Purpose Impact of COVID-19 pandemic on healthcare is huge. We intended to demonstrate how COVID-19 pandemic affected primary head and neck oncology patient’s referral and admission to a tertiary center by comparing the retrospective patient data in March–September 2020 and the same period in 2019. Methods In this cross-sectional study, from March 15th, 2020 to September 15th, 2020, medical records of 61 patients (Group 1) diagnosed and scheduled for surgery for head and neck cancer in our tertiary care center were revised and compared with 64 head and neck cancer patients treated in the same institution in the same time period of the previous year (Group2). Surgical site, TNM stages, need for reconstruction with flap, time from first symptom occurrence to first admission to our institution, and time to surgery were noted. Results In Group 1, out of 56 patients, 26 were diagnosed with T1-2 tumor, while 30 had T3-4 tumor. In Group 2, 43 of 60 patients had T1-2 tumor, while only 17 of them were diagnosed with T3-4 tumor. The rate of T3-4 tumors had significantly increased in 2020 when compared to 2019 ( p = 0.049). In oral cavity cancer patients, N stage was significantly increased in Group 1 when compared to Group 2 ( p = 0.024). Need for reconstruction with regional or free flaps were significantly increased in oral cavity cancer patients ( p = 0,022). The mean time from the beginning of the first symptom to the admission was 19.01 ± 4.6 weeks (ranging between 11 and 32 weeks) in Group 1, while it was 16.6 ± 5.9 weeks in Group 2 (ranging between 6 and18 weeks); with significant increase ( p = 0,02). The time to surgery from first admission was 3.4 ± 2.5 and 2.9 ± 1.2 weeks in Group 1 and 2, respectively, with no statistically significant difference ( p = 0.06). Conclusion The COVID-19 pandemic has caused delay in the diagnosis and treatment of many diseases as such in head and neck cancers. Admission with advanced stage disease and the need for more complex reconstructive procedures were increased. During the pandemic, the management of other diseases that cause mortality and morbidity should not be neglected and priorities should be determined.

Purpose: This study was designed to investigate whether preoperative embolization is a useful procedure to decrease blood loss and neurovascular complications for carotid body tumor (CBT) surgery or not. Methods: Medical records of our tertiary care center from 2012 to 2019 were scanned for patients who underwent surgery for CBT, retrospectively. Age, gender, complaint and head and neck examination findings at the time of presentation, preoperative complete blood count parameters, imaging records (cervical magnetic resonance imaging and carotid artery angiography), Shamblin classification, tumor size, intraoperative findings, and postoperative complications were noted. Results: A total of 26 patients were operated due to CBT between 2012 and 2019 in our clinic; preoperative arterial embolization was performed to 15 (57.7%) patients, and 11 (42.3%) patients were operated without embolization. Youngest patient was 24 years old, while oldest was 69 years and mean age was 44.35 ± 12.73. (embolization group: ages ranging between 24 and 64 with a mean of 41.5 ± 11.02 years; in nonembolization group: ages ranging between 26 and 69 with a mean of 48.1 ± 14.3). Embolization status was not significantly related to cranial nerve injury, vascular injury, overall complications, and hematocrit decrease. Arterial injury is more likely to occur with increasing Shamblin class ( r = .39; P = .04). Tumor size is not found to be significantly related to cranial nerve injury, vascular injury, overall complications, and hematocrit decrease, but cranial nerve injury and vascular injury were more likely to occur in large tumors ( r = .34; P = .089 and r = .34; P = .087, respectively). Age was significantly and negatively correlated to vascular injury ( r = −.51; P = .05). Vascular injury was significantly correlated with gender (male predominance: r = −.64; P = .000). Conclusion: Although preoperative arterial embolization is considered to attenuate the complication risk, we found that there was no significant difference among the patients with or without embolization.

