[Intranasal sinus operation in palliative therapy in maxillary cancer patient--preliminary report]. / Zastosowanie wewnatrznosowej operacji zatok w leczeniu paliatywnym raka zatoki szczekowej--doniesienie wstepne.

The authors present a case of 64 years old woman treated with palliative radiotherapy due to maxillary sinus cancer--non-operative stage. The cancer-relative pain couldn't be released after radiotherapy and with pain killers. She used NSAIDs and opioid drugs. Before chemiotherapy she was undertaken intranasal sinus operation as a palliative operation. Maxillary sinus was opened. The pain after operation diminished significantly. She died 2 and a half months later, during chemiotherapy, but free of pain.

[Possibility and limits of the endonasal approach in sinonasal inverted papilloma cases--the technique and own experience. Preliminary report]. / Mozliwosci i ograniczenia techniki wewnatrznosowej operacji brodawczaka odwróconego nosa i zatok przynosowych--dóswiadczenia wlasne. Doniesienie wstepne.

The aim of this article is to present the technique of endonasal operation due to sinonasal inverted papilloma with it's limitations. Material consists of 21 patients operated with microscope and endoscopes. The tumor is resected in few pieces, but I try (especially in the beginning) to keep the resected tumor as much as possible in one part--which makes easier to assess the tumor borders. Mostly it is possible to leave at place the inferior turbinate and only the upper part of it must be resected with the tumor. Involvement of the frontal sinus is the contraindications for a purely endonasal approach, but this involvement must be assessed intraoperatively, due to preoperative CT scan limitations. Tumor involving the orbit is also contraindication to endonasal approach. Tumor is resected with anterior or total ethmoidectomy, because of coexistence of inflammations in sinuses. It is possible to resect tumor from all ethmoid cells and both sphenoid sinuses from endonasal approach. Mostly it is possible to resect tumor from maxillary sinus from endonasal approach. I leave a healthy mucosa of the maxillary sinus and resect only tumor and the margins. But in the case of prelacrimal recess involvement of the maxillary sinus or difficulty with removing tumor from the bottom of the sinus I open it through the Caldwell-Luck approach (2 cases). Postoperative cavity usually heals very well. In the presented material I didn't observed recurrence of the tumor and the patients are very well (17 patients: 1-4.5 years of observation, 4 patients: under 1 year of observation). Advantages of the endonasal method are: small bleeding, operation under magnification, good view around the corner in 70 degrees endoscope, leaving anterior bony wall of the maxillary sinus, leaving inferior turbinate and small post-op. disturbances, relatively small op. injury and quick healing, possibility of removing the tumor from the nose, ethmoidal and sphenoidal and maxillary sinuses (mostly), possibility to extend the operation with external approaches if needed. Disadvantages and limits of the method are: not possible to remove the tumor from frontal sinus, difficulty in removing the tumor from prelacrimal sac recess (sometimes combined approach needed).

[Objective assessment of the respiratory function of the larynx after fronto-lateral laryngectomy with epiglottoplasty and after supracricoid laryngectomy with CHP or CHEP]. / Obiektywna ocena funkcji oddechowej krtani po laryngektomii fronto-lateralnej poszerzonej z epiglottoplastyka oraz nadpierscieniowej z CHP lub CHEP.

