The comparison of the quality of life and intranasal edema between the patients with or without nasal packing after septoplasty.

Septoplasty is one of the most common operations performed in otolaryngology and anterior nasal packing is done routinely to prevent postoperative bleeding, septal hematoma or nasal synechia. Currently, transseptal sutures have gained a broader application area, not only for preventing the complications such as septal hematoma and bleeding but also closing any accidental tears of septal mucosa and providing additional support for the cartilage pieces retained in septoplasty. We evaluated the quality of life of the patients in early postoperative period (in the first postoperative week), intranasal edema with endoscopic examination and the intranasal changes with acoustic rhinometry. We performed a prospective and randomized study with patients undergoing septoplasty without inferior turbinectomy. As packing material, there were two groups: in group A, gauze in a glove finger and in group B, Doyle splint were used, and in the additional group C, only transseptal suture with 4/0 vicryl among the cartilaginous septum was performed. The patients were invited to control examinations on the postoperative 2nd, 4th and 7th days to evaluate the scores from 1 to 5 on the questionnaire for the pain, nasal fullness, sneezing, epiphora, difficulty in swallowing and sleep disturbances. The patients were also administered an endoscopic nasal examination for the purpose of detecting the intranasal edema, and acoustic rhinometry was performed during the control examinations to detect the intranasal changes. Total occluding packing was found to cause much more frequent and higher scores of epiphora, sneezing, difficulty in swallowing, but mainly, the pain compared to in silicone packing with airway and transseptal suture only. Although the silicone packing with airway was found to be much more comfortable, it also led to sneezing and epiphora. The patients without nasal packing had more comfortable period especially in the early postoperative days (the first 4 days). However, 1 week after surgery, groups with and without nasal packing were found to be equalized on behalf of the objective and subjective parameters. As any complication was not observed due to not using nasal packing, it is thought that nasal packing usage following septoplasty is not a necessity.

Quantitative analysis of the terminal branches of facial nerve in fresh frozen head and neck specimens.

BACKGROUND: The first aim of this study was the quantification of nerve fibres found in terminal branches of facial nerve and the second aim was the ultrastructural analysis of these terminal branches in order to observe their ultrastructural differences, if present. In the examination of literature; we could not find any studies related to this subject. MATERIALS AND METHODS: Four fresh frozen head and neck specimens were used and the dissections were done bilaterally. Therefore; totally 8 samples were examined. The samples were prepared according to routine transmission electron microscopic tissue preparation technique. The semi-thin sections were examined under light microscope by camera lucida. In every sample, the quantitative analysis was performed in 5 different areas in an area of 0.01 mm2 and statistical analysis was done. Secondly; the ultrastructural appearance of these terminal branches were examined under transmission electron microscope. RESULTS: In the quantitative analysis of terminal branches of facial nerve in an area of 0.01 mm2; the least number of nerve fibres were found in temporal branches and the highest number were detected in cervical branches. In transmission electron microscopic examination, no significant difference was found in between these branches. In the statistical analysis; statistically significant differences were obtained in between the temporal and buccal, marginal mandibular, cervical branches; zygomatic and marginal mandibular, cervical branches; buccal and marginal mandibular, cervical branches; marginal mandibular and cervical branches. CONCLUSIONS: These numerical data will have an importance during the nerve repair process of terminal branches of facial nerve in various injuries.

Long-term results and reasons for failure of intranasal endoscopic dacryocystorhinostomy.

The aim of this study was to evaluate the long-term results and the factors influencing the success in patients with nasolacrimal duct obstruction treated with intranasal endoscopic dacryocystorhinostomy (DCR) and silicone tube intubation (STI). We prospectively investigated 158 patients with lacrimal obstruction in two groups, one of which comprised 108 patients treated primarily with intranasal endoscopic DCR by experienced surgeons and the other comprised 50 patients who were operated on by inexperienced surgeons. In a mean follow-up time of 49 months the surgical success was 94.4% in experienced hands and 58.0% in inexperienced hands. The endoscopic examination of six patients with failure in the first group revealed granulation tissue around the tube in four, atonic sac in one and persistence of bone that was supposed to have been excised in the nasal cavity in one. There were 21 failures out of 50 patients in the second group: granulation tissue in 2 cases, fenestration to the nasolacrimal duct instead of the sac in 6 cases, synechia between the lateral nasal wall and the middle turbinate in 2 cases, bony spicles causing obstruction in 5 cases and fenestration anterior to the sac in 2 cases. In 4 cases no reasons were found for failure, but perhaps the small fenestration and failure to remove the medial half of the membranous sac wall was the reason. DCR and STI can be performed for primary treatment in lacrimal obstruction. There is a learning curve for the operation. False localization of the lacrimal sac, granulation tissue formation around the tubes, retained bony spicles, inadequate removal of the medial wall of the sac and the synechia between the lateral wall and the middle turbinate are the most common causes of failure.

