[Reconstruction after maxillectomy using the temporalis muscle flap--our experience]. / Rekonstrukcja po maksylektomii z zastosowaniem plata miesnia skroniowego--doswiadczenia wlasne.

THE AIM OF STUDY: The study presents a method of a reconstruction of the palatum after maxillectomy. This method is choosen in selected cases of malignant tumors of the maxilla. MATERIAL AND METHODS: The method is combined of preparation of the temporalis muscle flap and its dislocation it under arcus of zygoma into the oral cavity. The surface of the flap covered with temporal fascia is oriented into the oral cavity and has been stitched in the hole of the palatum. The surface of the flap covered with periostium is connected to postoperative cavity of the maxilla. The flap covered the palatum tightly divides oral cavity from postoperative cavity of the maxilla. The vascular pedicle of the flap, with deep temporal vessels supply blood for proper healing of the palatum. Oncologic control of the postoperative cavity is performed using imaging investigation (computer tomography, magnetic resonance). The loss of tissue in the temporal fossa is covered by temporal fossa fat or synthetic material. RESULTS AND CONCLUSIONS: The reconstruction method brings satisfactory functional result. The method allows to avoid using inconvenient prostheses--obturators of palatum--in patients after maxillectomy. Complications in this method as postoperative perforation of the palatum and necrosis of the muscle flap are rare--less than 5% cases.

[Impact of tobacco smoking on biologic background of laryngeal squamous cell carcinoma]. / Intensywnosc wypalanych papierosów a biologia raka plaskonablonkowego krtani.

The most common risk factors related to the occurrence of laryngeal cancer is related to tobacco smoking. It is interlinked to the presence of chemical substance in tobacco smoke. These substances are mutagenic factors and they are carcinogens. These substances penetrate cell, they penetrate cellular nucleus and in consequence, it causes damage to the genetic material. Accumulation of mutations enables cells to conduct local invasion, and it initiates tumor invasion and metastasis. We used tissue samples from 11 patients that were selected from all head and neck specimens and diagnosed at Department of Clinical Pathology in Bydgoszcz in 2008. We have made immunohistochemical staining in order to describe localization of MMP-2. Furthermore, the expression of proliferative antigens: PCNA and Ki-67 in laryngeal carcinoma and their relations to tumor invasion and metastasis were measured. We divided patients into two groups: people who smoke less than 20 cigarettes a day and people who smoke over 20 cigarettes a day. All patients were diagnosed with a squamous cell carcinoma with histological grade G2. Tumors were staged according to the TNM classification. Studied patients were classified ranging T2 - T4, N0 - N3 and all were M0. We found out similarities in expression of analyzing antigens in individual groups of patients. We observed decreased expression of MMP-2, PCNA and Ki-67 amongst patients who smoke less than 20 cigarettes a day in comparison with patients who smoke more than 20 cigarettes a day. We noticed such trend in tumor cells and in dysplastic cells. We certify differences between levels of expression of researched markers according they intensity of exposure on tobacco smoking. Probably those differences may represent different levels of cell damage.

[Spontaneous temporal bone meningo-encephalocele]. / Samoistna przepuklina oponowo-mózgowa kosci skroniowej.

INTRODUCTION: Spontaneous meningocele or meningoencephalocele of the temporal bone are very rare. Mostly they are result from otologic surgery or head trauma. Spontaneous meningoencephalocele may occur mostly in the epitympanum or mastoid antrum. It could be a result of pathologic obesity. Often it could be misdiagnosed because of less symptomatic. The most expected symptoms could be: unilateral conductive hearing loss with meddle ear effusion, pulsatile tinnitus or CSF leak. MATERIAL AND METHODS: We present a case of 61 year old, obese woman with spontaneous meningoencephalocele of the left temporal bone. The patient presented symptoms of conductive hearing loss with fullness in the left ear and pulsatile tinnitus. The imagine study such as CT scan and MRI showed a dehiscent areas in the tegmen at the right side and meningoencephalocele protruding into the left mastoid cavity on the left side. RESULTS: After complete diagnosis we preformed surgery. A mastoidectomy of the left temporal bone was done and the meningoencephalocele tissue was encountered. The bony defect and CSF leak was closure. The patient was released from pulsatile tinnitus and fullness in the ear, but a component of hearing dysfunction is still present. CONCLUSIONS: Spontaneous meningoencephalocele of the temporal bone may occur in an obese patient. The most finding will be a middle ear effusion and conductive hearing loss with pulsatile tinnitus. The combination of CT and MRI will help in proper preoperative diagnosis. The operation include transmastoid, middle cranial fossa repair or combination of both. The multi layer closure of bony defect is very important to avid CSF leak.

