Mehmet Ali Babademez

Low-Temperature Bipolar Radiofrequency Ablation (Coblation) of the Tongue Base for Supine-Position-Associated Obstructive Sleep Apnea

Objective: To assess the effectiveness of low-temperature bipolar radiofrequency ablation for Coblation of the tongue base in the multilevel management of supine-position-associated obstructive sleep apnea syndrome (OSAS). Study Design and Setting: A retrospective analysis of the data of 16 subjects undergoing uvulopalatopharyngoplasty and tongue base Coblation. The efficacy of the procedure was investigated on the basis of polysomnographic results. Results: The success rate was 62.5% in 16 patients who underwent surgery for OSAS, with decreases in the mean Apnea Hypopnea Index of 20.1–8.9. The success rate was separately evaluated according to the subjects’ posture. A rate of 87.5% was found for the supine position, while the rate was 56.6% in non-supine positions. The minimum postoperative O2 saturation was significantly increased for REM and non-REM stage 3 sleep rates. Conclusion: It is important to evaluate the relation of the disease to the body position in sleep apnea subjects. Coblation of the tongue base is an applicable method of therapy for patients who have sleep apnea that is more marked in the supine position.

Comparison of Minimally Invasive Techniques in Tongue Base Surgery in Patients with Obstructive Sleep Apnea

Objective. To compare the effectiveness and morbidity of 3 microinvasive tongue base surgical procedures combined with uvulopalatopharyngoplasty (UPPP) in supine-dependent obstructive sleep apnea (OSA) patients. Study Design. A prospective, randomized clinical study. Setting. A tertiary referral center. Methods. Fifty OSA patients were randomly advised to undergo UPPP combined with low-temperature bipolar radiofrequency (group 1), submucosal minimally invasive lingual excision with radiofrequency (SMILE-R; group 2), or submucosal minimally invasive lingual excision with a harmonic scalpel (SMILE-H; group 3). The Epworth Sleepiness Scale, the visual analog scale (VAS) for snoring, the pre- and postoperative 3-month polysomnography (PSG) findings, and the decrease in tongue volume using magnetic resonance imaging (MRI) were compared. The operation times, the postoperative pain VAS score, the analgesic requirement, and the time in commencing a normal diet were compared in the 3 groups. Results. The decrease in apnea-hypopnea index (AHI) and supine AHI values at the postoperative 3-month time point was significant in group 2 (P < .05). The decrease in tongue volume at the 3-month postoperative time point according to the MRI evaluations was higher in groups 1 and 2 (P < .05). In the subjective comparison of effectiveness, there was no significant difference. The operation time was significantly lower in group 3. In the assessment of postoperative pain, no significant difference was found between the groups. Conclusion. When the PSG findings and MRI were evaluated, UPPP + SMILE-R were found to be more effective. No significant difference was found between the 3 techniques when morbidity and complications were compared.

Comparison of radiofrequency ablation, laser and coblator techniques in reduction of tonsil size.

Abstract Conclusions: Coblation was seen to be a much safer method for tonsil reduction surgery with less morbidity and with a higher efficacy in early and long-term follow-up. Objective: The objective was to compare the efficacy, morbidity and safety of three techniques for reduction of tonsil size in tonsillar hypertrophy in children. Methods: This was a prospective, randomized clinical study. Seventy-nine children aged 4–13 years with symptoms of tonsillar hypertrophy were included in the study. They were randomized to the coblator (group A), laser tonsillotomy (group B) or radiofrequency (group C) technique for tonsil reduction. The efficacy was evaluated by assessing tonsillar size after surgery. Morbidity was evauated by assessing by postoperative pain and return to normal diet and activity. Results: Pain on the first day was significantly higher for children in group B (p = 0.0001). The mean values for analgesic usage and number of days until return to normal diet and normal activity were lower in group A. At 1-year postoperative follow-up, the mean tonsil size was higher in group C (p < 0.05). None of the children in group A, two of the children (8.3%) in group B and six of the children (21.4%) in group C need reoperation for tonsillary hypertrophy.

Anomalous relationship of the retromandibular vein to the facial nerve as a potential risk factor for facial nerve injury during parotidectomy.

