Effect of endoscopic endonasal skull base approaches on olfactory function and facial development in children.

INTRODUCTION: Endoscopic approaches for skull base pathologies are increasingly being performed, and the subsequent complications, especially in the long term, have also been partially clarified. However, there is no information on the effects of endoscopic endonasal skull base surgeries (EESBS) in children on odor and facial development in parallel with long-term development. We conducted this study to investigate postoperative olfactory function and facial development in pediatric patients who underwent skull base surgery using the endoscopic endonasal method. METHODS: We evaluated the smell test, sinonasal symptoms, and facial development of pediatric patients who underwent endoscopic endonasal skull base surgery after long-term follow-up. Odor was evaluated using the "Sniffin' Sticks" test kit, which assessed the T (odor threshold), D (odor discrimination), and I (odor identification) parameters. Sinonasal symptoms were evaluated using the SNOT-22 (sinus-nose outcome test) questionnaire. SNA (sella-nasion-A point), SNB (sella-nasion-B point), and ANB (A point-nasion-B point) angles were calculated from maxillofacial tomography and magnetic resonance imaging) to evaluate facial development. Data were compared with those of the healthy control group. RESULTS: We included 30 patients comprising 19 (63.3%) boys and 11 (36.7%) girls, with no age difference between case and control groups. The mean follow-up period was 7 years. Odor test data, cephalometric measurements, and SNOT-22 analysis results showed no statistically significant differences between the two groups. CONCLUSION: To our knowledge, this is a comprehensive study with the longest follow-up period in terms of evaluation of facial development after EESBS in children to analyze odor using the Sniffin' Sticks test kit and the quality of life using SNOT-22. Olfactory function, facial development, and quality of life remained unaffected after long-term follow-up after EESBS  in children. Although this surgical approach is minimally invasive, we recommend considering the possibility of complications, and the procedure should be performed by an experienced surgical team with adequate equipment.

The effectiveness of different surgical techniques in the treatment of obstructive sleep apnea syndrome. Clinical and polysomnographic outcomes.

AIM: The aim of this study is to emphasiz technique in the treatment ofe the importance of DISE in the treatment of OSAS and to evaluate the effectiviness of surgical treatment methods in patients who have undergone OSAS Surgery. MATERIAL AND METHODS: Patients with OSAS were evaluated using preoperative and postoperative Epworth Sleepiness Scale results and preoperative and postoperative sixth month polysomnography (PSG) results. All patients had a DISE preoperatively to assess the upper airway and to decide the surgical approach. RESULTS: There were 44 men (78.6%) and 12 women (21.4%) included in the study. According to the preoperative the Apnea-hypopnea index (AHI), 19 (33.9%) patients were mild OSAS, 19 (33.9%) were severe OSAS and 18 (32.2%) were moderate OSAS. According to the postoperative AHI, 24 (42.9%) patients had only simple snoring. Postoperatively there were 20 (35.7%) mild OSAS, 7 (12.5%) moderate OSAS and (8.9%) severe OSAS detected. When comparing preoperative and postoperative AHI, the greatest decrease was observed in the combined oropharynx and tongue base surgery group. CONCLUSIONS: OSAS is a disease caused by multiple levels of obstruction. The results of this study show a small, statistically significant reduction in the AHI after combined oropharynx and tongue base surgery. KEY WORDS: Drug Induced Sleep Endoscopy, Obstructive Sleep Apnea Syndroma, Polysomnography.

Survival Outcomes of Non-squamous Cell Carcinoma and Rare Squamous Cell Carcinoma Variants of the Larynx.

The literature focuses primarily on laryngeal differentiated squamous cell carcinoma (SCC), and only a limited number of studies have evaluated the outcomes of rare variants of SCC (vSCC) and non-SCC malignancies (nSCC). To our knowledge, this is the first study to compare the survival outcomes of these two groups. We retrospectively reviewed the records of 816 patients who underwent laryngeal surgery from January 2010 to November 2022. Forty-nine (6.2%) were identified as having unusual larynx malignancies and categorized in the nSCC or vSCC groups. The patients' clinicopathological features were then recorded. We compared the two groups' overall survival (OS) and recurrence-free survival (RFS) outcomes. Thirty-three (4.2%) patients had vSCC, and 16 (2%) had nSCC. Forty-two (85.7%) were male, and the mean age was 58.57 years. The median follow-up time was 69 months. The 5-year OS rate was 71.4% in the nSCC group vs. 87.9% in the vSCC group (p = .055). Only surgical margin (HR: 4.68; 95% CI:1.13-19.37, p = .033) was an independent prognostic factor for OS in the multivariable analysis. The 5-year RFS rate was 50% for the nSCC group compared to 90.9% for the vSCC group (p < .001). In the multivariable analysis, surgical margin positivity (HR: 21.0, 95% CI 3.97-98.1, p < .001), and lymphovascular invasion (HR: 0.043, 95% CI 0.005-0.357, p = .004) were independent prognostic factors for RFS. Although OS did not show a statistical difference, nSCC malignancies of the larynx demonstrated worse OS and RFS outcomes than vSCC malignancies. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-03934-8.

