Voice and Quality-of-Life Outcomes of Diode Laser for Tis-T1a Glottic Cancer.

The aim of this prospective study was to analyze the voice and quality-of-life outcomes of microscopic diode laser surgery (MDLS). The study was conducted on a series of 46 patients with Tis-T1a glottic carcinoma treated with microscopic endolaryngeal diode laser surgery. Patients were asked to complete the Voice Handicap Index and quality-of-life questionnaires of the European Organization for Research and Treatment of Cancer. When comparing the pre- and postoperative scores, there were significant difference on the physical scores (P = .014) of the patients who underwent type III cordectomy and functional (P = .022), emotional (P = .002), and overall scores (P = .005) of the patients who underwent type IV cordectomy, in the direction of better quality of voice after MDLS. The postoperative functional, physical, emotional, and overall scores of groups were significantly increased with the extension of resection.

Swallowing and Aspiration: How Much Is Affected by the Number of Arytenoid Cartilages Remaining After Supracricoid Partial Laryngectomy?

OBJECTIVES: The aim of this study was to compare the effect of the presence of one or two arytenoids on early/late period swallowing-aspiration functions. METHODS: Supracricoid partial laryngectomy (SCPL) with the diagnosis of laryngeal cancer between 2012 and 2014 were retrospectively evaluated. The patients were categorized into two groups as follows: group I, patients who underwent SCPL with one arytenoid cartilage and group II, patients who underwent SCPL with two arytenoid cartilages. The time of decannulation and oral feeding onset, and swallowing-aspiration functions were evaluated and compared in the early nutritional period, first, and third months. RESULTS: There was no significant correlation between decannulation time and swallowing-aspiration. The aspiration rates in group I and group II were similar and there was no significant difference in oral feeding onset and aspiration grades in the first and third months between both groups. CONCLUSION: We found similar oncological and functional outcomes in SCPL which protected one or two arytenoid cartilages. Therefore we suggest to be performed one arytenoid cartilage SCPL in selected patients who was advance stage and tumor volume over with larynx cancer.

Long-Term Results of Partial Laryngectomized Patients.

AIM: This study was to present long-term oncological results, as well as the variables, that can increase nodal metastasis and reduce survival in patients diagnosed in the early and late stages of laryngeal cancer. METHODS: A total of 85 patients were included in the study. These patients were grouped as supracricoid partial laryngectomy (PL), supraglottic horizontal PL, and vertical frontolateral PL. Furthermore, at least 3 years of the long-term outcomes of the patients in these 3 groups were compared. RESULTS: Twenty-two of the patients (26%) had nodal metastasis, 16 (72%) of these patients were in Group I (P = 0.017); 14 patients (51%) had preepiglottic space (P = 0.075); 12 patients (50%) had paraglottic space involvement (P = 0.002); 9 (45%) patients with nodal metastasis had a depth of invasion more than 20 mm (P < 0.001). Out of the 16 patients who had positive intraoperative surgery margins, 5 (18%) of them had nodal metastasis (P = 0.589) and 14 (16%) patients were positive for perineural invasion, 3 (19%) of these patients had lymph node involvement (P = 0.074). One (5%) patient died with nodal metastasis. Median survival rate of all the patients was 44 ±â€Š0.836 (42.36-45.63) months and the overall survival rate was 92.9%. CONCLUSIONS: Paraglottic space involvement and tumor invasion depth were statistically effective on increased nodal metastasis. However, we suggest that depth of invasion may not be effective alone as a prognostic factor. In contrast to the known effect on overall survival was less lymph node.

Long-term effects of parotidectomy.

The present study investigated the long-term complications of parotidectomy, the differences in these complications in regard to the pathological diagnosis and type of surgery. The patients were questioned regarding the presence of facial paresis-paralysis, pain, loss of sensation, scarring, collapse, and mouth dryness in the area of operation. Complaints of pain (p = 0.287), scarring (p = 0.456), and mouth dryness (p = 0.136) did not show statistically significant differences between the cases with benign or malignant pathological outcomes. However, complaints of loss of sensation (p < 0.001), collapse in the area of operation (p = 0.025), paresis-paralysis (p < 0.001), and fear of repeated surgery (p = 0.032) were present at significantly higher rates. Complaints of pain (p = 0.258), scarring (p = 0.665), mouth dryness (p = 0.113) and fear of repeated surgery (p = 0.053) did not show statistically significant differences between the cases who underwent superficial or total parotidectomy. However, complaints of loss of sensation (p = 0.002), paresis (p < 0.001), and collapse in the area of operation (p = 0.019) were present at significantly higher rates. The type of tumor and surgical approach significantly affect the quality of life; however, parotidectomy generally does not lead to serious long-term complications that would disturb the patients.

