RESUMEN
In Marfan's syndrome, which is a connective tissue disorder of hereditary origin, collagenous tissue development and bone synthesis are generally altered in addition to the occurrence of many systemic deformities. External ear, stapes, and vestibular aqueduct pathologies are reported as some of the otological deformities. However, the malleus and incus pathologies of the ear are not reported in any study. In the morphometric measurements carried out, the distance between the malleus head and manubrium was found to be 9.8 mm. When similar measurements were carried out for the incus, the distance between the upper part of the incus body and tip of the long process was found to be 6.9 mm. All of these measurements were detected to be greater than in normal people. It can be concluded from this study that in Marfan's syndrome, in addition to the musculoskeletal alterations particularly in bone synthesis, the ossicular chain in the middle ear is also affected.
Asunto(s)
Audiometría/métodos , Pérdida Auditiva Conductiva/diagnóstico , Yunque/diagnóstico por imagen , Martillo/diagnóstico por imagen , Síndrome de Marfan/diagnóstico , Tomografía Computarizada por Rayos X , Niño , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Pérdida Auditiva Conductiva/etiología , Pérdida Auditiva Conductiva/cirugía , Humanos , Yunque/patología , Yunque/cirugía , Martillo/patología , Martillo/cirugía , Síndrome de Marfan/complicaciones , Procedimientos Quirúrgicos Otológicos , Índice de Severidad de la EnfermedadRESUMEN
OBJECTIVE: We report a rare case of a spindle cell lipoma with atypical clinical course. CASE REPORT: A 51 year old female patient referred to our clinic with feeling of mass in the throat she had had for two years. The patient described difficulty in swallowing. Indirect laryngoscopy did not reveal any masses at bilateral pyriform sinuses, and the mucosa had a natural appearance. However, a mass with a stalk was detected in the side of the mouth when the patient retched. Endoscopic monitoring of the mass revealed its origin to be the left sinus pyriformis. No pathological structures could be detected in the indirect laryngoscopy taken after the patient gulped again. The mass was shown by magnetic resonance imaging to extend into the esophagus. It was removed using suspension microlaryngoscopy. Postoperative control revealed a complete healing at the excision site. Immunohistochemical examination for pathological diagnosis indicated a spindle cell lipoma. CONCLUSIONS: Laryngeal and hypopharyngeal lipomas are rare forms of benign laryngeal neoplasms. Their asymptomatic course makes diagnosis difficult. The patient is presented here with related clinical and pathological features.
Asunto(s)
Neoplasias Hipofaríngeas/diagnóstico , Lipoma/diagnóstico , Femenino , Humanos , Hipofaringe/patología , Neoplasias Laríngeas/diagnóstico , Laringoscopía , Persona de Mediana EdadRESUMEN
OBJECTIVES: Loss of taste function was studied pre- and postoperatively in patients who underwent myringoplasty. PATIENTS AND METHODS: Thirty-two patients who were diagnosed with chronic otitis media and underwent myringoplasty between May 2007 and May 2009 were included in the study. Regional taste test was performed preoperatively and two weeks after the operation in all patients planned to undergo myringoplasty. For patients describing disturbance in the postoperative taste test or in the questionnaire form, the taste test was repeated at six months after the operation and the questionnaire form was completed. RESULTS: Chorda tympani was preserved in 18 patients (56.2%), traumatized in nine patients (28.1%), and cut completely in five patients (15.7%). Totally in 10 out of 32 patients (31.2%), an disturbance in the taste test was found at two weeks postoperatively. Sweetness/saltiness, bitterness, and sourness taste disturbances were found in 10, nine, and two patients, respectively. Improvements were identified in two out of 10 patients in the taste test performed at six months. The disturbances in the taste tests of eight patients continued to exist at that time. Sweetness/saltiness, bitterness, and sourness taste disturbances were found in eight, seven and two patients, respectively. CONCLUSION: The chorda tympani nerve may be traumatized or completely cut as a complication of ear surgery. Sacrificing the nerve, where it is highly traumatized by surgical devices, reduces the duration of postoperative complaints.
