Małgorzata Wierzchowska

Chirurgiczna rehabilitacja głosu chorych po laryngektomii całkowitej z zastosowaniem systemu Provox

Summary The aim of study Comparison the voice quality of patients after total laryngectomy using the Provox 2 voice prosthesis and patients with esophageal speech and to discuss difficulties and complications related with its implantation. Material and methods The study group consists of 39 patients after total laryngectomy and Provox puncture. 36 patients underwent primary puncture, 3 patients – secondary puncture. 32 patients underwent radiotherapy. The time starting of speech learning was approx the 9th day after total laryngectomy and 1st–3th day after secondary implantation. The authors subjectively and objectively analyzed voice of 34 patients with fistular speech and it compared with esophageal speech of 10. The spectrograms analysis of the voice was based on Remacles scale. The study showed juxtaposition of early and late complications of patients with voice prostheses. Results 90% of patients (35 patients) learned the fistular speech. The speech was louder and more intelligible than esophageal voice in subjective estimation. The fistular voice had higher of mean volume (61,1 dB vs. 59 dB), mean longer maximum phonation time (9,5 s vs. 2,2 s), mean higher base frequency F0 (108 Hz vs. 87Hz) and smaller variability of F0 based on mean Jitter ratio (3,8% vs. 6,6%), mean Shimmer ratio (23,18% vs. 23,52%) and mean HPQ ratio (127,34 vs. 141,73) than esophageal voice in objective estimation. Mean range of frequency of the speech was smaller but it was in higher frequencies. The most frequent type of spectrogram was 3th type in experimental group and 2nd type in control group. The mean lifetime of prostheses was 295 days. The most common cause of replacement of the prosthesis was leakage associated with mycosis infection (26 cases). Early complications were observed. The most frequent of them was infection around the fistula during supplementary radiotherapy (7 cases after primary puncture). The most frequent of later complications was widening of fistula and leakage around prosthesis (4 cases). Conclusions Rehabilitation of patients after total laryngectomy is better using Provox system than learning esophageal speech (according to voice quality aspect). Using of voice prostheses in patients after total laryngectomy can combine with appearance of complications.THE AIM OF STUDY Comparison the voice quality of patients after total laryngectomy using the Provox 2 voice prosthesis and patients with esophageal speech and to discuss difficulties and complications related with its implantation. MATERIAL AND METHODS The study group consists of 39 patients after total laryngectomy and Provox puncture. 36 patients underwent primary puncture, 3 patients - secondary puncture. 32 patients underwent radiotherapy. The time starting of speech learning was approx the 9th day after total laryngectomy and 1st-3th day after secondary implantation. The authors subjectively and objectively analyzed voice of 34 patients with fistular speech and it compared with esophageal speech of 10. The spectrograms analysis of the voice was based on Remacles scale. The study showed juxtaposition of early and late complications of patients with voice prostheses. RESULTS 90% of patients (35 patients) learned the fistular speech. The speech was louder and more intelligible than esophageal voice in subjective estimation. The fistular voice had higher of mean volume (61,1 dB vs. 59 dB), mean longer maximum phonation time (9,5 s vs. 2,2 s), mean higher base frequency FO (108 Hz vs. 87Hz) and smaller variability of FO based on mean Jitter ratio (3,8% vs. 6,6%), mean Shimmer ratio (23,18% vs. 23,52%) and mean HPQ ratio (127,34 vs. 141,73) than esophageal voice in objective estimation. Mean range of frequency of the speech was smaller but it was in higher frequencies. The most frequent type of spectrogram was 3th type in experimental group and 2nd type in control group. The mean lifetime of prostheses was 295 days. The most common cause of replacement of the prosthesis was leakage associated with mycosis infection (26 cases). Early complications were observed. The most frequent of them was infection around the fistula during supplementary radiotherapy (7 cases after primary puncture). The most frequent of later complications was widening of fistula and leakage around prosthesis (4 cases). CONCLUSIONS Rehabilitation of patients after total laryngectomy is better using Provox system than learning esophageal speech (according to voice quality aspect). Using of voice prostheses in patients after total laryngectomy can combine with appearance of complications.

Powikłania wczesne i późne po implantacji protezy głosowej Provox 2 u chorych po laryngektomii całkowitej

Summary Introduction Effective communication is an important element of social life. For a long time depravation of the capacity of such communication has been perceived as one of the most aggravating disabilities. It happens when the necessity to remove the larynx in patients with cancer appears. Contemporary methods of speech rehabilitation in patients after total laryngectomy create the possibility to communicate by three methods. One of them is generated speech with the use of voice prosthesis. Material and methods The examination included group of 76 patients (7 women, 69 men) after total laryngectomy with implanted voice prosthesis Provox 2. All the patients were operated on at the Department of Otolaryngology CM UMK. The early and late complication after implantation of voice prosthesis was analyzed. Results In our material we observed more frequentyly late complications. In 97.4% a leakage through or around the prosthesis was observed. In 35 cases we observed leakage through the wide tracheooesophagal fistula with good outcome due to spontaneusly contract of it after removal of the prosthesis. In four cases we used stitches above the fistula and in three patients we did tracheostomal plastic. The granulation tissue from the region of the fistula was removed in 11 patients. Spontaneous falling out of the prosthesis appeared in 6 cases. The late complications as tracheal immflamation, stricture of the oesophagus or occlusion of the fistula were less common. Conclusions The late complications after implantation of Provox 2 prosthesis are more common in this type of patients’ rehabilitation. The leakage through or around the prosthesis required its exchange and generated additional medical costs, which should be reserved in medical insurance policies.

