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PURPOSE Nasal septal perforation (NSP) consists of defects of mucosa, cartilage, and bone. Nasal septal surgery is by far the most common cause of NSP. Many surgical approaches have been described for NSP repair. In this study, the authors describe a novel technique for repairing all sizes of NSP using an only fascia lata graft. METHODS The authors implemented a retrospective study design. Seventeen patients who underwent NSP repair between January 2016 and January 2019 were included to the study. Entire nasal surgical steps were performed under endoscopic view, harvested fascia lata graft is placed in tympanoplasty fashion after all edges of perforation is elevated and implantation bed is prepared. RESULTS The mean size of the septal peforations were 18.52 ± 4.17 mm horizontally, 11.52 ± 3.42 mm vertically. The mean follow up period was 14.47 ± 9.5 months (range: 2-36). In 15 of the 17 patients, total NSP closure was achieved (88,23%). CONCLUSIONS Endoscopic close technique using fascia lata for nasal septal perforation closure is a safe and reliable technique with high success rate and it should be considered in patients with nasal septal perforation.

Open technique septorhinoplasty (SRP) provides better surgical control and stronger anatomical assessment; however, one of its biggest disadvantages is postoperative columellar scar. In this study, the authos aimed to compare the absorbable polyglactin 910 (PG) (Vicryl Rapide 6/0; Ethicon Inc.) and nonabsorbable polypropylene (PP) (Prolene 6/0; Ethicon Inc.) suture materials and their effects on the postoperative columellar scar. In this study, 89 patients (61 females and 28 males) who underwent primary open technique SRP were included; 42 patients were included in the PP group and 47 were included in the PG group. Sutures were removed in PP group on 7th postoperative day. Sutures were left to be absorbed in the PG group. Columellar scar was assessed with visual analog scale (VAS) subjectively and with the modified Stony Brook Scar Evaluation Scale (SBSES) objectively in 6th postoperative month. SBSES results in PG and PP groups were 3.88 ± 0.80 and 3.67 ± 0.80, respectively. There was no statistical significance between the two groups (p = 0.352). VAS results in PG and PP groups were 8.04 ± 0.91 and 7.71 ± 0.85, respectively. There was no statistical significance between the two groups (p = 0.200). No postoperative wound infection was seen in either of the groups. PG delivers good postoperative results in columellar scar. We recommend using PG for columellar incision closure since it provides less discomfort and anxiety for the patient, and less office time for the surgeon during the suture removal.

Structural deficiencies of the nasal dorsum are most commonly of congenital, traumatic, or iatrogenic etiology. Various grafts, including autografts, homografts, and synthetic materials, have been used to this end and are described in the literature.Autologous septal cartilage is the most commonly used graft material when limited augmentation rhinoplasty is planned. However, it is difficult to retain sufficient cartilage to allow of such augmentation in instances where most of the septal cartilage has been used. The authors place moderately crushed cartilage beneath a monolayer of surgicel when performing limited nasal dorsum augmentation. The aim of the present study is to describe authors' approach and its utility by reviewing other methods reported in the literature.

The soft triangle is a basic, yet delicate and vulnerable, subunit of the nose that is under-rated both academically and surgically. The soft triangle is located at the apex of the nostril, at the point where the dermis is in direct contact with dermis that contains no intervening subcutaneous tissue and it may be unintentionally harmed during rhinoplasty.The authors suggest using a modified incision and closure and filling with significantly or severely crushed cartilage to prevent notching and to provide support for the soft triangle. The more the authors understand the nature of the soft triangle, the more they will be able to obtain superior surgical results in the nasal tip area.