Finding and protecting the facial nerve are a challenge for the surgeon performing parotid surgery. The abnormal relationship between the retromandibular vein and facial nerve and its branches may increase the risk of facial nerve injury during surgery. In this clinical report, we have reported a 41-year-old female patient with pleomorphic adenoma undergoing superficial parotidectomy, and we have discussed a new variation of facial nerve-retromandibular vein relationship.

Anomalous relationship of coexisting ipsilateral recurrent and nonrecurrent inferior laryngeal nerves during thyroid surgery.

One of the most important complications of thyroid surgery is inferior laryngeal nerve injury. Variations of inferior laryngeal nerve may increase the risk of iatrogenic injury. Coexistence of ipsilateral nonrecurrent laryngeal nerve and recurrent laryngeal nerve is a very rare variation, and sufficient data are not available on the anatomical and functional relationship of the 2 branches and probable clinical outcomes resulting from the injury of one of them. Herein, we present a case with coexistence of nonrecurrent laryngeal nerve and ipsilateral recurrent laryngeal nerve and discuss the clinical importance of this rare variation.

A rare cause of obstructive sleep apnea syndrome: lingual thyroid

Thyroid tissue descends to its normal pretracheal location on the seventh week of fetal life via the thyroglossal duct connected to the tongue base from the foramen cecum from which it originates during embryological development. Ectopic thyroid tissue develops as the result of exposure of thyroid tissue totally or partially to a defective descent related to the embryological defect of the tongue base. Lingual thyroid is the most common location of ectopic thyroid tissue and often located on the juncture of the buccal and pharyngeal parts of the tongue [1]. While 90% of ectopic thyroid tissues are seen on the tongue, they have also been reported in sublingual, submandibular, prelaryngeal, tracheal, mediastinal, cardiac, esophageal, diaphragmatic, and peripharyngeal sites. Although the prevalence of lingual thyroid has been reported between 1:100,000 and 1:300,000, its incidence among patients in whom hypothyroidism has been detected is between 1:4,000 and 1:10,000. It is seen at a 7-fold greater frequency in women [2]. Although the patients are usually asymptomatic, it can lead to symptoms such as dysphonia, dysphagia, and sensation of foreign body in the throat, or it can mimic a lingual tumor [2, 3]. Obstructive sleep apnea syndrome (OSAS) is an important clinical condition resulting from anatomical narrowings developing in the upper respiratory tract during sleep, affecting the quality of life substantially, leading to serious complications. Herein, we present a 24-year-old male patient with OSAS caused by lingual thyroid, and along with this rare case, we discuss the clinical features of lingual thyroid, imaging methods, and therapeutic approaches.

The effect of oral isotretinoin (13-cis retinoic acid) on hearing systems in patients with acne vulgaris: a prospective study.

Isotretinoin is widely used in the treatment of extensive and nodulocystic acne. The objective of this prospective study was to investigate whether oral isotretinoin could affect the hearing system. Thirty‐eight patients with acne vulgaris (76 ears) who were diagnosed and treated at the Department of Dermatology were included in the current study. Study evaluation visits were performed at baseline and at Weeks 1, 2 and 3. Pure‐tone averages (PTAs) of air conduction thresholds at 250 Hz (PTA1); 500, 1000, and 2000 Hz (PTA2); 4000, 8000, and 10, 000 Hz (PTA3); and 12, 500, 16, 000, 18, 000 and 20, 000 Hz (PTA4) for each ear were calculated separately. Assessment of the efficacy was based on the audiometric findings. Compared with pre‐treatment evaluation, the PTAs of patients were found to be significantly different at the first week for PTA2 (P = 0.033) and PTA3 (P = 0.001), at the second week for PTA1 (P = 0.036), and at the third week for PTA4 (P = 0.002). Our results suggest that the oral isotretinoin (13‐cis retinoic acid), which is a derivative of retinol (vitamin A), improved the hearing level of the patients in all audiometric frequencies in a short‐period follow‐up.

A rare presentation of mucocele of the tongue.

