Is the 3D exoscope better than the surgical microscope in parotid surgery: a prospective, randomized single-center study.

BACKGROUND: High-definition, three-dimensional (3D) exoscopes are being used to perform a growing number of head and neck surgeries. However, the use of the 3D exoscope in parotid gland surgery has not been previously described. Our initial experience with the VITOM 3D exoscope in the surgical treatment of parotid gland tumors is detailed here. METHODS: We made a prospective study of patients with benign parotid gland tumors indicated for surgical resection. Between January and December 2018, patients were randomly assigned to undergo surgery assisted with the VITOM 3D system (n = 31) or an operating microscope (n = 40). Visualization quality (greater auricular nerve, digastric muscle, tragal pointer), operating time, conversion rates, and surgical outcomes were compared. RESULTS: A total of 71 patients underwent superficial (n = 18) or total parotidectomy (n = 53). No exoscope-related complications were observed. Five patients undergoing exoscope-guided deep lobe surgery required intraoperative conversion to a microscope. No differences were observed in the subjective quality of intraoperative visualization of key anatomical structures. However, a significantly higher percentage of patients in the exoscope group developed transient facial nerve paralysis (n = 9; 29% vs. n = 4, 10%). CONCLUSIONS: These findings suggest that the VITOM 3D is a valid visualization tool for parotid gland surgery, comparable to the operating microscope but with higher resolution 3D visualization, an increased degree of freedom of movement, and better ergonomics. However, the high rate of transient nerve palsy, possibly related to decreased depth perception and the brief learning curve, merits further investigation.

Colour Doppler sonography in the preoperative assessment of the vascular pedicle from the anterolateral thigh flap: proposal for a mathematical formula to predict pedicle length.

INTRODUCTION: The anterolateral thigh flap (ALT) is one of the most commonly used grafts in head and neck reconstructive surgery. In this type of surgery, it is essential that the vascular pedicle be long enough to ensure proper vascular anastomosis. However, it is difficult to accurately estimate the pedicle length preoperatively. In this context, the current study had two aims: (1) to assess the value of colour Doppler sonography (CDS) in the preoperative assessment of the vascular pedicle and (2) to develop a mathematical model to predict the length of the vascular pedicle based on the ultrasound findings. MATERIALS AND METHODS: Retrospective review of patients who underwent primary surgery for head and neck cancer followed by ALT flap reconstruction at our institution from 2014 to 2018. All patients underwent CDS prior to surgical excision of the flap. RESULTS: Preoperative CDS was useful to identify the location of the vascular perforators, to estimate the pedicle length, and to identify the vascularization variant. Using the proposed mathematical formula, the estimated minimum pedicle length and actual length agreed in 73.9% of cases, increasing to 84.1% when a 5 mm margin of error was allowed. Moreover, preoperative ultrasound accurately distinguished the two anatomical variants of the ALT vasculature in nearly all cases (97.1%). CONCLUSION: This study confirms the value of preoperative colour Doppler sonography for ALT flap reconstruction. The proposed mathematical model provides a highly accurate method of preoperatively assessing the length of the vascular pedicle, which may be of value in head and neck surgery.

Basal cell carcinoma in farmers: an occupation group at high risk.

