Comparison of long-term functional results between standard supracricoid laryngectomy and modified technique with sternohyoid muscle.

INTRODUCTION: Laryngeal cancer is the most common cancer of the upper respiratory tract. The main methods of treatment included surgery (partial laryngectomy and total laryngectomy) and radiation therapy. Laryngeal dysfunction is seen after both treatment modalities. OBJECTIVE: The aim of the study is to compare postoperative functional results of the standard supracricoid partial laryngectomy technique and a modified supracricoid partial laryngectomy technique using the sternohyoid muscle. METHODS: In total, 29 male patients (average years 58.20±9.00 years; range 41-79 years) with laryngeal squamous cell carcinoma who underwent supra cricoid partial laryngectomy were included. The patients were divided into two groups in terms of the surgical techniques. In Group A, all patients underwent standard supracricoid partial laryngectomy technique between January 2007 and November 2011. In Group B, all patients underwent modified supracricoid partial laryngectomy between August 2010 and November 2011. Fiberoptic endoscopic evaluation of swallowing test, short version of the voice handicap index scores, and the MD Anderson dysphagia inventory, the time of oral feeding and the decanulation of the patients after surgery of each groups were compared. RESULTS: The mean maximum phonation time was 8.68±4.21s in Group A and 15.24±6.16s in Group B (p>0.05). The S/Z (s/s) ratio was 1.23±0.35 in Group A and 1.08±0.26 in Group B (p>0.05); the voice handicap index averages were 9.86±4.77 in Group A and 12.42±12.54 in Group B (p>0.05); the fiberoptic endoscopic evaluation of swallowing test averages were calculated as 12.73±3.08 in Group A and 13.64±1.49 in Group B (p>0.05). In the MD Anderson dysphagia inventory, evaluation of swallowing, the emotional, physical, and functional scores were 29.21±4.11, 32.21±6.85, and 20.14±2.17 in the Group B, and 29.20±2.54, 32.4±4.79, and 19±1.92 in Group A, respectively. CONCLUSION: Although there is no statistical difference in functional outcome comparisons, if rules are adhered to in preoperative patient selection, modified supracricoid partial laryngectomy can be applied safely and meaningful gains can be achieved in functional outcomes.

A Practical Recommendation for Teaching Neck Anatomy During Neck Dissection in the Operating Room.

Anatomy knowledge is not only essential for surgeons but also has importance for anyone who performs an invasive procedure on a patient, and provides examination and diagnosis of patients and sharing of these findings to the patient and other medical professionals. It is accepted that most surgical procedures could facilitate anatomic perception in surgical internships. There is an educational tendency to explore innovative instructional tools and methods that can help support current education styles. This study investigates the effect of a green laser pointer on students' perceptions and educational effectiveness when neck dissection is performed in the operating room.

Comprehensive analysis of parotid mass: A retrospective study of 369 cases.

OBJECTIVE: To present the results of patients who underwent superficial or total parotidectomy because of parotid gland tumors in our tertiary care clinic. METHODS: The data of 362 patients who underwent parotid surgery from January 2008 to November 2015 were collected and analyzed in demographic, histopathological features, and complications. RESULTS: Three hundred sixty-nine cases (performed in 359 patients) were analyzed and we assessed complications of parotid surgery such as transient or permanent facial paralysis and Frey's syndrome. Pleomorphic adenomas and Warthin's tumors consisted 74% of all parotid gland tumors. These tumors were generally located in the superficial lobe and tail of the parotid gland (81%). Also, tumor size in the positive surgical margin group was larger than in the negative surgical margin group (p=0.012). CONCLUSIONS: Most of parotid gland tumors are benign. However, the frequency of malignancy increases in deep lobe of parotid gland. High grade malignant tumors have more tendency to have positive surgical margin during surgery, and facial paresis preoperatively.

Are XPD and XPG gene variants related to the mechanism of oral squamous cell carcinoma?

Oral cavity cancers have anatomically a big part of the body system and include several types of cancer. The aim of the study is to investigate the relation between XPG and XPD gene variants in the DNA repair system and oral squamous cell cancers. A total of 111 patients with a pathologic diagnosis of oral squamous cell carcinoma and a control group of 148 healthy volunteers who presented to Istanbul Faculty of Medicine, Department of Otolaryngology & Head and Neck Surgery and Dentistry Faculty were included in the study. Isolation of DNA was achieved using an Invitrogen Purelink Genomic DNA Kit. XPD alleles of Lys751Gln (rs13181) and XPG Asp1104His (rs17655) loci from genomic DNA samples were reproduced using polymerase chain reaction. A statistically significant difference in XPD genotype distribution between control and patient groups was determined (P=0.019). XPD Lys+ was significantly more common in the patient group than in the control group, and a two-fold increased risk for disease was determined. XPD Gln/Gln+ was significantly more common in the control group than in the patient group, and a two-fold decrease in risk for disease was determined (P=0.045). In the other region of the study, there was no statistically significant difference in terms of disease development between XPG genotypes. In conclusion, Lys751Gln polymorphism in the XPD gene could play a role in oral squamous cell development. It is important to increase the numbers of subjects in patient groups and healthy controls in studies to increase the possibility of determining XPD's potential as a molecular risk factor.

