Comparison of the result of consolidative technique otoplasty and incisionless otoplasty in the repairs of prominent ears.

We aimed to compare the long-term results of complications of consolidative technique otoplasty (CTO) and incisionless otoplasty (IO). The study consists of 156 patients who were operated between 2006 and 2015. According to surgical techniques, these patients were divided into two groups as IO group and CTO group. The distance between the head and the ear was assessed by measuring the four points preoperatively and postoperatively (SUP: most superior helical point, SCA: superior conchal attachment, ICA: inferior conchal attachment, and lobule). Early and late postoperative complications, operative time were recorded. 128 ears in IO group, 163 ears in CTO group were prominent. When postoperative SUP, SCA, ICA, lobule values for right and left ears in both groups were statistically evaluated, it was found that CTO technique has led to significantly greater improvement compared to the IO technique (p < 0.001). The success rate in IO technique and CTO technique was 72 and 96 %, respectively. Early complications were similar in both groups. The late period complication determined much more frequently was seen in the IO group. Concerning operative time, it was identified as significantly lower in the IO group (p < 0.001). The early-term outcomes of both techniques were similar; however, the complication rates due to suture material and needed for revision in IO technique were higher whereas CTO technique was more permanent with lower complication risks.

Systemic side effects of locally used oxymetazoline.

OBJECTIVES: The object of the study is to experimentally investigate the possible systemic side effects of Oxymetazoline including its nasal spray which has been in use for a long time both by the physicians and patients. There is no study in the literature to address the damages of oxymetazoline on the end organ. MATERIALS AND METHODS: The study conducted on 2 groups of rat. Group 1 (n = 8): Control; and Group 2 (n = 8): Oxymetazoline. During 4 week, the control group was applied with 2 drops of saline water on each nasal cavity 3 times a day and the other group was applied with 2 drops of oxymetazoline HCl 3 times a day. At the end of experiment, samples from mandible, parotid and tails of the rats were taken in 10% formalin for histopathological investigations. RESULTS: In histopathological experiments, when compared with the control group, the oxymetazoline group showed significant increase in many of the histopathological parameters (ischemic changes: P = 0.0001; congestion: P = 0.0006; arterial thrombosis: P = Ns; PNL accumulations: P = 0.001; necrosis: P = 0.0001; and ulceration: P = 0.014). The results of histopathologic tests on the samples taken from mandible and parotid gland, in comparison with the control group, showed no significant increase (focal inflammation: P = Ns; and lymphocyte aggregation: P = Ns). CONCLUSION: Due to the damage that the long-term use of nasal spray including oxymetazoline, it may cause injury on the end organ, which we revealed in our histopathological experiments. We believe that it's essential for the physicians to provide information on the side effects of the medicine to their patients who use for a long term.

Higher frequency of methicillin resistant bacteria in children with familial mediterranean fever.

OBJECTIVE: To investigate resistant microorganisms in nasal mucosa of children with Familial Mediterranean Fever. METHODS: The study was conducted from March to May 2013 at Mustafa Kemal University, Turkey, and comprised children with Familial Mediterranean Fever and healthy controls. All subjects had no history of antibiotic or local and/or systemic steroid use within the preceding 2 weeks. Nasal swab samples were obtained from all the subjects. Strain identification was done by using standard methods. SPSS 13 was used for statistical analysis. RESULTS: Of the 151 subjects in the study, 73 (48.34%) were cases and 78 (51.65%) were controls. Among the cases, there were 26(35.6%) girls, while among the controls, there were 40(51.3%) girls (p=0.052). The mean age of the cases was 7.78 ± 3.34 years (range: 3-15 years), while it was 8.15 ± 2.71 years (range: 3-16) among the controls (p = 0.208). Methicillin-resistant coagulase-negative staphylococcus and methicillin-resistant staphylococcus aureus were isolated in both the groups. The growth rate of resistant bacteria was 63% (n = 46) in the cases, in the controls (p = 0.003; odds ratio [OR]: 2.7; 95% confidence interval [CI]: 1.4-5.2). Among the controls, history of hospitalisation increased the risk for the presence of resistant bacteria by 7.7 fold (OR: 7.7; 95% CI: 1.4-40.4). CONCLUSION: Higher rates of resistant bacteria showed that they were at risk of comorbidities related to antibiotic resistance.

