Effects of phenytoin injection on vocal cord healing after mechanical trauma: An experimental study

Background/aim: Phenytoin is an anticonvulsant drug which causes fibroblast proliferation, collagen synthesis, and an increase in epidermal growth factor. Therefore, the aim of the present study is to evaluate the effect of phenytoin injection on the wound healing process in rats with vocal cord injury by histopathological methods. Materials and methods: The vocal cords of 10 albino Wistar rats were damaged bilaterally; the left vocal cord was kept as the control group. Phenytoin was injected in the right vocal cord. Ten rats were sacrificed. The thickness of the lamina propria and density of the fibroblast and collagen were evaluated histopathologically. Results: Thickness of the lamina propria was 18.0 ± 7.1 µm in the control group, 65.5 ± 10.7 µm in the phenytoin group. The density of fibroblast and collagen were statistically lower in the control group compared the phenytoin group (P < 0.05). Conclusion: Phenytoin injection in rats after vocal cord injury significantly increased the thickness of the lamina propria and density of fibroblast and regular and mature collagen in the lamina propria. The findings in our study provide a feasible scientific view for adding phenytoin treatment to vocal cord surgeries in otolaryngology practice, but further studies are needed in order to evaluate the use of phenytoin in preventing the formation of scar tissue and possible effects on vocal cord vibration in humans after vocal cord injury.

The effect of hypoxia on hearing function

Background/aim: This study was conducted to determine the critical partial oxygen pressure (pO2) value that would impair hearing function by evaluating the effects of hypoxia on hearing function in subjects diagnosed with chronic obstructive pulmonary disease (CPOD). Materials and methods: The study included 25 male and 5 female patients referred to our clinic who were diagnosed with COPD, according to spirometry and PaO2 values, and who did not show pathology upon autoscopic examination. The control group consisted of 14 female and 16 male patients who had no lung disease and were in the same age range as the COPD group. Results: A statistically significant difference was found between the two groups for distortion-product otoacoustic emission (DPOAE) (P < 0.001). The COPD group was divided into two groups according to pO2 levels (pO2 ≤ 70 and pO2 > 70) in order to find a critical pO2 level which might cause significant change at a certain audiological extent. Conclusion: Hypoxia causes long-term decline in hearing thresholds, deterioration of DPOAE results, and prolongation of I­V interpeak latency in auditory brainstem response. However, the critical oxygen level that disrupts hearing function could not be determined.

Vestibular evoked myogenic potential responses in obstructive sleep apnea syndrome.

Obstructive sleep apnea syndrome (OSAS) provokes oxidative stress and ischemia, which affects the central nervous system. The degeneration of neurons in the brainstem due to periodic hypoxia can be evaluated by vestibular and audiologic tests. The objective of this study is to determine brainstem damage in severe OSAS patients with the help of vestibular evoked myogenic potential (VEMP) responses. Prospective, randomize, double-blind. Research-training hospital. We compared cervical vestibular evoked myogenic potential (cVEMP) responses between severe OSAS patients and a control group. 54 patients were included and divided into the OSAS group, with severe OSAS (apnea-hypopnea index, AHI >70), and a control group with snoring without OSAS (AHI <5). Both groups underwent cVEMP. Bilateral recordings with simultaneous binaural logon stimulations were used during VEMP recordings. The existing p1n1 and n2p2 responses, p1, n1, n2, and p2 latencies and amplitudes, and p1n1 and n2p2 intervals were measured. Statistically significant differences were revealed between patients and controls for the response rate of the p1n1, n2p2 and p1n1, n2p2 amplitudes. There were no significant differences between the two groups with respect to the latencies of p1, n1, n2 and p2, or the p1n1 and n2p2 intervals. The VEMP response rate was lower in severe OSAS patients, and all amplitudes were shorter than in healthy subjects. VEMP recordings in severe OSAS subjects demonstrates abnormalities in brainstem pathways. It appears that brainstem damage in severe OSAS can be detected by cVEMP recordings.

Association between XRCC3 Thr241Met polymorphism and laryngeal cancer susceptibility in Turkish population.

