Eur Arch Otorhinolaryngol (2007) (Suppl 1) 264:S5–S151 DOI 10.1007/s00405-007-0344-7

HNS - Head and Neck , Larynx and Others

INSTRUCTIONAL COURSES indication for EPT in patients with squamous cell cancer of the upper aerodigestive tract. HIC 1 Thyroid surgery and dealing with complications HIC 3 Jan Betka Digital volume tomography in oto-rhino-laryngology Department of Otorhinolaryngology and Head and Neck Surgery, 1st Faculty of Medicine, Charles University, Faculty Hospital Carsten Dalchow Motol, V U´ valu 84, 150 06 Prague 5, Czech Republic Park-Klinik Weissensee, Scho¨ nstr. 80, 13089 Berlin, Germany The course provides overview of technique of thyroid surgery The digital volume tomography (DVT) is an extension of pano- including both standard and up-to-date modern methods includ- ramic tomography. With this diagnostic technique, characterized ing not-cold instruments (harmonic knife), miniinvasive methods, by high resolution, minimal section thickness of 0.125 mm, and endoscopic thyroid surgery. The extent of surgery (total thyroid- three-dimensional (3D) display, small pathological processes can ectomy, hemithyroidectomy) is discussed. Various procedures for be well visualized. identification of the recurrent nerve (including nerve monitoring) The digital volume tomograph Accu-I-tomo (Morita, Kyoto, and parathyroid glands are shown. The question how to drain (if Japan) was routinely used to examine patients with a history of a any) the wound is gone over. Finally special focus is aimed at in the field of oto-rhino-lanyngology. A 3D dataset of a dealing with complications—recurrent nerve palsy (unilateral, cylinder was obtained in one 360 rotation with 80 kV and 8 mA bilateral), parathyroid gland injury. adjustments. The images of the temporal bone region are analysed with special 3D-software. The data were displayed after recon- struction on a PC monitor in three planes oriented vertically to each other with minimal intersection distance and a minimal HIC 2 section thickness of 0.125 mm. The section angle, section thick- Electroporation therapy in head and neck cancer ness, and intersectional distance were modified to selectively de- pict individual structures. The first generation DVT with M. Burian, M. Formanek, B. Zeitlinger dimensions of a 3 · 4 cm cylinder and a grey scale of 256 was later AKH Vienna, Vienna, Austria replaced by the second generation DVT visualizing 6 · 6 cm with Electroporation therapy (EPT) is a new and promising method to a grey scale of 4,096. treat solid tumors. The presence of an electrical field increases the Clinical investigations showed smallest bony modifications of permeability of cell membranes. This mechanism allows for trans- the temporal bone and frontal skull base with the DVT. Small membraneous transport of a variety of compounds into the cell lesions like an erosion of the ossicles, semicircular canals, cochlea, interior. Using bleomycin as a cytotoxic agent, this method can be internal auditory canal or apex of the temporal bone as well as used in the treatment of squamous cell cancer of the head and neck. pathologies of the frontal skull base can be routinely visualized. The tumor is infiltrated with bleomycin and subsequently The 3D presentation allows good spatial orientation and a precise treated by means of a six needle applicator which delivers the planning of surgical approaches. electrical fields to the tumor and tumor surrounding tissue. Since Digital Volume Tomography expands the application of diag- EPT act very tumor specific, it is possible to spare healthy tissue in nostic possibilities in the lateral and frontal skull base. Therefore we the surrounding of the tumor to a high extent. believe improved pre-op diagnosis can be achieved along with more The device as well as the technique of Electroporation Therapy accurate planning of the surgical procedure. In comparison with will be shown in detail during the course. EPT seems to serve as an conventional CT and digital volume tomography, DVT delivers a interesting, tissue sparing treatment alternative in head and neck smaller radiation dose and a higher resolution coupled with lower cancer. Future trials have to figure out the most appropriate purchase price of the equipment.

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HIC 4 tarily.FEES plays an important key role in the diagnostic work-up Challenges of professional voice because it allows a direct morphological and functional analysis of theupperaerodigestivetract.Thetargetofthiscourseistopresentthe Felix de Jong1, Willy Wellens2, Manuel Pais Clemente3, current status of FEES and it´ s position within the diagnostic arma- Bozena Woznica4, John Rubin5, Ekaterina Osipenko6, mentarium. Based upon history, the standardized, but individually Antonio Schindler7, Willem Kersing8 tailored endoscopic procedure will be demonstrated, as well as ben- 1Leuven, Belgium; Nijmegen, The Netherlands efits and limitations. Case reports illustrate the theoretical back- 2 Leuven, Belgium ground. Furthermore, new developments and trends are discussed. 3Oporto, Portugal Conclusions: FEES is an important tool for the ENT specialist/ 4Poznan, Poland phoniatrician in the management of the dysphagic patient. 5London, UK 6Moskow, Russia 7 HIC 6 Milano, Italy Mucosal melanomas 8Enschede, The Netherlands B. Folz The voice has been acknowledged to be the primary tool for com- Germany munication, that in turn has been described as the most existential act of man. The voice is used to express emotions and meanings. Background: Malignant mucosal melanoma of the upper aerodi- Consequently, voice problems often have a significant psychologi- gestive mucous membranes is a rare tumor. In comparison with cal, social, physical, occupational and communicational impact on cutaneous and ocular melanoma the prognosis is poor. Most studies an individual. Professional voice use can be characterized as a top have been case series and reports about larger series are rare. The sport, representing a great mental and physical effort. Professional aim of the course is to provide the participants with the key voice disorders are often complex with a multifactor genesis and the knowledge about mucosal melanoma with regard to natural history, professional voice has been found to be influenced by and exposed diagnosis, therapy and prognosis. to various and different risk factors. These risks factors broadly may Methods: The data presented are based on 51 cases from three dif- be classified for the sake of description into four domains: vocal ferent centers and an extensive literature survey. load, physical factors, psycho-emotional factors and environmental Results: The nose and paranasal sinuses are the most commonly factors. To develop occupational safety and health in voice pro- affected site in the head and neck with regard to mucosal melanoma. fessions it is essential to demonstrate the relationship between voice The basic symptoms are diffuse and not specific for the disease, they problems and the various risk factors, in order to create a risk profile rather reflect the typical signs of nasal malignancies, like unilateral of the professional voice user. The impact of a voice problem de- nasal obstruction, epistaxis, nasal discharge, and in ad- pends also on how an individual perceives the problem. Therefore, it vanced cases—diplopia. If possible therapy should be surgical, but is extremely relevant to assess the degree of handicap and the risk even with clear margins the recurrence rate is 80%. The explanation factors that are perceived to exert a negative influence on the voice in might lie in satellite tumors, micrometastasis and tumor cell subjects with voice complaints and those with a voice handicap. migration within the mucosa at early stages of the disease. Rare sites Remarkably, often insufficient attention is paid to voice training in for tumor manifestation are the , larynx and the middle ear. various educations for professions with high vocal demands. Repeated therapy achieves prolongued survival and combined Obviously there is a need for adequate voice training and the pre- therapies show a tendency towards better results. The overall diction of voice problems in the concerning educations. prognosis however is bad, the 5-year-survival is below 40%. Conclusion: Mucosal melanoma is a rare tumor with a poor prog- nosis. The course tries to provide key knowledge about the disease, HIC 5 which could to establish diagnostic and therapeutic standards for Current diagnostics of swallowing disorders: the ENT this rare tumor. Pooling data from different centers might then help specialist´s and phoniatrician´s role to gain more knowledge about the disease. Doris-Maria Denk-Linnert, Gudrun Mancusi ENT Department, Division of Phoniatrics and Speech Pathology, HIC 7 Medical University of Vienna, Wa¨ hringer Gu¨ rtel 18-20, 1090 Clinical application of different laryngoplasty Vienna, Austria techniques Objective: Over the last years, diagnostics and therapy of oro-pha- G. Friedrich ryngeal swallowing disorders have become a major task for the ENT Ear, Nose and Throat Hospital, Department of Phoniatrics, Speech specialist/phoniatrician within a multidisciplinary team. Statistics and Swallowing, Auenbruggerplatz 26/28, 8036 Graz, Austria demonstrate the individual, social and economic relevance of an adequate dysphagia management. Up to 14% of patients in acute Every surgery performed direct on the vocal folds in evitable care hospitals and up to 60% in nursing hospitals suffer from carries the risk of damaging the delicate structure of the vocal swallowing disorders. Aspiration pneumonia is the fourth frequent folds thus leading to the risk of unfavourable postoperative result cause in patients over 65 years. which can occur due to scaring and stiffening. The idea of influ- Methods: To enable an appropriate treatment of the dysphagic pa- encing the endolaryngeal biomechanics and consequently tient, a thorough diagnostic procedure is indispensable. The main improving the voice without touching the vocal folds by diagnostic focus is to find out whether aspiration is present or not. In just changing shape and/or position of the laryngeal cartilages is addition to this screening task, the etiology and pathophysiology of an ingenious idea which adds a new dimension to the field of dysphagia have to be revealed in order to establish the therapy reg- phonosurgery. Based on Isshiki´ s fundamental research four types imen and to recommend the type of feeding. Since the presence or of laryngeal framework surgery have been defined which allow to absence of aspiration can only be visualized, the instrumental diag- approximate, expand, relax or tension the vocal folds. The various nosticmethodsofvideoendoscopy(fiberopticendoscopicevaluation surgical procedures, their indications and KI for voice improve- of swallowing, FEES) and videofluoroscopy are used complemen- ment and/or changes will be explained in detail.

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HIC 8 It is feasible to perform continuous flexible laryngoscopy concomitant with symptoms in most patients with breathing dif- Applications of CO2 laser in phonosurgery ficulties during exercise. By this novel procedure for laryngoscopy, Sachin Gandhi laryngeal function during exercise can be precisely defined. Voice Disorder Clinic, Deenanath Mangeshkar Hospital, , In this instructional course we will show how this test can be , performed and practical advises will be given. A short summery of our results will be presented and there will be time for discussion Objective: To evaluate the role of CO2 laser technology for pho- nosurgery and to assess the benefits of its advanced accessories at the end of the session. (acublade, flashscanner). Methods:CO2 laser application includes setting up of laser HIC 10 instrument with microscope and archiving system along with specific microsurgical instruments and anaesthetic techniques. The transnasal endoscopic analysis CO2 laser is used in surgery of benign laryngeal pathology which of the oesopharyngeal function include protruding lesions like cord polyp, recessed lesions like Ingo F. Herrmann sulcus vocalis and flat lesions like leukoplakic patches, intrader- mal cysts. It is also used in surgical management of laryngeal Rome, Italy malignancies, sex reassignment and compromised laryngotracheal During this course the technique of the transnasal endoscopy of airway especially in cases of bilateral immobile vocal cords. The the oeso-pharyngeal function is demonstrated life. No sedation or presentation would describe the surgical methods which increase anesthesia is necessary for the passage through the upper the efficacy of CO2 laser surgery as well as the precautions to be oesophageal sphincter. The patient drinks the endoscope with taken to prevent the complications. Pre and post surgery voice clear water. No air-insufflation. The upright or recumbent posi- therapy is applied to maximize the results of phonosurgical tion, sitting or running changes the relationship of the anatomical methods. structures as well as the function while eating or drinking. Results: The surgical outcome in phonosurgery is measured with This physiological approach is the basis for the understanding voice analysis (maximum phonation duration, fundamental fre- of the function and dysfunction of the oeso-pharyngeal unit as, quency, jitter and shimmer) and digital videostroboscopy to ob- e.g., the different manifestations of reflux and their treatment and serve the mucosal wave. Preservation of mucosal wave indicates the different dysphagia problems. lack of scarring following surgery, and makes usage of CO2 laser a It allows to see the gas in the gas-pressure chamber of the viable proposition in phonosurgery. stomach and oesophagus as well. Gasreflux is the main reason for Conclusion:CO2 laser with its advanced accessories has distinct the extra-oesophageal complications of reflux. advantages over established phonosurgical methods. Its careful The endoscopy of the function is easy to perform. For the right application with complete knowledge of laser tissue interaction interpretation of the well-known measurement techniques as pH- and surgical set up is vital. Inadvertent use may result in surgical metry, impedanzometry, ergometry and polysomnography the complications. combination with the endoscopy of the function will be a must in the near future.

HIC 9 HIC 11 A method for visualising laryngeal stridor during Computer-assisted quantitative upper airway analysis exercise and calibrated cephalometry John-Helge Heimdal1, Robert C. Maat1,2 Dr. Hsu Pon Poh 1 Department of Oto-rhino-laryngology/Head and Neck Surgery, Changi General Hospital, Singapore Haukeland University Hospital, Bergen, Norway 2Department of Pediatrics, Haukeland University Hospital, Objective: This course introduces the various techniques of upper Bergen, Norway airway assessment in obstructive sleep apnea syndrome. This will enable the accurate identification of specific sites of upper airway Breathing difficulties during exercise due to airway obstruction at collapse and the precise quantification of the airway at various the laryngeal level is surprisingly often misdiagnosed as exercise levels. induced asthma. This misdiagnosis should be avoided to prevent Method: There will be a detailed step-by-step demonstration on unnecessary medication. how to perform computer assisted videoendoscopic quantitative The larynx normally opens widely at both the supraglottic and upper airway measurement. The presentation format with be glottic level during exercise in non-symptomatic individuals. The didactic lecture with digital slides and videos to demonstrate the pathophysiological mechanisms explaining the exercise induced various techniques discussed. reduction of the internal area at either one or both of these lar- Result and Conclusion: Participants will be able to perform and yngeal levels in symptomatic subjects, are still under discussion. appreciate the various techniques of upper airway assessment Exercise induced airflow constraint in an otherwise normal larynx discussed. In particular, they will be able to perform computer- becomes visible only at high airflow level. Since airflow rapidly assisted videoendoscopic quantitative airway measurements in decreases after exercise, both pre- and post exercise laryngeal their own office practice. This simple, cost-effective technique examinations are not optimal. Respiratory symptoms should will allow them to obtain precise airway measurements and therefore be recorded and larynx continuously visualised during identify the anatomical sites of the upper airway in need of exercise if laryngeal dysfunction is to be studied in detail. correction and assist in the selection of surgical procedures to A diagnostic set up has been developed for continuous laryngeal improve the upper airway. This technique also enables com- inspection as well as recording of gas exchange parameters, exercise parison of airway dimensions before and after surgery. Efficacy flow volume loops and breath sounds during exercise. This test has of various surgical procedures can also be compared with this been entitled Continuous Laryngoscopy Exercise (CLE)-test. technique.

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HIC 12 HIC 14 Diagnosis of sleep disordered breathing using portable Management of sialorrhoea (drooling) in children devices: how to improve the quality of an out-patient Haytham Kubba, Jane Leonard recording Departments of Otolaryngology and Community Paediatrics, Royal Hospital for Sick Children, Yorkhill, Glasgow, Scotland, K. Ho¨ rmann, J. T. Maurer UK Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Germany Drooling of saliva (sialorrhoea) can be a major problem in children with neurodisability (for example, cerebral palsy). Although it may Introduction: Portable devices are regularly used to diagnose sound trivial, sialorrhoea can have a significant impact on the sleep disordered breathing in an outpatient setting as they are quality of life for the carers and it impacts upon the child physically cheap and easy to use. However, the recording cannot be at- (excoriation of the skin), socially (less physical display of affection tended while the patient sleeps at , which may lead to a from family, reduced contact with peers) and psychologically deterioration of the recording quality and misinterpretation of (embarrassment). In this instructional course we aim to share the the results. Editing of the raw data is necessary but time con- experience gained in our multi-disciplinary saliva control clinic. We suming during the tight daily schedule. will present the results of our studies on the local prevalence of Course content: The participants will learn how to improve the sialorrhoea, together with information from our studies on quality quality of an outpatient recording. They will learn to evaluate of life. We will discuss the various management options that we offer outpatient recordings properly and to recognise misinterpreta- in our clinic, including oral motor skills training by the speech and tions of the registrations obtained. Original raw data as well as language therapist, anticholinergic medications, botulium toxin numeric and graphic report data will be used. injections, saliva diversion surgery and saliva reduction surgery. The indications, techniques and outcomes will be discussed. We hope to show that it can be very rewarding to treat these children and that otolaryngologists have much to offer in their management. HIC 13 Management of patients after corrosive substance ingestion HIC 15 Ljiljana Jovancevic, Dragan Dankuc The subcranial approach to the anterior skull base Clinical Center, Novi Sad, ENT Clinic, Novi Sad, Serbia Dan M. Fliss, Sergei Spektor, Avraham Abergel, Ziv Gil Management of patients after corrosive substance ingestion at Skull Base Surgery Unit, Department of Otolaryngology-Head first must mean first aid measures, reanimation of the patient and Neck Surgery, Tel-Aviv Sourasky Medical Center, Sackler and substance dilution. The dilution can be done within 60 min, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel with water or milk. After the stabilisation of all vital parame- ters, further treatment should start by meaning of diagnostics Introduction: The purpose of this study is to present the technique and therapeutic measures. The best diagnostic procedure to of the extended subcranial approach to the anterior skull base, determine the presence and severity of corrosive oesophageal and to review the results of 100 cases operated for extirpation lesions is oesophagoscopy. Basic therapeutic principles in the tumors in this anatomical region. management of patients after corrosive substance ingestion are Methods: A retrospective review was conducted on the records of accepted worldwide and must be applied. It is contraindicated patients who underwent excision of tumors originating in the nasal to induce , diarrhoea and do corrosive substance cavity, paranasal sinuses, orbit or meninges. The evaluation pro- neutralisation. Charcoal has no effect. The kind and quantity of cedures, surgical technique and complications were reviewed. ingested substance must be determined, oral feedings stopped, Results: Forty-four cases involved malignant tumors and 56 in- fluid and electrolyte balance carefully assessed and development volved benign tumors. The most common benign pathology was of complications followed. meningioma and the most common malignant tumor was squa- We have treated a total number of 107 patients during mous cell carcinoma. The principal skull base reconstruction 10 years, mostly adults (age average 50 years). There was 32.7% procedure was performed using a multi-layered fascia lata. Post- male and 67.3% female patients. Ingestions of corrosives were operative follow-up (26 months in average) revealed that 80% of suicidal in 67.3% patients and accidental in 32.7%. In 55.1% of the patients are without evidence of disease, 12% are alive with patients there was acid ingestion, and in 25.2% alkali. Oesoph- disease, 2% died of their and 6% died of unrelated cau- agoscopy was done in 86 (80.4%) patients, out of which 59 ses. The rate of severe complications was 4.4%, and included (68.6%) were with and 27 (31.4%) without corrosive oesopha- meningitis (n = 2), cerebrospinal fluid rhinorrhea (n = 1) and geal lesions. Stenosis of the oesophagus developed in 10 tension pneumocephalus (n = 1). (9.4%)patients. Out of all 107 treated patients, 13 (12.2%) died. Conclusions: We conclude that the extirpation of anterior skull This instructional course will present the complete treatment base tumors via the subcranial approach is simple, reproducible protocol of ENT Clinic, Clinical Center, Novi Sad, Serbia. This and reliable, and is associated with reasonable complication rate. protocol has been in use for 6 years now (since 2000) and the Keywords: Subcranial approach, Craniofacial surgery, Skull base, results are excellent. Paranasal sinuses, Anterior fossa tumors

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HIC 16 and neck area but also of the whole body for localizing distant Microvascular reconstructive surgery in head metastases. For head and neck cancer where anatomy is often difficult, especially after treatment, the fused PET/CT images give and neck cancer: practical approach towards a much better accuracy in staging and restaging head and neck better quality of life cancer but also for detecting CUP. C. Rene´ Leemans, Remco de Bree This instructional course will provide pertinent and The Netherlands timely information on current guidelines, indications, and interpretation of PET-CT scanning in the initial diagnostic To reconstruct oral and pharyngeal defects after surgery several work-up and in treatment monitoring of head and neck cancer techniques have been developed for restoring functional and patients. cosmetic features. These are primary closure, skin grafts, local transpositions of skin, mucosa or muscle, regional flaps and free vascularised flaps. Because of the ‘bulky’ and pedicled structure of the locoregional flaps, with consequent frequently unsatis- HIC 18 factory functional results, free vascularised flaps have gained Bipolar radiofrequency induced thermotherapy almost uniform popularity during the last decade. Vascularised (RFITT) for snoring and OSA flaps encompasses soft tissue free flaps and bony free flaps. For reconstruction of oral cavity and pharyngeal defects, fasciocu- Josef Lindenberger taneous (e.g., radial forearm flap and anterolateral thigh flap) Kopfklinik Frankfurt Main, Germany and myocutaneous free flaps (e.g., rectus abdominis and latissi- This course is designed to help and improve ORL specialists to mus dorsi) have proven to be very reliable. In the reconstruction find an approach for R-F surgery. Final outcomes are shown for of bony defects of the mandible or maxilla free vascularised different treatment modalities of an internationally well accepted osteocutaneous flaps (e.g., fibula flap and iliac crest) allows an minimally invasive procedure. adaptable approach to be used for each type of defect. Sleep related breathing disorders (SDB), such as habitual Depending on the site, size and involved tissues of the defect and snoring or obstructive sleep apnea (OSA), often originate from properties of the patient different reconstructive options are obstructions at different levels in the naso- and oro-pharynx. available. For both soft tissue and bony defects of the upper Those obstructions are often caused by a combination of various aerodigestive tract, microvascular free flaps provide good func- indications, such as turbinate hypertrophy, an enlarged or slack- tional outcomes, resulting in acceptable quality of life. ened soft palate, an enlarged and/or weak base muscle, as well as hypertrophy of the . Limiting the treatment to only HIC 17 one of these indications can lead to unsatisfactory results. How- ever, conventional multi level methods, like turbinectomy, UPPP, Application of F-18-FDG PET/CT in head and neck tongue base wedge excision, or corrections of the cancer jaw, are invasive and often painful procedures. Bipolar radiofre- quency induced thermotherapy (RFITT) can be applied to pa- Peter Lind1, Susanne Kohlfurst1, Ewald Kresnik1, ¨ tients with different extent of SDB, in order to increase the Markitz2, Hans Edmund Eckel2, Martin Lobnig3, effectiveness. Video clips for this surgery procedures will be Klaus Armin Hausegger3 1 shown: turbinate reduction, tightening of the soft palate, short- Department of Nuclear Medicine and Endocrinology, PET/CT ening of the uvula and removal of webbing with bipolar cutting Center, Klagenfurt, Austria 2 unit, volume reduction of the palatine tonsils, tongue base volume Department of Oto-Rhino-Laryngology, Head and Neck Sur- reduction. A significant therapeutic effect, rated by reduction of gery, LKH Klagenfurt, Austria 3 the snoring sound and AHI, can be achieved in a well selected Departnment of Radiology, LKH Klagenfurt, Austria group of patients. Furthermore, morbidity in multi level RFITT is The incidence of head and neck cancer is increasing world-wide. not significantly higher than in single level RFITT and consider- In addition to clinical investigation including palpation and ably lower compared to conventional surgery. endoscopy with biopsy, conventional morphological imaging Therapy for a surgeon only can be successful using one methods, i.e., ultrasonography, radiography, computed tomog- system in the beginning. A decision must be made which device raphy and magnetic resonance imaging (MRI), have a routine fits best. We are showing our long term results with the Celon role in the diagnosis of malignant head and neck cancer. R-F device which is (a) widely used in Germany and (b) for a However, the primary tumour often cannot be found despite very long period of years. That’s why a comparison with dif- extensive examination of the head and neck by means of several ferent medical groups and procedures can be shown in this techniques (CUP). Furthermore, for staging purposes as well as course. for the detection of tumour recurrences after chemotherapy There is a discussion of the world wide literature, evaluation and/or external radiotherapy, morphological examination tech- of short and long term efficacy of a ‘‘multi level’’ therapy niques such as CT and MRI are of limited accuracy. In recent shown with a wide range of video clips. Step by step develop- years F-18 FDG PET is playing an increasing role in the ment of different approaches and surgical procedures with the assessment of malignant head and neck cancer. This is not only R-F system. true for staging and restaging of head and neck cancer but also Different R-F lesions treatment modalities for the soft palate for the detection of CUP in case of histologically proven lymph and tongue base are demonstrated as well as the long term out- node metastases. comes of our treatment in a private ORL medical center. In recent years combined PET/CT maschines are availabe with Our subjective data, shown in the course, (evidence based data are the possibility to overlay the metabolic (FDG PET) and mor- still very rare !) demonstrate a safe procedure which is well ac- phologic (CT) information resulting in fusion images of the head cepted by patients.

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HIC 19 HIC 21 Cricotracheal resection: the surgical solution Evidence based voice assessment for subglottic stenosis in children? Mette Pedersen P. Monnier Denmark Switzerland Introduction: In the clinical work, diagnoses in laryngology can Despite constant improvements and refinements in surgical often be secured with supplementary acoustical measurements. techniques, the management of pediatric laryngotracheal ste- Material: Laryngological disorders are diagnosed in hospitals nosis (LTS) remains challenging for the otolaryngologist. The and private clinics. As a routine fiberscopy and at the same laryngotracheal reconstruction (LTR) has proved very success- time an evaluation of the upper airways/mucosa is commonly ful in the treatment of pediatric LTS, but has shown some made. Especially the mucosal function is evaluated. Often al- limitations when dealing with the most severe grades of LTS lergy and functional deviation of the nose and pharynx is taken (grade III and IV = subtotal or total obstruction of the into account. This is to some extent also the case for lower airway). airways and esophagus/stomach problems with for example In an attempt to improve the surgical outcome of severe reflux, Helicobacter pylori and food intolerance. (grades III and IV) LTS, the concept of removing the diseased Method: The overall functions of the mucosa of the upper segment of the airway has emerged as an attractive alternative to airways are diagnosed, based on the patients complaints. It is LTR to allow decannulation. Partial cricotracheal resection suggested that Jitter, Shimmer, Fundamental Frequency and (PCTR) with primary thyrotracheal anastomosis spares the glottis Glottis closure is measured with a sustained tone and standard and reconstructs a rounded, more ‘‘normal’’ mucosalized sub- text as well. In singers and speakers it is also suggested that glottic airway. It minimizes the problems of wound-healing seen phonetograms and overtone measurement is made as a routine. with costal cartilage graft and with stenting in LTR. Results and conclusion: We have used the above-mentioned pro- Extended partial cricotracheal resection (extended PCTR) is gram for several years now and systematic studies have been made. used to describe a PCTR combined with an additional open airway procedure. The indication is typically that of LTS with glottic involvement, either posterior glottic stenosis with possi- HIC 22 ble crico-arytenoid joint fixation, fusion of the vocal cords or Crico-tracheal resection and anastomosis (CTRA) laryngeal distorsion resulting from previous failed LTR. In this forcintrsinsic and extrinsic tumors of the laryngo- situation, PCTR cannot be done as a single-stage procedure, and a tracheostomy must be left inside until the airway is fully trahealjunction (LTJ): indications, techniques, healed and stable after a period of stenting with a laryngeal oncologic, and functional outcome mold. G. Peretti, C. Piazza This course will address in detail all the problems related to the Department of Otolaryngology, University of Brescia, Spedali appropriate indications, the technique of the surgery, the post- Civili, Piazza Spedali Civili 1, 25123 Brescia, Italy operative management and the results of this type of surgery. Objective: CTRA is mostly applied to benign subglottic stenoses. HIC 20 Aim of this course is to describe our experience in approaching by CTRA selected cases of LTJ tumors, with particular emphasis Selective neck dissection given to indications, surgical techniques, management of periop- Eugene N. Myers erative complications, and oncologic outcomes. Distinguished Professor and Emeritus Chair, Department of Methods: Between September 1996 and January 2007, we per- Otolaryngology, University of Pittsburgh School of Medicine and formed CTRAs in 92 patients, 31 of them (34%) affected by Medical Center, USA LTJ tumors. Eleven were primary tumors (1 pleomorphic ade- noma, 6 low-grade chondrosarcomas, 2 low-grade mucoepider- Cancer of the head and neck is an uncommon disease. The most moid, 1 adenoid cystic, and 1 squamous cell carcinomas), 20 important indicator of survival in cancer of the head and neck is the were tumors from adjacent sites involving the airway (11 well- extent of metastases to the neck; therefore management of the neck differentiated and 3 dedifferentiated thyroid cancers, 3 thyroid remains an important part of cancer control. Treatment by surgery, metastasis from non-head and neck malignancies, and 3 meta- radiotherapy or both depends upon the site and state of the primary static recurrential lymph nodes from cancer of the UADT). All as well as the clinical and pathological staging of the neck. The of them were submitted to CTRA involving only tracheal rings selective neck dissection (SND) which removes lymph nodes vul- in 9 cases, the trachea and the cricoid arch in 12, the trachea, nerable to metastases from various primary sites spares adjacent the arch and part of the cricoid plate in 10. At last consulta- structures and has low morbidity. The SND originally applied for tion, all patients with primary LTJ tumors were free of disease diagnostic purposes in the N0 neck may also be used successfully in (mean follow-up, 62 months; range 12–126). Among patients the treatment of the N+ neck. Indications for surgery, surgical with tumors arising from adjacent sites, 10 (50%) were free of technique, postoperative management complications and outcomes disease (mean follow-up, 20 months; range 2–51), 7 (35%) were will be discussed. alive with distant metastases (mean follow-up, 34 months; range 6–91), 2 died for local-regional disease 12 and 2 months after surgery, and 1 died for distant metastases 32 months after CTRA. Complications occurred in 9 patients (29%) and re- quired permanent tracheotomy in 1 patient and total laryn- gectomy in another. Conclusions: CTRA is an organ preservation technique to be considered oncologically safe in selected LTJ tumors in which the endoscopic approach either failed or was thought unfeasible.

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HIC 23 The pre-and postoperative result has been documentated by vid- Instrumentation for endolaryngeal surgery eostroboscopic examination and accustically by Multispeech of Kay Elemetrics and the Phonetogramm of Hacki/Homoth and H. E. Eckel, Marc Remacle Lingcom/Lingwaves. The author will demonstrate in these work- ENT-Department, LKH Klagenfurt, Austria; Cliniques Univers- shop the pretherapeutic documentation, the technic of the vocal itaires U.C.L. de Mont Godinne, Belgium fold augmentation by the indirect transoral technic and the post- The use of endoscopic surgery for benign and malignant lesions of therapeutic management. the larynx has modified numerous operative procedures in lar- This method is a simple and low morbiditic procedure that can yngology and has given way to a wide variety of innovative and be performed at an outpatient office under topical anesthesia. sophisticated procedures. The specific instrumentation required for these interventions will be discussed in detail during this instructional course. HIC 25 The essential problem in microlaryngoscopic surgery is to Foreign bodies localized in larynx, trachea, bronchus obtain an adequate view of the operative field and to have the ability to use the necessary instruments at the surgical site. In and esophagus in children: diagnostic and treatment laryngeal surgery, operating laryngoscopes are employed for this Fernando Silva Chaco` n purpose. Since no laryngoscope can satisfy all requirements, the Children Hospital Francisco De Icaza Bustamante, Ecuador laryngeal surgeon should have an assortment of different models on hand. The most important are Kleinsasser laryngoscopes (sizes The author present 1,211 cases of foreign bodies located in the A–C, DN, J, JL), bivalved laryngoscopes in various sizes (Rudert, digestive, airway system, being a frequent pathology in the seen Steiner, Weerda), Lindholm laryngoscopes (when they are in- hospital emergency treated by the author from January of 1986 until serted into the vallecula they provide an excellent view of supra- August of the 2006. Realizing the diagnostic by the clinical history, glottic structures ore even of the whole larynx), diverticuloscopes (aphonia, cough, wheezing, distress in airway, dysphagia, swal- for endoscopic cricopharyngeal myotomy, and pediatric laryn- lowing, ingest only liquids, lost of weight in esophagus) completing goscopes (various models). it with radiological study, in some cases one doesn’t observe the foreign body for what was requested C.T., in a study carried out by For tissue ablation, the CO2 laser meets the criteria for use for most benign and malignant laryngeal lesions, particularly in the author with T.C. to diagnose foreign bodies in 12 cases. In 10 phonosurgery, stenosis surgery, swallowing rehabilitation, and for they reported that the foreign body was not seen. the resection of laryngeal tumours. Implants are needed to replace For rigid endoscopy (esophagoscopy, laryngoscopy and bron- anatomical structures an to restore function. choscopy) the foreign bodies were extracted corresponding in their Endolaryngeal approaches can now solve most clinical chal- majority coins, seeds, toys, chicken bone, etc. Of these 1,211 cases, lenges in operative laryngology. Adequate instrumentation, bigger incidence in the masculine sex from 1 to 3 years of age followed however, is indispensable to accomplish the goals of this mini- by 4 years old, 143 were in to the airway (Larynx 35, traquea15, mally invasive approach. bronchus’s 93) and in esophagus 1,068 cases (cervical Esophagus 923, middle third of esophagus 107 and lower third 38) 5 cases presented complications: two for foreign body in the airway and three HIC 24 esophagus perforations post extraction and they evolution favorably Vocal fold augmentation with Bioplastique material to their surgery treatment(thoracic surgeon closed the perforations by indirect phonosurgical treatment under topical diagnostic the first hours) and intravenous . anesthesia HIC 26 Josef Schlo¨ micher-Thier, Matthias Weikert Advanced techniques of radiofrequency surgery HNO- Office and Austrian Voice Institute, Salzburgerstrasse 34, in otorhinolaryngology 5202 Neumarkt, Salzburg, Austria Klaus Vogt Vocal cord paralysis is a complex and multifactorial condition. In Medic. Faculty, University of Latvia, Riga; Tagesklinik im Pro- this study we present 23 patient with vagus nerve lesions that affect vianthaus, Rendsburg, Germany only the recurrent laryngeal nerve and two patient with a vagus nerve lesions above the level of the pharyngeal nerve branch.The Objective: The interstitial applications of RF-surgery or widely unilateral abductor paralysis of these patients occurs as a result of known as principles of modern somnosurgery. The minimal lateral lesions caused by following reasons. heat and the versatility of RF-Techniques by changing energy, 2x intrathoracic malignant neoplasms, 1x trauma to the neck, waveform and different tools allow precise dissections and coagu- 14x thyroidectomy, 2x idiopathic disorders, 5x intrathoracic sur- lation in anatomically difficult regions as in the nose and in the gery and 2x vagus nerve lesions caused by malignant neoplasms of middle ear. These techniques are demonstrated in videospots and in the skull base. Twenty-four patients has had the vagus nerve lesion some model experiments. more then 1 year, only two patient with intrathoracic malignant Methods to be demonstrated: The differences between classic elec- neoplasms where treated within 2 month after the paralysis occurs. trosurgery and RF-surgery are outlined by some model and cadaver All the patient where treated with intracordal Bioplastique head demonstrations. The following surgical details will be shown injection by indirect transoral technique in topical anesthesia under by using 4 MHz-technology and new application instruments: a direct laryngoscope. Bioplastique is a biologically stable and Radiofrequencytonsillotomy, dissection techniques in neck and suitable material without allergic reaction and without resorption of parotid surgery, endoscopic and microscopic endonasal surgery, in the material. It had been used since more then 30 years for medical particular by using microfiber technique, RF-Myringotomy and products without complications. The authors have developed a applications in the middle ear, modifications of pharyngoplasties in special equipment to inject the bioplastique material by a ‘‘one hand snoring and OSAS, techniques of cartilage modelling in intranasal technique‘‘ to place the material for a successful augmentation to surgery and otoplasty, new techniques in endolaryngeal RF- treat the glottic incompetence and to reinstall the glottic vibration. surgery.

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HIC 27 minimal. This approach also allows the control of the internal Skin cancer with emphasis on plastic surgical carotid artery and removal of other lesions located in the central skull base. procedures During the course, surgical procedure to expose the naso- Alexander Weber1, Angelika May2 pharynx and central skull base with the maxillary swing approach 1HNO-Klinik, kath. Hospital St. Josef, Kliniken Essen Su¨ d, will be illustrated step by step through slides and video. Practical Germany hints to avoid complications will be stressed. 2J.W.-Goethe Universita¨ tsklinik, Frankfurt am Main, Germany Basal cell and squamous cell carcinoma are the most common HIC 29 types of skin cancer found among the Caucasian population. It is Neoplasms of the parotid gland estimated that 2.8 million cases of nonmelanoma skin cancer will be diagnosed each year worldwide. Environmental and individual Peter Zba¨ ren factors predispose to tumor formation. Bern, Switzerland If conservative strategies fail histologic controlled surgery is the Educational objectives: (1) Know the occurrence of the different most effective way to cure skin cancer. The correct interpretation histiotypes of parotid neoplasms. (2) Know the histologic char- of macroscopic appearance of skin malignancies is important, acteristics of the capsule of pleomorphic adenoma and understand because solid well-differentiated basaliomas behave different from their impact on surgical treatment. (3) Understand the indication wide spreading morphea-like basaliomas. In addition histologic and value of different diagnostic modalities, such as MR imaging, diagnosis will influence the treatment to achieve local control. fine-needle aspiration cytology and frozen section analysis, in the Thorough understanding of the esthetic units and functional diagnosis of malignant primary parotid carcinomas. anatomy of the face are necessary to plan successful reconstruction Course abstract: First, an overview of the different histiotypes and with a favourable outcome. Therefore, this course will familiarize the frequency of benign and malignant parotid neoplasms is the participants with causes, symptoms and types of skin cancer. presented on the basis of our own 900 parotid neoplasms, treated The main focus is laid on operative strategies to cure skin during the last two decades.The second part deals with benign cancer. In a step by step demonstration of reconstruction tech- tumors. The histologic characteristics of the capsule of pleomorphic niques the participant will learn how to reconstruct most defects adenoma is demonstrated. In this context, our experience with 40 seen in normal practise as well as challenging cases. The algorisms recurrent pleomorphic adenomas is presented and discussed and include primary closure, advancement flaps, pedical flaps, or compared with the literature. The controversial debated extent of grafts. On a simple model the participants can get practical expe- pleomorphic adenoma surgery is discussed on the basis of studies in rience with flap techniques. Alternative treatment options such as the literature. radiation therapy or immune modulation will be discussed. The last part deals with primary parotid carcinomas. The value of diagnostic modalities, such as MR imaging, fine-needle aspira- tion cytology and frozen section analysis in the diagnostic work-up HIC 28 for primary parotid carcinomas is presented. The outcome of the Surgical treatment of residual/recurrent different histiotypes is covered. Finally, the indication for elective nasopharyngeal cancer neck dissection in cNO neck and postoperative irradiation for small carcinomas are discussed. William I. Wei FRCS FRCSE FRACS (Hon.) FACS, W. Mong Chair in Otorhinolaryngology, The University of Hong Kong HIC 30 In current practice, the primary treatment modality for naso- B-Mode- and colour-coded-sonography of the head pharyngeal cancer is concomitant chemotherapy and radiother- and neck apy. To manage those patients who develop a small residual or Heinrich Iro, Alessandro Bozatto, Johannes Zenk recurrent tumour in the nasopharynx after the chemoradiation, Germany the logical strategy is salvage nasopharyngectomy. Anatomically, the nasopharynx is located in the center of the Ultrasound in its different applications (B-Mode, Color coded head; it is difficult to expose the region adequately for an onco- ultrasound, Power Mode, Harmonic imaging, contrast enhanced logical procedure. We have employed the anterolateral approach ultrasound) is in our hands a very powerful diagnostic tool in the to the nasopharynx to carry out the salvage nasopharyngectomy. head and neck area. This procedure essentially swings the maxillary antrum laterally During the last 10 years the quality of the images has been while it remains attached to the anterior cheek flap. The tumour in significantly improved so that ultrasound is as sensitive and specific the nasopharynx and its vicinity is adequately exposed and all as MRI concerning diagnosis of neck and parotid gland masses. pathologies can be resected under direct vision. After tumour Within our course we describe the different techniques cur- extirpation, this osteocutaneous complex is returned to its original rently used and provide also the possibility to follow through position and fixed to the rest of the facial skeleton. Over the years, normal sonographic anatomy as well as the multiple variety of this has been carried out for 189 selected patients and a 5-year pathologies of the head and neck. actuarial local tumor control rate of 63% with a 5-year disease A main focus will be the sonography of the salivary gland free survival rate of 54% could be achieved. disorders as well as the possibilities of prediction of malignancies The surgical procedure is not difficult and there was no hos- in sonographic findings. Moreover we will discuss the meaning pital mortality. With the modification of surgical techniques, the and indication of colour coded sonography and contrast enhanced palatal fistula which previously occurred in 20% of patients has sonography. Participants of the course will also have the possi- been eliminated. The associated morbidity with the procedure was bility to be trained live on site.

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HIC 31 hypopharyngeal SCC including all tumour stages and therapeu- Sialendoscopy course tical regimens. After pyrosequencing the genotypes were corre- lated with the clinical data. Francis Marchal Results: The median follow-up of the 219 patients (178#:41$) was Director of the European Sialendoscopy Training Center, 33, the average 43 months. The allele frequencies [TT = 54 Switzerland (25%), CT = 95 (43%) and CC = 70 (32%)] were not signifi- Sialendoscopy is one of the most fascinating innovations intro- cantly different from those of healthy blood donors, which makes duced in the last few years in the field of oto-laryngology, head an association between the T393C SNP and a predisposition for and neck surgery. Sialolithiasis and sialadenitis is one of the most the analysed tumours unlikely. The analysis of disease progression frequently presenting disorders of the salivary glands. It’s classical revealed that the relapse-free survival (RFS) was significantly treatment ranges from the use of surgery—intra-oral extraction or correlated with the genotype (P = 0.02 log-rank test). This effect external lithotripsy, to the more frequent performance of external was pronounced in males (average relapse free survival TT = 86, excision of the gland. TC = 72, CC = 52 months; P = 0.003 log-rank test). In multi- Diagnostic sialendoscopy allows for optical exploration of the variate Cox proportional hazard analysis AJCC tumour stage, salivary ductal system and its diseases, while interventional sial- gender, and tumour localization, but also the T393C SNP were endoscopy enables extraction of the stones by a basket under independent prognostic factors for RFS. In comparison to endoscopic view, laser-fragmentation, or stenosis dilatation under homozygous T-allele patients, homozygous C-allele patients had a endoscopic control. In Geneva, a specific training and demon- 2.0 fold (95%-CI 1.03–3.97) higher risk for a recurrence of disease stration model for Sialendoscopy has been validated in the (P = 0.034). European Sialendoscopy Training Center, where an International Conclusion: The T393C polymorphism turns out to be a reliable Faculty reports their clinical, radiological, medical and surgical genetic tumour marker to predict the clinical course of patients approaches to salivary gland pathologies twice a year for training suffering from oro- and hypopharyngeal cancer. courses. This present course aims to give a complete overview on the sialendoscopic techniques, for the treatment of all ductal pathologies, including salivary stones, recurrent parotitis of chil- HL2 dren, single or multiple stenotic processes of the ducts, and more rarely ductal tumors. In difficult cases, where the results of sial- Human papillomavirus frequency in head and neck endoscopy are poor, we have developed other surgical techniques, squamous cell carcinoma combining sialendoscopy and external surgery which will be pre- Mircea Romanitan1, Tina Dalianis2, Torbjorn Ramqvist2, sented: These techniques allow the extraction of large stones, or Corneliu Romanitan3, Romeo Calarasu1, Eva Munck-Wikland4 the treatment of ductal stenosis by a veinous patch interposition. 1 The author, who has developed the instrumentation and the IFACF – ORL ‘‘Prof.Dr.D.Hociota’’, str. Mihail Cioranu 21, sector 5, Bucharest, Romania technique, presents his personal experience over the last 12 years, 2 on more than 1,000 sialendoscopies. Participants will have during Cancer Centrum Karolinska, Department of Oncology-Pathol- ogy, Karolinska Institutet, Stockholm, Sweden this course a complete and detailed overview on all available 3 methods to treat ductal diseases. Central Military Hospital, str. Mircea Vulcanescu 88, sector 1, Bucharest, Romania 4Department of Oto-Rhino-Laringology, Head and Neck LECTURES Surgery, Karolinska University Hospital, Stockholm, Sweden

Objective: The aim of this study was to examine the presence of Basic Science Human Papillomavirus (HPV) in head and neck cancer in a Greek material collected between the years 1986–2005 and to compare it HL 1 with our previous studies in Sweden. The relapse-free survival in oro- and hypopharyngeal Methods: DNA was extracted from 93 paraffin embedded pre- treatment biopsies. For the detection of HPV, PCR with HPV squamous cell carcinoma correlates significantly consensus primers GP5+/6+ and CPI/IIG were used. For with the genotype of the T393C polymorphism detection of HPV 16, a PCR with HPV 16 type specific primers of the Gas gene was used. 1 1 1 3 3 Results: In total 9/93 tumours were HPV positive. Eight of the 18 G. Lehnerdt , P. Franz , A. Zaqoul , A. Bankfalvi , K. Schmitz , tonsillar cancer samples (44%) were HPV positive and notably, S. Lang1, K. W. Schmid3, W. Siffert2, K. Jahnke1, U. Frey2 1 within the same material, 7/12 (58%) of the tonsillar cancer sam- Department of Otorhinolaryngology, University of Duisburg- ples obtained between years 2000–2005 were HPV positive. Seven Essen, Hufelandstraße 55, 45122 Essen, Germany 2 (88%) out of the eight HPV positive tonsillar tumours were HPV Institute of Pharmacogenetics, University of Duisburg-Essen, 16 positive. Of the tongue cancer samples 1/31 (3%) were Hufelandstraße 55, 45122 Essen, Germany 3 HPV positive, while none of the 44 oral cavity cancer samples were Institute of Pathology and Neuropathology, University of HPV positive. Duisburg-Essen, Hufelandstraße 55, 45122 Essen, Germany Conclusions: In summary, almost half of all the Greek tonsillar Introduction: In preliminary studies we could demonstrate that the cancer patients had presence of HPV in their tumours, and HPV-16 T-allele of a specific Single Nucleotide Polymorphism (SNP) in the was the dominant type. In Sweden, we have demonstrated a highly Gas gene (T393C) correlates with increased Gas expression and significant and parallel increase both in the increase of tonsillar hence apoptosis and therefore represents a potential factor with cancer and the proportion of HPV-positive tumors. We concluded regard to carcinogenesis, progression, and therapeutical response. that the incidence of Greek HPV positive tonsillar cancer was Method: Objective of the study was the evaluation of the prog- almost as high as in Sweden confirming our previous reports nostic value of the T393C SNP in an unselected series of oro- and regarding HPV as an important risk factor for tonsillar cancer.

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HL 3 HL 4 The comparison of the presence of Epstein-Barr Ultrastructural aspects of olfactive mucosa derived latent membrane Protein-1 gene in cervical of laryngectomees metastatic lymph nodes of patients with head and neck Barbara Cutrera1, Maurizio Marchini2, Fulvia Ortolani2, carcinoma Cesare Miani2, Giancarlo Tirelli1, Lucia Petrelli2 1University of Trieste, ENT Clinic Bijan Khademi1, Jalal Mahmoudi1, Ahmad Monabati2, 2University of Udine, Human Morphology Department Mohammad J. Ashraf2 1Department of Otolaryngology, Head and Neck surgery, Khalili Objective: Patients who have undergone total laryngectomy Hospital,Shiraz, Iran experience a decrease of odor perception. The aim of the study is 2Department of Pathology, Shiraz University of Medical Sciences, understanding if this lack of olfaction is simply the result of the Shiraz, Iran disconnection between upper and lower airways due to surgery or if there are citopathological findings at the base of this, through an Background: Cervical lymphadenopathy is occasionally of un- ultrastructural analysis of olfactory mucosa specimens of laryn- known origin & Nasopharyngeal carcinoma (NPC) closely asso- gectomees and rhinologically normal patients. ciated with Epstein-Barr Virus which is frequently related with Methods: Olfactory mucosa specimens were endoscopically col- malignant cell transformation through the action of the onco- lected from seven laryngectomees and from three rhinologically protein latent membrane protein -1 (LMP -1). normal subjects (as controls) and then examined with a CM-12 Objective: In this retrospective study the presence of EBV-derived Philips transmission electron microscope. LMP-1 gene in nasopharynx and metastatic nodes of nasopha- Results: There have been observed deep ultrastructural changes in ryngeal, oral cavity, laryngeal and skin cancers and nonmalignant the morphology of olfactory neuroepithelium that appeared of patients were compared. widely disrupted and degenerated. Methods: Eighty-four paraffin-embedded tissues of various head Conclusions: The citopathological damage observed in the olfac- and neck specimens including nasopharynx, oral cavity, larynx tory mucosa of laryngectomees is a direct cause of decreased and skin were examined for the presence of LMP-1 gene, using neurosensorial performance in this group of patients. polymerase chain reaction. Results: Ten of 12 nasopharyngeal biopsies and 8 of 10 speci- mens from metastatic lymph nodes of the same NPC were positive for LMP-1 gene. The LMP-1 gene was detected in HL 5 metastatic lymph nodes of NPC with a sensitivity of 80%, HPV as prognostic factor in oral/oropharyngeal specificity of 100%, positive predictive value of 100% and squamous cell cancer negative predictive value of 91%. On the contrary after appli- cation of PCR, the LMP-1 gene was not detected in any Jan Klozar, Ruth Tachezy, Vı´ t Kratochvı´ l, Eva Vesela, samples of other head and neck carcinomas,their metastatic Roman Kodet, Eva Hamsikova nodes and tonsillar specimens. There was a significant associa- Department of Otorhinolaryngology Head and Neck Surgery, tion between the presence of LMP-1 gene and tumor location in Motol Faculty Hospital, Prague nasopharynx (P < 0.0001). Objective: To compare the survival between patients with HPV Conclusion: The study demonstrated that the presence ofLMP-1 positive and HPV negative tumours. To compare the presence gene detected by PCR in metastatic tumor cells is only signif- and type of regional metastases in the patient population with icantly associated with tumor location in nasopharynx and EBV HPV positive and negative tumours. To find out about the has no essential role in the tumorigenesis of carcinomas arising prognostic factors of survival and to find out whether HPV from other head and neck sites. The polymerase chain reaction status is an independent prognostic factor. method is a potential tool for localizing primary site of a cer- Methods: Investigations were carried on 81 patients treated by vical metastatic cacinoma. surgery including neck dissection for oral or oropharyngeal squamous cell cancer. A computerized medical report was completed for each patient. Analysis of the tumour specimen was performed on paraffin fixed tissue. HPV DNA detection and typing was done by by GP5+/GP6+BIO reverse line blot hybridization. Results: In the whole group 64% (52/81) of the tumours were HPV positive, in tonsilar location it was 80% (41/51). HPV po- sitive patients had significantly better survival than HPV negative patients both overall (73 vs. 35%) and disease specific (78 vs. 45%). No significant differences were found in the prevalence of regional metastases and in the nature of the involved nodes be- tween HPV positive and HPV negative tumours. The significant prognostic factors of survival found were the presence of HPV in the tumour, gender, extracapsular spread and the T classification. HPV presence, female gender and no extracapsular spread were still significantly associated with better survival after the Cox multivariate analysis. Conclusion: As the HPV status seems to be the strongest prognostic factor, we should possibly consider it in clinical treatment decisions.

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HL 6 analysis of the respective genes showed that Beta-Catenin1 was Correlation between p53 and PCNA in lymph nodes expressed in 60–70% of tumor cells, TCF-4 in 20% and Wisp-1 and Wisp-2 in 10–20% of tumor cells. metastases of oral/oropharynx cancer Conclusion: Genes of the Wnt pathway are regulated in OSCCs. Giancarlo Tirelli1, Ledia Papanikolla1, Mauro Melato2, 1 Elena De Nardi HL 8 1ENT Clinic, University of Trieste 2Flow Cytometry Center, University of Trieste Response from upper airway epithelial cells to X-irradiation Objective: To characterize p53 and PCNA expression in primary tumors and lymph nodes metastases of oral/oropharynx carci- R. Reiter1, T. Deutschle1,D. Bartkowiak2, nomas by flow cytometry and to evaluate the relationship be- T. Wiegel2,H. Riechelmann1 tween these parameters in primary tumors and locoregional 1University of Ulm, ENT Department, Ulm, Chair: Prof. Dr. G. metastases, clinical-hystopathological parameters and survival Rettinger time. 2University of Ulm, Department of radio-oncology, Ulm, Chair: Methods: Twenty-eight patients were retrospectively studied: 13 Prof. Dr. T. Wiegel with metastases and 15 without metastases. The parameters Objective: Radiotherapy of head and neck tumours may also affect considered were the degree of keratinization, Broder’s grading normal epithelial cells, which contribute to adverse tissue reac- of histological differentiation, invasive cell grading, thickness tions. Mechanisms involved in dose and time dependent effects on and tumor size. Nuclei were stained using anti-p53 and anti- airway epithelial cells of X-irradiation should be investigated. PCNA FITC conjugated monoclonal antibodies. Was used a n Coulter Epics Elite flow cytometer. Methods: Cultures of BEAS-2B-cells ( = 27)were X-irradiated in triplicate experiments with single doses of 2, 5 and 8 Gy with a Results: A close relationship between p53 and PCNA in pri- Philips MG 320 (300 kV X-rays, 1 Gy/min). After 2, 6 and 24 h mary tumors; no correlation with clinical-histopathological parameters; no correlation between p53 and PCNA expression differential gene transcription (1,232 genes) was analyzed and in primary tumors and in lymph nodes metastases; no corre- grouped by biological themes according to the ‘‘Gene Ontology Consortium‘‘. Enrichment factors (ef) of upregulated gene clusters lation between p53 and PCNA values in primary tumors and were determined with GoTREE (http://bioinfo.vanderbilt.edu/ survival. Conclusions: The different expression of p53 and PCNA in gotm). Additionally ten cytokines were measured in cell culture primary tumors and lymph nodes metastases is a questionable supernatants. Early cell cycle response and apoptosis induction were determined by flow cytometry 0, 24, 48 and 96 h after irradiation. prognostic parameter.

HL 7 HL 9 Analysis of the wingless pathway in oral squamous cell Elevated levels of circulating endothelial progenitor carcinomas cells in patients with head and neck squamous cell cancer Dietmar Thurnher1, Patricia Pintor dos Reis2, Boban Erovic1, Phillip Kloimstein1, Ralph Gilbert2, Patrick Gullane2, Markus Brunner, Dietmar Thurnher, Mattha¨ us C. Grasl, Jonathan Irish2, Suzanne Kamel-Reid2,3 Christoph Arnoldner, Boban M. Erovic 1Department of Otolaryngology-Head and Neck Surgery, Department of Otorhinolaryngology, Head and Neck Surgery Medical University of Vienna, Austria Medical University of Vienna, Vienna, Austria 2Applied Molecular Oncology, Ontario Cancer Institute and Objecives: Measurement of circulating endothelial cells (CECs) Otolaryngology and Surgical Oncology University Health and progenitor cells (CEPs) has potential as a surrogate marker Network, Toronto, ON, Canada for monitoring antiangiogenetic treatment and both cells might be 3Laboratory Medicine and Pathobiology, University of Toronto, the target of new therapeutic strategies. This study evaluated the Toronto, ON, Canada significance of CECs and CEPs in the blood of patients with head- Background: Reduction in cell–cell adhesion and vascular invasion and neck squamous cell cancer (HNSCC). are essential steps in the progression from localized malignancy to Methods: In a multicentered prospective study, fresh blood sam- metastatic disease. Proteins involved in intercellular adhesion, ples from 21 patients with HNSCC and from 17 age/sex matched such as E-cadherin and Beta-catenin play an important role in controls were using multiparametric flow-cytometry. metastatic processes and cellular differentiation. Less is known 1 · 106 cells were analyzed per sample. CECs were defined as about the role of the Wingless (Wnt) pathway in head and neck being positive for CD31 and CD146 and negative for CD45, CD3 cancer. Our objectives are thus to examine the expression of these and 7AAD. CEPs were defined as being positive for CD133 and genes in oral squamous cell carcinomas (OSCCs). KDR and negative for CD3, CD19, CD33 and 7AAD. Patients and methods: OSCC tissue samples were obtained at the Results: Median levels (Min/Max) of CECs were 4 (0/9) in the time of surgery from the Toronto General Hospital and snap tumor and 5 (1/13) in the control cohort (P = 0.33). Median frozen in liquid nitrogen. RNA was isolated from 20 OSCC levels of CEPs were 8 (2/37) in the tumor and 3 (1/13) in the specimens. Quantitative real-time RT-PCR (QRT-PCR) was used control cohort (P = 0.001). CEC and CEP levels were not found for relative quantification of gene expression. Data analysis was to correlate with tumor size and did not predict response to performed using the Delta Delta Ct method. Protein expression radiation-therapy after 6 months of observation (n = 12). was determined using tissue micro arrays. Conclusions: CD133 positive circulating endothelial progenitor Results: QRT-PCR analysis showed that the Wnt pathway genes cells were significantly elevated in the blood of patients with Beta-Catenin1, TCF4 and Wisp2 were 100-fold, 40-fold and six- HNSCC. These results warrent an extension of our study to fold overexpressed, respectively, whereas Wisp-1 was not over- determine whether CEP levels are surrogate markers for the re- expressed when compared to reference DNA. Protein expression sponse to antiangiogentic therapies.

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HL 10 expression of E-cadherin and beta-catenin in salivary gland tu- Carbonic anhydrase IX in head and neck malignant mors in order to evaluate their possible roles in the formation of salivary gland tumors. tumours: a meta-analysis Methods: Archival formalin-fixed, paraffin-embedded sections of Stamatios Th. Peridis1, Dimitrios Iosif1, Michail Chatzimichalis2, 46 mixed tumors (pleomorphic adenomas), 18 Warthin tumors, 3 Georgios Kostas1, Charalambos Nikolou1, Basilios Roditis1. mucoepidermoid carcinomas, 1 adenoid cystic, 1 acinic cell and 1 1Department of Oto-Rhino-Laryngology Head and Neck Surgery, squamous cell carcinoma, total 70 tumors, were studied immu- General Hospital of Rhodes, Greece nohistochemically using an Envision/horseradish peroxidase 2Department of Oto-Rhino-Laryngology Head and Neck Surgery, (HRP) technique. Healthy salivary glands were used as controls. Anticancer Hospital of Piraeus ‘‘Metaxa’’, Greece Results: Membrane and cytoplasmic associated E-cadherin and beta-catenin expression was present in 54/69 and 68/69 of the Objective: Carbonic anhydrases (CA) are proteins involved in the tumor types studied, respectively. E-cadherin and beta-catenin catalytic hydration of carbon dioxide (CO2) to carbonic acid 3– showed a similar distribution; however E-cadherin was less fre- (HCO ). The protein CA IX is an endogenous marker up-regu- quently expressed than beta-cadenin. Expression of both proteins lated by tumour hypoxia. The present study uses meta-analytical was stronger in Warthin tumors and in mucoepidermoid, adenoid techniques to compare CA IX (–) versus CA IX (+) and CA IX cystic, acinic cell and squamous cell carcinomas. Reduction and/ low versus high expression at different cut-offs for resected or absence of E-cadherin was only observed in mixed tumors. specimens in patients with any head and neck malignant tumours Conclusions: This study suggests a direct association of E-caderhin with regards to long-term outcomes. and beta-catenin expression with neoplastic histology phenotype Methods: The literature was searched using Medline, Embase, of salivary gland tumors. Ovid, and Cohrane databases for all studies published. Compar- ative studies between 2001 and 2006 of CA IX (–) versus CA IX (+) and CA IX low versus high for head and neck cancer were included in the analysis. The end points evaluated were: CA IX HL 12 expression of the resected specimens, and long-term outcomes Genotoxicology studies with human laryngeal (overall survival at maximal follow-up and recurrence free sur- miniorgan cultures vival at maximal follow-up). Random-effect meta-analytical techniques were used for analysis. Norbert Kleinsasser, Christian Ginzkey, Katja Kampfinger, Results: Seven studies matched the selectioncriteria, reporting on 758 Rudolf Hagen patients, of whom 159 (41.84%) were CA IX (–), 221 (58.16%) were Otolaryngology, Head and Neck Surgery, Julius-Maximilian- CA IX (+), 102 (36.88%) were CA IX low and 178 (63.12%) were University, Josef-Schneider-Str. 11, 97080 Wu¨ rzburg, Germany CA IX high for any head & neck cancer. CA IX (+) was significantly expressed (P < 0.00001) on the resected specimens. Overall survival Miniorgan cultures (MOC) of upper aerodigestive tract epithelia, (P = 0.02) and recurrence free survival (P < 0.005), were all sig- as first described by Steinsvag and Olofsson, have been shown to nificantly reduced when CA IX was positive. be a relevant tool in genotoxicology studies. MOC allow repetitive Conclusion: CA IX (+) results in a reduced overall survival and or chronic exposure of cells to xenobiotics and monitoring of recurrence free survival at maximal follow-up when compared to CA possible adverse effects. The present report focuses on initial IX (–) patients, i.e., CA IX is an indicator for poor survival rate when experiences with MOC from supraglottic laryngeal epithelia. positive. Culture of mini organs was performed by cutting pieces of 1mm3 from fresh specimens of human laryngeal epithelium. MOC were incubated on multi-well plates with Bronchial Epi- HL 11 thelial Basal Medium and on days 7, 9, and 11 aliquots were exposed to xenobiotics, e.g., nicotine. Cytotoxic effects were Immunohistochemical detection of E-cadherin monitored by the trypan blue exclusion test, genotoxic effects by and beta-catenin in salivary gland tumors the aid of the single cell microgel electrophoresis assay, structure of MOC by repetitive histology. Theodoros Papadas1, Nicholas S. Mastronikolis1, MOC showed a good viability over the experimental period. Panagiota Ravazoula2, Maria Gkermpesi2, First observations demonstrated an elevated DNA-migration after Gabriel Tsiropoulos1, Panos D. Goumas1 triple exposure to nicotine at 4 mM whereas after single exposures 1Department of Otorhinolaryngology, University Hospital migration enhancement was not significant. MOC were coated by of Patras, Patras, Greece epithelium after one week. However, in some MOC with a too big 2Department of Pathology, University Hospital of Patras, diameter, centrally located cells appeared to be ill-nourished. Patras, Greece This type of organ culture of laryngeal epithelia provides an Objective: E-cadherin links to the cytoskeleton via catenins and in vitro model suitable for the assessment of genotoxic effects of mediates cell-cell homophilic adhesion. Beta-catenin not only environmental pollutants mimicking the in vivo situation with regulates cell–cell adhesion, as a protein interacting with cadherin, target cells of carcinogens in their functional organ specific but also functions as an important component of the Wnt sig- intercellular architecture. However, further refinements of the naling pathway which has been found to be closely associated with protocol are necessary and studies to demonstrate the metabolic tumor formation. This study was performed to examine the competence of laryngeal MOC.