A novel tumor suppressor gene in basal cell carcinoma: inhibition of growth factor-2.

In loss of heterozygosity (LOH) studies at the chromosome 4q22-35 region, it was shown that the amount of deletion was high in basal cell carcinoma (BCC). It has been proposed that genes located in this chromosomal region could be tumor suppressor genes in BCC. It has been thought that deletions in the ING2 gene located in the same region can play a role in the pathophysiology of BCC and that deletions occurring in this region may influence the level of ING2 expression in BCC. Tumoral and non-tumoral tissues from 75 patients with BCC (45 men and 30 women) were included to the study. Lesions were excised by a surgical margin of 0.5 cm. After excision, RNA was isolated from tumoral and non-tumoral tissue samples. ING2 messenger RNA (mRNA) expression level was determined in tumoral and non-tumoral tissues by the real-time polymerase chain reaction (RT-PCR). It was detected that ING2 mRNA expression level decreased in tumoral tissues when compared to non-tumoral tissues from BCC patients (p = 0.0001). It was found that expression levels of this gene were comparable among patients with primary, recurrent, or multiple BCC. It is thought that ING2 gene expression level could contribute to the development of BCC but not be associated with the stage and the prognosis of the tumor.

The effect of width of facial canal in patients with idiopathic peripheral facial paralysis on the development of paralysis.

The aim of this prospective study is to investigate whether the possible stenosis due to anatomic variations of labyrinthine segment (LS), tympanic segment (TS) and mastoid segment (MS) of the facial canal in the temporal bone is a predisposing factor in the development of paralysis. 22 patients with idiopathic peripheral facial paralysis (IPFP) were included in the study. Multi-slice computed tomography (MSCT) with 64 detectors was used for temporal bone imaging of the patients. Reconstruction images in axial, coronal and sagittal planes were created in workstation computers from the captured images. The diameters and lengths of LS, TS and MS of the facial canal were measured. The mean values of LD, ND and SL of LS were 1.31 ± 0.39, 0.91 ± 0.27, 4.17 ± 0.48 in patient group and 1.26 ± 0.29, 0.95 ± 0.21, 4.60 ± 1.36 in control group, respectively. The mean values of LD, ND and SL of TS were 1.11 ± 0.22, 0.90 ± 0.14, 12.63 ± 1.47 in patient group and 1.17 ± 0.23, 0.85 ± 0.24, 12.10 ± 1.79 in control group, respectively. The mean values of LD, ND and SL of MS were 1.80 ± 0.30, 1.44 ± 0.29 vs. 14.3 ± 1.90 in patient group 1.74 ± 0.38, 1.40 ± 0.29, 14.15 ± 2.16 in control group, respectively. The measurements of the parameters of all three segments in patient group and control group were similar. Similar results between patient and control group were obtained in this study investigating the effect of stenosis in facial canal in the development of IPFP.

Effect of carboxyhemoglobin on postoperative complications and pain in pediatric tonsillectomy patients.

BACKGROUND: Carbon monoxide (CO) is a product of burning solid fuel in stoves and smoking. Exposure to CO may provoke postoperative complications. Furthermore, there appears to be an association between COHb concentrations and pain. We thus tested the primary hypothesis that children with high preoperative carboxyhemoglobin (COHb) concentrations have more postoperative complications and pain after tonsillectomies, and secondarily that high-COHb concentrations are associated with more pain and analgesic use. METHODS: 100 children scheduled for elective tonsillectomy were divided into low and high carbon monoxide (CO) exposure groups: COHb ≤3 or ≥4 g·dl(-1) . We considered a composite of complications during the 7 days after surgery which included bronchospasm, laryngospasm, persistent coughing, desaturation, re-intubation, hypotension, postoperative bleeding, and reoperation. Pain was evaluated with Wong-Baker Faces pain scales, and supplemental tramadol use recorded for four postoperative hours. RESULTS: There were 36 patients in the low-exposure group COHb [1.8 ± 1.2 g·dl(-1) ], and 64 patients were in the high-exposure group [6.4 ± 2.1 g·dl(-1) ]. Indoor coal-burning stoves were reported more often by families of the high- than low-COHb children (89% vs 72%, P < 0.001). Second-hand cigarette smoke exposure was reported by 54% of the families with children with high COHb, but only by 24% of the families of children with low COHb. Composite complications were more common in patients with high COHb [47% vs 14%, P = 0.0001, OR:7.4 (95% Cl, lower = 2.5-upper = 21.7)], with most occurring in the postanesthesia care unit. Pain scores in postanesthesia care unit and one hour after surgery were statistically significantly lower in the low-exposure group [respectively, P = 0.020 (95%CI, lower = -1.21-upper = -0.80), P = 0.026 (95% CI, lower = -0.03-upper = 0.70)], and tramadol use increased at 4 h (3.5 (interquartile range: 0-8) vs 6 (5-9) mg, P = 0.012) and 24 h (3.5 (0-8) vs 6 (5-9) mg, P = 0.008). CONCLUSION: High preoperative COHb concentrations are associated with increased postoperative complications and pain.

