Davut Akduman

Relationships between clinical behavior of laryngeal squamous cell carcinomas and expression of VEGF, MMP-9 and E-cadherin.

The biological mechanisms of cancer and associations with behavior of tumours need to be studied to understand progression and determine appropriate treatments. Here we investigated expression of VEGF, MMP-9 and E-cadherin in laryngeal SCCs and their relations with clinical behavior. This prospective study was based on 38 surgical specimens from patients with primary laryngeal SCC and data recorded in their cards. Expression of the three factors in tumor tissue was examined using immunohistochemistry and correlations with clinical parameters of primary tumors, regional lymph node metastases, stage of disease, histopathologic differentiation, and vascular/cartilage invasion were investigated. Regarding the cases with positive MMP-9 expression, the difference between well and moderately/poorly differentiated tumors was statistically significant. However, differences between early stage (stage I and II) and late-stage (stage III and IV) tumours, and between positive and negative for pLN metastasis were not. No significant relationship between positive VEGF and tumor differentiation or stage was apparent, but E-cadherin levels significantly differed between well and moderately/ poorly differentiated tumours and with the presence of pLN metastasis. E-cadherin staining did not vary between MMP-9 positive and negative cases. In conclusion, MMP-9 may be a negative predictor of differentiation in laryngeal SCC, while E-cadherin is a predictor of differentiation and nodal metastases. Even if the difference between VEGF expression and tumor stage was not statistically significant, it seems that there exists some relationship, which might be clarified with a greater number of cases.

Effect of functional neck dissection and postoperative radiotherapy on the spinal accessory nerve

Conclusions. We encountered shoulder syndrome after functional neck dissection (FND) less frequently than reported in the literature. This technique is a favorable treatment choice for appropriately selected patients with head and neck cancer with cervical metastasis. It depends on careful dissection of neurovascular tissues during surgery and preserved shoulder function due to chronic neurological degeneration caused by surgery. Also, radiotherapy has an evident negative effect on the accessory nerve. Objectives. To perform postoperative electrophysiological tests on the spinal accessory nerve (SAN) after FND and postoperative radiotherapy. Subjects and methods. A study group of 16patients with head and neck cancer who underwent 22FNDs and 10volunteers in the control group were evaluated. The SAN latency and amplitude were measured and then upper trapezius muscle electromyography (EMG) was performed on all the patients and the volunteers. Results. The EMG results of the study group revealed 19cases with normal findings, 1 with total and 2 with partial axonal degeneration. The amplitude levels of the SAN in the study group showed statistically significant decrease when compared with the control group. The latency levels of the SAN in the four patients who received postoperative radiotherapy were significantly longer than those in cases who did not receive this therapy.

The effects of aminoguanidine, methylprednisolone, and melatonin on nerve recovery in peripheral facial nerve neurorrhaphy.

Background:The medications may enhance the recovery after nerve paralysis. We aimed to evaluate the effects of aminoguanidine (AG), melatonin, and methylprednisolone on peripheral facial nerve neurorrhaphy. Methods:The buccal branch of the facial nerve was transected and autografted in 32 New Zealand rabbits. Subjects were divided into 4 groups equally (AG, melatonin, methylprednisolone, and control). After the medical treatment latency and amplitude were measured with nerve conduction study at 3, 6, and 10 weeks. Then, coapted segments of nerve were examined microscopically. The groups were compared with each other. Results:The latent period was shortened, and the amplitudes were increased in the AG group; the latent period was shortened, and the amplitudes did not show significant change in the melatonin group with the time. There were no significant differences between the amplitudes at 3 to 6 and 3 to 10 weeks in the methylprednisolone group, and the latent period was shortened. There was no significant difference between the amplitude values at 3, 6, and 10 weeks in the control group. In the histological examination, AG had the best influence on preventing myelin degeneration and reducing the accumulation of myelin debris. Considering the increase in collagen fibers, the best results were achieved in the melatonin group. The degree of myelin-axonal degeneration was higher in the methylprednisolone group. The degree of collagen fiber increase, axonal degeneration, myelin degeneration, and the accumulation of myelin debris were detected quite high in the control group. Conclusions:Aminoguanidine and melatonin alone achieved an increase in regeneration after peripheral facial nerve neurorrhaphy, but methylprednisolone did not. The best healing was determined in the AG group.

The treatment of neck and parotid gland in cutaneous squamous cell carcinoma of face and forehead and the review of literature.

