Long term effects of palatal implant method in adult patients with simple snoring and obstructive sleep-apnea syndrome.

OBJECTIVE: To investigate the long term effect and reliability of palatal implant surgery, which is a minimally invasive technique, used in simple snoring and obstructive sleep-apnea syndrome types based on objective and subjective data. MATERIALS AND METHODS: Seventy-eight patients were included prospectively in this study. It has been possible to obtain preoperative and postoperative polysomnography results in 59 patients. The cases were followed-up for 8 months on average. Considering the apnea index and AHI values, the patients were divided into 5 groups, namely simple snoring (n=13), mild OSAS (n=21), moderate OSAS (n=17), severe OSAS (n=8), and the group on which polysomnography could not be performed, the no-polysomnography group (n=19). The cases were evaluated based on polysomnography and the Epworth Sleepiness Scale and visual analog scale filled by relatives or friends of the patients. RESULTS: The AHI of 46 patients diagnosed with OSAS decreased from 14.9 to 10.14 (31% decline) (p=0.279). The AHI of 13 patients with simple snoring diagnosis reduced from 3.09 to 2.02 (p=0.033). A 40% improvement was observed in VAS of all cases. Implant rejection occurred in 7 of our cases and 3 patients experienced ecchymosis. CONCLUSIONS: It is concluded that palatal implant procedure is a good option for appropriate cases, it is equivalent to other methods in terms of treatment efficacy and that is more advantageous than other techniques in that it can be applied in office settings with low morbidity, is minimally invasive and brings about higher patient compliance.

Acinic cell carcinoma originating in the nasal septum.

Acinic cell carcinoma represents approximately 2.5% to 4% of all salivary gland tumors and 13% of all malignant parotid tumors. The nasal septum is a rare site of an acinic cell carcinoma. We have treated such a tumor in a 47-year old man who had been asymptomatic for the past 1.5 year. This is the second reported case of acinic cell carcinoma at the nasal septum.

Tracheal reconstruction with porous high-density polyethylene tracheal prosthesis.

The variety of methods used for the treatment of severe tracheal stenosis and the occasional failure to obtain lasting and consistent relief are measures of the difficulty of the problem. Presently, several surgical approaches are used for reconstructing large defects of the cervical trachea, reminding us that no single technique has gained wide clinical acceptance. We resected a U-shaped cartilage from 6 to 8 rings of the trachea of 10 New Zealand rabbits. We used a porous high-density polyethylene (PHDP) prosthesis to reconstruct the cervical trachea, and did not perform a tracheotomy during this operation. We followed up the rabbits for 4 to 10 months. One of the rabbits died in the second month because of respiratory distress; another was lost in the fourth month of the study while delivering young. The others continued to thrive; in fact, one of them gave birth 3 times after our study and was well able to take care of her young. At the end of the study, the rabbits were painlessly sacrificed in order to remove the larynx and trachea and examine them histopathologically. In the histopathologic examinations, the prostheses were incorporated into the native trachea and adhered to the surrounding organs, especially to the esophagus. No mucosal irregularities were seen on the surface of the prosthesis, and all the surfaces appeared to be covered with ciliated pseudostratified epithelium. This tracheal prosthesis provides good results in rabbit tracheal reconstruction, and appears very promising for the clinical repair of tracheal defects.

Diagnostic significance of impression cytology in allergic rhinoconjunctivitis.

Impression Cytology (IC) is a noninvasive and easily repeated technique for investigating many pathologies of the conjunctiva such as dry eye, drug toxicities, and melanoma. In addition to skin tests and determination of serum IgE levels, the presence of eosinophilia in the nasal mucosa and the conjunctiva is an important diagnostic factor in allergic rhinoconjunctivitis. Eosinophilia can classically be shown by the nasal smear technique as well as IC. The nasal smear is a difficult test to carry out and does not always give adequate results. With this in mind, we collected cells from the nasal mucosa and superior palpebral conjunctiva from 27 patients with allergic rhinoconjunctivitis (17 female, 10 male) using 5 x 5 mm, 0.22 micron pore-sized cellulose acetate paper. The specimens were fixed in 95% alcohol and were then stained with hematoxylin eosin and periodic acid-Schiff stain for examination by light microscopy. Taking the free and intraepithelial eosinophilia into consideration, the specimens were grouped. Of all patients, 92.6% and 85.2% had nasal and conjunctival eosinophilia, whereas 44.4% and 25.9% had nasal and conjunctival mononuclear cells, respectively. Our study has shown that IC is a very reliable and practical technique that offers a valuable alternative test for investigating both the intraepithelial and free eosinophilia in allergic rhinoconjunctivitis and other pathologies that cause cytologic changes.

Lead article: The prognostic significance of proliferating cell nuclear antigen (pcna) in laryngeal cancer.

Squamous cell carcinoma arising from upper aerodigestive tract carries with it a significant morbidity and mortality and, over the last few decades, its incidence has steadily increased. The management of patients requires thorough investigation to determine the local, regional, and distant extent of the disease, and treatment options include surgery, radiotherapy, chemotherapy, or combinations of these.Despite the large number of therapeutic and hsitopathologic studies in print, there is currently no morphologic or cytologic feature available which consistenly predicts outcome in patients with laryngeal carcinoma. The use of proliferating cell nuclear antigen (PCNA), a newly available marker of a cell's proliferative activity ( S-phase fraction), was evaluated in 25 cases of squamous cell carcinoma of the larynx. PCNA scores differed, statistically significantly as far as the localization of the lesion, pathological grade, clinical stage, presence of lymph node metastases and prognosis of the patients were concerned.These data suggest that PCNA is an indicator of the malignant potential of the larynx. PCNA can be used in decision making for treatment and assessing prognosis in carcinoma of the larynx.

Giant cholesteatoma of the external auditory canal.

Cholesteatomas are found almost exclusively in the middle ear and mastoid. Occasionally this disease is seen in the external auditory canal. Cholesteatoma of the external auditory canal is a rare condition. Severe pain and profuse discharge associated with a normal eardrum and normal hearing are essential clinical features. In addition, we found facial paresis and conductive hearing loss in our case. Smaller cholesteatomas can be managed by frequent debridement in the office; larger lesions require surgical intervention. Surgery is successful in resolving otorrhea and relieving pain. In addition, our own experience has shown that surgery is successful in relieving facial paresis.