Maciej Pabiszczak

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.

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.

Zabiegi rekonstrukcyjne w wielkich guzach gruczołów ślinowych

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.

Cena uzyskania wolnego płata przedramienia w rekonstrukcjach w obrębie jamy ustnej i gardła – powikłania 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.

Trudności diagnostyczne w przebiegu mięsaka polimorficznego krtani

Summary 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.

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.

Czerniak złośliwy zatok przynosowych – opis przypadku

Summary 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 ilness.

Rzadki przypadek szpiczaka pozaszpikowego okolicy policzka

Summary 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-Hodgkins lymphomas. The characteristic feature of that group is monoclonal proliferation of B lymphocytes. One of the most common locations is nasopharynx and paranasal sinuses.

Application of Low-Cost 3D Printing for Production of CT-Based Individual Surgery Supplies

The main problem addressed in this paper is the use and evaluation of low-cost additive manufacturing (3D printing) techniques and CT images as tools for manufacture of usable and individualized, anatomically correct models, assisting surgeons in their daily work. The authors formulate own methodology of design and additive manufacturing of medical products on the basis of medical imaging data. A specific case was selected—a surgical lower jaw template for use in the middle of operation. Two Fused Deposition Modeling machines—professional and low-cost—were used to manufacture the same product, which was later evaluated, inspected for accuracy (by 3D scanning) and used during the surgery. By two 3D printing processes comparison it was found that the low cost comes at a price of lower accuracy and increased demand for process supervision. The authors obtained a fully usable medical product used during an actual reconstruction surgery. Partial clinical results are presented—use of 3D printed templates helped reduce surgery time and generally improved the patient recovery process.

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.