DNA repair systems are essential for normal cell function. Genetic alterations in the DNA repair genes such as X-ray repair cross-complementing group 3 (XRCC3), can cause a change in protein activity which results in cancer susceptibility. The aim of this study was to investigate the association of XRCC3 Thr241Met single nucleotide polymorphism (SNP), smoking and alcohol consumption with the risk of laryngeal cancer in Turkish population. The frequencies of Thr241Met SNP were studied in 58 laryngeal cancer cases (SSC) and 67 healthy individuals. Genomic DNA was isolated from peripheral blood samples of both controls and laryngeal cancer cases. Thr241Met SNP was genotyped by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. The genotype and allele frequencies of Thr241Met polymorphism were not statistically significant between the laryngeal cancer and control groups. Carrying mutant allele was not associated with the risk of laryngeal cancer. On the other hand, smoking and chronic alcohol consumption were associated with the risk of laryngeal cancer but there is no association between Thr241Met, smoking and alcohol consumption in laryngeal cancer cases. These results indicate that Thr241Met polymorphism was not associated with the development of laryngeal cancer in Turkish population. However, it should be kept in mind that the association of a polymorphism with cancer susceptibility can differ due to several factors such as cancer type, selection criteria, ethnic differences and size of the studied population.

Detection of XRCC1 gene polymorphisms in Turkish head and neck squamous cell carcinoma patients: a comparative analysis with different populations.

PURPOSE: X-ray repair cross-complementing (XRCC1) is one of the most important genes for the maintenance of genomic integrity and protection of cells from DNA damage. Although tobacco and alcohol consumption are the major risk factors for the development of head and neck squamous cell carcinoma (HNSCC), sequence variation in XRCC1 gene may alter HNSCC susceptibility. Reports on the relationship between HNSCC and polymorphisms in XRCC1 gene have been inconsistent so far. The aim of this study was to investigate the association of XRCC1 Arg194Trp and Arg399Gln single nucleotide polymorphisms (SNP), smoking and alcohol consumption with the risk of HNSCC in Turkish population and also to compare to these results with the ones from both Turkish and different populations in the literature. The frequencies of Arg194Trp and Arg399Gln SNPs were studied in 55 HNSCC and 69 healthy individuals. METHODS: Genomic DNA was isolated from peripheral blood and SNP was genotyped by PCR-RFLP method. RESULTS: The genotype and allele frequencies of both polymorphisms were not statistically different between the HNSCC and control groups. On the other hand, smoking and chronic alcohol consumption were associated with risk of HNSCC, but there was no association between Arg194Trp, Arg399Gln polymorphisms, smoking and alcohol consumption in HNSCC cases. CONCLUSION: These results indicate that both Arg194Trp and Arg399Gln polymorphisms were not associated with the development of HNSCC in Turkish population. In addition, the allele frequencies of polymorphisms were in line with other Turkish population results that were studied previously. However, compared to different populations, there were marked differences in allele frequencies.

Changes in serum levels of MDA and MMP-9 after UPF in patients with OSAS.

The aim of the study was to assess the markers of oxidant-antioxidant status in patients with obstructive sleep apnea syndrome (OSAS) who underwent uvulopalatal flap (UPF) surgery. Twenty-five patients who underwent UPF surgery participated in this study. Polysomnographic examinations were performed before and after the surgery to assess sleep apnea in all patients and to determine the success of the UPF surgery regarding the improvement in the apnea-hypopnea index (AHI). Descriptive factors (BMI, age, gender and neck thickness, etc.) of patients were recorded before operation. Blood samples were taken preoperatively, and repeated postoperatively at 6-month intervals to determine the changes in serum malondialdehyde (MDA) and matrix metalloproteinase-9 (MMP-9) levels. The mean age at surgery was 45.6 ± 9.9 years (range 25-63 years). There was a significant difference between preoperative and postoperative AHI, MDA and MMP-9 values (p < 0.05). There was no significant correlation between categorical variables. There was no correlation between postoperative ODI, MMP-9 and MDA. These results indicate that OSAS is associated with abnormal lipid peroxidation, which can be improved by UPF surgery. OSAS may increase risks of cardiovascular morbidity; however, UPF might be useful for decreasing these risks in patients with OSAS who are suitable candidates for UPF surgery.

Early paper patching versus observation in patients with traumatic eardrum perforations: comparisons of anatomical and functional outcomes.

