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  • Küçük Resim
    Öğe
    Comparison of Total Endoscopic Ear Surgery and Microscopic Postauricular Canal-Wall-Down Approach on Primary Acquired Cholesteatoma
    (AVES, 2024) Zorlu, Mehmet Ekrem; Yaramis, Berk; Ceylan, Mehmet Emrah; Dalgic, Abdullah
    BACKGROUND:This This study aimed to compare total endoscopic ear surgery (TEES) and microscopic postauricular canal-wall-down tympanomastoidectomy (CWD) in cholesteatoma surgery in our clinic. METHODS: This study included 59 patients, of whom 30 and 29 were operated on with CWD in 2016-2018 and TEES in 2019-2021, respectively and compared regarding intraoperative findings, hearing outcomes, long-term outcomes, and recidivism rates between groups. This study excluded patients in stage IV according to the European Academy of Otology and Neurotology/Japan Otological Society Staging System on Middle Ear Cholesteatoma, aged < 18, with congenital cholesteatoma, who underwent revision surgery. RESULTS: Two patients in the TEES group had recidivism (6.9%), with recurrent disease observed in both patients and residual disease in none, whereas 3 patients in the CWD group had recidivism (10%), including recurrent disease in 2 and residual disease in 1 patient. Tympanic membrane perforation occurred in 2 (6.9%) and 1 (3.3%) patients in the TEES and CWD groups, respectively. The 2 groups revealed no significant difference in terms of recidivism and perforation rates (P = 1.000, P = .612). The CWD group had a longer mean operation time (225.54 +/- 47.86 minutes) than the TEES group (160.55 +/- 24.98 minutes) (P < .001). The 2 groups demonstrated no significant difference regarding pre- and postoperative air-bone gap (ABG) and ABG gain (P = .105, P = .329, P = .82, respectively). CONCLUSION: Total endoscopic ear surgery provides similar results in terms of hearing, recidivism, and long-term outcomes with the microscopic CWD approach. However, the CWD approach is still important, especially in patients in advanced stages.
  • Küçük Resim
    Öğe
    Sfenoid sinüs ve komşu nörovasküler yapıların anatomik varyasyonları
    (2021) Müderris, Togay; Zorlu, Mehmet Ekrem; Doblan, Ahmet; Mişe, İbrahim
    Amaç: Çalışmamızda Endoskopik Endonazal Transsfenoid Yaklaşım (EETY) ile opere edilen hastaların operasyon öncesi bilgisayarlıtomografilerini değerlendirerek sfenoid sinüs pnömatizasyonunu, sfenoid sinüs varyasyonlarını, internal karotid arter (İKA) dehisans veprotruzyonunu, optik sinir ve maksiller sinir dehisans ve protruzyonlarının sfenoid sinusle ilişkisini incelemeyi amaçladık.Materyal-Metod: Hastanemizde 2006-2015 yılları arasında hipofiz adenomu tanısı ile beyin cerrahisi ile birlikte EETY ile opere edilen113 hastanın dosyası retrospektif olarak incelendi.Bulgular: Çalışmaya 64'ü kadın 49'u erkek olmak üzere toplam 113 hasta dahil edildi. Sfenoid sinüs pnömotizasyonu %1.8 konkal,%7.3 presellar, %47.7 sellar ve %43.3 postsellar tip olarak saptandı. Erkeklerde postsellar (%44.8) ve sellar tip (%44.8) eşitken, kadınlardaise sellar tipin (%50) en sık olduğu görüldü. İnternal karotid arter (İKA) protruzyonu %28.3 ve dehisansı %2.65 idi. Erkeklerde İKAprotruzyonu kadınlara oranla daha yüksek bulundu (p = 0.008). Çalışmamızda optik sinir protrüzyonunun %25,6, optik sinir dehisansının ise%1.76 olduğu tespit edildi. Maksiller sinirin protruzyonu genel olarak %25.9 iken maksiller sinirin dehisansı genel olarak %7.4 olaraksaptandı. Klinoid pnömotizasyonu erkeklerde %27 iken, kadınlarda %14.1 olarak izlendi. Aradaki farkın istatiksel olarak anlamlı olduğugörüldü (p<0.005) Sfenoid interseptum 25 hastada (%22) sol internal karotis arterin üzerinde sonlanırken, 13 hastada (%11,5) sağ internalkarotis arterin üzerinde sonlandığı tespit edildi. 54 hastada (% 47,7) sella turcica üzerinde sonlandığı görülürken, 3 hastada (%2.65) septumizlenmedi.Sonuç: Çalışmamızın verileri sfenoid sinüs anatomisinin büyük bir değişiklik gösterdiğini ortaya koymuştur. Kafa tabanına endonazaltranssfenoidal koridor ile yaklaşırken sellaya güvenli bir ulaşım sağlayarak komplikasyonları en aza indirebilmek için rutin preoperatif BTbulgularının cerrahi ekip tarafından ayrıntılı bir şekilde incelenmesi oldukça önemlidir.
  • [ X ]
    Öğe
    Use of Cervical Fascia to Prevent Pharyngocutaneus Fistula After Total Laryngectomy
    (Wiley, 2024) Zorlu, Mehmet Ekrem; Kertmen, Canberk; Aysel, Abdulhalim; Yilmaz, Fatih; Dalgic, Abdullah; Muderris, Togay
    Objective: This study aimed to compare the pharyngocutaneous fistula (PCF) between patients who underwent reconstruction using cervical fascia after total laryngectomy and those who did not and to investigate the factors affecting PCF rates. Methods: We retrospectively compared 22 patients operated between February 2021 and March 2023 who received cervical fascia flap as the study group and 21 patients operated between January 2018 and March 2023 who did not receive fascia flap as the control group. The study included patients who underwent total laryngectomy for Stage 3 and 4 squamous cell laryngeal cancer. Results: We included 43 patients, with 22 (51.2%) and 21 patients (48.8%) in the study and control groups, respectively. The age and sex were not different between the two groups (p=0.471, p=0.176, respectively). The distribution of patients as per sex, smoking, alcohol use, chronic obstructive pulmonary disease, diabetes mellitus, coronary artery disease, and multiple comorbidities was similar in both groups (p>0.05). PCF was observed in one patient (4.5%) and seven patients (33.3%) in the study and control groups, respectively. The PCF rate was significantly lower in the study group (p=0.021). When the relationship between flap use and risk factors was compared by correlation analysis, a moderate negative relationship was found between flap use and PCF (p=0.015, r=-0.370). Conclusion: The use of a cervical fascia flap is effective in reducing fistula rates after total laryngectomy. Its main advantages include being technically simpler than alternative techniques, locally available, cost-effective.