Bilateral Barotraumatic Involvement of the Infraorbital Nerve with Dehiscence and Ectopic Course: A Case Report.

The infraorbital nerve is responsible for the sensory innervation of the lower eyelid, the lateral nose, the cheek, the upper lip, and the maxillary teeth. It passes along the infraorbital canal, which runs superior to the maxillary sinus. Dehiscence of the infraorbital canal and its ectopic course in the maxillary sinus is a rare variation. A nerve with these variations may be affected by pathologies in the maxillary sinus and this may constitute a rare cause of facial pain. In this report, we present the clinical symptoms of a 29-year-old male patient who had an infraorbital nerve with an ectopic course and dehiscence in light of the literature.

Frozen Section Evaluation for Surgical Margins in Laryngeal Squamous Cell Carcinoma: Is it a Reliable Method for Partial and Total Laryngectomies?

BACKGROUND: In this study, we aimed to compare the accuracy of frozen section evaluation in partial and total laryngectomies performed to treat laryngeal squamous cell carcinoma . METHODS: A retrospective study was conducted to evaluate the efficacy and accuracy of frozen section analysis for laryngeal squamous cell carcinoma of 65 patients, operated at a tertiary hospital. Two groups were recruited according to the surgical procedure. RESULTS: The sensitivity and specificity of frozen section diagnosis in laryngeal cancer were 20% and 99.73%, respectively. For partial laryngectomy, the sensitivity was 16.66% and specificity was 100%. For total laryngectomy, sensitivity was 22.2% and specificity 99.13%. Discordances between the initial frozen section diagnosis and the subsequent permanent section diagnosis were found in 13 (3.35%) pairs (3.37% partial laryngectomy and 3.33% total laryngectomy). CONCLUSION: Our study shows that the surgical method applied has no effect on discordances. However, sampling errors are likely to be more common in partial laryngectomy procedures. It should be kept in mind that the sensitivity of frozen section evaluation is low.

Transoral penetrating upper cervical injury: a case report.

Transoral penetrating foreign body injury of the neck involving the cervical spine is a rare condition. We present an injury caused by transoral penetration of a broken piece of a wooden plank into the neck with injury to the upper cervical spine in a 31-year-old male patient. The foreign body was removed transorally with the patient making a full recovery under close observation and was discharged and followed up with no complications. This paper highlights the types of neck injuries, the key points to be considered in zone III neck injury in light of existing literature and a discussion on the management of these patients.

Surprise Egg in the Nasopharynx: Basal Cell Adenocarcinoma.

Basal cell adenocarcinoma is a rare salivary gland neoplasm. It is most commonly seen in the parotid gland, and its involvement in the minor salivary glands or upper respiratory tract is very rare. Surgical excision and/or radiotherapy are the mainstay treatment modalities. The nasopharynx is an unusual location for salivary gland basal cell adenocarcinoma. In this case report, the nasopharyngeal punch biopsy of a 60-year-old male patient was reported as salivary gland adenoma, but the final pathological diagnosis was changed to basal cell adenocarcinoma after endoscopic nasopharyngectomy. The clinical, radiological, and histopathological features of the case are presented in light of the literature. In addition, diagnostic clues are emphasized in cases of suspected non-epithelial tumors of the nasopharynx.

Oral Lipoma Resembling Popeye's Pipe: A Case Report.

Lipomas are benign neoplasms of mesenchymal origin. Although they are frequently seen in other parts of the body, they are rare in the oral cavity. In the oral cavity, they most often develop from buccal mucosa. They tend to grow slowly, so they may remain asymptomatic for a long time and go unnoticed. Lipomas in the oral cavity may cause deterioration in chewing-speaking and esthetic problems over time, depending on the increase in their size. The most reliable imaging method for differential diagnosis is magnetic resonance imaging. Complete excision of the lipoma is essential for treatment. In this study, a case of an unusual oral lipoma, causing nutrition-speaking difficulties in a geriatric male patient is presented.

The role of raftlin in the pathogenesis of chronic rhinosinusitis with nasal polyps.

