Endoscopic dacryocystorhinostomy with a T-type ventilation tube.

BACKGROUND: The aim of this article is to present a different endoscopic dacryocystorhinostomy technique and its results on patients with blockage of the nasolacrimal drainage system. METHODS: Eleven patients (seven female and four male) who had chronic epiphora with the diagnosis of chronic nasolacrimal duct blockage were operated on using T-type ventilation tubes. Oral antibiotics, nasal steroids, oral antihistamines, and antibiotic eyedrops were given to all cases. The ventilation tubes were removed 3 months after surgery. RESULTS: Of 11 cases, 9 patients had unilateral and 2 patients had bilateral blockage. Eleven sides of nine patients were symptom free (85% success rate), and two patients had decreased continuation in complaints. Granulation tissue occurred in two revision patients. CONCLUSION: Endoscopic dacryocystorhinostomy using a T-type ventilation tube is an easy and cost-effective alternative and has low complication rates in the management of patients with nasolacrimal duct obstruction.

Isolated turbinitis and pneumatization of the concha inferior in a child.

Concha bullosa of the inferior turbinate is an extremely rare anatomic malformation with 11 reports of this condition in the literature. The inferior turbinate is an independent bone originating from the lateral nasal wall. Although inferior concha bullosa is generally asymptomatic and diagnosed incidentally by computed tomography, nasal obstruction, headache, and epiphora are some of the possible symptoms. Isolated turbinitis with no additional paranasal infection is also very rare. Although there is only 1 reported case of pediatric inferior concha bullosa before, this case is the first pneumatized inferior concha with associated isolated turbinitis.

Nasal obstruction as a common side-effect of sildenafil citrate.

Sildenafil citrate is an effective oral drug for erectile dysfunction. The main action of sildenafil is the enhancement of the effect of nitric oxide (NO) by inhibiting the cyclic guanosine monophosphate (cGMP)-specific phosphodiesterase-5 (PDE-5), an enzyme responsible for degradation of cGMP. NO is also present in the nasal mucosa and is responsible for vasodilation causing congestion and nasal obstruction. The aim of this study was to detect the effect of sildenafil on nasal mucosa in terms of nasal obstruction. A total of 16 patients presented to urology clinic suffering from impotence and medicated with sildenafil were included in the study. Before and after oral administration of 50 mg sildenafil, in all of the patients the nasal patency was examined by active anterior rhinomanometry (a method of assessing nasal resistance) using air pressure of 150 Pascal. In addition, all patients were asked about their sensation of nasal patency to detect the symptomatic nasal obstruction. There was a significant decrease in nasal air flow values (cm(3)/s) (p < 0.05). Except for three cases, all patients indicated that they had the sensation of nasal obstruction after the use of sildenafil (p < 0.05). Nasal obstruction is a common complaint for the patients using Sildenafil.

Oxidants and antioxidants in tonsillar and adenoidal tissue in chronic adenotonsillitis and adenotonsillar hypertrophy in children.

OBJECTIVE: The aim of the study is to determine the possible role of oxidants and antioxidants in the pathogenesis of chronic adenotonsillitis and adenotonsillar hypertrophy in children. PATIENTS AND METHODS: The children were divided into infection and hypertrophy groups, which were comparable according to age and gender distribution. The infection group was consisted of 20 children with the diagnosis of chronic adenotonsillitis and the hypertrophy group was made up of 19 children with adenotonsillar hypertrophy to whom adenotonsillectomy was performed. Preoperative blood levels of erythrocyte MDA, serum MDA, erythrocyte catalase and serum catalase, and adenoidal and tonsillar tissue levels of MDA and catalase were studied. RESULTS: There were significant increase in tonsil MDA, adenoid MDA, tonsil catalase and adenoid catalase levels in infection group (p<0.05). CONCLUSION: Oxidants and antioxidants are found to have an important role in the pathogenesis of adenotonsillar hypertrophy and chronic adenotonsillitis. These findings strengthen the hypothesis that indicates adenotonsillar hypertrophy and chronic adenotonsillitis are different diseases of the same tissues.

Evaluation and treatment of antrochoanal polyps.

