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Sotirović J, Baletić N, Dimić A, Vukomanović Đurđević B, Milojević M, Čukić O, Perić A. Large Paraganglioma of the Larynx-Surgical Resection With Laryngeal Framework Preservation. Ear Nose Throat J 2024:1455613241241961. [PMID: 38533742 DOI: 10.1177/01455613241241961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024] Open
Affiliation(s)
- Jelena Sotirović
- Department of Otorhinolaryngology, Faculty of Medicine, Military Medical Academy, University of Defence, Belgrade, Serbia
| | - Nenad Baletić
- Department of Otorhinolaryngology, Faculty of Medicine, Military Medical Academy, University of Defence, Belgrade, Serbia
| | - Aleksandar Dimić
- Department of Otorhinolaryngology, Military Medical Academy, Belgrade, Serbia
| | - Biserka Vukomanović Đurđević
- Pathology and Forensic Medicine Institute, Faculty of Medicine, Military Medical Academy, University of Defence, Belgrade, Serbia
| | - Milanko Milojević
- Department of Otorhinolaryngology, Faculty of Medicine, Military Medical Academy, University of Defence, Belgrade, Serbia
| | - Ognjen Čukić
- Department of Otorhinolaryngology, Military Medical Academy, Belgrade, Serbia
| | - Aleksandar Perić
- Department of Otorhinolaryngology, Faculty of Medicine, Military Medical Academy, University of Defence, Belgrade, Serbia
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Perić A, Đurđević BV, Sotirović J, Milojević M, Baletić N. Chondromesenchymal Hamartoma With Nasopharyngeal Involvement: Two Unusual Cases of an Extremely Rare Lesion. Ear Nose Throat J 2023; 102:NP8-NP12. [PMID: 33393813 DOI: 10.1177/0145561320986031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Chondromesenchymal hamartoma (CMH) is a rare, benign lesion of the nasal cavity, paranasal sinuses, and skull base, composed of islands of hyaline cartilage in a myxoid background. The vast majority of CMH cases are infants and young children. According to the world literature, nasopharyngeal involvement of CMH is extremely rare. In all cases, the lesions were masses protruding from the nasal cavity or paranasal sinuses to the nasopharynx. We hereby report 2 adult male patients with masses completely situated in the nasopharyngeal space. In the first patient, the tumor originated from the posterior edge of the nasal septum and in the second one, from the posterolateral wall of the nasopharynx, adjacent to the pharyngeal orifice of the Eustachian tube. In both patients, the lesion was excised endoscopically, and histopathological analyses were consistent with a diagnosis of CMH. To our knowledge, those are the only cases of CMH completely situated in the nasopharynx.
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Affiliation(s)
- Aleksandar Perić
- Department of Otorhinolaryngology, Military Medical Academy Faculty of Medicine, University of Defence, Belgrade, Serbia
| | | | - Jelena Sotirović
- Department of Otorhinolaryngology, Military Medical Academy Faculty of Medicine, University of Defence, Belgrade, Serbia
| | - Milanko Milojević
- Department of Otorhinolaryngology, Military Medical Academy Faculty of Medicine, University of Defence, Belgrade, Serbia
| | - Nenad Baletić
- Department of Otorhinolaryngology, Military Medical Academy Faculty of Medicine, University of Defence, Belgrade, Serbia
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Perić A, Đurđević BV, Labus M, Gaćeša D, Barsova GK, Baletić N. Simultaneous Nasal Septal Schneiderian Papilloma and Respiratory Epithelial Adenomatoid Hamartoma. Ear Nose Throat J 2022:1455613221135648. [PMID: 36250396 DOI: 10.1177/01455613221135648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Schneiderian papilloma is typically found on the lateral nasal wall, but, in rare cases, can be located at the mucosa of the nasal septum. Respiratory epithelial adenomatoid hamartoma (REAH) is rare, non-neoplastic lesion characterized by an abnormal proliferation of glandular part of the respiratory nasal mucosa. We present a case of a 42-year-old man with five-year history of bilateral nasal obstruction, rhinorrhea, epistaxis, and hyposmia. On endoscopic examination, we found lobulated, yellowish-pink soft tissue masses on both sides of the nasal septum. The results of histopathological analyses showed the characteristics of Schneiderian papilloma in the lesion excised from the right and REAH in the lesion excised from the left side of the nasal cavity. To our knowledge, cases of simultaneous presentation of Schneiderian papilloma and REAH on opposite sides of the nasal septum have not been published so far. An appropriate cooperation of rhinologist and pathologist allows for a correct diagnosis of these rare and unusual lesions.
