Diagnosis and management of multiple paragangliomas of the head and neck.

Paragangliomas (PGs) are slowly growing, usually benign neoplasms. The aim of the study was to analyze the incidence, diagnostic and therapeutic management of patients with multiple paragangliomas of the head and neck. A retrospective review of the records of 84 patients with head and neck PGs, diagnosed and treated in our institution was performed for the years 1983-2013 to identify patients with multiple tumors. Fourteen (16.6 %) patients developed multiple PGs, synchronous or metachronous, within 4-21 years of follow-up. Clinical data of these patients were reviewed to evaluate the diagnosis, location, stage and management strategy. There was a total number of 37 tumors in 14 patients. There were 20/37 (54.0 %) carotid PGs, 9/37 (24.3 %) jugular PGs and 8/37 (21.7 %) vagal PGs. Carotid PGs were observed in 12/14 (86 %) patients and in 8/14 (57 %) cases bilateral tumors occurred. Vagal PGs developed in 7/14 (50 %) patients and bilateral tumors were found in 1/14 (7 %) case. Jugular PGs occurred in 9/14 (64 %) patients. There were 30 synchronous tumors and seven metachronous PGs diagnosed 2-18 years after removal of the first tumor. Single metachronous mediastinal PG occurred. All patients had at least one tumor removed, with histopathological confirmation of the diagnosis. One patient had positive history of familial PGs. Carotid PGs are most common multiple paragangliomas. Radiological survey of the head and neck is required to detect multicentric tumors. Metachronous mediastinal and abdominal tumors may occur. Regular, prolonged follow-up is essential to identify metachronous PGs and possible postoperative gradual ICA occlusion.

[Cigarette smoking and alcohol consumption in patients with oral cancer]. / Palenie papierosów i spozywanie alkoholu w grupie chorych z nowotworami zlosliwymi jamy ustnej.

The study aim was to analyse the frequency of simultaneous smoking and alcohol consumption in 142 patients with oral cancer and in the control group. A connection between the prevalence of these habits and epidemiological traits of the patients and features of malignant lesions was evaluated. Statistical analysis revealed that simultaneous smoking and alcohol abuse were significantly more frequent in the cases group. A strong influence of these habits on the development of oral squamous cell carcinoma was noted.

Juvenile nasopharyngeal angiofibroma with intracranial extension - diagnosis and treatment.

INTRODUCTION: This retrospective study analyzes radiological findings, therapeutic management and outcomes of patients with intracranial extension of JNA. The routes of intracranial spread, incidence of intracranial disease and influence on therapeutic approach are discussed. MATERIAL AND METHODS: An evaluation on the records of 62 patients with JNA was performed and 10 patients with intracranial tumors were included in the study. All patients were males aged 10 to 19 years. R esults: According to Andrews' classification 8 patients presented with stage IIIb, 1 patient stage IVa and another patient stage IVb tumor. Intracranial invasion was extradural in 8 cases and intradural in 2 patient. Surgery was performed in 9 cases and the most common was combined approach: infratemporal fossa and sublabial transantral. One patient was referred for radiotherapy. Follow-up ranged from 8 to 26 years. There was extracranial recurrence in 2 (22%) of 9 operated patients. C onclusions: The superior orbital fissure is the most frequent route of intracranial spread in patients with extensive involvement of the infratemporal fossa. Due to high risk of recurrence and potential serious complications advanced cases of JNA should be managed by experienced multidisciplinary team, preferably in tertiary referral centers, with an access to modern diagnostic and therapeutic modalities.

Laryngeal cancer in farmers from Lublin region of Poland.

The aim of the study was to analyse if work related risk factor had any influence on stage, localisation and histology of type of malignant tumour. Demographic and risk factors and results of treatment of farmers with patients working outside farming were compared. The group included 148 patients with primary laryngeal squamous cell carcinoma (LSCC) diagnosed and treated in our institution in the years 1999-2002. 84 (56.8%) of 148 patients were farmers and 64 (42.2%) patients worked outside farming. The univariate analysis of demographical and clinicopathological features of the farmers' group versus the other professions group with LSCC showed a statistical significance for sex, age and G stage. Nearly statistical significance was observed for the N stage (p=0.06) and for primary localisation of the tumour (p=0.05). The difference in 3 and 5-year survival rates between the group of farmers in comparison with the group of patients working outside farming and with LSCC was not significant for most of the demographical and clinicopathological features. Local, nodal or local plus nodal recurrence occurred in 15 (21.1%) of 84 farmers during 3 years follow-up. Distant metastases were observed in 7 (8.3%) of 84 farmers with LSCC, 6 to the lungs and one to the liver. Farmers with larynx cancer had different presentation pattern than other profession patients. The incidence of glottic cancer and well differentiated cancer was higher in farmers than in other professions. The prevalence of larynx cancer in women was significantly lower among farmers than in other professions. There were older patients in the group of farmers and relatively less women than in the group of patients with other professions.

