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Subperiosteal temporal pocket versus standard technique in cochlear implantation: a comparative clinical study.

Objective: In the standard technique of cochlear implantation, the internal receiver-stimulator (IRS) is fixed into a socket drilled on the calvarial bone. In the subperiosteal technique, the IRS is fixed under the subperiosteal plane, and drilling is not necessary. The purpose of this study was to compare the subperiosteal and the standard techniques. Study Design: Retrospective clinical study. Setting: Tertiary referral center; cochlear implant program. Patients: One hundred forty-eight patients who underwent cochlear implantation. Intervention: The researcher who evaluated the patients was not informed which of the 2 techniques was used on the patients and administered a visual analog scale (VAS) analysis. The duration of the operation, intraoperative and postoperative complications, and migration of the IRS were assessed. Main Outcome Measures: A VAS survey was administered to the patients or to their parents to evaluate the practicability of the implant. Results: The duration of the operation was 73.4 ± 17.8 minutes in the subperiosteal group and 105.5 ± 17.8 minutes in the standard technique group. The difference was statistically significant. Intracranial complications or migration of the IRS was also not observed in any patient. The VAS score was 4.2 ± 2.1 in the standard group and 4.3 ± 1.9 in the subperiosteal group. The difference was not statistically significant. Conclusion: The subperiosteal technique can be safely and effectively used in cochlear implantation. Not only are there no intracranial complications and no migration of IRS was observed but also the mean operation time is reduced up to 30% and none of the patients have reported difficulty with fixing of the external device.

An unusual complication of stapes surgery: profuse bleeding from the anteriorly located sigmoid sinus

Major bleeding during stapes surgery is a rare condition. The anterior course of the sigmoid sinus is comparatively common in contracted mastoid bones, but rare in good pneumatized temporal bones. We report a case of an unusual anterior course of the vertical segment of the sigmoid sinus, which led to profuse bleeding during a stapedotomy operation. The 34-year-old female patient presented with conductive-type hearing loss in the right ear. During the operation, the unintentional sliding movement of a blunt curette caused injury to the anteriorly positioned sigmoid sinus, which was separated from the posterior wall of the external auditory canal by an extremely thin shell of bone. Profuse bleeding from the sigmoid sinus was controlled by pushing the middle part of the oxidised regenerated cellulose inside the lumen, without compromising the sinus flow. After bleeding was restrained, the stapedotomy operation was completed successfully. During the 1-year follow-up, there was neither an air-bone gap nor a sensorineural hearing loss in pure tone audiogram.

[The use of botulinum toxin type A in masseter muscle hypertrophy: long-term effects and lasting improvement].

OBJECTIVES In this study, we aimed to evaluate the long-term efficacy of botulinum toxin A injection in reducing the masseter muscle thickness. PATIENTS AND METHODS Between 2007 and June 2008, we retrospectively analyzed the data from 28 patients (21 females, 7 males; mean age: 25.5±4.5 years; range 20 to 46 years) with benign masseter hypertrophy treated with botulinum toxin A injections. All patients were diagnosed by the morphometric analysis of the masseter muscle. The injections were repeated intermittently every six months and totally for six times. The patients were recalled and the last measurement was performed at a mean follow-up of 13.2 months. RESULTS The values obtained following consecutive injections were compared and a statistically significant reduction in thickness of masseter muscle thickness after every single injection was found (p<0.001). The final measurement following treatment discontinuation revealed that this reduction was long-lasting. CONCLUSION Botulinum toxin A injection is a safe and long-term effective therapy for the masseter muscle hypertrophy.

The Effect of Arytenoidectomy on Functional and Oncologic Results of Supracricoid Partial Laryngectomy

Objective: The effect of arytenoid resection was investigated in patients who had undergone supracricoid partial laryngectomy (SCPL) by comparing functional and oncologic results between patients with both arytenoids preserved with those with one arytenoid resected. Methods: Patients were divided into 2 groups: (1) both arytenoids preserved SCPL (BASCL) cases and (2) one arytenoid preserved SCPL (OASCL). The functional outcomes of the 2 groups were compared in terms of nasogastric tube removal time, decannulation time, incidence of aspiration pneumonia, and Performance Status Scale Scores for Head and Neck Cancer Patients for the late postoperative period. Additionally, the oncologic outcomes of both groups were compared using the 5-year local control rate, overall survival, disease-specific survival, and larynx preservation rate. Results: Of the 68 patients who were enrolled in the study, 20 of them were in the OASCL group and 48 in BASCL group. There was no statistically significant difference in the early and late functional outcomes, and the oncologic outcomes were also similar. Conclusion: In addition to the proven oncologic safety, arytenoid resection does not increase the functional morbidity of the SCPL.