PURPOSE: The aim of this study was to investigate the possible role of raftlin (RFTN) in chronic rhinosinusitis with nasal polyps (CRSwNP). There is no study in the literature investigating the role of RFTN in the pathogenesis of CRSwNP. METHODS: The present study was designed as a case-control study and conducted between 25.09.2020 and 01.01.2022. CRSwNP and control groups were formed in the study. Serum and tissue samples were taken from each patient in the study and their RFTN levels were measured. While nasal polyps were used for tissue samples in the CRSwNP group, middle meatus mucosa obtained during concha bullosa surgery was used in the control group. RESULTS: The control group included 31 patients (8 female, 23 male) and the CRSwNP group included 49 patients (14 female, 35 male). The mean age of the control group was 40.42 ± 9.99 years, while the mean age of the CRSwNP group was 43.47 ± 10.19 years. When the groups are compared in terms of gender and age, there were no statistically significant differences (p = 0.78, p = 0.19, respectively). The serum RFTN levels in the control and CRSwNP groups were 7.85 ± 10.87 ng/ml, and 7.02 ± 8.59 ng/ml, respectively (p = 0.45). The tissue RFTN levels in the control group and CRSwNP group were 87.15 ± 69.91 ng/ml, and 66.50 ± 17.10 ng/ml, respectively (p = 0.04, statistically significant). CONCLUSION: RFTN deficiency in nasal polyp tissue may be one of the reasons for the development of CRSwNP. Further studies are needed to elucidate the role of RFTN in CRSwNP.

The Importance of Prostate-Specific Membrane Antigen Expression in Carotid Body Paragangliomas.

OBJECTIVE: Prostate-specific membrane antigen (PSMA) is a transmembrane protein expressed in prostate cancer. It is, however, also expressed in the neovasculature of some non-prostatic solid tumors. Carotid body paragangliomas (CBPs) are highly vascular neoplasms. In this study, we aimed to investigate the possible role of PSMA expression in CBPs. There are no studies in the literature that report to have investigated the relationship between PSMA and CBPs. METHODS: This study is a retrospective analysis of cases diagnosed with CBP based on their demographic, clinical, radiological, surgical and immunohistochemical findings. Immunohistochemical examination results of Ki-67, S100, synaptophysin, chromogranin were retrieved from patient files. Then, the paraffin blocks of CBPs specimens, stained by PSMA-antibody by immunohistochemical methods were examined histopathologically. RESULTS: The number of patients operated on for CBP was 12 (four men and eight women). Ten out of 12 specimens were suitable for staining and histopathological examination. Capsular and/or vascular invasions of tumors were seen in complicated cases. Intratumoral vascular PSMA expression was seen in all specimens except one. Extratumoral vascular PSMA expression was not detected in any of the cases. Tumoral cell PSMA staining was seen in six of ten cases. CONCLUSION: We found higher intratumoral vascular expressions of PSMA nearly in all CBPs, but we could not assess the statistical significance because of the small number of specimens. These data might be a guide for future studies that are planned for either diagnostic or therapeutic approaches to CBPs.

A Giant Diving Ranula Extending to the Skull Base in Pediatric Age.

ABSTRACT: Ranula is a retention cyst that develops from the salivary glands. It has 2 subtypes, oral and diving. There are differences in the clinical features of ranula subtypes. In particular, diving ranula is more prone to extend in the neck spaces than oral ranula. The enlargement of the diving ranula is generally downward in the neck. If the opposite occurs, we may encounter very interesting and difficult cases. Diving ranula should be kept in mind in the differential diagnosis of cystic neck masses in the pediatric age group and its treatment should be done surgically.A 15-year-old girl admitted to our clinic with the complaint of swelling in the floor of the mouth and neck. In physical examination of the patient, a mass with cystic content was observed adjacent to the left Wharton canal. In addition, a 4 × 3 cm, soft, fluctuant, nonfixed, painless mass was palpated in the left submandibular area. Magnetic resonance imaging revealed that the neck mass was a diving ranula extending from the parapharyngeal space to the skull base. In the surgery, submandibular and sublingual salivary glands were removed together with the diving ranula. We observed no complications in the postoperative period.Magnetic resonance imaging should be used to confirm the diagnosis of diving ranula. In the treatment of diving ranula, excision of the ranula alone is not enough surgically. We also recommend excision of the submandibular and/or sublingual salivary glands associated with ranula to reduce the recurrence rate.

Can the systemic immune inflammation index preoperatively predict nasal polyp subtypes?

