Transoral Robotic Surgery in the Management of Submandibular Gland Sialoliths: A Systematic Review

This study aimed to systematically review the literature to determine the efficacy and safety of transoral robotic surgery (TORS) in the management of submandibular gland (SMG) sialolithiasis. PubMed, Embase, and Cochrane were searched for English-language articles evaluating TORS in the management of SMG stones published up to 12 September 2022. Nine studies with a total of 99 patients were included. Eight patients underwent TORS followed by sialendoscopy (TS); 11 patients underwent sialendoscopy followed by TORS and sialendoscopy (STS); 4 patients underwent sialendoscopy followed by TORS only (ST); and 4 patients underwent TORS without sialendoscopy (T). The mean operative time amounted to 90.97 min. The mean procedure success rate reached 94.97%, with the highest for ST (100%) and T (100%), followed by the TS (95.04%) and STS (90.91%) variants. The mean follow-up time was 6.81 months. Transient lingual nerve injury occurred in 28 patients (28.3%) and was resolved in all of them within the mean of 1.25 months. No permanent lingual nerve injury was reported. TORS is a safe and effective management modality for hilar and intraparenchymal SMG sialoliths, with high procedural success in terms of successful sialolith removal, SMG preservation, and reduced risk of permanent postoperative lingual nerve damage.

Allergen immunotherapy against house dust mites in patients with local allergic rhinitis and asthma

METHODS

The study was a prospective, double-blind, placebo-controlled trial with patients diagnosed with LAR to HDMs and with concomitant asthma who underwent a 12-month treatment course of SLIT for HDM allergies. Seventeen patients were randomized to SLIT with the use of allergen extracts of D. pteronyssinus and D. farinae (50/50%) in SQ-HDM SLIT tablets and 15 patients were randomized to the placebo group. The total rhinitis score (TRSS), total asthma symptom score (TASS), combined total symptom score (TSS), total medication score (TMS), and FEV1 were analyzed.Results: In the final analysis, 16 patients who received SLIT and 14 who received placebo who completed the study protocol were included. Significant reductions in TRSS, TASS, TSS, and TMS after 12 months of treatment were observed in patients after SLIT (p < 0.05). A significant increase in the mean FEV1 between baseline and after 12 months of therapy was observed in the study, with p = 0.03 in the study group. Conclusion: SLIT can improve nasal and bronchial symptoms and reduce symptomatic treatment in patients with LAR and asthma and with hyperresponsiveness to HDMs.

The assessment of phonatory and ventilatory functions in patients after microsurgery for Reinke's edema

BACKGROUND

Short and long-term results of microsurgical treatment with the mini-microflap technique in patients with Reinke's edema (RE) were assessed based on the phonatory and ventilatory functions of the larynx.

OBJECTIVES

To assess the short and long-term results of microsurgical treatment with the mini-microflap technique in patients with RE based on the phonatory and ventilatory functions of the larynx.

MATERIAL AND METHODS

Twenty patients diagnosed with advanced stage of RE confirmed with laryngovideostroboscopy (LVS) were enrolled in the study. Phonatory function disturbances were additionally assessed on the basis of Maximum Phonation Time (MPT) measurement, Voice Handicap Index (VHI) and Voice-Related Quality of Life (V-ROOL) questionnaires. Ventilatory function was assessed using spirometry. The aforementioned complex examinations were conducted prior to surgery and 1, 6 and 9 months following the surgery.

RESULTS

Good postsurgical results were obtained in subjective and objective evaluation, which assessed the phonatory function and ventilatory parameters. Post-surgery increase in MPT, VHI and VQROL was noticed in all patients in 3 check points (p < 0.001). The results demonstrate postsurgical improvement for some LVS parameters, including assessment of glottis closure (p < 0.003) observed 6 months after the surgery. An improvement in most of the ventilation parameters was observed also 6 months after surgery (p < 0.001). For the spirometry flow parameter PEF, significant improvement was noted in each check point (p1 < 0.004, p6 < 0.001, p9 < 0.001). The study revealed a correlation between phonatory parameter - MPT and PEF observed 1 month after the procedure (p = 0.026), confirming the interdependence of ventilatory efficiency and phonatory condition of larynx.

CONCLUSIONS

Mini-microflap surgery brings satisfactory clinical effect in patients with advanced stages of RE by optimization of phonatory and ventilatory functions of the larynx.

Profiling of tRNA Halves and YRNA Fragments in Serum and Tissue From Oral Squamous Cell Carcinoma Patients Identify Key Role of 5' tRNA-Val-CAC-2-1 Half

Oral squamous cell carcinoma (OSCC) is the most common type of head and neck cancer and, as indicated by The Oral Cancer Foundation, kills at an alarming rate of roughly one person per hour. With this study, we aimed at better understanding disease mechanisms and identifying minimally invasive disease biomarkers by profiling novel small non-coding RNAs (specifically, tRNA halves and YRNA fragments) in both serum and tumor tissue from humans. Small RNA-Sequencing identified multiple 5' tRNA halves and 5' YRNA fragments that displayed significant differential expression levels in circulation and/or tumor tissue, as compared to control counterparts. In addition, by implementing a modification of weighted gene coexpression network analysis, we identified an upregulated genetic module comprised of 5' tRNA halves and miRNAs (miRNAs were described in previous study using the same samples) with significant association with the cancer trait. By consequently implementing miRNA-overtargeting network analysis, the biological function of the module (and by "guilt by association," the function of the 5' tRNA-Val-CAC-2-1 half) was found to involve the transcriptional targeting of specific genes involved in the negative regulation of the G1/S transition of the mitotic cell cycle. These findings suggest that 5' tRNA-Val-CAC-2-1 half (reduced in serum of OSCC patients and elevated in the tumor tissue) could potentially serve as an OSCC circulating biomarker and/or target for novel anticancer therapies. To our knowledge, this is the first time that the specific molecular function of a 5'-tRNA half is specifically pinpointed in OSCC.

MicroRNA regulation in colorectal cancer tissue and serum

Colorectal cancer is recognized as the fourth leading cause of cancer-related deaths worldwide. Thus, there is ongoing search for potential new biomarkers allowing quicker and less invasive detection of the disease and prediction of the treatment outcome. Therefore, the aim of our study was to identify colorectal cancer specific miRNAs expressed in cancerous and healthy tissue from the same patient and to further correlate the presence of the same miRNAs in the circulation as potential biomarkers for diagnosis. In the current study we detected a set of 40 miRNAs differentially regulated in tumor tissue when comparing with healthy tissue. Additionally, we found 8 miRNAs differentially regulated in serum of colorectal cancer patients. Interestingly, there was no overlap in miRNAs regulated in tissue and serum, suggesting that serum regulated miRNAs may be not actively secreted from colorectal tumor cells. However, four of differentially expressed miRNAs, including miR-21, miR-17, miR-20a and miR-32 represent the miRNAs characteristic for different tumor types, including breast, colon, lung, pancreas, prostate and stomach cancer. This finding suggests important groups of miRNAs which can be further validated as markers for diagnosis of tumor tissue and regulation of carcinogenesis.

The prevalence and characteristics of local allergic rhinitis in Poland

BACKGROUND

Local allergic rhinitis (LAR) is found in some patients with typical symptoms but who have negative skin prick tests and negative IgE to aeroallergens while presenting with positive nasal provocation tests for proper allergens. Little information about the clinical characteristics and prevalence of LAR has been published. The aim of this study was to determine the prevalence and characteristics of LAR in patients with symptoms of chronic rhinitis.

