TREATMENT OF EARLY GLOTTIC CARCINOMA WITH TRANSORAL ENDOSCOPIC LASER SURGERY.

Laryngeal carcinoma is one of the most common tumors of the head and neck, just after skin cancer. Alongside open surgery, transoral endoscopic laser surgery (TOLS) has become widespread as a treatment method. Our aim was to assess the efficacy of transoral laser cordectomy in a group of patients with early glottic carcinoma. We retrospectively analyzed data on 131 patients who underwent TOLS in the 2017-2021 period. We divided patients into groups according to tumor stage and type of cordectomy performed, and compared outcomes between the groups. Our results revealed a higher number of patients in the group with Tis and T1a than in those with T1b and T2 who underwent type III cordectomy, and also a higher number of those for whom outpatient follow-ups were sufficient after surgery in the same group. We did not observe significant difference in outcomes according to cordectomy type except for type V (a-d), where a higher number of patients had to undergo radiotherapy. This study underlines the importance of careful patient selection for TOLS, as well as the need for close cooperation with pathology and radiology specialists to ensure optimal approach and extent of surgery for each individual patient. It also displayed TOLS as a sound therapeutic option for early stages of glottic carcinoma but also indicated the need for similar studies in a larger number of patients to elucidate the effectiveness in certain glottis areas.

Morphological, anatomical, radiological and clinical features of Mladina type 6 nasal septum deformations in humans.

PURPOSE: The objective of this study was to prove the higher frequency of the type 6 deformations overall compared to the results obtained by conventional diagnostic methods, such as computed tomography images and clinical examination. METHODS: The study was performed at the Institute of Anatomy, where a total of 114 randomly selected skulls were examined. The skulls were then scanned in a fixed position using the cone-beam technique (CBCT). The literature epidemiological data of the clinical incidence of type 6 in studies that also used Mladina classification were obtained. RESULTS: There was a statistically significant difference (p < 0.0001) in the frequency of type 6 deformation as diagnosed by visual inspection (22.8%) and computed tomography (7.9%). The frequency obtained by CT imaging amounted 7.9% and was almost the same as the results obtained by a clinical examination which varied between 9 and 11%. CONCLUSIONS: The frequency of type 6 nasal septal deformation is higher by visual inspection of the skulls than by computed tomography imaging at a level of significance of 0.05. The incidence of type 6 findings on coronal CT images of paranasal sinuses is approximately the same as that found with anterior rhinoscopy. Type 6, visible or concealed; probably have one-fourth to one-fifth people in population, so the number of clinically overlooked and/or unrecognized types 6 is much greater than we thought it to be.

Overview of Thyroid Surgery Complications.

INTRODUCTION: The most obvious indication for thyroid surgery is malignancy, but other indications are also not rare. As with any other surgical procedure, those surgeries also carry risks which can be classified as minor or major. DISCUSSION: In this overview, we present minor (seroma, scarring) and major complications of thyroid surgery (recurrent nerve injury, hypoparathyroidism, and bleeding). We discuss the possibilities of prevention and treatment of each of those complications. CONCLUSION: In recent years, thyroid surgery is becoming safer due to the development of new surgical, hemostatic, and other techniques such as intraoperative monitoring of the recurrent laryngeal nerve and parathyroid gland detection.

Thyroid Surgery in Children and Adolescents: A 10-year Retrospective Study at a Single Institution.

