Anatomical Insights on the Cervical Nerve for Contemporary Face and Neck Lifting: A Cadaveric Study.

BACKGROUND: Despite its significant roles in the functions of the platysma and lower lip, the cervical branch of the facial nerve is often overlooked compared to other branches, a consideration critical for ensuring the safety of neck surgeries. OBJECTIVES: We aimed to clarify the anatomical discrepancies associated with the cervical branch of the facial nerve to enhance surgical safety. METHODS: The study utilized twenty fresh-frozen hemiheads. A two-stage surgical procedure was employed, beginning with an initial deep-plane facelift including extensive neck dissection, followed by a superficial parotidectomy on fresh frozen cadavers. This approach allowed for a thorough exploration and mapping of the cervical nerve in relation to its surrounding anatomical structures. RESULTS: Upon exiting the parotid gland, the cervical nerve consistently traveled beneath the investing layer of the deep cervical fascia for a brief distance, traversing the deep fascia to travel within the areolar connective tissue before terminating anteriorly in the platysma muscle. Single branch was observed in two cases, while two branches were noted in eighteen cases. CONCLUSIONS: The cervical nerve's relatively deeper position below the mandible's angle facilitates a safer subplatysmal dissection via a lateral approach for the release of the cervical retaining ligaments. Due to the absence of a protective barrier, the nerve is more susceptible to injuries from direct trauma or thermal damage caused by electrocautery, especially during median approaches.

Effects of Combined Visible and Infrared Light Rhinophototherapy in Patients With Allergic Rhinitis.

BACKGROUND: Intranasal phototherapy offers an alternative treatment method for patients with allergic rhinitis who cannot benefit from intranasal corticosteroids and oral antihistamines. Different wavelengths have been tried with promising results. OBJECTIVE: In this present study, we aimed to investigate the effects of visible light-infrared light phototherapy on clinical improvements together with its cytologic effects in patients with allergic rhinitis. METHODS: Patients with confirmed allergic rhinitis were given a 4-week course of intranasal phototherapy treatment. Weekly symptom questionnaires were applied to monitor clinical effects. Nasal lavage specimens were obtained before the start and at the completion of the 4-week therapy. Fluorescence-activated cell sorting analyses of CD16+, CD24+, and CD 45+ cells were performed. Statistical analyses are performed of weekly changes in symptoms and cell counts. RESULTS: CD45+CD16highCD24+ neutrophil count in nasal lavages decreased significantly whereas CD45+CD16dim/-CD24+ eosinophil counts significantly increased and CD45+ granulocyte counts remained unchanged. Symptom scores including nasal itching, nasal discharge, nasal obstruction, sneezing, eye itching, throat itching, and ear itching all statistically decreased compared to baseline at the end of 4 weeks. CONCLUSION: Four-week course of intranasal phototherapy with visible and infrared light leads to clinical improvement in allergic rhinitis patients.

Middle Ear Resonance Frequency in Pilots and Pilot Candidates.

BACKGROUND: Barotrauma is a frequent problem in aviation medicine. Eustachian tube dysfunction plays a critical role in the pathogenesis of barotrauma. Function of the Eustachian tube can be indirectly assessed by multifrequency tympanometry, which provides valuable information about the resistance and permeability of the middle ear in a wide frequency range. The aim of this study was to research whether multifrequency tympanometry could be used for assessing middle ear impairments in pilots. METHODS: There were 140 pilots and pilot candidates between the ages of 20-55 with normal otoscopic examination who were evaluated by audiological test batteries. Body mass index values, flight hours, audiometric pure tone thresholds, tympanometry and multifrequency tympanometry test results were noted. RESULTS: There was statistically significant decrease in the multifrequency tympanometry measurements of the left and right ears of the pilots with 200-3000 flight hours compared to pilot candidates, and similarly, the pilots with 3000-10,000 flight hours compared to pilot candidates. DISCUSSION: Multifrequency tympanometry values changed between pilot candidates and pilots. However, the values of multifrequency tympanometry did not change due to flight hours. This test battery should not be used for follow up of pilots in the clinic. Tuncer MM, Babakurban ST, Aydin E. Middle ear resonance frequency in pilots and pilot candidates. Aerosp Med Hum Perform. 2016; 87(10):876-881.

FCN2 c.772G>T polymorphism is associated with chronic adenoiditis and/or tonsillitis, but not -4 A>G and -602 G>A.

