Browsing by Author "Eskiizmir, G"
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Item Association Between Interleukin-6 and Head and Neck Squamous Cell Carcinoma: A Systematic ReviewUz, U; Eskiizmir, GInterleukin-6 (IL-6) is a proinflammatory cytokine which plays an important role in several regulatory mechanisms of cancer. Moreover, experimental and clinical studies have reported that IL-6 targeted therapies might provide significant benefits for cancer treatment. The purpose of this systematic review is to evaluate IL-6 activity in patients with head and neck squamous cell carcinoma (HNSCC). A systematic review of the association between serum, saliva and tumor IL-6 and HNSCC was developed on PubMed/Medline in the publication range from January 1995 to January 2019. Our literature analysis demonstrated that overexpression and elevated serum and/or saliva 1L-6 concentrations in patients with HNSCC are related to poor survival and oncological outcomes. Although there is a correlation between IL-6 concentrations and tumorigenicity, it is noteworthy that IL-6 targeted therapies are generally performed in vitro and in experimental studies.Therefore, prospective, randomized clinical trials are required that focus on IL-6 targeted therapies for the treatment of HNSCC.Item Skin Cancers of the Auricle: A Retrospective Analysis of 41 PatientsÖzgür, E; Kamiloglu, U; Temiz, P; Eskiizmir, GObjective: Skin cancers of the auricle usually present with challenges because of the unique anatomy and topography of the auricle and the behavior of the tumor. The purpose of this study was to evaluate the clinical and histopathological characteristics and the surgical outcomes in patients with skin cancer of the auricle. Methods: Medical records who underwent surgery for a skin cancer of the auricle at two different tertiary medical centers during 2010 to 2020 were reviewed retrospectively. Sociodemographic data of patients, tumor location and size, histopathological type and subtype, T-stage, recurrence, and reconstructive technique were evaluated. Results: The study included 41 patients with skin cancers of the auricle. Thirty-six (87.8%) were male and five (12.2%) were female; with a male-to-female ratio of 7.2:1. The mean age of the patients was 71.4 (46-92) years. Eighteen (43.9%) tumors were basal cell carcinoma (BCC) and 17 (41.5%) tumors were cutaneous squamous cell carcinoma (cSCC). The most common subunit for tumor location was the helix (n=17, 41.5%). Wedge resection plus primary closure was the most common surgical technique (58.5%). Recurrent disease was detected in five patients (12.1%). Conclusion: The frequency of the skin cancers of the auricle was remarkably high in men, and the helix was the most common subunit. Both BCC and cSCC were the most common histopathological types. Poor prognostic factors such as lymph node metastasis, perineural invasion, and recurrence were relatively common in patients with cSCC of the auricle.Item The Management, Current Treatment Modalities and Reconstruction Techniques for Lip CancerTanyeri, G; Eskiizmir, GThe lips are important anatomic structures which have vital and social functions such as eating, drinking, phonation, speaking, kissing and expressing emotions. Squamous cell carcinoma is the most common histopathological type of lip cancer. Sun exposure, smoking, and chronic irritation have an important role in the etiopathogenesis. Lip cancers constitute a serious health problem and their treatment requires a multidisciplinary approach. The operability status of patients, comorbid disease and patient expectations, tumor stage, location, size, depth and characteristics should be carefully evaluated while planning the treatment of these cancers. The purpose of this article is to present contemporary treatment modalities in cancers of the lip, tumor staging and treatment planning, analysis of lip defects related to surgery, major principles and techniques of lip reconstruction.Item The histopathological effect of thymoquinone on experimentally induced rhinosinusitis in ratsCingi, C; Eskiizmir, G; Burukoglu, D; Erdogmus, N; Ural, A; Ünlü, HBackground: Rhinosinusitis is a common disorder and its