[Thyroid gland function after therapy of the laryngeal cancer: prospective examinations]. / Funkcja hormonalna tarczycy po leczeniu raka krtani--badania prospektywne.

The paper presents the results of the study concerning thyroid gland function of the patients suffering from larynx cancer treated with: a) surgery only (n = 31), b) surgery with further radiotherapy with radical doses 5400-7000 cGy (n = 44), c) radiotherapy along with radical doses 6400-7000 cGy (n = 7). 82 patients (M-73, F-9) were examined. Average age was 58 (min. 30, max. 80). Thyroid gland function was evaluated by measurement of: a) hTSH, fT3, fT4, b) serum lipids concentration. The examinations mentioned above were performed before as well as after the treatment at: a) 1, b) 1-6, c) 6-12, d) 12-24, e) longer than 24 months after completion of treatment. The longest period of observation involved 8 years. Our results show that hypothyroidism (mostly subclinical) occurs seldom (6% of all the cases) in the early phase (up to 1 month) after surgical treatment. After radiotherapy only--no subclinical hypothyroidism was observed. The combined treatment seems to be the most frequent cause of subclinical hypothyroidism. Its frequency increases (up to 27%) with the length of time since the conclusion of treatment. We also tried to explain the pathogenesis of subclinical hypothyroidism on the basis of histopathologic examination of thyroid tissue (n = 13) derived from the patients after various ways of treatment. The studies were compared to the results of histological examinations of the thyroid sections obtained during autopsy (n = 20) from the control group (not suffered from thyroid diseases).

[Vascular pedicle flap of the thyroid or submandibular gland in the reconstruction following partial laryngectomy]. / Naczyniowo uszypulowany przeszczep tarczycy i slinianki podzuchwowej jako material rekonstrukcyjny w czesciowych laryngektomiach.

The paper presents the merits and drawbacks of vascular pedicled flaps of thyroid and submandibular glands in the reconstructive surgery following partial laryngectomy (combined with the resection of tongue base if necessary), as well as the results of clinical, radiological, radionucleoloid++ and histological investigation carried out in 81 cases with various extend of neoplasm (T1-T4). The average observation period was 8.2 (min. 1, max. 14) years. The discussed flaps were satisfactorily elastic and rigid, allowed formation in monobloc even complex structures (for instance vocal cord, arytenoid eminence, lateral wall of the larynx) with the high healing rate (1 total and 2 partial losses only), with an insignificant degree of atrophy in the larynx and a considerably greater one in the tongue base (despite a very difficient cover with mucosa), as well as a small local recidive range (3/81 cases all coming from the tissue out of the flap). With the above data, the discussed flaps seem to be superior in many respects to the materials conventionally used in the reconstruction of the larynx. A subclinical form of hypothyreosis (reduced level of T3, T4 and TSH) was stated in 1 case only, whereas xerostomy was not observed in any. The detailed oncological and functional results obtained in the whole group of patients will be published in another paper.

[Hormonal function of the thyroid gland after therapy for laryngeal cancer]. / Funkcja hormonalna tarczycy po leczeniu raka krtani.

The paper presents the results of the study concerning thyroid gland function of the patients suffering from larynx cancer treated with: a) surgery only, b) surgery with further radiotherapy with radical doses 5000-6500 cGy, c) radiotherapy along with radical doses 6500-7200 cGy. Thyroid gland function was evaluated by measurement of: a) hTSH, FT3, FT4, b) serum lipids concentration. The hTSH concentration was evaluated by immunoradiometric method whereas FT3 and FT4 by DELFIA techniques (deleted fluorescence). 162 patients (M-148, F-14) were examined. Average age was 57 (min.-30, max.-80). The patients were divided into two groups. The first group (n = 90) involved those who had been examined once at different time since the end of treatment (retrospective examinations). The patients who had been examined before as well as after treatment were established as the second group (n = 72) (prospective examinations). In this case the examinations are still being continued and they are carried out at: a) 1, b) 1-6, c) 6-12, d) 12-24, e) longer than 24 months after completion of treatment. Our preliminary data show that hypothyroidism (mostly subclinical) occurs seldom (7% of all the cases) in the early phase (up to 1 month) after surgical treatment and gets normal spontaneously (up to 6 months). After radiotherapy only--no subclinical hypothyroidism was observed. Interestingly, the combined treatment seems to be the most frequent cause of subclinical hypothyroidism. Its frequency increases (up to 47%) with the length of time since the conclusion of treatment (2 years and longer). Because of continuation of our examinations the presented data are still preliminary and they will be verified in the next paper. We also tried to explain the pathogenesis of subclinical hypothyroidism on the basis of histopathologic examination of thyroid tissue derived from the patients (after combined treatment and after radiotherapy) during further total laryngectomy performed because of neoplasm renewal.

[The choice of transplantation in reconstructive surgery of the larynx after partial laryngectomy]. / W sprawie wyboru przeszczepu w chirurgii rekonstrukcyjnej krtani po laryngektomii czesciowej.

Hitherto applied methods of larynx reconstruction after laryngectomies of various extension or extended by the tongue base were discussed. Disadvantages of hitherto applied transplants were pointed out. The possibility of application of vascular pedicle transport of thyroid gland or submandibular gland for larynx reconstruction was presented.

