Colour Doppler sonography in the preoperative assessment of the vascular pedicle from the anterolateral thigh flap: proposal for a mathematical formula to predict pedicle length.

INTRODUCTION: The anterolateral thigh flap (ALT) is one of the most commonly used grafts in head and neck reconstructive surgery. In this type of surgery, it is essential that the vascular pedicle be long enough to ensure proper vascular anastomosis. However, it is difficult to accurately estimate the pedicle length preoperatively. In this context, the current study had two aims: (1) to assess the value of colour Doppler sonography (CDS) in the preoperative assessment of the vascular pedicle and (2) to develop a mathematical model to predict the length of the vascular pedicle based on the ultrasound findings. MATERIALS AND METHODS: Retrospective review of patients who underwent primary surgery for head and neck cancer followed by ALT flap reconstruction at our institution from 2014 to 2018. All patients underwent CDS prior to surgical excision of the flap. RESULTS: Preoperative CDS was useful to identify the location of the vascular perforators, to estimate the pedicle length, and to identify the vascularization variant. Using the proposed mathematical formula, the estimated minimum pedicle length and actual length agreed in 73.9% of cases, increasing to 84.1% when a 5 mm margin of error was allowed. Moreover, preoperative ultrasound accurately distinguished the two anatomical variants of the ALT vasculature in nearly all cases (97.1%). CONCLUSION: This study confirms the value of preoperative colour Doppler sonography for ALT flap reconstruction. The proposed mathematical model provides a highly accurate method of preoperatively assessing the length of the vascular pedicle, which may be of value in head and neck surgery.

Highlights from the Second International Symposium on HPV infection in head and neck cancer.

The Second International Symposium on HPV Infection in Head and Neck Cancer was held on 3rd-4th November 2016 in Leipzig, Germany. The meeting brought together researchers and clinicians to share the latest knowledge on HPV infection in head and neck cancer and to join active and constructive scientific discussions. This report summarizes the major themes discussed during the symposium.

Best practice guidelines in the psychosocial management of HPV-related head and neck cancer: recommendations from the European Head and Neck Cancer Society's Make Sense Campaign.

Over the past three decades, oral human papillomavirus (HPV) has been associated with an increase in the incidence of oropharyngeal squamous cell carcinoma (OPSCC) in several countries. Specialist oncologists in head and neck cancer are observing a wider range of demographics, sexual behaviours, and survival outcomes with their patients. Additionally, there are fewer smokers, consumers of alcohol, or people of lower socioeconomic status than in previous decades. In order to support patients, the European Head and Neck Society's Make Sense Campaign aims to promote best practice in the management of head and neck cancer through the delivery of counselling, psychological assessment, support with the patient experience following HPV-related cancer diagnosis, sexual impact (in terms of communication, behaviour and prevention), facilitating access to educational resources about HPV in head and neck squamous cell carcinoma and OPSCC, and early referral if necessary. New concerns about psychosocial distress and unmet psychosocial needs following diagnosis, therefore, exist throughout the disease and treatment periods. Oncologists treating patients with HPV-related head and neck cancer must integrate new parameters focused on infection risk transmission and sexual topics. The development and dissemination of best practice guidelines through The European Head and Neck Cancer Society Make Sense Campaign will help healthcare professionals to be more confident and resourceful in supporting patients with HPV-related head and neck cancer.

Age of onset of recurrent respiratory papillomatosis: a distribution analysis.

OBJECTIVE: Distribution of age of onset of recurrent respiratory papillomatosis (RRP) is generally described to be bimodal, with peaks at approximately 5 years and 30 years. This assumption has never been scientifically confirmed, and authors tend to refer to an article that does not describe distribution. Knowledge of the distribution of age of onset is important for virological and epidemiological comprehension. The objective of this study was to determine the distribution of age of onset of RRP in a large international sample. DESIGN: Cross-sectional distribution analysis. PARTICIPANTS: Laryngologists from 12 European hospitals provided information on date of birth and date of onset of all their RRP patients treated between 1998 and 2012. Centers that exclusively treated either patients with juvenile onset RRP or patients with adult onset RRP, or were less accessible for one of these groups, were excluded to prevent skewness. MAIN OUTCOME MEASURES: A mixture model was implemented to describe distribution of age of onset. The best fitting model was selected using the Bayesian information criterion. RESULTS: Six hundred and thirty-nine patients were included in the analysis. Age of onset was described by a three component mixture distribution with lognormally distributed components. Recurrent respiratory papillomatosis starts at three median ages 7, 35 and 64 years. CONCLUSIONS: Distribution of age of onset of RRP shows three peaks. In addition to the already adopted idea of age peaks at paediatric and adult age, there is an additional peak around the age of 64.

