The Turkish Version of the Rhinoplasty Outcomes Evaluation Questionnaire: Validation and Clinical Application

Background: An assessment of rhinoplasty from the patient's perspective, in terms of satisfaction and quality of life, is quite important because these are the predominant factors indicating the success of rhinoplasty. Aims: To translate the Rhinoplasty Outcomes Evaluation into Turkish and then validate the new version for use in Turkish patients. Study Design: Validation study. Methods: We enrolled 30 participants who were able to read and write Turkish and underwent primary rhinoplasty. The control group consisted of 58 healthy volunteers with no need for aesthetic or functional nasal surgery. The reliability of the Rhinoplasty Outcomes Evaluation-T was analyzed according to its internal consistency and test-retest reproducibility. Discriminant validity was calculated by comparing the Rhinoplasty Outcomes Evaluation-T scores between the patient and control groups. Responsiveness and sensitivity to changes in rhinoplasty outcomes were analyzed by comparing the patients' pre- and postoperative Rhinoplasty Outcomes Evaluation-T scores. Results: The scores for questions 1-6 of the Rhinoplasty Outcomes Evaluation-T, as well as the total scores, were significantly lower in the patient group than in the control group (all p<0.05). In the patient group, the scores for questions 1-6 of the Rhinoplasty Outcomes Evaluation-T, as well as the total scores, were higher postoperatively than preoperatively (all p<0.05). The scores for each Rhinoplasty Outcomes Evaluation-T question, as well as the total scores, did not differ significantly with respect to test-retest reproducibility (all p>0.05). The internal consistency of the Rhinoplasty Outcomes Evaluation-T was high, as evidenced by Cronbach's α values of 0.887 preoperatively and 0.798 postoperatively. Conclusion: The Rhinoplasty Outcomes Evaluation-T constitutes a validated instrument with which to measure rhinoplasty outcomes among Turkish patients.

Outcomes of external septorhinoplasty in a Turkish male population.

INTRODUCTION: The first and one of the most important steps in facial plastic surgery is accurate preoperative facial analysis and recording of data that may help the surgeon to check the outcomes of his/her techniques, promoting a surgeon's professional development. OBJECTIVE: To evaluate the esthetic outcomes of external septorhinoplasty relevant to ethnic facial harmony and to investigate the relationship of the columellar incision scar with the type of skin and columellar incision type in a Turkish population. METHODS: In total, 28 consecutive adult male patients with a mean age of 32.14±10.66 years (range: 18-61 years) were included the study. Primary outcomes were preoperative and postoperative photogrammetric facial analyses of the patients including measurement of nasofrontal angle, nasolabial angle and nasal projection ratios (Gode) assessed according to the data derived from the Rhinobase program. Results were compared to facial proportions of the Turkish population. Columellar incision scar scores related to the Fitzpatrick skin type classification of the patients and columellar incision types used for the external approach were secondary outcomes of the study. RESULTS: Mean preoperative and postoperative nasofrontal angles were 148.04°±8.18° and 144.50°±7.15°, respectively, while mean preoperative and postoperative nasolabial angles were 87.59°±14.01° and 98.50°±9.71°, respectively. Mean preoperative and postoperative nasal tip projection ratios were 0.56±0.05 and 0.60±0.06, respectively. The differences between pre- and postoperative measurements were all significantly different and were in accordance with Turkish nasal harmony. Columellar inverted "V" incisions were performed in 15 (53.6%) patients while "V" incisions were used in 13 (46.4%) patients. Fitzpatrick skin Type 4 was seen in 46.42% of the patients, Fitzpatrick Type 3 in 46.42% and Fitzpatrick Type 2 in 7.14% of the patients. No significant difference was seen between columellar scar scores according to skin type and columellar incision type used for external septorhinoplasty. CONCLUSIONS: This study demonstrated that outcomes for nasofrontal angle, nasolabial angle and nasal tip projection ratios analyzed using the Rhinobase program in patients who underwent external septorhinoplasty were similar to reference values for the Turkish population.

Interobserver Consistency of Drug-Induced Sleep Endoscopy in Diagnosing Obstructive Sleep Apnea Using a VOTE Classification System.

