E-ISSN 2602-4837
The Turkish Journal of Ear Nose and Throat - Tr-ENT: 19 (5)
Volume: 19  Issue: 5 - 2009
ORIGINAL ARTICLE
1.Approach to the primary mass and neck in lower lip cancers: analysis of 24 cases
Çağatay Han Ülkü, Yavuz Yavuz Uyar
Pages 227 - 231
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Objectives: In this study, we analyzed the surgical approach
which we carried out for treatment of the primary mass and neck
in 24 lower lip cancer cases and its results.
Patients and Methods: 24 patients (5 females, 19 males; mean
age 56.8; range 41 to 72 years) who were operated on in our
clinic for lip cancer between March 1995 and March 2007 and
whom we were able to long term follow-up were included in this
study. Tumor was resected with 1-2 cm surgical margin in all
cases. The tissue defect was reconstructed by either primary
closure or local/regional flaps. If the tumor was located in the
middle of the lip, bilateral neck dissection, otherwise unilateral
neck dissection was performed. Postoperative radiotherapy was
used in cases who had neck metastatic disease. Functional
results were evaluated regarding recurrence and mortality rates
during five-year mean follow-up period.
Results: Tumor was originated from the lower lip alone in 20 cases.
There was secondary commissure involvement in four cases.
According to the TNM (tumor, node, metastasis) classification
(AJCC, 2002), distribution of the cases was T1N0M0 (n=10), T2N0M0
(n=9), T3N1M0 (n=3), T4N2aM0 (n=1), T4N2cM0 (n=1). Primary closure
(n=7), Abbe-Estlander flap (n=9), Karapandzic flap (n=4), Melolabial
flap (n=3), Fan flap (n=1), pectoralis major myocutaneous flap (n=2)
were used as reconstruction techniques. Histopatologically, metastatic
disease was determined in the neck in four cases. During the
follow-up period, there occurred ocal recurrence in two cases and
regional metastasis in one. Two cases with distant metastasis died.
Survival rates without illness for early and advanced stage tumors
were 100% and 20%, respectively. Functional results after reconstruction
were satisfactory, except in two cases which we used
pectoralis major myocutaneous flap for reconstruction.
Conclusion: Five-years survival rates without illness were significantly
lower in cases with advanced stage tumor and N positive
neck. This result indicates that stage of the tumor and neck involvement
have a significant effect on prognosis. Furthermore, more satisfactory
functional results were achieved in early stage tumors.

2.Repair of nasal septal perforation with different intranasal flap techniques and their outcomes
Ahmet İslam, Sevim Felek, Hatice Çelik, Necmi Arslan, İlknur Haberal Can, Haldun Oğuz
Pages 232 - 238
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Objectives: The aim of this study was to reveal the efficacy
of different nasal mucosal flap techniques in the repair of
nasal septal perforation.
Patients and Methods: Between April 2006 and May 2009
21 patients (12 males, 9 females; mean age 36.6±12.7 years;
range 17 to 60 years) with the complaints of nasal obstruction,
bleeding, crusting, whistling during inspiration, and pain
and in whom septum perforation was detected were operated
on and they were included in this study. The patients were
followed-up for an average of 16.9 months (3 to 35 months).
Cross-stealing technique was performed on 11 patients while
advancement flap was performed on three patients and rotation
flap was performed on seven patients. Patients were
followed-up for at least three months before the evaluation of
the postoperative results.
Results: Complete closure was observed in 16 out of 21
patients (76.2%) and partial closure in one patient (4.8%).
In four patients (19%) perforation was not closed and its
size remained unchanged.
Conclusion: In the literature, many different surgical techniques
have been described for the repair of nasal septal
perforation. The main aim of the repair is not only the closure
of perforation but also the restoration of normal function and
physiology in the nose. In order to achieve this, the most
physiologically and anatomically suitable method is the closure
of nasal septal perforation with three layers composed
of two mucoperichondrial flaps and one interpositional graft.
Although cross-stealing technique may be an anatomically
and physiologically feasible option for the closure of smallmiddle
sized perforation located anteriorly, the highest success
rates are obtained with advancement and rotation flaps
when the location and size of perforation are considered.

