Çiğdem Tepe Karaca

Role of nasal packing in surgical outcome for chronic rhinosinusitis with polyposis

To analyze the differences between biodegradable and nondegradable nasal dressings with regard to their effects on wound healing in the short and medium term and on surgical outcomes in the long term, after endoscopic sinus surgery (ESS).

Hyperbaric oxygen versus steroid in facial nerve injury: An experimental animal study

OBJECTIVE The aim of this experimental study was to evaluate the effects of hyperbaric oxygen, methylprednisolone and combined hyperbaric oxygen-methylprednisolone treatments on traumatic facial nerve regeneration in rats. SUBJECTS AND METHODS After exposure to facial nerve injury, four groups of rats were created with five subjects in each group: Group 1 (hyperbaric oxygen), group 2 (control), group 3 (combined hyperbaric oxygen-methylprednisolone), group 4 (methylprednisolone). Facial nerve specimens from sacrificed animals were examined for axonal degeneration, vascular congestion, macro vacuolization, axon diameter and thickness of myelin sheath. RESULTS There were significant differences with regard to axonal degeneration, vascular congestion and axon diameter between group 3 and the control group. In addition to lower axonal degeneration and vascular congestion, a larger diameter of axons was observed in group 3. There were significant differences with regard to vascular congestion and axon diameter between group 4 and the control group. We observed thicker myelin and lower axonal degeneration in group 3 compared with group 4. CONCLUSION The combination therapy with hyperbaric oxygen and methylprednisolone had an additive beneficial effect on regeneration of the facial nerve and may provide better treatment outcomes than methylprednisolone or hyperbaric oxygen therapy alone.

Alveolar ridge preservation with a free gingival graft in the anterior maxilla: volumetric evaluation in a randomized clinical trial.

The aim of this study was to evaluate and compare the dimensional changes in maxillary extraction sockets that have healed spontaneously and those treated with free gingival grafts. Ten subjects with at least two maxillary anterior teeth scheduled for extraction were selected for this study. Two maxillary teeth were allocated randomly to either the test group or the control group. In the test group, the extraction socket was covered with a free gingival graft harvested from the palate, while in the control group the sockets healed spontaneously. Cone beam computed tomography (CBCT) scans were taken on the day of extraction and at 3 months postoperative. Soft tissue healing of the extraction sockets was assessed visually by clinical inspection. Hard tissue measurements were obtained from the CBCT scans. After 3 months of healing, the control sockets had lost height in the buccal and lingual crestal bones (-1.03 and -0.56mm, respectively); however, the height in the buccal and lingual crestal bones was preserved at the test sites (+0.06 and +0.25mm, respectively). This difference between the two groups was statistically significant (P<0.05). In contrast, both the control and test groups lost width in the buccal and lingual crestal bones; the difference between the control and test groups was not statistically significant (P>0.05). The authors propose that covering the orifice of the extraction socket with a free gingival graft can result in preservation of the alveolar bone height.

Effect of Nose Skin on the Columellar Incision Scar in a Turkish Population

Objectives To investigate the causes of columellar scar formation in a Turkish population in relation to nasal skin thickness, texture, and type and discuss possible solutions for better results. Study Design Prospective, clinical study. Setting Otorhinolaryngology department of a tertiary hospital. Methods The preoperative dermal thickness of 50 consecutive patients undergoing “external approach” septorhinoplasty was measured (using a 14 MHz ultrasound probe) at the midportion of the right and left nostril, tip, supratip, and columella. Surgery was performed using a middle columellar gullwing incision. All patients had a minimum follow-up of 6 months after surgery. Assessment of the columellar scar was performed according to the Stony Brook Scar Evaluation Scale modified for columellar scars. The mean values of skin thickness measurements, skin type (according to the Fitzpatrick skin classification scale), skin texture (oily, combination, normal, dry, and sensitive types), smoking habit, and patient gender were recorded and compared with the columellar incision scar scores. Results There was no statistically significant difference in healing between the skin thickness of the tip, supratip, left nostril, right nostril, columella and mean skin thickness values, skin types (Fitzpatrick 2, 3, 4, 5), skin textures, and smoking with regard to columellar scar formation (P > .05). However, men healed significantly better than women (P < .05). Conclusions The columellar incision heals independently of the influence of skin thickness; texture; Fitzpatrick skin types 2, 3, 4, and 5; and smoking. Male gender seems to be a significant factor in healing.

