E-ISSN 2602-4837
Tr-ENT: 19 (1)

Volume: 19  Issue: 1 - 2009

ORIGINAL ARTICLE
1.Management of pain after tonsillectomy: a prospective, randomized clinical study
Nusret İnci, Oğuz Basut, Fikret Kasapoğlu, Hakan Coşkun
Pages 1 - 8
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Objectives: We evaluated the alleviation of posttonsillectomy
pain with systemic and topical applications.
Patients and Methods: Data obtained from 78 patients
(28 females, 50 males) who had undergone tonsillectomy
for recurrent tonsillitis by conventional cold surgery
were reviewed with prospective, randomized clinical
study. Initially, the patients were assigned into topical
and systemic drug groups. These groups were then
divided into three sub-groups; (i) clindamycin, dexamethasone,
and control (saline) (ii) groups for the topical
drug group; (iii) cefprozil, amoxicillin+clavulanate
and control (no medications except analgesic) for the
systemic drug group. The intensity of pain perceived
by the patients at 21 different times was assessed by
visual analog scale and facial scale.
Results: No significant relation was found between
topical or systemic antibiotic use and pain intensity
after tonsillectomy.
Conclusion: Neither topical application nor systemic
administration is significantly superior to the other
for postoperative management of pain

2.Unexpected findings in the neck dissection specimens for primary head and neck squamous cell carcinoma
Uğur Dokuzlar, Levent Erişen, Fikret Kasapoğlu, Hakan Coşkun, Oğuz Basut, Selçuk Onart, İbrahim Hızalan
Pages 9 - 15
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Objectives: We aimed to determine the incidence of unexpected
pathological findings observed during the histopathological
examination of the neck dissection specimens performed
for primary head and neck squamous cell carcinoma,
and their impacts on the treatment and follow-up plans.
Patients and Methods: We retrospectively reviewed 410
patients (369 males, 41 females; 169 patients unilateral,
241 patients bilateral) with a diagnosis of squamous cell
carcinoma of head and neck, who underwent 651 neck dissections.
Results: Unexpected pathological findings were found in 3.2%
of patients and 2% of neck dissections. These unexpected findings
were tuberculosis in eight patients (2%), metastatic papillary
thyroid carcinoma in three patients (0.7%), Warthin’s tumor
in one patient and cystic hygroma in one patient. All patients
who had metastatic papillary thyroid carcinoma received
radioactive iodine treatment after thyroidectomy. In control
examinations, none of these cases had problem related to
neither primary disease nor thyroid pathology. Only two of eight
patients who had tuberculosis in lymph nodes received medical
treatment for tuberculosis, while the others were observed by
clinical and radiological examinations. None of these patients
had problems related to tuberculosis. We had no long-term
follow-up results for cystic hygroma and Warthin’s tumor since
these patients did not continue their routine examinations.
Conclusion: During the pathologic examination of neck
dissections, unexpected pathologic findings may occasionally
be encountered. Most frequently seen unexpected
findings were tuberculosis lymphadenitis and metastatic
papillary thyroid carcinoma. However, these pathologic
findings do not seem to affect the management of the
primary disease.

3.Relations between symptoms, durations and triggers of attacks and concurrent diseases in paradoxical vocal fold movement disorder
Kürşat Yelken, Mehmet Güven, İbrahim Aladağ, Ahmet Eyibilen
Pages 16 - 21
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Objectives: To discover the relation between initial symptoms,
triggers and durations of attacks of paradoxical
vocal fold movement disorder (PVFMD) and concurrent
laryngeal and respiratory diseases.
Patients and Methods: Twenty one PVFMD patients
(17 females, 4 males; mean age 50 year; range 31 to 72
years) were included in the study. Diagnosis of PVFMD
was established when inpiratory and/or expiratory vocal
cord adduction was seen during laryngostroboscopy.
Results: Laryngeal and respiratory diseases accompanying
PVFMD were laryngopharyngeal reflux (n=15; 71%),
asthma (n=11; 52%), allergic rhinitis (n=6; 28%), chronic
sinusitis (n=1; 4%), right vocal cord paresis (n=1; 4%)
and chronic obstructive pulmonary disease (n=2; 9%),
(p=0.346). The most common symptoms were inspiratory
stridor (n=16; 76%), dyspnea (n=13; 60%) and cough
(n=9; 42%), (p=0.346). There was no significant relation
between concurrent diseases and the frequencies
of symptoms (0.091). Triggers for attacks were found to
be air pollutants including dust, smoke and temperature
variations (n=8; 38%), exercise (n=7; 33%), perfumes and
detergents (n=6; 28%), animal fur and pollen (n=4; 19%),
phonation and loud speaking (n=3; 14%) and emotional
stress-anxiety (n=1; 4%), (p=0.308). Durations of attacks
were several minutes in 14 patients (66%), several seconds
in five patients (23%) and more than one hour in two
patients (9%), (p=0.338).
Conclusion: Durations and triggers of attacks and initial
symptoms in paradoxical vocal fold movement disorder
seems not to be related with concurrent laryngeal and
respiratory diseases.

