E-ISSN 2602-4837
The Turkish Journal of Ear Nose and Throat - Tr-ENT: 17 (1)
Volume: 17  Issue: 1 - 2007
ORIGINAL ARTICLE
1.The results of combined treatment (surgery and postoperative radiotherapy) for tongue cancer and prognostic factors
Ahmet Karadeniz, Mert Saynak, Züleyha Kadehci, Merdan Fayda, Görkem Aksu, Hümeyra Kocaelli, Günter Hafız
Pages 1 - 6
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Objectives: We evaluated the results of surgical treatment
and postoperative radiotherapy and prognostic factors
in patients with primary tongue carcinoma.
Patients and Methods: The study included 60 patients
(31 males, 29 females; median age 54 years; range 22 to
82 years) who underwent surgery and postoperative radiotherapy
for oral tongue cancer. Tumor staging based on
the AJCC-1997 criteria was as follows: stage I (n=1), stage
II (n=21), stage III (n=12), and stage IVA (n=26). Surgery
included hemiglossectomy (n=46, 76%), partial (n=13,
22%) and total (n=1, 2%) glossectomy. Neck dissection
was performed in 47 patients (78%). Radiotherapy dose
was generally 6000 cGy/30 fr. The median follow-up was
51 months (range 5 to 180 months).
Results: The five-year overall and relapse-free survival
rates were 50% and 47%, respectively. Survival at five
years was 70% for stage I-III, and 20% for stage IVA. Most
of the relapses occurred in the first two years after treatment.
Recurrences were encountered in 31 patients
(52%). The median survival after recurrence was eight
months (range 1 to 53 months). In multivariate analyses,
significant prognostic factors for overall survival and
locoregional control were tumor size, stage, N stage,
extracapsular lymph node spread, and total duration of
radiotherapy. Complications were within acceptable limits.
Conclusion: Postoperative radiotherapy should be standard
for patients with stage III and IVA tongue cancer.

2.Transpalatal approach in juvenile nasopharyngeal angiofibroma
E. Evrim Ünsal Tuna, Cihan Karaca, Mustafa Kaymakçı, Cem Özbek, Cafer Özdem
Pages 7 - 12
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Objectives: Juvenile nasopharyngeal angiofibroma
(JNA) cases treated with transpalatal approach were
evaluated with respect to localization, complications,
intraoperative blood loss, recurrence, and prognosis.
Patients and Methods: The study included 15 male
patients (mean age 13 years; range 10 to 16 years)
treated for JNA. The patients were classified according
to the Chandler staging system. Transpalatal surgical
excision was performed in 14 patients. Preoperative
embolization of the maxillary arteries was performed in
three patients. One patient with intracranial extension
was treated with radiotherapy. The mean follow-up was
3 years-7 months (range 7 months to 7 years).
Results: Three patients (20%) had Chandler stage
II, 11 patients (73%) had stage III, and one patient
(7%) had stage IV disease. The mean intraoperative
blood loss was 575 ml in three patients with preoperative
embolization, and 1,079 ml in those without
embolization. The average intraoperative transfusion
requirement was 2.3 units. Recurrences developed
in three patients (20%), two of whom were
treated by surgery and one by radiotherapy.
Conclusion: Transpalatal surgical approach is
effective in the treatment of JNAs localized in the
nasopharynx, nasal cavity, and sphenoid sinuses,
with minimal mortality and morbidity.

3.The role of thyroplasty in the management of sulcus vocalis
Tolga Kandoğan
Pages 13 - 17
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Objectives: The results of objective and subjective
evaluation of postoperative vocal function were
assessed in patients treated with thyroplasty for the
correction of sulcus vocalis.
Patients and Methods: Six patients (5 males, 1
female; mean age 26 years; range 18 to 34 years)
underwent thyroplasty for sulcus vocalis. Voice evaluations
were performed one week before and two
months after surgery. None of the patients had voice
therapy before evaluations in the postoperative period.
The mean follow-up period was 14.8 months.
Results: Compared to the preoperative values,
postoperative voice handicap index scores were
significantly different (p=0.002). However, the difference
between the dysphonia severity index (DSI)
scores were not significant (p=0.810).
Conclusion: A subjective rather than an objective
improvement was observed in voice. Our results
suggest that, in the evaluation of voice patients,
therapeutic success should not be based only on
objective criteria, but subjective criteria should also
be considered.

