Simultaneous myringoplasty and septoplasty, and the use of nasal septal perichondrium.

To investigate the more ideal graft for optimal repair of tympanic membrane perforation, we examined the use of septal perichondrium in myringoplasty. Twenty-five patients with ages ranging between 18 and 54 were included in this study. All had a persistent, symptomatic tympanic membrane perforation, and nasal obstruction. All patients were scheduled for myringoplasty by a transmeatal approach in combination with septoplasty under general anaesthesia. Twenty-three patients had intact graft material and had more than 5 dB HL improvement in conductive hearing thresholds at least three frequencies in the follow up period. An overall success rate of 92 and 92% was recorded in terms of hearing improvement and perforation closure, respectively. Nasal septal perichondrium is easily accessible, cost-effective, time saving, sufficiently large, and patient friendly as a graft material in myringoplasty and has a good chance of postoperative survival.

Frontal sinus obliteration by a composite multifractured osteoperiosteal flap: a pilot study.

The objective result is to obliterate the frontal sinus by a neo-osteogenic tissue, which develops behind the composite multifractured osteoperiosteal flap (CMOF) tailored from the anterior wall's bone cortex of the frontal sinus in the New Zealand rabbit model. In this study, as surgical objects 4 New Zealand rabbits were used. First, in each animal, the CMOF was formed from the anterior wall's bone cortex of the frontal sinus. After obtaining the CMOF, the remainder of the cortical bone of the anterior wall was removed by a drill. This procedure provided an anteriorly opened frontal sinus cavity, which has been filled firstly with absorbable gelatin sponge and finally covered with the CMOF. To investigate any possible neo-osteogenic activity behind the CMOF, CT scans of the paranasal sinuses were obtained on the first day and on the third month after surgery. Besides those, to histologically verify the developments, biopsies were obtained from behind the flap at the end of the third month. Evaluation of the CT images of the paranasal sinuses, confirms that more than half of the volume has been filled in frontal sinuses. Likewise, histologically, clear evidence of osteoblastic activity has been detected in each biopsy material. In this rabbit model, we have shown that more than half of the frontal sinus' cavity can be filled by the neo-osteogenic tissue forming behind the CMOF.

[Endoscopic adenoidectomy]. / Endoskopik adenoidektomi.

OBJECTIVES: This study evaluated endoscopic adenoidectomy operations performed in children for hypertrophic adenoid tissue in the nasopharynx. PATIENTS AND METHODS: A total of 125 patients (67 boys, 58 girls; mean age 4.8+/-2.4 years; range 2 to 15 years) underwent endoscopic adenoidectomy under general anesthesia for one or more of the following complaints: nasal obstruction, mouth breathing, snoring, loss of appetite, slower development than peers, and decreased hearing. Preoperatively, 48 patients were eligible for endoscopic rhinoscopy, which showed an adenoid mass causing total or almost total obstruction of the nasal passage. In the remaining patients, lateral cranial radiographs showed a mass narrowing the air passage in the nasopharynx. Postoperative controls were carried out at one and four weeks by physical examination and an inquiry into the patients' satisfaction. In addition, endoscopic rhinoscopy was performed in the fourth week in eligible patients. Final controls were carried out at the end of the second year. RESULTS: At the end four weeks, none of the patients had nasal obstruction or related complaints. Postoperative endoscopic rhinoscopy performed in 39 patients showed almost complete removal of adenoid tissues. None of the patients exhibited recurrent adenoid hypertrophy at the end of two years. CONCLUSION: Hypertrophic adenoid tissue in the nasopharynx, especially those encroaching on the nasal cavity, can be removed completely under direct endoscopic visualization. Endoscopic adenoidectomy is a more satisfactory method than conventional adenoidectomy, because it allows control of how much adenoid tissue is removed.

[External auditory canal reconstruction and mastoid cavity obliteration with composite multifractured osteoperiosteal flap: a preliminary study]. / Komposit çokkirikli osteoperiostal flep ile mastoid kavite obliterasyonu ve dis kulak yolu rekonstrüksiyonu: On çalisma.

OBJECTIVES: Open cavity mastoidectomy techniques cause some cavity problems. We used inferior pedicled composite multifractured osteoperiosteal flap, which is our original surgical approach to obliterate the mastoid cavity, reconstruct the external auditory canal (EAC), and to prevent open cavity problems. PATIENTS AND METHODS: Composite multifractured osteoperiosteal flap was used to obliterate the mastoid cavity and reconstruct the EAC in four patients (2 females, 2 males; mean age 34; range 31 to 38 years) who previously underwent radical mastoidectomy to treat chronic otitis media with cholesteatoma. Small meatoplasty was applied in all the patients to relive their esthetical concerns. The patients were followed-up for two years. RESULTS: The epithelization of the new EAC was complete at the end of the second month. Cholesteatoma, granulation, or recurrence of osteitis did not occur in any of the patients. We detected new bone formation filling the mastoid cavity on postoperative temporal bone CT images. CONCLUSION: An almost natural EAC was obtained due to neo-osteogenesis that developed behind the composite multifractured osteoperiosteal flap.

Multilateral scrutiny of the Gülhane mastoidectomy.

This study has been conducted in order to analyze the outcomes of a previously described technique for chronic otitis media surgery: the improved radical mastoidectomy with flap (formerly IRMF), which consisted of improved radical mastoidectomy (formerly IRM), inferiorly based fascioperiosteal flap and large meatoconchoplasty (Kahramanyol, Ear Nose Throat J 71:70-77, 1992; Kahramanyol et al., Ear Nose Throat J 79:524-526, 2000). The technique is hereafter referred as the Gülhane mastoidectomy. During a period of 22 consecutive years, 255 patients have been operated on and treated utilizing the technique mentioned above. Despite extensive otologic destruction and concomitant severe complications, the technique rendered impressive outcomes: the cavities became smaller over time and remained healthy, providing good life quality for the patients. Cholesteatoma recurrence was observed in but one patient. The outcomes confirm the value and usefulness of the technique.

Canal wall reconstruction and mastoid obliteration with composite multi-fractured osteoperiosteal flap.

We used inferior pedicled composite multi-fractured osteoperiosteal flap (CMOF), our original and new surgical approach, to obliterate the mastoid cavity and reconstruct the external auditory canal (EAC) to prevent the open cavity problems. CMOF was used to obliterate the mastoid cavity and reconstruct the EAC in 24 patients (13 women, 11 men; age span 12-51 years) who underwent radical mastoidectomy to treat the chronic otitis media between 1998 and 2004. Small meatoplasty was done in all 24 patients to relieve their aesthetical concerns. Temporal bone CT scanning was done to observe the neo-osteogenesis in the mastoidectomy cavity and the CMOF, and the EAC volume was measured postoperatively. All our patients were followed-up for 2 years. The epithelization of the new EAC in our patients was complete at the end of the second month. Cholesteatoma, granulation, and recurrence of osteitis did not occur in any of the patients. We saw the new bone formation filling the mastoid cavity in the postoperative temporal bone CT scanning images. The mean volume of the new EAC on the 24th month was 1.83 +/- 0.56 cm(3). We had an almost natural EAC, which owed its existence to the neo-osteogenesis that grows behind the CMOF, which we use to obliterate the mastoid cavity and to reconstruct the EAC.