Omer Karakoc

The many faces of fungal disease of the paranasal sinuses: CT and MRI findings.

The prevalence of fungal rhinosinusitis has increased worldwide over the last two decades. Fungal rhinosinusitis includes a wide variety of infections, from relatively innocent to rapidly fatal processes. Fungal infection may be one of the most challenging forms of sinonasal pathology to manage, especially the invasive forms, which have high mortality rates. Therefore, it is essential to correctly diagnose and classify fungal disease of paranasal sinuses in order to accurately predict prognosis and implement effective therapy. This essay describes the different manifestations of fungal sinusitis on computed tomography and magnetic resonance imaging to optimize differentiation, and includes correlation with the pathologic classifications.

The upper airway evaluation of habitual snorers and obstructive sleep apnea patients.

Objective: To investigate the relationship between the Apnea Hypopnea Index (AHI) and upper airway examination findings of habitual snorers and obstructive sleep apnea (OSA) patients. Materials and Methods: This study included 264 patients whose tonsils were evaluated in 4 grades. The Mallampati classification was used to determine the relationship between tongue and palate. All patients performed the Müller maneuver in a sitting position. The Fujita classification was used to define the type of obstruction. All patients had polysomnography and were divided into 4 groups according to AHI. Statistical analysis was performed to evaluate the relationship between examination findings and AHI. Results: Of the patients, 133 (50.4%) were habitual snorers, 66 (25%) were mild OSA, 40 (15.2%) were moderate OSA and 25 (9.5%) were severe OSA patients. There was a positive correlation between neck circumference, BMI and AHI in males (p < 0.001). There was a significant difference between patient groups according to Mallampati classification, collapse at the velopharyngeal level and hypopharyngeal level and Fujita classification (all p < 0.001). There were significant relationships between tonsil size, Fujita classification, Mallampati classification, collapse ratios and AHI. Conclusion: We saw that hypopharyngeal area often contributes to obstruction and some examination methods correlate more with AHI. This can aid sleep physicians in the evaluation of OSA patients.

Nasalance scores for normal-speaking Turkish population.

ObjectiveThe aim of this study was to obtain normative nasalance scores for adult and children subjects speaking Turkish language and obtain a reference for normality when nasality is evaluated. MethodsMean nasalance scores were obtained from 35 normal-speaking children aged 7 to 13 years, and 125 adults aged 18 to 69 years during the repetition of 3 nasalance passages that were categorized according to the amount of nasal consonants (oral, oronasal, and nasal passages). The Nasometer (model 6400) was used to obtain nasalance scores for the 3 reading passages. ResultsGroup mean ± SD nasalance scores of children for oral passage, oronasal passage, and nasal passage were 15.14 ± 4.81, 37.76 ± 4.42, and 49.23 ± 6.95, respectively. Nasalance scores for the adult group were 13.46 ± 6.26, 37.84 ± 6.13, and 50.28 ± 7.77, respectively. There were significant differences in mean nasalance scores for oral versus nasal materials both for children and adult groups. ConclusionsThe present study provides normative nasalance scores for Turkish-speaking children and adults. The results indicated acceptable differentiation between oral and nasal materials.

SUBMANDIBULAR TRIANGLE MASSES

Objective The study aims to analyze the demographic data of a large case series operated on because of submandibular triangle mass for more than 10 years and presents a review of the literature. Materials and Methods The charts of patients who underwent surgical intervention for submandibular triangle mass between January 2000 and November 2010 were reviewed. The medical history, age, sex, duration of symptoms, clinical presentation, preoperative investigations, and histopathologic diagnosis were reviewed. Results The study included 66 subjects; 12 patients (18.2%) with submandibular sialolithiasis, 18 patients (27.2%) with sialadenitis, 10 patients with lymphadenitis (15.1%), and 26 patients (39.3%) with tumors. Of the tumors, 23% was malignant and 77% was benign. Benign tumors of submandibular gland comprised 22.7% and malign tumors of submandibular gland comprised 3% of all submandibular mass. The most common benign tumor was pleomorphic adenoma. The most frequent histopathologic diagnoses of submandibular masses originated from the submandibular gland, and these comprised 71.2% of all submandibular mass pathologies. The main symptom was a painless mass. Ultrasonography was the most common preoperative diagnostic procedure. Fine-needle aspiration biopsy was performed in 26 patients. A clear diagnosis could not be provided in 3 (12%) patients. Conclusion Infectious conditions and benign tumors are more frequent than malign tumors in the submandibular region. The histopathologic diagnoses mainly consisted of submandibular sialadenitis, sialolithiasis, pleomorphic adenoma, and lymphadenitis. Ultrasonography is the first option of radiologic evaluation. Fine-needle aspiration biopsy is a very useful and usually sufficient diagnostic procedure for histopathologic diagnosis. Excisional biopsy can be performed when the fine-needle aspiration biopsy failed.

