Fikret Çetik

Pharyngocutaneous fistula following laryngectomy

Pharyngocutaneous fistula (PCF) following laryngectomy is a serious complication, and its incidence varies from 7.6% to 50%. Despite the relative frequency of this complication, there is still uncertainty about the predisposing factors.

Surgical and medical management for complications in 475 consecutive pediatric cochlear implantations

OBJECTIVE The purpose of this study is to assess complications occurring after cochlear implantation (CI) in children and to discuss revision surgeries and medical interventions occurring during follow-up. STUDY DESIGN Retrospective study of 475 consecutive pediatric cochlear implantations at a tertiary referral center. METHODS The patients (n = 475) who received cochlear implants in our institution between March 2000 and March 2012 were followed up (range, 5 months-12 years). All complications were systematically reviewed, and their causes were analyzed for prevention and therapy. RESULTS All children received unilateral CI. Mean age at implantation was 3 years 7 months (ranged from 10 months to 18 years). Forty-three patients (9%) experienced complications. Twenty-one patients (4.4%) had major complications, consisting of device failure (10 patients), flap necrosis (4 patients), meningitis (2 patients), electrode shifting (2 patients), hematoma (2 patients) and magnet migration (1 patient). Twenty-two (4.6%) had minor complications, consisting of acute otitis media (5 patients), skin lesion due to pressure reaction in contralateral ear during surgery (4 patients), flap swelling (3 patients), minor wound infection (3 patients), transient facial paralysis (2 patients), transient vertigo (2 patients), hematoma (1 patient), facial stimulation (1 patient), subcutaneous emphysema (1 patient). Complications led to reimplantation in 13 (30.2%) and other revision surgery in 7 (16.2%) of the 43 patients. One patient with meningitis cured with medical treatment and 22 patients with minor complications cured with either medical treatment or spontaneously. CONCLUSIONS Cochlear implantation is a safe technique in experienced hands with a relatively low complication rate. Long term follow up is mandatory to minimize and control surgical complication.

Acyclovir in the Treatment of Recurrent Respiratory Papillomatosis: A Preliminary Report

INTRODUCTION In this study, we evaluate the effect of acyclovir in the treatment of recurrent respiratory papillomatosis (RRP), in addition to CO2 surgery. MATERIALS AND METHODS We include 12 patients who had aggressive RRP and required at least three prior endoscopic surgeries in this study. Acyclovir treatment started the day after the surgery. During the planned treatment period of 6 months, patients older than 5 years were asked to take the daily dose of 800 mg, and those younger than 5 years were asked to take 400 mg. RESULTS Nine of 12 patients were disease free during the follow-up periods, which ranged from 14 to 25 months with a mean of 18 months. Only 3 patients who used the drug inadequately required reoperation. CONCLUSION Because of the specific viral origin of RRP, we hope that addition of acyclovir to surgery will preclude or at least decrease the number of recurrences in this potentially fatal disease.

Salivary duct carcinoma ex pleomorphic adenoma: Analysis of the findings in fine-needle aspiration cytology and histology

Salivary duct carcinoma (SDC) is an uncommon and highly aggressive neoplasm that reveals histopathologic features resembling infiltrating duct carcinoma of the breast and prostate. SDC arising on the basis of preexisting pleomorphic adenoma (PA) is very rare. This report describes the fine‐needle aspiration (FNA) cytology of a case of SDC ex PA. FNA smears were cellular with cells with large, pleomorphic nuclei, some prominent nucleoli, and finely vacuolated cytoplasm. The neoplastic cells were forming groups, sheets, and papillary structures and a cribriform pattern was present in some sheets. Mitotic figures were frequently seen. Necrosis was prominent in the background. Histologic sections of the tumor revealed areas of comedo carcinoma, papillary carcinoma, and infiltrative carcinoma as well as multiple foci of PA. The presence of a cribriform pattern, tumor cells resembling breast ductal carcinoma cells, and a necrotic background are helpful features for an accurate cytodiagnosis of SDC. Diagn. Cytopathol. 1998;19:201–204.

