Comparison of Treatment Outcomes Between Total and Near Total Glossectomy with Larynx Preservation and Flap Reconstruction: A Single Institution Experience with 23 Patients.

Objective: The purpose of this study was to evaluate the functional and oncological outcomes of total glossectomy with laryngeal preservation (TGLP) compared to near-total glossectomy with laryngeal preservation (nTGLP). Methods: In this retrospective study, the data of 23 patients who underwent either TGLP or nTGLP between January 2010 and December 2020 in a tertiary university hospital were analyzed. The data including demographic findings, tumor stage, extent of surgery and technique, method of reconstruction, complications, overall survival (OS) and recurrence-free survival (RFS), and tracheostomy and gastric tube dependence during follow-up were assessed. Results: Of the 23 eligible patients, 15 had undergone nTGLP (Group 1) and 8 had undergone TGLP (Group 2). Tracheostomy dependence and gastric tube dependence rates at the sixth month were 3/19 (15.7%) and 12/19 (63.1%), respectively, with no significant differences between the two groups. OS and RFS at one year were 47.6% and 27.8%, respectively, for the study population. OS rate showed significance with nodal positivity and extranodal extension (p=0.004 for both) only, but not within patient groups (p=0.734). Conclusion: Both TGLP and nTGLP are feasible treatment options in patients with advanced tongue cancer with no differences in terms of functional and oncological results. Survival rates are still not satisfactory, and recurrences are high despite appropriate treatments. Proper selection of patients who are highly motivated and willing for long-term postoperative rehabilitation is essential.

The Impact of Comorbid Diseases on Postoperative Complications in Children after Adenotonsillectomy: Is It a Myth?

OBJECTIVE: Adenotonsillar surgery remains the second most common surgical practice in pediatric otolaryngology. We aimed to evaluate whether a comorbid disease in children undergoing surgery has any impact on postoperative complication rate. METHODS: This study was conducted at a tertiary otolaryngology department with 643 children. The study included children with symptoms of obstructive sleep-disordered breathing and recurrent infection who underwent adenotonsillar surgery. Patients with a comorbid disease constituted the study group and otherwise healthy children constituted the control group. The data were evaluated to find out any association among clinical variables such as gender, age, tonsil grade, type and extent of surgery, indication for surgery, body mass index percentile, comorbid diseases and postoperative complications. RESULTS: There were 245 (38.1%) patients with a comorbid disease. The most common comorbidity was cardiovascular diseases (n=68) followed by neurological diseases (n=48). We performed adenoidectomy in 319, tonsillectomy in 44, tonsillotomy in nine, adenotonsillectomy (AT) in 190 and adenoidectomy with tonsillotomy (ATT) in 81 patients. The overall rate of postoperative late complication was 17/643 (2.6%) with post-tonsillectomy hemorrhage being the most common (n=10). There was no association between other clinical variables and the complication but older age (p=0.042) and type of surgery (p<0.001) revealed increased risk. The rates of complications in patients with or without comorbid disease were found 5/245 (2%) and 12/389 (3%), respectively, with no difference (p=0.621). CONCLUSION: The risk of postoperative complications was increased in older children and in patients undergoing AT and ATT, however, the presence of comorbid disease did not increase likelihood of postoperative complications.

Treatment Outcomes for Primary Retromolar Trigone Carcinoma: A Single Institution Experience.

OBJECTIVE: Retromolar trigone (RMT) is a rare location for oral cavity cancers. RMT cancers are aggressive malignancies that mostly present at an advanced stage. In this study, we aimed to evaluate treatment outcomes in patients who underwent initial radical surgical resection and postoperative radiotherapy or chemoradiotherapy with a diagnosis of primary RMT squamous cell carcinoma in our institution. METHODS: The study included 20 primary RMT tumor patients out of 191 oral cavity cancer cases treated from January 2010 through December 2019. We retrospectively analyzed treatment details, histopathology reports, postoperative clinical course and survival outcomes. RESULTS: The mean age at presentation was 59.4 years. Eighty percent of all patients were either stage 3 or stage 4. We performed mandibular resection in 14 patients (70%) and partial maxillectomy in eight patients (40%). Nineteen patients (95%) underwent unilateral neck dissection. The incidence of metastatic cervical lymph node was 13/20 (65%). Overall survival (OS) and disease-free survival (DFS) rates during follow-up (mean 26.3 months) were 60% and 75%, respectively. There was statistical significance between presence of multilevel metastatic lymph nodes and OS (p=0.013). DFS and OS of early stage and advanced stage groups were 100% vs 75% and 100% vs 50%, respectively, with no statistical significance (p=0.189 and p=0.084). CONCLUSION: The survival of advanced stage RMT cancer is poor despite appropriate treatment. Bone involvement that necessitates resection is common due to the proximity of the tumor to the mandible and the maxilla. Multilevel positive cervical lymph nodes and advanced stage are poor prognostic factors.