Synchronous ossifying fibromas of the jaws: a review

According to the World Health Organization, it is proposed that benign fibro-osseous lesions be divided into 3 categories, including fibrous dysplasia, ossifying fibroma (OF), and osseous dysplasia. OF arises from the periodontal ligament, which contains multipotential cells. These benign tumors may become large and aggressive. Slow growth and lack of symptoms are the cardinal features. OF tends to occur in the second and third decades of life, with predilection for women and for the mandibular premolar-molar area. The method of treatment used for large or rapidly expanding lesions is surgical removal (enucleation). Rarely, OFs occur multifocally. We report a 20-year-old man with synchronous OFs of his maxilla and mandible and review other synchronous cases reported. Such lesions can be properly diagnosed and treated by correlating radiographic, clinical, surgical, and histopathologic findings.

Minor salivary gland neoplasms.

ObjectiveThis study aimed to investigate the clinical presentation, histopathologic and epidemiological aspects, as well as the treatment modalities and outcomes of patients with minor salivary gland tumors (MSGTs). Subjects and MethodsA series of 23 patients with MSGTs were reviewed retrospectively. ResultsThis study included 11 (48%) benign and 12 (52%) malignant tumors of minor salivary glands. Minor salivary gland tumors were more common in men (70%) than in women (30%). The mean age was 31.3 years for benign tumors and 46.3 years for malignant tumors. Pleomorphic adenoma was the most common benign tumor, followed by myoepithelioma. Mucoepidermoid carcinoma and adenoid cystic carcinoma were the most common malignant tumors. The most common symptom was a painless mass of the palate. Surgical treatment was performed in all patients. Adjuvant radiotherapy was used in 3 malignant tumors. Twenty-three patients were followed-up for a median of 5 years. Two patients with malignant tumors underwent a second surgery for postoperative local recurrence. They were successfully treated with the second surgery. ConclusionsMinor salivary gland tumors are relatively uncommon neoplasms of the head and neck region. There is limited literature on MSGTs. This study provides a versatile approach for MSGTs from demographic data and clinical presentations to treatment modalities and treatment outcomes.

Do Pharyngeal Surgeries for Snoring and Obstructive Sleep Apnea Have an Impact on Nasalance Scores

Objective:Most of the surgeries which are used in the treatment of habitual snoring and obstructive sleep apnea (OSA) mainly target velopharyngeal structures, which play an important role in voice characteristics such as nasalance. The aim of this study is to assess the effect of different types of such surgical procedures including expansion sphincter pharyngoplasty (ESP), lateral pharyngoplasty (LP), and anterior palatoplasty (AP) on nasalance scores. Subjects and Methods:Forty-nine consecutive patients with primary snoring or OSA who underwent AP, LP, and ESP procedures were included in this study. All patients underwent a fully attended overnight polysomnography and detailed otolaryngologic examination. Nasalance studies were performed with Nasometer II instrument (model 6400; Kay Elemetrics, Lincoln Park, NJ) by reading 3 passages that were categorized according to the amount of nasal consonants (oral, oro-nasal, and nasal passages), preoperatively, and 3 months after surgery. Results:There was no statistically significant difference in either group between preoperative and postoperative assessments of nasalance scores for all 3 passages. Seven patients experienced nasal regurgitation symptoms for fluids for a short time after LP, 2 patients after AP, and 7 patients after ESP. None of these symptoms showed persistence and diminished approximately at 1-month follow-up. Conclusion:Anterior palatoplasty, LP, and ESP seem not to have any impact on nasalance scores of males.