Enlarged fronto-lateral laryngectomy with epiglottoplasty and supracricoid laryngectomy with cricohyoidopexy (CHP) or cricohyoidoepiglottopexy (CHEP) differ from each other as regards surgical technique, extent of the resection and method of reconstruction. Despite of that, selected carcinomas of the true vocal cord staged as T2N0, which are included in indications to all mentioned laryngectomies, can be equally treated with each of these methods. The aim of this study is objective evaluation of the respiratory function of the larynx after three types of operation and comparison of the results. Material included 64 patients treated during the period of 1993-2002: 39 patients after supracricoid laryngectomy (18 with CHP and 21 with CHEP) and 25 after enlarged fronto-lateral laryngectomy with epiglottoplasty. Spirometry was performed before and after the operation in 27 cases and only after the operation in 34 cases. The shapes of flow-volume loops and 32 spirometric parameters were evaluated. The decannulation rates were: a) 98,5% after enlarged fronto-lateral laryngectomy with epiglottoplasty, b) 80,6% after supracricoid laryngectomy with CHP, c) 70,1% after supracricoid laryngectomy with CHEP. Although the decannulation rate was better after CHP than after CHEP the spirometric parameters were better in patients after CHEP than in those after CHP. The airflow similar to normal was found in 15% patients after CHEP as well as after CHP and in 28% patients after epiglottoplasty. There were no restrictive abnormalities in the whole group of operated patients, but occurrences of obturation, especially inspiratory, were quite often. In conclusion, which follows from the comparison of three types of reconstructive laryngectomies, better results of respiratory function of the larynx were found after epiglottoplasty than after supracricoid laryngectomy with CHEP or CHP.

[Pyocele of the posterior ethmoidal cell as the cause of visual loss]. / Pyocele komórki sitowia tylnego jako przyczyna slepoty.

INTRODUCTION: Mucocele is a cystic slow-growing lesion of paranasal sinuses with sterile content. Pyocele contains purulent substance. Muco-/pyocele is rarely localised in ethmoid or sphenoid sinus and may involve the orbit and cause ophthalmic complications including visual loss. MATERIAL AND METHODS: We report the case of a 25-year-old woman who suffered from sudden visual loss of her left eye. She was treated for optic nerve papillitis by neurologists and ophthalmologists with steroids and recovered after about 6 weeks. Magnetic resonance imaging was ordered to find the cause of visual disturbance and revealed an oval-shaped lesion in the left posterior ethmoid sinus. The patient underwent functional endoscopic surgery and transethmoidal marsupialisation of the muco-/pyocele. RESULTS: After endoscopic microsurgery the patient recovered without complications, she is under follow-up and has no symptoms of any disease. Because there were no evidence of any other causes of optic nerve affection, the muco-/pyocele was regarded as the cause of visual loss. CONCLUSIONS: The posterior ethmoid muco-/pyocele can present with ophthalmic manifestations including blindness. Endonasal operation and steroids administration are the treatment of choice in such cases.

[Anxiety and depression in patients with laryngeal and hypopharyngeal cancer (preliminary report)]. / Lek i depresja u pacjentów z rakiem krtani i gardla dolnego (doniesienie wstepne).

Occurrence of anxiety and depression was investigated in 76 patients with recognized larynx and/or hypopharynx cancer and with or without alcohol dependence. The patients were treated using total or partial laryngectomy or radiotherapy. Patients were examined three times using questionnaires: SCID, BDI, STAI. The greatest intensity of anxiety was observed before treatment, especially in patients qualified for surgery. After finishing the treatment, independently of the type of operation, intensity of anxiety was lower than in patients treated using radiotherapy In patients after total laryngectomy the greatest intensity of depression was observed 7 days after operation. The mood of these patients has improved significantly before discharge from hospital. In patients treated with partial laryngectomy such great changes of mood were not observed. In patients treated using radiotherapy were stated greater intensity of depression at the end of treatment - despite of initial mood improvement. Patients with alcohol dependence were stated greater intensity of anxiety and depression than in the other patients. Dynamics of the intensity of anxiety and depression in the different diagnostic and therapeutic groups of patients with laryngeal or hypopharyngeal cancer should be done under consideration of their prophylactic and rehabilitative effects.

[Horizontal glottectomy--oncologic and functional results. Part I. Horizontal glottic laryngectomy--oncologic results and assessment of the protective and respiratory function of the larynx]. / Laryngektomia pozioma glosniowa-- wyniki onkologiczne i funkcjonalne. Czesc I. Laryngektomia pozioma glosniowa--wyniki onkologiczne, ocena funkcji ochronnej i oddechowej.

