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Poutoglidis A, Forozidou E, Fyrmpas G, Mantsopoulos K, Paraskevas GK, Lazaridis N, Savvakis S, Karamitsou P. A Novel and Simple Technique to Reduce the Rate of Pharyngocutaneous Fistula Formation Following a Total Laryngectomy - our Initial Results. Indian J Otolaryngol Head Neck Surg 2024; 76:997-1001. [PMID: 38440597 PMCID: PMC10908975 DOI: 10.1007/s12070-023-04343-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/02/2023] [Indexed: 03/06/2024] Open
Abstract
Objective: Pharyngocutaneous fistula (PCF) is a common and often devastating complication of total laryngectomy. Patients undergoing a total laryngectomy need enhancement of the neopharynx to reduce the risk of PCF formation. Our study aimed to evaluate the formation of a PCF following a total laryngectomy in patients that underwent a modified closure technique of their neopharynx. This technique included the recruitment of a flap of the muscular division of the pretracheal fascia that invests the strap muscles as a protective blanket. We called this surgical technique the 'curtain call'. Methods: We conducted a retrospective study for patients who underwent a total laryngectomy in our department between May 2022 and May 2023. Results: Twelve patients were identified. Our results demonstrated that the recruitment of this modified closure technique to cover the neopharynx resulted in a very low rate of postoperative PCF formation (8.3%). Conclusion: The 'curtain call' technique is an excellent method to support the neopharynx with extremely low rates of postoperative chronic dysphagia and with no evidence of impairing the development of esophageal speech. It could sometimes substitute much more time-consuming techniques like major pectoralis flap and supraclavicular flap. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-023-04343-7.
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Affiliation(s)
- Alexandros Poutoglidis
- Department of Anatomy and Surgical Anatomy, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, 54124 Greece
| | - Evropi Forozidou
- Department of Otorhinolaryngology-Head and Neck Surgery, ’G. Papanikolaou’ General Hospital, Leoforos Papanikolaou 57010, Thessaloniki, Greece
| | - Georgios Fyrmpas
- Department of Otorhinolaryngology, School of Medicine, Democritus University of Thrace, Alexandroupolis, 69100 Greece
| | - Konstantinos Mantsopoulos
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - George K. Paraskevas
- Department of Anatomy and Surgical Anatomy, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, 54124 Greece
| | - Nikolaos Lazaridis
- Department of Anatomy and Surgical Anatomy, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, 54124 Greece
| | - Stavros Savvakis
- Department of Anatomy and Surgical Anatomy, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, 54124 Greece
| | - Paraskevi Karamitsou
- Department of Otorhinolaryngology-Head and Neck Surgery, ’G. Papanikolaou’ General Hospital, Leoforos Papanikolaou 57010, Thessaloniki, Greece
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Maržić D, Marijić B, Braut T, Janik S, Avirović M, Hadžisejdić I, Tudor F, Radobuljac K, Čoklo M, Erovic BM. IMP3 Protein Overexpression Is Linked to Unfavorable Outcome in Laryngeal Squamous Cell Carcinoma. Cancers (Basel) 2021; 13:cancers13174306. [PMID: 34503117 PMCID: PMC8430545 DOI: 10.3390/cancers13174306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/23/2021] [Accepted: 08/23/2021] [Indexed: 02/02/2023] Open
Abstract
Simple Summary IMP3 expression was analyzed in patients with malignant (laryngeal squamous cell carcinoma), semi-malignant (dysplasia) and benign (nodules, polyps) laryngeal lesions and correlated with clinical characteristics. Higher IMP3 stains were particularly found in malignant laryngeal pathologies, which might be useful for differentiation between premalignant and malignant lesions. In laryngeal cancer patients, higher IMP3 expression was associated with positive neck nodes and worse disease-specific survival. Abstract Background: The aim of this study was to (i) determine IMP3 protein expression in benign and malignant laryngeal lesions, (ii) compare its expression to Ki-67, p53, cyclin D1, and (iii) finally, to examine the prognostic power of IMP3 in squamous cell carcinomas of the larynx (LSSC). Methods: IMP3 protein expression was evaluated in 145 patients, including 62 LSCC, 45 dysplasia (25 with low and 20 with high-grade dysplasia), and 38 benign lesions (vocal cord polyps and nodules). Results: IMP3 was significantly higher expressed in LSCC compared to dysplasia and benign lesions (p < 0.001; p < 0.001, respectively). Similarly, higher expression patterns were observed for Ki-67 and p53, whereas cyclin D1 was equally distributed in all three lesions. IMP3 (p = 0.04) and Ki-67 (p = 0.02) expressions were significantly linked to neck node positivity, and IMP3 overexpression to worse disease-specific survival (p = 0.027). Conclusion: Since IMP3 showed significantly higher expression in laryngeal carcinomas, but not in high- or low-grade dysplasia, it serves as a useful marker to differentiate between invasive and noninvasive lesions. Higher IMP3 expression represented a significantly worse prognosticator for clinical outcomes of patients with squamous cell carcinoma of the larynx.
