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Backgroud/Objectives: Transoral laser laryngeal microsurgery (LTLM) has been widely used in the treatment of early-stage glottic laryngeal squamous cell carcinoma (LSCC) for the past few decades. Although T stage, tumor grade, anterior commissure involvement, type of cordectomy, positive surgical margin, and postoperative additional therapies were accused as the prognostic factors for recurrence, there is still controversy about these data in the literature. The purpose of this study was to evaluate the oncological results of our patients with early glottic LSCC treated with LTLM as a single-modality therapy in a single-center study. Methods: Patients with early-stage (Tis-1–2/N0) glottic LSCC who underwent LTLM as a primary treatment from 2011 to 2019 were retrospectively reviewed. The clinicopathological factors and oncologic outcomes were analyzed. Results: One hundred and sixty-one patients were enrolled in this study. The 5-year overall (OS), disease-specific (DSS), disease-free (DFS), and laryngectomy-free survival rates were 84.5%, 97.9%, 79.2%, and 93.5%, respectively. The most common stage, histopathological type, and type of endoscopic cordectomy were T1 stage, well-differentiated cancer, and type 2 cordectomy, respectively. A positive surgical margin was defined in 20 (12.4%) patients. There was a significant relationship between histopathological grade and positive surgical margins (p = 0.038). OS and DSS rates of “wait and see” modality were lower, while DFS of radiotherapy was lower than that of other treatment modalities in patients with positive surgical margins, but the differences were not statistically significant. Nineteen (11.8%) patients had a recurrence. DSS was statistically significantly lower in patients with recurrence (p < 0.001). Conclusion: The results of our study showed that anterior commissure involvement, surgical margin positivity, and higher T stage statistically did not reduce survival rates in early-stage LSCC patients treated with LTLM. As the histopathological grade of the tumor worsens, the risk of surgical margin positivity increases. RT may have a negative effect on recurrence and organ preservation in the additional treatment of patient with positive surgical margins.

Background/aim Because of close relations to important anatomical structures such as cavernous sinus and optic nerve, sphenoid sinus variations must be well trained by the Otolaryngologist who has an interest in endoscopic sinus surgery. Newly defined sphenoseptal cell (SSC) is one of those variations that may lead to insufficient endoscopic sinus surgery outcomes if not defined preoperatively with imaging studies. The present study aimed to present the main characteristics of this special type of nasal cell. Materials and methods In this study 610 paranasal sinus CT scans were analyzed and reviewed retrospectively between May 2018 and December 2019. Also, endoscopic findings of SSC, that cause a surgical catastrophe in identifying skull base and sella are presented during transnasal transsphenoidal pituitary surgery. Results According to its definition and relation to the sphenoid sinus and the skull base, an SSC was seen in 21 scans of 610 patients (3.4%), 11 were women (55%) and 10 were men (45%). Conclusion Although an SCC is a rare variation of nasal air cells, preoperative diagnosis of this cell is of paramount importance in some patients during endoscopic transnasal surgery for the identification of skull base.

Background/aim: This study aimed to assess the inflammatory adverse reactions of vocal fold injection laryngoplasty with hyaluronic acid. Materials and methods: This study was a retrospective chart review of patients who underwent vocal fold injection augmentation with HA injection from January 2005 to September 2016 in nine different institutions. Demographic data, indication for injection, injection techniques, types of injection material, settings of procedure, and complications were reviewed. The types of complication, onset time, and management of complications were also noted. Results: In all, 467 patients were identified. The majority of patients had been injected under general anesthesia (n = 382, 84.7%). For injection material, two different types of hyaluronic acid were used: hyaluronic acid alone or hyaluronic acid with dextranomer. Complications occurred in nine patients (1.9%). The majority of complications were inflammatory reactions (n = 7, 1.47%). Main symptoms were dysphonia and/or dyspnea with an onset of 0 h to 3 weeks after the hyaluronic acid injection. Three patients were hospitalized, one of which was also intubated and observed in the intensive care unit for 24 h. Systemic steroids and antibiotics were the main medical treatment in the majority of cases. There was no statistical difference in complication rates between patients who received hyaluronic acid and those who received hyaluronic acid with dextranomer (P = 0.220). Conclusion: Hyaluronic acid can be considered as a safe substance for the injection of vocal folds with a low risk of inflammatory reaction.

COVID-19 is highly transmissible and spreads rapidly in the population. This increases the occupational risk for health care workers. In otolaryngology clinic practice, patients with upper respiratory tract infection symptoms are common. Also, routine head and neck examinations such as oral cavity examination, nasal/nasopharyngeal examination, or video laryngostroboscopic evaluation are highly risky because of the aerosol formation. To emphasize this issue, two leading otolaryngology organizations in Turkey; ‘Voice Speech and Swallowing Disorders Society’, and ‘Professional Voice Society’ gathered a task force. This task force aimed to prepare a consensus report that would provide practical recommendations of the safety measurements during routine clinical care of laryngology patients. To fulfill this, universal aim, on the 2(nd) and 9(th) of May 2020, two web-based meetings were conducted by 20 expert physicians. This eighteen items list was prepared as an output.

