Nasal obstruction: comparison of radiofrequency with lateral displacement of the inferior turbinate and radiofrequency alone.

OBJECTIVE: To compare the outcomes of the nasal obstruction, the main symptom of the patients who underwent radiofrequency and lateral displacement of the inferior turbinate and patients who were treated with radiofrequency alone. METHODS: The prospective randomised study was conducted at the Department of Otorhinolaryngology and Head-Neck Surgery, Balikesir University Medical School, Balikesir, Turkey, between July and December 2012. It included 60 patients, diagnosed with allergic or non-allergic chronic rhinitis with inferior turbinate hypertrophy which was refractory to medical therapy. Half of the patients were treated with radiofrequency, and the rest with radiofrequency and lateral displacement. The main symptom of the patients was nasal obstruction. The frequency and degree of nasal obstruction were evaluated by patients' self-assessments using the standard 10-cm visual analogue scale. The evaluations were performed first pre-operatively and on the 1st, 3rd, 5th and 7th days postoperatively as well as at the end of the 4th week. SPSS 18 was used for statistical analysis. RESULTS: Nasal obstruction frequency and severity scores in patients treated with both radiofrequency and lateral displacement on post-operative days 3, 5 and 7 were found to be significantly lower (p<0.001) compared to the patients treated with only radiofrequency. CONCLUSIONS: The study demonstrated that radiofrequency and lateral displacement together is an effective method to prevent inferior turbinate oedema in the early post-operative period.

Long-term anatomic and functional results of cartilage tympanoplasty in atelectatic ears.

The purpose of this study was to analyze the anatomic and functional results of cartilage tympanoplasty performed on atelectatic ears using the palisade technique and to assess the long-term efficacy of cartilage palisades in preventing recurrent retractions. The records of 54 patients (56 ears) who underwent surgery for atelectasis with or without mastoidectomy from January 2000 to August 2005 were retrospectively evaluated. A successful outcome was defined as complete and intact healing of the graft without perforation, retraction, or lateralization for at least 36 months after the operation, in addition to improvement of hearing indicated by a pure-tone average air-bone gap (PTA-ABG) of less than 20 dB. The mean follow-up period was 44.5 +/- 8.0 months (range, 36-68 months). Closure of the tympanic membrane was achieved in 91% of ears. Otomicroscopic evaluation revealed nine (16%) mild and five (8%) moderate retractions, but none of the retractions was deep enough to necessitate tube placement. Postoperative PTA-ABG was less than 20 dB in 71% of ears. The average preoperative and postoperative ABG values, including all types of tympanoplasty operations (Type I, II and III), were 28.4 +/- 5.8 and 16.9 +/- 6.7 dB, respectively (p < 0.001). No significant difference in the change in PTA-ABG was found between the groups with or without mastoidectomy (p > 0.05). Palisade cartilage tympanoplasty is an effective technique for tympanic membrane closure and hearing improvement in atelectatic ears. Mastoidectomy does not change the anatomic or audiologic findings in these types of ears. We recommend this technique to other otologic surgeons.

Incidence of fallopian canal dehiscence at surgery for chronic otitis media.

