Comparison of paper-patch, fat, and perichondrium myringoplasty in repair of small tympanic membrane perforations.

OBJECTIVE: To compare the effectiveness of paper-patch, fat, and perichondrium myringoplasty in the treatment of chronic tympanic membrane perforations smaller than 3 mm. SUBJECTS AND METHODS: This investigation included 45 patients with chronic tympanic membrane perforations smaller than 3 mm. The patients were equally divided into 3 main groups according to surgical procedures. Each group consisted of 3 subgroups, which had 1-mm, 2-mm, and 3-mm perforations. The patients underwent paper-patch, fat, or perichondrium myringoplasty via transcanal approach under local anesthesia. Healing of perforation, hearing improvement, and complications were investigated. RESULTS: Closure rates of the perforations in the paper-patch, fat, and perichondrium myringoplasty groups were 66.7%, 86.7%, and 86.7%, respectively. There were no statistically significant differences in tympanic membrane closure rates between techniques with regard to size. CONCLUSION: Three techniques were found to be feasible for tympanic membrane perforations smaller than 3 mm.

Histologic effects of injection snoreplasty and radiofrequency in the rat soft palate.

OBJECTIVE: This study was undertaken to compare the effects of radiofrequency and injection snoreplasty on the histological structure of the soft palate in an animal model. STUDY DESIGN AND SETTING: This is a blinded, controlled histologic evaluation of rat soft palates that underwent separate palatal interventions. Fifty rats were divided into 5 groups of 10 rats (Group 1 = injection snoreplasty [IS], Group 2 = IS + steroid, Group 3 = saline injection, Group 4 = radiofrequency ablation [RFA], and Group 5 = no intervention). The animals were sacrificed after 24 hours, 1 week, 3 weeks, and 5 weeks. Then the soft palates were subjected to histological analysis. RESULTS: Histological analysis demonstrated normal remucosalization in all specimens, with fibrosis increased in Group 1. Interstitial edema was minimal in Group 2. Keratinization was most apparent in Group 4. CONCLUSION: Radiofrequency and injection snoreplasty stiffen the rat soft palate compared with controls.

Comparison of uvulopalatopharyngoplasty, laser-assisted uvulopalatoplasty and cautery-assisted uvulopalatoplasty in the treatment of primary snoring.

OBJECTIVE: Our aim was to compare the postoperative pain and surgical results of uvulopalatopharyngoplasty (UPPP), laser-assisted uvulopalatoplasty (LAUP), and cautery-assisted uvulopalatoplasty (CAUP) procedures in the treatment of primary snoring. METHODS: 54 patients were stratified according to a modified Friedman staging system (MFSS) for sleep-disordered breathing. Tonsil size (1, 2, 3) and palatal position scale (grade 1-2) and body mass index <30 according to the MFSS were included for standardization. Three workgroups consisting of 18 patients each were formed and UPPP, LAUP and CAUP procedures were performed. The success of the surgical procedures was evaluated by applying the Epworth Sleepiness Scale to the patients, and the patients' bed partners were asked to evaluate the snoring level preoperative and 45 days after the operation to determine any improvement in snoring complaints. Patients were followed for postoperative pain, secondary infection, bleeding, permanent velopharyngeal insufficiency and nasopharyngeal stenosis. RESULTS: Snoring was relieved in 83.3% of UPPP and CAUP groups and in 88.8% of LAUP 45 days after operation. The mean pain duration was 5.71 days for the UPPP patients, 6.28 days for the LAUP patients and, 4.12 days for the CAUP patients. The mean pain score was 2.1 for the UPPP patients, 2.38 for the LAUP patients, and 1.6 for the CAUP patients. Only 1 patient was hospitalized due to pain in the LAUP group. CONCLUSION: The effectiveness of UPPP, LAUP and CAUP procedures were found to be similar (more than 83%). Postoperative pain was mostly seen in LAUP and UPPP cases. The CAUP procedure was easy and the least painful.

Effective dose of 5-fluorouracil for myringotomy in rats.

BACKGROUND: The purpose of this study is to compare the effects of two different doses of 5-fluorouracil (5-FU) on closure rates and histopathological findings in myringotomy to those of simple myringotomy with saline application. MATERIAL/METHODS: 36 rats were divided into two study groups and a control group of 12 rats each. After bilateral myringotomy, we applied 5-FU 50 mg/ml in group A, 10 mg/ml in group B and saline in the control group for 10 minutes. Examination was made by otoendoscopy on days 1, 3, 5, 7, 10, 15, 20, 25. After the follow up examination, two rats from each group were randomly sacrificed on days 7, 15, 25 and 35. Both tympanic membranes were investigated for fibrosis and inflammation by light microscopy. RESULTS: Most of the tympanic membranes from group B and the control group healed on the 10th day, but 16 myringotomies were patent in group A; by the 25th day, all myringotomies in all three groups were completely healed. The mean healing time was 14.62 days, 10.20 days and 10.40 days respectively in groups A, B and control. Fibrosis and inflammation were less in group A than in group B and the controls. CONCLUSIONS: 5-FU at a concentration of 50 mg/mL is effective in prolonging the patency of myringotomies in rat tympanic membranes, while a concentration of 10 mg/mL has no greater effect than a simple myringotomy procedure with saline application.

