Tumor, host and surgery related factors predisposing to cranial nerve deficits after surgical treatment of parapharyngeal space tumors.

PROPOSE: Identification of relevant features acquired on preoperative evaluation of parapharyngeal space (PPS) tumors or related to the performed surgical approach that are predictive of the most important complication of surgical treatment of these tumors, cranial nerve palsy. METHODS: This was a retrospective analysis of 68 patients with PPS tumors treated with surgical resection in a tertiary referral center from 2009 to 2019. The preoperative clinical symptoms, age, sex, tumor size, location, histopathological type, surgical approach, radical resection, intraoperative bleeding and the occurrence of complications were collected, evaluated and compared. RESULTS: Cross-table and chi-square test results revealed that cranial nerve deficits were more common in neurogenic tumors than in other types, including malignant tumors (χ2 = 6.118, p = 0.013); the cervical approach was selected more often for neurogenic tumors (χ2 = 14.134, p < 0.001); neurogenic tumors were more frequently removed intracapsularly (χ2 = 6.424, p = 0.011); and neurogenic tumors were more likely to be located in the poststyloid area (χ2 = 17.464, p < 0.001). The two-sample t test revealed a significant correlation between age and the prevalence of cranial nerve complications (t = 2.242, p = 0.031). The mean age in the group of patients with cranial nerve palsy was 45.89 years, and that of the group without complications was 54.69 years. The results of logistic regression confirmed that the risk of nerve deficits was almost 8 times higher for neurogenic tumors (OR = 7.778, p = 0.01). None of the other analyzed variables related to tumor or surgery was significantly correlated with an increased risk of cranial nerve dysfunction. CONCLUSION: Surgical resection of tumors other than neurogenic tumors of the PPS reveals no significant risk for permanent neural dysfunction. Tumor size also had no significant effect on the risk of postoperative nerve palsy.

Jejunal and ileocolic free flaps for digestive tract reconstruction following pharyngo-laryngo-oesophagectomy - 30 years of single-centre experience.

INTRODUCTION: Hypopharyngeal cancer accounts for 3-5% of all squamous-cell carcinoma (SCC) of the head and neck and has one of the worst prognoses. The aim of the study was to evaluate oncologic and functional treatment outcomes in patients with T3-T4a squamous cell hypopharyngeal and laryngeal cancer. MATERIAL AND METHODS: Retrospective analysis of the material from one treatment site included 90 patients (81 male, 9 female) who had undergone surgery between 1986 and 2010. Their mean age was 55.06 years (range 36-75). RESULTS: TNM (T - tumour, N - node, M - metastasis) staging assessment was feasible in 70 treatment-naïve patients (77.78%): 57 (63.33%) were classified to stage T4a, and 13 were classified to T3 (14.44%). Cervical lymphadenopathy was observed in 53 (63.3%) patients; in 44 patients (48.89%) postoperative histopathology confirmed metastatic disease. G2 or G3 SCC was detected in 80% of patients. All patients underwent laryngopharyngoesophagectomy (LPE). Digestive tract reconstruction was performed using one of two methods: jejunal autograft (JA) in 79 patients (87.78 %) - Group A or ileocolic autograft (IA) in 11 patients (12.22%) - Group B. Comparative statistical analysis of both groups showed statistically significant differences only for substitute speech production. The mean survival time of patients from both groups was 2.21 years after reconstruction surgery. CONCLUSIONS: JA or IA for digestive tract reconstruction in patients after LPE are burdened with high risk of complications but offer patients the chance of a normal oral diet shortly after surgery. Ileocolic autograft enables rapid production of substitute speech.

Oncological outcomes of CO2 laser cordectomies for glottic squamous cell carcinoma with respect to anterior commissure involvement and margin status.

