Efficacy of octyl-2-cyanoacrylate in type I tympanoplasty.

OBJECTIVE: To evaluate the safety and efficacy of octyl-2-cyanoacrylate for type I tympanoplasty. METHODS: This study involved 23 patients (14 females and 9 males) with chronic otitis media who underwent type I tympanoplasty. During surgery, the temporal fascia is placed underlying the eardrum remnant, and octyl-2-cyanoacrylate was dropped over the temporal fascia. The mean air-bone gap (ABG) at the 4 frequencies (500, 1000, 2000, and 4000) was calculated for each patient before and after surgery. These data were compared by Student t test. RESULTS: The mean follow-up was 10 months (range, 6-12 mo). Successful tympanic membrane grafting occurred in 21 patients (91.3%). Graft failure was seen in 2 patients. The mean preoperative ABG of the 23 patients was 19.3 (SD, 5.7) dB, and the postoperative ABG improved to a mean value of 8.2 (SD, 5.9) dB (P ≤ 0.0001). CONCLUSIONS: Octyl-2-cyanoacrylate is effective and safe in using as a compound on temporalis muscle fascia in type I tympanoplasty and can be used more widely in tympanoplasty.

A comparison of endonasal with external dacryocystorhinostomy in revision cases.

The objective is to compare the success rates of revision endonasal dacryocystorhinostomy (END-DCR) with revision external dacryocystorhinostomy (EXT-DCR). The present retrospective study was conducted between January 2002 and July 2009. Seventy-four consecutive patients (17 males, 57 females) who had epiphora or recurrent dacryocystitis after a previous failed EXT-DCR procedure were enrolled in the study. The END-DCR group consisted of 43 patients (10 males, 33 females) who underwent 44 END-DCRs, whereas the EXT-DCR group included 31 patients (7 males, 24 females) who underwent 31 dacryocystorhinostomies (DCRs). Successful DCR was defined as relief of symptoms as demonstrated by saline irrigation at the last post-operative visit. Further nasal surgery was performed in 18 (40.9%) eyes in the END-DCR group. The average follow-up time for the END-DCR and EXT-DCR groups was 11 and 9 months, respectively. The success rate was 77.4% (24/31 DCRs) in the END-DCR group, and 84.1% (37/44 DCRs) in the EXT-DCR group. There was no significant difference between the groups regarding overall success (p = 0.465). END-DCR is as safe and efficient technique as external approach with low complication rates in revision cases. END-DCR yields good esthetic and functional results and has a success rate similar to that of the external approach.

Surgical outcomes of primary and revision endoscopic dacryocystorhinostomy.

OBJECTIVE: In the current study, whereas the results of endoscopic primary and revision endoscopic dacryocystorhinostomies (END-DCR) were evaluated, the success rates in patients who did or did not undergo nasal surgery were also compared. METHODS: A retrospective medical record review of 70 patients (with a total of 72 affected cases) who were admitted to our clinic with a primary complaint of epiphora between January 2002 and July 2009 was performed. Patients who required additional nasal procedures were also included in the analysis. A successful DCR was defined as relief of symptoms on testing with irrigation at the last follow-up visit. RESULTS: The success rates were 82.1% (23/28 DCRs) in the primary END-DCR group and 84.1% (37/44 DCRs) in the revision END-DCR group. There were no significant differences between the groups regarding overall surgical success rates (P = 0.829). The need for additional nasal surgery was significantly higher in the revision cases (52.3%) than the primary cases (28.6%; P = 0.048). No significant difference regarding success rates existed between the patients who required an additional septoplasty or ancillary sinus surgery and the patients who did not have nasal pathology and underwent END-DCR alone (P = 0.456). The mean follow-up period was 11 months in the revision END-DCR group and 8 months in the primary END-DCR group. CONCLUSIONS: Endoscopic DCR should be considered as the treatment of choice in cases with intranasal pathologies. Endoscopic DCR is a safe and effective procedure in revision cases, as well as in primary cases.

Unilateral osteotomies for external bony deviation.

OBJECTIVE: Deviated nose is a challenge for rhinoplasty surgeons. We applied a new technique to correct nasal bone asymmetry in selected patients. We assessed the efficacy of the technique and discussed the surgical outcomes. METHODS: We retrospectively analyzed 29 patients with deviated nose who received unilateral osteotomy alone or unilateral osteotomy with camouflage graft placement to the other side of the nose. Preoperative and postoperative photographs were studied to evaluate the outcomes. RESULTS: Twenty-nine unilateral osteotomies were done. Camouflage grafting was performed to 20 of the 29 patients. Nasal humps were removed in all patients. No postoperative complications occurred during the follow-up period. Twenty-six of 29 deviated noses were corrected with unilateral osteotomy. CONCLUSIONS: The unilateral osteotomy technique seems to be a useful method for correcting deviated nose.

