Volume 12 Issue 1 (2022)

Background: Robot-assisted and image-guided surgery have become increasingly important because it outperforms human dexterity. For procedures on sub-millimet-ric level, fixing the patient’s head firmly is crucial. Although the neck is not the targetorgan of the operation, it may be at risk of postoperative complaints due to position-ing or fixation. The incidence of postoperative symptoms after head and neck surgery with fixation is hardly reported and probably underestimated, in regards to the life-threatening cranial pathologies for which the surgery was required.

Methods: To identify papers on risk factors for postoperative complaints after headand neck surgery, we performed a systematic review. PubMed and Web of Sciencedatabases were searched using predefined in- and exclusion criteria. Meta-analysesand reviews were excluded. Postoperative complaints concerned pain, quality oflife, discomfort, neuropraxia, and musculoskeletal problems. This review is reportedaccording to PRISMA guidelines.

Results: Seven eligible studies were identified, only 2 concerned surgery requiring head fixation. The significant risk factors resulting from our analysis were preopera- tive pain (odds ratio=2.19), expected pain (odds ratio=2.15), short-term fear (odds ratio = 1.42), age between 45 and 59 years old (odds ratio = 1.40), pain catastrophizing (odds ratio = 1.21), and female gender (odds ratio = 0.74).

Conclusion: Six significant risk factors for iatrogenic postoperative complaints after head and neck surgery have been identified. These risk factors should be consideredas possible confounding factors in future research. Little literature could be found. Upcoming robotic surgeries in the head and neck area pose a clinical need for morespecific studies on postoperative iatrogenic complaints.

Background: Woakes’ syndrome, first described by Woakes in 1885 which is also bet- ter known as ethmoiditis, is a very uncommon entity of severe nasal polyposis caus-ing disfigured facial appearance. In this study, we aimed to present the diagnosis and management of seven patients’ series with Woakes’ syndrome in the light of currentliterature.

Methods: The medical records of seven patients who had functional endoscopic sinussurgery because of nasal polyposis that caused nasal roof deformity between January 2013 and June 2020 in a tertiary hospital otorhinolaryngology department were eval-uated retrospectively. Demographic aspects, examination data, rhinological surgeryhistory, Lund-Mackay scores at admission, surgical procedures performed, and follow- up periods were analyzed.

Results: All patients had bilateral severe nasal polyposis and significant nasal boneexpansion. Bilateral functional endoscopic sinus surgery was applied to all patients and additionally septoplasty was applied to one patient and septorhinoplasty to two patients in the same session. Five patients stated they did not want septorhinoplastyin the same session. We tried reduction of nasal bones with a finger pressure in thesepatients. While we achieved a satisfactory reduction in three of these patients, it was unsuccessful in two cases.

Conclusion: Treatment of nasal polyps should be achieved by functional endoscopic sinus surgery for Woakes’ syndrome. Topical and systemic treatment of the noseshould slow down or evade the recurrence of the nasal polyps. Approach to nasal deformity should be addressed during the initial surgery if feasible.

Objective: Juvenile angiofibromas are benign tumors that almost exclusively affect male adolescents. Over the last decades, there is an evolution from open surgery toless-invasive endoscopic techniques.

Methods: The medical records of 39 consecutive patients who underwent endoscopic sinus surgery for a juvenile angiofibroma were retrospectively analyzed.

Results: The distribution of the tumor stages according to the classification system ofRadkowski was as follows: 1 in stage IA, 5 in IB, 7 in IIA, 13 in IIB, 5 in IIC, 4 in IIIA, and 4 in IIIB. Preoperative angiography with embolization was performed in all but 1 patient.The mean postoperative follow-up time was 32 months. Five patients (12.8%) hada recurrence after a mean period of 9 months (range 3-24 months), of which 2 ini-tially had incomplete macroscopic tumor removal due to intracranial extension. The mean operating time was 106 minutes (range 35-400 minutes). The mean duration of hospitalization was 4.3 days (range 1-9 days). Two patients (5.1%) had postopera- tive bleeding out of the internal maxillary artery for which a reintervention and blood transfusion was needed.

