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Objective: Measuring head circumference is a quick, simple, cheap, noninvasive and reliable procedure for determining underlying brain size and provides information about risk for medical problems. Growth percentages of head vary from one community to another.Methods: We aim to create head circumference growth curves for children aged 0-18 years in Turkish community. Measurements were performed by same person using a rigid and calibrated tape meter. In addition, the parents were asked to fill out a questionnaire with variables that could affect children's growth.Results: Data analysis has shown that there is no relationship between the children's head circumference and whether there exists someone with a large/small head circumference in their families, or the average monthly income of their families and the parent’s education level. Only the independent variables child’s school performance, birth weight, nutrition, smoking are significantly effective on the HC measures of boys at alpha=0.05 level. For girls, only the independent variables birth weight and nutrition form are significantly important in explaining the variability of HC at the level of alpha=0.05. One gram increase in birth weight causes a 0.001 cm increase in the HC of both genders. In addition, head circumference growth curves were created for both genders to include all children aged 0-18.Conclusions: Our study offers recent and gender-specific head circumference norms. These new values can be used more effectively in child follow-up., Genel Bilgiler: Baş çevresi ölçümü, beyin hacmi ve ilişkili olabilecek sorunları belirlemede hızlı, basit, ucuz, non- invaziv ve güvenilir bir yöntemdir ve olası medikal problem risklerinin tanınma ve takip sürecinde bilgi sağlar. Baş çevresi büyümesi toplumlar arasında ve cinsiyete göre değişkenlik gösterebilir. Yöntemler: Türkiye’de yaşayan 0-18 yaş arası çocuklar için baş çevresi büyüme eğrileri oluşturmak hedeflendi. Ölçümler aynı kişi tarafından kalibre edilmiş, esnemeyen bir mezura kullanılarak yapılmıştı. Ayrıca ebeveynlerden çocukların büyümesini etkileyebilecek değişkenleri içeren bir anket doldurmaları istendi.Bulgular: Veri analizi, çocukların baş çevresi ile ailelerinde baş çevresi büyük/küçük olan birinin olup olmadığı, ailelerinin ortalama aylık geliri, ebeveynin eğitim düzeyi arasında bir ilişki olmadığını göstermiştir. Erkek çocuklar için çocuğun okul başarısı, doğum ağırlığı, beslenmesi, annenin sigara içmesi bağımsız değişkenler olarak belirlenmiştir ve alfa değeri 0,05 idi. Kızlar için doğum ağırlığı ve beslenme şekli bağımsız değişkenlerdi ve alfa değeri 0,05 idi. Doğum ağırlığındaki bir gram artışın, her iki cinsiyette baş çevresinde 0,001 cm'lik bir artışa neden olduğu gösterildi. Ayrıca her iki cinsiyet için 0-18 yaş arası tüm çocukları kapsayacak şekilde baş çevresi büyüme eğrileri oluşturuldu.Sonuçlar: Güncel ve cinsiyete özgü veriler ile oluşturulmuş baş çevresi büyüme eğrilerinin kullanılmasını gerektiğini önermekteyiz. Bu yeni değerler çocuk takibinde daha etkin olarak kullanılabilecektir.

Parapharyngeal space tumors are rare tumors that make up about 0.5% to 1% of all head and neck neoplasms. The majority of parapharyngeal space tumors, which are usually benign, consist of salivary gland tumors and neurogenic tumors. Although the transcervical, transparotid or transmandibular approach is generally preferred for the excision of these tumors, the transoral approach, which is more advantageous in terms of cosmetics and function, can be applied in selected cases. This article presents a case in which the giant pleomorphic adenoma originating from the deep lobe of the parotid gland is removed by transoral approach.

Background To present an effective and easily applicable method for tracheoesophageal puncture (TEP) closure by using a localized annular flap instead of bulky and distant flaps. Methods The medical records of patients who underwent TEP closure surgery with the annular mucosal flap technique between July 2012 and August 2018 were retrospectively reviewed. Fistula size, indication for closure, duration of surgery, radiotherapy status, and surgery results were analyzed. Results We have used our technique in nine patients. No postoperative bleeding, wound infection, esophageal stenosis, and tracheostoma stenosis occurred. In all these patients except one, successful closure was achieved. None of the patients had a recurrence of the TEP. Conclusion The annular mucosal flap technique for TEP closure is easy and quick to apply. The patient's oral feeding at the sixth hour after procedure without using a nasogastric tube makes the technique preferable as a priority.

