Rahmi Kilic

Transposition of lingual thyroid gland to the submandibular region by transoral approach

The purpose of this case report is to demonstrate surgical technique of only functional but symptomatic lingual thyroid gland transposition to submandibular region by transoral approach without mandibulotomy and tongue-splitting. A 37-year-old female patient was admitted to our hospital with dysphagia and apnea symptoms. Physical examination revealed 3cm×3cm lingual thyroid gland was detected at the tongue base. The patient was euthyroid and thyroid gland was not detected in the neck. Under general anesthesia, right submandibular gland excision and transposition of lingual thyroid tissue to submandibular region with dorsal lingual artery axis flap were performed by transoral approach. Thyroid hormones remained normal in the postoperative period. In conclusion transoral transposition of lingual thyroid to submandibular region as a flap without mandibulotomy is a minimally invasive and function preserving alternative approach. Besides preserving thyroid functions, this transoral surgical technique can be preferred by patients who avoid skin incision for esthetic concerns.

Blood parameters as indicators of upper airway obstruction in children with adenoid or adenotonsillar hypertrophy.

Adenotonsillar hypertrophy (ATH) is the most common cause of obstructive sleep apnea in children. This study aimed to evaluate the blood parameters of children with ATH who underwent surgery.

The Role of Platelet-Derived Growth Factor in the Pathogenesis of Sinonasal Polyps: Immunohistochemical Assessment in Epithelial, Subepithelial and Deep Layers of the Mucosa

Objectives The aim of this study is to investigate the role of platelet-derived growth factor (PDGF) in the pathogenesis of sinonasal polyps. Methods Study group (groups 1-3) consisted of nasal polyp samples of patients with sinonasal polyps and the control group consisted of inferior turbinate samples of patients without nasal polyp. In group 1, 14 specimens from ethmoid sinus; in group 2, 10 specimens from nasal cavity; in group 3, 10 specimens from maxillary sinus; and in group 4 (control), 9 specimens from inferior turbinate were included. By immunohistochemical staining technique, the PDGF positivity index (PI) in mucosal layers and in the inflammatory cells were assessed at the epithelium (EP), subepithelial layer of lamina propria (SE), and deep paraglandular layer of the mucosa (D). Results Polymorphonuclear cell (PMNC)-percentage (%) values of ethmoid and maxillary sinus, and the PDGF PI from all cells of ethmoid sinus and nasal cavity were significantly higher than those of the control group. As mononuclear cell-% (MNC-%) increased, the PDGF_EP_basal PI, PDGF_SE_endothelial PI, and PDGF_D_endothelial PI decreased. As PMNC-PDGF PI increased, the PDGF_D_perivascular PI decreased and PDGF_D_endothelial PI increased. As PDGF-MNC PI increased, the PDGF_EP_apical PI, PDGF_SE_endothelial PI, and PDGF_D_endothelial PI decreased. As PDGF-all cells (PMNCs, MNCs, and fibroblasts) PI increased, the PDGF_EP_basal PI and PDGF_D_endothelial PI decreased, and the PDGF_D_perivascular PI increased. Conclusion We concluded that the PDGF systems play important roles in polyp pathogenesis. Fibroblast-derived PDGF may be more important than MNC-derived PDGF in polyp developing process. Increased perivascular-PDGF-PI in deep layers of the mucosa may result in sinonasal polyp formation by causing an increase in vascular permeability and extracellular edema, and thus promoting migration of inflammatory cells to extracellular area. Tissue oxygenization may be important for the initiation of PDGF release system. Because of this reason, nasal obstruction should be medically treated earlier, and, if necessary, by surgical approaches.

Morphometric Analysis of the Fronto-maxillary Sinuses in Adult Patients with Traumatic Septal Deviations

OBJECTIVEnThe aim of the current study was to investigate a change in the volume of the frontal and maxillary sinuses in patients with nasal septum deviations due to physical trauma.nnnMATERIALS AND METHODSnParanasal sinus computed tomography data of 100 patients admitted to Kirikkale University medical faculty hospital between November 2013 and June 2014 were retrospectively analyzed. The side of the nasal septal deviation, the deviation angle, the severity of the deviation, and bilateral frontal and maxillary sinus volumes were calculated using a computer program. The relationship between sinus volumes and deviated septum characteristics was investigated.nnnRESULTSnThe maxillary sinus volumes did not differ between the two genders. However, the female patients had significantly decreased frontal sinus volumes when compared with the male patients (p < 0.05). A right-sided septal deviation was found to be associated with a significantly decreased maxillary sinus volume (p < 0.001), and the severity of the deviation was a significant determinant of the maxillary sinus volume (p < 0.001). The age of the patient at the time of the septal trauma was significantly associated with their maxillary sinus volumes. Patients who had experienced this trauma after 12 years of age had significantly increased maxillary sinus volumes when compared with those who experienced the trauma before the age of 12.nnnCONCLUSIONnA distorted septal anatomy was found to be a significant parameter for developing paranasal sinuses. Right-sided and severe traumatic deviations with an onset before the age of 12 were significantly associated with a decreased maxillary sinus volume.