A Novel Approach to Crooked Nose in Rhinoplasty: Asymmetric Level Osteotomy Combined With Unilateral Spreader Graft.

The crooked nose is certainly among the most difficult to treat deformities for rhinoplasty surgeons. This deformity is a complex problem because each structural nasal component can be effected and they may be asymmetric bilaterally. Despite the use of sophisticated techniques and an additional effort, unfortunately the long-term aesthetic results may not be perfect with some minor flaws. Here in this study, the authors introduce a new technique that is used to correct crooked nose deformity. Sixteen consecutive patients who underwent open approach rhinoplasty by the same senior author between January 2015 and January 2018 with the diagnosis of C-shaped, reverse C-shaped, and I-shaped crooked nose deformity were included. The authors performed low-to-low lateral osteotomy with transverse root osteotomy to concave side (wider side) and low-to-high osteotomy to convex side (narrower side) combined with a unilateral spreader graft to concave side. Frontal images were taken preoperatively and 6 months postoperatively to use for further assessments. The authors compared the preoperative deviation angle values at rhinion (RDA) and at nasal tip (tip deviation angle) with postoperative values. In the study group, RDA value showed significant decrease after surgery; the preoperative RDA value was 6.2° (1.66°-16.39°) and it was calculated as 2.44° (0.7°-5.77°) with P < 0.001 postoperatively. The changes at tip deviation angle were also significant (P < 0.001) and tip deviation was successfully decreased from a value of 5.08° (2.8°-10.62°) to 2.13° (0.5°-6.6°) postoperatively. In conclusion, this study offers a new and effective technique to correct crooked nose deformity that can be used safely with satisfying aesthetic results.

Prognostic significance of soft tissue deposits in laryngeal carcinoma / Importância prognóstica de depósitos de tecido mole no carcinoma laríngeo

Abstract Introduction: Soft tissue deposits is tumorous islands apart from lymph nodes and occasionally diagnosed in neck dissection specimens. Their importance has begun to be recognized, however, their value has not been investigated in laryngeal cancer as a single tumor site. Objective: To investigate the prognostic value of soft tissue deposits in patients with laryngeal carcinoma. Methods: Medical records of 194 patients with laryngeal carcinoma who were treated primarily by surgery and neck dissection were reviewed. Prognostic significance of soft tissue deposits was assessed along with other clinical and pathological findings. Recurrence rates, overall and disease-specific survival rates were examined. Results: The incidence of soft tissue deposits was found to be 7.2% in laryngeal carcinoma. N stage was more advanced in patients who had soft tissue deposits. Regional recurrence rate was higher and disease specific and overall survivals rates were significantly lower in patients with soft tissue deposits in univariate analysis. However, in multivariate analysis, soft tissue deposits were not found as an independent risk factor. Conclusion: In laryngeal carcinoma, soft tissue deposits was diagnosed in patients with more advanced neck disease and their significance was lesser than other factors including extranodal extension.

