The Effects of Nasal Septal Deviation on Anterior Skull Base Parameters.

Introduction Functional endoscopic sinus surgery and endoscopic skull base surgery are frequently performed surgeries today. Nasal septal deviation is a common finding and can affect the surgical area. Therefore, it is important to examine the effect of this deviation on other anatomical structures. Objective The aim of the present study was to determine whether there is a relationship between the degree of nasal septal deviation and anterior skull base structures using computed tomography (CT). Methods A total of 312 patients (aged 18 to 65 years old) whose paranasal sinus CT images were available were included in the study. Measurements were obtained on images retrieved from Picture Archiving and Communication System (PACS) and Horos image archive systems in the bone window in the coronal and axial plane. Results The mean age of 312 patients was 33.00 years old (standard deviation [SD] 11.22 years). The presence of septal deviation was not associated with changes in olfactory fossa (OF) depths, Keros degrees, and the angle between the lateral lamella and the cribriform lamella. However, OF depths and Keros degrees on the deviated side of the septum were found to change at a significant level ( p < 0.05). No significant association was observed between the degree of septal deviation and cribriform lamella-lateral lamella angle. Conclusion The study showed significantly increased OF depth and Keros degree on the deviated side of the nasal septum. Performing CT scans before endoscopic sinus surgery and endoscopic skull base surgery is important to increase the chances of a successful surgical outcome and to reduce complications.

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.

Effects of hyaluronic acid-collagen nanofibers on early wound healing in vocal cord trauma.

BACKGROUND: Vocal cord scarring is the most crucial obstacle in voice quality after surgery. This study aimed to evaluate the effectiveness of hyaluronic acid (HA)-collagen nanofibers on the healing of vocal cords after surgical trauma. METHOD: Right vocal cords of 12 New Zealand white rabbits were traumatized, and the experimental group was received 1.08 mg/75 ml topical HA-collagen nanofiber (Gelfix® spray) for 3 days. Three animals in each group were sacrificed on the 7th day, and the remaining of the animals were sacrificed on the 21st day. The laryngeal specimens in the experimental and control groups were examined histopathologically. RESULT: The 7th-day H&E staining evaluation revealed pink, dense, and thin collagen fibers. Besides, the collagen content was scattered and irregular in the experimental group. The 21st-day assessment showed that the collagen bundles in the granulation tissue were almost with the same formation in both of the groups. Masson Trichrome staining on the 7th day of the study showed that the collagen fiber bundles were less frequent in the control group than the experimental group. The 7th-day Van Gieson staining analysis showed that the pattern of reticular fibers was more regular with the parallel formation in the experimental group than the control group. CONCLUSION: HA-collagen nanofiber can be used in diseases that impair voice quality due to the thickening of the lamina propria layer in the vocal cord and impaired viscoelasticity due to fibrosis after tissue trauma.

Evaluation of the Relationship Between the Required Pressure Level in Continuous Positive Airway Pressure Treatment and Voice in Patients With Obstructive Sleep Apnea Syndrome.

OBJECTIVE: The aim of this study was to investigate the effect of obstructive sleep apnea syndrome on voice, the relationship between the required pressure levels in continuous positive airway pressure (CPAP) and voice, and the effects of CPAP therapy on voice. MATERIAL AND METHODS: A total of 73 subjects consisting of 53 patients and 20 control subjects were included in the study. The patient group was further divided into low- (Group A) and high- (Group B) pressure groups according to the required pressure level. All subjects underwent acoustic sound analysis to evaluate fundamental frequency (F0), jitter, shimmer, and noise-to-harmonics ratio (NHR). Acoustic voice analysis was repeated after 3 months of regular CPAP treatment in the patient group. The mean F0, jitter, shimmer, and NHR values of the patient group and control group were compared. Intergroup comparisons were also performed between Group A and the control group, and between Group B and the control group. Finally, before and after CPAP treatment values of mean F0, jitter, shimmer, and NHR were compared in Group A and Group B. RESULTS: The mean shimmer and NHR values of the patient group were significantly higher than the control group (P = 0.01 and P = 0.023, respectively). The mean shimmer and NHR values of Group B were statistically higher than the control group (P = 0.002 and P < 0.001, respectively). The mean jitter, shimmer, and NHR values after CPAP treatment were significantly lower than those measured before CPAP treatment in Group B (P = 0.003, P = 0.001, and P = 0.001, respectively). CONCLUSION: Voice is negatively affected in obstructive sleep apnea syndrome patients who require high pressure in CPAP treatment. CPAP treatment leads to improved voice in these patients.

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.

Effect of mastoid bone pneumatization on the conformation and depth of the sinus tympani, a high-resolution computed tomography study.

