Assessment of taste functions in allergic rhinitis patients undergoing allergen-specific immunotherapy.

BACKGROUND: We evaluated taste functions of patients with perennial allergic rhinitis (AR) before and after allergen-specific immunotherapy (AIT). METHODS: The study was designed as a prospective clinical study in our tertiary care hospital. Patients (n = 21) who were diagnosed with perennial AR on the basis of physical examination, skin prick test of at least 3* for HDM allergen and treated with AIT were enrolled in this study. A control group (n = 21) was selected from patients who were given intranasal steroids (INS) for perennial AR. Both groups had self-reported hyposmia and subjective loss of the sense of taste before treatment. Taste strips (Burghart, Wedel, Germany) were used for the taste identification scores before and after 6 months treatment. RESULTS: A total of 42 subjects were included, with a mean age of 24.1 ± 7.9 years (range 15-43 years). Overall, the AIT group showed more of an improvement of taste function, observed in the total average test scores, compared to the INS group (p < 0.05), but no change was detected between the groups before treatment. No difference was found for the bitter taste scores between the study groups (p = 0.053). CONCLUSION: Subcutaneous allergen immunotherapy resulted in more of an improvement in taste function than intranasal steroids. Further studies are needed.

Frontal Sinus Preservation During Cerebrospinal Fluid Leak Repair.

BACKGROUND: To validate the repair of frontal sinus cerebrospinal fluid (CSF) leaks with preservation of frontal sinus drainage pathway (FSDP), independently of the approach used, and to establish the indications and limits of the endoscopic approach. METHODS: A retrospective evaluation of patients undergoing surgery for frontal sinus CSF leaks was performed. Demographics, indications for both endoscopic/combined endoscopic and open approaches, complications, methods for maintaining FSDP, and perioperative outcomes were examined. RESULTS: Fifty-three patients (average age 45 years) with frontal sinus CSF leaks were treated surgically from 2000 to 2018. All CSF leak repairs were successful at the 1st attempt with a mean follow-up of 76.8 months (range 4-227 months). Etiology was spontaneous (14), traumatic (26), and iatrogenic (13). In 17 patients, a purely endoscopic approach was performed, while an endoscopic endonasal orbital transposition procedure was added in 4 out of this group. In 23 patients, a combined endoscopic and osteoplastic procedure was employed, while in 13 patients a combined craniotomy and endoscopic procedure was performed. All frontal sinuses remained patent except for 2 cranialization patients. CONCLUSION: With contemporary endoscopic instrumentation and techniques, endoscopic closure of frontal sinus CSF leaks even in the far superolateral wall is feasible in selected patients. However, the surgeon should consider the option of combining an external approach when required. Preserving the FSDP should be the main aim regardless of the approach.

Tonsillar Plasmacytoma: clues on magnetic resonance imaging.

BACKGROUND: Malignant plasma cell proliferation may present as a disseminated disease (multiple myeloma), a solitary plasmacytoma of bone, or an extramedullary plasmacytoma of soft tissue. The latter plasmacytomas represent approximately 3% of all plasma cell proliferations, and 80% develop in the head-and-neck region. The unexpected clinical presentation of such masses may be present. CASE PRESENTATION: Here, we report a rare case of primary tonsillar plasmacytoma in a 42-year-old female. The patient presented with asymmetric tonsillar hypertrophy that was resistant to antibiotherapy. Upon further workup, we found no evidence of multiple myeloma or light-chain disease. The patient underwent surgery and, at the last follow-up, exhibited no evidence of such disease. CONCLUSIONS: In adults presenting with asymptomatic tonsillar enlargement, the possibility of submucosal masses should be considered, thus encouraging the radiologist to evaluate crypts within the palatine tonsil on a postcontrast MRI, besides enlargement and signal change.

A Bullet Lying Next to the Common Carotid Artery in the Neck of a Young Boy.