Resumo Introdução: Depósitos de tecido mole são ilhas tumorais diferente dos linfonodos e ocasionalmente diagnosticados em amostras de esvaziamento cervical. Sua importância começou a ser reconhecida, mas seu valor não foi investigado no câncer de laringe como um único local de tumor. Objetivo: Investigar o valor prognóstico do depósito de tecido mole em pacientes com carcinoma laríngeo. Método: Os prontuários de 194 pacientes com carcinoma laríngeo tratados principalmente por cirurgia e esvaziamento cervical foram analisados. O significado prognóstico dos depósitos de tecido mole foi avaliado juntamente com outros achados clínicos e histopatológicos. As taxas de recidiva, as taxas de sobrevida geral e específicas da doença foram avaliadas. Resultados: Observou-se uma incidência de depósitos de tecido mole de 7,2% no carcinoma laríngeo. O estágio N foi mais avançado em pacientes com depósitos de tecido mole. A taxa de recorrência regional foi maior e as taxas de sobrevida geral e específica da doença foram significativamente menores nesses pacientes na análise univariada. No entanto, na análise multivariada, o depósito de tecido mole não foi observado como um fator de risco independente. Conclusão: No carcinoma laríngeo, o depósito de tecido mole foi diagnosticado em pacientes com doença cervical mais avançada, mas sua significância foi menor do que outros fatores, inclusive a extensão extranodal.

Is There a Change in the Treatment of T1 Glottic Cancer After CO2 Laser? A Comparative Study with Cold Steel.

OBJECTIVE: Carbon dioxide (CO2) laser provides high local control and disease-specific survival rates with minor morbidity and good quality of life in transoral cordectomy. We aimed to compare the oncological outcome and survival between cold steel and CO2 laser in the treatment of early glottic cancer. METHODS: In this retrospective study, the participants were divided into two groups. The first group comprised patients who were operated upon between 2001 and 2007 using cold steel (group 1, n=38), and the second group comprised patients who were operated upon between 2008 and 2016 using CO2 laser (group 2, n=88). Both groups were compared regarding age, gender, pathological grade, T stage, type of cordectomy, margin status, anterior commissure involvement, follow-up, locoregional recurrence, and disease-free survival (DFS). RESULTS: The overall survival rate and DFS were similar between the two groups (94.7% vs. 98.9% and 100% vs. 98.9%, respectively), and no association was found between surgical margin positivity and local recurrence. However, a significant association between the presence of anterior commissure involvement and recurrence was found in all 126 patients (p=0.016). Local recurrence was significantly higher in the group 2 (p=0.024), but it did not affect overall survival and DFS in these patients (100% vs. 94.1%). CONCLUSION: Although CO2 laser excision is considered to be superior to cold steel regarding surgical time and bleeding control, the local recurrence rates were found to be higher with the laser than the cold steel. Thus, we argue that cases should be selected more carefully concerning the anterior commissure, depth of tumor invasion lateral to vocal muscle, difficulty at endoscopic exposure for lesions with anterior commissure involvement, and reliability of surgical margins at frozen sections.

Comparison of the effectiveness of Brandt-Daroff Vestibular training and Epley Canalith repositioning maneuver in benign Paroxysmal positional vertigo long term result: A randomized prospective clinical trial.

OBJECTIVE: Benign paroxysmal positional vertigo (BPPV) is the most common peripheral cause of vertigo. It can be defined as transient vertigo induced by rapid change in head position, associated with a characteristic paroxysmal positional nystagmus. Posterior canal benign paroxysmal positional vertigo is the most frequent form of BPPV. The aim of our study was to investigate and compare the effectiveness of Epley maneuver and Brand-Daroff home exercises for the treatment of posterior canal BPPV. METHODS: A total of 50 patients between 27 and 76 years of age who were diagnosed with unilateral posterior canal into BPPV were randomized prospectively into two groups. In Group-1, modified particle repositioning maneuver and in Group-2 Brandt-Daroff exercises were utilized as treatment. Patients were followed weekly. Cure weeks were recorded. The patients were followed for 12 to 24 months for recurrence. RESULTS: The recovery rates at the first, second and third week controls were 76%, 96% and 100% for Group-1 (modified Epley maneuver) and 64%, 88% and 100% for Group-2 (Brandt-Daroff exercises) respectively. The recovery rates were similar for both groups. The average follow-up duration was 18 months. In Group 1, 7 patients (28%) and in Group 2, 5 patients (20%) had recurrence, which was also similar with no statistical difference. CONCLUSION: It was concluded that both Brandt-Daroff Exercises and Modified Epley maneuvers were almost equally effective in the treatment of BPPV.

Comparison of Tongue-in-Groove and Columellar Strut on Rotation and Projection in Droopy Nasal Tip: Contribution of a Cap Graft.