3.Palatal Pillar implants for the treatment of simple snoring
Ozan Seymen Sezen, Hande Kaytancı, Banu Salepçi, Gülfem Yurteri, Utku Kubilay, Temel Coşkuner, Benan Çağlayan, Şeref Ünver
Pages 239 - 245
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Objectives: In this study the efficacy of palatal implants
for treatment of snoring was evaluated.
Patients and Methods: Seventeen patients (10 males,
7 females; mean age 49.2±7.8 years; range 31 to 66
years) with primary snoring and an apnea-hypopnea
index of less than 15 were treated with palatal implants
after clinical and endoscopic examination. Snoringrelated
symptoms were evaluated at baseline and
90 days after surgery and polysomnography was
performed. Patients and their spouses completed
questionnaires and visual analog scales (VAS) evaluating
snoring, apneas, and the intensity, duration, and
social effects of daytime sleepiness at baseline and 90
days after surgery. Pre- and postoperative assesment
results were compared.
Results: Epworth sleepiness scale score was significantly
decreased in the postoperative period (p<0.05).
Postoperative mean VAS snoring, apnea, and daytime
sleepiness scores were also significantly improved
(p<0.01). No patients reported worsening of apnea,
5.9% of patients reported no change in apnea, and
94.1% of patients reported a marked decrease in
apneas. In the postoperative period, 76.4% of patients
reported reduced snoring, and 88.3% of patients
reported reduced daytime sleepiness.
Conclusion: Palatal implants have been demonstrated
to be a safe and effective treatment for snoring
with minimal patient discomfort. Establishing realistic
pretreatment expectations can maximize patient satisfaction.

4.Otorhinolaryngologic examination in obstructive sleep apnea syndrome: the correlation between the severity of sleep disorder and physical examination
Baran Acar, Mehmet Ali Babademez, Hayriye Karabulut, Bülent Çiftçi, Emre Günbey, Rıza Murat Karaşen
Pages 246 - 252
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Objectives: The aim of this study was to compare nasopharyngeal
examination findings with those of polysomnography, which
is considered to be the gold standard, in positional and nonpositional
obstructive sleep apnea syndrome (OSAS) patients.
Patients and Methods: The study included 374 patients
(215 males, 159 females; mean age 44.9 years; range 11 to
77 years) presenting with OSAS or simple snoring. Patients
underwent polysomnography recordings and otorhinolaryngologic
examination including fiberoptic nasopharyngoscopy
with the Müller maneuver. The correlation of the data scoredwith
the polysomnographic findings and body mass index
(BMI) was investigated. The findings were assessed using
the Mann Whitney U-test (anatomic findings) and Student
t-test (Müller maneuver).
Results: Body mass index was correlated with apnea-hypopnea
index (AHI), AHI-Lateral AHI-supine, the grade of the
tongue base and neck circumference (p<0.05). In general,
the dominant level of obstruction was at the soft palate level
in patients with severe OSAS. There was a positive correlation
between the grade of lateral obstruction at the soft palate
level and AHI and AHI-lateral (p=0.01, p=0.02, respectively).
The grade of anteroposterior obstruction at the tongue base
level had a significant correlation with AHI- total and AHIsupine
(p<0.05). The grade of the tonsillar hypertrophy
revealed significant correlation with AHI-total and AHI-supine
(p<0.05). There was no significant correlation between the
degree of the nasal septal deviation and AHI (p>0.05).
Conclusion: When upper airway obstruction is evaluated,
AHI and positional AHI values should be used separately.

5.Voice quality assessment via acoustic and spectrographic analysis in patients who had endolaryngeal microsurgery
Abdullah Onur Göksel, İlhan Topaloğlu
Pages 253 - 258
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Objectives: In this study, changes in quality of voice in
patients who underwent endolaryngeal microsurgery were
assessed by objective voice analyses.
Patients and Methods: Thirty patients (17 females, 13
males; mean age 34.3±11.5 years; range 17 to 65 years),
who underwent endolaryngeal microsurgery because of
benign vocal cord pathology and 25 people (12 females,
13 males; mean age 28.7±6.6 years; range 22 to 50 years),
without laryngeal pathology were included in this study.
Voice records, which were taken from the patients pre- and
postoperatively, and also from the control group, were analyzed
acoustically and spectrographically. Cool-Edit software
was used for voice recording, and Praat software was
used for voice analysis. Parameters, which were obtained in
the study, were compared statistically.
Results: When pre- and postoperative acoustic analysis
results were compared, it was found out that there was
significant difference in all parameters except fundamental
frequency. While S/Z ratio, and jitter and shimmer values
were significantly decreased postoperatively, maximum
phonation time, harmonic/noise ratio, and intensity values
were significantly increased. No important changes were
detected in fundamental frequency value. Postoperative
and control group findings were not significantly different.
At long term average spectrum analysis of the phonetically
balanced read passage records, postoperative
amplitude value was increased significantly, compared to
preoperative values.
Conclusion: Acoustic and spectrographic voice analyses
are objective methods which can be used to assess
effects of endolaryngeal microsurgery on quality of
voice.

