3D evaluation of the maxillary sinus volumes in patients with bilateral cleft lip and palate.

One of the most common congenital anomalies of the head and neck region is a cleft lip and palate. This retrospective case-control research aimed to compare the maxillary sinus volumes in individuals with bilateral cleft lip and palate (BCLP) to a non-cleft control group. The study comprised 72 participants, including 36 patients with BCLP and 36 gender and age-matched control subjects. All topographies were obtained utilizing Cone Beam Computed Tomography (CBCT) for diagnostic purposes, and 3D Dolphin software was utilized for sinus segmentation. Volumetric measurements were taken in cubic millimeters. No significant differences were found between the sex and age distributions of both groups. Additionally, there was no statistically significant difference observed between the BCLP group and the control group on the right and left sides (p > 0.05). However, the mean maxillary sinus volumes of BCLP patients (8014.26 ± 2841.03 mm3) were significantly lower than those of the healthy control group (11,085.21 ± 3146.12 mm3) (p < 0.05). The findings of this study suggest that clinicians should be aware of the lower maxillary sinus volumes in BCLP patients when planning surgical interventions. The utilization of CBCT and sinus segmentation allowed for precise measurement of maxillary sinus volumes, contributing to the existing literature on anatomical variations in BCLP patients.

Comparison of endoscopic and microscopic methods in stapedotomy: a retrospective analysis.

PURPOSE: The goal of the present study was to compare the audiologic results, complications, and advantages/disadvantages of endoscopic and microscopic stapedotomy. METHODS: Patients who experienced stapedotomy surgery in the Ear Nose Throat Clinic (ENT) of Selcuk University Faculty of Medicine between September 2011 and January 2018 were included in the study. The data of all patients were analyzed and divided into two groups. Those who underwent endoscopic stapedotomy were included in group I, and patients who underwent microscopic stapedotomy formed group II. Surgical findings, complications, and operation times were compared for the two groups. Air and bone conduction thresholds were evaluated at the frequencies of 500, 1000, 2000, and 4000 Hz pre- and postoperatively at 1, 3, and 6 months, and the mean (± SD) air-bone gap value was recorded. RESULTS: While the mean pre- and postoperative air-bone gaps were 34.38 ± 7.47 dB (23-53 dB) and 9.69 ± 4.43 dB (0-19 dB), respectively, in group I, 34.32 ± 7.57 dB (23-6 dB) and 9.62 ± 4.25 dB (2-23 dB) were the respective means calculated in group II (p < 0.05). When the mean postoperative air-bone gap was compared, there was no statistically significant difference between the two groups (p = 0.774). The mean operative times for groups I and II were 57.22 ± 4.37 min and 63.70 ± 7.34 min, respectively (p < 0.001). The requirement for chorda tympani nerve manipulation and scutum curettage was significantly less in group I compared to group II (p = 0.003). Postoperative dysgeusia and postoperative pain were found to be higher in group II than group I, but they were not statistically significant (p > 0.05). CONCLUSION: Endoscopic stapedotomy displayed similar audiological results, shorter operation times, and similar complication rates, as well as being a less invasive surgery, compared to the microscopic approach.

Relationship of endoplasmic reticulum stress with the etiopathogenesis of chronic tonsillitis and tonsillar hypertrophy in pediatric patients: a prospective, parallel-group study.