Can Impression Procedures Affect Certain Vital Functions of Edentulous Patients? A Clinical Study

PURPOSE The most suitable treatment conditions and timing for medically unstable patients with severe systemic diseases about to undergo invasive dental treatment are well documented in the literature; however, no medical guides or recommendations identify these conditions for noninvasive dental treatments in such patients. The aim of this clinical study was to determine the effect of impression procedures on arterial oxygen saturation (AOS) and pulse rates (PRs) of edentulous subjects. MATERIALS AND METHODS A total of 28 Caucasian edentulous participants (15 females, 13 males) were included in the study. Pulse oximetry recordings (150 seconds) were performed for each participant at three stages; recording at rest (CON), during mandibular impressions (MANIs), and maxillary impressions (MAXIs). The mean values of PR, AOS, and event scores (ESs) indicating desaturation were obtained from the records. The comparisons of mean PR and AOS values were performed with the Bonferroni-corrected Wilcoxon-signed ranks test. The ESs were analyzed with the McNemar Test. RESULTS The mean AOS values of MANI and MAXI did not display significant changes when compared with CON; however, the ESs obtained in both MANI and MAXI were significantly higher than those of CON (p = 0.008, p = 0.004). In addition, mean PR values obtained in MAXI were significantly higher than CON (p = 0.009). CONCLUSIONS According to the results of this clinical study, the impression procedures may affect the PR values and lead to desaturation events in edentulous patients; however, further studies evaluating blood gas levels, which indicate precise AOS values, are necessary to support the results of this study.

Do Pharyngeal Surgeries for Treatment of Snoring and Sleep Apnea Have an Impact on Nasalance

Objectives: Most of the surgeries used in the treatment of snoring and obstructive sleep apnea mainly target velopharyngeal structures, which play an important role in voice characteristics such as nasalance. The aim of this study is to assess the effect of different types of such surgical procedures including expansion sphincter pharyngoplasty, lateral pharyngoplasty, and anterior pharyngoplasty on nasalance. Methods: Forty-four consecutive patients with primary snoring or obstructive sleep apnea (OSA) who underwent anterior palatoplasty, lateral pharyngoplasty, and expansion sphincter pharyngoplasty procedures were included in this study. All patients underwent a fully attended overnight polysomnography and detailed otolaryngologic examination. Nasalance studies were performed by using Nasometer II instrument (model 6400; Kay Elemetrics) preoperatively and 3 months after surgery. Results: The mean preoperative nasalance score for AP, LP, and SP groups were 49.06±10.72, 46.65±8.70, and 48±10.95, respectively. The mean postoperative nasalance score for AP, LP, and SP groups were 48.25±8.78, 46.82±5.2, and 49.36±10.81, respectively. There was no statistically significant difference in either group between preoperative and postoperative assessments of nasalance scores for all three passages. Seven patients experienced nasal regurgitation symptoms for fluids for a short time after LP, two patients after AP, and five patients after SP. None of these symptoms showed persistence, and they revealed at approximately 1-month follow-up. Conclusions: The results of this study showed that these surgical techniques did not lead to an objective velopharyngeal insufficiency, since no significant change in nasalance scores was observed.

An unusual case of anterior and posterior laryngeal cleft together: combined cleft of larynx

Congenital clefts of the larynx are rare and usually found dorsally. An anterior or ventral cleft of the larynx is extremely rare. Only a few patients with this defect have been reported in the literature. The purpose of this paper is to present a patient having an anterior and posterior laryngeal cleft together. A 20-year-old man presented with a history of dysphonia since childhood. He did not report symptoms of swallowing or respiration, and had no history of neck trauma. Findings of videolaryngoscopy showed a grossly abnormal larynx. The anterior commissure was wider than normal, and the vocal folds did not show a fusion anteriorly. There was an interarytenoid cleft posteriorly. A neck CT with 3D reconstruction demonstrated a ventral cleft or nonfusion of the thyroid cartilage with a posterior cricoid cleft. Barium swallow study was in normal limits. Since the patient did not have any problem with swallowing or respiration, no surgical intervention was planned, and the patient was put on speech therapy, which revealed improvement in voice. To our knowledge, this is the first case of a combined laryngeal cleft. The diagnosis is established by the clinical symptoms, endoscopic evaluation, and radiographic examinations including 3D and barium studies.