Georgios Psychogios

Carcinoma of unknown primary in the head and neck: Comparison between positron emission tomography (PET) and PET/CT

Comparison of the diagnostic validity of positron emission tomography (PET) alone with integrated PET and CT (PET/CT) in the search for occult primary tumors in patients with cancer of unknown primary (CUP) site in the head and neck.

Sonoelastography of parotid gland tumours: initial experience and identification of characteristic patterns.

ObjectivesThe aim of this study was to investigate B-mode and elastographical ultrasound criteria capable of differentiating between benign and malignant parotid tumours and to define characteristic elastographical patterns for pleomorphic adenomas and Warthin’s tumours.MethodsFifty-seven patients with parotid gland tumours were examined using a combination of B-mode and elastographic ultrasounds. The data acquired were analysed retrospectively by two experienced ultrasound operators to identify specific sonographical features of benign and malignant lesions. Additionally, elastographical patterns were defined and analysed for their specificity.ResultsA blurred margin proved to be the only significant criterion in B-mode ultrasound capable of differentiating between malignant and benign tumours. The garland sign was defined as an elastographical pattern found significantly more frequently in malignant tumours, improving sonographical prediction of the benign or malignant nature of a parotid lesion. A logistic regression model was developed that achieved a correct prediction in 87.7% of cases. A “dense core” sign was also specifically defined for pleomorphic adenomas and a “half-half” sign for Warthin’s tumours.ConclusionsElastography is an innovative and powerful diagnostic tool that can improve the sonographical examination of parotid gland tumours by revealing easily recognised and characteristic patterns of tissue distribution.Key Points• Elastography can help differentiate benign from malignant parotid tumours during parotid ultrasound.• The elastographical “garland sign” is more frequent in malignant than benign parotid tumours.• Pleomorphic adenomas show an elastographical “dense core sign”.• Warthin’s tumours show an elastographical “half-half sign”.• Parotid cysts show an elastographical “bull’s-eye sign”.

Incidence of occult cervical metastasis in head and neck carcinomas: Development over time

With the development of imaging techniques in diagnostics of head and neck carcinomas, especially computed tomography and ultrasonogaphy, one might expect that the incidence of occult metastases would be reduced. The aim of this study was to determine the rate of occult metastases in a large population cohort and explore its changes with improvement of imaging techniques over the last 30 years.

Predicting the long-term outcome after idiopathic facial nerve paralysis.

Objective: To investigate long-term recovery after Bells palsy and evaluate specific parameters for predicting the long-term outcome of facial weakness. Study Design: Retrospective clinical study combined with long-term follow-up. Setting: Tertiary care university hospital (Department of Otorhinolaryngology, Head and Neck Surgery, University of Thessaloniki, Greece). Patients: Forty-four patients who were followed up 2 to 6 years (mean, 4.01 yr) after the onset of facial weakness. Main Outcome Measures: The failure rate of complete recovery was studied for age, initial nerve excitability test, electroneurography, initial severity of paralysis, and number of days from onset of facial weakness to the start of medical treatment. Results: Thirty-two (73%) of 44 patients had a satisfactory outcome, and 12 (27%) had a nonsatisfactory recovery. Initial House-Brackmann grades V/VI and electroneurographically detected degeneration of 90% or more were shown to affect the long-term outcome of facial weakness significantly (p = 0.024 and p = 0.000, respectively). Conclusion: The initial severity of facial weakness and the electroneurographically detected facial nerve degeneration were found to be important factors in predicting the long-term prognosis of Bells palsy.

Results of Minimally Invasive Gland-Preserving Treatment in Different Types of Parotid Duct Stenosis

OBJECTIVE To assess differences in minimally invasive treatment in various types of Stensen duct stenoses, because sparse data have been published concerning this. DESIGN Retrospective study. SETTING Tertiary reference center, level of evidence: 2b. PATIENTS Ninety-three patients with stenoses. METHODS Treatment of 111 parotid duct stenoses was evaluated with particular attention to which treatment strategies were successful in various types of stenoses (type 1, inflammatory; type 2, web-associated fibrous; and type 3, fibrous). Minimally invasive treatment consisted of sialendoscopy-guided rinsing with cortisone (all cases) and interventional sialendoscopy with instrumental dilation alone or combined with transoral ductal surgery. RESULTS Sialendoscopy-guided rinsing with cortisone was sufficient in 73.0% of cases of type 1 stenosis (21.5% of all cases). Interventional sialendoscopy with instrumental dilation was successful in 47.1% of cases of type 2 stenosis and 70.5% of cases of type 3 stenosis (59.2% of all patients). Interventional sialendoscopy combined with transoral duct surgery was successful in 72.7% of cases of type 3 stenosis (8.6% of all cases). Glands could be preserved in 96.4% of cases. CONCLUSIONS Stenoses that can be differentiated using sialendoscopy seem to require different minimally invasive treatment. Sialendoscopy-guided rinsing with cortisone is an important basic anti-inflammatory treatment, particularly in inflammatory stenoses. Interventional sialendoscopy with instrumental dilation, transoral ductal surgery or a combination of both are the first choice in fibrous stenoses.

