Comparison of the effectiveness of Brandt-Daroff Vestibular training and Epley Canalith repositioning maneuver in benign Paroxysmal positional vertigo long term result: A randomized prospective clinical trial.

OBJECTIVE: Benign paroxysmal positional vertigo (BPPV) is the most common peripheral cause of vertigo. It can be defined as transient vertigo induced by rapid change in head position, associated with a characteristic paroxysmal positional nystagmus. Posterior canal benign paroxysmal positional vertigo is the most frequent form of BPPV. The aim of our study was to investigate and compare the effectiveness of Epley maneuver and Brand-Daroff home exercises for the treatment of posterior canal BPPV. METHODS: A total of 50 patients between 27 and 76 years of age who were diagnosed with unilateral posterior canal into BPPV were randomized prospectively into two groups. In Group-1, modified particle repositioning maneuver and in Group-2 Brandt-Daroff exercises were utilized as treatment. Patients were followed weekly. Cure weeks were recorded. The patients were followed for 12 to 24 months for recurrence. RESULTS: The recovery rates at the first, second and third week controls were 76%, 96% and 100% for Group-1 (modified Epley maneuver) and 64%, 88% and 100% for Group-2 (Brandt-Daroff exercises) respectively. The recovery rates were similar for both groups. The average follow-up duration was 18 months. In Group 1, 7 patients (28%) and in Group 2, 5 patients (20%) had recurrence, which was also similar with no statistical difference. CONCLUSION: It was concluded that both Brandt-Daroff Exercises and Modified Epley maneuvers were almost equally effective in the treatment of BPPV.

Impact of Septoplasty on Eustachian Tube Functions.

OBJECTIVE: To evaluate the impact of nasal septum deviation (NSD) and septoplasty on eustachian tube (ET) functions. MATERIAL AND METHODS: The study was designed as a prospective controlled study and conducted in a tertiary referral center. A study group of 25 patients who were scheduled for septoplasty for NSD; and a control group of 25 healthy individuals having no ear or nose symptoms were formed. Tympanometric analysis of ET function, subjective and objective analysis of nasal functions with acoustic rhinometry and rhinomanometry were performed. Patients in study group underwent nasal surgery and tests were repeated at postoperative 1st and 3rd months. RESULTS: Eustachian tube functions of study group were significantly worse than the control group (P = 0.032). ET functions were found to be poorer as the nasal airway resistances increase which was found to be close to significance (P = 0.056). One and 3 months after corrective surgery, both nasal airway functions and ET functions improved significantly reaching to the level of control group. CONCLUSIONS: Nasal septum deviation was associated with higher rates of ET dysfunction, which could be improved by the nasal surgery. However, in some patients, nasal surgery itself caused ET dysfunction in the early postoperative period.

Comparison of Clinical Results in Nasal Tip Augmentation Either Via Face to Face or Back to Back Technique With Autogenous Auricular Conchal Cartilage.

OBJECTIVE: To compare the objective and subjective findings between patients who underwent nasal tip augmentation surgery via two different methods using autogenous auricular conchal cartilage. MATERIALS AND METHODS: This study included the data of 21 patients who underwent nasal tip augmentation surgery. The patients were randomly divided in two groups according to the technique used to form a double layer columellar strut graft; either face to face (group 1) and back to back (group 2). All patients were assessed via nasal obstruction symptom evaluation scale (NOSE) and via acoustic rhinometry and rhinomanometry at preoperative and postoperative 1st and 6th months. RESULTS: There was statistically significant improvement in symptom score in both patient groups with no difference inbetween. Total nasal resistance decreased nonsignificantly at the end of 6th month in both groups; 13.1 Pa/cm3 to 8.6 Pa/cm3 and 10.3 Pa/cm3 to 9.5 Pa/cm3 respectively. There was no significant increment in MCA values for both groups except left MCA1. CONCLUSIONS: We achieved good results in tip augmentation via both techniques. An autogenous conchal cartilage is a good alternative to replace lacking caudal septal cartilage. It provides safe and stable support to the nasal tip. However, further comprehensive studies with larger sample size and long follow-up are required to elucidate any difference between these two techniques.

