The Hellenic Voice Handicap Index of Different Laryngeal Mass Lesions: A Receiver-Operating Characteristic Analysis.

BACKGROUND: Voice disorders influence the quality of people's life. When the type of disorder is determined then the clinicians are capable of finding their patients' needs and address their complaints concerning their vocal problems. One of the most used tools, for assessing the patients' quality of life (in accordance with their vocal status), is the Voice Handicap Index. In this study, we determined the cut-off scores of Voice Handicap Index for population with laryngeal mass lesions such as vocal polyps and nodules. The calculated cut-off points further guide clinicians toward applying a needed interventional method/therapy even in the cases where the condition of a person could not be easily estimated. METHODS: The study involved 130 participants (aged 19-74). Specifically, 90 nondysphonic people served as the control group, while 40 participants had already been diagnosed with voice disorders due to laryngeal mass lesions. Participants who were diagnosed with a laryngeal inflammation or had undergone a surgery were excluded from the study. The cut-off scores were determined through a receiver-operating characteristic (ROC) analysis. RESULTS: The calculated cut-off points were 19.50 for the total score of VHI, 7.50 for the functional domain, and 8.50 for the physical and the emotional domain. CONCLUSIONS: The aforementioned cut-off points could be used in empowering the everyday clinical practice. Moreover, their knowledge could help the construction of an individualized therapy plan, as well as monitoring-biofeedback tool for the populations with vocal fold lesions.

Substernal goiter: Treatment and challenges. Twenty-two years of experience in diagnosis and management of substernal goiters.

OBJECTIVE: Descending goiter has been a focus of controversy in thyroid surgery until nowadays. This study aims to investigate the diagnosis and treatment options of thyroid goiters extending into the mediastinum and the thoracic cavity. METHODS AND MATERIALS: A retrospective study was conducted assessing all cases of substernal goiter managed in a tertiary care referral center within 22 years. Demographics, clinical, operative, anatomical, and pathological data of the patients were recorded and analyzed. RESULTS: Among 3.028 total thyroidectomies, 212 procedures for substernal goiters were studied. All cases underwent total thyroidectomy. The surgical approach was cervical in all but two cases. A very low rate of complications and zero mortality were noted. Incidence of malignancy on permanent histology was 16%. CONCLUSION: Descending goiter constitutes a major indication for thyroid surgery. The overwhelming majority of descending goiters may be managed surgically through a neck incision. In experienced hands good results with low morbidity should be expected. Such cases should be considered as challenging, however, and therefore management in a referral center may be necessary in order to ensure optimal results.

Postoperative day 1 levels of parathyroid as predictor of occurrence and severity of hypocalcaemia after total thyroidectomy.

BACKGROUND: Hypocalcaemia is a common and serious complication after thyroidectomy. The purpose of this study is to assess the effectiveness of first postoperative day parathyroid hormone (PTH) measurement in order to predict the presence and severity of postthyroidectomy hypocalcaemia. METHODS: One hundred consecutive cases undergoing total thyroidectomy in a tertiary referral center were prospectively assessed. Preoperative measurements of PTH were compared with postoperative levels in the first morning after surgery. All cases of hypocalcaemia were recorded and evaluated with regard to preoperative and postoperative levels of PTH. RESULTS: A decrease of 56% of PTH levels on the first postoperative day could accurately predict postoperative hypocalcaemia with a sensitivity and specificity of 80%. CONCLUSION: Serum PTH levels on the first postoperative day may be used as a reliable predictive marker for calcium supplementation need and even prolonged hospitalization in cases undergoing total thyroidectomy.

Recurrent Desmoid Tumor of the Neck: A Case Report of a Benign Disease with Aggressive Behavior.

