[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to describe our experience with benign parapharyngeal space tumours resected via a transcervical route without mandibulotomy and to investigate associated postoperative sequelae and complications. The study investigated and analysed the retrospective charts of 44 patients who underwent surgery for benign parapharyngeal space tumours over a 10-year period. The diagnosis was reached in all patients with clinical and radiologic findings; preoperative fine-needle aspiration biopsy was not performed in any case. The preferred means of accessing the parapharyngeal space in all patients was a transcervical route. In 5 of these patients, transparotid extension was performed due to the position of the tumour. Tumours were classified radiologically as poststyloid in 27 cases and prestyloid in 17 cases. The final histopathologic diagnosis was vagal paraganglioma in 16 cases, pleomorphic adenoma in 13 cases, schwannoma in 10 cases and comparatively rarer tumours in the remaining 5 cases. In three patients, cranial nerve paralysis was observed during preoperative evaluation. Permanent cranial nerve paralysis occurred in 19 cases (43.2%) in the postoperative period, the majority of which were neurogenic tumours such as vagal paraganglioma (n = 16) and schwannoma (n = 2), and one case of non-neurogenic parapharyngeal tumour. The median duration of follow-up was 61 ± 33 months. There was no local recurrence in any patient during the follow-up period. A transcervical approach should be the first choice for excision of parapharyngeal space tumours, except for recurrent or malignant tumours, considering its advantages of providing direct access to the neoplasm, adequate control of neurovascular structures from the neck and optimal aesthetic outcomes due to preservation of mandibular continuity with minimal morbidity and hospitalisation time.
Acta otorhinolaryngologica Italica: organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale 10/2014; 34(5):310-316. · 1.64 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background:
Serum paraoxonase 1 is involved in mechanisms that protect cells from oxidative stress damage. This study aimed to investigate the correlation between serum paraoxonase 1 activity and polymorphisms in patients with oral squamous cell carcinoma.
Methods and materials:
Fifty-seven patients with oral squamous cell carcinoma and 59 matched healthy controls participated in the study. Serum paraoxonase 1 activity and polymorphisms in blood samples were compared with results for polymerase chain reaction and restriction fragment length polymorphism tests.
Mean serum paraoxonase 1 activity levels were lower in patients than controls (mean ± standard deviation, 21.9 ± 5 units/l and 120.4 ± 2 units/l, respectively) (p = 0.001). The serum paraoxonase 1 192 glutamine polymorphism was more common in patients than controls.
Patients with oral squamous cell carcinoma had significantly lower serum paraoxonase 1 activity levels and a greater prevalence of the serum paraoxonase 1 192 glutamine allele, compared with controls. Serum paraoxonase 1 may play a role in the aetiology of oral squamous cell carcinoma.
The Journal of Laryngology & Otology 11/2013; 127(12):1-6. DOI:10.1017/S0022215113002533 · 0.67 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Supraglottic region is one of the most common sites of laryngeal cancer. Delayed manifestation and the common presence of neck metastasis at the time of diagnosis lead to a worse prognosis in this type of tumors. Possible treatment alternatives for early stage supraglottic tumors are radiation therapy, open surgery, laser and robotic surgeries. In addition, a supplementary therapy for the neck should be planned independent of the primary lesion's stage
[Show abstract][Hide abstract] ABSTRACT: It has been hypothesised that vitamin D receptor (VDR) gene polymorphisms may influence both the risk of cancer occurrence and prognosis.
The distribution of VDR Taq I polymorphism in 64 patients with OSCC was determined by polymerase chain reaction based restriction fragment length polymorphism (RFLP) and compared with that of 87 healthy controls.
There was a significant difference in the distribution of VDR Taq I genotypes between OSCC patients and healthy controls. Patients with the VDR Tt genotype were found to be at significantly higher risk for OSCC than those with other genotypes (p=0.036). In particular, female OSCC patients were at higher risk (p<0.001) for oral cancer.
