Primary surgical treatment versus salvage surgery: Results of free flap reconstruction performed in 100 patients with oropharyngeal cancer.

This research sought to analyze the functional results of free flap reconstruction in two groups of patients with head and neck cancer: first group started with radiochemotherapy followed by reconstructive surgery, second group underwent initiative surgery. MATERIALS AND METHODS: In a group of 100 patients, surgery was used as the primary form of treatment in 55 (55%) patients, and the remaining 45 patients (45%) had chemoradiotherapy introduced first. Statistical analysis was performed with Statistica v. 12. The chi-square test and test of proportion were used for categorical data. Student's t-test was used for continuous data. Probability of survival was calculated using the Kaplan-Meier method where the censoring variable was time to death. To compare survival between cohorts, we used the Cox's test. The level of significance was set at p < 0.05. RESULTS AND CONCLUSIONS: Initial radiochemotherapy prior to surgical treatment indicated an increased risk of local tumor recurrence, flap degeneration, and other local complications.

One-Step Laryngotracheal Reconstruction With Prefabricated Corticoperiosteal Flap.

Large airway reconstruction is difficult and requires a flap that will mirror the tissue variety. The main challenge is to keep the reconstruction stable and prevent collapse. In this report, we present a laryngotracheal reconstruction with a buccal mucosa-prefabricated medial femoral condyle free flap, after chondroma excision in a 1-step procedure. Functional results are promising and were confirmed by endoscopy and computed tomography examination 12 months postoperatively. This reconstruction-with-prefabrication technique, among others, may be used in the reconstruction of different regions like craniofacial bone defects, apart from larynx and trachea.

Functional results after total cricoidectomy with medial femoral condyle free flap reconstruction.

Our goal was to describe a laryngeal-preserving single-stage procedure for the treatment of low-grade chondrosarcomas of the larynx: a total cricoidectomy with medial femoral condyle flap reconstruction. The study was designed as a case series of three consecutive patients with low-grade chondrosarcomas of the cricoid cartilage lamina, diameter 4.4, 5.2, 3.8 cm, respectively, who underwent total cricoidectomy in 2012. Single-staged reconstruction of the defect with medial femoral condyle flap including the periosteum and thin underlying cortical layer of the bone was conducted. Oncologic and functional results were observed during 3 years of follow-up. No evidence of tumor recurrence was detected during follow-up. One month after surgery, all patients were able to tolerate a soft diet and to speak satisfactorily. None of the patients reported aspiration after surgery nor experienced aspiration-related problems, which was confirmed by means of the Leipzig-Pearson scale. The speech ability was good, maximum phonation time was 14, 18, 21 s, respectively, and the voice handicap index scores ranged from 24 to 36 and had improved noticeably at 1, 3 and 6 months follow-up. Two patients were ultimately decannulated, and one female still has a tracheostomy; however, she is able to keep the tracheostoma closed for most of the time, maintaining good phonatory and swallowing functions. Total cricoidectomy with reconstruction by means of medial femoral condyle flap may replace the total laryngectomy in large low-grade chondrosarcomas of the cricoid cartilage.

The reconstruction of large laryngeal defect with medial condyle femur corticoperiosteal free flap--a case report.

The larynx is a complicated organ with very important functions. Reconstructive operations of the larynx often result in some function reduction caused by scars and stenoses. The aim of this report is to present the results of the one-stage reconstructive operation after a large excision of the chondrosarcoma of the larynx. The patient was male, aged 48 with the history of the operation of the highly mature cartilaginous sarcoma of the thyroid on the right side with tumor recurrence. The one-stage reconstructive surgery using medial condyle femur corticoperiosteal free flap which reshaped the cartilage scaffold and restored an inner layer as the mucosa was made. The flap survived without local and systemic complications. Six months follow-up revealed no local recurrence and good breathing results. There was no restriction of movement of the lower limbs. The patient returned to work previously performed. Results were shown in endoscopic examinations and computer tomography. The medial condyle femur corticoperiosteal free flap may be an option for reconstruction of large laryngeal defect with restoring its shape and inner layers.

The double opposing myomucosal cheek flap in hard palate reconstruction.