Galvanic skin response test: a new quantitative diagnostic method for Frey syndrome.

OBJECTIVE: Frey syndrome is one of the most common complications following parotid surgery. The current most common test for objectively diagnosing Frey syndrome is Minor starch-iodine test. This test might be insufficient because its results are not quantitative and therefore tests with quantitative results are investigated. The objective of this study was to investigate the efficiency of galvanic skin response (GSR) test, which measures changes in skin resistance, as a method with quantitative results for diagnosis of Frey syndrome. METHODS: Thirty patients who underwent superficial parotidectomy were assessed postoperatively (mean, 24.7 ± 25.7 months; range, 6-109 months). Patients completed a symptomatic evaluation questionnaire and underwent Minor starch-iodine test and GSR. RESULTS: Diagnostic validity of GSR test was found to be >2.91 following analysis. Sensitivity and specificity of this value were 100% and 55%, respectively, based on symptomatic assessment. Sensitivity and specificity were 87.5% and 57.1%, respectively, based on Minor starch-iodine test. CONCLUSIONS: When compared to symptomatic evaluation of patients who underwent superficial parotidectomy, GSR test was shown to be 100% sensitive in diagnosing Frey syndrome and quantitative results of GSR test could determine severity of Frey syndrome.

[Ramsay Hunt syndrome and current approaches]. / Ramsay Hunt sendromu ve güncel yaklasimlar.

Ramsay Hunt syndrome (RHS) is a disease characterized by acute peripheric facial paralysis, vesicular eruptions on the auricular skin and severe ear pain caused by reactivation of latent Varicella zoster virus in the geniculate ganglion. In addition to clinical findings, the diagnosis is confirmed with the presence of viral DNA in the involved tissue and vesicular exudate, as assessed by polymerase chain reaction. Corticosteroids for their anti-inflammatory effects and antiviral agents for their anti-replicative effects on viral load are used as the first-line therapy. However, there is a limited number of studies which proved the efficacy of this treatment.

[Bone cement or incus interposition in type 2 tympanoplasty: prognostic factors and functional outcomes]. / Tip 2 timpanoplastide kemik çimento veya inkus interpozisyonu: Prognostik faktörler ve fonksiyonel sonuçlar.

OBJECTIVES: In this study, we compared the functional results of incus interposition and the use of bone cement in patients who underwent type 2 tympanoplasty due to isolated incus defects. PATIENTS AND METHODS: A total of 47 patients including 12 patients with incus interposition and 35 patients with bone cement were enrolled in the study. The middle ear risk indices (MERI) of the patients were evaluated from the patient files. The mean air conduction thresholds at 0.5, 1, 2 and 4 kHz and air-bone gap were estimated, evaluating preoperative and postoperative audiogram results at 12 months of all patients. The success rate of surgery and functional outcomes were compared between the patients of similar MERI groups on which ossicular reconstruction was performed using different methods (bone cement or incus interposition). RESULTS: In all patients, there was a statistical significant improvement in terms of the mean air conductance threshold and decrease in the mean air-bone gap (p<0.001, p=0.001). The comparison of percentage changes of functional gain between incus interposition and bone cement groups showed no statistically significant difference (p=0.542, p=0.534). CONCLUSION: In this study, similar functional outcomes were attained between the patient groups in which type 2 tympanoplasty with either sculptured incus interposition or bone cement was performed. Several factors including the cost of the material to be used, status of the middle ear and ossicles, defect size, and experience of the surgeon should be also considered.

