Volume 10 Issue 2 (2020)

In the present review, we aim to give an overview of the development and utilization of robotic surgery in otolaryngology-head and neck surgery from its introduction, current status, and future applications. Robotic surgery has been applied either pre-clinically or is already in clinical use for several indications in otolaryngology and head and neck surgery. Due to its rapid progress and technological development, it appears it will be a more active tool in the future for the diagnosis and treatment of a number of diseases in otolaryngology-head and neck surgery practice.

Objective: To compare intact and diseased ears for Eustachian tube (ET) length and width in patients with unilateral chronic otitis media (COM), and to assess the relationship between cholesteatoma spread, stapes erosion, lateral semicircular canal (LSCC) fistula and ET width and length retrospectively.

Methods: Subjects with unilateral COM (122 subjects with 244 ears) who underwent surgery for cholesteatoma were evaluated retrospectively for this study. The width of the distal orifice of the bony segment and the length of the bony segment of the ET for both the diseased and healthy ear were measured. Subjects’ healthy and diseased ears were compared for ET length and width. The diseased sides were compared to assess the relationship between ET dimensions and cholesteatoma spread, stapes erosion and LSCC fistula.

Results: The mean ET length and width in healthy and diseased ears was 11.38±1.7 and 1.43±0.37 mm, and 10.99±1.6 and 1.27±0.35 mm, respectively; the difference was statistically significant (p<0.001). No significant differences were found in terms of ET length and width between the subjects with and without stapes erosion and LSCC fistula (p=0.765, p=0.573, and p=0.436, p=0.790, respectively). No significant relation was found between cholesteatoma spread and ET length and width (p=0.647).

Conclusion: ET dysfunction is frequently associated with COM. Chronic otitis media with cholesteatoma is significantly related to ET length and width. Measurement of ET length and width in CT scans is a basic method that can be used in clinical practice.

Objective: The purpose of the present study was to investigate the relationship between vertical facial development and angular and linear measurements of the face.

Methods: Pretreatment cephalometric radiographs of subjects with class III malocclusion were divided into three groups according to vertical facial development as low, normal and high angle. Nine angular, three dimensional and one ratio measurements were performed with the analysis program (AudaxCeph ver. 5.2.0.3610, Audax Slovenia) on the cephalometric radiographs and compared between the vertical growth groups.

Results: There was a significant negative correlation between the Sella-Nasion/Gonion-Menton (SN-GoMe) and Saddle-Nasion-A (SNA), Saddle-Nasion-B (SNB), Incisal Mandibular Plane Angle (IMPA) and Jarabak ratio measurements, whereas a significant positive correlation was found between the SN-GoMe and the Gonial and Saddle measurements.

Conclusion: According to the results of the present study, we determined that anterior and posterior development of the face decreases with the increase in the vertical direction of the face. Also, an increase in vertical direction angles including Gonial and Saddle angles significantly correlated with the increase in SN-GoMe angle. Since vertical growth problems can cause complicated and long orthodontic treatment, factors that may affect vertical growth should be addressed, such as mouth breathing.

Objective: To investigate the reliability and validity of the Turkish version of the Mini-Tinnitus Questionnaire (TQ 12-T).

Methods: The study consisted of 120 patients with tinnitus (60 F + 60 M; Mean Age: 46.8±15.1 years). Audiological evaluation, tinnitus mapping, tinnitus handicap inventory (THI) and TQ 12-T were applied to the participants. Internal consistency and reliability were assessed by Cronbach’s alpha. To evaluate the accuracy of the original findings, a retest was performed with 20% of the participants. The validity of the TQ 12-T was assessed, analyzing the correlation with THI. We assessed construct validity by analyzing the patients according to their age and tinnitus duration.

Results: High internal consistency, reliability (α=0.87) and a high intraclass correlation coefficient (ICC 0.96, p < 0.001) were found. The internal consistency reliabilities of the two subscales were α=0.74 and α= 0.84 for “health anxiety” and “cognitive distress,” respectively. There was a strong positive correlation between THI and TQ 12-T total scores (r=0.985, p<0.01).

