Thiol/disulphide homeostasis in Bell's palsy as a novel pathogenetic marker.

OBJECTIVES: The aim of this study was to investigate the relationship between Bell's palsy and a novel oxidative stress parameter, thiol/disulphide homeostasis. DESIGN: A prospective study evaluating oxidative stress in Bell's palsy. SETTING: This research took place in the department of Otorhinolaryngology, Ataturk Training and Research Hospital. PARTICIPANTS: Totally, 77 patients with Bell's palsy and 38 healthy controls were included in this study. MAIN OUTCOME MEASURES: The blood levels of total and native thiol and disulphide activity were assessed, and their levels were compared in the patients and controls. RESULTS: There were statistically significant differences between the patients and controls regarding thiol/disulphide parameters. The mean native thiol and total thiol were significantly lower and disulphide levels were higher in the Bell's palsy than controls. On binary logistic regression analysis, the created model showed 45.3% variation. The cut-off value was 18.95 for disulphides. CONCLUSION: Native and total thiol levels were low in the Bell's palsy. This metabolic disturbance may have a role in the pathogenesis of Bell's palsy.

Children's quality of life after adenotonsillectomy.

OBJECTIVE: Although adenotonsillectomy is one of the most frequently performed surgical procedures in the pediatric population, its impact on health-related quality of life (HRQL) has not been well established. The objective of this study was to determine the impact of adenotonsillectomy on children's HRQL. METHODS: Parents of the children who underwent adenotonsillectomy were invited to our clinic approximately one year after the surgery for a face-to-face survey to evaluate their child's HRQL. In total, 119 parents of children who underwent adenotonsillectomy for different reasons were interviewed. To quantify the benefit of the operation, the Glasgow Children's Benefit Inventory (GCBI) was used. RESULTS: The mean GCBI score was 58 +/- 17.5 (minimum -22.9, maximum 79.2), indicating an increase in overall HRQL. Gender had no influence on the GCBI scores (p > 0.05). Satisfaction scores of the children aged 2-6 years were significantly higher than those of other age groups. CONCLUSION: Surgical treatment of chronic adenotonsillar disease has a positive impact on children's HRQL. Although surgery is highly effective in all age groups, in terms of children's quality of life, better results can be obtained if the operation is done in the earliest years of life.

Retropharyngeal abscess presenting with acute respiratory distress in a case of cervical spondylodiscitis.

We treated a 41-year-old man who presented with dysphagia, fever and respiratory distress. Magnetic resonance imaging (MRI) showed a large retropharyngeal abscess (RPA) extending to the C5-6 level, C5-6 spondylodiscitis and a spinal epidural abscess. The RPA was drained surgically under emergency conditions. Because the tuberculin skin test was positive, the patient underwent a triple anti-tuberculous drugs regimen. After six months of drug therapy, the epidural abscess was completely resolved. One of the most important aetiologies of RPA is thought to be tuberculous spondylodiscitis, and cervical vertebrae should be scanned thoroughly with pre-operative MRI.

A giant paediatric mandibular aneurysmal bone cyst and reconstruction with bilateral iliac bone graft.

A giant paediatric mandibular aneurysmal bone cyst and reconstruction with bilateral iliac bone graft. Aneurysmal bone cyst (ABC) is an unusual, non-neoplastic, expansile lesion of the bone. ABC is not a true cyst and it is characterised by the replacement of bone by fibro-osseous tissue containing blood-filled sinusoidal or cavernous spaces. The expanding mass often disrupts the normal bony architecture, with erosion of the cortex. Surgical treatment consists of complete excision or curettage. In this report, we present a 5-year-old girl with a huge aneurysmal bone cyst in the corpus of the mandible, which was reconstructed with bone graft taken from bilateral anterior iliac crests.

A case of concha pyocele (concha bullosa mucocele) mimicking intranasal mass.

Concha bullosa is the most common anatomic variant of the middle turbinate that usually remains asymptomatic. If the mucosal lining of pneumatized middle turbinate becomes inflamed, symptoms such as nasal obstruction, post-nasal discharge, snoring, headache, and fever occur. We report a case of concha pyocele (concha bullosa mucocele) in a 19-year-old girl. Computed tomography identified a right intranasal mass expanding towards the medial wall of the right maxillary sinus, nasal septum and right ethmoidal cells. The concha pyocele caused obstruction of the ostiomeatal complex, leading to right maxillary, ethmoid and sfenoid sinusitis. The patient was endoscopically treated under local anaesthesia. Histological examination of the mass revealed an active chronic inflammation caused by a foreign body.

Papillary thyroid carcinoma presenting as a giant cervical mass: a case report.

