Tomasz Kopeć

Radiotherapy induced xerostomia: Mechanisms, diagnostics, prevention and treatment – Evidence based up to 2013

Definition and prevalence of xerostomia were shortly presented. Radiosensitivity of the salivary glands, mechanism, diagnostics, and possible prediction methods of the intensity of xerostomia in the pre-radiotherapy period are widely discussed. Prevention of xerostomia: salivary gland sparing radiotherapy, cytoprotective agents, preservation by stimulation with cholinergic muscarinic agonists, surgical transfer of submandibular glands according to ASCO Management Guidelines and Quality of Life Recommendations were cited. Oral Care Study Group (2010) therapeutic approaches for relieving xerostomia are referred. Current therapies, restricted to symptom relief such as oral hygiene with fluoride agents, antimicrobials to prevent dental caries, saliva substitutes to relieve symptoms, and sialogenic agents to stimulate saliva were also discussed.

Stenoses of the salivary ducts-sialendoscopy based diagnosis and treatment

Our aim was to analyse the nature of a sialendoscopy-based classification and present its use in the treatment of stenoses of Whartons and Stensens ducts. The classification of stenoses of Whartons duct has not been published before. We did 133 sialendoscopies in 114 patients who presented with possible obstruction of the ducts to the tertiary centre for ENT at the University Department in Poznań. Twenty-seven patients had their parotid ducts treated, and 24 their submandibular ducts. Suspicion of stenotic changes of the ductal system was suggested during ultrasound examination. They were examined with semirigid endoscopes that enabled direct visualisation of the stenotic areas. A total of 69 stenoses were diagnosed in 51 patients. Stenoses were divided into three groups according to their site. Patients with stenosis of the salivary ducts were treated by dilatation of the stenotic area, intraductal steroid injections, and insertion of a stent for 14-21 days. Forty of the 51 reported considerable improvement, and 7 partial improvement. Four patients had no improvement. Sialendoscopy is a safe way to treat obstruction of the salivary glands. Short and medium term follow up show that it is extremely successful.

The presence of facial nerve weakness on diagnosis of a parotid gland malignant process

The objectives of this article are to assess the frequency and significance of facial paralysis and undiagnosed nerve infiltration in patients with parotid malignancies. 103 patients with parotid gland malignancies were treated in a single institution, the tertiary center for ENT at the University Department in Poznan between 1996 and 2006. Facial palsy at the initial presentation was found in 32 patients. The stage of the primary tumor in the examined group of 103 patients is as follows: 20—T1, 31—T2, 20—T3, 32—T4. The correlation between facial nerve function before treatment and patients’ characteristics, including the treatment methods, were analyzed. Intact facial nerve function at patient presentation was a very strong prognostic factor determining the treatment and final outcome for malignant neoplasms of parotid gland. Similarly, T stage and a high-grade malignant histology had a direct influence on the duration of patients’ survival.

PRAME expression in head and neck cancer correlates with markers of poor prognosis and might help in selecting candidates for retinoid chemoprevention in pre-malignant lesions

OBJECTIVES PRAME (Preferentially Expressed Antigen in Melanoma) is a tumor-associated antigen recognized by immunocytes, and it induces cytotoxic T cell-mediated responses in melanoma. PRAME expression in tumors interferes with retinoic acid receptor (RAR) signaling thus promoting tumor progression. Here, we study PRAME expression in head and neck squamous cell carcinoma (HNSCC) to determine its potential clinical significance. MATERIALS AND METHODS PRAME expression in HNSCC was evaluated by immunohistochemistry in tissue microarrays of primary tumors (n=53), metastatic lymph nodes (n=8) and normal oral mucosa (n=11). Biopsies of dysplastic oral lesions (n=12) were also examined. PRAME expression levels in tissues were correlated with markers of poor prognosis in HNSCC. PRAME mRNA in HNSCC cell lines and in normal immortalized human keratinocytes (HaCaT cell line) was measured by qRT-PCR, and the protein expression by flow cytometry and western blots. RESULTS PRAME was expressed in HNSCC cell lines and HNSCC lesions. PRAME expression in dysplastic mucosa was variable. No or only weak expression was found in normal cells or tissues. PRAME expression levels significantly correlated with the tumor grade, size, nodal involvement and the clinical status of HNSCC patients. CONCLUSIONS Elevated PRAME expression associates with clinicopathologic markers of poor outcome in HNSCC and might identify potential candidates with pre-cancerous lesions for chemoprevention with retinoids.

