[An influence of some factors on the logopedic rehabilitation of patients after total laryngectomy]. / Wplyw wybranych czynników na rehabilitacje logopedyczna chorych po calkowitym usunieciu krtani.

INTRODUCTION: The operation of total laryngectomy deprives patients of the ability of voiced communication, causes isolation and loneliness. The loss of voice and speech leads to a predominant cripplehood, disturbs verbal communication in the social and family circle. The best ways of voiced communication of the patients after laryngectomy are an esophageal speech and the speech using voice prosthesis. AIM: The aim of the study is to estimate the voice and speech rehabilitation of the patients after total laryngectomy. MATERIAL AND METHODS: The study comprised 30 patients who in the years 2007-2009 underwent an operation of laryngectomy at the Department of the Surgery of the Head and Neck and the Laryngological Oncology in the Greater Poland Cancer Center in Poznan. In this group 9 patients used voiced speech after grafting the voice prosthesis, 15 patients (12 men and 3 women) underwent a classical rehabilitation of the esophageal speech, 6 patients (4 men and 2 women) used an electronic voice prothesis. The most important factors which influenced on mastering an esophageal speech were: pressure inside the esophagus, appearing a reverberation, time of training at home, length of time of logopedic rehabilitation, age and education. RESULTS: Necessary time to master a speech in the group of 9 patients with voice prothesis was 4-5 days. Length of time of the classical speech rehabilitation lasted from 3 to 8 months. 3 persons (20%) mastered a very good degree of esophageal speech, 7 patients a good degree (46.67%) and 2 patients (13.33%) - a sufficient degree of esophageal speech despite of low pressure inside the esophagus and appearing a reverberation quickly. 3 patients (20%) used an oral and guttural pseudo-whisper, a voiced reverberation was not obtained during the whole time of logopedic rehabilitation. CONCLUSIONS: The surgical voice rehabilitation, in spite of the possibility of complications, enjoys a great popularity among patients. The classical rehabilitation of the esophageal speech was more difficult for the tasted group of patients but mastering a speech to a very good and good degree lets communicate naturally.

Value of intraoperative ultrasonography in tonsil cancer.

BACKGROUND: The exact assessment of a tonsil carcinoma's size is often difficult because of the tumour's submucosal extension and deep infiltration. AIM: The aim of the study is to assess the usefulness of intraoperative ultrasonography in tonsil cancer. MATERIAL: Twenty patients with carcinoma of the tonsil were included in the study (squamous cell carcinoma keratosis - 12, squamous cell carcinoma akeratosis - 6, diffuse large B cell lymphoma - 1, neoplasma malignum microcellulare - 1). METHOD: Transcutaneous, endoscopic, and intraoperative ultrasonography were performed using a linear 7.5 MHz probe. RESULTS: The difference in the results was statistically significant between palpation examination and intraoperative ultrasonographic examination, between transcutaneous ultrasonographic examination and intraoperative ultrasonographic examination, and between endoscopic ultrasonographic examination and intraoperative ultrasonographic examination in tonsil tumours. Generally, tumour size assessed by intraoperative ultrasonography was more advanced than those assessed by other methods. CONCLUSIONS: Intraoperative ultrasonography is a safe, non-invasive method, which can be repeated at every stage of surgery. There were no contraindications or side effects. In all cases histological margins corresponded to sonographic margins. Intraoperative ultrasonography provides a quick and reliable orientation during resection of tonsil carcinoma.

[Endoscopic decompresion of orbital cavity in the course of the Graves' ophthalmophaty]. / Endoskopowe odbarczenie oczodolów w przebiegu wytrzeszczu zlosliwego w chorobie Graves-Basedowa.

Thyroidorbithopaty is inflammatory disease against the autoimmune reaction. Clinical symptoms are connected within-creasing the volume of retrobulbar tissues. As a result of the autoimmune reaction is reaching to the blow-up, thickening extrabulbar muscles, of appearance of the swelling of the inflammable body of the fat body and tear glands. Heightened retrobulbar pressure is leading to the exophthalmos of the eyeball. He can be a consequence of the exophthalmos insuffiency of eyelids, drying, ulcerations of the cornea. In external eyball muscles changes are leading to eyeball mobility limitation, the double vision, whereas the pressure on the optic nerve can be a reason of injuring it what next serious complications constitute thyroidorbitopathy. In the case active orbithopaty an immunosuppression is an essential way of curing. Disabled advanced form thyroidorbithopaty is a reading for curing applying treatment methods. Outside clinical symptoms among others findings of CT, MR examinations are deciding using it. A treatment is one of methods of operating intranasal curing, of endoscopic decompression of the orbital cavity. Authors are showing the method of operating curing on the basis of the case ill around thyroid orbithopathy in the course of illness Graves- of Basedow with accompanying diabetes.

