[Subcutaneous emphysema after septoplasty: a case report]. / Septoplasti sonrasi subkutan amfizem: Olgu sunumu.

Subcutaneous emphysema is characterized by the presence of air in the connective tissue within the fascial planes. The etiology of subcutaneous emphysema includes trauma, iatrogenic causes, or spontaneous development. Head and neck subcutaneous emphysema is a well-defined and life-threatening condition. In case of a large amount of air leaks into the fascial planes, the air can also extend into the retropharyngeal, mediastinal, pleural, and retroperitoneal spaces beyond the subcutaneous layers. Although numerous maxillofacial surgical procedures can cause subcutaneous emphysema, septoplasty has not been reported previously. In this unique case, subcutaneous emphysema developed after elective septoplasty and involved the maxillofacial, retropharyngeal, deep cervical, and orbital regions. The patient was treated conservatively with antibiotic prophylaxis and the condition completely resolved by day 10 spontaneously. Herein, we discuss the available literature data and optimal management strategies for unusual cases of head and neck subcutaneous emphysema.

Factors influencing the longevity and replacement frequency of Provox voice prostheses.

INTRODUCTION: This study aimed to assess the factors that influence the longevity and replacement frequency of Provox voice prostheses following their placement. METHODS: The medical records of 27 patients who received Provox voice prostheses after total laryngectomy and attended follow-up regularly between 1998 and 2012 were retrospectively reviewed. The success rate of the Provox voice prostheses (i.e. whether speech was achieved), quality of speech achieved, number and type of complications encountered, frequency of prostheses replacement and reasons for prostheses replacements were evaluated. RESULTS: All 27 patients were men and their mean age was 63.0 (range 43-78) years. The mean follow-up period was 60.3 (range 1-168) months. Fluent and understandable speech was achieved in 85.0% of the patients. The mean duration before prosthesis replacement had to be performed was 17.1 (range 1-36) months. The most frequent complication was fluid leakage through the prosthesis. There was a strong positive correlation of 77.1% between the longevity of prostheses and postoperative follow-up duration (r = 0.771; p < 0.01). CONCLUSION: The voice prosthesis is a tool that can be delivered in a practical fashion and replaced easily with no serious complications. It is a means by which speech can be restored, with a high success rate, after total laryngectomy. In the present study, we found that postoperative follow-up duration was the most important factor influencing the longevity of the Provox voice prosthesis.

Parathyroid scintigraphy and minimal invasive surgery in parathyroid adenomas.

OBJECTIVES: This study aims to identify the diagnostic capacity of the technetium 99m sestamibi scintigraphy with single photon emission computed tomography for localizing parathyroid pathologies. PATIENTS AND METHODS: Data of 13 patients (4 males, 9 females; mean age 49.23 years; range 27 to 63 years) who had minimally invasive parathyroidectomy due to primary hyperparathyroidism at the Haseki Training and Research Hospital Ear-Nose-Throat clinic between January 2013 and December 2013 were retrospectively analyzed. Two patients were excluded due to incomplete documentation. RESULTS: Mean preoperative parathyroid hormone and calcium levels were 284.36 (134-1,083 pg/mL) and 11.9 (10.7-13.5 mg/dL), respectively. The operation was deemed adequate if intraoperative parathyroid hormone dropped by 50% from the preoperative level or frozen section analysis showed hypercellular gland or adenoma. Only sestamibi scintigraphy results were consistent with focal exploration findings in all patients. Focal exploration and parathyroid adenoma excision via minimally invasive parathyroidectomy were successfully carried out in 10 patients with single adenoma confirmed by sestamibi. CONCLUSION: Technetium 99m sestamibi scintigraphy with single photon emission computed tomography and frozen section analysis may provide more meaningful information and be more advantageous compared to other preoperative localization techniques.

Diagnostic value of frequency-associated vestibular-evoked myogenic potential responses in Ménière's disease.

Thirty subjects with unilateral Ménière's disease (MD) and 18 age-matched controls underwent cervical (cVEMP) and ocular vestibular-evoked myogenic potential (oVEMP) testing using bilateral air-conducted stimulation (ACS) with stimulus frequencies of 500 and 1,000 Hz. The aim of this study is to determine the diagnostic value of frequency-associated responses in MD using oVEMP and cVEMP following 500- and 1,000-Hz ACS. In healthy controls and unaffected ears, responses to 500 Hz were found better than 1,000-Hz ACS in both oVEMP and cVEMP, while ears with MD responded to 1,000-Hz ACS better than to 500-Hz ACS in oVEMP. In cVEMP tests, affected ears responded to 500-Hz and 1,000-Hz ACS equally. Amplitude ratios of 1,000/500 Hz in both oVEMP and cVEMP were successful in differing affected ears from unaffected ears and healthy controls. This study showed frequency alteration of oVEMP and cVEMP can be used as a diagnostic test battery in MD.

