Jejunal and ileocolic free flaps for digestive tract reconstruction following pharyngo-laryngo-oesophagectomy - 30 years of single-centre experience.

INTRODUCTION: Hypopharyngeal cancer accounts for 3-5% of all squamous-cell carcinoma (SCC) of the head and neck and has one of the worst prognoses. The aim of the study was to evaluate oncologic and functional treatment outcomes in patients with T3-T4a squamous cell hypopharyngeal and laryngeal cancer. MATERIAL AND METHODS: Retrospective analysis of the material from one treatment site included 90 patients (81 male, 9 female) who had undergone surgery between 1986 and 2010. Their mean age was 55.06 years (range 36-75). RESULTS: TNM (T - tumour, N - node, M - metastasis) staging assessment was feasible in 70 treatment-naïve patients (77.78%): 57 (63.33%) were classified to stage T4a, and 13 were classified to T3 (14.44%). Cervical lymphadenopathy was observed in 53 (63.3%) patients; in 44 patients (48.89%) postoperative histopathology confirmed metastatic disease. G2 or G3 SCC was detected in 80% of patients. All patients underwent laryngopharyngoesophagectomy (LPE). Digestive tract reconstruction was performed using one of two methods: jejunal autograft (JA) in 79 patients (87.78 %) - Group A or ileocolic autograft (IA) in 11 patients (12.22%) - Group B. Comparative statistical analysis of both groups showed statistically significant differences only for substitute speech production. The mean survival time of patients from both groups was 2.21 years after reconstruction surgery. CONCLUSIONS: JA or IA for digestive tract reconstruction in patients after LPE are burdened with high risk of complications but offer patients the chance of a normal oral diet shortly after surgery. Ileocolic autograft enables rapid production of substitute speech.

[Malignant mixed tumors of the parotid gland: a review of the Department of Otolaryngology Medical University of Warsaw experience]. / Zlosliwe gruczolaki wielopostaciowe slinianki przyusznej w materiale Kliniki Otolaryngologii Warszawskiego Uniwersytetu Medycznego.

OBJECTIVES: Pleomorphic adenoma (PA), or benign mixed tumor, is the most common salivary gland neoplasm. One of the factors influencing the management strategy in parotid PA is the risk of malignant transformation of this tumor. The objective of this study was the clinical and pathological analysis of malignant mixed tumors treated surgically at the Department of Otolaryngology, Medical University of Warsaw. MATERIALS AND METHODS: Retrospectively analysed clinical material included 12 patients with malignant mixed tumors selected from the group of 423 patients who underwent surgical treatment for parotid pleomorphic adenoma at the Department of Otolaryngology, Medical University of Warsaw, between January 1988 and June 2010. There were 7 women and 5 men; age ranged from 39 to 67 years, with a mean of 56 years. The following parameters were analysed: demographic data, symptoms and disease duration, results of diagnostic tests, intraoperative data, results of histopathological examination, and adjunctive therapy. Four patients with a follow-up shorter than 5 years were excluded from the analysis of treatment results. RESULTS: A group of 12 patients with malignant mixed tumours included 10 (83.3%) cases of a primary tumor and 2 (16.7%) cases of a recurrent tumor. In the complete study sample (n=423), patients with malignant mixed tumor comprised: 2.8% of all patients, 2.5% of patients with primary PA and 5.1% of patients with recurrent PA. Patients with malignant mixed tumor were significantly older than patients with benign PA (an average patient age was 56.0 and 43.2 years, respectively p<0.001). 83.3% (n=10) patients were older than 50 years. An average disease duration was longer in patients with malignant tumors. Considering all data from preoperative patient assessment (medical history, physical examination, FNAB, imaging studies), a preliminary diagnosis of malignant disease was made in 6 (50%) patients. All patients were treated surgically and 10 also had radiation therapy. The group of patients (n=8), subjected to evaluation of treatment results, included three patients with non-invasive carcinoma and five patients with invasive carcinoma. All patients with non-invasive carcinoma were free from disease symptoms during the follow-up of 9 to 21 years after the treatment. Five-year survival was 80% (4 of 5 patients) in a group of patients with invasive carcinoma. The rate of death for the underlying disease was the same (80%). An overall 5-year survival in patients with malignant mixed tumor was 87.5%. CONCLUSIONS: 1. Malignant transformation of pleomorphic adenoma more frequently occurs in recurrent tumors and in older patients. 2. Uncharacteristic clinical picture of malignant mixed tumors allows to make an accurate initial diagnosis only in half of the patients. 3. Extracapsular cancer invasion is a vital prognostic factor. Overall 5-year survival for invasive and noninvasive carcinoma was 80 % and 100 % respectively.

