Olfactory dysfunction and coronavirus disease 2019 severity: a prospective cohort study.

OBJECTIVE: The primary goal of this study was to evaluate the association between olfactory dysfunction or taste impairment and disease severity and radiological findings in coronavirus disease-2019. The secondary goal was to assess the prevalence, severity and course of olfactory dysfunction or taste impairment in patients with coronavirus disease 2019. METHOD: This prospective observational cohort study evaluated patients hospitalised with coronavirus disease 2019 between April 1 and 1 May 2020. Olfactory dysfunction and taste impairment were evaluated by two questionnaires. Chest computed tomography findings and coronavirus disease-2019 severity were assessed. RESULTS: Among 133 patients, 23.3 per cent and 30.8 per cent experienced olfactory dysfunction and taste impairment, respectively, and 17.2 per cent experienced both. The mean age was 56.03 years, and 64.7 per cent were male and 35.3 per cent were female. No statistically significant association was found between olfactory dysfunction (p = 0.706) and taste impairment (p = 0.35) with either disease severity or chest computed tomography grading. CONCLUSION: Olfactory dysfunction or taste impairment does not have prognostic importance in patients with coronavirus disease 2019.

Evaluation of receiver-stimulator migration in cochlear implantation using the subperiosteal pocket technique: a prospective clinical study.

OBJECTIVE: This study aimed to evaluate migration of the receiver-stimulator after cochlear implantation using the subperiosteal pocket technique. METHODS: A prospective clinical study was performed of 32 paediatric patients (aged between 12 months and 8 years; mean ± standard deviation, 28 ± 19 months) who underwent cochlear implantation in tertiary referral centres. The degree of migration was evaluated using measurements between the receiver-stimulator and selected reference points: the lateral canthus, tragus and mastoid tip. All distances were measured during and six months after surgery. RESULTS: No receiver-stimulator migration was observed when using the subperiosteal pocket technique. CONCLUSION: Concerns about implant migration in the subperiosteal pocket technique are unwarranted: this is a safe technique to use for cochlear implantation.

Medicolegal aspects of rhinology practice.

OBJECTIVE: To investigate rhinology-related malpractice claims with the aim of optimising safe practice. METHODS: The database of the National Institute of Forensic Medicine was reviewed. In total, 241 otorhinolaryngology malpractice case reports dating from 2005 to 2012 were evaluated, and 83 malpractice cases related to rhinology treatments were separated. RESULTS: There was no significant difference between the number of male (n = 42) and female (n = 41) claimants. The mean patient age was 32.07 ± 10.53 years (range, 10-75 years). Seventy-nine cases involved surgical treatment in rhinology. The most common complaints were: unsatisfactory cosmetic results (n = 30), optic nerve injury (n = 10), septal perforation (n = 9) and intracranial penetration (n = 4). Malpractice was detected in 21 cases (25.3 per cent). No delinquency was found in 62 cases (74.7 per cent). CONCLUSION: Physicians should be aware of legal consequences related to rhinology practice. Further study is needed on this topic, as well as interdisciplinary collaboration, to ensure best practices and to avoid litigation.

Tailed Palva flap in the subperiosteal pocket technique for cochlear implantation.

BACKGROUND: In recent years, the subperiosteal pocket technique has become popular for minimal access cochlear implantation. Many incision techniques have been described in cochlear implantation. OBJECTIVE: This study aimed to demonstrate the safety and reliability of a new periosteal incision, called tailed Palva incision, in cochlear implantation. METHODS: A total of 280 patients who underwent cochlear implantation with the subperiosteal pocket technique between June 2008 and January 2013 were included in the study. RESULTS: The patients were followed up for between 11 and 74 months (mean ± standard deviation = 34 ± 19 months). No intracranial complications were seen during or after the operations. Additionally, there was no migration of the receiver-stimulator. Revision surgery was performed in eight patients (3 per cent), one of whom (0.4 per cent) had local flap failure and infection. CONCLUSION: This study shows that the tailed Palva incision facilitates easy insertion of the implant and, by creating a one-way obscured pocket, this technique also enhances stabilisation of the receiver-stimulator, thereby avoiding anterior migration.

