Does evaluation of tumor volume or/both origination site better guide to optimal surgery for inverted papilloma? / A avaliação do volume do tumor e/ou dos seus locais de origem fornece a melhor orientação para a técnica cirúrgica ideal do papiloma invertido?

Abstract Introduction Sinonasal inverted papilloma is noted for its high rate of recurrence. Staging systems aid to reduce recurrence and avoid excessive surgeries by guiding the selection of the optimal surgical approach. Objective To evaluate the effectiveness of different endoscopic approaches in inverted papilloma by assessing tumor origin site and tumor volume. Methods Krouse classification system that is based on tumor volume was used for staging; furthermore, tumor origin sites were grouped as lateral nasal wall, medial wall and other walls of maxillary sinus. The main treatment method for all patients was endoscopic sinus surgery. Endoscopic extended middle meatal antrostomy, endoscopic Caldwell-Luc and endoscopic medial maxillectomy were the additional surgery types performed in different combinations. Results Fifty-five patients (42 male) with a mean 54.9 ± 14.4 years of age were included. 37 patients were diagnosed with advanced stage inverted papilloma (67.2 %). Recurrence was observed in 12 patients (21.8 %). In early stage lateral nasal wall origination, no recurrence was observed in the simple tumor resection group (0/10). In early stage medial wall origination, no recurrence was observed in the extended middle meatal antrostomy group (0/8). In advanced stage medial wall origination, the recurrence rates of extended middle meatal antrostomy, extended middle meatal antrostomy + endoscopic Caldwell- Luc and endoscopic medial maxillectomy were 100.0 %, 53.8 % and 13.6 %, respectively (p = 0.002). In advanced stage other walls of maxillary sinus origination, recurrence rates of extended middle meatal antrostomy + endoscopic Caldwell-Luc and endoscopic medial maxillectomy were 20 % and 16.6 %, respectively (p = 0.887). Conclusion Tumor origin site, tumor stage and surgery types show an impact on recurrence. Despite the fact that tumor origin site singly could lead to appropriate selection of the surgery type in most cases, tumor stage carries substantial importance in selection of surgery type for sinonasal-inverted papilloma. An operation plan regarding both tumor volume and tumor origin site may aid surgeons in selecting optimal endoscopic surgical method to avoid recurrence or excessive surgeries.

Resumo Introdução O papiloma invertido nasossinusal é conhecido por sua alta taxa de recorrência. Os sistemas de estadiamento ajudam a reduzir a recorrência e evitar cirurgias excessivas e orientam a seleção da abordagem cirúrgica ideal. Objetivo Avaliar a eficácia de diferentes abordagens endoscópicas no papiloma invertido, de acordo com o local de origem e o volume do tumor. Método Para o estadiamento, usou-se o sistema de classificação de Krouse, baseado no volume do tumor; além disso, os tumores foram agrupados de acordo com seus locais de origem: parede nasal lateral, parede medial e outras paredes do seio maxilar. O principal método de tratamento para todos os pacientes foi a cirurgia endoscópica nasossinusal. Foram feitos, em diferentes combinações, os seguintes tipos de cirurgia: antrostomia estendida do meato médio, Caldwell-Luc endoscópica e maxilectomia medial endoscópica. Resultados Foram incluídos 55 pacientes (42 homens) com média de 54,9 ± 14,4 anos. Trinta e sete pacientes foram diagnosticados com papiloma invertido avançado (67,2%). Foi observada recorrência em 12 pacientes (21,8%). No estágio inicial com origem na parede nasal lateral, não foi observada recorrência no grupo de ressecção simples de tumor (0/10). No estágio inicial com origem na parede medial, não foi observada recorrência no grupo de antrostomia estendida do meato médio (0/8). Com tumor em estágio avançado com origem na parede medial, as taxas de recorrência na antrostomia estendida do meato médio, antrostomia estendida do meato médio + Caldwell-Luc endoscópica e maxilectomia medial endoscópica foram de 100,0%, 53,8% e 13,6%, respectivamente (p = 0,002). No tumor em estágio avançado em outras paredes do seio maxilar, as taxas de recorrência na antrostomia estendida do meato médio + Caldwell-Luc endoscópica e maxilectomia medial endoscópica foram de 20% e 16,6%, respectivamente (p = 0,887). Conclusão O local de origem do tumor, o estágio do tumor e os tipos de cirurgia mostram impacto na recorrência. Apesar da consideração de que na maioria dos casos o local de origem do tumor pode, de forma isolada, orientar a seleção apropriada do tipo de cirurgia, o estágio do tumor tem importância substancial na seleção do tipo de cirurgia para papiloma invertido nasossinusal. Um planejamento cirúrgico considerando tanto o volume quanto o local de origem do tumor pode ajudar os cirurgiões a selecionar o tipo ideal de cirurgia endoscópica para evitar recorrências ou remoções excessivas.