Abrikossoff tumor of the larynx.

Case report about laryngeal localization of a granular cell tumor in a 38 years old female without recurrence over an observation period of two years.

Autologous fat augmentation for voice and swallow improvement after cordectomy.

Surgery for the treatment of early-stage glottic carcinoma still remains a valid option. In most patients, newly formed neocord tissue preserves glottic functions, but in some patients an important glottic gap leading to glottic insufficiency may occur. In our study, 11 patients who had serious glottic insufficiency after endoscopic laser and laryngofissure cordectomy were treated with autologous fat injection (AFI) into the neocord tissue for voice and swallowing rehabilitation. One patient did not attend the first control visit and was excluded from the study. The remaining 10 patients were evaluated in the preoperative and postoperative periods for phonatory functions and efficacy of AFI by videolaryngostroboscopy and computerized acoustic analysis. Phonatory functions showed statistically significant improvement in the shimmer, noise-to-harmonic ratio, maximum phonation time and fundamental frequency. Perceptual ratings (GRBAS scale) also showed statistically significant improvement in all 5 parameters. Despite improvement in glottic closure, the mucosal wave deteriorated. Due to recurrence of symptoms of glottic insufficiency, AFI was repeated in 2 patients at the third and fifth months, respectively. One year later, the AFI resulted in successful rehabilitation of swallowing in all patients. The probability of resorption of autologous fat and the deterioration of the mucosal wave after AFI remain a problem, but re-injection can be done easily. As AFI is an easy, safe and cheap method, we concluded that it is a promising alternative procedure for managing voice problems after laser or laryngofissure cordectomy defects.

[Long-term results of intracordal or neocordal autologous fat injection in patients with unilateral vocal cord paralysis and cordectomy]. / Tek tarafli vokal kord paralizili ve kordektomili olgularda intrakordal veya neokordal otolog yag enjeksiyonunun uzun dönem sonuçlari

OBJECTIVES: We investigated the long-term results of autologous fat injections for unilateral vocal cord paralysis and laryngofissure and cordectomy defects. PATIENTS AND METHODS: We evaluated the efficacy of autologous fat injections in 21 patients (16 males, 5 females; mean age 57 years; range 24 to 72 years) with unilateral vocal cord paralysis (n=11) and cordectomy defects (n=10) in the light of computed acoustic analysis, phonatory functions, and videolaryngostroboscopic findings and the effect of injections on swallowing. The mean follow-up was 14 months (range 10 to 22 months). RESULTS: Voice quality improved in 14 patients. Glottic insufficiency recurred in three patients in the early period, and in two patients in the late period. Phonatory functions showed significant improvement in all parameters except for jitter and functional interference (p<0.05). Videolaryngostroboscopy showed significant improvement in glottic closure, but mucosal waves remained unchanged. Of 18 patients with swallowing disorders, aspiration symptoms improved in 15 patients. Patients with unilateral vocal cord paralysis had better results compared to those with cordectomy defects. CONCLUSION: Autologous fat injections may be considered effective in patients with cordectomy defects or unilateral vocal cord paralysis.

Polymorphisms of the XRCC1 DNA repair gene in head and neck cancer.

Inherited polymorphisms in the genes controlling the cell cycle or functioning in the DNA repair mechanisms may impair their function and contribute to genetic susceptibility. Abnormalities in the DNA repair have been reported in head and neck cancer. The XRCC1 gene functions in singlestrand break and base excision repair processes. In this study, two polymorphisms of the XRCC1 gene, Arg194Trp and Arg399Gln were investigated in 95 patients with head and neck carcinoma. The polymorphic regions were amplified by PCR followed by digestion with methylation-specific restriction enzymes, and analyzed electrophoretically. Genotype and allele frequencies were calculated, and association with cancer risk or clinical parameters was investigated. No association was observed between the genotypes and head and neck cancer for either polymorphism. Distribution of the alleles did not significantly differ between the patients and the control group. A significant association was only found for the Trp194 allele among the smoking individuals. Our data indicate that the Arg194Trp and Arg399Gln polymorphisms do not confer a significant risk for head and neck carcinogenesis.

[Factors that affect in situ lifetime of Provox voice prosthesis]. / Provox ses protezinin kullanim süresini etkileyen faktörler.

