The aim of this study was to report the post-surgical and oncologic outcomes of patients who unde... more The aim of this study was to report the post-surgical and oncologic outcomes of patients who underwent supracricoid partial laryngectomy (SCPL). 90 patients who underwent SCPL between 1994 and 2014 were reviewed. 45 patients underwent cricohyoidopexy (CHP) and 45 patients cricohyoidoepiglottopexy (CHEP). Median nasogastric (NG) tube removal time, decannulation time, overall survival, disease-free survival and local control rates were calculated. The effect of the type of surgery on functional and oncologic outcomes were assessed. Median NG tube removal time was 16.5 days (IQR = 10) and 14 days (IQR = 9) in CHP and CHEP patients, respectively (p > 0.05). Median decannulation time was 30 days (IQR = 26) and 19 days (IQR = 15) in CHP and CHEP patients, respectively (p < 0.05). Resection of one arytenoid significantly increased NG tube removal time. Median follow-up time was 55 months. There were 15 oncologic failures and the median time interval for tumor recurrence was 9 months. Five-year overall survival rate was 80.4%. The 3- and 5-year disease-free specific survival rates were 81.7 and 76.7%, respectively. Given the more extensive surgery applied for CHP, functional outcomes were better in patients with CHEP. Resection of an arytenoid had a negative outcome on swallowing.
The aim of this study was to investigate the predictive value of preoperative neutrophil, platele... more The aim of this study was to investigate the predictive value of preoperative neutrophil, platelet and lymphocyte counts in local recurrence and survival in the patients operated for early-stage squamous cell carcinoma (SCC) of the tongue. 57 patients who underwent surgery for early-stage (stage 1-2) SCC of the tongue were enrolled in the study. Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and neutrophil × PLR value (N × PLR) were used as outcome measures. Local recurrence was detected in 11 (19.3 %) patients during follow-up period. Mortality was seen in 7 (12.3 %) patients. 37 (64.9 %) patients had stage 1 and 20 (35.1 %) patients had stage 2 tumor. NLR, PLR and N × PLR cutoff values were determined as 2.26, 146,855 and 689,912, respectively, by receiver operating characteristic analysis. The relationship between NLR, PLR, N × PLR and local recurrence was statistically significant according to these cutoff values (p values 0.021, 0.020, 0.017, respectively). We suggest that NLR, PLR and N × PLR may be used to predict local recurrence, while their use in overall and disease-free survival is limited. Further studies involving large patient groups are required.
Mandibulectomy and mandibulotomy procedures are performed with the oscillating saw and the acoust... more Mandibulectomy and mandibulotomy procedures are performed with the oscillating saw and the acoustic energy generated during the osteotomies is transferred to the cochlea via temporomandibular joint and air conduction. The aim of this study was to assess the effect of mandibulectomy and mandibulotomy on cochlear function. This study was carried out on 15 patients who underwent at an otolaryngology department of a tertiary medical center between January 2013 and August 2015. The study was designed as a prospective study. All of the data were prospectively collected. These included demographic data, date of the surgery, type of surgery, preoperative pure-tone audiometry, preoperative and postoperative distortion product otoacoustic emission (DPOAE) measurements. Of the DPOAE measurements, there was a statistically significant difference between the signal-to-noise ratio measurement on the right ear measurement at 4 kHz (P <0.05). Additionally, there was a statistically significant correlation between the signal-to-noise ratio measurements and the side of the osteotomy (P <0.05). In conclusion, it is found that mandibulectomy and mandibulotomy procedure has a negative effect on cochlear function in the early period. The DPOAEs were diminished on the osteotomy site in day one postoperatively. Results with a longer follow-up time can yield more information on the prognosis of the cochlear damage.
