László Lujber

Ionomer cement for reconstruction of the long process of the incus: the Pécs experience

•  Experience gained with the repair of the defects of the long process of the incus with ionomer cement in 35 patients is reported. •  The integrity of the reconstructed tympanic membrane and the four‐frequency average of the air‐bone gaps of the postoperative audiograms (best, most recent and at around 1 year) were evaluated. •  This ‘physiological’ reconstruction of the ossicular chain fulfilled our expectations in 40% of the patients (air‐bone gap ≤ 10 dB). •  The background of the unsuccessful cases was investigated.

Inserting a percutaneous endoscopic gastrostomy tube via a cervical fistula formed after major surgery on a patient with a head and neck tumor.

Several percutaneous endoscopic gastrostomy techniques have been devised so far to provide enteral nutrition for patients with head and neck cancer, because no single technique is adequate for all. Anatomic and functional deficits caused by advanced tumor extension or by surgery or irradiation often hinder traditional peroral gastroscopy. Transnasal, laryngoscopically guided, or intraoperative gastroscopic procedures are useful technical methods for percutaneous endoscopic gastrostomy placement. This article introduces a new method of gastroscopy, as yet unpublished. After total laryngectomy and partial pharyngectomy, the remaining narrow hypopharyngeal lumen often is insufficient for peroral gastroscopy. However, coexisting cervical pharyngocutaneous fistula can provide an approach and route for percutaneous endoscopic gastrostomy. The procedure was carried out successfully with no complications.

Laser stapedotomy – the up-to-date solution of otosclerotic stapes fixation

A vezeteses hallascsokkenest okozo otoscleroticus stapesfixatio műteti megoldasanak folyamatos fejlődese az elmult fel evszazad egyik fulsebeszeti sikertortenete. A stapedectomia, illetve parcialis stapedectomia mellett manapsag a stapedotomia is elterjedt műteti megoldasnak tekinthető. Cel: A minimalisan invaziv lezerstapedotomia hazai bevezetese, tapasztalatok szerzese, valamint a műteti hallaseredmenyek es a posztoperativ komplikaciok elemzese. Modszer: A szerzők kozlemenyukben KTP-lezerrel asszisztalt, Nitinol-pisztonnal vegzett 14 esetuk kapcsan ismertetik lezerstapedotomiakkal szerzett első tapasztalataikat. 2006 marciusa es 2007 aprilisa kozott 11 nőbeteget es 3 ferfi beteget operaltak. A betegek atlageletkora 42,2 ev volt, 6 esetben bal, 8 esetben jobb fulon tortent a műtet. A betegek atlagos kovetesi ideje 9 honap volt. Eredmenyek: A posztoperativ audiogramok ertekelesekor az 500–1000–2000–3000 Hz frekvenciakat figyelembe veve a legvezetes atlagos javulasa 21,5 dB volt. Ugyanezen frekvenciakon a ...

Poland’s syndrome and head-and-neck tumour: an unusual association causing a reconstruction dilemma

Poland’s syndrome is a rare congenital anomaly characterized by unilateral chest wall hypoplasia and ipsilateral hand abnormalities. The literature data suggest its sporadic nature. The prevailing theory concerning its cause is hypoplasia of the subclavian artery or its branches, which may lead to a range of developmental changes. Relationships have been demonstrated between tumours and Poland’s syndrome and also between tumours and other developmental defects. The explanation may lie in abnormal homeobox and tumour suppressor genes. This paper presents the first literature report of a malignant tonsillo-lingual tumour with metastatic neck involvement in a patient with partial Poland’s sequence. In consequence of the aplasia of the pectoralis major muscle, an alternative (a free radical forearm flap) to the routine head-and-neck reconstruction (pedicled pectoralis major flap) was necessitated following tumour excision and radical neck dissection. This case report surveys the diagnostic and therapeutic considerations when previously unnoticed Poland’s syndrome is diagnosed in a patient with head-and-neck cancer. One year following major head-and-neck surgery, our patient is tumour-free.

Effect of KTP laser on implants used in middle-ear surgery

The present study is intended to explore the effects of the KTP laser on various types of implant, used in middle-ear surgery. A laboratory study was undertaken to evaluate the interaction between the KTP laser (KTP-532 Orion Laser, Laserscope, UK) and individual middle-ear implants. A variety of middle-ear implants were used: a silicone sheet, Teflon, hydroxylapatite, ionomeric cement, gold and titanium prostheses as well as gelfoam. Following exposure to the laser, these implants were studied by direct inspection using an operating microscope. The KTP laser induced no detectable alteration in any of the implants when they were clean and dry. However, in the presence of fresh blood, under the influence of the energy of the absorbed laser, the silicone burnt and melted and the Teflon piston was vaporized. Likewise, a few tiny holes appeared on the surface of the ionomeric implant and then the prosthesis deformed. The hydroxylapatite implant broke into two pieces. However, no detectable alteration could be observed on gold or titanium pistons, even in the presence of blood. The authors conclude, that in the presence of blood, interaction between the KTP laser and both silicone and hydroxylapatite implants needs to be avoided. Teflon prostheses can be cautiously vaporized. Gold and titanium prostheses were unaffected by laser even in the presence of blood.