In this article, we present four patients who underwent cochlear implantation due to far advanced otosclerosis. Preoperative evaluations, intraoperative findings, complications, and postoperative benefits were analyzed. Cochlear implantation is a treatment option providing excellent audiological results for rehabilitation of patients with far advanced otosclerosis. However, facial nerve stimulation after cochlear implantation is observed more frequently in patients with otosclerosis. Also, caution should be paid in patients with otosclerosis in terms of cochlear ossification and inconsistent results.

Objectives/Hypothesis The aim of this study was to evaluate outcomes of postlingual postmeningitic patients who received an auditory brainstem implant (ABI). Study Design Retrospective analysis was performed on postlingual postmeningitic patients with bilateral profound sensorineural hearing loss who underwent ABI between the years 2007 and 2014 Methods All patients were postlingually deaf due to cochlear ossification as a consequence of bacterial meningitis. The patients received a MED-EL or Neurelec ABI. All patients were operated on at different hospitals by the same primary surgeon. The patients were tested using Ling 5 sound detection, sound field implant thresholds between 250 Hz and 6 kHz, and 6 to 12 choice closed-set word and sentence tests. Results Nine patients with postmeningitic cochlear ossification received an ABI. Five of nine ABI users (55.5%) wear their audio processors (AP) most of the time. Four (44.5%) with no perceivable benefit have become nonusers. Three of the five consistent ABI users reported good benefit. The other two ABI users who do wear their APs do not respond to sound in daily living but reported benefits such as “feeling sound” in a good way. Conclusions In this study, five of nine patients (55.5%) with bilateral ossified cochlea had some degree of benefit from their ABI. An ABI may be useful in hearing restoration in postlingual patients with bilateral ossified cochlea due to meningitis. However, poor results may be related to side effects, which may necessitate deactivation of electrodes, long duration of auditory deprivation, or impairments in the auditory neural structures as a result of meningitis. Level of Evidence 4. Laryngoscope, 2015

Amaç: Bu çalışmada karotis cisim tümörü olan hastalarda tanı ile birlikte uygulanan tedavi ve takip işlemleri, klinik deneyimlerimiz ve konuya ilişkin literatür eşliğinde sunuldu.Hastalar ve Yöntemler: Kasım 2001 - Mayıs 2012 tarihleri arasında karotis cisim tümörü nedeni ile kliniğimizde ameliyat edilen 10 hasta 5 erkek, 5 kadın; ort. yaş 53.2 yıl; dağılım 27-80 yıl çalışmaya dahil edildi. Tanı yöntemi olarak ultrasonografi, bilgisayarlı tomografi, manyetik rezonans görüntüleme, manyetik rezonans anjiyografi, selektif karotis anjiyografi, balon oklüzyon testi, biyokimyasal testler ve ameliyat öncesi embolizasyon kullanıldı. Komplikasyonlar kaydedildi.Bulgular: Balon oklüzyon testi ameliyat öncesi dönemde tüm olgulara uygulanırken, yedi hastaya embolizasyon yapıldı. Tüm kitleler karotis arterden subadventisiyal yaklaşım ile diseke edildi. Dokuz hastada karotis bütünlüğü korunurken, bir hastada damar grefti kullanıldı. Bir hastada geçici nörolojik bozukluk, safen venle greftleme yapılan bir hastada ise geçici hipoglossal parezi gözlendi.Sonuç: Çalışma bulgularımız i karotis cisim tümörlerine tedavisinin multidisipliner yaklaşım gerektirdiğini, ii balon oklüzyon testinin cerrahiye alınacak tüm hastalara yapılması gerektiğini, iii tümör çıkarılırken cerrahi sahayı genişletmek gerekirse kraniyal ve frenik sinirlere özellikle dikkat edilmesi gerektiğini ve iv patolojik incelemelerin deneyimli bir ekip tarafından ve gerekirse çok merkezli olarak yürütülmesi gerektiğini göstermektedir, Objectives: In this study, we report our clinical experience in a series of patients with carotid body tumors along with diagnosis, treatment and follow-up procedures in the light of related literature data. Patients and Methods: Between November 2001 and May 2012, 10 patients 5 males, 5 females; mean age 53.2 years; range 27 to 80 years who underwent surgery due to a carotid body tumor in our clinic were included. Diagnosis was based on ultrasonography, computed tomography, magnetic resonance imaging, magnetic resonance angiography, selective carotid angiography, balloon occlusion test, biochemical tests and preoperative embolization. Complications were also recorded. Results: Balloon occlusion test was performed in all patients preoperatively, while embolization was implemented in seven patients. All masses were dissected by carotid artery subadventitial approach. Carotid integrity was maintained in nine patients, while a vein graft was used in one patient. Neurological disorder was observed in one patient, whereas transient hypoglossal paresis was in one patient who underwent saphenous vein grafting. Conclusion: Our study results suggest that i carotid body tumors should be handled with multidisciplinary approach; ii balloon occlusion test should be performed in all patients undergoing surgery; iii a particular attention should be paid to cranial and phrenic nerves, if it is necessary to extend the surgical field while removing the tumor; and iv pathological examination should be carried out by an experienced team and in a multi-centered fashion, if necessary.

