Subglottic cysts in preterm infants: superficially located cysts versus deeply buried cysts in the mucosa.

PURPOSE: To analyze the reason for the diversity of the clinical course of subglottic cysts and discuss their pre- and coexistence with subglottic stenosis. METHODS: The medical records of patients who were treated for subglottic cysts between 2003 and 2020 were retrospectively reviewed and direct laryngoscopy videos were analyzed to assess the healing patterns of their disease. RESULTS: Of the 15 patients, 10 had a history of intubation in the neonatal period. In 11 patients, the cysts were transparent and well defined, and no recurrence of subglottic cysts occurred after the initial surgery. In four patients, the cysts were located deep in the mucosa and did not have the typical appearance of a cyst, but rather of a stenotic segment; all of them had a history of intubation and three of them required laryngotracheal reconstruction. CONCLUSION: Transparent, thin-walled superficial subglottic cysts with healthy surrounding mucosa can easily be treated with endoscopic marsupialization; however, the treatment of deep subglottic cysts can be challenging. The coexistence of subglottic cysts and subglottic stenosis is not rare. We point out the need for considering the possibility of a missed deep submucosal cyst in a seemingly refractory case of pediatric subglottic stenosis with atypical endoscopic findings and with a background history of prior intubation.

Massive pulmonary embolism presenting with hemoptysis and S1Q3T3 ECG findings.

BACKGROUND: Venous thromboembolism clinically presenting with a deep vein thrombosis or pulmonary embolism is among the most commonly seen cardiovascular syndromes. The aim of this case presentation is to emphasise the typical electrocardiographic findings that are detected with massive pulmonary embolism along with the electrocardiographic S1Q3 and S1Q3T3 accompanied by T negativity at the D3 derivation based on prevalent T negativity. CASE PRESENTATION: We present the case of an adult male who presented with a massive pulmonary embolism that was associated with tachycardia, haemoptysis and typical S1Q3T3 electrocardiographic findings. Tomographic findings showed filling defects in the two main pulmonary artery lumens, which were found to be compatible with a massive embolism. Intravenous heparin was injected (5000 IU), and low molecule weight heparin (LMWH) treatment was initiated. After two days of observation and treatment in the coronary intensive care unit, the patient was discharged for outpatient care. DISCUSSION: Massive pulmonary embolism is an urgent life-threatening clinical situation that is frequently confused with acute ST elevation myocardial infarction. The definitive diagnosis of massive pulmonary embolism was made with a computed tomography pulmonary angiogram. Electrocardiographic findings and hypoxic hypercarbia in the blood gas analysis are typical. Early diagnosis with laboratory and imaging investigations is vital in the treatment and prognosis of pulmonary embolism. CONCLUSIONS: Ventricular overload signs accompanied by ST segment elevation in electrocardiography and S1Q3 and prevalent T negativity are crucial features in terms of distinguishing between pulmonary embolism and myocardial infarction and selecting effective treatments for patients admitted to the emergency department.

Neuronavigation-assisted percutaneous balloon compression for the treatment of trigeminal neuralgia: The technique and short-term clinical results.

BACKGROUND: Percutaneous balloon compression (PBC) has been widely used in the treatment of trigeminal neuralgia. However, this technique has a steep learning curve and significant complications were reported that were related to foramen ovale puncturing. The aim of this study was to evaluate the clinical results of a small patient group who underwent neuronavigation-assisted PBC. METHODS: An intraoperative computed tomography (CT) device (CereTom, Neurologica, Danvers, MA/USA) was used to obtain CT scans with 2-mm slice thicknesses. The data were transferred to a neuronavigation system planning station (BrainLab, Feldkirchen, Germany). A soft touch registration system was used for image registration. With the image guidance, a trajectory was defined and the foramen ovale was cannulated using neuronavigation and Hartel's landmarks. RESULTS: Sixteen procedures were performed on 13 patients (4 female and 9 male) without complications. The total length of the procedure was not more than 57 min in all instances. CONCLUSIONS: We believe that image-guided neuronavigation is useful for neurosurgeons who are at the beginning of their PBC learning curve. It may also be an alternative for particular patients with significant anatomic variations that result in an unsuccessful foramen ovale puncture.

