Suha Beton

Current diagnosis and treatment of laryngocele in adults

Objective To evaluate the treatment outcome of a series of laryngoceles and to comment on the current diagnosis and management of laryngoceles. Study Design and Setting A retrospective review of charts, radiological and histopathological notes, videolaryngostroboscopic records, and acoustic voice analyses of patients with laryngocele treated over a 10-year period was undertaken. Results Seven patients had internal laryngoceles; one had external; another one had combined laryngocele. Patients with internal laryngocele underwent endoscopic CO2 laser resection, while those with external or combined laryngocele were treated via external approach. Quality of voice was improved and no recurrences were encountered during the follow-up. No evidence of laryngeal cancer was found on the histological examinations. Conclusion Endoscopic CO2 laser resection of internal laryngocele provides a reliable and cost-effective method that minimizes hospitalization and the need for tracheotomy. We believe that advances in the applications of laser in microlaryngosurgery will alter the traditional management of all type of laryngoceles.

Olfactory functions after transsphenoidal pituitary surgery: Endoscopic versus microscopic approach

Olfactory disturbances could be observed following transsphenoidal pituitary surgeries. To our knowledge, no previous comparative studies on olfactory functions after transsphenoidal endoscopic and microscopic approaches have been performed.

How Often Does Isolated Sphenoid Sinus Disease Turn Out to be a Neoplasm

AbstractIsolated sphenoid sinus disease (ISSD) describes a wide spectrum of pathologies including inflammatory, vascular, bony dysplastic, and neoplastic diseases. The aim of this study was to assess the frequency with which a neoplastic process was diagnosed in patients of ISSD and patient management strategies. A retrospective analysis was conducted for all ISSD patients who underwent surgery between January 2005 and January 2014 at a tertiary center. The clinical characteristics, radiologic studies, operative findings, endoscopic surgical techniques, pathology results, and treatment outcomes of the patients were analyzed. In all, 42 patients (31 women and 11 men) were included in the study. Histopathologic examinations revealed that 10 patients (23.4%) had neoplasms (8 benign and 2 malignant), 19 (45.2%) had mucocele, 7 (16.7%) had fungal disease, and 6 (14.3%) had meningoencephalocele and cerebrospinal fluid leakage. With the exception of 2 patients with plasmacytoma, complete removal of the lesions was achieved in all patients using transnasal or transethmoidal endoscopic approaches, and no local recurrences were observed during the mean follow-up period of 42 months. More than one fifth of the patients with ISSD were diagnosed with neoplasms. The results indicated that endonasal endoscopic approaches could effectively help manage patients with ISSD lesions, including those that were neoplastic. It is clear that precaution during preoperative planning is imperative to avoid unexpected situations and complications that may put surgeons in a difficult position during surgery.

Does Dehiscence of the Facial Nerve Canal Affect Tympanoplasty Results

AbstractThis study aimed to evaluate the prevalence of facial nerve canal dehiscence in tympanoplasty patients and its influence on the need for revision surgery and on hearing results and anatomical outcomes. Patients who underwent tympanoplasty with/without mastoidectomy at Ankara University Otolaryngology Department from 2006 through 2013 with a minimum follow-up period of 6 months were reviewed retrospectively in this original study. Patients were divided into those with and without cholesteatoma. Numbers and frequencies of dehiscence were recorded according to disease type, the need for revision surgery, and hearing results and anatomical outcomes. Study subjects included 206 patients, of whom 15 (7.3%) had dehiscence. The prevalence of dehiscence was significantly high in the patients with cholesteatoma (13/50 patients) compared with those without (2/156 patients). The dehiscence frequency was significantly high in cholesteatoma (42.8%), as well as overall (14.7%), revision-surgery patients. Hearing results (P < 0.05) and anatomical outcomes were better in patients without dehiscence. Dehiscence is more common in patients with than without cholesteatoma and negatively affects tympanoplasty outcomes, including hearing results, anatomical outcomes, and the need for revision surgery.

Does Type of Pharyngeal Packing during Sinonasal Surgery Have an Effect on PONV and Throat Pain

Objective Postoperative nausea and vomiting (PONV) is a common problem that affects up to 30% of all surgical patients after general anaesthesia, which increases in sinonasal surgery due the very potent emetic effect of ingested blood that is swallowed during the procedures. Therefore, a hypo/oropharyngeal packing is commonly placed in an effort to prevent blood ingestion. The primary aim of this study was to compare the efficacy of 3 packing types in preventing PONV and to compare the results with patients who received no packing. The secondary aim was to compare the postoperative throat pain in all 4 groups. Study Design A prospective double-blind randomized controlled study. Setting A university hospital. Subjects and Methods After Institutional Review Board approval and informed consent, 201 adult patients scheduled for sinonasal surgery were randomized to 4 groups to have dry packing (n = 52), packing soaked with water (n = 48), packing soaked with chlorhexidine gluconate and benzydamine hydrochloride (n = 51), or no packing (n = 50). Postoperative PONV and throat pain were assessed. Results Demographic data, procedural characteristics, and PONV risk scores were similar among groups. The PONV incidences, throat pain scores, and analgesic use were comparable in all 4 groups. Conclusion Despite commonly used practices, usage of different types of pharyngeal packing did not affect incidence of PONV and throat pain, nor did usage of no packing.