treatment includes a variety of topical and systemic drugs. This study was designed to determine the histopathological effect of thymoquinone on experimentally induced rhinosinusitis in rats. Methods: Sixty rats were randomly allocated into 3 test and 2 control groups, each of which consisted of 12 animals. The rhinosinusitis model was induced using intranasal application of platelet-activating factor. In test groups, the animals were separated into groups: (1) rhinosinusitis-antibiotherapy, (2) rhinosinusitis-thymoquinone, (3) rhinosinusitis-combination therapy. The positive and negative control groups were defined: rhinosinusitis group without any treatment and the group without rhinosinusitis, respectively. The histopathological features (vascular congestion, inflammation, and epithelial injury) in nasal respiratory and olfactory mucosa of animals were examined and graded according to their severity. A quantitative and statistical analysis of histopathological features was performed. Results: All histopathological features showed statistically significant differences between negative and positive control groups, respectively. Conversely, neither the group with rhinosinusitis-antibiotherapy nor the group with rhinosinusitis-thymoquinone had a statistically significant difference with the negative control group. Moreover, none of the histopathological features showed a statistically significant difference, when the group with rhinosinusitis-antibiotherapy and the group with rhinosinusitis-thymoquinone were compared. A statistically significant difference was not determined when the group with rhinosinusitis-combination therapy was compared with the group with rhinosinusitis-thymoquinone. The histopathological features did not show a statistically significant difference between the group with combination therapy and the negative control Conclusion: Thymoquinone is a promising bioactive agent for the treatment of rhinosinusitis, and its histopathological effect is as equivalent as an antibiotic. (Am J Rhinol Allergy 25, e268-e272, 2011; doi: 10.2500/ajra.2011.25.3703)Item Current Treatment Strategies in Cutaneous Malignant Melanoma of the Head and NeckÖzgür, E; Karakullukcu, B; Eskiizmir, GCutaneous malignant melanoma is potentially an important health problem for white people. The incidence of melanoma is rising faster than other solid cancers. Despite the new melanoma drugs surgery for localised melanoma and regional metastasis is still the standard of care. However management of cutaneous melanoma differs from other cancers at some points such as biopsy technique, surgical margine, incorporation of sentinel lymph node biopsy for staging etc. In this review we focused on the role of the head and neck surgeon in management of cutaneous melanoma of head and neck region according to current knowledge.Item Comparative Analysis of Primary and Secondary Rhinoplasties According to Surgeon's Perspective, Patient Satisfaction, and Quality of LifeCingi, C; Eskiizmir, G; Çakli, HObjectives: We sought to analyze and compare the problems and technical difficulties related to surgical intervention, patient satisfaction, and quality of life after primary and secondary rhinoplasties. Methods: A total of 168 cases of rhinoplasty were grouped as primary or secondary according to the patient's history of rhinoplasty. The type of nasal deformity, the surgical approach, and the difficulty of the surgery were recorded. The levels of patient satisfaction and the quality of life were assessed before and after the operation with the Rhinoplasty Outcomes Evaluation (ROE) and European Quality of Life-5 Dimension (EQ-5D) questionnaires. A quantitative and statistical analysis was performed. Results: Thirty-three patients had secondary rhinoplasty. and 135 patients had primary rhinoplasty. Relatively high rates of saddle nose deformity, crooked nose, and tip asymmetry were observed in the secondary rhinoplasty group. The preoperative and postoperative scores on the ROE and EQ-5D questionnaires demonstrated statistically significant differences in both the primary and secondary rhinoplasty groups. The comparison of postoperative change between the primary and