Evaluation of Advanced Oxidation Protein Products (AOPP) and Superoxide Dismutase (SOD) Tissue Levels in Patients with Nasal Polyps.

The aim of this study is to eveluate levels of advanced oxidation protein products (AOPP) which are thought to increase in the polyp tissue and superoxide dismutase (SOD), an antioxidant enzyme, with using specthrophotometry in polyp tissue and healthy mucosa. 30 nasal polyp patients without inflammatory disease except for nasal polyposis were included in the study. The control group consisted of 18 patients who did not have allergy, asthma, inflammatory and granulomatous disease and planned surgery due to septum deviation and concha hypertrophy. AOPP and SOD tissue levels were measured by spectrophotometry in polyp tissue specimens taken from patients with nasal polyps and concha samples taken from patients in the control group. The mean AOPP tissue level of patients in the nasal polyposis group was statistically significantly higher than the control group. (p < 0.05). The mean SOD activity level was significantly lower in the nasal polyposis group than the control group. (p < 0.05) As a result of this study, high AOPP levels in polyp tissue and low SOD levels in polyp tissue compared to healthy nasal mucosa, oxidative stress plays an important role in nasal polyp development.

Expression profiles of CD11b, galectin-1, beclin-1, and caspase-3 in nasal polyposis

Background/aim: Nasal polyposis is a chronic inflammatory disease affecting the paranasal sinuses and nasal mucosae. It is thought that genetic and molecular mechanisms in inflammatory and apoptotic pathways are the main factors in the etiopathogenesis of nasal polyposis. The aim of this study was to investigate the expression patterns of CD11b, galectin-1, beclin-1, and caspase-3 in nasal polyps.Materials and methods: The mRNA expression levels of CD11b, galectin-1, beclin-1, and caspase-3 protein and western blot analysis of caspase-3 protein were evaluated in inferior turbinate mucosae and nasal polyp tissues.Results: CD11b expression was markedly higher in nasal polyp tissues when compared to turbinate mucosae (5.5 times higher, P < 0.05). Expression of galectin-1 was not statistically higher in nasal polyp tissues when compared to the controls. Beclin-1 expression in nasal polyp tissues was lower than in controls (17 times lower, P < 0.05). Caspase-3 expression was significantly lower in nasal polyp tissues than in controls (5.5 times lower, P < 0.05).Conclusion: Inflammation, apoptosis, and hyperproliferation are the major cellular processes in nasal polyposis and these proteins may take part and play some important roles in formation of this disease and the targeting of new treatment protocols.

Microbiological and Histopathological Effects of Nasal Packing Containing Probiotics on Nasal Mucosa.

BACKGROUND: Nasal packing is frequently used after surgical interventions to prevent bleeding and synecchia formation and for the treatment of diseases such as epistaxis. One of the most morbid complications of nasal packing applications is the toxic shock syndrome (TSS). Owing to the microbiological structure of nasal mucosa, antibiotics are administered to all patients who are applied nasal packages for prevention of TSS. AIM: The aim of this study is the evaluation of microbiological and histopathological changes taking place in nasal mucosa with nasal packing containing probiotics. METHODS: Three groups were formed with 6 rats in each group. The nasal packings with the same characteristics were applied to nasal cavities of rats in all 3 groups. In group 1, only nasal packs were used. Probiotics or parenteral antibiotics were not used. In group 2, parenteral antibiotics were used along with nasal packs. In group 3, nasal packs with probiotics containing Lactobacillus strains were applied. No parenteral antibiotics were used. After 3 days packages were removed and nasal cavity was irrigated with saline. Both packages and irrigation materials were analyzed for microbiological content. After scarification, nasal and paranasal structures were examined for histopathological changes. RESULTS: In group 3 statistically the total bacteria load was significantly lower in comparison to the other groups. However, in the histopathological evaluation of the mucosa of rats in group 3, bleeding and inflammation findings were significantly higher statistically. CONCLUSIONS: It has been determined that the total microbiological load significantly decreases with the application of packing containing probiotics. So, the use of probiotics along with nasal packings is promising to prevent unnecessary use of medications.

Analysis of choanal polyps.

