Impact of Nasal Trauma on Olfactory Function

OBJECTIVE

To determine the impact of nasal trauma with and without the potential to produce nasal fracture on the olfactory function.

STUDY DESIGN

A descriptive analytical study.

PLACE AND DURATION OF STUDY

Ear, Nose, Throat Clinic, Ankara Numune Training and Research Hospital, Ankara from October 2018 to June 2019.

METHODOLOGY

The study included patients with nasal trauma and control subjects. The patients with nasal trauma were divided into two groups as fracture group (Group F, n=83) and non-fracture group (Group Non-F, n=30). The Group F was further divided into two subgroups according the presence as septal fracture as Group SF (patients with septal fracture) and Group Non-SF (patients with non-septal fracture). The smell functions of all participants were evaluated using the Sniffin' Sticks test. The odour scores of Group F and Group Non-F were compared versus control group, using the independent sample t-test or Mann-Whitney U-test. Percentage of patients with olfactory dysfunction was compared between Group F and Group Non-F and between Group SF and Group Non-SF using the Chi-square test.

RESULTS

There were a total of 113 participants with mean age of 35.64±10.44 years. The median TDI score of Group F was significantly lower in comparison to control group, no significant difference was found between Group Non-F and control group in terms of median TDI score. There was a significant difference between Group F and Group Non-F in terms of the percentage of patients with olfactory dysfunction. No significant difference was found between Group F and Group Non-F with respect to the percentage of patients with olfactory dysfunction.

CONCLUSION

Nasal trauma can lead to olfactory dysfunction only if it has the potential to produce a nasal fracture. Key Words: Smell disorders, Nasal bone, Bone fractures, Trauma.

Elevated serum calprotectin as an inflammatory marker in obstructive sleep apnea

OBJECTIVE

To investigate the serum calprotectin (SCal) levels and neutrophil/lymphocyte ratio (NLR) values in patients with obstructive sleep apnea (OSA).

METHODS

Sixty-seven OSA patients and 46 healthy volunteers without any sleep disorders were included in the study. The patient group was divided into three subgroups according to the severity of OSA. The SCal levels and NLR values were compared among subgroups and between the experimental and control groups.

RESULTS

The mean SCal level and NLR value were higher in the study group than in the control group (p = 0.002 and p = 0.001, respectively). The SCal levels were significantly higher in patients with severe OSA than in those with moderate and mild OSA (p = 0.004 and p = 0.001, respectively).

DISCUSSION

Unlike NLR, the SCal level may inform the severity of OSA and could be used as an indicator for OSA.

Endoscopic Resection of Pleomorphic Adenoma of the Nasal Septum

Pleomorphic adenomas originating from the minor salivary glands are rare in the nasal cavity. Total surgical excision is the preferred treatment for pleomorphic adenomas. Lateral rhinotomy, midfacial degloving, transpalatal surgery and endoscopic surgery are among the surgical approaches. Endoscopic tumor removal produces less morbidity, reduces blood loss during surgery, decreases hospital stay, avoids external scars and excessive unnecessary resection, enables the surgeon to better visualize the tumor margins, and has a low recurrence rate. However, only 3 pleomorphic adenomas of the nasal septum have been removed by the endoscopic approach to date. In this paper we report on a case of pleomorphic adenoma of the nasal septum that was removed successfully by the endoscopic approach without any recurrences.

Shoulder Function in Various Types of Neck Dissection. Role of Spinal Accessory Nerve and Cervical Plexus Preservation

Aims and background

The aim of this study is to determine the effects of two different types of nerve-sparing neck dissection on shoulder function. Even if the spinal accessory nerve is spared in functional neck dissection, some degree of shoulder syndrome may occur. The role of the cervical plexus in shoulder function and the effects of dissection of level 5 are emphasized.

Methods

Twenty-six patients with laryngeal carcinoma were studied prospectively. Seventeen anterolateral and 15 functional neck dissections were performed. Electromyographic evaluation was carried out in all patients to assess spinal accessory nerve function preoperatively and at the sixth week and sixth month postoperatively. Shoulder disability was evaluated by a questionnaire (shoulder pain disability index) and goniometric measurements were done preoperatively and at the sixth postoperative month.

Results

In patients who underwent anterolateral neck dissection, the goniometric results were better than in the functional neck dissection group. The questionnaire results also showed better quality of life of patients who underwent anterolateral neck dissection. Electrophysiological evaluation of the trapezius muscles of both groups at the sixth week showed significant differences. The distal motor latency values of the anterolateral neck dissection group were shorter than those of the other group. Electrophysiological evaluation at the sixth postoperative month showed shorter distal latency values in the anterolateral dissection group, without statistical significance.

