Lokman Uzun

Craniofacial differences according to AHI scores of children with obstructive sleep apnoea syndrome: cephalometric study in 39 patients

BackgroundCephalometry is useful as a screening test for anatomical abnormalities in patients with obstructive sleep apnoea syndrome (OSAS).ObjectiveTo evaluate comprehensively the cephalo metric features of children with OSAS, with or without adenotonsillar hypertrophy, and to elucidate the relationship between cephalometric variables and apnoea-hypopnoea index (AHI) severity.Materials and methodsThe study population consisted of 39 children, aged 4–12 years, with OSAS. Cephalometry was analysed using 11 measurements of the bony structures, their relationships and the size of the airways. Additionally, adenoid and tonsillar hypertrophy were graded.ResultsCranial base angles (BaSN and BaSPNS) were found to correlate with increasing levels of AHI scores (P<0.001). Protrusion of the maxilla (SNA) and mandible (SNB) did not correlate with AHI scores (P>0.05). The length of the mandibular plane (GnGo) and the minimal posterior airway space (MPAS) were inversely correlated with AHI scores (P<0.001). There was positive correlation between MPAS and GnGo (r=0.740, P<0.001), and negative correlation between MPAS and gonial angle (ArGoGn) (r=−0.541, P<0.001). There was significant correlation between cephalometric data and adenotonsillar hypertrophy concerning BaSN, BaSPNS, ArGoGn, GnGoH, BaN-GnGo, MPAS, GnGO and MPH (P<0.001).ConclusionsThere is significant correlation between cephalometric data and AHI score severity in children with OSAS. Adenotonsillar hypertrophy affects the cephalometric measurements adversely. The study clearly mandates the institution of early and effective therapy of adenotonsillar hypertrophy in children with OSAS.

Effectiveness of dexmedetomidine in reducing bleeding during septoplasty and tympanoplasty operations.

STUDY OBJECTIVE To determine the effect of dexmedetomidine on intraoperative bleeding during septoplasty and tympanoplasty operations. DESIGN Randomized, placebo-controlled study. SETTING Univesity medical center. PATIENTS 80 ASA physical status I and II patients, aged 18 to 65 years, 40 of whom were scheduled for septoplasty and 40 to undergo tympanoplasty operations. INTERVENTIONS Patients undergoing septoplasty (S) and tympanoplasty (T) operations were randomly divided into 4 groups. Dexmedetomidine (D) was administered to Group SD and Group TD first as a bolus dose of one microg kg(-1), then intraoperative maintenance was supplied with dexmedetomidine 0.7 microg kg(-1) hour(-1). Groups S and T (controls) were given identical amounts of saline. If systolic blood pressure measurements are greater than 20% preoperative values, then fentanyl one microg kg(-1) was given. MEASUREMENTS Intraoperative blood loss was determined with suction volumes and gauze counting. Bleeding was rated according to a 6-point scale. Hemodynamic parameters and fentanyl administration were recorded. MAIN RESULTS Group SD had less bleeding and lower bleeding scores (P < 0.05). In addition, this group received less intraoperative fentanyl (P < 0.05). The only significant difference between Groups TD and T was the amount of intraoperative fentanyl given (35.4 +/- 58.8 vs 110.0 +/- 81.0 microg) (P < 0.05). CONCLUSION Dexmedetomidine reduces bleeding, bleeding scores, and intraoperative fentanyl consumption during general anesthesia in septoplasty operations.

Effect of adenoidectomy and/or tonsillectomy on cardiac functions in children with obstructive sleep apnea.

Background/Aims: We aimed to determine the effects of adenoidectomy and/or tonsillectomy (AT) on cardiac functions in children with adenoid and/or tonsillary hypertrophy and obstructive sleep apnea syndrome (OSAS) by using echocardiography with tissue Doppler imaging facility (TDI). Methods: Twenty-nine children with adenoid and/or tonsillary hypertrophy and OSAS and 26 children with primary snoring entered the study. Cardiac functions were assessed by echocardiography with TDI in both groups. Tests were repeated in the OSAS group 6 months after treatment with AT. Results: Echocardiography showed a decrease in estimated pulmonary artery systolic pressure from 31 ± 4.2 to 13.1 ± 2.3 (p < 0.001). In TDI, tricuspid Em and Em/Am increased from 11.0 ± 2.7 to 13.5 ± 2.7 cm/s (p < 0.001), and 1.46 ± 0.52 to 1.82 ± 0.53 (p = 0.004), respectively, following AT, indicating improvement in right ventricular diastolic dysfunction. Similarly, mitral Em and Em /Am increased from 12.3 ± 2.1 to 16.3 ± 2.7 cm/s, and from 1.65 ± 0.51 to 2.30 ± 0.54, respectively (p < 0.001). There was no significant difference between postoperative values and control group values. Conclusion: TDI is a technique able to detect diastolic dysfunction unnoticeable by conventional echocardiography. Following AT, we observed improvement in both left and right ventricular diastolic functions using TDI.

