Cog graft, a new septal extension graft for designing nasal tip rotation and projection in rhinoplasty.

BACKGROUND: Adjusting the nasal tip rotation and tip projection according to the patient's face and wishes is a very important stage in rhinoplasty with the use of a cog graft positioning the tip point in the appropriate place is possible by adjusting the nose length, tip projection and tip rotation together. OBJECTIVE: The aim of this study is to facilitate positioning the tip rotation and projection in the appropriate place according to the patient's needs in rhinoplasty with Cog graft. MATERIALS AND METHODS: Cog graft was applied in 32 patients who underwent rhinoplasty. Cog graft was prepared from costal cartilage in 10 patients and from septal cartilage in 22 patients. Cog graft was prepared by shaping the superior edge of the septal extension graft like a gear wheel. It is fixed to provide desired projection to the caudal septum. In the position where rotation and projection are evaluated adequately, the graft is fixed with sutures. They were followed in average 18 months (between 6 and 24 months). RESULTS: Twenty of the patients were primary cases and 12 were revision cases. The targeted rotation and projection results were achieved in all patients. All patients had satisfactory esthetic results. CONCLUSIONS: Cog graft is a useful graft with which we can adjust the nose length, projection and rotation appropriately and in a short time with a single graft.

Vertical Alar Lengthening technique in correcting short noses.

BACKGROUND: It is crucial that the nose length must be compatible with the face in order to obtain beautiful results that suits the face. Shorter and upturned noses appear as if the tip of the nose is cut from the front and gives a piggy appearance to the patient's face. OBJECTIVE: The aim of this study is to obtain longer noses with increased tip definition by effectively lengthening the medial and lateral crura's in patients with short nose and Asian noses. MATERIALS AND METHODS: Vertical Alar Lengthening (VAL) technique was applied to 17 revision and 12 primary Asian noses. VAL technique consists of three steps. In the first step, the medial crus were lengthened by stealing from the lateral crus. Later, a lateral crural extension graft was applied to the shortened lateral crus, and the lateral crus was lengthened and sutured to the medial crus. In the final stage, a subdomal graft was placed and supported in the space formed underneath the alar tip between the mucosa and the new dome. They were followed in average 12 months (between 6 and 18 months). RESULTS: VAL technique was applied to 17 revision and 12 primer Asian noses. Suggested surgical technique move the tip forward and downward reduced its cephalic rotation and lengthened the nose. Targeted tip point, rotation and projection results were achieved in all patients. All patients had satisfactory esthetic results. CONCLUSIONS: In revision cases and short nose deformities in Asian noses, the nasal tip point was extended forward and downward with the VAL technique, reducing its rotation and lengthening the nose.

The hammer graft: A novel technique to provide dorsal support, tip projection, and rotation in rhinoplasty.

BACKGROUND: There are numerous cartilaginous grafts that can be used in rhinoplasty, depending on the specific needs of the patient. These include spreader grafts, dorsal onlay, tip grafts, septal extension, and columellar struts grafts, among others. OBJECTIVE: The aim of this study is to demonstrate use of the hammer graft in rhinoplasty; this technique can be used to improve dorsal support, tip projection, and tip rotation using a single cartilage graft. MATERIALS AND METHODS: This novel graft was applied in 18 patients who underwent rhinoplasty. In revision patients, hammer graft was harvested from costal cartilage and in primary cases from septum cartilage. They were followed in average 12 months (between 6 and 18 months). RESULT: Three of these patients were revision cases and 15 were primary cases. In revision patients, hammer graft was harvested from costal cartilage and in primary cases from septal cartilage. The targeted results were achieved to a large extent in all patients. All patients had satisfactory esthetic results. CONCLUSION: The hammer graft as a single and stable graft useful support for the dorsal part, caudal part and extension part of the septum to be used in primary and revision rhinoplasty.

Hearing status in vitamin B12-deficient children.

