Cuneyt Yilmazer

Correlation between adenoid-nasopharynx ratio and endoscopic examination of adenoid hypertrophy: a blind, prospective clinical study.

OBJECTIVE To determine the reliability of adenoid-nasopharynx (A/N) ratio that is calculated on lateral cephalometric graphies for measuring the adenoid tissue size. METHODS 85 patients that had been examined in our clinic with a prediagnosis of adenoid hypertrophy between June 2007 and March 2008 were included in the study. Local ethics committee approved the study protocol. Patients who had a previous adenoidectomy history and anatomic anomaly or acute infection in nose, palate or nasopharynx were excluded. Endoscopic nasal examination was done in all patients in addition to the routine ear nose throat examination. Lateral cephalometric graphs were obtained from all patients. Digital images obtained during endoscopic examination were evaluated on computer and obstruction ratios of adenoid tissue to choanal opening were calculated. Each cephalometric graph was evaluated by a blinded author. A/N ratio was calculated by dividing the distance from the outermost point of convexity of adenoid shadow to basiocciput to the distance between sphenobasiocciput and posterior end of hard palate (Fujioka Method). A/N ratio of each patient was then compared with the obstruction ratio obtained in nasal endoscopy. Pearson correlation test was used for statistical analysis and a p-value of <0.05 was accepted as significant. RESULTS There were 52 male and 33 female patients between the ages of 2 and 12 years (mean age, 5.0+/-2.2; median, 4.5). In nasal endoscopy, adenoid tissue was determined to obstruct the choanal opening as 88.5+/-12.0% (range, 51-99%) in an average. Mean adenoid nasopharynx ratio was found to be 0.87+/-0.1. There was a statistical significant correlation between A/N ratio and nasal endoscopic examination findings (r=0.511; p<0.0001). CONCLUSIONS A/N ratio is an easily applicable, noninvasive method that can correctly measure the size of the adenoid tissue in patients who are suspected to have adenoid hypertrophy.

Efficacy of lornoxicam for acute postoperative pain relief after septoplasty: a comparison with diclofenac, ketoprofen, and dipyrone

STUDY OBJECTIVES To compare the efficacy of injectable lornoxicam with diclofenac, ketoprofen, and dipyrone for acute postoperative pain. DESIGN Prospective, randomized, placebo-controlled, double-blind study. SETTING University hospital. PATIENTS 200 ASA physical status I patients who were scheduled for elective septoplasty with general anesthesia. INTERVENTIONS Patients were divided into 5 groups according to the intramuscularly administered analgesic drug: lornoxicam 8 mg (twice daily), diclofenac 75 mg (twice daily), ketoprofen 100 mg (twice daily), dipyrone 1 g (three times daily), and placebo (twice daily). MEASUREMENTS Pain intensity was evaluated with a 0 to 100 mm Visual Analog Scale (VAS) at the 2nd, 4th, 6th, 8th, 12th, 16th, 20th, and 24th hour postoperatively. Intramuscular pethidine 1 mg/kg was administered to patients requiring additional analgesia, and treatment-related adverse effects were noted. MAIN RESULTS Pethidine requirement was found to be significantly higher in the placebo group (1.8 mg/kg per 24 hours; 95% confidence interval, 1.5-2.2) than in the other groups (P = 0.001). No significant difference in opioid requirement was found among the treated groups (P > 0.05). Postoperative VAS scores were significantly lower at specific hours in the treatment groups when compared with placebo group (P < 0.05). No statistically significant difference in adverse effects was found among the groups studied (P > 0.05). CONCLUSIONS Efficacy of lornoxicam in the management of acute postoperative pain was not superior to that of other nonopioid analgesics used in this study.

Patient-controlled analgesia with lornoxicam vs. dipyrone for acute postoperative pain relief after septorhinoplasty: a prospective, randomized, double-blind, placebo-controlled study.