Conclusions: Endoscopic surgery for juvenile angiofibromas is an effective and safe technique with good outcomes and low postoperative morbidity. This technique should be used as the first choice in the treatment of small to medium-sized tumors(I-IIB) and is a worthy alternative to open surgery for advanced tumor stages (IIC-IIIB) when performed by an experienced surgeon.

Objectives: Thirteen cases of laryngeal chondroradionecrosis unresponsive to conser- vative treatment and treated with laryngectomy were presented with an analysis of possible risk factors.

Methods: Retrospective analysis of 13 patients operated on for chondroradionecrosis was made. Characteristics of the primary tumor, chondroradionecrosis grade, number of biopsies needed to rule out recurrence, and laryngectomy indications were ana-lyzed. The possible predisposing factors such as alcohol and tobacco use and othermajor chronic diseases were investigated.

Results: All of the patients had a history of smoking. The most common comorbiditywas hypertension (46.2%), followed by chronic obstructive pulmonary disease (23.1%).The onset of symptoms was documented within the 10 months following the radiationtherapy in 12 of the patients (93.3%) and 12 years after the primary radiation therapy in 1 patient. As the most common symptom, fetor oris was observed in all of the patients, followed by dysphagia (69.2%), hoarseness (61.5%), pain (53.8%), dyspnea (46.2%), andnecrotic fistula formation in the anterior neck (15.4%) consecutively. Tumor suspicion(84.6%) was the most common indication for laryngectomy followed by chronic aspi-ration or feeding disorder (61.5%). Twelve patients were treated with total and 1 with supraglottic laryngectomy. Pectoralis major muscle flap was used in all of the patients for pharyngeal reconstruction or protection against salivary fistula.

Conclusion: Diagnosis of chondroradionecrosis is challenging, and tumor recurrenceshould always be kept in mind. Patients must be informed about the possibility of chondroradionecrosis complications including laryngectomy.

Introduction: Chondroradionecrosis is a rare and the most severe complication of radi- ation therapy for laryngeal carcinoma.

Background: In this study, we analyzed the clinical characteristics and outcomes of severe epistaxis patients admitted to our tertiary center and compared our results with the literature.

Methods: We retrospectively analyzed clinical records of epistaxis patients admittedto our hospital between January 2018 and December 2019 with respect to their age, gender, duration of hospitalization, anterior/posterior nasal packing, hospitalization month, surgical intervention, bleeding diathesis, comorbid diseases, anticoagulant/antiplatelet drug therapy, blood transfusion, and laboratory values.

Results: A total of 79 patients were enrolled in this study, 50 (63.3%) of them were malesand 29 (36.7%) were females. The mean age of all patients was 55.3±17.2. Epistaxis was most common in patients over 70 years of age and the most frequent months for hos-pitalization were January and February. The anterior nasal pack was applied to 74.7% of the patients. The mean hospitalization duration was 3.8±1.8 days (min 2 to max 11)mainly affected by the nasal pack type. The surgical intervention rate was 7.6%, andpatients who needed intervention had lower hemoglobulin values and higher bloodtransfusion rates. The most common comorbid disease was hypertension (54.4%) fol-lowed by cardiac disease (29.1%). The low hemoglobulin value on the day of admissionwas the main factor for blood transfusion and surgical intervention.

Conclusions: Despite recent advances in diagnostic modalities of otolaryngology,epistaxis is still one of the most common emergencies with the same basis of treat-ment worldwide. Hypertensive male patients over 50 years of age displayed the major clinical profile of our study group. Non-surgical intervention was the main treatmentmethod, and the duration of hospitalization predominantly depended on nasal packtype. Our study showed physicians should be alert to epistaxis patients with lowhemoglobulin levels as these patients are prone to surgical intervention and blood transfusion.

Objective: Novel coronavirus disease is a new infectious agent of the respiratory tract characterized by severe acute respiratory syndrome. For this disease, there are limited data with regard to the clinical characteristics of the patients and prognostic factors.

Methods: We collected data from 213 patients who were hospitalized intoCOVID-19 isolation with positive PCR test results. We recorded various patient val- ues, including blood test results. We also noted age, gender, additional diseases, dura- tion of discharge, whether they live or die, whether they smoke, and their radiological staging.

