Intramuscular hemangiomas of the head and neck: Three case reports.

Hemangiomas are tumors of vascular origin that frequently occur on the skin and mucosal surfaces in the pediatric age group. Hemangiomas located in skeletal muscles are called intramuscular hemangiomas. Intramuscular hemangiomas mostly occur in the extremities and the trunk. In this article, 3 cases of surgically treated intramuscular hemangiomas that could not be diagnosed by routine preoperative investigations are presented in light of recent literature.

Retrospective analysis of surgical treatment of choanal polyps.

OBJECTIVES: This study aims to discuss the efficacy of the surgical method performed in patients with choanal polyp in the light of the literature. PATIENTS AND METHODS: The study included 76 patients (42 males, 34 females; mean age 25.36 years; range 7 to 73 years) diagnosed with choanal polyp in the sinonasal region between January 2005 and December 2013 in the otorhinolaryngology clinic of Kocaeli University. Age, sex, and presenting complaints of the patients, as well as the characteristics of the polyps (localization, direction) were retrospectively investigated. RESULTS: The majority (98.68%) of the patients with choanal polyp presented with nasal obstruction, followed by snoring, sleeping with the mouth open (25.0%), and nasal discharge (21.05%). According to their localizations, the origin of the polyps was the maxillary sinus in 65 patients, sphenoid sinus in six patients, middle turbinate in two patients, septum in two patients, and ethmoid sinus in one patient. CONCLUSION: Endoscopic approach is a safe and effective procedure for choanal polyp treatment. There was no significant difference between the success rates of the endoscopic approach and combined approaches.

Endoscope-assisted transoral approach to parapharyngeal space tumors.

BACKGROUND: Parapharyngeal space (PPS) tumors are rare tumors for which the surgical management differs widely. The purpose of this study was to discuss the advantages and disadvantages of the endoscope-assisted transoral approach over the traditional approaches. METHODS: This prospective study included 4 patients who were diagnosed with PPS tumors and treated with the endoscope-assisted transoral approach. RESULTS: The endoscope-assisted transoral approach described here safely allowed for the resection of benign neoplasms with high surgical view to the parapharyngeal neurovascular structures. The average tumor size was 42 mm. Three patients had isolated PPS tumors, and 1 patient had a tumor originating from the deep lobe of the parotid gland. The postoperative histopathological diagnosis of the patients was pleomorphic adenoma for 3 of the patients, and marginal zone and follicular hyperplasia for the other. CONCLUSION: This technique provided less operative trauma, a more comfortable postoperative period, and, most importantly, increased operative exposure.

[Sinonasal teratocarcinosarcoma]. / Sinonazal teratokarsinosarkom.

Sinonasal teratocarcinosarcoma is an extremely rare malignant neoplasm presenting with the characteristics of a malignant teratoma and carcinosarcoma. The most common sites of origin of teratocarcinosarcomas are the nasal cavity and paranasal sinuses. The clinical presentation is usually with nasal obstruction and episodes of epistaxis. Teratocarcinosarcomas are aggressive and rapidly growing tumors with a poor prognosis. The incidence of sinonasal teratocarcinomas is higher in men than women. Treatment is primarily surgery, followed by radiotherapy. In this article, we report a 46-year-old male case of sinonasal teratocarcinosarcoma who was admitted with complaints of pain and swelling around the right eye and treated surgically followed by radiotherapy.

[Evaluation of efficacy of otosclerosis surgery on hearing outcomes]. / Otoskleroz cerrahisinin isitme sonuçlari üzerine etkinliginin degerlendirilmesi.

OBJECTIVES: In this study we aimed to evaluate the audiologic results and audiologic success rates following otosclerosis surgery and to discuss surgical complications and their management. PATIENTS AND METHODS: We retrospectively analyzed 115 ears of 100 patients who were diagnosed with clinical otosclerosis and operated at Kocaeli University, Faculty of Medicine, Department of Otolaryngology between May 2002 and April 2013. Postoperative air-bone gap was used in the evaluation of the success of the hearing results. The postoperative air-bone gap less than 20 dB was accepted as a success criterion. Intraoperative and postoperative complications were recorded. RESULTS: Functional success was achieved in 105 of 115 operated ears (91.3%). Functional success rates according to types of piston for 0.6 mm wire Teflon piston (n=71), fluoroplastic Teflon piston (n=30), K piston (n=12) and Easy piston (n=2) groups were, 88.7%, 93.3%, 100%, and 100% respectively. Six patients (5.2%) underwent revision surgery. CONCLUSION: Our study results suggest that stapes surgery is a successful and safe treatment modality with high success and low complication rates in the management of otosclerosis.

Meningioma arising from the anterior skull base and filling the nasal cavity.

