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Öğe Association between superoxide dismutase 2, glutathione peroxidase 1, xeroderma pigmentosum group d gene variations, and head and neck squamous cell cancer susceptibility(Inst Bioloska Istrazivanja Sinisa Stankovic, 2022) Köse, Gülçin; Oz, Merve Demirbugen; Cömert, Ela; Suzen, Halit SinanAs oxidative stress is implicated in the pathogenesis of head and neck squamous cell cancer (HNSCC), the functions of antioxidant enzyme systems and DNA repair proteins are critical in the development of cancer. To investigate the role of genetic polymorphisms of the antioxidant superoxide dismutase 2 (SOD2) Val16Ala, glutathione peroxidase 1 (GPX1) Pro198Leu, and the DNA repair Xeroderma Pigmentosum Group D (XPD) Lys751Gln genes under exogenous risk factors, including smoking and alcohol consumption, in HNSCC carcinogenesis, we conducted a case-control study on 139 unrelated cases and 265 non-cancer controls. Polymorphisms were analyzed in additive, dominant and recessive genetic models, individually and in an interaction model. Carriers of the T allele of SOD2 were associated with an increased risk for HNSCC in males and smokers; similarly, the T allele of GPX1 was associated with elevated risk in the overall and smoker subgroup. A 12.47-fold increased risk was observed for the carriers of GPX1 TT, SOD2 CT and XPD CC genotypes for HNSCC. This is the first study presenting the potential roles of SOD2, GPX1 and XPD polymorphisms in interaction and under three genetic models in the development of HNSCC. The results suggest that these polymorphisms slightly modify the risk in HNSCC development individually but are significantly higher when they functioned and were evaluated together.Öğe BAŞ BOYUN KANSERLERİNDE NÜTRİSYON(2021) Cömert, ElaNütrisyon, baş ve boyun kanserli hastalarda morbidite ve mortalite üzerinde etkili faktörlerden biridir. Bu hastalarda kanserin neden olduğu olumsuz metabolik etkiler tümöre bağlı bölgesel faktörlere ek olarak gözlenir. Baş boyun bölgesine uygulanan cerrahi, radyoterapi ve kemoterapi tedavileri beslenmeyi olumsuz etkiler. Bu nedenle baş boyun kanserli hastanın tedavi öncesi beslenmesinin değerlendirilmesi, tedavi öncesi, sırasında ve sonrasında desteklenmesi gerekir. Baş boyun kanserli hastalarda beslenme desteğine ihtiyaç duyan hastalar vücut kitle indeksi 18.5 kg/m2’nin altında olan, 3-6 ayda %10 ve üzeri kilo kaybı olan, 5 gün üzerinde oral alımı azalmış ve katabolik etkilerin gözlendiği hastalardır. Planlanacak beslenme hastanın oral alımının olup olmadığı, beslenme desteğinin ne kadar süre gerekli olduğu ve besin alım sorununun kısmi veya total olmasına bağlı değişir. Oral beslenebilen hastalara gıda aralarında yüksek protein içerikli, lösin veya dallı zincirli aminoasitler ve omega-3 yağ asidinden zengin, yüksek enerji içerikli (2 kcal/mL) beslenme solüsyonları önerilir. Oral alımı olmayan hastalarda kısa süreli kullanımda parenteral beslenme, uzun süreli durumlarda veya evde hasta takibinde tüple beslenmeye geçilmelidir.Öğe Does face mask affects sleep quality in patients with nasal septal deviation: evaluated by mini sleep questionnarie(2022) Şencan, Ziya; Cömert, Ela; Muluk, Nuray Bayar; Koçak, Furkan Melih; Tekin, YasinObjectives: The aim of this study was to investigate the effects of face mask usage on the sleep quality of patients with nasal septal deviation. Material and Method: Thirty-four patients with unilateral nasal septum deviation (Group 1) and 27 healthy subjects without septum deviation (Group 2, control) were included in the study. Mask usage time per day (hours) in the last week, weight, length and BMI values, smoking, and alcohol habits were asked. In both groups, the sleep quality of the patients was evaluated by Mini Sleep Questionnaire (MSQ). Sleep delay (SD), sleep awakenings (SA), sleep medications (SM), daytime sleep (DS), morning fatigue (MF), habitual snoring (HS), morning awakening (MA), morning headache (MH), chronic fatigue (CF), and restless sleep (RS); and total MSQ items were evaluated. Results: All subjects used surgical masks. In the nasal septal deviation group, the right-sided deviation was detected in 15 (44.1%) patients and left-sided deviation was detected in 19 (55.9%) patients. Deviation located was anterior deviation in 12 (35.3%) patients, posterior deviation in 13 (38.2%) patients and antero-posterior deviation in 9 (26.5%) patients. Sleep Medications (SM) and Morning Headache (MH) values of the deviation group (Group 1) were significantly lower than those in the control group (p<0.05). There was no difference between other MSQ items and total MSQ score of the septal deviation and control groups (p>0.05). In older patients with septal deviation, Sleep Awakenings (SA), Habitual Snoring (HS), Morning Awakening (MA), and Total MSQ scores increased (p<0.05) Conclusion: Facial mask usage did not cause sleep disorders in patients with nasal septal deviation. However, aging may cause disturbed sleep quality.