Long-term clinical results of radiofrequency tissue volume reduction for inferior turbinate hypertrophy.

OBJECTIVE: To investigate the long-term clinical results of radiofrequency tissue volume reduction for symptomatic inferior turbinate hypertrophy. STUDY DESIGN: Patients who were unresponsive to medical treatment (n = 197) received turbinate reduction using radiofrequency energy. Subjective symptoms were assessed using a 10 cm visual analogue scale, and all patients underwent acoustic rhinometry before the procedure and six, 24, 48 and 60 months afterwards. RESULTS: Of the 197 treated patients, 148 completed the protocol. No significant peri-operative complications were observed. Thirty-two patients required follow-up treatment. Significant improvements were seen in nasal obstruction and discharge scores and in acoustic rhinometry values, at six, 24, 48 and 60 months post-operatively, compared with pre-operative values (p < 0.001 and p < 0.05, respectively). CONCLUSION: Radiofrequency tissue volume reduction is an effective procedure for inferior turbinate hypertrophy. The clinical benefit of this procedure persisted 60 months after the procedure.

Is routine bilateral neck dissection absolutely necessary in the management of N0 neck in patients with supraglottic carcinoma?

The supraglottic larynx has a rich lymphatic network that places patients with supraglottic laryngeal carcinomas at high risk for early dissemination of the disease into the cervical lymphatics. Therefore, elective neck treatment of clinically N0 neck in patients with supraglottic carcinomas is widely accepted as a standard approach. However, the issue whether elective neck treatment should routinely be directed on both sides of the neck is still controversial. The present study is aimed at determining whether T2-T4 stage supraglottic carcinomas require bilateral neck dissection in the management of N0 necks. We designed a prospective study on 72 patients with N0 supraglottic laryngeal carcinoma. Patients were divided into three groups according to the site and extension of the primary tumors. Group I consisted of 21 patients with lateralized (clear lateral) lesion reaching but not crossing the midline. Group II comprised 25 patients with cancer largely involving one side and crossing to the midline. Group III included 26 patients with carcinoma equally involving both sides of the larynx or growth into the midline larynx. All patients underwent bilateral lateral neck dissection in conjunction with various types of laryngectomies selected to the status of the primary. Of the 72 patients, 16 were found to have occult regional metastases in pathologic examination (9 pN1, 4 pN2b, 3 pN2c). The prevalence of occult metastases proportionally increased with T stage from 8.3 to 22.7 and 31.2%, respectively, for T2, T3 and T4. Bilateral neck metastases were found in 2 of 26 patients (7.7%) with central lesions. There was only one patient (4%) with both ipsilateral and contralateral lymph node metastasis in group II. None of the 21 patients with lateral lesion (group I) had contralateral neck metastasis. Routine bilateral elective neck dissection may not be a part of the surgical procedure in all supraglottic laryngeal carcinoma patients. Bilateral neck dissection should be preferred for cases with central tumors and lateral tumors with positive nodes in the ipsilateral side of the neck.

Functional surgical approach to the level I for staging early carcinoma of the lower lip.

OBJECTIVE: The management of the neck in patients with T1-T2 carcinoma of the lower lip (LLC) remains controversial. Suprahyoid neck dissection seems a reliable diagnostic approach, although it sacrifices the submandibular gland and its vascularity. STUDY DESIGN AND SETTING: This study was a prospective, randomized study. Patients with previously untreated T1 or T2 primary LLC underwent either classical suprahyoid neck dissection (CSHD) or functional suprahyoid neck dissection (FSHD) in continuity with the resection of the cancer of the lip. RESULTS: A total of 48 suprahyoid neck dissections were performed in 36 patients. Among these dissections, 27 were CSHD and 21 were FSHD. The average number of dissected lymph nodes was similar for both classical and functional type operations. The overall follow-up period was 40.5 months. CONCLUSIONS: The end result of this series supports the idea that FSHD is a reliable diagnostic method for the management of level I lymph nodes in LLC. FSHD can avoid undertreatment or overtreatment of the patients with early LLC while preserving the submandibular gland.

Brown tumor of the maxilla associated with primary hyperparathyroidism.

Brown tumors represent the terminal stage of the remodeling processes during primary or secondary hyperparathyroidism. During the last three decades primary hyperparathyroidism has been recognized much more commonly and the increase has generally been attributed to the routine determination of calcium by new automated methods and the advent of new and more objective parathyroid hormone radioimmunoassay techniques. Early diagnosis and successful treatment of the disease have made clinical evidence of bone disease uncommon. While, the mandible is the most frequently involved bone in the head and neck region, maxillary involvement is extremely rare. A case of brown tumor on the maxilla associated with primary hyperparathyroidism is reported. This patient presented multiple skeletal lesions, which are uncommonly seen nowadays. The diagnosis was suggested by the clinical history and confirmed by biochemical, radiological and histopathological determinations. Excision of a parathyroid adenoma normalized the metabolic status. Excision of the maxillary mass led both histopathological confirmation of the disease and early masticator rehabilitation.

Inflammatory myofibroblastic tumor of the nasal cavity: a case report and review of the literature.

Our aim is to describe clinicopathological, histochemical, and immunohistochemical findings of one case of inflammatory myofibroblastic tumor of the nasal cavity. A 10-year-old female presented with a short history of nasal obstruction, epistaxis, nasal discharge and headache. Computerized tomography (CT) scans showed a space-occupying lesion in the right nasal cavity. Histological examination of initial biopsy showed fascicles of spindle cells in a mixed inflammatory background with a predominance of plasma cells, typical of inflammatory pseudotumor. The spindle cells were positive for vimentin and actin. The mass was completely excised without any difficulty under generalized anesthesia. Inflammatory myofibroblastic tumor of the nasal cavity is a localized and completely benign lesion. Simple complete excision is curative.

