Piotr Pieńkowski

Oral cavity and oropharyngeal squamous cell carcinoma in young adults: a review of the literature

Abstract Background. Head and neck squamous cell carcinoma (HNSCC) is a disease of middle-aged to elderly adults. However, an increased incidence of HNSCC in young people under 45 years of age has been reported recently. In the present review, we focused on the epidemiology and aetiology of HNSCC in adults under 45 years of age. Methods. We reviewed literature related to HNSCC in adult patients less than 45 years of age and discussed current treatment options and prognosis. Results. HNSCC in young adults is associated with a higher incidence rate in nonsmokers, lower female-to-male ratio, a higher percentage of oral cavity and oropharynx tumours, and fewer second primary tumours. However, aside from traditional risk factors of tobacco and alcohol exposure, the causes of these cancers in young adults remain unclear. Agents that might contribute to risk include infection with high-risk human papillomavirus subtypes as well as genetic factors or immunodeficiency status. The expected increase in incidence and mortality of the young with HNSCC may become a major public health concern if current trends persist, particularly lifestyle habits that may contribute to this disease. Conclusions. Given the younger age and potential long-term adverse sequelae of traditional HNSCC treatments, young adults should be treated on a case-by-case basis and post-therapy quality of life must be considered in any treatment-decision making process.

Występowanie i rola aktywnej infekcji wirusem brodawczaka ludzkiego (HPV) w rakach płaskonabłonkowych głowy i szyi

Summary HPV, mainly HPV type 16 and to a lesser extent type 18, is a newly identified causal factor for SCCHN. The association between HPV and SCCHN is strongest for cancers of the tonsil, intermediate for the rest of the oropharynx, and weakest for the oral cavity and larynx. However, The prevalence of HPV in SCCHN in Poland reported in the literature varies from 0–72% One of the reasons of such a different results may be in our opinion method-related false positive results. The aim of the study, was the assessment of HPV prevalence in the head and neck cancer patients in polish population of SCCHN patients. The material comprised of tumor tissue obtained from 50 HNSCC patients with a primary tumor in the oral cavity, oropharynx or larynx, who were scheduled for surgical treatment. For all cases algorithm was performed: First p16 immunostaining was conducted and secondly the HPV DNA has been detected with the use of HPV DNA general primer (GP)5+/6+ PCR, followed by RLB hybridization. In 8% of cases the staining was observed in 50% of cancer cells or more. There was no HPV DNA detected in any case. There was no HPV DNA detected in any case, which may indicate the lower HPV prevalence in polish population than in Western Europe and US and smoking and drinking associated carcinogenesis. The p16 expression has been found in 8% of the patients and supplementary (GP)5+/6+ PCR did not detect the presence of HPV DNA. Thus, the p16 immunostaining is of limited use as a sole method of HPV detection and needs to be complemented by other techniques.

Intraoperative facial nerve monitoring for parotid gland surgery

INTRODUCTION The route of the facial nerve in its extracranial part determines the technique of parotid gland surgery. Permanent facial nerve paralysis after parotidectomy is not rare. It is the most devastating complication for the patient and surgeon. Facial nerve monitoring by observing or palpating the face during the surgery is a long-standing practice. Using an EMG device is a standard procedure at present. AIM OF THE STUDY Evaluation of the effectiveness of intraoperative facial nerve monitoring for parotid gland surgery. MATERIAL AND METHODS Fifty three patients operated on due to parotid gland tumour in the Head and Neck Surgery and Laryngological Oncology Department of the Greater Poland Cancer Center in 2007-2008. All patients had been provided with EMG and ENG examinations of the facial nerve before the surgery and continuous facial nerve monitoring during the operation. Facial nerve function after surgery was assessed according to the House-Brackmann grading system. RESULTS Six (12%) patients presented facial nerve dysfunction after surgery. Three (6%) patients had temporary paralysis grade III H-B with complete recovery in 6 weeks. Three (6%) patients with deep lobe tumour had grade V H-B with complete recovery in one patient after 3 months, and two (4%) patients had grade III H-B after one year since the surgery. CONCLUSIONS Intraoperative facial nerve monitoring should be a standard procedure during parotid gland surgery in most clinical situations.Summary Introduction The route of the facial nerve in its extracranial part determines the technique of parotid gland surgery. Permanent facial nerve paralysis after parotidectomy is not rare. It is the most devastating complication for the patient and surgeon. Facial nerve monitoring by observing or palpating the face during the surgery is a long-standing practice. Using an EMG device is a standard procedure at present. Aim of the study Evaluation of the effectiveness of intraoperative facial nerve monitoring for parotid gland surgery. Material and methods Fifty three patients operated on due to parotid gland tumour in the Head and Neck Surgery and Laryngological Oncology Department of the Greater Poland Cancer Center in 2007–2008. All patients had been provided with EMG and ENG examinations of the facial nerve before the surgery and continuous facial nerve monitoring during the operation. Facial nerve function after surgery was assessed according to the House-Brackmann grading system. Results Six (12%) patients presented facial nerve dysfunction after surgery. Three (6%) patients had temporary paralysis grade III H-B with complete recovery in 6 weeks. Three (6%) patients with deep lobe tumour had grade V H-B with complete recovery in one patient after 3 months, and two (4%) patients had grade III H-B after one year since the surgery. Conclusions Intraoperative facial nerve monitoring should be a standard procedure during parotid gland surgery in most clinical situations.

