Contralateral Depressor Labii Inferioris Chemodenervation for Congenital Unilateral Lower Lip Palsy.

INTRODUCTION: Congenital unilateral lower lip palsy - also known as asymmetric crying facies - is isolated asymmetry of the lower lip unilaterally. It is characterized by isolated lower lip asymmetry during smiling and speech. Although etiology is unknown, depressor labii inferioris (DLI) weakness is hold responsible. AIM: Purpose of this study was to evaluate the effectiveness of contralateral depressor labii inferioris botulinum toxin injection on patients' concern levels and patient satisfaction. Ten units of botulinum toxin A injection was carried out to the healthy contralateral side. METHODOLOGY: Eleven patients were treated. Patients' pretreatment and posttreatment concern regarding asymmetry during speech and smiling was evaluated with a questionnaire. Patients' perception of treatment satisfaction was also evaluated with a questionnaire. RESULTS: Mean score related to concern about asymmetric appearance during smiling decreased from 1.6 ±â€Š0.8 to 0.5 ±â€Š0.5. Mean score related to concern about asymmetric appearance during speech decreased from 1.6 ±â€Š0.5 to 0.4 ±â€Š0.5. Eleven out of 11 patients reported improvement with speech whereas 10 out of 11 patients reported improvement with smiling. No weakness about oral competence was reported. CONCLUSION: Most congenital unilateral lower lip palsy patients are concerned regarding their asymmetric appearance while smiling or speaking. Chemodenervation of the contralateral DLI muscle reduces concern levels and has high patient satisfaction. Chemodenervation of the contralateral healthy DLI muscle is a valid, practical treatment option.

Transient Velopharyngeal Insufficiency After Calcified Stylohyoid Ligament Resection.

Elongation of the stylohyoid process or calcification of the stylohyoid ligament is known as the Eagle syndrome. Mostly, it is seen incidentally on imaging or with extreme suspicion and usually patients are asymptomatic.Surgery is the preferred method in symptomatic patients. Transcervical or transoral methods may be preferred as surgical route.A 28-year-old female patient who had formerly underwent tonsillectomy presented with throat and ear pain. A neck computed tomography was performed, and the patient was diagnosed as Eagle Syndrome. Surgery was recommended.Patient developed transient velopharyngeal insufficiency on postoperative day 4. Ventilation exercise and follow-up was recommended. Complaints of the patient decreased on the 15th day.It should be kept in mind that stylohyoid ligament may be calcified in young age group and middle age group patients with dysphagia or odynophagia, and differential diagnosis should be performed. Another issue is the condition of velofaringeal insufficiency which may occur due to the damage of the pharynx muscles by deep dissection during surgery.

The Effectiveness of Asymmetric Dorsal Preservation for Correction of I-Shaped Crooked Nose Deformity in Comparison to Conventional Technique.

Importance: Using asymmetric dorsal preservation (ADP) (pushdown technique for deviated side and letdown technique to the contralateral nondeviated side) is an alternative surgical method to correct osseocartilaginous deviation in crooked nose deformity. Objective: Aim of this study was to evaluate whether ADP rhinoplasty is a good method to address I-shaped crookedness in comparison with conventional midvault deconstructing/reconstructing rhinoplasty. Design, Setting, and Participants: This study was conducted between June 2017 and August 2019. Twenty-two consecutive patients' I-shaped crookedness was addressed with either ADP (n = 10) or conventional midvault techniques (n = 12). Patients were followed up at least for 6 months. Main Outcomes and Measures: Pre- and postoperative frontal photographs and digital screen protractor was utilized for measurement of crookedness in a single-blinded manner. Surgical success were calculated and compared. Results: In ADP group, mean angle of deviation was 10.2 ± 3.7° and 0.5 ± 1.0° pre- and postoperatively, respectively. In control group, mean angle of deviation was 9.5 ± 1.8° and 0.3 ± 0.9° pre- and postoperatively, respectively. Change in angle was statistically significant for both groups. Postoperative calculated mean success rate was 96.3 ± 7.9% and 97.5 ± 8.5% for dorsal preservation and control group, respectively. Eight out of 10 patients in dorsal preservation group and 11 out of 12 patients in the control group achieved the ideal angle of 0°, hence had 100% postoperative surgical success. Conclusions and Relevance: Utilization of dorsal preservation principles for correction of I-shaped crookedness presents as a promising and practical surgical alternative approach that should be in every rhinoplasty surgeon's armamentarium.

Effect of Distal Masseter to Facial Nerve Transfer in Paralytic Patients with Preserved Facial Nerve Continuity on Improving Scaled Measurement of Improvement in Lip Excursion (SMILE): A Vectoral Analysis.