Conclusion: TQ 12-T is a valid, reliable and brief questionnaire. TQ 12-T could easily be used alongside other tinnitus or health-related questionnaires since it takes only a few minutes to complete.

Objective: 8-hydroxy-2’-deoxyguanosine (8-OHdG) and 8-iso-prostaglandin F2α (8-iso-PGF2α) are indicators of oxidative stress in the human body. The aim of the present study was to investigate serum 8-OHdG and 8-iso-PGF2α levels in patients with larynx carcinoma and to compare them with healthy controls.

Methods: A total of 50 patients, consisting of 25 patients with larynx carcinoma (study group) and 25 healthy subjects (control group), were enrolled in the present study. Serum 8-OHdG concentration was measured using an ELISA kit, whereas an enzyme immunoassay kit was utilized for the measurement of serum 8-iso-PGF2α levels. TNM stages of the patients were recorded from the patient records in the study group.

Results: 8-OHdG and 8-iso-PGF2α levels were significantly higher in patients with larynx carcinoma than the control subjects. 8-OHdG levels were significantly higher in patients with LN metastases than the patients without LN metastases in the study group.

Conclusion: The findings of the present study showed the presence of significantly increased serum 8-OHdG and 8-iso-PGF2α levels in patients with larynx carcinoma, which may support the role of oxidative stress in the development laryngeal cancers.

Objective: The utricle is a crucial structure for a sense of gravity, but the contribution of proprioceptive receptors is also essential. This study aimed to measure the effect of head roll and soft surface on subjective visual vertical (SVV) in healthy subjects to determine the effect of neck and plantar proprioceptive inputs.

Methods: In the first experiment, 78 healthy subjects performed 0, 15, 30, and 45-degree head rolls to the left and right side while standing. Three measurements were performed in every position. In the second experiment, 40 healthy subjects performed the same head maneuvers on a 20 cm thick soft surface. The Virtual SVV system (Virtual SVVTM, Interacoustics, Denmark) was utilized for all measurements.

Results: The mean SVV on a hard surface was -0.99±2.34 degree at 0°. The SVV deviation increased with increasing head roll angle. The head roll to the right on a hard surface resulted in significantly different SVV angles than the neutral position (p0.05). SVV deviation increased on the soft surface. Nevertheless, there was no significant difference between the two surface conditions.

Conclusion: The new Virtual SVV system measures SVV accurately. SVV deviation in the neutral position is similar to published results. However, under stress conditions such as with head roll and on a soft surface, every clinic has to set their normative data before comparing patients.

Objective: The porous polyethylene implant (PPEI) is one of the most commonly used alloplastic materials in cranio-maxillofacial surgery. It is widely preferred because of its biocompatible, durable, flexible and thin nature as well as for its low complication rates. The purpose of the present study was to review the clinical and surgical outcomes of PPEI usage for orbital floor fractures.

Methods: The present study included 76 patients who underwent orbital floor fracture reconstruction using PPEI between July 2000 and July 2018. All demographic characteristics of the patients were recorded and the patients were questioned and/or examined whether there was any complaint or complication secondary to the surgery.

Results: The mean age of the patients was 35.2 years with a male predominance. The most common causes of injury were in-vehicle traffic accidents, falls, physical assaults and pedestrian accidents, respectively. 73 patients had other concomitant fractures of the facial bones along with the orbital floor fracture. The mean time between the injury and the surgical repair was eight days. Scleral show was observed in two patients (2.6%) due to scar contracture of the subciliary incision whereas one patient had surgical removal of the PPEI.

Conclusion: The present study revealed that PPEI is a reliable and flexible material for the reconstruction of orbital floor fractures with a low risk of complications. To prevent or minimize postoperative complications, the orbital septum must be repaired meticulously.

Objective: Adenoid hypertrophy and nocturnal enuresis, comorbidities that are quite prevalent among children, are both associated with sleep problems. However, limited research has specifically focused on sleep domains and their parameters. In the present study we thus aimed to investigate the impact of adenoid hypertrophy and nocturnal enuresis on sleep, both when the two disorders coexist and when they do not coexist.

