[Morphology of the glottis and perceptiv-acoustic characteristic of the voice and speech after extended fronto-lateral epiglotttoplasty]. / Morfologia glosni i charakterystyka percepcyjno-akustyczna glosu i mowy po laryngektomii fronto-lateralnej poszerzonej z nastepowa epiglotoplastyka.

UNLABELLED: For optimalisation glottis morphology and its phonatory function after frontolateral laryngectomy (FLL) the reconstruction of larynx is made; in Clinic of Otolaryngology the most common is using epiglottis wit or without its vertical incision. AIM OF THE STUDY: the influence of widening laryngeal resection and epiglottis incision on shape of reconstructed glottis, level and degree of phonatory closure and perceptive--acoustic characteristic of voice and speech. MATERIAL: 39 patients (38 M and 1 F) after FLL widened of false vocal cord (n = 11), false vocal cord and part of cricoid cartilage (n = 22), whole cricoid cartilage (n = 6). Vertical incision of epiglottis was made in 31 cases. Mean age was 52 (min.-39, max.-70) years. METHODICS: videolaryngoscopic examination, subjective voice estimation using GRBAS scale, objective phonetic--acoustic voice analysis. RESULTS: In videolaryngoscopic examination the most common shape of glottis was irregular triangle (n = 24), rhombus (n = 7), half--moon (n = 2), irregular (n = 6). 2 patients were using whisper. In spectrographic recordings (n = 39) only noise character of stimulation source was in 2 patients, noise--periodic with noise component present in whole acoustic spectrum in 37. F0 for single word and sentence vocalized in affirmative and interrogative form had the value of male voices and its changes during speaking were well noted. In subjective and objective estimation, the worse voice quality was after FLL widened of false vocal cord, part or whole cricoid cartilage. CONCLUSION: 1) FLL with subsequent epiglottoplasty in 94% of patients makes satisfactory morphologic and biophysical conditions for production of voice and sociological efficient speech. 2) Widening resection of false vocal cord, part or whole cricoid cartilage has unbeneficial influence on perceptive--acoustic characteristic of voice and speech.

[Pyocele of the posterior ethmoidal cell as the cause of visual loss]. / Pyocele komórki sitowia tylnego jako przyczyna slepoty.

INTRODUCTION: Mucocele is a cystic slow-growing lesion of paranasal sinuses with sterile content. Pyocele contains purulent substance. Muco-/pyocele is rarely localised in ethmoid or sphenoid sinus and may involve the orbit and cause ophthalmic complications including visual loss. MATERIAL AND METHODS: We report the case of a 25-year-old woman who suffered from sudden visual loss of her left eye. She was treated for optic nerve papillitis by neurologists and ophthalmologists with steroids and recovered after about 6 weeks. Magnetic resonance imaging was ordered to find the cause of visual disturbance and revealed an oval-shaped lesion in the left posterior ethmoid sinus. The patient underwent functional endoscopic surgery and transethmoidal marsupialisation of the muco-/pyocele. RESULTS: After endoscopic microsurgery the patient recovered without complications, she is under follow-up and has no symptoms of any disease. Because there were no evidence of any other causes of optic nerve affection, the muco-/pyocele was regarded as the cause of visual loss. CONCLUSIONS: The posterior ethmoid muco-/pyocele can present with ophthalmic manifestations including blindness. Endonasal operation and steroids administration are the treatment of choice in such cases.

[Objective assessment of the respiratory function of the larynx after fronto-lateral laryngectomy with epiglottoplasty and after supracricoid laryngectomy with CHP or CHEP]. / Obiektywna ocena funkcji oddechowej krtani po laryngektomii fronto-lateralnej poszerzonej z epiglottoplastyka oraz nadpierscieniowej z CHP lub CHEP.

