Mucociliary transport and histopathological changes in rotation flaps of the nasal mucosa.

Normal mucociliary transport in the mucoperichondrium of the nasal septum is from a distal (anterior) to proximal (posterior) direction. This study was to determine the direction of mucociliary transport and histopathological changes in nasal mucosal rotation flaps when their transport directions were anatomically reversed. Thirty-two rabbits were divided into four groups. Surgical septal rotational flaps were prepared in the experimental groups. Group I was the control group. The distal aspect of the flap was sutured through a large septal window to the other side of the nasal septum, thus changing the direction of the flap. Evaluation was performed 1 week, 1 month and 9 months later with each of these groups named as groups II, III, and IV, respectively. The rate and direction of the mucociliary transport was determined and histopathological investigations were performed from the flaps. The direction of mucociliary transport was observed to continue as distal to proximal direction in the rotated segments. The mucociliary transport rate was found to be decreased in group II, nearly normal in group III, and in normal limits in group IV after surgery. Intense inflammation and decreased number of cilia were present in group II. The inflammation was milder in group III and the epithelium was found to be nearly normal in group IV. The originally programmed direction of mucociliary transport in the nasal rotation flaps is maintained and is not altered or reprogrammed. Histopathological changes revert back to normal from an inflammatory state to reach pre-surgical status over time.

Cerebrospinal fluid otorrhea and recurrent bacterial meningitis in a pediatric case with Mondini dysplasia.

Mondini dysplasia is a congenital malformation of the inner ear, which is characterized by a short and large cochlear canal of 1.5 turn rather than 2.5 turns and an apical region with cystic dilatation. Patients present with congenital deafness, when both cochlea are affected. Unilateral disease may cause recurrent meningitis, otorrhea or rhinorrhea. In this article, we report a three-year-old pediatric case with a history of meningitis and cerebrospinal fluid otorrhea following tympanostomy tube placement for serous otitis media.

A rare tumor of nasal bone in a child: osteoblastoma.

Benign osteoblastoma is an uncommon bone tumor, representing 1% of all benign tumors and 3% of all primary bone tumors. Intranasal or paranasal osteoblastoma is particularly rare. Osteoblastoma occurs more frequently in males, at a peak age between 10 and 20 years. We report an osteoblastoma of the nasal septum in an 11-year-old boy who presented with swelling of the nasal septum. The diagnosis and management of this unusual lesion, as well as the histopathology and imaging characteristics, are reviewed. Magnetic resonance imaging (MRI) revealed a solid midline nasal mass originating from the septum with intense contrast enhancement. There was no evidence of osteoid or chondroid matrix mineralization on computed tomography (CT). Biopsy was performed. Histologically, the tumor contained abundant plump osteoblast-like cells, with eosinophilic cytoplasm and large nuclei that were frequently juxtaposed to the newly formed osteoid. Conservative excision was performed. The literature concerning occurrence of osteoblastoma in this unusual location is reviewed.

Laryngeal adenoid cystic carcinoma in an adolescent.

Malignant tumors of the larynx are extremely rare in children and adolescents. Adenoid cystic carcinoma accounts for less than 1% of all malignant tumors in the larynx. We presented a 16-year-old girl with subglottic adenoid cystic carcinoma, whose symptoms of prolonged and exacerbating dyspnea had been attributed to asthma at another medical center. Indirect flexible and rigid laryngoscopy revealed a smooth mass in the subglottic region occupying 80% of the airway passage. The lesion was also confirmed by both CT and MRI. There was no lymphadenopathy in the neck. The patient was successfully treated by surgery and postoperative radiotherapy. Pathological staging was T4N0M0 according to the AJCC, 2003. During six years of follow-up, there was no evidence for local recurrence or regional and distant metastasis.

[Odontogenic and nonodontogenic jaw cysts: experience in 25 cases]. / Cenenin odontojenik ve odontojenik olmayan kistleri: 25 olguda deneyimlerimiz.

