Complications following secondary voice prosthesis insertion and impact of previous irradiation on their appearance.

OBJECTIVE: The aim of this study was to analyze the complications following secondary voice prosthesis insertion and impact of previous irradiation on their appearance. METHODS: This study included 106 totally laryngectomized patients who underwent secondary Provox 2 voice prosthesis insertion. Among them, 79 (74.5%) were irradiated. Surgery, prosthesis, fistula, and voice-related complications were analyzed and presented. RESULTS: Complications occurred in 23 (22%) patients. Fifteen of them were previously irradiated. There were no surgery-related complications. In the group of prosthesis-related complications, one patient had increased negative pressure during swallowing with extremely short prosthesis life time. There were 17 complications in the group of fistula related ones; 3 patients had excessive granulation tissue around the fistula and 14 patients experienced prosthesis displacement (7 had closed esophageal end of the fistula, 5 had the prosthesis turned sideways in an open fistula, one patient inhaled and one ingested the prosthesis). Tracheoesophageal voice was not established in 5 patients. Previous irradiation had no statistically significant influence on the complication rate (P = 0,251). CONCLUSIONS: The majority of complications following secondary voice prosthesis insertion are fistula-related ones, among which, displacement of the voice prosthesis is the most common. Previous irradiation does not significantly increase the risk of developing complications.

The uncalibrated prothrombinase-induced clotting time test. Equally convenient but more precise than the aPTT for monitoring of unfractionated heparin.

The activated partial thromboplastin time test (aPTT) represents one of the most commonly used diagnostic tools in order to monitor patients undergoing heparin therapy. Expression of aPTT coagulation time in seconds represents common practice in order to evaluate the integrity of the coagulation cascade. The prolongation of the aPTT thus can indicate whether or not the heparin level is likely to be within therapeutic range. Unfortunately aPTT results are highly variable depending on patient properties, manufacturer, different reagents and instruments among others but most importantly aPTT's dose response curve to heparin often lacks linearity. Furthermore, aPTT assays are insensitive to drugs such as, for example, low molecular weight heparin (LMWH) and direct factor Xa (FXa) inhibitors among others. On the other hand, the protrombinase-induced clotting time assay (PiCT®) has been show to be a reliable functional assay sensitive to all heparinoids as well as direct thrombin inhibitors (DTIs). So far, the commercially available PiCT assay (Pefakit®PiCT®, DSM Nutritional Products Ltd. Branch Pentapharm, Basel, Switzerland) is designed to express results in terms of units with the help of specific calibrators, while aPTT results are most commonly expressed as coagulation time in seconds. In this report, we describe the results of a pilot study indicating that the Pefakit PiCT UC assay is superior to the aPTT for the efficient monitoring of patients undergoing UFH therapy; it is also suitable to determine and quantitate the effect of LMWH therapy. This indicates a distinct benefit when using this new approach over the use of aPPT for heparin monitoring.

Ketoprofen is superior to metamizole in relieving postoperative pain after head and neck tumor operation.

PURPOSE: Recently, nonsteroidal analgoantipyretics are recommended in the management of postoperative pain, with great attention to their safety. We conducted a randomized, single blind study to compare the analgesic efficacy and safety of ketoprofen and dipyrone (metamizole) after major head and neck surgery. PATIENTS AND METHODS: 60 patients received postoperatively 100 mg ketoprofen or 2.5 g metamizole i.v. every 8h over 72h with additional administration of tramadol in case of inadequate analgesia. Pain was assessed by visual numeric scale every 2h during the 72h. RESULTS: Patients in both groups had similar pain score during the first 2 postoperative days, while on the 3rd postoperative day patients in the ketoprofen group had significantly lower pain score (p <0.05). CONCLUSION: The efficacy of ketoprofen to achieve postoperative analgesia was comparable to metamizole during the first 48h, while ketoprofen was superior to metamizole during the 3rd postoperative day.

[Classification of dysphonias based on the primary etiologic factor (part I)]. / Klasifikacija disfonija prema primarnom etioloskom faktoru (I deo).

