Effects of rapid maxillary expansion on the airways and ears--a pilot study.

The aim of this prospective study was to describe the morphological and functional changes of the upper airways and the middle ears after rapid maxillary expansion (RME). Thirteen patients comprised the original study sample, of these three patients dropped out. Of the remaining 10 subjects, seven (two females, five males; average age, 8.7 years) underwent orthodontic RME with a Hyrax screw and three (one female, two males; average age, 8.3 years) served as the controls. Inclusion criteria for the study group were a uni- or bilateral crossbite with the evidence of a maxillary deficiency. Exclusion criteria were acute or chronic respiratory disease, allergies, cleft lip and palate, or absence of adenoids. An ear, nose, and throat (ENT) examination, lateral cephalometry, anterior rhinomanometry, tympanometry, and posterior rhinoscopy were carried out for each child at baseline (E1) and after 6 months (E2). Descriptive statistics were calculated for all diagnostic variables and correlations between the study and control group were evaluated. Rhinomanometry showed a correlation (r=0.57) between the size of the nasal pharyngeal area and nasal airflow, but only at 150 daPa. The size of the adenoids measured on the lateral cephalograms was correlated with the endoscopic findings. The size of the adenoids remained the same after RME. Patients with maxillary constriction had the largest adenoids and showed a negative pressure in the middle ear. However, this was reduced after RME. The results suggest a possible impact of maxillary deficiency on otorhinological structures. RME may lead to otorhinological changes. Further interdisciplinary investigations are needed to corroborate these findings.

[Surgical treatment options in oropharyngeal cancer]. / Indikationen zur chirurgischen Therapie des Oropharynxkarzinoms.

Therapy of oropharyngeal squamous cell cancer traditionally has been radiation-based, with surgery mainly in reserve. With increasing depth of local infiltration and volume of regional metastases the role of surgery in safeguarding curative chances increases. However, after failed chemoradiation of oropharynx cancer, few patients are cured by salvage surgery. Thus, primary surgery with postoperative radiotherapy may be contemplated if circumtances are favorable. The oropharynx can be approached by transoral, transmandibular or transcervical routes. Primary surgery is increasingly valuable when resultant morbidity is decreased as in the case of more elaborated transoral approaches. Classical approaches also have improved with increasing use of midline mandibulotomy, marginal mandibulectomy, reconstructive surgery, selective neck dissection (ND), and rehabilitation. Elective ND is restricted to levels I or II to III or IV, therapeutic ND is comprehensive (classic or modified radical depending on capsular integrity), and salvage ND is individualized. Surgery, most often followed by radiotherapy, in selected cases of oropharynx cancer is an interesting alternative to chemoradiation, and in advanced disease a facultative but essential part of multimodal therapy.

Descending necrotizing mediastinitis treated with rapid sternotomy followed by vacuum-assisted therapy.

BACKGROUND: Descending necrotizing mediastinitis (DNM) is a life-threatening emergency after oropharyngeal infection. The diagnosis must be established rapidly. DNM is associated with septic shock and respiratory insufficiency. Because mortality rates may be as high as 60%, aggressive surgical treatment is indicated. METHODS: Between December 2001 and December 2005, 5 patients (3 men, 2 women) with DNM, average age of 69 years (range, 24 to 72 years), were treated at our department. Surgical treatment consisted of one or more cervical drainages and drainage of the mediastinum through sternotomy after mediastinitis had been confirmed by computed tomography. The latter investigation also revealed mediastinal abscess and empyema. After radical debridement, a vacuum-assisted closure device was inserted. RESULTS: The outcome was favorable in 4 patients. A 72-year-old woman died of prolonged septic shock and subsequent multiple organ failure. Tracheotomy was performed in all patients to create an airway. The duration of the intensive care unit stay was 51 +/- 24.2 days. CONCLUSIONS: Rapid and extensive cervical and mediastinal debridement is mandatory in patients with DNM. A vacuum-assisted closure device is useful because it promotes tissue approximation and stimulates the ingrowth of granulation tissue.

[The Pearson method of "near total" laryngectomy: a radical surgical procedure with preservation of laryngeal phonatory function]. / "Near-total" laringektomija po Pearsonu: radikalan operativni zahvat sa cuvanjem fonatorne funkcije larinksa.

INTRODUCTION: Patients with advanced T3 and T4 laryngeal and hypopharyngeal carcinoma need surgical treatment--total laryngectomy. Excision of the larynx affects enormously the quality of patient's life. Near total laryngectomy appeared about twenty years ago, and was accepted worldwide during the last decade of the twentieth century. Two years ago we started performing this operative procedure. Although we still don't have great experiance, first results are satisfying. We point to the importance of this procedure especially in developing countries, where phonatory protheses are expensive, patients' education of esophageal speech is not satisfactory and number of those who were successfully trained is small. The aim of this paper was to introduce near total laryngectomy as a surgical procedure which improves quality of life of patients with advanced stages of laryngeal and hypopharyngeal carcinoma. NEAR TOTAL LARYNGECTOMY: The original procedure described by Pearson was very complicated to understand, so we accepted Monux procedure which is easier. The resection of the laryngeal structures corresponds to those in total laryngectomy, but we spare a small part of cricoid cartilage and whole or 2/3 of the healthy vocal cord. CONCLUSION: A number of arguments, presented in this paper, speak in favor of near total laryngectomy. This technique has the same oncological results as total laryngectomy, but much better functional results and quality of life in patients with laryngeal and some hypopharyngeal carcinomas.