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OBJECTIVES The study aimed to display the growth pattern of the tympanic ring in fetal cadavers of 20-30 weeks of gestation. METHODS In the study, 32 temporal bones of 16 fetuses (8 males, 8 females) of 24.62 ± 3.44 weeks of gestation were dissected to measure the height (TRH), width (TRW), and perimeter (TRP) of the annulus, and the width (TNW) of the opening part of the annulus at the level of the tympanic notch. RESULTS The TRH, TRW, TRP, and TNW were measured as 8.25 ± 1.04 mm, 7.64 ± 1.08 mm, 24.93 ± 3.40 mm, and 4.01 ± 0.91 mm, respectively. The parameters were similar at the seventh and eighth months of gestation; therefore, there was no variation from the seventh month. Linear function was calculated as y = 1.328 + 0.281 x weeks (P < .001) for the TRH, y = 1.284 + 0.258 x weeks (P < .001) for the TRW, y = 3.367 + 0.876 x weeks (P < .001) for the TRP, and y = -0.603 + 0.188 x weeks (P < .001) for the TNW. CONCLUSION The parameters (TRH, TRW, TRP, and TNW) did not alter from the seventh month in utero. The linear functions (which represent the growth pattern of the parameters) of the tympanic ring may be useful for ear professionals to guess the annulus diameters, and to diagnose growth retardation and probable congenital anomalies in utero during sonographic imaging.

The study aimed to examine morphometric properties of the round window (RW) and oval window (OW) and to show their relation with the tympanic nerve (the Jacobson’s nerve, JN) in human fetuses from the otologic surgeon’s perspective. Thirty temporal bones of 15 fetal cadavers (8 males, 7 females) aged with 24.40 ± 3.71 weeks were included in the study. The height, width and surface area of the RW and OW and also distance from the JN to the OW and RW were measured. The height, width and surface area of the RW in this work were measured as 1.48 ± 0.25 mm, 1.57 ± 0.37 mm, and 2.05 ± 0.69 mm2, respectively. The RW was detected as round-shaped (8 cases, 26.7%), oval-shaped (15 cases, 50%), and dome-shaped (7 cases, 23.3%). The height, width and surface area of the OW were measured as 1.42 ± 0.26 mm, 2.90 ± 0.44 mm, and 3.63 ± 0.74 mm2, respectively. The OW was observed as oval-shaped (15 cases, 50%), kidney-shaped (10 cases, 33.3%), D-shaped (4 cases, 13.3%), and trapezoid-shaped (1 case, 3.3%). The JN was found 1.21 ± 0.60 and 1.18 ± 0.54 mm away from the RW and OW, respectively. This study containing morphological data about the shapes, diameters and area of the RW and OW may be useful to predict surgical difficulty, and to select implants of suitable size preoperatively for the windows. Knowing the relationship between the JN and the windows can be helpful to avoid iatrogenic injuries of the nerve.

Objective The main objective of the study was to show the morphologic features of optic strut (OS) and prechiasmatic sulcus (PS) in the fetal skull base with a surgical anatomical perspective. Methods Twenty-three fetal cadavers (9 female, 14 male) with an average age of 21.70 ± 3.12 (range: 16–28) weeks of gestation in the inventory of the Anatomy Department were included in the study. Measurements were made with a digital image analysis software and goniometer. Results The sulcal length, interoptic distance, planum length, and sulcal angle were detected as follows: 3.91 ± 0.74 mm, 6.88 ± 1.04 mm, 6.55 ± 1.51 mm, and 24.52 ± 9.51°, respectively. Considering the location of the posteromedial margin of OS according to PS, OS was identified as the sulcal in 56.5% (13 cases), postsulcal in 30.4% (7 cases), and asymmetric in 13% (3 cases). According to the sulcal length and angle, PS was identified as type 1 in 26.1% (6 cases), type 2 in 21.7% (5 cases), type 3 in 30.4% (7 cases), and type 4 in 21.7% (5 cases). Conclusions Our findings suggest that the sulcal length and angle reach adult size in utero. Taking into account the fetal and the gathered adult measurements, the high percentage of steep angle compared to flat angle show that after birth, PS become more flat, probably depending on the variations of the sphenoid sinus pneumatization. Thus, more studies conducted on the alterations in PS and OS types relative to the pneumatization are needed in terms of patient positioning, selection of appropriate surgical approach, and intraoperative decision-making.

Introduction: A cadaveric experimental investigation aimed to show the rupture pressure of the tympanic membrane (TM) for otologists to evaluate its tensile strength. Methods: Twenty adult ears in 10 fresh frozen whole cadaveric heads (four males, six females) mean age 72.8 (SD 13.8) years (range 40–86) were studied. The tensile strength of the TM was evaluated with bursting pressure of the membrane. The dimensions of the membranes and perforations were measured with digital imaging software. Results: The mean bursting pressure of the TM was 97.71 (SD 36.20) kPa. The mean area, vertical and horizontal diameters of the TM were 57.46 (16.23) mm2, 9.54 (1.27) mm, 7.99 (1.08) mm respectively. The mean area, length and width of the perforations were 0.55 (0.25) mm2, 1.37 (0.50) mm, and 0.52 (0.22) mm, respectively. Comparisons of TM dimension, bursting pressure, and perforation size by laterality and gender showed no significant differences. The bursting pressure did not correlate (positively or negatively) with the TM or perforation sizes. Conclusions: The TM can rupture during activities such as freediving or scuba diving, potentially leading to serious problems including brain injuries. Studying such events via cadaveric studies and data from case studies is of fundamental importance. The minimum experimental bursting pressures might better be taken into consideration rather than average values as the danger threshold for prevention of TM damage (and complications thereof) by barotrauma.