Guzy oczodołu w materiale Oddziału Chirurgii Głowy i Szyi i Onkologii Laryngologicznej Wielkopolskiego Centrum Onkologii w Poznaniu w latach 2007–2010

INTRODUCTION Tumors of the orbit are diagnosed sporadically. Based on the tumor registry of the American Cancer Society the incidence of tumors of the orbit is assessed at fewer than 1 per 100 000 persons. Tumors of the orbit can be divided into three groups: primary tumors, tumors penetrating the orbit from neighboring structures, and tumors that are metastases of malignant cancers from distant organs. AIM OF THE STUDY To present the results of treatment of patients with tumors of the orbit treated in the Head and Neck Surgery and Laryngological Oncology Ward of the Greater Poland Cancer Centre in Poznań during 2007-2010. MATERIAL AND METHODS The study group consisted of 26 patients surgically treated during 2007-2010 in the Head and Neck Surgery and Laryngological Oncology Ward of the Greater Poland Cancer Centre in Poznań. RESULTS In the postoperative histopathological examination 18 patients (69%) were diagnosed with malignant tumors, 7 patients (27%) with non-malignant tumor and 1 patient (4%) with inflammatory lesion. Among malignant tumors the most frequent was basal cell carcinoma, diagnosed in 7 patients (27%). When removing the tumors of the orbit 4 types of operation were performed: lateral orbitotomy, superior orbitotomy, eye enucleation, and exenteration of the orbit. In 3 patients (12%) cancer recurrences occurred. All patients with recurrences underwent reoperation. In a patient with an extensive recurrence of squamous cell carcinoma the surgery was not radical and the patient died during palliative chemotherapy. CONCLUSIONS Patients with tumors of the orbit should be treated operatively in appropriately prepared centers. In our material the confirmation of this thesis is the group of patients with recurrences of basal cell carcinoma, operated on many times in the past, who due to the extent of the cancerous process had to have the seeing eye removed. In the case of malignant cancers of the orbit an interdisciplinary approach to the problem and the assurance of psychological care for patients who have lost an orbit are essential.Summary Introduction Tumors of the orbit are diagnosed sporadically. Based on the tumor registry of the American Cancer Society the incidence of tumors of the orbit is assessed at fewer than 1 per 100 000 persons. Tumors of the orbit can be divided into three groups: primary tumors, tumors penetrating the orbit from neighboring structures, and tumors that are metastases of malignant cancers from distant organs. Aim of the study To present the results of treatment of patients with tumors of the orbit treated in the Head and Neck Surgery and Laryngological Oncology Ward of the Greater Poland Cancer Centre in Poznan during 2007–2010. Material and methods The study group consisted of 26 patients surgically treated during 2007–2010 in the Head and Neck Surgery and Laryngological Oncology Ward of the Greater Poland Cancer Centre in Poznan. Results In the postoperative histopathological examination 18 patients (69%) were diagnosed with malignant tumors, 7 patients (27%) with non-malignant tumor and 1 patient (4%) with inflammatory lesion. Among malignant tumors the most frequent was basal cell carcinoma, diagnosed in 7 patients (27%). When removing the tumors of the orbit 4 types of operation were performed: lateral orbitotomy, superior orbitotomy, eye enucleation, and exenteration of the orbit. In 3 patients (12%) cancer recurrences occurred. All patients with recurrences underwent reoperation. In a patient with an extensive recurrence of squamous cell carcinoma the surgery was not radical and the patient died during palliative chemotherapy. Conclusions Patients with tumors of the orbit should be treated operatively in appropriately prepared centers. In our material the confirmation of this thesis is the group of patients with recurrences of basal cell carcinoma, operated on many times in the past, who due to the extent of the cancerous process had to have the seeing eye removed. In the case of malignant cancers of the orbit an interdisciplinary approach to the problem and the assurance of psychological care for patients who have lost an orbit are essential.