Shear Wave Elastography: A New Noninvasive Tool to Assess the Intensity of Fibrosis of Irradiated Salivary Glands in Head and Neck Cancer Patients

The aim of the study was to assess salivary gland parenchyma by means of sonoelastography in patients irradiated for head and neck squamous cell carcinoma (HNSCC). The studied group consisted of 52 patients after radiotherapy (RT) and 54 healthy volunteers. All of the former were treated for advanced larynx (40), oropharynx (9), or maxilla (3) squamous cancers and suffered from chronic dryness. Ultrasonography (US) and elastography (ES) were performed, as well as an assessment of the amount of saliva and Common Terminology Criteria for Adverse Events (CTCAE) scale. There was a statistical difference between ES values in the RT group and in the controls for parotid glands (41.7 kPa versus 26.03 kPa, P = 0.0018) and for submandibular glands (37.6 kPa versus 22.4 kPa; P = 0.005). There was a significant correlation between the CTCAE scores and objective saliva amount (P = 0.0005), and the median amount of saliva in the examined group was lower than in the reference group (1.86 g versus 2.75 g, P = 0.0006). In conclusion sonoelastography adds a new parameter to ultrasonography in “one touch examination” and may be a useful tool for major salivary gland evaluation during the radiotherapy course and follow-up period.

Value of open horizontal glottectomy in the treatment for T1b glottic cancer with anterior commissure involvement.

The aim of the study was to evaluate the treatment outcomes in the group of 108 T1b glottic cancer patients with the anterior commissure involvement treated with open horizontal glottectomy and to compare them with transoral laser microsurgery (TLM) or primary radiotherapy (XRT) results from the literature review.

Sialendoscopy and sialendoscopically-assisted operations in the treatment of lithiasis of the submandibular and parotid glands: our experience of 239 cases.

We present the results of treatment of sialolithiasis of the submandibular and parotid glands using sialendoscopy and sialendoscopy-assisted surgery. Between 2009-2013, 397 consecutive patients (mean (range) age 48 (18-76) years) were treated for obstructive diseases of the major salivary glands (sialolithiasis n=239, 175 submandibular and 64 parotid). In a total of 175 patients with 191 stones in the submandibular gland treated by endoscopic retrieval or surgical release, 149 patients (85%) were rendered free of stones (by sialendoscopy alone n=82, and sialendoscopy with operation n=67) Twenty patients (11%) had residual stones and 6 patients (4%) required excisionof the gland. Sixty-four patients had 71 stones removed from the parotid gland by endoscopic retrieval or surgical release and 43 (67%) were free of stones (by sialendoscopy alone n=25, and sialendoscopy with operation n=18). Twenty patients (31%) had residual stones and one (2%) required removal of the gland. In the group of patients whose stones were removed endoscopically, the effectiveness of sialendoscopy was 87% and 85%, respectively. We confirm that sialendoscopy and sialendoscopy-assisted removal is the current treatment of choice for stones in the submandibular and parotid glands. The indications for excision of the gland are becoming less common as first-line treatment, although it is still indispensable in some cases.