Background/aim We aimed to revealthe incidence and predictive role of insulin resistance and distorted oral glucose tolerance test in nondiabetic patients withBell’s Palsy (BP). Materials and methods Eighty-sixpatients with BP and 28 control subjects; all with normal blood glucose levels and no history of diabetes, were enrolled in the study. We investigated insulin resistance (IR) in all subjects, in terms of HOMA-IR greater than 2.7. Sixty-two of the patients also underwent an oral glucose tolerance test (OGTT). Results The mean HOMA-IR value was significantly increased in patients, compared to the control group (3.2 vs 1.6; P < 0.01). IR was detected more in BP patients than in controls (P < 0.05). The patients with higher HOMA-IR values had more severe facial dysfunction at the initial presentation and complete recovery time took longer than the patients with normal HOMA-IR value (75 days vs 42 days; P < 0.05). Following a 2h-OGTT, impaired glucose tolerance and newly diagnosed DM were found in 60% of the patients. Recovery time was significantly longer in prediabetics and newly diagnosed diabetic patients than in patients with normal glycemia (68 days, 52 days, and 32 days, respectively; P < 0.01). Conclusion There is a strong linkage between HOMA-IR value and BP prognosis so HOMA-IR value may have a significant role of predicting BP prognosis at presentation.

Amaç: Glomus karotikum, vagale ve jugulare tümörlerinde preoperatif yapılan endovasküler embolizasyon işlem sonuçlarının değerlendirilmesi amaçlandı.Gereç ve Yöntemler: 2012-2017 yılları arasında glomus tümörü nedeniyle 18 hastaya tanısal anjiyografi ve bazılarına da embolizasyon yapıldı. Hastaların demografik bilgileri, tümör tipleri, embolizasyon ve komplikasyon oranları analiz edildi. Tümör embolizasyonunun etkinliğine, girişim öncesi ve sonrası alınan anjiyografiler karşılaştırarak karar verildi. Hastalar girişim sonrası vital bulgular ve olası komplikasyonlar açısından en az 24-48 saat takip edildi.Bulgular: Tanısal anjiyografi yapılan 18 hastadan 10’una eş zamanlı embolizasyon da uygulandı. Altı hastada glomus jugulare, 1 hastada glomus vagale, 10 hastada glomus karotikum ve 1 hastada eş zamanlı glomus jugulare ve vagale mevcuttu. En sık embolize edilen arter %50 oranı ile asendan faringeal arterdi. Embolizasyon yapılan hastalarda tümör kan akımında en az %70 oranında bir azalma meydana geldiği saptandı. Yapılan işlemler ile ilgili herhangi bir komplikasyon oluşmadı. Sonuç: Endovasküler selektif arter embolizasyonu glomus tümörlerinin preoperatif tedavisinde güvenilir ve etkin bir yöntemdir.

Yazıcı, Haşmet (Balikesir Author), Object: To prepare a national guideline for Oto-rhinolaryngologist who treat allergic rhinitis patients Methods: The study was conducted by three authors, namely the writing support team. The support team made the study plan, determined the writing instructions, chose the subgroups including the advisory committee, the advisors for authors and the authors. A workshop was organized at the very beginning to explain the details of the study to the team. Advisors took the chance to meet their coworkers in their subgroups and determined the main headings and subheadings of the guideline, together with the authors. After key words were determined by the authors, literature search was done in various databases. The authors keep in touch with the advisors and the advisors with the advisory committee and the support group at every stage of the study. National and International published articles as well as the abstracts of unpublished studies, imperatively presented in National Congresses, were included in this guideline. Only Guideline and meta-analyses published in last seven years (2013- 2017) and randomized controlled studies published in last two years (2015- 2017) were included. After all work was completed by the subgroups, support team brought all work together and edited the article. Results: A detailed guideline about all aspects of allergic rhinitis was created. Conclusion: The authors believe that this guideline will enable a compact and up-to-date information on allergic rhinitis to healthcare professionals. This guideline is the first in the field of Otolaryngology in Turkey. It should be updated at regular intervals.

Background/aim To evaluate the clinical and histopathological effects of fetal brain tissue derived mesenchymal stem cells (FBTMSC) and fibrin glue (FG) on the facial nerve (FN) regeneration in rats with traumatic FN injury. Materials and methods Twenty-eight Sprague Dawley rats were included in the study and divided into 4 groups. Traumatic FN injury (FP) was created by a surgical clamp compression to the main trunk of left FN in all groups. In the control group (group 1) no treatment was applied, in group 2 (FBTMSC group) 2 × 106 FBTMSC was injected, in group 3 (FG group) only FG was applied, in group 4 (FBTMSC and FG groups) both FBTMSC and FG were applied to the injured section of the nerve. The FN functions were evaluated clinically, immediately after the procedure and at 3rd, 5th, and 8th weeks postoperatively. The FNs of all subjects were excised after the 8th week; then the rats were sacrificed. The presence of stem cells in the injured zone was assessed using bromo-deoxyuridine (BrdU), and apoptosis was determined by the TUNEL method. Results After the damage, total FP was observed in all subjects. Statistically significant functional improvement was observed in group 4 compared to all other groups (P < 0.005). TUNEL-positive cell count was statistically significantly higher in the control group than the other groups (P < 0.001). TUNEL-positive cell count was statistically significantly lower in group 4 than the other groups. The proportion of BrdU-stained cells in group 4 (5%) was higher than group 2 (2%). Conclusion Clinically and histopathologically FBTMSC applied with FG may play a promising role as a regenerative treatment in posttraumatic FP.

