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Background: Botulinum toxin (BT) is primarily known for its aesthetic applications, but there are many opportunities to use the toxin for the prevention and treatment of various other conditions. BT is not very widespread in otolaryngology practice, but can be effective in many diseases. The TB mechanism is related to the blockade of the muscular plate or the glandular one and is therefore effective in various muscular disorders and autonomic secretory disorders. Aim: The purpose of this work is to review the applications of botulinum toxin in otolaryngology. Material and methods: Scientific publications on the Pubmed platform were reviewed using the keywords: botulinum toxin and otolaryngology, and time descriptors were set for 20122022. Results: Botulinum toxin is an effective and safe treatment that causes minor and transient side effects, and its duration of action varies depending on the condition for which it is used (from 36 months on average, up to several years in Lucia Frey syndrome). This is the first-line treatment in Lucia Frey syndrome, laryngeal dystonia and synkinesis. The most common otorhinolaryngological indications, discussed in the following paper, in which botulinum toxin is one component of treatment include Lucia Frey syndrome, salivary fistulas, excessive salivation syndromes, laryngeal dystonia, vocal tremor, vocal granuloma, synkinesis in facial nerve palsy, dysphagia, and an interesting new indication for the use of the toxin in the treatment of resistant rhinitis. The following paper reviews the treatment protocols with botulinum toxin for the aforementioned indications and includes information such as management, dosage, injection sites. The study provides an introduction for ENTs interested in introducing botulinum toxin into their practice, as well as updates practical information for those already practicing. Conclusions: Botulinum toxin is a safe and effective treatment for a wide range of non-aesthetic indications in otorhinolaryngology.

Introduction: The challenges of modern medicine go beyond merely effective diagnostics and therapy for extension of human life, but must also strive to improve its quality. The benefits of multidisciplinary cooperation in patient care are now unquestionable and result in the dissemination of such a trend among most medical fields. Clinical speech therapists are valuable partners for otorhinolaryngologists in the treatment of many diseases of the head and neck region. Aim: The aim of this article is to present the role of the speech therapist at an otorhinolaryngology ward, as well as to analyze the current legal regulations that constitute the basis for such cooperation. In accordance with the legal regulations currently in force in Poland, the position of a speech therapist at the otolaryngology department is financed for the rehabilitation of patients with cochlear implant and brain stem implants. Unfortunately, the role of a speech therapist in other diseases including voice, speech, hearing and swallowing disorders within otorhinolaryngology wards has not yet been sanctioned, hence many patients continue to be deprived of comprehensive pre- and postoperative care. Conclusion: Speech therapy rehabilitation in ENT departments, apart from patients with hearing loss, is particularly important for patients with organic lesions of the larynx undergoing intra-laryngeal surgery as well as open surgery procedures, patients with neurogenic voice and/or swallowing disorders or as a result of iatrogenic dysfunction. Such therapy includes diagnostic and information activities as well as exercises to improve functions. Speech therapists contribute substantially to the comprehensive care of patients both in the preoperative and postoperative periods.

Total laryngectomy removes the larynx and separates the oral and nasal cavities from the lower respiratory tract. In the process of speech therapy of laryngectomiezed patients, the main element is the voice rehabilitation, and the olfactory functions are often neglected. The work contains contemporary literature review on the methods of olfactory function assessment, techniques of its stimulation and the possibility of monitoring the progress of rehabilitation.

Aim: The aim of the study was to analyze the impact of the COVID-19 pandemic and the related change of the teaching mode from stationary to distance learning on the severity of voice-related ailments among teachers. Materials and methods: A questionnaire survey of teachers was conducted to assess voice disorders during stationary and remote work using the Vocal Tract Discomfort (VTDs) scale and Numeric Rating Scale (NRS), and the respondents’ subjective feelings were assessed. Demographic and environmental factors associated with voice work were examined. Data on sickness absence, which were obtained from the “Health Needs Maps 2020” Ministry of Health’s, were also analyzed. Responses were subjected to statistical analysis. A P-value level below 0.05 was considered statistically significant. Results: 128 teachers participated in the survey. The overall assessment of voice disorders using VTDs and NRS scales showed no statistically significant differences for complaints between stationary and remote work. Detailed analysis revealed more se-vere voice disorders in teachers working more than 6 months remotely (P = 0.049) and having more than 20 lessons per week (P = 0.012). Subjective assessment confirmed a significantly lower percentage of teachers reporting voice disorders when wor-king remotely compared to stationary (P = 0.043). This resulted in less sickness absence and a 40% decrease in sick leave related to voice disorders in 2020 compared to 2019. Conclusions: During the remote learning period of the COVID-19 pandemic, teachers reported lower severity of voice disor-ders and this influenced the reduction of sickness absences. There were no statistically significant differences in voice complaints as assessed by VTDs and NRS scales for both teaching modes. Several factors affecting the severity of vocal tract disorders were identified – the number of class hours per week (>20) for stationary teaching and a long period of remote teaching (>6 months).

Purpose: The review of indications for surgical treatment of major salivary glands in adults hospitalized in the Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Warsaw. Materials and methods: The retrospective analysis was based on the 1173 postoperative histopathological examinations of the salivary glands collected over a period of 10 years (2010-2020). Analysis included histopathological diagnosis, localization of lesions, multifocality, complete resection, lymph node involvement, as well as demographical data of sex and age. Results: Over half (61.38%) of all indications for surgical treatment of the salivary glands were benign tumors (n = 720) with the most common pleomorphic adenoma, which accounted for 33.5% of all cases (n = 393). The next most frequent group of diagnoses were non-neoplastic diseases of the salivary glands, 24.98% of all cases (n = 293). Malignant neoplasms of the salivary glands accounted for 13.64% of all diagnoses (n = 160). Salivary gland diseases slightly predominated among the female sex, with a particularly pronounced predominance in pleomorphic adenoma. Men, on the other hand, were treated more often for malignant neoplasms. The mean age of the patients was the lowest in the group of non-neoplastic diseases of the salivary glands. The mean age of patients with malignant neoplasms was significantly higher than in other pathologies. The largest tumors size was identified for malignant neoplasms. Diseases of the salivary glands treated surgically were most often located in the parotid gland, with the exception of non-neoplastic diseases, which most often involved the submandibular gland. Conclusions: Surgical management in pathologies of the salivary glands applies to all types of lesions, both neoplastic and non-neoplastic diseases. Patients with particular diseases are characterized by a different structure of age, sex and location of changes.