Determination of oxidative stress and effect of erdosteine on rhinitis medicamentosa in a rat model.

We aimed to determine the presence of oxidative stress in rhinitis medicamentosa (RM) and to evaluate the effect of erdosteine (ED) on mucosal changes in a rat model. Twenty-four male rats were used in this experimental study. Three groups were created. Group 1 (n=8) was the control group. Two puffs of 0.05% oxymetazolin were sprayed into the nasal cavities of the remaining rats (n=16) three times daily for eight weeks. One of these 16 rats was scarified at the end of the eight weeks and examined to confirm the presence of RM. Seven of the remaining 16 rats were killed, and venous blood samples were taken (Group 2). Group 3 (n=8) received 10mg/kg of an ED suspension orally for seven days. All rats were put on formalin for light microscopy. The total antioxidant status (TAS) was similar in all groups (p=0.073). The total oxidative status (TOS) of the RM group was significantly higher than that of the control group and RM+ED group (Group 3) (p=0.003 and p=0.011, respectively). The pathological recovery of the nasal mucosa of the rats was similar in the RM+ED and control groups. The TOS was high in this RM rat model, and oxidative stress was associated with RM. ED significantly ameliorated nasal mucosal changes induced by RM, suggesting that oxidative stress may play an important role in the pathophysiology of this condition.

[An unusual Wohlfahrtia magnifica myiasis case localized in cutaneous and subcutaneous tissues in a patient with head-neck cancer]. / Bas Boyun Kanserli Hastada Kutaneöz ve Subkutaneöz Yerlesimli Siradisi Wohlfahrtia magnifica Vakasi.

Auricular tumors constitute 6% of all head-neck tumors. Malignant tumors of the auricula are generally squamous or basal cell carcinomas. Myiasis rarely occurs in healthy individuals. In general, it is a parasite that is seen in patients with mental retardation or psychiatric disorders, elderly individuals, those with poor self-care and hygiene, and those with immune system disorders. In humans, it is mainly seen in tropical and subtropical regions; however, in rare instances, it may be seen in other regions of the world. In the literature, there are limited numbers of myiasis cases reported from Turkey. In this study, we aimed to present a myiasis case (Wohlfahrtia magnifica) involving cutaneous and subcutaneous tissues with an underlying head-neck cancer, which, to the best of our knowledge, has not been reported before in the literature.

Pseudoaneurysm of the carotid arterial system.

Pseudoaneurysms of internal, external, and common carotid arteries are seen rarely. Blunt traumas caused by automobile accidents are the prior reasons to this. Central venous catheterization, ballistic trauma, cystic medial necrosis, fibromuscular dysplasia, atherosclerosis, and other inflammatory processes are some other potential reasons for pseudoaneurysm. In contrast to true aneurysms, it does not contain 3-layer structure with adventitia, media, and intima sublayers in its wall. The wall contains coagulum and fibrous capsules. Clinically, after trauma, it presents itself as swelling after days to weeks of damage to vascular walls. Because it causes morbidity and mortality when it is ruptured, It should be treated via surgical or vascular intervention.

Perioperative difficulties and early postoperative complications of transoral approach in mouth base surgery.