Clinical outcome and patient satisfaction using biodegradable (NasoPore) and non-biodegradable packing, a double-blind, prospective, randomized study ☆

INTRODUCTION Nasal packing after endoscopic sinus surgery is used as a standard procedure. The optimum solution to minimize or eliminate all disadvantages of this procedure may be accomplished using biodegradable packs. OBJECTIVE The aim of this study was to compare patient satisfaction and clinical outcome associated with absorbable and non-absorbable packing after FESS. METHODS In total, 50 patients were included in a prospective, double-blind, randomized trial. One side was packed with polyurethane foam, while the opposite side was packed with gauze packing. On the 2nd, 10th, and 30th postoperative day, the patients were questioned with the aid of a visual analog scale. The standardized questionnaires for bleeding, nasal breathing, feeling of pressure, and headache were used. The presence of synechiae, infection, or granulation was noted and recorded with the video-endoscopy. RESULTS A significant difference according to lower pressure was found in the NasoPore group compared to the controls on day ten after surgery. The NasoPore packing had lower scores with respect to postoperative nose blockage on the 2nd and 10th days. Mucosal healing was better for the NasoPore group, both at day ten and 30 compared with the control group. CONCLUSION The overall patient comfort is higher when using NasoPore compared to non-resorbable traditional impregnated gauze packing. Intensive saline douches applied three to four times per day are mandatory after the operation to prevent synechiae formation and fluid resorption by the packing.

Diffuse idiopathic skeletal hyperostosis inducted stridor and dysphagia

Diffuse Idiopathic Skeletal Hyperostosis (DISH) is a condition characterized by calcification and ossification of soft tissues, mainly ligaments and enthesis. Dysphagia is the commonest complaint, stridor secondary to osteophyte compression has rarely been documented. The osteophytes may cause symptoms by mechanical compression or by inducting inflammatory reaction. When an upper segment of the C-spine is involved, particular C3 - C4 level, the larynx may be affected. This could be result of hoarseness, stridor, laryngeal stenosis and obstruction. Sometimes vocal fold paralysis may result from injury to the recurrent laryngeal nerve. Treatment of the breathing problems required first on stabilization the airway with tracheostomy. Next step is osteophysectomy which generally relief patients from symptoms.

Rare benign pleomorphic adenoma of the nose: short study and literature review.

Pleomorphic adenoma is one of the most common benign tumors of the major salivary glands. It can also occur in the minor salivary glands, which exist in the nasal cavity. Intranasal pleomorphic adenoma usually originates from glands of the nasal septum mucosa. We present the results of endoscopic endonasal surgery of this pathology. The aim of the study was to present the endoscopic technique for nasal septum pleomorphic adenoma surgery. The retrospective examination of 3 patients was performed. There were 2 women and 1 man. Age ranged from 15 to 46 years. All the patients presented with nasal obstruction and occasional epistaxis for at least for 6 months. We performed endoscopic surgery to remove the tumors. In all cases we dissected the septal perichondrium to achieved free margins of the tumor. The microscopic examination revealed an epithelial and myoepithelial component with tubular structures composed of two cell layers, ducts, and a solid area found in a loose myxochondroid area. Additionally, immunohistochemical staining was performed using antibodies against cytokeratin, Ki-67, and vimentin. Patients’ postoperative course was uneventful, and no complications were encountered. No recurrence was present during patients’ postoperative visits. Nasal benign pleomorphic adenoma is a rare tumor which should be taken into consideration in the nasal cavity during surgery. The correct histological diagnosis can be confirmed by additional histological studies. Endoscopic endonasal surgery is reserved for small tumors.

Zespół cichej zatoki u dziecka

Summary Introduction Silent sinus syndrome (SSS) is rare clinical entity described in ophthalmology and otolaryngology literature. It is characterized by spontaneous and progressive enophthalmos and hypoglobus caused by maxillary collapse in the setting of chronic maxillary sinus hypoventilation. The authors report an unusual case of SSS in child. Material and methods A 15 year old boy presented with 6 months history of developing of right cheek deformity with no clinically signs and symptoms of chronic rhinosinusitis. According to nasal endoscopy and CT and NMR scans the silent sinus syndrome was recognized. What is the most important, the deformity of anterior maxillary wall was the main problem and complaint. The patient underwent surgical endoscopic uncinectomy with medial antrostomy. Results The performed treatment successfully corrected both the cheek and the upper eyelid sulcus deformity. The control CT scans performed 3 months after surgery showed normal sinus ventilation with wide medial antrostomy. Conclusions Silent sinus syndrome in a child is characterized by more active resorption and remodeling of anterior maxillary wall with clinically visible deformity. The goal of the treatment is restoration of normal maxillary sinus aeration and this guaranty further normal sinus development.