Meningiomas are usually benign tumors that are frequently encountered in the intracranial region. They account for 15% of the overall intracranial tumors. Of the intracranial meningiomas, less than 3% extend up to the sinonasal region. The frequency of meningioma in females is 2 times higher than that in males; it is most commonly observed in the fifth decade of life. It is usually asymptomatic and detected incidentally. A small number of meningiomas may cause some symptoms including seizure attacks and cranial nerve paralysis according to their locations. On the physical examination of a 56-year-old woman, who presented with nasal obstruction, a mass that completely obliterated the left nasal passage was detected. An incisional biopsy finding of the mass revealed meningioma, and the patient was hospitalized in the clinic for surgical procedure. The mass was excised by endonasal endoscopic method. In this present article, we aimed to discuss a quite rare case, which had meningioma arising from the anterior skull base and completely obliterating the left nasal passage with the coexistence of right nasal polyp, in the light of the current literature.

[Odontogenic and nonodontogenic jaw cysts: experience in 25 cases]. / Cenenin odontojenik ve odontojenik olmayan kistleri: 25 olguda deneyimlerimiz.

OBJECTIVES: We retrospectively evaluated the patients with jaw cysts treated at our center. PATIENTS AND METHODS: The study included 25 patients (14 males, 11 females; mean age 33+/-19 years; range 7 to 69 years) who underwent surgery for odontogenic or nonodontogenic jaw cysts. RESULTS: The most common presentation was a swelling in the jaw with or without dental problems. Involvement was in the mandible in 18 patients, and in the maxilla in seven patients. The lesions consisted of eight radicular, six dentigerous, two nasoalveolar, two globulomaxillary cysts, and three keratocysts. Four patients had gingival, nasopalatine, residual, and median mandibular cysts, respectively. Marsupialization, curettage, extensive burring, enucleation, or marginal resection were performed depending on pre- and intraoperative findings. The defects were repaired with a corticocancellous iliac bone block graft in three patients and cancellous iliac bone chips in five patients. During a mean follow-up of 14 months (range 12 to 46 months), recurrence was seen in only one patient with a keratocyst. CONCLUSION: A good preoperative assessment, complete removal of the cystic lesion, and close radiographic follow-up are essential for a successful outcome in jaw cysts. In selected cases, reconstruction of the defects with autogenous corticocancellous iliac bone graft yields highly satisfactory results.

The comparison of acellular dermal matric (Alloderm), Dacron, Gore-Tex, and autologous cartilage graft materials in an experimental animal model for nasal septal repair surgery.

BACKGROUND: The aim of this study was to compare the compatibility of Alloderm, Dacron, Gore-Tex, and autologous cartilage graft materials with host tissues in nasal septal perforation repair surgery. METHODS: The materials were placed into the nasal septum of 16 New Zealand rabbits. At the end of the 3rd month, septums of the rabbits were removed totally and reactions, such as inflammation;foreign body giant cell; or fibrosis that developed in the surrounding tissue against the implant material were evaluated. RESULTS: Acute inflammation reactions occurred mostly with Gore-Tex. There were no differences between groups according to chronic inflammation. When the number of reactions and tissue compatibility were taken into consideration, cartilage performed the best followed by Alloderm. There were more reactions with Dacron, but it still showed compatibility. CONCLUSION: Cartilage was found to be the best material followed by Alloderm and Dacron, but Gore-Tex was found unsuitable.

Choanal polyps: an evaluation of 53 cases.

BACKGROUND: The aim of this study was to evaluate our experience on the diagnosis and treatment of choanal polyps (CP). METHODS: This study consists of 53 patients with CP diagnosed by means of rhinoscopy, nasal endoscopy, computerized tomography, surgical, and histologic findings between 1996 and 2005. RESULTS: The origins of the CPs were the unilateral maxillary sinus in 47 patients, simultaneously bilateral maxillary sinus in 2 patients, septum in 2 patients, sphenoid sinus in I patient, anterior ethmoid sinus in 1 patient. The most common presenting symptoms were unilateral nasal obstruction, snoring, and rhinorrhea. In the cases of the antrochoanal polyps, the most common preoperative radiological finding was the total opacification of the maxillary sinus. CONCLUSION: Endoscopic approach for complete removal of the CPs is an extremely safe and effective procedure. It should be focused on the detection of the exact origin and the extent of the polyp to prevent recurrence.

Injection tongueplasty: effects of sclerosant OK-432 on rat tongue.

Our aim was to investigate the effect of sclerosant agent OK-432 on tongue fibrosis and to determine whether the fibrosis formed by this substance increases with dose. Fifty Wistar albino rats were divided into three groups for the study. In the first group 0.2 ml OK-432, in the second group 0.5 ml OK-432, and in the third group physiological saline as the control substance was injected into the tongue of these rats. Subjects were sacrificed on the first day, first week, first month, third month and sixth month following the injection. Cross-sections of the tongues were stained with hematoxylin-eosin (HE) and Masson Tri-chrome. The degree of fibrosis was measured using ocular micrometry. A significant amount of fibrosis was observed in both the 0.2 ml (P = 0.020) and 0.5 ml (P = 0.003) OK-432 injection groups. OK-432 is a material that causes significant fibrosis in the muscle when compared to physiological saline. The degree of fibrosis in the tongue increases with dose.

Management of lateral sinus thrombosis in chronic otitis media.

