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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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    Microscopic bilateral posterior cordotomy in severe obstructive sleep apnea syndrome with bilateral vocal cord paralysis
    (SPRINGER HEIDELBERG, 2012) Sariman, Nesrin; Koca, Oncel; Boyaci, Zerrin; Levent, Ender; Soylu, Akin Cem; Alparslan, Sumeyye; Saygi, Attila
    Vocal cord paralysis is a rare cause of obstructive sleep apnea syndrome (OSAS). Recurrent laryngeal nerve injury after thyroid gland surgery is one of the leading causes of acquired vocal cord paralysis. A 46-year-old woman with OSAS due to bilateral abductor vocal cord paralysis was presented. She had thyroidectomy 30 years ago and had a weak, breathy voice. She had been referred with a history of high-pitched snoring, apnea witnessed by her spouse, and excessive daytime sleepiness for the last 5 years. Full-night polysomnography revealed that her apnea-hypopnea index was 72/h and minimal oxygen saturation level was 81%. There was no REM and deep sleep periods. Ear-nose-throat consultation offered an endoscopic bilateral posterior cordotomy operation via microscopic suspension laryngoscopy (MLS) as a treatment option. Instead of using a nasal positive airway pressure (nCPAP) device, she was treated surgically. Her OSAS resolved completely within 5 months of the surgery. Her phonation was preserved, and symptoms such as snoring and hypersomnolance disappeared. In OSAS patients with bilateral vocal cord paralysis, MLS-associated bilateral posterior cordotomy can be a choice of treatment as an alternative to nCPAP application.
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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.