The role of gold weight implants in the management of paralytic lagophthalmos.

BACKGROUND: The study aims to evaluate the usage of gold weight implants and monitor complaints and comfort of patients. METHODS: A hundred and ninety-one implantations performed between January 2009 and January 2019 were analyzed. Seventy-eight patients included in this study The average age of the patients was 51.3 ± 14.5 years. Forty-five (57.7%) of them were male and 33 (42.3%) female. Patient satisfaction was measured with a questionnaire containing the most common complaints related to gold weight in the literature through telephone surveys. RESULTS: The average follow-up time was 74.5 months. Ninety-three-point-five percent of subjects had operational causes, among which the most widespread was acoustic neuroma (44.9%). The average time between facial paralysis and implantation was 141.1 days. Implantation was performed 26.6 days on average after acoustic neuroma surgery and 3.2 days on average after temporal zone malignancy surgery. Thirty-eight patients had their implants removed over either complication (n = 14) or recovery (n = 24). Recovery was the fastest after facial nerve decompression (mean= 4.75 ± 3.6 (2-10) months) and the slowest after 7-12 cranial nerve transfer (mean= 18.3 ± 8.2 (3-31) months). Twenty-six-point-nine percent (n = 21) of patients had complications, of which the most common was extrusion (n = 10). The overall satisfaction rate was 88.5% with the highest in visual acuity and the lowest in continuous requirement for artificial tear. DISCUSSION: The gold weight implantation is an effective, reversible, and easy procedure significantly reducing complaints regarding paralytic lagophthalmos. Early implementation may be beneficial for ocular complications. A dynamic facial reanimation could terminate need of implant.

Does evaluation of tumor volume or/both origination site better guide to optimal surgery for inverted papilloma?

INTRODUCTION: Sinonasal inverted papilloma is noted for its high rate of recurrence. Staging systems aid to reduce recurrence and avoid excessive surgeries by guiding the selection of the optimal surgical approach. OBJECTIVE: To evaluate the effectiveness of different endoscopic approaches in inverted papilloma by assessing tumor origin site and tumor volume. METHODS: Krouse classification system that is based on tumor volume was used for staging; furthermore, tumor origin sites were grouped as lateral nasal wall, medial wall and other walls of maxillary sinus. The main treatment method for all patients was endoscopic sinus surgery. Endoscopic extended middle meatal antrostomy, endoscopic Caldwell-Luc and endoscopic medial maxillectomy were the additional surgery types performed in different combinations. RESULTS: Fifty-five patients (42 male) with a mean 54.9±14.4 years of age were included. 37 patients were diagnosed with advanced stage inverted papilloma (67.2 %). Recurrence was observed in 12 patients (21.8 %). In early stage lateral nasal wall origination, no recurrence was observed in the simple tumor resection group (0/10). In early stage medial wall origination, no recurrence was observed in the extended middle meatal antrostomy group (0/8). In advanced stage medial wall origination, the recurrence rates of extended middle meatal antrostomy, extended middle meatal antrostomy+endoscopic Caldwell- Luc and endoscopic medial maxillectomy were 100.0 %, 53.8 % and 13.6 %, respectively (p=0.002). In advanced stage other walls of maxillary sinus origination, recurrence rates of extended middle meatal antrostomy+endoscopic Caldwell-Luc and endoscopic medial maxillectomy were 20 % and 16.6 %, respectively (p=0.887). CONCLUSION: Tumor origin site, tumor stage and surgery types show an impact on recurrence. Despite the fact that tumor origin site singly could lead to appropriate selection of the surgery type in most cases, tumor stage carries substantial importance in selection of surgery type for sinonasal-inverted papilloma. An operation plan regarding both tumor volume and tumor origin site may aid surgeons in selecting optimal endoscopic surgical method to avoid recurrence or excessive surgeries.