INTRODUCTION: Skin cancer is the most commonly diagnosed cancer type worldwide, and 80 % of skin cancers are basal cell carcinoma (BCC). The main risk factor for developing BCC is exposure to ultraviolet radiation (UVR), particularly high-dose exposure at a young age. Outdoor workers, particularly farmers, are at high risk of developing BCC. However, studies of BCC in this population are scant. OBJECTIVE: To comprehensively evaluate all cases of BCC of the head and neck region treated during the years 2007-2013 at our hospital in Poland, and to compare the tumour characteristics in farmers to non-farmers. MATERIALS AND METHODS: Retrospective analysis of 312 patients treated for head and neck BCC during the study period (2007-2013). RESULTS: Most patients (198 cases; 63 %) were males, with 114 females (37 %). Median age was 73 years (range 32-96 years). The most common tumour location was the nose and cheek (114 pts; 37 %) followed by the auricle (82 pts; 26 %), lips (54 pts; 18 %), scalp (26 pts; 8 %), and eye (36 pts; 12 %). The most common disease stage on presentation was stage T2 (104 pts, 33 %), followed by stage T1 (79 pts; 25 %), stage T3 (89 pts; 28 %), and stage T4 (40 pts; 14 %). By occupation, farmers accounted for 33 % of all patients (102 of 312 pts). The most common tumour localisations in the farmer subgroup were the nose and cheek (50 pts; 49 %; p < 0.001; odds ratio [OR] 2.19; 95 % confidence interval [CI] 1.35-3.57), followed by the auricle (32 pts; 31 %), scalp (16 pts; 16 %), ocular region (3 pts; 3 %), and lips (1 pt; 1 %). Patients in the farmer group were significantly younger than non-farmers (62 vs. 73 years; p < 0.001; OR 0.90, 95 % CI 0.88-0.93). Farmers were significantly more likely to present disease recurrence (27 vs. 12 % of cases; p < 0.001; OR 5.94; 95 % CI 2.86-12.33). CONCLUSION: The results highlight the increased incidence and risk of recurrence of BCC in farmers. It is therefore necessary to consider enhancing educational programmes and other preventative measures in this occupational group and to evaluate the effectiveness of such programmes.

The importance of stem cell engineering in head and neck oncology.

Head and neck squamous cell carcinoma is the sixth leading cause of cancer worldwide. The most common risk factors are carcinogens (tobacco, alcohol), and infection of the human papilloma virus. Surgery is still considered as the treatment of choice in case of head and neck cancer, followed by a reconstructive surgery to enhance the quality of life in the patients. However, the widespread use of artificial implants does not provide appropriate physiological activities and often cannot act as a long-term solution for the patients. Here we review the applicability of multiple stem cell types for tissue engineering of cartilage, trachea, vocal folds and nerves for head and neck injuries. The ability of the cells to self-renew and maintain their pluripotency state makes them an attractive tool in tissue engineering.

Uncontrolled human papilloma virus infection in a 28-year-old man leading to death - case report and review of literature.

Recurrent respiratory papillomatosis is an increasingly common disease which leads to organic and functional limitations. Clinical symptoms depend on the location and extent of the papillomatosis. They include hoarseness, cough, and, in some cases, significant narrowing of the respiratory and digestive tracts. The present report describes a fatal case of a young man (28 years old) who developed a very dynamic papilloma infection of the larynx, which spread to the trachea, the oesophagus, the soft tissues of the neck, and the mediastinum. Multimodal treatment did not stop the progression of the disease. The papillomatous lesion was removed with a CO2 laser used in a Kleinsasser microlaryngoscopy and under a microscope using a electrocoagulation loop with argon plasma during the gastroscopy. Antiviral treatment with cidofovir was introduced, as well as in further follow-up radiotherapy. Congenital or acquired immunodeficiency was also excluded. Despite multimodal treatment, successful eradication of the infection was not possible. In our case, aggressive progression of the disease was observed. We were unable to confirm malignant transformation. Papillomatosis was the only disease, and its aggressive development led to the patient's death. In the case of aggressive, uncontrolled progression - when the infiltration spreads beyond the larynx and the hypopharynx - there are no alternative treatment methods that would lead to an effective cure.

The role of colour duplex sonography in preoperative perforator mapping of the anterolateral thigh flap.

The anterolateral thigh (ALT) flap was first described in 1984. It is now widely used in reconstructive surgery following extensive tumour resection in head and neck cancer. Routine preoperative perforator mapping is recommended due to variability of the vascular anatomy of the flap. A wide array of diagnostic tools is available for this purpose, including colour duplex sonography (CDS). In this study, we report our experience with CDS. The number, location, and course (myocutaneous or septocutaneous) of ALT perforators were assessed by CDS prior to reconstructive surgery in 22 patients with head and neck cancer. These data were compared with the intraoperative anatomical findings to assess agreement and reliability. The positive predictive value and sensitivity of CDS in detecting perforator location was 89.4 and 94.4%, respectively, when compared to the surgical report. CDS also identified the perforator course with 100% accuracy. Colour duplex sonography is an effective, non-invasive, and relatively inexpensive technique for assessing the location of skin perforators.