Limited defects in the oral cavity can be treated with local and pedicled cheek flaps. It allows to preserve the functions of the resected organ. Large defects in the midline of the hard palate can be reconstructed with double opposing myomucosal cheek flaps. The aim of this study was to discuss the methodology of the flap harvest and to show our experiences of treatment in a group of 15 patients with oral cavity cancer. In 1 patient the double opposing myomucosal cheek flap was harvested due to the wider local defect. The small size of the flap with ability to use the double opposing cheek flap in more extended defects as well as short duration of the surgery procedure can lead to reduced risk of postoperative complications. Finally, cheek flaps form an effective method of treatment of defects in the oral cavity.

Supraclavicular artery pedicled flap in reconstruction of pharyngocutaneous fitulas after total laryngectomy.

The aim of the study was to analyze the efficacy of treatment of closure of cutaneopharyngeal fistulas, following total laryngectomy, using a fasciocutaneous flap. In the group of 6 patients treated in years 2013-2014, in 4 (67%) patients the healing process was successful, in one patient complete flap necrosis was noted on the 6th day, in another patient a small cutaneopharyngeal fistula was recognized, which closed secondarily with no intervention. Flaps of this type, having a small risk of local complications at donor site and satisfactory functional and aesthetic results, may be an alternative form of flap to others used in the reconstruction of superficial deficits in the head and neck areas.

Evaluation of outcomes after reoperative neck dissection due to thyroid cancer.

AIM OF THE STUDY: Aim of the study was to assess the results of surgical treatment of cervical recurrences in patients with thyroid cancer. MATERIAL AND METHODS: We assessed 66 reoperations of thyroid cancer recurrences in 51 patients. Reoperative surgeries covered I-VII neck levels. RESULTS AND CONCLUSIONS: The localization of cervical recurrence and the number of removed nodes did not depend on the type of thyroid cancer. Metastatic spread was predominantly observed in the central neck. Bilateral changes tended to be observed more often in younger patients (p = 0.07). Radical neck dissections were performed more often at younger age (p < 0.01). Postoperative vocal cord paresis was noted in 13 patients; in 5 permanent tracheotomy was necessary, and 2 underwent laser glottis procedures (posterior cordectomies). Two patients died in the postoperative period - 1 due to chylothorax and 1 due to severe bleeding from the common carotid artery.

[Salvage surgery in unresectable tumors of the neck. Outcome after ligation of the common carotid artery]. / Operacje ratujace w nieresekcyjnych guzach szyi. Wyniki leczenia po podwiazaniu tetnicy szyjnej wspólnej.

The aim of this study was to analyze two cases with advance tumors of the neck with infiltration of the common or internal carotid artery. Patients were surgically treated in Department of Otolaryngology Poznan University of Medical Sciences. Authors present the current state of knowledge concerning the proceedings in unresectable tumors of the neck and possibility to use the salvage surgery. Based on literature data and our own experience a risk of the carotid artery infiltrations is difficult to assay in diagnostic procedure. It decrease the possibility of radical surgery resection and indicate the most advance stage. Choosing the proper treatment requires interdisciplinary cooperation: ENT specialist, radiologist, vascular surgeon and oncologist. The high rate of complications and local recurrence rate makes the results of treatment are unsatisfactory.

[Reconstructive surgery in huge tumors of salivary glands]. / Zabiegi rekonstrukcyjne w wielkich guzach gruczolów slinowych.

OBJECTIVE: Evaluation the outcome after extensive surgery of salivary glands tumors with simultaneous reconstruction of soft tissue and skin defect. MATERIAL: In the period 2007-2011, surgery treatments performed in 295 of major salivary glands. 31 patients underwent surgery due to malignant parotid gland tumors: 19 women (61%) and 12 men (39%). In 8 (26%) presented skin infiltration. 10 (32%) patients had facial palsy between II-IV degree (House Brackmann scale). The radiographic findings in some patients showed infiltration of the deep lobe of parotid gland, external auditory canal, infiltration of mastoid process, skull base and the subtemporal fossa. METHODS: Of the 31 patients in 13 (42%) reconstruction techniques with muscle cutaneous trapezius flap were applied in 4 (31%) patients. In group of 7 (54%) patients using a muscle flap based on the sterno-cleido-gland, in 2 (15%) patients defects were covered using the free anterior lateral thigh flap. RESULTS: In all patients, healing proceeded normally. In the operated patients, one patient did not receive radical surgery due to the infiltration of the skull base. Length of hospitalization ranged between 7-21 days. In no case was lost flap, also there was no local complications at the donor. CONCLUSIONS: The choice of treatment for malignant parotid gland tumors which are usually radioresistant is surgical resection. In patients with extensive tumors with infiltration of neighbouring organs reconstruction with use of distant flaps are recommended. It provides a good oncological and aesthetic result.