Sonoelastography – A Useful Adjunct for Parotid Gland Ultrasound Assessment in Patients Suffering from Chronic Inflammation

Background Shear wave elastography (SWE) is widely used in breast, liver, prostate and thyroid evaluations. Elastography provides additional information if used to assess parotid gland pathology. We assessed parotid glands by means of SWE to compare the parenchyma properties in different types of inflammation. Material/Methods Prospective analysis included 78 consecutive patients with parotid gland pathology: sialolithiasis (33), Stensen’s duct stenosis (15), chronic inflammation (10), and primary Sjögren syndrome (pSS) (20) treated at the Department of Otolaryngology, Head and Neck Surgery of PUMS. The primary predictor variable was type of parotid pathology, and secondary predictor variables were patient age and the duration and intensity of complaints. Ultrasound pictures were compared with elastography values of parotid parenchyma. Results Mean elasticity values for pSS (111 Kilopascals (kPa), Stensen’s duct stenosis (63 kPa), sialolithiasis (82 kPa), and chronic inflammation (77 kPa) were significantly higher than the mean value for healthy patients (24 kPa). Elasticity increased proportionally to the intensity of complaints: mild (51 kPa), moderate (78 kPa), and strong (90 kPa). Increased elasticity did not correspond with ultrasonographic pictures. In pSS the parenchyma was almost twice as stiff as in chronic inflammation (p=0.02), although subjective complaints were mostly mild or moderate, and the ultrasonographic picture did not present features of fibrosis. Conclusions Sonoelastography, by improving routine ultrasonographic assessment, might be a useful tool for parotid evaluations during the course of chronic inflammation. An extraordinarily high degree of stiffness was revealed in pSS despite lack of fibrosis by ultrasonography and moderate subjective complaints, suggesting that sonoelastography could be a valuable diagnostic tool.

Epidemiologia guzów niezłośliwych ślinianek podżuchwowych i przyusznych na podstawie 675 przypadków

Summary Neoplasm of salivary glands constitutes about 3% of all tumours of head and neck. Within the category we can differentiate tumours of a very different histological structure. What lies behind such great differences in the changes within the salivary glands is complex embryogenesis of the glands. About 80% of all tumours of salivary glands is located in parotid gland, from 10 to 20% – in submandibular gland and several percent in sublingual and small salivary gland. This work aims at the assessment of the frequency of occurrence of non-malignant neoplasm in parotid and submandibular gland based on the material collected at the ENT Department of the Medical University in Poznan in the years 1995–2006. In the 12-year period, 778 patients in total suffered from tumours of large salivary glands. The number of non-malignant neoplasm was 675, and the number of malignant neoplasm was 103. With regard to paroid glands, 586 non-malignant tumours and 82 malignant tumours were identified, with regard to submandibular glands the numbers were respectively: 89 and 21. Main aim of this work has been achieved through the execution of partial steps: the analysis of the trends in occurrence of non-malignant neoplasm in the 12-year period, the analysis of the epidemiological differences: sex, age, place of residence – town or country, duration of symptoms, diameter of the tumour at the time the patient reported for treatment, histological structures that were carried on the basis of the comparison of data collected in the two periods of time: period I – the years 1995–2000 and period II – the years 2001–2006. The frequency of operations on non-malignant tumours of salivary glands (as compared to the total number of operations) was 4.11% in the first period and 4.18% in the second. In both periods the most frequent benign tumour was the mixed tumour (54.9% of all tumours) and constituted 60% and 54% of all tumours in the respective periods analyzed. The next most frequently occurring tumour was Warthins tumour, identified in 31.2% of the patients, in 23% in period I and 35% in period II. Duration of the symptoms, ranged from 1 month to 20 years, 14 months on average, yet in 263 cases the tumour has been developing developed for over a year. The diameter of the non-malignant tumours undergoing operation ranged from 1 cm to 8 cm, with the average being 3 cm. It was 3 cm with regard to the most frequently occurring tumours: adenoma polymorphum, adenoma monomorphum and cystadenolymphoma.Neoplasm of salivary glands constitutes about 3% of all tumours of head and neck. Within the category we can differentiate tumours of a very different histological structure. What lies behind such great differences in the changes within the salivary glands is complex embryogenesis of the glands. About 80% of all tumours of salivary glands is located in parotid gland, from 10 to 20% - in submandibular gland and several percent in sublingual and small salivary gland. This work aims at the assessment of the frequency of occurrence of non-malignant neoplasm in parotid and submandibular gland based on the material collected at the ENT Department of the Medical University in Poznan in the years 1995-2006. In the 12-year period, 778 patients in total suffered from tumours of large salivary glands. The number of non-malignant neoplasm was 675, and the number of malignant neoplasm was 103. With regard to paroid glands, 586 non-malignant tumours and 82 malignant tumours were identified, with regard to submandibular glands the numbers were respectively: 89 and 21. Main aim of this work has been achieved through the execution of partial steps: the analysis of the trends in occurrence of non-malignant neoplasm in the 12-year period, the analysis of the epidemiological differences: sex, age, place of residence - town or country, duration of symptoms, diameter of the tumour at the time the patient reported for treatment, histological structures that were carried on the basis of the comparison of data collected in the two periods of time: period I--the years 1995-2000 and period II--the years 2001-2006. The frequency of operations on non-malignant tumours of salivary glands (as compared to the total number of operations) was 4.11% in the first period and 4.18% in the second. In both periods the most frequent benign tumour was the mixed tumour (54.9% of all tumours) and constituted 60% and 54% of all tumours in the respective periods analyzed. The next most frequently occurring tumour was Warthins tumour, identified in 31.2% of the patients, in 23% in period I and 35% in period II. Duration of the symptoms, ranged from 1 month to 20 years, 14 months on average, yet in 263 cases the tumour has been developing developed for over a year. The diameter of the non-malignant tumours undergoing operation ranged from 1 cm to 8 cm, with the average being 3 cm. It was 3 cm with regard to the most frequently occurring tumours: adenoma polymorphum, adenoma monomorphum and cystadenolymphoma.

