A Giant Cervical Lymphangioma.

Cervical lymphangiomas are benign congenital malformations of lymphatic system usually seen in children under 2 years of age. It is rare in adults. They can be seen in any part of the body but the most common area in the neck region is posterior triangle. They usually present as asymptomatic masses. There are various ways of treatment, but the most common treatment modality is surgical resection. Here, the authors present a giant lymphangioma in the neck region of an adult who is treated with surgical resection without any complication.

Frontal Mucocele Extended Orbita and Endoscopic Marsupialization Technique.

Mucocele is benign, slow-growing, mucous-filled cystic lesions that arise in the paranasal sinuses. It causes progressive distension of the bony walls and induces compressive symptoms. Surgical treatment of paranasal sinus mucoceles includes endoscopic approach or external approach. The authors report a patient of frontal mucocele who presented with a history of progressive unilateral protrusion. Computed tomography scan revealed a large mucocele of the frontal sinus with orbital extension on the same side. He was successfully treated with endoscopic marsupialization without any serious complications.

A Giant Lymphangioma on the Neck.

Lymphangioma is a congenital malformation of the lymphatic system, which is located mostly on the head and neck region. Most of the cases are seen at age younger 2 years. It is rare in adult population and when detected, it can be treated with surgical excision. We present a 50-year-old patient with giant lymphangioma on the posterior cervical region of the neck treated by surgical treatment successfully.

A new preserved technique for laryngocele: modified lateral thyrotomy approach.

Laryngocele is a benign abnormal dilatation of the laryngeal saccule. We present a 30-year-old male patient who complained with hoarseness since 1 year. Paraglottic laryngocele is detected on medical examination. The patient is operated on successfully with our new thyroid cartilage preserved technique (modified lateral thyrotomy method).

Complicated giant mucoceles of the frontal sinus: approach to endoscopic marsupialization technique.

A number of external and radical procedures have been the only surgical approaches for the treatment of frontal sinus mucoceles. However, these procedures have major complications including high surgical morbidity, esthetic concerns of postoperative scar formation, and difficulty in radiologic diagnosis of recurrence after obliteration. In this clinical report, we demonstrated an endoscopic marsupialization technique that could easily be applied to a very large mucocele that has extended to the intracranial region, without any serious complications.

Quality of life in patients with persistent allergic rhinitis treated with desloratadine monotherapy or desloratadine plus montelucast combination.

OBJECTIVES: This study aims to compare the effectiveness of desloratadine monotherapy and desloratadine plus montelukast combination therapy on quality of life in patients with persistent allergic rhinitis. PATIENTS AND METHODS: This study consists of 40 patients (28 females, 12 males, mean age 29.8 years; range 17 to 44 years) referred to ear, nose, and throat outpatient clinic between May 2010 and September 2010. A six-week randomized, double-blind, cross-sectional study was performed in two arms: In group 1, 20 patients received desloratadine (5 mg/d) alone; in group 2, 20 patients received desloratadine (5 mg) plus montelukast (10 mg) combination therapy. Quality of life was assessed on the day before starting treatment and on the last day of each treatment period using the Rhinoconjunctivitis Quality of Life Questionnaire and Nighttime Symptom Scores. RESULTS: In group 1, the mean quality of life scores before and after treatment were 3.17 and 2.43, respectively. In group 2, the mean quality of life scores before and after treatment were 2.94 and 1.73, respectively. CONCLUSION: Desloratadine plus montelukast combination therapy may have a positive impact on quality of life, sleep symptoms in particular.

Severe destruction of the upper respiratory structures after brief exposure to a dieffenbachia plant.

