Long-term outcomes of facial nerve decompression by transmastoid versus middle cranial fossa approach for traumatic facial paralysis.

OBJECTIVES: To evaluate and compare the long-term results of patients who underwent facial nerve decompression surgery with either transmastoid-supralabyrinthine (TMSL) or combined transmastoid- middle cranial fossa (MCF) approach for traumatic facial nerve paralysis. MATERIALS AND METHODS: This is a single-center retrospective case-control study. The medical records of traumatic facial paralysis patients with House Brackmann (HB) Grade 6 who underwent facial nerve decompression surgery at via either TMSL or MCF approach between January 2011 and December 2017 were reviewed. The patients who had otic capsule involvement and total sensorineural hearing loss, therefore underwent translabyrinthine facial nerve decompression, and the patients follow-up period has not yet reached four years were excluded from the study. Postoperative HB score and hearing status were compared. RESULTS: Eleven patients were operated with MCF approach (group 1), while 9 patients with TMSL approach (group 2). Average age of patients was 20.04 + 15.2 (range:4-47) years. Three (15 %) patients were female, while 17 (85 %) was male. Geniculate ganglion (90 %) was the most affected segment of the facial nerve. Facial nerve edema was observed in all cases, while intraneural hematoma were encountered in 4 (20 %) cases. Statistically significant improvement in median HB scores were reached in both groups, and no significant difference was observed in post-operative HB scores between both techniques. No significant difference in median AC 0,5-4 khZ and BC 0,5-3 kHz thresholds was observed between both techniques. CONCLUSION: Even middle fossa approach is the best surgical technique to explore geniculate ganglion and labyrinthine segment of facial nerve, the functional results of transmastoid supralabrynthine approach, which is not needed craniotomy with low complication rate are as successful as middle fossa approach in selected patients.

Wideband Absorbance Outcomes of Cochlear Implantation: A Comparative Clinical Study.

OBJECTIVES: Wideband tympanometry (WBT) measurements show sensitivity to trends in external ear canal/middle ear maturation and changes in middle ear status as a result of different types of dysfunction. This study aims to determine the effects of cochlear implantation (CI) on middle ear status. MATERIALS AND METHODS: This is a prospective comparative clinical study that has been done in a tertiary referral center. The patients who underwent unilateral cochlear implantation were included in the study. All the participants were under 18 years of age and had congenital bilateral profound sensorineural hearing loss (SNHL). WBT measurements of implanted ears were calculated and compared to those of non-implanted ears (control group) in the same patient group. The differences in these measurements were subjected to statistical analyses. RESULTS: A total of 48 patients (96 ears) who underwent unilateral CI were included in the study. Our study revealed that significant reductions in the average absorbance ratios occurred at all measured frequencies and that the average resonance frequency increased more significantly in the implanted ears compared with those of control group (p<0.001). The difference in the average peak pressure was not significant among two groups. (p=0.211) CONCLUSION: This study shows that the average absorbance ratio decreases and average resonance frequency increases after cochlear implantation. These findings may be related to increased stiffness in middle and inner ear system. Future studies are needed for more detailed information and recommendations on this topic.

Investigation of DFNB4 SLC26A4 mutation in patients with enlarged vestibular aquaduct.

OBJECTIVES: Mutations of the SLC26A4 gene causing enlarged vestibular aqueduct (EVA) syndrome have not yet been fully elucidated. The study aimed to investigate SLC26A4 mutations in patients with EVA syndrome in the Turkish population. Identifying these mutations may play an essential role in determining the prognosis, follow-up, and management options of these patients. METHODS: Whole exome sequencing and/or Sanger sequencing of SLC26A4 in 22 patients with sensorineural hearing loss associated with isolated EVA without inner ear anomalies, and 22 controls were performed. RESULTS: Twenty-two patients and 22 control subjects were included in the study. The onset of hearing loss was pre-lingual in 15 patients, and post-lingual in 7. The mean (standard deviation) vestibular aqueduct width of the patients was 3.23 mm (1.28). Twenty SLC26A4 variants, 15 of them unique, were identified in 22 patients. Among them, seven variants were heterozygous, and 13 were homozygous. The variants p.E37X (c.109G > T), p.Y27H (c.79T > C), p.C706Y (c.2117G > A) have not been previously reported. CONCLUSION: The detection of rare and previously unreported mutations in our study showed that studies with a larger number of patients with EVA might reveal more role of the SLC26A4 gene. Besides, to understand the etiopathogenesis of the disease, other related genes also should be investigated.

