Introduction: Extracranial meningioma might be primary (ectopic), without any connection to the cranial cavity or it might be secondary as an extracranial extension of intracranial tumor. The aim of the study: The aim of the study was to... more
Introduction: Extracranial meningioma might be primary (ectopic), without any connection to the cranial cavity or it might be secondary as an extracranial extension of intracranial tumor. The aim of the study: The aim of the study was to evaluate clinical presentation and results of treatment of secondary extracranial meningioma. Material and methods: The group included 4 patients with the tumor of the nasal cavity and sinuses, and 7 patients with the tumor involving the infratemporal fossa. Patient notes were reviewed to collect required data. Apart from one case all the patients were operated first in a Department of Neurosurgery 6months – 13 years before presentation to our institution. CT and/or MRI were performed and the radiograms well demonstrated location and extension of the tumor. For nasal and sinus tumors endonasal or sublabial approach was used. In a patient with infratemporal fossa, orbit and sphenoid sinus tumor sublabial transantral removal was performed. Other menin...
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Giant cell tumours (osteoclastoma) are very uncommon neoplasms in the facial skeleton. Their usual clinical presentation is in the long bones. The differential diagnosis of giant cell tumour (GCT) in the facial skeleton includes giant... more
Giant cell tumours (osteoclastoma) are very uncommon neoplasms in the facial skeleton. Their usual clinical presentation is in the long bones. The differential diagnosis of giant cell tumour (GCT) in the facial skeleton includes giant cell granuloma (GCG), brown tumour, nonossifying fibroma, chondroblastoma and odontogenic cyst. It can be very difficult to differentiate histologically three lesions: giant cell tumour, giant cell granuloma and brown tumour related to hyperparathyroidism One case of GCT and five cases of GCG are presented. Four men and one woman aged 14–68 years had GCG that occupied the maxillary sinus and nasal cavity. Clinical symptoms included swelling of the cheek, nasal obstruction and facial pain. CT well demonstrated extension of the lesion and erosion of the alveolar process and sinus walls. The lesions were removed using sublabial approach with disease free 4–15 years follow up. A 16 years old boy presented with unilateral blindness, headache and biopsy resu...
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Introduction: Laryngocele containing air and mucus arises from impaired drainage of the laryngeal sacculus. Unusual cases of association of laryngocele with larynx cancer have been already reported in literature. Material and methods:... more
Introduction: Laryngocele containing air and mucus arises from impaired drainage of the laryngeal sacculus. Unusual cases of association of laryngocele with larynx cancer have been already reported in literature. Material and methods: During the last 20 years 12 patients with laryngocele or laryngomucocele[for full text, please go to the a.m. URL]
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HPV DNA was amplified by the nested-PCR method to identify E6/E7 HPV16 from 72 deep-frozen (-70 o C) specimens of LSCC tumours collected after a total laryngectomy. HPV was identified in 38.9% of the specimens. There was no statistically... more
HPV DNA was amplified by the nested-PCR method to identify E6/E7 HPV16 from 72 deep-frozen (-70 o C) specimens of LSCC tumours collected after a total laryngectomy. HPV was identified in 38.9% of the specimens. There was no statistically significant correlation between the presence of HPV and epidemiological, clinical, and pathological features, and recurrence. There was no statistically significant correlation between the presence of HPV and survival. HPV infection is not likely to influence survival rates as an independent prognostic factor in patients with laryngeal cancer. The presence of HPV infection in 38.9% of the cases suggest a possible role in the aetiology of laryngeal cancer and support the role of high-risk types of HPV 16 in LSCC.