Background/aim This study aims to determine the therapeutic superiority of the addition of intratympanic steroid or hyperbaric oxygen therapy to systemic steroid treatment in idiopathic sudden sensorineural hearing loss as initial treatment, and evaluate the long- term results of salvage treatment. Materials and methods This study was a retrospective clinical trial with a total of 96 patients with idiopathic sudden sensorineural hearing loss. Patients were divided into 3 groups. Group 1 (n: 32) received systemic steroid treatment. Group 2 (n: 32) received the Group 1 protocol plus intratympanic steroid treatment. Group 3 (n: 32) received the Group 1 protocol plus hyperbaric oxygen treatment. Pretreatment and postinitial audiologic evaluations were performed, and the hearing outcome was analyzed with Furuhashi criteria. All patients, except those who experienced total recovery after initial treatment, were directed to salvage treatment. Audiologic assessment was performed again after salvage treatment and a mean follow-up period of 36.5 months. Results Each group was homogenous according to demographics, audiologic data, and prognostic factors. There was no statistically significant difference in recovery and success rate within the 3 groups after initial treatment. (P: 0.66, P: 0.248, respectively). Successful results were obtained after salvage treatment in only 3 patients (5%). These patients received follow-up treatment at a mean of 36.5 months, but there was no spontaneous recovery after the end of salvage treatment. Conclusion The addition of intratympanic steroids or hyperbaric oxygen to systemic steroids caused no significant hearing improvement as the initial treatment of idiopathic sudden sensorineural hearing loss. The efficacy of salvage treatment was limited, and there was no spontaneous hearing improvement after the long-term follow-up.

Objectives The majority of thyroid nodules are discovered incidentally, and the management may be a challenge if the fine needle aspiration specimen yields indeterminate findings. Our aim was to develop an individualized risk prediction model to provide an accurate estimate of cancer risk in patients with cytologically indeterminate thyroid nodules. Materials and methods Clinical records, ultrasound images, and cytopathology reports of patients who underwent thyroidectomy were retrospectively reviewed. Logistic regression analysis was used to identify the predictive ability of each variable for malignancy, and a nomogram was built by integrating patients' age, multiplicity of nodules, cytology results, and suspicious ultrasound features, such as microcalcifications and irregular margins. Results For the 233 indeterminate nodules according to the Bethesda System for Reporting Thyroid Cytopathology, the malignancy rates of the subgroups "atypia of undetermined significance," "suspicious follicular neoplasia," and "suspicious for malignancy" were 44.3, 47.7, and 88.0%, respectively. It was found that the Bethesda category "suspicious for malignancy," microcalcifications, and irregular margins were independent risk factors for malignancy. The area under the receiver operating characteristics curve was 0.784, which suggested that the presented nomogram had considerable discriminative performance. Conclusions The nomogram developed in our study accurately predicts the malignancy risk of thyroid nodules with indeterminate cytology by using clinical, cytological, and ultrasonographic features.

Background To analyze protective/regenerative effects of adipose tissue-derived mesenchymal stem cells (ADMSC) on 131I-Radioiodine (RAI)-induced salivary gland damage in rats. Materials and Methods Study population consisted of controls (n:6) and study groups (n:54): RAI (Group 1), ADMSC (Group 2), amifostine (Group 3), RAI+amifostine (Group 4), concomitant RAI+ADMSC (Group 5) and RAI+ADMSC after 48 h (Group 6). We used light microscopy (LM), transmission electron microscopy (TEM), and salivary gland scintigraphy (SGS), and analyzed data statistically. Results We observed the homing of ADMSC in salivary glands at 1st month on LM. RAI exposure affected necrosis, periductal fibrosis, periductal sclerosis, vascular sclerosis and the total sum score were in a statistically significant manner (P < 0.05). Intragroup comparisons with LM at 1st and 6th months revealed statistically significant improvements in Group 6 (P < 0.05) but not in Groups 4 and 5. Intergroup comparisons of the total score showed that Groups 4 and 5 in 1st month and Group 6 in 6th month had the lowest values. TEM showed vacuolization, edema, and fibrosis at 1st month, and an improvement in damage in 6th month in Groups 5 and 6. SGSs revealed significant differences for the maximum secretion ratio (Smax) (P = 0.01) and the gland-to-background ratio at a maximum count (G/BGmax) (P = 0. 01) at 1st month, for G/BGmax (P = 0.01), Smax (P = 0.01) and the time to reach the maximum count ratio over the time to reach the minimum count (Tmax/Tmin) (P = 0.03) at 6th month. 1st and 6th month scans showed differences for Smax and G/BGmax (P = 0.04), but not for Tmax/Tmin (p > 0.05). We observed a significant deterioration in gland function in group 1, whereas, mild to moderate deteriorations were seen in protective treatment groups. Conclusions Our results indicated that ADMSC might play a promising role as a protective/regenerative agent against RAI-induced salivary gland dysfunction.

