Giant Hypopharyngeal Fibrovascular Polyp: A Case Report and Review of the Relevant Literature

Fibrovascular polyps occur most commonly in the cervical esophagus and are extremely rare in the hypopharynx. In this paper, we report a case of fibrovascular polyp of a 52-year-old female, who presented with progressive dysphagia and weight loss and regurgitating a mass from her mouth. By the endoscopic examination, a polyp covered by normal mucosa with a wide stalk was detected at the hypopharynx. The pedicle of the mass was identified under general anesthesia and the 13 × 3 × 2 cm mass was completely resected perorally. Histopathological examination of the tumor showed oedematous subepithelial fibrous stroma, surrounded by squamous epithelium and containing many congested vascular structures. No recurrence was detected over one year of follow-up. This case highlights the need for clinicians to be aware of this rare entity and to develop the best approach to patient management

Relief of Pain at Rest and During Swallowing After Modified Cautery-Assisted Uvulopalatopharyngoplasty: Bupivacaine Versus Lidocaine

Kuran, Gokhan/0000-0002-0709-1887WOS: 000355236700010PubMed: 25933151Objectives: We investigated the efficacy of bupivacaine, lidocaine, and saline infiltrations to peritonsillar region and uvula and soft palate regions for pain relief after tonsillectomy and modified cautery-assisted uvulopalatopharyngoplasty (MCAUP) in patients with obstructive sleep apnea. Methods: In this prospective study, 91 patients (32-65 years old) with obstructive sleep apnea underwent tonsillectomy and MCAUP and were divided into 3 groups. In group 1 patients (n = 31), 0.25% bupivacaine HCl + 1/200,000 epinephrine (10 mL); in group 2 patients (n = 31), 1% lidocaine HCl+1/200,000 epinephrine (10 mL); and in group 3 patients (n = 29), 0.9% saline (10 mL) were injected to peritonsillar region and uvula and soft palate regions. Operation duration, amount of bleeding, and analgesic requirement and visual analog scale for pain at rest and at swallowing were evaluated in all groups. Results: Mean body mass index values were between 27.0 and 27.3 kg/m(2) in all groups. Their apnea-hypopnea index values were between 15.3 and 16.9 per hour, and there were no significant differences between their body mass index and apnea-hypopnea index values. Duration of operation of patients in the bupivacaine group was significantly lower than that of patients in the lidocaine and saline groups. In addition, in the lidocaine group, operation duration was significantly lower than that in the saline group. Bleeding amount and postoperative analgesic requirement of the saline group were significantly higher than those of the bupivacaine and lidocaine groups. Although both these measures (operation duration and amount of bleeding) were statistically significant, a mean operating time of 44.3 versus 46.0 minutes and 64.4-mL versus 68.4-mL blood loss for the bupivacaine and lidocaine groups were clinically irrelevant and not too important. In terms of visual analog scale for pain at rest and/or swallowing, Bupivacaine provided more relief than lidocaine and saline injections. The lidocaine provides pain relief less than bupivacaine and more than saline at rest and/or swallowing. Conclusion: We recommend the use of bupivacaine injections in peritonsillar, uvular, and soft palate regions during tonsillectomy + MCAUP operations. It reduces operation duration and provides more pain relief postoperatively. When patients had cardiac problems, lidocaine may also be recommended because of its cardiac depressant and antiarrhythmic effects and positive effects for pain relief compared with saline injections

Is there a Relationship Between Keros Classification of Olfactory Fossae Depth, Septal Deviation Angle and the Distance Between Infraorbital Foramens?

INAL, MIKAIL/0000-0003-0642-7913WOS: 000443684600014Objectives: We retrospectively investigated the relationship between olfactory fossae depth, septal deviation angle, paranasal sinuses and the distance between infraorbital foramens (IOFs). Methods: Computerized Tomography (CT) images of 315 adult subjects were used. Paranasal sinus dimensions; Keros classification of olfactory fossae, length of Crista Galli (CG), the distance between IOFs (ZP), The distance between inferior part of crista galli and basal-inferior part of the nasal septum at the midline (CG-Sbasal) (XY), ZP/XY ratio, septal deviation side and angle were measured. Results: Keros type I was detected in males (50.3%) and Keros type II was detected in females (59.5%) mainly. In females, Keros type was highly related to the males. Both right-deviated and left deviated subjects, Keros type II (49.7% and 54.3% respectively) was the most detected Keros-type for olfactory fossae. Higher ethmoid sinus-height, maxillary sinus-width; and lower maxillary sinus-height values were related to higher Keros types. As IOFs (ZP) distance increased, Keros type also increased. Conclusion: When Endoscopic Sinus Surgery (ESS) is performed in patients having nasal septal deviation, surgeons should be careful for Keros type II olfactory fossae to avoid intracranial penetration. If possible, navigation systems should be used in these patients