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Introduction: Juvenile nasopharyngeal angiofibroma (JNA) is a rare, benign, vascular tumor originating in the nasopharynx. The treatment of choice for JNA is surgical excision. In recent years, surgical management has been greatly... more
Introduction: Juvenile nasopharyngeal angiofibroma (JNA) is a rare, benign, vascular tumor originating in the nasopharynx. The treatment of choice for JNA is surgical excision. In recent years, surgical management has been greatly influenced by the use of the transnasal endoscopic technique. The aim: The aim of the study was to present our experience with the transnasal microscopic removal of JNA. Material and methods: Ten patients with JNA aged 12-17 underwent diagnostics imaging and transnasal microscopic tumor excision. Medical records of patients were retrospectively reviewed. The main outcome measures were complications and recurrences. Preoperative embolization of feeding vessels was performed in 7 patients. Results: According to Andrews’ classification, the group included 2 stage I patients, 6 stage II patients and 2 stage IIIA patients with the extensive occupation of the infratemporal fossa. 9 patients had no recurrence in 6-11 years follow up. One stage IIIA patient had a ...
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The aim of this study was to analyze the prevalence of BK virus, Human Papillomavirus and Epstein-Barr virus in oropharyngeal cancer, and to test our hypothesis that BKV/HPV/EBV co-infection plays a role in oropharyngeal squamous cell... more
The aim of this study was to analyze the prevalence of BK virus, Human Papillomavirus and Epstein-Barr virus in oropharyngeal cancer, and to test our hypothesis that BKV/HPV/EBV co-infection plays a role in oropharyngeal squamous cell carcinoma. The correlation between viral infection, OSCC, anatomic location, pre-treatment staging, evidence of metastases to lymph nodes, and grading was also investigated. The examination samples were collected from 62 patients from paraffin tissue blocks. Males (90.3%) with, smoking (83.9%) and alcohol abuse (67.7%) problems prevailed in the studied group. G2 histological type was recognized in 80.6% cases. T4 (77.4%) and N2 (56.5%) traits occurred in the majority of patients. No cases of metastasis were observed (M0 100%). HPV – 24.2%, EBV – 27.4% and BKV 17.7% were detected in the studied samples. We observed co-infection EBV/BKV in 8% of cases, HPV/BKV in 4.8%, and HPV/EBV in 9% cases. Only in two cases co-infection of all three viruses was found.
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In a group of 124 patients a site of origin of paranasal sinus and nasal cavity malignancies was evaluated on the basis of computed tomography (CT) and on the basis of operative findings. The most common malignant tumor was squamous cell... more
In a group of 124 patients a site of origin of paranasal sinus and nasal cavity malignancies was evaluated on the basis of computed tomography (CT) and on the basis of operative findings. The most common malignant tumor was squamous cell carcinoma (41, 1%) and then cancers of salivary origin (20, 2%). The most common site of origin was the maxillary sinus (53, 2%) and then the nasal cavity (31, 5%). Within the maxillary sinus the most frequent neoplasm was cancer whereas in the nasal cavity melanoma and olfactory neuroblastoma. In three (2, 4%) patients site of tumor origin demonstrated on CT was different form that of operative finding.
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In order to evaluate the vocal quality of tracheo-oesophageal (TE) and oesophageal (E) speech, several acoustic parameters were measured in the acoustic waveform (fundamental frequency, maximum phonation time, maximum intensity) and in... more
In order to evaluate the vocal quality of tracheo-oesophageal (TE) and oesophageal (E) speech, several acoustic parameters were measured in the acoustic waveform (fundamental frequency, maximum phonation time, maximum intensity) and in the frequency spectrum: harmonicity-to-noise ratio [HNR], pitch perturbation [Jitter], Shimmer. Thirteen patients using tracheo-oesophageal speech (Provox 2 valve) and 11 good oesophageal speakers were evaluated. The control group consisted of 10 healthy men with normal speech. Digital recordings were obtained from examined subjects as they sustained the vowel "a". Maximum phonation time in TE samples was significantly longer than in E speech recordings and similar to the normal speech. The tracheo-oesophageal voices more often showed a detectable fundamental frequency which was fairly stable and lower than in oesophageal and normal speech. In our cohort of patients maximum voice intensity in both groups of alaryngeal speakers was similar an...