We present a case of a desmoid tumor recurrence in a patient with a history of a resected desmoid tumor of the right neck area with free surgical margins six months earlier. The neoplasm was found to invade the parapharyngeal space, and wide excision was performed including most of the sternocleidomastoid muscle (SCM), the thrombosed internal jugular vein (IJV), and the infiltrated spinal accessory nerve (SAN). The histopathologic findings displayed free microscopic margins, with close margins at the site of the parapharyngeal space extension. After 3 months, there was no sign of tumor recurrence. After 6 months, local tumor recurrence was identified on clinical examination and imaging. The decision of the Oncology Board was further treatment with radiotherapy (RT). Response to treatment was satisfactory, and the patient was on close follow-up for twelve months. Desmoid tumors are very rare benign neoplasms of mesenchymal origin with negligible mortality but high morbidity, due to their high recurrence rates, local tissue infiltration, and unpredictable disease course and response to treatment. No universally acceptable treatment protocols have been introduced to date. Appropriate patient counseling and close follow-up are warranted in all cases.

Efficacy of inferior turbinoplasty with the use of CO(2) laser, radiofrequency, and electrocautery.

BACKGROUND: Inferior turbinate surgery is one of the most commonly performed methods for the treatment of rhinitis symptoms, especially nasal obstruction. This is a comparative study of CO2 laser, electrocautery, and radiofrequency turbinoplasty in the treatment of rhinitis symptoms. METHODS: From 1994 to 2011, 3219 patients were enrolled in the study. Two hundred eighty-three patients were lost during follow-.up. Of the remaining 2936 patients, 1066 were managed using the CO2 laser, whereas 664 and 1206 were managed with the use of radiofrequency and electrocautery, respectively. All procedures were performed under local anesthesia. Patients were asked to evaluate their symptoms with the visual analog scale (VAS) preoperatively, as well as 1 month and 1 year postoperatively. Rhinomanometry was used to objectively evaluate the effect on nasal obstruction. RESULTS: Mean VAS values preoperatively, regarding nasal obstruction, were 7.43 ± 0.96, 7.33 ± 0.87, and 7.64 ± 0.95 in the CO2 laser, radiofrequency, and electrocautery group, respectively. One month postoperatively, the score was significantly improved in all groups (CO2 laser, 3.44 ± 0.99; radiofrequency, 3.26 ± 0.76; electrocautery, 3.19 ± 0.79), which was almost stable in the 1st year of follow-up. Similar results were also observed in the evaluation of sneezing and rhinorrhea. Outcome did not statistically differ between the three methods. CONCLUSION: The CO2 laser, radiofrequency and electrocautery offer excellent postoperative results in turbinoplasty cases under local anesthesia.

Management of locally advanced laryngeal cancer.

BACKGROUND: Management of advanced laryngeal cancer is complex and ideal strategy is yet to be defined. This study evaluates the experience of a single head and neck oncologic centre in the management of T4 laryngeal cancer. METHODS: Retrospective assessment of cases primarily treated for T4a squamous cell carcinoma of the larynx, between 1980 and 2007, at a tertiary referral center. RESULTS: A total of 384 cases were studied. Five-year disease specific survival was 56.2% and local control 87.4%. Regional and distal control estimates were 90.3% and 88.3% respectively. Prognosis was significantly superior for cases treated with primary surgery compared to cases solely managed with non-surgical modalities. Positive surgical margins and regional disease worsened prognosis. CONCLUSION: This study suggests that primary surgery remains a key element in the treatment of advanced laryngeal cancer. The need for well-designed, prospective, randomised studies in order to further evaluate the remaining role of primary surgery in the modern management of locally advanced laryngeal lesions is emphasized.

Synchronous multifocal medullary and papillary thyroid microcarcinoma detected by elastography.

INTRODUCTION: A few cases of concomitant medullary and papillary carcinoma in the same thyroid nodule have been described in the literature. However, the presence of multiple foci of both types of malignancy in the same gland is very rare. PRESENTATION OF CASE: A 39 year-old female with multiple thyroid nodules, elevated serum calcitonin levels and elastographic findings suggestive of thyroid malignancy, underwent total thyroidectomy and central neck dissection. Histology revealed the presence of one focus of medullary and one focus of papillary carcinoma on each thyroid lobe. Subsequently, the patient underwent treatment with radioactive iodine. DISCUSSION: This is the third case of synchronous multifocal medullary and papillary thyroid carcinoma reported in the literature. Several theories for the simultaneous development of these malignant entities have been proposed. CONCLUSION: Ultrasound elastography can be a useful, noninvasive tool in the assessment of thyroid nodules.