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HL 13 Our previous data indicates that sFRP1 protein/mRNA expres- Peptidomic study of saliva from subjects affected sion is substantially suppressed in advanced head and neck can- cers. The aim of this study is to identify the role of sFRP1 gene by precancerous and cancerous lesions of the oral methylation in the HNSCC. cavity and larynx Method: The study population was recruited from the Head and Scarano Emanuele1, Inzitari Rosanna2, Agostino Stefania1, Neck oncology clinic. Informed consent was obtained from each Fanali Chiara2, Fiorita Antonella1, Cabras Tiziana3, patient for molecular analysis of the resected specimen. We per- Passali Giulio Cesare1, Mario Rigante 1, Castagnola Massimo2, formed methylation specific PCR in a cohort of 18 HNSCC Paludetti Gaetano1, Messana Irene3 samples and compared these with expression levels in normal 1Institute of Otolaryngology, Catholic University, Rome upper aero digestive mucosa samples from the same patient. 2Institute of Biochemistry and Clinical Biochemistry, Catholic Results: Hypermethylation of sFRP1 was detected in 10 out of 18 University, Rome patients. The expression of sFRP1 proteins was lower in 14 patients. 3Department of Sciences Applied to Biosystems, Cagliari Conclusion: Above study indicates the hypermethylation of sFRP1 University, Italy gene is a common event in HNSCC. Aberrant promoter methyla- tion appears to functionally silence sFRP1 gene expression in Objective:The object of this study is to investigate and quantify HNSCC. These pathways may be useful targets for chemopreven- specific salivary peptides (statherin, histatin 1-3-5, PB peptide and tion strategies in this common solid tumour. a-defensin 1–3) in patients affected by precancerous and cancer- ous lesions of the oral cavity and larynx, in order to evaluate the use of salivary samples as test of screening for cancer risk. HL 15 Methods: We investigated 34 patients divided in three groups: (1) 14 patients with precancerous and cancerous lesions of the oral Expression of VEGF-A/C, VEGF-R2, PDGF-a/b, cavity; (2) 20 patients with laryngeal neoplasm, (3) 15 healthy c-kit, EGFR, Her-2/Neu, Mcl-1 and Bmi-1 in Merkel volunteers. Saliva specimens were diluted with acidic solution cell carcinoma: is targeted anticancer therapy (0.2% TFA) and analyzed by HPLC-mass spectrometry. Non- a feasible option? parametric test (Mann–Whitney) was used. Results: Statherin and PB peptide levels were found significantly Boban M. Erovic1, Markus Brunner1, Johannes Pammer2, lower in both patients groups with respect to control group Sylvana Geleff2, Gregor Heiduschka1, Christoph Arnoldner1, (P = 0.001 for both peptides in group II; P = 0.006 and 0.02, for Dietmar Thurnher1 statherin and PB, respectively, in group I). Also levels of histatin 1 1Department of Otorhinolaryngology, Head and Neck Surgery, and 5 were significantly reduced in both groups (P £ 0.009 for Medical University of Vienna, Vienna, Austria histatin 1; P £ 0.004 for histatin 5). No significant differences were 2Department of Clinical Pathology, Medical University of Vienna, found for a-defensin 1–3 levels in groups I and II with respect to Vienna, Austria control group. Objecitves: The aim of the study was to evaluate, whether targeted Conclusions: This study evidences the reduction of levels of anticancer and anti-angiogenic therapies such as receptor tyrosine specific salivary peptides in oral and laryngeal cancer. The role kinase inhibitors and antisense oligonucleotides are feasible of human salivary proteins in oral cancerogenesis is actually not treatment options in Merkel Cell Carcinoma (MCC). We deter- yet understood. On the bases of our results we suggest an mined the expression of the target molecules VEGF-A and -C, evaluation of salivary proteins as biomarkers for malignant le- VEGF-R2, PDGFa/b, EGFR, c-kit, Her-2/Neu, Bmi-1 and Mcl-1 sions of larynx and oral cavity and as possible test of screening in 15 samples of patients with MCC. C-kit positive samples were for cancer risk. analyzed for clinically relevant mutations. Methods: Formalin fixed, paraffin embedded sections were stained HL 14 immunohistochemically with antibodies directed against the above mentioned proteins and the percentage of staining was Hypermethylation of secreted frizzled related protein categorized into low, moderate and intense expression. Muta- genes in head and neck sqaumous cell carcinoma tional analysis of c-kit (Exons 9 and 11) was performed on the two samples that showed c-kit expression in immunohistochemistry. Miguel Angelo, Hyppolito, Ricardo C. Demarco Results: We found that c-kit (13%), Mcl-1 (87%), Bmi-1 (100%) Faculty of Pharmaceutics Sciences of Riberao VEGF-A (73%) and VEGF-R2 (33%) were expressed in MCC. Hypothesis: We postulate hypermethylation of sFRP1 gene is a No DNA-mutations were found in samples expressing c-kit. frequently occurs in head and neck cancers. Discussion: Since VEGF-A, VEGF-R2 and c-kit are targets of new Background: The molecular pathology of head and neck squa- cytostatic agents used in the treatment of other cancers, inhibition mous cell carcinoma (HNSCC) is poorly understood. Regions of by a multi-targeted chemotherapy could be a very promising the short arm of chromosome 8(8p11.2) are deleted frequently in a treatment option. High expression of Bmi-1 and Mcl-1 validates range of solid tumours, indicating that tumour suppressor genes further studies on the use of antisense oligonucleotides in Merkel reside in these loci. The sFRP1 gene was proposed to lie at 8p11.2. cell carcinoma.

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HL 16 Methods: The primary and saturated epithelial cell culture of dog GPI-15427, a PARP-1 inhibitor, radiosensitizes laryngeal mucosa was obtained as a result of conducted study. The scarring in subglottic laryngeal area was modeled in animals. in head and neck cancer The scar tissue from previously deepithelized parts of laryngeal Khurram Khan, Guayan Li, Xin Li, Jie Zhang, Weizheng Xu, mucosa was excised following the laryngeal fissure. The saturated David Calvin, Lisa Morgan, Zhaocheng Tang, Krystyna suspension of epithelial cells with medium was applied to the first Wozniak, Christina Alemu, Randall Hoover, Bert O’Malley Jr, wound. Then this defect was closed by autofibrine membrane fixed Rena Lapidus, Daqing Li supra- and submucosally on the wound. The reconstruction of the Department of Otolaryngology-Head and Neck Surgery, Hospital second laryngeal wound was performed using monolayer epithe- of the University of Pennsylvania, Philadelphia, PA, USA [KK, lial cell culture located on the nitrocellulose filter. GL, XL, BO, DL] and MGI Pharma, Baltimore, MD, USA [JZ, Results: Twenty experiments aimed at the reconstruction of the WX, DC, LM, ZT, KW, CA, RH, RL] mucosal laryngeal epithelium were carried, the results of 18 being positive. Regardless the type of the transplant the epithelial cells Objective: Inhibition of poly(ADP-ribose) polymerase-1 (PARP- were revealed in the center of the wound, and they were not 1), an enzyme involved in DNA repair, has been reported to en- associated with the lateral zone. The lateral zone represented hance the tumourical effect of radiotherapy. In this study we monolayer multiline epithelium of laryngeal mucosa per se. This tested a novel PARP-1 inhibitor GPI-15427 (MGI Pharma, Bal- phenomenon suggests the possibility for the scar defect epitheli- timore, MD) with radiotherapy in human head and neck squa- zation due to the transplantation of epithelial cell culture. mous cell cancer (HNSCC). Conclusions: The possibility of transplantation and engraftment of Methods: Pharmokinetic analysis was determined using oral and obtained saturated epithelial cell culture of laryngeal mucosa was intravenous bioavailability assays in rats. Human xenograft confirmed experimentally. HNSCC tumours were established in nude mice. Animals were treated with GPI-15427 (at 4, 10, 40 mg/kg) intravenously, administered 30 min before tumour irradiation (2 Gy for 2 con- secutive days). The model was repeated using orally administered HL 18 GPI-15427 (at 10, 30, 100 mg/kg) given 1 h prior to tumour Matrixmetalloproteinases in patients with larynx irradiation. Three-dimensional tumour volumes were measured cancer and benign glottic lesions pre and post-treatment. Neutral comet assay was employed to analyze DNA double strand break damage and the ‘‘tail moment’’ Ilknur Haberal Can1, Kursad Ceylan1, Muzaffer Caydere2, (product of the amount of DNA in the tail and distance of tail Ethem Erdal Samim1, Huseyin Ustun2, Hatice Emir1, migration) calculated. Zeynep Kizilkaya1 Results: GPI-15427 competitively inhibits PARP-1, and reached a 1Ministry of Health Ankara Research and Training Hospital Ear Cmax of 4,189 + 327 ng/ml in plasma after a single iv dose of Nose and Throat Department, Ulucanlar Cad. No: 1Mamak 40 mg/kg. Combined GPI-15427 and radiation significantly re- Ankara, Turkey duced tumor volume compared to controls, radiation alone, and 2Ministry of Health Ankara Research and Training Hospital GPI-15427 alone treatment groups (P < 0.01). No drug-related Pathology Department, Ulucanlar Cad. No: 1 Mamak Ankara, toxicities or deaths were observed. Neutral comet analysis re- Turkey vealed the mean tail moment, indicative of DNA damage, to be Objective: To investigate MMPs (Matrix metalloproteinase) levels significantly elevated in cells treated with combined GPI-15427 in patients with larynx cancer and benign glottic lesions com- and radiation compared to radiation alone (P < 0.001). paring to control group with a retrospective, clinical trial in a Conclusions: The PARP-1 inhibitor GPI-15427 significantly en- tertiary care centre. hances the effect of radiotherapy by impairing DNA repair: this Methods: The excisional biopsy specimens from rigid suspension represents a promising new treatment in HNSCC. direct laryngoscopy performed on patients with laryngeal cancer and benign glottic lesions were examined immunohistochemically. HL 17 MMp levels including MMP 7, MMP9 and MMP 1 tissue inhibitor levels were investigated in each specimens. There were 20 Transplantation of epithelial laryngeal cell culture patients selected in each group. All results were compared with the in experiment results of the control group which included patients with chonca Chekan Valery bullosa. Results: Over expression MMP 9 was observed in laryngeal cancer Departament of Otorhinolaryngology Belarusian, Medical specimens when compared to benign glottic lesions and control Academy of Post Graduate Education, I` insk, Republic of Belarus groups (P < 0.001 for both). MMp 1 and MMP 7 levels did not Objective: The main and the most difficult problem in treating differ significantly in comparison of the three groups. chronicscarred laryngeal stenoses is preventing restenosis of Conclusion: The physiopathologic mechanisms causing laryngeal respiratory tract. cancer is still unclear. This study is one of the studies related to the The aim of this research was to study the possibility of trans- etiopathogenesis of this disease. Our study indicates that the plantationof laryngeal mucosal epithelial cells for reconstructing expression of MMP-9 is up-regulated in invasive laryngeal carci- the mucosal defects after the scar excision. noma.

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HL 19 type 6 and HPV type 11 in relation to the age of patients from our Osteopontin expression predicts the clinical outcome bank of data. Patients and methods: A multicenter study was conducted in of laryngeal intraepithelial neoplasia 1983–2006 in Germany and in 1988–2006 in Russia. The data D. Testa1,G. Motta1, A. Celetti2, S. Staibano3,R. Iovine1, of 90 patients matched our criteria and were taken from our M. Mascolo3,G. De Rosa3, M. Santoro2 bank of data for analysis. Patients had active histologically 1Institute of Otorhinolaryngology, Second University of Naples confirmed papillomas with identified HPV type and the follow- 2Institute of Endocrinology and Experimental Oncology of CNR up period not less than 5 years. Eighty-two patients had juve- c/o Biology and Cellular and Molecular Pathology Department nile-onset RRP, mean age of onset was 3.5 ± 3.0 years and ‘‘L.Califano’’- University of Naples ‘‘Federico II’’ eight patients had adult-onset RRP, mean age of onset was 3Department of Functional and Biomorphological Sciences-Uni- 30.7 ± 10.8 years. Mean follow-up duration of patients in versity of Naples ‘‘Federico II German group was 15.3 ± 1.8 years after of a-IFN therapy. The virus type was identified by Soutern blot and PCR. Factors related to malignant transformation of laryngeal pre- Results: Patients with juvenile-onset RRP induced by HPV type cancerous lesions is largely unknown. Laryngeal carcinogenesis is 11 and HPV type 6 had onset of symptoms at mean age of a multistep process with premalignant lesions progressing to 3.3 ± 3.0 and 4.1 ± 3.2 years, respectively. Patients younger invasive carcinoma over a period of years. The aim of the study 2 years were more likely to be affected by HPV type 11 than by was to examine the potential utility of osteopontin and CD44v6 as HPV type 6 (P = 0.007). All patients with adult-onset RRP candidate biomarkers for detecting laryngeal intraepithelial neo- had HPV type 6 except one patient with type 11 and two more plasia (LIN) of different degree.Osteopontin (OPN) is a glycosi- patients with type 6/11. All patients with pulmonary spread and lated phosphoprotein found in all body fluids and in the squamous cell carcinoma of the lung had HPV type 11. Patients proteinaceous matrix of mineralized tissues. We studied 82 cases with RRP associated with HPV type 11 demonstrated more of laryngeal precancerous lesions, compared to hyperplastic and severe course than patients with RRP associated with HPV type normal tissue, to evaluate the immunoreactivity and histological 6(P = 0.029). findings. Conclusions: HPV type 11 is more likely to cause severe course Osteopontin expression was higher in all severe LIN than in of RRP with high recurrence rate, pulmonary spread, malignant patient matched normal mucosa. Its expression levels were sig- transformation, requiring more aggressive surgical treatment nificantly correlated with degree of displasia (P = 0.0094), the and it is more common in children of younger age. HPV type 6 recurrence of dysplasia after intervention and the development of is more likely to induce less severe disease and primarily affects laryngeal squamous cell carcinoma (P < 0.0001). Osteopontin older children. expression was paralleled by progressive cell surface reactivity for CD44v6. CD44v6 intense positivity correlated negatively with disease free survival, too (P = 0.007). Our findings identify os- teopontin and Cd44v6 as predictive markers of recurrence or Dysphagia + Reflux aggressiveness in Laryngeal Intraepithelial Neoplasia. HL 21 dysphagia and chorea Huntington disease: report on a blinded follow-up study HL 20 Age-related aspects of the course of RRP induced by W. Habermann, A. Pilhatsch, A. K. Hodl, M. K. Magnet, HPV-6 and 11 R. M. Bonelli Department of General ENT Head and Neck Surgery (Head Prof. Natalia Babkina1, Iouri L. Soldatski2,3, Nadzeya Barysik1, Dr. H. Stammberger), Department of Radialogy, Department of Sergei Backanov4, Polina Lukashenko1, Herbert Pfister5, Psychiatry, Medical University Graz, Auenbruggerplatz, 8036 Valentin Gerein1,6 Graz, Austria 1Department of Pediatric Pathology, Institute of Pathology, Objective: Dysphagia with aspiration pneumonia is the mean University of Mainz, Langenbeckstrasse 1, 55101 Mainz, cause of death in patients with Chorea Huntington disease. The Germany purpose of this study was to analyse the course of dysphagia in 2Department of Otorhinolaryngology, IM Sechenov Medical relation to the course of disease. Academy, Moscow, Russia Methods: Prospective blinded cohort study, classification of 3Department of Otorhinolaringology, St. Vladimir Moscow Huntington disease, classification of pathologies of videocine- Children’s Hospital, Rubtsovsko-Dvorcovaya Street, 1/3, matography by two blinded investigators according to prede- Moscow 107014, Russia fined criteria, statistical analysis (SPSS 14.0, Spearman´ s 4Snegiri Clinic, Regional Children’s Clinical Hospital, Medgor- correlation) odok, 454076 Chelyabinsk, Russia Results: Seventy-six patients were included, significant correla- 5Institute of Virology, University of Cologne, tions were found between: stage of disease and: drooling, con- Fu¨ rst-Pu¨ ckler-Straße 56, 50935 Cologne, Germany trol of oral bolus, pathological swallowing reflex, leaking, and 6Pediatric Clinic of Johann Wolfgang Goethe University, Frank- bolus passage. Duration of the disease and: control of oral am Main, Germany Theodor-Stern-Kai 7, 60596 Frankfurt bolus, pathological swallowing reflex, leaking, and penetration. am Main, Germany Conclusions: In patients with Huntington disease the oral part Objective: The aim of our study was to analyze the course of of swallowing is much earlier affected then the pharyngeal and recurrent respiratory papillomatosis (RRP) associated with HPV laryngeal part.

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HL 22 tion among patients with clinically diagnosed neurological dys- Bile acids and total bilirubin detection in saliva phagia. Design: A retrospective notes review of 100 patients attending of patients submitted to gastric surgery combined swallow clinic for clinically diagnosed aspiration. All E. De Corso, S. Baroni, G. Cammarota, M. R. Marchese, patients were subjected to both Milk Nasendoscopy and Video- J. Galli fluoroscopy. Correlation of investigation results was reviewed by Instituto di Otorinolaringoiatria, Universita` Cattolica del Sacro Kappa testing, and difference statistically examined with Chi Cuore, Policlinico A.Gemelli, L.go F. Vito 00168, Roma squared testing. Results: Assessment of aspiration in pre-swallow, swallow and Objective: Recently it has been hypothesized that biliary-reflux post-swallow phases was reviewed using Milk Nasendoscopy and may reach the upper aero-digestive tract and enhance the devel- Videofluoroscopy. The significance of difference was measured opment of laryngeal malignancies, even though, the presence of using Chi squared testing. Milk Nasendoscopy detected post duodeno-gastric contents in this region has never been revealed. swallow phase aspiration significantly more than videofluoros- The aim of this study is to detect bile acids and total bilirubin in copy with no significant difference in pre swallow phase. saliva of gastrectomized patients, in order to confirm objectively Conclusion: In the investigation of clinically diagnosed neurolog- presence of biliary laryngo-pharyngeal reflux and its relationship ical dysphagia, substantial correlation was seen in detection be- with laryngeal mucosa damage. tween Videofluoroscopy and Milk Nasendoscopy. We suggest that Methods: We carried out a prospective observational case-control Milk Nasendoscopy could be used as a preliminary clinic based study on 52 patients (cases) previously submitted to gastric sur- test thereby reducing the need for investigations requiring radia- gery and on 51 healthy volunteers (controls). Patients were sub- tion doses. mitted to clinical interview, esofago-gastro-duodenal endoscopy, endoscopic laryngeal evaluation and saliva collection. In all saliva samples bile acids, total bilirubin and Pepsinogen II were assayed. HL 24 Results: In cases bile acids levels were recorded in 17/52 (32.6%) Instrumental and logopaedic approach in adult patients, while in 35/52 (67.4%) they were undetectable. All neurological dysphagia controls were negative for bile acids. A significant (P < 0.05) correlation between bile acids, total bilirubin and Pepsinogen II Bruno Fattori, Andrea Nacci, Valentina Mancini, values was found in cases positive for bile acids, and a significant Fabio Matteucci, Roberta La Vela, Francesco Ursino (P < 0.05) higher prevalence of symptoms and findings of lar- 3rd Otorhinolaringology Unit, Department of Neurosciences, yngeal damage and of previous aryngeal neoplastic lesions was University of Pisa, Italy observed in positive cases if compared to negative one. Objective: Dysphagia can be secondary to numerous neurological Conclusions: We found detectable levels of bile acids and total diseases, whether acute or chronic-degenerative. bilirubin in saliva of patients submitted to previous gastric sur- Methods: With this study we compared two groups of patients: gery, prospecting an intriguing diagnostic role of this dosage in the first group (22 cases) included patients affected with Am- the study of biliary laryngo-pharyngeal reflux. We revealed finally yotrophic Lateral Sclerosis (ALS) and the patients in the second a high incidence of laryngeal disorders in patients with positive (13 cases) had suffered ictus cerebri. All patients underwent bile acids in saliva. phoniatric examination, analysis of their swallowing function by means of morphological and functional examination of the oro- HL 23 pharyngeal structures, and with instrumental tests such as fiberoptic endoscopic evaluation of swallow (FEES) and oro- Milk nasendoscopy v/s videofluoroscopy pharyngo-esophageal scintigraphy (OPES). in investigation of aspiration Results and conclusions: FEES revealed altered motility of the V. Singh1, S. Berry1, M. J. Brocbbank2,R. A. Frost2, phono-articulation organs in both groups of patients whereas the S. E. Tyler2,D. Owens1 greatest sensorial deficits were seen in the ictus patients. The study on swallowing demonstrated that the bolus most easily managed by 1Department of Otolaryngology, Royal Glamorgan Hospital, both groups of patients was a semi-solid one. The data produced by Llantrisant, UK OPES confirmed an increase in oro-pharyngeal retention index in 2Department of Otolaryngology, Radiology and Speech therapy, both groups studied, the most evident alterations with liquid bolus Salisbury district hospital, Salisbury, UK being those in the subjects with the neurodegenerative disease (81% Objective: Videofluoroscopy has become the gold standard of patients). Logopaedic therapy was carried out in both groups and investigation for assessment of aspiration in patients with clini- the results obtained were clinically assessed by FEES. The semi- cally diagnosed dysphagia due to neurological causes. Modified quantitative evaluation performed with OPES showed improve- nasendoscopy has been described for detection of aspiration with ment in the oro-pharyngeal retention index in the post-ictus patients varying findings. Milk Nasendoscopy is a simple clinic based both with a liquid bolus and with a semi-solid one (pre- and post- technique to evaluate swallow dysfunction, requiring no radio- logotherapy with the liquid bolus: 14.8 and 20.3%, respectively; pre- logical input. This paper aims to review the correlation of Milk and post-logotherapy with the semi-solid bolus: 16.2 and 21.9%, Nasendoscopy and Videofluoroscopy in the detection of aspira- respectively).

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HL 25 endoscopic records of all the patients who were given 30 mg of Using scoring system and empiric treatment lansoprozol twice a day before and in first and third months of treatment were evaluated by two physicians having different in the diagnosis of reflux experiences without knowing periods of diagnosis and treatment. A. Batioglu, M. Kulekci, O. Develioglu, Taksim Egitim T test was used to compare the scores of all the findings. Arastirma Hospital, Istanbul, Turkey Results: Except granulation a significant decrease in scores and ratios of all finding which constituted RFS with treatment. Objective: There is no optimal method for evaluation of laryn- (P < 0.001). Though some findings soluterly were not spesific for gopharyngeal reflux (LFR). Although pH monitoring is a gold LFR, acceptance of a 7 and higher score as reflux according to standard for diagnosis, the difficulty of application and the RFS made the presence of at least a few findings together over- insufficiency in detecting non-acid reflux patients, make the test come this negativity. Resolution of findings with treatment proved impractical for screening and diagnosing the disease. This study that these findings were due to reflux. aims to evaluate success of medical treatment in patients suf- Conclusions: This study shows that the improvement of endo- fering LFR disease by scoring findings and symptoms with em- scopic findings is an appropriate way to follow the response to the piric treatment with a follow up period of 1 and 3 months, treatment. respectively. Keywords: Endoscopic findings, Antireflux treatment, Improve- Methods: Our study included 122 patients with complaints of ment globus, coughing and soreness that were examined. Patients with a score of 13 or higher in reflux symptom index (RSI) and 7 or higher in reflux finding score (RFS) were considered to have reflux. Patients were treated with 30 mg lansoprozol twice a day. HL 27 All patients were evaluated before and during the treatment Reevaluation of surgical treatment by external period at 1 and 3 months. Student’s t test and Pearson’s corre- lation were used to detect significance for RSI, RFS records at 1 approach for Zenker’s diverticulum and 3 months. M. D. Cobzeanu1, V. Costinescu1, Carmen Daniela Rusu1, Results: A significant improvement is determined in findings and Monica Voineag1, V. Drug2, Camelia Cobzeanu3 symptoms due to treatment modality (P < 0.001). These 1ENT Clinic, ’’Sf. Spiridon’’ Hospital, Iasi, Romania improvements in RFS and RSI were correlated, thus confirming 2Gastroenterology and Hepatology Institute, Iasi, Romania the diagnosis. This finding also strengthens the reliability of the 3Radiological Ambulatory Department of ‘‘Sf. Spiridon’’ score indices that we have used in the study. Hospital, Iasi, Romania Conclusions: This study (1) confirms reflux diagnosis in patients improving with empiric antireflux treatment with scores higher Objective: Surgical options for treating symptomatic Zenker’s than 7 in RBS and higher than 13 in RSI. (2) strengthens the diverticulum include both traditional external procedures as well reliability of RBS and RSI. We suggest that this scoring system is as endoscopic and minimally invasive techniques. The authors a useful diagnostic tool that can be used easily in outpatients as a make a retrospective evaluation of the treatment for Zenker first choice instead of ph monitoring. It will also prevent patients diverticulum by classic external approach. from over treatment. Methods: The study included seven cases (mean age 69 years) with Keywords: Scoring system, Empiric treatment, Reflux different sizes Zenker’s diverticulum, treated by external surgery in our department between 2000 and 2005. The presenting symptoms were dysphagia, halitosis, regurgitation, aspiration, HL 26 hoarseness, weight loss. In five cases, Zenker diverticulum was associated with gastroesophageal reflux. Paraclinical assessment Changes in the findings of laryngopharyngeal reflux included barium esophagography, esophageal manometry, flexible with treatment endoscopy, CT scan. In the selected cases, different surgical pro- cedures by external approach were performed. One of these cases M. Kulekci, A. Batioglu, O. Develioglu, Taksim Egitim is reported: a 61-year-old patient with large Zenker’s diverticulum Arastirma Hospital, Istanbul, Turkey who underwent cricopharyngeal myotomy and diverticulectomy Objective: Until recently, no definite test for the diagnosis of lar- by laterocervical approach. yngopharyngeal reflux (LFR) is present, except for the healing of Results: Cricopharyngeal myotomy associated with diverticulec- laringitis with acid suppression. Although compatibility between tomy or diverticulopexy was the preferred treatment in the se- findings and LFR or response to treatment are controversy, value lected cases with large Zenker diverticulum and allowed a of improvement of endoscopic findings is definite in diagnosis. complete excision, without recurrences. Medical treatment for Our aim was to compare the endoscopic findings that constitude gastroesophageal reflux was associated. No major complications reflux finding scores before treatment with first and third months occurred and more than 90% of patients reported complete res- of treatment and indicate improvements of treatment quantita- olution of symptoms. tively. Conclusions: The surgical treatment should be performed Methods: One hundred and twenty-two patients with complaints according to the clinical and paraclinical characteristics of diver- of reflux symptoms and patients with a score of 13 or higher in ticulum and the patient. In certain selected cases, the external reflux symptom index (RSI) and 7 or higher in reflux finding score surgery remains a good option with favorable long term func- (RFS) have been studied between January 2005 and 2006. The tional results.

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HL 28 the pharyngeal anatomy, naso-endoscopy was carried out, fol- Swallowing outcomes in oropharyngeal squamous cell lowed by VF. The swallow assessments were carried out with three consecutive 10 ml of Baritop liquid and were digitally carcinoma recorded using the Kay’s Swallowing Workstation. Ligy Thomas, Derek Lowe, Sankalp Tandon, Terry Jones, Results: The posterior pharyngeal wall moved further, relative Simon Rogers to the tongue base, for all patients. Significant gender and age University Hospital Aintree, Longmoor Lane, Liverpool, UK differences were found which were in-keeping with previous studies of normal swallows. BMI was found to have a signifi- Management of cancer tends to focus on maximising survival, cant effect on the width of the pharyngo-eosophageal (PES) with less regard for functional outcome. A cross-sectional survey opening. It was found that whilst the diameter of the PES in was carried out to assess post treatment swallowing disability. the lateral view showed no significant differences for gender, Aim: To assess swallowing outcome for patients who had curative from the anterior-posterior view there was a significant differ- treatment for orpharyngeal carcinoma (soft palate, oropharynx, ence, with PES diameter being larger in males than in females tonsil and base of tongue). (P = 0.026/0.022). Objective: (1) To compare the swallowing domain of The Uni- Conclusions: The spatial measurements of the pharynx in the versity of Washington Quality of Life scale (UW-QOLv4) with swallows of patients with small head and neck cancers (T1 MD Anderson Dysphagia Inventory (MDADI) and Swallowing larynx) were in-line with those of normal swallows. Quality of Life measure (SWAL QOL). (2) To compare sub- jective rating with clinician-rated FEES (using penetration aspiration score). Method: All patients treated between 01/01/1999 and 31/05/05 HL 30 for oropharyngeal Ca from the Liverpool Head and Neck A randomised prospective assessement of lidocaine oncology database were identified. Among the 110 patients eligible, 77 were willing to participate, 29 unwilling and 4 were spray during flexible nasoendoscopy in normal untraceable. Patients completed three validated questionnaires volunteers and FEES assessment. S. H. Vyas, S. Gollins, S. Ford Findings: Median follow-up was 21 months (range 2– Wales Cancer Treatment Centre, Glan Clwyd Hospital, Rhyl, UK 60 months). Swallow was normal in 19, 52% could swallow certain solid foods, 18% were restricted to liquids and 11% Objective: To assess and compare patient discomfort during could not swallow. A third were dependant on feeding tubes for flexible nasoendoscopy (FN), with or without the use of lido- nutrition. There were differences in swallowing scores with caine nasal spray. Also to see if it made any difference to treatment modality. The Spearman correlation co-efficient be- swallowing. tween UW-QOL swallowing domain and MDADI & SWAL- Method: One hundred and ten healthy volunteers were recruited QOL was 0.6 (P < 0.001). Correlation between FEES score for the study and randomised into two groups: Group A (58), and swallowing status was –0.46, P < 0.001. prior to FN had 2.5 ml of lidocaine hydrochloride 5% w/v Conclusions: The swallowing domain in UW-QOL correlates intranasal spray (which also contained phenylephrine hydro- well with detailed dysphagia assessment tools and clinician chloride 0.5% w/v). Group B (52) had no spray prior to FN. rated assessment. Further prospective study required to eluci- The volunteers underwent examination of their nasal cavity, date the differences between treatment groups. post-nasal space, base of tongue, and larynx. As part of a further ’normal’ swallowing study they underwent a series of HL 29 swallow tests with 20 ml of natural blue dye, 1, 10, and 20 ml of water. The patient discomfort was assessed using a Visual Spatial measurements of the pharynx in the swallows Analogue Scale (VAS 0-5). A further questionnaire was filled to of patients with small head and neck cancers assess any other symptoms such as rhinorrhea, , vomit- ing, and altered sensation of swallowing. S. H. Vyas, S. Ford, S. W. Gollins, P. Hobson, H. Zeitoun Results: VAS (0-5): Group A (58): 1(28/58,48.3%), 2(25/ Glan Clwyd Hospital, Sarn Lane, Rhyl, N. Wales, UK 58,43.1%), 3(5/58,8.6%). Group B (52): 1(12/52,23.1%), 2(24/ Objective: To assess the swallowing in T1 laryngeal carcinoma 52,46.2%), 3(14/52,26.9%), 4(2/52,3.8%).Rhinorrhea: 13/58 patients, using video-fluroscopy (VF), prior to radiotherapy. In (22.4%) in group A. 8/52 (15.4%) in group B. Difficulty in particular the effects of age, gender, body mass index (BMI) and swallowing: 13/58 (22.4%) in group A and 6/52 (11.5%). cancer site are evaluated. Nausea: 8/58 (13.8%) in group A and none in group B. Methods: Forty-eight consecutive patients (34 males and 14 fe- Conclusions: In group A, 53/58 (91.3%) and in group B 36/52 males) diagnosed with T1 laryngeal carcinoma were included in (69.2%) reported VAS up to 2. Therefore using lidocaine ap- the study, prior to radiotherapy treatment. Their demographic pears to be slightly better at preventing discomfort, however details along with BMI, past medical history, as well as perception of other symptoms such as rhinorrhea, nausea and smoking and alcohol consumption were recorded. To evaluate altered sensation of swallowing are higher.

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HL 31 (57.69%) was not significantly different. Swallowing was signifi- Dysphagia due to chemoradiotherapy of head cantly better in the group who had no radiotherapy (P = 0.0008), 80.76% managed solids, compared to 38.95% in the surgery with and neck cancer radiotherapy group. E´ . Remena´ r, K. Me´ sza´ ros, M. Gode} ´ ny, A. Boe´ r, J. Lo¨ vey, Conclusions: The impact of radiotherapy on total laryngectomy Z. Taka´ csi-Nagy, E. To´ th, M. Ka´ sler patients results in further impairment of swallowing. Interestingly, National Institute of Oncology, Budapest, Hungary voice seemed only minimally influenced by radiotherapy. Objective: To evaluate the swallowing function of head and neck cancer patients before and after chemoradiotherapy. HL 33 Methods: Physical and endoscopic examination, swallowing X-ray Complete recanalization of a completely obstructed with water-soluble contrast material of different viscosity, quality of life questionnaires, type and quantity of food, weight measures cervical esophagus with an endoscopic-radiologic performed before, during and after chemoradiotherapy in 35 pa- rendez-vous and self-expanding stent tients. De Vincentiis Marco1, Fiocca Fausto2, Salvatori Filippo Maria3, Results: Impaired oropharyngeal motility, reduced elevation of the Ceci Vincenzo2, Donatelli Gianfranco2, Corona Mario3, larynx, silent aspiration, fluid only or parenteral nutrition and Boatta Emanuele3, A. Gallo1 weight loss were the most common findings during or within one 1Department of ENT, ‘‘G. Ferreri’’, University ‘‘La Sapienza’’, week after chemoradiotherapy. These parameters slightly improved Rome, Italy. Policlinico ‘‘Umberto I’’, Viale del Policlinico, 1 month after the end of therapy, but even at the 12-week control of 155- Rome, Italy the therapy response most of the patients had at least one of the 2Department of Emergency Endoscopic Surgery, above mentioned symptoms. University ‘‘La Sapienza’’, Rome, Italy. Policlinico ‘‘Umberto I’’, Conclusions: Despite of the promising results of chemoradio- Viale del Policlinico, 155- Rome, Italy therapy with respect to organ sparing and overall survival in 3Department of Radiology, University ‘‘La Sapienza’’, Rome, advanced head and neck cancer, functional disabilities especially Italy. Policlinico ‘‘Umberto I’’, Viale del Policlinico, swallowing disorders due to this therapy are severe and require 155- Rome, Italy more activities from the speech and swallowing therapist, until less toxic treatments will be introduced. Objective: Radiotherapy for head and neck cancer frequently causes injury to the cervical esophagus with strictures that need frequently endoscopic dilatation. Mini-invasive treatment of a HL 32 long complete obliteration of the cervical esophagus after Swallowing and speech dysfunction radiotherapy for cancer of the rinopharinx is reported. A 37 years old woman with advanced (T3 N1 M0) cancer of the in post-laryngectomy patients. Does radiotherapy rinopharinx underwent chemo-radiotherapy for intractable can- make a difference? cer. A PEG and tracheostomy were placed before therapy. After Carmen de Casso, Jarrod Homer 60 Gy and 5-FU radio-chemotherapy the patient, free of disease, after 6 months developed complete obstruction of the esophagus. Department of Otolaryngology, Manchester Royal Infirmary, An upper endoscopy found a complete obliteration at the level Oxford Road, Manchester, M13 9WL of the crico-pharinx muscle not allowing the transit of a small Treatment of carcinoma of the larynx by total laryngectomy, guide wire or contrast medium. alters significantly speech and swallowing, resulting in marked Methods: With a bronchoscope through the PEG the cardias was impact in the patients quality of life. incannulated and a cannula inserted in the distal esophagus: a Objective: (a) To determine the incidence and severity of dys- complete stricture 3 cm long was evidentiated. Controlling the phagia in patients treated for carcinoma of the larynx with total exact alignment under fluoroscopy a needle was advanced from laryngectomy as a single modality treatment or with surgery and the distal esophagus toward the above where the needle was radiotherapy. (b) To determine the ability to communicate and the catched with a snare. When the continuity was reestablished with preferred method. a guide wire after a balloon dilatation up to 10 mm a feeding Methods: Multi-centre retrospective cross-sectional study. tube was left in place. After two days a full covered removable Participants: One hundred and twenty-one post-laryngectomy self- expanding stent 16 mm in diameter was inserted and patients all of which had completed definitive treatment at least mantained in place for 1 month. The patient tolerated well all 6 months before this study. Twenty-six patients had total laryn- procedures under general anesthesia and tolerated well the stent. gectomy as a single modality treatment and 95 had total laryn- Results: After the stent was removed a good patency of the gectomy and radiotherapy. esophagus was found without dilatation. The patient is doing Main outcome measures: Swallowing (solid food, soft diet or fluid/ well after 6 months and she can swallow after a period of PEG) and voice development (valve, oesophageal speech or no reeducation. surgical speech). Conclusions: Complete obstruction of the esophagus after che- Results: Data was analysed using SPSS, Chi square and Fisher’s mo-radiotherapy for head and neck cancer may occur in as great exact test. Ninety-eight (81%) communicated verbally. However, 23% of patients and is condition that is badly tolerated espe- only 82 (67.76%) patients developed a surgically restored voice, cially by young patients. Surgery is difficult and often at risk. with 16 (13.22%) needing an electro-larynx. Fifty-nine (48.76%) Efforts should be done to improve the quality of life of these could swallow solids, 23 (19%) soft food, 25 (20.66%) fluids and patients. The combination of endoscopical and radiological 17 (14%) required a PEG as supplementary or only feed. Speech expertise with the aid of new technologies can solve many in patients who had radiotherapy (69.47%) or no radiotherapy problems.

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HL 34 specificity and sensitivity of autofluorescence endoscopy imaging Videofluoroscopy in neopharyngeal dysfunction post in comparison to white-light endoscopy. laryngectomy Methods: One hundred and twenty-nine patients with various laryngeal epithelial pathologies entered the study. All patients Samit Ghosh1, Jeffrey Lancaster1, Sankalap Tandon1, underwent white-light endoscopy (and stroboscopic examination Eileen Gilmartin2, Huw Lewis Jones3, Terry Jones1 when possible) followed by autofluorescence (blue-light) endos- 1Department of ENT-Head and Neck Surgery, University copy. Biopsy samples were obtained as reference. Specificity and Hospital Aintree, Liverpool, UK sensitivity were calculated. Chi-square test was used for statistical 2Department of Speech and Language Therapy, University analysis. Hospital Aintree, Liverpool, UK Results: AF-endoscopy proved to be a sensitive (95.6%) method 3Department of Radiology, University Hospital Aintree, with high specificity (81.6%) in diagnosing laryngeal lesions. It Liverpool, UK shows significant advantage over white-light examination (P < 0.01), especially when diagnosing early pre-cancerous le- Objective: We assessed the videofluoroscopic appearances of sions or early stages of laryngeal cancer. neopharynx in patients with with either/and/or dysphagia, poor Conclusions: AF-endoscopy is an excellent addition to classic valve voice, central valve leakage to see if any part of the surgical white-light endoscopy and stroboscopic examination. It is highly procedure, or modification thereof, can alter outcome. sensitive and specific in diagnosing early stages of carcinogenesis, Methods: Fourteen patients presented 11 months (median, range starting from LIN II. It allows to precisely define borders of le- 2–59) after laryngectomy. Videofluoroscopy was performed and sions. Unlike stroboscopic examination, AF-endoscopy can be surgical factors assessed. used in diagnosing and monitoring changes located in supraglottic Results: No patients suffered poor valve voice or dysphagia alone. area of the larynx. One patient had all three problem, one had dysphagia and leak- age, two patients had central leakage, two had leakage + poor voice. Six patients had poor valve voice and dysphagia. Three patients had partial pharyngectomies, 12 patients had constrictors closed, 9 patients had pharyngeal myotomy. Nine patients had HL 36 speech valve placed primarily and three secondarily. One patient Current state of robotic scanning applications did not have a valve. In the swallowing series six patients dem- with the CO2 laser onstrated cricopharyngeal spasm, three were normal, six had persistent spasm from C3 to C7 delaying barium transit which Marc Remacle, Georges Lawson, Monique Delos typically disappeared on relaxation. In voicing, six patients had Department of ORL, Head and Neck Surgery, cricopharyngeal spasm and five had long segment spasm reducing Department of Pathology, University Hospital of Louvain at air passage through the valve reducing volume, duration and Mont-Godinne quality of phonation. In two cases where constrictors were not Introduction: The development of the automatic scanning system closed, one patient had dysphagia and poor voice,and the other has considerably enhanced CO2 laser energy delivery, improving dysphagia alone. cutting and ablation modes. Conclusion: In dysphagia the most common finding is cricopha- Objective: In order to know if there are any differences in ryngeal spasm and neopharyngeal spasm appears to be the main phonosurgery between SuperPulse and UltraPulse lasing appli- issue in valve voice problems. As a result a change in practice has cations (both compatible with the scanning system) with regard been adopted to not close the constrictor muscles in our patients to thermal diffusion into the surrounding tissues, healing time thus also leaving it easier to treat cricopharyngeal spasm with and clinical results, 13 patients with bilateral and similar vocal single site botulinum toxin injection. fold lesions have been operated, one side in SuperPulse mode and the other side in UltraPulse mode. Larynx Methods: The UltraPulse mode allows for higher pulse energies as compared to SuperPulse mode at the same average power. This impacts the amount of thermal damage positively. The automatic HL 35 parameters for phonosurgery have been: depth of 0.2 mm, 10 W, Autofluorescence endoscopy imaging in diagnosis single pulse, 0.10 s for SuperPulse; two passes, 10 W, single pulse, of laryngeal neoplasia 0.10 s for UltraPulse. Results: Incisions are sharper with UltraPulse, making the surgery Maciej Dariusz Zatonski, Tomasz Krecicki, easier but at the first postoperative control after 8–10 days no Maria Zalesska-Krecicka differences were observed in the presentation, the healing and the Medical University of Wroclaw, Department of Otolaryngology, vibration of the two vocal cords. Coagulation along the incision Head and Neck surgery line is 40 lm for SuperPulse and 25 lm for UltraPulse. Objective: Autofluorescence endoscopy imaging is a new diag- Conclusions: In comparison with SuperPulse, the UltraPulse CO2 nostic method in otolaryngology, and seems to have many laser makes a procedure easier, but did not improve the clinical important advantages. The objective of this study was to assess outcome.

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HL 37 Not detect malignant tumor in larynx alone but also their com- Chronic hyperplastic laryngitis (a clinical follow-up bination with laryngeal hygiene lecture and individual guidance is important. study) Keywords: Human dry dock, Laryngeal cancer, Hygiene lecture Dejan Radaljac1, Zeljko Petrovic2, Ivan Boricic3 1ORL Department, Hospital ‘‘Dr. M.Marin’’, Loznica, Serbia 2Institute of ORL and Maxillofacial Surgery, Belgrade HL 39 3Institute of Pathology, School of Medicine, Belgrade University Bilateral vocal cord palsy associated with myxedema Objective: Chronic hyperplastic laringopathies are considered Vikto´ ria Kova´ cs, A´ kos Reme´ nyi, Gyo¨ rgy Lichtenberger precancerous lesions because of their possible transformation in Szent Ro´ kus Hosp. and Inst., Department of ORL-HNS, 1085 time into malignant epithelial neoplasia. The aim of this study Budapest, Gyulai Pa´ l u. 2., Hungary was to evaluate in the long-term the risk of malignancy occurring in the larynx of patients with chronic hyperplastic Objective: Bilateral vocal cord palsy and laryngeal myxedema are laryngitis. sever complications of thyreoidectomy. Management of dyspnoea caused by association of these factors means a great therapeutic Methods: A series of 138 cases of hyperplastic chronic laryngitis challenge. Methods: In the acute post-operative period of thyreoi- was studied from 1998 to 2003. All patients entered the study after dectomy for managing dyspnoea caused by bilateral vocal cord microlaryngoscopy and biopsy, 11 patients with initial biopsy palsy we perform reversible vocal cord lateralisation. However later before 1998. Histological diagnosis were graded according to when there is no chance for the recovery of the recurrent laryngeal Ljubljana classification into simple, abnormal and atypical nerves irreversible procedure is done. Applying these techniques we hyperplasia and Ca in situ. The mean follow-up period was can achieve satisfactory breathing in about 95% of cases avoiding 40 months. tracheostomy. In 5% of cases there are other factors in the back- Results: Malignancy developed in 37% (10/27) of the cases with ground of unsuccessful results. From these we emphasize the role of atypical hyperplasia, and in 5% (6/111) with simple and abnormal myxedema. Between 01.01.1989 and 30.09.2006 we did 154 revers- hyperplasia (P < 0.001). The groups were correlated with epi- ible and 125 irreversible vocal cord lateralisations. From these cases demiological factors. three men had further obstruction due to myxedema. We demon- Conclusions: There is a positive connection between age, gender, strate our experience achived by managing these patients. tobacco smoking, alcohol consumption, degree of epithelial Results: Applying endoscopic glottis dilating operations and lev- hyperplasia and cellular atypia in bioptic material and the risk of othyroxine replacement therapy sufficiently wide glottic chink has developing larynx carcinoma. Patients affected by chronic been achieved in all the cases. hyperplastic laryngitis need regular follow-up and immediate Conclusion: According to our experience dyspnoea caused by surgery in cases of relapse. bilateral vocal cord palsy after thyreoidectomy needs interdisci- plinar therapeutic approach beside glottis dilating operations.

HL 38 HL 40 Clinical study of laryngeal cancer screening in human Videocontact endoscopy associated with microsurgical dry dock ‘‘cold’’ techniques and CO2 LASER techniques Shun-Ichi Sasaki, Toshikazu Maeda, Yoshihiro Watanabe in the surgery of the glottic plan Department of Oto-Rhino-Laryngology Head and Neck Surgery, Ashikaga Red Cross Hospital, Japan Viorel Zainea, Romeo Calarasu, Razvan Hainarosie, Novac Popescu, Anca Iliescu Objecitves and methods: Since 1998 laryngeal cancer check with Institute of Phono-audiology and Functional ENT Surgery from fiberscope and stroboscope as optional subject have been per- Bucharest; No. 21 Mihai Cioranu Street, District 5, Bucharest, formed in persons who underwent human dry dock in our Romania hospital. From 1998 to 2006 these checks were examined total 1,084 persons (males 916, females 168). This study was reported Introduction: Videocontact endoscopy of the vocal fold represents background, diagnosis, and improvement of life style in these an interesting opportunity to study the lesions of the vocal fold cases. ‘‘in vivo’’ and ‘‘in situ’’. The aim of this study was to verify if this Results: The most diseases were as follows, in 1998 chronic method can contribute to the decision of approaching the lesion corditis (M 26.2%, F 4.8%), atrophy (M 6.2%), GERD (M with ‘‘cold’’ instruments or/and CO2 Laser techniques. 7.7%), nodule (M 3.1%), in 2001 chronic corditis (M 23.3%, F Method: The patients underwent videocontact endoscopy during 12.5%), GERD (M 7.7%), atrophy (M 5.4%), polypoid endoscopic surgery of the larynx. Videocontact endoscopy showed degeneration (M 4.5%), in 2006 chronic corditis (M 30.1%, F the aspects concerning the uniformity of the epithelial field, ratio 13.5%), GERD (M 8.1%), polypoid degeneration (M 6.2%, F between nucleus and cytoplasm, the shape and the size of the 10.0%). The rate of repeat was 70.8 (1999), 66.4 (2001), epithelial superficial cells ‘‘in vivo’’ and ‘‘in situ’’. The surgical and67.0% (2006) (range 66.2–73.8%). The rate of smoker was decision concerning the approach using ‘‘cold’’ instruments or 1998—M: 58.3%, F: 19.0%, 2001—M: 50.9%, F: 12.5%, CO2 Laser techniques took into account the images offered by 2006—M: 42.2%, F: 6.7%. In all period two cases of laryngeal videocontact endoscopy. Some representative cases illustrate the cancer (T1aN0) and one case of hypopharyngeal cancer (T1N0) main results in different pathologic situations. were detected. Results: Videocontact endoscopy represents an interesting method Conclusions: These examinations motivated them to improve voice to be used before taking the decision of approaching the lesion habits, because they could know how to use vocal fold and how with ‘‘cold’’ instruments or with Laser techniques at the level of smoking and vocal abuse are bad for their phonation. the glottic plan.

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HL 41 tracheostomised patients, endoscopic arytenoidectomy was Towards an automatic categorization of images undertaken with CO2 laser. The vocal ligament was severed from vocal process. The vocal folds retracted anteriorly. The submu- of laryngeal diseases cosal muscular and fibrous bands were vaporised and the body Antanas Verikas1,2,3,4, Adas Gelzinis2, Marija Bacauskiene3, was extracted submucosally. Soft tissue and any tags were va- Virgilijus Uloza4 porised until a posterior airway of between 5 and 7 mm, 1Intelligent Systems Laboratory, Halmstad University, Halmstad, depending upon the size of the patient, was achieved. Postoper- Sweden atively the patients were given steroid sprays and inhalations. Six 2Department of Applied Electronics, Kaunas University of week postoperatively staged decannulation was successfully Technology, Kaunas, Lithuania achieved as inpatient. In the absence of a contributing pathology 3Department of Applied Electronics, Kaunas University of such as subglottic stenosis, the endoscopic laser method offers an Technology, Kaunas, Lithuania elegant method for restoration of airway and decannulation 4Department of Otolaryngology, Kaunas University of Medicine, without significant patient morbidity. An expectant management Kaunas, Lithuania is possible by cord suture lateralisation made technically easier by Lichtenberger dedicated needle holder. If restoration of movement Objective: To elaborate an approach integrating the global and is not observed in nine to twelve months, then suture lateralisation local kernel-based automated analysis of vocal fold images aiming is made permanent by burying it under the skin. Open neck sur- to categorize laryngeal diseases. gery management is now considered obsolete. Methods: This study used a set of 785 digital laryngeal images. The images were acquired during routine direct microlaryngoscopy employing the Moller-Wedel Universa 300 surgical microscope. The 3-CCD Elmo color video camera of 768 · 576 pixels was used HL 43 to record the images. The problem was treated as an image analysis Optimizing the results of Type 1 thyroplasty: and recognition task. A committee of support vector machines was our experience employed for performing the categorization of vocal fold images into healthy, diffuse, and nodular classes. In this study, the main Handa, Kumud Kumar task was to differentiate between the healthy class and pathological All India Instittue Of Medical Sciences, New Delhi, India classes and then differentiate among the classes of vocal fold mass Objective: The authors present their work of Type 1 Thyroplasty lesions. Two groups of mass lesions of vocal folds were distin- alone or with arytenoids adduction in their institution All India guished i.e. nodular lesions (localized thickenings): nodules, pol- Institute of Medical Sciences, New Delhi from 1998 to date. The yps, and cysts, and diffuse lesions: papillomata, hyperplastic commonest indication was Unilateral Vocal cord paralysis. The laryngitis with keratosis, and carcinoma. Analysis of image color objective was to determine the factors which would help in distribution, Gabor filtering, co-occurrence matrices, analysis of achieving the best possible results after Type 1 Thyroplasty. color edges, image segmentation into homogeneous regions from Methods: The data included patients who underwent Type 1 the image colour, texture and geometry view point, analysis of the Thyroplasty alone or with arytenoids adduction. The parameters soft membership of the regions in the decision classes, the kernel studied included Role of pre-operative stroboscopy, Type of principal components based feature extraction were the techniques prosthesis, Shape of prosthesis, Combination of thyroplasties and employed for the global and local analysis of laryngeal images. whether cartilage was removed or not. Combination of thyropl- Results: The correct classification rate of over 94% was obtained. asty with arytenoids adduction and presence of any co-existing Conclusion: Bearing in mind the high similarity of the decision lesions on the vocal cords. The outcome measures were Objective classes, the results of automatic correct classification of laryngeal voice analysis and perceptual analysis. Siliastic block was used in images are rather encouraging. 67 out of 72 patients while in 5 patients Netterville prosthesis was used. In four patients Type 1 Thyroplasty had to be combined HL 42 with Type 4 Thyroplasty. Results: The results showed that Type 1 Thyroplasty suffices for Endoscopic laser management of bilateral vocal fold glottic defects which are elliptical but for glottic defects which are immobility because of higher lesions and due to combined superior laryngeal and recurrent laryngeal paralysis arytenoid adduction is required Vasant Oswal1, Sachin Gandhi2 along with Type 1 Thyroplasty. Proper patient selection and 1James Cook University Hospital, Middlesbrough, England, UK preoperative stroboscopy is essential. Preoperative stroboscopy 2Deenanth Mangeshkar Hospital, Pune, India helps identify certain subtle lesions which may be the cause of non Patients with bilateral vocal fold immobility require life long improvement of voice post operatively. The quality of siliastic in tracheostomy. Endoscopic laser arytenoidectomy is the method of preformed prosthesis may be better than that in siliastic blocks choice for a successful decannulation Out of 66 patients, 33 had where due to repeat sterilization the quality may be affected. iatrogenic aetiology. Twenty-seven of these had intubation trauma Removing the cartilage window gives better results than retaining whereas six were post-thyroidectomy. Other aetiology was idio- it. The free cartilage is likely to under go resorption. pathic bilateral abductor paralysis, neck trauma, chemical burns, Conclusion: Type 1 Thyroplasty alone or in combination with and congenital. All but one had undergone tracheos- Type 4 Thyroplasty or in combination with arytenoids adduction tomy. Patient without tracheostomy decided to come back later is the standard treatment for Unilateral paralysed cord. However for a more definitive surgery of arytenoidectomy. Sadly, this the best results can be obtained by keeping the above mentioned patient developed acute stridor and was dead on arrival. In variables in mind.

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HL 44 laterofixation developed. In four (28.6%) patients this swelling Bilateral vocal cord paralysis: aerodynamic measures was minimal and with no influence on breathing. In seven (50%) patients the swelling of laryngeal structures on the side of lat- and quality of life erofixation caused heavy breathing 3 days after the intervention, W. Harnisch1, S. Brosch1, R. Hagen1 specially during the night even with corticosteroid therapy. These 1Univ.-ENT-Clinic Wuerzburg, Germany patients were treated with desopstructive corticosteroid therapy, inhalations of ephedrine solutions, oxygenation and bed rest. At Objective: The aim of this study was to evaluate the long-term the end of the first week after the intervention the swelling of the effect of surgical treatment on airflow dynamics and quality of life larynx as well as breathing difficulties were reduced. In two in patients with bilateral vocal cord paralysis. (14.3%) patients due to swelling of laryngeal structures and se- Methods: Ten patients underwent flow-volume spirometry and vere breathing problems we performed bilateral vocal cord lat- body-plethysmography at least 6 months after glottal surgery. erofixation, and then tracheostomy. One patient died even after The chronic respiratory questionnaire (CRQ-SAS) and the EO- the tracheostomy was performed. Values of thyroid gland hor- RTC QLQ-C30, H&N35 were used to assess breathing difficulties mones (T3 and T4) as well as TSH were within normal ranges. and health related quality of life. The size of the glottal area, Four months after the intervention vocal cord function unilate- residual vocal fold movement and mucosal wave were determined raly recovered in two patients and the sutures arround the vocal during microlaryngostroboscopy. cords were removed. Two patients remained tracheotomised Results: Residual recurrent nerve activity was seen in five patients. while others had satisfactory lung functions according to body Pulmonary data varied widely and were not closely related to the pletysmography. size of the glottal area. Patient’s subjective dyspnoea, quality of Conclusions: Endo-extralaryngeal laterofixation of vocal cords is life and physical functioning were found to be correlated with an alternative method to urgent tracheostomy in early treatment expiratory airflow. of patients with bilateral recurrent nerve palsy. Critical period Conclusions: Surgical success in terms of an enlarged glottal area during the first week after the procedure requires corticosteroid might not lead to sufficient respiratory improvement and patient’s therapy with inhalations of symphatheticomimetics and oxy- satisfaction. Reduction in inspiratory speaking efforts in addition genotherapy. In certain number of patients, in spite of conser- to acquisition of special breathing techniques during speech vative treatment, permanent swelling of laryngeal structures therapy improve airflow stability as well as effectiveness of res- requires tracheostomy. piration, thus leading to enhanced quality of life.

HL 45 HL 46 Difficulties and complications of endo-extralaryngeal Exercise induced stridor due to obstruction laterofixation of the vocal cords in the treatment at the laryngeal or tracheal level of bilateral recurrent laryngeal nerve pals Robert C. Maat1, Ola D. Roksund2, John-Helge Heimdal1, Jovic´ Rajko1, Mitrovic´ Slobodan1, Janjevic´ Dusˇica2, Dragicˇevic´ Thomas Halvorsen2, Britt T. Skadberg2, Jan Olofsson1 Danijela1,Cˇanji Karol1 1Department of Oto-Rhino-Laryngology, Head and Neck Sur- 1University ENT Clinic, Medical Faculty, Clinical Center, Hajduk gery, Haukeland University Hospital, Bergen, Norway Veljkova 1 Novi Sad 21000 Serbia, 2Department of Paediatrics, Haukeland University Hospital, 2Anaestesiology Department of ENT Clinic, Clinical Center, Bergen, Norway Novi Sad Objectives: Exercise related breathing difficulties concurrent with Objective: The aim of this study is to point out our experiences in noisy breathing and wheeze are often treated as exercise in- using endo-extralaryngeal laterofixation of the vocal cords as a duced asthma. Breathing difficulties during exercise can how- method for treatment of bilateral recurrent laryngeal nerve palsy, ever, be caused by airway obstruction at the laryngeal or as well as the complications of this method and the ways of their tracheal level. resolving. Methods: A method for combined ergospirometry and continuous Methods: During the period from January 2003 to December laryngeal inspection during exercise, Continuous Laryngoscopy 2006, we performed 14 endo-extralaryngeal vocal cord latero- Exercise test (CLE-test), has been used to verify this problem. fixations in patients with bilateral recurrent nerve palsy. There Until now 81 youngster’s complaining of exercise related breath- were 12 women and 2 men, ages from 26 to 78 years (average age ing difficulties have been investigated. When stridor was observed 57.4). The cause of bilateral recurrent nerve palsy in 11 patients without sign of laryngeal dysfunction further examination as was thyroid gland surgery, in one patient it was fire arm chest tracheal CT scan and tracheoscopy were performed. injury, in one patient it was esophageal diverticulum surgery and Results: From the 81 subjects, investigated with the CLE-test, in one patient it developed after tracheal stenosis operation. Two eight had no objective pathology at the laryngeal level. Seventy- of these patients were admitted with previously performed tra- eight showed a minor or major obstruction at the laryngeal level cheostomy, while other 12 were without tracheostomy. Latero- while exercising. Eight subjects who developed stridor without any fixation was performed in the period from 8 to 40 days after visual pathology, where followed with a CT scan of the trachea bilateral recurrent nerve palsy occured. The procedure was done and thorax. They showed pathology at subglottic or tracheal level under with JET ventilation with using endo- like stenoses and impressions. extralaryngeal laterofixation suture technique by placement two Conclusions: Pathology in the larynx and trachea may be relatively sutures arround the vocal process of the arytenoid of the vocal rare, but this area should be kept in mind in patients with exercise cord. related breathing difficulties and particularly with stridor. The Results: During the postoperative period in all patients swelling described CLE-test is of great value for a correct diagnosis, and to of the arytenoid and other laryngeal structures on the side of select patients for further investigation and treatment.

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HL 47 patient population. There seems to be an increased risk for Endoscopic arytenoid lateralization for the treatment thrombo-embolic incidents, which may be attributable to pre- operative immobilisation of the dyspnoeic patients. of bilateral vocal cord immobility L. Rovo´ , S. Madani, G. Smeha´ k, J. Czigner, J. Jo´ ri ENT Department, University of Szeged, Hungary, Tisza L krt 111 HL 49 Szeged, Hungary Self-expanding Nitinol stents in the treatment Objective: One of the treatment options for the bilateral vocal of malignant tracheal stenoses cord immobility (bVCI) is the ‘‘simple’’ suture lateralization of the B. M. Lippert, D. Koutsimpelas, H. Gouveris, W. J. Mann vocal cord(s) (VC) from external or endoscopic approach. Department of Otorhinolaryngology, Head and neck Surgery, Methods: Between 1986 and 2006 146 patients with bVCI were University of Mainz treated at the ENT department of Szeged University. From 1995 a minimally invasive technique was applied in 112 patients (75 wo- Objective: Cancer of the upper aerodigestive tract can cause airway men, 37 men, ranged 18–81 years), which provided the lateraliza- stenosis or tracheoesophageal fistula with servere aspiration. Since tion of the arytenoid cartilage in a physiological abducted position surgery and radio-chemotherapy is limited, palliative treatment by an endoscopically inserted suture loop. The fixated cricoaryte- modalities are necessary. In recent years nitinol stents have been used increasingly in these cases. noidal joints were previously mobilized by CO2 laser and a special blade designed by the authors. Seventy-four bVCIs were due to Patients and methods: Tracheal stenoses or fistula had occurred in nerve injury, and most of the 38 mechanical fixation cases developed 25 patients (19 men, 6 women, mean age 68.8 years) with esophageal after prolonged intubation. carcinoma (n = 13), peristomal recurrent tumor after hypopha- Results: Immediate postoperative adequate airway was achieved in ryngeal carcinoma (n = 7), primary carcinoma of the trachea 102 cases. One patient required postoperative tracheostomy and in (n = 4), and one mediastinal metastasis (hypopharyngeal carci- nine ones, the preroperatively existing tracheostomy had to be noma). Thirty-two self-expanding nitinol-stents were placed under sustained for more than a week. Three of them remained canulated. general anesthesia with endoscopical and fluoroscopical guidance. Two elderly women were later tracheostomized for aspiration. After Results: Stent insertion was successful in all cases and led to an the recovery of the VC movement the suture was removed in 52 immediate relief of the morphological and functional airway cases, which ensured further voice improvement. In 46 of the 55 obstruction. No immediate complications were noted. In five cases permanent bVCIs the airway remained stable over a year. additional stents were necessary because of tumor over growth, Conclusion: This method is a good primary solution of bVCI, stent dislocation, and tumor related tracheoesophageal fistula. because it can provide immediate and stable airway with the Conclusion: Tracheobronchial stents have proved their efficacy in preservation of the laryngeal function to a large extent. the treatment of malignant incurable tracheobronchial obstructions and fistula. The main advantage is the rapid and effective opening of HL 48 the stenosed central airway leading to a better quality of life. Cricotracheal resection in non-tracheotomized adults: a prospective case series HL 50 Treatment of laryngeal stenosis Christian Sittel, Alexandra Streckfuss, Sebastian Blum, Peter K. Plinkert V. N. Bakumov, V. V. Reznikov, E. A. Nabatova, A. S. Drannikov, University of Heidelberg, Department of Otolaryngology/Head I. V. Andreeva, B. O. Shahab, V. V. Uskova and Neck Surgery, Im Neuenheimer Feld 400, 69120 Heidelberg, Volgograd, Russia Germany Laryngeal stenosis is one of the most difficult problems of modern Objective: Cricotracheal resection (CTR) is a modern technique of ORL. In the period of 1995–2006 we have had 127 patients. The airway reconstruction in case of subglottic stenosis (SS). We report stenosis duration ranged from 2 weeks up to 21 years. Twelve a case series of adult, non-tracheotomized patients. patients had complete or almost complete atresia of the larynx Methods: Fifteen patients with significant SS were identified, and upper ring of trachea. presenting with dyspnea and stridor. Grade of stenosis was III in The surgery was performed externally through laryngofissure with 14 cases and II in 1 case, according to the Cotton-classification. the fixation of endolaryngeal-stent, T-shape tube or prosthetics of Etiology was manifold, with intubation and tracheotomy being other form in the larynx cavity. The stent remained in the larynx for the predominant risk factors. CTR was performed in all cases with 7.5 months in average. To one of the patients, the endolaryngeal- pre- and postoperative videotracheoscopy. stent was put 2 weeks after the trauma after the elimination of the Results: Mean postoperative intubation time was 41.7 h (11– shock and mediastinitis. Eighteen patients after the stent removal 103 h), mean length of ICU-stay was 2.6 days (3–9 days). Videot- had stenosis in the tracheostoma looking like ’’sand glass‘‘. They racheoscopy for reassessment was performed after 69 days in the had to undergo the circular resection of the trachea. The treatment if average. In 13/15 patients the subglottic lumen had been normal- performed in close contact with non-ORL doctors. ized. In one case a restenosis could be managed with repeated As a result of the treatment, all the patients were released from the endoscopic interventions. One patient died at post-OP day 4 due to a canules and the natural way of breathing was gained in 101 cases. fulminant pulmonary embolism. Further complications comprised Noticeable changes in the voice were stated. The voice function of one axillary vein embolism, ventilator-associated pneumonia in 28 patients was fully restored. The rest had voice malfunctions of four cases and one transient unilateral recurrent nerve palsy, which different degree. Recurrence of the stenosis treated this way was recovered completely. fixed 5 years after the surgery in 15.2% of cases. Re-stenosis was Conclusion: CTR is a reliable and versatile technique for recon- treated by repeated tracheotomy, CO2 laser, repeated endopros- structing the subglottic airway, almost regardless of the underlying thetics, which allowed 16 patients to be decanulated within 2 years etiology. Most complications observed have not been associated and their level of life is satisfactory. Three patients failed to get directly to the procedure, but reflect the complex morbidity of the decanulated even after the surgery.