A Rare Entity: Adult Asymptomatic Giant Vallecular Cyst.

Background. Cysts in the larynx are rare and generally asymptomatic. However, large cysts in adults can be symptomatic. If they are symptomatic, they typically present with respiratory and feeding difficulties. They are usually benign in terms of pathology. Several surgical techniques may be used for treatment. Case Report. A 56-year-old man presented to our clinic with hoarseness. Routine laryngeal examination revealed a giant mass and the larynx could not be visualized. At magnetic resonance imaging (MRI), a cystic mass originating from the vallecula was detected. There was no pathology at the glottic level. We planned tracheotomy for the airway and endoscopic surgery for excision. The mass was excised using CO2 laser and was reported as benign. Conclusion. An asymptomatic vallecular cyst may cause difficult intubation in any operation. It may also cause respiratory or other complications. Airway management should be led by an ear, nose, and throat surgeon, since tracheotomy may be required. Endoscopic excision with CO2 laser is a good choice for treatment in elective cases. In this report, we discuss the diagnosis and treatment of a patient with an asymptomatic giant vallecular cyst.

Effect of the Rhinoplasty Technique and Lateral Osteotomy on Periorbital Edema and Ecchymosis.

AIM: The present study aimed to compare edema and ecchymosis in the early and late postoperative periods following the application of different surgical techniques (open and endonasal) and different types of lateral osteotomy (internal and external). METHODS: The files and photographs of a total of 120 patients whose records were regularly maintained/updated and who underwent septorhinoplasty operation with the same surgeon were retrospectively evaluated. Sixty-nine (57.5%) patients were women and 51 (43.5%) were men. The patients were divided into 4 different groups according to the operations they underwent as follows--Group I: open technique septorhinoplasty + internal/continuous lateral osteotomy; Group II: endonasal rhinoplasty + internal/continuous lateral osteotomy; Group III: open technique septorhinoplasty + external/perforating lateral osteotomy; and Group IV: endonasal rhinoplasty + external/perforating lateral osteotomy. Postoperative edema and ecchymosis, and lateral nasal wall mucosal damage because of osteotomy were evaluated. RESULTS: Postoperative second day edema and ecchymosis scores were statistically significantly better in patients in Group II compared with the patients in Group I (P = 0.010 and P = 0.004, respectively). Postoperative first day edema and postoperative seventh day ecchymosis scores were statistically significantly better in the patients in Group IV compared with the patients in Group III (P = 0.025 and P = 0.011, respectively). Intraoperative bleeding was similar in all groups. The nasal tip was more flexible in patients who underwent closed technique rhinoplasty. Unilateral mucosal damage occurred in 3 patients (4%) with internal lateral osteotomy, whereas no mucosal damage was present in patients with external osteotomy. CONCLUSIONS: The difference in the rate of edema and ecchymosis in the early postoperative period between the closed technique rhinoplasty and the open surgical approach was statistically significant, whereas osteotomy did not cause a significant difference. According to these results, the authors suggest endonasal surgery to prevent the development of edema and ecchymosis, whereas the choice of lateral osteotomy should be dependent on the experience of the surgeon.

The effect of radiotherapy on mucociliary clearance in patients with laryngeal and nasopharyngeal cancer.

The present study aimed to demonstrate how the nasal mucociliary transport times are affected in the patients receiving radiotherapy for head-neck tumor in two different anatomic localizations. The study included 44 patients receiving radiotherapy under the diagnoses of the nasopharyngeal and laryngeal cancer. The mucociliary transport times of both groups were measured via saccharine tablets before radiotherapy, and at months 3 and 6 after radiotherapy. The difference between the groups was statistically evaluated. The pre-irradiation (pre-RT) mean transport times of NPC and LC patients were 9.7 and 9.1 min, respectively. The difference in the mucociliary transport times between these two groups was not statistically significant (p = 0.49). The mean transport time was 26.1 min at post-RT month 3, 23.9 min, at month 6; the change from pre-RT to month 3 was significant (p < 0.05) and the change from month 3 to 6 was not statistically significant (p = 0.182). The mean transport time of the LC patients was 16.8 min. At post-RT month 3, 12.4 min. at month 6; the change from pre-RT to month 3 (p < 0.05) and the change from month 3 to 6 were statistically significant (p = 0.007). It was found that radiotherapy affected the physiological conditions of the patients with nasopharyngeal cancer in a more severe and sustained way compared to the LC patients, which negatively affects the patient's response to the treatment by the resulting organic and psychological effects.

