The role of gold weight implants in the management of paralytic lagophthalmos.

BACKGROUND: The study aims to evaluate the usage of gold weight implants and monitor complaints and comfort of patients. METHODS: A hundred and ninety-one implantations performed between January 2009 and January 2019 were analyzed. Seventy-eight patients included in this study The average age of the patients was 51.3 ± 14.5 years. Forty-five (57.7%) of them were male and 33 (42.3%) female. Patient satisfaction was measured with a questionnaire containing the most common complaints related to gold weight in the literature through telephone surveys. RESULTS: The average follow-up time was 74.5 months. Ninety-three-point-five percent of subjects had operational causes, among which the most widespread was acoustic neuroma (44.9%). The average time between facial paralysis and implantation was 141.1 days. Implantation was performed 26.6 days on average after acoustic neuroma surgery and 3.2 days on average after temporal zone malignancy surgery. Thirty-eight patients had their implants removed over either complication (n = 14) or recovery (n = 24). Recovery was the fastest after facial nerve decompression (mean= 4.75 ± 3.6 (2-10) months) and the slowest after 7-12 cranial nerve transfer (mean= 18.3 ± 8.2 (3-31) months). Twenty-six-point-nine percent (n = 21) of patients had complications, of which the most common was extrusion (n = 10). The overall satisfaction rate was 88.5% with the highest in visual acuity and the lowest in continuous requirement for artificial tear. DISCUSSION: The gold weight implantation is an effective, reversible, and easy procedure significantly reducing complaints regarding paralytic lagophthalmos. Early implementation may be beneficial for ocular complications. A dynamic facial reanimation could terminate need of implant.

Assessment of olfactory and gustatory functions in COVID-19 patients

Background/aim: This study aims to evaluate of olfactory and gustatory functions of COVID-19 patients and possible risk factors for olfactory and gustatory dysfunctions. Materials and methods: The cross-sectional study included adult patients who were diagnosed with COVID-19 in Gazi University Hospital between April 2020 and June 2020. Volunteered patients participated in a survey in which olfactory and gustatory functions and various clinical information were questioned. Sinonasal Outcome Test-22 was also administrated to all patients. Results: A hundred and seventy-one patients participated in this study. Olfactory and gustatory dysfunctions rates were 10.5% (n: 18) and 10.5% (n: 18), respectively. Patients without any symptom other than smell and taste dysfunctions were clustered as group 1 and patients who are clinically symptomatic were clustered as group 2. Olfactory dysfunction occurred in 8% of group 1 and 17.4% of group 2 (p = 0.072). Gustatory dysfunction rate of smokers was 19.7% and significantly higher than gustatory dysfunction rate of nonsmokers (5.5%) (p = 0.007). Twenty-seven-point-eight percent of the patients with olfactory dysfunction (n = 5) were male and 72.2% (n: 13) were female. Sex did not show significant effect on rate of olfactory dysfunction. Twenty-five patients participated in psychophysical olfactory function test. No participant reported olfactory dysfunction at the time of test. Of the participants, 64% (n: 16) were normosmic and 36% (n: 9) were hyposmic according to Sniffin' Stick test. Conclusion: Olfactory and gustatory dysfunctions are more common in patients who are clinically symptomatic than those diagnosed during contact tracing. Objective tests may show that frequency of olfactory dysfunction is greater than frequency of self-reported olfactory dysfunction.

Evaluation of Caldwell-Luc Operation in the Endoscopic Era: Experience From Past 7 Years.

PURPOSE: We wished to draw attention to the changes in the surgical method and indications for the Caldwell-Luc (CL) operation in the endoscopic era. PATIENTS AND METHODS: The patients who had undergone the CL operation in the previous 7 years were included in the present study. All operations had been performed by otolaryngologists. The CL operation was performed as 2 types of antrostomy: radical canine fossa antrostomy (RA) and mini-canine fossa antrostomy (MA). The surgical methods were grouped as follows: RA alone, endoscopic sinus surgery (ESS) plus RA, and ESS plus MA. RESULTS: RA alone, ESS plus RA, and ESS plus MA had been performed in 24 (25.5%), 6 (6.3%), and 64 (68.1%) patients, respectively. RA had been used for a total of 30 patients and had been combined with ESS for only 6 patients. The indications were categorized as mucosal sinus disease and odontogenic lesions. A statistically significant difference was found between the rates of the preferred antrostomy type for the treatment of sinus mucosal disease and odontogenic lesions (P < .001). CONCLUSIONS: In otorhinolaryngology practice, the CL procedure has mostly been required to provide easy access to the maxillary sinus when ESS alone would be inadequate. However, the formal CL operation, including RA, could still be considered a main surgical technique in oral and maxillofacial surgery practice.