OBJECTIVES: To explore the interobserver consistency of drug-induced sleep endoscopy (DISE) for patients with obstructive sleep apnea syndrome (OSAS) and review the current literature. METHODS: In total, 55 patients with an apnea-hypopnea index >5, as determined by on overnight sleep study, were included in this study, 45 males and 10 females, with an average age of 46.87 ±â€Š10.06 years old (range, 19-71). For all OSAS patients, DISE was performed by the same surgeon, which was recorded digitally. The video recordings of DISE were evaluated independently by 3 experienced surgeons who were asked to note his or her decisions as the pattern, site, and degree of upper airway collapse using a VOTE (velum, oropharynx lateral wall, tongue base, and the epiglottis) classification system. RESULTS: Interobserver consistency in the diagnosis of velum-related obstruction in anteroposterior, lateral, and concentric configurations ranged from poor to good. Only significant interobserver consistency among observers A and B was obtained in the diagnosis of oropharynx-related obstruction in the lateral configuration (concordance 60.0%, kappa: 0.365, P < 0.05). Interobserver consistency in the diagnosis of the tongue-related collapse in an anteroposterior configuration, the epiglottis-related collapse in an anteroposterior and lateral configuration ranged from fair to moderate (all kappa values >0.20, all P values < 0.05). CONCLUSION: Our data suggested that the interobserver consistency of DISE ranged from poor to good. Therefore, further studies with larger numbers of patients are needed to standardize DISE procedures, training, and interpretation.

Do the Angle and Length of the Eustachian Tube Affect the Success Rate of Pediatric Cartilage Type 1 Tympanoplasty?

OBJECTIVES: To investigate the relationships between the angle and length of the Eustachian tube (ET) (the ETa and the ETl) and the success rates of pediatric type 1 tympanoplasty. STUDY DESIGN: A retrospective clinical chart review. METHODS: In total, 51 children (31 females and 20 males; average age, 11.92 ±â€Š3.46 years; age range: 7-18 years) who underwent cartilage type 1 tympanoplasty were included. Demographics and anatomical outcomes were recorded. The patients were divided into 2 groups in terms of anatomical success. In group A, all patients had intact grafts without perforation, retraction, or lateralization, and a dry ear, at 6 months postoperatively. In group B, reperforation of the tympanic membrane was evident 6 months postoperatively. The average ETa and ETl values of each group were measured on computed tomography images using a multiplanar reconstruction technique, and compared. RESULTS: The ETa values of diseased ears of males and females were, respectively, 26.60 ±â€Š6.42° and 23.29 ±â€Š6.51°, compared to 27.25 ±â€Š5.23° and 23.32 ±â€Š4.61° for normal male and female ears, respectively. In group A, the ETa was 26.46 ±â€Š6.82° in males and 22.95 ±â€Š7.50° in females. In group B, the ETa was 26.85 ±â€Š6.12° in males and 23.90 ±â€Š4.45° in females. In group A, the mean ETl was 41.0 mm (29.6-45.3 mm) in males and 37.9 mm (32.0-44.5 mm) in females. In group B, the mean ETl was 40.5 mm (30.5-47.1 mm) in males and 38.0 mm (32.8-45.0 mm) in females. In group A, the ETa value of diseased ears did not differ between females and males, but in normal ears, the ETa was higher in males than females (P = 0.020 and P < 0.05, respectively). In group B, no difference was evident between the ETa values of normal and diseased ears (P > 0.05). No difference in the ETl values of diseased and normal ears, in either group, was apparent between females and males (both P > 0.05). CONCLUSIONS: Neither the ETa nor the ETl affected the success rate of pediatric cartilage type 1 tympanoplasty. Further studies with larger numbers of patients are needed to compare anatomical outcomes after placement of various graft types and the effects of anatomical features of the ET on the success rate of pediatric tympanoplasty.

Correlation between the extent of pneumatization of Agger agger Nasi nasi cells and the anterior-to-posterior length of the frontal recess: A a computer-assisted anatomical study.