Asunto(s)
Nervio de la Cuerda del Tímpano/lesiones , Miringoplastia/efectos adversos , Otitis Media/cirugía , Trastornos del Gusto/etiología , Adolescente , Adulto , Nervio de la Cuerda del Tímpano/fisiología , Nervio de la Cuerda del Tímpano/fisiopatología , Femenino , Humanos , Enfermedad Iatrogénica , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Trastornos del Gusto/diagnóstico , Adulto JovenRESUMEN
Radiofrequency ablation (RFA) is a technique which causes a reduction in tissue amount using ablation by high-frequency current. Beside other surgical tools, RFA has become quite popular over the past decade. Hypertrophy of the inferior turbinate is a common cause of chronic nasal obstruction. There is no agreement on how to deal with this problem. An ideal procedure for turbinate reduction should be performed with minimal discomfort or adverse reactions and should preserve the physiologic function of the turbinate, such as regulation of humidification and temperature of inspired air. All the current techniques have potential short and long-term complications such as bleeding and atrophic rhinitis. No technique is perfect, and the main goal of turbinate surgery should be the preservation of mucosal surfaces with reduction of submucosal tissue. The variety of surgical techniques available indicates the lack of consensus on the optimal technique. Radiofrequency tissue reduction is a surgical procedure that uses radiofrequency heating to induce submucosal tissue destruction, leading to the reduction of tissue volume. This energy induces ion agitation within the tissue, which increases the local temperature and causes a thermal lesion that should occur in the deep mucosa without damaging the surface. The healing process secondarily induces fibrosis with wound contraction, leading to tissue volume reduction. Radiofrequency ablation is an efficient, easily applicable technique, which does not lead to serious complications in the treatment of the nasal obstruction caused by inferior turbinate hypertrophy.
Asunto(s)
Ablación por Catéter , Hiperostosis/cirugía , Obstrucción Nasal/etiología , Cornetes Nasales/patología , Cornetes Nasales/cirugía , Ablación por Catéter/efectos adversos , Ablación por Catéter/métodos , Humanos , Hiperostosis/complicaciones , Obstrucción Nasal/cirugía , Recurrencia , Reoperación , Resultado del TratamientoRESUMEN
Management of recurrent epistaxis in patients on anticoagulant therapy is a challenging problem. In this article, we report our experience concerning the use of bivalve septal teflon splint (BSTS) for the treatment of recurrent mild epistaxis in a group of patients who underwent anticoagulant therapy after cardiac valve surgery. The study included 18 patients whose epistaxes recurred despite standard methods such as local pressure, vasoconstrictors, sedation, packing or cauterization. BSTS was sutured on the both sides of the nasal septum and held in place during one month. Epistaxis was controlled in all of the patients. We believe that the use of BSTS is an effective, easily applied, non-traumatic, well-tolerated additional method for the treatment of recurrent mild epistaxis in patients undergoing anticoagulant therapy, when other conventional treatments fail. Further controlled studies with larger groups are warranted in order to further evaluate this method.
Asunto(s)
Epistaxis/terapia , Férulas (Fijadores) , Adulto , Anticoagulantes/administración & dosificación , Epistaxis/inducido químicamente , Femenino , Implantación de Prótesis de Válvulas Cardíacas , Humanos , Masculino , Persona de Mediana Edad , Tabique Nasal , Politetrafluoroetileno , Recurrencia , Resultado del TratamientoRESUMEN
Idiopathic rhinitis without eosinophilia is a group of frequently observed diseases, the aetiopathogenesis of which is not yet well known. One of the most disturbing symptoms for patients within this disease group is nasal hypersecretion. Although many different treatments have been tried for hypersecretion, nasal topical drugs form the basis of any such therapy today. Ipratropium bromide (IB) is a drug offirst choice in nasal hypersecretion therapy. It displays a parasympatholytic effect in topical use and antagonizes acetylcholine transport in efferent parasympathetic nerves, thus decreasing submucosal gland secretion, which is the cause of hypersecretion. Botulinum toxin type A (BTX-A) is among the alternative treatment choices that is increasingly used in symptomatic treatment of nasal hypersecretion. Our study was planned with the aim of comparing the effect of these two groups of drugs on nasal hypersecretion. Thirty-eight patients who were diagnosed with idiopathic rhinitis without eosinophilia were included in the study and were divided in 3 different groups: In the first group, a total of 10 units of BTX-A were injected into both nasal cavities. In the second group, 3x2 IB was injected into both nasal cavities for 4 weeks. The third group received intranasal physiologic saline as placebo. The patients were evaluated in terms of nasal hypersecretion with visual analogue scale prior to the treatment and at weeks 1, 2, 4, 8, and 12 during the follow-up period. Throughout the 8 weeks follow-up period, the patient complaints displayed a 41.2% decrease in the group that received BTX-A and a 61.4% decrease in the group which received IB, while no change was observed in the control group. Both drug groups were well tolerated by the patients, with no serious adverse or systemic effects. As a result, while IB and BTX-A differ in terms of method of application, they display a similar degree and duration of efficiency in hypersecretion therapy.
