ENT Doctor in Istanbul

17/05/2026

The MRI image above shows a right hypertrophied inferior nasal turbinate, a left-deviated nasal septum, and a bony nasal septal spur touching the lateral nasal wall. The patient also presents with nasal congestion and headache. Typically, when nasal septum deviation is present, the inferior turbinate in the larger nasal passage becomes compensatorily larger than the other. Two main symptoms associated with nasal sepal spur are intranasal airway spasm and related nasal obstruction, while the other symptom is Rhinogenic contact point headache associated with mucosal contact point. There is even a very old article highlighting the relationship between nasal septal spur and headache! Septal spur cephalalgia article published in "The Pennsylvania medical journal" in 1956.

https://www.ent-istanbul.com/2018/03/nasal-bone-spur-atypical-headaches.html

15/05/2026

A complicated 4th revision nose job involving removal of PCL (polycaprolactone) implants in a patient with severe nasal irregularities and structural collapses represents one of the most challenging scenarios in modern rhinoplasty practice, as it combines multiple layers of surgical difficulty including distorted anatomy, scarred tissue planes, weakened cartilage support, and the presence of previously implanted synthetic scaffold materials that may alter both the biomechanics and healing characteristics of the nasal framework. In this particular case, the patient had already undergone three prior rhinoplasty surgeries, which significantly increased the complexity of the nasal structure due to cumulative surgical trauma, loss of native cartilage integrity, and irregular fibrotic healing patterns that contributed to contour deformities and functional impairment. According to the clinical documentation of this fourth revision case, the patient presented with visible nasal dorsum irregularities, including both protrusions and depressions that became more evident after postoperative swelling subsided, along with asymmetry that was particularly noticeable under dynamic facial movements and lighting conditions, suggesting an unstable and uneven underlying structural framework. The patient’s history revealed that a sheet-type PCL scaffold material (Bloocell® PCL) had been used in a previous procedure, and over time, irregular integration of this material contributed to surface deformities, localized stiffness, and uneven contour transitions between grafted and native nasal tissues, which is a known potential complication in complex implant-based rhinoplasty cases. During the revision surgery, multiple fragmented implant materials were carefully identified and removed from different nasal regions, some of which were tightly adherent to the overlying soft tissue envelope, making dissection technically demanding and increasing the risk of further tissue trauma if not handled with extreme precision and microsurgical technique. As described in the surgical report, after removal of the PCL scaffold remnants, significant irregularities remained in the nasal dorsum and supratip areas, which required further refinement using a micromotor-assisted tungsten instrument to smooth out bony and cartilaginous transitions and restore a more continuous nasal contour line. One of the key reconstructive challenges in such revision cases is the presence of collapsed or weakened support zones, particularly in the nasal bridge and valve regions, where prior over-resection or implant-induced tissue stress can lead to partial collapse and functional airway compromise. To address these defects, autologous grafting using temporal fascia was performed, with grafts harvested from the patient’s left temporal region and strategically placed into sunken and structurally deficient nasal areas, providing both a biological camouflage layer and a supportive scaffold to improve long-term contour stability. In addition, fascia grafts were used in an extended, layered fashion along the midline and irregular dorsal segments, which helps to distribute soft tissue tension more evenly and reduce the risk of postoperative contour irregularities becoming visible through thin or compromised skin envelopes. This case also highlights the importance of addressing both aesthetic and functional aspects simultaneously in revision rhinoplasty, as patients with multiple prior surgeries often present not only with cosmetic deformities but also with nasal valve collapse, airflow restriction, and internal structural instability that require careful reconstruction of both cartilage framework and soft tissue support systems. Internal stabilization using supportive techniques and grafting is essential in such cases to prevent recurrent collapse during the healing process, especially in patients with scarred tissue beds where natural cartilage recoil and structural memory are significantly diminished. As emphasized in the clinical discussion of this complex revision case, PCL-based scaffold materials, while widely used in modern reconstructive and aesthetic nasal surgery due to their biodegradable and tissue-engineering properties, may in certain cases contribute to long-term irregularities, delayed resorption patterns, or uneven tissue integration, particularly when used in thin-skinned patients or in areas with high mechanical stress such as the nasal dorsum. The removal and reconstruction process in this 4th revision rhinoplasty demonstrates the necessity of individualized surgical planning, meticulous dissection, and the use of autologous tissue grafts to restore both form and function in severely compromised noses. Postoperatively, careful follow-up is essential to monitor graft integration, soft tissue adaptation, and long-term stability of the reconstructed nasal framework, as final aesthetic outcomes in revision cases often evolve gradually over several months due to prolonged edema resolution and tissue remodeling. Ultimately, this case underscores that complicated revision rhinoplasty, particularly after multiple prior operations and implant use, requires a highly experienced surgical approach combining structural reconstruction principles with advanced soft tissue management to achieve both functional airway improvement and aesthetically harmonious nasal contour restoration.

