Frequently Asked Questions. Op.Dr. Çağatay Ruhi

Beta germs (beta hemolytic streptococci) can infect only the tonsils, pharynx or both. It often affects children between the ages of 5 and 15. It is transmitted by droplets from the respiratory tract of sick people.

Sometimes beta germs can also cause a rash called scarlet fever. If the beta germ that causes throat disease is left untreated or inadequately treated, unlike other germs, it can cause permanent rheumatic disease in the heart, kidneys and joints. Although these complications are rare, they make beta germs important because they cause permanent heart and kidney disease.

The most basic way to protect yourself from the beta germ is to avoid close contact with the infected person and to use items such as cutlery used by the infected person.

In beta carriers, the germ is detected in throat cultures and strep tests for beta germs without symptoms of the disease. These children do not need any treatment.

When we talk about a mass in the neck, we think of swelling of the lymph nodes present in everyone's neck, enlargement of some congenital anomalies or abnormal conditions that occur in the neck organs and enlarge them. The most common cause of a neck mass is enlargement of the lymph nodes due to inflammation or tumor.

The age of the patient is very important when evaluating neck masses. Possible causes may vary according to the age of the patient. While lymph node enlargement due to infections or congenital masses are frequently seen in childhood, lymphadenopathy due to infections, swelling due to organs in the neck such as goiter, and more rarely malignant tumors are encountered between the ages of 20-40. In advanced ages, every mass in the neck should be approached with suspicion. Especially when malignant tumors spread to the lymph nodes, swelling in the neck is seen.

The first thing to do in neck masses is a detailed ENT examination. Infections or tumors, which often spread to the lymph nodes, spread to this area from the facial skin, inside the mouth, tongue, tonsils, throat, nose, nasal area, ear, larynx. More rarely, it can also spread from internal organs such as the lungs or stomach.

The main symptoms of Bening's Positional Paroxysmal Vertigo (BPPV) are short-term, sometimes extremely severe rotatory dizziness attacks that occur due to rapid head movement, with or without nausea.

The typical triggering movement is lying in bed, getting out of bed, turning around in bed, bending down to tie shoes, looking up, doing something above head level. After these movements, there is a very severe (lightning-like) dizziness attack. Dizziness lasts for seconds. In the following periods the patient is normal.

The nose is in the center of our face and the most protruding point of our face. Its relationship and harmony with other structures creates the expression and beauty of our face. For this reason, the harmony and relationship of the aesthetics to be planned in the nose with all facial structures is very important for a beautiful and natural nose.

For example, a short nose on a person with a long face, no matter how beautiful and natural the nose is, total beauty will not be achieved. A narrow nose will not look good on a person with protruding cheekbones. Likewise, a nose with a wide rounded tip will not be suitable for a person with a narrow chin structure.

For this reason, facial analysis is very important when planning rhinoplasty. While explaining facial analysis, it is necessary to examine the concept of the golden ratio, which was popularized by Da Vinci but was previously used in architecture and art in Ancient Egypt and the Greeks.

The golden ratio literally means a numerical ratio that is considered to give the most appropriate dimensions in terms of the harmony observed between the parts of a whole in mathematics and art.

Its numerical value corresponds to a number like 1,618. In facial aesthetics, this ratio is the ratio of large organs to the organs we call its sub-organs.

For example, if you plan the ratio of the back of the nose to the height of the nose according to the golden ratio, you will get a more natural and harmonious nose image. Like this, it is important that the width of the base of the nose does not exceed the distance of the eyes in order to achieve facial harmony.

With the help of the golden ratio and many other aesthetic criteria, it is possible to make natural noses that are compatible and proportional to other facial structures such as forehead, lips and chin and that are not obvious to be operated.

First of all, if you are planning a rhinoplasty, you should evaluate the shape of your nose and decide what kind of nose you want. The "my doctor knows best" approach, which is a submissive behavior in such surgeries, can create big problems for both your doctor and you in the future. For this, you should determine your wishes and share them with your doctor. Your doctor will guide you by evaluating these wishes.

It is extremely important that the patient and the doctor understand each other before rhinoplasty surgery. Your expectations should be known by your doctor, whether these expectations are realistic or not and how much of them can be met should be explained to you.