Evaluation of Tp-e interval and Tp-e/QT ratio in major burn patients.

INTRODUCTION: Major burn injury is an acute stress reaction with systemic effects. Major burn injury has been associated with a number of cardiovascular dysfunctions, including ventricular arrhythmias. The mechanism of increased ventricular arrhythmias in burn patients uncertain. The aim of the present study was to evaluate the ventricular repolarization by using the Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio as candidate markers of ventricular arrhythmias in patients with major burn patients. In addition, the relationship between the repolarization parameters and the CRP(C-reactive protein) and ABSI(Abbreviated Burn Severity Index) score was investigated. METHODS: 55 major burn patients, 55 age and sex matched healthy subjects were included in the study between January 2017 and September 2019. The risk of ventricular arrhythmias was evaluated by calculating the electrocardiographic Tp-e and QT interval, corrected QT(QTc), Tp-e/QT and Tp-e/QTc ratios. ABSI score was calculated in burn patients. Left ventricular functions were evaluated by echocardiography. RESULTS: Tp-e interval (80.7 ±â€¯5.7 vs. 67.4 ±â€¯5.7; p < 0.001), Tp-e/QT ratio (0.21 ±â€¯0.01 vs. 0.18 ±â€¯0.01; p < 0.001) and Tp-e/QTc ratio (0.20 ±â€¯0.01 vs.0.17 ±â€¯0.01; p < 0.001) were significantly higher in major burn patients than the control group. There was a significant positive correlation between Tp-e interval, Tp-e/QTc ratio and ABSI score in major burn patients (r = 0.870, p < 0.001, r = 0.312, p = 0.020 consecutively). CONCLUSION: Our study showed for the first time in literature that the Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio, which were evaluated electrocardiographically in major burn patients, were prolonged compared with normal healthy individuals. A positive correlation was determined between repolarization parameters and ABSI score. Whether these changes increase the risk of ventricular arrhythmia deserve further studies. TAKE-HOME MESSAGE: Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio, which were evaluated electrocardiographically in major burn patients, were prolonged compared with normal healthy individuals and a positive correlation was found between these repolarization parameters and burn severity.

Thermal Chondroplasty Technique for Costal Cartilage Harvesting and Contouring.

Although costal cartilage autograft has versatile usage, harvesting the graft is an invasive procedure with potential risks for complications. Therefore, it is important to make every effort to minimize these risks. Moreover, sculpting costal cartilage to the desired shape is challenging and time-consuming because of the natural rigidity. This study aimed to evaluate cases of costal cartilage harvest in terms of the most important donor site complications and to present a novel, practical and inexpensive technique to overcome the challenges in costal cartilage harvesting and contouring. A retrospective review of patient records was made of 103 patients who underwent costal cartilage harvest by the senior author. Costal cartilage harvest was applied using either the thermal chondroplasty technique or the conventional technique on patients undergoing revision rhinoplasty surgery. The number of complications and operation times were compared between the 2 techniques.A cohort of 47 patients (30 males, 17 females; mean age 34.5 years [range, 28-48 years]) underwent costal cartilage harvest using the thermal chondroplasty technique and a cohort of 56 patients (31 males, 25 females; mean age 36 years [range, 28-52 years]) underwent costal cartilage harvest with the conventional technique. The mean operation time for the costal cartilage harvest decreased by 7.5 minutes and the total operation time decreased by 17 minutes with the use of the thermal chondroplasty technique compared to the conventional technique (P < 0.05). Complications of 2 pneumothorax and 1 hematoma developed in the conventional technique group, and no complications were seen in the thermal chondroplasty group. The results of this study suggest that the thermal chondroplasty technique is safer and time-saving compared to the conventional technique.

