Browsing by Author "Kutluhan, A."

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Carotid Body Tumors: Challenging Complexity of Diagnosis and Surgical Treatment
(2003) Kiriş, M.; Cankaya, H.; Kutluhan, A.; Kiroglu, A.F.
OBJECTIVES: To evaluate the patients treated for carotid body tumors and the problems encountered during diagnosis and treatment. PATIENTS AND METHODS: The study included eight patients (5 females, 3 males; mean age 50 years; range 36 to 68 years) who underwent surgery for carotid body tumors. Diagnosis was confirmed by power Doppler ultrasonography and computed tomography or magnetic resonance imaging in all patients. Angiography was performed in three patients to evaluate vascularity and to perform embolization before surgery. Two patients had previously undergone biopsy elsewhere. The mean follow-up was 15 months (range 2 to 36 months). RESULTS: The size of the tumors varied from 3 cm to 11 cm. In two patients the tumors were found to extend to the skull base. Ligation of the external carotid artery and the common carotid artery was performed in five patients and in one patient, respectively. Surgery-associated injuries given to the internal carotid artery in two patients were repaired by sutures. The 10th cranial nerve was dissected in two patients who had undergone a prior biopsy. They developed cord paralysis and hoarseness postoperatively. Resection of the 11th cranial nerve in one patient resulted in shoulder pain and drop shoulder. The 12th cranial nerve was repaired end-to-end by neurorrhaphy in two patients. They exhibited significant improvement in nerve functions a year after surgery. CONCLUSION: The larger the tumor is, the more difficult the resection is, and the more injuries are caused to the surrounding nerves and vessels.
Castleman's Disease Arising in the Cervical Region: a Case Report
(2003) Yuca, K.; Kösem, M.; Çankaya, H.; Kutluhan, A.; Kiris, M.
Castleman's disease (CD) (angiofollicular lymph node hyperplasia) is a rare lymphoproliferative disease of unknown etiology. On rare occasions it is the cause of a solitary neck mass. Definitive diagnosis and treatment is possible with complete surgical resection. This report describes a case of this disorder of the hyalinovascular type as a solitary neck mass in a 35-year-old woman. The patient was treated by surgical excision.
Clinical Value of Preoperative Intraoral Ultrasonography in Tonsillectomy
(1998) Kutluhan, A.; Sakarya, M.E.; Çankaya, H.; Akkaya, S.
In this prospective study, 43 chronic tonsillitis patients underwent intraoral ultrasonography preoperatively and the width and thickness of tonsils and tonsillocarotid distances were measured. Positive correlation was obtained in postoperative measurements compared with ultrasonographic measurements of tonsils. The mean tonsillocarotid distances were 8.6 mm in the left and 8.25 mm in the right tonsillar fossa. This study showed that preoperative intraoral ultrasonography was to be help of tonsillectomy operations particularly in surgical anatomical orientation.
Differences in Clinical and Histopathologic Features Between Chronic Adenotonsillitis and Chronic Adenotonsillar Hypertrophy
(2003) Kutluhan, A.; Ugraş, S.; Kiriş, M.; Cankaya, H.; Kiroglu, A.F.; Yurttaş, V.
OBJECTIVES: This study sought to determine the clinical and histopathological differences between chronic adenotonsillitis and chronic adenotonsillar hypertrophy. PATIENTS AND METHODS: This prospective study included 286 patients (147 males, 139 females; mean age 16.6 years; range 3 to 45 years) with chronic adenotonsillitis and 197 patients (98 males, 99 females; mean age 9.5 years; range 2 to 18 years) with adenotonsillar hypertrophy. Clinical and histopathological findings were compared. RESULTS: The mean age was significantly higher (p<0.001) and acute attacks of fever, dysphagia, and sore throat were more frequent in chronic adenotonsillitis. Patients with adenotonsillar hypertrophy more commonly manifested snoring, mouth breathing, and dispnea. Physical examination showed hyperemia of the anterior plica in 93% and 15% in chronic adenotonsillitis and adenotonsillar hypertrophy, respectively. Histopathologically, the former was more commonly associated with severe lymphocyte infiltration to surface epithelium, surface epithelial defects, plasma cells, atrophy, and fibrosis. The sole outweighing difference in favor of chronic adenotonsillar hypertrophy was increased germinal centers. CONCLUSION: Clinical and histopathologic findings suggest that chronic adenotonsillitis and chronic adenotonsillar hypertrophy may be diverse diseases requiring different approaches in treatment.
