Anatomical Insights on the Cervical Nerve for Contemporary Face and Neck Lifting: A Cadaveric Study.

BACKGROUND: Despite the significant roles it plays in the functions of the platysma and lower lip, the cervical branch of the facial nerve is often overlooked compared to other branches, but its consideration is critical for ensuring the safety of neck surgeries. OBJECTIVES: The aim of this study was to clarify the anatomical discrepancies associated with the cervical branch of the facial nerve to enhance surgical safety. METHODS: The study utilized 20 fresh-frozen hemiheads. A 2-stage surgical procedure was employed, beginning with an initial deep-plane facelift including extensive neck dissection, followed by a superficial parotidectomy on fresh-frozen cadavers. This approach allowed for a thorough exploration and mapping of the cervical nerve in relation to its surrounding anatomical structures. RESULTS: Upon exiting the parotid gland, the cervical nerve consistently traveled beneath the investing layer of the deep cervical fascia for a brief distance, traversing the deep fascia to travel within the areolar connective tissue before terminating anteriorly in the platysma muscle. A single branch was observed in 2 cases, while 2 branches were noted in 18 cases. CONCLUSIONS: The cervical nerve's relatively deeper position below the mandible's angle facilitates a safer subplatysmal dissection via a lateral approach for the release of the cervical retaining ligaments. Due to the absence of a protective barrier, the nerve is more susceptible to injuries from direct trauma or thermal damage caused by electrocautery, especially during median approaches.

The Genotoxic Effect of Nasal Steroids on Human Nasal Septal Mucosa and Cartilage Cells In Vitro.

OBJECTIVE: To determine whether budesonide (Bud) and triamcinolone acetate (TA) cause DNA fractures in the nasal mucosa and septal cartilage cells through examinations using the comet assay technique. STUDY DESIGN: Prospective, controlled experimental study. SETTING: University hospital. METHODS: Septal mucosal epithelial and cartilage tissue samples were taken from 9 patients. Cell cultures were prepared from these samples. Then, budesonide and triamcinolone acetate active ingredients at 2 different doses of 0.2 and 10 µM were separately applied to the cell cultures formed from both tissues of each patient, except the control cell culture, for 7 days in one group and 14 days in one group. After the applications, genotoxic damage was scored with the comet assay technique and the groups were compared. RESULTS: In both the budesonide and triamcinolone acetate groups, the comet scores at low and high doses, on the 7th and 14th days were found to be significantly higher in both cartilage and epithelial tissue than in the control group. CONCLUSION: The study results showed that budesonide and triamcinolone acetate lead to a significantly high rate of genotoxic damage in both epithelial tissue and cartilage tissue.

Effects of Combined Visible and Infrared Light Rhinophototherapy in Patients With Allergic Rhinitis.

BACKGROUND: Intranasal phototherapy offers an alternative treatment method for patients with allergic rhinitis who cannot benefit from intranasal corticosteroids and oral antihistamines. Different wavelengths have been tried with promising results. OBJECTIVE: In this present study, we aimed to investigate the effects of visible light-infrared light phototherapy on clinical improvements together with its cytologic effects in patients with allergic rhinitis. METHODS: Patients with confirmed allergic rhinitis were given a 4-week course of intranasal phototherapy treatment. Weekly symptom questionnaires were applied to monitor clinical effects. Nasal lavage specimens were obtained before the start and at the completion of the 4-week therapy. Fluorescence-activated cell sorting analyses of CD16+, CD24+, and CD 45+ cells were performed. Statistical analyses are performed of weekly changes in symptoms and cell counts. RESULTS: CD45+CD16highCD24+ neutrophil count in nasal lavages decreased significantly whereas CD45+CD16dim/-CD24+ eosinophil counts significantly increased and CD45+ granulocyte counts remained unchanged. Symptom scores including nasal itching, nasal discharge, nasal obstruction, sneezing, eye itching, throat itching, and ear itching all statistically decreased compared to baseline at the end of 4 weeks. CONCLUSION: Four-week course of intranasal phototherapy with visible and infrared light leads to clinical improvement in allergic rhinitis patients.

Comparing the Efficiencies of Hyperbaric Oxygen Therapy and Intratympanic Steroid Treatment for Sudden Hearing Loss.

