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Background: Despite all the advances in thyroid surgery, thyroidectomy remains an operation open to complications due to the recurrent laryngeal nerve (RLN) which the thyroid gland is closely surrounded by. This study aims to investigate the anatomical relationship of the RLN with the surrounding structures and define the relationships between these structures. Methods: In this prospective study, the relationship of the RLN with the surrounding anatomical structures, which consist of Berry’s ligament, inferior thyroid artery, tracheoesophageal groove, and the inferior constrictor muscle, and the presence of extralaryngeal branching were evaluated during thyroid surgery performed on 91 patients. Results: A total of 151 thyroid lobectomies were performed, which included 75 right and 76 left lobectomies. One patient presented a nonRLN on the right side, and of the remaining 150 thyroid lobectomy materials, 40 (26.7%) demonstrated a nerve passing anterior to, 93 (62%) passing inside, and 17 (11.3%) passing posterior to the tracheoesophageal groove. Evaluation of the relationship between the nerve and Berry’s ligament revealed that the nerve was located on the lateral side of Berry’s ligament in 114 lobectomies (76%). The nerve passed anterior to the inferior thyroid artery in 29 lobectomies (19.3%), between its branches in 17 (11.3%), and posterior to the artery in 104 (69.4%). The nerve was found to penetrate the crico-pharyngeal part of the inferior pharyngeal constrictor muscle in 8 lobectomies (5.3%), while it entered the larynx immediately under the muscle fibers in 142 (94.7%). The RLN demonstrated branching before entering the larynx in a total of 9 cases (6%). It was determined that the relationship of the nerve and the associated anatomical structures did not cause a significant difference in either side.

Objective: Fanconi anemia (FA) is a rare bone marrow deficiency syndrome due to the DNA repair gene mutations, and Oral Squamous Cell Carcinoma (OSCC) is seen more frequently in FA patients than in the general population. The dysregulation of PI3K and Wnt signaling has been implicated in OSCC pathogenesis and abnormal expressions of miRNAs (a class of non-coding small regulatory RNAs) associated with these signaling pathways has been reported in OSHK patients. Salivary miRNAs are valuable biomarker candidates for OSCC development and prognosis. In this study, salivary levels of miR-9, miR-34a and miR-196a miRNAs related to PI3K and Wnt signaling pathways were examined in OSCC and FA patients and compared with the healthy control group. Methodology: Saliva samples were collected from 89 subjects including 25 OSCC patients, 24 FA patients and 40 healthy controls. Total RNA was isolated using Quick-RNA Miniprep Kit (Zymo Research) due to the kit instructions. cDNA was generated with miRCURY LNA miRNA PCR Assay (Qiagen, Hilden, Germany) and Quantitative real-time PCR was performed with miRCURY LNA SYBR Green PCR Kit (Qiagen, Hilden, Germany) according to the manufacturer's protocol. For the normalization of the expression levels of each miRNA, the mean expression U6 SnRNA was used as reference. The ΔΔCt value and the normalized miR-9, miR-34a and miR-196a salivary levels were calculated with Livak Method. Results: Our results showed that miR-9 and miR-34a levels in OSCC patients were significantly lower compared to healthy control groups (p= 0,01 and p= 0,012), and there was no significant difference in miR-196a levels (p> 0,05). In FA patients, miR-9 and miR-34 levels were lower than in control groups, likewise the OSCC patients (p =0,017 and p =0,014). There was no significant difference between miR-9, miR-34a, and miR-196a levels of FA patients and OSCC patients (p >0.05). Conclusion: According to our results, low levels of miR-9 and miR-34a in saliva are biomarker candidates that may be important for OSCC development. In FA patients, close follow-up of the levels of miR-9 and miR-34 would be appropriate considering OSCC development. Further studies are needed to confirm the potential of miR-9 and miR-34a as biomarkers for OSCC.

Oncocytic-type papilloma is the rarest histologic type of all sinonasal papillomas, and usually present with a unilateral mass in adults. Histologically, oncocytic Schneiderian papilloma (OSP) has an exophytic and endophytic growth pattern with oncocytic features. As in inverted papillomas, the potential of malignant transformation and the rate of recurrence are high in cases of oncocytic papilloma. In this report, we present a 16 year old girl with OSP that originated from both maxillary sinuses, who underwent endoscopic transnasal bilateral medial maxillectomy.

