Aksakal, Ceyhun; Akti, Serdar; Kars, Ayhan; Gökçe, Erkan

Frontal recess is an important region in endoscopic surgery in terms of its complex anatomic structure and excessive pneumatized cell variations. With the International Frontal Sinus Anatomy Classification (IFAC), classification and nomenclature of cellular variations in this region have been facilitated. The aim of the present study was to determine the incidence of frontal recess cell variations in computed tomography (CT) according to IFAC and to investigate the possible effect of these cells on the development of frontal sinusitis. In this observational, retrospective, and cross-sectional study, the frontal recess cell variations on both sides of the patients who underwent paranasal sinus CT examination were analyzed according to IFAC, and the possible relationship between these cellular variations and the presence of frontal sinusitis was evaluated by statistical methods. A total of 428 sides of 214 paranasal sinus computed tomography were examined. Agger nasi cell (ANC) was observed in 90.8%, while supra agger cell (SAC) were detected in 57.9% and supra agger frontal cell (SAFC) in 20.5%. Supra bulla cell (SBC) were observed in 80.1% of the sides and supra bulla frontal cell (SBFC) in 19.3%. Supraorbital ethmoid cell (SOEC) were detected on the 41.8% of sides, while frontal septal cells (FSCs) were observed in the 28.9%. The results of the present study showed that the prevalence of cells, especially other than ANC cells varies between populations. In addition, the presence of SAC, SAFC, SBC, SBFC, and SOEC appeared to be associated with a tendency to the development of frontal sinusitis.

Sahin, Abdulkadir; Sakat, Muhammed Sedat; Kilic, Korhan; Kars, Ayhan

Nasal septal perforation (NSP) is an anatomic defect located in the nasal septal cartilage/bone and mucosa. The most common cause of NSPs is septoplasty. Repair of NSPs is difficult regardless of the surgical technique due to their location and the health of the surrounding tissues. Currently, no technique has been defined to be used for the closure of all NSPs. We aimed to present our bipediculated crescent-shaped unilateral slide flap technique, which we designed and used as a modification for closure of NSPs, and its surgical results. A retrospective medical record review of patients who underwent NSP repair in our clinic was performed. All patients underwent a surgical procedure with the same technique by the same surgeon. Thirty-six patients were included in the study. The mean age of the patients was 35.58±9.6. The most common cause of NSP was previous septal surgeries. The NSP dimensions of the patients were between 5 and 23 mm. The NSP closure rate was determined as 94.4% in the 6-month follow-up results after surgery. A bipediculated crescent-shaped unilateral sliding flap is an effective, easy, and modification in the repair of NSPs.

Aksakal, Ceyhun; Kars, Ayhan; Altiparmak, Serkan

The aim of this study was to measure postoperative functional satisfaction in patients who underwent spreader graft or spreader flap procedures using the standardized Nasal Obstruction Symptoms Evaluation Score (NOSE) and to compare the 2 methods. Preoperative and early (1–3 mo), middle (4–6 mo), and late (≥9 mo) postoperative NOSE scores were compared in patients who underwent open rhinoplasty with the spreader graft (group 1) or spreader flap (group 2) techniques at our hospital. The patients’ demographic and surgical data were also analyzed. The study involved 63 patients who met the inclusion criteria. The spreader flap technique was used in 34 cases (29% female, mean age: 27.0±4.7 y) and the spreader graft in 29 (31% female, mean age: 26.2±5.4 y). The mean NOSE scores improved significantly in both groups at postoperative early evaluations (21.4±9.5 in the spreader flap and 18.7±14.9 in the spreader graft groups) compared with preoperative values (77.6±13.7 in the spreader flap and 76.9±15.4 in the spreader graft groups) (P<0.001). However, there were no significant differences in evaluations among the early, middle, and late postoperative periods. The study results revealed no significant difference between spreader graft and flap use in terms of improvement in functional outcomes. Both techniques are therefore functionally effective in rhinoplasty.