PURPOSE: To investigate the relationship between mastoid pneumatization and the conformation and depth of the sinus tympani (ST) in patients with chronic otitis media (COM), based on the high-resolution computed tomography (HRCT) scans. METHODS: Two hundred and two patients affected by COM were included in the study. The patients were divided into three groups according to the extent of mastoid pneumatization on HRCT scans; pneumatized (group 1), diploic (group 2) or sclerotic (group 3). The variation in the ST area (types A, B, C) was assessed using a radiomorphological classification based on the relationship between the medial boundary of the ST and the third portion of the facial nerve. Depth of the ST was calculated by measuring the distance between the medial boundary of the ST and medial boundary of the third portion of the facial nerve RESULTS: There was a statistically significant difference between the groups in terms of the type of ST (p < 0.001). The mean depths of the ST were 1.59 ± 0.82 mm (0.00-2.80 mm) in group 1, 1.10 ± 0.79 mm (0.00-3.00 mm) in group 2 and 0.53 ± 0.63 mm (0.00-2.60 mm) in group 3. The groups were significantly different in terms of the depth of the ST (p < 0.001). CONCLUSION: A well-pneumatized mastoid is highly associated with a deep and posteriorly positioned ST with respect to the facial nerve. The preoperative HRCT scans of patients with cholesteatoma should be carefully evaluated to determine the conformation and depth of the ST.

Predicting Severe Sleep Apnea in Patients with Complaints: Pulse Oximetry and Body Mass Index.

OBJECTIVE: An adequate evaluation combined with an easily accessible test would be a useful way to direct the appropriate patients to sleep centers in circumstances with a limited opportunity for polysomnography (PSG). For this reason, it is necessary to use a screening method prior to PSG evaluation. The aim of the present study was to investigate whether the use of body mass index (BMI) and pulse oximetry is sufficient to predict the severity of obstructive sleep apnea syndrome (OSAS) without PSG. METHODS: A total of 956 patients who were admitted to a tertiary referral center with complaints of witnessed apnea, excessive daytime sleepiness, and previously performed PSG were included in the study. Data of PSG (included pulse oximetry) and BMI were investigated for the determination of cut-off points for parameters in the patients. RESULTS: Based on the presence of severe OSAS, the cut-off points were ≥31.7 kg/m2 for BMI, <81% for minimum oxygen saturation (Min O2), and ≥14.1 min for sleep time with oxygen saturation <90% (ST90). Severe OSAS risk was found to be higher in patients with BMI ≥31.7 kg/m2, ST90 ≥14.1 min, and Min O2 ≤81% than in those without (OR: 37.173; 95% CI: 22.465-61.510, p=0.001). Specificity and accuracy were 94.85% and 72.49%, respectively, when all three cut-off scores were provided. CONCLUSION: The appropriate cut-off values obtained from combining BMI and pulse oximetry data can provide accurate results for predicting the severity of OSAS.

Effects of parenteral papaverine and piracetam administration on cochlea following acoustic trauma.

INTRODUCTION: Noise exposure, the main cause of hearing loss in countries with lot of industries, may result both in temporary or permanent hearing loss. The goal of this study was to investigate the effects of parenteral papaverine and piracetam administration following an acoustic trauma on hearing function with histopathologic correlation. MATERIALS AND METHODS: Eighteen Wistar albino rats exposed to noise for 8 h in a free environment were included. We divided the study population into three groups, and performed daily intraperitoneal injections of papaverine, piracetam, and saline, respectively, throughout the study. We investigated the histopathologic effects of cellular apoptosis on inner hair cells (IHCs) and outer hair cells (OHCs) and compared the distortion product otoacoustic emissions (DPOAEs) thresholds among the groups. RESULTS AND DISCUSSION: On the 3rd and 7th days, DPOAE thresholds at 8 kHz were significantly higher both in papaverine and piracetam groups compared with the control group (P = 0.004 for 3rd day, P = 0.016 and P = 0.028 for 7th day, respectively). On the 14th day, piracetam group had significantly higher mean thresholds at 8 kHz (P = 0.029); however, papaverine group had similar mean thresholds compared to the control group (P = 0.200). On the 3rd and 7th days following acoustic trauma, both IHC and OHC loss were significantly lower in both papaverine and piracetam groups. On the 7th day, the mean amount of apoptotic IHCs and OHCs identified using Caspase-3 method were significantly lower in both groups, but the mean amount identified using terminal deoxynucleotidyl transferase dUTP nick end labeling method were similar in both groups compared to the control group. CONCLUSION: We demonstrated the effects of papaverine and piracetam on the recovery of cochlear damage due to acoustic trauma on experimental animals using histopathologic and electrophysiologic examinations.

Efficiency of Expansion Sphincter Pharyngoplasty in the Treatment of Obstructive Sleep Apnea Syndrome.