Burunda Dev Yabancı Cisim: Rinolit

Rinolit, tek tarafli ve kotu kokulu burun tikanikligina neden olan minerallesmis kitlelerdir. Tipik semptomlarina ragmen tani ve tedavide gecikmelere sik rastlanmaktadir. Tanisal nazal endoskopi ve goruntuleme yontemleri ile tani konur. Kitle etkisiyle septal perforasyon, epistaksis, maksiller sinus duvarinda harabiyet ve oroantral fistul gorulebilir. Tedavide endoskopik sinus cerrahisi lokal ya da genel anestezi altinda uygulanabilir. Bu yazida epistaksis yakinmasiyla basvuran dev bir rinolit vakasi literatur bilgileri esliginde sunuldu.

SEPTOPLASTİ SONRASI RETİNAL ARTER DAL OKLÜZYONU

Nazal septum deviasyonu sonrasi burundan nefes alamama Kulak Burun Bogaz polikliniklerinde en sik rastlanilan sikâyetler arasindadir. Bu sebeple nazal septoplasti operasyonu da Kulak Burun Bogaz kliniklerinde siklikla yapilmaktadir. Gecici ya da kalici gorme kayiplari septoplasti operasyonu sonrasi cok ender gorulebilen komplikasyonlar arasindadir. Biz de bu vakamizda septoplasti sonrasi retinal arter dal okluzyonuna bagli gorme kaybini sunmayi amacladik. Otuz alti yasinda erkek hasta klinigimize burun tikanikligi sikâyetiyle basvurdu. Anamnezde hastanin sikâyetlerinin uzun suredir oldugu ve cocukken burnuna darbe aldigi ogrenildi. Hasta sigara icmiyordu ve ek hastaligi da yoktu. Hastaya klinigimizde septoplasti operasyonu yapildi. Hastanin postop 1. saatte sol gozde gorme azligi tespit edildi. Hastanin Goz muayenesinde sol goz alt retinal dalcik trasesi ve alt perifer retinal arter trasesi bolgelerine uyan retinada odem izlendi. Siklikla yapilan Septoplasti operasyonlari hastalarin burun tikanikligini dramatik olarak degistirdigi icin perioperatif donemde hastalar iyi takip edilmeli ve degerlendirilmelidir. Medikal ve hukuki yaptirimlarla basa cikabilmek icin Goz hekimleri ve Kulak Burun Bogaz hekimleri bu gibi komplikasyonlarin olusma ihtimali konusunda dikkatli olmalidirlar.

Steroide Cevaplı Rekürren Ani İşitme Kaybı

Ani isitme kaybi, etyolojisinin tam aydinlatilamadigi ve tedavide tam bir standardizasyonun olmadigi sik gorulen klinik bir durumdur. Rekurren ani isitme kaybi ise oldukca nadir gorulur. Rekurren hastaligin dusuk ve yuksek frekanslari tutan klinik tipleri bulunmaktadir. Dusuk frekanslarda sensorinoral kayipla karakterize idiyopatik ani isitme kaybi etyolojisi bilinmeyen digerlerinden, yuksek frekanslarda isitme esiklerinin korunmasi ve vertigo, bulanti, kusma gibi vejetatif bulgularin olmamasiyla ayrilir. Bu yazida birkac ay ara ile 4 kez unilateral ani isitme kaybi geciren olgu sunuldu. Birkac gundur devam eden sag kulakta cinlama, ugultu ve isitme kaybi yakinmasi ile 50 yasinda erkek hasta klinigimize basvurdu. Otoskopik muayenesi dogal olan hastanin dusuk frekanslarda 55dB sensorinoral isitme kaybi mevcuttu. Hospitalize edilen hastaya intravenoz steroid tedavisi baslandi. Hastanin 1 hafta sonra kontrol odyograminda 27 dB duzelme saptanmasi uzerine hasta taburcu edildi. Taburculugunu takip eden 3, 8 ve 10. aylarda yine sag tarafli ani isitme kaybi ile basvuran hastaya her atakta hospitalizasyon ve intravenoz steroid tedavisi uygulandi. Hasta yasadigi son isitme kaybi ataginda, isitme kaybina kulakta dolgunluk ve bas donmesinin de eklenmesi uzerine 15 gun sonra basvurdu. Ilk 3 tedavisinde isitme kaybinda duzelme saptanan hastanin son isitme kaybina yonelik tedavi sonrasi odyograminda 65dB sensorinoral isitme kaybinin devam ettigi saptandi. Rekurren ani isitme kaybinin tani ve tedavisine iliskin cok az sayida veri bulunmaktadir. Dusuk frekanslari tutan rekurren ani isitme kaybi, prognozu iyi olan hastalik grubundadir. Ancak ilerleyen donemlerde rekurren hastalik yasayan hastalarin seyrinde sonradan kalici olabilen isitme kaybi ve Meniere hastaligina progresyon gorulebilmektedir. Her hastada isitme kaybi derecesi ve seviyesi farkli olabileceginden uzun donem takip yapilmasi ve hastalik progresyonunun iyi dokumente edilmesi gerekmektedir.