Different anesthetic agents-soaked sinus packings on pain management after functional endoscopic sinus surgery: which is the most effective?

Kuran, Gokhan/0000-0002-0709-1887WOS: 000377413500017PubMed: 26511988In the present study, we investigated the efficacy of local anesthetics soaked non-absorbable sinus packs on pain management after functional endoscopic surgery (FESS). One hundred and fifty patients with the diagnosis of bilateral chronic sinusitis with or without nasal polyps who underwent FESS were included into the study. Their pre-operative Lund-Mackay computerized tomography (CT) Scores were similar. We applied anesthetic agents of 2 % lidocaine HCl, 0.25 % Bupivacaine HCl, 0.2 % Ropivacaine, 2 % Prilocaine and 0.9 % NaCl (Saline) in groups 1-5 onto the sinus packs after FESS. At postoperative period, acetaminophen (250 mg/5 ml) was used in 10-15 mg/kg per dose (4 times a day). Bleeding grade, operation duration, postoperative number of gauze/24 h, additional painkiller need, pain values at 1, 2, 4, 8, 12 and 24 h were noted. Lund-Kennedy endoscopic scores were also evaluated at 1st, 2nd and 4th weeks postoperatively. In saline group, 93.3 % of the patients needed additional painkiller. Whereas, in Bupivacaine group, additional painkiller use (20.0 %) is less than the other groups. In Bupivacaine group, number of gauze/24 h use was lower than lidocaine, ropivacaine and prilocaine groups. In our study, except 1st and 24th hours, pain values of groups can be written in ascending order (from less to higher) as Bupivacaine, Lidocaine, Prilocaine, Ropivacaine and Saline. In the first hour, pain values of groups can be written in ascending order (from less to higher) as Lidocaine, Prilocaine, Bupivacaine, Ropivacaine and Saline. In the 2nd week, in the Bupivacaine and Lidocaine Groups separately, postoperative Lund-Kennedy scores were lower than the Prilocaine and Saline Groups. In the 1st month, Lidocaine Group's Lund-Kennedy scores were significantly lower than the Saline Group. Synechia values were not different between groups. Bupivacaine help the lower pain values and less additional painkiller need after FESS. Therefore, we recommend to use Bupivacaine soaked sinus packs after FESS for achieve less pain values and to improve patient satisfaction

Is There a Relationship Between Optic Canal, Foramen Rotundum, and Vidian Canal?

INAL, MIKAIL/0000-0003-0642-7913; celebi, umut orkun/0000-0003-2539-2525WOS: 000357569600141PubMed: 26080202Objectives: In this retrospective study, we investigated the relationship between paranasal sinus, optic canal, foramen rotundum, and vidian canal measurements. Methods: Computed tomographic (CT) images of 320 adult subjects and 640 sides (right and left) were used. Paranasal sinus dimensions, optic canal (OC), foramen rotundum (FR), vidian canal (VC), bilateral FR (FRFR), bilateral vidian canal (VCVC), VC-foramen rotundum (VCFR), and VC-optic canal (VCOC) distances were measured. Results: Right VCFR (6.06 mm), and right and left VCOC values (20.34 and 20.31 mm) of the males were significantly higher than those of the females (5.50, 18.91, and 18.80 mm, respectively). Foramen rotundum, OC, and VC values were positively correlated with each other. There was also positive correlation between FR width and maxillary sinus height. Increase of OC width was related to increase in FR width and area, VCVC distance; and decrease in maxillary sinus width. There was positive correlation between FRFR, VCVC, VCFR, and VCOC distance values. There was negative correlation between VC width and area; VCVC, VCFR, and VCOC distance; and maxillary sinus, ethmoid sinus, and sphenoid sinus measurement values. As these sinuses pneumatized more, VC width and area values decreased. Conclusion: As a conclusion, the paranasal sinus, OC, VC, and FR values showed relationship with each other. Before performing craniofacial and/or skull base surgeries, CT view should be taken to evaluate the localization and the course and dimensions of the OC and vidian nerve. It should be kept in mind that in the presence of more pneumatized paranasal sinuses in CT views, VC dimensions decreased