Conclusions

Preservation of the cervical plexus and less disturbance of the spinal accessory nerve are important to diminish postoperative shoulder disability. The type of neck dissection has an important influence on shoulder function.

Relationship Between Neutrophil to Lymphocyte Ratio, Platelet to Lymphocyte Ratio and Obstructive Sleep Apnea Syndrome

BACKGROUND

Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) give information about many diseases. An increase in inflammation markers occurs in patients with obstructive sleep apnea syndrome (OSAS).

OBJECTIVES

The aim of this study is to determine the relationship between OSAS and NLR and PLR values.

MATERIAL AND METHODS

Two hundred eighty four patients with complaints of snoring and excessive daytime sleepiness were included in the study. Polysomnography had been performed on all patients and the control group. Fourty eight of these patients with apnea-hypopnea index (AHI) less than 5 (pure snoring) were included in the control group, 67 patients with AHI between 5 and 14.9 in the mild OSAS group, 61 patients with AHI between 15 and 29.9 in the moderate OSAS group and 108 patients with AHI more than 30 in the severe OSAS group. NLR and PLR values were calculated from the complete blood count (CBC) analysis of the patients and control group. The OSAS and control groups were compared by age, gender, body mass index (BMI) and PSG parameters as well as NLR and PLR values.

RESULTS

The PLR value in the OSAS group was found to be less than in the control group (p=0.006). As the non-REM AHI increased, the value of PLR decreased. As the nocturnal time spent with arterial oxygen saturation<90% increased, the value of NLR was determined to increase.

CONCLUSIONS

NLR and PLR values can give valuable information in OSAS.

Investigation of lateral pharyngeal walls in OSAS

The aim of this study is to investigate the relationship between the site of obstruction detected on Müller's maneuver and the polysomnography findings in patients with obstructive sleep apnea syndrome. This study is a prospective cohort study in a setting of Tertiary referral center. The study was performed on 87 patients (59 males and 28 females) with a mean age of 50 ± 10.34 years (range 20-83 years) who presented with the complaints of snoring, apnea, witnessed apnea and daytime sleepiness. The height and body weight of the enrolled patients were measured and the body mass indexes were calculated. The obstruction degrees of the soft palate and lateral pharyngeal walls at the level of the soft palate and the obstruction degrees of the tongue base and lateral pharyngeal walls at the level of the tongue base were determined using the Müller's maneuver. All patients underwent whole-night polysomnography at our hospital's Sleep Center. The apnea-hypopnea index values of the patients increased as their ages and body mass index values increased. There was a highly statistically significant correlation between apnea-hypopnea index and the obstruction degree of the lateral pharyngeal walls at the level of the tongue base on Müller's maneuver (p < 0.01). We found that the apnea-hypopnea index increased as the obstruction degree of the lateral pharyngeal walls increased on Müller's maneuver. In patients with obstructive sleep apnea syndrome, a high apnea-hypopnea index can be predicted if the obstruction degree of the lateral pharyngeal walls is high at the level of the tongue base on Müller's maneuver.

Investigation of the cochlear effects of intratympanic steroids administered following acoustic trauma

OBJECTIVES/HYPOTHESIS

To electrophysiologically and histomorphologically demonstrate the effects of intratympanic corticosteroids administered following an acoustic trauma on cochlear hair cells.

METHODS

The trial was performed on 16 Wistar albino rats. The rats underwent distortion product otoacoustic emissions (DPOAE) measurement before the acoustic trauma, and subsequently rats were exposed to noise. Following acoustic trauma, the otoacoustic emission measurement was repeated. The rats were divided into two groups, a study group and a control group. The study rats were injected with methylprednisolone via the intratympanic route throughout the study. In the control group, the rats were injected daily with saline. After performing repeated otoacoustic emission measurements, one rat in each of the groups was sacrificed and their cochleae isolated.

RESULTS

The histological investigation performed after the 1st week revealed a statistically significantly higher rate of apoptotic cells in the inner and particularly the outer hair cells of the rat cochleae in the control group compared to the study group. Early measurement of DPOAE within the 1st week demonstrated significantly better amplitudes in the study group compared to controls. The otoacoustic emission assessment performed on the 14th day demonstrated statistically similar DPOAE values between the two groups.

CONCLUSIONS

Intratympanic methylprednisolone injection administered following an acoustic trauma appears to reduce cochlear outer hair cell loss. The impact on hearing loss is less certain. Early measurement of DPOAE within the 1st week shows significantly better amplitudes in the study group compared to controls. However at 2 weeks, there is no statistically significant difference in DPOAE amplitudes between the study and control group.