The exposure of the round window (RW) through the facial recess (FR) is sometimes partial. The an... more The exposure of the round window (RW) through the facial recess (FR) is sometimes partial. The anatomic variations that alter RW exposure during cochleostomy have not been clearly defined to date. The aim of this study was to assess the best FR position in which to achieve the widest exposure of the RW niche and to define the topographic relationship between two other important anatomical structures, the facial nerve (FN) and the chorda tympani (CT). Cadaver study. Twenty-four temporal bones were included in the study. Anterior and posterior epitympanectomy and posterior tympanotomy were performed after mastoidectomy. Bone was removed until the FN and CT were skeletonized and the CT branching point was visible. Two pictures were taken. The first was taken when the facial recess was at its widest exposure, while the second was taken when the RW niche was maximally exposed through the facial recess. Various measurements were taken. The RW niche was totally visible in 19 temporal bones (79.2%). The RW was partially visible in the remaining five bones (20.8%). The unexposed part of the RW lay posteromedial to the FN in these five bones. While the branching point of the CT could be visualized in all cases at the widest exposure of RW, the part of the FN distal to the branching point was hidden in eight subjects (33.3%) under the posterior wall of the external ear canal. The RW niche was totally visible in most of the temporal bones. The RW lay posteromedial to the FN in some cases and total exposure was impossible.
Clinical and Experimental Otorhinolaryngology, 2016
Bilateral vocal fold abductor paralysis (BVFAP) both deteriorates quality of life and may cause l... more Bilateral vocal fold abductor paralysis (BVFAP) both deteriorates quality of life and may cause life-threatening respiratory problems. The aim of this study was to reduce respiratory symptoms in BVFAP patients using cricothyroid (CT) botulinum toxin (BTX) injection. Before and 2 weeks and 4 months after bilateral BTX injection into the CT muscles under electromyography; alterations in respiratory, acoustic, aerodynamic and quality of life parameters were evaluated in BVFAP patients with respiratory distress. For the respiratory evaluation modified Borg scale and spirometry, for the voice and aerodynamic evaluations Voice Handicap Index-30 (VHI-30), GRBAS, acoustic analysis (sound pressure level, F0, jitter%, shimmer%, noise-to-harmonic ratio) and maximum phonation time and for the quality of life assessment Short Form-36 (SF-36) form were used. All patients were female with a mean age of 47±8.1 years. There was a mean time of 11.8±5.5 (minimum 2, maximum 23) months between BVFAP development and BTX injection. In all cases, other than one case with unknown aetiology, the cause of vocal fold paralysis was prior thyroid surgery. In total 18.6±3.1 units of BTX were applied to the CTs. In the preinjection period, and the 2nd week and 4th month after injection, the Borg dyspnea scale was 7.3/5.3/5.0, FIV1 (forced inspiratory volume in one second) was 1.7/1.7/1.8 L, peak expiratory flow (PEF) was 1.4/1.7/2.1 L/sec, maximum phonation time was 7.0/6.4/6.2 seconds and VHI-30 was 63.2/52.2/61.7 respectively. There was no significant alteration in acoustic analysis parameters. Many of the patients reported transient dysphagia within the first week. There were insignificant increases in SF-36 sub-scale values. After BTX injection, improvements in the mean Borg score, PEF and FIV1 values and SF-36 sub-scale scores showed the restricted success of this approach. This modality may be kept in mind as a transient treatment option for patients refused persistent tracheotomy or ablative airway surgeries.
The aim of this study was to report the post-surgical and oncologic outcomes of patients who unde... more The aim of this study was to report the post-surgical and oncologic outcomes of patients who underwent supracricoid partial laryngectomy (SCPL). 90 patients who underwent SCPL between 1994 and 2014 were reviewed. 45 patients underwent cricohyoidopexy (CHP) and 45 patients cricohyoidoepiglottopexy (CHEP). Median nasogastric (NG) tube removal time, decannulation time, overall survival, disease-free survival and local control rates were calculated. The effect of the type of surgery on functional and oncologic outcomes were assessed. Median NG tube removal time was 16.5 days (IQR = 10) and 14 days (IQR = 9) in CHP and CHEP patients, respectively (p > 0.05). Median decannulation time was 30 days (IQR = 26) and 19 days (IQR = 15) in CHP and CHEP patients, respectively (p < 0.05). Resection of one arytenoid significantly increased NG tube removal time. Median follow-up time was 55 months. There were 15 oncologic failures and the median time interval for tumor recurrence was 9 months. Five-year overall survival rate was 80.4%. The 3- and 5-year disease-free specific survival rates were 81.7 and 76.7%, respectively. Given the more extensive surgery applied for CHP, functional outcomes were better in patients with CHEP. Resection of an arytenoid had a negative outcome on swallowing.
