Mobile Bony Cap (Meysem Yorgun Technique): An Innovative Technique in Preservation Rhinoplasty for Crooked Nose Deformity.

Crooked nose deformity is a vertical axis deviation of the nasal pyramid; despite all advancements, it remains a significant problem to resolve. In this study, we present our I- and C-shaped crooked nose rhinoplasty results with this new osteotomy technique. Methods: This study included 25 patients with I- or C-shaped crooked nose deformities who underwent correction with a closed-approach let-down procedure. In this technique, the middle vault is preserved, the bony cap is mobilized and preserved, and the lateral nasal bones are equalized by a piezo device or classical osteotomes. By the mobilization of the bony cap, tension on the dorsal septum is released, and slight asymmetries are hidden behind this mobile bony cap. Results: The postoperative angles for both type I and C deformities were closer to the ideal angle, and the difference was statistically significant. All patients were satisfied with their aesthetic and functional results. Conclusions: In this procedure, we correct asymmetries at the lower maxillary nasal junction, such as in the let-down approach, as well as asymmetries at the K-point, such as in the structural approach. Thus, we combine the advantages of both techniques. Additionally, the mobile-bony cap left on the patient is very useful for releasing the tension of the septal dorsum and hiding slight asymmetries that remain below in the patients.

Host and Surgical Factors Affecting the Frequency and Duration of Revision Endoscopic Sinus Surgery.

Background Endoscopic sinus surgery is accepted as an effective surgical approach in the management of chronic rhinosinusitis. Different clinical pictures can be observed in chronic rhinosinusitis with nasal polyps (CRSwNP). Unfortunately, the eradication of the disease is impossible in all cases even if it is performed by experienced surgeons. In a significant number of patients, the polyps may regenerate and symptoms may reappear more or less in different durations. Due to the complex pathophysiology of the disease, revision sinus surgery is accepted as a multifactorial problem. We investigated the possible host and surgical factors which are related to increased frequency and earlier revision surgeries in CRSwNP. Methodology Patients operated on two or more times between 2010 and 2020 were retrospectively identified. A total of 49 patients with CRSwNP (38 male, 11 female) were statistically analyzed. The effects of host and surgical factors on the frequency and duration of revision surgery in CRSwNP were assessed. Results Samter's syndrome was noted to be a significant host factor affecting recurrence and revision surgeries. In addition, we observed significantly more frequent scarring and adhesions in patients with a higher number of operations. Conclusions Patients with Samter's syndrome should be informed of possible revision surgeries. The soft and mucosa-preserving technique is important for less scarring and good postoperative results.

Effect of nerve monitoring on complications of thyroid surgery.

OBJECTIVE: The most frequent and critical complications of thyroid surgery are recurrent laryngeal nerve palsy and hypocalcemia. In first years of the 21st century, intraoperative neuromonitoring (IONM) was introduced as a new technique to avoid the recurrent laryngeal nerve (RLN) injury. However, the role and the benefits of IONM are still controversial. In this study, we aimed to compare the postoperative complication rates during thyroid surgery with IONM usage (Group 1) and conventional direct visual technique without IONM usage (Group 2). METHODS: We conducted retrospective review of all patients undergoing thyroid surgery in Lütfiye Nuri Burat State Hospital General Surgery Department between 2014 and 2016 years. Patients have been classified in to two groups: Group 1 and 2. RESULTS: Overall, 191 patients were included in the study; Group 1 comprised 79 patients and Group 2 comprised 112 patients. Unilateral RLN paralysis was observed in 7 patients in Group 1 (8.9%) and 15 patients in Group 2 (13.4%) without any significant difference between the groups (p=0.368). Hypocalcemia was encountered in 5 patients (6.3%) in Group 1 and 18 patients (16.1%) in Group 2; this difference was statistically significant (p=0.045). Other complications (such as hematoma and suture reaction) were not significantly different. Operation time was found to be significantly shorter in Group 1 (Mean time, 93.08 min) than in Group 2 (116.54 min) (p=0.03). CONCLUSION: Proven effect of IONM on RLN paralysis is still controversial. However, easy identification of RLN, which gives more confidence to surgeon, and shorter operation time may be factors to lower hypocalcemia rates.

