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Acute invasive fungal rhinosinusitis: Survival analysis and the prognostic indicators
(Ocean Side Publications Inc, 2015) Gode, Sercan; Turhal, Goksel; Ozturk, Kerem; Aysel, Abdulhalim; Midilli, Rasit; Karci, Bulent
Background: Acute invasive fungal rhinosinusitis (AIFR) is a highly mortal, progressive fungal infection of the paranasal sinuses and surrounding structures that is almost always seen in patients who are immunocompromised. Despite the use of newer antifungal treatments and early diagnosis, the prognosis of AIFR does not improve significantly. Due to the higher incidence of patients who are immunocompromised and have more complex disease, AIFR is a growing medical issue in tertiary medical centers. Objective: The aim of this study was to present the outcomes and analyze the prognostic indicators of patients with AIFR who underwent surgery. Methods: Between October 2009 and November 2014, 37 patients who underwent surgery for AIFR at a tertiary care university hospital were included in the study. Overall survival and disease-specific mortality and survival rates were calculated to estimate survival function. The impact of age, sex, underlying disease, extent of AIFR, applied medical treatment, and causative species (mucormycosis, aspergillosis) were also taken into consideration. Also, the effect of a variety of laboratory parameters, such as hemoglobin, leukocyte, neutrophil, lymphocyte, platelet, and C-reactive protein (CRP) levels, to survival were evaluated. Results: The median follow-up time was 58 days (interquartile range = 304). Overall and disease-specific mortality rates were 64.9 and 51.4%, respectively. Fever was the most common symptom (86.5%), along with nasal obstruction and/or fullness (48.6%) and epistaxis (48.6%). Age and sex did not have a significant impact on survival (p > 0.05). Palate involvement was significantly associated with mortality (p < 0.05). According to the results of Cox, regression analysis for disease-specific mortality rate, leukocyte and neutrophil counts as well as CRP levels had a significant effect on survival function (p < 0.05). Conclusions: Palatal involvement was associated with a higher mortality in our study. Also, leukocyte counts, neutrophile counts, and CRP values had a significant impact on survival function. The reversal of the underlying disease and immunosuppression is as important as the medical and surgical treatment.
The buccal fat pad flap for the reconstruction of intraoral buccal defects following buccal cancer surgery
(Elsevier Science Inc, 2022) Ozturk, Kerem; Turhal, Goksel; Sahin, Fetih Furkan
Objective: There are many reconstruction techniques for the repair of the intraoral buccal defects following oncological resections. The pedicled buccal fat pad (BFP) flap can be used for reconstruction of medium-sized buccal defects. The purpose of this study was to investigate the outcomes of the reconstruction with BFP flap following the resection of buccal tumors and risk factors on BFP flap success. Methods: This study was designed as a retrospective case series research. Ten patients with squamous cell carcinoma of the buccal mucosa underwent BFP flap reconstruction following tumor resection. The dimensions of the primary tumor and post-resection defect were calculated. The intraoral operation field was evaluated on the postoperative 7th day and in the postoperative 1 st and 6th months. Postoperative flap status, disease recurrence, risk factors for flap success were assessed. Results: The mean greatest dimension of the post-resection buccal defect was 41.9 +/- 10.3 mm. A partial dehiscence was observed in three patients in the postoperative 7th day. The 6th month-examination revealed no flap complications. The mean greatest dimension of post-resection buccal defect in uncomplicated patients was 42.7 +/- 11.4 mm and in patients with partial dehiscence was 40 +/- 8.6 mm (p = 0.727). There was no significant difference between uncomplicated patients and patients with partial dehiscence according to body mass index (normal vs overweight, p = 0.667). Conclusion: The BFP flap is a reliable reconstruction method in medium sized buccal defects following oncological resection. It has low complication and donor site morbidity rates and also good anatomical and oncological outcomes. (C) 2021 Asian AOMS, ASOMP, JSOP, JSOMS, JSOM, and JAMI. Published by Elsevier Ltd. All rights reserved.