The use of LigaSure™ vessel sealing system in head and neck surgery was reported to be reliable a... more The use of LigaSure™ vessel sealing system in head and neck surgery was reported to be reliable and safe, providing sufficient hemostasis and reducing operating time. The aim of this study was to evaluate efficacy of this technique in patients undergoing selective neck dissections. This study was carried out as a prospective controlled study at an otolaryngology department of a tertiary medical center between July 2013 and July 2015. Twenty-five patients older than 18 years who underwent unilateral selective neck dissection for head and neck cancer were included in the study. In the control group (group 2, 10 patients) only monopolar and bipolar diathermy was used; in the Ligasure group (group 1, 15 patients) Ligasure was used for hemostasis and dissection in addition to the conventional techniques. Cervical lymphadenectomy time, operation time, preoperative hemoglobin levels, preoperative hematocrit levels, postoperative hemoglobin levels, postoperative hematocrit levels, total neck drainage and drain removal time were analyzed and compared between the groups. Median operation time in group 1 and 2 were 95 min (IQR = 35) and 142.5 min (IQR = 63), respectively. Median cervical lymphadenectomy time in group 1 and 2 were 55 min (IQR = 23) and 102.5 min (IQR = 49), respectively. Median operation time and cervical operation time were significantly lower in group 1 (p < 0.05). In conclusion, LigaSure™ vessel sealing system is a safe, efficacious technique and significantly lowers cervical lymphadenectomy and operation time in selective neck dissections compared to controls. Given the superb hemostatic properties, this technique should be in the surgeon's armamentarium when possible.
Acute invasive fungal rhinosinusitis (AIFR) is a highly mortal, progressive fungal infection of t... more 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. The aim of this study was to present the outcomes and analyze the prognostic indicators of patients with AIFR who underwent surgery. 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. 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). 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.
Primary thyroid-like papillary adenocarcinomas are extremely rare neoplasms that generally origin... more Primary thyroid-like papillary adenocarcinomas are extremely rare neoplasms that generally originate in the nasopharynx. We report the case of a 24-year-old woman who was diagnosed with a thyroid-like papillary adenocarcinoma that originated in the nasal septum. The tumor was surgically removed, and the patient showed no evidence of local recurrence during 4 years of follow-up.
Kulak burun boğaz ihtisas dergisi : KBB = Journal of ear, nose, and throat, 2015
This study aims to assess the value of facial nerve monitorization and minimum facial nerve stimu... more This study aims to assess the value of facial nerve monitorization and minimum facial nerve stimulation thresholds during superficial parotidectomy in the prediction of postoperative facial nerve function. Twenty superficial parotidectomy patients (9 males, 11 females; mean age 52 years; range 23 to 80 years), who treated in our clinic between January 2013 and May 2013 were recruited in this study. Intraoperative facial nerve monitorization was applied and minimum facial nerve stimulation thresholds were recorded in the main trunk at the end of the operation. Postoperative facial nerve functions were evaluated by House Brackmann (HB) grading system. In early postoperative evaluation, minimum stimulation thresholds of 12 patients with facial nerve function HB grade 1 (normal) and of eight patients with HB grade 2 facial paresis in marginal mandibular branch were 0.20±0.14 mA and 0.22±0.05 mA respectively (p>0.05). At the end of the first day, minimum stimulation thresholds in 17 H...
