A hystopathological study of thyroarytenoid muscle invasion in early (T1) glottic carcinoma.

PATIENTS AND METHODS: Surgical specimens belonging to 16 patients who underwent partial laryngectomy for T1 glottic cancer were subjected to detailed histopathologic examination; 11 of the patients were staged as T1a while 5 were staged as T1b. RESULTS: It was detected that in 11 patients the tumor was confined to the mucosal or submucosal connective layer, and in 5 (31.2%) cases, the tumor invaded the thyroarytenoid (TA) muscle. In cases involving the one-third anterior part of the vocal cords and the anterior commissure, a 50% (4/8) TA muscle invasion was detected. DISCUSSION AND CONCLUSION: Our finding TA muscle invasion at the rate of 31.2% in our 16 case series clinically staged as T1 revealed that deep invasion did not always impair the vocal cord mobility. Observing TA muscle invasion at the rate of 50% in cases involving the one-third anterior part of the vocal cord and the anterior commissure suggested that TA muscle invasion in the anterior part did not significantly impair mobility.

[Approach to the recurrent laryngeal nerve in thyroid surgery]. / Tiroit cerrahisinde rekürrent larenjeal sinire yaklasimimiz.

OBJECTIVES: We evaluated our surgical approach to the identification of the recurrent laryngeal nerve (RLN) under the guidance of operation microscope and RLN dissections during thyroidectomy. PATIENTS AND METHODS: Twenty-three patients (20 females, 3 males; mean age 37 years) undergoing thyroidectomy were included in the study. Thirty RLN dissections were performed, being unilateral in 16 patients, and bilateral in seven patients. The recurrent laryngeal nerves were identified at the inferior thoracic inlet with the use of the operation microscope having an ocular lens of 250 mm, followed by a total dissection up to the laryngeal entrance. Endoscopic laryngeal examinations were performed for vocal cord movements one day before surgery and postoperatively on days 1, 3, and 7. RESULTS: No abnormal vocal cord movements were detected preoperatively. Following surgery, none of the patients developed persistent RLN paralysis. Two patients exhibited transient vocal cord paralysis (limitation in vocal cord movements). The use of the operation microscope for RLN dissections resulted in prolongation of the operation time ranging from 15 to 40 minutes for each side, which tended to decrease with enhanced experience of the surgeon. CONCLUSION: The use of the operation microscope enables safe RLN dissections during thyroidectomy operations.

[A case of laryngeal chondroradionecrosis]. / Larenjeal kondroradyonekroz: Olgu sunumu.

Chondroradionecrosis is one of the rare but important complications of radiation therapy for laryngeal carcinoma. A sixty-one-year-old male patient with glottic carcinoma (T1bN0M0) was treated with radiotherapy because he did not give consent to surgery. He developed difficulty in breathing and halitosis three months following radiotherapy. Radiologic and clinical signs were consistent with a diagnosis of laryngeal chondroradionecrosis. Medical treatment with steroids and antibiotics did not relieve his symptoms, so total laryngectomy was performed. No postoperative complications were seen. The surgical specimen was free of tumor.

[The importance of the Delphian lymph node in subtotal laryngeal surgery]. / Subtotal larenks cerrahisinde Delphian lenf nodunun önemi.

OBJECTIVES: The study was designed to investigate the incidence of the Delphian lymph node in patients who underwent supracricoid laryngectomy (SL) for squamous cell carcinoma of the larynx and to evaluate our surgical approach to the primary tumor and the neck. PATIENTS AND METHODS: Twenty patients underwent SL for squamous cell carcinoma of the larynx. Laryngeal reconstruction was performed with cricohyoidopexy in 17 patients and cricohyoidoepiglottopexy in three patients. The presence of the Delphian lymph node was evaluated, together with its effect on the surgical technique, tumor metastasis, and prognosis. RESULTS: Preoperatively, no Delphian lymph nodes were detected by palpation. Intraoperative exploration revealed 13 lymph nodes in eight patients. Histopathologic examination showed metastatic spread in only one patient, the other nodes were found reactive. Surgical resection of the patient with Delphian node metastasis included the perichondrium of the cricoid cartilage as the lowest surgical margin, and neck dissection was extended to include the sixth level and postoperative radiation therapy was administered including the superior mediastinum. The patient died eight months after surgery from lung metastasis and neck recurrence. CONCLUSION: Evaluation of the Delphian lymph node existence particularly in patients with tumors involving the anterior commissure, anterior subglottic area, epiglottic petiole, and the pyriform sinus is important in excluding the possibility of leaving metastatic nodes behind in surgical techniques in which partial or total preservation of the cricoid cartilage is considered.

