Tomasz Pastusiak

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.

Zwężenie podgłośniowe w ziarniniakowatości Wegenera – problem diagnostyczny i terapeutyczny

Summary Wegeners granulomatosis (WG) is a disease caused by necrotising vasculitis of small and middle blood vessels of upper and lower respiratory tract and kidneys of unknown etiology. ENT symptoms develop in more than 90% of patients and tracheobronchial involvement occurs in about 20% of patients, most often as a subglottic stenosis. Subglottic stenosis occurs usually as a late complication of disease, but sometimes it may be an early isolated symptom. It is usually irregular, no longer than 2–4 cm and affects mucosa and submucosa but sometimes also cartilage. The diagnosis is based on clinical symptoms, X-ray of the chest, urine analysis, c-ANCA detection and histological examination of the granulation from the stenosis. The main treatment of subglottic stenosis in WG is a causal immunosuppressive treatment, however an equally important is a preservation of respiratory tract passage, because a dominant symptom in this form of WG is problem with breathing or even dyspnoea. In this publication basing on literature review different methods of treatment of laryngotracheal stenosis and its importance in WG are described and discussed. In literature presently less invasive operations are recommended. The treatment of choice is endoscopic treatment with repeated dilatations and injections of steroid into the stenosis. In big stenosis in immunologically active disease patient sometimes requires tracheotomy and after remission of disease and maturation of the subglottic scar laryngotracheal resection can be considered.

Wyniki leczenia wczesnych raków głośni

INTRODUCTION Early glottic cancer (stage T1, T2) is connected with very good prognosis as well as organ and function preservation. The aim of the study was the assessment of early glottic treatment results. MATERIAL AND METHODS Between 1999-2005 1007 patients with larynx cancer were treated in Dept. of Otolaryngology Head Neck Oncological Surgery Poznań University of Medical Sciences. The majority constitute the patients with II and III stage of clinical advancement of the disease. Early glottic cancer was diagnosed in 43 patients (4.3%). The diagnose of the larynx cancer was set upon indirect and direct laryngoscopy, histological examination of larynx samples and neck ultrasonography. In all 43 patients CO2 laser surgery in Klein1 sasser microlaryngoscopy set was performed. RESULTS In all cases, confirmed in histological examination the resection was radical. Follow-up was conducted every month in the first year of observation, then every 2-3 months. The time of follow-up ranged from 40 to 64 month, mean 51 month. In 4 patients (9.3%) treated for early glottic cancer with CO2 laser surgery the local relapse occurred after 10, 15, 19 and 28 month respectively. In two patients total laryngectomy, in one reconstructive partial laryngectomy and in one radiotherapy was performed. The mean time of observation after salvage treatment is 29 months. All patients are alive and free of disease. CONCLUSION The laser surgery is an effective and non-invasive treatment of early glottic cancer but the strict follow-up regimen is demanded.Summary Introduction Early glottic cancer (stage T1, T2) is connected with very good prognosis as well as organ and function preservation. The aim of the study was the assessment of early glottic treatment results. Material and methods Between 1999–2005 1007 patients with larynx cancer were treated in Dept. of Otolaryngology Head Neck Oncological Surgery Poznan University of Medical Sciences. The majority constitute the patients with II and III stage of clinical advancement of the disease. Early glottic cancer was diagnosed in 43 patients (4,3%). The diagnose of the larynx cancer was set upon indirect and direct laryngoscopy, histological examination of larynx samples and neck ultrasonography. In all 43 patients CO2 laser surgery in Klein-sasser microlaryngoscopy set was performed. Results In all cases, confirmed in histological examination the resection was radical. Follow-up was conducted every month in the first year of observation, then every 2–3 months. The time of follow-up ranged from 40 to 64 month, mean 51 month. In 4 patients (9,3%) treated for early glottic cancer with CO2 laser surgery the local relapse occurred after 10, 15, 19 and 28 month respectively. In two patients total laryngectomy, in one reconstructive partial laryngectomy and in one radiotherapy was performed. The mean time of observation after salvage treatment is 29 months. All patients are alive and free of disease. Conclusion The laser surgery is an effective and non-invasive treatment of early glottic cancer but the strict follow-up regimen is demanded.

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.

Mandibular Reconstruction with Osteo-cutaneous Free Flaps in a Patient afterExtensive Surgery Supported with 3D Printed Models

Introduction and objective: The aim of the study was to evaluate usefulness of 3-D models utilizing generated incremental techniques from thermoplastic materials in mandibular reconstruction with utilization of free osteocutaneous fibular and scapular flaps. Methods: 12 patients were treated due to an advanced oral cavity squamous cell carcinoma (T4b). In four patients with a mandibular defect a physical 3-D model consisting of the reconstructed and unaffected sites was prepared for a reconstruction protocol. The 3-D models were designed based to high resolution CT scans. Results: Assessment of comparative functionality (stability of junction, mobility, mastication ability), and cosmetics was examined in both groups, following an 8- week healing period. Conclusion: Applying 3-D models for mandibular manufacturing using a three dimensional printing technologies allows for obtainment of better functionality of restored mandible in comparison to the traditional method. Utilization of mandibular and fibular model significantly decreases time of the operation and allows for achievement of desired shape and esthetic effect within the 1/3 of the lower face.

