Omer Erdur

Transoral surgery for an infant thyroglossal duct cyst

A 2-month-old female infant with respiratory distress, cyanosis and swallowing difficulties following birth was referred to our hospital by the pediatric clinic. Flexible fiber optic laryngoscopic examination of the patient revealed a red-purple smooth-surfaced mass inside the tongue base and vallecula. No additional features were identified by otorhinolaryngological examination. A 2-cm cystic mass located at the tongue base was identified by neck computed tomography (CT) imaging. The cystic mass was marsupialized transorally with the assistance of the da Vinci robotic surgery system (TORS) and histopathologically diagnosed as a thyroglossal duct cyst. Surgery was completed with TORS without complications and prolonged intubation was extubated carefully. No respiratory distress or other complications were observed. All symptoms were completely resolved with surgery and the patient was discharged on the third postoperative day. The patient is still undergoing follow-up and no recurrence has been observed up to the eighth post-operative month.

Is Metabolic Syndrome Associated with Obstructive Sleep Apnea in Obese Adolescents

OBJECTIVE To investigate whether there is an association between metabolic syndrome and obstructive sleep apnea syndrome (OSAS) in obese adolescents. METHODS In total, 240 pubertal children or prepubertal children older than 11 y recruited consecutively from the pediatric endocrinology unit, obesity clinic. Patients with tonsillar and adenoid hypertrophy (grade 3/4), systemic illnesses, or chronic drug usage were excluded. After anthropometric measurement and laboratory study, patients were divided into two groups according to metabolic syndrome (MS): MS and non-MS. Overnight polysomnographic evaluation was performed and 104 subjects were included for statistical analysis. The two groups were compared in terms of sleep efficiency, number of awakenings per night, oxygen desaturation index, snoring time, and obstructive/central/ mixed apnea-hypopnea index (AHI). RESULTS Of the obese adolescents, 51 had MS and 53 did not. The AHI was ≥ 1 in 25 of the 53 non-MS children (47.2%) and in 25 of the 51 MS children (49%). The median obstructive AHI value was 0.9 (0.2-2.4) and total AHI was 0.9 (0.2-2.5) in the MS group; these values were 0.9 (0.25-3.55) and 0.9 (0.3-3.55), respectively, in the non-MS group. Obstructive, central, mixed, and total AHI values in the MS and non-MS groups were not statistically significantly different (p > 0.05). CONCLUSIONS In our study, we did not find an association between MS and sleep apnea in obese adolescents.

Maxillary sinus volumes of patients with unilateral cleft lip and palate

BACKGROUND AND OBJECTIVE Studies about maxillary sinuses of cleft lip-palate patients have increased since sinusitis is commonly observed in these patients. It is evident that maxillary sinus will be morphologically affected in these patients. And anatomic differences may be a cause or at least a contributor of sinusitis. The aim of this study was to compare maxillary sinus volumes of the non-syndromic patients with unilateral cleft lip-palate and control group by using Cone-Beam computed tomography. METHODS Tomography scans of 44 unilateral cleft lip-palate patients (18 right and 26 left) with age and gender matched 45 control patients were evaluated for the study. The images used in the study were part of the diagnostic records collected due to dental treatment needs. All tomographs were obtained in supine position by using Cone-Beam computed tomography (NewTom 5G, QR, Verona, Italy). The patient-specific Hounsfield values were set to include the largest amount of voxels in the sinuses volume calculation individually. All data were measured in mm(3). RESULTS There was no statistically difference between the gender and age distributions of the groups. No statistically significant difference was found on the cleft and non-cleft side, the right and left side of the unilateral cleft lip-palate patients and the control group (P>0.05). For the inter group comparison, mean maxillary sinus volumes volume of unilateral cleft lip-palate patients (9894.55±4171.44mm(3)) was statistically smaller than the control group (11,977.90±4484.93mm(3)) (P<0.05). CONCLUSION Maxillary sinus volumes were effected negatively in unilateral cleft lip-palate patients when compared with the healthy control group. No difference was found on the cleft, non-cleft side and the right-left side of the unilateral cleft lip-palate patients.

The role of Onodi cells in sphenoiditis: results of multiplanar reconstruction of computed tomography scanning.

INTRODUCTION Onodi cells are the most posterior ethmoid air cells and extend superolateral to the sphenoid sinus. These cells are also intimately related with the sphenoid sinus, optic nerve, and carotid artery. Radiologic evaluation is mandatory to assess for anatomic variations before any treatment modalities related to the sphenoid sinus. OBJECTIVE To evaluate the effect of Onodi cells on the frequency of sphenoiditis. METHODS A retrospective analysis was performed in 618 adult patients who underwent high-resolution computed tomography between January 2013 and January 2015. The prevalence of Onodi cells and sphenoiditis was evaluated. Whether the presence of Onodi cells leads to an increase in the prevalence of sphenoiditis was investigated. RESULTS Onodi cell positivity was observed in 326 of 618 patients and its prevalence was found to be 52.7%. In the study group, 60.3% (n=73) were ipsilaterally (n=21) or bilaterally (n=52) Onodi-positive, whereas 39.7% (n=48) were Onodi-negative (n=35) or only contralaterally Onodi-positive (n=13). Of the control group, 48.3% (n=240) were Onodi-positive and 51.7% (n=257) were Onodi negative. The co-existence of Onodi cells ipsilaterally was observed to increase the identification of sphenoiditis 1.5-fold, and this finding was statistically significant (p<0.05). CONCLUSION The prevalence of sphenoiditis appears to be higher in patients with Onodi cells. However, it is not possible to state that Onodi cells are the single factor that causes this disease. Further studies are needed to investigate contributing factors related to sphenoiditis.