[Comparison of adenoid and tonsil core cultures in chronic adenotonsillitis]. / Kronik adenotonsillitli olgularda adenoid ve tonsil merkez kültürlerinin karsilastirilmasi.

OBJECTIVES: Tonsil and adenoid core cultures were compared and beta-lactamase producing bacteria were determined in patients with chronic adenotonsillitis. PATIENTS AND METHODS: Thirty-two patients (21 boys, 11 girls; mean age 5 years) with chronic adenotonsillitis underwent elective adenotonsillectomy. The core swaps of tonsil and adenoid tissues were obtained under sterile conditions and were inoculated in 5% sheep blood agar, eosin methylene blue agar, and chocolate agar plates. The frequency of beta-lactamase producing isolates were assessed. RESULTS: Staphylococcus aureus was the most common pathogen both in tonsil and adenoid core cultures. Among pathogenic bacteria isolated from tonsil (n=27) and adeonid (n=22) cultures, the same strains were isolated in 20 cultures (75%). The frequencies of beta-lactamase producing bacteria were 44% and 41% in tonsil and adenoid core cultures, respectively. S. aureus was associated with beta-lactamase production in 88% and 100% in tonsil and adenoid tissues, respectively. CONCLUSION: Differences between tonsil surface and core bacterial flora may have implications in the etiopathogenesis and treatment of chronic tonsillitis. The range of species isolated seems to be similar for both chronic tonsillitis and adenoiditis.

[A comparison between findings of high resolution computed tomography and magnetic resonance imaging in the preoperative assessment of cochlear implant patients]. / Koklear implantasyon öncesinde yüksek çözünürlüklü bilgisayarli tomografi ve manyetik rezonans görüntüleme bulgularinin karsilastirilmasi.

OBJECTIVES: We compared the preoperative findings of high resolution computed tomography (HRCT) and magnetic resonance imaging (MRI) with those observed during surgery to determine their value for cochlear implant patients. PATIENTS AND METHODS: A retrospective assessment was made on preoperative HRCT and MRI scans of 124 cochlear implant patients (71 males, 53 females; mean age 15 years; range 2 to 63 years). Congenital cochlear anomalies, cochlear ossification, new bone formation in the middle ear, and structures in the internal auditory canal were evaluated and compared with intraoperative findings. RESULTS: Cochlear anomalies detected in five patients by HRCT and MRI were confirmed intraoperatively. Cochlear ossification encountered in six patients during surgery was only demonstrated in four patients; HRCT and MRI scans only showed a narrow basal turn in the remaining two patients. During surgery, eight patients were found to have cochlear fibrosis: this finding was documented in five patients (62.5%) by MRI, and in none by HRCT scans. CONCLUSION: Although HRCT provides valuable information for surgical planning, its limitations may justify the additional use of MRI before cochlear implantation.

Do micrometastases detected with cytokeratin immunoperoxidase reactivity affect the treatment approach to neck in supraglottic cancers?

OBJECTIVES: The aim of this study was to determine the occult lymph node metastasis rates with immunoperoxidase staining for cytokeratin in supraglottic larynx cancers and to assess our approach to the neck. STUDY DESIGN: Twenty-two patients who had squamous cell carcinoma in the supraglottic region and no histopathologic metastasis in the neck who had their cancer detected with the use of hematoxylin-eosin were included in the study. All of the specimens were reevaluated with the use of immunoperoxidase staining for cytokeratin. RESULTS: Micrometastatic disease (pN1) has been detected in 3 patients (13.61%) in whom no metastasis was detected with routine histopathologic examination. CONCLUSION AND SIGNIFICANCE: Results suggest that the occult metastasis rates are higher than those detected with routine hematoxylin-eosin staining. However, because it is accepted that neck dissection alone has adequate therapeutic efficiency in pN1 patients, the detected 13.61% rate of micrometastases has not changed our treatment plan in the neck.