Objective Flexible optic laryngoscopy (FOL) allows us to visualize the obstructive sleep apnea (OSA)-related airway passages. However, objective data presenting evidence of OSA through this perspective are lacking. The aim of this study was to quantify the surface area of the retropalatal region in control subjects and OSA patients utilizing FOL images. This was a prospective, case-control study. The study was performed at the otolaryngology department of a university hospital. Subjects and methods Sixty-seven OSA patients in group 1 and 87 patients with no complaints of OSA in group 2 were evaluated. Retropalatal region photographs were captured at the base of uvula through endoscopic images. The retropalatal surface area (RPSA) was measured using AutoCAD. Groups 1 and 2 RPSA measurements were analyzed. The RPSA measurements of subgroups in group 1 were analyzed to document severity of OSA. Results Mean RPSA measurements in group 1 was 73.21 (SD, 31.99), and that in group 2 was 129.31 (SD, 26.54), respectively. Retropalatal surface area is significantly larger in group 2 when compared with group 1 (P = 0.0001). Twenty-four patients had mild (mean respiratory disturbance index [RDI], 10.83 [SD, 3.63], 26 had moderate (mean RDI, 20.9 [SD, 4.14]), and 17 had severe OSA (mean RDI, 52.13 [SD, 17.24]) in group 1. The mean RPSA measurements are 72.48 (SD, 28.9) in mild subgroup, 73.88 (SD, 30.5) in moderate subgroup, and 73.22 (SD, 39.59) in severe subgroup, showing no evidence of correlation between the severity OSA and RPSA measurements. Conclusions The RPSA measurements are significantly larger in control subjects (group 2) when compared with OSA patients (group 1). This might implicate that RPSA measurements through FOL examination can be a predictor of OSA when screening patients.

Objective To analyze the ototoxicity of Burow solution as an otologic preparation. Background Burow solution has been used for years in the treatment of acute or chronic otitis externa and chronic suppurative otitis media. This acidic solution has antibacterial and antiedematous properties. Ototoxic effect of Burow solution has not been known, so the current study was designed to observe the ototoxic effect of Burow solution experimentally. Materials and methods Experiments were performed in 32 young, male albino guinea pigs (weight, 450-550 g). Twenty animals in the experimental group were divided into 2 groups of 10 animals each. The first group received 13% Burow solution (13% aluminum subacetate), and the second received 4% Burow solution (4% aluminum subacetate). Twelve animals in the control group were divided into 2 groups of 6 animals each. The first group received gentamicin (40 mg/mL; ototoxic control), and the second received saline solution (negative control). Under general anesthesia, pretreatment auditory brainstem responses (ABRs) from the right ear were obtained from the animals in all groups. The right tympanic membranes were widely perforated, and a small piece of Gelfoam was applied to the middle ear. Ear solutions at concentrations of 0.1 mL were applied through transcanal approach to the middle ear twice a day in 10 days. Under general anesthesia, the Gelfoam was removed from the right middle ear, and posttreatment ABRs were obtained 14 days later after the initial time in all groups. Results Baseline ABR results were normal in right ears of all animals tested. Animals undergoing placement of Gelfoam with either 13% Burow solution, 4% Burow solution, or saline in the middle ear showed no changes in ABR threshold. The gentamicin group showed significant change in the ABR threshold. Conclusion Burow solution was considered to be an effective and safe otologic preparation.

Objective/Hypothesis The aim of this study was to assess the tissue response to Gore-Tex (expanded polytetrafluoroethylene) in rats and compare the results of surgical placement modalities. Study Design Prospective animal study. Materials and Methods Experiments were performed in 18 young Sprague-Dawley rats that were divided into 3 groups. Gore-Tex patches were implanted subcutaneously over the periosteum in the first group and under the periosteum in the other groups. Gore-Tex was immersed in an antibiotic-containing solution in the third group. All animals were killed 4 weeks after the procedure. The tissue samples were stained with hematoxylin and eosin stain and evaluated using a light microscope. Results The Gore-Tex patches were displaced and not observed at the originally implanted sites in the first group. The Gore-Tex patches were observed at the originally implanted sites in the other groups. In group 1, edema and inflammation were prominent. In the second group, ossification was detected in 5 rats and foreign-body reaction and edema were identified in 1 rat. In the third group, all of the rats were found to have developed ossification, but no inflammatory reactions were observed. Conclusions The results suggest that implanting synthetic graft materials immersed in an antibiotic solution at the subperiosteal plane provides better stabilization and low complication rates.

Cephalic trimming of the lower lateral cartilage (LLC) of the nose is often performed to refine a broad nasal tip in the horizontal dimension. The focus of cephalic trimming remains the preservation of the width of the lateral crura and the cartilage remnant at the cephalic end of the LLC is usually left intact, which leads to inadequate cephalic trimming.The authors suggest that cephalic trimming should continue all the way to the cephalic end of the LLC and no remnant cartilage should be left in the scroll area. This would make it possible to reduce the bulk of the nasal tip in an acceptable manner. Trimming of the whole cephalic side of the LLC would disrupt the scroll area, allowing authors to assess rhinoplasty as a 2-stage surgical procedure: that is, nasal tip and middle vault.In conclusion, complete cephalic trimming without leaving any remnant cartilage in the scroll area is necessary for adequate nasal tip refinement, and disruption of the scroll area allows the rhinoplasty to be compartmentalized to achieve more desirable results in the middle vault and the nasal tip.