A Rare Cause Of Unilateral Chronic Nasal Obstruction: Fibrous Dysplasia of The Middle Turbinate

Fibrous dysplasia is a nonneoplastic fibro-osseous lesion characterized by fibroblastic proliferation and progressive replacement of normal bone with fibrotic tissue and disorganised bony trabeculae.Fibrous dysplasia infrequently occurs in the sinonasal tract. Location in the middle turbinate is extremely rare. It is usually asymptomatic but, in the advanced stage, nasal obstruction due to extension of disease and pain due to neural compression, or pathological fractures may occur. It is usually secondary to extension of disease from adjacent bones. In this case report we presented a 54 year old woman with unilateral chronic nasal obstruction [Cukurova Med J 2015; 40(Suppl 1): 106-111

Prospective Randomized Trial to Determine Whether Inhalational Anesthetics Have Any Effects on Hearing Function

WOS: 000273634500012PubMed: 19755091Objective: The purpose of this study was to investigate and compare the effects of inhalation anesthetics (sevoflurane and isoflurane) on hearing function by using an audiometric test battery. Design: A prospective, randomized, double-blind, clinical trial. Setting: University hospital. Patients: Fifty-three adult patients (American Society of Anesthesiologists I-II) scheduled for sinonasal surgery with intratracheal general anesthesia were enrolled in the study. The patients were premedicated with diazepam intramuscularly. Propofol 2 mg/kg (Diprivan, AstraZeneca, Wilmington, DE) was given intravenously (IV) for induction of general anesthesia. After endotracheal intubation with vecuronium IV (1 mg/kg), in group 1 (n = 27) sevoflurane 2% and in group 2 (n = 26) isoflurane 1.2% were used to maintain general anesthesia. All patients received nitrous oxide during maintenance. Main Outcome Measures: The patients' hearing function was measured before anesthesia and 24 hours after surgery by means of pure-tone audiometry, high-frequency pure-tone audiometry, and transient evoked otoacoustic emissions (TEOAEs) by the same clinician. Results: There were no statistically significant differences between the demographic data and the hemodynamic and respiratory parameters of the groups. No significant differences were found between groups in hearing thresholds of conventional pure-tone audiometry and extended high frequency (p > .05). For TEOAE responses, no statistically significant differences were determined between pre- and postoperative measurements (p > .05). Conclusion: It was audiometrically demonstrated that general anesthesia did not affect the hearing function in any of the patients undergoing sinonasal surgery. These findings encourage the use of sevoflurane or isoflurane as a safe agent without any ototoxic effects in otorhinolaryngologic surgery with general anesthesia

Preincisional infiltration of tonsils with ropivacaine in post-tonsillectomy pain relief: double-blind, randomized, placebo-controlled intraindividual study

WOS: 000238166800003PubMed: 16929992Objective: To determine whether pre-emptive ropivacaine has an influence on postoperative pain in adult patients undergoing tonsillectomy. Design: A prospective, randomized, double-blind, placebo-controlled clinical trial. Setting: University hospital. Patients: The study included 20 adult patients undergoing elective tonsillectomy. Anesthetic induction and maintenance, dissection tonsillectomy, hemostasis techniques, and postoperative analgesic treatment were standardized for all patients. Before the onset of incision, one tonsillar fossa was administered 5 mL of 2% ropivacaine hydrochloride with epinephrine, whereas the other side received 5 mL of 0.9% saline with epinephrine and was designated as the control side. Main Outcomes Measures: For each side, postoperative pain, otalgia, operating time, amount of intraoperative blood loss, and postoperative hemorrhage were assessed. The intensity of postoperative pain was measured at rest and when the patient was drinking and was scored on a visual analogue scale. The patients were followed up for 10 days after surgery. Results: There was no statistically significant difference in the amount of intraoperative hemorrhage and operation time between sides (p >.05). The constant postoperative pain in the ropivacaine side at rest was significantly less than in the placebo side on days 1, 2, 5, and 6 (p <.05). The post-tonsillectomy pain experienced in the ropivacaine side when swallowing was significantly less than that in the placebo side throughout the study period except on day 10 (p <.05). Conclusion: Based on the present findings, preincisional infiltration of ropivacaine 2% appears to be effective against both early and late postoperative pain, especially on swallowing, following tonsillectomy in adults