Taking your photographs in pre-operative interviews and describing your expectations through this photograph will ensure a healthier patient-doctor relationship. The corrections that the doctor will make on the photographs taken with the help of computer programs are useful in terms of showing you what can happen. However, it should not be forgotten that these photo edits only help to plan the surgery and determine your wishes. The expectation that the patient will have the exact same result after the surgery is a wrong idea.

In fact, we have patients in both situations. Since I am an otolaryngologist, I encounter patients with compulsory conditions more often. My patients often have health problems. They cannot breathe through the nose. Nasal congestion reduces the quality of life. Snoring, chronic pharyngitis, sinus problems occur. The solution to these problems requires nose surgery.

At this point, we need to talk about nose surgery, it will be a bit technical, but nasal midline curvatures cannot be corrected by 30-40% with the closed conventional technique. After nasal surgery, the patient's complaint of congestion continues, in this group of patients, especially in people whose curvature in the nose continues on the back of the nose, it is necessary to approach it like aesthetic surgery and correct the entire curved midline. Success in this type of surgery reaches up to 95%.

Apart from that, there are psychological factors. This can be seen as a need in people. I have patients who have aesthetics to feel better, to increase self-confidence, to rejuvenate or to be renewed. In this patient group, the preoperative interview should be done very carefully. Mostly, their expectations should be well understood and the result should be well explained to the patient. Because these patients often have high expectations. They believe that their whole life will change with nose surgery. It is necessary to discuss the change and its results with these people. It is necessary to explain that a successful rhinoplasty can positively affect their life, but it will not be a solution to everything.

In the first days after aesthetics, swelling is more noticeable around the eyes and forehead due to the plaster and bandage. The front end of the nose, which is outside the bandage, is more affected by swelling than other areas. The swelling around the eyes will regress between the 3rd to 5th day after aesthetics and afterwards.

At the end of the 1st week, when the plaster and bandage are removed, there is moderate swelling of the nasal skin. In the first 3-4 days, there may be an increase in swelling in the nose in general. For this, bandaging for 4 days after surgery prevents this additional swelling. During this period, the nose is larger than its original size. Especially the anterior tip of the nose appears more swollen. This diffuse edema often dissipates quickly.

From the 10th day onwards, there is swelling on the skin of the nose. However, this is not too much to affect the person's work or normal life. So the nose is slightly larger than its normal appearance.

In the 1st month, the appearance of the nose is often to the patients' liking and the swelling has decreased. However, healing continues rapidly. During this period, patients often complain that they look bigger in the photograph. It is not photogenic.

In the 2nd to 3rd months, most of the healing is completed and the appearance is close to normal. It now looks more beautiful in photographs. Most of the swelling has dissipated.

At the end of the 1st year, full recovery is completed in most patients, rarely it may take longer. Apart from this normal process, there may be an increase in swelling in your nose during the day or according to weather conditions. My patients often report an increase in swelling in their nose when they wake up in the morning.

However, as the blood vessels dilate in hot weather, swelling changes with the air temperature.

The postoperative process should be explained to the patients well, they mostly come to the surgery interview with hearsay information. I even had patients who said that they should lie on their backs for 1 month after surgery. In fact, it used to be said so in the 70s and 80s, but with the development of technology and surgical techniques, the patient returns to normal life in 8-10 days in modern rhinoplasty. Of course, there is swelling in and around the nose and we impose some restrictions for the first 2-6 weeks.

We can summarize the operation process and the postoperative period as follows. The surgery takes about 2-3 hours. The patient is under general anesthesia during this process, that is, he is fully asleep. We start feeding with liquid and soft foods 4-6 hours after the operation. If there are no narcosis-related side effects such as nausea and vomiting, if the general condition is good, we usually allow the patient to go home, that is, hospitalization is usually not after rhinoplasty.