The objectives of this study were to determine the incidence and locations of dehiscence of the fallopian canal (FC) in patients undergoing surgery for different middle ear pathologies and to describe the findings that will aid in pre-operative prediction of dehiscence. Charts and operative details of the 118 ears managed with canal wall-down and 147 ears managed with canal wall-up tympanomastoidectomy performed by a single surgeon were retrospectively reviewed. The distribution of the diagnoses for ears that were operated was as follows: 118 ears cholesteatoma, 42 ears adhesive otitis, 23 ears tympanosclerosis, and 82 ears chronic otitis media. The presence and the location of facial nerve dehiscence after exenteration of the disease as well as the presence of any coexisting inner ear fistula and dural defect were noted. FC dehiscence was observed in 56 of the cases. The incidence of dehiscence was highest among ears with cholesteatoma (n = 44, P < 0.05). Adults and also male patients in the study had significantly higher incidence of dehiscence compared to pediatric (P < 0.05) and female (P < 0.01) patients. The most common location for dehiscence was the tympanic segment which was significantly higher than the other locations (P < 0.01). Among the ears with FC dehiscence, labyrinthine fistula presence was seen in ten ears which was also significant (P < 0.001). Patients with dural exposure were 12.06 times more likely to have FC dehiscence than those without dural exposure. The incidence of FC dehiscence was 1.26 times higher in revision operations, but the difference was not significant (P > 0.05). An otologic surgeon should be more careful while performing operation for cholesteatoma in an adult and male patient because of the high incidence of dehiscence observed in these ears. Presence of lateral semicircular canal fistula and erosion of the bony tegmen should also be considered as a clue for the presence of dehiscence before surgery. Operation of these ears should be performed by experienced surgeons in otology.

Investigation of the synergism between alcohol consumption and herpes simplex virus in patients with laryngeal squamous cell cancers.

We investigated the synergism between alcohol consumption and herpes simplex virus (HSV) in the development of laryngeal squamous cell cancer and in the clinical course of this disease. HSV DNA was searched by polymerase chain reaction (PCR) technique in the fresh tumor tissues of 22 patients with laryngeal cancer without alcohol consumption (Group 1) and of 23 patients with chronic alcohol consumption (Group 2), and their HSV prevalences were compared. No statistically significant difference was detected between the two groups in terms of HSV incidence frequency (P > 0.05), but the risk of finding HSV in tumor tissue in patients with alcohol consumption history was 3.4-fold higher than in those without alcohol consumption history (OR = 3.378, 95% CI = 0.762-14.982). There were no statistically significant differences in terms of lymph node metastasis, tumor localization, tumor diameter, tumor stage and tumor differentiation between the patients in Group 1 and Group 2 (P > 0.05). Larger case series will further elucidate the role of HSV in the development of laryngeal cancer, the nature of its interactions with other carcinogens and its effect on the clinical course.

[Surgical management of lower lip cancers]. / Alt dudak kanserlerine cerrahi yaklasim.

OBJECTIVES: We evaluated the results of surgical treatment of lower lip cancers. PATIENTS AND METHODS: The study included 47 patients (7 females, 40 males; mean age 53 years; range 34 to 71 years) who underwent surgery for primary lower lip carcinoma. Five patients received postoperative adjuvant radiotherapy. Data were reviewed on clinical features, risk factors, localization of the lesion, regional lymph node status, tumor staging, results of surgical treatment and pathological examination, locoregional recurrence, and prognosis. The mean follow-up period was 60.1 months (range 6 to 110 months). RESULTS: Histopathologic diagnosis was squamous cell carcinoma in all cases. Tumor differentiation was good in 39 patients (83%), moderate in seven patients (15%), and poor in one patient (2%). Stage 1 tumor was seen in 29 patients (61%). T and N staging were as follows: 31 T1, 14 T2, 2 T3; 40 N0, 6 N1, and 1 N2. Histopathologically, three N0 patients (7%), four N1 patients (66%) had lymph node metastasis, and one N2 patient had extracapsular invasion. Three patients (6%) had perineural invasion. Local recurrence developed in one stage 1 patient (9%) and in one stage 2 patient (16%). Neck recurrence was seen in three patients (6%). One stage 4 patient developed distant metastasis two years after the diagnosis. Mortality occurred due to lip cancer in five patients (10%), and to other causes in seven patients (15%). Of 35 patients who survived, 34 (72%) were disease-free. CONCLUSION: Due to its advantages, surgery should be the treatment of choice for cancers of the lower lip of any stage.

[Transpalatal approach in juvenile nasopharyngeal angiofibroma]. / Juvenil nazofarenks anjiyofibromunda transpalatal yaklasim.

