Umit Aydin

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.

Relationship between Nasal Valve Changes and Nasalance of the Voice

Objective It is well known that the nasal cavity and paranasal sinuses affect the acoustic characteristics of the voice as resonators. Any expansion in nasal valve area, the narrowest segment of the nasal cavity, affects the nasal resistance and therefore has the potential to alter the nasalance. The aim of this study was to investigate the effect of nasal valve changes on nasalance of the voice by using an external nasal dilator strip that widens the nasal valve area. Study Design Before-and-after study. Setting Tertiary university hospital. Subjects and Methods Healthy volunteer subjects who had no nasal or voice-related complaints were enrolled in the study. All subjects underwent acoustic rhinometry and nasometry before and while wearing a commercially available external nasal dilator strip. The data with and without the nasal strip were compared. Results Twenty-five subjects were enrolled in the study. After the application of nasal strips, statistically significant increases were observed in the minimal cross-sectional area of the nasal valve. However, there were no significant changes in the nasalance measurements. Conclusion Despite increasing the nasal valve area, application of the nasal strips did not cause any significant change in nasalance scores in healthy subjects, showing no relationship between the nasal valve and nasalance of the voice.

Intraoral excision of a huge retropharyngeal lipoma causing dysphagia and obstructive sleep apnea

Lipomas, derived from the mesenchyme, are the most common soft-tissue tumors in the body, but only 15% of them are located in the head and neck region.1 Head and neck lipomas usually arise from posterior cervical triangle and the incidence of lipoma in the retropharyngeal region is very rare.2,3 Herein, we present a case of retropharyngeal lipoma causing progressive dysphagia and obstructive sleep apnea (OSA) which is treated by transoral surgical excision. We also review the literature to discuss the management of retropharyngeal lipomas causing OSA. To the best of our knowledge, present case shows the most huge retropharyngeal lipoma in the English literature causing dysphagia and OSA.

Neurofibroma around the Ear Canal: Report of Three Cases.

Facial nerve neurofibromas are an uncommon entity, particularly in the intraparotid region. Three cases are presented herein, including the first reported case of both an intratemporal and intraparotid facial nerve malignant neurofibroma. To the best of our knowledge, this is the first medical publication to describe a neurofibroma involving both the intratemporal and intraparotid regions. The aim of this clinical record was to present the surgical experiences in three cases of intratemporal and intraparotid facial neurofibroma. Of the three cases of neurofibroma included in this report, the first case was a 30-year-old male who initially presented with a parotid mass without facial dysfunction. The other two cases were intratemporal neurofibromas, one of which was confirmed as a plexiform neurofibroma by pathology. These tumors often involve two or more segments of the facial nerve. The outcomes of these tumors are closely related to nerve integrity, preoperative facial nerve function level, and the follow-up period. Neurofibromas are most commonly found with neurofibromatosis type 1 and are characterized by incorporation of the nerve fibers within their matrix. Presentation of the intratemporal facial neurofibromas is variable, with facial palsy most common. Furthermore, the incidence of a solitary neurofibroma of the facial nerve originating in the parotid region is extremely low.

Osteoma and Ectopic Tooth of the Left Maxillary Sinus: A Unique Coexistence.

BACKGROUND Ectopic eruption of a tooth or osteoma rarely occurs within the maxillary sinus. Coexistence of these two rare entities in the maxillary sinus has never been reported in the English literature. CASE REPORT Herein, we present a 21 year-old male patient with osteoma and ectopic tooth in the left maxillary sinus treated with the removal of the ectopic tooth by endoscopic sinus surgery and excision of the osteoma by the Caldwell-Luc procedure. CONCLUSION Unique coexistence of two different entities in the maxillary sinus is most likely due to pediatric facial trauma. Pediatric patients with maxillofacial trauma should be carefully watched for dental injury both clinically and radiologically.

Reliability and validity of the Turkish Nose Obstruction Symptom Evaluation (NOSE) scale

Background/aim: The aim of this study was to validate the Turkish Nasal Obstruction Symptom Evaluation (T-NOSE) scale. Materials and methods: The NOSE scale was translated into Turkish. A prospective study was conducted involving adult subjects with nasal obstruction and a control group. The patients were divided into three groups, namely nasal septum deviation (NSD), septoplasty, and control groups. Internal consistency, test-retest reliability, validity, responsiveness, and the magnitude of the effect of surgery were all investigated. Results: In total, 253 subjects were enrolled in the study. Cronbach’s alpha was 0.938 and 0.942 upon test and retest, respectively, which proved good internal consistency. The mean kappa value was 0.82, indicating a high level of reproducibility. The difference between postoperative and control groups was not statistically significant (P < 0.05). The T-NOSE score of the NSD group was 65.67 ± 16.77, while it was 10.75 ± 12.25 for the control group (P < 0.01). The mean score improved following septoplasty (P < 0.001). The magnitude of the effect of surgery was considered high. The correlation between the visual analogue scale and NOSE scores was 0.948. Conclusion: The T-NOSE scale is a valid instrument with good internal consistency, reliability, reproducibility, validity, and responsiveness.

