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Cancer is a disease the incidence of which rises with age. Given that the risk of developing cancer increases with advancing age, a growing number of elderly patients will need treatment for cancer in the future, and head and neck surgeons are increasingly being faced with therapeutic dilemmas regarding this age group. Related publications show that older patients are less likely than younger patients to receive standard treatment. Therapeutical planning must be based not only on tumor characteristics, but also on the physiological, rather than the chronological, age of the patient. Comorbidity is the most important factor in less intensively treatment of elderly patients. Complete geriatric assessment and a multidisiclinary approach are the crucial points. Surgeons, radiation therapy specialists, medical oncologists and geriatricians must actively cooperate in this setting. Recruitment of elderly cancer patients to more clinical trials is needed to enhance our knowledge and to offer optimum treatment to this unique subgroup.

Objectives: We evaluated patients who were treated for head and neck paragangliomas., Patients and Methods: The study included 40 patients (25 females, 15 males; mean age 48 years; range 26 to 74 years) who were operated on for paragangliomas of the head and neck region between 1993 and 2007. Clinical findings, treatment modalities, and the results of treatment were evaluated., Results: The most common complaint was neck swelling (n=30), followed by tinnitus (n=7), hearing loss (n=6), imbalance (n=3), pain (n=2), hoarseness (n=2), and nasal obstruction (n=1). The mean duration of symptoms was 22 months. The most common paraganglioma was glomus caroticum (n=28) with a mean tumor diameter of 4.5 cm (range 2 to 12 cm). Urinary vanilmandelic acid concentration was measured in 24 patients and found above normal range in two patients. Octreotide scintigraphy was performed in 14 patients and femoral angiography was performed in 27 patients. Multicentric disease was present in one patient and one patient had bilateral involvement. Transcervical excision was the most common approach. Complications were as follows: transient facial nerve paresis (n=3), vagal nerve palsy (n=2), hypoglossal nerve palsy (n=2), permanent facial paralysis (n=1), bleeding (n=1), and total hearing loss (n=1). No recurrences were encountered during a mean follow-up of 71 months., Conclusion: Preoperative evaluation of all patients with respect to catecholamine secretion and multicentric disease is important for choosing the proper treatment and preventing possible complications.

Objectives: We retrospectively analyzed patients undergoing surgery for thyroid masses., Patients and Methods: A total of 131 patients (80 males, 51 females) who underwent surgery for thyroid masses between 1993 and 2007 were evaluated with respect to clinical findings, histopathologic diagnoses, and treatment modalities., Results: The thyroid masses were found benign in 48.1% and malignant in 51.9% of the patients. Forty-one females (65%) and 22 males (35%) had benign thyroid masses, while 39 females (57%) and 29 males (43%) had malignant thyroid masses. According to histopathologic results, the most common benign and malignant diagnoses were multinodular goiter (n=57, 43.5%) and papillary carcinoma (n=50, 38.2%), respectively. The mean duration of complaints was 58 months for benign and 30 months for malignant tumors., Conclusion: Thyroid operations are becoming increasingly common in otorhinolaryngologic surgical procedures.

Objectives: This study was designed to determine electromyographic findings of the spinal accessory nerve (SAN) after elective functional (level II-V) and lateral neck dissections (level II-IV) in N0 patients with supraglottic larynx carcinoma., Patients and Methods: The study included 10 patients (five bilateral) who underwent functional (FND), and 10 patients (all bilateral) who underwent lateral (LND) neck dissection for supraglottic larynx carcinoma. Those with a history of myopathy, neuropathy, recurrent disease, or previous radiotherapy were excluded. Functions of the SAN were evaluated with EMG after at least 12 months postoperatively. The results were assessed in four groups as normal functions, or neurogenic deficit of mild, moderate, or severe degree., Results: Neurogenic deficits were found in the sternocleidomastoid muscle in eight necks (53.3%) and in the trapezius muscle in seven necks (46.6%) in the FND group. However, only two necks (10%) exhibited neurogenic deficits affecting both muscles in the LBD group. Comparison between the two groups showed a significant difference in terms of SAN functions (p<0.05)., Conclusion: Compared to FND, LND is associated with significantly less neurogenic damage secondary to SAN dissection.

Objectives: We evaluated the clinical significance of adenoidal vegetations which are overlooked as a cause of nasal obstruction in adults., Patients and Methods: The study included 12 patients older than 15 years of age (10 males, 2 females; mean age 23.5 years; range 15 to 32 years) who presented with nasal obstruction due to adenoidal vegetations. The patients were evaluated with respect to age, sex, complaints, findings of physical examination, computed tomography of the nasopharynx, and nasal endoscopy, and histopathologic results., Results: All the patients had nasal obstruction. The most common symptom was snoring. Physical examination showed a vegetative mass in the posterior wall of the nasopharynx obstructing the choana. Five patients had bilateral serous otitis media and eight patients had postnasal purulent drainage. All the patients underwent adenoidectomy under general anesthesia and with transnasal endoscopic control. Histopathologic examination of surgical specimens showed lymphoid hyperplasia., Conclusion: Although adenoidal tissue undergoes regression toward the adolescent period, it may present as the chief cause of nasal obstruction in adults.