Total Lower Lateral Cartilage Reconstruction in Multiple Revision Rhinoplasty Patients.

OBJECTIVE: The aim of this study is to demonstrate a novel surgical technique of total lower lateral cartilage reconstruction using costal cartilage grafts in multiple revision rhinoplasty cases. METHOD: Total lower lateral cartilage reconstruction technique was utilized in 24 patients who underwent open technique septorhinoplasty between 2019 and 2023. Fourteen of the patients were female, and 10 were male. In this technique, we performed total lower lateral cartilage reconstruction in multiple revision cases where the support of both medial and lateral crura was poor. In cases where only the medial crus or only the lateral crus support was inadequate, we performed reconstruction only for the poorly supported portion. A new lower lateral cartilage was created with grafts obtained from the costal cartilage. RESULTS: The mean age of the patients was 23. The mean follow-up time of the patients was between 6 and 18 months. No complications were observed due to this technique. Satisfactory results were obtained in the postoperative period after surgery. CONCLUSION: Multiple revision rhinoplasties present significant difficulties due to complicated nasal anatomy and weakened lower lateral cartilages. We have shown that successful results can be achieved in these complex cases with total lower lateral cartilage reconstruction using costal cartilage grafts. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Sutureless transconjunctival insertion of eyelid gold weight.

OBJECTIVE: Surgical intervention for paralytic lagophthalmos has been gold weight implant through supratarsal crease incision for decades. The aim of this study is to propose a modified novel minimally invasive approach that can be described as sutureless and transconjunctival placement of eyelid weights. METHOD: Unilateral eyelid gold weights were implanted in six patients due to paralytic lagophthalmos secondary to peripheral facial nerve palsy. The patients were followed for an average of 6 months. RESULTS: Functional and aesthetically desired results were obtained in all six patients with suture-free transconjunctival placement of the eyelid weight. The patients did not experience any discomfort and avoided the burden of suture removal after the surgery. No complications developed in six patients during the postoperative period. CONCLUSION: Sutureless transconjunctival insertion of eyelid weight without external incision and suturing is practical, relatively easy and fast to perform. It preserves attachment of the levator muscle to the tarsus and presents functional results similar to conventional method. Fixing the implant with sutures to the tarsal plate is not needed. Sutureless of this method avoids external wound care, burden of suture removal for both surgeons and patients, and hence, suture related complications are eliminated.

Key stone plasty and asymmetric hump resection in crooked nose deformity.

OBJECTIVE: The aim of this study is to propose a new approach in crooked nose deformity with key-stone plasty and asymmetric hump resection. METHOD: Twelve patients with crooked nose deformities were operated using the open rhinoplasty technique. Our method, unlike other methods, has two different steps. Following asymmetric hump resection, cartilaginous and osseous septum were cut separated at the key stone area or more caudally and fix the septum with sutures again by allowing them to slide over each other in a way that directs the septum to the midline. If there is an inability to reveal the septum, we apply a longer spreader graft to the cartilage septum side. RESULTS: The mean ages were 27.4 years. The mean follow-up time of the patients was 19.1 months. No complications were observed due to this technique. This technique was effective in the treatment of all our patients with crooked nose deformities. CONCLUSION: A novel surgical approach with key-stone plasty and asymmetric hump resection method was proposed in crooked nose deformity with a video animation.

Supratip suture and skin scoring technique in the patient with thick skin in rhinoplasty.

OBJECTIVE: The aim of this study is to demonstrate a new surgical technique to achieve ideal nasal tip rotation and projection with nasal supratip angle in patients with thick skin. METHOD: Supratip suture and skin scoring technique was used in 24 patients who underwent open technique septorhinoplasty operation between the years 2019 and 2022. In this technique the nose skin was thinned with scissors. Scoring and supratip sutures were applied to the skin. Kenacort (Triamcinolone 8 mg) was injected into the supratip area without closing the skin. Fourteen of the patients were female and 10 were male. RESULT: The mean age of the patients was 22. The mean follow-up time of the patients was between 6 and 18 months. No complications were observed due to this technique. Satisfactory results were obtained in the postoperative period after surgery. CONCLUSION: A new surgical approach has been proposed to create the desired dimensions with nasal tip rotation and projection and supratip angle in patients with thick skin using the supratip suture and skin scoring technique.

