Asli Bostanci

Factors influencing sleep time with oxygen saturation below 90% in sleep-disordered breathing

To determine factors influencing sleep time with oxygen saturation below 90% (ST90) in a population referred to a tertiary sleep center for assessment of possible sleep‐disordered breathing (SDB).

Sublingual heterotopic large cyst in a newborn: anesthetic management

A one-month-old 3,950-g male infant was hospitalized with a sublingual cystic lesion that caused feeding difficulty and respiratory distress. The cyst was first diagnosed in the fourth month of pregnancy during a routine prenatal ultrasound examination. Shortly after delivery, the cyst was reduced in size by needle aspiration. It rapidly re-grew, however, and on return to hospital, a cystic lesion (4 9 4 cm) on the ventral surface of the infant’s tongue extended outside the oral cavity (Figure, panel A). In the accompanying magnetic resonance

Endoskopik kadavra çalışması: Aksesuar maksiller ostium

2 Akdeniz Üniversitesi Tıp Fakültesi Kulak Burun Boğaz Hastalıkları Anabilim Dalı, Antalya, Türkiye 3 Akdeniz Üniversitesi Tıp Fakültesi Anatomi Anabilim Dalı, Antalya Yazışma Adresi /Correspondence: Alper Sindel, Akdeniz Üniversitesi Diş Hekimliği Fakültesi Ağız, Diş ve Çene Cerrahisi Anabilim Dalı Antalya Email: sindelm@akdeniz.edu.tr Geliş Tarihi / Received: 24.10.2013, Kabul Tarihi / Accepted: 23.11.2013 Copyright

Hyalinizing Clear Cell Carcinoma of the Maxilla

Hyalinizing clear cell carcinoma (HCCC) is a rare low-grade salivary gland tumor with distinctive clear cell morphology, accounting for < 1% of all salivary gland tumors. In the majority of cases, the tumor originates typically from the minor salivary glands in the oral cavity. A total of 155 cases of HCCCs from head and neck region have been reported in the literature until 2017, of which only 16 are of maxillary origin. Due to its low incidence, there is no clear consensus on prognostic factors and optimal treatment strategies yet. In this paper, a new case of HCCC of the maxilla is presented and its clinical and histopathological features are discussed.

Can Statistical Machine Learning Algorithms Help for Classification of Obstructive Sleep Apnea Severity to Optimal Utilization of Polysomnography Resources

OBJECTIVES The goal of this study is to evaluate the results of machine learning methods for the classification of OSA severity of patients with suspected sleep disorder breathing as normal, mild, moderate and severe based on non-polysomnographic variables: 1) clinical data, 2) symptoms and 3) physical examination. METHODS In order to produce classification models for OSA severity, five different machine learning methods (Bayesian network, Decision Tree, Random Forest, Neural Networks and Logistic Regression) were trained while relevant variables and their relationships were derived empirically from observed data. Each model was trained and evaluated using 10-fold cross-validation and to evaluate classification performances of all methods, true positive rate (TPR), false positive rate (FPR), Positive Predictive Value (PPV), F measure and Area Under Receiver Operating Characteristics curve (ROC-AUC) were used. RESULTS Results of 10-fold cross validated tests with different variable settings promisingly indicated that the OSA severity of suspected OSA patients can be classified, using non-polysomnographic features, with 0.71 true positive rate as the highest and, 0.15 false positive rate as the lowest, respectively. Moreover, the test results of different variables settings revealed that the accuracy of the classification models was significantly improved when physical examination variables were added to the model. CONCLUSIONS Study results showed that machine learning methods can be used to estimate the probabilities of no, mild, moderate, and severe obstructive sleep apnea and such approaches may improve accurate initial OSA screening and help referring only the suspected moderate or severe OSA patients to sleep laboratories for the expensive tests.

Intraoperative assessment of laryngeal malignancy using elastic light single‐scattering spectroscopy: A pilot study

The elastic light single‐scattering spectroscopy (ELSSS) system is a new tool for the real‐time diagnosis of cancerous lesions. In the current study, we have employed ELSSS to investigate its ability in differentiation between normal and cancerous larynx tissues ex vivo.