BACKGROUND AND OBJECTIVES: Controversial prognostic factors of primary CO2 laser cordectomy are anterior commissure involvement (ACI) and status of margin. STUDY DESIGN/MATERIALS AND METHODS: Retrospective analysis of oncological outcomes in 102 patients with early glottic cancer undergoing laser cordectomy between 2013 and 2015. RESULTS: The T stages distribution included: 72.6% T1a, 14.7% T1b, and 12.7% T2. The ACI was diagnosed in 26 patients. The primary cordectomy was radical in 72 patients. The 2- and 5-year disease free survival (DFS) for all patients were, respectively, 83.3% and 77.3%.The 2-year DFS rates for T1a, T1b, T2 were, respectively, 91.7%, 66.7%, and 53.9% and the differences were statistically significant (P < 0.001). The 2-year DFS rates according to the ACI and free anterior commissure tumors were, respectively, 65.4% and 89.2%, and the ACI indicated worse prognosis (P = 0.057). The 2-year DFS rates according to margins status were higher for patients with close or positive margins, who had second resection (88.9%) compared with those of negative margins (80.9%) (P = 0.340). Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

Microvascular density and hypoxia-inducible factor in intraepithelial vocal fold lesions.

OBJECTIVE: The promotion of neovascularisation is a crucial aspect of carcinogenesis. The study evaluates the microvascular density (MVD) and expression of hypoxia-induced factor (HIF-1α) in hypertrophic vocal fold (VF) lesions of different histopathological states including non-dysplastic, low-grade, high-grade dysplasia and invasive glottic cancer. MATERIALS AND METHODS: Histological specimens collected from patients diagnosed and treated in a single centre with different histological grades were immunohistochemically stained with CD31, CD34 and HIF-1α. Of the total number of 77 analysed VF specimens, 20 were non-dysplastic, 20 had low-grade dysplasia, 17 high-grade dysplasia and 20 were invasive cancers. RESULTS: The highest mean value for MVD evaluated with expression of CD31 (MVD CD31) was 21.23 ± 14.46 and identified in the low-grade dysplasia group. The average MVD CD31 was 13.74 ± 5.56 and 20.11 ± 9.28 in the high-grade dysplasia and invasive cancer group, respectively. The highest MVD evaluated with CD34 (MVD CD34) was revealed for invasive cancer 35.64 ± 17.21. The MVD CD34 was higher for low-grade than in high-grade dysplasia (25.87 ± 12.30 vs 24.65 ± 15.92, respectively). The expression of HIF-1α was strong or very strong in 60% of non-dysplastic lesions, 100% of low-grade dysplasia cases, 53% of high-grade dysplasia cases and 50% of invasive cancer cases. The comparison of MVD CD31 with MVD CD34 revealed a strong positive correlation (ρ value 0.727). The comparison of both MVD CD31 and MVD CD34 with HIF-1α resulted in no linear relationship (ρ value of 0.143 and 0.165, respectively). CONCLUSION: The stage of low-grade dysplasia in intraepithelial vocal fold lesions is related to significant advancement of angiogenesis together with the highest hypoxia level.

Laryngeal stroboscopy-Normative values for amplitude, open quotient, asymmetry and phase difference in young adults.

OBJECTIVE: To provide the normative values for laryngeal stroboscopy (LS) concerning amplitude, open quotient, asymmetry and phase difference in healthy, young subjects. STUDY DESIGN: Prospective case-control study. SETTING: Patients treated at a single institute. METHODS: A total of 68 healthy subjects were included in the study (35 women, 33 men), aged 18-35 years. After obtaining LS recordings, image processing was performed to attain parameters of vocal fold vibration. RESULTS: In women, the location of the maximum vibration amplitude is approximately in the 1/3 posterior part of the glottis, while in men, the location is moved to the glottis centre. In males, the relative amplitude vibration of the vocal folds in the 1/3 anterior part of the glottis was significantly higher than in females (P = 0.029). Women showed significantly higher open quotients (OQ) at the posterior part of the glottis than the male subjects (P < 0.001) and men presented significantly higher OQ at the anterior part of the glottis than the females (P < 0.001). The average OQ values for both sexes were almost the same. Females showed significantly higher relative glottal gap area (P = 0.044). Women presented a significantly lower amplitude asymmetry than men (P = 0.002). The weighted absolute left-right phase difference reached up to 24° and remained insignificantly higher in the men than the women (P = 0.142). CONCLUSIONS: The study provides normative values for LS in young adults for the measurement of therapy outcomes in patients with voice disorders and realisation of evidence-based medicine. The LS parametrisation is easy to perform in clinical practice.