OBJECTIVE: To present our experience with the diagnosis and treatment of lateral sinus thrombosis (LST) secondary to otogenic disease. PATIENTS AND METHODS: We have retrospectively reviewed all the cases of LST caused by chronic otitis media in ten years. RESULTS: In our series of five patients, four patients were successfully treated by surgery without opening the sigmoid sinus. On the other hand, one of our patients developed hydrocephalus and ataxia during preoperative antibiotic treatment. CONCLUSION: Most patients with thrombotic/nonabscessed sinuses will have successful outcomes with this approach, but careful observation is needed, given the possibility of advancing disease.

The learning curve in endoscopic pituitary surgery and our experience.

Experience is the important point in reduction of the complications and in the effectiveness of the surgical procedure in pituitary surgery. Endoscopic pituitary surgery differs from microscopic surgery, since it requires a steep learning curve for endoscopic skills. In this article, we evaluate our learning curve in two groups, as early and late experience. Purely endoscopic transsphenoidal operations were performed on 78 patients, which were retrospectively reviewed and grouped as early and late experience groups. We used the purely endoscopic endonasal approach to the sella that was performed via an anterior sphenoidotomy, without the use of a transsphenoidal retractor. All patients with adenomas were evaluated considering operation time, endocrinology, ophthalmology, total removal and, especially, modifications of standard technique. On the basis of the experience gained with the use of the endoscope in transphenoidal surgery over the years, modifications can be performed on the different phases of the endoscopic approach. Reviewing our cases in two groups of period due to our experience showed that the effectiveness of endoscopic surgery increases and operation time decreases. In our study, we identified a learning curve in endoscopic pituitary surgery.

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.

Cervical bronchogenic cysts in head and neck region.

Congenital cysts of the neck are not uncommon. Most of these are thyroglossal, branchial cleft and thymic cysts. Bronchogenic cysts are uncommon developmental anomalies of the tracheobronchial tree and rarely occur in the neck. More than 70 cases of bronchogenic cysts in the head and neck region have been reported in the literature. We report three cases presenting with neck swelling in the hyoid region that were diagnosed as bronchogenic cysts based on clinical and histopathological findings.

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.

An erosive mass involving the nasal cavity and maxillary sinus: rhinosporidiosis.

Rhinosporidiosis is a chronic granulomatous inflammatory disease of the mucous membranes caused by Rhinosporidium seeberi. The disease is endemic in India, but is very rare in other countries. A review of the literature shows that our patient is the second documented case from Turkey. Involvement and erosion of the anterior wall of the maxillary sinus as in this case is very rare. A 47-year-old-male is presented with the clinicopathological features and transmission of the disease is discussed.

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.

[Evaluation of the combined suprahyoid-transoral approach to the tongue base tumors]. / Dil kökü kanserlerinde kombine suprahiyoid-transoral yaklasim.

OBJECTIVES: To evaluate the efficacy and functional results of the combined suprahyoid-transoral approach in early-stage tongue base cancers. PATIENTS AND METHODS: Five patients (4 females, 1 male; mean age 47 years; range 12 to 65 years) with tongue base tumors underwent surgery via the combined suprahyoid-transoral approach. Diagnoses were adenoid cystic carcinoma in three patients and squamous cell carcinoma in two patients. The mean follow-up period was 32.4 months (range 10 to 54 months). RESULTS: One patient with adenoid cystic carcinoma and two patients with squamous cell carcinoma required neck dissection. Postoperative radiotherapy was administered to two patients with squamous cell carcinoma. Tracheotomy was performed in all cases during surgery. All patients were safely decannulated within a mean of 11.4 days (range 9 to 14 days) and converted to oral feeding within a mean of 8.6 days (range 7 to 11 days) with no aspiration problem. All patients had negative surgical margins. All patients had satisfactory phonation. No local or regional recurrences developed during the follow-up period. CONCLUSION: Functional results obtained through the combined suprahyoid-transoral approach justify its use in the treatment of T1 or T2 tongue base carcinomas.

A case of congenital bilateral stapes agenesis.

Congenital absence of the stapes and the oval window is an anomaly reported in only sporadic cases. We present a 17-year-old male patient with congenital bilateral conductive hearing loss. The external auditory canal and the tympanic membrane appeared normal on both sides. An exploratory tympanotomy in the right ear revealed dehiscence of the the horizontal segment of the facial nerve, which was displaced inferiorly, occupying the area of the absent oval window. The stapes was totally absent and a malformed long process of the incus was attached by a fibrous band to the promontory. Manipulation of the facial nerve in association with stapedectomy or vestibulotomy was avoided in order not to injure the nerve. Instead, amplification with hearing aids was recommended to the patient.

[ENT examination in SCUBA divers and ENT pathologies restricting diving]. / SCUBA dalicilarinda KBB muayenesi ve dalisa engel KBB patolojileri.

SCUBA diving can be safely performed if a careful pre-dive examination regarding the medical standards of diving is performed, and if all necessary precautions are taken with attention being paid to the potential risks of diving. The most frequent medical problems arising from SCUBA diving fall into the otolaryngology discipline; thus, candidates should be examined in terms of ENT disorders that may prevent them from diving. This article aims to review particular aspects of ENT examination, investigation methods, and criteria for candidates