OBJECTIVE: The aim of this study was to discuss perioperative difficulties and temporary or permanent complications that can be seen at early postoperative period in cases undergoing transoral surgical approach for disorders of mouth base. STUDY DESIGN: The study included 19 patients undergoing transoral surgical approach between September 2011 and January 2013 who were retrospectively evaluated. Exclusion criteria were patients with malign submandibular gland tumor or other suspected tumors at mouth base, those with a benign solid mass larger than 10 × 10 cm, and those who did not accept the transoral approach. RESULTS: Mean age was 28.47 ± 17.89 years (range, 8-76 years) in 19 patients included (9 male and 10 female subjects). Of these, submandibular gland excision was performed in 9 cases, whereas thyroglossal duct cyst excision was performed in 3 (2 transfrenulum approach and 1 lateral lingual approach), lymphangioma excision in 1, diagnostic lymph node excision at the posterior of submandibular gland in 3 cases, and dermoid cyst excision (2 with midline and 1 with left submandibular localization) in 3 cases. Perioperative difficulties included dissection problems due to adhesion, partial adhesion between Wharton canal and lingual nerve, fragmented dissection of the gland, capsule rupture of submandibular adenoma, and facial artery rupture. While visualization of surgical field and retraction of mouth base muscles are an important issue in midline approaches, resection of hyoid bone corpus is challenging in lateral approaches. Early postoperative complications included edema at mouth base, lingual ecchymosis, and postoperative temporary abnormal tongue sensation. CONCLUSIONS: Transoral mouth base surgery is a safe approach in selected patients. Permanent injuries of neural structures are rarely encountered, which is considered as a concern by head and neck surgeons. Temporary complications are at a level that can be tolerated by patients.

Identification of nasal bacterial flora profile and carriage rates of methicillin-resistant Staphylococcus aureus in patients with allergic rhinitis.

The aim of the present study was to evaluate the effect of allergic rhinitis (AR) on the nasal flora and colonization rates of resistant microorganisms in comparison to healthy individuals. This colonization may be important in terms of AR-related disorders, the resistant microorganisms' carriage, and its complications and co-morbidities. The study was performed with two groups. The study group was composed of 54 adult patients with AR. The control group was composed of 50 healthy individuals. None of the individuals in both groups have used any antibiotics, local or systemic steroid within the last month. Composition of bacterial nasal flora and carriage rates of methicillin-resistant Staphylococcus aureus (MRSA) were evaluated with conventional methods by taking nasal smears with a swab. In the study group, methicillin-sensitive coagulase-negative staphylococci (MRCNS) were detected in 30%; whereas diphtheroids in 25%, methicillin-resistant coagulase-negative staphylococci in 13%, methicillin-sensitive S. aureus in 9%, methicillin-resistant S. aureus in 3.7%, and extended-spectrum beta lactamases-positive gram-negative bacilli (GR-ESBL+) in 3.7% were detected. In the control group, methicillin-sensitive coagulase-negative staphylococci were detected in 54%; whereas diphtheroids in 21%, methicillin-resistant coagulase-negative staphylococci in 1.5%, methicillin-sensitive S. aureus in 16%, methicillin-resistant S. aureus in 1.5%, Gr-ESBL(-) in 4%, and viridians streptococci in 3% were detected. It is found that the MRSA and MRCNS colonization is higher in patients with AR. This colonization may be important in terms of AR-related disorders, the resistant microorganisms' carriage, and its complications and co-morbidities in comparison to healthy subjects.

Treatment of displaced mandibular condylar fracture with botulinum toxin A.

The aim of this case report is to discuss the effect on condylar reduction of botulinum toxin A treatment used in a child with displaced fracture at condylar neck of mandible. A 3-years old boy was admitted to our clinic for incomplete fracture of mandibular symphysis and displaced condylar fracture at the left side. An asymmetrical occlusal splint with intermaxillary fixation was used instead of open reduction and internal fixation because of incomplete fracture of symphysis and possible complications of condyle surgery. However, it was observed that condylar angulation persisted despite this procedure. Thus, botulinum toxin A was administered to masseter, temporalis and pterygoideus medialis muscles. At the end of first month, it was seen that mandibular condyle was almost completely recovered and that fusion was achieved. In conclusion, Botulinum A toxin injection aiming the suppression of masticatory muscle strength facilitates the reduction in the conservative management of displaced condyle in pediatric patients.

The reflection of the Syrian civil war on the emergency department and assessment of hospital costs.