Oral cavity and oropharyngeal squamous cell carcinoma in young adults: a review of the literature.

BACKGROUND: Head and neck squamous cell carcinoma (HNSCC) is a disease of middle-aged to elderly adults. However, an increased incidence of HNSCC in young people under 45 years of age has been reported recently. In the present review, we focused on the epidemiology and aetiology of HNSCC in adults under 45 years of age. METHODS: We reviewed literature related to HNSCC in adult patients less than 45 years of age and discussed current treatment options and prognosis. RESULTS: HNSCC in young adults is associated with a higher incidence rate in nonsmokers, lower female-to-male ratio, a higher percentage of oral cavity and oropharynx tumours, and fewer second primary tumours. However, aside from traditional risk factors of tobacco and alcohol exposure, the causes of these cancers in young adults remain unclear. Agents that might contribute to risk include infection with high-risk human papillomavirus subtypes as well as genetic factors or immunodeficiency status. The expected increase in incidence and mortality of the young with HNSCC may become a major public health concern if current trends persist, particularly lifestyle habits that may contribute to this disease. CONCLUSIONS: Given the younger age and potential long-term adverse sequelae of traditional HNSCC treatments, young adults should be treated on a case-by-case basis and post-therapy quality of life must be considered in any treatment-decision making process.

Analysis of selected recurrence risk factors after treatment of head and neck basal cell carcinoma.

INTRODUCTION: Basal cell carcinoma (BCC) is the most common type of non-melanoma malignant skin tumors. Eighty-five percent of all cases are located on the skin of the head and neck. The risk of recurrence after surgery is estimated at 5-15%. AIM: To evaluate the selected risk factors for recurrence after surgical treatment of head and neck BCC at the Department of Head and Neck Surgery in the Greater Poland Cancer Centre of the Poznan University of Medical Sciences. MATERIAL AND METHODS: A retrospective analysis was made of patients treated at the Department of Head and Neck Surgery in the Greater Poland Cancer Centre of the Poznan University of Medical Sciences in 2007-2012 for BCC of the head and neck region. The study covered 312 patients: 198 males (63%) and 114 females (37%), aged 32-96 years. RESULTS: In the study group of 312 tumors, recurrence after initial treatment in this Centre was diagnosed in 18 patients (9%), whereas in patients who were previously operated elsewhere, recurrence was found in 22 cases (17%). The nodular type was the most common BCC type in the study group and concerned 175 patients (56%). The most numerous group (114; 37%) in this study group comprised patients with external nose and cheek tumors. CONCLUSIONS: The importance of preoperative biopsy to assess the histological type as a routine treatment of patients with BCC is essential. Ultrasound evaluation to assess the exact size and depth of tumor invasion should also be implemented.

[Our experience in the use of anterolateral thigh flap for reconstruction of the head and neck neoplasms]. / Doswiadczenia wlasne w zastosowaniu wolnych platów udowych w rekonstrukcji ubytków po rozleglych operacjach nowotworów zlosliwych glowy i szyi.

INTRODUCTION: Free flaps with vascular anastomosis have been widely used in clinical practice for more than 30 years. They are standard in reconstructive surgery following extensive resections caused by neoplasms of the head and neck. The anterolateral thigh flap (ALT) constitutes very good reconstructive material due to the long vascular pedicle, the appropriate diameter of vessels, the large skin island plane, and thickness depending on requirements. MATERIAL: The own material comprises 5 patients who have had extensive neoplastic infiltrations removed at different anatomic locations within the area of healthy tissue. RESULTS: Reconstructions have been conducted using a microvascular thigh flap (ALT). All of the operated patients are under constant supervision. The observation period ranges from 2 to 3 months. No recurrence of the neoplastic process or graft rejection has been observed in any of the patients.