OBJECTIVE: The aim of the study was to analyze clinical characteristics, surgical treatment, complications, and prognosis related to thyroid surgery in children and adolescents in a 10-year study at a single institution. Study Design. Retrospective study. METHODS: We performed a retrospective analysis of clinical data of children and adolescents who underwent thyroid surgery due to benign thyroid disease and thyroid cancer from January 2011 to May 2020. We presented the clinical characteristics and type of surgical treatment for different thyroid diseases. Results. We present data on surgical procedures and complication rates following surgery, which was comparable to other published data. We emphasize the importance of radioiodine and hormone replacement postoperative therapy in cancer patients and our opinion on total thyroidectomy and neck dissection in thyroid cancer surgery. CONCLUSION: This study demonstrated that thyroid surgery in children and adolescents is a safe and efficient procedure in the hands of experienced surgeon for adult thyroid surgery. For children and adolescents with thyroid carcinoma, our method of choice is total thyroidectomy with occasionally paratracheal neck dissection, whereas lateral cervical lymph node dissection is only necessary in fine needle aspiration positive lymph nodes. Our results according to postoperative outcomes and complications are comparable to other recently published data.

Silicon foil patching for blast tympanic membrane perforation: a retrospective study.

AIM: To establish whether covering the tympanic membrane perforation after war blast injury with silicon foil can enhance the ear drum healing rate and to determine the appropriate timing of silicon patching. METHODS: We retrospectively analyzed the charts of 210 patients wounded during the Homeland War in Croatia 1991-1995, with 315 blast tympanic membrane perforations. In 44 patients (61 perforations), the eardrum perforation was covered by silicon foil, whereas in 166 patients (254 perforations) it was left to heal spontaneously. The patients who underwent the patching procedure were divided in two groups according to the time period between the blast injury and the procedure: 38 perforations were treated within 3 days and 23 perforations were treated 4 to 6 days after the blast injury. RESULTS: The rate of tympanic membrane healing in the silicon foil patching group was significantly higher (91.8%) than that in the group of perforations left to heal spontaneously (79.9%, P=0.029). The healing rate was significantly higher in the group treated within 3 days after the blast injury (97.4%) than in the group treated 4 to 6 days after the injury (82.6%, P=0.042). CONCLUSION: Covering the perforation after the war blast injury with silicon foil significantly improves the rate of tympanic membrane healing. To obtain the best healing outcome, the procedure should be performed within the first 72 hours after the trauma.

Basement membrane protein ladinin-1 and the MIF-CD44-ß1 integrin signaling axis are implicated in laryngeal cancer metastasis.

Laryngeal squamous cell carcinoma (LSCC) is the most common form of malignant disease in the head and neck region characterized by frequent occurrence of metastases in the neck lymph nodes early in the disease onset. In the presented study, we performed quantitative proteomic profiling of patient-matched primary tumor and adjacent non-tumorous tissues derived from metastatic LSCC as to identify new protein candidates with potential diagnostic and therapeutic significance. Obtained results revealed for the first time involvement of the basement membrane protein ladinin-1 in laryngeal cancer metastases. Alterations in the cellular microenvironment that propel metastatic events in laryngeal cancer include activation of MIF-CD44-ß1 integrin signal transduction pathway and induction of downstream signaling mediated by NF-κB and Src tyrosine kinase, which ultimately impinge on cytoskeletal dynamics and architecture resulting in increased cellular motility and invasiveness. In this context, particularly interesting finding is upregulation of several actin-binding proteins novel to laryngeal cancer pathogenesis including coronin-1C and plastin-2, whose functional significance in laryngeal carcinogenesis has yet to be established. We also detected for the first time a complete loss of afamin in metastatic laryngeal cancer tissues, which warrants further studies into its use as a possible marker for monitoring disease progression and/or treatment outcome.

Pectoralis major myocutaneous flap in the reconstructive surgery of the head and neck--our experience.