Introduction: Posterior pharyngeal wall is the most rare subsite for hypopharyngeal carcinomas. Because of its rarity, there are few studies published in the literature specifically concerning posterior pharyngeal wall carcinoma. Objectives: To report our functional results in patients with the carcinoma of the posterior wall of the hypopharynx after surgical treatment by resection via a lateral or infrahyoid pharyngotomy approach, with the preservation of the larynx and reconstruction with a radial forearm free flap. Methods: The study included 10 patients who underwent surgery for a carcinoma of the posterior wall of the hypopharynx over a 6 year period. The associated postoperative morbidity was investigated and functional results were analyzed. Results: Nine patients had T3 lesions and one patient had a T2 lesion. The preferred approach to access the hypopharynx was a lateral pharyngotomy in 5 patients and lateral pharyngotomy combined with infrahyoid pharyngotomy in 5 patients with superior extension to oropharynx. The pharyngeal defects were reconstructed successfully with radial forearm free flaps. Four patients received adjuvant radiotherapy only, and 4 patients with N2b and N2c neck diseases received adjuvant chemoradiotherapy. The mean duration of hospitalization was 15.6 days (range, 10–21 days). All patients achieved oral intake in a median time of 74 days (range, 15–180). Decannulation was achieved in all patients and the median time for decannulation was 90 (range, 21–300 days). The mean followup duration was 38.3 months (range, 10–71 months) and 8 patients survived. One patient died due to regional recurrence in the retropharyngeal lymph nodes and 1 patient died due to systemic metastasis. Conclusion: Primary surgery is still a very effective treatment modality for the carcinoma of the posterior wall of the hypopharynx and does not permanently compromise the swallowing and laryngeal functions if pharyngeal reconstruction is performed with a free flap.

Objective:To determine flap success rate and complications in patients who underwent microvascular free tissue reconstruction after major head and neck ablative surgery and to report the improvement in the results.Methods:Medical records of 124 patients who were operated on in 2012 to 2019 were retrospectively reviewed. Indications for different free flap types, success rates and re-exploration rates, donor site morbidities, and reasons for flap loss were analyzed. Patients were divided into two groups to identify the effects of the anticoagulant and the antiaggregant treatments on postoperative results.Results:There were 127 flaps in 124 patients, including two different free flaps each in three patients that were harvested and used in the same surgical session. Of the total 127 flaps, 82 (64.6%) were radial forearm flaps, 39 (30.7%) were fibula flaps, and 6 (4.7) were rectus abdominis flaps. Four patients were re-explored for flap perfusion problems, and 18 patients were re-explored for hematoma drainage (n=22/124, %17.3). The rate of hematoma and re-exploration was higher in patients who received anticoagulant and antiaggregant treatments synchronously (p=0.02). Three flaps were lost, and the overall success rate was 97.6%. Two patients died from perioperative complications. No major complications were observed at the donor site; minor complications were observed in 30 patients.Conclusion:The success rate for the 127 flaps in 124 patients were found comparable to those reported in the literature. These results show that successful outcomes can be achieved with experience and a head and neck team dedicated to improving the results in microsurgical reconstruction, and flap failure rarely occurs if perioperative care of the patients is given meticulously.

Supratracheal laryngectomy (STL) is the ultimate option in conservation surgery, and can be used as an alternative to total laryngectomy in selected tumors. This case series is the first report from Turkey that analyzes the oncological and functional outcomes of STL along with a literature review. Files of five patients who underwent STL between June 2016 and June 2019 were analyzed. Primary tumor findings, postoperative pathology reports, treatment modalities and oncological and functional outcomes of the surgical intervention were noted. Two patients were operated on for horse-shoe glottic tumors with subglottic extension, one patient for primary subglottic mass and two for transglottic ventricular tumors with anterior subglottic extension. Pathological stage of two patients was T3, and of three patients was T4a due to thyroid cartilage invasion. No neck metastases were observed. Three patients with T4a primary tumor were treated with adjuvant radiotherapy. All patients were found disease free in their last follow-up visit. Nasogastric tube was removed in the 1st postoperative month in all patients. While one patient remained tracheostomized in the follow-up period, the remaining four were decannulated. This technique can be used as an alternative to total laryngectomy especially in selected cases with subglottic extension.