OBJECTIVES: To compare the efficiencies of hyperbaric oxygen therapy (HBOT) and intratympanic steroid (ITS)treatment for idiopathic sudden sensorineural hearingloss (ISSHL). MATERIALS AND METHODS: A total of 136 patients who were treated for ISSHL were reviewed fromthemedical records. All of the patients were given systemic steroid therapy (SST). Among them,33patients received HBOT and 36 patients received ITS treatment following SST. The starting time to treatment, risk factors, hearing level, hearing gain (HG), and recovery rate were evaluated from retrospectiverecords. RESULTS: No substantial change in HG was observed for either the HBOT or ITS treatment cohort (p>0.05). But the time to recovery was higher in the ITS treatment cohort (40%) than in theHBOT cohort (17%). The starting time to ITS treatment was 4 days (range: 1-30) and that to HBOT was 8 days (range:3-30). There was a significant difference in the starting time to treatment (Mann-Whitney U-test, p=0.043). Also, hearing loss in the HBOT group was significantly higher than in the ITS treatment group. A significant difference was observed before and after ITS treatment (p<0.05). CONCLUSION: In patients compared with late-onset treatment, ITS may be more effective than HBO after SST failure. It can be used as salvage therapy in patients with ISSHL who are unresponsive to a primary systemic steroid. We observed that HBOT didnot improve results when it was started late. Therefore, more studies that include both ITS treatment and HBOTas anearly treatment option are needed.

The differences in the expression of fractalkine and its receptor in conditions of tonsillar hypertrophy and chronic tonsillitis.

OBJECTIVE: Fractalkine, member of chemokine family, is involved in many inflammatory processes in the human body. The aim of this study is to compare expression levels of fractalkine ligand and its receptor in chronic tonsillitis and hypertrophic tonsil samples. METHODS: The study was conducted at Baskent University Departments of Otorhinolaryngology and Medical Genetics. It is designed as a prospective, non-randomized, controlled clinical study. Total 97 samples, obtained from adenotonsillectomy due to chronic tonsillitis or tonsillar hypertrophy, were participated in the study. Fractalkine and its receptor expression levels were determined and comparison was made between the tissue groups. c.839C>T (T280M) polymorphism of fractalkine receptor was analyzed, then relationship between polymorphism and the expression level of fractalkine receptor was investigated. RESULTS: Fractalkine receptor expression was significantly higher in the hypertrophic tonsil group than chronic tonsillitis group (p<0.05). CONCLUSION: Fractalkine, member of chemokine family, and its receptor may play role in preventing chronic-recurrent tonsillitis.

Effect of mometasone furoate nasal spray on the DNA of nasal mucosal cells

Background/aim: Allergic rhinitis (AR) is a respiratory disease caused by inflammation of the nasal mucosa. Intranasal corticosteroids (ICs) are an effective treatment for AR; however, their use has been associated with atrophy in nasal mucosae. Because DNA damage has been linked to several chronic diseases, we hypothesize that use of ICs could cause DNA damage in nasal mucosa cells, leading to mucosal atrophy and septal perforation. Materials and methods: Sixty patients with moderate or severe AR were divided randomly into two groups. Mometasone furoate (MF) and antihistamine tablets (desloratadine) were given to the study (IC) group. Physiologic saline and desloratadine were given to the control ((serum physiologic (SP)) group. Nasal irrigation fluid was taken from patients before study commencement and after 4 weeks of treatment. The comet assay was applied to detect DNA damage in nasal mucosa cells. Results: Nineteen patients were excluded, leaving a study population of 41 patients (IC group: 17 patients; SP group: 24 patients). Genotoxic damage was evaluated by comet assay. Conclusion: Treatment with MF spray for 4 weeks does not cause DNA breaks within cells in the nasal mucosa. These results could form the basis of clinical trials involving treatment with different ICs over longer treatment periods.

Middle Ear Resonance Frequency in Pilots and Pilot Candidates.