INTRODUCTION: Phonation is a complex integral function of the organism. Regular phonation is characterized by: clarity and adequate pitch. Dysphonia is a disorder of phonation. It may have many acoustic forms, but hoarseness is the best known symptom of dysphonia. Acoustic phenomena are caused by: aperiodicity of vocal vibration, turbulent air flow in the glottis and incomplete glottis closure. PREVIOUS CLASSIFICATIONS OF DYSPHONIAS: The best known classification of dysphonias was introduced by Perello. There are two groups: organic dysphonias and functional dysphonias. On the 8th Congress of Union of European Phoniatricians, in Koszeg (Hungary, 1979), Majdevac proposed a new classification. CLASSIFICATION OF DYSPHONIAS: We are proposing a new classification, made according to the primary etiologic factor in dysphonias. In this paper, we shall consider the first four. I DYSPHONIAS CAUSED BY PRIMARY FUNCTIONAL DISORDERS: This group includes: 1. Hyperkinetic dysphonia grade I 2. Hyperkinetic dysphonia grade II 3. Hypokinetic dysphonia 4. Contact hyperplastic dysphonia 5. Dysodic dysphonia II DYSPHONIAS CAUSED BY PRIMARY NEUROGENIC DISORDERS: This group includes: 1. Central dysphonias 2. Spasmodic (spastic) dysphonia 3. Dysphonia caused by myasthenia gravis 4. Dysphonia within skull base syndromes 5. Dysphonia caused by unilateral palsy of the inferior laryngeal nerve 6. Dysphonia caused by bilateral palsy of the inferior laryngeal nerve 7. Dysphonia caused by palsy of the superior laryngeal nerve III DYSPHONIAS CAUSED BY PRIMARY PSYCHOGENIC DISORDERS: This group includes: 1. Psychogenic aphonia 2. Psychogenic dysphonia 3. False mutation IV DYSPHONIAS CAUSED BY PRIMARY SOMATIC DISORDERS: This group includes: 1. Dysphonia caused by insufficiency of vocal cords 2. Dysphonia caused by oedema of vocal cords 3. Dysphonia caused by laryngitis (secondary functional) 4. Cord-ventricular voice 5. Posttraumatic dysphonia 6. Arthrogenic dysphonia 7. Presbyphonia CONCLUSION: Dysphonia is a disorder of phonation which originates at the glottis level. When disorders of phonation are concerned it is necessary to study the organism as a whole as well as all mechanisms which take part in voice production. In that case the damaged part of the phonation system can be diagnosed, which enables efficient medical treatment of the disorder.

[Hereditary angioedema in organs of the head and neck as an indication for emergency tracheotomy]. / Hereditarni angioedem organa glave i vrata kao indikacija za urgentnu traheotomiju.

INTRODUCTION: Angioedema (angioneurotic edema) is often associated with urticaria, but edema is located deeper in the skin and mucous membranes. There are limited, painless, soft and medium hard swellings. Lack of general symptoms is evident, except if mucous membranes of the gastrointestinal system are affected and pain appears. It is particularly dangerous if located in the brain or larynx when there is a risk of suffocation. In 20% cases with laryngeal involvement intubation or tracheotomy is necessary. CASE REPORT: This is a case report of a patient hospitalized at the Clinic, having a swelling at the front side of neck, lower lip and difficulties with deglutition. Occasionally the patient had similar difficulties in the main joints whereas periodical swellings are characteristic for his father, sister, and sister's daughter. Clinical check-up indicated a greyish swelling, of the oropharynx structure, with 1 cm respiratory space. Larynx was not visible due to swelling of epiglottis. The patient received intravenous steroid therapy, followed by infusion of physiologic solution with calcium. As his condition become very bad half an hour after admittance he was transported to the operation room. He received adrenaline but within the excepted time his respiration did not improve. Emergency tracheotomy was performed and afterwards his respiration and skin colour became normal. Regarding family anamnesis, clinical picture and laboratory results, hereditary angioedema was diagnosed. DISCUSSION: Hereditary angioedema is a rare form of angioedema which is an inherited autosomal dominant disorder. The disease is a result of deficit in C esterase inhibitor, which is a serum glycoprotein of SERPIN family (serum protease inhibitors), that is usually synthesized in hepatocytes. All the diseased are heterozygotes. There are two genetic variantions of the disease: I--patients with decreased quantity of inhibitor level in serum due to decreased synthesis and II--patients that have normal protein concentrations, but with abnormal protein, which is functionally inactive. Laryngeal edema can very soon cause narrowing of respiratory space, and if tracheotomy is not performed on time, suffocation occurs. Tracheotomy is one of the most urgent surgical interventions with the purpose to make patient's breathing easier to prevent suffocation and sometimes to save thr patient from certain death. CONCLUSION: In differential diagnosis of laryngeal edema, hereditary angioedema should be considered. Therapy of acute hereditary angioedema attacks should involve antihistamines, corticosteroids and adrenaline, as well as administration of fresh frozen plasma or infusion of C 1 inhibitor concentrate. Hereditary angioedema of the head and neck causing airway obstruction, is an indication for emergency tracheotomy.