[Transpalatal approach for juvenile angiofibroma]. / Dojscie przez podniebienie do naczyniakowlókniaka mlodzienczego.

INTRODUCTION: Juvenile nasopharyngeal angiofibromas (JNA) are highly vascular, locally invasive tumours which originate in the sphenopalatine foramen. Several surgical approaches are described for this tumour. The aim of this study was to evaluate the transpalatal approach for juvenile angiofibroma. MATERIAL AND METHODS: In a group of 22 patients with JNA transpalatal approach was employed. A retrospective patients notes review was done. Extension of tumour, complications of surgery and recurrences were analyzed. RESULTS: In 17 patients the tumour was confined to the nasal cavity and the nasopharynx. In 5 patients the tumour invaded the sphenoid sinus. No complications were observed after surgery. Two (9%) patients had recurrence. CONCLUSION: Transpalatal approach is best suited to small tumours (Andrews grade I and II) limited to the nasopharynx, nasal cavity and sphenoid sinus.

Transnasal microscopic approach for juvenile nasopharyngeal angiofibroma.

INTRODUCTION: Juvenile nasopharyngeal angiofibroma (JNA) is a rare, benign, vascular tumor originating in the nasopharynx. The treatment of choice for JNA is surgical excision. In recent years, surgical management has been greatly influenced by the use of the transnasal endoscopic technique. THE AIM: The aim of the study was to present our experience with the transnasal microscopic removal of JNA. MATERIAL AND METHODS: Ten patients with JNA aged 12-17 underwent diagnostics imaging and transnasal microscopic tumor excision. Medical records of patients were retrospectively reviewed. The main outcome measures were complications and recurrences. Preoperative embolization of feeding vessels was performed in 7 patients. RESULTS: According to Andrews' classification, the group included 2 stage I patients, 6 stage II patients and 2 stage IIIA patients with the extensive occupation of the infratemporal fossa. 9 patients had no recurrence in 6-11 years follow up. One stage IIIA patient had a recurrence posteriorly to the pterygopalatine process and it was completely removed. No complications during or after surgery occurred. CONCLUSION: Transnasal microscopic excision is an effective approach to resect stage I-IIIA JNA.

Doppler ultrasound appearance of neck tumors.

AIM: The purpose of this study was the evaluation of the sonographic appearance of neck tumors and determining the features useful in differential diagnosis. MATERIAL AND METHOD: The studied group consisted of 57 patients: 16 patients with carotid body tumors, 9 patients with neurogenic tumors, 8 patients with venous anomalies, 12 patients with neck cysts, 6 patients with lipomas, 5 patients with extracranial carotid artery aneurysms and 1 with a laryngocele. RESULTS: All carotid paragangliomas were located within the carotid bifurcation and demonstrated rich low-resistance vascular flow, with higher maximum velocity and lower flow resistance parameters registered in the ipsilateral external carotid artery. In 7 out of 9 cases, neurogenic tumors were homogeneous, and in the remaining 2 cases - heterogeneous. Four schwannomas were hypervascular or showed moderate vascularity, and the rest of neurogenic tumors were hypovascular or avascular, with symmetrical maximum velocity and resistance values of carotid blood flow. Apart from one branchial cleft cyst with multiple fine internal acoustic reflexes, all other neck cysts were anechoic and avascular, and presented with posterior acoustic enhancement. The laryngocele presented as a well-demarcated, hypoechoic, homogeneous lesion located in the immediate proximity of the larynx, without signs of internal vascular flow. Lipomas were well-demarcated, homogeneous, hypoechoic tumors with regular margins, without signs of internal vascular flow. Venous malformations presented as irregular, hypoechoic spaces with venous blood flow, easily compressed by the probe. Extracranial carotid artery aneurysms were hypoechoic, well-defined spaces, which presented with slow internal, turbulent flow on Doppler study, and showed continuity with the carotid artery. CONCLUSIONS: Doppler ultrasound allows to visualize features characteristic for certain neck tumors. Solid or cystic structure, echogenicity, localization, as well as internal flow signals and vascularity pattern create a combination of ultrasound findings helpful in the differential diagnosis of lesions such as paragangliomas, venous malformations, neurogenic tumors, aneurysms, cysts and laryngoceles.

