Slobodan M. Mitrović

Laryngotracheal stenosis and restenosis. What has the influence on the final outcome

The aim of this study is to analyze the impact of various parameters on the course and treatment outcome in patients with laryngotracheal stenosis and recurrent stenosis. Two groups of patients were compared: Group I included 29 patients with primary stenosis, and Group II included 22 patients with recurrent stenosis. The most frequent etiological factor for the development of stenosis was prolonged endotracheal intubation (79.3:77.3%), with subglottic-tracheal (44.8:45.5%) and tracheal (48.3:36.4%) localization being the most affected. Subglottic-tracheal stenosis was more common in men. There were no significant differences between the groups in regard to the grade of lumen obstruction and the length of the resected segment. In male patients, the length of the resected stenotic segment was significantly longer. Subglottic-tracheal stenoses were longer than tracheal ones. Various surgical procedures were performed, with additional management of recurrent laryngeal nerve paralysis, if necessary. Laryngotracheal reconstruction (LTR) with costal cartilage grafting (CCG) was statistically significantly more often performed in Group II, while cricotracheal resection (CTR) was more common in Group I. The incidence of complications in Group I was 24.1%, and in Group II it was 31.8%. Satisfactory airway lumen with undisturbed breathing was achieved in 93.1% of patients in Group I, and in 95.3% in Group II. Since the success rate was similar in both groups of the patients, it could be concluded that treatment outcome depends less on the factors associated with the stenosis, and more on adequate choice of surgical procedure and surgical team know-how.

Giant antrochoanal polyp: Case report and literature review

INTRODUCTION Antrochoanal polyp is a benign tumor of the maxillary sinus mucosa passing through the sinus ostium into the nasal cavity. Nasal obstruction is the most common symptom in all patients. CASE REPORT The authors present a case of a 28-year old female who was admitted to hospital with breathing difficulty, unilateral nasal secretion, headache and deformity of the nasal pyramid. Computerized tomography examination of the nose and paranasal sinuses indicated a possibility of giant antrochoanal polyp. The antrochoanal polyp was extirpated completely using forceps, under general endotracheal anesthesia. The length of the giant polyp was 16 cm. A follow-up examination of the nose and the right maxillary sinus was performed using a rigid endoscope, but no remains of the polyp were found. CONCLUSION The authors believe that this is probably the first or a very rare published case of complete extirpation of a giant antrochoanal polyp of this size.

Isolated fracture of hyoid bone as a result of bicycle injury

Authors present a rare case of isolated hyoid bone fractures as a result of a traffic accident. Ten hours before the exam, the patient injured his neck by hitting it against a metal pole which he did not notice while riding a bicycle. Immediately afterwards he felt the pain, and came for an examination due to pain with swallowing. ENT examination discovered no signs of trauma in the oral cavity, oropharynx, hypopharynx, larynx and visible part of trachea. Computed tomography discovered an isolated fracture of hyoid bone. After 24 hour observation, patient was discharged for home care, and was shown a swallowing technique which significantly reduces swallowing pain. At control ENT examination 10 days later patient had no complaints. Control CT examination was not performed, as patient refused it.

Surgical treatment of primary tracheal dyskinesia in a 14-month-old child—Case report

The primary form of tracheal dyskinesia in early childhood is a rare congenital malformation of unknown origin. The degree of the posterior membranous tracheal wall involvement determines the intensity of obstruction and the severity of the clinical picture. The aim of this paper is to present a case of a 14-month-old child with severe tracheal dyskinesia that required surgical treatment. Fascia lata graft fixated with fibrin glue was used in strengthening the posterior tracheal wall. Three years following the surgery, the child is without breathing difficulties. In severe cases of primary dyskinesia, surgical treatment using fascia lata graft, fixated with fibrin glue is recommended in strengthening the posterior tracheal wall.

Surgical approach and results of treating two subcategories pT2 glottic carcinoma of the larynx

Background: T2 glottic carcinoma is a nonhomogenous localization of laryngeal carcinoma with two subcategories. The aim of the study was to retrospectively analyze the results of surgically treated pT2 glottic carcinomas and to determine the importance of subcategories of glottic carcinomas in diagnostics, surgical treatment, and patients’ survival. Methods: During the period 1990-2000, 71/701 (10%) patients were diagnosed. with pT2 glottic carcinoma. All patients were treated with different surgical techniques. Results: Total laryngectomy was performed in 14/71 patients. Involvement of anterior commisure in local spreading of the cancer was found in 24/71 patients; total laryngectomy was performed in 13/24 and reconstructive surgery in 11/24. Selective resection of neck was done in 49 patients and metastases were found in 2 of these patients. Out of fifty-seven patients who had reconstructive laryngeal surgery local disease recurrence appeared in 8 patients. These 8 patients were treated with total laryngectomy. Overall 5-year survival was 90.1% with a slight difference between subcategories (89.1% subcategory I; 93.7% subcategory II) which was not statistically significant (p>0.05). Disease free 5-year survival was 83.6% with a difference between subcategories (81.1% subcategory I; 93.3% subcategory II) which was not statistically significant (p>0.05). Conclusion: Spreading of glottic carcinoma toward supraglottic and subglottic structures complicates exact preoperative evaluation of tumor size regardless to preoperative diagnostic procedures. Just owing to that, larger surgical resections performed bring more radicalness with less percentage of local recurrence and better effects on overall survival and disease free survival rate.

Selective neck dissection in the treatment of pN1/2 neck lymph-node metastases

INTRODUCTION As yet there is no single reliable and accurate method for detection of neck lymph node metastases. Therapeutic approaches differ from one author to other. The aim of this paper was to establish the extent to which, with good control of primary process, we can control spreading of malignant disease by means of selective neck dissection. MATERIAL AND METHOD This retrospective study included 595 surgically treated patients in the period 1990-1998. There were 525 patients with malignant laryngeal tumors, and 70 patients with malignant hypopharyngeal tumors. Preoperative diagnostics of enlarged lymph nodes was based on palpation of the neck, without CT, US, NMR diagnostics. With all risky N0 patients, selective neck dissection was performed for presence of occult metastases. Intraoperative frozen section analysis was not performed. Adjuvant radiatitherapy was performed in all patients in whom presence of neck lymph node metastases was histologically proved. RESULTS Selective lateral neck dissection was performed in 389 (65.4%) patients. In 78 (20%) patients, lymph node metastases were pathohistologically detected. In 5 (6.4%) transitional cellular cancer was histologically diagnosed, and the remaining 73 (93.6%) presented with squamous cell cancer. Postoperative radiation therapy was applied in 54 patients (69.2%) while 24 (30.8%) were not irradiated. 5-year survival was achieved in 18 (23.1%), and 3-year survival was achieved in 15 (19.2%) patients. Out of 45 patients who lived less than tree year, 18 (40%) presented with metastatic relapse and fatal outcome. Relapse of neck metastases appeared in 12 (11.9%) on the side and in the zones of lymph nodes which were included in neck dissection. Recurrence of neck metastases appeared in 8.3% of patients who were not irradiated postoperatively and in 32.1% of cases irradiated postoperatively. DISCUSSION This study includes comparison of our results with results of literature data. CONCLUSION Neck lymph node metastases point to advanced malignant process of the third or forth stage of the disease when results are the worst and 5-year survival decreases with or without adjuvant radiotherapy.