Underrotation of the nasal tip with narrow nasolabial angle is a common nasal deformity that leads to a long nose appearance, named drooping nose. In these patients, there are various techniques described to correct droopy tip and to achieve a desirable nasal tip rotation such as lateral crural steal, lateral crural overlay, tongue-ingroove, columellar strut graft, tip rotation sutures, cephalic trimming, and others. In this study, the effects of tongue-in-groove (TIG) and columellar strut graft (CS) and the contribution of cap graft on nasal tip rotation and projection were evaluated. Twenty-eight consecutive patients who underwent open approach rhinoplasty by the same senior author (ULD) between January 2015 and December 2016 with the diagnosis of septonasal deformity and droopy nasal tip were included. In 9 of these patients nasal tip was constructed with strut graft, in 6 patients with both strut and cap grafts, in 6 patients with TIG technique and in 7 patients with both TIG and cap graft. Standardized right lateral images were taken preoperatively and 6 months postoperatively to use for further assessments. The nasal tip rotation was evaluated by measuring nasolabial angle (NLA) and the nasal projection (NP) was evaluated by using the Goode method. Finally, the postoperative values of NLA and NP at the 6th month were compared with preoperative recorded values in between groups. Each group showed increase at nasal projection; however, significance was present only in CS graft and TIG groups (P=0.011 and P=0.027 relatively). Each 4 groups showed significant increase in nasal tip rotation. In addition, the comparison of percent changes between preoperative and postoperative NP and NLA revealed no difference (P=0.56 and P=0.431 relatively). In conclusion, the authors argued that TIG and CS graft techniques are both reliable methods to correct droopy nasal tip and using additional cap graft over dome area when required is safe and useful.

Prognostic significance of soft tissue deposits in laryngeal carcinoma.

INTRODUCTION: Soft tissue deposits is tumorous islands apart from lymph nodes and occasionally diagnosed in neck dissection specimens. Their importance has begun to be recognized, however, their value has not been investigated in laryngeal cancer as a single tumor site. OBJECTIVE: To investigate the prognostic value of soft tissue deposits in patients with laryngeal carcinoma. METHODS: Medical records of 194 patients with laryngeal carcinoma who were treated primarily by surgery and neck dissection were reviewed. Prognostic significance of soft tissue deposits was assessed along with other clinical and pathological findings. Recurrence rates, overall and disease-specific survival rates were examined. RESULTS: The incidence of soft tissue deposits was found to be 7.2% in laryngeal carcinoma. N stage was more advanced in patients who had soft tissue deposits. Regional recurrence rate was higher and disease specific and overall survivals rates were significantly lower in patients with soft tissue deposits in univariate analysis. However, in multivariate analysis, soft tissue deposits were not found as an independent risk factor. CONCLUSION: In laryngeal carcinoma, soft tissue deposits was diagnosed in patients with more advanced neck disease and their significance was lesser than other factors including extranodal extension.

Should Nasal Function be Considered Prior to Tympanoplasty?

OBJECTIVE: To evaluate the association between nasal airway function and Eustachian tube (ET) functions and their impact on tympanoplasty in patients with chronic suppurative otitis media (CSOM). MATERIALS AND METHODS: The study group (CSOM group) consisted of 33 patients scheduled to undergo tympanoplasty for CSOM. Two control groups were formed: a nasal septal deviation (NSD) group of 25 patients scheduled to undergo nasal surgery for NSD, and a control group of 25 healthy individuals with no otologic or rhinologic symptoms. ET functions were assessed tympanometrically with automatic Williams test (ETF1) and modified pressure equalization inflation-deflation test (ETF2) and nasal functions were analyzed using acoustic rhinometry and rhinomanometry. The patients in the CSOM group underwent tympanoplasty, and tests were repeated at the end of the 3rd postoperative month. RESULTS: Both acoustic rhinometry and rhinomanometry revealed similar nasal function in the CSOM and NSD groups, which was inferior to that of the control group. The CSOM group had the worst ET function. Dysfunctional ETs in the CSOM group improved at 3 months postsurgery, and all groups had a similar outcome regarding ET functions. The outcome of ear surgery was not affected by nasal function, and the graft take rate was 90%. CONCLUSION: Patients with NSD had generally poor ET function; however, this did not affect the outcomes of tympanoplasty. The preoperative ET function results were inconsistent with the results following tympanoplasty; therefore, they were not predictive of need for septoplasty. Thus, we do not universally recommend surgical correction of NSD prior to ear surgery; however, this decision should be made on an individual basis.