Tas, Hakan Gokalp

Intensive care units (ICUs) frequently perform percutaneous tracheostomy (PDT) on patients who need continuous mechanical ventilation. Percutaneous dilatational tracheostomy has a number of postoperative complications that vary in intensity and time, although being less invasive than surgical tracheostomy. This retrospective observational study looked at complication rates in adult patients who had PDT in a tertiary anesthetic ICU between January 2015 and December 2024. Patients who spent <30 days in the hospital overall were not included. The mean age of the 647 patients who were included was 67.1 ± 17.1 years. A total of 139 patients (21.5%) experienced complications following surgery. Minor bleeding and subcutaneous emphysema were among the minor complications (12.2%). Pneumothorax, bleeding requiring transfusion, and deep tissue infection were among the major complications (10.5%). Life-threatening complications (2.3%) included tracheoesophageal and tracheoarterial fistulas. There were no documented deaths from the surgery. Early postoperative surveillance is crucial, as the majority of problems (89.9%) happened within 7 days of surgery. Patients who developed complications had prolonged ICU stays and more complex treatment requirements during hospitalization. The results highlight the necessity of systematic postoperative care and surveillance by confirming that, despite PDT’s general safety, considerable morbidity can occur. These findings back up upcoming multicenter research aimed at improving patient outcomes and complication management procedures.

Atalay, Fatma; Kars, Ayhan; Kaan Önder, Mehmet Oguz; Gözeler, Mustafa Sitki; Demirci, Elif

Cervical thymic cyst is rare lesions leading to cervical mass. As it is a rare entity, it might be confused with other congenital neck masses or neoplastic lesions. Preoperative diagnosis is almost impossible. In the present study, a patient who was operated with prediagnosis of branchial cyst and diagnosed with thymic cyst according to the histopathologic examination was presented. A 16-month-old girl was admitted to our clinic with the complaint of growing right neck mass that was realized about 4 months ago. Magnetic resonance imaging (MRI) of the neck demonstrated a rim-enhanced hypointense cystic lesion in the posterior aspect of the submandibular gland, without tracheal right lateral and mid plane on MRI, curving common carotid artery to the medial. Patients underwent surgery under general anesthesia in company with existing findings. Hypoglossal nerve was surrounded by the mass, and the mass was totally resected. The final pathology result was reported as thymic cyst. Cervical thymic masses might be unnoticed in the differential diagnosis of the cervical mass as they are rarely seen entities. Histopathologic examination of the thymus tissue was performed for diagnosis. Surgical excision is the ideal treatment approach and no postoperative recurrence has been reported.

Akyuz, Servet; Turan, Fatih; Gurbuzler, Levent; Arici, Akgül; Sogut, Erkan; Ozkan, Ozalkan

Aim: To investigate and analyze the anti-inflammatory and antioxidant efficacy of curcumin in experimentally induced middle ear infection. Method: Twenty-four Wistar albino rats with otomicroscopic examination findings within normal limits were included in the study. Study groups were established after Streptococcus pneumoniae was inoculated into the middle ear cavity of all rats. No medication was administered to Group 1, the control group. Group 2 was administered 50 mg/kg/day amoxicillin intraperitoneally. Group 3 was administered 50 mg/kg/day amoxicillin together with 30 mg/kg/day curcumin intraperitoneally. Blood specimens and temporal bones were collected on the 10th day of medication from the 22 rats in which acute otitis media developed. Serum glutathione peroxidase and superoxide dismutase activities and malondialdehyde levels were measured. Inflammatory cell infiltration, vascular proliferation, and epithelial proliferation were assessed histopathologically in middle ear mucosa specimens, and the results were compared among the groups. Results: Malondialdehyde levels in the group given curcumin were significantly lower than those of the control group, while serum glutathione peroxidase activity was also lower compared to that of the control group. No significant difference was observed among the groups in terms of superoxide dismutase activity. Although there were no significant findings in terms of histopathological data, epithelial proliferation in the groups receiving antibiotherapy was suppressed compared to the control group. Similarly, curcumin was observed to have a positive effect on inflammatory cell infiltration. No significant changes were observed in terms of vascular proliferation. Conclusion: With its wide and safe dose range, curcumin represents grounds for optimism in terms of anti-inflammatory treatment in acute otitis media.