Objectives:The aim of this retrospective case-control study was to define epiglottis morphologies and to investigate the relationship between the angle of the laryngeal surface of the epiglottis (ALSE) and the severity of obstructive sleep apnea (OSA) using flexible optic laryngoscopy (FOL) images.Methods:Eighty-three patients with OSA (Group 1) and 87 patients with no complaints of OSA (Group 2) were evaluated. The ALSE was measured using ImageJ through FOL images. ALSE measurements were compared between the two groups. The correlation of ALSE measurements to the respiratory disturbance index (RDI) was analyzed.Results:Group 1 comprised 79 male and 4 female patients with a mean age of 43 years. Group 2 comprised 72 male and 15 female patients with a mean age of 39 years. The mean ALSE measurement was 139.7 degrees in Group 1 and 140.08 degrees in Group 2 and was not significantly different between the two groups (P value greater than 0.05). The mean RDI in Group 1 was 28.83, showing evidence of a low cor...

Routine flexible optic laryngoscopy (FOL) can visualize the airway from the nasopharynx to the hypopharynx in obstructive sleep apnea (OSA). With the tip of a flexible endoscope at the nasopharyngeal inlet (NPI), we can visualize the morphology of this area. We evaluated the effect of NPI morphology on OSA severity. Videos were obtained during FOL examinations of the NPI in 83 patients (11 females, 72 males; mean age 42.1 ± 9.5 years) and NPI morphology was examined. Two main morphologies were seen: wide and narrow. The narrow NPI group (n = 45) was further subdivided into kidney-shaped (n = 34), elliptical (n = 6), and circumferential (n = 5) groups. The wide NPI group (n = 38) was subdivided into circumferential (n = 20) and kidney-shaped (n = 18) groups. Mean Respiratory Disturbance Index (RDI) values were 30.38 ± 22.36 and 14.51 ± 13.9 in the narrow and wide groups, respectively. Mean RDI values were 45.32 ± 30.6, 23.74 ± 10.8, and 28.72 ± 21.5 in the narrow circumferential, elliptical, and kidney-shaped groups, respectively. Mean RDI values were 11.58 ± 12.91 and 17.8 ± 14.6 in the wide circumferential and kidney-shaped groups, respectively. RDI values were significantly lower in the wide morphology group (p

Objective: Routine flexible optic laryngoscopy (FOL) displays obstructive sleep apnea (OSA) related airway passages from nasopharynx to hypopharynx. Tip of the flexible endoscope awaiting at the na...

OBJECTIVE The purpose of this study was to present the placement technique of Gore-Tex implants for nasal augmentation. METHODS The study group comprised 32 patients of various nasal deformities who underwent consecutive rhinoplasty via open approach with Gore-Tex implant material for dorsal augmentation. A pocket is made subperiostally at the nasal dorsum. The implant is rinsed in antibiotic solution and placed in position. Complications due to Gore-Tex were observed during the follow-up period. RESULTS There were 12 men and 20 women. The mean age was 28.4 years. There were 9 primary rhinoplasty and 23 revision rhinoplasty. Patients were followed up postoperatively for 12 to 24 months. During the postoperative follow-up period, no complications were encountered in this series of patients. The implants were stable and immobile under the skin. CONCLUSIONS In the cases of nasal dorsum augmentation, Gore-Tex can be a suitable graft material. We recommend implanting graft materials at subperiosteal plane to provide better stabilization and low complication rates.