[Orbital tumors in material of Department of Head and Neck Surgery and Oncological Laryngology of Greater Poland Cancer Center 2007-2010]. / Guzy oczodolu w materiale Oddzialu Chirurgii Glowy i Szyi i Onkologii Laryngologicznej Wielkopolskiego Centrum Onkologii w Poznaniu w latach 2007-2010.

INTRODUCTION: Tumors of the orbit are diagnosed sporadically. Based on the tumor registry of the American Cancer Society the incidence of tumors of the orbit is assessed at fewer than 1 per 100 000 persons. Tumors of the orbit can be divided into three groups: primary tumors, tumors penetrating the orbit from neighboring structures, and tumors that are metastases of malignant cancers from distant organs. AIM OF THE STUDY: To present the results of treatment of patients with tumors of the orbit treated in the Head and Neck Surgery and Laryngological Oncology Ward of the Greater Poland Cancer Centre in Poznan during 2007-2010. MATERIAL AND METHODS: The study group consisted of 26 patients surgically treated during 2007-2010 in the Head and Neck Surgery and Laryngological Oncology Ward of the Greater Poland Cancer Centre in Poznan. RESULTS: In the postoperative histopathological examination 18 patients (69%) were diagnosed with malignant tumors, 7 patients (27%) with non-malignant tumor and 1 patient (4%) with inflammatory lesion. Among malignant tumors the most frequent was basal cell carcinoma, diagnosed in 7 patients (27%). When removing the tumors of the orbit 4 types of operation were performed: lateral orbitotomy, superior orbitotomy, eye enucleation, and exenteration of the orbit. In 3 patients (12%) cancer recurrences occurred. All patients with recurrences underwent reoperation. In a patient with an extensive recurrence of squamous cell carcinoma the surgery was not radical and the patient died during palliative chemotherapy. CONCLUSIONS: Patients with tumors of the orbit should be treated operatively in appropriately prepared centers. In our material the confirmation of this thesis is the group of patients with recurrences of basal cell carcinoma, operated on many times in the past, who due to the extent of the cancerous process had to have the seeing eye removed. In the case of malignant cancers of the orbit an interdisciplinary approach to the problem and the assurance of psychological care for patients who have lost an orbit are essential.

The kinetics of γ-H2AX during radiotherapy of head and neck cancer potentially allow for prediction of severe mucositis.

Background The aim of the study was to evaluate the changes in γ-H2AX expression in peripheral blood lymphocytes (PBL) according to severity of radiation-induced mucositis. Patients and method Fifty patients with head and neck cancer treated with radiotherapy (RT) or chemoradiation were included in the study. Blood samples were collected before treatment to measure baseline γ-H2AX levels. Second sample was taken 45 minutes after the first RT fraction and then once a week, 45 min after irradiation. In patients treated with chemoradiation the blood sample was taken the day after chemotherapy. Mucositis was evaluated once a week and reported according to CTCAE v4 and RTOG/EORTC scales. PBL were analyzed with flow cytometry and level of H2AX phosphorylation at every time point was evaluated. Results In 35 patients mild to moderate (grade 1-2) mucositis was observed and 15 patients developed severe (grade 3) mucositis. No cases of grade 4 mucositis were observed. The difference in baseline levels of γ-H2AX between groups with mild and severe mucositis was statistically insignificant (p = 0.25). The statistically significant difference in γ-H2AX level was observed in week 7 of treatment (p = 0.01). No significant differences in γ-H2AX level were found neither between group treated with concomitant chemoradiation or RT alone neither between groups with and without common comorbidities. In the analysis of the kinetics of γ-H2AX during treatment, a statistically significant difference (p = 0.0088) between groups with mild and severe mucositis was observed. After fourth week of treatment levels of γ-H2AX decreased significantly in the group with severe mucositis and increased in patients with mild side effects. The observed difference was not caused by the decrease in peripheral lymphocyte count, which was similar in both groups. Conclusions Presented results indicate that severity of radiation-induced mucositis does not correlate directly with γ-H2AX levels measured in vivo in PBL. Prediction of mucositis grade based on γ-H2AX level is not yet possible, either before treatment or early during treatment, but preliminary results, indicating significant differences in γ-H2AX kinetics between groups, encourage further studies.

