[Diagnostic algorithm in patients with cervical metastasis of malignant tumours unknown primary location].

Carcinoma of unknown primary location are heterogeneous group of metastatic tumours where primary location could not be discovered with detail anamnesis, clinical examination and diagnostic procedures. Patients with metastasis carcinoma of unknown primary location in clinical oncology are represent with about 4% of total number of patients with solid tumours. The most frequent location carcinoma of unknown primary location, discovered with autopsy, are lungs, pancreas, colon, kidney, prostate and breast. Metastasis in cervical lymph nodes carcinoma of unknown primary location are represent between 3-9% of total number of patients with head and neck carcinoma. Patients with persistent cervical lymph node should be examined through diagnostical plan "step by step" for identification carcinoma of unknown primary location.

[Preliminary results of applying the inverse stapedotomy].

The authors have analyzed a group of 90 patients (105 operations) that have underwent stapes surgery over three years period. First group of 40 patients (45 operations) have been operated on by a classic stapedotomy from 2006 to 2007 and the second group of 50 patients (60 operations) by inverse stapedotomy in 2007. Manual perforator has been used in all of the patients. In a group of patients operated by inverse technique not a single case of floating basal plate has occurred during surgery. Rate of postoperative complaints regarding nausea and balance disorders was considerably lower when reversal of the steps has been used. Closure of air bone gap better than 20dB in about 80% patients in both series, with slight advantage of the inverse technique, but no statistically significant difference was proven. Inverse stapedotomy is efficient procedure as compared to classic stapedotomy with less intraoperative complications and postoperative complaints. Postoperative audiograms have shown similar improvement of hearing thresholds in both groups.

[Hearing damage caused by noise].

INTRODUCTION: Noise is most common profession risk, as well as risk from environment, for hearing loss. Top limit for industrial noise is 85 dB. OBJECTIVES: Aim of our study was to determined all number of recognized professional diseases in our country, as well as to see which of industries are with highest prevalence of professional hearing damage caused by noise. MATERIALS AND METHOD: We use an cohort study for analyzing patient histories which were hospitalised in the Institute of occupational health. All of them have recognized professional disease hearing loss. In order to be recognized as cases of a professional hearing damage, all of them had to satisfy all legal requirements. RESULTS: Average age of patients with professional damage of cochlear nerve was 50 y. They have high total time period as well as exposed time period. In 2003 and 2004 there was highest number of detected and recognized cases of such professional diseases. More than half of examined patients had lesion between 30 and 40 percent following tables of F. S. Most of them were metal and mining industry workers. CONCLUSION: Following results of the study we can conclude that regular medical examinations of workers in all industries are necessary, specially in metal and mining industry. It is also needed to use personal protection items and to provide appropriate medical education of both workers and the management staff of said industries in order to prevent this kind of profession disease.

[Laser surgery of supraglottic laryngeal carcinoma].

The limited excision addresses small superficial lesions affecting free edge of the epiglottis, the aryepiglottic fold or the superior edge of the arytenoid. The median supraglottic laryngectomy excluding the pre-epiglottic space addresses small superficial T1 lesions of the endolaryngeal epiglottis. The incision line extends to the pre-epiglottic space but does not aim at removing the pre-epiglottic space entirely. The pharyngo-epiglottic folds, aryepiglottic folds, and ventricular folds are preserved. The median supraglottic laryngectomy including the pre-epiglottic space addresses T1 and T2 lesions of the endolaryngeal epiglottis. The entire pre-epiglottic space is removed as far as possible. Depending on extent of the lesion, the resection can include one or two ventricular bands and the aryepiglottic folds. The lateral supraglottic laryngectomy addresses lesions affecting the three folds or T1 and T2 lesions of the aryepiglottic fold. The procedure removes free edge of the epiglottis ipsilateral to the lesion, the area of the three folds and the aryepiglottic fold. The resection can include the inner wall and anterior angle of the pyriform sinus, the entire ventricular fold and the arytenoid (provided it is mobile).

[Functional results of treatment of early carcinoma in the glottic region of the larynx].

Early stage glottic cancer can be successfully treated with open surgery, LASER surgery or radiotherapy. During this treatment the physician obviously has to bear in mind principles of oncological radicality, but also, none the less, the preservation of all the functions of the larynx, and especially the preservation of voice quality. The aim of the study is to compare, in a specifically designed prospective study, the method of treatment with the functional results of basic characteristics of spoken voice of patients with early stage cancer of the glottis region. Then, based on the analysis of the results, to try and determine the most successful method of treatment. The first study group consisted of 72 patients operated using transoral laser microsurgery; the second study group consisted of 75 patients operated using open surgery; and the third study group consisted of 74 patients treated with radiotherapy. The voice quality is much better after laser chordectomy compared to open surgery chordectomy with reconstruction. Furthermore, the functional results of voice quality, after a laser chordectomy, are worse when compared to the group of patients treated with radiotherapy. Taking into account all objective and subjective phoniatric parameters, we determined that there is no crucial difference in the voice quality of patients operated using laser chordectomy and patients primarily treated with radiotherapy. From a functional point of view these two methods are superior to open surgery chordectomy.

