The management of the oropharyngeal anterior wall cancer.

INTRODUCTION: Anterior wall of the oropharynx or the base of the tongue is the site of different types of cancers, most of them usually diagnosed in advanced stages. The most common histological type of cancer diagnosed in these patients is squamous cell carcinoma (SCC). The treatment methods are multiple, but the optimal therapeutic option with best results on outcome and on the patients' quality life has not been established. The objectives of our study were to evaluate the tongue base SCCs treated by transhyoid approach and the oncological outcomes of the surgery combined with radiotherapy. PATIENTS, MATERIALS AND METHODS: The retrospective study was performed over a period of 10 years (2001-2010) on 37 previously untreated patients. All the tumors were biopsied and after histopathological (HP) diagnosis, the tumors were excised. All the specimens were fixed in 4% (v/v) buffered formalin and sent for the HP evaluation. RESULTS: In the study were included only the patient diagnosed on biopsy with different types of SCC. The mean age was 61 years old, most of the patients (94.59%) being males. We performed a tongue base transhyoid tumor resection in 23 (62.17%) cases followed by epiglottectomy in five (13.51%) cases or horizontal supraglottic laryngectomy in nine (24.32%) cases, respectively. Bilateral neck dissections and postoperative radiotherapy were performed in all cases. The postoperative and post-therapeutic evolution was favorable at three years (81.1%) and five years (75.67%). There were no signs of local or regional recurrences. The tumor specific three-year and five-year survival rates were: pT2 100%, pT3 87.5%, pT4a 71.42% and 57.14%, and pT4b 50% and 25%, respectively. The stage specific three-year and five-year survival rates were: stage II 100%, stage III 85.71%, stage IVA 83.33% and 79.16%, and stage IVB 50% and 25%, respectively. CONCLUSIONS: The prognosis for the SCC of the tongue base is poor. Cancer resection by transhyoid approach is a feasible procedure, which permits a good tumor control with limited postoperative morbidity, with an important benefit on the life quality of the patients.

Rare benign tumor of the larynx - laryngeal amyloidosis.

We report a case of rare benign tumor of the larynx - amyloidosis of larynx - in a 52-year-old female who presented to the Department of Ear, Nose and Throat (ENT), Timisoara Municipal Hospital, Romania, with dysphonia. The patient's first presentation was in June 2012, with a polypoid formation localized on left vocal cord. The patient underwent a suspended microlaryngoscopy (SM) with tumor removal followed by histopathological examination, which revealed a laryngeal amyloidosis. The tumor recurred in 2013, 2014, 2016, 2017 and 2018. The patient underwent tracheotomy, followed by SM with endoscopic CO2 laser procedures, in order to remove the tumor and to ensure the airway. The follow-up was for six years. In May 2018, amyloid was located in subglottis, glottis and left false vocal fold. The patient needed five revision surgical procedures. The patient did not developed systemic amyloidosis during the follow-up period.

Anterior commissure laryngeal neoplasm endoscopic management.

The CO2 laser surgery represents a treatment method of laryngeal bicordal and anterior commissure glottic cancer T1b, T2, N0. In Department of ENT, Timisoara, Romania, during 1.01.2001-31.12.2011 were analyzed 781 files from patients with laryngeal neoplasm. One hundred twenty-seven patients presented the tumor that involved both vocal cords and anterior commissure, stages T1b, T2 and T3. Therapeutic options included CO2 laser microsurgical excision for 55 (43.30%) patients, frontolateral hemilaryngectomy for 16 (12.59%) patients, total laryngectomy for 42 (33.07%) patients, radiotherapy for 10 (7.87%) patients, and four (3.14%) patients, initially, refused any treatment modality. Endoscopic laser CO2 microsurgery was the primary and solitary management for curative resection of the glottic cancer. All operations were performed under general anesthesia with orotracheal intubations. The mean follow-up was 58 months, with the range between 36 to 84 months. Suspended microlaryngoscopy with CO2 laser surgery has been performed in 43 (33.85%) patients staged T1bN0Mx and 12 (9.44%) patients staged T2N0Mx. In five (9.09%) patients, we encountered local recurrences. The endoscopic CO2 laser surgery is in our view the elective and preferable surgical method in laryngeal glottic cancer stage T1b and T2 for cure, with oncological and functional results superior to those of conventional surgical procedures.

Treatment of Meniere's disease with intratympanic dexamethazone plus high dosage of betahistine.

PURPOSE: The aim of the present study was to assess if the combined therapy of intratympanic dexamethasone (ITD) and high dosage of betahistine (HDBH) is able to provide increased vertigo control compared to ITD alone in patients suffering from definite unilateral Meniere's disease (MD). MATERIALS AND METHODS: Consecutive MD patients were enrolled and randomly divided in two groups, each comprising 33 cases. Group A received a combination of ITD and identical-appearing placebo pills while Group B received a combination of ITD and HDBH. ITD protocol consisted of three consecutive daily injections. HDBH comprised 144mg/day (48mg tid). The main outcome measures were: 1) vertigo class, pure tone average (PTA), speech discrimination score (SDS) and Functional Level Score (FLS) according to the American Academy of Otolaryngology-Head and Neck Surgery criteria; 2) complete and substantial vertigo control according to the Kaplan-Meier survival method. RESULTS: Sixty two patients completed the 24-month follow-up. A complete vertigo control was achieved in 14 patients (44%) from Group A and in 22 patients (73.3%) from Group B, statistically significant (p=0.01). Complete vertigo relief is also significant according to the Kaplan-Meier method: p=0.027, log rank test. Substantial vertigo control was obtained in 21 patients (65.6%) in Group A and 27 patients (90%) in Group B. The difference is statistically significant, p=0.02. The difference is significant according to the Kaplan-Meier method: p=0.035, log rank test. No significant differences between hearing levels and tinnitus scores were demonstrated between the groups. CONCLUSIONS: Our preliminary results demonstrate that complete and substantial vertigo control is significantly higher in patients treated with a combination of HDBH and ITD.