Defects in mucosal healing after sinonasal surgery cause infection, scar formation causing obstruction, relapse of the disease within a shorter period and revision surgery. The present study aimed to create a functional ciliated epithelium using a stem cell and stem cell sheet of adipose tissue origin and to show such regeneration ultra-structurally on experimentally injured rabbit nasal epithelium. This was an experimental animal study and basic research. A total of 18 white New Zealand rabbits were divided into three groups. The medial wall of the maxillary sinus of the subjects was peeled off bilaterally. No additional procedure was applied to the subjects in Group 1. In Group 2, adipose tissue-derived mesenchymal stem cell was implanted on the wound edges of the subjects. In Group 3, a stem cell sheet of three layers was laid onto the defect area. All subjects were killed after 3 weeks. The presence of the stem cell stained with bromo-deoxyuridine was assessed with a light microscope, whereas cilia density, ciliated orientation and cilia structure were evaluated with a scanning electron microscope. Ciliary densities in Group 2 and Group 3 were statistically superior compared to the control group (p

The objective of this study was to evaluate the volume of paranasal sinuses (PNS) and turbinate in patients with unilateral choanal atresia (CA). Computed tomography images of PNS in 11 individuals with unilateral CA were evaluated retrospectively. Mucosal thickness and volume of the maxillary, frontal and sphenoidal sinuses were determined, in addition to the volume of the middle and inferior turbinate. The unaffected nasal side of patients was used as a control group for the measurements. The results comprised the measurements of the atresic side compared to those of the healthy side. There was no significant difference between the atresic and healthy side of the nose in patients with CA with respect to mucosal thickness and volume of the PNS (the maxillary, frontal and sphenoidal sinuses) and the middle and inferior turbinate (p > 0.050). The complete absence of nasal unilateral airflow had no effect on the development of the PNS and the middle and inferior turbinate. Moreover, mucosal thickness in the sinuses was similar to that in the control group.

Traditionally, optic nerve decompression was performed via craniotomy, extranasal transethmoidal, transorbital, transantral, and intranasal microscopic approaches. Nowadays, transnasal endoscopic approach has been preferred for optic nerve decompression because this surgical approach provides excellent visualization, decreased morbidity by avoidance of external surgeries, preservation of important structures like olfaction, or developing teeth in children. Although this surgery is performed most frequently for post-traumatic optic neuropathy, compression on optic nerve from skull base tumors or fibro-osseous lesions seem most favorable indications. Indications for optic nerve decompression include traumatic optic neuropathy (TON), fibro-osseous lesions, skull base tumors, Graves’ ophthalmopathy associated with optic neuropathy, and idiopathic intracranial hypertension. TON is the most frequent indication for optic nerve decompression. TON means acute injury to the optic nerve due to craniofacial trauma. Approximately, 5% of severe head injuries affect some part of visual tract. Up to 1.5% cases of them have TON. The most common cause of optic neuropathy in pediatric age group is falls, whereas it is motor vehicle accidents in adults [6]. Otolaryngol Clin North Am. 44:903–22, 2011. Although it is not a common issue, TON should be evaluated in all cases of head injuries due to its devastating morbidity for the patient. In this chapter, we aimed to focus on the indications, surgical technique, and complications of endoscopic optic nerve decompression. Also we aimed to discuss controversial subjects as decision-making or timing of the surgical intervention.

Background: Head and neck paragangliomas are slowly growing benign tumors and they originate from specialized neural crest cells.Aims/objectives: This study aimed to express the safety of paragangl...

Objective This study aimed to investigate the correlation between morphological features of vocal fold polyps (VFPs) and subjective/objective voice parameters. Methods Perceptual evaluations, aerodynamic and acoustic tests were performed on 47 patients with VFPs. Still images were captured from video and the morphological features associated with the size of VFP were quantified. To reveal the correlation between size-related morphological features (length of polyp base, the ratio of polyp base to vocal fold length, glottal gap area) and objective/subjective parameters of voice, Pearson's and Spearman's tests were carried out. Results This cohort was composed of 30 (63.8 %) male and 17 (36.2%) female patients with the mean age of 45.2 years and 41.3 years, respectively. No correlation was found between the morphological features of VFPs and any of perceptual, aerodynamic and acoustic voice parameters. Conclusions Our findings indicated that controversies still exist regarding the role of vocal fold polyp morphology in clinical decision making.

