Pharyngeal and hypopharyngeal reconstruction after multilating surgery for malignant hypopharyngeal cancers.

The authors summarise their reconstructive surgical experience after the radical excision of hypopharyngeal tumours. In selective cases the preservation of the larynx is a reliable surgical option and supraglottic surgery is sufficient to remove the tumour. Myocutaneous paddle flaps were used in every case after the surgical resection for the reconstruction of the pharyngo-oesophageal entrance. After total circular pharyngo-laryngectomy, the continuity of the upper digestive tract was reconstructed by tubed myocutanous flaps.

Peroral endoscopic removal of a regurgitated giant polisegmented fibrovascular polyp of the esophagus.

BACKGROUND: Giant fibrovascular polyps (FVP) are relatively rare benign neoplasm of the upper esophagus and hypopharynx. Without previous history, their diagnosis might be difficult as the endoscopic findings are sometimes misinterpretedMaterials and methods: The present report describes a case, in which the patient regurgitated his giant polypoid mass into his mouth and captured it between his teeth and buccal surface until the emergency endoscopic removalResults: After one-year of follow-up, the patient is going well, without recurrence of his polypConclusion: Although the adequate therapy for these lesions is mainly the open surgical resection, most often via cervical esophagotomy, in our case the polyp was removed successfully by peroral endoscopic operation.

Intracordal autologous fat injection for aspiration after recurrent laryngeal nerve paralysis.

The present prospective study was designed to analyze the results achieved with intracordal autologous fat injection for aspiration in a series of 20 patients with recurrent laryngeal nerve paralysis. Swallowing was documented by having each patient swallow puréed food colored with methylene blue during nasofibroscopy. No laryngeal adverse effects were associated with the intracordal injection of fat. One patient developed an abdominal hematoma at the donor site. The intracordal injection of autologous fat after 1 year resulted in an 85% successful rehabilitation of swallowing. One of the three patients who failed the initial rehabilitation of swallowing was managed successfully with reinjection of autologous fat, resulting in a 90% definitive successful rehabilitation of swallowing. In all patients, speech and voice were immediately improved after the intracordal injection of autologous fat. Objective acoustic recordings documented the improvement in selected speech and voice parameters when compared with pretreatment data. Our presented experience shows that the intracordal autologous fat injection is a safe and valuable treatment option in patients with aspiration after recurrent laryngeal nerve paralysis.

Leiomyosarcoma of the larynx. Review of the literature and report of two cases.

Leiomyosarcoma of the larynx is an extremely rare malignancy. Until now, only 35 cases have been reported, and only 19 were reported in English. We present 2 new cases observed in the last 3 years at our department. Correct histologic diagnosis can only be made on immunohistochemical and electron microscopic grounds. A 65-year-old man previously treated for a premalignant vocal cord lesion and a 31-year-old woman who previously underwent operation on a benign vocal cord lesion are presented. Only surgical treatment (total laryngectomy and endolaryngeal laser resection) was performed. Thirty-six and 22 months after the initial surgical intervention, both patients are alive and well, with no evidence of local recurrence or distant metastasis.

Carotid artery resection and reconstruction in patients with squamous cell carcinomas of the neck.

The authors performed a retrospective review of their 10-year experience of carotid artery resection with vascular reconstruction for advanced squamous cell carcinoma of the neck. From 1986 to 1997, four patients underwent elective and one patient acute carotid artery resection with revascularization at the Department of Otolaryngology, Albert Szent-Györgyi Medical University, Szeged, Hungary. Primary lesions were three laryngeal and two hypopharyngeal squamous cell carcinomas. All five resected specimens had metastatic invasion by tumor of the carotid adventitia on pathological examination, while only four specimens exhibited tumorous destruction of the arterial wall. No cerebrovascular accident occurred in any patient, although one patient died postoperatively from cardiac failure. The four remaining patients died of local-regional recurrences or metastatic disease within 17 months after their carotid artery resections. Our findings show that carotid artery resection with replacement is superior to ligation alone in avoiding neurological complications. This approach can provide local control of tumor, but may fail to achieve significant disease-free survival.

Pharyngeal localizations of branchial cysts.

Two cases with unusual pharyngeal localizations of branchial cysts medial to the great neck vessels and pharyngeal constrictor muscle are presented. The authors reviewed the theories of origin of the branchial cysts and the surgical treatment options. In their first case the transoral approach was chosen. Because of previous unsuccessful attempts at surgical treatment, the pharyngeal cyst was extremely adherent to adjacent tissue with much scar tissue, and it was very difficult to remove. As a result of this disappointing operation, an external neck exploration was indicated in the second patient. Histological examinations confirmed that the excised cysts were branchial in both cases.

A cadaver larynx holder for teaching laryngomicrosurgery.

Although many reports can be found in the literature about temporal bone holders for postgraduate temporal bone surgery courses, the author did not find any kind of suitable description of a larynx holder for laryngomicrosurgery courses. A cadaver larynx holder is presented, made by the author himself for individual and postgraduate teaching courses. This simple model has been proved already to be a unique and a very useful tool for a practising course on laryngomicrosurgery during two training courses and the instructional session of the IIIrd EUFOS Congress in Hungary in 1996.