Asunto(s)
Toxinas Botulínicas Tipo A/administración & dosificación , Broncodilatadores/administración & dosificación , Ipratropio/administración & dosificación , Mucosa Nasal/metabolismo , Fármacos Neuromusculares/administración & dosificación , Rinitis/tratamiento farmacológico , Administración Intranasal , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Moco/metabolismo , Mucosa Nasal/fisiopatología , Estudios Prospectivos , Rinitis/fisiopatología , Resultado del TratamientoRESUMEN
UNLABELLED: Although there are several factors affecting the pathogenesis of chronic otitis, the pathological process has not been entirely defined yet. One of the theories suggested for the development of middle ear diseases is tubal dysfunction. The aim of the study is to analyze the function of the tensor veli palatini (TVP) muscle electromyographically in chronic middle ear pathologies and to evaluate the role of this muscle in eustachian tube dysfunction and pathogenesis of associated middle ear diseases by comparing with the results of healthy individuals. STUDY DESIGN: A prospective, controlled, clinical trial. We enrolled 24 patients with chronic middle ear pathologies into our study and 18 controls without any previous ear problem. Electromyographic (EMG) needle was inserted into the TVP muscles in all patients transnasally. Functions of the TVP muscle were analyzed by using the amplitudes of the motor unit potential (MUP) and MUP durations detected on EMG. MUP amplitudes and MUP durations were compared statistically in all groups. When the mean MUP amplitudes and durations obtained from TVP muscles of all ears from the patient group were compared to the mean MUP amplitudes and durations obtained from healthy individuals, no statistically significant difference was observed between sick ears and control ears. Values obtained from the sick ears needed to be compared with mean values obtained from the control group separately, since absence of statistically significant difference cannot mean that we should ignore individual muscle dysfunction. The results we obtained from our study support that in the formation of different middle ear pathologies, myogenic defects in the eustachian tube have limited effects, except for existence of a predisposing factor like palate pathology. In all patients with chronic middle ear disease it is not appropriate to expect functional muscle dysfunction, however evaluation of TVP muscle function correctly may be helpful for bringing up the underlying possible muscle and nerve pathologies not in all patients.
Asunto(s)
Enfermedades del Oído/fisiopatología , Electromiografía , Trompa Auditiva/fisiopatología , Músculo Esquelético/fisiopatología , Adulto , Enfermedad Crónica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
OBJECTIVES: Nasal obstruction caused by inferior turbinate hypertrophies is one of the most frequent problems in otolaryngology. Treatment of this disease may involve medical and surgical methods. Thermal ablation with radiofrequency energy has become quite popular in the recent years as one of the surgical methods used when medical therapy is not adequate. STUDY DESIGN: Prospective, clinical trial. METHODS: Thermal ablation with radiofrequency energy was used in this study on the inferior turbinates of 21 patients who had nasal obstruction caused by inferior turbinate hypertrophy only. The results were evaluated subjectively by preoperative and postoperative patient- and physician-assigned visual analogue scales and objectively by magnetic resonance imaging (MRI) investigation. RESULTS: By the end of the postoperative week 10, 64.76% recovery was detected according to the patient evaluation, and 40.75% recovery was detected according to the physician evaluation. Measurement of the average volumes of the inferior turbinates by MRI revealed a 8.70% postoperative reduction. The most significant change was detected in the anterior-posterior length measurement performed in the axial plane. CONCLUSIONS: These results suggest that thermal ablation with radiofrequency energy is an easily applied, efficient, and reliable technique in treatment of the inferior turbinate hypertrophy, and that anterior-posterior length measurement in the axial section of the inferior turbinate by MRI, which is thought as an objective evaluation method, could be an efficient diagnostic tool in detecting the efficiency of radiofrequency on inferior turbinate.
