Teoman Dal

Langerhans cell histiocytosis (LCH) is a rare disease, which may involve various organ systems; therefore, it has multiple clinical manifestations. Case report: We present the case of a 56-year-old woman admitted to Amerikan Hospital Ear-Nose and Throat outpatient clinic with a complaint of progressive hearing loss in both ears, which had started 10 years ago. She was treated with corticosteroids for 10 years until last year, 2017. Surgical exploration was performed and histologic evaluation revealed LCH. Conclusions: LCH has clinical manifestations depending on the site of infiltration. In adults, isolated bilateral mastoid infiltration, as an initial symptom, is a very rare condition. With corticosteroid uptake, the period of initial symptom was 10 years in our patient, which is, as per our knowledge, the longest reported in literature. This infiltration may mimic acute or chronic infections of the ear. Therefore, LCH should be considered in the differential diagnose of patients who present with bilateral mastoid cavity disease. Cite this article as: Bahar S, Dal T. Langerhans Cell Histiocytosis of Bilateral Mastoid Cavity. J Int Adv Otol 2018; 14(2): 341-3.

In endoscopic sinus surgery (ESS) synechiae formation and ostial stenosis are frequently encountered. This is not uncommon after frontal recess and ostium interventions due to the narrow recess and difficult anatomy of the region. The goal of this study is to evaluate the efficacy of the new cross-linked hyaluronan gel—PureRegen^® Gel Sinus—on wound healing and synechiae prevention in endoscopic frontal sinus surgery. The study consists of two groups of patients who underwent ESS, including frontal sinus surgery. In the study group of 37 patients, PureRegen^® Gel Sinus was applied to both the frontal recess and ostium at the end of the procedure. The control group consisted of 28 patients. In this group, nasal dressing material was not applied at the end of surgery—neither to the frontal recess nor to the ostium. Postoperatively, epithelization was found to be significantly better at 2 and 4 weeks in the study group when compared with the findings in patients where no postoperative dressing was applied. In the eighth week, there was no significant difference found between the two groups in terms of epithelization. Synechiae formation was significantly lower in the PureRegen^® Gel Sinus group than the control group at all 2, 4 and 8 weeks postoperative evaluations. The effects of PureRegen^® Gel Sinus on wound healing, especially in reepithelization, have shown to occur earlier in the postoperative period. Rapid reepithelization and control of infection related granulation tissue formation with antibiotics in the early postoperative period may explain the low stenosis rate in frontal sinus ostia in PureRegen^® Gel Sinus applied patients.

Objective: To investigate the effects of dicing and different degrees of crushing on cartilage graft viability and outcome in rhinoplasty. Methods: Cartilage was harvested from both ears of 29 rabbits. For each animal, 6 cartilage pieces were prepared as follows and inserted into the paraspinal subcutaneous tissue: (1) left intact, (2) diced to approximately 1 × 1-mm pieces and then wrapped in oxidized regenerated cellulose, (3) slightly crushed, (4) moderately crushed, (5) significantly crushed, and (6) severely crushed. Animals were killed at 2, 5, and 10 months, and graft specimens were microscopically examined. Results: As crushing intensity rose, cartilage viability decreased and more cartilage tissue was transformed to connective tissue. The intact and slightly crushed grafts showed significant chondrocyte proliferation. This decreased as crushing intensity increased, and the severely crushed and diced cellulose-wrapped grafts exhibited almost no peripheral chondrocyte proliferation. Conclusions: Slight crushing of a cartilage graft can produce outstanding graft material that forms softer nasal contours and fills defects well. However, severe crushing of cartilage grafts results in extensive necrosis and eventual reduction in graft volume. The use of oxidized regenerated cellulose to wrap diced cartilage grafts also tends to reduce clinical predictability owing to negative effects on cartilage viability and regeneration.

Reconstruction of tracheal defects continues to be a difficult problem in head and neck surgery. In this study, to evaluate the outcomes of tracheal reconstruction with a nonautogenous material, we used solvent‐dehydrated human costal cartilage in 3 different forms: graft, neovascularized graft, and prefabricated free flap. Thirty‐five Sprague‐Dawley rats were distributed into 3 groups with 10 animals in groups 1,10 in group 2, and 15 in group 3. Surgically created tracheal defects were repaired with a free cartilage graft in group 1, and a piece of cartilage was neovascularized for 3 weeks in the inguinal region and then used as a fibrovascular tissue‐coated cartilage graft in group 2. In group 3, the neovascularized cartilage was transferred to the defect as a prefabricated free flap based on a vascular pedicle containing femoral vessels. Four weeks later, the tracheal reconstruction specimens were evaluated with light microscopy to determine cartilage survival, infection, and epithelial regrowth. The most favorable outcomes were obtained in group 3, where the material was used as a prefabricated neovascularized free flap.

The canalith repositioning maneuver (CRM), as defined by Epley, can be an effective treatment for benign paroxysmal positional vertigo (BPPV). The staff at Başkent University’s Ear Nose and Throat Clinic performed CRM on 68 cases of canalithiasis in 64 BPPV patients from June 1996 to August 1997. Symptoms resolved after the first session in 49 patients (72%) and after the second session in 11 cases (16.2%). It was necessary to repeat the maneuver three times in two cases (2.9%) and four times in one patient (1.5%). Discounting three patients who were lost to follow-up, only two patients in our study did not respond to CRM treatment. There was no co-existing pathology found in all but two of the patients studied. Our experience indicates that unless there is no response to CRM or there is suspicion of an incorrect diagnosis, it is not necessary to perform diagnostic studies routinely for differentiating other neuro-otologic disorders prior to using CRM in BPPV patients diagnosed by the Dix-Hallpike test.

The relative merits of a vascularized autogenous cartilage flap (VACF) are discussed in reconstruction of tracheal defects in rabbits. Sixteen albino Vienna rabbits were divided into two groups of eight animals each. In all rabbits, a rectangular tracheal defect was created. In the experimental group, a VACF was designed on the left auricle. This island flap was then transposed through a subcutaneous tunnel to the trachea and used to repair the defect. In the control group, tracheal defects were reconstructed with free cartilage grafts. In histologic evaluations, it was found that the reconstructed site showed a greater degree of vascularization when a VACF was used, and the gap between the trachea and flap was filled with new cartilage tissue, to a much greater extent than with the free cartilage grafts. It is concluded that use of the VACF is a relatively safe and effective procedure for repairing tracheal defects.

Liposarcomas of the head and neck region are rare. Those originating in the buccal mucosa cause special diagnostic and therapeutic difficulties. In this report, a predominantly well-differentiated liposarcoma of the cheek in a 32-yr-old man is reported. The tumor continued to grow slowly over a period of 3 yr before definitive diagnosis was established. Radical maxillectomy was performed with total excision of the tumor. Recommendations for earlier and correct diagnosis and treatment of this rare neoplasm are discussed.