Laryngeal carcinoma and estrogen receptor analysis in patients after long-term follow-up.

Limitations in determining the progress and treatment of malignant diseases have prompted the investigation of new factors. Many molecules including estrogen receptors have been studied in an effort to understand the biological behavior of a tumor. To determine the effect of estrogen on laryngeal malignant cells, we analyzed the clinical findings of patients during long-term follow-up and compared these with the expression of estrogen receptors (ER). Fresh tissue samples from 30 patients with laryngeal carcinomas were analyzed for ER by a cytochemical method. Seven patients (23.3%) were found to be ER+. Advanced stages of the disease in patients with supraglottic tumors were found to be significantly ER-. While all patients were still alive for > or = 4 years in the ER+ group, two patients were dead due to primary tumor in the ER- group. Although the results of this study suggest that ER may play a role in determining the prognosis of disease in certain cases, further studies with larger series are needed before ER can be accepted as a prognostic marker.

Laryngeal pleomorphic rhabdomyosarcoma.

A case of an extremely unusual tumor of the larynx, pleomorphic rhabdomyosarcoma, is presented with a review of literature. This is the fifth case of this malignancy described in the larynx in the English language literature. A histopathological diagnosis was made with immunohistochemistry and electron microscopy. In contrast to other reported cases, the tumor in the present case had a very aggressive behavior. Despite radical surgery involving total laryngectomy and neck dissection followed by radiation therapy, the patient died of disease 8 months following treatment.

Subdural empyema and blindness due to cavernous sinus thrombosis in acute frontal sinusitis.

In this era of antibiotics, the complications of acute sinusitis are much less frequently encountered. Although orbital complications are most common, intracranial complications carry a high rate of mortality and morbidity. We describe a case of acute frontal sinusitis with subdural empyema and blindness due to cavernous sinus thrombosis and carotid artery thrombosis with a discussion of treatment of these complications and the etiology of blindness in sinusitis.

Trace elements in children with chronic and recurrent tonsillitis.

Trace elements are indispensable for life and play a very important role in the essential functions. According to some reports in the literature lower trace element levels increase the susceptibility to recurrent infections. Since there are no reports available in the English literature about the effects of trace elements on recurrent and chronic tonsillitis, 37 children with recurrent and chronic tonsillitis were evaluated for Zn, Cu and Mg levels. Serum levels of Zn in 6 patients were slightly lower than the normal limit. All the other serum levels of Zn, Cu and Mg were within the normal range. On the other hand, the mean serum level of Zn in the 37 patients was significantly lower than in a control group of 28 age and sex matched children. In contrast, the mean serum levels of Cu and Mg in the patients were significantly higher than in the control group. Whether this alteration in the trace element status causes or fosters recurrent and chronic tonsillitis is not clear.

Glass in the frontal sinus: report of three cases.

Patients with paranasal sinus foreign body are not commonly seen in otolaryngological practice; glass in the frontal sinus as a complication of maxillofacial trauma should be very rare, and papers dealing with this issue appear to be rare in the English literature. To elucidate the diagnostic pitfalls and the treatment aspects we present three cases of glass in the frontal sinus which occurred as a result of road traffic accidents.

Blindness as a rare complication of neck dissection.

Blindness is a rare and rather unexpected complication of neck dissection. There have been only a few cases reported to date, all following bilateral neck dissections. We present a case of blindness after one-sided neck dissection and an insidious finding of bilateral common carotid artery occlusion.

Ataxia telangiectasia and mucoepidermoid carcinoma of the parotid gland: a case report.

Ataxia telangiectasia (AT) is an immunodeficiency disorder with increased incidence of malignancy. Most of the tumors are lymphomas, and salivary gland neoplasms are very uncommon. A case with ataxia telangiectasia and mucoepidermoid carcinoma of the parotid gland, the second case in English literature, was presented. The treatment was discussed under the view of the literature.