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Affiliation(s)
- Diana Maržić
- Department of Audiology and Phoniatrics, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia; (D.M.); (K.R.)
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia; (B.M.); (T.B.); (M.A.); (I.H.); (F.T.)
| | - Blažen Marijić
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia; (B.M.); (T.B.); (M.A.); (I.H.); (F.T.)
- Institute of Head and Neck Diseases, Evangelical Hospital, 1180 Vienna, Austria
- Department of Otorhinolaryngology, Head and Neck Surgery, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia
| | - Tamara Braut
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia; (B.M.); (T.B.); (M.A.); (I.H.); (F.T.)
- Department of Otorhinolaryngology, Head and Neck Surgery, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia
| | - Stefan Janik
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University Vienna, 1190 Vienna, Austria;
| | - Manuela Avirović
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia; (B.M.); (T.B.); (M.A.); (I.H.); (F.T.)
- Clinical Department of Pathology and Cytology, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia
| | - Ita Hadžisejdić
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia; (B.M.); (T.B.); (M.A.); (I.H.); (F.T.)
- Clinical Department of Pathology and Cytology, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia
| | - Filip Tudor
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia; (B.M.); (T.B.); (M.A.); (I.H.); (F.T.)
- Department of Otorhinolaryngology, Head and Neck Surgery, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia
| | - Katarina Radobuljac
- Department of Audiology and Phoniatrics, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia; (D.M.); (K.R.)
| | - Miran Čoklo
- Center for Applied Bioanthropology, Institute for Anthropological Research, 10000 Zagreb, Croatia;
| | - Boban M. Erovic
- Institute of Head and Neck Diseases, Evangelical Hospital, 1180 Vienna, Austria
- Correspondence:
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Gheorghe DC, Ilie A, Niculescu AG, Grumezescu AM. Preventing Biofilm Formation and Development on Ear, Nose and Throat Medical Devices. Biomedicines 2021; 9:1025. [PMID: 34440229 PMCID: PMC8394763 DOI: 10.3390/biomedicines9081025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/10/2021] [Accepted: 08/14/2021] [Indexed: 12/17/2022] Open
Abstract
Otorhinolaryngology is a vast domain that requires the aid of many resources for optimal performance. The medical devices utilized in this branch share common problems, such as the formation of biofilms. These structured communities of microbes encased in a 3D matrix can develop antimicrobial resistance (AMR), thus making it a problem with challenging solutions. Therefore, it is of concern the introduction in the medical practice involving biomaterials for ear, nose and throat (ENT) devices, such as implants for the trachea (stents), ear (cochlear implants), and voice recovery (voice prosthetics). The surface of these materials must be biocompatible and limit the development of biofilm while still promoting regeneration. In this respect, several surface modification techniques and functionalization procedures can be utilized to facilitate the success of the implants and ensure a long time of use. On this note, this review provides information on the intricate underlying mechanisms of biofilm formation, the large specter of implants and prosthetics that are susceptible to microbial colonization and subsequently related infections. Specifically, the discussion is particularized on biofilm development on ENT devices, ways to reduce it, and recent approaches that have emerged in this field.
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Affiliation(s)
- Dan Cristian Gheorghe
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- “M.S. Curie” Clinical Emergency Hospital for Children, 077120 Bucharest, Romania
| | - Andrei Ilie
- Faculty of Engineering in Foreign Languages, University Politehnica of Bucharest, 060042 Bucharest, Romania; (A.I.); (A.-G.N.)
| | - Adelina-Gabriela Niculescu
- Faculty of Engineering in Foreign Languages, University Politehnica of Bucharest, 060042 Bucharest, Romania; (A.I.); (A.-G.N.)
- Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, 060042 Bucharest, Romania
| | - Alexandru Mihai Grumezescu
- Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, 060042 Bucharest, Romania
- Research Institute of the University of Bucharest—ICUB, University of Bucharest, 050657 Bucharest, Romania
- Academy of Romanian Scientists, 3 Ilfov Street, 50044 Bucharest, Romania
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Do Salivary Bypass Tubes Reduce the Risk of Pharyngocutaneous Fistula after Laryngopharyngectomy-A Systematic Review and Meta-Analysis. Cancers (Basel) 2021; 13:cancers13112827. [PMID: 34204054 PMCID: PMC8201015 DOI: 10.3390/cancers13112827] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/30/2021] [Accepted: 06/02/2021] [Indexed: 01/12/2023] Open
Abstract
Simple Summary Salivary bypass tubes (SBT) have been introduced in order to reduce the risk of pharyngocutaneous fistula (PCF) after laryngectomy with pharynx reconstruction. Although the current literature is rather heterogenous, our meta-analysis demonstrates a favorable effect of SBT insertion on PCF formation in patients after laryngopharyngectomies. Abstract To evaluate the effect of salivary bypass tube (SBT) usage on the occurrence of pharyngocutaneous fistula (PCF) in patients after a laryngopharyngectomy, a total of 20 studies, published between 1988 and 2021, were identified including 2946 patients. We performed a meta-analysis assessing the risk of PCF occurrence in patients after SBT application compared to those without. PCF occurred in 26.8% of cases (669/2496) and SBT was applied in 33.0% of patients (820/2483). There was an overall trend towards lower PCF rates when using SBTs (22.2% vs. 35.3%; p = 0.057). We further selected five studies, comprising 580 patients who underwent laryngopharyngectomies, for meta-analysis showing that application of SBT reduced the risk of PCF formation (OR 0.46; 95% CI 0.18–1.18; p = 0.11). The meta-analysis demonstrates a beneficial effect of SBT insertion on PCF formation in patients after laryngopharyngectomy.