METHODS

In total, 680 patients out of 3400 pre-screened subjects with chronic rhinitis who were at least 5 years old were included from 17 sites in Poland in the study protocol. The following medical history and diagnostic procedures were performed with aeroallergens: skin prick tests, allergen specific serum IgE and nasal provocation tests. In addition to LAR, allergic rhinitis (AR) and non-allergic (NAR) rhinitis were explored and compared.

RESULTS

In total, 621 patients were examined. LAR was diagnosed in 109 (17.6%) patients; AR was diagnosed in 251 (40.4%) patients; and NAR was diagnosed in 261 (42%) patients. In the LAR group, younger, non-smoker patients with allergies to D. pteronyssinus or grass pollen were predominant. Polysensitization was more prevalent in AR patients than in LAR patients. Bronchial asthma was at a similar level in patients diagnosed with AR (38%) and LAR (35%) but was significantly less prevalent in patients diagnosed with NAR (16%). The mean age of disease onset was similar between patients with AR and LAR (17.6 plus or minus 4.8 yrs), and it was significantly lower than that in patients with NAR (24.5 plus or minus 6.9 yrs, p less than 0.05).

CONCLUSIONS

LAR is a significantly understudied problem in patients of various ages with chronic nasal symptoms. Patients with LAR and AR have similar clinical phenotypes.

A Review of Selected Factors of Salivary Gland Tumour Formation and Malignant Transformation

Salivary gland tumours represent about 6% of head and neck neoplasms and about 0.5% of all malignancies in humans. Tumour growth and malignant transformation are complex processes involving various actions of molecules. Furthermore, some malignant salivary gland tumours are deemed to be caused by dedifferentiation or malignant transformation of benign tumours. The mechanisms of this transformation depend on a variety of different elements, such as cell cycle regulators, oncogenes, proteins, angiogenesis factors, and adipocytokines. The authors used PubMed, Medline, and Google websites to find and review the most significant papers related to malignant transformation in benign salivary gland tumours.

Endoscopic evidence of reflux disease in the larynx

CONCLUSION

The severity of laryngeal mucosal lesions in patients with gastroesophageal reflux disease (GERD) is significantly greater than in controls. A higher degree of laryngeal mucosal injury is documented in patients in whom GERD is associated with more advanced esophageal lesions.

OBJECTIVES

(1) To confirm the presence of inflammatory lesions in the laryngopharynx of patients with GERD. (2) To analyze the relationship between the severity of laryngopharyngeal and esophageal lesions on the basis of the reflux finding score (RFS) and the Los Angeles (LA) scale of esophageal mucosal injury.

METHODS

The study included 92 subjects, among them 46 patients with GERD and 46 individuals without endoscopic evidence of esophageal lesions, qualified for routine endoscopy due to other indications. The endoscopic images of the inferior pharynx, larynx, and esophagus were analyzed during the video-endoscopic examination of the upper gastrointestinal tract. The laryngeal images were assessed according to RFS criteria and the numeric value of RFS was calculated. The degree of esophageal mucosal injury was described according to the LA scale.

RESULTS

Both global RFS score and the scores of all RFS parameters except the presence of granulomatous tissue were significantly higher in patients with GERD than in the controls. Patients in whom GERD was associated with more severe esophageal lesions (group B according to the LA scale) had significantly higher global RFS score and scores of all analyzed parameters of laryngeal injury except subglottic edema than individuals in whom the degree of esophageal involvement was classified as group A.

[Long term results of partial laryngectomies in patients suffering from laryngeal cancer]

AIM

The aim of the study was to evaluate the results of partial laryngectomies in patients with laryngeal cancer treated in the 2(nd) Clinical Department of Laryngology SUM in Zabrze in the years 1990-2000.

MATERIALS AND METHODS

Retrospective clinical material includes 209 patients in whom surgery was a primary treatment method. No distant metastases (M1) or another malignant cancer were found. The group consisted of 20 (10%) women and 189 (90%) men. The mean age was - 51.2 years. The stage of the neoplasm progression was defined as T1 in 91 patients (44%), T2 in 109 patients (52%). In other 9 patients (4%) the progression stage was T3 and T4. Clinical examination in 191 patients (91%) did not show enlarged lymph nodes in the area of head and neck (N0). In the group of remaining 18 patients (9%) the node progression was found to be N1-N3. In all 209 patients the squamous cell carcinoma of various stage of malignancy (G1-G3) was found in preoperative histopathological tests, out of which five cases were of papillary squamous cell carcinoma. The most common operation in the analyzed group was a chordectomy - 83 surgeries (40%), followed by 38 (18%) vertical partial laryngectomies, 28 (13%) horizontal glottis surgeries, 19 (9%) frontal-lateral and frontal-anterior operations, and supracricoid operations with a reconstruction of CHEP and CHP type, a total of 20 operations (9%). Other types of partial operations were performed less commonly. In 79 patients (38%) partial laryngectomy was complemented with a nodal operation, while cervical lymph nodes were not removed in 130 patients (62%). In 19 cases (9%) the metastases of squamous cell carcinoma to regional lymph nodes were confirmed in postoperative material. 82 patients of the study group (39%) underwent radiotherapy. The median of the observation period was 9 years. Local recurrence, nodal recurrence and distant metastasis are rated as treatment failure. Treatment effectiveness was evaluated with relation to local control, overall survival, disease-free survival and cause specific survival. All the aforementioned parameters were analyzed with the method of updated percentages. The level of statistical significance was assumed to be p ≤ 0.05.

RESULTS

The updated 5-year and 10-year percentage of overall survivals was respectively 75% and 63%. The updated 5-year and 10-year percentage of cancer specific survivals was 85% and 79%, respectively. The updated 5-year and 10-year percentage of disease-free survivals was 72% and 56%, respectively. The percentage of 5-year and 10 year local controls was 86% and 79%, respectively.

[Cartilage tissue reconstruction by the polymer biomaterials--early macroscopic and histological results]

INTRODUCTION

The surgical treatment of large cartilage defects in the region of head and neck is often impossible because of the atrophy of surrounding tissues and lack of suitable material for reconstruction. In the surgical treatment many of methods and reconstructive materials have been used. For many years the suitable synthetic material for the cartilage defects reconstruction has been searched for.

THE AIM OF THE STUDY

Was to evaluate two different biomaterials with proper mechanical and biological features for the cartilage replacement.

MATERIAL AND METHODS

Two type of biomaterials in this study were used: resorbable polymer - poly(L-lactide-co-glycolide) (PLG) acting as a supportive matrix. A thin layer of sodium hyaluronate (Hyal) was also deposited on the surface as well in the pore walls of PLG scaffolds in order to provide biologically active molecules promoting differentiation and regeneration of the tissue. The studies were performed on the 50 animals--rabbits divided into 2 groups. The animals were operated in the general anaesthesia. The incision was done along the edge of the rabbit's auricle. Perichondrium and cartilage of the auricle on the surface 4 x 3 cm were prepared. Subperichondrically 1 x 1 cm fragment of the cartilage was removed by the scissors. This fragment was then replaced by the biomaterials: PLG in first group of 25 rabbits and PLG-Hyal in second group 25 rabbits. The tissues were sutured with polyglycolide Safil 3-0. The animals obtained Enrofloxacin for three days after the operation. Then 1, 4 and 12 weeks after the surgery the animals were painlessly euthanized by an overdose of Morbital. Implants and surrounding tissues were excised and observed macroscopically and using an optical microscope.

