Nasal bone grafts from the removed hump used as overlay grafts to camouflage concave lateral crura.

Alar cartilage consists of a medial crus, middle crus and lateral crus. The lateral crus is an important aesthetic and functional structure of the nose. A 32-year-old male patient with concave lateral crura was operated by the authors. An open rhinoplasty with a dorsal approach to the septum is preferred. The nasal bones harvested from the hump, which is an autogenous graft trimmed and sutured on both concave lateral crura as an overlay camouflage grafts. Satisfactory result was achieved.

[Can enough lymph nodes be taken out through lateral neck dissection in patients with larynx cancer?]. / Larenks kanserli hastalarda lateral boyun diseksiyonu ile yeterli sayida lenf nodu çikarilabiliyor mu?

OBJECTIVES: This study aims to evaluate whether the number of lymph nodes which are dissected by lateral neck dissection (LND) is enough and to compare the number of lymph nodes which are dissected from the same lymph node regions by radical and type 1 modified radical neck dissection (RND). PATIENTS AND METHODS: Between January 2000 and June 2004, data of 98 neck dissection materials which were performed to 63 patients (52 males, 11 females; mean age 61.9 years; range 48 to 75 years) with larynx cancer were retrospectively analyzed. The number of lymph nodes taken from the second, third and fourth regions of radical and type 1 modified RND and LND were individually and totally compared. The American Joint Committee on Cancer (AJCC) tumor node metastasis (TNM) classification system was used for primary tumor and neck metastasis classification, while the Memorial Sloan-Kettering Cancer Center classification system was used for the classification of cervical lymphatic chain. RESULTS: Two patients (3.17%) had subglottic, 19 (30.15%) had glottic, and 42 (66.66%) had supraglottic lesions. A total of 732 lymph nodes were removed from three regions in RND group, while 1042 lymph nodes were removed in LND group. CONCLUSION: Our study results showed that the number of lymph nodes removed by LND was sufficient and RBD was not superior in terms of the number of lymph nodes removed.

Everolimus-coated tympanostomy tube on rat tympanic membrane.

OBJECTIVES: Everolimus is an immunosuppressant and an antiproliferative macrolide agent which is used for coronary stent coating for local inhibition of in-stent restenosis. The aim of this study was to evaluate the effect of everolimus-coated tympanostomy tubes in rat tympanic membrane. STUDY DESIGN: Prospective controlled animal study. MATERIALS AND METHODS: Twenty-one Sprague-Dawley rats were included in the study. They were bilaterally myringotomized. An everolimus-coated fluoroplastic tympanostomy tube was inserted into one ear of each of the rats (everolimus-coated TT Group; n=21) and a standard fluoroplastic tympanostomy tube was applied to the contralateral ear of the same rats (Standard TT Group; n=21). Tympanic membranes and tubes were routinely examined otomicroscopically every other day for two months. Then the membranes were harvested and evaluated histologically. RESULTS: In everolimus-coated tubes, the tube obstruction was found to be significantly lower than in standard tubes (p<0.05). The tube extrusion rate was less for everolimus-coated tubes than for standard tubes, but no statistically significant difference was observed between the two tubes. There was no statistically significant difference in the incidence of otorrhea between two tubes. Histopathological examination under light microscope revealed that everolimus-coated tubes resulted in less fibrosis and less inflammation in tympanic membranes than standard tubes (p<0.01). CONCLUSION: The study shows the potential role of everolimus-coating of tympanostomy tubes in reducing tube obstruction. In addition, inflammatory reaction and fibrosis were observed to be significantly less with these tubes.

The effect of continuous positive airway pressure on middle ear pressure.