Oxidative stress values of tumor core, edge, and healthy thyroid tissue in thyroid masses.

PURPOSE: Reactive oxygen radicals play an important role in tumor formation, progression, and invasion. In this study, the aim was to investigate the relationship between the oxidative stress values of tumor core, edge, and healthy thyroid tissue in thyroid tumors. METHODS: A total of 51 patients with thyroid tumor, 24-malignant, and 27-benign, were included in this study. Samples, measuring 5 × 5 × 5 mm, were taken from the tumor core, edge, and healthy thyroid tissue of the participants. Total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) values were examined. The oxidative stress values of core, edge, and healthy thyroid tissue of all tumors (n = 51) were compared according to the localization. The participants were divided into two groups as malignant (Group 1: Differentiated thyroid cancers) and benign (Group 2: Multinodular goiter). The groups were compared according to tissue localizations. RESULTS: The TOS value of tumor edge was significantly higher than the values of tumor core and healthy thyroid tissue. The OSI value of tumor edge was significantly higher than the values of tumor core and healthy thyroid tissue. There was no significant difference between Group 1 and Group 2 in terms of TAS, TOS, and OSI values of tumor core. The OSI values in tumor edge and healthy thyroid tissue were significantly higher in Group 1 than in Group 2. There was no significant difference between the groups in terms of TAS and TOS values of tumor edge and healthy thyroid tissue. CONCLUSION: The oxidative stress values of tumor edge were significantly higher than the tumor core and healthy thyroid tissue values. The oxidative stress values of tumor edge and healthy thyroid tissue were significantly higher in malignant thyroid tumors compared to benign thyroid tumors.

A new method in eardrum perforation repair: Accordion myringoplasty technique.

OBJECTIVE: The aim of this study is to describe the accordion myringoplasty technique as a novel method used in the perforation of the eardrum. MATERIALS AND METHODS: The study included thirty patients operated by utilizing accordion myringoplasty technique. RESULTS: We achieved complete closure of the eardrum perforations with the accordion myringoplasty technique in all patients. CONCLUSION: Accordion myringoplasty technique was inspired by conventional fascial and cartilage myringoplasty techniques to protect hearing while increasing surgical success.

A feasibility study in the treatment of obstructive sleep apnea syndrome and snoring: Nasopharyngeal stent.

OBJECTIVE: The objective of this study is to create a new choice of treatment with nasopharyngeal stent in isolated retro palatal obstruction and snoring for the treatment of obstructive sleep apnea syndrome (OSAS). MATERIAL AND METHOD: The study included five patients with mild OSAS and snoring. Nasopharyngeal stents were applied in these patients with drug-induced sedation endoscopy. RESULTS: With the nasopharyngeal stents, we aimed to prevent the soft palate to fall backwards while sleeping, especially at supine position in order to prevent the occurrence of apnea and hypopnea, providing a way for the airway to remain open as well as a support behind the soft palate and thus prevent snoring based on the vibration created by draught. CONCLUSION: We suggest a new alternative treatment approach to devices that need to be continuously used such as CPAP or intraoral devices or surgical methods that have many unwanted discomforts for the patients.

Use of topical fluorescein in the diagnosis and localization of perilymphatic fistula.

OBJECTIVE: The purpose of this video presentation is to demonstrate the effect of intraoperative dilute topical fluorescein in perilympatic fistula diagnosis and localization. MATERIALS AND METHODS: Explorative tympanotomy was performed for the diagnosis, localization and repair of the fistula in the patient who had a pre-diagnosis of perilymphatic fistula. Topical fluorescein was applied intraoperatively to localize the defect. RESULT: A clear change of color was distinguished from yellow to green leading to diagnosis of the perilymphatic fistula and also showed the origin of the fistula. CONCLUSION: Topical application of dilute fluorescein is a convenient and effective tool in the diagnosis and localization of perilymphatic fistula.

