Silent sinus syndrome.

We present a case of silent sinus syndrome (SSS) who underwent unilateral surgical endoscopic maxillary meatotomy. Orbital floor reconstruction is delayed after follow up. Enophthalmos recovered 8 months after the surgery and radiologic findings improved. SSS is a clinical entity that should be kept in mind in the differential diagnosis of enophthalmos and can be treated successfully via endoscopic approach.

Investigation of age, sex and menstrual stage variation in human cerumen lipid composition by high performance thin layer chromatography.

OBJECTIVE: The objective of the study was to correlate quantitative changes in the lipid composition of human cerumen with changes in age, sex and menstrual cycle stage. DESIGN: Cerumen samples were collected from the external ear canal and analysed using sequential, one dimensional, high performance thin layer chromatography. SUBJECTS: The following age groups of both sexes were investigated: one to 10 years; 11-18 years; 19-40 years; and 40 years and over. Additionally, cerumen samples from subjects in three stages of the menstrual cycle were compared. RESULTS: In the cerumen samples, the peak values for wax ester and cholesterol occured between the ages of one and 10 years for both sexes. However, squalene and triglyceride content reached maximum levels at puberty. Men aged 19-40 years had a significantly greater percentage of cerumen lipid squalene content than women from the same age group; however, their cholesterol content was found to be lower. Regarding the various menstrual cycle stages, cerumen samples taken at the follicular stage from women aged 19-40 years had a significantly lower free fatty acids content, and higher cholesterol and squalene levels, compared with samples taken in the luteal or menstrual stages. CONCLUSION: The proportions of the lipid constituents of cerumen varied with age, sex and menstrual stage. In cerumen, the main lipid constituent stimulated at puberty appears to be squalene, not wax esters as reported for sebum. The relevance of lipid constituents to cerumen's protective role is discussed.

Effect of dexmedetomidine on bleeding during tympanoplasty or septorhinoplasty.

BACKGROUND AND OBJECTIVE: The aim of this study was to evaluate the efficacy of dexmedetomidine, an alpha(2)-adrenoceptor agonist, on intraoperative bleeding, anaesthetic drug requirement and postoperative pain. METHODS: Forty patients scheduled for elective tympanoplasty and septorhinoplasty operations under general anaesthesia were included in the study. The patients were randomly assigned to receive either a dexmedetomidine 1 microg kg(-1) bolus 10 min before induction of anaesthesia plus 0.5 microg kg(-1) h(-1) infusions during maintenance or placebo. Mean arterial pressure was maintained between 60 and 80 mmHg. Perioperative mean arterial pressure, heart rate, time to extubation and time to awakening were recorded. Bleeding during surgery was assessed by the surgeon, blinded to the study drugs, both intraoperatively and postoperatively as a final personal opinion about the whole surgical process. RESULTS: The heart rate and mean arterial pressure were significantly lower during induction, operation and extubation in the dexmedetomidine group (P < 0.05). Blood losses were lower in the dexmedetomidine group (P < 0.05). Propofol dose required for induction, and fentanyl and isoflurane consumption were significantly reduced in the dexmedetomidine group (P < 0.05). The total amounts of nitroglycerin and meperidine used were higher in the control group (P < 0.05). CONCLUSIONS: Dexmedetomidine decreased bleeding, postoperative analgesic requirements and intraoperative anaesthetic requirements and was associated with more stable haemodynamic responses to anaesthesia. We conclude that dexmedetomidine is a useful adjuvant to decrease bleeding when a bloodless surgical field is requested.

Polyurethane stent obstruction as a cause of recurrent epiphora. Case report.

SUMMARY: A Song's nasolacrimal duct stent was placed in a patient with epiphora due to primary nasolacrimal duct obstruction and the stent was kept for 32 months. Mitomycin C 0.02% eye drops four times a day were prescribed for four weeks following polyurethane stent placement procedure. No epiphora-related complaints occurred for thirty months after then the epiphora started. Nasolacrimal stent was removed from nasal cavity endoscopially and the tissues within the extruded stent were examined histopathologically. The patient's complaints were relieved following stent removal. Dacryocystogram revealed normal passage and a filling defect within the lacrimal sac. Macroscopic evaluation of the stent revealed a firm mass in the stent mushroom, causing complete obstruction. Pathological examination of the mass revealed chronic inflammation, increased connective tissue and vascular proliferation. Nasolacrimal polyurethane stents can be removed easily by nasal approach. Nasolacrimal passage may be left open temporarily after stent removal. The use of Mitomycin C drop is a novel approach in nasolacrimal stent placement cases. However, when the long-term results of endoscopic and external dacryocystorhinostomy are considered, further research is needed on the biocompatibility of stent material.

