Management of facial nerve paralysis in noncholesteatomatous chronic otitis media.

OBJECTIVE: The objective of this study was to analyse the clinical presentations, treatment course, and outcomes for patients treated for chronic otitis media associated with facial paralysis in noncholesteatomatous ears. METHODOLOGY: The present study looked at 13 patients (10 men, 3 women; ranging in age from 15 to 59 years) treated for facial paralysis due to chronic otitis media without cholesteatoma. RESULTS: Six patients had dehiscence of the fallopian canal whereas the bony canal was intact in the remaining patients. Decompression of the facial nerve was not performed in 5 of the 7 ears with an intact fallopian canal. Four ears underwent total decompression from the geniculate ganglion to the stylomastoid foramen, while the remaining 4 ears underwent partial nerve decompression. However, statistical analysis did not show any difference in recovery between the patients with surgical decompression and those without decompression (p = 0.171). All the patients not receiving decompression had successful outcomes (80% classified as Grade I and 20% as Grade II). CONCLUSION: All patients not receiving decompression had successful outcomes. Intravenous antibiotic treatment in conjunction with steroid therapy is the mainstay management of facial paralysis due to chronic otitis media without cholesteatoma. It is therefore not necessary to decompress the facial nerve in cases of facial paralysis in noncholesteatomatous chronic otitis media.

Sialadenoma papilliferum of nasal cavity: case report.

OBJECTIVE: We report a rare case of sialadenoma papilliferum. METHOD: A case report of sialadenoma papilliferum is presented. RESULTS: A 67-year-old woman presented with recurrent epistaxis. She was found to have an exophytic, well circumscribed mass on the nasal septum mucosa. The lesion was completely excised. A diagnosis of sialadenoma papilliferum was made based on the characteristic histological pattern. Follow up showed no evidence of recurrence. Subsequently, the patient remained well without complaint of epistaxis. CONCLUSION: To our knowledge, this is the first report in the world literature of sialadenoma papilliferum of the nasal cavity. This case indicates that this rare tumour can present with epistaxis, and can be resolved by means of total excision.

The role of Helicobacter pylori infection in the cause of squamous cell carcinoma of the larynx.

OBJECTIVE: Helicobacter pylori can cause chronic infection that has been linked to the development of both benign and malignant disease of the aerodigestive tract. The purpose of this study was to determine the link between H pylori infection and squamous cell carcinoma of the larynx (SCCL). METHODS: We estimated the presence of IgG antibodies against H pylori antigens by using ELISA technique in the sera of 26 patients with SCCL and 32 matched controls without carcinoma of the larynx. RESULTS: The incidence of seropositivity of patients with SCCL was 73.07% and of controls was 40.62%. These data support an etiologic role for H pylori infection on development of SCCL (chi(2) = 4.85, P< 0.05). CONCLUSION: H pylori infection of the upper aerodigestive tract might result in mucosal disruption, allowing for subsequent transformation by known carcinogens such as tobacco and alcohol.

Pentoxifylline effects on acute and late complications after radiotherapy in rabbit.

Soft tissue damages after radiotherapy are an uncommon but serious complication. Late damage after radiation is the principal dose-limiting factor in radiation therapy today and is dependent on vascular pathology as a result of radiation. Pentoxifylline is a methylxanthine derivative that produces dose-related improvement in blood flow, lower blood viscosity, improved erythrocyte flexibility, and increased tissue oxygen levels. An agent that increases blood flow and tissue oxygen content may contribute to enhanced healing of soft tissue pathology. Sixteen adult New Zealand rabbits were separated into 2 groups and inspected for 30 weeks after radiation. We noted acute and chronic reactions and pathologic changes in different regions of the head and neck of rabbits. The prophylactic administration of pentoxifylline in the postirradiation period can reduce late soft tissue pathology, but it does not affect acute radiation reactions.

Myoepithelioma of the parotid gland: a report of two cases.

We describe the clinical and pathologic features of two benign myoepitheliomas of the parotid gland. Through 1985, only 42 other cases had been reported in the literature--39 benign and three malignant. Fewer than 100 cases had been reported through 1993. Since then, two other reports have been published. But are these tumors really rare, or are they simply not well recognized? It is our opinion that they are not as rare as is generally believed because the number of case reports is increasing as pathologists have become more aware of their existence.

