Mehmet Aslan

Endoscopic versus microscopic approach to type 1 tympanoplasty in children

OBJECTIVES We investigated the outcomes of the endoscopic versus microscopic approach to type 1 tympanoplasty in pediatric patients. METHODS In this retrospective study, the outcomes of 61 ears of 60 pediatric patients (33 male and 27 female) who underwent type 1 tympanoplasty were evaluated. One patient underwent a bilateral operation. The age range of the patients was 7-16 years. Group 1 underwent tympanoplasty with an endoscopic technique (n=32), and Group 2 underwent tympanoplasty with the conventional microscopic technique (n=29). A boomerang-shaped chondroperichondrial graft was used in both groups. The outcomes were analyzed in terms of the hearing gain, duration of surgery, and graft success rate. RESULTS In both groups, the postoperative air-bone gap (ABG) was significantly lower than the preoperative ABG. There were no significant differences between the preoperative and postoperative ABG values (in dB) in either group. The mean operative duration in Group 1 was significantly lower than that in Group 2 (51.37 vs. 67.03 min, respectively). In the preoperative evaluation, 65.6% of patients in Group 1 had larger perforations and 34.4% had smaller perforations. In Group 2, 58.6% and 41.3% of patients had larger and smaller perforations, respectively. Perforations were detected in two (6.25%), four (12.50%), and four (12.50%) of the patients in Group 1 at postoperative months 1, 6, and 12, respectively. Perforations were detected in two (5.71%) patients in Group 2 at postoperative months 1, 6, and 12. At 12 months postoperatively, there were smaller perforations in four (12.5%) of the children in Group 1 and in two (5.71%) of the children in Group 2. The difference between the perforation conditions (larger vs. smaller) was not significant in either group. The preoperative and postoperative increases in the ABG were associated. The operative duration was shorter in Group 1 than in Group 2. CONCLUSION In pediatric patients undergoing type 1 tympanoplasty, especially if the external ear canal is narrow and the anterior canal wall is prominent, the endoscopic and microscopic approaches appear to give equal results in terms of easy visualization of the entire tympanic membrane and no requirement for extra intervention to evaluate the ossicular system. A shorter operative duration is an advantage of the endoscopic tympanoplasty technique.

Congenital hairy polyp of the soft palate.

Hairy polyp is an unusual developmental malformation that is most frequently seen as a pedunculated tumor in the neonate. They are benign lesions containing elements of both ectodermal and mesodermal origin. The symptoms of hairy polyps relate both to their location and their size. Larger lesions produce symptoms due to feeding difficulties and airway obstruction while smaller lesions cause intermittent symptoms resulting from a ball-valve type of obstruction. We present two cases of a soft palate hairy polyp causing respiratory and feeding difficulties and review the literature.

Schwannoma of the hard palate.

About half of all neurogenic tumors are seen in the head and neck region. The types of neurogenic tumors must be distinguished. Schwannomas originate from Schwann cells of the neural sheath and are solitary, well-encapsulated, slow-growing adjacent to the parental nerve but extrinsic to the nerve fascicles.Approximately 25% to 45% of all schwannomas are seen in the head and neck region and are found rarely in the oral cavity. Most of the intraoral schwannomas are located in the tongue. Other less common locations are the buccal mucosa, palate, base of the mouth, gingiva, and lips.In this study, we report a rare case of schwannoma of the hard palate, which was excised intraorally.

Bipolar cautery tonsillectomy using different energy doses: Pain and bleeding

OBJECTIVE Tonsillectomies are the most frequently applied operations in the ENT practice. Even though different surgical tonsillectomy techniques have been used, bipolar cautery is the most frequently used one. Our aim was to compare postoperative bleeding rates, pain scores and recovery times in tonsillectomies performed by using bipolar cautery in Joules (1Watt·sec or Ws) calculated by multiplying Watts by the duration of cauterization. METHODS Adenotonsillectomy and tonsillectomy patients, admitted to the Department of otorhinolaryngology of Izmir Ataturk Training and Research Hospital and Mardin State Hospital, between January 2007 and December 2012 constituted the study group prospectively. The patients divided into 4 groups due to the energy they exposed. RESULTS Patients in Group 1 recovered most rapidly (mean recovery time, 13.9 ± 1.8 days). Statistically significant results were obtained between Groups 1 and 4 and also Groups 2 and 4 when recovery times of the patient groups were evaluated with Bonferroni correction test. CONCLUSION As a result, for hemostatic control, electrocauterization should be used at lower doses and short-term as possible so as to decrease frequency of bleeding episodes, alleviate postoperative pain and accelerate wound healing.