Dieffenbachia is a common domestic plant. Oral contact with the plant generally causes slight effects, but when chewed it may result in painful oropharyngeal edema. Even though the mechanism through which this plant causes toxicity is not known, calcium oxalate crystals (rhaphides) and protease in the idioblast of the plant are considered to be the causes. Our aim was to show the lethal effects of a common domestic plant named Dieffenbachia.A 70-year-old male patient applied to our clinic with aphasia, dysphagia, sialorrhea, wounds on the lips and tongue, and swelling on the face. There was edema on his tongue, soft palate, uvula, anterior pharyngeal plica, epiglottis and aryepiglottic fold, and ulceration on the right side of his tongue, the right cheek mucosa, right-lower gingival, soft palate, tongue base, epiglottis anterior surface, and free edge.Dieffenbachia toxicity presents both minimal and serious problems, which can be life threatening, as in our case. Toxic cases resulting in serious clinical pictures due to Dieffenbachia are rare.

Expression Levels of Glutathione S-Transferase and Cytochrome P450 Isoenzymes in Nasal Polyp Tissue.

Nasal polyps are benign sinonasal masses composed of eosinophils and extracellular edema. Pathogenesis of the polyp formation is unclear but several studies strongly suggest a correlation with infection, inflammation and allergy conditions. Our aim is to investigate the potential link between allergy and nasal polyp in tissue level. Nasal polyp group included 60 patients whose diagnosis was confirmed with biopsy and the control group included 38 healthy patients. Tissue sample of the control group was taken from inferior turbinate mucosa under local anesthesia and nasal polyp tissue was collected from functional endoscopic sinus surgery. The glutathione S-transferase (GST) and cytochrome P450 (CYP) isoenzyme expressions of the tissue samples were investigated under light microscopy and graded by a senior pathologist. GSTP1 protein expression was significantly higher in tissue samples from nasal polyp group compared to that of control group (p < 0.05). However, CYP1A1, GSTM1 and GSTA1 isoenzymes were not different between the two groups (p > 0.05). We have found that GSTP1 isoenzyme was elevated in nasal polyp tissue compared to the control. The increase in protein expression of GSTP1 might have occured as a tissue response to the increased oxidative stress thus suggesting a role of GSTP1 in polyp formation.

Huge internal carotid artery aneurysm presenting as tonsillar asymmetry.

Aneurysms of the extracranial portion of the carotid artery are extremely rare. Internal carotid artery aneurysm is an uncommon cause of tonsillary asymmetry. Although internal carotid artery aneurysms usually remain asymptomatic, the clinical manifestation requires the tonsillar enlargement. Asymmetry as a sole determining factor for tonsillectomy may lead to unnecessary operations. We report a patient with a giant internal carotid artery aneurysm presenting as tonsillary asymmetry that might be mistaken for a tonsillar neoplasia. When faced with a tonsillar asymmetry, an otolaryngologist must keep aneurysms in mind.

Laryngeal granular cell tumor; rare location.

Granular cell tumors are benign subcutaneous or submucosal lesions of neurogenic origin. In this case study one patient was diagnosed and treated successfully with complete surgical resection of a laryngeal granular cell tumor that was originated from the left arytenoid region that very rare location. There is no evidence of recurrence 2 years after surgery. Granular cell tumors should be considered in the differential diagnosis of laryngeal masses, particularly in the posterior glottis.

A Retrospective Analysis of Nasopharyngeal Biopsy Results in Adult Patients.

Introduction The widespread use of endoscopic evaluation in otolaryngology practice enables early diagnosis and treatment of nasopharyngeal cancers. This study aimed to evaluate the complaints, endoscopic examination findings, preferred radiological imaging methods, and pathology results of patients who underwent endoscopic nasopharyngeal biopsy. Methods Medical records of 956 patients (543 males and 413 females) who underwent nasopharyngeal biopsy between 2013 and 2018 were analyzed retrospectively. Age, gender, application complaint, endoscopic imaging findings, preferred radiological imaging methods, and biopsy results of the patients were retrospectively analyzed. The patients were grouped as benign and malignant according to their pathological diagnosis. Statistical evaluation was made between the benign and malignant groups in terms of parameters. Results The age range of the patients was 16-88 years. Pathology results of 102 patients were reported as malignancy. The most common malignancy was undifferentiated non-keratinized carcinoma (2.5%). The most frequently reported benign pathology was chronic nonspecific inflammation. The most common complaint was nasal congestion, which was observed at a rate of 63.1%. The most frequently requested radiological imaging was MRI with 43.1%. Conclusion The image of the masses found during endoscopic examination is very important to make a decision of malignancy. Even if the repeated biopsy is performed in patients with biopsy due to suspicious mass or with additional symptoms for nasopharyngeal carcinoma, radiological imaging is important for the exclusion of malignancy.