Surgical treatment of locally limited tonsillar cancer

BACKGROUND This study aimed to assess the efficacy of primary surgical treatment in the management of locally limited tonsillar carcinoma and the incidence of occult cervical metastasis. METHODS We conducted a retrospective evaluation of the records of all patients treated with primary surgery for pT1 and pT2 tonsillar carcinomas at a tertiary referral center between 1977 and 2005. All cases were assessed for disease-specific survival as well as local control rates, with respect to T and N classification, status of surgical margins, decision on neck management, and adjuvant therapy. Cases were also evaluated for incidence of major complications and incidence of tracheotomies. RESULTS A total of 209 cases were assessed. Positive surgical margins after completion of surgical treatment and advanced neck disease were shown to be significant negative prognostic factors. The occult metastasis rate was 18.4%. CONCLUSION Primary surgical treatment is a very effective modality against locally limited tonsillar carcinoma. Low rates of complications and permanent tracheotomies are to be expected.

Comparison of different surgical approaches in T2 glottic cancer

The purpose of this study was to evaluate retrospectively the oncologic results of endoscopic and open surgical techniques in treating T2 glottic carcinomas.

Spatiotemporal Analysis of High-Speed Videolaryngoscopic Imaging of Organic Pathologies in Males

PURPOSE The aim of this study was to identify parameters that would differentiate healthy from pathological organic-based vocal fold vibrations to emphasize clinical usefulness of high-speed imaging. METHOD Fifty-five men (M age = 36 years, SD = 20 years) were examined and separated into 4 groups: 1 healthy (26 individuals) and 3 pathological (10 individuals with contact granuloma, 12 with polyps, and 7 with cysts). Vocal fold vibrations were recorded using a high-speed camera during sustained phonation. Twenty objective glottal area waveform and 24 phonovibrogram parameters representing spatiotemporal characteristics were analyzed. Statistical group comparisons were performed to document spatiotemporal changes for organic lesions that cannot be determined visually. To look for specific pattern profiles within organic lesions, the authors performed linear discriminant analysis. RESULTS Thirteen parameters showed significant differences between the healthy group and at least 1 pathological group. The differences occurred more in temporal than in spatial parameters. Contact granuloma showed the fewest statistical differences (3 parameters), followed by cysts (9 parameters), and polyps (10 parameters). Linear discriminant analysis achieved accuracy performance of 76% (all groups separated) and 82% (healthy vs. pathological). CONCLUSION The results suggest that for males, the differences between healthy voices and organic voice disorders may be more pronounced within temporal characteristics that cannot be visually detected without high-speed imaging.

Long‐term results and subjective outcome after gland‐preserving treatment in parotid duct stenosis

To assess the objective long‐term results and subjective outcome after treatment of Stensens duct stenosis.

Evaluation of the Different Transcervical Approaches for Zenker Diverticulum

Objective. The aim of this study was to evaluate the results of open surgical techniques in the treatment of Zenker diverticulum. Study Design. Case series with chart review. Setting. Academic tertiary referral center. Subjects and Methods. Fifty-four patients with Zenker diverticulum were treated using a transcervical approach. Three with a Brombart I diverticulum underwent a simple myotomy of the cricopharyngeal muscle. Myotomy was combined with a diverticulum inversion in 14 patients and myotomy with diverticulectomy was performed in 37 patients. The surgical procedures were compared with regard to mean anesthesia time, duration of hospitalization, overall complication rate and rate of serious complications, recurrence rate, and follow-up results. Results. Hospitalization times were significantly shorter in the inversion group (P = .024). No statistically significant differences were observed between the transcervical modalities for any of the other variables investigated. Conclusions. Inversion is an effective modality and is by definition less traumatic than traditional diverticulectomy. Although the size of the diverticulum appeared to be a helpful criterion, careful intraoperative evaluation is the key element in deciding which transcervical procedure should be used. In the authors’ view, inversion always should be considered if the individual anatomy of the diverticulum sac (in terms of pharyngeal pouch size and intactness of the mucosa) allows it.