Research Interests: Audiology, Speech Acoustics, Phonation, Medicine, Humans, and 10 moreFemale, Male, Jitter, Aged, Middle Aged, Adult, Trachea, VOWEL, Laryngectomy, and Case Control Studies
Distant metastases in head and neck region are very uncommon. Nasal bleeding was the first symptom in a patient with metastasis from renal cell carcinoma. Nasal tumour biopsy revealed renal carcinoma to be the primary lesion. Initially... more
Distant metastases in head and neck region are very uncommon. Nasal bleeding was the first symptom in a patient with metastasis from renal cell carcinoma. Nasal tumour biopsy revealed renal carcinoma to be the primary lesion. Initially the patient refused surgery and nephrectomy was performed 8 months later. MR scans demonstrated diffuse intracranial invasion which made complete removal impossible. Potential routes of renal carcinoma spread are presented. Renal cell carcinoma should be considered in the diagnosis of nose and paranasal tumours. Epistaxis can be the first symptom of renal carcinoma metastasis to the nose and paranasal sinuses.
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Transglabellar, transorbital approach through the bottom of the frontal sinus for tumours invading anterior skull base in presented. Exposure was improved by rhinectomy and lateral swing of the nose. The most common tumours in the group... more
Transglabellar, transorbital approach through the bottom of the frontal sinus for tumours invading anterior skull base in presented. Exposure was improved by rhinectomy and lateral swing of the nose. The most common tumours in the group of 11 patients were squamous cell carcinoma (4) and olfactory neuroblastoma (4). Skull base was excised en block with partial maxillectomy in 8 patients and with total maxillectomy in 3 patients. Orbitectomy was performed in 6 cases. Dura defect was closed with fascia lata and fibrin glue. No serious complications after surgery developed. Rhinoscopy and computed tomography demonstrated clear cavity and no dura prolapse. Transglabellar, transorbital approach provides good exposure for anterior skull base tumours excision and repair.
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The majority of salivary fistulas after laryngectomy or after laryngo-pharyngectomy close spontaneously within 2-3 weeks, and the remaining require surgical reconstruction. In the years 1987-2000 the pharyngo-cutaneous fistula was closed... more
The majority of salivary fistulas after laryngectomy or after laryngo-pharyngectomy close spontaneously within 2-3 weeks, and the remaining require surgical reconstruction. In the years 1987-2000 the pharyngo-cutaneous fistula was closed in 19 patients. The fistula developed after laryngectomy because of larynx cancer T3 and T4. 13 patients were irradiated before. In all the patients laryngectomy was combined with unilateral or bilateral neck dissection. Salivary fistula was closed in one stage operation using pectoralis major myocutaneous flap: 1) skin island of the flap to replace defect of the neck skin and mobilized mucosa from inside, 2) skin island for lining and deltopectoral skin flap from outside, 3) skin island for lining and free split skin flap for external cover, 4) skin island of the flap divided in two paddeles, one for lining and another for external cover. Indications for each method were discussed. Very good result of total fistula closure was obtained in 15 out of...
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In a group of 15 patients with malignant melanoma of the nasal cavity and paranasal sinuses the place of origin was nasal mucosa in 11 patients, the ethmoid cells in 2 cases and the maxillary sinus in 2 cases. Only 5 patients had tumour... more
In a group of 15 patients with malignant melanoma of the nasal cavity and paranasal sinuses the place of origin was nasal mucosa in 11 patients, the ethmoid cells in 2 cases and the maxillary sinus in 2 cases. Only 5 patients had tumour limited to infrastructure of the nasomaxillary complex, in 10 patients tumour occupied also suprastructure. Total maxillectomy was performed in 4 patients, partial maxillectomy in 8 patients with orbital exenteration in 3 patients. Of 12 patients operated on three patients died one year, two patients two years and one patient 6 years after surgery. One patient is alive 12 years, three patients are alive three years and one patient is alive one year after surgery.
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In the group of 42 patients after maxillectomy face deformation and function defects were assessed. The best cosmetic and functional result was observed after maxillectomy without orbital exenteration, with preservation of lateral part of... more
In the group of 42 patients after maxillectomy face deformation and function defects were assessed. The best cosmetic and functional result was observed after maxillectomy without orbital exenteration, with preservation of lateral part of the zygomatic bone and at least a half of nasal skeleton. Severe face deformation developed after orbital exenteration, resection of the palpebrae, cheek and external nose.