Endoscopic evaluation of middle ear anatomic variations in autopsy series: analyses of 204 ears / Avaliação endoscópica das variações anatômicas da orelha média em uma série de autópsias: análise de 204 orelhas

Abstract Introduction Microsurgery of the ear requires complete evaluation of middle ear surgical anatomy, especially the posterior tympanic cavity anatomy. Preoperative assessment of the middle ear cavity is limited by the permeability of eardrum and temporal bone density. Therefore, middle ear exploration is an extremely useful method to identify structural abnormalities and anatomical variations. Objective The aim of this study is to determine anatomic variations of the middle ear in an autopsy series. Methods All evaluations were performed in the Forensic Medicine Institute Morgue Department. The cases over 18 years of age, with no temporal bone trauma and history of otologic surgery included in this study. Results One hundred and two cadavers were included in the study. The mean age was 49.08 ± 17.76 years. Anterior wall prominence of the external auditory canal was present in 27 of all cadavers (26.4%). The tympanic membrane was normal in 192 ears (94%) while several eardrum pathologies were detected in 12 ears (6%). Agenesis of the pyramidal eminence and stapedial tendon was found in 3 ears. While the ponticulus was bony ridge-shaped in 156 of 204 ears (76.4%), it was bridge-shaped in 25 ears (12.3%). The ponticulus was absent in 23 ears (11.3%). While complete subiculum was present in 136 of all ears (66.7%), incomplete subiculum was present in 21 ears (10.3%). Subiculum was absent in 47 ears (23%). Facial dehiscence was found in 32 ears and the round window niche was covered by a pseudomembrane in 85 ears (41.6%). A fixed footplate was present in 7.4% of all ears, and no persistent stapedial artery was seen in any cases. Conclusion The pseudomembrane frequency covering the round window niche was found different from reports in the literature. In addition, the frequency of the external auditory canal wall prominence has been reported for the first time.

Resumo Introdução A otomicrocirurgia requer avaliação completa da anatomia cirúrgica da orelha média, especialmente da anatomia da cavidade timpânica posterior. A avaliação pré-operatória da cavidade timpânica é limitada pela permeabilidade do tímpano e densidade do osso temporal. Portanto, a exploração da orelha média é um método extremamente útil para identificar anormalidades estruturais e variações anatômicas. Objetivo Determinar as variações anatômicas da orelha média em uma série de autópsias. Método Todas as avaliações foram realizadas no necrotério do Instituto Médico-Legal. Os casos com mais de 18 anos, sem trauma do osso temporal e história de cirurgia otológica foram incluídos neste estudo. Resultados Cento e dois cadáveres foram incluídos no estudo. A média de idade foi de 49,08 ± 17,76 anos. A proeminência da parede anterior do conduto auditivo externo estava presente em 27 de todos os cadáveres (26,4%). A membrana timpânica era normal em 192 orelhas (94%), enquanto várias alterações do tímpano foram detectadas em 12 orelhas (6%). Agenesia da eminência piramidal e do tendão do estapédio foi encontrada em 3 orelhas. Enquanto o pontículo tinha formato de crista óssea em 156 das 204 orelhas (76,4%), tinha o formato de ponte em 25 orelhas (12,3%). O pontículo estava ausente em 23 orelhas (11,3%). Enquanto o subículo completo estava presente em 136 de todas as orelhas (66,7%), encontrava-se incompleto em 21 orelhas (10,3%). O subículo estava ausente em 47 orelhas (23%). Deiscência facial foi encontrada em 32 orelhas e o nicho da janela redonda estava coberto por uma pseudomembrana em 85 orelhas (41,6%). A platina fixa foi observada em 7,4% de todas as orelhas e a artéria estapediana persistente não foi vista. Conclusão A frequência da pseudomembrana que cobre o nicho da janela redonda foi diferente daquela encontrada na literatura. Além disso, a frequência da proeminência da parede do canal auditivo externo foi relatada pela primeira vez.