To the Editor: A previously healthy 37-year-old woman presented with a 3-month history of progressive dysphagia. She had no tobacco or alcohol consumption. No systemic problems were noted as well. In clinical examination, a painless tense, well-defined swelling, 2 cm in diameter, was localized on the tongue root. The lesion extended to the posterior plica (Fig. 1). The lesion was surgically removed under general anesthesia and submitted for histopathologic analysis. The cyst wall was quite thin, and the surface was smooth. Pale yellow viscous fluid was collected from the cyst cavity. Microscopic examination showed a cystic lesion filled with mucin and lined with mucinous epithelium, which was consistent with a mucocele (Fig. 2). In our case, the treatment was simple surgical excision without further treatment. Mucous retention cysts are common oral mucosal lesions originating from damage of minor salivary glands. The extravasation of mucus due to physical trauma is the primary cause of mucocele formation. It may also be seen in cases of nicotinic stomatitis, in which irritation from heat and noxious tobacco products can lead to narrowing of the ductal openings. Mucous retention cyst clinically presents as a discrete, more or less soft, nonpainful swelling of the mucosa. Discomfort, interference with speech, mastication and swallowing abnormality, and external swelling depend on size and location. Usually, mucous retention cysts form below the basal membrane or in connective tissue. Mucous retention cysts are more common in patients younger than 30 years and occur in both men and women. The lesion has no sex predilection. The most common locations are lower labial mucosa, but mucoceles may develop at virtually any location where minor salivary glands exist, including the soft palate, retromolar region, and buccal mucosa; nevertheless, the dorsal surface of the tongue is quite a rare location. We report a case of mucous retention cyst with an unusual location. To the best of our knowledge, this lesion has not been previously described in the dorsal surface of the tongue. Baran Acar, MD Emre Günbey, MD Mehmet Ali Babademez, MD Hayriye Karabulut, MD Department of Otorhinolaryngology Kecioren Training and Research Hospital Ankara, Turkey emregunbeymd@hotmail.com

Oral Flurbiprofen Spray for Posttonsillectomy Pain.

Objective Tonsillectomy is still one of the most common surgical procedures, but there exists no standard guideline for pain management after tonsillectomy. Our aim is to determine whether oral spray of flurbiprofen reduces pain and has an influence on other morbid outcomes following tonsillectomy. Study Design Prospective, double-blind, randomized, placebo controlled. Setting Patients at Ataturk Training and Research Hospital, Ankara, Turkey. Subjects and Methods This study was performed on 84 patients (45 in flurbiprofen group, 39 in placebo group) who underwent tonsillectomy. The patients were randomly chosen, and each used oral spray of flurbiprofen 3 times daily or placebo solution at the same regimen. Efficacy was assessed by changes in Numeric Pain Rating Scale. Data were collected at postoperative days 1, 3, 5, and 7 for pain, bleeding, and healing. Data for Mallampati scores were also collected. Results There were no significant difference between groups with respect to the demographic data. The flurbiprofen group had statistically significant lower pain scores at days 1, 3, 5, and 7 (P = .000, P = .002, P = .001, P = .000, respectively). On days 3 and 7, pain scores were significantly different between different Mallampati groups (P = .049, P = .015, respectively). The flurbiprofen group required less analgesic than the placebo group during the study period on days 1, 3, 5, and 7 (P = .001, P = .001, P = .03, P = .001, respectively). Healing and side effects were not significantly different between the groups. Conclusion In this study, topical use of flurbiprofen may reduce posttonsillectomy pain without any evidence of additional complications.

Allergic rhinitis (AR) in geriatric patients

Allergic rhinitis (AR) can be defined as an inflammatory disease of the nose and the paranasal sinuses, characterized by a specific IgE-mediated hypersensitivity reaction. The aim of this study was to evaluate the correlation between the symptoms of AR and the prick test results in geriatric patients presenting with symptoms of AR by comparing these with those of a young control group. Thirty-two geriatric patients (Group 1) were analyzed retrospectively, and 37 patients (Group 2) were selected as the control group. Diagnosis of AR was made based upon the physical examination findings, nasal endoscopic examination findings and the skin prick test results. While the skin prick test positivity was 50% in Group 1, this rate was found as 75.7% in Group 2. The difference was found to be statistically significant (p=0.044). A statistically significant difference was found between the two groups in terms of susceptibility to mugwort pollen and fish (p=0.048, p=0.033). In conclusion, in geriatric patients presenting with AR symptoms, systemic treatment should not be initiated before performing skin prick test, due to the adverse effects of the drugs.