Effectiveness of MESNA on the success of cholesteatoma surgery.

IMPORTANCE: It is important that chronic otitis media with cholesteatoma be treated successfully in patients to protect them from having repeated surgeries with related surgical co-morbidities and hearing loss. OBJECTIVE: To evaluate the effectiveness of MESNA usage on the residual cholesteatoma rates of the patients who underwent surgery due to chronic otitis media with cholesteatoma. DESIGN: Retrospective single-institution study of a prospectively collected database. SETTING: Tertiary University Hospital. PARTICIPANTS: Nine hundred and thirty-four patients underwent surgery due to chronic otitis media between September 2000 and March 2012 by the same surgeon. One hundred and forty-one cases out of 934 patients were selected who had cholesteatoma for the study. These randomly selected 141 cases were divided into two groups as follows: I. Forty-six cases were applied MESNA (Sodium 2-mercaptoethanesulfonate) intraoperatively, and II. Ninety-five cases were not applied MESNA intraoperatively. The cases that were followed-up at least one year were included in this study. INTERVENTION: MESNA (Ureomitexan, MESNA, Baxter oncology, Germany) was diluted with saline (20% MESNA and 80% saline) that was applied, and then a waiting period of approximately 5 min followed to start to dissect cholesteatoma matrix. MAIN OUTCOMES AND MEASURES: Residual cholesteatoma rates between intraoperative MESNA, a disulfide bond breaking chemical agent, applied and MESNA non-applied cases in the postoperative follow-up period were compared for the success of the surgery. RESULTS: MESNA was used in 46 patients out of 141 cases intraoperatively. Twenty-four of these patients underwent CWD (canal wall down), and twenty-two patients underwent CWU (canal wall up) mastoidectomy. For the other 95 subjects, 56 patients with CWD and 39 with CWU mastoidectomy, MESNA was not applied. Residual cholesteatoma rates were found to be significantly higher in MESNA non-applied group than MESNA applied group (p<0.05). Residual cholesteatoma rates between CWD and CWU mastoidectomy procedures were not statistically significant (p>0.05). CONCLUSIONS AND RELEVANCE: MESNA application that breaks disulfide bonds in the structure of the matrix in cholesteatoma surgery may assist the elimination of the disease, and increase surgical success by facilitating the elevation of the epithelium. Thereby, it causes a decrease in the possibility of remaining residual epithelium after surgery, which decreases the need for second-look surgery. TRIAL REGISTRATION: The retrospective research protocol was approved by the Inonu University Clinical Research Ethics Committee. REGISTRATION NUMBER: ………

Schwannoma with an uncommon upper lip location and literature review.

Schwannomas are usually single, encapsulated, and benign tumors of the nerve sheath that arise from the perineural Schwann cells. Schwannomas are mostly seen in the fourth decade. Despite its location in the head and neck region is 25-45%, lip location of schwannoma are very rare. We present a case of a upper lip schwannoma in the pediatric age and review the literature.

Posterior plica synechia: rare complication of adenotonsillectomy.

Tonsillectomy is one of the most common operations performed by otolaryngologists. Fever, otalgia, dehydration, sore throat, and hemorrhage are common complications. In this clinical report, a 7-year-old boy was presented with a synechia between the posterior plicae together with recurrence of adenoid hypertrophy after adenotonsillectomy 1 year previously. The synechia and adenoid were resected, and the patient was discharged from the hospital after 2 days. The complication in this case was most likely caused by traumatic injury of the posterior plicae during the previous tonsillectomy. This complication is, however, very rare.

Cutaneous myiasis in a malignant wound of the head and neck region.

Myiasis is a parasitic infestation of vital tissue of humans or other mammals by dipterous larvae. Human myiasis is a rare clinic condition but more frequently seen in tropical and subtropical areas, in patients who have poor hygiene, have bad housing conditions, are with mental retardation, or have advanced age. We report a case of myiasis in a malignant wound (squamous cell carcinoma) in the head and neck region because a few literature reports were seen in this localization. The patient's treatment was antisepsis, larval removal, and general care preventions, whereas standard treatment options or guidelines are not available.