[Laser surgery of malignant tumors of the glottic region of the larynx].

The Nomenclature Committee of the European Laryngological Society taken the personal classification used by various members were analyzed and integrated into a common format. Thus, a new classification (Remacle et al., 2000) end next modification (Remacle et al., 2007) in was proposed and accepted by the members. This nomenclature takes into account both the histological and anatomical extent of surgery, and groups it into several categories. Subepithelial cordectomy--excision of the epithelium and the superficial layer of the lamina propria. Subligamentous cordectomy--excision of the epithelium, Reinke's space, and vocal ligament is undertaken. Transmuscular cordectomy--resection consists of the epithelium, lamina propria, and part of the vocal fold muscle, and may extend from the vocal process to the anterior commissure. Total or complete cordectomy--excision extends from the vocal process to the anterior commissure. Anteriorly, the incision is made at the anterior commissure. Type Va extended cordectomy--includes the anterior commissure and contralateral vocal fold, if necessary. In type Vb extended cordectomy, the excision is extended to remove part or all of the arytenoids. The posterior arytenoids mucosa is preserved. In Type Vc extended cordectomy, the whole of the ventricle and the ventricular fold is removed together with the vocal fold. In Type Vd extended cordectomy, surgery is extended inferiorly to include the subglottic mucosa. Type VI cordectomy--Anterior billateral cordectomy in this operation surgical intervention is focused on anterior commissure, therefore some authors name it commissurectomy.

[Bilateral vocal paralysis phonosurgery in adults].

Ordinary clinical manifestation of the patient with bilateral vocal fold paralysis is inability of abducting the cords with a result of narrowing the glottic space, causing inspiratory stridor and mild dysphonia. Such patients can be life threatened due to narrowing airway. Some kind of surgery has to be performed on these patients in order to enlarge the airway. When we treat patients with OPG, the most reasonable way is to gradually enlarge airway at glotic level and there are several surgical methods for achieving this. The least agresive and the safest procedures are posterior transversal cordectomy (PTC) or medial arytenoidectomy (MA), after which we can perform extended versions of some of these methods or combination of both. Bilateral vocal fold paralysis has to be diagnostically different from stenosis of posterior commissure, even though the procedures such as medial arytenoidectomy, posterior transversal cordectomy and total arytenoidectomy can be performed in both cases. The patients have to be explained that the aim of the procedure is to enlarge airway to the detriment of voice quality and voice capabilities.

[Forensic importance of face, mouth, teeth, ear, throat, nose and labyrinth injuries].

Evaluation of bodily injuries and diminished general vital activity from face and facial bones injuries accompanied by scars and disfiguration ranges from 5 to 50 percent depending on the disfiguration, loss of function and degree of aesthetic marring. They are graded accordingly and they may be: mild (5 to 20%), medium (20 to 35%) and serious when the degree of bodily injury and diminished general vital activity is 35 to 50%. Percentage of bodily injuries and diminished general vital activity from jaw defects ranges from 30 to 80 percent depending on the disfiguration, loss of function and degree of aesthetic marring. Percentage of bodily injuries and diminished general vital activity from nose structure nasal pyramid defects ranges from 10 to 20 percent depending on the disfiguration, loss of function and degree of aesthetic marring. Partial loss of nose structure is estimated at 15%, whereas the complete one may go up to 30%. Diminished general vital activity and percentage of bodily injury with partial laryngectomy ranges from 20 to 40%. In case of subtotal laryngectomy, this is up to 60% and with total one, it reaches 80%.

[Postoperative morbidity and quality of live in patients after radical and modified radical neck dissection].

Useful of radical neck dissection would not be questioned if the effects would be perfect. When postoperative morbidity is associated with oncological shortage of radical neck dissection in functional and cosmetics disfunction, looking for a new therapeutics procedures are justify. In our study were 319 patients. They were treated in period from 01 January 2000 to 31 December 2002. The follow-up was 5 year. We tried to consolidate distribition of n. accesorius operative injuries in modified radical neck dissection and relationship beetwen shoulder pain and shoulder droop after modified and radical neck dissection. Injured n.accesorius in modified radical neck dissection was significantly decreased in patients with modified radical neck dissection. The frequence of patients is significantly different (chi m2=26.662; df = 1; p<0.01) in categories of complications of n.accesorius (shoulder pain, shoulder droop). Shoulder pain and shoulder droop were significantly decreased in modified radical neck dissection (p<0.01).