OBJECTIVE: Ficolins are complement activating peptides that play a role in the initial host defense against infectious pathogens. In the present study, we investigated the relationship between single nucleotide polymorphisms (SNPs) in the ficolin 2 gene (FCN2) and chronic adenotonsillitis in pediatric cases. STUDY DESIGN: Case-control study. METHODS: A total of 101 pediatric patients diagnosed with chronic adenotonsillitis and 100 healthy children were enrolled in the study. Genotypes of FCN2 promoter SNPs - 602 G>A and -4 A>G, and the exonic SNP c.772G>T were determined by light SNP assay after realtime PCR analysis using genomic DNA samples obtained from peripheral blood samples of all participants. RESULTS: Of the 101 chronic tonsillitis patients, 38 were girls and 63 were boys; the mean age was 5.2 ± 2.3 years. The c.772G>T SNP frequency was significantly higher in chronic adenotonsillitis cases compared to the control group (p = 0.00); however, no significant difference was determined at positions -602 G>A or -4 A>G (p > 0.05). CONCLUSIONS: The FCN2 c.772G>T genotype appears to be associated with predisposition to chronic adenotonsillitis in the pediatric age group. This nucleotide change is likely to influence the level of gene expression and contribute to the development of disease.

Recurrent Pleomorphic Adenoma of the Submandibular Gland.

Pleomorphic adenoma (PA) is the most common benign tumor of salivary glands. Most PAs occur in the parotid (80%), followed by the submandibular gland (10%) and minor salivary and sublingual glands (10%). Submandibular gland PAs usually manifest in the submandibular area as a painless hard mass. Although several recurrent parotid gland PA cases have been reported in the literature, recurrent submandibular gland PA is quite rare. Complete surgical removal of tumor of the submandibular gland and keeping the capsule intact are important to prevent recurrence. Here we present a rare case of submandibular gland PA recurrence that occurred 5 years after the first surgery and methods to prevent recurrence.

Lack of association of matrix metalloproteinase-9 promoter gene polymorphism in obstructive sleep apnea syndrome.

PURPOSE: Obstructive sleep apnea syndrome (OSAS) is a public health problem. There is an effort to establish the genetic contributions to the development of OSAS. One is matrix metalloproteinases, extracellular matrix degrading enzymes related to systemic inflammation. However, the impact of matrix metalloproteinase-9 (MMP-9) genotypes on the development of OSAS is unknown. Our aim was to determine whether MMP-9 single nucleotide polymorphism (SNP) (MMP-9 -1562C > T) is related to susceptibility to OSAS. MATERIAL AND METHODS: A total of 106 patients with a history of sleep apnea and 88 controls without a history of sleep apnea were enrolled in this study. Genotypes were determined by restriction fragment length polymorphism analyses after polymerase chain reaction. RESULTS: Genotypes and allele frequencies of the MMP-9 -1562C > T SNP was not statistically different between the patient and control groups (p > 0.05). There was a statistical association between apnea-hypopnea index (AHI) and body mass index (BMI), and also between AHI and neck circumference (p < 0.001). There was no association among the genotypes and AHI, neck circumference, or BMI (p > 0.05). CONCLUSIONS: We found no association between MMP-9 -1562C > T SNP and OSAS. Studies to investigate the role of other polymorphisms and expression of MMP-9 gene will provide more information.

Chronic tonsillitis is not associated with beta defensin 1 gene polymorphisms in Turkish population.

BACKGROUND: Defensins are antimicrobial peptides expressed on mucosal surfaces. They function as part of the innate immune system. Palatine tonsils play important roles in innate immune system. However, our knowledge on the pathophysiology of chronic tonsils is limited. OBJECTIVE: The aim of this study was to investigate the association between beta defensin 1 gene single nucleotide polymorphisms and chronic tonsillitis. STUDY DESIGN: Prospective, non-randomized, controlled clinical study. SETTING: Tertiary referral center. SUBJECTS AND METHODS: Eighty six patients with chronic tonsillitis and eighty controls without history of chronic tonsillitis were enrolled in this study. Genotypes were determined by restriction fragment length polymorphism analyses after polymerase chain reaction. RESULTS: Genotype and allele frequencies of the -20G/A (rs11362), -44C/G (rs1800972) and -52G/A (rs1799946) single nucleotide polymorphisms were not statistically different between patients and control groups (p>0.05). CONCLUSION: In this study, we found that DEFB1 gene -20G/A, -44C/G and -52G/A single nucleotide polymorphisms were not associated with chronic tonsillitis. Studies, which analyse other polymorphism of the beta defensin 1 gene in large case series, should be conducted to understand the role of DEFB1 gene on chronic tonsillitis.

Evaluation of Hearing Loss in Pilots.