AIM: The aim of this study is to investigate the effects of vitamin B12 deficiency on hearing in school-aged children by pure-tone audiometry. METHODS: Forty-three vitamin B12-deficient children and 37 age-matched control subjects were enrolled in the study. Tympanometric evaluations and pure-tone audiometry including high frequencies were performed on the subjects. The results were compared between the two groups. RESULTS: Both right and left ear pure-tone hearing thresholds (PTHTs) at 0.25-4 kHz, and four-frequency pure-tone average values were significantly better in the control group compared with the patient group (P < 0.05). However, PTHTs at 8-16 kHz were not different between the two groups (P > 0.05). Vitamin B12 level also did not show any significant correlation with the PTHTs at 0.25-16 kHz (P > 0.05). CONCLUSION: This study indicates that vitamin B12 deficiency may contribute to hearing impairment at low frequencies as a possible aetiological factor in children.

Effects of Rhinoplasty on Labyrinthine Function.

BACKGROUND: Rhinoplasty is a common surgical procedure that is requested and accepted by patients for cosmetic and functional reasons. Osteotomies are performed on nasal bone, maxillary crest, or vomer to fix the deviations of the nasal dorsum or septum. During the percussion of the osteotomes with the surgical mallet, the vibration energy diffuses to the cranium. Auditory and vestibular systems may be affected by these vibrations. OBJECTIVES: To assess the effects of rhinoplasty, in which osteotomies were performed using a hammer, on the audiovestibular system. METHODS: Thirty adults who underwent rhinoplasty were included in the study group. Ten age and gender matched adults who had nasal surgery without surgical mallet or osteotome served as the control group. The patients in both groups were assessed using pure tone audiometry, tympanometry, distortion product otoacoustic emission testing, and vestibular-evoked myogenic potential, as well as video head impulse tests (vHIT) before the operation and 1 week after the operation. RESULTS: On auditory assessment, there was no significant difference between the study and control groups regarding pure tone thresholds at frequencies of 250 Hz to 8 kHz (P > 0.05) as well as otoacoustic emissions. The vestibular assessment performed by using vestibular-evoked myogenic potential and vHIT did not reveal a statistically significant difference between the groups, before surgery or after surgery (P > 0.05). CONCLUSIONS: Rhinoplasty appears to be a safe operation in terms of audiovestibular functions, and osteotomy, in which a hammer is usually used, does not have an impact on hearing or balance functions of the ear.

Developmental delays in preschool children with adenotonsillar hypertrophy.

OBJECTIVES: This study aims to investigate the effects of adenotonsillar hypertrophy on general development, as well as fine and gross motor capabilities, social communication, and language development in children with adenotonsillar hypertrophy by applying the Denver Developmental Screening Test-II. PATIENTS AND METHODS: The study included 30 patients (12 boys, 18 girls; mean age 53.3±12.2 months; range 32 to 72 months) who were indicated for adenotonsillectomy due to adenotonsillar hypertrophy between February 2013 and July 2013. The control group comprised 30 children participants (12 boys, 18 girls; mean age 53.1±12.8 months; range 32 to 72 months) with no adenotonsillectomy indication. All participants included in the study were performed routine physical examination, flexible fiberoptic nasopharyngoscopy, and tympanometry. Brodsky scale and fiberendoscopic findings were used to categorize tonsil and adenoid sizes, respectively. Following ear, nose, and throat evaluation, a psychologist conducted Denver Developmental Screening Test-II in all participants blindly. RESULTS: Adenotonsillar hypertrophy patients had higher abnormal levels of general development (c2=7.13, p=0.028). Although patients and controls had similar levels of fine motor, gross motor, and personal-social development levels, there was a statistically borderline difference between them in terms of language development (t=1.82, p=0.074). CONCLUSION: The possibility of adenotonsillar hypertrophy should definitely be considered in children with delayed general and language developments.

The Effect of Dehydration and Fasting on Corneal Biomechanical Properties and Intraocular Pressure.

