A comparative study of two adenoidectomy technics for efficacy and safety: Conventional curettage adenoidectomy versus endoscopic microdebrider adenoidectomy.

PURPOSE: Conventional cold curettage adenoidectomy (CCA) is the most used method for Adenoidectomy. With the advances in surgical instruments, endoscopy assisted less invasive techniques are coming into use. Herein we compared CCA with endoscopic microdebrider adenoidectomy (EMA) in terms of safety and recurrence. METHODS: Patients who underwent adenoidectomy in our clinic between 2016 and 2021 years were included into the study. Study performed retrospectively. Patients operated with CCA accepted as GroupA and EMA as GroupB. Two groups compared for the recurrence rate and post-operative complications. RESULTS: We studied 833 children aged between 3 and 12 years (mean 4,2 years old), had adenoidectomy, including 482 male(57.86 %) and 351 female (42.14 %). There were 473 patients in GroupA, and 360 patients in GroupB. Seventeen patients (%3.59) in GroupA had reoperation for the recurrence of adenoid tissue. There was no recurrence in GroupB. Residual tissue, recurrent hypertrophy, and postoperative otitis media rates were higher in GroupA, and this was statistically significant (p < 0.05). Whereas ventilation tube insertion rates didn't differ significantly (p > 0.05). Although hypernasality rate at second week was slightly higher in GroupB, this was not statistically significant (p > 0.05), and in further period it resolved in all patients. No major complications were reported. CONCLUSION: Our study indicates that EMA is a safer technique than CCA, and prominent postoperative complications like residual adenoid tissue, recurrent adenoid hypertrophy, and postoperative otitis media with effusion rates are lower.

Mulberry hypertrophy and accompanying sinonasal pathologies: A review of 68 cases.

Mulberry hypertrophy occasionally coexists with sinonasal pathologies. There are very few reports in the literature on this clinical entity. We conducted a retrospective study to draw attention to this condition in the context of accompanying sinonasal pathologies. Our study group was made up of 68 patients-51 males and 17 females, aged 13 to 57 years (mean: 34.9)-who had been diagnosed with mulberry hypertrophy and at least one accompanying sinonasal pathology. All patients had a long-standing chronic discharge. Forty-nine of these patients (72.1%) had unilateral mulberry hypertrophy. The most common concomitant pathologies were chronic rhinosinusitis and ostiomeatal complex disease; others included septal deviation, nasal polyposis, allergic rhinitis, and concha bullosa. Thirty-six patients (52.9%) with varying degrees of choanal/nasal obstruction were operated on with endoscopic excision to treat the mulberry hypertrophy. In all, most patients underwent some sort of surgery to treat either the mulberry hypertrophy or the accompanying sinonasal pathology. Based on our findings, we suggest a clinical staging system to serve as a way to standardize management and guide future basic and clinical research.

The effects of aminoguanidine, methylprednisolone, and melatonin on nerve recovery in peripheral facial nerve neurorrhaphy.

BACKGROUND: The medications may enhance the recovery after nerve paralysis. We aimed to evaluate the effects of aminoguanidine (AG), melatonin, and methylprednisolone on peripheral facial nerve neurorrhaphy. METHODS: The buccal branch of the facial nerve was transected and autografted in 32 New Zealand rabbits. Subjects were divided into 4 groups equally (AG, melatonin, methylprednisolone, and control). After the medical treatment latency and amplitude were measured with nerve conduction study at 3, 6, and 10 weeks. Then, coapted segments of nerve were examined microscopically. The groups were compared with each other. RESULTS: The latent period was shortened, and the amplitudes were increased in the AG group; the latent period was shortened, and the amplitudes did not show significant change in the melatonin group with the time. There were no significant differences between the amplitudes at 3 to 6 and 3 to 10 weeks in the methylprednisolone group, and the latent period was shortened. There was no significant difference between the amplitude values at 3, 6, and 10 weeks in the control group. In the histological examination, AG had the best influence on preventing myelin degeneration and reducing the accumulation of myelin debris. Considering the increase in collagen fibers, the best results were achieved in the melatonin group. The degree of myelin-axonal degeneration was higher in the methylprednisolone group. The degree of collagen fiber increase, axonal degeneration, myelin degeneration, and the accumulation of myelin debris were detected quite high in the control group. CONCLUSIONS: Aminoguanidine and melatonin alone achieved an increase in regeneration after peripheral facial nerve neurorrhaphy, but methylprednisolone did not. The best healing was determined in the AG group.