The Effect of Repositioning Maneuver Applied with the TRV Chair on Residual Dizziness after Benign Paroxysmal Positional Vertigo.

OBJECTIVE: This study aims to investigate the effect of TRV chair on residual dizziness (RD) after idiopathic posterior semicircular canal benign paroxysmal positional vertigo (BPPV) successfully treated with canalith repositioning maneuver (CRM). STUDY DESIGN: Prospective case-control study. SETTING: Hospital. PATIENTS: Thirty-three patients with posterior canal BPPV were included in the study. These patients were divided into two identical groups. CRM was applied to the first group with a TRV chair (TRV group) and manually to the second group (manual group). INTERVENTIONS: Dizziness Handicap Inventory (DHI), Beck Anxiety Inventory (BAI), and video head impulse test were applied to the patients. Patients in both groups were asked to report the RD developed after successful CRM daily by visual analog scale (VAS). RESULTS: The TRV group's first-day RD rate was 94.1% with VAS, and the RD duration was 2.47 ± 1.77 (0-7) days. The manual group's first-day RD rate was 100%, and the RD duration was 3.38 ± 1.70 (1-7) days. There was no difference between the groups in terms of RD duration ( p > 0.05). Mean RD severity and severity in the first 3 days were lower in the TRV group compared with the manual group ( p < 0.05). There was no difference between the groups on other days ( p > 0.05). In addition, there was a positive correlation between RD and DHI and BPPV duration ( p < 0.05). CONCLUSION: RD is a multifactorial symptom associated with how the repositioning maneuver is performed, BPPV duration, and DHI. Performing the repositioning maneuver with the TRV chair can reduce the severity of RD.

Purely Endonasal Endoscopic Approaches for Extracranial Trigeminal Nerve Schwannoma.

OBJECTIVE: The aim of this study is to assess the effectiveness and safety of purely endonasal endoscopic resection of extracranial trigeminal schwannomas (TGSs), with assessment of surgical and clinical outcomes in order to identify optimal candidates for an endonasal endoscopic approach (EEA). METHODS: A retrospective review of patient's records operated for TGSs between 2008 and 2021 was conducted. Patients operated with a purely EEA were included in this study. Pictures from a frozen fresh cadaver head dissection were used to demonstrate the surgical approach and to show anatomic relationships, complexity of the surgical area and safe corridors for surgery. RESULTS: A total of 5 patients (4 females and 1 male) were operated for TGS. All patients had facial numbness (100%) as a presenting symptom, followed by facial pain in 2 patients (40%), and orbital pain in 1 (20%). Also, 3 patients (60%) had a tumor originating at the level of the foramen ovale and 2 (40%) at the foramen rotundum. The mean tumor diameter was 3,7 ± 2 cm. Gross total resection were achieved in all cases. Postoperatively, 1 patient had severe mastication problems, 1 had blurred vision, and in the long-term follow-up, 1 had frontal sinusitis. The mean follow up was 106.6 (min:49, max:132, SD: 29.82) months. No recurrences were detected. CONCLUSIONS: In cases with the extradural TGS having limited extension into Posterior Cranial Fossa, or located in the Middle Cranial Fossa, a purely EEA is possible even for tumors bigger in size. Unilateral endonasal corridors are adequate for resection in most cases.

The Elderly Voice: Mechanisms, Disorders and Treatment Methods.

The elderly population is increasing globally. In Turkey, the population aged 65+ is predicted to grow to more than 15% of the whole population by 2050. Just like the rest of the body, the voice also changes with age. Voice changes throughout life have been reported in up to 52.4% of aged individuals and may have a negative impact on their quality of life. Voice is affected by various factors, including age, disease, hormones, medications, and physiological, psychological, and social conditions. A multidisciplinary approach is therefore needed to achieve the best voice outcomes. In this review, we summarize the mechanisms involved in voice changes in the elderly together with the applicable diagnostic and treatment methods.

Endonasal Endoscopic Removal of a Langerhans Cell Histiocytosis from Far Lateral Frontal Sinus.

