Endoscopy-Assisted Ear Surgery for Treatment of Chronic Otitis Media With Cholesteatoma, Adhesion, or Retraction Pockets.

The objective of this study was to analyze the results of endoscopy-assisted ear surgery for the treatment of chronic otitis media with cholesteatoma, adhesion, or retraction pockets.Fifty-one patients who underwent oto-endoscopy-assisted canal wall up tympanomastoid surgery and/or limited anterior atticotomy with tympanoplasty for chronic otitis media with cholesteatoma, adhesion, or retraction pocket from 2006 to 2013 have been included in this study. Eradication of the disease from the middle ear and mastoid air cells was achieved by combination of the oto-microscobic and oto-endoscopic approaches. Second look surgery was performed 18 months later from the initial surgery in selected patients. Age, gender, pre-/postoperative otoscopy findings/audiograms, type of the used prostheses, and follow-up time were obtained from the patient's file. Anatomic integrity rates of the tympanic membrane, the mean gains of air bone gap, on pure-tone audiogram at 4 frequencies and existence of the residual disease were reviewed parameters. Functional evaluation was made in patients with intact tympanic membrane.Of the 51 patients, the ratios of the chronic otitis media with cholesteatoma and isolated adhesive otitis or retraction pocket cases were 74.5% (38/51) and 25.5% (13/51), respectively. Ossicular chain reconstruction was made with PORP in 27 patients and TORP in 20 patients, whereas the ossicular chain was intact in 4 patients. Anatomic integrity rates of the tympanic membrane were 90.2% (46/51). The overall (n = 46) pre-/postoperative mean ABG obtained at 4 frequencies were 28.3 ±â€Š12.26 and 9.18 ±â€Š5.68 dB (P < 0.0001) respectively. Residual cholesteatoma rate was 10.5% (34/38) for chronic otitis media with cholesteatoma patients. However, there was no recurrence or new cholesteatoma formation in isolated retraction pockets or adhesive otitis patients.Oto-endoscopic eradication of the cholesteatoma or epithelial tissue from hidden area after the all visible cholesteatoma removal by oto-microscope improves the quality of surgery, significantly decreases the frequency of the canal wall-down procedure and posterior tympanotomy requirements with acceptable residual cholesteatoma rates.

[Effect of radiofrequency thermal ablation treatment on nasal mucociliary clearance in patients with isolated inferior turbinate hypertrophy]. / Izole alt konka hipertrofisi olan hastalarda radyofrekans termal ablasyon tedavisinin nazal mukosilier klirens üzerine etkisi.

OBJECTIVES: This study aims to evaluate the effect of the radiofrequency thermal ablation on nasal mucociliary clearance in patients with isolated inferior concha hypertrophy. PATIENTS AND METHODS: Thirty patients (10 females, 20 males; mean age 31.0±12.0 years; range 18 to 61 years) who were admitted to our clinic with a complaint of chronic nasal obstruction and diagnosed with isolated inferior concha submucosal hypertrophy between May 2009 and December 2009 were included. Radiofrequency thermal ablation was applied to the inferior concha at three separate points with 350 joule at 75 °C as a treatment. Nasal mucociliary clearance was evaluated through saccharin clearance test in pre- and postoperative (at eight weeks) period. RESULTS: The mean pre- and postoperative saccharin clearance tests were 565.4±253.9 sec and 558.7±257.7 sec, respectively. However, there was no significant difference in two measurements (p>0.05). CONCLUSION: Our study results show that radiofrequency thermal ablation application for the treatment of isolated inferior concha hypertrophy has no effect on nasal mucociliary clearance.

[Evaluation of efficacy of radiofrequency thermal ablation technique by computed tomography and visual analog scale in treatment of isolated inferior turbinate hypertrophy]. / Izole alt konka hipertrofisi tedavisinde radyofrekans termal ablasyon teknigi etkinliginin bilgisayarli tomografi ve görsel analog ölçegi ile degerlendirilmesi.

