Ela Cömert

External jugular vein duplication.

The external jugular vein is a preferred option in the head and neck free tissue transfer as the recipient vein and for central venous catheterization. We report observations on a patient operated on for head and neck cancer in whom we observed duplication of the external jugular vein. The external jugular vein was seen duplicated in the middle third near the posterior border of sternocleidomastoid muscle before penetrating deep fascia. Although there are cases of duplication of the internal jugular vein, external jugular vein duplications were not reported. We think it was interesting, and this variation alerts clinicians and surgeons performing neck, vascular, or reconstructive surgery about unexpected variations of the external jugular vein in the hope of preventing inadvertent injury.

Microsurgical anatomy for intraoperative preservation of the olfactory bulb and tract.

Damage to the olfactory bulb and tract is a frequently described complication of brain surgery in the frontal region, and it seems to be influenced by the surgical approaches. Eighty cerebral hemispheres and 5 formalin-fixed cadavers filled with colored latex were used. Parameters were directly measured, and after olfactory bulb and tract were mobilized with careful dissections, retraction of the frontal lobe was noted. The anterior border of the olfactory bulb is 22.21 (SD, 5.45) mm posterior to the frontomarginal sulcus, and arachnoidal dissection should be performed parallel to olfactory structures using sharp instruments to allow early visualization. Overall mobilization of the olfactory bulb and tract as 29.3 (SD, 6.4) mm in length is possible without disrupting the structures and enables a greater degree of the frontal-lobe elevation window up to 13.1 (SD, 3.2) mm. Using the morphometric data and anatomic knowledge may prevent unwanted anosmia complication during surgical approaches.

Comparison of Early Oncological Results of Diode Laser Surgery with Radiotherapy for Early Glottic Carcinoma

Objective To evaluate the oncologic results of transoral endolaryngeal microscopic diode laser surgery (MDLS) and radiotherapy (RT) for T1 and T2 glottic carcinoma. Study Design Case series with planned chart review. Setting Ankara Oncology Education and Research Hospital. Subjects and Methods The study was conducted on a series of 140 cases of early glottic carcinoma (T1, T2) treated with MDLS or RT. The tumors were defined according to T stage and the involvement of the anterior commissure (AC). Results The 3-year locoregional control rate of MDLS and RT groups was 93.1% and 89.7%, respectively (P = .434). There was no difference in 3-year disease-free survival when comparing T1 and T2 tumors treated with MDLS and those treated with RT (P = .618 for T1, P = .084 for T2). There was no difference in disease-free survival when comparing AC– and AC+ tumors treated with MDLS and those treated with RT (P = .291 for AC– and P = .530 for AC+ tumors). Conclusions Microscopic diode laser surgery in early glottic cancer seems to be an oncologically safe procedure that has similar oncological results with RT. In T2 glottic tumors and AC involvement, the results with either treatment are less satisfactory.

Effect of the Rhinoplasty Technique and Lateral Osteotomy on Periorbital Edema and Ecchymosis.

Aim:The present study aimed to compare edema and ecchymosis in the early and late postoperative periods following the application of different surgical techniques (open and endonasal) and different types of lateral osteotomy (internal and external). Methods:The files and photographs of a total of 120 patients whose records were regularly maintained/updated and who underwent septorhinoplasty operation with the same surgeon were retrospectively evaluated. Sixty-nine (57.5%) patients were women and 51 (43.5%) were men. The patients were divided into 4 different groups according to the operations they underwent as follows—Group I: open technique septorhinoplasty + internal/continuous lateral osteotomy; Group II: endonasal rhinoplasty + internal/continuous lateral osteotomy; Group III: open technique septorhinoplasty + external/perforating lateral osteotomy; and Group IV: endonasal rhinoplasty + external/perforating lateral osteotomy. Postoperative edema and ecchymosis, and lateral nasal wall mucosal damage because of osteotomy were evaluated. Results:Postoperative second day edema and ecchymosis scores were statistically significantly better in patients in Group II compared with the patients in Group I (P = 0.010 and P = 0.004, respectively). Postoperative first day edema and postoperative seventh day ecchymosis scores were statistically significantly better in the patients in Group IV compared with the patients in Group III (P = 0.025 and P = 0.011, respectively). Intraoperative bleeding was similar in all groups. The nasal tip was more flexible in patients who underwent closed technique rhinoplasty. Unilateral mucosal damage occurred in 3 patients (4%) with internal lateral osteotomy, whereas no mucosal damage was present in patients with external osteotomy. Conclusions:The difference in the rate of edema and ecchymosis in the early postoperative period between the closed technique rhinoplasty and the open surgical approach was statistically significant, whereas osteotomy did not cause a significant difference. According to these results, the authors suggest endonasal surgery to prevent the development of edema and ecchymosis, whereas the choice of lateral osteotomy should be dependent on the experience of the surgeon.

