[Objective evaluation of respiratory function of the larynx after partial laryngectomy of various range]. / Obiektywna ocena funkcji oddechowej krtani po laryngektomiach czesciowych róznej rozleglosci.

The aim of the study was to identify factors and their effect on the respiratory efficiency of the larynx after partial laryngectomy. The material consisted of 72 patients aged 30 to 71 years (mean 54.3 years) who underwent partial laryngectomy due to cancer, and 10 healthy volunteers aged 22 to 29 years (mean 24.5 years). Airflow was measured under normal conditions and upon application of external resistance. Methods included history taking and physical examination, spirometry, laryngovideoscopy (Lvs), and computed tomography (CT) of the larynx. Some airflow parameters were decreased prior to surgery in comparison to predicted values. In a majority of patients, surgery had a negative effect on all parameters of airflow. Reduction was greater for inspiratory than expiratory parameters. Analysis of the shape of flow-volume loops in patients after surgery showed that the mixed type prevailed. This is characterized by reduction of the inspiratory and expiratory parameters, with greater effect on the inspiratory phase. Morphologically, the mixed type corresponds to narrowing of various extent with flaccid wall stenosis. The flow-volume shape changed dynamically during the healing process of the larynx until normalization was observed. This process was independent of the type of surgery but depended on the size of the laryngeal lumen and wall stiffness. Significant differences were found when laryngeal lumen was measured using CT or Lvs, with Lvs being more accurate. Lung volume parameters remained unchanged, but a statistically significant relationship with lumen size was observed both in experimental and clinical investigations. The most useful parameters for estimating laryngeal airflow were: PIF, FIF50, FIV1, FIV1%/N FEV1 and % Rz/N PEF. Upper and lower values were established for PIF (1.4-2.0 L/s), FIF50 (0.7-1.9 L/s), FIV1 (0.7-1.6 L), FIV1%/N FEV1 (40-60%),% Rz/N PEF (20-40%) on the basis of which the decision to restore respiration through the larynx (decannulation) may be made. It can be concluded from the results that spirometry and Lvs are more accurate than CT for assessment of the respiratory function of the larynx after partial laryngectomy.

[Own experience in supracricoid laryngectomy with GHP and GHEP type of reconstruction due to larynx cancer]. / Wlasne doswiadczenia stosowania laryngektomii nadpierscieniowej z rekonstrukcja typu CHP i CHEP w leczeniu raka krtani.

The results of the surgical treatment of the larynx cancer (glottic-supraglottic) by supracricoid laryngectomy with CHP and CHEP type of reconstruction were presented. Material consists of 160 cases (88 after CHP and 72 after CHEP). 5 years survival rate was obtained in over 71% of cases in all material. Decannulation was possible in 126 (79%) patients. Feeding tube removal before 4 weeks after operation was done in 139 (87%) cases. In subjective assessment all patients had social efficient speech. Favourable results of the treatment encourage wider application of supracricoid laryngectomy.

[Laryngotracheal separation procedure after oncological pharyngeal and laryngeal operations]. / Postepowanie chirurgiczne (rozdzielenie krtani i tchawicy) w przewleklej aspiracji po operacjach onkologicznych gardla i krtani.

Principles of the operative technique and indication for permanent laryngotracheal separation in chronic aspiration after oncological operations are being presented. The operation is done while the tracheostomy is present. It consists of horizontal section of the trachea on the level of the tracheostomy and formation the new one by using the lower of the trachea with the skin. Upper sublaryngeal section of the trachea is being closed by stitches. This operation was performed in our clinic in one patient after partial laryngectomy due to the cancer and in two patients after extended resection of the palatal tonsil, base of the tongue and lateral wall of the hypopharynx. In all the cases the follow up was without major complications.

Stenosis of the larynx and trachea: diagnostics and treatment.

36 cases (26 males and 10 females aged 19-69, average age 40.3) of larynx and trachea stenosis (23/36 i.e. 64%) and occlusion (13/36 i.e. 36%) were observed between 1990-1999. The cause of larynx and trachea lesion was the prolonged intubation in 17 (47%) cases, tracheostomy--in 13 (36%) (in 12 cases performed outside our centre), external trauma in 5 cases (14%) and burns of the upper airway in 1 patient (3%). For the diagnosis endoscopic, radiologic and spirometric examinations were performed. Length of the constricted or occluded section was estimated at 5-65 mm. Patients were treated applying three methods: endoscopy, splitting of the larynx and/or trachea and "end to end" anastomosis. In most cases surgical proceeding was multistaged. The best result was obtain after "end to end" anastomosis (all patients were deccanulated).

[Treatment of chronic aspiration by Lindeman's tracheosophageal diversion procedure]. / Leczenie przewleklej aspiracji metoda wytwarzania przetoki tchawiczo-przelykowej wedlug Lindemana.

Three cases of swallowing disorders have been presented in the course of atrophic lateral sclerosis in two patients, and in the pseudobulbar in one. All patients have been operated on after Lindeman method. It consists in formation of the tracheoesophageal anastomosis--tracheoesophageal diversion. Aim was achieved in all the cases. All patients have been taking food by mouth and recurrences of pneumonia were not observed.