Penetrating neck trauma is most commonly caused by firearm discharge, and is potentially very dangerous, being associated with a high risk of mortality. A 12-year-old patient with a recent history of a gunshot wound to the neck was evaluated in detail; a bullet was located in close proximity to the left common carotid artery. Neck exploration was performed and the foreign body was removed without any complications. The management of the patient is discussed, as are contemporary approaches to the treatment of penetrating neck trauma. However, the choice of treatment for a stable patient with a penetrating neck injury remains controversial.

Albuminuria in Pediatric Patients With Adenotonsillar Hypertrophy.

The relationship between intermittent nocturnal hypoxia and albuminuria in pediatric patients with adenotonsillar hypertrophy was evaluated in this prospective study. Fifty children with grade 3 to 4 adenotonsillar hypertrophy scheduled for adenoidectomy and/or adenotonsillectomy were selected for study group. Fifteen patients with adenotonsillar grade 1 to 2 or adenotonsillectomized subjects in a similar range of sex, age, and body mass index scheduled for other surgeries were selected for control group. All children were monitored using finger pulse oximeter during the night before surgery. At the day of surgery, first morning urine samples were sent to the laboratory for analysis of albuminuria.Albuminuria was determined in 8 (16%) patients in study group and 1 (6.7%) patient in control group. This difference between groups was determined not to be statistically significant (P > 0.05). None of the pulse oximetry parameters was also found to be associated with albuminuria statistically (P > 0.05). However, the adenoid grade was observed to be associated with albuminuria (P = 0.011).This study revealed no relationship between albuminuria and intermittent hypoxia in children, although previous studies have reported that intermittent hypoxia causes albuminuria in adults. On the contrary, the adenoid grade was found to be in association with albuminuria. The reason seems to be unclear because of the lack of studies investigating albuminuria in children with adenotonsillar hypertrophy. However, inflammatory mediators arising from adenoid tissue may cause increase in renal capillary permeability and urine albumin excretion.

Nasal Sprays Containing Mometasone Furoate for Relief of Post-Adenotonsillectomy Pain in Children: A Prospective Controlled Study.

OBJECTIVES: Adenotonsillectomy is one of most common surgeries performed in childhood. Post-operative pain associated particularly with tonsillectomy is still a problem for many physicians. Despite advances in surgical techniques, analgesics, or anti-inflammatory drugs, no unique strategy for post-tonsillectomy pain management has been suggested. The aim of this study is to investigate the analgesic effect of steroid containing nasal spray applied to tonsillar region after tonsillectomy. METHODS: Eighty-two patients were assigned into two groups as study and control. In study group, nasal spray containing steroid was applied to each tonsillar region after surgery for 5 days. Post-operative pain of all patients was assessed using a visual analog scale and results were compared. RESULTS: Pain decreased gradually over time in both the study and control groups. Although the pain scores from 4 h post-surgery to post-operative day 5 were not found to significantly decrease in children that used nasal spray containing steroid, these patients developed less pain on post-operative day 5,with statistical significance (p<0.05). CONCLUSION: Post-tonsillectomy pain was reported to increase around post-operative day 5, which coincides with the time of intense wound inflammation. Therefore, significant pain reduction on post-operative day 5 observed in children that used nasal spray with steroid may have clinical importance for overcoming this problem.

Adenoid cystic carcinoma of the parotid metastasising to the dura fifteen years post primary resection: A case report.

Adenoid cystic carcinoma (ACC), regardless of the primary site, is typically characterized by a long clinical course associated with a high rate of distant metastases. Intracranial metastasis of ACC is a very rare entity with only few reported cases in the literature. In this study, we report an unusual case of extra-axial intracranial metastasis of ACC in the dura. The primary parotid gland tumour was resected 15 y back. No recurrence had been detected before the occurrence of extra-axial metastasis. After surgical decompression, palliative radiotherapy was administered. To our knowledge, this is the longest interval for the development of metastases following excision of a parotid adenoid cystic carcinoma. This case can raise awareness across specialties that patients with adenoid cystic carcinoma are still at risk of developing metastases even following specialist discharge.