The Effect of Antioxidant Agents on Cisplatin-Induced Laryngeal Histological Alterations in Rats.

The larynx-related adverse effects that depend on cisplatin decrease patient comfort and many antioxidants have been used to eliminate these side effects. We aimed to identify the laryngeal mucosal changes imposed by cisplatin and investigated whether antioxidants, and their healing effects on these changes, may help reduce laryngeal complications in patients resulting from adverse effects in the larynx. A rat model was designed to evaluate the effects of cisplatin on the larynx and the protective role of antioxidants. Single-dose cisplatin was given both intraperitoneally alone and additionally administered with p-coumaric acid, melatonin, resveratrol, vitamin D, and oleic acid over 5 days. Whole larynges were dissected and evaluated histologically, histochemically, and immunohistochemically. Varying degrees of mucosal changes cisplatin group, but neither erosion nor an ulcer was observed. Numerous variable histological effects of antioxidants were observed on cisplatin exposed laryngeal mucosa. The most obvious effects of cisplatin were edema. The results of the study showed that resveratrol was the most preventive antioxidant agent against cisplatin-dependent mucosal changes. The highest increase in the Ki67 index was in the oleic acid group. Vitamin D increased stromal cyclooxygenase-2 expression that may have an effect on increasing mucosal damage.

An analysis of skin prick test reactions in allergic rhinitis patients in Istanbul, Turkey.

This retrospective, population-based study reviewed skin prick test (SPT) results against various allergens of 1,552 patients with allergic rhinitis (AR) in the district of Kartal, Istanbul, Turkey. The skin prick tests yielded a positive result in 946 patients (60.9%). Seven hundred and forty-give (48%) patients had perennial AR, 558 (36%) perennial AR with seasonal exacerbations and 249 (16%) had seasonal AR. The prevalence of AR was highest in the age of 21-40 years with 48.7%. The allergen group with the highest SPT positivity was pollens at 44.3%, followed by molds at 38.4%, mites at 35.1%, and epithelia-insect at 30.8%. The strongest single allergen was Altemaria altemata with 33.3%, followed by Dermatophagoides farinae with 29.3%, Dermatophagoides pteronyssinus with 25.3% and a mix of four cereals (barley, maize, oat, wheat) with 25.2%. This information will help etiological research as well as the development of more efficient treatment plans for patients with allergic rhinitis in our country.

Microscopic guide to the middle ear anatomy in guinea pigs.

OBJECTIVES: To reveal microscopic surgical anatomy of the middle ear in guinea pigs (GPs). MATERIALS AND METHODS: Twenty ears of GPs were dissected under dissection microscopy via inferior approach. By using digital equipment, the most suitable photograph was taken for each step. Differences and similarities between the ears of GPs and those of human beings are discussed to show the advantages and disadvantages of the GP ear for experimental studies. RESULTS: Tympanic membrane of the GP merely consists of pars tensa and above this there is a bony segment called as supratympanic crest. There were two spaces called bulla and hypotympanium in the GP,s middle ear. Cochlea, which is normally found in the inner ear in humans, separates these two spaces. Upper part of this space which is called epitympanium is a slit like cavity having a bony complex called malleoincudal complex. Bulla, the largest cavity in the middle ear, is a hemispherical cavity having a smooth surface. It corresponds to hypotympanum and mesotympanum of human middle ear. Cochlea has 3.5 turns from basal turn to apical turn. While the oval window is placed vertically, the round window is placed horizontally. While the stapes is almost identical to that of the humans, there is a bony bridge between the crura of the stapes called crista stapedius. Stapes can not removed unless this bony bridge is taken. CONCLUSION: The middle ear in GP differs from the human middle ear in many aspects. Researchers who are planning to the study with this animal model should be aware of all these differences.