A case of a coexisting aberrant internal carotid artery and persistent stapedial artery: the role of MR angiography in the diagnosis

We describe the case of a 37-year-old woman who presented with a complaint of recurrent headaches since childhood. Clinical examination revealed the presence of a reddish-bluish mass in the inferior half of the tympanic membrane in her right ear. Source and three-dimensional time-of-flight magnetic resonance angiography (MRA) detected a protruded right internal carotid artery (ICA) in the hypotympanum. The vertical segment of the ICA was absent, and the artery was narrowed and lateralized and had a "reverse 7" shape. Meanwhile, a persistent stapedial artery (PSA) was seen originating in the petrous portion of the ICA to form a middle meningeal artery. The A1 segment of the right anterior cerebral artery was hypoplastic. Based on these findings and on follow-up findings on computed tomography, the patient was diagnosed with a concomitant aberrant ICA and PSA. No intervention was undertaken. We review the management of this rare finding, and we discuss the role of MRA in its diagnosis.

Analysis of lower airway inflammation in a rabbit model of acute rhinosinusitis

This study aimed to investigate the association of inflammatory changes of upper and lower airways in a rabbit model of acute rhinosinusitis. The study included six adult albino rabbits. The sinuses of one animal were injected with saline solution and the animal was served as sham control. Other animals were implanted with intranasal S. aureus soaked-absorbable gelatin sponge. Acute rhinosinusitis was induced and subjects were sacrificed at the end of the second week. Tissue samples from all levels of the airway were obtained. They were evaluated for the presence of inflammatory changes histologically. A scoring system for airway inflammation was used for quantitative assessment of the degree of inflammation. Structural changes in the epithelial and stromal layers of the upper and lower airway structures were analyzed, as well. The animal of which the sinuses were injected with saline solution developed neither acute rhinosinusitis nor lower airway inflammation. In contrast, the animals in which acute rhinosinusitis was induced demonstrated significant upper and lower airway inflammation histologically. Inflammatory changes ranged from engorgement of blood vessels and polymorphonuclear cell proliferation within the capillaries, in the perivascular tissue of the epithelium or in the lamina propria and to epithelial disruption. Nasal airway inflammation scores (2.86 ± 1.81) were significantly higher than lower airway scores (1.36 ± 0.77), (P < 0.01). We obtained a generalized mucosal inflammatory response against localized bacterial inflammation in a rabbit model of acute rhinosinusitis, confirming the suggestion of 'one airway--one disease' from a bacterial infection point of view.

Comparison of glass ionomer cement and incus interposition in reconstruction of incus long process defects

The ossicles may be affected through the mass effect of the pathological tissue in chronic otitis media. Ossicular reconstruction may be accomplished using the patients' own ossicles or with alloplastic materials. Glass ionomer ossiculoplasty is a fast, efficient, safe and cost-effective method and it has been used more frequently in recent years. Forty-six patients who had surgery for chronic otitis media were included in this study. All patients had an incus long process defect and a normal stapes superstructure. Ossicular reconstruction was performed using glass ionomer cement (GIC) (Ketac-Cem, Espe Dental AG, Seefeld, Germany) in 23 patients (group 1), while incus interposition was performed in other 23 patients (group 2). Preoperative and postoperative air pure tone averages of the group 1 patients were 42.8 and 35.2 dB, respectively (p < 0.01). These values were 42.9 and 34.5 dB in group 2 (p < 0.01). Two groups were similar with respect to postoperative hearing gain (p > 0.05). The air bone gap of group 1 was 27 dB preoperatively and 20.7 dB postoperatively. These values were 28.7 and 20.2 dB, respectively, in group 2. The closure of air bone gap was statistically significant in both the groups (p < 0.01, p < 0.01). The comparison of the mean gains of the air bone gap revealed no difference between the groups (p > 0.05). In conclusion, the use of both GIC ossiculoplasty and incus interposition are efficient methods for reconstruction of incus long process and one is not superior to the other. A larger study population may be useful for comparison of these methods.

