E-ISSN 2602-4837
Tr-ENT: 20 (5)

Cilt: 20  Sayı: 5 - 2010

İdyopatik ani işitme kayıplı olguların genetik yapılarının analizi
Genetic constitution analysis of idiopathic sudden hearing loss
Adem Bora, Emine Elif Altuntaş, Öztürk Özdemir, İsmail Önder Uysal, Suphi Müderris
Sayfalar 219 - 225
Objectives: The purpose of this research is to understand
the etiology of sudden hearing loss due to genetic factors
in Turkish people. Determination of these genetic factors
and better understanding of molecular pathogenesis may
guide more realistic planning and treatment recommendations.
Patients and Methods: Forty patients (Group 1; 19 males,
21 females; mean age 37.9±15.6 years; range 9 to 76 years)
who presented with sudden hearing loss to the Ear, Nose
and Throat Clinic of Medical Faculty Hospital of Cumhuriyet
University between January 2008 and June 2009, and were
diagnosed with sudden hearing loss through history, physical
examination and review of audiometric findings, and 20
healthy volunteers (Group 2; 14 males, 6 females; mean age
31.7±4.4 years; range 24 to 43 years) for the control group
were included in this study. All Patients were evaluated by
the genetic clinic for the GJB2, GJB3, GJB6 and WFS1
gene using multiplex ligation-dependent probe amplification
(MLPA) method mutation analysis.
Results: No difference was found in the peripheral blood
sample analyses of the two groups at WFS1 exon 8 and
connexin 26, 30 and 31 gene zones using the MLPA
method with respect to heterozygous mutation (p=0.291,
p>0.05). In four patients in group 1 heterozygous mutation
was detected at the target gene zone. Heterozygous mutation
was in the WFS1 exon 8 zone in two patients; and in
the WFS1 exon 1 zone in other two patients.
Conclusion: Sudden hearing loss studies in the future
should include connexin 26, connexin 30 and other gene
mutations that may affect the function of the gap-junction
located in the region of the cochlea stria vascularis (stV),
basal membrane (BM), spiral limbus (Li) and spiral ligament
(SL). These studies should be performed on larger series,
and should include family members of patients with sudden
hearing loss.

Kompleks baş boyun defektlerinin rekonstrüksiyonunda latissimus dorsi kas deri flebi kullanımı
The use of the latissimus dorsi myocutaneous flap in the reconstruction of complex head and neck defects
İsmet Aslan, Yusufhan Süoğlu, Bora Başaran, Günter Hafız
Sayfalar 226 - 231
Objectives: To compare and contrast the use of the
latissimus dorsi myocutaneous flap in complex head
and neck defects requiring major reconstructive surgery
with respect to the other reconstruction techniques, and
to emphasize the importance of this flap as an life and
surgeon-saving reconstruction modality.
Patients and Methods: In this study, 20 cases (17 males,
3 females; mean age 58.5 years; range 48 to 72 years)
of major head and neck operations reconstructed with a
latissimus dorsi myocutaneous flap in İstanbul University,
İstanbul Medical Faculty, Ear, Nose and Throat Clinic
between October 2004 and November 2006 were retrospectively
examined. The latissimus dorsi myocutaneous
flap was prefered as a primary reconstructive modality in
eight of the cases and a secondary reconstructive modality
in the remaining 12 cases. The reasons for choosing
the latissimus dorsi myocutaneous flap as the reconstructive
modality were examined in this study and compared
with other reconstruction techniques.
Results: Partial flap necrosis was observed in four of the
20 cases. In two of these unsuccessful cases, minor intervention
was sufficient to achieve functionally satisfactory
results. However, one case with partial flap necrosis was
lost due to the uncontrollable primary disease. In the one
remaining case who had undergone cranioplasty, partial
necrosis of the flap developed after the completion of
radiotherapy in the 4th postoperative month. No total flap
necrosis was encountered in any of the cases.
Conclusion: The latissimus dorsi myocutaneous flap is
a reconstructive modality with a high success rate and
should be considered among reconstruction alternatives.

