Umut Akyol

Endolaryngeal dilatation versus laryngotracheal reconstruction in the primary management of subglottic stenosis

OBJECTIVES The scope of the study is to compare endolaryngeal dilatations (ED) with laryngotracheal reconstruction with cartilage grafting (LTRCG) in terms of restenosis. METHODS Pediatric subglottic stenosis patients treated in Hacettepe University, between 2002 and 2012 were retrospectively evaluated. Patients who had ED or LTRCG as primary management were included in the study. EDs were grouped into bronchoscopic dilatation (BD), laser incision and balloon dilatation (LBD) and cold knife incision and balloon dilatation (CKBD). The groups were evaluated in terms of restenosis and decannulation rates. RESULTS There were 35 patients (9 females, 26 males; mean age 4.42). LTRCG was performed in 16 patients (9 anterior and 7 anterior and posterior grafts). EDs were performed in 19 patients with 6 CKBDs, 7 LBDs and 6 BDs. There were 3 grade II, 13 grade III cases in the LTRCG group while 4 grade I, 6 grade II, 8 grade 3 and 1 grade 4 in the ED group. Overall decannulation rate was 97% (34/35) in all patients. Restenosis was higher in the ED group (63.2%) than the LTRCG group (31.3%) with rates of CKBD 16.7% (1/6), LBD 71.4% (5/7) and BD 100% (6/6). Restenosis rates were found to be increasing with higher grades (grade I-25%, grade II-66%, grade III-85%). CONCLUSION ED may need more repetitive interventions than LTRCG due to restenosis. Less restenosis might be observed when balloon is used for dilatation and cold knife for mucosal incisions.

Minimally invasive endoscope-assisted surgery for bilateral branchial cleft fistula

INTRODUCTION Branchial cleft anomalies are the second most common head and neck congenital lesions seen in children. They present as cysts, fistulas, sinuses, or cartilaginous remnants. Bilateral anomalies occur in 2% to 3% of all cases; the rate of bilateralism is higher in familial cases. Fistulas of the second branchial cleft are the most common branchial anomalies, accounting for as many as 90% of all branchial cleft fistulas. They are typically seen at a site along the anterior border of the sternocleidomastoid muscle. These lesions do not regress spontaneously and have a high rate of recurrent infections. Surgical excision is the definitive treatment for branchial anomalies. Their excisions can be difficult and complicated because the tract follows a long way in the neck and usually travels to the carotid bifurcation and opens into the pharyngeal pouch, or goes high and opens to tonsillary fossa. This report describes a technique in which a complete excision of fistula of the second branchial arch is facilitated by using endoscopes.

Treatment of congenital nasal cavity stenosis by balloon dilatation in a newborn: A case report

Neonates are obligate nasal breathers, and any form of neonatal nasal obstruction may have serious consequences. Prompt diagnosis and appropriate treatment are essential to avoid severe hypoxia. Congenital bony nasal stenosis (CBNS) is an extremely rare cause of neonatal nasal airway obstruction and can easily be confused with choanal atresia or stenosis. This is a paper to describe a balloon dilatation technique that can be an effective alternative to surgery for the treatment of congenital nasal cavity stenosis, with minimal stress to the patient.

Kimura's disease in paraglottic space.

Kimura’s disease (KD) is a chronic non-neoplastic entity that was first described by Kimura et al in 1948. It is primarily seen in male Asians during the second and third decades of life. Although described as occurring throughout the subcutaneous areas of the body, the major physical manifestation of this disorder is slowly enlarging subcutaneous masses often found in the head and neck area, particularly on the external ear and usually in association with peripheral blood and tissue eosinophilia in combination with markedly increased serum IgE concentrations. The cause of the disease is still unknown but several theories including a hypersensitivity reaction to a continuous antigenic stimulus, a parasitic infection, and neoplastic change have been proposed. The general consensus favors hypersensitivity reaction. The disease is self-limiting and responds best to adequate local surgical excision. The clinical and pathologic features of Kimura’s disease overlap significantly with those of angiolymphoid hyperplasia with eosinophilia (ALHE). Pathologically both are characterized by vascular proliferation and chronic inflammation with a conspicuous infiltration of eosinophils. The terms KD and ALHE have been used synonymously in many reports in the American and European literature. Despite their similarities, today they are accepted to represent different entities, differing in both histopathologic and clinical grounds. Histopathologically, they can be differentiated mainly with respect to the morphology of the vascular endothelial cells. The vessels in Kimura’s disease are lined by endothelial cells that are flat and bland, those in ALHE on the other hand are characterized by an epithelioid or histiocytoid appearance. ALHE, also known as “epithelioid hemangioma” is therefore thought to represent the benign spectrum of vascular entities such as epithelioid hemangioendothelioma and epithelioid angiosarcoma, all of which

Flow-volume curve in the diagnosis and follow-up of intrathoracic airway obstruction

Spirometry is an easy method to measure lung function and to show pathophysiology. It assists not only to determine the severity of bronchial obstruction in asthma but also to differentiate the characteristics of the intrathoracic diseases narrowing the central airways. Different types of benign and malignant tumors of the trachea may cause emergence of symptoms of airway obstruction. Herein a patient who had been initially diagnosed with asthma but later on shown to have intratracheal myofibroblastic tumor is presented. The importance of flow-volume curve in both initial diagnosis of the mass and in the detection of recurrence is discussed.

Otorhinolaryngological, audiovestibular and swallowing manifestations of patients with Niemann-Pick disease Type C §

OBJECTIVES The aim of this study is to evaluate audiovestibular and swallowing impairment of patients with NPC. METHODS Audiovestibular and swallowing evaluation were performed on patients with Niemann-Pick disease type C (NPC) at Hacettepe University between 20013 and 2015 prospectively. Pure-tone audiometry (PTA), Auditory Brain stem response (ABR), Flexible endoscopic evaluation of swallowing (FEES) test and posturography were done. Hearing, swallowing and balance states were measured. RESULTS There were 16 patients (5 male and 11 female, with a median age of 6.5 years old). The most common ABR abnormalities observed were absent waves I and III (%70 absent I waves, %43.75 absent III waves). Twelve of sixteen patients (%75) had an ABR abnormality in at least one ear, of these, four patients had normal hearing and three of them had periferal hearing loss. 12 (75%) patients had complaint of postural imbalance. 11(69%) of patients had peripheral and one (6%) patient had central impairment. Nine of sixteen patients (56.25%) show some degree of dysphagia (either penetration or aspiration). Two patients (12.5%) showed aspiration both liquid and viscous nutrition. Three patients (18.75%) showed aspiration primarily in liquids and two of them had penetration with viscous nutrition. Three patients (18.75%) had penetration with no aspiration neither liquid nor viscous nutrition (PEN-ASP score was 3, 3, 5, respectively). CONCLUSION There is no curative treatment for this devastating and fatal disorder and hearing impairment, balance and swallowing disorders can be seen especially late onset form of disease.