2D and 3D cell cultures - a comparison of different types of cancer cell cultures.

Cell culture is a widely used in vitro tool for improving our understanding of cell biology, tissue morphology, and mechanisms of diseases, drug action, protein production and the development of tissue engineering. Most research regarding cancer biology is based on experiments using two-dimensional (2D) cell cultures in vitro. However, 2D cultures have many limitations, such as the disturbance of interactions between the cellular and extracellular environments, changes in cell morphology, polarity, and method of division. These disadvantages led to the creation of models which are more closely able to mimic conditions in vivo. One such method is three-dimensional culture (3D). Optimisation of the culture conditions may allow for a better understanding of cancer biology and facilitate the study of biomarkers and targeting therapies. In this review, we compare 2D and 3D cultures in vitro as well as different versions of 3D cultures.

Gene expression analysis of head and neck squamous cell carcinoma survival and recurrence.

The squamous cell carcinomas represent about 90 % of all head and neck cancers, ranking the sixth most common human cancer. Approximately 450,000 of new cases of head and neck squamous cell carcinoma (HNSCC) are diagnosed every year. Unfortunately, because of diagnosis at the advanced stages and early metastasis to the lymph nodes, the HNSCC is associated with very high death rate. Identification of signature biomarkers and molecularly targeted therapies could provide more effective and specific cancer treatment, prevent recurrence, and increase survival rate. We used paired tumor and adjacent normal tissue samples to screen with RT² Profiler™ PCR Array Human Cancer PathwayFinderTM . Total of 20 up-regulated genes and two down-regulated genes were screened out. Out of 22 genes, 12 genes were subsequently validated to be significantly altered in the HNSCC; the samples were from all 41 patients. Five year survival and recurrence selected genes that could represent the biomarkers of survival and recurrence of the disease. We believe that comprehensive understanding of the unique genetic characteristics of HNSCC could provide novel diagnostic biomarkers and meet the requirement for molecular-targeted therapy for the HNSCC.

National Programme for Prevention and Early Detection of Head and Neck Cancer.

550,000 new cases of cancer of the oral cavity and pharynx and 160,000 of larynx are diagnosed each year worldwide. It is estimated that each year because of head and neck cancer 400,000 of patients will die. Head and neck neoplasms are the tumors which, because of their location, secretly develop and produce uncharacteristic symptoms identical to those that accompany the banal infections of the upper respiratory tract. Results of treatment of patients with head and neck cancer in Poland are highly unsatisfactory. This is due to significant advancement of tumor at the moment of diagnosis. Therefore, raising awareness and improving knowledge of health care workers on head and neck cancers by creating access to prevention research is a priority that will ensure improvement in treatment outcomes in this group of tumors in Poland and abroad.

Circulating small non-coding RNA signature in head and neck squamous cell carcinoma.

The Head and Neck Squamous Cell Carcinoma (HNSCC) is the sixth most common human cancer, causing 350,000 individuals die worldwide each year. The overall prognosis in HNSCC patients has not significantly changed for the last decade. Complete understanding of the molecular mechanisms in HNSCC carcinogenesis could allow an earlier diagnosis and the use of more specific and effective therapies. In the present study we used deep sequencing to characterize small non-coding RNAs (sncRNAs) in serum from HNSCC patients and healthy donors. We identified, for the first time, a multi-marker signature of 3 major classes of circulating sncRNAs in HNSCC, revealing the presence of circulating novel and known miRNAs, and tRNA- and YRNA-derived small RNAs that were significantly deregulated in the sera of HNSCC patients compared to healthy controls. By implementing a triple-filtering approach we identified a subset of highly biologically relevant miRNA-mRNA interactions and we demonstrated that the same genes/pathways affected by somatic mutations in cancer are affected by changes in the abundance of miRNAs. Therefore, one important conclusion from our work is that during cancer development, there seems to be a convergence of oncogenic processes driven by somatic mutations and/or miRNA regulation affecting key cellular pathways.