Introduction The microarchitecture of the mucosal and submucosal vessels is crucial for diagnosis of vocal fold lesions. Neo-angiogenesis is a confirmed biological parameter that implicates progression and metastasis in laryngeal cancer. Objective This study investigates the correlation between vascular pattern classifications by narrow band imaging and immunohistological microvessel density in different types of intraepithelial vocal fold lesions. Methods Analysis of immunohistological microvessel density using CD31 and CD34 antibodies was performed in 77 lesions including: 20 non-dysplastic lesions, 20 with low-grade dysplasia, 17 with high-grade dysplasia and 20 invasive cancers. The evaluation of vascular patterns with narrow band imaging according to the Ni classification and European Laryngological Society guidelines was performed prior to surgical resection. Results The mean value of CD31 microvessel density was the highest for Ni Type IV lesions (20.55), whereas for the longitudinal and perpendicular patterns according to the European Laryngological Society classification it was 12.50 and 19.45 respectively. The highest mean value of microvessel density with CD 34 was identified in Ni Type Va (35.43) lesions and in the longitudinal and perpendicular patterns according to the European Laryngological Society classification was 15.12 and 30.40 respectively. Conclusions The microvascular morphological changes of intraepithelial laryngeal lesions observed under narrow band imaging endoscopy are positively correlated with angiogenesis indexes of immunohistological evaluation.

(1) Background: Malignant tumours of the salivary glands have different clinical and histopathological characteristics. They most commonly involve the parotid gland. Histopathologically, the most common are mucoepidermoid carcinoma (MEC), adenoid cystic carcinoma (AdCC), acinic cell carcinoma (AcCC), adenocarcinoma, carcinoma in pleomorphic adenoma (CPA), and squamous cell carcinoma (SCC). (2) Methods: We analysed 2318 patients with malignant parotid gland tumours reported to the National Cancer Registry (NCR) in Poland over 20 years (1999–2018). The demographic characteristics of patients, clinical factors, and overall survival (OS) were analysed. (3) Results: The average age was 61.33 ± 16.1 years. The majority were males (55%) and urban citizens (64%). High percentage of carcinomas was diagnosed in locoregional (33.7%) and systemic (10.4%) stadium. The most prevalent diagnoses were SCC (33.3%) and adenocarcinoma (19.6%). Surgical resection with adjuvant RT (42.1%) was the most common treatment. The OS analysis showed a median survival time of 5.6 years. The most favorable median OS was found in patients with AcCC (18.30 years), the worst for SCC (1.58 years). (4) Conclusion: AcCC has the best prognosis and SCC the worst. Tumour stadium, treatment, and demographic factors affect prognosis. Improvements in diagnosis and re-evaluation of treatment standards are necessary to enhance the outcome of patients with parotid gland cancers in Poland.

The involvement of the larynx in plasma cell myeloma (PCM) may manifest as solitary extramedullary plasmacytoma of the larynx (sEMP-L) or as infiltration of the larynx during newly diagnosed or relapsed systemic disease with bone marrow involvement (plasma cell myeloma with laryngeal involvement, PCM-L). To increase knowledge about these rare conditions, we performed a retrospective analysis along with a comprehensive literature review of cases of sEMP-L or PCM-L. Six patients (two sEMP-L and four PCM-L) were identified in our tertiary laryngological centre from 2009 to 2021, constituting 0.88% of all malignant laryngeal tumours. The literature search yielded 187 cases, including 152 sEMP-L and 35 sPCM-L. A comparison of baseline characteristics between sEMP-L and PCM-L performed in the combined cohort of cases from literature review and retrospective analysis revealed that patients with sEMP-L were younger (56 vs. 64 years, p ≤ 0.001) and presented less commonly with thyroid or cricoid cartilage involvement (2.2% vs. 30.8%, p ≤ 0.001). The prognosis of sEMP-L was better than PCM-L (overall survival 86% vs. 55% at 5 years, p = 0.002). Analysis of potential factors that could influence progression-free survival (PFS) in the group of sEMP-L revealed that male sex and cartilage involvement negatively affected PFS in univariate analyses, while only cartilage involvement retained statistical significance in multivariate analysis (HR = 19.94, p = 0.024). In conclusion, PCM with laryngeal involvement is sporadic. Secondary involvement of the larynx during PCM might be more common than sEMP-L and is associated with worse survival. The involvement of cartilage adversely influences the outcome of sEMP-L.

BackgroundEarly and proper diagnosis of laryngeal lesions is necessary to begin treatment of the patient as soon as possible with the possibility of preserve organ functions. Imaging examinations are oft aided by artificial intelligence (AI) to improve quality and facilitate appropriate diagnosis. The aim of the study is to investigate of the diagnostic utility of AI in laryngeal endoscopy.MethodsFive electronic databases (PubMed, Embase, Cochrane, Scopus, Web of Science) were searched for studies published before October 15, 2021 implementing artificial intelligence (AI) enhanced models assessing images of laryngeal lesions taken during laryngeal endoscopy. Outcomes were analyzed in terms of accuracy, sensitivity and specificity.ResultsAll 13 included studies presented overall low risk of bias. The overall accuracy of AI models was very high (from 0.806 to 0.997) and the number of images used to build and evaluate the models ranged from 120 to 24,667. The accuracy was significantly higher in studies using larger database. The pooled sensitivity and specificity for identification of healthy laryngeal tissue (8 studies) was 0.91 (95% CI: 0.83-0.98) and 0.97 (95% CI: 0.96-0.99), respectively. The same values for differentiation between benign and malignant lesions (7 studies) were 0.91 (95% CI: 0.86-0.96) and 0.95 (95% CI: 0.90-0.99), respectively. The analysis was extended to a comparison of sensitivity and specificity of AI models assessing Narrow Band Imaging (3 studies) and white light endoscopy images (4 studies). The results were similar for both methods, no subgroup effect was revealed (p = 0.406 for sensitivity and p = 0.817 for specificity).ConclusionsIn assessing images of laryngeal lesions, AI demonstrates extraordinarily high accuracy, sensitivity, and specificity. AI enhanced diagnostic tools should be introduced into everyday clinical work. The performance of AI diagnoses increases efficacy with the size of the image database when using similar standards for evaluating images. The multicentre cooperation should concentrate on creation of huge database of laryngeal lesions images and implement their sharing, which allows building AI modes with the best performance, based on vast amount of images for learning and testing.

