Danijela Dragičević

Laryngotracheal stenosis and restenosis. What has the influence on the final outcome

The aim of this study is to analyze the impact of various parameters on the course and treatment outcome in patients with laryngotracheal stenosis and recurrent stenosis. Two groups of patients were compared: Group I included 29 patients with primary stenosis, and Group II included 22 patients with recurrent stenosis. The most frequent etiological factor for the development of stenosis was prolonged endotracheal intubation (79.3:77.3%), with subglottic-tracheal (44.8:45.5%) and tracheal (48.3:36.4%) localization being the most affected. Subglottic-tracheal stenosis was more common in men. There were no significant differences between the groups in regard to the grade of lumen obstruction and the length of the resected segment. In male patients, the length of the resected stenotic segment was significantly longer. Subglottic-tracheal stenoses were longer than tracheal ones. Various surgical procedures were performed, with additional management of recurrent laryngeal nerve paralysis, if necessary. Laryngotracheal reconstruction (LTR) with costal cartilage grafting (CCG) was statistically significantly more often performed in Group II, while cricotracheal resection (CTR) was more common in Group I. The incidence of complications in Group I was 24.1%, and in Group II it was 31.8%. Satisfactory airway lumen with undisturbed breathing was achieved in 93.1% of patients in Group I, and in 95.3% in Group II. Since the success rate was similar in both groups of the patients, it could be concluded that treatment outcome depends less on the factors associated with the stenosis, and more on adequate choice of surgical procedure and surgical team know-how.

Transient evoked otoacoustic emissions in young children with otitis media with effusion before and after surgery

OBJECTIVE Otitis media with effusion (OME) is one of the commonest causes of acquired hearing loss in children with increasing incidence. In young children the diagnosis is restricted to clinical trials and tympanometry whereas evaluation of the auditory function is impossible due to noncompliance during pure tone audiometry. For this purpose, measurement of otoacoustic emissions, especially transient evoked ones (TEOAE), can be applied. The aim of this study is to evaluate the parameters of TEOAE in young children with OME prior and after surgery. METHODS Prospective study included 50 children with OME, both sexes, aged 2-5 years. Preoperatively tympanometric examination was performed and TEOAE were recorded. Surgery was performed under general anesthesia and included myringotomy with/without ventilation tube insertion. Measurements of TEOAEs (correlation percentage, signal to noise ratio and amplitude) were repeated on the first and six day postoperatively as well as 6 weeks and 6 months postoperatively. RESULTS The preoperative TEOAEs were not recorded in 93.5%, with values of all TEOAE parameters being the most affected on highest frequencies. Significant changes of all TEOAE parameters were found 6 weeks postoperatively with further improvement 6 months postoperatively. Statistically highly significant difference of TEOAE between examinees with and without inserted ventilation tubes was established only in regard to preoperative results. CONCLUSION In small children with OME, application of TEOAEs in follow-up of surgical effects is a method of choice for hearing screening due to its objectivity, simplicity and ease of use even after insertion of ventilation tubes. Follow-ups of TEOAE correlation percentage and signal to noise ratio reflect the condition earlier than follow-ups of TEOAE amplitude.

Endoscopic repair of cerebrospinal fluid rhinorrhea

INTRODUCTION Nasal liquorrhea indicates a cerebrospinal fluid fistula, an open communication between the intracranial cerebrospinal fluid and the nasal cavity. It can be traumatic and spontaneous. OBJECTIVE The aim of this study was to assess the outcome of endoscopic repair of cerebrospinal fluid fistula using fluorescein. METHODS This retrospective study included 30 patients of both sexes, with a mean age of 48.7 years, treated in the period from 2007 to 2015. All patients underwent lumbar administration of 5% sodium fluorescein solution preoperatively. Fistula was closed using three-layer graft and fibrin glue. RESULTS Cerebrospinal fluid fistulas were commonly located in the ethmoid (37%) and sphenoid sinus (33%). Most patients presented with traumatic cerebrospinal fluid fistulas (2/3 of patients). The reported success rate for the first repair attempt was 97%. Complications occurred in three patients: one patient presented with acute hydrocephalus, one with reversible encephalopathy syndrome on the fifth postoperative day with bilateral loss of vision, and one patient was diagnosed with hydrocephalus two years after the repair of cerebrospinal fluid fistula. CONCLUSION Endoscopic diagnosis and repair of cerebrospinal fluid fistulas using fluorescein intrathecally has high success rate and low complication rate.