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Affiliation(s)
- Aleksandar Perić
- Department of Otorhinolaryngology, Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
| | - Biserka Vukomanović Đurđević
- Institute for Pathology, Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
| | - Milica Labus
- Department of Otorhinolaryngology, Military Medical Academy, Belgrade, Serbia
| | | | | | - Nenad Baletić
- Department of Otorhinolaryngology, Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
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Dimić A, Perić A, Grgurević U, Sotirović J, Labus M, Baletić N, Milojević M, Stanojević I, Vojvodić D. Different levels of mucus inflammatory mediators in nasal polyposis with and without aeroallergen sensitivity. Laryngoscope Investig Otolaryngol 2022; 7:671-678. [PMID: 35734071 PMCID: PMC9194980 DOI: 10.1002/lio2.794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives Biomarker levels in nasal secretions can reflect the inflammatory status of nasal mucosa and evolution of sinus disease. The aim of this study was to evaluate the relationship between local inflammatory mediator production and clinical characteristics of patients with nasal polyposis (NP). Methods Thirty‐one nonaeroallergen sensitized patients with NP (NANP), 29 aeroallergen sensitized patients with NP (ANP), and 30 subjects without inflammation of nasal mucosa as controls (C) entered this prospective, cross‐sectional study. Clinical parameters (symptoms, endoscopic, and radiological findings) were assessed. The concentrations of heat shock protein 70 (HSP70), eosinophil cationic protein (ECP), tryptase, substance P and Clara cell protein 16 (CC16) were measured in the nasal secretion samples of all participants by ELISA method. Results Our results showed higher concentrations of HSP70, ECP, and tryptase in ANP than in NANP and C (p < .001 for all markers). On the other hand, levels of CC16 were significantly higher in C than in NANP and ANP groups (p < .001; p < .001, respectively). We found positive correlations between HSP70, ECP, tryptase, and substance P levels and nasal symptom score in patients with NP. Also, HSP70, ECP, tryptase, and substance P showed different levels of positive correlation among themselves, with HSP70 showing highest positive correlation with ECP. Finally, relatively strong negative correlations were found between the levels of CC16 and nasal symptoms, as well as between the CC16 levels and levels of other four mediators in nasal fluid. Conclusion HSP70, ECP, tryptase, and substance P might play a role in the pathogenesis of NP. The results suggest that chronic inflammation in NP involves a self‐sustaining local release of HSP70, ECP, and tryptase, independent of aeroallergen stimulation of the mucosal layer, although the production of these mediators is higher in aeroallergen sensitized NP patients.
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Affiliation(s)
- Aleksandar Dimić
- Department of Otorhinolaryngology Military Medical Academy Belgrade Serbia
| | - Aleksandar Perić
- Department of Otorhinolaryngology, Faculty of Medicine of the Military Medical Academy University of Defence Belgrade Serbia
| | - Uglješa Grgurević
- Department of Otorhinolaryngology Military Medical Academy Belgrade Serbia
| | - Jelena Sotirović
- Department of Otorhinolaryngology, Faculty of Medicine of the Military Medical Academy University of Defence Belgrade Serbia
| | - Milica Labus
- Department of Otorhinolaryngology Military Medical Academy Belgrade Serbia
| | - Nenad Baletić
- Department of Otorhinolaryngology, Faculty of Medicine of the Military Medical Academy University of Defence Belgrade Serbia
| | - Milanko Milojević
- Department of Otorhinolaryngology, Faculty of Medicine of the Military Medical Academy University of Defence Belgrade Serbia
| | - Ivan Stanojević
- Institute for Medical Research, Division of Clinical and Experimental Immunology Faculty of Medicine of the Military Medical Academy Belgrade Serbia
| | - Danilo Vojvodić
- Institute for Medical Research, Division of Clinical and Experimental Immunology Faculty of Medicine of the Military Medical Academy Belgrade Serbia
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Perić A, Matković-Jožin S, Baletić N. Large Doubly Septated Concha Bullosa: An Unusual Anatomic Variation. Acta Med (Hradec Kralove, Czech Repub ) 2016; 52:129-131. [DOI: 10.14712/18059694.2016.118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Partial or total pneumatization of the middle turbinate is called concha bullosa. It’s one of the most common anatomic variations of the lateral nasal wall. The exact reason of such pneumatization is not known. It can originate from the frontal recess, middle meatus, sinus lateralis or, less frequently, from the posterior ethmoid cells. Concha bullosa remains usually asymptomatic. However, an extensively pneumatized middle turbinate may constitute space-occupying mass, and thus, it may cause nasal obstruction. We report an extremely rare case of a patient with a large, doubly septated concha bullosa with four different sources of aeration.