OBJECTIVES: Juvenile nasopharyngeal angiofibroma (JNA) cases treated with transpalatal approach were evaluated with respect to localization, complications, intraoperative blood loss, recurrence, and prognosis. PATIENTS AND METHODS: The study included 15 male patients (mean age 13 years; range 10 to 16 years) treated for JNA. The patients were classified according to the Chandler staging system. Transpalatal surgical excision was performed in 14 patients. Preoperative embolization of the maxillary arteries was performed in three patients. One patient with intracranial extension was treated with radiotherapy. The mean follow-up was 3 years and 7 months (range 7 months to 7 years). RESULTS: Three patients (20%) had Chandler stage II, 11 patients (73%) had stage III, and one patient (7%) had stage IV disease. The mean intraoperative blood loss was 575 ml in three patients with preoperative embolization, and 1,079 ml in those without embolization. The average intraoperative transfusion requirement was 2.3 units. Recurrences developed in three patients (20%), two of whom were treated by surgery and one by radiotherapy. CONCLUSION: Transpalatal surgical approach is effective in the treatment of JNAs localized in the nasopharynx, nasal cavity, and sphenoid sinuses, with minimal mortality and morbidity.

The incidence of atopy in adults with recurrent secretory otitis media: screening with Phadiatop.

OBJECTIVES: This is a preliminary report of a relatively new method, Phadiatop, in screening atopic adult patients with recurrent secretory otitis media (SOM). The sensitivity and specificity, and its use in atopic adult patients with recurrent SOM were evaluated. PATIENTS AND METHODS: Eighty-four patients (54 females, 30 males; mean age 36.7; range 19 to 62 years) who were diagnosed as recurrent SOM were included in the study. The patients were evaluated with respect to history, laboratory tests, skin-prick test, and total IgE. Patients with at least one positive skin-prick test result and/or a high total IgE level with a positive history were considered to be in atopic status. RESULTS: According to certain criteria, atopy was detected in 31 of 84 patients. Negative Phadiatop values were found in all non-atopic patients as well as in one atopic patient. Among 31 patients having atopy, 30 patients showed positive Phadiatop values (specificity 1.00, sensitivity 0.97, positive predictive value 1.00, negative predictive value 0.98). CONCLUSION: These results indicate that Phadiatop is an effective test to detect atopy in patients with recurrent SOM.

Computed tomography virtual laryngoscopy: comparison between radiological and otolaryngological evaluations for laryngeal carcinoma.

OBJECTIVES: We evaluated the utility of computed tomography virtual laryngoscopy (CTVL) in identifying endolaryngeal lesions in laryngeal tumors. PATIENTS AND METHODS: Virtual laryngoscopic images were obtained from axial CT scans of 21 patients with known laryngeal carcinoma. Findings from rigid telescopic videolaryngoscopy (RTV) and CTVL images were evaluated and compared with reference to operative records. RESULTS: Lesions localized in the base of the tongue, pyriform sinus, aryepiglottic folds, and arytenoids were well visualized by both RTV and CTVL. The two techniques were not found effective in identifying lesions of the ventricular bands, ventricular cavities, and the anterior commissure. Virtual laryngoscopy was superior to RTV in the visualization of the subglottic area and vocal cords. CONCLUSION: Virtual laryngoscopy is a noninvasive and reliable technique that provides visualization of endolaryngeal surfaces and tumor extension. It may be beneficial in staging larynx carcinoma and planning the most appropriate surgical procedure.

Peritonsillar abscess: a comparison of outpatient i.m. clindamycin and inpatient i.v. ampicillin/sulbactam following needle aspiration.