OBJECTIVES: Tonsil tissue is a very important component of the human immunity system, contributing to the functioning of the cellular and humoral defence system, especially in childhood. The endoplasmic reticulum (ER) is an organelle that has a very important function in the balanced functioning of cells, in which the accumulation of a cellular protein called ER stress occurs in case of dysfunction. ER stress influences the pathogenesis of many diseases and immune system functions. We aimed to investigate the relation between the diseases of tonsil tissue and ER stress response to elucidate the mechanisms of diseases related with the immune system. METHODS: A prospective study was conducted in 46 children aged between 2 and 16 years who underwent tonsillectomy for chronic tonsillitis or tonsillar hypertrophy. Tonsil tissue was separated into two groups according to their size and evaluated in terms of ER stress markers and apoptosis markers by Real-time PCR and Western blot analysis. RESULTS: The ΔCT levels of ER stress markers (ATF4, ATF6, CHOP, GRP78, EIF2AK3, ERN1, GRP94) were greater in children with chronic tonsillitis (p < 0.005). In contrast, the tonsillar hypertrophy group had greater ΔCT levels of apoptosis markers (BAX, BCL-2) according to the Real-time PCR method (p < 0.005). According to the Western blot analysis, the normalized levels of ATF4, ATF6, CHOP, GRP78, and ERN1 genes were found greater in the chronic tonsillitis group than the tonsillar hypertrophy group. There was no difference between the two groups in terms of normalized BCL-2 and BAX levels by Western blot analysis. CONCLUSION: This is the first study in the literature investigating the effect of the ER stress pathway on the etiopathogenesis of tonsil diseases. It was concluded that the ER stress pathway plays a role in the etiopathogenesis of chronic tonsillitis. Investigating the relationship between ER stress and structures such as the tonsil tissue that make up the immune system can help create new treatment strategies. CLINICAL TRIAL REGISTRATION: Trial Registration ClinicalTrials.gov Identifier: NCT04653376.

Coblation cryptolysis method in treatment of tonsil caseum-induced halitosis.

PURPOSE: Halitosis, is a social problem affecting many patients seeking help from clinicians. Tonsil stones can cause halitosis and especially occur in crypts of palatine tonsils. Coblation cryptolysis is an alternative method for tonsil caseum treatment. The coblation technology includes passing a radiofrequency bipolar electrical current through a medium of normal saline which results in the production of a plasma field of sodium ions. In this study, our aim was to investigate the effectiveness of coblator cryptolysis treatment method in chronic caseous tonsillitis-induced halitosis. METHODS: We included in our study 28 patients who underwent coblator cryptolysis surgery for halitosis due to chronic caseous tonsillitis. The efficacy of treatment and the presence of caseoma were evaluated with the Finkelstein test, organoleptic test and VAS before the procedure and at the 6th month control after the treatment was completed. RESULTS: At the 6th month follow-up after the procedure (a single coblation cryptolysis) we found that 23 of the patients (82.1%) had no caseum. There was a statistically significant change in Finkelstein measurements before and after the procedure (p < 0.001). Organoleptic measurements demonstrated that 21 patients had no halitosis postoperatively and the mean organoleptic test score was calculated as 0.39 ± 0.79 after the procedure. The recovery was statistically significant (p < 0.001). The mean VAS score before coblation cryptolysis was 8.0 ± 1.33 (range 5-10). On the other hand 6 months after a single coblation cryptolysis session, the mean VAS score was 1.25 ± 1.78 (range: 0-6). This difference was statistically significant (p < 0.001). CONCLUSIONS: Our results suggest that coblation crptolysis is an effective, safe, minimally invasive and practical alternative method in treatment of halitosis due to tonsil caseums. We did not observe any complication after the procedure.

Evaluation of the Facial Soft-Tissue Thickness in Patients With Cleft Lip and Palate.