Variable course of progression of oral cavity and oropharyngeal carcinoma in young adults.

AIM OF THE STUDY: The main aim of this article is the epidemiological analysis of patients treated due to oral and oropharyngeal cancer, with a special interest in the group under the age of 40, evaluation of the differences in the clinical course of the disease as well as assessment of the treatment results, regarding the age of the affected individuals. MATERIAL AND METHODS: 523 individuals affected by oral and oropharyngeal cancer who were treated in the Otolaryngology and Laryngeal Oncology Department between 2000 and 2008. Precise analysis was performed on 360 out of 523 affected individuals, in whom full clinical status was determined; 13 patients were young adults. The retrospective analysis was created based on case histories, surgical protocols and emergency records. RESULTS: In young adults there is a markedly increased risk of organ involvement according to the Mann-Whitney U-test analysis (p = 0.044907). The probability of recurrence in the group of young adults is also much higher. Analysis of Kaplan-Meier test results indicated that the chance for the lack of recurrence within a 6-month period was 85.7%; however, the risk of recurrence increased, and after 12 months was equal to the arithmetic data (50%). CONCLUSIONS: Among young adults there is an increased risk of local recurrence following 12 months after surgical intervention. According to our observations, despite rapid progression and early recurrence in young adults (4/7) the prognosis for both groups is not statistically different.

[Cost effectiveness of a free forearm flap in reconstruction of the oral cavity and pharynx--the donor site complications]. / Cena uzyskania wolnego plata przedramienia w rekonstrukcjach w obrebie jamy ustnej i gardla--powiklania miejsca donorowego.

PURPOSE: Evaluation of the donor site efficiency in patients after reconstructive surgery with use of free forearm flap. All patients were treated for oral cavity and larynx cancer. MATERIALS AND METHODS: a group of 21 patients (16 men and 5 women) treated in 2007-2011. The retrospective analysis was conducted on the anamnesis, operating protocols, physical examination and a questionnaire, there was completed by patients during a routine ENT follow up examination. The PRWE (Patient Rated Wrist Evaluation) subjective questionnaire was used to estimate the rate of pain severity and wrist mobility. RESULTS: In 59% of patients the wrist was healed primary, in 36% of patients by granulation. In all patients the wound was healed satisfactory in follow up examination, but 60% of patients revealed extensive scars formation. 62% of patients showed no local pain at rest, while in 38% of them worsening of symptoms was noticed--average 0.5/10 (median 1.0). Pain was more intense in patients who did basic motor activity of hands approximately 1/10 and lifting weights averaging 2.1/10. Dysfunction of the wrist was at the level of the average value of 4.2/50. CONCLUSIONS: Surgical reconstruction with a use of the free forearm flap is associated with the formation of extensive wrist scars. The risk of local complications is low while preserving the qualification protocol, postoperative care and proper surgical management. Reconstructive surgery based on the free forearm flaps gives satisfactory functional results of the donor site. However, it requires surgical experience and practical knowledge of anatomy.

[Buccal flap in reconstruction of mucosal defects in oral cavity]. / Plat policzkowy do rekonstrukcji ubytków blony sluzowej jamy ustnej.

INTRODUCTION: The buccal flaps are an effective alternative in treatment patients with small defects of the oral cavity due to: the small size of the flap, the lack of donor site, less risk of postoperative complications and short procedure time. MATERIAL AND METHODS: In the Department of Otolaryngology and Laryngological Oncology in Poznan in the years 2005-2008 was performed 7 resections of oral cavity due to cancer in which the reconstructions were based on two types of flaps: from the buccal mucosa (3 patients), and muscular-buccal mucosal flap (4 cases). The paper presents aspects of the anatomical structure of the cheek and technique for flap dissection. RESULTS AND CONCLUSIONS: In the majority group of patients the primary defect healing properly. The mucosal buccal flaps are a good alternative to free flaps, but their indications are limited to the primary defects of small extent.

[Paranasal sinuses melanoma--a case report]. / Czerniak zlosliwy zatok przynosowych--opis przypadku.