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HL 51 during coagulation was set at 1, 0–1, 2 l/min. All operations were Tracheal injuries in percutaneous tracheotomy performed under general anaesthesia. Results: We observed different improvements in each treated 1 1 2 Michael Wolf , Adi Primov- , Ilya Novikov child. In all cases no complications occurred and no progression 1Department of Otorhinolaryngology, Head and Neck Surgery, of the cicatrix in the subglottic region was observed. The appli- Chaim Sheba Medical Center, Tel-Hashomer and Sackler School cation of APC during endoscopic dilation of the larynx enabled of Medicine, Tel-Aviv University, Tel-Aviv, Israel the decannulation of six children, and ten other patients are still 2The Gertner Institute for Epidemiology and Health Policy re- being treated. search, Chaim Sheba Medical Center, Tel-Hashomer and Sackler Conclusions: An analysis of the effects of treatment of postintu- School of Medicine, Tel-Aviv University, Tel-Aviv, Israel bation laryngeal stenosis shows that treatment with argon plasma Objective: To prospectively examine the incidence and extent of coagulation seems safe and effective in cases with I and II degree tracheal injury during guide-wire dilatational tracheotomy of stenosis. (GWDT) in relation to patients’ characteristics and technique. Methods: Prospective randomized controlled study in a tertiary referral medical center. HL 53 Consecutive 185 patients undergoing GWDT by otolaryn- The end to end anastomosis in the tracheal stenosis gology surgeons under endoscopy and video-monitor-control by P. Theodosis, D. Gourziotis, B. Gregoriou, S. Papaspyrou one of three surgeons (senior attending and two senior resi- General Hospital Of Athens ‘‘Eyaggelismos’’ dents). Surgical details were described by each surgeon, and follow-up was prospectively registered. Statistical analysis used Introduction: The stenosis of cervical trachea is a challenge for t-test when comparing age between two groups and one-way every ENT surgeon. There are many suggested techniques devel- ANOVA when comparing more groups. The Pearson chi- oped by the years. The resection of tracheal segments and the end square and Fisher exact test were used for testing independence to end anastomosis provide reliable and long term results by one between categorical variables. The following parameters were stage operation. examined: site of tracheal puncture and extent of tracheal in- Materials and methods: We examined 19 patients with tracheal jury, procedure-related complications. stenosis with the resection of the segments and end to end Results: Site of tracheal puncture was significantly dependent anastomosis the last 4 years, four of them were treated at first upon age (P < 0.0013), also, significant differences were with other technique, Laser beam (CO2), stents, grafts. Most of encountered between surgeons in distribution of site of tracheal them were hospitalized in intensive care units for various rea- puncture (P < 0.001). Tracheal fracture was noted in 43 cases sons at the past. The MRI of the neck–trachea and laryngot- (23.2%). The incidence of fractures was dependent on surgeons racheoscopy with the flexible fiber optic laryngoscope have been (P < 0.04) and positively correlated with age (P = 0.07). performed preoperative. The high points of the end to end Complications were not found to correlate with any of the technique are at first a U shaped cervical incision to expose the examined parameters. trachea up to the sternum. A tracheostomy is performed if Conclusions: Age was found to be a detrimental factor upon the there is not any, only for the needs of the operation, below to site of GWDT and the incidence of cartilaginous fracture. It may the point of the stenosis. Once the trachea has been exposed suggest that GWDT in the elderly should be cautiously consid- and mobilized with find the lesion and determine the number of ered, especially when neck extension is limited. the segments that we will resect. Blunt dissection of the trachea from the surrounding tissues at the tracheal wall follows step by step careful maneuvers for separation from the esophagus. An incision is made at the lesion and we resect the defect rings up HL 52 to the healthy tissue. The release of the muscles above and Argon plasma surgery in the subglottic stenosis below the hyoid bone takes place only when the defect is more in children than 5 cm. The first leading sutures are made to the posterior wall, while at that point intubation is carried out in the open Lidia Zawadzka-Glos, Mieczyslaw Chmielik field. The use of absorbable sutures with the nodes outside the Paediatric ENT Department, Warsaw, Poland trachea and an end to end anastomosis is carried out. The Objective: Subglottic laryngeal stenosis develops in most cases as a number of the resected segments varied from 2 to 8 in different result of prolonged intubation. A lot of methods for treatment of cases. postintubation stenosis are known, both classic methods for Results: All patients had a follow up from 9 months to 4 years. reconstruction of the larynx through an external approach, and The postoperative lumen of the trachea reaches the normal. endoscopic methods for dilation of the larynx. The selection of the Complications presented only two patients, one with a small method of treatment depends on the degree of stenosis and kind of pneumothorax that conservatively dealed and another one with a operations performed earlier. One of them is argon plasma sur- vocal cord paralysis that was treated surgically by Kashima gery (APC). Sixteen children aged from 6 months to 12 years, cordotomy with Laser beam CO2. with postintubation laryngeal stenosis from I to IV degrees Conclusions: After years of using various techniques we concussed according to the Meyer-Cotton grading system, were qualified for to the end to end anastomosis. The end to end anastomosis is a treatment of laryngeal stenosis with APC. reliable method of treating selected cases of tracheal stenosis. In Methods: Argon plasma coagulation was applied to treat lar- comparison with the other surgical techniques provides long term yngeal stenosis.Different coagulation times were used, ranging safe results at a one stage operation and requires less hospital- from 1 to 3 s repeated a few times. The flow rate of the argon gas ization.

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HL 54 risk factors for the development of RE (smoking, gastro- Laryngeal and tracheobronchial amyloidosis esophageal reflux-GER, allergy, thyroid dysfunction, vocal overuse and misuse, the unfavourable microclimate at work) Kenneth Wu1, Samit Majumdar1, Peter Bull1 was taken. Skin prick allergic tests, and the determination of 1Department of ENT Surgery, Royal Hallamshire Hospital, serum IgE and TSH levels were also performed. ENT exami- Sheffield, UK nation revealed the signs of GER and allergy. The test and the control group were compared regarding etiologic factors using Objective: Amyloidosis in the airway is a rare condition which 2 presents with respiratory symptoms. Knowledge of the natural v -test and Mann–Whitney test. history of the condition thus is still not well established. To better Results: Smoking (P = 0.000), GER (P = 0.003), voice misuse determine the course of the disease we reviewed existing literature and overuse (P = 0.040) appeared in the majority of the pa- and clinical features of patients seen at our institution. tients and demonstrated to be significantly more often present Methods: Literature review of papers discussing regional and in the patients with RE than in the control group. The unfa- systemic amyloidosis. Retrospective review of cases from our vourable microclimate at work, thyroid hypofunction and al- institution. lergy appeared as less important factors which were present in the minority of the patients. In 65% of patients at least two Results: Analysis of information from papers and patient records risk factors were found. was conducted. Amyloidosis is a general term for a spectrum of disorders that cause deposition of protein in an abnormal fibrillar Conclusions: For a permanent cure of RE all possible etiologic form. Biochemically, several forms exist such as primary idio- factors must be actively searched for and treated properly. pathic and reactive. There are localized and systemic manifesta- tions. Laryngeal amyloidosis is the most common site for localized disease. It can also be a component of systemic amyloidosis. Three HL 56 cases (three women) are discussed with disease involvement of the larynx, trachea and bronchus. Treatment included endoscopic Immunohistochemical examinations of sex hormone laser resection of lesions. receptors (ER alpha, PR, AR) in the human vocal fold Conclusions Localized amyloidosis does not normally progress to Berit Schneider, Eleonora Cohen, Andrea Kolbus, Josefine Stani, systemic disease. However, there may be involvement of sur- Margarethe Rudas, Reinhard Horvat, Wolfgang Bigenzahn, rounding organs. Clinical investigations are only of limited use. Michael van Trotsenburg Regular follow-up of patients is mainstay of management due to Department of Otorhinolaryngology/Division of Phoniatrics-Lo- long-term disease progression. Appropriate surgical intervention gopedics, University Hospital of Vienna, Austria should be reserved for patients with resistant clinical symptoms. Background: Several voice disorders are assumed to be caused by the direct influence of hormones on the larynx. There is only very limited data on the evidence of steroid receptors in the HL 55 vocal folds, although voice alterations due to hormonal influ- Ethiologic factors for Reinke’s edema on vocal folds ence and treatment have been found. Goal of the study: To investigate the expression of estrogen a, Alenka Kravos1, Irena Hocevar-Boltezar2, Bogdan Cizmarevic1, progesterone and androgen receptors in human vocal folds. Avgust Zupevc2 Methods: Immunohistochemically, vocal fold cadaver specimens 1Department of Otorhinolaryngology and Head and Neck Sur- of 15 autopsied patients (six female, nine male) which were taken gery, General Hospital Maribor, Ljubljanska 5, SI-2000 Maribor, approximately 4–8 h postmortem were investigated. Slovenia Results: No specific immunohistochemical staining for the dif- 2Department of Otorhinolaryngology and Head and Neck Sur- ferent types of steroid hormones investigated could be seen in gery, University Medical Center Ljubljana, Slovenia either the post-mortem taken biopsies nor the intraoperatively Objective: In order to avoid the recurrence of the disease, all one. However, several unspecific staining patterns could be etiologic factors should be identified even before the surgery. observed. The aim of the study was to evaluate different etiologic factors Conclusion: The results of this study contradict recently published for RE. data and question the expression of sex hormone receptors in the Methods: Eighty patients with RE and 80 control subjects were vocal folds. Main causes of false interpretations of unspecific included in the study. In all subjects a precise history about the staining are discussed.

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HL 57 nerve segments along their spread (skip metastasis). This may Experimental examinations on cleaning and reuse preclude obtaining tumor-free surgical margins, since there may still be viable tumor cells beyond the surgeon’s resection limits, of cuffed tracheostomy tubes under hospital conditions which may be responsible for recurrent disease. The purpose of Matthias Leonhard1, Ojan Assadian2, Florian Daxbo¨ ck2, this study is to investigate if more proximal segments of superior Maria Stadler2, Michaela Zumtobel1, Wolfgang Bigenzahn1, and inferior laryngeal nerve stumps involved by PNS in a routine Berit Schneider1 laryngectomy. 1Department of Otorhinolaryngology, Medical University of Methods: Average of 2 cm extralaryngeal segments of superior Vienna, Waehringer Guertel 18–20, 1090 Vienna, Austria and inferior laryngeal nerves were resected in 15 consecutive lar- 2Clinical Institute for Hygiene and Medical Microbiology, yngectomies (60 nerve segments). Both laryngectomy specimens Division of Hospital Hygiene, Medical University of Vienna, and the harvested nerve segments were histopathologically Waehringer Guertel 18–20, 1090 Vienna, Austria examined for the presence or absence of PNS. Results: Regardless of the presence or absence of PNS in the Objective: Due to the lack of accepted recommendations on larynx, none of the nerve segments showed evidence of PNS (0 out reprocessing cuffed tracheostomy tubes, the theoretically possible of 60 nerve samples). reuse is not introduced in clinical practice yet. Goal of this study Conclusion: It is highly unlikely that PNS extends beyond the was the application of selected cleaning methods giving special surgical resection limits in routine laryngectomies. Therefore, re- emphasis to reduction of microbial contamination, economical ported worse outcomes in the presence of PNS in laryngeal cancer aspects and material deterioration. does not seem to be related to residual tumor cells in more Methods: Cuffed tracheostomy tubes of different types and man- proximal portions of these nerves. ufacturers were contaminated under controlled laboratory con- ditions with defined suspensions of clinically relevant micro- organisms and reprocessed using five cleaning methods: manual HL 59 cleaning using brushes; manual cleaning combined with chemical disinfection; cleaning using a dishwasher; ultrasound cleaning; Efficacy of endoscopic tracheoplasty for treating enzymatic cleaning tracheostomy-related airway stenosis 3 Results: The theoretically required reduction of 10 micro- Reza Nouraei1, Khalid Ghufoor2, Karan Kapoor1, organisms, was achieved by all methods tested, but they differed David J. Howard1, Guri Sandhu1 in reliability, related costs, hands-on-time and material deteri- 1Department of Otolaryngology, Charing Cross Hospital, oration. Manual cleaning reached the required reduction of London, UK microbes only in combination with time consuming disinfection. 2Department of Otolaryngology, Barts and London Hospital, Ultrasound and enzymatic cleaning showed sufficient reduction London, UK of micro-organisms in a shorter period of time. The dishwasher reached a very good and reliable reduction of micro-organisms, Objective: To evaluate the results of endoscopic tracheoplasty as but with longer processing time and increased thermal stress of an alternative to open tracheal resection for treating post-tra- material. cheostomy stomal stenosis caused by inward collapse of over- Conclusions: In summary, intraindividual reuse of cuffed trache- resected tracheal rings. ostomy tubes is possible. The cleaning methods tested in this study Methods: Patients treated for post-tracheostomy ‘lambdoid’ tra- differ in regard to costs, expenditure of time, availability, waste cheal deformity between April 2004 and 2006 were reviewed. management and endangerment of staff. Automated cleaning Patients were treated with endoscopic CO2 laser resection of col- processes imply higher acquisition costs, but work more cost- lapsed tracheal rings, dilatation and endotracheal mitomycin C efficient with increasing numbers of tracheostomy tubes. application. Shared-airway surgery was undertaken using sus- pension micro-laryngo-tracheoscopy and high-frequency supra- glottic jet ventilation. Perioperative patient and lesion HL 58 characteristics and results of treatment were assessed. Perineural spread in squamous cell carcinoma Results: There were seven males and four females. The average age at presentation was 56 years. The average lesion height and dis- of the larynx: histopathological evaluation of inferior tance from glottis were 11 ± 5 and 35 ± 12 mm, respectively. and superior laryngeal nerve proximal stumps The median number of treatments was 3, falling from 4 at the start of the series to 2 at the end (P = 0.08). Three patients required Emre Vural1,2, Chun Y. Fan3, Paul Spring1,2, Brendan C. Stack temporary tracheal stents, and one patient also underwent lar- Jr1, Mimi Kokoska2, Ehab Hanna4, James Y. Suen1 yngofissure and anterior augmentation with hyoid-on-sternohyoid 1Department of Otolaryngology-Head and Neck Surgery, composite flap for concomitant glottic stenosis. The average fol- University of Arkansas for Medical Sciences, 4301 West low-up was 17 ± 8 months and no patient relapsed after six Markham, Slot 543, Little Rock, AR 72205, USA symptom-free months. All but one patient with pre-existing pul- 2Division of Otolaryngology-Head and Neck Surgery, John monary disease achieved and maintained a Medical Research McClellan VA Hospital, Little Rock, AR 72205, USA Council Dyspnea Scale of I or II, and resumed normal activities. 3Department of Pathology, John McClellan VA Hospital, Little There were no cases of dysphonia or dysphagia. Rock, AR 72205, USA Conclusions: Endoscopic tracheoplasty is a successful treatment 4Department of Head and Neck Surgery, MD Anderson Cancer for airway stenosis caused by the post-tracheostomy lambdoid Center, Houston, TX, USA deformity of the trachea. It achieves a successful outcome while Objective: Perineural spread (PNS) is an important risk factor for avoiding the operative risks, prolonged hospitalization, and locoregional failure and correlated with reduced survival rates in morbidity that is associated with tracheal resection. We rec- squamous cell carcinoma of the larynx. PNS may extend proxi- ommend it as the standard of care for treating patients with mally and/or distally in the nerve sheath by leaving uninvolved this injury.

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HL 60 patients were treated by vertical partial laryngectomy with lar- Outcome of endoscopic treatment of adult yngeal reconstruction by platysma myofascial flap. The surgical procedure and flap design were described. Vocal function was postintubation tracheal stenosis assessed by videolaryngostroboscopy and subjective and objective Reza Nouraei1,2, Khalid Ghufoor2, Anil Patel2, Tina Ferguson2, voice analysis before and after surgery. David Howard1,2, Guri Sandhu1,2 Results: No flap necrosis and no disturbance of airway patency or 1Department of Otolaryngology, Charing Cross Hospital, deglutition were noted during 1-year follow-up. Complete neo- London, UK glottic closure and acceptable quality of voice were obtained by 2Royal National Throat Nose and Ear Hospital, London, UK platysma myofascial flap in all cases. However, no statistically significant difference was found between the preoperative and Objective: To assess the results of primary endoscopic treatment postoperative acoustic parameters including GRBAS scores, the of adult postintubation tracheal stenosis, to identify predictors of average fundamental frequency, the jitter, the shimmer and the a successful outcome, and better define the scope and limitations harmonic to noise ratio. of minimally invasive surgery for this condition. Conclusions: Platysma myofascial flap provides the basic Methods: Sixty-two consecutive patients treated between April requirements for laryngeal reconstruction with its own favourable 2003 and 2006 with initial endoscopic surgery were prospectively characteristics and also allows complete glottic closure without studied. Patient and lesion characteristics, treatment details, interfering respiration and deglutition. This tecnique of laryngeal complications, and decannulation and open surgery rates were reconstruction may constitute an effective alternative achieving recorded. Actuarial analysis and Cox regression were used to acceptable quality of voice. identify predictors of decannulation and freedom from external surgery. Results: There were 34 males and the average age was 45 ± 16 years. The average stenosis height was 18 mm (range 5– HL 62 55 mm), and 82% of lesions were Myer-Cotton grades III or IV. Influence of age on laryngeal cancer Lesion height and intubation-to-treatment latency independently predicted success of endoscopic surgery. Ninety six percent of Elvir Zvrko, Mirko Popovic´ , Vladan Knezevic´ , Slavko Janjusˇevic´ patients with lesions < 30 mm in height were treated endoscop- Clinic for ORL and MFS, Clinical center of Montenegro, ically, but success rate fell to 20% for lesions longer than 30 mm. Podgorica, Montenegro Patients with recalcitrant lesions underwent airway augmentation The frequency of head and neck cancer in older patients is now (n = 11) or resection (n = 3), with a 79% success rate. All pa- higher as a result of constant increase in human life expectancy. tients were decannulated, but some with morbid obesity required Also, there is the hypothesis of a different biological behavior of long-term stents for dynamic airway compromise. Ninety-eight the tumor in relation to age. percent of re-interventions occurred within 6 months. The aim of this study was to compare clinicopathologic charac- Conclusions: Endoscopic surgery is effective in postintubation teristics of laryngeal cancer between the patients older than 65 and airway stenosis and obviates the need for external surgery in most younger patients. patients. Patients with old and long lesions are less likely to be The data for 108 patients with laryngeal cancer were ana- cured endoscopically. For most patients in this subgroup, endo- lyzed. All cases were diagnosed and treated at the Clinic for scopic surgery makes airway augmentation a viable, less-invasive otorhinolaryngology and maxillofacial surgery of the Clinical alternative to resection. Patients were unlikely to require further center of Montenegro in Podgorica. The clinicopathological therapy after 6 months of symptom-free follow-up. characteristics of 76 patients (Group A) with laryngeal carci- noma diagnosed when they were 65 or younger are compared HL 61 with a group B of 32 older patients. In our study, 30% of cases were diagnosed when the patient Laryngeal reconstruction by Platysma myofascial flap was older than 65. Male–female ratio was 4:1 in group A and 5.4:1 after vertical partial laryngectomy in group B. The group of elderly patients had a higher proportion Ozan Bagis Ozgursoy, Gursel Dursun of tumors located in the glottis. In the group of younger patients the incidence of supraglottic location was higher. A higher pro- Department of Otorhinolaryngology-Head and Neck Surgery, portion of N+ category was found in younger patients (11% in Ankara University Faculty of Medicine, Ibni Sina Hastanesi KBB Group A, compared to 6% in Group B). Advanced laryngeal AD, 06100, Ankara, Turkey cancer (Stage III, IV) had 26% of patients in group A and 12% of Objective: The purpose of this study was to reestablish the glottic patients in group B. integrity by platysma myofascial flap after vertical partial laryn- The group of elderly patients (older than 65) with laryngeal gectomy and to evaluate the outcomes of this technique. cancer showed a higher proportion of men, a higher incidence of Methods: Eighteen patients with T2 squamous cell carcinoma of glottic location, a higher proportion of early laryngeal cancer, less the glottis were included in this prospective clinical trial. All use of tobacco.

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HL 63 Methods: The present study is based on a retrospective clinical- Carbon dioxide laser laryngectomy: preliminary pathological analysis of ’’en bloc‘‘ resected glottic specimens and patient’s charts obtained from 232 patients having vocal cord results carcinoma treated by endoscopic-microscopic laser surgery. Calarasu Romeo, Ion Carmen, Codreanu Sorina Results: For minimum 3-year follow-up (May 1987–March 2004), Institute of Phonoaudiology and Otorhinolaryngology Functional the endoscopic CO2-laser surgery alone controlled the early vocal Surgery, 21 Mihail Cioranu Street, Bucharest, Romania cord carcinoma in 87% (194/224), 13% required salvage therapy. After ’’laser-salvage’’, the local control rate was mounted to 93%, The current tendency of laryngeal oncologic surgery in our insti- and with the conventional salvage therapy finally resulted in 97%. tute is to approach laryngeal tumors by endoscopic CO2 laser The organ preservation’s rate achieved 96%, and eight patients had surgery. lost their larynges. The vocal function was really good in most pa- Methods: This is a retrospective study of 238 patients with lar- tients, because no excess of normal tissue was sacrificed. yngeal cancer stage T1–T3 who underwent endoscopic CO2 laser Conclusions: Based on 20 years of experience with laser-cordec- surgery from 1992 to 2006. tomy, the excellent re-treatment options in case of local failure We have applied the oncologic surgery principles, this meaning and these favorable oncological results, endoscopic minimally resection the lesion with healthy surrounding tissue and patho- invasive laser cordectomy should be the first choice of treatment logic assessment of the margins. for early glottic cancer. Radiotherapy and open partial laryngec- Depending on the extent of the lesions, we performed one of tomy should be reserved for salvage therapy. the following types of endoscopic techniques: cordectomy or partial endoscopic laryngectomies (frontolateral, frontoanterior, horizontal supraglottic, horizontal glottic, endolaryngeal evis- ceration). The endoscopic surgery was performed alone or fol- HL 65 lowed by adjuvant radiotherapy administered early (3–5 days) Endolaryngeal CO2 laser resection for early or late (4–6 weeks). supraglottic carcinoma combined with neck dissection Results: The 3-, 5- and 10-year survival rates were analysed. From the 238 patients who underwent surgery, only 174 (73.1%) pa- Miklo´ s Csana´ dy, Jeno} Czigner, Bala´ zs Sztano´ ,Jo´ zsef Jo´ ri tients checked in for the postoperative follow-up. From the 131 Department of Otorhinolaryngology, Head and Neck Surgery, patients who underwent laser laryngectomy alone or combined University of Szeged, Hungary with late radiotherapy, 93.9% (123 patients) survived disease-free Objective: Authors present the option of endolaryngeal CO2 laser and 6.1% (8 patients) developped local recurrence. From the 43 resection of T1N1, T2N1 supraglottic (marginal) tumours and patients who underwent laser laryngectomy combined with early neck dissectionin selected cases. radiotherapy, 83.7% (36 patients) survived disease-free, 16.3% (7 Methods: Fifty-five patients with supraglottic cancer underwent patients) developped local recurrence. laryngomicroscopic CO2 laser resection (1987–2007). Neck dis- Conclusions: Endoscopic laser laryngectomy was the classic section (mRND) was performed simultaneously, in order to indication as a curative treatment for laryngeal cancer stage T1. remove metastatic lymphnodes in 7 of 55 patients, that were The good oncologic results obtained after long-term follow-up resected with laser (three epigottis, two vallecula and two in patients who underwent laser surgery combined with early marginal tumours). radiotherapy extended the indication of this therapy to stage Results: Forty of fifty-five (73%) patients after laser surgery T2, T3. showed no recurrence after a single laser-excision. In 15 patients locally recurred tumour was found, so six patients underwent repeated laser-resection, three patients got radiation therapy, HL 64 four horizontal supraglottic resection and two laryngectomy (salvage-therapy). Development of late metastasis required 5 Laser-cordectomy is the best treatment option RNDs. One of those seven patients after CO2 laser surgery and for early glottic carcinoma: 20 years of experience neck dissection underwent 1 RND of the 5 RNDs, another Jeno} Czigner, Ro´ bert Paczona, Miklo´ s Csana´ dy, Jo´ zsef Jo´ ri patient had a supraglottic resection and radiation therapy of a local recurrence. No postoperativ oedema, but moderate aspi- Department of Otorhinolaryngol., Head and neck Surgery, ration was observed. University of Szeged, Hungary Conclusions: Endoscopic CO2 laser resection could be a method Objective: Twenty years of experiences with endoscopic-micro- of choice in selected patients of supraglottic cancer and can be scopic laser-cordectomy for early glottic carcinoma. Familiariza- combined with primary neck dissection in one stage to manage tion with the practicability of this surgery in relation to the stages metastatic lymph nodes. Late manifest metastasis was treated of vocal cord lesions resulted in subgroups, i.e., ‘‘superficial’’, by secondery neck dissection (RNDs). Of the total of 30 epi- ‘‘partial’’, ‘‘total’’ and ‘‘extended’’ cordectomy which was adapted glottis, 9 other supraglottic, 6 vallecula e´ s 3 supraglottic-mar- by the E. L. S. (2000). ginal (hypopharyngeal extension) tumours.

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HL 66 squamous cell carcinoma. The mean age was 58.2 years for men and 59.2 years for women. 274 patients underwent CHP and 76 Endoscopic CO2 laser surgery in supraglottic cancer CHEP. Evaluation of patients included onchological and func- Stan Cotulbea, Stelian Lupescu, Caius Doros, Alin Horia Marin, tional results. Horatiu Stefanescu Results: The 3, 5, 10 year over survival rates were 86, 79 and 58%, ENT Department, University of Medicine and Pharmacy ‘‘Victor respectively. Tumor category, lymph node category, tumor stage Babes’’ Timisoara and recurrence all had a significant influence on the survival rate. Objective: This study presents the indications, general principles, Functional outcomes had better results in patients who underwent contraindications, limits and results of this modern therapeutic CHEP in short time evaluation. In long time evaluation results method. Supraglottic cancer is an aggressive, with high tendency become similar for both groups of patients and with no age dif- for nodal metastasis. Therefore early detection and effective ference. treatment is of outmost importance. Conclusion: Evaluation of post-operative swallowing disorders Methods: Between 1996 and 2006, 27 patients with supraglottic included a careful observation of the patients by the physician, cancer T or T and N , have been treated with supraglottic laryn- fiberoptic endoscopic evaluation of swallowing (FEES), and vid- 1 2 0 eofluoroscopy (VFS). Supracricoid partial laringectomy has gectomy with CO2 Laser. All patients were carefully selected using modern video-endoscopical procedures (flexible laryngoscopy, shown excellents results in functional and onchologic outcomes, suspended microlaryngoscopy) and CT-scan or neck ultrasonog- whereas surgical indications are respected. raphy. Carefull preoperative selection is of outmost importance for the clinical outcome of patients. In the studied group we applied simple epiglotectomy—8 cases, extended epiglotectomy—12 cases, HL 68 HSL (horizontal supraglottic laryngectomy)—7 cases. Postopera- Endoscopic imaging of precancerous lesions tive follow-up was between 12 and 48 month, average 36 month. of the vocal folds Naso-gastric feeding tube was necessary in only two cases for a few days postoperative (patients with HSL). Christoph Arens, Hiltrud Glanz, Marcel Kraft Results: In our group we obtained the following oncological re- Department of Otorhinolaryngology/Head and Neck Surgery, sults: no evidence of disease (NED)—24 cases (88.9%) and local University Hospitals Giessen and Marburg, Giessen, Germany reccurrence in three cases (11.1%). All patients who presented Objective: The early detection of precancerous and cancerous local reccurrence in larynx were in stage T N of the disease; the 2 0 lesions of the vocal folds is associated with improved survival salvation treatment we applied consisted in total laryngectomy. and the potential for complete endoscopic resection. It may be Immediate functional results were very good and good in all cases. enhanced by several promising diagnostic imaging techniques Conclusions: Endosocopic CO laser surgery appears to be an 2 such as fluorescence endoscopy, contact endocopy and optical effective and safe alternative treatment for T –T ,N supraglottic 1 2 0 coherence tomography (OCT), as these modalities offer the cancer, with superior oncologic and functional results than the potential to identify in real-time lesions that are inconspicuous other techniques, requiring short hospitalization, no tracheostomy under conventional endoscopy. and feeding tube and providing superior rehabilitative result with Methods: Patients in different stages of laryngeal dysplasia, car- a good quality of life. cinoma in situ and laryngeal cancer were examined by means of the previous mentioned imaging techniques during microlaryn- HL 67 goscopy. Results were compared to histological findings. Results: During the autofluorescence (AF) examination of the Supracricoid partial laryngectomy. Oncological endolaryngeal mucosa precancerous and cancerous lesions and functional results showed a red to violet fluorescence outlined against the light de Vincentiis Marco, Fanfoni Fabio, Pagliuca Giulio, Del Gaizo green AF of the normal mucosa. During 5-Aminolevulinic acid Raffaele, Bianco Nicola, Gallo Andrea (5-ALA) induced fluorescence protoporphyrin IX accumulated ENT Department, ‘‘G. Ferreri’’, ‘‘La Sapienza’’ University, in these lesions presenting a bright red orange fluorescence. Rome, Italy After staining the vocal cords with methylene blue, it was possible to observe the cells, nuclei and cytoplasm. OCT Objective: The purpose of laryngeal partial surgery is to keep the imaging of the vocal folds provided information on the thick- patient under control from an oncological point of view, but also ness of the epithelium, integrity of the basement membrane, and to restore phonatory, respiratory and swallowing functions. structure of the lamina propria. Supracricoid partial laryngectomies, and in particular Cri- Conclusion: Fluorescence endoscopy, contact endoscopy as well as cohyoidopexy (CHP) and Cricohyoidoepiglottopexy (CHEP), are OCT are promising new imaging techniques supplementing mi- surgical procedures that permit, through the conservation of a crolaryngoscopy. They are suitable to differentiate dysplasia, cricoarytenoid unit, the creation of a neolarynx adequate for carcinoma in situ, microinvasive lesions as well as the evaluation swallowing as well as for speaking. of tumorous margins, while coherence tomography especially Methods: The study population comprised 290 consecutive pa- improves the assessment of tumorous infiltration into the mucosa tients (267 men and 23 women) with glottic and supraglottic and the lamina propria.

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HL 69 Patients and methods: Fifty-one (m 35, f 16, 37–85 years with an Adjuvant therapy in laryngeal papillomatosis average of 60) patients at ENT Elisabethinen Graz underwent a supraglottic horizontal laryngectomy by a modification of the Irena Hocevar-Boltezar1, Mojca Maticic2, Maja Sereg-Bahar1 Calcaterra technique during the period from 1992 to 2006. The 1University Medical Center Ljubljana, Department of Otorhino- TN stages were T1N0 (4), T2N0 (17), T2N1 (11), T2N2b (16), laryngology and Head and Neck Surgery, Zaloska 2, SI-1000 T2N3 (1) and T2N2c (2). Ljubljana, Slovenia Results: In the period of observation from 7 months to 14 years, 2University Medical Centre Ljubljana, Department for Infectious three patients died with local recurrence, two with regional lym- Diseases and Febrille Illnessess, Slovenia phnode metastases and two with metastases in the lung and in the Objective: Adjuvant therapy is indicated only in the aggressive brain. forms of laryngeal papillomatosis. The aim of the study was to Conclusions: The advantage of this technique is that it is a sin- assess the success of adjuvant therapy with acyclovir/valacyclovir glestage resection with good cure rates for early lesions and sat- in our patients. isfactory maintenance of the voice and deglutition. Methods: Fifty-five patients (17 juvenile and 38 adult cases) were included in the study. In the case of an aggressive disease or accelerated growth of the papillomas the serologic testing for HL 71 possible infection with herpesviruses (HSV-1, HSV-2, EBV, and Extended supracricoid partial laryngectomies: CMV) was performed. Adjuvant therapy was used when infection preliminary experience of ten cases with HSV-1 or HSV-2 was detected. The number of operations, the length of the period between the operations and the estimation G. Peretti, C. Piazza, D. Cocco, P. Nicolai of the laryngeal disease were compared before and after adjuvant Department of Otolaryngology, University of Brescia, Spedali therapy using paired t-test. Civili, Piazza Spedali Civili 1, 25123 Brescia, Italy Results: Seventeen patients had aggressive form of the disease. Objective: Neoplastic subglottic extension below the crico-thyroid One juvenile and 12 adult cases with HSV-1 infection and one membrane is usually considered a contraindication to supracricoid juvenile case with HSV-2 infection were treated with acyclovir or partial laryngectomy (SCPL). Initial reports have been published valacyclovir in standard dose for 2 months. The number of the concerning extended SCPLs with removal of the cricoid arch with necessary surgical procedures significantly decreased after the or without half of the cricoid plate and corresponding arytenoid therapy (P = 0.019). The length of the interval between the with tracheo-hyoido-pexy (THP). Aim of this paper is to present operations increased and the extent of the papilloma growth de- techniques, functional outcomes, and preliminary oncologic re- creased after the therapy but not significantly (P = 0.154, sults of such a surgical option. P = 0.390, respectively). Twelve patients had no evidence of the Methods: Between 2002 and 2006, ten males affected by T3–T4 disease, and two patients had a recurrence 4–103 months after the laryngeal cancer involving the cricoid arch, plate, or the first treatment (mean 29 months). tracheal ring have been treated by extended SCPL (in three cases Conclusions: The adjuvant therapy with acyclovir/valacyclovir can with removal of one arytenoid) with THP at our Institution. Two help in selected patients with proven infection with HSV . of them were recurrences after RT and the others refused or We suppose that the antiviral therapy against HSV can decrease cannot tolerate chemo-RT. Clinical, functional, and oncologic the aggressiveness of the laryngeal papillomatosis because HSV outcomes were prospectively collected. helps in duplication of HPV. Results: Perioperative complications occurred in two (20%) pa- tients: requiring revision of the surgical field in one case HL 70 and minimal dehiscence of the pexy healed by hyperbaric oxygen therapy in another. All patients were decannulated after 7– Supraglottic horizontal laryngectomy: modified 30 days (mean 13). All of them resumed normal oral intake with Calcaterra technique removal of the nasogastric feeding tube after 14–25 days (mean 20). No postoperative ab ingestis pneumonia was recorded. Two Patricia Steinwender, Robert Jakse, Klaus Jakse of them (20%) had local recurrence 7 and 6 months after ex- HNO Krankenhaus der Elisabethinen, Graz, Austria tended SCPL and were treated by total laryngectomy plus RT. Objective: In most cases of supraglottic carcinoma with mobile Eight (80%) are free of local-regional disease (mean 21 months; vocal folds, the primary lesion can be sucessfully eradicated by range 2–61). supraglottic horizontal laryngectomy. The greatest postoperative Conclusions: Extended SCPL with THP is feasible without an functional problems are deglutition disorders with aspiration. The increased burden of complications and morbidity when compared suspension technique described by Calcaterra allows better pro- to standard SCPLs. Oncologic outcomes seem equally encourag- tection of the laryngeal inlet by the base of the tongue and provides ing even though the short follow-up of our series should be taken a laryngeal tilt to promote clearing of residual liquid on the glottis. into account.

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HL 72 submitted to the complete approach to the endolarynx, with in- Near-total laryngectomy: a failure analysis cluded a wide ventricular opening and suturing. The animals were followed for 20 days and their clinical condition was observed. At Alok Thakar, Sudhir Bahadur, K. C. Toran, Bidhu K. Mohanti, the 20th day, a laryngoscopic examination under general anes- P.K. Julka thesia was performed prior to euthanasia, to accomplish macro- All India Instiute of Medical Sciences, New Delhi scopically the larynx and cervical area. The larynxes were removed Objective: To improve case selection for Near-Total laryngectomy and examined. (NTL) by identifying causes of poor oncologic and functional Results: It was possible to access the ipsilateral vocal fold and outcomes. the contralateral hemilarynx through a wide opening of the Methods: Analysis of prospectively accrued data of 28 consecutive laryngeal ventricle. The procedure enabled bi-instrumental cases of near-total laryngectomy undertaken from 1996 to 2005 at handling of the vestibular fold, laryngeal ventricle, vocal fold, a tertiary care centre. Analysis of impact of tumor extent and anterior commissure and arytenoids. No animal showed any location, patient physiological status, and surgical technique on clinical complications during the follow-up period, and the disease free survival and on functional outcome. Functional status histology show good cicatrisation without visible scar formation graded as per a scale comprising of speech and swallowing func- or sequelae. tion. Conclusions: This technique, performed in animal model, can be Results: Four year actuarial disease free survival was 79.6%. well standardized in its surgical steps and initial objectives; its Eighty-two percent (23/28) had good to excellent functional out- application was successful, and proved to be feasible, providing comes. Pre-operative tumor extension to the Ipsilateral arytenoid wide endolarynx exposure and adequate organ reconstitution. significantly compromised disease free survival (2 year sur- After this, some clinical applications can be suggested. vival—40%, P < 0.001). Internal communicating fistula forma- tion (fistula between neopharynx and myomucosal shunt lumens) occurred in 5/28 cases and was uniformly associated with poor HL 74 functional outcome (lack of phonation with/ without aspiration). Fistula formation was significantly more likely in cases with tumor Total resection of the cricoid cartilage involving the ipsilateral arytenoid (3/6, RR—5.25) and the ipsi- with thyrotracheal anastomosis in the treatment lateral subglottis (2/4, RR—3.83). of low-grade chondrosarcoma of the larynx Conclusions: Significant disparity exists in functional outcomes of NTL among cases that develop post surgical internal fistula versus de Vincentiis Marco, Soldo Pietro, Bigelli Cristina, Pagliuca those with uneventful healing. Tumor involvement of the ipsilat- Giulio, Del Gaizo Raffaele eral arytenoid compromises the oncological and functional results. ENT Department, ‘‘G. Ferreri’’, ‘‘La Sapienza’’ University, Tumor extension to the subglottis compromises functional out- Rome, Italy come. NTL should be avoided in cases with ipsilateral arytenoid Objective: The objective of our study was to describe a partial involvement and undertaken with caution in cases with subglottic laryngeal surgery technique for the treatment of cartilaginous extension. tumors of the larynx (chondroma and low-grade chondrosar- coma of the larynx). These tumors are well-defined masses that arise within the endolaryngeal structures, predominantly on HL 73 cricoid cartilage. They are rarely found in an ENT location Transventricular chondroplastic laryngotomy: a new and have similar histological features. The most common sur- surgical technique for the endolarynx gical management consist in a total excision of the tumor but a total laryngectomy and permanent tracheostomy could be Marcos Sarvat, Nedio Steffen, Henrique Olival-Costa, Paulo avoided. Pontes Methods: On November 2006 two patients, a male and a female UNIFESP, ICAO and INLARIO, Rua Conde de Iraja´ 148, with the diagnosis of low-grade chondrosarcoma, were under- Botafogo, Rio de Janeiro RJ 22271-020, Brazil gone to total removal of the cricoid cartilage. A pexy was In spite of the number of techniques allowing direct access to the performed between the trachea and the remaining part of the endolarynx through an external approach, the literature remains larynx. evasive about one well-established, standardized, safe and easy Results and conclusions: We present our functional results surgery that promotes the full restitution of the framework after regarding swallowing and speaking. Postoperative follow-up has the procedure. not shown any evidence of tumor recurrence, airway compromise, Objectives: To verify in a reproducible experimental model the or laryngeal collapse. One month after the operation, all patient surgical feasibility and clinical impact of an endolaryngeal access were able to tolerate a soft diet. However no definitive oncologic procedure called Transventricular Chondroplastic Laryngotomy conclusions can be drawn, at present, as a result of the short (TCL). follow up. This new reconstructive procedure may obviate the Methods: Three pigs were submitted to thyroid cartilage flap need for total laryngectomy when the integrity of the cricoid ring raising without opening of the laryngeal ventricle, and seven were must be violated for benign tumor.

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Oncology less than 5% of carcinomas involving the upper respiratory tract. We retrospectively reviewed all cases treated in our Department during the last 15 years. HL 75 Methods: Ninety-two patients aged between 32and 87 years (mean Cancer of the mobile tongue: analysis of 150 cases 67.5) were included. 49% were male and 51% female. In 45% the treated by one surgical team over a 15 years period maxillary sinus was either the site of origin of the tumors or was affected from the direct extension of disease. Fifty-three percent Alexander D. Rapidis1, Evgenia Tsompanaki2, Spyros Valsamis1, 1 1 had an intraoral extension through the palate. Ten percent pre- Efstathios Eleftheriadis , Spyros D. Stavrianos , Gregory Farat- sented with cervical lymphadenopathy. Sixty (65%) had squa- 1 2 zis , Anastasia Kostaki mous cell carcinoma and 32 (35%) had glandular type 1 Department of Head and Neck/Maxillofacial Surgery, Greek malignancies. Anticancer Institute, Saint Savvas Hospital, 171 Alexandras Results: Ninety-two percent of the patients were treated surgically Avenue, 115 22 Athens, Greece 2 and in 42% surgery was complimented with radiotherapy and/or Department of Statistics, Athens School of Economics, 76 Pati- chemotherapy. In 14% a neck dissection was also performed. sion Avenue, 104 34 Athens, Greece Negative surgical margins were achieved in 80% of the cases. Locoregional recurrence occurred in 40% of the patients. The Objective: Squamous cell carcinoma (SCC) of the tongue repre- overall 5 year survival rate was 48% whereas the 5 year disease sents the most common intraoral malignancy in western coun- specific survival was 72%. Survival differences between glandular tries. More than two thirds of tongue cancers affect the oral and squamous cell carcinomas were not statistically significant. tongue. Factors that strongly influenced survival were the surgical margins Methods: Between the years 1992 and 2006, 150 consecutive cases (P < 0.0001). of SCC of the tongue were treated in our Department and were Conclusions: Epithelial malignancies of the middle third of the analyzed. Multivariate statistical analysis of various clinical and face present the same biologic behavior with their counterparts pathological features were correlated for their statistical signifi- encountered in the oral cavity. Surgery is the method of treat- cance to patients prognosis and survival. There were 91 men ment and survival depends from a safe disease-free margin (60.7%) (mean 60.41) and 59 female (39.3%) (mean 63.25). resection. Elective neck dissection is not recommended in N0 Results: From the predisposing factors smoking was found in 58% neck. of the patients, alcohol consumption in 35.3% whereas preexisting leukoplakia 11.7%. In 12.3% of the patients no predisposing factor was identified. Ninety-two percent of the patients were treated surgically and 55% had an elective or therapeutic neck HL 77 dissection. The overall recurrence rate was 31.3%. T1 lesions were Evaluation of marking superficial head and neck skin found in 21.3%, T2 in 48%, T3 in 14.6% and T4 in 16%. About cancer lesions with the eye and microscope 57.4% of the patients presented with N0 neck. In 79.4% surgical margins were clear of tumor, 17.5% were near to resection Samit Ghosh, Paul Goodyear, Krishna Reddy, Sucha Hampal ( < 1 cm) and in 3.05% were positive. Stage I disease had 40% of Department of Otolaryngology, North Cheshire Hospitals NHS the patients, Stage II 35.33%, Stage III 18% and Stage IV 6.67%. Trust, Warrington Hospital, Lovely Lane, Warrington, UK The 5-year disease specific survival was found to be 57% and the Objective: To study the accuracy of marking surgical margins for difference in survival between the various stages were significant excision of skin lesions with naked eye and microscope and to Conclusions: Our study showed an increasingly higher incidence assess if the percentage error would differ in margin measurements among young adult males without predisposing factors. The sur- between the two methods. vival and the results from the statistical analysis did not differ Methods: Experimental study using the British dermatological from those reported from other centers. guidelines for excision of skin cancer. Twenty-four ENT surgeons interested in facial plastic surgery of various grades with differing HL 76 experience were asked to mark different margins around different Epithelial malignancies of the middle third of the face. lesions at different sites on the face using the above mentioned two methods (Naked eye and Microscope) and to assess the repro- Clinicostatistical analysis of 92 patients treated over ducibility of drawing different margins. a 15 year period Results: The percentage error found was 8, 7.5, 14.2, 10.5 and 28% for the 3, 4, 5, 8 and 10 mm margins with naked eye and 7.6, Alexander D. Rapidis1, Gregory Faratzis1, Spyros Valsamis1, 6.0, 8.0, 10.5, 23.0% with microscope, respectively (regardless of Efstathios Eleftheriadis1, Spyros D. Stavrianos1, the grade of surgeon). Repetition of the experiment on paper with Evgenia Tsompanaki2, Anastasia Kostaki2 out the lesions but to draw different circles of various sizes 3, 5, 1Department of Head and Neck/Maxillofacial Surgery, Greek 8 mm revealed 6.6, 8.6, 10.5% errors with naked eye and 4.3, 5.8, Anticancer Institute, Saint Savvas Hospital, 171 Alexandras 8.6% with microscope. Avenue, 115 22 Athens, Greece Conclusions: This study has defined the errors inherent in the 2Department of Statistics, Athens School of Economics, 76 Pati- marking of surgical margins, and these should be taken into ac- sion Avenue, 104 34 Athens, Greece count specifically when defined histological margins are required. Objective: Malignant neoplasms of the paranasal sinuses, nasal Neither the naked eye nor the microscope is accurate but the cavity and the maxillary alveolus are uncommon and represent microscope usage can reduce the error.

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HL 78 were 32, 22 and 27%, respectively. The proportion of late Role of US and CT in detection of neck metastases metastases and residual disease was 11 and 9%. After 2 years 67% and after 3 years 80% of metastases had occurred with a clus- of squamous cell carcinomas tering between the 13th and 21st month. After 50 months 95% of Giancarlo Tirelli1, Barbara Cutrera1, Andrea Palmieri1, Roberto non-primary metastases and after 80 months 95% of primary Di Lenarda2 metastases were diagnosed. Seventy-one percent of the metastases University of Trieste, 1ENT Clinic, 2Maxillofacial Clinic were treated with curative intention. This group showed a 24% higher survival, with a 5-year-survival of 34%. Late- and recurrent Objective: To optimize the selection of patients eligible for surgical metastases were treated with curable intention in 64 and 54%, neck treatment optimizing a diagnostic routine to identify neck respectively (5-year survival 34 and 38%). Statistical significant metastases. metastasis-free survival of patients with primary metastases after Methods: Comparison between sensibility, specificity and diag- therapy compared to patients with non-primary metastases gives nostic accuracy of clinical examination, echography (US), com- cause to define two different follow-up periods. The results puted tomography (CT) in detection of cervical metastases in 53 underscore the relevance of postoperative ultrasound investiga- patients with carcinoma of the upper aerodigestive tract. tions and short follow-up intervals to identify patients that could Results: Clinical examination: sensibility 82.1%, specificity 80%, benefit from a second time surgery in connection with improved diagnostic accuracy 81.1%—US with a cut off point for minimal survival. adenopathy diameter of 0.5 cm sensibility 92.8%, specificity 77.3%, diagnostic accuracy 77.3%—US with a cut off point of 1 cm sensibility 82.1%, specificity 80%, diagnostic accuracy 81.1%—US with a cut off point of 1 cm, also considering round HL 80 shape of multiplicity of the adenopathy: sensibility 82.1%, speci- Sentinel lymph node biopsy for patients with early ficity 80%, diagnostic accuracy 81.1%—CT with cut off point stage cutaneous melanoma in the head and neck 0.5 cm: sensibility 92.8%, specificity 32%, diagnostic accuracy 1 1 1 2 3 64.1%—CT with cut off point 1 cm: sensibility 85.7%, specificity M. Ivkic , V. Bedekovic , D. Vagic ,A. Balenovic , H. Cupic , M. Situm4 64%, diagnostic accuracy 75.4%—CT with cut off point 1 cm, 1 also considering central necrosis, extracapsular spread, multi- University Hospital ’’Sestre milosrdnice‘‘ Department of ENT and Head and Neck Surgery, Vinogradska c. 29, Zagreb, Croatia plicity of adenopathy: sensibility 89.2%, specificity 60%, diag- 2 nostic accuracy 75.5%. Department of Oncology and Nuclear Medicine, Vinogradska c. 29, Zagreb, Croatia Conclusions: (a) A neck positive to palpation must be submitted to 3 neck dissection (81.1% possibility of having a metastases); (b) a Department of Pathohystology, Vinogradska c. 29, Zagreb, Croatia neck negative to palpation must be further investigated using the 4 US and CT cut off point of 1 cm; (c) the combined use of US Department of Dermatology, Vinogradska c. 29, Zagreb, Croatia and TC does not offer remarkable advantages in detection of Objective: The aim of this study is to evaluate a 7 year experience metastases. in preoperative lymphoscintigraphy, as well as accuracy of senti- nel lymph node biopsy (SLNB) performed at our institution in early stage melanoma patients. Also, the aim of the study is to evaluate the recurrence rate related to pathohistological findings. HL 79 Methods: Seventy-eight patients who underwent an SLNB for Relevance of ultrasound for post-therapeutic follow-up cutaneous melanoma were included into a prospective study of 584 patients with head and neck cancer starting in January 2000. The indications for SLNB were histo- logicaly proven melanoma with a minimum Breslow thickness of Andreas E. Albers1, Daniel Winter2, Ulrike Schulz2, Martin 1.0 mm or less if other adverse factors, such as tumor ulceration, Laudien2, Joachim Quetz2, Barbara Wollenberg3, Jens E. Meyer3 1 were present and clinically regional or distant metastases were Univ. HNO-Klinik Charite Universita¨ tsmedizin, Hindenburg- absent. SLNB was performed with gamma probe after preopera- damm 30, 12200 Berlin, Germany tive technetium Tc 99 m lymphoscintigraphy. 2Univ. HNO-Klinik UKSH, Ratzeburger Allee 160, 23538 Results: Intraoperative sentinel node identification rate was 98 and Lubeck, Germany ¨ 23% of patients had tumor-positive sentinel lymph nodes. Sentinel 3Univ. HNO-Klinik UKSH, Brunswiker Straße 10, 24105 Kiel, node was identified by preoperative lymphoscintigraphy in all but Germany two patient. Rate of false-negative SLNB as measured by nodal The application of ultrasound in the post-therapeutic care of pa- recurrence in a tumor-negative sentinel lymph node patients was tients is well established and relies on its good availability, bio- 1.4%. Anomalous lymphatic drainage patterns were observed in logic safety and diagnostic precision. Aim was to define time 15% of all patients. intervals relevant for early diagnosis of recurrent disease and to Conclusions: Preoperative lymphoscintigraphy and SLNB are investigate whether patients benefit from second line therapy. Of sensitive, effective and important diagnostic methods for precise 584 patients 101 were diagnosed by ultrasound with a recurrence, staging of patients with N0 cutaneous melanoma. All patients with subsequently secured by histology. The distribution of UICC- positive SLNB or with locoregional metastasis identified on fol- stages was as follows: I 21%, II 16%, III 26%, IV 36%. The low-up have all been offered therapeutic neck dissection and/or percentages of recurrence of metastases, early- and late metastases parotidectomy when indicated.

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HL 81 Methods: Retrospective case-control of 62 BSCC patients mat- Follow-up of head and neck cancer patients: ched to 186 patients with conventional squamous cell carcinoma (SCC) of an academic department of Otolaryngology, Head and a prospective analysis Neck Surgery. Pathologic and clinical data for all 62 cases of Richard Hewitt, Prasad Kothari, Arvind Singh, Francis Vaz, BSCC were reviewed from 1985 to 2005. Each BSCC case was Paul O’Flynn matched with three cases of conventional SCC according to Centre for Head and Neck Oncology, University College London TNM stage and head and neck subsite and statistically evalu- Hospital, 1st Floor East Wing, 250 Euston Road, London, NW1 ated. 2PG Results: Our comparative study of stage and site matched controls Objective: What does the current follow-up regimen in Head of conventional SCC shows a statisticaly significant difference in and Neck Cancer achieve? In all cancer orientated specialties clinical outcome for BSCC patients. Most significant difference is there has been much debate into the best follow-up regimen. considering the formation of second primary tumor. The provision of a service that meets the highest standards of Conclusions: BSCC is an aggressive SCC variant. Poorer outcomes care whilst being cost effective has never been more pertinent suggest more intensive, multimodality approaches may be neces- given the worldwide escalating cost of health care today. This sary in these patients. study addresses the basis of the current guidelines and their relevance in the modern management of Head and Neck Can- cer. Does routine follow-up facilitate the early diagnosis of HL 83 recurrence or is diagnosis lead by patient symptoms? Is there a Primary tumor volume calculation: a better predictive cohort of patients who require a more intensive follow-up regimen due to the nature of their disease, treatment or mor- factor of prognosis for nasopharyngeal carcinoma bidity? And do the current guidelines represent the most cost Ching-Chih Lee, Hsu-Chueh Ho effective system? Department of Otolaryngology, Buddhist Dalin Tzu -Chi General Methods: One thousand consecutive, outpatient consultations Hospital; 2, Ming-Shen Road, Dalin, Chiayi, 622, Taiwan were analysed by a tailored questionnaire in a prospective, multi- Objective: The TNM staging system developed by American centre study. Inclusion criteria: adult patients who had undergone Joint Committee on Cancer (AJCC) is universally used and multidisciplinary, multimodality management for head and neck widely accepted but its prediction of prognosis in nasopharyn- carcinoma. geal carcinoma (NPC) in endemic area receives a lot of chal- Results: The case mix is representative of all head and neck tu- lenge. Primary tumor volume had been reported to have close mour sites and stages. In excess of 90% of patients requesting an relationship with prognosis of head and neck cancer. We con- appointment and less than 5% of asymptomatic patients had a duct a retrospective study to elucidate the effect of primary tu- pertinent clinical finding. More than a third of patients required mor volume on treatment outcomes in patients with NPC who input from allied health care professionals. were treated with radiotherapy of concurrent chemoradiotherapy Conclusions: Follow-up should be tailored to individual cases. (CCRT). Patient education and close relationships with clinicians and allied Methods: Form 1999 to 2005, 71 patients with newly diagnosed health professionals is essential for the early diagnosis and man- NPC who were treated with radiotherapy or CCRT were en- agement of recurrence and morbidity. rolled. Using summation of area technique, computed tomog- raphy-derived or magnetic resonance-derived primary tumor volume was calculated. The correlation between AJCC disease HL 82 stage, primary tumor volume and disease-specific survival were Outcomes of patients with basaloid squamous cell analyzed. Results: The median primary tumor volume for whole series was carcinoma of the head and neck: comparative study 11.39 ml (range 1.25–166.58 ml). The median primary tumor of 62 cases versus 186 controls volume was 2.62 ml in T1 disease, 8.58 ml in T2 disease, 24.57 ml in T3 disease, and 64.47 ml in T4 disease. Disease and stage and T Miroslav Tedla1, Michael J. Rossi2, Pamela Roehm2, stage carried no prognostic significance (P = 0.1424 and William Gooding3, Eugene N. Myers2, Robert L. Ferris2 P = 0.0956, respectively). Thtee categories of primary tumor 11st ENT Department, Comenius University Bratislava, Slovakia volume (£20, 20–40, >40 ml) had prognostic significance 2Department of Otolaryngology, UPMC, Pittsburgh, USA (P = 0.0045). 3Biostatistisc Facility, UPMC, Pittsburgh, USA Conclusions: Primary tumor volume has closer relationship with Objective: Basaloid squamous cell carcinoma (BSCC) is a variant survival rates of patients with NPC who. Besides the current of squamous cell carcinoma, first described in 1986. The outcomes AJCC staging system, calculation of primary tumor volume may of patients with BSCC has been controversial with some small be needed to predict prognosis of NPC and adjust treatment studies suggesting a worse prognosis. strategy.

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HL 84 therapy with concurrent chemotherapy (5-FU, mitomycin Postoperative concomitant chemoradiation C ± leucovorin). Primary tumour and regional lymph nodes re- ceived 5 · 2 Gy/week during the first three treatment weeks. in advanced head and neck carcinoma Thereafter the fractionation was accelerated with 1.4 Gy given Miha Zargi, Lojze Smid, Marjan Budihna, Branko Zakotnik, twice daily up to a total dose of 72 Gy. Primoz Strojan, Erika Soba, Hotimir Lesnicar, Igor Fajdiga Results: The overall response rate was 100%. The median follow- University Department of Otorhinolaryngology and Cervicofacial up period was 71 months. In ten patients salvage surgery of the Surgery, Ljubljana, Slovenia and Institute of Oncology, Ljublj- lymph nodes was performed revealing vital tumour in six cases. ana, Slovenia The actuarial 5-year local-control rate was 64% (95%CI 47– 81%), overall survival at 5 years was 70% (95%CI 53–86%). Between 1997 and 2001, 114 eligible patients with stage III or IV Conclusions: Hyperfractionated accelerated radiotherapy with squamous cell head and neck carcinoma were randomized to re- concurrent chemotherapy in locally advanced nasopharyngeal ceive postoperatively radiotherapy alone (group A) or radiother- carcinoma is effective and feasible. apy combined with simultaneous mitomycin C and bleomycin (group B). Patients were stratified according to the stage and site of the primary tumor and presence or absence of high-risk prog- HL 86 nostic factors. Primary surgical treatment was performed with curative intent in all patients. Patients in both groups were post- Use of complementary and alternative medicine operatively irradiated to the total dose of 56–70 Gy. Chemo- by patients attending the head and neck clinic 2 therapy included mitomycin C15 mg/m after 10 Gy, and 5 mg of Muhammad Shakeel, Jonathan R. Newton, Kim W. Ah-See bleomycin twice a week during irradiation to the planned total Department of Otolaryngology, Aberdeen Royal Infirmary, dose of 70 mg. At 5 years, in patients from radiochemotherapy Aberdeen, Scotland, AB25 2ZN, UK group, locoregional control (86%) was better than in radiotherapy group (60%) (P = 0.014), as were disease free survival 70 and Objective: The Complementary and alternative medicine (CAM) is 55%, respectively (P = 0.099) and overall survival 51 and 37%, increasingly popular in the European hemisphere. Little UK data respectively (P = 0.144). Patients who benefited by chemotherapy is available on its use in adults attending the Head and Neck were those with risk factors. The results indicate that concomitant oncology clinic. We studied the prevalence and pattern of CAM postoperative radiochemotherapy with mitomycin C and bleo- use among adult patients attending an Head and Neck clinic, in a mycin improves locoregional control and survival in patients with university teaching hospital. advanced head and neck carcinoma. Method: A structured anonymous questionnaire with an explanatory letter was distributed prospectively to all patients at their primary visit to the clinic. Data was collected over 8-week HL 85 period from October to December 2005, and analyzed using Improved survival in patients with locally advanced SPSS v 12. nasopharyngeal carcinomas after accelerated Results: Response rate was 69% (138/200), 61% were male and 39% were female. Seventy-five percent (103/138) were older than hyperfractionated radiotherapy with concurrent 50 years, 62% (86/138) were married and 42% (58/138) had not chemotherapy completed high school education. Fifty percent (69/138) had used CAM, 26% in the preceding year. The popular herbal CAM were M. Fischer1,C.Po¨ ttgen2, S. Wechsler1, M. Stuschke2, S. Lang1, Cod liver oil, Primrose oil, Cranberry, Echinacea and St. Johns K. Jahnke1 wort. Other therapies include Massage, Acupuncture, Chiro- 1Department of Oto-Rhino-Laryngology, University of Duisburg- practic, Homeopathy, Reflexology and Reiki. Mostly these were Essen, Hufelandstr. 55, 45122 Essen, Germany used to promote health, to treat UTI and for relaxation. Only 2Department of Radiotherapy, University of Duisburg-Essen, 14% (10/69) patients used CAM for their current illness, 41/69 Hufelandstr. 55, 45122 Essen, Germany stated CAM were effective and would recommend it to others. Objective: The excellent results of hyperfractionated and acceler- Fifty percent (34/69) stated that their family physician was una- ated radiotherapy with concurrent chemotherapy in locally ware of their use of CAM. advanced oropharyngeal and hypopharyngeal carcinomas lead to Conclusion: Despite concerns over CAM efficacy, safety and the investigation of this therapeutic regime in nasopharyngeal cost effectiveness, use of CAM is popular among patients carcinomas as well. attending an H&N oncology clinic. Otolaryngologist should be Methods: Thirty-five patients with nasopharyngeal carcinomas in abreast of available literature on CAM to counsel their patients stage III and IV received accelerated hyperfractionated radio- effectively.

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HL 87 Results: Adenocarcinomas were obsereved in 30% of the patients Primary malignant tumor of nose and paranasal (18), squamous cell carcinomas in 24% (15), adenoid cystic tu- mors in 20% (12), undifferentiated tumors in 9% (6), mucoepi- sinuses. A series of 91 cases dermoid carcinomas in 6% (4), malignant mixed tumors in 6% Giovanni Almadori, Mario Rigante, Francesco Bussu, (4), and other types in 3% (2). All patients underwent surgery as Attilio Limongelli, Antonello Giunta, Michele Visocchi, primary modality. Neck dissection was performed only in 12 Gaetano Paludetti patients (30%), of whom four clinically N0 staged patients (but Institute of Otolaryngology, Catholic University of Sacred , with high grade tumors) underwent elective neck dissection, two Rome, Italy of them showed occult metastasis. Radiation therapy was per- formed in 20 patients (33%), depending on tumor size, node Objective: To evaluate the oncological outcome of the treatment metastasis, residual tumor, perineural invasion and tumor grade. of malignant tumors of nose and paranasal sinuses. The overall survival rate at 5 years was 68% and the disease-free Methods: Ninety-one patients (mean age 64.39) affected by nose survival rate 52%. Pre-operative facial palsy were observed in and paranasal sinuses malignancies were retrospectively studied. four patients (7%), facial nerve sacrifice was performed in 10 Sixty-five of these neoplasm arised in the maxillary sinus, 21 in the patients (17%). nasal cavity, 5 in the ethmoid sinuses. 40.4% were SCC, 11.7% Conclusions: Surgical excision, i.e., total parotidectomy associated adenocarcinoma,10.6% melanoma, 8.5% esthesioneuroblastoma, with postoperative radiation and neck dissection in selected pa- 8.5% lymphoma, 8.5% sarcoma, 5.3% adenoidocystic carcinoma, tients (depending on tumor size, node metastasis, residual tumor, 5.3%, neuroendocrine tumor, 1.2% cordoma. 75.9% of the pa- perineural invasion and tumor grade) provides a good locore- tients underwent primary surgery partial maxillectomies (47.2%), gional control and disease free survival in patients with malignant total maxillectomies (10.9%), enlarged maxillectomies (7.6%), tumors of the parotid gland. craniofacial resection (6.6%), endoscopic resection (3.3%). Results: Three-year overall survival was 61%, while disease spe- cific survival was 67%. According to the histotype 3-year OS was 69% for SCC, 60% for adenocarcinoma, 45% for melanoma and HL 89 37% for esthesioneuroblastoma, while DSFS was respectively 70, Results: of primary simultaneous polychemotherapy 69, 60, 64%. 42.8% of patient presented recurrences: local in the in 174 advanced squamous cell cancer of the oral 79% of the cases were, regional in 8%, both local and regional in 12% and distant in 2%. cavity and pharynx: critical comment Conclusions: Surgery, if feasible, represents the treatment of H. Glanz, R. Engenhard-Cabillic, A. Kruchten, C. Caspari, choice, combined with adjuvant radiotherapy in advanced stages. A. Burkhard, C. Arens The surgical approaches of choice remains the external transfacial German ENT Society or combined craniofacial ones, even if in the last years endoscopic resection is gaining room, especially for early well selected cases. Objective: For organ preservation primary simultaneous poly- Total maxillectomy possibly enlarged to the pterygomaxillary chemoradiotherapy (SPCR) is recommended in squamous cell fossa in maxillary tumors with a spread through the posterior wall cancer (SCC) of the upper aerodigestive tract. In a larger series of (T3–T4) improves the local control and decreases the incidence of cases this therapeutical option should be analysed critically local recurrence, which relevantly influences prognosis nose and according to toxicity, oncological and functional outcome for paranasal sinus malignancies. better selection for this kind of therapy. Methods: In a retrospective study 971 patients with SCC of the HL 88 oral cavity and the pharynx were treated during a 15 year period: 326 patients by primary surgery alone, 471 by surgery combined Treatment of malignant parotid gland tumors: with postoperative irradiation and 174 advanced cancers were our experience treated with primary SPCR. The cumulative survival rates were relied to the primary site of the tumour. Data were analysed Mario Rigante, Claudio Parrilla, Francesco Bussu, according to TNM classification, toxicity, oncological and func- Eugenio De Corso, Alberto Artuso, Giovanni Almadori, tional results. Gaetano Paludetti Results: The cumulative 5-year survival rate was 27.6% in SCC Institute of Otolaryngology, Catholic University of Sacred Heart, of the oral cavity 43.7% in SCC of the oropharynx and 9.9% Rome, Italy in SCC of the hypopharynx. Toxicity was high and quality Objective: The best treatment of malignant parotid tumors is still of life was reduced distinctively. Poor Oncological results debated. The low incidence and heterogeneity of histology of were observed especially when the bony skeleton of the larynx primary parotid carcinomas makes these tumors difficult to the cervical spine or the mandible was infiltrated by the evaluate. tumour. Methods: Sixty-one patients (40 males and 21 females) ranging in Summary: According to our results we recommend primary SPCR age from 37 to 79 years (mean 60 years) with a malignant tumor in larger oropharyngeal cancer primarily in a more selectively in of the parotid gland over a 15-year period were analyzed retro- SCC of the oral cavity. In Hypopharyngeal cancer however with spectively. Treatment consisted of surgery, radiation therapy or a involvement of the laryngeal skeleton primary SPCR should not combination. The effects of treatment modalities on locoregional be recommended because of poor oncological and functional re- control, the incidence of locoregional recurrences, distant metas- sults and high toxicity as well as reduced quality of life caused by tases and survival rates were evaluated. the therapy.

