Murat Karaman

Cartilage reinforcement tympanoplasty: otological and audiological results

Abstract Conclusion: High risk perforations including total, subtotal, atelectatic perforations, those with cholesteatoma and revision cases can be treated efficiently with cartilage reinforcement tympanoplasty. Objective: The purpose of this study was to describe the perforation closure rates and hearing results of cartilage reinforcement tympanoplasty. Methods: This was a retrospective chart review and included 60 patients who underwent surgery with the cartilage reinforcement technique between November 2006 and October 2008 at the Department of Otorhinolaryngology of Haydarpasa Numune Research and Training Hospital, Istanbul, Turkey. The male to female ratio was 28 (46.7%)/32 (53.3%). The mean age of the patients was 30.10 ± 11.50 years (range 13–55). Results: Preoperatively, only one patient had a retraction pocket but not a perforation, 12 (20%) patients had perforation of < 25% of the total tympanic membrane diameter, 12 patients had perforation between 25% and 50% of the total membrane diameter, 18 patients had a perforation between 50% and 75% of total membrane diameter and 17 patients had a perforation of > 75% of the total membrane diameter. Postoperatively we achieved total closure of tympanic membrane perforations for 47 patients but the perforations of 13 patients remained in various sizes (7 patients had tympanic membrane perforation < 25% of the total membrane diameter, 3 between 25% and 50%, 2 between 50% and 75% and 1 patient had a perforation > 75% of the total membrane diameter). There was a statistically significant difference between percentages of preoperative perforation and postoperative perforations (p = 0.001). Only 1.7% of patients had no perforation preoperatively and this ratio increased to 78.3% postoperatively. Also, 30% of patients had a perforation between 50% and 75% of the total membrane diameter, 28.3% of the patients had a perforation > 75% of the total membrane diameter preoperatively and this ratio decreased to 3.3% and 1.7%, respectively. Concerning the audiological parameters, the difference between preoperative and postoperative hearing levels was statistically significant (p = 0.001).

Effect of functional neck dissection and postoperative radiotherapy on the spinal accessory nerve

Conclusions. We encountered shoulder syndrome after functional neck dissection (FND) less frequently than reported in the literature. This technique is a favorable treatment choice for appropriately selected patients with head and neck cancer with cervical metastasis. It depends on careful dissection of neurovascular tissues during surgery and preserved shoulder function due to chronic neurological degeneration caused by surgery. Also, radiotherapy has an evident negative effect on the accessory nerve. Objectives. To perform postoperative electrophysiological tests on the spinal accessory nerve (SAN) after FND and postoperative radiotherapy. Subjects and methods. A study group of 16patients with head and neck cancer who underwent 22FNDs and 10volunteers in the control group were evaluated. The SAN latency and amplitude were measured and then upper trapezius muscle electromyography (EMG) was performed on all the patients and the volunteers. Results. The EMG results of the study group revealed 19cases with normal findings, 1 with total and 2 with partial axonal degeneration. The amplitude levels of the SAN in the study group showed statistically significant decrease when compared with the control group. The latency levels of the SAN in the four patients who received postoperative radiotherapy were significantly longer than those in cases who did not receive this therapy.

Amniotic membrane covering for facial nerve repair

Amniotic membranes have been widely used in ophthalmology and skin injury repair because of their anti-inflammatory properties. In this study, we measured therapeutic efficacy and determined if amniotic membranes could be used for facial nerve repair. The facial nerves of eight rats were dissected and end-to-end anastomosis was performed. Amniotic membranes were covered on the anastomosis sites in four rats. Electromyography results showed that, at the end of the 3rd and 8th weeks after amniotic membrane covering, the latency values of the facial nerves covered by amniotic membranes were significantly shortened and the amplitude values were significantly increased. Compared with simple facial nerve anastomosis, after histopathological examination, facial nerve anastomosed with amniotic membrane showed better continuity, milder inflammatory reactions, and more satisfactory nerve conduction. These findings suggest that amniotic membrane covering has great potential in facial nerve repair.

Functional capacity of the thyroid autograft and heterograft: An experimental study

The aim of this study was to investigate the functional capacity of thyroid autografts/heterografts in a guinea pig model.