My patient spends the first day comfortably, but on the 2nd day, he has a little trouble due to the nasal tampon. Mild headache, feeling of pressure on the face is the most common complaint of my patients, it is definitely not a very painful process. After the 3rd day, he can do his normal daily work. You can take a shower after the 3rd day, provided that it is not hot. Teeth can be brushed slowly. There is no situation that requires him to lie down all the time. In the 1st week, the casts are removed. On the 10th day, he can return to work and normal life. Of course, there are swellings on the nose in this process; but it is not effective in going to work or returning to normal life. We do not want him to do sports for the first 2-3 weeks. Because there is a risk of nosebleeds with heavy activities. In the first 6 weeks, we restrict collective and group sports such as tennis and basketball. We do not want the new nose to be hit. Of course, sunglasses are forbidden in the first 2 months.

In the first days, swelling and edema are evident around the nose. Especially on the 3rd and 4th day, the eyelid may close due to swelling.

Applying ice as much as possible, especially until the tampons are removed, and sleeping with the head slightly elevated (for example with two pillows on the back) will help reduce swelling.

Each doctor has his/her own style for ice application. While some doctors use special cooling face masks called hilotherm, our preference is to apply ice to both eyes separately.

In the 1st week, after the bandages are removed, the nose will be bandaged again for 3-4 days or 1 week under office conditions depending on the edema on the back of the nose. This prevents further swelling of the nose.

During the recovery period, massages can be done to disperse the edema on the skin of the nose with the recommendation of your doctor.

For permanent nasal skin swelling, bandaging, dietary adjustment, massage with cortisone cream or cortisone injection under the skin can be applied under office conditions.

All patients wonder how long the swelling in the nose will last after rhinoplasty and when complete recovery will result. They often question this in aesthetic interviews. Rhinoplasty is not an aesthetic operation where full results can be obtained in a short time. Getting the desired full result usually results in a 1-year process and rarely in a longer period.

Some patients respond faster to the healing process after nose surgery and the swelling is less. However, the response of some patients to the healing process may take longer and the swelling may be more pronounced. Some patients have a better recovery response, while others may experience a delayed recovery.

There are many factors that affect the intensity and resolution of the swelling after rhinoplasty. These are

The technique of the surgery: There is less swelling in closed rhinoplasty compared to open rhinoplasty. The scope and duration of the surgery: For example, in cases with advanced curvature or prominent bone on the dorsum of the nose and longer duration requiring more aggressive work, swelling is more and healing may be later in the degree of aggressiveness of the procedure.

Whether you have had rhinoplasty before: In patients who undergo correction rhinoplasty, the swelling dissipates later.

Postoperative care: Ice application is very important after surgery. It limits the formation of subcutaneous swelling as it will constrict the vascular mouth.

Different parts of the nose respond differently to swelling: While swelling at the tip of the nose will heal later, swelling on the back of the nose will heal faster.

The perspective and approaches in rhinoplasty are very much affected by society. So there are trends. New approaches are completely in favor of naturalness, small pointed noses according to the slide-style face made in the past years are no longer desired. People demand strong noses that are suitable for the face, which is not obvious that it is natural surgery, revealing the eyes in the background, but strong noses. It is possible to achieve this. The important thing is to consider the face as a whole when planning rhinoplasty, to ensure the harmony of the new nose with the eyes, eyebrows and lips.

The time to be chosen for rhinoplasty is important for healthy healing. Approximately 80% of the healing is completed in the first 2 months after rhinoplasty. In this period, bruises and swelling are at the forefront around the eyes for the first 10 days, and then the swelling we call edema is concentrated on the skin of the nose. Recovery is completed in 6-12 months.

In order to achieve the best result in rhinoplasty; this process should be considered when planning the date of surgery. We can say that the winter months and spring period are the most suitable time.

Swelling and bruises around the eyes after rhinoplasty make the skin sensitive to the sun. Exposure of bruises to direct sunlight can cause permanent spots on the face. This sensitivity lasts for 1 to 1.5 months. Another reason why we recommend winter and spring is that the risk of postoperative bleeding is higher in hot weather. Hot weather causes relaxation and dilation of the blood vessels and may cause unwanted nosebleeds.

However, it causes bruises and swelling to increase. It affects healing in a bad way. For this, we apply ice application after surgery. For these reasons, nose operations performed in January, February or March should be preferred more because they will show full recovery in June.

