Comparative Survival Function in Patients with Positive Surgical Margins Following Laryngectomy.

Aims: This study aims to make a comparative analysis of disease-free survival (DFS) and overall disease-specific survival (OS) in patients with laryngeal carcinoma. Materials and methods: The study was designed retrospectively. Sixteen patients with postoperative PSM and 30 with negative surgical margins (NSM) were included. Survival analysis and Long-Rank comparisons was performed for DFS and OS between groups. Results: PSM was a significant independent risk factor for loco-regional recurrence and disease-related mortality (p = 0.004, HR: 1.6, p = 0.002, HR: 3.2, respectively). DFS and OS were significantly longer in NSM group (p = 0.001 and 0.003, respectively). For PSM group, 2- and 5-year DFS rates were 57%; OS rates were 80% and 34% respectively. In NSM group, 2- and 5-year DFS rates were 96% and 83%; OS rates were found to be 96%. Conclusion: PSM had significant relation with poor prognosis.

Inferior Turbinate Bone Graft for Dorsal Augmentation in Rhinoplasty.

The most serious form of nasal dorsum pathologies is saddle nose deformity. Vary of nasal dorsal augmentation grafts were reported in the literature but inferior bone graft (ITBG) alone has not attracted attention. The ITBG has advantages such as easy and fast harvesting, easy to shape due to cancellous bone tissue. The graft technique is similar to the inferior turbinoplasty with the medial mucosal flap technique and can be performed without bioabsorbable hemostatic material (e.g. Turkish Delight), suture fixation, or without tissue adhesives. Major complications of the ITBG technique are injury of the posterior lateral nasal branch of the sphenopalatine artery and subdermal mucous cyst that developing on nasal dorsum. Since easy application, fast harvesting, and similar permanence to cartilage grafts as augmentation material, ITBG can also been used successfully in minor dorsal deficits in addition to saddle nose deformities.

Lacrimal Sac Anterior Border-Maxillary Line Distance: Effect on Endoscopic Dacryocystorhinostomy (EDCR) Surgery Results and NLDO-SS Questionnaire.

This study aimed to investigate the effect of the maxillary line (ML)-lacrimal sac anterior border (LSA) distance on the results of endoscopic dacryocystorhinostomy (EDCR) operation. The study was designed retrospectively. The distance between LSA and ML was measured from preoperative paranasal sinus computed tomography (PNSCT) images. Nasolacrimal duct obstruction symptom score (NLDO-SS) was calculated before and after surgery. The endoscopically proven of the transition of the 2% fluorescein drop instilled into the eye to the nasal passage accepted as a surgical success. 47 patients included in the study and eight of them underwent bilateral EDCR. The average age of the patients was 50.3 ± 14.8. The LSA-ML distance was 4.2 ± 1.0 mm in all patients. The duration of surgery was found as 38.1 ± 6.1 min for each side. The preoperative NLDO-SS mean was 54.9 ± 11.7 and 22.2 ± 12.1 postoperatively (p = 0.000, CI = 28.9-36.2). Six patients (11%) required revision surgery. A statistically significant high positive correlation was found between duration of surgery and LSA-ML distance (p = 0.000, r = 0.840). There was a significant negative correlation between the duration of surgery and postoperative NLDO-SS (p = 0.041, r = -0.276). The LSA-ML distance calculated in this study was found to be significantly associated with the decrease in the duration of surgery and the NLDO-SS score obtained after surgery. However, more valid results can be obtained if similar studies are carried out in larger samples containing a sufficient number of revision cases.

Anterior Palatoplasty With Expansion Sphincter Pharyngoplasty for All Type of Pharyngeal Collapse.