Expression levels of insulin-like growth factors 1 and 2 in head and neck squamous cell carcinoma.

Insulin-like growth factors (IGF) 1 and 2 are known as potential mitogens for normal and neoplastic cells. IGF2 is a main fetal growth factor while IGF1 is activated through growth hormone action during postnatal growth and development. However, there is strong evidence that activation of IGF2 by its E2F transcription factor 3 (E2F3) is present in different types of cancer. Also high levels of IGF1 strongly correlate with cancer development due to anti-apoptotic properties and enhancement of cancer cell differentiation, which can be attenuated by IGFBP3. Head and neck cancer is known as one of the six most common human cancers. The main risk factor for head and neck cancer is consumption of tobacco and alcohol as well as viral infection and bacterial infection by stimulation of chronic local inflammation. There is also a genetic basis for this form of cancer; however, the genetic markers are not yet established. In this study we investigated the levels of the expression of IGF2, IGF1, E2F3 and IGFBP3 in human cancers and healthy tissues surrounding the tumor obtained from each of 41 patients. Our study indicated that there is no alteration of the levels of expression of IGF2, E2F3 and IGF1 in head and neck squamous cell carcinoma (HNSCC) cases studied in selected experimental population, but there was evidence for upregulation of pro-apoptotic IGFBP3 in cancer when comparing to healthy tissue. These important findings indicate that insulin-growth factors are not directly associated with HNSCC showing some variability between patients and location of tumor. However, elevated level of IGFBP3 suggests possible regulatory role of IGF signal by its binding protein in this type of tumor.

[Evaluation of the effectiveness of ¹8F-FDG-PET/CT examination of head and neck cancer--own experience]. / Znaczenie badan PET/CT w diagnostyce nowotworów glowy i szyi--doswiadczenia wlasne.

PURPOSE: The aim of the study was to evaluate the usefulness of ¹8F-FDG-PET/CT in diagnosis of head and neck cancer. MATERIAL AND METHODS: 60 ¹8F-FDG-PET/CT examinations were performed in 50 patients diagnosed and treated for head and neck cancer in Department of Head and Neck Surgery and Nuclear Medicine Department of The Greater Poland Cancer Centre in Poznan, Poland from 2007 to 2011. Patients were divided into 2 subgroups: CUP Syndrome patients (25 PET/CT exams) and patients being under control after treatment (35 PET/CT exams). RESULTS: In the group of CUP Syndrome patients 6 PET/CT examinations were negative, in 7--possible primary tumor was indicated, in 10--only cervical lymph node metastases were diagnosed, in 2 cases--distant metastases occured. Within the second subgroup 14 PET/CT examinations were negative, 11 exams--indicated the recurrent disease, 2--cervical lymph node metastases and 8--distant metastases. The sensitivity and specificity of ¹8F-FDG-PET/CT in this study within the CUP Syndrome patients group were 100% and 55% respectively. The positive predictive value was 74%. The negative predictive value was 100%. The sensitivity and specificity of ¹8F-FDG-PET/CT in this study within the second group of patients were 88% and 66% respectively. The positive predictive value was 71%. The negative predictive value was 86%. CONCLUSIONS: ¹8F-FDG-PET/CT is useful for staging of head and neck cancer, identification of an unknown primary tumor, delineation of the extent of regional lymph node involvement, detection of distant metastases and occasional synchronous primary tumor.

[Early surgical revision as a salvage procedure in the anterolateral thigh flap failure prevention--case report]. / Interwencja chirurgiczna w obrebie szypuly naczyniowej jako wczesna profilaktyka martwicy plata ALT--opis przypadku.

Microsurgical free flaps are considered state of the art in head and neck reconstruction after composite tumor resections. The anterolateral thigh (ALT) flap is frequently used in ablative head and neck surgery, providing superior functional and aesthetic restoration with a minor donor-site morbidity. However, flap failures do occur occasionally, vascular obstruction within first 24 postoperative hours is one of the main reasons of flap compromise. We present a case report of an early surgical exploration as a successful salvage procedure for ALT flap used for reconstruction of the massive scalp excision due to basal cell carcinoma.