A Case with Thyroid Cartilage Fracture after Sneezing
(Aves, 2020) Ates, Murat Samet; Turhal, Goksel; Aysel, Abdulhalim; Durusoy, Duygu; Ozturk, Kerem
Non-traumatic laryngeal injuries are unusual occasions. in the medical literature we found only six reports of cases that had laryngeal injury after sneezing. We report a case of a 34-year-old man diagnosed with thyroid cartilage fracture after a strong sneeze. in physical examination, edema and hematoma were seen in the right vocal cord and the right band. Computed tomog-raphy scan revealed an anterior thyroid cartilage fracture without separation. Antibiotics and steroids were administered. This is a very rare entity and the seventh case reported in the literature. Ear Nose Throat specialist should be aware of this situation.
Cavernous Sinus and Parasellar Region: An Endoscopic Endonasal Anatomic Cadaver Dissection
(Lippincott Williams & Wilkins, 2018) Erdogan, Umut; Turhal, Goksel; Kaya, Isa; Biceroglu, Huseyin; Midilli, Rasit; Gode, Sercan; Karci, Bulent
The aim of this study was to investigate the neurovascular structures of the cavernous sinus with the endonasal endoscopic transpterygoid approach on fresh human cadavers. Additionally, the course of internal carotid artery (ICA) and relevant anatomy was thoroughly investigated to refine the anatomical landmarks, exposure difficulties, potential complications, and limitations using the endonasal endoscopic technique. This study was carried out at an otolaryngology department of a tertiary medical center between June 2014 and June 2015. The surgical dissection was performed on 10 fresh human cadaver specimens using paranasal sinus and skull base endoscopic instruments. Cavernous sinuses and parasellar area were explored via an endoscopic endonasal transpterygoid approach. Dehiscence was present in 5 (25%) cavernous ICAs. Projection of the cavernous ICA on the whole lateral sphenoid wall was prominent in 6 (%30) sphenoid sinuses. Anterior curve was prominent in 12 (60%) cavernous ICAs, whereas posterior was prominent in 7 (35%). Mean distance between the lateral wall of eustachian tube orifice and petrous ICA was 19.50 +/- 1.05 mm (range 18-22 mm). Cranial nerves of the cavernous sinus showed no variation. Control of the ICA is critical during the endonasal endoscopic approach to the cavernous sinus and skull base. The vidian nerve is a reliable and important landmark to the petrous ICA in the transpterygoid approach. Dissection of the eustachian tube and its relation to the ICA has to be kept in mind during nasopharyngeal surgery.
Comparative outcomes of extracapsular dissection and superficial parotidectomy
(Taylor & Francis Ltd, 2019) Ozturk, Kerem; Ozturk, Arin; Turhal, Goksel; Kaya, Isa; Akyildiz, Serdar; Uluoz, Umit
Background: Retrospective analysis of extracapsular dissection (ECD) and superficial parotidectomy (SP). Aims/objectives: Comparing the outcomes of ECD and SP in surgery of benign parotid masses. Material and methods: Total of 136 patients included in the study. The inclusion criteria were pathologically proven benign FNA biopsy, lack of deep lobe invasion and single tumour diameter lower than 4 cm, absence of radiologically and clinically malignant lesion and facial paralysis at the time of diagnosis. Objectives: Drain volumes and seroma presence, clinical evaluation of face nerve function; signs of infective complications were collected from patients' clinic chart. Complications and recurrence rates were obtained from follow-up forms. Results: The mean follow-up period was 42.53 +/- 14.88 months. In SP group, three patients with disease recurrence were found, 8 (10.2%) had early facial nerve paralysis (grade 2 and 3) and 11 (14.1%) had Frey's syndrome. No postoperative complication, early facial paralysis and recurrence were observed in ECD group.