OBJECTIVES: To explore the correlation between the volume of the aAgger nNasi (AN) cell bulge and the A-P length of the frontal recess (FR). SUBJECTS AND METHODS: In total, 120 patients, who underwent septoplasty, were included. All patients underwent preoperative paranasal sinus computed tomography of the paranasal sinuses (PNS CT) imaging. In total, CT data on of all 120 PNSs patients were analyzed in terms of thewith respect to the extent of pneumatization of the AN cell bulge and the A-P dimensions of the FR. Each side was analyzed separately. RESULTS: We included 120 patients,: 78 (65.0%) females and 42 (35.0 %) males. Their average age was 33.7 ± 11.6 years (range: 18-65 years). The mean volume of the AN cell bulge was 0.26 ± 0.4 mm3 on both the right and left sides. The A-P length of the FR was 7.7 ± 2.2 mm. No significant between-side difference in the mean volume of the AN cell bulge was apparent observed (p=0.906). This volume did not differ significantly by age or sex (p=0.844 and p=0.971, respectively). We found no correlation between the volume of the AN cell bulge and the A-P length of the FR (r = 0.098, p=0.192). CONCLUSION: In the present study, no correlation between AN cell volume and the A-P length of the FR was found. When studying the anatomical complexity of the FR, it is essential to consider the AN cell volume. We suggest that preoperative CT imaging is critical when endoscopic sinus surgery is planned. However, further studies with larger numbers of patients are needed to explore the relationship between AN cell pneumatization and the anatomy of the FR.

The Use of Human Epididymis 4 and Cancer Antigen 125 Tumor Markers in the Benign or Malignant Differential Diagnosis of Pelvic or Adnexal Masses.

BACKGROUND: Ovarian cancer is one of the highest mortality cancers in gynaecology. Discrimination of benign masses from malignant ones may sometimes become a challenge for the clinician since there is not a reliable tumour marker, thus some unnecessary, highly morbid operations can be performed. AIMS: To explore the efficacy of human epididymis 4 (HE 4) and cancer antigen 125 (CA 125) markers in differentiating malignant and benign pelvic masses of ovarian origin and to identify the cut-off points for those markers. STUDY DESIGN: Prospective study. METHODS: Fifty-one patients who were diagnosed and planned to undergo surgery for ovarian mass between June 2008 and December 2008 were enrolled into this study. Preoperative venous blood samples were taken and frozen for marker investigation and final diagnoses were concluded by histopathological examination. After recruitment of all cases CA 125 and HE 4 levels were evaluated. RESULTS: The statistical analysis did not indicate any statistically significant difference between the CA 125 levels of the patients with malignant and benign adnexal masses (p=0.105). The HE 4 levels of the patients with malignant adnexal masses were higher at a statistically significant level compared to the patients with benign adnexal masses (p=0.002). For HE 4 tumour marker and at the cut-off point of >25 pM, sensitivity was 1, specificity 0.40, positive cut-off value 0.19, negative cut-off value 1, accuracy 0.47 and positive likelihood ratio 1.65. CONCLUSION: Human epididymis 4 is a better diagnostic tool than CA 125 in benign-malignant discrimination of adnexal masses. The cut-off value of 25 pmol/L for human epididymis 4 will contribute to providing proper guidance to patients with adnexal masses and applying the proper treatment method.

Auricular Lobuloplasty.

OBJECTIVE: To evaluate surgical outcomes of auricular lobuloplasy. METHODS: In total, 13 patients (10 females and 3 males; average age, 32.3±8.48 years; range 21-44 years) who underwent auricular lobuloplasty were included in this study. Demographic characteristics, cause of surgery, presence of complications, and patient satisfaction were evaluated. RESULTS: The mean follow-up was 16.5±9.6 months with the shortest and the longest follow-up being 6 and 34 months, respectively. Surgeries were performed under local anesthesia in 10 cases (76.9%) and under general anesthesia in three cases (23.1%). Lobuloplasty were performed in eight cases (61.5%) with a diagnosis of partial lobule cleft, four cases (30.7%) with a diagnosis of elongated lobule, and one case (7.8%) with a diagnosis of congenital earlobe cleft. There were no postoperative complications and revision surgery was not necessary for any of the patients. CONCLUSION: Multiple surgical techniques exist for repairing earlobe deformities. Auricular lobuloplasty is a surgical procedure that has several advantages including safety, ease of use, and effectiveness.

Vidian Canal Types and Dehiscence of the Bony Roof of the Canal: An Anatomical Study.

