Utku Aydil

Evaluation of the Results of Endoscope-Assisted Acoustic Neuroma Surgery through Posterior Fossa Approach

The objective of this study was to evaluate the results of endoscope-assisted acoustic neuroma surgery in posterior fossa approach. Between 1996 and 2002, 60 consecutive patients with acoustic neuroma were operated via the retrosigmoid suboccipital approach. Standard 4-mm sinus endoscopes at different angles were used during the surgeries either for inspection or tumor endoscopic dissection. Clinical parameters and treatment outcome were evaluated retrospectively. Tumor sizes were small, medium and large in 46.6, 45 and 8.3% of the patients, respectively. The hearing preservation rate, which did not correlate with tumor size (p > 0.05), was 24.4%. The need for facial reanimation surgery, which was needed in 5% of patients, was significantly higher in the large tumors than in the small and medium tumors (p < 0.001). Cerebrospinal fluid fistula rate, which was not related to tumor size (p > 0.05), was 13.3%. Tumor recurrence or residual tumor was not encountered at all. In conclusion, endoscopes give accurate information about the relationship between the tumor and the adjacent structures and help control the fundus of the internal auditory canal to ensure complete tumor removal. It is also helpful in visually verifying the continuity of the facial and cochlear nerves. The use of endoscopes does not appear to increase the hearing preservation rate, but is very helpful in complete tumor removal in the posterior fossa approach.

Choanal polyp originated from the inferior nasal concha

Almost all choanal polyps originate from the maxillary sinus and a choanal polyp (CP) originating from the inferior nasal concha (INC) is a rare entity. It presents in a similar manner to the more common antrochoanal polyp and may be confused on anterior rhinoscopy. In this report, an unusual case of a CP taking origin from the INC that was removed by endoscopic endonasal surgery in a young man is presented. No intraoperative or postoperative complication occured, and the symptoms immediately resolved after the operation. Although very rare, CPs arising from the INC should be kept in mind in the differential diagnosis of a solitary nasal polyp.

Characteristics and management of intractable neck involvement in tularemia: report of 19 patients

The objective of this study is to determine the clinical characteristics and to evaluate the treatment options of intractable neck involvement in tularemia. The medical records of 19 tularemia patients with neck involvement were reviewed retrospectively. On physical examination, fluctuation indicating an abscess formation was detected in 78.9% of the patients. Bilateral involvement was seen in 15.8% of the patients. The most common clinical form was glandular form (63.1%). The most commonly involved lymph node group was upper jugular nodes (78.6%). Six patients underwent incision and drainage procedure, five patients underwent superselective neck dissection and eight patients had only medical treatment. Complete and immediate cure, and better tissue healing with less scarring could be achieved in all patients who underwent superselective neck dissections. In conclusion, intractable neck masses and an abscess can be the initial finding in tularemia, and a high index of suspicion is needed in the differential diagnosis. Superselective neck dissection is a safe and effective option in the treatment of long lasting cervical tularemia unless it responds to medical treatment.

Investigation of fungi in massive nasal polyps: microscopy, culture, polymerase-chain reaction, and serology.

Background Although some clues exist about the causative relationship of fungi and chronic rhinosinusitis, the relationship of nasal polyps and fungi has not been enlightened. The purpose of this study was to determine whether a relationship exists between fungi and massive nasal polyps and to evaluate current available diagnostic techniques for detection of fungi. Methods Thirty cases of massive nasal polyposis (NP) were evaluated prospectively for fungal evidence and were compared with 18 cases of concha bullosa based on direct microscopy, fungal culture, serology, polymerase chain reaction (PCR), and sequencing. Results Fungal colonization was detected in 15 (50.0%) of the cases with massive NP, but only in 2 (11.1%) of the cases with concha bullosa. A significant difference was found between the study and the control groups in terms of fungal existence (p < 0.016). Direct microscopy was positive in 14 (46.7%) and 1 (5.6%) of the cases; fungal culture was positive in 8 (26.7%) and 4 (22.2%) of the cases; serology was positive in 9 (30.0%) and 2 (11.1%) of the cases; PCR was positive in 18 (60.0%) and 6 (33.3%) of the cases with massive NP and concha bullosa, respectively. Conclusion Fungal colonization was found to be more common in massive NP patients compared with the control group. According to our results, microscopy and PCR were most sensitive techniques for detection of fungi.

Mucosal melanoma of the head and neck: recurrence characteristics and survival outcomes

OBJECTIVE The aim of this study was to review oncologic outcomes and recurrence characteristics of head and neck mucosal melanomas (HNMMs) managed at a tertiary referral center. STUDY DESIGN Clinical records of 10 patients who were managed for HNMMs between 2001 and 2013 were retrospectively analyzed. RESULTS The median age was 66 years (range 28-76 years) and male/female (M/F) ratio was 1:5. The 3-year disease-free survival (DFS) rates and overall survival (OS) rates were 11.7% and 35%, respectively; and the 5-year DFS rates and OS rates 11.7% and 23.3%, respectively. The median DFS and OS periods were 12 months (range 2-36 months) and 17 months (range 7-96 months), respectively. The rates of development of local, regional, and systemic recurrences were 20%, 50%, and 80%, respectively. Lungs were involved in all patients who had distant metastasis. CONCLUSIONS This study shows that HNMMs has a very aggressive course and that distant metastases are common. For this reason, systemic control of the disease is an important aim of treatment.

