Internal Nasal Valve Expanding Graft for Middle Vault Reconstruction.

Various surgical techniques and approaches for addressing nasal valve collapse have been described in the literature. Still, new techniques continue to be developed and old techniques continue to be improved upon. The aim of the present study was to validate the use of the internal nasal valve expanding graft for middle vault reconstruction and to review the authors' experience using this technique. A total of 32 patients who underwent middle vault reconstruction were retrospective reviewed. Analysis using Visual Analogue Scale (VAS) and Nasal Obstruction Symptom Evaluation (NOSE)-scale was performed pre- and postoperatively. Visual Analogue Scale scores for nasal airflow per side were collected on a 10-point scale, with 1 indicating total obstruction and 10 indicating a perfect nasal airway. Nasal Obstruction Symptom Evaluation scale was used to assess nasal obstruction. Minimum follow-up period was 6 months after the operation. Pre- and postoperative VAS scores were used to assess degree of nasal valve collapse according to examination findings. It was significant that there was improvement in nasal valve collapse after surgery (P < 0.05). Based upon pre- and postoperative calculations made using NOSE scores, there was significant improvement regarding nasal blockage or congestion, troubled breathing and sleeping, and air through nose during exercise, respectively (P < 0.05). No complications in terms of septal perforation, hematoma, synechiae, or infection that required further intervention were noted at postoperative follow-ups. In conclusion, internal nasal valve expanding graft has now been shown to be successful for middle vault reconstruction in a group of appropriately selected patient.

Superficial Parotidectomy Versus Partial Superficial Parotidectomy: A Comparison of Complication Rates, Operative Time, and Hospital Stay.

PURPOSE: The type and extent of surgery for benign parotid tumors are a subject of debate. We aimed to measure and compare hospital stay, operative time, and complication rates associated with superficial parotidectomy (SP) and partial superficial parotidectomy (PSP). MATERIALS AND METHODS: This retrospective cohort study included all patients who underwent surgery for benign parotid gland tumors in our tertiary center between January 2006 and March 2014 and were followed up for at least 3 years. The predictor variable was the type of parotidectomy, and the main outcome parameters were operative time, hospital stay, and postoperative complications. The demographic characteristics (age and gender), clinical history, and preoperative findings were obtained from patient records. The Kolmogorov-Smirnov test, Mann-Whitney U test, and χ2 test were used to analyze the data. P < .05 was considered statistically significant. RESULTS: The sample was composed of 321 patients (184 men and 137 women) with a mean age of 54.0 ± 14.7 years (range, 18 to 87 years). Of these, 190 underwent SP and 131 underwent PSP. Pleomorphic adenoma was the most common tumor (83 patients, 53%), followed by Warthin tumor (50 patients, 32%). The mean hospital stay was 6.7 ± 2.3 days in the SP group and 4.8 ± 2.4 days in the PSP group (P < .001). The mean operative times in the SP and PSP groups were 134.0 ± 24.6 and 92.1 ± 21.9 minutes, respectively (P < .001). The overall complication rates were 21.6% and 12.2% in the SP and PSP groups, respectively (P = .031). No tumor recurrence was observed in either group. CONCLUSIONS: Compared with the SP group, the PSP group had shorter operative and hospital stay durations and fewer postoperative complications with a comparable recurrence rate. Therefore, PSP should be considered in suitable cases.

Endoscopic Repair of Persistent Oroantral Communications Using the Caldwell-Luc Approach.

In this article, a novel endoscopic technique used to close oro-antral fistulas will be described. In the technique described here, 24 cases were surgically treated between May 2011, and November 2014. Under endonasal endoscopic examination following partial inferior uncinectomy, the natural ostium of the maxillary sinus was identified; through this tract, a curved aspirator was advanced into the sinus. If present, we extracted endoscopically tissues causing obliteration of the ostium through the Caldwell-Luc antrostomy, taking care to preserve the integrity of the natural ostium. In the technique described here, endoscopic examination using the Caldwell-Luc approach, the inside of the maxillary sinus is explored fully, existing infection and polyps are eliminated locally, and natural patency of the maxillary sinus ostium can be achieved. The graft used to obliterate the oroantral fistula can be easily harvested from the bone of the anterior wall of the maxillary sinus by accessing the surgical entry tract.

The effects of hypotensive anaesthesia on otoacoustic emissions: a prospective, randomized, double-blind study with objective outcome measures.