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HL 90 Materials and methods: Data obtained prospectively from patients Elective neck dissections in early oral treated by transoral laser surgery for a selected group of previ- ously untreated T3 and T4 tumors. Minimum follow-up of and oropharyngeal carcinoma in The Netherlands 24 months. R. de Bree, I. Van der Waal, J. A. Castelijns, P. Doornaert, Results: One hundred and six met the criteria: 84 supraglottic, C. R. Leemans 26 glottic, 16 piriform sinus tumors. Thirty-one (25.6%) had a VU University Medical Center, Amsterdam, The Netherlands fixed vocal cord. Most patients presented with a stadium III (n = 78; 61.9%) and stadium IVA (n = 44; 34.9%). Seventy- Objective: To investigate the management of the clinically nega- six (60.3%) did not receive postoperative radiotherapy, 18 tive neck in patient with early oral and oropharyngeal carcinomas (14.3%) did on the neck, and 29 (23%) on the tumor and neck. in The Netherlands. Eight patients needed a temporal gastrostomy, four a definitve Materials and methods: A questionnaire was sent to the eight head one. A total of eight (6.3%) aspiration pneumonia were and neck centers of Dutch Head and Neck Oncology Cooperative registered. One hundred patients (79.4%) never had a trache- Group (NWHHT). The questionnaire included factors influencing ostomy, 18 (14.3%) needed a temporary, 8 (6.3%) a definitive the decision making to perform an elective neck dissection and on one. Function was good or acceptable in 63/84 supraglottic cases with different tumour sites, stages and extensions. (75%), 22/26 glottic (84.6%) and 7/16 piriform sinus (43.8%) Results: All eight questionnaires were returned filled in. Site tumors. 84/125 (67.2%) patients preserve a functional larynx, (n = 6), size (n = 7) and thickness (n = 6) of the primary tu- some needing temporary tracheostomy/gastrostomy. Adjusted mour were important clinicopathological factors. Ultrasound- survival rates: 71.2 and 60.7% for stages III and IV and 92.8 guided fine needle aspiration cytology was the most (n = 7) fre- and 59.3% for glottic and and supraglottic T3–T4 tumors, quently used diagnostic technique to detect occult metastases, but respectively. 50% of the centers considered negative findings not fully reliable Conclusions: Organ and function preservation is feasible by means to refrain from elective neck dissection. Depending on site and of transoral laser resection showing no reduction of the survival stage of the primary tumor presented in the cases 3–7 of the rate. centers would perform an elective neck dissection. Selective neck dissections are more frequently performed than modified radical neck dissection and dissection of level I–III, sometimes extended to level IV was the most frequently performed type. HL 93 Conclusions: There is no consensus regarding the management of Management of N0 neck in supraglottic the clinically negative neck in early stage oral and oropharyngeal carcinomas in The Netherlands. and transglottic carcinomas Cem Ozer1, Fulya Ozer1, Erdinc Aydin1, Osman Kızılkılıc2, Can HL 91 Alper Cagici1, Levent Naci Ozluoglu1 The role of elective neck dissection in T1T2N0M0 1Baskent University Faculty of Medicine, Department of Oto- anterior tongue cancer patients rhinolaryngology Head and Neck Surgery, Ankara, Turkey 2Baskent University Faculty of Medicine, Department of Radi- Daniel Mirea, Serban Vifor Gabriel Bertesteanu, Raluca Grigore, ology, Ankara, Turkey Cristian Radu Popescu Objective: The aim of this study was to compare efficacy of ENT Department, Coltea Clinical Hospital, Bucharest, Romania modified radical neck dissection type III (MRND) and lateral Objective: Elective neck dissection in T1T2N0 anterior tongue cancer neck dissection (LND) in the management of supraglottic and patients is controversial. On the other hand, it had been demonstrated transglottic laryngeal cancer patients with clinically and radio- that the presence of metastatic lymphadenopathies reduce with 50% logically negative neck (N0) findings. the 5 years survival. Our study show that elective neck dissection is Methods: The medical records of 70 patients with supraglottic necessary even in N0 patients with anterior tongue tumors. and transglottic squamous cell carcinoma who underwent elec- Methods: The results are based on a prospective study of 86 patients tive neck dissection (either MRND or LND) for the manage- with T1 (30) and T2 (56) anterior tongue cancer, with no presence of ment of N0 neck were reviewed retrospectively. Patients who cervical metastatic lymphadenopathies. Partial glossectomy and had previously treated with surgery or radiotherapy, had posi- elective neck dissection was the standard treatment of this patients. tive surgical margins at the time of primary resection, had Results: Histopathological examination of laterocervical lympha- multiple primary tumors or distant metastasis at the time of tic tissue demonstrated the presence of micrometastasis in five of diagnosis were excluded from the study. A total of 61 patients T1 patients (16%) and 16 of T2 patients (29%). Laterocervical were included in the study. metastasis were found in 24.4% of all patients. Results: MRND and LND was performed in 38 (26 bilateral) and Conclusions: Because of the poor prognosis of anterior tongue 23 (17 bilateral) patients, respectively. Occult lymph node cancer patients with cervical metastasis, we considere that an metastasis were detected in 10 (16.4%) (6 in MRND group and 4 elective neck dissection should be made in all patients with early in LBD group) patients. Most commonly involved nodes were anterior tongue cancer. sited at levels II and III. Neck recurrences were observed in 3 (% 4.9) patients (2 in MRND group and 1 in LND group). Disease HL 92 free survival and overall survival rates estimated by Kaplan-Meier method did not differ significantly in both groups (log rank test Organ and function preservation after transoral CO2 P = 0.793 and 0.620, respectively). laser resection in advanced tumors Conclusion: Our results confirm the efficacy of lateral neck dis- Manuel Bernal-Sprekelsen, Isabel Vilaseca, Jose-Luis Blanch section in the management of N0 neck in patients with supraglottic ENT-Dept., Hospital Clinic, Villarroel, 170, 08036 Barcelona, Spain and transglottic carcinomas. Objective: To assess the functional organ preservation and survival.

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HL 94 mean age of patients was 60.5 ± 11.767 years, (range 31– Evaluation of malignant cervical lymphadenopathy 88 years) and the mean follow up was 21 months, (range 6– 36 months). The study revealed an overall accuracy for PET of unknown primary origin: changes in the relative scanning of 80%. For the detection of suspected metastatic frequency of primary tumor sites disease (n = 48 patients), PET had an accuracy of 90%. For the Stamatios Fergadis, Zissis Pappas, Sotirios Papouliakos, detection of suspected tumor recurrence (n = 12), PET revealed Eva Zacharioudaki an accuracy of 86%. For the identification of possible primary The State General Hospital of Athens,154 Messoghion Avenue, site (n = 20), PET showed an accuracy of 77%. Finally during Athens 115 27,Greece post treatment surveillance (n = 24), PET had an accuracy of 67%. False positive results were largely due to inflammatory Objective: Aim of the study has been to compare frequency processes after treatment. changes in the sites of unknown primary tumors in patients Conclusion: FDG–PET can provide important information in the with malignant cervical lymphadenopathy, who underwent diag- assessment of neoplastic disease in head and neck. In many nostic workup towards detection of the primary site, in a single instances PET is primarily a confirmatory imaging modality to institution. avoid unnecessary surgical interventions. Methods: Three hundred and thirty-six patients with malignant lymphadenopathy of unknown primary origin were evaluated within a 14-year period. Patients underwent panendoscopy under HL 96 general anesthesia in an attempt to locate the primary tumor site. Best supportive care (Palliative care) for patients Since the introduction of endoscopes in that clinical setting, an with incurable head and neck cancer initial endoscopic examination and endoscopically directed biopsy taking would take place and patients with negative biopsies would Michaela Salzwimmer1, Hans Eckel2 subsequently undergo panendoscopy. A comparison in the rela- 1ENT Universitiy Hospital Graz tive frequencies of unknown primary tumor sites was performed, 2ENT Hospital Klagenfurt between two periods. Head and Neck cancer account for 6% of all cancers world- Results: Among patients within the first 7-year period, the most wide. More than 90% are SCC, and they are largely due to common sites of primary tumor detection were the nasopharynx tobacco and alcohol abuse.1 More than two-third of patients and hypopharynx (134 patients 40%), with tonsillar fossa and present in stage III and IV (UICC). Unfortunately survival base of tongue sites accounting for 18% of cases. Among patients rates are not improving although efforts have been done in in the second 7-year period group, there has been a frequency shift research and treatment combinations. Especially for patients towards the base of tongue and tonsillar fossa sites (33%). No with incurable head and neck cancer quality of life gains more changes were made to the technique and protocol of panendos- importance. When we talk about quality of life, the basic def- copy throughout this period. inition of health and disability is required. The WHO definition Conclusions: Since endoscopy has recently been integrated in the (1948) says: ‘‘health is a state of complete physical, mental and initial physical examination of patients with tumors of unknown social well-being and not merely the absence of disease or primary origin, the ‘paradigm shift’ in the relative frequency of infirmity is a fundamental human right.’’ A bit more recent unknown primary sites may be attributed to more effective reads the WHO definition of disability (1980): ‘‘…any restric- endoscopically directed biopsy taking, thus leading to the inclu- tion or lack (resulting from an impairment) of ability to per- sion in the panendoscopy group of more cases of unknown ton- form an activity in the manner or within the range considered sillar and base of tongue tumors. normal for a human being.’’ Both, health and disability, are the base for the quality of life assessment. Receiving a cancer diagnosis and tumorspecific treatment greatly impact on indi- HL 95 viduals living with the disease and their families. All persons Positron emission tomography: a useful tool with a cancer diagnosis need general supportive care, which in diagnosis and management of head and neck cancer represents a wide range of services to help the patients to live as actively as possible until death. The WHO definition of pallia- Efthimios Kyrodimos, Ioannis Aidonis, Laurence DiNardo, tive care reads as follows: ’’Palliative care is an approach that Aristides Sismanis improves the quality of life of patients and their families facing Department of Otolaryngology-Head and Neck Surgery, Virginia the problem associated with life-threatening illness, through the Commonwealth University Medical Center, Richmond, Virginia, prevention and relief of suffering by means of early identifica- USA tion and impeccable assessment and treatment of and other problems, physical, psychosocial and spiritual.‘‘ The fol- Objective: To evaluate the efficacy and accuracy of [18F] fluro- lowing items will be discussed: pain therapy, therapy of anae- deoxyglucose positron emission tomography (FDG-PET) in the mia and leukopenia, antimicrobial prophylaxis, prevention and assessment of suspected metastatic, persistent, or recurrent neo- plastic disease and in the identification of possible primary site in therapy of mucositis, care of skin, antiemetic treatment, intra- venous access and feeding tube, quality of life (psychosocial patients with unknown primary tumor in head and neck. support), antithrombotic prophylaxis. Study design: Retrospective chart review at a tertiary referral center. Methods: PET scan’s diagnostic reports were reviewed among with reports from conventional imaging studies (CT and MRI). Histopathology reports from surgical interventions among with patient’s clinical outcome were used to confirm the PET scan findings. Results: One hundred and four patients (80 males and 24 fe- 1 J-L Lefebvre (2005) Current clinical outcomes demand new males) were evaluated between Aug-2000 and Aug-2005. The treatment options. Ann Oncol 16(Suppl 6): vi7–vi12 123 S44 Eur Arch Otorhinolaryngol (2007) (Suppl 1) 264:S5–S151

HL 97 distant or local metastasis disease. The oral realimentation can The range of postoperative complications begin after 14 days. after surgery and microvascular reconstruction Conclusions: The oesophageal prosthesis is a safe method of reconstruction of the pharyngoesophageal segment, which allow of tumors in the oral and maxillofacial region. an early oral refeeding, with a low rate of major complication and Results from the study of 70 patients low cost. Anastasia Loupatatzi, Spyros D. Stavrianos, Gregory Faratzis, Efstathios Eleftheriadis, Alexander D. Rapidis HL 99 Department Head and Neck/Maxillofacial Surgery, Greek Anti- Trapezius flap: an underutilized reliable reconstruction cancer Institute, Saint Savvas Hospital, 171 Alexandras Avenue, modality in ablative head and neck surgery 115 22 Athens, Greece Emre Vural Objective: This is a retrospective study that analyzes the factors Department of Otolaryngology-Head and Neck Surgery, Uni- associated with postoperative complications in a series of 70 pa- versity of Arkansas for Medical Sciences, 4301 West Markham, tients with cancer in the oral and maxillofacial region who Slot 543, Little Rock, AR 72205, USA underwent microvascular reconstruction. Methods: During the years 1999–2005, 71 free tissue transfers Objective: Most surgeons currently consider microvascular free were performed in our institution on 70 patients. There were 51 tissue transfer (MFTT) in reconstruction of the large head and male and 19 female. 65 flaps were used for reconstruction after neck defects. Although, there is definitely a need for MFTT in oncological craniofacial resections and 1 flap for facial reani- certain head and neck defects; trapezius flap may offer the surgeon mation. Fifty-three radial forearm, ten rectus abdominis, five a faster, safer, less expensive and probably more reliable recon- osteocutaneous fibula, two latissimus dorsi, and one grasilis structive alternative in various large head and neck defects. In this were used. Microvascular tissue transfer was successful in paper, the author presents his experience with trapezius flap in 94.3% of the cases. After a mean follow up period of reconstruction of various head and neck defects; and provides 27.6 months, 49 of the 70 patients are alive and free of disease. surgical anatomy and technical details for trapezius flap. Results: Complications were observed in 38 cases. Systemic com- Methods: Various oropharyngeal, oral cavity, posterior neck and plications occurred in 7 patients (10%) including cerebrovascular lateral temporal bone/composite parotidectomy defects were accident (1), pneumonia (2), pulmonary embolism (1), dysphagia successfully reconstructed with trapezius flap. (1), deaths (2). Twenty-nine (40.8%) patients developed compli- Results: Except one partial skin paddle loss in an oropharyngeal cations from donor and recipient side such as wound dehiscence repair, all of the flaps were successful. All donor site defects were (8), bone fracture (2), mobility and sensitivity deficit (3), total flap closed primarily. Two patients required needle aspiration for loss (4), fistula formation (1), seroma (2), and delayed wound seroma formation in the donor site, after removal of the drains. healing (4). In five cases re-exploration of the anastomoses was Advantages of this flap seemed to be its reliability, safety, lower mandatory. cost, straightforward surgical technique and shorter operative Conclusions: Despite the length of the operation time, the inci- time. The main disadvantages of this flap is the necessity of dence of systemic complications was comparatively low and in changing the position of the patient in the operating room for agreement with the findings from other centers. Complications harversting the flap and its limitation of use with certain anatomic were found to be mostly dependent on specific factors such as the site defects due to its pedicle dependence. This flap seemed to be age, preoperative radiation, Charlson’s comorbidity index, and the best suited for composite parotidectomy/auriculectomy defects anatomical site of the primary tumor. with lateral temporal bone resections. Conclusion: Trapezius flap is a fast, reliable, safe and less costly alternative to free flaps in selected head and neck defects. HL 98 Pharyngoesophageal reconstruction with synthetic HL 100 prosthesis Carbon-dioxide (CO2) laser in oral cancer S¸ erban Vifor Gabriel Bertesteanu, Daniel Mirea, Raluca Grigore, Sanjoy Panda, P. C. Pathy, K. S. Panda Cristian Radu Popescu Panda Medical Centre, Telengapenth, Cuttack, 753051 India ENT Department of Coltea Clinical Hospital, 1st I.C. Bratianu CO laser has been historically used for hypopharyngeal and Blvd., Bucharest, Romania 2 laryngeal lesions. Oral cancer is most common in Orissa state of Objective: Circumferential pharyngoesophageal defect represents India. Here people are mostly tobacco chewers and develop one of the biggest reconstructive challenges. Following ablative superficial type of lesions. These lesions are very much amenable surgery, proper 3D reconstruction is necessary for a good quality of for surgery by CO2 laser. We have operated 128 cases of oral life. Our objective is to assess the oesophageal synthetic prosthesis as cancer since February 2006 with extremely good comparable tu- a method of pharyngoesophageal reconstruction in patients who mor control. In 58 cases, we were able to avoid reconstruction like have cancer of the hypopharynx and cervical oesophagus cancer. PMMC/free flap. Neck was addressed appropriately and post-op Methods: We diagnosed 21 patients with phayngoesophageal RT given where indicated. Local failure was seen in four cases cancer, who underwent circular pharyngolaryngectomy and whereas one patient developed distance metastasis with another reconstruction with esophageal prosthesis. Each case was assessed three developing neck nodes. Margins were positive in five cases. for complications. Patients were also evaluated for their ability to The follow-up was for nearly 1 year and additional secondary maintain an oral diet. Patients were followed up for a minimum of treatment was done by conventional protocols. Increased accu- 2 months after surgery. racy, improved accessibility, minimal collateral tissue damage, Results: Seventeen patients had received postoperative external instantaneous lymphatic sealing, reduced pain and edema, mini- beam irradiation. There were two fistulae and five patients with mal bleeding, fast epitheliasation, less medication and shortened other complications. Two patients died 3 months after surgery of hospital stay are the major definitive advantages.

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HL 101 vascular history, tumor characteristics, details of surgery and Detection of pulmonary tumours in head and neck postoperative recovery were recorded. Patients had a cardiac Tro- ponin (TnI) assay on day 2 postoperatively. Logistic regression was cancer patients used to identify risk factors for postoperative myocardial injury. Samit Ghosh1, Aman Kumar1, Nicholas Roland1, Results: There were 46 males (71%) and the average age at pre- Sankalap Tandon1, Huw Lewis Jones2, Terry Jones1 sentation was 62 ± 12 years. Sixteen patients (25%) had post- 1Department of ENT-Head and Neck Surgery, University operative myocardial injury, including three myocardial Hospital Aintree, Liverpool, UK infarctions leading to one death. TnI+ and TnI- groups were 2Department of Radiology, University Hospital Aintree, matched for age, sex, cardiovascular risks and comorbidity, and Liverpool, UK for the site and TNM stage of tumors and length and nature of primary site, neck and reconstructive undertaken. Fac- Objective: Screening for synchronous pulmonary tumours at ini- tors identified as predictors of postoperative injury were blood tial presentation is held to be important as detection may alter pressure level (117 ± 11 mmHg, TnI+, vs. 106 ± 10 mmHg, subsequent management. There is currently no consensus in best TnI–; P < 0.001), coefficient of intraoperative heart rate vari- practice. We present the largest series reported comparing CT and ability (12.4 ± 5% vs. 7.5 ± 3%; P < 0.003) and the degree of Chest X-ray (CXR) to examine the efficacy of both modalities, postoperative inflammatory response (73 ± 34 mg/l/ and give statistical evidence for a rational screening policy. day—CRP—vs. 31 ± 23 mg/l/day; P < 0.0001). Patients with Methods: Retrospective review of patients presenting with squa- myocardial injury were hospitalized for longer and had more mous cell carcinoma from January 1996 to January 2007. Find- complications. ings were assessed with respect to diagnosis or exclusion of Conclusions: Myocardial injury manifested by postoperative TnI is pulmonary tumour. a known independent predictor of cardiovascular prognosis. Its Results: One thousand eight hundred and seventy-nine patients incidence in head and neck patients may be reduced with careful identified. 1,143 had CT, and 741 had CT and CXR. Overall 66 preoperative blood pressure management, tight intraoperative (3.5%) pulmonary tumours [bronchial carcinomas (1.4%), heart rate control, and through dampening of the postoperative metastases (2.1%) were found. In the CT/CXR subgroup 43 tu- inflammatory response. mours (5.8%) were detected(bronchial carcinomas (2.6%), metastases (3.2%)]. The sensitivity for CXR was 62% for all synchronous lesions (68% for bronchial tumours, 58% for metastases) compared to 100% for CT. Using Fisher’s exact test HL 103 the primary site does not have an effect on incidence of syn- Innovative concepts in the treatment of head chronous tumour. Stage group, T or N stage has no relation to bronchial carcinoma. Stage group I is significant for predicting and neck cancer absence of metastases, IV for predicting metastases (P < 0.05). S. Lang1, S. Brandau1, R. Zeidler2 T1 stage (P < 0.05), is significant against metastases, T3 tu- 1Department of Otorhinolaryngology, Head and Neck Surgery, mours are significant for metastases (P < 0.005). N0 is signifi- University of Duisburg-Essen, Essen, Germany cant against metastases and N3 is significant for metastases. 2Department of Otorhinolaryngology, Head and Neck Surgery, Conclusions: CT screening is far more sensitive then CXR in Großhadern Medical Center, Ludwig-Maximilians-University of detecting pulmonary tumours. Metastases are predicted for by Munich, Germany stage group IV, T3, and N3 disease. Recurrent disease has sta- tistical significance for predicting bronchial carcinoma in our The overall survival in patients suffering from head and neck series. cancer remained poor and nearly unchanged over the last dec- ades. This underlines the necessity for innovative diagnostic and therapeutic strategies. Above all, new adjuvant immunothera- HL 102 peutical agents applied pre- or postoperatively may improve patients’ prognosis. In this context, we report on different Myocardial injury following head and neck surgery: oncological projects, which are currently under investigation in role of perioperative inflammation and hemodynamic our clinic: (1) a phase I study in order to investigate the phar- instability macokinetics, safety and tolerability of a new serine protease 1 1 1 2 inhibitor in patients with advanced head and neck carcinoma; (2) Reza Nouraei ,ChadAl-Yaghchi,GuriSandhu, Dino Giussani , epidermal growth factor receptor inhibitors as chemopreventive Patrick Doyle1, Peter Clarke1 1 agents that could also significantly prolong patients survival, and Department of Otolaryngology, Charing Cross Hospital, (3) mesenchymal stem cells (MSC) as carrier for tumor antigens London, UK 2 in order to eliminate tumor cells. Genetically modified MSC may Department of Neuroscience, Physiology and Development, as well help to to regenerate salivary gland function and thus Cambridge University, UK alleviate xerostomiaafter head and neck irradiation. These ther- Objective: To review the incidence of and risk factors for myo- apeutic efforts are completed by a diagnostic program aiming at cardial injury following head and neck surgery, to help optimize the detection and evaluation of new biomarkers for early cancer patient care and develop perioperative cardio-protective strategies. detection. In conclusion, the implementation of innovative con- Methods: Records of 65 patients undergoing oncological resections cepts in clinical routine strategies will significantly contribute to for squamous cell carcinoma of the upper aerodigestive tract be- an improved prognosis as well as a better life quality in SCCHN tween 2005 and 2006 were reviewed. Information about cardio- patients in the future.

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Pediatrics of the airways. The treatment and removal of the foreign bodies were performed using paediatric and adult Karl-Storz bron- choscopy set, under general anesthesia with video documenta- HL 104 tion. Paediatric neck abscesses: microbiology Results: The repartition of the cases according to age was: 118 and management cases—10 month to 3 years; 11 cases—3 years to 7 years, 12 cases—7 years to 16 years, 9 cases—16 to 44 years. In 81 cases the Isam Rustom, Zvoru Makura foreign body was located in the right bronchia, in 33 cases in the Department of Otolaryngology, Head and Neck Surgery, Leeds left bronchia, in 16 cases in both bronchia and in 15 cases in the General Infirmary, Great George Street, Leeds, LS1 3EX, UK trachea and 4 cases with subglottic localization. The nature of the Objective: To identify the presenting symptoms in children, the foreign bodies extracted was organic (sunflower, pumpkin and appropriateness of prescribed antibiotics and the role of atypical corn seed, popcorn, beans, peanuts and nuts) in 131 cases and mycobacterium neck infection. anorganic in 19 cases. In one patient there was necessary trache- Design: Retrospective analysis and literature review. ostomy; same patient deceased during the intervention. All other Setting: University teaching hospital. Sixty-four children who patients had a good evolution, with no complication after underwent incision and drainage of neck abscesses at Leeds extraction of the foreign body. General Infirmary from 1 February 2002 to 31 July 2006. Conclusions: Close cooperation between the ENT, endoscopist, Main outcome measure: Resolution of abscess. radiologist and anesthesiologist are needed for a safe outcome and Results: The mean presenting age was 44.2 months (3.68 years). efficient team-work is absolute necessary for these major emer- There were 46 (72%) patients under the age of four years old. The gency represented by tracheobronchial foreign bodies. commonest signs and symptoms were neck mass (96.9%), fever (54.7%) and poor oral intake (12.6%). The commonest site of infection was in the submandibular region (37.5%), followed by posterior triangle (25%) and parotid (12.5%). The mean period of HL 106 hospitalization was (3.7 days ±SD 1.9). Imaging facilities were Foreing body injuries in children: the Susy Safe used in 43.8% of the patients. Staphylococcus aureus (48.4%) was Project the commonest cultured organism. Atypical mycobacteria was found in 4.7% of the specimens. Flucloxacillin and amoxicillin were Dario Gregory, The Susy Safe Study Group the most common antibiotics used by surgeons (57.8, 39.1%) University of Turin respectively. The abscess recurrence rate was 4.7%. Tracheostomy Objective: Injuries due to foreign body (FB) aspiration/choking/ was not required in any of the patients and no mortality has been ingestion/insertion are common in children up to 14 years old. reported in this series of patients. The outcome was satisfactory in The objective of this study is to investigate paediatric foreign body 95.3%. injury. Conclusions: Early diagnosis, appropriately prescribed intrave- Methods: A total of 6,943 paediatric patients, gathered by the Susy nous antibiotics and surgical drainage remain the main core of the Safe project in 28 European hospitals and 1 Pakistani hospital treatment. Our first line of treatment for neck abscesses from 01/01/1987 to 31/12/2006, were included in this study. Data is flucloxacillin. Atypical mycobacterium infection is an important were statistically analyzed. differential diagnosis of a cervico-facial mass. Results: Median age was 3 (IR 2, 6), the 63% of children was older than three years and the 53% were males. FBs were HL 105 mostly located in the nose (45%) and in the ears (24%). Fifty- Tracheo-bronchial foreign bodies in children two percent of the FBs were inorganics. Among them pearl, ball and marble (13%), toy (5%), coin (4%). were the most and adults recurrent objects. Among organics, fish bones and bones ac- Nicolae Balica, Stan Cotulbea, Stelian Lupescu, Caius Doros, counted for 23% of cases and nuts for 12%. The shape of the objects was spherical in the 34% of the cases. The volume was Gheorghe Iovanescu 3 ENT Department, University of Medicine and Pharmacy ‘‘Victor calculated and the median value was 37.7 mm (IR 16.76, Babes’’ Timisoara 96.74). Complications arose in the 10% of the cases, and hos- pitalization was required in the 30% of the injuries with a Objective: The study presents the experience of our Department in median length of stay of one day. Injuries took place in the the diagnosis and treatment of tracheobronchial foreign bodies in absence of adult supervision in the 51% of cases. The 52% of children and adults during a period of 15 years (1992–2006) on a injuries occurred while children were playing and 42% while study group of 150 cases with ages between 10 month and they were eating. 44 years. Conclusion: The foreign body injury remains a major burden for Methods: The diagnosis was based on history, physical exami- children and the risk it presents makes it mandatory to increase nation, cardiopulmnary X-ray and rigid tracheo-bronchoscopy the awareness in general population.

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HL 107 Results: However, in three patients the stridor was seen occasionally Characteristics of objects causing foreign body injuries but of mild degree. Obstructive apnea and cyanosis resolved in all patients. In six patients the associated symptoms responded in children favorably. Oral intake increased and weight gain was noticed fol- Berchialla Paola, The Susy Safe Study Group lowing resolution of airway obstruction in all the cases. Department of Public Health and Microbiology, University of Conclusion: Endoscopic laser surgery has avoided the need of doing Torino tracheostomy in infants and children with severe laryngomalacia. Coordination between laryngologist, paediatrician, anaesthetist and Objective: To characterize shape, consistency and sizes of no food intensive care team is of prime importance in managing these cases. objects causing foreign body (FB) aspiration/choking/ingestion/ Endoscopic laser management of the most severe cases of laryngo- insertion. malacia has now been established as surgical method of choice. Methods: A total of 2,295 paediatric patients, gathered by the Susy Safe project in 28 European hospitals from 01/01/1987 to 31/12/ HL 109 2006, were included in this study. Objects causing injuries were Botulinum toxin into salivary glands to reduce saliva characterized by shape, consistency and size. According to their shape, they were assigned to one of the following four categories: in neurological children spherical, 3D, cylinder and needle shape. Thus their volume was Dayse Manrique calculated. Data were statistically analyzed. AACD (Associac¸ a˜o de Assisteˆncia a` Crianc¸ a Deficiente- Disabled Results: The most common extracted objects were pearl, ball and Child Assistance Association), Rua Cana´ rio, 1112 -61. Sa˜o Paulo, marble (30%), toy (12.78%), pebble (7.56%) and stationery Brazil, CEP 04521-005 (5.65%) such as pen cap and lead. Rigid objects caused a signif- icantly (P < 0.001) higher proportion of hospitalization in chil- Objective: To demonstrate the effect of local application of bot- dren younger than three years (81%) versus those older than three ulinum toxin type A (BTA) in children with neurological diseases, years (37%). Spherical objects were associated to the presence of following our 2002 institutional protocol of sialorrhea treatment. complications (OR = 1.34, P = 0.0156). The median volume Study design: Clinical prospective. was 50.27 mm3 (IR 16.76, 104.72). Methods: Twenty-five children assisted at Clinic of Otolaryngol- Conclusion: Rigid objects with spherical shape such as part of toy, ogy of AACD (Associac¸ a˜o de Assisteˆncia a` Crianc¸ a Deficiente). pearl, ball and marble pose a high risk of aspiration/choking/ They were all submitted to local injection of BTA in salivary ingestion and insertion in children of any age. Since prevention is glands and followed up for a year. The protocol consists of clinical the most essential key to deal with these types of injuries, more questionnaire about the inability of swallowing saliva and its effort in caregivers’ public education is warranted. repercussions in quality of life. Patients must be previous dental treatment, intolerance to the adverse effects of anti-cholinergic agents and no use of TBA in others sites at least 6 months. The HL 108 injection was ultra-sound guided and the dose was 30 U in one Endoscopic laser surgery for laryngomalacia point for submandibular gland, and 20 U in two points for each parotid gland. Sachin Gandhi1, Vasant Oswal2 Results: Twenty-five patients with neurological diseases and sia- 1Voice Disorder Clinic, Deenanath Mangeshkar Hospital Pune, lorrea, aged 9–7 years old have been undergone to TBA into Maharshtra, India salivary glands injection. We observed that the symptoms of 2James Cook University Hospital, Cleveland, UK sialorrhea changed dramatically in twenty patients. Fifteen chil- Objective: To judge the efficacy of endoscopic laser management dren stayed almost 4 months without complaints with repercus- in severe cases of laryngomalacia. sion in the quality of life. No patient presented local or systemic Methods: Nine cases with age ranging from 7 days to 11 years at the effects with local injection of TBA. time of intervention were operated with endoscopic laser in last Conclusion:Saliva reduction is an effective, safe and temporary 3 years. Diagnosis was confirmed with flexible laryngoscopy and 30 technique to reduce saliva and the repercussions of sialorrhea in degree sinus endoscope with Macintosh (anaesthetist’s) laryn- drooling, oral disabilities, chronic pulmonary aspiration, with gosocpe. The laser supraglottoplasty was done with diode laser. improvement in general health and social integration.

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HL 110 HL 112 High frequency radiosurgery in pediatric Long term phoniatric results of arytenoid otorhinolaryngology lateralisation Gabor Katona G. Smeha´ k, L. Rovo´ , A. Szamosko¨ zi, J.Jo´ ri Budapest, Hungary ENT Department, University of Szeged, Hungary, Tisza L krt 111 Objective: Report on own experiences using high radiofrequen- Szeged, Hungary cy (HFRF) surgery in special pediatric otorhinolaryngologic cases Objective: Endoscopic arytenoid lateralization is one of the and comparing this technique with conventional methods treatment options of bilateral vocal cord palsy. This method Methods: In a tertiary level pediatric hospital, HFRF surgery was causes only a minimal damage in laryngeal structures, thus good used in special cases: facial and buccal haemolymphangiomatosis, phoniatric outcome can be expected after surgery. laryngeal and hypopharyngeal papillomatosis, velopharyngeal pap- Methods: Twenty-eight consecutive patients (follow-up period is illoma, epiglottis granulomatosis in Haberland syndrome, parotid more than 1 year) operated for bilateral palsy, were divided into tumors, etc. Conventional surgery in same cases served as the con- three main groups. The movement of the vocal cord recovered in trol. Comparisons were made in the following categories: excessive one or both sides in 12 patients thus the lateralization was sus- blood loss, time of surgery, postoperative pain, and wound healing. pended. In seven patients only partial recovery was detected, Results: HFRF was superior to conventional methods in almost hence the lateralization was sustained. In nine patients the palsy all types of surgeries. The operating time was significantly short- was complete on both sides. The measured patameters were F0, ened because the need to control bleeding was minimized. In a MPT, harmonicity, Jitt and Shimm. drooling surgery, HFRF achieved an almost bloodless prepara- Results: In full recovery of one or both sides good voice quality tion which was important to the precision of the work. In the was detected. In partial recovery (persisting lateralization) the haemolympnagioma case, HFRF resulted in an excellent out- voice in four out of seven was good, three was hoarse but come; no other method (including LASER) provided a better acceptable. In four out of nine patients with no movement cosmetic and functional result. After removal of granulomas from recovery acceptable voice was detected by using false vocal cord the laryngeal surface of the epiglottis in Haberland syndrome, no phonation and five had whispering, hoarse voice. edema occurred and healing was excellent. In aryepiglottoplasty Conclusion: Results show that endoscopic arytenoid lateralisation HFRF made surgery shorter and because of less bleeding, easier. can be used in temporary palsy without significant damage in Same observations were seen in cleft lip and palate surgery. phonation. In cases of permanent palsy in the most cases voice was Conclusion: HFRF surgery proved to be very useful in pediatric socially acceptable due to the residual movements of the larynx. otorhinolaryngology. In special cases HFRF provided a much better result and made for a more efficient surgery compared to conventional methods. Operating time was shorter, postoperative pain was minimized, and blood loss was diminished when com- HL 113 pared to conventional surgical methods. Hoarseness in school-age children Phoniatrics Robert Sˇifrer, Irena Hocˇevar-Boltezˇar, Miha Zˇargi HL 111 University Department of Otorhinolaryngology and Head and Neck Surgery, Ljubljana, Zalosˇka 2, Ljubljana, Slovenia Objective study of the voice in dysphonia caused by vocal polyps Objective: The aim of the study was to establish the incidence and causes of dysphonia in school children and to determine the Renzo Mora, Massimo Dellepiane, Francesco Mora, acoustic properties of the hoarse and healthy voices. Barbara Jankowska Methods: The research was prospective. The studied group con- ENT Department, University of Genoa, Italy sisted of 100 10-year-old and 102 14-year-old children. They an- Objective: Endolaryngeal microsurgery is functionally oriented, swered the questionnaires on diseases and habits affecting voice. therefore, assessment of vocal function is important to evaluate The voice samples (spontaneous speech, text reading) were re- the effect of the surgery on voice. corded and subjectively assessed using an analogue visual scale. Methods: A study of the objective evaluation of voice was made of Acoustic analysis of the vowel/a/samples was performed and 20 voices of healthy adults and 20 with disphonia by vocal cord fundamental frequency (F0), jitter and shimmer measured. One to polyps. Before and after surgery, a laryngostroboscopy and an 3 months after the voice recording, the hoarse children were acoustic analysis was made to everyone. A sustained vowel ’’a‘‘ examined and the causes of dysphonia were assessed. The results was carried out and digitalized with MDVP (Multi Dimensional were statistically analysed with Mann–Whitney’s test and v2-test. Voice Program, Kay Elemetrics). These parameters were esti- Results: The voices of 34.2% children were dysphonic. Boys mated: fundamental frequency (Fo), Jitt, Shim, noise to harmonics (60.9%) and 10-year-old children (52.2%) were more often af- ratio (NHR), voice turbulence index (VTI), soft phonation index fected. After 1–3 months there were still 14.9% dysphonic chil- (SPI), degree of voiceless (DUV), degree of voice breaks (DVB). dren. The causes for dysphonia were respiratory infection Results: In the patients affected by disphonia, the analysis of Jitt, (19.3%), allergic catarrhal laryngitis, muscle tension dysphonia, Shim, NHR, VTI, SPI, DUV and DVB showed a postsurgical de- mutational voice disorder and reflux laryngitis. In the group of crease. Comparison with healthy adults highlighted a postsurgical children with persistent dysphonia there were significantly more normalization of Fo, Jitt, Shim, NHR, VTI, SPI, DUV and DVB. children with fast speaking rate and asthma. Lower F0, higher Conclusions: We highlight the importance of objective evaluation jitter and shimmer were significant for dysphonic voices. of voice disorders, the MDVP method may be useful for analyzing Conclusions: Dysphonia is quite frequent in school children. Acute abnormal vocal function and quantitatively evaluating the effects respiratory tract infection is the most common cause of dyspho- of surgical excision of vocal nodules and polyps: our results nia. In children with persistent dysphonia the cause for it should confirm a high degree of effectiveness of endolaryngeal micro- be treated. Healthy voice is a necessary condition for undisturbed surgery on vocal rehabilitation. choice of the future profession.

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HL 114 are predictive for a need of voice therapy after the successful Perception of the transgender voice operation. Emma McNeill, Janet A. Wilson, Susan Clark, Jayne Deakin School of Surgical and Reproductive Sciences, Faculty of Medical HL 116 Sciences, Newcastle University, Newcastle-upon-Tyne, NE2 4HH, Transverse laser cordotomy (TLC) for adductor UK spasmodic dysphonia Objective: Fundamental frequency (F ) of speech is used to mea- 0 Muhammad Shakeel, Akhtar Hussain sure the success of voice therapy in male-to-female transgender Department of Otolaryngology and Head and Neck Surgery, clients. This study evaluates the relationship between fundamental Aberdeen Royal Infirmary, Aberdeen, Scotland AB25 2ZN, UK frequency and patients’ happiness with their voice. Methods: Twelve male-to-female transgender participants com- Objective: Adductor Spasmodic Dysphonia (ASD) is a central pleted visual analogue scales, rating happiness with and self-per- neurological disorder with focal manifestation. Botulinum toxin ceived femininity of their voice. Fifteen speech and language (BTX) remains the gold standard treatment but is temporary. therapists and 40 naive observers evaluated the anonymised Reported surgical procedures are invasive with significant mor- recordings, using the same rating system. The correlation between bidity and variable long term success rate. We have modified and mean F0 and participant happiness was established. Relationships employed Laser Cordotomy as a curative procedure and to reduce between participant happiness and rater opinions were explored. the morbidity and present our early experience. Results: A significant relationship between F0 and participant Method: Patients who have been treated with BTX were given the happiness could not be demonstrated (r = 0.32, P = 0.32). There option of surgical intervention. Informed institutional consent was a moderately strong positive correlation between self-per- was obtained for TLC. All procedures were performed by the ception of vocal femininity and perception of femininity by speech senior author (AH), with the CO2 laser set at 10 W and a spot size and language therapists and naive observers (r = 0.76 and 0.68, of 1.5 mm and a depth of 2 mm. One to three transverse cuts were P = 0.003 and P = 0.01, respectively). made in the lateral Thyroarytenoid muscle. The lamina propria Conclusions: This study demonstrates that happiness with voice in and the vocalis muscle were preserved. male-to-female transgender clients is not directly related to F0. Results: Four patients (2 male, 2 female; mean age 65 years) were Clients can assess femininity of their voice in the form of perceived included. The mean duration of ASD was 11 years while average pitch. This may not affect happiness scores. Voice satisfaction BTX sessions being 17. Elimination of voice break was observed may not correlate with perceptions of supervising voice profes- clinically. No complications were observed during the follow-up. sionals. However, professionals can reliably evaluate how the All patients reported improvement in voice quality, fluency and voice will be received by the lay public. Subjective measures of no voice breaks or straining. The average follow-up was patient satisfaction, including visual analogue scales, are reliable 10 weeks. and valid tools in evaluating therapeutic success. Conclusion: Modified TLC appears to be successful in relieving the strained voice and eliminating the voice breaks and enhance flu- HL 115 ency without any dysphonia. No alteration was observed post- Voice therapy after vocal fold polyp operation operatively on the vibratory surface of the vocal fold and the stroboscopy showed normal mucosal wave. Long term follow-up Maja Sereg Bahar, Irena Hocevar Boltezar will be necessary but the short term results are very encouraging. University Department of otorhinolaryngology and Head and Neck Surgery Ljubljana, Zaloska 2, 1000 Ljubljana, Slovenia HL 117 Objective: To find out etiological factors of vocal fold polyps and to assess factors that may be predictive to have a need of voice Assessment of acoustic examination in patients therapy after surgery. with rhinolalia aperta Methods: Ninety-five patients with vocal fold polyp (61 F, 34 M) R. Markowska, A. Szkiekowska, J. Ratyn´ ska, W. Be˛dzin´ ski and 48 healthy volunteers (32 F, 16 M) were included in the study. International Center of Hearing and Speech History, Voice Handicap Index (VHI) and acoustic analysis of voice (Fo, jitter, shimmer) were made before and 3 months after the Objective: The aim of this study was to assess the usefulness of operation. The treatment was supplemented by voice therapy at acoustic analysis (SPG, FFT) for measuring degree of hyperna- patients who were suspected to have muscle tension dysphonia sality in patients with rhinolalia aperta. concomitant. Both groups were compared and the patients before Methods: Subjects includes 30 patients (males 14 and 16 females, and after the operation and those who had and who did not have a their mean age was 22 years, with a range of 6–46 years) with voice therapy. hypernasality due to: cleft palate (n = 10), short palate (n = 10) Results: Groups did not differ in age (P = 0.72) and gender. The and velopharyngeal incompetence (n = 10). Each patient was patients with vocal fold polyps were statistically more often pro- subjected to the following assessment: clinical ENT examination fessional voice users (P = 0.001), vocal misuse (P = 0.03) and with fiberoptic flexible nasopharyngoscopy, perceptual speech smoking (P = 0.001). VHI and sub-tests differed significantly in assessment and acoustic analysis (FFT, SPG) of vowel ‘‘i’’ using both groups before and after surgery. VHI score improved sig- progrm of KAY CSL 4300B nificantly after the operation and the jitter too. Voice therapy Results: The results showed that patients with hypernasality had needed more often patients with VHI score after the operation significantly higher energy level for the bands range from 500 to more than 21 (P = 0.011), VHI-F 5 (P = 0.04) and VHI-P 11 1,300 Hz than speakers with normal resonance. The authors (P = 0.004) and those with jitter more than 2.0 (P = 0.0). Wo- showed four-point scale for hypernasality rating. men needed voice therapy 8-times frequently than man. Conclusion: SPG and FFT are good tool to measurung in objec- Conclusions: Factors predicting vocal fold polyps are professional tive way the progress of rehabilitation in patients with hyperna- voice use, voice misuse and smoking. VHI score more than 21, sality and this examination is easy to perform and do not require VHI-F 5, VHI-P 11, jitter 2.0 after the operation and female sex additional software.

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HL 118 and shimmer% in relation to a grading of abnormal videostro- Second generation videokymography in routine boscopies of the larynx (hardware and software by Laryngograph, Ltd). In this study we try to implement results of irregularity clinical vocal fold assessment percent of reading The Northwin and the Sun and intonation of Tjouwke A. van Kalkeren1, Harm K. Schutte2, Qingjun Qiu2, an /ah/ for 4 sin a supplementary statistical setting in relation to Jan G Sˇvec2, Hans F. Mahieu1 the earlier results. The second aspect focuses on irregularity per- 1Department of Otorhinolaryngology and Head and Neck Sur- cent before and after treatment. gery, Meander Medical Centre, Amersfoort, The Netherlands Results and conclusion: There are statistical differences between 2Groningen Voice Research Lab, Biomedical Technology, Faculty normal and pathological measures of voice with all parameters. of Medical Sciences, University Medical Centre Groningen, The supplement with voice measures gives a more secure evalua- Groningen, The Netherlands tion of pathology than videostroboscopy alone. Design and method of study and analysis: Vibrational characteris- tics of the vocal folds are a fundamental component of voice pro- duction. Stroboscopic examination is currently the golden standard T+A for investigating vocal fold behaviour, but has limitations. Quan- tification is difficult; furthermore irregular vibrations of the vocal HL 120 Experience of the endoscopic adenoidectomy folds cannot be studied at all. High-speed imaging does enable investigation of irregular vibrations and qualitative evaluation. But Mikhail Melnikov the tradeoff between spatial resolution and recording speed remains Novosibirsk State Medical University, Russian Federation an important limitation in most high-speed imaging techniques. Endoscopic surgery of adenoids has got broad spreading in the Because of this most high-speed cameras now available have a world, including in Russia. The modern concept to surgery of comparatively low image quality. In contrast, videokymography adenoids expects: (1) endotracheal narcosis; (2) visual checking; (VK), as initially developed by Sˇvec and Schutte, is based on one- (3) using of shaver. However in Russia is to date practised using line scanning with an image rate of about 8,000 frames per second as the procedure of adenotomy on local anesthesia. a replacement for full image, can support both high speed as well as Objective: (1) study the frequency of the complications after high resolution qualities. However, widespread use was hampered endoscopic adenoidectomy; (2) compare the amount of the com- by a number of shortcomings; firstly the scan position along glottal plications after endoscopic adenoidectomy and after adenotomy, length was not shown. Secondly the scanning line was fixed at the executed under local anesthesia. top of the endoscopic image. Methods. Under observation are found 1,496 patients, which is Summary of results: A second generation videokymograph was executed endoscopic adenoidectomy for period since 1996 on developed in collaboration with the Groningen Voice Research present time. The group of the comparison were results of the Lab. It now has a scanning line in the middle of the endoscopic operative treatment adenoid beside 202 children, which was exe- image. The new system provides an even better resolution than the cuted operation under local anesthesia. first kymographic image. Furthermore the possibility to apply the Results: The complications were in all group patients. Among technique to flexible endoscopes further broadens its clinical them: postoperative beside 2.9% in the first group application. and 7.5% in the second group. In group patients after endoscopic operation, only beside 4 not to manage to stop the bleeding without using back tamponade. A complications were HL 119 Advanced voice assessment: videostroboscopy in the second group in the manner of aspiration by blood and objective voice measurement beside one patient (0.5%), subluxation of atlanto-occipitale Mette Pedersen M.D., Umbreen Yousaf joint beside one patient (0.5%), cervical lymphadenitis beside two patients (1%). Total, the early complications observed The Medical Centre beside 5.4% in the first group and 9.5% in the second Objective:In the larynx the arytenoid regions and not only the group. The repeated growing adenoid is registered beside 2 vocal cords are often severely affected by infection, allergy and patients (0,13%) first groups and beside 6% patients second reflux. group. Methods: We have earlier measured the glottis closure% and Conclusion: Endoscopic adenoidectomy is more efficient and safe standards deviations with laryngograms (glottograms), jitter% in contrast with adenotomy, executed under local anasthesia.

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HL 121 have standards of data submission similar to ours, the conclusions Radiofrequency adenoidectomy drawn upon those data should be regarded with great caution. Ragab Sameh HL 123 Bayan, Kuwait Aspects on histopathology following adenoidectomy Objectives/hypothesis: The objective was to conduct a prospective and tonsillectomy in children randomized controlled trial describing and investigating the effi- cacy and safety of transoral telescopic-assisted radiofrequency Philipp Dost adenoidectomy in young children. Hals-Nasen-Ohren-Heilkunde, Plastische Operationen, Marien- Study design: Prospective randomized controlled trial. hospital, Virchowstrasse 135, 45886 Gelsenkirchen Methods: One hundred and twenty patients who were 36 months Objective: Is histological work-up of tonsils and adenoids in of age or less and planned to undergo adenoidectomy or ade- Germany performed routinely in paediatric cases? How frequent noidectomy with insertion of tympanostomy tubes were included are unexpected histological results in children? in the study. Children were prospectively and randomly assigned Methods: German ORL-specialists (n = 299) were surveyed by a into two equal treatment groups: the telescopic-assisted adenoid- questionnaire. They were asked if they would routinely send ectomy using radiofrequency curette and the conventional ade- tonsils or adenoids for histological examination in the case of a noid-curette adenoidectomy. The main parameters included visual child, up to 10 years old, presenting with a history and a status of analogue scale score for nasal breathing, amount of blood loss, chronic inflammation or hyperplasia and undergoing adenoidec- operating time, completeness of adenoid resection, smoothness of tomy or tonsillectomy. Furthermore 400 children, 10 years old or postoperative recovery, and complications. less, were identified from our charts, that consecutively underwent Results: Both groups had a significant improvement in the visual adenoidectomy/ tonsillectomy due to recurrent throat infection or analogue scale score after surgery with no evidence for a signifi- stenotic symptoms of the throat. cant difference between the conventional adenoid-curette and Results: The survey resulted in a feedback of 79%. All tissue was radiofrequency groups. The amount of blood lost during radio- send for examination by 59% of the ENT-specialists; palatine frequency adenoidectomy was minimal, with a mean difference of tonsils only were send for examination by 14%; no tissue at all 31 ml and a median difference of 26 ml. There was a tendency for was send for examination by 27%. The histological results of the shorter operative time in the radiofrequency group, but this did 400 children showed no other diagnosis than ‘‘lymphatic hyper- not reach a statistical significance. No evidence for a significant plasia’’ or ‘‘chronic ’’. Conclusions: We do not have any difference was noticed in the smoothness of postoperative recov- consensus practiced in Germany concerning the necessity to send ery or complication rate. tissues for histological examination following adenoidectomy or Conclusion: Telescopic-assisted radiofrequency-curette adenoid- tonsillectomy in children. The results from our own patients ectomy allows removal of huge adenoids completely in a precise, support the opinion, that unexpected histological results following easy, and cost-effective procedure, with minimal blood loss and adenoidectomy/tonsillectomy in children are very rare. Therefore short operating time. The use of transoral telescopes provides a the necessity of routine histological examination should be dis- clear visualization that helps complete removal of the adenoids, cussed under ethical and economical aspects. reduction of unnecessary trauma, and effective control of bleeding. NB: video presentation is included. HL 124 Outpatient laser partial tonsillectomy for chronic HL 122 tonsillitis in 527 patients NPTA: an audit of an audit and some worrying conclusions Y.-V. Kamami, L. Pandraud, A. Bougara Saint-Cloud Hospital, 3 place Silly, 92, Saint-Cloud, France Paul Nankivell, Swami Hunagathatta, David D. Pothier Objective: (1) Report the risks and benefits of Laser-Assisted In- ENT Department, Royal United Hospital, Combe Park, Bath tracapsular Partial Tonsillectomy (LAIPT) as an outpatient BA1 3NG, UK technique for the treatment of chronic tonsillitis in adults. (2) Objective: The UK National Prospective Tonsillectomy Audit Report the complication rate of LAIPT and compare this with (NPTA) was set up to record data concerning all other techniques. (3) Demonstrate that adult LAIPT is a safe and performed in England and Wales over a 15 month period. It was effective procedure for chronic tonsillitis. the largest prospective study of tonsillectomy ever undertaken. Methods: A retrospective review was performed over a 17-years Unfortunately, a great deal of reliance was placed on accurate period, from March 1989 to March 2006. All patients aged 13 or recording of complication data. We aimed to assess whether the over undergoing LAIPT for chronic tonsillitis were reviewed. audit is flawed by systemic bias and therefore underestimates the Postoperative pain, complications, and day taken to return to rates of haemorrhage. work and normal diet were compared to conventional surgery. All Methods: Case notes of tonsillectomy patients whose data were patients were followed for a minimum of 6 months. sent to the NPTA were retrieved (Gloucestershire Royal 250 and Results: Five hundred and twenty-seven patients (340 women, 187 Bath 300). These notes were reviewed independently of the NPTA men) were treated. Eighty-nine percentof patients noted an form for data that was required by NPTA. improvement of their initial symptoms (recurrent , cat- Results: The review of the case notes showed a far higher rate of arrh, bad breath, tiredness, crypts). They were all able to return to complications than the data sent to the NPTA. Rates of delayed normal diet in a short space of time following LAIPT. They were discharge were 58% higher, the readmission rate was 54% higher likely to recommend LAIPT, feeling more a discomfort than a real and the return to theatre rate from the case note review was over post-operative pain. Recurrent tonsillitis occurred in 4.9% (26 out double that of the data we sent to the NPTA. of 527), requiring additionnal laser treatment. Conclusion: The value of the results of the NPTA is dependant on the Conclusions: LAIPT is a quick, simple, safe and effective in-office quality of data submitted to it. If the other participants in the NPTA procedure for adults with symptoms of chronic tonsillitis

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HL 125 ciency despite of conventional massive antimicrobic therapy. Evaluation of humoral and cellular immunity Twenty-four patients with the pronounced symptoms of endotoxicosis as a result of chronic tonsillitis complicated with parameters in children before and after peritonsillar phlegmon were examined. All patients simulta- adenotonsillectomy neously with conventional antimicrobic and intensive therapy Mohammad Hossein Baradaranfar1, Fereshteh Dodangeh2, combined with surgery, every 24 h were treated with membra- Shokouh Taghipour Zahir3, Mehdi Atar4, M. Sadeghi5 nous plasmapheresis in a volume of 1% of the patient’s weight. 1Associate Professor and Chairman, Department of Otolaryngology At the same time the extracorporeal loading of autoerythrocytic and Head and Neck Surgery, Yazd University of Medical Science mass with the minimal single dose of amikacin was performed 2Otolaryngologist and Head and Neck Surgen, Chaharmahal- in a volume of 3 ml RBC and 1 ml of 1% solution of sodium Bakhtiari University of Medical Science adenosine triphosphate per 1 kg of the patient’s weight after 3Assistant Professor of Pathology, Yazd University of Medical 20 min incubation. The control group consisted of the patients Science receiving conventional therapy. During the carried out treat- 4Hematologist, Yazd Blood Transfusion Center ment all patients of the basic group showed accelerated 5Assistant Professor of Otolaryngology and Head and Neck Sur- improvement of the general condition, biochemical and clinical gery, Tehran University of Medical Science parameters of blood, normalization of hemodynamics as com- pared with the control group. Significant improvement of the Objective: Adenoids and tonsils are active lymphoid organs and immune status was registered: the increase of CD4 cells count, play an important role against invading antigens of upper aero- normalization of CD4 /CD8 ratio, increase of lgG, rise of the digestive tract in children. The present study analyes the changes phagocytic activity of neutrophils. in cellular and humoral immunity of children 6 months after adenotonsillectomy. Materials and methods: The study population consisted of 30 children (aged 4–10 years)whit chronic adenotonsillar hypertro- phy and 30 age-matched healthy children. HL 127 In all children serum level of IgM and IgG, percentage of T Intravenous hydration can reduce pain following lymphocytes (CD3), T helper (CD4), T (CD8) and B lympho- tonsillectomy cyts(CD20) were measured.These parameters were remeasured in Ruta Pribuisiene, Virgilijus Ulozas, Algis Babarskas patients 6 months after adenotonsillectomy. Kaunas University of Medicine, Lithuania Results: Before the operation,a reduction in percentage of T lym- phocytes (CD3),TCD4,TC8 and B CD20 was seen compared to Objective: To determine the benefit of intravenous hydration for control group.This reduction was only significant in T lymphocytes postoperative pain following tonsillectomy. (CD3) (P value = 0.03).The serum IgM level was not different in Methods: The study is consisting of two groups of patients fol- two groups and IgG level was elevated in two groups but not sig- lowing tonsillectomy performed in a university hospital. One nificantly different. Six months after operation the percentage of group received adequate intravenous hydration during and lymphocytes T CD3,T CD8 and BCD20 was increased and reached after operation while the other did not have and dehydration the control group.The IgM level was also significantly decreased in was detected. 100 mm visual analogue scale (VAS) for patients after operation (P value = 0.00). detecting postoperative throat pain was used. Two-tailed Conclusion: Our results indicate that cellular and humoral unpaired Student’s t-test was used to compare the two inde- immunity decreases in children with chronic adenotonsiller pendent groups. P < 0.05 was accepted as statistically signifi- hypertrophy preoperatively and increases to healthy children le- cant. vel, 6 months postoperatively.It means that chronic adenotosillar Results: The total amount of the intravenous solutions was in hypertrophy affect’ some parameters of cellular and humoral mean: 1,591.7 (SD 666.7) ml for male (weight 79.1 SD 10.5 kg), immunity and adenotonsillectomy by removing chronic stimula- 1,269.2 (SD 525.0) ml for female (weight 70.4 SD 12.7 kg), 1,281.3 tions and reverses these changes without any negative effect on (SD 625.6) ml for boys (weight 52.1 SD 13.5 kg), and 1,188.5 (SD immune function of pationts. 641.0) ml for girls (weight 45.1 SD 12.3 kg). The dehydration in 35 (76.1%) patients was detected. There were 19 adults (9 male, 10 HL 126 female) and 16 children (5 boys, 11 girls) in this group. The Extracorporeal immunocorrection in complicated hydration (H) group had significantly (P < 0.05) less postoper- ative pain compared with the dehydration (D) group. The mean cases of chronic tonsillitis with amikacin pain in H group was 21.4 (SD 17.5) VAS points and 36.5 (SD and plasmapheresis 21.1) points in D group, respectively. There was no age depen- dence. Alexander P. Gonchar-Zaykin, Igor A. Shulga, Andrey I. Shulga Conclusions: Results of the current study suggest that adequate Orenburg, Russia intravenous hydration can reduce postoperative pain in Generalization of the infection manifesting itself as a systemic postoperative period following tonsillectomy in children and inflammatory response aggravates the secondary immunodefi- adults.

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HL 128 Study design: Prospective study of 130 patients undergoing ton- Advantages of ultrasonic harmonic scalpel sillectomy with or without adenoidectomy. tonsilectomy Methods: At tonsillectomy, swabs were taken of the pharyngeal tonsil surface, the pharyngeal tonsillar core, and the adenoid Miroslav Kendrisic, Goran Ivic, Mirjana L. Kendrisic surface. Tissue samples were taken from the tonsil core, and the Health Centre Sremska Mitrovica, ENT Department adenoid. Each sample was analyzed for GABHS by rcPCR and SCx. Objective: The ultrasonic harmonic scalpel tonsillectomy has be- Results: GABHS was detected at the tonsil surface in 29 of 130 come safe alternative to traditional cold steel tonsillectomy. We patients. Adenoidectomy was performed in 23 of those 29 patients compared two techniques—Ultrasonic harmonic scalpel (UHS) and GABHS was detected at the adenoid of all 23 (100%). Of the and traditional cold steel technique (CS) tonsillectomies by: in- six patients with GABHS on the tonsil surface with no adenoid- traoperative blood loss, primary haemorrhage (within 24 h), de- ectomy performed, 75% had GABHS detected by adenoid swab layed haemorrhage (7–10 days after the operations), at the time of surgery. In the 23 patients with GABHS detected at postoperative pain and operating time. the tonsil surface and the adenoid, 12 (52%) had infectious indi- Method: After approval of the local ethical comittee two groups of cations for tonsillectomy. patients were included in this prospective randomised study. UHS Conclusions: All patients undergoing both tonsillectomy and group of 620 patients aged 6.6 ± 3.8 years (med 5, mod 5) and adenoidectomy had detectable GABHS at the adenoid when group CS of 583 patients aged 7.4 ± 4.5 years (med 5, mod 5). GABHS was detected at the tonsil surface. This study suggests a Intraoperative blood loss was analised by measuring of the vol- role of adenoidectomy in patients with GABHS positive tonsils ume blood in the suction unit. Postoperative pain was analised by undergoing tonsillectomy for both infectious and obstructive Visual Analog Scal (VAS). Statistics were analysed with the Chi- indications. Squared test and Student‘s t test. HL 130 P Results: UHT CS value Hazards, precautions, advantages of diathermy Age (years) 6.6 ± 3.8 7.4 ± 4.5 NS tonsillectomy Intraoperative blood loss (ml) 35 ± 15 125 ± 37 P < 0.01 M. K.Taneja Primary haemorrhage (no) 0 2 NS Chief, Indian Institute of Ear Diseases, E-982, C.R. Park, New Delayed haemorrhage (no) 3 8 NS Delhi, National Treasurer-Association of Otolaryngologists of Operating time (min) 7 ± l.7 12 ± 1.6 P < 0.005 India, Editor-Indian Journal of Otology Postoperative pain (VAS) 5 5 NS Objective: To asses the advantage of bipolar diathermy tonsillec- tomy over blunt dissection. Method: First group—retrospective review of amount of bleeding, Conclusions: Intraoperative blood loss and operating time were hospital stay and severity of pain was assessed of last 20 years. significantly lower in UHS group. Immediate haemorrhage, de- Second group—118 cases right side was operated by blunt dis- layed haemorrhage and postoperative pain were lower, but not section and left was operated by bipolar diathermy. significantly in UHS group. Result: In first group by blunt dissection and ligature mean time and blood loss was 33 min, 138 ml, with blunt dissection and HL 129 cautery 22 min, 76 ml and with bipolar diathermy dissection and cautery 17 min, 12 ml. Second Group—right side mean time was Group A b-hemolytic Streptococci in the adenoid 3.4 min, bleeding 18 ml, left side (diathermy) mean time was of tonsillectomy patients 3.5 min, bleeding 8 ml. To prevent fire measures adopted (Rule of 20). Diathermy current should not exceed 20 W. Unipolar should Laura J. Orvidas1, Jonathan H. Lee1, Franklin R. Cockerill2, not be used in adenoidectomy, may lead to subluxation of atl- James R. Uhl2 antoaxial joint. Endotracheal tube should be pushed a little more 1Department of Otorhinolaryngology/Head and Neck Surgery, in trachea to minimize retrograde gas flow (20 mm). Positive Mayo College of Medicine, Rochester, MN, USA pressure should be kept below 20 mm of water. Endotracheal tube 2Division of Clinical Microbiology, Mayo College of Medicine, should be 20 mm away from site of surgical area. Bipolar forceps Rochester, MN, USA should be at right angle to anterior pillar. Continuous suction to Objective: Using standard swabbing techniques, rapid-cycle real be used from another nostril to maintain oxygen level at atmo- time PCR (rcPCR) has been shown to detect group A b-hemolytic spheric level in surgical area, suck all fumes (carcinogenic). Streptococci (GABHS) at rates equal to standard culture (SCx), Conclusion: Bipolar diathermy forceps dissection is safe, trusted and requires only a few hours for results. This study examines the and established procedure specifically in anemia and blood dys- rates of GABHS detection by rcPCR and SCx at the adenoid in crasia, with comparable pain to blunt dissection tonsillectomy tonsillectomy patients. with gross reduction in bleeding.

