E-ISSN 2602-4837
The Turkish Journal of Ear Nose and Throat - Tr-ENT: 29 (3)
Volume: 29  Issue: 3 - 2019
1.Cover

Pages I - IV

ORIGINAL ARTICLE
2.Utilization of Tutopatch® bovine pericardium xenograft for nasal dorsum augmentation in primary and secondary rhinoplasties
Aret Çerçi Özkan, Erdem Güven
doi: 10.5606/Tr-ENT.2019.63825  Pages 111 - 118
INTRODUCTION: The aim of this study was to present the utilization of Tutopatch® bovine pericardium xenograft for nasal dorsum augmentation and/or camouflage in primary and secondary rhinoplasties.
METHODS: Between January 2017 and July 2019, the Tutopatch® bovine pericardium was used for nasal dorsum or glabellar augmentation in eight patients (3 males, 5 females: mean age 35 years; range, 25 to 43 years) and used for camouflage in six patients (1 male, 5 females; mean age: 30 years; range, 27 to 38 years) having rhinoplasty operations. Medical data of the patients were retrospectively analyzed. Pre- and postoperative results were compared. Degree of satisfaction was self-reported by the patients.
RESULTS: The mean follow-up was 16 (range, 6 to 24) months. Only one major complication due to the overcorrection of the nasal dorsum with a small hump was observed in a secondary rhinoplasty case necessitating further revision. Other types of complications such as erythema, undercorrection, malposition, seroma, hematoma, or graft extrusion were not observed. All patients, except for the case necessitating further revision were satisfied with the outcomes.
DISCUSSION AND CONCLUSION: Utilization of Tutopatch® bovine pericardium xenograft in wrapping the diced cartilage for nasal dorsum augmentation or as the camouflage material over the nasal dorsum and nasal tip skeleton in either primary or secondary rhinoplasty operations can be a wise option without any adverse allergic reaction or donor site morbidity.

3.Evaluation of vestibular system using c-VEMP and o-VEMP in patients with relapsing-remitting multiple sclerosis
Belgin Tutar, Güler Berkiten, Ziya Salturk, Ayca Baskadem Yilmazer, Canan Emir, Enis Ekincioğlu, Yavuz Uyar, Ömür Biltekin Tuna
doi: 10.5606/Tr-ENT.2019.51423  Pages 119 - 125
INTRODUCTION: This study aims to evaluate the role of vestibular evoked myogenic potentials (VEMPS; the cervical VEMP [cVEMP] and the ocular VEMP [oVEMP]) in the vestibular system in patients with relapsing-remitting multiple sclerosis (RRMS).
METHODS: Between December 2016 and December 2017, a total of 42 ears of 21 RRMS patients (8 males, 13 females; mean age 41 years; range, 25 to 57 years) and 42 ears of 21 healthy controls (7 males, 14 females; mean age 44 years; range, 38 to 62 years) were included. All participants underwent neurological evaluation, brain magnetic resonance imaging (MRI), audiometry, tympanometry, and stapedial reflex testing. Their oVEMPs and cVEMPs were recorded.
RESULTS: For cVEMP testing, the mean P1 and N1 latencies of the left ears of RRMS patients were significantly higher compared to the controls. There was no significant difference between patients and controls in terms of the P1-N1 interval or mean amplitude of the left ear (p>0.05). The P1 and N1 latencies and the mean P1-N1 interval of the right ears of RRMS patients were significantly higher than the controls (p=0.019, p=0.001, p=0.004; p<0.05, respectively). There was no significant difference in the amplitudes or amplitude asymmetry ratios (AARs) of either ear between patients and controls (p>0.05 for all). The P1 and N1 latencies were prolonged in 13 (42%) of 42 RRMS ears and 27 ears (64%), respectively. For oVEMP testing, eight patients (19%) had no response in the oVemp test of the right ear (n=4) and left ear (n=4) of RRMS patients. There was no significant difference in P1 or N1 latencies or the P1-N1 interval, amplitude or AAR of right ears between the patients and controls (p>0.05 for all). The P1 and N1 latencies were prolonged in 26 (62%) of RRMS ears and 27 ears (64%), respectively.
DISCUSSION AND CONCLUSION: Based on our study results, VEMPs are useful for the evaluation of central vestibulopathies. The VEMP testing can diagnose brainstem lesions in RRMS patients quickly, easily, and safely without pain, although MRI shows no brainstem involvement. The VEMP testing is an electrophysiological test which can detect early stage pathologies of the vestibular system.