Evaluation of Caldwell-Luc Operation in the Endoscopic Era: Experience From Past 7 Years.

PURPOSE: We wished to draw attention to the changes in the surgical method and indications for the Caldwell-Luc (CL) operation in the endoscopic era. PATIENTS AND METHODS: The patients who had undergone the CL operation in the previous 7 years were included in the present study. All operations had been performed by otolaryngologists. The CL operation was performed as 2 types of antrostomy: radical canine fossa antrostomy (RA) and mini-canine fossa antrostomy (MA). The surgical methods were grouped as follows: RA alone, endoscopic sinus surgery (ESS) plus RA, and ESS plus MA. RESULTS: RA alone, ESS plus RA, and ESS plus MA had been performed in 24 (25.5%), 6 (6.3%), and 64 (68.1%) patients, respectively. RA had been used for a total of 30 patients and had been combined with ESS for only 6 patients. The indications were categorized as mucosal sinus disease and odontogenic lesions. A statistically significant difference was found between the rates of the preferred antrostomy type for the treatment of sinus mucosal disease and odontogenic lesions (P < .001). CONCLUSIONS: In otorhinolaryngology practice, the CL procedure has mostly been required to provide easy access to the maxillary sinus when ESS alone would be inadequate. However, the formal CL operation, including RA, could still be considered a main surgical technique in oral and maxillofacial surgery practice.

Thermal Chondroplasty Technique for Costal Cartilage Harvesting and Contouring.

Although costal cartilage autograft has versatile usage, harvesting the graft is an invasive procedure with potential risks for complications. Therefore, it is important to make every effort to minimize these risks. Moreover, sculpting costal cartilage to the desired shape is challenging and time-consuming because of the natural rigidity. This study aimed to evaluate cases of costal cartilage harvest in terms of the most important donor site complications and to present a novel, practical and inexpensive technique to overcome the challenges in costal cartilage harvesting and contouring. A retrospective review of patient records was made of 103 patients who underwent costal cartilage harvest by the senior author. Costal cartilage harvest was applied using either the thermal chondroplasty technique or the conventional technique on patients undergoing revision rhinoplasty surgery. The number of complications and operation times were compared between the 2 techniques.A cohort of 47 patients (30 males, 17 females; mean age 34.5 years [range, 28-48 years]) underwent costal cartilage harvest using the thermal chondroplasty technique and a cohort of 56 patients (31 males, 25 females; mean age 36 years [range, 28-52 years]) underwent costal cartilage harvest with the conventional technique. The mean operation time for the costal cartilage harvest decreased by 7.5 minutes and the total operation time decreased by 17 minutes with the use of the thermal chondroplasty technique compared to the conventional technique (P < 0.05). Complications of 2 pneumothorax and 1 hematoma developed in the conventional technique group, and no complications were seen in the thermal chondroplasty group. The results of this study suggest that the thermal chondroplasty technique is safer and time-saving compared to the conventional technique.

Neurocognitive disorders and sleep in children with primary ciliary dyskinesia.