A Comparative Study: Platelet-Rich Fibrin Packing as an Alternative to the Absorbable Gelatine in Tympanoplasty
(Aves, 2022) Turhal, Goksel; Ozturk, Arin; Kirazli, Tayfun; Kaya, Isa
BACKGROUND: We aimed to investigate platelet-rich fibrin's potential role as packing material in both the middle ear and external auditory canal. METHODS: Twenty-nine patients undergoing transcanal endoscopic type 1 cartilage tympanoplasty were included in this controlled prospective clinical study. Patients were randomly assigned to platelet-rich fibrin (n = 14) or absorbable gelatine (n = 15) groups. Preoperative and postoperative pure-tone audiometry results, graft healing rates, tympanometry values, and Glasgow Benefit Inventory scores were compared. RESULTS: No significant postoperative complications were observed and the graft intake rate was 100% in both groups. Mean aft-bone gap gain was 9.82 +/- 4 dB HL in the postoperative first month and 10.08 +/- 491 dB HL in the sixth postoperative month in the platelet-rich fibrin group. There was no statistically significant difference between the postoperative air-bone gap gains of the groups in the first (P= .537) and sixth month (P= .723) controls. There was no statistically significant difference in compliance (P = .453) between groups. The physical benefit scores of the Glasgow Benefit Inventory were significantly higher in the platelet-rich fibrin group (P= .01).There was no difference in general and sodas benefit scores (P> .05). CONCLUSION: As a middle and external auditory canal packing agent, platelet-rich fibrin was as successful as absorbable gelatine in transcanal endoscopic cartilage tympanoplasty with similar functional results and graft healing rate.
A comparison of electrothermal bipolar vessel sealing system and electrocautery in selective neck dissection
(Springer, 2016) Ozturk, Kerem; Kaya, Isa; Turhal, Goksel; Ozturk, Arin; Gursan, Gulce; Akyildiz, Serdar
The use of LigaSure (TM) vessel sealing system in head and neck surgery was reported to be reliable and safe, providing sufficient hemostasis and reducing operating time. The aim of this study was to evaluate efficacy of this technique in patients undergoing selective neck dissections. This study was carried out as a prospective controlled study at an otolaryngology department of a tertiary medical center between July 2013 and July 2015. Twenty-five patients older than 18 years who underwent unilateral selective neck dissection for head and neck cancer were included in the study. In the control group (group 2, 10 patients) only monopolar and bipolar diathermy was used; in the Ligasure group (group 1, 15 patients) Ligasure was used for hemostasis and dissection in addition to the conventional techniques. Cervical lymphadenectomy time, operation time, preoperative hemoglobin levels, preoperative hematocrit levels, postoperative hemoglobin levels, postoperative hematocrit levels, total neck drainage and drain removal time were analyzed and compared between the groups. Median operation time in group 1 and 2 were 95 min (IQR = 35) and 142.5 min (IQR = 63), respectively. Median cervical lymphadenectomy time in group 1 and 2 were 55 min (IQR = 23) and 102.5 min (IQR = 49), respectively. Median operation time and cervical operation time were significantly lower in group 1 (p < 0.05). In conclusion, LigaSure (TM) vessel sealing system is a safe, efficacious technique and significantly lowers cervical lymphadenectomy and operation time in selective neck dissections compared to controls. Given the superb hemostatic properties, this technique should be in the surgeon's armamentarium when possible.
COMPARISON OF SWALLOWING IN DIFFERENT TYPES OF PARTIAL LARYNGECTOMIES
(Istanbul Univ, Fac Medicine, Publ Off, 2021) CetIn, Zeynep E. R. D. O. G. A. N.; EyIgor, Sibel; Ozturk, Kerem; Turhal, Goksel; Akyildiz, Serdar; Yavuzer, Atilla
Objective: We designed this study to assess and compare the effects of different partial laryngectomy (PL) techniques on swallowing. Material and Methods: Ten patients had laryngofissure with cordectomy, ten had frontal anterior laryngectomy with epiglottic reconstruction (FAL), ten had frontolateral laryngectomy (FLL), ten had cricohyoidopexy (CHP), ten had cricohyoidoepiglottopexy (CHEP), and ten had supraglotic laryngectomy. Swallowing was assessed with flexible endoscopy. Results: Mild or moderate dysphagia for solid foods was discovered significantly more often in CHP patients compared to FLL and FAL (p 0.05) patients. Dysphagia discoveries for semi-solid and liquid food didn't significantly differ among PL's (p 0.05). Compared to other PLs, the penetration-aspiration test with 10 ml of water was distinctly lower in cordectomy and FLL patients (p<0.05). Conclusion: Penetration and aspiration with 10 ml of water was marked lower in cordectomy and FLL patients matched to other PL patients. With studies involving more patients, it will be possible to increase the evidence value of our results.
