Delayed Phase Nasal Metastasis of Renal Cell Carcinoma as a Rare Epistaxis Cause

WOS: 000376563400039Malign tumors of sinonasal area composes % 1 of malignant tumors in adults and % 3 of head and neck malignities. Metastasis to this area is rare but malignities that metastatic to head and neck and below down clavicula, renal cell carcinoma (RCC) is the third after lung and breast cancer. As the most frequent malignancy of kidney, RCC is generally seen in male over 40 year old and forms % 3 of malign tumors in adults and in RCC cases % 8 of disease arises by the metastasis to head and neck which is accepted as a bad prognostic factor. In this case report, a 81 year old male patient is presented with literature datas who is underwent nephrectomy 8 years ago for RCC and referred with recurrent epistaxis and delayed phase nasal RCC metastasis

Reconstruction of Orbital Walls with Bone Cement in a Maxillectomy Patient

WOS: 000373224500009PubMed ID: 29392004Orbital wall defects occur because of trauma and secondary to oncologic surgery. Reconstruction of orbital bones is of most importance to ensure normal eye functions and cosmesis. Acrylic resin materials can be used instead of a bone in orbital wall defects that are secondary to the resection of tumors invading the orbita. Polymethyl methacrylate is one of the acrylic resin materials. In this study, the orbital wall reconstruction technique with bone cement after maxillectomy and results are reported

Endoscopic endonasal approach to the vidian nerve and its relation to the surrounding structures: an anatomic cadaver study

WOS: 000443690000007PubMed ID: 30083826PurposeThe aim of this study was to investigate the neurovascular structures and their relevant anatomy with the endonasal endoscopic transpterygoid approach on fresh human cadavers. In addition, the relationship between the vidian nerve, ICA and surrounding structures were investigatedMethodsThis study was carried out at an otolaryngology department of a tertiary medical center between June 2014 and June 2015. Ten fresh human cadavers were included in this study. Pterygopalatine fossa was explored via an endoscopic endonasal transpterygoid approach. Same surgical dissection procedures were performed on all cadavers: maxillary antrostomy, anterior and posterior ethmoidectomy, sphenoidotomy, transpterygoid pterygopalatine fossa and vidian canal dissection.ResultsMean distance between the anterior nasal spine and ethmoidal crest was 60.35 1.31 mm (range 59-64 mm). Mean distance between the sphenopalatine foramen and superior border of choana was 18.30 +/- 1.38 mm (range 17-22 mm). Mean distance between the vidian canal and sphenopalatine foramen was 6.30 +/- 0.47 mm (range 5.5-7 mm). Mean distance between the vidian canal and anterior nasal spine was 64.6 +/- 1.71 mm (range 62-67 mm). Foramen rotundum was located superior lateral to the vidian canal in all specimens. Mean distance between foramen rotundum and vidian canal was 9.45 +/- 0.60 mm (range 8.5-10.5 mm). Course of the greater palatine nerve was always medial to the descending palatine artery. The mean length of the vidian nerve from the petrous ICA to the point the nerve exits the vidian canal (vidian canal length) was 17.90 +/- 1.59 mm (range 16-20 mm).ConclusionsThe distances between the vidian canal and surrounding neurovascular structures would help the skull base surgeon in this narrow and complex area

