Comparing the Effects of Tongue-In-Groove and Septocolumellar Suture With Short and Floating Columellar Strut of Open Rhinoplasty on Nasal Tip Rotation and Projection.

PURPOSE: In rhinoplasty, it is important to maintain the desired tip projection and rotation. The aim of the present study was to compare the tongue-in-groove (TIG) method and the septocolumellar suture method with short and floating columellar strut methods over a six-month follow-up period. METHODS: A total of 69 patients were evaluated. The TIG method was used on 39 patients (group 1, TIG group), and the remaining 30 patients received septocolumellar suture supported with short and floating columellar strut (group 2, suture + graft group). Standardized right profile images were taken preoperatively and 6 months after the operations. Goode's method and nasofacial angle were used to evaluate nasal tip projection, and the nasolabial angle was measured to evaluate tip rotation. The outcomes of the 2 surgical approaches were compared, and P values lower than 0.05 were considered significant. RESULTS: Although nasal tip rotation in the postoperative sixth month was higher than that in the preoperative period in both groups (TIG: 96.8° vs 108.2° and suture + graft: 100.8° vs 104.2°, respectively), this change was significant only in the TIG group (P < .001). Goode's ratio increased significantly in both groups compared with the postoperative period (TIG: 0.62 vs 0.57 and suture + graft: 0.62 vs 0.58; P < .001 and .047, respectively). On the other hand, nasofacial angle decreased significantly in both groups compared with the postoperative period (TIG: 147.8° vs 144.0° and suture + graft: 149.1° vs 146.3°; P < .001). CONCLUSIONS: As per the results of the present study, both studied methods can be safely used in nasal tip surgery. Compared with the septocolumellar suture + columellar strut method, the TIG method resulted in a higher rotation increase. Both methods led to significant increases in projection, and these increases did not differ between the groups.

Traction Suture Technique for Correction of Caudal Septal Deviation.

OBJECTIVES: Correcting the caudal septum deviation is one of the most difficult parts of the septoplasty. The aim of the present study was to evaluate the efficiency and usefulness of traction suture method in caudal septum deviations. METHODS: Medical records of 35 patients who underwent endonasal septoplasty using traction suture method for caudal septum deviation in August 2017-February 2019 period were studied retrospectively. Preoperative nasal obstruction symptom evaluation (NOSE) scores of the patients were compared with postoperative sixth month NOSE scores. Besides, preoperative nasal examination findings of the patients were compared with the ones in postoperative period. RESULTS: Average age of the 35 patients (9 women and 26 men) in the study was 26.3 ±â€Š10.1 years. Postoperative observations revealed that a straight septum was achieved in 31 patients (91.1%). Average pre- and postoperative NOSE scores were 85.1 ±â€Š20.4 and 22.4 ±â€Š4.2, respectively (P < 0.0001). Nasal obstruction was "much improved" in 19 patients (54.2%) and "improved" in 12 (37.1%), while 4 patients (8.6%) reported "no change." None of the patients developed postoperative complications. CONCLUSIONS: Traction suture method is a safe, efficient, and useful option to be used by surgeons for caudal septum deviation.

Double-Layered Closuring to Repair an Oroantral Fistula Using Septal Cartilage and Buccal Fat Pad.

ABSTRACT: Oroantral fistula (OAF) is a pathological connection between the maxillary sinus and oral cavity, and it usually occurs after tooth extraction. Proper repair of OAF is important for the prevention of recurrences. The present case offers a technique of OAF repair using septal cartilage and buccal fat pad for the repair of the defect after excision of fistula tract. This double-layered closure is a new technique that could be used to repair chronic OAF.

Surgical Outcomes of Bony Batten Grafting Through Endonasal Septoplasty in the Correction of Caudal Septum Deviation.