Paranazal sinüs mukosellerinin göz komplikasyonları
Ophthalmic complications of paranasal sinus mucoceles
Caner Şahin, Abdullah Durmaz, Üzeyir Yıldızoğlu, Yusuf Uysal, Fuat Tosun
Sayfalar 232 - 236
Objectives: This study aimed to describe ophthalmic
complications of paranasal sinus mucoceles and
principles of treatment.
Patients and Methods: The medical records of 25 paranasal
sinus mucoceles patients (18 males, 7 females;
mean age 35 years; range 20 to 62 years) that had
been treated in two different ear, nose and throat clinics
between the years January 2004 and June 2009 were
evaluated retrospectively. Out of 22 patients of who had
developed internal mucoceles in anterior paranasal
sinuses, diplopia was observed in five, proptosis in four
and partial loss of sight in one. Out of three patients with
posterior paranasal sinus mococeles, two developed
diplopia and one developed proptosis, with loss of sight
in all three. Eight patients were treated using osteoplastic
flap technique and the remaining 17 were treated
using endoscopic sinus surgery.
Results: In only one patient was loss of sight permanent
whereas, in all the other patiens eye complications
Conclusion: In mucoceles that involve the posterior
ethmoid and sphenoid sinuses loss of sight can be
observed often because of their adjacency to the
optic nerves, and loss can be permanent in advanced
disease. It is possible to obtain good results in most
patients treated in time with endoscopic sinus surgery
and osteoplastic flep techniques.

Nüks alt dudak kanserlerine yaklaşım
Management of recurrent lower lip carcinomas
Ömer Genç, Hasan Mete İnançlı, Şefik Sinan Kürkçüoğlu, Ümit Tunçel, Murat Enöz, Mehmet Haksever
Sayfalar 237 - 242
Objectives: In this study patients who had locoregional
recurrence of lower lip carcinomas after therapies
such as surgery, electrocoagulation, cryotherapy or
traditional local therapies are discussed.
Patients and Methods: The records of 16 cases
(1 female, 15 males; mean age 58 years; range 30 to
83 years) with recurrent lower lip carcinoma admitted
between March 2002 and September 2007 to
Dr. Abdurrahman Yurtarslan Oncology Training and
Research Hospital, Ear, Nose and Throat Department
were retrospectively reviewed.
Results: Fourteen patients had been treated in other
institutions, while two had been treated in our center.
Four of the patients had recurrence in the lip, four
patients had recurrence only in the neck, and the
remaining eight patients had both lip and neck recurrence.
Ten patients received modified radical or radical
neck dissection because of their palpable lymphadenopathies,
three patients received supraomohyoid
neck dissection due to non palpable lymphadenopathies,
and the remaining three patients did not have
neck dissection because of co-morbid diseases. Seven
patients (43%) died in the first postoperative year
because of lower lip carcinomas and three patients
died because of other reasons. Six patients survived
for the first two years without any evidence of disease.
Conclusion: Patient survival will be affected by the
applied treatment. For patients with primary lower
lip cancers, otolaryngologists experienced in oncology
must plan surgery rather than local treatments. In
case of locoregional recurrence, immediate treatment
should be planned.

