Elif Aksoy

Reliability of high-pitch ultra-low-dose paranasal sinus computed tomography for evaluating paranasal sinus anatomy and sinus disease.

Objectives The aim of this study was to evaluate the reliability of high-pitch ultra-low-dose computed tomography (CT) for detecting important paranasal sinus anatomic landmarks and pathologies. Materials and Methods Sixty patients (22 females, 38 males) aged 15 to 67 years (mean age, 33.68 y; SD, 9.83 y) underwent high-pitch ultra-low-dose CT of the paranasal sinuses between February and June 2012. To determine the lowest possible dose for evaluation of the paranasal sinuses, the patients were divided into three groups randomly and prospectively. A different low-dose CT protocol was applied to each group. The image quality was assessed subjectively by a radiologist and an otorhinolaryngology head and neck surgeon independently using a 4-point grading scale (0 = structures could not be identified, 1 = indistinctly defined structures, 1.5 = relatively well-defined structures, 2 = very well-defined structures). Anatomic landmarks and mucosal structures were evaluated. Mean scores were evaluated to assess statistical significance. Results According to the anatomic landmark scoring, excluding the ethmoid foramen for ethmoid artery identification, all of the structures in all 3 groups were very well-defined structures. The ethmoid foramen for ethmoid artery identification was scored as either could not be identified or an indistinctly defined structure in all groups. On evaluating the mucosa of the paranasal sinuses, normal and pathologic mucosal structures were scored as very well defined in all of the patients. The interobserver agreement was excellent. Conclusion High-pitch ultra-low-dose CT is a safe, reliable paranasal sinus screening tool.

Incidental diagnosis of mastoiditis on MRI

The aim of this study was to document patients with clinical mastoiditis who were reported to have mastoiditis by radiologists due to increased fluid signal intensity in the mastoid air cells on magnetic resonance imaging (MRI). Brain and temporal bone MRI reports between January 2004 and November 2009 were obtained from the radiology units of four different hospitals of the same Health Care Group. MRI reports for keyword mastoiditis and 406 patients were reported to have radiological mastoiditis on MRI due to increased fluid signal intensity. Otoscopic examination findings of 275 of these 406 radiological mastoiditis patients were documented and compared with MRI reports for clinical infectious otological disease. Forty-eight (17, 45%) (48/275) patients were found to have clinical otological disease on examination. The remainder of the patients (227/275, 82%) did not show any evidence of clinical otologic infectious disease. Of these 48 patients, 18 patients (37, 5%) had eustachian tube dysfunction, 13 patients (27%) had serous otitis media, nine patients (9%) had chronic otitis media, five patients (10%) had tympanosclerosis, and three patients (6%) had acute otitis media. The results of this study showed that MRI is not an effective diagnostic tool for mastoiditis. 82% of the MRI mastoiditis did not show clinical mastoiditis contradicting MRI reports. Fluid signal in the mastoid on MRI should not always be interpreted as mastoiditis by radiologists. Radiological mastoiditis does not necessarily point out to clinical mastoiditis.

Removing Intranasal Splints After Septal Surgery

Background: The aim of this retrospective chart review of the patients who had septal surgery with or without turbinate surgery was to compare the postoperative complication rates according to the time of intranasal-splint (INS) removal. Methods: The data of 137 patients who underwent septal surgery with or without turbinate surgery at 2 different hospitals of Acıbadem Health Care Group between January 2007 and March 2009 were retrospectively evaluated. The patients who had these risk factors were eliminated, and 96 patients were included in this study. The patients were divided into 2 groups according to splint-removal time. The first group comprises patients whose nasal splints were removed in 24 hours after surgery, and the second group comprises patients whose splints were removed 5 days after the surgery. Any bleeding, septal hematoma, and synechia after pack removal were recorded. Analysis of the rate of complications was done with the &khgr;2 test. Results: Sixty-five male and 31 female patients with a mean age of 32.4 years (range, 18-57 years) were included in the study groups. Septal surgeries were performed in association with turbinate surgery in all 96 patients. These patients were divided into 2 groups. In the first group (n = 50), INSs were removed in 24 hours after surgery. In the second group (n = 46), INSs were removed 5 days after surgery. Bleeding within the first postoperative week was not recorded in both groups. Late bleeding was recorded in 2% (n = 1) of group 1 and in 2.17% (n = 1) in group 2. Septal hematoma and synechia were not recorded in none of the groups. The results were not statistically significant (P = 1). Conclusions: The routine use of INSs after septoplasty and removing them 24 hours after septoplasty are sufficient to avoid postoperative complications, and it minimizes postoperative discomfort.