Asunto(s)
Ablación por Catéter/métodos , Imagen por Resonancia Magnética , Obstrucción Nasal/patología , Obstrucción Nasal/cirugía , Complicaciones Posoperatorias , Encuestas y Cuestionarios , Cornetes Nasales/patología , Cornetes Nasales/cirugía , Adulto , Enfermedad Crónica , Femenino , Estudios de Seguimiento , Humanos , Hipertrofia/etiología , Hipertrofia/patología , Hipertrofia/cirugía , Masculino , Persona de Mediana Edad , Cuidados Posoperatorios , Cuidados Preoperatorios , Estudios Prospectivos , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
OBJECTIVES: We compared the extent of healing and hearing improvement following tympanoplasties performed with the use of cartilage-perichondrium composite grafts and temporalis muscle fascia grafts. PATIENTS AND METHODS: Fifty consecutive patients (22 males, 28 females; mean age 30+/-14 years; range 11 to 63 years) with chronic otitis media were divided into two groups to receive cartilage-perichondrium composite grafts or temporal muscle fascial grafts. All the patients were evaluated by pure-tone audiometry and otomicroscopic examination in the 1st, 3rd, 6th, and 12th months. RESULTS: At the end of the first year, graft survival was 92% in the cartilage group, and 85% in the fascia group. Hearing levels improved at the end of the first year; however, the two groups did not differ significantly in terms of hearing improvement and graft survival. Hearing gains were greater in central and subtotal perforations. In comparison with a steady increase in the cartilage group, hearing levels remained unchanged after the sixth month in the fascia group. CONCLUSION: Cartilage-perichondrium composite grafts may be easily and safely used in type I tympanoplasties, with successful results including hearing improvement.
Asunto(s)
Cartílago/trasplante , Fascia/trasplante , Otitis Media/cirugía , Membrana Timpánica/cirugía , Adolescente , Adulto , Anciano , Audiometría de Tonos Puros , Niño , Enfermedad Crónica , Supervivencia de Injerto , Humanos , Persona de Mediana Edad , Timpanoplastia/métodos , Cicatrización de HeridasRESUMEN
The sphenoid and the posterior ethmoid sinuses are surrounded by more vital structures than any other sinus. With the widespread acceptance and expanding role of endoscopic sinus surgery, a proper understanding of the anatomy of the sphenoid and the posterior ethmoid sinuses is achieved. We reviewed 100 CT studies of the paranasal sinuses belonging to patients examined for a chronic inflammatory disease of the nasal cavity and the paranasal sinuses. The relationship between the optic nerves and the paranasal sinuses is classified into four discrete categories. Type 1 with a proportion of 64% is observed to be the most often localized optic nerve. Type 2 is detected in 22% of the cases; types 3 and 4 are both 7% of the total number. A bony dehiscence was detected in 13.5% of the total cases, while it was observed in 39% of type 2 and 43% of type 3. We found a pneumatization of the anterior clinoid process in 11% of the patients. The proportion of pneumatization of the anterior clinoid process in type 3 configurations is found out to be as high as 86%. Optic nerve dehiscence was seen with a proportion of 23% in cases of pneumatization of the anterior clinoid process. Pneumatization of the posterior nasal septum was detected in 15% of the 100 cases. When the optic nerves were evaluated in these cases, mostly the type 1 configuration with a proportion of 63% was observed. An extensively pneumatized sphenoid sinus was detected in 4% of the 100 cases. Five of the investigated 8 optic nerves of these 4 cases were found out to be type 3 (62.5%). No significant optic nerve variations were met in patients with pneumatization of the posterior nasal septum. Nevertheless while performing surgery, it is important to bear in mind that there may be significant optic nerve variations with pneumatization of the anterior clinoid process and extensively pneumatized sphenoid sinuses.