Best practices in the management of the psycho-oncologic aspects of head and neck cancer patients: recommendations from the European Head and Neck Cancer Society Make Sense Campaign.

Squamous cell carcinoma of the head and neck (SCCHN) is considered a worldwide health care problem. The majority of patients have a history of alcohol abuse and high-level tobacco consumption; however, SCCHN is also associated with exposure to viruses including human papillomavirus (HPV) and Epstein-Barr virus. A major problem facing SCCHN patients is that their disease is often diagnosed at an advanced stage where treatment options may not be curative, or can have severe post-treatment consequences. Confronted with their diagnosis and treatment options, the patient can express a range of emotional reactions which may lead to maladaptive coping. During the SCCHN patient journey, there are a number of stages where emotional support could be offered. A point of contact should be allocated to help patients navigate these stages and deliver practical emotive support (such as encouraging attendance at hospital appointments, compliance with lifestyle modifications and treatment adherence), and to identify if or when more advanced emotive support, in the form of a mental health professional, might be needed. This role might be carried out by a representative within the multidisciplinary health care team (e.g. a nurse). While optimal care is provided by specialist health care professionals, each with specific roles and responsibilities during the patient journey, all are important in screening for emotional distress and providing referral to the mental health team. This article reviews the key points for delivering emotional support to SCCHN patients at each stage of their care. Emotional problems cannot be ignored in SCCHN patients if optimal outcomes are to be achieved, particularly as therapeutic options extend overall survival for many patients. Health care professionals must be able to implement efficient screening for psychological distress to support patient's compliance to their care and treatment. They must also be able to recognize when to refer patients at risk for pharmacological and/or psychotherapeutic interventions.

The ultrasound examination in assessment of parotid gland tumours: the novel graphic diagram.

Ultrasound is one of the main diagnostic techniques for parotid gland tumours. It is inexpensive, non-invasive and widely available. However, interpretation of the images is highly subjective and constitutes a major limitation. To overcome this problem, we developed a graphic diagram to provide a standardised template that can be used for more precise identification of the tumour localisation within the parenchyma of the parotid gland. This new diagram may be used to provide surgeons with an improved and more objective localisation of the tumour. The study included 237 patients who underwent surgery for parotid tumours. To obtain the precise spatial location of the tumours, three topographic coordinates of tumour location in the coronal, sagittal and transversal plane were marked preoperatively during sonography within the parenchyma of the parotid gland. The localisation identified ultrasonically was then compared to the postsurgical report: 197 (83 %) tumours were found within the superficial lobe of the parotid gland and 40 (17 %) within the deep lobe of the parotid gland. In 157 (66 %) cases, tumours were found within the lower pole of the parotid gland, and in 64 (27 %) at the level of earlobe and its insertion, 16 (7 %) tumours were located at the level of the tragus and above it. Based on the results obtained, a graphic diagram of parotid gland tumour locations was developed.

Safety of intralesional cidofovir in patients with recurrent respiratory papillomatosis: an international retrospective study on 635 RRP patients.

Intralesional use of cidofovir (Vistide(®)) has been one of the mainstays of adjuvant therapy in patients with recurrent respiratory papillomatosis (RRP) since 1998. In 2011, a communication provided by the producer of cidofovir addressed very serious side effects concerning its off-label use. As this was a general warning, it was inconclusive whether this would account for its use in RRP. The aim of this study is to determine whether nephrotoxic, neutropenic, or oncogenic side effects have occurred after intralesional use of cidofovir in patients with RRP. Update of recent developments in RRP, a multicentre questionnaire and a multicentre retrospective chart review. Sixteen hospitals from eleven countries worldwide submitted records of 635 RRP patients, of whom 275 were treated with cidofovir. RRP patients received a median of three intralesional injections (interquartile range 2-6). There were no statistical differences in occurrence of neutropenia or renal dysfunction before and after cidofovir. There was no statistical difference in occurrence of upper airway and tracheal malignancies between the cidofovir and the non-cidofovir group. In this retrospective patient chart review, no clinical evidence was found for more long-term nephrotoxicity, neutropenia or laryngeal malignancies after the administration of intralesional cidofovir in RRP patients.