Papillary thyroid carcinoma (PTC) is a relatively uncommon malignancy. The prognosis is generally good and the mortality rate is low. PTC is more common in younger patients; incidence is two to three times higher in women and in individuals with radiation exposure to the neck. We report on a 75-year-old woman with PTC admitted to our clinic for a giant mass in the neck dating back ten years. A hyperintense huge cystic lesion and hypo-intense central solid component were seen on T1- and T2-weighted magnetic resonance imaging. No distant metastasis was present. The PTC was treated surgically and radioiodine (131I) treatment was applied postoperatively. No recurrence was observed one year later.

Squamous cell carcinoma of the lower lip and supra-omohyoid neck dissection.

PURPOSE: The aim of this study is to evaluate our approach to patients with squamous cell carcinoma of lower lip. PATIENTS AND METHODS: This study includes 31 lower lip squamous cell carcinomas followed up between 1994 and 2000. Primary treatment was applied to 28 patients of whom 23 were in stages I-II and five in stages III-IV. Three patients presented locoregional recurrence. Neck dissection was performed during primary lip resection in patients with palpable cervical lymph node involvement. Patients with unpalpable cervical lymph nodes were divided into two subgroups: one was submitted to elective neck dissection (n = 11) and the other had isolated lip resection (n = 8). Unilateral or bilateral selective supra-omohyoid neck dissection (SOHND) was performed according to the localisation of the disease. Radical dissection was performed in a secondary intervention, when SOHND revealed lymph node metastases. Radiotherapy and chemotherapy were applied for curative and/or adjuvant treatment in addition to surgery in patients with locoregional recurrence and metastatic lymph nodes or with perineural involvement. RESULTS: Occult cervical metastasis within a single lymph node was found in one of the 11 No patients who underwent elective neck dissection. Delayed neck metastasis developed in one of the eight patients in whom isolated lip resection (without neck exploration) was performed. Chemoradiotherapy was administered to this patient, but he died. Neck metastasis was established histologically in four of five patients in stages III-IV. Postoperative radiotherapy was used on these patients. One of the patients in this group died due to inoperable local recurrence in the neck, another died because of distant metastasis. Local mandibular recurrence was seen in one of these patients after three years. COMMENT: Six patients (19%) died due to lower lip carcinoma in this series. Our findings show the importance of elective neck dissection and intact surgical resection margins.

Pneumatization of the concha inferior as a cause of nasal obstruction.

Chronic nasal obstruction is a common disorder. Hypertrophy of the inferior turbinates is responsible for nasal obstruction more frequently than it is commonly thought. A pneumatized inferior turbinate has recently been described as a cause for nasal obstruction and only two cases have been reported until now. Inferior nasal turbinate develops by endochondral ossification of components of the mesethmoid and ectethmoid. The chondral framework of the inferior turbinate consists of a double lamella and two separate ossification centers that develop between the fifth and seventh month of fetal life. The separate ossification centers meet by the eighth fetal month. During ossification, the inferior turbinate detaches from the ectethmoid and becomes an independent bony structure. During that time the epithelium may misinvaginate into double lamellas and such double lamellas formed by the inferior turbinate may become persistent. A patient was referred to our clinic with headaches and nasal obstruction. A CT scan was performed which showed that the right lower concha was pneumatized. The headache of the patient disappeared after partial resection of the lower and middle turbinate.

The efficacy of topical ciprofloxacin in the treatment of chronic suppurative otitis media.

We conducted a test of the efficacy of ciprofloxacin eardrops in 80 patients (95 ears) with otorrhea due to chronic suppurative otitis media in two treatment settings. One group (n = 40; 47 ears) received daily ciprofloxacin therapy plus aspiration in the clinic. The other group (n = 40; 48 ears) self-administered ciprofloxacin at home. Overall, otorrhea resolved in 88% of all ears within 12 days of the initiation of treatment. The clinic-treated patients tended to respond more rapidly than did the self-treated patients, but there was no statistically significant difference in success rates between the two groups. Side effects were negligible. We conclude that empiric topical ciprofloxacin therapy is an effective, safe and relatively inexpensive treatment for otorrhea in patients with chronic otitis media.

Is aspiration necessary before tympanostomy tube insertion?

Aspiration of middle ear fluid after myringotomy is performed routinely, although investigators imply a cause-and-effect relationship between suction noise and acoustic trauma. This prospective randomized study investigated if aspiration was necessary. Fifty-one myringotomies and 50 tympanostomy tube insertions were performed on 27 patients. A suction instrument was utilized in 24 ears and was not used in 27 ears. In a follow-up period, no difference was observed between the two groups. The authors did not establish that aspiration is indeed harmful, but tympanostomy tube insertion can be performed without suctioning middle ear effusion.