The objective of the study was the assessment of the long-term efficacy of submucosal uvulopalatopharyngoplasty in patients with obstructive sleep apnea syndrome. Thirty-two of 156 patients who underwent UPPP between January 2001 and March 2007 with a follow-up period of 36–96 months (mean, 56 months) were included in the study conducted at the university affiliated center. Preoperative and postoperative snoring evaluation forms and Epworth Sleepiness Scale (ESC) scores were used for subjective analysis. Preoperative and postoperative respiratory distress index (RDI) levels were evaluated objectively. Patients who had 50% or more reduction in RDI levels postoperatively were named as responders to the procedure. The other patients were named as non-responders. Body mass index (BMI) was also analyzed preoperatively and postoperatively. Snoring disappeared in 83% of the patients, did not change in 13% and deteriorated in 4% of the patients (p

Objectives/Hypothesis: This study endoscopically and radiologically evaluated whether a surgically crushed concha bullosa (CB) can form again. Study Design: Prospective study. Methods: This study included 14 adults who underwent CB surgery between March 2010 and February 2011. The middle turbinate was examined endoscopically and classified pre- and postoperatively into four groups according to size. The CB volume of all patients was measured using pre- and postoperative paranasal sinus computed tomography (CT). The pre- and postoperative measurements were compared using the paired t test. Results: This study included 22 CB in 11 men and 3 women with a mean age of 35.85 (range, 20–47) years. The mean follow-up period was 4.42 (range, 2–10) months. The middle turbinates were significantly smaller postoperatively (P < .0005), as was the CB volume measured using paranasal sinus CT (P < .0005). Conclusions: The CB crushing technique is an easy, conservative treatment modality. As the CB does not appear to reform after crushing, this technique can be considered a definitive treatment. Nevertheless, these patients should be followed for the long term.

Objectives This study aims to show the placement of extended spreader grafts in reductive septorhinoplasty operations to support the nasal bony vault as well as the middle cartilaginous structures. Patients and methods Thirty-eight patients (16 males, 22 females; mean age 26.4 years; range 18 to 55 years) who underwent septorhinoplasty under general anesthesia via open approach between January 2008 and December 2010 were included in this study. Two separate cartilage grafts were placed end-to-end and secured to the septum on both sides after removing the cartilage and bony hump. These grafts not only transverse the full length of the middle one-third of the nose, also run approximately 1 cm under the nasal bones cephalically and the anterior septal angle caudally on both sides. The obtained data were evaluated retrospectively. Patients were followed up postoperatively for 7 to 24 months with a mean follow-up of 14 months. Results There was no significant bony vault collapse or irregularity, inverted-V deformity or middle-vault narrowing observed during the postoperative period. All of the patients were satisfied with the cosmetic and functional results. Conclusion We think that extended spreader grafts are more beneficial not only in reconstructing the middle one-third of the nose but also in supporting the collapsed and/or distrupted nasal bony vault in reductive septorhinoplasty.

Objective: Retropalatal region is a part of upper airway contributing to obstructive sleep apnea (OSA). We aimed to demonstrate the changes in the retropalatal surface area (RPSA) after uvulopalatopharyngoplasty (UPPP) in an attempt to exhibit enlargement as a predictor of surgical treatment.Method: Twenty patients with OSA who underwent UPPP were retrospectively evaluated. Pre and postoperative respiratory disturbance index (RDI), RPSA measurements were studied. Retropalatal region photos were captured at the base of uvula during fiber optic nasopharyngolaryngoscopy to measure RPSAs using AutoCad2004. RDI levels, RPSA measurements were compared using paired t test.Results: The RPSA measurements in the preoperative subjects were between 20 and 72 (mean 44.18). The RPSA measurements in the postoperative patients were between 37 and 107 (mean 72.82). The RPSA significantly increased in postoperative patients (P = .001). The mean RDI decreased from 27.5 ± 22.2 to 14.6 ± 12.4 (P > .05).Conclusion: RPSA increa...

Objective: Fiberoptic nasopharyngolaryngoscopy (FNPL) allows us to visualize the obstructive sleep apnea (OSA) related airway passages. However, objective data presenting evidence of OSA through this perspective is lacking. The aim of this study was to quantify the surface area of the retropalatal region in normal and OSA patients utilizing FNLP images.Method: Fifty-two OSA patients in group 1 and 68 patients with no complaints of OSA in group 2 were retrospectively evaluated. Retropalatal region photos were captured at the base of uvula through endoscopic images. Retropalatal surface area (RPSA) was measured using AutoCad. Results were analyzed using unpaired t test.Results: The RPSA measurements in group 1 were between 20 and 143 [mean (sd) 64.13 (27.4)]. The RPSA measurements in group 2 were between 51 and 202 [mean (sd) 121.9 (32.4)]. The mean difference was 57.761. RPSA values of group 2 were significantly higher than group 1.Conclusion: The RPSA is significantly higher in OSA group 2, implicating pr...

