The changes in submandibular gland size and function following chorda tympani section.

To investigate the effects of chorda tympani section on submandibular gland size and function in the early (postoperative day 7) and late (postoperative month 6) postoperative period by ultrasonography, scintigraphy, and biochemical analysis of the saliva patients with unilateral chronic otitis media. One-hundred and thirty patients (46 males and 84 females) who were ≥16 years of age and diagnosed with unilateral chronic otitis media and for whom type 1 tympanoplasty was indicated in 1st Outpatient Clinic of Kartal Dr. Lutfi Kirdar Training and Research Hospital between August 2004 and February 2007 were enrolled in the study. Of 130 patients, 102 patients who were eligible and gave written approval were included in the study. However, of these patients 99 underwent type 1 tympanoplasty and 3 had a canal down mastoidectomy. In 99 patients, chorda tympani nerves of 16 were cut, but 3 patients had to be excluded due to allergic reactions. Before the operation, bilateral submandibular gland ultrasonography was performed on all patients and the anterior-posterior length, the frontal lateral-medial width (transverse), and the paramandibular depth of both submandibular glands were measured. In scintigraphic examinations, perfusion index (PI), uptake ratio and excretion fraction were measured. Then, in biochemical analysis of the saliva the levels of sodium, potassium, chloride, calcium, magnesium, amylase, and the values of pH and density were assessed by the saliva collection through Wharton duct. In the statistical comparison of operated and healthy side of the patients with respect to these parameters Mann-Whitney U test, and in intragroup analysis Wilcoxon test was used. The volume of the submandibular gland of the operated side was significantly lower compared to the healthy side in postoperative month 6 (P < 0.05). According to the baseline volume of the submandibular gland of the healthy side, the increase in postoperative day 7 and month 6 were found to be statistically insignificant (P > 0.05). According to the baseline PI value, the decreases in the PI value in the postoperative day 7 and postoperative month 6 were statistically significant (P < 0.01). The uptake ratio of the patients was lower in the postoperative day 7 and month 6 than those at the baseline; however, the difference was statistically insignificant (P > 0.05). The excretion fraction values in the postoperative day 7 were significantly lower than the baseline values (P < 0.05), whereas the decrease in the EF values in the postoperative month 6 were statistically insignificant (P > 0.05). In conclusion, the present study was the first in the literature in which three parameters of assessment, such as ultrasonography, scintigraphy, and biochemical analysis, were used to determine the changes in submandibular gland size and function following the chorda tympani section. After chorda tympani section, the volume of submandibular gland decreased in the late postoperative period. Moreover, chorda tympani section led to decrease in the saliva secretion and the PI value of the patients in the early and late postoperative period.

[The efficacy of preoperative local bupivacain application on postoperative pain in patients who had undergone tonsillectomy]. / Tonsillektomi uygulanmis olgularda ameliyat öncesi lokal bupivacain uygulamasinin ameliyat sonrasi agri üzerine etkisi.

OBJECTIVES: To investigate the efficacy of preoperative local bupivacain application on postoperative pain and complications in tonsillectomy. PATIENTS AND METHODS: Fourty-five patients (mean age 8.07+/-3.34 years; range 4 to 20 years) who had undergone tonsillectomy were included in this study and they were divided into two groups. Study group included 30 patients and were preoperatively injected with 2.5 ml 0.5% bupivacain in each peritonsillar area. Control group included 15 patients and were injected with 0.9% NaCl. Both groups were compared with respect to operation and anesthesia duration, intraoperative blood loss and postoperative pain parameters (15. minute, 1, 4, 12, 16. and 24. hours). RESULTS: There were no statistically significant differences in operation or anesthesia duration and intraoperative bleeding between two groups (p>0.05). Postoperative pain at the 15th minute, and 1st hour, were significantly lower in controls when compared with study group (p<0.05). While these values were significant for the postoperative 15th minute, they were not significant for the 1st hour. Postoperative pain score at the 4th hour was significantly lower in the study group when compared with the control group (p<0.05). Postoperative pain score at the 24th hour was considerably lower in the study group when compared with the control group (p<0.01). CONCLUSION: Preoperative local bupivacain application reduces postoperative pain especially at the 24th hour in patients who have undergone tonsillectomy.