[The surgery voice rehabilitation after total laryngectomy with the Provox system]. / Chirurgiczna rehabilitacja glosu chorych po laryngektomii calkowitej z zastosowaniem systemu provox.

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 Remacle's 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.

[Primary squamous cell carcinoma of the frontal sinus--a case report]. / Pierwotny rak zatoki czolowej--opis przypadku.

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.

[Tracheocoele--a complication after decanniulation]. / Tracheocoele--powiklanie po dekaniulacji.

A case of tracheocoele as a complication after decanniulation in a patient after brain trauma is presented. Within twelve months after decanniulation patient was operated three times to close the tracheocutaneous fistula without good effect. A pretracheal air cyst was recognized after the radiological examinations. Tracheocoele was evacuated with its tract. No recurrences were observed.

[Multiple bilateral lymphatic adenomas of the parotid glands]. / Mnogie obustronne gruczolaki limfatyczne slinianek przyusznych.

INTRODUCTION: Multiple primary tumours of the parotid glands are very rare. They may occur unilaterally or bilaterally, synchronously or metachronously. Whartin's tumour is mostly find in bilateral parotid gland tumours. MATERIAL AND METHODS: The authors present an unusual case of 60 years old man with bilateral, multifocal Whartin's tumour of the parotid glands. The tumours have appeared synchronously two years before the diagnosis was done. We performed bilateral superficial partial parotidectomy with removal of the tumours. RESULTS AND CONCLUSION: The multifocal, synchronous bilateral Whartin's tumours of the parotid glands are very rare. Minimal surgery procedures with tumour excision is the method of choice. The recurrence rate is very low.

[A case of giant-size mucoepidermoid carcinoma of parotid gland]. / Przypadek olbrzymiego guza--raka sluzowo-naskórkowego slinianki przyusznej.

INTRODUCTION: A mucoepidermoid carcinoma is a rare disease of the salivary glands. It usually occurs as a small tumor (a few centimeters diameter). The most important diagnostic procedure for the treatment is a histological examination. MATERIAL AND METHODS: We present the case of 71 years old woman with giant in size tumor of the left parotid gland. The tumor had developed in the three years' time and no paresis of the facial nerve had occurred during that time. Preoperative fine needle aspiration biopsy of the parotid gland masses showed pleomorphic adenoma cells. RESULTS: The surgery treatment was introduced. The function of the facial nerve was preserved. The histological examination result was mucoepidermoid carcinoma. We observed local recurrence of the tumor five months after the operation. But there was still no facial nerve paralysis. The patient was submitted to the radiotherapy treatment. CONCLUSION: The big size of the tumor may be an obstacle in full resection during an operation. The false negative results during a fine needle aspiration and preserved normal function of the facial nerve can cause correct treatment as an extremely difficult goal.

[Malignant tumors of the nose and paranasal sinuses in the years 1992-2001]. / Nowotwory zlosliwe nosa i zatok przynosowych w latach 1992-2001.

On the base of retrospective analysis of 927 cases of malignant neoplasms of the nose and paranasal sinuses, diagnosed and treated in 10 clinical centers in Poland from 1992-2001, the assessment of basic epidemiological data, including the localization of tumor, and stage of local and clinical advancement of the disease at the time of diagnosis has been conducted. In analyzed period of 10 years the trends to change the mentioned above parameters has been examined. The index of morbidity in this period was constant and compareable with figures published earlier. In the analyzed material there is a predominance of males and the sex ratio was 1.45. The majority of cases were between 50-69 years (55%). The most common histopathological diagnosis was carcinoma (58%). The majority of cases of malignant tumors of the nose and paranasal sinuses was diagnosed in the advanced stage T3-T4 (72.3%) with the highest percentage in the middle region. 90% of all cases were treated surgically, but in about 30% it was the only treatment (also in cases of stage T2-T4). In 56% of all patients the surgical procedure was completed by radiotherapy. This data suggest that indications for additional irradiation should be extended.

[A iatrogenic case of foreign body in the frontal sinus]. / Przypadek jatrogennego ciala obcego zatoki czolowej.

The authors show a case of long behinding iatrogenic foreign body in frontal sinus, which in spite of over twelve years recurrent pain syndromes hasn't diagnosed and treated. Pay attention to great weight of surveyform and stratiform radiological investigations in foreign body diagnostic. The patient has been operated with retirement syndromes. After operation we have settled supposed causes leaving foreign body in frontal sinus.