AIM: In this study the authors aimed to evaluate craniofacial morphology and facial soft tissue thickness of the patients with cleft lip and palate.(CLP), and to compare the results with a sex and age-matched noncleft healthy control group. METHODS: Craniofacial and soft tissue thickness measurements of 20 patients with unilateral cleft lip palate (UCLP) and 20 patients with bilateral cleft lip palate (BCLP) were compared with 20 noncleft control subjects. Angles between Sella-Nasion-A point, Sella-Nasion-B point, Nasion-A and Nasion-B line, Sella-Nasion line and Gonion-Gnation line, and linear (glabella, rhinion, subnasale, labrale superius, stomion, labrale inferius, labiomentale, pogonion, and gnathion) measurements were assessed on lateral cephalometric radiographs. Group differences were evaluated with 1-way analysis of variance and post hoc Tukey test. RESULTS: Unilateral cleft lip palate and BCLP groups demonstrated lower values of skeletal measurements than control group except for Sella-Nasion line and Gonion-Gnation line value (P < 0.01). Maxillary incisors were retruded in BCLP group compared with the other groups (P < 0.001). Thickness of the rhinion, subnasale, and stomion demonstrated no significant difference between UCLP and BCLP groups (P > 0.05). Thickness of rhinion and stomion was found significantly higher in both groups, and thickness of the subnasale was found significantly lower than the healthy group (P < 0.05). CONCLUSION: Findings of the study suggested that patients with CLP showed differences on craniofacial morphology and facial soft tissue thickness. Before planning orthodontic treatment and esthetic surgeries, soft tissue thickness should be taken into consideration in addition to skeletal measurements in CLP patients.

Evaluation of upper esophageal sphincter in benign vocal lesions.

PURPOSE: To evaluate upper esophageal sphincter (UES) activity in patients with benign glottic lesions. METHODS: Twenty-three patients with benign vocal fold (VF) lesions scheduled for manometric evaluation were enrolled as the study group (SG); 20 healthy subjects without vocal pathology or dysphagia were included as the control group (CG). UES residual, basal, relaxation time and peak pharyngeal pressures were evaluated by manometry. The reflux symptom index (RSI) and reflux finding score (RFS) were used to estimate the clinical findings of laryngopharyngeal reflux, and the voice handicap index (VHI) was measured in both groups. The patients' data were compared using the Mann-Whitney test and t test. RESULTS: The diagnoses in the SG were vocal nodules, vocal polyps, vocal cysts, sulcus vocalis, or Reinke's edema. The evaluation scores (RSI, RFS, and VHI) were significantly higher in the SG than in the CG (P < 0.05). UES basal and relaxation pressures, relaxation time, and peak pharyngeal pressures did not differ between the SG and the CG (P > 0.05). CONCLUSION: UES manometric pressure was similar in patients with VF mucosal lesions and controls. Studies involving larger populations are necessary to confirm the manometric changes in the UES and to elucidate the pathogenesis of benign VF lesions.

Hydatid Cyst of the Parotid Gland: A Rare Location.

Hydatid disease of the parotid gland is a very rare entity and may be easily overlooked in the diagnosis of parotid masses. Although Turkey remains an endemic area for echinococcosis, involvement of the parotid gland is extremely rare. A 26-year-old man presented with primary parotid gland mass without any other organ involvement. During the first surgery, the cyst was perforated accidentally and in a short time recurrence was occurred. Maximum attention was given for the second surgery for total removal without damaging the cyst with medical treatment. The clinicians should take hydatid disease of parotid gland into consideration and great care must be given for not damaging the capsule of the cystic tumors in order to prevent recurrences.

An Alternative Rhinoplasty Technique: Rotational Spreader Flap ("Rabbit Flap").

BACKGROUND: In modern rhinoplasty, septal cartilage is the most commonly used graft material. It is a big challenge if septal cartilage is insufficient. We present an alternative technique named the "rabbit flap," created from the cephalic portion of the lower lateral cartilage to show its effectiveness on nasolabial angle, nasal axis deviation, and nasal dorsal line. METHODS: An alternative flap, called a "rabbit flap," is constituted from the cephalic portion of the lower lateral cartilage (LLC). The key for this flap's success is in not cutting the connection between the lateral and medial crus of the alar cartilage. The flap is rotated and placed between the upper lateral cartilage and the septum to ensure a spreader graft effect; it can also be moved forward and backward to adjust the nasal tip rotation. Patients whose minimum width of LLC was 12 mm were included in this study. We subjectively evaluated the results of this technique for 24 patients who completed the rhinoplasty outcomes evaluation (ROE) questionnaire and objectively by measuring the nasal axis and nasolabial angles in the preoperative and postoperative first-year periods. RESULTS: There were significant improvements in ROE, nasal axis deviation, and nasolabial angle scores when preoperative and postoperative first-year controls were compared (p < 0.001). We also observed no complications. CONCLUSIONS: With this technique, we can correct both a nasal tip rotation and a mild nasal axis deviation. Moreover, we can achieve a proper nasal dorsal line and prevent an inverted V deformity. By expanding the internal nasal valve, a functionally effective surgery can be performed. However, the LLC must be strong enough to avoid alar collapse. In light of our results, we believe that the technique we call the "rabbit flap" can be used as an alternative rhinoplasty technique. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Conchae Bullosis in a Pediatric Patient.