PURPOSE: To evaluate the changes in corneal biomechanical properties and intraocular pressure (IOP) during fasting period in healthy subjects. METHODS: Seventy-two eyes of 72 fasting subjects (study group), and 62 eyes of 62 nonfasting subjects (control group) were enrolled in this prospective study undertaken at a single university hospital. All subjects underwent complete ophthalmologic examination including ocular biomechanical evaluation with ocular response analyzer. Ocular response analyzer measurement was performed on the right eyes of the subjects between 5.00 and 6.00 PM after approximately 14 hr of fasting for the study group and after a nonfasting period for the control group. The corneal hysteresis, corneal resistance factor, mean corneal compensated IOP (IOPcc), and Goldmann-correlated IOP (IOPg) values were measured with a patented dynamic bidirectional applanation process. RESULTS: Goldmann-correlated IOP and IOPcc measurements in the study group and the control group were found as 13.8±2.8 mm Hg, 14.6±2.6 mm Hg and 16.3±2.2 mm Hg, 15.7±2.4 mm Hg, respectively. There was statistically significant difference within the two groups in IOPg and IOPcc (P<0.001). In addition, corneal hysteresis and corneal resistance factor significantly decreased in study group compared with control group (P<0.001, P=0.012, respectively). CONCLUSION: Prolonged fasting causes a significant decrease in IOPg, IOPcc, corneal hysteresis, and corneal resistance factor in healthy subjects, altering the biomechanical properties of the cornea.

Open Versus Closed Septorhinoplasty Approaches for Postoperative Edema and Ecchymosis.

OBJECTIVE: The aim of this study was to compare periorbital edema and ecchymosis seen after closed (endonasal) and open (external) septorhinoplasty (SRP). METHODS: In total, 50 patients undergoing hump extraction and osteotomies were allocated to 2 groups. Group 1 consisted of 25 patients who underwent closed SRP. Group 2 consisted of 25 patients who underwent open SRP. Operation time, amount of intraoperative bleeding, and complications were recorded. Scoring of eyelid edema and periorbital ecchymosis was evaluated on the first, third, and seventh postoperative days using a scale of 0 to 4 by the first author. RESULTS: There was no statistically significant difference between the groups in terms of age, sex, or operation time. No significant difference was observed clinically or statistically in the scores of periorbital edema or ecchymosis between groups 1 and 2 on the first, third, and seventh postoperative days (P > 0.05). CONCLUSIONS: The authors observed no clinically or statistically significant difference in comparing periorbital edema and ecchymosis seen after closed and open SRP.

Effect of anesthesia without a neuromuscular blocking agent on intraoperative bleeding in adenotonsillectomy patients.

OBJECTIVE: The purpose of this study was to examine the effect of general anesthesia, applied without a neuromuscular blocking agent, on the extent of intraoperative bleeding in children undergoing adenotonsillectomy. MATERIALS AND METHODS: A total of 81 adenotonsillectomy cases were examined retrospectively. The patients' ages, genders, and tonsil and adenoid sizes, as well as anesthetic technique, operation time, extent of bleeding during operation, and period of stay in the postanesthesia care unit, were reviewed. Among the patients, 38 were administered anesthesia with a neuromuscular blocker (control group) and 43 patients were given anesthesia without a neuromuscular blocker (study group). RESULTS: No statistically significant difference was found between groups in terms of age, gender, and tonsil and adenoid sizes (p > 0.05). The operation times of the study group were significantly lower than those of the control group (p = 0.036; p < 0.05). A highly statistically significant difference was found between groups in terms of extent of bleeding (p = 0.001; p < 0.01). Bleeding in the study group was significantly lower than that in the control group. No statistically significant difference was found in terms of period of stay in the post anesthesia care unit (p > 0.05). CONCLUSION: In this study, we determined that, general anesthesia without a neuromuscular blocking agent significantly decreases operation time and intraoperative bleeding in adenotonsillectomy patients.

Histopathological evaluation of Ankaferd blood stopper use in the rabbit septoplasty model.