Effects of the chorda tympani damage on submandibular glands: scintigraphic changes.

The aim of this study is to compare the scintigraphic results of a denervated submandibular gland with the contralateral normal side in patients with unilateral chorda tympani damage. Sixteen patients (11 women and five men with a mean age of 27) with unilateral proven chorda tympani damage during their previous ear surgery were included in the study. The perfusion ratio (PR), concentration ratio (CR) and stimulated excretion ratio (SER) were calculated scintigraphically and the results from the salivary glands on opposite sides were compared. For submandibular glands, the perfusion ratio (PR), concentration ratio (CR) and stimulated excretion ratio (SER) were found to be 0.65 +/- 0.21, 0.70 +/- 0.21, 0.79 +/- 0.37, respectively. All ratios resulted from statistically decreased radioactivity accumulation on the affected side (p<0.05). Chorda tympani damage negatively affects the function of the ipsilateral submandibular glands despite the absence of atrophy. Dynamic salivary gland scintigraphy is a practical and valuable method of disclosing the decreased capacity of perfusion, concentration and secretion function in unilateral neurological deprivation.

Bacterial etiology of otitis media with effusion; focusing on the high positivity of Alloiococcus otitidis.

The etiology of otitis media with effusion (OME) is unclear. The bacterial analyses of middle ear effusion (MEE) in OME may reveal important information regarding its etiology. Alloiococcus otitidis, Heamophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis were investigated by using microbiologic culture and a multiplex PCR method in the middle ear fluid of 32 children (54 samples) with chronic OME. PCR yielded positive results in 18 (33.3%) middle ear effusions while culture resulted positive for 3 (5.6%). The PCR method detected A. otitidis in 10 (18.5%) specimens, H. influenzae in 7 (13%), M. catarrhalis in 4 (7.4%) and S. pneumoniae in 2 (3.7%) specimens. The multiplex PCR method enhances the detection rate significantly compared to that of the conventional culture method. A. otitidis is the most common detected pathogen in the MEE of the OME.

An important procedure in ossiculoplasty: autoclaving the ossicles.

Autoclaving of the ossicles prior to ossiculoplasty is a very important procedure in surgery of cholesteatomatous chronic otitis media. Autoclaving allows the reuse of the ossicles removed from patients with cholesteatomatous chronic otitis media as an autograft. It also allows utilization of the malleus, incus and stapes taken from cadavers or of the uneroded malleus and incus removed from patients undergoing non-functional middle ear surgery chosen carefully with detailed history and laboratory analysis. The powerful disinfecting effect of the sterilising procedures of the homografts inactivates prion proteins which cause degenerative encephalopathies. In various studies, it has been concluded that autoclaving does not alter the matrix of the bone which is responsiable for its biophysical properties, whereas it removes all viable cells within the bone and dentures the soft tissue attached to the surface of the ossicle. We have also found confirming histological results in our two previous studies published in 1999 and 2001. It is usually recommended that soft tissue on the surface of the ossicles is removed before autoclaving. It is also sufficient to autoclave the ossicles at 134 degrees C, and at 2.5 atmosphere pressure for 5 minutes in a flash autoclave. The autoclaving time of the homograft ossicles must be longer, for 20 minutes. Following the autoclaving, these homograft ossicles should be kept at pH 5.6 for 3 days, then use a solution of 0.5% formaldehyde at pH 7 and 4 degrees C for 21 days and it should be washed with physiologic saline solution three times for 7 minutes before use. Depending on the results obtained from our planned comparative experimental study, there will be no need for additional formaldehyde fixation procedure after autoclaving and the autoclaved ossicles will be used immediately without preservation in formaldehyde solution for 24 days.