The Effectiveness of Unilateral Tonsillectomy in Chronic Adenotonsillar Hypertrophy
(2005) Kutluhan, A.; Caksen, H.; Yurttaş, V.; Kiriş, M.; Yuca, K.
OBJECTIVES: This study sought to determine whether unilateral tonsillectomy was effective in the treatment of chronic adenotonsillar hypertrophy. PATIENTS AND METHODS: A total of 197 patients (96 girls, 101 boys) with chronic adenotonsillar hypertrophy were prospectively included. The patients were randomly assigned to either bilateral tonsillectomy (n=113; mean age 10.1 years; range 4 to 18 years) or unilateral tonsillectomy (n=84; mean age 4.5 years; range 3 to 8 years) performed with or without adenoidectomy. All the patients were followed-up for at least a year. RESULTS: The two groups did not differ significantly with respect to preoperative symptoms, the size of tonsils, and the presence of adenoid hypertrophy. At the end of the follow-up, no significant differences were found with respect to relief of snoring, mouth breathing, and upper airways obstruction between the two groups. A greater number of patients achieved complete improvement in snoring in the bilateral tonsillectomy group (p<0.05). With unilateral tonsillectomies, three patients required tonsillectomy to the other side, two had recurrent tonsillitis, and one had severe compensatory hypertrophy with persistent difficulty in inspiration and mouth breathing. CONCLUSION: Unilateral tonsillectomy seems to be as effective as bilateral tonsillectomy in the treatment of chronic adenotonsillar hypertrophy.
The Effects of Hyaluronic Acid on Myringoplasty in Rats
(1999) Kutluhan, A.; Ugras, S.; Inalkac, E.; Akpolat, N.
Tympanic membrane perforations arise from a variety of causes. Some of them require myringoplasty. In this study, we used hyaluronic acid, a polysaccharide with high-molecular-weight which may be obtained commercially and affects modulations of cell function. An experimental myringoplasty was performed on rats in which a chronic dry tympanic membrane perforation was formed. While physiological saline was embedded in Gelfoam® which was supported under and over the graft, in group 1, hyaluronic acid embedded gelfoam was used in group 2. Better epithelization, less calcification and scar tissue were established in group 2 myringoplasties. This study shows that hyaluronic acid may be used in myringoplasty especially in myringosclerotic tympanic membrane perforations.
The Efficacy of Topical Ciprofloxacin in the Treatment of Chronic Suppurative Otitis Media
(Medquest Communications LLC, 1998) Kiris, M.; Berktas, M.; Egeli, E.; Kutluhan, A.
We conducted a test of the efficacy of ciprofloxacin eardrops in 80 patients (95 ears) with otorrhea due to chronic suppurative otitis media in two treatment settings. One group (n=40; 47 ears) received daily ciprofloxacin therapy plus aspiration in the clinic. The other group (n =40; 48 ears) self administered ciprofloxacin at home. Overall, otorrhea resolved in 88% of all ears within 12 days of the initiation of treatment. The clinic- treated patients tended to respond more rapidly than did the self-treated patients, but there was no statistically significant difference in success rates between the two groups. Side effects were negligible. We conch that empiric topical ciprofloxacin therapy is an effective, safe and relatively inexpensive treatment for otorrhea in patients with chronic otitis media.
Endodermal Sinus (Yolk Sac) Tumor of Oral Cavity Originating From Gingiva
(1998) Kutluhan, A.; Ugraş, S.; Akman, E.
Endodermal sinus tumor is a malignant germ cell tumor which usually arises in gonads. Extragonadal endodermal sinus tumors in the head and neck are very rare. Here a gingival endodermal sinus tumor is reported. The lesion demonstrated typical microscopic features of the endodermal sinus tumors of gonads. The tumor cells showed α-fetoprotein immunoreactivity in immunohistochemical evaluation. The serum α-fetoprotein level was high. This is the first gingival case in the related literature.