secondary rhinoplasty groups did not demonstrate a statistically significant difference. Conclusions: The surgical difficulty of secondary rhinoplasty is approximately twice that of primary rhinoplasty because of the high rate of major deformities. However, the levels of patient satisfaction and improvements in quality of life are similar after primary and secondary rhinoplasties.Item NANOMATERIALS: PROMISING STRUCTURES FOR THE MANAGEMENT OF ORAL CANCEREskiizmir, G; Ermertcan, AT; Yapici, KItem A Comparison of Thresholds of Auditory Steady-State Response and Auditory Brainstem Response in Healthy Term BabiesÇelik, O; Eskiizmir, G; Uz, UOBJECTIVE: The goal of this study was to assess the effectiveness of auditory steady-state response (ASSR), determine the cut-off values for each frequency, and detect the best correlated frequencies when compared with the auditory brainstem response (ABR) thresholds in term babies under the age of 12 months. MATERIALS and METHODS: In total, 88 term babies with a mean age of 2.98 (1-11) months (174 ears) underwent ASSR and ABR tests. The ASSR thresholds for the frequencies of 500, 1000, 2000, and 4000 Hz were compared with the hearing level of the ABR thresholds. In the ABR test, a cutoff value of 30 dB nHL was selected for normal hearing. In addition, the best correlation between the ABR and ASSR thresholds and the estimated cut-off thresholds of ASSR for each of the abovementioned frequencies were obtained. RESULTS: In total, 135 ears had values indicating normal hearing ability and 39 ears had hearing loss according to the ABR thresholds. Although statistically significant correlations were found between the ABR and ASSR thresholds at all frequencies in all groups, these correlations were not strong. On the other hand, a strong correlation was found between the responses of the ABR and ASSR thresholds at 4000 Hz in the hearing-impaired subjects. CONCLUSION: Our findings suggest that ASSR may not be beneficial or reliable as a screening test. Thus, it is likely to be considered as a complementary test rather than an alternative to the ABR test.Item The role of facial canal diameter in the pathogenesis and grade of Bell's palsy: a study by high resolution computed tomographyCelik, O; Eskiizmir, G; Pabuscu, Y; Ulkumen, B; Toker, GTIntroduction: The exact etiology of Bell's palsy still remains obscure. The only authenticated finding is inflammation and edema of the facial nerve leading to entrapment inside the facial canal. Objective: To identify if there is any relationship between the grade of Bell's palsy and diameter of the facial canal, and also to study any possible anatomic predisposition of facial canal for Bell's palsy including parts which have not been studied before. Methods: Medical records and temporal computed tomography scans of 34 patients with Bell's palsy were utilized in this retrospective clinical study. Diameters of both facial canals (affected and unaffected) of each patient were measured at labyrinthine segment, geniculate ganglion, tympanic segment, second genu, mastoid segment and stylomastoid foramen. The House-Brackmann (HB) scale of each patient at presentation and 3 months after the treatment was evaluated from their medical records. The paired samples t-test and Wilcoxon signed-rank test were used for comparison of width between the affected side and unaffected side. The Wilcoxon signed-rank test was also used for evaluation of relationship between the diameter of facial canal and the grade of the Bell's palsy. Significant differences were established at a level of p = 0.05 (IBM SPSS Statistics for Windows, Version 21.0.; Armonk, NY, IBM Corp). Results: Thirty-four patients - 16 females, 18 males; mean age +/- Standard Deviation, 40.3 +/- 21.3 - with Bell's palsy were included in the study. According to the HB facial nerve grading system; 8 patients were grade V, 6 were grade IV, 11 were grade III, 8 were grade II and 1 patient was grade I. The mean width at the labyrinthine segment of the facial canal in the affected temporal bone was significantly smaller than the equivalent in the unaffected temporal bone (p = 0.00). There was no significant difference between the affected