OBJECTIVES: This study aims to evaluate the efficacy of radiofrequency thermal ablation (RFTA) technique by computed tomography (CT) and visual analog scale (VAS) in patients with isolated inferior turbinate hypertrophy. PATIENTS AND METHODS: Between May 2009 and December 2009, 30 patients (10 females, 20 males; mean age 31.0±12.0 years; range 18 to 61 years) who were diagnosed with an isolated inferior turbinate hypertrophy were included in this study. As a treatment, RFTA was applied to the inferior turbinate on three separate points. Evaluation of turbinate dimensions was performed by CT in pre- and postoperative period. Also, the evaluation of turbinate dimension by another otorhinolaryngologist and of the nasal obstruction by the patients in pre- and postoperative period through VAS were asked. RESULTS: The mean dimensions of the left and right inferior turbinate on CT in pre- and postoperative period were 112.42±28.41 / 81.53±22.57 and 117.72±27.85 / 86.53±23.66 mm2, respectively. The mean VAS values of the left and right turbinate dimensions were determined by another otorhinolaryngologist in pre- and postoperative period as 6.60±2.48 / 4.30±1.47 and 7.60±1.67 / 4.63±1.40, respectively. The mean VAS values of nasal obstruction in pre- and postoperative period were 6.77±1.19 and 3.57±1.46, respectively. CONCLUSION: Radiofrequency thermal ablation technique used for the treatment of the inferior turbinate hypertrophy is an effective procedure in the light of the CT and VAS evaluation results.

[Lingual schwannoma]. / Lingual schwannom.

Schwannomas are benign, slow growing, solitary and encapsulated neuroectodermal tumors arising from Schwann cells of the nerve sheath. Twenty-five percent of all extracranial schwannomas are seen in the head and neck region. Intra-oral schwannomas are rare and commonly seen at the tongue base. In this article, a 20-year-old female case with lingual schwannoma as a rare clinical condition and characteristics of the disease were summarized in the lights of the literature.

Analysis of potential protective effects of caffeic acid phenethyl ester against gentamicin ototoxicity: An experimental study.

Objectives: In this study, it is aimed to investigate the potential protective effect of caffeic acid phenethyl ester (CAPE) on ototoxicity caused by gentamicin in a rat model. Materials and Methods: Thirty Wistar albino rats were divided into 3 groups. Group I was selected as the control group. Gentamicin was administered intraperitoneally in group II, gentamicin and CAPE in group III. Audiological assessment was performed by the distortion product otoacoustic emission (DPOAE) and auditory brainstem response (ABR) measurements before and after treatment of each group. At the end of the study all rats were decapitated, cochlea was removed and electron microscopic examination was performed. Results: In group II post-treatment DPOAE levels were found to be lower than pretreatment DPOAE levels (P<0.05). However, in group III, there is no significant difference between pre- and post-treatment DPOAE levels (P>0.05). Except for Group I, ABR thresholds increased after the procedure and this increase was statistically significant (P<0.0001). According to histological examination by transmission electron microscopy, CAPE has a cellular protective effect against gentamicin ototoxicity. Conclusion: CAPE may ameliorate hearing deterioration caused by gentamicin ototoxicity and protect the cochlear cells from apoptosis due to the strong antioxidant effect.

[Isolated stapedius tendon ossification: a case report]. / Izole stapedial tendon ossifikasyonu: Olgu sunumu.

In this study, a case with bilateral isolated stapedius tendon ossification was reported, since it is a rare clinical condition. A 46-year-old female patient was admitted to our clinic with the complaint of bilateral hearing loss. Tympanic membrane was bilateral normal in color and appearance on otomicroscopic examination. Pure tone air bone gap was between 20-25 dB at 1 kHz and 4 kHz on audiogram bilaterally. Middle ear pressure was normal and stapedius reflex was negative bilaterally. Preoperative diagnosis was otosclerosis. Right exploratory tympanotomy was performed. Isolated stapedius tendon ossification was determined. Normal stapedius movement was achieved by cutting the tendon. Three months later, the same procedure was performed on the left ear. Pure tone air bone gap was bilateral 0 dB at 0.5 kHz, 1 kHz and 2 kHz, and 5-10 dB at 4 kHz on audiogram postoperatively.

