Ozan Gökdoğan

Facial reanimation with end-to-end hypoglossofacial anastomosis: 20 years' experience.

OBJECTIVE This study aimed to evaluate retrospectively the results of experience with end-to-end anastomosis of cranial nerves VII and XII, performed due to transection of the facial nerve during acoustic neuroma removal. METHODS We assessed the facial reanimation results of 33 patients whose facial nerves had been transected during acoustic neuroma excision via a retrosigmoid approach, between 1985 and 2006, and who underwent end-to-end hypoglossofacial anastomosis. We compared the facial nerve functions of patients receiving short term (two to three years) and long term (more than three years) follow up, and we assessed any complications of the anastomosis. RESULTS A House-Brackmann grade III facial function was achieved in 46.2 and 86.4 per cent of the patients in the short and long term, respectively. House-Brackmann grade IV facial function was achieved in 53.8 and 13.6 per cent of the patients in the short and long term, respectively. There was a statistically significant difference between the facial recovery results, comparing the short and long term follow-up periods (p = 0.03). Disarticulation was the most common complication, seen in 19 (57.6 per cent) patients; numbness of the tongue was the next commonest (10 (30.3 per cent) patients). None of the patients developed dysphagia. CONCLUSION Despite such morbidities as disarticulation and tongue numbness, end-to-end hypoglossofacial anastomosis is still an effective procedure for the surgical rehabilitation of static and dynamic facial nerve functions. Significant improvement in facial nerve function can occur more than three years post-operatively.

Association of GJB2 gene mutation with cochlear implant performance in genetic non-syndromic hearing loss

OBJECTIVE To analyze the association of GJB2 gene mutations with cochlear implant performance in children. METHODS Sixty-five consecutive children who underwent cochlear implantation due to congenital profound senseurineural hearing between 2006 and 2008 were included in the study. In children, GJB2 gene mutation analysis was performed. Their auditory performance was assessed using MAIS, MUSS and LittlEARS tests. RESULTS Twenty-two of sixty-five patients GJB2 mutations, and 35delG was the most frequent mutation. No significant difference was found between the auditory performance of mutation positive and negative children after one year follow up (p>0.05). CONCLUSION GJB2 gene mutations do not impact on the outcome of cochlear implantation.

The Rate of Epistaxis Incidence in New-Generation Anticoagulants and Perioperative Approach in Otorhinolaryngological Practices.

Abstract Nose bleeding is a common situation seen in otorhinolaryngological practices. One of the greatest risk factors in nose bleeding is the use of anticoagulant medicine. With the medicine developed in recent years, the risk of nose bleeding due to the frequent use of anticoagulant and antiagregant is gradually increasing. The purpose of this study is to determine the effects of especially new-generation anticoagulants on nose bleeding. In addition, the use and complications of new-generation anticoagulants and antiagregants have been compiled in light of information obtained from the literature. Three hundred forty patients whose follow-up is conducted by the cardiology department and who use oral antithrombocytic medicine have been included in the study. It has been determined that 15% of these patients use new-generation oral anticoagulants (Rivaroksaban, apiksaban, dabigatran, danaparoid) and the other patients are treated with conventional antithrombocytic treatment (Aspirin, Warfarin, Enoksaparin sodium). The rate of nose bleeding in patients who use classical anticoagulants has been observed to be 28%. In 30 of these patients who had nose bleeding, while cauterization and buffering by otorhinolaryngology specialists, major intervention has not been necessary for any of the patients. While bleeding has been observed in 26% of the patients who use new-generation anticoagulants, bleeding that required operational intervention has taken place in 2 patients. Bleedings have been stopped surgically through a large number of cauterization and buffering. While the new-generation anticoagulants cause lower rate of bleeding, it has been observed that controlling these bleedings is more difficult.

Sphenopalatine artery pseudoaneurysm: a rare cause of intractable epistaxis after endoscopic sinus surgery.

AbstractEpistaxis is a frequent health problem and the most common cause of emergency in otorhinolaryngology practice. In this report, a case of a 26-year-old patient with intractable epistaxis after endoscopic sinus surgery was presented. The epistaxis began at the fourth postoperative day and was unresponsive to endoscopic cauterization and anterior and posterior nasal packing. On angiographic investigation, a pseudoaneurysm of the sphenopalatine artery was detected and treated with microcatheter embolization. This is the second case of postoperative sphenopalatine pseudoaneurysm as a complication of endoscopic sinus surgery in the literature.