BACKGROUND: Primary ciliary dyskinesia (PCD) patients have higher incidence of sleep disordered breathing which lead neurocognitive impairments such as attention-deficit/hyperactivity disorder (ADHD). It may effect academic performance of children and may cause impairment in emotional relationships. This study aim to evaluate hyperactivity and attention deficiency in PCD patients and investigate the relationship between sleep and hyperactivity and attention deficiency in PCD patients. METHOD: Fifteen PCD patients aged 8-18 years and 31 age-matched healthy controls were compared. Ear, nose, and throat examination and home sleep testing were performed in PCD patients. Pediatric sleep questionnaire, Conners' Parents and Teacher scale and Stroop test were applied in both groups in order to investigate the relation between sleep disordered breathing and ADHD in PCD children. RESULTS: PCD patients had chronic rhinosinusitis (100%), tonsillar hypertrophy (80%) and adenoidal hypertrophy (60%). FEF25-75 was low in pulmonary function test. Sixty percent of the PCD patients had mild obstructive sleep apnea syndrome in home sleep testing. Mean AHI was 1.54 ± 0.27. Compared with the controls PCD patients had higher PSQ scores. Hyperactivity scores on Conners' Parents scale and inattention findings in Stroop test were higher in PCD patients than the healthy controls (P < 0.05). CONCLUSION: Most of PCD children had mild obstructive sleep apnea syndrome. Hyperactivity and inattention findings were higher in PCD patients. Sleep disordered breathing assessment should be a routine part of PCD patients management and these patients should be carefully monitored in terms of hyperactivity and inattention.

Isolated sphenoid sinus pathologies: a series of 40 cases

Background/aim: Isolated sphenoid sinus-derived lesions are rare and generally present with unclear symptoms. We are sharing our experience to be mindful of such lesions in differential diagnosis and to help accomplish successful treatment while avoiding revisions and complications.Materials and methods: Data from patients who underwent isolated sphenoid sinus surgeries (ISSs) were retrospectively extracted from the period of January 2005 to August 2015. Demographic data, chief complaints and presenting symptoms, imaging findings, surgical management, and results were evaluated. Results: There were 40 patients who underwent ISS. These patients had different pathologies. The chief complaint was nonspecific headache, except for cerebrospinal fluid leak patients who presented with serous rhinorrhea. Conclusion: It is critical to investigate suspicious symptoms with clinical findings and imaging techniques to avoid late diagnoses of isolated sphenoid pathologies. The transnasal approach is more minimally invasive and tissue-sparing. In our experience, we have noted that excising the inferior one-third of the superior turbinate decreases revisions. On the other hand, results show that the presence of concomitant pathology and invasive fungal disease increases the risk of revision surgery and complications.

Nonsteroidal anti-inflammatory drugs-exacerbated respiratory disease in adolescents.

BACKGROUND: There has been no study investigating nonsteroidal anti-inflammatory drugs (NSAIDs)-exacerbated respiratory disease (NERD) exclusively in childhood. Therefore, in the current study, the authors aimed to evaluate the diagnostic features, clinical characteristics, and follow-up of adolescents diagnosed with NERD. METHODS: The patients who were consecutively diagnosed with NERD between January 2011, and November 2013, included in the study. Oral provocation test (OPT) with at least 2 different NSAIDs was used to confirm NSAID hypersensitivity in patients with underlying asthma/chronic rhinosinusitis/nasal polyps. All patients were followed regularly in 3-month intervals by the Pediatric Allergy and Otorhinolaryngology Department for asthma, allergic rhinitis, or chronic rhinosinusitis with or without nasal polyps. RESULTS: A total of 10 adolescents with NERD were included in the study. The mean age of the patients at the time of diagnosis was 14.9 ± 1.5 years. Hives or angioedema accompanied respiratory complaints induced by NSAIDs. The mean duration of follow-up was 28.9 ± 12.4 months. All patients had asthma except 1 with asymptomatic bronchial hyperreactivity. Asthma of patients was well-controlled with moderate dose of inhaled corticosteroids. Chronic rhinosinusitis with or without nasal polyps developed in 2 patients. Aspirin desensitization was required in these 2 patients with recurrent nasal polyps. CONCLUSION: NERD in childhood has much more favorable clinical characteristics and course than in adulthood. Few adolescents with NERD refer with typical chronic upper respiratory tract complaints. The asthma component seems to be mild and is well controlled in the short-term follow-up.