Introduction: Laryngeal cancer is the most common cancer of the upper respiratory tract. The main methods of treatment included surgery (partial laryngectomy and total laryngectomy) and radiation therapy. Laryngeal dysfunction is seen after both treatment modalities. Objective: The aim of the study is to compare postoperative functional results of the standard supracricoid partial laryngectomy technique and a modified supracricoid partial laryngectomy technique using the sternohyoid muscle. Methods: In total, 29 male patients (average years 58.20 ± 9.00 years; range 41–79 years) with laryngeal squamous cell carcinoma who underwent supra cricoid partial laryngectomy were included. The patients were divided into two groups in terms of the surgical techniques. In Group A, all patients underwent standard supracricoid partial laryngectomy technique between January 2007 and November 2011. In Group B, all patients underwent modified supracricoid partial laryngectomy between August 2010 and November 2011. Fiberoptic endoscopic evaluation of swallowing test, short version of the voice handicap index scores, and the MD Anderson dysphagia inventory, the time of oral feeding and the decanulation of the patients after surgery of each groups were compared. Results: The mean maximum phonation time was 8.68 ± 4.21 s in Group A and 15.24 ± 6.16 s in Group B (p > 0.05). The S/Z (s/s) ratio was 1.23 ± 0.35 in Group A and 1.08 ± 0.26 in Group B (p > 0.05); the voice handicap index averages were 9.86 ± 4.77 in Group A and 12.42 ± 12.54 in Group B (p > 0.05); the fiberoptic endoscopic evaluation of swallowing test averages were calculated as 12.73 ± 3.08 in Group A and 13.64 ± 1.49 in Group B (p > 0.05). In the MD Anderson dysphagia inventory, evaluation of swallowing, the emotional, physical, and functional scores were 29.21 ± 4.11, 32.21 ± 6.85, and 20.14 ± 2.17 in the Group B, and 29.20 ± 2.54, 32.4 ± 4.79, and 19 ± 1.92 in Group A, respectively. Conclusion: Although there is no statistical difference in functional outcome comparisons, if rules are adhered to in preoperative patient selection, modified supracricoid partial laryngectomy can be applied safely and meaningful gains can be achieved in functional outcomes. Resumo: Introdução: O câncer laríngeo é o câncer mais comum do trato respiratório superior. Os principais métodos de tratamento incluem cirurgia (laringectomia parcial e laringectomia total) e radioterapia. A disfunção laríngea é observada em ambas as modalidades de tratamento. Objetivos: Comparar os resultados funcionais pós-operatórios da técnica de laringectomia padrão supracricoide e a técnica de laringectomia supracricoide modificada com o uso do músculo esterno-hióideo. Método: Foram incluídos 29 pacientes do sexo masculino (média de 58,20 ± 9,00 anos, intervalo de 41 a 79) com carcinoma espinocelular de laringe submetidos à laringectomia supracricoide parcial. Os pacientes foram divididos em dois grupos em termos de técnicas cirúrgicas. Todos os pacientes do Grupo A foram submetidos à laringectomia padrão supracricoide entre janeiro de 2007 e novembro de 2011. No Grupo B, todos os pacientes foram submetidos à laringectomia supracricoide modificada entre agosto de 2010 e novembro de 2011. A avaliação endoscópica da deglutição por fibra ótica, os escores da versão curta do Voice Handicap Index e do MD Anderson Dysphagia Inventory, o tempo de alimentação oral e a decanulação dos pacientes foram comparados após a cirurgia em cada grupo. Resultados: A média do tempo máximo de fonação foi de 8,68 ± 4,21 segundos no Grupo A e 15,24 ± 6,16 segundos no Grupo B (p > 0,05). A razão S /Z (seg/seg) foi de 1,23 ± 0,35 no Grupo A e 1,08 ± 0,26 no Grupo B (p > 0,05); as médias do Voice Handicap Index foram 9,86 ± 4,77 no Grupo A e 12,42 ± 12,54 no Grupo B (p > 0,05); as médias da avaliação endoscópica da deglutição por fibra ótica foram calculadas como 12,73 ± 3,08 no Grupo A e 13,64 ± 1,49 no Grupo B (p > 0,05). Na avaliação da deglutição pelo MD Anderson Dysphagia Inventory, os escores emocional, físico e funcional foram 29,21 ± 4,11, 32,21 ± 6,85 e 20,14 ± 2,17 no Grupo B e 29,20 ± 2,54, 32,4 ± 4,79 e 19 ± 1,92 no Grupo A, respectivamente. Conclusão: Embora não haja diferença estatística nas comparações de resultados funcionais, se as regras forem respeitadas na seleção pré-operatória do paciente, a laringectomia supracricoide parcial modificada pode ser aplicada com segurança e ganhos significativos podem ser alcançados em termos de resultados funcionais. Keywords: Modified supracricoid laryngectomy, Cancer, Larynx, Voice quality, Decanulation, Palavras-chave: Laringectomia supracricoide modificada, Câncer, Laringe, Qualidade de voz, Decanulação