OBJECTIVE: The aim of the present study was to evaluate the efficiency and usefulness of bony batten grafts through endonasal septoplasty in the correction of caudal septum deviations. METHOD: In this case-controlled retrospective study, 65 patients who had bony batten graft procedure for the correction of caudal septum deviation using endonasal septoplasty with complete pre-operative and post-operative questionnaire information and complete post-operative follow-up data (an average follow-up period of 24.1 months) in our hospital in September 2013 and August 2018 period were evaluated. Nasal Obstruction Symptoms Evaluation (NOSE) scores of the patients before and after the operation were compared. Besides, severity of nasal symptoms (mouth dryness, hyposmia, rhinorrhea, epistaxis and snoring) before and after the operation was compared using visual analog scale (VAS). Complications which developed in post-operative period were also analyzed. FINDINGS: Average age of the 65 patients (14 female and 51 male) was 27.6 ±â€Š11.3. A straight septum was achieved in 57 patients (87.6%) in post-operative period while 8 patients (12.4%) had residual deviation. Average pre-operative NOSE score was 79.8 ±â€Š22.3 while average post-operative NOSE score was 21.4 ±â€Š4.6 and the difference was significant (P < 0.0001). Significant improvements were observed in VAS scores of all evaluated symptoms in post-operative period. Two patients developed septal hematoma in post-operative period. CONCLUSION: Bony batten graft procedure through endonasal septoplasty is an efficient and useful method with low complication rate for the correction of deviation of caudal septum.

A Very Rare Localization of Rhinolith: Fossa of Rosenmuller.

Sixty-five-year old male patient applied to our clinic with nonspecific complaints such as tinnitus, otalgia, headache, halitosis, and persistent globus pharyngeus which had been continued for 5 years. His complaints persisted despite different extensive treatments. In nasoendoscopy, a yellow-colored mass with purulent discharge around was observed in eustachian tube opening in left fossa of Rosenmüller. Computed tomography scan showed a mass of 6 × 6 mm size in left fossa of Rosenmüller. After excision of the mass under local anesthesia, significant reductions were observed in patient's symptoms. Histopathology of the mass was reported as rhinolith. Although fossa of Rosenmüller is a quite rare localization for rhinoliths, it needs to be considered in differential diagnosis of patients with nonspecific symptoms such as halitosis, globus pharyngeus, and otalgia. This report represents a patient with rhinolith localized in fossa of Rosenmüller as the 2nd report in the literature.

Does being a healthcare professional affect satisfaction after septorhinoplasty?

This study aims to determine the differences in satisfaction levels after septorhinoplasty between patients who are healthcare workers and those who are not. The study includes patients who underwent primary septorhinoplasty surgery, divided into two groups: healthcare workers and non-healthcare workers. The Rhinoplasty Outcome Evaluation (ROE) questionnaire was administered to the patients at the 6th postoperative month. Among the 37 patients, 18 were healthcare workers, and 19 were non-healthcare workers. The mean Rhinoplasty Outcome Evaluation score for healthcare workers at the 6th postoperative month was 75.69 ± 16.06, while in the non-healthcare worker group, the ROE scores were 60.31 ± 27.69. The findings from our study indicated that individuals in the healthcare profession exhibited significantly greater satisfaction rates following septorhinoplasty in comparison to those in the non-healthcare worker group, with a statistically significant difference noted (p: 0.046). Having more knowledge about septorhinoplasty surgery and its complications among healthcare workers may allow for more realistic expectations regarding the surgical intervention. Simultaneously, it may facilitate better communication with the surgeon and the expression of expectations. Clinicians should pay attention not only to the patient's intellectual level but also to their health literacy in communication with the patient.

Fat graft myringoplasty with the newly developed surgical technique for chronic tympanic membrane perforation.

The purpose of this prospective clinical trial was to evaluate the success rate of our newly developed surgical technique for fat graft myringoplasty (FGM). We also aimed to assess the correlations between the size of perforations and closure rates, as well as the results of re-gained hearing in successful cases with respect to sizes of perforations. Thirty consecutive patients with persistent tympanic membrane perforation were included in this study. All patients underwent fat graft myringoplasty with a newly developed technique. Treatment success was defined as an intact tympanic membrane (TM) at the 3-month follow-up visit. Bone conduction (BC) and air conduction (AC) thresholds at the frequencies of 0.5, 1, 2, 3, and 4 kHz were recorded preoperatively and at the 3rd month postoperatively. The range of perforation sizes among the 30 patients was 7 mm in 13 of the patients (43 %), 6 mm in 8 of the patients (27 %), and 5 mm in nine of the patients (30 %). Closure of tympanic membrane perforations with this new technique was achieved in 27 out of the 30 patients, with a success rate of 90 %. The average of the air-bone gap (dB) was similar in preoperative and postoperative periods for 5- and 6-mm sized perforation groups (p = 0.09 and p = 0.49). However, in the 7-mm sized perforation group, the average of the air-bone gap (dB) was higher in the preoperative period than the postoperative period (p = 0.004). The average of the air-bone gap (dB) for all patients was higher in the preoperative period than the postoperative period (p = 0.001). In conclusion, FGM performed with this technique may be used as an alternative for the closure of tympanic membrane perforations larger than 5 mm.