[25 years experience in treatment of glottic cancer with classical extented fronto-lateral laryngectomy]. / 25 lat doswiadczen w leczeniu raka glosni klasyczna i rozszerzona laryngektomia fronto-lateralna.

190 patients with glottic cancer (177 male and 13 female) treated by surgery in the course of the last 25 years are being presented. In 92 cases classic and in 98 extended fronto-lateral laryngectomy was carried out. Diagnostic and surgical procedures, depending on anatomical structures of the larynx infiltrated by the neoplasm, were discussed. Own experiences in reconstruction of tissue's defects with pedicle skin flaps from the nearest neighbourhood (13 cases), vascular pedicle gland flaps (19 cases) and with epiglottis (50 cases) were talked over. 5 years survival rate amounted to 90-91%. Oncological and functional results were presented. The weight of personal experience in the improvement of those results in the last 5 years was stressed.

[Fronto-lateral laryngectomy with subsequent epiglottoplasty: operative technique]. / Laryngektomia fronto-lateralna rozszerzona z nastepowa epiglotoplastyka--technika chirurgiczna.

Operative technique is being presented comprising excision of the larynx neoplasm with the vocal cord and anterior commissure. This kind of operation enables the extension of resection to include the arytenoid cartilage, false cord with laryngeal ventricle, part of the subglottis and the base of the epiglottis. The defect resulted is covered by moved down epiglottis. The operation was done in 98 patients with satisfactory oncological and functional results.

[Horizontal-glottic laryngectomy: operative technique]. / Laryngektomia pozioma glosniowa--technika chirurgiczna.

Operative technique is being presented, applied in some cases of glottic cancer with preserved movability of the vocal cords (cancer of both vocal cords, diffuse dysplasia of the vocal cords with cancer in situ, verrucous carcinoma of the glottis, carcinoma of single vocal cord crossing superficially through the anterior commissure into the opposite side). The operation consists of excision of the vocal cords together with part of the thyroid cartilage preserving one or both arytenoid cartilages. Reconstruction is done by join.

[Supra-cricoid laryngectomy with subsequent cricohyoid-epiglottopexy: operative technique]. / Laryngektomia nadpierscieniowa z nastepowa crico-hyo-epiglotopeksja--technika chirurgiczna.

Operative technique is being presented, applied in the therapy of larynx neoplasms, originating mainly from the glottic-subglottic area. Operative technique consists of exposure of the larynx by "U" skin incision, supracricoid excision of the organ together with the neoplasm and following reconstruction through the anastomosis of the cricoid cartilage with the epiglottis and hyoid bone.

[Disorder types of the larynx airflow in patients after partial laryngectomy: objective examination]. / Rodzaje zaburzen przeplywu krtaniowego u chorych po laryngektomiach czesciowych--badania obiektywne.

223 spirometric examinations, 144 laryngovideoscopic examinations and 43 CT of the larynx in 70 patients after partial laryngectomies of various extents were analysed. The shape of the flow volume curve was divided in 3 kinds of larynx obturation: fixed, dynamically variable and mixed (with characteristics to both). Factors depending on larynx influence the dimension of the obturation (surface and length of the contraction and also stiffness of the walls) as well as numerous extra laryngeal factors do, independently of the contraction itself. On the base of the parameters and the shape of the flow volume loop the volume flow capacity can be estimated (helpful in estimation of the respiratory sufficiency of the patient), the kind of the obturation (resulted from stiffness of the scar or elasticity of the walls), probable spot of the contraction (obturation of the larynx or bronchial narrowing), changes of the obturation in course of time (specific for the healing process or for developing complications). The results obtained were compared with the laryngovideoscopy, radiological examination and (in several cases) with the interoperative assessment. Great measure of conformability of the spirometric diagnostics with the above mentioned investigations was found. The usefulness of those investigations in the after care of the patients following partial laryngectomies was stressed, as well as in making decision for eventual reoperation and also economic advantages.

[Subjective and objective evaluation of the experimental fixed upper airways obturation]. / Subiektywna i obiektywna ocena doswiadczalnej obturacji typu stalego górnych dróg oddechowych.

Investigations were carried out on 10 healthy volunteers. The subjective and objective--with spirometry--airway flow was evaluated under normal conditions and after artificial narrowing of the respiratory tract. For contraction--8 pipes were used with surface section of 78.5 to 12.56 sq mm placed between mouthpiece of the device and the examined. The investigations were carried out in repose. The intensified and free flow was examined. In case of obturation of the respiratory tract characteristic changes are being observed earlier in objective than in the subjective evaluation of the patient. The changes concern the flattening of the volume flow curve and lowering of flow parameters (in sequences: PIF, PEF, FIV1, and FEV1). After application of large contractions, quotient FEV1max./FEV1free and FIV1max./FIV1free dropped several times 2 to 3. In respiration through large narrowing greater discomfort was observed in free flow than in the intensified one.

[Rare palate tumors: treatment and results]. / Rzadziej wystepujace guzy podniebienia--leczenie i wyniki.