PURPOSE: Chronic rhinosinusitis with nasal polyps can be classified as eosinophilic or neutrophilic based on the major inflammatory cell type in the tissue. There is a need for predictive parameters to enable rhinologists to identify the type of nasal polyp in a patient without surgery. The aim of the present study was to test the predictive value of the markers of inflammation to estimate eosinophilic nasal polyps. METHODS: The study analyzed 299 patients who underwent sinus surgery for nasal polyps from 2012 to 2019. Patients were divided into two groups according to pathology results (eosinophilic polyps = group 1, neutrophilic polyps = group 2). The values of preoperative complete blood count, systemic immune inflammation index, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio were compared. RESULTS: In our series, results of ROC analyses for both mean eosinophil count and systemic immune inflammation index were statistically significant. For the eosinophil count (AUC = 0.681, p < 0.001) and systemic immune inflammation index (AUC = 0.621, p = 0.001). Patients with an eosinophil cut-off value of 0.25 cells × 109/L had ORs of 49.27 (95% CI 11.68-207.81) and sensitivity: 0.69, specificity: 0.64. Patients with a systemic immune inflammation index cut-off value of 332.39 had ORs of 1.003 (95% CI 1.002-1.004) and sensitivity: 0.84, specificity: 0.39. CONCLUSION: The systemic immune inflammation index and absolute blood eosinophil count could be used to predict nasal polyp subtypes before surgery. We believe that systemic immune inflammation index should also be studied to estimate postoperative recurrence.

Evaluation of Serum Selenium and Erythrocyte Glutathione Peroxidase Levels in Patients with Recurrent Tonsillitis.

The aim of this study is to investigate serum selenium (Se) and glutathione peroxidase (GSH-Px) levels in patients with recurrent tonsillitis. The study included 53 patients with recurrent tonsillitis and 51 healthy children. The measurement of serum Se levels were done in graphite furnace atomic absorption spectrophotometer using Zeeman background correction. Erythrocyte GSH-Px levels were indirectly measured by using the spectrophotometry. The ages of children in both groups ranged between 3 and 13 years, with a mean age of 7.60 years for patient group and 7.22 years for control group. Mean serum Se levels in patient and control groups were 60.4 and 78.7 µg/dL respectively. Mean erythrocyte GSH-Px levels in patient and control groups were 7.0 and 23.1 U/g hb, respectively. The mean blood Se and GSH-Px levels in patients with recurrent tonsillitis were significantly (P < 0.001) lower than control group. In our study, we found that serum Se and erythrocyte GSH-Px levels of cases with recurrent tonsillitis were significantly lower than healthy controls. The decline in serum Se and erythrocyte GSH-Px enzyme levels may predispose a chronic disease state but this issue needs further investigation.

Investigation of GLUT1, HIF1α and TBX21 Gene Polymorphisms in Laryngeal Cancer.

OBJECTIVE: We aimed to investigate the association of the frequency of three single-nucleotide polymorphisms [glucose transporter isoform 1 (GLUT1) reference single-nucleotide polymorphism (rs) 710218, hypoxia-inducible factor 1 alpha (HIF1α) rs11549465, and T-box transcription factor protein 21 (TBX21) rs17250932], which have been proved to be related with various benign and malignant diseases, with the development of laryngeal cancer and its size and grade. METHODS: In this study, we included 35 patients with laryngeal cancer and 35 volunteers at least 30 years old who had smoked for at least 20 years. DNA was obtained from the blood samples of the participants using an isolation kit. Then, polymorphisms for both the groups were determined using real-time polymerase chain reaction. RESULTS: No significant differences were detected regarding the genotype and allele frequencies in the three polymorphisms assessed between the two groups. In the patient group, on examining the association of polymorphisms with tumor size and grade, no significant relation was observed in three polymorphisms regarding the related parameters. CONCLUSION: GLUT1, HIF1α, and TBX21 polymorphisms have no impact on the development of laryngeal cancer.

Uncinate Process Variations and Their Relationship with Ostiomeatal Complex: A Pictorial Essay of Multidedector Computed Tomography (MDCT) Findings.

The ostiomeatal complex (OMC) is a key area for the drainage and ventilation of the paranasal sinuses. Stenosis created by inflammation and anatomic variations in this region causes an ideal ground for parasanal sinus infections, by preventing the drainage and ventilation of the sinuses. In today's diagnostics of paranasal sinus infections, the role of evaluation of OMC anatomical variations and soft tissue pathology has increased.. Knowing the anatomical details is important in terms of directing both medical and surgical treatment. The uncinate process (UP) constitutes the most important structure of the ostiomeatal complex, playing a role in mucociliary activity. UP variations can cause mucociliary drainage and ventilation problems, causing complications during surgery. Therefore, knowing and identifying their appearances in multidetector computed tomography (MDCT), the most frequently used radiological imaging method for these variations, becomes a very important consideration.

Antrochoanal polyp: clinical presentation and retrospective comparison of endoscopic sinus surgery and endoscopic sinus surgery plus mini-Caldwell surgical procedures.