Less known non-infectious and neuromusculoskeletal system-originated anterolateral neck and craniofacial pain disorders

Pain syndromes of neuromusculoskeletal origin are not well-known by most of the clinicians working on head and neck area. As a result, most of the patients with these syndromes are either overlooked without having any treatment or they inappropriately have antibiotic treatments or surgical interventions such as dental extractions and tonsillectomies. Better recognition of the pain syndromes of the neck and face region or entities related to neuromusculoskeletal system may result in more appropriate and effective management of such conditions while avoiding unnecessary medical and surgical treatments. In this review, causes, clinical characteristics, diagnostic and treatment modalities of relatively less known craniofacial and neck pain entities including Eagle syndrome, carotidynia, glossopharyngeal neuralgia, superior laryngeal neuralgia, hyoid bone syndrome, acute calcific retropharyngeal tendinitis, temporal tendinitis, thyroid and cricoid cartilage syndromes, and mastoid process syndrome are summarized.

Unilateral agenesis of middle nasal turbinate

OBJECTIVE We present the first report of agenesis of the middle nasal turbinate. METHOD We present a case report and briefly discuss the world literature. RESULTS A 57-year-old man presenting with sinonasal symptoms was evaluated clinically and radiologically. Agenesis of the patients left middle turbinate was detected. Coronal computed tomography images showed a septal spur replacing the absent left middle turbinate. CONCLUSION The lateral nasal wall has complex anatomy, and several anatomical variations have been reported. The most common anatomical variation of the middle nasal turbinate is concha bullosa. Unilateral agenesis of the middle nasal turbinate has not previously been reported; the presented patient represents the first reported case.

Sphenopalatine artery pseudoaneurysm: a rare cause of intractable epistaxis after endoscopic sinus surgery.

AbstractEpistaxis is a frequent health problem and the most common cause of emergency in otorhinolaryngology practice. In this report, a case of a 26-year-old patient with intractable epistaxis after endoscopic sinus surgery was presented. The epistaxis began at the fourth postoperative day and was unresponsive to endoscopic cauterization and anterior and posterior nasal packing. On angiographic investigation, a pseudoaneurysm of the sphenopalatine artery was detected and treated with microcatheter embolization. This is the second case of postoperative sphenopalatine pseudoaneurysm as a complication of endoscopic sinus surgery in the literature.

Analysis of choanal polyps.

AbstractChoanal polyps (CPs) are unilateral benign masses usually originating from paranasal sinuses. Maxillary, ethmoid, and sphenoid sinuses are involved in order of decreasing frequency. In this study, the medical records of patients operated on with a clinical diagnosis of CP between 1998 and 2011 were reviewed. A total of 98 patients with a mean age 24.3 years were analyzed. Histopathologic diagnoses were CP in 94 patients and inverted papilloma in 4 patients. The sites of origin were maxillary sinus in 89 patients (90.8%), sphenoid sinus in 6 patients (6.1%), bulla ethmoidalis, inferior concha, and uncinate process in 1 patient each (1.0%). The most common symptoms were nasal obstruction (98.0%) and postnasal drip (30.6%). The surgical approaches were endoscopic sinus surgery in 63 patients (62.4%) unilaterally and in 12 patients (11.9%) bilaterally and unilateral endoscopic sinus surgery with mini Caldwell in 26 patients (25.7%). All 3 recurrences were in pediatric patients, and the recurrence rates among pediatric patients and overall were 7.7% and 3.1%, respectively.Endoscopic sinus surgery is an effective surgical procedure for treatment of CP; however, addition of a mini-Caldwell approach is safe for antrochoanal polyp resection if the endonasal technique fails. Histopathologic examination is mandatory because inverted papillomas may present as CPs.

An individualised treatment algorithm for tumour stage 1 glottic squamous cell carcinoma

OBJECTIVE To report and discuss the outcome of a treatment algorithm for patients with tumour stage 1 glottic squamous cell carcinoma. METHOD A retrospective outcome analysis study was performed using data from a tertiary referral centre. RESULTS Sixty-nine patients were treated with radiotherapy and 26 with surgery, in accordance with the treatment algorithm. Five-year overall survival rates were the same for both treatment groups (92 per cent). Five-year disease-specific survival rates were 100 per cent for surgery, 98 per cent for radiotherapy and 99 per cent overall. The overall 5-year laryngeal preservation rate was 89.1 per cent, being 95.7 per cent for surgery patients and 86.7 per cent for radiotherapy patients (p = 0.502). There was no significant association between laryngeal preservation rates and age (p = 0.779), anterior commissure involvement (p = 0.081), tumour stage (1a or 1b) (p = 0.266) or treatment modality (surgery or radiotherapy; p = 0.220). There was no significant difference in local recurrence rates between the two treatment groups (19.3 per cent for radiotherapy vs 10.0 per cent for surgery; p = 0.220). The overall 5-year regional recurrence rate was 1.2 per cent. CONCLUSION Tumour stage 1 glottic carcinoma can be managed with different treatment modalities, following an individualised treatment algorithm, with results comparable to published outcomes.