Choanal polyps (CPs) are unilateral benign masses usually originating from paranasal sinuses. Maxillary, ethmoid, and sphenoid sinuses are involved in order of decreasing frequency. In this study, the medical records of patients operated on with a clinical diagnosis of CP between 1998 and 2011 were reviewed. A total of 98 patients with a mean age 24.3 years were analyzed. Histopathologic diagnoses were CP in 94 patients and inverted papilloma in 4 patients. The sites of origin were maxillary sinus in 89 patients (90.8%), sphenoid sinus in 6 patients (6.1%), bulla ethmoidalis, inferior concha, and uncinate process in 1 patient each (1.0%). The most common symptoms were nasal obstruction (98.0%) and postnasal drip (30.6%). The surgical approaches were endoscopic sinus surgery in 63 patients (62.4%) unilaterally and in 12 patients (11.9%) bilaterally and unilateral endoscopic sinus surgery with mini Caldwell in 26 patients (25.7%). All 3 recurrences were in pediatric patients, and the recurrence rates among pediatric patients and overall were 7.7% and 3.1%, respectively. Endoscopic sinus surgery is an effective surgical procedure for treatment of CP; however, addition of a mini-Caldwell approach is safe for antrochoanal polyp resection if the endonasal technique fails. Histopathologic examination is mandatory because inverted papillomas may present as CPs.

Sphenopalatine artery pseudoaneurysm: a rare cause of intractable epistaxis after endoscopic sinus surgery.

Epistaxis is a frequent health problem and the most common cause of emergency in otorhinolaryngology practice. In this report, a case of a 26-year-old patient with intractable epistaxis after endoscopic sinus surgery was presented. The epistaxis began at the fourth postoperative day and was unresponsive to endoscopic cauterization and anterior and posterior nasal packing. On angiographic investigation, a pseudoaneurysm of the sphenopalatine artery was detected and treated with microcatheter embolization. This is the second case of postoperative sphenopalatine pseudoaneurysm as a complication of endoscopic sinus surgery in the literature.

Neoplasms of the hard palate.

PURPOSE: Although the most common neoplastic lesion of the oral cavity is squamous cell carcinoma (SCC), primary neoplastic lesions of the hard palate have not been systematically reviewed to date. The aim of this study was to determine the histopathologic composition and characteristics of neoplasms of the hard palate. MATERIALS AND METHODS: A retrospective analysis of 66 patients with a primary neoplasm of the hard palate managed at the authors' institution from 1985 through 2012 was performed. Demographic features, malignancy rate, histopathologic characteristics and distribution, TNM staging results, metastasis patterns, and management strategies were investigated. RESULTS: The sample was composed of 66 patients (mean age, 45.0 yr; 57.6% men). Neoplasms were benign in 57.6% of cases and malignant in 42.4%. Epithelial neoplasms and mesenchymal neoplasms were encountered in 52 patients (78.8%) and 14 patients (21.2%), respectively. Minor salivary gland tumors (MSGTs) were the most common histopathologic group (60.6%), followed by benign mesenchymal tumors (15.2%), SCCs (12.1%), malignant melanomas (6.1%), lymphomas (3.0%), and sarcomas (3.0%). Although 75.0% of malignant epithelial neoplasms were at an advanced stage, there were no pN+ SCC or malignant MSGT cases at presentation. CONCLUSION: The most common neoplasms of the hard palate were MSGTs. SCCs were relatively rare in this series. Although three-fourths of neoplasms were at an advanced stage, neck metastasis was not a characteristic of malignant epithelial neoplasms located in the hard palate.

[The role of COX-2, ALOX12 and iNOS genes in nasal polyposis]. / COX-2, ALOX12 ve iNOS genlerinin nazal polipozisteki rolü

OBJECTIVES: The aim of this study was to investigate whether cyclooxygenase-2 (COX-2), arachidonate 12-lipoxygenase (ALOX12) and inducible nitric oxide synthase (iNOS) which are well-known mediators in inflammatory process play a role in nasal polyposis (NP) and to show their roles in initiation and progression of inflammation. PATIENTS AND METHODS: We investigated the expression levels of COX-2, ALOX12 and iNOS genes by real-time polymerase chain reaction (PCR) method in NP tissues obtained from 10 patients (4 females, 6 males; mean age ?? years; range 21 to 54 years). RESULTS: The mRNA levels of COX-2 expression observed in NP was found to be relatively increased, compared to the control tissue (p>0.05). The ALOX12 levels were relatively decreased (p>0.05), while the expression level of iNOS mRNA was significantly higher in NP tissue (p<0.05). CONCLUSION: These data suggest that nitric oxide (NO), a gene product of iNOS, may play a physiological role in the upper airways and also NO is associated with inflammatory processes in the airways.