INTRODUCTION: In the Otolaryngology and Laryngological Oncology Department of the Pomeranian Medical University in Szczecin (Poland) horizontal glottectomy is executed from 1985. MATERIAL AND METHODS: Material consists of 27 patients (26 males and 1 female; an average age 57 min. 40, max.). We evaluated: 1) oncological results, 2) 3 and 5-years survival rate without recurrence of the cancer, 3) evaluation of the protective and respiratory function. Protective function was evaluated basing on: a) period after operation when feeding tube was removed, b) subjective assessment of swallowing liquid and solid food. For evaluating respiratory function we stated period after operation to decannulation and also spirometric investigations were done. RESULTS: From among 27 operated patients died 4 (15%)--one on the second day after operation. Recurrence of the cancer (local or into lymph nodes) were observed in 5/26 (19.2%). Three years without symptoms of recurrence survived 89% (17/19), five years--80% (12/15). Swallowing through natural way was possible during the first 24 hours after operation in 13 of 26 (50%) patients. In the remaining 13 only 2 feeding tubes were removed on the 35th day after operation. Decannulation was possible at 92% (24/26) patients. 15 (58%) patients were decannulated in the first two week after operation. Spirometric investigation (n = 10) showed no restriction and very small obturation on the larynx - very good laryngeal flow nearing to normal. CONCLUSIONS: Oncologic results, protective and respiratory function after horizontal function results are satisfactory and comparable to the other researchers.

[Usefulness of ventilation tests in the diagnosis and evaluation of treatment results in select laryngeal diseases]. / Przydatnosc badan wentylacyjnych w diagnostyce i ocenie wyników leczenia wybranych schorzen laryngologicznych.

The obstruction of upper airways is a common symptom of some laryngological diseases. The patients need exact diagnosis and proper treatment. The ventilation tests seem to be one of the most important tool in process of diagnosis and treatment, however they are more pulmonological than laryngological procedures. The aim of the study was to evaluate the efficacy of ventilation tests and analysis of their interpretation in patients with laryngeal and/or tracheal obstruction. Also, we intended to show a method of spirometric examination in patients with tracheostoma. Based on our common clinical experience (more than 3000 tests in patients with upper airways obstruction in ENT Departments in Zabrze and Szczecin) we presented our observations. In majority, the tests were used in patients after laryngeal surgery due to the cancer or bilateral vocal cord paralysis and in patients with tracheostomy, before decannulation. The attention was paid on usefulness of some coefficients, especially in diagnosis of upper airway obstruction. For better results interpretation the authors introduced the term of mixed obstruction in contrast to fixed and dynamically variable narrowing. Also the FIV1/N FEV1 parameter was purposed. In conclusion the great role of ventilation tests was emphasized, especially in diagnosis of the narrowing on the larynx and trachea level and also in evaluation of the results after surgical procedures on upper airways.

[Horizontal glottectomy--oncological and functional results. Part II. Morphology of the glottis and perceptive-acoustics characteristic of the voice and speech after horizontal glottectomy]. / Laryngektomia pozioma glosniowa-- wyniki onkologiczne i funkcjonalne. Czesc II. Morfologia glosni i charakterystyka percepcyjno-akustyczna glosu i mowy po laryngektomii poziomej glosniowej.

INTRODUCTION: The authors showed findings concerning glottis morphology and perceptual-acoustic characteristics of voice and speech after partial classical (PCGLg) and extended glottic partial laryngectomy (PEGLg). MATERIAL AND METHODS: 10 patients (9 M., 1 F. average age 56 (min. 47 max. 65) were examined. All patients were undergone glottic partial laryngectomy: a) classical (n = 5) b) extended of vocal process (n = 3) with (n = 2) or without (n = 1) the removal of the mucous false folds, c) extended of part of arytenoid cartilage with (n = 2) or without (n = 1) the removal of the mucous of the false folds. The following examinations were executed: phoniatric, videolaryngoscopic and perceptual-acoustic analysis. RESULTS: After PCGLg and one extended of vocal process, voice and speech has mostly characterized of features of hypofunction dysphonia. Hyperfunction was found in patients after removal of the mucous of the false folds due to leucoplakia. In case of removing of a part of arythenoid cartilage the notable or entire standstill or lack of full phonatory closure were found. The phonetical-acoustic analysis showed that in patients using melodious voice, the character of the source of actuating was periodically-noise, with the component of noise in all range of the course of the acoustic signal of voice. The parameters such as F0, jitter, shimmer does not make coherent conclusions and are less useful in the assessment of the quality of voice. CONCLUSIONS: In case of the resection of the part of the arythenoid cartilage during glottis laryngectomy, we take into account lack of full phonatory closure and using whisper by the patients. Obtaining the reliable conclusions needs continuations of the investigations and increasing number of patients. These researches are in progress.