Impact of Septoplasty on Eustachian Tube Functions.

OBJECTIVE: To evaluate the impact of nasal septum deviation (NSD) and septoplasty on eustachian tube (ET) functions. MATERIAL AND METHODS: The study was designed as a prospective controlled study and conducted in a tertiary referral center. A study group of 25 patients who were scheduled for septoplasty for NSD; and a control group of 25 healthy individuals having no ear or nose symptoms were formed. Tympanometric analysis of ET function, subjective and objective analysis of nasal functions with acoustic rhinometry and rhinomanometry were performed. Patients in study group underwent nasal surgery and tests were repeated at postoperative 1st and 3rd months. RESULTS: Eustachian tube functions of study group were significantly worse than the control group (P = 0.032). ET functions were found to be poorer as the nasal airway resistances increase which was found to be close to significance (P = 0.056). One and 3 months after corrective surgery, both nasal airway functions and ET functions improved significantly reaching to the level of control group. CONCLUSIONS: Nasal septum deviation was associated with higher rates of ET dysfunction, which could be improved by the nasal surgery. However, in some patients, nasal surgery itself caused ET dysfunction in the early postoperative period.

Comparison of Videonystagmography and Audiological Findings after Stapedotomy; CO2 Laser vs Perforator.

OBJECTIVE: Various types of laser, microdrill, and perforator are effectively used in the surgical treatment of otosclerosis. However, they have certain disadvantages along with advantages. The aim of this study was to evaluate the effects of carbon dioxide (CO2) laser and perforator stapedotomy techniques on audiological outcomes and postoperative vestibular functions via videonystagmography (VNG). MATERIALS AND METHODS: This prospective and randomized clinical study was conducted in an academic tertiary medical center. Sixty-nine patients diagnosed with otosclerosis who underwent stapedotomy were enrolled in this study. Patients were divided into two groups based on the technique used in stapedotomy: CO2 laser and perforator. Postoperative hearing gain and VNG findings were the main outcome measures. Subsequently, the two study groups were compared for analysis. RESULTS: The preoperative air-bone gap was 32.7±8.9 decibel (dB) in the study population and it was improved to 12.9±8.4 dB after operation. There were no differences in VNG findings and vertigo symptoms between the laser and perforator groups at postoperative day 2. There was no significant gain difference regarding the air conduction, bone conduction, and air-bone gap between the two groups (p=0.294, p=0.57, and p=0.37, respectively). CONCLUSION: Both CO2 laser and perforator stapedotomy have successful audiological outcomes with no difference in postoperative vestibular disturbance.

Comparison of Clinical Results in Nasal Tip Augmentation Either Via Face to Face or Back to Back Technique With Autogenous Auricular Conchal Cartilage.

OBJECTIVE: To compare the objective and subjective findings between patients who underwent nasal tip augmentation surgery via two different methods using autogenous auricular conchal cartilage. MATERIALS AND METHODS: This study included the data of 21 patients who underwent nasal tip augmentation surgery. The patients were randomly divided in two groups according to the technique used to form a double layer columellar strut graft; either face to face (group 1) and back to back (group 2). All patients were assessed via nasal obstruction symptom evaluation scale (NOSE) and via acoustic rhinometry and rhinomanometry at preoperative and postoperative 1st and 6th months. RESULTS: There was statistically significant improvement in symptom score in both patient groups with no difference inbetween. Total nasal resistance decreased nonsignificantly at the end of 6th month in both groups; 13.1 Pa/cm3 to 8.6 Pa/cm3 and 10.3 Pa/cm3 to 9.5 Pa/cm3 respectively. There was no significant increment in MCA values for both groups except left MCA1. CONCLUSIONS: We achieved good results in tip augmentation via both techniques. An autogenous conchal cartilage is a good alternative to replace lacking caudal septal cartilage. It provides safe and stable support to the nasal tip. However, further comprehensive studies with larger sample size and long follow-up are required to elucidate any difference between these two techniques.

Anatomical correlation between existence of concha bullosa and maxillary sinus volume.