Development of the sphenoid sinus from newborn to age 18: A computed tomography imaging analysis.

OBJECTIVES: The sphenoid sinus (SS) is an important anatomical formation in terms of its location and relationship with important neurovascular structures. It is essential to evaluate the pneumatization and dimensions of the SS with Computed Tomography (CT) in the preoperative period of transsphenoidal interventions to be performed on tumors located in this region. The aim of this study was to evaluate the correlation of the volume and dimensions of the SS measured with CT with age in the period from birth to 18 years of age. METHODS: In this retrospective study, a total of 360 brain, paranasal sinus, temporal bone and maxillofacial CT scans of individuals from birth to 18 years of age were evaluated. The cohort was divided into 18 groups with 20 (10 female, 10 male) patients in each age group. The height, width, length and volume values of the SS were measured on CT and their correlations with age and the differences between genders were evaluated statistically. RESULTS: It has been determined that the increases in the size and volume of the SS accelerate especially between 1 and 2 years of age and begins to reach adult dimensions after 12 years of age. Height and length of the sphenoid sinus showed a high correlation coefficient (r = 0.717 and r = 0.731 respectively) with age, while its width and volume showed a moderate correlation coefficient (r = 0.662 and 0.543 respectively). There was no statistically significant difference between the genders in terms of SS height, width, length and volume. CONCLUSIONS: SS dimensions and volume showed a logaritmic growth pattern from birth to 18 years. The results of this study may help to better understand the normal development of SS in children and may serve as a reference for more comprehensive CT studies. In addition, it can help surgeons to evaluate the developmental characteristics of SS in surgical interventions for SS in children.

Evaluation of the Association between Paranasal Sinus Osteomas and Anatomic Variations Using Computed Tomography.

OBJECTIVE: The pathogenesis of paranasal sinus osteoma (PSO) has not been fully elucidated. It is thought that both embryological and developmental factors play a role in the etiology. The aim of the present study was to investigate the association of frequency and localization of PSOs detected on computed tomography (CT) examination with osteoma presence. METHODS: In this retrospective study conducted in December 2017 through March 2020 in Gaziosmanpasa University Faculty of Medicine, images of a total of 18,867 patients who underwent paranasal sinus, maxillofacial CT and brain CT angiography were reviewed for the presence of PSOs. Sizes of PSOs and accompanying mucosal pathologies were identified. Associations between PSOs and paranasal sinus variations were evaluated statistically compared to the control group (200 patients without PSO). RESULTS: A total of 176 patients (0.92%) were found to have PSO. Average age of the patients with PSO was 59.9 years (range: 18-93). PSOs were unilateral in 152 patients while 24 patients had multiple osteomas. Female/male ratio was 1.1/1. PSOs were most commonly located in the frontal sinuses. Frequencies of vertical concha bullosa, secondary middle turbinate, twisted uncinate, supraorbital ethmoid cell, intersinus septal cell, ethmoidomaxillary cell, Haller's cell, frontal sinus hypoplasia and sphenoid sinus hypoplasia were significantly higher in the patient group compared to the control group. CONCLUSION: Higher or lower incidence rates of some anatomic variations in the patients with PSO could be explained by the possible effects of genetic and/or environmental factor. Additional studies are needed to evaluate these possible associations.

Caudal Septal Division and Batten Graft Application: A Technique to Correct Caudal Septal Deviations.