OBJECTIVES/HYPOTHESIS: This study was aimed to compare the efficiency of the anterior palatoplasty and expansion sphincter pharyngoplasty (APwESP) technique for all patterns of velopharyngeal obstruction (anterior-posterior [APPC], lateral [LPC], or combined circular pharyngeal collapse [CPC]). STUDY DESIGN: The study was designed as a randomized prospective trial at Kâtip Çelebi University, Atatürk Training, and Research Hospital. METHODS: Patients only with velopharyngeal obstruction were included. Three groups were created according to the obstruction pattern (APPC, LPC, and CPC) for the study. Outcome parameters included patient's demographics, apnea-hypopnea index (AHI), lowest oxygen saturation (LOS), Stanford subjective scale of snoring (SSSS), and Epworth sleepiness scale (ESS). RESULTS: Thirty-one (34.1%) patients were in APPC group, while 30 (33.0%) patients were in LPC, and 30 (33.0%) were in CPC group. Preoperatively for all patients, on average, AHI was 33.4 ± 13.6, SSSS was 8.3 ± 1.0, ESS was 16.5 ± 2.6, and LOS was determined as 85.5 ± 3.6. There was a significant postoperative improvement in all parameters for all patients. There was no significant difference in outcome parameters between the groups according to obstruction pattern postoperatively. After APwESP surgery, obstruction pattern was not a significant factor for AHI (P = .234), SSSS (P = .180), and LOS (P = .280) (repeated measure analysis of variance test). The rate of surgical success was detected similarly for both of the study groups (P = .435). The rate of successful surgery for severe obstructive sleep apnea in the APPC group was 72.2%, 88.2% in the LPC group, and 75.0% in the CPC group (P = .472). CONCLUSION: A combination of APwESP surgery can manage all types of pharyngeal obstruction confidently. LEVEL OF EVIDENCE: 3 Laryngoscope, 132:1313-1319, 2022.

The Wheel-Shaped Composite Cartilage Graft for Type 1 Tympanoplasty: Comparison with Palisade and Island Cartilage Graft.

This study aims to compare the graft success and hearing results of the palisade and island cartilage graft, with wheel-shaped composite cartilage graft (WsCCG) for type 1 tympanoplasty. The study was designed retrospectively. Only patients with conductive hearing loss and simple pars tensa perforation of the tympanic membrane were included in the study. Pure tone average (PTA), air-bone gap gain (ABG), word recognition score (WRS), ABG closure and grafts success were compared between the graft groups. Records of 111 patients were analyzed. The graft success rate was 89.7% for palisade cartilage graft (PCG, n = 39), 86.1% for island cartilage graft (ICG, n = 36), and 97.2% for wheel-shaped composite cartilage graft (WsCCG, n = 36) (p = 0.244). Average postoperative PTA and ABG values were significantly affected by the cartilage graft type, but WRS was not affected. (p = 0.005, 0.019, 0.306, respectively, One Way-Anova test). Post-Hoc LSD test showed a statistically significant decrease in PTA and ABG averages for WsCCG group compared to the ICG group (p = 0.004; CI%95 = 15.1-2.2 dB and p = 0.023; CI%95 = 8.2-0.4 dB, respectively). Postoperative PTA and ABG averages for WsCCG and PCG groups were similar (p = 0.069 and p = 0.053, respectively). In addition, while there were 2 (5.1%) retractions in the PCG group and 1 (2.7%)in the ICG group, there was no retraction in the WsCCG group. The WsCCG provided comparable results with classical reliable graft techniques (PCG and ICG) and may recommend as a more suitable graft due to hearing results and resistance against retraction.

Does cartilage tympanoplasty impair hearing in patients with normal preoperative hearing? A comparison of different techniques.