Enlarged fronto-lateral laryngectomy with epiglottoplasty and supracricoid laryngectomy with cricohyoidopexy (CHP) or cricohyoidoepiglottopexy (CHEP) differ from each other as regards surgical technique, extent of the resection and method of reconstruction. Despite of that, selected carcinomas of the true vocal cord staged as T2N0, which are included in indications to all mentioned laryngectomies, can be equally treated with each of these methods. The aim of this study is objective evaluation of the respiratory function of the larynx after three types of operation and comparison of the results. Material included 64 patients treated during the period of 1993-2002: 39 patients after supracricoid laryngectomy (18 with CHP and 21 with CHEP) and 25 after enlarged fronto-lateral laryngectomy with epiglottoplasty. Spirometry was performed before and after the operation in 27 cases and only after the operation in 34 cases. The shapes of flow-volume loops and 32 spirometric parameters were evaluated. The decannulation rates were: a) 98,5% after enlarged fronto-lateral laryngectomy with epiglottoplasty, b) 80,6% after supracricoid laryngectomy with CHP, c) 70,1% after supracricoid laryngectomy with CHEP. Although the decannulation rate was better after CHP than after CHEP the spirometric parameters were better in patients after CHEP than in those after CHP. The airflow similar to normal was found in 15% patients after CHEP as well as after CHP and in 28% patients after epiglottoplasty. There were no restrictive abnormalities in the whole group of operated patients, but occurrences of obturation, especially inspiratory, were quite often. In conclusion, which follows from the comparison of three types of reconstructive laryngectomies, better results of respiratory function of the larynx were found after epiglottoplasty than after supracricoid laryngectomy with CHEP or CHP.

[Horizontal glottectomy--oncologic and functional results. Part I. Horizontal glottic laryngectomy--oncologic results and assessment of the protective and respiratory function of the larynx]. / Laryngektomia pozioma glosniowa-- wyniki onkologiczne i funkcjonalne. Czesc I. Laryngektomia pozioma glosniowa--wyniki onkologiczne, ocena funkcji ochronnej i oddechowej.

INTRODUCTION: In the Otolaryngology and Laryngological Oncology Department of the Pomeranian Medical University in Szczecin (Poland) horizontal glottectomy is executed from 1985. MATERIAL AND METHODS: Material consists of 27 patients (26 males and 1 female; an average age 57 min. 40, max.). We evaluated: 1) oncological results, 2) 3 and 5-years survival rate without recurrence of the cancer, 3) evaluation of the protective and respiratory function. Protective function was evaluated basing on: a) period after operation when feeding tube was removed, b) subjective assessment of swallowing liquid and solid food. For evaluating respiratory function we stated period after operation to decannulation and also spirometric investigations were done. RESULTS: From among 27 operated patients died 4 (15%)--one on the second day after operation. Recurrence of the cancer (local or into lymph nodes) were observed in 5/26 (19.2%). Three years without symptoms of recurrence survived 89% (17/19), five years--80% (12/15). Swallowing through natural way was possible during the first 24 hours after operation in 13 of 26 (50%) patients. In the remaining 13 only 2 feeding tubes were removed on the 35th day after operation. Decannulation was possible at 92% (24/26) patients. 15 (58%) patients were decannulated in the first two week after operation. Spirometric investigation (n = 10) showed no restriction and very small obturation on the larynx - very good laryngeal flow nearing to normal. CONCLUSIONS: Oncologic results, protective and respiratory function after horizontal function results are satisfactory and comparable to the other researchers.

[Horizontal glottectomy--oncological and functional results. Part II. Morphology of the glottis and perceptive-acoustics characteristic of the voice and speech after horizontal glottectomy]. / Laryngektomia pozioma glosniowa-- wyniki onkologiczne i funkcjonalne. Czesc II. Morfologia glosni i charakterystyka percepcyjno-akustyczna glosu i mowy po laryngektomii poziomej glosniowej.

INTRODUCTION: The authors showed findings concerning glottis morphology and perceptual-acoustic characteristics of voice and speech after partial classical (PCGLg) and extended glottic partial laryngectomy (PEGLg). MATERIAL AND METHODS: 10 patients (9 M., 1 F. average age 56 (min. 47 max. 65) were examined. All patients were undergone glottic partial laryngectomy: a) classical (n = 5) b) extended of vocal process (n = 3) with (n = 2) or without (n = 1) the removal of the mucous false folds, c) extended of part of arytenoid cartilage with (n = 2) or without (n = 1) the removal of the mucous of the false folds. The following examinations were executed: phoniatric, videolaryngoscopic and perceptual-acoustic analysis. RESULTS: After PCGLg and one extended of vocal process, voice and speech has mostly characterized of features of hypofunction dysphonia. Hyperfunction was found in patients after removal of the mucous of the false folds due to leucoplakia. In case of removing of a part of arythenoid cartilage the notable or entire standstill or lack of full phonatory closure were found. The phonetical-acoustic analysis showed that in patients using melodious voice, the character of the source of actuating was periodically-noise, with the component of noise in all range of the course of the acoustic signal of voice. The parameters such as F0, jitter, shimmer does not make coherent conclusions and are less useful in the assessment of the quality of voice. CONCLUSIONS: In case of the resection of the part of the arythenoid cartilage during glottis laryngectomy, we take into account lack of full phonatory closure and using whisper by the patients. Obtaining the reliable conclusions needs continuations of the investigations and increasing number of patients. These researches are in progress.