6.Temporal bone transverse fracture and peripheric facial paralysis: our surgical approach and results
Çağatay Han Ülkü, Yavuz Uyar, Gökhan Kurnaz
Pages 259 - 262
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Objectives: In this study, our surgical approaches in temporal
bone transvers fracture cases with facial paralysis and their
results were evaluated.
Patients and Methods: Five temporal bone transverse fracture
cases (2 females, 3 males; mean age 32.8 years; range 4 to
62 years) with facial paralysis which were treated in our clinic
between July 1998 and July 2008 were included in this study.
Radiologic, audiologic, topographic and electrodiagnostic investigations
were made preoperatively. The evaluation of facial
nerve function was performed by using House-Brackmann (HB)
classification. Tympanic segment, ganglion geniculi and labyrinthine
segment were exposed by translabyrinthine approach
in all cases. Integrity of the facial nerve was achieved via
re-routing and end-to-end anastomosis or n. auricularis major
interpositional graft. The cases were evaluated regarding complications
and facial nerve function postoperatively.
Results: In the audiologic investigation ipsilateral total neurosensorial
hearing loss was determined in all cases. In four
cases facial paralysis was recognized immediately and in one
patient it was recognized when the patient was discharged from
the intensive care unit. Facial nerve function was HB stage V
in all cases. Surgery was performed in the first six weeks and it
was observed that integrity of the labyrinthine segment was distorted
in all cases. Reconstruction was performed by re-routing
and end-to-end anastomosis in three cases and n. auricularis
major interpositional graft in two cases. There were no postoperative
complications. Facial nerve function was HB stage II in
three cases (re-routing) and HB stage III in two cases (graft).
Conclusion: In temporal bone fracture cases with neurosensorial
hearing loss and facial paralysis, we achieved good exposure
via translabyrintine approach. Better functional results
were obtained in re-routing and end-to-end anastomosis technique
when compared to interpositional grafting.

7.The effect of intraperitoneal administration of zinc aspartate on myringosclerosis in perforated tympanic membranes of rats
İlhami Yıldırım, Harun Çıralık, Erdoğan Okur, Barlas Aydoğan, M. Akif Kılıç
Pages 263 - 267
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Objectives: The objective of the present study was
to determine the effect of zinc aspartate on myringosclerosis
in perforated rat tympanic membrane.
Patients and Methods: Fifteen Sprague-Dawley
rats were randomly divided into three groups each
containing five rats. Automicroscopic examinations
were performed and then all rats were bilaterally
myringotomized. Group 1 received no treatment.
Group 2 was treated with intraperitoneal injection of
physiological saline and group 3 with intraperitoneal
injection of zinc aspartate. Tympanic bullas were harvested
after 20 days. Histopathological evaluation
was carried out under the light microscope.
Results: When the groups were compared in the light of
the myringosclerotic findings, while there was no significant
difference between group 1 and 2 (p=1.00), it was
found that there were significant differences between
group 1 and 3, and between group 2 and 3 (p<0.03).
Conclusion: It appears that zinc aspartat treatment
has beneficial effects on prevention or retardation
of the development of myringosclerosis, but further
studies are needed to clarify this effect.

CASE REPORTS
8.Spontaneous displacement of silastic prosthesis 10 years after type 1 thyroplasty: a case report
Sinan Kocatürk, Güçlü Kaan Beriat, Cem Doğan
Pages 268 - 271
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Implant dislocation following type 1 tyroplasty mostly
results from the effects of triggering factors in the early
postoperative period. A 42-year-old female patient who
had had tyroplasty type 1 surgery with silastic implant,
applied to our clinic with cough episodes, dyspnea
and hoarseness following an upper airway infection
10 years after the surgery. In laryngeal endoscopic
examination of the patient, white colored irregularity
on anterior left vocal cord and left band ventricule
fullness was seen. Regarding the patient’s medical
history, it was thought that the silastic prosthesis which
had been implanted in the type 1 thyroplasty surgery
might have displaced. The silastic prosthesis was
removed by means of microsurgery technique through
endolaryngeal way under general anesthesia. During
the first month follow-up of the patient, dyspnea and
hoarseness complaints were improved right away and
she had no other problems. The causes and consequences
of displacement of the prothesis which rarely
occurs, after tyroplasty type 1 have been discussed
along with the latest data in the literature.

9.Reconstruction of the defects in the middle of the nose with subcutaneous pedicled nasolabial island flap: report of two cases
Rüştü Köse, İhsan Okur
Pages 272 - 276
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Two cases with basal cell carcinomas on the middle
of the nose were treated by using subcutaneous pedicled
nasolabial island flap. There were no partial or
total flap losses in either case and neither of the cases
had local recurrence during the follow-up period. The
subcutaneous pedicled nasolabial flap should be
considered to be an alternative to the paramedian
forehead flap for the reconstruction of defects on the
middle of the nose. In this article two cases in whom
subcutaneous pedicled nasolabial island flap method
was applied for the reconstruction of middle defects of
the nose are presented in the light of the literature.

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