These results suggest that the VDR Taq I polymorphism may be associated with susceptibility to OSCC. Female predilection of the OSCC risk in association with VDR gene polymorphism should also be investigated.
In vivo (Athens, Greece) 09/2010; 24(5):755-9. · 0.97 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In this article, we present the use of the superior labial artery musculo-mucosal (SLAMM) flap for intraoral reconstruction.
The study included five patients (2 females, 3 males; mean age 36 years; range 11 to 56 years) who consulted at our clinic between October 2008 and January 2010. Five oral defects were reconstructed with the SLAMM flap. Three patients underwent reconstruction with SLAMM flap following oncologic resection. The other two patients had traumatic defects in the oral cavity which necessitated flap application. First, the distal end of the flap was incised and the superior labial artery was identified after dissection. After ligation of the artery, the mucosa, submucosa and the cuff of orbicularis oris muscle were elevated. The dissection was extended laterally and anteriorly, depending on the necessary flap size.
None of the patients had partial or total flap necrosis. During the follow-up period, contracture developed in only one patient. Successful reconstruction was observed in all patients.
The superior labial artery musculo-mucosal flap is a simple and feasible technique which can be used for reconstruction of intraoral defects.
Kulak burun bogaz ihtisas dergisi: KBB = Journal of ear, nose, and throat 01/2010; 20(3):118-22.
[Show abstract][Hide abstract] ABSTRACT: An association between restriction fragment length polymorphism (RFLP) of known oncogenes and a predisposition to develop cancer has been postulated. Our aim was to test the hypothesis that there was an association between the L-MYC S allele in oral squamous cell carcinoma (OSCC) and a predisposition for the disease.
The distribution of L-MYC polymorphism in 80 patients with OSCC was determined by polymerase chain reaction-based RFLP and compared with that of 60 healthy controls.
There was no significant difference between patients with OSCC and healthy controls. Patients with the L-MYC S allele and a positive family history of cancer were found to be 1.74 times more at risk for OSCC than those with any other genotype (95% confidence interval=0.88-3.45). Moreover, tumor recurrence was higher among individuals carrying a L-MYC S allele than those with any other allele type.
L-MYC polymorphism was not a significant marker for predicting susceptibility to OSCC in this population but may be a useful marker for identifying patient susceptibility to tumor recurrence and to developing OSCC, especially in individuals having a family history of cancer.
Anticancer research 08/2009; 29(7):2519-24. · 1.83 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Head and neck reconstruction with dorsoradial forearm free flap: a preliminary clinical study.
The most common criticism of the radial forearm free flap (RFFF) is donor site morbidity. Delayed or defected integration of split thickness skin graft (STSG) is the most commonly encountered complication. Defective healing or excessively thin skin coverage of important forearm structures, such as the median nerve and ulnar artery-nerve bundle, places these structures at increased risk of injury. The current study aims to modify the RFFF to utilize a dorsoradial skin island in order to protect the volar tissue aspect of these structures.
Seven patients were included in the study between 2005 and 2008. All patients had oncologic resections in the oral cavity necessitating free tissue transfer. The main variation from the standard RFFF technique is that the medial incision was placed 1 cm lateral to the palmaris longus tendon. The dissection was extended laterally and dorsally, depending on the necessary flap size. The donor side defect was covered with a thigh STSG.
None of the patients had partial or complete flap necrosis. This surgical modification provided tissue coverage along the course of the median nerve and ulnar neurovascular bundle.
Dorsoradial forearm free flap is a feasible technique that allows preservation of tissue coverage on the volar surface of the forearm.
[Show abstract][Hide abstract] ABSTRACT: We evaluated complications of free flap reconstruction following oncological head and neck surgery in elderly patients who smoked heavily.