[Our experience in the use of anterolateral thigh flap for reconstruction of the head and neck neoplasms]. / Doswiadczenia wlasne w zastosowaniu wolnych platów udowych w rekonstrukcji ubytków po rozleglych operacjach nowotworów zlosliwych glowy i szyi.

INTRODUCTION: Free flaps with vascular anastomosis have been widely used in clinical practice for more than 30 years. They are standard in reconstructive surgery following extensive resections caused by neoplasms of the head and neck. The anterolateral thigh flap (ALT) constitutes very good reconstructive material due to the long vascular pedicle, the appropriate diameter of vessels, the large skin island plane, and thickness depending on requirements. MATERIAL: The own material comprises 5 patients who have had extensive neoplastic infiltrations removed at different anatomic locations within the area of healthy tissue. RESULTS: Reconstructions have been conducted using a microvascular thigh flap (ALT). All of the operated patients are under constant supervision. The observation period ranges from 2 to 3 months. No recurrence of the neoplastic process or graft rejection has been observed in any of the patients.

[Adenoid cystic carcinoma of the head and neck--a 10 years experience]. / Rak gruczolowato-torbielowaty glowy i szyi--doswiadczenie 10 lat.

INTRODUCTION: Adenoid cystic carcinoma (ACC) was first described in 1853 and 1854 by three french scientists, Robin, Lorain and Laboulbène. ACC is a rare cancer of the head and neck (about 1%) and it comprises from 6% to 10% of all malignant tumors of the salivary glands. 15%­30% of these tumors are located in submandibular gland, 30% occur in small salivary glands (in the palate, tongue, mouth, nose, sinuses, mucous membrane of the cheeks) and about 6% in parotid gland. Because of its specificity ACC is a challenge for the doctor ­ it is usually recognized at an advanced stage, spreads along the nerves, it has a high propensity for recurrence, often gives distant metastases, 10-year survival are very small. AIMS: Aim of this study is the epidemiological and clinical analysis of patients with adenoid cystic carcinoma. MATERIAL AND METHODS: Includes a retrospective analysis of 21 cases of patients with ACC of the head and neck were hospitalized at the ENT Clinic of the Warsaw Medical University between 2001 and 2011. Data from medical records contain information about the location of the tumor, symptoms and clinical signs, diagnostic methods, method of treatment and local recurrences and distant metastases. RESULTS: most cases ACC occurred in the large salivary glands (14 cases), in 5 cases in the nasal cavity and maxillofacial region, in 2 cases in the tongue. In order to accurately determine the extent of the tumor, its relationship to adjacent structures was performed computed tomography and magnetic resonance imaging. Most of patients before treatment have been made biopsy of the tumor or download tissues by forceps for histopathological examination. Reported symptoms depend on the location of the tumor. In 20 cases the patients were treated by surgical therapy and followed by radiotherapy, in one case because of the extent of the tumor was sent to radiotherapy. CONCLUSIONS: Surgical treatment of ACC requires a wide margin of healthy tissues; For the risk of local recurrences affected positive surgical margins, skull base locations of primary tumor and perineural invasion; Because of unpredictable nature of the tumor (local recurrences, distant metastasis), observation of patients after treatment should be carried out permanently, along with periodic imaging studies.

[Pharyngocutaneous fistula as a complication after total laryngectomy--clinical study and literature review]. / Przetoki skórne jako powiklanie po laryngektomii calkowitej--analiza materialu Kliniki Otolaryngologii WUM i przeglad pismiennictwa.