[Infraorbitally located tuberculous lypmhadenitis: a case report]. / Infraorbital yerlesimli tüberküloz lenfadenit: Olgu sunumu.

Tuberculosis, which is one of the oldest diseases of the human kind, is again becoming an important health issue in recent years. Although mostly seen in lungs, it can also be localized in the lymph nodes, skin, meninges, spleen, surrenal tissues, which is referred to as extrapulmonary forms of tuberculosis. Tuberculous lymphadenitis is the most common clinical form of extrapulmonary tuberculosis and it is generally localized in cervical lymph nodes. A 50-year-old female patient presented with a hard fixed mass originating from medial canthus ending at nasolabial sulcus. In the magnetic resonance imaging examination, a solid contrast enhancing mass 20 x 18 x 15 mm in size, which was isointensely monitored with muscular structures in T1 based visuals and hyperintense in T2 sequences, was seen. The mass was excised under general anesthesia and histopathological examination revealed tuberculous lymphadenitis. Thus, the case is discussed according to literature and shows us that tuberculosis may be the reason for lymphadenitis in the areas out of the cervical region and it should always be kept in mind in the differential diagnosis.

[The comparison of the expansion of polyps according to the Ki-67 and computed tomography scores]. / Polip yayginliginin Ki-67 ve bilgisayarli tomografi skorlarina göre karsilastirilmasi.

OBJECTIVES: The disease extention in nasal polyps was compared by using the mitotic activity rates and the computed tomography scores. PATIENTS AND METHODS: This study was conducted on 19 nasal polyposis patients (8 males, 11 females; mean age 40.0+/-13.7 years; range 20 to 63 years). The preoperative computed tomography records of the patients were evaluated according to the Lund-Mackay grading system. The polyp tissues of the same patients were stained with the Ki-67 antigen for immunohistochemical evaluation. The correlation between the radiologic results and the Ki-67 values was compared by means of the Spearman's correlation test. RESULTS: The mean computed tomography score was observed as 14.3+/-4.7 (range 7-24). The mean Ki-67 score resulting from the immunohistochemical staining was calculated as 24.3+/-18.5 (range 3.3-73.5%). A significant correlation was determined between the Ki-67 values and the computed tomography scores. ("Spearman's" correlation factor: 0.677; p<0.001). CONCLUSION: As the mitotic activity rate of nasal polyps increases, both the volume of the polyps and the computed tomography scores increase as a result of the blockage of the sinus ostiums by the increased polyp volume.

The effect of curcumin on healing in an animal nasal septal perforation model.

OBJECTIVES/HYPOTHESIS: We investigated the effect of intranasal topical curcumin on nasal septum mucosa wound healing in a nasal septal perforation model produced in rabbits. STUDY DESIGN: Experimental study. METHODS: Fourteen male New Zealand rabbits were included in the study. For each rabbit, 5-mm-diameter circular perforations were created at 5 mm away from the columella to the nasal septum. Curcumin (study group) and saline (control group) were administered intranasally once daily for 10 days. At the end of the 10th day, the animals were sacrificed and the nasal septum specimens were sent for histological examination. Epithelial regeneration and degeneration, cartilage degeneration and regeneration, presences of fibroblast, eosinophil, acute/chronic inflammatory and giant cells, capillary density, amounts of granulation tissue and collagen, and macroscopic closure rate of perforation parameters were compared in each group. RESULTS: Epithelial and cartilage regeneration, and the amounts of collagen and granulation tissue were significantly higher in the curcumin group compared to the control group (P < .05). No statistically significant difference was found in comparison of other parameters (P > .05). CONCLUSIONS: Topical application of curcumin improves the wound-healing process of nasal septum perforation in the animal model. Therefore, curcumin can be used as a safe and effective medical agent to prevent the development of septal perforation. LEVEL OF EVIDENCE: NA Laryngoscope, 129:E349-E354, 2019.

