Tevfik Sözen

Microsuture after benign vocal fold lesion removal: a randomized trial☆

PURPOSE Removal of benign vocal fold lesions results in small to moderate-sized mucosal defect on vocal fold, which heals by secondary intention. Microsuturing this defect leads to primary wound healing with fastened recovery and less scar. However, its value has not been determined. MATERIALS AND METHODS This is prospective, randomized, and controlled study performed in university hospital. Forty adults with vocal polyp, cyst, and Reinkes edema were included. Preoperatively, all patients completed VHI (Voice Handicap Index)-30, had acoustic analysis with continuous /a/ and videolaryngostroboscopy (VLS). The patients were randomly assigned to study group (with 1 or 2 6/0 vicryl suture) (n = 20) or control group (n = 20). Postoperative follow-up was done at the first, second, and fourth weeks. During follow-up examinations, VLS was repeated; the patients completed VHI-30 and had an acoustic analysis again. RESULTS All patients recovered with normal VLS and without complications; all were satisfied with the treatment result. The VHI results and acoustic analysis parameters of the study group were statistically significantly better than those of the control group at the first postoperative week (P < .05) but not at the second and fourth weeks (P > .05). Normal VLS was obtained significantly more early in the study group compared with the control group (P < .05). CONCLUSIONS Microlaryngoscopic removal of benign vocal fold lesions is a safe, satisfying procedure with excellent to good results if done according to its principles. Microsuturing of the mucosal defect helps to speed up recovery, although final result remains to be clinically unchanged. It may be beneficial for professional voice users by making early return of vocal fold function possible.

Total and Partial Laser Arytenoidectomy for Bilateral Vocal Fold Paralysis.

Introduction. Treatment for bilateral vocal fold paralysis (BVFP) has evolved from external irreversible procedures to endolaryngeal laser surgery with greater focus on anatomic and functional preservation. Since the introduction of endolaryngeal laser arytenoidectomy, certain modifications have been described, such as partial resection procedures and mucosa sparing techniques as opposed to total arytenoidectomy. Discussion. The primary outcome measure in studies on BVFP treatment using total or partial arytenoidectomy is avoidance of tracheotomy or decannulation and reported success ranges between 90 and 100% in this regard. Phonation is invariably affected and arytenoidectomy worsens both aerodynamic and acoustic vocal properties. Recent reports indicate that partial and total arytenoidectomies have similar outcome in respect to phonation and swallowing. We use CO2 laser assisted partial arytenoidectomy with a posteromedially based mucosal flap for primary cases and reserve total arytenoidectomy for revision. Lateral suturing of preserved mucosa provides tension on the vocal fold leading to better voice and leaves no raw surgical field to unpredictable scarring or granulation. Conclusion. Arytenoidectomy as a permanent static procedure remains a traditional yet sound choice in the treatment of BVFP. Laser dissection provides a precise dissection in a narrow surgical field and the possibility to perform partial arytenoidectomy.

Endoscopic Z-plasty for Treatment of Supraglottic Stenosis: A New Technique.

Endoscopic Z-plasty for Treatment of Supraglottic Stenosis: A New Technique Otolaryngology– Head and Neck Surgery 2015, Vol. 153(6) 1064–1066 American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/0194599815607201 http://otojournal.org Taner Yılmaz, MD, Shamkhal Jafarov, MD, Oğuz Kus xcxu, MD, Tevfik Sözen, MD, and Ahmet Emre Süslü, MD

Possible role of apoptosis in pathogenesis of adenoid hypertrophy and chronic adenoiditis: Prospective case-control study.