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SUMMARYCommon variable immunodeficiency (CVID) can show variant histological patterns in the gastrointestinal system. We present a case of an 11-year-old boy who has been followed up with a diagnosis of CVID since he was 6 months old. He presented with abdominal pain and diarrhoea. Colonoscopic biopsy showed crypt destructive colitis, severe decrease and focal absence of plasma cells. Three months later he suffered from abdominal pain, vomiting and bloody diarrhoea. Macroscopic examination of small intestinal resection material revealed multiple perforation areas, ulcers. Histopathology showed mildmoderate active enteritis with aphthous ulcers, purulent peritonitis, decrease in plasma cells and loss of primary follicles in lymph nodes. Histopathological findings were consistent with inflammatory bowel disease (IBD)-like CVID. Although in 6-10% of patients with CVID an IBDlike presentation is observed, this highly aggressive form is rarely seen. We present this case because of its extraordinary presentation displaying perforating active enteropathy. BACKGROUND

ABS TRACT Objective: Although corona virus disseminates by aerosol or droplet and colonizes in nasal cavity and nasopharynx, symptoms related to upper respiratory tract are uncommon in coronavirus-disease-2019 . In this report we aimed to classify the patients applying to COVID-19 outpatient clinics according to ear-nose-throat (ENT) specific and COVID-19 specific symptoms and to compare these patients' prognosis. Material and Methods: Sixty-five patients with COVID-19 were included to the study. The patients were classified according to their presenting symptoms. The symptom categories were COVID-19 specific (Group 1) and Covid-19+ENT specific (Group 2) symptoms. As specific symptoms of COVID-19; fever, cough, headache, myalgia and dyspnea were assumed. Mild ENT symptoms were also included to this group. As otolaryngology-specific symptoms; dysfunction in smell, nasal congestion, runny nose, sneezing, postnasal drip, sore throat, dysphagia, dysphonia, hearing loss, tinnitus, dizziness/vertigo and aural fullness were considered. C-reactive protein, leukocyte, lymphocyte, platelet levels in peripheral blood, and oxygen saturation levels were also recorded. The symptom scores were analyzed by visual analog scale scoring system. Results: The most common presenting symptom of the patients in Group 1 was fever followed by constitutional symptoms and cough, whereas the most common presenting symptom in Group 2 was constitutional followed by myalgia and fever. Olfactory dysfunction was prevalent in the patients in Group 2 with a significant difference. Average nasal symptom scores of the patients in Group 2 were; none: 3, mild: 0, moderate: 25, severe: 12 and the difference was statistically significant. Oral cavity/oropharynx symptoms were again more prevalent in Group 2. The average ear symptom scores of the patients among groups did not differ significantly. Fourteen of the patients in Group 1 had better prognosis and 15 had worse outcome. In Group 2 better prognosis was seen in 25 patients and worse prognosis was detected in 11 patients. Conclusion: The evaluation of the parameters concluded that although the patients with ENT predominant symptoms were doing better than the patients with more systemic symptoms, the difference was not statistically significant.

Hyperbaric oxygen treatment (HBOT) is widely used in otorhinolaryngology for various purposes. A 20-year-old male patient was admitted following a traumatic nasal wound which occurred several hours prior. He had a nasal glass cut from the radix to the supratip area which was primarily closed by non-absorbable suture. The following day, there was a haematoma and necrosis of the skin. The haematoma was drained under local anaesthesia. Blood supply to the nasal skin was severely compromised and only the columellar artery remaining intact, by definition designating this a difficult to heal wound with the risk of overall healing failure. Necrosis of the skin had developed within the first 24 hours. Accordingly, the patient underwent 30 HBOT sessions (two hours at 253.3 kPa) twice daily for four days and daily thereafter. Antibiotic cover and conservative wound management were also used. Complete healing was achieved without the need for additional surgical intervention. We conclude that timely use of HBOT may be a valuable adjunct to conservative wound management in a case of sharp nasal trauma.

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