Mucoepidermoid carcinoma (MEC) is the most common malignant tumor of the salivary glands and is seen most commonly in the parotid gland. Intraosseous MECs can be rarely seen and is mostly detected in the posterior part of the mandible. This condition can be acknowledged as an entity different from salivary gland MECs. In this case series, we delineated three patients of intraosseous MEC, two mandible tumors and one maxillary tumor and discussed the diagnostic characteristics and treatment methods of this rare entity.

Human papillomavirus (HPV)-associated tumors account for a significant proportion of head and neck squamous cell carcinomas (HNSCC) in developed countries. In recent years, there has been a rise of HPV infections associated with HNSCC, especially HPV16, which is the most commonly detected type in oral and oropharyngeal cancers. To investigate the frequency of HPV-driven HNSCC among patients living in Turkey, HPV DNA positivity and p16INK4A expression were assessed in primary tumor biopsies (n = 106). Eighteen out of one hundred and six (19%) HNSCC tumors showed p16INK4A overexpression, and 26/106 cases (24.5%) were positive for HPV DNA. Sixteen out of twenty-six samples were positive for both HPV DNA and p16INK4A staining. HPV16 could be isolated from 22/26 samples (84.6%) and was found to be the most frequently detected HPV type. This study represents the largest cohort of Turkish patients with HNSCC characterized according to HPV status and p16INK4A expression. Our data suggest that HPV16 infection, along with smoking, contribute to the development of HNSCC.

Acute external laryngotracheal injuries constitute one of the most urgent conditions of the field of otolaryngology. In such cases, immediate decision-making and intervention are imperative to prevent possible detrimental consequences. The situation is even more serious if the wounded is of the pediatric age group. In this report, we present a 7-year old boy with a blunt trauma to the anterior neck, which resulted in fractures of the thyroid and cricoid cartilages and dissection of the trachea with insidious onset of retropharyngeal air trapping and pneumomediastium. After securing the airway by emergent tracheotomy, appropriate reconstruction of the injured larynx was performed under elective conditions. Unexpected serious complications like acute retropharyngeal emphysema and pneumomediastinum in a patient of pediatric age group makes our case extraordinary.

Nager syndrome is a rare disorder characterized by congenital conductive hearing loss and acrofacial dysostosis. Eighty-three cases of Nager syndrome have been reported in the literature up to current time. In this study, a 4-year-old girl, with moderate conductive hearing loss due to external ear canal atresia and mental retardation which has never been reported so far, is presented.

Objectives:The aim of the study is to evaluate the paramedian forehead flap in the reconstruction of the major nasal defects and to compare the results with other reconstruction methods.Materials and Methods:Paramedian forehead flap has been performed in reconstruction of 10 cases with major nasal defects between April 1997 and December 2000 in Istanbul University, Faculty of Medicine. All of the cases were surgically ablated cases due to nasal carcinomas.Results:The reconstruction in all cases revealed out satisfactory results. The main complication was the postoperative deformity which was encountered as a result of contraction of the inner lining of the nasal cavity.Conclusion:Paramedian forehead flap is a versatile and costeffective method for the reconstruction of defects following major surgical procedures of the nose.

Myxoma is a rare benign mesenchymal tumor, and occurs most commonly in the mandible and maxilla in the head and neck region. Myxoma of the larynx is extremely rare and is frequently misdiagnosed as a vocal polyp. We report a myxoma arising from the right vocal fold presented with a 3 years history of intermittent dysphonia in a 42-year-old female who was pre diagnosed as an intracordal cyst.