In an attempt to assess the effect of antibiotic choice on the treatment of peritonsillar abscess, we compared the clinical efficacy of empiric intramuscular clindamycin and intravenous ampicillin/sulbactam (following needle aspiration of the abscess) in a prospective, randomized study of 58 patients. Patients in the clindamycin group were treated on an outpatient basis, whereas those in the ampicillin/sulbactam group were hospitalized for the duration of their treatment (minimum: 7 days). Comparison of clinical outcomes with respect to the posttherapeutic duration of fever and throat pain and the time to resumption of eating revealed no statistically significant difference between the two groups. These results suggest that intramuscular clindamycin is an excellent choice and can be safely prescribed on an outpatient basis following needle aspiration, thereby reducing both antibiotic and hospital costs.

[Three cases of mucosal malignant melanoma of the nose and paranasal sinuses]. / Uç olguda burun ve paranazal sinüs mukozal malign melanomlari

We evaluated the clinical course and treatment of three patients who were found to have mucosal malignant melanoma of the nose and paranasal sinuses. The presenting complaint was recurrent epistaxis in all the patients. One patient had been followed-up for nasal polyposis for a long time. In older patients with recurrent epistaxis, endoscopic examination of the nasal cavity and obtaining a biopsy from suspected regions are essential for early diagnosis of mucosal malignant melanomas.

A Unique Case of Intranasal Metastasis from Occult Poorly Differentiated Thyroid Carcinoma.

BACKGROUND: Poorly differentiated thyroid carcinomas (PDTCs) lie, both morphologically and behaviorally, between well-differentiated and undifferentiated carcinomas. Metastasis of poorly differentiated thyroid carcinoma to the intranasal cavity has not been reported previously in the literature. CASE REPORT: A 48-year-old male patient presented with massive epistaxis and nasal obstruction. On nasal examination, a bleeding, vascular mass was seen filling the left nasal cavity. The histopathological report of the nasal mass was well-differentiated thyroid carcinoma metastasis. Whole body scintigraphy, ultrasonography and positron emission tomography were done to rule out other possible metastases in the body and determine the origin of the tumor, which was identified as the left lobe of the thyroid gland, and there were multiple metastases involving the lung, sacroiliac area, and left humerus. Histopathological examination of a thyroidectomy specimen revealed PDTC consisting of insular, follicular, and papillary components. Postoperatively, the patient received radioactive iodine ablation therapy (iodine-131) and a course of external beam radiation therapy to the sacroiliac area and other metastatic regions. No recurrences were observed in a follow-up period of 5 years after surgery. CONCLUSION: The metastasis of differentiated thyroid carcinoma as a component of PDTC to the intranasal cavity has not been reported before. It is interesting that the well-differentiated component of the tumor was metastasized in our patient. Due to the aggressiveness of PDTC and the poor survival rates in patients who undergo surgery alone, a multidisciplinary treatment approach is required.

Prophylactic effect of pentoxifylline on radiotherapy complications: a clinical study.

OBJECTIVE: The purpose of this study was to assess the prophylactic effect of pentoxifylline (Ptx) on complications related to radiation. STUDY DESIGN AND SETTING: Seventy-eight patients who had postoperative radiotherapy for squamous cell carcinoma of the head and neck were enrolled into a prospective study. Patients were randomly assigned to the Ptx group (40 patients) and the control group (38 patients). Ptx was given to the patients at a dose of 400 mg 3 times a day orally to a total of 1200 mg. We noted radiotherapy complications in each group. RESULTS: Four patients were not able to tolerate this drug due to the development of gastrointestinal symptoms and dizziness. Late skin changes, fibrosis, and soft tissue necrosis were more severely in the control group than in the Ptx group (P < 0.05). We could find no positive effects on acute skin reactions and pain (P > 0.05). CONCLUSION: Our study suggests that Ptx has a prophylactic effect on the radiation complications. This can be explained by protective effect of Ptx against vascular pathology.

Hypervascular parapharyngeal schwannoma: an unusual case.