UNLABELLED: Pharyngocutaneous fistula is an important therapeutic problem. It occurs in approximately 20% of cases as a complication after total laryngectomy, performed due to the larynx and/or hypopharynx cancer. The process of fistulas' conservative treatment is very long and sometimes reconstructive surgery of the pharynx and esophagus is necessary. Clinically, it is desirable to isolate a group of patients with risk factors of this complication. Numerous pathologies implicated in fistula formation are mentioned in the literature: wound infection, radiotherapy prior to surgery, hypoalbuminaemia, concomitant general diseases, postoperative anemia, location of the cancer in larynx and many others. OBJECTIVE: This paper analyzes the incidence and etiology of cutaneous fistulas after total laryngectomies as well as overall characterization of risk factors on the basis of the material collected by the Department of Otolaryngology Medical University of Warsaw between the years 2006-2011. Furthermore, an analysis of the literature on cutaneous fistula after total laryngectomy of the last 10 years was performed. MATERIAL AND METHODS: A retrospective analysis of medical records of patients with laryngeal and hypopharyngeal cancer, treated with total laryngectomy was performed. 12 patients developed cutaneous fistula in the early postoperative period. RESULTS: The mean time of appearance of fistula after total laryngectomy was 19.3 days. In most cases, conservative management was used to obtain fistulas' closure - after an average of 32.5 days. For two patients operative closure was needed. Microbiological study confirmed the infection in the region of the fistula in 10 patients. There were identified different pathogens, both aerobic and anaerobic bacteria and fungi. 3 patients with a fistula were preoperatively irradiated. The most common location of the cancer in this group was supraglottic area and piriform recessus (8/12 patients). CONCLUSIONS: The pathogenesis of cutaneous fistula as a complication after total laryngectomy seems to be complex. The most significant risk factors for fistula formation are: radiotherapy, supraglottic location of the tumor, extension of the surgery to the pharynx and malnutrition of the patient. Postoperative wound infection favors the formation of fistulas and extends their healing time. It seems reasonable to plan the surgery with the reconstruction of the pharynx for patients with several risk factors of fistulas' onset.

[Complications of parotid surgery for pleomorphic adenomas]. / Powiklania leczenia chirurgicznego gruczolaka wielopostaciowego slinianki przyusznej.

OBJECTIVES: Surgery for benign parotid tumours is associated with potential sequelae which may significantly deteriorate patient's quality of life. Sometimes the pursuit of reducing the risk of these complications induces surgeon to limit the extent of the parotid gland removed with a tumour. This may lead to a decrease in tumour local control which is especially true for pleomorphic adenoma. The purpose of this study was to evaluate the incidence of complications after certain types of parotid surgery for primary pleomorphic adenomas and to analyse risk factors related to their occurrence. MATERIALS AND METHODS: The medical records of 386 consecutive patients (250 women and 136 men) operated on for primary pleomorphic adenoma between the years 1988 and 2008 at the Otolaryngology Department, Medical University of Warsaw, were reviewed. RESULTS: Postoperative facial nerve impairment was the most common complication of parotid surgery for primary pleomorphic adenomas (found in 84 [21.8%] of patients). The other adverse effects of this type of surgery included: sialocele (12.2%), salivary fistula (6.7%), Frey's syndrome (6.2%), and hematoma (2.8%). Significantly more often iatrogenic facial nerve injury was encountered in women and in the elderly. Impaired function of the facial nerve was found more commonly after total parotidectomy (41.9%; p<0.001), and least commonly after extracapsular tumour resection (4.8%; p=0.036). The lack of sialoceles and salivary fistulas after extracapsular tumour resection and isolated deep parotidectomy was symptomatic. CONCLUSIONS: Impairment of the facial nerve function is the most common complication of surgical treatment of primary pleomorphic adenomas. Statistically significant risk factors of postoperative facial nerve dysfunction include: female gender; older patient age, tumour location in the deep lobe, type of surgical procedure (total parotidectomy). Some decrease in the incidence of sialoceles and salivary fistulas may be achieved by preservation of the Stensen's duct or by radical resection of glandular tissue.

[Benign parapharyngeal space tumors]. / Guzy lagodne przestrzeni przygardlowej.

INTRODUCTION: Parapharyngeal space tumors are rare and represent from 0.5% to 1% of all head and neck tumors. Benign tumors occur in about 80% of all cases and the remaining 20% are malignant tumors. Most of the tumors derive from salivary glands or neural tissue (about 75%), the next 25% have other histopathological origin. Because of poor, late signs and symptoms, and difficult surgical approaches, the tumors of this region are a diagnostical and surgical challenge for every doctor. THE AIM OF STUDY: Epidemiological and clinical analysis of patients with benign tumors of the parapharyngeal space. MATERIAL AND METHODS: Includes a retrospective analysis of 16 patients hospitalized and treated at the ENT Clinic of the Warsaw Medical University between 2001 and 2010 with confirmed benign tumors of the parapharyngeal space. The data from medical records contain informations about signs and symptoms, diagnostic techniques, surgical approaches, complications and histopathological results. CONCLUSIONS: The most frequently reported symptoms included: discomfort and a sensation of a foreign body in the throat. Some patients complained about having difficulty swallowing, hearing problems, and hoarseness. In most cases, the tumor remained symptomless and was discovered only during medical examination. The clinical symptoms usually included a tumor in the throat and/or the neck. To precisely determine the location and nature of the tumor, and its relationship to adjacent structures, computed tomography and magnetic resonance imaging were performed (and angiography in a few cases). All patients received surgical treatment. The type of surgical approach depended on the location of the tumor, its size and relationship to large vessels and nerves. Usually, it was transcervical and transparotid approach. In one case, combined transoral-transcervical approach was used with lateral mandibulectomy. In the histopathological examination, tumors had mainly originated from a part of the salivary gland and nerve tissue.