OBJECTIVES: We retrospectively evaluated the patients with jaw cysts treated at our center. PATIENTS AND METHODS: The study included 25 patients (14 males, 11 females; mean age 33+/-19 years; range 7 to 69 years) who underwent surgery for odontogenic or nonodontogenic jaw cysts. RESULTS: The most common presentation was a swelling in the jaw with or without dental problems. Involvement was in the mandible in 18 patients, and in the maxilla in seven patients. The lesions consisted of eight radicular, six dentigerous, two nasoalveolar, two globulomaxillary cysts, and three keratocysts. Four patients had gingival, nasopalatine, residual, and median mandibular cysts, respectively. Marsupialization, curettage, extensive burring, enucleation, or marginal resection were performed depending on pre- and intraoperative findings. The defects were repaired with a corticocancellous iliac bone block graft in three patients and cancellous iliac bone chips in five patients. During a mean follow-up of 14 months (range 12 to 46 months), recurrence was seen in only one patient with a keratocyst. CONCLUSION: A good preoperative assessment, complete removal of the cystic lesion, and close radiographic follow-up are essential for a successful outcome in jaw cysts. In selected cases, reconstruction of the defects with autogenous corticocancellous iliac bone graft yields highly satisfactory results.

Laryngeal reconstruction with porous high-density polyethylene.

OBJECTIVE: This study was undertaken to evaluate the use of the Medpor (Porex Surgical, College Park, GA) implant in laryngeal reconstruction and to discuss potential indications of this material in head and neck surgeries. METHOD: Twelve rabbits were used in this particular study. Laryngoplasties were performed by extracting 5 x 10-mm thyroid cartilage and replacing it with Medpor implant. Animals were sacrificed in the 1st, 2nd, and 4th weeks and 2, 6, and 9 months after implantation. The degree of fibrous capsule formation, histiocytic reaction, foreign body giant cell reaction, lymphocytic and neutrophilic reactions, vocal fold changes, and hyaline cartilage formation in the implant bed were evaluated. RESULTS: Fibrous capsule was formed around the implant in 2 weeks. Four weeks after the implantation cellular reaction in the implant bed decreased significantly. Foreign body giant cell reaction was detected only the first 2 weeks after the implantation. CONCLUSION: According to the results of this study, the Medpor implant can be safely used in laryngeal reconstruction.

Management of lateral sinus thrombosis in chronic otitis media.

OBJECTIVE: To present our experience with the diagnosis and treatment of lateral sinus thrombosis (LST) secondary to otogenic disease. PATIENTS AND METHODS: We have retrospectively reviewed all the cases of LST caused by chronic otitis media in ten years. RESULTS: In our series of five patients, four patients were successfully treated by surgery without opening the sigmoid sinus. On the other hand, one of our patients developed hydrocephalus and ataxia during preoperative antibiotic treatment. CONCLUSION: Most patients with thrombotic/nonabscessed sinuses will have successful outcomes with this approach, but careful observation is needed, given the possibility of advancing disease.

Soft tissue response of the larynx to silicone, Gore-Tex, and irradiated cartilage implants.

OBJECTIVE: The aim of the study is to compare the efficiency of three different materials (Silicone, Gore-Tex, and irradiated cartilage) used in medialization laryngoplasty. Local tissue reaction to implants in laryngeal skeleton has been examined for this purpose. STUDY DESIGN AND METHODS: In this prospective study, New Zealand rabbits were used. Different materials have been implanted in the paraglottic space of both sides of the larynx to enable a better comparison of the different materials used. Limited medialization was applied. Special care has been taken not to narrow the airway and cause breathing problems. The reaction of the tissue in this region against the materials used has been studied. Each material was implanted 14 times in total. The rabbits were killed 6 months after the implementation to study their larynx. For each material, the fibrous capsule formation, histiocyte infiltration, foreign body giant cell infiltration, eosinophil infiltration, neutrophil infiltration, and lymphoplasmacytic infiltration levels were investigated histologically. RESULTS: Best fibrous capsule formation has been observed around silicone. Allergic reactions and inflammatory responses were minimal for this material. Fibrous capsule formation was more limited with Gore-Tex. Some degree of chronic inflammatory response (in few cases) has been observed against this material. Severe allergic response was observed against irradiated cartilage, and the implant material was resorbed completely in most cases. CONCLUSION: According to histopathologic results of this study (tissue compatibility of three materials), silicone is the most suited material among the study materials for medialization. Gore-Tex can also be used for this purpose. Irradiated cartilage, on the other hand, appears not to be a suitable material for medialization laryngoplasty.

Cervical bronchogenic cysts in head and neck region.

Congenital cysts of the neck are not uncommon. Most of these are thyroglossal, branchial cleft and thymic cysts. Bronchogenic cysts are uncommon developmental anomalies of the tracheobronchial tree and rarely occur in the neck. More than 70 cases of bronchogenic cysts in the head and neck region have been reported in the literature. We report three cases presenting with neck swelling in the hyoid region that were diagnosed as bronchogenic cysts based on clinical and histopathological findings.