The purpose of this study was to compare the outcomes of patients with acute tympanic membrane perforation after spontaneous healing and paper-patching procedure. METHODS DESIGN, SETTING, AND PARTICIPANTS: In this study, we performed a retrospective chart review with a prospective follow-up in 63 patients with tympanic membrane perforations. The patients undergoing a paper-patching procedure were assigned to group 1 (n = 33), whereas the patients that healed spontaneously were included in group 2 (n = 30). Retrospective analyses of the otoscopic examination findings and audiometric test results of the groups at the sixth-week follow-up were compared. RESULTS: Eardrum healing was achieved in 90.9% of the patients in group 1 and 76.7% of the patients in group 2 at the sixth week (P > 0.05). The mean values of air conduction were significantly improved, and the air-bone gap was markedly decreased in the patients treated with paper patching, when compared with the patients in group 2 (P < 0.001). The area of perforation was found to be inversely related to the healing success. CONCLUSIONS: Early intervention by paper patching, which is a readily applicable procedure, may be offered to the patients with acute perforation of the tympanic membrane, because of the slightly better closure rates and significantly higher hearing functions when compared with simple observation.

Protective effects of resveratrol on cisplatin-dependent inner-ear damage in rats.

Cisplatin is a common chemotherapeutic agent used in many solid and hematologic malignancies. The main unwanted effect of cisplatin is ototoxicity, for which no standard treatment has been reported. The present study examined the protective efficacy of resveratrol on cisplatin-dependent ototoxicity through an experimental model. Fifteen rats were randomized into three groups. Group 1 (control group) (n = 5) received intraperitoneal (i.p.) 15 mg/kg cisplatin; group 2 (resveratrol group) (n = 5) received i.p. 100 mg/kg resveratrol, followed by i.p. 15 mg/kg cisplatin; group 3 (n = 5) served as a vehicle group and received i.p. 1 ml dimethyl sulfoxide. All rats underwent the auditory brainstem response (ABR) test before and 72 h after the treatment. Pretreatment ABR values of the groups were not significantly different. The pretreatment hearing threshold values of the groups were 30 ± 6.60 and 28.5 ± 5.29 dB in groups 1 and 2, respectively (p > 0.05). The post-ABR-I and post-ABR-IV values were, respectively, 1.41 ± 0.18 and 5.83 ± 0.16 ms in the control subjects and 1.19 ± 0.22 and 4.58 ± 0.27 ms in the study group. The ABR-I and ABR-IV durations in rats treated with resveratrol were significantly shorter (p < 0.01). A comparison of threshold values shows that the resveratrol-treated rats had significantly lower values than the control rats. After cisplatin injection, ABR I-IV intervals were compared among the groups. The ABR I-IV interval duration was 4.42 ± 0.16 ms in the control group, while the resveratrol-treated rats showed a significantly shorter ABR I-IV interval duration of 3.49 ± 0.27 ms (p < 0.001). Resveratrol attenuated cisplatin-dependent inner-ear damage, as shown by the ABR-I, ABR-IV, ABR I-IV interval, and hearing threshold values. Our results suggest that this natural antioxidant may be effectively used in reducing the unwanted effects of cisplatin on the ear physiology of patients, particularly those undergoing chemotherapy.

The effects of CPAP treatment on nasal mucosa in patients with obstructive sleep apnea.

The aim of the study was to demonstrate the effects of nasal CPAP treatment on the morphology and function of nasal mucosa in patients with obstructive sleep apnea (OSA). Patients with complaints relevant to OSA underwent respiratory function tests, arterial blood gas analyses and polysomnography. Saccharine test and nasal biopsies were performed to assess the mucociliary transport time and to observe the histopathological changes in patients with apnea-hypopnea index ≥15 in whole night polysomnography. Tissue samples were obtained from middle and inferior turbinates and septal mucosa to observe the degree of inflammation and fibrosis by semiquantitative means. Biopsies and mucociliary transport test were performed before and 3 months after the initiation of CPAP treatment. A total of 25 patients with a mean age of 52 were enrolled in the study. While the pretreatment mucociliary transport time before and 3 months after the treatment were 10.50 and 11.50 min respectively. The difference between these values was statistically insignificant. Mean apnea-hypopnea index was 63.19, while mean partial oxygen pressure was 75.46 mmHg. Nasal CPAP treatment was introduced with a mean pressure of 9.54 cmH2O. The degree of inflammation and fibrosis was found to be significantly increased after CPAP treatment. Nasal CPAP leads to alterations in mucosa. Efforts should be directed to make CPAP treatment a safer method via protecting the morphologic and functional properties of the nasal mucosa.