The differential diagnosis of parotid gland tumors with high-resolution ultrasound in otolaryngological practice.

The aim of the study is to define the utility of ultrasound (US) in differentiating benign from malignant parotid tumors as well as pleomorphic adenomas (PA) from monomorphic adenoma (MA). Seventy-two consecutive parotid gland tumors were analysed with high-resolution ultrasonography (12 MHz) with color Doppler imagining. The histopathological diagnosis was confirmed after parotidectomy for each lesion. The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) for the US were established. Receiver operating characteristic curves were constructed to determine the predictive values of echogenicity, heterogeneity, and vascularity on color Doppler. Area under the curve (AUC) was calculated for each parameter considered. The analysed material included 27 MA, 26 PA, 1 basal cell adenoma, 8 inflammatory conditions, and 10 malignant neoplasms. The sensitivity, specificity, and accuracy of US in differentiation of malignant from benign lesions in the parotid gland were 60, 95.2, and 90.3%, respectively. The predictive values were: PPV 66.8% and NPV 93.6%. Differentiating diagnoses between PA and MA with US resulted in a sensitivity of 61.5%, specificity of 81.5%, and accuracy of 73.1%. The predictive values were: PPV 50% and NPV 68.8%, respectively. For distinguishing malignant from benign tumors, the highest AUC values noted were for heterogeneity and vascularization (0.8 and 0.743, respectively). The AUC values were the highest for hypoechogenicity and vascularization in separating PA from MA (0.718 and 0.685, respectively).

Evaluation of polymorphisms in microRNA biosynthesis genes and risk of laryngeal cancer in the Polish population.

MicroRNAs are the largest group of short regulatory RNAs. They regulate genes participating in many physiological and pathological processes. The role of micro RNAs in cancer development is also considerable. Therefore, the aim of this study was to evaluate the relationship between DROSHA (rs6877842) and DGCR8 (rs417309, rs1640299) gene polymorphisms with risk of occurrence of laryngeal cancer. The study included 100 patients and 100 healthy subjects. Genomic DNA was extracted from formalin-fixed, paraffin-embedded tissues. Analysis of the gene polymorphisms was performed using TaqMan SNP Genotyping Assay. The rs417309 AA genotype was found to be correlated with increased risk of larynx cancer. The rs1640299 TG and rs6877842 CG heterozygotes were significantly inversely associated with the presence of larynx cancer. Additionally, rs417309 AA genotype increased the risk of larynx cancer in the T1 stage, and the rs1640299 TG heterozygote occurred more frequently in the control group than those in the T3 and T4 stage. The rs417309 and rs1640299 polymorphisms of the DGCR8 gene as well as rs6877842 of the DROSHA gene might be associated with a risk of laryngeal cancer occurrence in the Polish population.

Particular aspects in the cytogenetics and molecular biology of salivary gland tumours - current review of reports.

Salivary gland tumours are a group of lesions whose heterogeneity of biological and pathological features is widely reflected in the molecular aspect. This is demonstrated by an increasing number of studies in the field of genetics of these tumours. The aim of this study was to collect the most significant scientific reports on the cytogenetic and molecular data concerning these tumours, which might facilitate the identification of potential biomarkers and therapeutic targets. The analysis covered 71 papers included in the PubMed database. We focused on the most common tumours, such as pleomorphic adenoma, Warthin tumour, mucoepidermoid carcinoma, and others. The aim of this study is to present current knowledge about widely explored genotypic alterations (such as PLAG1 gene in pleomorphic adenoma or MECT1 gene in mucoepidermoid carcinoma), and also about rare markers, like Mena or SOX10 protein, which might also be associated with tumourigenesis and carcinogenesis of these tumours.