Source: https://www.ent-istanbul.com/2025/12/complicated-4th-revision-rhinoplasty-bloocell-sheet-type-pcl-removal.html

15/05/2026

A nasal septum perforation measuring approximately 3.5 cm × 2.5 cm represents a large and clinically significant defect of the nasal septum, which is the central structure dividing the nasal cavity into two separate airflow channels, and such a condition can lead to a wide range of functional and structural problems including nasal obstruction, crusting, recurrent bleeding, whistling sounds during breathing, dryness, and in more advanced cases, secondary changes in nasal airflow dynamics that may even affect the lower respiratory tract. In clinical practice, large septal perforations are particularly challenging because the surrounding mucosal tissue is often dry, inflamed, and structurally weakened, making spontaneous healing impossible and surgical repair technically demanding. The case of a 3.5 cm × 2.5 cm septal perforation, as documented in clinical follow-up with preoperative and postoperative findings, demonstrates both the complexity of such defects and the potential for successful reconstruction when advanced surgical techniques are applied. According to the detailed clinical report shared in the ENT Istanbul case documentation, the patient presented with a large ellipsoid-shaped septal perforation, with unhealthy mucosal edges and significant airflow turbulence through the nasal cavity, which had also contributed to progressive symptom worsening over time, including crust formation and irritation of the nasal lining. In such large perforations, one of the key challenges is the lack of well-vascularized mucosa at the margins of the defect, which is essential for successful closure, as well as the tendency for the perforation to enlarge due to continuous exposure to turbulent airflow that dries and damages the surrounding tissue. Surgical repair in this case was performed using an open technique, which allows direct visualization of the septal defect and precise reconstruction of both mucosal layers. A critical component of the procedure involved harvesting fascia from the temporal region and using cartilage graft material to reconstruct the structural integrity of the nasal septum, thereby providing both a scaffold for healing and long-term stability of the repaired area. The use of graft materials such as temporal fascia is particularly important in large perforations because it provides a biologically compatible, well-vascularized support layer that enhances mucosal regeneration and reduces the risk of recurrence. In addition, silicone splints were placed inside the nasal cavity and maintained for an extended period of approximately three months, which plays a crucial role in stabilizing the reconstructed septum, protecting the graft from mechanical trauma, and minimizing postoperative adhesions or collapse during the critical healing phase. Postoperative care is equally important in such complex cases, and patients are typically instructed to perform regular nasal irrigation using antibiotic-containing saline solutions to maintain mucosal moisture, reduce crust formation, and prevent infection while the newly reconstructed tissue matures. After the removal of silicone splints at the three-month follow-up, endoscopic evaluation revealed that the perforation area was completely closed, with healthy pink mucosa covering the reconstructed septal region, indicating successful integration of the graft and restoration of septal continuity. This outcome highlights the importance of combining advanced surgical techniques with meticulous postoperative management in achieving successful closure of large septal perforations. However, it is also well recognized in rhinologic surgery that perforations of this size are at the upper limit of surgical repairability, and outcomes can vary depending on factors such as mucosal quality, patient compliance, previous surgeries, and the presence of systemic conditions that may impair wound healing. In many cases, revision surgery or staged reconstruction may be required, especially when the surrounding tissue has been previously scarred or damaged. The successful closure of a 3.5 cm × 2.5 cm septal perforation demonstrates that even large and complex defects can be repaired when appropriate patient selection, surgical expertise, and reconstructive materials are combined effectively, restoring not only nasal structure but also significantly improving the patient’s quality of life by reducing symptoms such as crusting, dryness, and airflow discomfort. Ultimately, this case emphasizes that large nasal septal perforations should be approached as reconstructive challenges requiring individualized planning, advanced grafting techniques, and long-term follow-up to ensure durable functional and anatomical restoration of the nasal septum.