The Derkay staging system quantifies recurrent respiratory papillomatosis (RRP) severity based on involvement of laryngeal structures. Despite its broad use in the laryngology literature, the association between Derkay score and voice-related quality of life has not previously been studied. It is hypothesized that Derkay score positively correlates with the Voice Handicap Index-10 (VHI-10).Case series with chart review.Tertiary medical center.Forty-six adult RRP patients treated from 2007 to 2013 at a tertiary medical center were included. Anatomic Derkay scores at the time of each RRP procedure were calculated. VHI-10 scores obtained within 30 days preceding the procedures were used to assess for correlation between Derkay staging system and VHI-10.Ninety-three procedures performed on 46 patients met inclusion criteria. Mean Derkay score was 11.9 (range, 2-28), and mean VHI-10 was 18.0 (range, 0-40). There was a significant positive correlation between Derkay score and VHI-10 (Spearman coefficient r = 0.42, P.0001).The anatomic burden of RRP as assessed by Derkay staging system is positively correlated with voice-related quality of life as quantified by the VHI-10.

Objectives/Hypothesis To investigate the effects of anterior palatoplasty on the presence and stage of floppy eyelid syndrome (FES) among patients diagnosed with mild or moderate obstructive sleep apnea (OSA) according to the apnea-hypopnea index (AHI). Study Design Prospective controlled trial. Methods Those patients whose AHI scores were between 5 and 30 according to full-night polysomnography were included in the study. The patients in whom anterior palatoplasty was performed were included in the study group, whereas those refusing surgery comprised the control group. All patients were evaluated for the presence of FES. The sleep studies were repeated after the third postoperative month, and the results were statistically compared. Results Sixty-two patients were included in the study. Thirty-five patients who were treated with anterior palatoplasty comprised the study group, and 27 patients were included in the control group. In the surgically treated group, 60% (n = 21) had FES, whereas 55.5% (n = 15) of the control group had FES (P = .798). In the surgically treated group, the FES ratio decreased to 25.7% (n = 9) after the third postoperative month (P = .007). In surgically successful cases, the preoperative–postoperative oxygen desaturation index and preoperative–postoperative lowest oxygen saturation values were 11.755% ± 9.037% and 6.77% ± 5.362% (P = .04), and 86.1% ± 3.89% and 87.8% ± 2.85%, respectively (P = .124). These values were 12.166% ± 5.767% and 14.780% ± 9.924% (P = .385), and 86.13% ± 4.18% and 85.26% ± 4.26%, respectively (P = .579), in patients who underwent unsuccessful surgery. Conclusions FES presence and stages were decreased following successful anterior palatoplasty surgery. This effect may have resulted from the correction of tissue hypoxia, which is common in the pathophysiology of both OSA and FES. Level of Evidence 2b Laryngoscope, 2016

The aim of this case report is to demonstrate a very rare coincidental existence and management of the Killian-Jamieson diverticulum during thyroid surgery in a patient with dysphagia. An 18-year-old female patient with the complaints of progressive dysphagia and a rapidly growing mass at the anterior cervical region was undergone thyroid lobectomy. Coincidentally, a 2×2 cm Killian-Jamieson diverticulum was observed and simultaneously excised with the thyroid lobe, preserving the recurrent laryngeal nerve. Dysphagia is a frequent symptom, especially in patients with a rapidly growing thyroid mass. Thyroid surgeons should keep in mind that hypopharyngeal and upper esophageal pathologies can mimic the symptoms of a thyroid mass; therefore, detailed imaging techniques should be used for the differential diagnosis.

To investigate the convenience of laryngeal electromyography (EMG) findings in patients with chronic cough thought to be postviral vagal neuropathy (PVVN) with the clinical symptoms.Prospective cohort study.We applied PVVN questionnaire and chronic cough quality of life (QoL) questionnaire, which is for determining the effect of chronic cough on the QoL, to 20 chronic cough applicants who has no explanatory cause in differential diagnosis. We also carried out videolaryngostroboscopy (VLS) and laryngeal needle EMG in these patients.The mean duration of persisting cough was 1.875 months (SD ±0.825). The overall mean symptom score of chronic cough questionnaire was 58.80 (SD ±9.89). There was a significant positive correlation between total EMG score and chronic cough score (Spearman r, 0.489, P0.05). The correlation between VLS findings and either chronic cough scores or EMG scores did not reach statistical significance.Cranial nerves might be affected by inflammatory processes as occur in the PVVN, which must be considered in the etiology of chronic cough. We showed that the laryngeal EMG can be used as an appropriate diagnostic tool for these patients.