[The advanced hypopharyngeal cancers surgery treatment complications]. / Powiklania po chirurgicznym leczeniu zaawansowanych raków gardla dolnego.

INTRODUCTION: Hypopharynx is the anatomical region created by strictly functionally connected regions: two pyriform sinuses, retrocricoid region and the posterior pharyngeal wall on its level. Hypopharyngeal Cancer is in 95% planoepithelial carcinoma, it constitute about 5-10% of all malignant tumors of the upper part of digestive tract and the respiratory system. Occult early symptoms make it advanced stages detectible. It easily spreads in to surrounding anatomical structures such as: larynx, oral cavity, oropharynx, esophagus, prevertebral space. It gives relatively quick and common metastases to lymph nodes (opposed or both sites). AIM: The aim of our study is to analyze the complications of the advanced hypopharyngeal tumor surgery. MATERIAL AND METHODS: Material was 53 patients treated for advanced hypopharyngeal cancer (or hypopharyngeal cancer with larynx and cervical part of esophagus involved), in Otolaryngology Clinic, Medical University of Warsaw, between 1999 and 2010. We performed the circular removal of hypopharynx, cervical part of esophagus and larynx with concomitant digestive tract reconstruction by autotransplantation of the jejunum (41 cases) or the ileocecal segment (12 cases). In most cases surgery was extended to lymph nodes removal. CONCLUSION: In our group of patients we had complications such as: Intraoperative complications of surgery - the intestine transplant ischemia. Early post operative complications - transplant ischemia, salivary fistula, hematoma of postoperative cavity (without necrosis of the transplant), massive arterial anastomosis bleeding, and wound infection. Late postoperative complications - late salivary fistula, tracheostomy stenosis, local tumor recurrence, spread of the cancer and swallowing disorder. The different complications were very uncommon.

[Management of recurrent pleomorphic adenoma of the parotid gland: analysis of the material of Otolaryngology Department, Medical University of Warsaw between 1998 and 2008]. / Postepowanie z nawrotowym gruczolakiem wielopostaciowym slinianek przyusznych: analiza materialu Kliniki Otolaryngologii WUM od 1988 do 2008 roku.

OBJECTIVES: Treatment of patients with recurrent pleomorphic adenoma of the parotid gland is a challenge for a surgeon due to frequent problems with complete resection of all tumour foci while preserving continuity and function of the facial nerve. The aim of this study was to evaluate the clinical presentation and treatment results of patients with recurrent pleomorphic adenoma of the parotid gland. MATERIALS AND METHODS: The medical records of 35 patients (25 women and 10 men) operated on (44 operations) for recurrent pleomorphic adenoma between the years 1988 and 2008 at the Otolaryngology Department, Medical University of Warsaw, were reviewed. These patients accounted for 8.9% of all patients treated for pleomorphic adenoma of the parotid gland (N=395). A retrospective analysis was performed to examine clinical features, surgical technique and facial nerve management. RESULTS: All patients had palpable, nontender mass or masses in a parotid bed after 1 to 5 previous operations. Multifocal recurrences were present in 79.5% of cases. Median interval between initial treatment and commencement of recurrences was 6.1 (0.25-29) years. Patients with more than one recurrence were younger than patients who had only one. Malignant transformation of recurrent pleomorphic adenoma was observed in two patients (5.7%). Postoperative facial nerve paresis occurred in 15 cases. In two additional cases eradication of recurrent tumour required the facial nerve resection and reconstruction. CONCLUSIONS: Recurrent pleomorphic adenoma occurs more often in younger patients and women. The risk of the facial nerve injury increases with each successive operation. Surgical treatment should be individualized, taking into consideration the extent of the previous surgery and the type of recurrence.

[Management of recurrent sinonasal inverted papilloma in the experience of ENT Department Medical University of Warsaw]. / Postepowanie w przypadkach wznowy brodawczaka odwróconego nosa i zatok przynosowych po leczeniu operacyjnym w materiale Kliniki Otolaryngologii Warszawskiego Uniwersytetu Medycznego.