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Sotirović J, Šuljagić V, Baletić N, Pavićević L, Bijelić D, Erdoglija M, Perić A, Soldatović I. Risk factors for surgical site infection in laryngeal cancer surgery. Acta Clin Croat 2015; 54:57-64. [PMID: 26058244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
Surgical site infection (SSI) is a significant factor of morbidity and mortality in patients surgically treated for laryngeal carcinoma. The aim of this prospective study in 277 patients was to determine the incidence of SSI in patients surgically treated for laryngeal squamous cell carcinoma and to identify risk factors for development of SSI. Patients with previous chemotherapy and/or radiotherapy were excluded. All patients had tracheostomy postoperatively and received antibiotic prophylaxis with cephalosporin, aminoglycoside and metronidazole. The overall incidence of SSIs in our cohort was 6.5% (18 patients): 4 (22.22%) patients with superficial infections, 11 (61.11%) with deep infections and 3 (16.66%) with organ-space infections. The remaining infections included pneumonia (1 case) and Clostridium difficile colitis (2 cases). The median hospital stay in patients having developed SSIs was longer than in those without SSIs (33.5 vs. 16 days, p < 0.001). By using univariate analysis American Society of Anesthesiologists score > 3, duration of surgery longer than 120 minutes and National Nosocomial Infections Surveillance risk index > 1 were found to be significantly associated with the occurrence of SSI. Age, sex, body mass index, history of smoking, underlying diabetes and preoperative length of stay were found not to be associated with SSI. The most frequently isolated microorganism was Klebsiella spp.
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Perić A, Baletić N, Sotirović J, Špadijer-Mirković C. Macrophage Inflammatory Protein-1 Production and Eosinophil Infiltration in Chronic Rhinosinusitis With Nasal Polyps. Ann Otol Rhinol Laryngol 2014; 124:266-72. [DOI: 10.1177/0003489414554944] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Eosinophil recruitment to the nasal mucosa involves a number of chemokines. The aim of this study was to evaluate nasal secretion levels of macrophage inflammatory protein-1 alpha (MIP-1α) and MIP-1β and to correlate these levels with clinical characteristics and degree of eosinophilia in nonallergic and allergic patients with nasal polyposis (NP). Methods: Fourteen nonatopic and 14 atopic patients with NP were recruited for this cross-sectional study. Fourteen healthy subjects were included as controls. The concentrations of MIP-1α and MIP-1β in nasal secretions were measured by flow cytometry. Eosinophil counts were performed by cytological examination of the scraped nasal mucosa. We scored each of the 28 patients according to the nasal symptom score, endoscopic score, and computed tomography (CT) score. Results: We found significantly higher concentrations of MIP-1α in nasal fluid of nonallergic and allergic NP patients compared to control subjects. In nonallergic patients, we found positive correlations between MIP-1α levels and endoscopic score, CT score, and the percentage of eosinophils. Conclusion: MIP-1α may play a role in eosinophil recruitment in NP. Our results suggest that the measurement of MIP-1α in nasal secretions could be useful in evaluating the degree of eosinophil inflammation and severity of disease in nonallergic patients.