OBJECTIVE: To analyze the effectiveness of diffusion-weighted magnetic resonance imaging (DW-MRI) in the evaluation of recurrent cholesteatomas. MATERIALS and METHODS: Twenty-three patients undergoing second-look surgery were included in our study. There were 14 men and 9 women with ages ranging from 10 to 50. All patients underwent DW-MRI prior to second-look surgery. All magnetic resonance imaging (MRI) examinations were performed with a 1.5-T MRI unit using a standard 8-channel neurovascular coil. DW-MRI and apparent diffusion coefficient maps were included in the examination. Cholesteatoma was diagnosed on the DW-MRI as a marked hyperintense signal in comparison with brain tissue. All cases were classified as positive or negative. RESULTS: The sensitivity and specificity of DW-MRI were 86% and 87%, respectively. The positive predictive value of DW-MRI was 92%, while the negative predictive value was 77%. CONCLUSION: The DW-MRI technique is an important and effective technique in the evaluation of residual cholesteatoma. It can be an alternative method to second-look surgery, which can spare patients repeat operations.

The aim of choanal atresia (CA) surgery is to achieve bilateral nasal patency. Among the different methods of CA repair, the endoscopic transnasal approach has gained recent popularity with the advent of endoscopic instruments and techniques. This article describes our experience regarding CA repair that was done either using or not using a stent in different periods of time in our department. Between February 2006 and February 2016, a total of 29 patients aged 2 days–53 years underwent endoscopic transnasal CA repair. While in early years stents were used to maintain nasal patency, since 2010, all cases were repaired endoscopically without stenting. Of the 29 patients, 8 were excluded because of inadequate follow-up data. The mean follow-up time for the remaining 21 patients after surgery averaged 53 months (range 12–111 months). Intranasal stents were used in 5 of 21 patients for 8 out of 32 operative sides. Of the 8 stented neochoanae, 6 (75%), restenosed at a mean time of 15.2 weeks (5–24). The restenosis rate was 25% (6/24 nasal sides) in 16 patients who underwent stentless repair. In unilateral CA, 2 of 10 (20%) patients underwent atresia repair using stents and only these cases restenosed after surgery in this group. Of the 11 patients with bilateral disease, 5 (45.4%) underwent revision surgeries. In the bilateral group, 2 of 3 (66.6%) stented patients required revision surgeries, whereas 3 of 8 (37.5%) patients who underwent stentless repair relapsed. In one patient, we have experienced an alar cartilage injury intraoperatively caused by drilling. The transnasal endoscopic repair has proved to be effective and yielded long-term satisfactory results. The use of stent seems to have no advantage over a stentless repair regarding maintenance of a patent nasal airway. Patients experienced restenosis more frequently with stenting.

Amac: Uyku apnesinde inflamatuar surec, endotelial fonksiyon bozuklugu ve oksidatif stresin iliskisinin incelenmesi. Yontem: Ucuncu basamak bir referans hastanesinde planlanan calismaya 63 yeni tani almis uyku apnesi hastasi ve 9 basit horlama hastasi dahil edildi. Hastalar ek sistemik hastaliklar ve laboratuvar testleri acisindan degerlendirildi, fizik muayeneleri yapildi. Rutin laboratuvar testlerine ek olarak oksidatif stres belirtecleri (leptin, RBP), endothelial fonksiyon bozuklugu belirtecleri (ICAM-I, VCAM-I) ve inflamatuar surec belirtecleri (CRP, IL-6, TNF-alfa, izoprostan) acisindan analiz edildi. Hastalar apne hipopne indekslerine gore 4 alt gruba ayrildi. Gruplar arasinda capraz analizler yapilarak gruplar arasindaki farkliliklar test edildi. Bulgular: Izoprostan seviyesi ile ortalama apne suresi arasinda hafif, maksimum apne suresi arasinda orta seviyede korrelasyon gozlendi. Hastalarin yas ortalamasi ile leptin ve VCAM-I arasinda zayif pozitif korrelasyon gozlenirken, CRP seviyesi ile ortalama yas arasinda zayif negatif korelasyon izlendi. Leptin seviyesi ile vucut kitle indeksi ve abdominal cevre arasinda orta seviyeli korelasyon izlendi. ICAM-I seviyesi ile vucut kitle endeksi ve karin cevresi arasinda zayif korelasyon mevcuttu. Sonuc: Calismamiz sonucunda oksidatif stress ile uyku apnesi arasinda iliski oldugunu tespit ettik. Bu iliski uyku apnesine eslik eden komorbid hastaliklarin aciklanmasinda onemli bir basamak olabilir. Bu konuda yapilacak olan yeni calismalarda bu inflamatuar surecin basamaklari ve klinik yansimalari aciklanmaya calisilmalidir.

An acute transient sialadenitis of the major salivary glands in the early postoperative period is called ‘anesthesia mumps’. It has been reported in different surgical procedures especially in neurosurgical procedures. Anesthesia mumps develops very fast after the extubation period but it usually regresses with no sequelae within a few hours. However, sometimes serious complication can occur such as respiratory distress. In this report, we present a 3-year-old girl with an anesthesia mumps and facial palsy occurring after successful auditory brainstem implantation and we discuss the cause and the management of this rare complication in this report.