Surgical Anatomy of the Infralabyrinthine Approach

Objective The objective of this study is to demonstrate the surgical anatomy of the infralabyrinthine approach (ILA) and ways to prevent complications based on the complex anatomy. Study Design Cadaveric study. Setting Ankara University Faculty of Medicine, Department of Anatomy. Subjects and Methods Temporal bones were selected from 30 sides of 20 fixed human cadaver heads. Computed tomography (CT) scans of the heads were performed and, afterward, the cadavers were dissected using a surgical microscope and electric drill. Results An appropriate tract could be achieved in 73.3% of the dissections by applying slight pressure to the jugular bulb (JB). The narrowest portion of the ILA was defined as the inner window, which was located superior-inferiorly between the inferior border of the cochlea and the inferior wall of the petrous apex and anterior-posteriorly between the posterior wall of the carotid canal and the cochlear opening of the cochlear aqueduct. The ILA could not be performed when the distances between the facial nerve-JB and JB-cochlea were less than 2.9 mm and 2.6 mm, respectively, on CT scan. Conclusion Close attention should be paid to the access and inner window during preoperative temporal bone imaging to assess for ILA. The detailed anatomy of the route, measurements of the topography of the cochlea from the mastoid view, and angles of the route are defined to prevent complications.

Surgical anatomy of facial nerve for revision transmastoid surgery.

AbstractWe analyze the relationships of the 3 segments of the facial nerve with respect to constant anatomic structures that can be identified during revision surgery via translabyrinthine approach. This study was conducted on 15 formalin-fixed cadavers whose facial nerves were dissected bilaterally under operative microscope via translabyrinthine approach. The distances between the round window niche and the midpoint of the tympanic segment and the beginning of the mastoid segment were 6.64 ± 1.79 mm and 3.99 ± 0.79 mm, respectively. The distances between the tympanic ostium of the eustachian tube and the first and the second genu were 7.02 ± 0.62 mm and 12.25 ± 1.24 mm, respectively. We used the superior semicircular canal, the tympanic ostium of the eustachian tube, and the round window niche as landmarks to identify the facial nerve during revision surgery. Our study also showed that the auricular branch may also be originated from the posterior surface of the facial nerve.

Preliminary Results of Diode Laser Surgery for Early Glottic Cancer

Objective To analyze the complications and preliminary oncologic results of microscopic diode laser surgery. Study Design Prospective research. Setting Ankara Oncology Education and Research Hospital. Subjects and Methods This prospective study was conducted on a series of 64 patients with glottic carcinoma (Tis, T1, T2) treated with microscopic endolaryngeal diode laser surgery. Results Four patients had local recurrence (6.2%). Local control and larynx preservation rates were 93.8% and 100%, respectively, for all groups of patients. Two-year disease-free survival after primary surgery was 100% for the Tis group, 96.4% for the T1 group, and 89.7% for the T2 group. When considering anterior commissure involvement, 2-year disease-free survival after primary surgery was 100% for the AC0 group, 85.7% for the AC1 group, and 85.7% for the AC2 group. Conclusion Our study of microscopic diode laser resection of Tis, T1, and T2 glottic tumors showed similar oncologic results to previous reports about CO2 laser surgery. In anterior commissure tumors, both techniques had high complication and recurrence rates.