RESULTS

In all the observation periods we observed proper macroscopic healing process of biomaterials. We didn't stated strong inflammatory process and necrosis around the implanted biomaterials.

CONCLUSIONS

The histological and macroscopic examinations indicated that both materials developed in this study have properties similar to cartilaginous tissue and seem to be good for her restoration. Although the quickest tissue regeneration was found after implantation of PLG-Hyal.

[Efferent suppression test--sensitivity and specificity]

INTRODUCTION

The amplitude of click evoked otoacoustic emissions can be suppressed (reduced) with contralateral acoustic stimulation (CAS). This is thought to be due to the inhibitory control that the medial efferent auditory nerve exerts on outer hair cell function. One commonly used test of medial olivocochlear (MOC) function in humans involves measuring the degree of suppression of ipsilateral otoacoustic emissions (OAEs) by CAS. This effect is called contralateral suppression, efferent effect or olivocochlear reflex. Aim of the study. The objective of this study was to measure cut-off level of contralateral suppression, sensitivity and specificity of the efferent test.

MATERIAL AND METHODS

To evaluate the function of MOC system click evoked otoacoustic emissions (CEOAEs) with and without continuous contralateral broadband noise (BBN) stimulation were recorded in 14 patients with multiple sclerosis, 16 patients with unilateral cerebello-pontine angle tumor and control group matched for age and gender. BBN was presented at 50 dB SL and otoacoustic emissions were recorded in response to nonlinear clicks at 70 +/- 3 dB SPL.

RESULTS

The cut-off level was established at -1.4 dB. For 1.4 dB cut-off level of contralateral suppression the sensitivity of the efferent test was 90% and specificity was 70%.

CONCLUSIONS

To conclude, assessment of efferent suppression may be a useful addition to the battery test employed in the investigation of multiple sclerosis and cerebello-pontine angle tumors. The MOC suppression test may provide a tool for an early diagnosis of the brainstem pathology.

[Biodegradation of tracheal carbon implant in animal experiment]

INTRODUCTION

The radical treatment of tracheal stenosis comprises segmental resection and its reconstruction. The most successful type of reconstruction is the "end to end" technique. In cases with large tracheal defects (over 6 cm) this kind of reconstruction is impossible. From many years the adequate biomaterial is searched for the tracheal reconstruction. Most of the implanted biomaterials undergo biodegradation process.

AIM

The aim of the study was to analyze the biodegradation process in carbon fibers of prosthesis implanted in tracheal defects in animal experiment.

MATERIAL AND METHODS

We studied the prosthesis implanted in tracheal defects in sheep. The prosthesis were built with composite biomaterial composed of carbon fibers and polisulfone. The observation period was 1, 2, 3, 4, 6, 8, 24 and 38 weeks. In the morphometric evaluations the breadth, curve width, fullness factor and mean grey level of carbon fibers were assessed.

RESULTS

The results showed that carbon fibers undergo progressively degradation in animal environment. The width gradually decreased. The mean grey level in the first three weeks decreased, but in the next period it increased. Conclusion. The carbon fibers of segmental tracheal prosthesis undergo gradually degradation process in biological environment expressed by decreasing of their dimensions connected with the lost of irregularities and changes of structure density.

[Extramedullary plasmacytoma of the neck--case report]

Extramedullary plasmacytoma (EMP) is a rare neoplasm which belongs to non-Hodgkin's lymphomas, which is characterized by monoclonal, neoplastic proliferation of B-type lymphocytes in the soft tissues. The most common location for EMP to occur is the nasopharynx and paranasal sinuses. Treatment is efficacious with surgery, radiotherapy or combination these two methods. This report presents a case of EMP of the neck in 63-year-old patient, diagnosed and treated in ENT Department of Medical University of Silesia in Zabrze. On the basis of physical examination and radiologic studies the extensiveness of the tumour was determined and the surgical procedures were undertaken. Diagnosis was established on the basis of histopatological and immunohistochemical postoperative examinations as well as radiologic studies and trepanobiopsy. Surgery was followed by radiotherapy. 6 months later because of progression and dissemination of the disease chemotherapy and hematological treatment were performed. Patient remains in laryngological, oncological and transplantological follow-up.

[Treatment of invasive rhinosinusitis--the case report]

The frequency of fungal etiology of sinusitis contains between 9 and 49 % according to different authors. Fungal rhinosinusitis has been divided into noninvasive and invasive forms. Noninvasive infections include fungus ball (mycetoma) and allergic fungal rhinosinusitis. Invasive infections include acute (or fulminates) fungal rhinosinusitis and invasive chronic rhinosinusitis. The case of chronic invasive rhinosinusitis was presented. Patient performed surgery--Functional Endoscopic Sinus Surgery and paranasal sinuses operation from subcranial approach. Surgery procedures were followed by antifungal pharmacotherapy (Orungal and Worykonazol). The presented case of fungal invasive chronic rhinosinusitis was treated according to recommended procedures with surgery followed by adequate antifungal farmacotherapy. In this case we have reached a successful outcome.

[Surgical treatment of patients suffering from allergic chronic sinusitis with nasal polyps]

INTRODUCTION

Chronic sinusitis with nasal polyps is very often associated with allergy. The results of surgical treatment (Functional Endoscopic Sinus Surgery--FESS) in this group of patients are different and rather poor, especially in long term observations.

THE AIM

of our study was to evaluate the results of surgical treatment (FESS) in patients suffering from chronic sinusitis with nasal polyps associated with allergy.

MATERIAL AND METHODS

We study the group of 33 patients with allergy-related polypoid lesions in the nasal cavity and paranasal sinuses. The patients with allergy-related disorder were previously under the control of allergologists and pulmonologists. All the patients underwent functional endoscopic sinus surgery. The patients were evaluated in postoperative period 4-6 years after the surgical treatment. The effectiveness of FESS was assessed on the basis of the nasal cavity endoscopic state and amelioration of symptoms.

RESULTS

The most frequent symptoms were postnasal drip and breathing disturbance through the nose. In 37.5% of patients the recurrence of symptoms was observed in the 4-6 years follow-up period. When we assessed aspirin intolerance syndrome patients this ratio increased to 64.7%.

CONCLUSION

In the allergy-related patients high rate of recurrence after the FESS treatment is stated in the long term observations.

[Study of selected biomaterials for reconstruction of septal nasal perforation]

INTRODUCTION

The septal nasal perforation is an important problem for the laryngologists and plastic surgeons. The reasons of septal nasal perforations are injuries, neoplasm, self-mutilation, chronic rhinitis, allergy, Wegener granuloma, sarcoidosis, tuberculosis, toxic metals (arsenic, chrome), some drugs (steroids), narcotizing agents (cocaine) and complications after endoscopic and septal nasal operations. The surgical treatment, especially in the cases of large septal perforation, is often difficult because of the atrophy of nasal mucosa and lack of suitable material for reconstruction. In the surgical treatment many of methods and reconstructive materials have been used. The following autogenous tissues were used in the reconstruction of septal perforation: alloderm, temporal fascia, septal and auricle cartilage, cranial periosteum, perichondrium, ethmoidal and hip bone. The defect of such materials is progressive resorption. For many years the suitable synthetic material for septal nasal reconstruction has been searched for. Among the biomaterials the following have been used without success: Dacron, porous polyethylene, dolomite, bioglass. The rejection of synthetic material was the reason of failure. The aim of our study was to evaluate two different biomaterials with proper mechanical and biological features for nasal cartilage replacement.

