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This paper presents a unique clinical observation of 16 years of use without replacement of a domestic voice prosthesis in a patient after laryngectomy. Long-term recurrence-free survival was achieved as a result of treatment of laryngeal leiomyosarcoma.

A clinical case of a rare malignant tumor of the larynx, carcinosarcoma, is described. The features of the clinical picture, diagnostic methods: instrumental and morphological are presented.

The literature review presents historical and modern aspects of the rehabilitation of vocal function after laryngectomy, in particular, external devices, tracheopharyngeal bypass surgery, esophageal speech, tracheoesophageal bypass surgery without the use of a prosthetic device, voice prostheses are described. The advantages and disadvantages of each voice restoration technique, functional results, complications, prosthesis designs, their service life, bypass techniques, methods of prevention and treatment of damage to the valve apparatus of the prosthesis by colonies of microorganisms, fungal flora are analyzed.

A review of the literature on modern aspects of organ-preserving surgery for laryngeal cancer - endolaryngeal and open resections - is presented. The indications for these operations are determined depending on the location and extent of the tumor, as well as on the anatomical features. The advantages and disadvantages of each method, complications, functional and oncological results are shown.

Neoplasms of the upper respiratory tract and ear are tumors of visual localization; however, patients often go to specialized medical institutions in the presence of a widespread tumor process. This paper presents a brief overview of the most common benign and malignant tumors with localization in the oropharynx, nasopharynx, larynx and ear. The clinical picture, diagnosis and various treatment options are presented. Attention is paid to early diagnosis and the need for timely consultation with an oncologist and doctors of related specialties.

Adenocystic carcinoma accounts for 3-5% of all malignant neoplasms of the head and neck organs. Due to the rarity of detecting this cancer in the larynx, treatment options are still controversial: surgery with postoperative radiation therapy or surgery alone. Patient A. , 64 years old, turned to the City Clinical Oncological Hospital No. 1 in October 2019 with complaints of moderate pain when swallowing, sensation of a foreign body. Fibrolaryngoscopy revealed an exophytic form of growth bright red color formation with a small tuberous surface up to 12 mm in size in the area of the free left edge of the epiglottis. There was a thickening of the pharyngeal-epiglottis fold. Histological examination revealed adenocystic cancer. Diagnosed with Laryngeal cancer with cT1N0M0. On December 23, 2019, endolaryngeal resection of the larynx was performed using an operating microscope in the volume R0. This observation is of interest both in morphological terms (extremely rarely detected cancer of the larynx) and in terms of treatment (an organ-preserving operation was performed - endolaryngeal resection of the larynx).

Transplantation of human internal organs is accompanied by the risk of the subsequent occurrence of a malignant neoplasm. The increased incidence of malignant neoplasms is due to immunosuppressive therapy, which leads to impaired immune surveillance for malignant neoplasms, as well as increased susceptibility to oncogenic viruses. We have not found a description of the laryngeal cancer development after heart transplantation in the available literature. Here is our observation. Patient P., 66 years old, was admitted to the department of head and neck tumors of the State Clinical Hospital No. 1 on 05/27/19 with complaints of hoarseness. Based on the examination, the diagnosis of laryngeal cancer cT3N0M0M was established. Anamnesis revealed that due to ischemic cardiomyopathy, post-infarction mitral insufficiency, balloon angioplasty and stenting of the right coronary artery on 17.08.11 and 06.11.13, orthotonic heart transplantation was performed. The clinical situation was discussed with mutual participation of oncologists, radiologists, chemotherapists - a combined treatment plan was developed with preoperative radiation therapy of total focal dose (TFD) 44Gy at the first stage, which was carried out with slight positive dynamics, followed by laryngectomy. The uniqueness of this observation lies in the fact that a patient 6 years after heart transplantation was diagnosed with laryngeal cancer, he underwent combined treatment with neoadjuvant radiation therapy, TFD 44 Gy and an operation in the volume of laryngectomy without complications.

The early diagnostics of the malignant tumours of the larynx provides a basis for the timely beginning of their conservative treatment and endolaryngeal surgical interventions. However, neither the conservative treatment nor endolaryngeal surgery ensures the sufficiently efficient treatment when the tumour spreads over the anterior commissure, subglottic space, and/or laryngeal ventricles. The open surgical resection of the larynx is indicated for the management of the patients presenting with this condition. Our experience is based on the performance of vertical resection of the larynx in 98 patients including the fronto-lateral and extended fronto-lateral interventions in 63 and 35 of them, respectively. The formation of the malignant tumour is known to result in the alteration of the acoustic characteristics of the patient's voice as compared to the initially normal ones in the preceding period. Specifically, the mean values of the fundamental tone frequency increases, the intensity of the sound signal decreases, and the amplitudes of the fundamental tone harmonics tend to be reduced. At the same time, both the dispersion and the variability of the acoustic characteristics being studied undergo an enhancement in comparison with the normal values. Open resection of the larynx with its simultaneous endoscopic correction made it possible to restore the respiratory and vocal functions in 90.8% and 92.1% of the treated patients respectively.