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2015
There are diseases that affect the stroma of the inferior turbinate and many surgical interventio... more There are diseases that affect the stroma of the inferior turbinate and many surgical interventions that alter it. However, an objective method that can evaluate the turbinate's stromal structure in detail has not been defined yet. The primary aim of this study was to investigate the effectiveness and reliability of ultrasound elastography for objective evaluation of the inferior turbinate stroma and define the most suitable elastographic technique. Twenty inferior turbinates in 10 healthy participants were included. Five of the participants (50%) were male, and 5 (50%) were female, with a mean age ± SD of 28.3 ± 3.2 years (range, 26-35) years. To obtain reliable and reproducible results, elastography was performed twice, 3 days apart, with and without a topical decongestant to evaluate the effects of the nasal cycle and mucosal edema. Two previously described valid elastographic outcome measures were reevaluated for the inferior turbinate. The tissue strain ratio and sound wave...
European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, Jan 11, 2015
The aim of this study is to assess the effect of partial superficial parotidectomy and facial ner... more The aim of this study is to assess the effect of partial superficial parotidectomy and facial nerve dissection to electrophysiologic parameters of intraoperative facial nerve monitoring such as nerve stimulation threshold, stimulus amplitude and latency. Twenty-five patients who underwent partial superficial parotidectomy for benign parotid gland mass were included in the study. After the identification of the facial nerve main trunk, minimum stimulation threshold, latencies and amplitudes of the orbicularis oculi (electrode 1) and orbicularis oris (electrode 2) electrodes at 0.50 milliamperes (mA) were recorded. All of the recordings were repeated after the completion of parotidectomy. Median nerve dissection duration was calculated and size of the tumors was measured during macroscopic pathology. The median minimum nerve stimulation threshold was 0.15 mA [interquartile range (IQR) = 0.05] before and 0.15 mA (IQR = 0.08) after the parotidectomy (p = 0.02). Median nerve dissection d...
Primary thyroid-like papillary adenocarcinomas are extremely rare neoplasms that generally origin... more Primary thyroid-like papillary adenocarcinomas are extremely rare neoplasms that generally originate in the nasopharynx. We report the case of a 24-year-old woman who was diagnosed with a thyroid-like papillary adenocarcinoma that originated in the nasal septum. The tumor was surgically removed, and the patient showed no evidence of local recurrence during 4 years of follow-up.
Ultrasound (US) elastography has been widely used for thyroid, liver, and lymph nodes as a resear... more Ultrasound (US) elastography has been widely used for thyroid, liver, and lymph nodes as a research tool in the current medical practice. It has been described in the inferior turbinates and validated as a reliable, reproducible, noninvasive, and objective method that can detect the fibrosis-related tissue strain. There is no previous study that investigated the amount of fibrosis induced by radiofrequency and bipolar electrocautery in the inferior turbinates in a noninvasive and objective manner. The aim of this study was to assess the amount of inferior turbinate soft tissue fibrosis that was induced by radiofrequency ablation (RFA) and submucosal bipolar diathermy (SBD) by US elastography. Thirty-eight inferior turbinates of 19 patients were included. RFA was applied to 18 inferior turbinates (group 1) and SBD was applied to 20 inferior turbinates (group 2). US elastography and visual analog scale (VAS) assessments were performed on all patients preoperatively and 6 months postoperatively. Preoperative mean US elastography scores in groups 1 and 2 were 2.55 ± 0.78 m/s and 2.56 ± 0.49 m/s, respectively (p < 0.05). Postoperative mean US elastography scores in groups 1 and 2 were 2.91 ± 1.03 m/s and 3.41 ± 0.86 m/s, respectively (p < 0.05). Preoperative mean VAS scores in groups 1 and 2 were 2.78 ± 0.94 and 2.50 ± 1.15, respectively. Postoperative mean VAS scores in groups 1 and 2 were 6.61 ± 1.61 and 6.10 ± 1.4, respectively (p < 0.05). Correlation of US elastography and VAS scores was insignificant (p > 0.05). Both RFA and SBD of the inferior turbinates were effective in inducing scar tissue and, eventually, fibrosis in the soft tissue of inferior turbinates. Cauterization has been found to cause significantly higher amounts of fibrosis than radiofrequency; however, it did not reflect the comparable clinical outcome. This is the first study that objectively and noninvasively evaluates the targeted tissue fibrosis of the inferior turbinate surgeries by the novel inferior turbinate US elastography.