[Provox 2 use for voice restoration after total laryngectomy]. / Total larenjektomi sonrasi ses restorasyonu için provox 2 kullanimi

OBJECTIVES: This study aims to determine the problems of patients applied provox 2 voice prosthesis for speech rehabilitation with their prosthesis and our treatment modalities to increase the quality of life of these patients. PATIENTS AND METHODS: A total of 210 patients (180 males, 30 females; mean age 58±11.9 years; range 37 to 83 years) who underwent total laryngectomy, applied and changed provox 2 voice prosthesis for voice restoration were included in the study. For speech restoration of the patients with a primary (intraoperative) and secondary (postoperative) tracheoesophageal fistula was opened. In the 15th postoperative day, provox 2 voice prosthesis was placed to approximately 0.5 cm inferior and midline fistula line of the tracheostoma. The patients underwent speech exercises. RESULTS: The mean change time of prosthesis was 7.5 months (range 1 to 48 months). Fungal colonization was detected in 141 patients (66%) who had voice prostheses. Granulation tissue developed around the voice prosthesis in 30 patients (14%), three patients (1%) swallowed their voice prosthesis, tracheoesophageal fistula width remained permanently in two patients (1%), and these patients were abandoned to use their voice prosthesis. Mediastinitis occurred in one patient (1%). CONCLUSION: Due to several reasons such as success of high speech despite of complications and being easy to fight with these complications, provox voice prosthesis is an effective method to use for voice restoration.

Giant ethmoid osteoma originated from the lamina papyracea.

INTRODUCTION: Osteomas are slow- growing, benign tumors. They are the most common neoplasms of the paranasal sinuses. They are usually originates from the frontal and ethmoid sinus and much less frequently seen in the maxillary and sphenoid sinuses. Although the lamina papyracea is a part of ethmoid bone, a giant osteoma originated from the lamina papyracea is very uncommon. An osteoma of the paranasal sinus is usually asymptomatic. Headache, proptosis, epiphora, diplopia, dizziness, facial deformity, face pain and cerebral complications are possible symptoms. The treatment of the paranasal osteomas are controversial. CASE REPORT: A 65 year old patient that applied with stuffiness and headache to our clinic. She has had a smooth mass in the right nasal cavity. Paranasal sinus tomography showed an osseous lesion, the size of 4 x 3 cm, arising from the right lamina papyracea. The mass excised endoscopically and reported as osteoma histopathologically. There was no complication. After 9 months, there was no recurrence. CONCLUSION: Giant osteomas of paranasal sinuses, especially originated from the lamina papyracea are rare. They can be treated successfully by endoscopic approaches without any recurrence and complication despite its size.

Nonmelanoma facial skin carcinomas: methods of treatment.

AIM: The objective was to present in this study the administered treatment, reconstruction, and outcomes for lesions excised according to a prediagnosis of facial tumor, whose pathological finding was reported as nonmelanoma skin tumor. METHODS: A total of 178 patients with full medical histories who were operated on for skin tumors in the Ear, Nose, and Throat Clinic of Ankara Oncology Education and Research Hospital between February 2010 and March 2012 were evaluated retrospectively. The test group was made up of 125 men (70%) and 53 women (30%), with a median age of 56 years (range, 29-89 years). RESULTS: Basal cell carcinoma was diagnosed in 112 patients (63%), 45 (40%) of whom underwent flap reconstruction procedures; squamous cell carcinoma (SCC) was diagnosed in 55 patients (31%), 25 (45%) of whom underwent flap reconstruction procedures; 5 patients (3%) were diagnosed with basosquamous carcinoma, 3 (60%) of whom underwent flap reconstruction, and metatypical carcinoma was found in 6 patients (3%), and 5 (80%) underwent flap reconstruction treatment. Recurrence occurred in 10 (18%) of the 55 SCC patients. Invasion depths in the patients with recurrence were between 7 and 30 mm. In 21 (46%) of the 45 patients without recurrence, invasion depths were between 4 and 30 mm, whereas the invasion depths in the other 24 patients (53.3%) were less than 4 mm. CONCLUSIONS: Metastatic lymph node involvement localized to the auricular, infra-auricular, and postauricular was present in the pathological specimens of all patients with lesions who had selective neck dissection I to IV included into their treatment. The depth of invasion of SCCs was found to be statistically significant in terms of recurrences.