BACKGROUND: Barotrauma is a frequent problem in aviation medicine. Eustachian tube dysfunction plays a critical role in the pathogenesis of barotrauma. Function of the Eustachian tube can be indirectly assessed by multifrequency tympanometry, which provides valuable information about the resistance and permeability of the middle ear in a wide frequency range. The aim of this study was to research whether multifrequency tympanometry could be used for assessing middle ear impairments in pilots. METHODS: There were 140 pilots and pilot candidates between the ages of 20-55 with normal otoscopic examination who were evaluated by audiological test batteries. Body mass index values, flight hours, audiometric pure tone thresholds, tympanometry and multifrequency tympanometry test results were noted. RESULTS: There was statistically significant decrease in the multifrequency tympanometry measurements of the left and right ears of the pilots with 200-3000 flight hours compared to pilot candidates, and similarly, the pilots with 3000-10,000 flight hours compared to pilot candidates. DISCUSSION: Multifrequency tympanometry values changed between pilot candidates and pilots. However, the values of multifrequency tympanometry did not change due to flight hours. This test battery should not be used for follow up of pilots in the clinic. Tuncer MM, Babakurban ST, Aydin E. Middle ear resonance frequency in pilots and pilot candidates. Aerosp Med Hum Perform. 2016; 87(10):876-881.

FCN2 c.772G>T polymorphism is associated with chronic adenoiditis and/or tonsillitis, but not -4 A>G and -602 G>A.

OBJECTIVE: Ficolins are complement activating peptides that play a role in the initial host defense against infectious pathogens. In the present study, we investigated the relationship between single nucleotide polymorphisms (SNPs) in the ficolin 2 gene (FCN2) and chronic adenotonsillitis in pediatric cases. STUDY DESIGN: Case-control study. METHODS: A total of 101 pediatric patients diagnosed with chronic adenotonsillitis and 100 healthy children were enrolled in the study. Genotypes of FCN2 promoter SNPs - 602 G>A and -4 A>G, and the exonic SNP c.772G>T were determined by light SNP assay after realtime PCR analysis using genomic DNA samples obtained from peripheral blood samples of all participants. RESULTS: Of the 101 chronic tonsillitis patients, 38 were girls and 63 were boys; the mean age was 5.2 ± 2.3 years. The c.772G>T SNP frequency was significantly higher in chronic adenotonsillitis cases compared to the control group (p = 0.00); however, no significant difference was determined at positions -602 G>A or -4 A>G (p > 0.05). CONCLUSIONS: The FCN2 c.772G>T genotype appears to be associated with predisposition to chronic adenotonsillitis in the pediatric age group. This nucleotide change is likely to influence the level of gene expression and contribute to the development of disease.

A comparative study on nasal packing after septoplasty: does it matter in terms of patient comfort, bleeding, and crust or synechia formation?

OBJECTIVES: This study aims to compare pain, bleeding, nasal obstruction, crust and synechia formation, and anesthesia-related morbidity in patients with and without use of nasal packs after septoplasty. PATIENTS AND METHODS: A total of 66 patients (32 women, 34 men; mean age 24 years; range 18 to 48 years) who underwent Cottle's septoplasty under general anesthesia were randomly allocated to three groups in this prospective cohort. Telfa nasal packs were used in sutures + telfa group (n=22) and Merocell nasal packs in merocel alone group (n=22). No packs were administered in sutures alone group (n=22). Three groups were compared in terms of nasal obstruction, bleeding, pain, crust and synechia formation, as well as the amount of secretion, the need for oropharyngeal airway, the presence of laryngospasm, and effort for nasal breathing after anesthesia. RESULTS: The amount of bleeding was higher with lower degree of nasal obstruction in sutures alone group. Pain and secretion were more remarkable in merocel alone group. After the first week, these differences were unable to be differentiated among the groups. There were no differences between three groups with respect to crust and synechia formation two weeks after septal surgery. CONCLUSION: Nasal packs can be more useful in patients who suffer from bleeding-related morbidity, while septoplasty applied without nasal packs can be more suitable in patients with obstructive sleep apnea. The use of nasal packs in septoplasty should be determined on an individualized basis with respect to the characteristics of each patient.

Adenoidectomy: current approaches and review of the literature.