Mortality risk factors in burn care units considering the clinical significance of acinetobacter infections.

BACKGROUND: This study aimed to evaluate risk factors and the role of Acinetobacter isolates in mortality due to burns since morbidity and mortality rates are considerably high. METHODS: A total of four hundred and sixty-five patients hospitalized in our Burn Care Unit between January 2009 and May 2011 were reviewed retrospectively. Logistic regression analysis was used in order to predict the risk. RESULTS: Mortality rates were as follows: 7.5% in general, 3.9% for under 17 years of age, 12% for between 18-64 years of age, and 24% for over 65 years of age (p<0.001). CONCLUSION: As the burnt body surface area increased, higher mortality rates were detected. Despite higher mortality rates, Acinetobacter infections were not found risk factors for mortality.

Analysis of choanal polyps.

Choanal polyps (CPs) are unilateral benign masses usually originating from paranasal sinuses. Maxillary, ethmoid, and sphenoid sinuses are involved in order of decreasing frequency. In this study, the medical records of patients operated on with a clinical diagnosis of CP between 1998 and 2011 were reviewed. A total of 98 patients with a mean age 24.3 years were analyzed. Histopathologic diagnoses were CP in 94 patients and inverted papilloma in 4 patients. The sites of origin were maxillary sinus in 89 patients (90.8%), sphenoid sinus in 6 patients (6.1%), bulla ethmoidalis, inferior concha, and uncinate process in 1 patient each (1.0%). The most common symptoms were nasal obstruction (98.0%) and postnasal drip (30.6%). The surgical approaches were endoscopic sinus surgery in 63 patients (62.4%) unilaterally and in 12 patients (11.9%) bilaterally and unilateral endoscopic sinus surgery with mini Caldwell in 26 patients (25.7%). All 3 recurrences were in pediatric patients, and the recurrence rates among pediatric patients and overall were 7.7% and 3.1%, respectively. Endoscopic sinus surgery is an effective surgical procedure for treatment of CP; however, addition of a mini-Caldwell approach is safe for antrochoanal polyp resection if the endonasal technique fails. Histopathologic examination is mandatory because inverted papillomas may present as CPs.

Parotid gland involvement as a presenting feature of Wegener's granulomatosis.

Salivary gland involvement is a rare presenting clinical feature of Wegener's granulomatosis (WG). Early recognition and identification of any unusual presentations of WG may enable the early commencement of appropriate treatment. We report a case in which the initial manifestation of the disease was parotid gland swelling, and discuss the management of the patient. WG should be considered in the differential diagnosis when salivary gland enlargement occurs with other otolaryngological symptoms.

Serum interleukin-16 levels in patients with nasal polyposis.

OBJECTIVE/HYPOTHESIS: Several inflammatory and allergic disorders have been reported to correlate with interleukin-16 (IL-16). IL-16 is a highly potent chemotactic and chemoattractant molecule for eosinophils. Nasal polyposis (NP) has an inflammatory basis, and eosinophilia is a common finding in polyp tissue. In this study, we aimed to determine serum IL-16 levels in NP patients. STUDY DESIGN: Prospective controlled study in a tertiary academic hospital. METHODS: Peripheral blood samples were obtained and used for serologic studies with enzyme-linked immunosorbent assay kits to determine IL-16 levels. RESULTS: The study and the control groups consisted of 17 and 10 patients, respectively. Mean serum IL-16 levels were significantly higher in the study group when compared to the control group (447.9 pg/mL vs. 260.2 pg/mL) (P < .001). CONCLUSIONS: Serum IL-16 levels are significantly elevated in NP patients. This finding may represent identification of a valuable serum biomarker and potential therapeutic target in NP patients.

Can bile acids be an etiological factor for laryngeal carcinoma?