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HL 131 described as minor or major depending whether the instrument Peritonsillar abscess: indication for tonsillectomy? was discarded or replaced intra-operatively. Results: Eleven thousand one hundred and forty operations G. Kecskes, E. Sauvaget, P. Tran Ba Huy, P. Herman were performed consuming 110,886 individual instruments. Albert Szent-Gyo¨ rgyi Medical and Pharmaceutical Centre, Failure levels over 0.5% were considered high. Three hundred Department of Pediatrics and Child Health Center, Szeged, and eight minor faults and 263 major faults were reported. Hungary Timeline studies reveal a pattern of increasing faults followed Department of Oto Rhino Laryngology, Hopital Lariboisiere, by correction. Faults in instruments with high usage are ame- Paris, France liorated more rapidly than those with less widespread use. Objective: To evaluate the recurrence rate of tonsillar or peri- Haemorrhage was not significantly different where instruments tonsillar infection following peritonsillar abscess (PTA); and to had failed or not, primary haemorrhage with surgical manage- identify the factors of the risk of recurrence. ment (95%CI 0.76–1.12 and 0.12–1.63) and secondary haem- Methods: Retrospective study of 333 patients admitted in a ter- orrhage requiring surgical management (95%CI 0.40–0.67 and tiary ENT Emergency Centre in Hopital Lariboisiere with PTA 0.48–2.61), respectively. between January 1999 and December 2000. Conclusions: Surveillance of single use instruments is a necessary Inclusion criteria: First episode of PTA, ascertained by aspiration part of their use, to maintain standards and drive improvement. or CT. One hundred and forty-six patients were included. Instruments failure is rare but due to clustering can be identified, failure of instruments with high consumption are more identified The recurrence rate was evaluated by a questionnaire, which has easily. No statistical increase in post-operative haemorrhage rate been completed by 48 patients (33%). is seen when instrument failure occurred. Results: The population consisted of 26 males (54%) and 22 fe- males (46%). The mean age was 32 years (17–79 years). The mean follow-up period was 5.4 years (4.1–7 years). Recurrent PTA developed among seven patients (14.6%). Four HL 133 patients (8.33%) had one episode, three patients (6.25%) had two episodes of recurrence. The mean delay between the episodes of Coblation versus CO2 laser scanning system for tonsil recurrence was 1.71 years (1.5–5 years). ablation in adults The recurrence rate of PTA was remarkably higher by patients Marc Remacle, Georges Lawson, Jacques Jamart with positive medical history (33.3%) than by patients without Department of ORL, Head and Neck Surgery, Center for bio- medical history (3.3%). Episodes of tonsillitis would not become statistics, University hospital of Louvain at Mont-Godinne more frequent after the episode of PTA. Conclusions: A 14.6% recurrence rate was evidenced, with a great New technologies have been proposed for tonsil ablation aiming difference between patients with (33%) or without medical history at decreasing the pain and the risk of bleeding. CO2 laser scanning (3.3%). In view of this low rate, indications for interval tonsil- system and radiofrequency (coblation) are two of these efficient lectomy following PTA should remain minimal. tools. Objective: To compare the two techniques with regard; (1) to pain; (2) time for surgery; (3) bleeding. HL 132 Methods: Fifty-two adult patients underwent tonsil ablation and The use of disposable instruments in adenoid and tonsil were randomly assigned to have one tonsil removed with cobla- surgery the detection of instrument consumption tion and the other subtotally ablated (intracapsular vaporization of 80–90% of the tonsil lymphoid tissue) with CO2 laser scanning and the detection of failure rates. The requirement system. Outcome measures included time to treat each tonsil, in- for long-term surveillance traoperative blood loss, patient-reported pain intensity measured with a visual analog scale of 10 cm, number of days of pain, day David Owens1, Wendy Harrison2, Victoria Mcclure2, Sue Harris2, of maximum pain, postoperative hemorrhage and amount of Mark Temple2, Alun Tomkinson1 healing 2 weeks after surgery. 1University Hospital of Wales, Heath Park, Cardiff, Wales Results: Mean time of surgery was 24.3 ± 5.8 min for CO laser 2Centre for Disease Control (Wales), Abton House, Wedal Rd, 2 and 10.6 ± 2.8 min for coblation (P < 0.001), intraoperative Cardiff, Wales bleeding was 0.7 ± 0.5 ml for CO laser and 0.5 ± 0.7 ml for Objective: To establish the use of disposable instruments and the 2 coblation (P = 0.031), pain intensity was 4.2 ± 2.4 for CO laser detection of their failure in adenoid and tonsil surgery. To discuss 2 and 5.1 ± 2.7 for coblation (P < 0.001) with the day of maxi- the requirement of long-term surveillance with disposable instru- mum pain being the third for the both techniques. Duration of ments. pain was 5.7 ± 3.4 days for CO2 laser and 6.8 ± 3.8 for cobla- Method: Data was collected between Feb 2003 and Dec 31st 2005 tion (P = 0.001). Postoperative hemorrhage was observed in one was using Single use Instrument Program (SISP) database. case after coblation tonsillectomy. Healing was similar between Instrument use and failure were recorded. Instrument failure the two techniques after 2 weeks.

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HL 134 performed using cold steel dissection with bipolar diathermy for Adherent biofilms in adenotonsillar diseases haemostasis. in children Results: Postoperative haemorrhage needing surgical revision occurred in 121 patients (1.73%). The peak incidences were be- Khalid A. Al-Mazrou, Abdulaziz Al-Khattaf tween the day of surgery and the third postoperative day and King Saud University, PO Box 245, Riyadh 11411, Saudi Arabia between the sixth and ninth postoperative day. No seasonal correlation was observed. Neither indication for tonsillectomy Objective: Adenotonsillar diseases are common in children. nor the experience of the surgeon (trainee/resident) was found Biofilms have been demonstrated in adenoid surface in association to be a risk factor for the incidence of post-tonsillectomy with sinusitis and otitis media. Our aim is to study biofilms haemorrhage. formation on the epithelial surfaces of tonsils and adenoids of Conclusion: To provide optimal care for post-tonsillectomy pa- children undergoing adenotonsillectomy (A&T). tients a hospitalisation until the 9th postoperative day is actually Design: A prospective study. necessary. However, economical considerations might interfere Setting: A tertiary academic hospital. with this notion. Patients and methods: Between September 2005 and August 2006, 76 children below the age of 18 years undergoing adenotonsil- lectomy due to infections, obstruction, or both were included. HL 136 Biofilms were detected using the Scanning Electron Microscopy (SEM). Benchmarking post-tonsillectomy hemorrhage: Results: Male to female ratio was 1.8:1 and their mean age was a reflection of surgical skills only? National 5.7 years. Forty-four patients (58%) had obstruction, 26 patients Norwegian data 1999–2005 (39%) had infections, and 6 (8%) had both. Adherent biofilm formation was demonstrated in 46 patients (60.5%). Biofilm was K. J. Kvaerner detected in 22/26 patients undergoing A&T for infectious causes University of Oslo, Medinnova, The National Hospital, Norway compared with 18/44 patients undergoing A&T for obstruction Objective: Control of postoperative bleeding, the major compli- (P < 0.05). cation following tonsillectomy, serves as a landmark for the safety Conclusion: Biofilms were identified on the surfaces of infected or of operations. In Norway, hospitalization due to post-tonsillec- enlarged (inflamed) tonsils and adenoids. These developed bio- tomy hemorrhage (ICD-10 code T81.9) is a national bench marker films are thought to have played a significant role in the patho- for otolaryngologic surgery. The aim of the study was to estimate genesis of adenotonsillar diseases in children. A better hospitalizations for post-hemorrhage bleeding and -surgery, understanding of this role may aid in the development of a new identify treatment trends and markers for re-bleeding surgery approach of treatment and more effective antibacterial strategies requiring general anesthetics. in the field of pediatric otolaryngology. Methods: National study using data from the Norwegian Patient Registry 1999 through 2005 with complete information on the incidence of post-haemorrhage hospitalizations (ICD-10 diagnosis HL 135 T81.0), the incidence of re-bleeding surgery (surgical code Surgical revision of haemorrhage after cold steel EWE00), and (adeno)tonsillectomy rates, age, gender, duration of stay and time of onset of re-bleeding. tonsillectomy: a review of 6,995 cases in a 14 years Results: One patient per 200 tonsillectomies was hospitalized tertiary hospital experience and diagnosed post-tonsillectomy hemorrhage during the 6 year study period. Re-operations requiring general anesthetics were Christoph Arnoldner, Dietmar Thurnher, Jafar-Sasan Hamzavi, found in less than one per 1,000 tonsillectomies. The incidence Markus Brunner, Boban M. Erovic of tonsillectomies increased from 1.2 to 2.1 per 100,000 (36%), Department of Otorhinolaryngology, Medical University of and in-patient treatment became rarer. While there was in in- Vienna, Waehringer Guertel 18–20, 1090 Vienna, Austria crease in the incidence of post-tonsillectomy bleeding during the Objective: The aim of this study was to evaluate the incidence and study period, the re-bleeding surgery requiring general anes- possible predictive factors of post tonsillectomy haemorrhage thetics remained stable and was performed in approximately 1 needing surgical revision in patients undergoing cold dissection per 1,000 surgeries. Markers for re-bleeding surgery will be tonsillectomy for different indications. presented. Methods: We performed a single institution retrospective study of Conclusions: The slight increase in surgery requiring general 6,995 patients who underwent tonsillectomy between 1993 and anesthetic may be explained by the activity based increase in 2006. Indications for tonsillectomy were chronic tonsillitis, peri- Norwegian tonsillectomies, more day-care surgery or surgical tonsillar abscess and obstructive sleep apnoea. Surgery was skills.

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HL 137 Results: Of the 2,266 children that have been operated from Long-term improvement of life quality after January 2005 to December 2006, 795 have tonsillectomy with or without adenoidectomy and tubes insertion, 1,028 have ade- tonsillotomy in youths noidectomy ± tubes insertion, 218 had tonsillotomy (subcap- Elisabeth Ericsson, Torbjo¨ rn Ledin, Elisabeth Hultcrantz sular tonsillectomy) with adenoidectomy and 225 had other Division of Otorhinolaryngology, Department of Neuroscience procedures like tubes insertion, ankyloglossia or ranula treat- and Locomotion, Faculty of Health Sciences, University of ment. Twenty-six (0.032%) children of the first group, Linko¨ ping, Sweden 15(0.015%) of the second, 4(0.014%) of the third and one (0.004%) of the fourth group were admitted because of a Objective: This is a 1 year follow-up to compare the effects of complication. Laryngitis or airway distress and postoperative partial tonsil resection using radiofrequency technique (RF), hemorrhage were the two most common complications re- ‘‘tonsillotomy’’ (TT), with total tonsillectomy (TE) (blunt dissec- corded. The tonsillectomy group had significant higher major tion). Obstructive symptoms, tendency for infections and health complication rate (P = 0.012). Fifty-four children younger than related quality of life (HRQL) were studied and compared with 3 years old had tonsillectomy and the major complication rate the HRQL-data from a normal population. of this group did not differ statistically with that of older Methods: The study-group consisted of 76 patients (16–25 years) children. randomized to TT (n = 32) or TE (n = 44) with obstructive Conclusion: Major complication rates are low even in those less throat problems with or without recurrent tonsillitis. Short-Form than 3 years old, indicating that tonsillectomy and/or adenoid- (SF-36) and EuroQul Visual Analogue Scale were used to evaluate ectomy is a safe procedure when performed as a day surgery in HRQL. A questionnaire investigated the degree of obstruction otherwise healthy children living in relative close distance to the and history of infections. hospital. Results: Preoperatively both groups reported significantly lower HRQL in all dimensions of SF-36 compared with the normal population (P < 0.05–P < 0.001). After 1 year, a large improvement (P < 0.01–P < 0.001) in both groups in HRQL HL 139 was found. No differences were found when compared with nor- Comparison of the post-operative haemorrhage rates mal population or between the study-groups. The effect on snoring was the same for both groups and the rate of recurrence of of tonsillectomy in relation to diathermy and pure cold infections was low and not higher in the TT-group. steel techniques and implications for consent Conclusion: Preoperative obstructive problems, in combination 1 2 2 David Owens , Wendy Harrison , Victoria Mcclure , with recurrent tonsillitis have a negative impact on HRQL. Both Sue Harrison2, Mark Temple2, Alun Tomkinson1 TT and TE-groups demonstrate large improvements on HRQL, 1University Hospital of Wales, Heath Park, Cardiff, Wales infections and obstructive problems one year after surgery, indi- 2Centre for Disease Control (Wales), Abton House, Wedal Rd, cating that both surgical methods are equally effective. With its Cardiff, Wales reduced post-operative complications, less pain, shorter recovery time, and cost reduction, tonsillotomy with the radiofrequency Objective: To compare the effect of using diathermy on the timing technique ought to be considered as the method of choice. of complications post tonsillectomy (without adenoidectomy) haemorrhage rates. Methods: Data was collected from May 2003 to Feb 2006, and HL 138 analysed for surgical technique, patient demographics and rate of Tonsillectomy and adenoidectomy as a day-case primary (R1) and secondary (R2) haemorrhage requiring return procedure to theatre in relation to pure cold steel and all techniques involving the use of diathermy. I. Vlastos, I. Athanasopoulos, S. Kegioglou, E. Koudoumnakis, Results: Seven thousand six hundred and nineteen tonsillecto- P. Leotsakos, J. Ekonomides, M. Houlakis mies were undertaken, 2,667 male 4,952 female. Pure cold steel Department of Otolaryngology, Head and Neck Surgery, techniques were used in were used in 3,215 (male 33% female Aghia Sophia Children’s Hospital of Athens, Athens, Greece 67%) R1 was 26 (1% CI 0.85–1.18) R2 was 7 (0.22% CI 0.11– Objective: To evaluate whether tonsillectomy and adenoidectomy 0.45). Diathermy was used in 3,827 cases (male 36% female can be performed safely as a day case procedure by investigating 64%) R1 was 31 (1.08% CI 0.76–1.53) and R2 was 31 (1.08% complicating rates and possible contraindications. CI 0.76–1.53). Serious secondary haemorrhage rates were three times higher where diathermy had been used. Methods: A retrospective review of the records of all the children admitted to the day surgery clinic of the Department of Otolar- Conclusions: The timing of serious haemorrhage is affected by yngology Head and Neck Surgery of Aghia Sophia Children’s choice of technique. Secondary haemorrhage is three times more Hospital, the major pediatric hospital of Athens, during a 2 years likely if diathermy has been used. The choice or requirement to period. Type and reason of operation, age and kind of compli- use diathermy may inform both clinician and patient of a higher cation that resulted to an overnight stay in the hospital were risk of returning with potentially serious haemorrhage after dis- recorded. charge from hospital.

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HL 140 randomly and divided into two groups; case and control. Both Tonsillectomy improves long-term morbidity groups received 40 mg/kg/day Amoxicillin and 10 mg/kg/dose Acetaminophen syrup. associated with chronic tonsillitis above the effect 3 The case group was administered 1g/10 cm sucralfate, while of time. A longitudinal study the control group was given 10 cc dimethicone every 6 h. The Rosemary Fox1, David Owens2, Mark Temple3, severity of sore throat was assessed using a visual analog scale Alun Tomkinson2 (from 0 to 5) and the frequency of acetaminophen use on the first, 1National Public Health Service for Wales, Temple of Peace and second and third day, post operatively. For statistical analysis of Health, Cardiff, Wales results, t test and a = 95% with P value < 0.05 was used and 2University Hospital of Wales, Heath Park, Cardiff, Wales analyzed by SPSS. 3Centre for Disease Control (Wales), Abton House, Wedal Rd, Results: The difference between the intensity of sore throat in the Cardiff, Wales two groups was significant. (P value < 0.0001) The difference in the mean amount of acetaminophen consumed was also signifi- Objective: To compare the effect of surgical intervention with non- cant (P value < 0.0001). The results of the study were in line intervention on the morbidity associated with chronic tonsillitis. with other similar studies which prove that sucralfate by coating Method: Tonsil surgery ceased between 2001 and 2003 in Wales the tonsillar bed sore acts as an effective analgesic. due to a perceived risk of vCJD transmission. Conclusion: Considering the efficacy of sucralfate in reduction of The morbidity of all patients placed on the waiting list at the post tonsillectomy pain and its few side effects including cost University of Wales who had been waiting 2 years or more were effectiveness and availability, sucralfate usage is recommended in evaluated by questionnaire in 2003. In 2005 following recom- tonsillectomy patients, post operatively. mencement of tonsil surgery two cohorts were identified, 1. where tonsillectomy had been undertaken and 2. where tonsillectomy was still awaited. The questionnaire was re-issued and comparison of the cohort results evaluated. Thyroid Results: Of 415 initial responders 2003, 195 responded in 2005 (48%) 69 adults and 129 children. Thirty-five adults and 102 HL 142 children had undergone tonsillectomy. All respondents experi- Remote results of surgical treatment of patients enced less morbidity in 2005 than described in 2003. Matched pair with cancer of the thyroid gland comparison, of individual respondent’s overall condition in 2003 and 2005 revealed that respondents who had tonsillectomy had I. Zinkevich, N. Prokodanova, O. Zinkevich significantly less morbidity compared to those who had not Rostov-on-Don Regional Hospital, Department of Endocrine (P = 0.03). Children who had undergone surgery experienced Surgery significantly less morbidity than those who had not in all areas apart from long-term absence from school. In our hospital 412 operations for cancer of the thyroid gland were performed from 1999 to 2003. Two groups of patients were Conclusions: The severity of severe chronic tonsillitis, if left un- singled out: the first group—217 patients were under observation treated, appears to diminish with time; however, intervention by for 5 years; the second group of patients were under observation tonsillectomy provides significant additional benefit in effecting a from 3 to 5 years. The mortality was 2.9% (12 patients): in the much greater reduction in morbidity than time alone. first group—2 patients, in the second—10 patients. The histopa- thology of these were medullary carcinoma in six, follicular HL 141 carcinoma in three and papillary carcinoma in three. An over- whelming number of lethal results were observed in the second Assessment of the effectiveness of sucralfate group. in reducing pain of tonsillectomy patients Recurrences were found in 11 cases. Seven patients were operated for a second time. The volume of operative intervention Chasem Karimi, Mohammed Hossein Baradaranfar, (412 patients) depended on stages of the tumorous process: thy- Abbas Mirvakily, Saeid Atighehi, MohamadReza Vahidy roidectomy with central lymphodissection in 144 patients. Thy- Department of Otolaryngology and Head and Neck Surgery, roidectomy with central + compartment-fascial (one-side) Yazd University of Medical Sciences lymphodissection—60, thyroidectomy with central + double Introduction: Pain is one of the serious compilcations in patients compartment-fascial lymphodissection—12, total-subtotal resec- after tonsillectomy. It is essential to use a medication which re- tion with central lymphodissection—183, subtotal resection of the duces the pain with least side effects, cost, and availability. The thyroid gland—13. purpose of this study was to study the effectiveness of sucralfate in The volume of operative intervention by means of hemithy- reduction of pain and dosage of acetaminophen post tonsillec- roidectomy + isthmus with subtotal resection of contralateral tomy part in the first or second stage of the tumor (T1–T2) seems to be Methods: This was an analytic study performed as a clinical trial. sufficient. With more vast lesions (T3–T4) a total laryngectomy is In this study, 60 patients (older than 7 years) admitted to Shaheed necessary. Probability of development of a recurrence after Sadoughi hospital, Yazd undergoing tonsillectomies were chosen 5 years of observation is significantly reduced.

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HL 143 able for inclusion. Patients who were diagnosed with malignant Tumors of uncertain malignant potential (UMP) disease post-operatively were excluded. Histological examination of the resected thyroid lobe was performed for pathological of the thyroid diagnosis and the degree of lymphocytic infiltration present. Guevara Nicolas1, Lassalle Sandra2, Haddad Antoine1, Assessment was made of the relationship between the presence of Hofman Ve´ ronique2, Brucker-Davis Franc¸ oise3, post-operative hypothyroidism and the pre-operative (TSH), the Sadoul Jean-Louis3, Santini Jose´ 1 pathological diagnosis, and the presence of lymphocytic infiltra- 1Thyroid Surgery Unit, University of Nice, France tion. 2Pathology Unit, University of Nice, France Results: Ninety-two patients were suitable for inclusion in this 3Endocrinology Unit, University of Nice, France study. Fifteen (18.3%) patients developed hypothyroidism, clini- cal or subclinical, post-operatively. Objective: A few thyroid encapsulated vesicular lesions do not Conclusion: A relatively raised pre-operative (TSH) and the meet standard criteria of histopathologic assessment because of presence of lymphocytic infiltration in the resected specimen are focal nuclear changes or questionable capsular invasion. Those significant risk factors for the development of post-operative two morphological features were reported in the last WHO clas- hypothyroidism. The presence of these risk factors requires a sification of endocrine tumors (2004), as tumors of UMP. Fea- patient to undergo yearly thyroid function testing for life. In the tures accounting for these lesions are not well and therapeutic absence of these risk factors a patient can be discharged from strategies are not codified yet. The goal of our study was, to (1) further follow up at 12 months. evaluate the incidence of the thyroid UMP, (2) recognize their clinical, ultrasonic, histopathological features and, (3) discuss the best therapeutic approach when dealing with them. HL 145 Methods: A prospective study was conducted over 18 months The management of locally invasive thyroid carcinoma (2004–2006); all patients were undergoing thyroid surgery for nodular disease. Ricard Simo3, Jean-Pierre Jeannon3, Ben Wallwork3, Results: Four hundred and forty-one samples from thyroidecto- Guillem Bruch3, Mary O’Connell1, Sue Clarke2 mies were studied. Fourteen (3.2%) were UMP tumors (diagnosis 1Department of Otorhinolaryngology Head and Neck Surgery, established by a double expert pathologist reviewing). Eighty- London, UK eight (20%) were malignant carcinomas with a size over than 2Clinical and Radiation Oncology and Nuclear Medicine, 1 cm. UMP tumors represented 16% of the non medullar malig- London, UK nant tumors. The sex ratio was 0.75 (8F/6M), the mean age was 3Guy’s and St Thomas’ Hospital NHS Foundation Trust, 54.5 years. No clinical or ultrasonic features were specific. We London, UK found five well-differentiated tumors of UMP and nine follicular Objective: The aim of this paper is to analyze our experience in the tumors of UMP. No pejorative evolution was noted. management of these cases using a uniform approach to surgical Conclusions: Thyroid tumors of UMP were found in our experi- and adjuvant treatment. ence to represent a significant percentage of thyroid lesions Methods: Retrospective study of 131 patients with thyroid carci- encountered. We propose a therapeutic protocol including a noma treated with thyroid carcinoma between January 2000 and diagnostic confirmation (double checking of histopathologic January 2007. One hundred and eleven patients had well differ- findings by an expert specialist), and an extensive patient infor- enciated thyroid carcinoma (WDTC). All patients underwent mation, including long term follow-up. We have also initiated a ultrasound-guided fine needle aspiration, MRI scanning of the data tissue biobank gathering in an effort to lead to a prospective head and neck and CT scanning of the chest. All patients were multicentric study on these tumors. assessed in a multidisciplinary clinic and received post-operative radioiodine treatment. 30 patients received external beam radio- therapy according to a standard protocol. Follow-up ranged from HL 144 3 months to 6 years. Hemithyroidectomy for benign disease: who needs Results: One hundred and eleven patients with WDTC were follow-up? treated. Seventy-nine were women and 32 were men. The average age was 51 years (range 25–86). Twenty-two patients had strap R. N. Wormald, M. Toner, C. Timon muscle invasion, 16 had recurrent laryngeal nerve involvement Department of Otolaryngology-Head and Neck Surgery and and nine had pre-operative evidence of nerve paralysis. Seven Pathology, St. James’s Hospital, Dublin, Ireland patients had tracheal involvement, four had laryngeal involve- Objective: Hypothyroidism is a recognized complication following ment and two patients both. One had gross invasion of the hemithyroidectomy. The reported incidence varies from 5.0 to internal jugular vein. Overall survival was 95%. For patients 41.9%. There are no universally accepted guidelines for the without local invasion the survival is 100%. For those with local monitoring of thyroid function after hemithyroidectomy. The invasion is 93%. objectives of this study were to assess the incidence of hypothy- Conclusion: The optimal management of locally invasive differ- roidism after hemithyroidectomy, to identify possible risk factors entiated thyroid carcinoma continues to evolve. A multidisci- for the development of hypothyroidism and to determine a simple plinary approach is essential. Surgery remains the mainstay for protocol for the post-op monitoring of thyroid function for these treatment of loco-regional disease and should aim to remove all patients disease whilst minimizing morbidity. Postoperative radioiodine Methods: This was a prospective study on all consecutive patients ablation has a well-established role. External beam radiotherapy undergoing hemithyroidectomy. All euthyroid patients were suit- may improve local control and possibly survival.

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HL 146 Results: Seven patients (all women, mean age of 50 years) devel- The management of retrosternal goitres: indications oped postoperative haematoma. Case control (n = 7) were se- lected. Perioperative factors did not show difference between for sternotomy groups. The most common symptoms included neck swelling in Ricard Simo1, Jean-Pierre Jeannon1, Guillem Bruch1, five patients, drain tube looses in three, pain/pressure in the neck Ben Wallwork1, Karen Harrison-Phipps2 in three, respiratory distress in three, laryngeal oedema in three 1Guy’s and St Thomas NHS Trust, London, UK patients. Five patients were reexplored within 6 h, one between 7 2Head and Neck Surgery and Thoracic Units, Guy’s and St and 24 h and one beyond 24 h. Bedside evacuation was necessary Thomas NHS Trust, London, UK in four patients. The bleeding site was superior thyroid artery three times, inferior thyroid artery three times, Berry ligament Objective: To analyze the presentation, evaluation, indications for area six times. Within the first 130 procedures five incidents oc- sternotomy and surgical management of patients with retrosternal curred. Mean hospital stay was longer in the study group (12 vs. or intrathoracic non-toxic goitres. 6 days). The rate of complications (prolonged intubations, tra- Methods: Retrospective review of 640 patients who underwent cheostomy, hypocalcemia and recurrent nerve palsy) was higher in thyroidectomy in our unit between January 2000 and January the study group (5 vs. 1). 2007. Ninety-seven patients had goitres with either retrosternal or Conclusions: Postoperative haematoma is uncommon, but intrathoracic extension. All patients were evaluated with ultra- potentially serious complication of the thyroid surgery. The risk sound-guided fine needle aspiration, MRI and/or CT scan of the factors are unpredictable. The more experienced surgeon, the less neck and chest. chance of development of haematoma. The meticulous haemo- Results: Of the 97 patients, 86 were women and 11 were men. stasis is the basic prevention of this complication. If developed, Ninety-one patients underwent surgery via a cervical approach. an urgent reintervention is strongly advised. Reexploration has Only six required a transthoracic approach via a sternotomy. an impact of the length of hospital stay and postoperative Patients required sternotomy due to: Giant intrathoracic exten- morbidity. sion (1), complex anatomical distribution (1), retroesophagic extension (1) and previous failed cervical approach (3). In all cases the transverse diameter of the retrosternal component was sig- nificantly larger than the thoracic inlet (3). No patients in this HL 148 group had vocal cord paresis Complications included two pneu- Expanded indications and technique of minimally mothorax and two patients had temporary hypocalcaemia that invasive thyroidectomy recovered after 3 months. Conclusions: The optimal management of retrosternal goiters re- Robert L. Ferris, Stephen Lai, Seungwon Kim, Rohan Walvekar quires careful evaluation and planning. Although the large Unviersity of Pittsburgh majority of this NTG can be approached and successfully excised Objective: Thyroid disease is increasing in frequency for several by a transcervical approach a significant minority will require reasons, including improved methods of detecting thyroid nod- sternotomy for access. MRI and CT scanning with multiplanar ules through ultrasound evaluation. Unfortunately, current reconstructions is essential to determine the anatomy of the goi- standard of care often includes open thyroid lobectomy to tres and allowing adequate surgical planning. A multidisciplinary determine the histologic nature of many nodules. We have per- team approach between the head and neck and thoracic surgery formed endoscopic assisted, minimally invasive thyroidectomy teams is essential. for indeterminate thyroid nodules and for small thyroid cancers. In addition, recently we have expanded our indications to include HL 147 larger multinodular goiters and completion thyroidectomy pro- Postthyroidectomy haematoma requiring urgent cedures. reexploration Methods: Retrospective patient review. Results: Our review of 48 prospectively studies thyroidectomy Pavol Prazˇenica, Richard Holy´ procedures using these expanded indications supports the safety ENT Department, Central Military Hospital Prague, Czech Republic and efficacy of this approach, including up to 6 cm thyroid masses. Routine outpatient surgery is possible in approximately Objective: The study was undertaken to assess the risk of cervical half of our patients undergoing partial thyroidectomy (lobec- haematoma following thyroidectomy requiring urgent reexplora- tomy) without drainage tube use. No bleeding event occurred. tion. Postoperative pain and cosmesis is significantly enhanced. Methods: A retrospective study includes 432 patients who under- Hypoparathyroidism or residual thyroid tissue on radioiodine went total thyroidectomy or hemithyroidectomy between 2001 scanning was not significantly increased, as compared to our and 2006. All patients were treated by the same surgeon. Specific open procedures. risk factors and risk patients, timing of haematoma, surgeon’s Concusions: The results of this study support the expanded indi- experience, clinical picture and morbidity of reexploration were cations and technical modifications based on our series. studied.

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HL 149 problems,potential for malignancy when medical therapy was Thyroid surgery from point of view unsuccessful. of Otorhinolaryngology Methods: Ninety-six patients with substernal goiter were operated at our Department. Jo´ zsef Pytel, Pe´ ter Mo´ ricz, Krisztina Somogyva´ ri Results: Most common symptoms of goiter were cervical mass Department of Otorhinolaryngology, Head and Neck Surgery, (95.8%), respiratory symptoms (91.6%) and dysphagia (48.9%). Medical School, Pe´ cs University, Hungary Acute airway occurred in 11.4% and some were asymptomatic 12.5%. All goiters were removed through cervical incision. In Objective: More and more thyroid surgery is done by ENT sur- 3.1% cases occurred postoperative hypocalcaemia. There were no geons. The authors discuss the surgical problems during the thy- operative deaths. roid surgery. Conclusions: Transcervical approach for substernal goiter is dif- Study design: Three problems may arise during thyroid surgery. ferent from that used for routine thyroid surgery and need expe- (1) The recurrent laryngeal nerve lesion. (2) The superior laryngeal rienced surgeon. Difficult phase of surgery are identification of nerve lesion. (3) Parathyroid gland injury or removal. The authors RNL and parathyroid glands. The majority of substernal goiters discuss how to avoid these complications. can be resected transcervicaly, but rarely will require a sternal split Setting: Otorhinolaryngological university department. (in case of recurrency). Participants: Two hundred and forty-four thyroid surgeries was done in the ENT Department in Pe´ cs. The authors demonstrate the technique of searching and saving the recurrent nerve, the Miscellaneous superior laryngeal nerve. E special new technique is demonstrated to identify the parathyroid glands with contact hysteroscopy (vi- deo demonstration). HL 151 Results: There was no recurrent paresis. One case occurred with Evaluation of preoperative investigations in elective hypoparathyroidismus. One temporary superior laryngeal nerve ENT surgery damage occurred. Amrita Sinha, Yohanna M. Takwoingi, Arun Sinha Conclusion: We can avoid the nerve injury with the special prep- aration technique and the contact hysteroscopy is a very useful Department of ENT, City Hospital, Dudley Road, Birmingham intraoperative technique to identify and save in vivo the para- B18 7QH, UK thyroid glands. Objective: Pre-operative investigations are routinely carried out in patients undergoing elective ENT surgery. Some of these investigations may be unnecessary. The objectives of this study HL 150 are: To determine the level of compliance to the UK National Difficult thyroid surgery Institute of Clinical Excellence (NICE) guidelines for pre-oper- ˇ ative investigations for elective ENT operations; To assess the M. Bura, G. Poje, R. Prstacˇic´ , H. Galic´ ,M.Zizˇic´ -Mitrecˇic´ , financial implications; To develop appropriate guidelines for I. Botica pre-admission clinics University Hospital Center Zagreb Methods: Medical notes of 100 random patients undergoing Objective: Difficult thyroid surgery occurs in substernal goiter, elective ENT procedures under general anaesthesia were subject recurrent thyroid cancer and locally aggressive thyroid cancer. to retrospective audit. Pre-operative screening investigations Most important step for recurrent thyroid cancer is to evaluate (full blood count, haemostasis, urea and electrolytes, random initial surgical procedure combining with histological evaluation, glucose, chest X-ray and urine analysis) were analysed for parathyroid reserve evaluation,disease extension, thyroid func- individual grades of surgery and American Society of Anaes- tion and intralaryngeal examination. If recidive occurs in lobe or thesiologist (ASA) grades of patients and compared to the isthmus after one-side lobectomy, isthmectomia or partial recommendations in keeping with the NICE guidelines. lobectomy is in order.Difficult surgical procedures occurs after Results: Of the 100 patients selected, a total of 256 tests were subtotal bilateral resection or recidive metastasis in thracheoo- performed. It was found that 45% (n = 114) of pre-operative esophageal groove and fibrous scars. Most difficult are identifi- investigations ordered were ‘not recommended’ according to the cation of nervus reccurens and remaining parathyroid glands. NICE guidelines. Only 12% (n = 32) of investigations were ‘rec- Substernal goiters are those which at least 50% of gland is in ommended’. Of the ‘not recommended’ tests, 80% (n = 90) mediastinum. It occurs in five to six decade with incidence three comprised of full blood count, renal and liver function tests. This to four times greater in women. Regarding to vessels and nerve,it led to four times as much spending on the ‘not recommended’ tests. can be anterior or posterior. Substernal goiter is best diagnosed Overall 0.9% (n = 25) investigations yielded abnormal results by radiological studies,ultrasound, cytological and radionuclide which did not cause surgical delay or post-operative complications. scintigraphic methods. Due to location ultrasound,cytological Conclusions: The results indicate that some routine pre-operative and scintigraphic methods are not always reliable. CT or MR investigations are unnecessary. They should be done selectively imaging is useful for evaluation of goiter substernal extension in keeping with the NICE guidelines. This will result in sub- and tracheal dislocation and compression. Indication are pres- stantial time and financial savings without compromising pa- sure effects in longstanding goiter,potential for acute airway tient safety.

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HL 152 HL 153 Angulation of the styloid process in eagle’s syndrome Management of facial hemangiomas: circular excision Fatma Caylakli1, Haluk Yavuz1, Tulin Yildirim2; and ‘‘purse string suture’’ 1 Levent N. Ozluoglu A. Vlahovic, R. Simic, V. Subarevic, Dj. Kravljanac 1 Baskent University Faculty of Medicine, Otorhinolaryngology Department of Pediatric surgery, Department of Otorhinolaryn- Head and Neck Surgery, Ankara, Turkey gology, Institute for Mother and Child Health Care of Serbia, 2 Baskent University Faculty of Medicine, Radiology, Ankara, Radoja Dakica street 6–8, Belgrade, Serbia Turkey Objective: Hemangiomas are the most common soft tissue tumors Objective: The aim of this study was to investigate and compare of infancy. Tretament options for hemangioma are numerous. The the angulation, length of the styloid process between the patients scar after lenticular excision and linear closure is often unaccept- operated for symptomatic elongated styloid process and control able. Localized cutaneus infantile hemangioma acts like tissue ex- group with plain radiographs. pander. Therefore circular excision and purse string suture are Methods: Thirty patients with 51 elongated styloid processes applicable for hemangioma in any stage. underwent surgery. There were 27 females and three males, with Methods: In 2-year period we have operated fourteen patients with mean age of 48.2 years. As control group, patients with chronic hemangioma usin circular excision and purse string suture. In eight otitis media and trauma were included in the study. There were 28 patients hemangioma was localized in the head and neck region. females and three males in the control group with mean age of Two infants with large hemangioma are presented. One patient had 45.5 and none of them had symptoms characteristic of an elon- hemangioma with ulceration resistant to conservative treatment. gated styloid process. The length, medial and anterior angulation Second patient had the giant hemangioma which caused partial of the styloid processes of the patient and control groups were obstruction of visual axis with unacceptable aesthetic performance. measured on lateral skull and Towne’s radiographs. Patients who We performed circular excision, purse-string suture with placement received antiinflammatory drug therapy to rule out tendinitis or of a small full thickenes graft in the center of defect in both patients. myositis preoperatively and did not relieve of their complaints Results: There were no intra- or postoperative complications. The were included into this study. aesthetic result was satisfactory. Upon follow up, the patients had Results: The length of the styloid process in the patient group was adequate facial simetry and functional impairments. 5 cm on average on right and 5.2 cm on left which was 2.8 and Conlusions: After circular excision of hemangioma and purse- 2.6 cm, respectively, in control group. There is a difference be- string suture the scar was markedly shorter comparing to single or tween two groups for the length of the styloid process on both staged lenticular excision and linear closure. Circular excision and sides (P = 0.001). Medial angulation of the process on average purse string suture minimize the distorsion of surrounding struc- was 14 on right, 18.1 on left in patient group, whereas these were tures and should be the first choise for resection of hemangioma, 15 and 16.3 in control group respectively and there is no dif- particulary in the head and neck region. ference between the patient and control groups for medial angu- lation on right and left sides (P = 0.459 and P = 0.191 respectively). And measurements for anterior angulation, in pa- HL 154 tient group it was 33.6 on right, 36.7 on left on average which Necrotizing fasciitis of the head and neck-34 cases were 21.4 and 18.5 respectively in control group. There is a difference between the patient and control groups for anterior in single institution experience! angulation on both sides (P = 0.001). On long term control of Bostjan Lanisnik, Bogdan Cizmarevic, Vojko Didanovic patients, only 2 of 51 procedures did not result in improvement of Department for ENT-Head and Neck Surgery, General Hospital symptoms which shows that this surgery is really efficient. Maribor, Ljubljanksa 5, 2000 Maribor, Slovenia Conclusions: Our study revealed that length and anterior angula- tion of the styloid process are responsible for the symptoms rather Objective: To analyze the occurrence and course in aggressive than medial angulation when the patient and control groups are management of the head and neck necrotizing fasciitis. compared. Methods: A prospective cohort study of the patients with necro- tizing fasciits (NF) of the head and neck. A NF was divided in two broad catergories: NF of the neck with/without mediastinits and NF of the face. The NF of the neck was further subdivided according to the fascial plane involved (superficial and deep). Results: From 1992 to 2006 34 patients with NF were treated in our department. Among those patients five patients presented with facial NF. The most severe complication in these group was a skin nsecrosis which was a uniformal finding. Twenty-nine pa- tients had a NF of the neck, 16 (55%) of them presenting with mediastinits. The common feature of the patients with media- stinits was pretracheal fascia NF. From 34 patients with NF only one died from uncontrolled infection. Fifteen patients (44%) had no significant comorbidity. All patients were treated with aggressive surgical necrectomy, mediastinal drainage with or without thoracotomy/sternotomy. Conclusion: NF was considerd a disease with high mortality. We proved that it is not necessarily throuth, if infection is managed surgically, early in course of the disase and with multidisciplinary approach.

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HL 155 performed or prolonged tracheal tube placement with drainage Neck trauma owed to car accidents was used (5, 19.2%). Results: Adequate abscess drainage, regeneration of organs, local Georgios Kloutsos, Dimitrios Balatsouras, Ioannis Anastasakis, treatment and appropriate antibacterial therapy enabled us to Georgios Kourtis, Dimitris Achrianis, Nicolas C. Economou, eliminate complications in all damaged organs with restoration of Antonis Kaberos functions. No deaths occurred. ENT Department, ‘‘Tzanion’’ General Hospital of Pireus, Greece Conclusions: Suturing of the defect along with anastomosis re- Objective: Neck injuries owed to car accidents have become mains the major treatment in the cases of penetrating damages, common occurrencies for ENT Emergency Departments. The aim extensive and circumferential ruptures of trachea and larynx. of this presentation is to document the types and severity of these Surgical treatment of damages to esophagus and pharynx should injuries, considering two factors: (1) the use of the safety belt or be individualized and aimed at reconstruction of organs and not; (2) driving under the influence of alcohol. elimination of consequences. Methods: The charts of 95 consecutive cases of neck injury that have presented to the ENT Department of our Hospital during the last year have been studied. Sixty-two (65%) drivers made use HL 157 of the safety belts and 33 (35%) did not. Role of endoscopic surgery and intralesional steroid Results: In the first group the following injuries have been ob- therapy for acute obstructive tracheobronchial served: (1) 36 (38%) cases with contusions and abrasions; (2) 17 Wegener’s Granulomatosis (18%) cases with subcutaneous neck haematomas; (3) 6 (6%) cases with intraluminal laryngeal heamatomas; (4) 3 (3%) cases with Reza Nouraei1, Rupert Obholzer1, Philip Ind2, Alan Salama3, hyoid bone fractures. In the second group the following injuries David Howard1, Guri Sandhu1 occurred: (1) 20 (21%) cases with neck contusions and abrasions, 1Department of Otolaryngology, Charing Cross Hospital, subcutaneous heamatomas, intraluminal laryngeal hematomas London, UK and thyroid cartilage fractures; (2) 7 (8%) cases with dislocation of 2Department of Respiratory Medicine, Hammersmith Hospital, the arytenoid cartilage; (3) 4 (4%) cases with cricoid cartilage London, UK fractures; (4) 2 (2%) cases with thyroid cartilage fracture. Of the 95 3Department of Renal Medicine, Hammersmith Hospital, patients, 58 (61%) were driving under the influence of alcohol. London, UK Conclusions: From the study of these cases it is concluded that Objective: Upper airway compromise due to tracheobronchial those of the drivers who used their safety belts had less severe stenosis commonly occurs in patients with Wegener’s Granulo- injuries, in comparison with those who did not use it. Intake of matosis (WG). There is at present no consensus on the optimal alcohol before driving constitutes a major factor that increases the management of this life-threatening condition. We assessed the possibility of an accident. results of laryngo-tracheo-bronchoscopy, intralesional steroid therapy, laser surgery and dilatation in managing obstructive HL 156 tracheobronchial WG. Methods: Records of eighteen previously-untreated stridulous pa- Trauma of cervical parts of respiratory and digestive tients with obstructive tracheobronchial WG, treated between 2004 organs and 2006 were retrospectively reviewed. Information about patient and lesion characteristics and treatment details were recorded. D. I. Zabolotny, M. M. Bagirov, I. M. Bagirova Treatment progress was illustrated using a timeline plot, and Kiev Otholaryngology Institute intervention-free intervals were calculated with actuarial analysis. Objective: Proving the efficiency of reconstructive operations on Results: There were nine males and the average age at presentation cervical parts of respiratory and digestive organs. was 40 ± 16 years (range 13–74). There were thirteen patients Methods: We treated 45 patients with acute traumatic damages to with tracheal, and five patients with tracheal and bronchial lesions. respiratory and digestive organs (38 adults up to 77 years, 84.4%; The average tracheal lesion height was 8 ± 3 mm, located and 7 children, 15.6%). Patients were admitted within first hours 23 ± 9 mm below the glottis. There were 1, 10 and 7 Myer-Cotton after trauma in 42.2% of cases, 17.8%—within first day and 40% grade I, II and III lesions respectively. Intervention-free interval cases—later (with cervical phlegmona, mediastinitis and pleural following minimally-invasive treatment was 26 ± 2.8 months. No empyema). Twenty-one patients were admitted in grave condition predictors of treatment durability were identified on Cox regres- with cervical phlegmona and mediastinitis (17 patients) and sion. Topical mitomycin application caused one major airway complete transsection of trachea and esophagus (four patients). complication. Following endobronchial therapy the median Damages to trachea (larynx) took place in 46.7% cases, to intervention-free interval was 22 months (P > 0.8 vs. tracheal esophagus (pharynx) in 40%, to digestive and respiratory organs lesions). No patient required a tracheostomy or endoluminal stent. concurrently in 13.3% cases. In 11 cases out of 26 damages to Conclusions: Intralesional steroid therapy and conservative end- esophagus and pharynx the operation envisaged multiple drainage oluminal surgery is an effective strategy for treating airway of cervix and mediastinum (42.3%) and suturing the wound in 12 compromise due to active tracheal and bronchial WG. It obviates cases (46.2%). In three patients (11.5%) we performed circum- the need for airway bypass or stenting. We recommend the ferencial esophagopharyngeal anastomosis. In cases of trauma combination of endotracheal dilatation, conservative laser surgery to respiratory organs (26) the defect was sutured lengthwise and steroid therapy as the standard of care for treating airway (17, 65.4%), tracheocricothyroideus anastomosis (4, 15.4%) was compromise due to obstructive tracheobronchial WG.

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HL 158 Results: Children’s average age (±SD) was 11.8 ± 3.2 years Sialolithiasis: diagnosis and treatment (range 5–17). Their total sleep time was 408 ± 40 min (range 333–469 min). The AHI based on PSG and Watch_PAT100 were Gu¨ nther Pabst 8.8 ± 7.1 and 7.6 ± 9.5, respectively (P = 0.7). The correlation Kantonsspital Luzern between PSG AHI and Watch_PAT100 AHI was 8.8 Retrospective analysis of 210 patients after interventional sialen- (P < 0.001). The distribution compared to the line of identity is doscopy treated between 2002 and 2006 and 400 patients after shown in the Figure. extracorporeal shock wave lithotripsy, witch were treated between Conclusions: We conclude that utilizing autonomic activation 1996 and 2006 and the investigation of sialolithiasis of the salivary index is an accurate tool in diagnosing sleep disordered glands by ultrasound is demonstrated on the basis of ultrasound breathing events in children. We believe that the previously video. reported blunted arousal response to respiratory stimuli in Results: Following extracorporeal shock wave lithotripsy 71% of children with OSA is applicable for cortical arousals or arousals the patients suffering from parotid lithiasis and 57% suffering scored by criteria determined for adults, but not for autonomic from submandibular lithiasis were free of complaints. 210 patients responses. underwent interventional sialendoscopy. Eighty-three percent were treated successfully and remained asymptomatic.Sonogra- phy have replaced sialography in the evaluation of patients with HL 160 sialolithiasis. Cephalometric analysis in patients with obstructive Discussion: In many cases the diagnosis of sialoitthiasis is easy due to obvious clinical features, but if a treatment is considered sleep apnea syndrome ultrasound of the salivary glands is very useful in the evaluation of Ewa Olszewska1, Janusz Rozycki2, Andrzej Sieskiewicz1, patients with sialolithiasis. Besides traditional surgical procedures Eugeniusz Tarasow2, Marek Rogowski1 new conservative treatment modalities like extracorporeal shock 1Department of Otolaryngology Medical University of Bialystok, wave lithotripsy or interventional sialendoscopy have changed the Poland management of salivary gland stones. 2Department of Radiology Medical University of Bialystok, Poland Osas Objective: The aim of the study was to evaluate the usefulness of cephalometric radiograhs in OSAS patients with the comparison HL 159 of craniofacial computed tomography as well as to demonstrate Sleep disordered breathing events are robustly the relationship between the severity of sleep-disordered breathing and severity of cephalometric abnormalities. associated with autonomic activationsin children Methods: Twenty-eight randomly selected patients with snoring with OSA and varying degrees of sleep-disordered breathing were included in this study. A control group included 22 patients. These pa- G. Pillar, T. Etzioni tients had no snoring or clinical evidence of sleep–disordered Sleep laboratory, Meyer Children’s Hospital, Rambam Medical breathing. No patients had prior pharyngeal or maxilloman- Center and Technion - Israel Institute of Technology, Haifa, Israel dibular surgery. All patients were evaluated by otolaryngologi- Objective: Respiratory cessations in adults with obstructive sleep cal examination and had polysomnography, cephalometric apnea (OSA) are associated with arousals from sleep. In children, radiographs and craniofacial CT scans. In study group the however, this response may be blunted. The Watch_PAT100 de- evaluation between cephalometric analysis on radiographs and vice is a tool to detect sleep disordered breathing events pre- CT scans was made. dominantly by assessing the autonomic arousals at the Results: The cephalometric parameters revealed major differences termination of events. We have therefore sought to study children between controls and patients with OSAS regarding the size and with OSA with the Watch_PAT100, to assess whether they position of soft palate and uvula, volume and position of tongue, experience autonomic activation at the termination of events. We hyoid position, mandibulo-maxillary protrusion and size of the hypothesized that they may not experience cortical arousals, but pharyngeal airway space. Patients were then classified to certain will demonstrate autonomic activation at the termination of SDB procedures according the measurements. events. Conclusions: Obstructive sleep apnea syndrome is associated with Methods: Seventeen children with OSA (11 m/6f) underwent statistically significant changes in cephalometric measurements. simultaneous recording of in-lab polysomnography and Watch_- Lateral cephalometric analysis and craniofacial CT adds further PAT100 sleep study. PSG was blindly scored for apneas and information regarding the anatomical assessment of patients with hypopneas based on common practice for clinical sleep studies in OSAS. We found craniofacial CT scans easier, more accurate children. WatchPAT100 was automatically scored for respiratory measurements especially applying to soft tissues and more useful events based predominantly on autonomic activations. for patient classification to surgical procedures.

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HL 161 Results and conclusion: In about 400 video sleep endoscopies with Long and shortterm results: of LAUP for snoring and without sleep and CR monitoring we tested the feasibility of the systems. We saw an exact reproducibility in repeated preop- and sleep apnea syndrome erative endoscopies and found esp. the Somnoscreen to be a Y.-V. Kamami, L. Pandraud, A. Bougara good tool to make sure that depth of sleep and CR events Saint-Cloud Hospital, 3 place Silly, 92, Saint-Cloud, France resemble those known from patients previous sleep lab study. For Dr Yves-Victor Kamami, 43 Boulevard Malesherbes, postoperative control sleep endoscopies it is essential to perform 75008 Paris, France DISE under the same conditions as the preoperative investigation was. Therefore sleep and CR monitoring is mandatory for stan- Objective: The purpose of this study is to report long- and short- dardization of DISE. term effects of Laser-Assisted UvulaPalatoplasty (LAUP). Methods: 3,071 patients (491 females, 2,580 males) with symp- toms related to snoring or mild sleep apnea were treated in an HL 163 office environment, using a CO2 laser, between December 1988 A prospective study comparing ApneaGraph and July 2006. All subjects completed surveys before and three months after treatment. 644 patients completed long-term sur- with sleep nasendoscopy and polysomnography veys ranging from 6 months to 15 years from the date of their in patients with snoring and obstructive sleep apnea procedures. Hiba Al-Reefy, Arvind Singh, Richard Hewitt, Bhik Kotecha Results: Early evaluation on a Visual Analogic Scale at 3 months Royal National Throat Nose Ear Hospital London, UK demonstrated an complete symptoms improvement on 73.5%, and a partial improvement on 23.5% of patients. Long-term Objective: The management of sleep apnoea and snoring remains benefit was achieved in 65% of patients satisfied initially. The controversial. Our institution provides an excellent level of care for recurrence of snoring was mainly caused by reccurence of nasal the management and treatment of snoring and OSA and continues obstruction and/or gain of weight. Eighty-two percent of patients to develop this service. ApneaGraph is a new diagnostic method would repeat the procedure or recommend it. The daily post- measuring pressure and airflow simultaneously at different levels in operative visual analogic score for post-operative pain was im- the pharynx identifying the segment of airway obstruction and proved when an intra-muscular injection of a pain-killer was providing baseline respiratory parameters. This study aims to practiced at the end of the procedure. evaluate ApneaGraph (AG) and correlate results with both Sleep Conclusions: This study demonstrates that LAUP is an effective Nasendoscopy (SNE) and Polysomnography (PSG). in-office procedure in the treatment of snoring and mild sleep Methods: Comparative prospective study of 25 patients with apnea syndrome. Favorable short- and long-term subjective data Snoring/OSA. Patients had PSG and ApneaGraph study simul- were reported. taneously in the Sleep Lab. Patients undergoing SNE had a ten minute ApneaGraph analysis. Results: PSG was used to validate the ApneaGraph system. There HL 162 are no significant differences (Independent t-test, P > 0.15) be- Standardization of drug-induced sleep endoscopy tween AG compared to PSG based on the Apnoea-Hypopnea index, average oxygen saturations and total number of apnoeic/ in obstructed sleep apnea syndrome and snoring hypopnoeic events. This suggests that the AG is a reliable tool in patients assessing OSA. Crude assessment based on an upper or lower level of obstruction Robert Pavelka shows a 60% concordance between AG and SNE findings. ENT-Department, General Hospital, Corvinusring 3-5, However, when analysing percentage contribution of site to A-2700 Wiener Neustadt, Austria overall obstruction, less than half the cases agree within 20%. Objective: Drug-induced sleep endoscopy (DISE) is used to Statistically, there is no correlation between the two groups identify the sites of obstructions/vibrations in OSAS and snoring (Spearman rho, P = 0.3). In the cases of discordance, AG places patients in order to improve surgical outcome by a feasible day- greater emphasis on a lower pharyngeal contribution. time method. Criticism states on differences to natural sleep due Uniquely, Apneagraph can be performed in drug-induced and to side effects of the drugs like muscle relaxation or central natural sleep. Although the two states are entirely different, we respiratory depression, interaction of the inserted endoscope, etc. will discuss the findings and limitations in interpretation. Poten- Methods: We monitored the depth of sleep during Propofol or tially, AG may provide a cost-saving in the evaluation of snoring Midazolam induced sleep endoscopy using two systems: the Bi- and OSA but it’s limitation will be discussed. spectral Index (BIS) from Aspect Medical, USA, analyzing the Conclusion: This unique study analyses the ApneaGraph system in frontal EEG frequency and the temporal EMG and the Somno- the diagnosis of Obstructive Sleep Apnea and Snoring. It dem- screen from Somnomedics, GE, recording full polysomnogra- onstrates the benefits of this new system and highlights certain phy (PSG) and cardiorespiratory (CR) parameters and events limitations in localising the site and level of pharyngeal obstruc- simultaneously to the inserted endoscopic video. tion in patients with sleep disorders.

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HL 164 HL 166 Mild obstructive sleep apnea. Is it worth treating? The annoyance of snoring J. Seppa¨ , J. O. Sahlman, M. Pukkila, H. Tuomilehto Alfred Dreher, Martin Patscheider, Christine Klemens, Department of Otorhinolaryngology, Kuopio University Hospital Tobias Rader, Caroline Schultheiss, Richard de la Chaux and University of Kuopio, Finland Ludwig-Maximilians-University, Munich, Germany Objective: To evaluate the evolution of mild obstructive sleep Several surgical and nonsurgical procedures for the treatment apnea (OSA) after different treatments. of snoring have been developed. Their efficacy is estimated Methods: One hundred adult patients with mild OSA were based on the impression of the bedpartner or the measurement examined at the Department of Otorhinolaryngology in Kuopio of the sound pressure. The impression of the bedpartner is University Hospital between 1998 and 2004. In 2005, follow-up influenced by a lot of factors which are independent of the studies went through with the same symptom-questionnaire as snoring sound and the sound pressure doesn’t take in regard earlier. Totally 50 of 100 patients also had overnight control po- the effect of the noise on humans. Therefore a psychoacoustic lysonography. The patients were devided into three groups evaluation of snoring, combining both aspects, was used for the according to the treatment they had received after the first visit first time. (conventional, CPAP, surgery). The evolution of mild sleep apnea Ten patients complaining of loud snoring had polysomnography was then estimated by the chance of symptoms and AHI-findings with recording of their snoring. Typical sections of the snoring in relation to different treatments. sound, lasting 30 s, were presented to three examiners for evalu- Results: CPAP and surgery were significantly more effective in ation (0–100) of their annoyance. alleviating subjective daytime sleepiness, restless sleep, snoring and The annoyance of all snoring sequences was estimated at apneas compared to untreated patients. Conventionally treated 46.9 ± 23.3, the most acceptable snoring sequence at 15 ± 9, the patients had a statistically significant increase in AHI (13.3, SD 18.3) worst at 85 ± 5. The estimations of the examiners concerning a during the follow-up. Half of these patients developed moderate or single snoring sequence varied by 8.6 ± 5.0. severe degree of OSA, and only 10% were cured (AHI < 5). In The psychoacoustic evaluation of snoring seems to be a prac- patients who were treated with CPAP the degree of OSA got worse in ticable and promising tool for the measurement of snoring. This 64% of cases, and in 27% of patients the AHI turned to normal new method should make the comparison of different kinds of ( < 5). The degree of OSA in operated patients deteriorated only in procedures for the treatment of snoring more reliable and rele- 18% of patients, and in 27% AHI turned normal. vant. Conclusions: Even mild OSA merits active measures which can significantly improve overall quality of life. HL 167 HL 165 Esophagopharyngeal pressure measurement Weight reduction and lifestyle intervention in sleep-disordered breathing as a treatment of mild obstructive sleep apnea (OSA) R. de la Chaux, A. Dreher, C. Klemens, M. Patscheider, Henri Tuomilehto1, Juha Seppa¨ 1, Johanna Sahlman1, N. Feucht, K. Fuge, A. Berghaus Markku Partinen2, on behalf of Kuopio Sleep Apnea Group ENT-Department, University of Munich, Marchioninistrasse 15, 1Kuopio University Hospital, Department 81377 Munich, Germany of Otorhinolaryngology, Kuopio, Finland Objective: Esophagopharyngeal pressure measurements are 2Skogby Sleep Clinic, Rinnekoti Research, Espoo helpful in the differentiation of obstructive respiratory events by Introduction: OSA is a highly prevalent disease associated with measuring the esophageal pressure during polysomnography. In increased morbidity and mortality. Obesity is one of the most addition the localization of snoring and obstructive respiratory important risk factors for OSA. events is possible with multichannel pharyngeal pressure mea- Objective: To evaluate, if supervised weight reduction and lifestyle surement. Advantages and limitations of this method will be intervention improve the findings of mild OSA in comparison to a explained by an experience period of 6 years. conventional dietary counseling. Methods: Between 2000 and 2006 esophagopharyngeal pressure Methods: Prospective, randomized, controlled clinical follow-up measurements were done during nocturnal polysomnography in study. The study consists of 50 adult patients with mild to mod- 100 patients with suspected obstructive sleep apnea syndrome. erate obesity and in the polysomnography mild OSA. The patients Only eight patients did not tolerate the pressure probe. A com- in the first group (N = 25) were given a single dietary counseling. puter-based software allowed us to analyse the data manually and The second group (N = 25) received a 3-months very low-calorie automatically for each separate channel. diet followed by regular weight reduction and lifestyle counseling. Results: Without disruption of the physiological sleep architecture The first control polysomnography and clinical findings were re- an increase of the esophageal pressure was found with increasing corded three months from the randomization. We considered the depth of sleep. Esophageal pressure correlated well with the treatment successful if AHI turned to normal. These results are respiratory disturbance index. seventy-two patients showed a part of a larger study. highfrequent snoring signal with localization in the velar region, Results: In the active group two patients out of three had a normal multilevel snoring was shown in 63 patients. Analysis of the region AHI at the control visit, but in the conventional group only one of obstruction was sometimes difficult, however a velar region of patient out of four had a normal AHI, (P = 0.004). obstruction was found in 78 patients. Conclusions: Weight reduction and lifestyle intervention results Conclusions: The most important value of esophagopharyngeal not only improved, but turned AHI normal in most patients with pressure measurement consists in the preoperative selection of mild OSA. The study is in progress and the randomization has patients with velar snoring or velar obstruction. The method is ended in September 2006. limited by high financial and personal requirements.

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HL 168 Discomfort in throat and algesis decreased and finally disap- Information content of snoring sounds peared in the shortest terms. The cicatrisation in the second group passed more slowly and the configuration of the soft Thomas Ku¨ hnel, Sophie Glas, Matthias Huber, Thomas Steffens palate had unnaturally changed. The discomfort and algesis re- ORL-Dept., University of Regensburg mained longer. Results of snore and obstructive sleep apnea were Objective: Snoring is perceived more annoying by spouses than by identical in both groups. the originator. Spouses complain of severe disturbance of sleep Conclusions: Despite of a similar final result of snore and which habitual snorers are not affected of. Why does snoring obstructive sleep apnea, the method of submucosal destruction of disturb the spouses´ but not the snorers´ sleep? This is matter of this soft palate and palate’s tongue is more preferable. The sparing study. We hypothesize that snoring sound transports information influence is more intensive and postoperative period shorter. The relevant for sleep besides its physical properties. discomfort and algesis are less expressed. Methods: Snoring sounds were recorded under standardized acoustic conditions within a routine polysomnography. Fifteen persons were presented snoring sounds of different sound levels HL 170 during distinct sleep stages. Frequency of arousals caused by ei- Prediction of nocturnal obstructive apneas ther snoring sound of alien origin or own origin was compared. by simulated snoring Results: Snoring sounds of exactly the same physical properties 1 1 2 such as loudness, frequency spectrum, acuity and fluctuation Michael Herzog , Thomas Bremert , Beatrice Herzog , 1 1 strength are percepted unequal. Arousals were recorded more Werner Hosemann , Holger Kaftan 1 frequently with alien snoring sounds. Results are highly significant. Department of Otorhinolaryngology, Head and Neck Surgery, Ernst-Moritz-Arndt University, Greifswald, Germany Conclusions: Snoring sounds comprise of more than physical 2 properties. There is also the information content of the sound that Institute of Community Medicine, Section Epidemiology of characterises the sleep disturbing power. There is no alarming Health Care and Community Health, Ernst-Moritz-Arndt information in one´ s own, habitual snoring sound whereas exter- University, Greifswald, Germany nal, particularly apnoic snoring causes increased numbers of Objective: The clinical examination of the upper airway in patients arousals. with suspected obstructive sleep apnea syndrome (OSAS) is fre- quently performed before night time polysomnography. ‘‘Static’’ examination like dorsalization of the tongue base, Malampatti HL 169 index and Mueller Maneuver are discussed to be of low predictive Laser surgery of a soft palate at snore and obstructive value. The newly developed ‘‘dynamic’’ examination of the upper sleep apnea airway during simulated snoring in wake patients is analysed in terms of their predictive value for suspected OSAS. Alexei Gagauz Methods: 131 patients with a history of snoring were examined P.O. Box 1416, MD 2043, Chisinau, Moldova prior to night time polysomnography and the results were corre- Objective: Investigate the contact and submucosal laser influence lated to the obtained polysomnographic data. on a soft palate at snore and obstructive sleep apnea. Results: Correlations were detected between an increased dorsal- Methods: A retrospective analysis of patients (operated in 1997– movement of the tongue base as well as pharyngeal collapse at 2005 years) in a postoperative period was performed. Two groups tongue base level and the AHI. The patient’s body position each of 272 patients (males and females, the age ranged from 28 to during simulated snoring did not influence the results. The 66 years) underwent a full clinical examination, the settled diag- ‘‘static’’ examinations like dorsalilzation of the tongue base, nosis was ‘‘snore and obstructive sleep apnea’’. Surgery was per- Malampatti index and Mueller Maneuver did not correlate with formed with a surgical laser - wavelength 1.06 m km, the feed of the AHI. Patients with a high degree pharyngeal collapse at energy through quartz-polymeric fiber (diameter of 0.2–0.4 mm, tongue base level in combination with a dorsal-movement of the pineal shape of a fiber’s working part). Two kinds of laser inter- tongue base during simulated snoring revealed a probability of vention were applied: the first group underwent a submucosal 75% to have an AHI more than 10 and 92% for an AHI more influence, the second—a laser resection of hyperplasia’s parts of than 5. the soft palate and palate’s tongue. Conclusion: The ‘‘dynamic’’ examination of the upper airway Results: The quicker cicatrisation of epithelium was noted in the under simulated snoring in wake patients is an easy to perform first group of patients. The configuration of the soft palate and method to predict the probability of an OSAS prior to night time palate’s tongue remained the same, but with the reduced size. polysomnography.

