[Electrochemotherapy for multiple cutaneous tumors in immunosuppressed patients]. / Immunszupprimált betegek multiplex bordaganatainak elektrokemoterápiás kezelése.

INTRODUCTION: The risk of cutaneous malignancies is significantly higher in immunosuppressed patients compared to the general population. These high-risk skin tumors tend to be aggressive, multiplex, rapidly growing lesions. It is common to see local recurrence after surgical excision. Multiplex tumors are difficult to treat, especially in the head/neck region. OBJECTIVE: Amongst the standard treatment options, electrochemotherapy can be a suitable option. Our aim was to evaluate the efficacy of electrochemotherapy in immunocompromised patients. METHOD: In 9 immunosuppressed patients, 118 (average: 13, n = 5-27) non-melanoma skin tumors were treated with electrochemotherapy with intravenous administration of bleomycin, according to the ESOPE criteria. RESULTS: The median follow-up was 15 months. 6 months after the treatment, the objective response rate was 96%. We observed complete response in 88%, partial response in 8% and progressive disease in 2% of the treated lesions. In 2%, the response was not evaluable. CONCLUSION: In immunocompromised patients, electrochemotherapy is an effective and safe therapeutic option for non-melanoma skin tumors. In order to provide more ideal management for this special sub-group, prevention, multidisciplinary approach and optimized immunosuppressive therapy is essential. Orv Hetil. 2023; 164(37): 1462-1468.

Challenges in the Complex Management of Neglected Cutaneous Melanomas in the Head and Neck Area: A Single Center Experience.

Familiar controversies in the management of head and neck melanomas are more remarkable in locally advanced cases, and they represent a treatment challenge both surgically and oncologically. In our retrospective study, patients with surgically treated primary malignant melanoma of the head and neck region larger than 3 cm in diameter were included. Five patients met our inclusion criteria. In all cases, wide excision and immediate reconstruction were performed without sentinel lymph node biopsy. The defect on the scalp was covered by a split skin graft, with local flaps chosen for reconstruction on the face on an individual basis. After a 2-6 year follow-up, a good oncological, functional, and esthetic result was achieved. Our results show that in the case of large, locally advanced melanomas, surgical treatment still plays a crucial role that can provide long-term local control and support the effect of systemic treatment.

[Subcutaneous and intramuscular heterotopic calcification of the neck 42 years after radiotherapy]. / Subcutan és intramuscularis heterotop kalcifikáció a nyakon 42 évvel a sugárkezelést követoen.

Radiotherapy-induced heterotopic tissue calcification is an exceedingly rare complication in the head and neck region. We report a patient with extensive, radiotherapy-induced, combined subcutaneous and intramuscular, heterotopic calcification of the neck. An 80-year-old male presented with a 2-month history of severe dysphagia and a painful ulcer on the neck 42 years after salvage total laryngectomy following radiotherapy (total dose: 80 Gy) for a T3N0M0 glottic squamous cell carcinoma. We excluded recurrence or secondary malignancy by biopsy and performed computed tomography, which revealed subcutaneous and intramuscular calcification in the area of the skin ulcer and close to the hypopharyngeal wall, moreover, total occlusion of the common carotid and vertebral arteries bilaterally. Surgical correction involved removing the calcified lesions and closure using fasciocutaneous flap transposition. The patient has been asymptomatic for the past 48 months. Radiotherapy plays an essential role in the treatment of patients with head and neck squamous cell carcinoma. Distorted postoperative anatomy, excessive scar formation, radiotherapy-induced fibrosis as well as skin and subcutaneous tissue calcification can present as atypical findings. Orv Hetil. 2023; 164(10): 383-387.

Clinical considerations of bleomycin based electrochemotherapy with variable electrode geometry electrodes for inoperable, deep-seated soft tissue sarcomas.

