Yezdan Firat

Grisel Syndrome: Nontraumatic Atlantoaxial Rotatory Subluxation

Grisel syndrome is the subluxation of atlantoaxial joint as a result of infectious or inflammatory processes of the head and neck region. The etiopathogenesis of this clinical entity is not clear yet. Early interventions (antibiotherapy, cervical traction, and immobilization) are critical to avoid catastrophic outcome. Early detection of pediatric atlantoaxial subluxation is essential. It requires a combination of clinical assessment and appropriate radiographic imaging. In this report, we present a clinical and radiologic follow-up of a Grisel syndrome; by this way, we discuss the role of radiology on the diagnosis of this rare entity and preview the relevant literature.

Effect of Intranasal Estrogen on Vocal Quality

The objective of this study was to evaluate the effect of intranasal estrogen therapy on female vocal quality. Thirty-two women who had surgically induced menopause were included into the study group and examined through hall year for this study. Estrogen treatment was proposed to all of the patients. Twenty-three of them accepted the treatment protocols including oral (n=12) (2mg estradiol; Estrofem; Novo Nordisk, Denmark) and intranasal (n=11) (300 mc g 17beta-estradiol; Aerodiol; Servier, Chambray-les-Tours, France) form of estrogen. The rest of patients refused estrogen treatment and those patients constituted the control group (n=9). Vocal changes were evaluated with Voice Handicap Index (VHI) and acoustic analysis of voice variations (fundamental frequency [F0], SD F0, jitter, shimmer, normalized voice energy, and harmonics-to-noise ratio) at baseline and after 1-year follow-up. According to VHI, while voice improvement was not clear in oral estrogen group, it was significant at intranasal estrogen group. Voice quality in patients treated with hormone replacement therapy (HRT) was significantly higher than patients without HRT. But between two treatment groups, there were no any statistical discrepancy. According to acoustic analysis, vocal stability among the women who use HRT was significantly better than those who did not use. Intranasal estrogen exerted the most significant effects on vocal stability. The data of our study support that voice undergoes changes in lack of estrogen in surgically induced menopausal women. Taken together with the relevant studies, while oral estrogen replacement therapy shows a favorable influence on voice quality, it seems to be more pronounced with intranasal estrogen than oral form.

Primary mucosa-associated lymphoid tissue lymphoma of hypopharynx.

Mucosa-associated lymphoid tissue lymphomas are low-grade B-cell lymphomas that arise from a number of extranodal sites, including both nonmucosal and mucosal organs such as the hypopharynx. We reported a patient with a primary hypopharynx mucosa-associated lymphoid tissue lymphoma presenting with a swallowing dysfunction and severe throat pain. The clinical, radiologic, and histopathologic findings are presented. The patient was followed up for 5 years and treated with nonspecific antibiotics, chemotherapy, and radiation therapy. Because of prevertebral fascia invasion at the initial presentation, surgical treatment was not preferred. The last biopsies of the hypopharynx revealed no evidence of lymphoid infiltrate. Mucosa-associated lymphoid tissue lymphoma involving the hypopharynx is rare and there is no consensus on its treatment. The treatment protocol is presented and the relevant literature is reviewed.

Experimental otoacoustic emission and auditory brainstem response changes by stellate ganglion blockage in rat

INTRODUCTION To investigate the effect of stellate ganglion (SG) block on hearing in rats. MATERIALS AND METHODS Sixteen male adult rats were randomly divided into 2 equal groups. Both groups underwent preblock auditory brainstem responses (ABRs) in response to tone bursts at 4, 6, and 8 kHz and otoacoustic emissions in response to distortion products as a function of f2 frequency at 1, 2, 4, and 6 kHz. Local anesthetic (0.2 mL of 2% prilokain) was administered to the left SG of the study group by posterior cervical percutaneous approach for cervical sympathetic blockage. In the control group, 0.2 mL of physiological saline was injected to the left SG. Postblock hearing evaluations were made after 15 minutes of injections. RESULTS Both Dp-gram and I/O function records suggested that whereas hearing thresholds were not affected in lower frequencies after SG blockage, it tended to increase at higher frequencies. In ABR records, waves I and II showed marked latency shift across all frequencies. The interpeak latency of waves I and II was shortened after blockage. Saline injection did not show any significant ABR or distortion-product otoacoustic emission threshold shift across frequencies at 60, 70, 80, and 90 dB sound pressure level. CONCLUSION Our data demonstrate that SG block improved the hearing parameters in rats with normal cochlear blood flow. To recommend SG blockage as a treatment option in the vascular pathologies of cochlea, further investigation should assess the efficiency of ganglion blockage in hearing parameters of rats with impaired cochlear blood flow.

The effect of dexmedetomidine on middle ear pressure.

OBJECTIVE: Dexmedetomidine is a preferred anesthetic agent in otological surgery because it provides controlled hypotension and good surgical field visibility. The aim of this study was to evaluate the influence of this novel agent on middle ear pressure. STUDY DESIGN AND SETTING: This prospective clinical trial was performed in 60 patients who were scheduled for elective surgery. They received dexmedetomidine or saline infusion for 20 minutes before induction of anesthesia. Tympanometric measurements were recorded for both ears at preoperative, intraoperative, and postoperative states. RESULTS: Mean difference of tympanometric peak pressure from baseline was statistically significant between dexmedetomidine and control group at the 30th minute of operation (24.8 daPa, P = 0.003 for right ear; 20.5 daPa, P = 0.02 for left ear) and at the end of the operation (25.8 daPa, P = 0.01 for right ear; 28.1 daPa, P = 0.004 for left ear). CONCLUSIONS: Dexmedetomidine anesthesia raises the tympanometric parameters, but they never exceed the limits of normal.