Titanium versus Hydroxyapatite Prostheses: Comparison of Hearing and Anatomical Outcomes after Ossicular Chain Reconstruction

Objective This study aimed to compare hearing and anatomical outcomes after ossicular chain reconstruction with titanium or hydroxyapatite prostheses. Methods In this study, patients who underwent tympanoplasty and ossicular chain reconstruction with titanium or hydroxyapatite prostheses at a university hospital from January 2007 to February 2013 were retrospectively reviewed; they had a minimum follow-up period of 6 months. Patients were divided into 4 groups according to the type of prostheses. The surgical procedure, follow-up examinations, preoperative, and postoperative audiometry results were noted and evaluated for partial and total prostheses. The results were compared both for titanium and hydroxyapatite prostheses. Results The study subjects included 51 patients. Titanium had better hearing results in partial prostheses (p<0.05), while the anatomical outcomes were similar. Nevertheless, both types had similar results in total prostheses (p>0.05). The extrusion rate was 5.8% for all patients. Conclusion Both types of prostheses had satisfactory functional and anatomical results and no preponderance could be stated, except for the hearing results of partial titanium prostheses.

Pneumocephalus after endoscopic odontoidectomy in a pediatric patient: the lesson learned

IntroductionPostoperative pneumocephalus is an unexpected condition after endoscopic odontoidectomy surgery.CaseWe present the first case of pneumocephalus after odontoidectomy in a pediatric patient. The clinical presentation, radiological findings, and surgical procedures are described with related pathophysiology.ConclusionWe outline the key for management of a rare intracranial air entrapment case after an endoscopic odontoidectomy surgery in a pediatric patient and the measures taken to prevent its occurrence in the future.

Endoscopic endonasal approaches to craniovertebral junction pathologies: a single-center experience

AIM: To review our experience of using the endoscopic endonasal approach for clivus and odontoid pathologies as well as craniovertebral junction anomalies at our institution. MATERIAL and METHODS: We retrospectively evaluated 41 patients (21 male, 20 female; age range, 2–65 years) who underwent endoscopic endonasal procedures for craniovertebral junction pathologies between 2008 and 2017. RESULTS: Of the 41 patients, 27 had clivus lesions, 7 had odontoid lesions, 6 had basilar invagination, and 1 had rhinorrhea repair. Six patients underwent an additional posterior decompression/fusion either before or after the endonasal procedure. None of the patients required tracheostomy, and cerebrospinal fluid leakage was postoperatively detected in one patient. The patients’ mean modified Rankin scale and visual analog scale scores were 3 and 4, respectively. The follow-up period ranged from 12 to 50 months. CONCLUSION: Although the microscopic transoral approach has been considered the gold standard for craniovertebral junction surgical management, endoscopic approaches are feasible, safe, and effective for addressing pathologies in this region, with developing technique and surgical experience.

Cartilage reinforcement graft versus fascia graft in tympanoplasty

Background/aim: The purpose of this study was to compare cartilage reinforcement graft results with temporalis fascia graft alone in terms of hearing and anatomical outcomes in tympanoplasty. Materials and methods: Patients who underwent tympanoplasty with/without ossiculoplasty and/or mastoidectomy at a university hospital from 2006 through 2013 were reviewed retrospectively. The patients were divided into those grafted with temporalis muscle fascia alone and with fascia reinforced with cartilage. The postoperative air bone gap, gain in hearing thresholds, and graft status were evaluated for each group. Results: The study subjects included 179 patients. There were 82 patients in the fascia group and 97 patients in the cartilage group. Successful hearing results were elicited in 79.2% of the fascia group and 85.5% of the cartilage group. There was no significant difference in overall graft success. The graft was intact in 82.9% of the fascia group and 86.5% of the cartilage group. Conclusion: In this comparative study the use of cartilage to reinforce the temporalis muscle fascia was analyzed, showing better hearing and anatomical results than sole use of fascia in tympanoplasty both for primary and revision cases. Thus, in the light of our results, when performing tympanoplasty we recommend the use of cartilage reinforcement grafting whenever needed and indicated.