Endoscopic evaluation of middle ear anatomic variations in autopsy series: analyses of 204 ears.

INTRODUCTION: Microsurgery of the ear requires complete evaluation of middle ear surgical anatomy, especially the posterior tympanic cavity anatomy. Preoperative assessment of the middle ear cavity is limited by the permeability of eardrum and temporal bone density. Therefore, middle ear exploration is an extremely useful method to identify structural abnormalities and anatomical variations. OBJECTIVE: The aim of this study is to determine anatomic variations of the middle ear in an autopsy series. METHODS: All evaluations were performed in the Forensic Medicine Institute Morgue Department. The cases over 18 years of age, with no temporal bone trauma and history of otologic surgery included in this study. RESULTS: One hundred and two cadavers were included in the study. The mean age was 49.08±17.76 years. Anterior wall prominence of the external auditory canal was present in 27 of all cadavers (26.4%). The tympanic membrane was normal in 192 ears (94%) while several eardrum pathologies were detected in 12 ears (6%). Agenesis of the pyramidal eminence and stapedial tendon was found in 3 ears. While the ponticulus was bony ridge-shaped in 156 of 204 ears (76.4%), it was bridge-shaped in 25 ears (12.3%). The ponticulus was absent in 23 ears (11.3%). While complete subiculum was present in 136 of all ears (66.7%), incomplete subiculum was present in 21 ears (10.3%). Subiculum was absent in 47 ears (23%). Facial dehiscence was found in 32 ears and the round window niche was covered by a pseudomembrane in 85 ears (41.6%). A fixed footplate was present in 7.4% of all ears, and no persistent stapedial artery was seen in any cases. CONCLUSION: The pseudomembrane frequency covering the round window niche was found different from reports in the literature. In addition, the frequency of the external auditory canal wall prominence has been reported for the first time.

Endoscope-Assisted Surgery for Petrous Bone Cholesteatoma with Hearing Preservation.

OBJECTIVES: Petrous bone cholesteatoma is a rare pathologic entity and may be a difficult surgical challenge because of potential involvement of the facial nerve, carotid artery, dura mater, otic capsule and superior petrosal or lateral sinus. The objective of this article is to present the endoscope-assisted surgery for petrous bone cholesteatoma. MATERIALS AND METHODS: Eight patients (nine ears) who underwent endoscope-assisted petrous bone surgery for cholesteatoma. Pure tone audiogram, magnetic resonance imaging were performed at preoperatively, and at approximately 12 months postoperatively. RESULTS: Endoscope assisted surgery was performed in 8 patients and 9 ears. Of these patients, 6 were male and 2 were females. Median age was 19,5 (range 7-52) years. Hearing was able to preserved in 8 ears (8/9). Recurrence disease was observed one ear in long term follow up (1/9). In another one patient, cholesteatoma pearl was removed in the office. CONCLUSION: Endoscope-assisted surgery can allow removal of cholesteatoma of petrous apex with preserving hearing. It also provides to remove the cholesteatoma via transmastoid approach for perilabyrinthine space as "minimally invasive surgery" instead of middle fossa approach that is standard surgical procedure. In apical and peri-labyrinthine cholesteatomas, endoscopes allow to preserve hearing with middle fossa approach instead of trans-otic/ trans-labyrinthine/trans-cochlear approach.

Turkish Translation and Validation of Chronic Otitis Media Questionnaire-12.

OBJECTIVE: The aim of this study was to translate the Chronic Otitis Media Questionnaire-12 (COMQ-12) into Turkish, evaluate the internal consistency of the test and test-retest reliability, and validate the adaptation for further use in Turkish studies. METHODS: A total of 50 healthy subjects and 50 patients with chronic otitis media (COM) have completed a translated Turkish version of the COMQ-12. Healthy subjects were asked to complete the test twice. A statistical analysis was performed to evaluate the validity and test-retest reliability of the questionnaire. Patients were divided into three groups. Group 1 were patients with COM; Group 2 represented the first test of the control group; and Group 3 represented the second test of the control group. Cronbach's test was performed to test internal consistency, and Spearman's test was performed to evaluate test-retest validity. RESULTS: The average score was 30.64 for Group 1, 3.60 for Group 2, and 3.66 for Group 3. The COMQ-12 score of the patient group was significantly higher than the score of the control group (p<0.001). The area under the receiver operating characteristics curve value was calculated as 0.992, which showed a strong diagnostic accuracy, and the cut-off point was defined as 9. A Cronbach's alpha value of 0.810 was found. Spearman's rank correlation coefficient value (Spearman's rho) was calculated as 0.920. CONCLUSION: The Turkish adaptation of the COMQ-12 is a consistent and valid test with high sensitivity and specificity that can be used in Turkish for further studies instead of the original questionnaire.