Functional Rhinoplasty.

Understanding nasal anatomy and physiology are the most important points for successful functional rhinoplasty. Anatomic structures playing major roles in nasal breathing functions include the septum, and internal and external nasal valves, so physical examination of these regions is essential. Planning for functional rhinoplasty involves the identification of the sites of nasal airway obstruction or old trauma, and addressing those regions during the operation with a number of different techniques that have been described.

Is there any effect of pneumoperitoneum pressure on coagulation and fibrinolysis during laparoscopic cholecystectomy?

BACKGROUND: Laparoscopic cholecystectomies (LC) are generally performed in a 12 mmHg-pressured pneumoperitoneum in a slight sitting position. Considerable thromboembolism risk arises in this operation due to pneumoperitoneum, operation position and risk factors of patients. We aim to investigate the effect of pneumoperitoneum pressure on coagulation and fibrinolysis under general anesthesia. MATERIAL AND METHODS: Fifty American Society of Anesthesiologist (ASA) I-III patients who underwent elective LC without thromboprophlaxis were enrolled in this prospective study. The patients were randomly divided into two groups according to the pneumoperitoneum pressure during LC: the 10 mmHg group (n = 25) and the 14 mmHg group. Prothrombin time (PT), thrombin time (TT), International Normalized Ratio (INR), activated partial thromboplastin time (aPTT) and blood levels of d-dimer and fibrinogen were measured preoperatively (pre), one hour (post1) and 24 h (post24) after the surgery. Moreover, alanine amino transferase, aspartate amino transferase and lactate dehydrogenase were measured before and after the surgery. These parameters were compared between and within the groups. RESULTS: PT, TT, aPTT, INR, and D-dimer and fibrinogen levels significantly increased after the surgery in both of the groups. D-dimer level was significantly higher in 14-mmHg group at post24. CONCLUSION: Both the 10-mmHg and 14-mmHg pressure of pneumoperitoneum may lead to affect coagulation tests and fibrinogen and D-dimer levels without any occurrence of deep vein thrombosis, but 14-mmHg pressure of pneumoperitoneum has a greater effect on D-dimer. However, lower pneumoperitoneum pressure may be useful for the prevention of deep vein thrombosis.

Two-port laparoscopic appendectomy assisted with needle grasper comparison with conventional laparoscopic appendectomy.

PURPOSE: The 2-port laparoscopic appendectomy technique (TLA) is between the conventional 3-port and single-port laparoscopic appendectomy surgeries. We compared postoperative pain and cosmetic results after TLA with conventional laparoscopic appendectomy (CLA) by a 3-port device. METHODS: Patients undergoing TLA were matched with patients undergoing CLA between February 2015 and November 2015 at the same institution. Thirty-two patients underwent TLA with a needle grasper. The appendix was secured by a percutaneous organ-holding device (needle grasper), then removed through a puncture at McBurney's point. Another 38 patients underwent CLA. Patient demographics, operative details, and postoperative outcomes were collected and evaluated. RESULTS: One patient in the TLA group developed a wound infection and 1 patient in the CLA group developed a postoperative intra-abdominal abscess and 3 wound infections. There was no significant difference between the groups when comparing the length of hospital stay, time until oral intake, and other complications. The pain score in the first 12 hours after surgery was significanly higher in CLA group than the TLA group (P < 0.001). Operative time was significantly shorter in the CLA group compared to the TLA group (P < 0.001). CONCLUSION: TLA using a needle grasper was associated with a significantly lower pain score 12 hours after surgery, better cosmetic results, and lower cost, than the CLA 3-port procedure because of the fewer number of ports.

Quality of Life in Pediatric Cochlear Implantations.

OBJECTIVE: To evaluate the satisfaction of patients with a cochlear implant using a Parents' Perspective Questionnaire and analyze the significant parameters. MATERIALS AND METHODS: Patients who received a cochlear implant in Çukurova University between March 2002 and November 2012 were included in the study. Parents were asked to answer the Parents' Perspective Questionnaire. RESULTS: The age ranges of 62 patients were 2-5 years and of 99 patients were 6-11 years and over. In total, 144 parents were satisfied with the cochlear implant. Patients who attended school had more self-confidence, and users of an implant aged over 18 months had better social relations and self-confidence. CONCLUSION: Cochlear implants' positive effect on the quality of life is a fact, but parents have concerns in the preoperative and postoperative periods. Patients and parents should be informed carefully about cochlear implants. Also, patients' satisfaction is correlated with increasing duration of the implant and age.