Changes in expression of oncogenes and TP53 tumour suppressor gene as biomarkers in head and neck cancers

Despite modern diagnostic procedures and up-to-date therapy, the survival of head and neck tumour patients is unfavourable. This can be explained by several factors, one of which is the late recognition of the tumour. This study related to the changes in expression of the c-myc and Ha-ras oncogenes and the p53 tumour suppressor gene as biomarkers in head and neck cancer cases. The gene expressions were investigated on RNA gained from peripheral white blood cells of head and neck cancers patients before and after definitive treatment. The results were compared with those on a control group of patients with non-tumorous diseases. The gene expressions were significantly higher in the cancer group than that in the control group (volunteer medical staff and medical students). After definitive treatment, the expressions of all these genes were decreased in patients in whom there was no recurrence of the tumour, but enhanced in the event of recurrence. Such measurement may serve as reliable biomarkers to monitor tumour development and the efficiency of therapy. The method may also be useful for the early identification of populations exposed to noxe, which may lead to the development of head and neck cancers.

Radiofrequency Transoral Microsurgical Procedures in Benign and Malignant Laryngeal and Hypopharyngeal Lesions (Institutional Experiences)

Besides cold-steel and laser instruments, the use of radiofrequency (RF) devices in transoral microsurgery is getting increasing popularity mainly due to its minimal thermal effect on the collateral soft tissue. Authors summarize their surgical technique, results, and experience gained with RF applied during laryngeal interventions at the Department of Otorhinolaryngology, Head and Neck Surgery at Medical School, University of Pécs. Transoral microsurgery using radiofrequency was carried out in 23 cases in total between 1 January 2011 and 1 March 2013. Fourteen histopathologically different benign lesions and 9 malignant planocellular carcinomas of the larynx were removed using different Micro-Larynx RF Probes powered by Surgitron Dual 4.0 MHz Frequency RF (Ellman International, Oceanside, NY, USA) device. No major bleeding event occurred during or after the procedures and neither laryngeal oedema nor significant postoperative pain was recorded. Authors also reviewed the international literature in this topic while detailing some of their most interesting cases.

Childhood Laryngeal Rhabdomyosarcoma Causing Acute Airway Obstruction

A 17-year-old boy was urgently referred to the ENT Department of Pécs University with a 2-week history of inspiratory stridor, irritative cough, and respiratory distress. Flexible nasal endoscopy revealed a papilloma-like subglottic growth almost totally obstructing the laryngotracheal lumen (Figure 1). During an urgent microlaryngoscopy, the tumor mass was resected endolaryngeally with a CO 2 laser, and the tumor bed was vaporized with a KTP laser until the skeleton of the arytenoid cartilage restored patent

Second look endoscopy by a laryngo-fiberscope passed via the feeding tube of the percutaneous endoscopic gastrostomy.

&NA; The most commonly used techniques for percutaneous endoscopic gastrostomy (PEG) require two passes of the gastroscope. The aim of this study was to clarify whether the second per oral gastroscopy can be replaced by passing a laryngo‐fiberscope through the previously inserted PEG feeding tube. Twelve patients with head and neck cancer undergoing “pull through” PEG procedures were included in this prospective study. Instead of the second per oral pass of the gastro‐intestinal fiberscope, a laryngo‐fiberscope was passed through the inserted feeding tube to assess the correct position of the PEG internal disc. To gain more deflection to the tip of the instrument a string was led through the instrument channel and was brought back to the hand of the examiner outside the instrument. Pulling the string provided a bigger angulation to the end of the scope and thus a good view. In all twelve patients the “trans tubal” endoscopy was successful and provided a good second look to judge the position PEG internal disc. The procedure caused no inconvenience for the patient. “Trans tubal” endoscopy is a simple, safe and painless procedure to assess the position of the PEG feeding tube without having to pass the gastro‐intestinal fiberscope a second time.

Combination of severe facial and cervical vascular malformation with obstructive sleep apnea syndrome: Diagnostic and therapeutic approaches

The combination of obstructive sleep apnea syndrome and vascular malformation within the head and neck region is a rare condition, and interestingly, only a few cases have recently been published. Propagation of the vascular mass to the larynx and pharynx can cause breathing and swallowing difficulties. Due to these sypmtoms, examination and initiation of appropriate therapy for such patients are indeed challenging. We reviewed the literature available and present our case of a 64 year old woman emphasizing the complaints of sleep apnea syndrome and vascular malformation of the face and neck region. Polygraphic examination detected severe obstructive sleep apnea syndrome. The MR examination of the neck revealed extensive vascular mass narrowing the pharyngo-laryngeal region, thereby causing temporal bone destruction on the right side with intracranial propagation. ENT examination demonstrated significant narrowing of the pharyngeal lumen and the laryngeal aditus caused by multiple hemangiomas. CPAP titration showed the minimalization of the apnea-hypopnea index on the effective pressure level. Regular CPAP usage resulted in diminishing a majority of the patients complaints. Our examination clearly demonstrates, obstructive sleep apnea syndrome coupled with significantly obstructing vascular malformation in the head and neck region can be effectively treated safely with a CPAP device, if surgical therapy is not possible. We summarized our findings and the data available in the literature to set up recommendations for the appropriate examination and therapy (including mask fit, etc.) of vascular malformations and hemangiomas causing pharyngo-laryngeal obstruction.