Radical mastoidectomy cavity myiasis caused by Wohlfahrtia magnifica

In this article, a Wohlfahrtia magnifica otomyiasis case, a 31-year-old, non-mentally retarded patient who had undergone radical mastoidectomy previously is presented. Maggots in the radical mastoidectomy cavity were removed then topical treatment was applied. The maggots were identified as W. magnifica. In cases of myiasis, identification of larvae following direct extraction and application of preventative methods is essential.

Effectiveness of the Jaw-Thrust Maneuver in Opening the Airway: A Flexible Fiberoptic Endoscopic Study

Objective: A prospective study was carried out to find the exact site of obstruction in sleep model and to quantitatively evaluate the effect of Jaw-thrust maneuver (JTM) in opening the obstructed airway using flexible fiberoptic endoscope. Methods: Twenty-eight ASA physical status I or II patients with snoring symptom undergoing elective surgery were included. The patients were held in supine position without hyperextension of the neck. Having induced anesthesia, the base of the tongue and laryngeal inlet and/or epiglottis were visualized using endoscope. The patients’ epiglottides were classified as leaf-shaped, curved (concaved or omega-shaped) and floppy types. We graded the airway opening at the level of epiglottis into six grades and obstruction at the tongue base level into four grades. The grades during inspiration (GrIns), expiration (GrExp) and after JTM (GrJTM) were recorded and compared with Pearson chi-square test. Results: The strictly curved (Ω-shaped or concaved) epiglottis supplied a salvage pathway for airflow that resisted collapsing with the posterior movement of the tongue base in 2 patients. When we compared GrIns with GrExp for epiglottis the difference was statistically significant (χ2 = 0.001), but the difference for tongue base was not (χ2 = 0.152). After JTM, GrJTM for both epiglottis and tongue base were significantly better than GrIns and GrExp (χ2 < 0.001). Conclusion: Tongue base was the principal site of obstruction although during the respiratory cycle the position of epiglottis changed prominently and increased the obstruction in inspiration. JTM alone significantly relieved the obstruction at the tongue base and epiglottis levels and increased the retroglossal airway.

Enlargement of the bone component in different parts of compensatorily hypertrophied inferior turbinate.

Background To evaluate the unilateral compensatorily hypertrophied inferior turbinate (CHIT) by computed tomography (CT) and determine the enlargement of the bone component in different parts of the CHIT. Methods Patients were studied in three groups: those with a straight or nearly straight septum (n = 143), with mild deviation (n = 42), and with moderate to severe deviation (n = 99). The cross sectional area (CSA) of the inferior turbinate (IT) bone and the whole turbinate were measured at anterior, middle, and posterior thirds of the IT in coronal sections. The ratio of CSA of the IT bone on two sides of the septum (interturbinate ratio) and the ratio of the CSA of the overall turbinate to the IT bone (intraturbinate ratio) were calculated. Results The interturbinate ratio of the bony turbinate CSA for the severe deviation group was significantly higher compared with other groups in anterior and middle segments (p < 0.0001). The intraturbinate ratio was highest in the posterior segment and lowest in the middle segments in compensatorily hypertrophied sides for all groups (p < 0.001). Conclusion Skeletal enlargement is prominent in anterior and middle thirds of CHIT in patients with pronounced septal deviation.

A reliable surface landmark for localizing supratrochlear artery: Medial canthus

OBJECTIVE: To determine the reliability of medial canthus as a surface landmark to locate supratrochlear vascular pedicle. STUDY DESIGN AND SETTING: The distance from medial canthal line to supratrochlear vascular pedicle was measured in 57 healthy volunteers (Doppler imaging study) and also in 15 fresh cadavers. RESULTS: In the Doppler study, the pedicle was found at most 3 mm lateral or medial to medial canthus (mean ± SD, 0.8 ± 0.7 mm). SVP mark tended to be medial to the medial canthus mark in females (males, 6; females, 42), whereas it was lateral to it in males (males, 20; females, 5). In the cadaver study, the pedicle was found 0.7 mm away from medial canthus on average. CONCLUSION: Medial canthus can be used as a reliable landmark for paramedian forehead flaps. When Doppler examination fails, pedicle may be found at most 3 mm away from medial canthus. SVP is more commonly located lateral to medial canthus in males and medial to it in females.