Surgical and audiological evaluation of the Baha BA400.

OBJECTIVE: Despite extensive soft tissue reduction, the most common complications associated with bone-anchored hearing aid systems, also known as bone-anchored hearing implants, are related to adverse skin reactions around the abutment. The necessary soft tissue reduction also adds complexity to the surgical procedure. This study aimed to evaluate the surgical and audiological outcomes of a new connective interface of the Cochlear™ Baha® BA400 device implanted using the one-stage surgical technique. METHOD: A multicentre, retrospective case series is presented, including data collected from three tertiary care institutions. RESULTS: In total, 16 patients who had undergone bone-anchored hearing aid surgery over a 10- to 12-month period were assessed for hearing performance, implant stability and surgical complications. CONCLUSION: This case series indicates that new abutments with a hydroxyapatite coating can be implanted percutaneously without soft tissue reduction. Furthermore, device implantation using this surgical technique may have some advantages compared with a conventional device and procedure combination over 12- to 16-months of follow up.

Identification of a differential expression signature associated with tumorigenesis and metastasis of laryngeal carcinoma.

OBJECTIVES: Metastasis is the most significant prognostic factor for laryngeal carcinoma which necessitates the identification of molecular alterations associated with metastasis. The identification of such molecular alterations will not only prove useful in treatment but also provide insight into mechanisms of cancer metastasis. The studies conducted so far have not specifically focused on metastasis or invasion pathways. Therefore we investigated the expression profiles with a pathway focused approach. MATERIALS AND METHODS: Total RNA was extracted from 36 laryngeal tumors and paired cancer free tissue. Expression levels of 88 genes were determined using a PCR array system following cDNA synthesis. Obtained data was used for the calculation of altered expression levels, facilitating relevant algorithms. Significant alterations were determined according to their p-value obtained by Student's t-test. RESULTS: Sixteen genes have shown altered expression when compared with adjacent cancer-free tissue. 2 of these 16 genes have shown differential expression in tumors with neck metastasis in respect to non-metastatic tumors. CONCLUSION: We found that TGFB1, TIMP1, c-Myc, SPARC, COL4A2 and SOX4 show altered expression in laryngeal tumors. c-Myc and SOX4 expression is decreased as laryngeal tumors switch to metastatic phenotype.

Is it necessary to remove submandibular glands in squamous cell carcinomas of the oral cavity?

The aim of this study was to determine the frequency and the mechanism of submandibular gland (SMG) involvement in oral cavity squamous cell carcinomas (OCSCC), and to discuss the necessity of extirpation of the gland. The authors investigated and analyzed the retrospective charts of 236 patients who underwent surgery for OCSCC over a 10-year period and the pathology reports of 294 neck dissections with SMG removal. SMG involvement was evident in 13 cases (4%). Eight cases were due to direct invasion, which was the most common mechanism. Four cases had infiltration from a metastatic periglandular lymphadenopathy, and in 1 case, metastatic disease was confirmed. The tongue and floor of the mouth were the most frequent primary sites associated with SMG involvement. The study found no bilateral cases, and in 135 SMG specimens benign pathologies were detected. Involvement of the SMG in OCSCC is not frequent. It is appropriate to preserve the gland unless the primary tumour or metastatic regional lymphadenopathy is adherent to the gland.

Follicular dendritic cell sarcoma of the nasopharynx.

Follicular dendritic cell (FDC) sarcomas of the nasopharynx are rare tumours; only seven cases have been reported in the English language medical literature. The authors present an eighth case, which occurred in a 70-year-old woman whose main complaint was nasal obstruction. It has been more than 10 years since FDC sarcoma was reported to occur in extranodal sites, and clinical and pathological characteristics of extranodal FDC sarcomas remain to be defined. The lack of a high index of suspicion is the main reason for misdiagnosis. The authors point out the difficulties in the diagnosis and management of this rare condition.