Pan-Asian adaptation of the EHNS-ESMO-ESTRO Clinical Practice Guidelines for the diagnosis, treatment and follow-up of patients with squamous cell carcinoma of the head and neck.

The most recent version of the European Society for Medical Oncology (ESMO) Clinical Practice Guidelines for the diagnosis, treatment and follow-up of squamous cell carcinoma (SCC) of the oral cavity, larynx, oropharynx and hypopharynx was published in 2020. It was therefore decided by both the ESMO and the Korean Society of Medical Oncology (KSMO) to convene a special, virtual guidelines meeting in July 2021 to adapt the ESMO 2020 guidelines to consider the potential ethnic differences associated with the treatment of SCCs of the head and neck (SCCHN) in Asian patients. These guidelines represent the consensus opinions reached by experts in the treatment of patients with SCCHN (excluding nasopharyngeal carcinomas) representing the oncological societies of Korea (KSMO), China (CSCO), India (ISMPO), Japan (JSMO), Malaysia (MOS), Singapore (SSO) and Taiwan (TOS). The voting was based on scientific evidence and was independent of the current treatment practices and drug access restrictions in the different Asian countries. The latter was discussed when appropriate. This manuscript provides a series of expert recommendations (Clinical Practice Guidelines) which can be used to provide guidance to health care providers and clinicians for the optimisation of the diagnosis, treatment and management of patients with SCC of the oral cavity, larynx, oropharynx and hypopharynx across Asia.

p53, PCNA and Ki67 in laryngeal cancer.

Immunohistopathological staining for p53, PCNA and Ki67 was performed in 120 specimens from previously untreated laryngeal carcinomas using the avidin-biotin method with peroxidase as a marker enzyme and diaminobenzidine as a chromogen. A 5-grade staining score system was used. Statistically significant correlations (Chi-square) were seen between T- and N-stage and histopathological grading. p53 and Ki67 scoring correlated with T- and N-stage whereas PCNA with T-stage. All staining correlated with histopathological grading. The score of staining for p53, PCNA and Ki67 correlated with each other. The patients with recurrences within 3 years had mainly carcinomas with higher staining scores. Using Chi-square analysis the p53, PCNA and Ki67 staining scores were also independent prognostic indicators.

[Unilateral prolapse of the laryngeal pouch due to the deformity of the thyroid cartilage]. / Jednostronne wypadniecie kieszonki krtaniowej spowodowane deformacja chrzastki tarczowatej.

Our examination included 10 male patients in the age of 40-72. Microlaryngoscopic examination revealed smooth prominence of the larynx vestibule always on the left side concealing partly the vocal fold but with its mobility preserved. Our greatest attention was focused on CT since we expected possible explanation of the asymmetry of the larynx vestibule. That examination disclosed: left-side shift of the thyroid cartilage lamina to the larynx, elongation of the thyroid cartilage lamina and measurements of interlaminar angles revealed contraction of that angle to the value 60-78.

[Metastasis of the cancer of mamma in the middle ear]. / Przerzut raka sutka do ucha srodkowego.

The rare case of the metastasis cancer of mamma on the middle ear was described. The diagnostic difficulties, treatment and clinical course were also discussed.

[Diagnostic difficulties in cases of laryngeal cancer]. / Trudnosci diagnostyczne w przypadkach raka krtani.

The span of time between the appearance of the first symptoms of larynx cancer and the moment it is diagnosed in Poland amounts to approximately 6 months. It is the result primarily of the fact that patients tend to consult a doctor late after the symptoms show as they underestimate them due to their lack of knowledge concerning their nature. In some cases the diagnosis may be difficult to give even for a specialist. The paper presents the cases of three patients with an unusual course of larynx cancer.

[p53 oncogene in the laryngeal cancer]. / Onkogen p53 w raku krtani.