Nasopharyngeal Mass Diagnosed as Transsphenoidal Encephalocele in an Adult Patient.

Transsphenoidal encephalocele, a rare congenital malformation, is generally diagnosed during childhood when investigating the reason for complaints such as nasal obstruction and recurring cerebrospinal fluid fistula. In this adult patient, the authors identified an asymptomatic transsphenoidal encephalocele after requested monitoring of a pedunculated mass detected in the nasopharynx during nasal endoscopy. After evaluation, the authors decided to follow the patient. Few cases of transsphenoidal encephalocele have been reported, and even fewer have been reported in older patients, with no other anomaly or symptoms. The success of surgical treatment for these masses is debatable. The authors did not consider surgery for this asymptomatic case. With this case presentation, the authors wish to emphasize that without making radiologic assessments of any masses identified in a nasopharyngeal examination, it would be inappropriate to perform a biopsy or any intervention.

The morphology of the nasopharyngeal inlet in obstructive sleep apnea.

Routine flexible optic laryngoscopy (FOL) can visualize the airway from the nasopharynx to the hypopharynx in obstructive sleep apnea (OSA). With the tip of a flexible endoscope at the nasopharyngeal inlet (NPI), we can visualize the morphology of this area. We evaluated the effect of NPI morphology on OSA severity. Videos were obtained during FOL examinations of the NPI in 83 patients (11 females, 72 males; mean age 42.1 ± 9.5 years) and NPI morphology was examined. Two main morphologies were seen: wide and narrow. The narrow NPI group (n = 45) was further subdivided into kidney-shaped (n = 34), elliptical (n = 6), and circumferential (n = 5) groups. The wide NPI group (n = 38) was subdivided into circumferential (n = 20) and kidney-shaped (n = 18) groups. Mean Respiratory Disturbance Index (RDI) values were 30.38 ± 22.36 and 14.51 ± 13.9 in the narrow and wide groups, respectively. Mean RDI values were 45.32 ± 30.6, 23.74 ± 10.8, and 28.72 ± 21.5 in the narrow circumferential, elliptical, and kidney-shaped groups, respectively. Mean RDI values were 11.58 ± 12.91 and 17.8 ± 14.6 in the wide circumferential and kidney-shaped groups, respectively. RDI values were significantly lower in the wide morphology group (p < 0.0005). NPI morphology might predict OSA during routine FOL examination. Further analysis of the subgroups supported evidence of narrowing, reflected as higher RDI values.

Reliability of high-pitch ultra-low-dose paranasal sinus computed tomography for evaluating paranasal sinus anatomy and sinus disease.

OBJECTIVES: The aim of this study was to evaluate the reliability of high-pitch ultra-low-dose computed tomography (CT) for detecting important paranasal sinus anatomic landmarks and pathologies. MATERIALS AND METHODS: Sixty patients (22 females, 38 males) aged 15 to 67 years (mean age, 33.68 y; SD, 9.83 y) underwent high-pitch ultra-low-dose CT of the paranasal sinuses between February and June 2012. To determine the lowest possible dose for evaluation of the paranasal sinuses, the patients were divided into three groups randomly and prospectively. A different low-dose CT protocol was applied to each group. The image quality was assessed subjectively by a radiologist and an otorhinolaryngology head and neck surgeon independently using a 4-point grading scale (0 = structures could not be identified, 1 = indistinctly defined structures, 1.5 = relatively well-defined structures, 2 = very well-defined structures). Anatomic landmarks and mucosal structures were evaluated. Mean scores were evaluated to assess statistical significance. RESULTS: According to the anatomic landmark scoring, excluding the ethmoid foramen for ethmoid artery identification, all of the structures in all 3 groups were very well-defined structures. The ethmoid foramen for ethmoid artery identification was scored as either could not be identified or an indistinctly defined structure in all groups. On evaluating the mucosa of the paranasal sinuses, normal and pathologic mucosal structures were scored as very well defined in all of the patients. The interobserver agreement was excellent. CONCLUSION: High-pitch ultra-low-dose CT is a safe, reliable paranasal sinus screening tool.