Malignant peripheral nerve sheath tumor in the parotid gland developed on the basis of neurofibromatosis type 1

Malignant peripheral nerve sheath tumors arising from the parotid gland are very rare. They can develop as sporadic cases, or on the basis neurofibromatosis type 1. Tumors originating from the parotid gland are generally easy to palpate and have a solid characteristic. Even if the tumor is malignant in character, the incidence of facial paralysis at the time of diagnosis is around 15% in various studies. However, a malignant tumor originating from the nerve itself may not be noticed during the physical examination for a long period time although it cases facial paralysis and may be mistaken with other non-neoplastic diseases involved in the etiology of facial paralysis leading to a delay in the diagnosis and treatment. Especially patients with type 1 neurofibromatosis have a great tendency to develop malignant peripheral nerve sheath tumors. In this article a case of malignant peripheral nerve sheath tumor developed on the basis of neurofibromatosis type 1 was reported.

Comprehensive analysis of parotid mass: A retrospective study of 369 cases

OBJECTIVE To present the results of patients who underwent superficial or total parotidectomy because of parotid gland tumors in our tertiary care clinic. METHODS The data of 362 patients who underwent parotid surgery from January 2008 to November 2015 were collected and analyzed in demographic, histopathological features, and complications. RESULTS Three hundred sixty-nine cases (performed in 359 patients) were analyzed and we assessed complications of parotid surgery such as transient or permanent facial paralysis and Freys syndrome. Pleomorphic adenomas and Warthins tumors consisted 74% of all parotid gland tumors. These tumors were generally located in the superficial lobe and tail of the parotid gland (81%). Also, tumor size in the positive surgical margin group was larger than in the negative surgical margin group (p=0.012). CONCLUSIONS Most of parotid gland tumors are benign. However, the frequency of malignancy increases in deep lobe of parotid gland. High grade malignant tumors have more tendency to have positive surgical margin during surgery, and facial paresis preoperatively.

[The relationship between operation type, adjuvant radiation therapy, spinal accessory nerve and quality of life in patients with laryngeal cancer].

OBJECTIVES In this study, we aimed to investigate the effect of operation type, adjuvant radiation therapy (RT), and preserved spinal accessory nerve on the quality of life in patients with laryngeal cancer. PATIENTS AND METHODS A total of 191 consecutive patients (185 males, 6 females; mean age 59±10 years; range 42 to 79 years) who were operated due to laryngeal cancer were included. The quality of life scores were estimated using the Washington University Quality of Life Questionnaire, version IV. The patients were divided into six groups according to the operation type, the need for postoperative RT and preserved or operated spinal accessory nerve during the neck dissection. Group 1 consisted of patients with total or near total laryngectomy; group 2 consisted of those with partial laryngeal surgery; group 3 consisted of those with postoperative RT; group 4 consisted of those without postoperative RT; group 5 consisted of those with preserved 11th cranial nerve during the neck dissection, and group 6 consisted of those with non-preserved 11th cranial nerve during the neck dissection. The questionnaire scores were compared among the groups. RESULTS The compact quality of life scores were 77.4±11.3 in group 1, 86.2±7.2 in group 2, 79.1±9.5 in group 3, 83.4±10.6 in group 4, 87.3±9.4 in group 5, and 79.4±10.8 in group 6. There was a statistically significant difference in the compact quality of life scores among the surgery groups, neck dissection groups and RT groups (p=0.018, p<0.001, p<0.001, respectively). There was no effect of preserved 11th cranial nerve on daily activity, swallowing, chewing, appearance, recreation, salivation, taste, speech, mood, and anxiety parameters. This nerve was not preserved in 71.9% of the patients who were urged to change their job due to shoulder problems. The difference was statistically significant (p<0.001). CONCLUSION According to our study results, we concluded that partial laryngectomy improved the quality of life, rather than total or near-total laryngectomy, while postoperative RT had an adverse effect on the quality of life and preserved spinal accessory nerve during the neck dissection had a positive impact on the quality of life in patients with laryngeal cancer.