Stapedectomy in patients with dehiscent and prolapsed facial nerve.

OBJECTIVE: The aim of this study is to apply the modified stapedectomy technique in cases with dehiscent and prolapsed facial nerve canal, and to compare the postoperative results with those with normal facial nerve canal anatomy. MATERIAL AND METHOD: 28 patients who underwent primary stapedectomy were included. Of the patients, 17 were in the normal anatomical facial nerve group, and 11 were in the dehiscent and prolapsed facial nerve group. Facial nerve was retracted with micro elevator in dehiscent and prolapsed group. and Titanium-Teflon prosthesis was angled and used in accordance with facial nerve course at this group. RESULT: No facial paresis or paralysis was observed in any patient postoperatively. In the first year, no significant difference was found in terms of air-bone gap. CONCLUSION: It is safe to retract the facial nerve for a limited time in cases of stapedectomy in cases with dehiscent and prolapsed facial nerve canal. In these cases, modifying the stapedial prosthesis in accordance with the facial nerve course does not cause disadvantage in terms of hearing gain.

Tracheoesophageal Puncture Site Closure With Butterfly Cartilage Graft.

A tracheoesophageal voice prosthesis is very effective for improving speech after total laryngectomy. Although it is generally a safe method, it may be necessary to close the tracheoesophageal fistula due to complications such as prosthesis-related cellulitis, granulation tissue formation, tracheoesophageal fistula necrosis, or salivary leakage around the prosthesis. Surgical and non-surgical methods for closure have been described. In this article, a method for closing the tracheoesophageal fistula with a butterfly cartilage graft is described. The butterfly cartilage technique is safe and efficient in terms of anatomical closure of the fistula. This study shows that the method can be easily applied, with low morbidity, using an auto-graft material with local anesthesia in an outpatient setting.

Intraoperative thermal safety of endoscopic ear surgery utilizing a holder.

PURPOSE: Despite the ever-growing popularity of endoscopic ear surgery (EES), there are still concerns regarding the potential thermal risk associated with the use of light sources and also questions raised about the thermal safety of extended stationary applications of endoscopes with holders that allow the use of both hands in the middle ear. The temperature changes witnessed during EES when using different calipers on static endoscopes fitted with camera holders during true operations were measured, and effects of varying light source intensities, as well as the cooling effect of irrigation and suction, were investigated. METHODS: This study included 12 patients with chronic otitis who were scheduled to undergo myringoplasty surgery. Two of five different endoscopes with xenon light sources (4 mm-0°, 3 mm-0°, 2.7 mm-0°, 3 mm-45° and, 2.7 mm-30°) were used on each patient. Following irrigation and aspiration, gradually increasing heat measurements were recorded at two-minute intervals using a thermocouple thermometer for the entire period the endoscope remained in the ear. Three measurements obtained within the final 6 min, all of which were the same and reached a plateau, were considered to be the peak heat value. Measurements were repeated twice in each patient at 100% and 50% light intensities. RESULTS: The highest heat was recorded by the 4 mm-0° endoscope, with heats at 100% and 50% light intensity recorded as 48.4 °C and 43.2 °C, respectively. The highest heat was measured by the 2.7 mm-0° endoscope, and heats recorded at 100% and 50% light intensities were 37.8 °C and 35.3 °C, respectively. CONCLUSION: Stationary use of endoscopes with 3 mm and smaller calipers without irrigation or aspiration, the heat in the middle ear would appear to be safe, and at a level that does not cause thermal trauma to tissue. The present study demonstrates that frequent aspiration or intermittent irrigation may prevent potential thermal damage, even in procedures performed using endoscopes of a 4 mm caliper. Light intensity settings of 50% can be adopted as a further safety measure against potential thermal risk without compromising visual acuity.

Effect of nasal antihistamine on secretory IgA in nasal lavage of rats.