4.Single-center validation study of the American College of Radiology Thyroid Imaging Reporting and Data System in a Turkish adult population
Bülent Çolakoğlu, Deniz Alış
doi: 10.5606/Tr-ENT.2019.48569  Pages 126 - 133
INTRODUCTION: This study aims to evaluate diagnostic performance of the American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS) in the Turkish adult population.
METHODS: A total of 422 thyroid nodules of 368 patients (103 males, 265 females; mean age 46.43 years; range, 18 to 81 years) diagnosed by fine needle aspiration biopsy (FNAB) or surgical pathology were retrospectively analyzed. The decisions for FNABs were mostly made by the experts of our hospital without using the ACR-TIRADS. The observers assessed five different aspects of thyroid nodules: echogenicity, shape, composition, margin, and echogenic foci. Nodules with 0 points were categorized as TR1, 2 points as TR2, 3 points as TR3, 4-6 points as TR4, and ≥7 points as TR5. The sensitivity, specificity, and diagnostic accuracy of ACR and the proportion of benign nodules and malignant nodules to be biopsied according to the ACRTIRADS were calculated.
RESULTS: The ACR-TIRADS identified 47 of 54 malignant nodules and identified 264 of 368 benign nodules yielding 73.6% diagnostic accuracy. Using the ACR-TIRADS would have spared 64.1% of benign nodules from FNAB. Of 54 malignant nodules, 23 were to be biopsied, 30 to be followed, and one malignant nodule was not planned to be biopsied or followed according to the ACR-TIRADS recommendations.
DISCUSSION AND CONCLUSION: Despite its robustness in sparing a substantial number of benign nodules from FNAB, the use of ACR-TIRADS would prevent 55.5% of malignant nodules from FNAB. We suggest that FNAB threshold levels of the ACR-TIRADS should be extensively reviewed by the Turkish radiologists, endocrinologists, general surgeons, and ear, nose and throat surgeons before integrating the system to their daily practice.

5.Evaluation of facial complications of hyaluronic acid fillers
Aret Çerçi Özkan, Burcu Çelet Özden
doi: 10.5606/Tr-ENT.2019.29591  Pages 134 - 141
INTRODUCTION: This study aims to evaluate facial complications of dermal fillers and to increase the public awareness about serious adverse outcomes of these applications.
METHODS: Between January 2015 and June 2019, a total of 12 patients (2 males, 10 females; mean age 41 years; range, 28 to 64 years) who experienced hyaluronic acid (HA) filler-related complications were retrospectively analyzed. Complications were recorded using the hospital records.
RESULTS: The mean follow-up was 7 (range, 6 to 9) months. In one patient, livedo reticularis over the nose caused by the filler to the nasolabial fold was seen. In another patient, livedo reticularis over the nose caused by the HA filler for tip augmentation was observed. Both patients were treated with heating and oral acetylsalicylic acid. In another two patients, cellulitic infections were observed. Oral antibiotics and topical antibiotic cream were applied. In two patients, infraorbital edema was seen caused by HA filler application to the nasojugal folds. Hyaluronidase was applied for treatment. In two patients, a granuloma was seen at the right infraorbital region and at the left nasolabial region, respectively. Both of them were treated with hyaluronidase. In one patient, a granuloma and infectious abscess of the upper lip caused by the HA filler application for lip augmentation was observed. For the treatment of the abscess, surgical drainage was used and hyaluronidase was applied for the treatment of the granuloma. In three patients, bruising was observed which was treated with the Arnica cream.
DISCUSSION AND CONCLUSION: Our study results show that fillers are not completely innocent products. We recommend that these materials should be used in experienced hands in accordance with the relevant regulations.

