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The objective of this study is to evaluate the efficacy of the Harmonic ACE™, Harmonic FOCUS™ and harmonic scalpel with 5-mm curved blade in head and neck surgery. During a 15-month period, we performed 295 thyroidectomies, 23 parotidectomies and 45 tonsillectomies using the harmonic scalpel. Control group consisted of 106 thyroidectomies, 9 parotidectomies and 30 tonsillectomies performed with the use of conventional hemostatic techniques. The use of both Harmonic ACE™ and Harmonic FOCUS™ scalpel reduced the time of thyroid and parotid surgery by 20–25%. The use of Harmonic ACE™ reduced the mean time of tonsillectomy, while the use of 5-mm curved blade had no significant effect. Postoperative pain and complication rate were comparable for both the groups. In conclusion, the use of both Harmonic ACE™ and Harmonic FOCUS™ devices significantly reduces operative time in the head and neck procedures and enables a smaller neck skin incision in thyroidectomy.

Chordomas are rare, malignant, slowly growing neoplasms which develop from vestigial remnants of the fetal notochord. Most chordomas arise in the sacrococcygeal and spheno-occipital region. Extranotochordal chordomas are extremely unusual. A case of extranotochordal chordoma with extralaryngeal localization is described. A 73-year-old male presented with swallowing difficulties and hoarseness. Contrast-enhanced magnetic resonance imaging of the neck revealed a well-encapsulated tumor mass that was well enhanced and located in the left retrolaryngeal space at the level of C4, dislocating the larynx to the right. Left radical neck dissection and tumor extirpation were performed. The tumor had not invaded cervical vertebra and the surrounding soft tissue but superficial erosions of the ossificated thyroid and cricoid cartilage were found. High-power pathologic examination and immunohistochemistry defined the lesion as a dedifferentiated type of chordoma. The patient received adjuvant radiotherapy. Four years after the surgery, the patient has been free from tumor recurrence.

The level of Ki-67 antigen expression has been proven to correlate with cellular proliferation. The aim of the study was to show correlation of Ki-67 expression with the clinical stage and its predictive value for the prognosis of laryngeal carcinoma. The study included 48 patients with surgically removed carcinoma of the larynx. Study results pointed to a significant difference in the mean value of Ki-67 reactivity between the study and control group consisting of cadaveric laryngeal tissue free from the disease. Correlation was found between the TNM stage of carcinoma and percentage of Ki-67-labeled cells. A significant correlation was also observed between Ki-67 reactivity at the time of laryngeal surgery and 2-year clinical outcome of the disease. Ki-67 reactivity was significantly higher in the group of patients with disease remission compared with the control group but was significantly lower as compared with the group of patients with poor outcome.

Foreign bodies in paranasal sinuses are found quite infrequently. They are usually detected after various types of head trauma and most commonly occur as a consequence of improper handling of firearms or explosives. In countries at war, eg, during the war in Croatia, adults and children were almost equally exposed to these injuries. The diagnosis should be based on results from precise computer tomography (CT) scanning in axial and coronal sections, and, using these data, tissues of different densities at these anatomical locations can be differentiated. The possibility of exact preoperative, noninvasive visualization of the spatial relationships of anatomic and pathologic structures with 3-dimensional (3D) computer-assisted diagnosis and intraoperative navigational techniques allows the surgeon to achieve a considerable advantage in the preoperative examination of the patient and to reduce the risk of intraoperative complications, all by the use of virtual surgery (VS) or virtual diagnosis. The expected contribution of the mentioned computer-assisted surgical technique manifests itself in defining the most appropriate mode of CT scanning of the head to design the 3D operating field model, and the possibility of active and dynamic 3D visualization of the desired anatomical regions is realized. 3D reconstruction of anatomic units becomes a routine preoperative procedure, providing a highly useful and informative visualization of the regions of interest, and, thus, advancing the definition of geometric information on anatomical contours of the 3D model by the transfer of so-called image pixel to contour pixel.

Objectives: The superficial layer of deep cervical fascia represents a valuable material for the reconstruction of defects secondary to partial vertical laryngeal resections. However, there are drawbacks to the use of this flap, which include possible weakness and subsequent instability of the laryngeal wall. Methods: To overcome this problem, we included platysma along with the superficial layer of deep cervical fascia to form a composite soft tissue flap that will meet all reconstructive needs following partial vertical laryngeal resection. Results: Inclusion of platysma yields more durable and adequately vascularized flap resistant to saliva, seroma formation, and infection. Because of segmental blood supply of strap muscles and their indirect perforating vessels, medially based horizontal composite flap is better supplied with blood in comparison with cranially based vertical flap. Medial insertion of the horizontal flap is much more convenient than lateral, due to ancillary blood supply from the contralateral side and easier pursuance of ipsilateral neck dissection. Conclusions: The method of our choice for laryngeal reconstruction after partial vertical laryngeal resections is paramedially based horizontal platysmofascial composite flap with the insertion opposite to the side of the primary laryngeal tumor.