To present the quantitative development of the geniculate ganglion (GG) in foetal cadavers.This study focused on 60 temporal bones of 30 (15 female and 15 male) foetuses aged 18?30 weeks of gestation (mean age, 22.83 ± 3.49 weeks) to measure the length, width and area of the GG.According to gestational weeks and months, the ganglion length (1.21 ± 0.41 mm), width (1.03 ± 0.28 mm) and area (1.24 ± 0.61 mmsup2/sup) did not change. In terms of sexes or sides, ganglion dimensions were not significantly different. Positive correlation was found between the length and width (p=0.033, r=0.276), between the length and area (p0.001, r=0.762) and between the width and area (p0.001, r=0.622). Linear functions were calculated for the ganglion area (y=0.355 + 0.039 × weeks), length (y=0.636 + 0.025 × weeks) and width (y=0.634 + 0.017 × weeks).The ganglion size did not change in foetal cadavers aged 18?30 weeks of gestation. This finding may be important for anatomists and embryologists in performing morphometric studies and understanding the development of the GG and for neurootologists and neurosurgeons in achieving greater success in skull base surgeries.

This study aimed to peruse anatomic features of the cranial aperture of the optic canal (CAOC) for obtaining an extended morphometric dataset in children. Computed tomography images of 200 children were included in this retrospective work to analyze the shape, location and diameters of the CAOC. The CAOC area, width and height were observed as 17.53 ± 2.80 mm2, 6.12 ± 0.84 mm, and 4.35 ± 0.64 mm, respectively. The angle of the optic canal in axial plane was found as 39.28 ± 5.13°, while in sagittal plane as 16.01 ± 6.76°. The distance between the CAOC and the midsagittal line was 7.17 ± 1.48 mm. The CAOC was measured as 54.04 ± 5.23 mm and 42.55 ± 3.28 mm away from the anterior and lateral boundary of the anterior skull base, respectively. The CAOC shape was described as the tear-drop (186 foramina, 46.5%), triangular (156 foramina, 39%), oval (47 foramina, 11.8%), and round (11 foramina, 2.8%). The depth, angle and diameter measurements belonging to the CAOC were changing according to its shape or demographic data (e.g., sex and age). Therefore, preoperative radiologic evaluation containing the shape, location and size of the CAOC should be considered by multidisciplinary operating teams in terms of surgical interventions such as implant positioning.

The work aimed to compare fetal and adult tympanic membrane (TM) sizes for understanding dimensional development from intrauterine life to adulthood. Fifty-six temporal bones (18 fetuses, 10 elderly adults, half male and half female in each group) were included in this study. Using a digital image software, the TM height, width and area were measured. The mean area, height and width of the TM in adults were found as 58.84 ± 22.01 mm2, 9.06 ± 1.33 mm, and 8.10 ± 1.43 mm, respectively. Moreover, the mean area, height and width of the TM in fetuses were measured as 47.62 ± 12.57 mm2, 8.22 ± 1.12 mm, and 7.25 ± 1.15 mm, respectively. The TM dimensions were increasing in fetuses between 20–32 weeks of gestation. However, the TM dimension was statistically similar at the 7th month, the 8th month and adult periods. The TM height was greater than its width in fetuses and adults. The calculated regression equations of the TM parameters in fetuses may be used to estimate its size. The TM size did not change from the 7th gestational month, and thus the membrane reached adult diameter in fetal life. The TM height and width showed a very wide range; therefore, we thought that the 12 mm (the height) × 10 mm (the width) graft might be ideal dimension during the repair of the TM perforations.

This study aimed to establish an extended morphometric dataset regarding the stapedius muscle for anatomists and otologists. The tympanic cavity of ten cadavers (five females, five males) aged with 75.70 ± 13.75 years was bilaterally dissected. Morphometric properties of the stapedius muscle (i.e., its muscular belly and tendon) and its relationship with the neighborhood structures including the facial nerve was evaluated. The length of the entire stapedius muscle was found as 4.80 ± 1.13 mm. The depth between the entrance of the external auditory canal and stapedius muscle was measured as 18.23 ± 2.30 mm. The incudostapedial joint and stapedial tendon were found to be 1.66 ± 0.25 mm and 1.18 ± 0.19 mm away from the facial nerve, respectively. The stapedial tendon length was standardized as five types: Type 1, extremely short tendon (under 0.5 mm), 5% of cases; Type 2, short tendon (between 0.5 and 1 mm), 30% of cases; Type 3, normal tendon (between 1 and 2 mm), 55% of cases; Type 4, long tendon (between 2 and 2.5 mm), 10% of cases; and Type 5, extremely long tendon (above 2.5 mm), no cases. Our findings showed that the stapedius tendon size in adults was quite similar to fetuses. Therefore, probably entire muscle dimension does not alter after birth. Considering the concordance between direct anatomic (our findings) and radiologic measurements (literature findings) of the stapedius muscle, preoperative radiological evaluation may be important for otologists in terms of the choice of surgical tools such as diamond burr sizes. Due to the lack of standardization regarding the evaluation of the stapedius tendon size (i.e., extremely short or extremely long), we defined the tendons below 0.5 mm as extremely short (Type 1) and above 2.5 mm as extremely long (Type 5).

Purpose To investigate the characteristics of the prechiasmatic sulcus in children aged between 1–20 years. Methods Patient files of 200 children admitted to the university hospital on 2019 were analyzed, retrospectively. The computed tomography images of patients were used to obtain anatomical knowledge containing prechiasmatic sulcus types and dimensions. Results The measurements related to the sulcal length (6.94 ± 1.25 mm) and sulcal angle (31.01 ± 18.13°) showed that the sulcal length did not alter in children between 1 and 20 years, whereas the sulcal angle did not vary from infancy to prepubescent period, but it was decreasing in postpubescent period. In 29 patients, the sulcal length was observed to divide into 2 parts with an evident angle. The interoptic distance and planum length were found as follows: 14.70 ± 2.85 mm and 14.84 ± 4.12 mm, respectively. The order of PS types was observed as type 4 (26.5%, 53 cases) > type 2 (26%, 52 cases) > type 1 (24%, 48 cases) > type 3 (23.5%, 47 cases). Conclusions The sulcal length did not vary in children, whereas the sulcal angle decreased with an irregular pattern. The sulcal angle decreased after prepubescent period, possibly due to the sphenoid sinus pneumatization and spheno-occipital synchondrosis. The sulcal length angle mostly in infants and young children may cause surgical orientation difficult during the resection of tumors using transcranial approaches.