Isolated sphenoid sinus pathologies: a series of 40 cases

Background/aim: Isolated sphenoid sinus-derived lesions are rare and generally present with unclear symptoms. We are sharing our experience to be mindful of such lesions in differential diagnosis and to help accomplish successful treatment while avoiding revisions and complications.Materials and methods: Data from patients who underwent isolated sphenoid sinus surgeries (ISSs) were retrospectively extracted from the period of January 2005 to August 2015. Demographic data, chief complaints and presenting symptoms, imaging findings, surgical management, and results were evaluated. Results: There were 40 patients who underwent ISS. These patients had different pathologies. The chief complaint was nonspecific headache, except for cerebrospinal fluid leak patients who presented with serous rhinorrhea. Conclusion: It is critical to investigate suspicious symptoms with clinical findings and imaging techniques to avoid late diagnoses of isolated sphenoid pathologies. The transnasal approach is more minimally invasive and tissue-sparing. In our experience, we have noted that excising the inferior one-third of the superior turbinate decreases revisions. On the other hand, results show that the presence of concomitant pathology and invasive fungal disease increases the risk of revision surgery and complications.

Analysis of choanal polyps.

Choanal polyps (CPs) are unilateral benign masses usually originating from paranasal sinuses. Maxillary, ethmoid, and sphenoid sinuses are involved in order of decreasing frequency. In this study, the medical records of patients operated on with a clinical diagnosis of CP between 1998 and 2011 were reviewed. A total of 98 patients with a mean age 24.3 years were analyzed. Histopathologic diagnoses were CP in 94 patients and inverted papilloma in 4 patients. The sites of origin were maxillary sinus in 89 patients (90.8%), sphenoid sinus in 6 patients (6.1%), bulla ethmoidalis, inferior concha, and uncinate process in 1 patient each (1.0%). The most common symptoms were nasal obstruction (98.0%) and postnasal drip (30.6%). The surgical approaches were endoscopic sinus surgery in 63 patients (62.4%) unilaterally and in 12 patients (11.9%) bilaterally and unilateral endoscopic sinus surgery with mini Caldwell in 26 patients (25.7%). All 3 recurrences were in pediatric patients, and the recurrence rates among pediatric patients and overall were 7.7% and 3.1%, respectively. Endoscopic sinus surgery is an effective surgical procedure for treatment of CP; however, addition of a mini-Caldwell approach is safe for antrochoanal polyp resection if the endonasal technique fails. Histopathologic examination is mandatory because inverted papillomas may present as CPs.

Can bile acids be an etiological factor for laryngeal carcinoma?

PURPOSE: The objective of this study is to show the accumulation of bile acids in laryngeal tissues of laryngeal carcinoma patients. MATERIALS AND METHODS: The present study compared the total bile acid level in the hypopharyngeal tissue, tumor tissue, and blood of 21 primary laryngeal carcinoma patients (study group) to that in the hypopharyngeal tissue and blood of 15 patients with benign laryngeal lesions (control group). RESULTS: The total bile acid level was significantly higher in the tumor and hypopharyngeal tissues of the study group than in the hypopharyngeal tissues of the control group; however, the difference in the blood total bile acid level between the 2 groups was not significant. CONCLUSION: Bile acids in reflux material accumulate in the laryngeal tissue in laryngeal carcinoma patients; therefore, bile acids should be considered a carcinogenic factor in the etiology of laryngeal carcinoma because of their mutagenicity due to DNA breaking, as they cause chronic inflammation due to intracellular accumulation.

Does evaluation of tumor volume or/both origination site better guide to optimal surgery for inverted papilloma?