The humoral IgA is an immunoglobulin which plays a defensive role for organisms on mucosal surfaces. Today, intranasal antihistamines are effectively used in the treatment of allergic rhinitis. In our study, the effect of azelastine hydrochloride-a nasal antihistaminic-on humoral IgA of the nasal mucosa has been reviewed empirically. Twenty-four female Sprague-Dawley rats were included in our study. The rats were divided into three groups randomly. Group 1(azelastine hydrochloride): rats in this group had nasal azelastine hydrochloride (0.05%) applied for 30 days at 10 µl/nostril dosage. Group 2 (saline): saline (0.09%) was applied to the rats in this group for 30 days at 10 µl/nostril dosage. Group 3 (control): no application was made throughout the study. The chemicals applied in Groups 1 and 2 were applied to both nostrils by mounting a flexible micropipette to the end of an insulin injector. At the beginning of the study, nasal lavage was performed to both nostrils of the rats in every group on the 15th and 30th day to aspirate irrigation solution (distilled water). The aspirated liquids were kept at - 80° temperature and reviewed together at the end of study. Within-group comparisons: in Group 1 (azelastine hydrochloride), the humoral IgA value on the 15th day was significantly higher than the basal value (p = 0.037). There is a significant difference between humoral IgA value on the 30th day and humoral IgA value on the 15th day (p = 0.045). In Group 2 (saline), no significant difference is available between basal, 15th day and 30th day humoral IgA values (p = 0.265). In Group 3 (control), no significant difference is available between basal, 15th day and 30th day humoral IgA values (p = 0.374). Between-group comparison: there is no significant difference in between-group humoral IgA basal values (p = 0.714). On days 15 and 30, Humoral IgA value of Group 1 was significantly higher than that of Groups 2 and 3 (p = 0.013, p = 0.024, respectively). According to the results we achieved in our study, nasal antihistaminic (azelastine hydrochloride) significantly increases the level of humoral IgA. Our study is the first one in the literature to reveal a relation between nasal antihistaminic and humoral IgA and there is a further need for clinical, randomized and prospective studies.

Proposal of a Budget-Friendly Camera Holder for Endoscopic Ear Surgery.

Endoscopic ear surgery (EES) is increasingly a preferred technique in otologic society. It offers excellent visualization of the anatomical structures directly and behind the corners with variable angled telescopes. It also provides reduced operative morbidity due to being able to perform surgical interventions with less invasive approaches. Operative preparation and setup time and cost of endoscopy system are less expensive compared with surgical microscopes. On the other hand, the main disadvantage of EES is that the surgery has to be performed with 1 single hand. It is certainly restrictive for an ear surgeon who has been operating with 2 hands under otologic microscopic views for years and certainly requires a learning period and perseverance. Holding the endoscope by a second surgeon is not executable because of insufficient surgical space.Endoscope/camera holders have been developed for those who need the comfort and convenience afforded by double-handed microscopic ear surgery. An ideal endoscope holder should be easy-to-set up, easily controlled, providing a variety of angled views, allowing the surgeon to operate with 2 hands and, budget-friendly. In this article, a commercially available 11-inch magic arm camera holder is proposed by the authors to be used in EES due to its versatile, convenient, and budget-friendly features. It allows 2-handed EES through existing technology and is affordable for surgeons looking for a low-cost and practical solution.

Adjunctive Use of the Dermocartilaginous Ligament for Dorsal Irregularities in Primary Rhinoplasty.

Nasal dorsal irregularity is a common postrhinoplasty complication in spite of meticulous smoothing. Utilization of the dermocartilaginous ligament in 2 different fashions for different purposes was described before. A novel utilization of the dermocartilaginous ligament as a flattened and pedicled flap from the cephalic attachment for nasal dorsal irregularities was presented in this article. This surgical technique was applied in 11 cases. Eight of them had thin skin, 2 had skin with medium thickness, and 1 had thick skin. They were followed on an average for 27 months (between 6 and 37 months). All of the patients had satisfactory esthetic results, and there was no apparent irregularities observed over the nasal dorsum. No complications such as infection or hematoma occurred during the early or late follow-up periods. Instead of discarding the dermocartilaginous ligament, it can be used adjunctively to conceal the nasal dorsal irregularities to attain a smoother dorsal nasal surface by increasing soft tissue cushion over the osseocartilaginous dorsum. Transposing of the dermocartilaginous ligament also relieves dynamic drooping of the nasal tip, shortening of the upper lip, and undesirable gingival display.

