Comparison of Early Versus Delayed Oral Feeding After Total Laryngectomy in Terms of Pharyngocutaneous Fistula Development

Objective:There is still no consensus on the effect of early oral feeding and nasogastric tube feeding on the development of pharyngocutaneous fistula (PCF) after total laryngectomy. The aim of the present study was to compare the effects of early oral feeding and nasogastric tube (NGT) feeding after total laryngectomy on the incidence of PCF.Methods:A total of 59 male and three female patients with a mean age of 61.65 (range 44-77) years who underwent total laryngectomy and bilateral neck dissection between May 2010 and June 2016 were evaluated retrospectively. Thirty-two patients started oral feeding on postoperative day three, and 30 patients started NGT feeding on postoperative day one following oral feeding on 7th day. Besides the investigation of the factors which can affect PCF formation, the incidence of PCF was also determined between the two groups of patients.Results:Only preoperative albumin value was different between the groups in the determination of factors which can affect development of PCF. No statistical difference was found between the two groups in terms of the development of PCF and the length of hospital stay (p>0.05).Conclusion:To start oral feeding on postoperative day three or with a NGT feeding on postoperative day one following oral feeding on day seven did not affect the development of PCF and the length of hospital stay in patients who underwent total laryngectomy

Comparison of Hydroxyapatite Prosthesis and Incus Interposition in Incus Defects

Objective: Chronic otitis media most commonly causes an ossicular chain defect in incus. Different materials can be used for repair of this defect. In this study, the hydroxyapatite prosthesis, used for repair of the incus defect, was compared with the incus interposition.Methods: Between 2010 and 2016, 27 female and 16 male patients who underwent ossiculoplasty due to an incus defect were studied retrospectively. Patients' hearing results at the sixth month were compared. The hydroxyapatite prosthesis was used in 24 patients (group 1) and incus interposition was used in 19 patients (group 2) for the ossicular chain repair. Hearing gain at 500, 1000, 2000, and 4000 Hz between the two groups and the success rates in the two groups were compared.Results: Successful hearing reconstruction was performed on 10 patients in each group (group 1, 41.6% and group 2, 52.9%). There was no statistically significant difference between groups both in terms of successful hearing and hearing gain at 500, 1000, 2000, and 4000 Hz. There was no extrusion of the materials used in both groups.Conclusion: As it does not have any additional cost and is easily shaped and biocompatibility problem is not encountered; we recommend using incus interposition primarily in incus defects

Apparent diffusion coefficient for discriminating metastatic lymph nodes in patients with squamous cell carcinoma of the head and neck

PURPOSEWe aimed to evaluate the apparent diffusion coefficient (ADC) values of metastatic lymph nodes in patients with squamous cell carcinoma (SCC) of the head and neck.METHODSPatients with metastatic lymph nodes underwent 1.5 Tesla diffusion-weighted magnetic resonance imaging (MRI). The ADC values of the histologically proven metastases were evaluated retrospectively and mean ADC values were compared using one-way analysis of variance test. Receiver operating characteristic analysis was performed to identify ADC threshold values.RESULTSWe included 33 patients (27 males, 6 females; mean age, 60.7 years) with 53 metastatic lymph nodes in the study. Mean ADC values for nodal metastases of nasopharyngeal carcinoma (NPC) (n=7), oropharyngeal (n=12), laryngeal (n=27), and hypopharyngeal (n=7) carcinoma were (0.810±0.158)×10-3 mm2/s, (0.985±0.099)×10-3 mm2/s, (1.037±0.150)×10-3 mm2/s, and (0.948±0.081)×10-3 mm2/s, respectively. The mean ADC values of nodal metastases of NPC were significantly lower than ADC values of laryngeal carcinoma (LSCC) (P = 0.002). An ADC value less than 0.890×10-3 mm2/s was found to facilitate differentiation of NPC from LSCC with a sensitivity of 71% and specificity of 85% (area under the curve, 0.852).CONCLUSIONThe mean ADC values showed significant differences between nodal metastases of NPC and LSCC. Considering SCCs as a single group may affect the accuracy of ADC-based differentiation. Location of the primary tumor should be taken into account and cutoff values should be determined separately for each anatomical location