[Classification of dysphonias based on the primary etiologic factor (part II)]. / Klasifikacija disfonija prema primarnom etioloskom faktoru (II deo).

INTRODUCTION: Phonation is a complex integral function of an organism. Regular phonation is characterized by: clearness and adequate pitch. Dysphonia is a disorder of phonation. It can have many acoustic forms, but hoarseness is the best known symptom of dysphonia. Acoustic phenomena in regard to voice are caused by: irregularities in vocal cord vibration, turbulent airflow in the glottis and obstruction of glottis. PREVIOUS CLASSIFICATIONS OF DYSPHONIAS: The best known classification of dysphonias was introduced by Perello. There are two groups: 1. organic dysphonias and 2. functional dysphonias. On the 8th Congress of the Union of European Phoniatrists, in Köszeg (Hungary, 1979), Majdevac proposed a new classification. CLASSIFICATION OF DYSPHONIAS: We are proposing a new classification according to the primary etiologic factor of dysphonias. In this paper, we shall consider four gropus: from the fifth to eighth. V DYSPHONIAS CAUSED BY PRIMARY ENDOCRINE DISORDERS: This group includes: 1. Dysphonia caused by pituitary disorders 2. Dysphonia caused by thyroid gland disorders 3. Dysphonia caused by parathyroid glands disorders 4. Dysphonia caused by pancreatic function disorders 5. Dysphonia caused by suprarenal function disorders 6. Dysphonias caused by sexual glands function disorders 7. Intersexuality. VI DYSPHONIAS CAUSED BY COMPLEX PROFESSIONAL REASONS: This group includes: 1. Permanent hyperkinetic dysphonia 2. Permanent hyperkinetic dysphonia with vocal cord nodules 3. Dysphonia caused by myogenic imperfect closure of vocal cords 4. Phonastenia. VII DYSPHONIAS CAUSED BY PRIMARY DISPLASTIC DISORDERS: This group includes: 1. Dysphonia caused by laryngeal hypoplasia 2. Dysphonia caused by laryngeal asymmetry 3. Dysphonia caused by epiglottal anomalies 4. Dysphonia caused by laryngeal diaphragm. VIII DYSPHONIAS CAUSED BY LARYNGEAL TUMORS: This group includes: 1. Dysphonia caused by benign tumors 2. Dysphonia caused by malignant tumors. CONCLUSION: Dysphonia is a disorder of phonation which originates from glottal level. Disorders of phonation require observation of an organism as a whole and studying all mechanisms which take part in voice production. This provides examination of voice disorders, their establishment and adequate treatment.

[Mycotic disease of the mucous membranes of the head and neck]. / Mikoticno oboljenje sluzokoza organa glave i vrata.

INTRODUCTION: Candidiasis is usually a superficial infection of the moist areas of the body and is generally caused by Candida albicans. Visceral infections occur in diabetes, lymphomas and leukemias, malnutrition, avitaminosis and they are associated with antibiotic, corticosteroid and immunosuppressive therapy. Candida albicans was isolated from middle ear inflammation. The diagnosis is made on the basis of microscopic appearance of colonies and characteristic smell. Candidiasis is successfully treated with nystatin, imidazol derivatives (fluconazole, ketoconazole and intraconazole), amphotericin B, 5-fluorocystosine and 1% iodine solution. CASE DESCRIPTION: This is a case report of a 46-year-old patient with a persistent nasal, sinus and ear infection of unknown origin. The patient first received antibiotic and steroid therapy and trepanation of the right maxillary sinus was performed. As the patient's condition aggravated with increase of temperature and bad laboratory findings, he was hospitalized. Radiography revealed a pathological process in both maxillary sinuses and both mastoids, so mastoidectomy and left maxillary sinus trepanation were performed. Histopathological examination of the right mastoid revealed a mould infection. The immunologic status pointed to hypogammaglobulinemia IgG. The following diseases were excluded: systemic diseases, blood diseases, Reiter's syndrome, AIDS, Hepatitis B, other viral diseases, toxoplasmosis, trichinellosis, borreliosis, typhus, paratyphus and exanthematous typhus. The diagnosis of candidiasis caused by Candida crusei and Candida kefyr was made on the basis of macroscopic and microscopic findings and biochemical identification. Ketoconazole was introduced (400 mg/per day) as well as high doses of vitamins and povidone-iodine locally. After a period of remission the patient died due to myocarditis, sepsis, acute kidney failure associated with severe mucosal necrosis of the mouth, esophagus and throat. Differential diagnosis in fever of unknown origin must include the possibility of mycotic infection, whereas the therapy of mycotic diseases must include two antimycotics at the same time. DISCUSSION AND CONCLUSION: Candida albicans is often found in the oral cavity and skin as well as in intestines of 18% of healthy subjects. It is unknown why it causes clinical illness. Antibiotic therapy of bacterial infections enables candida colonization especially in immunosuppressed patients. In our patient two types were found: Candida krusei and Candida kefyr. It is of special importance to perform differential diagnosis in cases with fever of unknown origin in order to include the possibility of mycotic infections, whereas treatment of systemic fungal infections requires a team of physicians.