Research Interests: Face, Treatment Outcome, Adolescent, Medicine, Humans, and 8 moreFemale, Male, Aged, Middle Aged, Adult, Nose, Orbit, and Cheek
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The aim of the study was to assess the effect of CO(2) laser on stapes prostheses and measure the heat transmission to the vestibule in experiment model. CO(2) laser was applied on two types of prostheses with power settings (2 and 6W;... more
The aim of the study was to assess the effect of CO(2) laser on stapes prostheses and measure the heat transmission to the vestibule in experiment model. CO(2) laser was applied on two types of prostheses with power settings (2 and 6W; 0.05 s). Transmission of heat to the 'vestibule' was measured using type K thermocouple and DC-80 data logger during application of the laser on prostheses using a training model of temporal bone. Application of the laser on stainless steel prosthesis did not have any effect on the structure of the prosthesis. The use of the laser on the fluoroplastic-wire piston caused melting and produced holes in the piston. Greater temperature rises occurred with stainless steel than with the fluoroplastic-wire piston. Application of CO(2) laser on stainless steel pistons with 6W can produce inner ear trauma. The use of the laser on fluoroplastic-wire piston is not likely to irritate the inner ear.
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The use of closed technique in cholesteatoma treatment carries a significant risk of development of residual disease thus requires a second look operation in a proportion of patients. In those with no residual cholesteatoma the second... more
The use of closed technique in cholesteatoma treatment carries a significant risk of development of residual disease thus requires a second look operation in a proportion of patients. In those with no residual cholesteatoma the second surgery could be avoided. was to evaluate the use of non-echo planar HASTE diffusion-weighted MR imaging in the detection of cholesteatoma in patients after canal wall up surgery due to cholesteatoma. We evaluate the results of half-Fourier-acquisition single-shot turbo-spin-echo (HASTE) diffusion-weighted magnetic resonance imaging in 18 patients after canal wall up surgery performed 6 to 20 months after primary surgery. 16 patients were operated in our center and 2 elsewhere. All the patients underwent second look surgery that verified the result of MRI scanning. MRI DWI detected 2 cholesteatomas in patients operated elsewhere and none in patients operated in our center. Four cholesteatomas were found during second look operations. Two false negatives were in 1 patient with cholesteatoma pearl of less than 2mm in diameter and in 1 patient with mural cholesteatoma. There were no false positive results. Non EPI MRI DWI can be used as a screening tool to detect residual or recurrent cholesteatoma and may substitute the need of second look surgery.
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We studied the transmission of heat to the vestibule during revision stapes surgery with a piston in situ, using a CO2 laser, in an in vitro model. A type K thermocouple was placed around the medial end of stainless steel and... more
We studied the transmission of heat to the vestibule during revision stapes surgery with a piston in situ, using a CO2 laser, in an in vitro model. A type K thermocouple was placed around the medial end of stainless steel and fluoroplastic wire pistons in a ‘vestibule’ filled with saline. The effect of laser hits on fluoroplastic wire and stainless steel stapes prostheses was investigated. The effect of introducing a vein graft to seal the stapedotomy was also examined. Greater temperature rises occurred with stainless steel than with fluoroplastic wire pistons. The addition of the vein graft reduced heat transmission.Application of the CO2 laser to fluoroplastic wire pistons, using the power settings suggested by the manufacturer, is not likely to damage the inner-ear structures. Application of 6 W laser energy to stainless steel pistons can potentially disturb the inner-ear function.