Comparison of Histopathological and CT Findings in Experimental Rabbit Sinusitis

The aim of this study was to investigate and compare histopathological and computerized tomographic (CT) findings of experimental acute sinusitis in an animal model. The noses of five healthy rabbits were inoculated with a gelatin sponge impregnated with a solution containing Staphylococcus aureus, and one healthy rabbit acted as the control. The animals were sacrificed on the tenth day, following the acquisition of paranasal CT scans. Specimens were obtained from the lateral nasal walls, and the ethmoid and maxillary sinuses of the animals for histopathological examination. Histopathological and CT findings were compared. Various degrees of epithelial disorganization, foci of ruptured epithelial cells, and inflammatory cell infiltration in the lamina propria were seen in the histopathological examinations of the five study rabbits, and mucosal thickening and soft tissue density were noted in their CTs. There was no correlation between the histopathological and CT findings. It was shown that CT did not reflect the acute changes in the sinus mucosa. Patients with chronic sinusitis must be evaluated for a chronic process. Computerized tomographic scans should not be obtained in acute sinusitis cases. In this way, both unnecessary radiation exposure and economic waste can be avoided.

Activation of vocal fold healing with topical vitamin A in rabbits

CONCLUSION

The results suggest that vitamin A can prevent scar formation in the vocal fold after surgery.

OBJECTIVES

This study aimed to evaluate the effects of topically applied vitamin A on healing after vocal fold trauma.

MATERIALS AND METHODS

Vocal folds of 20 adult rabbits were traumatized unilaterally. Ten of them were treated with topical application of vitamin A and the others served as controls. All animals were sacrificed after 10 days. Vocal folds were resected for analysis by light microscopy.

RESULTS

The untreated vocal folds showed extensive deposition of collagen and fibroblast on light microscopy and vocal folds treated with vitamin A showed less deposition. There was a significant difference between the two groups according to the percentage of collagen and fibroblasts in the lamina propria (p<0.01).

A misdiagnosis: duplication of the external auditory canal

We present imaging and clinical findings of a case with a duplicated external auditory canal, which led to misdiagnosis secondary to lipomatous content on imaging studies prior to surgery. It is a very rare congenital anomaly. This entity is usually misdiagnosed not only clinically but also radiologically. This leads to a delay and failure in diagnosis and treatment. To the best of our knowledge, herein is the first case report of the duplication of the external auditory canal presenting with dominant lipomatous imaging features. In this report, we aim to draw attention to the atypical presentation.

Traumatic nasal abscess concomitant with sinusitis: a case report

PROBLEMS/OBJECTIVES

Nasal septal abscesses are usually formed following nasal trauma or haematoma. A nasal septal abscess is defined as a collection of purulent material (pus) between the cartilage or bony septum and the mucoperichondrium or mucoperiosteum. Sinusitis and periorbital cellulites have been reported among the etiological factors and the complications.

METHODOLOGY

A case of posttraumatic nasal septal abscess is reported in a 35-year-old male patient.

RESULTS

Frontal, ethmoid, and sphenoid sinusitis, as well as periorbital cellulites were seen to accompany the septal abscess. The abscess was surgically drained and intravenous antibiotherapy was instituted.

CONCLUSION

Nasal trauma patients should be carefully assessed for posttraumatic haematoma and abscess formation, so that possible complications can be avoided by taking appropriate therapeutic measures.

Microdebrider for reduction of inferior turbinate: evaluation of effectiveness by computed tomography

OBJECTIVE

The microdebrider has been widely used in rhinologic surgery in the last few years, and there are reports on its use for inferior turbinate reduction. Computed tomography (CT) is commonly employed to show the reduction in the inferior turbinate after surgery; however, measurements on the scans are rarely made.

DESIGN

A prospective study.

SETTING

A tertiary research and training hospital.

METHODS

We investigated the effectiveness of microdebrider reduction in inferior turbinate hypertrophy in 12 turbinates of 9 patients.

MAIN OUTCOME MEASURES

Mean bone thicknesses were measured in CT in the anterior and middle portions of the inferior turbinates as an objective parameter. Preoperative and postoperative visual analogue scale scores for symptoms and endoscopic grading of the inferior turbinates were also used.

RESULTS

In the postoperative period, visual analogue scale scores for nasal obstruction decreased significantly. Endoscopic grading revealed that the inferior turbinates were significantly smaller in the postoperative period. Postoperative mean bone thicknesses measured in CT in the anterior and the middle portions of the inferior turbinates were significantly smaller than the preoperative ones; however, there was no significant difference between the measurements of the medial and lateral soft tissue thicknesses.

CONCLUSIONS

We suggest microdebrider turbinate surgery as a reliable alternative method for inferior turbinate reduction, especially in case of hypertrophy of the turbinate bone. Measurement of the inferior turbinate size in paranasal CT is a useful objective method for evaluation of the inferior turbinate hypertrophy and the assessment of the surgical outcomes.

Auditory brainstem response and otoacoustic emissions in Duane retraction syndrome

OBJECTIVE

We aimed to investigate the origin of hearing loss with relevance to auditory brainstem responses and otoacoustic emissions in patients with Duane's retraction syndrome (DRS).