INTRODUCTION: Sinonasal inverted papilloma is noted for its high rate of recurrence. Staging systems aid to reduce recurrence and avoid excessive surgeries by guiding the selection of the optimal surgical approach. OBJECTIVE: To evaluate the effectiveness of different endoscopic approaches in inverted papilloma by assessing tumor origin site and tumor volume. METHODS: Krouse classification system that is based on tumor volume was used for staging; furthermore, tumor origin sites were grouped as lateral nasal wall, medial wall and other walls of maxillary sinus. The main treatment method for all patients was endoscopic sinus surgery. Endoscopic extended middle meatal antrostomy, endoscopic Caldwell-Luc and endoscopic medial maxillectomy were the additional surgery types performed in different combinations. RESULTS: Fifty-five patients (42 male) with a mean 54.9±14.4 years of age were included. 37 patients were diagnosed with advanced stage inverted papilloma (67.2 %). Recurrence was observed in 12 patients (21.8 %). In early stage lateral nasal wall origination, no recurrence was observed in the simple tumor resection group (0/10). In early stage medial wall origination, no recurrence was observed in the extended middle meatal antrostomy group (0/8). In advanced stage medial wall origination, the recurrence rates of extended middle meatal antrostomy, extended middle meatal antrostomy+endoscopic Caldwell- Luc and endoscopic medial maxillectomy were 100.0 %, 53.8 % and 13.6 %, respectively (p=0.002). In advanced stage other walls of maxillary sinus origination, recurrence rates of extended middle meatal antrostomy+endoscopic Caldwell-Luc and endoscopic medial maxillectomy were 20 % and 16.6 %, respectively (p=0.887). CONCLUSION: Tumor origin site, tumor stage and surgery types show an impact on recurrence. Despite the fact that tumor origin site singly could lead to appropriate selection of the surgery type in most cases, tumor stage carries substantial importance in selection of surgery type for sinonasal-inverted papilloma. An operation plan regarding both tumor volume and tumor origin site may aid surgeons in selecting optimal endoscopic surgical method to avoid recurrence or excessive surgeries.

Perioperative Severe Anaphylaxis to Paracetamol in a Child.

The data on perioperative anaphylaxis (PA) in children is limited and usually reported with neuromuscular blocking agents and antibiotics. However we present a first pediatric case who developed PA with paracetamol unlike the literature.

Histopathological examination of the effects of radiofrequency treatment on mucosa in patients with inferior nasal concha hypertrophy.

Radiofrequency reduction has become one of the most popular methods in the treatment of inferior nasal concha hypertrophy. During surgical treatment of inferior nasal concha hypertrophy, it is important to cause minimal injury to the overlying ciliated epithelium, since if the ciliated structure of this epithelium is permanently disrupted, it is hard to carry out one of the important functions of lining of the nasal cavity, mucociliary clearance. In this study, the ultrastructure of inferior nasal concha epithelium was examined by transmission and scanning electron microscopy in 40 patients with inferior nasal concha hypertrophy. The biopsy specimens were taken before the radiofrequency treatment and 8 weeks after the radiofrequency treatment. Then, the effects of radiofrequency treatment on concha epithelium and morphology of ciliae were examined ultrastructurally. In the scanning and transmission electron microscopic examination of the tissue samples taken before radiofrequency treatment, no ultrastructural pathology was observed in the number and morphology of the ciliae and the inferior nasal concha epithelium. The biopsy specimens obtained 8 weeks after radiofrequency treatment also did not show any ultrastructural pathology in these parameters. However, in the transmission electron microscopic examination of the subepithelial tissue, fibrosis was observed in local areas in the biopsy specimens obtained 8 weeks after radiofrequency treatment. In conclusion, the results obtained from this study suggest that ciliated epithelium of the inferior nasal concha is not destroyed by radiofrequency reduction.

Role of nitric oxide synthase gene intron 4 and exon 7 polymorphisms in obstructive sleep apnea syndrome.

The objective of our study was to assess the association of eNOS4 and eNOS296 polymorphisms of endothelial nitric oxide synthase (eNOS) gene with obstructive sleep apnea syndrome (OSAS). Forty-eight patients with OSAS and 181 healthy volunteers were included in the study. Genotype analyses were performed for eNOS intron 4 VNTR and exon 7, Glu298Asp (G --> T) polymorphisms. There was no significant difference between the patients and controls regarding eNOS4 polymorphism (P > 0.05). There was a significant difference between the patients and controls regarding eNOS296 polymorphism. Glu/Asp variant was more frequent whereas Glu/Glu variant was less frequent in the patients compared to controls (P < 0.001). There was no relationship between eNOS4 and eNOS296 polymorphisms and polysomnography parameters, apnea-hypopnea index, age, gender, body weight and height, body mass index, hypertension, coronary artery disease, arrhythmia, diabetes mellitus, hypercholesterolemia and smoking (P > 0.05). The eNOS4 polymorphism of NOS gene is not associated with OSAS. However, eNOS296 polymorphism of NOS gene is associated with occurrence of OSAS, but not with severity of OSAS.

