UNİLATERAL ALT KONKA AGENEZİSİ Fonksiyonel endoskopik sinüs cerrahisinin otorinolarengoloji kliniklerinde popüler bir cerrahi olması nedeniyle sinonazal anatomi ve potansiyel anatomik varyasyonlarının kulak burun boğaz hekimleri tarafından iyi bilinmesi gerekmektedir. Nazal konkalar diğer paranazal yapılarda olduğu gibi anatomik varyasyonlar gösterebilmektedir. Konkal yapının önemi endoskopik sinüs cerrahisinde anatomik referans noktalarından biri olması ve nazal fizyolojik balanstaki rolünden ileri gelmektedir. Bizim olgumuzda burun tıkanıklığı ve geniz akıntısı şikayetleriyle kliniğimize başvuran ve yapılan muayene ve tetkikleri sonrası sol alt konka agenezisi saptanan 50 yaşında bir kadın hastadan bahsedilmiştir. Abstract

A visible scar on the columella is undesirable result for both patient and surgeon. So it is one of the major disadvantage of open nose surgery. Different columellar incision types have been used in open technique of nasal surgery. In this prospective study, we compare W incisions and inverted-V columellar incisions with a scar assessment scale. In this prospective randomized study, open nasal surgery (open rhinoplasty and open technique septoplasty) were performed on 93 patients between November 2009 and July 2012. The inverted-V incision was used on 31 patients (24 males, 7 females). The "W" incision was used on 62 patients (40 males, 22 females). The entire surgical procedure was performed by a single surgeon. The columellar incision was closed using 6-0 interrupted polypropylene sutures. All sutures were removed on the seventh postoperative day. Scars were assessed at 6 moths, with 3 items scar assessment scale, we observed satisfactory scar, pigmentation, and notching. We compared both groups and found that the scar pigmentation, notching and scar formation are similar to each other. As a result of this study we concluded that the inverted-V incision or "W" incision might be a similar choice in open nasal surgery.

OBJECTIVES:This study aims to investigate the influence of laryngopharyngeal reflux on the improvement of chronic rhinosinusitis (CRS) in patients who underwent endoscopic sinus surgery (ESS).PATIENTS AND METHODS:A total of 48 patients (28 males, 20 females; mean age 41.6±15.1 years; range 18 to 75 years) with CRS without polyposis were assessed for the presence of gastric reflux with Reflux Symptom Index (RSI) and Reflux Finding Scores (RFS) before undergoing primary ESS. Patients with a RSI >12 and RFS >7 were included in the reflux(+) and those with either score under these cutoffs in the reflux(-) group. Improvement scores were accepted as the difference between preoperative scores and postoperative sixth-month Lund-Mackay Radiology Scores, Lund-Kennedy Endoscopy Scores (LKES), and Sinusitis Symptom Scores (SSS).RESULTS:There was no significant difference between improvements of the reflux(+) and reflux(-) groups in terms of radiology, endoscopy, and symptom scores (p>0.05). However, preoperative and postoperative six-month radiology scores were significantly higher in reflux(+) patients (p<0.01). Also, postoperative six-month LKES were significantly higher in reflux(+) patients. No statistically significant differences were detected between preoperative and postoperative six-month SSS in reflux(+) or reflux(-) patients.CONCLUSION:Laryngopharyngeal reflux was associated with worse radiology and endoscopy scores in CRS without polyposis; however, it had no role on the improvement scores after primary ESS.

We aimed to find out whether snoring relieve with nasal surgery in patients with nasal obstruction. Sixty-four patients who underwent septoplasty under general anesthesia with complaint of nasal obstruction and snoring at Haydarpasa Numune Education and Research Hospital were enrolled in the study. All patients were evaluated by otolaryngological examination. Septal deviation was graded as mild, moderate and severe with endoscopy. Variables examined included age, sex, body mass index. All patients also completed the questionnaires, including Nose Obstruction Symptom Evaluation scale (NOSE), Epworth Sleepiness Scale (ESS), and Snore Symptom Inventory (SSI) before and after septoplasty. NOSE scale, ESS, and SSI scores showed statistically significant improvement after nasal surgery (p < 0.01) but we could not find any statistically significant association between septal deviation grading and improvement in scores of NOSE scale, ESS, and SSI (p > 0.05). Added to this, the association between body mass index (BMI) and improvement in scores of NOSE scale, ESS, and SSI did not reach statistical significance (p > 0.05). Our results demonstrated that septoplasty is effective on the subjective parameters of nasal obstruction in habitual snorers irrespective of the nasal septal deviation and severity of BMI.