Congenital muscular torticollis in older children: treatment with Z-plasty technique.

Abstract Congenital muscular torticollis (CMT) is a common congenital disorder of the musculoskeletal system in neonates and infants. The aim of this study was to evaluate the results of inferior Z-plasty in older children with CMT. They had mean age of 10 years (range, 5–14 years) and were followed up for 1 to 6 years. Postoperative protocol included a neck exercise program composed of active and passive movements in all cases and immobilization with a cervical collar in only 4 patients. This study concluded that surgical management of older children with CMT using Z-lengthening gives excellent clinical and functional results. The procedure is much more effective than other techniques and relatively complication-free and safe. Postoperative cervical collar and a well-planed physiotherapy protocol go a long way toward ensuring good to excellent results. Early diagnosis and treatment are necessary for good results.

Second primary cancer occurrence on forehead flap after reconstruction of nasal carcinoma.

We reported a case of basal cell carcinoma on the flap which was initially treated with excision of squamous cell carcinoma and forehead flap reconstruction of nasal dorsum. After 8 years of reconstruction, basal cell carcinoma was developed on the flap surface. This may be due to a recurrence, or a second primary tumor, or an activation of a dormant tumor with perturbing factors like surgery. In this report, our purpose was to discuss the possible etiopathogenesis, most appropriate diagnostic procedures, and treatment protocol for a carcinoma of the flap which has been used to reconstruct the previous cutaneous cancer.

NON-RECURRENT INFERIOR LARYNGEAL NERVES: REPORT OF TWO CASES AND REVIEW OF THE LITERATURE

Although the non-recurrent inferior laryngeal nerve (NRILN) is a rare occurrence, it may become damaged inadvertently during cervicotomy and causes permanent ipsilateral vocal cord paralysis. Several published reports have described an incidence of NRILN of 0.21–1.6%, with most occurring on the right side.1–3 However, it is difficult to establish the exact incidence of this anomaly. To date, three anatomical variants have been recognized: In type 1, NRILN arises from cervical vagus directly and descends into the larynx at the level of the upper thyroid pole. In type 2A, NRILN follows a transverse path parallel to and over the trunk of inferior thyroid artery, at the level of isthmus. In type 2B, NRILN follows a transverse path parallel to and under the trunk of inferior thyroid artery, making a downward curve.1,2 The most common is type 2A. Herein, we present findings of two cases in which one of them showed previously unrecognized anatomical variant of a NRILN. Two female patients of age 42 and 47 years presented with swelling of their thyroids. Physical, radiological and laboratory examinations showed multinodulary goitre. During thyroidectomies, when the right inferior laryngeal nerves (ILN) could not be identified in a normal anatomic position, we continued to dissect further laterally and found NRILN. In the first patient the NRILN arose from vagus nerve, passed over carotid artery and descended into the larynx at the level of the upper thyroid pole (type 1) (Fig. 1). In the second patient the NRILN followed a transverse path parallel to and over the trunk of inferior thyroid artery, making a slightly downward curve (type 2A). The nerves were carefully traced and preserved. The patient’s postoperative courses were uneventful. Although an NRILN was observed in a cadaver by Stedman 1823, it was not introduced in the surgical published work until 1932. Since then, numerous reports of NRILN have appeared with

Traumatic thrombosis of internal carotid artery sustained by transfer of kinetic energy.

A 31-year-old male patient with a fatal thrombosis of the internal carotid artery caused by gun shot injury was presented in this case report. The patient was referred to the hospital with a diffuse edema on his left cheek. On otolaryngologic examination, there was a bullet entrance hole at the left mandibular corpus. No exit hole could be found. The finding from his axial computed tomography of neck and paranasal sinuses was normal. On neurological examination, a dense right hemiparesis was observed. In his cerebral angiogram, left common carotid artery was totally obliterated. Diffuse ischemia was observed in the left cerebral hemisphere. Despite intensive interventions, the patient died 4 days after the accident. In the autopsy, a large thrombosis was obtained in the left common carotid artery. This case emphasizes a fatal kinetic energy effect in vascular structures. It is stressed that a gun shot injury could be fatal with its indirect kinetic energy effects at subacute phase.

Do comorbidities influence objective and subjective recovery rates of nasal polyposis

Objectives: To investigate the clinical and laboratory outcomes both objectively and subjectively in nasal polyposis patients with or without comorbidity (CoM; asthma and allergy). Patients and Methods: Thirty-three nasal polyposis patients (13 women and 20 men) were included into the study. Their mean age was 39.23 ± 9.13 years. CoM(+) and CoM(−) nasal polyposis patients were compared with each other. Evaluations contained endoscopic nasal examination, acoustic rhinometry, rhinomanometry, visual analog scale score of nasal blockage, olfactory function score, respiratory function test, skin prick tests, and paranasal sinus computed tomography. Results: Recovery was statistically significant in all observed evaluations for endoscopic and radiologic staging, nasal obstruction, and sense of smell compared with the first evaluation in all patients regardless of the subgroups. Although objective measurements of respiratory functions did not show any change, clinical improvement was detected in CoM(+) patients with a decrease of need to their antiasthmatic medical treatment. Conclusions: Results of CoM(+) patients led to no statistical difference when compared with CoM(−) subgroup. When applying predefined nasal polyposis treatment protocol, the polyp patients with CoMs do not need close follow-up compared to the patients without CoMs.