CASE REPORTS
6.Intravascular papillary endothelial hyperplasia of the masseter muscle
Mustafa Caner Kesimli, Deniz Kaya, İsmet Aslan, Murat Ünal, Selçuk Bilgi
doi: 10.5606/Tr-ENT.2019.20592  Pages 142 - 145
Intravascular papillary endothelial hyperplasia (IPEH) is a rare, benign, non-neoplastic vascular lesion which usually occurs in the skin, subcutaneous tissue, and mucous membrane originating from any place where the vessel is located. It is most commonly seen in the head and neck region, while oral cavity involvement is rare. The clinical significance of IPEH is its histopathological similarity with Kaposi sarcoma, intravenous atypical vascular proliferation, spindle-cell hemangioendothelioma, and particularly with angiosarcoma. Surgical resection is the main treatment option. Herein, we present a case of IPEH of the masseter muscle which was resected successfully.

7.An aggressive papillary tumor of middle ear: A case report
Berkay Çaytemel, Can Doruk, Çağla Karaoğlan, Beldan Polat
doi: 10.5606/Tr-ENT.2019.40326  Pages 146 - 149
Aggressive papillary tumors of the middle ear constitute a small percent of adenomatous middle ear tumors. Patients usually present with long-lasting tinnitus, hearing loss, and vertigo and occasionally facial paralysis. Computed tomography findings predominantly suggest bone invasion. Thus, it is commonly misdiagnosed with chronic otitis media with a cholesteatoma. A 72-year-old man presented with chronic ear pain and ear drainage. The patient had a 63 decibels (dB) mixed-type hearing loss and a mass lesion at the temporal bone high resolution computed tomography. Explorative tympanotomy revealed a tumor with thick mucoid secretion and no bone erosion, for which an incisional biopsy revealed an adenoma. Radical modified mastoidectomy was performed and the definite pathology result was compatible with an aggressive papillary tumor. The patient was free of disease at six months of follow-up.

REVIEW
8.Laser supraglottoplasty for laryngomalacia: A pediatric case series
Berat Demir, Adem Binnetoglu
doi: 10.5606/Tr-ENT.2019.41636  Pages 150 - 154
We retrospectively reviewed the medical records of a total of nine patients who underwent laser SGP for severe laryngomalacia at our hospital between 2014 and 2015. All patients had respiratory distress as soon as birth. All patients had one or more comorbidities. Only one patient who had vocal cord paralysis remained tracheostomy-dependent at three years of follow-up. In conclusion, supraglottoplasty is an effective and safe method in the treatment of severe laryngomalacia.

SURGICAL TECHNIQUE
9.An extralaryngeal, extraesophageal surgical approach to a low-grade posterior cricoid chondrosarcoma
Selçuk Güneş, Burak Olgun, Mustafa Çelik, Zahide Mine Yazici, İbrahim Sayın
doi: 10.5606/Tr-ENT.2019.30602  Pages 155 - 158
A chondrosarcoma is a malignant tumor originating from cartilage and may occur in any part of the body. It occurs most commonly in the posterior lamina of the cricoid cartilage, followed by the thyroid cartilage, arytenoid cartilage, vocal cords, and epiglottis. In the literature, 25 cases of tracheal chondrosarcoma were reported between 1964 and 2017, but only two cases of cricoid cartilage chondrosarcoma. Currently, no consensus on chondrosarcoma treatment has been established yet, due to the rarity of the condition, and no therapeutic protocol has been shown to be clearly superior to others. Herein, we present the third case of a cricoid chondrosarcoma in the literature. We used a surgical procedure different from those employed earlier; we employed an extr

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