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The aim of the study was evaluation of the use of cartilage and perichondrium for reconstruction of meatal wall. In the group of 27 patients transmeatal atticotomy was performed to remove cholesteatoma from epitympanic recess. Auricular... more
The aim of the study was evaluation of the use of cartilage and perichondrium for reconstruction of meatal wall. In the group of 27 patients transmeatal atticotomy was performed to remove cholesteatoma from epitympanic recess. Auricular or tragal perichondrium with cartilage island were used for reconstruction of meatal wall and tympanic membrane defect. Good closure of the defect was obtained in 24 (89%) patients in 3-6 years follow up. We had one failure and no follow up in 2 patients. Of 7 patients with intact ossicular chain 0-10 dB air-bone gap was obtained in 5 and 11-20 dB gap in 2 patients. Perichondrium and cartilage are very good for reconstruction of meatal wall and drum defect.
Research Interests: Treatment Outcome, Adolescent, Humans, Child, Cartilage, and 7 moreFemale, Male, Middle Aged, Adult, Perichondrium, Pinna, and Tympanoplasty
The aim of the study was to analyse if work related risk factor had any influence on stage, localisation and histology of type of malignant tumour. Demographic and risk factors and results of treatment of farmers with patients working... more
The aim of the study was to analyse if work related risk factor had any influence on stage, localisation and histology of type of malignant tumour. Demographic and risk factors and results of treatment of farmers with patients working outside farming were compared. The group included 148 patients with primary laryngeal squamous cell carcinoma (LSCC) diagnosed and treated in our institution in the years 1999-2002. 84 (56.8%) of 148 patients were farmers and 64 (42.2%) patients worked outside farming. The univariate analysis of demographical and clinicopathological features of the farmers' group versus the other professions group with LSCC showed a statistical significance for sex, age and G stage. Nearly statistical significance was observed for the N stage (p=0.06) and for primary localisation of the tumour (p=0.05). The difference in 3 and 5-year survival rates between the group of farmers in comparison with the group of patients working outside farming and with LSCC was not si...
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Many authors suggest that HPV infection can play a great role in development of benign and malignant tumours of upper respiratory tract in human. The aim of this study was to determine the prevalence of E6/E7 HPV-16 in laryngeal squamous... more
Many authors suggest that HPV infection can play a great role in development of benign and malignant tumours of upper respiratory tract in human. The aim of this study was to determine the prevalence of E6/E7 HPV-16 in laryngeal squamous cell carcinoma, and normal laryngeal mucosa, and to analyse their correlation with sex, lymph node status, primary tumor stage, localization, and histological differentiation. HPV 16 DNA presence was analysed using PCR technique in 72 samples of laryngeal carcinoma and in samples of 50 normal mucosa. Human papillomavirus was detected in 26 (36.1%) of the 72 patients. There was no statistically significant correlation HPV positivity and clinicopathological features of the analysed group. In 5 (10%) of 50 samples of normal mucosal. HPV 16 presence in normal mucosa and in laryngeal squamous cell carcinoma was detected in 3 patients. Our observations suggest that HPV16 can play a role in pathogenesis of laryngeal cancer.
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The aim of the study was evaluation of the use of tracheostomy T-tube in patients with tracheal stenosis. The advantages of closed T-tube over open tracheotomy are: 1/ normal breathing through the nose, 2/ normal speech without necessity... more
The aim of the study was evaluation of the use of tracheostomy T-tube in patients with tracheal stenosis. The advantages of closed T-tube over open tracheotomy are: 1/ normal breathing through the nose, 2/ normal speech without necessity to close the tube with a finger, 3/ no spitting during cough. Silicone tracheostomy T-tube was used in 12 patients with tracheal stenosis. The stenosis resulted in 7 patients from prolonged intubation, in 4 patients from defective tracheostomy and in one patient from failure of tracheal resection. In all the patients rigid tracheoscopy and/or flexible bronchoscopy revealed the length of the stenosis and the distance from vocal cords. T-tube was placed under local anesthesia. The patients used to wear closed T-tube from 1-12 years. The tube was exchanged every 2-4 years. The only adverse effect was recurrent granulation around tracheostomy in two patients. 7 of 12 patients were decannulated with good result in 3 months - 5 years follow up. In two dec...
