Ultrasonic identification of internal jugular vein fenestration.

OBJECTIVE: Anatomic variations have curicial importance during neck surgery. We present a fenestrated internal jugular vein variation and the accessory nerve passing through it. Also, we discuss preoperative diagnosis of this variation using ultrasonography. METHOD: The possible recognition of this variation by ultrasonography is introduced. RESULTS: The accessory nerve in an internal jugular vein fenestration can be seen using ultrasonography. CONCLUSION: Preoperative identification of this rare variation may secure surgeon from potential complications.

Does the Degree of the Mastoid Pneumatization Affect the Side of Bell Palsy?

OBJECTIVE: The aim is to investigate the impact of degree of mastoid pneumatization on the affected side of Bell palsy (BP). STUDY DESIGN: Retrospective study in tertiary academic hospital. METHODS: In total, 52 patients who were diagnosed with as BP were included in the study. Each patient was staged using House-Brackmann (HB) staging system. All patients underwent temporal bone computed tomography imaging. House-Brackmann scores, side of the BP, and mastoid pneumatization of all of patients were evaluated in the present study. RESULTS: Regarding the degree of the mastoid pneumatization, there were no significant differences between the affected side and the unaffected side (P = 0.439). The degree of the mastoid pneumatization of the affected side and the unaffected side did not differ between males and females (P = 0.918 for the affected side, P = 0.765 for the unaffected side, respectively). A negative correlation between the age and mastoid pneumatization of each side was found (P = 0.001, P = 0.025, respectively). There was no significant correlation between HB score and the degree of the mastoid pneumatization of each side (P = 0.789, P = 0.703). CONCLUSION: As a conclusion, the degree of the mastoid pneumatization is not one of the risk factors for BP. Further randomized studies with larger numbers of patients are needed to confirm these findings.

The Effect of the Angle and Length of the Eustachian Tube on the Success Rate of Cartilage Type 1 Tympanoplasty.

OBJECTIVES: To explore the relationships between the angle and length of the eustachian tube (ET) (the ETa and the ETl) and the success rates of type 1 tympanoplasty. STUDY DESIGN: A retrospective clinical chart review. METHODS: In total, 160 patients (81 females and 79 males; average age, 37.12 ±â€Š12.46 years; age range: 18-65 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. The average ETa and ETl values of each group were measured on computed tomography images using a multiplanar reconstruction technique, and compared. A P value <0.05 was considered to reflect statistical significance. RESULTS: In group A, the ETa of diseased ears was 27.74 ±â€Š12.06° in males and 21.87 ±â€Š7.58° in females. In group A, the ETa of normal ears was 27.53 ±â€Š4.15° in males and 22.25 ±â€Š4.67° in females. In group B, the ETa of diseased ears was 28.85 ±â€Š6.19° in males and 22.91 ±â€Š5.65° in females. In group B, the ETa of normal ears was 27.71 ±â€Š5.23° in males and 23.72 ±â€Š6.20° in females. In group A, the mean ETl of diseased ears was 42.1 mm (28.9-45.1) in males and 38.2 mm (31.0-44.7) in females. In group A, the mean ETl of normal ears was 41.9 mm (29.2-45.8) in males and 37.4 mm (30.5-44.1) in females. In group B, the mean ETl of diseased ears was 40.8 mm (30.2-47.4) in males and 37.9 mm (31.8-45.2) in females. In group B, the mean ETl of normal ears was 41.6 mm (30.0-45.0) in males and 39.1 mm (30.0-43.7) 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 =0.002 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). CONCLUSION: Neither the ETa nor the ETl affected the success rate of 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 type 1 tympanoplasty.

Acute Palatal Perforation and Peroperative Repair Method During Septoplasty Operation.

Septoplasty is a frequent and relatively low-risk procedure in otolaryngology practice. Palatal perforation complication is very rare in the literature and only a few patients have been reported. In this clinical report, a patient with palatal perforation that has been developed and noticed during the septoplasty operation with no anatomical abnormality and alternative repair method are reported with video of the procedure.

Correlation Between the Degree of the Mastoid Pneumatization and the Angle and the Length of the Eustachian Tube.