[The evolution of epidemiology and clinical characteristics of laryngeal and hypopharyngeal carcinoma in Poland from 1991 to 2001]. / Ewolucja obrazu epidemiologicznego i klinicznego raka krtani i krtaniowej czesci gardla w Polsce w latach 1991-2001.

On the base of retrospective analysis of 12,888 cases of carcinoma of larynx and hypopharynx, diagnosed in 19 ENT Departments in Poland from 1991 to 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 11 years the trends to change of the mentioned above parameters has been examined. The significant increase of female patients in this period was observed, with average proportion M:F = 8:1. The glottis localization of carcinoma dominated (47.6%), followed by supraglottis (40.8%) and pyriform fossa (7.8%), with significant increase of pyriform fossa tumors in the analyzed period of 11 years. In the majority of cases the carcinoma of larynx and hypopharynx was diagnosed in the advanced stage (T3 + T4) of local disease, with the highest percentage in localization within the pyriform fossa (81.0%), and the lowest percentage in glottis tumors (45.6%). The regional lymph nodes metastases has been diagnosed in 46.7% of the analyzed group, with the highest percentage in tumors localized in pyriform fossa (82.9%), and the lowest percentage in tumors of glottis localization (33.1%). In the 11 years time the significant drop down of N0 cases and tendency to increase of N2 and N3 in the supraglottis localization of tumor. The distant metastases in the analyzed group at the time of diagnosis has been registered in 2.0%, with the highest percentage in posterior pharyngeal wall (7.6%) and pyriform fossa (7.4%). The authors postulate the renewal of prospective study on epidemiology, clinical characteristics and treatment results of larynx and hypopharynx carcinoma in Poland.

[Surgical technique of endonasal micro-endoscopic operation in patients with massive and recurrence nasal polyposis--own experience]. / Technika chirurgiczna mikroendoskopowej operacji wewnatrznosowej u chorych z masywnymi i nawrotowymi polipami nosa i zatok przynosowych--doswiadczenia wlasne.

The author presents modification of the well-known surgical techniques used in endonasal optically aided operations in the patients with massive and recurrent nasal polyposis. After septal correction the attachment of the middle turbinate and lower turbinate is identified. It helps to find an appropriate place to open a maxillary sinus through uncinectomy. Opened maxillary sinus makes possible to find orbital lamella. The posterior maxillary sinus wall as the anatomic point helps to find the anterior wall of sphenoid sinus through posterior ethmoidectomy. After finding choane it is possible to open sphenoid sinus without cutting the posterior part of the middle turbinate. From this part it is possible to continue the operation like in the posterior-to-anterior technique, because it is well known where is the ethmoid roof. The operation is finished after opening frontal recess and correction of the middle turbinate. I did 110 total endonasal sphenoethmoidectomies using this technique in the patients with massive and recurrent nasal polyposis without any serious complications. I didn't have any problems with orientation in operative field even in very complicated cases.

[Fixation of the crico-arythenoid joints in rheumatoid arthritis--preliminary report]. / Unieruchomienie w stawach pierscienno-nalewkowych w przebiegu reumatoidalnego zapalenia stawów--doniesienie wstepne.