The aim of this study was to report the post-surgical and oncologic outcomes of patients who unde... more The aim of this study was to report the post-surgical and oncologic outcomes of patients who underwent supracricoid partial laryngectomy (SCPL). 90 patients who underwent SCPL between 1994 and 2014 were reviewed. 45 patients underwent cricohyoidopexy (CHP) and 45 patients cricohyoidoepiglottopexy (CHEP). Median nasogastric (NG) tube removal time, decannulation time, overall survival, disease-free survival and local control rates were calculated. The effect of the type of surgery on functional and oncologic outcomes were assessed. Median NG tube removal time was 16.5 days (IQR = 10) and 14 days (IQR = 9) in CHP and CHEP patients, respectively (p > 0.05). Median decannulation time was 30 days (IQR = 26) and 19 days (IQR = 15) in CHP and CHEP patients, respectively (p < 0.05). Resection of one arytenoid significantly increased NG tube removal time. Median follow-up time was 55 months. There were 15 oncologic failures and the median time interval for tumor recurrence was 9 months. Five-year overall survival rate was 80.4%. The 3- and 5-year disease-free specific survival rates were 81.7 and 76.7%, respectively. Given the more extensive surgery applied for CHP, functional outcomes were better in patients with CHEP. Resection of an arytenoid had a negative outcome on swallowing.
The aim of this study was to investigate the predictive value of preoperative neutrophil, platele... more The aim of this study was to investigate the predictive value of preoperative neutrophil, platelet and lymphocyte counts in local recurrence and survival in the patients operated for early-stage squamous cell carcinoma (SCC) of the tongue. 57 patients who underwent surgery for early-stage (stage 1-2) SCC of the tongue were enrolled in the study. Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and neutrophil × PLR value (N × PLR) were used as outcome measures. Local recurrence was detected in 11 (19.3 %) patients during follow-up period. Mortality was seen in 7 (12.3 %) patients. 37 (64.9 %) patients had stage 1 and 20 (35.1 %) patients had stage 2 tumor. NLR, PLR and N × PLR cutoff values were determined as 2.26, 146,855 and 689,912, respectively, by receiver operating characteristic analysis. The relationship between NLR, PLR, N × PLR and local recurrence was statistically significant according to these cutoff values (p values 0.021, 0.020, 0.017, respectively). We suggest that NLR, PLR and N × PLR may be used to predict local recurrence, while their use in overall and disease-free survival is limited. Further studies involving large patient groups are required.
Mandibulectomy and mandibulotomy procedures are performed with the oscillating saw and the acoust... more Mandibulectomy and mandibulotomy procedures are performed with the oscillating saw and the acoustic energy generated during the osteotomies is transferred to the cochlea via temporomandibular joint and air conduction. The aim of this study was to assess the effect of mandibulectomy and mandibulotomy on cochlear function. This study was carried out on 15 patients who underwent at an otolaryngology department of a tertiary medical center between January 2013 and August 2015. The study was designed as a prospective study. All of the data were prospectively collected. These included demographic data, date of the surgery, type of surgery, preoperative pure-tone audiometry, preoperative and postoperative distortion product otoacoustic emission (DPOAE) measurements. Of the DPOAE measurements, there was a statistically significant difference between the signal-to-noise ratio measurement on the right ear measurement at 4 kHz (P <0.05). Additionally, there was a statistically significant correlation between the signal-to-noise ratio measurements and the side of the osteotomy (P <0.05). In conclusion, it is found that mandibulectomy and mandibulotomy procedure has a negative effect on cochlear function in the early period. The DPOAEs were diminished on the osteotomy site in day one postoperatively. Results with a longer follow-up time can yield more information on the prognosis of the cochlear damage.