Bilateral choanal atresia in an adult woman with pycnodysostosis

Pycnodysostosis (PYCD, OMIM: 265800) is an uncommon, autosomal recessive condition, first described by Maroteaux and Lamy in 1962 (Maroteaux and Lamy 1962). PYCD is also known as Toulouse-Lautrec disease, after the French artist Henri de Toulouse-Lautrec who may have had the disease (Hodder et al. 2015). Responsible gene for this phenotype (CTSK) codes the enzyme cathepsin K that is important for normal osteoclasts’ function. The characteristic features of pycnodysostosis are short stature, bone fragility with osteosclerosis, acro-osteolysis of the distal phalanges, delayed suture closure, obtuse mandibular angle, prominent eyes and brachydactyly. Craniofacial abnormalities such as maxillofacial malformations, narrow palate and dental anomalies frequently accompany pycnodysostosis. Airway problems have also been described in pycnodysostosis patients (Testani et al. 2014). Congenital choanal atresia was first described by Roederer in 1755 (Hengerer and Strome 1982). Choanal atresia can occur alone or it can be a component of other syndromes such as CHARGE syndrome, and other craniosynostosis syndromes (Crouzon syndrome, Pfeiffer syndrome etc.). Here, we describe a pycnodysostosis case with bilateral choanal atresia in addition to other findings. A 23-year-old woman from a consanguineous Turkish family was referred to us because of her craniofacial dysmorphism, short stature, unilateral hearing loss and bilateral choanal atresia. Clinical examination showed frontal bossing, bilateral frontotemporal grooving, proptosis, prominent nose, retro-micrognathia, narrow palate, wrinkled skin, brachydactyly, broad thumbs, bilateral sandal gap deformity (Fig. 1a). Her height was 133 cm, (below 3 percentile) and her mental status seemed normal. Pedigree analysis showed autosomal recessive pattern with two more similar patients in the family. Radiographic examinations showed metopic craniosynostosis, open wide cranial sutures, hypoplasia of terminal phalanges and acro-osteolysis, sclerosis of vertebral bodies and anterior scalloping (spool-shaped vertebrae), Madelung deformity of forearm, and Erlenmayer flaks deformity of long bones (Fig. 1b–e). Genomic DNA was isolated from peripheral blood samples of the patient using MagnaPure LC DNA Isolation Kit-Large Volume and MagnaPure LC instrument (Roche Applied Science, Mannheim, Germany). CTSK gene mutation analysis was performed by sequencing of the coding exons and the exon-intron boundaries of the genes. Sequencing was carried out with Miseq V2 chemistry on MiSeq instrument (Illumina California, USA). Analysis was performed with IGV software. c.934C > T (p.R312X) homozygote mutation was found in the 8th exon of the CTSK gene. She had complained of nasal congestion and was refered to the otorhinolaryngology department. During endoscopic examination, bilateral choanal atresia with unilateral pin point perforation were found (Fig. 1f). On computed tomography, soft tissue was detected in the posterior portion of the nasal cavity, which was obliterated to choana and also open cranial sutures were seen (Fig. 1b,d). Endoscopic transnasal repair of choanal atresia was performed. Cathepsin K is a cysteine protease that plays an important role in degradation of collagen type I and other bone proteins (Motyckova and Fisher 2002). Cathepsin K is a major lysosomal protease in bone resorption that is highly expressed in osteoclasts. Pycnodysostosis is caused by homozygous or compound heterozygous mutations in the CTSK gene. In pycnodysostosis osteoclast numbers and demineralizing function are normal; however, degradation of the organic matrix is insufficient (Gelb et al. 1996). Various mutations in the CTSK gene were identified in patients. In our case, nonsense c.934C > T (p.R312X) homozygote mutation was observed and this mutation was reported previously in Turkish patients (Arman et al. 2014). This mutation occurs by changing of the C residue of CGA encoding arginine to T resulted in TGA, stop codon on CTSK gene. Choanal atresia is a congenital abnormality and it can be unilateral or bilateral. The bilateral defect is more rare and generally present in a newborn as a medical emergency. Hence, bilateral choanal atresia is uncommon in adults and there are only a few cases reported in the literature. Respiratory involvement, such as obstructive sleep apnea syndrome, upper airway narrowing and respiratory distress, is frequent in patients with pycnodysostosis (Testani et al. 2014). However, pycnodysostosis with bilateral choanal atresia have not been reported earlier in the literature. Choanal atresia can be a component of a genetic syndrome. Medical genetics consultation should be requested when choanal atresia is not isolated.