Effect of the Fascia Graft Size on Healing Rate of Cavities in Patients Undergoing CWD Tympanomastoidectomy: A Clinical Prospective Study.

OBJECTIVES: To evaluate the effects of size of temporal fascia graft on healing of the mastoid cavity in patients undergoing canal wall down (CWD) procedures. MATERIALS AND METHODS: The study included 32 patients (ages from 10 to 69 years) who were performed CWD tympanomastoidectomy from 2016 to 2018. Patients were divided into 2 different groups randomly based on size of fascia used in the operations. Group 1 consisted of 19 patients with temporal muscle fascia large enough to extend up to antrum by passing through over the facial ridge. Group 2 consisted of 13 patients with fascia of a size hardly enough to create a middle ear space, which were quite smaller than those the first group. It was also observed that whether or not the type of pathology (cholesteatoma, granulation tissue or both) had an effect to the epithelialization time of the cavity. RESULTS: Thirty-two patients met inclusion criteria. Nineteen patients were randomized to study (large fascia) group and 13 patients were to control (small fascia) group. The mean duration for epithelialization of cavities with study group-large grafts was 34.10 days and that was 39.76 days in control group-small grafts. According to type of pathology; in cases with cholesteatoma, with granulation, and cases of coexisting granulation with cholestatoma; the mean epithelialization times were 38.73, 31.33 and 34.42 days, with respectively. CONCLUSION: Placement of larger fascia graft to line the mastoidectomy cavity facilitate rapid epithelialization and healing in patients undergoing CWD tympanomastoidectomy. Further studies with larger groups would be beneficial to confirm this result in the aspect of statistical significance.

Histopathological Effects of Bone Cement on Cartilage Tissue.

INTRODUCTION: Glass ionomer bone cement is frequently applied with cartilage grafts in otology, even as a single unit. OBJECTIVE: This experimental study was performed to investigate the histopathological effects of bone cement on cartilage tissue. METHODS: The study was conducted between January 2018 and April 2018 and used 12 New Zealand White rabbits. The right ears of the rabbits constituted the study group, while the left ears were the controls. Ketac Cem Radiopaque (3 M Germany) was used as glass ionomer cement. Tissue samples from the rabbits were subjected to histopathological analysis to compare acute and chronic inflammation, foreign body reaction, angiogenesis, collagenesis, fibrosis, necrosis, cartilage fracture, osseous metaplasia, and loss of chondrocyte nuclei between the groups. RESULTS: The rates of cartilage fracture (P = 0.044), foreign body reaction (P < 0.001), acute inflammation (P = 0.009), chronic inflammation (P = 0.002), and angiogenesis (P = 0.003) were significantly higher in the study group compared with the controls. The study group showed some degree of necrosis; no necrosis was observed in the control group, but the difference was not statistically significant (P = 0.101). There were no significant differences in fibrosis, collagenesis, osseous metaplasia, or loss of chondrocyte nuclei between the groups. CONCLUSIONS: This study showed that application of bone cement can cause acute and chronic inflammation, foreign body reactions, angiogenesis, and cartilage fractures. Further studies are needed to determine the long-term effects of bone cement on cartilage.

Effect of Septoplasty on Cardiopulmonary Functions in the Patients With Nasal Obstruction.

OBJECTIVE: In this study, the authors aimed to investigate whether septoplasty has an effect on cardiopulmonary functions in the patients with nasal obstruction. METHODS: A total of 53 patients with nasal obstruction due to septum deviation were included in the study. All the patients were performed septoplasty operation. Echocardiography and spirometric analysis were performed to assess cardiopulmonary functions before and after the operation (6 months postoperatively). The same evaluation was done for the degree of nasal obstruction by visual analogue scale. The preoperative and postoperative values were compared with each other. RESULTS: Of the total 53 patients, 44 were males (83%) and 9 were female (17%). The mean age was 31.71 ±â€Š9.46. The preoperative and postoperative mean right ventricular volumes were 2.0736 and 2.0906, respectively. The preoperative and postoperative mean left ventricular volumes were 4.4264 and 4.3528, respectively. The preoperative and postoperative mean cardiac septal thicknesses were 0.9642 and 0.9358, respectively. The mean value of preoperative cardiac posterior wall thicknesses was 0.8849, whereas the postoperative value was measured as 0.8340. The preoperative and postoperative mean pulmonary artery pressures were 27.8302 mmHg and 23.6415, respectively, and this was statistically significant (P < 0.001). The preoperative and postoperative mean forced vital capacities (FVC) were 4.3221 and 4.5564, respectively, and this was statistically significant (P < 0.001). The preoperative and postoperative mean 1st second forced expiratory volumes (FEV1) were 3.6698 and 3.8085, respectively, and this was statistically significant (P < 0.001). The mean value of preoperative FEV1/FVC was 84.9811, whereas postoperative mean value was measured as 83.8019 and this was statistically significant (P < 0.001). CONCLUSION: In this study, the authors observed that septoplasty has positive effect on cardiopulmonary functions in the patients with nasal obstruction due to nasal septum deviation. The authors also claim that septoplasty may be a preventive procedure for future pathologies of cardiopulmonary functions.

Pectoralis major myofascial flap in salvage laryngectomy.

OBJECTIVE: The main purpose of this study was to evaluate the effect of the pectoralis major myofascial flap on pharyngocutaneous fistula formation and time to oral feeding. METHODS: This retrospective study reviewed 155 total laryngectomies. Patients were divided into two main groups. Group 1 included 110 patients who were treated primarily by total laryngectomy and group 2 comprised 45 patients who were treated by salvage laryngectomy with or without a pectoralis major myofascial flap. RESULTS: The use of a pectoralis major myofascial flap did not have a significant effect on pharyngocutaneous fistula formation in the salvage group (p = 0.376). When comparing the oral feeding day of patients with pharyngocutaneous fistula, a significant difference was observed between the salvage group with pectoralis major myofascial flap reinforcement and the salvage group without pectoralis major myofascial flap reinforcement (p = 0.004). DISCUSSION: Our study demonstrated that pectoralis major myofascial flap reinforcement did not decrease the rate of pharyngocutaneous fistula formation. Instead, it prevented the formation of large fistulas that would require surgical management, and showed a similar time to oral feeding and length of hospital stay to primary laryngectomy.