The goal of this retrospective study is the evaluation of pectoralis major myocutaneous pedicle flap (PMMPF) reliability in clinical practice based on the analysis of the leading indication and postoperative complications. In the period from 2005 to 2011 at the University Department of Otorhinolaryngology and Head and Neck Surgery, Zagreb University Hospital Center, a total number of 27 PMMPF were used in the treatment of 26 patients. Indications for flap use were upper aerodigestive tract and soft tissue defects following resection of head and neck cancer. One-stage reconstructive technique was used in all patients. Basic demographic data, clinical stage of malignant disease, indications, postoperative complications and management of flap-related complications were systematically analyzed. In 24 cases (89%) leading indication for flap use was primary defect reconstruction following head and neck carcinoma resection and in 3 cases (11%) "salvage" reconstruction following salivary fistula formation and flap-related complications. Tumor invaded skin in 2 (8%) cases, oral cavity in 1 (4%) case, oropharynx in 12 (46%) cases, larynx and/or hypopharynx in 10 (38%) cases and major salivary gland in 1 case (4%). Mucous defect occurred in 21 (81%), cutaneous defect in 3 (11%) and muco-cutaneous defect in 2 patients (8%), respectively. 16 postoperative complications (59.3%) were recorded but only one patient (4%) sustained total flap necrosis. Previously irradiated patients had significantly higher postoperative complication rate. The rate of complications requiring surgical treatment was 25%. Although the overall complication rate was substantially high, PMMPF achieved desired reconstructive goal in 96% cases. Functional and aesthetic assessment was difficult due to the small series of patients. In conclusion, pectoralis major myocutaneous pedicle flap is still safe and acceptable reconstructive method in surgical treatment of patients with head and neck tumors.

Merkel cell carcinoma of the head and neck and associated second primary cancers: report of three cases.

Merkel cell carcinoma (MCC) is a rare and aggressive neuroendocrine skin carcinoma. The purpose of this study is to describe clinical and pathological characteristics, diagnostic procedure and treatment outcomes of the patients with MCC of the head and neck treated in Otorhinolaryngology, Head and Neck Surgery Department of the University Hospital Center Zagreb between the years 2007 and 2011. Three patients with MCC of the head and neck were treated during this period. First patient was diagnosed with MCC of the left retroauricular region with metastases in the lymph nodes of the left side of the neck, pT2N2M0 Stage IIIB. Second patient was diagnosed with anaplastic carcinoma of the lower lip, pT1N1bM0 Stage IIIB and third patient was diagnosed with MCC of the face which was previously treated as benign lesion, cT1N1bM0 Stage IIIB. Two of the patients had second primary tumor of different histology. All of the patients were treated with wide surgical excision of the tumor and neck dissection combined with adjuvant radiotherapy. Treatment outcome was poor and reason for this was late detection of disease. Menagment of the MCC patients requires multidisciplinary approach with high clinical suspicion of the treating specialist and pathologist due to immunohistochemical techniques required for diagnosis. Detection of the MCC in earlier stages is necessary for the better survival rate.

Overview of 100 patients with voice prosthesis after total laryngectomy--experience of single institution.

Surgical procedures, especially total laryngectomy, used for treatment of advanced laryngeal carcinoma, have a profound adverse effect on the patient's physical, functional, and emotional health, and almost always decrease quality of life. There are three main types of voice rehabilitation after surgery. They are: esophageal speech techniques, the use of artificial larynx devices and tracheoesophageal puncture with the insertion of various types of voice prostheses. Voice prosthesis was inserted in 100 patients in the ENT Department, University Hospital Center Zagreb, from January 2004 until February 2011, and 91 of these patients were included in our study. The prosthesis was inserted secondary at 71 patients, while in other 20 it was inserted primary, i.e. immediately after laryngectomy as a part of the same procedure. Voice rehabilitation was initiated 10th day after primary insertion and 1st-3rd day after secondary insertion. The postoperative voice quality was compared with a five degree scale, which was taken from Hilger's retrospective study (2000). The rehabilitation was successful in 75.8% of our patients. Early complication rate was 4.4%, and 10.9% of patients had late complications. Statistical analysis didn't show significant differences regarding the complications rate and success rate of rehabilitation between groups of patients, formed according to age, irradiation status and timing of prosthesis insertion.

Neuroendocrine tumors of larynx--two case reports and literature review.