Endoscopic Endonasal Transpterygoid Approach to Sphenoid Sinus Lateral Recess Defects.

Background Lesions affecting sphenoid sinus lateral recess (SSLR) are difficult to visualize and manipulate through the transnasal routes, especially when the sinus is highly pneumatized. External approaches to this area involve extensive surgery and are associated with significant morbidity. The aims of this study are to present our experience with the endoscopic transpterygoid approach as a method for approaching lesions of the SSLR and to evaluate the outcomes of this procedure. Methods Clinical charts of patients who had lesions in the SSLR and who were treated at our institution from September 1998 to June 2018 were retrospectively reviewed. All these patients were managed by the endoscopic endonasal transpterygoid approach. Results Thirty-nine patients were identified. No cerebrospinal fluid leak recurrences were observed during follow-up (range: 1-19.7 years; median: 2.3 years). Hypoesthesia (temporary, 1; persistent, 4) in the region innervated by the maxillary branch of the trigeminal nerve was detected in five (12.8%) patients, while symptoms due to the Vidian nerve damage (dry eye, 3; dry nasal mucosa, 1) were present in four (10%) patients. Conclusions Although the endoscopic endonasal transpterygoid approach is an excellent corridor for dealing with lesions of the SSLR, limited rate of neurologic and lacrimal complications was observed. Potential morbidity of the intervention should be discussed during preoperative counselling.

Endoscopic Endonasal Resection of Sinonasal and Nasopharyngeal Pleomorphic Adenomas: A Case Series.

The aim of this study is to describe the clinicopathological characteristics of intranasal pleomorphic adenomas (PAs), as well as the role and outcomes of endoscopic endonasal resection. A retrospective review of the clinical data from patients with PA of the nasal cavity who were treated by the authors at three tertiary medical centers between June 1998 and December 2019. A total of five patients with PA were found. Three patients were male, two were female and their mean age was 62.2 years. All cases were resected "en bloc" with endoscopic endonasal approach. No evidence of disease was observed during a mean follow-up of 10.6 years. No case presented with malignant transformation into carcinoma ex-PA. PA of the sinonasal tract and the nasopharynx is difficult to diagnose due to nonspecific clinical and radiological findings. Endoscopic endonasal approaches can be considered the gold standard in the treatment of these tumors and provide excellent visual control of the surgical field and clear margins.

Ultrasonic Scalpel-Assisted Endoscopic Endonasal Surgery of Infratemporal Fossa: Our First Impressions.

BACKGROUND: The endoscopic endonasal transpterygoid approach is emerging as a valid option for treating selected tumors in the infratemporal fossa. Compared with traditional open approaches, the endoscopic endonasal approach presents more difficulty in controlling bleeding and less choice in surgical instruments for endoscopic tumor dissection, which is often performed with bipolar forceps or steel dissectors. CASE DESCRIPTION: We describe the use of an ultrasonic scalpel device for performing endoscopic endonasal resection of 2 rare infratemporal fossa tumors (mature teratoma and hemangiopericytoma), which has not been reported in the literature so far. We also review the literature on endoscopic ultrasonic scalpel use. CONCLUSIONS: The ultrasonically activated scalpel is a safe, effective and simple to use device, which achieved excellent hemostasis and did not damage adjacent neurovascular structures.

The role of red cell distribution width in the locoregional recurrence of laryngeal cancer.