The aim of the current prospective pilot study exclusively for deep-seated soft tissue sarcomas (STS) was to evaluate efficacy and safety of bleomycin-based ECT using VEG (variable electrode geometry) electrodes. During a 2-year period, seven surgically inoperable STSs were treated at the University of Szeged, Department of Surgery in Hungary. Electrode placement was determined by software planning using preoperative imaging (CT/MRI) and intraoperative ultrasound. Intravenous bleomycin (15.000 IU/m2) was administered 8 min before first pulse generation which lasted up to 40 min. Tumour response was evaluated through CT/MRI 2 months after treatment as per RECIST v.1.1. Five male- and 2 female patients were treated with fibromyxoid sarcoma (n = 2), epitheloid sarcoma (n = 3), liposarcoma (n = 1) and myofibroblastic sarcoma (n = 1) with median age of 54 years (49-88). Median tumour diameter, tumour volume and tumour depth was 5.9 cm (3.7-22.5), 131.13 cm3 (35.6-2456.22) and 6.18 cm (3.74-18.18), respectively. Median operative time was 75 min (35-180), median hospital stay 2 days (2-20). Two month follow-up confirmed partial response in 5 patients, while stable disease in 1 patient, and progressive disease in 1 case as per RECIST v.1.1. Grade 2 ulceration was experienced in four cases, and a transient left musculus quadriceps femoris plegia occured in one patient. Local control of deep-seated STSs with BLM-based VEG ECT holds a promising perspective and our results may serve as a practical guide for further investigation and treatment planning.

Long-term experiences by using modified facial degloving technique / A módosított "facial degloving" technikával szerzett hosszú távú tapasztalataink.

Összefoglaló. Bevezetés: Az orrmelléküreg-daganatok kezelésében a legfrissebb nemzetközi ajánlások alapján továbbra is a sebészi reszekció az elsodlegesen választandó módszer. Bár az endoszkópos technikák fejlodésével a külso feltárással járó mutétek bizonyos esetekben háttérbe szorultak, napjainkban még mindig a Weber-Fergusson-féle metszést tartják a legszélesebb feltárást biztosító technikának, annak ellenére is, hogy a módszer stigmatizáló hegeket és deformitásokat hagy a páciensek arcán. Módszer: A "facial degloving" eljárást mint alternatív, hegmentes technikát eloször az 1970-es években publikálták, azóta számos módosítását írták le. A szerzok az orrmelléküregi tumorok eltávolítására már 8 éve kizárólag az általuk módosított technikát alkalmazzák. 2012 és 2019 között Klinikánkon 34 beteg esett át a módosított "facial degloving" mutéten. A módszer alapja egy felso szájpitvari behatolásból a középarc területén kialakított oszteoplasztikus lebeny, melynek felemelésével széles rálátás nyílik az orrüregre és melléküregeire, valamint az elülso koponyaalapra is. A mutéti terület a daganat eltávolítását követoen jó kozmetikai eredménnyel rekonstruálható. Eredmények: A szerzok akusztikus rinometriai vizsgálatokkal és az arckifejezéseket ábrázoló posztoperatív képi dokumentációval támasztották alá eredményeiket. Az operált oldalon sem az orrbemenet beszukülését (orrlégzés gátoltsága), sem pedig az arcmozgás zavarait, az arc aszimmetriáját nem észlelték. Betegeik túlélését Kaplan-Meier-görbén ábrázolták. Megbeszélés, következtetés: Habár az eredeti "facial degloving" technikának számos módosítását publikálták, az itt bemutatott módszer (oszteoplasztikus lebeny, melyben a középarc lágy részeinek integritása megtartott) rövidebb hospitalizációs idot és kevesebb komplikációt eredményezett. A bemutatott módosított "facial degloving" technika véleményünk szerint megfelelo és biztonságos sebészi reszekciót biztosít orrmelléküregi rosszindulatú daganatok esetén, továbbá kombinálható endoszkópos technikákkal, és szükség esetén nyitott mutétté alakítható, akár orbitalis kiterjesztéssel. Orv Hetil. 2021; 162(10): 392-398. INTRODUCTION: The widely used external approach (Weber-Fergusson's incision) for the removal of maxillo-ethmoidal tumors leaves stigmatizing scars and deformities on the patient's face. As an alternative technique, the scarless facial degloving approach was first described in the 1970's, and since then, several modifications have been developed. METHOD: We have been using our modified facial degloving technique for eight years now with maxillo-ethmoidal tumors. Between 2012 and 2019, 34 consecutive patients have been operated with our modified facial degloving approach at the Department of Oto-Rhino-Laryngology and Head-Neck Surgery, University of Szeged, Hungary. We describe our method which provides a wide surgical approach via an osteoplastic flap for the whole nasal and paranasal region, with good cosmetic results. RESULTS AND CONCLUSION: We have evaluated our results with acoustic rhinometry and photo-documentation of the facial mimic postoperatively. Neither narrowing of the nasal cavity on the operated side (loss of nasal breathing function), nor facial movement dysfunction was visible in our patients. We represent our patients' survival in Kaplan-Meier curve. Although several modifications of the original facial degloving approach have been published, in our technique, the novel osteoplastic flap and the intact soft tissue of the nasal and midfacial region results in shorter hospitalization time and fewer complications. Our modified facial degloving technique offers proper and safe surgical resection for tumors of the maxillo-ethmoid region. It can be routinely combined with endoscopic techniques, and, if necessary, can be converted to an open approach. Orv Hetil. 2021; 162(10): 392-398.