Adenoid is a secondary lymphoid organ located in the nasopharynx. Due to its location, it plays an important role in the host defense of the upper respiratory tract. Immunoglobulin G3 and immunoglobulin A1 antibodies are prevalent antibodies in the adenoid tissue. Adenoidal hypertrophy is a common condition in children causing symptoms such as mouth breathing, nasal discharge, snoring, sleep apnea, and hyponasal speech. It also plays a role in the pathogenesis of rhinosinusitis, recurrent otitis media, and otitis media with effusion. Currently, adenoidectomy is one of the most commonly performed pediatric surgical procedures worldwide. Although there is still poor evidence in the literature, recurrent upper respiratory infections, otitis media with effusion, and obstructive sleep apnea syndrome are considered to be the main indications of adenoidectomy. Adenoidectomy can be carried out with several techniques and instruments. Although rare, surgery possesses some risks and may cause emotional distress both for the patient and the family. Non-surgical treatments such as intranasal steroids are also used in the treatment of adenoid hypertrophy. In this review, we discuss the current literature on the adenoid function, adenoidectomy indications, and treatment of adenoid hypertrophy.

Recurrent Pleomorphic Adenoma of the Submandibular Gland.

Pleomorphic adenoma (PA) is the most common benign tumor of salivary glands. Most PAs occur in the parotid (80%), followed by the submandibular gland (10%) and minor salivary and sublingual glands (10%). Submandibular gland PAs usually manifest in the submandibular area as a painless hard mass. Although several recurrent parotid gland PA cases have been reported in the literature, recurrent submandibular gland PA is quite rare. Complete surgical removal of tumor of the submandibular gland and keeping the capsule intact are important to prevent recurrence. Here we present a rare case of submandibular gland PA recurrence that occurred 5 years after the first surgery and methods to prevent recurrence.

Lack of association of matrix metalloproteinase-9 promoter gene polymorphism in obstructive sleep apnea syndrome.

PURPOSE: Obstructive sleep apnea syndrome (OSAS) is a public health problem. There is an effort to establish the genetic contributions to the development of OSAS. One is matrix metalloproteinases, extracellular matrix degrading enzymes related to systemic inflammation. However, the impact of matrix metalloproteinase-9 (MMP-9) genotypes on the development of OSAS is unknown. Our aim was to determine whether MMP-9 single nucleotide polymorphism (SNP) (MMP-9 -1562C > T) is related to susceptibility to OSAS. MATERIAL AND METHODS: A total of 106 patients with a history of sleep apnea and 88 controls without a history of sleep apnea were enrolled in this study. Genotypes were determined by restriction fragment length polymorphism analyses after polymerase chain reaction. RESULTS: Genotypes and allele frequencies of the MMP-9 -1562C > T SNP was not statistically different between the patient and control groups (p > 0.05). There was a statistical association between apnea-hypopnea index (AHI) and body mass index (BMI), and also between AHI and neck circumference (p < 0.001). There was no association among the genotypes and AHI, neck circumference, or BMI (p > 0.05). CONCLUSIONS: We found no association between MMP-9 -1562C > T SNP and OSAS. Studies to investigate the role of other polymorphisms and expression of MMP-9 gene will provide more information.

Chronic tonsillitis is not associated with beta defensin 1 gene polymorphisms in Turkish population.

BACKGROUND: Defensins are antimicrobial peptides expressed on mucosal surfaces. They function as part of the innate immune system. Palatine tonsils play important roles in innate immune system. However, our knowledge on the pathophysiology of chronic tonsils is limited. OBJECTIVE: The aim of this study was to investigate the association between beta defensin 1 gene single nucleotide polymorphisms and chronic tonsillitis. STUDY DESIGN: Prospective, non-randomized, controlled clinical study. SETTING: Tertiary referral center. SUBJECTS AND METHODS: Eighty six patients with chronic tonsillitis and eighty controls without history of chronic tonsillitis were enrolled in this study. Genotypes were determined by restriction fragment length polymorphism analyses after polymerase chain reaction. RESULTS: Genotype and allele frequencies of the -20G/A (rs11362), -44C/G (rs1800972) and -52G/A (rs1799946) single nucleotide polymorphisms were not statistically different between patients and control groups (p>0.05). CONCLUSION: In this study, we found that DEFB1 gene -20G/A, -44C/G and -52G/A single nucleotide polymorphisms were not associated with chronic tonsillitis. Studies, which analyse other polymorphism of the beta defensin 1 gene in large case series, should be conducted to understand the role of DEFB1 gene on chronic tonsillitis.