and unaffected temporal bones at the geniculate ganglion (p = 0.87), tympanic segment (p = 0.66), second genu (p = 0.62), mastoid segment (p = 0.67) and stylomastoid foramen (p = 0.16). We did not find any relationship between the HB grade and the facial canal diameter at the level of labyrinthine segment (p = 0.41), tympanic segment (p = 0.12), mastoid segment (p = 0.14), geniculate ganglion (p = 0.13) and stylomastoid foramen (p = 0.44), while we found significant relationship at the level of second genu (p = 0.02). Conclusion: We found the diameter of labyrinthine segment of facial canal as an anatomic risk factor for Bell's palsy. We also found significant relationship between the HB grade and FC diameter at the level of second genu. Future studies (MRI-CT combined or 3D modeling) are needed to promote this possible relevance especially at second genu. Thus, in the future it may be possible to selectively decompress particular segments in high grade BP patients. (C) 2016 Associacao Brasileira de Otorrinolaringologia e Cirurgia Cervico-Facial. Published by Elsevier Editora Ltda.Item The evaluation of pretreatment neutrophil-lymphocyte ratio and derived neutrophil-lymphocyte ratio in patients with laryngeal neoplasmsEskiizmir, G; Uz, U; Onur, E; Ozyurt, B; Cikrikci, GK; Sahin, N; Oran, A; Celik, OIntroduction: Systemic inflammatory biomarkers are promising predictive and prognostic factors for solid cancers. The neutrophil-lymphocyte ratio and derived neutrophil-lymphocyte ratio are used to predict inflammation and used as biomarker in several malignancies. Objective: The purpose of this study was to demonstrate the diagnostic, predictive and prognostic role of neutrophil-lymphocyte ratio and derived neutrophil-lymphocyte ratio in patients with laryngeal neoplasms. Methods: A retrospective study was conducted on medical records involving 229 patients with benign, premalignant and malignant laryngeal neoplasms between 2002 and 2015. The diagnostic, predictive and prognostic role of neutrophil-lymphocyte ratio and derived neutrophil-lymphocyte ratio were evaluated using uni- and multivariate analysis. Results: The neutrophil-lymphocyte ratio and derived neutrophil-lymphocyte ratio were not statistically different between patients with benign, premalignant and malignant laryngeal neoplasms. Both neutrophil-lymphocyte ratio and derived neutrophil-lymphocyte ratio were predictive factors for stage, lymph node metastasis, and distant metastasis. Patients with high neutrophil-lymphocyte ratio value (>= 4) had a poor prognosis when compared with patients with low neutrophil-lymphocyte ratio value (5 year, Overall Survival: 69.0% vs. 31.1%, p < 0.001; 5 year, disease free survival: 70.0% vs. 32.7%, p < 0.001; 5 year, locoregional recurrence free survival: 69.7% vs. 32.0%, p <0.001). Furthermore, neutrophi [-lymphocyte ratio was an independent prognostic factor for 5 year: Overall survival (HR = 2.396; 95% CI 1.408-4.077; p = 0.001), Disease free survival (HR= 2.246; 95% CI 1.322-3.816; p =0.006) and locoregional recurrence free survival (HR =2.210; 95% CI 1.301-3.753; p= 0.003). Conclusion: Pretreatment neutrophil-lymphocyte ratio is a useful and reliable predictive and prognostic biomarker for patients with laryngeal carcinoma. (C) 2018 Associacao Brasileira de Otorrinolaringologia e Cirurgia Cervico-Facial. Published by Elsevier Editora Ltda.Item Significant Changes in Trans-Epithelial Barrier Proteins of Adenoid Tissue with Atopic Status in ChildrenYilmaz, Ö; Simsek, Y; Inan, S; Buga, Ö; Eskiizmir, G; Pinar, E; Kanik, E; Yüksel, HOBJECTIVES: Adenoid tissue is important in local immune response and epithelial barrier dysfunction of this tissue may contribute to allergies. The aim of this study was to evaluate the relationship between the status of cross-epithelial barrier elements in adenoid tissue lymphoepithelium and inhalant allergen sensitization. MATERIALS AND METHODS: Children aged 5-15 years, who underwent adenotonsillectomy, participated in this study. All subjects underwent skin prick testing with environmental inhalant allergens. Occludin, ZO1, e-cadherin, beta-catenin, desmoglein, desmoplakin, and connexon-43 were stained