Comparison of Three Tonsillectomy Techniques: Cold Dissection, Monopolar Electrocautery, and Coblation

Abstract Introduction Tonsillectomy is among the most common otolaryngological surgeries. Objective To evaluate and compare three tonsillectomy techniques: cold steel dissection (CSD), monopolar electrocautery (MEC), and coblation. Methods The present study retrospectively reviewed the medical records of patients who underwent tonsillectomy between January 2014 and January 2016. Postoperative visual analog scale (VAS) pain scores, analgesic use, surgical duration, time to return to normal activity, and postoperative bleeding status were noted. Results The CSD group had less analgesic use and shorter return to normal activity than the MEC group (p =0.037 and p < 0.001, respectively). The coblation group had lower VAS pain scores than the MEC group only at 1 hour to 4 hours postsurgery (p <0.016). The postoperative bleeding rate was similar in all groups (p = 0.096). Conclusion Cold steel dissection tonsillectomy is associated with less postoperative pain and shorter recovery than MEC. Coblation is better than MEC in terms of postoperative pain at 1 hour to 4 hours only, whereas CSD is associated with less postoperative pain than coblation at 2 days to 7 days.

Skull base osteomyelitis: Comprehensive analysis and a new clinicoradiological classification system.

OBJECTIVE: Skull baseosteomyelitis (SBO) is a rare phenomenon that typically occurs in diabetic or immunocompromised patients, causing significant morbidity and mortality. This study aimed to analyze a single institution's treatment results in SBO patients and propose anew integrated clinicoradiological classification system. METHODS: The medical records of 32 SBO patients that were treated at a tertiary care center between 2006 and 2017 were retrospectively reviewed. A scoring system based on anatomical involvement according to MRI was created. Subsequently, the scoring system was integrated with cranial nerve dysfunction status and a clinical grading system (CGS) was proposed. RESULTS: Among the 32 patients, 78.1% were diabetic and 63% had cranial nerve dysfunction at presentation. Bone erosion based on CT was greater in the patients without regression (P = 0.046). The regression rate decreased from clinical grade (CG)1 to CG3 (P = 0.029). Duration of hospitalization increased as CG increased (P = 0.047). Surgery had no effect on regression status at the time of discharge (P = 0.41). The 1-year, 2-year, and 5-year overall survival rates were 82.2%, 70.8%, and 45.8%, respectively. CG was significantly correlated with overall survival but not with disease-specific survival (log-rank; P = 0.017, P = 0.362, respectively). CONCLUSION: SBO continues to pose a challenge to clinicians, and causes significant morbidity and mortality. The proposed new classification system can be an option for grouping SBO patients according to clinical and radiological findings, helping clinicians estimate prognosis.

The Association Between Modiolar Base Anomalies and Intraoperative Cerebrospinal Fluid Leakage in Patients With Incomplete Partition Type-II Anomaly: A Classification System and Presentation of 73 Cases.

OBJECTIVE: Modiolus and modiolar base abnormalities in patients with incomplete partition-II anomaly (IP-II) increase the risk of intraoperative cerebrospinal fluid (CSF) leakage. This study aimed to classify modiolar abnormalities and define objective radiological measures for preoperatively evaluating intraoperative CSF leakage risk. STUDY DESIGN: Retrospective case series. SETTING: Tertiary referral center. PATIENTS: The study included 73 patients with IP-II that underwent cochlear implant surgery between 2002 and 2017. INTERVENTION: Analysis of preoperative temporal bone computed tomography (CT) scans and surgical records. MAIN OUTCOME MEASURES: Preoperative CT modiolar anomalies and intraoperative CSF leakage status. RESULTS: Among the 73 patients (41 men and 32 women), mean age at cochlear implant surgery was 11.4 (range, 0-42) years. Preoperative CT-based modiolar base anomaly classification was as follows: grade 1 (complete modiolus, n = 1), grade 2 (thin plate of bone in the modiolar base + partial modiolus, n = 14); grade 3 (thin plate of bone in the modiolar base, n = 53); grade 4 (total modiolar base defect, n = 5). The gusher rate was 8%. All patients with grade 4 anomaly had an intraoperative gusher. Patients with grade 3 anomaly accounted for 86% of oozing cases. Oozing, pulsation, and no CSF leakage rates were similar in those with grade 2 anomaly. CONCLUSIONS: The modiolus and modiolar base must be carefully evaluated in patients with IP-II. Gushers primarily occur in IP-II patients with grade 4 anomaly. A thin plate of bone in the modiolar base most commonly prevents gushers.

Effects of Expansion Sphincter Pharyngoplasty on the Apnea-Hypopnea Index and Heart Rate Variability.

PURPOSE: Heart rate variability (HRV) is a noninvasive and sensitive method used to evaluate autonomic function of the heart based on specific polysomnographic parameters. This study aimed to determine the effect of expansion sphincter pharyngoplasty (ESP) on HRV and the apnea-hypopnea index (AHI) in patients with obstructive sleep apnea (OSA). MATERIALS AND METHODS: This retrospective cohort study included patients who presented to the Department of Otorhinolaryngology, Hacettepe University Hospital (Ankara, Turkey), were diagnosed with OSA, and underwent ESP. Patient medical records, including demographic data, polysomnographic findings, and HRV parameters, were reviewed. The predictor variable was the effect of ESP on the AHI and the primary outcome variables were HRV parameters. Descriptive and bivariate statistics were computed using χ2 test, t test, and Mann-Whitney U test. RESULTS: The mean age of the 28 patients (20 men and 8 women) was 43 ± 9.9 years. Surgical success (AHI, <20; 50% decrease in the AHI) was achieved in 16 patients (57.1%). The AHI decreased in 22 patients (78.6%) but increased in 6 patients (21.4%) after ESP. The ratio of low-frequency power (LF) to high-frequency power (HF) decreased significantly in the patients with successful surgery and in those whose AHI decreased after surgery (P = .02 and P = .001, respectively). For the change in the LF/HF ratio, 19 patients had a decrease in sympathetic activity, whereas 9 had an increase in sympathetic activity, after ESP. A decrease in sympathetic activity after ESP was significantly associated with surgical success and a decrease in the AHI (P = .033 and P = .001, respectively). CONCLUSION: ESP is an effective surgical option for the treatment of OSA and lowers the AHI. Successful ESP plays a role in decreasing sympathetic activity of the heart, which might be associated with a decrease in the risk of cardiovascular disease.

A neglected giant parotid gland mass: excision and reconstruction with facial nerve preservation.

Carcinoma ex pleomorphic adenoma (CXPA) is a malignant transformed variant of pleomorphic adenoma (PA). Generally it presents with a rapidly growing mass in the parotid gland within a preexisting PA or following surgical resection of PA. Mainstream treatment modality is surgical resection followed by radiotherapy if necessary. Facial nerve preservation and complete resection of the tumor are the main principles of the operation. Giant malignant derivates are not seen frequently and constitute a challenging task for surgeons to achieve the main principles of resection. Prognosis of CXPA is poor and aggressive treatment should be performed immediately after the diagnosis. We present a 82-year-old woman with a giant malignant parotid gland mass who was successfully treated with surgery without any facial nerve injury.