Purpose The main objective of this study was to display the morphologic properties of the anterior clinoid process (ACP) in human fetuses in term of early childhood surgeries. Methods Twenty-four (10 females and 14 males) fetal cadavers aged from 16th to 28th weeks of gestation (at mean, 21.54 ± 3.11 weeks) were included in the present study. The dimensions of ACP were measured with a digital image analysis software. Results Taking into account the length, width, and angle of ACP, it was classified as Type 1 in 20.83% (10 cases), Type 2 in 10.42% (5 cases), Type 3 in 10.42% (5 cases), Type 4 in 2.08% (1 case), Type 5 in 8.33% (4 cases), Type 6 in 16.67% (8 cases), Type 7 in 8.33% (4 cases), and Type 8 in 22.92% (11 cases). According to the attachment site of the optic strut (OS) relative to ACP, OS was identified as the anterior 3/5 in 16.67% (8 cases), anterior 4/5 in 68.75% (33 cases), and posterior 1/5 in 14.58% (7 cases). Neither right-left nor male-female significant differences were observed between the quantitative values belonging to ACP and OS. Conclusion The percentage of the most complex and challenging type of ACP (the long, narrow, and narrow-angled ACP) in fetuses was found to be close to adults. Thus, routine adult surgical procedures such as anterior clinoidectomy might be successfully used in young children and infants. The attachment site of OS relative to ACP in adults was more anterior according to fetuses probably due to postnatal development such as the pneumatization of the sphenoid bone. In this regard, for pediatric neurosurgeons to avoid iatrogenic injuries and to select appropriate surgical approaches, further studies conducted on the attachment of OS relative to ACP in children are needed.

This retrospective computed tomography (CT) study was aimed to assess the growth dynamic of the external aperture of the carotid canal (EACC) in children aged between 1 and 20 years. Two hundred patients (sex 100 females/100 males, average age 10.50 ± 5.77 years) with good head CT image quality were included in this study. CT images of the patients were used to obtain data related to the location, shape and dimension of EACC. EACC shapes were identified as oval shaped, round shaped, and tear-drop shaped in 58.3% (233 sides), 24% (96 sides) and 17.8% (71 sides), respectively. EACC length, disEACC–MSP (distance between EACC and midsagittal plane), and EACC width did not change from the prepubescence period; while, the disEACC–SC (distance between EACC and supramastoid crest) seemed to reach adult size in the postpubescence period. Linear functions for EACC length and width were calculated as: y = 5.453 + 0.091 × years, and y = 5.398 + 0.059 × years, respectively. The regression equations of the measured parameters representing the growth dynamic of EACC in children can be helpful to estimate its size, location and angulation, which suggest that the dimension and distances to certain anatomical landmarks seemed to reach adult size in different developmental periods. In this context, the findings of this study may seem to emphasize the importance of preoperative radiological evaluation on skull base, related to EACC, for multidisciplinary surgeon teams during childhood surgeries in terms of patients’ positioning, and the selection of appropriate surgical approach.

Objective The main aim of this study placed on cadavers was to compare the data related to geniculate ganglion (GG) dehiscence and dimension obtained from computed tomography (CT) with dissection values. Methods This study was conducted on 20 temporal bones obtained from 10 cadavers (4 female, 6 male) aged between 45 and 92 (71.50 ± 15.98) years. All the measurements related to GG dimension were performed with a CT scanner and microdissection. Results The size of GG including its area, length, and width did not show statistically significant differences in terms of sex, side, and assessment method (CT and cadaveric dissections). The dehiscent GG was observed in 6 (30%) and 5 (25%) out of 20 temporal bones in CT and cadaveric dissections, respectively. The presence and absence of GG dehiscence in CT and dissection were similar in 75%. Conclusions Our findings based on dissection data suggest that radiologic evaluation of dehiscent GG detection might be erroneous by 25%, which highlights that surgeons should be careful when lifting the dura to prevent GG injury during middle cranial fossa surgical approaches. On the other hand, there was no statistical difference between CT and dissection measurements related to GG dimension.

OBJECTIVES: This study aimed to compare the right and left sides of the carotid foramen (CF) to determine its precise location according to certain anatomical landmarks. MATERIALS AND METHODS: Twenty human dry skulls were included in the study. A digital caliper and a digital image analysis software were used to obtain direct anatomical numerical values. Then, the same parameters on dry skulls were assessed with computed tomography (CT). RESULTS: CF was found to be round shaped (62.5%), oval shaped (32.5%), and tear-drop shaped (5%). In all cases, the position of CF was seen as just postero-laterally of the foramen lacerum. According to the jugular foramen, CF was seen to be anterior in 85% and antero-medial in 15% of the cases. Regarding the morphometric values of the surface area, the length and width of CF were observed to be 37.86±11.24 mm(2), 8.02±1.09 mm, and 6.86±0.90 mm at direct anatomical measurements and 39.69±10.07 mm(2), 7.89±1.14 mm, and 6.41±0.90 mm at CT, respectively. The angles between the supramastoid crest-CF-zygoma root and the supramastoid crest-CF-mastoid process were determined as 37.11±6.87° and 42.22±6.40° at direct anatomical measurements and 36.59±4.94° and 43.71±4.55° at CT, respectively. CONCLUSION: A significant difference in sides was not observed in relation with the numerical data of CF obtained from CT or from direct anatomical measurements of dry skulls. Moreover, a significant difference was not found between radiological and direct anatomical measurements. Therefore, precise radiological assessment of this region by an experienced neuroradiologist may be assumed as a fundamental need for successful surgeries of the skull base, in addition to thorough anatomical knowledge of neurootologists and neurosurgeons.