Cartilage tympanoplasty with island technique for reconstruction of tympanic membrane perforation: anatomic and audiologic results.

OBJECTIVES: The aim of this study was to evaluate anatomic/audiologic outcomes of cartilage tympanoplasty with island technique and compare the results with the results of temporalis fascia tympanoplasty. PATIENTS AND METHODS: The charts of 40 patients who underwent surgery for primary type 1 tympanoplasty either with perichondrium-cartilage (12 males, 11 females; mean age 29.7 years; range 12 to 58 years) or fascia graft (9 males, 8 females; mean age 32.4 years; range 13 to 61 years) between January 2006 and January 2008 were retrospectively reviewed. Patients in whom the only pathology was subtotal tympanic membrane perforation with intact ossicular chain were included in the study. Pre- and postoperative audiograms, postoperative otoscopy findings and follow-up time were obtained from the patient's chart in both groups. Reviewed parameters were the complete closure rates of the tympanic membrane perforation and the change in air bone gap at each of four frequencies (0.5, 1, 2, 4 kHz). Audiologic evaluation was made among the patients in whom complete ear drum closure was achieved in both groups. RESULTS: Anatomic closure rates of the tympanic membrane perforation for perichondrium-cartilage and fascia group were 91.3% and 88.2%, respectively. Pre- and postoperative pure tone average air bone gap obtained at four frequencies for the perichondrium-cartilage and fascia group were 21.3+/-6.7 dB, 9.0+/-3.9 dB, and 21.2+/-6.9 dB, 8.5+/-4.4 dB, respectively. These findings revealed the overall gains of 12.3 dB for the cartilage-perichondrium group and 12.7 dB for the fascia group (p>0.05). CONCLUSION: The anatomic and audiologic results after cartilage tympanoplasty with island technique are comparable to those after temporalis fascia tympanoplasty. Furthermore, the cartilage is more resistant than the fascia to the anatomic deformation and necrosis. Therefore, we advise its use as a routine tympanic membrane reconstruction material without concern about effecting audiometric resuls.

Myxoma Arising from the Middle Ear: A Case Report.

The primary head and neck myxomas are rare, generally arising from the mandible, maxilla, and oral cavity. Other anatomical areas, such as cardiac myxomas, may also have metastases to the head and neck regions. The middle ear is an extremely rare location for myxomas. Myxoma slowly grows and is usually asymptomatic until it affects the surrounding structures. Surgical treatment is performed with a complete en bloc resection where possible. We report a case of a 42-year-old woman with myxoma arising from the right middle ear because of her tumor's rare anatomical region. Her main complaints were progressive fullness and loss of hearing which she felt for approximately 1 year on the right ear. High-resolution computed tomography (HRCT) revealed an isodense soft tissue mass localized in the right mastoid bone and the middle ear. The mass was totally removed by canal wall up tympanomastoidectomy. At the last follow-up examination on 36 months after the surgery, the patient was asymptomatic, and there were no signs of recurrence.

[Approach to the primary mass and neck in lower lip cancers: analysis of 24 cases]. / Alt dudak kanserlerinde primer kitle ve boyna yaklasim: 24 olgunun analizi.