Can bile acids be an etiological factor for laryngeal carcinoma?

PURPOSE: The objective of this study is to show the accumulation of bile acids in laryngeal tissues of laryngeal carcinoma patients. MATERIALS AND METHODS: The present study compared the total bile acid level in the hypopharyngeal tissue, tumor tissue, and blood of 21 primary laryngeal carcinoma patients (study group) to that in the hypopharyngeal tissue and blood of 15 patients with benign laryngeal lesions (control group). RESULTS: The total bile acid level was significantly higher in the tumor and hypopharyngeal tissues of the study group than in the hypopharyngeal tissues of the control group; however, the difference in the blood total bile acid level between the 2 groups was not significant. CONCLUSION: Bile acids in reflux material accumulate in the laryngeal tissue in laryngeal carcinoma patients; therefore, bile acids should be considered a carcinogenic factor in the etiology of laryngeal carcinoma because of their mutagenicity due to DNA breaking, as they cause chronic inflammation due to intracellular accumulation.

Intracerebral tension pneumocephalus complicating endoscopic sinus surgery: case report.

BACKGROUND: Various forms of intracranial air have been described in the literature. AIM: This report aims to present clinical, radiological and intraoperative findings of a rare intracranial air entrapment case after endoscopic sinus surgery.

[Use of dehydrated temporal fascia in chronic otitis media surgery and tympanoplasty]. / Kronik otit cerrahisi ve timpanoplastide dehidrate temporal fasya kullanilmasi.

OBJECTIVES: We evaluated the use of homograft dehydrated temporal fascia (Tutoplast) in repair of tympanic membrane perforations secondary to chronic otitis media. PATIENTS AND METHODS: Dehydrated temporal fascia was used during tympanoplasty in 17 patients (10 females, 7 males; mean age 34 years; range 15 to 53 years) with chronic otitis media. Operations were type 1 tympanoplasty in six patients, tympanoplasty and mastoidectomy in three patients, and revision tympanoplasty and/or mastoidectomy in the remaining patients. The patients were followed-up for at least two years. RESULTS: Complete wound healing was achieved without complications, and the material used was well tolerated in all the patients. Only one patient had a small perforation. The tympanic membranes were anatomically intact in 16 patients (94%). CONCLUSION: The use of dehydrated temporal fascia provides maximum microsurgical comfort due to its soft, flexible feature and maintenance of its delicacy even in contact with blood. Thus, dehydrated temporal fascia should be considered for selected cases for its ease of use and anatomical success.

Pleomorphic adenoma of the nasal columella.

Pleomorphic adenoma (mixed tumor) is the most common benign neoplasm of the salivary glands. It is considered to occur primarily in the major salivary glands, such as the parotid and submandibular glands. It is much less common in the minor salivary glands, and rarely occurs at other sites, such as larynx, pharynx, trachea, lacrimal gland, and sinonasal tract. An external nose localization of this lesion is very rare. Irrespective of the site where the lesion originates, its preferred treatment should be surgery. We describe a very rare case of recurrent pleomorphic adenoma originating from the columella.

Surgical treatment of elongated styloid process: experience of 61 cases.

AIM: To describe the management of patients with elongated styloid process syndrome (Eagle's syndrome). MATERIALS AND METHODS: Sixty-one patients with elongated styloid process were treated between 2000 and 2005. Computed tomography examination defines those whose symptoms suggest the diagnosis. Patients with styloid processes longer than 25 mm were treated by surgical resection. RESULTS: Fifty-seven (93.4%) of 61 patients treated for Eagle's syndrome became asymptomatic after resection. There were no serious complications. CONCLUSION: Patients with clinically and radiologically established elongated styloid process can be managed successfully by surgical resection using an external approach.