Background and objective: We compared the efficacy of intravenous lornoxicam vs. dipyrone in patient‐controlled analgesia for postoperative analgesia. Methods: The study included 105 patients who had undergone elective septorhinoplasty after receiving general anaesthesia. Patients were divided into three groups to receive lornoxicam (24 mg day−1), dipyrone (5 g day−1) or placebo. Pain was evaluated using a 0‐100 mm visual analogue scale at 2, 4, 6, 8, 12, 16, 20 and 24 h postoperatively. Pethidine (1 mg kg−1) was administered intramuscularly to patients requiring rescue analgesia. Pethidine requirements were recorded during the first 24 h postoperatively, and treatment‐related adverse effects were noted. Results: Postoperative pain scores were significantly lower with lornoxicam compared with dipyrone at 8 h (P = 0.016). No significant differences regarding pain scores at 2, 4, 6, 12, 16, 20 and 24 h were found. Significantly fewer patients in the lornoxicam group required rescue analgesics (vs. dipyrone, P = 0.046; vs. placebo, P = 0.001); fewer patients in the dipyrone group required rescue analgesics compared with placebo (P = 0.008). Significantly fewer patients in the lornoxicam group had nausea (vs. dipyrone, P = 0.022; vs. placebo, P = 0.006); no significant differences were found between the other two groups. Antiemetic use was significantly lower in the lornoxicam group (vs. dipyrone, P = 0.002; vs. placebo, P = 0.001). Conclusions: Lornoxicam has better tolerability and is a more effective analgesic than dipyrone when administered by patient‐controlled analgesia for postoperative analgesia after septorhinoplasty.

Appropriate interslice gap for screening coronal paranasal sinus tomography for mucosal thickening

The objective of this study was to establish the appropriate interslice gap for screening coronal paranasal sinus tomography to identify sinus mucosal thickening. We reviewed 100 coronal paranasal sinus tomographic scans (interslice gap, 2 mm) that had been performed at our institution between January 2004 and November 2004 to evaluate rhinosinusitis. Digital photographs of all slices from each tomographic scan were taken. The intervening slices were eliminated to form six different sets of interslice gaps of 4, 6, 8, 10, 16, and 20 mm. The remaining slices for each set were moved to corresponding folders created on a computer to catalog each interslice gap. The same specialist evaluated each folder of interslice gap. The paranasal sinuses, the ethmoid infundibulum, and the frontal recess were evaluated for mucosal thickening. The sensitivity, specificity, and accuracy of each interslice gap in detecting mucosal thickening were calculated by accepting the results of 2-mm-thick slices as the gold standard. The interslice gap of 2 mm was compared with that of other interslice gaps using the chi-square test for dependent groups (the McNemar test). The value of 20 mm interslice gap in detecting sinus mucosal thickening was found to be significantly low when compared with the interslice gap of 2 mm (P = 0.022). Using coronal paranasal sinus tomography, an interslice gap up to 16 mm may be used to detect sinus mucosal thickening.

Correlation of diagnostic systems with adenoidal tissue volume: A blind prospective study ☆

OBJECTIVES To determine the correlation between adenoid tissue volume and three diagnostic methods of deciding whether to perform an adenoidectomy. METHODS The study used 152 patients (mean age, 5.8+/-2.5 years; age range, 2-12 years) who underwent an adenoidectomy at our clinic between April 2005 and April 2007. Patients requiring a revision operation and those with a cleft palate were excluded. To estimate the extent to which the adenoid narrowed the choana, an evaluation was made using nasal endoscopy (%), a mirror (%), and palpation (rated from 1 to 5) with the patient in Roses position just before surgery. Postadenoidectomy tissue volume was measured (in cm(3)). The Spearman rank correlation and stepwise linear regression analyses were used to statistically evaluate the data. RESULTS Nasal endoscopy revealed that the choana was narrowed by the adenoid at an average of 86.6+/-13.1% (range, 50-99%). When viewing upward by a mirror, the choana was observed as being narrowed at an average of 44.2+/-30.2% (range, 5-100%). The mean palpation value was 3.2+/-1.4 (range, 1-5). The mean volume of adenoidal tissue measured was 1.8+/-0.8 cm(3) (range, 0.7-4.5 cm(3)). Nasal endoscopy was determined to be the best means of checking by the Spearman rank correlation. Mirror (R=0.64, P<.0001), palpation (R=0.62, P<.0001), and volume (R=0.62, P<.0001) were correlated with the nasal endoscopy; however, regression analysis found that only palpation (P=.003) and volume (P<.001) were independent variables affecting the image of nasal endoscopy, mirror inspection (P=.260) was not. CONCLUSIONS Nasal endoscopy is considered the most important tool to indicate adenoidectomy. This study showed that nasal endoscopy and palpation provide the most accurate determination of the volume of adenoidal tissues dissected by adenoidectomy.