Background/aim: The aim of this study was to investigate alterations in voice parameters among patients using continuous positive airway pressure (CPAP) for the treatment of obstructive sleep apnea syndrome. Materials and methods: Patients with an indication for CPAP treatment without any voice problems and with normal laryngeal findings were included and voice parameters were evaluated before and 1 and 6 months after CPAP. Videolaryngostroboscopic findings, a self-rated scale (Voice Handicap Index-10, VHI-10), perceptual voice quality assessment (GRBAS: grade, roughness, breathiness, asthenia, strain), and acoustic parameters were compared. Results: Data from 70 subjects (48 men and 22 women) with a mean age of 44.2 ± 6.0 years were evaluated. When compared with the pre-CPAP treatment period, there was a significant increase in the VHI-10 score after 1 month of treatment and in VHI- 10 and total GRBAS scores, jitter percent (P = 0.01), shimmer percent, noise-to-harmonic ratio, and voice turbulence index after 6 months of treatment. Vague negative effects on voice parameters after the first month of CPAP treatment became more evident after 6 months. Conclusion: We demonstrated nonsevere alterations in the voice quality of patients under CPAP treatment. Given that CPAP is a long-term treatment it is important to keep these alterations in mind.

Nasal gliomas are rarely seen, congenital, benign and nonhereditary lesions. These are not true tumors that occur due to extradural malposition of ectopic glial tissue during embryologic development. These are generally diagnosed during childbirth and may have an intracranial extension with fibrous stalk. Treatment of these masses that cause nasal obstruction and cosmetic deformity according to location, is total excision. In this case report, we present an extranasal glioma case whose surgery was done when she was 11 days old. Nasal gliomas are congenital midline lesions in the newborn period and it is necessary to be careful in differential diagnosis and during surgery due to possible intracranial extension.

WOS:000393324400005 PubMed: 29392039 Objective: To investigate the outcomes of superficial musculoaponeurotic system (SMAS) flap and classic techniques in superficial parotidectomy in terms of Frey's syndrome (FS) and cosmetic satisfaction. Methods: In this study, a retrospective chart review of patients that underwent superficial parotidectomy was performed. These patients were divided into two subgroups: group 1 included patients in which the SMAS flap was harvested and group 2 comprised the remaining patients on whom classic superficial parotidectomy was performed. All the patients were evaluated clinically and with Minor's starch-iodine test for FS. For the evaluation of the cosmetic results, the patient's satisfaction was queried according to the incision scar and surgical field skin retraction/facial symmetry. Both groups were compared in terms of complications and numbness of surgical area. Results: Fifty-five patients (31 male and 24 female) with a mean age of 50.19 years were included in the study. Thirty-two patients were in group 1 and 23 in group 2. Thirteen patients (23.7%) described as having FS and six of them were in group 1, while seven were in group 2. Minor's starch-iodine test was positive in nine patients in group 1 (28.1%) and six patients in group 2 (26.1%) (p=1.000). With regard to cosmetic satisfaction, eight patients (25%) stated mild discomfort from the incision scar and two patients (6.3%) stated cosmetic dissatisfaction for facial asymmetry in group 1. In group 2 for the same factors the number of patients were 11 (47.8%) and 2 two (8.7%), respectively (p=0.027). There were no statistically significant differences in means of complication and numbness (p>0.05). Conclusion: According to our study results, there was no superiority between both the groups in terms of FS and incision scar satisfaction. We determined that there was a significant benefit of SMAS flap application in the prevention of volume loss and surgical area retraction.

Thyroidectomy has been used for the treatment of thyroid disease for more than 100 years. In spite of the advancement of surgical techniques, there is still a risk of laryngeal nerve injury. The risk of partial or complete injury still depends on some surgical and disease-related factors. The aim of this study is to show the partial injury and to establish these risk factors via laryngeal electromyographic analysis (LEMG) in postthyroidectomy patients with normal vocal cord motion and mucosal anatomy. Patients who had undergone thyroid surgery were enrolled in this prospective study. LEMG analysis was performed to all patients with normal vocal cord mobility preoperatively and was repeated after the first and the third months of surgery. Thyroarytenoid (TA) and cricothyroid (CT) muscles were used to evaluate recurrent and external branch of superior laryngeal nerves, respectively. Four of the 32 patients had mild-to-moderate degrees of partial LEMG changes during preoperative LEMG analysis of TA and CT muscles on each side. After 3 months of surgery, there was a statistically significant worsening of LEMG findings in the right and left external branches of superior and left recurrent laryngeal nerves. Disease and surgery-related risk factors were analyzed. However, there was no significant relationship on the progression of LEMG findings according to these parameters. This is the first prospective study which supports the risk of progression of LEMG changes in patients with normal laryngoscopic examination after thyroid surgery. No reliable significant risk factor was found influencing the LEMG progression.