Swallowing and Aspiration: How Much Is Affected by the Number of Arytenoid Cartilages Remaining After Supracricoid Partial Laryngectomy?

Objectives The aim of this study was to compare the effect of the presence of one or two arytenoids on early/late period swallowing-aspiration functions. Methods Supracricoid partial laryngectomy (SCPL) with the diagnosis of laryngeal cancer between 2012 and 2014 were retrospectively evaluated. The patients were categorized into two groups as follows: group I, patients who underwent SCPL with one arytenoid cartilage and group II, patients who underwent SCPL with two arytenoid cartilages. The time of decannulation and oral feeding onset, and swallowing-aspiration functions were evaluated and compared in the early nutritional period, first, and third months. Results There was no significant correlation between decannulation time and swallowing-aspiration. The aspiration rates in group I and group II were similar and there was no significant difference in oral feeding onset and aspiration grades in the first and third months between both groups. Conclusion We found similar oncological and functional outcomes in SCPL which protected one or two arytenoid cartilages. Therefore we suggest to be performed one arytenoid cartilage SCPL in selected patients who was advance stage and tumor volume over with larynx cancer.

Anatomic basis of percutaneous Kirschner wire insertion in zygoma fractures.

The combination of Gillies elevation with 1-point percutaneous Kirschner wire fixation of isolated simple zygoma fractures was found to be effective in restoring preinjury appearance and function and avoiding soft tissue morbidity. The proximity of the infraorbital nerve, inferior orbital rim, and dental roots warrants care in the placement of the wire. The need for precise anatomic guidelines becomes apparent when considering these relationships. Eighteen adult skulls (36 sides) were examined, and specific points were determined that could be important while inserting Kirschner wire for zygoma fractures, and the distances between those points were measured with a digital caliper. Then, by using these points, the wire was inserted into the zygoma through the medial wall of the maxillary sinus, and the insertion point of the wire on the lateral wall of the maxilla and the angle of the wire were determined. The mean lengths of the wires of the right and left sides of each skull were counted, and for 18 skulls, the mean length of the wire was measured as 45.12 mm. Direction of the insertion during drilling zygoma, conversely to the location of the insertion, nearly determines the course of the wire and the point of insertion on the lateral wall of the maxilla. Obtaining precise information concerning the installation angle and length of the wire before surgery should contribute to safer and smoother surgical procedures.

Long-Term Results of Partial Laryngectomized Patients.

Aim:This study was to present long-term oncological results, as well as the variables, that can increase nodal metastasis and reduce survival in patients diagnosed in the early and late stages of laryngeal cancer. Methods:A total of 85 patients were included in the study. These patients were grouped as supracricoid partial laryngectomy (PL), supraglottic horizontal PL, and vertical frontolateral PL. Furthermore, at least 3 years of the long-term outcomes of the patients in these 3 groups were compared. Results:Twenty-two of the patients (26%) had nodal metastasis, 16 (72%) of these patients were in Group I (P = 0.017); 14 patients (51%) had preepiglottic space (P = 0.075); 12 patients (50%) had paraglottic space involvement (P = 0.002); 9 (45%) patients with nodal metastasis had a depth of invasion more than 20 mm (P < 0.001). Out of the 16 patients who had positive intraoperative surgery margins, 5 (18%) of them had nodal metastasis (P = 0.589) and 14 (16%) patients were positive for perineural invasion, 3 (19%) of these patients had lymph node involvement (P = 0.074). One (5%) patient died with nodal metastasis. Median survival rate of all the patients was 44 ± 0.836 (42.36–45.63) months and the overall survival rate was 92.9%. Conclusions:Paraglottic space involvement and tumor invasion depth were statistically effective on increased nodal metastasis. However, we suggest that depth of invasion may not be effective alone as a prognostic factor. In contrast to the known effect on overall survival was less lymph node.