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Follow-up of laryngeal carcinoma patients is considered to be the important part of their care. The main purpose of follow-up is to early detect potential disease recurrence and second primary tumous, besides assessment of treatment effectiveness and rehabilitation. There is still no definitive guideline based on the data of survival rates, and our aim is to summarize current guidelines and recommendations based on current recommendations and our experience. A review of the literature regarding follow-up and rehabilitation of laryngeal cancer patients was made. Our considerations are based on critical appraisal of the current literature and clinical evidence. Staging is based on the current UICC (Union for International Cancer Control) laryngeal cancer TNM Classification. The parts of follow-up that we discussed in this review include the duration, frequency and setting of the visits, and imaging regarding the mode of treatment (surgery and/or chemoradiotherapy). One of the most important segments of follow-up is patient’s education about potential recurrence or second primary tumor signs and symptoms. Large prospective and retrospective studies remain to be undertaken for the current recommendations and practices to be properly evaluated for survival rates.

The aim of this study was to demonstrate the impact of COVID-19 pandemic on the number and characteristics of head and neck cancer patients in two consecutive periods, pre-pandemic and pandemic. For this purpose, we performed a retrospective analysis of patients with primary carcinomas of head and neck mucosal sites, salivary gland tumors, as well as neck metastases. Two pre-COVID-19 years (2018-2019) and two pandemic years (2020-2021) were compared. Demographic data, overall number of patients, TNM classification of the two most affected sites (oral cavity and larynx), time from symptom onset to first outpatient admission to our department, and time from first admission to treatment initiation were noted. Study results revealed a higher number of patients during the pandemic period and difference in the distribution of tumor sites (χ2=33.68, df=9, p

Laryngeal carcinoma is one of the most common tumors of the head and neck, just after skin cancer. Alongside open surgery, transoral endoscopic laser surgery (TOLS) has become widespread as a treatment method. Our aim was to assess the efficacy of transoral laser cordectomy in a group of patients with early glottic carcinoma. We retrospectively analyzed data on 131 patients who underwent TOLS in the 2017-2021 period. We divided patients into groups according to tumor stage and type of cordectomy performed, and compared outcomes between the groups. Our results revealed a higher number of patients in the group with Tis and T1a than in those with T1b and T2 who underwent type III cordectomy, and also a higher number of those for whom outpatient follow-ups were sufficient after surgery in the same group. We did not observe significant difference in outcomes according to cordectomy type except for type V (a-d), where a higher number of patients had to undergo radiotherapy. This study underlines the importance of careful patient selection for TOLS, as well as the need for close cooperation with pathology and radiology specialists to ensure optimal approach and extent of surgery for each individual patient. It also displayed TOLS as a sound therapeutic option for early stages of glottic carcinoma but also indicated the need for similar studies in a larger number of patients to elucidate the effectiveness in certain glottis areas.

Introduction: The radial forearm free flap (FAFF) is ideal for head and neck reconstructive surgery due to its pliable tissue and long pedicle. In this study we analysed the role of perioperative factors on prolonged forearm healing and patient-reported aesthetic and functional outcomes. Materials and methods: The study was conducted at the Otorhinolaryngology and Head and Neck Surgery Department, Clinical Hospital Centre Zagreb, from 2018 to 2021. During this time, 31 FAFF were harvested, and 18 patients were available for analysis of aesthetic and functional outcome. Using the Visual Analogue Scale (VAS), each patient evaluated the aesthetic and functional state of their forearm. The Patient and Observer Scar Assessment Scale (POSAS) was used by patients and surgeons to evaluate scar quality from the harvested forearm flap, as well as from the harvested partial thickness skin graft used for reconstruction of the donor area. The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was used to evaluate functional disability of the forearm. Numerical variables obtained from the questionnaires were translated into categories and compared to patient demographic and anamnestic data. Results: Smoking and increased body weight were negatively associated with radial forearm donor site reconstruction. Although 33.3% of the skin grafts healed properly, 72.2% of the patients experienced their donor site scar as good or even excellent. The scar on the proximal volar forearm area, were the partial thickness skin graft had been harvested, was evaluated as very bad in only 5.6% of the patients. None of the patients experienced their forearm as aesthetically bad 15 months after surgery. Conclusion: Skin graft failure in the donor area is associated with smoking intensity, and a higher body mass index. The preserved functionality of the hand directly depends on the preserved forearm sensation, and indirectly on the aesthetic outcome. Postponed healing and negative forearm aesthetics negatively affect everyday use of the operated extremity. This correlation diminishes six weeks after surgery, when the majority of forearms obtain their final appearance.

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

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.