OBJECTIVE: Obstructive sleep apnea syndrome (OSAS) is characterized by recurrent episodes of upper respiratory-tract obstruction during sleep and decrease in arterial oxygen saturation. Expansion sphincter pharyngoplasty (ESP) is a simple, safe, and effective method for the surgical treatment of OSAS. The aim of our study was to evaluate the efficacy of ESP with polysomnography (PSG) in OSAS patients. METHODS: This study was conducted on patients referred to our center for the treatment of snoring, apnea, witnessed apnea, and daytime sleepiness during 2010-2018. Overall, 67 patients (16 females, 51 males) who had PSG test at postoperative three months and were considered suitable with history, physical examination, and surgery after PSG were included in the study. Patients were classified into three groups according to OSAS severity: mild, moderate, and severe. Patient age, sex, body mass index (BMI), pre- and postoperative period apnea-hypopnea index (AHI), Epworth sleepiness scores, and PSG data were recorded. RESULTS: The mean BMI of all groups was 27.44±2.73. The postoperative AHI decreased from 18.26±2.23 to 8.01±0.97 (p<0.001). Surgical success rate was 67.2%; it was higher in females (p=0.047). The highest success rate was found in the mild OSAS group; however, this difference was not statistically significant when compared to the other groups (p=0.217). There were statistically significant improvement at postoperative Epworth sleepiness scores and minimum O2 saturations (p<0.001 and p=0.018, respectively). CONCLUSION: ESP is an effective and successful surgery in selected patients with lateral pharyngeal and retropalatal narrowing.

Investigation of neutrophil-to-lymphocyte ratio and mean platelet volume in sudden hearing loss, / Investigação da relação neutrófilos/linfócitos e volume médio de plaquetas na surdez súbita

ABSTRACT 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.

RESUMO INTRODUÇÃO: Várias teorias tentam explicar a fisiopatologia da surdez súbita (SS). OBJETIVO: O objetivo deste estudo foi investigar o possível papel da inflamação e da aterotrombose nos pacientes de SS através da relação neutrófilos/linfócitos (RNL) e volume plaquetário médio (VPM). MÉTODO: Forma de estudo - coorte histórica com corte transversal (retrospectivo). Este estudo foi realizado com 59 indivíduos portadores de SS e 59 saudáveis, com as mesmas características em distribuição de gênero e idade. Os níveis de VPM e RNL foram medidos nos pacientes diagnosticados com SS e no grupo controle, verificando-se se tais resultados implicavam em um melhor ou pior prognóstico com o tratamento da surdez súbita. RESULTADOS: Os níveis da RNL são muito mais altos em pacientes com SS, em comparação com o grupo controle. De forma semelhante, níveis médios da RNL são mais altos nos pacientes não recuperados, em comparação com os recuperados (p = 0,001). Essas diferenças entretanto, não foram observadas em relação aos níveis de VPM (p > 0,05). CONCLUSÃO: RNL é um indicador rápido e confiável no que diz respeito ao diagnóstico e prognóstico de SS; por outro lado, VPM pode ser um indicador menos importante neste aspecto.

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.

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.

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 squamous cell carcinoma of larynx compared to benign and precancerous laryngeal lesions.

BACKGROUND: Laryngeal carcinogenesis is a multifactorial process that has not been fully elucidated. Despite extensive research, reliable markers with diagnostic and prognostic value are still lacking. It was recently reported that an elevated preoperative neutrophil-to-lymphocyte ratio (NLR) may correlate with an increased risk of recurrence, tumor aggressiveness and poorer prognosis in various malignancies. The aim of this study was to examine whether NLR could be used as an inflammatory marker to differentiate laryngeal squamous cell carcinoma (LSCC) patients from benign laryngeal lesion (BLL) and precancerous laryngeal lesion (PLL) patients. MATERIALS AND METHODS: This retrospective study was performed on 209 patients admitted to a tertiary referral center with laryngeal lesions and undergoing biopsies to establish their histopathological diagnosis. We reviewed the patient files for their clinical, histopathological and laboratory data. The patients were divided into three groups according to their histopathological findings, as BLL, PLL and LSCC groups. The patients in the PLL group were also divided into three subgroups as mild, moderate and severe dysplasia/ carcinoma in situ (CIS) subgroups. The groups were compared for NLR and the other laboratory data. RESULTS: The mean NLRs of the BLL, PLL and the LSCC groups were 2.12 ± 0.86, 2.32 ± 0.68 and 3.46 ± 1.51, respectively, and the difference was statistically significant (p = 0.001). The mean NLRs of the patients with PLL and LSCC were significantly higher than the patients with BLL (p = 0.031 and p = 0.001, respectively). The mean NLRs were similar among mild dysplasia, moderate dysplasia and severe dysplasia / CIS groups (p > 0.05). CONCLUSIONS: To our knowledge, this is the first study investigating NLR in BLL, PLL and LSCC. NLR is an inexpensive, reproducible and widely available blood test, and could be a useful inflammatory marker to differentiate LSCC from BLL and PLL.

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.