Obstructive upper airway problems and primary enuresis nocturna relationship in pediatric patients: reciprocal study.

OBJECTIVE: To determine the relationship between primary enuresis nocturna (PEN) and obstructive upper airway problems (OUAPs). DESIGN: Prospective, descriptive study. SETTING: Tertiary care academic medical centre. METHODS: Two groups of patients were included in the study. Newly diagnosed pediatric PEN patients between August 2004 and June 2005 were evaluated for OUAPs in the Department of Otorhinolaryngology of our institution and constituted the first group of patients. During the same period, patients who were on the surgery list for upper airway problems were examined for PEN in the Department of Pediatric Psychiatry as the second group. Obtained data were analyzed with regard to patient demographics and the relationship between PEN and OUAPs, and follow-up results are reported. MAIN OUTCOME MEASURES: There were 32 patients in each group. In the first group, 5 patients (15.6%) had totally obstructing severe septal deviation, 8 patients (25.0%) had moderate septal deviation, 10 patients (31.3%) had allergic rhinitis and inferior turbinate hypertrophy, 3 patients had adenotonsillar hypertrophy (9.4%), and 1 patient (3.1%) had septal perforation. The frequency of OUAP in PEN patients was 65.6%. In the second group, 10 patients (31.3%) had a PEN diagnosis. After at least 3 months (mean 6.3 months) of follow-up, four patients (40%) were free of PEN and two patients (20%) experienced improvement in PEN. Another four patients did not have any change in the severity of PEN. CONCLUSIONS: According to our results, OUAPs are very common in PEN patients and PEN is a common symptom of OUAPs.

[Hemodynamic effects of local anesthetics with adrenaline during septal surgery]. / Nazal cerrahide adrenalinli lokal anestetiklerin hemodinamik etkileri.

OBJECTIVES: We investigated the hemodynamic effects of local anesthetics with adrenaline used before septal surgery. PATIENTS AND METHODS: In a prospective, controlled design, administration of local anesthetics was performed with and without adrenaline in 39 patients and 10 patients, respectively, undergoing septal surgery. Plasma adrenaline concentrations were measured before anesthesia, and after 2, 5, and 10 minutes from anesthesia. The patients were monitored with respect to pulse rate, electrocardiographic findings, and blood pressure. RESULTS: Preoperative plasma adrenaline levels were similar in patients receiving local anesthetics with or without adrenaline (0.8 nmol/l vs 0.7 nmol/l). Following adrenaline administration, adrenaline levels showed significant increases to 2.2, 1.9, and 1.7 nmol/l after 2, 5, and 10 minutes, respectively (p<0.001), whereas they remained similar in the control group. No side effects related to adrenaline use were detected. CONCLUSION: Despite systemic absorption of local injections, adrenaline-related side effects during septal surgery are extremely rare when the patients are closely monitored.

Investigation of fungi in massive nasal polyps: microscopy, culture, polymerase-chain reaction, and serology.

BACKGROUND: Although some clues exist about the causative relationship of fungi and chronic rhinosinusitis, the relationship of nasal polyps and fungi has not been enlightened. The purpose of this study was to determine whether a relationship exists between fungi and massive nasal polyps and to evaluate current available diagnostic techniques for detection of fungi. METHODS: Thirty cases of massive nasal polyposis (NP) were evaluated prospectively for fungal evidence and were compared with 18 cases of concha bullosa based on direct microscopy, fungal culture, serology, polymerase chain reaction (PCR), and sequencing. RESULTS: Fungal colonization was detected in 15 (50.0%) of the cases with massive NP, but only in 2 (11.1%) of the cases with concha bullosa. A significant difference was found between the study and the control groups in terms of fungal existence (p < 0.016). Direct microscopy was positive in 14 (46.7%) and 1 (5.6%) of the cases;fungal culture was positive in 8 (26.7%) and 4 (22.2%) of the cases; serology was positive in 9 (30.0%) and 2 (11.1%) of the cases; PCR was positive in 18 (60.0%) and 6 (33.3%) of the cases with massive NP and concha bullosa, respectively. CONCLUSION: Fungal colonization was found to be more common in massive NP patients compared with the control group. According to our results, microscopy and PCR were most sensitive techniques for detection of fungi.

