Management of a Spontaneous Thyroid Nodule Hemorrhage Causing Acute Airway Obstruction

Spontaneous intrathyroidal hemorrhage (ITH) causing airway obstruction is relatively rare. We report a case with no known history of a thyroid disease that presented with an ITH causing severe airway obstruction as a life-threatening situation. A 57-year-old female patient presented to the emergency department with sudden onset of swelling of the anterior neck, severe dyspnea, and unconsciousness. Computerized tomography scan after intubation revealed a 6.2x5.3 cm mass originating from the right thyroid lobe and compressing the airway. Drainage of hematoma with right lobectomy was done. When the patient was extubated one day after the surgery the vocal cords were found to be mobile. She was discharged after two days and there was no need for further intervention during the one-month follow-up. Spontaneous life-threatening ITHs are rare entities. Immediate assessment of airway obstruction and achieving a secure airway are crucial. Besides drainage of hematoma, thyroidectomy may also be necessary

Titanium versus Hydroxyapatite Prostheses: Comparison of Hearing and Anatomical Outcomes after Ossicular Chain Reconstruction

Objective:This study aimed to compare hearing and anatomical outcomes after ossicular chain reconstruction with titanium or hydroxyapatite prostheses.Methods:In this study, patients who underwent tympanoplasty and ossicular chain reconstruction with titanium or hydroxyapatite prostheses at a university hospital from January 2007 to February 2013 were retrospectively reviewed; they had a minimum follow-up period of 6 months. Patients were divided into 4 groups according to the type of prostheses. The surgical procedure, follow- up examinations, preoperative, and postoperative audiometry results were noted and evaluated for partial and total prostheses. The results were compared both for titanium and hydroxyapatite prostheses.Results:The study subjects included 51 patients. Titanium had better hearing results in partial prostheses (p0.05). The extrusion rate was 5.8% for all patients.Conclusion:Both types of prostheses had satisfactory functional and anatomical results and no preponderance could be stated, except for the hearing results of partial titanium prostheses

Can Intratympanic Steroid Be Initial Therapy for Sudden Sensorineural Hearing Loss?

Objective:To evaluate the efficacy of intratympanic steroid treatment with concurrent systemic steroids as an initial therapy for sudden sensorineural hearing loss (SSNHL).Methods:Patients who were diagnosed as idiopathic SSNHL and received no therapy were included in the study. Patients were divided into control and study groups. Patients in the study group received concurrent intratympanic steroid treatment with systemic steroid therapy. Patients in the control group received standard systemic steroid treatment alone. The duration of time before the treatment was evaluated for all the patients. Pure tone audiometry (PTA) was performed for all the patients in the pre-treatment and post-treatment period in order to record the responses for both in terms of the individual frequencies and the pure tone average.Results:Twenty nine patients (16 female and 13 male) with a mean age of 43.6 years were enrolled in the study. There was 15 patients in the study group and 14 patients in the control group. The mean duration of time for the initial therapy was 4 days for the control group and 6.5 days for the study group (p=0.125). The mean recovery in PTA for the control group was 10.29±4.10 decibel (dB) (0-15) while it was 19.40±18.84 dB (3-68) for the study group (p=0.003).Conclusion:At the end of treatment, significantly better hearing results were obtained for the patients in the study group when compared to the control group both for PTA and all the frequencies individually. We suggest that concurrent intratympanic steroids with systemic steroid therapy gives better hearing results than the standard systemic therapy alone

Reliability of Frozen Section Pathology in Transoral Laser Laryngectomy

Objective:To evaluate the reliability of frozen section analysis in transoral laser laryngectomy (TOLL).Methods:A retrospective analysis was conducted for patients who underwent TOLL in a university hospital between January 2012 and February 2014. The grade of the tumor and the histopathological diagnosis were noted. The results of frozen section pathologies and routine histological examinations were compared.Results:A total number of 84 sections from 21 patients with a mean age of 57.3 years were included in the study. All the patients were operated with superpulse continuous mode carbon dioxide laser with a power of 5–8 watts. Squamous cell carcinoma was histologically diagnosed in all patients. The tumor was grade 1 in 80.95% of the patients, grade 2 in 9.52%, and grade 3 in 9.52%. A routine histopathological examination confirmed the frozen section in 94.04% of the patients.Conclusion:Laser surgery is a commonly preferred treatment modality in early-stage laryngeal carcinomas, in particular. However, a safe surgical margin is a debate in transoral laser surgery. In light of our results, we can conclude that frozen section pathology is a reliable method to achieve safe surgical margins in TOLL

Functional and Oncological Outcomes of Open Partial Laryngectomy vs. Transoral Laser Surgery in Supraglottic Larynx Cancer

Objective: The aim of the presented study was to evaluate the outcomes of open partial laryngectomy (OPL) versus transoral laser surgery (TLS) in patients operated on for supraglottic laryngeal carcinoma based on functional parameters (duration of hospitalization, oral nutritional status and duration of transition to oral feeding, weaning status and duration after tracheotomy, and postoperative voice results) and oncological results (overall survival rate, disease-specific survival rate, recurrence, and presence of second primary tumors) in both groups.Methods: All laryngeal carcinoma patients who had undergone either OPL or TLS in the period from January 2012 to March 2017 in our center and were followed-up at least for 36 months were included in the study. Statistical analyses were carried out using the t-test and the Mann-Whitney U test to compare the means, and the Kaplan-Meier test for survival analysis.Results: Fifty patients (44 males and 6 females) met the study criteria, of whom 31 had undergone OPL and 19 TLS. Patients that underwent TLS had less tracheotomy needs, needed shorter hospitalization periods, and transitioned to oral feeding earlier, compared to those that underwent OPL. There were no significant differences between the two groups based on oral feeding rates and voice outcomes. The impact of TLS and OPL on organ preservation in supraglottic laryngeal cancer were comparable. For local recurrences, repeated endolaryngeal laser surgeries and adjuvant treatments could be used in the TLS patient group. There were no significant differences between the two groups based on overall survival rate and disease specific survival rate.Conclusion: Although no significant differences were found in our study between the two surgical procedures in terms of oncological outcomes, TLS appeared to produce better functional outcomes in supraglottic laryngeal carcinoma than OPL

Ameloblastoma of the Posterior Mandible: Radical Resection and Reconstruction Using Osteofaciocutaneous Free Fibular Flap

This study reports a case of an ameloblastoma in the posterior region of the right mandible in a 38-year-old female patient. The diagnosis was made after needle aspiration biopsy and resection treatment was planned. The resected mandible was constructed via osteofaciocutaneous free fibular flap. Today, this treatment option is considered the gold standard and in the present case, treatment results were favorable