Transmandibular and transcervical surgical approach in treatment of tongue base cancers - ten-year results

Introduction. The aim of this study was to present oncological and functional results of surgical treatment of the base of tongue cancer by analyzing retrospectively 115 patients treated during a ten-year period. During this period, 150 patients with cancer of the base of tongue were diagnosed, which accounts for 5.6% of all diagnosed head and neck cancers and 24.1% of all oropharyngeal cancers. In 111 patients (96.5%), planocellular carcinoma with various degrees of differentiation was pathohistologically verified. Neck metastases were found in 88 (76.5%) patients. Advanced III and IV stages of disease were verified in 92.9% of patients (stage III in 23.4%, IV A in 59.1%, IV % B in 10.4%). Transmandibular approach was performed in 5.2% of patients, while 94.8% of patients were approached through pharynx The defects were covered by primary reconstruction; the pectoralis major myocutaneous flap was used in 4 patients . During immediate postoperative period, 17 (14.7%) patients developed complications: bleeding occurred in 7 patients (6%), fistula and wound infection developed in 5 (4.3%) and 11 (9.5%) patients, respectively. Postoperatively, 61 (53%) patients were treated by radiation therapy. Swallowing function was resumed in all patients except in three, who underwent gastrostomy due to the lesion of both hypoglossal nerves. Gasrostoma was closed after six months when swallowing was resumed. Local and regional recurrence developed in 13 (11.3%) and 24 (20.8%) patients, respectively, and distant metastases developed in 4 (3.5%) patients. Second primary cancer was diagnosed in 9 (7.8%) patients Disease-specific 3-year survival rate (according to the T category) was 73%, 60%, 45% and 21% in patients with T1, T2, T3 and T4, respectively. Diseasespecific 3-year survival rate (according to category N) was 68% in N0 and 32%) in N +. The overall 3-year survival rate was 42%.

Tracheobronchial foreign body aspiration: A 13-year retrospective analysis

Introduction. Foreign body aspiration into the respiratory tract remains a diagnostic and therapeutic challenge in clinical practice, especially in young children, who are the most frequently affected age group. The aim of this study was to present the results of treating the patients with foreign body aspiration in all age groups. Material and Methods. The medical and radiological records of 64 patients with confirmed foreign body out of 146 patients with suspected foreign body aspiration were retrospectively analyzed during the period of 13 years (from 2001 to 2013). Results. A foreign body was found in 64 (44%) of the 146 patients of all age groups with suspected foreign body aspiration. The patients’ age ranged between 11 months and 80 years. There were 84% children and 16% adults, and 63% of patients were male. Time between the moment of aspiration and admission to the Department ranged between 0.5 hours and 14 days, with majority of patients (70%) being admitted during the first 24 hour. History of respiratory drama was present in 92% of patients. Physical and radiological findings were positive in 66% and 47% of patients, rescpectively. Organic vegetable foreign bodies accounted for 75% of all cases, and they were most frequently found in the right main bronchus (63%). All foreign bodies were successfully extracted by rigid bronchoscopy, without serious complications and fatal outcomes. Conclusion. Bronchoscopy should be performed in any case of suspected foreign body aspiration, even if clinical and radiological findings are normal, in order to avoid serious and possible life-threatening complications. More should be done to raise awareness of this potentially preventable condition.