The aim of the present study was to compare pre- and post-operative otoacoustic emission examinations of patients who experienced surgery under hypotensive anaesthesia using distortion product otoacoustic emission (DPOAE) and transient evoked otoacoustic emission (TEOAE). Forty-one patients, admitted to our tertiary centre for nasal valve surgery, were prospectively and randomly assigned into two groups. Hypotensive group included 20 patients, while control group included 21 patients. All investigators and patients were blinded to anaesthesia assignment throughout the course of the study. DPOAEs and TEOAEs were performed before surgery and repeated after 15 days in both groups. In control group, DPOAE-DP1 levels per frequency increased significantly in the post-operative period when compared with the pre-operative values in all patients. However, DPOAE-DP1 levels decreased significantly in hypotensive group. Similarly, DPOAE-SNR levels per frequency decreased significantly in hypotensive group. In conclusion, we have observed that under the influence of hypotensive general anaesthesia, the amplitudes of OAEs are affected.

Prevertebral space invasion in head and neck cancer: negative predictive value of imaging techniques.

OBJECTIVE: This study evaluated the diagnostic value of magnetic resonance imaging (MRI) and computed tomography (CT) in prevertebral space invasion in patients with head and neck squamous cell carcinomas (HNSCC). SUBJECTS AND METHODS: This study retrospectively reviewed 197 patients with advanced primary laryngeal or hypopharyngeal carcinoma who underwent laryngectomy and neck dissection at our institution. The MRI and CT findings were compared with the surgical findings and postoperative pathology. RESULTS: In 191 patients, the macro- and microscopic margins of the surgical specimens were tumor-free. In the remaining 6 patients, prevertebral space involvement was observed intraoperatively. MRI predicted the absence of prevertebral fascia invasion in 40 of 42 patients with a negative predictive value of 100% and specificity of 95.2%, while the negative predictive value and specificity of CT were 99.2% and 88.2%, respectively. CONCLUSION: Preservation of the retropharyngeal fat plane on MRI reliably predicts the absence of prevertebral space fixation in patients with advanced HNSCC.

Transection of Nasolacrimal Duct in Endoscopic Medial Maxillectomy: Implication on Epiphora.

OBJECTIVE: Management of the nasolacrimal system is usually recommended during medial maxillectomy via external approach because of reported higher rates of postoperative epiphora. Association of the endoscopic medial maxillectomy (EMM) with epiphora, however, is not clearly stated. In this study, we attempted to evaluate whether patients develop epiphora after simple transection of the nasolacrimal duct during EMM. PATIENTS AND METHODS: Medical records of 26 patients who underwent endoscopic tumor resection for inverted papilloma (IP) were retrospectively reviewed. Patients who underwent EMM with nasolacrimal canal transection were included and recalled for lacrimal system evaluation. Twelve patients were eligible for inclusion and fluorescein dye disappearance test (FDDT) was performed for each patient. Patient demographics, tumor data, surgical procedures, and follow-up time were recorded. RESULTS: Of the 12 patients included in the study, 6 underwent canine fossa transantral approach concurrently with EMM. The mean duration of follow-up was 21.1 months (range, 6-84 months). Eight patients were graded as 0, whereas 4 patients were graded as 1 according to FDDT. All test results were interpreted as negative for epiphora. All patients were completely symptom free of epiphora. CONCLUSIONS: Epiphora after EMM with nasolacrimal canal transection among patients with sinonasal tumors appears to be uncommon. Therefore, prophylactic concurrent management of nasolacrimal system including stenting, dacryocystorhinostomy (DCR), or postoperative lacrimal lavage are not mandatory for all patients.

Tortuosity of the internal carotid artery detected during tonsillectomy: two case reports.

Tonsillectomy is one of the most common performed surgical procedures in childhood. Tortuosity of the internal carotid artery (ICA) is an anatomical variation of the course of the ICA, and can be seen at any levels along the course of the artery, even in lateral oropharyngeal wall. In this article, we present two cases in which ICA tortuosity detected as a pulsating mass in the lateral oropharyngeal wall in an eight-year and a five-year-old girls, during tonsillectomy.

Behcet's disease impairs voice quality without laryngeal and hypopharyngeal involvement.