OBJECTIVE: High-intensity noise sources with an increase in air traffic and sudden changes in atmospheric pressure can cause hearing loss in pilots. The main goal of this research is to examine hearing loss due to age, the total flight hours and aircraft types and to evaluate the effects of personal conditions that can influence the hearing level. METHODS: We examined the data of 234 Turkish pilots aged between 25 and 54 years who were examined due to the aviation Law for annual control from January 2005 to January 2014 at Baskent University Medical Faculty, Ankara Hospital. The audiometric results of the pilots were used. While 1, 2, 3, 4, 6, and 8 KHz were used for the airway threshold, 1, 2, and 4 KHz were used for the bone conduction threshold. RESULTS: According to the data of the 234 pilots, there was a significant correlation between high-frequency hearing loss and the total flight hours and pilots' ages. The average hearing loss was higher, particularly in the left ear, in pilots using helicopters than in those using other aircraft types. There was no statistically significant correlation between hearing loss and diabetes, hypercholesterolemia, high blood pressure, anemia, obesity, and smoking. CONCLUSION: A significant correlation was observed between high frequency hearing loss and the total flight hours, pilots' age, and aircraft types in our study.

The Importance and Place of Adenotonsillectomy in Syndromic Children.

OBJECTIVE: Upper airway obstruction and sleeping disorders are important issues in syndromic children, including mouth, lower-upper jaw, or all facial abnormalities. Tonsillectomy and/or adenoidectomy is required because of systemic problems and upper airway obstruction that increase the existing systemic problems, except those anomalies. However, tonsillectomy and/or adenoidectomy are mostly avoided because of the tendency to cause both intubation/perioperative systemic problems and respiratory complications in the postoperative period and in delays in the oral intake. However, these surgeries are sometimes required. In this context, we present our experience related with performing tonsillectomy and/or adenoidectomy in syndromic children admitted to our hospital. METHODS: We retrospectively examined the data on tonsillectomy and/or adenoidectomy performed in syndromic patients in our clinic between 2001 and 2011. RESULTS: We did not observe any postoperative complications in adenoidectomy and/or tonsillectomy performed by the same surgeon in 14 syndromic cases. CONCLUSION: It should be noted that respiratory problems may arise from many different anatomical regions in syndromic patients. Therefore, surgery should be performed taking into consideration all of these factors in these patients. These patients must be hospitalized in the postoperative period.

Fractalkine receptor polymorphism and chronic tonsillitis.

The objective of this study is to examine whether there is an association of fractalkine gene receptor polymorphisms with chronic tonsillitis. This is a cross-sectional study in the setting of a tertiary referral center. The study group included 79 patients with chronic tonsillitis and 76 controls without history of chronic tonsillitis. Genotypes were identified by restriction fragment length polymorphism analyses after polymerase chain reaction. c.745G>A (V249I) single nucleotide polymorphism and the frequencies of the G and A alleles did not differ in the patient and control groups (p = 0.363; p = 0.743, respectively). c.839C>T (T280M) single nucleotide polymorphism was found to be higher in controls than in the patients with chronic tonsillitis (p < 0.001). Consistent with this result, T allele frequency was higher in controls than in the patients with chronic tonsillitis (p < 0.001). In this study, we suggested that fractalkine gene receptor c.839C>T (T280M) single nucleotide polymorphism could be associated with a reduced risk of chronic tonsillitis.

The relationship of homocysteine, vitamin B12, folic acid levels with vertigo.

OBJECTIVES: In this study the relationship of serum homocysteine, vitamin B12, folic acid levels and peripheral vestibular dysfunction (PVD) was investigated. PATIENTS AND METHODS: Forty-one patients (31 females, 10 males; mean age 57.34±14.3 years; range 12 to 80 years) who admitted to Baskent University Hospital Ear Nose and Throat Department between the dates of April 2005 - December 2007 with complaint of vertigo were prospectively analyzed and diagnosed using audio-vestibular test, at the same time serum homocysteine, vitamin B12, folic acid measurements was done from the blood samples of patients. The patients were divided into three groups as Meniere's disease, vestibular neurinitis, and benign paroxismal positional vertigo (BPPV) according to the diagnoses and serum homocysteine, vitamin B12, folic acid levels of patients were compared to normal values in and between groups. RESULTS: Of the patients, 29.3% (n=12) were diagnosed with Meniere's disease, 36.6% (n=15) with vestibular neurinitis, and 34.1% (n=14) with BPPV. Serum homocysteine leves of patients were 12.42±3.56 umol/L, 11.32±4.14 umol/L and 10.72±2.95 umol/L (p>0.05) in Meniere's disease, vestibular neurinitis, and BPPV respectively; vitamin B12 levels were 371.58±141.35 pg/ml, 288.13±139.51 pg/ml, 352.14±150.41 pg/ml (p>0.05) respectively and folic acid levels were 8.76±3.2 umol/L, 10.63±6.59 umol/L, 8.8±3.18 umol/L (p>0.05) respectively. The values were similar in all patients. No statistically significant difference was found in and between groups comparing with normal values. CONCLUSION: This is the first prospective study investigating the relationship of serum homocystein, vitamin B12 and folic acid levels with PVD. We found that there is no relationship of homocysteine, vitamin B12, folic acid levels with PVD.