Surgical Solution for the Transformation of the Percutaneous Bone Anchored Hearing Aid to a Transcutaneous System in Complicated Cases.

Bone-anchored hearing aids (BAHAs) have been used for multiple types of hearing loss both in pediatric and adult cases. In the last decades, the percutaneous BAHA® Connect System (Cochlear Ltd., Sydney, Australia) was replaced by the fully implanted transcutaneous, magnet-based BAHA® Attract System (Cochlear Ltd., Sydney, Australia). Since the implantable part of the Attract device is fully covered with soft tissue, skin complications that were frequently observed in the percutaneous system, could be eliminated. As an outcome of this important advantage of the Attract System, conversion of the percutaneous into a transcutaneous system should be considered. In the following methodology report, a possible surgical technique is described. The method can easily be adopted to different conditions in which the replacement of the percutaneous device is necessary.

Giant Squamous Cell Papilloma of the Eyelid-Diagnostic and Therapeutic Challenges.

Squamous cell papilloma (SCP) is generally a human papillomavirus (HPV) induced exophytic or endophytic proliferation on the surface of the skin, oral cavity, larynx, esophagus, cervix, vagina, and anal canal. The endophytic type SCP can cause differential diagnostic difficulties with keratoacanthoma, inverted follicular keratosis, and squamous cell carcinoma; however, these lesions are not associated with HPV infection. The authors present a female patient who noticed an extremely rapidly growing tumor destructing the left lower eyelid. The histological analysis of the biopsy sample revealed a virus-induced squamoproliferative lesion. The eyelid affected was completely removed, and the histological examination resulted in a HPV induced endophytic squamous cell papilloma. The tarsus and the conjunctiva were replaced by a chondromucosal graft harvested from the nasal septum, while the skin defect could be closed directly. Restoration of the eyelid function has been achieved with satisfying functional and cosmetic results.

[Nasolabial suspension of the malar fat pad: a new, minimally invasive and reversible technique for facial symmetrization in permanent facial paralysis]. / A középarc lágy részeinek nasolabialis függesztése: új, minimálinvazív és reverzibilis módszer az arc statikus szimmetrizálására végleges arcidegbénulásban.

Introduction: For the treatment of asymmetry of the midface due to permanent peripheral facial nerve palsy of different etiologies - which means a great psychical burden for the patients - several surgical solutions have been described. Aim: Our goal was to elaborate a minimally invasive surgical technique, that, on one hand, restores an adequate nasolabial fold, which is the most determinative keystone of facial symmetry. On the other hand, our technique can give an appropriate lift for the malar fat pad with shorter operative time and burden, with much lower complication rate and shorter recovery period compared to the classic static sling suspension techniques. Method: Out method is based on the formation of a neo-nasolabial fold, which is then suspended to the temporal fascia by permanent threads thus restoring facial symmetry and giving a lifting effect on the midfacial soft tissues as well. Results: Between 2014 and 2017, six patients had been operated with this nasolabial lifting technique of the malar fat pad without any major complications under local anesthesia on an outpatient basis at our Department. Conclusions: As our surgical exploration is minimal, the postoperative period is shorter, no visible scars remain on the face and the complication rate is negligible. If necessary, suspension could easily be adjusted, and as the technique is reversible, no other possible facial reconstruction methods are excluded. Our method can symmetrize the face in resting position completely on the long term, which is the most important issue for our patients according to their feedback. Orv Hetil. 2019; 160(22): 869-872.