Reflex sympathetic dystrophy following neck dissections

PURPOSE Reflex sympathetic dystrophy (RSD), which is a disorder that occurs after injury or surgery on the extremities, has not been reported as a complication of neck dissections until now. A group patients with head and neck cancer have been examined to determine the incidence of RSD in neck dissections. PATIENTS AND METHODS Forty-six patients with head and neck cancer, who had undergone neck dissections together with the removal of the primary tumor, were evaluated for RSD on their routine controls. RESULT AND CONCLUSION The presentation of RSD in two patients who were treated with radical neck dissection is probably a result of sympathetic hyperactivity that is secondary to surgical trauma.

Small cell carcinoma of the larynx

(Editorial Comment: These authors report a good response in patients treated for small cell carcinoma of the larynx with combination chemotherapy, including cisplatin and etoposide. Further observation will need to be made to corroborate these findings.) Primary small cell carcinoma (SCC) of the larynx is a rare malignancy associated with frequent, early, widespread metastases and poor prognosis.1-3 This tumor is thought to emerge from the argyrophilic Kulchitsky’s cells present in laryngeal mucosa.1*3 In the head and neck region, these tumors were also reported in the nasal cavity, paranasal sinuses, tongue, salivary glands, esophagus, and trachea.‘+3’4 A pproximately 0.5% of all primary laryngeal carcinomas are estimated to be SCCs, and approximately 125 cases have been reported in the literature.ls3 This tumor occurs mainly in men who have been heavy smokers, and it usually presents when the patient is between 60 and 80 years old.lp3 Patients often present with hoarseness and/or a neck mass. ‘p3r5 At the initial presentation, 50% of the patients had cervical nodal metastases,lV3 and other common sites of metastatic spread were liver, lung, bone, and bone marrow.1’3*5 The diagnosis is based on the light microscopic appearance, and immunohistochemical techniques and electron microscopy may be helpful in confirming the diagnosis. 306 The 2and 5-year survival rates were reported as 16% and 5% respectively,

A thyroid tumor extending to the parapharyngeal space

BackgroundThe metastasis of papillary thyroid carcinoma to the parapharyngeal space is rare and discussed in the English literature before. Encountering a parapharyngeal mass with cystic appearance on imaging, one should rule out thyroid malignancy as differential diagnosis.Case presentationThe case presented here is a 22-year-old woman who was referred to our clinic with complaints of painless neck mass, dysphagia and hoarseness for two years. After radiologic and pathological examination, the mass thought to be relevant with the thyroid gland. Peroperatively, the tumor was found to originate from the superior pole of the right thyroid gland, with a narrow stalk, and extended following the neurovascular bundle to the lower part of the parapharyngeal space. The bulk was removed via transservical approach with total thyroidectomy.ConclusionThe occurrence of the follicular variant of papillary thyroid carcinoma in the parapharyngeal space is extremely rare. The management of this rare case was discussed with the review of literature.

Serum Levels of Tumor Necrosis Factor in Squamous Cell Carcinoma of the Head and Neck

PURPOSE Tumor necrosis factor (TNF)-alpha is a multifunctional cytokine that influences the clinical outcome in a number of diseases. This study was undertaken to evaluate its role in the differential diagnosis of malignant and benign tumors and in the follow-up of patients. We also studied the correlation of TNF-alpha levels with the stage and differentiation of the diseases. METHODS In this study, serum levels of TNF-alpha are determined by the immunoradiometric assay method in 26 patients with head and neck cancer, and results are compared with 8 control patients with benign diseases. In both groups, serum samples were taken before and after the therapy. After centrifugation, the sera was stored at -70 degrees C until analyzed. TNF-alpha levels were measured by TNF-alpha immunoradiometric assay (IRMA) kit (Medgenix, Diagnostics SA, Belgium). RESULTS The pretreatment mean value of TNF-alpha in the study group (814.1 pg/mL) was almost 100 times higher than in the control group (8.6 pg/mL) (P = .001). It was also noted that posttreatment mean value (94 pg/mL) was significantly lower than pretreatment mean value in the study group (P = .001). No statistically significant difference was found between serum TNF-alpha levels and the stage and differentiation of the tumor. CONCLUSION The serum levels of TNF-alpha may be an efficient tumor marker in the diagnosis of patients with head and neck cancer.