In reply: Using a Mcintosh blade for retromolar intubation: a comment

To the Editor, We read Drs Veyckemans’ and Fayoux’s valuable comments on our report outlining the airway management of a one-month-old infant who presented with an obstructive sublingual cyst. They recommended cyst aspiration to allow easier direct laryngoscopy. Certainly, in the presence of airway obstruction, intubation after cyst drainage and/or urgent tracheostomy can be options to secure an airway. However, after respiratory tract obstruction is evaluated with preoperative magnetic resonance imaging (MRI) and no respiratory tract compression is observed, we believe that opting for tracheal intubation without cyst aspiration is a reasonable choice. Nevertheless, we ensured that a surgical team was immediately available to perform urgent cyst aspiration and tracheostomy if needed. In our case, intubation was performed successfully using a curved blade, and urgent cyst aspiration and tracheostomy were not required. Veyckeman and Fayoux also recommended nasal flexible bronchoscopic (FB) intubation as an alternative technique. Indeed, intubation using a FB permits direct visualization of the glottis to facilitate passage of an endotracheal tube into the trachea and clearly would provide a reliable alternative method in cases of difficult intubation. This application, however, requires extensive experience and knowledge of complicated pediatric airway management. In addition, only very small diameter FBs can be placed through a 3-mm endotracheal tube, which was not available in our centre. Veyckemans and Fayoux also referred to muscle relaxant use in cases of difficult intubation, which carries a risk of increased oropharyngeal obstruction due to loss of muscle tone. This risk must be balanced against the potential benefit of preventing laryngospasm. If intubation could not be performed successfully, we had planned for cyst aspiration and direct intubation. Lastly, their recommendation for using a straight (i.e., Miller) blade for intubation must be balanced against the difficulty of the advancing the straight blade toward the vallecula during intubation when the cyst may be blocking that route. Indeed, during our first intubation attempt, the tongue could not be moved laterally with a straight blade, and the vocal cords could not be seen. On our second intubation attempt, the laryngoscope was successfully advanced through the right molar gap, and the epiglottis was easily visualized with use of the curved blade. Successful intubation ensued. Accordingly, we believe both straight and curved blades should be kept available prior to intubation and alternative options be considered and made available.

Chronic Invasive Nongranulomatous Fungal Rhinosinusitis in Immunocompetent Individuals

Chronic invasive nongranulomatous fungal rhinosinusitis is a well-described but uncommon type of fungal rhinosinusitis (FRS). While the prevalence of chronic FRS is 0.11% in healthy individuals, only 1.3% of them are in nongranulomatous invasive nature. The majority of the cases in the literature have been reported from developing countries mostly located in the tropical regions, as typically occurring in the background of diabetes mellitus or corticosteroid treatment. The current paper reports four consecutive cases, who were diagnosed within a short period of six months at a single center of a country located outside the tropical climate zone. None of the patients had a comorbid disease that may cause immune suppression or a history of drug use. The only risk factor that may have a role in development of chronic invasive nongranulomatous FRS was that all of our patients were people working in greenhouse farming. Three cases underwent endoscopic sinus surgery, and one case underwent surgery with both endoscopic and external approaches. Systemic antifungal therapy was initiated in all cases in the postoperative period with voriconazole 200 mg orally twice a day. All patients achieved a complete clinical remission. Chronic invasive nongranulomatous FRS should be kept in mind in the presence of long-standing nonspecific sinonasal symptoms in immunocompetent individuals, particularly with a history of working in greenhouse farming.

Internal Jugular Vein Thrombosis following Oropharyngeal Infection

Internal jugular vein thrombosis (IJVT) is a rare condition which may lead to life-threatening complications such as sepsis and pulmonary embolism. Prolonged central venous catheterization, intravenous (IV) drug use, trauma, and radiotherapy are the most frequent causes of the IJVT. IJVT that develops after the oropharyngeal infection is a quite rare situation today. In this paper, a 37-year-old woman was presented; swelling occurred on her neck after acute tonsillitis and she was diagnosed with IJVT through Doppler ultrasonography and magnetic resonance imaging and managed without complications. Early diagnosis and conservative treatment with broad-spectrum IV antibiotics and anticoagulant agents have a critical importance for the prevention of fatal complications.

Spindle Cell Carcinoma of the Larynx: A Confusing Diagnosis for the Pathologist and Clinician

Laryngeal spindle cell carcinoma (SpCC) is an uncommon subtype of squamous cell carcinoma which represents 0.5% of all laryngeal squamous cell carcinomas. It is a biphasic tumor consisting of the combination of a malignant mesenchymal spindle cell component and a squamous cell component that includes dysplasia, carcinoma in situ, or invasive carcinoma. Although it has aggressive biological features, the probability of making a diagnosis in the early stages is high as it often leads to obstructive symptoms in the early period. Due to its low incidence, there is no clear consensus on prognostic factors and optimal treatment strategies yet. In this paper, a 60-year-old laryngeal SpCC case that was effectively treated with wide local excision followed by adjuvant radiotherapy was presented with the literature.