Emre Günbey

Comparison of Minimally Invasive Techniques in Tongue Base Surgery in Patients with Obstructive Sleep Apnea

Objective. To compare the effectiveness and morbidity of 3 microinvasive tongue base surgical procedures combined with uvulopalatopharyngoplasty (UPPP) in supine-dependent obstructive sleep apnea (OSA) patients. Study Design. A prospective, randomized clinical study. Setting. A tertiary referral center. Methods. Fifty OSA patients were randomly advised to undergo UPPP combined with low-temperature bipolar radiofrequency (group 1), submucosal minimally invasive lingual excision with radiofrequency (SMILE-R; group 2), or submucosal minimally invasive lingual excision with a harmonic scalpel (SMILE-H; group 3). The Epworth Sleepiness Scale, the visual analog scale (VAS) for snoring, the pre- and postoperative 3-month polysomnography (PSG) findings, and the decrease in tongue volume using magnetic resonance imaging (MRI) were compared. The operation times, the postoperative pain VAS score, the analgesic requirement, and the time in commencing a normal diet were compared in the 3 groups. Results. The decrease in apnea-hypopnea index (AHI) and supine AHI values at the postoperative 3-month time point was significant in group 2 (P < .05). The decrease in tongue volume at the 3-month postoperative time point according to the MRI evaluations was higher in groups 1 and 2 (P < .05). In the subjective comparison of effectiveness, there was no significant difference. The operation time was significantly lower in group 3. In the assessment of postoperative pain, no significant difference was found between the groups. Conclusion. When the PSG findings and MRI were evaluated, UPPP + SMILE-R were found to be more effective. No significant difference was found between the 3 techniques when morbidity and complications were compared.

Comparison of radiofrequency ablation, laser and coblator techniques in reduction of tonsil size.

Abstract Conclusions: Coblation was seen to be a much safer method for tonsil reduction surgery with less morbidity and with a higher efficacy in early and long-term follow-up. Objective: The objective was to compare the efficacy, morbidity and safety of three techniques for reduction of tonsil size in tonsillar hypertrophy in children. Methods: This was a prospective, randomized clinical study. Seventy-nine children aged 4–13 years with symptoms of tonsillar hypertrophy were included in the study. They were randomized to the coblator (group A), laser tonsillotomy (group B) or radiofrequency (group C) technique for tonsil reduction. The efficacy was evaluated by assessing tonsillar size after surgery. Morbidity was evauated by assessing by postoperative pain and return to normal diet and activity. Results: Pain on the first day was significantly higher for children in group B (p = 0.0001). The mean values for analgesic usage and number of days until return to normal diet and normal activity were lower in group A. At 1-year postoperative follow-up, the mean tonsil size was higher in group C (p < 0.05). None of the children in group A, two of the children (8.3%) in group B and six of the children (21.4%) in group C need reoperation for tonsillary hypertrophy.

Anomalous relationship of the retromandibular vein to the facial nerve as a potential risk factor for facial nerve injury during parotidectomy.

Finding and protecting the facial nerve are a challenge for the surgeon performing parotid surgery. The abnormal relationship between the retromandibular vein and facial nerve and its branches may increase the risk of facial nerve injury during surgery. In this clinical report, we have reported a 41-year-old female patient with pleomorphic adenoma undergoing superficial parotidectomy, and we have discussed a new variation of facial nerve-retromandibular vein relationship.

Anomalous relationship of coexisting ipsilateral recurrent and nonrecurrent inferior laryngeal nerves during thyroid surgery.

One of the most important complications of thyroid surgery is inferior laryngeal nerve injury. Variations of inferior laryngeal nerve may increase the risk of iatrogenic injury. Coexistence of ipsilateral nonrecurrent laryngeal nerve and recurrent laryngeal nerve is a very rare variation, and sufficient data are not available on the anatomical and functional relationship of the 2 branches and probable clinical outcomes resulting from the injury of one of them. Herein, we present a case with coexistence of nonrecurrent laryngeal nerve and ipsilateral recurrent laryngeal nerve and discuss the clinical importance of this rare variation.

A rare cause of obstructive sleep apnea syndrome: lingual thyroid

Thyroid tissue descends to its normal pretracheal location on the seventh week of fetal life via the thyroglossal duct connected to the tongue base from the foramen cecum from which it originates during embryological development. Ectopic thyroid tissue develops as the result of exposure of thyroid tissue totally or partially to a defective descent related to the embryological defect of the tongue base. Lingual thyroid is the most common location of ectopic thyroid tissue and often located on the juncture of the buccal and pharyngeal parts of the tongue [1]. While 90% of ectopic thyroid tissues are seen on the tongue, they have also been reported in sublingual, submandibular, prelaryngeal, tracheal, mediastinal, cardiac, esophageal, diaphragmatic, and peripharyngeal sites. Although the prevalence of lingual thyroid has been reported between 1:100,000 and 1:300,000, its incidence among patients in whom hypothyroidism has been detected is between 1:4,000 and 1:10,000. It is seen at a 7-fold greater frequency in women [2]. Although the patients are usually asymptomatic, it can lead to symptoms such as dysphonia, dysphagia, and sensation of foreign body in the throat, or it can mimic a lingual tumor [2, 3]. Obstructive sleep apnea syndrome (OSAS) is an important clinical condition resulting from anatomical narrowings developing in the upper respiratory tract during sleep, affecting the quality of life substantially, leading to serious complications. Herein, we present a 24-year-old male patient with OSAS caused by lingual thyroid, and along with this rare case, we discuss the clinical features of lingual thyroid, imaging methods, and therapeutic approaches.