Methods: We investigated 178 children (mean age: 7.24±1.02 years, range=6-9 years), 50 (28.1%) of whom had only adenoid hypertrophy, 39 (21.9%) of whom had only nocturnal enuresis, 35 (19.7%) of whom had coexistence of adenoid hypertrophy and nocturnal enuresis, and 54 (30.3%) of whom were healthy-control children. Psychiatric disorders were diagnosed by a semi-structured diagnosis interview and the diagnosis of adenoid hypertrophy was confirmed by flexible fiberoptic nasopharyngoscopy. Sleep habits and disturbances were assessed via the Children’s Sleep Habits Questionnaire and Modified Epworth Sleepiness Scale.

Results: Our results showed that the comorbid condition was the most severe form in terms of both adenoid hypertrophy and enuresis. Regarding sleep difficulties, the “Sleep-Disordered Breathing”, “Night Wakings”, “Sleep Onset Delay” and “Sleep Duration” parameters were closely associated with adenoid hypertrophy and its severity, while “Bedtime Resistance”, “Parasomnias” and “Sleep Anxiety” domains of sleep were strongly related to nocturnal enuresis.

Conclusion: Otorhinolaryngologists, child psychiatrists and pediatricians should be aware of the relationship between enuresis and adenoid hypertrophy, that both diseases are associated with impaired sleep patterns, and that children affected by the comorbidity of the two disorders experience more sleep disturbances.

Objective: Objectives: The present study aimed to retrospectively evaluate patients who were operated for carotid body tumors (CBT) in our clinic.

Methods: The present study involved 19 patients who underwent surgical CBT removal in the Otorhinolaryngology- Head and Neck Surgery Department of Karadeniz Technical University Medical Faculty between 2013 and 2018. Sociodemographic characteristics, clinical presentation and findings of physical examination, Shamblin classifications based on preoperative radiological images, surgical procedure, histopathological diagnosis and complications were recorded from hospital records.

Results: Seven of the patients were male and 12 were female. The mean age of the patients was 48.8 years and the most frequent symptom was a painless mass in the neck. According to the Shamblin classification, seven of our patients had Shamblin type I, nine patients had Shamblin type II and three patients had Shamblin type III tumors. Twelve patients had preoperative embolization of the tumor and seven patients were operated without embolization. Three patients had intraoperative carotid artery injury-related complications, whereas one patient had weakness in tongue movements due to hypoglossal nerve paresis.

Conclusion: The main treatment for CBT is surgery, however, preoperative embolization is still controversial. Successful management of patients with CBT can be achieved via a multidisciplinary approach with the participation of head and neck surgery, cardiovascular surgery and radiology departments.

Objective: The present study compared three study groups composed of patients with only papillary thyroid carcinoma (PTC), patients with only Hashimoto’s thyroiditis (HT) and patients with PTC+HT in terms of BRAF-V600E, KRAS, NRAS and epidermal growth factor receptor (EGFR) mutations. Also, the association between clinicopathological prognostic indicators including tumor multifocality, extrathyroidal extension (ETE), lymph node (LN) metastasis and recurrence and BRAF-V600E mutations were investigated in the PTC and PTC+HT groups.

Methods: A total of 53 patients (two males and 51 females) who underwent a hemi/total thyroidectomy due to suspicion of malignancy or malignant lesion according to the thyroid cytopathology participated in the study. The study groups were composed of 19 patients with PTC, 18 with PTC+HT and 16 with HT according to the histopathological examination records. Histopathological sections from the paraffin blocks of the patients were investigated for BRAF-V600E, KRAS, NRAS and EGFR gene mutations using real-time polymerase chain reaction (PCR) assay.

Results: There was no significant difference between the groups in terms of BRAF-V600E KRAS, NRAS and EGFR mutation rates. Also, presence of the BRAF-V600E mutation was not correlated with the prognostic indicators for the patients with PTC and PTC+HT.

Conclusion: In the present study, no significant association was found between PTC and HT, and the BRAFV600E, KRAS, NRAS and EGFR mutations. Further studies with a larger number of patients may help to clarify the clinicopathological and diagnostic importance of the BRAF-V600E, KRAS, NRAS and EGFR mutations in thyroid diseases.