Temporal Scalp Thickness, Body Mass Index, and Suprafascial Placement of Receiver Coil of the Cochlear Implant.

OBJECTIVE: The objectives of this study are to demonstrate the relationship between the thickness of the temporal scalp and body mass index (BMI), age, and sex, and to present the surgical technique which we perform in patients with a thick scalp. MATERIALS AND METHODS: This is a retrospective, cross-sectional study. This study was performed in a tertiary referral center. Cranial computed tomography images of 469 subjects were included in the study. These subjects were evaluated according to BMI, age, and sex. These individuals were divided into 6 groups based on the BMI levels. Differences between the groups were compared in terms of temporal scalp thickness. In 5 patients with a mean scalp thickness of 9.7 mm, the receiver coil was placed over the temporal muscle fascia through a transmuscular incision without surgical thinning of the skin flap. RESULTS: Average scalp thickness was measured as significantly higher in males than in females, with advancing age, and increasing levels of BMI. In 5 adult patients with a scalp thickness measured as ≥7 mm who underwent cochlear implantation, suprafacial placement of the receiver coil achieved successful surgical and audiological results. CONCLUSION: Thinning of the skin flap is recommended in patients with a scalp thickness ≥ 7 mm to provide effective transmission, minimalized power requirement, and magnet retention. Suprafascial placement of the receiver coil can be recommended in patients with a thick scalp without any excisional thinning impairing integrity and vascularity of the skin.

Betahistine exacerbates amikacin ototoxicity.

OBJECTIVE: Betahistine augments cochlear blood flow and is currently used as an efficient therapeutic agent. Amikacin is used in a wide range of areas, but its ototoxic effect continues to be problematic. This study investigates the effect of betahistine on amikacin-induced ototoxicity. METHODS: Thirty-two healthy rats were randomized to 4 groups of 8 rats in each group (amikacin, amikacin+betahistine, betahistine, and no treatment). Amikacin was administered intramuscularly to groups 1 and 2 for 14 days. Betahistine was delivered by oral gavage to groups 2 and 3 for 21 days. Distortion-product otoacoustic emissions (DPOAE) and auditory brainstem response (ABR) tests were conducted on all rats. RESULTS: There were significant decreases in the DPOAE levels and significant increases in the ABR thresholds of the amikacin and amikacin+betahistine groups on the 7th, 14th, and 21st days, as compared to their basal values. The DPOAE levels of the amikacin+betahistine group significantly decreased on days 7, 14, and 21, and the ABR thresholds significantly increased on the same days, as compared to the amikacin group. CONCLUSION: Our study implies that amikacin's ototoxic effects are augmented by the concurrent use of betahistine. Experimental and clinical research, supported by histopathological studies, is needed to affirm our findings.

Thermal effects of cold light sources used in otologic surgery.

The objective of this study was to investigate the thermal effects of cold light sources and endoscopes on the inner ear. 25 male guinea pigs were assigned equally to five groups (1: Halogen-1 min, 2: Halogen-5 min, 3: Xenon-1 min, 4: Xenon-5 min, 5: Controls). After both bullae of the guinea pigs were opened, light sources and endoscopes were positioned in the middle ears of the first four groups for specific time periods. DPOAE and ABR tests were conducted on all animals at the beginning of the study, at the end of surgery, and 2 h after surgery. The temperatures of cold light sources were measured by a thermocouple thermometer, and the surface temperatures of the endoscopes were measured by an infrared thermometer. DPOAE and ABR measurements performed right after and 2 h after surgery in group 1, 2, 3, and 5 did not reveal any significant difference. In group 4, DPOAE values were significantly lower and ABR threshold values were significantly higher than those in the other groups, right after and 2 h after surgery. Thermocouple thermometer readings showed that, after the first minute, the Xenon light source generated significantly more temperature rise than the Halogen light source. The surface temperatures of all endoscopes returned to normal approximately 1 min after light sources were turned off. Our study demonstrated that when an endoscope using a Xenon light source was applied to the middle ear for a specific time periods, inner ear functions deteriorated, as reflected by audiologic tests.