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HL 171 and changes in apnoea-hypopnoea index and Epworth score Inflammatory biomarkers in mild obstructive sleep documented. Visual analogue scores of intensity and duration of discomfort were completed and the extrusion rate documented. apnea Results: The visual analogue snoring score changed from a pre- Johanna Sahlman1, Keijo Peuhkurinen2 and Henri Tuomilehto1 operative median of nine (range 5–9.7) to a postoperative median 1Department of Otorhinolaryngology, Kuopio University of six (range 3–9.5). Ladder plots of the change in snoring scores Hospital, Kuopio, Finland and AHI are demonstrated. Morbidity was minimal. Only one 2Department of Cardiology, Kuopio University Hospital, patient required simple analgesia for more than 2 days. Two of 80 Kuopio, Finland implants extruded. Conclusions: The Pillar implant represents an effective advance Objective: Atherosclerosis is inflammatory disease and obstructive with low morbidity in the reduction of palatal snoring in simple sleep apnea (OSA) is known to elevate the level of some pro- snorers inflammatory cytokines. We evaluated the plasma concentration (pg/ml) of pro-inflammatory biomarkers interleukin-6 (IL6), tu- mor necrosis factor alpha (TNFa), interleukin-1b (IL1b), high HL 173 sensitivity C-reactive protein (hsCRP) and anti-atherogenic interleukin-10 (IL10) and interleukin-1 receptor antagonist A prospective randomised clinical trial: laser assisted (IL1RA) in untreated mild obstructive sleep apnea patients com- Uvulopalatoplasty versus Celon Radiofrequency pared to control patients. Procut Palatoplasty for snoring and obstructive sleep Methods: Seventy-eight overweight patients (group A) with newly apnoea diagnosed mild OSA (oxygen desaturation index, ODI4 5–15) and 42 overweight snorers (ODI < 5) were enrolled in prospective Bhik Kotecha, Hesham Khalil controlled study. At baseline, cytokines were measured and Royal National Throat Nose and Ear Hospital, Grays Inn Road, compared between groups. London, UK Results: There were no significant differences in BMI, sex, Objective: Snoring is a common problem affecting approximately smoking, diabetes-, hyperlipidemia- or hypertension medications 40% of the adult population. Laser-Assisted Uvulopalatoplasty between groups. Adjustment for age was performed in statistical (LAUP), in particularly (Kotecha Technique 2006), was designed analysis because snorers were younger than OSA patients. TNFa to improve outcome and reduce postoperative complications and (P = 0.002) and hsCRP (P = 0.036) had a significantly higher morbidity. mean concentration in the A-group (1.7, SD 0.9; 2.3, SD 1.7) than Tatla et al. (2003) investigated the use of bipolar radiofre- in the C-group (1.3, SD 0.5; 1.8, SD 1.8). IL1 was higher RA quency technology (Celon, AG) in treatment of soft palatal (P = 0.000) in the A-group (528.5, SD 252.1) than the C-group snorers which produced significant improvement in snoring, and (365.3, SD 230.2). IL1b: group A = 0.19 (SD 0.07), group provides advantages including inherent safety, auto-stop energy C = 0.24 (SD 0.07); P = 0.000. IL6 levels didn’t differed from application and reduced procedure time. each other. The mean concentration of IL10 was 1.6 (SD 1.8) for In our study we are comparing the effect and morbidity of two A-group and 0.8 (SD 0.4) for C-group; P < 0.05. techniques, Laser Assisted Uvulopalatoplasty versus our new Conclusions: Both groups had elevated hsCRP levels, which technique of Celon Radiofrequency Procut Palatoplasty in ran- associate with moderate cardiovascular risk. The pro-atherogenic domly selected participates, assigned and agreed surgical soft hsCRP and TNFa were higher among mild OSA patients. Results palatal treatment mainly for snoring ± OSA. of other cytokines are ambiguous. Methods: A prospective Randomised Clinical Study. Fifty patients fulfilling inclusion and exclusion criteria randomly HL 172 assigned into two groups, the first group underwent the Kotecha The pillar implant in simple snoring patients technique of (LAUP), and the second group underwent Celon Bioplar Interstitial, procut palatoplasty technique. John de Carpentier, Ian Bruce, Zirca Rasul, and Karen Jepson Main outcome measures: Primary: Objective measures on repeated Lancashire Teaching Hospitals NHS Trust, Royal Preston sleep study at 3 months; subjective measures on repeated vali- Hospital, UK dated questionnaires, again including visual analogue scoring of Objective: To assess the effectiveness of pillar implants in the snoring, sleep quality and daytime somnolence, but also postop- reduction of snoring in a UK cohort of patients. To assess the erative pain. Secondary: With each procedure- acceptability, morbidity and complication rates of this technique. compliance, morbidity, side effects and complications. Methods: Forty patients were recruited from a snoring and sleep Results: We observed with the use of both techniques a statisti- disturbance clinic. All had preoperative domiciliary sleep studies cally significant (P < 0.05) improvements were observed in to exclude sleep apnoea. Data on age, sex, BMI, witnessed ap- snoring loudness, sleep quality and daytime somnolence in noeas and Epworth scores was collected. Each patient had three participating individuals. Both groups were comparable. pillar implants inserted into the soft palate close to the junction of Conclusion: Objective improvements in snoring intensity and the soft and hard palate under local anaesthetic in an out patient apnoea-hypopnoea indices were also demonstrated. High patient setting. All were assessed at three months with repeat sleep acceptability of and compliance with RFITT were noted, as was studies. Snoring reduction was assessed on visual analogue scores minimal patient morbidity.

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HL 174 rolled in a prospective non-randomized study. Standard surgical A prospective clinical study of simultaneous procedure for the hyoid myotomy was performed and a tita- nium expansion plate (Air-FrameTM System) was used to ex- multi-segmental application of bipolar radiofrequency pand the hyoid bone, increasing the lateral dimensions of the induced thermotherapy for snoring and obstructive hyoid bone. sleep apnoea Patients were evaluated with polysomnography (PSG), Epworth Sleepiness Score (ESS), Funcional Outcomes of Sleep Question- Hesham M. B. Khalil, Bhik Kotecha naire (FOSQ) and Spouse/bedpartner Survey (SBPS) pre-opera- Royal National Throat Nose and Ear Hospital, Grays Inn Road, tive, and again 3, 6 and 12 months post-operative. London, UK Results: At 3–12 month evaluations, AHI remained unchanged Objective: Habitual snoring can be a significant social issue, (26 to 25.9, n = 25) as measured by PSG. At 6–12 months, ESS affecting upto 40% of adults. Moreover, at times, it may be the decreased from 10.7 to 7.3 (n = 22) and FOSQ increased from only sign of obstructive sleep apnoea (OSA). The problem gen- 16.1 to 18.1 (n = 22). During the same period, SBPS showed a erally arises from dynamic collapse of one or more segments of 60% improvement with scores increasing from 25.7 to 41.2 the upper airway. Radiofrequency interstitial thermotherapy (n = 17). Four patients were cured with an AHI below 5 at (RFITT) has recently been developed as a minimally invasive 12 months follow-up. There were four adverse events and one option for snoring and OSA. The study designed to investigate the serious adverse event, all not device related. efficacy and effectiveness of the application of Celon bipolar Conclusions: These results indicate that the Airframe System is RFITT to the soft palate and tongue base simultaneously in pa- well tolerated with improvements in ESS, FOSQ and SBPS. The tients with snoring with or without OSA. AHI however remained unchanged. Further research is required Methods: Prospective non-randomised clinical study. Forty con- to determine the role of this treatment in the (multilevel) surgical senting patients were recruited, adhering to strict inclusion/ approach of OSA. exclusion criteria. Patients completed validated questionnaires preoperatively including visual analogue scoring of snoring, sleep quality and daytime somnolence. Patients received two sessions of Salivary Glands RFITT, via a Celon pro sleep generator, to both the soft palate and tongue base, under general anaesthesia. Each session was HL 176 separated by 6–8 weeks. Parotid pathology and outcomes of parotidectomies Main outcome measures: Primary: Objective measures on repeated sleep study at 3 months; subjective measures on repeated vali- in children dated questionnaires, again including visual analogue scoring of Sam Majumdar, Neil Bateman, Peter Bull snoring, sleep quality and daytime somnolence, but also postop- Sheffield Children’s Hospital NHS Trust, Sheffield, UK erative pain. Secondary: Acceptability of and compliance with procedure; side effects and complications. Objective: To determine the modes of presentation and spectrum Results: Statistically significant (P < 0.05) improvements were of parotid salivary gland pathology in children and outcomes of observed in snoring loudness, sleep quality and daytime somno- surgery. lence in participating individuals. Objective improvements in Methods: This is a retrospective review of parotidectomies in snoring intensity and apnoea-hypopnoea indices were also dem- children done over a 20 year period. The following data was re- onstrated. High patient acceptability of and compliance with corded: age at surgery, diagnosis, facial nerve function and com- RFITT were noted, as was minimal patient morbidity. plications. Conclusion: Bipolar RFITT is both efficacious and effective as Results: Fifty four patients, 32 girls and 24 boys, were identified. either primary multi-segmental treatment or adjunctive treatment The mean age at surgery was 6.5 years and the age ranged from for snoring and OSA. Naturally, careful selection of patients is of 1 month to 15 years. Overall, 40.7% of patients had inflammatory utmost importance. or infectious lesions, 14.8% had a congenital anomaly of the first branchial cleft with a cervico-aural fistula, 5.5% had benign sal- ivary neoplasms and 14.8% patients had malignant tumours. Two HL 175 patients presented with facial nerve palsy. Post operatively 52 patients had normal facial function. Two patients were left with a Lateral hyoid expansion for treatment of obstructive permanent marginal mandibular nerve weakness. The most sleep apnea common complication was development of a hypertrophied scar E. Hamans1, B. Stuck2, A. Baisch2, A. Boudewyns1, A. Devolder1, (12.9%). Other complications were haematoma (1), stitch abscess J. Verbraecken1, M. Willemen1, P. Van de Heyning1 (1) and great auricular neuroma (1). Two cases were of self lim- iting Frey’s syndrome. 1University Hospital Antwerpen, Belgium 2University Hospital Mannheim, Germany Conclusion: Infectious or inflammatory conditions are the most common lesions in this large series of paediatric parotid gland Objective: Obstructive Sleep Apnea (OSA) can be caused by col- surgery. Parotid neoplasms in children are less common than in laps of the lateral hypopharyngeal wall. The present study ad- adults; but there is a greater proportion of malignant disease. In dresses the safety and efficacy of a novel implantable device for this series, paediatric parotidectomy is associated with minimal lateral hyoid bone expansion in patients with OSA. morbidity with low risk of facial nerve damage. We conclude that, Methods: Twenty-six patients with OSA (apnea-hypopnea-index in experienced hands, parotidectomy in children is a very safe (AHI) between 15 and 50) and intolerant to CPAP, were en- operation with an acceptable level of morbidity.

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HL 177 extension and thickness of this layer. The aim of this study is to Nicotine: a potential risk factor for salivary gland evaluate the presence of the capsule, its histopathological char- acteristics, and its rilevance in the PA surgery, in terms of tumors? oncological radicality and complications. Thirty-three patients Christian Ginzkey, Katja Kampfinger, Gudrun Friehs, with PA were enrolled, 11 male (33%) and 22 female (67%), Rudolf Hagen, Norbert Kleinsasser aging between 22 and 72 years (mean 47.6 years); all subjects Otolaryngology, Head & Neck Surgery, Julius-Maximilian-Uni- were submitted between July 2004–2006 to the surgical procedure versity, Josef-Schneider-Str. 11, 97080 Wu¨ rzburg, Germany of nucleoresection. On the histomorphological examination it was always found capsular integrity of the PA; in the largest Nicotine is the major alkaloid in tobacco and causes addiction to tumors it appeared in some points thin (10 lm). These results smoking. Recently, genotoxic effects of nicotine in human fibro- comfirm the hypotesis that the lesion is enclosed by a layer of blasts, mucosal cells and lymphocytes were demonstrated. Due to fibrous tissue of various thickness but evident also on pseudo- elevated nicotine levels in saliva the cells of salivary glands are podes. The capsule is a valid clivage plane in conservative exposed more intensely. Hence, the present study focuses on techniques, like nucleoresection; this surgical procedure can possible genotoxic effects of nicotine on human parotid gland cells guarantee the same possibility of excision and recurrence rate in vitro. Separated single cells from parotid glands were exposed similar to superficial or total parotidectomy, with lesser compli- to nicotine in rising concentrations and periods. From the same cances and functional damage. probes, tissue cubes were cultured as miniorgans for one week followed by nicotine exposure as well. Possible genotoxic effects were determined with the single cell gel electrophoresis assay. A dose dependent enhanced DNA-migration induced by nicotine on HL 179 separated salivary gland cells could be shown. In contrast, minor Parotid function after selective deep lobe effects were seen after nicotine exposure of miniorgan cultures. parotidectomy The directly alkylating agent methyl-methane-sulfonate was used 1 1 1 as positive control and showed high DNA-migrations in both G. Colella , A. Giudice , D. Testa variations. The present results indicate genotoxic effects of nico- 1Department of Head and Neck Surgery - Second University of tine in human salivary glands. Thus, further studies concerning Naples other steps in xenobiotic induced salivary gland tumorigenesis are Selective deep lobe parotidectomy is a demanding technique, but warranted. The lower DNA-migration of cells harvested from it preserves healthy glandular tissue, improves cosmetic results miniorgans could be due to either a better protection of cells and minimises the incidence of Frey’s syndrome. We have evalu- growing in a tissue formation or a superior DNA repair system. ated postoperative function of the superficial lobe of the parotid The effectiveness of DNA-repair in miniorgans is subject of after selective resection of the deep lobe. Fourteen patients who ongoing studies. each had a mass involving the deep lobe of the parotid were se- lected from 127 patients with tumours of the parotid gland who HL 178 were seen and treated between January 2001 and March 2004. Of the 14, 12 matched the study criteria. The preoperative diagnosis Pleomorphic adenoma of parotid gland: significance was made using both computed tomography (CT) and ultrasound of capsule or fine needle aspiration cytology, and the diagnosis was con- firmed by histological analysis. All cases were treated by the same G. Motta1, G. Colella1, G. Guerra2, R. Iovine1, A. Giudice1, surgeon. At 6 months follow-up all patients had a House– D. Testa1 1 Brackmann test, iodine starch test, and scintigraphy of both Department of Head and Neck Surgery - Second University parotid glands. Semi-quantitative analysis was done by the same of Naples 2 radiologist. After scintigraphy the maximum uptake value and Department of Functional and Biomorphological Sciences - function of the gland were evaluated with the concentration index University of Naples ‘‘Federico II’’ (CI) and the CI percentage ratio: CI = (Maximum uptake Pleomorphic adenoma (PA) is the most common tumor of the value · background)/ background · CI percentage ratio = CI parotid gland (60–80%).This benign lesion is composed of epi- resected side/CI normal side · 100%. The concentration function thelial and myoepithelial cells, arranged with various morpho- of the gland in the resected side of the study group had a mean logical patterns and subtypes: the classification of this tumor is (SD) CI index of 5.5 (3.6) and a CI percentage ratio of 84%. based on the amount and nature of the stroma (myxomatous, Selective deep lobe parotidectomy has the following advantages: it chondroid, mucochondroid, etc.). In literature there are many minimises the impact of treatment on the facial contour, it does authors that suggest that PA is enclosed by a layer of fibrous not increase postoperative morbidity and it preserves the function tissue—capsule—but there is disagreement about the form, of the gland.

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HL 180 ligation increased the risk of nerve palsy in the distribution of Parotidectomy for benign parotid disease: outcome zygomatic and buccal branches. Operations for Warthin’s tu- mor were associated with an elevated risk of dysfunction of the and risk analysis cervical branch of the nerve. Half of patients had intraoperative Orlando Guntinas-Lichius1, C. Wittekindt1, J. Peter Klussmann2 facial nerve stimulation and this did not influence the likelihood 1ENT-Department, Friedrich-Schiller-University Jena, Germany of facial paresis. The recovery of facial nerve function showed a 2ENT-Department, University of Cologne, Germany biphasic distribution, with 90% of patients having normal function within 12 months, followed by a slower recovery rate Objective: Analyze outcome after standardized parotidectomy for for up to 2 years. benign parotid tumours and chronic parotitis. Conclusions: The incidence of postoperative complications was Methods: A retrospective unicentric study in a tertiary university influenced by the pathology, with inflammatory lesions signifi- centre of 963 lateral and total parotidectomies treated from 1986 cantly increasing the risk of facial nerve dysfunction and other to 2004. complications, but also by variations in surgical practice such as Results: Eighty-five percent of the cases were primary operations parotid duct ligation. Overall, the incidence of permanent facial (85%) and 15% revision operations. A lateral parotidectomy was paralysis was under 2%, but a temporary nerve palsy was com- necessary in 56% total parotidectomy in 34%, and modified pro- mon at 40%, with most patients regaining normal function within cedures in 10%. The incidence of transient facial nerve dysfunc- one year of the operation. tion, permanent weakness, and relevant Frey’s syndrome was 25, 6, 5%, respectively. Significantly more complications were seen after total parotidectomy and in revision cases. Significant univariate and multivariate risk factors for a transient facial palsy were HL 182 age >70 years, operation time >260 min, and a specimen volume >70 cm3. Prior surgery was a significant risk factor for develop- Ultrasound-guided Botulinum toxin type-A (Botox-A) ment of a permanent palsy. A significant risk factor for the injections for treatment of sialorrhoea in adults: development of Frey’s syndrome could not be estimated. For pa- a New Zealand study tients treated for recurrent pleomorphic adenoma, the risk of 1 2 3 clinically evident re-recurrence after 1 year, 5, 15 years were 16, 42, Subhaschandra Shetty , Patrick Dawes , Dean Ruske , Mohannad Al-qudah4, Brett Lyons5 and 75%, respectively. Female sex, young age at initial treatment, 1 and enucleation instead of parotidectomy for treatment of the first Otolaryngology-Head and Neck Surgeon, Whangarei Base Hospital, Whangarei, New Zealand recurrence were significant risk factors for re-recurrence. 2 Conclusions: Standardized lateral and total parotidectomy for Senior Clinical Lecturer and Consultant Otolaryngology-Head treatment of benign parotid disease is safe, and demonstrates a low and Neck Surgeon, Dunedin Public Hospital, Dunedin, New Zealand perioperative and long-term morbidity. Surgery of recurrent pleo- 3 morphic adenoma shows high facial nerve morbidity and a high Consultant Otolaryngology-Head and Neck Surgeon, Dunedin Public Hospital, Dunedin, New Zealand chance of re-recurrence. Extended parotidectomy seems to be the best 4 approach for the re-operation to reduce the risk of re-recurrence. Clinical Fellow in Otolaryngology-Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, Dunedin Public Hospital, Dunedin, New Zealand HL 181 5Clinical Leader and Head of the Department of MR Imaging, An analysis of complications following surgical Southland Hospital, New Zealand treatment of benign parotid disease Aim: To report our initial experience using ultrasound-guided Botox-A injection to the salivary glands to control sialorrhoea. S. A. R. Nouraei1, Y. Ismail2, M. S. Ferguson1, N. R. McLean3, 2 4 5 Methods: Eight adult patients with significant sialorrhoea were R. H. Milner , P. J. Thomson , A. R. Welch referred from an inpatient rehabilitation unit, GP referral, and 1 Department of Otolaryngology, Charing Cross Hospital, internal medicine department. All subjects underwent bilateral London, UK submandibular gland injections and, in addition, one patient (the 2 Department of Plastic Surgery, Royal Victoria Infirmary, first) also had intraparotid injections. Injections were performed Newcastle upon Tyne, UK with ultrasound guidance at Dunedin Hospital, New Zealand. Six 3 Institute of Craniofacial Studies, Adelaide, Australia patients received a total of 30 Units and two patients received 60 4 Department of Maxillofacial Surgery, Newcastle General Hos- Units in the submandibular glands without any complications. pital, Newcastle upon Tyne, UK Outcome was assessed using a drooling scale and VAS self report 5 Department of Otolaryngology, Freeman Hospital, Newcastle of sialorrhoea. upon Tyne, UK Results: Of the eight patients treated, six reported a marked Objective: To study the incidence of, and risk factors for developing reduction in salivation following treatment, and one patient im- complications following parotidectomy for benign disease, to im- proved partially. One patient did not find the Botox injection prove preoperative patient counselling and surgical management. helpful in controlling sialorrhoea and was offered escalation of the Methods: An 11-year retrospective review of 162 parotidectomies Botox dose with a subsequent partial response. No serious adverse for benign disease, collecting and analyzing data about presenta- events occurred, and no procedure-related complications were tion, investigations, surgical treatment, postoperative facial nerve noted. function, Frey’s syndrome, and other surgical complications. Conclusions: Our initial experience suggests that injection of Results: Mean age at presentation was 58 years. The commonest Botox-A injected at a relatively low dose to the submandibular pathology was benign pleomorphic adenoma (43%), followed glands can be used to achieve desired results for the treatment of by Warthin’s tumor (30%) and chronic sialadenitis (22%). sialorrhoea. This is an easily performed procedure with low Sialadenitis was a significant risk factor for facial nerve palsy, morbidity and can be recommended as a first-line intervention in and increased the incidence of salivary fistulae. Parotid duct the treatment of adult sialorrhoea.

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POSTERS hTERT were constructed. Cells were treated with shRNA expression vectors directed against hTERT mRNA and control vectors that included mismatched shRNA. HP 1 Results: We found that treatment of special shRNA expression Customized, defect specific scaffolds for Tissue vectors induced significantly decrease in hTERT expression, tel- Engineering in the means of reconstructive surgery omerase activity, and cell viability in Hep-2 and NEC cells. In contrast, the shRNA control showed none of these effects. And Dr. Staudenmaier Rainer, Blunk Thorsten, Eyrich Daniela, none of these effects appeared in hMSCs cells. Dr. Maier Gerhard, Wiese Hinrich, Wenzel Magdalene Conclusions: Our results suggest that shRNA against hTERT University Regensburg, Pharma Technology mRNA inhibits telomerase activity and cell viability through Tissue Engineering (TE) of cartilage for reconstructive surgery suppression of the hTERT expression in cancer cells. And this seems a promising option to gain tissue for 3D structures with a treatment has no side effect on healthy cells lack of telomerase minimal donor site morbidity. A specific defect needs a activity. RNA interfering technology may be a promising strategy customized implant because each tissue requires a specific scaffold for the treatment of cancers. with precisely defined properties which depend on physiological Keywords: Telomerase, Human telomerase reverse transcriptase, environment. For the creation of a custom-made implant the Short hairpin RNA, Cancer, Stem cells defect is detected via clinical CT data. Rapid prototyping tech- nologies offer the possibility to fabricate scaffolds accuratley according to these data. Thereto the CT data have to be processed into CAD data and they are turned, e.g. into STL data files which HP 3 can be feed into a Rapid Prototyping machine. RP technologies Overexpression of human 27 kDa heat shock allow to fabricate scaffolds with any geometric complexity, even protein in laryngeal cancer cells confers the inner architecture of the object can be varied in a defined manner and at a defined spot. Most TE srategies rely on the chemoresistance associated with cell growth delay application of resorbable 3D scaffolds to guide the growing tissue. Dong-Il Sun, Kwang-Jae Cho, Young-Hoon Joo, Jeong-Hae Cho, Since there had been no ideal biomaterial for Rapid Prototyping Min-Sik Kim, Jeong-Hwa Lee1 in Tissue Engineering we developed a totally new biomaterial Department of Otolaryngology-Head and Neck Surgery, The which enables us to create an individual scaffold for Tissue Catholic University of Korea, College of Medicine, Seoul 137-701, Engineering of cartilage. This two-component material, based on Korea polycaprolacton, builts up an interconnective foam, with a mechanical stability comparable to native cartilage. It shows Purpose: HSP70 and HSP27 have been implicated in tumorigen- homogenous 3D-structure, good cell adhaesion and biocompati- esis and chemoresistance, probably via the prevention of apop- bility. We evaluated first promising preliminary results for Tissue tosis. HSP27 levels are frequently increased in large populations of Engineering of cartilage. The combination of Tissue Engineering tumors of the head and neck, but the mechanism of its chemo- and Rapid Prototyping presents the basis for the realization of resistance is not yet fully understood. In the present study, the role customized implants. of HSP27 in the resistance to cytotoxic stress was studied in Hep-2 Keywords: Rapid prototyping, Tissue engineering, Scaffold, human laryngeal cancer cells. Polyurethane, Polycaprolacton Method: We established a Hep-2 cell line overexpressing HSP27 and examined whether the expression of HSP27 provides resis- HP 2 tance to heat shock and several cytotoxic agents using a MTT colorimetic assay. Cell cycle progression was assessed by flow Inhibition of telomerase activity in cancer cells using cytometry and fluorescence staining was performed for F-actin short hairpin RNA expression vectors filaments. Results: HSP27 overexpression induced cellular resistance to Shi-Ming Chen, Ze-Zhang Tao, Hong-Gang Duan, Jie Cheng, heat shock at 45C for 1 h as well as against several cytotoxic Bo-Kui Xiao agents. However, no difference in sensitivity to irradiation or Department of Otolaryngology-Head and Neck Surgery, serum starvation was found. Moreover, HSP27 overexpressing Renmin Hospital of Wuhan University, Wuhan 430060 China Hep-2 cells showed a delayed cell growth, compared to control Objective: Telomerase activity is mainly regulated by the human cells. The synchronized Hep-2 cells were resistant to cisplatin telomerase reverse transcriptase (hTERT) gene. Our objective was and H2O2, but not to irradiation or serum starvation, corre- to investigate the effect of short hairpin RNA (shRNA) directed lating the protection effect shown in HSP27 overexpressing against hTERT mRNA on telomerase activity in laryngeal cancer cells. cells (Hep-2), nasopharyngeal carcinoma cells (NEC) and human Conclusions: These results suggest that the overexpression of bone marrow mesenchyme stem cells (hMSCs). Design Short HSP27 in Hep-2 cells confers chemoresistance which is associated hairpin RNA expression vectors targeting the messenger RNA of with the delay in cell growth.

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HP 4 chromosomal region 3q26-3q28 in histologically normal mucosa The prognostic impact of bcl-2 expression adjacent to tumor samples, thus confirming the presence of molecular dysplasia and its possible role in early cancerogenesis. on advanced nasopharyngeal carcinomas Gain of genetic material is frequent in tumorsurrounding mucosa Mu-Kuan Chen1,2, Jui-Chung Lai1 and indicates the overexpression of oncogenes. To evaluate the role 1Department of Otorhinolaryngology, Head and Neck Surgery, of putative oncogenes of early cancerogenesis of HNSCC we ap- Changhua Christian Hospital, Changhua, Taiwan plied real-time PCR on a study group of 12 patients with HNSCC. 2Department of Respiratory care, Chang Jung Christian Univer- Samples of tumor, nonmalignant mucosa 1 and 2 cm away from sity, Tainan, Taiwan the tumor margins and mucosa samples excided more than 10 cm from tumor margins as a reference tissue were proceeded in a real- Objective: Nasopharyngeal carcinoma (NPC) is generally sensi- time PCR.. Five microassays were used, including the following tive to radiotherapy. However, the prognosis is still poor in genes: PIK3CA, TP73L(TP63), WIG1, ECT2 and SKIL. The advanced cases. The purpose of this study is to evaluate the overexpression in tumor samples was shown in all genes investi- prognostic impact of bcl-2 expression on patients with advanced gated, whereas the significantly higher expression in tumor adja- NPC. cent histologically normal tissue samples compared to normal Methods: One hundred and five advanced NPC treated with high mucosa was evident only in TP73L, thus indicating its possible role dose radiotherapy with or without chemotherapy were included in in early cancerogenesis in HNSCC. The value for the diagnosis and this study. The relationship between the bcl-2 expression, TNM prognosis will have to be proven in follow-up studies. stage, and the disease-specific survival was analyzed. Results: Forty-eight patients were stage III and 16 (33.3%) of them were bcl-2 positive. The disease free survival was similar HP 6 early after treatment but diverged after 2 years, with the dif- ference favoring the negative bcl-2 expression (P = 0.06). Fifty- Expression of metalloproteinases MMP-2 seven patients were stage IV and 24 (42.1%) of them were bcl-2 and MMP-9 in salivary gland tumors positive with poorer prognosis. The disease free survival of stage Nicholas S. Mastronikolis1, Theodoros Papadas1, IV NPC with negative bcl-2 expression was paradoxically better Panagiota Ravazoula2, Maria Gkermpesi1, than that of stage III NPC with positive bcl-2 expression. In the Dimitrios Chorianopoulos1, advanced NPC, the disease-free survival of stage III patients Panos D. Goumas1 was better than that of stage IV patients but the difference was 1Department of Otorhinolaryngology, University Hospital of not significant (P = 0.06); in contrast, patients with bcl-2 po- Patras, Patras, Greece sitive tumors had a worse disease-free cumulative 5-year survival 2Department of Pathology, University Hospital of Patras, Patras, (29.9%), and the difference was statistically significant Greece (P = 0.02, adjusted for chemotherapy). Conclusions: In advanced staged (III and VI) NPC, bcl-2 Objective: Matrix metalloproteinase (MMPs) are involved in expression represented an important prognostic factor of extracellular matrix turnover. MMPs belong to a family of zinc- treatment outcome. The 5-year disease-free survival rate of dependent endopeptidases and are classified according to their patients with positive bcl-2 expression was only 29.9%. Patients substrate specificity. Although MMPs are among the potential key with positive bcl-2 expression should be treated more aggres- mediators of cancer invasion, their involvement premalignant le- sively. sions is not clarified. The aim of our study were to evaluate the expression of gelatinase A (MMP-2) and gelatinase B (MMP-9) in benign and malignant salivary gland tumors. HP 5 Methods: We examined immunohistochemically formalin-fixed, paraffin-embedded tumor samples from 70 patients with ploe- Gene-expression study of putative oncogenes morphic adenoma (48/70), Warthin tumors (17/70), and muco- harbouring chromosomal region 3q26-28 in HNSCC epidermoid carcinomas (5/70) for MMP-2 and MMP-9. Results: Cytoplasmic MMP-2 staining was detected in epithelial Kastner J1,2, Betka J1, Brieger J2, Zima T3, Mann WJ2 cells of 36 out of 48 pleomorphic adenomas, all Warthin tumors, 1Department of Otorhinolaryngology and Head and Neck Sur- as well as in fibroblasts and endothelial cells in the tumors. MMP- gery, 1st Faculty of Medicine, Charles University, Prague, Czech 9 cytoplasmic staining was detected in myooepithelial cells of 32 Republic out of 48 pleomorphic adenomas, in epithelial cells of 15 out of 17 2Tumor Biology Laboratory, Department of Otorhinolaryngol- Warthin tumors and in inflammatory cells of stroma. Nuclear ogy and Head and Neck Surgery, Mainz Medical School, Gut- immunostaining for MMP-9 was also detected in epithelial cells of tenberg University, Mainz, Germany some pleomorphic adenomas. In mucoepidermoid carcinomas 3Institute of Clinical Biochemistry, 1st Faculty of Medicine, MMP-2 and MMP-9 were alsoimmunoexpressed in squamous Charles University, Prague, Czech Republic malignant component. In our gene expression study we continued our previous molecular Conclusions: MMP-2 and MMP-9 expression is an early event in studies on head and neck squamous cell carcinoma (HNSCC) salivary gland tumorigenesis suggesting roles of MMPs in tumor which had shown the evidence of fine molecular aberrations of initiation in addition to invasion.

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HP 7 cytotoxicity requires Toll like receptor 7 (TLR7). Increased Oxidative DNA damage in human cells expression of NK cell TLR7 was shown in response to ss-is- RNA. These results suggest ss-isRNA as a potential immu- and the protective potential of vitamin C and zinc nostimularory tool of human NK cells against HNSCC. P. Baumeister, T. Hu¨ bner, C. Matthias, U. Harre´ us Department of Otolaryngology/Head and Neck SurgeryLudwig- Maximilians-University Munich, Germany HP 9 Induction of c-Myc dependent cell proliferation Objective: Oxidative DNA damage plays an important role in upper aerodigestive tract carcinogenesis. Reactive oxygen species through TLR3 in head and neck cancer deriving from cell metabolism and environmental substances Lisa Hogrefe, Ralph Pries, and Barbara Wollenberg cause DNA strands breaks and gene modification. Whereas epi- Department of Otorhinolaryngology, University of Schleswig- demiologic studies suggest, that diets rich in fruits and vegetables Holstein Campus Lu¨ beck, Ratzeburger Allee 160, 23538 Lu¨ beck, lower the risk for head and neck cancer, there is a lack of sup- Germany porting experimental data. This study provides the evaluation of the DNA protective potential of vitamin C and zinc against oxi- Protein expression of human Toll-like receptors (TLR) 1–10 was dative DNA damage. measured in cell lines and solid tumors of head and neck squa- Methods: Miniorgan cultures (MOCs) were cultivated from mu- mous cell carcinoma (HNSCC). All HNSCC cell lines and 80% of cosa specimens of human nasal turbinates. The MOCs were solid tumors were found to express TLR3 as a predominantly incubated on three consecutive days for 30 min with vitamin C intracellular protein, while no other TLR proteins were expressed. (10, 100 lM) and zinc chloride (10, 100 lM) respectively. On day TLR3 has previously been shown to contribute to the activation of NF-jB, a transcription factor which promotes several kinds of 3 oxidative DNA damage was introduced to the MOCs by H2O2 (200 lM, 30 min). DNA strand breaks were detected using the human cancers. Significantly, NF-kB expression was strongest in formamidopyrimidine glycosylase comet assay, a highly sensitive protein extracts from carcinoma tissue in which TLR3 was over- method for the evaluation of oxidative DNA damage. expressed. Inhibition of TLR3 expression in permanent HNSCC Results: Pretreatment with vitamin C (10 lM, 100 lM) reduced cell lines resulted in decreased expression of the oncoprotein c- Myc resulting in decreased cell proliferation. Correspondingly, the H2O2 induced DNA damage by 56 and 60%, respectively. Oxidative DNA damage was diminished by 57 and 60%, when overexpression of human TLR3 in mouse fibroblasts resulted in preincubated with zinc chloride (10 lM, 100 lM). an upregulation of c-Myc and increased sensitivity for PolyI:C Conclusion:Generally a vitamin and trace element rich diet is induced cell proliferation. Our data suggest that TLR3 contributes useful since upper aerodigestive tract cells are constantly affected to the malignant phenotype leading to invasive carcinoma in by oxidative stress. This can not only lead to carcinogenesis but HNSCC. also supports upper aerodigestive tract infections. Based on our results, dietary supplementation with vitamin C and zinc should be recommended for head and neck cancer patients. HP 10 Functional alteration of myeloid dendritic cells through head and neck cancer HP 8 Up-regulation of NK cell function against head and Henning Frenzel, Ralph Pries, Barbara Wollenberg Department of Otorhinolaryngology, University of Schleswig- neck cancer in response to ss-isRNA requires TLR7 Holstein Campus Lu¨ beck, Ratzeburger Allee 160, 23538 Lu¨ beck, Ralph Pries, Sandra Wulff, Rebecca Kesselring, and Barbara Germany Wollenberg Background: In head and neck squamous cell carcinoma Department of Otorhinolaryngology, University of Schleswig- (HNSCC), the secretion of various immunosuppressive mediators Holstein Campus Lu¨ beck, Ratzeburger Allee 160, 23538 Lu¨ beck, contributes to large-scale effects on the immune functions. The Germany influence of HNSCC on various cellular functions of human Natural killer (NK) cells play a crucial role in the innate myeloid dendritic cells (MDC) was analyzed in this work. immunity as effectors against tumor cells and pathogen-infected Materials and methods: MDCs were isolated from peripheral cells. NK mediated host defence against tumor cells is strongly blood by ‘magnetic bead separation’. Cellular functions were impaired in patients with head and neck squamous cell carci- analyzed using flow cytometry, migration- and ELISPOT assays noma (HNSCC). Tumor secretion of various immune suppres- as well as cytokine detection assays. sive mediators contributes to massively affected immune Results: HNSCC massively affects MDCs to induce effective functions. Here we demonstrate that NK cell cytotoxicity T-cell responses. Analysis of MDC migration and cytokine against tumor cells of HNSCC can be efficiently stimulated by secretion revealed that HNSCC triggers the production of tumor- single stranded immunostimulatory RNA (ss-isRNA). Stimula- promoting and immunosuppressive cytokines IL-1 and IL-10 and tion with ss-isRNA results in an increased production of results in an increased MDC migration activity. CpG-ODN is able interferon-c (IFN-c) and effector proteins perforin and gran- to act contradictory to HNSCC. zyme B. Our investigations reveal that supernatants of perma- Conclusion: HNSCC is able to modulate various functions of nent HNSCC cell lines negatively affect the ss-isRNA triggered human MDCs. CpG-ODN is suggested as a potential immuno- stimulation of cytolytic NK cell functions. Stimulation of stimulatory agent of human MDC.

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HP 11 Methods: Eighty-four paraffin-embedded tissues of various head Oxidative stress and tumor grade in HNSCC and neck specimens including nasopharynx,oral cavity, larynx and skin were examined for the presence of LMP-1 gene, using poly- R. Salzman1, R. Kostrˇica1,L.Pa´ cal2, K. Kanˇkova´ 2, J. Tomandl3, merase chain reaction. 1 Z. Hora´ kova´ Results: Ten of twelve nasopharyngeal biopsies and 8 of 10 1Clinic of Otorhinolaryngology and Head and Neck Surgery of St. specimens from metastatic lymph nodes of the same NPC were Anne’s University Hospital in Brno positive for LMP-1 gene. The LMP-1 gene was detected in met- 2Department of Pathological Physiology, Masaryk University, astatic lymph nodes of NPC with a sensitivity of 80%,specificity Brno of 100%,positive predictive value of 100% and negative predictive 3Biochemical Department of Medical School of Masaryk Uni- value of 91%. On the contrary after application of PCR,the LMP- versity, Brno 1 gene was not detected in any samples of other head and neck Oxidant-antioxidant status is supposed to play an important role in carcinomas,their metastatic nodes and tonsillar specimens. There cancer development. The aim of the study was to investigate a was a significant association between the presence of LMP-1 gene relationship among activities and levels of glutathione peroxidase and tumor location in nasopharynx (P < 0.0001). (GPx), malondialdehyde (MDA); Pro197Leu polymorphism in the Conclusion: The study demonstrated that the presence ofLMP-1 gene encoding GPx1 and the stage and grade of the head and neck gene detected by PCR in metastatic tumor cells is only significantly squamous cell carcinoma (HNSCC). Prospective cohort study associated with tumor location in nasopharynx and EBV has no comprised 88 patients after surgery for HNSCC. Genotypes were essential role in the tumorigenesis of carcinomas arising from other detected by PCR-based methodology. Activity of GPx in erythro- head and neck sites. The polymerase chain reaction method is a cytes (GPx-ery) and alveolar macrophages (GPx-AM) and TNFa potential tool for localizing primary site of a cervical metastatic were determined by ELISA, and MDA concentration by high per- cacinoma. formance liquid chromatography. Non-parametric Mann–Whit- ney, Kruskal-Wallis ANOVA, Spearman correlation tests and v2- HP 13 test were used for comparison of parameters. Our study revealed The correlation of cytokeratin antigens expression higher activity of GPx-ery in T1-2 patients compared to T3-4 in lymph nodes with the morphological features (P = 0.03, Mann-Whitney). Tumor grade negatively correlated with plasmatic GPx level (P = 0.02), MDA (P = 0.05) and posi- of the tumor front in laryngeal carcionoma—the tively correlated with GPx-AM (P = 0.001), GPx-ery (0.12, prognostic significance of the Anneroth, Batsakis Spearman). The frequencies of GPx alleles were 62.1 and 37.9% and Lunas’ classification in the presence (Pro/Pro 45.5%, Pro/Leu 33.3%, Leu/Leu 21.2%). Genotype fre- of micrometastases quencies were in agreement with HW equilibrium (P > 0.05, v2 test). Genotype and allele frequencies of the Pro197Leu did not Katarzyna Starska1, Marek ukomski1, Iwona Lewy-Trenda2 differ between groups defined according to the stage of primary 1Medical University Lodz, Department of Otolaryngology and disease (TNM). Carriers of Pro/Pro genotype manifested elevated Laryngeal Oncology, Poland plasmatic level of GPx (P = 0.03) and decreased activity of GPx- 2Medical University Lodz, Department of Patomorphology, AM (0.04, Kruskal-Wallis). In conclusion, our results suggest that Poland GPx plays an important role in cancer development and shows Introduction: Lymph nodes estimated as pN0 in conventional correlation with oncologic parameters of HNSCC. morphological studies could have focuses of carcinoma cells with The project is supported by grants NR/7996-3 and NR/9200-3 a diameter of £2 mm referred to as micrometastases (pN+) which from The Internal Grant Agency of The Ministry of Health of could be cause of nodal recurrence and poorer survival. New Czech Republic. clinico-morphological features are still being assessed in order to find prognostic factors in laryngeal carcinoma which allow to predict the presence of micrometastases as well. HP 12 Materials and methods: To presented the direct correlation between The comparison of the presence of Epstein–Barr virus the morphological features of tumor acc. to the classification of derived latent membrane Protein-1 gene In cervical Anneroth, Batsakis and Luna and the probability of micrometas- tases we have analyzed 22 patients operated for squamous cell metastatic lymph nodes of patients with head and neck carcinoma of the larynx at the ENT Department of the Medical carcinoma University of Lodz between 1998 and 1999. The total score of Bijan Khademi*, Jalal Mahmoudi*, Ahmad Monabati**, classification and particular features were analyzed with the pres- ** ence of micrometastases as assessed by immunohistochemical Mohammad J. Ashraf methods with a panel of cytokeratin antigens (CK 4,6,8,10). *From the Department of Otolaryngology, Head and Neck Results: Our study showed that the total morphologic score is very surgery, Khalili Hospital useful in the prediction of micrometastases in patients with lar- ** Department of Pathology, Shiraz University of Medical yngeal squamous cell carcinoma of the larynx. The statistical Sciences, Shiraz -Iran analysis has revealed a significant correlation between the total Background: cervical lymphadenopathy is occasionally of un- score, the mode of invasion and the depth of invasion. known origin and Nasopharyngeal carcinoma (NPC) closely Conclusions: The results of our study suggest that it is necessary to associated with Epstein-Barr Virus which is frequently related extend traditional patomorphologic evaluation by a number of with malignant cell transformation through the action of the on- features from the classification of Anneroth, Batsakis and Luna coprotein latent membrane protein -1(LMP -1). which could aid the diagnosis of micrometastases and thus might Objective: In this retrospective study the presence of EBV-derived influence therapeutic decisions and eventually lead to more LMP-1 gene in nasopharynx and metastatic nodes of nasopha- appropriate and individualized therapy. ryngeal, oral cavity, laryngeal and skin cancers & non malignant Keywords: Laryngeal carcinoma, Anneroth, Batsakis and Lunas’ tonsil of patients were compared. classification, cytokeratin filaments, micrometastases

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HP 14 day was administered intravenously to nine patients after partial Production of cytokines by peripheral blood laryngectomy and 13 patients after total laryngectomy. lymphocytes T under influence in vitro of squamous Results: Complications were observed in five out of the seven cases treated by partial laryngectomy without PGE1 adminis- cell carcinoma of the larynx tration, while no complications were observed in the nine cases Katarzyna Starska1, Marek ukomski1, Henryk Tcho´ rzewski2, treated with PGE1 postoperatively. On the other hand, compli- Ewa Gowacka2 cations including major leakage were observed in six out of the 1Medical University Lodz, Department of Otolaryngology and 15 patients who underwent total laryngectomy without PGE1 Laryngeal Oncology, Poland but no complications were observed in the 13 patients who re- 2Insitute of Mother’s Health Lodz, Department of Immunology, ceived PGE1 administration. Frequencies of complications of the Poland patients with PGE1 administration were significantly lower than that of the patients without it (P = 0.0001). Moreover, duration Introduction: The most important mechanism of host humoral of hospital stay was significantly shorter in the patients treated immunity in antitumor response is cytokines activity produced by with PGE1 administration than those treated without it T lymphocytes. It is well known that peripheral blood lympho- (P = 0.005). cytes from patients with advanced-stage cancer have a poor im- Conclusions: PGE1 administration is useful and effective for pa- mune. The aim of this study was estimation of IL-6, IL-8, IL-10 tients who underwent laryngeal surgery after radiation failure to and TNF-a serum concentration in patients with squamous cell eliminate the risk of postoperative complications and maintain the laryngeal carcinoma and analysis of indirected influence of neo- quality of life of patients. plasm cells to the function of T lymphocytes and modification of cytokines profile. Materials and methods: For analysis of cytokine secretion the cultures of isolated peripheral blood lymphocytes, isolated cen- HP 16 trum and margin neoplasm cells and noncancerous cells were Study of the polymorphisms genes (SNP), responsible established. Production of cytokines in supernatants was detected for tobacco metabolism in patients diagnosed by Elisa. In study the serum concentrations was correlated with clinicopathological features of primary tumor. with head and neck cancer Results: Authors reported that in vitro laryngeal squamous car- Jaime Comas Julia1, Marta Amat Soley1, Mariano Monzo2, cinoma cells modified T lymphocytes activity and production of Xavier Perich Alsina3, Palmira Foro Arnalot4, Angel Gayete cytokines. The presence of carcinoma cells in lymphocyte culture Cara3, Joan Fontane Ventura1, Joan Carles Galceran5 may increase concentration of TNF-a especially with margin 1Hospital del Mar. E.N.T. Department, c/Diagonal 299, cells and decrease IL-6 and IL-8 commonly with centrum cells. 3-1ª 08013 Barcelona, Spain The serum concentrations of cytokines IL-6, IL-8 were found to 2Barcelona University, Biologic Molecular Laboratory, Barce- be weakly correlated with pathological features of primary tu- lona, Spain mor. 3Hospital del Mar, Radiologic Department, Barcelona, Spain Conclusions: We conclude that cytokines important in proin- 4Hospital del Mar, Radioterapeutic Department, Barcelona, flammatory and proangiogenic responses are detected in tissue Spain specimens and serum from patients with advanced-stage laryngeal 5Hospital del Mar, Oncologic Department, Barcelona, Spain cancer and may be useful as biomarkers for therapy. Objectives: The polymorphism genes variations condition the different answer to the treatments, as well as different toxicity. In HP 15 this study is analysed the importance of these polymorphism genes related with the tobacco in patients with Head and Neck cancer PGE1 makes no complications in post-radiation treated with surgery. laryngeal surgery Methods: A retrospective study achieved in 108 patients with Head and Neck cancer treated with surgery as first therapeutic Kiyoto Shiga, Masaru Tateda, Kazuto Matsuura, Shigeru Saijo, treatment, And analysed different polymorphisms genes changes Toshimitsu Kobayashi EPOXH-122, EPOXH-40, NAT-2-1-30, CYP1B1-07 and Department of Otolaryngology-Head and Neck Surgery, Tohoku CYP1B1-58. The alelic discrimination technique was used. University Hospital, Department of Head and Neck Surgery, Results: Clinic stage: I 33 (39.3), II 14 (16.7), III 17 (20.2), IV 20 Miyagi Cancer Center Hospital (23.8), Location: larynx 20 (23.8), hypopharynx 3 (3.6), oral cavity Objective: Some of the patients in whom radiation therapy has 35 (41.7), oropharynx 13 (15.5), nasal cavity 5 (6), unknown lo- failed to control the laryngeal cancer, surgery represents a sal- cated 8 (9.5). The genes are: NAT 2-1-30 (CC 27, CT 29, TT 6), vage option. However, there is an increased incidence of post- NAT 2-2-31 (AA 59), EPOHXI-22 (AA 44, AG 14, GG2), EP- operative complications in such patients compared with those OHX-40 (GG 29, GA 33, AA 1), CYP1B1-07 (TT 34, TC 21, CC treated with initial surgery. The aim of this study is to examine 8), CYP1B1-58 (AA 32, AG 20, GG 9). the usefulness and efficacy of PGE1 administration after lar- Conclusions: No relationship was found among the age of diag- yngeal surgery in patients who were previously treated by radi- nosis in the polymorphisms genes studied. But relationship among ation therapy. cancer time progression and the expression of heterozigotic Methods: Our method was retrospective chart review of the 16 polymorphisms for the genes NAT-2-1-30, EPOXH-22 and for the patients who underwent partial laryngectomy and 28 patients who CYP1B1-07 (SNP) were reported. No foundings between patient underwent total laryngectomy. In these patients, PGE1 at 120 lg/ survival and the different polymorphimsgenes.

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HP 17 Methods: Tracheas of donor rats were removed and the distal end Current promising molecular markers in head was ligated. LPS or control medium (Ham’s F-12) was instilled into the lumen and the proximal end was ligated. The tracheas and neck squamous cell cancer were then homografted subcutaneously on the back of recipient Jan Plza´ k1, 2, 3, Martin Chovanec1, 2, 3, ZdeneˇkCˇada1, 2, rats and maintained for 4 weeks. CAM and dexamethasone was Jan Betka1, Karel Smetana Jr.2, 3 administered orally, or intraperitoneally, respectively, for 4 weeks. 1Department of Otorhinolaryngology and Head and Neck Sur- The implanted trachea was dissected from recipient rats and the gery, 1st Faculty of Medicine, Charles University, Faculty Hos- mucus in the homografted trachea was collected and analyzed. pital Motol, V U´ valu 84, 150 06 Prague 5, Czech Republic Histological examination was performed both in homografted 2Institute of Anatomy, 1st Faculty of Medicine Charles Univer- tracheas and tracheas of recipient rats (normal tracheas). sity, Unemocnice 3, 128 00 Prague 2, Czech Republic Results: The mucus amount was significantly higher in the trachea 3Center for Cell Therapy and Tissue Repair, 2nd Faculty of with LPS than that with the control medium. Oral administration Medicine, Charles University, Faculty Hospital Motol, V U´ valu of CAM for four weeks significantly reduced mucus amount in the 84, 150 06 Prague 5, Czech Republic LPS administered homografted trachea. Dexamethasone also re- duced mucus volume in the LPS treated homografted trachea Objective: Mortality rates of head and neck squamous cell carci- significantly. The spinability of mucus in LPS treated trachea was noma (HNSCC) have not changed despite recent advances in significantly higher than that of mucus in the trachea containing surgical treatment, radiotherapy and chemotherapy regimens. control medium. There was no morphological difference between Molecular identification of tissue biomarkers may not only iden- normal tracheas and the trachea with control medium. On the tify patients at risk for developing HNSCC but may also select other hand, goblet cell metaplasia was observed in LPS. Systemic patients that may benefit from more aggressive treatment administration of dexamethasone remarkably inhibited the goblet modalities thus improving treatment results. cell metaplasia. Methods: PubMed survey using keywords ‘‘molecular marker Conclusions: This animal model is useful for the study to evaluate head and neck squamous cell carcinoma’’ in combination with our the mucus property and to examine the effect of drugs on mucus. previous research work in this field were performed for analysis of the most promising biomarkers. Results: Sixty-six related papers were found in PubMed database HP 19 from 1989 till January 2007. A lot of various interesting biomar- kers of HNSCC have been so far investigated. The most prom- Lymphocytes infiltrating laryngeal carcinomas ising ones seem to be epidermal growth factor receptor, vascular overexpress growth factor receptor, p16, p53, cyclin D1, Cox-2 enzyme, matrix NF-jB metalloproteinases, etc. that could be use for the benefit of 1 1,2 HNSCC patients. Theodoros Papadas , Konstantinos Kourelis , Georgia 2 2,3 1 Conclusions: Some progress has been made with respect to Sotiropoulou-Bonikou , Gerasimos Vandoros , Panos Goumas 1 molecular markers and head and neck squamous cell carcinoma. Patras University Hospital, Department of Head and Neck Translational and prospective, hypothesis-driven research must Surgery, Rio-Patras 2 proceed to facilitate the clinical applicability of such results. Patras Medical School, Department of Anatomy, Rio-Patras 3 Acknowledgments: Supported by the National Research Program Aegion General Hospital, Department of Pathology. II No. 2B06106: Novel genomic and biotechnological practice in Objective: Squamous cell carcinomas (SCCs) of the larynx are molecular oncology: Towards early diagnosis and targeted commonly surrounded by a mixed population of lymphocytes therapy. (Tumor Infiltrating Lymphocytes, TILs), which participate in the immune response against tumors, but also seem to promote neoplasms’ aggressiveness. Nuclear Factor-jB (NF-jB) is a fun- HP 18 damental transcription factor involved in lymph cell maturation. Effects of drugs on mucus production in homographted Our aim was to assess its presence in laryngeal TILs. rat trachea Methods: Our clinical material is comprised of biopsy samples 1 2 1 from 95 laryngeal cancer patients and 32 controls (normal and Masako Ishikawa , Takeshi Shimizu , Kazuhiko Takeuchi , premalignant). Paraffin-section immunohistochemistry was uti- Yuichi Majima1 1 lized, to detect the p65 subunit of NF-jB. Department of Otorhinolaryngology-Head & Neck Surgery, Mie Results: NF-jB demonstrated intense cytoplasmic immunostain- University Graduate School of Medicine 2 ing in the lymphocytic population. Malignant invasion was sig- Department of Otorhinolaryngology, Shiga University nificantly associated with the presence of NF-jB-positive of Medical Science lymphocytes (P < 0.001). However, no correlation was estab- Objectives: In order to examine the effect of drugs on mucus, we lished between SCC Grade and NF-jB expression in TILs. developed an animal model which produce tracheal mucus in the Conclusions: NF-jB overexpression in TILs surrounding laryngeal homografted rat trachea. The effects of clarithromycin (CAM) tumors might account both for their defensive potential as well as and glucocorticoid on the mucus production was examined. their recently described tumor-promoting capacity.

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HP 20 Methods: Quantitative reverse-transcription polymerase chain In vitro activity of HPMA-based targeted conjugates reaction (Q-RT-PCR) and immunohistological staining (IS) was used to detect CXCR4 and SDF-1 in normal mucosa and lymph against HNSCC nodes, primary tumor and lymphatic metastasis. The tissue sam- J. Boucek1,2, J. Betka1, J. Strohalm3, D. Plocova3, ples were collected from previously untreated patients who V. Subr3, T.Mrkvan2, O. Hovorka2, K. Ulbrich3, B. Rihova2 underwent surgical procedures. We had overall 22 patients, 1Department of Otorhinolaryngology, Head and Neck Surgery, including 19 hypopharyngeal and three laryngeal cancer. 15 pa- The First Medical Faculty, Charles University, University Hos- tients presented metastatic lymph nodes on the neck (pN+ pital Motol, V Uvalu 84, 150 06, Prague 5, Czech Republic group), confirmed by histopathological analysis. In seven cases 2Institute of Microbiology, ASCR, Videnska 1083, 142 20, Prague there was no regional spread (pN0 group). 4, Czech Republic Results: CXCR4 was expressed in primary HNSCC and normal 3Institute of Macromolecular Chemistry, ASCR, Heyrovsky sq. 2, mucosa. The strongest expression was in the corresponding meta- 162 06, Prague 6, Czech Republic static cancer tissue. We found no significant correlation between the initial tumor stage and the CXCR4 expression in primary HNSCC Objective: Overexpression of EGFR is typical for head and neck tumor. The highest expression level of CXCR4 in primary tumors squamous-cell carcinoma (HNSCC). We have chosen EGFR for was found in the cases with advanced neck metastasis (pN2a, b, c), targeting of polymeric prodrugs in order to improve their efficacy. but the difference from pN0 group was not significant (P = 0,15 Water-soluble synthetic polymers based on N-(2-hydroxypro- Mann–Whitney test). Expression level of CXCR4 in primary tu- pyl)methacrylamide (HPMA) are recognized as useful carriers in mors tends to be greater in the pN+ group than in the pN0 group, targeted drug delivery. As already published by many groups, but the difference was statisticaly not significant (P = 0,24). conjugation of the drug dramatically reduces its adverse effect. SDF-1 ligand expression of the primary tumor is down-regulated. Methods: The FaDu cells were used as a model line for head and Conclusions: Primary tumor CXCR4 expression is a possible neck carcinoma. The capacity of the conjugate to bind to the cell predictive marker of lymphatic metastasis in patients with surface of the cancer cells expressing EGFR was measured by flow HNSCC. Further investigations are needed with a bigger set of cytometry (FACS). We tried to evaluated the importance of patients to clarify the role of CXCR4/SDF-1 chemokine system in receptor mediated endocytosis for internalization of tested con- the progression of HNSCC. jugates by fluorescent microscopy, by FACS kinetic measurement and by modified cytotoxic test. Results: We proved that both conjugates containing antibodies HP 22 (either specific mAb or non-specific HuIg) had the same rate of The prognostic value of CYFRA 21-1 in stage II-III internalization. We also proved that preincubation with relevant squamous cell carcinoma of the larynx and its role antibody, even in redundancy, did not influence the uptake of the targeted therapeutics, even though it blocs the specific bind to the in early detection of recurrences cell surface. A. Eleftheriadou1, T. Chalastras1, I. Yiotakis3, Z. Pappas1, Conclusion: Targeted conjugates containing a cytotoxic drug L. Kyriou2, E. Ferekidou3, G. Papacharalampous3, D. Kandilo- (doxorubicin) bound to a polymeric backbone targeted with anti- ros3 EGFR monoclonal antibody represent a novel modality in man- 1Department of Otolaryngology, G Gennimatas Hospital, Athens agement of cancers. Our recent data indicate that receptor medi- 2Department of Biochemistry, Evangelismos Hospital, Athens ated endocytosis is not the main mechanism of the uptake of 3Department of Otolaryngology, University of Athens, Hippok- antibody-targeted polymeric prodrugs. We have been studying the ration Hospital details of the process of internalization. Acknowledgment: The research was supported by CSF 310/03/ Objective: To investigate whether assessment of changes in serum H147 and by CSF 305/05/2268. CYFRA 21-1 in stage II and III squamous cell carcinoma (SCC)of the larynx patients is correlated with the clinical outcome during prolonged follow up. HP 21 Methods: Thirty-four patients with SCC of the larynx were included CXCR4 chemokine receptor and SDF-1 chemokine in this study. Fourteen were in stage II and 10 in stage III.13 of them expression in HNSCC underwent surgical treatment,10 radio/chemotherapy and 11 ´ 1 2 3 2 4 combined surgery and chemo/radiation. CYFRA 21-1 serum levels A. Ova´ ri , H. Hegyesi , B. Horva´ th ,P.Po´ cza ,K.Po´ cza , were measured before and after treatment and periodically with B. Szabo´ 1, P. Koltai6, Zs. Balatoni5,G.Re´ pa´ ssy1, A. Falus2 1 serial assays during the clinical follow up or until recurrence. The Department of Oto-Rhino-Laryngology, Head and Neck Sur- mean time of follow up for all 34 patients was 19 ± 6.2 months. gery, Semmelweis University of Medicine, Budapest, Hungary 2 Results: CYFRA 21-1 serum levels presented elevated in 21 Department of Genetics, Cell and Immunbiology, Semmelweis (61.76%) patients before treatment. After therapy, serum levels University of Medicine, Budapest, Hungary 3 were less than the cut-off value for all but three patients. 15(44.1%) Department of Oto-Rhino-Laryngology, Head and Neck Sur- of the 34 patients were diagnosed with recurrent or residual disease gery, National Medical Center, Budapest, Hungary 4 during the follow up study and four (11.7%)of them died. The 11 Department of Pathology, Uzsoki Teaching Hospital, Budapest, (73.3%) of the 15 patients with recurrence showed significant ele- Hungary 5 vation of CYFRA 21-1 levels before the diagnosis of recurrent Department of Oto-Rhino-Laryngology, Head and Neck Sur- disease. The mean time between the elevation of the marker and gery, Uzsoki Teaching Hospital, Budapest, Hungary 6 the diagnosis of clinical recurrence was 3 ± 2.8 months The rest Department of Head and Neck Surgery, National Center of 19 patients showed during the follow up period. In 17 of the rest 19 Oncology, Budapest, Hungary patients with no evidence of recurrence, there was no significant Objective: To analyse the expression of the CXCR4 chemokine elevation of CYFRA 21-1 during follow up. receptor and its corresponding ligand SDF-1 in head and neck Conclusion: CYFRA 21-1 provides a monitoring tool for early squamous cell carcinoma (HNSCC). recognition of recurrences in stage II–III SCC of the larynx.