Rheumatoid arthritis (RA) is a systemic disease of connective tissue which affects joints lined with synovial membrane. Laryngeal joints also have such a structure. Among all reasons leading to their inflammation rheumatoid arthritis is mentioned on the first place. In larynx RA mostly affects cricoarythenoid joints (CA). RA of the CA joints is found in 27% to 78% suffering from RA. In the acute phase of the disease patients complain of burning and foreign body sensation in the throat, hoarseness, pain on speaking, voice fatigability, problems with swallowing. Chronic RA of the CA joints can lead to their fixation and dyspnoea, requiring emergency tracheotomy. According to the literature, this state occurs in 10% to 25% patients suffering from RA. A case of 75 years old woman is presented, who was admitted to our Clinic with severe inspiratory dyspnoea requiring tracheotomy. She was suffering from RA for 26 years. She complained of effort dyspnoea, problems with swallowing and tightness sensation in the throat for 4 years. Patient complained also about cervical spine pain, upper right extremity and knee joint periodic oedema. The patient was suffering from so severe lower extremities pain and rheumatoid changes in knee joints that she had to walk on crutches. Little hands' joints were deformed with significant ulnarisation. Videolaryngostroboscopic examination showed no movement in CA joints, paramedian position of the vocal folds and narrowing of the glottic rim to 1.5 mm. Phonatory mobility of the vocal folds was preserved. Electromiographic examination of the internal laryngeal muscles made a) during phonation--showed bilateral normal bioelectrical record from thyroarythenoid muscles, b) at rest--there was no denervation activity. In computerized tomography study no degenerative changes in CA joints were found. On the basis of clinical view and examinations results, there was considered that fixation in CA joints was due to degenerative changes, which were the result of their rheumatoid inflammation. It was emphasized that this subject has been mentioned only several times in laryngological and phoniatric handbooks and in few articles.

[Surgical methods of treating patients with laryngeal and hypopharyngeal cancer in Szczecin's EMT University Department during the years 1970-2002]. / Chirurgiczne metody leczenia raka krtani i gradla dolnego stosowane w Klinice Szczecinskiej w latach 1970-2002.

In the thesis are presented surgical methods of treating larynx and hypopharynx cancer used in the Szczecin Clinic throughout more than 30 years, i.e. between 1970 and 2002. During this period in the Szczecin center 2591 patients ill of larynx cancer underwent surgical treatments. In the analysed period was recorder an increase in: a) the number of patients suffering from larynx and hypopharynx cancer, b) patients' average age, c) percentage of larynx cancer sick rate in females in relation to males and d) the number of patients with advanced stage of disease. Predominant with the patients were supraglottic cancers, however in the recent years there was an increase in the number of glottic cancer patients. In the years 1970-1980 prevailed partial laryngectomies and total laryngectomies were performed sporadically. In the next decade, what became noticeable was a drop in operations with creation of autoplastic vocal shunt and a growth in the number of partial operations with the preservation of respiratory way. In the last decade there was also an increase in the number of operations of total laryngectomies and a decrease in the number of partial operations, whereas the number of performed subtotal operations with the reconstruction of phonatory functions remained at the same level. Oncological and functional results assessed both subjectively and objectively after all kinds of laryngectomies were satisfactory. In the thesis attention was also paid to surgical methods elaborated in the Clinic, which substantially contributed to the progress in surgical treatment of larynx cancer as well as to improvements in revalidation of the phonatory function and its quality with patients after total, subtotal and partial removal of larynx structures.

[Factors influencing morphology and function of the pharynx and pharyngoesophageal sphincter after total laryngectomy. Part II. The impact of degenerative changes in the neck segment of the vertebral column on the rest pressure within pharyngoesophageal sphincter after laryngectomy]. / Czynniki wplywajace na morfologie i funkcje gardla oraz zwieracza gardlowo-przelykowego po laryngektomii calkowitej. Czesc II. Wplyw zmian zwyrodnieniowych w szyjnym odcinku kregoslupa na cisnienie spoczynkowe w obrebie zwieracza gardlowo-przelykowego po laryngektomii calkowitej.