Evaluation of Hearing Loss in Pilots.

OBJECTIVE: High-intensity noise sources with an increase in air traffic and sudden changes in atmospheric pressure can cause hearing loss in pilots. The main goal of this research is to examine hearing loss due to age, the total flight hours and aircraft types and to evaluate the effects of personal conditions that can influence the hearing level. METHODS: We examined the data of 234 Turkish pilots aged between 25 and 54 years who were examined due to the aviation Law for annual control from January 2005 to January 2014 at Baskent University Medical Faculty, Ankara Hospital. The audiometric results of the pilots were used. While 1, 2, 3, 4, 6, and 8 KHz were used for the airway threshold, 1, 2, and 4 KHz were used for the bone conduction threshold. RESULTS: According to the data of the 234 pilots, there was a significant correlation between high-frequency hearing loss and the total flight hours and pilots' ages. The average hearing loss was higher, particularly in the left ear, in pilots using helicopters than in those using other aircraft types. There was no statistically significant correlation between hearing loss and diabetes, hypercholesterolemia, high blood pressure, anemia, obesity, and smoking. CONCLUSION: A significant correlation was observed between high frequency hearing loss and the total flight hours, pilots' age, and aircraft types in our study.

The Importance and Place of Adenotonsillectomy in Syndromic Children.

OBJECTIVE: Upper airway obstruction and sleeping disorders are important issues in syndromic children, including mouth, lower-upper jaw, or all facial abnormalities. Tonsillectomy and/or adenoidectomy is required because of systemic problems and upper airway obstruction that increase the existing systemic problems, except those anomalies. However, tonsillectomy and/or adenoidectomy are mostly avoided because of the tendency to cause both intubation/perioperative systemic problems and respiratory complications in the postoperative period and in delays in the oral intake. However, these surgeries are sometimes required. In this context, we present our experience related with performing tonsillectomy and/or adenoidectomy in syndromic children admitted to our hospital. METHODS: We retrospectively examined the data on tonsillectomy and/or adenoidectomy performed in syndromic patients in our clinic between 2001 and 2011. RESULTS: We did not observe any postoperative complications in adenoidectomy and/or tonsillectomy performed by the same surgeon in 14 syndromic cases. CONCLUSION: It should be noted that respiratory problems may arise from many different anatomical regions in syndromic patients. Therefore, surgery should be performed taking into consideration all of these factors in these patients. These patients must be hospitalized in the postoperative period.

Fractalkine receptor polymorphism and chronic tonsillitis.

The objective of this study is to examine whether there is an association of fractalkine gene receptor polymorphisms with chronic tonsillitis. This is a cross-sectional study in the setting of a tertiary referral center. The study group included 79 patients with chronic tonsillitis and 76 controls without history of chronic tonsillitis. Genotypes were identified by restriction fragment length polymorphism analyses after polymerase chain reaction. c.745G>A (V249I) single nucleotide polymorphism and the frequencies of the G and A alleles did not differ in the patient and control groups (p = 0.363; p = 0.743, respectively). c.839C>T (T280M) single nucleotide polymorphism was found to be higher in controls than in the patients with chronic tonsillitis (p < 0.001). Consistent with this result, T allele frequency was higher in controls than in the patients with chronic tonsillitis (p < 0.001). In this study, we suggested that fractalkine gene receptor c.839C>T (T280M) single nucleotide polymorphism could be associated with a reduced risk of chronic tonsillitis.

Injectable tissue-engineered cartilage using commercially available fibrin glue.

