Volume 10 Issue 1 (2020)

Langerhans’ cell histiocytosis (LCH) is a rare group of diseases characterized by abnormal clonal proliferation of Langerhans cells in one or more systems. LCH can occur in any system. We report a case of bilateral otologic LCH that presented as a case of mastoiditis. Despite multiple courses of antibiotics, there was no improvement. Subsequent excision biopsy of a postauricular mass confirmed the diagnosis of LCH. The patient responded well to chemotherapy

We report the case of a 55-year old Caucasian female who presented with dysphagia after being operated for a brain glioblastoma. Fiberoptic endoscopy and magnetic resonance imaging showed a submucosal tumefaction of the posterior hypopharyngeal wall. Direct laryngoscopy and biopsy did not reveal a definitive diagnosis. The lesion was completely removed using a transoral C02 laser, and histopathological examination of the lesion showed a diagnosis of hypopharyngeal schwannoma. The patient recovered uneventfully and has remained clinically and radiologically disease-free for 6 months. Surgical excision and S100 protein immunohistochemistry remain the gold standards for treatment and diagnosis of hypopharyngeal schwannomas.

Objective: V-Y advancement flaps are pliable local flaps that can be used in nearly every part of the body with relatively minimal technical difficulty. These flaps provide the best color and quality match, especially in the facial region. With effective planning, donor site morbidity can be acceptable, even on the face.

Methods: The results of 38 patients who underwent 53 V-Y advancement flap facial reconstructions were analyzed retrospectively. The defects were evaluated according to their anatomical region, etiology, postoperative complications, and final aesthetic results.

Results: V-Y advancement flaps were used for defects that were either not amenable to primary repair or had a high risk of cosmetic distortion. The defects were located in the cheek (9 patients), nasolabial fold (7 patients), nose (6 patients), forehead (5 patients), preauricular area (3 patients), infraorbital region (3 patients), lower lip (1 patients), gingivobuccal sulcus (2 patients), and medial canthal region (2 patients). In 32 patients, the primary pathology was malignant tumor (22 basal cell carcinomas, 9 epidermoid carcinomas, 1 malignant eccrine poroma). Etiologies of the other patients’ defects were benign tumors (n=2), traumatic wounds (n=2), and contractures (n=2).

Conclusions: Despite the widespread use of V-Y flaps in surgical practice, the technique continues to demonstrate additional advantages, particularly in facial reconstruction. They are not only applicable for medium and small defects, but can be used for all defects with sufficient surrounding tissue. They enable various modifications and the elevation of multiple flaps.

Objective: To present technical details and experiences regarding the use of a Tubbs-Logan mitral valve dilator for the closed reduction of zygomatic arch fractures.

Method: Over a period of about three years, closed reduction was indicated and performed in 22 patients with a zygomatic arch fracture. In all patients, depressed fracture segments were reduced using a Tubbs-Logan mitral valve dilator via the Gillies’ temporal approach.

Results: The majority of the injuries were due to motor vehicle collisions (n=8, 36.4%). The zygomatic arch fracture was isolated in 12 patients (54.5%). However, it was a component of a zygomatic complex fracture in 10 patients (45.5%). Of those, rigid internal fixation of the zygomatic body was performed in 8 and the zygomatic body was only closely reduced by a bone hook in 2 patients. Repair of a concomitant orbital floor fracture was performed in 2, a mandibular angle fracture in 1 and a frontal sinus fracture in 1 patient. The reduction status of the zygomatic arch was excellent in 12 (54.5%), good in 8 (36.4%) and fair in 2 patients (9.1%). During the follow-ups, no functional or cosmetic sequelae regarding repaired fractures of the zygomatic arch, zygomatic body or other facial bones were recorded.

Conclusion: We suggest that the Tubbs-Logan mitral valve dilator is a safe and effective alternative in terms of closed reduction of zygomatic arch fractures, whether they are isolated or not. We think that further ergonomic modifications would be beneficial to improve the positioning of the instrument in restricted areas observed due to severe depression of the zygomatic arch.

Introduction: In the present study, we aimed to evaluate the relationship between neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and systemic immune inflammation index (SII) values and overall survival (OS) and disease-free survival (DFS) in patients undergoing radiotherapy (RT) with a diagnosis of oral cavity cancer (OCC).

Methods: 58 patients were included who were treated with a diagnosis of OCC who applied to Cumhuriyet University Faculty of Medicine Radiation Oncology Clinic between January 2009 and December 2018. Kaplan-Meier analysis was used to determine OS and DFS. Multivariate Cox regression analysis was also performed to detect independent prognostic factors.

