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    Burkitt Lymphoma Like Nodular Diffuse Atypical Lymphoid Infiltration: A Case Report
    (Aves, 2013) Çelik, Öner; Atespare, Altay; Boyaci, Zerrin; Yener, Nese; Vural, Çetin
    Burkitt's lymphoma is a type of B-cell lymphoma that grows rapidly and it usually localizes extranodally. Sometimes it occurs as leukemia-like infiltration. Lymph node involvement is rare. It has very high mitotic index. Starry sky view occurs as a result of phagocytosis of overproduced apoptotic cells by macrophages. Although it is a very fast growing tumor, cure can be achieved with intensive therapy. A twenty-six-year-old female patient presented to our clinic with a complaint of swelling in the neck. Fine needle aspiration biopsy was performed. Pre-diagnosis of the mass was atypical Burkitt's lymphoma. We agreed to perform excisional biopsy. In this paper we are presenting a rare case of 'Burkitt's lymphoma-like atypical diffuse lymphoid nodular-infiltration', finally diagnosed as a result of advanced hemato-pathologic analysis. Despite no oncological treatment, no recurrence occured in 1 year period of follow up.
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    Conservative Costal Cartilage Harvest for Revision Septorhinoplasty
    (LIPPINCOTT WILLIAMS & WILKINS, 2013) Boyaci, Zerrin; Celik, Oner; Atespare, Altay; Koca, Oncel
    Objective: We present our experience with a conservative costal harvesting to be used for patients undergoing secondary septorhinoplasty. Methods: Sixty-five patients who underwent revision septorhinoplasty requiring autogenous costal cartilage harvest performed by the senior author from 2005 to 2011 have been included in this retrospective study. Assessment of the outcomes includes harvesting time, incision size, availability of graft material, and postoperative complications. Results: The mean operation time was 25 minutes. The incisions varied from 3 to 4 cm. Sufficient cartilage volume was harvested for the targeted purpose in all cases. No wound infection developed. One patient had pleural damage, and no more major complications were noted. The patients suffered from mild pain. Postoperative scar was minimal. No deformity was observed in the donor site on postoperative analysis. Conclusions: The described technique is very safe and minimizes donor-site morbidity. In addition, it allows the acquisition of nonepithelialized dermal graft and muscle fascia for soft tissue reconstruction.
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    The Effect of Duration of Merocel in Glove Finger With Tetracaine Solution on Septoplasty Morbidity
    (LIPPINCOTT WILLIAMS & WILKINS, 2013) Celik, Oner; Boyaci, Zerrin; Atespare, Altay; Develioglu, Omer; Karaca, Cigdem Tepe; Caglar, Erdem; Vural, Cetin
    Objective: We aimed to decrease the postseptoplasty morbidities depending on nasal packing by using Merocel within glove finger moistened with tetracaine 0.25% solution. Study Design: The study was designed as a randomized prospective study. Setting: A university hospital in Turkey. Subjects and Methods: Our study consisted of 80 patients who underwent septoplasty. The Merocel nasal tampon within glove finger was inserted after surgery in the study group and removed after 24 or 48 hours. Merocel was moistened with tetracaine 0.25% solution after insertion into the nasal cavity and just before removal. The morbidities and normal breathing time were recorded and compared with those of the control group. Results: The postseptoplasty morbidities were significantly decreased in the study group compared with those in the control group. The morbidities were also improved after removal of tampons after 24 hours compared with 48 hours. However, the normal breathing time was prolonged when the nasal tampons were removed after 24 hours. Conclusions: The glove finger provides comfortable removal of nasal packing. The Merocel tampons might be safely removed just after 24 hours postoperatively without any complication.
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    Mucociliary transport and histopathological changes in rotation flaps of the nasal mucosa
    (SPRINGER, 2015) Atespare, Altay; Ustundag, Emre; Dalcik, Hakki; Celik, Oner
    Normal mucociliary transport in the mucoperichondrium of the nasal septum is from a distal (anterior) to proximal (posterior) direction. This study was to determine the direction of mucociliary transport and histopathological changes in nasal mucosal rotation flaps when their transport directions were anatomically reversed. Thirty-two rabbits were divided into four groups. Surgical septal rotational flaps were prepared in the experimental groups. Group I was the control group. The distal aspect of the flap was sutured through a large septal window to the other side of the nasal septum, thus changing the direction of the flap. Evaluation was performed 1 week, 1 month and 9 months later with each of these groups named as groups II, III, and IV, respectively. The rate and direction of the mucociliary transport was determined and histopathological investigations were performed from the flaps. The direction of mucociliary transport was observed to continue as distal to proximal direction in the rotated segments. The mucociliary transport rate was found to be decreased in group II, nearly normal in group III, and in normal limits in group IV after surgery. Intense inflammation and decreased number of cilia were present in group II. The inflammation was milder in group III and the epithelium was found to be nearly normal in group IV. The originally programmed direction of mucociliary transport in the nasal rotation flaps is maintained and is not altered or reprogrammed. Histopathological changes revert back to normal from an inflammatory state to reach pre-surgical status over time.