Esthetically Favorable Surgical Alternative for the Removal of Sinonasal Malignant Tumors-The Modified Facial Degloving Technique.

PURPOSE: The widely used external approach (Weber-Fergusson incision) for the removal of maxillary ethmoid tumors leaves stigmatizing scars and deformities on the patient's face. As an alternative technique, the scarless facial degloving approach was first described in the 1970s; since then, several modifications have been developed. PATIENTS AND METHODS: The authors have been using a modified facial degloving technique for 7 years to remove maxillary ethmoid tumors. This article is a retrospective methodologic review. The inclusion criteria for this retrospective study were patients who underwent the modified facial degloving technique for management of malignant maxillary ethmoid tumors. The exclusion criteria were patients who did not undergo a surgical procedure (who received primary chemoradiation therapy) and patients who underwent an endoscopic surgical procedure for an early-stage localized tumor. The authors describe their method, which provides for a wide surgical approach using an osteoplastic flap for the entire nasal and paranasal region, with good cosmetic results. They present the adaptability of their method for 3 malignant maxillary ethmoid tumors in different locations. RESULTS: From 2012 through 2016, 23 consecutive patients underwent surgery with the modified facial degloving approach at the Department of Otorhinolaryngology, Head and Neck Surgery at the University of Szeged (Szeged, Hungary). The authors evaluated their results with acoustic rhinometry and photographic documentation of postoperative facial expressions. Neither narrowing of the nasal cavity on the operated side (loss of nasal breathing function) nor facial movement dysfunction was visible in these patients. CONCLUSION: Although several modifications of the original facial degloving approach have been published, in the present technique, the novel osteoplastic flap and the intact soft tissue of the nasal and midfacial region result in shorter hospitalization time and fewer complications. No functional or esthetic distortion was visible. No severe complications were observed; the patients' only complaint was the dryness of the nasal mucosa and temporary crusting of the nose. The present modified facial degloving technique offers proper and safe surgical resection for tumors of the maxillary ethmoid region. It can be routinely combined with endoscopic techniques and, if necessary, can be converted to an open approach.

Secondary correction of nasal deformities in cleft lip and palate patients: surgical technique and outcome evaluation.

BACKGROUND: Nasal deformity associated with cleft lip and palate is a highly challenging reconstructive problem in rhinoplasty. In the literature, several operative solutions and evaluation methods have been described, however these do not offer a standard procedure for the surgeon. Our aim was to standardize our surgical technique-as much as the uniqueness of each case allowed it-based on the most frequent deformities we had faced; and to evaluate our results via a postoperative patient satisfaction questionnaire. Between 2012 and 2014 12 consecutive patients with combined cleft lip and palate deformities underwent secondary nasal and septal correction surgery with the same method by the same surgeon. The indications of surgery were, on one hand, difficult nasal breathing and altered nasal function (tendency for chronic rhinosinusitis) and on the other hand the aesthetic look of the nose. No exclusion criteria were stated. In our follow-up study we evaluated our results by using a modified Rhinoplasty Outcome Evaluation (ROE) questionnaire: patients answered the same four questions pre- and postoperatively. Data were statistically analyzed by t-test. RESULTS: Based on the questionnaire, all patients experienced improvement of nasal breathing function, improved appearance of the nose and less stigmatization from the society. According to the t-test, all scores of the four questions improved significantly in the postoperative 4-6 months, compared with the preoperative scores. CONCLUSIONS: In our opinion with our standardized surgical steps satisfactory aesthetic and functional results can be achieved. We think the modified ROE questionnaire is an adequate and simple method for the evaluation of our surgical results.

Multidisciplinary management of cervical neuroblastoma in infants.