The objective of the study was to investigate voice evaluation parameters in Behcet's disease patients. A prospective controlled study was performed in a tertiary referral center. A total of 31 patients (21 female, 10 male) with a diagnosis of Behcet's disease had voice evaluations by means of laryngostroboscopy, acoustic analysis, aerodynamic measurements and perceptual assessment. Data obtained from the patients were compared to 31 healthy control subjects. Laryngeal endoscopy was within normal limits in all patients. The mean fundamental frequency in male control subjects (134 ± 14 Hz) was significantly higher than in male patients (124 ± 20 Hz), (p = 0.043). Mean intensity was significantly higher in control subjects (74 ± 5 dB) than in the patients (63 ± 4.6 dB), (p < 0.001). Shimmer in patients (3.4 ± 2.5) was significantly higher than in control subjects (2 ± 1.3), (p = 0.01). Maximum phonation time in control subjects (25 ± 5.8 s) was significantly longer than in patients (20 ± 7.9 s), (p = 0.007), and s/z ratio was found to be nearly equal between patients (0.9 ± 0.2) and control subjects (0.96 ± 0.1), (p > 0.05). The patients showed a mean GRBAS score of 1.8 ± 1.9 and the control group showed a mean score of 0.48 ± 1.06, (p = 0.002). The VHI-10 scale revealed a mean score of 2.2 ± 4.8 in BD patients and 2 ± 2 in control subjects (p > 0.05). Behcet's disease impaired voice quality without laryngostroboscopically visible laryngeal and hypopharyngeal involvement. This impairment was documented by objective voice evaluation methods including acoustic analysis and aerodynamic voice measurements and by subjective voice evaluation method including perceptual assessment.

Clinical and laboratory findings of tularemia: a retrospective analysis.

OBJECTIVES: This study aims to define demographic characteristics and clinical and laboratory findings of the patients with tularemia and to assess the treatment outcomes. PATIENTS AND METHODS: A total of 58 consecutive patients (26 males, 32 females; mean age 37±22 years; range 6 to 80 years) with tularemia were retrospectively analyzed in this study. Demographic characteristics, laboratory findings, physical examination findings and treatment outcomes were recorded. RESULTS: Forty patients (86.2%) had glandular tularemia; seven (12.1%) had oropharyngeal tularemia, and one (1.7%) patient had oculoglandular tularemia. The most common symptoms were swollen neck lymph nodes high fever and sore throat. Fifty seven patients (98.2%) had swollen neck lymph nodes; 39 (67.2%) patients had high fever (67.2%) and 36 (62.1%) patients had sore throat. Complete recovery was obtained in 45 patients (77.6%), while 13 (22.4%) were unresponsive to the treatment. The most frequent laboratory findings were high level of C-reactive protein (CRP) and increased erythrocyte sedimentation rate (ESR). Mean leukocyte counts, aspartate aminotransferase (AST), alanine aminotransferase (ALT), urea and creatinine levels were within normal range in all patients. CONCLUSION: Tularemia should be differentiated from upper respiratory tract infections and cervical lymphadenopathy. The most commonly used hematological and biochemical assays do not provide significant benefits for the diagnosis of tularemia. However, increased level of ESR and CRP at one month may support the diagnosis. Early diagnosis and appropriate treatment may prevent therapeutic failure.

The Role of Serum Adhesion Molecules s-ICAM-1 and s-VCAM-1 in Chronic Otitis Media Pathogenesis: A Prospective Controlled Study.

The aim of this study was to determine the levels of soluble intracellular adhesion molecule-1 (s-ICAM-1) and soluble vascular cell adhesion molecule- 1 (s-VCAM-1) in patients with chronic otitis media (COM) according to the disease profile and to compare with ears without otitis media. Eighty-nine patients had ear surgery were included in the study prospectively. 78 patients who underwent tympanomastoidectomy included in the study group and 11 patients who underwent exploratory tympanotomy included in the control group prospectively. The level of s-ICAM-1 and s-VCAM-1 measured with ELISA technique. s-ICAM-1 and s-VCAM-1 levels compared between COM specific diseases group and with the control group. Levels of s-ICAM-1 and s-VCAM-1 measured as 584.5 ± 165.3 ng/ml and 541.1 ± 237.3 ng/ml in patients with COM, 384.4 ± 99.6 ng/ml and 551.7 ± 336.4 ng/ml in the control group respectively. The mean of s-ICAM-1 detected significantly higher in the COM group (p < 0.001). But the mean of s-VCAM-1 in the COM and control group was similar (p = 0.895). Also, s-ICAM-1 was significantly higher in patients with cholesteatoma, ossicular chain defects and tympanic membrane retraction (p = 0.037, 0.045 and 0.032, respectively). Although s-VCAM-1 level was not affected by cholesteatoma, ossicular chain defect and tympanic membrane retraction (p = 0.178, 0.243, p = 0.164, respectively). While the mean of s-ICAM-1 was detected significantly higher in COM and related pathologies therefore, increased serum levels may reflect the severity of the disease. But, s-VCAM-1 was not affected by COM and COM-specific diseases.