Impact of Routine Plain X-ray on Postoperative Management in Cochlear Implantation.

OBJECTIVES: To determine the benefit of a routine plain radiography (X-ray) for confirming the optimal electrode position in cochlear implant surgery. MATERIALS AND METHODS: In total, 245 patients (135 males and 111 females) who underwent cochlear implantation in a single tertiary referral center were included in this study. Postoperative plain X-ray findings and electrophysiological tests were retrospectively analyzed. RESULTS: The mean age was 11.4±14.6 years (range, 1-70 years). Overall, 196 (80%) patients were pediatric patients (age, <18 years) and 49 (20%) were adults (age, >18 years). The mean rotation of electrode arrays was 1.03±0.17 turns. The plain X-ray revealed that electrode misplacement was present in 5 patients (2%); incomplete insertion in 3 patients, and tip rollover and electrode migration in 1 patient each. A revision was performed for the last patient who had an extracochlear electrode position in the plain X-ray. CONCLUSIONS: Postoperative imaging is mostly used to confirm the electrode array position after cochlear implant surgery. In addition, intraoperative evaluations have low positive predictive value and sensitivity. Thus, this study revealed that postoperative radiological imaging should be considered even when all intraoperative electrophysiological measures and surgical reports are normal.

Breast Cancer Metastasis on the Neck Mimicking a Glomus Tumor.

Cervical metastases from breast carcinoma are extremely rare after several years of disease-free survival. In this article, a metastatic tumor of the neck originating from a breast carcinoma, which has been treated 14 years ago, is discussed. A case is presented of a 48-year-old female patient with a history of breast carcinoma, which was surgically treated approximately 14 years ago. Patient was evaluated as glomus vagale because of clinical and radiologic characteristics. The resection of the mass was performed under general anesthesia, without any complications. The diagnosis of metastatic breast carcinoma was confirmed by histopathologic evaluation. In the differential diagnosis of cervical masses, the cervical metastasis of the breast carcinoma with mimicking clinical presentations should be kept in the mind; especially patients with breast cancer history.

A Rare Complication of Cochlear Implantation After Magnetic Resonance Imaging: Reversion of the Magnet.

Cochlear implants are mechanical devices used for patients with severe sensory-neural hearing loss, which has an inner magnet. It is proven that 1.5 Tesla magnetic resonance imaging (MRI) scanners are safe to use in patients with cochlear implant. In our patient, the authors aim to introduce a rare complication caused after a 1.5 Tesla MRI scanning and the management of this situation; the reversion of the magnet of the implant without displacement and significance of surgery in management.

Endoscopic-Assisted Cochlear Implantation: A Case Series.

The aim of the present study was to describe the use of the endoscopic-assisted cochlear implantation in cases with an unsuccessful standard surgical technique because of not achieving adequate exposure to the round window (RW). Three patients with a bilateral profound hearing loss were operated using an endoscopic-assisted cochlear implant procedure at our tertiary university referral center between 2012 and 2014. In all of the patients, a retroauricular "c" shaped incision was performed and a subperiosteal pocket was created. Standard cortical mastoidectomy and posterior tympanotomy were accomplished using a otomicroscope. However, RW and promontory could not be seen using this approach. The tympanomeatal flap was elevated and the middle ear cavity was entered A rigid 0 degree endoscope (2.7 mm wide, 18 cm in length) (Karl Storz company, Tuttlingen, Germany) and a connected HD camera system (Karl Storz Company, Tuttlingen, Germany) were used to expose RW through posterior tympanotomy, and a drill was passed through the external ear canal. The RW niche was removed using a diamond burr under endoscopic view; the endoscope was placed through the external ear canal, and electrodes were transferred through posterior tympanotomy. The electrodes were fully inserted under the endoscopic view in all cases. Endoscopic-assisted cochlear implantation may be a safe alternative surgical technique in cases where surgeons are not able to visualize RW and promontory using a microscope.

