Analysis of the Correlation of the Lamina Papyracea-to-Midline Distance with the Location of Anterior Ethmoidal Artery and Keros Classification.

The aim of the study was to investigate the relations between anatomical structures that are susceptible to inadvertent injuries during the surgery using preoperative computed tomography (CT) scans. 153 CT scans were reviewed and the distance from the lamina papyracea (LP) to the midline and the distance of the anterior ethmoidal artery (AEA) to the skull base were measured bilaterally. Also, the depth of olfactory fossa was measured and categorized using the Keros classification. The measurements were analyzed to determine whether LP-to-midline distance was correlated with the distance between the AEA and the skull base and Keros classification. Additionally, correlation of Keros classification with the distance from the AEA to the skull base was investigated. In a total of 306 measurements, 26 (%8.49) were classified as Keros type I, 200 (65.35%) as Keros type II and 80 (25.14%) as Keros type III. Statistically, LP-to-midline distances on the right and left sides were significantly associated with the distance from the AEA to the skull base on the same side (R:p < 0.001, L:p = 0.01) and the Keros classification on the same side (R:p < 0.001, L:p = 0.004). Also, a significant association was found between the Keros classification and the distance from the AEA to the skull base (R:p < 0.001, L:p = 0.02). The locations of anatomical structures are defined in relation to each other during the development of maxillofacial bones. CT scans should be examined and anatomical structures and relations among them reviewed very carefully before ESS. Otherwise, some accidental injuries may arise during the surgery while trying to avoid complications. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-03931-x.

Is There a Relationship Between Bell's Palsy and White Matter Lesions?

BACKGROUND The present study aimed to investigate the relationship between Bell's palsy (BP) and cerebral white matter lesions (CWMLs) on brain gadolinium-enhanced magnetic resonance imaging (MRI). MATERIAL AND METHODS The study included 51 patients who were diagnosed with BP and a control group of 40 individuals who underwent brain MRI for investigation of headache etiology. The brain MRIs of the patients were reviewed with respect to CWMLs. CWMLs were compared between the 2 groups, and within the BP group, the correlation between CWML and House-Brackmann (HB) facial nerve palsy grade was investigated as well. RESULTS There were significantly more CWMLs in the BP group than in the control group (P=0.003). There was a statistically significant difference between the HB subgroups in terms of absence/presence of CWMLs (P=0.040). Within the BP patient group, there were significantly more CWMLs in the HB grade 5 and 6 groups compared with the HB grade 2 group (P=0.025 and P=0.042, respectively). Overall, the CWML scores correlated positively with HB grade. When absence/presence of CWMLs was compared between the BP and control groups in only patients aged <50 years, there was a statistically significant difference between the groups (P=0.008). No statistically significant difference in absence/presence of CWMLs, however, was found between the BP and control groups when only patients age ≥50 years were considered (P=0.809). CONCLUSIONS We showed that as the severity of Bell's palsy increased, CWMLs increased and there was an association between CWMLs and BP. Microvascular ischemic pathologies may be among the most important factors in the etiopathogenesis of BP.

Elevated serum calprotectin as an inflammatory marker in obstructive sleep apnea.

OBJECTIVE: To investigate the serum calprotectin (SCal) levels and neutrophil/lymphocyte ratio (NLR) values in patients with obstructive sleep apnea (OSA). METHODS: Sixty-seven OSA patients and 46 healthy volunteers without any sleep disorders were included in the study. The patient group was divided into three subgroups according to the severity of OSA. The SCal levels and NLR values were compared among subgroups and between the experimental and control groups. RESULTS: The mean SCal level and NLR value were higher in the study group than in the control group (p = 0.002 and p = 0.001, respectively). The SCal levels were significantly higher in patients with severe OSA than in those with moderate and mild OSA (p = 0.004 and p = 0.001, respectively). DISCUSSION: Unlike NLR, the SCal level may inform the severity of OSA and could be used as an indicator for OSA.