Neuroendocrine tumors (NET) of the larynx are rare and heterogenous group, with much confusion about nature and classification of these neoplasms in the past. Diagnosis is based primarily on light microscopy and confirmed by immunohistochemistry and electron microscopy. A classification in 4 different types; paraganglioma, typical carcinoid, atypical carcinoid and small cell neuroendocrine carcinoma (SCNC) is a current consensus. Thorough diagnostic and a proper classification of neuroendocrine neoplasms are of paramount importance--prognosis and treatment differ significantly. We present two cases: 63-year old patient with SCNC of the larynx and a 53-year old patient with atypical carcinoid of the larynx. OctreoScan is useful tools for diagnostics and follow up of the patients and it is predictive for effectiveness of octreotide therapy.

[Locally invasive papillary thyroid cancer--our experience]. / Lokalno invazivni papilarni karcinom stitnjace--nasa iskustva.

Differentiated thyroid carcinomas, particularly papillary carcinoma, are the tumors with good prognosis, but sometimes have a tendency to spread into the surrounding tissue. The spread of these tumors usually involves muscle, cartilage and upper aerodigestive tract. During two years (2008-2009) at the Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Center Zagreb, 233 patients with differentiated thyroid carcinoma were treated. Among them there were 23 cases of locally invasive papillary thyroid carcinoma. In this paper we present our experience in treating 23 patients with locally invasive papillary thyroid carcinoma with special reference to extrathyroid spread, surgery and postoperative treatment. Our recommendations for the treatment of such patients are total thyroidectomy and selective neck dissection, removal of macroscopically visible tumors, radical surgery for tumors with intraluminal expansion in the upper aerodigestive tract and postoperative adjuvant therapy.

CpG islands in MyD88 and ASC/PYCARD/TMS1 promoter regions are differentially methylated in head and neck squamous cell carcinoma and primary lung squamous cell carcinoma.

BACKGROUND: Patients with head and neck squamous cell carcinoma (HNSCC) can develop lung squamous cell carcinoma (LuSCC), which could be the second primary tumor or HNSCC metastasis. Morphologically it is difficult to distinguish metastatic HNSCC from a second primary tumor which presents a significant diagnostic challenge. Differentiation of those two malignancies is important because the recommended treatments for metastatic HNSCC and primary LuSCC differ significantly. We investigated if the quantification of the promotor methylation status in HNSCC and LuSCC differs. METHODS: Primary HNSCC (N = 36) and LuSCC (N = 17) were included in this study. Methylation status in the ASC/TMS1/PYCARD (apoptosis-associated speck-like protein containing a caspase recruitment domain; 8 CpG sites) and MyD88 (Myeloid differentiation primary response protein 88; 10 CpG sites) promoters was analyzed. Bisulfite converted DNA, isolated from tumor tissue was quantified using pyrosequencing. Results of pyrosequencing analysis were expressed as a percentage for each tested CpG site. Receiver-operating characteristic (ROC) curve analysis was used for the evaluation of the diagnostic properties of selected biomarkers. RESULTS: CpG sites located in the promoters of ASC/TMS1/PYCARD_CpG8 (- 65 upstream) and MyD88_CpG4 (- 278 upstream) are significantly hypermethylated in the HNSCC when compared with LuSCC (p ≤ 0.0001). By performing ROC curve analysis we showed that corresponding areas under the curve (AUC) were 85-95%, indicating that selected CpG sites are useful for a distinction between primary LuSCC and primary HNSCC. CONCLUSIONS: Results of the present study indicate that there is a significant difference in the methylation status of tested genes between primary HNSCC and LuSCC. However, to prove this approach as a useful tool for distinguishing second primary LuSCC from HNSCC metastasis, it would be necessary to include a larger number of samples, and most importantly, metastatic samples.

A prospective observational study of 363 cases operated with three different harmonic scalpels.