[The role of sentinel lymph node biopsy in oral cavity cancer]. / Oral kavite kanserlerinde sentinel lenf nodu biyopsisinin rolü

OBJECTIVES: This study aims to evaluate the role of sentinel lymph node (SLN) biopsy in patients who had clinically N0 oral cavity cancer in the neck assessment. PATIENTS AND METHODS: Between May 2006 and May 2008, nine patients with clinically N0 oral cavity cancer (6 females, 3 males; mean age 57±24.7 years; range 31 to 71 years) who underwent surgical treatment were enrolled in this study. Eight of them had corpus linguae carcinoma, while one had lower lip carcinoma. Tumor stages were T1 in four, T2 in four patients, and T4a in one patient. The patients underwent surgery within 8 to 16 hours after lymphoscintigraphy was performed for detecting SLNs. Initially primary tumor was excised. Then, SLNs which were identified by a gamma probe, lifting skin flap of the neck were excised. Neck dissection was performed as scheduled. SLNs were examined in frozen sections. The results of frozen section and definitive histopathological diagnosis of SLNs were compared with each other, as well as the definitive histopathological diagnosis of the dissection materials. RESULTS: In all patients SLNs were completely identified and excised successfully, including one node in one patient, two nodes in six patients and three nodes in two patients. All nodes were localized ipsilaterally in the neck. In addition, the frozen section and definitive histopathological examination results of all nodes were consistent. Biopsy results indicated that eight patients were SLN-negative, while one was SLN-positive. Only one patient was SLN-negative, although the pathological diagnosis was found to be N1. CONCLUSION: Our study results suggests that SLN biopsy may be applicable for early stage oral cavity tumors.

The role of selective neck dissection in pathological N1 squamous cell carcinomas of the head and neck.

OBJECTIVES: This study aims to evaluate the effectiveness of selective neck dissection (SND) in stage pN1 head and neck cancers. PATIENTS AND METHODS: Patients who underwent neck dissection due to squamous cell carcinoma of oral cavity, larynx, oro-hypopharynx were evaluated retrospectively. Sixty-one patients diagnosed with pathological N1 by neck dissection were included in the study. Thirty-four of the 61 necks, to which SND was applied, comprised the study group, and 27 necks, which underwent comprehensive neck dissection (CND), comprised the control group. RESULTS: Neck recurrence rates were 4.9% for all cases, 5.9% for the SND group and 3.7% for the CND group. Two- and five-year disease-specific survival rates were similar for SND group (78.6%, 72.5%) and CND group (90.5%, 82.9%). Two- and five-year overall survival rates were also similar for SND group (67.6%, 58%) and CND group (81.5%, 66%). None of them were significantly different between groups (p>0.05). CONCLUSION: Selective neck dissection provides comparable results to CND in the treatment of pN1 necks.

Preoperative evaluation of chronic rhinosinusitis patients by conventional radiographies, computed tomography and nasal endoscopy.

OBJECTIVES: The aim of this study was to compare the efficacy of conventional radiography (CR), computed tomography (CT) and nasal endoscopy for the preoperative evaluation of chronic rhinosinusitis in patients with persistent complaints despite appropriate medical therapy. PATIENTS AND METHODS: Forty-three patients (26 males, 17 females; mean age 43 years; range 15 to 73 years) were prospectively evaluated. All patients underwent detailed physical examination, CR and coronal high resolution CT of paranasal sinuses. Thirty of them were evaluated with detailed nasal rigid and/or flexible endoscopy as well. The anatomic variations and mucosal changes in paranasal sinuses were noted. The specificity and sensitivity of CR was calculated using CT findings as a reference point. Surgery was performed on two of the other three patients because of obstructive symptoms of middle turbinate. Paradoxal middle turbinate surgery was performed on one patient due to a headache of rhinogenic origin. RESULTS: In our study 40 (93%) of all patients showed mucosal abnormalities on CT. Computed tomography scanning of the patients revealed anatomic variations in 74.4% of the cases. Mucosal pathology was most frequently observed in the anterior ethmoid region (middle meatus). While we found mucosal anomalies in 47.4% of all sinuses using CR, 42.2% of these cases were confirmed with CT. Also, 19.5% of all sinuses evaluated as normal with CR presented pathologic findings on CT. An overall correlation of 75.3% was observed between CR and CT, while diagnostic nasal endoscopy and CT findings were correlated at a rate of 87%. CONCLUSION: (i) While no ipsilateral maxillary or frontal sinus disease was detected when no abnormality in the anterior ethmoid region and infundibulum was observed endoscopically in the presence of mucosal abnormalities similar abnormalities were seen at the same side for maxillary or frontal sinuses. (ii) Anatomic variations of nasal and paranasal sinuses may be considered as etiologic and predisposing factors of chronic rhinosinusitis. (iii) Conventional radiography should not be used as a single diagnostic tool in preoperative evaluation; however, due to its high sensitivity, CR technique may be used alone in the diagnosis and follow-up of maxillary sinus disease. (iv) Nasal endoscopy may reduce unnecessary diagnostic CT scanning procedures.