Intrinsic nasal muscles and their electromyographic evaluation after external septorhinoplasty.

OBJECTIVES: Rhinoplastic surgery is performed for the improvement in the appearance of the nose, but it should not cause any detrimental effect on the intrinsic muscles. This study was conducted to evaluate the influence of the external rhinoplasty on intrinsic nasal muscles. METHODS: Twenty-one patients were operated on by external septorhinoplasty. Functions of the nasal muscles were assessed by electromyography in response to voluntary nasal movements in patients before and after surgery. RESULTS: Postoperative electromyographic activities of the muscles were significantly less than preoperative measurements for all movements. CONCLUSION: Influence of the surgical incisions, alterations of the sites of origin and/or insertion of the muscles, and the postoperative healing process can be incriminated for the decreased muscular activity. Nasal muscle function requires a better appreciation and respect for the achievement of the best aesthetic and functional results. The nasal valve reconstructive procedures should be applied routinely to compensate for this inevitable muscular involvement.

Butylcyanoacrylate tissue adhesive for columellar incision closure.

Cosmetic outcome of the columellar incision closure in external rhinoplasty patients has been a subject of discussion. This study was conducted to assess whether tissue adhesives provide an alternative option for sutureless closure of columellar skin incisions for cases utilizing open technique rhinoplastic surgery. One hundred and one patients undergoing external rhinoplasty were randomized to either topical application of butylcyanoacrylate or polypropylene sutures for columellar skin closure. The majority of tension on the wound edges was taken up using 5-0 chromic catgut. Cosmetic outcomes were evaluated by two otolaryngologists independently using visual analogue and Hollander wound evaluation scales in a blinded manner. There was no statistically significant difference in cosmesis between the surgeons' evaluation scores for either type or repair of the columellar incision. Since the tissue adhesive forms its own protective barrier, post-operative care is simplified. Closure with adhesives eliminates the need for post-operative suture removal requiring an extra visit that should lead to more efficient use of physician and patient time. Butylcyanoacrylate performs cosmetically as well as standard suture closure of columellar skin incision used for external rhinoplasty.

Cervical subcutaneous emphysema: an unusual complication of adenotonsillectomy.

Removal of the tonsils and adenoid tissue because of recurrent infection and/or respiratory obstruction is one of the most commonly performed operations. A rare complication during this intervention is subcutaneous surgical emphysema. The awareness of anaesthesiologists and otolaryngological surgeons will protect the patient from serious consequences. We report our experience with this complication and provide a review of the literature.

Doppler echocardiography in adenotonsillar hypertrophy.

OBJECTIVE: Adenotonsillar hypertrophy causing upper airway obstruction may lead to the pulmonary hypertension and cor pulmonale. This study aimed to clarify the diagnostic methods of this complication, besides polysomnography, to find another objective criterion for surgical intervention and to demonstrate the curative effect of adenotonsillectomy on this complication using this objective criterion. METHODS: We studied the outcomes of 17 children with pulmonary hypertension secondary to the adenotonsillar hypertrophy. Pulmonary arterial pressure measurement was performed noninvasively by Doppler echocardiography. RESULTS: Mean preoperative pulmonary arterial pressure was 29.12+/-4.41 mmHg and decreased dramatically after relief of upper airway obstruction by adenoidectomy and/or tonsillectomy to the normal level of 12.06+/-3.09 mmHg. These results were analyzed by equal variances t-test and found very significant (P<0.01). Regarding the symptoms of upper respiratory obstruction, symptom scores of these children decreased very significantly and were analyzed by equal variances t-test (P<0. 01) in the postoperative period. For all the symptoms individually (snoring, mouth-breathing during sleep and daytime, hyponasal voice, restless sleeping, daytime somnolence, enuresis nocturna), comparing percentages of preoperative and postoperative symptoms by unequal variances t-test, we obtained very significant decrease (P<0.01). CONCLUSIONS: This study illustrates that Doppler echocardiography is a safe, practical and noninvasive-method in diagnosing cardiovascular disturbances--one of the complications of adenotonsillar hypertrophy and especially for measuring the pulmonary arterial pressure. All the symptoms and disorders due to the adenotonsillar hypertrophy may be reversible by performing early adeno- and/or tonsillectomy.