[Therapeutic approach and results in the treatment of subglottic tracheal stenosis]. / Terapijski pristup i rezultati lecenja subgloticno-trahealnih stenoza.

INTRODUCTION: We had the opportunity to treat upper respiratory tract stenosis, so the aim of this paper was to present results of treatment of subglottic and upper tracheal stenosis in our clinical material. MATERIAL AND METHODS: Retrospective study included a period of 5 years (1990-1995), and evaluated results of treating 11 patients with subglottic laryngeal stenosis--with stenosis of proximal tracheal part. There were 6 females and 5 males ranging from 2-65 years of age. Nine patients had postintubational stenosis, one patient had corrosive injury, and one had congenital stenosis which occurred in older age. Apart from two patients, the rest were already treated in other institutions in our country (1-6 times) where they underwent laser (6 patients) or open surgical resection (3 patients). Diagnosis of stenosis was based on laryngotracheoscopy, laryngotracheal tomography, and CT. RESULTS: The patient with congenital subglottic stenosis underwent resection with laryngomicroscopy. Two weeks later, she was decannulated, having good breathing and voice. Two youngest patients, aged 2 and 10 years, underwent dilatation of upper tracheal part and subglottic stenosis, followed by Montgomery T tube placement. The two-years-old boy had the tube for 26 months. During that period, his tube was once replaced with wider one, and after that, he was decannulated. He has a good voice with preserved mobility of vocal cords, but he still has stenosed subglottic level, which partly narrows the lumen, so his tracheotomy is still present. We successfully decannulated a 10-year-old boy, who had the tube for 18 months after stenosis dilatation. In eight patients stenosis of proximal tracheal part and subglottic part of larynx was diagnosed. It was 2.5 to 4 cm long. In three patients we diagnosed tracheal malacia, and in one of them also cricoid malacia with luxation of one arytenoid and ankylosis of the other. In all patients we performed resection of proximal tracheal part with excision of half of cricoid ring. What was left of laryngeal stenosis was cut out and covered with distal tracheal mucosa or Thiersch grafting. In two patients after resection of proximal part of the trachea and part of cricoid ring, end-to-end anastomosis was performed without tube placing, with excellent results. In six patients Montgomery T tube was placed, and in four of them it stayed for 6 to 12 months. These four patients were later decannulated with good functional results. In the rest of two patients, we did not resolve the stenosis of proximal part of trachea and subglottic space of the larynx. DISCUSSION: In etiology of chronic subglottic stenosis postintubational stenoses are dominate. Methods we used were successful in solving high tracheal and subglottic stenosis if the stenotic part was at cricoid level. In higher subglottic stenosis, other techniques are to be used. CONCLUSION: We presented cases of 11 patients with high tracheal and/or subglottic laryngeal stenosis. In one patient stenosis was solved by laryngomicroscopy, in two with subglottic stenosis dilatation. Eight patients were operated using segmental resection of proximal tracheal part and part of cricoid ring, using end-to-end method. In our opinion this method gives good results in stenosis which does not spread higher than upper cricoid cartilage. Some patients can be operated without tracheotomy. For higher stenoses, this method is not recommended.

