Selcuk Inanli

The effects of topical agents of fluticasone propionate, oxymetazoline, and 3% and 0.9% sodium chloride solutions on mucociliary clearance in the therapy of acute bacterial rhinosinusitis in vivo.

Objectives The aims of the study were to determine: 1) how mucociliary activity in acute bacterial rhinosinusitis is affected; 2) how this activity is changed by therapy; 3) the effects of topical agents on mucociliary clearance, and 4) the most appropriate topical agent(s) to be used in the therapy of sinusitis.

The Use of Expanded Polytetrafluoroethylene (Gore-Tex) in Rhinoplasty

BackgroundSeptal cartilage still is the most appropriate graft material used in rhinoplasty. In traumatic or revision cases, septal cartilage can be insufficient, and the need for an implant material emerges. In this study, the safety and efficacy of polytetrafluoroethylene (Gore-Tex) used as an implant material in nasal dorsal augmentation were assessed.MethodsThis study retrospectively reviewed 74 patients who underwent nasal dorsal augmentation with Gore-Tex. Of the 74 patients who underwent rhinoplasty with Gore-Tex for dorsal augmentation from February 1999 to January 2006, 46 (62.2%) represented primary cases and 28 (37.8%) represented revision cases. The patients were followed from 5 to 62 months (average, 28 months) and questioned about cosmetic and functional outcomes. The results were assessed according to patients’ charts as well as preoperative and postoperative photographic documentation.ResultsThere were no complications such as infections, foreign body reaction, extrusions, resorption, or migration, and all the patients were satisfied with their results. Only one case of soft tissue reaction was observed, which lasted for 3 weeks postoperatively.ConclusionsBiocompatibility, ease of use, lack of extrusion or resorption, and low rate of infection make Gore-Tex a good alternative to autogenous tissue. However, long-term success and complication rates still are lacking, and large numbers of patients with longer follow-up periods are required.

Actinomycosis of the larynx

Actinomycosis is a rare chronic granulomatous disease that involves the upper airway and gastrointestinal tract. Approximately 40–55% of actinomycosis comprises the cervicofacial form. It presents a challenging clinical diagnostic dilemma because of variable presentations in the head and neck. Herein, we report a rare case of actinomycosis presenting as a vocal cord nodule in a healthy 21-year-old man who was not immunocompromised and had no other known medical disease.

Unusual Presentation and Location of Thyroglossal Duct Cyst in a Child

Thyroglossal duct cysts (TDCs) are common congenital neck masses resulting from persisting epithelial tissue of the thyroglossal duct that enlarges because of inflammation, infection, and mucus retention. They can be found anywhere in the midline between the foramen cecum and the thyroid gland. TDCs are most frequently found below the level of the hyoid bone (85%). They may occur above the hyoid (8%), at the base of the tongue (1.2%), or low in the neck (5%). They are the most common nonodontogenic cysts in the neck and present frequently with a painless anterior midline neck mass occurring at the second or third decade of life. Other less common midline neck masses, such as dermoid cysts, branchial cleft cysts, cystic higromas, and teratomas, should be considered in the differential diagnosis. Despite the close proximity of the cyst to laryngeal structures and being mostly infrahyoid, only 10 cases have been reported to extend into the larynx. Although intralaryngeal extension can be seen in cases of malignant transformation of cysts, this condition is extremely rare in normal benign TDCs and clinically causes hoarseness, dysphagia, and dyspnea. Our patient is the 11th case and the only pediatric patient reported in the literature to have a TDC with intralaryngeal extension. A 2-year-old child presented with dyspnea, history of attacks of stridor, and harsh sound with respiration for one year. These complaints had started increasing in the past month before his admission to the hospital. He had no fever, dysphagia, cough, neck mass, or any lung or lung-related diseases. His medical history was indicative of recurrent medical therapy of laryngitis and croup. His family history was unremarkable.

A new consideration of scar formation in open rhinoplasty.

Rhinoplasty is one of the most variable operations in facial plastic surgery because of the various deformities involved and dissimilar methods used to correct them. Although the exposure of the surgical anatomy with an open approach to rhinoplasty is much better than with the endonasal approach, many surgeons focus mainly on the risk of a visible columellar scar. However, despite this unfavorable complication of a midcolumellar incision, a better understanding of the nasal deformities can be gained, and a more detailed reconstruction can be performed. Surgeons have developed various methods to reduce the risk of scar formation. Different incision types include the Z, V, reverse V, and W incisions. In our experience, meticulous inverted V midcolumellar incision closure results in a better scar. There is no convincing reason to reject the transcolumellar incision for external rhinoplasty.