MATERIALS AND METHODS

17 patients with DRS were included in the study. 14 patients were diagnosed as DRS type 1 and the remaining three as type 3. The control group consisted of nine healthy subjects. Pure tone audiogram, auditory brainstem response, as well as distortion product otoacoustic emissions were recorded in all the patients and the controls.

RESULTS

Among the 17 patients with DRS, 15 demonstrated normal hearing according to pure tone audiogram. One patient with DRS had profound sensorineural hearing loss with a pure tone average of 110 dB, and one patient had moderate sensorineural hearing loss with a pure tone average of 60 dB. Auditory brainstem response latencies of the waves I, III and V, and interwave latencies were calculated in 15 patients with DRS and were compared with the control group. There was statistically significant increase in wave I latency of left ear in the DRS group compared to the controls (P<0.05). Amplitudes of distortion product otoacoustic emissions were also recorded at frequencies of 2, 3, 4, 6, and 8 kHz in both groups and the comparison of the DRS patients and controls revealed no statistically significant difference.

CONCLUSIONS

We recommend auditory examinations be undertaken in patients with DRS by auditory brainstem response tests, as well as distortion product otoacoustic emissions, whereas all patients with normal results should be followed-up for future hearing loss.

Tortuous internal carotid artery narrowing pyriform sinus: two cases

An elongation of the internal carotid artery should be classified as a tortuosity or a kink. Tortuosity of the carotid artery is rarely seen in otolaryngologic practice. In videolaryngoscopic examination, bilateral pyriform sinus narrowing was found in one patient and unilateral pyriform sinus narrowing in the other patient. Computed tomographic scans showed tortuous internal carotid artery in both patients. Awareness of the possible internal carotid artery tortuosity is very important to prevent serious complications during laryngeal and pharyngeal surgical procedures.

Rhinolithiasis with a nasal polyp: a case report

Rhinoliths are uncommon mineralized masses that form as a result of calcification of an endogenous or exogenous nidus. The most common manifestations of rhinolithiasis are unilateral nasal discharge, nasal obstruction, and facial pain. The diagnosis is made by nasal endoscopy and computed tomography. The differential diagnosis includes chronic inflammation, osteomyelitis, benign tumors (e.g., calcified nasal polyps, ossifying fibromas, osteomas, and chondromas), and malignant tumors (e.g., osteosarcomas, chondrosarcomas, and squamous cell carcinomas). Rhinoliths may cause rhinosinusitis, erosion of the nasal septum and medial wall of the maxillary sinus, and perforations of the palate. To the best of our knowledge, the occurrence of a nasal polyp associated with rhinolithiasis has not been previously reported in the English-language literature. In this article, we describe such a case.

Vestibular nerve functions in children with auditory neuropathy

In disorders affecting the cochlear nerve it is highly probable that the vestibular nerve is involved as well. The caloric test and VEMP (vestibular evoked myogenic potentials) enable a separate evaluation of the inferior and superior vestibular nerve. In the present study we evaluated the inferior and superior vestibular nerves in three children with auditory neuropathy. Electrophysiological tests, VEMP and caloric tests were carried out in these three cases with the preliminary diagnosis of auditory neuropathy. Magnetic resonance imaging was obtained which revealed an intact cochlear nerve in all three patients. The caloric tests were all normal, while in two out of the three cases the VEMP test yielded abnormal results. Since the caloric test may prove abnormal as well, as reported in the literature, it would be valuable to carry out both of the tests in the vestibular evaluation of children with auditory neuropathy, in our opinion.

Rhinolithiasis with a Nasal Polyp: A Case Report

Rhinoliths are uncommon mineralized masses that form as a result of calcification of an endogenous or exogenous nidus. The most common manifestations of rhinolithiasis are unilateral nasal discharge, nasal obstruction, and facial pain. The diagnosis is made by nasal endoscopy and computed tomography. The differential diagnosis includes chronic inflammation, osteomyelitis, benign tumors (e.g., calcified nasal polyps, ossifying fibromas, osteomas, and chondromas), and malignant tumors (e.g., osteosarcomas, chondrosarcomas, and squamous cell carcinomas). Rhinoliths may cause rhinosinusitis, erosion of the nasal septum and medial wall of the maxillary sinus, and perforations of the palate. To the best of our knowledge, the occurrence of a nasal polyp associated with rhinolithiasis has not been previously reported in the English-language literature. In this article, we describe such a case.