Indications for surgical treatment of major salivary glands pathologies with epidemiology analysis in adults - cohort study of 1173 cases.

PURPOSE: The review of indications for surgical treatment of major salivary glands in adults hospitalized in the Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Warsaw. MATERIALS AND METHODS: The retrospective analysis was based on the 1173 postoperative histopathological examinations of the salivary glands collected over a period of 10 years (2010-2020). Analysis included histopathological diagnosis, localization of lesions, multifocality, complete resection, lymph node involvement, as well as demographical data of sex and age. RESULTS: Over half (61.38%) of all indications for surgical treatment of the salivary glands were benign tumors (n = 720) with the most common pleomorphic adenoma, which accounted for 33.5% of all cases (n = 393). The next most frequent group of diagnoses were non-neoplastic diseases of the salivary glands, 24.98% of all cases (n = 293). Malignant neoplasms of the salivary glands accounted for 13.64% of all diagnoses (n = 160). Salivary gland diseases slightly predominated among the female sex, with a particularly pronounced predominance in pleomorphic adenoma. Men, on the other hand, were treated more often for malignant neoplasms. The mean age of the patients was the lowest in the group of non-neoplastic diseases of the salivary glands. The mean age of patients with malignant neoplasms was significantly higher than in other pathologies. The largest tumors size was identified for malignant neoplasms. Diseases of the salivary glands treated surgically were most often located in the parotid gland, with the exception of non-neoplastic diseases, which most often involved the submandibular gland. CONCLUSIONS: Surgical management in pathologies of the salivary glands applies to all types of lesions, both neoplastic and non-neoplastic diseases. Patients with particular diseases are characterized by a different structure of age, sex and location of changes.

Analysis of Mutational Profile of Hypopharyngeal and Laryngeal Head and Neck Squamous Cell Carcinomas Identifies KMT2C as a Potential Tumor Suppressor.

Hypopharyngeal cancer is a poorly characterized type of head and neck squamous cell carcinoma (HNSCC) with bleak prognosis and only few studies focusing specifically on the genomic profile of this type of cancer. We performed molecular profiling of 48 HPV (Human Papilloma Virus)-negative tumor samples including 23 originating from the hypopharynx and 25 from the larynx using a targeted next-generation sequencing approach. Among genes previously described as significantly mutated, TP53, FAT1, NOTCH1, KMT2C, and CDKN2A were found to be most frequently mutated. We also found that more than three-quarters of our patients harbored candidate actionable or prognostic alterations in genes belonging to RTK/ERK/PI3K, cell-cycle, and DNA-damage repair pathways. Using previously published data we compared 67 hypopharyngeal cancers to 595 HNSCC from other sites and found no prominent differences in mutational frequency except for CASP8 and HRAS genes. Since we observed relatively frequent mutations of KTM2C (MLL3) in our dataset, we analyzed their role, in vitro, by generating a KMT2C-mutant hypopharyngeal cancer cell line FaDu with CRISPR-Cas9. We demonstrated that KMT2C loss-of-function mutations resulted in increased colony formation and proliferation, in concordance with previously published results. In summary, our results show that the mutational profile of hypopharyngeal cancers might be similar to the one observed for other head and neck cancers with respect to minor differences and includes multiple candidate actionable and prognostic genetic alterations. We also demonstrated, for the first time, that the KMT2C gene may play a role of tumor suppressor in HNSCC, which opens new possibilities in the search for new targeted treatment approaches.

Correlation of narrow band imaging vascular patterns with immunohistological microvessel density in vocal fold lesions.

