How I do it: modified lichtenberger-brown tracheoesophageal puncture procedure.

BACKGROUND: Tracheoesophageal puncture (TEP) with use of a prosthesis is nowadays a standard for voice restoration after laryngectomy. Different TEP approaches exist. METHODS: We retrospectively reviewed our series of patients who underwent TEP by a novel technique, based partially on the Lichtenberger endo-extralaryngeal needle carrier. The instrument is covered with a protective Nelaton catheter and introduced via the mouth to the neopharynx/esophagus. No rigid endoscope is used for visualization of the TEP site. The tip is palpated through the stoma at the posterior tracheal wall and incision is done to the catheter tip. The prosthesis is introduced through the mouth and the neopharynx in a retrograde fashion. RESULTS: In 14 laryngectomees with postoperative radiation voice prosthesis was successfully placed with this technique. A total of 18 procedures were performed. One misplacement occurred. No other early or late complications were observed or any other TEP or prosthesis related problems. CONCLUSIONS: The rationale of our technique is to simplify the procedure, avoid risk-bearing approaches and instruments such as rigid endoscopes, simplify the armamentarium and reduce tissue trauma. The initial clinical experience in 18 TEPs confirmed it usefulness in both standard and anatomically challenging situations. TRIAL REGISTRATION: The current study obtained the ethical approval from the Faculty of Medicine at Medical University "Prof. Dr. Paraskev Stoyanov"-Varna, Bulgaria (Protocol 087/24.10.2019 (retrospectively registered).

Endoscopic Repair of Pharyngocutaneous Fistula Following Laryngectomy.

Pharyngocutaneous fistula (PCF) is a typical complication after total laryngectomy. It is managed predominantly via conservative techniques, but in cases of a large orifice or a substantial loss of surrounding soft tissue, surgical management is mandatory. Our aim was to apply a new endoscopic surgical approach for closure of a pharyngocutaneous fistula. We report a case of a 61-year-old patient, who had been subjected to total laryngectomy with partial resection of tongue base and postoperative radiotherapy for advanced laryngeal carcinoma. Pharyngocutaneous fistula developed two years after the initial treatment. Barium swallow radiographs revealed a fistula between the neopharynx and the skin at the C2-C4 level. An endoscopic surgical repair was performed. Fat tissue harvested from the abdomen was injected into the area surrounding the pharyngeal opening of the fistula. The opening was sclerosed and sutured. The patient resumed a normal diet after several days and the fistula did not recur throughout the follow-up period. The management of pharyngocutaneous fistula is mainly conservative and only in therapy-refractory cases, surgery is considered. In well-selected cases, an endoscopic approach can be used. Autologous fat injection around the hypopharyngeal opening of the PCF may be one of the possible options.

18F-FDG PET/CT in the diagnosis of an extranodal relapse of diffuse large B-cell lymphoma (DLBCL): a clinical case with a literature review.

Extranodal lymphoma, secondary to or accompanying nodal disease is uncommon, but not unusual finding. 18-Fluorodeoxyglucose positron emission tomography (18F-FDG PET/CT) imaging has an essential role in the staging of lymphoma, in treatment response monitoring, and in detection of recurrence. We present a case of a 52-year-old man with generalized diffuse large B-cell lymphoma (DLBCL) with multiple extranodal sites involvement detected by 18F-FDG PET/CT. With this clinical case we demonstrate that 18F-FDG PET-CT is a more effective technique than CE-CT for the evaluation of viable extranodal involvement of the diffuse large B-cell lymphoma (DLBCL) and should be combined in the monitoring of DLBCL.