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Affiliation(s)
- Aleksandar Perić
- Department of Otorhinolaryngology, Faculty of Medicine, Military Medical Academy, Belgrade, Serbia
| | - Nenad Baletić
- Department of Otorhinolaryngology, Faculty of Medicine, Military Medical Academy, Belgrade, Serbia
| | - Jelena Sotirović
- Department of Otorhinolaryngology, Faculty of Medicine, Military Medical Academy, Belgrade, Serbia
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Sotirović J, Vukomanović-Djurdjević B, Baletić N, Pavićević L, Bijelić D, Perić A. Recurrent lipomatous tumor of hypopharynx: case report and literature review. Acta Clin Croat 2014; 53:365-368. [PMID: 25509250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
Liposarcoma is one of the most common soft-tissue sarcomas in adults, but head and neck are rarely involved, especially regions of the larynx and hypopharynx. According to Enzinger and Weiss, liposarcoma can be divided into 5 subtypes: well-differentiated, myxoid, round cell, pleomorphic and dedifferentiated. We present an unusual case of well-differentiated liposarcoma of the hypopharynx in a patient with previous three procedures of endoscopic removal of hypopharyngeal tumor classified as benign lipoma. Well-differentiated liposarcoma is a tumor of low-grade malignancy, which frequently recurs locally, but does not metastasize. Wide tumor resection with free margins is mandatory. Immunohistochemistry is a useful diagnostic tool. We also discuss recently published literature on this unusual presentation of well-differentiated liposarcoma.
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Milojević M, Đerić D, Jovanović M, Perić A, Baletić N. „OMEGA SHAPE“ ANOMALY OF THE TYMPANIC SEGMENT OF THE FACIAL NERVE – A CASE REPORT. AMM 2012. [DOI: 10.5633/amm.2012.0306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Erdoglija M, Sotirović J, Baletić N. Early postoperative complications in children with secretory otitis media after tympanostomy tube insertion in the Military Medical Academy during 2000-2009. VOJNOSANIT PREGL 2012; 69:409-413. [PMID: 22764543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND/AIM Secretory otitis media (SOM) is a chronic, nonpurulent inflammation of the middle ear, characterized by a long-term presence of liquids of different density in the middle ear for at least three consecutive months, different degrees of hearing loss and the absence of perforation of the eardrum. The aim of this study was to estimate the early postoperative complications after insertion of tympanostomy tube (TT) in children with secretory otitis media (SOM) in an 18-month period after TT insertion. METHODS This retrospective study included children with SOM (n = 478), aged from 2.5 to 16 years, operated from 2000 to 2009. During these ten years 365 children had TT in both ears, 131 children had TT in one ear and 55 children were operated two or more times. Totally 843 ears were operated on. Date were obtained by regular fallow up in Out-patient clinic concerning symptoms reported by children and parents, otomicroscopy findings and hearing measurements (audiometry and tympanometry). RESULTS Transient otorrhea was the most common early postoperative complication (16.5%), then obstruction (9.5%), premature extrusion of TT (3.9%), chronic otorrhea (3.1%), granulation tissue (1.1%) and medial displacement (0.5%). According to our experience gold and silicone TT were shown less successful than others. The incidence of premature extrusion of TT was significantly higher with gold TT, comparing to others (6/33, 18%; p < 0.001). We also found significantly more frequent medial displacement with silicone TT than with other ones (2/4, 50%; p < 0.001). CONCLUSION There are many early postoperative complications of TT insertion, but they depend on the meticulous surgery techniques, regular postoperative examinations and the type of TT. The type of TT should be determined according to own experience.
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Affiliation(s)
- Milan Erdoglija
- Clinic for Ear, Nose and Throat, Military Medical Academy, Belgrade, Serbia.
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Perić A, Matković-Joiin S, Baletić N. Large doubly septated concha bullosa: an unusual anatomic variation. Acta Medica (Hradec Kralove) 2009; 52:129-131. [PMID: 20073426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Partial or total pneumatization of the middle turbinate is called concha bullosa. It's one of the most common anatomic variations of the lateral nasal wall. The exact reason of such pneumatization is not known. It can originate from the frontal recess, middle meatus, sinus lateralis or, less frequently, from the posterior ethmoid cells. Concha bullosa remains usually asymptomatic. However, an extensively pneumatized middle turbinate may constitute space-occupying mass, and thus, it may cause nasal obstruction. We report an extremely rare case of a patient with a large, doubly septated concha bullosa with four different sources of aeration.