Surgical Anatomy of the Infralabyrinthine Approach.

OBJECTIVE: The objective of this study is to demonstrate the surgical anatomy of the infralabyrinthine approach (ILA) and ways to prevent complications based on the complex anatomy. STUDY DESIGN: Cadaveric study. SETTING: Ankara University Faculty of Medicine, Department of Anatomy. SUBJECTS AND METHODS: Temporal bones were selected from 30 sides of 20 fixed human cadaver heads. Computed tomography (CT) scans of the heads were performed and, afterward, the cadavers were dissected using a surgical microscope and electric drill. RESULTS: An appropriate tract could be achieved in 73.3% of the dissections by applying slight pressure to the jugular bulb (JB). The narrowest portion of the ILA was defined as the inner window, which was located superior-inferiorly between the inferior border of the cochlea and the inferior wall of the petrous apex and anterior-posteriorly between the posterior wall of the carotid canal and the cochlear opening of the cochlear aqueduct. The ILA could not be performed when the distances between the facial nerve-JB and JB-cochlea were less than 2.9 mm and 2.6 mm, respectively, on CT scan. CONCLUSION: Close attention should be paid to the access and inner window during preoperative temporal bone imaging to assess for ILA. The detailed anatomy of the route, measurements of the topography of the cochlea from the mastoid view, and angles of the route are defined to prevent complications.

Comparison of early oncological results of diode laser surgery with radiotherapy for early glottic carcinoma.

OBJECTIVE: To evaluate the oncologic results of transoral endolaryngeal microscopic diode laser surgery (MDLS) and radiotherapy (RT) for T1 and T2 glottic carcinoma. STUDY DESIGN: Case series with planned chart review. SETTING: Ankara Oncology Education and Research Hospital. SUBJECTS AND METHODS: The study was conducted on a series of 140 cases of early glottic carcinoma (T1, T2) treated with MDLS or RT. The tumors were defined according to T stage and the involvement of the anterior commissure (AC). RESULTS: The 3-year locoregional control rate of MDLS and RT groups was 93.1% and 89.7%, respectively (P = .434). There was no difference in 3-year disease-free survival when comparing T1 and T2 tumors treated with MDLS and those treated with RT (P = .618 for T1, P = .084 for T2). There was no difference in disease-free survival when comparing AC- and AC+ tumors treated with MDLS and those treated with RT (P = .291 for AC- and P = .530 for AC+ tumors). CONCLUSIONS: Microscopic diode laser surgery in early glottic cancer seems to be an oncologically safe procedure that has similar oncological results with RT. In T2 glottic tumors and AC involvement, the results with either treatment are less satisfactory.

Surgical anatomy of facial nerve for revision transmastoid surgery.

We analyze the relationships of the 3 segments of the facial nerve with respect to constant anatomic structures that can be identified during revision surgery via translabyrinthine approach. This study was conducted on 15 formalin-fixed cadavers whose facial nerves were dissected bilaterally under operative microscope via translabyrinthine approach. The distances between the round window niche and the midpoint of the tympanic segment and the beginning of the mastoid segment were 6.64 ± 1.79 mm and 3.99 ± 0.79 mm, respectively. The distances between the tympanic ostium of the eustachian tube and the first and the second genu were 7.02 ± 0.62 mm and 12.25 ± 1.24 mm, respectively. We used the superior semicircular canal, the tympanic ostium of the eustachian tube, and the round window niche as landmarks to identify the facial nerve during revision surgery. Our study also showed that the auricular branch may also be originated from the posterior surface of the facial nerve.

Giant ethmoid osteoma originated from the lamina papyracea.