OBJECTIVE Apoptosis is a programmed cell death; it provides an important balance between lymphocytes in adenoid tissue. The aim of this study is to investigate the role of apoptosis in chronic adenoiditis and adenoid hypertrophy. This is the first study in the literature about apoptosis in adenoid hypertrophy and chronic adenoiditis. METHODS Prospective case-control study in a tertiary referral university hospital was conducted. 46 patients who had chronic adenoiditis and adenoid hypertrophy underwent adenoidectomy. Adenoids were evaluated for apoptosis and assembled into groups according to their size. Apoptotic cells were counted in three different microscopic fields and their average was taken for every microcompartment. As a result of immunohistochemical staining, specimens were compared for their apoptotic cell rate. RESULTS The difference in apoptosis of chronic adenoiditis and adenoid hypertrophy groups is statistically significant (p<0.05). The age 6 was used as a cut-off to compare apoptosis in adenoid tissue. The difference was not statistically significant for patients at and below 6 years of age; however, the difference was statistically significant for patients above 6 years of age. The comparison of apoptosis in microcompartments of adenoid tissue (intrafollicular, interfollicular, subepithelial and intraepithelial) between chronic adenoiditis and adenoid hypertrophy groups revealed significant differences for intrafollicular and intraepithelial areas, and insignificant differences for interfollicular and subepithelial areas. CONCLUSION Although apoptosis could not totally explain the pathogenesis of chronic adenoiditis and adenoid hypertrophy, it appeared to play an important role in it. Apoptosis functions to limit adenoid hypertrophy. Adenoid apoptosis appears to be age-dependent.

Quality of Life and Its Assessment Methods in Laryngeal Cancer

Treatment of laryngeal cancer commonly affects several basic physiological functions, such as breathing swallowing, speech, and salivary function. Selection of treatment modality and survival among these cases are both related to clinical stage at presentation. In selected situations where the surgical and non surgical treatment options (radiation therapy and chemotherapy) have shown similar survival benefits, Quality of Life (QoL) may be determinant factor in deciding between these modalities [1]. Although survival is the main interest concerning the patient’s treatment, other parameters such as quality of life are important, when various treatments options are compared, such as surgery and chemoradiation [2].

Association of Skin Thickness With Alar Base Reduction in Patients Undergoing Lateral Crural Repositioning and Strut Grafting

Importance Knowing the operation plan is important for rhinoplasty surgeons to prevent unpredictable results. Objectives To investigate the frequency of alar base resection in patients with different skin thickness who underwent lateral crural repositioning and lateral crural strut graft and to evaluate the results in the context of the current literature. Design, Setting, and Participants This retrospective case series study included 621 patients who underwent primary open septorhinoplasty by the same surgeon between January 1, 2012, and June 30, 2015. From the surgical notes, operation type (lateral crural repositioning [LCrep] with lateral crural strut grafting [LCSG] and with or without alar base resection) and skin type were recorded. Study participants’ skin types were determined intraoperatively and divided into 3 groups: (1) thick skin (the tip definition was limited by skin thickness and subcutaneous tissue), (2) thin skin (the tip cartilage was visible and could be observed despite overlying soft tissue and skin), and (3) normal skin (the tip cartilage during the procedure had no effect on the tip definition). Main Outcomes and Measures The rate of alar base resection according to the type of operation performed and patient skin thickness. Results Of the 621 patients in the study, 95 (15.3%) were men and 526 (84.7%) were women. Lateral crural repositioning with LCSG was performed in 319 surgical procedures (51.4%), and alar base reduction was performed in 329 (53.0%). The rate of alar base resection differed significantly on the basis of whether LCrep with LCSG was performed (odds ratio [OR], 1.82; 95% CI, 1.32-2.50; P < .001). In patients with thin skin, there was no significant difference in the incidence of alar base resection associated with LCrep with LCSG (OR, 2.034; 95% CI, 0.912-4.539; P = .08). In patients with thick skin, a significant difference in the frequency of alar base resection was associated with the application of LCrep with LCSG (OR, 1.995; 95% CI, 1.228-3.241; P = .005). In patients with normal skin, LCrep with LCSG had no significant association with the frequency of alar base resection (OR, 1.557; 95% CI, 0.930-2.607; P = .09). Conclusions and Relevance The necessity of alar base reduction after LCrep with LCSG is greater in patients with thick skin than in patients with thin and normal skin. This study is the first to our knowledge to examine this topic in rhinoplasty. Level of Evidence 3.