Radiological examinations of the vertebral column neck segment were done in 41 patients after total laryngectomy (n = 29) and laryngopharyngectomy (n = 12). Degeneration changes of different degree (from I degree to IV degree) were stated in 37 cases. Criteria of assessment were as follows: a) the width of the intervertebral space b) appearance and degree of the exostoses c) the length of the degenerative process in vertebral segment of the neck. The advanced degenerative changes in the vertebral column (IV degree) included all neck segment and were characterized by significant narrowing of the intervertebral spaces and exostoses longer than 0.5 cm. These changes were seen statistically more often in the patients after 50. The pharyngoesophageal sphincter's (p.e.s.) rest pressure was statistically rising significantly with the degree of the degeneration changes in the vertebral column. The high pressure in p.e.s. (5.7 + 2.85 kPa--43 + 21 mm Hg) was seen only in the cases of the IV degree degree. In the patients with the IV degree degree of degenerative changes in 67% retention of saliva in the hypopharynx was seen. Probably it was due to irritation of the sympathetic part of the autonomic system. The statistically significant correlation between the degree of the degenerative changes and the complains like pain during the head movement and limitation of the neck motion was also observed. In IV degree degree these complains were noted in 57% cases. The results of the investigations prove the hypothesis of influence of the sympathetic part of the autonomic system on the pharyngoesopghageal sphincter rest pressure.

[Comparison of the classical and extended fronto-lateral laryngectomy considering the respiratory function of the larynx]. / Porównanie laryngektomii frontolateralnej klasycznej i poszerzonej w zakresie funkcji oddechowej krtani.

In Szczecin during the period between 1973-1999, 107 patients were treated with classical fronto-lateral laryngectomy (LFLC) and 112 with extended fronto-lateral laryngectomy (LFLE) due to glottic cancer. We report 30 patients (27 male and 3 female)--13 after LFLC and 17 after LFLE (including 15 cases of LFLE with epiglottoplastic). 72 laryngovideoscopies, 87 spirometric examinations and 18 computerised tomographies were performed. Larynx lumen and 32 spirometric parameters were evaluated. Somewhat higher values of air flow parameters were state in patients qualified for LFLC than LFLE. Average value of the spirometric parameters were also a little bit higher after LFLC than after LFLE. Air flow through the larynx was sufficient to decannulate 11/13 patients after LFLC and 16/17 patients after LFLE. After both types of operations normal air flow was seen in 5 patients after LFLC and 2 patients after LFLE. Spirometric examination with flow-volume loop was the most useful in evaluation of respiratory function of the larynx.

[Morphology and function of the pharyngoesophageal segment]. / Morfologia i funkcja segmentu gardlowo-przelykowego.

Basing on the review of the foreign and domestic literature the point of view concerning the anatomical structure, innervation and histomorphology of the pharyngoesophageal segment (pes) is being presented. Special attention was paid to the impact of the somatic and autonomic (particularly its sympathetic part) nervous system on the function of the pharynx, as well as the pressure at rest with the pharyngoesophageal sphincter. Histomorphologic investigations suggest that the pes function and tension of the particular pharyngeal constrictors (upper, middle and inferior) is determined by: a) structure, b) distribution of the IX and X nerve fibre ends in pharyngeal sphincters, c) structure of the pharyngeal sphincter, which is also supplied with the nervous fibre ends of the upper cervical sympathetic trunk. The sympathetic trunk is located on both sides of vertebral column from the skull base till the tip of the sacral bone. In case of degenerative process in the neck segment of the vertebral column, irritation of the sympathetic part of the autonomic system is taking place. Experimental investigations revealed that the stimulation of the sympathetic nervous fibres of the autonomic system results in weakening of the upper and middle pharyngeal sphincter's tension and increase of tension in its lower part (cricopharyngeal muscle). This can be an etiopathogenic factor under physiological condition in disturbances of the pharyngeal phase of deglutition act. After total laryngectomy, however, high pressure in the lower part of the pes (in the area of pharyngoesophageal sphincter) renders it difficult or even impossible to introduce the air into the esophagus to master the phonation and esophageal speech. The significance of the knowledge of the pes innervation in clinical practice is important for prognosis in mastering of supplementary, esophageal and shunt phonation.