This paper examines the reports on the selection criteria and the post-operative performance of 25 children implanted with the Neurelec Digisonic SP. This study reported benefits from Neurelec Digisonic SP cochlear implant in auditory and speech perception outcomes. There has been a lack of studies into the additional factors such as level of the mothers' education and bilingualism, which is a factor that may have a significant effect on the success of cochlear implantation. This paper examines the reports on the reasons for the differences in performance and the post-operative performance of 25 children implanted with the Neurelec Digisonic SP. Meaningful Auditory Integration Scale and Meaningful Use of Speech Scale questionnaires were used just before 3, 6, 12, and 18 months following implantation. Electrode array was inserted without difficulty in all cases, with no complications to date. This is a retrospective and cross-sectional study and all the data were collected between March 2010 and December 2012. Auditory performance improved over time for up to 12 months after implantation. Our experience indicates that the Neurelec Digisonic SP cochlear implant system in children under the age of two is relatively safe and reliable. The Neurelec Digisonic SP device surgery can be performed without complications. Auditory performance results support the effectiveness of early implantation. These important findings further support the importance of professionals working very closely with parents or especially mothers and enhancing their involvement in achieving therapy goals to develop auditory skills and speech in young children following cochlear implantation.

Metachromatic leukodystrophy is a lysosomal storage disease caused by the deficiency of the enzyme arylsulfatase A. If arylsulfatase A is deficient, sulfatide accumulates. Functionally, this accumulation results in progressive neurological deterioration. The reports about the extra nervous system manifestations of metachromatic leukodystrophy are related to the gallbladder involvement such as polyposis. Unexplained vomiting began in a 5½-year-old girl with late infantile metachromatic leukodystrophy. Endoscopy showed multiple polypoid masses in the pylor of the stomach and duodenum. Severe gastrointestinal bleedings occurred during nasogastric feeding. Intestinal intussusception developed later. To the authors’ knowledge, intestinal polypoid masses and obstruction with metachromatic leukodystrophy have not previously been reported. The persistent vomiting may be a symptom of intestinal obstruction due to intestinal polypoid masses with metachromatic leukodystrophy. There may be a trend for the development of polypoid masses in intestine as well as in the gallbladder in metachromatic leukodystrophy.

Adverse drug reactions are the major cause of morbidity and mortality worldwide. Cutaneous drug reaction is the most common type of adverse reaction. Toxic epidermal necrolysis (TEN) is a rare, life-threatening mucocutaneous disease, usually attributable to drugs. There is no proven therapy for TEN. The mainstay of therapy is immediate withdrawal of the culprit drug, using disease-modifying agents, and meticulous supportive care. Several disease-modifying agents have been used such as steroid, i.v. human immunoglobulin (IVIg), plasmapheresis. A 10-year-old epileptic girl was admitted with lamotrigine-induced TEN. She was unresponsive to steroid. Her condition deteriorated despite IVIg treatment. She was treated with N-acetylcysteine (NAC). To our knowledge this is the first report of a child with TEN, a potentially lethal disorder, treated with NAC. NAC may be effective for children with TEN.

