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Total laryngectomy is surgical removal of the entire larynx and is performed in cases of advanced larynx cancer. There are three methods of restoring voice after total laryngectomy: electrolaryngeal voice, esophageal voice, or tracheoesophageal voice with voice prosthesis where mucosa of pharyngoesophageal segment is the source of voice production. The acoustic analysis of alaryngeal voice is gold standard in assessing the voice quality in patients after total laryngectomy. Unfortunately, by using videostroboscopy, standard diagnostic procedure for visual analysis of vocal mucosa vibratory behavior, it is not possible to visualize and measure vibrations of pharyngoesophageal segment. High-speed videoendoscopy has proven to be the optimal method for visual recording of vibratory movement of the mucosa of pharyngoesophageal segment. By reviewing the current literature we provided a detailed insight into application of high-speed videoendoscopy in the analysis of phonatory behavior of pharyngoesophageal segment in laryngectomized patients.

Head and neck cancers are associated with significant morbidity and mortality despite advancements in treatment in recent decades. A multidisciplinary approach to the treatment of these diseases is thus of essential importance and is becoming the gold standard. Head and neck tumors also endanger relevant structures of the upper aerodigestive tracts, including bodily functions such as voice, speech, swallowing, and breathing. Damage to these functions can significantly influence quality of life. Thus, our study examined not only the roles of head and neck surgeons, oncologists and radiotherapists, but also the importance of the participation of different scientific professions such as anesthesiologists, psychologists, nutritionists, stomatologists, and speech therapists in the work of a multidisciplinary team (MDT). Their participation results in a significant improvement of patient quality of life. We also present our experiences in the organization and work of the MDT as part of the Center for Head and Neck Tumors of the Zagreb Clinical Hospital Center.

We performed a review of recent literature in order to present new insights in pathophysiology, symptomatology, diagnostics and therapy of laryngopharyngeal reflux (LPR). Although the number of LPR studies has increased significantly over the past few years, there are still no gold standards or standardized protocols for diagnosing and treating LPR, and an interdisciplinary approach is necessary. Questionnaires for symptom severity self-assessment and clinical signs should include both symptoms and signs of gastroesophageal reflux disease and respiratory system, and primary objective diagnostic tool should be a simple determination of the most reliable biomarker pepsin, from easily obtainable fluid, such as saliva. Unclear cases should be referred for further assessment with multichannel impedance and pH monitoring. It allows the determination of the type of reflux (acidic, mixed and non-acidic) and implementation of personalized therapy. According to the latest findings, behavioural therapy would be the method of choice in the treatment of mild forms of the LPR. In moderate and severe forms, the combination of drugs depends on the reflux type. Drug therapy should be carried out for a minimum of eight weeks, optimally three months, followed by follow-up examination and revision of symptoms and clinical findings. Significant improvement allows drug therapy reduction, while cases with slight improvement demand dosage increase and another three months of treatment. In cases without change or possible deterioration, patients should undergo additional gastroenterological work-up and potential surgical treatment. Strict adherence to behavioural measures is proposed, while long-term prescription of proton pump inhibitors is not recommended given the proven number of adverse drug reactions.

Lateral lymph node metastases occur in 30–80% of papillary thyroid carcinoma patients. It is generally accepted that they do not impact the overall survival but are identified as an independent risk factor for locoregional recurrence. However, their significance is still not clearly understood. The aim of this study is to analyse metastasizing to the lateral neck levels in a cohort of patients with papillary thyroid carcinoma and lateral neck metastases, and also to assess the recurrence rate through regular check-ups. Methods: We prospectively analysed the data of 135 patients who underwent total thyroidectomy with selective neck dissection (levels II–VI), from 2011 to 2020. We analysed demographics and clinical characteristics of patients and assessed their correlation. Patients were followed up until April 2021. The median follow-up period was 62 months. Patients were followed up through regular check-ups and hospital records. Results: The median age was 36.8 years, 28 percent were men. The most frequently affected neck levels were III, IV, II, and V, respectively. Primary tumours larger than one cm displayed a higher number of positive lymph nodes, while extracapsular spread was revealed to be an independent risk factor for a higher number of positive lymph nodes. During a median follow-up period of 62 months, 18 (13.3%) patients developed regional recurrence of the disease, while two patients (1.2%) developed distant metastases.The mean disease-free period was 16.7 months. Conclusion: Lateral neck metastases occur in predictable patterns. The most frequently affected neck level was III, followed by IV. In two-thirds of the patients, metastases were found in multiple lateral neck levels. Tumour size and extracapsular spread show association with a higher number of positive lymph nodes, and with the higher number of positive nodes in patients with extracapsular spreading. Considering the recurrence rate in the follow-up period, we can conclude that selective neck dissection of levels II–VI proved to be an optimal treatment modality for such patients.