8 patients (7 male and 1 female) treated between 1991-1998 in Szczecin centre due to the tumours different than carcinoma planoepithelial of the palate were presented. Their age ranged from 30 to 81 years. The dimension of the tumour ranged from 1 to 5 cm. The diagnosis of those tumours was: adenoid cystic carcinoma--2 cases, rare (unnamed) tumour of low malignancy probably of salivary gland origin--1 case, cystis lined with cylindrical epithelium--1 case. 7/8 patients were treated by surgery and in 3 cases RTG therapy followed surgery. One patient refused the treatment. 6/8 patients are alive. One patient died 2 years after surgery. There is no information about the one, who wasn't operated on. 3 patients remain without complains. 3 developed rhinolalia aperta and one from them (following RTG therapy) complain of dryness in the oral cavity. None from the operated on reports any swallowing problems.

[Rare neck tumors: diagnosis and treatment]. / Rzadkie guzy szyi--postepowanie diagnostyczne i lecznicze.

A group of 14 patients is presented which has been treated at the ENT Clinic PAM between 1989-1998, due to rare tumours of the neck. Among them were: paraganglioma--3 cases, neurilemmoma--3 cases, actinomycosis--2 cases and 1 case of plasmocytoma, ganglioneuroma, oncocytoma, lipoma, toxoplasmosis and cystic tumour of salivary gland origin. For diagnosis FNB, USG, radiological and laboratory examinations, adenectomy, excision of the tumour for diagnosis and explorative cervicotomy were carried out. Beside surgery antibiotics, chemotherapy and RTG therapy were applied, depending on the kind of the tumour. Satisfactory results were obtained (12/14 patients are alive, 1 after removal of oncocytoma died due to cardio-vascular cause).

[Results of the surgery in verrucous carcinoma of the larynx]. / Wyniki leczenia chirurgiznego raka brodawkowatego krtani.

Group of 10 patients treated between 1989-1998 at the ENT Clinic of PAM due to verrucous carcinoma of the larynx was presented. All were male aged 45-73 years. Clinical progress of the neoplasm was evaluated as follows: T1NoMo--7 cases, T2NoMo--1 case, T3N1Mo--1 case and T4N2Mx--1 case. In 5 cases the neoplasm was removed in endoscopy. In 2 cases chordectomy was carried out, in 1 extended fronto-lateral laryngectomy with subsequent epiglotoplasty, 1 subtotal laryngectomy with vocal fistula and 1 total laryngectomy. Follow up period amounted 2-10 years. Satisfactory oncological and functional results were obtained. 7/10 patients are alive, among them 2 over 5 years and 3--above 3 years. In 1 case death occurred in the perioperative period. Two patients died 2 and 3 years respectively after operation due to malignancy of different organs without recurrency symptoms in the larynx.

[Results of nasopharynx cancer treatment: some prognostic factors]. / Wyniki leczenia raka nosogardla: niektóre czynniki prognostyczne.

42 cases of nasopharynx cancer treated between 1985 and 1995 in ENT and Radiotherapeutic Clinic of the Pomeranian Medical Academy were analyzed. In 15 patients (34.5%) planoepithelial carcinoma was found, in 9 (20.9%)--anaplastic carcinoma, in 6 (13.9%)--lymphoepithelial, and in individual cases--spindle-shaped and mucoepidermal carcinoma solidum. 34 patients were treated by radical irradiation (60-70 Gy doses) and 8--by palliative (20-35 Gy). In 7 patients neck dissection was carried out. Better results were achieved in older patients (over 60 years old) than in younger ones. Prognosis in women was better than in men. 5 years' survival rate for T1-2 group was achieved in 77% of cases. For T3-4 group it amounted to 48%; in N0-1--69% and in N2-3 group--52%. 71% patients with planoepithelial carcinoma, whereas only 48% with undifferentiated carcinoma survived 5 years. The rate of 56% of 5 years' survival time is comparable with good results of other authors.

[Fibrosarcoma of the larynx]. / Wlókniakomiesak krtani.

Fibrosarcoma is the most common neoplasm of the larynx of mesenchymal origin. Between 1991 and 1996 three cases of fibrosarcoma were observed in the ENT Clinic of the Pomeranian Medical Academy. There were two males and one female aged 49-66. It makes 0.5% (3 in 655 cases) of all malignant neoplasms of the larynx treated by surgery in the mentioned period of time. The primary focus of the neoplasm in one case was located in anterior commissure and in the two others--in the vocal cord. In all the cases surgery was done. Results of the treatment were given.

[Treatment of bilateral vocal cord paralysis: surgical technique and functional results]. / Postepowanie lecznicze w obustronnym porazeniu nerwów zwrotnych: technika chirurgiczna i wyniki czynnosciowe.

The authors present possibilities of the surgical treatment in bilateral vocal cord paralysis. We described the technique of the operation which is being used in our department in such a cases. 13 patients were analyzed after operations (11 women, 2 men). Bilateral vocal cord paralysis was caused by thyroidectomy (11 cases), virus infection (1 case) and in the course of multiple sclerosis (1 case). Functional results were evaluated by subjective examination, indirect laryngoscopy, spirometry and video-laryngoscopy. The effects of the treatment were satisfied.