Objective:To evaluate quality of life after surgery for benign neoplastic disease of the parotid gland.Patients and methods:A quality of life questionnaire, which was created from the Hebrew version of the University of Washington Quality of Life prototype, was applied to 55 patients who underwent surgery for benign neoplastic parotid disease. All patients were examined in Baskent University Adana Teaching and Medical Research Center, where all except 10 subjects (who responded by phone) completed the quality of life questionnaire.Results:The highest overall score was 96.3 indicating no salivary fistula. Only one patient complained of salivary secretion through the wound scar. The lowest overall score was 59.5 indicating loss of sensation. Although no post-surgical pain was reported by 32 (58 per cent) patients, 16 (29 per cent) patients reported a post-surgical change in their appearance. Scarring and surgical site depression were reported by 26 (47 per cent) and 17 patients (30 per cent), respectively. Facial nerve impairment was reported by seven patients (13 per cent) during the early post-operative period; these patients recovered from that impairment. The only significant statistical correlations were noted between general health and gender, and between post-surgical pain and gender. There was not any statistical correlation between all data and age, tumour type and education level.Conclusion:The general status of patients who have undergone surgery for a benign parotid neoplasm can be assessed with a quality of life questionnaire. Patients' post-surgical quality of life can be improved by the correct choice of surgical approach and reconstructive method.

Objective: To assess the hearing outcomes and complications of the microdrill and pick stapedotomy techniques. Patients: We assessed 123 primary otosclerosis operation in 103 patients who had more than 1 year follow-up (71 microdrill; 52 pick stapedotomies). There were 87 women and 36 men in the study group (mean age, 44 T 11.2 years) at surgery. Intervention: Stapedotomy for otosclerosis. Main Outcome Measures: Pure tone hearing thresholds and clinical evaluation for complications. Results: In the microdrill group, preoperative mean air conduction was 61 dB, and mean bone conduction was 27 dB, postoperatively, these values improved to 31 dB and 16 dB, respectively. In the pick group, mean air conduction was 61 dB, and mean bone conduction was 27 dB, which improved postoperatively to 33 dB and 18 dB, respectively. Postoperative hearing gains were similar in both groups (p 9 0.005). The mean postoperative gain in bone conduction was significant (p G 0.001) in each group: 11 dB in the microdrill group and 9 dB in the pick group, with no significant difference between the two groups. The preoperative air-bone gap was 34 dB in both groups, and improved to 15 dB in both. Complication rates were similar. Conclusion: The microdrill and pick stapedotomy techniques produced similar hearing results and complication rates. Within the limitations of the present study, we found no evidence of microdrill-induced acoustic trauma. The microdrill can be a useful technique in performing a stapedotomy and seems to produce similar results to those associated with pick stapedotomy. Key Words: Acoustic traumaVComplicationV HearingVMicrodrillVOtosclerosisVPickVStapedotomy. Otol Neurotol 28:998Y1001, 2007.

Sydenham's chorea, the neurological manifestation of rheumatic fever, is the most common acquired chorea of childhood. In this retrospective study, the authors aim to present the clinical and laboratory findings of 65 Sydenham's chorea patients, followed up in a clinic over less than 7 years. The mean age at the onset of the symptoms was 11.7 ± 2.6 years (range, 6-17 years). Of the patients, 63% were female and 37% were male (male/female: 1.7/1). Chorea was generalized in 78.5% of the patients, right hemichorea in 12.3%, and left hemichorea 9.2%. There was a history of rheumatic fever in 30.8% of the patients. Echocardiographic study showed cardiac valve involvement in 70.5% of 61 patients. Brain magnetic resonance imaging, which was performed on only 18 patients, was evaluated as normal in all. Electroencephalography was also performed on only 18 patients and showed abnormal waves in 50% of them. Pimozide was mostly the first choice of drug therapy. Nevertheless, drug therapy was not needed in 18.5% of the patients. The recovery period of the first attack of the chorea was 1 to 6 months in 51.7% of the patients. The recurrence rate was 37.9%. In conclusion, Sydenham's chorea is still an important health problem in Turkey with respect to its morbidity.

