Nasal bone grafts from the removed hump used as overlay grafts to camouflage concave lateral crura.

Alar cartilage consists of a medial crus, middle crus and lateral crus. The lateral crus is an important aesthetic and functional structure of the nose. A 32-year-old male patient with concave lateral crura was operated by the authors. An open rhinoplasty with a dorsal approach to the septum is preferred. The nasal bones harvested from the hump, which is an autogenous graft trimmed and sutured on both concave lateral crura as an overlay camouflage grafts. Satisfactory result was achieved.

Does rheumatoid arthritis have an effect on audiovestibular tests?

The study aimed to determine the characteristics of hearing loss, vestibular responses and the incidence of vestibular disturbances in RA patients. This prospective study was performed at the Otolaryngology Department of Bozok University School of Medicine between May and November 2012. Eighty-one RA patients (69 women and 12 men) with a mean age of 40.8 ± 13.4 years (23-67 years) and 81 healthy controls (67 women and 14 men) with a mean age of 41.3 ± 13.8 years (24-66 years). Each subject was tested with low and high-frequency audiometry by a single experienced investigator under standard audiometric testing conditions. For each set of tests, mean values of air and bone conduction at each frequency and tympanometric values were calculated for the study groups. Videonystagmography (VNG) including smooth pursuit, saccade, positional, and caloric tests were also performed. The mean air conduction threshold values at high frequencies (4,000, 6,000, and 8,000 Hz) in RA group were lower than control groups. The difference between mean air conduction threshold values of the control groups against RA group at high frequencies were statistically significant (p < 0.05). There was no statistically significance between the two groups in tympanometric values (p < 0.05). VNG testing revealed central abnormalities in twenty patients (24.69%), peripheral abnormalities in five patients (6.17%), and mixed abnormalities in six patients (7.4%). There was no association between VNG abnormalities in patients with RA and age, sex, duration of disease, accompanying vertigo complaint, the laboratory findings and hearing levels (p < 0.05). Our findings suggest an association of RA and audiovestibular system dysfunction regardless clinical and demographic situation of patients. We assume the hearing and vestibular disturbances in RA are more prevalent than previously recognized. Also hearing losses in high frequencies in RA patients may be considered as an indicator of cochlear involvement in this disease.

Lower lateral crural reverse plasty.

The lateral crus plays a significant role in the aesthetic appearance of the nose. Excessive concavities of the lower lateral crura can lead to heavy aesthetic disfigurement of the nasal tip and to insufficiencies of the external nasal valve. The lateral crus of the alar cartilage may also cause a concavity of the alar rim and even collapse of the alar rim in severe cases. Surgical techniques performed on the lateral crus help to treat both functional and aesthetic deformities of the lateral nasal tip. We present a reverse plasty technique for the lateral crus, and we evaluated the advantages and disadvantages of the technique.

[Can enough lymph nodes be taken out through lateral neck dissection in patients with larynx cancer?]. / Larenks kanserli hastalarda lateral boyun diseksiyonu ile yeterli sayida lenf nodu çikarilabiliyor mu?

OBJECTIVES: This study aims to evaluate whether the number of lymph nodes which are dissected by lateral neck dissection (LND) is enough and to compare the number of lymph nodes which are dissected from the same lymph node regions by radical and type 1 modified radical neck dissection (RND). PATIENTS AND METHODS: Between January 2000 and June 2004, data of 98 neck dissection materials which were performed to 63 patients (52 males, 11 females; mean age 61.9 years; range 48 to 75 years) with larynx cancer were retrospectively analyzed. The number of lymph nodes taken from the second, third and fourth regions of radical and type 1 modified RND and LND were individually and totally compared. The American Joint Committee on Cancer (AJCC) tumor node metastasis (TNM) classification system was used for primary tumor and neck metastasis classification, while the Memorial Sloan-Kettering Cancer Center classification system was used for the classification of cervical lymphatic chain. RESULTS: Two patients (3.17%) had subglottic, 19 (30.15%) had glottic, and 42 (66.66%) had supraglottic lesions. A total of 732 lymph nodes were removed from three regions in RND group, while 1042 lymph nodes were removed in LND group. CONCLUSION: Our study results showed that the number of lymph nodes removed by LND was sufficient and RBD was not superior in terms of the number of lymph nodes removed.