[Comparison of the classical and extended fronto-lateral laryngectomy considering the respiratory function of the larynx]. / Porównanie laryngektomii frontolateralnej klasycznej i poszerzonej w zakresie funkcji oddechowej krtani.

In Szczecin during the period between 1973-1999, 107 patients were treated with classical fronto-lateral laryngectomy (LFLC) and 112 with extended fronto-lateral laryngectomy (LFLE) due to glottic cancer. We report 30 patients (27 male and 3 female)--13 after LFLC and 17 after LFLE (including 15 cases of LFLE with epiglottoplastic). 72 laryngovideoscopies, 87 spirometric examinations and 18 computerised tomographies were performed. Larynx lumen and 32 spirometric parameters were evaluated. Somewhat higher values of air flow parameters were state in patients qualified for LFLC than LFLE. Average value of the spirometric parameters were also a little bit higher after LFLC than after LFLE. Air flow through the larynx was sufficient to decannulate 11/13 patients after LFLC and 16/17 patients after LFLE. After both types of operations normal air flow was seen in 5 patients after LFLC and 2 patients after LFLE. Spirometric examination with flow-volume loop was the most useful in evaluation of respiratory function of the larynx.

[Surgical methods of treating patients with laryngeal and hypopharyngeal cancer in Szczecin's EMT University Department during the years 1970-2002]. / Chirurgiczne metody leczenia raka krtani i gradla dolnego stosowane w Klinice Szczecinskiej w latach 1970-2002.

In the thesis are presented surgical methods of treating larynx and hypopharynx cancer used in the Szczecin Clinic throughout more than 30 years, i.e. between 1970 and 2002. During this period in the Szczecin center 2591 patients ill of larynx cancer underwent surgical treatments. In the analysed period was recorder an increase in: a) the number of patients suffering from larynx and hypopharynx cancer, b) patients' average age, c) percentage of larynx cancer sick rate in females in relation to males and d) the number of patients with advanced stage of disease. Predominant with the patients were supraglottic cancers, however in the recent years there was an increase in the number of glottic cancer patients. In the years 1970-1980 prevailed partial laryngectomies and total laryngectomies were performed sporadically. In the next decade, what became noticeable was a drop in operations with creation of autoplastic vocal shunt and a growth in the number of partial operations with the preservation of respiratory way. In the last decade there was also an increase in the number of operations of total laryngectomies and a decrease in the number of partial operations, whereas the number of performed subtotal operations with the reconstruction of phonatory functions remained at the same level. Oncological and functional results assessed both subjectively and objectively after all kinds of laryngectomies were satisfactory. In the thesis attention was also paid to surgical methods elaborated in the Clinic, which substantially contributed to the progress in surgical treatment of larynx cancer as well as to improvements in revalidation of the phonatory function and its quality with patients after total, subtotal and partial removal of larynx structures.

[Ethmoid sinus mucocele penetrating to the orbit and anterior cranial fossa - case report]. / Sluzowiak zatok sitowych penetrujacy do oczodolu i przedniego dolu czaszki - opis przypadku.

Paranasal sinus mucocele is the cystic formation lined by inflammatory changed mucoperiosteum. This is slow-growing pathology with a tendency to bone erosion. The symptoms are dependent on the direction of the penetration, and are as follows: increasing headaches, deformations of frontal or orbital region, ophthalmic manifestations such as lacrimation, decreased visual acuity, exophthalmos, ocular movement limitation, diplopia. The most common location of the mucocele is fronto-ethmoid region. The most useful diagnostic tests are a magnetic resonance imaging (MRI) and a computed tomography (CT) which show the progress of the disease and bone destructions. Surgery is the only method of treatment (external approach or FESS). This paper reports the case of a 74-year-old woman with ethmoid mucocele penetrating into the orbit, frontal sinus and anterior cranial fossa with compression of frontal lobe of the brain. The patient underwent CT and MRI and was treated with endoscopic intranasal marsupialization of the cyst. There are no clinical signs of disease recurrence 7 months after surgery. The endoscopic surgical management in treatment of sinus mucocele is a good alternative to the operation from external approach because of its low invasiveness, low complication risk, rapid healing and good therapeutic effects.