Safety and Efficacy of Chitosan-Dextran Hydrogel in the Middle Ear in an Animal Model.

OBJECTIVES: To investigate the efficacy of chitosan-dextran hydrogel (CDH) in preventing postoperative adhesions between the tympanic membrane (TM) and intratympanic structures, and to evaluate its ototoxicity in an animal study. METHODS: In the first step, ototoxicity was evaluated with 7 male albino guinea pigs (GPs) via auditory brainstem responses (ABR) before and 4 weeks after unilateral intratympanic injection of CDH and saline solution contralaterally. In the second step, 12 GPs underwent bilateral ear surgery. The middle ear (ME) mucosa was abraded, and the cavity was filled with CDH on one side and packed with Gelfoam on the contralateral side. A control group of 6 GPs underwent the same procedure except that no material was applied in the ME. The animals were euthanized at the end of the 7th week, and otomicroscopic findings were noted and the temporal bones harvested for the histologic examination. The findings were scored and compared. RESULTS: There was no statistically significant difference between the pre- and postoperative ABR thresholds. In the otomicroscopic findings, the most prominent difference between the two groups was the presence of retraction of the TM in the Gelfoam group. The histopathologic findings revealed a higher degree of inflammation in the Gelfoam group compared with the CDH group. CONCLUSION: This study demonstrated that CDH has no ototoxic effects in GPs. Its use as an ME packing material revealed significantly less TM retraction and inflammatory reaction compared with Gelfoam.

Two Different Percutaneous Bone-Anchored Hearing Aid Abutment Systems: Comparative Clinical Study.

OBJECTIVE: To compare two different percutaneous bone-anchored hearing aid (BAHA) abutment systems regarding operation time, scar healing, quality of life, implant stability, audiologic results, and complications. MATERIALS AND METHODS: The study involves a prospective multi-center clinical evaluation. Thirty-two consecutive patients who had undergone BAHA surgery from January 2011 to January 2013 in two tertiary centers were included in the study. The Glasgow Inventory Benefit Score was used to assess the patients at least 6 months after surgery. The operation time and complications were recorded. Implant stability quotient (ISQ) values were recorded using resonance frequency analysis. Holger's classification was used to evaluate skin reactions. RESULTS: The mean length of the operation was 39.2±4 min for standard abutment and 18.3±5.7 min for hydroxyapatite-coated abutment. ISQ scores were significantly better for standard abutment in all tests. The mean total Glasgow Inventory Benefit Score was 39.3±19 for the standard abutment and 46.3±24.5 for the hydroxyapatite-coated abutment groups, but there was no statistical significance between the two groups. There was no difference in audiological improvement between the two groups after surgery. CONCLUSION: Hydroxyapatite-coated abutment provided a shorter operation time that was significantly different from standard abutment. There were no significant differences between standard abutment and hydroxyapatite-coated abutment regarding audiologic improvement, quality of life, loading time, and complications.

Transcutaneous Bone-anchored Hearing Aids Versus Percutaneous Ones: Multicenter Comparative Clinical Study.

OBJECTIVE: The aim of this study is to compare the clinical audiological outcomes as well as patient satisfaction of bone-anchored, hearing aid surgery between the percutaneous Dermalock and the transcutaneous Attract systems. STUDY DESIGN AND METHODS: This is a multicenter, retrospective clinical study. The patients who underwent Baha Dermalock and Baha Attract surgery were analyzed for hearing results, surgical complications, and postoperative follow-up specifications for both systems. Speech reception thresholds and bone conduction thresholds with and without aided conditions were evaluated. Patient satisfactions were also determined for both groups by Glasgow Benefit Inventory questionnaire. RESULTS: Both of the groups had some minor complications such as skin irritations around the abutment and skin erythema over the magnet. Both of the groups benefit from the devices audiologically; however, when the groups were compared, better results were observed in the percutaneous, bone-conduction group. CONCLUSION: We can confirm that both transcutaneous and percutaneous techniques are effective in the rehabilitation of conductive hearing loss when conventional hearing aids cannot be used. However, both of the systems have some advantages and limitations in terms of audiological and surgical perspectives.

