Serdar Karahatay

Primary parotid tuberculosis mimicking parotid neoplasm: a case report.

IntroductionTuberculosis of the parotid gland is a rare clinical entity which causes some difficulties in diagnosis because of the similarities in presentation to that of a neoplasm. Diagnosis mainly relies in the treating physician having a high index of suspicion. The diagnosis is generally overlooked by otolaryngologists and most cases are undergoing unnecessary surgery.Case presentationA 20-year-old male presented with a mass in the right parotid region. The mass had been present for one year. Physical examination revealed a mobile, non-tender mass occupying the superficial lobe of the right parotid gland. Radiologic investigations revealed a well-defined, solid, mass lesion located in the posterior part of the superficial lobe of the right parotid gland. A provisional diagnosis of a neoplasm of the parotid gland was made and a right superficial parotidectomy was performed. Histopathologic examination of the specimen was reported as tuberculosis of the parotid gland. The patient was commenced on antitubercular chemotherapy.ConclusionAlthough rare, tuberculosis should be kept in mind and considered in the differential diagnosis of patients presenting with a solitary tumor in the parotid gland in order to avoid unnecessary surgery.

Eosinophilic granuloma of the bilateral temporal bone.

An unusual presentation of eosinophilic granuloma (EG) of the bilateral temporal bone in a 2-year-old male child is discussed with the literature review. Involvement of the temporal bone is relatively uncommon and otorrhea or symptoms resembling mastoiditis are nonspecific. This rare condition should be kept in mind in differential diagnosis of otitis media refractory to medical therapy.

Repair of transected facial nerve with mesenchymal stromal cells: histopathologic evidence of superior outcome.

Despite advanced surgical techniques, clinical results of the transected facial nerve are still far from the desired outcome. Mesenchymal stromal cells (MSCs) were shown to transdifferentiate into Schwann cells and express some growth factors beneficial in peripheral nerve injury. We aimed to document histopathological improvement obtained from application of the homograft bone marrow‐derived MSCs immediately after conventional anastomosis of a transected facial nerve branch in rats, and to compare the results with those nerves anastomosed only.

SUBMANDIBULAR TRIANGLE MASSES

Objective The study aims to analyze the demographic data of a large case series operated on because of submandibular triangle mass for more than 10 years and presents a review of the literature. Materials and Methods The charts of patients who underwent surgical intervention for submandibular triangle mass between January 2000 and November 2010 were reviewed. The medical history, age, sex, duration of symptoms, clinical presentation, preoperative investigations, and histopathologic diagnosis were reviewed. Results The study included 66 subjects; 12 patients (18.2%) with submandibular sialolithiasis, 18 patients (27.2%) with sialadenitis, 10 patients with lymphadenitis (15.1%), and 26 patients (39.3%) with tumors. Of the tumors, 23% was malignant and 77% was benign. Benign tumors of submandibular gland comprised 22.7% and malign tumors of submandibular gland comprised 3% of all submandibular mass. The most common benign tumor was pleomorphic adenoma. The most frequent histopathologic diagnoses of submandibular masses originated from the submandibular gland, and these comprised 71.2% of all submandibular mass pathologies. The main symptom was a painless mass. Ultrasonography was the most common preoperative diagnostic procedure. Fine-needle aspiration biopsy was performed in 26 patients. A clear diagnosis could not be provided in 3 (12%) patients. Conclusion Infectious conditions and benign tumors are more frequent than malign tumors in the submandibular region. The histopathologic diagnoses mainly consisted of submandibular sialadenitis, sialolithiasis, pleomorphic adenoma, and lymphadenitis. Ultrasonography is the first option of radiologic evaluation. Fine-needle aspiration biopsy is a very useful and usually sufficient diagnostic procedure for histopathologic diagnosis. Excisional biopsy can be performed when the fine-needle aspiration biopsy failed.

A comparative study on efficiency of middle ear pressure equalization techniques in healthy volunteers

OBJECTIVE To compare success rates of middle ear inflation device (Ear Popper (©)), Valsalva maneuver and Toynbee maneuver in middle ear pressure equalization in healthy adults. MATERIALS AND METHODS Adult volunteers with otoscopically healthy ears were enrolled to the study. In a prospective setting, 60 ears of 35 volunteers were divided into two groups according to eustachian tube (ET) functions tested using the nine step inflation deflation test. Group A: good eustachian tube function at nine step inflation deflation test (30 ears), Group B: possible dysfunction of the ET at nine step inflation deflation test (30 ears). All the volunteers performed Valsalva maneuver, Toynbee maneuver and Ear Popper(©) application, respectively. The efficiencies of all the three techniques were statistically compared first overall, then paired-wise between the two groups. RESULTS There was no statistical difference in success rates of middle ear pressure equalization techniques in 60 ears, regardless of ET function results (Valsalva and Toynbee maneuvers 51.7% effective, Ear Popper(©) 43.3% effective). There was also no statistical difference among the middle ear pressure shifts obtained by these three techniques. In almost half of the subjects in whom at least one technique was unsuccessful, the other two was effective. When the groups were separately compared; there was no significant difference between Valsalva and Toynbee maneuvers, whereas Ear Popper(©) was found more effective in Group A (56.7% vs. 30%, p=0.037). CONCLUSION No statistical difference in equalization of the middle ear pressure was found among Valsalva maneuvers, Toynbee maneuvers and Ear Popper(©) in healthy adults under physiological conditions. Using alternative techniques may improve the success individually when a technique fails.

