Semih Sütay

Pharyngocutaneous fistula and total laryngectomy: possible predisposing factors, with emphasis on pharyngeal myotomy

Ninety-two total laryngectomy cases were investigated with reference to post-laryngectomy fistula formation. Fistula was observed in eight cases (8.69 per cent). There were no statistically significant differences between the fistula group and the non-fistula group with regard to pre-operative tracheotomy, tumour differentiation, positive surgical margins, concurrent neck dissection, previous radiotherapy, T stage of the tumour, presence of extended hypopharyngeal mucosal excision, and placement of nasogastric tube. The only statistically significant positive association was found with primary pharyngeal myotomy. Myotomy was performed in six of the fistula patients and in two cases a technical error was observed. In these cases myotomy was performed adjacent to the edge of hypopharyngeal mucosa resulting in a weakened area of pharyngeal closure, possibly contributing to the fistula. This should be kept in mind and avoided at all costs during the performance of myotomy. Since it was not possible to find out any specific causal relationship with myotomy in four other cases, further studies are needed to establish the association of myotomy with pharyngocutaneous fistula.

Submaxillary hypoglossal neurilemmoma

Neurilemmomas of the hypoglossal nerve are uncommon neoplasms. A unique case of submaxillary hypoglossal neurilemmoma is presented with radiological and surgical results. Methods of diagnosis and differential diagnosis are discussed.

Investigation of topical ciprofloxacin ototoxicity in guinea pigs.

Antibiotic eardrops mostly contain potentially ototoxic aminoglycosides. Ciprofloxacin is an alternative, and there is limited experience in its topical use. To investigate the topical ototoxicity of ciprofloxacin, 11 guinea pigs have been operated on. Transbullae silicone drug delivery tubes were placed to both ears of the animals. After the operation the guinea pigs were divided into two groups. The first group of animals received 0.2 ml of 4% gentamicin in one ear and 0.2 ml of 0.9% sodium chloride solution in the other. The second group received 0.2 ml of 0.2% ciprofloxacin in the test ear and 0.2 ml of 0.9% sodium chloride solution in the control ear. All drugs were given once a day on 7 consecutive days. Auditory brainstem response thresholds were recorded using click, 4 and 8 kHz logon stimuli before and after the operation, and after topical drug application. Results were statistically compared using Wilcoxon matched pairs signed-ranks test. Comparison of the thresholds before and after the operation, physiological saline application, as well as ciprofloxacin application yielded no statistically significant differences, whereas application of gentamicin resulted in total hearing loss. The results indicate that topical use of 0.2% ciprofloxacin is not ototoxic in guinea pigs.

Polymerase chain reaction in the diagnosis of parotid gland tuberculosis

A parotid gland mass with presenting features of malignancy is a diagnostic and therapeutic challenge. The histological nature of the lesion must be clearly determined before proceeding with facial nerve sacrificing surgery. Although rare, tuberculosis of the parotid gland must be included in the differential diagnosis of a parotid gland mass especially when the social characteristics of the patient suggests a mycobacterial infection. Primary tuberculosis of the parotid gland is generally encountered among populations with a high incidence of pulmonary disease. The difficulty in the differential diagnosis of a parotid gland malignancy may be helped by a high degree of clinical suspicion, since laboratory tests generally do not identify the specific causative organism. This article reports the first case of parotid gland tuberculosis with clinical and radiodiagnostical features simulating malignancy in which the diagnosis was confirmed by the polymerase chain reaction (PCR).

Management of parapharyngeal space cysts

Parapharyngeal space cysts, besides salivary gland origin may be derived from the first and dorsal portions of the second pharyngeal pouches. They are mucosal or epithelial lined structures with no external or visceral opening and always present on the lateral aspects of the nasopharyngeal wall. Two consecutive cases of parapharyngeal space cysts totally excised by transoral and transparotid routes are presented.

Microdebrider assisted endoscopic marsupialization of congenital intranasal nasolacrimal duct cysts.

OBJECTIVE To provide information on the clinical characteristics and management of an uncommon congenital nasolacrimal system anomaly, intranasal nasolacrimal duct cyst. METHODS Three patients treated with microdebrider assisted endoscopic marsupialization for intranasal nasolacrimal duct cysts were included in this study. Management and outcomes are compared to previous reports in the literature. RESULTS Patients were presented in between 2007 and 2010. Diagnosis was made by clinical observation and endoscopic nasal examination. The first patient is a 1 year old child with congenital dacryocystocele presented as a right medial canthal mass and ipsilateral intranasal cyst. The second patient is a 60 days old child presented with nasal obstruction and feeding difficulty who was found to have bilateral intranasal cystic masses. The third patient was a 6 days old newborn with respiratory distress, whose nasal endoscopy revealed bilateral choanal atresia and left side intranasal cyst. All three cases were treated with nasal endoscopic marsupialization and no recurrence of symptoms and physical findings were found. CONCLUSIONS Intranasal nasolacrimal duct cysts may lead to nasal obstruction, respiratory distress and feeding difficulty. An otorhinolaryngologist should be consulted, as nasal endoscopy is fundamental for diagnosis. Microdebrider assisted endoscopic marsupialization is a safe and curative treatment.