MATERIAL AND METHODS

We studied two types of biomaterials: biostable terpolymer PTFE/PVDF/PP and resorbable copolymer of glycolide and L-lactide (PGLA). The pilot studies were performed on two experimental animals (rabbits). The animals were operated in the general anesthesia. The biomaterials were implanted in the rabbit auricular cartilage because of its similarity to the septum and easy surgical access. Subperichondrically 1 x 1 cm fragment of the cartilage was removed. This fragment was then replaced with the biomaterial. The rabbits were painlessly sacrificed after 4 months of observation.

RESULTS

A very good integration of PGLA implant with auricular cartilage was observed. In the histological examination the lack of excessive inflammatory reaction as well as no cartilage necrosis were observed.

CONCLUSIONS

4 months after implantation of PGLA in the rabbit auricular cartilage very good macroscopic and histological results were achieved.

[Surgical treatment of chronic sinusitis in children]

INTRODUCTION

Chronic sinusitis presents important problem in children. General approach in chronic sinusitis in children consists of: findings the proper diagnosis, optimal pharmacotherapy (oral or intravenous antibiotics), treatment coexisting allergic or systemic diseases and considering employing surgical treatment. The main surgical procedures in the treatment of chronic sinusitis in children are adenoidectomy and functional endoscopic sinus surgery (FESS).

MATERIAL AND METHODS

32 children with chronic sinusitis treated in ENT Department Silesian Medical University in Zabrze in the years 2000-2005 were presented in this study. 26 patients were treated surgically and 6 children by pharmacotherapy. In the surgically treated patients we performed 10 Functional Endoscopic Sinus Surgery, 4 unilateral and 8 bilateral sinusoscopy of maxillary sinus, and in 4 cases we removed choanal polyps.

RESULTS

In the group of 26 surgically treated children we did not observed the recurrence of symptoms in the 24 months follow-up period.

[Strategy of the sinonasal tumors treatment]

INTRODUCTION

The sinonasal tumors belong to rare diseases. They state 0.2-0.8% of all the malignant neoplasms and about 3% of head and neck tumors. These tumors are two times frequent observed in men than in women, mainly between 50 and 70 years old. In the sinonasal complex besides the primary are seen also the metastatic tumors. They state about 1% of all tumors (kidney, testum, breast, pulmonary).

AIM

The aim of our study was to retrospective analysis of the sinonasal tumors, treated in the ENT Department Silesian Medical University in Zabrze. The special attention was carried on the preoperative diagnostics and proper qualification to the surgical treatment.

MATERIAL AND METHODS

26 patients treated in the ENT Department Silesian Medical University in Zabrze between 2000 and 2006 suffered from the sinonasal tumors were retrospectively analyzed.

RESULTS

In the histological examination in 4 patients the benign neoplasm and in 22 patients malignant tumors were diagnosed. 24 patients were surgically treated (2 patients were not qualify to surgery because of the general diseases). On the basis of the CT and MRI examination as well as the description of the surgical procedure we stated that in 13 cases the primary localization of neoplasm was the maxillary sinus, in 5 cases ethmoidal cells, in 3 nasal cavity. In one patient the estimation of primary tumor localization was not possible, because of the very large extension of the neoplasm. The choice of the surgical procedure was depend on the tumor extension and localization. In 19 cases lateral rhinotomy with different modifications was performed. In one case the cranial incision was done. In 8 patients with the infiltration of lateral nasal wall the medial maxillectomy were performed. In 8 other patients upper maxillary resection were done. In two cases the total maxillectomy were performed, in the next two lower maxillary resection. All the patients were postoperatively treated by radiotherapy.

Long-term results in patients after combined laser total arytenoidectomy with posterior cordectomy for bilateral vocal cord paralysis

The problem of ventilation efficiency after total laser arytenoidectomy with posterior cordectomy due to bilateral vocal cord paralysis is discussed. There are a number of views on the usefulness and efficacy of different surgical procedures aimed at widening the glottis, but the studies concerning the long-term functional results are still lacking. The objective of the study is to evaluate the durability of ventilation results in patients after laser arytenoidectomy with posterior cordectomy based on the comparison between the early postoperative results and those assessed after a period of 5 years. Thirty patients (24 females, 6 males) aged between 30 and 80 (mean 58.5) with bilateral vocal cord paralysis after thyroid surgery, who underwent laser arytenoidectomy with posterior cordectomy, were analyzed. Ventilation tests were performed immediately after the operation and 5 years later with Body-Master Laab (Jaeger). The actual and predicted values of FVC, FEF(25), FEF(50), FEF(75), PEF, MMEF(75/25), AREA(Ex), sR(T0T), R(T0T) were compared and analyzed. Also, the values of the inspiratory parameters FIV(1), FIF(50), PIF and the coefficients FEF(50)/FIF(50) and FIV(1)/FEV(1) were assessed. Moreover, subjective evaluation was performed based on a questionnaire. The statistical analysis reveals a significant decrease in FIV(1), FIF(50), PIF and FIV(1)/FEV(1). FEF(50)/FIF(50) and sR(T0T) (actual and predicted values) increased significantly after 5 years from the operation. However, the patients did not complain nor was this tendency reflected in their answers to the questionnaire. The probable reasons for such ventilation results are discussed. The role of phoniatric rehabilitation and the time elapsed is emphasized. In general, it can be concluded that laser arytenoidectomy with posterior cordectomy is a durable and effective procedure, although the objective assessment does not fully match the patient's subjective impression.

Sleep apnea syndrome and snoring in patients with hypothyroidism with relation to overweight

The relation between snoring and obstructive sleep apnea as well as hypothyroidism is the object of interest of many authors. The respiratory disturbances during sleep are often observed in patients suffering from hypothyroidism. The relation of snoring to overweight in those patients has not been taken into account. The aim of the study was to evaluate the relations between hypothyroidism and quantitative and qualitative respiratory disturbances during sleep. Additional aim was to establish the relations of sleep apnea syndrome, snoring, hypothyroidism and overweight. The subjects included 15 patients (11 females and 4 males) aged from 28 to 73 (mean 50.3) suffering from hypothyroidism. All of them underwent thyroid testing before and after the hormonal treatment. TSH and fT4 concentrations were determined. At the same time the sleep assessment (PolyMESAM) was performed twice. Data were obtained from sleep studies and questionnaires (Epworth sleepiness scale). After the thyroid hormones stabilization significant decrease of snoring severity was observed. On the contrary, the respiratory disturbance index (RDI), desaturation index (DI), the lowest saturation (LSAT) did not change significantly, however, the Epworth scale score showed significant improvement. The correlations showed the strong relation between loud snoring and TSH (r=0.73, p<0.01) and fT4 (r=-0.66, p<0.003) concentrations before the treatment. The analysis showed no correlation between body mass (BMI) and snoring. The hormonal stabilization in patients suffering from hypothyroidism causes improvement in snoring severity. Based on our investigation the relationship between hypothyroidism and severity of snoring and excessive daytime somnolence was confirmed. It indicates a possible connection between hypothyroidism and upper airway resistance syndrome.

Huge retropharyngeal lipoma causing obstructive sleep apnea: a case report

Lipoma of the retropharyngeal space is a very rare benign tumor often causing unspecific clinical symptoms. The most common symptoms are dysphagia and/or respiratory disturbances. The clinical diagnosis may be difficult. The radiological imaging techniques (CT and MRI) can provide adequate information with regard to the composition and extension of the tumor, although final histological confirmation is essential. Surgery is the treatment of choice. We present a case of 40-year-old male patient complaining of obstructive sleep apnea symptoms (respiratory disturbances, excessive daytime somnolence, morning headache). The radiological examination (CT) showed a huge (11.7 x 7.2 cm) lipoma of the retropharyngeal space extending from the nasopharynx to the superior mediastinum. The tumor was removed via transcervical approach with complete amelioration of symptoms.