Postoperative hypertension effect of carotid sinus denervation.

Postoperative arterial blood pressures were monitored in 43 patients who had undergone bilateral neck dissection during a 6-week period at Ankara Numune Hospital's IInd Otorhinolaryngology Department. During the first operations, all cases received carotid sinus denervation, whereas no denervation was done for the opposite side dissections held 6 weeks later. Study and control groups were composed of the same patients to achieve an objective outcome for the risk of postoperative hypertension. Hypertension was observed in 10 (23%) of 43 patients after the first operations and 12 (28%) of 43 patients after the opposite side dissections, for which no carotid denervation was done. The difference between the rates was insignificant statistically.

The use of preoperative lidocaine to prevent stridor and laryngospasm after tonsillectomy and adenoidectomy.

The most important complications from tonsillectomy and adenoidectomy are bleeding, stridor, and laryngospasm. This controlled, double-blind study was designed to investigate the effects of topical and intravenous lidocaine on stridor and laryngospasm. A total of 134 patients scheduled for elective tonsillectomy and/or adenoidectomy were randomly separated into four groups. In the topical lidocaine group 4 mg/kg of 2% lidocaine was applied to subglottic, glottic, and supraglottic areas before endotracheal intubation. Normal saline solution was used topically for the first control group. In the intravenous lidocaine group, patients were given 1 mg/kg of 2% lidocaine before extubation, and the same amount of 0.9% NaCl was given to the second control group. Postoperative stridor, laryngospasm, cyanosis, bleeding, sedation degree, and respiratory depression were observed, and plasma lidocaine levels were measured. Both topical and intravenous lidocaine groups revealed less stridor and laryngospasm than the control groups, and no difference was found between the topical and intravenous lidocaine groups except the higher sedation scores in the early postoperative period for the intravenous lidocaine group.

Isolated sphenoid sinusitis.

Isolated sphenoid sinusitis is a relatively rare clinical entity and can cause severe complications. Diagnostic nasal endoscopy using Hopkins telescopes and coronal and axial paranasal-sinus CT made the diagnosis of the sphenoid sinus disease easier. Eight out of 221 patients with paranasal sinus infection refractory to medical treatment--and treated surgically at the 2nd ENT Clinic of Ankara Numune Hospital between 1990-1995--had isolated sphenoid sinus infection. The most common symptom was headache felt in the retro-orbital region. Surgical procedure was intranasal endoscopic approach to the sphenoid sinus. The symptoms of the patients with isolated sphenoid sinusitis were completely resolved after surgery. As the literature is reviewed, it is concluded that endoscopic approach to the sphenoid sinus disease is the most appropriate method of surgery in order to reduce intra-operative morbidity and mortality.

Role of suprahyoid neck dissection in the treatment of squamous cell carcinoma of the lower lip.

Treatment of squamous cell carcinoma of the lip is primarily surgical. Unlike other oral lesions, lower lip cancers do not metastasize to lower cervical lymph nodes without invading submental and submandibular lymph nodes. This study presents 30 patients with N0 lower lip carcinoma who were treated by en bloc resection of the tumor with suprahyoid neck dissection. Occult metastasis was found in 4 patients (13%). Four patients, 3 of whom had no occult metastases, died of local or regional uncontrollable disease. Suprahyoid or modified radical neck dissection appears to be beneficial, even in small tumors of the lower lip, in detecting occult metastases.

Postoperative hypertension after radical neck dissection.

Postoperative hypertension after radical neck dissection was detected in 20.2% of 109 neck dissections in our department between 1989 and 1993. It was probably caused by carotid sinus denervation and appeared after the vasodilation generated by anesthesia had subsided. If postoperative hypertension was encountered after the first operation, the risk of such hypertension after surgery on the contralateral side significantly increased.

Rhinolithiasis.

Rhinoliths are mineralized masses located in the nasal cavity. In this report, 12 patients with rhinolithiasis who were operated at the 2nd ENT Clinic of Ankara Numune Hospital are presented. The most frequently seen symptom is nasal obstruction, which has been seen in 9 patients. The disease most frequently seen in association with rhinolithiasis is chronic sinusitis. All masses have been extracted intranasally.