Glutathione S-transferase enzyme activity and protein expression in patients with recurrent tonsillitis and idiopathic tonsillar hypertrophy.

OBJECTIVES: The palatine tonsil is a significant part of the secondary immune system. Tonsillitis and idiopathic tonsillar hypertrophy (ITH) are the most common pathologies of this component. Although there are studies on their pathogenesis, there is insufficient study of the role of antioxidant agents. Glutathione S-transferase (GST) isozymes contribute to the antioxidation reactions in the tissue via the glutathione pathway. The purpose in this study was to reveal the levels of the GST enzyme activity and protein expression of GSTP1 and GSTA1 isozymes in patients with tonsillitis and tonsil hypertrophy, and to investigate their role in the pathogenesis of these diseases. MATERIALS AND METHODS: Sixteen patients with recurrent tonsillitis and 5 patients with ITH and were included in the study. Cytosolic extracts were prepared from post-tonsillectomy tissues of both patient groups and GST enzyme activities were measured. RESULTS: The expression of GSTP1 was found to be significantly higher than GSTA1 in tissue samples of patients with ITH and recurrent tonsillitis (P<0.001). Increased GST activity and GSTP1 isozyme expression were shown in patients with recurrent tonsillitis compared to the idiopathic tonsillar hypertrophy study group. There was a positive correlation between the expressions of GSTP1 (P=0.040; r=0.47). CONCLUSION: Increased GST activity and GSTP1 isozymes were demonstrated histologically in the pathogenesis of ITH and recurrent tonsillitis. We believe that the data of changes in antioxidant capacity, obtained from studies with more extensive and larger samples, would support our findings.

Nasal Congenital Panfollicular Nevus.

Congenital nasal midline lesions are rarely observed pathologies. While relatively frequently encountered lesions are dermoid cyst, glioma, encephalocele, nasal polyp and epidermoid cyst, an other very rare reason is the congenital panfollicular nevus. The treatment of this syndrome appearing with a recurrent discharge in clinic is the surgical excision. We will hereby present the excision of the case of congenital panfollicular nevus with three different fistula openings.

Prevalence of adenoid hypertrophy and nocturnal enuresis in primary school children in Istanbul, Turkey.

OBJECTIVE: The purpose of this study is to investigate the prevalence of an existing relationship between adenoid hypertrophy and nocturnal enuresis in primary school children. METHODS: The study was performed in four primary schools that were chosen randomly in Kartal, Istanbul. The children's parents were asked to fill out a questionnaire that included questions concerning the associated symptoms of adenoid hypertrophy and nocturnal enuresis. The interrelations between adenoid hypertrophy and nocturnal enuresis items were examined by X2 tests. RESULTS: The study population consisted of 1132 (625 girls, 621 boys) primary school children between 5 and 14 years of age (mean 9.59+/-2.60 years). The children were divided into three groups with 5-7 years old children in Group I (n=232), 8-10 years old children in Group II (n=506) and 11-14 years old children in Group III (n=394). Of the 1132 distributed questionnaires, 1090 (87.4%) were filled in adequately and were accepted for evaluation. Prevalence of adenoid hypertrophy in school children was found to be 58 in Group I (27%), 94 in Group II (19.5%) and 78 in Group III (19.9%). Prevalence of nocturnal enuresis in school children was found to be 35 in Group I (15.1%), 51 in Group II (10.1%) and 18 in Group III (4.6%). No statistically significant association was present between adenoid hypertrophy and nocturnal enuresis in either Group I, II or III school children. CONCLUSION: In contrast to previous studies, our prevalence study did not find an association between adenoid hypertrophy and nocturnal enuresis. Thus, this prevalence study provides otolaryngologists new and interesting information.