INTRODUCTION: Inverted papilloma is benign epidermal neoplasm of not recognized etiology. The lesion is estimated to represent 0.5-4% of sinonasal tumors. Generally inverted papilloma is unilateral, arises from the lateral nasal wall and characterizes with local destruction and rapid growth. The tumor can possibly undergo malignant transformation. The treatment of choice is surgery, recently endoscopic approach is considered to be superior to the open approach. THE AIM OF STUDY: was evaluation of recurrent inverted papilloma treatment results in the experience of Otolaryngology Department, Medical University of Warsaw, from 1982 to 2009. MATERIAL: The group of 124 patient (66 men and 58 women) aged from 26 to 79 with inverted papilloma operated between 1982 and 2009 were enrolled in the study. Follow up was from 6 months to 27 years. RESULTS: Most common primary localization of the tumor was combined lateral nasal wall and maxillary sinus (42%). In 37% the lesion involved unilaterally the lateral nasal wall, maxillary sinus and ethmoid sinuses, rarely it was localized only in the lateral nasal wall (16.1%) and exclusively in the nasal septum (4.8%). All the patients were treated surgically, 46% of patients underwent endoscopic procedure, 37.1% lateral rhinotomy, 15% Denker rhinotomy and 1.6% midfacial degloving. Recurrence was observed in 15.3% including 57.9% after endoscopic surgery, 26% after Denker operation and 15.8% after lateral rhinotomy. Malignant transformation was observed in 5 patient (4%). All the patients with recurrent inverted papilloma were treated surgically, 5.3% of patient underwent midfacial degloving, 5.3% Caldwell-Luc operation, 10.5% endoscopic procedure, 26.3% Denker operation and 52.6% lateral rhinotomy. CONCLUSIONS: 1. Endonasal and open approach should be considered in the surgical treatment of recurrent inverted papilloma. 2. Endoscopic approach is preferred in the recent years but qualification for each method should depend on lesion localization, extent and volume. 3. Regular follow-up enables early recurrence diagnosis and treatment.

[Abscess of the parotid gland]. / Ropien slinianki przyusznej.

Inflammatory processes developing in the region of parotid gland can be specific or non-specific. Non-specific inflammation of bacterial or viral origin, which almost always are secondary to inflammatory processes in the region of oral cavity and pharynx, can be caused by presence of sialoliths in parotid gland or in the excretory duct. In the paper we presented 11 patients treated for the reason of parotid gland abscesses. Etiology, the course of the disease, and the method of treatment were analyzed.

[Reconstruction of the nose after oncological operations]. / Rekonstrukcje ubytków nosa po operacjach onkologicznych w materiale Kliniki Otolaryngologii Warszawskiego Uniwersytetu Medycznego w latach 1998-2007.

INTRODUCTION: Skin cancer (basal cell carcinoma, squamous cell carcinoma) and melanoma are the most frequent malignancy appearing in a human begin. The treatment of choice is surgical excision of tumor with margins of healthy tissue. An extent of resection determines the method of reconstruction. MATERIAL: The authors present reconstructive methods of nasal skin cancer defects performed in 61 patients treated in the Department of Otolaryngology of Medical University of Warsaw between 1998 and 2007. Basal cell carcinoma, squamous cell carcinoma and melanoma were diagnosed in 49, 10 and 2 patients respectively. Depending on the extend of tumor resection different reconstructive techniques were performed. RESULTS: In 9 patient tumor recurrence was detected during 1-2 years of follow-up. Among them, in 7 patients another reconstruction procedure was required, and 1 patient underwent several surgical procedures due to subsequent recurrences. CONCLUSIONS: Surgical wounds after resection of skin cancer of the nose can be closed primarily or by means of variety of reconstructive techniques that in some cases may be combined depending on the extent of a defect.

[Bilateral internal jugular vein thrombosis following treatment of laryngeal carcinoma--a case report]. / Przypadek obustronnej zakrzepicy zyly szyjnej wewnetrznej w przebiegu raka krtani.

The authors present the case of bilateral internal jugular vein thrombosis, which was diagnosed in a patient after combined therapy (surgery and radiotherapy) because of laryngeal carcinoma. Thrombosis is the frequent complication and the second largest death cause from neoplasms. In review of the literature the cases of bilateral internal jugular vein thrombosis are uncommon. Jugular vein thrombosis has previously been reported in association with deep head and neck infections, sepsis, central vein catherization and the neck injuries. Because of that the presented case of internal jugular vein thrombosis seems to be interesting.