Photodynamic therapy in palliative treatment of head and neck cancer.

INTRODUCTION Head and neck cancers account for about 6% of all malignant tumors. Head and neck cancers are responsible for about 650,000 new cases and approximately 260,000 deaths in the world annually. About 50% of patients fail to achieve cure or relapse of cancer occurs despite intensive combined treatment. A small number of patients is eligible for re-treatment, and for most of them symptomatic treatment is used. Photodynamic therapy(PDT) may be an alternative these patients. PDT improves the quality of life in patients who are at the stage of the disease recognized as incurable according to present knowledge. MATERIALS AND METHODS Study group consisted of three patients treated in the Department of Head and Neck Surgery in Poznan due to recurrence of squamous cell carcinoma of the head and neck. Patients were qualified to the palliative PDT ( Photodynamic therapy)with Foscan. when other possibilities of treatment have been used up. RESULTS Two patients achieved a partial response (PR) by RECIST criteria. One patient achieved disease stabilization (SD). DISCUSSION Photodynamic therapy is a therapeutic option in the palliative treatment of patients with squamous cell carcinoma of the head and neck. The careful qualification of the patients for this type of treatment is very important. One should take into account the location of the tumor and its size. Great advantage of photodynamic therapy is that it can be used repeatedly. Treatment with photodynamic therapy should be performed in specialized centers because of the need of adequate technical facilities. PDT may improve the quality of life of selected patients with incurable cancer of the head and neck.

Doświadczenia własne w zastosowaniu wolnych płatów udowych w rekonstrukcji ubytków po rozległych operacjach nowotworów złośliwych głowy i szyi

Summary Introduction Free flaps with vascular anastomosis have been widely used in clinical practice for more than 30 years. They are standard in reconstructive surgery following extensive resections caused by neoplasms of the head and neck. The anterolateral thigh flap (ALT) constitutes very good reconstructive material due to the long vascular pedicle, the appropriate diameter of vessels, the large skin island plane, and thickness depending on requirements. Material The own material comprises 5 patients who have had extensive neoplastic infiltrations removed at different anatomic locations within the area of healthy tissue. Results Reconstructions have been conducted using a microvascular thigh flap (ALT). All of the operated patients are under constant supervision. The observation period ranges from 2 to 3 months. No recurrence of the neoplastic process or graft rejection has been observed in any of the patients.

Śródoperacyjne monitorowanie czynności nerwu twarzowego w chirurgii ślinianki przyusznejIntraoperative facial nerve monitoring for parotid gland surgery

INTRODUCTION The route of the facial nerve in its extracranial part determines the technique of parotid gland surgery. Permanent facial nerve paralysis after parotidectomy is not rare. It is the most devastating complication for the patient and surgeon. Facial nerve monitoring by observing or palpating the face during the surgery is a long-standing practice. Using an EMG device is a standard procedure at present. AIM OF THE STUDY Evaluation of the effectiveness of intraoperative facial nerve monitoring for parotid gland surgery. MATERIAL AND METHODS Fifty three patients operated on due to parotid gland tumour in the Head and Neck Surgery and Laryngological Oncology Department of the Greater Poland Cancer Center in 2007-2008. All patients had been provided with EMG and ENG examinations of the facial nerve before the surgery and continuous facial nerve monitoring during the operation. Facial nerve function after surgery was assessed according to the House-Brackmann grading system. RESULTS Six (12%) patients presented facial nerve dysfunction after surgery. Three (6%) patients had temporary paralysis grade III H-B with complete recovery in 6 weeks. Three (6%) patients with deep lobe tumour had grade V H-B with complete recovery in one patient after 3 months, and two (4%) patients had grade III H-B after one year since the surgery. CONCLUSIONS Intraoperative facial nerve monitoring should be a standard procedure during parotid gland surgery in most clinical situations.Summary Introduction The route of the facial nerve in its extracranial part determines the technique of parotid gland surgery. Permanent facial nerve paralysis after parotidectomy is not rare. It is the most devastating complication for the patient and surgeon. Facial nerve monitoring by observing or palpating the face during the surgery is a long-standing practice. Using an EMG device is a standard procedure at present. Aim of the study Evaluation of the effectiveness of intraoperative facial nerve monitoring for parotid gland surgery. Material and methods Fifty three patients operated on due to parotid gland tumour in the Head and Neck Surgery and Laryngological Oncology Department of the Greater Poland Cancer Center in 2007–2008. All patients had been provided with EMG and ENG examinations of the facial nerve before the surgery and continuous facial nerve monitoring during the operation. Facial nerve function after surgery was assessed according to the House-Brackmann grading system. Results Six (12%) patients presented facial nerve dysfunction after surgery. Three (6%) patients had temporary paralysis grade III H-B with complete recovery in 6 weeks. Three (6%) patients with deep lobe tumour had grade V H-B with complete recovery in one patient after 3 months, and two (4%) patients had grade III H-B after one year since the surgery. Conclusions Intraoperative facial nerve monitoring should be a standard procedure during parotid gland surgery in most clinical situations.