OBJECTIVES: We evaluated the effect of age, radiotherapy, insertion time of prosthesis, the period between radiotherapy and insertion time on in situ lifetime of Provox, voice quality and complications. PATIENTS AND METHODS: The study included the use of 62 Provox voice prosthesis in 50 total laryngectomy patients (46 males, 4 females; mean age 61 years; range 43 to 77 years). The patients visited our clinic regularly every three months for the first year after insertion and every six months in subsequent years. The ease of use and complications of prothesis and voice quality of the patients were evaluated. RESULTS: The mean in situ lifetime was 24 months (range 1 to 49 months). Age, radiotherapy, insertion time of the prosthesis, the period between radiotherapy and the insertion time had no influence on the in situ lifetime of Provox. These variables were not associated with the complications of the prosthesis. A statistically significant good voice quality was found in nonirradiated patients and those in whom the prosthesis was inserted between 6 and 24 months after laryngectomy. The use of Provox was easier in nonirradiated patients than irradiated patients (p<0.001). CONCLUSION: In situ lifetime of Provox was not influenced by age, radiotherapy, insertion time, and the period between radiotherapy and insertion time of prosthesis. We believe that the patient factor is the most important factor that affect the in situ lifetime of Provox.

Metastasis to infraclavicular lymph nodes in head and neck cancer: a report of three cases.

Metastasis predominantly occurs via the lymphatic system in head and neck tumors. The disturbance of the lymphatic system in the cervical region resulting from neck dissection or radiotherapy may result in unusual patterns of metastasis in patients with recurrent tumors. This is more frequent when the recurrent tumor invades the myocutaneous flap used for the primary reconstruction. We encountered three patients (2 men, 1 woman) with infraclavicular lymph node metastasis. All were previously treated by surgery, postoperative radiation therapy, and reconstruction with the use of the pectoralis major myocutaneous flap.

[Primary carcinoma of the subglottic larynx]. / Primer subglottik larenks kanseri.

OBJECTIVES: Primary carcinoma of the subglottic larynx is very rare. This study was designed to evaluate patients who were treated for primary carcinoma of the subglottic larynx. PATIENTS AND METHODS: The study included 15 patients (14 men, 1 woman; mean age 62.8 years; range 45 to 95 years) with primary subglottic carcinoma. Correlations of different clinical parameters with three-year survival rate and Kaplan-Meier survival analysis were investigated. RESULTS: On presentation, two patients (14%) had T1, five patients (33%) had T2, three patients (20%) had T3, and five patients (33%) had T4 tumors. The overall three-year survival rate was 73.4% (11/15). The median survival calculated by the Kaplan-Meier method was 45 months. No significant differences were found between the survival rates of patients with and without extralaryngeal extension. CONCLUSION: Although primary subglottic cancer is locally aggressive with high tendency to extend to the extralaryngeal compartment at the time of diagnosis, high survival rates can be expected when appropriate treatment modalities are selected.

Expression of the the cyclin-kinase inhibitors p21(WAF1) and p27(Kip1) and the p53 tumor suppressor genes in adult-onset laryngeal papillomas.

Different types of human papilloma virus are known to be closely associated with laryngeal papillomas. On the other hand, the proliferation of epithelial cells is associated with various abnormalities in the mechanisms of cellular regulation. In this study, we detected the expressions of p53, p21 and p27 proteins in adult-onset laryngeal papillomas by immunohistochemical techniques. The objective of this study is to evaluate the expression of these factors in adult-onset laryngeal papillomas and to determine whether such expression is correlated with the existence of dysplastic epithelium covering the papillomas. Eighteen patients with adult-onset papillomas who were surgically treated at the Department of Otolaryngology at the University of Istanbul between January 1994 and December 1999 were included in this study. Anti-p21, -p27 and -p53 antibodies were used to perform immunostaining. Positive nuclear staining for p21 was detected in 14 of the 18 (78%) cases, especially in the parabasal layer. Also, in 78% of the cases, weak to strong immunoreactivity was observed for p27. In all cases, negative immunoreactivity was observed for p53 throughout the epithelium except for the basal and parabasal cells. A negative correlation was observed between the existence of dysplastic epithelium and p21 expression (P=0.02). In conclusion, variable p21 and p27 expression was detected by immunohistochemistry in our series of 18 cases of adult-onset laryngeal papillomatosis, and a statistically significant inverse correlation was detected between p21 expression and the existence of dysplastic epithelium covering the papillomas. Further prospective studies are warranted to determine the prognostic values of these variables and to evaluate their role in the pathogenesis of adult-onset laryngeal papillomas.

Management of carotid artery invasion in advanced malignancies of head and neck comparison of techniques.