OBJECTIVE: Distal masseter-to-facial neurorrhaphy is an option to improve smile excursion in facial paralysis patients in the early period without truncating the facial nerve truncus and by ensuring the continuity of the facial nerve. This study aimed to study the effect of distal masseter-to-facial neurorrhaphy on smile excursion. METHODS: Charts of eight patients were retrospectively examined. Screenshots showing the best possible smiles were taken from preoperative videos. Screenshots were taken from postoperative videos showing the best combination of a natural smile on the healthy side and a smile with clenched teeth on the paralytic side. Emotrics and Photoshop software were used for computing vertical, horizontal, and overall excursion from facial landmarks. Scaled measurements of improvement in lip excursion and lip angle was evaluated. Symmetry was evaluated by accepting the healthy side as 100 percent, and the paralytic side was calculated as a percentage of the healthy side. RESULTS: Five patients had total facial paralysis and three had facial paresis. Mean postoperative follow-up period was 15.0±10.2 months. The average interval between facial denervation and nerve repair was 14.0±4.1 months (range, 11-23). All neurorrhaphies were coapted end-to-end to either the zygomatic or the buccal branch without an interposition graft. Mean postoperative initial movement occurred at 95.5±20.5 days (range, 72-138). Paralytic side to healthy side horizontal excursion changed from preoperative 72.5±17.4% to postoperative 93.4±6.9%. Vertical excursion changed from preoperative 38.4±24.6% to postoperative 89.3±11.8%. Overall excursion changed from preoperative 68.4±19.6% to postoperative 92.9±10.4%. Paralytic side to healthy side mean lip angle changed from 64.7% preoperative to 95.2% postoperatively. All changes were statistically significant (p<0.05). CONCLUSION: Facial paralysis patients with an asymmetric smile benefit from distal masseter-to-facial nerve transfer and it improves smile excursion dramatically. This effect was especially prominent in the vertical component of the smiling vector.

Effects of Glycerol Test on Resonance Frequency in Patients with Ménière's Disease.

OBJECTIVE: To evaluate resonance frequency (RF) values via dehydration effects in the inner ear caused by the glycerol test, which is used as a diagnostic method for Ménière's disease (MD). METHODS: Twenty adult patients with unilateral MD were included in the study. Before, and then at 1, 2, and 3 h after administration of glycerol (1 g/kg), pure-tone hearing levels (125-8,000 kHz) and multifrequency tympanometry tests were performed. As a control, the RF values of the ears of 25 healthy subjects (i.e., 50 ears) were compared to the affected and unaffected ears in the 20 MD patients. RESULTS: There was a significant difference between the RF values of affected and healthy ears before glycerol administration (p = 0.047). The RF values before and after glycerol administration into affected ears were compared. The average RF values decreased significantly from 748.0 ± 402.1 to 808.0 ± 410.1 Hz at 1 h after glycerol intake, and this value increased during the subsequent hours. There were no statistically significant differences between the pure-tone levels before and 1 h after glycerol administration, but a significant decrease was observed at 3 h. CONCLUSION: We suggest that MD has different inner-ear dynamics and normal RF values when compared to healthy ears. Furthermore, decreased inner ear pressure causes reduction of the mass effect and a stiffening of the annular ligament. We conclude that pre- and post-RF tests should be added to the test battery for diagnosis of MD.

Audiological and vestibular measurements in Behçet's disease.

INTRODUCTION: Behçet's disease (BD) is a vasculitis that involves all small vessels and influences the multiple systems of the human body. This study aimed to evaluate the audio-vestibular system involvement of patients with BD and healthy individuals. MATERIALS AND METHODS: This study was designed as a prospective case-control blinded study. Thirty-one patients with BD and 31 healthy individuals were included. All the subjects were evaluated via pure tone audiometry (PTA), video head impulse test (vHIT), post head shake nystagmus test (PHSNT) and dizziness handicap inventory (DHI) to check for audio-vestibular system involvement. RESULTS: Patients with BD showed higher PTA scores in both speech and high frequencies. The vHIT revealed pathological saccades, particularly in horizontal canals (right ear: p = 0.002, left ear: p = 0.039). The gain values of the patients were slightly lower than those of the control group; however, gain and gain asymmetry differed significantly in a few canals. In the spontaneous nystagmus test and PHSNT, pathological nystagmus was detected to be significantly higher in the patient group than control group (p = 0.001); but the saccade presence in vHIT and nystagmus in PHNT did not differ among the patients (p = 0.106). In addition, the DHI scores of the patients group were higher than those of the control group (p < 0.001). No correlation was found between disease duration and saccade presence. CONCLUSION: The vHIT was used preliminary for evaluating the vestibular system in BD. This study showed the influence of BD on the audio-vestibular system, in particular isolated horizontal canal involvement was discovered in patients with BD. LEVEL OF EVIDENCE: Level III b.