Adenoid cystic carcinoma is one of the rare pathological conditions affecting the larynx. It is known to develop from the glandula elements present in this organ. The authors report a clinical observation of adenoid cystic carcinoma in the form of an exophytic tumour of the pale pink colour having a smooth surface and the well-pronounced vascular patterns at the base. The neoplasm is localized in the arytenoid and retroarytenoid cartilage regions. Being of 3.5-4 cm in size, the tumour causes the narrowing of the larynx in its posterior portions and restricts its mobility. Bearing in mind the considerable extension of the neoplastic process, we undertook laryngectomy including the resection of the orolaryngopharynx and the cervical portion of the oesophagus, the subtotal resection of the thyroid gland and the simultaneous reconstruction of the orolaryngopharynx.

The objective of the present study was to increase the efficiency of the treatment of the patients presenting with laryngeal cancer by the enhancement of the functional reserve of the preserved portion of the larynx and the prevention of the narrowing of its lumen. Another objective was to develop an algorithm for the rehabilitation of the patients with laryngeal localization of the tumour following open functionally sparing operations that consists of the operative and postoperative stages. During the period from 2006 to 2014, a total of 71 patients underwent functionally sparing operations. 66 of them were operated for laryngeal cancer, 1 for thyroid cancer spreading over trachea and larynx, 3 for papillomatosis. Resection of the larynx in the vertical and horizontal planes was performed in 62 and 9 patients respectively. Vertical plane surgery included the following procedures: fronto-lateral resection of the larynx in 51 patients, extended fronto-lateral resection in 10, and combined resection in 1 patient. It is concluded that the systemic approach to the treatment of the patients with laryngeal cancer and the proposed algorithm for their rehabilitation made it possible to restore the laryngeal function in 68 of the 71 patients (95.8%).

The objective of the present study was to enhance the effectiveness of rehabilitation of the patients presenting with laryngeal cancer after the resection of the organ and laryngotomy with tracheoesophageal by-pass and endoprosthetics. Our experience in this field is based on the treatment of 102 patients. They were distributed by the nosological forms as follows: primary laryngeal cancer in 97 patients including T1NoMo - 8 (8.2%), T2NoMo - 63 (65%), T3NoMo - 18 (17.6%), T2N1Mo - 1 (0.9%), T4NoMo - 3 (2.9%), and T4N1M0 - 4 (3.9%), root of the tongue cancer spreading over the vestibular part of the larynx in one patient, laryngeal sarcoma in one patient, relapse of cancer following the full-dose radiotherapy and organ-sparing surgery in 3 patients. Laryngeal resection was performed in 83 patients; 19 patients underwent laryngectomy with tracheoesophageal by-pass and endoprosthetics using a domestically manufactured voice prosthesis. The systemic approach to the rehabilitation of the patients and the use of the proposed treatment algorithm made it possible to restore the function of the larynx by means of organ-sparing surgery in 79 (95.1%) of the 83 patients. The vocal function in the patients following laryngectomy with tracheoesophageal by-pass and endoprosthetics was restored in 18 (94.7%) of the 19 patients.

The objective of the present study was to elucidate the causes of late detection of malignant neoplasms of ENT and oral cavity and low survival of the patents with these tumours in Moscow. The secondary objective was to elaborate the organizational measures for reducing the level of negligence and mortality from these malignancies among the city population. It was shown that the main cause behind the negligence is the late application of the patients for the medical assistance. Next in importance are asymptomatic clinical course of the disease in the absence of the pathognomonic and early signs of malignant neoplasms, a combination of several pathologies, imperfection of medical knowledge, and the poor resolving power of the modern methods. It is emphasized that the lack of vigilance against cancer among the practicing health providers is one of the main causes of medical errors. A few ways to address the problem of negligence with respect to malignant neoplasms of ENT and oral cavity in Moscow are proposed.

The authors summarize the experience with the treatment of 38 patients with disseminated laryngeal tumours (stages III and IV). All the patients underwent comprehensive medical examination using a variety of methods. Their advantages and drawbacks are analysed with reference to diagnostic value, potential for the detection of metastases, and possibility to use for the choice of extent of surgical intervention. Criteria for multispiral X-ray computed tomography have been developed to be applied to the identification of tumour spread outside the larynx and invasion of its cartilaginous structures.

This paper summarizes experience with the treatment of 50 patients with laryngeal cancer at different clinical stages of the pathological process. All the patients underwent comprehensive medical examination. Advantages and disadvantages of each method were evaluated in terms of efficiency for the assessment of the extent of laryngeal tumour and identification of metastases followed by the choice of treatment strategy and extent of surgical intervention.

