Bacterial cellulose as a new graft model for the Turkish delight technique in rhinoplasty: An experiment in 20 rats.

We conducted an experiment to investigate the effectiveness of bacterial cellulose, a new graft material, in correcting and preventing dorsal nasal disorder in rhinoplasty. The experiment was performed on 20 Wistar albino rats. The rats were evenly divided into two groups: a fascia group and a cellulose group. In the fascia group, grafts from the conchal cartilage were removed, shredded, and then wrapped in temporal muscle fascia. In the cellulose group, shredded cartilage was wrapped in the bacterial cellulose. These shredded gristle grafts, which were also placed in a subcutaneous area at the back of the rats, were excised after 60 days. We then performed histopathology to compare the health and integrity of the cartilage and the degree of vascularization, fibrosis, and chronic inflammation in the two groups. We found a significantly greater degree of vascularization (p = 0.004) and fibrosis (p = 0.005) in the fascia group and a significantly greater degree of chronic inflammation (p = 0.023) in the cellulose group. We found no statistically significant difference between the two groups in terms of cartilage health and integrity. Our results suggest that bacterial cellulose grafting may play a role as an alternative to fascia grafting for the wrapping of shredded cartilages in Turkish delight grafting, but further investigation is needed.

Metastatic chordoma of the tongue: Case report.

Chordomas are rare bone tumors that arise from notochord remnants. They most commonly occur in the sacrum, but they also can be seen in the skull base, cervical spine, and thoracolumbar vertebrae. Chordomas account for 1 to 4% of all primary skeletal tumors. They are usually indolent, locally growing tumors. Distant metastasis has been reported in 3 to 48% of cases. When metastasis occurs, it is usually observed in the lung, bone, and liver. To the best of our knowledge, no case of a chordoma metastasis to the tongue has been previously reported in the literature. We report such a case in a 61-year-old man.

The effects of surgery type and different ossiculoplasty materials on the hearing results in cholesteatoma surgery.

To investigate the effects of surgery type [intact canal wall (ICW) or canal wall down (CWD) mastoidectomy] and different ossiculoplasty materials on hearing outcome in single-staged cholesteatoma surgery. A retrospective case-control study. A total of 116 cases (97 adults, 29 children) underwent surgery, including ossiculoplasty, between 2012 and 2015 for cholesteatoma. Patients who had undergone surgery for the first time, and whose grafts were successful, were included in the study. Patients with adhesive otitis media, unsuccessful grafts, revision and recurrent cases, radical mastoidectomy, and craniofacial anomalies were excluded. Audiogram examinations of the enrolled patients were performed 3-6 months after surgery, and the audiometric results were analyzed according to the criteria of the American Academy of Otolaryngology, Head and Neck Surgery. All ossiculoplasties were performed during the first operation. The preoperative average air-bone gap (ABG) of the patients was decreased from 31.37 ± 10.1 to 27.42 ± 10.4 dB; this decrease was found to be highly significant (p = 0.0001). Concerning the ICW technique, statistical evaluation of the hearing gain at frequencies of 500, 1000, and 2000 Hz, as well as the mean frequency, showed a high level of significance. Improvement at 4000 Hz was not found to be statistically significant. When the ABGs at 500, 1000, 2000, and 4000 Hz, and the mean frequency in patients with an hydroxyapatite-partial ossicular replacement prosthesis (HA-PORP) or autograft-partial ossicular replacement prosthesis (APORP), were evaluated, it was found that, at 4000 Hz, the APORP significantly reduced the ABG (p = 0.02). No significant difference was determined between patients with the hydroxyapatite-total ossicular replacement prosthesis (HA-TORP) and those with the autograft-total ossicular replacement prosthesis (ATORP) (p = 0.565). Although the use of the malleus as an APORP was found to be less effective than other autografts, the degree of advantage of using the incus, malleus, cortical bone, and cartilage did not significantly differ between materials (p = 0.152). Despite the effects of the incus, malleus, and cortical bone not differing in terms of the postoperative ABG (p = 0.160), incus usage was highly beneficial for hearing gain (p = 0.009). Despite CWD tympanoplasty affecting all frequencies, it has a particularly negative effect on the hearing threshold at 1000 Hz. In patients with partial ossicular replacement, autogenous grafts are more successful in restoring hearing at high frequencies, particularly at 4000 Hz. Although autogenous materials do not differ in terms of partial replacement effectiveness, the incus has been shown to be most effective for total replacement.