OBJECTIVES/HYPOTHESIS: To investigate the effect of continuous positive airway pressure (CPAP) on middle ear pressure in patients with obstructive sleep apnea syndrome (OSAS). STUDY DESIGN: Prospective clinical case-control study. METHODS: Seventy-eight patients with moderate and severe OSAS (the mean apnea-hypopnea indexes were 22.70 ± 3.59 and 48.59 ± 12.50, respectively) using CPAP (study group) and 60 patients with no sleep apnea syndrome (control group) were included in the study. Forty-two of the patients were female and 96 were male. The mean age in the study group was 47.38 ± 6.23, whereas it was 46.10 ± 11.96 in the control group (P > .05). The middle ear pressure of all study subjects was evaluated with tympanometry at the beginning of the study and 6 months later. Tympanometric measurements of both groups were compared. Furthermore, the same data for the study group were also evaluated according to CPAP pressure levels. RESULTS: The middle ear peak pressure values of the patients in the study group were significantly increased from -63.04 ± 55.82 daPa to -39.6 ± 27.72 daPa after 6 months (P < .01). The middle ear pressure in the control group was found to be -13.26 ± 22.60 daPa at the beginning of the study and -13.60 ± 38.82 daPa after 6 months (P > .05). The mean middle ear pressure level was significantly higher in patients using CPAP at 12 to 14 cm H2 O pressure than in those using CPAP at 8 to 10 cm H2 O pressure (P < .05). CONCLUSIONS: There was a significant increase in the middle ear pressure of patients using CPAP regularly for 6 months. This increase was proportional to the pressure level of the CPAP device. LEVEL OF EVIDENCE: 3b.

Does tonsillectomy affect the outcome of drug treatment for the eradication of gastric H pylori infection? A pilot study.

Eradication of Helicobacter pylori, which is associated with diverse gastroduodenal pathologies of varying severity, is sometimes challenging. We conducted a prospective study to determine the effect of tonsillectomy on the eradication of H pylori from the gastrointestinal tract. Our study population was made up of 46 patients-32 females and 14 males, aged 14 to 58 years (mean: 28.84 ± 9.65)-who had chronic tonsillitis and concomitant dyspepsia. An initial gastrointestinal endoscopy was performed to obtain specimens for histology and a rapid urease test. These gastroscopies revealed that 32 patients were H pylori-positive (69.6%) and 14 were H pylori-negative (30.4%); these groups were designated A and B, respectively. The 32 H pylori-positive patients were divided into three subgroups based on the sequence in which they underwent drug therapy and tonsillectomy. All 3 subgroups received the same 14-day combination-drug regimen for eradication of gastric H pylori. The patients in group A1 (n = 12) underwent tonsillectomy prior to receiving drug treatment; 2 months after the cessation of drug therapy, they underwent a second gastroscopy. The patients in group A2 (n = 10) received drug treatment first followed by tonsillectomy; 2 months later, they underwent their second gastroscopy. The patients in group A3 (n = 10) received drug treatment first, then they underwent a second gastroscopy, and then they were taken for tonsillectomy. The success or failure of H pylori eradication was determined by the second gastroscopy. Also, analyses were performed after tonsillectomy to look for H pylori infection in tonsillar specimens. Eradication of gastric H pylori was achieved in 9 of the 12 group A1 patients (75.0%), 8 of the 10 group A2 patients (80.0%), and 7 of the 10 group A3 patients (70.0%); there were no statistically significant differences among the three groups. Likewise, there were no significant differences between any subgroups or combination of subgroups in terms of tonsillar positivity. As far as we know, this is the first study to investigate the effect of tonsillectomy on the outcome of H pylori eradication treatment. In light of our findings, we may speculate that tonsillar tissue does not seem to be a reservoir for H pylori infection. Although tonsillectomy had no significant effect on gastric H pylori eradication in our study, our results might have been skewed by the relatively small size of our sample.

Modified tongue base suspension for multilevel or single level obstructions in sleep apnea: clinical and radiologic results.