Delayed Reconstruction with Full-Thickness Skin Grafts Following Defect Size Reduction in Head and Neck Nonmelanoma Skin Cancer
(Thieme Medical Publ Inc, 2020) Sezgin, Baha; Kaya, Isa; Turhal, Goksel; Apaydin, Fazil
Different treatment modalities have been applied for nonmelanoma skin cancers (NMSCs) of the head and neck area. One of the most important points after surgical treatment is the selection of appropriate reconstruction methods. the aim of this study is to investigate the efficacy and feasibility of the use of both defect size reduction with sutures and secondary healing with delayed reconstruction with full-thickness skin grafts in NMSC patients. in total, 18 (42.8%) male and 24 (57.2%) female patients with NMSC were operated. Defect size was measured both after excision and just before repair, and the approximate defect area was calculated with ImageJ software. Reconstruction was performed after 14 days in all patients in the second session, using free skin grafts. There were 18 (42.8%) male and 24 (57.2%) female patients. the mean age was 70.5 (45-82) years. the mean follow-up period was 40.3 (16-68) months. the mean defect area measured after excision was 8.44 +/- 1.91cm (2) . After 14 days of delay, the mean defect area was 5.51 +/- 1.28cm (2) (34.8% reduction) ( p <0.05). Defect-reduction methods applied during the first session, together with proper interval prior to placement of graft, have been shown to be beneficial and acceptable methods, providing an advantage in reconstruction with free skin graft.
Double nasoseptal flap technique for endonasal pituitary surgery
(Springer, 2017) Gode, Sercan; Biceroglu, Huseyin; Turhal, Goksel; Erdogan, Umut; Ates, Murat S.; Kaya, Isa; Ozgiray, Erkin; Midilli, Rasit; Karci, Bulent
Endoscopic endonasal approach has been successfully used for the management of pituitary tumors; however, the loss of septal mucosa especially around sphenoethmoidal recess and posterior nasal septum might be a disadvantage of this technique. The aim of this study is to describe a variation of the endonasal approach, "double nasoseptal flap'' technique in endoscopic transsphenoidal pituitary surgery, and to evaluate its outcomes. The technique depends on fully harvested bigger nasoseptal flap on one side and smaller on the other. Thirty patients were included. Functional results were assessed by preoperative and postoperative first month visual analogue scale (VAS), and morphology was evaluated by achieving intact septum from the sphenoid ostium to the columella. Sphenoid sinusitis, the presence of synechia and crusting in the sphenoethmoidal recess was also assessed. Mean VAS was 71 and 67 mm preoperatively and postoperatively, respectively (p > 0.01). There were no septal perforations, synechia, and sphenoid sinusitis postoperatively. Three patients had (10 %) crusts on sphenoethmoidal recess on first month postoperatively. Double nasoseptal flap technique has advantages, such as wider exposure during surgery; prepared flaps could be used if needed, better morphological and functional outcomes postoperatively. The technique is safe without any perforations and minimal crusting.
The Effect of Endoscopic Tympanoplasty on Cochlear Function
(Korean Soc Otorhinolaryngol, 2018) Kaya, Isa; Turhal, Goksel; Ozturk, Arin; Gode, Sercan; Bilgen, Cem; Kirazli, Tayfun
Objectives. The aim of this prospective clinical study was to measure the audiologic outcomes of the patients that underwent endoscopic transcanal cartilage tympanoplasty, and to investigate the effects on cochlear function. Methods. Thirty-three patients (33 ears) who were diagnosed with noncomplicated chronic otitis media and underwent endoscopic transcanal cartilage tympanoplasty technique were included. Pre- and postoperative first month distortion product otoacoustic emission (DPOAE) signal-to-noise ratio (SNR), bone conduction hearing levels and air bone gap (ABG) values were measured and total endoscope usage time was noted. Results. Preoperative median SNR measurements at 0.5, 1, 2, and 4 kHz were 6 dB (1-11; interquartile range [IQR], 1), 6 dB (4-20; IQR, 1), 7 dB (3-26; IQR, 5) and 5.50 dB (0-9; IQR, 3), respectively. Postoperative median SNR measurements at 0.5, 1, 2, and 4 kHz were 6 dB (3-9; IQR, 1), 6 dB (2-21; IQR, 3), 7 dB (2-20; IQR, 3), and 6 dB (0-10; IQR, 7), respectively. Regarding the DPOAE measurements, there was no statistically significant difference between the SNR values of all given frequencies (P>0.05). Regarding the pure tone audiometry (PTA) measurements, bone conduction was significantly better at 0.5 and 1 kHz, postoperatively (P<0.05) and there was statistically significant difference at 2 and 4 kHz (P>0.05). Additionally, no statistically significant correlation was found between the SNR and PTA measurements and the endoscope usage time (P>0.05). Conclusion. We suggested that cochlear functions and sensorineural hearing remained stable after endoscopic transcanal cartilage tympanoplasty and cold light source doesn't cause significant adverse effects cochlear functions.