OBJECTIVES This study aims to evaluate surgical techniques and obtained outcomes in pediatric cholesteatoma. PATIENTS AND METHODS A total of 62 patients (41 males, 21 females; mean age 13 years; range 3 to 17 years) diagnosed as pediatric cholesteatoma between January 1998 and December 2014 were enrolled into the study. Of the patients, canal wall down (CWD) mastoidectomy was performed in 31, canal wall up (CWU) mastoidectomy in 13, inside-out (ISO) mastoidectomy in eight, and tympanoplasty in 10. Surgical approaches, staging, hearing outcomes, relapse status, and surgical data were retrospectively analyzed. RESULTS Cholesteatoma recurred in seven patients (11%). Recurrence rates for CWU and CWD mastoidectomies were 31% and 6%, respectively. While the number of patients with good serviceable hearing (pure-tone average ≥25 dB) was 10 preoperatively, it became 16 postoperatively. Ossicular erosion was higher in CWD group. Twenty-nine patients (47%) had extensive disease and CWD mastoidectomy was performed in 86% of these. Number of patients not requiring care was 45 (72.6%). CONCLUSION In this study, we observed no differences in terms of good serviceable hearing between CWU and CWD mastoidectomies. The preferred method was mainly CWD in patients with extensive disease and ossicular erosion. Recurrence rates were higher in CWU group. Therefore, ISO or CWD mastoidectomy come to the forefront as appropriate treatment options in the treatment of pediatric cholesteatomas according to the extensiveness of disease.

The aim of this study was to evaluate outcomes of postlingual postmeningitic patients who received an auditory brainstem implant (ABI).Retrospective analysis was performed on postlingual postmeningitic patients with bilateral profound sensorineural hearing loss who underwent ABI between the years 2007 and 2014 METHODS: All patients were postlingually deaf due to cochlear ossification as a consequence of bacterial meningitis. The patients received a MED-EL or Neurelec ABI. All patients were operated on at different hospitals by the same primary surgeon. The patients were tested using Ling 5 sound detection, sound field implant thresholds between 250 Hz and 6 kHz, and 6 to 12 choice closed-set word and sentence tests.Nine patients with postmeningitic cochlear ossification received an ABI. Five of nine ABI users (55.5%) wear their audio processors (AP) most of the time. Four (44.5%) with no perceivable benefit have become nonusers. Three of the five consistent ABI users reported good benefit. The other two ABI users who do wear their APs do not respond to sound in daily living but reported benefits such as "feeling sound" in a good way.In this study, five of nine patients (55.5%) with bilateral ossified cochlea had some degree of benefit from their ABI. An ABI may be useful in hearing restoration in postlingual patients with bilateral ossified cochlea due to meningitis. However, poor results may be related to side effects, which may necessitate deactivation of electrodes, long duration of auditory deprivation, or impairments in the auditory neural structures as a result of meningitis.4. Laryngoscope, 126:1889-1892, 2016.

Research reports indicate that vitamin B12 levels show racial differences, which suggests that using the reference ranges of varied populations may lead to inaccurate results. This study aimed to determine normal serum levels of vitamin B12 among children and young people in the Konya region of Turkey. It evaluated 1,109 samples; 54 were from cord-blood and 1,055 were from healthy subjects aged 0-24 year(s), who were admitted to primary healthcare centres. The normal reference levels obtained for vitamin B12 at 2.5-97.5 percentile (P2.5-P97.5) range were 127-606 pg/mL for girls, 127-576 pg/mL for boys, and 127-590 pg/mL for the entire study group. The reported reference values for vitamin B12 in other studies were higher than the current results. Vitamin B12 levels vary from country to country; comparisons between countries may not be valid, and normal levels for each population should be obtained.

Hydrocephalus represents a diverse group of conditions that are characterized with dilatation of the ventricular system and increased cerebrospinal fluid pressure Ventriculo peritoneal shunt placement is a commonly used treatment method for hydrocephalus for diverting the cerebrospinal fluid into the peritoneal cavity The most common complication of ventriculo peritoneal shunt is dysfunction of the shunt mainly due to catheter obstruction or infection Spontaneous bowel perforation is a rare complication of ventriculoperitoneal shunt This article aims to discuss ventriculo peritoneal shunt complications and the significance of colon perforation among these complications by presenting two cases of anal protrusion of ventriculoperitoneal shunt catheter that is inserted in order to reduce the hydrocephalus detected in the neonatal period Turk Arch Ped 2013; 48: 255 258, Hidrosefali değişik hastalık durumlarında ortaya çıkan ventriküllerde genişleme ve beyin omurilik sıvısı basıncının artması ile belirgin bir bulgudur Beyin omurilik sıvısı akımını düzeltmek için en sık uygulanan yöntem ventrikülo peritoneal şant vasıtasıyla beyin omurilik sıvısının periton içine boşaltılmasıdır Şant kullanımında en sık karşılaşılan komplikasyon enfeksiyon veya tıkanmaya bağlı olarak şantın işlev bozukluğudur Kendiliğinden kolon perforasyonu nadir görülen bir komplikasyondur Bu yazıda yenidoğan döneminde hidrosefali saptandıktan sonra ventrikülo peritoneal şant uygulaması yapılan ve şant kateterinin anüsten çıktığı görülen iki olguyu sunduk ve iki olgu nedeni ile hidrosefalik çocuklarda ventrikülo peritoneal şant komplikasyonlarını ve bunların içerisinde kolon delinmesinin önemini tartışmayı amaçladık.

