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The aim of this study was to evaluate spinal accessory nerve function after functional neck dissection (FND) and radical neck dissection (RND) by monitoring the nerve with electromyographic (EMG) examinations. A prospective, double-blind, clinical study was undertaken in 21 patients (42 neck side dissections) operated on for head and neck malignant diseases, separated into two groups: 10 neck sides in the RND group and 32 neck sides in the FND group. Electromyographic examinations were performed pre-operatively and post-operatively in the third week and third and ninth months. Additionally, a questionnaire, modified from the neck dissection impairment index, was applied to all the patients in order to assess shoulder function in the ninth post-operative month. All patients had maximum EMG scores pre-operatively. Following the operation, motor amplitudes decreased in both groups. At the third post-operative month, amplitudes decreased to their lowest values. As expected, the decreases in amplitude and EMG score were more prominent in the RND group. Following reinnervation, the amplitudes of the trapezius motor response increased in the FND group but never reached pre-operative values (during the time of follow up). The FND group scores for pain, neck and shoulder stiffness, and disability in heavy object lifting, light object lifting and reaching overhead were significantly lower than those of the RND group. In FND, one aims to preserve anatomically the spinal accessory nerve, and it is presumed to be intact after the procedure. However, using EMG nerve function monitoring, our study revealed that profound spinal nerve injury was detected immediately after FND surgery, which tended to improve over subsequent months but had not regained its original function by the end of the ninth post-operative month.

Objective: In this prospective study, we attempted to use objective techniques to measure shoulder disability and evaluate patients who underwent functional neck dissection (FND) procedure. Patients were compared on the basis of preoperative and postoperative range of motion (ROM) measurements, pain and stiffness domains. At the final visit, a Neck Dissection Impairment Index (NDII) questionnaire was applied to all patients., Method: Twenty-five patients treated with head and neck cancer who underwent bilateral FND simultaneously with the resection of primary tumor enrolled in this study from April 2001 to July 2004. Flexion, extension, abduction, internal and external rotations of the shoulder have been measured with electronic incliometer preoperatively, and at the 1st, 3rd, 6th, and 18th months postoperatively. A questionnaire modified from neck dissection impairment index was applied to all patients to measure neck and shoulder disability at final visit. Pain and stiffness domains were also assessed preoperatively and at postoperative 18th month., Results: Measurements of abduction at the first and third months were found to be decreased in comparison with preoperative measurements. These differences were statistically significant (p<0.05). The pain and stiffness scores of all patients at the final visit were significantly worse than the preoperative scores (p<0.005). At the final visit NDII of patients who underwent total laryngectomy were significantly worse than of the patients who underwent partial laryngectomy and glossectomy (p=0.002 and 0.043, respectively). All these results did not correlate with age, radiation therapy (RT), operation side, T stage., Conclusion: FND is oncologicaly safe procedure and gives rise to less shoulder morbidity. Although, ROM improved after 18 months from surgery, pain and stiffness were found to be worse than preoperative values. The patients with total laryngectomy had lower NDII scores regarding to other patients. Therefore, shoulder disability can be attributed not only to neck dissection but also to primary surgery.

Objectives: Healing after oral cavity surgery may be problematic in some cases, because it is a contaminated cavity. The purpose of this investigation was to evaluate the effect of fibrin glue on healing after surgical procedures in the oral cavity., Methods: Forty-two Sprague-Dawley rats were used at this study, 24 in study (Group 1) and 18 in control (Group 2) groups. First molars of the rats were extracted with some cortical bone. The exposed cavities were filled with fibrin glue after hemostasis in study group but 5/0 silk suture was used in control group. The rats were sacrificed after two, four and six weeks and histologic analysis was performed., Results: Healing was better in the study group. Foreign body reaction was lower in Group 1 (1/24, 4.1%) than Group 2 (6/18, 33.3%) (p<0.05). Also abcess formation scores were better in Group 1 (3/24, 12.5%) than Group 2 (10/18, 55.5%) (p<0.008, chi(2)=7). The last significant difference was on necrosis and better results were obtained in Group 1 (2/24, 8.3%) than Group 2 (10/18, 55.5%) (p<0.001, chi(2)=11.24)., Conclusions: The use of fibrin glue on wound healing in the oral cavity has a positive effect when compared with traditional suture techniques.