The Protective Effect of Platelet Rich Plasma Against Cisplatin-Induced Ototoxicity.

Cisplatin, a pharmacological agent widely used for treating many cancers, may cause serious side effects including ototoxicity, nephrotoxicity, and peripheral neuropathy. The present study aimed to investigate whether platelet-rich plasma (PRP) protects against cisplatin ototoxicity. Eight rats (16 ears) were divided into 2 groups: control group (4 rats, 8 ears) that received intratympanic saline and study group (4 rats, 8 ears) that received intratympanic PRP. Cisplatin (10 mg/day intraperitoneally) or vehicle was administered 2 times per day to the animals. Auditory brainstem responses were recorded preoperatively and postoperatively on day 4 and at week 3. The authors compared the morphological appearances of spiral ganglion cells and the organ of Corti and the density of spiral ganglion cells between treatment groups. The number of outer hair cells in the organ of Corti significantly decreased in the control group compared with that in the PRP group. Although no statistically significant difference was observed between the groups regarding ABR thresholds on day 4 (P = 0.083, a statistically significant difference was observed between groups at week 3 (P = 0.038). Our results suggest that PRP can prevent cisplatin-induced ototoxicity.

Investigation of neutrophil-to-lymphocyte ratio and mean platelet volume in sudden hearing loss.

INTRODUCTION: Several theories attempt to explain the pathophysiology of sudden hearing loss. OBJECTIVE: The objective of this study was to investigate the possible role of inflammation and atherothrombosis in sudden hearing loss patients through the neutrophil-to-lymphocyte ratio and mean platelet volume. METHODS: Study design - retrospective cross-sectional historical cohort. This study was conducted on two groups: one with 59 individuals diagnosed with sudden hearing loss, and other with 59 healthy individuals with the same characteristics of gender and age distribution, neutrophil-to-lymphocyte ratio and mean platelet volume levels were measured in patients diagnosed with sudden hearing loss as well as in the control group, and it was verified whether these results interfered for a better or worse prognosis with treatment of sudden deafness. RESULTS: Neutrophil-to-lymphocyte ratio levels are much higher in patients diagnosed with sudden hearing loss compared to the control group. Similarly, mean levels of neutrophil-to-lymphocyte ratio are higher in non-recovered versus recovered patients (p=0.001). However, we could not find a correlation with mean platelet volume levels (p>0.05). CONCLUSION: Neutrophil-to-lymphocyte ratio is a quick and reliable indicator regarding diagnosis and prognosis of sudden hearing loss; on the other hand, mean platelet volume may be considered a less important indicator in this aspect.

Giant cemento-ossifying fibroma of the maxilla.

INTRODUCTION: Fibro-osseous lesions of the skull and facial bones are benign tumors, but they can be mistaken for malignant tumors due to their clinically aggressive behavior. Cemento-ossifying fibroma (COF) is a benign fibro-osseous lesion characterized by slow growth and fibrous and calcified tissue content. COFs are locally destructive lesions causing deformities in the bones. The recurrence risk is high if they are not completely removed. CASE REPORT: In this case report we describe a giant COF mimicking chondrosarcoma in the oral cavity of a 55-year-old woman causing significant facial deformity and feeding problems. CONCLUSIONS: Giant COF occurs rarely in the jaws and given that this lesion has similar imaging and clinical features to several other tumors, the diagnosis is always a challenge for clinicians, radiologists and pathologists.

A new suggestion for the Epworth Sleepiness Scale in obstructive sleep apnea.