In this study, we report our clinical experience in a series of patients with carotid body tumors along with diagnosis, treatment and follow-up procedures in the light of related literature data.Between November 2001 and May 2012, 10 patients (5 males, 5 females; mean age 53.2 years; range 27 to 80 years) who underwent surgery due to a carotid body tumor in our clinic were included. Diagnosis was based on ultrasonography, computed tomography, magnetic resonance imaging, magnetic resonance angiography, selective carotid angiography, balloon occlusion test, biochemical tests and preoperative embolization. Complications were also recorded.Balloon occlusion test was performed in all patients preoperatively, while embolization was implemented in seven patients. All masses were dissected by carotid artery subadventitial approach. Carotid integrity was maintained in nine patients, while a vein graft was used in one patient. Neurological disorder was observed in one patient, whereas transient hypoglossal paresis was in one patient who underwent saphenous vein grafting.Our study results suggest that (i) carotid body tumors should be handled with multidisciplinary approach; (ii) balloon occlusion test should be performed in all patients undergoing surgery; (iii) a particular attention should be paid to cranial and phrenic nerves, if it is necessary to extend the surgical field while removing the tumor; and (iv) pathological examination should be carried out by an experienced team and in a multi-centered fashion, if necessary.

Objective: The objective of this study was to determine the value of barium swallow pharyng-oesophagography in the investigation of patients with globus pharyngeus who had no known disease, no operation history in the head and neck region, and no thyroid pathology. We compare the clinical presentation with the radiologic findings to assess the diagnostic accuracy of barium swallow in such patients. Methods: This was a retrospective study of the clinical records and radiologic reports of 194 patients with globus pharyngeus, between October 1998 and October 2004, that were reviewed and analyzed for correlations between clinical signs and symptoms and barium swallow findings using the ξ2 test. All the patients had normal ear, nose, and throat examination, including indirect laryngoscopy and/or nasoendoscopy. Patients with known pharyngeal and esophageal disease, neurologic disease known to cause pharyngeal or esophageal dysfunction, evidence of autoimmune disease or diabetes mellitus, with a thyroid operation in the past and thyroid nodules detected with radiologic investigation were excluded. Results: There were 116 (59.8%) female and 78 (40.2%) male patients. In 114 patients (59%), globus was the only symptom. Sore throat was the most common associated complaint. Benign barium swallow findings were detected in 63.9% of the patients. Cervical osteophyte indentation was the most common finding. In 36.1% of the patients, the radiologic finding was normal. The statistical analysis using the ξ2 test showed a significant relationship (P < .001) between the symptoms of globus pharyngeus and the barium swallow results. Conclusion: Barium swallow pharyngoesophagography is useful to detect underlying benign characteristic pathologies in patients with globus who have no known head and neck illness.

Epithelial cysts are benign epithelium-lined lesions that contain fluid or semisolid material. This type of cyst is rare in the oral cavity. Most epithelial cysts in this location are situated in the anterior floor of the mouth; the soft palate is seldom affected. Oral examination in a 6-year-old boy revealed a cyst in the soft palate. The lesion was excised under general anesthesia, and histopathological examination identified it as an epithelial cyst. The report discusses this rare location for an epithelial cyst and reviews the pertinent literature.

Adverse drug reactions are the major cause of morbidity and mortality worldwide. Cutaneous drug reaction is the most common type of adverse reaction. Toxic epidermal necrolysis (TEN) is a rare, life-threatening mucocutaneous disease, usually attributable to drugs. There is no proven therapy for TEN. The mainstay of therapy is immediate withdrawal of the culprit drug, using disease-modifying agents, and meticulous supportive care. Several disease-modifying agents have been used such as steroid, i.v. human immunoglobulin (IVIg), plasmapheresis. A 10-year-old epileptic girl was admitted with lamotrigine-induced TEN. She was unresponsive to steroid. Her condition deteriorated despite IVIg treatment. She was treated with N-acetylcysteine (NAC). To our knowledge this is the first report of a child with TEN, a potentially lethal disorder, treated with NAC. NAC may be effective for children with TEN.