Objectives: We evaluated the effect of neck metastasis on the survival rate of patients who underwent surgery for laryngeal cancer., Patients and Methods: A total of 256 patients who had undergone surgery between 1995 and 1999 were retrospectively reviewed. Of these, 186 patients (72%; 185 males, 1 female; mean age 57.5 years) who were accessible for follow-up were evaluated with respect to the localization and type of the primary tumor, neck metastasis, surgical procedures, and the survival. Survival rates were determined by the Kaplan-Meier method and compared by the log-rank test. The rates of neck metastasis and extracapsular spread in survivors and non-survivors were compared with the use of the chi-square test. The minimum follow-up period was two years (mean 41.2 months)., Results: Twenty-nine patients died from locoregional recurrences or distant metastasis and six patients died from other causes. The cumulative survival period was 69 months (75 months and 54 months with or without neck metastasis, respectively; log rank test 27.96, p<0.0001). The rates of neck metastasis and extracapsular spread in survivors (22%, 33/151; 7%, 10/151) and non-survivors (69%, 20/29; 59%, 17/29) were significantly different (p<0.001)., Conclusion: Neck metastasis and cervical recurrence were found as the most important factors affecting the results of laryngeal cancer surgery.

Objectives: To determine the speech perception levels of cochlear implant patients and to evaluate the possible effects of implant type, duration of deafness, and bacterial meningitis on the patients' hearing performance., Patients and Methods: A three-section test battery on speech perception was administered to 21 cochlear implant patients (12 males, 9 females; mean age 25 years; range 9 to 40 years). The patients' performance was assessed with respect to single- or multi-channel implant design, duration of hearing loss, and etiologic factors of hearing loss., Results: The overall mean success score was 74.6 (range 49-100). No significant difference was found between patients using single- or multi-channel implants. The mean score of 12 patients whose duration of hearing loss was below the average (8.2 years) was significantly higher than those of nine patients with a longer history of hearing loss (85.7 versus 59.6, p=0.001). Patients with meningitis-associated hearing loss exhibited a significantly lower performance than those presenting with other etiologic factors (61.9 versus 84.1, p=0.001)., Conclusion: Early diagnosis and rehabilitation are essential to achieve better performance following cochlear implantation.

Objectives: We compared the levels of hearing and tympanic membrane healing obtained by cartilage palisade and temporal fascia tympanoplasty techniques., Patients and Methods: Tympanoplasty procedures with the use of cartilage palisade (30 patients; 14 males, 16 females; mean age 28 years; range 10-62 years) and temporal fascia (30 patients; 17 males, 13 females; mean age 30 years; range 12-58 years) were compared with respect to tympanic membrane healing and hearing levels. The size of perforations in the cartilage tympanoplasty group was greater than that of the temporal fascia group. Audiological assessments were performed in the postoperative third and sixth months. The follow-up period was at least six months. Tympanic membrane healing and hearing levels were statistically analyzed using the chi-square and Mann-Whitney U-tests., Results: Tympanic membrane healing rates were 80% (24 patients) and 86% (26 patients) in the temporal fascia and cartilage tympanoplasties, respectively. Postoperatively, hearing levels improved in both groups. However, no significant differences were found between the two treatment groups with respect to tympanic membrane healing and hearing levels., Conclusion: Our findings suggest that cartilage palisade graft can be safely used in the treatment of tympanic membrane perforations, with no adverse effects on the hearing levels in the postoperative six months.

Hemangiopericytomas are rare vascular tumors and one-thirds occurs in the head and neck. These tumors grow slowly and may easily be mistaken for a benign lesion. A twenty-nine-year-old man presented with a large mass on the left side of his neck. Palpation, ultrasonography, and magnetic resonance imaging findings were incorporated into a histopathologic diagnosis of malignant hemangiopericytoma. The tumor was subtotally excised following preoperative embolization of the branches of the subclavian artery and the left vertebral artery. The patient was submitted to radiotherapy. He has been under close follow-up for 16 months without any recurrences.