The main aim of this retrospective computed tomography (CT) study was to examine the morphometric development of the geniculate ganglion (GG) in children aged between 1 and 18 years for surgical approaches. This study was placed on 41 patients (20 females and 21 males) including cochlear implantation cases aged from one to 18 (at mean, 6.44 ± 5.79) years. All the measurements belonging to the length, width and area of GG were performed with a CT scanner. The morphometric values of GG were not different in terms of sex or side, statistically (p > 0.05). The length (p = 0.155) of GG was not correlated with the increasing ages from one to 18 years; however, its area (p

The main objective of the study was to investigate the morphometric properties of the stapedial tendon (ST) for pediatric otosurgeons and anatomists. The present study was placed on 15 fetuses (8 females, 7 males) aged from 20 to 30 weeks of gestation (at mean, 24.27 ± 3.24 weeks) using the collection of the Anatomy Department of Medicine Faculty, Mersin University. All measurements were obtained with a digital image analysis software. In terms of male/female or right/left comparisons, no statistically significant difference was found in relation with the numerical data of ST. The surface area, length, and width of ST were detected as follows: 0.61 ± 0.15 mm2, 1.27 ± 0.30 mm, and 0.45 ± 0.08 mm, respectively. The absence of ST was observed in two fetuses with and without severe malformations. In another fetus with cleft lip and polydactyly, multiple abnormalities were bilaterally identified in the middle ear: (1) the absence of the incudostapedial joint and (2) the presence of an abnormal tissue attaching to the stapes. The abnormal tissue was determined to be irregular dense connective tissue using light microscope and electron microscope. Our findings showed that ST did not proportionally grow according to increasing gestational weeks. In the light of the numerical data, we thought that similar to stapes, ST attains the adult size in the fetal period. As ST anomalies may accompany severe malformations (e.g., cleft lip, polydactyly or syndactyly) that can be easily detected on observation by clinicians, we suggest that the detailed examination of middle ear in newborns should be taken into account for early diagnosis of conductive hearing loss to prevent any management delays.

Objectives The main aim of the study was to examine the development and course of the facial nerve within fetal temporal bones from an anatomical and neuro-otological perspective. Methods The study was conducted on 32 temporal bones from obtained fetuses (7 females, 9 male), on a mean gestational age of 26.75 ± 4.36 (range, 20–34) weeks from the collection of the Anatomy Department of Medicine Faculty. All the measurements were collected with a digital image analysis software. Results Neither male/female nor right/left significant differences were observed in relation with the algebraic data of the segment lengths and angles of the facial nerve (p > 0.05). Linear functions for meatal, labyrinthine, tympanic, and mastoid segment lengths of the facial nerve were calculated as: y = −1.206 + 0.200 × Age (weeks), y = −1.868 + 0.153 × Age (weeks), y = −2.327 + 0.325 × Age (weeks), and y = −1.507 + 0.246 × Age (weeks), respectively. In addition, linear functions for first and second genu angles were calculated as: y = 105.475–0.117 × Age (weeks) and y = 140.446–0.042 × Age (weeks), respectively. Conclusion The regression equations and the scatter plot with increment curve, representing the growth dynamics of the facial nerve can be used for estimating its lengths and for understanding its development. The data suggest that there is a dramatic change transition from fetal life to the gathered data of adulthood in the length of meatal and mastoid segments as well as in the second genu angle; in addition, there is a partial change in the length of labyrinthine and tympanic segments as well as in the first genu angle.

The painful torticollis only itself may be a major sign for the diagnosis of Grisel’s syndrome (GS). It is known as an inflammatory atlantoaxial rotatory subluxation following upper respiratory tract infections (URTI) and surgical otolaryngological procedures. The analysis of 16 pediatric GS patients were reviewed retrospectively by considering the diagnosis, the treatment modality, and the prognosis at the Department of Neurosurgery and Otorhinolaryngology in Mersin University, Faculty of Medicine between 2008 and 2018. In addition to the clinical cases, five cadavers were used to demonstrate atlantoaxial region, particularly the ligamentous complex and articulation of the atlas-axis, for the mechanism of these rare entities. The most common etiological factor of GS was URTI with 81.25% among 16 patients. Painful torticollis was the primary symptom of pediatric patients at admission. The X-Ray, computerized tomography (CT), and magnetic resonance imaging (MRI) investigations were used for the definitive diagnosis in the first week of admission, except one. No morbidity, mortality, and deformity were reported in this series. Early diagnosis is the principle of GS for avoiding of permanent neck deformity and complex surgical procedures. If GS can be diagnosed without any doubt by only considering patient’s history and clinical examination, CT scan is not recommended due to harmful effects of radiation. The treatment was achieved by reduction, external fixation under analgesia, or sedoanalgesia accompanying with antibiotic and anti-phylogistic treatment.

The CHARGE syndrome characterized by coloboma, heart defects, atresia of the choanae, retarded growth, genitourinary hypoplasia, and ear anomalies is one of the rare syndromes. Although certain clinical issues (scapular winging, sloping shoulder, Sprengel's deformity, kyphosis and scoliosis) which could be related to abnormalities in musculoskeletal structures of the neck and shoulder have been identified in CHARGE syndrome, data on details of muscle anomalies seem to be quite limited in the literature. In this case report, bilateral multiple muscular abnormalities (agenesis of the trapezius, presence of the rhombo-atloid muscle, and presence of the bipartite rhomboid minor with superficial and deep parts) was presented in a fetus cadaver with atypical CHARGE syndrome to attract the attention of clinicians for definitive diagnoses and surgical reconstruction of the shoulders deformity such as scapular winging and Sprengel's deformity. By considering the previous studies, we propose that the absence of the trapezius, as well as the other muscle abnormalities around the neck and shoulder, should be revised as being a component of CHARGE syndrome.