A novel myringoplasty technique: the placement of a complementary graft descending from the scutum to support an anterosuperior perforation.

We describe a novel myringoplasty procedure. We placed a separated fascia graft descending from the scutum, combined with underlay myringoplasty, to support an anterosuperior perforation. We reviewed data from patients who underwent myringoplasty procedures to treat perforations extending into the anterosuperior quadrant of the pars tensa from October 2012 to June 2014. A total of 42 patients who were followed for a minimum of 1 year were enrolled. The same technique was used in all operations. The tympanomeatal flap was elevated from the neck of malleus up to the tip of the lateral process of malleus. The anterior mallear fold was incised to create an opening running from the neck of the malleus to the anterior tympanic spine. A separate temporal fascia graft (complementary graft) was next inserted through the opening and pushed down into the protympanum. The upper part of the fascia graft was placed over the superior bony wall of the canal. Underlay myringoplasty was then performed. The inferior part of the fascia graft was next spread out to cover the lateral surface of the underlying graft. We measured graft take rate and preoperative and postoperative hearing parameters. The graft success rate was 97.7 % (41/42 patients). The preoperative air-bone gap was 22.56 ± 18.12 dB, and the postoperative air-bone gap was 8.4 ± 10.05 dB. This difference was statistically significant (P < 0.001). We believe that this myringoplasty technique is a safe, suitable, and effective for cases with tympanic membrane perforations extending into the anterosuperior quadrant of the pars tensa.

Pretreatment Neutrophil-Lymphocyte Ratio in Salivary Gland Tumors Is Associated with Malignancy.

OBJECTIVE: To assess pretreatment levels in the counts and percentages of leukocytes and the neutrophil-lymphocyte ratio (NLR) in benign and malignant salivary gland tumors (SGTs) while investigating whether NLR is an inflammatory marker for distinguishing low- from high-grade parotid gland tumors. STUDY DESIGN: Case series with chart review. SETTING: Tertiary referral center. SUBJECTS AND METHODS: This study was performed on 182 patients with SGTs (age range: 16-87 years; 93 male and 89 female) who were treated between January 2010 and May 2015. Pretreatment counts and percentages of leukocytes and NLR were measured preoperatively in benign and malignant tumors. RESULTS: Mean neutrophil percentage (63.50% ± 12.11% vs 58.76% ± 8.20%, P = .008) and NLR (3.29 ± 3.13 vs 2.13 ± 1.26, P = .008) were significantly higher in patients with malignant SGTs than in patients with benign SGTs. Mean lymphocyte count (2.42 ± 0.72 103/mm3 vs 1.97 ± 0.87 103/mm3, P < .001) and percentage (30.67% ± 7.68% vs 26.86% ± 10.15%, P = .011) were lower in patients with malignant SGTs than in patients with benign SGTs. Mean lymphocyte percentage and NLR were significantly different between low- and high-grade malignant parotid gland tumors (P = .026 and P = .030, respectively). CONCLUSION: Elevated NLR could be an inflammatory marker to distinguish low- from high-grade malignant parotid gland tumors.

A new graft material for myringoplasty: bacterial cellulose.

We aimed to determine the success rate of bacterial cellulose (BC) myringoplasty in tympanic membrane (TM) perforation. We reviewed the clinical records of 12 patients (16 ears) who underwent BC myringoplasty for long-standing TM perforations (>6 months) between March 2012 and January 2015. The mean duration of postoperative follow-up was 12.8 (range 6-24) months. In all patients, the perforation involved less than 50 % of the tympanic membrane, and the air-bone gap was ≤30 dB on the operative side. The age, gender, preoperative air average, bone average, air-bone gap, perforation size and location, and postoperative TM microscopic examinations of the patients were recorded. Following the BC myringoplasty, complete coverage of the perforation occurred in the first 6 months in 13 of 16 ears (81.3 %), although retraction occurred in two of these ears within 6 months. In three ears (18.8 %), the perforation persisted during the first postoperative month. The pre- and postoperative average air threshold was 19.56 (range 7-75) and 15.69 (range 5-75) dB, respectively. The pre- and postoperative average air-bone gap was 9.25 (range 0-25) and 5.63 (0-25) dB, respectively. Both the air threshold and air-bone gap improved postoperatively (both p = 0.008). No complications such as infection and granulation tissue formation were detected in any patient. BC is a safe graft material that is inexpensive, easy-to-use, and provides a high success rate in small tympanic membrane perforations. However, further studies of large tympanic membrane perforations with more samples and long-term follow-up are required.