Central giant cell granuloma.

The central giant cell granuloma (CGCG) is an uncommon benign bony lesion that accounts for less than 7% of all benign lesions of the jaws in tooth-bearing areas. Its etiology is unknown and its biological behavior is poorly understood. This condition is a slow-growing, asymptomatic lesion that usually affects children and young adults, predominantly females. The following report illustrates the differential diagnosis, surgery, final diagnosis and pathology of a fast-growing CGCG in a 4-year-old girl.

Multiple infiltrating lipomas of the tongue.

A rare case of multiple infiltrating lipomas in the tongue of a 54-year-old man is reported. There have been only five previously reported cases of infiltrating lipoma of the tongue. They were all solitary in nature. The present lesion is the first case reported in the English literature of multiple infiltrating lipoma of the tongue. Because of its infiltrating nature, this tumour may be mistaken for a liposarcoma. Achievement of adequate surgical margins is essential, as the recurrence rate may be as high as 62.5 per cent without complete excision.

Use of polyethylene terephthalate and expanded-polytetrafluoroethylene in medialization laryngoplasty.

Various materials have been used up to the present time in vocal fold augmentation. Although silicon has been the most frequently employed, the surgical difficulties encountered in shaping, positioning and placing this material have led to a search for a more easily applicable material. In our study, we investigated the local tissue reaction to implants in the laryngeal skeleton of 10 New Zealand rabbits in which we performed medialization laryngoplasty employing polyethylene terephthalate (PETP=Dacron) and expanded polytetrafluoroethylene (e-PTFE=Gore-Tex). When the local host tissue reaction to PETP and e-PTFE were compared, PETP was found to cause significant foreign body giant cell and histiocyte infiltration localized around fibres of the implant. The greater irregularity of the fibrous capsule formed in response to PETP and the density of foreign body giant cells around the PETP fibres suggested that resorption of the implant with time would decrease the degree of medialization.

A case of congenital bilateral stapes agenesis.

Congenital absence of the stapes and the oval window is an anomaly reported in only sporadic cases. We present a 17-year-old male patient with congenital bilateral conductive hearing loss. The external auditory canal and the tympanic membrane appeared normal on both sides. An exploratory tympanotomy in the right ear revealed dehiscence of the the horizontal segment of the facial nerve, which was displaced inferiorly, occupying the area of the absent oval window. The stapes was totally absent and a malformed long process of the incus was attached by a fibrous band to the promontory. Manipulation of the facial nerve in association with stapedectomy or vestibulotomy was avoided in order not to injure the nerve. Instead, amplification with hearing aids was recommended to the patient.

[Evaluation of the combined suprahyoid-transoral approach to the tongue base tumors]. / Dil kökü kanserlerinde kombine suprahiyoid-transoral yaklasim.

OBJECTIVES: To evaluate the efficacy and functional results of the combined suprahyoid-transoral approach in early-stage tongue base cancers. PATIENTS AND METHODS: Five patients (4 females, 1 male; mean age 47 years; range 12 to 65 years) with tongue base tumors underwent surgery via the combined suprahyoid-transoral approach. Diagnoses were adenoid cystic carcinoma in three patients and squamous cell carcinoma in two patients. The mean follow-up period was 32.4 months (range 10 to 54 months). RESULTS: One patient with adenoid cystic carcinoma and two patients with squamous cell carcinoma required neck dissection. Postoperative radiotherapy was administered to two patients with squamous cell carcinoma. Tracheotomy was performed in all cases during surgery. All patients were safely decannulated within a mean of 11.4 days (range 9 to 14 days) and converted to oral feeding within a mean of 8.6 days (range 7 to 11 days) with no aspiration problem. All patients had negative surgical margins. All patients had satisfactory phonation. No local or regional recurrences developed during the follow-up period. CONCLUSION: Functional results obtained through the combined suprahyoid-transoral approach justify its use in the treatment of T1 or T2 tongue base carcinomas.

Skin metastasis: an unusual localization from laryngeal carcinoma.