Does tonsillectomy affect the outcome of drug treatment for the eradication of gastric H pylori infection? A pilot study.

Eradication of Helicobacter pylori, which is associated with diverse gastroduodenal pathologies of varying severity, is sometimes challenging. We conducted a prospective study to determine the effect of tonsillectomy on the eradication of H pylori from the gastrointestinal tract. Our study population was made up of 46 patients-32 females and 14 males, aged 14 to 58 years (mean: 28.84 ± 9.65)-who had chronic tonsillitis and concomitant dyspepsia. An initial gastrointestinal endoscopy was performed to obtain specimens for histology and a rapid urease test. These gastroscopies revealed that 32 patients were H pylori-positive (69.6%) and 14 were H pylori-negative (30.4%); these groups were designated A and B, respectively. The 32 H pylori-positive patients were divided into three subgroups based on the sequence in which they underwent drug therapy and tonsillectomy. All 3 subgroups received the same 14-day combination-drug regimen for eradication of gastric H pylori. The patients in group A1 (n = 12) underwent tonsillectomy prior to receiving drug treatment; 2 months after the cessation of drug therapy, they underwent a second gastroscopy. The patients in group A2 (n = 10) received drug treatment first followed by tonsillectomy; 2 months later, they underwent their second gastroscopy. The patients in group A3 (n = 10) received drug treatment first, then they underwent a second gastroscopy, and then they were taken for tonsillectomy. The success or failure of H pylori eradication was determined by the second gastroscopy. Also, analyses were performed after tonsillectomy to look for H pylori infection in tonsillar specimens. Eradication of gastric H pylori was achieved in 9 of the 12 group A1 patients (75.0%), 8 of the 10 group A2 patients (80.0%), and 7 of the 10 group A3 patients (70.0%); there were no statistically significant differences among the three groups. Likewise, there were no significant differences between any subgroups or combination of subgroups in terms of tonsillar positivity. As far as we know, this is the first study to investigate the effect of tonsillectomy on the outcome of H pylori eradication treatment. In light of our findings, we may speculate that tonsillar tissue does not seem to be a reservoir for H pylori infection. Although tonsillectomy had no significant effect on gastric H pylori eradication in our study, our results might have been skewed by the relatively small size of our sample.

The effect of radiofrequency ablation on microbiology of the tonsils.

OBJECTIVE: To investigate the effect of tonsil size reduction using temperature controlled radiofrequency on the number of pathogenic bacteria in the tonsil tissue. MATERIALS AND METHODS: This study was performed on 25 patients who had undergone tonsillectomy under general anesthesia at our clinic. Immediately after the cold knife tonsillectomy both tonsils were removed, one was included in the control and the other one was included in the study group. In vitro radiofrequency was applied to the tonsil in the study group at eight distinct points, each lasting 15s. Biopsy materials were taken under sterile conditions from the center of each tonsil for further culturing. RESULTS: The difference in bacterial number was investigated between the two groups. The bacterial number following radiofrequency administration was found to be significantly very lower compared to the control group (p<0.01). Radiofrequency administration significantly reduced growth of all types of bacteria. CONCLUSION: The radiofrequency tonsil ablation technique, which is used safely and effectively in the management of obstructive tonsil hypertrophy, currently has no indication for the treatment of patients with chronic and recurrent tonsillitis. However, when the right conditions are provided, the radiofrequency tonsil ablation technique may be applied to patients with chronic and recurrent tonsillitis and further studies investigating the differences in the frequency of patients' tonsillitis episodes should be undertaken.

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.

Cervical lymph node metastasis in renal cell carcinoma.