OBJECTIVE: To determine the prevalence of Vidian canal types and dehiscence of the bony roof of the canal. METHODS: This study included 594 patients (391 males and 203 females; average age, 32.43±11.98 years; range, 18-65 years). Computed tomography (CT) images were analyzed in terms of the prevalence of Vidian canal types and dehiscence of the bony roof of the canal. RESULTS: Vidian canal types 1, 2, and 3 based on the sphenoid sinus body were found on the right side in 33.8%, 29.7%, and 6.5%, and on the left side in 36.4%, 27.4%, and 36.2% of the patients, respectively. Dehiscence of the bony roof of the canal was found on the right side in 22.2% of the patients and on the left side in 26.6%. In terms of Vidian canal types based on the sphenoid sinus floor, types 1, 2, 3, and 4 were found on the right side in 53.5%, 27.4%, 7.6%, and 11.5%, and on the left side in 54.9%, 26.6%, 6.6%, and 11.9% of the patients, respectively. On the right side, Vidian canal type 2 was significantly (p=0.002) more frequent in males than in females. CONCLUSION: When studying the complex anatomy of the sphenoid sinus, it is essential to consider Vidian canal types. Before endoscopic sinus surgery the Vidian canal and other anatomical structures should be carefully evaluated in all patients during preoperative paranasal sinus CT imaging to avoid complications.

Assessment of Approaches of Otorhinolaryngologists in Facial Plastic and Nasal Surgery: A Survey Study.

OBJECTIVE: To assess approaches and experiences of otorhinolaryngologists in facial plastic and nasal surgery. METHODS: In total, 234 surgeons (191 males and 43 females; average age, 37.22±8.4 years; age range, 26-63 years) were included. All participants were given a questionnaire comprising 22 multiple choice and closed-ended questions. All responses to the questionnaires were analyzed. RESULTS: Of 234 participants, 42 (17.9%) were residents and 192 (82.1%) were specialists in otorhinolaryngology. The most challenging cases in rhinoplasty were crooked nose (33.8%), ideal nasal dorsum (18.8%), revision cases (13.2%), and skin deformities (11.1%). The photodocumentation rate by surgeons before and after procedures of facial plastic surgery was 86.3%, whereas the intraoperative photodocumentation rate by surgeons was 47%. The most common facial plastic surgery procedures other than rhinoplasty were otoplasty (68.4%), filler-Botox-fat injections (20.5%), and mentoplasty (18.4%). CONCLUSION: This survey study is quite important because it assesses approaches of otorhinolaryngologists in facial plastic surgery. Although this study provides more valuable data for determining the current status, further studies with larger number of surgeons are required.

Impact of Laryngopharyngeal Reflux on the Levels of Depression and Anxiety in Patients With Obstructive Sleep Apnea Syndrome.

OBJECTIVES: The aim of the study was to assess the impact of the presence of laryngopharyngeal reflux (LPR) on the level of depression and anxiety in patients with obstructive sleep apnea syndrome (OSAS). STUDY DESIGN: A nonrandomized, prospective clinical study. METHODS: In total, 62 patients with an apnea-hypopnea index >5 were included in this study. Each patients completed the 21-item Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Epworth Sleepiness Scale (ESS), and Reflux Symptom Index (RSI). Patients were diagnosed with LPR based on laryngeal examination and symptom presentation, with RSI score >13. The patients were divided into 2 groups based on the presence of LPR. In group A, all patients were diagnosed with LPR. In group B, the patients had no diagnosis of reflux disease. RESULTS: The mean RSI was 3.86 ±â€Š2.46 in group B and 17.2 ±â€Š6.34 in group A. The mean ESS scores did not differ between the groups (P = 0.107). Mean BAI and BDI scores were both higher in group A than in group B (P = 0.016 and P = 0.011, respectively). There was no correlation between RSI and BAI scores (r = -0.237; P = 0.063), BDI scores (r = 0.191; P = 0.138), or ESS scores (r = 0.210; P = 0.102). A positive correlation was found between RSI and apnea-hypopnea index scores (r = 0.338; P = 0.007). CONCLUSION: The authors observed significantly higher levels of depression and anxiety in patients with LPR and OSAS. The authors suggest that the presence of LPR induces depression and anxiety in patients with OSAS and vice versa. Further studies involving larger numbers of patients are needed to confirm these initial findings.