INTRODUCTION: The microarchitecture of the mucosal and submucosal vessels is crucial for diagnosis of vocal fold lesions. Neo-angiogenesis is a confirmed biological parameter that implicates progression and metastasis in laryngeal cancer. OBJECTIVE: This study investigates the correlation between vascular pattern classifications by narrow band imaging and immunohistological microvessel density in different types of intraepithelial vocal fold lesions. METHODS: Analysis of immunohistological microvessel density using CD31 and CD34 antibodies was performed in 77 lesions including: 20 non-dysplastic lesions, 20 with low-grade dysplasia, 17 with high-grade dysplasia and 20 invasive cancers. The evaluation of vascular patterns with narrow band imaging according to the Ni classification and European Laryngological Society guidelines was performed prior to surgical resection. RESULTS: The mean value of CD31 microvessel density was the highest for Ni Type IV lesions (20.55), whereas for the longitudinal and perpendicular patterns according to the European Laryngological Society classification it was 12.50 and 19.45 respectively. The highest mean value of microvessel density with CD 34 was identified in Ni Type Va (35.43) lesions and in the longitudinal and perpendicular patterns according to the European Laryngological Society classification was 15.12 and 30.40 respectively. CONCLUSIONS: The microvascular morphological changes of intraepithelial laryngeal lesions observed under narrow band imaging endoscopy are positively correlated with angiogenesis indexes of immunohistological evaluation.

The Factors Contributing to Efficiency in Surgical Management of Purulent Infections of Deep Neck Spaces.

Deep neck infections (DNIs) are still emergency conditions in otorhinolaryngology. Due to rapid disease progression and life-threatening complications, the accurate surgical and medical treatment must be promptly applied. In the present study, we analyzed treatment protocols of 46 adults to assess efficacy of the treatment and search for prognostic factors of the outcomes. We performed retrospective analysis of medical data of 46 patients, who underwent surgical treatment in our department due to purulent DNI in the period from 2009 to 2017. Data investigated included age, sex, hospitalization time, duration of symptoms before drainage, comorbidities, selected laboratory tests results, location and the number of abscesses, results of microbiological cultures, and antibiotic treatment options. The study group consisted of 33 (71.7%) men and 13 (28.3%) women. Patients age ranged from 18 to 82 years. The mean duration of hospital stay was 13.2 ± 8.4 days. The most common site involved was submandibular space (43.5%), followed by parapharyngeal space (28.3%). The majority of patients had single abscess (81.2%), the multiple abscesses were revealed in 8 (18.8%) cases. The mean size of the abscesses was 42 mm. C-reactive protein level was increased in 96.7% patients (mean level 155.5  ±  146.7  mg/L), but the white blood cell count exceeded the normal in 60.9% cases (mean level 16.89  ±  5.59 â€Šâ€Š× â€Š109/L). Staphylococcus aureus (20.7%) and Peptostreptococcus (20.7%) were the most common species cultured from swabs. The antibiotic treatment included most commonly a combined ceftriaxone and metronidazole (n = 23). Two patients died due to complications. The correlation between different variables and the duration of hospitalization revealed only the hemoglobin level below 12.5 g/dL, a significant predictor of longer hospitalization (16.23 days vs 12.09 days, P = .017). Patients with purulent DNIs and decreased hemoglobin level are predisposed to prolonged recovery following the surgical drainage.

[Management of recurrent pleomorphic adenoma of the parotid gland: analysis of the material of Otolaryngology Department, Medical University of Warsaw between 1998 and 2008]. / Postepowanie z nawrotowym gruczolakiem wielopostaciowym slinianek przyusznych: analiza materialu Kliniki Otolaryngologii WUM od 1988 do 2008 roku.