PURPOSE: The objective of this study is to show the accumulation of bile acids in laryngeal tissues of laryngeal carcinoma patients. MATERIALS AND METHODS: The present study compared the total bile acid level in the hypopharyngeal tissue, tumor tissue, and blood of 21 primary laryngeal carcinoma patients (study group) to that in the hypopharyngeal tissue and blood of 15 patients with benign laryngeal lesions (control group). RESULTS: The total bile acid level was significantly higher in the tumor and hypopharyngeal tissues of the study group than in the hypopharyngeal tissues of the control group; however, the difference in the blood total bile acid level between the 2 groups was not significant. CONCLUSION: Bile acids in reflux material accumulate in the laryngeal tissue in laryngeal carcinoma patients; therefore, bile acids should be considered a carcinogenic factor in the etiology of laryngeal carcinoma because of their mutagenicity due to DNA breaking, as they cause chronic inflammation due to intracellular accumulation.

Castleman's disease of the parotid gland: a case report.

Castleman's disease (CD) is a very rare disorder characterized by non-neoplastic growths in lymph nodes in any body regions, although over 60% of cases are located in the mediastinum. The head and neck is the second most commonly involved site, with up to 14% of cases. Of these, nearly 85% are located in the neck. These lesions rarely occur in the salivary glands. Clinically, CD can be divided into unicentric and multicentric forms. We report an unusual case with unicentric CD presenting as a parotid tumor in a 34-year-old woman. The lesion was found coincidentally during routine cranial magnetic resonance imaging in the absence of symptoms such as swelling or a mass in the parotid region.

Histopathological examination of the effects of radiofrequency treatment on mucosa in patients with inferior nasal concha hypertrophy.

Radiofrequency reduction has become one of the most popular methods in the treatment of inferior nasal concha hypertrophy. During surgical treatment of inferior nasal concha hypertrophy, it is important to cause minimal injury to the overlying ciliated epithelium, since if the ciliated structure of this epithelium is permanently disrupted, it is hard to carry out one of the important functions of lining of the nasal cavity, mucociliary clearance. In this study, the ultrastructure of inferior nasal concha epithelium was examined by transmission and scanning electron microscopy in 40 patients with inferior nasal concha hypertrophy. The biopsy specimens were taken before the radiofrequency treatment and 8 weeks after the radiofrequency treatment. Then, the effects of radiofrequency treatment on concha epithelium and morphology of ciliae were examined ultrastructurally. In the scanning and transmission electron microscopic examination of the tissue samples taken before radiofrequency treatment, no ultrastructural pathology was observed in the number and morphology of the ciliae and the inferior nasal concha epithelium. The biopsy specimens obtained 8 weeks after radiofrequency treatment also did not show any ultrastructural pathology in these parameters. However, in the transmission electron microscopic examination of the subepithelial tissue, fibrosis was observed in local areas in the biopsy specimens obtained 8 weeks after radiofrequency treatment. In conclusion, the results obtained from this study suggest that ciliated epithelium of the inferior nasal concha is not destroyed by radiofrequency reduction.

Role of nitric oxide synthase gene intron 4 and exon 7 polymorphisms in obstructive sleep apnea syndrome.

The objective of our study was to assess the association of eNOS4 and eNOS296 polymorphisms of endothelial nitric oxide synthase (eNOS) gene with obstructive sleep apnea syndrome (OSAS). Forty-eight patients with OSAS and 181 healthy volunteers were included in the study. Genotype analyses were performed for eNOS intron 4 VNTR and exon 7, Glu298Asp (G --> T) polymorphisms. There was no significant difference between the patients and controls regarding eNOS4 polymorphism (P > 0.05). There was a significant difference between the patients and controls regarding eNOS296 polymorphism. Glu/Asp variant was more frequent whereas Glu/Glu variant was less frequent in the patients compared to controls (P < 0.001). There was no relationship between eNOS4 and eNOS296 polymorphisms and polysomnography parameters, apnea-hypopnea index, age, gender, body weight and height, body mass index, hypertension, coronary artery disease, arrhythmia, diabetes mellitus, hypercholesterolemia and smoking (P > 0.05). The eNOS4 polymorphism of NOS gene is not associated with OSAS. However, eNOS296 polymorphism of NOS gene is associated with occurrence of OSAS, but not with severity of OSAS.