Kronik otitis media düzeltme ameliyatları: Endikasyon ve sonuçlarının değerlendirilmesi
Revision surgery for chronic otitis media: evaluation of indications and results
Gökhan Göktürk, Hüseyin Dere, Adin Selçuk, Murat Özcan, Fatih Özdoğan, Özgür Akdoğan, İbrahim Özcan, Serdar Ensari
Sayfalar 243 - 248
Objectives: In patients who underwent primary and
revision surgery for chronic otitis media, the types of
revision surgery, most frequently observed regions of
cholesteatoma, hearing results and the status of graft
membrane were evaluated.
Patients and Methods: Forty-three of 495 patients
(21 males, 22 females; mean age 38.4±15.2 years; range
15 to 76 years) with chronic otitis media who underwent
revision surgery in our clinic between May 2003 and
March 2009 were evaluated retrospectively. Indications
for revision surgery were recurrence of the disease in
32 patients (74.4%) and reconstruction of hearing in 11
patients (25.6%). Forty patients (93.0%) underwent revision
surgery once and three patients (7.0%) underwent
revision twice. Over an average of 3.2 (range 1 to 6)
years follow-up after primary and revision surgery, the
types of revision surgery, the most frequently observed
regions of cholesteatoma, hearing results and the status
of graft membrane were assessed.
Results: Recurrence of cholesteatoma in revision surgery
was seen in 28 patients (65.1%). Out of 27 patients, 23
patients (85.1%) showed intact graft membranes and four
patients (14.8%) showed perforated graft membranes.
Conclusion: In revision surgery, the first goal is to
eliminate the disease. The management of chronic
otitis media with cholesteatoma is surgery. Because of
high postoperative recurrence rates, long-term followup
is necessary.

Baş ve boyun yassı epitel hücreli kanserlerinde boyun yayılım modelleri
Patterns of cervical metastasis from squamous cell carcinoma of the head and neck
Fadlullah Aksoy, Bayram Veyseller, Ömer Binay, Tayfun Apuhan, Yavuz Selim Yıldırım, Orhan Özturan
Sayfalar 249 - 254
Objectives: In this study, the existence, distribution and
characteristics of cervical lymph nodes metastases in
patients with laryngeal, hypopharyngeal and intraoral
squamous cell cancer were investigated.
Patients and Methods: A retrospective review of the
charts of 81 laryngeal, hypopharyngeal and intraoral
cancer patients (10 females, 71 males; mean age 55.9
years; range 30 and 81 years) surgically treated and
followed up in Haseki Training and Research Hospital
Ear, Nose and Throat Clinic between January 2004
and October 2007 was evaluated. The demographic
data of the patients, tumor localization sites, surgical
techniques, TNM stages and regional neck metastases
were evaluated.
Results: In laryngeal cancer patients, metastatic
lymph nodes were found in 36 of 83 (43%) neck specimens.
Patients with intraoral tumors had metastases
in six (36.4%) of 20 neck specimens. In hypopharynx
tumor patients in six of seven (85.7%) showed metastasis.
Conclusion: These results suggest that elective neck
treatment in patients with head and neck squamous
cell cancers, should include neck levels I, II, III, IV and
V. Upper aerodigestive system squamous cell cancers
have specific patterns of invasion in cervical region.
According to the localization of the primary tumor, high
risk sites of metastases were detected. Selective neck
dissections were planned according to these invasion
patterns of tumors.

Travmatik fasyal paralizili sıçanların sinir iyileşmesinde E vitaminiyle beraber kortikosteroid ve tek başına E vitamini uygulanmasının etkileri
The healing effects of vitamin E with corticosteroid and vitamin E alone on nerve healing in rats with traumatic facial palsy
Perihan Taşkale, İlhan Topaloğlu
Sayfalar 255 - 259
Objectives: We aimed to document the effects of vitamin
E and vitamin E plus corticosteroid on nerve healing in
Materials and Methods: Twenty-four Wistar Albino type
female rats were used in the study. The rats were divided
in to three groups, each with eight rats. Group 1 was
given methylprednisolone and Vitamin E, group 2 was
given Vitamin E alone and group 3 was the control group.
The buccal branch of the facial nerve was found under
anesthesia in all rats. After nerve identification, the stimulation
thresholds were assessed by Xomed Trace Nerve
Integrity Monitor NIM-2. The buccal branch of each facial
nerve in group 1 and 2 was traumatized by a vascular
clamp for an hour. After trauma the stimulus thresholds
were identified again. The nerve was not traumatized in
group 3. Group 1 was given 0.1 mg/kg/day vitamin E intramuscular
(i.m) and 1 mg/kg/day methylprednisolone i.m
for one month, group 2 was given 0.1 mg/kg/day vitamin
E i.m for one month and the control group was given 2
cc 0.09% NaCl subcutaneously every other day for one
month. At the end of a month the stimulus thresholds were
measured again and compared statistically.
Results: Mean stimulus threshold was 0.12 mA for all
of the groups at the beginning of the experiment. After
trauma mean stimulus threshold was 0.48 mA for the
group 1 and 2. At the end of one month stimulus threshold
was 0.22 mA for the group 1 and 0.33 mA for the group 2.
The stimulus threshold in the control group was measured
as 0.12 mA.
Conclusion: We concluded that the vitamin E has a positive
effect on nerve healing and corticosteroid enhances
its effect.

