The aim of this study is to assess the effect of partial superficial parotidectomy and facial nerve dissection to electrophysiologic parameters of intraoperative facial nerve monitoring such as nerve stimulation threshold, stimulus amplitude and latency. Twenty-five patients who underwent partial superficial parotidectomy for benign parotid gland mass were included in the study. After the identification of the facial nerve main trunk, minimum stimulation threshold, latencies and amplitudes of the orbicularis oculi (electrode 1) and orbicularis oris (electrode 2) electrodes at 0.50 milliamperes (mA) were recorded. All of the recordings were repeated after the completion of parotidectomy. Median nerve dissection duration was calculated and size of the tumors was measured during macroscopic pathology. The median minimum nerve stimulation threshold was 0.15 mA [interquartile range (IQR) = 0.05] before and 0.15 mA (IQR = 0.08) after the parotidectomy (p = 0.02). Median nerve dissection duration was 49 min (IQR = 38). Median amplitude and latency in electrode 1 before and after the facial nerve dissection were 322 millivolts (mV) (IQR = 330), 370 mV (IQR = 370) (p = 0.02), 3 milliseconds (ms) (IQR = 1) and 4 ms (IQR = 2) (p = 0.05), respectively. Median amplitude and latency in electrode 2 before and after the facial nerve dissection were 396 mV (IQR = 275), 365 mV (IQR = 836) (p = 0.86), 3 ms (IQR = 1.5) and 4 ms (IQR = 1.5) (p = 0.17), respectively. Minimal nerve stimulation threshold and amplitude of electrode 1 were affected by facial nerve dissection among the electrophysiologic parameters (p = 0.02 and p = 0.02). Of the electrophysiological parameters only the latency of electrode 2 was significantly correlated with tumor size (p = 0.03). Besides, none of the parameters were predictive for a possible postoperative facial nerve dysfunction regarding superficial partial parotidectomy.

The use of LigaSure™ vessel sealing system in head and neck surgery was reported to be reliable and safe, providing sufficient hemostasis and reducing operating time. The aim of this study was to evaluate efficacy of this technique in patients undergoing selective neck dissections. This study was carried out as a prospective controlled study at an otolaryngology department of a tertiary medical center between July 2013 and July 2015. Twenty-five patients older than 18 years who underwent unilateral selective neck dissection for head and neck cancer were included in the study. In the control group (group 2, 10 patients) only monopolar and bipolar diathermy was used; in the Ligasure group (group 1, 15 patients) Ligasure was used for hemostasis and dissection in addition to the conventional techniques. Cervical lymphadenectomy time, operation time, preoperative hemoglobin levels, preoperative hematocrit levels, postoperative hemoglobin levels, postoperative hematocrit levels, total neck drainage and drain removal time were analyzed and compared between the groups. Median operation time in group 1 and 2 were 95 min (IQR = 35) and 142.5 min (IQR = 63), respectively. Median cervical lymphadenectomy time in group 1 and 2 were 55 min (IQR = 23) and 102.5 min (IQR = 49), respectively. Median operation time and cervical operation time were significantly lower in group 1 (p < 0.05). In conclusion, LigaSure™ vessel sealing system is a safe, efficacious technique and significantly lowers cervical lymphadenectomy and operation time in selective neck dissections compared to controls. Given the superb hemostatic properties, this technique should be in the surgeon's armamentarium when possible.

