Senol Comoglu

Transnasal Prelacrimal Recess Approach for Recurrent Antrachoanal Polyp.

Purpose:To assess the effectiveness and usefulness of transnasal prelacrimal recess approach (TPRA) in patients with recurrent antrochoanal polyps. Methods:Twelve patients with antrochoanal polyp recurrence underwent surgery with a transnasal endoscopic prelacrimal recess approach. Success for visualization of the origin of the polyps, surgical complications, and recurrence was evaluated. Results:Transnasal prelacrimal recess approach was successful in 83% of the patients (10/12); polyps that originated from a posterior location (2 patients) were excised using the middle meatal approach. Nasolacrimal duct injury occurred in 2 patients but neither had epiphora postoperatively. Three patients (3/12; 25%) had synechia formation between the lateral nasal wall and septum just superior to the inferior turbinate. One of the 3 patients (1/12; 8.3%) with synechia was symptomatic and required surgical treatment under local anesthesia. During a mean follow-up period of 14.2 months (range, 8–21 months) no recurrence had developed. Conclusion:In experienced hands, TPRA is a novel, reliable, and useful method for the treatment of recurrent antrochoanal polyps. It ensures good exploration of the maxillary antrum and easy access to the polyp origin on the maxillary wall without the need of additional approaches.

Figure-of-Eight Suspension Suture in Open Technique Septorhinoplasty.

Abstract The aim of this study was to describe a novel surgical suture technique for achieving ideal nasal tip rotation and projection with nasal supratip angle. The figure-of-eight suspension suture (FOESS) technique was used in 68 patients who underwent open technique septorhinoplasty operation between the years 2013 and 2015. Fifty-four of the patients were female and 14 were male. The mean age of the patients was 28.2. The mean follow-up time of the patients was between 6 and 18 months. No complications were observed due to the FOESS technique. Satisfactory results were obtained in the postoperative period after surgery. The FOESS technique generated power against the anterior-inferior tensile strength of the alar cartilages. Thus, it can be possible to shape the nasal tip rotation and projection in the desired dimensions. In addition, this technique helps us to create supratip break point and angle.

Comprehensive analysis of parotid mass: A retrospective study of 369 cases

OBJECTIVE To present the results of patients who underwent superficial or total parotidectomy because of parotid gland tumors in our tertiary care clinic. METHODS The data of 362 patients who underwent parotid surgery from January 2008 to November 2015 were collected and analyzed in demographic, histopathological features, and complications. RESULTS Three hundred sixty-nine cases (performed in 359 patients) were analyzed and we assessed complications of parotid surgery such as transient or permanent facial paralysis and Freys syndrome. Pleomorphic adenomas and Warthins tumors consisted 74% of all parotid gland tumors. These tumors were generally located in the superficial lobe and tail of the parotid gland (81%). Also, tumor size in the positive surgical margin group was larger than in the negative surgical margin group (p=0.012). CONCLUSIONS Most of parotid gland tumors are benign. However, the frequency of malignancy increases in deep lobe of parotid gland. High grade malignant tumors have more tendency to have positive surgical margin during surgery, and facial paresis preoperatively.

Oncologic and functional outcomes of open surgery in early supraglottic tumors: is it still a valid technique?

OBJECTIVES In this study, we aimed to analyze the oncologic and functional outcomes of supraglottic laryngectomy. PATIENTS AND METHODS Medical records of 91 cases (85 males, 6 females; mean age 55.4 years; range 30 to 75 years) who underwent surgery due to early supraglottic laryngeal cancer in our clinic were retrospectively analyzed. Statistical analysis was performed using chi-square test and Fishers exact test. Mean values were estimated by means of t-test, while survival curves were drawn using Kaplan-Meier method. RESULTS With respect to oncologic assessment, disease-free survival rate was 81%, the rate of regional recurrence was 6%, the rate of local recurrence was 8%, the rate of distant metastasis was 7% and the rate of occult neck metastasis was 25%. Metastatic neck disease and extracapsular invasion in the lymphatic ganglia were found to be the most critical parameters in terms of survival. With respect to functional assessment, the mean time of decannulation was 41 days, while the mean time of nasogastric tube removal was 19 days. It was observed that cases with a Forced Expiratory Volume in 1 second (FEV-1) of <75% experienced more aspiration-related problems. The functional outcomes were worse in the cases who underwent bilateral neck dissection and postoperative radiotherapy. CONCLUSION Open surgery is a more effective treatment modality in the early supraglottic tumors in terms of oncologic and functional outcomes. It should be continued to be use as an alternative method to the novel and expensive technologies including transoral robotic surgery or transoral laser surgery.