The aim of the study is to discuss the role of NBI imaging in upper respiratory papillomatosis (RRP). In the available literature on the subject, as of 2009, there have been 117 publications on NBI imaging focusing on the diagnosis of the upper respiratory and digestive tract, especially the larynx. They discuss the following diagnostic and therapeutic problems: identifying an abnormal vascular pattern within the mucosa, differentiating benign and malignant lesions, assessing the nature of lesions under the leukoplakia plaque, pre-operative definition of laryngeal cancer margins, supporting laser procedures to obtain safe margins, postoperative monitoring after cancer treatment, detecting second simultaneous and metachronic neoplasms and primary tumors in the case of metastases from an unknown primary site. Few reports have been devoted to the assessment of the extent and recurrence of RRP. Due to its recurrent nature, this pathology deserves special attention as it requires multiple inspections and manipulation within the larynx. It also applies to the pediatric population, where there should be no margin for underestimating or overestimating changes, because any suspicion of recurrence results in subsequent general anesthesia. Hence the attempt to define an unambiguous picture of RRP recurrence and the criteria for referring for subsequent surgical treatment.

This article is a review of literature and a summary of the current guidelines in the diagnosis of hypertrophic vocal folds suspected of malignancy. It gives a detailed overview both of initial diagnosis, as well as the methods of in-depth intraoperative diagnostics and proposals for careful evaluation during post-treatment follow-up examinations.

Propose Identification of relevant features acquired on preoperative evaluation of parapharyngeal space (PPS) tumors or related to the performed surgical approach that are predictive of the most important complication of surgical treatment of these tumors, cranial nerve palsy. Methods This was a retrospective analysis of 68 patients with PPS tumors treated with surgical resection in a tertiary referral center from 2009 to 2019. The preoperative clinical symptoms, age, sex, tumor size, location, histopathological type, surgical approach, radical resection, intraoperative bleeding and the occurrence of complications were collected, evaluated and compared. Results Cross-table and chi-square test results revealed that cranial nerve deficits were more common in neurogenic tumors than in other types, including malignant tumors (χ2 = 6.118, p = 0.013); the cervical approach was selected more often for neurogenic tumors (χ2 = 14.134, p χ2 = 6.424, p = 0.011); and neurogenic tumors were more likely to be located in the poststyloid area (χ2 = 17.464, p t test revealed a significant correlation between age and the prevalence of cranial nerve complications (t = 2.242, p = 0.031). The mean age in the group of patients with cranial nerve palsy was 45.89 years, and that of the group without complications was 54.69 years. The results of logistic regression confirmed that the risk of nerve deficits was almost 8 times higher for neurogenic tumors (OR = 7.778, p = 0.01). None of the other analyzed variables related to tumor or surgery was significantly correlated with an increased risk of cranial nerve dysfunction. Conclusion Surgical resection of tumors other than neurogenic tumors of the PPS reveals no significant risk for permanent neural dysfunction. Tumor size also had no significant effect on the risk of postoperative nerve palsy.

Introduction: Rhabdomyomas (RM) are rare benign mesenchymal tumors. They are a much more uncommon entity than their malignant counterparts, rhabdomyosarcomas. Rhabdomyomas fall into two general categories: cardiac tumors and extracardiac tumors. Extracardiac myomas are among the rarest tumors in humans and can be classified as fetal and adult, depending on the degree of differentiation of individual tumors by light microscopy. Adult extracardiac myoma is most commonly characterized by the occurrence in the head and neck, and mainly in the laryngeal and pharyngeal area. Case report: This article presents a case of rhabdomyoma of the parapharyngeal space with a review of world literature.

Background: The aim of this study was a comprehensive analysis of the incidence of different salivary gland pathologies in the adult population of Poland. Methods: A retrospective analysis of salivary gland pathologies diagnosed in Poland in 2010–2019 based on the National Health Fund (NHF) database was performed. Non-neoplastic diseases, and benign and malignant lesions were identified using ICD-10 codes. Demographic characteristics, incidence rates, and the number of inpatient and outpatient medical services were analyzed. Results: Salivary gland pathologies were diagnosed in 230,589 patients over 10 years (85.5% were non-neoplastic lesions, 11.53% benign and 2.93% malignant neoplasms). Incidence rate for all pathologies was 59.94/100,000. The mean incidence for malignant neoplasms was 1.78, and decreasing trend was observed over the analyzed period. Contrarily, for benign neoplasms (mean incidence—6.91), an increase in numbers was noted annually. The incidence for non-malignant lesions was quite stable (mean: 51.25) over the time. The highest number of medical services per patient concerned malignant neoplasms (on average, two hospital stays, and eleven outpatient consultations). Conclusions: An increase of benign salivary gland tumors, and a decrease of malignant neoplasms was observed during the studied period. The number of medical services related to salivary gland pathologies increased during the period under study.

Objectives The aim of the study was to determine the influence of oral, oropharyngeal, laryngeal and hypopharyngeal dysplasia and cancer diagnosis on motivation to smoking cessation in patients. Consecutively, we assessed the competence of ENT specialists in counseling anti-smoking therapies. Methods Questionnaire of expected support, Schneider motivation test and Fagerström Test for Nicotine Dependence (FTND) were administered to 50 smoking patients. The online survey was collected from 152 ENT doctors. Results Mean FTND score was 4.58 and Heaviness of Smoking Index (HSI) was 3.1. Patients with oral cavity and oropharyngeal cancer showed the greatest dependence to nicotine 7.67 and 5.25, respectively, and with hypopharyngeal cancer had the lowest 3.5, (p = 0.039). The ranges of HSI were significantly higher for younger patients (p = 0.036). 35 patients were adequately motivated to quit smoking, and their mean age was statistically higher (p = 0.05). Self-reported motivation to smoking cessation was 76%. Of 152 surveyed doctors, only 39% declared knowledge of the diagnostic and therapeutic cessation interventions. 75% showed interest in the training programs.

