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Ciljevi: Cilj ovog istraživanja bio je prikazati utjecaj pandemije COVID-19 na rad Klinike za bolesti uha, nosa i grla i kirurgiju glave i vrata KBC-a Zagreb. Metode: Iz računalne baze podataka KBC-a Zagreb te baze onkoloških bolesnika Klinike retrospektivno su izvučeni te uspoređeni podatci o izvršenim postupcima i dijagnozama u razdoblju prva četiri mjeseca 2019., 2020. te 2021. godine. Rezultati: Ukupan je broj slučajeva 2020. bio veći za 32,4%, a 2021. za 13,19% (p, 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

In this case report we present successful airway management in a patient with predicted difficult airway using the Difficult Airway Society guidelines. Our patient presented with recurrence of reduced mouth opening due to post-traumatic bilateral temporomandibular ankylosis. Temporomandibular joint (TMJ) ankylosis often occurs after misdiagnosis, delayed treatment, inadequate surgery, prolonged immobilization or insufficient physiotherapy for intracapsular or subcondylar mandibular fractures. This condition is challenging to treat because it requires complete release of ankylosis followed by restoration of the condylar height to facilitate a full range of motion and good occlusion. As this is one of the most important predictors of difficult airway management, awake fiberoptic intubation was planned. After light sedation and thorough tropicalisation of the nasal cavity the flexible optic bronchoscope was successfully navigated into the trachea with “spray-as-yougo” technique and the endotracheal tube was railroaded over it. After a two-point check of the endotracheal tube placement the patient was put under anesthesia. The surgery was uneventful. The ankylosis of both temporomandibular joints was approached through temporal and periauricular cuts. The condylar processes were resected and the mandible was separated from the temporal bone on both sides. After the surgery, the patient was transferred to the ICU, intubated till airway edema relieves. Finally, a plan for a safe extubation was instituted and the patient was extubated uneventfully on the next day using the airway exchange catheter.

Ameloblastic carcinoma (AC) is a rare and aggressive malignant epithelial odontogenic tumor, most commonly located in the mandible or maxilla. An extremely rare extragnathic localization of AC with no connection to the jaws, ectopic ameloblastic carcinoma (EAC), has so far been described only three times. This report presents a 64-year-old male with skull base ameloblastic carcinoma and offers a review of diagnostic and treatment challenges related to EAC. Because of its rarity and histological similarity to other tumors, EAC is often misdiagnosed. This is why we established a pathohistological and immunohistochemical profile of EAC that differentiates it from histologically similar tumors. The most frequently used EAC treatment is radical surgical resection, but the majority of reviewed reports described local recurrence. Taking into consideration new scientific discoveries on the molecular pathogenesis of ameloblastoma, we are the first to have performed BRAF mutation analysis in an EAC patient. BRAF inhibitors offer promising results in the treatment of BRAF-positive ameloblastomas and should continue to be researched in AC and EAC patients. Finally, EAC should be considered in differential diagnosis of head and neck tumors outside the jaws.

Objectives: The high incidence of head and neck cancer (HNC), significantly associated with living environment and behaviour, can be prevented more efficiently. The aim of this study was to evaluate the environmental and behavioural risk factors for HNC. Methods: Using a detailed questionnaire on social status, education, living and occupational environment exposures, family cancer and lifestyle, HNC patients (103 cases, 76.7% of men) were compared with control subjects (244 subjects, 73% of men) balanced by age: mean (standard deviation) 63.8 (9.3) and 63.8 (9.0) for cases and controls, respectively. Results: The results of this study showed that smoking and low education were significant risk factors for HNC regardless of sex. Family HNC and breast cancer were significant predictors of HNC risk. Conclusion: The study confirmed previous results that smoking and low education are significantly associated with HNC. Additionally, results pointed to significant HNC and breast cancer risk in HNC patient's families that may have originated from passive smoking or a smoking habit stemming from social environments that support it. Better dissemination programmes regarding smoking risks for children and adults are needed, targeting not only individuals but also families.

The worldwide annual incidence of oral squamous cell carcinoma (OSCC) is over 300,000 cases with a mortality rate of 48%. This cancer type accounts for 90% of all oral cancers, with the highest incidence in men over 50 years of age. A significantly increased risk of developing OSCC exists among smokers and people who consume alcohol daily. OSCC is an aggressive cancer that metastasizes rapidly. Despite the development of new therapies in the treatment of OSCC, no significant increase in 5-year survival has been recorded in the past decades. The latest research suggests focus should be put on examining tumor stroma activation within OSCC, as the stroma may contain cells that can produce signal molecules and a microenvironment crucial for the development of metastases. The aim of this review is to provide an insight into the factors that activate OSCC stroma and hence faciliate neoplastic progression. It is based on the currently available data on the role and interaction between metalloproteinases, cytokines, growth factors, hypoxia factor and extracellular adhesion proteins in the stroma of OSCC and neoplastic cells. Their interplay is additionally presented using the Systems Biology Graphical Notation in order to sublimate the collected knowledge and enable the more efficient recognition of possible new biomarkers in the diagnostics and follow-up of OSCC or in finding new therapeutic targets.