The aim of this study was to investigate the probable effects of Hypericum perforatum (HP) on wound healing in diabetic rats.Thirty-five male Wistar rats were divided evenly into 5 groups. Diabetes formation was induced by intraperitoneal streptozotocin (60 mg/kg) administration for groups 1 (HP extract in olive oil), 2 (HP extract in ethanol), 3 (povidone-iodine application), and 4 (diabetic rats without any applied medication); group 5 was the control. Dorsal dermoepidermal incision was performed on each rat after 48 hours. The aforementioned solutions were applied only to groups 1, 2, and 3; groups 4 and 5 did not receive solution applications. At the end of the 7-day period, the cutaneous tissue was resected from the center of the incised and sutured region and divided into 3 pieces for biomechanical, biochemical, and histopathological assessments.Ultimate stress and toughness significantly decreased in groups 3, 4, and 5 compared to group 1. There was a significant difference between groups 2 and 3 for the same parameters (P.05). Compared with group 4, tissue malondialdehyde levels were found to be lower in the HP groups (P.05). Histopathological evaluation revealed the fibroblast count was reduced considerably in the HP-applied rats compared with other groups (P.05).Application of HP may be recommended as effective on wound healing in diabetic rats, but further investigation is needed to adapt the findings for clinical use.

Objectives:Wound healing, epithelial regrowth and collagen synthesis are very important factors in the repair of the traumatised tympanic membrane. The aim of the present study was to determine the role of plasma fibronectine in the aetiopathogenesis of tympanosclerosis.Methods:This prospective study included 58 patients with and 49 without tympanosclerosis. No inflammation or trauma was noted in either patient group. All patients underwent otoscopic and otomicroscopic examination, and the degree of tympanosclerosis was graded from mild (stage I) to severe (stage III). Following otological examination, blood samples were taken for plasma fibronectine measurement.Results:Following otoscopic and otomicroscopic examinations, patients' tympanosclerosis was graded as follows: 18 patients were stage I; 29 were stage II; and 11 were stage III. Statistical analyses revealed that the plasma fibronectine concentrations were significantly lower in the study group compared with the control group (p = 0.031). In addition, fibronectine levels were lowest in the patients with severest tympanosclerosis (p = 0.0001 in each comparison).Conclusion:The results of the present study show that serum fibronectine is important in the development and severity of tympanosclerosis.

PubMedID: 15004706 Antrochoanal polyp (ACP) is a soft tissue mass originating from the maxillary antrum, emerging from the ostium and extending to the choana through the nasal cavity. Our aim was to investigate the light microscopic and ultrastructural features of ACP and to compare these with nasal polyps originating from the middle meatus (MMP). Seven ACP and seven MMP specimens were evaluated by transmission electron microscopy (TEM) and light microscopy. TEM examination showed epithelial cells with intact cilia covering both polyps. In some MMP cases, degeneration of the epithelium associated with some cilia loss was noted. Goblet cell hyperplasia was more prominent in MMP cases. Degeneration and partial destruction of the endothelial cells of the blood vessels were common findings in ACP cases; however, in the MMP group, endothelial cells were mostly intact with a few aggregates of ribosomes, and intact cell junctions were noted. Light microscopic examination revealed that inflammatory cells in the ACP group were numerous. However, eosinophils were predominant in MMP cases. Squamous metaplasia of the surface epithelium was detected in five ACP cases, but in none of the MMP cases. Basement membrane thickening was detected in two cases of the ACP and in four cases of the MMP group. There was a statistically significant difference between the two groups for inflammatory cells, eosinophilic cell infiltration, squamous cell metaplasia, endothelial cell destruction and goblet cell metaplasia. In conclusion, the low number of eosinophils, the high number of other inflammatory cells, the normal appearing basement membrane and intact and normal surface epithelium may reveal that the etiology of ACP might arise from chronic inflammatory processes rather than allergy. The destruction of the endothelium may be considered as a further sign of chronic inflammation. © Springer-Verlag 2004.

To investigate the efficacy and safety of intraparotid botulinum toxin-A (BTX-A) injections into parotid gland using ultrasound-guided versus nonguided techniques for the treatment of sialorrhoea in patients with Parkinson's disease (PD).15 patients with PD and sialorrhoea were included and divided into two groups. Group A patients (n=8) were injected with BTX-A using ultrasound guidance. Group B patients (n=7) were injected with BTX-A without ultrasound guidance. Saliva secretion was assessed quantitatively at baseline and at weeks 1, 4, and 12. Patients and/or caregivers also assessed the saliva secretion using visual analog scale (VAS).All patients except one reported subjective improvement in sialorrhoea at the first week. Group A patients showed significantly higher rate of saliva reduction at the first week, whereas in Group B the reduction was not statistically significant from baseline at the first week (P0.05). Comparisons of quantitative saliva assessments at each follow-up visit also showed that ultrasound-guided injections were superior to blind injections for saliva reduction. VAS scores showed an improvement in the mean rate of saliva secretion in each group at first week (P0.05). Two patients suffered from dry mouth in mild severity lasting 1 month.Intraparotid BTX-A injections using ultrasound guidance may be an effective, easy, and safe treatment for parkinsonian sialorrhoea.

This study investigates the deleterious effects of corticosteroids on tracheal anastomotic healing and the ability of vitamin A to reverse these effects in a rat model.Forty-two adult Wistar rats were randomly divided into five groups. The animals underwent tracheal transection and primary anastomoses. The groups were assigned as follows: Group I, sham (N=6); Group II, control (N=6); Group III, dexamethasone, 0.1 mg/kg/day intramuscularly (N=10); Group IV, dexamethasone 0.1 mg/kg/day intramuscularly+vitamin A 10000 IU/kg/day by gavages (N=10); and Group V, vitamin A 10000 IU/kg/day by gavages for a week (N=10). After 7 days, anastomotic healing was assessed by measurement of bursting pressure, hydroxyproline content and subsequent histological grading using the modified Ehrlich/Hunt scale.Bursting pressures and hydroxyproline contents were as follows: Group I: 977+/-8 mmHg and 11.80+/-0.3 microg/mg (mean+/-standard error of the mean); Group II: 890+/-55 mmHg and 9.93+/-0.6 microg/mg; Group III: 555+/-26 mmHg and 11.90+/-1.3 microg/mg; Group IV: 873+/-73 mmHg and 10.24+/-2.2 microg/mg; Group V: 905+/-45 mmHg and 7.51+/-0.8 microg/mg, respectively. Bursting pressure of Group III was found to be significantly lower when compared to other groups (P0.0001). However, statistical significance was not found among the study groups for the hydroxyproline content. Except for inflammatory cell infiltration, histological parameters including epithelial regeneration, fibroblast proliferation, collagen content, and angiogenesis demonstrated significant differences among the groups.The present study demonstrates that dexamethasone significantly impairs the healing of tracheal anastomoses in rats and postoperative administration of vitamin A appreciably reverses this inhibitory effect. Patients receiving corticosteroids may benefit from vitamin A when undergoing prolonged intubation and laryngotracheal reconstruction.