The exposure of the round window (RW) through the facial recess (FR) is sometimes partial. The an... more The exposure of the round window (RW) through the facial recess (FR) is sometimes partial. The anatomic variations that alter RW exposure during cochleostomy have not been clearly defined to date. The aim of this study was to assess the best FR position in which to achieve the widest exposure of the RW niche and to define the topographic relationship between two other important anatomical structures, the facial nerve (FN) and the chorda tympani (CT). Cadaver study. Twenty-four temporal bones were included in the study. Anterior and posterior epitympanectomy and posterior tympanotomy were performed after mastoidectomy. Bone was removed until the FN and CT were skeletonized and the CT branching point was visible. Two pictures were taken. The first was taken when the facial recess was at its widest exposure, while the second was taken when the RW niche was maximally exposed through the facial recess. Various measurements were taken. The RW niche was totally visible in 19 temporal bones (79.2%). The RW was partially visible in the remaining five bones (20.8%). The unexposed part of the RW lay posteromedial to the FN in these five bones. While the branching point of the CT could be visualized in all cases at the widest exposure of RW, the part of the FN distal to the branching point was hidden in eight subjects (33.3%) under the posterior wall of the external ear canal. The RW niche was totally visible in most of the temporal bones. The RW lay posteromedial to the FN in some cases and total exposure was impossible.
Clinical and Experimental Otorhinolaryngology, 2016
Bilateral vocal fold abductor paralysis (BVFAP) both deteriorates quality of life and may cause l... more Bilateral vocal fold abductor paralysis (BVFAP) both deteriorates quality of life and may cause life-threatening respiratory problems. The aim of this study was to reduce respiratory symptoms in BVFAP patients using cricothyroid (CT) botulinum toxin (BTX) injection. Before and 2 weeks and 4 months after bilateral BTX injection into the CT muscles under electromyography; alterations in respiratory, acoustic, aerodynamic and quality of life parameters were evaluated in BVFAP patients with respiratory distress. For the respiratory evaluation modified Borg scale and spirometry, for the voice and aerodynamic evaluations Voice Handicap Index-30 (VHI-30), GRBAS, acoustic analysis (sound pressure level, F0, jitter%, shimmer%, noise-to-harmonic ratio) and maximum phonation time and for the quality of life assessment Short Form-36 (SF-36) form were used. All patients were female with a mean age of 47±8.1 years. There was a mean time of 11.8±5.5 (minimum 2, maximum 23) months between BVFAP development and BTX injection. In all cases, other than one case with unknown aetiology, the cause of vocal fold paralysis was prior thyroid surgery. In total 18.6±3.1 units of BTX were applied to the CTs. In the preinjection period, and the 2nd week and 4th month after injection, the Borg dyspnea scale was 7.3/5.3/5.0, FIV1 (forced inspiratory volume in one second) was 1.7/1.7/1.8 L, peak expiratory flow (PEF) was 1.4/1.7/2.1 L/sec, maximum phonation time was 7.0/6.4/6.2 seconds and VHI-30 was 63.2/52.2/61.7 respectively. There was no significant alteration in acoustic analysis parameters. Many of the patients reported transient dysphagia within the first week. There were insignificant increases in SF-36 sub-scale values. After BTX injection, improvements in the mean Borg score, PEF and FIV1 values and SF-36 sub-scale scores showed the restricted success of this approach. This modality may be kept in mind as a transient treatment option for patients refused persistent tracheotomy or ablative airway surgeries.
The aim of this study was to report the post-surgical and oncologic outcomes of patients who unde... more The aim of this study was to report the post-surgical and oncologic outcomes of patients who underwent supracricoid partial laryngectomy (SCPL). 90 patients who underwent SCPL between 1994 and 2014 were reviewed. 45 patients underwent cricohyoidopexy (CHP) and 45 patients cricohyoidoepiglottopexy (CHEP). Median nasogastric (NG) tube removal time, decannulation time, overall survival, disease-free survival and local control rates were calculated. The effect of the type of surgery on functional and oncologic outcomes were assessed. Median NG tube removal time was 16.5 days (IQR = 10) and 14 days (IQR = 9) in CHP and CHEP patients, respectively (p > 0.05). Median decannulation time was 30 days (IQR = 26) and 19 days (IQR = 15) in CHP and CHEP patients, respectively (p < 0.05). Resection of one arytenoid significantly increased NG tube removal time. Median follow-up time was 55 months. There were 15 oncologic failures and the median time interval for tumor recurrence was 9 months. Five-year overall survival rate was 80.4%. The 3- and 5-year disease-free specific survival rates were 81.7 and 76.7%, respectively. Given the more extensive surgery applied for CHP, functional outcomes were better in patients with CHEP. Resection of an arytenoid had a negative outcome on swallowing.