Nosebleeds, which scare us all, are often caused by simple diseases. If it recurs, it should be evaluated by a specialist because it may be a harbinger of some diseases.

As it is known, the most important task of the nose is respiration. It warms and moisturizes the dry and cold air in the outside world and presents it to the lungs. While fulfilling this task, it uses the extensive vascular network under the outermost layer we call mucosa. We often encounter bleeding in our nose, which contains so much vascular structure. Nosebleeds can be seen in all people regardless of age and gender. Nosebleeds often look more dangerous than they are. However, in rare cases it can be life-threatening.

Nosebleeds can be divided into two categories: those originating from the nose or those caused by systemic (whole body) diseases.

Those originating from the nose:

• Rhinitis due to the common cold (mucosal infection of the nose)
• After nose picking (digital trauma)
• Due to allergy (by increasing fragility in mucosal vessels)
• Due to nasal bone or cartilage curvature (due to dryness)
• In sinusitis attacks (by increasing the fragility of mucosal vessels)
• Frequent use of some nasal sprays
• Some diseases originating from the superficial layer of the nose (bleeding polyp of the septum, vascular anomalies)
• Nasal traumas-operations
• It can be seen in nasal foreign bodies or tumors.

Nosebleeds due to systemic diseases:

• Most commonly seen due to hypertension
• Use of blood thinners
• Coagulation disorders
• Liver diseases
• Blood cancers such as leukemia
• It can be seen in some cancers.

The most important factor in nasal obstruction is cartilage or bone curvatures in the midline and permanent swelling of the nasal flesh. These structural disorders in the nasal midline and turbinates disrupt nasal breathing by directly blocking the airway. Apart from nasal congestion, these curvatures can cause recurrent sinusitis attacks, middle ear infections and damage to the back wall of the throat (pharyngitis as a result of continuous mouth breathing) by blocking the sinus mouths that allow the sinuses to drain. These curvatures in the nose mostly develop due to trauma. Trauma can be congenital or structural. The treatment of these curvatures, which do not benefit from any drug treatment, is surgical. Bone curvatures in the nose and swelling of the nasal flesh can occur at the same time.

Hayat kalitesini etkileyen burun kemik eğrilikleri basit bir ameliyatla çözülebilir, böylece sizde nefes almanın tadına tekrar varabilirsiniz.

I have nasal congestion. Will there be a change in the shape of the nose in my nose surgery? I should have a nose surgery, can this surgery be performed together with plastic surgery? Is it included in plastic surgery to correct the curvature of my nasal bone?

We encounter these and similar questions in many of our patients. Nasal congestion often occurs due to curvatures in the nasal midline bone or swelling in the nasal flesh. Apart from these causes, narrowing of the nasal valve angle or collapse of the anterior tip of the nose or weakness in the wings of the nose can cause nasal congestion.

Classical closed technique nose surgery (septoplasty) for nasal bone curvature has a high chance of success in curvatures in the back or midline of the nasal midline, which we call the bone dorsum at the base of the nose. This surgery does not change the shape of the nose.

However, if the curvature of the nasal midline bone is in front or above, that is, if it obstructs the nasal valve, or if there is collapse in the anterior tip of the nose or weakness in the wings of the nose, if the back of the nose is curved, in these cases, nose surgery should be performed with an aesthetic approach. The chance of success is low when performed with the classical technique. In this surgery, which we call open technique septoplasty, all problems in the nasal midline bone can be solved. Weak cartilages are strengthened and curvatures outside the nose are corrected. The shape of the nose is improved. 95% of the congestion problem is solved. It is superior to closed surgery in the cases mentioned above.

In the health-related part, there is often no need to touch the upper bones of the nose if there is no advanced curvature in the nose. However, depending on the patient's request, if there is a bone protrusion on the back of the nose in the same surgery, it can be removed. Nasal reduction correction can be done additionally.

If you have nasal obstruction, the important thing is to determine the cause well before surgery. Your doctor will explain to you what kind of surgery you will need. If you have aesthetic expectations, discussing this openly with your doctor, discussing the changes that may occur in your nose after surgery with your doctor on your pictures will increase the success of this surgery and your satisfaction.