Effect of steroids for nasal polyposis surgery: A placebo-controlled, randomized, double-blind study.

Although medical intervention is the first option for treatment of nasal polyps, surgery is still a therapeutic option for symptomatic cases that do not respond or partially respond to medical intervention. However, there is a need for high‐level evidence for the preoperative use of steroids in nasal polyposis surgery. We aimed to assess the perioperative effect of preoperative use of oral prednisolone for advanced‐stage diffuse nasal polyposis.

Diagnostic contribution of virtual endoscopy in diseases of the upper airways.

PurposeVirtual endoscopy (VE) is a new diagnostic tool that generates 3-dimensional (3D) views of a lumen by exploiting cross-sectional images. The purpose of this study was to evaluate the usefulness of VE as a diagnostic tool in the diseases of the larynx and pharynx.Materials and MethodsTwenty-two patients with a mean age of 57 years were included in the study. The patients underwent larynx examination, optical endoscopy (OE), and computed tomography (CT) of the larynx. Later, VE was produced from the CT images.ResultsEight patients had larynx carcinoma, a 5-year-old patient had a laryngeal web, a 43-year-old man had fish bone stuck in his submucosal layer, 10 patients were normal, and the remaining two patients were under follow-up for treated nasopharynx carcinoma and had no evidence for recurrence. VE showed the laryngeal tumor in seven patients and the laryngeal web in one patient, but failed to show a plaquelike tumor and the fishbone within the submucosa.ConclusionsOur findings suggest that VE is a useful and complimentary method of 3D imaging in the diseases compromising the laryngeal lumen. Furthermore, it may be superior to OE in severe stenosis or obstructions where the endoscope cannot be passed through.

Sphenovomerine suture: a useful landmark for locating sphenoid sinus ostium.

AimThe aim of this study was to determine whether the sphenovomerine suture (SVS) can be used as a landmark to localize the sphenoidal sinus ostium. MethodsEndoscopic imaging was done on 152 skulls to identify ostium of the sphenoidal sinus, the SVS, and the articulation of sphenoidal process of palatine bone between the body of the sphenoid and the sphenopalatine foramen. The variables were as follows: (1) the distance between the medial border of the ostium and SVS (DSO-SVS); (2) the angle between them (ASO-SVS); (3) the distance between the inferior border of the ostium and the horizontal line (DSO-HL); (4) the distance between intersection point of the SVS-sphenoidal process of the palatine bone and the medial border of sphenopalatine foramen (DSPF-SVS); and (5) the number of sphenopalatine foramen. ResultsOf the 152 skulls, 289 sides were included in the study. The mean value for DSO-SVS was 3.15 (1.35) mm, DSO-HL was 5.99 (2.38) mm, DSPF-SVS was 7.07 (1.96) mm, and ASO-SVS was 5.99 (9.73) mm. As DSPF-SVS decreases, DSO-SVS and DSO-HL decrease with statistical significance (Ps = 0.02 and 0.001, respectively). The distribution of the numbers of sphenopalatine foramen was as follows: one 90%, two 9.7%, and four 0.3%. ConclusionsThe horizontal distance between the SVS and the sphenopalatine foramen plays a significant role in identifying the location of sphenoid sinus ostium. As with the other landmarks, the SVS provides an additional benefit in locating the sphenoid sinus ostium for endoscopic sinus surgeons. The incidence of 4 sphenopalatine foramen is 0.3%.

Computed Tomographic Analysis: The Effects of Frontal Recess Morphology and the Presence of Anatomical Variations on Frontal Sinus Pneumatization

Abstract The aim of this study is to describe the morphology of frontal recess area with its anatomical variations and to reveal if frontal recess morphology and the anatomical variations related to that region have effects on the pneumatization of the frontal sinuses. The frontal sinus and recess morphometry of 136 sides of 68 dry skulls were evaluated on multislice high-resolution computed tomography. The relationships between frontal sinus and frontal recess measurements were analyzed by correlation and linear regression analysis. The variables between the groups of anatomical variations were analyzed by Mann–Whitney U test and &khgr;2 test or Fisher exact test. A positive relationship between the sagittal length of spina nasalis interna and morphometric measurements of frontal sinus was revealed (P <0.05). Agger nasi cells were present in 64.2% of sides, supraorbital ethmoid cells (SOECs) in 19.6%, type 3 frontal cells (FCs) in 18.9%, suprabullar cells in 24.3%, and frontal bulla was noted in 5.4%. Intersinus septal cells were observed in 16.2% of the skulls. There were statistically different increases in the measurements of frontal sinus morphometry in the presences of SOECs and type 3 FCs (P <0.05). The diameter of frontal sinus ostium was decreased in the presences of AN, SOEC, type 3 FC, and supraorbital ethmoid cell statistically (P = 0.049, P = 0.029, P = 0.043, P <0.001 respectively). In conclusion, frontal sinus pneumatization was affected by the spina nasalis interna and the presence of anatomical variations related to frontal recess or ostium region instead of the morphology of that area.