Cüneyt Kucur

Functional and quality-of-life outcomes of transoral robotic surgery for carcinoma of unknown primary

To determine speech, eating, aesthetics, social disruption, and overall quality‐of‐life outcomes over a year period in patients who underwent transoral robotic surgery as part of carcinoma of unknown primary diagnosis and treatment.

Safety and efficacy of concurrent neck dissection and transoral robotic surgery

The literature is scarce regarding transoral robotic surgery (TORS) with simultaneous neck dissection. This study evaluates the safety and efficacy of concurrent neck dissection in oropharyngeal squamous cell carcinoma (SCC) treated with TORS.

Mean platelet volume levels in children with adenoid hypertrophy.

AbstractAdenoid hypertrophy (AH) is a common disorder in children, resulting in chronic nasal congestion. This chronic congestion should be evaluated carefully because it can lead to chronic upper airway obstruction. Many authors have suggested that increased nasal resistance to respiration may cause disturbances in the pulmonary ventilation and carry the risk of cardiopulmonary diseases. Mean platelet volume (MPV) is a marker of platelet function and is positively associated with indicators of platelet activity. Mean platelet volume is an indicator of larger and more reactive platelets and has been shown to be increased in patients with vascular disease, including peripheral, pulmonary, and coronary artery disease. Recently, MPV levels have also been shown to be increased in patients with severe obstructive sleep apnea, and marked nasal septal deviation. Moreover, increased MPV has also been shown to have a prognostic role in cardiovascular disease. We investigated whether MPV is higher in patients with AH and whether higher MPV levels can be reduced by adenoidectomy. To the best of our knowledge, this is the first study to investigate MPV in patients with AH. Our results suggest that MPV, a determinant of platelet activation, is elevated in patients with AH and adenoidectomy is an effective therapeutic measure in such patients. Increased platelet activation may be related to an increase of cardiopulmonary risk in patients with AH.

Transoral robot-assisted carbon dioxide laser surgery for hypopharyngeal cancer

Transoral robotic surgery (TORS) has been used as a novel procedure for the resection of laryngopharyngeal cancers with promising outcomes. There are several studies proposing the benefit of combining TORS with a carbon dioxide (CO2) laser in resecting upper aerodigestive tract tumors. The purpose of this study was to illustrate transoral robot‐assisted carbon dioxide laser surgery (TORS‐L) for hypopharyngeal cancers.

Feasibility and clinical outcomes of transoral robotic surgery and transoral robot-assisted carbon dioxide laser for hypopharyngeal carcinoma.

AbstractTransoral robotic surgery (TORS) has been used as a novel procedure for squamous cell carcinoma of the laryngopharyngeal cancers with encouraging outcomes. The safety, feasibility, and efficacy regarding this approach have previously been demonstrated. There are several studies proposing the benefit of combining TORS with carbon dioxide (CO2) laser in resecting upper aerodigestive tract tumors. We report a series of patients with hypopharyngeal carcinoma treated with primary TORS with or without the flexible carbon dioxide (CO2) laser. All TORS resections were completed without any intraoperative complication. None required conversion to an open procedure. Clinical outcomes in this preliminary analysis indicate that magnified view, 3D visualization with the wristed instruments and tremor reduction technology of robotic experience, allow en bloc resection of early stage hypopharyngeal cancers. TORS with CO2 laser is a promising, minimally invasive surgical alternative for the treatment of hypopharyngeal tumors with comparable oncologic outcomes.

Psychological Evaluation of Patients Seeking Rhinoplasty.

OBJECTIVE The aim of this study was to evaluate different determinants of the patients psychosocial functioning that might possibly affect the outcome of rhinoplastic surgery. MATERIALS AND METHODS Forty-one patients undergoing rhinoplasty, consecutively admitted to and operated upon at the Department of Otolaryngology, Erzurum Regional Training and Research Hospital, Turkey, were studied with regard to their psychological characteristics. RESULTS In the patient group, Liebowitz anxiety, Liebowitz/avoidance, and Liebowitz/total scores were significantly higher than the control group (p<0.001). No significant differences were found between the patient and control groups according to Rosenberg self-esteem scale and The Hospital Anxiety and Depression Scale. In the Quality of Life SF-36 results, significant differences were found between the patient and control groups apart from SF-36 scores of pain (p<0.05), vitality (p<0.05), social functioning (p<0.05) and emotional role difficulties (p<0.05). CONCLUSION Patient selection must be done very carefully to obviate not only physical, but also psychological postoperative complications. The SF-36 questionnaire may be of value in screening-patients for psychological problems prior to rhinoplasty.

Evaluation of the anatomical and auditory outcomes of minimally invasive cartilage myringoplasty: Our technique and experience.