Vitamins A, C, and E and selenium in the treatment of idiopathic sudden sensorineural hearing loss.

This study evaluated the effectiveness of vitamins A, C, and E, with selenium, in the treatment of idiopathic sudden sensorineural hearing loss (ISSNHL). This was a prospective, controlled study performed at a tertiary teaching and research hospital. Over a 32-month period, patients were treated with either our standard ISSNHL treatment regimen plus vitamins A, C, and E and selenium (ACE+ group) or with only our standard ISSNHL treatment regimen (ACE- group). The demographics, additional symptoms, mean initial and final hearing levels, mean hearing gain, and recovery data were compared between the two groups. The ACE+ group, consisting of 70 (55.5 %) patients, received vitamin A (natural beta-carotene, 26,000 IU), vitamin C (ascorbic acid, 200 mg), vitamin E (d-alpha-tocopherol, 200 IU), and selenium (50 µg) twice daily for 30 days in addition to our ISSNHL treatment regimen: methylprednisolone at an initial dose of 1 mg/kg body weight per day, tapered over 14 days; Rheomacrodex(®) [(10 g of dextran and 0.9 g of NaCl)/100 ml] 500 ml daily for 5 days; Vastarel(®) 20-mg tablet (20 mg of trimetazidine dihydrochloride) three times daily for 30 days; and ten 60-min hyperbaric oxygen (HBO) sessions (2.5 absolute atmospheres of 100 % O2), once daily, starting the day of hospitalization. The ACE- group comprised 56 (44.4 %) patients, who received only our ISSNHL treatment regimen. The mean hearing gains were 36.2 ± 20.3 dB in the ACE+ group and 27.1 ± 20.6 dB in the ACE- group. The mean hearing gain rates were significantly higher in the ACE+ group than in the ACE- group (p = 0.014). Treatment with vitamins A, C, and E and selenium was effective in ISSNHL patients undergoing treatment with methylprednisolone, dextran, trimetazidine dihydrochloride, and HBO, and might be more effective when the initial hearing level is below 46 dB.

Transoral robotic supraglottic partial laryngectomy.

OBJECTIVE: Transoral robotic supraglottic laryngectomy is a new surgical way to perform endolaryngeal resection of supraglottic laryngeal carcinoma. The aim of this report was to present our initial experience about transoral robotic supraglottic laryngectomy for early supraglottic cancer. METHODS: Subjects with early squamous cell carcinoma (T1-T2) of supraglottic region who managed using transoral robotic surgery in a tertiary referral center were included in the study. The technique of robot-assisted resection, intraoperative blood loss, mean robotic operating time, pathologic margin status, postoperative extubation, need for a tracheotomy, and length of hospitalization, complications, duration of oral nutrition, and neck dissection and radiotherapy needs were evaluated. RESULTS: Thirteen subjects (12 men, 1 woman) with T1-T2 supraglottic carcinoma were successfully operated on with transoral robotic surgery. In all subjects, negative margins were obtained. The mean total robotic surgery time was 31.6 (SD, 16.2) minutes (range, 20-80 minutes). Mean total blood loss was less than 40 mL. Subjects started oral nutrition with a mean of 10.8 (SD, 8.9) days (range, 4-30 days) postoperatively. The mean hospitalization was 15.4 (SD, 10.4) days (range, 7-42 days). CONCLUSIONS AND RELEVANCE: Transoral robotic supraglottic laryngectomy with the da Vinci robotic system can be regarded as a feasible, safe, and effective technique. Although short-term results seem discouraging, long-term results are needed to evaluate the oncologic safety.

Timely management of penetrating neck trauma: Report of three cases.

In head and neck surgery, penetrating neck injuries are uncommon. The neck contains many important structures, so such trauma can cause significant morbidity and mortality. A patient with penetrating neck trauma should be examined promptly in the emergency room. If possible, damaged tissue and organ fragments should be preserved carefully.

Transoral surgery for an infant thyroglossal duct cyst.

