Samet Ozlugedik

Numerical Study of the Aerodynamic Effects of Septoplasty and Partial Lateral Turbinectomy

Objectives: To investigate, first, the effects of septal deviation and concha bullosa on nasal airflow, and second, the aerodynamic changes induced by septoplasty and partial lateral turbinectomy, using computational fluid dynamics (CFD).

Retropharyngeal space and lymph nodes: an anatomical guide for surgical dissection.

Conclusions Identification of the alar fascia is the key part of surgical dissection of the retropharyngeal lymph nodes (RPLNs). In cases where mandibulotomy is not performed for the removal of the primary tumor and/or the posterior pharyngeal wall is not incised, the medial or lateral approaches described in this paper can be performed. Objective Surgical dissection of the RPLNs may improve prognosis and locoregional control in oropharyngeal, hypopharyngeal and cervical esophageal carcinomas. There have been no previous anatomical studies concerning landmarks and approaches for the surgical dissection of the RPLNs. This study was designed to illustrate the fascial anatomy of the retropharyngeal region (RPR), provide anatomical guidelines for RPLN dissection and describe and compare approaches for surgical removal of the RPLNs. Material and methods Twelve fixed cadavers were used. Slices were obtained from the necks of the first three cadavers and the RPRs of the slices were dissected under an operating microscope. The other nine cadavers were dissected in a surgical position to expose the RPLNs and the fasciae of the RPR. Results In the coronal plane, the alar fascia divides the space between the buccopharyngeal and prevertebral fasciae into two compartments and constitutes the posterior border of the retropharyngeal space, which contains the RPLNs. The alar fascia, an important landmark for reaching the RPLNs, can be identified by the cervical sympathetic trunk, superior sympathetic ganglion and superior laryngeal nerve. Two approaches can be performed to remove the RPLNs, namely medial or lateral to the internal and external carotid arteries, internal jugular vein and vagus nerve.

An atypical esthesioneuroblastoma of the inferior nasal cavity and maxillary sinus: report of a case.

Esthesioneuroblastoma is a rare malignant tumor of the nasal cavity that originates from the olfactory epithelium. In this paper a very rare clinical presentation of this tumor is described. The tumor originated from the maxillary sinus and alveolar process, and was independent of the olfactory region. The patient was a 14-year-old girl presenting with facial swelling and nasal obstruction. Paranasal computed tomography showed a mass filling the right nasal cavity, infiltrating the alveolar process, eroding the anterior wall of the maxilla and invading the subcutaneous tissues of the cheek. Fine-needle aspiration and incisional biopsies identified an esthesioneuroblastoma. After neoadjuvant chemotherapy, we performed a right subtotal and left inferior maxillectomy and reconstructed the maxillary defect with a permanent obturator. At 2 years’ follow-up the patient is free of recurrence.

CERVICAL SYMPATHETIC CHAIN SCHWANNOMA: TWO DIFFERENT CLINICAL PRESENTATIONS

In this report we present 2 cervical sympathetic chain schwannoma (CSCS) cases with different clinical presentations, one being a pulsatile neck mass associated with Horners syndrome and the other being an asymptomatic neck mass. CSCS usually presents as an asymptomatic neck mass and atypical findings such as Horners syndrome and/or pulsation may occur in rare cases. Pulsatile CSCSs are generally diagnosed as carotid body tumors at initial workup and patients are referred to vascular surgeons. The differences in symptomatology, the preoperative management, and the importance of differential diagnosis are discussed.

Simultaneous antrochoanal and sphenochoanal polyps : a rare clinical entity

Choanal polyps almost always appear as solitary growths and most commonly arise from the maxillary sinus. Sphenochoanal and ethmoidochoanal polyps are extremely rare. Co-existence of more than one choanal polyp is even more infrequent. We present a patient with an antrochoanal and an accompanying sphenochoanal polyp for the first time in the literature. We discuss the clinical presentation, pathogenesis and surgical management of this rare clinical entity.

Coexistence of laryngeal squamous cell carcinoma and non-Hodgkin's lymphoma with nasopharyngeal involvement.

Laryngeal squamous cell carcinoma (SCC) is one of the most frequent malignancies in the head and neck region. The risk of multiple malignancies is reported as 2-11 per cent and most of the second primaries are SCCs. Lymphogenic tumours as second primaries are extremely rare. In this paper, we report a case of laryngeal SCC with synchronous non-Hodgkins lymphoma and review the literature on the clinical and histopathological aspects of these malignancies.

Division of the stapedial tendon results in noise-induced damage to the inner ear.