Effects of topical application of mitomycin-C and 5-fluorouracil on myringotomy in rats.

OBJECTIVE: The effects of topical application of Mitomycin-C (MMC) and 5-fluorouracil (5-FU) for maintaining myringotomy patency were investigated in this experimental study. STUDY DESIGN: We performed simple myringotomy with a knife on 140 tympanic membranes of 70 rats. Rats were divided in two study groups and a control group. Each study group had 60 tympanic membranes, and the control group had 20. We applied Mitomycin-C (0.4 mg/ml) in Group A, 5-fluorouracil (50 mg/ml) in Group B topically, and sterile saline in the control group for 10 minutes. Examination was made with otoendoscope on days 1, 3, 5, 7, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, and 70, and patency rates were recorded. RESULTS: MMC and 5-FU Groups remained open for a mean of 46.17 days and 14.62 days, respectively. The control ears healed within 10.4 days. Fibrosis of the MMC-treated group was the same as that of 5-FU-treated groups. Fibrosis of both study groups was significantly lower than that of the control group. CONCLUSIONS: MMC is more effective than 5-FU, which is more effective than the simple myringotomy procedure in extending the patency of myringotomies in rat tympanic membranes (p < 0.05). Both medications are useful as an adjunct in preventing myringotomy closure.

The effects of mitomycin C and 5-fluorouracil/triamcinolone on fibrosis/scar tissue formation secondary to subglottic trauma (experimental study).

PURPOSE: The aim of the study was to compare the effects of mitomycin-C (MMC) and 5-fluorouracil/triamcinolone acetonide (5-FU/TA) on the development of fibrosis/scar tissue formation of rabbit subglottic area, which is injured acutely. MATERIALS AND METHODS: After standardized trauma to subglottic area the rabbits were divided into those that received treatment and those that did not (controls). The subjects were treated with either topical 0.4 mg/mL MMC or 5 mg 5-FU/TA injection. Those groups were further divided into subgroups depending on the time of examination: at 2 or 6 weeks. Each subgroup had 4 rabbits. The specimens were examined histopathologically and the measurements were performed using a software. RESULTS: The fibrosis indices (FIs) of the treated subgroups were significantly less than the FIs of their corresponding control subgroups (P<.05). The difference in FIs of the MMC-treated and 5-FU/TA-treated groups was not statistically significant (P>.05). MMC and 5-FU/TA did not interfere with regeneration of the epithelium although in 2 cases treated with 5-FU/TA the regenerated epithelium showed squamous metaplasia. CONCLUSIONS: Both MMC and 5-FU/TA decrease fibrosis/scar tissue formation secondary to experimentally induced acute subglottic trauma. There is no significant difference between the effects of the 2 drugs.

The effects of incisional myringotomy and CO2 laser myringotomy on rat tympanic membranes.

OBJECTIVE: The purpose of this study was to compare closure rates and histopathological findings of carbon dioxide (CO(2)) laser myringotomies to those of incisional myringotomy. STUDY DESIGN: We performed CO(2) laser round myringotomy on left ears and incisional round myringotomy on the right ears of 34 rats on the same day. The incisions were 2mm in size on both ears. Examination was made with otoendoscope on days 1, 3, 5, 7, 9, 11, 13, 15, 17, 19, 21, 25, 30, 35, 40, 45, 50 with videorecording. Two rats were sacrificed every 2 days for 25 days and every 5 days thereafter, randomly. The tympanic membranes (TM) were excised and hyalinization, fibrosis and inflammation were assessed with light microscope. RESULTS: Most of the CO(2) laser myringotomies healed after day 15, and all of them healed by day 50. Three of the incisional myringotomy perforations were closed at day 3, and the rest by day 15. Patency of CO(2) laser myringotomies was significantly longer than that of incisional myringotomies. Hyalinization, fibrosis and inflammation of the incisional myringotomy group were significantly less than those of the laser myringotomy group. CONCLUSIONS: CO(2) laser myringotomies remain patent for a longer period of time than the incisional procedure, however, they cause more tissue inflammation. We believe that CO(2) laser myringotomy is an effective method, however, additional studies are needed to identify its complications.

Mastoid osteomas: report of two cases.