Will a crushed concha bullosa form again

This study endoscopically and radiologically evaluated whether a surgically crushed concha bullosa (CB) can form again.

Importance of placing Gore-Tex in the subperiosteal plane for augmentation rhinoplasty.

Objective The purpose of this study was to present the placement technique of Gore-Tex implants for nasal augmentation. Methods The study group comprised 32 patients of various nasal deformities who underwent consecutive rhinoplasty via open approach with Gore-Tex implant material for dorsal augmentation. A pocket is made subperiostally at the nasal dorsum. The implant is rinsed in antibiotic solution and placed in position. Complications due to Gore-Tex were observed during the follow-up period. Results There were 12 men and 20 women. The mean age was 28.4 years. There were 9 primary rhinoplasty and 23 revision rhinoplasty. Patients were followed up postoperatively for 12 to 24 months. During the postoperative follow-up period, no complications were encountered in this series of patients. The implants were stable and immobile under the skin. Conclusions In the cases of nasal dorsum augmentation, Gore-Tex can be a suitable graft material. We recommend implanting graft materials at subperiosteal plane to provide better stabilization and low complication rates.

Quantification of retropalatal region in obstructive sleep apnea.

Objective Flexible optic laryngoscopy (FOL) allows us to visualize the obstructive sleep apnea (OSA)–related airway passages. However, objective data presenting evidence of OSA through this perspective are lacking. The aim of this study was to quantify the surface area of the retropalatal region in control subjects and OSA patients utilizing FOL images. This was a prospective, case-control study. The study was performed at the otolaryngology department of a university hospital. Subjects and Methods Sixty-seven OSA patients in group 1 and 87 patients with no complaints of OSA in group 2 were evaluated. Retropalatal region photographs were captured at the base of uvula through endoscopic images. The retropalatal surface area (RPSA) was measured using AutoCAD. Groups 1 and 2 RPSA measurements were analyzed. The RPSA measurements of subgroups in group 1 were analyzed to document severity of OSA. Results Mean RPSA measurements in group 1 was 73.21 (SD, 31.99), and that in group 2 was 129.31 (SD, 26.54), respectively. Retropalatal surface area is significantly larger in group 2 when compared with group 1 (P = 0.0001). Twenty-four patients had mild (mean respiratory disturbance index [RDI], 10.83 [SD, 3.63], 26 had moderate (mean RDI, 20.9 [SD, 4.14]), and 17 had severe OSA (mean RDI, 52.13 [SD, 17.24]) in group 1. The mean RPSA measurements are 72.48 (SD, 28.9) in mild subgroup, 73.88 (SD, 30.5) in moderate subgroup, and 73.22 (SD, 39.59) in severe subgroup, showing no evidence of correlation between the severity OSA and RPSA measurements. Conclusions The RPSA measurements are significantly larger in control subjects (group 2) when compared with OSA patients (group 1). This might implicate that RPSA measurements through FOL examination can be a predictor of OSA when screening patients.

Nasopharyngeal Mass Diagnosed as Transsphenoidal Encephalocele in an Adult Patient.

Transsphenoidal encephalocele, a rare congenital malformation, is generally diagnosed during childhood when investigating the reason for complaints such as nasal obstruction and recurring cerebrospinal fluid fistula. In this adult patient, the authors identified an asymptomatic transsphenoidal encephalocele after requested monitoring of a pedunculated mass detected in the nasopharynx during nasal endoscopy. After evaluation, the authors decided to follow the patient. Few cases of transsphenoidal encephalocele have been reported, and even fewer have been reported in older patients, with no other anomaly or symptoms. The success of surgical treatment for these masses is debatable. The authors did not consider surgery for this asymptomatic case. With this case presentation, the authors wish to emphasize that without making radiologic assessments of any masses identified in a nasopharyngeal examination, it would be inappropriate to perform a biopsy or any intervention.