Objectives In this study, we assessed the effect of endonasal phototherapy on quality of life, nasal obstruction and the other symptoms in allergic rhinitis with visual analog scale (VAS), sinonasal outcome test-20 (SNOT-20), and acoustic rhinometry. Patients and methods Twenty-four patients (6 males, 18 females; mean age 41.3±13.0 years; range 20 to 60 years) suffering allergic rhinitis refractory to anti allergic drugs for at least two years were enrolled in the study. Each patient underwent a total of six sessions of endonasal phototherapy with Rhinolight (Rhinolight Ltd, Szeged, Hungary) performed three times a week for two weeks. During course of the investigation, additional therapy was not applied to any of the patients. Before and one month after treatment, patients completed visual analog scale and SNOT-20 forms and nasal obstruction was evaluated with acoustic rhinometry. Results After the treatment, the mean VAS score and the mean total SNOT-20 score were found lower than the results before the therapy (p=0.0001, p=0.0001). A significant decrease was found in the scores of sneezing, nasal discharge, postnasal drainage, coughing after treatment (p=0.0001). During objective evaluation of nasal obstruction with acoustic rhinometry, no statistically significant difference was found between pre- and post-treatment findings. Conclusion Endonasal phototherapy is an effective modality in the treatment of symptomatology in allergic rhinitis patients refractory to antiallergic drugs. It is detected that endonasal phototherapy has positive effects on the quality of life. However, no effect on nasal obstruction was found with acoustic rhinometry which is an objective method.

This study was undertaken to evaluate and concentrate on the recurrent pleomorphic adenomas (PAs) of the parapharyngeal space. The records of 9 patients treated for recurrent PAs occupying parapharyngeal space were retrospectively reviewed. The study population comprised 6 women and 3 men with a mean age of 51 (range, 35-79 years). Before the first revision surgery, imaging studies and clinical examinations showed 1 solitary mass in 4 patients, 2 solitary masses in 3 patients, and 3 or more masses in 2 patients. After first revision surgery, 4 patients had rerecurrences with multinodular disease. Two of 4 patients underwent radiation therapy (RT), and the other 2 patients underwent second revision surgery, among whom 1 patient underwent third revision surgery, and the other one was also submitted to RT. Overall, 12 reoperations were performed, and at the end of all operations, 4 patients had rerecurrences and residual disease. In conclusion, we recommend RT to patients with multinodular disease, known tumor spillage, and residual tumor in addition to revision surgery. Histopathologic features, surgical resection, relationship to surrounding vital tissues, and postoperative adjuvant radiotherapy are the most important determinants for recurrent PAs.

Background: The aim of this retrospective chart review of the patients who had septal surgery with or without turbinate surgery was to compare the postoperative complication rates according to the time of intranasal-splint (INS) removal. Methods: The data of 137 patients who underwent septal surgery with or without turbinate surgery at 2 different hospitals of AcNbadem Health Care Group between January 2007 and March 2009 were retrospectively evaluated. The patients who had these risk factors were eliminated, and 96 patients were included in this study. The patients were divided into 2 groups according to splint-removal time. The first group comprises patients whose nasal splints were removed in 24 hours after surgery, and the second group comprises patients whose splints were removed 5 days after the surgery. Any bleeding, septal hematoma, and synechia after pack removal were recorded. Analysis of the rate of complications was done with the W 2 test. Results: Sixty-five male and 31 female patients with a mean age of 32.4 years (range, 18Y57 years) were included in the study groups. Septal surgeries were performed in association with turbinate surgery in all 96 patients. These patients were divided into 2 groups. In the first group (n = 50), INSs were removed in 24 hours after surgery. In the second group (n = 46), INSs were removed 5 days after surgery. Bleeding within the first postoperative week was not recorded in both groups. Late bleeding was recorded in 2% (n = 1) of group 1 and in 2.17% (n = 1) in group 2. Septal hematoma and synechia were not recorded in none of the groups. The results were not statistically significant (P =1 ). Conclusions: The routine use of INSs after septoplasty and removing them 24 hours after septoplasty are sufficient to avoid postoperative complications, and it minimizes postoperative discomfort.