OBJECTIVE: To discuss the differential diagnosis of two cases with mastoid mass. STUDY DESIGN: Case report and review of the literature. SETTING: The study was carried out in Gulhane Military Medical Academy, Haydarpasa Training Hospital, Istanbul, Turkey. PATIENT, INTERVENTION, AND RESULTS: Both cases were 23-year-old males. They admitted to our clinic with masses behind their left ears that had been progressively enlarging for 5 years. In both cases, coronal and axial computerized tomography scans revealed a wide-based lesion involving temporal bone cortex. The cases were operated on for diagnosis and for correction of the cosmetic deformity. Histopathological examinations were consistent with mixed and spongiotic osteoma. CONCLUSIONS: Mastoid osteoma is a rare, benign tumor of bone. It may cause cosmetic deformity such as external mass or an auricular protrusion. Other neoplasms of the mastoid region, such as osteosarcoma and osteoblastic metastasis, should be considered for the differential diagnosis.

[Primary Hodgkin's lymphoma of the parotid gland: a case report]. / Parotis bezi yerlesimli Hodgkin lenfoma: Olgu sunumu.

Primary Hodgkin's lymphoma of the parotid gland is rare. A twenty-one-year-old man presented with a lesion that recurred two years after an excisional biopsy for a parotid gland mass. He underwent superficial parotidectomy. Frozen section examination suggested a diagnosis of Hodgkin's lymphoma. The patient was treated by radiotherapy. A complete recovery was obtained after a 27-month follow-up.

The effectiveness of hyperbaric oxygen treatment in tracheal reconstruction with auricular cartilage grafts (experimental study).

PURPOSE: Tracheal stenosis or neoplastic changes, as well as, traumatic, congenital, or iatrogenic causes may require extensive tracheal resections. Complications like vascularization insufficiency and structural support problems occur nearly in all cases when end-to-end anastomosis of trachea is not feasible. Hyperbaric oxygen (HBO) treatment is a well-known method for the management of grafts and flaps that have vascularization problems. In this study, the effect of hyperbaric oxygen treatment on wound healing after tracheal reconstruction with auricular cartilage graft (ACG) has been evaluated. METHODS: Thirty-two rabbits were divided into 2 groups: study group (n = 16) and control group (n = 16). The anterior halves of the six tracheal rings were resected, and the defects were repaired with autogenic auricular grafts. Hyperbaric 100% pure oxygen was administered to the study group at 2.4 atmospheres of absolute pressure 2 times a day for 1 week. The control group did not receive any therapy except proper control of the wound. RESULTS: It was observed that in the study group, inflammation, fibrosis, and necrosis were less, whereas epithelialization and maturation were early and neovascularization and neochondrification were more than the control group only at specific weeks. But all tracheas in both groups showed excellent healing without graft rejection and excessive granulation tissue formation. Furthermore, there was no statistically difference between the 2 groups. CONCLUSIONS: Auricular cartilage grafts is a valuable management method of tracheal defects, and hyperbaric oxygen treatment is a good supplementary method in healing period of cartilage autografts.

[The effect of ostioplasty and nasoantral window opening on mucociliary activity in the maxillary sinus: an experimental study in the rabbit]. / Endoskopik sinüs cerrahisinde kullanilan ostioplasti ve nazoantral pencere açilmasi tekniklerinin maksiller sinüs mukosilier aktiviteye etkisi: Tavsanlarda deneysel çalisma.

OBJECTIVES: We evaluated the effects of ostioplasty and nasoantral window opening techniques employed in endoscopic surgery procedures for maxillary sinuses on mucociliary activity in rabbits. STUDY DESIGN: The study included 15 adult male New Zealand white rabbits (mean weight 3.5 kg). The animals were divided into three groups equal in number. Following a vertical incision in the midline, one group underwent ostioplasty to widen the natural ostium of the maxillary sinus; a new nasoantral window was opened in another group; the other group (controls) underwent only sinus exploration. Thirty days after surgery, mucociliary activity of the maxillary sinuses was evaluated scintigraphically. RESULTS: Compared with the control group, mucociliary activity decreased significantly in both groups, showing a higher deterioration with the nasoantral window opening technique (p<0.001) than that with the ostioplasty technique (p<0.05). CONCLUSION: Since both techniques have adverse effects on the mucociliary activity of the maxillary sinuses, ostioplasty and nasoantral window opening techniques should be reserved for patients in whom they are uniquely required.

[A case of giant frontal sinus osteoma]. / Dev frontal sinüs osteomu: Olgu sunumu.

Osteomas are the most frequent bone tumors of the facial bones, the most involving the frontal sinus and thus leading to symptoms of frontal sinusitis or associated complications. A twenty-one-year-old male patient presented with a growing swelling on the right side of the forehead. Examination revealed a slight facial asymmetry, a laterally shifted right orbital bulb, and disturbed vision. Cranial and orbital computed tomography showed a dense bony mass in the medial wall of the right orbit. The mass was excised totally following a bicoronal incision. The frontal and ethmoid sinuses were filled with fat tissue. Postoperatively, his vision improved to normal after two months and no complications or recurrences were detected in the sixth month.