INTRODUCTION: Osteomas are slow- growing, benign tumors. They are the most common neoplasms of the paranasal sinuses. They are usually originates from the frontal and ethmoid sinus and much less frequently seen in the maxillary and sphenoid sinuses. Although the lamina papyracea is a part of ethmoid bone, a giant osteoma originated from the lamina papyracea is very uncommon. An osteoma of the paranasal sinus is usually asymptomatic. Headache, proptosis, epiphora, diplopia, dizziness, facial deformity, face pain and cerebral complications are possible symptoms. The treatment of the paranasal osteomas are controversial. CASE REPORT: A 65 year old patient that applied with stuffiness and headache to our clinic. She has had a smooth mass in the right nasal cavity. Paranasal sinus tomography showed an osseous lesion, the size of 4x 3 cm, arising from the right lamina papyracea. The mass excised endoscopically and reported as osteoma histopathologically. There was no complication. After 9 months, there was no recurrence. CONCLUSION: Giant osteomas of paranasal sinuses, especially originated from the lamina papyracea are rare. They can be treated successfully by endoscopic approaches without any recurrence and complication despite its size.

Preliminary results of diode laser surgery for early glottic cancer.

OBJECTIVE: To analyze the complications and preliminary oncologic results of microscopic diode laser surgery. STUDY DESIGN: Prospective research. SETTING: Ankara Oncology Education and Research Hospital. SUBJECTS AND METHODS: This prospective study was conducted on a series of 64 patients with glottic carcinoma (Tis, T1, T2) treated with microscopic endolaryngeal diode laser surgery. RESULTS: Four patients had local recurrence (6.2%). Local control and larynx preservation rates were 93.8% and 100%, respectively, for all groups of patients. Two-year disease-free survival after primary surgery was 100% for the Tis group, 96.4% for the T1 group, and 89.7% for the T2 group. When considering anterior commissure involvement, 2-year disease-free survival after primary surgery was 100% for the AC0 group, 85.7% for the AC1 group, and 85.7% for the AC2 group. CONCLUSION: Our study of microscopic diode laser resection of Tis, T1, and T2 glottic tumors showed similar oncologic results to previous reports about CO2 laser surgery. In anterior commissure tumors, both techniques had high complication and recurrence rates.

Analysis of multicentricity in supraglottic laryngeal carcinoma treated with partial laryngeal surgery.

A clinicopathological analysis of multicentricity in patients treated with either supraglottic horizontal laryngectomy or supracricoid partial laryngectomy for supraglottic squamous cell carcinoma of the larynx was conducted. This study included 63 patients who underwent supracricoid partial laryngectomy or supraglottic horizontal laryngectomy for T2 or T3 supraglottic laryngeal squamous cell carcinoma. The patients were divided into two groups: Group 1 included patients with one focus of the tumor (monocentric), and Group 2 included patients who had more than one focus of the tumor (multicentric) diagnosed after pathology examination. Forty-eight (76.2 %) of the patients had one focus of the tumor (Group 1) and 15 (23.8 %) of the patients had more than one focus of the tumor (Group 2). The rates of lymph node metastasis in Group 1 and Group 2 were 12.5 and 60 %, respectively. The second focus was invasive in seven (46.6 %) of the patients, carcinoma in situ in six (40 %) of the patients, and both invasive and carcinoma in situ in two (13.3 %) patients. The overall 3- and 5-year survival rates of Groups 1 and 2 were 77.1-66.7 % and 56.2-46.7 %, respectively. With regard to survival rates, no statistically significant difference was observed between Group 1 and Group 2 (p = 0.576). The lack of statistical significance might have been associated with the low sample size. Although multicentric tumors of the supraglottic larynx have high incidence of nodal metastasis, no significant increase in the rate of recurrence was determined.

[The correlation of positron emission tomography-computed tomography assessment with histopathological results in the diagnosis of head and neck cancer of unknown primary]. / Primeri bilinmeyen bas boyun kanserleri tanisinda pozitron emisyon tomografi-bilgisayarli tomografi incelemesinin histopatolojik sonuçlar ile iliskisi.