[Reconstruction of the hypopharynx and cervical esophagus with gastric pull-up technique in the patient with recurrence carcinoma of the hypopharynx]. / Rekonstrukcja czessci szyjnej przelyku technika gastric pull-up w przebiegu wznowy raka gardla dolnego i krtani.

Patient with hypopharyngeal cancer are difficult to treat because they usually present with advanced disease, poor general health status and severe nutritional problems. Because of the poor prognosis, careful consideration has to be given regarding the choice of the correct surgical approach for respirato-digestive tract reconstruction. The authors present a case of recurrent hypopharyngeal cancer with cervical esophagus infiltration successfully treated with total laryngectomy and esophagectomy and gastric pull up reconstruction. Indications for technique, method of reconstruction and complications are, discussed. As most authors we consider the gastric transposition method as the preferred approach to restore digestive continuity after total esophagectomy. As the method is the single stage procedure it provides the best palliation of dysphagia and allows early resumption of an oral diet.

[Tumors infiltrating carotid artery--diagnostic and principles of treatment]. / Guzy naciekajace tetnice szyjna--diagnostyka i sposoby postepowania.

The involvement of internal or common carotid artery by neoplasmatic process usually indicates advanced stage of a disease and is always a serious problem for surgical treatment. The high risk of surgical and neurological complications, frequent local reappearance, distant metastases and significant loss of quality of life should have influence on mode of scheduled treatment. Current options of diagnosis and treatment with special focus on surgical carotid artery reconstruction are presented based on the review of the articles related to this problem. Our 3-years experience with this group of patients is presented.

[Local changes in the oral cavity in patients after operation of malignant tumours of the tongue and bottom of the oral cavity]. / Stan jamy ustnej u chorych po operacjach nowotworów zlosliwych jezyka i struktur przyleglych.

This study is aimed an objective and subjective evaluation of local changes after operations of malignant tumours of the tongue and the bottom of the oral cavity. THE MATERIAL AND METHODS: we have examined 74 patients (70 men and 4 women) treated in Department of Otolaryngology of the University School of Medical Sciences in Poznan with recognized of malignant tumour of the tongue and floor of the mouth. On the base of subjective and objective ultrasound and x-ray examination with use of contrast and stereognostic test it was evaluated movability, alteration of articulation zones, regularity of swallowing acts, sense of taste and efficiency of stereognosion. In all of the patients we found orders in swallowing, speech and taste dependen on the kind of the operation.

[The evolution of epidemiology and clinical characteristics of laryngeal and hypopharyngeal carcinoma in Poland from 1991 to 2001]. / Ewolucja obrazu epidemiologicznego i klinicznego raka krtani i krtaniowej czesci gardla w Polsce w latach 1991-2001.

On the base of retrospective analysis of 12,888 cases of carcinoma of larynx and hypopharynx, diagnosed in 19 ENT Departments in Poland from 1991 to 2001, the assessment of basic epidemiological data, including the localization of tumor and stage of local and clinical advancement of the disease at the time of diagnosis has been conducted. In analyzed period of 11 years the trends to change of the mentioned above parameters has been examined. The significant increase of female patients in this period was observed, with average proportion M:F = 8:1. The glottis localization of carcinoma dominated (47.6%), followed by supraglottis (40.8%) and pyriform fossa (7.8%), with significant increase of pyriform fossa tumors in the analyzed period of 11 years. In the majority of cases the carcinoma of larynx and hypopharynx was diagnosed in the advanced stage (T3 + T4) of local disease, with the highest percentage in localization within the pyriform fossa (81.0%), and the lowest percentage in glottis tumors (45.6%). The regional lymph nodes metastases has been diagnosed in 46.7% of the analyzed group, with the highest percentage in tumors localized in pyriform fossa (82.9%), and the lowest percentage in tumors of glottis localization (33.1%). In the 11 years time the significant drop down of N0 cases and tendency to increase of N2 and N3 in the supraglottis localization of tumor. The distant metastases in the analyzed group at the time of diagnosis has been registered in 2.0%, with the highest percentage in posterior pharyngeal wall (7.6%) and pyriform fossa (7.4%). The authors postulate the renewal of prospective study on epidemiology, clinical characteristics and treatment results of larynx and hypopharynx carcinoma in Poland.

[Ultrasonography in diagnosis of neck tumors]. / Badanie ultrasonograficzne w diagnostyce guzów szyi.

Tumours of the neck are very important problem of the contemporary otolaryngology. In the study the use of sonography in evaluation of expansions of the neck was studied in 200 patients with histologically proven diagnosis. To carry out a detailed evaluation of the individual character of particular types of tumours, all basic features were analysed using the following criteria: echogenicity, echostructure, separation and contour. In this group developed 159 (78.5%) benign tumours and 41 (21.5%) malignant tumours. Malignant tumours were mainly: cystic or solid-cystic, with irregular contour, thickened separation and high echogenicity. Benign tumours were regular, smooth, with low echogenicity and clear separation.