OBJECTIVES:This study aims to evaluate whether chronic otitis media (COM) may cause inner ear damages or middle ear surgery may improve this damage with regard to sensorineural hearing loss (SNHL) and tinnitus and dizziness-related disability.PATIENTS AND METHODS:An observational prospective study was performed on a series of 65 patients (41 males, 24 females; mean age 26.4±12.6; range 11 to 62 years) who were diagnosed with COM and were scheduled for surgical intervention at the Department of Otorhinolaryngology of the Haydarpasa Numune Education and Research Hospital. Patients were divided into two subgroups as tympanoplasty and mastoidectomy group according to the surgical procedure. Standard patient work-up included otomicroscopy, pure tone audiometry and completion of the Turkish translation of Dizziness Handicap Inventory (DHI) and Tinnitus Handicap Inventory (THI) before surgery and eight weeks after surgery.RESULTS:We found higher bone conduction thresholds in the group of patients with mastoidectomy preoperatively. There was a statistically significant difference in the mean preoperative and postoperative THI and DHI scores between the groups (p<0.05).CONCLUSION:Our study results suggest that a successful surgery results in improved tinnitus and vertigo symptoms in patients with COM.

Parotisin metastatik tümörleri nadir olarak görülmesine rağmen diğer tükürük bezlerinin metastatik kitlelerinden daha sık olarak izlenir.Bu bezin metastazdan diğer tükürük bezlerine göre daha sık etkilenmesinin nedeni içerisinde bulunan intraglandular lenf nodları ve periglandüler nod sayısının daha fazla olmasındandır.Kliniğimize yüzünün her iki yanında parotis kitlesi nedeni ile refere edilen ve ince iğne aspirasyon biopsilerinin sonucu maligniteyi düşündüren bulgular olarak rapor edilen bir hasta vesilesiyle total parotidektomi kararı vermeden önce nazofarinks karsinom metastazını ekarte etmenin ve dikkatli bir endoskopik muayene ve manyetik rezonans görüntülemenin önemini

The laryngeal squamous cell carcinoma (LSCC) is one of the most common malignant tumors occurring in the head and neck. Tumor necrosis factor related apoptosis induce ligand (TRAIL) and TRAIL-receptors (DR4, DR5, DcR1, DcR2) are known as important members of TRAIL-mediated biochemical signaling pathway. Associations between polymorphisms in these genes and clinicopathological characteristics of human laryngeal carcinoma are not well defined. This study therefore aimed to investigate a possible relationship among the TRAIL and TRAIL-DR4 polymorphisms and sTRAIL levels in the risk or progression of LSCC. A total of 99 patients with laryngeal cancer and 120 healthy subjects were enrolled in the study. DR4 C626G and TRAIL 1595 C/T genotypes were determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis and sTRAIL levels were measured by ELISA. There were significant differences in the distribution of DR4 C626G genotypes and frequencies of the alleles between laryngeal cancer patients and controls (p<0.001) but not in TRAIL 1595 C/T. We found the increased frequency of the DR4 C626G homozygote CC genotype in patients than in controls (p<0.001). Haplotype analysis revealed that there was also a statistically significant relationship between TRAIL and TRAIL-DR4 polymorphisms and laryngeal cancer. Serum sTRAIL levels in the laryngeal patients with CC genotype who had advanced tumour stage were lower than those of patients with early tumor stage (p=0.014). Our findings suggest that DR4 C626G genotypes and sTRAIL levels might be associated with progression of laryngeal cancer in the Turkish population.

Solitary extramedullary plasmacytomas (EMPs) are nonepithelial neoplasms of plasma cell origin categorized among non-Hodgkin lymphomas, without the bone marrow involvement and systemic spread seen in multiple myeloma. They are uncommon tumors comprising 3% of all plasma cell neoplasias. Although they usually occur in the upper respiratory tract, only 1 case of EMP localized to the frontal sinus has been reported in the English literature. We present in this report a rare case of EMP originated from the left frontal sinus leading to left eyeball proptosis and movement restriction. A survey of sinonasal EMPs in the Turkish literature is reported, as well. Paranasal computerized tomography and magnetic resonance imaging of a 69-year-old female who presented with left eyeball proptosis and left-sided headache revealed a solid mass in the left frontal sinus. Histopathological analysis of the completely excised mass supported the diagnosis of plasmacytoma. The definitive diagnosis of solitary EMP was confirmed with further investigations at hematology and oncology clinics. The patient was treated with surgery followed by local radiotherapy to the head and neck region, and she was disease-free at her 1-year follow-up. Treatment of sinonasal EMP is surgery alone or surgery combined with radiotherapy. Long-term follow-up is a requisite for systemic control because of the disease's high potential to transform into multiple myeloma.