Management of pain after tonsillectomy: a prospective, randomized clinical study.

OBJECTIVES: We evaluated the alleviation of post-tonsillectomy pain with systemic and topical applications. PATIENTS AND METHODS: Data obtained from 78 patients (28 females, 50 males) who had undergone tonsillectomy for recurrent tonsillitis by conventional cold surgery were reviewed with prospective, randomized clinical study. Initially, the patients were assigned into topical and systemic drug groups. These groups were then divided into three sub-groups; (i) clindamycin, dexamethasone, and control (saline) (ii) groups for the topical drug group; (iii) cefprozil, amoxicillin+clavulanate and control (no medications except analgesic) for the systemic drug group. The intensity of pain perceived by the patients at 21 different times was assessed by visual analog scale and facial scale. RESULTS: No significant relation was found between topical or systemic antibiotic use and pain intensity after tonsillectomy. CONCLUSION: Neither topical application nor systemic administration is significantly superior to the other for postoperative management of pain.

Unexpected findings in the neck dissection specimens for primary head and neck squamous cell carcinoma.

OBJECTIVES: We aimed to determine the incidence of unexpected pathological findings observed during the histopathological examination of the neck dissection specimens performed for primary head and neck squamous cell carcinoma, and their impacts on the treatment and follow-up plans. PATIENTS AND METHODS: We retrospectively reviewed 410 patients (369 males, 41 females; 169 patients unilateral, 241 patients bilateral) with a diagnosis of squamous cell carcinoma of head and neck, who underwent 651 neck dissections. RESULTS: Unexpected pathological findings were found in 3.2% of patients and 2% of neck dissections. These unexpected findings were tuberculosis in eight patients (2%), metastatic papillary thyroid carcinoma in three patients (0.7%), Warthin,s tumor in one patient and cystic hygroma in one patient. All patients who had metastatic papillary thyroid carcinoma received radioactive iodine treatment after thyroidectomy. In control examinations, none of these cases had problem related to neither primary disease nor thyroid pathology. Only two of eight patients who had tuberculosis in lymph nodes received medical treatment for tuberculosis, while the others were observed by clinical and radiological examinations. None of these patients had problems related to tuberculosis. We had no long-term follow-up results for cystic hygroma and Warthin,s tumor since these patients did not continue their routine examinations. CONCLUSION: During the pathologic examination of neck dissections, unexpected pathologic findings may occasionally be encountered. Most frequently seen unexpected findings were tuberculosis lymphadenitis and metastatic papillary thyroid carcinoma. However, these pathologic findings do not seem to affect the management of the primary disease.

[The relationship between lymph node size and metastasis and extracapsular spread in squamous cell carcinoma of the larynx, orohypopharynx, and oral cavity]. / Larenks, orohipofarenks ve oral kavite yassi hücreli karsinomlarinda lenf nodu boyutu ile metastaz ve ekstrakapsüler yayilim arasindaki iliski.

