PURPOSE:Several diagnostic modalities are used to detect CSF leaks. Intraoperative use of intrathecal fluorescein can help to detect and localize a CSF leak simultaneously. However, it is not FDA approved, the application is invasive and has serious complications. Topical fluorescein is reported to be a safe and sensitive alternative to ITF. In this study, we aimed to evaluate the effectiveness of topical fluorescein in CSF leak closure.METHODS:This retrospective study includes 27 consecutive patients (19 women, 8 men) who underwent endoscopic endonasal CSF leak closure using topical fluorescein, between 2011 and 2017.RESULTS:In two patients, radiologic studies false positively locate the defect. β2 transferrin and topical fluorescein tests were positive in these patients. Both cases needed a second operation.CONCLUSION:If radiologic studies fail to locate the defect properly, topical fluorescein only confirms the CSF leak, but the defect cannot be located anatomically intraoperatively.

Background The necessity of silicone stenting in endoscopic dacryocystorhinostomy (DCR) procedures is a controversial subject in the literature. Objective The purpose of the present study is to assess the long-term anatomical and functional outcomes of endoscopic-powered DCR (EP-DCR) without stenting or mucosal flaps. Methods One hundred twenty EP-DCR procedures were performed in 107 patients. Anatomical success was defined as a patent ostium on irrigation and functional success as free flow of dye from the ostium and resolution of epiphora. Results The mean follow-up was 46.5 months (range: 24–87). Of the 120 procedures, 13 were bilateral and 94 were unilateral. Anatomical and functional success rates of 92.5% were obtained. Conclusion EP-DCR without stenting is a safe and economic technique that provides satisfactory long-term results and could be considered as the treatment of choice for patients with postsaccal nasolacrimal duct obstruction.

Objective: The aim of this study is to evaluate and compare the surgical outcomes and hearing results in tympanoplasty surgeries according to graft support material. The results of patients with hyaluronate-carboxymethylcellulose membrane and spongostan and the results of patients with only spongostan were compared. Materials and Methods: This was a retrospective comparative study of 118 tympanoplasty operations of 118 patients who underwent tympanoplasty in the Department of Otorhinolaryngology at a tertiary medical center from September 2000 to December 2005. The subjects were classified into two groups; Group 1 (n = 38) in whom both sodium hyaluronate-carboxymethylcellulose membrane and spongostan had been applied and Group 2 (n = 80) in whom only spongostan had been applied as graft support material. The rate of graft success and pure tone audiometric results were evaluated and compared between the groups. Chi-square test and Mann–Whitney U-test were used for the analysis. Results: Pre- and post-operative audiometric results including air-bone gaps were not significantly different between the groups. In all groups, the postoperative air-bone gap was significantly improved compared to the preoperative air-bone gap. Graft success rate in Group 1 and Group 2 were 89% and 71%, respectively. The rate of tympanic membrane perforation closure was significantly higher in Group 1 (P < 0.05). Conclusion: Depending on these results, we suggest sodium hyaluronate-carboxymethylcellulose membrane as an additional option as graft support material in tympanoplasties. The positive effect on graft success rate is documented in the present study. Further investigations are needed to evaluate the benefits and clinical outcomes of hyaluronate carboxymethylcellulose membrane.

OBJECTIVE:The aim of this study was to share our clinical experience with the neurovascular myofasiocutan infrahyoid flap (NMIHF), which was used for the reconstruction of the defects after oral cavity cancer surgery.METHODS:Records of five patients who were diagnosed with oral cavity cancer and underwent tumor resection, neck dissection, and defect reconstruction with NMIHF between 2012 and 2017 were analyzed retrospectively.RESULTS:The infrahyoid flap was used in five patients: four males and one female. The mean age of patients was 61.8 years. Four patients underwent tumor resection and bilateral level I-III neck dissection, whereas one patient underwent tumor resection and unilateral level I-III neck dissection. NMIHF was used for the reconstruction of the defects during the same procedure in all the patients. Mean post-operative follow-up was 30.6 months. Partial skin necrosis was observed in two patients, but none of the patients showed total necrosis of the flap. Postoperatively, oral intake was initiated after an average of 12 days in all patients. For two patients who required post-operative radiotherapy (RT), the treatment was started after an average of 50 days.CONCLUSION:NMIHF does not prolong operation time and does not cause additional scar in the neck, and the defect in the donor field can be closed without the use of a graft or flap. This is considered to be a reliable and successful alternative to free flaps for the reconstruction of oral cavity defects.