Renal cell carcinoma represents 3% of all adult malignant tumors. It occurs more frequently in the fifth and sixth decade of life and in a male-female ratio of 1.5 : 1. Among all the primary tumors that arise below the level of the clavicle, renal cell carcinoma is the third most common neoplasm that metastasizes to the head and neck region, but rarely has it been described as the presenting symptom of this tumor. In 7.5% of the patients with renal cell carcinoma, head and neck metastasis is the presenting complaint. However, only 1% of the patients with renal cell carcinoma have metastases confined only to the head and neck; and a solitary cervical metastatic mass, as in the case of our patient, is rare.It seems that head and neck metastasis of renal cell carcinoma should preferentially be treated with surgical excision because of the associated morbidity and quality-of-life issues. Renal cell carcinoma should be considered in the differential diagnosis of any growing lesion in the head and neck.

Palatal Pillar implants for the treatment of simple snoring.

OBJECTIVES: In this study the efficacy of palatal implants for treatment of snoring was evaluated. PATIENTS AND METHODS: Seventeen patients (10 males, 7 females; mean age 49.2+/-7.8 years; range 31 to 66 years) with primary snoring and an apnea-hypopnea index of less than 15 were treated with palatal implants after clinical and endoscopic examination. Snoring-related symptoms were evaluated at baseline and 90 days after surgery and polysomnography was performed. Patients and their spouses completed questionnaires and visual analog scales (VAS) evaluating snoring, apneas, and the intensity, duration, and social effects of daytime sleepiness at baseline and 90 days after surgery. Pre- and postoperative assessment results were compared. RESULTS: Epworth sleepiness scale score was significantly decreased in the postoperative period (p<0.05). Postoperative mean VAS snoring, apnea, and daytime sleepiness scores were also significantly improved (p<0.01). No patients reported worsening of apnea, 5.9% of patients reported no change in apnea, and 94.1% of patients reported a marked decrease in apneas. In the postoperative period, 76.4% of patients reported reduced snoring, and 88.3% of patients reported reduced daytime sleepiness. CONCLUSION: Palatal implants have been demonstrated to be a safe and effective treatment for snoring with minimal patient discomfort. Establishing realistic pretreatment expectations can maximize patient satisfaction.

Comparison between tonsillectomy with thermal welding and the conventional 'cold' tonsillectomy technique.

BACKGROUND: The aim of this study was the evaluation of length of the procedure, anaesthesia, the amount of the intraoperative fluid required, total blood loss and postoperative pain of the 'thermal welding system tonsillectomy (TWS)' compared with the conventional 'cold dissection tonsillectomy'. METHODS: Fifty patients aged between 3 and 28 years were included in this prospective controlled study. Extracapsular tonsillectomy with TWS was carried out on 25 patients and conventional 'cold' extracapsular dissection complete tonsillectomy was carried out on the other 25 patients. Haemostasis was achieved with packing and 3/0 chromic catgut suture is used to treat the persistently bleeding sites in the 'cold' tonsillectomy group. Intraoperatively, the duration of the procedure, anaesthesia, the amount of the required intraoperative fluid, the total blood loss and the number of sutures were documented for each patient. In the hospital, the postoperative amount of intravenous fluids, oral intake (timing of onset and amount), the duration and the total dose of analgesics were recorded. Daily assessment included the type of diet, the level of appetite, the total number of analgesics, the presence of fever, the time required to return to normal activity and the pain score (twice daily). Pain was measured by means of Faces Pain Scale and Visual Analogue Scale. RESULTS: There was a statistically and clinically significant difference in the operating time in the intraoperative blood loss in favour of the conventional tonsillectomy group (P > 0.05). Although there was no statistically significant difference between the two groups for the postoperative evening pain scores (P > 0.05), there was a statistically significant difference for the morning pain scores (P < 0.05) in the first 2 days postoperatively (P > 0.05) and in the level of appetite in the first postoperative day (P > 0.05). The other outcome measures did not show any statistically significant difference. CONCLUSION: When we compared TWS with the conventional 'cold' dissection tonsillectomy, we found that TWS tonsillectomy offered an innovative new tonsillectomy method with significantly reduced blood loss and reduced surgical time and without any increase in the postoperative pain. It was a useful method for tonsillectomy.

Incudostapedial rebridging ossiculoplasty with glass ionomer cement: a case report.