The organ salving treatment of laryngeal neoplasms including their surgical resection at one of the stages was given to 25 patients. They were further followed up for the assessment of vocal function. Analysis of speech was performed by a group of 5 auditors. They counted how many times each patient heard a consonant as a sonant and vice versa. Based on the analysis of mistakes, the patients were divided into the following three groups: group 1 (many mistakes), group 2 (moderate number of mistakes), an group 3 (practically no mistakes). The most common mistake was devocalization of voiced sounds. Postoperative analysis of speech quality characteristics revealed their dependence on the extent of surgical intervention, the presence of tracheostoma, the type of plastic correction, and the dose of radiation therapy. It was shown that extensive and combined frontal-lateral resection leads to voice impairment. Tracheostoma also have negative effect on speech discrimination.

Statistics on ENT cancer detection in Moscow say that in the last 3 years 70% patients with ENT cancer were first examined by the oncologist at advanced stage (III-IV) of the disease. Main objective and subjective causes of late diagnosis are analysed and measures to improve the situation with late ENT cancer diagnosis are proposed. Special attention is paid to the problem of cancer alertness of general practitioners.

Results of the treatment of 174 patients with stenosis of larynx and trachea by conservative, surgical, and endoscopic methods at different periods after operation indicate that application of novel endoscopic and physical techniques substantially extends possibilities for the low-invasive correction of postoperative laryngeal and tracheal stenoses.

Laryngeal echosonography was made in 50 healthy subjects and 186 patients with laryngeal cancer to evaluate efficacy of ultrasound in diagnosis of laryngeal cancer. The study revealed sonographic characteristics typical for laryngeal cancer, endophytic tumors, in particular. Ultrasound can assess involvement of the laryngeal cartilages and severity of their lesion, invasion of the tumor into the underlying tissues and cervical organs. The tumor can be verified by puncture aspiration biopsy using ultrasound monitor. All this allows more effective choice of an optimal treatment method and planning of the scope of surgical intervention.

According to Moscow city Oncological Dispensary, the number of patients with malignant neoplasms of ENT organs has increased during the last 5 years. In 79-84% of the patients the diseases is diagnosed at stage III-V which leads to rather poor results of treatment. Results of analysis of causes for late diagnosis of ENT neoplasms point out to the necessity to raise oncologic alertness among ambulatory physicians. Up-to-date methods of early diagnosis of oncological diseases of ENT organs are discussed.

The article presents the results of conservative surgery in 102 patients with laryngeal cancer T2 and T3. Frontolateral laryngeal resections in different variants (endoprosthesis, extended, an inferior variant) were conducted in 85 (83.3%) patients, horizontal laryngeal resection - in 17 (16.7%) patients (a combined variant -in 2 of them). The treatment resulted in primary healing of a postoperative wound in 92 (90.2%) patients. Complications consisted in development of pharyngeal fistula, suppuration of the postoperative wound, first of all in combined and extended resections, after a total dose of radiotherapy. Minor operations on the larynx enabled decannulation of 98 (96.1%) patients. Four (3.9%) patients continue to carry cannula because of marked scarry alterations.

Multispiral computed tomography (MSCT) with intravenous bolus contrasting is a currently available method for radiodiagnosis of laryngeal cancer. MSCT is of much higher informative value in estimating the extent of a tumorous lesion than the traditional radiodiagnostic techniques: linear tomography, lateral X-ray study, roentgenoscopy and roentgenography of the laryngopharynx and esophagus with barium meal.

The authors have developed an original prosthetic appliance made of silicone rubber which makes it possible to conduct resections in advanced laryngeal tumors. Endoprosthetic resections have been performed in 21 patients. Frontal and lateral endoprosthetic laryngeal resections carried out in 15 patients enabled decanulation in 12 (80%) and voice recovery in 14 (93.3%) patients. 6 patients have undergone horizontal endoprosthetic resection after which 5 of them recovered respiratory and defense function. Vocal function returned to normal condition in all of them.

The paper is devoted to surgical procedures aimed at voice reestablishment in patients without larynx removed for cancer. Original surgical techniques practiced by the authors are proposed: tracheoesophageal shunt with creation of the defense valve from the esophageal mucosa, esophagus and lower lip mucomuscular graft, bypass repair. The procedures were used in 79 patients with removed cancer-affected larynx. Vocal function recovery occurred in 90%, the defense function restored in 80% of the patients treated.

This paper presents the results of fibroendoscopic examinations of 74 patients with laryngeal cancer of II-IV degree. Tumor dissemination was T2NO in 25 patients, T3NO in 36 patients, and T4NO in 13 patients. All the patients underwent modified resection patterns: 53 patients--horizontal resection (4 modifications) and 21 patients--frontolateral resection in the lower modification. Altogether 170 fibroendoscopic examinations were performed. Fibrolaryngoscopy helps to examine all laryngeal structures, evaluate and differentiate changes after various modifications of organ-preserving operations in the case of laryngeal cancer, and to detect at an early postoperative stage further tumor growth. Correct assessment of postoperative changes in the larynx prior to fibrolaryngoscopy can be carried out on the basis of reliable information about the operation, amount of tissue removed, and organ reconstruction.