The Effect of Garlic Derivatives (S-Allylmercaptocysteine, Diallyl Disulfide, and S-Allylcysteine) on Gentamicin Induced Ototoxicity: An Experimental Study.

OBJECTIVES: Gentamicin is a potent aminoglycoside antibiotic. Ototoxicity and nephrotoxicity are the main side effects which restrict the use of gentamicin. Garlic with its intrinsic antioxidant activity may prove beneficial in prevention from ototoxicity. S-allylmercaptocysteine (SAMC), diallyl disulfide (DD), and S-allylcysteine (SAC) are three active compounds found in garlic. In this study, we investigated the effect of SAMC, DD, and SAC on the ototoxicity induced by gentamicin in rats, by using brainstem evoked response audiometry (BERA). METHODS: Thirty male Wistar rats with intact Preyer's reflex initially weighing 220-260 g were randomly assigned to either the gentamicin injection with SAMC treatment group (Genta-w SAMC), DD treatment group (Genta-w DD), SAC treatment group (Genta-w SAC), gentamicin injection without any active compounds (AC) treatment groups (Genta-w/o AC), or control group (n=6 rats each group). Gentamicin was given 120-mg/kg body weight, intraperitoneally once daily for 25 days to subjects in all groups except the control group. SAMC 100-mg/kg, and DD 50-mg/kg body weight were given intragastrically, and SAC 250-mg/kg body weight was given intraperitoneally once daily to subjects in Genta-w SAMC, and Genta-w DD, and Genta-w SAC groups, respectively during the study. After 25 days hearing thresholds were evaluated by using BERA test. RESULTS: The mean amplitude of auditory thresholds (sensation level [SL]) measured by using BERA for the Genta-w SAMC, Genta-w DD, Genta-w SAC, Genta-w/o AC, and control groups were 22±8, 25±5, 30±9, 54±11, and 10±7 dB SL, respectively (mean±SD). The differences between every active compound group (Genta-w SAMC, Genta-w DD, and Genta-w SAC) and Genta-w/o AC were statistically significant (P<0.016). CONCLUSION: SAMC, DD, and SAC are derivative of garlic seems to attenuate aminoglycoside-induced hearing loss. The effect of SAMC and DD seems to be more prominent than that of SAC.

Assessment of nasal airway patency during pregnancy and postpartum period: correlation between subjective and objective techniques.

OBJECTIVES: This study aims to determine the physiological changes in a pregnant woman's nasal airway, the frequency of pregnancy rhinitis, and the correlation among anterior rhinoscopy (AnR), anterior rhinomanometry (ARM), and subjective nasal obstruction score as she progresses through pregnancy into the postpartum period (PPP). PATIENTS AND METHODS: Twenty non-smoking healthy pregnant women aged 19-35 (average 27.5±4.7) without a history of either respiratory allergy or chronic nasal or sinus problems were included in the study. Detailed history taking, AnR, and ARM were performed by the same ear nose and throat specialist at each trimester and postpartum second week. From then on, the participants scored, subjectively, morning levels of nasal obstruction (0= none, 1= slight, 2= moderate, 3= severe, 4= total obstruction). RESULTS: The AnR scores were low and the ARM findings were in normal range in the first trimester. Increasing AnR scores through pregnancy and decreasing AnR scores at PPP were statistically significant. Similarly, the ARM findings increased through pregnancy and decreased to normal levels at PPP; however, these changes among trimesters and PPP were not statistically significant. CONCLUSION: Anterior rhinomanometry and AnR are useful tools in the determination of nasal physiological changes as pregnancy progresses to PPP.

A Life Threatening Pitfall in Ear Surgery: Extracranial Sigmoid Sinus.

AIM: The aim of this article is to imply the significance of temporal bone computed tomography imaging before temporal surgeries. CASE: A 74-years-old patient was admitted to emergency department with dizziness and nausea. The neurologic examination showed a spontaneous nystagmus, whereas otologic examination revealed a left tympanic membrane perforation with mild discharge. A temporal bone computed tomography imaging was scheduled to exclude cholesteatoma and perilymphatic fistula. Computed tomography detected an anterior sigmoid sinus with middle fossa defect and subcutaneous course of the sinus in posterior-superior portion of the external ear canal skin with no cholesteatoma sign. Thus, Dix-Hallpike was performed on the patient and was positive on the right side. The patient was diagnosed as benign positional vertigo. CONCLUSIONS: Sigmoid sinus is an important landmark in otologic surgeries and in some patients it may be problematic because of its dehiscence. To avoid any surgical complications it is highly important to evaluate a temporal bone computed tomography imaging before any transmastoid, retroauricular and edoaural surgeries.