Comparison of anterior palatoplasty and uvulopalatal flap placement for treating mild and moderate obstructive sleep apnea

WOS: 000428092600008PubMed: 29554400We prospectively compared the efficacy of anterior palatoplasty and the uvulopalatal flap procedure for the treatment of patients with mild and moderate obstructive sleep apnea syndrome (OSAS). Our study group was made up of 45 patients who had been randomly assigned to undergo one of the two procedures. Palatoplasty was performed on 22 patients-12 men and 10 women, aged 28 to 49 years (mean: 39.2)-and the flap procedure was performed on 23 patients-14 men and 9 women, aged 28 to 56 years (mean: 41.3). Our primary outcomes measure was the difference in pre- and postoperative apnea-hypopnea index (AHI) as determined by polysomnography at 6 months after surgery. Surgical success was observed in 18 of the 22 palatoplasty patients (81.8%) and in 19 of the 23 flap patients (82.6%). Compared with the preoperative values, mean AHIs declined from 17.5 to 8.1 in the former group and from 18.5 to 8.6 in the latter; the improvement in both groups was statistically significant (p < 0.001). In addition, significant postoperative improvements in both groups were seen in mean visual analog scale (VAS) scores for snoring, in Pittsburgh Sleep Quality Index values, and in Epworth Sleepiness Scale scores (p < 0.001 for all). VAS scores for pain at rest were significantly lower in the palatoplasty group than in the flap group at 2, 4, and 8 hours post-operatively and on postoperative days 4 through 7 (p < 0.002). Likewise, VAS scores for pain during swallowing were significantly lower in the palatoplasty group at 2, 4, 8, and 16 hours and on days 4 through 7 (p < 0.009). We conclude that both anterior palatoplasty and uvulopalatal flap procedures are effective for the treatment of mild and moderate OSAS in patients with retropalatal obstruction. However, our comparison of postoperative pain scores revealed that anterior palatoplasty was associated with significantly less morbidity

Effects of septoplasty on olfactory function evaluated by the Brief Smell Identification Test: A study of 116 patients

Kuran, Gokhan/0000-0002-0709-1887WOS: 000414822300011PubMed: 29121376We conducted a prospective study of 116 patients-61 men and 55 women, aged 17 to 64 years (mean: 26.4)- to investigate the effects of septoplasty on olfactory function in patients with septal deviation (SD). The Mladina classification system was used to define SD types, and olfactory function was assessed with the Brief Smell Identification test (BSIT). The BSIT, which includes 12 odorants, was administered preoperatively and at postoperative months I and 3. The most common SD types were types 2 (20.7% of patients) and 1 (19.0%), followed by types 3 and 5 (both 16.4%). At postoperative month 1, the mean BSIT score was significantly higher in men than in the women. For patients with types 1 and 2 SD, BSIT scores at 1 month were significantly lower than the scores preoperatively and 3 months postoperatively. For types 3 and 4, BSIT values were significantly higher at 3 months than preoperatively or at 1 month. For type 3 SD, the preoperative mean score was significantly lower than those for types 1, 4, 5, 6, and 7; for type 2 SD, the BSIT score was significantly lower than those of types 5 and 6 only. At 1 month, the scores for types 2 and 3 were significantly lower than those for types 4, 5, 6, and 7. At 3 months, the BSIT score for type 2 was significantly lower than those of types I, 3, 4, 5, and 6; the type 3 SD score at 3 months was significantly higher than those for types I, 2, 5, 6, and 7. We conclude that septoplasty surgery for patients with a type 3 SD may improve olfactory function. In contrast, we found that olfactory function in patients with a type 2 SD did not improve to a satisfactory degree, even when good nasal patency was achieved with a corrected septum and an enlarged intranasal volume. Our findings should be investigated further in future studies