Wide-Open Dorsal Approach Rhinoplasty for Droopy Noses.

BACKGROUND: Because rhinoplastic surgery predominantly deals with the osseocartilaginous skeleton, droopy noses with thick skin remain a problem to be solved. In these noses, neglecting excess skin can impair long-lasting and complete correction of the nasal deformity. As these noses already require redundant dorsal skin resection, surgical manipulations can be executed entirely through the dorsal skin excision window instead of the transcolumellar approach. OBJECTIVE: The wide-open dorsal approach rhinoplasty (WoDAR) was developed to allow removal of excess dorsal skin and reconstruction of the nasal osseocartilaginous framework through the excised dorsal skin avoiding a transcolumellar incision. MATERIALS AND METHODS: Nine male patients with thick skin and significantly ptotic noses were operated with WoDAR. The cosmetic appearance of the noses was evaluated by the patients before and after the operation using a visual analog scale (VAS). The nasal obstruction symptom evaluation (NOSE) scale was evaluated individually preoperatively and postoperatively. The nasolabial angle (NLA) was measured preoperatively, at the third, twelfth, and twenty-fourth months postoperatively. Dorsal scars were evaluated by means of the Stony Brook's scar evaluation scale (SBSES). RESULTS: Patients (mean age: 51.4 ± 4.8 years) were followed for an average duration of 20.6 ± 8.4 months. Cosmetic evaluation revealed that the mean patient preoperative VAS score was 23.3 ± 25.6, whereas the postoperative VAS score was 92.6 ± 14.8. Preoperative and postoperative NOSE scores were 79.5 ± 16.5 and 11.5 ± 11.5, respectively. The mean preoperative NLA was 72.9 ± 2.9° and at the third and twelfth month postoperatively was 92 ± 6.5 and 91 ± 5.4. The NLA measurements of all four patients followed for 24 months revealed less than 2° derotation compared to third postoperative month. The mean SBSES score was 4.1 ± 0.8 out of 5. CONCLUSION: WoDAR allowed esthetically and functionally pleasing outcomes. This advantageous technique can be regarded as a surgical alternative for carefully selected aged patients with severely ptotic, thick-skinned noses who might otherwise end up with unsatisfying results both for surgeon and patients.

Dorsal approach to septum in external septorhinoplasty.

OBJECTIVE: During external septorhinoplasty, access from the caudal septum into subperichondrial space often poses difficulties and challenges for proper elevation of the mucoperichondrial flap. The dorsal and caudal approaches were compared with respect to duration and mucosal integrity. METHODS: The caudal approach was applied in 52 patients and the dorsal approach in 50 patients. The duration was recorded starting with septal incision, until the end of the completion of the bilateral subperichondrial and subperiosteal elevation. The mucosal integrity was inspected for any mucosal damage. RESULTS: The elevation durations for the caudal approach and the dorsal approach were 450.3 seconds and 232 seconds, respectively. The impairment in mucosal integrity was observed in 33 cases (63%) with the caudal approach and in 16 cases (32%) with the dorsal approach. Statistically significant differences were found between the 2 groups in terms of duration and mucosal integrity. CONCLUSION: The dorsal approach is a more advantageous choice that provides easier, safer, and faster access, ensures a comfortable and effective subperichondrial elevation, and is more advantageous for the protection of mucosal integrity as compared to the caudal approach from the anterior septal angle, since the perichondrium in the caudal septum is more attached to the underlying cartilage.