Öğe EFFECT OF DIABETES AND SYSTEMIC INFLAMMATION PARAMETERS ON THE PROGNOSIS OF BELL’S PALSY(2021) Şencan, Ziya; Cömert, Ela; Şimşek, Gökçe; Muluk, Nuray Bayar; Yaman, Serdar HanzalaObjective: This study aimed to evaluate the prognostic importance of diabetes mellitus, hematologic and biochemical test findings including neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic inflammation response index and triglyceride-glucose index in patients with Bell’s palsy and to compare these results with healthy subjects.Material and Methods: The study included 75 patients with incomplete Bell’s palsy.and 24 healthy subjects as the control group. Patients were divided into two groups as diabetes mellitus and non- diabetes mellitus patients. Complete blood count, biochemical tests including glucose, liver and renal function tests and blood lipid profile were analyzed from all the subjects and neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic inflammation response index and triglyceride-glucose index values were calculated from these results.Results: Neutrophil-to-lymphocyte ratio and systemic inflammation response index values were higher in patients with Bell’s palsy when compared with the control group. Triglyceride-glucose index was positively correlated with recovery time in all patients and the diabetes mellitus group. It was also positively correlated with prognosis in non- diabetes mellitus patients. High neutrophil-to-lymphocyte ratio was predictive for delayed recovery time only in non- diabetes mellitus patients.Conclusion: Our results indicated that diabetes mellitus didn’t influence severity, recovery time and prognosis of Bell’s palsy. High triglyceride levels and triglyceride-glucose index values were associated with long recovery time in patients with Bell’s palsy. For both diabetes mellitus and non- diabetes mellitus patients, House-Brackmann facial nerve grading scale-initial was the best parameter to predict the prognosis. Neutrophil-to-lymphocyte ratio and systemic inflammation response index values were significantly higher in patients with Bell’s palsy.Öğe PROGNOSTIC FACTORS IN DEEP NECK INFECTION(2022) Cömert, Ela; Şimşek, BuğraObjective: The present study aimed to evaluate the prognostic importance of hematologic test findings in addition to the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, systemic inflammation response index, and C-reactive protein in the patients with deep neck infection and to compare these results with healthy subjects.Material and Methods: The study included 32 patients diagnosed as deep neck infection and treated by surgical intervention and parenteral antibiotics. As none of the patients had life-threatening complications, the prognosis was determined by the length of stay in the hospital. The effect of age, sex, pre-treatment blood parameters, abscess culture results, and medical comorbidities on prognosis were analysed. Pre- and post-treatment blood parameters were compared in each patient. Blood parameters were also compared between healthy subjects and patients.Results: When comparing patients with length of stay in the hospital ?7 days and >7 days, significant differences were observed for age (t=-2.568, p=0.015) and red blood cell distribution width values obtained preoperatively (Z=-2.343, p=0.019). The correlation analysis revealed a positive correlation between age and length of stay in the hospital. (r=0.450, p=0.010), and between length of stay in the hospital and comorbidity (r=0.366, p=0.039). Logistic Regression analysis revealed that age could be the best marker in the prediction of the patients with worse prognosis (percentage of predicting patients with worse prognosis=73.3%, B=0.054, Wald=4.967, p=0.026).Conclusion: The present study confirmed that the prognosis was worse in older patients and patients with comorbid disease whereas no relation was observed between the inflammatory markers and prognosis.