Surgical Management of Dysphagia Due to Anterior Cervical Osteophytes.

Purpose: The present study was performed to share personal experiences and to discuss the advantages and disadvantages of anterior cervical osteophytes surgical procedures. Methods: The operative records of anterior cervical osteophytes patients who did not benefit from conventional treatments and underwent osteophytectomy were analyzed retrospectively. Transoral and transcervical anterolateral methods were applied, considering both the localization of the osteophyte and the patients preference. Results: Five patients were operated with the transcervical anterolateral method, and 3 patients were operated with the transoral procedure. Those using the transcervical method were likely to encounter complications, however, being comfortable for patients. Although the transoral procedure is much safer, the patients may face postoperative pain, long healing time, and morbidities as hematoma, cervical instability, and infection after surgery. Conclusions: Both transcervical and transoral methods will improve the functional swallowing pathologies and decrease aspiration-penetration. Transoral approach is not recommended due to slow healing times and postoperative pain, although it creates easier access to the spine.

Large Frontoorbital Osteoma Causing Ptosis

Osteomas are the most frequent benign tumor of the paranasal sinuses. The commonest site is the frontal sinus but intraorbital extension of frontal osteoma is rare. Here, the authors report a 15-year-old adolescent boy who presented with left superior orbital rim swelling and ptosis. Waters radiography and computed tomographic scan revealed a bone density mass in the left frontal sinus with upper orbital wall extension. The tumor was removed via open eyebrow incision. The histopathologic evaluation was consistent with osteoma.

Permanent Quadriplegia Following Replacement of Voice Prosthesis

The authors presented a patient with quadriplegia caused by cervical spine abscess following voice prosthesis replacement. The authors present the first reported permanent quadriplegia patient caused by voice prosthesis replacement. The authors wanted to emphasize that life-threatening complications may be faced during the replacement of voice prosthesis. Care should be taken during the replacement of voice prosthesis and if some problems have been faced during the procedure patients must be followed closely.

Foreign Body of Submandibular Gland.

Obstructive adenitis is common disorder of submandibular gland. Sialolithiasis is the most common etiologic factor causing obstruction. If a sialolith is not detected, chronic obstruction of salivary glands is called nonspecific sialoadenitis. Foreign body-associated sialoadenitis of submandibular gland is very rare within the literature. In this study, the authors presented a patient having an unrecognized foreign body in the submandibular gland beside the duct that was causing chronic sialoadenitis. Foreign bodies must be explored and all suspected areas must be examined carefully for avoiding secondary problems and surgeries in the future.

Long-term follow-up of tonsillectomy efficacy in children with PFAPA syndrome

INTRODUCTION The role of tonsillectomy in the periodic fever, aphthous stomatitis, pharyngitis, and adenitis syndrome, is controversial. Although some studies reported high success rates with tonsillectomy, further investigations are needed with larger numbers of patients. OBJECTIVE To seek the long-term outcomes of tonsillectomy in periodic fever, aphthous stomatitis, pharyngitis, and adenitis syndrome. METHODS Case series; multi-center study. The study comprised 23 patients with periodic fever, aphthous stomatitis, pharyngitis, and adenitis syndrome who underwent surgery (tonsillectomy with or without adenoidectomy) between January 2009 and November 2014. RESULTS 21 (91%) of 23 patients had complete resolution immediately after surgery. One patient had an attack 24h after surgery, but has had no further attacks. One patient had three attacks with various intervals, and complete remission was observed after 3 months. CONCLUSIONS Tonsillectomy is a good option for the treatment of periodic fever, aphthous stomatitis, pharyngitis, and adenitis syndrome.

Feasibility of endoscopic submandibular ganglion neurectomy for drooling

We performed endoscopic transoral neurectomy of the submandibular and sublingual glands to treat drooling. We bilaterally operated two adult cases with treatment‐resistant drooling. In these patients, conventional treatment had failed. Repeated botilinum toxin type A (BOTOX®, Abdi Ibrahim Pharmaceutical Company, Istanbul, Turkey) injections had been effective but were becoming less so. The patients benefited from surgery in that their saliva scores decreased. No issue emerged over 6 months of follow‐up. Endoscopic transoral neurectomy of the submandibular and sublingual glands reduces saliva production and allows management of drooling in treatment‐resistant patients. Laryngoscope, 127:1604–1607, 2017