Levent Saydam

The effect of paracetamol, metamizole sodium and ibuprofen on postoperative hemorrhage following pediatric tonsillectomy

OBJECTIVE To determine the risk of postoperative hemorrhage associated with the use of analgesic drugs including paracetamol, metamizole sodium and ibuprofen after pediatric tonsillectomy. PATIENTS AND METHODS Three hundred and forty consecutive children with recurrent tonsillitis and/or obstructive symptoms were included in the study. Children were divided into three groups based on the drugs used for postoperative pain relief. Each group received paracetamol, metamizole sodium and ibuprofen following the surgery. The study of population was compared respect to postoperative bleeding. Chi-square test was used for statistical analysis. RESULTS A total of 115 patients received ibuprofen, 115 patients were given metamizole sodium and 110 patients were given paracetamol. Posttonsillectomy hemorrhage occurred in fourteen (4.11%) children, consisting of primary hemorrhage in two patients and secondary hemorrhage in twelve patients. While 6 of 115 children (5.21%) who were given ibuprofen had postoperative hemorrhage, 4 of 115 children (3.47%) in metamizole sodium group and 4 of 110 patients (3.63%) in paracetamol group had hemorrhage. There was no significant difference with respect to hemorrhage rates between these three groups (p<0.05). CONCLUSION In our study we could not show significant risk of hemorrhage after using of ibuprofen, metamizole sodium and paracetamol administration and they can be used safely for posttonsillectomy pain.

Comparison of ropivacaine, bupivacaine and lidocaine in the management of post-tonsillectomy pain.

OBJECTIVES To compare the efficacy of preoperative peritonsillar injection of ropivacaine, bupivacaine and lidocaine for pediatric tonsillectomy. PATIENTS AND METHODS Between March 2009 and April 2012, 120 patients (66 males and 54 females) between ages of 4 and 13 years were included to the study. After informed consent was obtained from the parents, the patients were randomized into four groups. In Group 1 (31 patients, mean age 8.40 ± 4.05 years) received topical lidocaine hydrochloride with 1:100,000 epinephrine was applied to surgical bed following tonsillectomy. Group 2 (29 patients, mean age 8.15 ± 4.20 years) and group 3 (31 patients, mean age 7.75 ± 3.95 years) were administered 0.25% bupivacaine hydrochloride with 1:200,000 epinephrine and 0.5% ropivacaine respectively. In Group 4 (29 patients, mean age 8.15 ± 4.20 years) topical 0.9% saline was used. The operation time, postoperative pain, amount of intraoperative blood loss, postoperative hemorrhage and complications were assessed. The intensity of pain was scored on a visual analogue scale. The patients were followed up for 3 weeks after surgery. RESULTS The difference between mean operative time of the three groups against saline injected group was statistically significant (p<0.001). The difference between mean intraoperative blood loss of the lidocaine group against three groups was statistically significant (p<0.001). None of the patients in four groups experienced primary and secondary hemorrhage. The difference between mean pain score between ropovacaine and bupivacaine groups was not statistically significant (p>0.001). The difference between mean pain score of the two groups against lidocaine and saline groups was statistically significant (p<0.001). CONCLUSION Ropivacaine infiltration is as effective as bupivacaine for post-tonsillectomy pain management in children. In view of potential side effects of bupivacaine-epinephrin combination, ropivacaine is a safer choice, for post-tonsillectomy pain relief.

Laryngeal chondroma presenting as an external neck mass

Laryngeal chondromas are rare benign tumors originating from the cartilagenous framework of the larynx. Since its first description in 1882, about 250 cases have been reported in the literature. Depending on the size of the lesion, excision via an endoscopic or open surgical approach is the treatment of choice. The majority of these patients present with an endolaryngeal mass. To encounter an external neck mass as the reason for the initial presentation is a rare occurrence. In this article we report a case of laryngeal chondroma of cricoid cartilage origin, which presented as a neck mass. The lesion was totally excised using a transcervical approach. No tracheotomy or laryngeal stent was needed postoperatively. Despite its rarity, this diagnostic possibility should always be kept in mind for elderly patients with complaints of progressive voice changes and exertional dyspnea.

The possible associations of septal deviation on mastoid pneumatization and chronic otitis.

Objectives The purpose of this study was to determine the role of nasal septal deviation on volume of mastoid air cells and possible relationship to chronic otitis. Materials and Methods Between May 2010 and September 2012, paranasal sinus computed tomographic findings of 825 patients (470 male and 355 female subjects) who were treated in Ear Nose and Throat Department of Bozok University Medical Faculty were retrospectively analyzed. By excluding the other coexistent sinonasal pathologies, 100 patients (45 male and 55 female subjects; mean age, 37.7 ± 10.4 yr; range, 18–70 yr) with nasal septal deviations were recruited for the study. The convex side of the septal curvature was accepted as the direction of deviation. The findings were grouped according to the radiologically measured angle of nasal septal deviations. The deviation angle of the nasal septum was described as follows: mild (<9 degrees), moderate (9–15 degrees), or severe (≥15 degrees). The volume of each mastoid air cells was also calculated using the computer program. Chronic otitis was defined a abnormality criteria of the normal temporal scan. Criteria for a normal temporal bone were as follows: 1) absence of bony destruction or sclerosis; 2) absence of fluid or mass in any of the temporal bone air spaces; and 3) the presence of “normal” air cells. Results There were 45 male and 55 female subjects (mean age, 37.7 ± 10.4 yr; range, 18–70 yr). Nasal septal deviation angles were found to range between 5 and 28.1 degrees (mean, 14 ± 1.2 degrees). The left-sided deviations included 16 mild (<9 degrees, Group I), 15 moderate (9–15 degrees, Group II), and 17 severe (≥15 degrees, Group III) subjects. The right-sided deviations included 18 mild (<9 degrees, Group I), 16 moderate (9–15 degrees, Group II), and 18 severe (≥15 degrees, Group III) cases. We could not demonstrate a statistically significant difference between the right mastoid cell volumes of the Group I and Group II in left-sided deviation cases (p = 0.51). In the same side comparison of Group I to Group III and Group II to Group III, the mastoid cell volume differences were found to be significantly meaningful (p = 0.00 and p = 0.00, respectively). Identical results were yielded in the right-sided septal deviation group related to the mastoid cell volumes of Group I and Group II and Group I to Group III and Group II to Group III comparisons (p = 0.55, p = 0.00, and p = 0.011, respectively). In both right and left deviation groups, ipsilateral and contralateral mastoid cell volume comparisons produced statistically significant results (p = 0.04 and p = 0.003, respectively). The presence of chronic otitis findings were significantly increased in both groups (p = 0.00). Statistical significance was set at p < 0.05. Conclusion Our findings suggest that mastoid cell volumes tend to be larger at the contralateral side of the severe septum deviations.

Pseudomeningocele presenting as a cyst of the external auditory canal.

Pseudomeningocele is a cerebrospinal fluid collection in an extradural area after meningeal tear. The etiology of pseudomeningocele development is iatrogenic or traumatic in most cases. In this study, we report a case of the postsurgical pseudomeningocele presenting as a cystic mass in the external auditory canal and complete sensorineural hearing loss with a review of the relevant literature.