Does mitomycin-C increase collagen turnover as a modulator of wound healing in tracheostomyzed rats?

OBJECTIVES: This study aims to investigate the effect of mitomycin-C in the wound healing process on collagen synthesis in tracheostomyzed rats. MATERIALS AND METHODS: Fourteen healthy, in both sexes, mean weight of 270 g (range 250-300 g), Wistar-Albino type rats underwent tracheotomy and tracheal mucosa was damaged with micro-scissors on both sides of tracheostomyzed area. The rats were divided into two groups: The experimental group (group 1) received immediate topical application of mitomycin-C 0.2 mg/ml; the control group (group 2) received saline solution. The rats were sacrificed after a period of one month. Subsequently, the tracheostomyzed region was excised and vertically divided into the two parts. The level of hydroxyproline in the dry tissue was measured in one part of the tissue. Fibroblast count was performed in the other part of the tracheostomyzed region using the stereological method. RESULTS: The hydroxyproline level was much higher in the mitomycin-C group when compared to the control group (p<0.05). In contrary, the number of fibroblasts was lower in the mitomycin-C group than control group (p<0.05). CONCLUSION: When used in wound healing, mitomycin-C may increase collagen synthesis or quicken the wound healing process after one month.

High PI3K/mTOR and low MAPK/JNK activity results in decreased apoptosis and autophagy in nasal polyposis.

INTRODUCTION: Nasal polyposis is a progressive inflammatory disease that reduces the quality of life. The role of apoptotic and autophagic pathways in nasal polyposis pathogenesis is not yet clearly known. OBJECTIVE: In this study we aimed to investigate apoptotic (MAPK/JNK), anti-apoptotic (PI3K/mTOR) and autophagic (LC3) pathways which are related each other in the nasal polyposis tissues. METHODS: Twenty patients with nasal polyps and fifteen patients going through an inferior turbinate reduction were included in this study. Patients with asthma, Samter triad and allergic fungal sinusitis were excluded from the study. The apoptotic and autophagic pathways were investigated in paraffin-embedded nasal tissue sections of 20 NP and 15 samples from inferior turbinate reduction by H&E and immunohistochemistry with h-score. TUNEL method with apoptotic index was used to demonstrate apoptotic cells. RESULTS: Decreased immunoreactivity of P38 MAPK (p < 0.005) and JNK (p < 0.005) were observed in nasal polyposis compared to material from inferior turbinate reduction. This decrease may indicate a downregulation of apoptosis as demonstrated by decreased TUNEL staining in nasal polyposis (p < 0.005). The PI3K (p < 0.002) and mTOR (p < 0.005) immunoreactivities were increased in nasal polyposis. This increase indicates a downregulation of autophagy as demonstrated by decreased LC3 staining in nasal polyposis (p < 0.001). CONCLUSION: Deficient apoptosis and autophagy through MAPK/JNK and PI3K/mTOR pathways may have a role in the pathogenesis of nasal polyposis.

Prognostic value of 18F-FDG PET/CT parameters and histopathologic variables in head and neck cancer.

INTRODUCTION: 18F-fluorodeoxyglucose positron emission tomography/computed tomography parameters such as; maximum standardized uptake values, standard metabolic tumor volume and otal lesion glycosis are important prognostic biomarkers in cancers. OBJECTIVE: To investigate the prognostic value of these parameters in patients with head and neck cancers. METHODS: We performed a retrospective study including 47 patients with head and neck cancer who underwent18F-fluorodeoxyglucose positron emission tomography/computed tomography prior to treatment. Standard metabolic tumor volume, otal lesion glycosis and standardized uptake were measured for each patient. The prognostic value of quantitative 18F-fluorodeoxyglucose positron emission tomography/computed tomography parameters and clinicopathologic variables on disease free survival and overall survival were analyzed. RESULTS: The median (range) standard metabolic tumor volume and otal lesion glycosis and standardized uptake were 7.63cm3 (0.6-34.3), 68.9g (2.58-524.5g), 13.89 (4.89-33.03g/mL), respectively. Lymph node metastases and tumour differentiation were significant variables for disease free survival and overall survival, however, all 18F-fluorodeoxyglucose positron emission tomography/computed tomography parameters were not associated with disease- free survival and overall survival. CONCLUSION: Pretreatment quantities positron emission tomography parameters did not predict survival in head and neck cancer.