immunohistodiemically in the adenoid tissues obtained and scored by H-score. RESULTS: We enrolled 76 children, 14 among whom were sensitized to environmental allergens. Among the zonula occludens proteins, median H-scores for occludin, claudin, and ZO-1 were significantly lower in the atopic compared to the nonatopic group respectively (p<0.001). Similarly, median H-scores for e-cadherin and beta catenin proteins of the zonula adherens were significantly lower in the atopic group (p<0.001). Both desmoglein and desmoplakin H-scores were significantly lower in the atopic group [60 (50-100) vs 280 (260-300), p<0.001 and 105 (87.5-120) vs 280 (67.25-300), p<0.001 respectively]. Moreover, connexin-43 protein of the gap junction was significantly lower in the atopic group (p<0.001). CONCLUSION: Adenoid tissue, which is the initial point of contact of inhalant allergens demonstrates epithelial barrier junctional protein, changes in children with inhalant allergen sensitization without clinical allergic disease symptoms. Therefore, it may be concluded that epithelial barrier function plays an important role in the development of allergen sensitization versus tolerance.Item Cetuximab alone has a dose-dependent antitumor effect in oral cavity cancer cells: an in vitro studyEskiizmir, G; Çalibasi, G; Uysal, T; Ellidokuz, H; Baskin, YObjective: To evaluate the antitumor effect of cetuximab as a single agent for the treatment of oral cavity cancers and to clarify the dose-dependent growth inhibitory effect in oral cavity squamous cell carcinoma cell line (OCSCCCL). Methods: The OCSCCCL (UPCI-SCC131) were cultured and continuously monitored using the xCELLigence RTCA SP instrument. Thereafter, they were divided into seven groups as: (i) negative control: medium+OCSCCCL, (ii) positive control: medium+OCSCCCL+cisplatin 10 mu M/ml, (iii) medium+OCSCCCL+cetuximab 25 mu g/ml, (iv) medium+OCSCCCL+cetuximab 50 mu g/ml, (v) medium+OCSCCCL+cetuximab 100 mu g/ml, (vi) medium+OCSCCCL+cetuximab 200 mu g/ml, (vii) medium+OCSCCCL+cetuximab 400 mu g/ml. The cell index and viability were statistically analyzed and compared between groups. Results: The distribution of cell index (mean value) and percentage of viability in groups were as follows: (i) 2.66 (100%), (ii) 0.17 (6.08%), (iii) 2.28 (85.71%), (iv) 2.31 (86.84%), (v) 1.92 (72.18%), (vi) 1.79 (67.29%), (vii) 0.28 (10.53%). The change trend in drug concentration was statistically different in all study groups to which cetuximab was administered (Pillai's trace; p<0.0001). The antitumor effect of cetuximab was initially detected at a dose of 100 mu g/mL, when compared with negative control (p=0.01). However, a dose of 400 mu g/mL was required in order to have a statistically similar antitumor effect of cisplatin at a dose of 10 mu M. Conclusion: Cetuximab alone is a potentially effective chemotherapeutic agent and has a concentration-dependent growth inhibitory effect in OCSCCCL. The antitumor activity of cetuximab was initially detected at a dose of 100 mu g/mL. However, significant antitumor effect was determined at a dose of 400 mu g/mL.Item Sonoelastographic Features of Major Salivary Gland Tumors and Pathology CorrelationFarasat, M; Ovali, GY; Duzgun, F; Eskiizmir, G; Tarhan, S; Tan, AObjectives: To investigate the diagnostic efficiency of elastography in differentiation of malignant and benign tumors by evaluating salivary gland masses in means of their elastography scores and strain ratios. Patients and Methods: Twenty five patients with salivary gland mass lesions were detected through B- mode ultrasonography, Doppler ultrasonography, strain elastography and their strain ratios were calculated. The results were compared with histopathologic results. Results: Twenty five patients had 27 lesions consisting of seven malignant and 20 benign lesions. Mann Whitney U test, ROC analysis, Fisher test and Chi square tests were used statistically. Mean strain rates were calculated as 2.26 +/- 0.29 in the benign group and 2.02 +/- 0.59 in the malignant group. There was no statistically significant difference between the two groups (P = 0.698). Elastography score was calculated as mean 2.4 +/- 0.94 in the benign