Facial Nerve Schwannoma of Parotid Gland: Difficulties in Diagnosis and Management.

Facial nerve schwannomas (FNS) are encapsulated benign tumors arising from Schwann cells of seventh cranial nerve. Most of the facial nerve schwannomas are localized in intratemporal region; only 9% of cases involve a portion of the extratemporal segment. Preoperative diagnosis is often unclear; diagnosis is often made intraoperatively. Management of intraparotid FNS is troublesome because of the facial nerve paralysis. In this report we presented a case of intraparotid schwannoma in a 55-year-old male patient complaining of a painless mass without peripheral facial nerve palsy in left parotid gland. Clinical features, preoperative and intraoperative diagnosis, and difficulties during management are discussed with the review of the literature.

Does the Degree of Septal Deviation Affect Cribriform Plate Dimensions and Middle Turbinate Length?

OBJECTIVE: To investigate the effect of septal deviation severity on the dimensions of the lateral lamina of the cribriform plate (LLCP), middle turbinate length (MTL), and the angle of the lateral lamella of the cribriform plate (ALLCP). METHODS: Paranasal computed tomography (CT) scans of 148 patients with septum deviation (102 males, 46 females; age range 18-63 years) were retrospectively evaluated. The patients were divided into 3 groups according to the measured angle of nasal septal deviation as mild (<9°), moderate (9-15°), or severe (>15°). Height and width of LLCP, MTL, and ALLCP on both sides were measured and these parameters were compared between the groups according to the septal deviation side. RESULTS: The nasal septum was deviated to the right in 73 patients (49.3%) and to the left in 75 patients (50.7%). The LLCP dimensions, MTL, and ALLCP between the groups at the contralateral side were not statistically different (P > 0.05). The LLCP height, ALLCP between the groups at the ipsilateral side were not statistically different (P > 0.05). There was a significant difference in the LLCP width at the ipsilateral side between the groups (P = 0.039). The MTL at the ipsilateral side was significantly different between the groups (P = 0.003). CONCLUSION: The severity of nasal septum deviation in patients with nasal septum deviation affects the ipsilateral LLCP width and the ipsilateral MTL. These findings suggest that the increase in the severity of septum deviation in patients undergoing endoscopic sinus surgery does not increase the risk of possible damages that may occur in LLCP.

Histopathological Effects of Fibrin Glue and Cyanoacrylate on the Maxillary Sinus.

OBJECTIVE: To compare the histopathological effects of fibrin glue (FbGl) and cyanoacrylate (CyAc) on the maxillary sinus mucosa. METHODS: Twenty rabbits were divided into two groups of 10, and surgical defects were created in the maxillary sinuses. The right maxillary sinus was treated with FbGl in one group and with CyAc in the other group. As a control, the left maxillary sinuses of all rabbits were treated with sterile saline solution. One rabbit treated with CyAc died during the study and was excluded. On postoperative day 21, all animals were sacrificed. Maxillary sinus mucosa samples were studied to determine the extent of inflammation and fibrosis, foreign body reaction, cilia loss, increased osteogenesis in bony structures under the mucosa, and loss of serous glands. RESULTS: The FbGl group differed significantly from the CyAc and control groups in terms of a high degree of inflammation (p<0.001), fibrosis (p<0.001), foreign body reaction (p<0.001), cilia loss (p<0.001), and serous gland loss (p<0.001). In terms of osteogenesis, there were no significant differences between the FbGl and CyAc groups (p=0.650), while there was a significant (p=0.002) difference between these two groups and the control group. CONCLUSION: Histopathologically, CyAc had fewer side effects than FbGl. Further clinical studies are needed to demonstrate the validity of these results in humans.

Bilateral Facial Paralysis Caused by Bilateral Temporal Bone Fracture: A Case Report and a Literature Review.