Impact of Multilevel Surgical Treatment on Mean Platelet Volume in Patients With Obstructive Sleep Apnea Syndrome.

Background and Objectives:Mean platelet volume (MPV) is a potential marker of platelet reactivity. Increased MPV levels are shown to be the predictor of cardiovascular diseases, hypertension, and stroke. Previous studies demonstrated increased MPV levels in patients with obstructive sleep apnea syndrome (OSAS). The aim of this study was to examine the impact of 1-stage multilevel surgical treatment on MPV levels in patients with OSAS. Methods:Preoperative and postoperative 6-month hematologic parameters as well as polysomnographic findings of 42 patients, who underwent 1-stage multilevel surgery for treatment of moderate or severe OSAS, were compared. Results:In the comparisons of preoperative and postoperative apnea-hypopnea index (AHI) and MPV values, statistically significant decreases were detected There was a significant positive correlation between the decrease in mean AHI and decrease in MPV levels. Conclusions:One-stage multilevel surgery targeting the obstruction at the retropalatal and tongue-base levels was found to be effective in decreasing AHI and MPV. Mean platelet volume may be a new index to indicate the success of OSAS surgery.

A rare presentation of mucocele of the tongue.

To the Editor: A previously healthy 37-year-old woman presented with a 3-month history of progressive dysphagia. She had no tobacco or alcohol consumption. No systemic problems were noted as well. In clinical examination, a painless tense, well-defined swelling, 2 cm in diameter, was localized on the tongue root. The lesion extended to the posterior plica (Fig. 1). The lesion was surgically removed under general anesthesia and submitted for histopathologic analysis. The cyst wall was quite thin, and the surface was smooth. Pale yellow viscous fluid was collected from the cyst cavity. Microscopic examination showed a cystic lesion filled with mucin and lined with mucinous epithelium, which was consistent with a mucocele (Fig. 2). In our case, the treatment was simple surgical excision without further treatment. Mucous retention cysts are common oral mucosal lesions originating from damage of minor salivary glands. The extravasation of mucus due to physical trauma is the primary cause of mucocele formation. It may also be seen in cases of nicotinic stomatitis, in which irritation from heat and noxious tobacco products can lead to narrowing of the ductal openings. Mucous retention cyst clinically presents as a discrete, more or less soft, nonpainful swelling of the mucosa. Discomfort, interference with speech, mastication and swallowing abnormality, and external swelling depend on size and location. Usually, mucous retention cysts form below the basal membrane or in connective tissue. Mucous retention cysts are more common in patients younger than 30 years and occur in both men and women. The lesion has no sex predilection. The most common locations are lower labial mucosa, but mucoceles may develop at virtually any location where minor salivary glands exist, including the soft palate, retromolar region, and buccal mucosa; nevertheless, the dorsal surface of the tongue is quite a rare location. We report a case of mucous retention cyst with an unusual location. To the best of our knowledge, this lesion has not been previously described in the dorsal surface of the tongue. Baran Acar, MD Emre Günbey, MD Mehmet Ali Babademez, MD Hayriye Karabulut, MD Department of Otorhinolaryngology Kecioren Training and Research Hospital Ankara, Turkey emregunbeymd@hotmail.com

The relationships between the clinical and polysomnographic findings and the olfactory function in patients with obstructive sleep apnea syndrome

PurposeThis study aimed to investigate the relationships between the clinical and polysomnographic findings and the olfactory test results in patients with obstructive sleep apnea syndrome (OSAS).MethodsFour groups were established: non-snoring controls (group 1), non-apneic snorers (group 2), mild–moderate OSAS (group 3), and severe OSAS (group 4). The polysomnographic findings, otorhinolaryngologic findings, Epworth Sleepiness Scale (ESS), and Sniffin’ Sticks olfactory test results of the four groups were compared. The relationships between the clinical data and the olfactory parameters were evaluated.ResultsGroup 4 had the worst odor identification and discrimination scores. Non-apneic snorers also had worse odor parameters compared with the non-snorer controls. A significant negative correlation was found among the ESS, apnea–hypopnea index (AHI), mean arterial oxygen saturation, and odor identification and discrimination. Significant negative correlations were found between the tongue and tongue base sizes and among all olfactory parameters.ConclusionOur study revealed olfactory dysfunction in patients with OSAS. A strong negative correlation between the olfactory parameters and the severity of sleep apnea was also found. Olfactory tests may be used to predict the presence and severity of OSAS in the future.

Is preoperative paranasal sinus computed tomography necessary for every patient undergoing septoplasty

The aim of this study was to determine whether anterior rhinoscopy (AR), nasal endoscopy (NE) and paranasal sinus computed tomography (PNS CT) can predict other sinonasal obstructive pathologies in the setting of nasal septal deviation (NSD), and to evaluate the impact of preoperative PNS CT on the decision for a surgical procedure in patients with NSD.

Evaluation of olfactory function in adults with primary hypothyroidism

Sufficient clinical data are not available on the effect of hypothyroidism on olfactory function in adults. In this study, we aimed to evaluate the olfactory function of adult patients diagnosed with primary hypothyroidism.