The malignant melanoma has been presented in majority in the skin location. The mucosal form of melanoma is extremely rare, the localisation involving the structures of paranasal sinuses is the most frequent location according to head and neck region. The authors present the patients case with that location of illness.

[Difficulty in diagnostic procedure in the malignant fibrous histiocytomas of larynx]. / Trudnosci diagnostyczne w przebiegu miesaka polimorficznego krtani.

Malignant fibrous histiocytomas (MFH) of the upper respiratory tract are rare, aggressive mesenchymal neoplasms. Ultrastructurally MFH consisted of five different types of cells. It occurs principally as a mass of the extremities, abdominal cavity, or retroperitoneum in adults. There have been sporadic laryngeal cases reported in the literature. We report a case of a glottic malignant fibrous histiocytoma on a 45 year old man. There was difficulty to find finally diagnosis. Pathologic and immunohistochemical evaluation revealed tumor a few months after first symptoms. There was unilateral metastases into the neck lymph nodes. Immunohistochemical staining was positive for F13a, CD68 and negative for desmin and cytokeratin. Wide, aggressive excision of the tumour with total larygectomy to be the treatment of choice because it was difficult to prove clinically and pathologically that it was MFH. Unilateral neck dissection was done due to metastases into the neck lymph nodes. Radiation have been used after surgery. About two years after total laryngectomy the patient is well and free of disease.

[Distribution of alcohol dehydrogenase (ADH1C) genotypes in subjects with tobacco smoke-associated laryngeal cancer]. / Rozklad genotypów dehydrogenazy alkoholowej (ADH1C) u chorych na tytonio- zaleznego plaskonablonkowego raka krtani.

Laryngeal cancer in Poland is characterized by high levels of morbidity and mortality. The main risk factors for the larynx cancer are alcohol drinking and tobacco smoking. In contrary to well established tobacco-related evidence for an increased risk of larynx cancer, alcohol-related mechanisms of carcinogenesis remain unknown. Nevertheless the effect of alcohol is modulated by polymorphisms in genes encoding enzymes for ethanol metabolism. Hence we investigated the ADH1C *1 genotype and allele frequency in a group of 102 larynx cancer patients with heavy alcohol consumption recruited from the Department of Otolaryngology and Laryngological Oncology of the University of Medical Sciences in Poznan. The data were compared with 112 non-cancer age-matched individuals consuming similar amounts of ethanol. Blood samples were used for analysis of restriction fragment length polymorphism. DNA was isolated from the whole blood leucocytes and PCR with specific primers was used to amplify polymorphic region of rs698 in the ADH1C gene. The method was based on allele detection by Sspl restriction enzyme digestion and after the incubation with enzyme, samples run on an electrophoresis. The statistic analysis was performed to calculate Odds Ratio (ORs), 95% confidence intervals (CIs) and significance. Results suggest a slightly increased risk of larynx cancer for individuals who have inherited the ADH1C *1 allele (rs 698), however they did not reach the level of statistic significance.

[A rare case of extramedullary plasmocytoma of the cheek]. / Rzadki przypadek szpiczaka pozaszpikowego okolicy policzka.

It has been presented a rare case of extramedullary plasmocytoma in a 69-years-old woman. The tumor has arised in soft tissues of the right cheek. Extramedullary plasmocytoma is a rare tumor which belongs to non-Hodgkin's lymphomas. The characteristic feature of that group is monoclonal proliferation of B lymphocytes. One of the most common locations is nasopharynx and paranasal sinuses.

[Toluidine blue in monitoring of recurrences and second primary tumors in patients treated for oral cavity and pharynx cancer]. / Zastosowanie blqkitu toluidyny do monitorowania wznów i drugich pierwotnych ognisk nowotworowych w jamie ustnej i gardle u chorych leczonych z powodu raka jezyka i migdalka podniebiennego.