A case of greater occipital nerve schwannoma causing neuralgia.

Schwannomas are common tumors of the head and neck region, but they rarely develop in the suboccipital region. A 34-year-old woman presented with a left suboccipital mass causing local pain and neck stiffness. Following physical examination, fine needle aspiration biopsy was performed, which revealed benign cytology. In the light of preoperative radiologic examination and intraoperative observations, the lesion was thought to originate from the greater occipital nerve. Following complete excision of the lesion, histopathological diagnosis was made as schwannoma. Apart from mild neck stiffness and transient local paresthesia in the early postoperative period, no complications were seen during a two-year follow-up period.

Facial schwannoma of the parotid gland in a child.

Schwannomas may rarely arise from the facial nerve and most commonly occur in the intratemporal part of the nerve. Extratemporal facial nerve schwannomas are extremely rare. Intraparotid schwannomas usually develop in adults and only one pediatric case has hitherto been reported. Herein, we reported the second case of facial nerve schwannoma in a 7-year-old boy who presented with a slow growing, painless preauricular mass of three-year history. Superficial parotid ultrasonography revealed a solid mass with homogenous echogenicity originating from the superficial parotid lobe. There was no facial nerve dysfunction. Superficial parotidectomy was performed. The main truncus and main branches of the facial nerve were found intact. The mass, nearly 3x3 cm in size, was originating from a communicating nerve between the marginal mandibular and buccal branches of the facial nerve. The tumor was removed together with this communicating branch. Histopathologic examination revealed schwannoma. Facial nerve functions were normal after the operation, and no recurrence was encountered in a six-month follow-up.

Pleomorphic adenoma of the nasal columella.

Pleomorphic adenoma (mixed tumor) is the most common benign neoplasm of the salivary glands. It is considered to occur primarily in the major salivary glands, such as the parotid and submandibular glands. It is much less common in the minor salivary glands, and rarely occurs at other sites, such as larynx, pharynx, trachea, lacrimal gland, and sinonasal tract. An external nose localization of this lesion is very rare. Irrespective of the site where the lesion originates, its preferred treatment should be surgery. We describe a very rare case of recurrent pleomorphic adenoma originating from the columella.

Obstructive upper airway problems and primary enuresis nocturna relationship in pediatric patients: reciprocal study.

OBJECTIVE: To determine the relationship between primary enuresis nocturna (PEN) and obstructive upper airway problems (OUAPs). DESIGN: Prospective, descriptive study. SETTING: Tertiary care academic medical centre. METHODS: Two groups of patients were included in the study. Newly diagnosed pediatric PEN patients between August 2004 and June 2005 were evaluated for OUAPs in the Department of Otorhinolaryngology of our institution and constituted the first group of patients. During the same period, patients who were on the surgery list for upper airway problems were examined for PEN in the Department of Pediatric Psychiatry as the second group. Obtained data were analyzed with regard to patient demographics and the relationship between PEN and OUAPs, and follow-up results are reported. MAIN OUTCOME MEASURES: There were 32 patients in each group. In the first group, 5 patients (15.6%) had totally obstructing severe septal deviation, 8 patients (25.0%) had moderate septal deviation, 10 patients (31.3%) had allergic rhinitis and inferior turbinate hypertrophy, 3 patients had adenotonsillar hypertrophy (9.4%), and 1 patient (3.1%) had septal perforation. The frequency of OUAP in PEN patients was 65.6%. In the second group, 10 patients (31.3%) had a PEN diagnosis. After at least 3 months (mean 6.3 months) of follow-up, four patients (40%) were free of PEN and two patients (20%) experienced improvement in PEN. Another four patients did not have any change in the severity of PEN. CONCLUSIONS: According to our results, OUAPs are very common in PEN patients and PEN is a common symptom of OUAPs.