[A comparison of the long-term efficacy of cochlear implantation at early and late age]. / Erken ve geç yas koklear implant uygulamasinda uzun dönem etkinliklerinin karsilastirilmasi

OBJECTIVES: This study aims to investigate the effects of age factor on the long-term efficacy of cochlear implantation. PATIENTS AND METHODS: The electronic records of patients, who underwent cochlear implantation with the initial diagnosis of bilateral severe to profound sensorineural hearing loss in our clinic between January 2001 and December 2008, were analyzed retrospectively. The patients were divided into two groups according to their age at the time of cochlear implantation, including group 1 with the patients less than four years of age and group 2 with the patients more than four years of age. Groups were evaluated and compared for the in terms of demographic characteristics, Categories of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR) at three years following surgery. RESULTS: A total of 37 patients underwent cochlear implantation. Of them, 18 patients (48.6%) were operated at less than four years of age, while 19 patients (51.4%) were operated at more than four years of age. No significant difference was found between the groups in terms of sex, educational level and profession of the parents, operated side and duration of implant use. According to CAP and SIR categories, group 1 patients had statistically significantly higher level of the CAP and SIR categories (p=0.009 and p<0.001 respectively). CONCLUSION: Our study results suggested that the age of cochlear implantation has significant effects on long-term hearing and speech abilities. Cochlear implantation carried out at earlier ages (<4) enhances more satisfactory results in terms of long-term efficacy.

Endonasal endoscopic approach for the resection of chondroid chordoma with skull base involvement.

Chordoma is an uncommon tumor of bone that is believed to develop from remnants of the notochord. The chondroid variant of chordomas contains elements possessing both chordoma and cartilaginous tissues. Chondroid chordomas occur almost exclusively in the sphenooccipital region of the skull base. Primary treatment with surgical excision and radiotherapy for residual or recurrent tumor is recommended. Here, we describe a patient with chondroid chordoma with skull base involvement who underwent an expanded endonasal endoscopic approach for complete resection. In conclusion, endonasal endoscopic approach should be kept in mind for the resection of carefully selected chondroid chordomas with skull base involvement because of its minimally invasive characteristics.

Comparison of intravenous and peritonsillar infiltration of tramadol for postoperative pain relief in children following adenotonsillectomy.

BACKGROUND AND OBJECTIVE: The aim of this study was to compare the postoperative analgesic efficacy and side-effects of intravenous tramadol with peritonsillar infiltration of tramadol in children undergoing adenotonsillectomy. METHODS: Sixty-six children were randomized into two groups: group I received 2 mg kg(-1) tramadol intravenously and group II received 2 mg kg(-1) tramadol in 2 ml of normal saline (1 ml per tonsil) via peritonsillar infiltration. Modified Hannallah pain scale, nausea, vomiting, bleeding, rescue analgesia, sedation and Aldrete scores were recorded at the 1st, 15th, 30th and 60th minute postoperatively. The Aldrete score was used to determine the postanaesthesia care unit discharge criteria. Patients were evaluated for the analgesic requirement, nausea and vomiting, bleeding and sedation. RESULTS: There were no differences between groups during the first 1 h. In the postanaesthesia care unit, groups I and II had comparable pain scores that were not statistically significant (P > 0.05). But during the first 24 h the additional analgesic requirement of group I (141.81 mg) was more than group II (83.63 mg) (P = 0.002). Pain scores in the postoperative ward at 6, 12 and 24 h were significantly higher in group I than in group II (P < 0.001). Also four patients (12.12%) from group I and one patient (3.05%) from group II had nausea and vomiting in the postanaesthesia care unit and none of the patients had rescue analgesics. There were no differences between groups regarding nausea and vomiting, sedation and bleeding in the postoperative ward. CONCLUSION: In adenotonsillectomy cases, peritonsillar infiltration of tramadol maintains efficient pain relief with lower incidence of nausea and vomiting.

[Diagnostic value of fine needle aspiration cytology in salivary gland masses]. / Tükürük bezi kitlelerinde ince igne aspirasyon sitolojisinin tanisal degeri.