Effect of pharyngeal packing during nasal surgery on postoperative nausea and vomiting.

OBJECTIVE: The aim of this study was to evaluate the efficacy of pharyngeal packing in reducing postoperative nausea and vomiting (PONV) after nasal surgery by taking into consideration the surgery types. STUDY DESIGN: A prospective, randomized, controlled trial. SETTING: A tertiary referral center. SUBJECTS AND METHODS: After the study was approved by the local ethics committee, this study was conducted in the Otorhinolaryngology clinic with the collaboration of the Anesthesiology clinic. The development of PONV within 24 hours after surgery was evaluated in patients who were applied a pharyngeal pack (Group 1) or not (Group 2) during nasal surgery. RESULTS: There were 104 adult patients for routine nasal surgery included in the current study, yielding 100 (group 1, n = 50; group 2, n = 50) evaluable subjects. No significant difference was found in the incidence of PONV between the two groups at two (P = 0.41), four (P = 0.54), eight (P = 0.51), and 24 hours. According to surgery type, the incidence of PONV after two hours was 71 percent in septorhinoplasty, 68 percent in endoscopic sinus surgery, and 50 percent in septoplasty; after four hours it was 59 percent in septorhinoplasty, 53 percent in endoscopic sinus surgery, and 37 percent in septoplasty; and after eight hours it was 35 percent in septorhinoplasty, 39 percent in endoscopic sinus surgery, and 21 percent in septoplasty. PONV was not seen at 24 hours. Compared to the septoplasty group for which pharyngeal packing was used, significantly lower rates of PONV at four and eight hours were found in the septoplasty group in which pharyngeal packing was not used (P = 0.02). CONCLUSION: Pharyngeal packing in nasal surgery has no impact on PONV.

A randomised prospective trial of trans-septal suturing using a novel device versus nasal packing for septoplasty.

BACKGROUND: Nasal packing or trans-septal sutures are used to prevent postoperative complications in septoplasty. Trans-septal suturing is not commonly used, since it takes time and is technically difficult with the available devices following septoplasty. METHODS: This study included 64 patients who underwent septoplasty. Following septoplasty, the patients were divided into two groups: group 1 had trans-septal sutures placed using a novel device and group 2 had the nose packed with a tampon. The duration of surgery, postoperative symptoms and complications were compared. RESULTS: All of the postoperative symptoms were significantly less in the group with trans-septal sutures. The mean duration of surgery was 34.9 minutes in the nasal packing group and 37.8 minutes in the trans-septal suture group, and the difference was significant (p = 0.026). No postoperative bleeding, submucoperichondrial haematomas, infections or abscesses occurred in any of the patients, whilst nasal perforation was observed in one patient in each group. Two (5.4%) patients in group 1 and one (3.7%) patient in group 2 had postoperative adhesions. CONCLUSIONS: We have developed a simple, inexpensive device for performing trans-septal suturing that is easy to use in the nasal cavity. We conclude that the use of continuous septal suturing with our device is an easy modification of the standard procedure, with only a small increase in operating time.

Chorda tympani nerve analysis with electron microscopy in chronic suppurative otitis media.

CONCLUSION: Chronic suppurative otitis media causes some disturbance to the chorda tympani nerve (CTN), which may affect the facial nerve. It is not possible to perform a biopsy of the main truncus of the facial nerve, therefore studies of the CTN might show possible pathologic or physiologic changes of the facial nerve in the future. OBJECTIVES: The specific aim of this study was to investigate the effects of chronic suppurative otitis media on the CTN. METHODS: The tympanic segments of CTNs were collected for ultrastructural investigations in patients with chronic suppurative otitis media who underwent canal wall-down tympanoplasty. The study population comprised 10 patients, 7 males, 3 females; the age range was 16-66 years, and the mean age was 38. Qualitative and semiquantitative evaluations were performed on the specimens of CTN by electron microscopy. RESULTS: Our histopathologic examinations showed that there were changes of varying severity in all the CTNs such as scarcity of unmyelinated nerve fibers, Schwann cell nucleus condensation, scarcity of Schwann cell cytoplasm, adaxonal vacuolation and edema, myelin sheath disintegration, shrunken electron-dense axoplasm, increased collagen fibers, adaxonal circular lamellar complex, interstitial edema, and vacuolation of Schwann cell cytoplasm.

Minimally invasive cochlear implantation with mastoidal three-layer flap technique.