Intraoperative recurrent laryngeal nerve monitoring in revision thyroidectomy.

Recurrent laryngeal nerve (RLN) palsy is one of the most important complications after thyroid and parathyroid surgery. There is controversy in the literature regarding whether or not intraoperative nerve monitoring decreases the risk of injury. We report our experience using Nerve Integrity Monitoring (NIM) system in cases of revision thyroidectomy, providing clear indications for its use. A series of 97 patients who underwent revision thyroidectomy with and without intraoperative NIM alternately was evaluated. There were 121 RLN patients at risk. Use of NIM during revision thyroidectomy was not statistically significant compared to revision operation without monitoring (p value = 0.059). Furthermore, comparison of operative times either with or without NIM showed that use of NIM led to statistically significant prolonged operation time (p value <0.001). There is no strict indication to use RLN monitoring during thyroid surgery, especially as there is no statistical evidence that the use of this technique decreases the incidence of RLN palsy, although there is a trend especially in difficult revision cases.

Atypical solitary fibrous tumor of the nose and maxillary sinus.

BACKGROUND: Solitary fibrous tumor (SFT) belongs to a group of mesenchymal tumors, also known as benign fibrous mesotheliomas or submesothelial fibromas. SFTs of the sinonasal tract are extremely rare. METHODS: We report a rare case of an atypical SFT of the sinonasal tract presenting with ipsilateral nasal obstruction and recurrent epistaxis. Endoscopy and imaging studies showed a well-circumscribed mass of the nose and the maxillary sinus. The patient underwent total endoscopic resection of the tumor. RESULTS: Permanent histology and immunohistochemical studies revealed an atypical variant of SFT of the sinonasal tract, with negative surgical margins. The patient did not receive any adjuvant treatment. Postoperative monitoring was uneventful. CONCLUSION: In general, these tumors are reported to follow an indolent course. SFTs adopt a biological behavior that cannot be determined as malignant. Total surgical resection of the tumor remains the gold-standard method of treatment.

Rare presentation of occult medullary carcinoma of the thyroid as a mediastinal mass.

OBJECTIVE: To describe a rare case of occult (<1 cm in diameter) medullary thyroid carcinoma (MTC) in a 45-year-old woman, presenting as an asymptomatic mediastinal mass. DESIGN: The diagnostic methodology included laboratory measurements of relevant biochemical and hormonal parameters including calcitonin (CT), carcinoembryonic antigen (CEA) and chromogranin A, and imaging techniques including ultrasound (U/S), computed tomography (C/T), magnetic resonance imaging (MRI) and radio labeled somatostatin analog ((111)In-DTPA-octreotide). RESULTS: Chest CT revealed a mediastinal mass measuring 5 cm in diameter abutting the right thyroid lobe. CEA was elevated and an association with thyroid malignancies was considered. CT was found to be markedly elevated, pointing to the diagnosis of MTC metastatic to the mediastinum. The patient underwent total thyroidectomy, lymph node dissection and removal of the mediastinal mass. Histological examination revealed MTC of the right thyroid lobe measuring 0.5 cm, metastatic to regional and superior mediastinal lymph nodes. CONCLUSIONS: Occult MTC can infrequently present as an asymptomatic mediastinal mass. Elevated serum CT and CEA along with imaging techniques leads to the correct diagnosis and surgical management of the disease.

Management of advanced carcinoma of the base of tongue.

BACKGROUND AND OBJECTIVE: Base-of-tongue carcinoma is a relatively rare disease with aggressive behavior and poor prognosis. Up to date no consensus exists regarding the ideal management strategy for each stage of the disease. This study aims to evaluate the experience of a single head and neck oncology center in the management of advanced stage base-of-tongue cancer. METHODS: A retrospective evaluation of cases primarily treated for stage III/IV(A-B) base-of-tongue carcinoma, between 1980 and 2007, at a tertiary referral center. RESULTS: A total of 366 cases were studied. Five-year disease specific survival (DSS) was 42% and local control (LC) 80%. Regional and distal control estimates were 91.3 and 84%, respectively. Prognosis was significantly superior for cases receiving surgery plus adjuvant treatment compared to cases solely managed with non-surgical modalities. Positive surgical margins and regional disease significantly worsened prognosis. Satisfactory retention of pharyngeal function and no fatal complications were noted in surgical cases. CONCLUSION: Although no consensus exists regarding ideal therapy for advanced base-of-tongue carcinoma, combined strategies with the use of surgery and adjuvant chemoradiotherapy (CRT) seem to offer the best possibility for a positive outcome.