Comment on “Dysphagia and Obstructive Sleep Apnea in Acute, First-Ever, Ischemic Stroke”

We recently read the article by Losurdo et al published in the Journal of Stroke and Cerebrovascular Diseases.1 The authors suggest that both obstructive sleep apnea (OSA) and dysphagia are highly prevalent in first-ever, ischemic stroke, and these pathologies are associated in acute ischemic stroke. This is an interesting study, and the outcomes of the study are important for not only neurological sciences but also sleep medicine. We would like to emphasize 2 important issues regarding this article that should be taken into consideration. First, the authors mention that respiratory events were scored according to the current standard American Academy of Sleep Medicine criteria, and apnea hypopnea index (AHI) was calculated. AHI is the total number of events per hour, consisting of hypopneas, obstructive apneas, central apneas, and mixed apneas; therefore, in the polysomnography test, central apnea may be a component of total apneas. Central sleep apnea (CSA) is found rarer than OSA, and it occurs due to a temporary cessation of respiratory rhythmogenesis in neural respiratory networks during sleep.2 Frequently seen neurological diseases such as infarctions, arteriosclerosis, hemorrhage, tumors, head trauma, encephalitis, or other infectious diseases may cause central apnea during sleep.3 We want to point out that if the patient has ischemic stroke and apnea, he may also have CSA or Cheyne–Stokes breathing (CSB) besides OSA.4 Some of the patients included in present study may have predominantly CSA rather than OSA. The authors give no information about neither CSA nor CSB. Second, the endoscopic examination of the upper airway is one of the mandatory steps in the management of patients with OSA.5 The term “upper airway obstruction” in OSA may comprise functional (dynamic) obstructions, anatomical (i.e., large tonsils, septum deviation, nasal polyps) obstructions, or both. Endoscopic assessment shows not only the anatomical properties and closing patterns of the upper airway but also other pathologies such as nasopharyngeal, oropharyngeal, and hypopharyngeal mass lesions. Hypopharyngeal lesions may represent both OSA and dysphagia independent of stroke.6 Elderly patients with OSA and dysphagia are more likely to have a mass lesion in the hypopharyngeal region of upper airway compared with young patients, and the mean age is 66.9 ± 11.9 years in this study. So, the patients with newly diagnosed OSA may have unrecognized mass lesion causing mechanic obstruction and dysphagia in the upper airway if they are not evaluated with an endoscopic examination. Therefore, endoscopic evaluation is also mandatory for differential diagnosis of dysphagia especially in elderly patients with OSA. We appreciate the authors for their valuable work; however, we think that the materials and methods of this article lack aforementioned issues. Our comments do not minify the value and importance of this article, but the previously discussed points cannot be totally excluded from the management of patients with stroke having both OSA and dysphagia.

Another cause of difficult airway in an elderly patient: Tongue-base abscess

OBJECTIVE An abscess of the tongue base is rare, but it can be a potentially life-threatening situation in elderly patients. CASE REPORT A 72-year-old male patient presented with mid-anterior neck swelling, odynophagia, poor oral hygiene and severe dyspnoea. After a difficult intubation, the muscles were dissected via a submental suprahyoid approach and the abscess was drained. CONCLUSION Poor oral hygiene may predispose elderly patients to tongue-base abscesses. An early decision should be made for surgical drainage due to the risk of airway obstruction.

Chronic sialadenitis due to the stone inside the accessory duct of submandibular gland

PurposeSialolithiasis is the most common cause of chronic sialadenitis. In this case report, intraoperative finding of an accessory submandibular duct, obstructed with stone, originating from the same gland nearby the main Warthon’s duct, is presented.Case reportA 22-year-old male patient, suffering from eating-related pain and swelling in his left submandibular region, was diagnosed with left sublandibular gland sialadenitis with radiologically manifested sialolithiasis, and gland excision was advised. Surgery was performed under general anesthesia. When the full anatomical scenery was delineated before excision of the gland, we surprisingly encountered two submandibular ducts originating from ipsilateral gland, one of them was obstructed with stone. After two ducts were ligated, the gland with sialolith was excised. According to histopathologic examination, the duct obstructed with stone was identified as the accessory duct and the other one was the main Wharton’s duct. Postoperative days were uneventful; no neurologic complication was observed.ConclusionsOtolaryngologists should be aware of anatomic variations of the submandibular duct(s) to avoid possible complications, especially intraoperatively, because rutine preoperative radiologic preparation does not include investigation of possible accessory ducts.

A tertiary center experience with velopharyngeal surgical techniques for treatment of snoring and obstructive sleep apnea

OBJECTIVES The aim of this study was to assess the outcomes of patients who treated with the relatively new surgical procedures; anterior palatoplasty (AP), Cahali lateral pharyngoplasty (CLP), and expansion sphincter pharyngoplasty (ESP) for habitual snoring or obstructive sleep apnea (OSA). METHODS Prospective series of 93 patients were evaluated. The performed surgical techniques, polysomnographic outcomes, pre- and postoperative clinical parameters, and complication rates were assessed. RESULTS There were 14 snorers and 79 OSA patients. The mean age was 40.7 years, mean BMI was 27.67kg/m2, and the mean follow-up time was 5.90 months. There were 30 subjects in AP, 30 subjects in CLP, and 33 subjects in ESP groups. Apnea hypopnea index (AHI) improved from 16.90 to 14.27 (p=0.135) in AP, from 17.69 to 12.05 in CLP (p=0.004), and from 26.83 to 9.08 in ESP groups (p<0.001). When surgical success criteria is defined as more than 50% reduction in AHI to final AHI <15events/h, success rates were 45%, 64%, and 74% in AP, CLP, and ESP groups, respectively. Epworth Sleepiness Scale and visual analog scale for snoring significantly decreased after all procedures (p<0.05). The minimum oxygen saturation significantly increased after all procedures, however, only ESP caused statistically significant improvements in oxygen desaturation index, mean SaO2 and the percentage of sleep time with SaO2 below 90%. During the follow-up period, 61 of 93 patients (65.6%) indicated one or more complaints, but none of them was persistent. CONCLUSION We suggest that these relatively new velopharyngeal surgical techniques are effective in the management of snoring and OSA without causing persistent side-effects, and ESP is one step ahead of the other two techniques.