The use of LigaSure™ vessel sealing system in head and neck surgery was reported to be reliable a... more The use of LigaSure™ vessel sealing system in head and neck surgery was reported to be reliable and safe, providing sufficient hemostasis and reducing operating time. The aim of this study was to evaluate efficacy of this technique in patients undergoing selective neck dissections. This study was carried out as a prospective controlled study at an otolaryngology department of a tertiary medical center between July 2013 and July 2015. Twenty-five patients older than 18 years who underwent unilateral selective neck dissection for head and neck cancer were included in the study. In the control group (group 2, 10 patients) only monopolar and bipolar diathermy was used; in the Ligasure group (group 1, 15 patients) Ligasure was used for hemostasis and dissection in addition to the conventional techniques. Cervical lymphadenectomy time, operation time, preoperative hemoglobin levels, preoperative hematocrit levels, postoperative hemoglobin levels, postoperative hematocrit levels, total neck drainage and drain removal time were analyzed and compared between the groups. Median operation time in group 1 and 2 were 95 min (IQR = 35) and 142.5 min (IQR = 63), respectively. Median cervical lymphadenectomy time in group 1 and 2 were 55 min (IQR = 23) and 102.5 min (IQR = 49), respectively. Median operation time and cervical operation time were significantly lower in group 1 (p < 0.05). In conclusion, LigaSure™ vessel sealing system is a safe, efficacious technique and significantly lowers cervical lymphadenectomy and operation time in selective neck dissections compared to controls. Given the superb hemostatic properties, this technique should be in the surgeon's armamentarium when possible.
Acute invasive fungal rhinosinusitis (AIFR) is a highly mortal, progressive fungal infection of t... more 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. The aim of this study was to present the outcomes and analyze the prognostic indicators of patients with AIFR who underwent surgery. 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. 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). 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.
Primary thyroid-like papillary adenocarcinomas are extremely rare neoplasms that generally origin... more Primary thyroid-like papillary adenocarcinomas are extremely rare neoplasms that generally originate in the nasopharynx. We report the case of a 24-year-old woman who was diagnosed with a thyroid-like papillary adenocarcinoma that originated in the nasal septum. The tumor was surgically removed, and the patient showed no evidence of local recurrence during 4 years of follow-up.
Kulak burun boğaz ihtisas dergisi : KBB = Journal of ear, nose, and throat, 2015
This study aims to assess the value of facial nerve monitorization and minimum facial nerve stimu... more This study aims to assess the value of facial nerve monitorization and minimum facial nerve stimulation thresholds during superficial parotidectomy in the prediction of postoperative facial nerve function. Twenty superficial parotidectomy patients (9 males, 11 females; mean age 52 years; range 23 to 80 years), who treated in our clinic between January 2013 and May 2013 were recruited in this study. Intraoperative facial nerve monitorization was applied and minimum facial nerve stimulation thresholds were recorded in the main trunk at the end of the operation. Postoperative facial nerve functions were evaluated by House Brackmann (HB) grading system. In early postoperative evaluation, minimum stimulation thresholds of 12 patients with facial nerve function HB grade 1 (normal) and of eight patients with HB grade 2 facial paresis in marginal mandibular branch were 0.20±0.14 mA and 0.22±0.05 mA respectively (p>0.05). At the end of the first day, minimum stimulation thresholds in 17 H...
