Haluk Yavuz

Nasal and paranasal sinus schwannomas

Abstract. Although nearly half of all schwannomas involve the head and neck region, nasal and paranasal sinus presentations are quite rare in the literature. Two of the latter cases are presented in this report. In the first, the tumor originated from the nasal septum and was completely excised under local anesthesia. In the second, the schwannoma arose from the left frontal and anterior ethmoidal sinuses. This lesion was totally removed through a combined endoscopic intranasal and external frontoethmoidectomy approach. The patients have shown no tumor recurrence in 6 years and 18 months of follow-up, respectively. The extreme rarity of nasal and paranasal sinus schwannoma is the basis for discussion of these cases.

Endoscopic sinus surgery for maxillary sinus mucoceles

BackgroundMaxillary sinus mucoceles are relatively rare among all paranasal sinus mucoceles. With the introduction of endoscopic sinus surgical techniques, rhinologic surgeons prefer transnasal endoscopic management of sinus mucoceles. The aim of this study is to describe the clinical presentation of maxillary sinus mucoceles and to establish the efficacy of endoscopic management of sinus mucoceles.MethodsBetween 2003 and 2005, 14 patients underwent endoscopic sinus surgery for maxillary sinus mucocele. The presenting sign and symptoms, radiological findings, surgical management and need for revision surgery were reviewed.ResultsThere were eight males and six females with an age range of 14 to 65. Ten patients complained of nasal obstruction, five of nasal drainage, five of cheek pressure or pain and one of proptosis of the eye and cheek swelling. The maxillary sinus and ipsilateral ethmoid sinus involvement on computed tomographic studies was seen in 4 patients. Four patients had history of endoscopic ethmoidectomy surgery for ethmoid sinusitis and one had Caldwell-Luc operation in the past. Ethmoidectomy with middle meatal antrostomy and marsupialization of the mucocele was performed in all patients. Postoperative follow-up ranged between 8 to 48 months. All patients had a patent middle meatal antrostomy and healthy maxillary sinus mucosa. No patients need revision surgery.ConclusionThe most common causes of mucoceles are chronic infection, allergic sinonasal disease, trauma and previous surgery. In 64% of the patients of our study cause remains uncertain. Endoscopic sinus surgery is an effective treatment for maxillary sinus mucoceles with a favorable long-term outcome.

Giant sublingual epidermoid cyst: a report of two cases.

Epidermoid cysts are benign epithelial cysts that occur rarely in the neck. In contrast to dermoid cysts,epidermoid cysts do not include dermal attachments such as hair, hair follicles, sebaceous glands and sweat glands. They may be congenital or acquired. Acquired epidermoid cysts are either post-traumatic or iatrogenic. They rarely enlarge markedly.This study discusses epidermoid cysts in a 34-year-old woman and a 35-year-old man, both of which were giant epidermoid cysts in the sublingual space. Both patients were admitted for difficulty swallowing and cosmetic problems. The cysts of both patients had an aetiology of trauma and were documented by pathology sections and pre-operative magnetic resonance images. Both cysts were excised completely, one intraorally and one externally. Such cysts are benign and ought to be borne in mind in the differential diagnosis of oral cavity and neck cystic masses.

Reliability of Microdrill Stapedotomy: Comparison With Pick Stapedotomy

Objective: To assess the hearing outcomes and complications of the microdrill and pick stapedotomy techniques. Patients: We assessed 123 primary otosclerosis operation in 103 patients who had more than 1 year follow-up (71 microdrill; 52 pick stapedotomies). There were 87 women and 36 men in the study group (mean age, 44 ± 11.2 years) at surgery. Intervention: Stapedotomy for otosclerosis. Main Outcome Measures: Pure tone hearing thresholds and clinical evaluation for complications. Results: In the microdrill group, preoperative mean air conduction was 61 dB, and mean bone conduction was 27 dB, postoperatively, these values improved to 31 dB and 16 dB, respectively. In the pick group, mean air conduction was 61 dB, and mean bone conduction was 27 dB, which improved postoperatively to 33 dB and 18 dB, respectively. Postoperative hearing gains were similar in both groups (p > 0.005). The mean postoperative gain in bone conduction was significant (p < 0.001) in each group: 11 dB in the microdrill group and 9 dB in the pick group, with no significant difference between the two groups. The preoperative air-bone gap was 34 dB in both groups, and improved to 15 dB in both. Complication rates were similar. Conclusion: The microdrill and pick stapedotomy techniques produced similar hearing results and complication rates. Within the limitations of the present study, we found no evidence of microdrill-induced acoustic trauma. The microdrill can be a useful technique in performing a stapedotomy and seems to produce similar results to those associated with pick stapedotomy.

Embolisation of an extensive arteriovenous malformation of the temporal region as an alternate treatment: case report.