Source: https://www.ent-istanbul.com/2025/06/35-cm-x-25-nasal-septum-perforation.html

15/05/2026

Refinement of thick nasal skin using bilevel dissection and subcutaneous reduction is an advanced technique in modern rhinoplasty surgery designed to address one of the most challenging anatomical conditions in nasal aesthetics—thick, sebaceous, and heavy nasal skin that tends to mask underlying cartilage refinement and reduce the visibility of surgical improvements. In patients with thick-skinned noses, especially those with bulbous tip deformity, enlarged sebaceous glands, or poor skin elasticity, achieving a well-defined nasal tip and sharp nasal contours can be significantly more difficult compared to thin-skinned individuals. This is because thick nasal skin has a strong “camouflage effect,” meaning that even when the underlying cartilage framework is reshaped successfully, the external appearance may still remain round, bulky, or less defined due to the overlying soft tissue envelope. To overcome this limitation, surgeons have developed specialized methods such as bilevel skin dissection combined with controlled subcutaneous tissue reduction, which aim to carefully thin and redrape the nasal skin while preserving its vascular integrity and structural viability. In bilevel dissection, the nasal skin is elevated in a controlled plane, separating it from the underlying cartilage and soft tissue structures, allowing the surgeon to access and selectively reduce excess subcutaneous tissue, including fibrofatty layers and dense connective tissue that contribute to excessive thickness. This process is not simply cosmetic thinning; it is a highly delicate surgical maneuver that requires precision to avoid damaging the dermal vascular network, which is essential for skin survival and proper healing. Subcutaneous reduction is then performed in a graded and conservative manner to avoid over-thinning, which could lead to complications such as skin necrosis, irregular contouring, or long-term skin contracture. The goal of this combined approach is to enhance the skin’s ability to adapt to the newly sculpted nasal framework, thereby improving definition, tip projection, and overall nasal contour over time. In patients with thick skin, postoperative swelling is typically more prolonged, and the final results may take longer to fully manifest, often requiring months or even years for optimal refinement. Therefore, structural support techniques are also frequently combined with skin management strategies, such as cartilage grafting, tip support reconstruction, and reinforcement of nasal valve areas, to ensure long-term stability of the aesthetic outcome. Additionally, bilevel dissection allows surgeons to reduce dead space between the skin and cartilage framework, which can help minimize postoperative edema and irregular scar tissue formation, both of which are common challenges in thick-skinned rhinoplasty cases. Careful patient selection is essential, as not all thick skin cases are suitable for aggressive thinning procedures; instead, individualized surgical planning based on skin thickness, sebaceous activity, cartilage strength, and nasal geometry is required to achieve optimal results. As highlighted in clinical experience and surgical case discussions, thick nasal skin management is one of the most technically demanding aspects of rhinoplasty, and success depends heavily on the surgeon’s ability to balance adequate thinning with preservation of skin viability and natural nasal aesthetics. When performed correctly, bilevel skin dissection and subcutaneous reduction can significantly improve nasal tip definition, enhance dorsal refinement, and create a more harmonious nasal-facial relationship without compromising nasal function. However, surgeons must always consider that thick skin has intrinsic biological limitations, and while surgical techniques can improve definition, they cannot fully convert a thick-skinned nose into a thin-skinned aesthetic ideal. Patient education and realistic expectation management are therefore crucial components of treatment planning in these cases. Ultimately, refinement of thick nasal skin represents a combination of structural rhinoplasty principles and soft tissue management strategies, aimed at achieving long-lasting, natural, and proportionate results in challenging nasal anatomies.

Source: https://www.ent-istanbul.com/2026/05/bilevel-skin-dissection-underskin-tissue-removal-in-thick-skinned-rhinoplasty.html