The influence of the sequence of surgical steps on complications rate in stapedotomy.

OBJECTIVE: To assess whether the incidence of complications of stapes surgery depended on the sequence of surgical steps and CO2 laser use in stapes surgery. STUDY DESIGN AND SETTING: Retrospective and prospective analysis of 420 consecutive stapedotomies was set in tertiary referral University Hospital. PATIENTS: 376 patients with otosclerosis in whom 420 primary stapedotomies were performed. INTERVENTION: Stapedotomy under local anesthesia using manual perforators and CO2 laser. MAIN OUTCOME MEASURE: The incidence of incus subluxation, floating footplate during stapedotomy. RESULTS: Comparison of the incidence of incus luxation in groups with the piston inserted after removal of the stapes arch, and groups with the piston inserted on the intact ossicular chain showed statistical significance. In the group where perforation of the footplate was performed after removal of the stapes arch floating footplate occurred more often than in groups with reversed sequence of steps. CONCLUSION: Perforation of the footplate before removal of stapes arch reduces the risk of floating footplate, and placing the prosthesis on the incus before removal of stapes arch reduces the risk of subluxation of the incus. CO2 laser stapedotomy with reversed sequence of steps was the safest method of stapes surgery.

An immunohistochemical study of cyclin D1 protein expression in laryngeal squamous cell carcinoma.

CONCLUSION: Contrary to most reports, our study shows that the expression of cyclin D1 is not an independent prognostic factor in patients with laryngeal cancer (LC). No correlation between cyclin D1 expression and survival rates in LC was found in a multivariate analysis. OBJECTIVES: The aim of this study was to determine the possible relevance of the expression of cyclin D1 protein in LC as prognostic criteria and to analyse correlation of the expression with clinicopathological features and survival rates. MATERIALS AND METHODS: Immunohistochemistry staining was used to detect the expression of cyclin D1 in 130 samples of laryngeal cancer and in 22 specimens of laryngeal nodules. RESULTS: Cyclin D1 expression was found in 52 (40%) LC samples and in 3 (13.6%) samples of laryngeal nodules. There was no significant correlation between cyclin D1 expression and clinicopathological features of LC. A multivariate analysis of survival confirmed that cyclin D1 expression was not an independent prognostic factor in LC.

[Invasion of the orbit in paranasal sinus tumours]. / Naciekanie oczodolu przez nowotwory zatok przynosowych.

The extension of paranasal sinus cancer into the orbit is one of arguments for carrying out orbital exenteration. Until the advent of high-resolution computed tomography, en bloc radical resection, including the orbit, was the most effective method of treating a cancer, whose size could not be adequately judged before surgery. Patient evaluation with computed tomography (CT) and magnetic resonance imaging (MR) is described. Different clinical situations relating the orbital content to sinus tumour and their management are discussed. Prosthetic options after orbital exenteration are also presented.

[Diagnostic evaluation of temporal paragangliomas]. / Diagnostyka przyzwojaków kosci skroniowej.

Paragangliomas are rare tumours deriving from paraganglia--small bodies of neuroendocrine tissue. Approximately 3% of paragangliomas occur in the head and neck area accounting for about 0,6% of all tumours of this region. Head and neck paragangliomas are divided into two groups: neck tumours (carotid body tumor and vagal paraganglioma) and temporal paragangliomas (jugular bulb tumor and tympanic paraganglioma). Temporal paragangliomas arise from paraganglia located in the petrous part of the temporal bone. Radiological evaluation of these lesions is essential for confirming the diagnosis and surgery planning. Most useful methods are magnetic resonance imaging and computed tomography. These modalities deliver important information about tumour location, extension and the state of the surrounding structures. Carotid angiography is a second step diagnostic method, performed in patients with jugular bulb paraganglioma. It has a diagnostic value and allows palliative or preoperative embolization of the tumor. Ultrasonographic evaluation and scintigraphy also provide advantages in diagnostic management.

[Extension of nasal and paranasal sinus malignancies on the basis of computed tomography]. / Rozleglosc nowotworów jamy nosowej i zatok przynosowych na podstawie tomografii komputerowej.