ObjectivesTo present the outcomes of our case series of head and neck necrotizing fasciitis (HNNF) in which vacuum-assisted closure (VAC) is used in most of the cases in the treatment.MethodsCase series in a tertiary referral center.ResultsEleven patients were treated for HNNF between January 2008 and January 2017. Patients were two females and nine males, the mean age was 57.1. Oral cavity and tracheotomy/tracheostomy sites were the main aetiological foci of the infection. Three patients were treated with aggressive debridements and conventional dressing, whereas eight patients were treated with incision and exploration followed by limited skin excisions and VAC dressing. The mean number of surgical debridements was 2.3. The mean length of hospital stay was 41.8days. Complications were observed in all patients except one. The mortality rate of HNNF in our series was 18%. The cause of death was severe sepsis and multi-organ failure in one case and mediastinitis followed by respiratory distress syndrome in the other case.ConclusionHNNF is still a mortal disease and surgical debridements are crucial. The current study is the only case series in the literature in which VAC treatment was used in consecutive cases of HNNF. VAC treatment can play a major role in the post-operative care of HNNF patients. It reduces the amount of excised skin during debridements and stimulates wound healing. VAC treatment may be included in the treatment protocol of HNNF alongside surgical debridements and medical therapy.

Background: The accuracy of fine-needle aspiration biopsy (FNAB) is controversial in parotid tumors. We aimed to compare FNAB results with the final histopathological diagnosis and to apply the ''Sal classification'' to our data and discuss its results and its place in parotid gland cytology. Methods: The FNAB cytological findings and final histological diagnosis were assessed retrospectively in 2 different scenarios based on the distribution of nondefinitive cytology, and we applied the Sal classification and determined malignancy rate, sensitivity, and specificity for each category. Results: In 2 different scenarios FNAB sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were found to be 81%, 87%, 54.7%, and 96.1%; and 65.3%, 100%, 100%, and 96.1%, respectively. The malignancy rates and sensitivity and specificity were also calculated and discussed for each Sal category. Conclusion: We believe that the Sal classification has a great potential to be a useful tool in classification of parotid gland cytology.

Objective To determine the predictive value of nasal endoscopic findings and symptoms in the diagnosis of granulomatosis with polyangiitis (GPA). Study Design A cross-sectional study. Setting A tertiary university hospital. Subjects and Methods A total of 116 adults were enrolled in the study: 19 patients with GPA, 29 patients with other rheumatic diseases, and 68 healthy volunteers. All patients were examined with a flexible endoscope, and nasal endoscopic images were recorded and evaluated blindly. The medical history of each patient was taken by a physician blinded to the patient’s diagnosis. Results Univariate analysis indicated a statistically significant difference in rhinorrhea (P = .002), postnasal drip (P = .015), epistaxis (P < .001), and saddle nose (P = .017). However, binary logistic regression analysis demonstrated that only history of epistaxis (P = .012; odds ratio, 5.6) was statistically significant in predicting GPA. Univariate analysis showed a statistically significant difference in nasal secretion (P = .028), nasal septal perforation (P < .017), nasal crusting (P < .001), nasal adhesion (P < .001), nasal granuloma (P = .017), and hemorrhagic fragile nasal mucosa (P < .001). A binary logistic regression analysis demonstrated that only hemorrhagic fragile nasal mucosa (P < .001; odds ratio, 52.9) was a statistically significant predictor of GPA. Conclusions Given the results of this study, we believe that hemorrhagic fragile nasal mucosa and history of recurrent epistaxis may put patients at risk for GPA and should be investigated accordingly.

