[Pharyngeal constrictor muscles closure after total laryngectomy is that really beneficial?]. / Czy zszywanie zwieracza gardla dolnego po laryngektomii calkowitej jest korzystne?

UNLABELLED: High pressure of pharyngo-esophageal segment is the most important factor of impaired development of alaryngeal speech (esophageal speech, tracheoesophageal speech) after total laryngectomy. To prevent pharyngo-esophageal spasm in Department of Otolaryngology in Szczecin are used: pharyngoesophageal plastic surgery with interposition of vascular thyroid flap, two-layer (only mucosa) non-muscular pharyngeal closure and tree-layer closure (mucosa and muscle layer leaving inferior pharyngeal constrictor unsutured). AIM OF STUDY: The aim of this study was to compare the pharyngo-esophageal pressure between patients after pharyngo-esophageal plastic surgery and following the non-muscular pharyngeal closure. MATERIAL AND METHODS: One hundred eighty two subjects after total laryngectomy were enrolled in this study, and included 108 patients subjected to the pharyngo-esophageal plastic surgery, 44 patients who underwent the two-layer pharyngeal closure, and 30 patients with the tree-layer closure. To evaluate the pharyngo-esophageal pressures manometric tests were performed, and to asses the pharynx morphology videopharyngoscopy was used. RESULTS: The average pharyngo-esophageal pressure in the group after the pharyngo-esophageal plastic surgery was 32 (min.-5, max. 50) mmHg. After the two-layer non-muscular pharyngeal closure mean pressure was 35 (min.-17, max.-40) mmHg, and after the tree-layer non-muscular pharyngeal closure the average pressure was 22,42 (min. 5, max. 40) mmHg. The average pharyngo-esophageal pressure was significantly lower (p < 0.01) among patients after the tree-layer non-muscular closure. CONCLUSION: The study suggests that the tree-layer non-muscular pharyngeal closure with inferior pharyngeal constrictor unsutured is the preferable method to prevent pharyngo-esophageal spasm after total laryngectomy. However, the efficacy and safety of this surgical procedure should be explored in further multicenter studies.

[Selected issues regarding implementing alternative medicine with special reference to the patients with laryngological problems]. / Wybrane zagadnienia dotyczace zastosowania leczenia niekonwencjonalnego ze szczególnym uwzglednieniem chorych z problemami laryngologicznymi.

The review of the literature and some media data referring to chosen methods of unconventional treatment, its history of the development in Poland and around the world has been made in this paper (homeopathy, waxing of ears, bio-energy therapy) and the increasing interest among the treated patients has been shown. It is essential that the doctors (including laryngologists) while carrying out the interview should take the unconventional way of treatment of patients into consideration. This may explain the registering of patients to appropriate treatment in the advanced state of illness, which is particularly unprofitable in cancer-afflicted states.

[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.