Bilateral facial paralysis caused by bilateral temporal bone fracture is a rare clinical entity, with seven cases reported in the literature to date. In this paper, we describe a 40-year-old male patient with bilateral facial paralysis and hearing loss that developed after an occupational accident. On physical examination, House-Brackmann (HB) facial paralysis of grade 6 was observed on the right side and HB grade 5 paralysis on the left. Upon temporal bone computed tomography (CT) examination, a fracture line exhibiting transverse progression was observed in both petrous temporal bones. Our patient underwent transmastoid facial decompression surgery of the right ear. The patient refused a left-side operation. Such patients require extensive monitoring in intensive care units because the presence of multiple injuries means that facial functions are often very difficult to evaluate. Therefore, delays may ensue in both diagnosis and treatment of bilateral facial paralysis.

Do the angle and length of the eustachian tube influence the development of chronic otitis media?

OBJECTIVES/HYPOTHESIS: To compare the eustachian tube (ET) angle (ETa) and length (ETl) of ears with and without chronic otitis media (COM), and to determine the relationship between ET anatomy and the development of COM. STUDY DESIGN: A retrospective case-control study. METHODS: The study group comprised 125 patients (age range, 8-79 years; 64 males and 61 females) with 124 normal ears and 126 diseased ears, including ears with chronic suppurative otitis media (CSOM) with central perforation, intratympanic tympanosclerosis (ITTS), cholesteatoma, and a tympanic membrane with retraction pockets (TMRP). ET angle and length were measured using computed tomography employing the multiplanar reconstruction technique. RESULTS: The ETa was significantly more horizontal in diseased versus normal ears of all study groups (P = .030), and there was no group difference in ETl (P = .160). ETl was shorter in CSOM versus ITTS ears and normal ears (P = .007 and P = .003, respectively) and in cholesteatoma versus TMRP ears (P = .014). In the unilateral COM group, there were no significant differences in the ETa or ETl of diseased versus contralateral normal ears (P = .155 and P = .710, respectively). The ETa was significantly more horizontal in childhood-onset diseased versus normal ears (P = .027), and there was no group difference in ETl (P = .732). The ETa (P = .002) and ETl (P < .001) were significantly greater in males than females. CONCLUSIONS: A more horizontal ETa and shorter ETl could be contributory (though not significantly) etiological factors in the development of COM. LEVEL OF EVIDENCE: 3b.

The effect of stapes fixation on hearing results in tympanosclerosis treated by mobilization.

We aimed to investigate the effect of stapes fixation on hearing results in patients who underwent mobilization surgery due to tympanosclerosis (TS). Seventy-nine patients were retrospectively analyzed and divided into two groups. Forty-four (55.7%) patients with mobile stapes were classified as group 1, and 35 (44.3%) patients with fixed stapes were classified as group 2. Improvement of the air-bone gap (ABG) to become less than 20 dB and the pure-tone average (PTA) by at least 10 dB postoperatively were accepted as success criteria. The PTA and ABG levels were significantly improved in both groups. The pre- and post-operative PTAs were 46.57 ± 15.55 and 25.84 ± 15.47 dB, respectively, in group 1 (p = 0.001). The pre- and post-operative PTAs were 55.64 ± 12.69 and 36.20 ± 14.47 dB, respectively, in group 2 (p = 0.001). The pre- and post-operative ABG levels were 35.36 ± 10.53 and 16.91 ± 8.54 dB, respectively, in group 1 (p = 0.001). The pre- and post-operative ABG levels were 41.68 ± 8.78 and 22.20 ± 10.03 dB, respectively, in group 2 (p = 0.001). A gain ≥10-dB in the PTA in groups 1 and 2 was found in 34 (77.2 %) and 23 (65.7%) patients, respectively, and the difference between the groups was not significant (p = 0.684). The post-operative AGB in groups 1 and 2 was less than 20 dB in 32 (72.7%) and 21 (60%) patients, respectively, and the difference between the groups was not significant (p = 0.733). No significant negative effect of stapes fixation on post-operative hearing results in TS was detected. Successful results can be obtained with a mobilization procedure, even if the stapes is fixed.

Surgery of isolated malleus fixation due to tympanosclerosis.