OBJECTIVES: The aim of the present study is to explore the correlation between the degree of the mastoid pneumatization and the angle (ETa) and the length of the Eustachian tube (ETl). STUDY DESIGN: The study design consisted of a retrospective clinical chart review. METHODS: In total, 217 patients (110 females and 107 males; average age, 33.14 ±â€Š12.88 years; age range: 18-65 years) were included in the study. The patients were divided into 3 groups in terms of the degree of the mastoid pneumatization. The mastoid pneumatization was measured between 0 and 5 cm for group A, between 5 and 10 cm for group B, and ≥10 cm for group C. The ETa and ETl of each group were compared. RESULTS: The mean mastoid pneumatization of groups A, B, and C was 4.32 ±â€Š1.96, 8.26 ±â€Š2.68, and 11.94 ±â€Š1.28 cm, respectively. The ETl of group A was lower than that of other groups statistically (P = 0.006 and 0.018, respectively). The mean ETl did not differ between the groups B and C (P = 0.698, >0.05, respectively). The ETa of each group did not differ (all P > 0.05). The mastoid pneumatization and the ETl were higher in males than in females (P = 0.004 and 0.001, respectively). The ETa did not differ between males and females (P = 0.0158). There was a positive correlation between the degree of the mastoid pneumatization and the ETl (r = 0.159/P = 0.002, <0.05, respectively). CONCLUSIONS: The present study is thus the first to analyze the relationship between the degree of the mastoid pneumatization and the ETa and the ETl. We found a positive correlation between the degree of the mastoid pneumatization and the ETl.

Impact of the Degree of the Mastoid Pneumatization on Cartilage Type 1 Tympanoplasty Success.

OBJECTIVES: To evaluate the effect of the degree of the mastoid pneumatization on the success rate of cartilage type 1 tympanoplasty. STUDY DESIGN: A retrospective clinical chart review. METHODS: In total, 90 patients (44 females and 46 males; average age, 38.40 ±â€Š11.12 years; age range: 21-65 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 mastoid air cell volumes of each groups were compared. RESULTS: The mean mastoid pneumatization in groups A and B was 5.32 ±â€Š1.96  and 5.06 ±â€Š2.12 cm, respectively. The mastoid pneumatization of diseased ears did not differ between the groups (P > 0.05). The mastoid pneumatization of diseased ears did not differ between males and females (P > 0.05). The mastoid pneumatization of normal ears did not differ between the groups (P > 0.05). The mastoid pneumatization of normal ears did not differ between males and females (P > 0.05). CONCLUSIONS: The degree of mastoid pneumatization did not affect the success rate of cartilage type 1 tympanoplasty. Further studies with larger numbers of patients are needed to evaluate the relationship between the degree of the mastoid pneumatization and anatomical outcomes after placement of various graft types.

Impact of the Angles of the Septal Deviation on the Degree of the Mastoid Pneumatization.

INTRODUCTION: The aim was to explore the developmental relationships between the angles of septal deviations and the degree of the mastoid pneumatization. MATERIALS AND METHODS: In total, 143 patients with a diagnosis of septal deviation who underwent septoplasty were included. The patients were divided into three groups in terms of the angles of the septal deviation. The angle of the septal deviations was defined as mild (<9 degrees), moderate (between 9 and 15 degrees) and severe (15 degrees and above). The degree of the mastoid pneumatization of each groups were compared. RESULTS: In right-sided septal deviation subjects, the right mastoid air cell volumes of group mild, moderate and severe were 6,31±2,33 cm3, 5,20± 1,51 cm3, and 5,31±1,57 cm3, respectively. The mean right mastoid volumes of each groups did not differ in right-sided deviations subjects (P>0.05). The mean left mastoid volumes of each groups did not differ in right-sided deviations subjects (P>0.05). In right-sided septal deviation subjects, the mean volume of the right and left-sided mastoid air cells of each groups did not differ (P>0.05). In left-sided septal deviation subjects, the mean volume of the right and left-sided mastoid air cells of each groups did not differ (P>0.05). CONCLUSIONS: No developmental relationships between the angles of septal deviations and the degree of the mastoid pneumatization was observed in the study.