group and mean 2.28 +/- 0.38 in the malignant group. There was no statistically significant difference between the two groups (P= 0.708). Accepting the strain rate as 0.89; sensitivity of elastography in differentiating malignant from benign lesions is 71%, and the specificity is 50%. However, the area under the ROC curve is 0.55, which is not statistically significant (P= 0.699). Conclusion: In conclusion, elastography is a supporting method for B-mode ultrasonography in the differentiation of benign and malignant salivary gland masses. However, the overlap of elastographic findings is evident in benign and malignant masses. Care should be taken to have tissues with similar stiffness under the reference tissue and the lesions in elastographic evaluation of the superficial mass. We have not met a study that has pointed out the importance of stiffness of the tissue located beneath the lesion that may affect the elastography results in the literature. In this respect our study is unique.Item Serum hypoxia-inducible factor-2: A candidate prognostic biomarker for laryngeal cancerEskiizmir, G; Koçal, GÇ; Uysal, T; Ellidokuz, H; Baspinar, YObjectives To determine the serum hypoxia-inducible factor-1, -2 and -3 (HIF-1, -2 and -3) levels in patients with laryngeal neoplasm, and to investigate their role in differential diagnosis, prediction of tumour characteristic and extension, and prognosis and survival. Study Design Prospective, cohort study at a tertiary referral centre. Settings The study was conducted in a tertiary medical centre. Participants Patients with benign, premalignant and malignant laryngeal neoplasms were included. Sixty-four patients with a laryngeal neoplasm were enrolled. Main Outcome Measures Serum HIF-1, -2 and -3 levels were measured from blood samples that were drawn before treatment, using ELISA. Results A statistically significant difference between benign (HIF-1, -2, -3:4046,1 pg/mL; 2581,5 pg/mL; 1321,0 pg/mL), premalignant (HIF-1, -2, -3:3630,3 pg/mL; 3229,7 pg/mL; 2549,8 pg/mL) and malignant (HIF-1, -2, -3:3576,7 pg/mL; 2595,8 pg/mL; 1106,3 pg/mL) laryngeal neoplasms was not detected when serum HIF-1, -2 and -3 levels were compared. However, high serum HIF-2 level adversely affected survival and locoregional control and had more than 7-fold increase in hazard ratio. Moreover, serum HIF-2 was an independent prognostic factor for 2-year overall, disease-free, distant metastasis-free survival and locoregional control. Conclusion This is the first clinical study in which the diagnostic, predictive and prognostic roles of hypoxia-related biomolecules were examined in laryngeal neoplasms. Hypoxia-inducible factor-2 is a prognostic factor in larynx cancer irrespective of treatment modality.Item Is there a vicious cycle between obstructive sleep apnea and laryngopharyngeal reflux disease?Eskiizmir, G; Kezirian, EObstructive sleep apnea (OSA) is a common sleep-related breathing disorder which is mainly characterized by the repetitive episodes of obstructive apneas and/or hypopneas. It is associated with daytime sleepiness, decrements in quality of life, cardiovascular and cerebrovascular diseases and endocrine disturbances. In addition, there is a high prevalence of gastric reflux (including both gastroesophageal reflux and laryngopharyngeal reflux diseases) in patients with OSA. However, the mechanism underlying this association has not been completely established. Herein, we hypothesize that there is a vicious cycle between OSA and laryngopharyngeal reflux disease. Increased respiratory efforts in OSA generate more-negative intrathoracic pressure, contributing to reflux of gastric contents, which in turn creates inflammation and sensory deficits in the laryngeal and pharyngeal tissues that contributes to progression of OSA through both inflammatory and neuromuscular pathways. (C) 2009 Elsevier Ltd. All rights reserved.Item Nonmelanoma Skin Cancer of the Head and Neck: PreventionOghan, F; Eskiizmir, G; Unlu, H; Cingi, CThe importance and effectiveness of prevention efforts and strategies for skin cancers are reviewed. Topical sunscreens and their proper use are presented. Topical and ingested forms of natural, synthetic, or