OBJECTIVES: To evaluate and compare functional outcomes of tympanoplasty procedures with temporalis fascia and four different types of cartilage grafts in chronic otitis media (COM) cases with normal preoperative hearing levels. METHODS: Records of patients who underwent type 1 tympanoplasty for non-complicated COM in a tertiary medical center between January 2010 and January 2017 were reviewed. Patients with central or marginal and dry perforations of the tympanic membrane, normal middle ear mucosa, intact ossicular chain and patients with a preoperative pure tone average (PTA) level of 25 dB or less and a word recognition score (WRS) of 88% or greater were included in the study. Graft success rates, preoperative and postoperative functional outcomes, and anatomical results were analyzed. RESULTS: One hundred and forty-four patients who met the inclusion criteria were evaluated in the study. PTA and Air-bone gap (ABG) levels decreased significantly both in TF and CG groups after the surgery (p = 0.001). Similarly, WRS scores increased significantly in both groups (p = 0.001). There was not a significant difference in terms of PTA increase, WRS increase, and ABG closure levels between cartilage and TF groups. Increase in PTA, closure in ABG, and increase in WRS levels were compared among TF, WsCCG, MCG, PCG, and CPIG groups. The increase in PTA levels was also found to be significantly superior in the TF group (p = 0,023). However, the multivariate analysis showed no significant difference for increase in WRS, closure in ABG and increase in PTA levels according to graft type (p = 0.285; p = 0.461; p = 0.106, respectively) and gender (p = 0.487; p = 0.811; p = 0.756, respectively). CONCLUSION: In COM cases with normal preoperative hearing, both TF and cartilage lead to superb functional and anatomical outcomes. There was not a significant difference in terms of PTA increase, WRS increase and ABG closure levels between cartilage and TF groups. The graft success rate of cartilage was found to be superior to TF, but there was not a statistically significant difference. Different types of cartilage grafts can be used in cases with normal preoperative hearing without the concern of hearing impairment.

The wheel-shaped composite cartilage graft (WsCCG) and temporalis fascia for type 1 tympanoplasty: a prospective, randomized study.

OBJECTIVES: To compare the anatomical and functional outcomes of two different grafts which are used for the reconstruction of subtotal or total tympanic membrane perforations: the wheel-shaped composite cartilage graft (WsCCG) and temporalis fascia (TF). METHODS: Ninety patients (94 ears) who underwent type 1 tympanoplasty for non-complicated chronic otitis media between March 2014 and June 2016 in a tertiary referral center were included in a randomized, controlled, prospective clinical trial. Tympanic membranes were reconstructed with the WsCCG or TF. RESULTS: Outcomes of 91 surgeries performed on 87 adults (> 18 years of age) were evaluated in the study. Forty-three patients (44 ears) were included in the WsCCG group; 44 patients (47 ears) were included in the TF group. The mean post-operative follow-up was 14.9 months for the WsCCG group and 15.1 months for the TF group. There was no statistically significant difference in post-operative pure tone average (PTA) (p = 0.19), air-bone gap (ABG) (p = 0.64), PTA gain (p = 0.82) and ABG closure (p = 0.89) values between two groups. Graft success rates at 6 months after surgery were 82.9% (39/47) and 97.7% (43/44) for TF and WsCCG, respectively. At the first year, success rates were 85.1% (40/47) for TF and 97.7% (43/44) for WsCCG. A statistically significant difference was observed in graft success rates between two groups (p = 0.039). CONCLUSIONS: Both TF and WsCCG lead to satisfactory functional results, but the WsCCG clearly leads to superior anatomical outcomes with a graft success rate of 97.7%. The WsCCG is a suitable graft for subtotal or total tympanic membrane perforations and has the advantages of being a one-piece, flexible, composite, and physically resistant graft.

Necrotizing fasciitis of the head and neck: our experience with vacuum-assisted closure therapy.