[Interleukin-10 in laryngeal cancer patients treated by surgery or radiotherapy]

INTRODUCTION

The early detection and right monitoring of the laryngeal cancer make a better chance of recovery. Therefore factors that might be showing the presence of neoplastic process are constantly being looked for. The detection of correlation between incidence of cancer and immunity system disorders makes us look for and try to answer an important question: are there any factors that might be cancer markers in immunity system? Cytokines are molecules that regulate the process of differentiation and proliferation. They are also the mediators of immunological and inflammatory reactions. Interleukina-10 (IL-10) is a cytokine that has various important functions stimulating immunity processes. IL-10 is a factor stimulating killer cells/cytoxic lymphocytes/ and is able to kill cancer cells growth spontaneously. It has been detected that some cancer cells can produce some IL-10, too. The aim of the study was to evaluate the serum level concentration of IL-10 in the laryngeal cancer patients before any medical treatment and its denotation after surgery or radiotherapy.

MATERIAL AND METHODS

A group of 43 male patients with laryngeal cancer was considered for the purpose of this study. 22 patients were treated by surgery and 21 by radiotherapy. In all the cases the serum concentration of IL-10 before the treatment, in the first and 30th days after therapy was evaluated. The results were compared with the group of 20 healthy volunteers.

RESULTS

The mean value of IL-10 concentration in laryngeal cancer patients treated by surgery was 14.0 pg/ml before treatment, 12.8 pg/ml in the 1 day and 14.4 pg/ml 30 days after the therapy. IL-10 concentrations in patients treated by radiotherapy were respectively: 15.4, 14.4 and 15.9 pg/ml. The mean value of IL-10 in the control group was 4.9 pg/ml. The serum concentrations of IL-10 in the laryngeal cancer patients were significantly higher than in the control group. These IL-10 concentrations didn't change significantly after the surgery or radiotherapy.

CONCLUSION

The serum concentration of IL-10 in the laryngeal cancer patients is significantly higher than in the healthy control group. The changes of serum concentrations after the surgery or radiotherapy of laryngeal cancer patients are not significant and characteristic.

[Interleukin 2 concentration changes in the laryngeal cancer patients during the surgical treatment]

INTRODUCTION

Cytokines are molecules that regulate the process of differentiation and proliferation. They are also the mediators of immunological and inflammatory reactions. One of the cytokines that participates in immunological processes is interleukine-2 (IL-2), whose participation in neoplastic processes has been proved in many researches. It's anticancer effect is an indirect one and is connected with stimulating processes of immunologically competent cells, which are cytotoxic for cancer cells. IL-2 is produced by T-helper lymphocytes (THL), and on the basis of feedback it stimulates those lymphocytes to new cells and other cytokines, which stimulate next immunity cells or kill the cancer cells, production. The aim of the study was to evaluate the serum level concentration of IL-2 in the laryngeal cancer patients before any medical treatment and its denotation after the surgical procedure.

MATERIAL AND METHODS

A group of 22 male patients with laryngeal cancer was considered for the purpose of this study. All of them were treated by surgery. In all the cases the serum concentration of IL-2 before the treatment, in the first and 30th day after therapy was evaluated. The results were compared with the group of 20 healthy volunteers.

RESULTS

The mean value of IL-2 concentration in laryngeal cancer patients treated by surgery was 23.4 pg/ml before treatment, increased to 37.8 pg/ml in the 1 day and to 54.3 pg/ml 30 days after the therapy. The serum concentrations of IL-2 in the laryngeal cancer patients were lower than in the control group before the surgical treatment. These IL-2 concentrations increased significantly after the surgery and 1 month after the treatment were higher than in the healthy population.

CONCLUSION

The serum concentration of IL-2 in the laryngeal cancer patients treated by surgery is lower than in the healthy control group. IL-2 increased significantly after the surgery to higher levels than in the control healthy group.

[Rare case of primary sinonasal tuberculosis]

INTRODUCTION

Tuberculosis, considering entry of infection, most frequent concerns the lungs. Rarely we observed extrapulmonary cases of tuberculosis within the bones, joints, urogenital organs and lymph nodes as well as within the head and neck region--larynx, middle ear, pharynx, tonsils, tongue, parotid glands and central nervous system. Sinonasal tuberculosis, either primary or secondary to pulmonary infection, is very rare, but should be considered in the differential diagnosis of sinonasal granulomas. The diagnosis of the head and neck tuberculosis is based on the medical patientis examination as well as on the bacteriological and histological study of the biopsy specimen.

AIM

The aim of the study was to show own, very rare case of primary sinonasal tuberculosis.

MATERIAL AND METHODS

We described a case of primary sinonasal tuberculosis in an adult female. She was suspected of the neoplastic disease. The diagnosis was based on the histopathology. The treatment was successful and consisted with antituberculous drug therapy and surgery (Functional Endoscopic Sinus Surgery). The patient was followed up for 12 months and during this time we did not notice any symptoms of recurrence.

CONCLUSIONS

Tuberculosis of the head and neck region should be take in to consideration during the differential diagnostic of the neoplastic diseases.

[An unusual parotid gland foreign body]

A foreign body in the parotid gland is extremely uncommon. It can penetrate to the parotid gland through the skin or from the oral cavity via the Stenonís duct. A case of 23-years-old man with the several pieces of glass within the superficial lobe of the right parotid gland was described. The surgical removal was performed and the diagnosis of the foreign body was quite easy.

[Perceptual method and videostroboscopy in patients with vocal fold hypertrophy underwent microsurgery]

INTRODUCTION

Chronic hypertrophic laryngitis concerns many people in our population. Their etiopathogenesis is complicated and usually connected with exogenous harmful factors like occupational or environmental exposure. Organic voice disorders of the larynx, particularly concerning vocal folds are the cause of dysphonia. Both surgical and conservative methods in the treatment of patients with laryngeal hypertrophy are applied. Objective assessment of the voice improvement after microsurgery is the subject of discussion of many authors. The problem of voice improvement is rarely approached to in the comprehensive way, that is with reference to activity and anatomy of the larynx. The basic aim of this research was to asses phonation function of the larynx after microsurgery on the basis of subjective and videostroboscopic voice analysis. The second aim was to estimate the surgical treatment effectiveness depending on vocal fold hypertrophy extensiveness.

MATERIAL AND METHOD

The research was conducted on 50 subjects chosen from the population of patients with vocal fold hypertrophy treated at the Department of Laryngology Silesian Medical Academy in Zabrze from January to December 2003. All the examined patients underwent classical microsurgery. Voice quality examinations were done just before microsurgery and 3 months after the operation. On the basis of histopathological results, following diagnosis were established: vocal fold polyps (oedematosus, teleangiectaticus and inflammatorius), oedema Reincke, laryngeal papilloma, laryngeal granuloma and cyst. The research methodology included: perceptual voice examination based on GRBAS scale (G--grade; R--roughness; B--breathiness; A--asthenicity; S--strain) and assessment of vibrations of vocal folds in videostroboscopy. Examination results in two groups with different extensiveness of vocal fold hypertrophy were compared. The control group presented 30 subjects without any voice disorders who did not use their voice for professional purposes.

RESULTS

In both groups (with minor and extensive vocal fold lesions) significant improvement in perceptual and videostroboscopic voice parameters was observed. The results in the group with minor vocal fold lesions were better after microsurgery.