Comparison of postoperative bleeding between submucosal uvulopalatopharyngoplasty and tonsillectomy.

BACKGROUND: The aim of this study was to compare the incidence of postoperative secondary hemorrhage for tonsillectomy and submucosal uvulopalatopharyngoplasty (smUPPP). MATERIALS AND METHODS: In this retrospective case series, the medical records of 404 patients who underwent tonsillectomy with unipolar electrocautery and smUPPP at our institution between January 2001 and December 2010 were reviewed. The patients were divided into two groups: Group 1 (198 patients) underwent tonsillectomy; Group 2 (206 patients) underwent smUPPP. Main outcome measures were incidence of bleeding or complications after tonsillectomy and smUPPP and the need for revision surgery. RESULTS: The mean age of Group 1 patients was 38.1 (±2.58) years and that of Group 2 was 37.7 (±2.25) years. Males were 51.3% of Group 1 and 46.7% of Group 2. No statistically significant difference in age or gender distribution was found between Groups 1 and 2. The incidence of secondary, delayed hemorrhage was 5.05% (10 patients) in Group 1 and 1.45% (three patients) in Group 2 (P = 0.05). The incidence of delayed hemorrhage requiring surgical treatment was 4.54% (nine patients) in Group 1 and 0.97% (two patients) in Group 2. CONCLUSION: In adults, smUPPP, which includes tonsillectomy, has a lower incidence of postoperative delayed hemorrhage than does tonsillectomy with unipolar cautery.

Ascending transaqueductal cystoventriculoperitoneal shunting in Dandy-Walker malformation: technical note.

The optimal treatment for Dandy-Walker malformation is still controversial. Ventriculoperitoneal shunting, cystoperitoneal shunting or combinations are the most common surgical options in the management of this clinical entity. Endoscopic procedures like ventriculocystostomy, 3rd ventriculostomy or endoscopy-assisted shunt surgeries have become the focus of recent publications. We describe a new transcystic endoscopic technique, with the usage of a single ascending transaqueductal shunt catheter with additional holes, whereby both the posterior fossa cyst and supratentorial ventricular compartments are drained effectively. By using this new technique complications associated with combined shunting can be avoided. In addition, by equalizing the pressure within the supra- and infratentorial compartments, the upward or downward herniations associated with single-catheter shunting can be prevented.

[Endonasal phototherapy in the treatment of allergic rhinitis]. / Alerjik rinit tedavisinde endonazal fototerapi.

OBJECTIVES: In this study, we assessed the effect of endonasal phototherapy on quality of life, nasal obstruction and the other symptoms in allergic rhinitis with visual analog scale (VAS), sinonasal outcome test-20 (SNOT-20), and acoustic rhinometry. PATIENTS AND METHODS: Twenty-four patients (6 males, 18 females; mean age 41.3±13.0 years; range 20 to 60 years) suffering allergic rhinitis refractory to anti allergic drugs for at least two years were enrolled in the study. Each patient underwent a total of six sessions of endonasal phototherapy with Rhinolight (Rhinolight Ltd, Szeged, Hungary) performed three times a week for two weeks. During course of the investigation, additional therapy was not applied to any of the patients. Before and one month after treatment, patients completed visual analog scale and SNOT-20 forms and nasal obstruction was evaluated with acoustic rhinometry. RESULTS: After the treatment, the mean VAS score and the mean total SNOT-20 score were found lower than the results before the therapy (p=0.0001, p=0.0001). A significant decrease was found in the scores of sneezing, nasal discharge, postnasal drainage, coughing after treatment (p=0.0001). During objective evaluation of nasal obstruction with acoustic rhinometry, no statistically significant difference was found between pre- and post-treatment findings. CONCLUSION: Endonasal phototherapy is an effective modality in the treatment of symptomatology in allergic rhinitis patients refractory to antiallergic drugs. It is detected that endonasal phototherapy has positive effects on the quality of life. However, no effect on nasal obstruction was found with acoustic rhinometry which is an objective method.

Congenital Mucocele of the Nasal Dorsum: A Case Report.