Expressions of p53, cyclinD1 and histopathological features in basal cell carcinomas.

BACKGROUND: We planned this study to analyze probable associations between p53, cyclinD1, Ki67 and histopathological features in basal cell carcinomas (BCC). METHODS: Histological differentiation types, histological growth patterns and tissue responses were analyzed in 50 cases of BCC. In immunohistochemical analysis, p53, cyclinD1 and Ki67 antibodies were investigated. P53 expression was evaluated based on a cut-off value of 25% positivity. CyclinD1 expression was graded from 0 to 3+ according to the percentage of positive nuclear staining. The percentage of positively staining cells for Ki67 was recorded. RESULTS: The following significant correlations were detected. Solid infiltrative type differentiation was related to the infiltrative histological growth pattern. The rates of p53 positivity and severe fibrosis in the groups of mixed and infiltrative growth patterns were higher than others. Besides, p53-positive cases showed more severe fibrosis and had a higher mean value for Ki67 index. Epidermal p53 and cyclinD1 clones in normal epidermal areas adjacent to tumors were noticed in 42% and 52% of the cases, respectively. CONCLUSIONS: P53 expression seems to be related to Ki67 index and some histopathological features of BCC, such as infiltrative histological growth pattern and probably fibrosis.

Paradoxical vocal fold motion dysfunction in asthma patients.

BACKGROUND AND OBJECTIVE: Paradoxical vocal fold motion dysfunction (PVFMD) is a disorder of the larynx characterized by adduction of the vocal cords during the respiratory cycle leading to symptoms of extrathoracic airway obstruction. PVFMD mimics asthma and patients with PVFMD (PVFMD+) are often diagnosed incorrectly as refractory asthma and receive unnecessary treatment. This study determined the prevalence of PVFMD in asthma patients and described the relationship between asthma and PVFMD. METHODS: A descriptive study of 94 asthmatic patients and 40 control subjects, all of whom were examined via laryngoscopy and had pulmonary function tests were performed. RESULTS: The prevalence of PVFMD was 19% (n = 18) in the asthmatic group and 5% (n = 2) in the control group (P < 0.001). No relationship was found between presence of PVFMD, asthma attacks and asthma severity (P > 0.05). Laryngopharyngeal reflux and allergy were significantly more prevalent in the PVFMD+ group than in the group without PVFMD (PVFMD-) (P < 0.05). The most common symptoms in the PVFMD+ patients were difficulty in breathing (88%), inspiratory stridor (66%) and a choking sensation (50%) and the most common symptoms in PVFMD- asthmatic patients were cough (63%), dyspnoea (55%) and wheezing (51%). CONCLUSIONS: Asthma seems to facilitate the formation of the paradoxical dysfunction in the larynx as the prevalence of PVFMD in asthma patients is significantly higher than in patients with out asthma.

[Pediatric plunging ranula and its surgery with transoral approach: a case report]. / Pediyatrik plunging ranula ve agiz yolu yaklasimiyla cerrahi tedavisi: Olgu sunumu.

The plunging ranula is an uncommon condition which presents itself as a fluctuating swelling in the neck. It is less frequent during childhood. The ranula, which is usually originated from sublingual gland, is called the plunging ranula when it affects the submandibulary space and adjacent structures in the neck. There are a lot of different methods used in surgical treatment. In this study, we present a plunging ranula case which was performed by excision of the pseudocyst and ipsilateral sublingual gland with transoral approach in a five-year-old girl. There has been no recurrence in four-year follow-up period.

The effectiveness of nasal decongestants, oral decongestants and oral decongestant-antihistamines in the treatment of acute otitis media in children.