Objective: Myringosclerosis often occurs in patients in whom ventilation tube insertion and tympanoplasty procedures are performed. Recent studies have revealed a relationship between the development of myringosclerosis and oxygen-derived free radicals, and some investigations have demonstrated that free radical scavengers prevent the development of myringosclerosis. N-acetylcysteine is a well-known anti-oxidant and anti-inflammatory agent. In this study, we aimed to investigate the preventive effect of N-acetylcysteine on myringosclerosis in myringotomized rat tympanic membranes. Methods: Twenty Sprague–Dawley rats were bilaterally myringotomized and divided into four groups. Group 1 received no treatment, group 2 was treated with topical saline solution in Spongostan, group 3 received topical 0.6 mg N-acetylcysteine in Spongostan and group 4 received 1.2 mg N-acetylcysteine in Spongostan daily for 12 days. Tympanic membranes were examined by otomicroscopy on day 12. Then, the membranes were harvested and evaluated histologically by light microscopy. Results: The tympanic membranes of groups 1 and 2 (saline and non-treated) showed extensive occurrence of myringosclerosis, whereas groups 3 and 4 (treated with N-acetylcysteine) showed lesser occurrence of myringosclerosis in otomicroscopic evaluation (P

The aim of this study was to investigate the dose-related effects of dichlorvos inhalation on electrophysiological alterations of diaphragm and phrenic nerve and the changes in the histologic structure of respiratory system. This study was performed on 33 rats divided into 5 groups, inhaling 1, 2, 5, 10, and 15 microg/L of dichlorvos, respectively. Electrodiagnostic investigations of diaphragm and phrenic nerve were made before and after inhalations. Aspiration samples were taken from lungs to evaluate the presence of infection agents. The airways, lungs, and diaphragms were dissected out for histologic investigation. Rats exposed to a low concentration of dichlorvos (1-5 microg/L) showed no symptoms of intoxication, but exposure to higher doses (10-15 microg/L) induced dyspnea in several animals. Lower doses of dichlorvos revealed no electromyographic changes on diaphragm, whereas higher doses revealed a clear neuropathic involvement. Delayed phrenic nerve motor conduction velocity was noted for each group (p.05). Morphologic changes on the tracheal epithelium, hyperplasia, thickening of the blood-air barrier, degeneration in alveoli, and ductus alveolaris were seen in histopathologic investigation. In conclusion, the acute inhalation of dichlorvos caused clear evidence of neuropathic involvement of the diaphragm and the phrenic nerve. Also, toxic pneumonitis and injury to the tracheal epithelial were noticed.

Myringosclerosis (MyS) is a common sequela of acute and chronic otitis media and ventilation tube treatment of serous otitis media. We aimed to study the effect of topical administration of N -acetylcysteine (NAC) on MyS by assessment of otomicroscopic evaluation, lipid peroxidation and nitric oxide (NO) (nitrite/nitrate) levels in experimental myringotomized rat tympanic membrane. Thirty adult rats were used and the upper posterior quadrant of the tympanic membranes of rats was myringotomized. Thereafter, they were divided into four groups. Group I received no treatment, group II was treated with saline, groups III and IV were treated with topical NAC (0.1 ml of 6 and 12 mg ml(-1), respectively). The levels of nitrite/nitrate and malondialdehyde (MDA) were measured in serum samples. In the otomicroscopic evaluation, non-treated and saline treated ears (controls) showed extensive occurrence of myringosclerotic plaques. Groups III and IV showed fewer occurrences of sclerotic plaques. There was no significant difference between groups III and IV regarding the development of MyS. The development of myringosclerotic lesion was found to be significantly different between NAC treated groups (III and IV) and the control groups (I and II). The levels of nitrite/nitrate of both groups III and IV were significantly lower than the control groups. The levels of MDA of these groups were also significantly lower than the control group. The relationship between groups III and IV was not statistically significant for the levels of nitrite/nitrate and MDA. We conclude that the topical treatment of NAC reduces the levels of MDA and NO products in rats. These results suggest that topical NAC application may be useful for the prevention of MyS.

Objective: Theeffectsofanimmunosuppressiveagent,mycophenolate mofetil (MM), were investigated and compared with those of methylprednisolone (MP) and dexamethasone (DXM) on the traumatic nerve function. Study Design: This is a randomized controlled animal study. Materials and Methods: This experimental study was performed on 84 male Wistar albino rats. The rats were assigned to 12 groups each consisting of 7 animals. The groups were formed according to application of normal-dose DXM (group 1A-B), high-dose MP (group 2A-B), normal-dose MP (group 3A-B), MM (group 4A-B), and MM with high-dose MP combination therapies (group VA-B). Right sciatic nerve dissection was performed, and compound muscle action potential thresholds were recorded. The nerve was traumatized with the compression of a Jeweller forceps for 20 seconds. Posttraumatic thresholds were also recorded. The compound muscle action potential thresholds were recorded in the first and fourth weeks for the assigned groups. Then, the nerve was transected and prepared for electron microscopic and histopathologic examinations. Nitric oxide and malondialdehyde assessments were performed on both tissue and blood samples. Results: Only the MM and MP+MM groups had satisfactory electron microscopic findings and were about to reach the tissue characteristics of the control animals. Despite the electrophysiologic recovery, the DXM group was found to have poor electron microscopic scoring. Conclusions: Mycophenolate mofetil has been found to be beneficial in the treatment of traumatic nerve paralysis. Although a complementary investigation is needed, this immunosuppressive agent may be an alternative to corticosteroids for the selected cases where steroid therapy is contraindicated.