OBJECTIVES: Antrochoanal polyp (ACP) is a benign maxillary sinus polyp that originates from the mucosa of the maxillary sinus, passes through a sinus ostium, and extends into the choana. The common presentation of ACP is unilateral nasal obstruction. The radiographic findings and differential diagnosis of ACPs are discussed by comparing them with data in the literature. METHOD: This study included 19 (14 male, 5 female; median age 24.5 years, range 8-75 years) surgically treated patients with ACPs diagnosed by clinical examination, nasal endoscopy, and computed tomography. RESULTS: Nasal obstruction was found in all cases. Endoscopic sinus surgery was preferred for removal of the nasal part of ACPs in 13 cases. Only in one case, polypectomy combined with Caldwell-Luc operation and septoplasty was performed. The observed complications were as follows: minor hemorrhage in three cases, mild cheek swelling with pain in two patients, and infraorbital hypoesthesia in one case. Histopathologic examination of ACPs revealed loose mucoid stroma and mucous glands, which were covered by respiratory epithelium. CONCLUSION: Endoscopic sinus surgery may be indicated in patients with ACPs because the function and capacity of the maxillary antrum are preserved. The greater portion of the antral part of polyp can be removed while leaving the healthy antral mucosa intact.

Pediatric intraoral ranulas: an analysis of nine cases.

An intraoral ranula is a retention cyst arises from the sublingual gland on the floor of the mouth as a result of ductal obstruction and fluid retention. Many techniques for management of ranulas have been described in the literature. The purpose of this study was to analyze our surgically treated pediatric patients with intraoral ranulas and to discuss the results in the light of the literature. Nine pediatric patients (six females and three males) with intraoral ranulas surgically treated were analyzed retrospectively regarding their treatment methods and results. The surgical specimens were also re-examined histologically. Seven cases of superficial, protruded and smaller than 2 cm ranulas were treated with marsupialization (unroofing). Two cases who were previously operated and then recurred had bigger than 2 cm ranulas. In these two cases, marsupialization of the ranula plus removal of the sublingual gland was performed. The most common complication was intraoperative cyst rupture of the ranula, which was noted in four cases. A recurrence was observed in only one case in the 16th months of follow up period. Our findings show that marsupialization is a suitable and effective method for pediatric intraoral ranulas, whereas in recurrent cases marsupialization of the ranula combined with total excision of sublingual gland may be preferred.

Monostotic fibrous dysplasia originating from ethmoid bone: treatment with endoscopic approach.

We present a case of monostotic fibrous dysplasia of the ethmoidal sinus in an 11-year-old boy. This condition is of interest to the otorhinolaryngologist because of the difficulty of differential diagnosis and treatment. This tumorlike growth was not restricted to the right ethmoidal sinus, but also compressed the orbit and the globe. Endoscopic and transnasal removal of the mass with a drill was performed under general anesthesia. No residual tumor was observed 6 months later.

Reconstruction of a congenital midpalatal hairy polyp.

Hairy polyps (dermoids or oronasopharyngeal teratomas) are a type of congenital tumour that contain elements of bigerminal origin (ectoderm and mesoderm). We describe a baby who presented with a hairy polyp of the hard palate protruding from the mouth. This was not causing respiratory distress but she had feeding difficulties. She was successfully operated on the age of 5 days, the defect was reconstructed with hairless skin of the mass and she was able to suck after a month.

[Differences in clinical and histopathologic features between chronic adenotonsillitis and chronic adenotonsillar hypertrophy]. / Kronik adenotonsillit ile kronik adenotonsiller hipertrofi arasindaki klinik ve histopatolojik farkliliklar.

