Volkan Kahya

Prospective, controlled clinical trial of Ankaferd Blood Stopper in children undergoing tonsillectomy

OBJECTIVES This is a prospective study evaluating the efficacy of Ankaferd Blood Stopper as a hemostatic agent compared to hemostasis by means of knot-tie after cold knife dissection tonsillectomy. METHODS Study design was the use of ABS and the KT to reach hemostasis for patients undergoing tonsillectomy. ABS is applied on right side tonsil fossa and KT is used on left side tonsil fossa. Measured outcomes such as blood loss, surgical time, and complication will be assessed. In total, 47 consecutive patients undergoing cold knife dissection tonsillectomy were studied, in all of whom Ankaferd Blood Stopper wet tampon was used for right side tonsil hemorrhage and knot-tie technique for left side tonsil hemorrhage. Data were collected intraoperatively. Follow-up visits of all patients were completed at postoperative days 1, 3, 7, and 10. RESULTS Ankaferd Blood Stopper side had shorter hemostasis time after tonsil removal than knot-tie side (3.19+/-0.74 min vs 7.29+/-2.33 min [mean+/-SD], p<0.01) and less blood loss (1.57+/-2.26 ml vs 14.04+/-7.23 ml [mean+/-SD], p<0.01). In addition, KT number was less with ABS side as compared to KT side (p<0.01). CONCLUSIONS The side on which Ankaferd Blood Stopper was used had statistically significant differences in hemostasis time, blood loss, and knot-tie number in the operation period. Ankaferd Blood Stopper is safe and efficient, and it decreases intraoperative bleeding, reduces operating time, as compared to the traditional hemostasis methods after cold knife dissection tonsillectomy.

Pharyngeal packing is a predisposing factor for postoperative aphthous stomatitis in nasal surgery.

Objective: To evaluate whether pharyngeal packing is a predisposing factor for the development of postoperative aphthous stomatitis in nasal surgery. Study Design: A prospective, randomized, controlled trial. Setting: A tertiary referral center. Subjects and Methods: After the study was approved by the local ethics committee, 100 adult patients scheduled for routine nasal surgery were enrolled. The development of postoperative aphthous lesions within three days after surgery was evaluated in patients in whom a pharyngeal pack was (Group 1) or was not (Group 2) applied during nasal surgery. Results: In Group 1, the presence of pharyngeal pack increased the risk for postoperative oral mucosal aphthae development by 4.64 times (P = 0.02, RR = 4.64, 95% CI = 1.22-17.91). No significant associations were found between postoperative oral mucosal aphthae development and sex (P = 1), age (P = 0.69), height (P = 0.73), weight (P = 0.22), or duration of surgery (P = 0.47) in Group 1. Conclusion: Pharyngeal packing during nasal surgery increases postoperative morbidity by leading to the development of painful oral aphthous lesions.

Surgical outcomes of primary and revision endoscopic dacryocystorhinostomy.

Objective: In the current study, whereas the results of endoscopic primary and revision endoscopic dacryocystorhinostomies (END-DCR) were evaluated, the success rates in patients who did or did not undergo nasal surgery were also compared. Methods: A retrospective medical record review of 70 patients (with a total of 72 affected cases) who were admitted to our clinic with a primary complaint of epiphora between January 2002 and July 2009 was performed. Patients who required additional nasal procedures were also included in the analysis. A successful DCR was defined as relief of symptoms on testing with irrigation at the last follow-up visit. Results: The success rates were 82.1% (23/28 DCRs) in the primary END-DCR group and 84.1% (37/44 DCRs) in the revision END-DCR group. There were no significant differences between the groups regarding overall surgical success rates (P = 0.829). The need for additional nasal surgery was significantly higher in the revision cases (52.3%) than the primary cases (28.6%; P = 0.048). No significant difference regarding success rates existed between the patients who required an additional septoplasty or ancillary sinus surgery and the patients who did not have nasal pathology and underwent END-DCR alone (P = 0.456). The mean follow-up period was 11 months in the revision END-DCR group and 8 months in the primary END-DCR group. Conclusions: Endoscopic DCR should be considered as the treatment of choice in cases with intranasal pathologies. Endoscopic DCR is a safe and effective procedure in revision cases, as well as in primary cases.

Unilateral osteotomies for external bony deviation.

Objective: Deviated nose is a challenge for rhinoplasty surgeons. We applied a new technique to correct nasal bone asymmetry in selected patients. We assessed the efficacy of the technique and discussed the surgical outcomes. Methods: We retrospectively analyzed 29 patients with deviated nose who received unilateral osteotomy alone or unilateral osteotomy with camouflage graft placement to the other side of the nose. Preoperative and postoperative photographs were studied to evaluate the outcomes. Results: Twenty-nine unilateral osteotomies were done. Camouflage grafting was performed to 20 of the 29 patients. Nasal humps were removed in all patients. No postoperative complications occurred during the follow-up period. Twenty-six of 29 deviated noses were corrected with unilateral osteotomy. Conclusions: The unilateral osteotomy technique seems to be a useful method for correcting deviated nose.