The aim of the present study was to describe our surgical approach for isolated malleus fixation in patients with tympanosclerosis and to analyze the postoperative results. A total of 30 patients presented with isolated malleus fixation were operated. The fixation was reached via canalplasty. Fixated areas were cleaned without damaging the ossicle. Pre- and postoperative audiometric results were evaluated for each patient. Improvement of the pure-tone average (PTA) by at least 10 dB and an air-bone gap (ABG) of less than 20 dB after 12 months of follow-up was accepted to indicate success. The recovery of the postoperative PTA and ABG measurements was significant. Pre- and postoperative PTA was 48.00 ± 11.86 and 24.90 ± 12.45 dB, respectively (p < 0.001). According to PTA measurements, 40-50 dB recovery was achieved in four (13.3 %) patients, 31-40 dB in six (20 %) patients, 21-30 dB in ten (33.3 %) patients, and 11-20 dB in five (16.6 %) patients, with a total success rate of 25/30 (83.2 %). Pre- and postoperative ABG levels were 38.95 ± 9.92 and 16.10 ± 7.79 dB (p < 0.001), respectively. The ABG level was between 0 and 10 dB for 8 (26.6 %) patients, and 11-20 dB for 16 (53.3 %), with a total success rate of 24/30 (80 %). In cases of isolated malleus fixation with tympanosclerosis, performing a canalplasty to clean the sclerotic plaques without damaging the normal anatomy of the ossicle system using a diamond burr is a safe surgical option that provides significant recovery in hearing levels.

[Tuberculous lymphadenitis]. / Tüberküloz lenfadenitleri.

OBJECTIVES: In this study, we evaluate tuberculosis (Tbc) lymphadenitis diagnosed patients age, gender, contact history, history of smoking, socioeconomic status, lymphadenitis localization, imaging techniques, fine needle aspiration biopsy (FNAB) and excisional biopsy results. PATIENTS AND METHODS: Between February 2006 and February 2008 104 patients were operated to determine the etiology of their neck masses. Twenty-six patients (16 females, 10 males; mean age 36.9 years; range 16 to 52 years) who were diagnosed as Tbc lymphadenitis according to pathology results were included in the study. Ear, nose and throat examinations were performed in all patients routinely. Hemogram, biochemical and serological tests were performed. The patients were evaluated with anterior-posterior chest radiographs and purified protein derivative (PPD) by chest diseases consultation imaging methods and FNAB was performed. All patients diagnosed with excisional biopsy of neck mass. During the operation, tissue culture and Ziehl-Neelsen method for staining was prepared. RESULTS: Out of 26 patients eight had a history of contact with Tbc. One person had previously lung Tbc. Six patients had previously received treatment because of Tbc lymphadenitis, but didn't complete the treatment. Neck ultrasonography and neck computed tomography detected a solid mass in 16 patients and cystic mass in 10 patients. The 24 patients were evaluated as positive PPD (>10 mm). None of the patients had an association between active pulmonary Tbc and Tbc lymphadenitis. CONCLUSION: Suspicion is the most important step in the diagnosis of Tbc lymphadenitis. In patients with low socioeconomic status, previous Tbc contact, tabacco usage, suppressed immune system, and particularly in those with drainage from neck masses, Tbc lymphadenitis should be considered in the differential diagnosis.

Laryngopharyngeal reflux might play a role on chronic nonspecific pharyngitis.

Chronic nonspecific pharyngitis is one of the most common reasons for visits to otorhinolaryngology physicians. The underlying conditions are still unknown. The aim of this study was to investigate the role of laryngopharyngeal reflux in chronic nonspecific pharyngitis patients based on the patient's history and clinical examination. Fifty consecutive patients with symptoms of chronic nonspecific pharyngitis and control group of 30 healthy persons were evaluated prospectively. 14C-urea breath test was used to exclude Helicobacter pylori infection of gastric mucosa. All the patients and the controls were assessed by blinded same laryngologist with the use of the reflux finding score (RFS) and reflux symptoms index (RSI). Also chronic nonspecific pharyngitis patients with laryngopharyngeal reflux (LPR) were evaluated prospectively before and 6 months after b.i.d treatment with proton pump inhibitors. The RSI of the nonspecific pharyngitis group was found significantly higher than the control group (P < 0.01). The RFS of nonspecific pharyngitis was found significantly higher than the control group (P < 0.01). The reflux finding score > or =7 has been accepted as LPR; the reflux incidence was significantly higher in the nonspecific pharyngitis group than the control group (P < 0.01). Posttreatment RSI of nonspecific pharyngitis patients group revealed a statistically significant decrease when compared with the pretreatment RSI (P < 0.01). Posttreatment RFS of nonspecific pharyngitis patients also revealed a significant decrease when compared with the pretreatment RFS (P < 0.01). We suggest that LPR may be related to the pathogenesis of chronic nonspecific pharyngitis.