OBJECTIVE:To investigate the duration of time elapsed between the onset of symptoms for necrotizing external otitis (NEO) and admission to hospital that may play a role in patient outcome. STUDY DESIGN:Retrospective case review. SETTING:Tertiary referral center. PATIENTS:Fourteen consecutive male patients with NEO with no improvement from the previous course of antibiotherapy and with findings of osteomyelitis on temporal bone CT, MRI, and positive detection of Tc-99m methylene diphosphonate on temporal bone, admitted as inpatients between 2008 and 2012. INTERVENTION(S):Medical treatment of NEO and surgical debridement. MAIN OUTCOME MEASURE(S):Patients were divided into 2 groups according to median time elapsed between onset of symptoms and hospitalization (<30 d or >30 d). HbA1c, fasting blood sugar, erythrocyte sedimentation rate, C-reactive protein, pain intensity, radiologic grade, improvement since diagnosis, and total time to cure were compared according to the groups. The relationships between the laboratory data were analyzed to determine the parameters associated with time to recovery. RESULTS:Otalgia was significantly worse in patients who were admitted to hospital greater than 30 days after symptom onset (Mann-Whitney U test, p < 0.002). Blood glucose increased related to delayed admission time (p < 0.001). CRP results were independently elevated from the admission time (p < 0.112). There was a statistically significant difference between groups according to ESR levels and recovery time (Mann-Whitney U test, p < 0.004 and p < 0.01). There was a positive correlation between HbA1c levels and recovery time in Group 1 and between ESR levels and recovery time in Group 2 (r = 0.872, p = 0.044; r = 0.630, p = 0.039). CONCLUSION:Clinical, laboratory, and outcome data worsen later than 30 days in NEO.

Amac: Merosel ve havayollu silikon nazal septal splint tamponlarinin septoplasti sonrasi olusabilecek komplikasyonlar ve nazal obstruksiyon uzerine etkisini karsilastirmak amaclanmis ve bu nedenle sinesi, septal perforasyon, rekurren deviasyon gibi postoperatif komplikasyonlar arastirilmis ve Nazal Obstruksiyon Semptom Skalasi kullanilarak nazal obstruksiyon degerlendirmesi yapilmistir. Yontem: Nazal obstruksiyon sikayeti ile septoplasti operasyonu uygulanan 96 hasta calismaya dahil edilmistir. Hastalar randomize olarak Grup A (merosel grubu) ve Grup B (silikon splint grubu) diye ikiye ayrilmistir. Cerrahiden iki ay sonra hastalar tekrar degerlendirilmis ve 4 farkli degisken arastirilmistir: (1) rekurren deviasyon, (2) sinesi, (3) septal perforasyon, (4) Nazal Obstruksiyon Semptom Skalasi. Bulgular: Merosel grubunda daha cok postoperatif komplikasyon gozlenmis ancak bu bulgu istatistiksel olarak anlamli bulunmamistir (p>0.05). Ayrica iki grup arasindaki Nazal Obstruksiyon Semptom Skalasi skorlari arasindaki fark istatistiksel olarak anlamlilik teskil etmemistir (p>0.05). Ilginc olarak, sinesisi bulunan hastalarin Nazal Obstruksiyon Semptom Skalasi skorlarinin sinesisi olmayan hastalar ile karsilastirildiginda anlamli oranda daha yuksek oldugu saptanmistir (p

Even though metastatic tumors of the parotid gland are rarely seen, they are observed more frequently than other salivary gland metastatic masses. The reason why this gland is more frequently affected by metastatic tumors as compared to other salivary glands relies on the higher number of intraglandular and periglandular lymph nodes that the parotid gland contains. The incidence of metastatic parotid masses is relatively low compared to other head and neck neoplasms, consequently, few cases have been reported in the literature. Here, we present a patient referred to our clinic with parotid gland masses on both sides suggesting malignant neoplasm after fine needle aspiration biopsy of both sides. In this report, we aimed to draw attention to nasopharyngeal carcinoma metastasis in the differential diagnosis of parotid gland masses and to emphasize the importance of a careful endoscopic examination and magnetic resonance imaging before deciding on total parotidectomy.

