Histopathological examination of the effects of radiofrequency treatment on mucosa in patients with inferior nasal concha hypertrophy.

Radiofrequency reduction has become one of the most popular methods in the treatment of inferior nasal concha hypertrophy. During surgical treatment of inferior nasal concha hypertrophy, it is important to cause minimal injury to the overlying ciliated epithelium, since if the ciliated structure of this epithelium is permanently disrupted, it is hard to carry out one of the important functions of lining of the nasal cavity, mucociliary clearance. In this study, the ultrastructure of inferior nasal concha epithelium was examined by transmission and scanning electron microscopy in 40 patients with inferior nasal concha hypertrophy. The biopsy specimens were taken before the radiofrequency treatment and 8 weeks after the radiofrequency treatment. Then, the effects of radiofrequency treatment on concha epithelium and morphology of ciliae were examined ultrastructurally. In the scanning and transmission electron microscopic examination of the tissue samples taken before radiofrequency treatment, no ultrastructural pathology was observed in the number and morphology of the ciliae and the inferior nasal concha epithelium. The biopsy specimens obtained 8 weeks after radiofrequency treatment also did not show any ultrastructural pathology in these parameters. However, in the transmission electron microscopic examination of the subepithelial tissue, fibrosis was observed in local areas in the biopsy specimens obtained 8 weeks after radiofrequency treatment. In conclusion, the results obtained from this study suggest that ciliated epithelium of the inferior nasal concha is not destroyed by radiofrequency reduction.

Which type of osteotomy for edema and ecchymosis: external or internal?

BACKGROUND: Osteotomy is one of the major parts of a rhinoplasty operation. Edema and ecchymosis most commonly appear as a result of this surgical manipulation. Different authors use different techniques to perform osteotomy. The external perforating approach and the internal continuous technique are the 2 main ways of doing osteotomy in rhinoplasty. In our study, we tried to compare the effects of these 2 techniques regarding edema and ecchymosis. MATERIAL AND METHODS: Two groups that consisted of 20 patients were studied. In group A, osteotomy was performed through an external route in a perforating fashion. In group B, the osteotomy was performed through an internal route and in a continuous fashion. The patients in each group were scored according to a visual scoring system that describes the site and extension of ecchymosis and degree of edema on the second and seventh days after the surgery. The scoring was made by 2 examiners blinded to the type of surgery. RESULTS: Edema scores were almost the same between the 2 groups on the second and seventh days after the surgery. Ecchymosis scores were the same between the groups on the seventh day. However, the score for ecchymosis on the second day is significantly less in the internal continuous technique (P < 0.05) when it is compared with the external technique. CONCLUSION: External and internal techniques of osteotomy almost give the same results regarding edema and ecchymosis, but the internal continuous technique shows a tendency to produce less ecchymosis on the second postoperative day.

c-met overexpression in supraglottic laryngeal squamous cell carcinoma and its relation to lymph node metastases.

BACKGROUND: The c-met oncogene encodes the receptor for the hepatocyte growth factor/scatter factor (HGF/SF), which is known to have the effects of stimulation of cell motility, dissociation of epithelial sheets, invasion of cellular matrix, and induction of angiogenesis. Many studies in solid tumors have indicated a role for c-met and HGF/SF in the progression of the disease. METHODS: The expression of c-met in tissue specimens was studied by immunohistochemical examination in 60 patients with supraglottic laryngeal squamous cell carcinoma. Patients were chosen such that there were 30 with lymph node metastases in the neck and 30 without metastases. TNM staging, differentiation, lymphovascular and perineural invasion, and growth pattern for tumors were also recorded, and their relation to lymph node metastases was analyzed. RESULTS: Overexpression of c-met was observed in 90% of the cases at the primary site and in 83% of the cases with lymph node metastases in the neck. Lymphovascular invasion (P = 0.005) and the N stage (P = 0.001) were found to be related to lymph node metastases, but other variables-c-met overexpression, the T stage, perineural invasion, and growth pattern-were found to have no relation to lymph node metastases in multivariate analysis of the data with linear regression. CONCLUSIONS: c-met overexpression is observed in both the primary site and the neck in supraglottic laryngeal squamous cell carcinoma. We believe that it may have a role in the progression of malignancy, but we were unable to find a definite relation between c-met expression and lymph node metastases.

Endoscopic surgery in treatment of juvenile nasopharyngeal angiofibroma.

OBJECTIVES: Juvenile nasopharyngeal angiofibroma (JNA) is a highly vascular and locally invasive tumor with a high incidence of persistence and recurrence. The classical treatment of this tumor is surgery and/or radiotherapy. Use of endoscopic techniques seems to be on the rise in treatment of these lesions. We tried to explore the roles and limits of endoscopic surgery alone or with classical surgical techniques in treatment of these tumors. METHODS: Retrospective case review was conducted at a tertiary referral center. Twelve patients were treated for nasopharyngeal angiofibroma using endoscopic approach between 1998-2002. The staging, average blood loss during surgery, residual, and/or recurrent tumor were evaluated. RESULTS: Eight of these patients (8/12) were up to stage IIC according to Radkowski staging. This group of patients has an average blood loss of 1000 ml and were followed for at least 6 months. We did not encounter any residual or recurrent tumor in this group. Four patients (4/12) had minimal intracranial extension, were staged IIIA, and had an average blood loss of 1500 ml during surgery. Two of these patients had minimal residual tumor around the cavernous sinus, but showed no progression of disease over a follow-up of 2 years with MRI. Two patients had no residual or recurrent tumor over a follow-up of 6 months. CONCLUSION: This data suggests that endoscopic surgery can be used in the treatment of JNA even with minimal intracranial extension with minimal morbidity and low recurrence rate.