İki taraflı kıvrımlı internal karotis arterin neden olduğu pulsatil orofarengeal ve boyun kitlesi: Olgu sunumu
Pulsatile oropharyngeal and neck mass caused by bilateral tortuous internal carotid artery: a case report
Güçlü Kaan Beriat, Hande Ezerarslan, Sinan Kocatürk, Ali Fuat Mıhmanoğlu, Erkan Kuralay
Sayfalar 260 - 263
The cervical course of the internal carotid artery is
almost straight in contrast to the intracranial portions
which are highly tortuous. The incidence of variations
in the cervical course of the internal carotid artery of
the population is approximately 10-40 percent. In
this case report, a 76-year-old female patient with a
pulsatile mass at the posterior oropharyngeal wall
and anterior neck was presented. Physical examination
revealed a pulsatile anterior neck mass, and a
pulsatile mass at the right posterior wall of the oropharynx.
Imaging revealed a bilateral tortuous internal
carotid artery and segmental left internal carotid
arterectomy and distal internal carotid artery - lateral
common carotid artery anastamosis were performed
with no postoperative complications.

Burunda adenolipom: Olgu sunumu
Adenolipoma of the nose: a case report
Kadir Serkan Orhan, Mehmet Veli Karaaltın, Tayfun Demirel, Beldan Polat, Bora Başaran
Sayfalar 264 - 266
Adenolipoma is a rare benign neoplasm composed of
both mature adipose tissue and glandular elements. In
this article we report a case of 19-year-old woman, who
had nasal blockage and deformity. On examination,
a round, soft, nonpulsatile submucosal mass in the
cartilagenous vault of the right nasal cavity was found.
There was also alar rim notching, nostril asymmetry on
the right side and septal deviation towards the opposite
side. Computed tomography revealed a clearly
demarcated dense mass located at the right submucopericondrial
level obstructing the nasal passage.
An open septorhinoplasty approach was preferred to
remove the mass and also to correct the deformities
caused by the mass. The histopathologic examination
was reported as an adenolipoma. No recurrence was
observed during postoperative two year follow-up. To
our knowledge, this is the first case report of an adenolipoma
of the nose in the English literature.

Burun boşluğunda gangliogliom: Olgu sunumu
Ganglioglioma in the nasal cavity: a case report
Ediz Yorgancılar, Müzeyyen Yıldırım, Ramazan Gün, Hüseyin Büyükbayram, Faruk Meriç
Sayfalar 267 - 270
Ganglioglioma is a tumor containing both astrocytic
and neuronal components. It may occur any where
in the central nervous system and spinal cord but is
only encountered rarely. Nasal glial heterotopia (also
known as “nasal glioma”), is a rare developmental
abnormality seen in a wide age group. Gangliogliomas
may also manifest as a nasal glial heterotopia, and
neurogenic tumors should be considered in the presence
of a nasal mass. In this article, we present a
case of ganglioglioma located in the right-nasal cavity.
The mass was excised totally through an endoscopic
approach. The ganglioglioma developed on
a nasal glial heterotopia base. To our knowledge, a
ganglioglioma arising from the nasal cavity has not
been described previously in the literature.

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