Gurkan Kayabasoglu

Modified olfactory training in patients with postinfectious olfactory loss

Patients with olfactory dysfunction benefit from repeated exposure to odors, so‐called olfactory training (OT). This does not mean occasional smelling but the structured sniffing of a defined set of odors, twice daily, for a period of 4 months or longer. In this prospective study, we investigated whether the effect of OT might increase through the use of more odors and extension of the training period.

Does septoplasty improve the quality of life in children

OBJECTIVES The aim of this study is to evaluate the outcomes of septoplasty and the effects of septoplasty on the quality of life and to determine postoperative patient satisfaction in children using nose obstruction symptom evaluation (NOSE) and visual analog scale (VAS). METHODS Only pediatric patients who underwent septoplasty were included in the study. Patients who underwent adenoidectomy, endoscopic sinus surgery, or turbinate surgery in addition to septoplasty and total septal reconstruction with open technique septorhinoplasty were excluded from the study. Patients and their parents were inquired about their nasal obstruction symptoms using the NOSE scale before and 3 and 12 months following the surgery. VAS was used to analyze overall satisfaction of the patients and their parents on the outcomes of surgery, at the last follow-up examination 12 months after the surgery. RESULTS Thirty-five patients with a mean age of 13.4 ± 2.8 (8-16) were included in the study. There was a very significant improvement in NOSE score at 3 months after septoplasty. The mean subjective satisfaction score measured with VAS at the 12th month postoperatively was 7.9 ± 2.1. Improvement in NOSE score was correlated with patient satisfaction. CONCLUSION Septoplasty is a very effective and satisfactory treatment for nasal obstruction caused by nasal septal deviation in children. The NOSE scale can be used for the evaluation of nasal obstruction symptoms.

Update on the Medical Treatment of Allergic Rhinitis

Allergic rhinitis is a global health problem affecting at least 10 to 25 % of the population. So far, numerous classifications and treatment modalities have been described. In the treatment of allergic disorders Pharmacotherapy is the most used therapeutic modality, especially in allergic rhinitis. The first step to successful management is the accurate diagnosis of the type of AR (intermittent or persistent) and assessment of its severity (mild or moderate to severe). Although objective measurements of the nasal airway have great value to evaluate and follow up the cases, in most centers they are not done in routine clinical practice. Allergen avoidance should be the initial step in the management of AR. Oral antihistamines are the first-line therapy for mild to moderate intermittent and mild persistent rhinitis. They are also recommended for moderate/severe persistent rhinitis cases which are uncontrolled on topical intranasal corticosteroids alone. Corticosteroids are well known for their antiinflammatory and anti allergic effects. Topical usage provides topical efficacy while avoiding systemic side effects. Meta-analysis shows that intranasal corticosteroids are superior to antihistamines. They act by suppression of inflammation at multiple points in the inflammatory cascade and reduce all symptoms of rhinitis. A meta-analysis demonstrated that Montelukast was better than placebo, as effective as antihistamines, but less effective than nasal corticosteroids in improving symptoms and QOL in patients with SAR. Good results were reported with subcutaneous and sublingual immunotherapy. Further investigations are promising.

A retrospective analysis of the relationship between rhinosinusitis and sinus lift dental implantation

IntroductionDental implants have been associated with the occurrence of postoperative rhinosinusitis. In some patients, preoperative sinus lifting must be performed to increase the chances of successful implant placement. This retrospective study examines the relationship of dental implants after sinus lifting with the occurrence of postoperative rhinosinusitis.MethodsA total of 268 dental implants were inserted in 94 patients (62 Males, 32 Females) between 2011–2013. The ages ranged from 29–71 (in males) and 33–64 (in females). Additionally, bilateral sinus lifing was performed in 51 patients, and unilateral sinus lifting was performed in 43 of the patients. Patients were evaluated for sinus pathology for a period of 5–47 months postoperatively using a satisfaction questionnaire, conventional radiographic examination, and nasal endoscopic examination.ResultsFour of the patients (4.2%) had a complication of postoperative sinusitis and were treated medically. In one patient, the implant was unsuccessful (even after treatment) and was removed. None of the patients needed surgery due to the sinusitis or any associated complications.ConclusionThe risk for postoperative rhinosinusitis was found to be higher in patients who suffer from chronic sinusitis and in cases in which a large amount of graft was utilized for sinus lifting. These predisposing factors need to be considered when evaluating patients for dental implants and sinus lift procedures.

Secondary Improvement in Static Facial Reanimation Surgeries: Increase of Nasal Function.

Objective:The aim of this study was to measure the effect of the static reanimation operation administered to patients with facial paralysis on nasal function area by comparing patients’ preoperative and postoperative subjective perception of the nasal airflow. Materials and Method:We applied the Nasal Obstruction Symptom Evaluation (NOSE) scale to 13 patients who underwent static reanimation because of facial palsies, both preoperatively and postoperatively, and results were compared statistically. The changes in nasal base angulation were recorded and compared based on the photographs of patients taken before and after the surgery. Results:Following the static reanimation operation, 76% (10/13) of the patients reported a subjective improvement in the nasal airflow, whereas 24% (3/13) did not report any change. Mean preoperative and postoperative NOSE scale scores were 66.92 ± 9.90 and 36.15 ± 9.61, respectively. The change in mean NOSE scale score was statistically significant (P < 0.001). In the preoperative and postoperative comparison of the photographs taken from the front view of the patients, a decreased nasal base angulation compared with preoperative period was detected in 8 (61.6%) patients. Conclusions:A statistically significant increase in subjective perception about nasal function was observed after the static facial reanimation; however, it is not certain whether this effect can be considered persistent. Long-term studies conducted on a larger patient population will provide beneficial results.