Introduction: Langerhans cell histiocytosis (LCH) is a rare disease in adults, and it is even uncommon in pediatric populations, affecting only 1-2 people per million. A LCH located in the frontal sinus is exceptionally unusual. We present a case of LCH located in the far lateral of the frontal sinus and discuss management as well as surgical techniques to control this far lateral frontal sinus lesion. Case Presentation: A 39 year old female, presented with a history of progressive headaches and purulent nasal discharge for three months. Computed tomography (CT) of the sinuses showed an approximately 15 × 10 mm soft tissue with osteolytic bony changes located in lateral wall of the frontal sinus on the left side. Total tumor removal was achieved by minimally invasive endonasal endoscopic surgery with a periorbital suspension technique. Histopathologic analysis revealed LCH and the patient was referred to a hematologist for further treatment. Conclusion: LCH is a rare hematological pathology. It should be diagnosed timely and treated with a multidisciplinary approach. To get a definitive diagnosis a biopsy is mandatory. Having LCH in the far lateral frontal sinus can be challenging for a biopsy even for experienced surgeons. Using curved instruments while performing an endonasal periorbital suspension technique makes it possible to access the lateral wall of the frontal sinus safely and provides an effective surgical route similar to traditional open approaches without causing any external scars.

Management of a Spontaneous Thyroid Nodule Hemorrhage Causing Acute Airway Obstruction.

Spontaneous intrathyroidal hemorrhage (ITH) causing airway obstruction is relatively rare. We report a case with no known history of a thyroid disease that presented with an ITH causing severe airway obstruction as a life-threatening situation. A 57-year-old female patient presented to the emergency department with sudden onset of swelling of the anterior neck, severe dyspnea, and unconsciousness. Computerized tomography scan after intubation revealed a 6.2x5.3 cm mass originating from the right thyroid lobe and compressing the airway. Drainage of hematoma with right lobectomy was done. When the patient was extubated one day after the surgery the vocal cords were found to be mobile. She was discharged after two days and there was no need for further intervention during the one-month follow-up. Spontaneous life-threatening ITHs are rare entities. Immediate assessment of airway obstruction and achieving a secure airway are crucial. Besides drainage of hematoma, thyroidectomy may also be necessary.

Endoscopic Anatomy and a Safe Surgical Corridor to the Anterior Skull Base.

OBJECTIVE: We describe the possibility to create precise preoperative planning for endonasal endoscopic approaches to the anterior skull base by overlapping endoscopic and radiologic anatomy. The important anatomic structures were marked. Morphometric measurements between these anatomic landmarks were performed endoscopically and compared with radiologic measurements of the same areas to ensure result compatibility. METHODS: Seven cadaver heads injected intravascularly with colored silicone were used for this study. Thin-section brain and paranasal sinus computed tomography scans were obtained on all cadavers. Using 0-degree rigid endoscopes and endonasal endoscopic surgical instruments, the anterior skull base was examined binostrally in all cadavers. Bilateral middle turbinates were identified and preserved. Next, an inferior uncinectomy and middle meatal antrostomy were performed. After performing a frontal antrostomy, bilateral anterior and posterior ethmoidal cells were opened and the skull base was identified and followed to the posterior wall of the frontal sinus. A transnasal transethmoidal sphenoidotomy was done with full exposure to the entire anterior skull base. RESULTS: The anatomic landmarks for endonasal endoscopic skull base approaches were distinguished and measurements were made. The anterior skull base was divided into 3 compartments: anterior (area between the posterior inferior border of the frontal sinus and the course of anterior ethmoidal artery), middle (area between the course of the anterior ethmoidal artery and that of the posterior ethmoidal artery [PEA]), and posterior (area between the course of the PEA and the attachment point of the anterior border of the sphenoid sinus to the skull base) compartments. The distances between important anatomic markers and endoscopic depth measurements of this area were measured. CONCLUSION: During endonasal endoscopic anterior skull base surgery, the area between the anterior border of the sphenoid sinus and PEA artery was safe as the first dissection zone. Preoperative radiologic width and depth measurements facilitate orientation to the endoscopic anatomy during surgery and help predict the endonasal surgical corridor anatomy preoperatively.

Endoscopic Transnasal Skull Base Surgery in Pediatric Patients.