AIMS: To describe and evaluate a minimally invasive cochlear implantation approach using mastoidal three-layer flap (TLF) technique. METHODS: We conducted a prospective clinical study at a tertiary referral center. The study population comprised 32 males and 16 females, with an age range of 1-51 years. Thirty-nine patients were operated on using the TLF technique and 9 patients were operated on using a classical cochlear implantation technique. The TLF technique was based on using the superficial musculoaponeurotic system (SMAS) as an additional, strong flap layer. The TLF, with 3 different pedicules, comprised an anteriorly based 4-cm skin flap, a superiorly based temporomastoidal flap, which included the SMAS, and an anteriorly based periostal Palva type flap in the same mastoidal area. RESULTS: No major complications, including flap-wound problems and receiver-stimulator migration or extrusion, were encountered. The mean operation time was 66 min in the TLF population and 92 min in the classical operation population, which shows a statistically significant difference noted in the time of operation (p = 0.0001). CONCLUSION: The TLF cochlear implantation enables complete receiver-stimulator coverage and safe fixation without any additional procedures, while allowing reduced operation time.

Prospective, controlled clinical trial of Ankaferd Blood Stopper in children undergoing tonsillectomy.

OBJECTIVES: This is a prospective study evaluating the efficacy of Ankaferd Blood Stopper as a hemostatic agent compared to hemostasis by means of knot-tie after cold knife dissection tonsillectomy. METHODS: Study design was the use of ABS and the KT to reach hemostasis for patients undergoing tonsillectomy. ABS is applied on right side tonsil fossa and KT is used on left side tonsil fossa. Measured outcomes such as blood loss, surgical time, and complication will be assessed. In total, 47 consecutive patients undergoing cold knife dissection tonsillectomy were studied, in all of whom Ankaferd Blood Stopper wet tampon was used for right side tonsil hemorrhage and knot-tie technique for left side tonsil hemorrhage. Data were collected intraoperatively. Follow-up visits of all patients were completed at postoperative days 1, 3, 7, and 10. RESULTS: Ankaferd Blood Stopper side had shorter hemostasis time after tonsil removal than knot-tie side (3.19+/-0.74 min vs 7.29+/-2.33 min [mean+/-SD], p<0.01) and less blood loss (1.57+/-2.26 ml vs 14.04+/-7.23 ml [mean+/-SD], p<0.01). In addition, KT number was less with ABS side as compared to KT side (p<0.01). CONCLUSIONS: The side on which Ankaferd Blood Stopper was used had statistically significant differences in hemostasis time, blood loss, and knot-tie number in the operation period. Ankaferd Blood Stopper is safe and efficient, and it decreases intraoperative bleeding, reduces operating time, as compared to the traditional hemostasis methods after cold knife dissection tonsillectomy.

Laryngeal transplantation in the setting of cancer: a rat model.

OBJECTIVE: Traditional immunosuppressive regimens make laryngeal transplantation in cancer patients prohibitive because of the increased risk of recurrence. Everolimus, a recently developed immunosuppressant, has demonstrated significant antitumor properties. The purpose of this study was to examine the effects of everolimus alone and in combination with other immunosuppressants on tumor growth in a combined laryngeal transplantation and tumor model. STUDY DESIGN: Animal, prospective, randomized, controlled, and blinded. METHODS: One million squamous cell carcinoma cells (SCC-158) were injected intravenously into a total of 40 rats 1 day before laryngeal transplantation. Rats were divided into four groups differing by immunosuppressive regimens. Lung surface metastases were counted 21 days after inoculation, and numerical transplantation rejection scores were recorded. A separate experiment for comparison was performed with no transplant on 24 rats, but with the same immunosuppressive treatment groups. RESULTS: The median number of lung surface metastases were: a) control (i.e., no immunosuppression): 85; b) everolimus 1.0 mg/kg: 25; c) tacrolimus 1.2 mg/kg: 1650; d) everolimus 1.0 mg/kg + tacrolimus 0.05 mg/kg: 1300. Rats receiving everolimus alone showed a statistically significant decrease in pulmonary surface metastases compared with the other groups. Transplanted rats had no difference in their outcomes when compared with non-transplanted rats. CONCLUSION: Everolimus significantly decreases SCC-158 growth in our combined transplantation and tumor model compared with controls and other immunosuppressants.

[Endoscopic approach in patients with choanal polyps]. / Koanal polipli olgularda endoskopik yaklasim.