Congenital nasal dorsum cysts are very rare lesions. Its differential diagnosis lies between gliomas, dermoid cysts and encephaloceles. We present a case of solitary congenital external nasal cyst with no intranasal fistulous tract connection in a newborn. Histopathologic analysis of the mass demonstrated findings consistent with an external mucocele. Total excision with external open approach provided the cure with good cosmetic outcome. This is the first report presenting an external mucocele in a newborn in the literature. External mucoceles should be kept in mind in the differential diagnosis of congenital nasal dorsum masses.

Posttraumatic pseudoaneurysm of the superficial temporal artery: After paintball game.

A 20-year-old man suffered from a swelling with a painless but cosmetic problem in the right temporal region. Pseudoaneurysm of the superficial temporal artery is rare. It typically occurs after blunt trauma to the temporal region and presents as a painless, preauricular and pulsatile mass during the following 2-6 weeks. The diagnosis is made simply by physical examination and ultrasound. Surgery under local anesthesia is a very effective treatment.

Endonasal choanal atresia repair; evaluating the surgical results of 58 cases.

BACKGROUND: Choanal atresia is the most common congenital nasal anomaly, with an incidence of 1:5000-1:8000 live births. Atresia can be seen as membraneous, bony or mixed type. When it is bilateral, it is accepted lifethreatening, therefore bilateral atresia necessitates immediate intervention. Diagnosis is confirmed by endoscopic examination and computed tomography. The absolute treatment is surgical, and different approaches have been proposed. METHODS: Herein, we describe our 15-year experience in the treatment of 58 patients of congenital choanal atresia with transnasal endoscopic approach, and we compare the efficacy of placement of an intranasal stent and applying mitomycin while endoscopic microsurgical repair. RESULTS: The study included 41 female patients (71%) and 17 male patients (29%) with congenital CA. The mean age was 3 years ranging from 10 days to 16 years. The atretic plate was bilateral in 24 patients (41%) and unilateral in 34 (59%). The most common atresia type was the mixed type with 29 patients (50%). A total of 17 patients (29%) required postoperative revision(s). Postoperative revisions were more frequent among patients with bilateral CA (50%), and with mixed CA (31%). Stenting was used additionally by surgical correction for 10 patients. After stenting, fibrosis and restenosis was seen in 7 patients (79%). Mitomycin C was applied peroperatively in 8 patients. Restenosis after mitomycin application was seen in 4 patients (50%). CONCLUSIONS: By our experience, endoscopic microsurgical repair of atresia proved to be an effective and safe procedure, results compared with adjuvant treatment modalities like stent or mitomycin C use, was not better. Restenosis was the major problem seen after surgical correction.

The relationship between positivity for COVID-19 RT-PCR and symptoms, clinical findings, and mortality in Turkey.

Introduction: This study aimed to assess the correlation between nucleic acid amplification test (real-time reverse transcription-polymerase chain reaction, RT-PCR) positivity of patients presenting with suspected COVID-19 and pneumonic infiltration consistent with COVID-19-specific pneumonia diagnosis on thoracic computed tomography (CT), with symptoms, laboratory findings, and clinical progression.Methods: The study included 286 patients (female:male 131:155; mean age, 53.3 ± 17.9 years) who were divided into two groups according to their RT-PCR test results. The symptoms, laboratory examinations, clinical findings, and thoracic CT imaging of the patients were evaluated.Results: While the physical examination, comorbidities, and total CT scores were similar between the groups, taste/smell abnormalities were observed more frequently in the PCR-positive group. The use of moxifloxacin, lopinavir/ritonavir, and tocilizumab was higher in the PCR-positive group (p = 0.016, p < 0.001, and p = 0.002, respectively). The duration of hospitalization, intensive care requirement, and mortality rate of the studied groups did not differ between the groups.Conclusions: Among patients presenting with suspected COVID-19 and pneumonic infiltration consistent with COVID-19 on thoracic CT, the symptoms, physical examination, total CT scores, duration of hospitalization, intensive care requirement, and mortality rate were similar between RT-PCR-positive and RT-PCR-negative patients. However, PCR-positive patients appeared to require more specific treatments.

Evaluation of Periarticular Soft Tissues in Patients With Juvenile Idiopathic Arthritis by Superb Microvascular Imaging and Shear Wave Elastography.