4.“Cochlear conductive hearing loss” in patients with Meniere’s disease
Sertaç Yetişer, Mustafa Kertmen
Pages 18 - 21
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Objectives: Physiological studies with experimental
models of endolymphatic hydrops in Meniere's disease
demonstrate some pressure changes at the level
of round and oval window. Interestingly, conductive
type hearing loss was observed in some patients during
Meniere episodes. A close auditory follow-up of
these patients may provide a better understanding of
hydrodynamic changes of the hydrops and micromechanics
of the inner ear.
Patients and Methods: Eighty-four patients (mean
age 34.3 years; range 17 to 77 years) with Meniere’s
disease were enrolled in the study. Duration of
Meniere symptoms ranged between six months to
22 years (mean 6.2 years). Longitudinal follow-up of
patients was planned for three years. Bone and air
conduction thresholds were averaged and the differences
between the thresholds were calculated.
Results: Twenty-four patients (28.4%) demonstrated
air-bone gap at least at one frequency, the differences
being 18.3, 11.8, 2.8, and 11.1 dB at 0.5, 1, 2,
and 4 kHz, respectively. The average air-bone gap
was 11.5 dB. The difference was the greatest at 0.5
kHz and the least at 2 kHz.
Conclusion: Low-frequency conductive hearing loss
may be detected in Meniere’s disease, which is apparently
not indicative of middle ear pathology. High incidence
of conductive involvement in patients who have
had a recent episode of vertigo may indicate a distortion
of vibratory movement of the stapes.

5.Does topical N-acetylcysteine application after myringotomy cause severe otorrhea?
Arif Şanlı, Mehmet Eken, Cen Evren, Günay Ateş, Mustafa Paksoy
Pages 22 - 25
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Objectives: The effect of topical N-acetylcysteine
(NAC) application was investigated on the healing of
acute experimental tympanic membrane perforations.
Materials and Methods: Twenty guinea pigs were
used in this study. Under intraperitoneal ketamine
anesthesia, incisional myringotomies were performed
in the posterosuperior quadrant of the tympanic
membranes with a straight otologic hook.
The diameter of the perforations was approximately
2 mm. Perforations in both ears were treated with
freshly prepared sponges soaked in either 0.1 ml
0.9% NaCl solution (10 control animals) or 0.6
mg/0.1 ml NAC (10 animals) for three consecutive
days. All the tympanic membranes were examined
by otomicroscopy on the third, fifth, seventh, and
ninth days.
Results: In the control group, all the perforations
were completely closed at the end of nine days.
During the same period, only 40% of the perforations
were completely closed in the NAC group. The
remaining ears exhibited otorrhea by the third day.
Conclusion: N-acetylcysteine may cause severe
otorrhea in the healing process of tympanic membrane
perforations. Further studies including
histopathological examinations are required to elucidate
this condition.

6.Management of nasal polyposis arising from the olfactory cleft
Maged B., NAGUIB MD.
Pages 26 - 29
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Objectives: Although nasal polypi frequently arise
from the middle meatus, they may occasionally originate
from the olfactory cleft. Removal of these
polypi may be difficult because of obscure location
and concomitant occurrence of septal deviation.
This work describes surgical management of olfactory
cleft nasal polypi with a combined approach
involving septoplasty and endoscopic sinus surgery.
Patients and Methods: The study included 12
patients (4 females, 8 males; mean age 30.4; range
17 to 58 years) who were treated for nasal polypi
arising from the olfactory cleft. Polypi were unilateral
in four patients and bilateral in eight patients.
Endoscopic removal of the nasal polypi required an
initial septoplasty to allow visualization of the olfactory
cleft and to straighten the nasal septum. The follow-
up period ranged from three to six months.
Results: Visualization of the olfactory cleft was
accomplished without complications. This allowed
radical removal of nasal polypi in all the patients with
relief of initial symptoms. Total relief of nasal
obstruction was achieved in eight patients. Four
patients who had sagging nasal mucosa and bilateral
nasal polyposis had moderate relief.
Conclusions: Nasal polyposis arising from the
olfactory cleft can be effectively removed by nasal
endoscopy following an initial septoplasty to widen
the narrow area at the olfactory cleft for better visualization
and manipulation.

CASE REPORTS
7.Unusual distant metastasis of larynx carcinoma: a case report
Muharrem Dağlı, Aydın Acar, Adil Eryılmaz, Celil Göçer
Pages 37 - 39
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Although distant metastasis from larynx carcinoma is
more common in the late stages, it may sometimes
occur in the initial period of the disease. The tumor
spread may be by a lymphatic or nonlymphatic route. A
40-year-old male patient presented with complaints of
hoarseness and shortness of breath. Indirect laryngoscopic
examination showed a vegetable mass extending
from the left laryngeal side of the epiglottis to the left
vocal cord. Level 3 lymphadenopathies were noted in
the jugular region. Biopsy result revealed epidermoid
carcinoma. Magnetic resonance imaging performed
due to complaints of back pain and foot numbness
demonstrated aggressive spinal cord metastases. The
patient died on the tenth day of hospitalization.