INTRODUCTION: Although the red cell distribution width has been reported as a reliable predictor of prognosis in several types of cancer, to our knowledge few reports have focused on the prognostic value of red cell distribution width in laryngeal carcinoma. OBJECTIVE: We aimed to explore whether the pretreatment red cell distribution width predicted recurrence in laryngeal cancer patients is a simple, reproducible, and inexpensive prognostic biomarker. METHODS: All laryngeal cancer patients who underwent curative surgery (n=132) over a 7 year study period were evaluated. Data on demographics, primary tumor site, T-stage, N-stage, histological features (differentiation; the presence of perineural/perivascular invasion), treatment group (total laryngectomy or partial laryngectomy) or adjuvant therapy (chemotherapy/radiotherapy); laboratory parameters (complete blood count, including the pre-operative red cell distribution width), and disease-free survival rates were retrospectively reviewed. All cases were divided into three groups by the red cell distribution width tertile [<13% (25th percentile) (n=31), 13-14.4% (50th percentile) (n=72), and >14.4% (75th percentile) (n=29)]. RESULTS: High-red cell distribution width group included more patients of advanced age, and more of those with recurrent and metastatic tumors (p=0.005, 0.048, and 0.043, respectively). Individuals with red cell distribution width >14.4% (75th percentile) had lower disease free survival rates than did those with red cell distribution width <13% (25th percentile) (p=0.014). Patients with red cell distribution width >14.4% at diagnosis were at a higher risk of locoregional recurrence (hazard ratio=5.818, 95% confidence interval (95% CI) 1.25-26.97; p=0.024) than patients with a normal red cell distribution width (<13%). CONCLUSION: We found that the pretreatment red cell distribution width was independently prognostic of disease free survival rate in patients with laryngeal cancer and may serve as a new, accurate, and reproducible means of identifying early-stage laryngeal cancer patients with poorer prognoses.

Septal Flip Flap for Anterior Skull Base Reconstruction After Endoscopic Transnasal Craniectomy: Long-Term Outcomes.

BACKGROUND: Endoscopic endonasal anterior skull base malignant sinonasal tumor resection and reconstruction remains a challenge. We describe our septal flip flap (SFF) reconstruction, a new surgical technique for repairing anterior skull base defects and report our outcomes. METHODS: We retrospectively reviewed the clinical data of 24 patients who underwent skull base reconstruction using a SFF following endoscopic resection with transnasal craniectomy. We raise the SFF from the contralateral nasal septum based on the septal branches of the anterior and posterior ethmoidal arteries; the SFF is then rotated laterally for anterior skull base reconstruction after transnasal resection with craniectomy. RESULTS: The SFF was used for multiple tumor types including, most commonly, intestinal-type adenocarcinoma, followed by olfactory neuroblastoma, squamous cell carcinoma, sinonasal undifferentiated carcinoma, and other types. All of the cases had either preoperative or postoperative radiation therapy. All flaps remained viable postoperatively. Postoperatively, nasal crusting was significantly reduced with faster healing of the surgical cavity. CONCLUSIONS: The SFF adds to the clinical armamentarium the opportunity to provide vascularized mucosal coverage extending from the frontal recess back to the planum sphenoidalis. The use of SFF requires careful consideration when dealing with paranasal sinus cancers so as not to infringe oncologic principles.

Paraganglioma of the larynx diagnosed with maneuvered three-phase contrast-enhanced computed tomography.

The standard diagnostic tool for laryngeal paraganglioma is generally accepted to be magnetic resonance imaging. However, the role of other imaging modalities has not been evaluated extensively. We describe the case of a 38-year-old man who had a history of voice distortion for several years. A hypervascular submucosal lesion was detected on maneuvered three-phase contrast-enhanced computed tomography (CT). The CT showed intense contrast enhancement in the first arterial phase (inspiration), a peak level in the second phase (Valsalva), and washing out in the final phase (phonation). This pattern of contrast enhancement suggested the presence of a hypervascular lesion, such as a hemangioma, paraganglioma, or vascular malformation of the larynx. We conclude that maneuvered three-phase contrast-enhanced CT may be useful for the diagnosis of paraganglioma of the larynx.

Multidetector Computed Tomography Findings of Auto-Evacuated Secondary Acquired Cholesteatoma: A Morphologic and Quantitative Analysis.

