Transoral Approach to the Giant Deep Lobe Parotid Gland Pleomorphic Adenoma.

ABSTRACT: Parapharyngeal space tumors are rare tumors that make up about 0.5% to 1% of all head and neck neoplasms. The majority of parapharyngeal space tumors, which are usually benign, consist of salivary gland tumors and neurogenic tumors. Although the transcervical, transparotid or transmandibular approach is generally preferred for the excision of these tumors, the transoral approach, which is more advantageous in terms of cosmetics and function, can be applied in selected cases. This article presents a case in which the giant pleomorphic adenoma originating from the deep lobe of the parotid gland is removed by transoral approach.

Toxic epidermal necrolysis treated with N-acetylcysteine.

Adverse drug reactions are the major cause of morbidity and mortality worldwide. Cutaneous drug reaction is the most common type of adverse reaction. Toxic epidermal necrolysis (TEN) is a rare, life-threatening mucocutaneous disease, usually attributable to drugs. There is no proven therapy for TEN. The mainstay of therapy is immediate withdrawal of the culprit drug, using disease-modifying agents, and meticulous supportive care. Several disease-modifying agents have been used such as steroid, i.v. human immunoglobulin (IVIg), plasmapheresis. A 10-year-old epileptic girl was admitted with lamotrigine-induced TEN. She was unresponsive to steroid. Her condition deteriorated despite IVIg treatment. She was treated with N-acetylcysteine (NAC). To our knowledge this is the first report of a child with TEN, a potentially lethal disorder, treated with NAC. NAC may be effective for children with TEN.

Vitamin B12 levels of subjects aged 0-24 year(s) in Konya, Turkey.

Research reports indicate that vitamin B12 levels show racial differences, which suggests that using the reference ranges of varied populations may lead to inaccurate results. This study aimed to determine normal serum levels of vitamin B12 among children and young people in the Konya region of Turkey. It evaluated 1,109 samples; 54 were from cord-blood and 1,055 were from healthy subjects aged 0-24 year(s), who were admitted to primary healthcare centres. The normal reference levels obtained for vitamin B12 at 2.5-97.5 percentile (P2.5-P97.5) range were 127-606 pg/mL for girls, 127-576 pg/mL for boys, and 127-590 pg/mL for the entire study group. The reported reference values for vitamin B12 in other studies were higher than the current results. Vitamin B12 levels vary from country to country; comparisons between countries may not be valid, and normal levels for each population should be obtained.

Short-term results of Neurelec Digisonic SP cochlear implantation in prelingually deafened children.

This paper examines the reports on the selection criteria and the post-operative performance of 25 children implanted with the Neurelec Digisonic SP. This study reported benefits from Neurelec Digisonic SP cochlear implant in auditory and speech perception outcomes. There has been a lack of studies into the additional factors such as level of the mothers' education and bilingualism, which is a factor that may have a significant effect on the success of cochlear implantation. This paper examines the reports on the reasons for the differences in performance and the post-operative performance of 25 children implanted with the Neurelec Digisonic SP. Meaningful Auditory Integration Scale and Meaningful Use of Speech Scale questionnaires were used just before 3, 6, 12, and 18 months following implantation. Electrode array was inserted without difficulty in all cases, with no complications to date. This is a retrospective and cross-sectional study and all the data were collected between March 2010 and December 2012. Auditory performance improved over time for up to 12 months after implantation. Our experience indicates that the Neurelec Digisonic SP cochlear implant system in children under the age of two is relatively safe and reliable. The Neurelec Digisonic SP device surgery can be performed without complications. Auditory performance results support the effectiveness of early implantation. These important findings further support the importance of professionals working very closely with parents or especially mothers and enhancing their involvement in achieving therapy goals to develop auditory skills and speech in young children following cochlear implantation.

Extensive cholesterol granuloma of the petrous apex presenting with facial paralysis and sensorineural hearing loss: a case report.