A study on the type of lesions achieved by three electrosurgical methods and their way of healing.

The technical progress in the medical sector in the past decades has continuously driven the development of electrosurgical techniques. The controversies surrounding the superiority of a certain technique relative to another - electrocautery, laser and radiofrequency - have determined us to carry out a histopathological design with the aim of comparing the healing sort of the shallow wounds generated by the three types of electrosurgical devices. The experimental study has investigated the healing process inflicted by the electrosurgical devices mentioned beforehand on 12 Wistar albino rats. The wounds were inflicted under intravenous general anesthesia with Xylazine and Ketamine and were performed lateral to the spine region, using laser, radiofrequency and electric cautery. The histological samples harvested at one, three, five, and seven days were sent to pathological examination. We followed by comparison the evolution of the first two phases of the wound healing produced by the three electrosurgical methods analyzed. We described the histopathological changes occurred in the epidermis, dermis and hypodermis and also the subcutaneous soft tissues in all of the three types of lesions. Electrocautery remains the most frequently used electrosurgical device, even if it has unquestionable disadvantages as compared to other modern instruments. Laser-assisted surgery and radiofrequency are refine energy-based instrumentation, being utilized at a multidisciplinary surgical level.

A case of bilateral tracheal bronchus: report of a rare association in multidetector computed tomography bronchoscopy.

Bilateral tracheal bronchus is a rare variation of the tracheobronchial tree. We present a 1-year 7-month-old male patient who presented with sepsis following endotracheal intubation. Upon review of multidetector computed tomography images, the patient was diagnosed with displaced bilateral tracheal bronchus. Imaging showed a right-sided anomalous bronchus arising 0.9 cm proximal to the carina. The left-sided anomalous bronchus arose 0.7 cm proximal to the carina, mimicking a tracheal trifurcation. When viewed together, the close proximity of both the right and left tracheal bronchi to the carina created a distinct tracheal quadrifurcation. This rare anatomic variation was additionally associated with an anorectal malformation (anal atresia). Unrecognized tracheal bronchus in patients undergoing endotracheal intubation can lead to serious complications. While bilateral tracheal bronchus is described in the literature, we are unaware of any case similar to this patient presentation. We present and analyze this unusual case of bilateral tracheal bronchus. The anatomy and clinical significance of this variation is then discussed.

Dual role of podoplanin in oral cancer development.

Podoplanin plays a crucial role for normal and pathological tissue development. Known as a lymphatic endothelial marker, podoplanin has been found to be overexpressed in tumor cells of various cancers with a certified involvement in tumor progression, invasion and metastasis. Oral cancer includes a heterogeneous group of malignancies with unpredictable behaviour and sometimes poor prognosis. Based on these facts, development of new molecular markers with a more reliable impact on therapy and prognosis is required. The present study was designed to characterize podoplanin expression in tumor cells of lip, oral cavity, tongue and pharynx squamous cell carcinomas, together with lymphatic vessels distribution, morphology, density and their impact on tumor progression. Evaluation of podoplanin by D2-40 immunohistochemistry assessement on 56 cases of oral cancers, revealed two different expression patterns in tumor cells depending on their location. Peri-tumor and intra-tumor lymphatic vessels density, morphology and distribution were correlated with lymph node status but not with tumor stage. The highest number of lymphatic vessels was observed in grade 3 squamous cell carcinomas. Dual expression of podoplanin in tumor cells and lymphatics with particular patterns correlated with histopathology and lymph node status in oral cancer, representing the molecular basis for testing podoplanin as a potential target for anti D2-40 antibody based therapy.

Detection of early laryngeal cancer and its precursor lesions by a real-time autofluorescence imaging system.

The prognosis of laryngeal carcinoma patients can be improved by early diagnosis. The autofluorescence endoscopy has been developed to gain more information about the biologic character of the precancerous or cancerous lesions. The aim of the present study was to evaluate the diagnostic potential and limitations of this imaging technique applied during indirect laryngoscopy and comparing with white light and microlaryngoscopy with biopsy. In a prospective study, 56 patients with suspected precancerous or cancerous lesions were investigated preoperatively by white light and fluorescence endoscopy during indirect laryngoscopy. The procedure was followed by microlaryngoscopy and biopsy. Results were compared to histopathological findings. Normal laryngeal mucosa displayed a typical green fluorescence, moderate to high epithelial dysplasia, in situ carcinoma and cancer showed a diminished green fluorescence. In 47 of 56 (84%) cases, we found concordant results. The experience from this study shows that autofluorescence by indirect laryngoscopy may be a useful complementary method for detecting laryngeal malignancies. Its advantages are non-invasiveness, high sensitivity and repeatability.