Role of allergy in children with adenotonsillar hypertrophy.

Objective The goal of this prospective study is to investigate the correlation between allergen sensitivity and radiographic evaluation of adenoidal obstruction and tonsil size. Subjects and Methods A total of 82 children with upper airway obstructive symptoms were evaluated for their tonsil size. All patients underwent digital lateral soft tissue radiographs. Assessment of nasopharyngeal obstruction in radiographs was done according to the Cohen and Konak method. Skin prick tests with multitest applicator including 14 allergens were carried out to investigate their allergic background. Results All children reacted positive to at least one of the 14 allergens tested. We found a statistically significant correlation between tonsil size and skin prick tests (P < 0.01). However, there was no statistically significant correlation between the adenoid size and skin prick test results (P > 0.05). Conclusions Although the degree of nasopharyngeal obstruction caused by adenoid hypertrophy does not increase with the degree of positivity to specific allergens in skin prick tests, allergic sensitivity may play an important role in children with tonsillar hypertrophy.

Treatment of oroantral fistulas using bony press-fit technique.

PURPOSE The objective of this study was to determine the effectiveness of the bony press-fit technique in closing oroantral communications (OACs) and oroantral fistulas (OAFs) and in identifying potential intraoral donor sites. PATIENTS AND METHODS Ten patients, 4 with OACs and 6 with OAFs, were treated with autogenous bone grafts using the bony press-fit technique. In 9 patients, dental extractions caused OACs or OAFs; in 1 patient, an OAC appeared after cyst enucleation. Donor sites included the chin (3 patients), buccal exostosis (1 patient), maxillary tuberosity (2 patients), ramus (1 patient), and the lateral wall of the maxillary sinus (3 patients). The preoperative evaluation of the patients, surgical technique, and postoperative management were examined. RESULTS In all 10 patients, a stable press fit of the graft was achieved. Additional fixation methods were not needed. In 2 patients, mucosal dehiscence developed, but healed spontaneously. In 2 patients, dental implant surgery was performed in the grafted area. CONCLUSION Treatment of 10 patients with OACs or OAFs was performed, with a 100% success rate. The bony press-fit technique can be used to safely close OACs or OAFs, and it presents some advantages compared with other techniques.

External auditory canal microbiology and hearing aid use

OBJECTIVE The aim of this study was to determine the presence and nature of bacterial flora on hearing aids and the ears of this population. We wonder if the microbiology of the ears with hearing aid wearing differs from the other ear. SETTING Tertiary referral center. DESIGN A prospective, clinical study. SUBJECTS AND METHODS Three samples were taken, one from the surface of the hearing aids ear mold; one from the hearing aid-wearing ear canal and the last one from the ear without hearing aid. Samples were cultured to determine qualitatively and quantitatively the pathogenic microorganisms present. RESULTS A total of 123 samples, obtained from 41 hearing aid users, were analyzed. Methicillin-resistant coagulase-negative staphylococci, methicillin-susceptible Staphylococcus aureus, methicillin-resistant S. aureus, Pseudomonas aeruginosa, Escherichia coli, Acinetobacter species, Staphylococcus auricularis, and Stenotrophomonas maltophilia were identified organisms. CONCLUSIONS We identified unexpected microorganisms both on hearing aids and hearing aid using ears. This study demonstrates that using hearing aid alters the ear canal flora. To avoid otitis externa, it is important to use an appropriate hygiene routine to clean and disinfect hearing aids and ear molds.