Orbital Complications of Acute Sinusitis: Evaluation, Management, and Results

Objective: Even though acute rhinosinusitis orbital complications are not very common, they can appear as very severe complications with high mortality rates, due to infection spreading to orbital and intracranial tissues. The objective of this study is to assess the treatment and its results for patients treated in our clinic due to rhinosinusitis complications.Methods:Patients who were admitted to our clinic due to acute rhinosinusitis complications between January 2010 and March 2012 were examined. We retrospectively evaluated 11 patients 8 (73%) males and 3 (23%) females with a mean age 12.36 years (range 6-20 years)who were treated for orbital complications of acute rhinosinusitis. Cases were evaluated according to age, sex, etiologic factors, localization, treatment, and outcome.Results: Preseptal cellulitis was observed in 9 patients (82%), orbital abscess was observed in 1 patient (9%), and subperiosteal abscess was observed in 1 patient (9%). Ten of 11 patients achieved full recovery through medical treatment, whereas 1 patient was treated with right subperiosteal abscess drainage and right functional endoscopic sinus surgery due to subperiosteal abscess. The patients’ average admission duration was 7 days.Conclusion: The orbita is the area with the most common sinusitis complications, due to its proximity to the paranasal sinuses and especially to ethmoid cells. Early diagnosis and aggressive treatment are important for the reduction of unwanted manifestations. Computed tomography with contrast remains the optimal imaging study for orbital inflammation. Surgical treatment is indicated when subperiosteal orbital abscess and orbital abscess are scenes

Foreign Body in Frontal Sinus: Case Report

A foreign body in the frontal sinus is extremely rare and most cases are related to maxillo-facial trauma. Sixty eight year-old female patient was admitted to our clinic with left nasal obstruction and left frontal pain. A polypoid mass was detected at the left middle meatus by endoscopic examination. Loss of frontal sinus aeration and soft tissue density, especially at the anterior ethmoid region, were observed in the computed tomography scans. The history of the patient was unremarkable except for a neurosurgical operation due to a benign frontoparietal tumour in 1998. Fronto-ethmoidectomy was performed with an endoscopic transnasal approach under general anaesthesia. The histopathological examination was reported as “bone-wax”. The patient had no problem in the 3rd postoperative month. This rare case is presented with clinical and radiological findings and a picture of the foreign body

Mastoid Emissary Vein Canal Incidence and Its Relationship with Jugular Bulb and Sigmoid Sulcus Anatomical Variations

Objective:We aimed to investigate the mastoid emissary vein (MEV) canal incidence and to identify its relationship with jugular bulb (JB) and sigmoid sulcus anatomical variations.Methods:We retrospectively reviewed 1,300 patients with temporal bone computed tomography (CT) scans in January 2016 to March 2020. The presence and the diameter of the MEV canal, and the anatomical variations of the sigmoid sulcus and the JB were reviewed by two radiologists. High riding JB, JB diverticulum, dehiscent JB, and anterior and lateral protrusion of the sigmoid sulcus were evaluated. All variables were summarized using descriptive statistics. The differences between the groups for categorical data were investigated using the chi-square test. Numeric variables were compared with the Mann-Whitney and the Kruskal-Wallis tests. Logistic regression models were constructed.Results:The study included 1,269 patients of whom 694 were female (54.7%) and 575 were male (45.3%). Their mean age was 39.01±18.47. Among them 915 (72.1%) had the right and 871 (68.6%) had the left MEV canal. Men were more likely to have the MEV canal on both sides. The presence of the right and left MEV canals was associated with the ipsilateral dominant JB/sigmoid sulcus. The left MEV canal was associated with the left high riding JB and right dehiscent JB.Conclusion:This is the largest patient population reported in the literature and allows a more precise estimate of the MEV canal incidence. We also classified the diameter of the MEV canal to identify clinically relevant, prominent MEV incidence. This is also the first study to demonstrate a relationship between the presence of the MEV canal, and the JB and sigmoid canal variations. Since both the prominent MEV and the JB variations may be symptomatic, knowing this association between them may have clinical relevance