OBJECTIVES: Treatment of patients with recurrent pleomorphic adenoma of the parotid gland is a challenge for a surgeon due to frequent problems with complete resection of all tumour foci while preserving continuity and function of the facial nerve. The aim of this study was to evaluate the clinical presentation and treatment results of patients with recurrent pleomorphic adenoma of the parotid gland. MATERIALS AND METHODS: The medical records of 35 patients (25 women and 10 men) operated on (44 operations) for recurrent pleomorphic adenoma between the years 1988 and 2008 at the Otolaryngology Department, Medical University of Warsaw, were reviewed. These patients accounted for 8.9% of all patients treated for pleomorphic adenoma of the parotid gland (N=395). A retrospective analysis was performed to examine clinical features, surgical technique and facial nerve management. RESULTS: All patients had palpable, nontender mass or masses in a parotid bed after 1 to 5 previous operations. Multifocal recurrences were present in 79.5% of cases. Median interval between initial treatment and commencement of recurrences was 6.1 (0.25-29) years. Patients with more than one recurrence were younger than patients who had only one. Malignant transformation of recurrent pleomorphic adenoma was observed in two patients (5.7%). Postoperative facial nerve paresis occurred in 15 cases. In two additional cases eradication of recurrent tumour required the facial nerve resection and reconstruction. CONCLUSIONS: Recurrent pleomorphic adenoma occurs more often in younger patients and women. The risk of the facial nerve injury increases with each successive operation. Surgical treatment should be individualized, taking into consideration the extent of the previous surgery and the type of recurrence.

[Paragangliomas of the neck--a 10-year experience of the Department of Otolaryngology of Warsaw Medical University]. / Przyzwojaki szyi w materiale Kliniki Otolaryngologii Warszawskiego Uniwersytetu Medycznego w latach 2001-2010.

UNLABELLED: Paragangliomas are rare neoplasms of neurological origin and account for 0.012% of all tumors. Only 10% of them have extraadrenal localization. Head and neck paragangliomas account for 0.33% neoplasms of that localization. Typically paragangliomas are benign tumors, but even 19% cases may have malignant potential. On the neck they are located typically closely to carotid artery bifurcation, jugular bulb and along the course of vagus nerve. Laryngeal localization is very rare. Nonspecific manifestation and wide spectrum of symptoms cause difficulty in diagnosis of paragangliomas. AIM: Presentation of the diagnostic process, performed treatment and obtained results of neck paragangliomas in the material of the Department of Otolaryngology of Warsaw Medical University in years 2001-2010. MATERIAL AND METHODS: There was performed retrospective analysis, based on the medical documentation of 14 patients with neck paragangliomas (9 women and 5 men), age range 25-62 years, hospitalized in the Department of Otolaryngology of Warsaw Medical University during the last 10 years. The date from the history, physical examination, radiological evaluation and the method of performed treatment and post-treatment complications were studied. RESULTS: Out of 14 patients with neck paragangliomas, there were 9 cases of isolated tumors and 5 cases of synchronic, multicentric neoplasms. The most common and single symptom was nonspecific neck mass. Doppler ultrasonography was adequate diagnostic tool in carotid artery paragangliomas. To diagnose mulicentric paraganglioma, vagal or laryngeal paraganglioma more thorough radiological examination was necessary, including computed tomography, magnetic resonance and angiography. All patients had performed surgical treatment. There were observed very good results in patients with isolated paragangiomas of carotid artery or larynx. Surgical management of multicentric and vagal paragangliomas was exposed to higher risk of cranial nerve paresis. CONCLUSIONS: (1) Paragangliomas are rare tumors of nonspecific clinical manifestation, making the early diagnosis very difficult. (2) Precise radiological evaluation is necessary taking into consideration quite high incidence of multicentric paragangliomas. (3) There is higher risk of cranial nerve paresis after surgical treatment of multicentric paragangliomas, neoplasms larger then 5 centimeters in diameter and vagal paragangliomas then in isolated carotid artery paragangliomas.

[Management of recurrent sinonasal inverted papilloma in the experience of ENT Department Medical University of Warsaw]. / Postepowanie w przypadkach wznowy brodawczaka odwróconego nosa i zatok przynosowych po leczeniu operacyjnym w materiale Kliniki Otolaryngologii Warszawskiego Uniwersytetu Medycznego.