Laryngeal Chondroma: An Unusual Complication Endotracheal Entubation.

Introduction:Laryngeal cartilaginous framework tumors are very rare. Chondroma and chondrosarcoma are the most common types of these tumors. Patient Presentation:A 27-year-old man with a history of intubation presented with exercise-induced dyspnea. A computed tomography scan of larynx showed a rounded and circumscribed mass without infiltration of the adjacent structures which obstructs 75% of airway. Histopathological investigation of the mass revealed the chondroma of the larynx. The patients’ history of intubation trauma with the subsequent progressive onset of clinical symptoms demonstrates the relationship between these 2 entities. Conclusion:Clinicians should consider laryngeal chondroma in the differential diagnosis of dyspnea after endotracheal intubation.

Case reportHoarseness: an unusual presentation of primary thyroid lymphoma with laryngeal infiltrationRouquidão: apresentação incomum de linfoma primário de tireoide com infiltração da laringe☆

Primary thyroid lymphoma is a relatively rare disease of the thyroid gland. PTL represents approximately 1%--5% of thyroid malignancies and less than 2% of extra nodal lymphomas: the prognosis is generally good. Thyroid lymphomas are more common in women with a predominance of 3--4:1. The main clinical manifestation is a rapidly enlarging thyroid mass, commonly in the seventh decade. Approximately 30%--50% of patients manifest compression symptoms of the adjacent structures, in addition to dysphagia, stridor, hoarseness, cough and a pressure sensation in the neck. Symptoms such as fever, night sweats and weight loss are less common. Hashimoto’s thyroiditis appears to be a risk factor for thyroid lymphoma although the association is still debated. The most common histopathological type of thyroid lymphomas is non-Hodgkin’s lymphoma with B cell origin. Hodgkin’s diseases and T-cell lymphomas are rare tumors.O linfoma primário de tireoide (LPT) é uma doença relativamente rara da glândula tireoide. LPT representa aproximadamente 1-5% das malignidades tireoidianas e menos do que 2% dos linfomas extranodais, geralmente com bom prognóstico.1 Os linfomas de tireoide são mais comuns em mulheres, com predominância de 3-4:1.2 A principal manifestação clínica do LPT é a presença de tumor de rápido crescimento, sobretudo na sétima década de vida. Aproximadamente 30-50% dos pacientes apresentam sintomas de compressão das estruturas adjacentes: disfagia, estridor, rouquidão, tosse e sensação de pressão no pescoço. Os sintomas B clássicos – febre, suores noturnos e perda de peso – são menos comuns. Ao que parece, tireoidite de Hashimoto é fator de risco para linfoma de tireoide, embora tal associação seja objeto de debate.1,2 O tipo histopatológico mais comum de linfoma de tireoide é o linfoma não-Hodgkin com origem no linfócito B. Doença de Hodgkin e linfoma T são tumores raros. Pacientes com linfoma do tecido linfoide associado à mucosa (MALT; mucosa-associated lymphoid tissue) tendem a apresentar uma evolução mais indolente e com melhor prognóstico, em comparação com pacientes com os tipos de linfoma difuso de grandes células B ou subtipos histológicos mistos, que podem ter curso mais agressivo.3 O percentual geral de sobrevida após cinco anos para pacientes com LPT é de aproximadamente 90%; assim, em geral, um bom planejamento terapêutico, com um diagnóstico acurado prontamente estabelecido, resultará em bom prognóstico.4

Determination of the level of noise in nurseries and pre-schools and the teachers' level of annoyance

Objective: The aim of this article is to determine the level of noise in nurseries and pre-schools and also to compare measured levels with standard levels and evaluate the teachers’ level of annoyance. Materials and Methods: The level of noise was measured in three different schools. A total of 162 students, whose ages were between 3 and 6 years, and 12 teachers were included the study. Every age groups’ level of noise was measured during sleeping, gaming, and eating activity. In addition, teachers’ annoyance was assessed in different age groups. Results: The 4- to 6-year-old groups were found to have higher level of sounds than 3-year-old group. Eating period was found to be the highest level of sound whereas sleeping was found the lowest. Furthermore, teachers’ annoyance was found higher as the age decreased. Conclusion: Nurseries and pre-schools have noisy environment both for the students and the teachers. High level of noise, which has bad effects on health, is a public health problem. Both the students’ families and teachers must be aware of this annoying situation.Objective: The aim of this article is to determine the level of noise in nurseries and pre-schools and also to compare measured levels with standard levels and evaluate the teachers’ level of annoyance. Materials and Methods: The level of noise was measured in three different schools. A total of 162 students, whose ages were between 3 and 6 years, and 12 teachers were included the study. Every age groups’ level of noise was measured during sleeping, gaming, and eating activity. In addition, teachers’ annoyance was assessed in different age groups. Results: The 4- to 6-year-old groups were found to have higher level of sounds than 3-year-old group. Eating period was found to be the highest level of sound whereas sleeping was found the lowest. Furthermore, teachers’ annoyance was found higher as the age decreased. Conclusion: Nurseries and pre-schools have noisy environment both for the students and the teachers. High level of noise, which has bad effects on health, is a public health problem. Both the students’ families and teachers must be aware of this annoying situation.

