Ilker Kocak

Assessment of the effectiveness of cyclosporine nasal spray in an animal model of allergic rhinitis

The aim of this study is to show if cyclosporine has an antiallergic role in a rat model of ovalbumin-induced allergic rhinitis. The 54 rats were divided into six equal groups. The first group was a negative control group without induced allergic rhinitis; the second group a positive control with induced allergic rhinitis not receiving treatment. The remaining four groups, after induction of allergic rhinitis, received intranasal cyclosporine treatment in doses of 0.05, 0.1, or 0.2% or nasal steroid treatment. In the biochemical examination, on the surface of the tissue tumor necrosis factor (TNF) interferon (IFN), interleukin (IL)-5, IL-13, as well as IL-2, IL-4, IL-17A, and IgE were studied. Histologically, ciliary loss, increase of goblet cells, vascular congestion, and the degree of eosinophil infiltration were rated. In all treatment groups, on average, a significant reduction in all histological and biochemical values was found compared to the positive control group. Comparing each of the three cyclosporine-using groups with the group of nasal corticosteroid did not show any significant difference in the average scores. Cyclosporine nasal drops are effective to be used in an animal model of experimental allergic rhinitis without systemic effects.

Association of Autologous Costal Cartilage Harvesting Technique With Donor-Site Pain in Patients Undergoing Rhinoplasty

Importance Postoperative pain at the donor site is a common morbidity following autologous costal cartilage grafting. Objective To evaluate postoperative pain at the donor site after the use of a muscle-sparing costal cartilage harvesting technique compared with a muscle-cutting technique using electrocautery. Design, Setting, and Participants Designed as a controlled trial without randomization, this prospective, comparative cohort study was conducted between January 1, 2016, and March 31, 2017. Participants included 20 patients who underwent rhinoplasty for various cosmetic and functional complaints from January 1, 2016, to February 28, 2017. Of the 20 patients, 1 was excluded owing to an infection that developed on postoperative day (POD) 7. Patients were grouped by the rib harvesting technique used that was either a muscle-sparing technique (n = 11) or a muscle-cutting technique (n = 8). Skin incisions for both groups were carried out with a blade. Transection of muscle fascia and muscle fibers was performed with monopolar electrocautery in the muscle-cutting technique group. Blunt dissection with a hemostat was performed in the muscle-sparing technique group. All other surgical techniques were identical. Main Outcomes and Measures Postoperative pain was assessed with visual analog scale scores for resting pain and movement pain. Eight pain measurements were noted at the sixth postoperative hour and on PODs 1, 2, 3, 7, 15, 30, and 45. During the hospital stay, the postoperative need for analgesics was recorded daily as the number of analgesic infusion vials used. Results The 19 patients in the study included 11 women and 8 men whose mean age (SD) was 33.2 (10.3) years The mean (SD) visual pain analog scale scores for resting pain and movement pain were consistently higher in the muscle-cutting technique group than in the muscle-sparing technique group. This difference was statistically significant on PODs 2, 3, and 15 for resting pain and on PODs 2, 3, 7, 15, 30, and 45 for movement pain. The mean postoperative need for analgesic infusion vials during hospital stay was higher in the muscle-cutting technique group, and the difference was statistically significant on POD 2 (1.9 [0.6] vials vs 1.0 [0.9] vials; P = .02). Conclusions and Relevance Both resting and movement pain at the donor site was significantly reduced in the muscle-sparing technique group during the postoperative period, findings that align with anecdotal reports in the literature. Routine use of the muscle-sparing technique in autologous costal cartilage harvesting is recommended to reduce postoperative pain. Level of Evidence 2.

Effect of the premedication with oral clonidine on surgical comfort in patients undergoing fess due to advanced nasal polyposis: A randomized double blind clinical trial ☆