Endoscopic removal of esthesioneuroblastoma

Esthesioneuroblastoma is a rare tumor of neural crest origin that arises in the nasal cavity. There is still no consensus on the optimal treatment for this neoplasm, and the literature contains very few accounts of endoscopic excision in these cases. We described a case report of 12-year-old girl with esthesioneuroblastoma that was confined to the nasal cavity and paranasal sinuses, with no orbital or intracranial extension. The tumor was removed via intranasal endoscopic approach and radiotherapy was administered postoperatively. The patient is currently being followed, and there has been no recurrence in 24 months after surgery.

Giant sublingual epidermoid cyst: a report of two cases.

Epidermoid cysts are benign epithelial cysts that occur rarely in the neck. In contrast to dermoid cysts,epidermoid cysts do not include dermal attachments such as hair, hair follicles, sebaceous glands and sweat glands. They may be congenital or acquired. Acquired epidermoid cysts are either post-traumatic or iatrogenic. They rarely enlarge markedly.This study discusses epidermoid cysts in a 34-year-old woman and a 35-year-old man, both of which were giant epidermoid cysts in the sublingual space. Both patients were admitted for difficulty swallowing and cosmetic problems. The cysts of both patients had an aetiology of trauma and were documented by pathology sections and pre-operative magnetic resonance images. Both cysts were excised completely, one intraorally and one externally. Such cysts are benign and ought to be borne in mind in the differential diagnosis of oral cavity and neck cystic masses.

Otologic T-tube in endonasal dacryocystorhinostomy: a new approach.

Conclusion. Otologic T-tubes had a success rate of 73% if implanted during endoscopic dacryocystorhinostomy (DCR). We suggest that they can be used successfully in endoscopic DCR, and are promising as an alternative to silicone stent intubations. Objective. To evaluate the efficacy of endoscopic DCR using otologic T-tube. Materials and methods. Twenty patients (22 eyes) with nasolacrimal duct obstruction underwent endoscopic DCR. After creating an aperture in the medial wall of the lacrimal sac, the otologic T-tube (1.15 mm diameter, Invotec, Jacksonville, FL, USA) was inserted into the sac transnasally. The T-tube was left in the lacrimal sac for between 3 and 6 months. The patients were followed up for between 6 and 24 months (mean 12.4 months). The improvement in patients’ epiphora complaint was grouped as very good, good, or no change. Results. Eleven eyes (50%) proved to be ‘very good’, whereas five eyes (23%) were good, and six eyes (27%) had no change. Of six eyes that were reported to have no change after the operation, three experienced spontaneous tube loss in the early period, one eye was a recurrent case, and the other two were primary cases.

Nasoalveolar Cysts: Review of 3 Cases

Nasoalveolar cysts, also known as nasolabial cysts or Klestadt’s cysts, are rare, nonodontogenic, soft-tissue lesions that arise during development of the maxilla. They occur lateral to the midline in the region of the maxillary lip and alar base. In this case report clinical features and treatment options of three patients with nasoalveolar cysts are discussed.

Comparison of nasal region dimensions in bilateral choanal atresia patients and normal controls: A computed tomographic analysis with clinical implications

OBJECTIVE To determine if any difference exists between a set of nasal dimension measurements in choanal atresia patients and in a control group. METHODS A retrospective study was undertaken to define the variation of values for a series of nasal dimension measurements through axial computed tomography in 9 patients with bilateral choanal atresia and compare the same dimensions with a control group 104 patients of similar gender and age distribution. The statistical significance of the differences in these dimensions was examined. RESULTS Nine of 17 variables showed a significant difference between normal and choanal atresia group. The result showed that the growth of the nasal complex can be influenced by nasal obstruction. CONCLUSION These findings might serve in understanding the differential growth patterns of nasal structures in the face of the nasal breathing obstruction. Computed tomography is valuable in defining the exact anatomical extent of the disease and also in preoperative evaluation of the patient.