Percutaneous nasal septal retraction technique for dorsal cartilaginous deviations

During Endocsopic Sinus Surgery, it may be necessary to perform septoplasty in order to increase vision and to create a corridor for the endoscope and surgical instrumentation. This article describes a percutaneous transient septal retraction technique, which can be used in patients who have a narrowed endoscopic vision due to dorsal cartilaginous septal deviation, but do not develop nasal obstructive problems. The technique described in this paper, which is defined especially for limited dorsal septal deviations, is a quick and effective procedure. It shortens total operative time in terms of avoiding septoplasty. This technique may be considered within the armamentarium of the pediatric surgeon. Possible indications we suggest for this technique are; pediatric patients with dorsal septal deviation; persistent septal deviations after endoscopic septoplasty; septal deviations which do not produce an obstructive symptom, but limit the endoscopic view; previously operated patients with persistent dorsal deviation; patients requiring limited operative time such as comorbid situations. This article is protected by copyright. All rights reserved.

Repair of Tegmen Tympani Defect Presenting with Spontaneous Cerebrospinal Fluid Otorrhea Using the Middle Cranial Fossa Approach

Spontaneous cerebrospinal fluid (CSF) otorrhea frequently occurs without temporal bone trauma, fracture, surgery, or any identifiable causes. It is usually associated with tegmen tympani defects of the temporal bone in adults. The congenital origin theory and the arachnoid granulation theory have been accepted to explain the tegmen tympani defect. Magnetic resonance imaging (MRI) and computed tomography (CT) are used to show the defects, brain tissue, and the meninges. We recently encountered three cases of spontaneous CSF otorrhea with a defect on the tegmental plate of the temporal bone. High-resolution CT (HRCT) scan of the temporal bones showed the tegmen tympani defects. The defects were successfully repaired with temporal muscle fascia or fascia lata graft and fibrin glue using the middle cranial fossa approach via craniotomy.

Migration of a foreign object to the parapharyngeal space: an unusual factitious disorder☆

Foreign body removal is a common procedure in Otorhinolaryngological (ORL) practice. It is common in pediatric age, however, it may also be seen in adults. In adults fish bones and swallowed Foreign Bodies (FB) are mostly seen. The most common places where FB are found are the palatine tonsils, vallecula and piriform sinuses; however, FB can, although rarely, migrate to deep neck spaces, like the parapharyngeal space. This case presents migration of a factitious foreign body to the Parapharyngeal Space (PPS).

Medicolegal aspects of rhinology practice

OBJECTIVE To investigate rhinology-related malpractice claims with the aim of optimising safe practice. METHODS The database of the National Institute of Forensic Medicine was reviewed. In total, 241 otorhinolaryngology malpractice case reports dating from 2005 to 2012 were evaluated, and 83 malpractice cases related to rhinology treatments were separated. RESULTS There was no significant difference between the number of male (n = 42) and female (n = 41) claimants. The mean patient age was 32.07 ± 10.53 years (range, 10-75 years). Seventy-nine cases involved surgical treatment in rhinology. The most common complaints were: unsatisfactory cosmetic results (n = 30), optic nerve injury (n = 10), septal perforation (n = 9) and intracranial penetration (n = 4). Malpractice was detected in 21 cases (25.3 per cent). No delinquency was found in 62 cases (74.7 per cent). CONCLUSION Physicians should be aware of legal consequences related to rhinology practice. Further study is needed on this topic, as well as interdisciplinary collaboration, to ensure best practices and to avoid litigation.

A new extended supracricoid laryngectomy technique for tongue base and hyoid bone involvement: crico-glosso-mandibulopexy technique.

In the conventional supracricoid laryngectomy technique, tumors extending beyond the lingual surface of the epiglottis with tongue base invasion are contraindicated due to the requirement of the hyoid bone resection. The loss of the hyoid bone causes intractable aspiration and renders the cricoidal pexy process impossible. Therefore, surgeons tend to treat such tumors with total or subtotal laryngectomies or organ preservation protocols. In this article, a new supracricoid partial laryngectomy technique for tumors requiring resection of the hyoid bone and the base of the tongue was described.

Revision surgery in cochlear implantation

OBJECTIVES In this study, we evaluated the reasons and management approaches for revision cochlear implant surgery. PATIENTS AND METHODS Thirty-two patients (20 males, 12 females; mean age 7.4 years; range 15 month to 54 years) who underwent revision cochlear implantation in our clinic were divided into two group, including reimplantation or non-reimplantation group. RESULTS Of patients who underwent revision surgery, 22 had reimplantation, while remaining 10 were not required reimplantation. The mean time from the first surgery to revision surgery was 17.3±15.2 months (range 1-59 months). In patients who underwent primary surgery in our clinic, the revision and reimplantation rates were 5.2% and 3.4%, respectively. The reasons for revision surgery included software failure of the device (n=7), local flap problems (n=7), reference electrode problems (n=5), magnet displacement (n=2), electrode migration to vestibule (n=2), extracochlear insertion of electrode (n=2), broken electrode (n=2), device failure following head trauma (n=2), facial stimulation and paralysis (n=1), electrode exposition from the external ear canal (n=1), and electrode exposition to the middle ear (n=1). CONCLUSION The most common reasons for the revision cochlear implant surgery are software failure of the device, local flap problems and electrode failures. In revision surgery, the problems should be solved without damaging the implant, if the implant is running.