Paranasal Sinus Anatomic Variations Accompanying Maxillary Sinus Retention Cysts: A Radiological Analysis

Objective:The risk factors for the development of retention cysts of the maxillary sinuses (RCMs) are not clear, although RCMs are common findings on radiographic images. This study was conducted to evaluate the correlation between RCMs and other nasal-paranasal anomalies and to demonstrate the possible effects of these anomalies on the development of RCMs.Methods:In the study, paranasal sinus computerized tomography (PNsCT) images from 5166 patients were retrospectively reviewed. Correlations between RCMs and osteomeatal complex obstruction, accessory ostium presence, abnormalities of the middle turbinate, and nasal septal deviation were analyzed in the PNsCT images. The paranasal sinus anomalies on the side of the RCMs were compared to the contralateral side.Results:A total of 1880 RCMs were detected in 1429 (27.6%) of 5166 patients. At least one nasal-paranasal sinus anomaly was associated with 88.7% of the RCMs. In the descending order, accessory ostium presence, accessory ostium, middle turbinate anomalies, and nasal septal deviation are pathologies that accompany RCMs. When unilateral RCMs were compared with the normal side, significant correlations were observed between RCMs and osteomeatal complex obstruction, accessory ostium, and middle turbinate anomalies (p=0.001, p=0.016, and p=0.03, respectively). RCMs were commonly found on the same side as osteomeatal complex obstruction (p=0.001), middle turbinate anomalies (p=0.001), and accessory ostium (p=0.052).Conclusions:In this study, the coexistence of osteomeatal complex obstruction, accessory ostium, middle turbinate anomalies, and nasal septum deviation with RCMs was analyzed by investigating PNsCT findings in 5166 patients. The results show that RCMs are associated with pathologies that increase paranasal inflammation, such as osteomeatal complex obstruction, and are good markers for nasal-paranasal sinus anomalies. The presence of incidental RCMs should be a warning sign of nasal-paranasal sinus anomalies

Comparison of the Postoperative Mucociliary Clearance Time Between Patients who Underwent Septoplasty with and Without Nasal Packing

Objective:To compare the postoperative mucociliary clearance time in septoplasty with and without nasal packing.Methods:Forty-six patients with nasal septal deviation (20 women, 26 men) were assessed in this study. The patients underwent septoplasty under local anaesthesia. Patients were divided in two groups. Merocell® nasal packing was performed in both of the nasal passages for septum stabilization in the first group (28 patients). On the second postoperative day nasal packing was removed and salin irrigation solution was started. Transseptal suturing was performed for nasal stabilization in the second group and at the sixth postoperative hour saline irrigation solution was started. Saccarine clearance test was performed preoperatively and postoperatively at the 7th day, and 3th month and the results were compared.Results:In the treatment of 46 patients with a mean age of 20-53, in the first group; preoperative mucociliary clearance time on the deviated side was 12.2 minutes and on the opposite side was 13.1 minutes. In the second group, preoperative mucociliary clearance time on the deviated side was 11.9 minutes, and on the opposite side 12.8 minutes. In the first group, the postoperative 1th week mucociliary clearance time on the deviated side was 12.5 minutes and on the opposite side was 13.2 minutes and in the second group on the deviated side was 10.1 minutes, and on the opposite side was 10.8 minutes. In the first group, at the postoperative 3th month mucociliary clearance time on the deviated side was 11.6 minutes and on the opposite side was 11.4 minutes while in the second group on the deviated side was 6.7 minutes, and on the opposite side was 7.8 minutes.Conclusion:The postoperative mucociliary clearance time in patients treated for septal deviation were evaluated. We have determined that the mucociliary clearance time was longer in the patients that underwent septoplasty with nasal packing