Antrochoanal polyp is a benign polypoid lesion orginating from the maxillary sinus antrum and extending to the choana. Our aim was to assess the clinical presentation and associated rhinological findings of antrochoanal polyp patients and to evaluate results of 2 surgical treatments termed endoscopic sinus surgery (ESS) and ESS plus mini-Caldwell operation. The study included 46 patients. Factors such as patient age, sex, history of chronic sinusitis, allergic rhinitis, septal deviations, chonca bullosa, turbinate hypertrophy, and the origin of the polyp were assessed. We also evaluated ESS and ESS plus mini-Caldwell surgical procedures for recurrences, synechia, bleeding, and ostium stenosis. Overall, there were 27 men and 19 women. The ESS approach was used in 26 cases, and 20 cases had combined ESS and mini-Caldwell procedures. The statistical significant difference between the 2 groups was only recurrence (P < 0.05). In the ESS group, bleeding, synechia, and ostium stenosis were seen more than in the ESS + mini-Caldwell group, but there was no significant difference between the 2 groups in bleeding, synechia, and ostium stenosis (P > 0.05). We thought that lower rate of recurrence found in ESS + Caldwell group in this study was associated with better visualization of the maxillary sinus walls and, therefore, easier resection of the remnant polyp. We concluded that higher incidences of bleeding and synechia were related to the mucosal damage occurring in the septum and the inferior concha due to excessive manipulation of endoscope and surgical instruments.

Ear protrusion after tympanoplasty and the use of mastoid dressing.

OBJECTIVES: This study aims to assess possible wound complications of tympanoplasty and tympanomastoidectomy with or without postoperative mastoid dressing. PATIENTS AND METHODS: A total of 37 patients (22 females, 15 males; mean age: 23.88 years; range 9 to 64 years) who underwent middle ear or mastoid operations via postauricular incision were included in this prospective, randomized, controlled study. The patients were divided into two groups as having mastoid dressing (n=17) and nonmastoid dressing (n=20). Through a close follow-up, postoperative complications were noted and distance from mastoid scalp and auricular rim was measured. RESULTS: The mean mastoid-helix distance of non-mastoid dressing group was found 17.2 mm in operated and 16.9 mm in non-operated ears. The mean mastoid-helix distance of mastoid dressing group was 15.53 mm in operated ears and 16.47 mm in non-operated ears. Skin erythema was seen in a patient. There was no statistically significant increase in mastoid-helix distance (p>0.05). CONCLUSION: Tympanoplasty with or without mastoidectomy does not cause postoperative complication or protrusion of the ear, even if no mastoid dressing is used. Our study results suggest no benefit of mastoid dressing after tympanoplasty with or without mastoidectomy.

Trace elements in nasal polyps.

The aim of our study is to evaluate the status of selenium and zinc in nasal polyp tissues and to investigate the possible role of trace elements and antioxidants including superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) in nasal polyps. In this study, the antioxidant enzyme and trace element levels measured in polyp tissues of 37 patients were compared with the levels measured in conchal mucosa of 27 control cases. The antioxidant enzyme and trace element levels in tissues were measured with graphite and flame spectrophotometry methods using Shimatsu UV.1601 spectrophotometer and Perkin Elmer atomic spectrometer. The mean tissue zinc and selenium levels were, respectively, 2.55 µg/g and 30.03 pg/g in patient group, 4.37 µg/g and 44.95 pg/g in control group. The mean tissue SOD and GSH-Px levels were, respectively, 4.27 and 0.69 U/mg protein in patient group, 7.09 and 0.77 U/mg protein in control group. When the measured levels in patients and control cases were compared, there were statistically significant differences between zinc, selenium, and SOD levels (P = 0.001). There was no significant difference between GSH-Px levels (P = 0.465). In conclusion, it has been revealed that the levels of zinc, selenium, and SOD in nasal polyps were significantly lower, and it may be concluded that this may have a role in the development of nasal polyps.

The effect of retinyl palmitate on healing of benign vocal fold lesions.