Blood Supply of the Inferior Turbinate and Its Clinical Applications

WOS: 000282665600004PubMed ID: 20607822One of the most effective treatments of inferior turbinate (IT) hypertrophy is surgical reduction. Bleeding from the IT branch of the posterior lateral nasal artery (ITB) may interfere with the outcome of IT surgery. The aim of this study is to define the anatomic localization of the ITB and its variations and to investigate its clinical importance. Anatomic relations of the ITB were determined by microdissecting 20 adult, sagittally cross-sectioned head specimens. Branching characteristics of the ITB and its anatomical relations were evaluated. The most consistent two markers to define the ITB on the lateral nasal wall were the posterior attachment of the IT (PAIT) and the posterior attachment of the middle turbinate (PAMT). Mean horizontal distances of the ITB from the PAIT and the PAMT were 7.2 mm +/- 2.8 mm (2.5-11.8 mm) and 8.2 mm +/- 2.8 mm (4-14.6 mm), respectively. ITB was the only major artery that supplied the IT in 85% of the specimens, and, in 15%, there was more than one artery. ITB was located lateral to the IT in 95% and medial to the IT in 5%. The ITB coursed on the lateral nasal wall, vertically between the middle and ITs and always anterior to the PAIT. All the variations of blood supply to the IT were within a one square centimeter area, similar to 1-cm anterior to the PAIT. Successful cauterization of this particular area may be an alternative cauterization site in IT surgery. Clin. Anat. 23:770-776, 2010. (C) 2010 Wiley-Liss, Inc.Division of Anatomy at Ege University Medical SchoolEge UniversityOur sincere appreciation to Mehmet Arca for providing us the illustrations for Figures 6 and 7 in the preperation of this article. The authors thank the Division of Anatomy at Ege University Medical School for their support of this study

Acute invasive fungal rhinosinusitis: Survival analysis and the prognostic indicators

WOS: 000368340500002PubMed ID: 26637563Background: Acute invasive fungal rhinosinusitis (AIFR) is a highly mortal, progressive fungal infection of the paranasal sinuses and surrounding structures that is almost always seen in patients who are immunocompromised. Despite the use of newer antifungal treatments and early diagnosis, the prognosis of AIFR does not improve significantly. Due to the higher incidence of patients who are immunocompromised and have more complex disease, AIFR is a growing medical issue in tertiary medical centers. Objective: The aim of this study was to present the outcomes and analyze the prognostic indicators of patients with AIFR who underwent surgery. Methods: Between October 2009 and November 2014, 37 patients who underwent surgery for AIFR at a tertiary care university hospital were included in the study. Overall survival and disease-specific mortality and survival rates were calculated to estimate survival function. The impact of age, sex, underlying disease, extent of AIFR, applied medical treatment, and causative species (mucormycosis, aspergillosis) were also taken into consideration. Also, the effect of a variety of laboratory parameters, such as hemoglobin, leukocyte, neutrophil, lymphocyte, platelet, and C-reactive protein (CRP) levels, to survival were evaluated. Results: The median follow-up time was 58 days (interquartile range = 304). Overall and disease-specific mortality rates were 64.9 and 51.4%, respectively. Fever was the most common symptom (86.5%), along with nasal obstruction and/or fullness (48.6%) and epistaxis (48.6%). Age and sex did not have a significant impact on survival (p > 0.05). Palate involvement was significantly associated with mortality (p < 0.05). According to the results of Cox, regression analysis for disease-specific mortality rate, leukocyte and neutrophil counts as well as CRP levels had a significant effect on survival function (p < 0.05). Conclusions: Palatal involvement was associated with a higher mortality in our study. Also, leukocyte counts, neutrophile counts, and CRP values had a significant impact on survival function. The reversal of the underlying disease and immunosuppression is as important as the medical and surgical treatment

The Joint Tip Graft: A Joint Support for Rim, Facet and Infratip Lobule in Rhinoplasty