OBJECTIVES: To present the outcomes of our case series of head and neck necrotizing fasciitis (HNNF) in which vacuum-assisted closure (VAC) is used in most of the cases in the treatment. METHODS: Case series in a tertiary referral center. RESULTS: Eleven patients were treated for HNNF between January 2008 and January 2017. Patients were two females and nine males, the mean age was 57.1. Oral cavity and tracheotomy/tracheostomy sites were the main aetiological foci of the infection. Three patients were treated with aggressive debridements and conventional dressing, whereas eight patients were treated with incision and exploration followed by limited skin excisions and VAC dressing. The mean number of surgical debridements was 2.3. The mean length of hospital stay was 41.8 days. Complications were observed in all patients except one. The mortality rate of HNNF in our series was 18%. The cause of death was severe sepsis and multi-organ failure in one case and mediastinitis followed by respiratory distress syndrome in the other case. CONCLUSION: HNNF is still a mortal disease and surgical debridements are crucial. The current study is the only case series in the literature in which VAC treatment was used in consecutive cases of HNNF. VAC treatment can play a major role in the post-operative care of HNNF patients. It reduces the amount of excised skin during debridements and stimulates wound healing. VAC treatment may be included in the treatment protocol of HNNF alongside surgical debridements and medical therapy.

Endoscopic-Powered Dacryocystorhinostomy Without Stenting: Long-term Outcomes of 120 Procedures.

Background The necessity of silicone stenting in endoscopic dacryocystorhinostomy (DCR) procedures is a controversial subject in the literature. Objective The purpose of the present study is to assess the long-term anatomical and functional outcomes of endoscopic-powered DCR (EP-DCR) without stenting or mucosal flaps. Methods One hundred twenty EP-DCR procedures were performed in 107 patients. Anatomical success was defined as a patent ostium on irrigation and functional success as free flow of dye from the ostium and resolution of epiphora. Results The mean follow-up was 46.5 months (range: 24-87). Of the 120 procedures, 13 were bilateral and 94 were unilateral. Anatomical and functional success rates of 92.5% were obtained. Conclusion EP-DCR without stenting is a safe and economic technique that provides satisfactory long-term results and could be considered as the treatment of choice for patients with postsaccal nasolacrimal duct obstruction.

Management of thyroid gland invasion in laryngeal and hypopharyngeal squamous cell carcinoma.

The objective of this study was to determine the incidence of thyroid gland invasion in laryngeal and hypopharyngeal squamous cell carcinoma; and the association between clinicopathological parameters and thyroid gland invasion. Medical records of 75 patients with laryngeal and hypopharyngeal squamous cell carcinoma who underwent total laryngectomy with thyroidectomy were reviewed, retrospectively. Preoperative computed tomography scans, clinical and operative findings, and histopathological data of the specimens were evaluated. There were 73 male and two female patients with an age range of 41-88 years (mean 60.4 years). Hemithyroidectomy was performed in 62 (82.7 %) and total thyroidectomy was performed in 13 patients (17.3 %). Four patients had histopathologically proven thyroid gland invasion (5.3 %). In three patients, thyroid gland involvement was by means of direct invasion. Thyroid gland invasion was significantly correlated with thyroid cartilage invasion. Therefore, prophylactic thyroidectomy should not be a part of the treatment policy for these tumors.

Correlation of computed tomography, echo-planar diffusion-weighted magnetic resonance imaging and surgical outcomes in middle ear cholesteatoma.

CONCLUSION: Echo-planar diffusion-weighted magnetic resonance imaging (DW MRI) is more reliable than high-resolution computed tomography (HRCT) in predicting the presence and localization of cholesteatoma before tympanomastoid surgery. OBJECTIVES: To evaluate the diagnostic accuracy of HRCT and echo-planar DW MRI in the detection and localization of cholesteatoma. METHODS: Fifty-nine patients were prospectively included in this study. Patients with suspected primary cholesteatoma were evaluated by HRCT and echo-planar DW MRI before tympanomastoid surgery. Radiological findings were correlated with intraoperative findings. RESULTS: HRCT and echo-planar DW MRI accurately predicted the presence or absence of cholesteatoma in 40/59 (67.8%) and 52/59 (88.1%) patients, respectively. The sensitivity, specificity, and positive and negative predictive values of HRCT were 68.97%, 66.67%, 66.67%, and 68.97%, respectively. However, sensitivity, specificity, and positive and negative predictive values of echo-planar DW MRI were 85.71%, 90.32%, 88.89%, and 87.50%, respectively.