The objective of this study is to evaluate the efficacy of the Harmonic ACE, Harmonic FOCUS and harmonic scalpel with 5-mm curved blade in head and neck surgery. During a 15-month period, we performed 295 thyroidectomies, 23 parotidectomies and 45 tonsillectomies using the harmonic scalpel. Control group consisted of 106 thyroidectomies, 9 parotidectomies and 30 tonsillectomies performed with the use of conventional hemostatic techniques. The use of both Harmonic ACE and Harmonic FOCUS scalpel reduced the time of thyroid and parotid surgery by 20-25%. The use of Harmonic ACE reduced the mean time of tonsillectomy, while the use of 5-mm curved blade had no significant effect. Postoperative pain and complication rate were comparable for both the groups. In conclusion, the use of both Harmonic ACE and Harmonic FOCUS devices significantly reduces operative time in the head and neck procedures and enables a smaller neck skin incision in thyroidectomy.

Transmastoid-infralabyrinthine tailored surgery of jugular paragangliomas.

This article presents our experience with the management and outcomes of patients with sporadic glomus jugular tumors using a tailored surgical approach. We conducted a retrospective study of 49 patients with sporadic jugular paragangliomas. Thirty-eight patients (78%) were treated using the transmastoid-infralabyrinthine (TM-IL) approach, and 11 (22%) were treated with the infratemporal fossa type A (IFT-A) approach. Mean follow-up period was 8.2 years. Surgical cure was achieved in all but 6 patients using the TM-IL approach (84%) and in 8 of 11 patients with the IFT-A approach (73%). A House-Brackmann grade of I or II facial nerve function was obtained postoperatively in 84% of TM-IL cases and in 56% of the IFT-A cases. The incidence of other complications-meningitis and transient cerebrospinal fluid leak-was higher in the TM-IL group (8% and 13%, respectively) compared with the IFT-A group (0% and 9%, respectively). We concluded that the TM-IL approach with individually tailored management of the facial nerve fulfills the long-term requirements of both keeping good postoperative facial function and obtaining adequate tumor resection.

Treatment of massive rhinophyma by combined electrosurgery and CO2 laser.

A case of massive rhinophyma that produced significant functional and cosmetic difficulties was treated using electrosurgery and carbon dioxide laser. Minimal bleeding occurred during the operative procedure despite grotesque enlargement and high degree of vascularity of the skin and soft tissue. Using this technique, restoration of normal function and excellent cosmetic effect was achieved without any complication.

[Nonepidermoid carcinomas of the larynx--15 years experience in the single institution]. / Neepidermoidni tumori larinksa--15-godisnje iskustvo u nasoj ustanovi.

Nonsquamous carcinomas of the larynx are very rare and present a diverse group of diseases. Timely recognition of these tumors is extremely important for their different origin, appearance, and approach in the treatment and prognosis. Polypoid and submucosal lesions of the larynx are characteristic findings in these tumors, and probably the reason for late diagnosis even in the presence of symptoms. According to cell origin, nonsquamous carcinomas are classified into secretory, connective tissue, lymphoreticular, melanoma, or metastatic carcinoma. In this study, 771 laryngeal carcinomas treated during a 15-year (1990-2005) period at the Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Center Zagreb, were reviewed to yield 11 cases of nonsquamous carcinoma, including one case of neuroendocrine carcinoma, leiomyosarcoma, fibrosarcoma, rhabdomyosarcoma, adenoid cystic carcinoma, and plasmacytoma, 2 cases of chondrosarcoma, and 3 cases of high-grade mucoepidermoid carcinoma. Our experience and treatment results for these tumors are presented.

[Basal cell adenoma of the nasal septum: a case report]. / Adenom bazalnih stanica nosnog septuma prikaz bolesnika.