Pleomorphic adenoma of the nasal columella.

Pleomorphic adenoma (mixed tumor) is the most common benign neoplasm of the salivary glands. It is considered to occur primarily in the major salivary glands, such as the parotid and submandibular glands. It is much less common in the minor salivary glands, and rarely occurs at other sites, such as larynx, pharynx, trachea, lacrimal gland, and sinonasal tract. An external nose localization of this lesion is very rare. Irrespective of the site where the lesion originates, its preferred treatment should be surgery. We describe a very rare case of recurrent pleomorphic adenoma originating from the columella.

Tonsillar regrowth following partial tonsillectomy with radiofrequency.

OBJECTIVES: To assess regrowth potential of the tonsils following partial tonsillectomy performed by using radiofrequency. METHODS: Follow-up results of 42 children (aged from 1 to 10 years) who consecutively had partial tonsillectomy with radiofrequency due to obstructive sleep apnea or snoring were evaluated for regrowth of the tonsils. RESULTS: Regrowth of the remaining tonsillar tissue was observed in 7 of 42 patients (16.6%). The upper respiratory tract obstruction symptoms recurred in 5 of these 7 patients while the remaining 2 patients were asymptomatic. The tonsils of symptomatic patients were removed completely. CONCLUSION: Partial tonsillectomy may have a significant potential for regrowth and thereby recurrence of the obstructive symptoms. Although the cause of this regrowth remains unknown, this problem should be remembered by the surgeons, and an informed consent should be obtained from the families prior to radiofrequency tonsillotomy.

Surgical treatment of elongated styloid process: experience of 61 cases.

AIM: To describe the management of patients with elongated styloid process syndrome (Eagle's syndrome). MATERIALS AND METHODS: Sixty-one patients with elongated styloid process were treated between 2000 and 2005. Computed tomography examination defines those whose symptoms suggest the diagnosis. Patients with styloid processes longer than 25 mm were treated by surgical resection. RESULTS: Fifty-seven (93.4%) of 61 patients treated for Eagle's syndrome became asymptomatic after resection. There were no serious complications. CONCLUSION: Patients with clinically and radiologically established elongated styloid process can be managed successfully by surgical resection using an external approach.

A case of greater occipital nerve schwannoma causing neuralgia.

Schwannomas are common tumors of the head and neck region, but they rarely develop in the suboccipital region. A 34-year-old woman presented with a left suboccipital mass causing local pain and neck stiffness. Following physical examination, fine needle aspiration biopsy was performed, which revealed benign cytology. In the light of preoperative radiologic examination and intraoperative observations, the lesion was thought to originate from the greater occipital nerve. Following complete excision of the lesion, histopathological diagnosis was made as schwannoma. Apart from mild neck stiffness and transient local paresthesia in the early postoperative period, no complications were seen during a two-year follow-up period.

Facial schwannoma of the parotid gland in a child.

Schwannomas may rarely arise from the facial nerve and most commonly occur in the intratemporal part of the nerve. Extratemporal facial nerve schwannomas are extremely rare. Intraparotid schwannomas usually develop in adults and only one pediatric case has hitherto been reported. Herein, we reported the second case of facial nerve schwannoma in a 7-year-old boy who presented with a slow growing, painless preauricular mass of three-year history. Superficial parotid ultrasonography revealed a solid mass with homogenous echogenicity originating from the superficial parotid lobe. There was no facial nerve dysfunction. Superficial parotidectomy was performed. The main truncus and main branches of the facial nerve were found intact. The mass, nearly 3x3 cm in size, was originating from a communicating nerve between the marginal mandibular and buccal branches of the facial nerve. The tumor was removed together with this communicating branch. Histopathologic examination revealed schwannoma. Facial nerve functions were normal after the operation, and no recurrence was encountered in a six-month follow-up.

Neurocognitive disorders and sleep in children with primary ciliary dyskinesia.