4.Combined treatment supported by piracetam and/or acyclovir in idiopathic sudden sensorineural hearing loss: experience with 81 cases
Süleyman Emre Karakurt, Mehmet Doğan Özkul, İbrahim Çukurova, Erhan Demirhan, Orhan Gazi Yiğitbaşı
Pages 22 - 27
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Objectives: To investigate the efficiency of piracetam
and acyclovir in treating sudden hearing loss.
Patients and Methods: Eightyone patients (44 males, 37
females; mean age 40.4 year; range 18 to 72 years) who
had treatment between January 2002 and December
2006 with diagnosis of idiopathic sudden hearing loss were
evaluated retrospectively. These patients were divided into
four groups according to the treatment they received. The
patients who had combined treatment constituted the first
group; those who had combined treatment and piracetam
the second; those who had combined treatment and
acyclovir the third; those who had combined treatment,
acyclovir, and piracetam the fourth group.
Results: For the four treatment groups, in the pre-and
post-treatment (10th day) evaluation of the treatment
efficiency made by calculation of the hearing thresholds
in 250-8000 Hz frequencies, no significant difference
between the groups was determined (p>0.05).
Conclusion: No additional benefit was obtained
with acyclovir and piracetam in treatment.

CASE REPORTS
5.Giant cervical lipoma invading carotid artery: a case report
Alper Tunga Derin, Kenan Güney, Murat Turhan, Abdullah Erdoğan, Bülent V. Ağırdır
Pages 28 - 31
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Lipomas are one of the most frequently encountered
benign tumors in any location. There is limited information
about head and neck lipomas in the litetature
and most data is in the form of case reports. Lipomas
can rarely reach gigantic sizes and can invade surrounding
tissues, especially skeletal muscles, and in
this case they are called infiltrating lipomas. In this
manuscript we report a case of cervical giant lipoma
surrounding and infiltrating the common carotid
artery which was treated by grafting carotid artery,
and our diagnostic work-up and treatment procedure
are discussed in the light of the literature

6.Pediatric plunging ranula and its surgery with transoral approach: a case report
Ahmet Eyibilen, İbrahim Aladağ, Mehmet Güven
Pages 32 - 35
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The plunging ranula is an uncommon condition
which presents itself as a fluctuating swelling in the
neck. It is less frequent during childhood. The ranula,
which is usually originated from sublingual gland,
is called the plunging ranula when it affects the submandibulary
space and adjacent structures in the
neck. There are a lot of different methods used in
surgical treatment. In this study, we present a plunging
ranula case which was performed by excision of
the pseudocyst and ipsilateral sublingual gland with
transoral approach in a five-year-old girl. There has
been no recurrence in four-year follow-up period.

7.Endoscopic treatment of idiopathic spontaneous although cerebrospinal fluid rhinorrhea: a case report
Leyla Kansu, Babür Akkuzu, Suat Avcı
Pages 36 - 40
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Although cerebrospinal fluid (CSF) rhinorrhea is a
rarely seen clinical entity, it is a condition which should
be considered carefully by otolaryngologists and neurosurgeons
because it has the possibility of serious
complications unless it is treated. Trauma is the most
common causative factor. Idiopathic spontaneous CSF
rhinorrhea is a very rare entity which is difficult to manage
and which hashigh recurrence rates. Although in
the past CSF rhinorrhea used to be treated by intracranial
route, nowadays endonasal endoscopic surgery is
preferred because of wide usage of rigid endoscopes
with much fewer complications, In this article, a case
of 43-year-old female with idiopathic spontaneous
CSF rhinorrhea repaired by endonasal endoscopic
surgery is presented, and the diagnosis and the treatment
of CSF rhinorrhea is reviewed

8.Extranasopharyngeal angiofibroma originating from the nasal septum: a case report
Melek Uyar, Mehmet Turanlı, Işın Pak, Sibel Bakır, Üstün Osma
Pages 41 - 44
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Angiofibromas (AFs) originate predominantly in the
nasopharynx and posterior nasal cavity. The incidence
of these lesions is less than 0.5% among
all neoplasms of head and neck. They originate
outside the nasopharynx rarely and can therefore
be misdiagnosed. The nasal septum is an extremely
rare site. Only four cases of extranasopharyngeal
angiofibromas arising in the nasal septum have been
reported so far. We report here a case of a vascular
mass arising from the nasal septum in a 19-year-old
boy which was extirpated by submucousal resection
endonasally. Histopathology confirmed it to be a
case of angiofibroma.

REVIEW
9.Head and neck cancers in geriatric patients
Ercihan Güney, Sedat Çağlı, İmdat Yüce
Pages 45 - 54
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Cancer is a disease the incidence of which rises
with age. Given that the risk of developing cancer
increases with advancing age, a growing number of
elderly patients will need treatment for cancer in the
future, and head and neck surgeons are increasingly
being faced with therapeutic dilemmas regarding
this age group. Related publications show that
older patients are less likely than younger patients to
receive standard treatment. Therapeutical planning
must be based not only on tumor characteristics, but
also on the physiological, rather than the chronological,
age of the patient. Comorbidity is the most
important factor in less intensively treatment of elderly
patients. Complete geriatric assessment and a multidisiclinary
approach are the crucial points. Surgeons,
radiation therapy specialists, medical oncologists and
geriatricians must actively cooperate in this setting.
Recruitment of elderly cancer patients to more clinical
trials is needed to enhance our knowledge and to
offer optimum treatment to this unique subgroup.

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