Cancer is a genetic disease and the development of the techniques of molecular biology in recent 10 years contributed to the new understanding of neoplasmatic process. The mutations of gene p53 became one of the most common abnormality in human cancer. The aim of this research was to mark oncoprotein p53 in 120 cases of larynx cancer and the correlation of its appearance with clinical and histopathological parameters. The evaluate the degree of immunohistochemical staining of cell nuclei a 5 degree scale was adopted. The positive staining of cell nuclei was observed in 70% of cases. Positive correlations based on a chi-square test was observed between p53 and T and N as well as between p53 and the degree of histological differentiation.

[Malignant neoplasms of the maxilla treated at the Otolaryngological Clinic, Medical Academy, in Poznan 1974-1987]. / Nowotwory zlosliwe masywu szczekowo-sitowego w materiale Kliniki Otolaryngologii AM w Poznaniu w latach 1974-1987.

In years 1974-1987 100 patients with malignant neoplasms of the maxilla were treated in the Otolaryngological Department of the Medical Academy in Poznan. Eleven patients carried on a profession concerned with wood dust. The most frequent complaint was unilateral obstruction of the nose. Short history and at the same time a considerable progression of the neoplasm were conspicuous in those cases. The physical examination was completed by tomograms of the paranasal sinuses and in the last four years scanner examination. Unfortunately in majority of patients extensive neoplastic infiltration was found in stage T3 and T4. In spite of such a large infiltrate, changes in the lymph nodes of the neck were observed only in 14% of patients. The treatment included first of all an extensive operational procedure completed by radiotherapy.

[Juvenile angiofibroma presented in the clinical materials of the Otolaryngological Department of the Academy of Medicine in Poznan in the years 1977-1993]. / Wlókniaki mlodziencze w materiale Kliniki Otolaryngologicznej Akademii Medycznej w Poznaniu w latach 1977--1993.

16 patients suffering from angiofibroma were treated in the Otolaryngological Clinic, Academy of Medicine in Poznan, in the years 1977--1993. The patients were aged from 10--36, the mean age 15. All patients were treated surgically, and the method choice was Denker's surgery. 3 patients were reoperated because of local relapse. On the bases of the described cases good results of full recovery of patients with angiofibroma treated surgically are presented.

[Diagnostic problems in coexistence of paranasal sinusitis with cerebral tumor]. / Problemy diagnostyczne w przypadku zapalenia zatok przynosowych ze wspólistnieniem guza mózgu.

Differential diagnosis between the intracranial complications of paranasal sinusitis and cerebral tumor belongs to very difficult tasks in otolaryngology and neurosurgery. Complications of sinusitis, such as intracranial abscess formation, are uncommon and often clinically unremarkable. The arising difficulties are even greater in inflammatory intracranial complications of sinusitis, giving symptoms similar to those of cerebral tumors. The illustrative case report was presented.

[Palisade cartilage tympanoplasty in reconstructing almost total defects of tympanic membrane: own experience]. / Technika palisadowa w odtwarzaniu prawie calkowitych ubytków blony bebenkowej--doswiadczenia wlasne.

The authors described 8 patients with almost total defects of tympanic membrane. The patients were operated on with palisade tympanoplasty technique (m. Heermann) with the use of conchal autografts for reconstruction of the tympanic membrane. The technique is very useful and gives good results.

[Usefulness of chromosome alteration analysis in cell lines derived from laryngeal tumors for evaluation of laryngeal neoplasms]. / Przydatnosc analizy uszkodzen chromosomów w liniach komórkowych wyprowadzonych z nowotworów krtani w ocenie przebiegu raka krtani.

A classical cytogenetic analysis was applied to analyse karyotypes of 9 cell lines derived from laryngeal cancer. The most frequent aberration was a deletion of the whole sex chromosome Y. An abundance of somatic chromosome alterations was further analysed to find correlation with tumour staging and grading. A conventional cytogenetic analysis seems to be not sufficient to recognize chromosome alterations specific for a given tumor stage. On the other hand, an analysis in respect to histologic grading has indicated for an association between rearrangement of 9 chromosome and a high tumor aggressiveness. It seems that a combination of conventional cytogenetics with molecular methods (FISH, CGH) would be helpful in diagnosing of laryngeal cancer.