Introduction Subglottic cysts (SGCs) are increasingly recognized as a cause of upper airway obstruction in previously intubated infants. Endoscopic marsupialization with cold steel instruments or CO2 laser has been reported to be the standardised treatment method for SGCs. SGC case series of 9 patients who were treated with endoscopic marsupialization with cold steel instruments or CO2 laser and mechanical decompression with balloon dilatation are presented. Patients and methods Retrospective study of 9 cases of subglottic cysts treated between 2003 and 2010 was done. Diagnoses were made by performing flexible nasopharyngolaryngoscopy and surgical treatment was done through endoscopic marsupialization with cold steel instruments or CO2 laser. Results The age range of SGC patients were between 3 months and 36 months (average 12, 11 months). Two of the patients were female (2/9), 7 of them were male (7/9). SGC diagnoses were made by flexible nasopharyngolaryngoscopy. History of intubation was noted in 3 of the patients (3/9). Duration of intubation was 28 days, 6 days, and 8 days respectively. Cysts were multiple in all cases, and located posteriorly and laterally at the subglottic area and upper trachea. The patients presented with were stridor, fail to thrive, and recurrent croup attacks. Treatment methods preferred for these patients were endoscopic marsupialization with cold steel instruments or CO2 laser and mechanical decompression with balloon dilatation. The follow-up period after treatment ranged between 8 months and 3 years. Recurrence of the SGCs did not happen and re-evaluation under general anesthesia was reserved for the symptomatic patients. Conclusion Diagnostic laryngoscopy and bronchoscopy are important in diagnosing SGC. History of premature birth and intubation are not ‘sine qua non’ of SGC as SGC may be congenital as well. Symptoms of SGCs may mimic the characteristic features of chronic obstructive lung disease, so evaluation of the airway should be considered in such infants if they have stridor or hoarseness not responding to routine treatment. Laryngoscopy and bronchoscopy are routinely indicated for airway evaluation in at-risk infants.

Objectives: Thegoal of the cochlear implant surgery is to place theelectrode array with minimal damage to preserve the residual hear-ing. Round-window insertion can be performed in a manner that ispotentiallylesstraumaticthanthestandardcochleostomy.Thepurposeof the study was to investigate audiological results of the round-window approach using standard electrode.Methods: A retrospective study was performed to evaluate ourexperience in patients with implanted through round window be-tween January 2007 and March 2009. Sixty patients had undergonecochlear implant surgery through the round window with full in-sertion of a standard electrode array. Preoperative and postoperativepure-tone thresholds were measured for implanted ears in the rangeof 250 to 4000 Hz.Results: Within these60cases,31patients hadbeen evaluated.Thepopulation comprised 16 women and 15 men. The mean age was15.96 years (range, 4Y64 years). Follow-up times ranged from 6 to26 months. Preservation oflow-frequencyhearing (250 and 500 Hz)was achieved in 27 (87%) of 31 patients. Complete hearing pres-ervation(allfrequencies)wasaccomplishedin11patients(35.48%).No hearing could be determined postoperatively in 4 patients(12.9%), having preoperative thresholds of 120 dB at 250, 500,and 1000 Hz.Conclusions: Round-window approach has been widely used forpreservation of residual hearing. In our patients with severe to pro-found hearing loss, we preserved residual hearing. Although the re-sidual hearing cannot be sufficient for using additional acousticstimulation, the preserved residual hearing means minimal damageand a more convenient cochlea, so this is promising for futuredevelopment.Key Words: Cochlear implantation, round-window approach,standard electrode, residual hearing(J Craniofac Surg 2011;22: 520Y522)

In stapedotomy, augmentation of the long process of the incus is necessary when the structure is too short or thin or when the bone has been eroded to the point that it is not possible to satisfactorily attach a piston prosthesis to it. One substance that has been used to augment the long process is glass ionomer cement (GIC). GIC is a dental bone cement that is finding new uses in otologic procedures. We conducted a retrospective study of 10 stapedotomies (6 primary and 4 revision cases) that included the use of GIC to augment an insufficient long process. In all 10 cases, surgery was successful and without complication. A comparison of pre- and postoperative audiometry revealed significant improvements in mean air-conduction threshold and air-bone gap following surgery. Our findings suggest that GIC is safe and effective in augmenting the long process of the incus during both primary and revision stapedotomy.