Upper lateral cartilage inner mucoperichondrial flap technique for the repair of nasal septal perforation.

Treatment of nasal septal perforations which decrease quality of life is a surgical challenge with variable success rates. Numerous surgical methods have been proposed for closure of perforations. The technique described in this article, i.e. closure of the perforation with an upper lateral cartilage mucoperichondrial flap through an external septorhinoplasty approach, is an alternative surgical technique. Twenty-four patients with symptomatic nasal septal perforation were operated on using this technique and followed up for a mean duration of 28 months. Preoperative and postoperative symptom scores for crusting, nasal obstruction, bleeding, discharge, whistling, headache, nasal pain, snoring and olfactory loss as well as overall discomfort levels were compared using a visual analogue scale. Complete closure of the perforation was achieved in 19 patients.

The treatment of lymphangioma in the buccal mucosa by radiofrequency ablation: a case report.

Lymphangioma is a benign, hamartomatous tumor of the lymphatic system. It is usually found in the head and neck region and is widely regarded as a developmental lesion rather than a true neoplasia. Most lymphangiomas are present at birth (60%), and by the age of 2 years 80% to 90% are present. In the head and neck area, the most common location is the submandibular region, followed by the parotid gland. When lymphangioma occurs in the mouth, the anterior two thirds of the tongue is the most commonly affected region. Various methods have been tried for treatment of lymphangioma including surgery, radiation, laser therapy, and sclerotherapy. Recently, a new and more conservative surgical approach to this lesion using radiofrequency ablation has been described. In this report, a case of lymphangioma in the right buccal mucosa of the mental foramen area that has been treated by radiofrequency ablation is presented.

[Isolated inverted papilloma of the sphenoid sinus: a case report]. / Sfenoid sinüsün izole inverted papillomu: olgu sunumu.

Inverted papilloma is a rare benign sinonasal tumor characterized by a potentially invasive nature. The lateral nasal wall represents the most common site of origin, whereas paranasal sinuses are frequently involved by extension. In contrast, primary sinus inverted papillomas have rarely been reported. The present study describes a 52-year-old man that presented with a one-year history of unilateral nasal obstruction, nasal discharge, epistaxis, occipital headache and decreased sense of smell. After nasal endoscopic examination, computed tomography was taken and endoscopic biopsy was performed which demonstrated isolated inverted papilloma of the left sphenoid sinus. Tumor was taken via transnasal endoscopic sphenoidotomy. No evidence for recurrent disease was seen after 12 months of follow-up and his symptoms were completely relieved. Endoscopic transnasal sphenoidotomy remains an effective treatment for these lesions.

[Endoscopic surgery of sphenochoanal polyp]. / Sfenokoanal polibin endoskopik cerrahisi.

Sphenochoanal polyp is a rare entity originating from the sphenoid sinus. It may be confused with an antrochoanal polyp on anterior rhinoscopy. Computerized tomography and nasal endoscopy have contributed to an increase of accuracy in the diagnosis of these masses. Simple polypectomy that leaves some part of the polyp inside the sphenoid sinus carries a high risk of recurrence. We present a case of sphenochoanal polyp in a child that was operated by endonasal endoscopic approach. She was free of symptoms after surgery. No complications and recurrences were observed at 16 months of follow-up periods respectively.

Accessory nerve function in lateral selective neck dissection with undissected level IIb.

BACKGROUND: To investigate the accessory nerve function in lateral selective neck dissections (LSND) performed in laryngeal squamous cell carcinoma patients without dissection of level IIB. METHODS: Fifteen LSND were performed in 11 N0 laryngeal carcinoma patients with preservation of level IIB. Distal latencies, compound muscle action potentials (CMAP), and electromyography findings were investigated before surgery, during the 3rd postoperative week, and 3 months thereafter to compare the effects of the procedure on the accessory nerve. RESULTS: Distal latencies and CMAP values were significantly lower in the early and late postoperative periods when compared with preoperative values. In 8 patients, there was no motor unit potential (MUP) in the early postoperative period. However, in the late postoperative period, there was no MUP loss. CONCLUSIONS: Only temporary functional deterioration of the accessory nerve was seen in patients in whom LSND was performed with undissected level IIB.