OBJECTIVES: We examined the relationship between lymph node size and metastasis and extracapsular spread (ECS) in patients who underwent neck dissection for squamous cell carcinoma of the larynx, orohypopharynx, or oral cavity. PATIENTS AND METHODS: We retrospectively evaluated a total of 200 neck dissections performed in 128 patients (107 males, 21 females; mean age 56+/-11 years; range 26 to 81 years) with squamous cell carcinoma of the larynx, orohypopharynx, or oral cavity, and having complete clinical and pathologic data. Along with 442 metastatic lymph nodes (139 with ECS), the greatest axial diameter of the biggest benign lymph node obtained from each patient was measured. Lymph nodes were classified according to the neck zone and size, and the relationship of lymph node size with metastasis and ECS was examined. RESULTS: Lymph nodes with metastasis and ECS were often 11 to 30 mm in size and the highest rates of metastasis and ECS were seen in lymph nodes measuring 31 to 60 mm. However, approximately 40% and 25% of lymph nodes with metastasis and ECS, respectively, were in the range of 1 to 10 mm, which is not clinically accepted as pathologic. CONCLUSION: In larynx, orohypopharynx, and oral cavity squamous cell carcinomas, the clinical assessment of the size of neck lymph nodes is usually not a predictor for lymph node metastasis or ECS. Thus, until methods like sentinel lymph node biopsy become standard to determine occult metastasis, the importance of elective neck dissections is still valid in clinically N0 necks.

Hypothyroidism after primary surgical treatment for laryngeal and hypopharyngeal cancer.

OBJECTIVES: We investigated the incidence of hypothyroidism after treatment of laryngeal or hypopharyngeal cancer (LHC), and evaluated its relationship with treatment modalities. PATIENTS AND METHODS: Thyroid functions of 42 patients (41 males, 1 female; mean age 58 years; range 35 to 81 years) undergoing surgical treatment with (74%) or without adjuvant radiotherapy for LHC were prospectively evaluated preoperatively, on the 15th day, and in the sixth month postoperatively. The results were compared in relation to the treatment methods employed. RESULTS: The overall incidence of post-treatment hypothyroidism was 23.8%. Five patients had hypothyroidism in the early postoperative period, and this number increased to 10 after six months. All patients with hypothyroidism had undergone total laryngectomy with bilateral neck dissection, followed by radiotherapy. A significantly higher incidence of hypothyroidism was associated with total laryngectomy, bilateral neck dissection, level VI dissection, partial or bilateral thyroidectomy, adjuvant radiotherapy, and upper mediastinal radiotherapy. CONCLUSION: The incidence of post-treatment hypothyroidism is not rare in LHC patients, requiring long-term monitoring of thyroid functions to prevent associated morbidities.

Prognostic significance of soft tissue deposits in laryngeal carcinoma.

INTRODUCTION: Soft tissue deposits is tumorous islands apart from lymph nodes and occasionally diagnosed in neck dissection specimens. Their importance has begun to be recognized, however, their value has not been investigated in laryngeal cancer as a single tumor site. OBJECTIVE: To investigate the prognostic value of soft tissue deposits in patients with laryngeal carcinoma. METHODS: Medical records of 194 patients with laryngeal carcinoma who were treated primarily by surgery and neck dissection were reviewed. Prognostic significance of soft tissue deposits was assessed along with other clinical and pathological findings. Recurrence rates, overall and disease-specific survival rates were examined. RESULTS: The incidence of soft tissue deposits was found to be 7.2% in laryngeal carcinoma. N stage was more advanced in patients who had soft tissue deposits. Regional recurrence rate was higher and disease specific and overall survivals rates were significantly lower in patients with soft tissue deposits in univariate analysis. However, in multivariate analysis, soft tissue deposits were not found as an independent risk factor. CONCLUSION: In laryngeal carcinoma, soft tissue deposits was diagnosed in patients with more advanced neck disease and their significance was lesser than other factors including extranodal extension.

Should Nasal Function be Considered Prior to Tympanoplasty?