The Effect of Mandibulectomy and Mandibulotomy on Cochlear Function
(Lippincott Williams & Wilkins, 2016) Gode, Sercan; Kaya, Isa; Turhal, Goksel; Kirazli, Tayfun; Bilgen, Cem; Ogut, Mehmet Fatih; Ozturk, Kerem
Mandibulectomy and mandibulotomy procedures are performed with the oscillating saw and the acoustic energy generated during the osteotomies is transferred to the cochlea via temporomandibular joint and air conduction. The aim of this study was to assess the effect of mandibulectomy and mandibulotomy on cochlear function. This study was carried out on 15 patients who underwent at an otolaryngology department of a tertiary medical center between January 2013 and August 2015. The study was designed as a prospective study. All of the data were prospectively collected. These included demographic data, date of the surgery, type of surgery, preoperative pure-tone audiometry, preoperative and postoperative distortion product otoacoustic emission (DPOAE) measurements. Of the DPOAE measurements, there was a statistically significant difference between the signal-to-noise ratio measurement on the right ear measurement at 4kHz (P<0.05). Additionally, there was a statistically significant correlation between the signal-to-noise ratio measurements and the side of the osteotomy (P<0.05). In conclusion, it is found that mandibulectomy and mandibulotomy procedure has a negative effect on cochlear function in the early period. The DPOAEs were diminished on the osteotomy site in day one postoperatively. Results with a longer follow-up time can yield more information on the prognosis of the cochlear damage.
The Effect of Mild Hypocapnia on Postoperative Ecchymosis in Rhinoplasty
(Sage Publications Inc, 2022) Turhal, Goksel; Ozturk, Arin; Berber, Veysel; Sergin, Demet; Gode, Sercan
Purpose: Ecchymosis and edema are the most common complications in patients following rhinoplasty in the early postoperative period. Vasoconstriction created by hypocarbia may have a positive effect on postoperative ecchymosis. The aim of this study was to evaluate the effect of mild hypocapnia induced in rhinoplasty on the severity of periorbital ecchymosis. Methods: The study was carried out retrospectively in the digital photographs (control group and study group) of 31 participants who underwent open technical rhinoplasty between January and March 2019. During the operation, partial carbon dioxide pressure in the study group was kept in the range of 32 to 38 mmHg and in the control group between 42 and 46 mmHg and this was confirmed by arterial blood gas measurements taken during the operation. Measuring the brightness and shadows of digital photos Digital color meter was used in MacOS X as a computer software. Results: The mean ratio of periorbital ecchymosis to forehead brightness was 0.84 +/- 0.05 in the study group and 0.81 +/- 0.03 in the control group. There was no significant difference between the study and control groups (P > .05). Conclusion: This study investigates the potential role of hypocapnia on postoperative ecchymosis during rhinoplasty. The severity of ecchymosis was less in the patients with induced mild hypocapnia regarding both subjective and objective evaluations, but this difference didn't reach statistical significance compared to the normocapnic control group.