This study was designed to investigate the effects of bipolar and mononopolar electrocauterization on peripheral nerve tissue. The comparison on the deleterious effects of the different cautery modalities and the importance of probe tip placement are evaluated using electrophysiological, electron microscopic and biochemical assessment parameters. Ninety-eight male Wistar albino rats, each weighing 250–275 g, were randomly divided into 14 groups. Each group consisted of seven animals. Monopolar and bipolar electrocautery were performed at 15 watts. The application was performed either directly on the nerve or 1 mm lateral to the longitudinal axis of the nerve for ‘near the nerve groups’, respectively. The electrophysiological findings showed that the mean amplitudes were at the lowest value in the first day for all the groups. At the end of the 3rd week, we recognised that the electrophysiological recovery continued. Electron microscopic evaluation showed myelin disruption in all groups. Myelin disruption of healthy neurons was at the highest level in the 1st day of application in accordance with the electrophysiological findings. Biochemical evaluation revealed statistical significance between the control and the two of the ‘near the nerve groups’ (GIII and GV) for NO (nitrite and nitrate) serum level. The data of the present study might suggest that electrocautery, independent of the type and form of application, may result in significant damage in histological and electrophysological basis. Although the relative proportions cannot be ascertained, the time course of recovery suggests that both axon and myelin damage have occurred. The probable electrocautery damage may be of substantial importance for the situation that the nerves are displaced by tumor masses or atypical neural traces.

Background and objectives: The cerebellar tonsillar herniation occurring in Chiari malformation Type I (CMI) mainly results from overcrowding of a normally developing hindbrain within a primary small posterior cranial fossa (PCF) due to an anomaly in the embryological development of the occipital bone. In the present study, the lengths of PCF parameters were studied in adult CMI patients. Patients and methods: The authors retrospectively examined 15 adult patients with CMI. Multiple measurements were made on magnetic resonance images (MRIs). The results were compared with the findings in 25 controls and 30 dry skulls. Results: Length of the neural structures did not significantly differ between the CMI and the control groups. The average length of the basiocciput was significantly shorter in the CMI group as compared with the control group. The mean length of the supraocciput was significantly shorter and the average diameter of the foramen magnum was significantly longer in the CMI group when compared to the control group and dry skulls. Conclusions: The morphometric data suggest that, in CMI, a hypoplastic occipital bone, possibly due to the paraxial mesodermal defect of the parachordal plate, causes overcrowding in PCF, which contains the normally developed neural structures.

Summary Objective To assess the relation between mastoid size and attic blockage in COME patients treated with ventilation tube insertion and prognosis regarding tympanometric compliance and computed tomography findings of temporal bones. Material and methods Twenty-four ears of 15 patients with chronic otitis media with effusion were selected prospectively. The ages of patients were between 5 and 13 years old and eight of them were females. All patient received medical treatment for 10 days. Ventilation tubes were inserted with or without adenoidectomy or adenotonsillectomy to the unimproved patients. Postoperative compliances were measured on first day, first week, and first month and the tympanometric results were compared each one with others and with mastoid pneumatization degree using computerized tomographic findings. Results The hearing thresholds were between 23 and 43 dB in left ears and between 22 and 45 dB in right ears. Mastoid pneumatization and aditus were normal and open in three (12.6%); sclerotic and open in eight (33.3%); sclerotic and blocked in 13 patients (54.1%), when the temporal bones assessed by computerized tomography. The mean compliance values of patients elevated postoperatively in regard with time and this increase was significant. There was a significant statistical relation between mastoid pneumatization and compliance of the ears. Conclusion Tympanometric assessment may be considered as a valuable and cost-effective method rather than CT in the evaluation of aditus blockage and residual soft tissue of the tympanomastoid region.

Congenital masses are the most common non-inflammatory neck lesions in children. Although usually present at birth, they can appear at any age. Dermoid cysts are benign lesions of congenital origin usually presenting as a midline neck mass. They rarely appear in the lateral region of the neck. Lateral cervical dermoid cyst is presented as a rare, unusual case, and differential diagnosis and management are discussed in light of recent literature.

Objective: To determine the effect of alprostadil on the ischemia–reperfusion (I/R) injury of the sciatic nerve in rats. Materials and methods: Pre-reperfusion administration of alprostadil (0.05 μg kg−1) was assessed in the I/R injury model of the rat sciatic nerve. In this model, blood samples were investigated for the I/R injury markers namely malondialdehyde (MDA), an indicator of lipid peroxidation, and nitrite/nitrate levels, products of nitric oxide (NO) metabolism. Results: A significant decrease in MDA, and increase in NO levels were observed in the groups which received alprostadil before reperfusion, when compared to their corresponding untreated controls (I/R only) at all time intervals (P=0.0001). There was a statistically significant difference in both MDA, and NO levels between certain time intervals. There was no statistical linear correlation between MDA and NO levels. Conclusion: Alprostadil may be suggested as a protective anti-inflammatory and a vasodilator pharmacological agent for I/R injury in peripheral nerves. Also, measurements of NO and MDA may be complementary to the generally accepted evaluation parameters of I/R injury including electromyography and nerve histopathology.