INTRODUCTION: Inverted papilloma is benign epidermal neoplasm of not recognized etiology. The lesion is estimated to represent 0.5-4% of sinonasal tumors. Generally inverted papilloma is unilateral, arises from the lateral nasal wall and characterizes with local destruction and rapid growth. The tumor can possibly undergo malignant transformation. The treatment of choice is surgery, recently endoscopic approach is considered to be superior to the open approach. THE AIM OF STUDY: was evaluation of recurrent inverted papilloma treatment results in the experience of Otolaryngology Department, Medical University of Warsaw, from 1982 to 2009. MATERIAL: The group of 124 patient (66 men and 58 women) aged from 26 to 79 with inverted papilloma operated between 1982 and 2009 were enrolled in the study. Follow up was from 6 months to 27 years. RESULTS: Most common primary localization of the tumor was combined lateral nasal wall and maxillary sinus (42%). In 37% the lesion involved unilaterally the lateral nasal wall, maxillary sinus and ethmoid sinuses, rarely it was localized only in the lateral nasal wall (16.1%) and exclusively in the nasal septum (4.8%). All the patients were treated surgically, 46% of patients underwent endoscopic procedure, 37.1% lateral rhinotomy, 15% Denker rhinotomy and 1.6% midfacial degloving. Recurrence was observed in 15.3% including 57.9% after endoscopic surgery, 26% after Denker operation and 15.8% after lateral rhinotomy. Malignant transformation was observed in 5 patient (4%). All the patients with recurrent inverted papilloma were treated surgically, 5.3% of patient underwent midfacial degloving, 5.3% Caldwell-Luc operation, 10.5% endoscopic procedure, 26.3% Denker operation and 52.6% lateral rhinotomy. CONCLUSIONS: 1. Endonasal and open approach should be considered in the surgical treatment of recurrent inverted papilloma. 2. Endoscopic approach is preferred in the recent years but qualification for each method should depend on lesion localization, extent and volume. 3. Regular follow-up enables early recurrence diagnosis and treatment.

Methods of surgical treatment of bilateral vocal fold paralysis.

Bilateral vocal fold paralysis presents as their complete or partial immobilisation. The median or paramedian position of vocal folds contributes to the narrowing of the airway at the level of the glottis and manifests as inspiratory dyspnoea. For many years iatrogenic injury of recurrent laryngeal nerves during thyroidectomy has been viewed as the most common underlying reason. It is very often a lifethreatening condition requiring not only corticosteroid administration and intubation, which only constitute a short-term symptomatic therapy, but also surgical intervention, including tracheostomy. The most common surgical methods implemented in bilateral vocal fold paralysis include posterior cordectomy, arytenoidectomy, and, more and more commonly, re-innervation. Other techniques used in restoring airway patency include laterofixation, botulinum toxin injection, and laryngeal stimulation, which is still under research. Stem cell and gene therapy are also being researched. Notably, the main purpose of surgical treatment is the provision of airway patency with the preservation of the phonatory and protective functions of the larynx.

Normative values for singing voice handicap index - systematic review and meta-analysis.

INTRODUCTION: There are no official diagnostic protocols for singing voice assessment. In this publication, on the basis of a literature review, standards for the singing voice handicap index exclusively dedicated to voice disorders in singing have been given. OBJECTIVE: The study aims to determine the normative values for the singing voice handicap index. METHODS: The study is a systematic review and a meta-analysis. A systematic literature search was performed using PubMed to access relevant databases and to locate outcome studies. The "inclusion" criteria were as follows: English language, original papers and human studies retrospective and prospective papers, cross-sectional and case-control studies. RESULTS: Eight articles were included for the final analysis. The normative value for the singing voice handicap index was 20.35 with a confidential range of 10.6-30.1 for a group of 729 healthy subjects whose voices were judged as normal, with an age range of 16-64 years. CONCLUSION: The mean normative value of the singing voice handicap index was 20.35 with the confidence levels between 10.6 and 30.1.

