Multidisciplinary Therapeutic Management in Complex Cervical Trauma.

Background and Objectives: In the current literature, mandatory surgical exploration is a controversial topic, with some advocating for it and others against it, proposing a selective conservative management. This multidisciplinary therapeutic approach is based on clinical examination and serial paraclinical explorations associated with supportive drug treatment. Materials and Methods: The study group consisted of 103 patients with complex cervical trauma pathology produced by various mechanisms such as car or domestic accidents, aggression, ballistic trauma, self-inflicted attempts, hanging or strangulation hospitalized in the Ear, Nose and Throat (E.N.T.) Clinic, at "St. Spiridon" Iași Hospital, between 2012 and 2016. Results: The universal clinical indication for urgent surgical exploration of the patient with complex cervical trauma is the presence of the following symptoms: unstable vital signs, significant pulsatile bleeding, hematoma with a substantial increase in size, shock, airway obstruction, open airway wound, hematemesis, or hemoptysis. In this context, we considered it worthwhile to research the management of complex cervical trauma in a reference university medical center, alongside the analysis of the patient's characteristics under different aspects (demographic, pathological aspects, therapeutic). Conclusions: Complex cervical trauma has a variety of clinical aspects, with a variable evolution, which involves multidisciplinary therapeutic management. The increasing trauma rate is one of the main public health problems, requiring epidemiological studies, and the implementation of control strategies.

[Etiologic considerations of postlaryngectomy dysphagia]. / Consideratii asupra etiologiei sindromului disfagic la pacientii laringectomizati.

UNLABELLED: Dysphagia following laryngeal surgery is a common and severe symptom. Two life-threatening complications can compromise the patiens quality of life: pneumonia and malnutrition. Diagnostic procedures of swallowing disorders are represented by videofluoroscopic evaluation, CT scan and fiberoptics endoscopy. MATERIAL AND METHODS: A retrospective evaluation was performed in a sample of 261 patients undergoing laryngectomy, hospitalized in the E.N.T Clinic of "St. Spiridon" Hospital, between 2006 and 2010. Postlaryngectomy dysphagia was diagnosed in 74 patients and was predominant in males (97.3%) aged between 50 and 60 years (37.8%). RESULTS: Main causes of dysphagia were pharingocutaneous fistulas, tumor recurrences, postoperative cervical infections and hipopharyngeal stenosis. CONCLUSIONS: This study reveled the predominance of dyphagia in rural male patients undergoing total laryngectomy. Gastroesophageal reflux can represents a favoring factor of this type of dysphagia.

[Laryngoplasty with cutaneous tube--methods of surgical treatment in caustic stenosis]. / Laringoplastia cu lambou cutanat, modalitate de tratament chirurgical in stenozele postcaustice.

The authors present a retrospective study on 84 cases with laryngo-pharyngo-esophageal stenosis treated in ENT Department of "Sf. Spiridon" Emergency Clinical Hospital from Iasi, over 25 years, between 1980-2005 which were solved by surgical treatment. In order to solve the different types of the superior laryngeal stenosis and the hypo-pharynx, there have been used deltoid-pectoralis cutaneous flaps. In all these cases, the anatomical integrity of the recurrent nerve and his branches was preserved in order to obtain a good respiratory function.