A 31-year-old woman presented with a complaint of hearing loss of a two-year history. Otoscopic examination revealed a central ear drum perforation without discharge. The air-bone gap was 35 dB at 0.5, 1, 2, and 3 kHz. Under general anesthesia, the patient underwent tympanoplasty for chronic otitis media. At surgery, the ossicular chain was intact except for discontinuity by a 2-mm gap between the long process of the incus and the head of the stapes. The gap was reconstructed with the use of a fluoroplastic prosthesis. Myringoplasty was successful, but the patient complained of hearing loss at the end of six months. Transcanal posterior tympanotomy was performed under local anesthesia for decreased conductive hearing. The prosthesis was still in place, but was not conducting the movements of the malleus to the stapes. It was removed and glass ionomer cement (Ketac-Cem) was applied for rebridging. The average air-bone gap measured in the postoperative sixth month was less than 10 dB.

Frequency of metastases at the area of the supraretrospinal (level IIB) lymph node in laryngeal cancer.

BACKGROUND: Neck dissection is the surgical gold standard for the treatment of patients with cervical lymphatic spread. The purpose of this study was to determine the presence of metastases in the supraretrospinal (level IIB) nodal group and the necessity of routine dissection of level IIB during neck dissection, in patients with squamous cell carcinoma of the larynx. METHODS: Over a 4-year period (between January 2000 and June 2004), the records of patients undergoing laryngectomy and neck dissection were retrospectively evaluated. The numbers of the lymph node and carcinoma metastases at level IIB were recorded. The American Joint Committee on Cancer tumor-node-metastasis classification system was used to classify the primary tumor and neck, and the Memorial Sloan-Kettering Cancer Center classification was used to classify the cervical lymphatic chain. RESULTS: Sixty-three patients with 98 neck dissections were included in the study. Two patients (3.17%) had subglottic lesions, 19 patients (30.15%) had glottic lesions, and 42 patients (66.66%) had supraglottic lesions. In total, 673 lymph nodes were dissected from level II, and 340 were dissected from level IIB. The 11 supraretrospinal lymph nodes of the 340 dissected nodes demonstrated histologic evidence of metastases (3.23%). Six patients (9.52%; 6/63) had metastases at level IIB, and 2 of them also had synchronous metastases at the contralateral level IIB. The patients without palpable lymph nodes at the neck had no metastases at level IIB. CONCLUSION: Our results showed that, if the level IIA shows positive metastatic changes, perioperative pathologic examination by frozen section that includes level IIb could be an alternative approach. This area may not be routinely dissected during the surgical management of laryngeal carcinoma with no palpable lymph nodes.

Connections between the facial, vestibular and cochlear nerve bundles within the internal auditory canal.

The vestibular, cochlear and facial nerves have a common course in the internal auditory canal (IAC). In this study we investigated the average number of nerve fibres, the average cross-sectional areas of the nerves and nerve fibres, and the apparent connections between the facial, cochlear and vestibular nerve bundles within the IAC, using light and scanning electron microscopy. The anatomical localization of the nerves within the IAC was not straightforward. The general course showed that the nerves rotated anticlockwise in the right ear from the inner ear end towards the brainstem end and vice versa for the left ear. The average number of fibres forming vestibular, cochlear, and facial nerves was not constant during their courses within the IAC. The superior and the inferior vestibular nerves showed an increase in the number of nerve fibres from the inner ear end towards the brainstem end of the IAC, whereas the facial and the cochlear nerves showed a reduction in the number of fibres. This suggests that some of the superior and inferior vestibular nerve bundles may receive fibres from the facial and/or cochlear nerves. Scanning electron microscopic evaluations showed superior vestibular-facial and inferior vestibular-cochlear connections within the IAC, but no facial-cochlear connections were observed. Connections between the nerves of the IAC can explain the unexpected vestibular disturbances in facial paralysis or persistence of tinnitus after cochlear neurectomy in intractable tinnitus cases. The present study offers morphometric and scanning electron microscopic data on the fibre connections of the nerves of the IAC.