The effect of partial superficial parotidectomy on amplitude, latency and threshold of facial nerve stimulation
(Springer, 2016) Ozturk, Kerem; Akyildiz, Serdar; Gode, Sercan; Turhal, Goksel; Gursan, Gulce; Kirazli, Tayfun
The aim of this study is to assess the effect of partial superficial parotidectomy and facial nerve dissection to electrophysiologic parameters of intraoperative facial nerve monitoring such as nerve stimulation threshold, stimulus amplitude and latency. Twenty-five patients who underwent partial superficial parotidectomy for benign parotid gland mass were included in the study. After the identification of the facial nerve main trunk, minimum stimulation threshold, latencies and amplitudes of the orbicularis oculi (electrode 1) and orbicularis oris (electrode 2) electrodes at 0.50 milliamperes (mA) were recorded. All of the recordings were repeated after the completion of parotidectomy. Median nerve dissection duration was calculated and size of the tumors was measured during macroscopic pathology. The median minimum nerve stimulation threshold was 0.15 mA [interquartile range (IQR) = 0.05] before and 0.15 mA (IQR = 0.08) after the parotidectomy (p = 0.02). Median nerve dissection duration was 49 min (IQR = 38). Median amplitude and latency in electrode 1 before and after the facial nerve dissection were 322 millivolts (mV) (IQR = 330), 370 mV (IQR = 370) (p = 0.02), 3 milliseconds (ms) (IQR = 1) and 4 ms (IQR = 2) (p = 0.05), respectively. Median amplitude and latency in electrode 2 before and after the facial nerve dissection were 396 mV (IQR = 275), 365 mV (IQR = 836) (p = 0.86), 3 ms (IQR = 1.5) and 4 ms (IQR = 1.5) (p = 0.17), respectively. Minimal nerve stimulation threshold and amplitude of electrode 1 were affected by facial nerve dissection among the electrophysiologic parameters (p = 0.02 and p = 0.02). Of the electrophysiological parameters only the latency of electrode 2 was significantly correlated with tumor size (p = 0.03). Besides, none of the parameters were predictive for a possible postoperative facial nerve dysfunction regarding superficial partial parotidectomy.
The Effect of Platelet-Rich Fibrin on Nasal Skin Thickness in Rhinoplasty
(Thieme Medical Publ Inc, 2019) Gode, Sercan; Ozturk, Arin; Kismali, Erkan; Berber, Veysel; Turhal, Goksel
The study hypothesized the potential positive effects of platelet-rich fibrin (PRF) in postoperative rhinoplasty patients, such as better wound healing, less dead space, and less edema. The authors assessed PRF for nasal dorsum camouflage and studied its potential effects on nasal dorsal skin in rhinoplasty. Thirty-eight patients who underwent open approach primary rhinoplasty were categorized into two groups: nasal dorsal PRF group and control group. PRF membrane was used for nasal dorsum camouflage and laid over the bony dorsum and cartilage framework of the supratip area. Skin and subcutaneous soft tissue thickness were measured by linear superficial tissue ultrasound at the pre- and postoperative first week and the third month in both groups. Mean skin thickness over the supratip area was significantly higher in the control group in the first-week control. There were no significant differences in both first-week and third-month controls' nasal dorsum mean skin thickness measurements between the two groups. Regarding PRF complications, we encountered no complications in either group, including scarring, hematoma, infection, skin discoloration, and acne. The authors present the application of PRF membrane over the bony dorsum and cartilage framework of the supratip area. They observed its positive effect on postoperative edema, especially in the early postoperative period. Long-term investigations have to be performed to evaluate its potential effect on the rhinoplasty procedure. This was a level of evidence 3 study.
En Bloc Resection of Supraglottic Carcinomas with Transoral Laser Microsurgery
(Galenos Yayincilik, 2021) Ozturk, Kerem; Ozturk, Arin; Turhal, Goksel
Objective: Complete en bloc supraglottic tumor excision with transoral laser microsurgery (TLM) can be achieved with good postoperative outcomes. We report surgical feasibility and the postsurgical outcomes of en bloc resection of supraglottic laryngeal squamous cell carcinomas (LSCC) with TLM. Methods: Seventeen patients who underwent TLM for supraglottic laryngeal cancer were inc luded in the study. Demographic and pathological data, clinic and follow-up outcomes of the patients were reviewed and analyzed. Results: Type 1 TLM was performed in three patients, type 2a in one patient, type 3b in 12 patients, and type 4b in one patient. Negative surgical margins were achieved in all of the cases. Re-excision or any adjuvant treatment for positive resection margins was not required in any of the cases. Eight patients received adjuvant radiotherapy due to lymph node metastasis. Mean follow-up time was 33.8 +/- 15.7 months (range: 10-65 months). None of the patients had recurrence or distant metastasis. Conclusion: The transoral approach with the use of CO2 laser and microscopy offers complete tumor excision for treating supraglottic LSCC. The three-dimensional structure of the supraglottis can be achieved with adequate exposure. En bloc resection is possible with safe margins.