Anatomical Factors in Children with Orbital Complications Due to Acute Rhinosinusitis.

INTRODUCTION: The role of the anatomical variations and severity of acute rhinosinusitis (ARS) in the development of ARS complications is still an unknown issue. Regarding this, the present study evaluated the relationship between the severity of ARS and anatomical nasal variations in pediatric patients with ARS-related orbital complications. MATERIALS AND METHODS: This study was conducted on 134 pediatric patients with orbital complications related to ARS. The data related to patients' demographics, complication types, and involved side were collected. Nasal sides were also compared in terms of the Lund-Mackay score (LMS), osteomeatal complex (OMC) obstruction, Keros classification, presence of agger nasi cells (AGC), concha bullosa, Haller cells, Onodi cells, septal deviation, and lower turbinate hypertrophy. RESULTS: The comparison of LMSs indicated a significant difference between the complicated and contralateral sides (8.37±2.44 vs. 5.62±2.71; P<0.0001). In addition, there was a significant difference between the complicated and contralateral sides in terms of the OMC scores (P<0.0001). The rates of lower turbinate hypertrophy and AGC on the complicated side were higher than those on the contralateral side (P=0.021 and P<0.00; respectively). CONCLUSION: As the results indicated, anatomical variability in adjacent structures affects the development of ARS-related orbital complications in pediatric patients.

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.

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 Effects of Septoplasty on Acoustic Parameters of Voice: A Prospective Clinical Study.

OBJECTIVE: To investigate the effects of septoplasty on the acoustic parameters of voice. METHODS: In total, 23 patients (seven females and 16 males; average age, 32.13±9.67 years; age range: 19-56 years) with a diagnosis of nasal septal deviation and who underwent septoplasty were included. Preoperative and on postoperative 30th day, acoustic analysis of voice was conducted for all patients. The recordings of /mana/ vowel were used to evaluate average fundamental frequency (F0), jitter, shimmer, and noise-to-harmony ratio (NHR). F0, shimmer percent, jitter percent, and NHR of two terms were compared. A p-value<0.05 was considered to indicate statistical significance. RESULTS: A statistically significant change was not observed in F0 (p=0.741), jitter (p=0.930), and shimmer (p=0.128) measured preoperatively and on postoperative day 30. However, the increase in NHR measured on postoperative day 30 were statistically significant compared with preoperative NHR (p=0.017). CONCLUSION: According to the findings of this study, except NHR value, no statistically significant changes on F0, jitter and shimmer were detected after septoplasty.

Is ventilation tube insertion necessary in children with otitis media with effusion?

OBJECTIVES: To compare audiological outcomes of ventilation tube insertion(VTI) and myringotomy alone in association with adenoidectomy in patient with otitis media with effusion(OME). STUDY DESIGN: Retrospective clinical chart review. SUBJECTS AND METHODS: In total, 148 patients (78 male, 70 female; average age of 6,02 ± 1,98 years, range 4 to 7 years) who had been underwent adenoidectomy in association with VTI or myringotomy alone in our clinic were included in this study. Demographics and audiological outcomes were collected. The patients were divided randomly into two groups, group A (72) were subjected to adenoidectomy with VTI and group B (76) were subjected to adenoidectomy with myringotomy. Audiological outcomes comparing the both groups at six months also continued to patients follow up to one year after surgery. Results with a p-value <0.05 were considered statistically significant. RESULTS: The mean pure tone hearing threshold preoperatively in group A was 28.68 ± 11.72 dB, while it was 24.25 ± 12.68 dB in group B. At postoperative six months, the means in group A were 8.4 ± 2,32 dB, while the means were 10,4 ± 3,36 dB in group B. Statistical analysis showed statistically significant difference between the means of pure tone hearing thresholds in both groups during the whole follow up period (p<0.05). CONCLUSION: Our data suggest audiological outcomes of VTI was higher compared with myringotomy alone in association with adenoidectomy. However, further studies with a higher number of patients are needed to compare the audiological outcomes of various ventilation tubes types.