Intramuscular benign lipoma commonly is found on the extremities, but is extremely rare in the head and neck region. Intramuscular type lipomas arise between the muscle fibers and pass through the intermuscular septa, infiltrating the surrounding tissue. A 29-year-old male patient presented with the complaint of a painless and slowly growing lateral neck mass on the left side. Physical examination revealed a 4x5-cm mass adjacent to the sternocleidomastoid (SCM) muscle. CT examination revealed a lobulated, well-circumscribed 5.5x2.5-cm diameter mass with adipose tissue signal density inside the SCM muscle. The surgical exploration of the mass was done under general anesthesia, and it was excised totally. Recurrence was not seen in the 3-year follow-up. This rare entity should be considered in the differential diagnosis of intramuscularly located neck masses. Complete removal of the tumor can only succeed if planned and performed after a thorough preoperative clinical and radiological assessment in order to prevent recurrences.

In this retrospective study, the computed tomography (CT) archives of paranasal sinus examinations were reviewed and three cases of antroliths are presented. The archivesof paranasal sinus CT studies of 1957 patients (1023 females, 934 males, mean age 36.5 years) were surveyed. CT studies were performed using 3 mm collimation and interval in the coronal, axial or both coronal and axial planes.Three out of 1957 patients demonstrated antroliths, all in the left maxillary sinus. Associated sinusitis was detected in all three patients. Only one patient was operated. The chemical analysis of the antrolith revealed it to be a calcium oxalate stone. All the relevant literatureis reviewed and only 25 other cases of true antrolithiasis were encountered. The clinical and radiological features of antroliths,as well as differential diagnosis were discussed.Antrolithiasis should be considered in any case of sinusitis, that does not respond to appropriate medical therapy.

Corticosteroids are shown to have deleterious effects on wound healing for various tissues. Arginine metabolism and nitric oxide (NO) synthesis play an important role in many aspects of inflammation and wound healing. The study was designed to evaluate the relationship of dexamethasone impaired healing of tracheal anastomoses to NO metabolism and lipid peroxidation. Forty-two adult Wistar rats were randomly divided into five groups. The animals underwent tracheal transection and primary anastomoses. The groups were assigned as follows: Group I (GI) (sham, N =6); Group II (GII) (control, N =6); Group III (GIII), dexamethasone, 0.1 mg kg −1 per day, intramuscularly for a week ( N =10); Group IV (GIV), dexamethasone, 1 mg kg −1 per day, intramuscularly for a week ( N =10); Group V (GV), dexamethasone, 6 mg kg −1 intramuscularly as a single dose ( N =10). After 7 days, bursting pressure was used to evaluate anastomotic healing. Serum nitrite/nitrate and malondialdehyde (MDA) levels were measured as an index of NO synthesis and lipid peroxidation, respectively. The bursting pressure significantly decreased in GIII and GIV when compared to the control group. The difference between GIII and GIV was also statistically significant. Nitrite/nitrate and MDA levels of GIII were found to be significantly higher than the control group. Also, the difference was found to be statistically significant between GIII and GIV in regard to nitrite/nitrate levels. The present study demonstrates that daily administration of dexamethasone for a week inhibits NO synthesis in a dose-dependent manner on tracheal anastomotic healing. Besides the generally accepted evaluation parameters including bursting pressure and hydoxyproline content; NO and MDA levels may be helpful in the assessment of wound healing especially for the investigation of impairment mechanism.

Hypothesis To understand cochlear dysfunction and the recovery pattern of the cochlea after acute electrical injury. Background The cochlea is believed to be more vulnerable to direct current than to alternating current. However, the damage-and frequency-specific recovery characteristics of the cochlea have not been well described. Methods Baseline distortion product otoacoustic emission measurements were taken via transtympanic electrodes from 19 guinea pigs. A 20-Hz alternating current and a positive direct current, both at a 1,000-microA intensity, were applied to 9 and 10 animals, respectively. The measurements were repeated immediately after the application of current and after 10 days. Comparisons were made for both groups individually in signal-to-noise ratios obtained before and immediately after, immediately and 10 days after, and before and 10 days after the application of electrical current. Results Alternating and direct currents caused a significant depression in signal-to-noise ratio immediately after the application. However, 10 days later, the mean signal-to-noise ratio in the animals subjected to alternating current came significantly close to the baseline value, particularly between the frequencies of 2,211 and 3,717 Hz. By contrast, the mean signal-to-noise ratio in the animals subjected to direct current remained significantly depressed throughout all frequencies except for 2,211 Hz. Conclusion Baseline distortion product otoacoustic emission measurements enabled cochlear function to be monitored in a frequency-specific manner after electrical injury. The functional damages were quantitatively close to each other for both types of currents at a given intensity. Nevertheless, recovery was more apparent in the animals exposed to alternating current than in those exposed to direct current. Recovery was also better in the midfrequency region than in higher frequencies. It is hypothesized that the reason for the difference in recovery in both groups was the net charge left by direct current.

The diagnosis of solitary plasma cell neoplasm is based on clinical, radiological and laboratory findings and it can be accepted as the precursor lesion of multiple myeloma as spread of disease occurs in 30-50% of affected patients. However, solitary plasmacytoma of the temporal bone is a rare pathology. We present an interesting case of plasmacytoma of the temporal bone which was controlled by a combination of surgery and radiotherapy.

PubMedID: 9740996 Salivary duct carcinoma (SDC) is an uncommon and highly aggressive neoplasm that reveals histopathologic features resembling infiltrating duct carcinoma of the breast and prostate. SDC arising on the basis of preexisting pleomorphic adenoma (PA) is very rare. This report describes the fine-needle aspiration (FNA) cytology of a case of SDC ex PA. FNA smears were cellular with cells with large, pleomorphic nuclei, some prominent nucleoli, and finely vacuolated cytoplasm. The neoplastic cells were forming groups, sheets, and papillary structures and a cribriform pattern was present in some sheets. Mitotic figures were frequently seen. Necrosis was prominent in the background. Histologic sections of the tumor revealed areas of comedo carcinoma, papillary carcinoma, and infiltrative carcinoma as well as multiple foci of PA. The presence of a cribriform pattern, tumor cells resembling breast ductal carcinoma cells, and a necrotic background are helpful features for an accurate cytodiagnosis of SDC.