Hypopharyngeal cancer is a poorly characterized type of head and neck squamous cell carcinoma (HNSCC) with bleak prognosis and only few studies focusing specifically on the genomic profile of this type of cancer. We performed molecular profiling of 48 HPV (Human Papilloma Virus)-negative tumor samples including 23 originating from the hypopharynx and 25 from the larynx using a targeted next-generation sequencing approach. Among genes previously described as significantly mutated

Hypopharyngeal cancer represents one of worst types of head and neck tumors with only few studies focusing on the genomic profile of this type of cancer. Using targeted next-generation sequencing we analyzed 48 HPV-negative tumor samples including 23 originating from hypopharynx, and 25 from larynx. Among genes previously described as significantly mutated, TP53, FAT1, NOTCH1, KMT2C and CDKN2A were found to be most frequently mutated. We also found that more than three-fourths of our patients harbored candidate actionable or prognostic alterations in genes belonging to RTK/ERK/PI3K, cell-cycle and DNA-damage repair pathways. Using previously published data we compared 67 hypopharyngeal cancers to 595 head and neck cancers from other sites and found no prominent differences in mutational frequency except for CASP8 and HRAS genes. Since we observed relatively frequent mutations of KTM2C (MLL3) in our dataset, we analyzed their role in vitro by generating KMT2C-mutant hypopharyngeal cancer cell line FaDu with CRISPR-Cas9. We demonstrate that KMT2C loss-of-function results in increased colony formation and proliferation, in concordance with its previously published results. In summary, our results show that mutational profile of hypopharyngeal cancers might be similar to the one observed for other head and neck cancers with respect to minor differences and includes multiple candidate actionable and prognostic genetic alterations. We also demonstrate for the first time that KMT2C gene may play a role of tumor suppressor in head and neck cancer, which opens new possibilities in the search for new targeted treatment approaches.

Deep neck infections (DNIs) are still emergency conditions in otorhinolaryngology. Due to rapid disease progression and life-threatening complications, the accurate surgical and medical treatment must be promptly applied. In the present study, we analyzed treatment protocols of 46 adults to assess efficacy of the treatment and search for prognostic factors of the outcomes. We performed retrospective analysis of medical data of 46 patients, who underwent surgical treatment in our department due to purulent DNI in the period from 2009 to 2017. Data investigated included age, sex, hospitalization time, duration of symptoms before drainage, comorbidities, selected laboratory tests results, location and the number of abscesses, results of microbiological cultures, and antibiotic treatment options. The study group consisted of 33 (71.7%) men and 13 (28.3%) women. Patients age ranged from 18 to 82 years. The mean duration of hospital stay was 13.2 ± 8.4 days. The most common site involved was submandibular space (43.5%), followed by parapharyngeal space (28.3%). The majority of patients had single abscess (81.2%), the multiple abscesses were revealed in 8 (18.8%) cases. The mean size of the abscesses was 42 mm. C-reactive protein level was increased in 96.7% patients (mean level 155.5 ± 146.7 mg/L), but the white blood cell count exceeded the normal in 60.9% cases (mean level 16.89 ± 5.59 × 109/L). Staphylococcus aureus (20.7%) and Peptostreptococcus (20.7%) were the most common species cultured from swabs. The antibiotic treatment included most commonly a combined ceftriaxone and metronidazole (n = 23). Two patients died due to complications. The correlation between different variables and the duration of hospitalization revealed only the hemoglobin level below 12.5 g/dL, a significant predictor of longer hospitalization (16.23 days vs 12.09 days, P = .017). Patients with purulent DNIs and decreased hemoglobin level are predisposed to prolonged recovery following the surgical drainage.

BACKGROUND AND OBJECTIVES Controversial prognostic factors of primary CO2 laser cordectomy are anterior commissure involvement (ACI) and status of margin. STUDY DESIGN/MATERIALS AND METHODS Retrospective analysis of oncological outcomes in 102 patients with early glottic cancer undergoing laser cordectomy between 2013 and 2015. RESULTS The T stages distribution included: 72.6% T1a, 14.7% T1b, and 12.7% T2. The ACI was diagnosed in 26 patients. The primary cordectomy was radical in 72 patients. The 2- and 5-year disease free survival (DFS) for all patients were, respectively, 83.3% and 77.3%.The 2-year DFS rates for T1a, T1b, T2 were, respectively, 91.7%, 66.7%, and 53.9% and the differences were statistically significant (P

Proliferative-inflammatory pathologies may occupy the temporal bone, resulting in: hearing loss, vestibular dysfunction, and neuropathies from cranial nerve compression. Although their occurrence is episodic, the appropriate diagnostic procedure is extremely important to achieve expected therapeutic effect. The aim of study was characterization of selected proliferative-inflammatory pathologies that may occupy the temporal bone: fibrous dysplasia, inflammatory pseudotumor, osteoradionecrosis, and presentation of diagnostic methods for the differentiation of these diseases as well as discussion on appropriate therapeutic options. Fibrous dysplasia (fibrous dysplasia) is a slowly progressive, benign bone disorder of unknown etiology characterized by abnormal proliferation of fibrous tissue. IPT (inflammatory pseudotumor) is a rare, non-malignant inflammatory process of unknown etiology, characterized by connective tissue proliferation and infiltration of inflammatory cells. Osteoradionecrosis of the temporal bone (TB-ORN) is a rare but potentially fatal complication of radiotherapy for head and neck cancer. Due to the similarity of symptoms with typical inflammatory conditions of middle ear (pain, otorrhea, hearing loss), selected disorders may be a dilemma regarding the diagnosis and proper further treatment. The clinical examination is mandatory, however radiological imaging may demonstrate the existence of specific changes and direct the diagnosis. The computed tomography of fibrous dysplasia shows the abnormal organization of the bone structure. Magnetic resonance, as the most sensitive for inflammatory pseudotumors, visualizes inflammatory infiltrates in soft tissues. The spiral tomography of temporal identifies the erosion in the course of osteoradionecrosis. However the final diagnosis may be establish post the histopathological examination and exclusion of the neoplastic process.