Aim: The aim of this study was to show changes in the work of the Ear, Nose, Throat and Head and Neck Surgery Department, UHC Zagreb, during the COVID-19 pandemic. Methods: We retrospectively extracted and compared the data on the procedures and diagnoses of the Department during the period from January 1st to April 30th in 2019, 2020 and 2021. Results: The total number of cases was lower by 34.2% in 2020, and by 13.19% in 2021, compared to 2019 (p

This study aims to provide insight into the etiology and frequency of swallowing complications that arise after thyroidectomy and to outline the available diagnostic procedures by revising the existing literature on this topic. We conducted a bibliographic search using the electronic database MEDLINE /PubMed to identify all relevant articles and 44 studies were included in the review out of a total of 218 published articles. Dysphagia after thyroid surgery is a common postoperative complication which, in the short- or long-term, significantly affects patient life quality. There is no standard diagnostic protocol for thyroidectomy-related swallowing impairment. Among the reviewed studies, 8 questionnaires and 12 instrumental diagnostic tools were used to identify swallowing difficulties related to thyroid surgery. The Swallowing Impairment Index (SIS-6) was the most-used questionnaire. Fiberoptic endoscopy is a standard diagnostic tool performed prior and after thyroid surgery, primarily to identify changes in vocal fold mobility. Although instrumental findings usually reveal non-specific alterations of swallowing; swallowing videofluoroscopy and esophageal manometry can be the most helpful tools in further management of thyroidectomy dysphagia. In patients with thyroidectomy-related swallowing difficulties and suspected laryngopharyngeal reflux, 24-hour MII - pH metry should be performed.

Autologous fat vocal fold augmentation is a widespread surgical procedure that aims to repair glottal incompetence in patients with unilateral vocal fold paralysis (UVFP). However, there are some concerns in the literature about the long-term results of this technique. At the ENT Department of the Zagreb University Hospital Centre, this technique has been in use for more than 15 years, and a retrospective medical chart review was conducted from June 2005 to November 2019. Overall, 78 patients with UVFP met the inclusion criteria for enrolment in the study. All patients underwent at least one preoperative and two postoperative voice assessments, one early (within 3 months from surgery) and one late (at least 1 year after surgery). All tested voice outcome parameters (maximum phonation time (MPT), jitter, shimmer, noise-to-harmonic ratio (NHR )) significantly improved after surgery, both early and late postoperatively (p

Cervical lymph node metastases are frequently found in papillary thyroid carcinoma (PTC) and occur in a stepwise fashion. Skip metastases that omit the central compartment and spread initially in lateral neck levels are present in a certain share of patients, and their significance is poorly understood. The aim of this prospective study was to identify their possible predictors and clinicopathological factors in a group of patients with PTC with lateral lymph node (LLN ) metastases. Methods: We enrolled 68 patients with PTC with preoperatively evaluated LLN metastases who underwent total thyroidectomy with lateral lymph node dissection between 2011 and 2018. We analysed the clinicopathological features and pattern of dissemination of continuous and skip metastases. Results: The prevalence of skip metastases was 23.5%. Compared with the continuous metastases group, the patients were older, had primary tumors that were more often situated unilaterally, and had smaller primary tumor size. Level II was less often involved, and none of the patients with skip metastases had all LNN positive (p = 0.05). Conclusion: Skip metastases occur more frequently in older patients and display certain clinicopathological features like smaller size of the primary tumor and dissemination in less lateral neck levels. In the view of the fact that they are found rather frequently, lateral neck regions should be meticulously investigated in patients with PTC without central lymph node (CLL ) metastases.