INTRODUCTION: Location and extension of tumour are crucial for results of treatment and prognosis in patients with nasal and paranasal sinus malignancies. The aim of the study was to evaluate the site and extension of nasal and paranasal sinus malignancies using computed tomography (CT). MATERIAL AND METHOD: The group included 124 patients aged 5-83 years. Biopsy confirmed malignant neoplasm in all the patients. Surgery was performed in 92 patients, for 32 inoperable patients palliation was applied. RESULTS: CT revealed that the most common (just above 70%) tumour sites were the nasal cavity, maxillary and ethmoid sinuses. The most common (about 50%) extrasinusal involvements were the orbit, subcutaneous cheek tissue and infratemporal fossa. Only 24.2% of patients had tumour limited to the nose and sinuses. CONCLUSIONS: CT well demonstrates extension of nasal and paranasal sinus malignancies. Vast majority of patients (75.8%) present with tumour extended beyond sinuses.

[Site of origin of paranasal sinus malignancies]. / Miejsca wyjscia nowotworów zlosliwych zatok przynosowych.

In a group of 124 patients a site of origin of paranasal sinus and nasal cavity malignancies was evaluated on the basis of computed tomography (CT) and on the basis of operative findings. The most common malignant tumor was squamous cell carcinoma (41, 1%) and then cancers of salivary origin (20, 2%). The most common site of origin was the maxillary sinus (53, 2%) and then the nasal cavity (31, 5%). Within the maxillary sinus the most frequent neoplasm was cancer whereas in the nasal cavity melanoma and olfactory neuroblastoma. In three (2, 4%) patients site of tumor origin demonstrated on CT was different form that of operative finding.

[Reconstruction of meatal wall with cartilage and perichondrium]. / Rekonstrukcja sciany przewodu sluchowego za pomoca chrzastki i ochrzestnej .

The aim of the study was evaluation of the use of cartilage and perichondrium for reconstruction of meatal wall. In the group of 27 patients transmeatal atticotomy was performed to remove cholesteatoma from epitympanic recess. Auricular or tragal perichondrium with cartilage island were used for reconstruction of meatal wall and tympanic membrane defect. Good closure of the defect was obtained in 24 (89%) patients in 3-6 years follow up. We had one failure and no follow up in 2 patients. Of 7 patients with intact ossicular chain 0-10 dB air-bone gap was obtained in 5 and 11-20 dB gap in 2 patients. Perichondrium and cartilage are very good for reconstruction of meatal wall and drum defect.

[The prevalence of E6/E7 HPV type 16 in laryngeal cancer and in normal mucosa]. / Obecnosc E6/E7 wirusa HPV16 w raku krani oraz w makroskopowo niezmienionej blonie sluzowej z marginesu operacynego.

Many authors suggest that HPV infection can play a great role in development of benign and malignant tumours of upper respiratory tract in human. The aim of this study was to determine the prevalence of E6/E7 HPV-16 in laryngeal squamous cell carcinoma, and normal laryngeal mucosa, and to analyse their correlation with sex, lymph node status, primary tumor stage, localization, and histological differentiation. HPV 16 DNA presence was analysed using PCR technique in 72 samples of laryngeal carcinoma and in samples of 50 normal mucosa. Human papillomavirus was detected in 26 (36.1%) of the 72 patients. There was no statistically significant correlation HPV positivity and clinicopathological features of the analysed group. In 5 (10%) of 50 samples of normal mucosal. HPV 16 presence in normal mucosa and in laryngeal squamous cell carcinoma was detected in 3 patients. Our observations suggest that HPV16 can play a role in pathogenesis of laryngeal cancer.

[The use of tracheostomy T-tube in the treatment of tracheal stenosis]. / Zastosowanie rurki tracheostomijnej T w leczeniu zwezen tchawicy.

The aim of the study was evaluation of the use of tracheostomy T-tube in patients with tracheal stenosis. The advantages of closed T-tube over open tracheotomy are: 1/ normal breathing through the nose, 2/ normal speech without necessity to close the tube with a finger, 3/ no spitting during cough. Silicone tracheostomy T-tube was used in 12 patients with tracheal stenosis. The stenosis resulted in 7 patients from prolonged intubation, in 4 patients from defective tracheostomy and in one patient from failure of tracheal resection. In all the patients rigid tracheoscopy and/or flexible bronchoscopy revealed the length of the stenosis and the distance from vocal cords. T-tube was placed under local anesthesia. The patients used to wear closed T-tube from 1-12 years. The tube was exchanged every 2-4 years. The only adverse effect was recurrent granulation around tracheostomy in two patients. 7 of 12 patients were decannulated with good result in 3 months - 5 years follow up. In two decannulated patients stenosis recurred. One patient was retracheostomized and in another patient stenosis was resected with end to end anastomosis. Three patients were not decannulated. Tracheostomy T-tube can be used temporary in patients with tracheal stenosis before planned stenosis resection or as a sole treatment with good chances for successful decannulation. When stenosis resection is not possible, T-tube can be placed for long time.