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Affiliation(s)
- Aleksandar Perić
- Clinic for Otorhinolaryngology, Military Medical Academy, 11040 Belgrade, Serbia.
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Perić A, Baletić N, Vukomanović-Durdević B, Jović M, Kozomara R. [Mucocoele of the maxillary sinus]. VOJNOSANIT PREGL 2007; 64:361-4. [PMID: 17585555 DOI: 10.2298/vsp0705361p] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Mucocoele is histopathologically benign, cystic change of paranasal sinuses filled with mucoid contents, which with its growth is pressuring and destroying local bone walls. In only 3% of the cases it can be localized in maxillary sinuses. Etiology is unknown. Pyocoele develops by secondary infection. CASE REPORT The male patient was 21 years old. His symptoms were runny nose with thick contents and heavy breathing on the right side of the nose, headaches, as well as the swelling of the right cheek. During clinical examination, the expansive change was found. It was completely closing the right side of the nose cavity. Computerized tomography (CT) of paranasal cavities showed excessive expansion of the right maxillary sinus, with very thinned walls, while the cavity was filled with liquid. After antibiotics therapy, the radical operation of the right maxillary sinus was performed, based on Caldwell Luc method. The frontal wall was found to be extremely convex and thinned, while the medial wall was with dehiscention. The cystic change was extirpated. Mucocoele was proved by pathohistologic findings. Its wall was about 2 mm thick and it showed squamous metaplasia in the large part of the mucocoela epithel. In the submucosa fibrosis and inflammatory infiltrate was present. Postoperative follow-up was under control. Clinicaly and radiographycaly, six months after therapy, the patient does not have troubles. CONCLUSION The rare localization of the mucocoeles in maxillary sinus can be explained with the width of the maxillary ostia. Infected mucocoeles, expanded to the local anatomical structures, should be operated on with classic radical surgical operation.
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Affiliation(s)
- Aleksandar Perić
- Vojnomedicinska akademija, Klinika za otorinolaringologiju, Beograd.
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Baletić N, Petrović Z, Malićević H. [New trends in endoscopic diagnosis of tumors of the larynx]. SRP ARK CELOK LEK 2003; 131:182-5. [PMID: 14608885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
Abstract
Early detection and accurate determination of localization and extent of benign growths, particularly precancerous lesions and malignant tumors of larynx have significant therapeutic and prognostic importance. Today, laryngomicroscopy (LMS) is worldwide accepted diagnostic procedure for detection, description and biopsy of laryngeal pathology. In many cases it is a therapeutic procedure. However, detection and accurate description of laryngeal lesion can often be a difficult task, requiring great experience of ENT specialist. Because that attempts to optimize diagnostic procedure for more sensitive detection, and more accurate describing of laryngeal pathology are still challenges for otolaryngologists. Each diagnostic procedure that is able to give accurate information about nature of laryngeal lesion without devastation of tissue has important advantages over standard biopsy. Contact laryngomicroscopy is in vivo microscopic examination of laryngeal mucosa without biopsy. Procedure is performed during laryngomicroscopy by introducing contact endoscope into larynx. Autofluorescent endoscopy is based on ability of flavin mononucleotide (FMN) in normal cells to emit green fluorescence when is exposed to blue light. Neoplastic cells do not have FMN and do not emit green fluorescence. This procedure does not require any substance as a photosenzitizer. Induced fluorescence is based on selective accumulation of protoporphyrine IX (PP IX) in neoplastic tissue that can be detected as a violet fluorescence that emit PP IX. Induction of tumor tissue to fluoresce is achieved with topic or systemic application of 5-aminolevulinic acid (5-ALA). These diagnostic methods have greater sensitivity in detection of tumor than laryngomicroscopy, but have some disadvantages. Combination of laryngomicroscopy and any of these procedures gives more accurate diagnosis than laryngomicroscopy alone.
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Affiliation(s)
- Nenad Baletić
- Clinic for Ear, Nose and Throat, Military Medical Academy, Belgrade.
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