Pierwotny rak zatoki czołowej – opis przypadku

Summary Introduction Primary frontal sinus cancer is rare tumor of the paranasal sinuses. Tumors in the frontal sinuses are more often extensions from the ethmoid sinus – secondary involvement. The authors present a case of man with primary squamous cell carcinoma of the right frontal sinus. Material and methods A 49 years old man was admitted to the Dep. of Otolaryngology with right frontal sinus tumor. The man had painless forehead and upper lid swelling followed by orbital symptoms – diplopia. CT showed large destruction of anterior frontal sinus wall and invading thought inferior wall to the orbit. The patient was qualified to frontal sinus operation with right orbit content removal. Histopathologic postoperative examination showed squamous cell carcinoma G2 of right frontal sinus. Results A combined treatment, surgery and postoperative radiotherapy succeeded in good result. The 5-year survival rate in this case is 100%. Conclusions Frontal sinus cancers are rare and diagnosed in late clinical stage. The treatment is both, surgery and obligatory postoperative irradiation. The effect of treatment is still insufficient in most cases.INTRODUCTION Primary frontal sinus cancer is rare tumor of the paranasal sinuses. Tumors in the frontal sinuses are more often extensions from the ethmoid sinus--secondary involvement. The authors present a case of man with primary squamous cell carcinoma of the right frontal sinus. MATERIAL AND METHODS A 49 years old man was admitted to the Dep. of Otolaryngology with right frontal sinus tumor. The man had painless forehead and upper lid swelling followed by orbital symptoms--diplopia. CT showed large destruction of anterior frontal sinus wall and invading thought inferior wall to the orbit. The patient was qualified to frontal sinus operation with right orbit content removal. Histopathologic postoperative examination showed squamous cell carcinoma G2 of right frontal sinus. RESULTS A combined treatment, surgery and postoperative radiotherapy succeeded in good result. The 5-year survival rate in this case is 100%. CONCLUSIONS Frontal sinus cancers are rare and diagnosed in late clinical stage. The treatment is both, surgery and obligatory postoperative irradiation. The effect of treatment is still insufficient in most cases.

Mięsak włóknisto-histiocytarny krtani ☆ ☆☆ ◊

Summary Introduction Malignant fibrohistiocytoma is one of the rare neoplasms of the larynx. It has nonepithelial origin. The most common sites of the neoplasm are: limbs, trunk and retroperitoneal space. Other localizations within head and neck are very rare. There are 5 histologic types. The most common is pleomorphic type. It is built of histiocytes, fibroblasts and multinuclear giant cells. An examination of the neoplasms consists of microscopic and immunohistologic examination with identification specific tissue markers and intermediate filaments of proteins. Treatment methods of the neoplasms are radical surgery, radiotherapy, chemiotherapy and associate methods of therapy. Prognosis is very bad. Material and methodic We present 71 years old man with croak for four months. The tumor of the larynx was examined in laryngoscopy. Biopsy of the tumor confirmed malignant fibrohistiocytoma. Laser surgery (chordectomy) was used to treatment this tumor without radiotherapy. Results One year observation of the patient didn’t show recurrence of neoplasm, but he had only croak. Conclusions Malignant fibrohistiocytoma of the larynx doesn’t differ from other malignant neoplasms of the larynx. Malignant fibrohistiocytoma of the larynx is very rare malignant neoplasms of the larynx.

Steroid vs. antibiotic impregnated absorbable nasal packing for wound healing after endoscopic sinus surgery: a randomized, double blind, placebo-controlled study

INTRODUCTION Endoscopic sinus surgery can lead to crusting or synechiae formation, which can affect the healing process. OBJECTIVE The aim of our study was to compare the influence of steroid versus antibiotic versus saline solution impregnated absorbable nasal spacers on postoperative wound healing and patient satisfaction. METHODS Eighty patients, 33 women and 47 men, were enrolled in this study. At the end of the surgery, two pieces of 4cm biodegradable material were applied in each ethmoid cavity. One of them was impregnated with saline solution, while the second one with steroid, or with antibiotic. RESULTS We observed statistically significant differences in the Lund-Kennedy score between the control and both treatment groups: for the Antibiotic-group on days 10 and 30 (p=0.009; p=0.009) and for the Steroid-group on day 90 (p=0.008). The extended endoscopic appearance of nasal mucosa indicated statistically significant differences in crust formation on day 10 comparing the steroid and control dressing (p=0.025), in secretion type on days 10 and 30 comparing the antibiotic and control dressing (p=0.003; p=0.016) and additionally for steroid and control on day 90 (p=0.046). On Day 90 we observed statistically significant differences in the absence of mucosal edema in the S-group compared to controls (p=0.007). CONCLUSIONS The results of this study reveal the significant positive influence of steroid- and antibiotic-impregnated biodegradable nasal packing on the postoperative healing process and patient satisfaction compared to the saline soaked dressing.