OBJECTIVES: To describe and quantify computed tomography (CT) findings of auto-evacuated (spontaneously drained) secondary acquired cholesteatoma (SAC). MATERIALS AND METHODS: This multicenter retrospective study included 69 patients with intermittent ear discharge diagnosed with SAC by autoscopy or automicroscopy who were surgically treated. Three independent radiologists measured the medial and lateral attic distance on coronal and axial planes using multidetector computed tomography (MDCT) in 75 ear CTs from 69 patients with intraoperatively verified diagnoses of pars flaccida cholesteatoma (n=36), pars tensa cholesteatoma (n=24), and auto-atticotomy or automastoidectomy (n=15) and compared them with contralateral healthy ears. RESULTS: A circular or elliptical air-filled cavity surrounded by granulation tissue was morphologically detected on MDCT in these patients. The lateral attic distance was significantly higher in pars flaccida cholesteatoma cases than in contralateral healthy ears on both coronal and axial planes (p<0.05). The medial attic distance was significantly higher in pars tensa cholesteatoma cases than in contralateral healthy ears in the axial pane, but with no difference in the coronal plane. CONCLUSION: In patients with chronic intermittent aural discharge, nonopacified areas surrounded by granulation tissue, which expands the medial or lateral attic in a CT scan, suggest an auto-evacuated cholesteatoma.

Does CT help in predicting preepiglottic space invasion in laryngeal carcinoma?

OBJECTIVE: Evaluating preepiglottic space involvement in laryngeal cancer by CT may lead misinterpretation. We sought to understand the causes of misinterpretation in evaluating the preepiglottic space by CT and assessed the effects of misinterpretation in treatment plans of patients with laryngeal squamous cell carcinomas. METHODS: Specimen histopathology reports of 102 (99 male, 3 female) patients who underwent total or partial laryngectomy due to supraglottic and/or transglottic laryngeal carcinoma were reviewed. Neck CTs were also re-assessed for preepiglottic space involvement by three radiologists. The initial surgical treatment choices were re-examined according to the current radiological evaluation in combination with pathological results of the specimens and physical examination findings in the patients. Interobserver agreement regarding image interpretation was based on a kappa analysis. RESULTS: The interclass correlation coefficient in predicting preepiglottic space invasion was 0.74; this was considered 'good.' Among the three radiologists, sensitivity, specificity, accuracy of CT in detecting preepiglottic space involvement were 86-93%, 75-93%, and 77-93%, respectively, while the negative and positive predictive values were 97-98% and 38-50%, respectively. Given the previous treatments applied, false-positive diagnoses for PES involvement resulted in overtreatment in 2.9% of cases. False-negative diagnoses of PES involvement (1.9% of cases) did not result in any undertreatment. CONCLUSIONS: Although CT is a practical and inexpensive imaging tool for evaluating laryngeal carcinomas, the PPV of CT in assessing preepiglottic space invasion, especially in advanced tumors, is low and may lead to overtreatment.

Neck Muscle Mass Index as a Predictor of Post-Laryngectomy Wound Complications.

OBJECTIVE: We investigated the relationship between paravertebral muscle cross-sectional area (PVM CSA) at the third vertebra (C3) level using computerized tomography (CT) neck images and its relationship with complications after total laryngectomy. DESIGN: Retrospective analysis of 60 advanced laryngeal cancer patients who underwent total laryngectomy was performed. The cross-sectional areas of paravertebral neck muscles using neck CT at C3 level images obtained preoperatively were analyzed. RESULTS: A significant difference in PVM CSA between complication and no complication groups, F(1, 53 = 4.319, P = .043), was identified by ANCOVA. There were no significant differences in between-subject effects: T-stage ( F = 1.652, P = .204), body mass index ( F = 0.889, P = .35), albumin ( F = .359, P = .552), age ( F = 1.623 P = .208), and smoking ( F = 4.319, P = .41). CONCLUSION: The PVM CSA measured at C3 level on pretreatment CT may help identify patients at higher risk of postoperative wound complications after total laryngectomy and who may particularly benefit from preoperative optimization of nutritional status.