Prolonged peripheral facial nerve paralysis in a child — think of temporal bone rhabdomyosarcoma: case report

Rhabdomyosarcoma is the most common type of soft tissue sarcoma in childhood. When localized in the middle ear and temporal bone, they are highly aggressive, whereas the outcome directly depends on an accurate and timely diagnosis, stage of the disease, and adequate multimodal therapy. Early clinical diagnosis of the temporal bone rhabdomyosarcoma is often difficult since clinical signs are not specific for this disease. We present a case of an embryonal rhabdomyosarcoma, botryoid subtype, of the middle ear in a girl aged 4 years and 4 months, diagnosed 34 days after the first symptoms — right ear pain with peripheral facial nerve palsy on the same side. The overall symptoms were poor, in no way suggesting such a serious condition. After the treatment, control follow-ups for more than 3 years showed no recurrence of the disease, while signs of the right peripheral facial palsy persist.ConclusionIn cases of prolonged peripheral facial nerve palsy in children, not responding to conservative treatment, a temporal bone rhabdomyosarcoma should be considered in a differential diagnosis.

Hemangiomas of the external auditory canal:a literature review and two new case reports

AimThe aim of this paper is to present two case reports of patients with hemangiomas of the external auditory canal, and to overview all cases published in English language literature so far.MethodsTwo patients with hemangiomas of the external auditory canal have undergone clinical and morphofunctional examination, surgical procedures, histopathological examination, and postoperative follow up.ResultsIn a 38-year-old female patient transmeatal approach was used to remove the cavernous hemangioma of the external auditory canal. The postoperative period was eventless, with normal morphofunctional findings during a 5-month postoperative follow-up period. In the second patient, a 68-year-old female, a capillary-cavernous hemangioma was removed using retroauricular approach.ConclusionCavernous hemangiomas are rare lesions of the external auditory canal. In the morphological diagnosis, computed tomography of the temporal bones is the leading diagnostic procedure, along with otoendoscopy and endocranial magnetic resonance imaging which are important in evaluation of the spread of the lesion. Biopsy of vascular lesions is not recommended. Complete surgical excision of hemangioma of the external auditory canal is the therapy of choice with a minor risk of hearing impairment.

Surgical treatment of primary tracheal dyskinesia in a 14-month-old child—Case report

The primary form of tracheal dyskinesia in early childhood is a rare congenital malformation of unknown origin. The degree of the posterior membranous tracheal wall involvement determines the intensity of obstruction and the severity of the clinical picture. The aim of this paper is to present a case of a 14-month-old child with severe tracheal dyskinesia that required surgical treatment. Fascia lata graft fixated with fibrin glue was used in strengthening the posterior tracheal wall. Three years following the surgery, the child is without breathing difficulties. In severe cases of primary dyskinesia, surgical treatment using fascia lata graft, fixated with fibrin glue is recommended in strengthening the posterior tracheal wall.

Surgical approach and results of treating two subcategories pT2 glottic carcinoma of the larynx

Background: T2 glottic carcinoma is a nonhomogenous localization of laryngeal carcinoma with two subcategories. The aim of the study was to retrospectively analyze the results of surgically treated pT2 glottic carcinomas and to determine the importance of subcategories of glottic carcinomas in diagnostics, surgical treatment, and patients’ survival. Methods: During the period 1990-2000, 71/701 (10%) patients were diagnosed. with pT2 glottic carcinoma. All patients were treated with different surgical techniques. Results: Total laryngectomy was performed in 14/71 patients. Involvement of anterior commisure in local spreading of the cancer was found in 24/71 patients; total laryngectomy was performed in 13/24 and reconstructive surgery in 11/24. Selective resection of neck was done in 49 patients and metastases were found in 2 of these patients. Out of fifty-seven patients who had reconstructive laryngeal surgery local disease recurrence appeared in 8 patients. These 8 patients were treated with total laryngectomy. Overall 5-year survival was 90.1% with a slight difference between subcategories (89.1% subcategory I; 93.7% subcategory II) which was not statistically significant (p>0.05). Disease free 5-year survival was 83.6% with a difference between subcategories (81.1% subcategory I; 93.3% subcategory II) which was not statistically significant (p>0.05). Conclusion: Spreading of glottic carcinoma toward supraglottic and subglottic structures complicates exact preoperative evaluation of tumor size regardless to preoperative diagnostic procedures. Just owing to that, larger surgical resections performed bring more radicalness with less percentage of local recurrence and better effects on overall survival and disease free survival rate.