CONCLUSIONS

The methodology based on the application of the two methods of voice examination could be an objective rate in the estimation of the treatment progress.

Sleep study in patients with overweight and obesity

Obstructive sleep apnea syndrome (OSAS) is a disorder characterized by repetitive collapse of the pharyngeal airway during sleep, which leads to oxygen desaturation, sleep fragmentation and daytime somnolence. Obesity is one of the most important risk factor for the development of OSAS. The exact mechanisms responsible for the relationship between obesity and OSAS are still unclear. The fat deposits in the pharynx region as well as the reduction in the lung volume have been considered as factors that might be responsible for the increase of the upper airway collapsibility. The aim of our study was to evaluate the correlation between the Body Mass Index (BMI) and sleep study parameters in overweight and obese patients suffering from breathing disturbances during sleep. We studied a group of 106 consecutive obese or overweight patients with a primary complaint of snoring or other breathing disturbances during sleep. In all cases, BMI and sleep studies (PolyMESAM) were examined. We evaluated relationship between the BMI and sleep study parameters such as Respiratory Disturbance Index (RDI), Apnea Index (AI), Desaturation Index (DI) and Average of Lowest Saturation (LSAT). The results showed the lack of significant statistical correlations between BMI and all the sleep parameters studied in the overweight patients and the statistical positive correlation between the BMI and RDI in the obese cases. We conclude that BMI determination may be considered as a simple, yet important predictor, of the OSAS in the group of obese patients.

The nasal airway evaluation in morbid obesity

The aim of the present study was to evaluate objectively the nasal patency in the obese patients. A total of 18 morbidly obese patients were recruited for the study. All of them were surgically treated because of morbid obesity using Bilo-Pancreatic Diversion (BPD) or Laparoscopic Gastric Banding (LGB) methods. The patients were free of nasal abnormalities, such as septum deviation, polyps, nasal concha hypertrophy and paranasal sinus diseases. This group comprised 10 men and 8 women aged from 17 to 54. The mean Body Mass Index (BMI) was 51.6 kg/m(2), ranged from 34.7 to 61.8 kg/m(2). In all of the patients the nasal patency was examined by active anterior rhinomanometry according International Standardization Rhinomanometric Committee using air pressure 75, 100 and 150 dPa. The results were compared to the healthy control group. The correlation between BMI and nasal airflow pressure was also examined. We found that inspiration values for 75, 100 and 150 dPa as well as the expiration values for 100 and 150 dPa in standard method and expiration values for 100 and 150 dPa in Broms method using anterior rhinomanometry in morbidly obese patients were statistically significant higher in comparison with the healthy controls. No statistical significant correlation between BMI of obese patients and the airflow pressure values was found. We conclude that in the morbid obesity the nasal patency is reduced as compared to the healthy controls.

[Treatment of otosclerosis in children]

Between 1994 and 2004 in the ENT Department Silesian Medical University Zabrze 330 stapedotomy were performed in patients suffered from otosclerosis. In this group of patient's 16 stapedotomies in 13 children aged from 9 to 17 years were performed. 4.85% of all the patients with otosclerosis treated in our Department were children. The purpose of this study was to analyze the audiologic results of stapedotomies in children. The postoperative evaluations were performed in the period from 6 months to 8 years after the surgical treatment. In the hearing state evaluation we analyzed the change of the air-bone gap, an average air conduction hearing improvement, the rate of percentage hearing improvement and an average hearing loss by Bell Telephone Laboratories. In all the operated children we observed the decrease of the air conduction hearing level. Stapedotomy was successful (postoperative air bone gap within 10 dB) in 62.5% of the cases. In 5 cases the air bone gap was lower than 20 dB (31.25%). In one case it was greater then 20 dB. The air bone gap closure was at the average of 4.39 dB level. The results were comparable with the other authors. Stapedotomy can be an effective procedure for correcting conducting hearing losses due to the otosclerosis in the pediatric patients.

[The rare case of sinonasal osteosarcoma in a 22-year-old patient (case report)]

Sarcomas of head and neck are very rare and comprise about 10 to 15% of all malignant nonepithelial neoplasms. A case of 22-year old patient with sinonasal osteosarcoma was presented. The authors stressed the significance of CT in the diagnostic procedures. The preoperative symptoms, histological character of the tumor and postoperative status were shown and discussed. Patient was treated by combined method: the surgical excision and radio-chemotherapy. The 24 months follow-up period was free of symptoms.

[Videostroboscopy assessment in patients with vocal fold hypertrophy underwent microsurgery]

Chronic hypertrophic laryngitis concerns many people in our population. Their aetiopathogenesis is complicated and usually connected with exogenous harmful factors like occupational or environmental exposure. The basic aim of this research was to asses phonation function of the larynx after microsurgery on the basis of videostroboscopy examination. The second aim was to estimate the surgical treatment effectiveness depending on vocal fold hypertrophy extensiveness. The research was conducted on 50 subjects chosen from the population of patients with vocal fold hypertrophy treated at the Department of Laryngology Silesian Medical Academy in Zabrze from January to December 2003. All the examined patients underwent classical microsurgery. Videostroboscopy examination was done just before microsurgery and 3 months after operation. Examination results in two groups with different extensiveness of vocal fold hypertrophy were compared. The first group consist of patients with minor vocal fold lesions (limited to I of vocal fold length), the second group consist of patients with extensive vocal fold lesions (above I of vocal fold length). The control group presented 30 subjects without any voice disorders who did not use their voice for professional purposes. In both groups (with minor and extensive vocal fold lesions) significant improvement in videostroboscopy parameters was observed. The functional results in the group with minor vocal fold lesions were better after microsurgery, but it turned out that results were not statistically significant.

[Sialolithiasis of the parotid gland--case report]

In this study the very rare case of a parotid gland sialolithiasis was presented. The authors described opinions concerned with symptomatology, localization, diagnostics and methods of treatment in parotid sialolithiasis. The 12 months follow-up period was free of symptoms.

[Tuberculosis within the laryngologic organs]

Tuberculosis, considering entry of infection, most frequent concerns the lungs. Rarely we observed extrapulmonary cases of tuberculosis within the bones, joints, urogenital organs and lymph nodes as well as within the head and neck region--larynx, nose and paranasal sinuses, middle ear, pharynx, tonsils, tongue, parotid glands and central nervous system. The diagnosis of head and neck tuberculosis is based on patient's examination as well as on the bacteriologic and histologic study of the biopsy specimen.

AIM

The aim of the study was to show our own, very rare cases of head and neck tuberculosis.

MATERIAL AND METHODS

We showed our own experience in the diagnosis and treatment of patients suffer from head and neck tuberculosis. 7 cases of head and neck tuberculosis (4 laryngeal, 2 sinonasal and 1 middle ear) were treated from 1986 to 2004 in the II ENT Department Silesian Medical University in Zabrze. In all the cases the diagnosis was based on the histological examination of the tissue specimen. All of the patients were suspected of the neoplastic disease. We assessed good long-term results after the conservative treatment (sometimes completed by surgery).

CONCLUSIONS

Tuberculosis of the head and neck region should be taken into consideration during the differential diagnosis of neoplastic diseases.