Öğe Pronator quadratus musculo-osseous free flap for wide hard palatal defect reconstruction: An anatomical study(Elsevier Sci Ltd, 2023) Iğde, Murat; Salman, Necati; Güngör, Yiğit; Yılmaz, Mehmet; Cömert, Ela; Sağlam, Murat Enes; Baykara, YiğitWide hard palate defects include congenital and acquired defects that are six square centimeters or larger in size. Obturator prostheses and autologous soft tissue transfers have been used to reconstruct palatal defects. This study aims to repair wide, hard palatal defects by using a pronator quadratus musculo-osseous free flap to achieve subtotal reconstruction. Seventeen formalin-fixed cadavers were dissected. Free musculo-osseous pronator quadratus flaps were prepared after a 12 cm curvilinear volar skin incision. Standard 30 x 23 mm (690 & PLUSMN; 52.12 mm2) hard palate defects were made by chisels and saws. A subcutaneous tunnel was created between the mandibular edge cross point of the facial vessels and the retromolar trigone through the subcutaneous to the superficial musculoaponeurotic system by dissection. Area measurements of the pedicle and palate defects were performed by the ImageJ program (National Institutes of Health, Bethesda, MD, USA) on drawings over an acetate layer of materials. Mandibular distances of gonion-facial vessel cross point (a), goniongnathion (m), and facial vessels' cross point-retromolar entrance point (h) were measured. Ratios of h/m and a/m were calculated. The mean pronator quadratus area was 2349.39 & PLUSMN; 444.05 mm2, and the arterial pedicle pronator quadratus diameter was 2.32 & PLUSMN; 0.34 mm. The mean pedicle length of the pronator quadratus was 117.13 & PLUSMN; 8.10 mm. Study results showed that musculo-osseous pronator quadratus flaps' bone and muscle parts perfectly fit on the defects in all cadavers. Pronator quadratus musculo-osseous flap is a feasible surgical option for wide, hard palatal defect reconstruction strategies.& COPY; 2023 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.Öğe Radiological Evaluation of the Effect of Laryngopharyngeal Reflux on the Thickness of Inferior Turbinate, Maxillary Sinus Mucosa and Nasal Septal Body(Springer India, 2024) Taş, Burak Mustafa; Sarıkaya, Pelin Zeynep Bekin; Şencan, Ziya; Cömert, Ela; Muluk, Nuray BayarBackground We investigated the relationship between Laryngopharyngeal Reflux (LPR) and maxillary sinus mucosal thickness (MSMT), inferior turbinate mucosal thickness (ITMT), inferior turbinate width (ITW) and nasal septal body thickness (NSBT), which can be signs of chronic rhinosinusitis and allergic rhinitis.Methods The study, which included 87 patients, was designed as two groups. While 42 of the patients were included in the Laryngopharyngeal Reflux group, 45 were included in the control group. Age and gender information of the patients were noted. MSMT, ITMT, ITW and NSBT values were measured in patients who had Paranasal Sinus Computed Tomography. MSMT, ITMT and ITW were measured as right and left. Both groups were evaluated in terms of these values.Results Right ITMT, bilateral ITW and MSMT values were found to be significantly higher in the LPR group than in the control group (p < 0.05). MSMT values were higher in males (p < 0.05). The left-ITT and NSBT values were not significantly different between the LPR group and the control group, but both values were higher in the LPR group than in the control group (p > 0.05). In the LPR group, there were positive correlations between ITMT and ITW values of the right side; and left side separately (p < 0.05).Conclusion It has been shown that Laryngopharyngeal Reflux increases maxillary sinus mucosal thickness, inferior turbinate thickness and width, and nasal septal body thickness, which can be signs of chronic rhinosinusitis and allergic rhinitis. The negative effects of LPR on nasal and paranasal mucosa and structures were demonstrated in this study.