Skin metastasis from laryngeal carcinoma is rare and indicates a poor prognosis. A case of laryngeal carcinoma with unusual metastasis to the skin of the hand is reported. The patient underwent total laryngectomy, left radical neck dissection, and right functional neck dissection. After the operation, the patient received radiotherapy. In the postoperative 18th month, a mass was observed in the left hand. It was found to be a metastatic tumor from laryngeal carcinoma, histopathologically as well as immunohistochemically. Metastatic potential in malignant neoplasms is generally correlated with reduced cellular adhesiveness. We investigated the expression of the vascular endothelial growth factor (VEGF), matrix metalloproteinase-9 (MMP-9), and E-cadherin. Interestingly, the immunohistochemical expression characteristics of such an aggressive tumor were not positive.

An erosive mass involving the nasal cavity and maxillary sinus: rhinosporidiosis.

Rhinosporidiosis is a chronic granulomatous inflammatory disease of the mucous membranes caused by Rhinosporidium seeberi. The disease is endemic in India, but is very rare in other countries. A review of the literature shows that our patient is the second documented case from Turkey. Involvement and erosion of the anterior wall of the maxillary sinus as in this case is very rare. A 47-year-old-male is presented with the clinicopathological features and transmission of the disease is discussed.

Ossicular reconstruction for incus long-process defects: bone cement or partial ossicular replacement prosthesis.

OBJECTIVE: The objective of this study was to compare hearing results in patients undergoing ossiculoplasty with bone cement (BC) vs partial ossicular replacement prosthesis (PORP) in cases of incudostapedial discontinuity during tympanoplasty surgeries. STUDY DESIGN: Case series with chart review. SETTING: Tertiary referral center. SUBJECTS: A total of 44 patients with incudostapedial discontinuity, 21 operated on with BC and 23 operated on with PORP, were enrolled in this study. METHODS: Preoperative and postoperative audiograms at 12 months were evaluated. Pure-tone averages and air-bone gaps (ABGs) were calculated according to the guidelines. RESULTS: The ABG was 26.61 dB preoperatively and 9.76 dB postoperatively in the BC group. The hearing gain in ABG was statistically significant (P = .0001). The preoperative and postoperative ABGs in the PORP group were 29.48 and 8.89 dB, respectively. The hearing gain in ABG was statistically significant (P = .0001). When the groups were compared for mean gains in the ABG, the difference was not statistically significant (P = .192). The postoperative ABG of less than 20 dB was achieved by 90.4% in the BC group and 86.9% in the PORP group. This difference was not statistically significant (P = .745). No adverse reactions or complications were observed. CONCLUSIONS: Both BC and PORP are reliable and efficient methods for the repair of incudostapedial joint defects. There is no difference between these 2 methods, based on the hearing results. Additional research is necessary to determine the maximum incudostapedial defect length suitable for bone cement repair.

Injection tongueplasty: effects of sclerosant OK-432 on rat tongue.

Our aim was to investigate the effect of sclerosant agent OK-432 on tongue fibrosis and to determine whether the fibrosis formed by this substance increases with dose. Fifty Wistar albino rats were divided into three groups for the study. In the first group 0.2 ml OK-432, in the second group 0.5 ml OK-432, and in the third group physiological saline as the control substance was injected into the tongue of these rats. Subjects were sacrificed on the first day, first week, first month, third month and sixth month following the injection. Cross-sections of the tongues were stained with hematoxylin-eosin (HE) and Masson Tri-chrome. The degree of fibrosis was measured using ocular micrometry. A significant amount of fibrosis was observed in both the 0.2 ml (P = 0.020) and 0.5 ml (P = 0.003) OK-432 injection groups. OK-432 is a material that causes significant fibrosis in the muscle when compared to physiological saline. The degree of fibrosis in the tongue increases with dose.

Choanal polyps: an evaluation of 53 cases.

BACKGROUND: The aim of this study was to evaluate our experience on the diagnosis and treatment of choanal polyps (CP). METHODS: This study consists of 53 patients with CP diagnosed by means of rhinoscopy, nasal endoscopy, computerized tomography, surgical, and histologic findings between 1996 and 2005. RESULTS: The origins of the CPs were the unilateral maxillary sinus in 47 patients, simultaneously bilateral maxillary sinus in 2 patients, septum in 2 patients, sphenoid sinus in I patient, anterior ethmoid sinus in 1 patient. The most common presenting symptoms were unilateral nasal obstruction, snoring, and rhinorrhea. In the cases of the antrochoanal polyps, the most common preoperative radiological finding was the total opacification of the maxillary sinus. CONCLUSION: Endoscopic approach for complete removal of the CPs is an extremely safe and effective procedure. It should be focused on the detection of the exact origin and the extent of the polyp to prevent recurrence.