OBJECTIVE: The aim of the study was to evaluate the surgical outcomes in patients who underwent in one session caudal septal division, strip excision and unilateral bony batten graft procedures, a method described for the correction of caudal septal deviations. METHODS: In this retrospective study, 27 patients with C-shaped caudal septal deviation who underwent endonasal septoplasty using caudal septal division, strip excision and unilateral bony batten grafting in our hospital in the period from August 2014 through October 2018 were reviewed. Patients were included in the study if their pre-operative and post-operative questionnaires and post-operative follow-up data (average follow-up period was 13.9 months) were available in full. RESULTS: The average age of the 27 patients (6 women and 21 men) was 29.6±12.4 years. Postoperative observations revealed that a straight septum was achieved in 23 patients (85.1%). Average pre- and post-operative Nasal Obstruction Symptom Evaluation (NOSE) scores were 85.1±20.4 and 22.4±4.2, respectively (p<0.0001). Septal hematoma developed in one patient in the postoperative period. CONCLUSION: The surgical outcomes of patients in whom we used caudal septal division, strip excision and unilateral bony batten graft to correct caudal septal deviations demonstrated the potential of this technique as an alternative to be used by surgeons.

Maxillary sinus fungus ball as a cause for facial pain: Analysis of three cases.

The development of a sinus fungus ball (FB) is a form of non-invasive fungal sinusitis that generally affects immunocompetent individuals. In this report, 3 cases of maxillary sinus FB are described, including 1 bilateral maxillary sinus case. The fungal debris was cleared using endoscopic sinus surgery in each case. No recurrence was observed in follow-up at the 6th, 7th, or 26th month. The headache and facial pain symptoms of the patients improved. Efficient cleansing of the maxillary sinus, particularly the anterior wall, improves the recurrence ratio.

Management of foreign bodies in the ear, nose and throat in children: a review of 829 cases from Northern Anatolia.

<b>Objective:</b> The aim of this study was to evaluate cases of of ear, nose and pharyngeal (ENT) foreign body (FB) in pediatric patients referred to the pediatric emergency department of the Department of Otorhinolaryngology in Tokat State Hospital (Turkey). <br><b>Methods:</b> The paper comprises a retrospective study of all ENT foreign bodies presented to the pediatric emergency Department of Otorhinolaryngology in Tokat State Hospital (Turkey) between January 1, 2012 and December 31, 2018. Subject to evaluation were also demographic and clinical characteristics of the patients, types and anatomic locations of FBs, locations of FB by age groups, the method used to remove FBs and the distribution of FB cases by months. <br><b>Results:</b> A total of 829 FB cases were evaluated in this study. The mean age of patients was 47.8 ± 31.4 months. Of all patients, 404 (48.5%) were male, and 425 (51.2%) were female. The nose (58.7%) and the ear (20.2%) were the most common anatomical locations followed by mouth/pharynx/tonsil (12.3%), esophagus (6.2%) and the laryngotracheobronchial tree (2.4%). The most common FBs in different locations were beads in the nose (30.8%), beads in the ear (32.1%), fishbones in the mouth/pharynx/tonsil (56.8%), nuts and peanuts in laryngotracheobronchial tree (70%) and a coin/disc battery in the esophagus (80.7%). <br><b>Conclusion:</b> FB in ENT is among the emergency conditions that require different diagnostic and treatment approaches based on anatomic localizations. Proper vision, adequate equipment and immobilization are important in the removal of ENT foreign bodies in children.

Frontal recess osteoma causing severe headache.

Frontal sinus osteomas are benign and well-defined masses that may cause various symptoms when they press on the surrounding tissues. Paranasal sinus osteoma is seen as a well-defined mass showing high opacity in Computed tomography. In this case study, we presented here a 53-year-old frontal recess osteoma with severe headache filling the left frontal recess in the context of the literature.

Rhinolith: Examining the clinical, radiological and surgical features of 23 cases.