Öğe Role of Microplastics in Chronic Rhinosinusitis Without Nasal Polyps(Wiley, 2024) Taş, Burak Mustafa; Tuna, Ayşegül; Kankılıç, Gökben Başaran; Koçak, Furkan Melih; Sencan, Ziya; Cömert, Ela; Bayar Muluk, NurayObjective: We aimed to examine the relationship between chronic rhinosinusitis without nasal polyps and microplastics. Methods: A total of 80 patients participated in this prospectively planned study. The patients were divided into two groups. Group 1 had 50 patients with chronic rhinosinusitis without nasal polyps, whereas Group 2 had 30 healthy volunteers. The age and gender of the participants were noted. Nose Obstruction Symptom Evaluation questionnaire was applied to the patients. The patients performed nasal lavage with saline. Microplastics were examined in the collected nasal lavage fluids, and their numbers were noted. The groups were compared on these values. Results: The mean age was 38.06 +/- 14.15 years in the chronic rhinosinusitis group without nasal polyps and 33.60 +/- 11.68 years in the control group. There was no significant difference between the groups in terms of age and gender. There was a significant difference in the number of microplastics between the chronic rhinosinusitis group without nasal polyps and the control group (p < 0.001). Microplastics were detected in all participants. Conclusions: We found more microplastics in patients with chronic rhinosinusitis without nasal polyps. According to this result, we can say that there may be a relationship between chronic rhinosinusitis and microplastics.Öğe Surgical anatomy of the transcanal infracochlear approach(Springer, 2022) Cömert, Ela; Cömert, AyhanPurpose The objective of this study is to describe the detailed surgical anatomy of the infracochlear approach to prevent complications and to compare the postauricular transcanal microscopic and endoscopic approaches to reach the petrous apex. Methods Cadaver heads were dissected using a binocular surgical microscope, endoscopes, and an electric drill. The dimensions of the access field that could be reached and manipulated with surgical instruments and straight drill via postauricular transcanal microscopic and endoscopic approaches were evaluated. Results Both postauricular microscopic and transcanal endoscopic approaches were considered to be inapplicable in cases with a tympanic cavity located jugular bulb closer than 3 mm to the cochlea. This relationship was seen in 3 (9%) sides of the cadavers. In 4 specimens (12%), a cochlear aqueduct with an open lumen was detected. Both postauricular microscopic and transcanal endoscopic approaches reached a nearly identic dissection area. Detailed anatomy of the approach and measurements about the topography of the third portion of the facial nerve from the tympanic cavity were presented. Conclusion Both traditional microscopic postauricular and endoscopic transcanal approaches provided comparable access areas to the inferior petrous apex with wide exposure, and radiologic measurements were compatible. A tympanic cavity located jugular bulb in close relation with cochlea was the only instance that restricted the applicability of this technique.Öğe THE USE OF NERVE MONITORIZATION IN PAROTID, SUBMANDIBULAR GLAND AND FACIAL SURGERY AND ITS EFFECT ON PROGNOSIS(Kırıkkale Üniversitesi, 2024) Cömert, Ela; Çetinkaya, Elif; Şimşek, Buğra; Şencan, Ziya; Bayar Muluk, Nuray; Bakar, BülentObjective: The facial nerve and its branches are at risk during facial surgery. The surgery with the highest risk is parotid and submandibular gland surgery. An attempt was made to determine threshold values in terms of paralysis in nerve monitoring parameters. These determined values could not be used to predict facial nerve function after surgery. The aim of this study is to investigate the relationship between the parameters detected by nerve stimulation during surgery and postoperative facial nerve dysfunction in patients who underwent parotid and submandibular gland surgery.Material and Methods: A total of 29 facial nerve branches of 13 patients who underwent superficial parotidectomy or submandibular gland resection were examined. Patients were examined in two groups: those who did not develop paralysis after surgery and those who developed paralysis or sequelae. The relationship between the patient's pre- and postoperative House-Brackmann staging and potential changes detected during surgery was investigated.Results: Paralysis was detected in 8 of 29 nerves that were stimulated, and the affected branches were the cervicofacial branch and the marginal mandibular branch. No difference was observed in the mean threshold stimulation values and responses determined before, during and at the end of dissection between patients who developed paralysis and those who did not.Conclusion: Unlike the literature, it is determined that no electrophysiological measurement result can predict the postoperative phase as a result of ROC-curve analysis and logistic regression analysis. It is thought that these results are caused by the fact that the developing paralysis is at low stages and heal within one month.