Oncologic and functional outcomes of open surgery in early supraglottic tumors: is it still a valid technique?

OBJECTIVES In this study, we aimed to analyze the oncologic and functional outcomes of supraglottic laryngectomy. PATIENTS AND METHODS Medical records of 91 cases (85 males, 6 females; mean age 55.4 years; range 30 to 75 years) who underwent surgery due to early supraglottic laryngeal cancer in our clinic were retrospectively analyzed. Statistical analysis was performed using chi-square test and Fishers exact test. Mean values were estimated by means of t-test, while survival curves were drawn using Kaplan-Meier method. RESULTS With respect to oncologic assessment, disease-free survival rate was 81%, the rate of regional recurrence was 6%, the rate of local recurrence was 8%, the rate of distant metastasis was 7% and the rate of occult neck metastasis was 25%. Metastatic neck disease and extracapsular invasion in the lymphatic ganglia were found to be the most critical parameters in terms of survival. With respect to functional assessment, the mean time of decannulation was 41 days, while the mean time of nasogastric tube removal was 19 days. It was observed that cases with a Forced Expiratory Volume in 1 second (FEV-1) of <75% experienced more aspiration-related problems. The functional outcomes were worse in the cases who underwent bilateral neck dissection and postoperative radiotherapy. CONCLUSION Open surgery is a more effective treatment modality in the early supraglottic tumors in terms of oncologic and functional outcomes. It should be continued to be use as an alternative method to the novel and expensive technologies including transoral robotic surgery or transoral laser surgery.

A giant mixed tumor originating from the parapharyngeal space.

A 66-year-old man presented with difficulty in breathing and swallowing caused by swelling in his throat. He was aware of this swelling for the last three years but he had avoided referring to a hospital until he started to have serious apnea attacks. Physical examination revealed a large mass in the oropharynx bulging submucosally from the right lateral pharyngeal wall that nearly occluded the whole oropharynx. The other remarkable findings were absence of the gag reflex on the right soft palate, deviation of the tongue to the right side and right vocal cord paralysis, reflecting glossopharyngeal, vagus and hypoglossal nerve palsies. On magnetic resonance imaging (MRI), a mass in the right parapharyngeal space was observed with the dimensions of 83x51x84 cm (anteroposterior x transverse x craniocaudal) obliterating nearly the whole parapharyngeal space at the level of the oropharynx and hypopharynx. The tumor had pushed the carotid space posteriorly and the masticator space anterolaterally. It had a heterogeneous hypointense signal but peripheral hyperintense signal due to hemorrhage on T1 weighted (T1W1) and heterogeneous hyperintense signal on T2W2. This mass lesion had also enlarged the stylomandibular foramen and had a solid component enhancing contrast intensely with a central large necrotic component (Figure 1a-c). Following MRI of the mass a transoral fine needle aspiration (FNA) biopsy was performed, the result of which was non-diagnostic necrotic cells. The mass was surgically excised through a transcervical-transparotid approach.

UNILATERAL ARYTENOIDECTOMY FOR INTRACTABLE ASPIRATION FOLLOWING SUPRACRICOID LARYNGECTOMY: A CASE OF SURGICAL DILEMMA

DOI : 10.26650/IUITFD.342778 Suprakrikoid larenjektomi larenks fonksiyonlarinin korundugu parsiyel larenjektomi metodlarindan biridir. Bu operasyonlari takiben en sik gorulen fonksiyonel bozukluk yutma guclugudur. Aritenoid kartilajlarin bilateral korunmasinin postoperatif donemde yutma fonksiyonlarinin cabuk iyilesmesinde faydali oldugu bildirilmektedir. Bu olgu sunumumuzda 2015 yilinda her iki aritenoid kartilajin korundugu suprakrikoid larenjektomi yapilmis bir erkek hastayi sunmaktayiz. Hastanin postoperatif donemde siddetli aspirasyon ve yutma problemleri olmustur. Hastayi total larenjektomiden kurtarmak icin tek tarafli aritenoidektomi denenlmis ve basarili olmustur. Hasta postoperatif 3. ay takibinde gastrostomi tubunden kurtulmustur.