The aim of this study was to suggest a new cutoff score for the Turkish version of Epworth Sleepiness Scale (ESS) in the patients with obstructive sleep apnea. In this study, the data of 483 patients who were admitted to our clinic with the complaints of daytime sleepiness and witnessed sleep apnea were reviewed retrospectively. The correlation between ESS and polysomnography (PSG) findings were assessed, and cutoff score of the Turkish version of the ESS was investigated. The mean apnea-hypopnea index (AHI) was 27.71 ± 26.69 eV/h, the mean ESS score was 8.42 ± 4.88. According to AHI, a statistically significant difference between ESS scores was detected (p = 0.001; p < 0.01). According to AHI (AHI ≥ 5, AHI ≥ 15 and AHI ≥ 30) the best cutoff score for ESS score was found as 8. The answers that were given to the ESS questions differ according to their sociocultural and economic condition. These results indicate that a score of 8 or higher on the ESS would seem a more appropriate cutoff score to suspect clinically relevant sleepiness in the Turkish population.

Elevated neutrophil-to-lymphocyte ratio in Bell's palsy and its correlation with facial nerve enhancement on MRI.

OBJECTIVE: The aim of this study was to investigate the role of inflammation and atherothrombosis in Bell's palsy (BP) by using neutrophil-to-lymphocyte ratio (NLR) and mean platelet volume (MPV), respectively, and to study their relations with the facial nerve enhancement on temporal gadolinium-enhanced magnetic resonance imaging (TGd-MRI). STUDY DESIGN: Case control study. SETTING: Tertiary health institution. SUBJECTS AND METHODS: This study was performed on 65 patients who were diagnosed with BP and a control group of 35 healthy individuals. The BP patients were also divided into 2 groups, those with facial nerve enhancement on TGd-MRI and those without enhancement. The NLR and MPV of each group were compared. RESULTS: The NLRs of the BP patients were significantly higher than control group (P = .001). The NLRs of patients with facial nerve enhancement on TGd-MRI were significantly higher than patients without enhancement (P = .001). There was a positive and significant correlation between NLR and House-Brackmann (HB) grade of the patients (r = 0.641; P < .05). MPV did not show any significant correlation with any of the parameters studied (P > .05). CONCLUSION: NLR can be used as a new and important marker in BP since it is high in BP patients and significantly correlated with HB grade and facial nerve enhancement on TGd-MR. On the other hand, MPV does not have such correlations. These results offer evidence to support an inflammatory theory rather than microvascular response theory in the etiopatogenesis of BP.

The Relation of the Obstruction Site on Muller's Maneuver with BMI, Neck Circumference and PSG Findings in OSAS.

We investigated relation of the site of obstruction detected on Muller maneuver (MM) with polysomnography (PSG) and physical examination findings. Data of 703 patients admitted to Ankara Numune Education and Research Hospital Sleep Laboratory between 2008 and 2013 were analyzed retrospectively; 394 patients with apnea-hypopnea indexes (AHI) ≥5/h were included. Site of collapse on MM was determined at retrolingual level at anteroposterior (M1) and lateral-lateral (M2) directions; at retropalatal level at anteroposterior (M3) and lateral-lateral (M4) directions. There were 125 (31.7 %) females and 269 (68.3 %) males. BMI had significant positive correlations with M2 (p < 0.001) and M4 (p = 0.002) scores, ESS (p = 0.013) and AHI (p = 0.001). AHI had significant positive correlations with ESS (p = 0.003), M2 (p < 0.001), M3 (p = 0.037) and M4 (p < 0.001) scores and NC (p = 0.001). Minimum oxygen saturation had significant reverse correlations with M1 (p = 0.046), M2 (p < 0.001), M3 (p = 0.003), M4 (p < 0.001), AHI (p < 0.001), ESS (p = 0.003) and BMI (p = 0.001). In OSAS patients, increased BMI, NC and AHI are correlated with lateral pharyngeal wall (LPW) collapse in retropalatal and retrolingual levels on MM. LPW collapse is more valuable to predict OSAS compared to anteroposterior collapse. LPW collapse on MM may be used as a selection criterion for ordering PSG. Further studies are needed to better clarify importance of LPW in OSAS surgery.