15/05/2026

Rhinoplasty, commonly known as nose job surgery, is one of the most frequently performed facial aesthetic procedures worldwide, aimed at improving both the functional and cosmetic aspects of the nose; however, despite its popularity and generally safe profile when performed by experienced surgeons, it is essential to understand that rhinoplasty is still a complex surgical intervention that carries a range of potential risks and complications, as highlighted in clinical discussions of nasal surgery outcomes. According to detailed medical explanations of rhinoplasty risks, complications can occur at different stages of the surgical process, including intraoperative, early postoperative, and late postoperative periods, and they may involve functional, aesthetic, infectious, or psychological components depending on the patient’s healing response, surgical technique, and individual anatomical characteristics. One of the most commonly discussed complications is nasal obstruction, which may develop when internal nasal structures such as the septum, turbinates, or nasal valves are altered during surgery, potentially leading to breathing difficulties even if the external cosmetic result appears satisfactory. Bleeding is another known risk, particularly in the first days following surgery, and while it is usually mild and self-limiting, patients with bleeding disorders or those using blood-thinning medications may have a higher risk of postoperative hemorrhage. Infection, although relatively rare in rhinoplasty due to sterile surgical environments and prophylactic measures, remains a possible complication that can affect soft tissue healing and, in severe cases, may contribute to cartilage or skin damage if not properly managed. Aesthetic complications are among the most emotionally significant risks for patients and may include asymmetry, irregular contours, persistent swelling, or dissatisfaction with nasal shape, which can sometimes lead to the need for revision rhinoplasty. Structural issues such as nasal deformities may also develop during the healing process, particularly if cartilage support is weakened or if scar tissue formation alters the intended surgical outcome. One of the well-documented complications in rhinoplasty literature is the possibility of septal perforation, which refers to the formation of a hole in the nasal septum when both mucosal layers and underlying cartilage are damaged, potentially resulting in symptoms such as whistling sounds during breathing, crusting, nasal dryness, and airflow disturbances. Another important complication is nasal tip drooping, which can occur if adequate structural support of the nasal tip is not maintained during surgery or if postoperative healing leads to weakening of cartilage support, often requiring additional corrective procedures in more severe cases. Scar-related complications are also relevant, particularly in open rhinoplasty techniques where a small incision is made at the columella; although this incision usually heals well and becomes barely visible, in some cases hypertrophic or noticeable scarring may develop depending on individual healing tendencies. In addition to these local complications, more rare but significant issues such as skin necrosis, soft tissue atrophy, granuloma formation, or adverse reactions to sutures or graft materials may occur, especially in revision cases or in patients with compromised vascular supply to nasal tissues. Psychological and emotional outcomes also play an important role in rhinoplasty satisfaction, as some patients may experience disappointment or body image concerns even in the absence of technical surgical complications, highlighting the importance of realistic expectations and thorough preoperative consultation. Importantly, medical literature emphasizes that while the overall complication rate of rhinoplasty is relatively low, estimated in some studies between approximately 4% and 19%, the majority of serious complications are uncommon, and most issues are mild or correctable with appropriate follow-up care and, if necessary, revision surgery. The success of rhinoplasty largely depends on a combination of surgical expertise, individualized surgical planning, patient-specific anatomical factors, and careful postoperative care, as well as the patient’s adherence to recovery instructions and avoidance of trauma during healing. Ultimately, rhinoplasty should be viewed as a balance between artistic precision and surgical science, where both aesthetic refinement and functional preservation must be carefully maintained to minimize risks and achieve long-term satisfactory outcomes. As emphasized in clinical discussions of rhinoplasty complications, patients should be fully informed about all potential risks before undergoing surgery to ensure informed decision-making and realistic expectations regarding the results.

Source: https://www.ent-istanbul.com/2018/08/risks-complications-of-rhinoplasty.html

15/05/2026

Nasal Tip Plasty, also known as tip rhinoplasty or nose tip surgery, is a highly specialized aesthetic and functional nasal procedure that focuses specifically on reshaping the most prominent and defining part of the nose—the nasal tip. Unlike full rhinoplasty, which involves modification of the nasal bones, bridge, and overall nasal framework, nasal tip plasty targets only the lower third of the nose, particularly the cartilage structures that determine tip definition, projection, rotation, and symmetry. As described in clinical practice, the nasal tip plays a crucial role in facial harmony because even minor irregularities in this region can significantly affect the overall appearance of the nose and, consequently, the entire facial balance. In modern aesthetic surgery, nasal tip plasty is performed for patients who are dissatisfied with the shape of their nasal tip, whether due to drooping, bulbosity, asymmetry, under-projection, or wide and undefined contours. It is also frequently indicated in patients who experience functional issues such as nasal valve weakness or airflow obstruction related to tip support problems. The procedure can be performed using either open or closed surgical techniques, with the open approach often preferred in more complex cases because it allows direct visualization of the nasal cartilage structures, enabling more precise reshaping and structural support. During nasal tip plasty, surgeons typically modify the lower lateral cartilages using suturing techniques, cartilage reshaping, or cartilage grafting to achieve a more refined, lifted, and proportionate nasal tip. In some cases, especially in patients with thick nasal skin, additional techniques such as subcutaneous tissue thinning or structured cartilage support may be applied to enhance definition and long-term stability of the results. One of the most important goals of nasal tip plasty is to maintain or improve nasal function while achieving aesthetic refinement, ensuring that the airway remains open and stable after surgery. The procedure is generally performed under local anesthesia with sedation or general anesthesia, depending on patient comfort, surgical complexity, and surgeon preference. Recovery after nasal tip surgery is typically faster compared to full rhinoplasty, although swelling in the nasal tip area may persist longer due to the thicker soft tissue and slower lymphatic drainage in this region. Patients can expect gradual refinement of the nasal shape over several months as swelling resolves and tissues settle into their new position. Nasal tip plasty is considered one of the most technically demanding aspects of nasal surgery because the nasal tip requires precise millimetric adjustments to achieve natural-looking, symmetrical, and durable results. Surgeons must carefully evaluate factors such as skin thickness, cartilage strength, nasal-lip angle, and overall facial proportions before determining the appropriate surgical plan. When properly performed, nasal tip plasty can significantly enhance facial aesthetics by creating a more balanced, elegant, and harmonious nasal contour without altering the natural identity of the patient’s face. It is especially popular among individuals seeking subtle but impactful improvements rather than dramatic changes, making it a cornerstone procedure in modern facial plastic surgery. According to clinical descriptions of nasal tip surgery, the procedure may involve tip reduction, tip refinement, or tip projection techniques depending on the patient’s anatomical needs and aesthetic goals, ensuring a personalized surgical outcome tailored to each individual case. Ultimately, nasal tip plasty represents a refined balance between art and surgical precision, offering patients a highly effective solution for improving nasal appearance and function simultaneously.