BACKGROUND: In the present study, it was aimed to assess the demographics, clinical features, and treatment costs of cases referred to our hospital after the Syrian civil war. METHODS: Of 1355 Syrian civil war victims referred to our hospital during the 14-month period between June 2011 and July 2012, 482 cases presenting to the emergency department were included in the study. The electronic data of these patients were retrospectively analyzed. RESULTS: Of 482 cases, 428 were male (88.8%) and 54 (11.2%) were female, with a mean age of 30.4±14.9 years (1-79 years). The mean age was 30.8±17.2 years (1-79 years) in males and 27.3±16.9 years (1.5-66 years) in females. There was a significant difference in terms of sex (p=0.007). It was found that the majority of the cases (41.1%) were aged 21-30 years. The highest number of admissions was recorded in June 2011 (159 patients, 33%), whereas the lowest number of admissions was in September 2011 (5 patients, 1%). All cases were transported to our hospital from nearby district hospitals and camps by emergency medical services. The most frequent presenting complaint was gunshot injury (338 cases, 70.1%). The most common diagnosis was extremity injury (153 cases, 31.7%). The number of forensic cases was found as 364 (75.5%). Of all the cases, 136 cases (28.2%) were managed in the emergency service, and the remaining cases were admitted to other services. They were most frequently admitted to the orthopedics ward (146 cases, 30.3%). The mean length of the hospital stay was 9.9 days (1-141).Overall, 456 cases (94.6%) were discharged, 22 cases died, and 4 cases were transferred to other facilities. The mean cost per case was estimated as 3723Turkish lira (TL) (15-69556). A positive correlation was found between cost and length of hospital stay. CONCLUSION: Among all Syrian cases, the majorities of young males and gunshot injuries was striking. Most of the cases were discharged after appropriate management. Preventive measures can avoid these negative outcomes and so avoidable costs will not occur, and this can preclude the damage to the budgets of the countries.

Determination of hearing levels in patients with Familial Mediterranean Fever.

OBJECTIVE: Familial Mediterranean Fever is the most common congenital, periodic fever condition that affects over 100,000 people worldwide. In the literature, there is limited number of studies about hearing levels in children with Familial Mediterranean Fever. In the present study, we aimed to investigate hearing levels and cochlear functions by using Distortion product Otoacoustic Emission and High Frequency Audiometry (250-20,000 Hz) in pediatric patients with Familial Mediterranean Fever. METHODS: The study included 62 children with Familial Mediterranean Fever and 27 healthy children with similar age and gender. After otoscopic examination, both groups underwent audiological evaluation including High Frequency Audiometry (250-20,000 Hz) and Distortion product Otoacoustic Emissions. The results obtained were assessed among groups. In addition, these results were compared regarding colchicine use, age at the onset of disease and duration of the diseases in the Familial Mediterranean Fever group. RESULTS: Of the Familial Mediterranean Fever patients, 93.5% were on colchicine therapy and mean duration of colchicine use was 19.9 ± 13.9 months. The mean age at diagnosis was 6.57 ± 2.86 years (min-max: 2-14) and mean duration of disease was 23 ± 17 months (min-max: 6-84). Pure tone audiometry values, and hearing levels between 9000 and 20,000 Hz were similar and within normal range in both groups. The Distortion product Otoacoustic Emissions responses at the frequencies of 1020, 2040, 3000, 4080 and 5040 Hz were similar for both groups. CONCLUSION: To the best of our knowledge, this is the first study evaluating hearing levels at the frequencies of 18k Hz and 20k Hz in children with Familial Mediterranean Fever in the literature. In children with Familial Mediterranean Fever, Pure tone audiometry values, hearing values obtained at all frequencies from 250 to 20,000 Hz, and Distortion product Otoacoustic Emissions levels were within normal range. Furthermore, hearing levels were found to be similar to those in healthy children.

Oxidative stress in chronic otitis media.

Chronic otitis media usually presents with a benign tumor-like lesion of the temporal bone known as a cholesteatoma. The role of oxidative stress in the pathogenesis of chronic otitis media and cholesteatoma has not yet been fully explored. Therefore, the aim of this study was to investigate the oxidative stress markers and antioxidant enzymes in patients with cholesteatomatous and noncholesteatomatous chronic otitis media and in healthy subjects. A prospective controlled trial was performed on cholesteatomatous and noncholesteatomatous chronic otitis media patients in a tertiary referral center in a university hospital. A total of 75 subjects, including 25 cholesteatomatous and 25 noncholesteatomatous chronic otitis media patients and 25 healthy subjects participated in this study. Serum total oxidant status (TOS) and oxidative stress index (OSI) levels were significantly increased in the patient groups with or without cholesteatoma compared with the control group. Serum total antioxidant status (TAS) levels and Paraoxonase and arylesterase activity were significantly lower in the patient groups with or without cholesteatoma compared with the control group. Serum TOS and OSI levels were lower in the noncholesteatomatous group, whereas serum TAS levels were higher compared with the cholesteatomatous group. Serum arylesterase activity was significantly lower in the noncholesteatomatous group compared with the control group. The results of this study reveal that in cholesteatoma cases, the oxidative stress and antioxidant enzyme imbalance were more significant than in cases of chronic otitis media without cholesteatoma.