OBJECTIVE: To evaluate the association between nasal airway function and Eustachian tube (ET) functions and their impact on tympanoplasty in patients with chronic suppurative otitis media (CSOM). MATERIALS AND METHODS: The study group (CSOM group) consisted of 33 patients scheduled to undergo tympanoplasty for CSOM. Two control groups were formed: a nasal septal deviation (NSD) group of 25 patients scheduled to undergo nasal surgery for NSD, and a control group of 25 healthy individuals with no otologic or rhinologic symptoms. ET functions were assessed tympanometrically with automatic Williams test (ETF1) and modified pressure equalization inflation-deflation test (ETF2) and nasal functions were analyzed using acoustic rhinometry and rhinomanometry. The patients in the CSOM group underwent tympanoplasty, and tests were repeated at the end of the 3rd postoperative month. RESULTS: Both acoustic rhinometry and rhinomanometry revealed similar nasal function in the CSOM and NSD groups, which was inferior to that of the control group. The CSOM group had the worst ET function. Dysfunctional ETs in the CSOM group improved at 3 months postsurgery, and all groups had a similar outcome regarding ET functions. The outcome of ear surgery was not affected by nasal function, and the graft take rate was 90%. CONCLUSION: Patients with NSD had generally poor ET function; however, this did not affect the outcomes of tympanoplasty. The preoperative ET function results were inconsistent with the results following tympanoplasty; therefore, they were not predictive of need for septoplasty. Thus, we do not universally recommend surgical correction of NSD prior to ear surgery; however, this decision should be made on an individual basis.

The relationship between shoulder pain and damage to the cervical plexus following neck dissection.

The aim of our study was to evaluate the relationship between shoulder pain and damage to the cervical plexus after neck dissection. The study was performed prospectively on 34 neck sides of 17 patients with laryngeal cancer who underwent laryngectomy plus bilateral selective neck dissection (II, III, IV, +/- VI) at the Department of Otorhinolaryngology of Uludag University between December 2003 and October 2004. The cervical plexus was protected on one side of the neck and sacrificed on the other, while the accessory nerve was spared on both sides. The degree of sensorial innervation of the cervical plexus and shoulder pain were evaluated in the preoperative period and postoperatively at 2 weeks, 1 month, 3 months, and 6 months. Data obtained from both sides of the neck were compared. Sensory reception scores were statistically higher in the neck sides in which the cervical plexus was spared than in those where the plexus was sacrificed (P < 0.05). However, the degree of shoulder pain was similar on both sides of the neck (P > 0.05). Damage to the cervical plexus during neck dissection causes loss of sensorial innervation of the neck, but sacrificing the cervical plexus during selective neck dissection has no negative effect on shoulder pain.

Can We Improve Pressure Feedback Methods in Vestibular Evoked Myogenic Potentials by Applying Custom Pressures?

OBJECTIVE: The aim of the present study was to use constant and customized pressure levels to improve the feedback method of the blood pressure cuff technique in order to decrease intra-subject and inter-subject variability. MATERIALS AND METHODS: The study was conducted in two stages. In the first stage, the relationship between the pressure level generated in the blood pressure cuff and electromyographic response in the sternocleidomastoid (SCM) muscle was investigated. In the second stage, vestibular evoked myogenic potential (VEMP) measurements were made using a custom-built VEMP chair at a constant pressure level of 40 mmHg (P40) or at 50% of the maximum pressure (Pmax50%) that could be generated by the SCM muscle. RESULTS: VEMP measurements were performed on 100 volunteers consisting of 48 males and 52 females whose ages were between 20 and 68 years. The response rate was 41% on a subject basis and 53% on an ear basis. Response rates were similar in males and females, and they decreased with age. The response rate was significantly lower in 11% of the volunteers who could not generate the stipulated 80 mmHg pressure level. Response rates obtained with P40 and Pmax50% were similar, and p13 and n23 latencies and p13-n23 amplitudes obtained from both sides were also similar. Amplitudes were higher in Pmax50% measurements compared to P40, and amplitudes obtained with P40 levels showed greater variance compared to Pmax50%. CONCLUSION: The use of Pmax50% provided reduced variation compared to P40; however, it did not have significant clinical implications. Further studies are needed for the control of many factors that are related to amplitude variability.

