[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.

Modified tongue base suspension for multilevel or single level obstructions in sleep apnea: clinical and radiologic results.

OBJECTIVES: To investigate the radiologic and polysomnographic success in opening the airway using a tongue base suspension procedure alone or in combination with uvulopalatal flap in obstructive sleep apnea syndrome (OSAS) patients. METHODS: This study was conducted in 20 patients with moderate or severe OSAS in a prospective manner. The tongue base suspension technique alone or with a uvulopalatal flap (UPF) technique was applied. Magnetic resonance imaging (MRI) scans of patients obtained during the preoperative period and at the 5th week of the postoperative period were compared. Changes in pain and swallowing difficulties were assessed. Polysomnography (PSG) was applied at the 12th postoperative month, and body mass index (BMI) and Epworth sleepiness scale (ESS) values were determined. The degree of satisfaction relative to the surgery was assessed with 4 questions. RESULTS: Preoperative apnea-hypopnea index (AHI) level was found to be 24.55±9.87, whereas postoperative AHI level was 12.40±9.87 (P<0.01). The success rate was determined to be 60%. Preoperative ESS values were 13.90±2.67 and were reduced to 6.55±3.13 postoperatively (P<0.01), and the preoperative posterior airway space (PAS) level was 10.08±1.23, which was increased to 11.64±1.46 postoperatively (P<0.01). Visual analog scale (VAS) values for swallowing difficulty were 8.62 at day 1 and decreased to 3.98 at day 7. The VAS values for pain were 9.14 at day 1, but were reduced to 4.18 at day 7. CONCLUSIONS: Patients with OSAS who have hypertrophy of the tongue base may safely receive a tongue base suspension procedure, which is a minimally invasive method. The postoperative hospital stay is short and the success rate is high, as shown with both PSG and MRI.

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.

[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.

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.

[Squamous cell carcinoma originating from the nasal septum: a case report]. / Nazal septumdan kaynaklanan skuamöz hücreli karsinom: olgu sunumu.

A 73-year-old male patient presented with a mass that developed in the left nasal cavity and projected out the nasal vestibule. Nasal endoscopy showed a polypoid, hyperemic mass that originated from the caudal end of the septum and almost filled the left nasal passage. Histopathologic diagnosis of the biopsy specimen taken from the lesion was squamous cell carcinoma. Ultrasonography of the neck showed no lymphadenopathy. The mass was excised via a lateral rhinotomy and the defect site was reconstructed with a nasolabial sulcus flap. No postoperative complications or recurrences were encountered during a follow-up of six months.

[Fracture of the thyroid cartilage and fixation with miniplate: a case report]. / Tiroit kartilaj kiriginin mini-plak ile onarimi: olgu sunumu.

Laryngeal traumas are rarely seen. A tracheostomy was performed in a 39-year-old male patient who developed dyspnea following a neck trauma. Computed tomography examination revealed fracture of the thyroid cartilage. He was treated successfully by open reduction and miniplate fixation. No problems were detected in airway patency and voice quality on postoperative controls. No complications were encountered within a follow-up period of five months.