The main goal of our dynamic 3D computer-assisted reconstruction of a metallic retrobulbar foreign body following orbital injury with ethmoid bone involvement was to use 3D-information obtained from standard computed tomography (CT) data to explore and evaluate the nasal cavity, ethmoidal sinuses, retrobulbar region, and the foreign body itself by simulated dynamic computed visualization of the human head. A foreign body, 10 x 30 mm in size, partially protruded into the posterior ethmoidal cells and partially into the orbit, causing dislocation and compression of the medial rectus muscle and inferior rectus muscle. The other muscles and the optic nerve were intact. Various steps were taken to further the ultimate diagnosis and surgery. Thin CT sections of the nasal cavity, orbit and paranasal sinuses were made on a conventional CT device at a regional medical center, CT scans were transmitted via a computer network to different locations, and special views very similar to those seen on standard endoscopy were created. Special software for 3D modeling, specially designed and modified for 3D C-FESS purposes, was used, as well as a 3D-digitizer connected to the computer and multimedia navigation through the computer during 3D C-FESS. Our approach achieves the visualization of very delicate anatomical structures within the orbit in unconventional (non-standard) sections and angles of viewing, which cannot be obtained by standard endoscopy or 2D CT scanning. Finally, virtual endoscopy (VE) or a 'computed journey' through the anatomical spaces of the paranasal sinuses and orbit substantially improves the 3D C-FESS procedure by simulating the surgical procedure prior to real surgery.

Various different procedures for partial or total reconstruction of the nose have been described, the methods of residual nasal tissue, and of buccal, frontal and temporal flaps being most widely used. Reconstruction of the nose with free vascular transplants is rarely used. Reconstruction of a nasal defect due to war injury of the nose with the use of prelaminated fasciocutaneous forearm flap with preserved allogeneic cartilage is described.

Objective:Nasopharyngeal tuberculosis is a rare condition, even in endemic tuberculosis areas. We report a case of primary nasopharyngeal tuberculosis from a non-endemic area, which presented with symptoms resembling exacerbation of previously diagnosed chronic rhinosinusitis.Case report:A 48-year-old man presented with extreme postnasal drip and an unpleasant nasal odour. Endoscopic examination revealed irregular thickening of the left lateral and posterior wall of the nasopharynx, partially covered with crusts and necrotic tissue. Histopathological study showed typical giant cell epithelioid granulomas with caseous necrosis. Direct examination after Ziehl–Neelsen staining was positive for tuberculosis. After six months of antituberculous triple therapy, endoscopic examination revealed a completely normal nasopharynx.Conclusion:To our best knowledge, this is the first published report of primary nasopharyngeal tuberculosis in a patient previously diagnosed with chronic rhinosinusitis. The difficulties in obtaining a proper diagnosis in such a case are discussed.

One of the main objectives of our 3-dimensional (3D) computer-assisted functional endoscopic sinus surgery was to design a computer-assisted 3D approach to the presurgical planning, intraoperative guidance, and postoperative analysis of the anatomic regions of the nose and paranasal sinuses. Such an extremely powerful approach should allow better insight into the operating field, thereby significantly increasing the safety of the procedure. The last step to implementing the technology in the operating room was to connect the computer workstations and video equipment to remote locations by using a high-speed, wide-bandwidth computer network. During patient preparation, the surgeon in the operating room consulted remote experienced and skillful surgeons by viewing CT images and 3D models on computer workstations. The surgeon and consultants used software for CT image previews and 3D model manipulations on top of collaboration tools to define the pathosis, produce an optimal path to the pathosis, and decide how to perform the real surgical procedure. With tele-flythrough or tele-virtual endoscopy rendered through the use of 3D models, both surgeons can preview all the characteristics of the region (ie, anatomy, pathosis) and so predict and determine the next steps of the operation. This ensures greater safety thanks to the operation guidance and reduces the possibility of intraoperative error. The duration of the teleconsultation is thus shortened, which may prove the greatest benefit of tele-3D computer-assisted surgery. If this method were used, clinical institutions would spend less money for telesurgical consultation.