OBJECTIVES: Neuroblastoma is the most common malignancy in infancy, it is a histologically and genetically heterogeneous tumor, the therapy and outcome of which is influenced by age, histological variant and genetic background as well. METHODS: We present two consecutive infant patients with neuroblastoma of the neck discussing the etiology, the diagnosis and the surgical and oncological treatment of the tumor, which was observed in a relatively rare manifestation in the head-neck region. RESULTS: Our first patient (age: 5.5 months) was MYCN (v-myc myelocytomatosis viral related oncogene, neuroblastoma derived) negative, INSS (International Neuroblastoma Staging System) Stage 3 and INRGSS (International Neuroblastoma Risk Group Staging System) Stage 3 because of the contralateral lymph node involvement while the complete gross resection of the primary tumor mass was feasible. The patient is tumor free after three years of follow-up. Our second patient (age: 5 months) was MYCN negative, INSS Stage 2 and INRGSS Stage 1, as both the primary tumor and the ipsilateral lymph nodes were totally removed via a modified radical neck dissection. The patient is tumor free after three years of follow-up. CONCLUSION: For MYCN negative patients, especially in early age, the prognosis of neuroblastoma is good, surgical resection and chemotherapy together is an adequate treatment protocol (as in our two patients). While MYCN-amplified patients require a combined and aggressive treatment with surgery, chemotherapy, radiotherapy, and immunotherapy to be able to obtain a favorable survival rate according to the literature.

Epicutaneous patch test--a new diagnostic option to prevent the rejection of silicone-covered cochlear implants in children.

OBJECTIVES: Cochlear implantation (CI) is a revolutionary method for hearing rehabilitation in patients with severe or profound sensorineural hearing loss. One of the surgical complications may be the necrosis of the skin flap above the receiver-stimulator coil, resulting in device extrusion. Our aim was to find the plausible causes of the silicone covered implant rejection. PATIENTS AND METHODS: Authors present four cases of cochlear implant rejection, briefly describe their dermato-surgical solutions and analyse their innovative method - the epicutanoeus patch testing with silicone samples. RESULTS: They observed positive skin reaction in three of the four cases. CONCLUSION: Authors analyse the applicability and results of their surgical solutions and the epicutaneous testing in connection with the prevention of skin flap necrosis and rejection of silicone-covered cochlear implants.

Extended lower trapezius myocutaneous flap to cover a deep lateral neck defect on irradiated skin: a new application.

Defects of the skin and underlying soft tissue of the neck are uncommon, and the surgeon's main objective is to achieve reliable long-term coverage of the exposed vital organs with well-vascularised tissue harvested from a distant donor site. We present a patient whose extended irradiation site together with the previous unsuccessful attempt to cover it with a latissimus dorsi myocutaneous flap, needed an extended lower trapezius myocutaneous flap, which seemed to be the only way in which to close the large and deep cervical defect.

Generation, spectroscopy, and structure of cyanoformyl chloride and cyanoformyl bromide, XC(O)CN.

Cyanoformyl chloride and cyanoformyl bromide, XC(O)CN (X = Cl and Br), have been investigated in the gas phase by UV photoelectron and mid-infrared spectroscopies. The ground-state geometries of the neutral molecules have been obtained from quantum-chemical calculations at the B3LYP and CCSD(T) levels using the aug-cc-pVTZ basis set. The individual spectroscopies provide a detailed investigation into the vibrational and electronic character of the molecules and are supported by quantum-chemical calculations. The results are compared to data for structurally and chemically related molecules.

Transoral CO2 laser management for selected supraglottic tumors and neck dissection.

This study aimed to evaluate transoral laser resection as a method of choice for conservation surgery for supraglottic laryngeal carcinoma in carefully selected patients. Between 1987 and 2006, 55 patients with early supraglottic carcinoma were selected for transoral laser surgery. The outcome of the endoscopic CO(2) laser resection and larynx-sparing functional results without tracheotomy was evaluated. Fifty-five patients with T1, T2 supraglottic carcinomas underwent transoral CO(2) laser resection and seven patients with manifest neck metastasis required a neck dissection at one session with additional postoperative radiation therapy. There was no need for tracheotomy; deglutition was moderately disturbed. Forty of the 55 (73%) patients had no signs of recurrence to date. Fifteen patients with local recurrences underwent salvage therapies: six repeated laser excisions, three radiotherapies, four supraglottic laryngectomies and two total laryngectomies. Laser-specific survival is 84% and larynx preservation is 96%. The overall 5-year-survival after salvage treatment is 98%. Development of late metastasis required five radical neck dissections (RND) and radiation therapy. The results indicated that transoral laser resection can control early supraglottic cancer in selected patients and can be combined with simultaneous neck dissection with less morbidity than "open surgery".