Fascia lata graft for nasal dorsal contouring in rhinoplasty.

Nasal dorsal irregularities are troublesome for both patient and surgeon, especially in patients with thin nasal dorsal skin. Many types of grafts have been used for nasal contouring; however, in this article, we report the use of fascia lata (FL) graft for dorsal contouring and camouflage in 63 patients who underwent rhinoplasty between May 2004 and December 2005. There were 26 male and 37 female patients, with ages ranging from 18 to 43 years (mean age: 28.7). Of the 63 patients, 49 underwent primary rhinoplasty, while 14 were secondary cases. An informed consent was obtained from all patients for the use of FL graft. The graft was harvested from the right lateral thigh. A simple method was used to place the graft over the nasal dorsum. Postoperative follow-up period was between 14 and 26 months (mean: 20). Clinical evaluation was made by inspection, palpation and photographic documentation. In addition, a questionnaire related to patient satisfaction and donor-site morbidity was sent to patients 1 year after surgery. All patients had satisfactory aesthetic results, and no apparent irregularities were observed over the nasal dorsum. The questionnaire results showed that all patients, but one, were satisfied with surgery, and were not concerned about donor-site scar; however, one patient had a donor-site morbidity. This study conclusively shows that TLF graft is a reliable, simple method for camouflaging any postoperative dorsal irregularities, particularly in patients with thin nasal skin.

Measuring nasal tip and lobule width; effect of transdomal and lateral crura suturing.

STATEMENT OF PROBLEM: There is no golden standard in measuring the width of the nasal tip and lobule. In this study we tried to validate the parameters Tip Index (TI) and Lobular Index (LI) as parameters for Nasal Tip Width (NTW) and Nasal Lobule Width (NLW) respectively. Trandomal suturing and lateral crura suturing were used to alter NTW and NLW respectively. METHODS: Standardized digital photographs (basal view) of open approach rhinoplasty patients were analysed. Transdomal sutures and lateral crura sutures were used in 29 and 28 patients, respectively. TI and LI were determined with digital imaging software (Adobe Photoshop) pre- and postoperatively. RESULTS: Average (SD) preoperative LI changed from 0.74 (0.07) to 0.71 (0.06) postoperatively with the lateral crura suturing technique (p = 0.045). We were not able to measure an effect in TI with the transdomal suturing technique. CONCLUSIONS: Detailed postoperative analysis with digital imaging software contributes to greater understanding of nasal tip mechanics. LI proved to be a valuable technique to describe NLW refinement.

Spinal accessory nerve function after neck dissections.

The aim of this study was to evaluate spinal accessory nerve function after functional neck dissection (FND) and radical neck dissection (RND) by monitoring the nerve with electromyographic (EMG) examinations. A prospective, double-blind, clinical study was undertaken in 21 patients (42 neck side dissections) operated on for head and neck malignant diseases, separated into two groups: 10 neck sides in the RND group and 32 neck sides in the FND group. Electromyographic examinations were performed pre-operatively and post-operatively in the third week and third and ninth months. Additionally, a questionnaire, modified from the neck dissection impairment index, was applied to all the patients in order to assess shoulder function in the ninth post-operative month. All patients had maximum EMG scores pre-operatively. Following the operation, motor amplitudes decreased in both groups. At the third post-operative month, amplitudes decreased to their lowest values. As expected, the decreases in amplitude and EMG score were more prominent in the RND group. Following reinnervation, the amplitudes of the trapezius motor response increased in the FND group but never reached pre-operative values (during the time of follow up). The FND group scores for pain, neck and shoulder stiffness, and disability in heavy object lifting, light object lifting and reaching overhead were significantly lower than those of the RND group. In FND, one aims to preserve anatomically the spinal accessory nerve, and it is presumed to be intact after the procedure. However, using EMG nerve function monitoring, our study revealed that profound spinal nerve injury was detected immediately after FND surgery, which tended to improve over subsequent months but had not regained its original function by the end of the ninth post-operative month.