Maxillofacial tumors are rare malignancies that constitute about 0.2-0.5% of all human malignancies. The initial symptoms of the disease are non-typical and imitate inflammation of paranasal sinuses. Most often, patients report one-sided nasal obstruction with bloody and purulent discharge and headaches. In addition to physical examination - often with the use of endoscopic nasal cavity assessment, it is necessary to perform computed tomography of the paranasal sinuses and magnetic resonance for accurate assessment of the extent of the lesions. Histopathological examination of tumor specimens is necessary for making the final diagnosis and planning treatment. Squamous cell carcinoma is the most common histological type in the sinonasal region. Other common malignancies in this area include adenocarcinoma, carcinoma adenoides cysticum, lymphomas, melanoma, and olfactory neuroblastoma. The treatment of choice of all malignant changes in the sinonasal complex, except for lymphomas, is surgical treatment. Unfortunately, a still high percentage of lesions is diagnosed at an advanced stage of the disease, when the infiltration includes the skull base. In these cases, the decision to perform a radical surgical treatment in the patient is very difficult and requires a lot of experience in the surgery of the skull base. However, due to the low radiosensitivity and low effectiveness of chemotherapy in sinonasal malignancy, resection of lesions and complementary treatment contribute to the prolongation of overall survival in this group of patients. The article discusses the cases of two patients with advanced cancer of the sinonasal complex reffered to the Otolaryngology Department of the Medical University of Warsaw.

Sjogren's syndrome (SS) is a complex connective tissue disease with autoimmune background and high clinical, radiological and molecular heterogeneity. SS is typically manifested by sicca syndrome, characterized by dry eyes and dry mouth due to autoimmune-induced inflammation of the lacrimal and salivary glands. Complications of sicca syndrome are dental caries, oral candidiasis, dysosmia, dysgeusia, difficulties in swallowing and chewing. SS may coexist with other diseases of rheumatoid and autoimmune etiology. SS is linked to a 16-fold increased risk of non-Hodgkin lymphoma. Early diagnosis results in inappropriate treatment and may slow down the course of the disease and limit extraglandular involvement. Due to diverse clinical phenotypes and symptomatology, establishing the diagnosis is often difficult. In 2016 the American-European Consensus Group (AECG) and European League Against Rheumatism (EULAR) proposed a classification system that defines SS as a systemic disease. Diagnostic tools in establishing SS diagnosis are serological tests, ultrasonography, Schirmer’s test, unstimulated whole saliva flow rate, and Ocular Staining Score. The complete curing of SS is still not possible. As a complex multisystem disease, SS requires multidisciplinary cooperation and individual diagnostic and therapeutic approaches in patients. Therapy is focused on the treatment of symptoms and prophylaxis of complications. The laryngological treatment of oral cavity symptoms in SS includes supervision of proper oral hygiene habits and adequate fluids supplementation. The EULAR Sjögren's syndrome disease activity index (ESSDAI) and Clinical Oral Dryness Score(CODS) is used to monitor disease progression and treatment effectiveness.

BACKGROUND: Amyloidosis is a group of diseases caused by extracellular accumulation of insoluble fibers referred to as amyloid fibers in tissues and organs. Amyloid fibers have a secondary beta-sheet structure which makes them resistant to proteolysis. In histological examination, amyloid deposits stain with Congo red and show apple-green birefringence in polarized light. Amyloid deposits disturb the function of organs and cause clinical symptoms. Their formation or accumulation within the system may be acquired or inherited. Due to the location of amyloid deposits, one may distinguish systemic and localized amyloidosis with the formation of tumors (usually composed of immunoglobulin light chains). CASE REPORTS: Five cases of amyloidosis in the head and neck region are presented in this paper. Locations of the amyloid deposits were as follows: larynx, nasopharynx, sublingual and submandibular gland and the tongue. The initial clinical presentation correlated with the location of amyloid tumour in our patients. Two patients had a history of local recurrence of the disease. Surgical resection and histopathological examination were performed. Sections stained with Congo red confirmed the diagnosis of amyloidosis. Three patients had potential conditions that predisposed them to amyloidosis, including previous radiotherapy, chronic inflammation due to hepatitis C virus infection and graft versus host disease. CONCLUSION: Amyloidosis should be considered as a possible cause of pathological symptoms in the head and neck region. The diagnosis requires a histopathological examination. The systemic form of the disease must be ruled out in all patients with head and neck amyloidosis. In localized amyloidosis, surgical resection of lesions is the procedure of choice; however, maintenance of organ's functionality should be taken into account.

Objectives: The aim of the study was the analysis of the epidemiology of laryngeal cancer over 10 years in relation to known risk factors and to assess the current survival rates in this group of patients. Methods: The data were retrospectively collected from patients’ medical records, then entered in the database using dedicated software and a statistical analysis was performed. Results: 512 subjects - 443 men (86.5%) and 69 women (13.5%) were enrolled into the study. The male-to-female ratio was 6.4:1. There were 97.1% smoking women and 98% smoking men, however the history of more than 20 cigarettes per day smoking admitted 81.1 % of women and 94.6% of men. Heavy alcohol consumption was the case in 14 (20.3%) women and in 307 (69.3%) men. For both the size of heavy alcohol consumption and the size of excessive tobacco use, there was found statistically significant difference between women and men with laryngeal cancer (p

Objective The promotion of neovascularisation is a crucial aspect of carcinogenesis. The study evaluates the microvascular density (MVD) and expression of hypoxia-induced factor (HIF-1α) in hypertrophic vocal fold (VF) lesions of different histopathological states including non-dysplastic, low-grade, high-grade dysplasia and invasive glottic cancer. Materials and methods Histological specimens collected from patients diagnosed and treated in a single centre with different histological grades were immunohistochemically stained with CD31, CD34 and HIF-1α. Of the total number of 77 analysed VF specimens, 20 were non-dysplastic, 20 had low-grade dysplasia, 17 high-grade dysplasia and 20 were invasive cancers. Results The highest mean value for MVD evaluated with expression of CD31 (MVD CD31) was 21.23 ± 14.46 and identified in the low-grade dysplasia group. The average MVD CD31 was 13.74 ± 5.56 and 20.11 ± 9.28 in the high-grade dysplasia and invasive cancer group, respectively. The highest MVD evaluated with CD34 (MVD CD34) was revealed for invasive cancer 35.64 ± 17.21. The MVD CD34 was higher for low-grade than in high-grade dysplasia (25.87 ± 12.30 vs 24.65 ± 15.92, respectively). The expression of HIF-1α was strong or very strong in 60% of non-dysplastic lesions, 100% of low-grade dysplasia cases, 53% of high-grade dysplasia cases and 50% of invasive cancer cases. The comparison of MVD CD31 with MVD CD34 revealed a strong positive correlation (ρ value 0.727). The comparison of both MVD CD31 and MVD CD34 with HIF-1α resulted in no linear relationship (ρ value of 0.143 and 0.165, respectively). Conclusion The stage of low-grade dysplasia in intraepithelial vocal fold lesions is related to significant advancement of angiogenesis together with the highest hypoxia level. Electronic supplementary material The online version of this article (10.1007/s00405-019-05355-2) contains supplementary material, which is available to authorized users.