Fibromatosis of the Mandible in a Child
(2002) Kutluhan, A.; Kiroglu, A.F.; Ugraş, S.
Fibromatosis represents a group of fibrous tumors showing clinic and biologic features between benign fibrous lesions and fibrosarcoma. These locally aggressive tumors have high recurrence rates (20% to 70%). A four-year-old boy presented with mandibular fibromatosis occupying the mandible completely and extending to the submandibular gland and soft tissues. Complete hemimandibulectomy and submandibular gland excision were performed followed by reconstruction with a curved Kirschner wire. No signs of recurrence was observed during a follow-up period of 18 months. In addition, no limitations in the functions of the jaw, mastication, and swallowing were noted.
Fibrosarcomatous Change in Dermatofibrosarcoma Protuberans
(1996) Ugras, S.; Kutluhan, A.; Bekerecioglu, M.; Karakok, M.
Dermatofibrosarcoma protuberans which included fibrosarcomatous areas is rarely seen. In one case, we estimated the proportion of area of dermatofibrosarcoma protuberans and fibrosarcomatous area. We also estimated mitotic rate, cellularity, and cytologic anaplasia in these areas. Histologically, the fibrosarcoma area showed a cellularity, mitotic figures, and cytologic anaplasia exceed those seen in the dermatofibrosarcoma protuberans area. The proportion of the fibrosarcoma area was 89%. In both dermatofibrosarcoma protuberans and fibrosarcoma areas, giant cells, necrosis and haemorrhagea was absent. In conclusion, we believe that the dermatofibrosarcoma protuberans which included fibrosarcomatous areas may be an intermediate type between dermatofibrosarcoma protuberans and fibrosarcoma.
Giant Pilomatrixoma Arising in the Preauricular Region: a Case Report
(2004) Yuca, K.; Kutluhan, A.; Cankaya, H.; Akman, E.
Pilomatrixoma is a rare, benign, calcifying cutaneous tumor, originating from pluripotential precursors of hair matrix cells. It is most commonly seen in the head and neck region, occurring in the first two decades of life. It usually occurs as a single nodule with a diameter of 0.5-3 cm, localized dermally or subcutaneously. Clinical diagnosis may be difficult when it presents in a large, ulcerated form or in elderly patients. A 65-year-old female presented with a painful and progressive, cutaneous, firm-solid mass with a diameter of 6 x 4 cm in the left preauricular region. The mass was surgically excised under general anesthesia. Histopathological diagnosis of the mass was pilomatrixoma which showed basophilic cells, shadow cells, and calcifications. Postoperative result of the operation field was cosmetically and functionally acceptable.
Larinks Tüberkülozu
(2002) Çankaya, H.; Uğraş, S.; Özbay, B.; Kutluhan, A.; Kiriş, M.
Larinks tüberkülozu giderek azalmakla birlikte halen görülmeye devam eden bir hastalıktır. Ses kısıklığı yanında ağrılı yutma güçlüğü yakınması olan olgularda da düşünülmelidir. Genellikle akciğer tüberkülozunun bir komplikasyonu olmasına karşın, bazen tek başına da görülebilmektedir. Larinks karsinomu ve diğer granülomatöz hastalıklar ile bu hastalığın ayırıcı tanısının yapılması önem arz etmektedir.
Maxillary and Temporal Fibrous Dysplasia
(Royal Belgian Soc Ear, Nose, Throat, Head & Neck Surgery, 2005) Kiroglu, A. F.; Yuca, K.; Çankaya, H.; Kutluhan, A.; Kara, T.
Maxillary and temporal fibrous dysplasia: three cases. Problems/objectives: Fibrous dysplasia (FD) is a benign, expansile lesion of bone with slow progression and unknown origin. The purpose of this report is to make physicians aware of the symptoms, methods for differential diagnosis, and treatment options. Methodology: Three cases of monostotic FD are presented; two involving the maxillary sinus, and one in temporal bone. CT scans are the definitive diagnostic and follow-up method. Surgical approaches to alleviate the symptoms, including facial deformity, are described. Results: FD went undiagnosed for three years in these patients. All three patients were relieved of the symptoms by limited surgery, and remained asymptomatic for up to two years after the surgery, with no signs of recurrence. Conclusions: Practitioners should be alert to the possibility of FD, particularly if patients develop narrowing of the ear canal, or progressive postauricular or maxillofacial enlargement. Minimal surgery to alleviate the symptoms is the treatment of choice.