OBJECTIVES: This study aims to compare the vascularity and elasticity of periarticular soft tissues by superb microvascular imaging (SMI) and power Doppler (PD) ultrasound along with shear wave elastography (SWE) between children with juvenile idiopathic arthritis (JIA) and healthy children. PATIENTS AND METHODS: This prospective single center study, conducted between March 2018 and May 2018, included 22 children with JIA (14 males, 8 females; mean age 11.27±5 years; range, 5 to 17 years) and 24 healthy pediatric volunteers (12 males, 12 females; mean age 13±5.5 years; range, 7 to 17 years). Quadriceps tendon (QT), patellar tendon (PT), infraarticular and supraarticular soft tissue elasticities were calculated via SWE. Supraarticular and infraarticular soft tissue vascularity index (VI) were evaluated via SMI and PD. RESULTS: No significant difference was found among the mean ages of the participants in study and control groups. Mean VI of both supraarticular (8.15%) and infraarticular soft tissues (7.9%) by SMI were significantly higher in study group compared to control group (2.88% vs. 2.57%, respectively). Mean VI of both supraarticular (9.1%) and infraarticular soft tissues (8.12%) by PD were significantly higher in study group compared to control group (3.4% vs. 3.1%, respectively). Highly significant good positive correlation was found between VI values obtained with PD and SMI (r=0.9, p=0.001). There was a significant moderate positive correlation between the mean elasticity of the QT with VI of the supraarticular soft tissues by SMI (r=0.4, p=0.003). There was a significant moderate positive correlation of VI of infraarticular soft tissues by SMI with mean elasiticity of PT (r=0.42, p=0.002). CONCLUSION: Vascularity index by SMI and PD could differentiate patients with JIA from healthy subjects. The SWE examination of tendons and soft tissues did not show any significant difference among patients with JIA and healthy subjects.

Clinical and radiological evaluation of cherubism: A rare case report.

Cherubism is a rare, non-neoplastic, genetic disorder, characterized by painless bilateral swelling of the jaws. A 5-year-old girl presented with a painless, bilateral symmetrical swelling of both mandible and maxilla. Intraoral examination revealed malocclusion with displacement of teeth and expansion of the alveolar ridges. There was a bilateral expansion of the jaws. In conclusion, cherubism is a genetic disorder that has non-neoplastic bone lesions that affect the jaws. If there is a functional or esthetic problem, it should be treated surgically. The surgical treatment is usually delayed until after puberty.

Unilateral Alar Ligament Injury: Diagnostic, Clinical, and Biomechanical Features.

BACKGROUND: Isolated unilateral alar ligament injury (ALI) is a very rarely diagnosed condition, with only 9 cases reported in the literature. The purpose of this study is to determine clinical, diagnostic, and biomechanical features of unilateral ALI. METHODS: A total of 6 patients diagnosed with ALI were included in this series. The hospital records and radiologic imaging of admission and follow-ups were investigated retrospectively. RESULTS: Rotation of the neck and/or hyperflexion was always present as a mechanism of injury. The patients were neurologically intact. All patients presented with mild neck pain aggravated by head rotation. On computed tomography (CT) scans, the dens was observed to be displaced to the opposite side. Magnetic resonance imaging (MRI) showed a widened lateral dens-atlas space with high signal intensity. All patients underwent lateral flexion-extension CTs for the confirmation of craniovertebral junction (CVJ) stability. The patients were treated with hard collars. The follow-up MRI of 3 patients obtained at the third month showed normal lateral dens-atlas interval and recovered ligaments. All patients were pain free after 6 months. CONCLUSIONS: Unilateral ALI appears to be more common but misdiagnosed than previously thought. Trauma mechanism consists of hyperflexion and contralateral rotation. Neck pain aggravated with rotation is the most significant clinical finding. Dens lateralization is the most important finding in CT scans. An MRI focusing on the CVJ is essential for the diagnosis. The stability of CVJ must be checked with a flexion-extension CT scan. Unilateral ALI is a stable condition and responds to conservative treatment.

Magnetic resonance imaging characteristics of cardiac hydatid cyst.