OBJECTIVES: In this study, we analyzed the surgical approach which we carried out for treatment of the primary mass and neck in 24 lower lip cancer cases and its results. PATIENTS AND METHODS: 24 patients (5 females, 19 males; mean age 56.8; range 41 to 72 years) who were operated on in our clinic for lip cancer between March 1995 and March 2007 and whom we were able to long term follow-up were included in this study. Tumor was resected with 1-2 cm surgical margin in all cases. The tissue defect was reconstructed by either primary closure or local/regional flaps. If the tumor was located in the middle of the lip, bilateral neck dissection, otherwise unilateral neck dissection was performed. Postoperative radiotherapy was used in cases who had neck metastatic disease. Functional results were evaluated regarding recurrence and mortality rates during five-year mean follow-up period. RESULTS: Tumor was originated from the lower lip alone in 20 cases. There was secondary commissure involvement in four cases. According to the TNM (tumor, node, metastasis) classification (AJCC, 2002), distribution of the cases was T1N0M0 (n=10), T2N0M0 (n=9), T3N1M0 (n=3), T4N2aM0 (n=1), T4N2cM0 (n=1). Primary closure (n=7), Abbe-Estlander flap (n=9), Karapandzic flap (n=4), Melolabial flap (n=3), Fan flap (n=1), pectoralis major myocutaneous flap (n=2) were used as reconstruction techniques. Histopathologically, metastatic disease was determined in the neck in four cases. During the follow-up period, there occurred ocal recurrence in two cases and regional metastasis in one. Two cases with distant metastasis died. Survival rates without illness for early and advanced stage tumors were 100% and 20%, respectively. Functional results after reconstruction were satisfactory, except in two cases which we used pectoralis major myocutaneous flap for reconstruction. CONCLUSION: Five-years survival rates without illness were significantly lower in cases with advanced stage tumor and N positive neck. This result indicates that stage of the tumor and neck involvement have a significant effect on prognosis. Furthermore, more satisfactory functional results were achieved in early stage tumors.

[Temporal bone transverse fracture and peripheric facial paralysis: our surgical approach and results]. / Temporal kemik transvers kirigi ve periferik fasiyal paralizi: Cerrahi yaklasim ve sonuçlarimiz.

OBJECTIVES: In this study, our surgical approaches in temporal bone transvers fracture cases with facial paralysis and their results were evaluated. PATIENTS AND METHODS: Five temporal bone transverse fracture cases (2 females, 3 males; mean age 32.8 years; range 4 to 62 years) with facial paralysis which were treated in our clinic between July 1998 and July 2008 were included in this study. Radiologic, audiologic, topographic and electrodiagnostic investigations were made preoperatively. The evaluation of facial nerve function was performed by using House-Brackmann (HB) classification. Tympanic segment, ganglion geniculi and labyrinthine segment were exposed by translabyrinthine approach in all cases. Integrity of the facial nerve was achieved via re-routing and end-to-end anastomosis or n. auricularis major interpositional graft. The cases were evaluated regarding complications and facial nerve function postoperatively. RESULTS: In the audiologic investigation ipsilateral total neurosensorial hearing loss was determined in all cases. In four cases facial paralysis was recognized immediately and in one patient it was recognized when the patient was discharged from the intensive care unit. Facial nerve function was HB stage V in all cases. Surgery was performed in the first six weeks and it was observed that integrity of the labyrinthine segment was distorted in all cases. Reconstruction was performed by re-routing and end-to-end anastomosis in three cases and n. auricularis major interpositional graft in two cases. There were no postoperative complications. Facial nerve function was HB stage II in three cases (re-routing) and HB stage III in two cases (graft). CONCLUSION: In temporal bone fracture cases with neurosensorial hearing loss and facial paralysis, we achieved good exposure via translabyrintine approach. Better functional results were obtained in re-routing and end-to-end anastomosis technique when compared to interpositional grafting.

Inlay Butterfly Cartilage Tympanoplasty: Anatomic and Functional Results.

To evaluate anatomic/functional results of inlay butterfly cartilage tympanoplasty and compare those with the results of over-underlay perichondrium-cartilage island or temporalis fascia tympanoplasties. Patients who operated for primary type 1 tympanoplasty (n = 78) with inlay butterfly cartilage (n = 25), over-underlay perichondrium-cartilage island (n = 36) or over-underlay temporalis fascia (n = 17) graft from January 2005 to January 2015 were included in the study. Age, gender, pre-/postoperative otoscopy findings/audiograms, and follow-up time were obtained from the patient's file. Anatomic integrity rates of the tympanic membrane, the mean gains of air bone gap on pure tone audiogram at four frequencies (0.5, 1, 2, 4 kHz) and complications were reviewed parameters. Functional evaluation was made in patients with intact tympanic membrane. Anatomic integrity rates of the tympanic membrane was 92.00% for inlay butterfly cartilage tympanoplasty, 91.67% over-underlay perichondrium cartilage island tympanoplasty and 88.2% over-underlay fascia tympanoplasty. The mean gains of air bone gap on pure tone audiogram for the inlay butterfly cartilage, over-underlay perichondrium cartilage island and over-underlay fascia graft group were 11.28, 12.84 and 12.66 dB respectively. Inlay butterfly cartilage tympanoplasty is a reliable and simple technique with satisfactory outcomes in selected cases. The anatomic and functional results after inlay butterfly cartilage tympanoplasty are parallel to the results of over-underlay perichondrium-cartilage island or temporalis fascia tympanoplasties.