Objective: To evaluate the clinical and pathologic parameters associated with level IIb metastasis in transglottic laryngeal carcinoma. Methods: A total of 238 laryngeal squamous cell carcinoma patients admitted to our tertiary center and surgically treated between January 2006 and January 2014. Of these 238 patients, 134 patients with transglottic laryngeal SCC were enrolled in the study. The type of neck dissection, the location of histopathologically proven metastatic lymph nodes, clinical N and T stages were reviewed. Palpable lymph nodes were accepted clinically cN(+) and the opposite as cN(-). Results: Of the 134 patients, 116 were diagnosed as cN(-), and 18 were as cN(+). Level IIb metastasis was diagnosed in 12 patients in the cN(+) group, and in two patients in the cN(-) group. Histopathological level IIb metastasis was shown in 14 of 134 patients, representing 16 of 268 neck dissection specimens. Level IIb metastasis was shown in the ipsilateral specimens in 12 patients and contralateral specimens in two patients. Forty-one of 134 patients presented cartilage invasion, and nine of them were diagnosed with level IIb metastasis. Conclusion: Thyroid cartilage invasion, the presence of level IIa invasion and advanced stage disease are the risk factors for level IIb metastasis. Therefore, level IIb should not be neglected during neck dissection in transglotticlaryngeal carcinoma.

Objective: To evaluate the clinical and pathologic parameters associated with level IIb metastasis in transglottic laryngeal carcinoma.Methods: A total of 238 laryngeal squamous cell carcinoma patients admitted to our tertiary center and surgically treated between January 2006 and January 2014. Of these 238 patients, 134 patients with transglottic laryngeal SCC were enrolled in the study. The type of neck dissection, the location of histopathologically proven metastatic lymph nodes, clinical N and T stages were reviewed. Palpable lymph nodes were accepted clinically cN(+) and the opposite as cN(-).Results: Of the 134 patients, 116 were diagnosed as cN(-), and 18 were as cN(+). Level IIb metastasis was diagnosed in 12 patients in the cN(+) group, and in two patients in the cN(-) group. Histopathological level IIb metastasis was shown in 14 of 134 patients, representing 16 of 268 neck dissection specimens. Level IIb metastasis was shown in the ipsilateral specimens in 12 patients and contralateral specimens in two patients. Forty-one of 134 patients presented cartilage invasion, and nine of them were diagnosed with level IIb metastasis.Conclusion: Thyroid cartilage invasion, the presence of level IIa invasion and advanced stage disease are the risk factors for level IIb metastasis. Therefore, level IIb should not be neglected during neck dissection in transglotticlaryngeal carcinoma.

Introduction: Posterior nasal neurectomy is an effective way of treating recalcitrant rhinitis. The aim of this study is to describe the anatomic relationship between the posterior inferior nasal nerve (PINN) and the structures that might be important for posterior nasal neurectomy.Materials and Methods: An anatomic study was conducted in a university hospital dissection laboratory with 15 formalin-fixed, sagittally cut adult cadaver heads. The distance between PINN and (1) nasal sill, (2) maxillary sinus ostium, (3) posterior fontanel, (4) torus tubarius, and (5) crista ethmoidalis was measured and the location of PINN with respect to the sphenopalatine artery was assessed to define the exact location of PINN.Results: The mean distance between PINN and nasal sill (56.4mm), maxillary sinus ostium (27 mm), posterior fontanel (12.5 mm), torus tubarius (13 mm), and crista ethmoidalis (8 mm) was determined. PINN was found consistently posterior to the sphenopalatine artery where the inferior turbinate attaches to the lateral nasal wall.Conclusion: Instead of finding PINN around the sphenopalatine foramen, PINN can be located more easily posterior to the sphenopalatine artery where the inferior turbinate attaches to the lateral nasal wall without cauterizing the sphenopalatine artery.