Öğe Tonsillar and Parotid Gland Metastases of Breast Cancer: Two Cases and A Literature Review(2019) Cengiz, Abdurrahman; Cömert, Ela; Tunçel, Ümit; Dilek, Gülay; Benzer, EmineBreast cancer is the most common tumor in women. One in eight women is affected by this disease in her lifetime. Both parotid gland and tonsillar metastases of breast cancer are extremely rare. Here, we present two separate cases of parotid gland and tonsillar metastases of breast carcinoma mimicking second primary tumors. The patient having parotid gland metastasis had disseminated disease and received palliative chemotherapy and hormone therapy. The other patient who had tonsillar metastasis underwent surgery without significant morbidity. Surgical resection of isolated tonsillar metastasis appears to have an influence on survival as the patient is free of disease at 12 months post-surgery.Öğe Topographical Anatomy of the Superficial Temporal Artery(Turkish Neurosurgical Soc, 2023) Güler, Tuğba Morali; Comert, Ayhan; Güngör, Yiğit; Güner, Yahya Efe; Sayacı, Yağız Emre; Korkmaz, Ali Can; Cömert, ElaAIM: To describe in detail the gross anatomy of the superficial temporal artery (STA), its course and branches, its relationships with the branches of the facial nerve, and certain anatomical and surgical landmarks to preserve these structures in daily neurosurgical practice, and to use the STA during revascularization surgery.MATERIAL and METHODS: This cadaveric study was conducted on 16 cadaver heads bilaterally, in which 32 silicon/latex-injected STAs were dissected using a microdissection technique in a neuroanatomy laboratory. The distances between the facial nerve, tragus, STA, superficial temporal vein (STV), and imaginary lines created between important anatomical landmarks were measured. The curvilinear lengths of STA and STV were also measured.RESULTS: The average distances of the most posteriorly located branch of the facial nerve to the frontal region and the tragus at the midpoint of zygoma in the horizontal plane, at the superior border of the zygoma and at the level of the superior border of the parotid gland, were measured as 25.39, 29.84, and 15.56 mm, respectively. The average distance directly measured between the tragus and STA was 39.29 mm, and that between the tragus and STV was 20.26 mm. The average curvilinear lengths of the frontal and parietal branches of STA were 97.63 and 96.45 mm, respectively.CONCLUSION: Understanding the clinical anatomy of the STA and its branches and its relationships with other structures is of critical importance for a successful and noncomplicated surgery. Our findings will be useful not only for surgical approaches such as pterional craniotomy and orbitozygomatic approaches but also for cerebral revascularization.Öğe UYANIK FİBEROPTİK ENTÜBASYON: BEKLENEN ZOR HAVA YOLU(2019) Aydın, Gülçin; Saraçoğlu, Ayşe Gizem; Şahin, Ahmet Tuğrul; Alparslan, Murat; Gündoğan, Seydi; Koçak, Yahya Fatih; Cömert, ElaZor hava yolu anestezistler tarafından zor yüz maskeventilasyonu ve zor trakeal entübasyonu kapsayan bir durumolarak tanımlanır. Entübasyon girişimlerinin %0.5-2.5’indezorlukla karşılaşılır. Başarısız girişimler perioperatif dönemdemorbidite ve mortaliteyi etkilemektedir. Beklenen zor hava yoluvakalarında ayrıntılı bir preoperatif değerlendirme ve ekipmanhazırlığı önemlidir. Zor hava yolunu öngörebilecek çeşitlianatomik ve antropometrik özellikler saptanan hastalarda yaygınfiberoptik entübasyon ihtiyacı olmaktadır. Fiberoptik entübasyoniçin ideal sedasyon tekniği sağlanmalıdır. Bu teknik hastanınanksiyetesini azaltan, konforunu bozmayan ve hemodinamikstabilitesini bozmayan bir teknik olmalıdır. İşlem süresindehastaların uyumlu ve koopere olması da çok önemlidir. Biz buyazımızda beklenen zor hava yolu vakasındaki anesteziyaklaşımımızı literatürler eşliğinde sunmayı amaçladık.