The objective of this study was to retrospectively investigate a single institution's experience with carotid artery resection performed as part of an oncological procedure and to determine acute and convalescent complication and survival rates. We performed a record review of 28 patients with head and neck malignancy invading the carotid artery. Immediate carotid artery resection and ligation on an emergent basis was performed on 12 patients (group 1), elective resection and ligation was performed on 8 patients (group 2), and elective resection and revascularization was performed on 8 patients (group 3). In group 1, although 1 patient survived for 1 year and 1 patient survived for 2 years, 1 patient died of severe neurologic deficit, 2 patients experienced neurologic deficit with good recovery, and 1 patient was moderately disabled. In group 2, 2 patients survived without disease for 5 years, and 2 patients experienced neurologic deficit, 1 with good recovery and the other with complete recovery. In group 3, only 1 patient survived for 5 years, and within this group, 1 patient died of severe neurologic deficit, 1 patient had neurologic deficit with moderate recovery, and 1 patient had neurologic deficit with complete recovery. No significant difference in mortality and morbidity rate was observed between the "resection and ligation" group and the "resection and revascularization" group (p = .52, chi(2) = 0.79). We conclude that the surgical treatment of patients with an invaded carotid artery, including carotid resection, provides a small but real chance of 5-year survival. The methods of carotid resection and repair should be guided by clinical presentation and by preoperative and intraoperative investigations.

The functional and oncologic effectiveness of near-total laryngectomy.

PURPOSE: To investigate the oncologic efficiency of near-total laryngectomy for advanced laryngeal and neighboring organ cancers and to evaluate the functional results. MATERIALS AND METHODS: A retrospective review of 135 cases of near-total laryngectomy carried out in a tertiary university hospital between 1989 and 2000 was undertaken. The original operation was carried out in 3 groups: classic "near-total laryngectomy" for endolaryngeal lesions; "near-total laryngectomy and partial pharyngectomy" for lesions originating from the pyriform sinus or lesions with extension to the pharynx or tongue base but reconstructed primarily; and "near-total laryngopharyngectomy" for lesions requiring pedicled flap reconstruction after resection. Oncologic success was evaluated according to the location and extent of the tumor and the particular operation. Functional outcome was evaluated according to phonation and its quality as well as to the severity of aspiration. RESULTS: Of the 135 cases, 121 were men, and 14 were women (age range, 33-80 years; mean, 56.2 years). Mean phonation time was 35.2 days, and mean onset of oral intake was 18.5 days. Of the 135 cases of the series, 124 were evaluated for survival. Thirteen of 26 (50.0%) cases of T2, 34 of 53 (64.2%) cases of T3, and 33 of 45 (73.3%) cases of T4 carcinomas survived by the end of the evaluation period. Likewise, 46 of 77 (59.7%) cases of N0, 16 of 19 (84.2%) cases of N1, and 18 of 27 (66.7%) cases of N2 survived the same period; however, none with N3 metastatic neck disease survived. The probability of survival with regard to the T and N stages of the disease did not reveal a statistically significant result (P =.15 and.49, respectively). CONCLUSIONS: According to these results, near-total laryngectomy is a valid alternative for extended laryngeal and neighboring organ cancers with an acceptable morbidity and a high success rate for voice preservation. Near-total laryngectomy should be offered as a surgical treatment alternative for these patients.

Near-total laryngectomy for laryngeal carcinomas with subglottic extension.

OBJECTIVE: To investigate whether Pearson classic near-total laryngectomy is a sensible surgical treatment modality for laryngeal carcinomas with subglottic extension. DESIGN: Retrospective analysis of patients treated by near-total laryngectomy in a university hospital that is an academic tertiary health care center. PARTICIPANTS AND INTERVENTION: Medical and computer records of 135 patients who were treated by near-total laryngectomy for laryngeal and hypopharyngeal carcinomas between April 1, 1989, and June 30, 2000, were searched thoroughly, and the final outcomes were confirmed by telephone contact. MAIN OUTCOME MEASURES: Survival rates of the patients with laryngeal carcinomas with subglottic extension treated by near-total laryngectomy were compared with those of the patients with malignancies of other laryngeal regions given the same treatment. RESULTS: Of the 135 patients in the study, 74 were available for determination of 5-year survival. The rate was 65.8% (27/41) for transglottic tumors, 53.8% (7/13) for supraglottic tumors, and 20.0% (4/20) for tumors with subglottic extension. Only 3 of 16 patients with laryngeal carcinomas with supraglottic or transglottic localization died of local recurrence; the rest of the deaths were from regional recurrence or distant metastasis. However, 6 of 13 patients with subglottic extension died of local recurrence, 5 of peristomal recurrence, and only 2 of distant metastasis. CONCLUSIONS: Success was directly related to adherence to precise indications in cancer surgery. While near-total laryngectomy is an effective and reliable treatment modality in laryngeal cancer surgery, its effectiveness in laryngeal cancers with subglottic extension is debatable. These subglottic lesions should be treated by total laryngectomy, which is a more radical surgery.