Analysis and comparison of changing in thyroid hormones after percutaneous and surgical tracheotomy

OBJECTIVES To evaluate the effect of the surgical and percutaneous tracheotomy on the thyroid hormones and their comparisons. MATERIALS AND METHODS Between January and May 2010, the surgical and percutaneous tracheotomy had been performed on 40 patients with respiration problems. The thyroid hormone levels were measured just before, after one and three hour of the operation and than these measurements were compared statistically. RESULTS The effect of the surgical and percutaneous tracheotomy on serum thyroglobulin (TG), free thyroxine (fT4), free triiodothyronine (fT3) and thyroid stimulating hormone (TSH) levels was found statistically significant. CONCLUSIONS The surgeons should not forget the possible increase of the serum thyroid hormone levels after the surgical and percutaneous tracheotomy because of the systemic effects of thyroid hormones. The patients, especially who have cardiac rhythm problems, should be monitored for a while after these processes because the increase of serum thyroid hormones may cause undesired cardiovascular effects.

Coincidence of conchachoanal polyp and complete mulberry hypertrophy of inferior concha.

We report two unique cases of 50‐ and 28‐year‐old Turkish men with coincidence of conchachoanal polyp and mulberry hypertrophy of the inferior concha. We operated on both cases with endoscopic stripping of the polypoid tissue while preserving the periosteum and healthy mucosa of the inferior nasal concha. The polypoid tile of the left inferior nasal concha was resected in the case with mulberry hypertrophy at only the tail of the concha. Both cases reported significant relief of symptoms after the operations. Laryngoscope, 2009

Comparison of radiofrequency and transoral robotic surgery in obstructive sleep apnea syndrome treatment

Abstract Introduction: Radiofrequency tissue ablation (RFTA) and transoral robotic surgery (TORS) are the methods used in OSAS surgery. We also aimed to compare the advantages and disadvantages of RF and TORS as treatment methods applied in OSAS patients in terms of many parameters, especially apnea hypopnea index (AHI). Materials and methods: Patients were classified by performing a detailed examination and evaluation before surgery. 20 patients treated with anterior palatoplasty and uvulectomy −/+ tonsillectomy + RFTA (17 males, 3 females) and 20 patients treated with anterior palatoplasty and uvulectomy −/+  tonsillectomy + TORS (16 males, 4 females) were included in the study. PSG was performed preoperatively and postoperatively in all patients and Epworth sleepiness questionnaire was applied. All operations were performed by the same surgeon and these surgical methods -RF and TORS- were compared in terms of many parameters. Results: When the patients treated with RF and TORS were compared in operation time, length of hospitalization and duration of transition to oral feeding; all parameters were significantly greater in the patients treated with TORS. Conclusions: TORS technique was found to be more successful than RF in terms of reduction of AHI value, correcting minimum arterial oxygen saturation value and decreasing Epworth Sleepiness Scale score.

Circulating Vascular Endothelial Growth Factor and Vascular Cell Adhesion Molecule in Laryngeal Squamous Cell Carcinomas

Objective : To assess the relationship between the immunohistochemical expression of vascular endothelial growth factor (VEGF) and vascular cell adhesion molecule (VCAM) with the clinical feature of laryngeal squamous cell carcinoma (LSCC). Study Design and Methods : Twenty-nine patients with LSCC were examined as the LSCC group. Twenty-one healthy people who showed no signs of regional or systemic disorders were used as the control group. The staging system for LSCC was determined using American Joint Committee on Cancer (AJCC) 2010 criteria. A quantitative enzyme-linked immunosorbent assay (ELISA) was performed to measure the concentration of soluble serum VEGF and VCAM-1. Results : VEGF levels were higher in the LSCC group compared to the control group (p = 0.001). VCAM levels were not significantly different (p = 0.617). VEGF levels were not correlated to the T and N stage in the LSCC group (p = 0.402). VCAM levels were significantly correlated with the T and N stage (p < 0.0001). Conclusions : VCAM levels could not be used as a tumor marker for diagnosis but were correlated with the stage and, therefore, the aggressivity of the cancer disease.