The purpose of this study was to assess closure rates in tympanic membrane perforations of various dimensions using the tragal cartilage-perichondrium composite graft and its effect on hearing values and also to present our own experiences. MATERIALS AND METHODS Sixty-one patients presenting to our clinic in 2014-2015 and diagnosed with tympanic membrane perforation were included in the study. Otomicroscopic and otoendoscopic examinations were performed preoperatively and at the 12th month postoperatively. Patients were divided into three groups depending on perforation diameter. Pure tone audiometry was performed at 500, 1000, 2000, and 4000Hz (Hz) preoperatively and at the 12th month postoperatively, air-bone values were recorded, and air-bone gap (ABG) was calculated. Surgery was performed under local anesthesia usıng the transcanal, push-through (transperforation) technique. Perichondrium supported by thinned cartilage graft obtained from the tragal cartilage was used for tympanic membrane repair. RESULTS Graft acceptance levels after 12months in small, medium, and large perforations were 100%, 93.5%, and 93.75%, respectively, and 95% on average. Preoperative air-bone gap values were 18.64±9.63 decibel (dB), 22.51±9.66dB, and 28.43±11.36dB, respectively, and 23.18±11.36dB on average, while 12th month postoperative air-bone gap values were 9.14±8.27dB, 11.25±6.73dB, and 17.37±9.22dB, respectively, and 12.37±8.28dB on average. The difference between pre- and postoperative 12th month air-bone gap values was statistically significant (p<0.005). CONCLUSION The use of thinned cartilage-supported perichondrial grafts in patients with all sizes of tympanic membrane perforation is safe and effective in terms of both anatomical healing and restoration of hearing and can represent a first-choice technique that is easy to perform and involves minimal morbidity.

Unilateral nasal pathologies: clinical presentation and management

Bulgular: Bulgular› incelenen 73 hastan›n; 16’s›nda neoplastik, 57’sinde neoplastik olmayan patoloji tespit edildi. Neoplastik olmayan lezyonlara bakt›¤›m›zda; 16 olguda inflamatuar polip, 11 olguda kronik sinüzit, 6 olguda antrokoanal polip, en çok göze çarpan nedenlerdi. Neoplastik grubu ise 2’si malign, 14’ü benign 16 olgu oluflturmaktayd›. Bu olgular; 1 adenokarsinom, 1 adenoid kistik karsinom, 8 inverted papillom, 1 hemanjioendotelyoma, 1 kapiller hemanjiom, 1 fibröz displazi, 1 osteom, 2 pyojenik granülomdan oluflmaktayd›. En s›k gözlenen semptom, tek tarafl› burun t›kan›kl›¤›yd›. Özellikle neoplazm olgular›nda burun kanamas› s›kl›¤› anlaml› olarak artm›flt› (p<0.05).

Fronto-ethmoid osteoma: case report

Osteomlar, yavaş büyüyen matür kemik dokusundan oluşmuş benign tümörlerdir. Osteomlar, en sık mandibulada yerleşir. Paranazal sinüsler içerisinde en sık frontal sinüsü takiben etmoidal ve maksillar sinüsü tutar. Osteomların tedavisinde endonazal ve eksternal yaklaşımlar uygulanmaktadır. Bu vakada, eksternal yaklaşımla eksize edilen frontal sinüsten kaynaklanıp ethmoid sinüse uzanan osteom olgusunu sunuyoruz. Altmış yedi yaşında erkek hasta 1 yıldır devam eden sağ yüz yarımında ağrı ve şişlik şikâyeti ile polikliniğimize başvurdu. Paranazal sinüs bilgisayarlı tomografi incelemesinde sağ frontal sinüsten kaynaklanıp ethmoid sinüse uzanan osteom ile uyumlu kitle görünümü izlendi. Osteoplastik flep yaklaşımıyla kitle salim sınırlarla eksize edildi. Abdomenden alınan yağ dokusu ile frontal sinüs oblitere edildi. Postoperatif 6 aylık takibinde nükse rastlanmadı. Osteomların büyük çoğunluğu asemptomatiktir. Cerrahi endikasyonlar dikkatle değerlendirilmelidir. Cerrahi yaklaşım ise kitlenin büyüklüğüne ve yerleşim yerine uygun olarak seçilmelidir. Aksi takdirde nükslerle ve komplikasyonlarla karşılaşılması kaçınılmaz olacaktır.

Elevated neutrophil-lymphocyte ratio in patients with euthyroid chronic autoimmune thyreotidis.

Abstract Objective. The neutrophil-lymphocyte ratio (NLR), determined from peripheral blood, is accepted as an available and practical indicator of the systemic inflammation. In this study, we aimed to determine whether the NLR was higher in euthyroid chronic autoimmune thyreotidis (CAT) patients compared to a healthy control group. Methods. A total of 112 patients were enrolled in this study, including 59 patients with euthyroid CAT on any form of therapy and 53 healthy controls. Th e CAT patients were similar in age to the healthy control group (mean 33.9±12.8 years versus 30.2±12.4 years, p=0.10). Measurements were available for the white blood cells (WBC), neutrophils, lymphocytes, platelets, C-reactive protein (CRP), thyroid peroxidase immune antibody (anti-TPO), and anti-thyroglobulin immune antibody (anti-TG). The NLR and platelet-lymphocyte ratio (PLR) were calculated. Differences between the CAT and control groups were tested using the student’s t-test and the correlations were determined using Pearson’s correlation coefficients. Results. There were no differences between the CAT and control groups for WBCs (7.9±0.3 and 7.4±0.2, respectively; p=0.1) or neutrophils (5.5±0.3 and 5.4±1.1; p=0.9), but lymphocytes were higher in the CAT group (3.1±0.5 vs. 2.04±0.1; p=0.05) as was the NLR (4.0±0.7 vs. 2.0±0.1; p=0.01). Th e NLR was positively correlated with CRP (r=0.6, p<0.001), anti-TPO (r=0.3, p<0.001), anti-TG (r=0.3, p=0.006), WBCs (r=0.4, p<0.001), and the PLR (r=0.73, p<0.001). The PLR was also higher in the CAT than the control group (p=0.02). Conclusions. In this study, we found that NLR values were higher in euthyroid CAT patients than in a healthy control group and that NLR correlated with autoantibodies used to diagnose the disease.