OBJECTIVES: In this study, we investigated the diagnostic value of fine needle aspiration cytology (FNAC) in salivary gland masses retrospectively. We compared FNAC and postoperative histopathologic results of patients who had undergone FNAC and had been operated on because of salivary gland masses. PATIENTS AND METHODS: Seventy six patients (40 females, 36 males; mean age 50.4 years; range 20 to 80 years) having salivary gland masses who underwent FNAC and surgical treatment between January 2001 and June 2008 were included in the study. Fine needle aspiration cytology and histopathologic results were compared retrospectively. The sensitivity, specificity, positive and negative predictive values and accuracy rate of the FNAC in salivary gland masses were evaluated in the light of the results. RESULTS: The most common benign and malign FNAC results were pleomorphic adenoma (22 patients; 29.7%) and mucoepidermoid carcinoma (4 patients; 5.4%), respectively. Fine needle aspiration cytology results of two patients were non-diagnostic and these patients were excluded. According to the FNAC and histopathologic results of 74 patients, sensitivity was found to be 80.9%, specificity 94.3%, positive predictive value 85% and negative predictive value 92.5% and accuracy rate of FNAC 90.5%. CONCLUSION: Fine needle aspiration cytology is a reliable method that has high sensitivity to distinguish between benign and malign salivary gland lesions. In case of suspicious FNAC reports, reliability and diagnostic value of the method is decreased.

Glomus tumors of the head and neck: thirteen years' institutional experience and management.

Background: Head and neck paragangliomas are slowly growing benign tumors and they originate from specialized neural crest cells. Aims/objectives: This study aimed to express the safety of paraganglioma surgery regarding complications, treatment, and outcomes of patients with head and neck glomus tumors. Materials and methods: Medical records of patients who were operated because of head and neck paraganglioma between 2006 and 2016 were reviewed. Results: The study group consisted of 49 patients (M/F: 6/43). The patients were distributed as follows: 22 glomus caroticum (GC) (44.8%), 8 glomus jugulare (GJ) (16.3%), 10 glomus tympanicum (GT) (20.4%), 4 glomus vagale (GV) (8.1%), 2 GC + GV (4%), 2 bilateral GC (4%) and 1 thyroidal glomus tumor (2%). All GC and GV tumors were resected via cervical approach. Three of GJ tumors were resected through transmastoid approach while five of them were resected through both transmastoid and cervical approach. Nine GT tumors were resected via transmastoid approach. One patient received cyberknife. Thyroid paraganglioma was diagnosed incidentally after total thyroidectomy. Mean follow-up period was 61.92 ± 35.11 months (1-124 m). Conclusions and significance: The choice of treatment depends on the size, location and biologic activity of tumor as well as the physical condition of the patient. Our results show that glomus tumors can be resected with low mortality and morbidity rates due to developing imaging and microsurgical methods.

Bilateral epithelial-myoepithelial carcinoma: an extraordinary tumor of the paranasal sinuses.

A 54-year-old woman presented with a 6-month history of swelling on the right side of her face. On physical examination she was found to have a huge mass in the right nasal cavity. Magnetic resonance images of the paranasal sinuses revealed a soft tissue mass in the right maxillary sinus and a mass was also seen in the left maxillary sinus. On histopathologic examination, the tumor had a lobular structure with infiltrating margins. Two cell types, an outer layer of myoepithelial and an inner layer of duct-like cells, were found. On immunohistochemical examination, myoepithelial cells stained positively for calponin, p63, GFAP, S-100 protein, alpha-smooth muscle actin cytokeratin-14. The tumors were resected completely and no recurrence or metastasis was found 30 months after surgery. We describe here an unusual case of epithelial-myoepithelial carcinoma (EMC) arising from the paranasal sinuses. This is the first case report in the literature describing bilateral EMC in the maxillary sinuses.

[The effectiveness of endoscopic sinus surgery in nasal polyposis]. / Nazal polipoziste endoskopik sinüs cerrahisinin etkinligi.

OBJECTIVES: We evaluated the effectiveness and outcomes of functional endoscopic sinus surgery in the treatment of nasal polyposis. PATIENTS AND METHODS: The study included 407 patients (262 males, 145 females; mean age 42+/-12 years; range 20 to 76 years) with nasal polyposis. Of these, 102 patients (25%) had asthma, 25 patients (6.1%) had asthma and aspirin sensitivity, and 142 patients (34.8%) had anatomic variations. The patients were operated on using the Messerklinger and Wigand techniques. Functional endoscopic sinus surgery was performed bilaterally. Evaluations were made preoperatively and at six months by endoscopic examination and paranasal sinus computed tomography (Lund-Mackay score). Postoperatively, the patients were treated with nasal irrigation and topical steroid spray. RESULTS: Following surgery, the mean computed tomography score decreased from preoperative 17.0+/-4.3 to 8.5+/-4.7. Major complication occurred in one patient. Nasal mucosal adhesion was the most frequent minor complication (5.4%). Nasal polyposis recurred in 78 patients (19.1%), of whom 57 patients underwent revision surgery. CONCLUSION: Our data show that functional endoscopic sinus surgery combined with corticosteroid administration is effective in the treatment of nasal polyposis.