Evaluation of tissue response to Gore-Tex (expanded polytetrafluoroethylene) implantation.

Objective/HypothesisThe aim of this study was to assess the tissue response to Gore-Tex (expanded polytetrafluoroethylene) in rats and compare the results of surgical placement modalities. Study DesignProspective animal study. Materials and MethodsExperiments were performed in 18 young Sprague-Dawley rats that were divided into 3 groups. Gore-Tex patches were implanted subcutaneously over the periosteum in the first group and under the periosteum in the other groups. Gore-Tex was immersed in an antibiotic-containing solution in the third group. All animals were killed 4 weeks after the procedure. The tissue samples were stained with hematoxylin and eosin stain and evaluated using a light microscope. ResultsThe Gore-Tex patches were displaced and not observed at the originally implanted sites in the first group. The Gore-Tex patches were observed at the originally implanted sites in the other groups. In group 1, edema and inflammation were prominent. In the second group, ossification was detected in 5 rats and foreign-body reaction and edema were identified in 1 rat. In the third group, all of the rats were found to have developed ossification, but no inflammatory reactions were observed. ConclusionsThe results suggest that implanting synthetic graft materials immersed in an antibiotic solution at the subperiosteal plane provides better stabilization and low complication rates.

Postoperative wound care regimen in open septorhinoplasty.

The many benefits of the open-approach septorhinoplasty should not be excluded on the basis of columellar scarring alone. Technical factors that contributed to the favorable outcome of the columellar scar included proper planning of location and design of the incision used, meticulous closure, and good postoperative care. In the current study, we describe a simple postoperative wound care procedure that allows clean visualized wound with less crust formation, easy removal of the sutures by the surgeon, and better columellar scar in the early postoperative period.

Choristoma of the parotid gland

Squamous cells might be encountered in a number of salivary gland disorders. However, benign neoplasms that mainly consist of squamous cells are rarely encountered, and they are neither listed in the World Health Organization (WHO) histologic typing of salivary gland tumors nor mentioned in major reference books. Seifert et al presented an unusual benign tumor of the parotid gland that consisted of mainly multilayer squamous cells lining cystic spaces filled with horn like material, namely keratotic lamellas. They defined this tumor as a choristoma, resembling a trichoadenoma. This was the first definition of such a tumor in the literature. Nagao et al screened retrospectively 1,921 cases of primary parotid tumors and found 2 cases resembling the one described by Seifert et al. Because of the histologic features, they proposed a new name for the entity: keratocytoma. Choristoma by definition is a tumorlike mass consisting of normal cells in an abnormal location. Nagao et al proposed that the tumors they present are primary tumors of parotid epithelial origin rather than choristomas. We are presenting a parotid tumor with similar histolologic features to the previously mentioned choristoma or keratocytomas. The ethical committee of the Acibadem Hospital was contacted, and the permit was waived because case reports do not need to be reviewed. A 28-year-old woman presented with a painless swelling in the left parotid gland for 6 months. Clinical evaluation was consistent with a nontender well-defined mass of a 2.5-cm diameter in the left parotid. Magnetic resonance imaging revealed a cystic mass within the left parotid gland and multiple lymph nodes in the left neck. Fine-needle aspiration biopsy was nondefinitive. Left superficial parotidectomy and selective neck dissection were performed. Histologic evaluation of the specimen revealed a cyst lined with keratinized squamous epithelum. Islands of sebaceous gland lobules, ecrine glands, hyalene cartilage, and striated muscle were present deep to the the squamous epithelium. Wide areas of fatty necrosis, lipogranulomas, and foreign-body reaction were observed surrounding the cyst (Figs 1 and 2). The histology was considered to be consistent with choristoma. Fourteen lymph nodes were identified in the neck dissection specimen. All were consistent with reactive lymph nodes. The patient has been followed for 16 months without any recurrence.