The relationship between posterior septum deviation and depth of maxillopalatal arch.

OBJECTIVE: To investigate the relationship between depth of maxillopalatal arch and deviation of posterior septum. METHODS: This study is based on paranasal sinus CT (PNSCT) scan in the coronal plane evaluation, and sinus paranasal scans were obtained from the database. One-hundred and fifty PNSCT scans were randomly chosen among the PNSCT scans which belong to adult (18 and older) patients. All scans were divided to three different groups. The first group constituted by those patients who had more convex deviation. The second group had those patients with either crest or spur deviations. The last group (control group) had no septum deviation. The data collected from each group were statistically compared. EXCLUSION CRITERIA: CT imaging which has a chronic sinusitis, nasal cavity mass, and nasal polyps. MAIN OUTCOME MEASURES: angle and distance measures were taken on maxillopalatal arch and posterior nasal septum. RESULTS: Strongly positive correlation between posterior septum deviation and depth of maxillopalatal arch was determined (r=0.479, p=0.001). CONCLUSION: These findings suggest that posterior septum deviations are considered as a result of increase in maxillopalatal depth.

Intraorbital isolated mucocele.

A 55-year-old man was presented with an orbital mass. The magnetic resonance imaging revealed that the dimensions of the mass were 29×19×17 mm. The most probable diagnosis with the magnetic resonance imaging findings was dermoid cyst. The mass was a cyst and marsupialized by functional endonasal endoscopic sinus surgery without any complication. Intraoperative findings of the mass were thought to be a hydatid cyst, but the diagnostic tests were negative, and the pathologic result was consistent with mucocele.

Giant pleomorphic adenoma of the nasal septum.

Pleomorphic adenoma is the most common benign tumor of the salivary glands, mainly arising from major salivary glands such as parotis and submandibular gland. In rare cases, however, pleomorphic adenoma presents in various unusual sites such as the nasal cavity, paranasal sinuses, hypopharynx, pharynx, larynx, trachea and lacrimal glands. We present a rare case of 80-year-old woman with pleomorphic adenoma of the nasal cavity.

Comparison of the effects of low-flow and high-flow inhalational anaesthesia with nitrous oxide and desflurane on mucociliary activity and pulmonary function tests.

BACKGROUND AND OBJECTIVES: The aim of this study was to investigate the effects of inhalational anaesthesia using low and high gas flow rates of nitrous oxide and desflurane on mucociliary clearance and pulmonary function. METHODS: Fifty adult patients of the American Society of Anesthesiologists physical status I-II, aged between 18 and 70 years, were recruited to the study. Patients were assigned randomly to one of two study groups. The fresh gas flow rate was 1 l min(-1) (0.5 l min(-1) O2 + 0.5 l min(-1) N2O + desflurane) in group 1 and 3 l min(-1) (1.5 l min(-1) O2 + 1.5 l min(-1) N2O + desflurane) in group 2. Patients' haemodynamic parameters and changes in the humidity and temperature of the inspired gases were recorded and the saccharin clearance time was measured before and after anaesthesia. Respiratory parameters, body temperature, end-tidal CO2 concentration and inspired and expired oxygen and nitrous oxide concentrations were also recorded. RESULTS: The forced vital capacity and forced expiratory volume in 1 s were significantly lower and the saccharin clearance time was significantly longer in group 2 compared to group 1 (P < 0.05). There were statistically significant differences between the groups regarding the humidity and temperature of the inspired gases (P < 0.05). CONCLUSION: Respiratory function and mucociliary clearance are better preserved in a low-flow anaesthesia technique than in high-flow anaesthesia with nitrous oxide and desflurane. Therefore, a low-flow anaesthesia technique with nitrous oxide and desflurane may provide an important clinical advantage because it provides appropriately heated and humidified gases to the tracheobronchial tree.