Spontaneous bone bed formation in cochlear implantation using the subperiosteal pocket technique.

OBJECTIVE: To show evidence of spontaneous bone pocket formation using the subperiosteal pocket technique for cochlear implantation surgery. STUDY DESIGN: Clinical capsule report. SETTING: University hospital. PATIENTS: We evaluated 8 pediatric revision cochlear implant patients who had previously undergone cochlear implantation using the subperiosteal pocket technique. The time between primary and revision surgery varied between 5 and 54 months. RESULTS: Spontaneous bone bed formation for the internal receiver stimulator and its electrodes was observed during revision surgeries in all patients. CONCLUSION: The subperiosteal pocket technique for cochlear implantation does not require pockets to be drilled in the skull, unlike the standard technique, because bone beds form spontaneously.

Persistent cough associated with osteophyte formation and vagus nerve impingement following cervical spinal surgery: case report.

Persistent cough due to irritation of the vagus nerve by osteophytes resulting from cervical spinal surgery is a very rare condition. The authors report the case of a 49-year-old woman who presented with a persistent cough subsequent to cervical spinal surgery. One year after the initial operation, the patient underwent surgery to free the larynx from the prevertebral fascia and cut the pharyngeal plexus, but her symptoms persisted. In order to control the cough, she used a soft cervical collar with padding inserted in the left side so that the larynx would be pushed to the right, a solution she discovered on her own. Without the collar, she coughed uncontrollably. A CT scan was performed and showed an osteophyte that had developed at the level of the prosthesis. Based on these findings, the authors hypothesized that the cough was caused by vagus nerve irritation due to the osteophyte. The osteophyte was resected and the vagus nerve was moved to a position anterior to the carotid artery and was isolated by means of an autogenous tensor fascia lata graft. The patient's symptom disappeared immediately after the surgery. At the most recent follow-up visit, 18 months after surgery, the patient was symptom free and was pursuing regular daily activities without using a cervical collar.

[Revision surgery in cochlear implantation]. / Koklear implantasyonda revizyon cerrahisi.

OBJECTIVES: In this study, we evaluated the reasons and management approaches for revision cochlear implant surgery. PATIENTS AND METHODS: Thirty-two patients (20 males, 12 females; mean age 7.4 years; range 15 month to 54 years) who underwent revision cochlear implantation in our clinic were divided into two group, including reimplantation or non-reimplantation group. RESULTS: Of patients who underwent revision surgery, 22 had reimplantation, while remaining 10 were not required reimplantation. The mean time from the first surgery to revision surgery was 17.3±15.2 months (range 1-59 months). In patients who underwent primary surgery in our clinic, the revision and reimplantation rates were 5.2% and 3.4%, respectively. The reasons for revision surgery included software failure of the device (n=7), local flap problems (n=7), reference electrode problems (n=5), magnet displacement (n=2), electrode migration to vestibule (n=2), extracochlear insertion of electrode (n=2), broken electrode (n=2), device failure following head trauma (n=2), facial stimulation and paralysis (n=1), electrode exposition from the external ear canal (n=1), and electrode exposition to the middle ear (n=1). CONCLUSION: The most common reasons for the revision cochlear implant surgery are software failure of the device, local flap problems and electrode failures. In revision surgery, the problems should be solved without damaging the implant, if the implant is running.

Autologous fascia lata graft for contour restoration and camouflage in tertiary rhinoplasty.