Pneumatization of the turbinates called concha bullosa is one of the most frequent anatomic variations of the nasal cavity. We report the first case of computed tomography findings of bilateral middle and inferior concha bullosa in a 13-year-old child with nasal obstruction. Here we describe a patient with extreme bilateral bullosa of inferior and middle conchas, as well as crista galli. The patient was treated successfully with endoscopic surgery of conchas. Nasal obstruction secondary to a bilateral turbinate bullosis in a child has not been described before. The clinicians should take this entity into consideration when evaluating the pediatric patients with nasal obstruction.

Esophageal Stricture in a Child With Habit of Acidic Drinks.

A 12-year-old boy with Down syndrome referred to the authors' department with dysphagia and growth retardation. Dysphagia was especially with solid foods and had a 12-month history. When he was 7, he had started to drink Coke and from that time he had a Coke drinking habit. Every day he was drinking more than 2 L Coke and was eating meals in small amounts. Investigations of the patient revealed esophageal stricture related to acidic drink habit and gastro-oesephageal reflux. The patient was treated with recurrent bouginage, antireflux medication, and nutrional support. The patient became symptom free from 13 months and gained weight. The clinicians should take the nutrition habits into consideration when evaluating the esophageal stricture patients.

Large Frontoorbital Osteoma Causing Ptosis.

Osteomas are the most frequent benign tumor of the paranasal sinuses. The commonest site is the frontal sinus but intraorbital extension of frontal osteoma is rare. Here, the authors report a 15-year-old adolescent boy who presented with left superior orbital rim swelling and ptosis. Waters radiography and computed tomographic scan revealed a bone density mass in the left frontal sinus with upper orbital wall extension. The tumor was removed via open eyebrow incision. The histopathologic evaluation was consistent with osteoma.

Role of Apoptosis in the Pathogenesis of Nasal Polyps Based Upon Galectin-3 Expression.

OBJECTIVE: The authors aimed to investigate the antiapoptotic mechanisms in nasal polyps that occur after glandular hyperplasia. STUDY DESIGN: Retrospective histopathological analyses of patients with nasal polyps. METHODS: The study comprised 54 patients (19 females; 35 males). Group-1 patients with a diagnosis of nasal polyposis; group-2 patients with a diagnosis of antrochoanal polyps; group-3 with a diagnosis of deviation of the nasal septum as a control group. Tissues were taken during their surgery and fixed in paraffin blocks, stained to detect galectin-3, and evaluated under a light microscope. Polymorphonuclear leukocytes on the surface epithelium, glandular epithelium, and connective tissue were divided into groups according to the intensity of galectin-3 staining: "mild," "moderate," and "strong." The percentage of stained tissue was also graded: <10%, 10% to 50%, 51% to 80%, and >80%. Hence, the extent of expression of galectin-3 and percentage of stained tissue was calculated. RESULTS: Significant differences in the staining intensity of polymorphonuclear leukocytes for galectin-3 were observed between the 3 groups (P <0.01). Staining intensity in control group was significantly lower than that in group I and group II (P = 0.001; P <0.01). However, there was no significant difference between group I and group II (P >0.05). CONCLUSION: These findings suggest that galectin-3 has a role in the formation of nasal polyps.

Surgical Management of Dysphagia Due to Anterior Cervical Osteophytes.