The study included eight patients (2 females, 6 males; mean age 68.5 years; range 65 to 74 years) over 65 years of age, who smoked heavily (at least 1 pack/day). All cases but one with mandibular ameloblastoma had intraoral squamous cell carcinoma. Two patients underwent reconstruction with free radial forearm osteoseptocutaneous flap following bilateral maxillary resection, and six patients with free fibular osteoseptocutaneous flap following mandibular resection. Postoperative complications, in particular those associated with the donor and recipient sites were evaluated.
No partial or total flap loss was observed. Wound healing problems were seen in three patients (37%), which were at the donor site in two patients, and at the recipient site in one patient. Psychogenic disorders were observed in two patients (25%). No other complications were encountered.
Aside from some recipient- and donor-site-related healing problems, heavy smoking and advanced age cannot be regarded as contraindications for free flap reconstruction.
Kulak burun bogaz ihtisas dergisi: KBB = Journal of ear, nose, and throat 01/2008; 18(2):61-5.
[Show abstract][Hide abstract] ABSTRACT: Free transfer of the fibula for mandibular reconstruction provides desirable functional and aesthetic results. However, unexpected donor- and recipient-site complications may be encountered with most free flap transfer procedures. A 62-year-old woman underwent wide resection and segmental mandibulectomy for low-grade squamous cell carcinoma of intraoral location. Reconstruction of the defect was performed at the same session with an osteoseptocutaneous free flap from the right fibula. A class III B vascular malformation was detected intraoperatively at the donor site, which resulted in restriction of foot inversion and abduction, and of toe extension during the follow-up.
Kulak burun bogaz ihtisas dergisi: KBB = Journal of ear, nose, and throat 01/2008; 18(6):367-70.
[Show abstract][Hide abstract] ABSTRACT: We evaluated the results of surgical treatment and postoperative radiotherapy and prognostic factors in patients with primary tongue carcinoma.
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).
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.
Postoperative radiotherapy should be standard for patients with stage III and IVA tongue cancer.
Kulak burun bogaz ihtisas dergisi: KBB = Journal of ear, nose, and throat 02/2007; 17(1):1-6.
[Show abstract][Hide abstract] ABSTRACT: This study was designed to compare different prefabrication models for circumferential tracheal reconstruction.
Thirty adult female New Zealand rabbits were divided into six groups for circumferential tracheal reconstruction with a different tissue combination. Prefabrication of neotrachea was performed without anastomosis. Lateral thoracic fascia or pectoralis major muscle were used for vascular supply. Polypropylene mesh, polytetrafluoroethylene (Gore-Tex), or cartilage rings were used for skeletal framework. Hairless epithelial skin graft was used for inner lining. The groups were compared in terms of viability of hairless epithelial graft, longitudinal flexibility, rigidity, flap wall thickness, internal diameter, and flap viability.
Epithelial skin graft was almost totally viable (95%-99%) in the polypropylene mesh groups. Gore-Tex groups exhibited almost total necrosis (74%-71%). Longitudinal flexibility and rigidity were similar to the native trachea in Gore-Tex and polypropylene mesh groups. Neotrachea prefabricated with cartilage grafts showed more than normal longitudinal flexibility and collapsed easily.
The prefabricated model with the use of polypropylene mesh for skeletal framework and lateral thoracic fascia for vascular supply seems to be the best alternative in the reconstruction of circumferential tracheal defects.
Kulak burun bogaz ihtisas dergisi: KBB = Journal of ear, nose, and throat 02/2007; 17(3):158-66.
[Show abstract][Hide abstract] ABSTRACT: A fibular flap has great versatility in reconstructive procedures. Osteomies and ostectomies enable the flap to be used for variable defects. We used combined horizontal/vertical osteotomy and ostectomy for reconstruction of complex craniofacial defects with one flap in two patients. Vertical osteotomy transforms the tubular structure of a fibula into a flat bone that can be used for reconstruction of wider defects with less vertical height. Neither vertical osteotomy nor ostectomy had negative effects on viability and bony healing of the segments in our patients. We think that the fibular flap, thanks to its versatility, can be used for reconstruction of complex orbito-zygomatic and orbito-cranial defects successfully.