Background The effect of division of the stapedial tendon on susceptibility to noise-induced inner ear damage has not been previously studied. This study aimed to evaluate the effects of noise exposure following division of the stapedial tendon in guinea pigs. Material/Methods Ten adult albino guinea pigs were used. The stapedial tendon of each right ear was cut. The stapedial tendon in each left ear was left intact and these ears served as a control group. DPOAEs and ABR tests were performed before and 10 days after noise exposure. The animals were exposed to a 110-dB noise stimulus for 6 h in a silent room a week after surgery. Cochleas of the animals were removed, and inner and outer hair cells were examined under a light microscope. Results We found that noise exposure adversely affected DPOAE measurements at all frequencies except 2 KHz in experimental ears. Noise exposure also produced significantly elevated ABR thresholds in experimental ears at 2, 4, 8, and 16 KHz. On histopathological examination, we found a significantly greater prevalence of apoptotic cells in the experimental ears. Conclusions Based on these findings, we can conclude that after division of the stapedial tendon, noise exposure may cause damage to the inner ear. This is the first study in the English literature that demonstrates the potential protective effect of the stapedial tendon against acoustic damage.

Monaural Hearing Aid Fitting Results in Patients with Presbycusis

Objective: The goal of this study was to evaluate the effects of the monaural hearing aid (HA) fitting on hearing and satisfaction in patients with presbycusis. Materials and Methods: This prospective study conducted with forty newly diagnosed patients with presbycusis that were prescribed an HA monaurally for the first time. Hearing Handicap Inventory for Adults (HHIA), pure tone audiometry thresholds (PTA) and speech discrimination score (SDS) were determined before and after six-month usage of HA. Also, International Outcome Inventory for Hearing Aids (IOI-HA) scores was determined after six months usage of HA for each patient. Results: HHIA scores was significantly improved (p < 0.01) after six months usage of HA. According to IOI-HA scores, 92.5% of the patients experienced at least moderate satisfaction. The mean SDS were significantly improved in both ears, especially in the aided ear (p < 0.01). There was no significant difference between the before and after mean PTA in both ears. Conclusions: Although the benefit and satisfaction rates are higher in binaural HA users when compared the monaural HA users, we observed a significant improvement in satisfaction and SDS after six months usage of monaural HA. Improved satisfaction and benefit were observed in patients with used HA more than 8 hours a day especially.

Long-Term Results of Partial Laryngectomized Patients.

Aim:This study was to present long-term oncological results, as well as the variables, that can increase nodal metastasis and reduce survival in patients diagnosed in the early and late stages of laryngeal cancer. Methods:A total of 85 patients were included in the study. These patients were grouped as supracricoid partial laryngectomy (PL), supraglottic horizontal PL, and vertical frontolateral PL. Furthermore, at least 3 years of the long-term outcomes of the patients in these 3 groups were compared. Results:Twenty-two of the patients (26%) had nodal metastasis, 16 (72%) of these patients were in Group I (P = 0.017); 14 patients (51%) had preepiglottic space (P = 0.075); 12 patients (50%) had paraglottic space involvement (P = 0.002); 9 (45%) patients with nodal metastasis had a depth of invasion more than 20 mm (P < 0.001). Out of the 16 patients who had positive intraoperative surgery margins, 5 (18%) of them had nodal metastasis (P = 0.589) and 14 (16%) patients were positive for perineural invasion, 3 (19%) of these patients had lymph node involvement (P = 0.074). One (5%) patient died with nodal metastasis. Median survival rate of all the patients was 44 ± 0.836 (42.36–45.63) months and the overall survival rate was 92.9%. Conclusions:Paraglottic space involvement and tumor invasion depth were statistically effective on increased nodal metastasis. However, we suggest that depth of invasion may not be effective alone as a prognostic factor. In contrast to the known effect on overall survival was less lymph node.

Killian Nasal Speculum-Assisted Tonsillectomy Under Local Anesthesia

Objective: To describe Killian nasal speculum-assisted tonsillectomy under local anesthesia in detail and to question the experience of our patients with this surgical procedure. Material and Methods: Group 1 included patients that underwent Killian nasal speculum-assisted tonsillectomy under local anesthesia (n=44) and Group 2 those who underwent classical cold dissection tonsillectomy under general anesthesia (n=28). Results: Among the patients in Group 1, 59.1% (26/44) reported mild, 27.3% (12/44) moderate, and 13.6% (6/44) excessive levels of anxiety preoperatively. All patients in Group 1 reported that they felt safe during surgery; 84.1% (37/44) reported that the surgery was easier than they had anticipated, whereas 15.9% (7/44) reported it was more difficult than anticipated. Duration of surgery in Groups 1 and 2 was 22.7 ± 7.0 minutes and 63.7 ± 16.3 minutes, respectively (p<0.001), and the median volume of intraoperative bleeding was 5 mL (range, 1-90 mL) and 180 mL (range, 40-400 mL), respectively (p < 0.001). No intraoperative complication developed in either group and the amount of postoperative bleeding did not show a significant difference between the groups. Conclusion: In selected adult patients, Killian nasal speculum-assisted tonsillectomy under local anesthesia is a time saving procedure, which produces less intra-operative blood loss compared to cold dissection tonsillectomy under general anesthesia.