Tertiary rhinoplasty is a surgical procedure to correct nasal deformities that have been developed after prior unsuccessful surgeries. Such surgery requires complicated manipulations and tissue grafting for proper restoration. In the current study, we report the use of fascia lata graft combined with cartilage grafts for contour restoring and camouflage. Twenty-three patients who had severe nasal deformities were included, of whom 14 were men and 9 were women. Their ages ranged between 24 and 34 years (mean, 29 y). All patients were twice previously operated on by surgeons other than the authors. An informed consent was obtained from all patients. After harvesting the costal cartilage, the fascia lata graft (mean size, 2-3 cm) was uniformly harvested from the right lateral thigh. Application of the fascia lata and the cartilage graft was achieved through the open rhinoplasty incision. The fascia lata was applied over the cartilage in the dorsal region in 20 patients (86.9%), applied over the reconstructed alar and dome area in the nasal tip in 8 patients (34.7%), and applied over both areas simultaneously in 4 patients (17.3%). Postoperative follow-up was between 14 and 35 months (mean, 24.5 mo); clinical evaluation, photographic documentation, and a questionnaire form related to donor-site morbidity and patient satisfaction were applied after 12 months of the follow-up period. Results showed that all patients had an improved aesthetic result, and no apparent irregularities were observed in the integument of the aesthetic lines. No complications or no requirement for revision surgery was observed later on. In conclusion, refinements of the nasal dorsum and the nasal tip in tertiary rhinoplasty are indeed important and difficult to be managed. Placing the fascia lata over the applied cartilage grafts provide a good cover that conceals the possible irregularities or distortions that may appear in the late postoperative period.

Subperiosteal temporal pocket versus standard technique in cochlear implantation: a comparative clinical study.

OBJECTIVE: In the standard technique of cochlear implantation, the internal receiver-stimulator (IRS) is fixed into a socket drilled on the calvarial bone. In the subperiosteal technique, the IRS is fixed under the subperiosteal plane, and drilling is not necessary. The purpose of this study was to compare the subperiosteal and the standard techniques. STUDY DESIGN: Retrospective clinical study. SETTING: Tertiary referral center; cochlear implant program. PATIENTS: One hundred forty-eight patients who underwent cochlear implantation. INTERVENTION: The researcher who evaluated the patients was not informed which of the 2 techniques was used on the patients and administered a visual analog scale (VAS) analysis. The duration of the operation, intraoperative and postoperative complications, and migration of the IRS were assessed. MAIN OUTCOME MEASURES: A VAS survey was administered to the patients or to their parents to evaluate the practicability of the implant. RESULTS: The duration of the operation was 73.4 ± 17.8 minutes in the subperiosteal group and 105.5 ± 17.8 minutes in the standard technique group. The difference was statistically significant. Intracranial complications or migration of the IRS was also not observed in any patient. The VAS score was 4.2 ± 2.1 in the standard group and 4.3 ± 1.9 in the subperiosteal group. The difference was not statistically significant. CONCLUSION: The subperiosteal technique can be safely and effectively used in cochlear implantation. Not only are there no intracranial complications and no migration of IRS was observed but also the mean operation time is reduced up to 30% and none of the patients have reported difficulty with fixing of the external device.

Assessment of shoulder impairment after functional neck dissection: long term results.

OBJECTIVE: In this prospective study, we attempted to use objective techniques to measure shoulder disability and evaluate patients who underwent functional neck dissection (FND) procedure. Patients were compared on the basis of preoperative and postoperative range of motion (ROM) measurements, pain and stiffness domains. At the final visit, a Neck Dissection Impairment Index (NDII) questionnaire was applied to all patients. METHOD: Twenty-five patients treated with head and neck cancer who underwent bilateral FND simultaneously with the resection of primary tumor enrolled in this study from April 2001 to July 2004. Flexion, extension, abduction, internal and external rotations of the shoulder have been measured with electronic incliometer preoperatively, and at the 1st, 3rd, 6th, and 18th months postoperatively. A questionnaire modified from neck dissection impairment index was applied to all patients to measure neck and shoulder disability at final visit. Pain and stiffness domains were also assessed preoperatively and at postoperative 18th month. RESULTS: Measurements of abduction at the first and third months were found to be decreased in comparison with preoperative measurements. These differences were statistically significant (p<0.05). The pain and stiffness scores of all patients at the final visit were significantly worse than the preoperative scores (p<0.005). At the final visit NDII of patients who underwent total laryngectomy were significantly worse than of the patients who underwent partial laryngectomy and glossectomy (p=0.002 and 0.043, respectively). All these results did not correlate with age, radiation therapy (RT), operation side, T stage. CONCLUSION: FND is oncologicaly safe procedure and gives rise to less shoulder morbidity. Although, ROM improved after 18 months from surgery, pain and stiffness were found to be worse than preoperative values. The patients with total laryngectomy had lower NDII scores regarding to other patients. Therefore, shoulder disability can be attributed not only to neck dissection but also to primary surgery.