The influence of age and comorbidities on the outcomes of surgical treatment with free tissue transfer: a retrospective study.

<b>Introduction:</b> Microvascular free tissue transfer enables the reconstruction of complex head and neck defects. The aim of the study was to assess the results of treatment of patients undergoing reconstructive surgery and to identify factors affecting these results, with particular reference to patient's age. <br><b>Materials and Methods:</b> All patients who underwent free-flap head and neck reconstruction in our institution between 2010 and 2017 were included in this retrospective study. A series of 66 patients met the inclusion criteria and were divided into 2 age groups: group G1 aged <65 years (n = 41) and group G2 aged ≥65 years (n = 25). Minor local complications and general complications as well as comorbidities were analyzed. <br> <b>Results:</b> No correlation was found between advanced age and the risk of free flap failure as well as the incidence of local minor complications. General complications were more frequent in the G2 group (32%) than in the G1 group (19.5%), although this is not a statistically significant difference. A statistically significant difference was found between the age and the patient's health status according to ASA (P = 0.010). In the younger low-risk group, 12 patients (29.3%) had general and local complications, while in the older low-risk group only 1 (4%). General and local complications were found in 5 (12.2%) high-risk G1 patients and in 7 (28%) high-risk G2 patients. <br><b>Conclusion(s):</b> Patients with advanced head and neck malignant tumors should undergo reconstructive microsurgery regardless of age.

Normative Value of SVHI-10. Systematic Review and Meta-Analysis.

OBJECTIVE: The study aimed to determine the normative value of SVHI-10. STUDY DESIGN: The study is a systematic review and a meta-analysis. METHODS: A systematic literature search was performed using PubMed and ScienceDirect to access relevant databases and to locate outcome studies. Eligibility criteria included type of publication, participant characteristics, and report of outcomes. Data analysis was conducted using the meta-analysis method. RESULTS: Six articles were included for the final analysis. The normative values for the SVHI-10 for a group of 528 subjects were 8.38 with confidence levels of 7.43-9.34 (age range 16-83). CONCLUSIONS: Based on the results of the meta-analysis the SVHI-10 can be used as a screening tool for a group of singers. In the future, it would be worthwhile to carry out a subordinate analysis to determine the SVHI-10 range for mild voice disorders or severe voice disorders in singing.

Morphology, Vibratory Function, and Vascular Pattern for Predicting Malignancy in Vocal Fold Leukoplakia.

BACKGROUND: The study evaluates clinical features of vocal fold (VF) leukoplakia in predicting its benign or malignant nature. MATERIALS: 57 patients with 84 lesions were evaluated before undergoing laryngeal microsurgery. The texture, color, thickness and size of the leukoplakia, along with an assessment of the surrounding mucosa vascularization using narrow-band imaging (NBI), and VF vibratory function were analyzed. Receiver-operating characteristic curves were constructed to determine the predictive value of each feature and area under the curve (AUC) was calculated. RESULTS: Histopathological examination revealed high-grade dysplasia or invasive cancer in 13 of VF leukoplakia. Seventy-one lesions were nondysplastic or low-grade dysplasia. Nonhomogenous color, irregular texture, and prominent thickness predicted malignancy with statistical significance (P < 0.05). AUC was 0.793, 0.793, and 0.679, respectively. Absence of a mucosal wave on laryngovideostroboscopy was significant for the detection of malignancy (P < 0.001) with an AUC of 0.927. The NBI diagnosis of horizontal vessel loops was significant with the highest AUC of 0.993. CONCLUSIONS: The comprehensive clinical evaluation of VF leukoplakia with laryngovideostroboscopy and NBI creates the opportunity to differentiate between low- and high-risk malignancy lesions. The perpendicular vascular pattern and the limited or absent mucosal wave appear to be the most powerful indicators of malignancy.