OBJECTIVE: The purpose of this study was to assess the use of Ankaferd blood stopper (ABS), an organic hemostatic agent of plant origin, in septoplasty operations, and to determine its effect on nasal septal tissues in the rabbit model. METHOD: The study was performed on 30 New Zealand adult male rabbits each weighing 2500-3500g (average: 3000g). The rabbits were randomly divided into 4 groups, namely, the control group (without septoplasty), the septoplasty+tampon group, the septoplasty+ABS group, and the septoplasty+tampon+ABS group. All animals were sacrificed after two weeks, and the nasal septums were total removed using the lateral rhinotomy technique. The specimens were obtained from similar sites of cartilaginous nasal septum. The sections were stained with hematoxylin-eosin and Mason trichrome stains and studied under the light microscope by the same pathologist who evaluated the mucosal ulcerations, the severity of inflammatory cell infiltration, the mucosal thickness, and the cartilage thickness. The data obtained were statistically analyzed using the Kruskal-Wallis variance analysis and the Mann-Whitney U test. RESULTS: No mucosal ulceration or inflammatory cell infiltration was detected in any of the rabbit groups. There was a statistically significant difference between the groups in terms of mucosal thickness and cartilage thickness (p<0.05). The values of mucosal thickness in the groups mentioned above were 147.7±17.6µm, 205.7±36.7µm, 139.6±14.8µm, and 190.2±17.5µm, respectively. The values of cartilage thickness were 398.2±28.9µm, 546.2±35.3µm, 363.7±24.7µm, and 447.8±28.2µm, respectively. There was no significant difference between the control group and the septoplasty+ABS group in terms of mucosal thickness and cartilage thickness (p>0.05). However, there was a significant increase in nasal mucosal and cartilage thickness in tampon-using groups when compared with the other groups (p<0.05). CONCLUSION: Although nasal tampons provide the contact of mucoperichondrium with the cartilage, they are generally accepted as a discomfort for patients. Ankaferd blood stopper can be used instead of nasal tampons to increase patient comfort.

The efficacy of tranexamic acid and corticosteroid on edema and ecchymosis in septorhinoplasty.

The aim of this study was to investigate the efficacy of tranexamic acid (TA) and methylprednisolone on periorbital edema, ecchymosis, and intraoperative bleeding in patients who underwent open septorhinoplasty (oSRP). Seventy-five patients performing hump extraction and osteotomies were allocated into 3 groups as follows: group 1, 25 patients as control; group 2, 25 patients who were administered oral TA as first dose 1 g starting 2 hours before surgery, 3 g daily in divided doses (1 g, every 8 hours) for 5 days; and group 3, 25 patients who were administered a single dose of 1 mg/kg intravenous methylprednisolone at the beginning of the surgery. Operation time, amount of intraoperative bleeding, and complications were recorded. Scoring of eyelid edema and periorbital ecchymosis was evaluated on postoperative first, third, and seventh days using scale of 0 to 4 by 2 observers. In groups using TA and methylprednisolone, periorbital edema and ecchymosis scores were significantly lower compared with the control group (P < 0.05). No significant difference was seen clinically and statistically in preventing or decreasing both periorbital edema and ecchymosis between group 2 and group 3. Patients given TA showed significantly less intraoperative bleeding compared with controls and patients who were administered methylprednisolone. We observed that the administration of methylprednisolone significantly decreases periorbital edema and ecchymosis. Additionally, our results support that TA use in patients who underwent oSRP with osteotomies was found clinically and statistically effective for prevention of bleeding during oSRP operations and reduction of both periorbital edema and ecchymosis.

Evaluation of the effects of phototherapy on cochlear function in newborns.