Temporomandibular joint involvement in rheumatoid arthritis: correlation of clinical, laboratory and magnetic resonance imaging findings

OBJECTIVE

Rheumatoid arthritis is a systemic autoimmune disorder that involves many body joints including the temporomandibular joint. The frequency of temporomandibular joint involvement based on clinical and radiological findings is rather diverse and involvement may manifest as pain, restricted range of movement and locking of the joint. The aim of this study is to investigate and correlate the clinical, laboratory and magnetic resonance imaging findings in patients with rheumatoid arthritis.

METHODOLOGY

The temporomandibular joint involvement in 43 patients with rheumatoid arthritis, whose diagnoses were based on the revised 1987 criteria of the American College of Rheumatology, were evaluated using clinical examination, laboratory findings and magnetic resonance imaging.

RESULTS

Temporomandibular joint involvement was clinically observed in 28 patients (65.1%), and radiologically in 33 patients (76.7%). The most frequent physical examination finding, a "click" in the joint upon opening of the mouth, was found in 21 (48.8%) patients. The most frequently observed radiological finding was synovial proliferation seen in 22 (51.1%) patients. A statistically significant correlation was observed between erythrocyte sedimentation rate and the findings on magnetic resonance imaging; between the rheumatoid factor results and physical examination findings; and between the findings of the physical examination and magnetic resonance imaging.

CONCLUSION

The erythrocyte sedimentation rate, the rheumatoid factor results, and the findings on magnetic resonance imaging were found to be important in indicating temporomandibular joint involvement in rheumatoid arthritis. Further studies are necessary to specify the risk factors in more detail.

Hyoid chondroma presenting as an external neck mass

Chondromas of the larynx are rare neoplasms; only a few examples of cartilaginous tumors affecting hyoid bone have been reported. A 33-year-old woman presented with a neck mass on the left carotid triangle. The patient's computed tomography and magnetic resonance imaging revealed a heterogenous mass, which seemed to originate from the left greater cornu of hyoid. The mass was excised using a transcervical approach with left greater cornu of hyoid bone. The pathologic diagnosis was chondroma of hyoid. Expert radiologic and pathologic review is mandatory in cartilaginous neoplasms of the larynx. Cartilaginous neoplasms of the hyoid should be included in the differential diagnosis of neck masses at the carotid triangle.

Ethmomaxillary sinus

Ethmomaxillary sinus is a variation of the posterior ethmoid cells. It is formed by the extension of the posterior ethmoid cells into the maxillary sinus and drains into superior nasal meatus. It is incidentally seen on paranasal sinus computerized tomography (CT) scans. Its prevalence has been reported as 0.7 and 2% in two studies. In this study, paranasal CT scans of 466 patients were investigated for the presence of ethmomaxillary sinus. The patients had paranasal CT with the preliminary diagnoses of septal deviation, chronic inflammatory paranasal sinus disease and nasal turbinate disorders. The ethmomaxillary sinus was present in nine of those patients (1.93%). It was septated in one of them. The CTs were further investigated for other anatomical variations and co-existent mucosal disease of the paranasal sinuses.

Derevator: a soft tissue elevator for maxillary sinus in endoscopic sinus surgery

Removal of the soft tissue lesions from the maxillary sinus is sometimes difficult and time consuming in endoscopic sinus surgery. Failure of endoscopic removal may necessitate combination of canine fossa approach and endoscopic approach. Our new instrument, 'Derevator', is designed for easy removal of the pathological soft tissue lesions from the maxillary sinus through middle meatal antrostomy. Derevators are available for both adults and children. Suction-tipped ones are also available.

Bifid inferior turbinate: a case report

OBJECTIVES

A bifid inferior turbinate is an extremely rare anatomical variation and has been reported in only two cases to date. Including the present report, the uncinate processes were missing in all three patients reported. It is suggested that, in the reported patient, bifid inferior turbinate coexisted with a developmental anomaly of the uncinate process, and that the bifid inferior turbinate represented two separate turbinates originating from the same site.

CASE REPORT

We present the first reported case of bilateral bifid inferior turbinates, with a secondary middle turbinate, in a patient complaining of nasal obstruction.

CONCLUSION

We suggest that the superior part of the bifid inferior turbinate may have been formed by severe medial displacement and inferior rotation of the uncinate process, and that the bifid inferior turbinate is an anatomical abnormality of the uncinate process.

Fibrous dysplasia of inferior turbinate, middle turbinate, and frontal sinus

Fibrous dysplasia (FD) is a non-neoplastic fibro-osseous lesion. Paranasal sinus involvement is infrequent. Involvement of the frontal sinus, sphenoid sinus, and middle turbinate is rare, and only sporadic cases have been reported in the literature. Nasal turbinates and especially the inferior turbinate are the least involved bones of the craniofacial region. To the best of our knowledge, only one case with McCune-Albright syndrome had FD of the inferior turbinate. Here, we report a rare case with FD of inferior and middle turbinates and review literature concerning FD of the craniofacial region.