[Prognostic factors in larynx cancers]. / Larenks kanserlerinde prognostik faktörler.

OBJECTIVES: We investigated the prognostic factors affecting survival and recurrence in laryngeal cancer. PATIENTS AND METHODS: The study included 116 patients (4 females, 112 males; mean age 55+/-9 years; range 35 to 75 years) who underwent surgery for squamous cell carcinoma of the larynx. Risk factors for survival and recurrence were analyzed using univariate analysis and Cox regression analysis. The mean follow-up period was 43+/-25 months. RESULTS: Mortality occurred in 14 patients, nine of which were due to tumoral causes. In univariate analyses, lymphovascular invasion, cartilage invasion, positive surgical margins, postoperative deglutition time, and complications had a significant effect on survival, while recurrence was influenced by age, postoperative deglutition time, postoperative radiotherapy, and positive surgical margins (p<0.05). Cox regression analyses showed that postoperative deglutition time, radiotherapy, recurrence, and tumor localization significantly affected survival, and preoperative differentiation, tracheotomy, pre- and postoperative tumor stage, radiotherapy, cartilage invasion, and positive surgical margins were significant prognostic factors for recurrence (p<0.05). CONCLUSION: Evaluation of the prognostic factors in larynx cancer may serve as a guide to treatment and follow-up.

Sublabial transseptal approach to pituitary adenomas with special emphasis on rhinological complications.

OBJECTIVE: The aim of this presentation is to show that the sublabial transseptal transsphenoidal approach to pituitary adenomas is the least invasive anatomic route with the lowest postoperative complication rates. PATIENTS AND METHOD: This study was based on a retrospective analysis of 276 patients with a diagnosis of pituitary adenoma who were surgically treated via the sublabial transsphenoidal route. RESULTS: The overall complication rate of the presented series was 14.8%. The recurrence rate was 14.1%; there were no deaths or intranasal complications in this series. Postoperative rhinological complications, such as septal perforation, synechiae, and mucosal tear which impaired nasal function, occur rarely with this approach compared to other approaches. CONCLUSION: Besides the technical advantages of this approach, performance of the initial phase of the operation by an otorhinolaryngologic surgeon is the basis of the low intranasal complication rate in our series.

Comparison of postoperative pain scores and dysphagia between anterior palatoplasty and uvulopalatal flap surgeries.

BACKGROUND: Dysphagia and pain are most common problems after soft palate surgery in obstructive sleep apnea (OSA) patients. OBJECTIVE: The aim of this study was to compare the postoperative pain scores and presence of dysphagia in patients who underwent anterior palatoplasty (AP) or uvulopalatal flap (UPF) surgeries. MATERIALS AND METHODS: In this prospective study, AP or UPF was performed on the patients with mild or moderate OSA. Daytime sleepiness of all patients was evaluated with Epworth sleepiness scale (ESS). Snoring, pain and dysphagia complaint of the patients was evaluated with visual analog scale (VAS). RESULTS: In both AP and UPF groups, VAS snoring and ESS scores decreased significantly after operation. VAS pain and dysphagia scores were determined to be significantly higher in UPF compared with the AP. CONCLUSION AND SIGNIFICANCE: Since the success rates of surgical interventions to the soft palate are similar, preferring surgical approaches with a less damage to the life quality of patients after operations is more rational. In this regard, AP, which is technically quite simple with a short operation time and fewer postoperative complaints affecting life quality such as pain or dysphagia may be preferred in selected patients with OSA.

Endoscopic sinus surgery of frontal mucocele.

The findings and symptoms associated with a mucocele depend on its location and on the extent of bony erosion. Men and women are affected equally, and these lesions are mostly encountered during the third and fourth decades of life. We describe a frontal mucocele that accompanied diplopia, headache, and displacement of orbita and was successfully managed by endoscopic sinus surgery and medical treatment.