OBJECTıVE: The objective of this randomized double blind study was to evaluate effect of the premedication with oral clonidine on blood pressure, cleaning of surgical site and bleeding in the ESS performed due to advanced NP. METHODS A total of 52 patients who underwent functional endoscopic sinus surgery (FESS) due to Kennedy grade 4 nasal polyposis (NP) were included. Patients were randomized into two groups. Group 1 (n=26) received 0.2mg oral clonodine one hour before the operation in addition to standard anesthesia procedure. Group 2 (n=26) was administered standard anesthesia procedure alone. The amount of bleeding during surgery, cleaning of surgical site and surgeons satisfaction were evaluated in comparison between the groups. RESULTS The amount of bleeding and mean arterial pressure were significantly lower in the Group 1 compared to the Group 2. The cleaning of surgical site was found to be significantly better and surgeons satisfaction significantly higher in the Group 1 than in the Group 2. Systolic, diastolic and mean arterial pressures during surgery were significantly lower in the Group 1 compared to the Group 2. CONCLUSION Premedication with oral clonidine provides a clearer view of surgical site, reduces the amount of bleeding and significantly increases surgeons satisfaction during the operation in FESS performed due to NP. Premedication with oral clonidine is a safe, inexpensive and effective methods in order to increase the surgical success and comfort and reduce complications in the FESS surgery.

Effect of Nasal Corticosteroid on Secretory Immunoglobulin A Measured in Rat Nasal Lavage: Experimental Study.

Objective In this study, we aimed to experimentally investigate the effects of nasal corticosteroids on the levels of secretory immunoglobulin A (sIgA) in nasal mucosa in rats. Study Design Prospective, randomized control trial. Setting Research laboratory. Subject and Methods Twenty-four male Sprague Dawley rats were included in our study. The rats were randomized into 3 groups. In group 1, nasal mometasone furoate was applied to the rats for 30 days. Saline was applied to group 2 for 30 days. Group 3 was the control group and received no treatment throughout the study period. Nasal lavage was conducted on both nasal openings of all rats in the 3 groups at the beginning of the study and on days 15 and 30, and the lavage solution (distilled water) was collected by aspiration. Results In group 1, the sIgA value was significantly higher at day 15 than at baseline. No significant difference was found between the sIgA values on day 15 and day 30. In groups 2 and 3, there were no significant differences in sIgA values at baseline, day 15, and day 30. The sIgA value of group 1 on day 15 was significantly higher than the values of groups 2 and 3. The sIgA value of group 1 on day 30 was significantly higher than the values of groups 2 and 3. Conclusion Topical corticosteroids (mometasone furoate) applied to the nasal mucosa significantly increase nasal sIgA levels.

Asymmetrically pressing nasal splint for crooked nose deformity.

ObjectivesCorrecting crooked nose deformity is one of the most difficult procedure in rhinoplastic surgery. For that reason, the authors have been designed an asymmetrically pressing nasal splint. In this prospective study, the aim was to compare the effects of applying asymmetrically pressing nasal splint and normal symmetrically splint on the crooked nose. MethodsThis study included 129 patients who were operated on for crooked nose deformity. Patients were divided into 2 groups. Normal symmetrically pressing nasal splint was applied to groups 1a (I type) and 1b (C type). Asymmetrically pressing nasal splint was applied to groups 2a (I type) and 2b (C type). All groups were compared according to deflection angle from the midline, the percentage of postoperative improvement, patient satisfaction with visual analog scale, and complication rate. ResultsI-type noses in both groups at postoperative angle values were reduced, and C-type noses in both groups at postoperative angle values were increased significantly compared with preoperative values. I-type noses of group 2 at postoperative angle values compared with group 1 were reduced, and C-type noses were increased in group 2 significantly. Patient satisfaction rate in group 2 were significantly better than in group 1. The closeness ratios to the ideal angles in group 1 were in “good” and “moderate” levels, whereas in group 2, it was in “excellent” level. There was no significant difference in complication rate in both groups. ConclusionsAsymmetrically pressing splint (novel design) showed increasing success rate clearly in crooked nose surgery than in normal splints.

A comparison of piezosurgery with conventional techniques for internal osteotomy

To compare conventional osteotomy with the piezosurgery medical device, in terms of postoperative edema, ecchymosis, pain, operation time, and mucosal integrity, in rhinoplasty patients. In this prospective study, 49 rhinoplasty patients were randomly divided into two groups according to osteotomy technique used, either conventional osteotomy or piezosurgery. For all patients, the total duration of the operation was recorded, and photographs were taken and scored for ecchymosis and edema on postoperative days 2, 4, and 7. In addition, pain level was evaluated on postoperative day 2, and mucosal integrity was assessed on day 4. All scoring and evaluation was conducted by a physician who was blinded to the osteotomy procedure. In the piezosurgery group, edema scores on postoperative day 2 and ecchymosis scores on postoperative days 2, 4, and 7 were significantly lower than in the conventional osteotomy group (p < 0.05). On postoperative day 2, the pain level was lower in the piezosurgery group than in the conventional osteotomy group (p < 0.05). In an endoscopic examination on postoperative day 4, while 24% of the patients in the conventional osteotomy group had mucosal damage, no such damage was observed in the piezosurgery group. When total operation duration was compared, there was no significant difference between the groups (p > 0.05). Piezosurgery is a safe osteotomy method, with less edema (in the early postoperative period) and ecchymosis compared with conventional osteotomy, as well as less pain, a similar operation duration, and no mucosal damage.