PURPOSE: The objective of this study was to assess the effects of concha bullosa variation on maxillary sinus volume and uncinate angle. METHOD: The study group included 169 patients (338 sides) who underwent either surgical or medical treatment with the diagnosis of chronic rhinosinusitis. The paranasal sinus computed tomography of these patients was analyzed to measure maxillary sinus volume, uncinate angle and existence of concha bullosa. Subsequently, these variables were evaluated to find out possible relationship inbetween. RESULTS: Mean maxillary sinus volume and uncinate angle at right and left sides were 15.21 ± 0.47 and 15.51 ± 0.48 mm(3), 30.57 ± 0.62° and 30.20 ± 0.68°, respectively. There was no difference between patients with or without concha bullosa in regard to maxillary sinus volume and uncinate angle at both sides. Maxillary sinus volume and degree of uncinate angle did not show any significant correlation at both sides; r = -0.124, p = 0.107 and r = -0.136, p = 0.078. CONCLUSION: In conclusion, concha bullosa is a common anatomical variation at nasal cavity. The existence of concha bullosa does not have any association with the volume of maxillary sinus and angle of uncinate process.

The effects of pregnancy on nasal physiology.

BACKGROUND: Nasal congestion that is not present before pregnancy represents a distinct clinical entity called pregnancy rhinitis. The aim of this study is to evaluate the clinical characteristics of nasal physiology over the course of pregnancy. METHODS: The study was conducted with 85 pregnant women and 26 nonpregnant controls. We measured nasal airway patency objectively via acoustic rhinometry (ARM) and anterior rhinomanometry (RMM) and subjectively via the Nasal Obstruction Symptom Evaluation (NOSE) scale in each trimester and compared the results to those of the controls. RESULTS: The NOSE scores of control and pregnant women showed no difference (p = 0.866). Minimal cross-sectional area (MCA1; minimal cross sectional area at nasal valve and MCA2; minimal cross sectional area at the level where the head of inferior turbinate is placed) decreased significantly between the first and third trimesters: first trimester 0.37 cm(2), third trimester 0.31 cm(2). There was no difference between each trimester with regard to total nasal resistance. The correlation analysis between the NOSE score and both total volume and MCA1 in all patients showed no significance (r = -0.10, p = 0.318; r = -0.04, p = 0.654, respectively). CONCLUSION: Pregnancy affects nasal physiology adversely and impairs nasal breathing in some women. However, based on the findings of this study, we concluded that this clinical entity may not be considered as a disease without complementary symptoms despite the presence of objective changes in nasal parameters.

The Efficiacy of Sternocleidomastoid Muscle Flap on Frey's Syndrome via a Novel Test: Galvanic Skin Response.

The aim of this study was to evaluate the effects of sternocleidomastoid (SCM) muscle flap on preventing Frey's syndrome by using, Galvanic skin responses (GSR). Fourty-three patients who underwent superficial parotidectomy were randomly divided into two groups and their GSR were recorded. SCM muscle flap was applied over the surgical area only in one group. Six months after the surgery, GSRs were remeasured. In addition, the patients completed a questionnaire regarding their complaints about clinical Frey's syndrome. Four patients had symptoms of clinical Frey's syndrome. Postoperative GSR measurements revealed no significant difference between two sides in flap group (p = 0.426) but higher in without flap group (p = 0.003). The patients with clinical Frey syndrome had significantly higher GSR values than the remaining patients. The SCM muscle flap was an effective method in preventing Frey's syndrome. Moreover, GSR test was highly sensitive and specific for diagnosis.

The impacts of adenotonsillar hypertrophy on periodontal health in children: a prospective controlled pilot study.