A cholesterol granuloma of the petrous bone is an expanding mass which contains fluids, lipids, chronic inflammatory cells, and cholesterol crystals surrounded by a fibrous lining. The goal of surgery is to provide drainage and ventilation of the affected area to prevent recurrences. In this article, we report a case of a 27-year-old man who was operated using the transmastoid infralabyrinthine approach to drain a cholesterol granuloma cyst.

Surgical treatment of carotid body tumors.

OBJECTIVES: In this study, we report our clinical experience in a series of patients with carotid body tumors along with diagnosis, treatment and follow-up procedures in the light of related literature data. PATIENTS AND METHODS: Between November 2001 and May 2012, 10 patients (5 males, 5 females; mean age 53.2 years; range 27 to 80 years) who underwent surgery due to a carotid body tumor in our clinic were included. Diagnosis was based on ultrasonography, computed tomography, magnetic resonance imaging, magnetic resonance angiography, selective carotid angiography, balloon occlusion test, biochemical tests and preoperative embolization. Complications were also recorded. RESULTS: Balloon occlusion test was performed in all patients preoperatively, while embolization was implemented in seven patients. All masses were dissected by carotid artery subadventitial approach. Carotid integrity was maintained in nine patients, while a vein graft was used in one patient. Neurological disorder was observed in one patient, whereas transient hypoglossal paresis was in one patient who underwent saphenous vein grafting. CONCLUSION: Our study results suggest that (i) carotid body tumors should be handled with multidisciplinary approach; (ii) balloon occlusion test should be performed in all patients undergoing surgery; (iii) a particular attention should be paid to cranial and phrenic nerves, if it is necessary to extend the surgical field while removing the tumor; and (iv) pathological examination should be carried out by an experienced team and in a multi-centered fashion, if necessary.

Evaluation of the Relationship Between Facial Nerve and Lateral Semicircular Canal in the Posterior Tympanotomy Approach.

BACKGROUND: To clinically and radiologically evaluate the relationship between the facial nerve and the lateral semicircular canal during posterior tympanotomy. METHODS: Patients who received cochlear implants between 2010 and 2020 were included in the study. The relationship between the facial nerve and the lateral semicircular canal was classified into 3 types by evaluating the axial section computed tomography images. If the facial nerve passed medially without contacting the lateral semicircular canal dome, it was classified as type 1; if the facial nerve passed by contacting the medial border of the lateral semicircular canal dome, it was classified as type 2; and if the facial nerve contacted the lateral border of the lateral semicircular canal dome or passed more laterally, it was classified as type 3. RESULTS: In total, 309 ears of 257 patients [139 males (54.1%) and 118 females (45.9%)] were included in the study. Ninety-three (30.1%) of the ears were classified as type 1, 179 (57.9%) were type 2, and 37 (12%) were type 3. It was found that the combined posterior tympanotomy/endomeatal approach was used in 6 ears (1.9%), of which 4 were type 3, and 2 were type 2 (P=.006). CONCLUSION: Systematic evaluation of the relationship between facial nerve and lateral semicircular canal in computed tomography axial sections might help prevent facial nerve damage that can occur during posterior tympanotomy. It was concluded that type 3 ears should be evaluated in this respect, as a combined posterior tympanotomy/endomeatal approach may be required.

Tracheoesophageal puncture closure with annular mucosal flap.

BACKGROUND: To present an effective and easily applicable method for tracheoesophageal puncture (TEP) closure by using a localized annular flap instead of bulky and distant flaps. METHODS: The medical records of patients who underwent TEP closure surgery with the annular mucosal flap technique between July 2012 and August 2018 were retrospectively reviewed. Fistula size, indication for closure, duration of surgery, radiotherapy status, and surgery results were analyzed. RESULTS: We have used our technique in nine patients. No postoperative bleeding, wound infection, esophageal stenosis, and tracheostoma stenosis occurred. In all these patients except one, successful closure was achieved. None of the patients had a recurrence of the TEP. CONCLUSION: The annular mucosal flap technique for TEP closure is easy and quick to apply. The patient's oral feeding at the sixth hour after procedure without using a nasogastric tube makes the technique preferable as a priority.