OBJECTIVES To report the case of a spontaneous arteriovenous malformation involving the auricula, external auditory meatus, middle ear and part of the petrous apex, and also to provide updated information about its management. CASE REPORT A 33-year-old woman presented complaining of accelerated growth of a retro-auricular swelling during her latest pregnancy, together with pain, pulsatile tinnitus and ear discharge. An arteriovenous malformation occupying the right auricula, external auditory canal, mastoid process of the temporal bone and the lateral half of the petrous segment was diagnosed, using temporal computerised tomography and magnetic resonance imaging. The lesion was embolised with polyvinyl alcohol particles at angiography. Excision of the arteriovenous malformation nidus was performed. Three years post-operatively, magnetic resonance imaging showed no residual lesion or recurrence at the temporal bone and petrous apex, although a few scanty, serpiginous, vascular remnants had persisted. CONCLUSIONS In the head and neck, arteriovenous malformations usually occur intracranially; they are rare outside the cranium. To our knowledge, there have been no previously published cases of such an extensive arteriovenous malformation involving the temporal region. Apropos of our case, the definition, clinical findings, diagnostic approaches and therapeutic management of arteriovenous malformations are discussed.

Effects of Different Suture Materials on Cartilage Reshaping

OBJECTIVE To examine the effects of different suture materials and suturation techniques on cartilage reshaping in a rabbit model. METHODS Twenty-two rabbits were used. Posterior skin flaps were elevated, and 4 cartilage struts were prepared on each auricula. Each strut was bent at its midpoint, and the skin under the bent area was elevated only in 1 side. The strut was sutured either with catgut, polyglactin 910, polydioxanone, or polypropylene sutures. Anteriorly, the suture was passed subcutaneously on 1 side, while transcutaneously on the other. Animals were killed at the first and fourth months. The shape of the struts was macroscopically evaluated. Inflammation and foreign body reaction around the suture were examined under light microscopy. RESULTS Maintenance of shape with all suture materials was significantly lower in the transcutaneously sutured group than in the subcutaneously sutured group. Because of high rates of suture loss in the transcutaneously sutured group, further evaluations on cartilage tissue were made only in subcutaneously sutured group. Success rate in maintenance of shape was similarly high in the polydioxanone, polyglactin 910, and polypropylene suture groups; however, it was significantly lower in the catgut suture group. CONCLUSION Long-lasting absorbable suture materials are as effective as nonabsorbable ones, and the subcutaneous technique is more effective than the transcutaneous technique.

Effect of preoperative hearing level on success of stapes surgery

Objective: We evaluated functional results after stapedotomy in terms of the influence of preoperative hearing threshold. Study Design: Case series and chart review. Subjects and Methods: We classified 141 patients according to preoperative mean air-conduction threshold: 40 to 54 dB, group 1; 55 to 69 dB, group 2; and 70 to 89 dB, group 3. Speech discrimination scores also were noted. Results: All groups showed significant improvement. The greatest increase in postoperative speech discrimination score was seen in group 3. Group 1 improved from moderate hearing loss (mean, 49 dB) to normal (mean, 24 dB); group 2, from moderately severe loss (mean, 61.2 dB) to mild (mean, 28 dB); and group 3, from severe loss (mean, 76.4 dB) to moderate (mean, 41.1 dB). Conclusion: Success in treating otosclerosis does not depend on extent of preoperative hearing loss. Patients with severe loss improved to moderate, increasing the benefit from use of a hearing aid. The patients attained good auditory function, improving their quality of life.

Reversed ipsilateral acoustic reflex pattern.

OBJECTIVE To determine the characteristics and possible origin of reversed ipsilateral acoustic reflex. STUDY DESIGN Retrospective. SETTING University hospital. PATIENTS Sixty-three ears in 52 patients (mean age 37.6 years) with unilateral or bilateral sensorineural hearing loss and 45 age- and sex-matched persons as controls. METHODS Audiometry and impedance audiometry examinations were studied retrospectively. Hearing test records were investigated, and patients with unilateral or bilateral sensorineural hearing loss were included. Forty-five age- and sex-matched persons served as controls. The ipsilateral and contralateral acoustic reflex patterns of these patients were investigated. Reflex-forming acoustic thresholds and latencies of ipsilateral reversed (positive) reflexes were compared with ipsilateral negative (upward) reflexes. RESULTS The ipsilateral acoustic reflexes of 18 of 63 ears with sensorineural hearing loss were absent, and the remaining 45 were reversed (positive). A significant difference was found between ipsilateral reversed and ipsilateral negative acoustic reflex thresholds (p < .001) and latencies (p < .001). No statistically significant differences were found between ipsilateral and contralateral negative reflex latencies. CONCLUSIONS The reversed acoustic reflex pattern is not an artifact but a physiologic event. This reflex does not appear to be related to stapedius or tensor tympani muscle contraction. We believe that the etiology of the reversed reflex is related to the system that contains the tympanic membrane, malleus, and incus and their ligaments but not the middle ear muscles.

Auditory brainstem implant in postlingual postmeningitic patients

The aim of this study was to evaluate outcomes of postlingual postmeningitic patients who received an auditory brainstem implant (ABI).