This article reports a case of an intranasal basal cell adenoma, which is an extremely rare tumor and comprises only 1 to 3% of salivary gland neoplasms. The tumor was removed by intranasal excision with the small alar rhinotomy to facilitate the access. Immunohistochemically the diagnosis of basal cell adenoma was confirmed. There was no recurrence after 24-month follow up. This location of basal cell adenoma has not yet been described in the recent literature.

[The use of harmonic scalpel in head and neck surgery: a report on 161 patients]. / Ultrazvucni rezac u kirurgiji glave i vrata: nase iskustvo sa 161 bolesnikom.

The harmonic scalpel cuts and coagulates simultaneously using a mechanical vibration. The present article reports our experience in the use of this instrument. Over a period of 5 months, we performed 123 thyroidectomies, 13 parotidectomies and 25 tonsillectomies using the harmonic scalpel. 106 thyroidectomies, 9 parotidectomies and 30 tonsillectomies were performed with the use of conventional hemostatic techniques (electrocautery and knot tying). The use of harmonic scalpel shortened the duration of thyroid and parotid surgery by 20-30% as compared with the conventional techniques. The average incision length for those undergoing thyroidectomy with the harmonic scalpel was 1.5 cm shorter compared with the conventional thyroidectomy group. The use of harmonic scalpel shortened the average duration of tonsillectomy by 5.5 minutes. Postoperative pain and complication rate were comparable for both groups. The use of the harmonic scalpel reduces surgical time and intraoperative blood loss, and enables shorter incision length in thyroid surgery.

[Sentinel lymphadenectomy in squamous cell carcinoma of the pharynx and larynx]. / Sentinelna limfadenektomija kod planocelularnih karcinoma larinksa i hipofarinksa.

The study included 20 patients with carcinoma of the pharynx and larynx. The incidence of metastases was compared between sentinel lymph nodes and the rest of lymph nodes in resected material. Patient inclusion criteria were primary tumor verified as squamous cell carcinoma by preoperative histopathology and negative clinical neck finding (cN0). Human serum albumin radiocolloid labeled with radioactive technetium-99m 0.5 mCi (18 MBq) was used. In two patients (with tumors of the hypopharynx and glottis), lymph nodes were not preoperatively visualized by scintigraphy. A total of 32 lymph nodes (range 0-4), were visualized. All nodes were found in regions II-IV, mostly in region II. In three patients, sentinel lymph nodes were detected bilaterally. Twenty six selective neck resections were performed (bilateral in six patients). A total of 319 (mean 12) lymph nodes were isolated in resected material, 7 of them were positive, all ipsilateral. A positive definitive histopathology finding was recorded in five patients. Three patients had one positive lymph node each (pN1), all sentinel lymph nodes. In one patient, positive sentinel lymph node histopathology was associated with tumor lesions detected in other lymph nodes (pN2b). One patient had false negative result. Study results confirmed the lymphatic drainage of the upper aerodigestive tract and metastasizing area from tumors of this localization are constant and predictable.

Comparison of Swallowing Act Videofluoroscopy after Open and Laser Partial Supraglottic Laryngectomy.

INTRODUCTION: The aim of this study was to compare the functional outcomes of swallowing act detected by videofluoroscopy of two different techniques in the treatment of laryngeal carcinoma. MATERIALS AND METHODS: This study was conducted on 41 patients undergoing two supraglottic laryngectomy techniques. The research population was assigned into two groups of open and laser supraglottic laryngectomy, including 21 and 20 patients, respectively. RESULTS: Food residue was present in most of the patients in the open laryngectomy group. Aspiration of the liquid and solid contrasts was observed in 16 and 4 patients, respectively. In the laser laryngectomy group undergoing a partial supraglottic laryngectomy via carbon dioxide (CO2) laser, aspiration was recorded in only six patients. There was a statistically significant difference between these two groups regarding the presence of aspiration as a marker of a bad functional outcome. CONCLUSION: Techniques that include the endoscopic removal of the tumor via CO2 laser result in good oncologic and functional outcomes, along with reduced postoperative morbidity and mortality.