OBJECTIVES: To investigate the radiologic and polysomnographic success in opening the airway using a tongue base suspension procedure alone or in combination with uvulopalatal flap in obstructive sleep apnea syndrome (OSAS) patients. METHODS: This study was conducted in 20 patients with moderate or severe OSAS in a prospective manner. The tongue base suspension technique alone or with a uvulopalatal flap (UPF) technique was applied. Magnetic resonance imaging (MRI) scans of patients obtained during the preoperative period and at the 5th week of the postoperative period were compared. Changes in pain and swallowing difficulties were assessed. Polysomnography (PSG) was applied at the 12th postoperative month, and body mass index (BMI) and Epworth sleepiness scale (ESS) values were determined. The degree of satisfaction relative to the surgery was assessed with 4 questions. RESULTS: Preoperative apnea-hypopnea index (AHI) level was found to be 24.55±9.87, whereas postoperative AHI level was 12.40±9.87 (P<0.01). The success rate was determined to be 60%. Preoperative ESS values were 13.90±2.67 and were reduced to 6.55±3.13 postoperatively (P<0.01), and the preoperative posterior airway space (PAS) level was 10.08±1.23, which was increased to 11.64±1.46 postoperatively (P<0.01). Visual analog scale (VAS) values for swallowing difficulty were 8.62 at day 1 and decreased to 3.98 at day 7. The VAS values for pain were 9.14 at day 1, but were reduced to 4.18 at day 7. CONCLUSIONS: Patients with OSAS who have hypertrophy of the tongue base may safely receive a tongue base suspension procedure, which is a minimally invasive method. The postoperative hospital stay is short and the success rate is high, as shown with both PSG and MRI.

Cervical lymph node metastasis in renal cell carcinoma.

Renal cell carcinoma represents 3% of all adult malignant tumors. It occurs more frequently in the fifth and sixth decade of life and in a male-female ratio of 1.5 : 1. Among all the primary tumors that arise below the level of the clavicle, renal cell carcinoma is the third most common neoplasm that metastasizes to the head and neck region, but rarely has it been described as the presenting symptom of this tumor. In 7.5% of the patients with renal cell carcinoma, head and neck metastasis is the presenting complaint. However, only 1% of the patients with renal cell carcinoma have metastases confined only to the head and neck; and a solitary cervical metastatic mass, as in the case of our patient, is rare.It seems that head and neck metastasis of renal cell carcinoma should preferentially be treated with surgical excision because of the associated morbidity and quality-of-life issues. Renal cell carcinoma should be considered in the differential diagnosis of any growing lesion in the head and neck.

Immunohistochemical localization of glutathione s-transferase isoenzymes (gsta, Gstp, Gstm4, And Gstt1) and tumour marker p53 in matched tissue from normal larynx and laryngeal carcinoma: correlations with prognostic factors.

OBJECTIVE: The immunohistochemical staining characteristics of glutathione S-transferase (GST) alpha (GSTA), pi (GSTP), mu (GSTM4), and theta (GSTT1) and P53 were investigated in laryngeal squamous cell carcinoma (LSCC) cases and normal laryngeal tissue from 46 patients. The relationships between expression of the GST isoenzymes and some clinicopathologic features were also examined. PATIENTS AND METHODS: For immunohistochemical studies, tissues from 46 patients with LSCC at the Dr. Lütfi Kirdar Kartal Education and Research Hospital were used. The relationship between expression of the GST isoenzymes and P53 in normal and tumour tissue was analyzed using the Wilcoxon signed rank test. The correlation between GST isoenzymes and P53 and clinicopathologic data was also examined using the Spearman rank test. RESULTS: When the normal and tumour tissues of these cases were compared according to their staining intensity and percentage of positive staining, GSTA expression in normal cells was significantly higher than in tumour cells, and GSTP and P53 expression was higher in tumour cells (p < .05). GSTM and GSTT1 expression was higher in normal cells; however, the statistical significance was low (p > .05). There was no correlation between P53 and GST expression in patients with LSCC. When the immunohistochemical results of GST isoenzymes and P53 were correlated with the clinical parameters, GSTA expression was increased in poorly differentiated laryngeal tumour, but GSTM4 and GSTT1 expression was decreased (p < .05). CONCLUSION: According to these results, GST-A, -P, and T1 and P53 were important in the diagnosis of LSCC.

Palatal Pillar implants for the treatment of simple snoring.