A multiform adenoma is the most commonly diagnosed benign tumor of the salivary glands. In the majority of patients, surgical resection of the tumor with the adequate surrounding tissue of salivary gland allows for complete recovery. A small percentage of the cases is a recurring pleomorphic adenoma. Even more rarely the diagnosis of carcinoma ex pleomorphic adenoma is made. The study presents two clinical cases of the malignant transformation of pleomorphic adenoma into the myoepithelial carcinoma. The surgical treatment and additional radiotherapy were performed in both cases.

Patients with head and neck cancers have an increased risk of second malignant neoplasm occurrence (25% in long-term follow-up, 4% yearly). Most patients with a primary tumor can be treated with organ-preserving strategies including radiotherapy (RT) or chemoradiotherapy (CRT). Very often after radical surgical excision there are indications for adjuvant radiotherapy. However, if recurrence or second malignancy will develop after definitive primary RT, there are limitation to use therapeutic dose of radiation again for the same area. Salvage surgery is regarded as the only curative option in those cases. In our study we analysed 3 patients, who presented with head and neck second cancer in the area of hypopharynx, within 10-25 years after primary radiotherapy due to oropharyngeal and laryngeal cancer. A total pharyngectomy with larynx preservation and bilateral neck dissection were performed in the first case and the radial forearm free flap (RFFF) was used for reconstruction of the pharynx. Second patient, due to perilaryngeal invasion in radiological images, underwent total pharyngolaryngectomy with selective bilateral cervical lymph nodes dissection and digestive track was restored also with RFFF. The third patient had previously undergone laryngectomy and after total pharyngectomy the free autologous jejunal flap (FAJF) was used for reconstruction. The main goal of reconstruction after salvage surgery due to hypopharyngeal cancer is to reconstruct the digestive tract. The other important aspect is to optimize the anatomy for voice rehabilitation and swallowing. Unfortunately, radiation and chemotherapy impair wound healing, which indicates increased risk of postoperative complications and makes salvage surgery results unpredictable.

ObjectivesThe study was designed to evaluate the tissue expression of NRP-1 and serum level of sNRP-1 in the same patients with intraepithelial laryngeal lesions or early staged laryngeal cancer to identify the clinical significance of these biomarkers in the diagnosis of laryngeal lesions.Material and methodsA prospective analysis of tissue was performed on specimens and blood samples from 49 patients, who were admitted for surgical resection due to suspicious vocal fold lesions and were diagnosed as non-dysplasia, low-grade dysplasia, high-grade dysplasia and invasive cancers.ResultsELISA was conducted on 48 blood samples. The minimum level of sNRP-1 was 0.15 ng/ml and maximum- 37.71 ng/ml. The Kruskal-Wallis one-way analysis of variance revealed no differences in sNRP-1 levels between different histopathological stages of vocal fold lesions (p = 0.234). IHC was conducted in 49 tissue samples. The evaluated mean scores of NRP-1 tissue expression were compared to histopathological stage of the lesion. The Kruskal-Wallis one-way analysis of variance revealed no differences in NRP-1 tissue expression between different histopathological stages of vocal fold lesions (p = 0.536). The correlation of tissue NRP-1 expression and serum levels of NRP-1 within analyzed group was insignificant. The Spearman's rank correlation coefficient was 0.076 (p = 0.606).ConclusionsThe NRP-1 tissue expression and serum levels are unlikely to be a prognostic factor for identification of laryngeal dysplasia or early stage laryngeal cancer. Further studies investigating biomolecules involved in laryngeal carcinogenesis are necessary.

Sarcoidosis is a systemic disease of unknown etiology. It is characterized by a formation of lumps known as noncaseating granulomas, which are not affected by necrosis. Typical collections of inflammatory cells may be found in any organ tissues but mainly in the lungs, skin or lymph nodes. Head and neck organs involvement is rare, although sarcoidosis can be found in lymph nodes, salivary glands, larynx, and sinuses. A search was performed based on medical records of patients admitted to the Department of Otolaryngology within four previous years. We analyzed two cases of sarcoidosis of salivary glands (parotid and submandibular), two cases of larynx involvement and one case of lymphadenopathy due to sarcoidosis. Patients (4 women and 1 man), age range 26-76 years old, were directed to the Otolaryngology Department with neck lymphadenopathy or a suspicion of a neoplastic tumor of salivary gland or larynx. Only one patient had the previous diagnosis of pulmonary sarcoidosis. Preoperative diagnostic procedures such as ultrasonography, biopsy, chest radiography did not suggest sarcoidosis on the initial assessment of other patients. Surgical removal of the pathological findings and histopathological examination confirmed extrapulmonary sarcoidosis. The computed tomography of lungs confirmed coexisting pulmonary sarcoidosis in only one patient.

Idiopathic facial nerve palsy, called also Bell palsy, can be a challenge for clinicians if a pregnant woman reports symptoms of facial paresis. The incidence of Bell's paralysis in pregnant women is almost three times higher than in the non-pregnant women's age group. The problem is the lack of guidelines for the treatment of idiopatic facial nerve palsy in this group of patients. In randomized studies, but without participation of pregnant women, greater efficacy was found in the return of nerve function after early treatment with corticosteroids than with other methods. The dilemma concerning therapy is intensified by the fact that the prognosis regarding the return of facial nerve function in pregnant women is significantly worse than in the remaining population and the weakness of facial muscles is yet diagnosed in a young woman. In the article we present the example of a patient consulted in our department and the review of current literature. We introduce recommendations for the treatment of pregnant women with facial nerve palsy. There are discussed benefits, advised medicines, doses, necessary precautions and potential side effects of corticosteroids, which are the only ones that have proven efficacy in the treatment of Bell's paralysis in pregnant women.