[The efficacy of combined medical treatment (antihistaminics, steroids, and macrolide antibiotics) in patients with nasal polyposis: preliminary results]. / Nazal polipozisli hastalarda kombine antihistaminik, steroid ve makrolid tedavisinin etkinligi: On sonuçlar.

OBJECTIVES: We evaluated the efficacy of combined medical treatment in cases with bilateral nasal polyposis without a history of any surgical or medical treatment. PATIENTS AND METHODS: Twenty-five patients (19 males, 6 females; mean age 45 years; range 30 to 60 years) who had not received any treatment for bilateral nasal polyposis were included. Treatment was comprised of an oral anti-histaminic agent (single dose daily for 3 weeks), and a topical steroid (as a nasal spray, twice daily for 6 months) and a single dose of intramuscular systemic steroid. Patients who did not respond to this therapy at the end of three weeks were administered a macrolide antibiotic (clarithromycin). The results were evaluated before treatment, and three weeks and six months after treatment with the use of a patient questionnaire, computed tomography and endoscopic examination findings. RESULTS: The patients' complaints improved by 85.5% and 79% at the end of three weeks and six months, respectively (p<0.005). Radiologic improvement was found to be 64% at the end of six months (p<0.005). The overall decrease in the size of the polyps was significant (p<0.005). No treatment-associated complications were encountered. CONCLUSION: Significant improvement achieved favors the use of combined medical treatment before surgery in selected patients with nasal polyposis.

Cochlear implantation in children with inner ear malformations: report of two cases.

UNLABELLED: Cochlear implantation of congenitally deaf children with inner ear malformations is gaining special interest. Although the number of the reported cases is increasing, the decision for implantation needs thorough investigation. Preoperative evaluation, surgical approach and postoperative follow-up can be challenging. STUDY DESIGN: A retrospective analysis of two cases with inner ear malformations. PATIENTS: One patient was a 3-year-old-girl who had cochlear and cochleovestibular nerve aplasia on the left side and incomplete partition on the other side. The other patient was a 5-year-old-boy who had hypoplastic cochlea on both sides. Both of them also had vestibular anomalies. Cases were implanted by using multichannel cochlear implant. RESULTS: No complications were encountered. Both patients responded to acoustic stimuli, and their speech perception skills were improved. After 10 months of cochlear implant use, their results seem encouraging. CONCLUSION: Except cochlear or cochleovestibular nerve agenesis, inner ear malformations cannot be accepted as a contraindication for cochlear implantation. Although there can be difficulties during the surgery or in the postoperative period, patients with inner ear malformations can also benefit from cochlear implantation. It is essential that all possible complications and postoperative performance should be discussed with the parents.

[Evaluation of occult lymph node metastasis in lower lip cancers and approach to N(0) neck metastasis]. / Alt dudak kanserlerinde gizli lenf nodu metastazi oranlari ve N0 boyna yaklasim.

OBJECTIVES: In this study, we evaluated the incidence of occult lymph node metastasis and the approach to N0 necks in carcinoma of the lower lip. PATIENTS AND METHODS: Sixty-eight patients who underwent surgery for squamous cell carcinoma of the lower lip were monitored for a minimum period of three years. All the patients were males (mean age 54 years; range 36 to 69 years). Preoperatively, 15 and 53 patients had N+ and N0 necks, respectively. Depending on the tumor localization, unilateral or bilateral suprahyoid neck dissections were performed. Nine patients underwent radical neck dissection following detection of metastasis on histopathologic examination. RESULTS: Histopathologic examination revealed metastasis in four patients (4/15; 26%) with N+ necks and in five patients (5/53; 9.4%) with N0 necks. Four patients (6.7%) developed late cervical lymph node metastasis at level 3. No evidence of neck disease was encountered in 93% of patients. CONCLUSION: Suprahyoid neck dissection appears to be effective in detecting occult lymph node metastasis. With improved surgical and histopathologic techniques and consideration of skip metastasis, more aggressive treatment approaches may be employed and better survival rates may be obtained.