The results of concurrent functional endoscopic sinus surgery and rhinoplasty.

Objective: The indications, management, and results are discussed in 45 patients who underwent the concurrent functional endoscopic sinus surgery (FESS) and rhinoplasty. Study Design: Retrospective clinical study. Patients and Methods: There were 27 women and 18 men with a mean age of 28 years. 28 patients had chronic rhinosinusitis and 17 patients had nasal polyposis refractory to medical therapy underwent the combined procedure by the same otolaryngologist. Results: A review of our 45 combined procedure performed between 2000 and 2005. There were no lifethreatening severe complications noted in this population. The patients were also satisfied with the aesthetic outcome. Conclusion: Combined rhinoplasty and endoscopic sinus surgery can be performed safely, cost- effectively and with perfect results in selected patients.

Surveillance of Haemophilus influenzae among respiratory tract samples of Turkish children

We conducted three prospective studies of Haemophilus influenzae in different groups of children. Pharyngeal swab samples were taken (i). from 1382 healthy infants and children between 0 and 10 years of age (group 1), attending well child clinics (n=438), day care centres (n=440) and elementary schools (n=504), and (ii). from 322 children aged 2-10 years (group 2), clinically diagnosed as having upper respiratory tract infection. Pharyngeal swab samples and sinus aspirates were obtained from 49 children between 2 and 9 years of age (group 3), clinically diagnosed as having sinusitis. H. influenzae was isolated in similar rates from 315 (22.7%) of children in group 1, 72 (22.3%) of children in group 2 and 12 (24.4%) of children in group 3. Serotype b comprised 7, 5.2 and 2% of all H. influenzae isolates for group 1, 2 and 3, respectively. Production of beta-lactamase was detected in 1.0% of H. influenzae type b isolates in group 1, 1.2 and 6.1% of all isolates in group 2 and 3, respectively. There were no beta-lactamase negative ampicillin-resistant strains.

Importance of placing Gore-Tex in the subperiosteal plane for augmentation rhinoplasty.

Objective The purpose of this study was to present the placement technique of Gore-Tex implants for nasal augmentation. Methods The study group comprised 32 patients of various nasal deformities who underwent consecutive rhinoplasty via open approach with Gore-Tex implant material for dorsal augmentation. A pocket is made subperiostally at the nasal dorsum. The implant is rinsed in antibiotic solution and placed in position. Complications due to Gore-Tex were observed during the follow-up period. Results There were 12 men and 20 women. The mean age was 28.4 years. There were 9 primary rhinoplasty and 23 revision rhinoplasty. Patients were followed up postoperatively for 12 to 24 months. During the postoperative follow-up period, no complications were encountered in this series of patients. The implants were stable and immobile under the skin. Conclusions In the cases of nasal dorsum augmentation, Gore-Tex can be a suitable graft material. We recommend implanting graft materials at subperiosteal plane to provide better stabilization and low complication rates.

A Combined Approach To Crooked Nose Deformity

BackgroundCrooked nose deformity is a complex anatomical deformity; therefore, repair remains a challenge. Here, we introduce a new technique for crooked nose deformity repair.Materials and MethodsTwenty-two patients underwent intraoperative evaluations and measurements, followed by surgery using the open rhinoplasty technique. Our method involves three major steps. First is the creation of an asymmetric medial oblique osteotomy using piezoelectric ultrasonic surgery and double lateral osteotomies, wherein the asymmetric bony ascending part of the maxillary bone at the base of the nasal vault is fractured, pushed in, and delivered to the face. Second is septoplasty with L-strut preservation. The L-strut is removed as a 1-cm block caudally from the septal stump of the keystone area. A (or double) fabricated batten cartilage graft is placed on the concave side of the deviation and sutured to cover the septal stump. The L-strut is then replaced and sutured on the batten graft, redirecting the septum toward the midline. Third is an overlapping cruroplasty on the side of the long asymmetrical lower lateral cartilage to equalize both wings and correct tip deviation.ResultsOur new technique was effective for the treatment of crooked nose deformity.ConclusionsOur technique of K-stone batten plasty with delivery to the face and overlapping cruroplasty may be an effective surgical method for crooked nose deformity.Level of Evidence VThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Closed rhinoplasty with an intercartilaginous midmarginal incision.

In septorhinoplasty, one of the most critical points is to reestablish the support for the nasal tip damaged by surgery. This can be achieved by suturing the nasal structures to each other. We describe our incision and suturing technique for closed rhinoplasty, which provides wide exposure and adequate nasal tip support.