Introduction: Parapharyngeal space (PPS) is the anatomical area lateral to the upper pharynx and clinically important due to PPS tumors. They account for less than 1% of head and neck neoplasms. Both benign and malignant neoplasms may arise there and typical for this localization is diversity of histological origin. Complete surgical excision is still the basis of treatment. Aim of the study: Evaluation of the results of surgical treatment of PPS tumors in the Department of Otolaryngology at the Medical University over the period 2015-2017. Material and methods: A retrospective analysis of medical records including complaints, physical examination, results of imaging studies, surgical approach, postoperative complication and histopathological results in 22 patients with a diagnosis of a PPS tumors. Results: The most frequent complaints reported by the patients were: discomfort in the throat, dysphagia, hearing disorders and a palpable tumor on the neck. Asymptomatic course of the disease was demonstrated in 4 cases. All patients were treated surgically: 2 with transoral approach, 9 with transparotid-transcervical approach, 11 with transcervical approach. In most cases the tumor was removed radically. In 2 patients intracapsular tumor resection was performed. Based on histopathological examination the benign lesions dominated (18/22). In 4 cases malignant neoplasms were diagnosed: carcinoma ex pleomorphic adenoma, adenoid cystic carcinoma and two cases of squamous cell carcinoma. The most common origin of PPS tumors was deep lobe of parotid gland and for this group 11 patients had diagnosis of pleomorphic adenoma. Other diagnosis included: paraganglioma, neurofibroma, hemangioma, lymphangioma and rhabdomyoma. Postoperative complications occurred in 9 patients and presented as hoarseness and dysphagia due to paresis of the lower group of cranial nerves (IX, X, XII). Significant intraoperative bleeding during surgery occurred in 2 cases and ligation of the external carotid artery was necessary. Conclusion: Due to the anatomical topography of PPS and its content with the essential vessels and the lower group of cranial nerves, the surgical treatment of pathology of this area is still a challenge for head and neck surgeons. The decrease of voice quality and impaired speech and swallowing should always be considered as complications post the surgical resection in PPS.

Background This study investigates relevance of narrow band imaging (NBI) in stratifying risk of malignant transformation within leukoplakia. Methods We conducted a prospective analysis that included 62 patients with 91 changes of leukoplakia on vocal folds. The NBI was obtained before microsurgery. Categorization of the lesion as benign was made when vessels of surrounding epithelium were classified as type I, II, or IV according to Ni classification. If there were visualized intraepithelial papillary capillary loops of type V, the lesion was classified as malignant. Results were compared to the histopathological diagnosis. Results The NBI assessment classified 75 lesions (82.4%) as benign and 16 (17.6%) as malignant. Histopathological results revealed the diagnosis of no dysplastic changes or low grade dysplasia in 77 cases (84.6%). Another 14 cases (15.4%) occurred with high-grade dysplasia, carcinoma in situ, and invasive cancer. Sensitivity, specificity, and accuracy of NBI in predicting malignancy within leukoplakia were 100%, 97.4%, and 97.8%, respectively. The kappa index was 0.92 (95% confidence interval 81.1%-100%). Conclusion The noninvasive procedure of an NBI endoscopy may be recommended as an accurate method in predicting the risk of malignant transformation within the vocal fold leukoplakia and, therefore, would be useful in the clinic for planning the patient's therapy.

BACKGROUND This is a comparative analysis of the diagnostic accuracy of narrow band imaging (NBI) and laryngovideostroboscopy (LVS) in the assessment of premalignant and malignant vocal fold lesions. METHODS A prospective analysis was performed on 105 consecutive patients with vocal fold lesions. The NBI and LVS were obtained before the microsurgery. RESULTS The NBI and LVS showed no significant differences in identifying premalignant and malignant pathologies. However, in analysis restricted to identification of only malignant lesions, the specificity (88.9% vs 20.6%), accuracy (90.5% vs 51.4%), and positive predictive value (PPV; 84.8% vs 45.1%) were significantly higher for NBI (P value < .001; .015; and .045, respectively). A comparison of LVS scored results relative to each NBI type revealed statistically significant differences (P < .001). A moderate positive correlation between NBI and LVS was demonstrated (P = .54). CONCLUSION The NBI and LVS are useful, complementary tools in evaluating early potential vocal fold malignancies. The NBI was superior to LVS on several statistical analyses.

Wstęp: Cel badania stanowi ocena efektów długoterminowych augmentacji krtani w znieczuleniu miejscowym przy pomocy hydroksyapatytu wapnia. Materiał i metody: W badaniu wzięło udział 17 pacjentów, którzy z powodu niewydolności szpary głośni (z powodu jednostronnego porażenia krtani oraz niewydolności mięśni wewnętrznych krtani) zostali zakwalifikowani do przeprowadzenia augmentacji krtani (10 kobiet i 17 mężczyzn), w wieku: 57,6±17,7 lat, mediana 61 lat, z zakresem: 32-83 lata. U wszystkich pacjentów wykonano augmentację krtani w znieczuleniu miejscowym, przez jamę ustną, podając bocznie od fałdu głosowego/ fałdów głosowych hydroksyapatyt wapnia (preparat Radiesse). W celu oceny efektów długoterminowych augmentacji krtani – przeprowadzano ocenę jakości głosu pacjenta przed augmentacją, a następnie 3 i 12 miesięcy po augmentacji krtani, przy pomocy oceny videolaryngostroboskopowej krtani, oceny odsłuchowej, analizy akustycznej, oceny aerodynamicznej oraz samooceny głosu dokonanej przez pacjenta przy pomocy kwestionariusza VRQoL. Wyniki: Uzyskano istotną statystycznie poprawę w ocenie odsłuchowej głosu dla parametrów G i A, po 3 miesiącach, dobre wyniki utrzymywały się w czasie 12-miesięcznej obserwacji. W ocenie akustycznej MDVP_Jitt, MDVP_Shim i MDVP_NHR poprawiły się odpowiednio do wartości: 2,5; 5 oraz 0,1 (3 miesiące po augmentacji) i 1,9; 3,6 oraz 0,1 (12 miesiące po augmentacji). MPTa wydłużył się do 12,2 i 11,9 s., odpowiednio po 3 i 12 miesiącach od augmentacji. Natężenie głosu poprawiło się z 67 do 68 oraz 71 dB(A), odpowiednio po 3 i 12 miesiącach. Wyniki: VRQoL poprawiły się do wartości 19,5 i 20, odpowiednio 3 i 12 miesięcy po augmentacji. Dyskusja Augmentacja krtani w znieczuleniu miejscowym przy pomocy hydroksyapatytu wapnia daje długotrwałe, dobre efekty leczenia.