WOS: 000468131400027PubMed ID: 30783724Background The authors of this study have developed a novel graft called the 'The Joint Tip Graft' which adds support to the lateral crus, camouflages the tip grafts, supports the facet and adds volume to the nasal tip as a single graft. The aim of this study was to define and introduce the tripod graft. Methods Thirty patients who underwent primary rhinoplasty at a tertiary academic center were included. Patients were randomly assigned into two groups according to the grafts used: group 1: Joint tip graft was additionally used, and group 2: Joint tip graft was not used. All patients were photographed by a photographer who is familiar with medical photography. Preoperative and postoperative sixth month photographs were taken for analysis. The brightest point of the infratip lobule and the darkest point of the facets were selected and analyzed with computer software. The luminance ratio of facet to infratip lobule was calculated to overcome light and head position differences. Results Mean infratip luminance scores were 112.2 +/- 05.72 and 109.73 +/- 7.13 in groups 1 and 2, respectively (p > 0.05). Mean facet luminance scores were 101.33 +/- 4.91 and 89.27 +/- 5.11 in groups 1 and 2, respectively (p < 0.05). Facet/infratip luminance ratios were calculated for each group. Mean facet/infratip luminance ratios were 0.90 +/- 0.01 and 0.82 +/- 0.16 for groups 1 and 2, respectively (p < 0.05). Conclusions The joint tip graft is a novel graft that is easy to harvest and apply. It spans both of the alar cartilages, supports the facet area and creates a smooth gradual light shadow transition. Additionally, it acts as a camouflage over the tip grafts

PI3K/AKT/mTOR pathway and autophagy regulator genes in paranasal squamous cell carcinoma metastasis

Avci, Cigir Biray/0000-0001-8251-4520WOS: 000528158000002PubMed: 32319010Although there are many studies on the role of PI3K/AKT/mTOR pathway and autophagy genes in the mechanism of head and neck cancer formation and prognostic significance, there is no study investigating the role of the genes in paranasal sinus carcinomas. the aim of the study was to assess the role of the PI3K/AKT/mTOR pathway and autophagy related gene expression changes in squamous cell carcinoma of paranasal sinuses with and without neck metastasis. Eight paranasal squamous cell carcinoma patients (five without and three with neck metastasis) were included. Tissues were obtained during the surgery. Total RNA was isolated from the tissues and cDNA synthesis was performed. Expression levels of the genes were determined using qRT-PCR method. the results were evaluated using the 2(- increment increment Ct) method, and fold changes of the gene expression levels in primary tumor and neck metastasis tissues were calculated according to the normal tissue. Expression levels of both PI3K/AKT/mTOR pathway and positive regulators of autophagy were significantly increased in metastasis-related two groups, especially in neck metastasis tissues. the increase in PI3K/AKT/mTOR pathway and autophagy related gene expression levels may support the metastatic character in paranasal squamous cell carcinomas. This is the first study to assess autophagy related genes in paranasal sinus cancer at transcriptome-level. Support of the transcriptome-level findings by the further protein analyses will contribute to the illumination of the rare paranasal sinus cancer molecular biology

Anatomic variations of sphenopalatine artery and minimally invasive surgical cauterization procedure

WOS: 000207944400009PubMed ID: 19775506Background: Sphenopalatine artery (SPA) ligation or cauterization stands to be one of the most common management options of refractory epistaxis. Ramification pattern of SPA as it passes through sphenopalatine foramen (SPF) has not been clearly established. The aim of this study is to investigate situations in which middle meatal approach may fail due to anatomic variations of SPA and to define a minimally invasive surgical cauterization procedure. Anatomic variations of SPA were determined by microdissection of 20 adult sagittally cross-sectioned head specimens. Methods: Branching characteristics of SPA and its anatomic relations were evaluated and anatomic variations were noted. Results: SPA was generally (80%) forming branches within SPF before entering into the nasal cavity. In 20% of the specimens, SPF was located superior to the horizontal lamella of the middle turbinate, and accessory foramen was present in 10%. In 10% of the cases, the posterior lateral nasal branch was situated as two branches in a deep sulcus in the middle meatus. Conclusion: The ramification pattern of SPA can not be fully exposed without resection of the posterior part of the middle turbinate via the middle meatal approach. Two-step procedures are advocated in reducing failure rates. Previously defined two-step procedures are relatively invasive. A less invasive procedure is defined based on the variations of SPA and SPF. (Am J Rhinol Allergy 23, e38-e41, 2009; doi: 10.2500/ajra.2009.23.3403