Inflammatory myofibroblastic tumor of the parotid gland.

An inflammatory myofibroblastic tumor, previously known as an inflammatory pseudotumor, is an uncommon neoplasm. This tumor, which has characteristic morphologic and immunohistochemical features, is mostly seen in the lung. We present a rare case of an inflammatory myofibroblastic pseudotumor of the parotid gland. A 45-year-old woman presented with a 4-month history of a swelling in her right parotid region. A partial parotidectomy with preservation of the facial nerve branches was performed. The incidence of inflammatory myofibroblastic tumor in the parotid gland is low, and local resection is currently the best treatment. A prolonged postoperative follow-up period is necessary for patients with inflammatory myofibroblastic tumor. Inflammatory myofibroblastic tumor of the parotid gland is discussed with a brief literature review.

Surgical success of boomerang-shaped chondroperichondrial graft in pediatric chronic otitis media cases

OBJECTIVES To reveal the success of boomerang-shaped chondroperichondrial graft (BSCPG) in pediatric chronic otitis media cases. METHODS A total of 43 pediatric patients (age 7-16 years) who had undergone type 1 tympanoplasty with the diagnosis of chronic otitis media between March 2010 and March 2013 were included in this retrospective study. The main outcome measures were the graft success rate and level of hearing improvement. RESULTS Graft intake success rate was 90.7%. Mean preoperative and postoperative air-bone gap values were 20.51 ± 4.34 dB SPL and 9.32 ± 5.64 dB SPL, respectively (p < 0.001). Mean preoperative and postoperative pure tone average values were 28.6 ± 3.52 and 12.24 ± 5.22 respectively (p < 0.001). Air-bone gap was improved to ≤ 10 dB in 38 (88.37%) patients during the postoperative period. CONCLUSIONS Boomerang-shaped chondroperichondrial grafting technique seems to be a successful alternative in the management of pediatric chronic otitis media cases. It has relatively higher grade graft success rate.

Aneurysmal bone cysts clinically mimicking a parotid gland mass.

choroid prolapsus. On her clinical follow-up, opacification of the cornea and the phthisis bulbi and an upper eyelid defect were detected. Then, the patient was referred to Plastic, Reconstructive, and Aesthetic Surgery Clinic for eyelid reconstruction 3 weeks later. We determined one-third lateral skin defect of the left upper eyelid extending from the eyebrow to the rim including the eyelashes. She had also healed lacerations and scars around the left eyebrow (Fig. 1). Because there were just healed tissues around the left eyebrow, a superior pedicled random flap harvested from the malar region was used for reconstruction. Because the eyelid mucosa was intact, there was no need for mucosal graft. It was assumed that refined vinegars do not contain some important nutrients that has healing attributes; traditional vinegar production is common in village areas. A shallow and wide-mouthed jar is selected to increase the contact surface. Half of the jar is filled with squeezed fruit juice and closed with a cheesecloth to allow airconditioning. Process is continued by tasting daily to arrange the taste and acidity of the vinegar until the smell of the vinegar starts. Chemically, vinegar production is carried out in 2 stages. In the first stage, the yeast anaerobically converts the fruit sugar to ethanol. In the second stage, ethanol is converted to acetic acid by Acinetobacter and Gluconobacter (called vinegar bacteria) aerobically. Carbon dioxide is released in both stages. Formation of vinegar is called an acetic acid fermentation (Fig. 2). There are 2 very important issues in making vinegar: appropriate temperature (15-CY25-C) and oxygen that is very is essential for the vinegar bacteria to work effectively. In this case, sealing the bottle have cut off the access to oxygen and led to the accumulation of the released carbon dioxide as well (Fig. 3). Carbon dioxide was continuously trapped in the bottle and resulted in the explosion of the bottle. These patients are not seen in plastic surgery clinics often. We especially report this case to draw attention of plastic surgeons and create awareness about this serious injury. We think public must be knowledgeable about its danger and must be taught by authorized people on how to do homemade vinegar.