Postępowanie w stanach przedrakowych krtani – dylematy i znaki zapytania☆☆☆

Summary Background Development of the laryngeal squamous cell carcinoma is taking place on the base of well-documented precancerous lesions. In histological examination precancerous lesions show dysplasia which may be reversible. The quick and proper diagnosis allows for applying the adequate and successful treatment. Aim Aim of the study was to evaluate the incidence of precancerous lesions of the larynx, their potential to evolve in relation to grade of dysplasia and discuss the pathologic findings. Material and method Retrospective analysis of histopathological documentation and ambulatory cards gathered in ENT Department between 1994–2003 was performed. The 173 patients with dysplasia and carcinoma in situ of vocal cord were analyzed. Results The 2719 directoscopies were performed in 10 year period. Two out of 117 patients with moderate and 5 out of 27 with severe dysplasia were treated for laryngeal cancer during the follow up period. Out of these 117 patients the group of 46 patients was chosen, in whom more then 2 microlaryngoscopies were performed (more then 3 in 71,7%) with mean follow up period 4,2 years (from 4 month to 10 years). This group of 45 males and 1 female with dysplasia was carefully analyzed. The mean age was 59,6. Hoarseness from 2 weeks to 20 years (mean 17,5 month) was observed, but most often the patients were seen by the doctor in 2 month duration of complaints. The time between first presentation in Outpatient Department and direct laryngoscopy was from 1 day to 1,5 year, but as routine 2 week period was established. In 10 cases the up-grading of dysplasia was observed. The pathologic findigs were presented. Conclusions Quick, adequate (sensitive, specific) diagnostics of premalignancy in the glottis allows for effective and not humiliating treatment (phonosurgery, laser, partial laryngectomy). The rigid schedule of precancerous patients treatment and follow-up should be drowning. The further diagnostic directions should attempt to find more sensitive methods than the routine histological examination for the assessment of the dysplastic lesions, allowing better evaluation of the risk for cancer development.

9-letnie doświadczenia Kliniki Poznańskiej w chirurgii czynnościowej zatok przynosowych – od mikroskopu operacyjnego do techniki czterech rąk

Summary Surgical procedure is used in chronic rhinosinusitis and aims at restoring proper drainage and ventilation. For this reason the surgery of this region is referred to as functional and in English literature is termed as FESS. It supplanted classical method of Caldwell-Luc or Denker. In the study nine years experience in the Department of Otolaryngology, Head and Surgery University of Poznan in the treatment of chronic sinusitis has been presented. 1463 patients treated with FEES were analyzed. Moreover, the method of selecting patients for the surgery, the diagram showing surgeries performed step by step as well as a list of various surgeries and intraoperative complications were presented. This work is the first part of the study. In the other part the results of the treatment based on the questionnaires sent to patients will be presented.

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.

Znaczenie postępowania pooperacyjnego w operacjach czynnościowych nosa i zatok przynosowych

Summary Introduction In this work we wish to emphasize the importance of postoperative care of patients who underwent FESS in ENT Department Medical University in Poznan. We feel that too little attention is still being paid to this treatment as we mostly focus on surgery. Material and methods Our observation are based on nine year experience in functional endoscopic sinus surgery. The analysis covers patients hospitalized in our Department from January 1998 to August 2007. The schedule of postoperative care has been presented. Results 1463 FESS operation were carried out in our Department from January 1998 to August 2007. Similar postoperative procedures were used with each patient. Full recovery of mucous membrane depended on a few parameters such as: if the patient underwent FESS for the first time, what kind of changes were observed: polips or chronic infection, as well as the method of surgery (“aggressive” versus “delicate”). Healing time ranged from 6 week to 3 month. Conclusions The scheme of procedures employed comes useful in postoperative treatment after FESS.

Czy tracheotomia wykonywana na oddziale Intensywnej Opieki Medycznej (IOM) jest procedurą bezpieczną

Summary Background The authors would like to present the problem of performing bedside tracheotomy in the Intensive Care Unit. The tracheotomy have been done in the highly specific group in poor or fatal general condition, so the complication rate according to the general status of the patients is discussed. Material 92 patients were treated with tracheotomy between I 2003 – XII 2005 and in this number 13 complications occurred. The general status of the patients (shock, stroke, sepsis, pneumonia, hypoalbuminemy) in the time of procedure was taken into consideration. Results In early complications dominated the bleeding – in 7 patients (7,9%) and wound infections – in 4 patients. Tracheal strictures, the only late complication found in our group, were stated during the follow up period in 2 patients (1,1%). The time of performing the tracheotomy i.e. day of the intubation (range from 0–13; mean – 5,7) and day of the decaniulation (range from 3–65; mean – 16) were analyzed. Conclusion Tracheotomy performed in the Intensive Care Unit as a bedside procedure is safe, quick and effective. Complication rate in the group of patients in poor general condition is comparable both to the average population and to the percutaneous technique.