Results: All patients had a squamous cell carcinoma (SCC) of the oral cavity composed of 50 tongue SCC and 8 buccal SCC. Cut-off values in ROC analysis: 954 [Area=0.665 (0.511-0.800), p=0.06] for SII, 174 [Area=0.659 (0.608- 0.795), p<.001] for PLR and 3.2 [Area=0.699 (0.556-0.841), p=0.016] for NLR. Prognostic factors affecting OS were SII, PLR, NLR and age. SII, NLR, PLR and grade were statistically significant prognostic factors for DFS. However, SII was an independent prognostic factor.

Conclusion: In this study, high SII value was found to be an indicator of shorter OS and DFS in patients with OCC.

Objective: It is known that the use of nasal packing has many disadvantages. The aim of this study was to investigate the effects of short-term nasal obstruction due to nasal packing on cognitive functions.

Methods: The study group consisted of 40 patients who had nasal congestion due to unilateral nasal septal deviation and for whom septoplasty was planned with a merocel pack to be used as a nasal pack at the end of surgery. All surgeries were performed under local anesthesia using 10 cc of jetocaine ampoule. Brief Symptom Inventory Test (BSI), Visual Analog Scale (VAS), Serial Digit Learning Test (SDL), Stroop Test, Visual Aural Digit Span Test (VADS) and P300 test were used to evaluate cognitive functions, symptoms of concentration difficulties and blunted affect both preoperatively and peroperatively before nasal pack removal.

Results: All symptoms showed significant per-operative (with a nasal pack in place) deterioration in all patients (p<0.001) on the VAS. The mean per-operative SDL (16.34±5.77), Stroop Test (26.67±3.39), BSI (22.25±11.95) and VADS (21.13±3.44) scores showed significant deterioration compared with mean preoperative Stroop Test (20.06±3.14), SDL (22.38±4.34), VADS (25.86±2.92) and BSI (32.58±12.49) scores (p<0.001). The peroperative and preoperative P300 latency and amplitude values showed a significant difference (p<0.001).

Conclusion: The use of a nasal pack, which closes both nasal passages fully, such as a merocel pack, has negative effects on cognitive functions such as the ability to focus and maintain concentration.

Objective: We aimed to examine patient characteristics, recurrence rate and efficacy of treatment methods in patients who underwent surgery with the diagnosis of ranula in our department retrospectively. The subject is discussed in the light of current literature.

Methods: Twenty-seven patients with ranula managed surgically between 2008 and 2018 were included in this study. The indications, age and sex distribution, surgical pathology reports, surgical methods, complications encountered and recurrence rates were examined retrospectively.

Results: The mean age was 27.48±18.66 years. There were 8 (29.6%) male and 19 (70.4%) female cases. The mean size of the ranula was 3.07±0.35 cm. When the symptoms were evaluated, 23 (85.2%) of the patients had a swelling in the floor of the mouth, 3 (11.1%) had a neck swelling and 1 (3.7%) had swelling on the lower surface of the tongue. The treatment method was marsupialization in 11 (40.7%) patients and ranula cyst excision in 16 (59.3%) patients. Four (14.8%) of these patients had a recurrence. The first surgical procedure was marsupialization in 3 (75%) and cyst excision in 1 (25%) of the cases with recurrence. Of the patients with recurrence, 3 subsequently underwent cyst excision and 1 of the patients underwent marsupialization. No complication or additional recurrence was observed in the follow-up of these patients.

Conclusions: Concerning our ten years of experience with the management of ranula, we can conclude that ranula can be treated by both marsupialization and cyst excision with a low risk of recurrence.

Objective: Objectives: The present study aimed to evaluate how selfies (self-photographs) are related to cosmetic surgery.

Methods: This is a prospective, observational study performed using a self-administered survey. An online questionnaire was distributed through social media to a random sample of 653 individuals from Saudi Arabia aged 18 to 65 years (mean 29.4±10.9 years). 25.1% of respondents were male (164 men), 74.9% were female (489 women).

Results: The majority of respondents were satisfied by their appearance in the selfie. 5.8% of respondents stated they had had a cosmetic procedure as a result of self-photography. The procedures involved were: lip fillers, botox, rhinoplasty, cheek fillers, chin implant, scar revision and face-lift. A further 37.8% of respondents expressed a wish to undergo a cosmetic procedure (rhinoplasty, lip fillers, chin implant, scar revision, cheek fillers, botox or facelift) due to selfies. 134 respondents expressed dissatisfaction with their appearance in selfies, 47 of whom (35.1%) expressed an interest in a cosmetic procedure. 46% of those who believed selfies reveal their deformities also wished to have a corrective procedure. Concerning their preferred type of procedure, women chose rhinoplasty, lip fillers, cheek fillers, anti-aging botox, face-lifts and chin implants more often than men.