Śródoperacyjne monitorowanie czynności nerwu twarzowego w chirurgii ślinianki przyusznej

INTRODUCTION The route of the facial nerve in its extracranial part determines the technique of parotid gland surgery. Permanent facial nerve paralysis after parotidectomy is not rare. It is the most devastating complication for the patient and surgeon. Facial nerve monitoring by observing or palpating the face during the surgery is a long-standing practice. Using an EMG device is a standard procedure at present. AIM OF THE STUDY Evaluation of the effectiveness of intraoperative facial nerve monitoring for parotid gland surgery. MATERIAL AND METHODS Fifty three patients operated on due to parotid gland tumour in the Head and Neck Surgery and Laryngological Oncology Department of the Greater Poland Cancer Center in 2007-2008. All patients had been provided with EMG and ENG examinations of the facial nerve before the surgery and continuous facial nerve monitoring during the operation. Facial nerve function after surgery was assessed according to the House-Brackmann grading system. RESULTS Six (12%) patients presented facial nerve dysfunction after surgery. Three (6%) patients had temporary paralysis grade III H-B with complete recovery in 6 weeks. Three (6%) patients with deep lobe tumour had grade V H-B with complete recovery in one patient after 3 months, and two (4%) patients had grade III H-B after one year since the surgery. CONCLUSIONS Intraoperative facial nerve monitoring should be a standard procedure during parotid gland surgery in most clinical situations.Summary Introduction The route of the facial nerve in its extracranial part determines the technique of parotid gland surgery. Permanent facial nerve paralysis after parotidectomy is not rare. It is the most devastating complication for the patient and surgeon. Facial nerve monitoring by observing or palpating the face during the surgery is a long-standing practice. Using an EMG device is a standard procedure at present. Aim of the study Evaluation of the effectiveness of intraoperative facial nerve monitoring for parotid gland surgery. Material and methods Fifty three patients operated on due to parotid gland tumour in the Head and Neck Surgery and Laryngological Oncology Department of the Greater Poland Cancer Center in 2007–2008. All patients had been provided with EMG and ENG examinations of the facial nerve before the surgery and continuous facial nerve monitoring during the operation. Facial nerve function after surgery was assessed according to the House-Brackmann grading system. Results Six (12%) patients presented facial nerve dysfunction after surgery. Three (6%) patients had temporary paralysis grade III H-B with complete recovery in 6 weeks. Three (6%) patients with deep lobe tumour had grade V H-B with complete recovery in one patient after 3 months, and two (4%) patients had grade III H-B after one year since the surgery. Conclusions Intraoperative facial nerve monitoring should be a standard procedure during parotid gland surgery in most clinical situations.

Rekonstrukcja części szyjnej przełyku techniką gastric pull-up w przebiegu wznowy raka gardła dolnego i krtani ☆

Patient with hypopharyngeal cancer are difficult to treat because they usually present with advanced disease, poor general health status and severe nutritional problems. Because of the poor prognosis, careful consideration has to be given regarding the choice of the correct surgical approach for respirato-digestive tract reconstruction. The authors present a case of recurrent hypopharyngeal cancer with cervical esophagus infiltration successfully treated with total laryngectomy and esophagectomy and gastric pull up reconstruction. Indications for technique, method of reconstruction and complications are, discussed. As most authors we consider the gastric transposition method as the preferred approach to restore digestive continuity after total esophagectomy. As the method is the single stage procedure it provides the best palliation of dysphagia and allows early resumption of an oral diet.Summary Patient with hypopharyngeal cancer are difficult to treat because they usually present with advanced disease, poor general health status and severe nutritional problems. Because of the poor prognosis, careful consideration has to be given regarding the choice of the correct surgical approach for respirato-digestive tract reconstruction. The authors present a case of recurrent hypopharyngeal cancer with cervical esophagus infiltration successfully treated with total laryngectomy and esophagectomy and gastric pull up reconstruction. Indications for technique, method of reconstruction and complications are discussed. As most authors we consider the gastric transposition method as the preferred approach to restore digestive continuity after total esophagectomy. As the method is the single stage procedure it provides the best palliation of dysphagia and allows early resumption of an oral diet.