[Speech rehabilitation using Provox voice prosthesis]. / Rehabilitacja glosu z zastosowaniem protezy glosowej typu Provox.

The first voice prosthesis was described in 1972 by Mozolewski. Eight years later Blom and Singer constructed the first commercial prosthesis. In 1988 another prosthesis was presented as Provox system prosthesis. The aim of the study was to describe the technique of tracheoesophageal puncture (TEP) and to present two years results of the technique performed in 21 patients. Primary TEP with immediate implantation of the Provox 2 prosthesis was applied in 16 (76%) patients. In five patients (24%) secondary TEP was performed. All the patient with primary TEP had cricopharyngeal myotomy. In 7 patients the vocal prosthesis was exchanged. In five because of leakage through the valve and in two patients the vocal prosthesis was extruded. Leakage around the prosthesis occurred in two patients with secondary TEP. The mean device-related lifetime was 216 days and ranged from 30 to 540 days. In non-radiated patients the lifetime of the prosthesis was 255 days and in patients after radiotherapy the lifetime was 150 days. In all the patients the prosthetic voice was more similar to normal voice than in patients with esophageal speech. The implantation of the voice prosthesis is a simple method of restoring of a good quality voice enabling communication.

[Juvenile angiofibroma: the value of CT and MRI for treatment planning and follow-up]. / Naczyniakowlókniak mlodzienczy: przydatnosc badania TK i MR do planowania i oceny wyników leczenia.

Juvenile angiofibroma is a rare, benign, hypervascular, nasopharyngeal tumour. The aim of the study was to assess the value of CT and MR in determining therapeutic approach and follow-up in patients with this condition. There were 40 patients with juvenile angiofibroma. All patients underwent angiography. In 24 patients CT and 5 patients MRI was performed. Most patients (67%) presented with tumour stage III according to Chandler. Preoperative tumour staging based on CT was in accordance with surgical evaluation in 92% of cases. In 4 (17%) of 24 patients CT and MRI showed a recurrence after surgery. On the bases of radiological findings 2 patients were referred to irradiation instead of surgery. CT allows correct tumour staging in 92% of patients. It well demonstrates the presence and extension of the recurrence.

Activity of matrix metalloproteinases-2 and -9 in advanced laryngeal cancer.

OBJECTIVES: Matrix metalloproteinases-2 and -9 (MMP-2 and MMP-9) are proteolytic enzymes that digest collagen type IV and other components of the basement membrane. They play a key role in local invasion and the formation of distant metastases by malignant tumors. The aim of this study was to evaluate the activity of MMP-2 and MMP-9 in stage III and IV laryngeal cancers. STUDY DESIGN: In the study we used specimens of laryngeal cancer and surrounding normal mucosa obtained from 23 patients undergoing surgical treatment as a primary therapy. After extraction of MMP-2 and MMP-9 from tissue samples, their activity was assessed with zymography. RESULTS: Greater activity of MMP-2 and MMP-9 and a higher active/latent MMP-2 ratio were found in cancer compared with normal mucosa. Moreover, N2 tumors revealed greater activity of MMP-2 in comparison with N1 and N0 tumors. CONCLUSIONS: Results of the study indicate that both MMP-2 and MMP-9 may be involved in the expansion of laryngeal cancer. MMP-2 may also play an important role in the lymphatic spread of some laryngeal tumors.

Effect of stapedectomy on subjective tinnitus.

A series of 149 patients, who had tinnitus associated with otosclerosis, and who underwent stapedectomy by a single operator were questioned about their tinnitus one to 19 years after surgery. Of these, 73 per cent reported that their tinnitus had ceased following surgery, 17 per cent that it had improved and only 10 per cent that it was unchanged. No pre-operative audiometric or patient data were associated with a favourable outcome in terms of tinnitus improvement. Patients who had poor hearing outcomes reported abolition of their tinnitus, suggesting that this was due to the improvement in the fluid mechanics of the cochlea resulting from stapedectomy. The tinnitus status was unrelated to the length of follow-up time.