The association of laryngoceles with squamous cell carcinoma of the larynx presenting as a deep neck infection

OBJECTIVES

We present a case of an external laryngocele with laryngeal carcinoma.

INTRODUCTION

A laryngocele is a rare benign lesion of the larynx resulting from an abnormal dilation of the laryngeal saccule filled with air. When the neck of the laryngocele is obstructed, it fills with mucus and is called a laryngopyocele.

RESULTS

There may be a relationship between laryngoceles and squamous cell carcinomas of the larynx. A review of the literature found a reported association between laryngoceles and carcinomas of the larynx of between 4.9 and 54%. In this report, we present a case of an external laryngocele associated with laryngeal carcinoma. Another important point of this case is that a deep neck infection was the first symptom.

CONCLUSION

In the light of the cases presented in the literature, patients with a deep neck infection should undergo CT imaging and patients with laryngoceles must also be examined with direct laryngoscopy.

Adenoid cystic carcinoma of the parotid gland presenting as temporal bone neoplasm: a case report

PROBLEM

Temporal bone tumours are rare head and neck cancers that may involve both the parotid and the neck. In cases with concomitant temporal bone and parotid tissue involvement, tumour origin determination can be challenging. A tumour with parotid and temporal bone involvement is usually of temporal origin. The tumour may also be a rare parotid neoplasm with intratemporal invasion through the facial nerve, such as adenoid cystic carcinoma. These are slow-growing, yet locally aggressive tumours marked by late-stage distant metastases.

CASE REPORT

We describe a case of parotid adenoid cystic carcinoma invading the temporal bone via the facial nerve, presenting as primary temporal bone tumour with parotid tissue involvement. We emphasize the significance of intracranial involvement by perineural invasion.

CONCLUSION

Tumours mimicking temporal bone neoplasms can originate from the parotid tissue and invade through the facial nerve. Preoperative fine needle biopsy evaluation is indispensable for malignancy type determination and surgical planning.

Is there a relationship between myringosclerosis and atherosclerosis?

OBJECTIVE

Myringosclerosis and atherosclerosis are two different pathologies seen in different parts of the body. Both of these occur following a similar physiopathological process. However this has not previously been adequately discussed in the literature. Trauma to either the tympanic membrane or to the intimal layer of the arterial wall results in the formation of a sclerotic plaque. The goal of this study was to investigate the relationship between myringosclerosis and atherosclerosis.

PATIENTS

A total of 421 patients with the diagnosis of coronary artery disease were included in the study. All of the patients were evaluated for the presence of atherosclerosis by coronary angiography and for myringosclerosis by otoscopic examination.

MAIN OUTCOME MEASURES

The presence of myringosclerotic plaques, plaque dimensions and bilateral involvement of tympanic membranes were compared in the groups with and without atherosclerosis.

RESULTS

Amongst the 316 patients (75.0%) shown to have atherosclerosis, 65 (20.5%) also had myringosclerosis. Amongst the 105 patients without atherosclerosis, 24 (22.8%) had myringosclerosis. There was no statistically significant relationship between atherosclerosis and myringosclerosis (p > 0.05). Neither plaque dimensions nor bilateral involvement of the ears showed significant difference between the two groups (p >0.05 and p >0.05, respectively).

CONCLUSIONS

We conclude that there is no similar genetic tendency between atherosclerosis and myringosclerosis. The significance of the plaque dimensions and the bilateral involvement of tympanic membranes have not been satisfactorily discussed in the literature and this is the first time that they are being addressed. In contrast to the reported articles, there is no relationship between atherosclerosis and myringosclerosis other than being similar pathological processes occurring as a result of endothelial-epithelial damage.

Ceruminous gland carcinoma of the external auditory canal presenting as chronic otitis media

OBJECTIVE

Ceruminous neoplasms of the external ear canal are rare. Classification, clinical behavior, and management of these tumours are controversial. We report a case of carcinoma originating from the ceruminous glands of the external ear canal (EAC), operated based on a diagnosis of chronic otitis media with polyp.

CASE REPORT

A 48-year-old man presented with left ear discharge and hearing loss. Clinical examination showed a well-circumscribed polypoid mass limited to the EAC. There was no history of bloody ear discharge or radiological findings of bony erosion suggestive of malignancy. Our preliminary diagnosis was chronic otitis media with polyp formation. Tympanoplasty was performed. Histopathology revealed a ceruminous carcinoma, and an additional operation involving lateral temporal bone dissection was performed, followed by 60 Gy radiation therapy.