A cholesterol granuloma of the petrous bone is an expanding mass which contains fluids, lipids, chronic inflammatory cells, and cholesterol crystals surrounded by a fibrous lining. The goal of surgery is to provide drainage and ventilation of the affected area to prevent recurrences. In this article, we report a case of a 27-year-old man who was operated using the transmastoid infralabyrinthine approach to drain a cholesterol granuloma cyst.

Neuromyelitis optica is a rare, severe idiopathic disease that predominantly involves optic nerves and spinal cord. Main clinical features of neuromyelitis optica are visual loss, paraparesis or tetraparesis, sensory loss, and sphincter dysfunction. A 13-year-old girl with vision loss and behavioral change was admitted. Her behavioral changes concerned demanding everything, eating cacik (a kind of meal prepared by yogurt) continuously, calling everyone “father,” and self-throttling during the last 1 month, and blurred vision started 15 days ago. On cranial magnetic resonance imaging (MRI), multiple lesions were seen. The patient was admitted 40 days later with walking difficulty. There were lesions in the medulla and cervical spinal cord on MRI. Neuromyelitis optica was diagnosed. Vomiting was the beginning complaint in 2 of 5 hospitalizations later. We conclude that neuromyelitis optica may involve atypical symptoms such as behavioral change and vomiting. Atypical presentations may delay diagnosis. Vomiting may be a recurrence messenger.

To decrease the postoperative pain and the probability of intraoperative complications during intraoral removal of an elongated styloid process.A prospective, clinical trial.Twenty-seven patients with 45 elongated styloid processes underwent surgery. There were 24 females and 3 males, with a mean age of 47.1 years. A simple visual analogue scale was used to assess pre- and postoperative pain. The length and medial and anterior angulation of each process were measured on lateral skull and Towne projection. During the surgery, after tonsillectomy was performed, the styloid process was identified and the process was stripped off proximally using a ring curette. The muscles and ligaments were in continuity with the periosteum, and attachments to the periostem were not disrupted.No intraoperative complications were seen. Only 2 of 45 procedures did not result in a decrease in pain, and a success rate of 95.6% was achieved by this modified surgical method.Excision of the styloid process without disturbing the attachments of the muscles and ligaments to the periosteum of the process is an important factor in relieving postoperative pain and complications.

To assess the therapeutic role and the effectiveness of the selective neck dissection in the management of the clinically node negative neck in the head and neck squamous cell carcinomas.The charts of 177 patients with squamous cell carcinoma, who underwent neck dissection between January 2000 and January 2007, were reviewed retrospectively. Seventy neck dissections in 58 patients (51 males, 7 females; mean age 63 years; range 21 to 85 years) in whom the primary site of the lesion was the larynx, oral cavity, oropharynx and hypopharynx, and who were considered to have N0 neck and to comply with the study criteria were included in the study. Details were collected on tumor site and stage, type of surgery, pathologic N stage, number and size of pathologic nodes, extracapsular spread of nodes, postoperative radiotherapy, local recurrence, follow up time and survival status in all patients.It was found out that selective neck dissection operations were performed on 99 of 102 N0 patients. The follow up time was approximately 23 months in 58 patients who were found to comply with the inclusion criteria. The most frequent site for primary tumor was larynx and most patients were at T2 stage. Nine patients had pathologically positive lymph node with occult metastasis rate of 13%. The overall recurrence rate was 19%. Postoperative radiotherapy was used as adjuvant therapy in 15 patients. Regional control rate was lower in patients with pathologically positive lymph nodes. However, it was not statistically significant.Selective neck dissection is an effective and safe method for controlling and staging of the patients with clinically N0 neck.

Melkersson-Rosenthal syndrome (MRS) includes the triad of oro-facial edema, facial nerve palsy and furrowed tongue. The exact etiology is unknown. However, genetic and acquired factors have been implicated. It is rare in children. In this study, we report a ten year old boy who was diagnosed with MRS with recurrent facial nerve paralysis and facial edema.