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    Septorhinoplasty With Spreader Grafts Enhances Perceived Voice Quality Without Affecting Acoustic Characteristics
    (MOSBY-ELSEVIER, 2012) Celik, Oner; Boyaci, Zerrin; Yelken, Kursat; Atespare, Altay; Celebi, Saban; Koca, Oncel
    Objective. To identify the effect of septorhinoplasty with spreader grafts on patients' perception of voice and to measure formant frequencies that may be responsible for perceived changes in voice quality. Methods. A total of 20 patients who underwent septorhinoplasty and had spreader grafts placed during the operations were included. All subjects were tested within the week before surgery and 1-3 months postoperatively by means of perceptual assessment (Voice Handicap Index-10 [VHI-10] and self-assessment of hypo/hypernasality), acoustic analysis, and formant frequency analysis. Results. The mean of VHI-10 score was decreased from 9.44 +/- 6.1 to 5.1 +/- 3.94 postoperatively (P = 0.03). Fifteen patients (75%) perceived their voices to be hyponasal before surgery, but only three perceived the hyponasality to persist after surgery (P < 0.001). No patient perceived the voice to be hypernasal either before or after surgery. Fifteen patients (75%) perceived their overall voice quality to be improved, whereas five patients perceived no change. None of the patients perceived their voice to be worse after surgery. There were no significant differences between pre- and post-operative acoustic analysis and formant frequency analysis (P > 0.05). Conclusion. Septorhinoplasty with spreader grafts significantly improved patients' perception of voice; however, acoustic analysis and formant frequency analysis of nasalized vowels did not reveal any significant differences after the operation.
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    The Use of Spreader Grafts in Revision Septoplasty
    (LIPPINCOTT WILLIAMS & WILKINS, 2016) Atespare, Altay; Boyaci, Zerrin
    Introduction:Persistent nasal obstruction at internal nasal valve was a common problem seen after septoplasty and submucous resection, the 2 methods used for surgical treatment for deviation of nasal septum during the first half of twentieth century. The authors performed cartilage-grafting technique and retrospectively analyzed the patients after 12 months with Nasal Obstruction and Septoplasty Effectiveness scale to emphasize persistent nasal obstruction.Methods:In this study, 115 (65 male, 50 female) patients operated between 2008 and 2013 who underwent revision septoplasty and complaints were evaluated with Nasal Obstruction and Septoplasty Effectiveness scale. The surgical technique was used in 32 (27.8%) of the patients open and in 83 (72.2%) closed approach. Wilcoxon sign test is used for the statistical analysis. Postoperative values were statistically significant compared with preoperative ones (P<0.05).Discussion:Septoplasty and submucous resection described by Cottle and Killian are similar techniques, but a septoplasty often includes less cartilage resection and septal cartilage modification or placement of a cartilage graft instead of resection. Most important disadvantage of these techniques is to be deficient in the correction of the caudal and/or dorsal deviations. In authors' experience these classical septoplasty techniques are not suitable for columellar and dorsal deviations and especially in revision surgery an internal nasal valve correction with cartilage grafts is a necessary alternative technique.
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    Utility of Cartilage Grafts Wrapped With Amniotic Membrane in Dorsal Nasal Augmentation
    (LIPPINCOTT WILLIAMS & WILKINS, 2016) Atespare, Altay; Kara, Hakan; Ilter, Erdin; Boyaci, Zerrin; Celik, Oner; Midi, Ahmet
    Objectives: The success of rhinoplasty may be compromised with postoperative problems like rough and rigid nasal dorsum. Biological grafts or alloplastic materials are required to hurdle and correct nasal dorsal deformities and also irregularities. The purpose of this experimental study was to compare pure cartilage graft, cartilage graft wrapped in amniotic membrane, and diced cartilage grafts wrapped in amniotic membrane for soft tissue augmentation. Methods: All grafts were transplanted through a subcutaneous tunnel created in the nasal dorsum of 18 rats, 6 in each group. After 3 months follow-up, the histopathological changes in all groups were evaluated by light microscopy and volumetric measurements. Results: With regard to cartilage viability, cartilage wrapped in amniotic membrane had a higher success rate than pure cartilage graft. Also, a further increased success rate was found in the diced group. Conclusions: In the soft tissue augmentation after rhinoplasty surgery, especially diced cartilage wrapped in amniotic membrane keeps the graft viable and adjoined.
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    Voice and Speech Changes in Various Phases of Menstrual Cycle
    (MOSBY-ELSEVIER, 2013) Celik, Oner; Celik, Aygen; Atespare, Altay; Boyaci, Zerrin; Celebi, Saban; Gunduz, Tonguc; Aksungar, Fehime Benli; Yelken, KursAt
    Background. The reproductive system in females undergoes a regular cyclic change known as the menstrual cycle. Laryngeal changes are evident and fluctuate systematically during the reproductive years with the menstrual cycle. The impact of estrogens in concert with progesterone produces the characteristics of the female voice, with a fundamental frequency (F-0) higher than that of male. Objective. To characterize changes in voice and speech in adolescent females in different phases of the menstrual cycle-during menstruation, after menstruation, mid-menstrual cycle, and premenstruation. Materials and Methods. Sixteen adult females who were nonusers of oral contraceptives participated in a cross-sectional study of menstrual cycle influences on voicing and speaking tasks. Acoustic analysis (F-0, intensity, perturbation measurements [jitter and shimmer], and harmonic-to-noise ratio), maximum phonation time (MPT), s/z ratio, and perceptual assessments (grade [G], roughness [R], breathiness [B], asthenia [A], and strain [S] [GRBAS] and Voice Handicap Index-10 [VHI-10]) scales were performed during all phases. Results. None of the acoustic analysis parameters and MPT and s/z ratio measurements revealed statistically significant difference (P > 0.05). Perceptual voice assessment scales either clinician based or patients self-evaluated showed significant differences among phases (P < 0.05). Conclusions. The objective voice analysis methods, such as acoustic analysis, MPT, and s/z ratio, determined no difference; however, the subjective voice analysis methods, such as clinician-based perceptual assessment (GRBAS) and patients self-evaluation (VHI-10) scales, demonstrated significant changes during different phases of menstrual cycle.