CONCLUSION

Ceruminous carcinomas should be considered in the differentialdiagnosis of middle and external ear pathologies in cases of soft tissue mass in the EAC.

Castleman's disease of the bilateral parotid gland: a case report

OBJECTIVE

Castleman's disease (CD) is a benign lymphoproliferative disorder characterized by enlarged hyperplastic lymph nodes. We describe a patient who was found to have Castleman's disease as the cause of a parotid mass.

METHODS AND RESULTS

The mass was the hyaline vascular type. After surgical excision of the largest masses on the right side, the patient was followed up for 6 months. Another mass in the left parotid region also became larger and was excised, with the pathological examination demonstrating Castleman's disease.

CONCLUSION

Although rare in the head or neck region, Castleman's disease should be considered when investigating head-neck diseases.

An epidermal cyst in the parotid gland following ear surgery: a case report

PROBLEM/OBJECTIVE

Iatrogenic epidermal cysts have been reported in various locations following otological surgical procedures. Especially after endaural incisions, surgeons may implant squamous epithelium into underlying tissue. An epidermal cyst of the parotid region may appear years after ipsilateral ear surgery.

METHODOLOGY

A cystic lesion in the superficial lobe of the parotid gland was identified by computed tomography and ultrasonography in a 30-year-old man with a history of myringoplasty and endaural surgery. A superficial parotidectomy was performed to remove the mass.

RESULTS

The mass was histopathologically diagnosed as an epidermal cyst.

CONCLUSION

If a cystic lesion is present in the parotid gland in a patient with a history of otologic surgery, it must be considered that the mass is of epidermal origin.

Extranasopharyngeal angiofibroma of the cheek

Angiofibromas rarely localize in extranasopharyngeal sites. The most common site for extranasopharyngeal angiofibromas is the maxillary sinus. The ethmoid and sphenoid sinuses, nasal septum, middle and inferior turbinates, conjunctiva, molar and retromolar region, and larynx are other sites where extranasopharyngeal angiofibromas have been reported. Only one case of buccal extranasopharyngeal angiofibroma has been reported to date. We present a case of buccal extranasopharyngeal angiofibroma that was excised completely following embolization and we also review the literature.

Endolaryngeal resection of laryngeal chondrosarcoma

Chondrosarcoma is a rare tumor. In this study, we present a case with laryngeal chondrosarcoma that was treated by an endolaryngeal approach using an operation microscope. The patient remains disease-free to date, with no evidence of new or recurrent disease more than 3 years after the endolaryngeal surgery. The computerized tomography and endoscopic examinations did not reveal any recurrent disease, indicating the success of the endolaryngeal approach.

Soft-tissue complications of laser surgery for recurrent respiratory papillomatosis

Twenty-two patients with recurrent respiratory papillomatosis underwent 105 carbon dioxide (CO2) laser microlaryngoscopic and tracheobronchoscopic operations from July 1986 through February 1990. All soft-tissue complications, whether intraoperative or delayed secondary to laser surgery, were retrospectively analyzed. The intraoperative laser-related soft-tissue complication rate was zero. Two of the 22 patients acquired slight unilateral true vocal cord scar tissue and 1 patient developed a small posterior laryngeal web. The delayed soft-tissue complication rate was 13.6%, which compares favorably with published reports of 28.7% and 45%. This low complication rate has resulted from the selection of appropriate CO2 laser emission parameters and the use of the microspot micromanipulator, which help minimize lateral and/or deep thermal damage at the site of laser impact.

Microsubglottoscopy: an expansion of operative microlaryngoscopy

The development of the adult subglottiscope has facilitated expansion of the indications for operative microlaryngoscopy to include surgery in the subglottic region of the larynx, as well as in the upper cervical trachea. A set of microlaryngeal instruments with an elongated shaft has been developed to support the use of the subglottiscope in the adult patient population. During the 18-month period from January 1, 1988, through June 30, 1989, sixteen adult patients with subglottic or upper cervical tracheal pathology were operated on a total of twenty-three times, using the adult subglottiscope to facilitate exposure and treatment. The patients' pathologic conditions included subglottic stenosis, subglottic granuloma, subglottic extension of laryngeal hemangioma and papilloma, and suprastomal granuloma. Two selected cases are presented to highlight indications for the use of this instrument. We have found the exposure of these subglottic and upper cervical tracheal lesions, using the binocular, microlaryngeal approach facilitated by the adult subglottiscope, to be improved over that obtained with existing microlaryngoscopes or conventional tracheoscopes.