Results: In CT imaging with a staging of maximum 4 points and minimum 0 points, the mean value resulted in 1.95. The average radiological stage of the dead patients' group was reported as 2.56. There was a correlation between the radiological predictor andthe outcome status (P = .002). The number of smokers was 14 (6.5%). Of the 26 patientswho died, 3 were smokers and 23 were non-smokers.

Conclusion: Fourteen patients in the study were smokers. While in COVID-19 isola-tion service, only a small rate of smoking was observed. That supports the theory that smoking has no negative impact on COVID-19 development. There was also a corre- lation between the radiological predictor and the outcome status. It seems that an elevated radiological stage is a predictor of death.

Background: Continuous positive airway pressure is the standard treatment forobstructive sleep apnea. However, nonadherence to continuous positive airway pres-sure use remains a significant limitation that prevents satisfactory results from being achieved. Epworth Sleepiness Scale score and sleep efficiency values may predict adherence. This study aims to assess the relationship between the Epworth Sleepiness Scale score and sleep efficiency measured during continuous positive airway pressuretitration polysomnography.

Methods: A retrospective analysis of the medical records of patients with obstructivesleep apnea/hypopnea who had undergone polysomnography for continuous positiveairway pressure titration in an ear, nose, and throat center between January 2014 and August 2017.

Results: Assessment of 170 individuals based on the Epworth Sleepiness Scale scoreand sleep efficiency during polysomnography with continuous positive airway pres-sure showed that patients with excessive daytime sleepiness had higher sleep effi- ciency (mean=82.0%) than patients with normal daytime sleepiness (mean=78.1%) (P = .043).

Conclusion: Patients with excessive daytime sleepiness as measured on the EpworthSleepiness Scale have higher sleep efficiency during continuous positive airway pres- sure titration polysomnography.

Background: The power of diagnostic tests is affected by pre-test probability, and clinical prediction models must be validated in different populations. The aim ofthis study was to determine the diagnostic value of symptoms and signs for group A Streptococcus tonsillopharyngitis and diagnostic power of Centor and Mclsaac crite- ria in a patient population with different pre-probability.

Methods: The study was conducted between September 2019 and February 2020 in Adnan Menderes University Hospital’s outpatient clinics. A total of 405 patients olderthan 36 months who presented with one of the complaints of acute tonsillopharyn-gitis participated in the study. Throat swab samples were taken from each patient. The diagnostic value of symptoms and signs was determined by performing univariateanalysis and multiple logistic regression analysis.

Results: The mean age of 405 patients was 24.7 (3-81 years). While group AStreptococcus positivity was 7.9% over the age of 3, the frequency of group A Streptococcus was 16.8% in children under the age of 15 and 4.7% in adolescents and adults. Group A Streptococcus positivity was 45.8% in those with a Centor score of 4 and 35.7% in those with a Mclsaac score of 4-5. In regression analysis, only 4 criteria included in the Centor score entered the model (P < .05).

Conclusions: Centor and McIsaac clinical prediction models were found to be valid inour patient group with low group A Streptococcus positivity. However, although thediagnostic power of both clinical prediction models does not change in the patient population with low group A Streptococcus positivity, they cannot increase the post- test probability above 40-50%.

Background: we aimed in this study to evaluate and present the long-term results of type 1 tympanoplasty patients who were operated by using boomerang-shaped chon- droperichondrial graft.

Methods: One hundred thirty-eight patients who underwent primary type 1 tympano- plasty, had tragal cartilage removal, and used boomerang-shaped chondroperichon- drial graft between September 2010 and March 2014 were examined and 62 patients who could be reached through their contact information and had complete preopera- tive records were included in this retrospective study. Audiological and otomicroscopicexaminations were performed on the patients who were contacted. The condition of the graft, preoperative and postoperative air-bone gap values, and retraction find-ings on graft were noted. These findings were compared with preoperative notes.

Results: The preoperative mean air-bone gap value of the patients was 23.690±1.036 decibels. As a result of the audiological examination performed at the last fol-low-up of these patients, the mean air-bone gap values of at least fifth year post- operatively were measured as 10.6±0.791 decibels (P < .0001). The control periodswere between 122 and 60 months and the mean control period was 73.03 months. Perforation was detected in 6 (9.7%) patients on otomicroscopic examination.

Conclusion: Considering the long-term results, we think that this grafting technique of tympanoplasty has adequate and satisfactory results.