Maxillofacial Traumas in Farmers Caused by Farm Animals, Agricultural Vehicles, and Materials.

Objective:It has been aimed at evaluating the relationship of maxillofacial fractures in farmers, which are caused due to traumas while working in farms, with trauma etiologies, maxillofacial fracture areas, age, sex, and seasonal variables. Methods:Among the farmers who have come to our emergency service unit as a result of maxillofacial trauma between 2010 and 2012, 146 patients have been analyzed retrospectively. The patients’ demographic findings, trauma etiologies, seasonal variables of trauma, and maxillofacial fracture area distribution have been analyzed. Results:Patients’ age varies between 12 and 80 and 87 of them are female (59.59%), while 59 are male (40.41%). The subjects’ etiological distribution is as follows: 47.5% is traumas caused by cattle among the farm animals; 15.75% is traumas caused by the blows of agricultural tools; 12.33% is traumas caused by tractor accidents; 9.59% is traumas caused by falling from haystacks; 7.53% is traumas caused by falling from agricultural vehicles, and 6.85% is traumas caused by horse kicks. When trauma etiology, age, sex, seasonal distribution, and the maxillofacial fractures were analyzed, statistically significant results have been determined. Conclusions:Although the number of maxillofacial traumas is considerably high in farmers due to farm animals, agricultural devices, and agricultural tools, while these traumas can cause functional and aesthetically minor fractures on the face, they can cause important and serious fractures as well. While knowing the mechanism of etiological fractures and accidents in different study groups can be guiding in the speedy diagnosis and treatment of possible fractures, it can also be helpful in taking precautions against traumas in these groups as well.

Microbiological and Histopathological Effects of Nasal Packing Containing Probiotics on Nasal Mucosa.

Background:Nasal packing is frequently used after surgical interventions to prevent bleeding and synecchia formation and for the treatment of diseases such as epistaxis. One of the most morbid complications of nasal packing applications is the toxic shock syndrome (TSS). Owing to the microbiological structure of nasal mucosa, antibiotics are administered to all patients who are applied nasal packages for prevention of TSS. Aim:The aim of this study is the evaluation of microbiological and histopathological changes taking place in nasal mucosa with nasal packing containing probiotics. Methods:Three groups were formed with 6 rats in each group. The nasal packings with the same characteristics were applied to nasal cavities of rats in all 3 groups. In group 1, only nasal packs were used. Probiotics or parenteral antibiotics were not used. In group 2, parenteral antibiotics were used along with nasal packs. In group 3, nasal packs with probiotics containing Lactobacillus strains were applied. No parenteral antibiotics were used. After 3 days packages were removed and nasal cavity was irrigated with saline. Both packages and irrigation materials were analyzed for microbiological content. After scarification, nasal and paranasal structures were examined for histopathological changes. Results:In group 3 statistically the total bacteria load was significantly lower in comparison to the other groups. However, in the histopathological evaluation of the mucosa of rats in group 3, bleeding and inflammation findings were significantly higher statistically. Conclusions:It has been determined that the total microbiological load significantly decreases with the application of packing containing probiotics. So, the use of probiotics along with nasal packings is promising to prevent unnecessary use of medications.

Recurrent Lymphoepithelial Carcinoma of the Parotid Gland.

Background: Lymphoepithelial carcinomas (LECs) are rare tumors of parotid gland. Although few cases were reported in literature, there is no reported recurrent case. Method: The authors report a case of recurrent LEC after 8 months of primary surgery. Total parotidectomy and selective neck dissection surgery were performed. Radiation therapy after surgery was planned. Patient had partial facial weakness in the early postoperative period that was getting better with follow-up. Conclusions: In the diagnosis of LECs of parotid region, nasopharyngeal carcinomas must be excluded. If LECs are not treated properly, recurrences may occur.