A 2-month-old female infant with respiratory distress, cyanosis and swallowing difficulties following birth was referred to our hospital by the pediatric clinic. Flexible fiber optic laryngoscopic examination of the patient revealed a red-purple smooth-surfaced mass inside the tongue base and vallecula. No additional features were identified by otorhinolaryngological examination. A 2-cm cystic mass located at the tongue base was identified by neck computed tomography (CT) imaging. The cystic mass was marsupialized transorally with the assistance of the da Vinci robotic surgery system (TORS) and histopathologically diagnosed as a thyroglossal duct cyst. Surgery was completed with TORS without complications and prolonged intubation was extubated carefully. No respiratory distress or other complications were observed. All symptoms were completely resolved with surgery and the patient was discharged on the third postoperative day. The patient is still undergoing follow-up and no recurrence has been observed up to the eighth post-operative month.

In vivo comparison of microcirculation and histomorphology of two different flap donor sites.

BACKGROUND: In soft tissue reconstruction surgery using free flaps, different donor sites from various anatomical regions should be considered. Local microperfusion and histomorphology at these donor sites are often neglected during planning and operation of free tissue transfers. The aim of this in vivo study was to evaluate the microperfusion and, simultaneously, the tissue morphology of two potential free fasciocutaneous flap donor sites on the upper and lower extremity. METHODS: In 23 healthy nonsmoking individuals (aged 30 ± 8.4 years), potential free-flap donor sites for the radial forearm flap (RFF) and the anterolateral thigh flap (ALTF) were investigated using high-resolution in vivo Reflectance-Mode-Confocal-Microscopy (Vivascope 1500, Lucid, Rochester, NY). The following parameters were evaluated: quantitative blood-cell flow; density of functional dermal capillaries; minimal epidermal thickness, and viable thickness of the epidermis. RESULTS: The quantitative blood-cell flow was higher in the RFF donor site (62 ± 3.1 cells/min) compared with the ALTF donor site (51 ± 2.4 cells/min, P < 0.05). The density of functional dermal capillaries at the RFF donor site was higher than at the ALTF donor site (38 ± 3 vs. 22 ± 2.2 capillaries/mm(2) , P < 0.05). The minimal epidermal thickness was thinner at the RFF donor site compared with the ALTF donor site (44 ± 2.9 vs. 55 ± 3.8 µm, P < 0.05). The viable thickness of the epidermis of the RFF region was thinner compared with the region of the ALTF (31 ± 2.1 vs. 42 ± 2.7 µm, P < 0.05). CONCLUSION: For the first time, significant differences in the in vivo microperfusion and histomorphology could be shown when comparing two different free-flap donor sites. The correlation to flap failure needs to be substantiated in further systematic trials.

Reflectance confocal-laser-scanning microscopy in vivo assessments of cigarette-induced dynamic alterations of cutaneous microcirculation on histomorphological level.

OBJECTIVE: Until now, high resolution reflectance confocal-laser-scanning microscopy (CLSM) was used for observation of cutaneous morphology in vivo and in real time. We hypothesized that CLSM also allows observation of dynamic processes of cutaneous microcirculation. METHODS: Reflectance CLSM (Vivascope1500; Lucid, Rochester, NY) was performed in 24 young male habitual smokers (23 years, range: 19-26, body mass index 23.9 +/- 4.04) with relatively limited cigarette exposure (mean: 3.1 +/- 2.4 pack-years). Eight matched nonsmokers served as controls. The quantitative blood cell flow and the diameter of capillary loops were determined prior (baseline), during, as well as 5 and 10 min after smoking. RESULTS: Baseline value for blood cell flow was 55.50 +/- 2.33 cells/min, and decreased over 45% during smoking (30.43 +/- 3.76/min; P = 0.02). They were still 22% lower (43.33 +/- 2.45/min; P = 0.01) 5 min after smoking and exceeded baseline values 10 min after smoking by 13% (63.00 +/- 3.10/min; P > 0.05). The baseline values for capillary loop diameter (9.03 +/- 0.22 microm) decreased by 21% (7.18 +/- 0.28 microm; P = 0.03) during smoking, remained about 9% (8.23 +/- 0.18 microm; P = 0.01) lower 5 min after smoking and exceeded baseline values insignificantly by 4% (9.38 +/- 0.28 microm; P > 0.05) 10 min after smoking. There were no significant differences to the controls. CONCLUSION: Reflectance CLSM enables qualitative and quantitative observation of dynamic processes of cutaneous microcirculation on histomorphological level.