OBJECTIVES: This study aims to evaluate the extent of the correlation between positron emission tomography-computed tomography (PET-CT) and histopathological and/or cytological evaluations in demonstrating malignancy and identifying the primary in patients with head and neck tumors of unknown primary. PATIENTS AND METHODS: The excision records and files of 32 patients (24 males and 8 females; mean age 54.2 years; range 24 to 75 years) with previous PET-CT evaluations performed due to a mass with an unknown origin and to identify the primary were retrospectively analyzed. Positron emission tomography-computed tomography results and neck dissection (ND) materials were compared and PET-CT's ability to provide localization of the primer was determined by standardizing the study data. RESULTS: In respect of determining primary localization, PET-CT's sensitivity was determined as 66.6%, its specificity as 33.3%, its positive predictive value as 80%, and its negative predictive value as 20%. When the neck dissection specimens were considered according to the different regions they were obtained from: PET-CT's specificity was determined as 63.6%, its sensitivity as 94.5%, its positive predictive value as 87.5%, and its negative predictive value as 58.1%. CONCLUSION: Positron emission tomography-computed tomography sensitivity in determine the regions with pathologic lymph node involvement according to the BD specimen results and positive predictive value in identifying primary localization was found to be in accordance with the literature. Based on these results, PET-CT is a valuable method for early diagnosis and treatment in difficult cases.

A comparison of unilevel and multilevel surgery in obstructive sleep apnea syndrome.

We conducted a retrospective study of 35 adults who had undergone tongue base suspension in addition to other surgery for the treatment of obstructive sleep apnea syndrome (OSAS). Our goal was to determine the most effective surgical approach by comparing these patients' preoperative apnea-hypopnea index (AHI) with their postoperative scores at 6 months. The 35 patients were divided into three groups based on a preoperative assessment of their level of airway obstruction; the assessment included a determination of AHI and endoscopic findings during the MÜller maneuver. Patients in group 1 (n = 9) exhibited unilevel obstruction, and they were treated with lateral pharyngoplasty; patients in group 2 (n = 13) also had unilevel obstruction, and they underwent Z-palatoplasty; patients in group 3 (n = 13) had multilevel obstruction, and they underwent combined surgery. Postoperatively, all three groups exhibited statistically significant improvements in AHI, but we determined that of the three approaches, multilevel surgery was significantly more effective (p < 0.001).

The effects of tumor size, degree of differentiation, and depth of invasion on the risk of neck node metastasis in squamous cell carcinoma of the oral cavity.

Cervical lymph node metastasis is the most important prognostic factor in patients with head and neck carcinoma. We retrospectively analyzed the effects of three different variables-tumor size, degree of differentiation, and depth of invasion-on the risk of neck node metastasis in 50 adults who had been treated with surgery for primary squamous cell carcinoma of the oral cavity. Primary tumor depth and other pathologic features were determined by reviewing the pathology specimens. Preoperatively, 36 of the 50 patients were clinically N0; however, occult lymph node metastasis was found in 13 of these patients (36.1%). The prevalence of neck node metastasis in patients with T1/T2 and T3/T4 category tumors was 51.5 and 58.8%, respectively. The associations between the prevalence of neck node metastasis and both the degree of differentiation and the depth of invasion were statistically significant, but there was no significant association between neck node metastasis and tumor size. We conclude that the prevalence of neck lymph node metastasis in patients with squamous cell carcinoma of the oral cavity increases as the tumor depth increases and as the degree of tumor differentiation decreases from well to poor, as has been shown in previous studies. It is interesting that tumor size, which is the most important component of the TNM system, was not significantly associated with neck node involvement.

Anatomic basis of percutaneous Kirschner wire insertion in zygoma fractures.

The combination of Gillies elevation with 1-point percutaneous Kirschner wire fixation of isolated simple zygoma fractures was found to be effective in restoring preinjury appearance and function and avoiding soft tissue morbidity. The proximity of the infraorbital nerve, inferior orbital rim, and dental roots warrants care in the placement of the wire. The need for precise anatomic guidelines becomes apparent when considering these relationships. Eighteen adult skulls (36 sides) were examined, and specific points were determined that could be important while inserting Kirschner wire for zygoma fractures, and the distances between those points were measured with a digital caliper. Then, by using these points, the wire was inserted into the zygoma through the medial wall of the maxillary sinus, and the insertion point of the wire on the lateral wall of the maxilla and the angle of the wire were determined. The mean lengths of the wires of the right and left sides of each skull were counted, and for 18 skulls, the mean length of the wire was measured as 45.12 mm. Direction of the insertion during drilling zygoma, conversely to the location of the insertion, nearly determines the course of the wire and the point of insertion on the lateral wall of the maxilla. Obtaining precise information concerning the installation angle and length of the wire before surgery should contribute to safer and smoother surgical procedures.