Efficacy of octyl-2-cyanoacrylate in type I tympanoplasty.

Objective: To evaluate the safety and efficacy of octyl-2-cyanoacrylate for type I tympanoplasty. Methods: This study involved 23 patients (14 females and 9 males) with chronic otitis media who underwent type I tympanoplasty. During surgery, the temporal fascia is placed underlying the eardrum remnant, and octyl-2-cyanoacrylate was dropped over the temporal fascia. The mean air-bone gap (ABG) at the 4 frequencies (500, 1000, 2000, and 4000) was calculated for each patient before and after surgery. These data were compared by Student t test. Results: The mean follow-up was 10 months (range, 6-12 mo). Successful tympanic membrane grafting occurred in 21 patients (91.3%). Graft failure was seen in 2 patients. The mean preoperative ABG of the 23 patients was 19.3 (SD, 5.7) dB, and the postoperative ABG improved to a mean value of 8.2 (SD, 5.9) dB (P ≤ 0.0001). Conclusions: Octyl-2-cyanoacrylate is effective and safe in using as a compound on temporalis muscle fascia in type I tympanoplasty and can be used more widely in tympanoplasty.

Eustachian Tube Function following Total Laryngectomy

Objective: The function of the Eustachian tube has been investigated in various conditions. However, its status has not been evaluated in total laryngectomized patients. This study was designed to investigate short- and long-term changes of the Eustachian tube that occur following total laryngectomy. Method: We enrolled 53 total laryngectomy patients. These patients were divided into 2 groups (within 2 years and more than 2 years after surgery). Fifty-one healthy volunteers were studied as a control. The functions of the Eustachian tube were evaluated using the P1(resting), P2 (Toynbee maneuver), and P3 (Valsalva maneuver) tympanometric measurement. Results: All groups were evaluated using intergroup comparisons in terms of right-side Eustachian tube functions. No significant difference was found between the groups in terms of P2, P1-P2, Pmax-Pmin values (respectively, P = .329, P = .474, P = .487). All groups were evaluated using intergroup comparisons in terms of left-side Eustachian tube functions. No significant difference was found between the groups in terms of P2, P1-P2, Pmax-Pmin values (respectively, P = .562, P = .400, P = .151). Conclusion: We determined that the functions of Eustachian tubes were not different between the patients who underwent total laryngectomy and the healthy volunteers. The lack of active airflow in the upper respiratory tract following total laryngectomy has no effect on the function of the Eustachian tube in the short and long term.

Impact of smoking on p65 nuclear factor κB, p38 mitogen-activated protein kinase, and inducible nitric oxide synthase expression levels in oral mucosa.

Objectives Smoking plays an important role in oral cancer development; however, the molecular carcinogenesis mechanism in oral mucosa is not well understood. The aim of this study was to examine and compare the levels of p65 nuclear factor &kgr;B (NF-&kgr;B), p38 mitogen-activated protein kinase (MAPK), and inducible nitric oxide synthase (iNOS) expressions between oral mucosa of nonsmoker and smoker volunteers. Methods Oral cheek mucosa was collected from 78 volunteers. Smokers were divided into 2 subgroups: light smokers (<40 pack years) and heavy smokers (≥40 pack years). Paraffinized tissue immunochemistry was carried out for p65 NF-&kgr;B, p38 MAPK, and iNOS expression with specific antibodies. Results were evaluated based on diffuseness and intensity of staining. Results Group 1 composed of 40 nonsmokers: 52.5% were female and 47.5% were male, with a mean age of 46.4 years. Group 2 composed of 38 smokers (20 light smokers, 18 heavy smokers): 39.5% were female and 60.5% were male, with a mean age of 48.9 years. Total immunohistochemical staining scores of smokers were significantly higher compared with those of nonsmokers in p65 NF-&kgr;B, p38 MAPK, and iNOS expression (P < 0.001). The highest p65 NF-&kgr;B, p38 MAPK, and iNOS expression levels were detected in the oral mucosa of heavy smokers. The expression of iNOS and p65 NF-&kgr;B in heavy smokers was significantly higher compared to that in light smokers (P < 0.01 and P < 0.05, respectively). Although p38 MAPK expressions were higher in heavy smokers compared with light smokers, the difference was not statistically significant (P > 0.05). Conclusions Our results show for the first time the significant increase in the expression of p65 NF-&kgr;B and p38 MAPK in the oral mucosa of smokers. Levels of p65 NF-&kgr;B, p38 MAPK, and iNOS expression in the oral mucosa of smokers were related to the number of pack years.