This report describes a 13-year-old girl who had a right pulsatile neck mass of the parapharyngeal space. We examined the patient with computerized tomography and angiography preoperatively and a heterogeneous, hypervascular mass was detected on her right neck. Intraoperative findings and the postoperative histopathologic diagnosis showed that this mass was a schwannoma that originates from cervical sympathetic chain and the superior thyroid artery supplied the mass. After careful scrutiny of English literature, this clinical manifestation is an unusual event.

Use of steroids in the treatment of peritonsillar abscess.

Peritonsillar abscess is the most common deep infection of the head and neck that occurs in adults; the treatment of the disease remains controversial. A prospective study using a single high dose steroid treatment for peritonsillar abscess, was undertaken in 62 patients to determine the treatment's effectiveness in relieving symptoms such as fever, throat pain, dysphagia and trismus. All patients were randomly assigned to two groups: 28 patients received intravenous antibiotic therapy and a single dose placebo and 34 patients were treated with single use of high dose steroid in addition to intravenous antibiotic. Patients were hospitalized after needle aspiration and therefore their clinical courses and responses to therapy could be rigorously assessed. Comparison of clinical outcomes with respect to hours hospitalized, throat pain, fever, trismus were assessed between the two groups. Clinical outcomes revealed a statistically significant difference between the two groups (p < 0.01), indicating that single use of high dose steroid prior to antibiotic therapy is more effective than the use of an antibiotic alone. These results suggest that single intravenous use of steroid in addition to antibiotic therapy is an excellent choice for the management of peritonsillar abscess.

Lymphatic malformation of the parapharyngeal space.

Lymphatic malformations are rare benign congenital lesions. A 28-month-old girl presented with a parapharyngeal lymphatic malformation. A cystic lesion had been diagnosed at 18 weeks' gestation by ultrasonography and she had been followed up conservatively until her referral to our department. We used a transcervical approach to excise the parapharyngeal lesion and 1 year later, there was no sign of recurrence.

[A case of auricular malignant melanoma]. / Auriküler malign melanoma.

We performed auricular excision, total parathyroidectomy, and extended radical neck dissection in a 36-year-old male patient who developed auricular malignant melanoma. Reconstruction of the surgical defect was made with a split-thickness skin graft. The patient received radiotherapy and chemotherapy after surgery. No evidence of local recurrences or distant metastasis was detected during a follow-up period of 14 months.

[Reconstruction of nasal cutaneous defects with the use of supratrochlear artery-based paramedian forehead flap]. / Nazal kutanöz defektlerin rekonstrüksiyonunda supratroklear arter bazli paramedyan alin flebi uygulamasi.

OBJECTIVES: We evaluated oncologic and functional results of paramedian forehead flap in the reconstruction of nasal cutaneous defects. PATIENTS AND METHODS: Supratrochlear artery-based paramedian forehead flap was employed in 14 patients (13 men, 1 woman; mean age 57 years; range 46 to 63 years) for the reconstruction of nasal cutaneous defects resulting from excision of squamous or basal cell carcinoma. No other treatment modalities were performed other than removal of the primary lesion. The mean follow-up was 42.4 months (range 8 to 83 months). RESULTS: None of the patients developed flap necrosis, local recurrences, or distant metastasis. Airway problems of varying extent were observed in 10 patients (71.4%), the severity of which became attenuated in time as the flap gained proper contraction. CONCLUSION: Acceptable functional and successful oncologic results can be obtained in the reconstruction with the use of paramedian forehead flap.

[Gastric pull-up in hypopharyngeal and cervical esophageal cancers]. / Hipofarenks ve servikal özofagus kanserlerinde gastrik pull-up.