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HP 23 examinations were done at Ankara University Pathology Immunohistochemical and serum cytokeratin Department. Tumor sections were examined and graded accord- ing to Broder’s criteria. For examining the CK and NE properties, expression patterns as a prognostic indicator low molecular weight CK (LMWCK), high molecular weight CK in oral cancer (HMWCK), CK 18, CK19, neuron specific enolase (NSE), syn- A. Eleftheriadou1, A. Lazaris4, T. Chalastras3, G. Agrogianis4, aptophysin (SYNF) and chromogrannin A (Chr A) antibodies I. Yiotakis3, E. Patsouris4, E. Ferekidou3, K. Papadimitriou2, were applied into tumoral and non-neoplastic mucosa sections P. Chatzipantelis2, D. Kandiloros3 with streptavidin-biotin peroxidase technique. 1Department of Otolaryngology, G Gennimatas Hospital, Athens, Results: Tumors included squamous cell (SC), adenosquamous Greece cell, verrucous, basaloid carcinomas and sarcomatoid carcinoma. 2Department of Pathology, Hippokration Hospital, Athens, Greece Grade II squamous cell cancer was the most prevalent type 3Department of Otolaryngology, University of Athens, Hippok- (63.3%). On IHC, LMWCK and HMWCK’s were found to have ration Hospital, Athens, Greece diffuse expression that disables any prognostic implication. CK 18 4Department of Pathology, University of Athens, Athens, Greece expression seemed to diminish by grade but increase by stage. CK 19 expression had positive correlation with both grade and stage. Objective: To compare the expression of cytokeratins (CK)8, 18 We found only one case with basaloid cancer to have true NE and 19 in patients with squamous cell carcinoma (SCC) of the oral differentiation with SYNF expression. cavity and to assess whether specific CK expression could be of Conclusions: On prognostic evaluation CK 18 expression was predictive value as a marker of disease progression. thought to have a positive correlation with neck metastases that Methods: Twenty-six patients with (SCC) of the oral cavity stage I would reach to significance level with a larger patient series. No to III were enrolled in this study. All tissues were analyzed im- larynx SC cancer sample was found to have true NE differentiation. munohistochemicallly with monospesific 8, 18 and 19 anti-keratin monoclonal antibodies. CYFRA 21-1,TPS and TPA-M serum levels were measured before and after treatment and during the HP 25 clinical follow up or until recurrence. The mean time of follow up Tumor markers in squamous cell carcinoma for all 26 patients was 12 ± 2.6 months. Results: CYFRA 21-1 presented elevated in 13 patients (50%) of the head and neck: prognostic value before treatment and over-expression of CK19 found in 17 spec- Anastasia Konstantinou, Joan Michali imens (65.38%) TPS was high in four and TPA-M in seven pa- ENT Department and Department of Clinical Oncology, tients, while CK 8 and 18 staining was only detected sporadically GH of Halkis, Greece (CK 8 in 5 and CK 18 in 8 specimens). Two months after therapy, all the three markers were decreased to normal cut-off values for Objective: Head and neck squamous cell carcinoma (HNSCC) all patients. Eight (30.7%) of the 26 patients were diagnosed with continues to cause significant morbidity and mortality. Current recurrent or residual disease during the follow up 6 of these 8 management strategies for (HNSCC), rely on the use of prog- appeared with elevated levels of CYFRA 21-1 before treatment nostic factors to guide selection of appropriate treatment. The aim and simultaneous over-expression of CK 19. of the present study was to determine whether a tumor markers Conclusion: SCC or the oral cavity giving rise to recurrences, panel is associated with such clinicopathological features as the metachronous tumors and distant metastasis were significantly invasive and metastatic potential. associated with CK 19 over-expression in tissue as well as in serum Methods: The clinical relevance of the carcinoembryonic antigen before treatment. Cyfra 21-1 appeared to be promising prognostic (CEA), CA 19-9, CA 125, Ca 15-5, squamous cell carcinoma tumor marker in oral cancer. antigen (SCC), CYFRA, TAT1 and Ferritin as tumor markers in the diagnosis and follow-up treatment of 23 patients with head and neck cancer, is evaluated. Serial serum samples were collected HP 24 before and at intervals after treatment at the end of the 6th and 12th month. Their serum levels were compared with samples of Prognostic meaning of cytokeratin healthy blood donors, patients with inflammatory pathology, and and neuroendocrine markers in larynx cancer benign tumors. Results: All markers expressed high rates of specificity over 90%. M. Kursat Gokcan1, Alp Demireller1, Ozden Tulunay2, Their combined sensitivity was raised to 90.6%. Significant dif- Cem Meco1, Suha Beton1, Ciler Tezcaner1 ferences were observed between cancer groups and other patients 1Ankara University Otorhinolaryngology Head and Neck Surgery in the majority of the markers’’ levels examined. In cases with Department nodal and distal metastases, during the follow-up period, the tu- 2Ankara University Pathology Department mor marker values were elevated significantly (10–12%). TAT1, Objective: In this prospective study, expression of distinct cytoker- CYFRA 21-1and CEA levels were declined significantly after atin (CK) subtypes and neuroendocrine (NE) markers in larynx surgical excision and thus could be potentially considered as cancer (LC) were examined by immunohistochemistry (IHC) and markers of surgery effectiveness. results were correlated with known prognostic factors, such as tumor Conclusions: Patients of high levels of these markers alone or in site, local extension, neck metastasis and degree of differentiation. combination had much lower parameters as cumulating percent Methods: Thirty LC patients that were operated at Ankara Uni- surviving relative percent dying and mean survival time than those versity ORL Department enrolled into study. Pathology and IHC with normal levels.

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HP 26 amplified by PCR and mutation analysis was performed using Isolation and characterization of mesenchymal stem the denaturing gradient gel electrophoresis (DGGE) method. cells from palatine tonsils Results and discussion: TP53 mutations in pleomorphic adenomas of the salivary gland may contribute to the assumed progression Sasa Janjanin1,2, Drago Prgomet1, Rabie M. Shanti2,3, from a benign adenoma to a squamous cell carcinoma ex pleo- Dolores Baksh2, Rocky S. Tuan2 morphic adenoma of the parotid gland. The results of the muta- 1Department of Otorhinolaryngology, Head and Neck Surgery, tion analysis of the TP53 exons and the clinicopathological Zagreb Clinical Hospital Center, Salata 4, 10000 Zagreb, Croatia implications of the currently ongoing study are presented and 2National Institute of Arthritis and Musculoskeletal and Skin discussed. Diseases, National Institutes of Health, Department of Health and Human Services, 9000 Rockville Pike, Bethesda, MD, 20892, USA 3 Harvard Medical School, Harvard University, 188 Longwood HP 28 Avenue, Boston, MA, 02115, USA Effect of closo-dodecaborate-containing linker on Objective: Mesenchymal stem cells (MSCs) are multipotent cells targeting HNSCC xenografts with radioiodinated that have the ability to differentiate into various cell types. Also, they have been determined to have immunomodulatory proper- chimeric monoclonal antibody U36. Dual-isotope ties. The purpose of this study was to assess the existence of MSCs comparative biodistribution study in human palatine tonsils and to characterize their stemness Junping Cheng1,2, Mats Engstrom1, Tomas Ekberg1, potential. Marika Nestor1, Matti Anniko1, Vladimir Tolmachev3 Methods: MSCs were isolated using routine cell culture tech- 1Department of Oto-Rhino-Laryngology and Head & Neck niques. Cell proliferation assays, limiting dilution and CFU-F Surgery, Uppsala University Hospital(Akademiska Sjukhuset), assays were performed. Confocal laser scanning microscopy and Uppsala, Sweden flow cytometric analysis were employed to profile specific CD 2Department of Oto-Rhino-Laryngology and Head & Neck Sur- markers. MSCs were induced to undergo adipogenic, osteogenic gery, Tianjin First Central Hospital, Tianjin, People’s Republic of and chondrogenic differentiation. Multilineage potential was China detected by RT-PCR, histology and histochemistry. 3Division of Biomedical Radiation, Department of Oncology, Results: Using cell culture techniques, MSCs can be successfully Radiology, and Clinical Immunology, Uppsala University, Upp- isolated from palatine tonsils and expanded in vitro. They possess sala, Sweden favorable proliferation characteristics, as well as surface epitope profiles. We demonstrated in vitro capacity of these cells to dif- Background: Radionuclide targeting to head and neck squamous ferentiate into multiple mesodermal lineages including fat, bone cell carcinomas (HNSCC) using monoclonal antibodies (MAbs) and cartilage. might contribute to a better diagnosis and staging, thereby mak- Conclusions: Owing to their ease of isolation, rapid proliferation in ing more effective treatment possible. Chimeric monoclonal the culture and self-renewal capacity, MSCs are an attractive antibody U36 (cMAb U36), specific to CD44v6 antigen, is a candidate cell type for the development of novel cell-based ther- candidate for targeting of HNSCC. However poor cellular apies. We hypothesized and showed that multipotent MSCs exist retention of radioactivity might be a problem in the case of con- in palatine tonsils and can be isolated and expanded in culture. ventional direct radioiodination. The use of the charged benzy- Human palatine tonsils could be source of MCSs for basic re- lisothiocyanate derivative of closo-dodecaborate (DABI) as a search and future clinical applications. linker may improve radioiodine retention and thus giving better tumour-to-surrounding tissues contrast. HP 27 Objective: The aim of the study was to compare the influence of closo-dodecaborate-based linker (DABI) for radioiodine with di- TP53 status evaluation in pleomorphic adenoma rectly radioiodinated cMAb U36 on biodistribution of chimeric of the parotid gland anti-CD44v6 antibody U36. Method: The study was performed in nude mice bearing UT-SCC7 Claudia Gedlicka1, Helga Martinek1, Boban M. Erovic1, HNSCC xenografts using dual-label. Influence of DABI on tu- Chike Item2, Dietmar Thurnher1 mour-to-organ ratio was evaluated. 1Department of Otorhinolaryngology, Head and Neck Surgery, Result: The radioactivity uptake in blood and organs decreased Medical University of Vienna, Austria with time, with the exception of tumour and thyroid. A quick 2Department of Pediatrics, Medical University of Vienna, Austria blood clearance and an elevated uptake in liver and spleen were Objective: Loss of TP53 function in salivary gland tumours may characteristic for DABI-labelled cMAb U36. The use of DABI result in altered cell growth and migration. The aim of this study enabled to improve tumour-to-blood and tumour-to-organs ratio was to evaluate the expression and mutation profile of different 1.5–2 times in comparison with direct radioiodination except liver TP53 exons in normal parotid gland tissue, pleomorphic adenoma and spleen. tissue and carcinomas of the parotid gland. Conclusion: Selective tumour uptake was confirmed in this animal Methods: Genomic DNA was extracted from paraffin-embedded model. These results indicate that DABI might be a promising tissue and expression status of the exons 2–11 was examined. linker for attachment of radoiodine to HNSCC-targeting conju- After total DNA isolation the respective TP53 exons were gates.

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Keywords: Nude mice, Chimeric monoclonal antibody U36, Head tion about biochemical alterations of human saliva during carci- and neck squamous cell carcinoma, Tumour transplantation, nogenesis. Radioimmunotherapy, Tumour targeting Methods: We compared 50 HNSCC patients, divided in two subsets basing upon tumor site, with a control group of 77 sub- jects, without a previous diagnosis of HNSCC, matched for age, HP 29 sex, alcohol consumption and smoking status. A phase IIA study for the evaluation Results: At tests for equality of means by Welch and Brown- of the efficacy of folic acid in the treatment Forsythe differences between groups resulted probable for sali- vary levels of glutathione (P = 0.004 and P < 0.001 respec- of laryngeal leucoplakia tively) but not for salivary levels of uric acid (P = 0.228 and Giovanni Almadori1, Francesco Bussu1, Pierluigi Navarra2, P = 0.122 respectively). Comparing groups by Tamhane test, the Jacopo Galli1, Mario Rigante1, Bruno Giardina3, patients with oral or pharyngeal cancer have significantly higher Gaetano Paludetti1 salivary levels of glutathione than both controls and patients with 1Institute of Otolaryngology, Universita` Cattolica del Sacro laryngeal cancer. Cuore, Policlinico A. Gemelli, Roma, Italy Conclusions: Salivary glutathione levels might be an index of 2 Institute of Pharmacology, Universita` Cattolica del Sacro oxidative stress at the level of the upper airways and in particular Cuore, Policlinico A. Gemelli, Roma, Italy of oral cavity and pharynx. Therefore high salivary glutathione 3 Institute of Clinical Chemistry, Universita` Cattolica del Sacro may be an epidemiological marker to identify subjects with an Cuore, Policlinico A. Gemelli, Roma, Italy increased risk of developing HNSCC, to submit to strict follow up and chemoprevention. Metabolic alterations of saliva could be Objective: We previously observed that patients with head and both an epidemiological marker and a target for chemoprevention neck squamous cell carcinoma or with laryngeal leucoplakia of oral and oropharyngeal carcinogenesis. present a significant reduction in plasma folate levels. This is a phase IIA pilot study assessing the effectiveness of folic acid as a chemopreventive agent in patients affected by glottic laryngeal leucoplakia. HP 31 Methods: Forty-three untreated patients affected by glottic lar- Galectin-7 in sqamous cell epithelia and carcinomas yngeal leucoplakia were enrolled in our ENT department. Glottic 1,2,3 1,3 1,3 ˇ 1,2 leucoplakia was initially diagnosed by indirect laryngoscopy and M. Chovanec , K. Smetana Jr , B. Dvorˇa´ nkova´ ,Z.Cada , 1,4 1,2,3 2 5 5 successively confirmed by diagnostic direct microlaryngoscopy L. Lacina , J. Plza´ k , J. Betka , M. Lensch , H. Kaltner , 5 with a biopsy for histological assessment. Folic acid (FolinaR) was S. Andre´ 1 administered orally (5 mg every 8 h) for 6 months. Patients were Department of Otorhinolaryngology and Head and Neck Sur- monitored every 30 days by videolaryngoscopy. gery, 1st Faculty of Medicine Charles University 2 Results: Twelve patients (28%) had no response, 19 (44%) had a Institute of Anatomy, 1st Faculty of Medicine Charles University 4 partial response, 12 (28%) had a complete response. The mean Department of Dermatovenerology, 1st Faculty of Medicine increase in serum folate levels (10.06 ± 0.53) and the mean de- Charles University 3 crease in homocysteine serum (3.65349 ± 0.85526) at the end of Center for cell Therapy and Tissue Repair, Prague Czech the study were highly significant (P = 0.0001). Republic 5 Conclusions: The larynx is one of the sites of major interest and Inst. for Physiological Chemistry, Faculty of Veterinary Medi- a good model for the development of chemopreventive agents cine, Ludwig-Maxmillians-University, Munich, Germany but so far proposed agents showed no clear efficacy on pre- Objective: Galectin-7 is member of b-galactoside-binding lectins cancerous lesions, or on the development of second malignan- (galectins) expressed characteristically in all keratinocytes. cies. Our results suggested the hypothesis that folate Galectins display multiple biological roles, e.g. in information insufficiency is a long acting risk factor, which increases along transfer, proliferation/differentiation and apoptosis control, and years the rate of carcinogenic progression following the expo- pre-mRNA splicing. sure to environmental carcinogens. The present pilot chemo- Methods: Expression of galectin-7 was studied in situ in squamous preventive study seems encouraging with a complete response cell epithelia (epidermis, epithelium of oropharynx and larynx), rate of 27% and no clinical or histological progression of leu- squamous cell carcinomas and their lymph node metastases), coplakia after a 6-month treatment. basal cell carcinomas, and in vitro (epidermal keratinocytes, FaDu). Simultaneous double labeling studies were performed to asses level of differentiation (cytokeratin 10, cytokretain 14), HP 30 proliferation (Ki67) and basal lamina formation (collagen IV). Imunohistochemical features were correlated with clinical and Salivary glutathione and uric acid levels in patients pathological findings. with head and neck squamous cell carcinoma Results: In nontransformed cells galectin-7 was detected Francesco Bussu, Attilio Limongelli, Mario Rigante, Jacopo throughout the depth of epithelia. Basal cell carcinomas were Galli, Gaetano Paludetti, Giovanni Almadori devoid of its signal. Different pattern of expression was seen in Institute of Otolaryngology, Catholic University of Sacred Heart, squamous cell carcinomas which correlated with pattern of basal Rome, Italy lamina formation, keratinization and differentiation level. Expression of galectin-7 reflected stratification of epidermal Objective: To evaluate the concentrations of glutathione and uric keratinocytes culture not observed in FaDu cells. acid, low molecular weight antioxidants, in saliva of patients with Conclusions: Monitoring of galectin-7 represent promising head and neck squamous cell carcinoma (HNSCC), in order to parameter in pathology of tumors originating from sqamous epi- identify differences with normal subjects and to obtain informa- thelia with expected clinical application in head and neck oncology.

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The study was supported by the IGA MZ CˇR, project No. NR The aim of the study is the analysis of gene expression profile in 9049-3 and by and by EC Marie Curie Research Training Net- laryngeal carcinoma. work grant (contract No. MRTN-CT-2005-019561) Materials and methods: The study comprised 14 patients suffering from squamous cell laryngeal carcinoma. Total RNA was isolated both from squamous larynx cancer tissue and from healthy larynx HP 32 tissue, collected from the same patient. After 16-h hybridisation Analysis of human telomerase reverse transcriptase on high density microarrays Human Genome U 133 Plus 2.0 protein in laryngeal cancer* (Affymetrix) read-out was performed, followed by data analysis. Results: Analysis was performed by means of non-parametric U 1 1 1 Pietruszewska Wioletta , Wicher Anna , Durko Marcin , Mann–Whitney test, with the assessment of percentage of false 1 2 Gryczyn´ ski Maciej , Kobos Jo´ zef positive results (FDR) applying the method of Benjamini-Hoch- 1Department of Otolaryngology, Medical University of Lodz, berg, as well as the Holm method. Using Mann–Whitney test, 1241 Poland transcripts were singled out, differentiating between both groups at 2Department of Pathology, Medical University of Lodz, Poland FDR < 5%. In the next stage that group was narrowed down to Objective: Human telomerase reverse transcriptase (hTERT), a 398 genes, meeting the criteria assumed, analysing by means of catalytic subunit of telomerase, has been known as an almost parametric test. Two genes, agiopoietin like transcript (231773_at, universal tumour marker but its predictive value has been found ANGPTL1, angiopoietin-like 1) and undefined protein CGI-115 in only a limited number of malignant tumour types. The aim of (219037_at) revealed a very substantial difference in expression, as this study was to detect hTERT protein in laryngeal cancer and well as complied with very rigorous criteria of error risk assessment study the relationship of hTERT expression with clinical and for group of genes (FWER) applying Holm method. histological features. Conclusions: Analysis of gene expression profile in laryngeal car- Methods: The subject were 41 patients with laryngeal cancer sur- cinoma allows to pick out new genes, which in future may become gically treated. Immunohistochemical staining of paraffin speci- molecular markers of that carcinoma. mens was supervised by the use of monoclonal antibody (NCL- Project financed by a grant of Polish Ministry of Education and hTERT, Novocastra). The results were compared with clinical Science (MeiN) No. 3 PO5B 112 25. and histological staging. Results: Intensity of hTERT protein expression in laryngeal cancer was significantly correlated with primary tumour size (T) and the HP 34 more advanced tumours were related to higher hTERT protein The diagnostic value of EBV detection using PCR expression (P = 0.01). We also perceived correlation between presence of nodal metastases (N), local recurrences and primary in metastatic carcinoma to cervical lymph nodes tumours occurrence in investigated patients and hTERT expres- Azza M. Rizk1, Soheir M. Hamam1, Shwikar M. Abd El-Salam1 sion. In those cases hTERT level was higher but the differences were Faculty of Medicine, Alexandria University not significant (P = 0.05). Although it was signed, that hTERT expression was significantly higher in case of nodal recurrence Objective: In nasopharyngeal carcinoma, the primary lesion is (P = 0.04). There were no significant dependence between the level difficult to find. Metastasis occurs frequently to neck nodes and is of hTERT protein and localization of tumour in larynx, overall and difficult to distinguish form other head and neck tumours. The disease free survival of the patients and histological grading conducted study comprised 40 cases of metastatic tumours to neck (P > 0.05). nodes, 20 of which were NPC and 20 were other head and neck Conclusions: Detection of telomerase may help to diagnose and carcinomas. Twenty more cases were controls determine the malignant grade of cancer. Therefore, this may Methods: As EBV has been implicated in the etiology of NPC, indicate the feasibility of IHC detection of hTERT protein in the aim of the present work was to identify the viral genome of laryngeal cancer as a potential diagnostic or prognostic marker. the EBV in the cells of this carcinoma by PCR assay in an *This study was supported by grant No 502-11-453 from Medical attempts to differentiate it from other metastatic head and neck University of Lodz tumours.. Results: It was found that all cases of nasopharyngeal carcinoma were EBV positive and monoclonal, while the other metastatic HP 33 head and neck carcinomas showed positive EBV in only 60% of Gene expression profile in laryngeal cancer cases, and these cases were all polyclonal. Also 45% of the control cases were EBV positive and also polyclonal. by oligonucleotide microarrays analysis Conclusion: PCR, through amplification of the EBV genome, is a Jaroslaw Markowski1, Tatiana Gierek1, reliable technique in differentiating NPC metastatic to neck nodes Malgorzata Oczko-Wojciechowska2, Jaroslaw Paluch1, form other metastatic head and neck tumours. Michal Jarzab3, Malgorzata Kowalska2, Zofia Wygoda2, Piotr Wardas1, Barbara Jarzab2, Dariusz Lange4 1ENT Department, Silesian Medical University, Katowice, Poland 2Department of Nuclear Medicine and Oncologic Endocrinology, Oncology Centre, Gliwice, Poland 3Department of Neoplasm Biology, Oncology Centre, Gliwice, Poland 4Department of Neoplasm Pathology, Oncology Centre, Gliwice, Poland

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HP 35 from 86 patients and 124 controls was available. Tumour tissue Immunohistochemy (EGFR and CD44) from cases and exfoliated cells from oral rinses of both cases and controls were examined for the presence of HPV DNA using PCR in hypertrophic laryngeal lesions with GP5+/6+BIO primers and reverse blot assay for typing of Elena Ionita˘*, Florin Anghelina*, Iulica˘Ionita˘**, the positive samples. Carmen Mogoanta˘*, Sorin Ciolofan**, Carmen Popescu**, Sera were tested by ELISA for presence of HPV-specific anti- Laurentiu Mogoanta˘*** bodies using HPV 6, 11, 16, 18, 31, and 33 VLPs and HPV16 E6 *ENT Department, University of Medicine and Pharmacy of and E7 recombinant proteins as antigens. Craiova Results: Patients with oropharyngeal SCC had significantly higher **Emergency Hospital of Craiova prevalence of anti-HPV16 VLP antibodies when compared to ***Histology Department, University of Medicine and Pharmacy control group (58.7% vs. 29.8%, P < 0.0001). The prevalence of of Craiova anti-E6 and E7 antibodies in patients with oropharyngeal SCC was 73.2 and 29.9%, while only 1.0 and 2.9% in the control Objective: We determinate expression of CD44 and EGFR in 57 group. There was highly significant correlation between the cases of hypertrophic laryngeal lesions and we correlated with presence of anti-E6 and E7 antibodies and of HPV DNA in the clinic and morphologic aspects. tumour. Materials and methods: The present paper represents a retro- Conclusions: The strong correlation between the presence of HPV- spective study on 45 cases of laryngeal epidermoid carcinomas, specific antibodies and the HPV DNA positivity in a subgroup of and 12 cases of laryngeal dysplasia, over a period of 5 years, oropharyngeal SCC suggests the causal role of HPV viruses in the 2001–2005. The material consisted of laryngeal biopsies and development of HNSCC and indicates the possibility to use specimens resulted from the laryngectomies performed in the ENT serology for early detection of tumours. Clinic of Craiova. The hystologic study has been made with col- ored solutions of hematoxiline-eozine, tricrome and with green light, while for the immunohistochimic study the LSAB has been used. The following markers of cellular proliferation have been HP 37 used: CD44 and EGFR EMMPRIN expression in oral squamous cell Results: The histologic study allowed us the reflection on the carcinoma varied degrees dysplasia lesions: mild dysplasia: seven Cases(58%), moderate dysplasia: three Cases(26%) severe dys- Matti Pukkila, Antti-Pekka Siljander, Ari Kosunen, plasia: two Cases(16%).The histopathological forms of laryngeal Jukka Virtaniemi, Risto Johansson, Henri Tuomilehto, cancer that we encountered were: 7 epidermoid carcinomas well Juha Seppa¨ , Juhani Nuutinen, Veli-Matti Kosma differentiated (15%), 14 moderate differentiated(15%) and 24 Institute of Clinical Medicine, Otorhinolaryngology, Head and poorly differentiated (54%).The TNM staging was as follows: Neck Surgery, Pathology and Forensic Medicine, and Oncology, three patients in stage I (7%), five patients in stage II (11%) 15 University of Kuopio and Kuopio University Hospital, P.O. Box patients in stage IV (33%), 22 patients in stage IV (49%). A 1777, 70211 Kuopio, Finland correlation was established between the presence of EGFR Objective: To investigate the expression of EMMPRIN and its expression and the degree of differentiation. EGFR was sub- associations with clinicopathological variables as well as prog- stantially present in the epithelium of well differentiated carcino- nosis in oral squamous cell carcinoma (OSCC). mas, and also in the moderate and poorly differentiated ones. Methods: Immunohistochemistry was used to study EMMPRIN Conclusion: The expression of CD44 and EGFR established a expression in 119 OSCCs. All pertinent clinical data were collected correlation with the degree of malignancy of the laryngeal cancer, retrospectively from the hospital records. and CD44 with the presence of lymph node metastases. Results: EMMPRIN was expressed on the tumour cell plasma membranes but not in the tumour stroma. The median tumour cell HP 36 expression percentage was 60. EMMPRIN expression was statis- tically significantly more active in bigger tumours (T1 vs. T2-4; Significance of anti-HPV VLP-16, E6 P = 0.04) and in more advanced cases (SI vs. SII-IV; P = 0.01). and E7 in detection of the oral/oropharyngeal SCC EMMPRIN expression did not associate with other clinicopath- ological factors; i.e., sex, age, general condition, N-class or his- Michal Zabrodsky1, Eva Hamsikova2, Ruth Tachezy2, tological differentiation of the tumour. In univariate analyses Jana Smahelova2, Martina Salakova2, Jan Klozar1, higher risk for disease recurrence did not associate with EMM- Viera Ludvikova2, Jan Betka1 PRIN expression or any other clinicopathological variable. In 1Department of Otolaryngology and Head and Neck Surgery, 1st univariate analysis of disease-specific survival (DSS) factors sug- Medical Faculty Charles University, Prague, Czech Republic gesting better prognosis were low T-class (P < 0.001), low N- 2Department of Experimental Virology, National Reference class (P < 0.001) and low stage (P < 0.001). EMMPRIN Laboratory for Papillomaviruses, Institute of Hematology and expression did not affect prognosis. In multivariate disease-spe- Blood Transfusion, Prague, Czech Republic cific survival (DSS) analysis, only high T-class (P = 0.005) and Objective: To evaluate the significance of HPV-specific seroposi- high N-class (P < 0.001) remained as independent predictors for tivity for the early detection of the HPV DNA+ tumours. poorer disease outcome. Methods: Patients surgically treated oral/oropharyngeal SCC and Conclusions: In the present study EMMPRIN was more actively age and gender matched controls willing to participate in the expressed in larger and in more advanced tumours. However, it study were enrolled. By the end of 2006 a complete set of data was not a prognostic factor in OSCC.

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HP 38 After the first operation he developed laryngeal edema requiring Rheological measurements in dysphagia an emergency tracheotomy. In cooperation with the orthopedic department the patient underwent excision of osteophytes through K. Me´ sza´ ros1, Zs. Varga2, P.Ka´ rpa´ ti3,A´ .A´ bra´ nyi4, T. Hacki5 an anterior lateral approach. Three months postoperatively the 1National Medical Center, 1135. Budapest, Szabolcs u.33-35, patient had no difficulty to breath and was tolerating regular Hungary nutrition without complaints, so the tracheostoma could be 2SOTE, Budapest, Hungary closed. 3Anton Paar Firma Hungary Conclusion: Cervical hyperostosis is commonly in the older pa- 4BME tients and usually asymptomatic, therefore most patients will be 5University of Regensburg treated nonsurgically. Nevertheless it can be a source of con- Viscosity is a fundamental rheological property both of the foods siderable morbidity and potential life-threatening airway used for feeding, and the test foods applied in endoscopic and X- obstruction. The respective physician should be able to recog- ray swallowing studies. The aim of this study was to determine the nise this clinical entity in order to initiate the appropriate viscosities of the test foods and that of the foods used for everyday treatment. feeding, to compare and standardize them. The measures were taken with a rotational viscometer, an UDS200 air-bearing sup- ported rotation/oscillation rheometer, at standard temperatures of HP 40 40 and 20C using US200 operating software and a PP50 plate/ Pharyngo–esophageal dysphagia caused by large plate measurement system. We prepared an increasing concen- osteophytes in the cervical spinal tract tration series of the test food (jelly, pudding, puree, mush) by adding water to Resource Thicken Up of corn-starch content, A. Chatziavramidis1, E. Kyrodimos2, I. Delis1, D. Gennadiou1, and determined the viscosities. We also measured the viscosities of Th. Sidiras2 commercial available foods as well as of self-prepared foods. 1Department of Otolaryngology-Head and Neck Surgery, General Hospital ‘‘Gianitsa’’, Greece 2Department of Otolaryngology-Head and Neck Surgery HP 39 ‘‘Theagenio’’ Cancer Hospital, Thessaloniki, Greece Cervical hyperostosis (Forestier disease) as a rare Introduction: Cervical osteophytes in the spinal tract are rather cause of dyspnea, aspiration, vocal cord common especially in the elderly population. The Diffuse Idio- immobilisation and extreme dysphagia pathic Skeletal Hyperostosis (DISH) is a situation which is characterized by calcification and ossification of the attached soft G. Psychogios, C. Alexiou, F. Waldfahrer, I. Vlastos*, tissues of the spinal column and in some instances can compro- A. Karatzanis*, H. Iro mise the function of the upper aero digestive tract. In this report Department of Otorhinolaryngology, Head and Neck Surgery, we present three different cases with DISH causing dysphagia. University Erlangen-Nurnberg, Waldstrasse 1, 91054 Erlangen, Case reports: Case 1: A 63 year old male was presented in the Germany outpatient department because of an acute episode of dysphagia. *Department of Otorhinolarygology-Head and Neck Surgery, Endoscopy revealed a partial obstruction of the lumen of hypo- University of Crete, Heraklion, Crete, Greece. pharynx due to osteophytes. No surgical excision of osteophytes Introduction: Cervical hyperostosis also known as a diffuse idio- was performed. Supportive measures (specific deglutition pathic skeletan hyperostosis (DISH) is a rare but well known maneuvers) were applied to relief some of the symptoms. Case 2: cause of dysphagia. Aspiration and dyspnea appear extreme rare A 72 year old male was presented in the outpatient department as a clinical manifestation. We present a case of an 82-year-old because of episodes of intermittent dysphagia. Observation of man with dyspnea, aspiration, pneumonia and an emergency pharynx-larynx with a rigid endoscope revealed a projection of the tracheotomy after a microlaryngoscopy. posterior pharyngeal wall due to osteophytes. Specific deglutition Case report: The laryngoscopy showed a severe bulging of the maneuvers were applied to eliminate possible aspiration hazards. posterior oropharyngeal and hypopharyngeal wall which left a Case 3: A 65 year old male was complained of dysphagia in solid thin cleft to the epiglottis. The view to the glottis was limited and food. Laryngoscopy with a rigid endoscope and barium shallow immobilisation of the right vocal cord could be seen. The com- revealed no pathology present. X-rays reveled osteophytes in the puted tomography demonstrated large anterior osteophytes and anterior portion of C3 to C7 vertebras. Proton pumps inhibitors ossification of the posterior longitudinal ligament from C2 to C5. and anti inflammatory drugs were administrated with some Barium swallow demonstrated massive aspiration. The patient encouraging results. underwent a panendoscopy to explore the upper aerodigestive Conclusions: The osteophyte-related dysphagia should raze the area and received a percutaneous gastrostomy to secure the suspicion to the physician especially when radiologic or functional nutrition. An intraoperative electromyography of the intrinsic modalities reveal the presence of thick osteophytes in the spinal laryngeal muscle on both sides showed normal action potentials. tract.

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HP 41 ***Tirana University Hospital ‘‘Mother Teresa’’ Gastroenterol- Detection of Helicobacter pylori in oropharyngeal ogy Department, Dibra street, Tirana, Albania diseases Objective: Laryngopharyngeal reflux may play a role in the eti- 1 1 1,3 2 ology of laryngeal squamous cell carcinoma. Petr Lukes , Jaromir Astl , Jan Plzak , Emil Pavlik , Methods: In this prospective study to investigate the incidence of Bela Potuznikova2, Ivan Sterzl2, Jan Betka1 1 laryngopharyngeal and gastroesophageal reflux in 48 untreated Department of Otorhinolaryngology and Head and Neck patients with histologically proven laryngeal squamous cell car- Surgery, 1st Faculty of Medicine, Charles University, Faculty cinoma and in the control group, video gastroscopy and 24-h Hospital Motol, V U´ valu 84, 150 06 Prague 5, Czech Republic 2 double-probe pH monitoring was performed. The control group Institute of Immunology and Microbiology of the 1st Faculty of consisted of 40 patients with typical manifestation of Gastro- Medicine, Charles University, Studnicˇkova 7, 128 00 Praha 2, esophageal Reflux (Pirosis and dyspepsia). Czech Republic 3 Results: Thirty-eight of the laryngeal cancer patients (79%) and 30 Institute of Anatomy, 1st Faculty of Medicine Charles Univer- patients of the control group (75%) revealed Gastroesophageal sity, Unemocnice 3, 128 00 Prague 2, Czech Republic Reflux (GER). On the other hand 30 patients with laryngeal Objective: Helicobacter pylori (HP) plays a major role in the cancer (62%) and only four control patients (10%) revealed pathogenesis of miscellaneous diseases (gastric ulcers, adenocar- Laryngopharyngeal Reflux(LPR). Sixty percent of the laryngeal cinoma, lymphoma). Recent studies have explored the relation- cancer patients (29/48) were smokers. The rate of gastroesopha- ship between HP and the oral cavity diseases. HP infection could geal reflux was close among the two groups, but the laryngo- cause the same immunological changes in the gastric and oro- pharyngeal reflux rate was much higher in the cancer group. pharyngeal mucosa. HP can induce production of different cyto- Conclusions: Both groups revealed Gastroesophageal Reflux kines and regulatory molecules, which could promote (GER) in similar rates but the Laryngopharyngeal Reflux (LPR) carcinogenesis of the oropharynx. Preliminary results of HP rate was much higher in cancer patients than in the control group. detection in tonsillar tissue are presented. LPR can be a factor in the development of the laryngeal cancer. Methods: The tissue specimens obtained from 16 patients with tonsillar cancer, 22 patients with chronic tonsillitis and 12 patients with obstructive sleep apnea syndrom (OSAS) were examined for HP 43 presence of HP by culture. Seven of them were examined by PCR. Helicobacter pylori colonizes the palatine tonsil Anti HP antibody levels were detected by commercial imunoassay but not the adenoid in venous blood. 1 1 2 Results: Serum antibodies were positive in 15 patients with cancer, E. Labropoulou , C. Labropoulou , G. Charalambopoulou , 1 1 2 8 with chronic tonsilitis and 9 with OSAS. HP was detected in one M. K. Gerolymos , C. Tzamalis , P. Morfaki 1 cancer specimen and one chronic tonsillitis specimen by culture. General Hospital of Messolonghi , Messolonghi, Greece 2 We found HP in 6 of 7 specimens by PCR. General Hospital of Agrinio , Agrinio, Greece Conclusion: Detection of tonsillar HP is mostly difficult. Serology Objective:H. pylori has been associated with the development of is very sensitive method, but it is not specific for oral infection. gastritis, peptic ulcer and gastric cancer. Although H. pylori in- Culture is specific and sensitive method for HP diagnosis in gastric fects up to >50% of the world’s population, to date the precise specimens but it could have high level of false negative results modes of transmission has not been fully understood yet. The when investigating oral specimens. The most promissing method presence of H. pylori in palatine tonsil and the adenoid has re- seems to be PCR, which is both sensitive and specific for HP in cently been reported. However, it has not been confirmed by oral specimens. Our preliminary results show that HP can be immunohistochemistry. detected in tonsillar tissue. Method: Formalin-fixed and paraffin-embedded tissues from 31 ˇ Acknowledgments: This poster was supported by the IGA MZ CR tonsillectomy, 3 adenoidectomy and 2 adenotonsillectomy were NR 9077-3. studied. Immunohistochemistry using a polyclonal antibody di- rected against H. pylori was performed. Results: H. pylori was present in 24 of the 33 tonsillectomy spec- HP 42 imens (72.72%) whereas all adenoidectomy specimens were neg- Laryngopharyngeal Reflux in patients with laryngeal ative. In H. pylori positive cases, both helical and coccoid forms were found in high numbers, in the superficial mucous layer, at- cancer tached to the surface epithelium of the tonsillar crypts. Jetmira Bulaj*, Pjerin Radovani*, Anila Kavaja**, Ilir Peposhi**, Conclusions: H. pylori colonizes the palatine tonsil, and thus may Floreta Kurti *** represent a risk factor for oro-oral route of transmission or, *Tirana University Hospital ‘‘Mother Teresa’’ ENT Depart- alternatively, for gastrointestinal re-infection and ulcer relapse mentDibra street, Tirana, Albania after cessation of antibiotic therapy. To the best of our knowl- **Tirana Hospital of Pulmonary Disease Sanatorium, Sauk, edge, this is the first study by immunohistochemistry with results Tirana, Albania positive for colonization of the palatine tonsil by H. pylori.

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HP 44 gia. Thirty six patients (49%) were already receiving acid sup- Relation of E.N.T patients complains for atypical pression treatment. Laryngopharyngeal reflux was the most common clinical finding. Barium swallow was normal in 39 pa- symptoms to Reflux tients (53%) and in the remaining cases benign pathologies were S. Triantos, S. Vlachou, G. Terzakis, D. Andrianopoulos, documented such as GERD, hiatus hernia and cricopharyngeal G Dritsas, G. Mireas, G. Papazoglou spasm. ENT Department, Red Cross Hospital, Athens, Greece Conclusion: None of the patients was found to have any malig- nancy on Barium swallow. Statistically, there was no correlation Objective: The scope of this study was to evaluate the percentage between the clinical findings and BS result. The benign findings of patients with atypical symptoms like chronic cough, throat seen in 47% of patients could all potentially play an aetiological clearing, mucous sensation in the throat, globus sensation and role in their symptoms. Barium swallow is helpful, not only to hoarseness suffering from reflux. exclude malignancy but also to delineate the benign pathologies in Methods: One hundered and ten patients were examined at the globus pharyngeus. outpatient clinic suffering from the above mentioned symptoms. There were 42 men and 68 women. The patients were submitted to complete clinical head and neck examination and indirect laryn- goscopy. All of them were referred to the gastroenterology clinic HP 46 for evaluation. Structural displacements during the swallow Results: Thirty-eight out of 110 (34%) patients were found to in patients with early primary cancers of the head suffer from various severity of reflux. The prevailing symptoms of and neck these patients were mucus and globus sensation in the throat and throat clearing. The main endoscopic findings were interarytenoid S. H. Vyas, S. Ford, S. Gollins, P. Hobson, space oedema and inflammation of the area, but they are not North Wales Cancer Treatment Centre, Glan Clwyd Hospital, pathognomonic findings. Rhyl, UK Conclusion: Reflux may present with atypical gastrointestinal Objective: To assess the baseline swallowing of T1 larynx and symptoms that may be typical ENT symptoms. The otolaryn- small head and neck cancer patients, in terms of spatial gologist should always consider reflux in the differential diagnosis movements of the pharyngeal structure during the swallow. of atypical laryngopharyngeal symptoms Further,more assess other factors that affect the swallow such as gender, age, and body mass index. This is then compared to HP 45 reported results of swallows in normal, healthy individuals. Role of barium swallow in patients with FOSIT Method: Swallows of 48 patients (with small head and neck can- cers) were assessed, using videofluroscopy, prior to definitive Muhammad Shakeel, Amanjot Dhaliwal, Andrew Evans, curative treatment. Twenty-four patients were T1 carcinoma of Kim W. Ah-See the larynx, and the other 24 were early cancers in other head and Department of Otolaryngology, Aberdeen Royal Infirmary, neck locations. Aberdeen, Scotland, UK, AB25 2ZN Results: Measurements were generally consistent with previously Objective: A feeling of something in the throat (FOSIT) is a reported results in healthy volunteers with normal swallows. common presentation of globus pharyngeus syndrome. The There were no significant differences between T1 larynx and chance of any sinister pathology presenting as FOSIT is extremely other small cancers. On univariate analysis, patients >70 ver- rare with Barium swallow (BS) providing a quick screening tool. sus < 70 years old, had a significantly greater hyoid-laryngeal We carried out a retrospective review to investigate any correla- distance and pharyngeal area at rest. Patients with BMI >26 tion between clinical findings and BS result in this group of pa- versus < 26 demonstrated a significantly greater maximal width tients. of the PES in the lateral view. On multiple regression analysis, Method: We reviewed the case notes of all patients undergoing BS greater hyoid-laryngeal distance at rest and at the point of between January 2002 and December 2004 under our care. A total maximal approximation were the significant predictors of male of 119 patients were identified. FOSIT was the only or the prin- versus female gender at the exclusion of all other variables, ciple complaint in 79 patients. Five of the 79 patients were ex- accounting for 59% of the variance seen. In no patient did cluded. Data was collected and analysed using SPSS. contrast touch the vocal cords during the swallow. Results: Out of 74 patients, 30 were male and 44 female (mean age Conclusions: This study forms a baseline for future prospective 57 years). FOSIT was the only complaint in 21 patients while studies of swallows in patients with early cancers of the head and others had associated symptoms such as hoarseness and dyspha- neck cancer post-treatment.

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HP 47 wheezing, regurgitation of feedings and emesis. The diagnostic Swallowing disorders: proposal of a method methods employed were discussed by sensibility and specificity: videoendoscopy of deglutition (VED), videofluoroscopy or mod- for forensic medicine assessment ified barium swallowing: Is considered standard in the study of Bruno Fattori1, Andrea Nacci1, Francesco Ursino1, swallowing function, radionuclide scintigraphy, bronchoalveolar Fabio Matteucci1, Valentina Mancini1, Vito Mallardi2 lavage (BAL) to calculate the lipid-laden macrophage index 13rd Otorhinolaringology Unit, Department of Neurosciences, (LLMI), thorax CT scan with high resolution provides clinically University of Pisa, Italy helpful information. 2Institute of Odontostomatology, Marche Region Polytechnic Results: Two hundred ten patients have been undergone to sur- University, Ancona, Italy gical procedure to control chronic aspiration, and age and etio- logical disease had no impact in limitating the surgical Objective: For a correct classification of dysphagia, morphologic management, but the level and clinical repercussions of CPA. The instrumental investigations capable of analysing the anatomical procedures more frequently performed were classified in mini- structures of the digestive tract, are undoubtedly essential, but the mally invasive as vocal fold medialization, cricopharyngeal my- most important investigations are the functional ones, such as otomy, saliva reduction (local injecton of botulinum toxin in videofluoroscopy, fiberoptic endoscopic evaluation of swallowing salivary glands)or bilateral submandibular gland excision and (FEES), oro-pharyngo-oesophageal scintigraphy (OPES), parotid duct ligation as a surgical procedure to long-term saliva manometry and pH-metry. The results of these exams enable us to reduction. Procedures more invasive were tracheotomy, and lar- identify, in patient with dysphagia, the extent of permanent yngotracheal separation (LTS). This technique (Lindeman modi- damage as a consequence of injury to the structures designated to fied) could be control aspiration in 56 patients, specially children swallowing must be such that it at least minimally impairs and with severe motor disease. diminishes the relative function, but to a degree that can be de- Conclusion: Chronic pulmonary aspiration is a not rare syndrome, tected and, in some manner, measured. specially in patients with craniofacial malformations, neurological Methods and results: From a penal point of view, alterations in diseases, neurosurgical postoperative periods, vascular diseases of swallowing caused by damage to structures belonging to the central nervous system, and the suspect of the CPA is the most respiratory-digestive can be found in crimes against persons and important tool to employ the most effective method diagnostic particularly in those involving body injury. In the case of civil and the specific treatment. The treatment is capable of avoiding and also in private or social insurance proceedings, it is nec- the most important cause of morbidity and deaths in patients with essary to distinguish which parameters are to be used as ref- neurological diseases. erence for evaluating and quantifying the injury in terms of reimbursement. With the introduction of complete biological well-being, injury is considered as an impairment of his worth and of his right to enjoy psychological-physical integrity as a HP 49 quality of his life. The criteria internationally used at the mo- Efficacy of once-daily Esomeprazole treatment ment take into account the conception of psychological-physical in patients with laryngopharyngeal reflux evaluated efficiency, nevertheless, in Italian forensic medicine there is no table that can give a thorough quantification of swallowing by 24-h pH-monitoring modifications, if one excludes oesophageal disorders. O. Reichel*, G. Rasp**, A. Berghaus* Conclusions: We propose an evaluation table dividing oro-phar- *Department of Otorhinolaryngology, Head and Neck Surgery, yngo-esophageal dysphagia into five, progressively serious classes. Ludwig Maximilians University, Marchioninistraße 15, 81377 Munich, Germany HP 48 ** Department of Otorhinolaryngology, Head and Neck Surgery, Chronic aspiration Katharinenhospital, Kriegsbergstraße 60, 70174 Stuttgart Objective: Laryngopharyngeal reflux (LPR) is generally treated Dayse Manrique with twice-daily (BID) proton-pump inhibitor (PPI) therapy. In UNIFESP-Universidade Federal de Sa˜o Paulo, AACD (Asso- this study the efficacy of esomeprazole 40 mg once-daily (QD) ciac¸ a˜o de Assisteˆncia a` Crianc¸ a Deficiente- Disabled Child together with lifestyle modifications was determined by repeated Assistance Association), Rua Cana´ rio, 1112-61, Sa˜o Paulo, Brazil, 24-h pH-monitoring. CEP 04521-005 Method: Prospective study. Forty-nine patients with suspected Objective: Described the methods to diagnose chronic pulmonary LPR underwent 24-h pH-monitoring. Twenty-seven of 49 patients aspiration (CPA) and level of aspiration and the clinical reper- with measurable abnormal proximal reflux reflected by a reflux cussions resulting from it indicating the type of treatment to be area index (RAI) >6.3 were treated with esomeprazole 40 mg QD proposed. Methods: Almost two thousand patients with oropha- and a second pH-study was performed. ryngeal deglutition disorders (dysphagia) and CPA were selected Results: In 22 of 27 patients QD PPI treatment reduced the RAI. and the methods that demonstrated the disorders in airway pro- Four of 5 patients with no RAI reduction reported on symp- tection, in the period of 1998 to 2006, at AACD (Disabled Child tomatic relief. Assistance Association). Specific clinical presentation of chronic Conclusions: In a considerable number of patients with suspected aspiration were included like: choking, fever, dyspnea, dysphonia, LPR pH-monitoring reveals no abnormal proximal reflux. frequent throat clearing, chest pain, disphagia, odynophagia, Esomeprazole 40 mg QD together with lifestyle modifications wheezing, regurgitation of feedings and emesis. Nonspecific clin- could reach adequate acid suppression in a large number of pa- ical presentation were: choking, fever, dyspnea, dysphonia, fre- tients. Symptom improvement is also reported by patients without quent throat clearing, chest pain, disphagia, odynophagia, measurable effects of therapy.

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HP 50 patients also affects quality of life due to hoarseness and risk of Microbiological colonization of tracheal tubes aspiration. RLNP has also been suggested as an important pre- dictor of need of need for surgery in thoracic aortic aneurysm Also after tracheostomy and its impact on colonization size, shape, and rate of growth of aneurysm are important. RLNP of the lower respiratory tract in severe trauma cases has been suggested as an early sign of aortic Michaela Zumtobel1, Alexander M. Hirschl2, Ulrike Holzinger3, injury and need prompt further management. We describe two Andja Bojic3, Mariam Nikfardjam3, Joanna Warszawska3, cases of left RLNP secondary to aortic arch aneurysm. Berit Schneider1 1Department of Otorhinolaryngology, Medical University of Vienna, Austria HP 52 2 Department of Clinical Microbiology, Medical University of Laryngeal fracture following shrapnel injury: Vienna, Austria 3Department of Internal Medicine, Intensive Care Units, Medical case report University of Vienna, Austria Neil Sharma, Mriganka De, Paul Pracy Objective: Mechanically ventilated patients are at increased risk to Department of Otorhinolaryngology, Head and Neck Surgery, develop pneumonia (‘‘ventilator associated pneumonia’’, VAP). University Hospital Birmingham NHS Trust, Edgbaston, Pneumonia incidence due to oro- or nasotracheal intubation has Birmingham, UK, B15 2TH been studied extensively, but little information is available on the Objective: To present a case of laryngeal fracture in a soldier due impact of tracheostomy on VAP incidence under prolonged tube to shrapnel injury. use. Goal of this study was to investigate the dynamics of Case report: A 26-year-old soldier was involved in an explosion microbiological colonization of tracheal tubes and the lower whilst serving in Afghanistan. He sustained a shrapnel injury to respiratory tract during the first two postoperative weeks. his neck. A cricothyroidotomy was performed followed by a Methods: Consecutively 50 patients were tracheotomized because surgical tracheostomy at the field hospital. He was transferred to of prolonged mechanical ventilation (on average 14 days prior to the UK where imaging revealed a disrupted left thyroid cartilage. tracheostomy) under intensive care conditions. Tracheal swabs He underwent neck exploration, laryngofissure and reconstruction were taken intraoperatively as well as on predefined postoperative of his larynx. Post operatively he made a good recovery. Fol- days (3rd, 5th, 7th, 10th and 14th days). Additionally rinses of the lowing decannulation his swallow and phonation were good. tracheal tube were performed on the same days of follow-up. Discussion: Penetrating laryngeal injuries should be dealt with by Results: At the day of surgery the tracheal mucosa was already emergency cricothyroidotomy or surgical tracheostomy. Full colonized in 47 of 50 patients; after 7 days all patients had a assessment of the patient accompanied by CT scanning of the microbiologically colonized trachea. The maximum concentration neck will delineate the extent of injury. This should be compli- of microorganisms on tracheal mucosa was measured after 3 days, mented by laryngeal framework surgery. The best outcome should on tracheal tubes after 5 days. However, no VAP was diagnosed be a patient with a near normal voice and good swallowing. after tracheostomy in the observation period. Conclusion: Tracheostomy is not associated with increased VAP incidence. However, high prevalence of colonization of the tube as HP 53 The comparison study of results endo- and well as the trachea with microorganisms affords special surveillance extralaryngeal methods of surgery bilateral paralytic and care. This study was approved by the Ethical Commission of the laryngeal stenoses Medical University of Vienna. (Nr: 331/2004) Mikhail Melnikov Novosibirsk State Medical University, Russian Federation HP 51 It is known and is described with literature main Methods surgical Vocal cord paralysis as the presenting sign of aortic treatment laryngeal paralyses after thyreodectomy: microsurgical arch aneurysm endolaryngeal laterofixation of vocal cords, reconstructive laryn- goplasty with external approach, reinnervation etc. The trials of Amit Kotecha, Yujay Ramakrishnan, Anna Leslie, Alwyn the study was a comparison result using of these methods. D’souza The methods: Endoscopic study of the larynx, spirometry, CT- New Cross Hospital, Wolverhampton scan of neck. Under our observation there were 21 patients with Recurrent laryngeal nerve palsy (RLNP) secondary to cardiovas- paralysis vocal cords after thyreodectomy, divided into two cular disease is a well recognised but uncommon complication. groups. The first group consisted of 8 patients, treated endola- Vocal cord paralysis (VCP) secondary to RLNP is a common ryngeal microsurgery method.The second group consisted of 13 clinical condition. The most common causes worldwide are carci- patients, treated by extalaryngel method. noma lung and tuberculosis, but many pathologies, benign and Results: In the first group of patients time improvement of func- malignant can cause this condition. Cardiovascular disease is a well tion of breath during the first month after operation was marked. recognised but uncommon cause of RLNP. When it does occur it The basic parameters of spirometry have slightly improved. In the has been described as the cardio vocal syndrome, also known as second group all patients on 14 day is made decanulation, satis- Otner’s syndrome. RLNP has been reported to occur in patients factory condition. Spirometric factors to external respiratory with pulmonary artery dilatation (secondary to mitral stenosis, function vastly increased. In 5 cases from patients first group is in valve replacement, septal defects, patent ductus arteriosus) and the same way made extralaryngeal laterofixation of vocal cords. In aortic arch aneurysm and repair. RLNP may be idiopathic or it is the same way either as in the second group all sick were decan- also seen in patients of thyroid tumour, lung carcinoma, oesopha- ulated and in the following social are adapted. geal carcinoma and postoperative complication. The importance of Conclusion: The extralaryngeal laterofixation of vocal cord is an knowing aortic arch aneurysms as a cause of causing RLNP is that most efficient method of the surgical treatment paralytic stenosis of but can resolve following treatment of aneurysm. RLNP in these the larynx, restoring respiratory function for satisfaction results.

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HP 54 Conclusion: This results indicates the necessity of preoperative Measurement and comparison of in vitro air-flow measurement of the predictors may be useful to estimate patients with DLE. characteristics of the most frequently used European indwelling voice prostheses types HP 56 1 1 1 2 P. Kress , P. Schaefer , F.-P. Schwerdtfeger , S. Roesler Reconstruction of the larynx and trachea in case 1Klinikum Mutterhaus der Borroma¨ erinnen gGmbH, Feldstr. 16, 54290 Trier, Germany of chronic stenosis associated with laryngopharyngeal 2University of applied sciences Esslingen reflux disease Recently underpressure related valve opening in indwelling voice Kokorina Victoria, Deragin Nikolai prostheses with a flap valve has been described as a frequent reason The Far Eastern State Medical University, ENT Department, for early device failure similar to biofilm formation. Anyway until 680000 Khabarovsk, Russia, Myravieva-Amurskogo str.35 today there were no objective aerodynamic profiles in SI-Units of Purpose: Chronic laryngeal and trachea stenosis is one of the the different types of indwelling voice prostheses available. In most challenging problems for ENT specialist in Russia. In cooperation with the University of applied sciences Esslingen we recent years this pathology is increasing as a result of prolong performed in vitro air flow measurements of the most frequently intubation and laryngeal trauma. Laryngopharyngeal reflux used types of indwelling voice prostheses in Europe. Pressure-flow (LPR) and acid exposure after laryngeal cane damage peri- charts from nine prosthesis types were taken with a laminar flow- chondrium and subglottic injury progress to a recurrent ste- meter HST LAM-ES 25-10 that is optimized for measurements of nosing lesion. So, in most cases decanulation is impossible low pressure differences in a laminar flow system. Special focus was because of malformation of the larynx and tracheal cartilage. In paid to asses the exact opening pressure of each valve type to case of breathlessness as a result of cartilage malformation and enable the user to choose the valve according to the patients tracheal wall collapse we need to install stents or implants to individual needs of valve resistance. A Second aim was to check reconstruct laryngeal and tracheal wall and to close tracheot- differences in aerodynamic characteristics due to production of the omy hole. The purpose of our research was to estimate the valves. For this purpose ten valves of each design were examined result of implantation of new type of material- micro perforated and significant differences were found. Further measurements will Ni-Titanium (Ni-Ti) for the reconstruction of trachea and lar- be performed to evaluate the changes in resistance and opening yngeal wall. To analyze influence of correction of a reflux on pressure of the valves after long term use in vitro and in vivo. frequency of postoperative complications Methods: Our patient were followed over a 2-year period from 2004 to 2006, during which there were 19 admissions. All these HP 55 patients got stenosis as a result of intensive therapy and prolong Preoperative clinical prediction of difficult laryngeal intubations. 16 patients (84, 2%) with subglottic stenosis had exposure positive pH probe studies (pH below 4 in the pharyngeal probe). This finding was noted in 13 patients despite therapy with proton Ercan Pinar*, Caglar Calli*, Semih Oncel*, Burcu Selek*, pump inhibitors at the time after operation during 3 months. For Bekir Tatar* the same 13 patients we use Ni-Ti flap for laryngeal and tracheal *Ataturk Training and Research Hospital, Izmir, Turkey implantation. Six patients with using auto cartilage implant, was Objective: We investigated clinical predictors of difficult laryngeal taken as a control group, and three patient from these group reject exposure(DLE) in patients undergoing microlaryngosurgery. to use proton pump inhibitors Methods: Ninety-three patients were included in this study. Results: After visualization of stenosis area, the granulation and Twelve clinic and physical parameters were carried out for all scar tissue are removed. For reconstruction the trachea and lar- patients preoperatively. During suspension laryngoscopy lar- yngeal wall Ni-Ti flap were implanted in the anterior wall with yngeal exposure scores were obtained for each patients and using coated Vicryl 3-0 for it fixation. Because of micro perforated compared with the parameters. Patients were divided into two structure and biological conformity Ni-Ti implants, we cane groups according to the laryngeal exposure score: DLE group and decanulat 12 patients. After 2 months implant were perforated non-DLE group. with fibrin a built-in tracheal tissue. In 1 case decanulation was Results: The patients’ age ranged from 22 to 85 years (mean age impossible because of repeated growth of scar tissue as a result of 52.70 ± 13.01). 22 of 93 patients had DLE. Relationship between postoperative inflammatory complications. In control group in 5 DLE score and parameters was analyzed with Spearman’s corre- cases decunulation was impossible because of malformation of lation coefficient. Of all parameters Cormack-Lehane score, neck cartilage implant and collapse of tracheal wall. Postoperative circumference, body mass index, full mouth opening, modified inflammatory complications were detecting in three cases (50%) in mallampati index, hyoid-mental, thyroid-mental, vertical thyroid- this group. mental and sternum-mental distance in full extension showed Conclusion: This research have showed the advantage of using new significant correlation in patients with DLE (P < 0.05). All the material- micro perforated Ni-Titanium (Ni-Ti) for the recon- significant variables in univariate analyses were included in the struction of trachea and laryngeal wall in case of chronic laryngeal multivariate logistic regression model with enter method. Only and trachea stenosis. In 2 months it was built-in tracheal tissue neck circumference >40 cm (P < 0.05; OR:12.82), hyoid-mental and we close laryngeal and tracheotomy hole with perfect cos- distance < 6.05 cm (P < 0.05; OR:6.80) and sternum-mental metic result. The association of LPR and chronic subglottic ste- distance < 13.9 cm (P < 0.05; OR:23.04) in full extension were nosis acts as a synergistic factor that stimulates inflammatory independently associated with DLE. process after laryngeal reconstruction and recurrent stenosis.

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HP 57 ment with severe airway obstruction caused by a large subglottic Chondronecrosis of the thyroid cartilage after tumoral mass migrated in glottic space during an accidental fall of pacient. An emergency tracheotomy was performed. The flexible combined chemotherapy and radiation therapy endoscopy and CT-scan revealed a large pedunculated mass M. Hernando, C. Perez, V. Garcı´ a, G. Plaza arising from the subglottic larynx and anterior wall of upper Department of Otolaryngology, Hospital de Fuenlabrada, cervical trachea with the obstruction of 2/3 from laryngotracheal Madrid, Spain lumen. Results: After a complex assessment, the tumor was excised by Objective: Describe a case of serious complication after combined external approach (median thyrotomy). The histopathologic exam chemotherapy and radiation therapy. of surgical specimen showed malignant nonHodgkin lymphoma Methods: Case report. Literature review. and the immunohistochemical profiles were evaluated in order to Results: We present a 63 year-old woman with chondronecrosis of establish the therapeutic strategy including combination chemo- the thyroid cartilage after chemotherapy and radiotherapy. This therapy in the Department of Oncology. patient presented with many risk factors (diabetes, chest distress Conclusions: Involvement of the subglottic larynx and trachea by and cardiovascular disease) which could have influenced the lymphoma is an uncommon problem which can cause severe air- development of the chondroradionecrosis after radiation therapy, way obstruction and requires multidisciplinary approach (ENT, especially concurrent chemotherapy. It is important to rule out the pneumology, oncology/hematology). The clinicopathologic fea- recurrence or persistence of the primary tumour in the cases where tures of this case have been described and compared with previ- chondronecrosis is suspected. This differential diagnosis may not ously reported cases. be easy, as imaging by MRI or CT scans are not always useful, in our case tridimentional reconstructions of the laryngeal CT and surgical specimen photographs are shown. Our patient finally required a total laryngectomy due to frequent aspirations and HP 59 pneumonias. Diagnosis and treatment of this entity are discussed. Spindle cell carcinoma of the larynx-inicial case report Conclusions: Even though the combination of chemotherapy and Zorica Novakovic1, Predrag Spiric1, Sanja Spiric1, radiation therapy is increasing for laryngeal cancer treatment, the 1 2 presence of chondroradionecrosis of the larynx is a complication Dalibor Vranjes , Radoslav Gajanin 1 to keep in mind when following this therapy. ENT clinic, Clinic center Banja Luka, Bosnia and Herzegovina 2Department of Pathology, Clinic center Banja Luka, Bosnia and Herzegovina HP 58 Objecitves: Spindle cell carcinoma of the larynx is a very Laryngotracheal NonHodgkin’s lymphoma uncommon neoplasm. It takes less than 1% of all laryngeal malignancies. Proper diagnosis and understanding of tumor nat- M. D. Cobzeanu*, V. Costinescu*, Carmen Daniela Rusu*, ure is essential for planning the treatment strategy. I. Hantescu*, A. Arama**, Sultana Mihailovici***, Delia Ciobanu***, M. Grigoras****, L.Miron***** Methods: Case report of a 70-years-old man with three months symptoms of hoarseness and one month difficulties with breath- *ENT Clinic, ‘‘Sf. Spiridon’’ Hospital, Iasi, Romania ing. **Pneumology Hospital, Iasi, Romania ***Histopathology Department,‘‘Sf. Spiridon’’ Hospital, Iasi, Results: We performed biopsy in MLS. Pathohistology diagnosis Romania with imunohistochemistry was:chondrosarcoma gradus III. Cli- ****Radiodiagnostic Department, ‘‘Sf. Spiridon’’ Hospital, Iasi, nicali anterior commisurae and anterior parts of vocal codrs were Romania involved. 5 mm subglottic spreading was noticed.We performed *****Oncology Department, ‘‘Sf. Spiridon’’ Hospital, Iasi, total laryngectomy wthout neck dissection (it was difficult to Romania choose side for elective neck dissection so we decided to ’’wait and see‘‘). Final pathohistology and immunohistochemistry diagnosis Objective: Malignant lymphomas of larynx and trachea are rare was Spindle cell carcinoma. Four months after surgery there is no tumors and require special diagnostic and therapeutic attention. signs of local recurrency or metastasis. The authors present an unexpected case of nonHodgkin Conclusions: Spindle cell carcinoma in our case was recognized as Lymphoma localized in the subglottic larynx and upper cervical chondrosarcoma at moment of biopsy. With examination of all trachea. The clinical presentation, diagnostic and therapeutic parts of tumor we found epithelial cells with squamous differen- approach, evolution and prognosis are discussed. tiation and spindle cells with elements of chondrosarcoma and Methods: We report a case of 25-year-old man patient, with osteosarcoma. Total laryngectomy was our choice although we anamnestic progressive dyspnea, presented in our ENT Depart- perform partial laryngectomy in similar cases with SCC.