OBJECTIVES: We evaluated the results of endoscopic treatment for choanal polyps. PATIENTS AND METHODS: Twelve patients (5 females, 7 males; mean age 25 years; range 10 to 49 years) underwent endoscopic surgery for choanal polyps. Preoperatively, all the patients were evaluated with endoscopic nasal cavity and nasopharyngeal examination and computed tomography of the paranasal sinuses. In addition, serum total and specific IgE levels were measured and prick test was performed. There were seven antrochoanal (58%), two ethmochoanal (17%), two sphenochoanal polyps, and one patient (8%) had a chonchachoanal polyp. Anterior ethmoidectomy and intranasal polypectomy were performed for ethmochoanal and sphenochoanal polyps, respectively. Two patients in whom antral part of the mucosa could not be clearly determined underwent transcanine sinoscopy. In all the patients, the mucosa giving rise to polyps was removed. Evaluations were made at one and six months and at the end of a year. RESULTS: The most common symptoms were nasal obstruction (70%) and nasal discharge (52%). Allergic tests were positive in two patients with antrochoanal polyps. The only complication was mild bleeding in two patients. No recurrences were encountered within a year follow-up. CONCLUSION: Endoscopic approach for choanal polyps can be applied at all ages and it is associated with low morbidity.

Immunotherapy of established murine squamous cell carcinoma using fused dendritic-tumor cell hybrids.

OBJECTIVE: To investigate the therapeutic efficacy of fused dendritic-tumor cell hybrids against murine squamous cell carcinoma (SCC). DESIGN: Squamous cell carcinoma VII is a poorly immunogenic murine SCC tumor in C3H/HEN (H-2(K)) mice. Subdermal tumors were established by inoculation in the mid abdomen of mice. Tumor diameters were measured with a Vernier caliper and used as an indication of treatment efficacy. Survival studies were performed on mice with 3-day pulmonary metastasis or subdermal tumors. Dendritic cells were generated from bone marrow and cultured for 8 days. Dendritic cells were harvested and mixed with cultured tumor cells in a 1:1 ratio. Cell fusion was achieved by exposing the cell mixture to an alternate electrical current to bring cells into alignment and close together, followed by a short direct electrical current pulse. SUBJECTS: Female C3H/HEN mice aged 8 to 12 weeks. INTERVENTIONS: Mice with 3-day established SCCVII tumors were vaccinated by inguinal intranodal injection of fusion cells (0.3 x 10(6) per side). To support the development of antitumor immunity, mice were given adjuvant injections intraperitoneally. Anti-OX40R monoclonal antibodies or interleukin 12 were used. Treatment groups included no treatment, anti-OX40R monoclonal antibodies or adjuvant IL-12 alone, fusion cells alone, and fusion cells with adjuvant treatment. MAIN OUTCOME MEASURES: Tumor size and overall survival. RESULTS: Mice treated with adjuvant treatment or fusion cells alone did not show a statistical difference in tumor growth when compared with controls. In contrast, fusion cells with adjuvant treatment demonstrated a significant decrease in tumor size when compared with nontreated mice (P < .001). Treatment with fusion cells also resulted in increased survival in the pulmonary metastasis and subdermal tumor models. CONCLUSION: Immunotherapy with fused dendritic-tumor cell hybrids can significantly affect 3-day established sSCC VII tumor growth.

Regional spread of cutaneous squamous cell carcinoma of the face via facial vein tumor thrombus: a case report.

Cutaneous squamous cell carcinoma of the head and neck most often spreads via direct extension or through lymphatics to regional lymph nodes. This is a unique case of a cutaneous squamous cell carcinoma of the nasal dorsum with direct vascular invasion of the facial vein. This was initially incorrectly identified as a regional level Ib lymph node metastases, and the intervening venous structures were neither extirpated during an initial surgery nor recognized during subsequent radiation therapy. The patient then presented with a sizable recurrence in the right suborbital subcutaneous tissue region extending into the neck and internal jugular vein. During further resection, direct tumor invasion into the facial vein was pathologically confirmed. This unusual involvement is presented as the first documented report of regional spread via tumor thrombosis within the facial vein as demonstrated in the facial vein with a tumor thrombus, as demonstrated by computed tomography and microscopic findings.

[Ectopic molar tooth in the maxillary sinus]. / Maksiller sinüste ektopik molar dis

The development of intranasal ectopic teeth is rare. Although they are more commonly seen in the palate and maxillary sinus, they can also be found in the mandibular condyle, coronoid process, and nasal cavity. A 30-year-old male patient presented with a complaint of headache. Computed tomography of the paranasal sinuses showed a bony mass in the right maxillary sinus wall, 1 cm in size. He did not have any history of maxillofacial trauma or operation. The mass was removed via a Caldwell-Luc procedure. It looked like a tooth. Histopathologic diagnosis was made as ectopic molar tooth. The patient was asymptomatic two weeks after the operation.