The treatment of neck and parotid gland in cutaneous squamous cell carcinoma of face and forehead and the review of literature.

INTRODUCTION: The treatment of cervical lymph node metastases have a significant prognostic effect on the face and forehead skin cancers. We aimed to point out the importance of loco-regional treatment in cutaneous squamous cell carcinoma of face and forehead. PRESENTATION OF CASE: We present our experience with four cases that had squamous cell carcinoma of face and forehead skin. All cases had regional recurrence following 1-3 years after the primary treatment, but did not have local recurrence. DISCUSSION: Loco-regional lymphatic treatment for face and forehead skin squamous carcinomas has vital importance especially in the cases with high-risk factors for lymph node metastasis. CONCLUSION: Elective lymph node dissection of appropriate region(s) should be included in the treatment plan for cases which have one or more of high-risk factors for lymph node metastases and long-term follow-up should not be ignored.

Repositioning of the caudal septal dislocations with notching and suturing the cartilage to the nasal spine.

We aim to define a cartilage reshaping and repositioning technique for caudal septal dislocations, with the logic of adapting the smoother tissues to the stiffer structures. The study was designed retrospectively with the patient charts and photographic analysis. Thirty-six patients who had septal surgery in a septoplasty or an open approach septorhinoplasty operation and meet the inclusion criteria were evaluated for the study. Postoperative success of the technique was based on preoperative and postoperative photographic analysis by two independent otorhinolaryngologists. The estimators classified 33 cases as near complete, 3 cases as improved but persisting caudal septal deviation, and any cases with no change. The improvement of the degree of reconstruction was near complete about 87% in septoplasty and 95% in septorhinoplasty groups, and 92% for all patients. In this study, we present a caudal septal repositioning maneuver which achieves a stable anchorage between postero-caudal septal cartilage and nasal spine. Septal cartilage is notched and fixed to nasal spine with two simple independent sutures as lock and key model. We define this maneuver as riding spine technique. It is an anatomic re-orientation between the septum and nasal spine for caudal septal deviations and subluxations.

The effect of BMP-2, BMP-4 and BMP-6 on bone destruction of cholesteatoma presence.

OBJECTIVE: The aim of our study was to investigate the relationship between the destruction of temporal bone structures, ossicular chain destruction, dissemination of cholesteatoma and the expressions of bone morphogenetic proteins (BMPs), BMP-2, BMP-4 and BMP-6 in patients with acquired cholesteatoma. MATERIAL AND METHODS: This study was performed in a total of 80 patients with cholesteatoma and without cholesteatoma who had undergone surgery due to chronic otitis media. The patients were grouped as the study and the control groups. The study group comprised patients with primary acquired cholesteatoma, and the control group consisted of chronic otitis media patients without cholesteatoma. The samples were obtained from cholesteatoma tissue and the external acoustic meatus skin in study group patients and they were obtained from the external acoustic meatus skin only in control group patients. The Reverse Transcriptase Polymerase Chain Reaction method was used for the measurements of BMPs, BMP-2, BMP-4 and BMP-6 expressions. Polymerase Chain Reaction was studied by isolation of Ribonucleic Acid from the tissue samples. RESULTS: When the expressions of BMP in the external acoustic meatus skin were compared between the study and the control groups, the BMPs, BMP-2 and BMP-6 were determined to have a statistically significant relation in the study group (p<0.05), but BMP-4 was not significant (p>0.05). When the expression of BMP in cholesteatoma tissue was investigated in the study group patients, the BMPs, BMP-2 and BMP-6 were determined with statistically significant positivity (p<0.05), but there was no significant positivity for BMP-4 (p>0.05). In the study group, there was no statistical significance between the expressions of BMPs, BMP-2, BMP-4 and BMP-6 in cholesteatoma tissue, in the external acoustic meatus skin, and temporal and ossicular chain destruction, and dissemination of cholesteatoma (p>0.05). A statistically significant positivity for BMPs expression in cholesteatoma tissue was determined in patients with destruction of the incus+malleus+stapes (p<0.05). CONCLUSION: The expressions of BMPs, BMP-2 and BMP-6, were elevated in cholesteatoma tissue. Furthermore, the positivity of BMPs expression was statistically significant in patients with destruction of all the ossicles, and we think that this marker can be used for evaluation of the aggressiveness of cholesteatoma.