Introduction In pediatric patients, endoscopic transnasal surgery (ETNS) poses challenges because of the small size of the developing skull and narrow endonasal corridors. Objective This study aimed to evaluate the efficacy of ETNS in children by assessing our experience of endoscopic skull base surgery. Materials and Methods All pediatric patients ( n = 54) who were eligible for surgery using only the endonasal endoscopic approach at our tertiary center between 2012 and 2018 were included in this study. The surgeries were performed simultaneously by an endoscopic skull base team of neurosurgeons and otolaryngologists. Hormonal analyses were conducted before and after surgery in all patients with sellar/parasellar lesions. Patients older than 8 years underwent smell and visual testing. Results In the 54 patients aged 1 to 17 years who underwent surgery, craniopharyngioma was the most common pathology (29.6%), followed by pituitary adenoma (22.2%). Gross total resection was achieved in 33 (76.7%) of 41 patients who underwent surgery because of the presence of tumors. All visual deficits improved, although one patient sustained olfactory deterioration. Sixteen (29.6%) patients presented with complications such as transient diabetes insipidus and temporary visual loss. Conclusions Despite anatomy-related challenges in children, adequate results can be achieved with high rates of success, and the functional and anatomical integrity of the developing skull and nose of children can be preserved. In pediatric patients, ETNS is a safe and effective option for addressing various lesions along the skull base.

Endonasal endoscopic management of the craniopharyngeal canal meningoencephalocele using a nasoseptal flap in a 6-month-old infant.

Endonasal endoscopic approach (EEA) has become a routine and effective method for the management of large skull base defects in adults and increasingly in older pediatric populations despite their challenging narrow transnasal corridors. To our knowledge, this is the first report in the literature of a large craniopharyngeal canal (CC) meningoencephalocele in a 6-month-old infant managed purely through EEA, also by utilizing a pedicled nasoseptal flap (PNF).

Preference and Perception of Enhanced Images During Endonasal Endoscopic Surgery.

Image enhancement is used widely in endoscopic sinonasal surgery. It is yet to be established whether image enhancement has advantages over white-light endoscopy. The authors aimed to evaluate the preferences and subjective visual perception of image enhancement in diagnostic images acquired at the beginning of endonasal endoscopic surgeries. An online survey consisting of 12 endoscopic images, 4 enhanced with Clara mode, 4 enhanced with Chroma mode, and 4 enhanced with Clara+Chroma mode, was distributed. The enhanced images were randomly presented with nonenhanced white-light images. These images were captured at the beginning of endonasal endoscopic surgeries for septal perforation, septal deviation, and chronic rhinosinusitis. Survey respondents (n = 205) included 81 otorhinolaryngologists, 94 other specialty physicians (35 endoscopy/laparoscopy users and 59 nonusers), and 30 nonmedical image experts. They were asked to choose superior images according to brightness, contrast and sharpness, depth of field, and overall preference. A quantitative study was also conducted to evaluate different enhancement modes. The authors found that Clara enhanced brightness and Chroma enhanced contrast and sharpness significantly (P < 0.001). Overall, 91.8% chose Clara and 91.7% chose Clara+Chroma-enhanced images for brightness enhancement. For contrast and sharpness, 87% chose Clara+Chroma and 86.7% chose Chroma. There was no significant difference between perception scores among the groups. Our survey group showed a significantly high overall preference for enhanced images. This preference was independent of profession or experience, but closely related to the quantitative enhancement of the specific mode. Continuous use of image enhancement in endonasal surgery may have advantages over white-light endoscopy.

How Often Does Isolated Sphenoid Sinus Disease Turn Out to be a Neoplasm?

Isolated sphenoid sinus disease (ISSD) describes a wide spectrum of pathologies including inflammatory, vascular, bony dysplastic, and neoplastic diseases. The aim of this study was to assess the frequency with which a neoplastic process was diagnosed in patients of ISSD and patient management strategies. A retrospective analysis was conducted for all ISSD patients who underwent surgery between January 2005 and January 2014 at a tertiary center. The clinical characteristics, radiologic studies, operative findings, endoscopic surgical techniques, pathology results, and treatment outcomes of the patients were analyzed. In all, 42 patients (31 women and 11 men) were included in the study. Histopathologic examinations revealed that 10 patients (23.4%) had neoplasms (8 benign and 2 malignant), 19 (45.2%) had mucocele, 7 (16.7%) had fungal disease, and 6 (14.3%) had meningoencephalocele and cerebrospinal fluid leakage. With the exception of 2 patients with plasmacytoma, complete removal of the lesions was achieved in all patients using transnasal or transethmoidal endoscopic approaches, and no local recurrences were observed during the mean follow-up period of 42 months. More than one fifth of the patients with ISSD were diagnosed with neoplasms. The results indicated that endonasal endoscopic approaches could effectively help manage patients with ISSD lesions, including those that were neoplastic. It is clear that precaution during preoperative planning is imperative to avoid unexpected situations and complications that may put surgeons in a difficult position during surgery.