OBJECTIVES: In this study the efficacy of palatal implants for treatment of snoring was evaluated. PATIENTS AND METHODS: Seventeen patients (10 males, 7 females; mean age 49.2+/-7.8 years; range 31 to 66 years) with primary snoring and an apnea-hypopnea index of less than 15 were treated with palatal implants after clinical and endoscopic examination. Snoring-related symptoms were evaluated at baseline and 90 days after surgery and polysomnography was performed. Patients and their spouses completed questionnaires and visual analog scales (VAS) evaluating snoring, apneas, and the intensity, duration, and social effects of daytime sleepiness at baseline and 90 days after surgery. Pre- and postoperative assessment results were compared. RESULTS: Epworth sleepiness scale score was significantly decreased in the postoperative period (p<0.05). Postoperative mean VAS snoring, apnea, and daytime sleepiness scores were also significantly improved (p<0.01). No patients reported worsening of apnea, 5.9% of patients reported no change in apnea, and 94.1% of patients reported a marked decrease in apneas. In the postoperative period, 76.4% of patients reported reduced snoring, and 88.3% of patients reported reduced daytime sleepiness. CONCLUSION: Palatal implants have been demonstrated to be a safe and effective treatment for snoring with minimal patient discomfort. Establishing realistic pretreatment expectations can maximize patient satisfaction.

Comparison between tonsillectomy with thermal welding and the conventional 'cold' tonsillectomy technique.

BACKGROUND: The aim of this study was the evaluation of length of the procedure, anaesthesia, the amount of the intraoperative fluid required, total blood loss and postoperative pain of the 'thermal welding system tonsillectomy (TWS)' compared with the conventional 'cold dissection tonsillectomy'. METHODS: Fifty patients aged between 3 and 28 years were included in this prospective controlled study. Extracapsular tonsillectomy with TWS was carried out on 25 patients and conventional 'cold' extracapsular dissection complete tonsillectomy was carried out on the other 25 patients. Haemostasis was achieved with packing and 3/0 chromic catgut suture is used to treat the persistently bleeding sites in the 'cold' tonsillectomy group. Intraoperatively, the duration of the procedure, anaesthesia, the amount of the required intraoperative fluid, the total blood loss and the number of sutures were documented for each patient. In the hospital, the postoperative amount of intravenous fluids, oral intake (timing of onset and amount), the duration and the total dose of analgesics were recorded. Daily assessment included the type of diet, the level of appetite, the total number of analgesics, the presence of fever, the time required to return to normal activity and the pain score (twice daily). Pain was measured by means of Faces Pain Scale and Visual Analogue Scale. RESULTS: There was a statistically and clinically significant difference in the operating time in the intraoperative blood loss in favour of the conventional tonsillectomy group (P > 0.05). Although there was no statistically significant difference between the two groups for the postoperative evening pain scores (P > 0.05), there was a statistically significant difference for the morning pain scores (P < 0.05) in the first 2 days postoperatively (P > 0.05) and in the level of appetite in the first postoperative day (P > 0.05). The other outcome measures did not show any statistically significant difference. CONCLUSION: When we compared TWS with the conventional 'cold' dissection tonsillectomy, we found that TWS tonsillectomy offered an innovative new tonsillectomy method with significantly reduced blood loss and reduced surgical time and without any increase in the postoperative pain. It was a useful method for tonsillectomy.

Incudostapedial rebridging ossiculoplasty with glass ionomer cement: a case report.

A 31-year-old woman presented with a complaint of hearing loss of a two-year history. Otoscopic examination revealed a central ear drum perforation without discharge. The air-bone gap was 35 dB at 0.5, 1, 2, and 3 kHz. Under general anesthesia, the patient underwent tympanoplasty for chronic otitis media. At surgery, the ossicular chain was intact except for discontinuity by a 2-mm gap between the long process of the incus and the head of the stapes. The gap was reconstructed with the use of a fluoroplastic prosthesis. Myringoplasty was successful, but the patient complained of hearing loss at the end of six months. Transcanal posterior tympanotomy was performed under local anesthesia for decreased conductive hearing. The prosthesis was still in place, but was not conducting the movements of the malleus to the stapes. It was removed and glass ionomer cement (Ketac-Cem) was applied for rebridging. The average air-bone gap measured in the postoperative sixth month was less than 10 dB.