High-Grade Basal Cell Adenocarcinoma Arising from the Parotid Gland: A Case Report and Review of the Literature.

Basal cell adenocarcinomas are exceptionally rare and were first included in the histopathological classification of salivary gland tumors by the World Health Organization in 1991. These tumors are generally described as a low-grade malignancy with rare regional or distant metastasis. However, 48 basal cell adenocarcinoma cases arising from the major salivary glands have been described as high-grade malignancy in the English literature. Surgical excision and possible postoperative radiotherapy is the treatment of choice. Close follow up is mandatory for early detection of possible local recurrence. A 66-year-old female with high-grade basal cell adenocarcinoma of the parotid gland was presented in this study. Total parotidectomy with protection of the facial nerve integrity and postoperative radiotherapy were performed. At the most recent follow-up examination, 24 months after the surgery, the patient had no complaints and there was no sign of disease recurrence.

Anterior atticoantrostomy for cholesteatoma surgery.

OBJECTIVES: We aimed to investigate the long-term results of anterior atticoantrostomy in adult patients with cholesteatoma. METHODS: A total of 83 ears in 78 patients were operated on by the anterior atticoantrostomy technique, supported by a periosteal flap, between 1991 and 2002. RESULTS: Cholesteatoma recurred in only 4 ears (4.8%). In the 79 ears without recurrence, re-perforation was observed in 3 ears (3.8%), and retraction pockets developed in the attic of 5 ears (6.3%), 2 of which needed ventilation tubes. Absorption or migration of cartilage grafts was not seen in any of the patients. The mean air-bone gap was 34.8 +/- 13.4 dB and 16.9 +/- 14.7 dB, and the mean high-tone bone conduction was 19.0 +/- 6.2 dB and 21.1 +/- 6.6 dB, in the preoperative and postoperative periods, respectively. CONCLUSIONS: In the reconstruction of the posterior canal wall, a cartilage graft supported by a periosteal flap prevents attic retraction and may increase the vascularization of the graft. After anterior atticoantrostomy, the recurrence rate and the probability of leaving residual tissue are low. Therefore, we believe that anterior atticoantrostomy is a relatively safe and effective technique that can be used in the management of cholesteatoma.

Transzygomatic-Subtemporal Approach for Middle Meningeal-to-P2 Segment of the Posterior Cerebral Artery Bypass: An Anatomical and Technical Study.

We evaluated the use of a bypass between the middle meningeal artery (MMA) and P2 segment of the posterior cerebral artery (PCA) as an alternative to an external carotid artery (ECA-to-PCA) anastomosis. Five adult cadaveric heads (10 sides) were used. After a temporal craniotomy and zygomatic arch osteotomy were performed, the dura of the floor of the middle cranial fossa was separated and elevated. The MMA was dissected away from the dura until the foramen spinosum was reached. Intradurally, the carotid and sylvian cisterns were opened. After the temporal lobe was retracted, the interpeduncular and ambient cisterns were opened and the P2 segment of the PCA was exposed. The MMA trunk was transsected just before the bifurcation of its anterior and posterior branches where it passes inside the dura and over the foramen spinosum. It was anastomosed end to side with the P2 segment of the PCA. The mean caliber of the MMA trunk before its bifurcation was 2.1 +/- 0.25 mm, and the mean caliber of the P2 was 2.2 +/- 0.2 mm. The mean length of the MMA used to perform the bypass was 32 +/- 4.1 mm, and the mean length of the MMA trunk was 39.5 +/- 4.4 mm. This bypass procedure is simpler to perform than an ECA-to-P2 revascularization using long grafts. The caliber and length of the MMA trunk are suitable to provide sufficient blood flow. Furthermore, the course of the bypass is straight.