Objective: We aimed to compare the use of Merocel nasal packs and airway integrated silicone nasal septal splints in the management of postoperative complications such as synechia formation, septal perforation, recurrent deviation and to evaluate nasal obstruction by using Nose Obstruction Symptom Evaluation scale following septoplasty.Methods: Ninety-six patients who complained of nasal obstruction and underwent septoplasty under general anesthesia were enrolled in the study. The patients were randomly allocated into two groups as Group A (Merocel group) and Group B (silicone splint group). A follow-up visit was scheduled two months after surgical procedure and four different variables were investigated: (1) recurrent deviation (2) synechia (3) septal perforation; and (4) Nose Obstruction Symptom Evaluation scale score.Results: We found more frequent postoperative complications in the Merocel group but this finding was not statistically significant (p>0.05). Additionally comparison of Nose Obstruction Symptom Evaluation scale scores for nasal packing materials did not detect statistically significant difference between 2 groups (p>0.05). Interestingly, we identified that in a subset of patients who had synechia formation, Nose Obstruction Symptom Evaluation scale scores had been significantly higher in comparison with the patients without synechia formation (p<0.05).Conclusion: Although our data did not reach statistical significance, our study and previous reports support a better quality of life by using intranasal splints, but that needs further studies.

Objectives/HypothesisTo analyze the differences between biodegradable and nondegradable nasal dressings with regard to their effects on wound healing in the short and medium term and on surgical outcomes in the long term, after endoscopic sinus surgery (ESS).Study DesignA prospective, randomized, partly blinded, controlled trial.MethodsA total of 56 patients undergoing bilateral ESS for chronic rhinosinusitis with polyposis were enrolled and randomized to receive biodegradable (Nasopore; Stryker, Hamilton, ON, Canada) on one side and nondegradable packing (Merocel; Medtronic Xomed, Minneapolis, MN) on the opposite side. Postoperative morbidities (pain, bleeding, facial edema, nasal blockage) related to dressings were assessed on postoperative day 6. Wound healing (edema, crusting, secretions, synechia, granulation tissue formation, and percentage re‐epithelialization) were evaluated at 2 weeks, 1 month, 3 months, and 6 months using modified Lund‐Kennedy scores. Long‐term assessment at 12 months was done using validated Lund‐Kennedy scores.ResultsMorbidities related to nondegradable packing were significantly higher than with degradable packing (Wilcoxon signed rank test, P < .01). Pain, bleeding, nasal blockage, and facial edema were significantly less with absorbable packing. No statistically significant difference was found between sinonasal cavities packed with biodegradable or nondegradable materials with regard to healing scores and percentage of re‐epithelialization at 2 weeks, 1 month, 3 months, 6 months, and surgical outcomes at 1 year (P > .05). However, healing at 6 months was correlated with the preoperative Lund‐Mackay radiology and surgery scores (Spearman's rho correlation test, P < .05 and P < .01, respectively).ConclusionsNo significant healing or surgical outcome differences were found between biodegradable and nondegradable packing. However pain, bleeding, nasal blockage, and facial edema were lower with biodegradable packing.Level of Evidence1b Laryngoscope, 124:1529–1535, 2014

The objective of the study is the invasion of anterior commissure (AC) by a laryngeal carcinoma has an oncological importance for the outcome. Detection of invasion is difficult due to particular anatomical features of this region. Therefore, we aimed to investigate the value of different diagnostic modalities for the detection of AC involvement at the patients with laryngeal carcinoma. Retrospective analysis of medical charts in a tertiary referral center. Records of preoperative clinical examination, computerized tomography (CT), peroperative examination and postoperative histopathological examination of 47 patients with laryngeal carcinoma were analyzed. The results of postoperative histopathological examination were accepted as true. Sensitivity, specificity, negative-predictive value, positive-predictive value and accuracy ratios were calculated for each modality. AC involvement was found to be positive in 23 patients according to the postoperative histopathological examination. Peroperative clinical examination was found to be superior to preoperative clinical examination and CT. In conclusion, classical multi-slice CT only on axial planes is not a reliable method to detect the invasion of AC. Preoperative clinical examination by suspension laryngoscopy under general anesthesia has an approximately 30% failure rate. Peroperative examination must not be neglected if possible.