Importance Management of recurrent respiratory papillomatosis (RRP) in adults has evolved to include office-based laser techniques. Objective To determine whether demographic or disease characteristics differ between patients undergoing office-based (office group) vs traditional operating room (OR group) surgical approaches for RRP. Design, Setting, and Participants This study was a medical record review of adult patients with RRP treated between January 2011 and September 2013 at a tertiary care center. Patients were divided into 2 groups according to the setting in which the patient had the most procedures during the past 2 years. Main Outcomes and Measures Demographic and disease characteristics were compared between patients receiving predominantly office-based vs predominantly OR management. Results Of 57 patients (47 male and 10 female, with a mean [SD] age of 53.5 [16.4] years) treated during the 2-year period, 34 patients underwent predominantly office-based management and 23 patients underwent predominantly OR management. Sex, age, and weight were not statistically significantly different between the 2 groups. Patients in the OR group had a younger age at RRP diagnosis (mean [SD], 28.7 [22.0] years in the OR group and 45.5 [20.5] years in the office group), with a mean difference of 16.8 years (95% CI, −28.3 to −5.4 years). Patients in the OR group also had a significantly higher Derkay score (mean [SD], 15.1 [5.7] in the OR group and 10.7 [5.0] in the office group), with a mean difference of 4.4 (95% CI, 1.6-7.3). No statistically significant differences in comorbidities were observed between the 2 groups except for type 1 or 2 diabetes, which was more common in the OR group. There were 5 patients (22%) with diabetes in the OR group and 1 patient (3%) with diabetes in the office group, with a mean difference of 19% (95% CI, 2.7%-35%). In a subanalysis that excluded patients with juvenile-onset RRP, Derkay score (mean [SD], 13.9 [4.5] in the OR group and 10.8 [5.1] in the office group), with a mean difference of 3.1 (95% CI, 0.5-6.1), and the incidence of diabetes (25% [4 of 16] in the OR group and 3% [1 of 31] in the office group), with a mean difference of 22% (95% CI, 3%-40%), remained significantly higher in the OR group, while age at diagnosis of RRP was no longer statistically significant (mean [SD], 40.2 [15.6] years in the OR group and 49.6 [16.4] years in the office group), with a mean difference of 9.4 years (95% CI, −19.4 to −0.7 years). Conclusions and Relevance There were no sex or age differences between patients with RRP treated in the office compared with those treated in the OR. Patients with earlier age at diagnosis of RRP and greater disease severity were more likely to be managed in the OR.

The objective of this study was to investigate whether prophylactic central lymph node dissection (pCLND) facilitates postoperative thyroglobulin (Tg) follow-up in the patients with papillary thyroid carcinoma (PTC). We also questioned whether radioactive iodine (RAI) remnant ablation provides any further advantage in this regard. The records of patients with low-intermediate risk PTC who underwent either only total thyroidectomy (TT) or TT in conjunction with pCLND were reviewed. Adjuvant RAI ablation was performed depending on tumor diameter, multifocality, the presence of positive lymph nodes and adverse histopathologic features. Pre-ablative and post-ablative Tg levels, post-operative complications and clinico-pathological characteristics were compared between the two groups (TT alone and TT with pCLND). Among the 302 patients, TT was performed in 140 (46.4%) and TT with pCLND in 162 (53.6%). More than half of all patients in both groups had papillary microcarcinoma (58.0% and 53,1%, respectively). Postoperatively, the median preablative Tg level was higher in the TT only group than that of the TT with pCLND group (0.96 vs 0.27 ng/ml, respectively). The post-ablative Tg levels were undetectable in both groups at the last follow-up visit. Also, a subgroup of patients (19.5%) who did not receive RAI ablation all became athyroglobulinemic at one year after surgery. Although performing pCLND with TT seems to have an advantage over TT alone as to achieve lower Tg levels in the early post-operative period, Tg levels become comparable following RAI ablation. On the other hand, the patients who have not been treated with adjuvant RAI ablation, also became athyroglobulinemic regardless of the surgical method.

Summary Objectives/Hypothesis The date of last menstruation period and ultrasonography are the most commonly used methods to determine gestational age (GA). However, if these data are not clear, some scoring systems performed after birth can be used. New Ballard Score (NBS) is a commonly used method in estimation of GA. Cry sound may reflect the developmental integrity of the infant. The aim of this study was to evaluate the connection between the infants' GA and some acoustic parameters of the infant cry. Study Design A prospective single-blind study was carried out. Methods In this prospective study, medically stable infants without any congenital craniofacial anomalies were evaluated. During routine blood sampling, cry sounds were recorded and acoustic analysis was performed. Step-by-step multiple linear regression analysis was performed. Results The data of 116 infants (57 female, 59 male) with the known GA (34.6 ± 3.8 weeks) were evaluated and with Apgar score of higher than 5. The real GA was significantly and well correlated with the estimated GA according to the NBS, F0, Int, Jitt, and latency parameters. The obtained stepwise linear regression analysis model was formulized as GA = (31.169) − (0.020 × F0) + (0.286 × GA according to NBS) − (0.003 × Latency) + (0.108 × Int) − (0.367 × Jitt). The real GA could be determined with a ratio of 91.7% using this model. Conclusions We have determined that after addition of F0, Int, Jitt, and latency to NBS, the power of GA estimation would be increased. This simple formula can be used to determine GA in clinical practice but validity of such prediction formulas needs to be further tested.