[Petrous bone lesions]. / Petröz kemik lezyonlari

OBJECTIVES: We evaluated the results of treatment and follow-up of patients with petrous bone lesions. PATIENTS AND METHODS: We retrospectively evaluated 13 patients (5 females, 8 males; mean age 33.8+/-17.4 years; range 4.5 to 65 years) who were treated and followed-up for petrous bone lesions between 1990 and 2004. The diagnoses were cholesterol granuloma (n=2; 15.4%), chondrosarcoma (n=1; 7.7%), and cholesteatoma (n=10; 76.9%). RESULTS: Patients with cholesterol granuloma had complaints of cephalgia and diplopia while those with cholesteatoma complained of otorrhea and hearing loss. One patient with cholesterol granuloma and eight patients with cholesteatoma underwent surgical operations with the use of middle skull base approach (n=1), transcochlear approach (n=2), translabyrinthine approach (n=1), and tympanopetrosectomy (n=5). Two cases with congenital cholesteatoma and one patient with cholesterol granuloma refused surgical intervention and were only followed-up. CONCLUSION: Besides surgical intervention, follow-up by computed tomography or magnetic resonance imaging may be considered in patients with incidental petrous bone lesions, presenting with limited symptoms.

Biocompatibility of vitallium as ossicular reconstruction material in the middle ear: experimental animal study.

CONCLUSION: Although long-term data will be necessary for confirmation, the result of this preliminary study indicates that vitallium may be a good alternative material for ossicular replacement prostheses in the middle ear. OBJECTIVES: To investigate the biocompatibility of vitallium (Co-Cr-Mo) as ossicular reconstruction material in the rabbit middle ear, and to compare the results with those obtained with titanium, well known as a highly biocompatible material, and non-implanted control groups. MATERIAL AND METHODS: Eighteen female New Zealand White rabbits were anesthetized. The tympanomeatal flap was elevated and 12 vitallium and 12 titanium implants were placed in the bulla away from the ossicles in 24 middle ears. Six rabbits were used as non-implanted controls. All animals were sacrificed under general anesthesia on the 180th day after implantation. The temporal bones were removed, fixed in 10% buffered paraformaldehyde and decalcified for a week in EDTA. Tissue samples were then prepared using an Autotechnicon and embedded in paraffin. Sections (30-microm thick) were cut with a microtome, stained with hematoxylin-eosin, von Gieson's stain and fibroblast growth factor (FGF) and examined under a light microscope. The numbers of lymphocytes, collagen fibers and FGF-positive cells were determined in all three groups. RESULTS: There was no significant difference in the numbers of collagen fibers between the groups (p > 0.05). No significant differences were found in the numbers of lymphocytes and FGF-positive cells between the titanium and vitallium groups (p > 0.05). The differences in the numbers of lymphocytes and FGF-positive cells between the control and other groups were found to be significant (p <0.05).

Management of lipomas arising from deep lobe of the parotid gland.