Research Interests: Treatment Outcome, Medicine, Humans, Female, Male, and 6 moreAged, Middle Aged, Adult, Time Factors, Tracheostomy, and Tracheal stenosis
The aim of the study was to analyze the incidence of anatomical variations and abnormalities of the facial nerve found during stapedectomy. Specific management in the case of an anomalous course of the facial nerve was also described. A... more
The aim of the study was to analyze the incidence of anatomical variations and abnormalities of the facial nerve found during stapedectomy. Specific management in the case of an anomalous course of the facial nerve was also described. A retrospective analysis of clinical records of 316 stapedectomies was carried out in search for facial nerve anomalies. In 25 (7.9%) patients the facial nerve had an abnormal course. Twenty patients exhibited partial and two total overhang of the nerve over the oval window. In two of them the facial nerve was dehiscent in the tympanic segment and in three patients an obliterative type of the disease was also noted. The facial nerve dehiscence without the protrusion was found in two more patients. Another individual demonstrated otosclerotic bone over the facial nerve. In one case a duplicated facial nerve was found. Two branches of the nerve were almost covering the oval window (Fig. 1B). The piston was placed in the footplate between the branches of ...
Research Interests: Treatment Outcome, Adolescent, Medicine, Humans, Child, and 7 moreFemale, Male, Facial Nerve, Aged, Middle Aged, Adult, and Retrospective Studies
Stapedectomy is a safe surgical procedure used in patients with otosclerosis. However, complications may occur and decrease hearing gain after the operation. The aim of the work was to analyze hearing results in patients with incus... more
Stapedectomy is a safe surgical procedure used in patients with otosclerosis. However, complications may occur and decrease hearing gain after the operation. The aim of the work was to analyze hearing results in patients with incus subluxation during stapedectomy. In 15 (5%) of 292 patients with otosclerosis, the incus was unintentionally luxated during surgery. In one patient the incus was completely dislocated and malleovestibulopexy with autoincus had to be applied. In 14 stapedectomies the incus was subluxated and though it was pathologically mobile it was held in position by its ligaments. This situation allowed delicate reposition of the incus and insertion of the piston prosthesis on the long incus process. Mean AC threshold improved by 24 dB. Mean ABG improved from 34.6+/-8.3 dB before to 13.1+/-6.3 dB 8 months after stapedectomy (t=9.7; p<0.0001). Ten years after surgery average ABG was 10.6+/-4.4, which means stable hearing result. In 6 patients including the individual...
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Research Interests: Pathology, Biology, Immunohistochemistry, Cryopreservation, Medicine, and 14 moreHumans, Female, Male, Polymerase Chain Reaction, Monoclonal Antibodies, Aged, Middle Aged, Oral Squamous Cell Carcinoma (OSCC), Adult, Formaldehyde, Sensitivity and Specificity, Fixatives, Biochemistry and cell biology, and Papillomaviridae
Research Interests: Adolescent, Medicine, Humans, Child, Female, and 8 moreMale, Young Adult, Clinical Sciences, Middle Aged, Adult, Angiofibroma, Cheek, and Nose Neoplasms
Resection of the whole circumference of the pharynx and esophagus is usually reconstructed with gastric pull-up, jejunum free graft or free forearm flap. The aim of this study was to assess the use of pectoralis major myocutaneous flap... more
Resection of the whole circumference of the pharynx and esophagus is usually reconstructed with gastric pull-up, jejunum free graft or free forearm flap. The aim of this study was to assess the use of pectoralis major myocutaneous flap for closure of total pharyngeal defect. In 11 patients with hypopharynx and larynx cancer, total pharyngo-laryngectomy and excision of the cervical part of the esophagus and neck dissections were performed; the defects were closed with pectoralis major myocutaneous flaps. The skin island was sutured to prevertebral muscles, forming a letter U shape. Good healing was obtained in six patients, and five patients developed fistula that closed spontaneously within 3-4 weeks. The use of U-shaped pectoralis major myocutaneous flap, suturing it to prevertebral muscles, gives good functional results, and it is a simple and time-saving second choice method of reconstruction of the pharynx after total pharyngo-laryngectomy.