Introduction The treatment of cervical lymph node metastases have a significant prognostic effect on the face and forehead skin cancers. We aimed to point out the importance of loco-regional treatment in cutaneous squamous cell carcinoma of face and forehead. Presentation of case We present our experience with four cases that had squamous cell carcinoma of face and forehead skin. All cases had regional recurrence following 1–3 years after the primary treatment, but did not have local recurrence. Discussion Loco-regional lymphatic treatment for face and forehead skin squamous carcinomas has vital importance especially in the cases with high-risk factors for lymph node metastasis. Conclusion Elective lymph node dissection of appropriate region(s) should be included in the treatment plan for cases which have one or more of high-risk factors for lymph node metastases and long-term follow-up should not be ignored.

A cost-effective way of maxillary sinus ostium dilatation with Foley catheter in patients with chronic rhinosinusitis: MOD-F technique.

R hinosinusitis is one of the most prominent health issues worldwide. Its incidence and prevalence continue to increase. The statistical data indicates that sinusitis is more prevalent than diabetes mellitus, arthritis, cardiac diseases, and headache.1 Furthermore, chronic rhinosinusitis (CRS) not only gives rise to important physical symptoms but also ends up with functional and emotional disorders.2 Nasal polyposis accompanies a significant proportion of CRS cases. It increases the negative impact of rhinosinusitis on quality of life, and the economic burden of treatment.3 Endoscopic sinus surgery was introduced by Messerklinger and Wigand for the treatment of CRS and nasal polyposis in 1960s. It has been popularized over Europe by Stammberger and in North America by Kennedy since the 1970s.4 This technique has been used confidently by otolaryngologists all around the world. During the last decade, the balloon catheter dilatation technique has been proposed as an alternative treatment for CRS in selected cases.5 The data obtained on the balloon catheter dilatation technique demonstrates satisfactory results for patients with CRS in terms of safety and efficacy.5 But this technique needs additional instruments and tools, and compared with conventional methods it is more expensive. The treatment results, also the role of the balloon catheter dilatation technique in nasal polyposis is still under debate.6 There are several balloon catheter sinusotomy tools in use with different brands and varieties on the market.7 The aim of this study was to define a new and costeffective technique for maxillary sinus ostium dilatation with a Foley catheter (MOD-F) in patients with CRS. The short-term results of the MOD-F technique were documented, and compared with the conventional surgical expanding (MOD-S) technique. Also, the factors that might contribute to changes in the ostium diameter were evaluated.

Coincidence of conchachoanal polyp and complete mulberry hypertrophy of inferior concha.

We report two unique cases of 50‐ and 28‐year‐old Turkish men with coincidence of conchachoanal polyp and mulberry hypertrophy of the inferior concha. We operated on both cases with endoscopic stripping of the polypoid tissue while preserving the periosteum and healthy mucosa of the inferior nasal concha. The polypoid tile of the left inferior nasal concha was resected in the case with mulberry hypertrophy at only the tail of the concha. Both cases reported significant relief of symptoms after the operations. Laryngoscope, 2009

Nasopharyngeal lymphangioma in an adult: a rarity.

Lymphangiomas are rare congenital tumors of the lymphatic system, most often encountered during childhood. Although the most frequent locations for lymphangioma are the head and neck region, isolated involvement of the nasopharynx is very rare and only two cases have been reported since 1969. We report a case of a 60‐year‐old male with a nasopharyngeal mass that presented with nasal obstruction. The surgical excision of mass was performed by a combined transoral and transnasal endoscopic approach. Histopathological evaluation revealed the diagnosis as lymphangioma. After a follow‐up of 18 months the patient is free of recurrence. Laryngoscope, 123:2972–2975, 2013

Semi-wrapping lateral cartilage to a square edged strut perpendicularly to prevent collapse in external nasal valve dysfunction: pseudodome technique

Objectives: During inhalation through the nose, the weakness of lateral cartilage may cause the collapse of nasal vestibule and sidewall, causing the complaint of difficult breathing through the nose. We aimed to support the lateral cartilage with a square edged strut to resolve this problem. Methods: We described a technique in 8 cases (5 males, 3 females). In this technique the lateral cartilage is semi wrapped from the underside to a square edged strut, and arched to outside with an open approach rhinoplasty. As it was only a physical support and did not create a new canting up through the skin, we named this maneuver as pseudodome technique . Results: All patients experienced relief of symptoms and no complications observed. The reinforcement effect of the strut was effective in preventing collapse of the nasal alar sidewall as well as did not cause contour irregularities. Conclusions: Pseudodome technique can be performed for acquired or congenital nasal sidewall collapse caused by lower lateral cartilage structural weaknesses successfully.

Reply to the letter to the editor concerning: ‘Inlay butterfly cartilage tympanoplasty in the treatment of dry central perforated chronic otitis media as an effective and time-saving procedure’ by Haksever et al.