[Extended fronto-lateral laryngectomy with epiglottoplasty]. / Laryngektomia czolowo-boczna rozszerzona z nastepowa epiglotoplastyka.

The report presents our experience of 20 years in extended fronto-lateral laryngectomy with subsegment epiglottoplasty. Material comprised 35 patients aged 31-70. There were 3 female and 32 male patients. Clinical stage of the glottic cancer was: T1N0-in 22 cases and T2N0-in 13. Technique of the extended fronto-lateral laryngectomy and reconstruction of the larynx, using epilottis was presented. 3 and 5 years survival rate was achieved in 92% and 88% of cases respectively. Functional results were satisfactory.

[Oncological and functional results after classic and extended fronto- lateral laryngectomy]. / Wyniki onkologiczne i czynnosciowe po klasycznej i poszerzonej laryngektomii czolowo-bocznej.

The authors present a retrospective study of 72 classic frontolateral partial laryngectomy and 63 extended frontolateral resection performed in the years 1973-1992 in the ENT Clinic of Pomeranian Medical Academy in Szczecin. The operation was performed in selected glottic carcinomas. For reconstruction of the larynx after laryngectomy, the skin, vascular pedicled flap of the thyroid gland and the epiglottis were used. The functional results in regard to respiration, deglutition and phonation were satisfactory. 88% of patients survived 3 years and 86% of patients 5 years.

[Horizontal laryngectomy of the glottis]. / Laryngektomia pozioma glosniowa.

The surgical technic of horizontal glottic laryngectomy and the oncological and functional results in 12 cases treated in ENT Clinic of Pomeranien Medical Academy in Szczecin during the years 1985-1991 are presented. In all cases the changes concerned the vocal cords and were of following extend: T1b--5 cases and T2--7 cases. The survival rate was: 5-years--4/6 patients, 3-year--8/10 patients and 1-2-years--2/2 patients. 3 patients died. The causes of death were: intraoperation--1 case, local recurrence--1 case and non neoplastic case--1 case. Among 12 cases decaniulation were possible in 9.

[Functional results after supracricoid reconstructive laryngectomy with cricohyoidopexy (chp) and cricohyoidoepiglottopexy (chep)]. / Wyniki czynnosciowe po laryngektomiach nadpierscieniowych rekonstrucyjnych typu CHP i CHEP.

The functional results in 61 patients after supracricoid reconstructive laryngectomy with CHP (28 cases) and CHEP (33 cases) performed in the University ENT Department in Szczecin between 1971-1989 are presented. Satisfactory lower airway protection in about 93% and respiration in the natural way in 83% are obtained. It was impossible to decaniulate 11 patients. The voice was socially sufficient in 89%.

[Partial supra-cricoid reconstructive laryngectomy with CHP and CHEP: surgical technique and oncologic results]. / Laryngektomie czesciowe nadpierscieniowe rekonstrukcyjne CHP i CHEP: technika chirurgiczna i wyniki onkologiczne.

The authors present a report on 62 cases of partial horizontal supracricoid reconstructive laryngectomy, including 28 cases of cricohyoidopexy (CHP) and 34 cases of cricohyoidoepiglottopexy (CHEP). The surgery was carried out in the years 1971 to 1989 in the ENT Clinic of Pomeranian Medical Academy in Szczecin. The indications, surgical technique and oncological results are presented. 78% patients survived after 3 years and 73% after 5 years without recurrence. The reasons of failure and the way of treatment are discussed.

[Treatment of advanced cancer of the palatine tonsil]. / Postepowanie w rozleglych rakach migdalka podniebiennego.

33 patients with the various clinical stage of palatal tonsil cancers were described together with their treatment. In T3 and T4 stages the best results were obtained by both surgery and radiotherapy in contrast to radiotherapy alone.

[Rehabilitation in esophageal speech and its perceptive-acoustic features after total laryngectomy without pharyngo-esophageal plastic surgery]. / Rehabilitacja mowy przelykowej i jej cech percepcyjno-akustycznych po laryngektomii calkowitej z i bez plastyki zwieracza gardlowo-przelykowego.

The experiences with the plastic surgery of pharyngo-oesophageal sphincter during the laryngectomy were presented. The sphincteric forces were studied accordingly to the rehabilitation successes and also the acoustic and perceptive data of the oesophageal speech. The results were compared with these after the classical laryngestomy. It was pointed out that the sphincteroplasty lowered its tension and made the rehabilitation more easier. The oesophageal voice produced in this occasion is better than after the classical laryngectomy. The fundamental frequency is two times higher, the prosody and speech tempo more normal. These positive results were encountered in 76% of cases. However, in some cases the psychological and social difficulties were so great that we preferred the surgical rehabilitation with shunt formation.

[Surgical rehabilitation of voice and speech after total or nearly-total laryngectomy]. / W sprawie chirurgicznej rehabilitacji glosu i mowy po calkowitej lub prawie calkowitej laryngektomii.

18 years of the own experience in phoniatric and surgical rehabilitation of voice and speech in laryngectomized was discussed. Within the surgical methods the authors comprised not only the vocal shunt formation, but also the surgical transformation of air-in-oesophagus-collection and the section with interposition of pharyngo-oesophageal sphincter (method devised by authors). By now the oesophagus speech is most convenient. The alloplastic shunt formation is indicated in cases with psychologic difficulties, unsuccessful oesophageal voice rehabilitation and in necessity of quick regaining the good speech.