Background Free tissue transfer is an integral part of reconstructive head and neck surgery today. Although increased experience and refinements in techniques have minimized flap loss, pharmacological agents have been used to prevent thrombus formation and flap failures, despite their questionable effectiveness. The aim of this study is to investigate the use of dextran 40 in thrombosis prophylaxis, as well as its effects on blood coagulability and flap survival. Methods This is a retrospective analysis of 176 free flaps performed at University Hospital Dubrava, Zagreb, Croatia, during a 4-year period. A comparison was made between 2 patient groups, based on their respective postoperative prophylaxis protocols. All patients were treated with low-molecular-weight heparin as deep vein thrombosis prevention, until patient mobilization. Group 1 was on dextran 40 protocol, whereas group 2 did not receive additional treatment. Primary outcome of the study was determined as flap loss rate, whereas secondary outcome was evaluated as the rate of thrombosis or hemorrhage. The hemodilution potential of dextran 40 was examined through blood count laboratory values. Results Total flap survival rate was 90.34%. There were 16 free flap losses and 1 partial loss overall. Anastomoses were re-explored in a total of 27 cases, of which 17 were salvaged. There were 29 events of hemorrhage or arterial or venous thrombosis: 17 in group 1 and 12 in group 2. A sum of 26 incidences of other postoperative complications was recorded, 13 in each group. Hemodilution status showed a statistically significant reduction in erythrocyte count and hemoglobin and hematocrit levels in the group receiving dextran 40, on postoperative days 1 and 3, but no such effect was observed on postoperative platelet count. Conclusions Although dextran 40 has been shown to have a valuable effect on hemodilution, which is beneficial in microsurgery, it did not demonstrate better outcomes in terms of flap survival. Because it can cause serious systemic complications, it is better not to administer it routinely. However, its important influence on reduction in erythrocyte count and hemoglobin and hematocrit levels should be further investigated.

Adenoid cystic carcinoma is a less commonly diagnosed cancer that may affect the major or minor salivary glands. We present a 70 year old male patient who was admitted to the Department of Oral Medicine, School of Dental Medicine in Zagreb, Croatia due to pain in the right maxilla. In this case we report a case of the patient with unilateral pain in the maxilla & eye which lead to the diagnosis of adenoid cystic cancer without any visible oral lesions.

Lejomiom je benigna novotvorina glatkog mišićnog tkiva. Vrlo rijetko se javlja u području gornjeg aerodigestivnog trakta. Posebno rijetko se javlja u području usne šupljine i sluznice koja pokriva obje čeljusti. Češće se javlja u području kože, reproduktivnih organa (maternica) i gastrointestinalnom traktu (jednjak). Iznimno rijetko se javlja u dječjoj dobi. U literaturi je opisano da se manje od 2,7 % slučajeva lejomioma glave i vrata javlja u usnoj šupljini. Lejomiomi glave i vrata razvijaju se iz glatkih mišića krvnih žila i većina može biti kategorizirana kao solidni lejomiomi i vaskularni lejomiomi. Gotovo 75 % opisanih slučajeva lejomioma usne šupljine pripada skupini tzv. vaskularnih lejomioma, dok su, iako rjeđe, opisane i tzv. epiteloidne varijante lejomioma (lejomioblastomi). Iako se, kako je ranije navedeno, vrlo rijetko javljaju u dječjoj dobi, najčešća sijela lejomioma dječje dobi su urogenitalni organi, probavni trakt, koža i duboka meka tkiva., Leiomyoma is a benign neoplasm of smooth muscle that is rare in the upper respiratory and digestive tract, extremely rare in the oral cavity affecting the maxilla, being far more common in the genitalia, skin and gastrointestinal tract. It rarely affects children. Fewer than 2.7% of human cases occur in the mouth. Leiomyomas of the head and neck region most likely develop from vascular smooth muscle tissue and most may be categorized as solid leiomyoma (deep soft tissue leiomyoma) and vascular leiomyoma (angiomyoma, angioleiomyoma). Almost 75% of the oral cases reported are of vascular nature. Epithelioid leiomyoma (leiomyoblastoma), a rare third type, has also been reported. Although rarely occurring in children, the most common occurrences reported are genitourinary and gastrointestinal, sometimes in soft tissues.

Metastatic tumours to the jaw bones are rare, and usually develop during the final stages of cancer. Some, such as those of lung, breast, and kidney, are more likely to metastasise to the jaw. We have therefore analysed the clinical and epidemiological characteristics of patients with metastatic tumours. We retrieved the notes of 4 478 patients with metastatic tumours to the jawbones who were treated in the Clinical Hospital Centre Dubrava in Zagreb, Croatia, during the 15 years 2002-17 and made a retrospective analysis of patients’ age, sex, site of primary tumour, site and clinical presentation of the metastases, time interval since diagnosis of the primary tumour and oral metastases, and time interval from diagnosis of oral metastases to death. Of the 10 who were diagnosed with metastases to the jaw, there were four male and six female patients (mean age 57 (range 51-84) years) and the most common primary tumours were kidney (n = 5), lung (n = 2), breast (n = 1), colon (n = 1) and unknown (n = 1). The mandible was more often affected (n = 7) than the maxilla (n = 3), and the most common histological type was adenocarcinoma (n = 6). The primary tumour in most of the patients (n = 7) was diagnosed before the oral metastatic lesion. A metastasis in the jaw was the first sign of metastatic tumour in three patients, and in one case the metastasis and the primary tumour were diagnosed at the same time. Most of the patients had some oral problems. The time intervals from diagnosis of an oral metastasis to death varied from one month - five years. Because of the rarity of the presentation, the diagnosis of an oral metastatic lesion remains challenging, so metastases in the jaw should be suspected in every patient with such cancers and lesions in the jaw.

Mesenchymal chondrosarcoma is a rare, high- grade malignancy of bone or soft tissue. It is most common in children and young adults (aged 10-30) with slight female preponderance. Because of its rarity it remains poorly understood and presents substantial diagnostic, prognostic, and management challenges.