We would like to reply to the comments on our manuscript titled ‘Inlay butterfly cartilage tympanoplasty for the treatment of dry central perforated chronic otitis media as an effective and time-saving procedure’ by Haksever et al. [1]. First of all, the comments and contributions of the author(s) are very precious and add value to the paper. I would like to thank the authors for their comments. The authors make four important comments and critical evaluations regarding the manuscript. We have tried to reply to each by providing our opinions below. First, the author asserts that the inclusion criteria are vague. Our inclusion criteria were stated in the manuscript [1] and also in the authors’ letter, making it unnecessary to define them again here. However, we want to reply to the comments about the myringosclerosis status of the remnant eardrum and Eustachian tube function as underlined by the authors. Myringosclerosis is hyalinization in the tympanic membrane resulting in hypovascularity of the wound edges, which negatively affects the take rate and audiologic results of the graft. In the presented study, myringosclerotic ears were excluded from both groups. Actually, we have started to use the Inlay butterfly cartilage tympanoplasty (ICBT) technique for cases with a limited myringosclerotic plaque at the tympanic membrane in the last 2–3 years. The use of ‘limited’ here means that sclerotic plaques could be cleaned from the perforation edges transcanally but there was no need to take out all plaques. Eustachian tube dysfunction (ETD) is an important problem in every kind of ear surgery. Negative pressure inside the middle ear causes medialization or adhesion of the repaired ear drum and these cases, therefore, need more stable and resistant material for tympanic membrane reconstruction. In our clinical practice, we prefer two different techniques for ears suffering from ETD, one of which is the ‘Pericondrium Attached Cartilage Island Graft (PACIT)’ [2] (newly accepted and to be published in the next issue of Acta Otolaryngologica Italica). The second is the ‘tri-layer tympanoplasty (the techniques used and the results of these cases are under review). The philosophy of both methods is to ensure a more durable ear drum using temporal facia supported by full thickness cartilage. Consequently, cases with myringosclerosis and ETD were excluded from the presented study [1]. Second, the author asserts that the IBCT technique is a relatively difficult operation for beginners. We agree with the author. In our institute, we prefer a step-by-step surgical approach for postgraduate students. First, beginners should be experienced with manipulating the external ear canal, cleaning cerumen, and especially ventilation tube insertion for serous otitis media. The techniques of conventional myringoplasty (CM) are easier than that of IBCT and ICBT should, therefore, be the next step to CM. For the IBCT technique, graft preparation and sizing need experience. For beginners, it is advised to use a 90 angled hook to measure the perforation size after refreshing the edges. The graft size (uncleavaged central part) should be adjusted to be 0.5–1 mm bigger than the perforation to provide stability between the graft and remnant eardrum. Cleavage This reply refers to the comment available at doi:10.1007/s00405016-4342-5.

Does amikacin treatment cause subclinical hearing loss in patients with cystic fibrosis

Introduction Aminoglycosides (AGs) have been widely used for potential life-threatening bacterial infections. Although AGs are well known for their ototoxic side effects, some AGs such as amikacin are considered less harmful to auditory functions; thus, auditory monitoring is mostly neglected during treatment with these drugs. Objective To reflect the potential auditory hazards of repeated amikacin use on the patients with cystic fibrosis (CF). Method 32CF patients with prior exposure to at least 3 courses of amikacin (the CF group) and 35 non-CF patients visiting the outpatient clinic with any complaint other than hearing loss and no history of treatment with any AG(the control, or C group) were compared with pure-tone audiometry(PTA). The diagnosis of CF was made by Nanoduck sweat test. Results The average age of the participants were 8.25 ± 2.76 years in the CF group and 8.58 ± 2.00 years in the C group (ranging from 5 to 13 years). 29 (43.28%) of the cases were female and 38 (56.71%) were male. Clinical SNHL(sensorineural hearing loss) was detected in 4 of the 32 subjects in the CF group. None of the subjects in the C group exhibited clinical SNHL. There was no statistically significant difference between the groups with regard to presence or absence of clinical SNHL (p > 0.05). However, hearing levels of the CF group were around 20 dB(decibel) HL(hearing loss), whereas hearing levels of the C group were around 5 dB. This difference was statistically significant for the pure tone averages of both all frequencies and speech frequencies (p < 0.05). Conclusion Repetitive exposure to AGs can cause permanent, although mild, sensorineural hearing loss. For prevention, hearing status of the patient should be closely monitored and treatment of choice should be precisely tailored according to the audiological evaluation. This is especially important in patients with CF who frequently experience medical conditions necessitating AGs use.