The leading cause of vocal fold lesions such as nodules and polyps is phonotrauma, which causes microhematoma formation in the vocal fold cover that can initiate an inflammatory process. Vitamin A (Vit A) is essential for immunity, cellular differentiation and maintenance of respiratory epithelium. The aim of this study is to investigate the effect of Vit A (retinyl palmitate) on healing of vocal fold lesions, including vocal polyps and nodules. Eighteen patients with vocal fold lesions were included in the study. Of the patients, 13 had vocal polyps and 5 had vocal nodules. Patients received 90,000 IU oral Vit A in palmitate form daily for 2 months. In addition to Vit A treatment, only vocal hygiene recommendations were given to the patients, without any other medication or specific voice therapy. Pre- and post-treatment acoustic analysis [jitter % (jitt %), shimmer % (shim %), normalized noise energy (NNE), maximum phonation time (MPT), etc.] were performed. Lesion dimensions and stroboscopic findings were evaluated. Voice handicap index (VHI) was applied. Statistical analysis was performed between pre- and post-treatment measurements. Of the 18 patients, 8 had immature lesions (6 polyp-like lesions and 2 immature nodules) and 10 had mature lesion (7 polyps and 3 nodules). None of the patients showed complete healing. Partial response was seen in four patients with immature lesions. There were minimal changes in lesion dimensions, but this difference did not reach statistical significance. MPT of patients with immature lesions were close to significance level but overall MPT revealed no significant improvement (p = 0.051). Jitt %, shim % and NNE did not change significantly. In this study, the only statistically significant finding was VHI of the patients with immature lesions. Three of the patients complained of weight gain. Our data showed that Vit A at a given level of dose and duration seems to be ineffective in the treatment of benign vocal fold lesions. On the other hand, whether Vit A is effective on mature and immature lesions of vocal folds at higher doses and/or longer duration of treatment or not requires further studies.

Hearing and cochlear function of patients with ankylosing spondylitis.

Ankylosing spondylitis (AS) is a chronic systemic inflammatory disorder that primarily affects the spine and sacroiliac joints. Recent studies described audiovestibular impairment in AS patients. The aim of this study was to evaluate the hearing and function of the cochlear system in patients with AS. Thirty-seven AS patients and 20 healthy controls were evaluated prospectively. Otorhinolaryngologic examinations were performed in all patients together with pure tone audiometry, speech discrimination test, tympanometry, and distortion product otoacoustic emission (DPOE). Disease duration, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores, and hematologic findings (CRP and ESR) were also collected. Pure tone audiometry findings of the patients and controls were significantly different in all frequencies (p < 0.01). Speech discrimination scores were also significantly different (p < 0.01). No significant difference was found between DPOE responses of the patients and controls (p > 0.05). There was no correlation between disease duration, BASDAI scores, hematological findings, and audiometry findings (p > 0.05). This study demonstrated that there is an association between AS and hearing loss, but the cochlea is not the main source of hearing loss.

Malondialdehyde level and adenosine deaminase activity in adenoid tissue of patients with OME and obstructive adenoid hypertrophy.

OBJECTIVE: The aim of our study was to determine and compare adenosine deaminase (ADA) activity and malondialdehyde (MDA) level in adenoid tissue of patients with or without otitis media with effusion (OME). METHODS: The study included 30 patients undergoing adenoidectomy due to obstructive adenoid hypertrophy (OAH) or OME. Tissue MDA level was measured by the method of Okawa with modification and tissue ADA activity by the method of Giusti. We measured, superoxide dismutase (SOD) and catalase (CAT) activities as well. RESULTS: In patients with OAH, mean tissue MDA level and ADA activity were 4.13 ± 0.90 nmol/mg Pr and 0.39 ± 0.04 U/mg Pr, respectively, which were significantly higher than those of OME group (1.43 ± 0.41 nmol/mg Protein and 0.22 ± 0.04 U/mg Pr, respectively) (P<0.05). SOD and CAT activities were found to be increased in patients with OAH when compared to the OME group but they did not reach statistically significant level (P=0.06 and 0.05 respectively). CONCLUSIONS: The present study showed the presence of measurable ADA activity in adenoid tissue, and also significant increases in both tissue MDA level and ADA activity in OAH tissue when compared to adenoid tissue of the patient with OME. However, the significance of changes in MDA and ADA activation in the pathogenesis of OAH requires further study.

The efficiency of Nose Obstruction Symptom Evaluation (NOSE) scale on patients with nasal septal deviation.

OBJECTIVE: The aim in this study was to evaluate the efficiency of Nasal Obstruction Symptom Evaluation (NOSE) scale for septoplasty (without turbinate reduction) in comparison with other examination methods. METHODS: Prospective observational study was undertaken in otolaryngology department of university hospital. NOSE scale for quality of life assessment, visual analog scale for examination findings, acoustic rhinometry and coronal computed tomography were performed before and after septoplasty. The efficiency of NOSE scale to assess for septoplasty results and the correlation between NOSE scores and other techniques was analyzed. RESULTS: Twenty-seven patients underwent septoplasty; there was a very significant improvement in mean NOSE scores of patients (60.2 versus 11.28, p<0.01). There was no correlation between NOSE scores and acoustic rhinometry. Correlation was found between NOSE scores and examination and computed tomography findings (p<0.05). CONCLUSION: NOSE scale that is well correlated with examination findings and computed tomography, is very useful tool to evaluate the effectiveness of pure septoplasty.