[Show abstract][Hide abstract] ABSTRACT: Microvascular mandibular reconstruction should be considered the procedure of choice for bone replacement in radiated tissue beds, orocutaneous fistulae with segmental bone loss, osteoradionecrotic mandibles, and for immediate composite tissue reconstruction. The free vascularized fibula has significant potential for the reconstruction of the mandible. We evaluated our clinical experience in 21 cases of mandible reconstruction with fibular flaps.
Between 1997 and 2002, we performed 7 free osseous fibula flaps and 14 osteocutaneous fibula flaps for a total of 21 mandible reconstructions in 21 patients (8 females, 13 males; mean age 41 years; range 22-58 years). Indications for mandibular resection were squamous cell carcinoma of the floor of the mouth, tongue, oropharynx, and/or alveolar ridge in 13 cases, ameloblastoma of the mandible in 4 cases, leiomyosarcoma of the mandible in 2 cases, and chondrosarcoma of the mandible in one case. There was a traumatic loss in one case. Of 21 patients, 17 were reconstructed primarily, and 4 patients had secondary reconstruction.
All flaps, except one, survived and their viability was confirmed by scintigraphy when available. The skin defect in this patient was repaired by local lip flap which needed commissurotomy later, but the patient refused bone reconstruction. In two cases, because of long-lasting orocutaneous fistula and saliva drainage without flap loss, we used a pectoralis major pedicled flap as a secondary procedure. In three cases, donor side skin healing problems were managed well by secondary intention or split-thickness regrafting. Two patients had temporary foot drop which recovered in an average of three months. Simple problems with wound healing such as dehiscence and delayed healing developed in five patients, which usually required only local antiseptic treatment. After the operation, patients began oral feeding and walking with crutches in the third week, adjuvant radiotherapy began in the 6th week, and walking without crutches in the eighth week.
Fibular bone allows to plan osteotomies in relation to the orientation of the bone and its vascular pedicle. Thick cortical bone readily accepts plates and screws for a secure interosseous fixation and osteointegrated implants may be placed in this bone safely. Among other alternatives like scapular and crista ilaca flaps, fibular flap has many advantages for mandible reconstruction and represents the first choice for the head and neck surgeon.
Kulak burun bogaz ihtisas dergisi: KBB = Journal of ear, nose, and throat 02/2004; 13(3-4):62-6.
[Show abstract][Hide abstract] ABSTRACT: Metastasis predominantly occurs via the lymphatic system in head and neck tumors. The disturbance of the lymphatic system in the cervical region resulting from neck dissection or radiotherapy may result in unusual patterns of metastasis in patients with recurrent tumors. This is more frequent when the recurrent tumor invades the myocutaneous flap used for the primary reconstruction. We encountered three patients (2 men, 1 woman) with infraclavicular lymph node metastasis. All were previously treated by surgery, postoperative radiation therapy, and reconstruction with the use of the pectoralis major myocutaneous flap.
Kulak burun bogaz ihtisas dergisi: KBB = Journal of ear, nose, and throat 01/2002; 9(5):368-71.
[Show abstract][Hide abstract] ABSTRACT: Following the uvulopalatopharyngoplasty and laser assisted uvulopalatoplasty as treatments for mild obstructive sleep apnea syndrome (OSAS) originating from the soft palate, palatal stiffening operations began to be described as causing less morbidity, interfering less with velopharyngeal and mucosal functions, and being applicable in outpatient settings. We present modified uvulopalatopexy procedure which can be used in mild OSAS patients is a simple, minimally invasive and effective new method. In this article, we present a modified form of sling snoreplasty method and two cases in whom this method was used.
Kulak burun bogaz ihtisas dergisi: KBB = Journal of ear, nose, and throat 20(1):51-5.