PURPOSE: The purpose of this article is to describe the magnetic resonance imaging (MRI) features of cardiac hydatid disease and show the specific findings in the diagnosis of hydatic cysts. MATERIALS AND METHODS: A retrospective review of cardiac MRI records between 2015 and 2017, 7 patients (3 males, 4 females; age range: 14-74) were identified with the histologic diagnosis of cardiac hydatid disease. Cardiac MRI examinations were performed in order to investigate the cardiac cystic-solid lesion obtained via previous echocardiography (ECG) and thorax computed tomography. 1.5 Tesla magnetic field power generation capacity was used and the images were acquired with ECG trigger. RESULTS: There is variation in signal characteristics of cysts on T1-weighted and T2-weighted images. Early contrast enhancement was not observed in the any of lesions on contrast-enhanced series. In all lesions examined, peripheral contrast enhancement was observed in the late contrast enhanced series, independent from the internal structure and signal intensity. CONCLUSIONS: MRI reveals the exact anatomic location and nature of the cyst structures. Peripheral enhancement of non-enhancing lesion is very valuable for diagnosis of cardiac hydatids on MRI.

Nasopharyngeal Glial Heterotopia with Intracranial Extension: A Case Report.

Nasopharyngeal glial heterotopia is a mass composed of mature neural tissue occurring outside the central nervous system and is extremely rare. The preoperative diagnosis of such a mass in the head and neck region is challenging. In this study, we report a case of a 16-month-old patient presenting with respiratory distress and snoring caused by nasopharyngeal glial heterotopia. Radiologic imaging and histopathology are obligatory for the definitive diagnosis of glial heterotopia. Preoperative evaluation of an intracranial connection is one of the most essential issues in the presence of pediatric nasopharyngeal masses. The gold standard of treatment is surgical excision. Early recognition and early surgical excision by endoscopic or external approach are crucial to relieve respiratory distress and to maintain healthy growth and development.

Reversible sensorineural hearing loss in a girl with Kawasaki disease.

Kawasaki disease is an acute, self-limited vasculitis of infants and children that is now the most common cause of acquired heart disease in the pediatric age group in the United States and Japan. This report presents a case of classic Kawasaki disease with reversible sensorineural hearing loss that was treated with steroid. In conclusion, Kawasaki disease caregivers must be aware of possible sensorineural hearing loss, which is reversible by early intervention and thus improves quality of life.

Ectopic intrathyroidal thymus in children: Prevalence, imaging findings and evolution.

Erol OB, Sahin D, Bayramoglu Z, Yilmaz R, Akpinar YE, Ünal ÖF, Yekeler E. Ectopic intrathyroidal thymus in children: Prevalence, imaging findings and evolution. Turk J Pediatr 2017; 59: 387-394. The aim of this study was to evaluate the ultrasound (US) features of intrathyroidal ectopic thymus (IET) and demonstrate the alterations after follow-up. This study included 36 lesions of 32 patients (mean age 95 ± 58 months) diagnosed with IET. The patients underwent follow-up US examination at least 22-months without a medication or surgical intervention. A total of 36 IETs with an incidence of 0.91% were detected among 3914 thyroid ultrasound (US) examinations. The mean of anteroposterior (ap), transverse (tr), and craniocaudal (cc) diameters in the initial US examinations were 3.1±1.19 mm, 4.89±1.86 mm, and 6.45±3.92 mm respectively. All of the lesions were well-demarcated, hypoechoic to the thyroid gland, and contained uniformly distributed punctate echogenic foci. Follow-up US examinations were performed after 684±85 days. The alterations between the initial and follow-up diameters for ap and cc direction were not statistically significant. However, a significant difference (p=0.007) was found for transverse diameters and the IETs were found to be smaller at follow-up US than in the initial US. Most of the IETs were located in the left lobe (64%), middle portion (83%), and extended to a border of thyroid gland (69%) and nonspherical in shape (89%). The descriptive findings of IETs are uniform distribution of punctate echogenic foci, absence of a rim, and the presence of vessels traversing through the lesion without parenchymal displacement. Given our findings, healthcare professionals should be aware of the diagnosis of IET. Patients with an IET could be safely managed with follow-up US and any surgical treatment would not be required.