ÖZAmaç: Bu çalışmada parotidektomi sırasında fasiyal sinir monitörizasyonu ve minimum fasiyal sinir uyarılma eşiklerinin ameliyat sonrası fasiyal sinir fonksiyonunu öngörmedeki değeri değerlendirildi. Hastalar ve Yöntemler:Ocak 2013 -Mayıs 2013 tarihleri arasında kliniğimizde tedavi edilen 20 yüzeyel parotidektomi hastası (9 erkek, 11 kadın; ort. yaş 52 yıl; dağılım 23-80 yıl) çalışmaya alındı. Ameliyat sırası fasiyal sinir monitörizasyonu uygulandı ve ameliyat bitiminde ana trunkusta minimum fasiyal sinir uyarılma eşikleri kaydedildi. Ameliyat sonrası fasiyal sinir fonksiyonları House Brackmann (HB) dereceleme sistemi ile değerlendirildi. Bulgular:Erken ameliyat sonrası değerlendirmede, fasiyal sinir fonksiyonu HB derece 1 olan (normal) 12 hastanın minimum uyarılma eşikleri ile marjinal mandibüler dalda HB derece 2 fasiyal parezili sekiz hastanın minimum uyarılma eşikleri sırasıyla 0.20±0.14 mA ve 0.22±0.05 mA idi (p>0.05). Birinci günün sonunda, 17 HB derece 1 hastasının minimum uyarılma eşikleri ile üç HB derece 2 hastasının minimum uyarılma eşikleri sırasıyla 0.20±0.12 mA ve 0.25±0.07 mA idi (p>0.05). Ameliyat sonrası fasiyal parezi gelişen ve gelişmeyen hastalar arasında uyarılma eşikleri açısından anlamlı fark bulunmadı. Tüm hastalar üçüncü ayın sonunda HB derece 1 idi. Tümör boyutu ile ameliyat sonrası fasiyal sinir fonksiyonu arasında ilişki saptanmadı (p>0.05). Sonuç:Yüzeyel parotidektomi sırasında minimum fasiyal sinir uyarılma eşikleri ameliyat sonrası hafif fasiyal sinir parezisini öngörmede etkili değildi.Anahtar Sözcükler: Fasiyal sinir; monitörizasyon; paralizi; parotidektomi; uyarılma. ABSTRACT Objectives:This study aims to assess the value of facial nerve monitorization and minimum facial nerve stimulation thresholds during superficial parotidectomy in the prediction of postoperative facial nerve function. Patients and Methods:Twenty superficial parotidectomy patients (9 males, 11 females; mean age 52 years; range 23 to 80 years), who treated in our clinic between January 2013 and May 2013 were recruited in this study. Intraoperative facial nerve monitorization was applied and minimum facial nerve stimulation thresholds were recorded in the main trunk at the end of the operation. Postoperative facial nerve functions were evaluated by House Brackmann (HB) grading system. Results:In early postoperative evaluation, minimum stimulation thresholds of 12 patients with facial nerve function HB grade 1 (normal) and of eight patients with HB grade 2 facial paresis in marginal mandibular branch were 0.20±0.14 mA and 0.22±0.05 mA respectively (p>0.05). At the end of the first day, minimum stimulation thresholds in 17 HB grade 1 patients and three HB grade 2 patients were 0.20±0.12 mA and 0.25±0.07 mA, respectively (p>0.05). No significant difference was detected in terms of stimulation thresholds between patients who developed or did not develop postoperative facial paresis. All patients were HB grade 1 at the end of third month. No correlation was found between tumor size and postoperative facial nerve fu...

Extramedullary plasmacytoma (EMP) is a rarely seen neoplasm of plasma cells which may be locally destructive by involving sub mucosal soft tissues of upper respiratory tract but without syste mic dissemination. It comprises less than 1% of head and neck malignities. Clinical presentation depends on tumor's effect and its involvement site. Diagnosis is made with histo pathologic examination of tissue biopsy. Responses to its treatment with local radiotherapy and surgery are similar. In this article; it is intended to update our knowledge regarding EMP and remind this rarely encountered disease by presenting various cases detected in nasopharynx, tonsil, buccal mucosa, larynx, mastoid cavity and sphenoid sinus, with literature line.

Median p53 in the primary tumor was 55% (interquartile range (IQR) = 67) and 5% (IQR = 71) in groups 1 and 2, respectively (p = 0.178). Median p53 in the surgical margin was 11% (IQR = 13) and 2% (IQR = 2) in groups 1 and 2, respectively (p = 0.001). In the logistic regression analysis only surgical margin p53 value was significant in the prediction of recurrences (odds ratio (OR) = 1.68, 95% CI = 1.1-2.6, p = 0.017). Receiver operating characteristic (ROC) curve analysis demonstrated that the area under the curve was 0.86 (p = 0.002) and 0.65 (p = 0.180) in the surgical margin and the primary tumor, respectively.