The effect of primary thyroid surgery on the morbidity of reoperative thyroid surgery.

OBJECTIVES: This study aims to investigate the effect of primary surgery on the morbidity of reoperative thyroid surgery. PATIENTS AND METHODS: Fifty-seven patients (14 male, 43 female; mean age 41 years; range 21 to 70 years), who underwent reoperative thyroid surgery in our clinic between January 2007 and January 2012 were retrospectively analyzed in terms of vocal cord paralysis, temporary or permanent hypoparathyroidism, and other complications. The patients were classified into two groups. The first group consisted of 42 completion thyroidectomy patients that had undergone the primary operation of unilateral total lobectomy + isthmusectomy in our clinic, whereas the second group consisted of 15 patients that had undergone bilateral subtotal or near total thyroidectomy in another center. Complication rates were compared between the groups. RESULTS: Complication rates were observed as permanent vocal cord paralysis in one patient (1.7%), permanent hypocalcemia in two patients (3.5%) and temporary hypocalcemia in four patients (7%). None of the patients had temporary vocal cord paralysis. The complications in the second group were significantly higher than the first group (p=0.021). CONCLUSION: The minimal operation should be hemithyroidectomy (total lobectomy and isthmusectomy) to minimize the complications. This approach removes the need for the intervention to the previous surgery field during reoperative thyroid surgery.

Investigation of recurrence risk in laryngeal cancer following laser surgery.

BACKGROUND: The general prognostic factors in larynx tumors are believed to be tumor stage, anatomical location, histological differentiation and the presence of neck metastasis. Effects of tumor invasion to sub-regions of larynx (anterior commissure, ventricle, subglottic space) and over-expression of p53, c-erb-B2 and Ki67 detected immunohistochemically on development of recurrence in patients were investigated in this study. METHODS: Twenty patients (Group 1) in whom recurrence had developed and 20 others (Group 2) without recurrence during follow-up were included in this study. RESULTS: Both the anterior commissure and ventricle involvements were found to be more frequent in patients with recurrence. But statistically significant difference was detected with only ventricular involvement (p=0.025). After Immunohistochemical evaluation none of the 3 immunohistochemical parameters were found to be higher in the recurrence group and not any of them showed a statistically significant difference between two groups. CONCLUSION: Only ventricle involvement may be a predictor factor for recurrence.

Endonasal treatment of acute invasive fungal rhinosinusitis in immunocompromised pediatric hematology-oncology patients.

OBJECTIVES: Acute invasive fungal rhinosinusitis (AIFR) is an aggressive fungal infection in immunocompromised patients with high mortality rates. The aim of this study is to present our experiences on endonasal treatment in immunocompromised pediatric hematology-oncology patients with AIFR. METHODS: Thirteen pediatric hematology-oncology patients treated for AIFR between March 2006 and December 2011 were analyzed retrospectively. We reviewed the following data for all patients: age, gender, predisposing disease, initial symptoms, pathological diagnosis, microbiological results, laboratory findings, surgical procedure, number of operations and treatment outcomes. RESULTS: Nine of 13 patients with lesions confined to sinonasal cavity were operated with endoscopic approach. Open surgery was performed in four patients, three of them had palatal and buccal lesions and one had facial skin involvement. Endoscopic approach was also used for sinonasal lesions of these four patients. A total of 7 patients died: 4 patients with progression of the underlying disease, 2 patients with sepsis and 1 patient due to renal failure. Survival rate in surgically treated patients was found 46% (6/13 patients). CONCLUSIONS: Endonasal endoscopic approach is both feasible and efficient technique, also enables excellent local control with less morbidity compared to open surgery. This approach is suitable for patients who are diagnosed in the early stages of AIFR and also presents a less traumatic option for patients with poor health status. Open surgical procedure should be preferred in patients with disease extending out of the sinonasal cavity.