OBJECTIVES: We would like to present our experience in management of lipomas arising in the deep lobe of the parotid gland, which were diagnosed and operated in our clinic from the point of complication/morbidity, and recurrence, in line with the literature. MATERIAL AND METHODS: Five patients with lipoma found in the deep lobe of the parotid gland, diagnosed and treated at our clinic in the 12-year period between March 1992 and March 2004, were included in this study. Limits of the tumors were determined by computed tomography (CT), and/or magnetic resonance imaging (MRI). Preoperative fine needle aspiration biopsy (FNAB) was also performed. Through a classic parotidectomy incision, the parotid gland was exposed. Full exposure of the facial nerve and its branches was performed. The removal of deep lobe parotid lipomas was achieved by enucleation in all cases. Postoperative complication/morbidity and recurrence were evaluated. RESULTS: The most common symptom was an otherwise asymptomatic mass on the parotid region and/or upper lateral neck. One of five patients was presented with medial displacement of the lateral pharyngeal wall, and tonsil as the additional physical finding. Preoperative radiologic evaluation results revealed that CT and/or MRI scans accurately localized 100% of the tumors in relation to the deep lobe of the parotid gland. FNAB did not enable us to make a diagnosis of lipoma in four of the cases. Total resection was achieved in all cases. Temporary facial nerve paralysis, due to the dissection of the facial nerve, did not occur in any cases. There was no recurrence of the tumors after a mean follow-up of 60 months. CONCLUSION: Assessment of the exact location of the tumor is an important consideration for selection of the appropriate surgical approach. Different from lipomas found in other locations, those observed in the parotid gland cannot be easily resected by simple dissection. Resection of these tumors requires full exposure of the facial nerve.

Increased expression of epidermal growth factor receptors in the tracheal epithelia after topical mitomycin-C in rabbits.

The aim is to examine histopathological changes and expression of epidermal growth factor receptor (EGFR) in tracheal epithelia caused by application of topical mitomycin-C (MMC) in rabbit model after the tracheotomy procedure. The conventional tracheotomy was performed in 16 rabbits. They were randomly divided into two equal groups. The first group was applied MMC at a concentration of 0.4 mg/ml around tracheotomy for 5 min, and the other group was not taken a treatment as a control. The animals were sacrificed at the end of 4 weeks. Their tracheas were evaluated with H&E and Masson's trichrome histochemically, and with antiepidermal growth factor receptor immunohistochemically. Results showed that there was no significant difference between MMC and control group for inflammatory cells (P=0.09). The numbers of fibroblasts and subepithelial tissue thickness in the group exposed to MMC were significantly lower than the control group (P<0.05). In contrast, the percentage of EGFR in the application of MMC group was significantly higher than the control group (P<0.05). The application of topical MMC on airway epithelia after tracheotomy showed significant elevation in the levels of epithelial EGFR expression compared to controls in a rabbit model. The activation of epithelial EGFR may facilitate epithelial healing, but further studies are needed to assess the effect of topical MMC on respiratory epithelia.

A modified technique to bypass the maxillary artery to supraclinoid internal carotid artery by using radial artery graft: an anatomical study.

OBJECTIVE: This study aims to examine the use of a radial artery graft for bypass of the maxillary artery (MA) to the supraclinoid internal carotid artery (ICA) in treating ICA occlusions. STUDY DESIGN AND SETTING: This method was carried out on five adult cadaver sides. The MA was reached 1-2 cm inferior to the crista infratemporalis, following a frontotemporal craniotomy and a zygomatic arch osteotomy. Extradurally 2-3 cm lateral to the foramen rotundum, a hole was drilled in the sphenoid bone with a 4 mm tipped drill. A radial artery graft was passed through the hole to the inside of the dura. Before giving the infraorbital artery branch, the MA was dissected from the surrounding tissue and transected. The proximal end of the graft was anastomosed end-to-end with the MA and the distal end of the graft end-to-side with the supraclinoid ICA. RESULTS: The mean calibre of the MA was 2.6 +/- 0.3 mm. The mean calibre of the proximal end of the radial artery graft was 2.5 +/- 0.25 mm and the distal end was 2.35 +/- 0.2 mm. The mean length of the radial artery graft was 4.0 +/- 0.5cm. CONCLUSION: This study suggested that the cases with ICA occlusion, which require high blood flow, may be treated as an alternative to current bypass methods requiring long vein grafts.

Dermoid Cyst Arising from the Epiglottis.

Dermoid cysts arising from the head and neck region are rare, slow-growing, and well-circumscribed neoplasms. Symptoms are non-specific and usually related to the size and the location of the lesion. A dermoid cyst of the epiglottis is extremely rare. To the best of our knowledge, only one case has been previously reported in the English literature. In this study, a case of a dermoid cyst arising from the epiglottis was presented as an extremely rare clinical condition. The characteristics, differential diagnosis, and treatment of the disease are summarized.