The many benefits of the open-approach septorhinoplasty should not be excluded on the basis of columellar scarring alone. Technical factors that contributed to the favorable outcome of the columellar scar included proper planning of location and design of the incision used, meticulous closure, and good postoperative care. In the current study, we describe a simple postoperative wound care procedure that allows clean visualized wound with less crust formation, easy removal of the sutures by the surgeon, and better columellar scar in the early postoperative period.

The aim of this study was to document patients with clinical mastoiditis who were reported to have mastoiditis by radiologists due to increased fluid signal intensity in the mastoid air cells on magnetic resonance imaging (MRI). Brain and temporal bone MRI reports between January 2004 and November 2009 were obtained from the radiology units of four different hospitals of the same Health Care Group. MRI reports for keyword mastoiditis and 406 patients were reported to have radiological mastoiditis on MRI due to increased fluid signal intensity. Otoscopic examination findings of 275 of these 406 radiological mastoiditis patients were documented and compared with MRI reports for clinical infectious otological disease. Forty-eight (17, 45%) (48/275) patients were found to have clinical otological disease on examination. The remainder of the patients (227/275, 82%) did not show any evidence of clinical otologic infectious disease. Of these 48 patients, 18 patients (37, 5%) had eustachian tube dysfunction, 13 patients (27%) had serous otitis media, nine patients (9%) had chronic otitis media, five patients (10%) had tympanosclerosis, and three patients (6%) had acute otitis media. The results of this study showed that MRI is not an effective diagnostic tool for mastoiditis. 82% of the MRI mastoiditis did not show clinical mastoiditis contradicting MRI reports. Fluid signal in the mastoid on MRI should not always be interpreted as mastoiditis by radiologists. Radiological mastoiditis does not necessarily point out to clinical mastoiditis.

Variation in nasal-tip deformity is the most common complaint of the patients requesting rhinoplastic surgery, and the goal of nearly every rhinoplasty is to achieve ideal nasal-tip rotation and projection. We describe a procedure that allows the surgeon to secure nasal-tip rotation and projection through a suspension suture technique. Preserving the interalar soft tissues over the dorsal caudal septum and interdomal ligaments during the surgery is the major basis of this technique. We use the soft tissues as a suspending material for the tip complex, which acts like one whole part.

Purpose Temporal bone fracture, which involves the otic capsule, can lead to complete loss of auditory and vestibular functions, whereas the patients without fractures may experience profound sensorineural hearing loss due to cochlear concussion. Cochlear implant is indicated in profound sensorineural hearing loss due to cochlear trauma but who still have an intact auditory nerve. Material and methods This is a retrospective review study. We report 5 cases of postlingually deafened patients caused by cochlear trauma, who underwent cochlear implantation. Preoperative and postoperative hearing performance will be presented. These patients are cochlear implanted after the cochlear trauma in our department between 2001 and 2006. Results All patients performed very well with their implants, obtained open-set speech understanding. They all became good telephone users after implantation. Their performance in speech understanding was comparable to standard postlingual adult patients implanted. Conclusion Cochlear implantation is an effective aural rehabilitation in profound sensorineural hearing loss caused by temporal bone trauma. Preoperative temporal bone computed tomography, magnetic resonance imaging, and promontorium stimulation testing are necessary to make decision for the surgery and to determine the side to be implanted. Surgery could be challenging and complicated because of anatomical irregularity. Moreover, fibrosis and partial or total ossification within the cochlea must be expected.

Traumatic paralysis of the facial nerve by external injury is the second most common cause of facial nerve paralysis after Bell's palsy. Causes of extratemporal facial nerve trauma include lacerations, stab wounds, gunshots, surgery of the parotid gland (both iatrogenic or therapeutic), mandibular fractures, soft tissue avulsion, and contusion. We report an unusual case with unilateral acute traumatic facial paralysis, due to a suicide attempt by hanging. A 46-year-old male patient presented with an immediate-onset right-sided facial paralysis after an attempted suicide by self-hanging. His vital signs were stable. The patient did not report hearing loss or any symptoms related to the respiratory tract. The results of the complete otolaryngologic and neurologic examinations were normal with the exception of a right-sided facial paralysis, indicating a score of III to IV, according to the House-Brackmann facial nerve grading scale (HBS). http://www.entnet.org/journal/casereports/OTO-16.pdf/