8.Amyloidosis of the larynx: a case report
Özden Tulunay, Gürsel Dursun, Süha Beton, Hilal Erinç, Hünkar Batıkhan
Pages 40 - 43
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A 75-year-old female patient presented with hoarseness
and foreign body sensation in the back of her
throat of one-month history. Direct laryngoscopy
showed bilateral, yellow, hyperemic masses on the left
false vocal fold and laryngeal ventricle. Both true vocal
folds were mobile. Excisional biopsies of the right
false vocal fold and ventricle showed extracellular,
insoluble, fibrillar protein accumulation, consistent
with amyloidosis. There was no evidence for neoplasm.
Serum and urine electrophoreses were negative.
The work-up for systemic amyloidosis and
multiple myeloma were negative. Treatment was
limited to surgical excision. No complications developed
within a six-month follow-up period.

9.Papillary carcinoma arising from a thyroglossal duct cyst
Recep Yağız, Abdullah Taş, Şemsi Altaner, Ahmet Karasalihoğlu
Pages 44 - 47
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Tiroglossal duktus kisti boyun orta hat kitleleri içinde
en s›k karfl›lafl›lan do¤ufltan anomalidir. Bu kistten
karsinom geliflimi ise nadir olup, en s›k histolojik
tipini papiller karsinom oluflturmaktad›r. Bu yaz›-
da, boyun orta hatt›nda hiyoid kemik hizas›nda, a¤-
r›s›z ve yutkunmakla hareketli kitle saptanan 23 yafl›
nda erkek hasta sunuldu. Hastaya tiroglossal
duktus kisti öntan›s›yla Sistrunk ameliyat› uyguland›.
Cerrahi örne¤in histopatolojik incelemesi, tiroglossal
duktus kistinden kaynaklanan papiller karsinom
olarak bildirildi. Ameliyat sonras› dönemde tiroid
supresyon tedavisine baflland›. Hasta planl›
poliklinik kontrolleri ile 30 ayd›r hastal›ks›z olarak
takip edilmektedir.

10.Primary manifestation of hepatocellular carcinoma as a cervical mass
Emin Karaman, Harun Cansız, Engin Acıoğlu, Dilek Yılmaz Bayhan
Pages 48 - 52
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Metastasis of hepatocellular carcinoma to the head
and neck region is unusual and its exact frequency is
unknown. A 72-year-old male patient presented with
a mass on the left side of the neck. Clinical examination
showed multiple, painless, immobile lymphadenopathies
in the cervical region. Computed
tomography revealed both an irregular mass in the
cervical region and hepatomegaly accompanied by a
lobulated liver contour. The patient was diagnosed as
having hepatocellular carcinoma following an excisional
biopsy from the cervical mass and fine needle
aspiration biopsy from the liver.

11.Malignant peripheral nerve sheath tumor of the parotid gland
İsmet Aslan, Çağatay Oysu, Bilge Bilgiç, Bora Başaran, Engin Yazıcıoğlu
Pages 53 - 57
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Malignant peripheral nerve sheath tumors originating
from the parotid gland are extremely rare. A 76-yearold
male patient underwent an incisional biopsy for an
ulcerated mass in the anteroinferior aspect of the left
auricle. The diagnosis was made as malignant mesenchymal
tissue sarcoma, but the patient refused
treatment. Upon progressive growth of the mass within
two months, he underwent a partial parotid gland
resection. After three months, he was referred to our
clinic with an aggressively growing parotid mass. Total
parotidectomy and radical neck dissection were performed.
Histopathological diagnosis was malignant
peripheral nerve sheath tumor. Following radiotherapy,
has been under follow-up for five years.

12.Transoral approach to a huge neurofibroma of the parapharyngeal space: a case report
Enver Altaş, Nesrin Gürsan, Harun Üçüncü
Pages 58 - 62
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Neurofibroma of the parapharyngeal space accounts
for less than 2% of all parapharyngeal space neoplasms.
A 38-year-old man presented with complaints
of snoring and left-sided nasal obstruction. Medical history
also revealed numerous huge skin neurofibromas
and multiple café au lait spots all over the body.
Pharyngeal endoscopic examination disclosed a firm,
nonpulsatile submucosal mass, pushing the left pharyngeal
region approximately 5 cm medially, and
extending to the inferior part of the epiglottis. The tumor
was removed by transoral excision without any subsequent
complications. Histological and immunohistochemical
examinations revealed a neurofibroma.

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