OBJECTIVES: Gastric pull-up is a common technique in the reconstruction of gastrointestinal continuity following surgery for the primary esophageal and hypopharyngeal tumors with involvement of the esophagus. We evaluated the results of surgery in patients with cervical esophageal and hypopharyngeal cancers. PATIENTS AND METHODS: Eleven patients (4 women, 7 men; mean age 46 years; range 18 to 70 years) underwent surgery for hypopharyngeal and cervical esophageal epidermoid carcinoma. Surgery included pharyngolaryngoesophagectomy, subtotal thyroidectomy, and gastric pull-up in all patients. In addition, nine patients had radical neck dissection on the involved side and modified radical neck dissection on the contralateral side. One patient had bilateral radical neck dissection. Patients who were alive were followed-up for a mean period of 27 months (range 14 to 46 months). RESULTS: The one-, two-, and three-year survival rates were 54% (6/11), 36% (4/11) and 18% (2/11), respectively. Three patients died from early postoperative complications, two from organ failure due to locoregional recurrence (7th month) and to distant metastasis (11th month). CONCLUSION: Despite the small size of the study, the results favor the use of gastric pull-up in selected patients with cervical esophageal and hypopharyngeal cancers.

[Functional outcomes after supracricoid partial laryngectomy]. / Suprakrikoid parsiyel larenjektomi sonrasi fonksiyonel sonuçlar.

OBJECTIVES: We evaluated functional outcomes in patients undergoing supracricoid partial laryngectomy (SCPL). PATIENTS AND METHODS: The study included 20 male patients (mean age 61.5 years; range 43 to 76 years) who underwent SCPL for advanced laryngeal carcinoma. Correlations were sought between variables (age, medical history, reconstruction techniques such as cricohyoidopexy or cricohyoidoepiglottopexy, arytenoid resection) and decannulation time, duration for oral feeding, weight change, and complications. The mean follow-up was 20.9 months (range 7 to 39 months). RESULTS: All patients were decannulated in a mean of 19.9 days. Eighty-five percent of patients achieved normal deglutition without aspiration or weight loss within six months postoperatively. The nasogastric feeding tube was removed in a mean of 39.7 days. Voice quality of patients was sufficient for their social communications. CONCLUSION: Our functional results suggest that SCPL is an alternative technique to total laryngectomy in patients in whom other partial laryngectomy techniques are not considered.

Functional and aesthetic results obtained by modified Bernard reconstruction technique after tumour excision in lower lip cancers.

BACKGROUND: In this study, we investigated the functional and aesthetic results in new lip formation using modified Bernard reconstruction technique after tumour excision in lower lip cancers. MATERIAL AND METHODS: The study included 47 patients. All were operated due to lower labial squamous cell carcinoma and underwent defect reconstruction using modified Bernard technique. The patients were separated into two groups as: 50-70% and 70% total defect occurring after surgical excision. The functional and aesthetic assessments were done after at least 1 year had passed, and the results were compared statistically with a control group. RESULTS: Of the 18 patients with 50-70% defect, sensibility was normal in 16 (89%) and complete competence was determined in all (100%). In 17 patients (94%), complete and symmetric pouting and mouth-opening movements were ensured. Normal mouth opening was noted in all patients. Nasolabial asymmetry was detected in one patient (6%) and apparent mentolabial scar tissue was detected in two patients (11%). The new vermilion was of equal width to the upper lip vermilion in 15 patients (83%). Of the 29 patients with 70% total defect, sensibility was normal in 21 (72%) and complete competence was detected in 27 patients (93%). Sialorrhoea on fluid intake was detected in one patient (3.5%) and sialorrhoea at rest in one patient (3.5%). In 22 patients (76%), complete and symmetric pouting and mouth-opening movements were ensured. Normal mouth opening was noted in 27 (93%) of the 29 patients. Asymmetry in nasolabial fold was detected in one patient (3.5%), apparent scar tissue in nasolabial fold in one patient (3.5%) and commissure asymmetry in one patient (3.5%). In 25 patients (86%), the new vermilion was of equal width to the upper lip vermilion. No statistically significant difference was found (p>0.05) among the two patient groups and the control group in terms of functional and aesthetic results. CONCLUSION: Modified Bernard technique provides a good degree of lip mobility and sensation after excision of lower lip malignant tumour and produces acceptable results.