OBJECTIVE: This study aimed to evaluate any potential effects of phototherapy on cochlear function in newborns using transient evoked otoacoustic emissions (TEOAEs). METHODS AND MATERIALS: Fifty-seven newborns, undergoing phototherapy for hyperbilirubinemia without any other risk factors, and a control group of 53 healthy newborns, were administered the TEOAE test prior to and following phototherapy. In the newborns undergoing phototherapy, otoacoustic emission (OAE) measurements obtained at baseline and following phototherapy were compared. Moreover, pre-phototherapy OAE measurements obtained in the newborns undergoing phototherapy were compared with the OAE measurements of the control group. RESULTS: In newborns undergoing phototherapy, there was no significant difference between pre- and post-phototherapy TEOAE amplitudes, nor in the reproducibility ratios. Similarly, no difference was found in the pre-treatment measurements of amplitude and reproducibility ratios between phototherapy-receiving newborns and controls (p>0.05). CONCLUSION: The normal TEOAE results observed in the newborns undergoing phototherapy suggest that phototherapy does not exert negative effects on the cochlea.

Bilateral lower eyelid basosquamous cell carcinoma: a rare case.

Basosquamous cell carcinoma is a subtype of basal cell cancer. It is known to be more aggressive than basal cell cancer. A 70-year-old male patient was admitted to our clinic for evaluation of cosmetic problems caused by masses on both lower eyelids for at least two years. The mass excision from and reconstruction of lower eyelids were performed. Histopathological examination of the resected masses was consistent with basosquamous cell carcinoma. We present a case of basosquamous cell carcinoma involving bilateral lower eyelids with a different clinical appearance. To the best of our knowledge, this is the first report of bilateral basosquamous cell carcinoma in a patient.

Tympanometric changes and eustachian tube function in patients with hypothyroidism.

OBJECTIVE: The aim of this study was to investigate the tympanometric changes and eustachian tube function (ETF) in patients with hypothyroidism. METHODS: Automatic ETF tests were performed and tympanometric measurements were evaluated to assess ETF in 40 patients diagnosed with hypothyroidism and a 40-patient euthyroid control group. Levothyroxine sodium tablet treatment was started in patients with hypothyroidism. After achieving a euthyroid state in these patients, the tympanometric measurements and automatic ETF tests were repeated. RESULTS: When the patient groups (hypothyroid and control) were compared in terms of ETF, a statistically significant ET dysfunction was observed in the hypothyroid patient group (P < 0.01).When hypothyroid patients were evaluated in terms of ETF before and after treatment, whereas 61.3% of cases had ET function before treatment, this ratio increased to 78.8% after treatment. Furthermore, according to pressure and compliance measurements, statistically significant increases were found in the after treatment measurements (P < 0.05). CONCLUSIONS: As a result of this study, we have come to the opinion that hypothyroidism can change tympanometric measurements and also cause ET dysfunction. However, more comprehensive and detailed studies researching the effects of hypothyroidism on tympanometric measurements are needed.

Oropharyngeal branchial cyst in a young child.

Second branchial cleft cysts are almost always located in the neck. Their presence in the oropharynx is extremely rare. An oropharyngeal branchial cyst in a 4-year-old child diagnosed by magnetic resonance and histopathology was presented. Anatomic location and pathological findings indicated the second branchial pouch origin. The cyst was excised transorally. Six months' follow-up of the child was uneventful and there was no recurrence.

Morphometric analysis of the maxillary sinus in patients with nasal septum deviation.

The aim of this study was to evaluate the relationship between nasal septum deviation, which is common in the general population, and maxillary sinus volume. A retrospective assessment was made for 96 patients with nasal septum deviation without coexisting sinonasal morbidity and compared to 60 healthy individuals. A three-dimensional reconstruction of computed tomography images was used to assess a total of 312 maxillary sinus volumes. Septal deviation angles and volumes were also measured to standardize and determine the severity of the septal deviations. Septal deviations were right-sided in 36.5% of the cases (n = 35) and left-sided in 63.5% (n = 61). Deviation angles varied between 5° and 24.4°, with a mean value of 12.9 ± 5.0. The mean value for the deviation volume was 4.6 ± 1.5 cm(3) (range 1.7-9.4). The right and left maxillary sinus volumes were 11.8 ± 4.7 cm(3) and 11.5 ± 4.4 cm(3), respectively, in control group. Statistically significant discrepancy was observed between the ipsilateral and contralateral maxillary sinus volumes, in regard to the side of the septal deviation in study group. Maxillary sinus volumes were found to be significantly smaller on the ipsilateral side of septal deviation compared with the contralateral side.