A novel method for nasal dorsal reconstruction: permanent fixation using Kirschner wire-guided hidden sutures.

Background:In this study, we aimed to present a novel application and use of Kirschner wire–guided suturing that is less invasive and allows permanent fixation for nasal dorsal reconstruction. Methods:A total of 23 patients, who underwent surgery between 2009 and 2013, were included in this study: 19 with saddle nose deformity and 4 patients with keystone area damage, or collapse of the dorsal nasal support during primary septoplasty or rhinoplasty. The patients were asked to fill out a nasal obstruction symptom evaluation (NOSE) scale preoperatively and at the postoperative sixth month to assess breathing quality. The patients were followed up for complications such as nasal dorsal contour irregularity, dorsal collapse, as well as graft malposition and infections. The results of the surgeries were assessed on the basis of preoperative and postoperative examinations, septal support test, NOSE scale results, and photographic comparison. Results:The mean (SD) NOSE scales were 78.91 (10.09) and 30.48 (10.71) in the preoperative and postoperative periods, respectively. The difference of mean NOSE scale was statistically significant (P < 0.001). None of the patients experienced nasal dorsal collapse or graft malposition. Two patients had nasal dorsal irregularity complaints owing to inadequate costal cartilage edge beveling. None of the patients had complications of suture reaction, suture visibility, or suture extrusion. All of the patients stated that they were happy with the cosmetic outcome. Conclusions:Permanent sutures introduced through channels made with the Kirschner wire provide a less invasive, cosmetically pleasing, and functional solution, promising more reliable results in the long term.

Bone grafts as a recyclable material in nasal surgeries

OBJECTIVE To evaluate long-term results of septal bone grafting and to show sustainable viability of bone grafts with objective parameters such as computed tomography. METHODS Nasal septal bones were used as splinting grafts during septo/rhinoplasty operations in 27 patients (Male=16; Female=11) between 2009 and 2013. Of these, only the 21 patients who were monitored long-term and who had computed tomography (CT) records were included in this investigation. The average duration of monitoring for the patients reported here was 17 (12-37 months) months. Patients were excluded for the following reasons: pregnancy; morbid obesity; uncontrolled diabetes; long-term oral steroid or chemotherapeutic agent use; inflammatory, systemic or immunodeficiency disease or acute local infections at the operative site. Bone graft positions, lengths and respective resorption were evaluated and compared pre-postoperatively for each patient. RESULTS Bone grafts retained 90% of their lengths in 14 of the 21 (66.6%) patients. In other cases, control computed sinus tomography showed four bone grafts at 80%, two grafts with 70%, and one graft retained 60% of the original lengths. None of the grafts showed resorption less than 50%. CONCLUSION Bone grafts are reliable grafts and can be used as an alternative to cartilage grafts.

Assessment of the correlation between nasal septal deviation and compensatory hypertrophy of the middle turbinate

The aim of the study was to investigate the relationship between nasal septal deviation and the middle turbinate hypertrophy using computed tomography. In this retrospective analysis, we examined 77 patients with nasal septal deviation. The mucosal and bone structures of the middle turbinate and the angle of the septum were measured using radiological analysis. Measurements of the middle turbinate on the convex side were compared to those on the concave side. Measurements of the bony and mucosal structure area of the middle turbinate were significantly greater than those on the concave side. The dimensions of medial mucosa thickness and bone thickness were not significantly different between the convex and concave sides. No significant correlation was found between the angle of deviation and other parameters. The present findings suggest that compensatory middle turbinate hypertrophy was caused both by conchal bone growth and mucosal hypertrophy in patients with nasal septal deviation.

An Unexpected Otoplasty Complication: Temporal Nerve Paresis

Abstract Otoplasty, for prominent ear correction, is the most common aesthetic surgery procedure done in children. While the outcome often has a positive impact on the psychological state of the patient, the procedure itself does have associated complications that must be considered. Common complications include hematomas, infection, necrosis, outer ear canal stenosis, extrusion of sutures, insufficient correction, overcorrection, keloids, and hypertrophic scars. This is the first case report of facial nerve palsy as a complication following otoplasty. Level of Evidence VThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

A Rare Pathology of Postauricular Region: Apocrine Hidrocystoma

Apocrine histocyctoma in the postauricular region is a very rare antity. Apocrine hidrocystomas which arise from the proliferation of apocrine glands are commonly a solitary mass diameter of 3-15 mm and located in periorbital region and axilla. It is very rare for apocrine hidrocyctoma to locate in postauricular region. The management of these lesions are extensive surgical excision. A 47 years old woman attended to our outpatient clinic with a painless mass in retroauricular region whose physical examination revelaed a mass consisting of conglomerating, flesh colored, multiple vesicules aproximately 10x15 mm in diameter. In this paper, we present a case whose histopathological examination diagnosed apocrine hidrocyctoma after extensive surgical examination.