Re-Evaluation of Open Partial Horizontal Laryngectomies at Our Institution According to the New Classification Recommended by the European Laryngological Society.

OBJECTIVE: The aim of this study was to re-evaluate the open partial horizontal laryngectomies (OPHLs) performed at our institution in terms of the new classification of the European Laryngological Society and compare the differences with the new classification system. METHODS: A retrospective analysis of 45 patients diagnosed with T1b, T2, and T3 laryngeal carcinoma who were treated with OPHLs in our department between 2010 and 2016 were conducted. RESULTS: All supraglottic laryngectomies (31 operations) were classified as OPHL Type 1. Among these, 11 operations required a resection of an additional structure including arytenoid (ARY) in five operations, piriform sinus (PIR) in four operations, the base of tongue (BOT) in one surgery, and ARY + PIR in one patient. Five supracricoid laryngectomies with cricohyoidoepiglottopexy (CHEP), five supracricoid laryngectomies with cricohyoidopexy (CHP), and four near-total laryngectomy operations constituted Type 2 OPHL (7 operations) and Type 3 OPHL (7 operations). Among these operations, two were classified into Type 2b OPHL and four into Type 3b OPHL as the superior margin of incision included epiglottis. CONCLUSION: We consider that, this new classification, because it allows understanding the content of the surgery from the related title, will be useful in comparing different series and techniques.

Outcomes of Open-Approach Extracorporeal Septoplasty Without Simultaneous Rhinoplasty: Effects on Nasal Tip Projection and Rotation.

Importance: Performing an open-approach extracorporeal septoplasty (OAES) without simultaneous rhinoplasty could have adverse effects. We sought to understand the effects of OAES without simultaneous rhinoplasty on nasal tip projection and rotation in patients with severe septal deviation. Objectives: To evaluate the outcomes of OAES without simultaneous rhinoplasty in terms of nasal tip projection and rotation using objective measurements. Design, Setting, and Participants: This retrospective study was conducted at a training and research hospital using medical records of 32 adult patients who underwent OAES without simultaneous rhinoplasty between April 10, 2012 and June 12, 2015. Patients who underwent endonasal septoplasty, revision septal surgery, septorhinoplasty, open-approach septoplasty with nasal tip plasty, or open-approach septoplasty without removal of the entire septal cartilage were excluded from the study. Postoperative photographs of the patients were taken at a mean (range) time of 16.4 (6-36) months after surgery. Nasolabial angle (NLA), nasofacial angle (NFA), and projection index (PI) were measured by the same surgeon on preoperative and postoperative lateral images. Main Outcomes and Measures: Projection index was measured using the Goode method; NLA and NFA were measured drawing lines between specific facial points according to the literature. All measurements were compared statistically. Results: Thirty-two adult patients (26 men and 6 women between ages 20 and 57 years) with severe septal deviation and underwent OAES without simultaneous rhinoplasty were included in the study. The postoperative values of NLA and NFA were observed to be decreased in all patients (100%). The PI was also determined to be decreased in 27 patients (84.6%) whereas it remained unchanged in 5 patients (15.4%). The overall postoperative mean values of NLA, NFA, and PI were found to be lower compared with preoperative mean values and the difference between them were determined to be statistically significant (NLA: 95% CI, 0.40-2.55, P = .005; NFA: 95% CI, 0.48-2.06, P = .003; and PI: 95% CI, 0.004-0.015, P = .002). Conclusions and Relevance: This study reveals that the nasal tip lost height from facial plane and rotated caudally in most patients who underwent OAES without simultaneous rhinoplasty. Patients demanding only relief of nasal obstruction and scheduled for OAES have to be informed about the potential cosmetic alterations when a simultaneous rhinoplasty is not requested.