Conclusion: Improvements to body-image through cosmetic surgery outcomes should improve body image and thereby promote self-esteem and socialization. The selfie may underlie the increase in demand for cosmetic procedures and the number of such procedures subsequently undertaken.

Objective: To review the long term outcome of juvenile onset recurrent respiratory papillomatosis (JORRP) in University Kebangsaan Medical Centre (UKMMC).

Methods: A sixteen-year retrospective study – from January 2002 to June 2019 – of patients who presented with JORRP at our hospital was carried out.

Results: Nineteen cases were identified with the youngest age of presentation being eight months old. The mean follow-up time was 4.8 years. All patients had glottic papilloma, ten had multi-site involvement, namely at the subglottic, trachea, oropharynx and one case of distal spread to the lungs. The majority (71.4%) of patients with tracheostomy had extralaryngeal spread and shorter surgical intervals (a mean of 3.2 procedures per year). All our patients were treated surgically. Two patients with aggressive disease received a trial of the adjuvant therapies Gardasil and Cidofovir. However, no improvement was observed.

Conclusion: The worst prognosis is seen in youngeronset JORRP. Surgery is the mainstay of treatment and patients with aggressive disease may need adjuvant therapy. Unfortunately, there is a lack of a standard protocol for adjuvant therapies. Tracheostomy increases the risk of extralaryngeal spread and aggressive disease, and thus should be reserved for patients with severe airway compromise.

Objective: The purpose of this research study was to evaluate dynamic thiol/disulphide homeostasis (TDH) as a novel oxidative stress marker in participants with noncholesteatomatous chronic otitis media (ncCOM) and cholesteatomatous chronic otitis media (cCOM), as well as to investigate lipid hydroperoxide (LOOH), total antioxidant status (TAS), total oxidant status (TOS) and oxidative stress index (OSI) markers and compare the results with a healthy control group.

Methods: This research was carried out at Harran University Medical Faculty Ear-Nose-Throat Department, between April 2017 and April 2019. This was a prospective controlled trial study including 121 participants, 40 ncCOM, 39 cCOM and 42 healthy controls. Total thiol, native thiol, disulphide levels and LOOH, TAS, TOS levels were measured in plasma of all patients and healthy volunteers.

Results: In our study, we found that total thiol, native thiol levels, native thiol/total thiol ratios and TAS levels were significantly lower in cCOM patients compared with the control group (p<0.01). Disulphide/native thiol, disulphide/total thiol ratios, LOOH, TOS and OSI levels were significantly increased in the cCOM group compared with the control group (p<0.01).

Conclusion: Oxidative stress (OS) is believed to be one of the underlying reasons for COM pathogenesis. In this research, we analyzed dynamic TDH as a novel OS marker using a novel improved fully automatic colorimetric technique, along with other parameters. This study may shed light on understanding the underlying reasons for the pathogenesis of COM and identify potential targets for antioxidant drug treatment.

Objective: Chronic otitis media (COM) is a multifactorial disorder, the pathogenesis of which has yet to be fully elucidated. Numerous aetiological factors, including genetics, eustachian tube dysfunction, autoimmunity, infection, osteoclastic activity, cytokines, endotoxins, and products of lipid peroxidation resulting from oxidative stress, have been proposed to explain the chronic inflammation which lies at the heart of the disorder. The aim of this study is to investigate a possible relationship between the pathogenesis of COM and polymorphism within the paraoxonase 1 (PON1) gene.

Methods: We investigated 49 patients admitted to the Otorhinolaryngology Department of Cumhuriyet University and diagnosed with COM between September and November 2017. The control group consisted of 51 healthy individuals. Polymerase chain reaction (PCR) – restriction fragment length polymorphism (RFLP) methods were used to genotype the PON1 Q192R (rs662) polymorphism.

Results: When the case and control groups were compared in terms of the existence of PON1 (Q192) polymorphism, there was no statistically significant difference between the groups (p=0.166, p>0.05). When intergroup comparison was performed on the type of PON1 (Q192) polymorphism, there was also no statistically significant difference (p=0.261, p>0.05).

Conclusion: The present study is the first known study in which PON1 polymorphism has been examined in cases of COM. The results of our study failed to indicate a statistically significant relationship between PON1 polymorphism and COM. However, it is important to note that the higher rate of 192RR polymorphism within the control group may indicate a protective effect in COM.