Split Cartilage Resection of Nasal Dome: A Solution to Ptotic Nasal Tips.

Objective:In ptotic noses, it is rather difficult to achieve the intended functional and cosmetic result without modifying the alar cartilage and creating a new nasal tip. The split cartilage resection method was intended to create a new and permanent nasal tip to protect the physiologic and cosmetic appearance of the nose in the presence of long and ptotic nasal tip. Method:A total of 53 patients who had nasal tip ptosis were included in the study: 26 patients (Group 1) who underwent lateral crural overlap because of the alar cartilage problem and 27 patients (Group 2) who underwent dome split cartilage resection. After at least 1 year of follow-up, the pre- and postoperative measurements of patients indicating their rotations and projections in their computerized images were compared and acoustic rhinometry was performed to determine the nasal valve function. Results:There were no significant differences between the 2 groups with respect to the pre- and postoperative nasolabial angels, rotation angles, Goode index, and nasofacial angle. There were no significant differences between the nasal cavity volume values of the 2 groups; the volume increase in wide nasal cavity in Group 2 was higher. After the operation, the increase in minimum cross-sectional area values in Group 2 was significantly >1 in Group 1. Conclusions:The nasal tip split resection method is a method that can be implemented and should be kept in mind as a technique, which must be considered as an alternative method for noses with ptotic and long nasal tip disorder.

A comparison of the long‐term results of crushing and crushing with intrinsic stripping techniques in concha bullosa surgery

A prospective endoscopic and radiologic evaluation of long‐term outcomes of crushing and crushing with intrinsic stripping, 2 minimally destructive techniques used for the surgical treatment of concha bullosa.

Nasopharyngeal Glial Heterotopia with Intracranial Extension: A Case Report

Nasopharyngeal glial heterotopia is a mass composed of mature neural tissue occurring outside the central nervous system and is extremely rare. The preoperative diagnosis of such a mass in the head and neck region is challenging. In this study, we report a case of a 16-month-old patient presenting with respiratory distress and snoring caused by nasopharyngeal glial heterotopia. Radiologic imaging and histopathology are obligatory for the definitive diagnosis of glial heterotopia. Preoperative evaluation of an intracranial connection is one of the most essential issues in the presence of pediatric nasopharyngeal masses. The gold standard of treatment is surgical excision. Early recognition and early surgical excision by endoscopic or external approach are crucial to relieve respiratory distress and to maintain healthy growth and development.

Evaluation of Benign Paroxysmal Positional Vertigo in American Football Players

OBJECTIVES The aim of this investigation was to evaluate the association between posterior channel benign paroxysmal positional vertigo (BPPV) and trauma that is frequently experienced by American football players. MATERIALS AND METHODS Participants were classified into the following two groups: (1) a study group consisting of 63 male participants aged 18-30 years who had been playing American football for more than 2 years and (2) a control group consisting of 49 male participants aged 18-27 years with no history of otologic/vestibular disease or acute/chronic trauma. Trauma, age, total duration of playing American football, and weekly training hours of subjects in the study group were analyzed to determine any relationship with BPPV occurrence. We performed otologic, audiologic, and vestibular assessments of pure sound audiometry, tympanometry, tandem walking test with eyes open and eyes closed, Romberg, head shaking, roll, and Dix-Hallpike tests to all participants. RESULTS A positive correlation between the total years of American football played and posterior channel BPPV frequency was observed in the study group. In addition, increasing weekly hours of training was shown to further increase the risk of BPPV. A total of 16 out of 63 athletes experienced BPPV, whereas none of the participants in the control group experienced BPPV. All participants completed the Vertigo Symptom Scale, which revealed that vertigo did not cause any significant negative impact on their training routine and activities of daily living. CONCLUSION Our results indicate that the weekly training hours and total years of training with American football increase posterior channel BPPV frequency.