Endoscopic endonasal approach to the vidian nerve and its relation to the surrounding structures: an anatomic cadaver study
(Springer, 2018) Karci, Bulent; Midilli, Rasit; Erdogan, Umut; Turhal, Goksel; Gode, Sercan
PurposeThe aim of this study was to investigate the neurovascular structures and their relevant anatomy with the endonasal endoscopic transpterygoid approach on fresh human cadavers. In addition, the relationship between the vidian nerve, ICA and surrounding structures were investigatedMethodsThis study was carried out at an otolaryngology department of a tertiary medical center between June 2014 and June 2015. Ten fresh human cadavers were included in this study. Pterygopalatine fossa was explored via an endoscopic endonasal transpterygoid approach. Same surgical dissection procedures were performed on all cadavers: maxillary antrostomy, anterior and posterior ethmoidectomy, sphenoidotomy, transpterygoid pterygopalatine fossa and vidian canal dissection.ResultsMean distance between the anterior nasal spine and ethmoidal crest was 60.35 1.31 mm (range 59-64 mm). Mean distance between the sphenopalatine foramen and superior border of choana was 18.30 +/- 1.38 mm (range 17-22 mm). Mean distance between the vidian canal and sphenopalatine foramen was 6.30 +/- 0.47 mm (range 5.5-7 mm). Mean distance between the vidian canal and anterior nasal spine was 64.6 +/- 1.71 mm (range 62-67 mm). Foramen rotundum was located superior lateral to the vidian canal in all specimens. Mean distance between foramen rotundum and vidian canal was 9.45 +/- 0.60 mm (range 8.5-10.5 mm). Course of the greater palatine nerve was always medial to the descending palatine artery. The mean length of the vidian nerve from the petrous ICA to the point the nerve exits the vidian canal (vidian canal length) was 17.90 +/- 1.59 mm (range 16-20 mm).ConclusionsThe distances between the vidian canal and surrounding neurovascular structures would help the skull base surgeon in this narrow and complex area.
Evaluation of Inferior Turbinate Stroma with Ultrasound Elastography in Allergic Rhinitis Patients
(Galenos Yayincilik, 2017) Turhal, Goksel; Gode, Sercan; Dalgic, Ceyda Tunakan; Sin, Aytul Zerrin; Kismali, Erkan; Kaya, Isa; Ozturk, Arin; Goksel, Ozlem; Midilli, Rasit; Ozturk, Kerem; Karci, Bulent
Background: Diagnosis of allergic rhinitis is primarily based on history, physical examination and allergy testing. A technique that noninvasively evaluates the soft tissue changes in the nasal mucosa of allergic rhinitis patients has not been defined. Aims: To assess nasal mucosal changes and measure the submucosal fibrosis in allergic rhinitis patients with sonoelastography. Study Design: Case control study. Methods: Eighty-eight turbinates of 44 patients were included in the study. There were 23 prick test positive allergic rhinitis patients. The control group constituted 21 patients. The rhinitis quality of life questionnaire and the visual analogue scale were applied to the allergic rhinitis patients. A higher visual analogue scale score indicated more severe allergic rhinitis symptoms. Sonoelastographic measurements were made from the lateral nasal wall. The propagation speed of sound waves was recorded in m/s. The presence of asthma and the type of allergic rhinitis (seasonal or perennial) was noted. Results: Ten patients had seasonal allergic rhinitis and thirteen patients had perennial allergic rhinitis. Six patients (26.1%) had accompanying asthma along with allergic rhinitis. The median visual analogue scale score was 7 (3-9) in allergic rhinitis patients. The median symptom duration was 7 (1-24) months. The median quality of life questionnaire score was 3.39 (1.68-5.43) points. The median sonoelastography scores of allergic rhinitis patients and healthy subjects were 2.38 m/s (0.9-4.47) and 2.42 m/s (1.62-3.50), respectively. Sonoelastographic measurements of seasonal and perennial allergic rhinitis patients did not differ significantly (p>0.05). The presence of asthma did not have a significant impact on the elastography measurements (p>0.05). However, regression analysis revealed a significant inverse correlation (coefficients: B=0.005, standard error=0.097, beta 0=0.008) between the visual analogue scale and sonoelastography scores (p<0.05). Conclusion: Sonoelastography was not suitable as a diagnostic tool in allergic rhinitis. Reduced sonoelastography scores were measured in more symptomatic patients. Higher visual analogue scale scores could be an indicator of disease severity.