Epidermoid carcinoma (also known as squamous cell carcinoma) of the parotid gland is more prevalent among the elderly, as are other head and neck tumors. In most cases it is observed either as a nodal metastasis of a primary tumor that drains into the parotid area or as a direct extension of a tumor that has originated in the upper dermis. Primary epidermoid carcinomas arising directly from the parotid gland are extremely rare. Similarly, secondary invasion of the orbital region by a neighboring tumor is more common than primary epidermoid carcinoma of the orbit, which is also rare. In this article, we discuss the diagnosis and treatment of a rare case of epidermoid carcinoma simultaneously invading the parotid gland and the orbit.

Evaluation and management of peritonsillar masses require specific attention because of their relationship to vital neighboring anatomical structures. A 57-year-old woman developed pseudoaneurysm of the internal carotid artery following a biopsy taken at another center from a mass in the left tonsillar region. She was treated by a multidisciplinary approach and an endovascular covered stent was implanted under local anesthesia in the left internal carotid artery. No recurrence was detected in the neck and the patient was asymptomatic in the postoperative second year.

Objective We evaluated functional results after stapedotomy in terms of the influence of preoperative hearing threshold. Study Design Case series and chart review. Subjects and Methods We classified 141 patients according to preoperative mean air-conduction threshold: 40 to 54 dB, group 1; 55 to 69 dB, group 2; and 70 to 89 dB, group 3. Speech discrimination scores also were noted. Results All groups showed significant improvement. The greatest increase in postoperative speech discrimination score was seen in group 3. Group 1 improved from moderate hearing loss (mean, 49 dB) to normal (mean, 24 dB); group 2, from moderately severe loss (mean, 61.2 dB) to mild (mean, 28 dB); and group 3, from severe loss (mean, 76.4 dB) to moderate (mean, 41.1 dB). Conclusion Success in treating otosclerosis does not depend on extent of preoperative hearing loss. Patients with severe loss improved to moderate, increasing the benefit from use of a hearing aid. The patients attained good auditory function, improving their quality of life.

To examine the effects of different suture materials and suturation techniques on cartilage reshaping in a rabbit model.Twenty-two rabbits were used. Posterior skin flaps were elevated, and 4 cartilage struts were prepared on each auricula. Each strut was bent at its midpoint, and the skin under the bent area was elevated only in 1 side. The strut was sutured either with catgut, polyglactin 910, polydioxanone, or polypropylene sutures. Anteriorly, the suture was passed subcutaneously on 1 side, while transcutaneously on the other. Animals were killed at the first and fourth months. The shape of the struts was macroscopically evaluated. Inflammation and foreign body reaction around the suture were examined under light microscopy.Maintenance of shape with all suture materials was significantly lower in the transcutaneously sutured group than in the subcutaneously sutured group. Because of high rates of suture loss in the transcutaneously sutured group, further evaluations on cartilage tissue were made only in subcutaneously sutured group. Success rate in maintenance of shape was similarly high in the polydioxanone, polyglactin 910, and polypropylene suture groups; however, it was significantly lower in the catgut suture group.Long-lasting absorbable suture materials are as effective as nonabsorbable ones, and the subcutaneous technique is more effective than the transcutaneous technique.

In a retrospective study, we investigated and compared the angulation and the length of the styloid process between patients operated for Eagle's syndrome and a control group by means of lateral skull and Towne's radiographs. Thirty patients with 51 symptomatic elongated styloid processes underwent surgery. As a control group, patients with chronic otitis media and trauma were included in the study and none of them had symptoms characteristic of an elongated styloid process. The length, medial and anterior angulation of the styloid processes of the patient and the control groups were measured on lateral skull and Towne's radiographs. The mean length of the styloid process was 5 cm on the right and 5.2 cm on the left in the patient group, whereas they were 2.8 and 2.6 cm, respectively, in the control group. The mean degree of anterior angulation in the patient group was 33.6 degrees on the right, 36.7 degrees on the left, whereas these were 21.4 degrees and 18.5 degrees , respectively, in the control group. There was a significant difference between the two groups for length and anterior angulation (P = 0.001). The mean medial angulation was 14 degrees on the right and 18.1 degrees on the left in the patient group, whereas these were 15 degrees and 16.3 degrees in the control group, respectively, and there were no significant differences between the two groups. The anterior angulation and the length of the styloid process are responsible for the symptoms of Eagle's syndrome.