Correlation of symptoms with total IgE and specific IgE levels in patients presenting with allergic rhinitis

Objective: The objective of this study was to investigate the correlation of symptoms in patients with presumed allergic rhinitis on the basis of their medical history and physical examination with the levels of total immunoglobulin E (IgE) and specific IgE, and to question the necessity of these tests in diagnosis. Methods: The records of 295 patients, who had at least two complaints of nasal itching, nasal obstruction, runny discharge and sneezing, and/or presumed as allergic rhinitis on physical examination findings were retrospectively screened. The correlation between the levels of IgE, specific inhalant IgE, and food-specific serum IgE were evaluated in these patients. Results: A total of 70 cases (23.7%) were determined to have a total value of IgE under 20 U/ml, 113 cases (38.3%) with IgE values between 20 U/ml and 100 U/ml, and 100 cases with IgE values above 100 U/ml. Results of total IgE could not be obtained in 12 (4.06%) patients. Dermatophagoides farinae was the most common allergy in this group with 74 (68.5%) cases. Conclusions: The determination of IgE in allergic rhinitis is a supportive method. However, it cannot be recommended for routine use because of the time loss and high cost.

Could radiofrequency myringotomy be an alternative to incisional myringotomy

OBJECTIVE To evaluate the usefulness of radiofrequency myringotomy (RFM) and the closure time of the myringotomy site in comparison to incisional myringotomy (IM). METHODS We performed conventional surgical myringotomy on the right ears and RFM on the left ears of 40 rabbits. In order to investigate the effect of the power of energy delivered on the patency period we arranged the animals into two groups: three power grade in RFM group 1 (RFMg1; n: 20) and six power grade in RFM group 2 (RFMg2; n: 20). The follow-up of the myringotomy procedure was performed on days 5, 8, 11, 14 and 17 with examination under the operating microscope. RESULTS At the first examination on day 5 after the procedure, all IM openings were found to be closed while seven and eight (36 and 44%) of the tympanic membranes in the radiofrequency groups 1 and 2 remained open, respectively. In these remaining ears, RFM site was patent up to days 11 and 14, respectively in the two RFM groups. None of the RFMs was patent on study day 17. The difference between the closure time of myringotomy sites of the radiofrequency and IM groups was statistically significant (p < 0.05). In comparison of the two RFM groups, we found approximately equal rates regarding the myringotomy patency (p > 005; chi2 yates: 0.02). The complication rates were 5 and 2% for the IM and RFM groups, respectively. CONCLUSIONS Radiofrequency myringotomies last longer than incisional myringotomies. With the low complication rate, it is possible to perform this bloodless RF procedure in an office setting. Increased power grade of radiofrequency has no effect on prolonging the myringotomy patency. RFM appears to be a safe and simple procedure that can be used as an alternative to IM.

Evaluation of Nasal Mucociliary Functions with Rhinoscintigraphy in Coal Workers’ Pneumoconiosis

Objective: To compare nasal mucociliary clearance (NMC) functions in coal workers with pneumoconiosis, coal workers without pneumoconiosis and healthy controls by using technetium-99m-labeled macroaggregated albumin rhinoscintigraphy. Methods: Sixty-five of the 86 coal workers were clinically documented as suffering from coal workers’ pneumoconiosis (CWP group). CWP workers were divided into two groups according to smoking status: 44 smokers (CWP-S) and 21 nonsmokers (CWP-NS). Twenty-one workers without pneumoconiosis (NCWP group) were similarly divided into two groups: 12 smokers (NCWP-S) and 9 nonsmokers (NCWP-NS). Thirty-three healthy male volunteers were selected for the control group [15 smokers (control-S), 18 nonsmokers (control-NS)]. The half-time (t½) value for the clearance of the radiopharmaceutical was calculated for each patient. Results: Mean t½ values for CWP-S, CWP-NS, NCWP-S, NCWP-NS, control-S and control-NS were 25.10 ± 7.75, 10.97 ± 3.24, 14.68 ± 4.98, 9.17 ± 3.71, 19.15 ± 5.04 and 15.08 ± 5.11, respectively (p < 0.001, Kruskal-Wallis variance analysis). Further, mean t½ values of smokers versus nonsmokers in CWP, NCWP and control groups were compared, and it was found that although smoking prolonged nasal transport time in all three groups, the difference was significant only in the CWP group (p < 0.001, p < 0.023 and p < 0.027, respectively, Bonferroni-adjusted Mann-Whitney test). Conclusion: Our findings demonstrated a synergistic detrimental effect of smoking with coal dust exposure on nasal transport time.