OBJECTIVES/HYPOTHESIS: To achieve injectable tissue-engineered cartilage using a commercially available fibrin sealant, and to determine the most suitable fibrin glue concentration, cartilage source, and cultured chondrocyte concentration. STUDY DESIGN: Animal research. METHODS: A total of 28 immunocompetent New Zealand white rabbits were divided into four groups. The cultured chondrocytes from different anatomical sources carried in fibrin glue with and without aprotinin in different concentrations of fibrinogen and thrombin (Tisseell), were injected into forehead and interocular regions of the rabbits. The new tissue formation was harvested at 8 weeks and analyzed through gross and histological analysis. RESULTS: The new tissue formations were found in round, elliptical, and flat forms. The mean value of Tisseell and cell suspension was 0.8 cc in all of the rabbits' injection regions, but the mean volume of the samples in which immature cartilage matrix and mature cartilage was 0.1 cc. In the 20 of the 55 injection regions of rabbits (36, 36%), mature and/or immature cartilage formation were observed. We observed inflammatory reactions, abscess formation, and foreign body reactions around the new cartilage tissue of tissue-engineered cartilage. The comparison of results using different cartilage sources, chondrocyte concentrations, or different fibrin glue concentrations did not show any significant difference. CONCLUSIONS: We observed that changing the concentrations of ingredients of commercially available fibrin glue, the source of the cartilage, or the cultured chondrocyte concentration did not have significant effect on neocartilage formation.

The relationship of homocysteine, vitamin B12, folic acid levels with vertigo.

OBJECTIVES: In this study the relationship of serum homocysteine, vitamin B12, folic acid levels and peripheral vestibular dysfunction (PVD) was investigated. PATIENTS AND METHODS: Forty-one patients (31 females, 10 males; mean age 57.34±14.3 years; range 12 to 80 years) who admitted to Baskent University Hospital Ear Nose and Throat Department between the dates of April 2005 - December 2007 with complaint of vertigo were prospectively analyzed and diagnosed using audio-vestibular test, at the same time serum homocysteine, vitamin B12, folic acid measurements was done from the blood samples of patients. The patients were divided into three groups as Meniere's disease, vestibular neurinitis, and benign paroxismal positional vertigo (BPPV) according to the diagnoses and serum homocysteine, vitamin B12, folic acid levels of patients were compared to normal values in and between groups. RESULTS: Of the patients, 29.3% (n=12) were diagnosed with Meniere's disease, 36.6% (n=15) with vestibular neurinitis, and 34.1% (n=14) with BPPV. Serum homocysteine leves of patients were 12.42±3.56 umol/L, 11.32±4.14 umol/L and 10.72±2.95 umol/L (p>0.05) in Meniere's disease, vestibular neurinitis, and BPPV respectively; vitamin B12 levels were 371.58±141.35 pg/ml, 288.13±139.51 pg/ml, 352.14±150.41 pg/ml (p>0.05) respectively and folic acid levels were 8.76±3.2 umol/L, 10.63±6.59 umol/L, 8.8±3.18 umol/L (p>0.05) respectively. The values were similar in all patients. No statistically significant difference was found in and between groups comparing with normal values. CONCLUSION: This is the first prospective study investigating the relationship of serum homocystein, vitamin B12 and folic acid levels with PVD. We found that there is no relationship of homocysteine, vitamin B12, folic acid levels with PVD.

Temporal branch of the facial nerve and its relationship to fascial layers.

OBJECTIVES: To eliminate the inconsistency in the nomenclature, to anatomically and definitively describe the topographic relationship of the temporal branch of the facial nerve to the fascial layers and the fat pads, and to create an effective algorithm to define the safest approaches and planes for surgical procedures in this area. METHODS: The study was performed using 18 hemifacial cadaveric specimens. In 12 hemifacial specimens, the facial halves were coronally sectioned and dissected. In 6 hemifacial specimens, planar dissection was performed layer by layer. RESULTS: The temporal branch of the facial nerve that traversed inside the deep layers of the temporoparietal fascia and the superficial musculoaponeurotic system coursed along the zygomatic arch as 1 (14.3%), 2 (57.1%), 3 (14.3%), and 4 (14.3%) twigs in the specimens. The temporoparietal fascia had no attachment to the zygomatic arch and continued caudally as the superficial musculoaponeurotic system. Adhesions were between the temporoparietal fascia and the superficial layer of the deep temporal fascia around the zygomatic arch. In most specimens, the superficial layer of the deep temporal fascia continued as the parotideomasseterica fascia, and a deep layer abutted the posterosuperior edge of the zygomatic arch. CONCLUSION: An easy and safe surgical approach in this area is to elevate the superficial layer deep to the intermediate fat pad directly on the deep layer of the deep temporal fascia descending to the periosteum along the zygomatic arch.