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2015
There are diseases that affect the stroma of the inferior turbinate and many surgical interventio... more There are diseases that affect the stroma of the inferior turbinate and many surgical interventions that alter it. However, an objective method that can evaluate the turbinate's stromal structure in detail has not been defined yet. The primary aim of this study was to investigate the effectiveness and reliability of ultrasound elastography for objective evaluation of the inferior turbinate stroma and define the most suitable elastographic technique. Twenty inferior turbinates in 10 healthy participants were included. Five of the participants (50%) were male, and 5 (50%) were female, with a mean age ± SD of 28.3 ± 3.2 years (range, 26-35) years. To obtain reliable and reproducible results, elastography was performed twice, 3 days apart, with and without a topical decongestant to evaluate the effects of the nasal cycle and mucosal edema. Two previously described valid elastographic outcome measures were reevaluated for the inferior turbinate. The tissue strain ratio and sound wave...
European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, Jan 11, 2015
The aim of this study is to assess the effect of partial superficial parotidectomy and facial ner... more The aim of this study is to assess the effect of partial superficial parotidectomy and facial nerve dissection to electrophysiologic parameters of intraoperative facial nerve monitoring such as nerve stimulation threshold, stimulus amplitude and latency. Twenty-five patients who underwent partial superficial parotidectomy for benign parotid gland mass were included in the study. After the identification of the facial nerve main trunk, minimum stimulation threshold, latencies and amplitudes of the orbicularis oculi (electrode 1) and orbicularis oris (electrode 2) electrodes at 0.50 milliamperes (mA) were recorded. All of the recordings were repeated after the completion of parotidectomy. Median nerve dissection duration was calculated and size of the tumors was measured during macroscopic pathology. The median minimum nerve stimulation threshold was 0.15 mA [interquartile range (IQR) = 0.05] before and 0.15 mA (IQR = 0.08) after the parotidectomy (p = 0.02). Median nerve dissection d...
Primary thyroid-like papillary adenocarcinomas are extremely rare neoplasms that generally origin... more Primary thyroid-like papillary adenocarcinomas are extremely rare neoplasms that generally originate in the nasopharynx. We report the case of a 24-year-old woman who was diagnosed with a thyroid-like papillary adenocarcinoma that originated in the nasal septum. The tumor was surgically removed, and the patient showed no evidence of local recurrence during 4 years of follow-up.
Ultrasound (US) elastography has been widely used for thyroid, liver, and lymph nodes as a resear... more Ultrasound (US) elastography has been widely used for thyroid, liver, and lymph nodes as a research tool in the current medical practice. It has been described in the inferior turbinates and validated as a reliable, reproducible, noninvasive, and objective method that can detect the fibrosis-related tissue strain. There is no previous study that investigated the amount of fibrosis induced by radiofrequency and bipolar electrocautery in the inferior turbinates in a noninvasive and objective manner. The aim of this study was to assess the amount of inferior turbinate soft tissue fibrosis that was induced by radiofrequency ablation (RFA) and submucosal bipolar diathermy (SBD) by US elastography. Thirty-eight inferior turbinates of 19 patients were included. RFA was applied to 18 inferior turbinates (group 1) and SBD was applied to 20 inferior turbinates (group 2). US elastography and visual analog scale (VAS) assessments were performed on all patients preoperatively and 6 months postoperatively. Preoperative mean US elastography scores in groups 1 and 2 were 2.55 ± 0.78 m/s and 2.56 ± 0.49 m/s, respectively (p < 0.05). Postoperative mean US elastography scores in groups 1 and 2 were 2.91 ± 1.03 m/s and 3.41 ± 0.86 m/s, respectively (p < 0.05). Preoperative mean VAS scores in groups 1 and 2 were 2.78 ± 0.94 and 2.50 ± 1.15, respectively. Postoperative mean VAS scores in groups 1 and 2 were 6.61 ± 1.61 and 6.10 ± 1.4, respectively (p < 0.05). Correlation of US elastography and VAS scores was insignificant (p > 0.05). Both RFA and SBD of the inferior turbinates were effective in inducing scar tissue and, eventually, fibrosis in the soft tissue of inferior turbinates. Cauterization has been found to cause significantly higher amounts of fibrosis than radiofrequency; however, it did not reflect the comparable clinical outcome. This is the first study that objectively and noninvasively evaluates the targeted tissue fibrosis of the inferior turbinate surgeries by the novel inferior turbinate US elastography.
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