Factors confusing the diagnosis of laryngopharyngeal reflux: the role of allergic rhinitis and inter-rater variability of laryngeal findings.

The objective of the study was to determine the inter-rater variability in assessment of laryngeal findings and whether diagnosing laryngopharyngeal reflux based on the laryngeal findings and history alone without considering allergic rhinitis leads to the overdiagnosis and overtreatment of laryngopharyngeal reflux. Patients with positive and negative skin prick tests were recruited from an allergy clinic in a tertiary teaching university hospital. All subjects completed the Reflux Symptom Index (RSI) and underwent laryngeal examinations by three physicians blinded to the skin prick test results and the Reflux Finding Score (RFS) was determined. RFS >7 or RSI >13 was considered reflux positive. Fleiss' kappa (κ) was used to measure inter-rater agreement. The inter-rater agreement was low for pseudosulcus vocalis (κ = 0.078), ventricular obliteration (κ = 0.206), diffuse laryngeal edema (κ = 0.204), and posterior laryngeal hypertrophy (κ = 0.27), intermediate for laryngeal erythema/hyperemia (κ = 0.42) and vocal fold edema (κ = 0.42), and high for thick endolaryngeal mucus (κ = 0.61). Although the frequency of allergy was high, there was no significant difference between allergy-positive and laryngopharyngeal reflux-positive patients. On logistic regression analysis, thick endolaryngeal mucus was a significant predictor of allergy (p = 0.012, odds ratio 0.264, 95 % confidence interval 0.093-0.74). The laryngeal examination for reflux is subject to marked inter-rater variability and allergic laryngitis was not misdiagnosed as laryngopharyngeal reflux. The presence of thick endolaryngeal mucus should alert physicians to the possibility of allergic rhinitis/laryngitis.

Does topical anesthesia using aerosolized lidocaine inhibit the superior laryngeal nerve reflex?

OBJECTIVE: This study was designed to evaluate the effectiveness of topical lidocaine in attenuating the laryngeal reflex and blunting hemodynamic response by inhibition of the superior laryngeal nerve in laryngeal microsurgery, which would be helpful in preventing potential complications. STUDY DESIGN: A prospective, randomized, double-blind study. SETTING: Tertiary medical center. SUBJECTS AND METHODS: Fifty-four patients requiring glottic and supraglottic laryngeal microsurgery were randomly assigned to 1 of 2 groups, with equal numbers. Before surgery, 10% lidocaine was topically applied to the laryngeal surface of the epiglottis and vocal folds under direct vision in the study group and saline aerosol was applied in the control group. Heart rates, arterial blood pressure, and SPO2 were recorded at baseline, after induction, immediately before and after intubation, during the surgery, and upon extubation. Laryngospasm, agitation, and coughing were recorded during the recovery period. RESULTS: Heart rates, arterial pressure, and SPO2 did not differ significantly from baseline to postintubation period among the groups. SPO2 values measured similar in the remaining study. Heart rates and blood pressures were slightly decreased in the study group after lidocaine administration, but only blood pressure at pre- and post-extubation was significantly decreased in the study group (P < .05). Also laryngospasm and coughing were not statistically different between the 2 groups. There was an obvious gap between the 2 groups for agitation. Study group agitation was noted significantly lower (P < .05). CONCLUSION: These findings indicate that preoperative topical lidocaine application may be helpful in attenuating airway-circulatory reflexes in laryngeal microscopic surgery.

Staphylococcus aureus cavernous sinus thrombosis mimicking complicated fungal sinusitis.