OBJECTIVES: To evaluate the impacts of obstructive adenotonsillar disease on periodontal health and to assess the efficacy of adenotonsillectomy in the prevention of chronic periodontitis in children. METHODS: This prospective and controlled clinical study was conducted between August 2012 and February 2013 with 35 pediatric patients who had permanent anterior dentition. The study group included twenty patients (n = 20) who had complaints of chronic mouth breathing and snoring and were diagnosed with obstructive adenotonsillar disease. These patients underwent adenoidectomy with or without tonsillectomy. We performed periodontal examinations to assess the periodontal health status in these children before and two months after surgery. The periodontal measures included plaque index (PI), pocket depth (PD) and gingival index scores (GI). Subsequently, these periodontal measures were compared with healthy control group who had no adenotonsillar disease (n = 15). RESULTS: Among the study group six patients underwent adenoidectomy and 14 patients underwent adenoidectomy combined with either tonsillectomy or tonsillotomy. The preoperative PI, PD and GI scores of the study group were 1.27 ± 0.39, 1.34 ± 0.31 and 0.97 ± 0.37 respectively. These scores were significantly higher compared to the control group (p < 0.001). These periodontal index scores were significantly improved after surgery (p = 0.008 for PI and p < 0.001 for both PD and GI). In addition, we found no difference in postoperative values of PD and GI between the study group and control group. CONCLUSION: We concluded that obstructive adenotonsillar disease adversely affects periodontal health in children and surgical management of obstruction improves the clinical findings. However, more comprehensive research is required to elucidate the association between adenotonsillar hypertrophy and periodontal disease.

An unusual presentation of a B-cell cutaneous lymphoma mimicking as nasolabial cyst.

Lymphoma is a cancer of the lymphocytes which leads to solid tumors in the lymphoid organs involving lymph nodes, spleen, liver, bone marrow and skin. Primary cutaneous lymphoma, a rare subtype of non-Hodgkin's lymphoma, can be classified as cutaneous T-cell or cutaneous B-cell lymphoma. These tumors are mostly T-cell origin and mainly locate on trunk, extremities and scalp or forehead. In this article, we report a 22-year-old female case without any symptoms of non-Hodgkin's lymphoma except a sign mimicking nasolabial cyst in the nasolabial fold, who was pathologically diagnosed with cutaneous B-cell lymphoma following surgery.

Association between skin flap thickness and Frey's syndrome in parotid surgery.

BACKGROUND: Frey's Syndrome is a frequent complication of parotid surgery. The aim of this study was to evaluate the association between skin flap thickness and Frey's Syndrome in patients who underwent superficial parotidectomy. METHODS: Thirty adult patients were randomized into 2 groups: subcutaneous and subsuperficial musculoaponeurotic (sub-SMAS) skin elevation. In both groups skin flap thickness was measured by a micrometer at defined points. The patients were queried for subjective Frey's Syndrome and Minor's test was performed for objective Frey's Syndrome. RESULTS: The thickness of skin flap in the subcutaneous group was significantly less than that in the sub-SMAS group. There was no statistical significance between skin flap thickness and objective Frey's Syndrome, although the dimension of the colored area in the subcutaneous group was larger compared with that of the sub-SMAS group: 7.5 cm(2) (0-48 cm(2) ) and 0.5 cm(2) (0-18 cm(2) ), respectively. CONCLUSIONS: In conclusion, sub-SMAS elevation of the skin flap in parotid surgery provides better results regarding Frey's Syndrome.

The effects of levobupivacaine infiltration on post-tonsillectomy pain relief in adults: a single-blinded, randomized, and controlled clinical study.

The aim of this prospective single-blinded and controlled study is to evaluate the efficacy of levobupivacaine infiltration on post-tonsillectomy pain relief in adults. The study was conducted with 40 adult patients who underwent tonsillectomy. These patients were randomized in either study group (SG) who received levobupivacaine infiltration to peritonsillary fossae prior to surgery or control group (CG) with no medication. After surgery, all the patients were queried for pain scores by visual analog scale. In addition, the volume of intraoperative bleeding, the duration of operation, the severity of postoperative complications, and the amount of analgesic requirement were the other outcome measures of this study. There were significant differences between groups regarding pain scores for the first 24 h in favor of SG. The analgesic requirement was also significantly lower in SG (p = 0.009). Although there was a sustained decrement at pain score during first 24 h for SG, however, the change from baseline score (immediate score) for each time interval revealed no significance compared to CG. In addition, the duration of operation and the volume of intraoperative bleeding were similar (p = 0.64 and p = 0.165). In conclusion, preincisional infiltration of levobupivacaine is a safe and reliable method for post-tonsillectomy pain reduction in adults. However, more in-depth, double-blinded and placebo controlled studies are required to elucidate its long term benefits.