Evaluation of Procalcitonin and hs-CRP Levels in Sudden Sensorineural Hearing Loss
(Aves, 2018) Gode, Sercan; Turhal, Goksel; Kaya, Isa; Mavili, Halil Ibrahim; Kirazli, Tayfun
OBJECTIVE: The aim of this study was to evaluate procalcitonin and high sensitive c-reactive protein (hs-CRP) levels in idiopathic sudden sensorineural hearing loss (ISSNHL) patients and assess their correlations with the clinical prognosis. MATERIALS and METHODS: Twenty-three ISSNHL patients were included in the study (group A). The control group was consisted of 19 patients (group B). Procalcitonin and hs-CRP levels were compared between the groups. The relationship between procalcitonin and hs-CRP levels and the configuration of the audiogram, degree of hearing loss [partial or total (>90 dB)], and status of improvement (improvement of >15 dB in the first month PTA) were evaluated. RESULTS: The mean age was 47.91 +/- 15.73 years (range 21-73 years) and 35.16 +/- 15.67 years (range 19-79 years) in groups A and B, respectively. Seven patients (30.4%) had underlying cardiovascular risk factors. Mean procalcitonin levels were 0.057 +/- 0.025 mu g/L and 0.041 +/- 0.016 mu g/L in groups A and B, respectively. Mean hs-CRP levels were 0.461 +/- 1.335 mg/dL and 0.129 +/- 0.125 mg/dL in groups A and B, respectively. Procalcitonin levels were significantly higher in group A than in group B (p=0.018). Procalcitonin levels were significantly lower (0.035 +/- 0.013 mu g/L vs. 0.061 +/- 0.025 mu g/L) in patients with low-frequency hearing loss (p=0.04). ROC analysis of procalcitonin values revealed that area under the curve was 0.80 (p=0.005). A cut-off procalcitonin level of 0.45 mu g/L yielded a sensitivity of 90% and specificity of 56.2%. CONCLUSION: In conclusion, as a proinflammatory marker, procalcitonin levels were higher in ISSNHL patients than in healthy controls. The procalcitonin level was significantly lower in upsloping-type hearing loss patients. This finding could be regarded as an indirect indicator of pathogenesis.
Evaluation of the Effect of Various Radiotherapy Modalities on Swallowing Function in Patients With Nasopharyngeal Cancer
(Sage Publications Inc, 2019) Cetin, Zeynep Erdogan; Eyigor, Sibel; Ozturk, Kerem; Akagunduz, Ozlem; Turhal, Goksel; Kirazli, Tayfun; Esassolak, Mustafa
The objective of this study was to compare the effect of curative 3-dimensional (3D) conformal radio-chemotherapy and intensity-modulated radiotherapy (IMRT) modalities on swallowing function in patients with nasopharyngeal cancer. Ten patients receiving 3D conformal radiotherapy and 10 patients receiving curative radiotherapy with IMRT, who were admitted for malignancy control for nasopharyngeal cancer, were included in the study. Swallowing functions were determined by flexible fiberoptic endoscopic evaluation. Premature spillage, retention pooling, penetration, aspiration, and reflex cough were evaluated. No statistically significant difference was found between patients receiving 3D conformal radiotherapy and IMRT regarding the scores of premature spillage, retention pooling, penetration, and aspiration with 3, 5, and 10 mL water and 5 mL yoghurt and fish crackers (P > .05). Velopharyngeal insufficiency or delayed onset of swallowing reflex was not found in any of the patients (P > .05). No significant difference was found between the groups in terms of the symptoms regarding subjective evaluation of swallowing (P > .05). Swallowing function did not differ among patients receiving IMRT and 3D conformal radiotherapy. Further studies with a larger sample size are warranted in order to verify the results.

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