Oxidant and antioxidant status in larynx squamous cell carcinomas.

In this study we reviewed 20 patients with laryngeal squamous cell carcinoma to evaluate the oxidant and antioxidant status on tissue level. Superoxide Dismutase (SOD) and Catalase levels, two important antioxidant enzymes, and Malondialdehyde (MDA) levels, a valuable index of lipid peroxidation, were compared in cancerous and normal tissues of the patients. In cancerous tissue SOD activities were significantly lower than in the normal tissue, while there was no significant difference in MDA levels and Catalase activities. It was also observed that SOD activities significantly decreased as the histopathologic malignancy grades increased in cancerous tissue. These changes in oxidant and antioxidant status in carcinomatous tissue of the larynx are considered to be of great interest.

Management of N0 neck in T1-T2 unilateral supraglottic cancer.

Early-stage supraglottic cancers (stage I and II) are treated with several different programs. Previously reported data have led us to design a therapeutic protocol in treatment of patients with early-stage squamous cell carcinoma of the supraglottic larynx. From 1991 to 1996, 39 patients with unilateral supraglottic carcinoma were treated according to this protocol. All patients underwent unilateral functional neck dissection and resection of the primary carcinoma in an en bloc fashion. Histopathologic studies showed that 9 (23%) of them had positive nodes, and they received planned adjuvant radiotherapy. None of the 30 patients with histopathologically NO necks received either adjuvant irradiation or contralateral neck dissection. The mean follow-up period was 34 months. All patients are alive, and none have developed any recurrence in either dissected or undissected sides of the neck. This treatment policy seems satisfactory and will avoid unnecessary therapeutic interventions. Routine bilateral neck dissection may not be necessary in the surgical treatment of all supraglottic laryngeal cancers.

Total lymphocyte and T lymphocyte subpopulation levels in head and neck squamous cell carcinomas.

This study was performed on 72 patients with head and neck squamous cell carcinoma. Total lymphocyte, natural killer cell and total lymphocyte subpopulation levels in peripheral blood were determined and the correlation of these levels with TNM and Histopathologic Malignancy Grading (HMG) systems were investigated. TNM and HMG systems, which are two important prognostic indicators, were significantly correlated whereas total lymphocyte, natural killer cell and total lymphocyte subpopulation levels in peripheral blood had no correlation with TNM and HMG scores.

Value of thallium-201 scintigraphy for primary tumour detection in patients with malignant neck masses.

The aim of this study was to assess the contribution of thallium-201 scintigraphy to primary tumour detection in patients with malignant neck masses and to evaluate its sensitivity and specificity. A total of 30 patients with histopathologically proven malignant tumours were included in the study. The sensitivity, specificity and accuracy of 201Tl scintigraphy were found to be 54%, 75% and 57% respectively. These results suggest that 201Tl scintigraphy has a limited value in the detection of the primary tumour in patients with malignant masses of the neck.

Functional neck dissection: cure and functional results.

In this study, the cure and functional results of 133 functional neck dissections performed between 1992-1997 in Erciyes University Medical Faculty were evaluated. The overall recurrence rate was three per cent. This rate was 1.4 per cent for elective functional neck dissections and five per cent for curative functional neck dissections. Electromyographic studies showed that there was severe neurogenic deficit in the trapezius muscle of seven patients (12.5 per cent), and in the sternocleidomastoid muscle of 12 patients (21.4 per cent) among 56 randomly selected patients. In all cases, the flow rate and diameter of the internal jugular vein was found to be normal by Doppler ultrasonography. The results of this study showed that functional neck dissection is a reliable technique for obtaining a high cure rate and functional results.

201Tl imaging for differentiating between malignant and benign neck masses.

The aim of this study was to assess the ability of 201Tl scintigraphy to differentiate between malignant and benign neck masses. Fifty-eight patients with neck masses, whose diagnoses were confirmed by histological examination, were examined. The sensitivity, specificity and accuracy of 201Tl scintigraphy were 80%, 96% and 88% respectively; when salivary gland masses were excluded, these values were 87%, 95% and 91% respectively. Our results suggest that 201Tl scintigraphy is highly reliable in determining the malignancy of neck masses, especially when salivary gland masses are excluded.

Comparison of topical silver nitrate and flunisolide treatment in patients with idiopathic non-allergic rhinitis.

In this study, 90 patients with idiopathic non-allergic rhinitis were divided into three groups. Silver nitrate was given to Group I, flunisolide to Group II, and placebo to Group III. Healing results according to symptoms, physical findings, nasal smear findings and biopsy findings were compared. Improvement ws noticed in symptoms (rhinorrhea 93%, sneezing 89%, nasal congestion 80%), physical findings (color of mucosa 89%, concha hypertrophy 87%, rhinorrhea 82%), nasal smear findings (94%) and biopsy findings (epithelium 76%, basal membrane 80%, edema 84%, eosinophilia 95%, inflammation 87%) in Group I. Recurrence was observed in symptoms and physical findings of 30% of the patients in Group I during the 6 months-follow-up period. In Group II, improvement was noticed in symptoms (rhinorrhea 73%, sneezing 70%, nasal congestion 61%), physical findings (color of mucosa 72%, concha hypertrophy 69%, rhinorrhea 62%), nasal smear findings (87%) and biopsy findings (epithelium 67%, basal membrane 63%, edema 70%, eosinophilia 77%, inflammation 70%). But symptoms recurred in all patients in approximately 1-3 months after competition of treatment. There was a statistically significant difference between silver treatment and flunisolide or placebo treatment.