Background: Although positron emission tomography computed tomography has proven diagnostic and staging value in head and neck carcinoma, it does not have optimal sensitivity or specificity. The positron emission tomography computed tomography fluorodeoxyglucose standardised uptake value has been shown to be associated with carcinoma stage. This study evaluated the impact of major clinicopathological factors on the standardised uptake value at the primary site and at neck lymph node metastases.Subjects and methods: Two hundred and forty-three oral cavity and laryngopharyngeal carcinoma patients who underwent positron emission tomography computed tomography were included. Correlation between the positron emission tomography computed tomography standardised uptake value and various clinicopathological factors was analysed.Results: A positive correlation was found between the standardised uptake value and the size and depth of tumour infiltration, and lymph node positivity. Higher standardised uptake values were seen for more advanced tumour stages. The presence of perineural invasion, lymphatic invasion and extracapsular spread were all associated with increased standardised uptake values.Conclusion: Most of the clinicopathological features of head and neck carcinoma which are well known to be poor prognostic factors have a significant impact on positron emission tomography computed tomography fluorodeoxyglucose standardised uptake value.

Objectives: Preoperative, intraoperative, and postoperative stagings of larynx cancer are compared to contribute optimum management of disease for individual patients who had larynx cancer.Methods: This study designed with retrospective review of 48 patients, 5 female (10.4%), and 43 male (89.6%), who had surgical management for larynx cancer without prior radiotherapy, at Haydarpasa Numune Education and Research Hospital, Otorhinolaryngology Department I.Results: The mean age of patients was 58.2 +/- 19.3, and 56.25% of them had transglottic, 27.08% had supraglottic, and 16.66% had glottic tumor. The rates of stage I tumors were 4.16% preoperatively, 8.33% postoperatively, while intraoperative none of them had stage I. The rates of stage II were 25, 27.03, 22.91%, stage III were 58.14, 39.58, 43.75%, and stage IV were 12.5, 33.33, 25% respectively. The mean inaccuracy rate was 40.4%. The stages of disease increased intraoperatively compared to preoperative results, and this was statistically significant (p<0.05). But there was not statistically significiance between preoperative with postoperative, and intraoperaive with postoperative staging when compared each other (p>0.05).Conclusion: The extension of lesion is evaluated beter during surgery. Therefore intraoperative evaluation should be consider important to decision extension of surgery.

ObjectiveOur aim in this experimental study was to evaluate the effects of hyperbaric oxygen (HBO), methylprednisolone (MP), and combined HBO‐MP treatments on traumatic facial nerve regeneration by histopathological examination of the facial nerve in rats.MethodFour groups of rats were created with 5 subjects in each group after exposure to facial nerve injury: group 1 (HBO), group 2 (control), group 3 (HBO‐MP), and group 4 (MP). Sacrified specimens were examined according to axonal degeneration, vascular congestion, macrovacuolization, axon diameter, and the thickness of myelin sheath.ResultsThere was significant difference regarding axonal degeneration, vascular congestion, and axon diameter between group 3 (combined HBO‐MP) and the control group. Besides lesser axonal degeneration and vascular congestion, larger diameter of axons were observed in group 3 (combined HBO‐MP). There was significant difference regarding vascular congestion and axon diameter between group 4 (MP) and the control group. Furthermore, we observed thicker myelin and lesser axonal degeneration in group 3 (combined HBO‐MP) in comparison to the group 4 (MP). However, there was no significant difference in the histopathological findings between group 1 (HBO) and the control group.ConclusionThe histopathological results in our study suggested that the combination therapy with HBO and MP had additive beneficial effect on the regeneration of facial nerve in an experimental animal model and may provide better treatment outcomes than isolated MP or HBO therapy.

Orofaciodigital syndrome is a very rare entity with X-linked dominant inheritance characterized by oral, facial, and digital anomalies. Thirteen different types have been described in the literature to date. Of these, orofaciodigital syndrome type I has the highest incidence. Renal and central nervous system malformations may accompany the oral, facial, and digital anomalies. We report a case of orofaciodigital syndrome type I in a 9-year-old girl. The patient was admitted with a complaint unrelated to the syndrome. The coexistence of an oral anomaly with a digital anomaly in this patient led us to search for other possible anomalies. Ultrasonography revealed a diagnosis of polycystic kidneys. Physicians must be mindful of the external appearance of patients with this syndrome and be aware of life-threatening anomalies possibly associated with it.