Gurkan Keskin

The learning curve in endoscopic pituitary surgery and our experience

Experience is the important point in reduction of the complications and in the effectiveness of the surgical procedure in pituitary surgery. Endoscopic pituitary surgery differs from microscopic surgery, since it requires a steep learning curve for endoscopic skills. In this article, we evaluate our learning curve in two groups, as early and late experience. Purely endoscopic transsphenoidal operations were performed on 78 patients, which were retrospectively reviewed and grouped as early and late experience groups. We used the purely endoscopic endonasal approach to the sella that was performed via an anterior sphenoidotomy, without the use of a transsphenoidal retractor. All patients with adenomas were evaluated considering operation time, endocrinology, ophthalmology, total removal and, especially, modifications of standard technique. On the basis of the experience gained with the use of the endoscope in transphenoidal surgery over the years, modifications can be performed on the different phases of the endoscopic approach. Reviewing our cases in two groups of period due to our experience showed that the effectiveness of endoscopic surgery increases and operation time decreases. In our study, we identified a learning curve in endoscopic pituitary surgery.

Cervical bronchogenic cysts in head and neck region: review of the literature

Congenital cysts of the neck are not uncommon. Most of these are thyroglossal, branchial cleft and thymic cysts. Bronchogenic cysts are uncommon developmental anomalies of the tracheobronchial tree and rarely occur in the neck. More than 70 cases of bronchogenic cysts in the head and neck region have been reported in the literature. We report three cases presenting with neck swelling in the hyoid region that were diagnosed as bronchogenic cysts based on clinical and histopathological findings.

Central giant cell granuloma

The central giant cell granuloma (CGCG) is an uncommon benign bony lesion that accounts for less than 7% of all benign lesions of the jaws in tooth-bearing areas. Its etiology is unknown and its biological behavior is poorly understood. This condition is a slow-growing, asymptomatic lesion that usually affects children and young adults, predominantly females. The following report illustrates the differential diagnosis, surgery, final diagnosis and pathology of a fast-growing CGCG in a 4-year-old girl.

Choanal polyps: an evaluation of 53 cases.

Background The aim of this study was to evaluate our experience on the diagnosis and treatment of choanal polyps (CP). Methods This study consists of 53 patients with CP diagnosed by means of rhinoscopy, nasal endoscopy, computerized tomography, surgical, and histologic findings between 1996 and 2005. Results The origins of the CPs were the unilateral maxillary sinus in 47 patients, simultaneously bilateral maxillary sinus in 2 patients, septum in 2 patients, sphenoid sinus in 1 patient, anterior ethmoid sinus in 1 patient. The most common presenting symptoms were unilateral nasal obstruction, snoring, and rhinorrhea. In the cases of the antrochoanal polyps, the most common preoperative radiological finding was the total opacification of the maxillary sinus. Conclusion Endoscopic approach for complete removal of the CPs is an extremely safe and effective procedure. It should be focused on the detection of the exact origin and the extent of the polyp to prevent recurrence.

Soft Tissue Response of the Larynx to Silicone, Gore‐Tex, and Irradiated Cartilage Implants

Objective: The aim of the study is to compare the efficiency of three different materials (Silicone, Gore‐Tex, and irradiated cartilage) used in medialization laryngoplasty. Local tissue reaction to implants in laryngeal skeleton has been examined for this purpose.

Multiple infiltrating lipomas of the tongue.

A rare case of multiple infiltrating lipomas in the tongue of a 54-year-old man is reported. There have been only five previously reported cases of infiltrating lipoma of the tongue. They were all solitary in nature. The present lesion is the first case reported in the English literature of multiple infiltrating lipoma of the tongue. Because of its infiltrating nature, this tumour may be mistaken for a liposarcoma. Achievement of adequate surgical margins is essential, as the recurrence rate may be as high as 62.5 per cent without complete excision.

Actinomycosis of the tongue: a diagnostic dilemma

Actinomycotic infections of the cervicofacial region are not uncommon. However, actinomycosis of the tongue is rare. A mass that may mimic both benign and malignant neoplasms can be seen at clinical presentation and may mislead the diagnosis. We report a patient who presented with a tumour-like tongue mass causing speech disturbance, diagnosed as actinomycosis.

Endoscope-assisted transoral approach to parapharyngeal space tumors.

Parapharyngeal space (PPS) tumors are rare tumors for which the surgical management differs widely. The purpose of this study was to discuss the advantages and disadvantages of the endoscope‐assisted transoral approach over the traditional approaches.

The comparison of acellular dermal matric (Alloderm), Dacron, Gore-Tex, and autologous cartilage graft materials in an experimental animal model for nasal septal repair surgery

Background The aim of this study was to compare the compatibility of Alloderm, Dacron, Gore-Tex, and autologous cartilage graft materials with host tissues in nasal septal perforation repair surgery. Methods The materials were placed into the nasal septum of 16 New Zealand rabbits. At the end of the 3rd month, septums of the rabbits were removed totally and reactions, such as inflammation; foreign body giant cell; or fibrosis that developed in the surrounding tissue against the implant material were evaluated. Results Acute inflammation reactions occurred mostly with Gore-Tex. There were no differences between groups according to chronic inflammation. When the number of reactions and tissue compatibility were taken into consideration, cartilage performed the best followed by Alloderm. There were more reactions with Dacron, but it still showed compatibility. Conclusion Cartilage was found to be the best material followed by Alloderm and Dacron, but Gore-Tex was found unsuitable.

Combined use of histopathology with touch smear cytology in biopsies of the larynx

The aim of this prospective study is to evaluate the effectiveness of combined use of histopathology with cytology in biopsies of the larynx. Biopsies taken for this purpose are studied by using two different methods and the results are evaluated. One hundred and thirty-five patients with suspected malignant laryngeal lesions were examined by direct microlaryngoscopy for primary diagnosis. Each lesion was biopsied first. Subsequently touch smear cytology was obtained from the biopsies. In all cases, cytologic slides (one or two per biopsy) were screened and compared to corresponding biopsies. Lesions were categorized as benign, laryngeal intraepithelial neoplasia and malignant. Results obtained were compared with surgical samples obtained from patients who have undergone surgery. In other cases, where surgery was not applied, results of the follow-up were evaluated. In larynx biopsies the results for histopathology were as follows: sensitivity 93.9%, specificity 100% and accuracy 96.3%. The results for cytology were as follows: sensitivity 82.5%, specificity 94.5% and accuracy 87.4%. A comparison of cytologic evaluation versus histopathologic evaluation in laryngeal biopsies reveals that histopathology is superior. According to the study results, in 88.9% (120/135) of the cases the agreement between cytological and histopathological results was found. In two other cases (1.5%) cytologic evaluation contributed to the histopathologic diagnosis.