Browsing by Author "Toker G.T."

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    The role of facial canal diameter in the pathogenesis and grade of Bell's palsy: a study by high resolution computed tomography; [O papel do diâmetro do canal facial na patogenia e grau de paralisia de Bell: estudo por tomografia computadorizada de alta resolução]
    (Elsevier Editora Ltda, 2017) Celik O.; Eskiizmir G.; Pabuscu Y.; Ulkumen B.; Toker G.T.
    Introduction 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. © 2016 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial
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    Local Nasal Flaps
    (Springer International Publishing, 2019) Toker G.T.; Eskiizmir G.; Baker S.R.
    Nose is a masterpiece because of its anatomy, physiology, and aesthetic appearance. It is located at the midface and involves three layers structurally: (1) outer covering (skin, subcutaneous tissue, and muscles), (2) framework (nasal bones, quadrangular cartilage, upper and lower lateral cartilages), and (3) inner lining (mucoperichondrium/periosteum and skin of the nasal vestibule). Moreover, it is aesthetically subdivided into different subunits according to its natural creases and/or boundaries: (1) dorsum, (2) sidewalls, (3) alar regions, (4) tip, and (5) columella. The outer covering is distinctive in each subunit and mainly grouped into three zones according to the degree of subcutaneous fat, skin thickness, sebaceous content, and mobility: (1) zone 1 has a non-sebaceous, thin, and mobile skin and includes upper dorsum and sidewalls; (2) zone 2 has a sebaceous, thick, and semimobile skin and includes supratip, tip, and alar lobules; and (3) zone 3 has a non-sebaceous, thin, nonmobile skin and includes soft tissue triangles, infratip lobules, and columella. Aesthetic improvement is of utmost important for nasal reconstruction. Therefore, reconstruction with a local flap is frequently preferred as a first-line surgical modality particularly for small to moderate nasal defects. Local nasal flaps may provide the ideal color and texture match using a healthy outer covering of nose. The most commonly used local nasal flaps are as follows: (1) bilobed flap, (2) rhombic flap, (3) dorsal advancement flap (Rintala flap), (4) dorsal nasal flap (Rieger flap), and (5) transposition flaps. This chapter describes the principles of nasal reconstruction with local nasal flaps and aims to guide surgeons in planning and decision-making with local nasal flaps in nasal reconstruction. © Springer Nature Switzerland AG 2020.
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    The ratio of facial nerve to facial canal as an indicator of entrapment in Bell's palsy: A study by CT and MRI
    (Elsevier B.V., 2020) Celik O.; Ulkumen B.; Eskiizmir G.; Can F.; Pabuscu Y.; Kamiloglu U.; Toker G.T.; Vidin N.
    Objectives: To find out if the ratio of facial nerve to facial canal diameter plays any role in the etiopathogenesis and grade of Bell's palsy. Patients and methods: Twenty-nine consecutive patients (16 females, 13 males) diagnosed with unilateral Bell's palsy were enrolled into the study. At admission, 5 patients were grade V, 11 were grade IV, 11 were grade III and 2 were grade II. The grade of Bell's palsy was documented by House–Brackmann facial nerve grading system at admission, 15th day, 1st month and 3th month. Temporal MRI and CT scans were obtained at the time of diagnosis. Diameter of facial nerve and facial canal at the middle of five different segments were measured equidistantly at the same workstation. Both sides of every patient (affected and unaffected) were measured by one radiologist who was not informed about the side of the paralysis. MRI and CT values of each segment were compared between affected and unaffected sides. In addition, FN/FC ratio of affected and non-affected sides was calculated and compared for each segment. We also analyzed if a relationship exists between above-mentioned measurements and the House–Brackmann grade. Results: Considering MRI values; statistically significant thickening of facial nerve between affected and unaffected sides was found at labyrinthine (p = 0.012), tympanic (p = 0.023) and geniculate parts (p = 0.04). Considering CT values; statistically significant difference between affected and unaffected sides was not found at any segment. Comparison of FN/FC ratio of both sides revealed statistically significant increment of the affected side at labyrinthine segment (p = 0.015) and geniculate ganglion (p = 0.032). We determined positive correlation between diameter of FN and HB grade at labyrinthine segment (p = 0.03, R = 0.531). On the other hand, we determined negative correlation between diameter of FC and HB grade at labyrinthine segment (p < 0.001, R = −318). A positive correlation between HB grade and FN/FC ratio was found only at the labyrinthine segment (p = 0.003, R = 0.673). Conclusion: FN/FC ratio of labyrinthine segment and geniculate ganglion was found to be increased in patients with Bell's palsy. In addition, a positive correlation was determined between this ratio and grade of Bell's palsy particularly at labyrinthine segment. Basing the current study, if FN decompression is recommended in Bell's palsy patients with objective findings of bad prognosis, conservative surgery targeting the labyrinthine segment and geniculate ganglion alone might be safer. © 2020 Elsevier B.V.
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    The effectiveness of medical prophylactic treatment on vestibular migraine and its effect on the quality of life
    (AVES, 2020) Çelik O.; Toker G.T.; Eskiizmir G.; İncesulu A.; Süyür N.Ş.
    OBJECTIVES: The aim of the present study was to determine the efficacy of propranolol treatment in patients with vestibular migraine by the Visual Analog Scale, Dizziness Handicap Inventory (DHI), Vertigo Symptom Scale, and Vestibular Disorders Activities of Daily Living Scale (VADL) and its effect on the quality of life. MATERIALS and METHODS: The study population consisted of 38 patients with vertigo/dizziness who underwent routine evaluation and ves-tibular examinations, were diagnosed with definitive vestibular migraine, and received the same medical treatment protocol (propranolol). The questionnaires and scales that were applied to the patients before and after treatment were evaluated. The results were evaluated with 95% confidence interval, and p<0.05 was accepted as statistically significant. RESULTS: The mean age of the patients was 47.55 (18-75) years, and 27 (71%) patients were female, and 11 (29%) were male. The mean total scores of the DHI before and after treatment were 50.21±22.39 (range: 8-92) and 9.31±9.86 (range: 0-58), respectively (p<0.001). The degree of disability after treatment was low in all patients (p<0.001). The total scores of the VADL before and after treatment were 186.63±79.65 (range: 32-280) and 55.52±51.89 (range: 28-273), respectively (p<0.001). There was no correlation between these two scales (p=0.235). CONCLUSION: To our knowledge, this is the first study to evaluate both the efficacy of propranolol treatment and its effects on the quality of life in vestibular migraine. The severity, frequency, and number of attacks and disability scores were reduced, and the quality of life was improved in patients with vestibular migraine with propranolol treatment. © 2020, AVES. All rights reserved.