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Grasl S, Schmid E, Heiduschka G, Brunner M, Marijić B, Grasl MC, Faisal M, Erovic BM, Janik S. A New Classification System to Predict Functional Outcome after Laryngectomy and Laryngopharyngectomy. Cancers (Basel) 2021; 13:cancers13061474. [PMID: 33806944 PMCID: PMC8004622 DOI: 10.3390/cancers13061474] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/11/2021] [Accepted: 03/19/2021] [Indexed: 12/27/2022] Open
Abstract
Simple Summary Evaluation of the long-term functional outcome after primary or salvage laryngopharyngectomy. Long term functional outcome mainly depends on extent of pharyngectomy and salvage situation, which is reflected by our new classification system. Abstract (1) Objective: To evaluate long-term functional outcome in patients who underwent primary or salvage total laryngectomy (TL), TL with partial (TLPP), or total pharyngectomy (TLTP), and to establish a new scoring system to predict complication rate and long-term functional outcome; (2) Material and Methods: Between 1993 and 2019, 258 patients underwent TL (n = 85), TLPP (n = 101), or TLTP (n = 72). Based on the extent of tumor resection, all patients were stratified to (i) localization I: TL; II: TLPP; III: TLTP and (ii) surgical treatment (A: primary resection; B: salvage surgery). Type and rate of complication and functional outcome, including oral nutrition, G-tube dependence, pharyngeal stenosis, and voice rehabilitation were evaluated in 163 patients with a follow-up ≥ 12 months and absence of recurrent disease; (3) Results: We found 61 IA, 24 IB, 63 IIA, 38 IIB, 37 IIIA, and 35 IIIA patients. Complications and subsequently revision surgeries occurred most frequently in IIIB cases but rarely in IA patients (57.1% vs. 18%; p = 0.001 and 51.4% vs. 14.8%; p = 0.002), respectively. Pharyngocutaneous fistula (PCF) was the most common complication (33%), although it did not significantly differ among cohorts (p = 0.345). Pharyngeal stenosis was found in 27% of cases, with the highest incidence in IIIA (45.5%) and IIIB (72.7%) patients (p < 0.001). Most (91.1%) IA patients achieved complete oral nutrition compared to only 41.7% in class IIIB patients (p < 0.001). Absence of PCF (odds ratio (OR) 3.29; p = 0.003), presence of complications (OR 3.47; p = 0.004), and no need for pharyngeal reconstruction (OR 4.44; p = 0.042) represented independent favorable factors for oral nutrition. Verbal communication was achieved in 69.3% of patients and was accomplished by the insertion of voice prosthesis in 37.4%. Acquisition of esophageal speech was reached in 31.9% of cases. Based on these data, we stratified patients regarding the extent of surgery and previous treatment into subgroups reflecting risk profiles and expectable functional outcome; (4) Conclusions: The extent of resection accompanied by the need for reconstruction and salvage surgery both carry a higher risk of complications and subsequently worse functional outcome. Both factors are reflected in our classification system that can be helpful to better predict patients’ functional outcome.
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Affiliation(s)
- Stefan Grasl
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, 1090 Vienna, Austria; (S.G.); (E.S.); (G.H.); (M.B.); (M.C.G.)
| | - Elisabeth Schmid
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, 1090 Vienna, Austria; (S.G.); (E.S.); (G.H.); (M.B.); (M.C.G.)
| | - Gregor Heiduschka
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, 1090 Vienna, Austria; (S.G.); (E.S.); (G.H.); (M.B.); (M.C.G.)
| | - Markus Brunner
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, 1090 Vienna, Austria; (S.G.); (E.S.); (G.H.); (M.B.); (M.C.G.)
| | - Blažen Marijić
- Institute of Head and Neck Diseases, Evangelical Hospital, 1180 Vienna, Austria; (B.M.); (B.M.E.)
- Department of Otorhinolaryngology, Head and Neck Surgery, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia
| | - Matthaeus Ch. Grasl
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, 1090 Vienna, Austria; (S.G.); (E.S.); (G.H.); (M.B.); (M.C.G.)
| | - Muhammad Faisal
- Shaukat Khanum Memorial Cancer Hospital, Lahore 54000, Pakistan;
| | - Boban M. Erovic
- Institute of Head and Neck Diseases, Evangelical Hospital, 1180 Vienna, Austria; (B.M.); (B.M.E.)
| | - Stefan Janik
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, 1090 Vienna, Austria; (S.G.); (E.S.); (G.H.); (M.B.); (M.C.G.)
- Correspondence:
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