biologic chemical agents that are potentially efficacious for chemoprevention are listtdldted and discussed.Item Predictive and prognostic factors for patients with locoregionally advanced laryngeal carcinoma treated with surgical multimodality protocolEskiizmir, G; Toker, GT; Celik, O; Gunhan, K; Tan, A; Ellidokuz, HThe prognosis is suboptimal in patients with locoregionally advanced laryngeal carcinoma even after multimodality protocols. The purpose of this study was to determine the potential influential factors that have an impact on the development of locoregional recurrence, distant metastasis, and oncological outcomes in patients with locoregionally advanced laryngeal carcinoma who had surgical multimodality protocols. A sample size of 85 cases was determined based on a power of 90% and an effect size of alpha (2) = 0.05. A retrospective analysis of 357 patients with a diagnosis of laryngeal cancer between 2002 and 2015 was performed. Eighteen variables based on sociodemographic, clinical, histopathological and treatment data were analyzed. Medical records of 85 consecutive patients with locoregionally advanced laryngeal carcinoma who underwent surgical multimodality protocols were reviewed. Five-year overall, disease-specific, disease-free, locoregional recurrence-free and distant metastasis-free survival were 68.7, 78.0, 69.6, 68.9 and 69.2%, respectively. Extracapsular extension was an independent predictive factor for locoregional recurrence. Pathologic tumor volume was an independent predictive factor for distant metastasis. pT-stage was an independent prognostic factor for 5-year overall survival, disease-free survival, locoregional recurrence-free survival and distant metastasis-free survival. High volume, pT4a laryngeal tumors with extracapsular extension are associated with a high risk of locoregional recurrence and distant metastasis; and have poor oncological outcomes in patients with locoregionally advanced laryngeal carcinoma treated with surgical multimodality protocols.Item Suction Tube Facilitates the Transfer of Nasal Tip Sutures in Endonasal RhinoplastyCingi, C; Toros, SZ; Eskiizmir, GNasal tip sculpturing is the most challenging aspect of rhinoplasty. It is principally performed by the reduction or increment of the nasal tip characteristics with sutures or grafts using endonasal or external approach. In endonasal approach, although most of the key structural mechanisms of the nasal tip can be preserved, the transfer of nasal tip sutures, which are used for contouring the alar cartilages and/or graft stabilization, from 1 nasal cavity to another has several difficulties such as time loss, need for extensive dissection, or injuring the soft tissue and alar cartilages. In the current article, we aimed to represent our surgical technique that facilitates suture contouring using a suction tube during the transfer of nasal tip sutures in endonasal rhinoplasty.Item New Modification of Cephalic Resection of Lateral Crus in Endonasal RhinoplastyCingi, C; Eskiizmir, G; Toros, SZA successful rhinoplasty mainly depends on maintaining adequate nasal tip projection and achieving the desired tip refinement. In endonasal rhinoplasty, the surgeon can modify the tip anatomy while still preserving the key structural support mechanisms. Herein, we describe a new modification of retrograde technique for the resection of the cephalic margin of the lateral crus in endonasal rhinoplasty in which a combined resection of the cephalic margin of the lateral crus and its underlying mucoperichondrium are performed.Item Microscopic Transnasal Approach: A New Technique for the Reconstruction of Frontoethmoidal MeningoencephaloceleCelik, O; Eskiizmir, G; Duran, AV; Yeniel, T; Uz, UFrontoethmoidal meningoencephalocele is a rare congenital malformation, which occurs due to a deficiency in neural tube closure. It may present as an external mass over the nose, nasal obstruction, rhinorrhea and attacks of central nervous system infections. Herein, the authors present a 3-month-old infant with naso-ethmoidal form of frontoethmoidal meningoencephalocele, who was operated on using a newly described approach that was performed under microscope.