PURPOSE: The present study was performed to share personal experiences and to discuss the advantages and disadvantages of anterior cervical osteophytes surgical procedures. METHODS: The operative records of anterior cervical osteophytes patients who did not benefit from conventional treatments and underwent osteophytectomy were analyzed retrospectively. Transoral and transcervical anterolateral methods were applied, considering both the localization of the osteophyte and the patient's preference. RESULTS: Five patients were operated with the transcervical anterolateral method, and 3 patients were operated with the transoral procedure. Those using the transcervical method were likely to encounter complications, however, being comfortable for patients. Although the transoral procedure is much safer, the patients may face postoperative pain, long healing time, and morbidities as hematoma, cervical instability, and infection after surgery. CONCLUSIONS: Both transcervical and transoral methods will improve the functional swallowing pathologies and decrease aspiration-penetration. Transoral approach is not recommended due to slow healing times and postoperative pain, although it creates easier access to the spine.

Foreign Body of Submandibular Gland.

Obstructive adenitis is common disorder of submandibular gland. Sialolithiasis is the most common etiologic factor causing obstruction. If a sialolith is not detected, chronic obstruction of salivary glands is called nonspecific sialoadenitis. Foreign body-associated sialoadenitis of submandibular gland is very rare within the literature. In this study, the authors presented a patient having an unrecognized foreign body in the submandibular gland beside the duct that was causing chronic sialoadenitis. Foreign bodies must be explored and all suspected areas must be examined carefully for avoiding secondary problems and surgeries in the future.

Permanent Quadriplegia Following Replacement of Voice Prosthesis.

The authors presented a patient with quadriplegia caused by cervical spine abscess following voice prosthesis replacement. The authors present the first reported permanent quadriplegia patient caused by voice prosthesis replacement. The authors wanted to emphasize that life-threatening complications may be faced during the replacement of voice prosthesis. Care should be taken during the replacement of voice prosthesis and if some problems have been faced during the procedure patients must be followed closely.

Noninvasive Treatment of Acquired Subglottic Stenosis.

A 23-day-old infant referred to the neonatal intensive care unit with difficulty breathing and inspiratory stridor increasing with exercise. Medical history included a cardiothoracic surgery for transposition of the great arteries, patent ductus arteriosus, atrial septal defect, and a history of intensive care unit from surgery. Flexible fiberoptic transnasal laryngoscopy revealed subglottic stenosis that was probably caused by prolonged intubation with a higher airway pressure. Computed tomographic scan of the neck showed a tiny stenosis without cartilage deformity and limited in subglottic region. Tracheotomy and external open surgery was found risky for sternal wound infection or mediastinitis as the neonate had newly thoracotomy. The patient had a balloon dilation under general anesthesia without intubation. Presenting symptoms of the neonate were fully improved with balloon dilation.

The role of drug-induced sleep endoscopy in surgical planning for obstructive sleep apnea syndrome.

This study investigated the role of drug-induced sleep endoscopy (DISE) in the surgical treatment planning of patients with obstructive sleep apnea syndrome (OSAS). This study was conducted using patients diagnosed with OSAS between January 2007 and March 2009, who were scheduled for surgical treatment. DISE was performed using propofol in patients considered to have upper respiratory tract obstruction as indicated by Muller's maneuver. After completing the sleep endoscopy, the patient was intubated and surgery was performed (tonsillectomy and uvulopalatopharyngoplasty). A successful operation was defined as a decrease in the respiratory disturbance index to below 5 or a decrease of ≥50 % following the operation. The study included 20 patients (4 female and 16 male) aged 19-57 years. No statistically significant correlation between modified Mallampati class and operation success or between the polysomnographic stage of disease and operation success was identified. A significantly high operation success rate was found in the group with obstruction of the upper airway according to DISE (p < 0.05), whereas a significantly low operation success rate was found in the group with obstruction of the lower airway according to DISE (p < 0.01). DISE may be used to identify the localization of obstruction for diagnostic purposes, and it can be helpful in selecting the treatment method.