Sialoendoskopia jako nieinwazyjna metoda leczenia kamicy i niezapalnych zmian obrzękowych gruczołów ślinowych

Summary Inflammatory and non-neoplastic diseases of salivary glands affect approximately 5% of patients in every day laryngology practice. Sialolithiasis is the most common cause of obstructive diseases in salivary glands and is supposed to affect 1,2% of population. Other, non inflammatory reasons of glandular swelling are sialodochitis (acute ductal inflammation), stenosis of the duct, and chronic, obstructive changes in the ductal epithelium found in patients with chronic recurrent (juvenile) parotitis. Sialendoscopy is a minimal invasive technique aiming to visualize the lumen of the salivary ducts and their pathologies. It could be used for diagnostic reasons, in case of sialolithiasis extraction of stones and in case of stenosis dilatation is performed (interventional sialendoscopy). In ENT Department Medical University in Poznan, in the period 2008 XII between 2010 IV, 46 sialendoscopies were performed. Sialolithiasis was observed in 29 patients, stenosis of main duct in 16 patients. In 1 case any changes in ductal system were observed. In group with sialolithiasis, in 19 cases stones were removed endoscopically, in 4 patients papillotomy was performed to extraction of the stone. In 3 patients with big stones and an extreme posterior location, bilateral (external and endoscopical) approach was used. Any postoperative complications were observed.Inflammatory and non-neoplastic diseases of salivary glands affect approximately 5% of patients in every day laryngology practice. Sialolithiasis is the most common cause of obstructive diseases in salivary glands and is supposed to affect 1,2% of population. Other, non inflammatory reasons of glandular swelling are sialodochitis (acute ductal inflammation), stenosis of the duct, and chronic, obstructive changes in the ductal epithelium found in patients with chronic recurrent (juvenile) parotitis. Sialendoscopy is a minimal invasive technique aiming to visualize the lumen of the salivary ducts and their pathologies. It could be used for diagnostic reasons, in case of sialolithiasis extraction of stones and in case of stenosis dilatation is performed (interventional sialendoscopy). In ENT Department Medical University in Poznań, in the period 2008 XII between 2010 IV, 46 sialendoscopies were performed. Sialolithiasis was observed in 29 patients, stenosis of main duct in 16 patients. In 1 case any changes in ductal system were observed. In group with sialolithiasis, in 19 cases stones were removed endoscopically, in 4 patients papillotomy was performed to extraction of the stone. In 3 patients with big stones and an extreme posterior location, bilateral (external and endoscopical) approach was used. Any postoperative complications were observed.