OBJECTIVES: This study sought to determine the clinical and histopathological differences between chronic adenotonsillitis and chronic adenotonsillar hypertrophy. PATIENTS AND METHODS: This prospective study included 286 patients (147 males, 139 females; mean age 16.6 years; range 3 to 45 years) with chronic adenotonsillitis and 197 patients (98 males, 99 females; mean age 9.5 years; range 2 to 18 years) with adenotonsillar hypertrophy. Clinical and histopathological findings were compared. RESULTS: The mean age was significantly higher (p<0.001) and acute attacks of fever, dysphagia, and sore throat were more frequent in chronic adenotonsillitis. Patients with adenotonsillar hypertrophy more commonly manifested snoring, mouth breathing, and dispnea. Physical examination showed hyperemia of the anterior plica in 93% and 15% in chronic adenotonsillitis and adenotonsillar hypertrophy, respectively. Histopathologically, the former was more commonly associated with severe lymphocyte infiltration to surface epithelium, surface epithelial defects, plasma cells, atrophy, and fibrosis. The sole outweighing difference in favor of chronic adenotonsillar hypertrophy was increased germinal centers. CONCLUSION: Clinical and histopathologic findings suggest that chronic adenotonsillitis and chronic adenotonsillar hypertrophy may be diverse diseases requiring different approaches in treatment.

Carotid body tumors: challenging complexity of diagnosis and surgical treatment.

OBJECTIVES: To evaluate the patients treated for carotid body tumors and the problems encountered during diagnosis and treatment. PATIENTS AND METHODS: The study included eight patients (5 females, 3 males; mean age 50 years; range 36 to 68 years) who underwent surgery for carotid body tumors. Diagnosis was confirmed by power Doppler ultrasonography and computed tomography or magnetic resonance imaging in all patients. Angiography was performed in three patients to evaluate vascularity and to perform embolization before surgery. Two patients had previously undergone biopsy elsewhere. The mean follow-up was 15 months (range 2 to 36 months). RESULTS: The size of the tumors varied from 3 cm to 11 cm. In two patients the tumors were found to extend to the skull base. Ligation of the external carotid artery and the common carotid artery was performed in five patients and in one patient, respectively. Surgery-associated injuries given to the internal carotid artery in two patients were repaired by sutures. The 10th cranial nerve was dissected in two patients who had undergone a prior biopsy. They developed cord paralysis and hoarseness postoperatively. Resection of the 11th cranial nerve in one patient resulted in shoulder pain and drop shoulder. The 12th cranial nerve was repaired end-to-end by neurorrhaphy in two patients. They exhibited significant improvement in nerve functions a year after surgery. CONCLUSION: The larger the tumor is, the more difficult the resection is, and the more injuries are caused to the surrounding nerves and vessels.

[The relationship between ostial patency and medical treatment in acute maxillary sinusitis: an experimental study]. / Akut maksiller sinüzitte sinüs ostium açikliginin medikal tedavi ile iliskisi: Deneysel çalisma.

OBJECTIVES: We investigated the relationship between ostial patency and medical treatment in an experimental model of acute maxillary sinusitis. DESIGN AND METHODS: Forty healthy New Zealand white rabbits were assigned to two groups. The left maxillary sinus ostia were filled with absorbable gelatin sponge in one group (n=20). In the other group, half of the ostuim was blocked by bone particles and tissue adhesive (Histoacryl). Following induction of acute maxillary sinusitis, each group was divided into four subgroups, one of which was left untreated. The other subgroups received systemic antibiotic therapy plus topical administration of physiological saline solution, a decongestant, and a steroid, respectively, for 10 days. All rabbits were monitored for four weeks. Each week nasal smear samples were obtained for neutrophil and leucocyte counts. In the end, maxillary sinus biopsies were obtained to determine the extent of healing. RESULTS: There were no significant differences between subgroups having the same ostium patency. However, compared to the subgroups with patent ostia, corresponding subgroups with semi-patent ostia exhibited significantly increased nasal smear and nasal biopsy scores starting from the second week. CONCLUSION: The degree of ostial patency seems to have a significant role in the treatment of acute maxillary sinusitis.

Fibromatosis of the mandible in a child.

Fibromatosis represents a group of fibrous tumors showing clinic and biologic features between benign fibrous lesions and fibrosarcoma. These locally aggressive tumors have high recurrence rates (20% to 70%). A four-year-old boy presented with mandibular fibromatosis occupying the mandible completely and extending to the submandibular gland and soft tissues. Complete hemimandibulectomy and submandibular gland excision were performed followed by reconstruction with a curved Kirschner wire. No signs of recurrence was observed during a follow-up period of 18 months. In addition, no limitations in the functions of the jaw, mastication, and swallowing were noted.