Objective: To assess the sensitivity and specificity of larngovideostroboscopy (LVS) in the diagnosis of precancerous and malignant lesions of the vocal folds. Material and methods: In 175 patients (128 men and 47 women), aged 19-88 years, mean age 61.5, who were admitted to the clinic with diagnosed premalignant conditions of vocal fold mucosa (leukoplakia, chronic hypertrophic inflammatory lesions) and thickening or tumor on the vocal fold, there was performed LVS before the laryngeal microsurgery. The LVS study included: localization of the leasion, movement of the vocal folds, mucosal wave, shape of glottis clousure, amplitude and symmetry of vocal fold vibration. In the evaluation, a point scale was applied for the individual functional parameters. The scale ranged from 0 to 14. Patients with impaired vocal fold motion or absent mucosal wave were positive on LVS for malignant lesions. Those with limitted mucosal wave were positive on LVS for dysplastic lesions. The results were compared with the final histopathological examination and the sensitivity, specificity, accuracy, positive (PPV) and negative (NPV) predictive value were calculated. Results: On the basis of histopathological examination, benign lesions (normal or inflammatory mucosa) accounted for 20% of diagnoses, hypertrophy and parakeratosis for 28%, low and middle grade dysplasia accounted for 10% and malignant lesions (high-grade dysplasia, pre-invasive cancer, Invasive cancer) was diagnosed in 42% of patients. The overall mean score for LVS was 4.5 and 8.0, respectively for benign and malignant lesions. Sensitivity, specificity, accuracy, PPV and NPV of LVS in detecting malignant lesions were respectively - 95.6%, 23.8%, 61.1%, 57.6% and 83.3% and in detecting both premalignant and malignant lesions were respectively – 90.7%, 31.4%, 78.9%, 84.1% and 45.8%. Conclusions: Because of the high sensitivity of LVS in detecting precancerous and malignant lesions, this method is a very good tool for screening of pathology within the larynx.

Introduction: Hemangiopericytoma is a mesenchymal tumour originating from pericytes surrounding the capillary vessels. The etiology of this tumour is still unknown. It may be located in any part of the human body. The most common sites are pelvis and lower limbs and less often it occurs in the head and neck. The characteristic signs of hemangiopericytoma are slow growth regardless of the malignancy level and high vascularity. Surgical excision of the tumour with additional radiotherapy is the treatment of choice. Case report: A symptom presentation and diagnostic-therapeutic process in a 71-year-old woman admitted to the Department of Otolaryngology of the Medical University of Warsaw due to increasing bilateral nasal obstruction and dysphagia is herein described. Diagnostic imaging showed highly vascularized tumour in the parapharyngeal space also obstructing the left side of the nasopharynx. After evaluation, tumour resection from the external approach was planned and performed, followed by an uncomplicated postoperative course. Histopathological examination revealed hemangiopericytoma. The patient was qualified for adjuvant radiotherapy. She stays under observation with no signs of recurrence since surgery. Conclusions: Hemangiopericytoma is a rare tumour with a wide variety of clinical presentations and a relapse-free survival that is difficult to predict. Long-lasting asymptomatic tumour growth results in late diagnosis. Imaging and primarily, histopathological examination are fundamental for the diagnostic process. The best outcome is observed after radical surgical treatment. In order to reduce the risk of recurrence, additional radiotherapy is advised. Local recurrence may appear years after finished treatment, therefore long-term follow-up is essential.

Desmoid fibromatosis is defined as a rare fibroblastic proliferation. Although histologically benign, desmoids are locally invasive and associated with a high local recurrence rate. When located in the head and neck region, fibromatosis tends to be more aggressive and associated with significant morbidity, which may be attributed to the proximity of the vital structures. We report a case of 33-year-old woman with aggressive fibromatosis of parapharyngeal space. Complete surgical excision of the lesion was performed and the postoperative period was without complications. The patient remains under careful follow-up and there is no recurrence of the disease.

Laryngeal reinnervation is the method of treatment in unilateral vocal fold paralysis. During the surgery an anastomosis between the main branch of ansa cervicalis and recurrent laryngeal nerve is formed. Regeneration of the nerve’s functional abilities is a long process, lasting from 4 to 6 months, up to a year. A 35 year-old male was admitted to the Department of Otolaryngology at Warsaw Medical University in order to undergo surgical removal of reoccurrence of Schwannoma in left cerebellopontine angle by translabyrinthine approach. Post-operative period was complicated with vagal nerve paralysis. The patient reported hoarseness, dysphagia and choking. Physical examination revealed left vocal fold immobilization in abducted position, saliva in piriform fossa and left-sided soft palate paralysis yet the patient was discharged home. 4 weeks after the surgery, the patient was admitted to the hospital again due to developing aspiration pneumonia. Augmentation of the left vocal fold with calcium hydroxyapatite was performed 2 months later. After this intervention temporary vocal improvement and choking frequency reduction was observed. Finally, the patient underwent laryngeal reinnervation with formation of ansa cervicalis main branch to recurrent laryngeal nerve anastomosis. Left vocal fold regained its functional abilities and the quality of the voice improved. Laryngovideostroboscopy performed 6 months later revealed mobilization of left vocal fold sufficient for proper glottis closure. The voice measures normalized and the swallowing improved. Conclusions This case report and analyzed data confirm that laryngeal reinnervation surgery in unilateral vocal fold paralysis helps achieve satisfactory effects in voice function and life quality.