Otorhinolaryngological Aspects of Xeroderma Pigmentosum
(1999) Kutluhan, A.; Bekerecioglu, M.; Güney, E.; Metin, A.
Objective: to evaluate the probable presence of otorhinolaryngological pathology accompanied by head and neck region skin findings in patients with Xeroderma pigmentosum. Methods: a total of 19 patients with Xeroderma pigmentosum were investigated for otorhinolaryngological findings. The patients gave their anamnesis and underwent physical examination, audiological tests and endoscopic examination. Results: various malignancies developed in 14 patients on the sun-exposed areas of the head and neck region. Multiple malignancies were found in six of them. There was no other pathological condition secondary to this rare clinical entity. Conclusion: Xeroderma pigmentosum causes skin lesions. Some otolaryngological findings such as rhinitis, sinusitis etc. were thought to be coincidental. Copyright (C) 1999 Elsevier Science Ireland Ltd.
The Place of Tonsillar Focal Infection in Tonsillectomy Bleeding in Chronic Tonsillitis
(2000) Kutluhan, A.; Kiroglu, F.; Akpolat, N.; Akdeniz, H.; Ugras, S.; Kiris, M.
Purpose: The aim of this study is to investigate whether there is any factor which influences tonsillectomy bleedings among clinical and histopathological findings. Methods: 380 patients who underwent tonsillectomy due to chronic tonsillitis were included in the study. The patients were divided into two groups according to peroperative bleedings. Group 1, included the patients whose bleedings stopped spontaneously or with gauze tampon and Group 2, the patients whose bleedings stopped with suturation-ligation or cauterisation. Results: Although there was no difference between the groups in age, sex, acute tonsillitis attack number, tonsil volume, lymphoide hyperplasia, lymphocyte infiltration to surface epithelium, epithelial defect, plasma cell and fibrosis; a statistical difference was present in view of polymorphonuclear leucocyte occurence against Group 1. Conclusion: We consider that an acute infection limited to the tonsils, exists in some cases with chronic tonsillitis and therefore this state may become a minor factor causing to bleeding in tonsillectomy.
Reconstruction of a Congenital Midpalatal Hairy Polyp
(Churchill Livingstone, 2004) Kiroglu, A.F.; Kutluhan, A.; Bayram, I.; Tuncer, O.; Sakin, F.
Hairy polyps (dermoids or oronasopharyngeal teratomas) are a type of congenital tumour that contain elements of bigerminal origin (ectoderm and mesoderm). We describe a baby who presented with a hairy polyp of the hard palate protruding from the mouth. This was not causing respiratory distress but she had feeding difficulties. She was successfully operated on the age of 5 days, the defect was reconstructed with hairless skin of the mass and she was able to suck after a month. © 2003 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
The Relationship Between Ostial Patency and Medical Treatment in Acute Maxillary Sinusitis: an Experimental Study
(2002) Kutluhan, A.; Inalkaç, E.; Kiroglu, A.F.; Akpolat, N.; Kiriş, M.
OBJECTIVES: We investigated the relationship between ostial patency and medical treatment in an experimental model of acute maxillary sinusitis. DESIGN AND METHODS: Forty healthy New Zealand white rabbits were assigned to two groups. The left maxillary sinus ostia were filled with absorbable gelatin sponge in one group (n=20). In the other group, half of the ostuim was blocked by bone particles and tissue adhesive (Histoacryl). Following induction of acute maxillary sinusitis, each group was divided into four subgroups, one of which was left untreated. The other subgroups received systemic antibiotic therapy plus topical administration of physiological saline solution, a decongestant, and a steroid, respectively, for 10 days. All rabbits were monitored for four weeks. Each week nasal smear samples were obtained for neutrophil and leucocyte counts. In the end, maxillary sinus biopsies were obtained to determine the extent of healing. RESULTS: There were no significant differences between subgroups having the same ostium patency. However, compared to the subgroups with patent ostia, corresponding subgroups with semi-patent ostia exhibited significantly increased nasal smear and nasal biopsy scores starting from the second week. CONCLUSION: The degree of ostial patency seems to have a significant role in the treatment of acute maxillary sinusitis.