BACKGROUND: Primary ciliary dyskinesia (PCD) patients have higher incidence of sleep disordered breathing which lead neurocognitive impairments such as attention-deficit/hyperactivity disorder (ADHD). It may effect academic performance of children and may cause impairment in emotional relationships. This study aim to evaluate hyperactivity and attention deficiency in PCD patients and investigate the relationship between sleep and hyperactivity and attention deficiency in PCD patients. METHOD: Fifteen PCD patients aged 8-18 years and 31 age-matched healthy controls were compared. Ear, nose, and throat examination and home sleep testing were performed in PCD patients. Pediatric sleep questionnaire, Conners' Parents and Teacher scale and Stroop test were applied in both groups in order to investigate the relation between sleep disordered breathing and ADHD in PCD children. RESULTS: PCD patients had chronic rhinosinusitis (100%), tonsillar hypertrophy (80%) and adenoidal hypertrophy (60%). FEF25-75 was low in pulmonary function test. Sixty percent of the PCD patients had mild obstructive sleep apnea syndrome in home sleep testing. Mean AHI was 1.54 ± 0.27. Compared with the controls PCD patients had higher PSQ scores. Hyperactivity scores on Conners' Parents scale and inattention findings in Stroop test were higher in PCD patients than the healthy controls (P < 0.05). CONCLUSION: Most of PCD children had mild obstructive sleep apnea syndrome. Hyperactivity and inattention findings were higher in PCD patients. Sleep disordered breathing assessment should be a routine part of PCD patients management and these patients should be carefully monitored in terms of hyperactivity and inattention.

Impact of Jacobson's (tympanic) nerve sectioning on middle ear functions.

OBJECTIVE: The purpose of this study was to evaluate the influence of sectioning of the Jacobson's (tympanic) nerve on middle ear functions. METHOD: Twenty-five adult New Zealand rabbits were included in this study. The Jacobson's nerve was cut in the left ear of the rabbits (study group), whereas only a small mucosal incision was performed while keeping the Jacobson's nerve intact in their right ear (control group). After the operation, the ears were assessed both otomicroscopically and histopathologically on Days 30, 60, and 90. RESULTS: On otomicroscopy, retraction pockets were observed in 48 and 4% of the ears in the study and control groups, respectively (p < 0.001). Middle ear effusion was observed in 56 and 12%, respectively (p < 0.01). Histopathologically, an inflammation in the middle ear mucosa was present in all ears in the study group, whereas it was present only in 20% of the control ears (p < 0.001). Goblet cells were observed in 48 and 20% in the study and control groups, respectively (p < 0.04). In the study group, the otomicroscopic and histopathologic findings were more prominent on Day 60 compared to Day 90 (p < 0.05). CONCLUSION: Tympanic glomus cells seem to act as middle ear chemosensory organs and are involved in the regulation of middle ear aeration. Disruption of these neural elements such as Jacobson's nerve negatively impacts on middle ear functions and may result in atelectasis.

[Hemodynamic effects of local anesthetics with adrenaline during septal surgery]. / Nazal cerrahide adrenalinli lokal anestetiklerin hemodinamik etkileri.

OBJECTIVES: We investigated the hemodynamic effects of local anesthetics with adrenaline used before septal surgery. PATIENTS AND METHODS: In a prospective, controlled design, administration of local anesthetics was performed with and without adrenaline in 39 patients and 10 patients, respectively, undergoing septal surgery. Plasma adrenaline concentrations were measured before anesthesia, and after 2, 5, and 10 minutes from anesthesia. The patients were monitored with respect to pulse rate, electrocardiographic findings, and blood pressure. RESULTS: Preoperative plasma adrenaline levels were similar in patients receiving local anesthetics with or without adrenaline (0.8 nmol/l vs 0.7 nmol/l). Following adrenaline administration, adrenaline levels showed significant increases to 2.2, 1.9, and 1.7 nmol/l after 2, 5, and 10 minutes, respectively (p<0.001), whereas they remained similar in the control group. No side effects related to adrenaline use were detected. CONCLUSION: Despite systemic absorption of local injections, adrenaline-related side effects during septal surgery are extremely rare when the patients are closely monitored.