OBJECTIVE: Rhinolith is a hard nasal mass formed in time by the mineral salts around an endogenous or exogenous-originating nidus. Rhinolith, which is seen rarely, has been reported in the literature as case reports. In this study, we are presenting the demographic and clinical features together with accompanying sinonasal pathologies of 23 rhinolith cases. METHODS: The medical records and radiological findings of 23 cases, who were operated for rhinolith between January 2010 and June 2018 in Tokat State Hospital, were analyzed retrospectively. The age, gender, the side where rhinolith exists, nidus presence, type of surgery and sinonasal pathologies that accompany rhinolith, and accompanying secondary sinonasal surgeries were examined. RESULTS: A total of 17 (73.2%) of the 23 cases were female, and 6 (26.8%) were male. The mean age was 24.9 years. The symptoms that were seen in the patients were nasal obstruction (100%), rhinorrhea (82.6%), nasal malodor (78.2%), oral malodor (26%), headache (26%), epistaxis (17.3%), face pain (4,3%), respectively. Nidus could be detected in 6 patients. The most frequent localization of rhinolith was between the inferior concha and the nasal septum (n=21). The most common concomitant sinonasal pathology in rhinolith was septum deviation (43.4%); and the second most common pathology was mucosal thickening (30.4%) in the maxillary sinus. The surgery type that accompanied rhinolith at the highest frequency was septoplasty (n=5). Other surgeries were septorhinoplasty (n=1), antrochoanal polyp excision (n=1), adenoidectomy (n=1). CONCLUSION: The most common symptoms of rhinolith, which is a rare nasal pathology, are nasal obstruction and rhinorrhea. Radiological imaging together with a rigid endoscopy is important especially to evaluate the placement of rhinolith. In addition to this, radiological imaging, evaluation of the sinuses that are not sufficiently evaluated with rigid endoscope are important for planning the type of the operation and secondary surgical procedures which may accompany.

Isolated vocal cord hematoma developing after blunt neck trauma.

INTRODUCTION: Blunt laryngeal trauma is a rare causes of emergency applications. Early diagnosis and treatment are important. CASE PRESENTATIONS: A 62-year-old woman applied to emergency department with pain over the larynx, hoarseness and dysphagia that starting after blunt laryngeal trauma. The patient had no respiratory distress. There was no ecchymosis and edema in the laryngeal area. Computed tomography showed no thyroid and cricoid cartilage fractures. Isolated hematoma was seen in the left vocal cord at the endoscopic view. CONCLUSION: Endoscopic examination is important when there is no obvious physical examination finding on the in blunt neck trauma.

Evaluation of neutrophil/lymphocyte ratio and platelet/lymphocyte ratio in recurrent epistaxis in childhood: case controlled study.

INTRODUCTION: the aim of this study was to investigate the possible relationship of neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) and routine hematological parameters with recurrent epistaxis in children. METHODS: In this retrospective case-controlled study, 294 patients aged between 2 and 18 years who applied to the Tokat State Hopital Ear Nose Throat Clinic due to recurrent epistaxis between January 1st 2013 and December 31st December 2017 and 329 sex-and age-matched controls were investigated. RESULTS: NLR was 1.45±0.75 in the study group and the 1.35±0.7 in the control group. There was no significant difference between the groups (p>0.05). PLR values were found significantly (p<0.05) higher in the study group than in the control group (103,21±29.57 vs. 97,3±30.38). Red Blood Cell Distribution Width (RDW) values were found significantly (p<0.05) lower in the study group than in the control group (39,56±2,87 and 38,92±2,46). CONCLUSION: the increase of PLR, an inflammatory marker, in epistaxis supports the effect of inflammatory factors in the etiology of epistaxis. However, more study in future is needed to support this.

Comparison of Routine Histopathological Examination Results in Children and Adults After Tonsillectomy and/or Adenoidectomy.

OBJECTIVE: Tonsillectomy and/or adenoidectomy is one of the most common otolaryngologic surgical procedures. There is still an ongoing debate as to whether or not histopathological examination should be performed in which cases after these surgeries. The aim of this study is to compare the histopathologic examination results of routine tonsillectomy and/or adenoidectomy surgical specimens of children and adults. METHODS: The routine histopathological examination results of patients who had adenoidectomy and/or tonsillectomy between April 2010 and April 2017 in Tokat State Hospital were evaluated from medical records retrospectively. The results were compared in terms of malignancy between children and adult patients. RESULTS: A total of 1849 histopathological examination results were included in the present study. Of the patients, 1574 were children, and 275 were adults. All of the patients who underwent adenoidectomy were diagnosed with reactive lymphoid hyperplasia. Of the 1356 patients who underwent tonsillectomy, only two were detected with malignancies. These two patients were adults. CONCLUSION: While routine histopathologic examination is necessary for every case in adult population, risk factors should be considered in pediatric patients after tonsillectomy and/or adenoidectomy.

Protective effects of melatonin and selenium against apoptosis of olfactory sensory neurons: A rat model study.