Frequency of metastases at the area of the supraretrospinal (level IIB) lymph node in laryngeal cancer.

BACKGROUND: Neck dissection is the surgical gold standard for the treatment of patients with cervical lymphatic spread. The purpose of this study was to determine the presence of metastases in the supraretrospinal (level IIB) nodal group and the necessity of routine dissection of level IIB during neck dissection, in patients with squamous cell carcinoma of the larynx. METHODS: Over a 4-year period (between January 2000 and June 2004), the records of patients undergoing laryngectomy and neck dissection were retrospectively evaluated. The numbers of the lymph node and carcinoma metastases at level IIB were recorded. The American Joint Committee on Cancer tumor-node-metastasis classification system was used to classify the primary tumor and neck, and the Memorial Sloan-Kettering Cancer Center classification was used to classify the cervical lymphatic chain. RESULTS: Sixty-three patients with 98 neck dissections were included in the study. Two patients (3.17%) had subglottic lesions, 19 patients (30.15%) had glottic lesions, and 42 patients (66.66%) had supraglottic lesions. In total, 673 lymph nodes were dissected from level II, and 340 were dissected from level IIB. The 11 supraretrospinal lymph nodes of the 340 dissected nodes demonstrated histologic evidence of metastases (3.23%). Six patients (9.52%; 6/63) had metastases at level IIB, and 2 of them also had synchronous metastases at the contralateral level IIB. The patients without palpable lymph nodes at the neck had no metastases at level IIB. CONCLUSION: Our results showed that, if the level IIA shows positive metastatic changes, perioperative pathologic examination by frozen section that includes level IIb could be an alternative approach. This area may not be routinely dissected during the surgical management of laryngeal carcinoma with no palpable lymph nodes.

Connections between the facial, vestibular and cochlear nerve bundles within the internal auditory canal.

The vestibular, cochlear and facial nerves have a common course in the internal auditory canal (IAC). In this study we investigated the average number of nerve fibres, the average cross-sectional areas of the nerves and nerve fibres, and the apparent connections between the facial, cochlear and vestibular nerve bundles within the IAC, using light and scanning electron microscopy. The anatomical localization of the nerves within the IAC was not straightforward. The general course showed that the nerves rotated anticlockwise in the right ear from the inner ear end towards the brainstem end and vice versa for the left ear. The average number of fibres forming vestibular, cochlear, and facial nerves was not constant during their courses within the IAC. The superior and the inferior vestibular nerves showed an increase in the number of nerve fibres from the inner ear end towards the brainstem end of the IAC, whereas the facial and the cochlear nerves showed a reduction in the number of fibres. This suggests that some of the superior and inferior vestibular nerve bundles may receive fibres from the facial and/or cochlear nerves. Scanning electron microscopic evaluations showed superior vestibular-facial and inferior vestibular-cochlear connections within the IAC, but no facial-cochlear connections were observed. Connections between the nerves of the IAC can explain the unexpected vestibular disturbances in facial paralysis or persistence of tinnitus after cochlear neurectomy in intractable tinnitus cases. The present study offers morphometric and scanning electron microscopic data on the fibre connections of the nerves of the IAC.

[Fracture of the thyroid cartilage and fixation with miniplate: a case report]. / Tiroit kartilaj kiriginin mini-plak ile onarimi: olgu sunumu.

Laryngeal traumas are rarely seen. A tracheostomy was performed in a 39-year-old male patient who developed dyspnea following a neck trauma. Computed tomography examination revealed fracture of the thyroid cartilage. He was treated successfully by open reduction and miniplate fixation. No problems were detected in airway patency and voice quality on postoperative controls. No complications were encountered within a follow-up period of five months.