Endoscopic versus microscopic stapes surgery

OBJECTIVE The aim of this study to compare the outcomes and complications of endoscopic stapes surgery versus microscopic stapes surgery. METHODS This study involved patients who underwent stapedotomy at the Department of Otorhinolaryngology, Faculty of Medicine, Cukurova University between January 2012 and July 2014. The patients were divided into two groups. Patients in group I were operated with endoscope and patients in group II were operated with microscope. Pure tone audiometry was carried out in all patients preoperatively. Peroperative surgical findings, complications, and duration of surgery were noted and compared between the two groups. Air conduction and bone conduction thresholds were measured at frequencies of 500, 1000, 2000, and 4000Hz, and the mean (±SD) air-bone gap was noted. RESULTS Mean preoperative air-bone gap was 36.9±6.8dB (23.3-50dB) in group I and 35.1±6dB (26.6-50dB) in group II. Mean postoperative air-bone gap was 9.3±7.1dB (0-30dB) in group I and 13.5±9.7dB (1.6-35dB) in group II. The difference in preoperative and postoperative air-bone gap between the two groups was statistically significant (p=0.023). Patients in group I did not complain of postoperative pain but this was felt in four patients in group II. The difference was statistically significant (p=0.045). CONCLUSION Endoscopic stapes surgery has many benefits such as good visualization, and easy accessibility to the stapes, oval window niche, and facial nerve. Removal of the scutum and manipulation of the chorda tympani nerve are less frequent with the endoscopic technique.

Radiological Imaging Findings of Patients with Congenital Totally Hearing Loss.

OBJECTIVE The aim of this study was to determine and classify inner ear abnormalities in patients who had cochlear implants because of congenital sensorineural hearing loss using preoperative temporal bone computed tomography and magnetic resonance imaging. MATERIALS AND METHODS Patients in the otolaryngology department who had cochlear implants because of congenital sensorineural hearing loss between January 2011 and December 2013 were included in the study. There were 167 male and 133 female patients, a total of 300. All of the patients were evaluated with 4-detector-row computed tomography and 1.5 Tesla magnetic resonance imaging. RESULTS Inner ear abnormalities were found in 136 of 600 ears (20.3%). There were six ears with incomplete partition-II (4.4%), five ears with incomplete partition-I (3.6%), two ears with Michel deformity (1.4%), two ears with cochlear hypoplasia (1.4%), two ears with cochlear otosclerosis (1.4%), and one ear with common cavity deformity (0.7%). Dilatation of the internal acoustic canal was found in 42 ears (30.9%); also, 21 ears with cochlear nerve aplasia/hypoplasia (15.4%), 5 ears with internal acoustic canal aplasia, and 1 ear with internal acoustic canal hypoplasia (0.73%) were detected. There were 10 ears with posterior semicircular canal (7.3%), 10 ears with lateral semicircular canal (7.4%), 8 ears with superior semicircular canal aplasia/hypoplasia (5.9%), and 8 ears with lateral semicircular canal-vestibular dysplasia. An enlarged vestibular aqueduct was found in 16 ears (11.7%). High jugular bulbs were found in 21 ears; however, this variation was not considered to be an inner ear abnormality. CONCLUSION Computed tomography and magnetic resonance imaging are essential for the evaluation, determination, and classification of inner ear abnormalities in patients with congenital sensorineural hearing loss who are candidates for cochlear implant operations. Also, these radiological instruments aid in determining contraindications and predicting intraoperative difficulties. Computed tomography and magnetic resonance imaging findings for these patients should be evaluated by an experienced radiologist before the operation.