BACKGROUND: Selenium plays a role in the prevention of oxidative damage and has been linked to regulatory functions in cell growth, apoptosis, cell survival, and cytotoxicity. Melatonin has an antioxidant effect, which protects against a number of free radical species. Given its antioxidant properties, melatonin has been widely known to inhibit neuronal apoptosis. We examined the cytoprotective effects of melatonin and selenium in rat olfactory sensory neurons after rhinosinusitis by immunohistochemical evaluation of olfactory bulb mucosa. METHODS: Rhinosinusitis was induced bilaterally in 24 animals. Twenty-four rats were randomly divided into three equal groups. The melatonin group was treated with intraperitoneal (i.p.) melatonin and ampicillin-sulbactam, the selenium group was treated with i.p. selenium and ampicillin-sulbactam, the antibiotic group was treated with i.p. ampicillin-sulbactam; all three groups were treated for 10 days. After a period of 10 days of treatment, the animals were killed for immunohistochemical analyses. All olfactory bulb mucosae were removed immediately. RESULTS: No histochemical differences were found in the three groups. Terminal deoxynucleotidyl transferase 2'-deoxyuridine 5'-triphosphate nick end labeling-positive cells were detected in each group. In the antibiotic group, the appearance of apoptotic cells was higher, whereas the number of apoptotic cells significantly decreased in the melatonin group. When compared with the selenium group, fewer terminal deoxynucleotidyl transferase 2'-deoxyuridine 5'-triphosphate nick end labeling-positive cells were observed in the melatonin group, which was not significant. In the antibiotic group, the cytoplasmic active caspase-3 and Bax immunostaining in the olfactory epithelium and glandular cells of stroma were higher when compared with the immunostaining in melatonin and selenium groups. Active caspase-3 and Bax immunostaining in the subepithelial stroma was dramatically reduced in the melatonin group. In contrast, the staining intensity and the number of Bcl-2 immunopositive cells were significantly increased in the melatonin group. In the selenium group, Bax and active caspase-3 were moderately immunopositive in the epithelium and subepithelial stroma. However, Bcl-2 immunostaining was more pronounced in the olfactory epithelium and some stromal cells. CONCLUSION: Our results indicated the possibility that the supplementation of melatonin and selenium, two antioxidant agents for the treatments in the rhinosinusitis rat model, might be reduced or prevent anosmia.

Manganese-superoxide dismutase and glutathione peroxidase 1 polymorphisms in recurrent tonsillitis and tonsillar hypertrophy.

OBJECTIVES: To investigate the association of manganese-superoxide dismutase and glutathione peroxidase 1 polymorphisms with susceptibility to recurrent tonsillitis and tonsillar hypertrophy. METHODS: The study consisted of 103 patients with recurrent tonsillitis, 105 patients with tonsillar hypertrophy and 106 control subjects with similar age and sex. Genomic DNA was extracted from peripheral leukocytes of whole blood which were obtained from all patients and control subjects. Genotyping was performed to identify MnSOD Ala-9Val and GPx1 Pro198Leu polymorphisms by a method based on PCR amplification and detection of polymorphisms with hybridization probes labeled with fluorescent dyes. Genotype and allele frequencies were compared between patients with recurrent tonsillitis and tonsillar hypertrophy and 106 healthy control subjects. RESULTS: The genotype distribution of the MnSOD Ala-9Val single nucleotide polymorphism was significantly different for the controls and the recurrent tonsillitis patients (P=0.009). Whereas, no significant difference was found between the patients with tonsillar hypertrophy and the control group (P=0.369). The frequency of the MnSOD CC genotype was lower, and that of the T allele was significantly higher, in recurrent tonsillitis patients than in control subjects. In addition, the frequency of tonsillitis was significantly higher in recurrent tonsillitis patients with the MnSOD Ala-9Val polymorphism than the patients with wild-type (P=0.008). Also, no significant difference was found between patient groups and control subjects in the distribution of the genotype and allele frequency of the GPx1 Pro198Leu single nucleotide polymorphism. CONCLUSIONS: The MnSOD Ala-9Val polymorphism causes susceptibility to recurrent tonsillitis in Turkish children. And we suggest that there may be a possible relation between local and recurrent infections or inflammation of the tonsillar tissue and the MnSOD Ala-9Val single nucleotide polymorphism in pediatric patients with RT.