Psychiatric disorders and symptoms severity in patients with adenotonsillar hypertrophy before and after adenotonsillectomy.

OBJECTIVE: The objective of this study was to compare the frequency of psychiatric disorders and the severity of psychiatric symptoms in patients with adenotonsillar hypertrophy with a healthy control group and investigate the potential improvement after adenotonsillectomy. MATERIALS AND METHODS: The study group consisted of 40 patients with adenotonsillar hypertrophy and a control group consisted of 35 healthy volunteers without adenotonsillar hypertrophy. A routine ear nose throat (ENT) examination, flexible nasopharyngoscopy and tympanometry were carried out. The same procedures were applied to the control group. The parents of all the participants were required to fill out the Early Childhood Inventory-4 form, the Strengths and Difficulties Questionnaire and a personal information form. At postoperative month six, the patients were re-examined, and their parents were required to fill out the same forms. RESULTS: Attention deficit hyperactivity disorders and sleep disorders determined with the Early Childhood Inventory-4 were more common in the patients with adenotonsillar hypertrophy than in the control group. There was a significant decrease in the rates of both types of disorders at postoperative month six. The total psychiatric symptom severity was higher in the patients with adenotonsillar hypertrophy and the following were more frequent: cases of attention deficit hyperactivity disorder, oppositional defiant disorder, symptom severity of anxiety disorders and sleep disorders determined with the Early Childhood Inventory-4, as well as emotional problems, attention deficit hyperactivity disorder problems, behavioural problems and peer problems determined with the Strengths and Difficulties Questionnaire parent-report form. There was a statistically significant decrease in all the other symptoms at postoperative month six, except for the severity of oppositional defiant disorder symptoms determined with the Early Childhood Inventory-4 and behavioural problems determined with the Strengths and Difficulties Questionnaire parent-report form. There were no differences in the severity of psychiatric disorders or symptoms between the adenotonsillar hypertrophy group and the control group at postoperative month six. CONCLUSION: Adenotonsillar hypertrophy is associated with psychiatric disorders and symptoms. Adenotonsillectomy ameliorated the symptoms and the severity of these disorders in most cases.

The prevelance of psichiatric symptoms in preschool children with adenotonsillar hypertrophy.

OBJECTIVES: The aim of this study was to determine the prevalence of psychiatric disorders and symptoms in preschool-age children who are indicated for operation due to adenotonsillar hypertrophy. MATERIALS AND METHODS: Forty-eight patients between the ages of three and five years with indication for adenotonsillectomy were included in the study, as well as 40 control patients. Cases underwent routine ear nose throat (ENT) examination, flexible nasopharyngoscopy and tympanometry. The Early Childhood Inventory-4 (ECI-4) parent form and Strengths and Difficulties Questionnaire (SDQ) parent form were completed by the parent caring for the child. The SPSS for Windows 16.0 program was used for statistical analysis. RESULTS: Groups were compared according to they received at least one psychiatric diagnosis measured by ECI-4, the group of adenotonsillar hypertrophy was diagnosed more than the control group. Attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD) and sleep disorders were detected at a higher rate in patients with adenotonsillar hypertrophy. It also was established that in the comparison of the severity of psychiatric symptoms determined by ECI-4, symptom severity of ADHD, ODD, anxiety disorders, and sleep disorders was higher in the adenotonsillar hypertrophy group than in the control group. In the evaluation of the SDQ parent form, it was determined that attention deficit, hyperactivity, behavioral, and peer relations problems occurred more frequently in the adenotonsillar hypertrophy group. CONCLUSIONS: In addition to oral respiration, snoring, and disordered breathing during sleep, adenotonsillar hypertrophy may also associated with psychiatric disorders and symptoms.