[Use of nasogastric intubation in laryngeal surgery]. / Upotreba nazogastricne sonde u hirurgiji larinksa.

INTRODUCTION: This article reviews postoperative feeding in 173 patients after total laryngectomy, pharyngolaryngectomy or functional partial laryngectomy. Nasogastic feeding-tube was used in all patients except those with chordectomy and there was a follow-up of average recovery time of the swallowing function in all operated patients. RESULTS: We compared effects of feeding, from the 4th postoperative day, via nasogastric tube and orally--without tube on appearance of pharyngocutaneous fistula in laryngectomized patients. Average time of appearance of fistula in total laryngectomies was 9.3 days, in pharyngolaryngectomies 9.7 days. The average length of feeding via nasogastric tube was 11.2 days in the first and 11.7 days in the second group, indicating that fistula appeared at the time of nasogastric tube-feeding, or that the tube did not prevent appearance of fistula. In horizontal supraglottic laryngectomy and subtotal laryngectomy nasogastric tube-feeding is necessary in the first 7 to 10 postoperative days. DISCUSSION AND CONCLUSION: When starting peroral feeding it is necessary to take out the tube due to changes it caused on laryngcal mucosa that can prolong the period of swallowing recovery. In vertical partial laryngectomy nasogastric tube is not necessary and peroral feeding can start from the 4th postoperative day. If we compare pharyngolaryngectomy and other kinds of laryngeal operations, the greatest body weight loss occurred in horizontal supraglottic laryngectomy p < 0.05 and subtotal laryngectomy p < 0.05.

[Results of treatment of deep neck abscesses and phlegmons]. / Rezultati lecenja dubokih apscesa i flegmona vrata.

INTRODUCTION: Neck, as a structure very closely connected with oral cavity and pharynx, with great number of lymph nodes, (about 2, 3 of all are in the neck), is sometimes a localization of purulent inflammatory process but its incidence is not so high as the incidence of inflammations of surrounding organs and tissue. Deep neck abscesses are localized under the upper fascial layer. They have a serious clinical picture which could be further complicated if inflammation spreads on vessels or neck organs. If the processes spread toward the mediastinum because of the communication space between medial and deep fascial layer with mediastinum, it could be mediastinal inflammation with high mortality. The aim of this study is evaluation of results of treatment in patients with deep neck abscesses and phlegmons treated at Clinic in a ten year period (1988-1997). MATERIAL AND METHODS: This study comprised 21 patients who were treated at the ENT Clinic in Novi Sad during 1988-1997. The group consisted of 5 female and 16 male patients from one to 65 years of age. Sixteen (76.2%) patients were treated with antibiotics in general practice, and 5 were admitted without previous therapy, 8 patients were afebrile, with temperatures between 37-38 degrees C and 5 with fever and high temperature. In 17 patients 5 days passed from onset of symptoms to admittance at the Clinic, and 4 patients had enlarged neck lymph nodes a few months. Unknown primary site of infections were in 13 (61.9%) patients, that means abscesses developed as colliquation of inflammatory changed lymph node. In the rest of 8 patients abscesses developed as: oropharyngeal inflammation (4 patients), foreign body perforation of esophagus, chronic otitis media, neck injury, malignant lymphoma. Lateral side of the neck was the most frequent site of neck abscesses and phlegmon in 16 (76%) patients. Red skin over the abscesses didn't appear in 4 patients. In 2 patients neck emphysema developed: anaerobic inflammation in one patient and esophageal perforation in the second. In a patient with SE over the 50 per hour the length of the abscess was over 7 cm, and in those with SE over 100 per hour, the whole neck inflammed. All patients underwent surgical therapy between 24 to 48 h after admission with incision or excision of the abscesses. Pus was collected for culture during the incision or excision of the abscesses and phlegmon. Bacteria were discovered in specimens taken during the incision in 4 (19%) of patients. Different aerobic and anaerobic bacteria were isolated: Enterococcus, Peptostreptococcus sp, Streptococcus viridans, Clostridium species. Surgery was the basic therapy of neck phlegmons and abscesses. In all patients incision was sutured in the second stage. Only one patient got paralysis of n. accesorius. One patient died with gas gangrene of the neck. DISCUSSION AND CONCLUSION: Deep neck abscesses and phlegmons are relatively rare inflammations in spite of high incidence of surrounding tissue inflammations. The most frequent causes are inflammatory changes of lymph nodes. Treatment has to be urgent, because of vital neck structures and communications between deep neck space and mediastinum. We consider that surgery is the basic principle of therapy although we have not had experience with needle aspiration. Antimicrobial agents must be given only parenterally.