Efficacy of glial growth factor and nerve growth factor on the recovery of traumatic facial paralysis.

The aim of this study was to assess the effects of Glial growth factor (GGF) and nerve growth factor (NGF) on nerve regeneration in facial nerve anastomosis. In this study, approximately a 1-mm segment was resected from the facial nerve and the free ends were anastomosed. All animals underwent the same surgical procedure and 30 rabbits were grouped randomly in three groups. Control group, the group without any medications; NGF group, the group receiving 250 ng/0.1 ml NGF in the epineurium at the site of anastomosis; GBF group, the group receiving 500 ng/0.1 ml GGF in the epineurium at the site of anastomosis. Medications were given at the time of surgery, and at 24 and 48 h postoperatively. After 2 months, the sites of anastomosis were excised and examined using the electron microscope. It was found that the best regeneration was in the group receiving GGF as compared to the control group in terms of nerve regeneration. Schwann cell and glial cell proliferation were found to be significantly higher in the group receiving GGF as compared to the group receiving NGF. Besides, the number of myelin debris, an indicator of degeneration, was significantly lower in the group with GGF as compared to NGF and control groups (p < 0.005). Using GGF and NGF in order to increase regeneration after nerve anastomosis in experimental traumatic facial nerve paralysis may be a hopeful alternative treatment option in the future. However, further studies on human studies are required to support these results.

MRI findings of papillary cystadenocarcinoma of the submandibular gland.

Papillary cystadenocarcinoma is an extremely rare malignant tumor of the salivary glands. Major locations of this neoplasm are the parotid gland, sublingual gland, and minor salivary glands, while occurrence in the submandibular gland is extremely rare. Magnetic resonance imaging (MRI) findings of this lesion have not been reported in the literature. Herein, we present a case of papillary cystadenocarcinoma arising from the right submandibular gland. MRI showed a 5-cm mass composed of solid and cystic components in the mildly enlarged gland. Pathologic evaluation revealed papillary cystadenocarcinoma.

[Pharyngocutaneous fistula after total laryngectomy: incidence, predisposing factors, and treatment]. / Total larenjektomi sonrasi farengokutanöz fistül: Sikligi, etkileyen faktörler ve tedavi yaklasimi.

OBJECTIVES: We investigated the incidence and etiologic factors of pharyngocutaneous fistulas occurring after total laryngectomy. PATIENTS AND METHODS: The study included 53 patients (46 males, 7 females; mean age 59 years; range 34 to 84 years) who underwent total laryngectomy for epidermoid carcinoma. Risk factors for pharyngocutaneous fistula, its incidence and time of occurrence, treatment approaches, and length of hospital stay were evaluated. RESULTS: Pharyngocutaneous fistula developed in 19 patients (35.9%) within a mean of 7.4 days postoperatively. Age, smoking, the presence of chronic systemic disease; T1-T2 stage, localization, and differentiation of tumor, concomitant bilateral neck dissection, T/Y shaped pharyngeal closure, and high fever in the first postoperative 48 hours did not show any significant relationship with the formation of fistula. Factors significantly associated with fistula formation were T4 stage, alcohol consumption, postoperative anemia, and hypoproteinemia. The mean hospital stay was 40.5 days in patients with pharyngocutaneous fistula compared with 15.3 days in patients without fistula. CONCLUSION: Postoperative anemia, hypoproteinemia, alcohol consumption, and T4 stage are significant risk factors for pharyngocutaneous fistula formation.