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

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

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

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

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

We report the case of a 19-year-old man with neurofibromatosis type 1 who presented for evaluation of odynophagia, left-sided hemiparesis, multiple café au lait spots all over his body, and numerous subcutaneous and cutaneous neurofibromas. Imaging revealed the presence of two large neurofibromas-a 60 × 50 × 35-mm tumor in the left parapharyngeal space and an intradural tumor measuring 25 mm in diameter. We removed the larger tumor via a transoral route with the Harmonic Scalpel. The size of this tumor far exceeded the size of any other reported tumor removed in this manner. Various approaches to the parapharyngeal space have been described in the literature. To the best of our knowledge, this case represents the first report of a transoral removal of a huge parapharyngeal space neurofibroma with a Harmonic Scalpel.

Ispitali smo postoje li razlike u intraoperacijskim i ranim postoperacijskim koncentracijama paratiroidnog hormona između prve skupine bolesnika kod kojih je izvršena tiroidektomija s pomoću ultrazvučnog rezača te druge skupine bolesnika operiranih standardnom tehnikom s pomoću elektrokoagulacije i ligatura kao hemostatskih metoda. U svih bolesnika s totalnom tiroidektomijom uzeta je krv u četiri mjerne točke: neposredno nakon indukcije u anesteziju, 10 minuta nakon odstranjenja prvog režnja štitnjače, 10 minuta nakon potpunog odstranjenja štitnjače i 24 sata nakon operacije. Iz uzoraka krvi određena je koncentracija paratiroidnog hormona s pomoću imunoradiometrijskog testa. Usporedba koncentracija paratiroidnog hormona između prve i druge skupine nije pokazala statistički značajnu razliku ni za jednu od četiri mjerne točke. Usporedba koncentracija paratiroidnog hormona unutar istih skupina u odnosu na prijeoperacijske vrijednosti (prvu mjernu točku) pokazala je da su u obje skupine koncentracije paratiroidnog hormona u sve tri postincizijske mjerne točke bile značajno niže od koncentracija izmjerenih prije početka operacije (p, We have examined if there are any differences in intraoperative and early postoperative concentrations of parathyroid hormone between the first group of patients, who had thyroidectomy surgery performed by harmonic scalpel, and the second group of patients operated on by standard techniqes with the use of electrocoagulation and ligature as primary hemostatic procedures. All the patients having total thyroidectomy had their blood taken in four measurement points; immediately after the induction anesthesia, 10 minutes after the first thyroid gland lobe removal, 10 minutes after total thyroid gland removal and 24 hours after the surgery. The blood samples were used to determine concentrations of the parathyroid hormone by an immunoradiometric test. The concentration comparison of parathyroid hormone between the first and the second group has not shown statistically significant difference for any of the four measurement points. The concentration comparison of parathyroid hormone within the same groups in relation to preoperational values (the first measurement point) has shown that in both groups the parathyroid hormone concentration, in all three post-incision measurement points, has been significantly lower in relation to the concentration measured before the surgery (p

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

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

We are reporting a case of a 42-yr-old female with a history of right breast carcinoma. She was surgically treated (breast quadrantectomy with axillary dissection) and receiving a third cycle of adjuvant chemotherapy when a feeling of a constant pressure in the front of the neck and lack of air occurred. Subsequent work-up revealed a node in the right thyroid lobe with enlarged paratracheal bilateral and right mid and lower jugular lymph nodes. Fine-needle aspiration cytology, repeated within a 20 days window and analyzed by two different cytologists, showed a medullary thyroid carcinoma with a cervical lymph nodes metastasis so the patient underwent total thyroidectomy with selective and paratracheal neck dissection. Histology and immunohistochemistry revealed the specimen to be metastasis of breast carcinoma. During regular follow-up of our patient, eighteen months after initial diagnosis, no new metastases were found. To our best knowledge, this is the first described case of a thyroid metastasis of breast carcinoma that was cytologically misdiagnosed as a medullary thyroid carcinoma.

Endoscopic CO 2 laser surgery (ELS) is a widely accepted treatment modality for early laryngeal cancer. Commonly re- ported advantages of ELS are good oncologic results with low incidence of complications. Although less common if com- pared with open procedures, complications following ELS can be very serious, even with lethal outcome. They can range from intraoperative endotracheal tube fire accidents to early and late postoperative sequels that require intensive medical treatment, blood transfusion, or revision surgery. We present our institutional experience, discuss the possible complica- tions of ELS for laryngeal cancer, and outline the concepts of their treatment, with comprehensive literature review. Com- plications are more frequent following the treatment of supraglottic as compared to glottic cancer. If compared with open surgery, ELS for laryngeal cancer is associated with a lower incidence of complications. Every surgeon performing ELS should comply with particular strategies to avoid complications in the first place, and have a clear concept of their management if they occur.

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

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

Akutna upala jezične tonzile neuobičajeni je uzrok jake grlobolje koji se u praksi vrlo rijetko dijagnosticira. Bolesnici s akutnom upalom jezične tonzile karakteristično se žale na jaku grlobolju, otežano gutanje i bolnost u razini hioidne kosti, a osobito je zanimljivo da bolesnici s prethodno učinjenom nepčanom tonzilektomijom pri ovoj bolesti mogu imati gotovo potpuno uredan nalaz orofarinksa. Diferencijalnodijagnostički potrebno je isključiti za život opasni epiglotitis. S obzirom na to da se korijen jezika ne može vizualizirati rutinskim orofaringoskopskim pregledom, dijagnoza se postavlja indirektnom ili transnazalnom fiberoptičkom laringoskopijom., Acute lingual tonsillitis is a rarely diagnosed cause of sore throat. The patient with acute lingual tonsillitis typically has severe sore throat, dysphagia and pain at the level of hyoid bone, and it is interesting that patients with previous palatine tonsillectomy can present with almost normal oral examination findings. The diagnosis of potentially fatal epiglottitis should be excluded. Because the base of the tongue can not be visualized by intraoral examination, diagnosis must be made by indirect or transnasal fiberoptic laryngoscopy.

We present our experience with primary CO2 laser surgery for planocellular supraglottic carcinoma. During a ten- -year period, we performed 64 curative supraglottic laryngectomies. Twenty-nine patients presented with T1 and 35 with T2 carcinoma. There were 46 patients without regional and/or distant metastases (N0 neck), and 18 patients with N+ neck. Thirty-three (52%) patients were treated with surgery alone, and in 31 (48%) patients surgical procedure was combined with radiotherapy. Estimated overall 5-year survival for all patients was 89%. Local and regional tumor control as well as survival rate were comparable with the results of other therapeutic options, i.e. radiotherapy or open supraglottic laryngectomy. Functional results outline the advantages of endoscopic laser surgery for laryngeal carcinoma. Transoral endoscopic CO2 laser surgery is efficacious treatment for T1 and T2 supraglottic carcinoma, and can be combined with neck dissection and postoperative irradiation.

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