Cochlear Implant Failure in the Pediatric Population.

BACKGROUND AND OBJECTIVES: In cochlear implant (CI) surgery, the results and causes of revision and reimplantation may guide surgeons in establishing surgical protocols for revision surgery with safe audiological outcomes. The aim of this study was to review our experience in terms of etiology, surgical strategy, and hearing outcomes in pediatric patients who underwent CI removal and reimplantation. SUBJECTS AND PURPOSE: All patients received implants of the same brand. Pre and postoperative Categories of Auditory Performance score and aided free-field pure tone audiometry thresholds were noted. In vivo integrity tests were performed for each patient and the results of ex vivo tests of each implant were obtained from manufacturer. RESULTS: A total of 149 CIs were placed in 121 patients aged <18 years. The revision rate in children was 6.7% (10/121 children). Six patients had a history of head injury leading to a hard failure. The causes of reimplantation in others were soft failure (n=1), electrode migration (n=1), infection (n=1), and other (n=1). All patients showed better or similar postreimplantation audiological performance compared with pre-reimplantation results. CONCLUSIONS: It is very important to provide a safe school and home environment and educate the family for reducing reimplantation due to trauma. Especially for active children, psychiatric consultation should be continued postoperatively.

Effect of preoperative hearing level on success of stapes surgery.

OBJECTIVE: We evaluated functional results after stapedotomy in terms of the influence of preoperative hearing threshold. STUDY DESIGN: Case series and chart review. SUBJECTS AND METHODS: We classified 141 patients according to preoperative mean air-conduction threshold: 40 to 54 dB, group 1; 55 to 69 dB, group 2; and 70 to 89 dB, group 3. Speech discrimination scores also were noted. RESULTS: All groups showed significant improvement. The greatest increase in postoperative speech discrimination score was seen in group 3. Group 1 improved from moderate hearing loss (mean, 49 dB) to normal (mean, 24 dB); group 2, from moderately severe loss (mean, 61.2 dB) to mild (mean, 28 dB); and group 3, from severe loss (mean, 76.4 dB) to moderate (mean, 41.1 dB). CONCLUSION: Success in treating otosclerosis does not depend on extent of preoperative hearing loss. Patients with severe loss improved to moderate, increasing the benefit from use of a hearing aid. The patients attained good auditory function, improving their quality of life.

[Melkersson-Rosenthal syndrome: a case report on a child]. / Melkersson-Rosenthal sendromu: Bir çocuk olgunun sunumu.

Melkersson-Rosenthal syndrome (MRS) includes the triad of oro-facial edema, facial nerve palsy and furrowed tongue. The exact etiology is unknown. However, genetic and acquired factors have been implicated. It is rare in children. In this study, we report a ten year old boy who was diagnosed with MRS with recurrent facial nerve paralysis and facial edema.

[The therapeutic role and effectiveness of selective neck dissection in the management of N0 neck]. / N0 boyun tedavisinde selektif boyun diseksiyonunun tedavideki rolü ve etkinligi.

OBJECTIVES: To assess the therapeutic role and the effectiveness of the selective neck dissection in the management of the clinically node negative neck in the head and neck squamous cell carcinomas. PATIENTS AND METHODS: The charts of 177 patients with squamous cell carcinoma, who underwent neck dissection between January 2000 and January 2007, were reviewed retrospectively. Seventy neck dissections in 58 patients (51 males, 7 females; mean age 63 years; range 21 to 85 years) in whom the primary site of the lesion was the larynx, oral cavity, oropharynx and hypopharynx, and who were considered to have N0 neck and to comply with the study criteria were included in the study. Details were collected on tumor site and stage, type of surgery, pathologic N stage, number and size of pathologic nodes, extracapsular spread of nodes, postoperative radiotherapy, local recurrence, follow up time and survival status in all patients. RESULTS: It was found out that selective neck dissection operations were performed on 99 of 102 N0 patients. The follow up time was approximately 23 months in 58 patients who were found to comply with the inclusion criteria. The most frequent site for primary tumor was larynx and most patients were at T2 stage. Nine patients had pathologically positive lymph node with occult metastasis rate of 13%. The overall recurrence rate was 19%. Postoperative radiotherapy was used as adjuvant therapy in 15 patients. Regional control rate was lower in patients with pathologically positive lymph nodes. However, it was not statistically significant. CONCLUSION: Selective neck dissection is an effective and safe method for controlling and staging of the patients with clinically N0 neck.