Surgical management of T1 oropharyngeal carcinoma.

BACKGROUND: The purpose of this study was to assess the efficacy of primary transoral surgery in the management of T1 oropharyngeal carcinoma. METHODS: A retrospective evaluation was conducted on the files of all patients treated with primary surgery for pT1 oropharyngeal carcinoma at a tertiary referral center between 1976 and 2005. RESULTS: A total of 223 cases were assessed. Disease-specific survival was 88% and local control 93%. Transoral surgery with the use of CO(2) laser or electrocautery was adopted in every case. Positive surgical margins and regional disease were found to significantly worsen prognosis. A low rate of complications and satisfactory retention of pharyngeal function were noted. CONCLUSIONS: Primary transoral surgical treatment is very effective against T1 oropharyngeal carcinoma. A low rate of complications should be expected. However, in every case complete excision of the tumor must be accomplished and the neck included in the primary treatment plan.

On the history of modern tonsillectomy: the contribution of Nikolaos Taptas.

The earliest reports on removal of the entire tonsil using a method of careful dissection came in the early 1900 s by American and British otorhinolaryngologists. These descriptions are credited as the first of the so-called modern tonsillectomy. In this report we present a technique of tonsillectomy conceived by Nikolaos Taptas, a Greek physician and citizen of the Ottoman Empire, which was introduced at the same period with the ones previously mentioned. Taptas practiced his technique in the very early 1900 s. He used his own instruments and reported excellent post-operative results with very few complications. He should therefore be considered among the pioneers of modern tonsillectomy.

Auditory brainstem response changes during exposure to GSM-900 radiation: an experimental study.

The objective of the present study was to investigate the possible electrophysiological time-related changes in auditory pathway during mobile phone electromagnetic field exposure. Thirty healthy rabbits were enrolled in an experimental study of exposure to GSM-900 radiation for 60 min and auditory brainstem responses (ABRs) were recorded at regular time-intervals during exposure. The study subjects were radiated via an adjustable power and frequency radio transmitter for GSM-900 mobile phone emission simulation, designed and manufactured according to the needs of the experiment. The mean absolute latency of waves III-V showed a statistically significant delay (p < 0.05) after 60, 45 and 15 min of exposure to electromagnetic radiation of 900 MHz, respectively. Interwave latency I-III was found to be prolonged after 60 min of radiation exposure in correspondence to wave III absolute latency delay. Interwave latencies I-V and III-V were found with a statistically significant delay (p < 0.05) after 30 min of radiation. No statistically significant delay was found for the same ABR parameters in recordings from the ear contralateral to the radiation source at 60 min radiation exposure compared with baseline ABR. The ABR measurements returned to baseline recordings 24 h after the exposure to electromagnetic radiation of 900 MHz. The prolongation of interval latencies I-V and III-V indicates that exposure to electromagnetic fields emitted by mobile phone can affect the normal electrophysiological activity of the auditory system, and these findings fit the pattern of general responses to a stressor.

T1 and T2 hypopharyngeal cancer treatment with laser microsurgery.

BACKGROUND AND OBJECTIVE: To assess the oncologic results and functional outcomes of CO(2) laser microsurgery in T1 and T2 hypopharyngeal cancer. METHODS: The files of 119 T1 and T2 hypopharyngeal carcinoma cases primarily managed with laser surgery were reviewed. Cases were assessed for 5-year disease-specific survival (DSS) as well as local control (LC) rates, with respect to T and N classification, status of surgical margins, and decision on neck management and adjuvant therapy. Cases were additionally evaluated for incidence of major complications and retention of laryngeal and pharyngeal function. RESULTS: DSS and LC rates of 72.6% and 85.4%, respectively, were noted overall in this series. Survival rates were found to be significantly better for cases with negative surgical margins. The presence of regional metastases was also found to significantly affect prognosis. Satisfactory retention of function and a low rate of major complications were noted. CONCLUSION: Laser surgery appears to be very effective for T1 and T2 hypopharyngeal cancer treatment as long as clear surgical margins can be achieved. Oncologic results are acceptable with low incidence of complications and satisfactory retention of function. The neck must always be included in the primary treatment plan of hypopharyngeal lesions.