Familial ring (18) mosaicism in a 23-year-old young adult with 46,XY,r(18) (::p11→q21::)/46,XY karyotype, intellectual disability, motor retardation and single maxillary incisor and in his phenotypically normal mother, karyotype 47,XX,+r(18)(::p11→q21::)/46,XX.

We report on a 23‐year‐old man with craniofacial findings of the holoprosencephaly spectrum disorder (microcephaly, hypotelorism, depressed nasal bridge, single median maxillary central incisor), fusion of C2–C3 vertebrae, intellectual disability, and severe sleep apnea. Chromosome analysis of blood lymphocytes showed 75% ring (18) cells and 25% normal cells, karyotype mos 46,XY,r(18)(::p11→q21::)[75]/46,XY[25]. His mother was phenotypically normal except for a double ureter and bifid renal pelvis as in his son. She had a supernumerary ring (18) in 10% of blood lymphocytes, karyotype mos 47,XX,+r(18)(::p11→q21::)[10]/46,XX[90]. Familial ring (18) is a rare cytogenetic abnormality. This is the first report of a mother with a supernumerary ring (18) and a son with ring (18) mosaicism. Interestingly, the son showed a true mosaicism (mixoploidy) of ring (18) and normal cells. The mothers 46,XX cells could be easily explained by mitotic instability and ring loss during cell division. However, the coexistence of ring (18) and normal cells in the son is unusual. Possibly, during early postzygotic divisions of a 47,XY,+r(18) zygote, two (possibly subsequent) genetic events could have occurred, one when one normal chromosome 18 was lost (resulting in a cell line with ring 18), and one when the ring 18 was lost (resulting in a cell line without ring, “escape to normal”). Alternatively, the zygote of the son could have been 46,XY,r(18), and postzygotic loss of the ring 18 could have resulted in monosomy 18 cells followed by duplication of chromosome 18 in these cells (a rare mechanism for cell survival previously described as “compensatory” isodisomy).

The effect of duration of merocel in glove finger with tetracaine solution on septoplasty morbidity.

Objective We aimed to decrease the postseptoplasty morbidities depending on nasal packing by using Merocel within glove finger moistened with tetracaine 0.25% solution. Study Design The study was designed as a randomized prospective study. Setting A university hospital in Turkey. Subjects and Methods Our study consisted of 80 patients who underwent septoplasty. The Merocel nasal tampon within glove finger was inserted after surgery in the study group and removed after 24 or 48 hours. Merocel was moistened with tetracaine 0.25% solution after insertion into the nasal cavity and just before removal. The morbidities and normal breathing time were recorded and compared with those of the control group. Results The postseptoplasty morbidities were significantly decreased in the study group compared with those in the control group. The morbidities were also improved after removal of tampons after 24 hours compared with 48 hours. However, the normal breathing time was prolonged when the nasal tampons were removed after 24 hours. Conclusions The glove finger provides comfortable removal of nasal packing. The Merocel tampons might be safely removed just after 24 hours postoperatively without any complication.

Nasal Obstruction and Unilateral Chronic Otitis Media: Evaluation by Acoustic Rhinometry

Objectives: In a prospective study at Umraniye Research and Education Hospital, we aimed to evaluate the differences in acoustic rhinometric findings between the affected and nonaffected sides in patients with unilateral chronic otitis media (COM) and to investigate whether unilateral COM correlates with the side of nasal obstruction. Methods: Fifty-five consecutive patients with unilateral COM were involved in this study. All patients were evaluated with acoustic rhinometry, the Nasal Obstruction Symptom Evaluation (NOSE) scale, and measurement of their nasal mucociliary transport time. Results: The mean cross-sectional area 1, mean cross-sectional area 2, volume 1, and volume 2 values were not different between the affected and nonaffected sides (p > 0.05). The NOSE score had a reverse correlation with the mean cross-sectional area 2 (p < 0.05) and volume 2 (p < 0.01) of the affected side. Saccharin time was not correlated with the acoustic rhinometric values of the affected side (p > 0.05). Conclusions: These findings do not support the hypothesis that unilateral COM is correlated with the side of nasal obstruction.