Source: https://www.ent-istanbul.com/2018/04/nasal-tip-plasty-in-istanbul-turkey.html

15/05/2026

About Tongue Tie in Infants 👶

Tongue tie, also known as ankyloglossia, is a condition present at birth in which the thin tissue under the tongue (lingual frenulum) is shorter, thicker, or tighter than normal. This can restrict tongue movement and may interfere with feeding, swallowing, and later speech development in some infants.

Common symptoms of tongue tie in babies include difficulty latching during breastfeeding, prolonged feeding sessions, clicking sounds while feeding, poor weight gain, ni**le pain in breastfeeding mothers, and limited tongue mobility. In some infants, the tongue may appear heart-shaped when extended. However, not every tongue tie causes symptoms or requires treatment.

Diagnosis is usually made through a physical examination by a pediatrician, ENT specialist, lactation consultant, or pediatric dentist. Evaluation focuses not only on the appearance of the frenulum but also on tongue function, feeding efficiency, and the baby’s weight gain. Current pediatric guidelines emphasize that treatment should mainly be considered in symptomatic infants with significant feeding difficulties.

Treatment depends on symptom severity. Mild cases may only require observation and breastfeeding support. When tongue mobility significantly affects feeding or oral function, a simple procedure called frenectomy or tongue tie release may be performed to free the tongue. In selected cases, frenuloplasty may be recommended. Early evaluation and individualized treatment planning are important for optimal outcomes.



Sources:
ENT Istanbul - Tongue Tie (Ankyloglossia)
https://www.ent-istanbul.com/2018/04/tongue-tie-ankyloglossia.html

Dil Bağı Ameliyatı - Dil Bağı Nedir? https://www.dilbagiameliyati.com/2017/06/dil-bagi-nedir-dil-bagi-belirtileri-dil.html

12/05/2026

Facial paralysis can develop suddenly and may affect blinking, smiling, speaking, and even eye protection. Distinguishing between peripheral and central facial paralysis is extremely important because some cases may be associated with serious neurological conditions such as stroke. Early diagnosis and treatment can significantly improve recovery outcomes. Learn more about the causes, symptoms, diagnosis, rehabilitation, and treatment options for facial paralysis in this detailed article:

Facial Paralysis – Symptoms, Causes, Diagnosis and Treatment
https://www.ent-istanbul.com/2026/05/facial-paralysis.html

Detailed information about facial paralysis symptoms, causes, differences between peripheral and central facial paralysis, and treatment methods.

01/05/2026

Labial Frenectomy - Upper Lip Tie Release Surgery

https://www.ent-istanbul.com/2022/01/lip-tie-definition-treatment-symptoms.html

Labial frenectomy is a simple and effective procedure used to release a tight upper lip frenulum (lip tie), restoring normal lip mobility and improving feeding function. In infants with upper lip tie, restricted lip movement can lead to breastfeeding difficulties, poor latch, and maternal discomfort. Surgical release helps improve oral function and can support healthier feeding and development.

Labial frenectomy performed on an infant with feeding problems and difficulty breastfeeding. The top photo shows the patient's tense and thick upper lip frenulum and a notch at the gum line (indicating diastema or possible cause!). The bottom photo shows the wound after the incision was completed. The incision was sutured with dissolvable stitches.