UNLABELLED: Assesment of recurrences in the oral cavity and pharynx is a serious diagnostic challenge particularly in patient after surgery and irradiation. Observed visible local lesions like oedema, formation of postoperative scars and pain made the diagnostic procedure difficult. Sometimes it's impossible to distinguish recurrences and inflammatory reaction. The aim of this research was to evaluate the usefulness of toluidyne blue in monitoring of recurrences and second primary tumors in the patients with oral and pharyngeal cancer. It was perform by comparison of the three methods: physical examination, endoscopic ultrasound probe and toluidine blue staining in detection of early malignancy. A group of 80 patients with oral and pharyngeal squamous cell cancer was treated in the years between 2000-2003 in the Department of Otolaryngology in Poznan. In 7 positive tested cases toluidine blue staining was confirmed in histological examination. 3 cases were false-positive staining (patients after reconstructive with infrahyoid and pectoral major flap). CONCLUSIONS: (1) toluidine blue staining is cheap effective diagnostic procedure in monitoring recurrences in patients after surgery and irradiation; (2) procedure is limited in patients after reconstructive flap surgery; (3) ultrasound endoscopy is of value in assesment of advanced tumors of oral cavity and pharynx, but it's limited in flat and superficial mucosal infiltrations.

[Infrahyoid musculo-cutaneous flap in head and neck reconstructions]. / Plat podgnykowy skórno-miesniowy w rekonstrukcji ubytków w regionie glowy i szyi.

INTRODUCTION: Background reconstructive surgery with infrahyoid musculo-cutaneous flap is the procedure used in head and neck cancer from the 80 years XX century. Technique of that operation was designed and described by Wang in 1979. Nowadays it is used in reconstructions after resection of the tongue and floor of the mouth. The flap is formed by infrahyoid muscles and skin island. It's pedicled on the superior thyroid vessels and superior root of ansa cervicalis. The most important contraindication is multiple metastases on the side of the neck unilateral to the designed flap. The relative contraindication is previous radiotherapy. AIM: The introduction of this method to the practice and assessment of the early results. MATERIAL AND METHOD: 5 patients underwent the treatment (floor of the mouth, tongue, oropharynx resection because of malignancy). In 1 patient the flap was used in esophageal reconstruction after iatrogenic rupture. Reconstruction technique according to Wang was performed. Clinical observation of the patients to asses the early results has been conducted. RESULTS: Preliminary results of treatment among 6 patients are as follows: necrosis was found in 2 patients (total necrosis of flap in 1 case, partial in 1 case). Speech and swallowing restoration was satisfactory in four patients. CONCLUSION: The procedure using the infrahyoid flap provide the satisfactory reconstruction of the anterior part of the oral cavity and oropharynx. The technique is simple and not time consuming. The infrahyoid flap can be recommended in elderly or in poor general condition patients descending the surgery time as short as possible.

[Localisation and direction of spread in oral and oropharyngeal cancer in the material of Head and Neck Oncological Surgery Department, University of Medical Sciences in Poznan]. / Kierunki progresji raka jamy ustnej i gardla na podstawie analizy materialu wlasnego Kliniki Otolaryngologii i Onkologii Laryngologicznej AM w Poznaniu.

UNLABELLED: The directions of tumor spread are determined by the anatomy of the affected organ. The vessel, nerve anatomy and presence of structures, that may potentially constitute a barrier for spread out of the tumor are of crucial importance. The aim of this paper was to presentation of the spreading directions of oral cavity and oropharyngeal squamous cell cancer based on the own experience. Material include 163 patients surgically treated between 2003-2003 in Department of ENT, Head and Neck Oncological Surgery Department in Poznan. The examination was conducted on the base of retrospective analysis of ambulatory charts and the hospital files. RESULTS: 163 (90%) patients were operated for primary oral and oropharyngeal cancer. The primary localization included in the palatine tonsil (82 patients), trunk of the tongue (48 patients) and floor of the mouth (20 patients) were predominated. The spread directions included: floor of the mouth (36) soft palate (35), base of tongue (33), hypopharynx (20) and trunk of tongue (16). The 31 crossed the midline, 27 infiltrated the tonsillopalatine angle, 9 retromolar area and 3 the mucosa of the cheek. Knowledge of anatomy facility in clinical evaluation of spreading malignancy. It helps in proper qualification to surgery or radiotherapy.

[A case of laryngeal papilloma with sudden dyspnea]. / Przypadek brodawczaka krtani przebiegajacego z nagla dusznoscia.

Laryngeal papilloma is one of the most common non-malignant tumors of the larynx. In adult they are included to pre-cancerous diseases. In morphological examination, it is a solid tumor. Often it is possible to cure them during one surgical procedure. The disease is mostly localized on the anterior commissurae region, vocal fold, ventricules, and on the laryngeal surface of the epiglottis. If the malignant transformation is suspected, a large excision with margin has to be performed, completed by a histological evaluation. A case of a huge laryngeal papilloma with dyspnea is presented.