[Suicidal knife injuries of the neck]. / Samoubilacke povrede vrata nanesene nozem.

During a 10-year period at the Otorhinolaryngology Clinic in Novi Sad (1984-1994), there were 19 patients with suicidal knife injuries of the neck. There were two mechanisms of injuries: cuts in 15 (78.9%) patients and stabs in 4 (21.10%). 9 injured patients had cut structures and open pharynx, 6 patients injured larynx and trachea, 2 injured only trachea and 2 patients injured pharynx and larynx. 3 (15.8%) patients had knife self-injuries on other parts of the body too, that is injuries of abdomen, top of the right lung lobe and wrist. The diagnosis was based on anamnestic data, clinical check-up, pharyngeal, laryngeal and esophageal directoscopy. Surgery was performed in less than 24 hours after injury. Injuries were successfully taken care of and swallowing, breathing and phonation were reestablished in 16 (84.2%) patients. Total laryngectomy with pharyngoplasty was performed in one patient with serious hypopharyngeal and esophageal injuries. Two patients (10.5%) died: one in the state of delirium tremens and one in serious hemorrhagic and traumatic shock.

[Swallowing and breathing after partial resection of the larynx]. / Gutanje i disanja posle parcijalnih laringektomija.

Fortyseven patients with partial resection of the larynx due to carcinoma, were examtned for difficulties in swallowing and breathing. Swallowing troubles were observedin 8 patients of 25 in whom horizontal partial laryngectomy was done. It might be that the main reason for difficult swallowing were infections of the perichondrium, resections of the tongue base and large resections of the larynx. Oedema of arytenoid, which appeared after supraglottic laryngectomy of resection of both upper laryngeal nerves, did not disturb the function of swallowing. None of 22 patients with partial vertical laryngectomy had difficulties with swallowing. Decannulation for correct espiratory function was done in 18 patients of 23 with horizontal supraglottic laryngectomy. In 5 patients decannulation could not be performed. In patients with horizontal glottectomy tracheostomy was not performed. Only 9 patients of 22 in whom vertical partial laryngectomy was done, were subjectad to tracheostomy. Decannulation was done in 8 patients. Due to recurrent carcinoma and total laryngectomy in one patient tracheostoma was left permanently.

[Partial laryngectomies]. / Parcijalne laringektomije.

After introduction of partial laryngectomies into the treatment of malignant larynx tumors, within a research project we analyzed symptoms, occurrence and the type of partial larynx resections for the two year period (October 1990 to September 1992). During this period of time 111 patients with malignant tumors were operated, while total laryngectomy was performed in 50 (45.0%). Laryngomicroscopy was performed in 14 patients (12.6%), and in 47 patients (42.3%) one of the partial resections of larynx was performed. Horizontal laryngectomy was performed in 25 patients (22.5%), while one of the vertical laryngectomies in 22 patients (19.8%). Concerning horizontal laryngectomies the following were performed: horizontal glossectomy, horizontal supraglottic laryngectomy and horizontal supraglottic laryngectomy spread to the tongue base, arytenoid and vocal cord. Concerning vertical laryngectomies the following were performed: hordectomy, frontal, frontolateral laryngectomy, vertical laryngectomy and hemilaryngectomy.

[Malignant tumors of the oropharynx]. / Maligni tumori orofarinksa.

Data on 31 patient suffering from malignant tumors of oropharynx were analyzed during a 5 year period at the Clinic for otorhinolaryngologic diseases. Oropharynx carcinoma was pathohistologically diagnosed in all patients. It is an illness which occurs in older people, in 87% in patients older than 60 years of age, and mostly in males (9:1). 77.4% were smokers, 83.8% consumed alcohol while 38.7% were treated for alcoholism. The first and most frequent symptoms are odynophagia (58.1%) and dysphagia (38.7%). Metastases of lymph nodes of the neck were present in 64.5% of the sick at the time when sickness was diagnosed and all were ipsilateral. 25.8% of patients were surgically treated and 6 of them were also treated by radiation. 54.8% of patients were primarily treated with telecobalt therapy. Three year survival in 3 patients points to extremely negative localization of the malignant process with a bad course and outcome.