Effects of different suture materials on cartilage reshaping.

OBJECTIVE: To examine the effects of different suture materials and suturation techniques on cartilage reshaping in a rabbit model. METHODS: Twenty-two rabbits were used. Posterior skin flaps were elevated, and 4 cartilage struts were prepared on each auricula. Each strut was bent at its midpoint, and the skin under the bent area was elevated only in 1 side. The strut was sutured either with catgut, polyglactin 910, polydioxanone, or polypropylene sutures. Anteriorly, the suture was passed subcutaneously on 1 side, while transcutaneously on the other. Animals were killed at the first and fourth months. The shape of the struts was macroscopically evaluated. Inflammation and foreign body reaction around the suture were examined under light microscopy. RESULTS: Maintenance of shape with all suture materials was significantly lower in the transcutaneously sutured group than in the subcutaneously sutured group. Because of high rates of suture loss in the transcutaneously sutured group, further evaluations on cartilage tissue were made only in subcutaneously sutured group. Success rate in maintenance of shape was similarly high in the polydioxanone, polyglactin 910, and polypropylene suture groups; however, it was significantly lower in the catgut suture group. CONCLUSION: Long-lasting absorbable suture materials are as effective as nonabsorbable ones, and the subcutaneous technique is more effective than the transcutaneous technique.

[Pseudoaneurysm of the internal carotid artery following a tonsil biopsy: endovascular repair with covered stent]. / Tonsil biyopsisine bagli gelisen internal karotis arter psödoanevrizmasi: endovasküler kapli stent ile onarim.

Evaluation and management of peritonsillar masses require specific attention because of their relationship to vital neighboring anatomical structures. A 57-year-old woman developed pseudoaneurysm of the internal carotid artery following a biopsy taken at another center from a mass in the left tonsillar region. She was treated by a multidisciplinary approach and an endovascular covered stent was implanted under local anesthesia in the left internal carotid artery. No recurrence was detected in the neck and the patient was asymptomatic in the postoperative second year.

Treatment of mitochondrial neurogastrointestinal encephalomyopathy with dialysis.

OBJECTIVE: To study the effect of continuous ambulatory peritoneal dialysis on nucleoside levels and clinical course in a patient with mitochondrial neurogastrointestinal encephalomyopathy (MNGIE). Patient We studied a patient with genetically verified MNGIE, who prior to treatment had lost weight progressively, developed amenorrhea, vomited multiple times daily, and had abdominal pain. Intervention The patient was treated with peritoneal dialysis for 3 years, and the effect on symptoms and plasma concentrations of thymidine and deoxyuridine were monitored. RESULTS: Dialysis stopped vomiting and reduced abdominal pain, and the patient gained 5 kg in weight and started to menstruate again. Symptoms returned if dialysis was paused. Dialysis did not affect plasma nucleoside levels. CONCLUSIONS: This study shows an unambiguous clinical benefit of peritoneal dialysis on gastrointestinal symptoms in MNGIE. Dialysis did not affect nucleoside levels, indicating elevated thymidine and deoxyuridine levels are not solely responsible for the pathogenesis of MNGIE.

Sydenham's chorea: a clinical follow-up of 65 patients.