OBJECTIVES: The aim of this study was to evaluate the effectiveness of nasal decongestants, oral decongestants and oral decongestant-antihistamines in the treatment of acute otitis media and resolution of the middle ear effusion in children. PATIENTS AND METHODS: 355 ears of 318 children [160 boys (179 ears) and 158 girls (176 ears)] who were diagnosed to have acute otitis media and treated for it with different drug regimens were evaluated retrospectively regarding resolution of the middle ear fluid. 151 ears were treated with antibiotics and analgesics (group 1), 64 with antibiotics, topical decongestants and analgesics (group 2), 81 with antibiotics, oral decongestants and analgesics (group 3), and 59 with antibiotics, oral decongestant-antihistamine combinations and analgesics (group 4). The children with middle ear effusion were followed up for three months. RESULTS: Group 1, 2, 3 and 4 had persistent middle ear effusion and the presence of middle ear effusion was 27.2%, 18.8%, 25.9%, 28.8% at the 1st month and 5.8%, 0%, 0% and 5.9% at the end of the 3rd month, respectively. At the end of the 3rd month, there was no significant difference between the groups regarding the resolution rates of the middle ear fluids in the antibiotic group and decongestants groups (p>0.05). CONCLUSION: We do not recommend the use of decongestants and antihistamines in the treatment of acute otitis media as they do not change the natural course of the disease.

[Relations between symptoms, durations and triggers of attacks and concurrent diseases in paradoxical vocal fold movement disorder]. / Paradoksal vokal kord hareketi hastaligi semptomlar, atak süreleri ve atak tetikleyicileri ile eslik eden hastaliklar arasindaki iliski.

OBJECTIVES: To discover the relation between initial symptoms, triggers and durations of attacks of paradoxical vocal fold movement disorder (PVFMD) and concurrent laryngeal and respiratory diseases. PATIENTS AND METHODS: Twenty one PVFMD patients (17 females, 4 males; mean age 50 year; range 31 to 72 years) were included in the study. Diagnosis of PVFMD was established when inspiratory and/or expiratory vocal cord adduction was seen during laryngostroboscopy. RESULTS: Laryngeal and respiratory diseases accompanying PVFMD were laryngopharyngeal reflux (n=15; 71%), asthma (n=11; 52%), allergic rhinitis (n=6; 28%), chronic sinusitis (n=1; 4%), right vocal cord paresis (n=1; 4%) and chronic obstructive pulmonary disease (n=2; 9%), (p=0.346). The most common symptoms were inspiratory stridor (n=16; 76%), dyspnea (n=13; 60%) and cough (n=9; 42%), (p=0.346). There was no significant relation between concurrent diseases and the frequencies of symptoms (0.091). Triggers for attacks were found to be air pollutants including dust, smoke and temperature variations (n=8; 38%), exercise (n=7; 33%), perfumes and detergents (n=6; 28%), animal fur and pollen (n=4; 19%), phonation and loud speaking (n=3; 14%) and emotional stress-anxiety (n=1; 4%), (p=0.308). Durations of attacks were several minutes in 14 patients (66%), several seconds in five patients (23%) and more than one hour in two patients (9%), (p=0.338). CONCLUSION: Durations and triggers of attacks and initial symptoms in paradoxical vocal fold movement disorder seems not to be related with concurrent laryngeal and respiratory diseases.

An unusual giant subacute necrotizing sialadenitis as an emergency case of otolaryngology.

Subacute necrotizing sialadenitis is an inflammatory necrotizing lesion occurring in minor salivary glands. Most cases occur in the palatal region. In this article, we reported a 36-year-old man referred to our clinic as an emergency with the complaints of excessive bleeding, airway obstruction and hipovolemia. Intraorally, there was a hemorrhagic, protruding giant mass in the palatal region. Following the first biopsy, which was not diagnostic, a second biopsy was performed. Histopathologic examination showed acinar cell necrosis and dense inflammation of the affected minor salivary glands in the second biopsy. The diagnosis of subacute necrotizing sialadenitis was made on the basis of clinical and histologic features of the lesion. Subacute necrotizing sialadenitis is a rare lesion, and admittance to the otolaryngology clinic as an emergency case is much rarer. To avoid unnecessary surgical intervention, it is necessary to diagnose subacute necrotizing sialadenitis correctly, which can be confused with malignant diseases of the salivary glands.

Unilateral isolated incus agenesis: detection by virtual endoscopy.

We report the first case of unilateral incus agenesis in the literature. Preoperative diagnosis by virtual endoscopy further enhances the significance of this case. We present thin-section temporal bone computed tomographic images and 3-dimensional reconstructed views which were all correlated with intraoperative findings. The patient was successfully treated with an ossicular prosthesis replacement.