Effect of repeated laser microsurgical operations on laryngeal cancer prognosis.

BACKGROUND: The aim of this study was to evaluate whether repeated sessions of transoral CO(2) laser microsurgery (TLM) aiming to achieve clear histologic margins carry a negative effect on the prognosis of laryngeal cancer. METHODS: This was a retrospective evaluation of 763 cases that underwent primary TLM treatment for laryngeal cancer. Cases were compared for overall survival and local control rates with respect to status of surgical margins and number of procedures necessary to achieve these margins. RESULTS: No significant differences were noted among cases with negative surgical margins regardless of the number of procedures necessary to achieve these margins. On the other hand, positive margins at the end of surgical treatment carried significant negative prognostic effect. CONCLUSION: The prognostic effect of negative surgical margins in TLM for laryngeal cancer is significant regardless of the number of procedures required to obtain such margins.

Long-term results of intranasal laser-assisted dacryocystorhinostomy with the use of a surgical microscope.

OBJECTIVE: To address the long-term results of our method that combines intranasal laser-assisted dacryocystorhinostomy with the use of surgical microscope. METHODS: The procedure is a modification of the West method. A retrospective series of the long-term results are presented in 105 patients that underwent 118 DCR procedures, over the past 6 years. Selection criteria were mainly acquired idiopathic nasolacrimal duct obstruction. RESULTS: 113 DCR cases (95.8%) were free of symptoms postoperatively (mean follow-up: 24 months). CONCLUSION: Our method when compared with traditional methods is correlated with excellent postoperative long-term results.

Evaluation of available surgical management options for early supraglottic cancer.

BACKGROUND: This study was undertaken to evaluate the oncologic results of endoscopic and open surgical techniques in early supraglottic cancer. METHODS: We performed a retrospective evaluation of 101 patients surgically treated for stage I or II supraglottic carcinomas. Laser surgery, horizontal laryngectomy, and total laryngectomy were compared for disease-specific survival and local control rates. Surgical techniques were additionally compared for incidence of major complications, related tracheotomies, and swallowing function retention. RESULTS: No statistically significant differences were noted among the different types of procedures regarding disease-specific survival and local control. A lower incidence of major complications, permanent gastrostomies, and significantly lower incidence of tracheotomies were noted for laser surgery compared with open techniques. CONCLUSION: Larynx-preserving surgical modalities offer comparable oncologic results with total laryngectomy in early supraglottic cancer. In addition, laser surgery has a lower incidence of complications and better functional results compared with open partial or total laryngectomy.

Resection margins and other prognostic factors regarding surgically treated glottic carcinomas.

BACKGROUND AND OBJECTIVES: This study aims to assess the prognostic significance of free histopathologic margins in the surgical treatment of glottic cancer. Furthermore, it evaluates other prognostic factors regarding cases that receive surgical management for glottic lesions. METHODS: A retrospective case-series study was conducted at an academic tertiary referral center. The files of 1,314 cases that underwent primary surgical treatment for glottic cancer were studied. Various prognostic factors, including age, surgical procedure, T classification, N classification, histological grade, and status of margins were assessed in univariate and multivariate analyses. All variables were investigated for their association with local and regional disease control as well as disease specific and overall survival. RESULTS: Status of margins significantly affected disease specific survival and local control regardless of tumor stage in this series. All other variables assessed in the univariate analysis for their association with survival were also found to be significant. However, status of surgical margins and N classification were the only significant variables in multivariate analysis. CONCLUSION: The prognostic value of negative surgical margins for the treatment of glottic cancer cannot be overestimated. Responsibility of the surgeon during primary surgical treatment of glottic carcinomas is emphasized.