Sydenham's chorea, the neurological manifestation of rheumatic fever, is the most common acquired chorea of childhood. In this retrospective study, the authors aim to present the clinical and laboratory findings of 65 Sydenham's chorea patients, followed up in a clinic over less than 7 years. The mean age at the onset of the symptoms was 11.7 +/- 2.6 years (range, 6-17 years). Of the patients, 63% were female and 37% were male (male/female: 1.7/1). Chorea was generalized in 78.5% of the patients, right hemichorea in 12.3%, and left hemichorea 9.2%. There was a history of rheumatic fever in 30.8% of the patients. Echocardiographic study showed cardiac valve involvement in 70.5% of 61 patients. Brain magnetic resonance imaging, which was performed on only 18 patients, was evaluated as normal in all. Electroencephalography was also performed on only 18 patients and showed abnormal waves in 50% of them. Pimozide was mostly the first choice of drug therapy. Nevertheless, drug therapy was not needed in 18.5% of the patients. The recovery period of the first attack of the chorea was 1 to 6 months in 51.7% of the patients. The recurrence rate was 37.9%. In conclusion, Sydenham's chorea is still an important health problem in Turkey with respect to its morbidity.

Reliability of microdrill stapedotomy: comparison with pick stapedotomy.

OBJECTIVE: To assess the hearing outcomes and complications of the microdrill and pick stapedotomy techniques. PATIENTS: We assessed 123 primary otosclerosis operation in 103 patients who had more than 1 year follow-up (71 microdrill; 52 pick stapedotomies). There were 87 women and 36 men in the study group (mean age, 44 +/- 11.2 years) at surgery. INTERVENTION: Stapedotomy for otosclerosis. MAIN OUTCOME MEASURES: Pure tone hearing thresholds and clinical evaluation for complications. RESULTS: In the microdrill group, preoperative mean air conduction was 61 dB, and mean bone conduction was 27 dB, postoperatively, these values improved to 31 dB and 16 dB, respectively. In the pick group, mean air conduction was 61 dB, and mean bone conduction was 27 dB, which improved postoperatively to 33 dB and 18 dB, respectively. Postoperative hearing gains were similar in both groups (p > 0.005). The mean postoperative gain in bone conduction was significant (p < 0.001) in each group: 11 dB in the microdrill group and 9 dB in the pick group, with no significant difference between the two groups. The preoperative air-bone gap was 34 dB in both groups, and improved to 15 dB in both. Complication rates were similar. CONCLUSION: The microdrill and pick stapedotomy techniques produced similar hearing results and complication rates. Within the limitations of the present study, we found no evidence of microdrill-induced acoustic trauma. The microdrill can be a useful technique in performing a stapedotomy and seems to produce similar results to those associated with pick stapedotomy.

Evaluation of patients with globus pharyngeus with barium swallow pharyngoesophagography.

OBJECTIVE: The objective of this study was to determine the value of barium swallow pharyngoesophagography in the investigation of patients with globus pharyngeus who had no known disease, no operation history in the head and neck region, and no thyroid pathology. We compare the clinical presentation with the radiologic findings to assess the diagnostic accuracy of barium swallow in such patients. METHODS: This was a retrospective study of the clinical records and radiologic reports of 194 patients with globus pharyngeus, between October 1998 and October 2004, that were reviewed and analyzed for correlations between clinical signs and symptoms and barium swallow findings using the chi2 test. All the patients had normal ear, nose, and throat examination, including indirect laryngoscopy and/or nasoendoscopy. Patients with known pharyngeal and esophageal disease, neurologic disease known to cause pharyngeal or esophageal dysfunction, evidence of autoimmune disease or diabetes mellitus, with a thyroid operation in the past and thyroid nodules detected with radiologic investigation were excluded. RESULTS: There were 116 (59.8%) female and 78 (40.2%) male patients. In 114 patients (59%), globus was the only symptom. Sore throat was the most common associated complaint. Benign barium swallow findings were detected in 63.9% of the patients. Cervical osteophyte indentation was the most common finding. In 36.1% of the patients, the radiologic finding was normal. The statistical analysis using the chi2 test showed a significant relationship (P < .001) between the symptoms of globus pharyngeus and the barium swallow results. CONCLUSION: Barium swallow pharyngoesophagography is useful to detect underlying benign characteristic pathologies in patients with globus who have no known head and neck illness.