Comparison of Videonystagmography and Audiological Findings after Stapedotomy; CO2 Laser vs Perforator.

OBJECTIVE: Various types of laser, microdrill, and perforator are effectively used in the surgical treatment of otosclerosis. However, they have certain disadvantages along with advantages. The aim of this study was to evaluate the effects of carbon dioxide (CO2) laser and perforator stapedotomy techniques on audiological outcomes and postoperative vestibular functions via videonystagmography (VNG). MATERIALS AND METHODS: This prospective and randomized clinical study was conducted in an academic tertiary medical center. Sixty-nine patients diagnosed with otosclerosis who underwent stapedotomy were enrolled in this study. Patients were divided into two groups based on the technique used in stapedotomy: CO2 laser and perforator. Postoperative hearing gain and VNG findings were the main outcome measures. Subsequently, the two study groups were compared for analysis. RESULTS: The preoperative air-bone gap was 32.7±8.9 decibel (dB) in the study population and it was improved to 12.9±8.4 dB after operation. There were no differences in VNG findings and vertigo symptoms between the laser and perforator groups at postoperative day 2. There was no significant gain difference regarding the air conduction, bone conduction, and air-bone gap between the two groups (p=0.294, p=0.57, and p=0.37, respectively). CONCLUSION: Both CO2 laser and perforator stapedotomy have successful audiological outcomes with no difference in postoperative vestibular disturbance.

Basaloid squamous cell carcinoma of the larynx: a report of four new cases.

OBJECTIVES: This study is designed to report the clinical and pathologic features and outcome of cases of basaloid squamous cell carcinoma (BSCC) of the larynx treated in our clinic. STUDY DESIGN: A retrospective review of the medical records of these patients. METHODS: Four cases of BSCC of the larynx were treated in our department. Histopathologic slides were reevaluated to confirm the diagnosis. Immunohistochemical studies were performed, and file records were reviewed. Follow-up was available for all patients and ranged between 11 and 72 (mean 37) months. RESULTS: All patients were male (mean 57), with supraglottic or transglottic larynx tumors. Two patients presented with stage-II disease and the other 2 with stage-IV disease. Initial diagnosis was invasive squamous cell carcinoma in 3 patients and BSCC in one patient. Two patients who had stage-II disease underwent partial laryngectomy and bilateral neck dissections; total laryngectomy and bilateral neck dissections were performed in stage-IV patients. Three patients received adjuvant postoperative radiotherapy, and 2 of them also received additional chemotherapy. Patients with stage-IV disease were found to have 4 and 27 metastatic lymph nodes on histopathologic examination and died because of distant metastases at 11 and 14 months, respectively. Patients with stage-II disease did not have cervical metastasis on histopathologic examination and were alive and free of disease at 52 and 72 months respectively. CONCLUSION: In contrast with the literature reporting the tendency of more aggressive clinical behavior of the BSCC, we can say that BSCC has a behavior similar to conventional squamous cell carcinoma based on our 4 cases.

Objective and early diagnosis of chylous fistula in the postoperative period.

OBJECTIVE: The study goal was to evaluate whether quantitative analysis of neck drainage contents is an important parameter of objective and early diagnosis of chylous fistula (CF) in the postoperative period. STUDY DESIGN AND SETTING: We prospectively evaluated 103 consecutive neck dissections during a 2-year period at a tertiary academic referral center. Six of the patients (5.8%) had CF. The data obtained from the patients with CF were matched with normal data obtained from patients without CF. RESULTS: A statistically significant difference was found between total drainage volumes of the patients with and those without CF (P < 0.05). In almost all patients with CF, drainage levels of triglycerides and cholesterol on postoperative day 1 were higher than serum levels. The difference between the drainage levels of triglycerides and cholesterol of the patients with and without CF was highly significant (P < 0.001). CONCLUSIONS: Serum and drainage levels of triglycerides and cholesterol on postoperative day 1 can be used as objective and early predictive parameters of CF.