Diagnosis and treatment of lingual thyroid: a review.

Lingual thyroid is a rare developmental anomaly. It occurs because of the defective descent of thyroid tissue through the thyroglossal duct to its normal pretracheal position. In this study, two patients who presented with a mass in the oropharynx, finally diagnosed as lingual thyroid are presented, and the literature is reviewed. The masses were 3 x 2.5 x 1.5 cm and 3.5 x 3 x 3 cm in size. The diagnosis was based on the clinical features, fine needle aspiration biopsy, laboratory tests and radiographic imaging studies. The first case was treated medically with thyroxine. No treatment was given for the second case because of the patient's refusal. Both cases have not required additional therapy so far.

Effect of blood transfusion on tumor recurrence and postoperative pharyngocutaneous fistula formation in patients subjected to total laryngectomy.

Some surgical oncologists and otolaryngologists have reported that transfusion-induced immunosuppression may increase the incidence of recurrence and infectious complications in patients subjected to head and neck surgery for carcinoma. The relationship between intra-operative blood transfusion and postoperative pharyngocutaneous fistula formation and/or tumor recurrence is controversial. In a retrospective study of 110 total laryngectomized patients, we found no statistically significant differences between the transfused and nontransfused groups in terms of tumor recurrence and fistula formation.

The use of molded tympanic heterograft (lamb peritoneum).

The molded heterograft tympanic membrane was applied to twenty-five ears during tympanoplasty. The advantages and disadvantages of the graft material are discussed. Although autograft use is the principal choice, we strongly believe that this heterograft technique may be an alternative for tympanic membrane grafting; especially in revision cases in which temporalis fascia has already been used.

Early oral feeding after total laryngectomy.

Following total laryngectomy, 110 patients were orally fed on the first/second postoperative day without using a nasogastric (NG) tube. Pharyngo-cutaneous fistula was observed in 23 patients (21%) only nine of which (8%) needed surgical intervention to close the fistula. Early postoperative oral feeding of laryngectomized patients does not increase the fistula rate but decreases postoperative hospitalization time and eliminates the disadvantages of the NG tube.

Basaloid squamous cell carcinoma of the larynx.

Basaloid squamous cell carcinoma is a variant of squamous cell carcinoma that was first described in 1986. In the English-language literature, only 26 cases of this infrequent histopathological entity have been reported in the larynx. Tumors have an aggressive biological behavior, justifying combined surgical treatment with radiotherapy. Two new cases are presented and the literature reviewed.

Androgen receptors in laryngeal carcinoma.

Specific androgen receptors were assayed from the cytosol fraction of laryngeal carcinomas from 15 male patients. Specimens also included the non-malignant laryngeal tissues from 3 of these patients. A specific radioligand was used and involved (3H) dihydrotestosterone incubation and a dextran-coated charcoal technique. Twelve of the laryngeal carcinomas showed detectable levels of high affinity but limited capacity androgen receptors. The number of binding sites varied from zero to 23.3 fmol/mg cytosol protein, with the dissociation coefficient (Kd) ranging from 0.46 to 1.85 x 10(-9) M. Androgen receptors were also found in all three non-malignant laryngeal tissues. Binding sites for these latter androgen receptors were 4.09 to 8.16 fmol/mg cytosol protein, with a Kd of 0.81 to 0.35 x 10(-9) M. Although further studies are necessary, the presence of androgen receptors in laryngeal carcinomas suggests that antiandrogen therapy might be used in the future for treating such disease.

Measurement of blood flow to human nasal mucosa in normal and pathological conditions by the use of the 133Xe clearance technique.

The blood flow to nasal mucosa in normal subjects and in allergic rhinitis, vasomotor rhinitis and laryngectomized patients was measured using the 133Xe clearance technique. The results were statistically compared and correlated with capillary diameter. Compared to the normal group, the blood flow to nasal mucosa increased in allergic and vasomotor rhinitis patients and decreased in laryngectomized patients. There was a statistically significant difference between allergic and vasomotor groups (p less than 0.01), so the present method could be used in the differential diagnosis of rhinitis.