The Role of Fine-Needle Aspiration Biopsy in the Evaluation of Head and Neck Masses
(2002) Kutluhan, A.; Kisli, E.; Yakut, F.; Yurttaş, V.; Kösem, M.
Purpose: The purpose of this study is to evaluate the role of diagnostic fine-needle aspiration biopsy (FNAB) of head and neck masses and to calculate the sensitivity and specificity of this method. Materials and Methods: The records of 219 patients who had undergone an FNAB of head or neck masses were reviewed. FNAB results were correlated with the histopathologic findings observed after surgery in 96 of 219 patients. Sensitivity, specificity and positive predictive value of FNAB for the detection of malignancy were calculated. Results: Four false-negative, 4 false-positive and 22 unsatisfactory results were obtained using FNAB, according to histopathologic findings. The overall sensitivity, specificity, accuracy and positive predictive value for malignancy were 87.5, 93.8, 91 and 87.5%, respectively. Conclusions: FNAB is a useful diagnostic tool for head and neck masses. However, FNAB results by themselves could be insufficient in the management of head and neck masses; therefore, they should be combined with clinical and radiologic findings. Copyright © 2005 S. Karger AG.
Squamous Cell Carcinoma of the Lower Lip and Supra-Omohyoid Neck Dissection
(ARSMB-KVBMG, 2003) Kutluhan, A.; Kiriş, M.; Kaya, Z.; Kisli, E.; Yurttaş, V.; Içli, M.; Käsem, M.
Purpose: The aim of this study is to evaluate our approach to patients with squamous cell carcinoma of lower lip. Patients and methods: This study includes 31 lower lip squamous cell carcinomas followed up between 1994 and 2000. Primary treatment was applied to 28 patients of whom 23 were in stages I-II and five in stages III-IV. Three patients presented locoregional recurrence. Neck dissection was performed during primary lip resection in patients with palpable cervical lymph node involvement. Patients with unpalpable cervical lymph nodes were divided into two subgroups: one was submitted to elective neck dissection (n = 11) and the other had isolated lip resection (n = 8). Unilateral or bilateral selective supra-omohyoid neck dissection (SOHND) was performed according to the localisation of the disease. Radical dissection was performed in a secondary intervention, when SOHND revealed lymph node metastases. Radiotherapy and chemotherapy were applied for curative and / or adjuvant treatment in addition to surgery in patients with locoregional recurrence and metastatic lymph nodes or with perineural involvement. Results: Occult cervical metastasis within a single lymph node was found in one of the 11 No patients who underwent elective neck dissection. Delayed neck metastasis developed in one of the eight patients in whom isolated lip resection (without neck exploration) was performed. Chemoradiotherapy was administered to this patient, but he died. Neck metastasis was established histologically in four of five patients in stages III-IV. Postoperative radiotherapy was used on these patients. One of the patients in this group died due to inoperable local recurrence in the neck, another died because of distant metastasis. Local mandibular recurrence was seen in one of these patients after three years. Comment: Six patients (19%) died due to lower lip carcinoma in this series. Our findings show the importance of elective neck dissection and intact surgical resection margins.
Treatment of Mucoepidermoid Carcinoma of the Parotid Gland and Successful Repair of Iatrogenic Facial Nerve Paralysis
(2008) Kutluhan, A.; Yurttaş, V.; Yuca, K.; Kösem, M.; Yakut, F.
A 15-year-old female patient developed facial nerve paralysis following surgical excision of a right parotid mass at another center. The histopathologic diagnosis of the lesion was mucoepidermoid carcinoma. On admission to our clinic, she underwent extended total parotidectomy and functional neck dissection. For facial nerve reanimation, cervical plexus nerve grafting was performed for frontal and buccal branches, and ansa hypoglossi anastomosis for the marginal mandibular branch. Postoperative radiotherapy was administered. Facial nerve functions returned to normal in the postoperative sixth month (House-Brackmann grade II). No locoregional recurrence or distant metastasis occurred in the follow-up period.