[Histopathologic changes of the soft palate in snoring and obstructive sleep apnea syndrome patients]

Histology of the soft palate and uvula in snorers and patients with OSA syndrome has been a subject of investigation of many authors. In majority of specimens the hypertrophy of the salivary glands as well as congestion and dilation of the thin-walled vessels were observed. Some of the samples presented atrophy of the muscle bundles. Also, the inflammatory changes as lymphocytic infiltrations were proven. In each case adults served as a control group. In this study the histologic analysis of the soft palate and uvula samples from patients suffering from snoring and OSA syndrome was performed. The uvula samples from the newborn who died on the first day of their lives were chosen as a control group. The choice of such a group excluded the influence of vibration force on the soft palate structure. Comparisons among the groups were made by Fisher exact two-tailed test. The muscular atrophy was observed only in patients with airway disturbances. No case of neonatal tissue sample with this pathology was found. Less dilation and congestion of the blood vessels were observed in the newborn group. Significantly more frequent superficial salivary glands localized between the muscle bundles and epithelium were found in the OSA and snoring patients. Our results showed distinct differences between the tissues of the patients with airway disturbances and the control group. These differences may be caused by the influence of the vibration on the soft palate and uvula, but on the other hand they may be the reason for excessive flaccidity of these structures and disturbances occurring during sleep.

[Treatment of patients with breathing disturbances during sleep in the II ENT Department Silesian Medical University Zabrze]

INTRODUCTION

The treatment of snoring and obstructive sleep apnea syndrome comprises preventive behavior, conservative methods (CPAP) and surgical treatment. In the diagnostics procedures the most important aim is to determinate whether the patient is an habitual snorer or OSA patient. Very important thing is also patient's qualification for proper mode of treatment. The aim of the surgical treatment is to remove all the reasons that obturate the upper airways and cause the increasing of respiratory air stream resistance. The most collapsible airway region during sleep is oropharynx involves the soft palate, uvula, tonsils, tonsillar pillars, base of the tongue and pharyngeal muscles.

MATERIAL AND METHODS

In the study the results of surgical treatment of 138 patients suffer from breathing disturbances during sleep treated at the ENT Department Silesian Medical University in Zabrze in the years 1997 to 2002 were presented. In the evaluated group were 51 habitual snorer and 87 OSA patients. Various type of surgical procedures were performed depend on the airway obturation level (septoplasty, tonsillectomy, LAUP, arytenoidectomy). The postoperative control sleep studies were performed in 68 patients (49.3%) 6 to 12 weeks after the end of the surgical treatment. In all the patients the subjective improvement were evaluated.

RESULTS

In 35 from 45 OSA patients (77.8%) RDI decreased after the surgical treatment more then 50% of the preoperative value or was lower then 10 (RDI lower then 10 was in 16 patients, in 19 patients decreased more than 50%). The subjective radical improvement was obtained in 107 patients (77.5%), moderate improvement in 19 cases (13.8%) and no improvement in 12 patients (8.7%).

CONCLUSIONS

On the base of our results we concluded that surgery is successful method for treatment of selected patients with breathing disturbances during sleep.

[A very rare case of low-grade angiosarcoma of the nose and paranasal sinuses]

Angiosarcomas of the nose and paranasal sinuses are extremely rare. Histologically angiosarcomas are divided into two groups: low and high-grade. We present a case of angiosarcoma of apparent low-grade malignancy localized within the nasal cavity and paranasal sinuses in a 74-year old woman treated by radiotherapy due to middle ear chemodectoma 21 years ago. She was surgically treated via the lateral rhinotomy. During the 23 months follow-up no recurrence or epistaxis have been observed.

Morphometric characteristics of cell nuclei of the precancerous lesions and laryngeal cancer

BACKGROUND

The purpose of this study was to characterize normal epithelium, precancerous lesions and laryngeal squamous cell carcinoma (SCC) with the use of nuclear morphometry. The relationship between the morphometric parameters of the cell nuclei and the pathological lesions was analyzed. In addition, a morphometric comparison was performed among normal epithelium, precancerous lesions, and cancer of the larynx.

MATERIAL/METHODS

Our research involved 12 patients after total laryngectomy. All the postoperative histological specimens consisted of laryngeal SCC, precancerous lesions (dysplasia), keratosis with mild dysplasia, and normal epithelium. The cell nuclei of the SCC, dysplasia, keratosis, and the basal and superficial layers of the normal epithelium were measured. The nuclear parameters included area, equivalent diameter, length, breadth, perimeter, mean and integrated grey levels, convex area and convex perimeter, roundness, aspect ratio and fullness ratio. For each case, 500 nuclei were studied using a Polyvar Reicher microscope connected to a Quantimet 500 computer system.

RESULTS

The relationship between karyometrical parameters and pathological lesions was found to be statistically significant. We observed the largest nuclei in keratosis lesions and the smallest in basal layers of normal epithelium. In some cases there were no significant differences between dysplasia nuclei and the superficial layers of normal epithelium.

CONCLUSIONS

Karyometrical parameters correlate with morphometrical lesions in the larynx and may be useful in the prediction of laryngeal neoplasm.

[Rare case of primary isolated orbital sarcoidosis in 53 year old woman]

Isolated to one organ cases of sarcoidosis are observed extremely rare. We described a case of 53 year old woman suffer from isolated to orbit form of sarcoidosis. Systemic sarcoidosis (lymphadenopathy, pulmonary infiltrates, skin lesions) are excluded. The patient was treated by surgery (excision of orbital tumor) with following prolonged steroidotherapy. Total retirement of symptoms was obtained. During the 19 months follow-up no recurrence have been observed.

[New composite implant for tracheal reconstruction--preliminary study]

Stenosis of trachea's diameter occurs the most often as complications after intubation and tracheotomy. Among the other reasons of narrowing of this organ the following are being named: mechanical injuries, chemical damages, primary and metastasis tumors. The therapy of trachea's stenosis includes both alternative and radical treatments. The radical treatment consists of surgical excision of the narrowed segment followed by reconstruction of trachea (anastomosing of free ends or filling of lost segment with use of auto- or allogenic material). There is no appropriate alloplastic material developed to date, the use of which in reconstructive surgery of large segment trachea defects would bring about positive long-term experimental results. The success of alloplastic material implantation in the reconstruction of large tracheal defects is limited by the fact that the biomechanical characteristics of replaced tissue are distinctly different from synthetic material. The work is devoted to evaluation of complex mechanical characteristic of natural sheep trachea before designing the proper synthetic material for large tracheal defects reconstruction. Various mechanical tests were conducted to study the mechanical behavior of total trachea. Samples of tissue cut out from trachea were also examined. The results revealed strong directional--dependent mechanical properties of trachea. Composite constituents, namely carbon fibers and biocompatible and biostable polysulfone were used to manufacture the implant.

Obstructive sleep apnea syndrome and snoring in patients with bilateral vocal cord paralysis

The analysis of the correlation between bilateral vocal cord paralysis and the occurrence of obstructive sleep apnea syndrome and snoring is presented. The aim of the study was to establish whether the decrease of the air flow in the upper airway in patients with bilateral vocal cord paralysis involves OSAS and/or snoring occurrence and whether arytenoidectomy affects an improvement of breathing parameters measured during sleep. Fourteen patients with bilateral vocal cord paralysis underwent Poly-MESAM examination before and 3 months after arytenoidectomy. They had never complained of snoring before. The Epworth sleepiness scale was used to quantify excessive daytime somnolence. The RDI, DI, mean saturation and percentage of snoring, loud snoring and sleep without snoring were estimated and compared pre- and postoperatively. The results were compared by the Student's t-test for dependent values. No significant differences were shown between the Epworth scores before and after the treatment. The RDI, DI and mean saturation were normal before and after the operation. The percentage of loud snoring decreased and the percentage of sleep without snoring increased significantly after arytenoidectomy in both cases. The mechanism of snoring in patients with vocal cord paralysis seems to be similar to OSAS. The difference consists in the level of flow limitation. On the basis of the results there is no reason to diagnose OSAS and UARS in patients with bilateral vocal cord paralysis. On the other hand, the intensive snoring that occurs after paralysis was significantly reduced as a result of arytenoidectomy.

