Differential expression of LOXL4 in normal and tumour tissue samples of laryngeal squamous cell carcinoma.

OBJECTIVE: Head and neck cancer is the sixth most common cancer in worldwide with an increasing incidence rate in recent years. LOXL4 is expressed in several tissues, and its expression has been shown to display a significant correlation with local lymph node metastasis. In this study, we aimed to explore the LOXL4 expression level in metastatic and non-metastatic LSCC tissues and to determine its prognostic significance. STUDY DESIGN: Basic science research study. SETTING: University hospital. PARTICIPANTS: A total of 40 patients were included in the study. MAIN OUTCOME MEASURE: LOXL4 expression status in metastatic, non-metastatic LSCC and normal tissue samples was investigated by quantitative reverse-transcription PCR. RESULTS: We demonstrated that LOXL4 was significantly overexpressed in LSCC tumour tissue samples in comparison with the corresponding normal tissues (P < 0.001); however, no significant relationship has been found between LOXL4 expression and either the metastatic potential or the T classification of the specimens. CONCLUSIONS: Although expression of LOXL4 is not statistically associated with neck metastases, we showed that LOXL4 expression significantly increased in laryngeal cancer.

Depression, self-esteem and sexual function in laryngeal cancer patients.

OBJECTIVE: The purpose of this study was to assess sexual function, affective disorders and self-esteem in patients who were surgically treated for laryngeal cancer. DESIGN: Retrospective, blind, cross-sectional study. SETTING: Single tertiary cancer centre. PARTICIPANTS: Seventy four patients who were operated on Istanbul University Cerrahpasa School of Medicine Otorhinolaryngology Department between 2008 and 2012 were classified according to the type of the operation as total laryngectomy (Group 1) and partial laryngectomy (Group 2). MAIN OUTCOME MEASURES: Sexual dysfunction, depression and self-esteem were evaluated with The Arizona Sexual Experiences Scale (ASEX), Beck's Depression Inventory (BDI) and Rosenberg Self-Esteem Scale (RSES), respectively. RESULTS: Average ASEX scores of the Group 1 were (13.98 ± 6.32) and Group 2 were (13.08 ± 4.96) without statistically significant difference (P = 0.537). Mean BDI score of Group 1 was (13.20 ± 10.41) higher than Group 2 (7.76 ± 8.14) and the difference was significant statistically (P = 0.026). Mean RSES scores of Group 1 and Group 2 were 20.68 ± 5.33 and 19.25 ± 4.70, respectively, again without significant difference (P = 0.262). However, when the average scores of each item of Rosenberg Scale were compared, significant difference was found in d4 (2.37 ± 0.78; 1.64 ± 0.99; P = 0.001), d6 (1.22 ± 1.05; 1.84 ± 1.14; P = 0.023), d10 (2.55 ± 2.39; 1.28 ± 1.49; P = 0.018) and d11 (1.35 ± 0.95; 2.00 ± 1.41; P = 0.021). BDI scores were correlated with RSES scores, and ASEX scores were correlated with age. CONCLUSION: The patients with total laryngectomy seem to have more psychological problems that must be addressed in the postoperative period.

Preoperative detection and management of tracheomalacia in advanced laryngotracheal stenosis.

OBJECTIVE: To determine the predictive value of endoscopic examination and radiological imaging in the evaluation of substomal tracheomalacia in advanced laryngotracheal stenosis. METHODS: Forty nine patients with advanced laryngotracheal stenosis were preoperatively evaluated with radiological (magnetic resonance imaging [MRI]) and endoscopy to determine the grade of laryngotracheal stenosis and presence of substomal tracheomalacia. The intraoperative findings were compared with the preoperative findings, and the percentage of operative plan changes was calculated. RESULTS: In a preoperative evaluation, 37 patients were found to have no substomal tracheomalacia; but during the surgical procedure, we detected substomal tracheomalacia in 12 (32.4%) of these patients and changed our preoperative plan during the procedure (p < 0.05). CONCLUSION: Laryngotracheal reconstruction plans are dependent on preoperative evaluations which can change significantly during the surgical procedure. Therefore, experienced physicians who can alter the preoperative plan immediately during the procedure and successfully perform an alternative procedure are necessary.

Endoscope assisted removal of cementoossifying fibroma in the paranasal sinuses in a five-year-old girl.

We report a five-year-old girl with a sinonasal cementoossifying fibroma with CT findings that reveal the invasion of all paranasal sinuses and the remodeling of facial bones. It was possibly a congenital lesion and caused a slowly progressive nasal obstruction and anosmia. Tumor removal with transnasal endoscopic approach was applied and total removal of the mass was accomplished. It was found out to be the cementoossifying fibroma of the paranasal sinuses when the results of the pathological examinations were obtained.

Primary malignant melanoma of the pharynx.

Primary mucosal malignant melanomas are rare. They appear late in life and their prognosis is grave. Although there is no consensus on therapy, wide surgical resection followed by radiotherapy, chemotherapy and immunotherapy are treatment modalities. In this report we present a case of widespread primary mucosal malignant melanoma located in the pharynx. After immunotherapy (four cycles of interleukin-2 and interferon-alpha) and chemotherapy (four cycles of cisplatin and dacarbazine) has been applied as primary therapy for suppression of the mass, transoral total pharyngeal resection was performed. After surgery three cycles of immunotherapy and three cycles of chemotherapy were administered followed by radiotherapy (total dose of 6600 cGy). An additional three cycles of immunotherapy and chemotherapy were administered. Although no local recurrence was observed during the 14 months of follow-up after the completion of radiotherapy, cranial and lung metastasis were detected in the 12th month.

Use of free composite graft for a large defect in the anterior skull base.

Until recently, most skull base tumors, particularly those extending into the orbit or anterior or middle cranial fossa base, were excised incompletely because of the technical difficulty in performing en bloc resections. However, improved craniofacial surgical techniques, recent developments in technology and equipment, improved imaging techniques, interdisciplinary collaboration, and improved anesthetic techniques have enabled a wide range of attempts resulting in successful clinical outcome. We present a case of recurrent meningioma with intracranial and extracranial extension in which three previous operations left a large craniectomy defect in the frontal area as well as a frontal lobe defect. After removal of the tumor, we reconstructed the large defect using composite graft (free bone and fascia lata).

Reconstruction with composite nasal septal cartilage and auricular cartilage in extended partial laryngectomy.

Several reconstruction techniques have been employed following partial laryngectomy in order to improve laryngeal function. We report 12 cases in which composite nasal septal cartilage and auricular cartilage were used. We decannulated the patients in an average of 19 days. Following the reconstruction we obtained a satisfactory phonatory function and swallowing. Six patients completed a follow-up period of three years without presenting any recurrences or mortality. Our experience with reconstruction using composite nasal septal and auricular cartilage following partial laryngectomy proved effective.

Free rectus abdominis muscle flap for the treatment of complications after neurosurgical procedures.

Neurosurgical procedures may lead to mortal complications. Exposure of the dura mater, brain, or other intracranial structures; persistent cerebrospinal fluid fistulas; and connection between the extradural space and the nasopharynx and paranasal sinuses are complications that can be best treated with microvascular free tissue transfers. We report two patients with complications that occurred after neurosurgical operations. Both patients were treated by a team, including a plastic surgeon, ear, nose, and throat surgeon, and a neurosurgeon. Free rectus abdominis muscle flap was the choice of treatment for reconstruction.