Genital involvement in pemphigus vulgaris (PV): correlation with clinical and cervicovaginal Pap smear findings.

BACKGROUND: The frequency of genital involvement in pemphigus vulgaris (PV) has not been clearly defined. OBJECTIVES: We sought to evaluate the frequency of cervical, vaginal, and vulvar involvement in PV and to determine their association with genital symptoms, clinical involvement, and cytological status. METHODS: The current study's sample included 34 female patients with PV. Gynecologic and ear, nose, and throat examinations and indirect immunofluorescence analyses were performed, and Pap smears were collected. RESULTS: Genital involvement was observed in 44.1% of patients. It was significantly associated with disease severity and clinical involvement. Pharyngeal involvement was observed in 61.8% of patients and was the second-most frequently involved mucosal region. Genital involvement was significantly associated with nasal mucosa involvement. Cervicovaginal Pap smears showed acantholytic cells of PV in 35.3% of patients. LIMITATION: The sample size is small. CONCLUSION: Genital involvement in PV is not rare. Genital mucosa is the most affected mucosal region after oral and pharyngeal mucosa. Furthermore, genital involvement is significantly associated with nasal involvement and genital symptoms. The need for complete gynecologic evaluations of patients with PV, nasal involvement, and genital symptoms is emphasized.

What is the Role of Diffusion Weigh Magnetic Resonance Imaging in Evaluation of Thyroid Nodules?

This study aimed to compare ultrasonography (US), contrast-enhanced computed tomography (CCT) of the neck, and diffusion-weigh magnetic resonance imaging (DW-MRI) in differentiating between benign and malignant nodules while approaching to thyroid nodules, and to estimate sensitivity and specificity of these methods. On thyroid US, echogenicity, calcification, presence/absence of halo, nodule size being larger/smaller than 20 mm, and nodule nature (cystic/solid nature) were evaluated. Findings on CCT of the neck were grouped according to the heterogeneity/homogeneity, presence/absence of enhancement, and intensity. On DW-MRI, diffusion restriction was evaluated. The findings of these tests were compared with postoperative histopathological findings, and specificity and sensitivity of the tests in differentiating malignant and benign nodules were assessed. The study included 38 patients (34 females, 4 males). The sensitivity and specificity of DW-MRI were 20 and 75 %, respectively. Presence of a >20 mm nodule in thyroid US had the highest sensitivity, whereas thyroid fine-needle aspiration biopsy (FNAB) had the highest specificity in detecting malignancy. The sensitivities and specificities of CCT of the neck and DW-MRI appeared relatively low. Evaluation of thyroid US findings together with thyroid FNAB findings provided high specificity and sensitivity and yielded better results than findings of CCT of the neck and DW-MRI.

Sudden sensorineural hearing loss in a multiple sclerosis case.

Multiple sclerosis (MS) is the most common demyelinating disease of the central nervous system. MS involves different regions of the central nervous system in different periods, and causes demyelination. MS is a neuromotor disorder which progresses with remissions and relapses. Symptoms of MS may regress completely or heal after the relapses leaving sequelae. Sudden sensorinerural hearing loss (SSHL) is hearing loss of 30 dB or more over at least three contiguous audiometric frequencies that develops over a period of a few hours to 3 days. In 4-10 % of the MS patients, sensorineural hearing loss occurs between relapses or remissions. In this case, audiotory brainstem response (ABR) test is the most appropriate test for the diagnosis of sensorineural hearing loss in MS patients. In this article, we will discuss a patient diagnosed as MS who presented with sudden sensorineural hearing loss during the remission of the disease.

Bilateral vocal cord paralysis secondary to head and neck surgery.

Even endotracheal intubation could be considered safe in operations under general anesthesia; rarely, it could cause recurrent laryngeal nerve paralysis as a complication. As mentioned in the literature, as a possible reason for this, anterior branches of the recurrent laryngeal nerve in the larynx could suffer from compression between the posteromedial part of the thyroid cartilage and the cuff of the tube. In the literature, unilateral vocal cord paralysis due to endotracheal intubation occurs more frequently in comparison to bilateral vocal cord paralysis. These types of palsies usually totally improve in approximately 6 months. A patient who experienced bilateral vocal cord paralysis in the early postoperative period after undergoing an endotracheal intubation process for general anesthesia and primary partial lip resection and supraomohyoid neck dissection due to lower lip carcinoma is presented in our article. Although vocal cord paralysis occurring after head and neck surgery is first thought as a complication of the surgery, endotracheal intubation should be considered as a possible cause of this paralysis. In relation with this patient, causes, clinical symptoms, and treatment procedures of vocal cord paralysis due to endotracheal intubation are discussed under guidance of the literature.