Septic cavernous sinus thrombosis is a rare and potentially life-threatening complication of infections involving the paranasal sinuses or the middle one-third of the face. We report a challenging case of cavernous sinus thrombosis to familiarize otolaryngologists with its clinical features, diagnosis, and management. The patient was a 45-year-old diabetic woman whose signs and symptoms mimicked those of complicated fungal sinusitis. She presented with fever, nausea without vomiting, frontal headache, bilateral ptosis and swelling, double vision, a partial loss of visual acuity in the left eye, and restricted lateral ocular movements. Her Snellen visual acuity had been reduced to 8/10 on the right and 6/10 on the left. Radiologic investigation revealed cavernous sinus extension of sphenoid sinusitis and a fungus-ball appearance in the sphenoid sinus. On the second day of her admission, the patient's vision was further reduced to 6/10 on the right and 2/10 on the left. She then underwent urgent bilateral anterior and posterior ethmoidectomy and sphenoidectomy. At postoperative follow-up, her vision had stabilized at 10/10 bilaterally. At 2 months after discharge, she exhibited no evidence of abducens nerve palsy, and her ocular function had returned to normal. The diagnosis of cavernous sinus thrombosis requires a high index of suspicion and confirmation by imaging. The favorable outcome in our case was attributable to early diagnosis, prompt initiation of appropriate intravenous antibiotic therapy, and surgical drainage by the skillful surgical team.

Comparison of different tympanic membrane reconstruction techniques in type I tympanoplasty.

The objective of the study was to assess the functional results after type I tympanoplasty with temporal muscle fascia, perichondrium/cartilage island and cartilage palisades. The records of 120 patients who underwent type I tympanoplasty operation between January 2003 and June 2007 were retrospectively reviewed. This study aimed to comprise a homogeneous group of patients to make the comparisons as accurate as possible. For this purpose, primary tympanoplasty cases with subtotal perforations, intact ossicular chain, dry ear for a period of at least 1 month, and normal middle ear mucosa were included in the study. Patients younger than 15 years of age and patients with cholesteatoma were excluded. Temporal muscle fascia was used in 67 (55.8%), perichondrium/cartilage island flap was used in 34 (28.3%), and cartilage palisades were used in 19 (15.8%) of the patients. Pre- and postoperative otoscopic examinations, pure-tone averages, and air-bone gaps were compared pre and postoperatively. Concerning all of the cases, the graft take rate was 85% (102/120). In the perichondrium/cartilage island flap group, the graft take rate was 97.7%, whereas the graft take rates for the fascia group and cartilage palisades group were 80.6 and 79.0%, respectively. In the perichondrium/cartilage island flap group, the pure-tone average was 36.36 dB, whereas the pure-tone averages for the fascia group and cartilage palisades group were 36.07 and 39.79 dB, preoperatively. The postoperative pure-tone averages were 24.54 dB fort he perichondrium/cartilage island flap group, 24.51 dB for the fascia group and 23.23 dB for the cartilage palisades group. Cartilage grafting is not only more enduring against infection and negative middle ear pressure but also it has low re-perforation rates on long-term follow-up. Thus, cartilage may be preferred more often for primary tympanoplasties with high graft rate and hearing improvement.

[Transnasal endoscopic approach in choanal atresia]. / Koanal atrezide transnazal endoskopik yaklasim.

OBJECTIVES: The aim of surgery for choanal atresia is to remove the atretic plate completely and to assure long-term patency. We evaluated the effectiveness and results of endoscopic transnasal approach in the treatment of choanal atresia. PATIENTS AND METHODS: The study included eight patients (1 male, 7 females; mean age 25.8 years; range 17 to 53 years) who were treated with endoscopic transnasal approach for choanal atresia. One patient had bilateral involvement. The diagnosis was based on findings of physical examination, endoscopic examination, and computed tomography. The follow-up period ranged from 10 months to four years. RESULTS: Only one patient developed partial obstruction which was reconstructed with mushroom-head forceps at a subsequent operation. One patient died from primary disease (nasopharyngeal cancer). The remaining patients became symptom-free. CONCLUSION: Endoscopic transnasal approach for the treatment of choanal atresia is a safe procedure, with a high success rate and low morbidity, enabling detailed evaluation of the anatomic structure.