Minor salivary gland neoplasms.

ObjectiveThis study aimed to investigate the clinical presentation, histopathologic and epidemiological aspects, as well as the treatment modalities and outcomes of patients with minor salivary gland tumors (MSGTs). Subjects and MethodsA series of 23 patients with MSGTs were reviewed retrospectively. ResultsThis study included 11 (48%) benign and 12 (52%) malignant tumors of minor salivary glands. Minor salivary gland tumors were more common in men (70%) than in women (30%). The mean age was 31.3 years for benign tumors and 46.3 years for malignant tumors. Pleomorphic adenoma was the most common benign tumor, followed by myoepithelioma. Mucoepidermoid carcinoma and adenoid cystic carcinoma were the most common malignant tumors. The most common symptom was a painless mass of the palate. Surgical treatment was performed in all patients. Adjuvant radiotherapy was used in 3 malignant tumors. Twenty-three patients were followed-up for a median of 5 years. Two patients with malignant tumors underwent a second surgery for postoperative local recurrence. They were successfully treated with the second surgery. ConclusionsMinor salivary gland tumors are relatively uncommon neoplasms of the head and neck region. There is limited literature on MSGTs. This study provides a versatile approach for MSGTs from demographic data and clinical presentations to treatment modalities and treatment outcomes.

Chyle Fistula after Neck Dissection for an Unusual Breast Cancer Recurrence.

Background: Chyle fistula is one of the rare complications of neck dissections. Even though no consented algorithm for the management of this entity has been established yet, conservative treatment options including somatostatin analogues have been suggested as an adequate modality for low output fistulas. Case Report: Here we present a patient with a right-sided neck fistula which was resistant to conventional treatment, and was finally treated by surgery. The neck dissection was performed for a malignant right neck mass that was accepted as the lymph node metastasis of formerly treated papillary thyroid carcinoma. The pathology of the specimen revealed a contralateral neck metastasis of previously treated breast carcinoma. Conclusion: We assume that consecutive surgeries on axillary and neck lymph pathways resulted in such a complicated and exceptional case.

Life Priorities in Head and Neck Cancer Patients Between Ages of 45 to 65.

Diseases in head and neck cancer patients and applied therapies according to former affect life quality to a higher extent. In this paper, life priorities in 49 patients with head and neck cancer who referred to Gulhane Military Medical Academy for diagnostic and therapeutic purposes and the relationship between these priorities and sociodemographic properties have been studied. Following life priorities have been observed more important for the patients: to communicate with people in social places, to eat without any help by themselves, external appearance, taste and odor sense, continuing sexual life. Other priorities have been observed less important for the patients: attending social activities like cinema and theater, swimming pool and sea sports, money required for check-ups, necessities like time. Besides, these necessities do not show dissimilarities to any significant extent according to sociodemographic properties of the patients.

The Practicability of Transnasal Esophagoscopy and the Evaluation of Patient’s Perception: A Prospective Study

Objectives Transnasal esophagoscopy (TNE) is a relatively new diagnostic procedure in the evaluation of patients with globus sensation and dysphagia. Enabling doctors to examine all of the upper aerodigestive system without the need for sedation, this technique is becoming more popular among otolaryngology specialists. The aim of this study is to evaluate the practicability of TNE and tolerability of patients to the test. Methods The study group consisted of 314 patients who were admitted to the swallowing center of a tertiary medical institution with the symptoms of dysphagia and globus sensation. In addition to other diagnostic procedures, patients were informed of the TNE and the necessary consents were obtained. Before the examination, patients were asked to foresee the level of discomfort they would presumably feel, according to the information they had. After the TNE, patients were asked to score the real level of discomfort they experienced during the test. A visual analog scale was used to note the levels. The duration of the tests and any complications were also noted. Results We could not perform TNE in 12 of the 314 patients due to nasal obstruction, intractable retching and vasovagal syncope (7, 4, and 1 patients, respectively). The average discomfort score foreseen before the test was 4.7±1.4 (mean±standard deviation). The post-procedure discomfort score was 1.6±1.1, and the difference was statistically significant (P<0.001). The average time to perform the TNE was 5 minutes (range, 3 to 13 minutes). Except for minor epistaxis in 7 patients (2%), no complications occurred. Conclusion According to our results, TNE is an easy and well-tolerated procedure, it may be logical to tell the patient that the procedure will be less annoying and irritating than they assume. It is also a time saving procedure with low complication rates.

Epiglottic cyst as an etiological factor of globus sensation

BACKGROUND/AIMS Globus is a subjective complaint that describes a sensation of a lump or a foreign body in the throat. Despite being a well-known and common clinical condition, the etiological factors have not been definitely elucidated yet. The study was set up to ascertain the relationship between epiglottic cysts and globus sensation. MATERIALS AND METHODS All patients undergoing investigation and treatments for globus sensation were included in the study. Patients with epiglottic cysts but no other possible causes of globus sensation were constituted the series of patients. Patients were asked to assess the levels of complaint before and after the carbon dioxide (CO2) laser excisions of the cysts. RESULTS Epiglottic cysts were found in 10 (5.4%) of the 182 patients. Three of these 10 patients who had concomitant diseases or conditions that may cause globus sensation and one patient who refused the surgery were excluded from the study. All the remaining six patients reported relief of the globus sensation after the CO2 laser excisions of the cysts. CONCLUSION Our results, obtained from this limited series, indicated that epiglottic cysts may be considered as one of the etiological factors of globus sensation.