[Ceruminous gland adenoma of the external auditory canal: a case report]

Ceruminous adenoma (ceruminoma) of the external auditory meatus is a rare neoplasm with benign clinical behavior. This tumor is mainly composed of the ceruminous gland cells (modified apocrine sweat glands). These glands are localized deep in the skin mostly in the cartilaginous part of the external auditory meatus. The most often symptom of the ceruminous adenoma of external auditory meatus is the unilateral conductive hearing loss. Occasionally symptoms of this tumor (pain, otorrhoea) can result from an otitis externa secondary to meatus obstruction. Ceruminous adenoma should be radical excised with adequate margins of the normal tissues. The prognosis of these tumors is good. The difficulties of nomenclature, histological structure of the auditory external meatus ceruminoma, as well as symptomatology, treatment and clinical behavior are discussed on the basis of the literature. A case of histologically confirmed ceruminoma (ceruminous adenoma) of the external auditory meatus in a surgically treated 53 years old men is presented.

[Nuclear shape assessment of the cells in precancerous lesions and laryngeal cancer]

The authors assessed morphometrically the nuclei shape of the normal mucosa, precancerous lesions (dysplasia, keratosis) and laryngeal cancer in the postoperative samples of 12 patients treated in the Laryngology Department Silesian Medical Academy in Zabrze. Five slides from the same patient, each 4 um thick were assessed. The histologic samples were measured by system Quantimet 500 + Color Option with magnification 2100x. Roundness, aspect ratio and fullness ratio were evaluated. The relationship among the morphologic lesions using shape descriptors was assessed. In some cases there were no significant differences between the nuclei of mild dysplasia cells and the cells of the normal epithelium. The results indicate significant karyometric shape differences of the normal mucosa, precancerous lesions and cancer of the larynx.

[Complication after laser assisted uvulopalatoplasty in the treatment of snoring and obstructive sleep apnea syndrome]

Laser Assisted Uvulopalatoplasty (LAUP) is the surgical technique for the treatment of snoring and obstructive sleep apnea syndrome. LAUP was first time performed by Kamami in 1986. LAUP can reduce the airway obstruction on the oropharynx level. LAUP is the simple, reliable surgical procedure performed in an office setting under the local anesthesia, without hospitalization. Between 1997 and 2001 the authors of the study prospectively evaluated 400 patients referred to ENT Clinic in Zabrze to treat the breathing disturbances during sleep. In this group of patients LAUP procedure was performed in 68 cases. There were 4 cases of complications (4.4%). These complications included: postoperative hemorrhage in one patient, 2 cases mycotic infections and in one patient, 2 cases mycotic infections and in one patient temporary loss of taste. In this group of patients there were no cases of bleedings needed hospitalization, nasal speech, nasopharyngeal stenosis, palatal incompetence, airway compromise or death.

[Hearing evaluation in patients suffering from hypercholesterolemia]

The negative influence of hypercholesterolemia on the blood vessels condition and following degeneration lesions of the organs is well known. The aim of our study was to estimate the lipid balance disorders influence on the small blood vessels of the brain and inner ear in the patients with hypercholesterolemia and hypertriglyceridemia on the base of the audiometric, ABR and TEOAE evaluations. In our study we observed no statistical significant differences between the mean auditory thresholds in the study and control groups as well as statistical negative correlation between cholesterol serum level and amplitudes of TEOAE. In the ABR evaluation we stated the prolonged latency of the wave III and V as well as I-III and III-V interpeaklatencies in the patients with hyperlipidemia in comparison with the control group.

[Surgical treatment of acquired external auditory canal atresia]

Acquired atresia of the external auditory canal is a relatively rare disease, that can be the result of the recurrent external otitis, chronic media otitis, ear trauma, neoplasms or iatrogenic complications. The surgical treatment results after operation in the 7 patients with acquired external auditory canal atresia were presented. The mean age of the patients was 34.1 and the female to male ratio was 2:5. In 6 cases we performed transcanal operation. The meatus atresia was removed and then the stenotic canal was widened by removing the skin and fibrous tissue. We especially focused our attention on the state of the anterior angle of the tympanic membrane. The bony canal was widened by burr in cases with bony overhangs. The bony canal walls were lined with pediculate or free skin grafts. In cases of tympanic membrane perforation we performed myringoplasty with temporal muscle fascia or tragus perichondrium. The follow-up period was from 8 to 39 months. The hearing improvement with primary closure of air bone gap within 20 dB was achieved in 43% of cases. In 28% of the patients recurrent atresia developed. The early surgical treatment is recommended in all the cases because cholesteatoma behind the atresia was found in 28% of patients.

[Stapedectomy in the treatment of otosclerosis in children]

In the years 1994-2000 in the Laryngology Department Silesian Medical Academy in Zabrze 167 stapedectomy were performed in 143 patients with otosclerosis. In this group of patients 11 stapedectomies in 8 children aged from 9 to 17 years were performed. 5.6% of all the patients with otosclerosis treated in our Department were children. The purpose of this study was to analyze the audiologic results of stapedectomies in children. The postoperative evaluations were performed in the period from 6 months to 6 years after the surgical treatment. In the estimation of the hearing state we analyzed the change of the air-bone gap, an average air conduction hearing improvement, the rate of percentage hearing improvement and an average hearing loss by Bell Telephone Laboratories. In all the operated children we observed the decrease of the air conduction hearing level. Stapedectomy was successful (postoperative air bone gap within 10 dB of the preoperative bone conduction) in 63.6% of the patients. In 3 cases the air bone gap was lower than 20 dB (27.3%). In one case it was greater then 20 dB. The air bone gap closure was at the average of 5.75 dB level. The results were comparable with the other authors. Stapedectomy can be an effective procedure for correcting conducting hearing losses due to the otosclerosis in the pediatric patients.

[Laser assisted uvulopalatoplasty (LAUP) in the treatment of snoring and obstructive sleep apnea syndrome]

Laser Assisted Uvulopalatoplasty (LAUP) the surgical technique for the treatment of snoring and obstructive sleep apnea syndrome was first performed by Kamami in 1988. LAUP can reduce the airway obstruction in the oropharynx level. LAUP is the simple, reliable surgical procedure performed in an office setting under the local anesthesia, without hospitalization. From 1998 to 2000 37 patients underwent LAUP in our ENT Department in Zabrze. This group comprised of 19 OSA patients and 18 habitual snorers. In cases of nasal obstruction by turbinate hypertrophy or septal deviation we performed septoplasty or partial inferior turbinectomy by laser CO2. In some cases with palatin or lingual tonsils hypertrophy we also performed tonsillectomy or lingual tonsil laser ablation. In 5 patients LAUP was performed in several stages. Before and after the surgical treatment each patient were evaluated by PolyMESAM--the device belongs to the third diagnostic level. In all postoperative evaluated OSA patients the RDI decreased significantly. In 4 patients (50% of evaluated after LAUP patients) the RDI dropped to 10 or lower. Snoring was eliminated or significantly reduced in 83% of patients classified as the habitual snorers. No serious complications were observed. LAUP is a good alternative to UPPP in the surgical treatment of habitual snorers and some of the patients with OSA syndrome.