Prognostic factors in type I tympanoplasty.

OBJECTIVE: To identify the preoperative factors that influence the success rate of type I tympanoplasty. METHODS: A total of 247 type I tympanoplasty procedures were included in the present study. We determined the effects of the following preoperative variables on the anatomical and functional outcomes of type I tympanoplasty in order to identify prognostic preoperative factors: age (<16 years vs. >16 years), history of ear surgery, state of the contralateral ear (healthy vs. diseased), size of perforation, presence of septal pathology, presence of adenoid disease and history of smoking. Additionally, we stratified the surgical procedures according to the type of graft materials used and analyzed the effects of the above preoperative variables on the success rates of each type of procedure separately in order to eliminate the confounding effect of surgical technique. RESULTS: The study was conducted on 217 subjects (130 females, 87 males) who underwent a total of 247 surgical procedures. The graft take rate was significantly higher after tympanoplasty with perichondrium-cartilage island flap (PCIF) grafts than after tympanoplasty with temporalis fascia (TF) grafts (87.8% vs. 72.3%, p=0.008). Young age (p=0.013), presence of adenoid hypertrophy (p=0.001) and abnormality of the contralateral ear (p=0.027) were associated with lower success rates after tympanoplasty with TF grafts. The success rate of tympanoplasty with PCIF grafts was not affected by any of the preoperative variables we tested. Postoperative audiometry showed that the improvement in hearing ability did not differ between patients who received TF grafts and those who received PCIF grafts (p=0.325). CONCLUSION: Tympanoplasty with cartilage grafts was associated with better graft takes and comparable hearing outcomes than those associated with tympanoplasty with TF grafts. In patients with risk factors such as contralateral ear disease, a young age or adenoid disease, cartilage-perichondrium grafts are preferable to TF grafts.

Advanced oxidation protein product level in children with chronic otitis media with effusion.

OBJECTIVE: To determine the level of advanced oxidation protein products (AOPPs) in children with chronic otitis media with effusion (COME), in an effort to elucidate the multifactorial etiology of this disease. METHODS: This study involved 25 COME patients and 30 healthy children (control group) recruited from the Ear, Nose and Throat (ENT) and Pediatric Departments, respectively, of the Haseki Research and Training Hospital. In the COME group, blood samples were collected before a middle ear operation, and middle ear fluid was sampled during the operation. Blood samples were also obtained from the control subjects. AOPP levels in the plasma and effusion fluid were measured by the spectrophotometric method. RESULTS: In the COME group, the mean AOPP levels in plasma and effusion fluid were 168.08 µmol/l and 412.75 µmol/l, respectively. In the control group, the mean plasma AOPP level was 141.54 µmol/l. The plasma AOPP levels did not significantly differ between the COME and control groups (p>0.05). In the COME group, however, the effusion fluid AOPP level (412.75 ± 204.54 µmol/l) was significantly higher than the plasma AOPP level (168.08 ± 68.45 µmol/l; p<0.01). CONCLUSION: We found that AOPP levels were elevated in the effusion fluid, but not in the plasma, of COME patients. Thus, COME was associated with protein oxidation abnormalities. Oxidative stress may play a role in the etiopathogenesis of COME, and AOPPs may be used as markers of oxidative stress; however, further studies are required to confirm these findings.

Septal perforation repair: mucosal regeneration technique.

A novel method for repair of septal perforations. Fifteen volunteers with symptomatic septal perforations were recruited. Open technique rhinoplasty approach was preferred: auricular conchal cartilage graft with intact perichondrium on both sides was harvested and shaped to fit the perforated site and attached to the septum with absorbable sutures. All margins of the graft were covered with nasal mucosa. The severity of patient symptoms was assessed at preoperation, 3 and 6 months postoperatively via visual analogue scale (VAS). Crust formation, whistling, nasal blockage, epistaxis and overall comfort were evaluated. Mucosal physiology was assessed by nasal mucociliary clearance time. The mean age of the patients was 47.3 years. Average perforation size was 1.86 ± 0.78 cm. 14/15 (93.3%) perforations were repaired, and only one patient required revision surgery. VAS scores improved significantly (p < 0.001). Mean mucociliary clearance time improved from 17.6 ± 3.83 to 10.3 ± 3.30 min and 9.3 ± 3.36 min at 3 and 6 months, respectively. This is a novel, simple and safe method for repairing the deficient mucosal area in septal perforations up to 25 mm in diameter.