Basat, Salih Onur; Ceran, Fatih; Askeroglu, Ufuk; Aksan, Tolga; Orman, Cagdas; Yazar, Memet; Uscetin, Ilker; Akan, Mithat; Bozkurt, Mehmet

Background: Prominent ear deformity (PD) is an unacceptable condition of pinna that affects 5% of the population and is associated with emotional stress, behavioral disturbances, and social restrictions in relationships. Conchal hypertrphy, inadequate formation of antihelical fold, earlobe placement ahead than it should be, or various combinations of these changes are main characteristics of PD. Many surgical techniques have been described for the PD. The authors' aim was to present laterally based postauricular dermal flap combination with cartilage-sparing methods and effectiveness of this technique in suture extrusion prevention and reducing the rate of recurrence with long-term results. Methods: Forty-one patients had bilateral and 6 patients had unilateral PD, a total of 47 patients with a mean age of 14.48 were operated by using this combined procedure. A laterally based supraperichondrial dermal flap was prepared from a deepithelized elliptical postauricular incision. Mustarde and Furnas suture techniques were used solely for PD correction. The dissected laterally based dermal flap was fixed to the mastoid bone with sutures in stretched position after reshaping the auricular cartilage with sutures. Results: The average helix-mastoid distance was (mm) 16.28±2.36, concha-mastoid angle was 25.71±0.968 on 12- month measurements. The helix-mastoid distance showed an increase of 1 to 3 mm, in the concha-mastoid angle measurements of 1° to 2°. Statistically significant changes were observed between the average preoperative, postoperative 1. month, postoperative 12. month helix-mastoid distances (mm), and month concha-mastoid angle (0) measurements (P=0.0001). Conclusions: The laterally based postauricular dermal flap technique is an effective method to prevent suture extrusion and recurrence which are the most important complications of otoplasty procedure and easy to apply.

Tozoglu, S.; Bayramoglu, Z.; Ozkan, O.

The objectives of this study were to determine the prevalence of otologic complaints in patients with temporomandibular joint (TMJ) closed lock (CL), and to evaluate the efficacy of arthrocentesis in temporomandibular disorder (TMD) patients with otologic symptoms. Fifty-seven patients with TMJ CL wereincluded in this study. The pre-treatment evaluations included assessment of the maximum mouth opening (MMO); pain level in palpation of the affected TMJ; pain level with function; and otologic complaints, including otalgia, tinnitus, vertigo, and hearing loss. Arthrocentesis treatment was performed for all the patients, and post-treatment data were recorded 1 month later. Before arthrocentesis and lavage, the mean MMO was 24.67±4.61 mm; the mean tenderness score was 7.02±1.09; and the mean score for pain in function was 6.86±1.31. Following TMJ arthrocentesis and lavage, the mean MMO was 39.81mm± 4.56 mm; the mean tenderness score was 2.37±0.65; and the mean score for pain in function was 2.45±0.69. Seventeen (29.82%) patients reported at least 1 otologic complaint, 17 (29.82%) patients reported otalgia, and 8 (14.04%) patients reported tinnitus. Vertigo was noted in 5 (8.77%) patients. Complaints of hearing loss were not noted in any of the patients. After treatment, 14 patients no longer complained of otalgia, 5 patients no longer complained of tinnitus, and 2 patients no longer complained of vertigo. This represented a significant improvement in the patients' condition, especially in patients with otalgia (P>0.0006). As evident from the results of this study, arthrocentesis procedures reduce both TMD symptoms and otologic complaints.