Asunto(s)
Senos Etmoidales/diagnóstico por imagen , Nervio Óptico/diagnóstico por imagen , Seno Esfenoidal/diagnóstico por imagen , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tabique Nasal/diagnóstico por imagen , Sinusitis/diagnóstico por imagen , Hueso Esfenoides/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVES: One of the major causes of chronic nasal airway obstruction is disease of the inferior turbinate. However, there is no agreement on how to deal with this problem. Comparison was made of the nasal functions after treatment by radiofrequency tissue ablation, laser ablation, and partial turbinectomy using subjective symptom scores and objective tests. STUDY DESIGN: Prospective, randomized clinical trial. METHODS: The study was conducted on three groups of 45 adult volunteer patients with symptoms and signs of nasal obstruction and stuffiness related to enlarged turbinates. In group A, laser ablation was applied to the inferior turbinate on one side and partial turbinectomy to the inferior turbinate on the other side. In group B, radiofrequency tissue ablation was applied to the inferior turbinate on one side and partial turbinectomy to the inferior turbinate on the other side. In group C, patients who were not treated by any surgical techniques were the control subjects. Clinical examinations, visual analogue scales, rhinomanometry, and isotopic study of nasal mucociliary transport time were used to assess treatment outcomes. RESULTS: At 12 weeks after surgery, the nasal mucociliary transport time results were compared in the same patients. The average time was 25.60 minutes on the side where laser ablation was applied and 11.40 minutes on the side where partial turbinectomy (PT) was applied. In the patients on whom radiofrequency tissue ablation and partial turbinectomy were applied, the average nasal mucociliary transport time was 10.33 minutes on the radiofrequency tissue ablation side, whereas it was 11.33 minutes on the partial turbinectomy side. Rhinomanometric measurements demonstrated a significant decrease in nasal resistances at 12 weeks in both sides in groups A and B. CONCLUSIONS: In the study it was demonstrated that radiofrequency tissue ablation to the turbinate is effective in improving nasal obstruction objectively and in preserving nasal mucociliary function. Laser ablation of the turbinate is effective in improving the nasal obstruction; however, it disturbs the mucociliary function significantly. With the partial turbinectomy technique, results obtained were similar to the results with the radiofrequency tissue ablation technique.
Asunto(s)
Dióxido de Carbono/uso terapéutico , Terapia por Láser/métodos , Depuración Mucociliar/fisiología , Obstrucción Nasal/fisiopatología , Obstrucción Nasal/cirugía , Procedimientos Quirúrgicos Otorrinolaringológicos/métodos , Cornetes Nasales/fisiopatología , Cornetes Nasales/cirugía , Adulto , Enfermedad Crónica , Femenino , Humanos , Hipertrofia/patología , Hipertrofia/fisiopatología , Hipertrofia/cirugía , Masculino , Estudios Prospectivos , Rinomanometría/métodos , Cornetes Nasales/patologíaRESUMEN
OBJECTIVES: This study aimed to evaluate the techniques used in open structure rhinoplasty operations, together with a presentation of our results and experience. PATIENTS AND METHODS: The study included 122 patients (64 males, 58 females; mean age 27 years; range 17 to 48 years) who underwent open structure rhinoplasty. Of these, 72.9% had primary, 9% had revision surgeries; 18% had traumatic deformities. The mean follow-up period was 18 months (range 3 to 24 months). RESULTS: We did not encounter transcolumellar scar formation or flap necrosis in any of the cases. In five cases (4%), edema and hyperemia were detected in the columellar skin in the early postoperative period. Resorption of the tip graft developed in one (0.8%) of the patients in whom auricular cartilage grafts were used. A year after surgery, one patient (0.8%) presented with granulation tissue formation in the nasal vestibule, secondary to the use of nylon suture material. Axial deviation was seen in the early postoperative period in two patients (1.6%). Five patients (4%) required revision surgery. CONCLUSION: Open structure rhinoplasty gives excellent results when employed on proper indications and by experienced surgeons.
Asunto(s)
Nariz/cirugía , Rinoplastia/métodos , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tabique Nasal/cirugía , Nariz/anomalías , Nariz/lesiones , Nariz/patología , Colgajos Quirúrgicos , Técnicas de Sutura , Resultado del TratamientoRESUMEN
OBJECTIVES: We evaluated the effectiveness of radiofrequency tissue ablation in respiratory obstruction due to snoring and turbinate hypertrophy. PATIENTS AND METHODS: Thirty-three patients (9 females, 24 males; mean age 35.3 years; range 19 to 55 years) underwent 38 submucosal probe applications in the inferior turbinate (n = 15), soft palate (n = 13), and both (n = 5). Applications were performed in four regions of the soft palate, and in the anterior, medial, or posterior regions of the inferior turbinate depending on the hypertrophic site. Evaluations were made prior to, in the second month, and at the end of the first year of treatment. Snoring was evaluated using the Epworth Sleepiness Scale and subjective assessment. Respiration was evaluated by a visual analog scale. Maximum follow-up period was one year. RESULTS: Subjective evaluations made at the end of the first year showed that snoring decreased in 44.5% and disappeared in 50%. No change was observed in 5.5%. According to the patients' subjective evaluations and clinical examination findings complaints of obstruction decreased by 65.4% and 45.61%, respectively. No significant complications occurred. CONCLUSION: Radiofrequency tissue ablation may prove to be useful in appropriate patients. It is minimally invasive, requires low power and heat, and no general anesthesia, and is associated with low complication risks.