CONCLUSION:Echo-planar diffusion-weighted magnetic resonance imaging (DW MRI) is more reliable than high-resolution computed tomography (HRCT) in predicting the presence and localization of cholesteatoma before tympanomastoid surgery.OBJECTIVES:To evaluate the diagnostic accuracy of HRCT and echo-planar DW MRI in the detection and localization of cholesteatoma.METHODS:Fifty-nine patients were prospectively included in this study. Patients with suspected primary cholesteatoma were evaluated by HRCT and echo-planar DW MRI before tympanomastoid surgery. Radiological findings were correlated with intraoperative findings.RESULTS:HRCT and echo-planar DW MRI accurately predicted the presence or absence of cholesteatoma in 40/59 (67.8%) and 52/59 (88.1%) patients, respectively. The sensitivity, specificity, and positive and negative predictive values of HRCT were 68.97%, 66.67%, 66.67%, and 68.97%, respectively. However, sensitivity, specificity, and positive and negative predictive values of echo-planar DW MRI were 85.71%, 90.32%, 88.89%, and 87.50%, respectively.

Lipomas, despite being the most common mesenchymal tumors of the trunk and extremities, are rarely encountered in the oral cavity. They comprise 1% to 4% of all the benign oral lesions. They are common in the buccal mucosa, tongue, and palate, but only 6% to 10% are sublingual.

Abstract The aim of our study was to present our retrospective experience in the single-stage surgical reconstruction of 21 tracheal stenosis (TS) patients during the last 17 years, considering the characteristics of the treated stenosis, surgical procedures performed, and postoperative outcomes and complications. All demographic and clinical data were collected retrospectively. Chest and neck computed tomography (CT) scans were performed to assess the stenosis, including length, location, and glottic involvement. The stenotic area was evaluated endoscopically according to an adapted Myer and Cotton grading scale. The aetiology of the (TS) was intubation related in 18 patients and idiopathic in three patients. The duration of intubation was 13.00 ± 6.83 days (range, 1 hour to 27 days). According to the Myers-Cotton classification, mean stage of stenosis for the study group was 3.33 ± 0.66 (range, 2–4). Mean length of the stenosis was 2.05 ± 0.80 (range, 1–3.5) cm. The mean number of stenotic segment involved was 3.67 ± 1.24 (range, 2–6). Mean follow-up for the study group, excluding two patients who died in the postoperative period, was 57 (range, 12–326) months. Of the 19 patients who survived, postoperative decannulation was achieved in 16 patients (76.19%), and decannulation was not achieved in 3 patients (14.29%) who are still on a T-tube. Of the 16 patients who are decannulated successfully, additional procedures were applied in 9 patients. Segmental resection with primary anastomosis is an effective method and can be used as the first option in selected patients of (TS).

Minor salivary gland neoplasms (MSGNs) are unusual, accounting for only 15-20% of all salivary gland tumors. The commonest site of MSGNs of the head and neck is the oral cavity. Pleomorphic adenoma is the most common benign neoplasm and mucoepidermoid carcinoma is the most common malignancy. The aims of this study is to describe our experience of MSGNs in the oral cavity seen over last 5years.

The objective of this study was to determine the incidence of thyroid gland invasion in laryngeal and hypopharyngeal squamous cell carcinoma; and the association between clinicopathological parameters and thyroid gland invasion. Medical records of 75 patients with laryngeal and hypopharyngeal squamous cell carcinoma who underwent total laryngectomy with thyroidectomy were reviewed, retrospectively. Preoperative computed tomography scans, clinical and operative findings, and histopathological data of the specimens were evaluated. There were 73 male and two female patients with an age range of 41-88 years (mean 60.4 years). Hemithyroidectomy was performed in 62 (82.7 %) and total thyroidectomy was performed in 13 patients (17.3 %). Four patients had histopathologically proven thyroid gland invasion (5.3 %). In three patients, thyroid gland involvement was by means of direct invasion. Thyroid gland invasion was significantly correlated with thyroid cartilage invasion. Therefore, prophylactic thyroidectomy should not be a part of the treatment policy for these tumors.