for the vowel /u/ in the cold knife tonsillectomy group were found to be significantly decreased (p<0.05). CONCLUSIONS: The surgical technique, whether it is cold knife or thermal welding system, does not appear to affect voice and speech in tonsillectomy patients.

Effects of the acute exposure to the electromagnetic field of mobile phones on human auditory brainstem responses.

The purpose of this study was to evaluate the short-term effects of the electromagnetic fields (EMF) of mobile phones on human auditory brainstem responses. This prospective study of healthy adults evaluated the influence of EMF. Eighteen healthy adult volunteers participated in this study. Mobile telephones emitting signals in the region of 900 MHz and with the highest SAR value of 0.82 W/kg were positioned in direct contact to the right ear, which was exposed to the phone signal for 15 min before and after ABR testing with click stimuli of 60 and 80 dB nHL intensities. The latencies of the waves and interwave latencies were measured on screen by an experienced audiologist. The differences of the mean latencies of waves I, III and IV were not significant in initial and post-exposure ABR measurements at both 60 and 80 dB nHL stimulus levels ( P >0.05). Similarly, differences of the mean interwave intervals I-III, I-V and III-V remained insignificant at the initial and postexposure ABR measurements at stimulus levels of both 60 and 80 dB nHL ( P >0.05). Acute exposure to the EMF of mobile phones does not cause perturbations in ABR latencies. However, these negative results should not encourage excessive mobile communication, because minor biological and neurophysiological influences may not be detectable by the current technology.