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HP 60 usually asymptomatic. We report a case presented with vocal cord Development of newer dilatating stents made paresis. from poly (HEMA) based biopolymers for treatment Case report: A 52-year-old male was presented in the outpatient department with symptoms of coughing and slowly worsening of laryngo-tracheal stenoses in chidren. hoarseness. No other symptoms were present. A right true vocal P. Janousˇek1,M.Prˇa´ dny´ 2, J. Vacı´ k2, A. Banˇasova´ 3, Z. Kabelka1 cord paresis was revealed on the fiberoptic examination. A soft 1Paediatric ENT Departement, ENT Clinic of the 2nd Medical encapsulated mass was identified in the right tracheosophagyal School, Charles University, Motol, Prague, Czech Republic groove during the neck and mediastinal exploration. The mass 2Institute of Macromolecular Chemistry, Academy of Sciences of was dissected inferiorly to the level of the aortic arch and removed the Prague, Czech Republic through the neck. The location of the tumor in the anterior aspect 3Departement of Physiology Medical School, Charles University, of the neck was compressing the trachea and resulting with Prague, Czech Republic symptoms of hoarseness. The macroscopic and microscopic find- ings were suggestive of a cervico-mediastinal hibernoma. The patient made an uneventful recovery and after one year follow up Objective: In treating chronic stenosis of larynx and trachea, an period there has been no recurrence. unequivocal, generally-accepted approach has not been estab- lished. The predominant method of treatment is surgical. Other Conclusion: The hibernoma is a rare benign tumor and in our case, Methods applied include endoscopic (laservaporation, stents) and although it originated from the mediastinum, resulted in func- external procedures (split, graft). tional abnormality causing neuropraxia (vocal cord paresis) due to compression. The removal of the tumor relieved patient’s Methods: We have worked on the development of stents suitable symptoms but close follow up is needed to prevent local recur- for clinical use that exhibit a combination of useful properties rence. (rigidity, absorbability, biocompatibility, microbial inactivity). The stents were developed by polymerisation of 2-hydroxyethyl- methacrylate. Tests of physical properties included traction and HP 62 pressure trials. Biological evaluation involved microbiological testing and testing the reactivity of the polymer in the subcuta- Simple suture’s optimal position for glottis widening. neous tissue and airways of laboratory rats and rabbits. Implan- Experimental sutdy on cadaversnves tation into the airways and ventilation function tests were L Szaka´ cs, G Smeha´ k, A Torkos, L Rovo´ practised. ENT Department, University of Szeged, Hungary, Tisza L. Krt. Results: Animal tests evinced that the implant evoked a minimal 111 Szeged, Hungary inflammatory reaction in the subcutaneous tissue and trachea. In addition, through measuring with a plethysmograph, it was pro- Objective: Attention to vocal cord laterofixation by a ‘‘simple’’ ven that parameters of ventilatory function in animals were sat- suture was drawn by the feasibility of glottis widening. The au- isfactory after stent implantation. thors used cadaver larynges for examining the optimal position of Conclusions: Stents produced on the basis of co-polymers of the suture(s), because it may determine both short and long term HEMA exhibit sufficient properties of biocompatability and results. biological inertness. Methods: Three Methods were examined with the use of digital area measuring on 60 cadaver larynges: vocal chord laterofix- ation (VL) where one laterofixing suture was positioned on the HP 61 vocal process and one in front of it; arytenoid laterofixation (AL) where the laterofixing suture was positioned with consid- Cervico-mediastinal Hibernoma presenting eration of the physiological rocking mechanism of arytenoid with vocal cord paresis cartilage; and King-Schobel method (KS). E. Kyrodimos1, N. Barbetakis2, A. Varsamis1, I. Thomaides1, Results: The average unilateral glottic area (measured from the 1 glottic midline to the edge of the vocal cord) gained by VL was Th. Sidiras 2 2 2 1 80.66 mm ; by AL was 124.11 mm ; and by KS was 107.73 mm . Department of Otolaryngology-Head and Neck Surgery, AL produced significantly better results than VL (P < 0.01). ‘‘Theagenio’’ Cancer Hospital, Thessaloniki, Greece Also significant difference was measured between KS and VL, odd 2Department of Thoracic Surgery, ‘‘Theagenio’’ Cancer Hospital, to the first (P < 0.01). The difference wasn’t significant between Thessaloniki, Greece AL and KS (P = 0.12). Objective: Hibernoma is a rare benign tumor usually derived from Conclusion: The results support the clinical observation of the vestigial remnants of brown adipose cells. The location of these authors, that the ideal place of fixating sutures is the one, which tumors usually parallels the normal anatomical distribution of provides physiological abduction position of the arytenoid carti- brown fat in humans. Head and neck locations are rarer and lages.

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HP 63 HP 65 Videostroboscopy and the management of laryngeal Results of hemilaryngectomy in treatment of laryngeal oncocytic cyst carcinoma Scott L. Lee1, Sara C. Scheid2 Jovica Milovanovic1, Vojko Djukic1, Ivan Baljosevic2, Predrag 1Albany Medical College, Division of Otolaryngology Head & Stankovic1, Vladimir Djordjevic1, Zeljko Petrovic1, Bojan Pavlo- Neck Surgery, 35 Hackett Blvd, MC-41, Albany NY 12208, USA vic1 2Capital Region Otolaryngology Head and Neck Group, 6 1Institute of Otorhinolaryngology and Maxillofacial Surgery, Executive Park Dr., Entrance C, Albany, NY 12203, USA Pasterova 2, 11000 Belgrade, Serbia 2 Institute for Health Care of Child and Mother, Belgrade, Serbia Objective: Oncocytic cysts of the larynx are a subgroup of laryngeal cysts that typically originate in the ventricle and present later in life. Objective: To assess postoperative results of hemilaryngectomy in These are rare lesions and may be solitary or multiple. Symptoms patients with T2 carcinoma of larynx, including appearance and range from mild and nonspecific, to airway obstruction necessitat- treatment of local and regional reccurences, and assessment of ing emergent management. We present a case report of an oncocytic functional status after treatment. cyst of the larynx, review the histopathology, and the pre and Methods: We present a retrospective study of 438 patients with postoperative videostroboscopic images. glottic carcinoma, treated with hemilaryngectomy, at the Institute Methods: Case report. of Otorhinolaryngology and Maxillofacial Surgery, Clinical Results: A preoperative videostroboscopic examination demon- Center of Serbia between 1988 and 1997. strated a cystic laryngeal lesion at the right anterior ventricle. The Results: The patients with positive margins (19.4% of all) were mass impinges on the vocal fold, limiting its mobility with noted postoperatively irradiated. Local recurrences of carcinoma were aperiodicity in vibration. The patient proceeded with a mucosal found in 17.3% of subjects, and regional recurrences in 16.4% of preserving excision under suspension microlaryngoscopy. Post- subjects. Those patients were treated with total laryngectomy or operatively, mild Renke’s edema persisted, but an improvement in radical neck dissection, and with radiotherapy. 5-years survival mucosal waves was demonstrated on videostroboscopy, There was rate in our patients was 79%. no evidence of recurrence. Conclusions: Hemilaryngectomy provided acceptable percent of Conclusions: Oncocytic cysts are rare lesions of the larynx char- local and regional recurrences, and good functional results: res- acterized by oncocytic epithelial proliferation. These lesions are piration, swallowing and voice quality. Therefore it could be the benign and complete excision is the treatment of choice. Advances first choice surgery technique in treatment of T2 laryngeal carci- in laryngoscopic evaluation, such as by videostroboscopy in the noma. office setting, aid in the preoperative diagnosis, assessment of mucosal wave impairment, and postoperative follow up for pa- tients with laryngeal pathologies. HP 66 HP 64 Low grade chondrosarcoma of the cricoid cartilage. Voice prosthesis in voice restoration after total A case presentation laryngectomy-complications C. Ikonomidis, P. Konu, E. Stauffer, D. Meier. Clinic of Oto-Rhino-Laryngology, Head and Neck and Maxillo- Predrag Spiric, Zorica Novakovic, Sanja Spiric, Dalibor Vranjes facial Surgery, Hoˆpital Cantonal of Fribourg, Switzerland ENT clinic, Clinic center Banja Luka, Bosnia and Herzegovina Objective: A case of a low grade chondrosarcoma of the cricoid Objective: TE puncture with voice prosthesis is widely accepted as cartilage is presented, underlying the importance of conservative good, fast and safe procedure. Anyway it is followed by different surgery as treatment of choice. complicationes. Some of them can be serious. All precautions Methods: A 52-year old man presented with persistent hoarseness, should be applied during and after surgical procedure in order to which had developed progressively in a 6 months period. The minimize risk. Among other criteria social, economical, educa- investigations by nasofibroscopy, CT scanner, MRI and endos- tional level of candidate must be considered as well as individual copy, revealed a low grade chondrosarcoma of the cricoid. (mass habits. With this overview of complications that we experienced of about 4 · 3 cm situated in the cricoid’s postero-lateral right we wanted to stress in what one can stuck if underestimate cha- part.) lenges of inserting the voice prosthesis. Results: The patient was treated with conservative surgery by Methods: We analized 25 patients with PROVOX 1 and 13 external approach (thyrotomy). The anatomopathologic image PROVOX 2 prosthesis inserted in six years peroid. All compli- showed an invasive and good differenciated (G1) chondrosar- cationes were conunted and succes rate was expressed in per- come of the cricoid cartilage.No indication for radiotherapy was centage. Each complication was individualy described. posed for this case and the decision for a clinical and radio- Results: In 6 years period we had 25 patients with PROVOX 1 and logical follow-up was taken. One year later, this patient presents 13 with PROVOX 2 prosthesis. We had patients with one or mul- no recurrence. tiple reinsertions with PROVOX 2. Wide range of complication Conclusions: Chondrosarcomas of the larynx are rare tumors that were described. All are devided in three groups, first due to anes- present a slow and progressive evolution. They have a low met- thesia, second during or immediately after surgery and third were astatic potential but local recurrence is common. They represent late complications. Different reasons and therapeutic strategies less than 1% of cartilaginous tumors of the body and less than were discussed. 0.2% of laryngeal tumors. Approximately 300 cases have been Conclusions: TE with voice prosthesis insertion is safe procedure documented in the literature since 1900.Conservative surgery is and method of choice in selected patients. Not all laryngectomized the treatement of choice. Radiotherapy is indicated in specific patients are candidates for voice prosthesis. Complications are cases. inevitable but can be minimazed if you follow certain procedures and therapeutic protocols.

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HP 67 stage T1 and T2 for cure, with oncologic and functional results Results of extended supraglottic laryngectomies superior to those of conventional surgical procedures when the indications, contraindications, general principles and technique of Zeljko Petrovic, Vladimir Djordjevic, Vladimir Nesic, Vojko endoscopic CO2 laser surgery are correctly applied. Djukic, Aleksandar Trivic, Jovica Milovanovic, Sead Ljajic Institute of Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre of Serbia, Belgrade Objective: The objective of the study was to analyze the success of HP 69 the extended supraglottic laryngectomy in relation to classical Larynx Pacing: a new minimal invasive approach supraglottic laryngectomy in indicated cases. for electrode insertion via cricoids cartilage Method: The study was retrospective and included the patients with evidenced and patohistologically verified carcinoma of the G. Fo¨ rster, A. Mu¨ ller supraglottis diagnosed and treated in our Institute, during the Klinik fu¨ r HNO-Heilkunde/Plastische Operationen, period 1976–2001. The total of 461 patients with supraglottic SRH Waldklinikum Gera, Straße des Friedens 122, 07548 Gera, laryngeal cancer were primary treated by surgery using the Germany method of supraglottic laryngectomy. Classical supraglottic lar- Objective: In 2003 Zealear et al. showed for the first time that yngectomy was performed in 401 patients, while 60 underwent laynx pacing in humans with recurrent laryngeal nerve palsy is extended supraglottic laryngectomy. possible. As part of our own efforts to improve the concept of Results: T1 tumor was found in 193 (41.9%) patients, T2 in 240 larynx pacing we thought of new ways to insert the stimulation (52.1%), while T3 was found in 28 (6.0%) cases. Local recurrence electrodes with the least possible surgical trauma. developed in 3 out of 60 patients operated by the extended su- Methods: The method was tested during total laryngectomy pro- praglottic laryngectomy, and in 19 out of 401 operated by classical cedures due to advanced laryngeal carcinoma. 2 supraglottic laryngectomy (v = 0.008, DF = 1, P = 0.929; Results: Electrical stimulation caused an opening of the vocal fold. Yates = 0.000, P = 1.00). Five-year survival of patients operated The required current was in the same dimension as is needed for by the extended supraglottic laryngectomy was reported in 45 out an excitation of nerve fibres. of 60 patients, while survival of patients operated by classical The project was sponsored by the German Federal Ministry of 2 supraglottic laryngectomy was noted in 305 out of 401 cases (v Education and Research (Project No. 01EZ0335). = 0.032, DF = 1, P = 0.858; Yates = 0.000, P = 0.986). Conclusion: There was no significant difference of local recurrence and five-year survival between patients treated by classical and HP 70 extended supraglottic laryngectomy. Voice quality after laser and open neck surgery for T2 glottic carcinoma HP 68 F. Palonta, M. Bussi, R. Teggi, F. Lira Luce, L.Giordano Our experience in the endoscopic LASER surgery San Raffaele Hospital- Vita e Salute University, Via Olgettina 60- of glottic cancer 20132 Milano Caius Doros, Stan Cotulbea, Stelian Lupescu, Marioara Poenaru, Objective: The T2 vocal fold tumor therapy allow the preservation Cristian Sarau of respiration and deglutition. The quality of phonation is the ENT Department, Cardiology Department University of Medi- most important criterion for the patient. The aim of the study is to cine and Pharmacy ‘‘Victor Babes’’ Timisoara retrospectively compare vocal function after treatment of T2 glottic tumors by endoscopic surgery and open neck supracrycoid Objective: The CO2 laser surgery is a modern method in the treat- laryngectomy. ment of laryngeal glottic cancer. In the ENT Department Timisoara Methods: Twenty patients, having very similar oncological con- during a period 01.01.1997–31.12.2006 were operated 261 patients ditions, but different treatment, were included in the study: 10 with laryngeal glottic cancer stage T1a (56 patients), T1b (28 pa- underwent supracricoid laryngectomy using an external ap- tients), T2 (160 patients) and T3 (17 patients) by endoscopic CO2 proach, and 10 underwent an endoscopic laser surgery. Video- laser surgery. The purpose of the study was to analyze the surgical, laryngoscopy and laryngostroboscopy were performed for each functional and oncologic results. subject. We performed an objective and subjective evaluation of Methods: Endoscopic laser CO2 microsurgery was the primary and speech. Voices were perceptually reated by an experienced solitary management for curative resection of the glottic cancer phoniatrician using the GRBAS scale and by subjective Voice performing four types of cordectomies (Type I, II, III, IV) Handicap Index. We evaluated hospitalization time, need for depending of the stage of tumor. All operations were performed and duration of feeding tube and tracheotomy, and complica- under general anesthesia with orotrachel intubation; tracheotomy tions. was not necessary. Preoperative evaluation of carcinoma and Results: Laser surgery had significantly better conditions con- postoperative control examination included modern videoendo- cerning time of hospitalization, peri and post operative compli- scopical procedures and CT-scan or sonography of the neck. The cations. Open neck surgery had a long stay in the hospital and mean follow-up was 36 months. more intra and postoperative complications, scar tissue impair- Results: We obtained the following oncologic results: no reccu- ment, bad compliance. But from a functional point of view, after a rence of disease in 94.3% (246 patients), local recurrence in the 2 year period of follow up, they showed a slightly better voice. larynx in 5.7% (15 patients). The functional results obtained in Conclusions: Post treatment voice results can have significant our series were very good and good in 73.9% (193 patients) of impact on the patient’s quality of life and his ability to maintain cases. employment. Even though a slightly better voice was found after Conclusions: The endoscopic CO2 laser surgery is in our view the open surgery, no statistically significant difference was measured elective and preferable surgical method in laryngeal glottic cancer in the two groups.

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HP 71 essential in reducing the chance of disease progression. Studies The management of laryngo-tracheal rupture have concluded that patients with laryngopharyngeal reflux have a high incidence of laryngeal carcinomas or dysplasia. This should and separation be considered with smoking and alcohol consumption as risk A´ kos Reme´ nyi, Gyo¨ rgy Lichtenberger factors for laryngeal cancer. Szent Ro´ kus Hospital, Dept of ORL-HNS, Budapest, H-1085, Methods: Our three patients had evidence of laryngeal dysplasia Gyulai P. u. 2, Hungary on laryngoscopic examination. There was a high index of suspi- cion of laryngopharyngeal reflux after flexible gastroscopic Objective: The authors describe the case of a patient whose tra- examination in all three cases. These patients were commenced on chea has been separated off from the larynx after self-hanging. high-dose anti-reflux medication in the form of proton-pump Methods: The patient undervent urgent tracheotomy and trans- inhibitors and followed up with nasendoscopic examination to mitted to the department of the authors. In the course of admis- assess disease progression. sion it has been seen that a gap of continuity of several centimetres Results: Our patient group had a variable outcome. During the was present between the cricoid cartilage and the broken-off tra- follow-up period our first patient demonstrated regression of chea. In this area the vaulting of the trachea was conspicuous. dysplastic changes. The second patient had no real change. The Based on indirect examination, the vocal cords were in parame- third patient did unfortunately progress to a T2 N0 M0 squamous dian position. cell carcinoma during the course of follow-up. He was managed After excision of the wound edges the continuity of the larynx and with external beam radiotherapy. trachea was restored by end to end anasthomosis. After healing of Conclusions: We conclude that the findings demonstrate the the wound, some months later partial arytenoidectomy and sub- importance of considering the role of laryngopharyngeal reflux in mucosal cordectomy was performed with laser, preserving and the management laryngeal dysplasia. Oesophagogastroscopy and lateralizing the medial mucous part of the vocal cord according to repeat biopsy in the confines of long-term, close, follow-up should Lichtenberger. Than the patient was decannulated. be a key part of the management of these patients. Result: Five years have passed since the performed operations and the closing of the tracheostoma. The breathing of the patient is satisfactory, the voice is slightly HP 74 weaker than normal, but can be well accepted for every day Tuberculosis: a rare differential diagnosis of laryngeal conversation. Conclusions: This case represents, that also combined laryngo- lesions tracheal injuries could be managed with satisfactory result per- Khushnood Alam, Heather Beaumont, Philip Michael, forming adequate techniques in appropriate time. Andrew Batch City Hospital, Birmingham, UK HP 72 Objective: Laryngeal tuberculosis (TB) is a rare disease usually Solitary plasmocytoma of the epiglottis. Presentation associated with pulmonary TB and accounting for less than 1% of of a clinical case and review of the literature all TB cases. The variable clinical presentation of laryngeal TB may generate diagnostic confusion with other laryngeal diseases J. Urbancic, J. Fischinger, A. Zupevc such as chronic laryngitis and laryngeal carcinoma. Laryngeal TB University Department for Otorhinolaryngology and Cervicofa- is the commonest ENT manifestation of tuberculosis and is cial Surgery, Ljubljana, Slovenia readily treatable with anti-tuberculous therapy. Solitary plasmocytoma is very rare tumor of the head and neck. It Methods: We present the case of a 49-year old Vietnamese gen- represents less than 1% of the malignancies in this region. Al- tleman. He was a smoker of 20 years and had been resident in the though difficult it has to be differentiated from multiple myeloma United Kingdom for the past 26 years. He complained of a early. Since this determines the initial treatment. We describe a 2-week history of sore throat associated with haemoptysis and a female patient with solitary plasmocytoma of the laryngeal part of 3-kg weight loss over the preceding week. epiglottis with surgery as primary treatment modality. Charac- Results: An initial referral was made to the otolaryngologist teristics of disease, diagnostic criteria and therapeutic possibilities from the respiratory physicians who noted an inflamed and are reviewed. swollen epiglottis on bronchoscopic examination. Clinical endoscopic appearances at a subsequent microlaryngoscopy were thought highly suggestive of a carcinoma but subsequent HP 73 histological and microbacterial investigations indicated a Laryngeal dysplasia: a management conundrum tuberculous aetiology. Conclusions: With the United Kingdom population becoming Khushnood Alam, Philip Michael, Andrew Batch increasingly multicultural and foreign travel becoming more City Hospital, Birmingham, UK widespread, the rates of tuberculous disease are rising. Therefore, Objective: Laryngeal dysplasia presents a management conun- while the index of suspicion of an underlying mycobacterial drum. There is a risk of progression from dysplasia to invasive pathology was high in this case, the otolaryngologist should ele- carcinoma. The management of dysplastic changes is controver- vate the consideration of tuberculous infection in the differential sial. There are no clear guidelines as to the length of follow-up diagnosis of laryngeal lesions in order to institute swift therapy time for this patient group. Early detection can be difficult but is and counsel contacts.

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HP 75 Results: The tumor was removed completely using an endola- Apneic anaesthesia with intermittent ventilation ryngeal approach without an external incision. A definitive diag- nosis of a laryngeal neurofibroma was based on the (AAIV) under propofol, in laryngeal microsurgery histopathologic demonstration of the characteristic spindle cells, Anastasia Konstantinou, Antelina Kotsa, Errika Dermitzaki, and a positive result in immunohistochemical staining for S-100 George Banos protein. There has been no recurrence after a follow-up of 2 years. ENT and Department of Anaesthesiology, GH of Halkis, Greece Conclusions: In the literature, a total number of 16 cases, laryngeal neurofibromas were documented in patients with NF1. Neurofi- Objective: Apneic anaesthesia with intermittent ventilation bromas of larynx occur most commonly in supraglottic area (AAIV) has been reported to provide a good visualization and (arytenoids and aryepiglottic fold), due to the abundance of sen- immobile field for microscopic laryngeal surgery. sory nerves at that location, as motor fibers are less involved. Due Methods: We evaluated AAIV using total intravenous anaes- to their slow growth nature, laryngeal neurofibromas can remain thesia with propofol and fentanyl instead of inhalational symptom free for years or become pathogenic since birth, depend anaesthesia on respiration and circulation in 34 patients on their location and size. A change in voice, dysphagia, or undergoing microsurgery of the larynx. As the technique is respiratory difficulty can constitute the spectrum of symptoms. considered potentially hazardous in those patients with upper Surgical excision is the treatment of choice. airway obstruction, such patients were excluded in this study. Anaesthesia was started and maintained with infusion of propofol and intermittent administration of fentanyl and HP 77 intravenously. The patients were ventilated with 100% oxygen and the period of intermittent apnea, guided by pulse oximetry Radiosurgery application in the larynx through and periodic measurement of end-tidal carbon dioxide (CO2) flexible endoscope levels, the endotracheal tube was removed. Jose´ M. Colio*, Valentı´ n Madrid**, Fe´ lix Ruiz de la Cuesta*, Results: The number of periods of apnea (mean ± SD) was Luis Cambra* 3.2 ± 1, and the duration of apnea was 265 ± 43 s. Neither *ENT Department, Marina Alta Hospital, Denia, Spain blood pressure nor heart rate changed during the apneic periods. **Anaesthesia Department, Marina Alta Hospital, Denia, Spain No significant complications have occurred with AAIV. Contra- indications to AAIV are age less than 2 years, significant cardio- pulmonary disease, and any hypermetabolic state. Objective: Presentation of a new technique which combines Conclusions: We conclude that AAIV using total intravenous 4.0 MHz radiofrequency and the flexible endoscope for removal anaesthesia, under constant monitoring of Spo2 is a useful and of benign laryngeal lesions. safe technique. Method: Laryngeal lesions for which this technique is indicated are benigns. Malignant lesions would be excluded from this indication. HP 76 Topical anaesthesia is applied, first by nebulisation and then di- Subglottic neurofibroma associated with von rectly (as you go) onto the lesion. Light sedation can be used in nervous patients. The fiberscopes used are an OLYMPUS with an Recklinghausen disease (Casereport and review external diameter of 4.8 mm and a working channel of 2.2 mm of the literature) and a STORZ with an external diameter of 3.7 mm and a working channel of 1.5 mm. As the source of the radiowaves we use a Anastasia Konstantinou, George Banos, Athanasios Sakellaridis SURGITRON DUAL 4.0 MHz unit manufactured by Ellman ENT Department, GH of Halkis, Greece International. The energy is applied to the lesion by means of a Objective: Neurofibromas of the larynx are extremely rare espe- microfiber electrode (from the same manufacturer) through the cially in the subglottic part. They occur in association with neu- working channel. rofibromatosis less frequently than solitary neurofibromas Results: Lesions removed include polyps, angiomas, nodules and a Methods: We describe a 24-year-old man with neurofibromatosis, granuloma of 16 mm diameter. The patients remained awake and presented to our department of otolaryngology with a 10-month cooperative and the tolerance was excellent in 9 of 10 cases operated. history of slight exertional dyspnea, without pain or dysphagia. There was no abnormal scarring or oedema in the post-operative The patient was diagnosed as having neurofibromatosis type 1 period. Early discharge in 3–4 h is also an important factor. (von Recklinghausen’s disease (NF1), by the established criteria. Conclusions: The radiosurgery to the larynx through the flexible NF1 is known as peripheral NF with cardinal findings, including endoscope is a safe and efficient method for the treatment of be- peripheral neurofibromas, cafe´ au lait spots, freckles, and Lisch nign lesions of the larynx. In those patients in whom general nodules. Fiberoptic laryngocopy revealed a round smooth sur- anaesthesia would be a major risk, this technique would be the faced submucosal subglottic mass. method of choice.

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HP 78 HP 80 Pharyngocutaneous fistula following total Control of haemorrhage by transoral removal laryngectomy of laryngeal haemangioma Cem Ozer*, Erdinc Aydin*, Fulya Ozer*, Haluk Yavuz*, A. Bihari, A´ . Reme´ nyi, S. Leitersdorfer, G. Lichtenberger Cuneyt Yilmazer*, Levent Naci Ozluoglu* Szent Ro´ kus Hosp. and Inst., Department of ORL-HNS, *Baskent University Faculty of Medicine, Department of Oto- 1085 Budapest, Gyulai Pa´ l u. 2., Hungary rhinolaryngology Head and Neck Surgery, Ankara, Turkey Objective: Laryngeal haemangioma in adults is a rare condition. It Objective: The objective of this study was to investigate the inci- may cause hoarsness, coughing and dysphagia. Nowadays laser dence and predisposing factors of pharyngocutaneous fistula surgery is the most common procedure, to treat these patients. (PCF) following total laryngectomy. Patients and methods: We present three cases of laryngeal and Methods: In this retrospective study, the medical records of 75 hypopharyngeal haemangioma in adult patients. Theirs com- patients who underwent total laryngectomy were reviewed. Age, plaints were: hoarsness, dysphagia, and coughing. The location of sex, smoking and drinking habits, presence of systemic diseases, the lesions were in one case on the ary-region and on the false preoperative tracheotomy, previous radiotherapy, duration of vocal cord, and in the other two cases at the postcricoid region. general anesthesia, concurrent neck dissection, partial phar- After check-up all patients were treated surgically, using CO2 laser yngectomy, type of pharyngeal closure (T versus horizontal), endoscopically. In two patients after removing of the haemangi- size and site of origin of the tumor, clinical stage of the tumor, oma, the coagulation of bleeding area was sufficient. In one pa- status of surgical margins, histologic grade, perioperative tient, who had a larger lesion at the postcricoid region, the transfusion, postoperative Hb level and time of postoperative coagulation was not sufficient to control haemorrhage. There we oral feeding were analyzed as potential risk factors in fistula had to adapt the mucosal edges around the wound bed and suture formation. them using the ligature-suture technique and instrument by Results: A pharyngocutaneous fistula was observed in nine Lichtenberger. (12%) patients. Among the possible risk factors investigated, Results: There were no complications. Histology proved to be in preoperative radiotherapy was significantly associated with all three cases cavernuos type haemangioma. All patients have PCF. Also, a significant decrease in the rate of fistula formation remained free of recurrence, and have no complaint. was found in patients orally fed on or before the fifth post- Conclusion: These cases present, that most laryngeal haemangio- operative day compared to those orally fed on or after the mas (under a reasonable size) can be safely managed with endo- seventh postoperative day. Other factors were failed to show scopic laser surgery. At larger lesions the bleeding may cause statistical significance. difficulties. The ligature-suture technique by Lichtenberger helps Conclusions: Evaluation of the risk factors for PCF in our series us to overcome this problem. indicates that early postoperative oral feeding significantly de- creases the rate of fistula formation which was emerged for the first time in the literature. The time after which it is safe to HP 81 initiate oral feeding is still a topic of debate and further con- HO:YAG and KTP lasers in the microsurgery trolled prospective multicenter studies are needed to confirm of the larynx our findings. D. M. Mustafaev, Z. M. Ashurov, E. V. Osipenko Ruusia, Moscow HP 79 Objective: The aim of the research is the increase of the efficiency of surgical treatment of the patients suffered from benign lesions Laryngocele: an unusual late complication of subtotal using the endolaryngeal microsurgery with the help of Ho: YAG laryngectomy and KTP of the lasers in the conditions of the transcatheter high- frequency artificial ventilation of the lungs (THFAVL). Dimitrios Lefantzis, Chrysa Lyra, Minas Artopoulos, Kostanti- Materials: One hundred and ninety-eight patients examined from nos Christidis 6 to 75 years suffered from papillomas and polypus of the larynx ENT Department, The Red Cross Hospital, Athens, Greece (2003–2007). The efficiency of the microsurgery Ho:YAG and Objective: Laryngoceles usually have a congenital origin or co- KTP using the lasers has been controlled by the measurement of exist with laryngeal carcinoma. Laryngocele is the result of the the acoustic parameters of the voice and the research of the dilation of saccule due to functional or true anatomic obstruction function of external breath (FEB) and bodyplethysmography. of the laryngeal ventricle.There also must be an important asso- Results: before the operation 100% of the patients have dyspho- ciation with laryngeal carcinoma because while the incidence of nia. The changes of permeability of the out of pectoral department laryngoceles in normal larynx was found to be about 2%, laryn- of the respiratory ways of the first degree was typical of 12.12% goceles occurred in 18% of specimens when carcinoma was After the operation the voice has recovered at 78.1% of the pa- present.However laryngocele can be a late complication of partial tients, the improvement of the voice was typical of 18.8%, there laryngectomy. were no changes in the health conditions at 3.1%. The restoration Methods: We present an unusual case of laryngocele occurring to of permeability out of pectoral of the department of the respira- a 49-year-old man who underwent a partial laryngectomy due to tory ways was typical of 93.4% of the patients. laryngeal carcinoma. Conclusion: (1) The use of Ho:YAG and KTP of lasers in Results: The main symptom of our patient, persistent hoarseness, microsurgical treatment benign lesions provides exsanguinity, and the endoscopic documentation of a laryngeal mass indicated smaller inflammatory reaction in comparison with instrumental the recidivation of the disease. methods of the endolaryngeal microsurgery; (2) THFAVL pro- Conclusions: The purpose of this presentation is to increase doc- duces maximum convenient and safe conditions for surgeon’s tors’ alertness in facing postoperative laryngoceles. actions in the terms of microsurgery of the larynx using the lasers.

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HP 82 Objective: To introduce the use of new high resolution magnifyng Basaloid squamous cell carcinoma of the larynx: endoscope in the endoscopic examination of the upper aerodi- gestive tract and discuss the usefulness of this tool in the diagnosis a case-report of laryngeal lesions. S. Vlachou1, A. Karageorgopoulos1, G. Plessas1, G. Terzakis1, Study design: Comparison between traditional electronic video- C. Barbatis2, G. Papazoglou1 endoscopy and new high resolution magnifyng endoscopy. 1ENT Department, Red Cross Hospital, Athens, Greece Methods: Twenty-six patients presenting different laryngeal 2Department of Pathology, Red Cross Hospital, Athens, Greece pathologies were examinated by means of an electronic videoen- doscope and a high resolution magnifyng endoscope. The images Objective: Basaloid squamous cell carcinoma (BSCC) is a recently obtained were examinated and compared. introduced subtype of laryngeal cancer, with less than 50 cases Results: In the 26 patients observed, the clinical diagnosis was presented since 1986. We report such a case diagnosed and treated changed with high magnification and digital image processing in in our Department. four patients. In 22 patients the high magnification examination Method: The patient presented 4 years ago because of odynopha- allowed a better description of the laryngeal lesions without gia. The clinical examination revealed leukoplacia of the orophar- leading to a significant switch in the diagnosis. In the cases of ynx, and a suspiscious foci on the tonsil. Biopsies taken showed a leukoplakia there were a more detailed examination of colour, non keratinized squamous cell carcinoma, grade III. The patient extension and thickness of the lesion, surface and borders irreg- was submitted to radiotherapy. One year later, in a follow up visit, ularities, with easy characterisation of aspect of neighbour lar- there was a lesion in the right glottis and adjacent arytenoid. Direct yngeal mucosa. Furthermore the optical magnifying zoom does laryngoscopy and biopsy revealed laryngeal cancer. The patient was not require a close approach to the laryngeal mucosa to well operated on and had a total laryngectomy. The tumor invaded the characterize the lesions so less local anaesthesia is required. right glottis, the thyroid cartilage, the laryngeal walls, extending to Conclusions: The high resolution magnified images obtained with the right thyroid lobe. The final histology was that of a BSCC. The this new tool provide precious information on the color of the tumor tested positive for CEA and high molecular weight cytocer- lesions, on their tridimentional aspects and precise extension in atines, while vimentin, CK 29 and a-sma were negative. the laryngeal structures. This new endoscopic technology, as al- Results: The patient passed away 1 year ago. ready happen in gastric, esophageal and colorectal pathologies, Conclusion: BSCC is a comparatively new type of SCC, with a can be also improved by using chromoedoscopy and other vital more aggressive clinical course. stain techniques in order to provide precious information about pre-neoplastic lesions of the larynx. HP 83 Rare laryngeal tumors. Presentation of 46 cases HP 85 Solution of dyspnoe due to paradoxical vocal cord G. Dritsas, G. Mireas, A. Karageorgopoulos, E. Nikolaidis, movement M.-F. Graikou, S. Triantos, G. Papazoglou ENT Department, Red Cross Hospital, Athens, Greece Judit Falvai, Krisztina Me´ sza´ ros*, Gyo¨ rgy Lichtenberger Szent Ro´ kus Hospital and Institutions, Department of Otorhi- Objective: The purpose of the present study was to present our nolaryngology, Head and Neck Surgery, 1085 Budapest, Gyulai data on rare laryngeal tumors.. Pa´ l u. 2., Hungary Methods: We report 46 consecutive cases diagnosed and treated in *National Medical Center, 1135 Budapest, Szabolcs u. 35., our Department within 7 years (1998–2004). The patients were 7 Hungary women and 39 men, 25 to 72 years old, who presented mainly with hoarseness, and some of them with odynophagia, neck swelling and dyspnea. All patients were admitted, clinically examined, and Objective: Paradoxical vocal cord movement is a very rare con- submitted to laboratory workup, including neck CT with contrast dition. It is characterized by the abnormal, conflicting adduction scan and underwent direct laryngoscopy and biopsy. of the vocal cords during inspiration and abduction during ex- spiration. The treatment is complex: speech therapy, pharmaco- Results: The histological examination revealed the following tumor logical therapy, psychotherapy, and/or surgical intervention, types. A: benign tumors. 1 neurilemmoma, 1 hemangioma, 1 depending on the causative factors. Paradoxical vocal cord mo- chondroma, 1 paraganglioma, 1 rabdomyoma. B: Malignant tu- tion can imitate upper airway obstruction. It is a serious condition mors 25 verrucous Ca, 5 mucoepidermoid Ca, 3 oat cell, 1 basaloid, that requires prompt diagnosis and treatment. 1 adenoid cystic, 2 neuroendocrines, 2 spindle cell carcinomas and 2 sarcomas.Depending on the histological type and tumor staging the Case history: We report a young female patient presenting with patients underwent different type of management including laryn- inspiratory dyspnoe, stridor and dysphonia after upper airway gectomy, neck dissection, radiation therapy or chemotherapy. infection. Examinations demonstrated paradoxical vocal cord motion without laryngological organic disorder. The patient Conclusion: The knowledge of the histological type along with the underwent an endoscopic reversible endo-extralaryngeal laterali- tumor staging determines the treatment in each since it is related sation by Lichtenberger in general anaesthesia with high frecvency to the biological behavior of the tumors. JET ventilation. HP 84 Results: Postoperative control examination, lung function tests and phoniatric checking proved, that the patient’s breathing and High resolution magnifyng endoscopy: a new voice became normal again. Probably the surgical thread-loop diagnostic tool also fu¨r laryngeal examination? pressed the vocal cords to perform near physiological motion. Conclusion: This procedure may open a new way in solution of Claudio Parrilla, Mario Rigante, Giovanni Cammarota*, Eugenio dyspnoe and acut respiratory distress due to paradoxical vocal De Corso, Luigi Corina, Giovanni Almadori, Gaetano Paludetti, cord movement. Jacopo Galli Institute of Otolaryngology and Gastroenterology; *Catholic University of Sacred Heart, Rome, Italy

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HP 86 Methods: In a retrospective study, 68 biopsies of laryngeal Chondroma and chondrosarcoma of the larynx. hyperplastic lesions were classified according to the Ljubljana classification comprising simple hyperplasia (benign spinous layer Two case reports augmentation), abnormal hyperplasia (benign basal and parabasal Sotirios Papouliakos1, Georgios Peristerakis1, Stamatios Ferga- layer augmentation), atypical hyperplasia (with a high risk for dis1, Dimitrios Aggeletos1, Eyaggelia Zacharioudaki1, malignancy) and carcinoma in situ. Sixty-eight biopsies with Spyros Kavvadias2, Zisis Pappas1 preneoplastic changes were classified according to Ljubljana 1ENT Department, General Hospital of Athens ‘‘G.Gennimatas’’ classification. 2Radiology Department, General Hospital of Athens ‘‘G. Genn- Results: We found 25 cases (36.8%) which showed simple, 23 imatas’’ (33.8%) abnormal, 18 (26.5%) atypical hyperplasia and 2 (2.9%) carcinoma in situ. Two cases of atypical hyperplasia (2.9% of all Objective: Cartilaginous tumours of the larynx represent less than investigated cases) progressed to invasive carcinoma during the 1% of laryngeal tumours, chondroma and chondrosarcoma being observation ranging from 5 to 9 years. None of the cases classified as the most common. Laryngeal chondromas are rare benign tu- simple or abnormal hyperplasia showed progression to malignancy. mours originating from the cartilagenous framework of the larynx Conclusion: The Ljubljana classification focuses on the important (mainly from the cricoid cartilage). Chondrosarcomas are usually clinical decision involving benign lesion that do not require strict diagnosed with significant delay due to nonspecific symptoms. We follow-up (simple and abnormal hyperplasia); and ‘‘risky’’ epi- present two cases with cartilaginous tumours of the larynx that thelium that require close follow-up with repeated histologic were diagnosed and treated to our department. assessment (atypical hyperplasia); and carcinoma in situ that re- Methods: The first patient presented with hoarseness, progressive quires fast, complete treatment. We suggest that the Ljubljana dyspnea, dysphagia and aspiration. Direct laryngoscopy revealed classification can be reliably applied for classifying all hyperplastic a glottic mass, while barium swallow was normal. CT scanning laryngeal lesions, may be essential for planning treatment and displayed a mass arising from the cricoid cartilage. The second prognosis in those patients. patient presented with a neck mass. CT scan of the neck displayed *This study was supported by grant No 502-11-453 from Medical a mass involving the cricoid cartilage. A biopsy was obtained University of Lodz revealing a chondrosarcoma. Results: On the first patient total laryngectomy was performed and the histopathologic diagnosis was chondroma. Vertical partial laryngectomy was performed on the second patient and the his- HP 88 topathologic diagnosis revealed a low-grade chondrosarcoma of Laryngitis and anabolic steroids the cricoid cartilage. Conclusions: The clinical presentation of chondromas and chon- Shalina Ray, Ajmal Masood, John Pickles, Ioannis Moumoulidis drosarcomas of the larynx is varied and dependent on their size Department of Otolaryngology, Luton and Dunstable Hospital, and location. The most common symptoms are hoarseness, Luton, UK dyspnea or a neck mass. CT scanning is necessary due to its ability Objective: The effects of anabolic steroids on the quality of voice to delineate tumour’s size and invasion into surrounding struc- have been well documented; however, no study has established tures.Direct laryngoscopy and biopsy may be useful regarding significant structural changes in the larynx as a direct result of diagnosis although it is not always easy to obtain a biopsy sample anabolic steroid use. We present a unique case of stridor due to because of the tumour’s submucosal location. Surgical treatment severe laryngitis in a patient who regularly used anabolic steroids is the standard therapy. Depending on the tumours extend wide as a part of his body building training. excision or laryngectomy may be performed. Method: A 47-year-old male smoker and professional body- builder presented with progressive dyspnoea, stridor and hoarse- ness. He was a professional body builder and admitted abusing HP 87 anabolic steroids regularly as a part of his routine training. Assessment of laryngeal epithelial hyperplastic lesions Microlaryngoscopy revealed hyperaemic laryngeal mucosa, in the Ljubljana classification* markedly congested and swollen supraglottis along with irregu- larly oedematous vocal cords Biopsy showed polypoid lesions 1 1 Pietruszewska Wioletta , Bojanowska-Poz´ niak Katarzyna , with hyperkeratotic and hyperplastic epithelium. 1 1 2 Gryczyn´ ski Maciej , Durko Marcin , Kobos Jo´ zef , Results:Conservative management failed to resolve his symptoms 1 Department of Otolaryngology, Medical University of Lodz, and a planned tracheostomy was performed to secure his airway. Poland Subsequently he was treated with multiple laser resections, and 2 Department of Pathology, Medical University of Lodz, Poland eventually decannulated. Objective: Diagnosis and treatment of laryngeal epithelial hyper- Conclusion: No previous cases found describing airway impair- plastic lesions have been frustrated because of failure to define the ment due to laryngeal changes associated with chronic anabolic histologic changes that may predict the potential for progression to steroid use. The changes noted in the larynx were similar but more invasive carcinoma. To validate criteria for the grading of hyper- florid to those found in experimental animal studies. These plastic epithelial laryngeal lesion, we used a Ljubljana classification. changes in the human larynx have not been reported previously.

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HP 89 Thirteen cases were of early glottic carcinoma for whom cordec- ‘‘Morphometric estimation of laryngeal cancer tissue’’ tomy was done. Seven cases came in respiratory distress and endoscopic laser debulking was done to avoid tracheostomy. In Tatiana Gierek1, Jaroslaw Paluch1, Jaroslaw Markowski1, five cases debulking was done as a palliative measure. 2 2 2 Jacek Chraponski , Jan Cwajna , Marian Malin´ ski , Results: In nine cases of T1a, one case of T1b and three cases of 3 3 1 Maciej Kajor , Ewa Zielinska – Pajak , Lucyna Klimczak-Golab T2a laser cordectomy was done. All 13 patients are under obser- 1ENT Department, Silesian Medical University, Katowice, vation. Three of them were given radiotherapy on follow up. Poland Patients have good postoperative voice and have shown no 2University of Technical Science, Katowice, Poland recurrence till date. Three patients came with respiratory distress 3Department of Pathology, Silesian Medical University, Katow- due to obstructive supraglottic mass. Debulking was carried out ice, Poland with diode laser and tracheostomy was avoided. Histopathology The purpose of study was to determine the degree of differentia- revealed evidence of malignancy in all three cases. tion of laryngeal squamous carcinoma, applying morphometric Conclusion: In carefully selected patients of early glottic carci- methods. The following research aims have been defined; (1) noma endoscopy laser surgery has given excellent control rates. determination of morphometric parameters of nuclei and nucleoli This procedure avoids morbidity and side effects associated with of laryngeal carcinoma cells, (2) performance of mathematical radiotherapy and gives one session therapy as compared to four to analysis of obtained size parameters of nuclei and nucleoli of six weeks therapy with radiation. Endoscopic laser surgery for laryngeal carcinoma cells, (3) comparison of investigation results early glottic carcinoma is a good treatment alternative in terms of in relation to specific degrees of pathomorphologic malignancy of oncological as well as functional results. laryngeal carcinoma and control group. Material: The investigation comprised 67 patients suffering from HP 91 squamous laryngeal carcinoma, malignancy degree between G1 Amyloidosis of the larynx and G3, undergoing surgical treatment. Methods; The material 1 1 2 ¨ 2 for studies consisted of laryngeal carcinoma tissues, while the Su¨ ha Beton ,Hu¨ nkar Batikhan , Hilal Erinc¸ ,Ozden Tulunay , 1 objects of studies were the nuclei and nucleoli of cells. The control Gu¨ rsel Dursun 1 group consisted of healthy laryngeal tissues. For morphometric Department of Pathology, Medical School of Ankara University, assessment was used microscope Olympus AX70-PROVIS. Sur- Ankara, Turkey 2 face and circumference of the cellular nuclei and nucleoli of lar- Department of Otorhinolaryngology, Medical School of Ankara yngeal carcinoma have been assessed. The images of objects University, Ankara, Turkey underwent mathematic examination using the specialist computer Objective: Amyloidosis is an acquired or inherited disorder asso- programme VISILOG 4.1 by NOESIS. ciated with deposition of extracellular, insoluble, fibrillar protein. Results: Morphometric measurements of the surface of flat cross- Laryngeal amyloidosis (LA) is an uncommon form of amyloidosis section of nuclei and nucleoli as well as flat circumference of with limited long-term clinicopathologic knowledge in the litera- cellular nuclei and nucleoli of laryngeal carcinoma have been ture. LA represents 0.5–1% of benign laryngeal disease, increasing shown statistically significant differences, depending on the with age but occasionally affecting young adults, We discussed malignancy degree of neoplasms; G1–G3. our experience in laryngeal amyloidosis. Conclusion: Size features of nuclei and nucleoli of cells as cir- Methods: A 75-year-old female presented with a 1 month of cumference and diameter of flat cross-section determined by hoarseness and a foreign body sensation in her throat. Direct means of morphometric method, may be use in diagnosis of laryngoscopy showed yellow, hyperemic mass on the left false fold malignancy degree of squamous laryngeal carcinoma. and laryngeal ventricle. Results: Microlaryngoscopic removal of the tissue (7 · 3 · 3 mm) was performed. Because of recurrence, 3 months later a mass HP 90 (5 · 3 · 3 mm) was removed. The histopathology revealed an Endoscopic laser surgery for laryngeal malignancy subepithelial, extracellular, acellular, amorphous, eosinophilic matrix deposition that is often accentuated around minor se- Sachin Gandhi, Vasant Oswal* romucous glands and vessels. A sparse inflammatory infiltrate Voice disorder Clinic, Deenanath Mangeshkar Hospital, Pune, predominantly made up of lymphocytes and plasma cells was Maharashtra, India noted, particularly at the leading edge of amyloid. There was no *James Cook University Hospital, Cleveland, UK evidence of neoplasm. Patient was followed up 3 years without recurrence. Objective: To assess the laser management of Tis, T1, T2 tumors Conclusions: The prognosis for patients with localized LA is of the larynx, and debulking of large tumors for palliation and excellent if the lesion is completely excised with safe margins. avoiding tracheostomy. Long-term monitoring for local recurrences or subsequent devel- Methods: This is a review of 25 cases of laryngeal malignancy opment of systemic disease is important. There has been no report operated between 2001 and 2006 with CO2 and diode laser. of malignant transformation in amyloid tumor.

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HP 92 HP 94 Actinomycosis and osteochondroradionecrosis Laryngeal stenosis in epidermolysis bullosa dystrophia of hyoid bone and thyroid cartilage Takuo Haruyama, Masayuki Furukawa, Fumihiko Matsumoto, Danic Hadzibegovic Ana, Danic Davorin, Prgomet Drago* Kenji Kawano, Katsuhisa Ikeda Department of Otorhinolaringology and Head and Neck Sure- Department of Otorhinolaryngology, Juntendo University School gery, General Hospital Slavonski Brod, Andrije Stampara 42, of Medicine, Tokyo, Japan 35000 Slavonski Brod, Croatia Epidermolysis bullosa dystrophia is a rare hereditary skin disease *Clinic of Otorhinolaringology and Head and Neck Surgery, of infancy in which minor trauma causes blister formation. We University Clinical Center Zagreb, Salata 3, 10000 Zagreb, Croatia report a rare case of epidermolysis bullosa dystrophia (recessive) with a stenosis of the larynx due to epiglotic deformity. We per- Osteoradionecrosis of hyoid bone and thyroid cartilage is rare and formed a tracheotomy followed by a long-term observation of severe complication of combined head and neck carcinoma therapy, tracheostoma. Although it has been suggested that a biological and it is known that irradiated bone is highly susceptible to infec- nature of the disease results in the erosion on a trachea mucous tions. Today, head and neck actinomycosis is a rare clinical entity, membrane by non-specific stimulation such as ttacheal intubation and laryngeal actinomycosis is even more unusual. Primary acti- or tracheostomy, the postoperative course in the present case was nomycosis occurs in immunocompromised patients with no head uneventful. and neck lesions, whereas secondary actinomycosis occurs after trauma, operative procedures and/or radiotherapy, or concurrently with malignant lesions, or other infectious diseases. To this date, no cases describing actinomycosis and osteoradionecrosis of the hyoid HP 95 bone and chondroradionecrosis of the laryngeal cartilage were EBV associated smooth muscle tumour mimicking found. We present a case of osteoradionecrosis of hyoid bone and bilateral vocal process granuloma chondroradionecrosis of laryngeal cartilage, both accompanied by actinomycosis, in a 54 year old patient following oropharyngeal Eng Cern Gan1, David P. C. Lau1, Khoon Leong Chuah2 carcinoma resection, reconstruction surgery, and postoperative 1Department of Otolaryngology, Singapore General Hospital radiotherapy. Clinical manifestations, diagnostic dilemmas and 2Department of Pathology, Singapore General Hospital therapeutic options are discussed. Objective: (1) To increase awareness that Epstein Barr virus associated smooth muscle tumour (EBVASMT) may mimic HP 93 bilateral vocal process granuloma, especially in immunocompro- Ionizing radiation and laryngeal carcinoma mised patients. (2) To understand the prevalence, pathogenesis, clinical behavior and treatment of EBVASMT in immunosup- T. Antoniv, A. Mickonas pressed patients or organ transplant recipients. (3) To review the Russian People‘s Friendship University literature concerning the differential diagnosis of polypoid vocal The quantity of oncological patients is still constantly growing. In process lesions. spite of the fact that tumour of such localization is easy to Methods: A case is presented of a 36-year-old Chinese lady with a examine the majority of the patients are admitted to the hospital renal transplant for end-stage renal failure due to Goodpasture’s in III, IV stages. Syndrome. She presented with a year’s history of throat discom- Objective: We analyzed the results of examination and treatment fort and acid regurgitation into her throat. Videolaryngoscopy of 490 patients with larynx cancer with were treated in our clinic revealed bilateral vocal process granulomas. These were presumed last 12 years. From 490, 165 patients had contact ionizing radia- to be due to gastroesophageal reflux and she received four weeks tion (main group) and (or) radionucleeds (atomic physicists, of high-dose Omeprazole. However on follow up a month later, sailors of atomic icebreakers and submarines, workers of atomic the granulomas had enlarged, and laser excision was undertaken. stations, liquidates in accident at Chernobyl AES). Histological and immunohistochemical stains were consistent with Methods: The tumour of upper larynx part according to research EBVASMT. manifests by dysphagia. Dysphonia appears late in patients with Results: EBV has been linked to conditions such as nasopha- primary upper laryngeal part tumour. The tumour of middle part ryngeal carcinoma, Burkitt’s lymphoma and post-transplanta- of larynx characterized by the other chronology of symptoms. The tion lymphoproliferative disorders. EBVASMT has been first appeared sign is dysphonia that transmit to hoarseness and reported in the lungs, kidney, liver, spleen, dura and skull base. then to aphonia. The first sign of low part tumour is dyspnoea Little is known of the pathogenesis of this rare disorder but the (respiratory failure), stenosis and apnoea. condition seems to improve with modification and reduction of Conclusions: The growth of tumour is fast (30–60 days) the low the immunotherapy dose. This is believed to be the first re- differentiated form of cancer prevail more than 20% of patients of ported case in the English literature of EBVASMT affecting the main group had primary multiply form of cancer, majority of vocal process. them (78%) died during the first year after treatment (surgery) Conclusions: Clinical awareness of this condition is important radio treatment as well as chemotherapy is not successful but especially in immunocompromised patients to facilitate early contraindicated diagnosis and institution of appropriate treatment.

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HP 96 Results: The mass was excised using a transcervical approach with left greater cornu of hyoid bone. The pathologic diagnosis was Homocysteine, folate and vitamin B12 plasma levels chondroma of hyoid. in laryngeal cancer Conclusions: Expert radiologic and pathologic review is manda- A. Nacci1, I. Dallan2, L. Bruschini2, F. Matteucci1, P. Bruschini2, tory in cartilaginous neoplasms of the larynx. Cartilaginous neo- V. Mancini1, F. Ursino1, B. Fattori1. plasms of the hyoid should be included in the differential 13rd Otorhinolaringology Unit, Department of Neurosciences, diagnosis of neck masses at the carotid triangle. University of Pisa, Italy 22nd Otorhinolaryngology Unit, Azienda Ospedaliero-Universi- taria Pisana, Italy. HP 98 Morphological aspects in laryngeal premalign lesions Objectives: Metabolic alterations, often non-specific, are common Florin Anghelina*, Elena Ionita˘*, Carmen Mogoanta˘*, in cancer patients. An association between folate and homocy- Iulica˘Ionita˘**, Sorin Ciolofan**, Carmen Popescu**, steine levels and head and neck squamous cell carcinoma Laurentiu Mogoanta˘*** (HNSCC) has been described. *ENT Department, University of Medicine and Pharmacy of Methods: We described our experience about homocysteine, folate Craiova and vitamin B plasma levels in laryngeal cancer. Serum levels of 12 **Emergency Hospital of Craiova homocysteine, folate and vitamin B have been measured in 25 12 ***Histology Department, University of Medicine and Pharmacy patients with histologically confirmed laryngeal carcinoma. The of Craiova control group was composed of 80 subjects (subdivided into smokers and non-smokers and into drinkers and non-drinkers). Objective: We investigated the proliferative activities in prema- Results: The mean level of total homocysteine in patients was 21 ± lignant laryngeal vocal chord lesions treated by epithelial stripping 12 versus 7.3 ± 1.8 SD lM/l in the control group (P < 0.001). in microlaryngoscopy, using immunohistochemical staining with The mean folate plasma level in patients was 4.3 ± 2.2 versus anti p-53, anti-PCNA and anti-Ki-67 monoclonal antibody and 7.9 ± 2.4 SD ng/ml in the control group (P < 0.001). we correlated with clinic and morphologic aspects. Conclusions: We believe that these metabolic alterations (espe- Materials and methods: The study was made on 32 patients cially hypofolatemia) could predispose, in association with other hospitalized in Craiova ENT Clinic in 2005 presenting lesions factors, either environmental or genetic, to laryngeal cancer. precursor to vocal cord malignity. The lesion’s aspect was ob- Lengthier follow-up studies and larger groups of patients will help served using suspended microlaryngoscopy, a biopsy was per- us to understand the real value of these metabolic alterations. formed and biological tests were examined from a pathological and immunohistochemical point of view, with the investigation of the following immunohistochemical markers: Ki-67, PCNA HP 97 and p53. Hyoid chondroma presenting an external neck mass Results: Thirteen cases (41%) presented red hypertrofic cronic laryngitis, 7 cases (22%) presented white hypertrofic cronic I. Ozcan*, K. M. Ozcan*, A. Selcuk*, G. Ergul**, H. Dere* laryngitis, 12 cases(37%) presented papillomas with with simple, *Ankara Numune Education and Research Hospital 4th ENT moderate, severe dysplasia and in situ carcinoma in 62.5, 22, Clinic, Turkey 12.5% and, respectively, 3% of the cases. All the dysplasic le- **Ankara Numune Education and Research Hospital Pathology sions, no matter the dysplasic degree, have presented alteration Clinic, Turkey of both surface eplitelium and chorion. The expression of Ki- Objective: Chondromas of the larynx are rare neoplasms, only a 67, PCNA and p53 was correlated with the dysplasia’s degree in few examples of cartilaginous tumors affecting hyoid bone have various proportion. been reported. Conclusion: In clinical practice, morphological grading of dys- Methods: A 33-year-old woman patient presented with a history of plasia is difficult to evaluate. The Ki-67 and PCNA markers were neck mass on the left carotid triangle. The patient’s computerized correlated with the dysplasia degree; the expression of p53 was tomography and magnetic resonance imaging revealed a heter- present only in 28% cases with moderate dysplasia and in one case ogenous mass which seemed to originate from the left greater with in situ carcinoma. cornu of hyoid.

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HP 99 to be successful and endoscopic methods are generally suggested Autofluorescent diagnostics of laryngeal precancerosis for only mild types of stenosis. The aim of this study was to introduce an endoscopic method that can solve suffocation and cancer without tracheostomy even in difficult cases. Nenad Baletic1, Hidajet Malicevic2, Zeljko Petrovic3, Methods: Thirty-three patients were enrolled with minimum two Jelena Sotirovic1 year follow-up. The interarytenoid scar was completely excised, 1Military Medical Academy, Clinic for Otorhinolaryngology, and the intracapsular fixing scar was transsected by a special blade Belgrade, Serbia designed by the authors. After this the arytenoid cartilages were 2Hospital Center Bezanijska Kosa, Pulmology Department, fixed in abducted position by endoscopically inserted suture. The Belgrade, Serbia peak inspiratory flow (PIF) was measured before (I), in the first 3Clinical Centre of Serbia, Institute for otorhinolaryngology and days after the procedure (II), and at the end of the first postop- maxillofacial surgery, Belgrade, Serbia erative year (III) Results: Average PIF I: 1.22 l/s; avg. PIF II: 2.56 l/s; avg. PIF III: Introduction: Autofluorescent endoscopy (AFE) is based on nat- 2.53 l/s. Good postoperative vocal cord function is proven by ural ability of coenzyme flavin-mononucleotide (FMN) contained objective voice analysis. in healthy tissue to emit green fluorescence when is exposed to Conclusion: The minimally invasive method we suggest provides blue light (435 nm). In precancerous and malignant tissue anaer- immediate and stable significant increase of breathing with good obic glycolytic pathway without FMN dominates, hence do not laryngeal function even in difficult cases of scarry fixation of vocal emit green fluorescence. cords. Objectives: To estimate diagnostic efficacy of AFE in patients with precancerous and malignant lesions of the larynx. Methods: In this prospective, descriptive analytic study we com- pared sensitivity (SN) and specificity (SP) of Pentax System of HP 101 Autofluorescent Endoscopy (SAFE) and microlaryngoscopy Voice and speech after laryngectomy (MLS) in 21 patient with laryngeal cancer and 16 patients with precancerous conditions, with pathohistology verification as a Smiljana Sˇtajner Katusˇic´ 1, Maja Musˇura 1, Damir Horga2, ’’golden standard’’. Dubravka Globlek1 Results: In diagnostics of laryngeal cancer SAFE had SN 95%, 1ENT Department, Sestre milosrdnice University Hospital, Zagreb and SP 71%, while MLS achieved 71 and 98%, respectivelly. In 2Department of Phonetics, Faculty of Philosophy, University of cases with precancerosis SAFE achieved SN and SP 94% and Zagreb, Zagreb, Croatia 71%, respectivelly, while these parameters in MLS were 75 and Objective: To compare voice quality in three groups of patients 100%. In both lesions SAFE had better sensitivity than MLS, but with electroacoustical (EASA), esophageal (ESOS) and tracheo- this difference was statistically significant only in cases with lar- esophageal (TESS) speech. yngeal carcinoma (Fisher’s test P = 0.047). Specificity of SAFE Methods: A short story was recorded in the sound-proof booth. was lower than MLS, mainly due to absorption of emited green The speech samples were analyzed subjectively by programs for fluorescence by haemoglobin in hyperaemic chronically inflam- acoustical speech analysis. med laryngeal mucosa. Keratosis of laryngeal epithelium with its Results: Voice quality, spech intelligibility and temporal orga- increased autofluorescent signal could mask underlying more nization of speech were analyzed. The results showed that important lesions like carcinoma or precancerous lesion. average frequency of voice of TESS speakers is nearer to voice Conclusions: Safe has great potential in detection and extent frequency of normal subjects (71 Hz vs. 57 Hz) while EASA determination of premalignant and malignant lesions of larynx, patients can regulate frequency of the aid. TESS speakers are but can not completelly replace MLS as standard diagnostic better in voice variables than ESOS speakers but EASA method, mainly due to low specificity. speakers are the best (jitter: 0.95%, shimmer: 1.15 dB). In variables of temporal organization of speech TESS speakers are HP 100 better than the other two groups: speech rate (TESS – 4.61 syl/ Endoscopic arytenoid lateralisation of scarry fixed s, ESOS – 1.39 syl/s, EASA – 2.56 syl/s), duration of phonetic vocal cords block (TESS – 2.30 s, ESOS – 0.71 s, EASA – 1.39 s), number of syllables in the phonetic block (TESS – 10.93, ESOS – 2.63, B. Sztano´ , L. Rovo´ , G. Smeha´ k, J. Czigner, J. Jo´ ri EASA – 4.97), speech rate in the longest phonetic block (TESS ENT Department, University of Szeged, Hungary; Tisza L. Krt. – 4.81 syl/s, ESOS – 3.21 syl/s, EASA – 4.53 syl/s). 111 Szeged, Hungary Conclusion: Air-stream source (lungs) in speech production of Objective: In severe cases of scarry fixation of cricoarytenoid TESS contributes to speech quality of alaryngeal speakers. joints (CAJ) only the external surgical interventions were proven

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HP 102 tomy was salvage surgery after conservative or reconstructive Management of juvenile recurrent laryngeal surgery, the 5-years survival rate is 28/84 (33%). papillomatosis Conclusion: Despite diagnostical and therapeutical achievements, prognosis for T3 and T4 malignoma of the larynx was not sig- Marioara Poenaru, Stan Cotulbea, Caius Doros, Gabriela Doros, nificantly approved in the last few decades. Delia Horhat ENT Department, University of Medicine and Pharmacy ‘‘Victor Babes’’ Timisoara, III-rd Pediatric Clinic, University of Medicine HP 104 and Pharmacy ‘‘Victor Babes’’ Timisoara Failures after laryngopharyngeal reconstruction Objective: Juvenile recurrent laryngeal papillomatosis (RLP) is a in caustic stenosis viral disease characterized by multiple recurrences of benign Irina Achim1, V. Costinescu2, Gina Stegaru3 tumours of the larynx mucosa and significant morbidity on pae- 1Medical center ‘‘MEDAS’’ Bucharest, Romania diatric patient and strain on their families. The aim of this study 2Univesity of Medicine and Pharmacy ‘‘Gr. T.Popa’’, Iasi, was to evaluate the results of combined treatment with CO2 laser Romania microsurgery and interferon (IFN) alpha 2b in children suffering 3University hospital ‘‘Sf. Spiridon’’, Iasi, Romania from laryngeal papillomatosis. Methods: During a 5 years period (2001–2006) 11 patients aged Objective: The authors describe some of the difficulties and fail- from 2.9 to 5.2 years (mean age 4.1 years) diagnosed with laryngeal ures after the reconstruction of the pharynx, larynx, and cervical papillomatosis were included in the study. Case management con- esophagus with cutaneous tube, due to caustic ingestion. sisted of CO2 laser microsurgery followed by adjuvant therapy with Methods: We analyze the causes which have determined the IFN. All patients underwent microsurgical excision and progressive appearance of the difficulties and even the failures occurred in 69 vaporization of papillomas with the CO2 laser under general anes- patients with laryngo-pharyngo-esophageal stenosis between 1996 thesia and good exposure. Tracheotomy was not necessary in any of and 2005. the cases. The follow-up time was 14 months on average. Results: After surgical reconstruction 15 patients presented Results: Clinical examination revealed regression of papillomas in digestive and/or respiratory problems. In three patients (4.3%) we all patients. Seven patients had complete regression after primary could not re-establish the continuity of the digestive and respira- CO2 laser microsurgery and additional interferon treatment. Four tory tract. patients had partial response to the combined treatment. In these Conclusions: The failures after the reconstruction with cutaneous cases second intervention was needed. No perioperative or post- tube depend on the complexity of the lesions, the status of the operative complications and no severe side-effects were noted. connective tissue, optimal time for the surgical treatment and also Conclusions: This combined treatment is a method of choice in on the surgical techniques that have been used. laryngeal papillomatosis in children, causing longer remission of the disease. Surgical ablation with laser CO2 is the elective treatment and its combination with IFN improved the prog- HP 105 nosis of this recurrent viral disease. Reachable functional re- Assessment of voice in patients with Reinke’s oedemas sults, good tumour control, short hospitalization makes it a after laser microsurgery favourable treatment in paediatric patients. A. Szkiekowska1,2, B. Mias´ kiewicz1, E. Wodarczyk1, H. Skarzyn_ ´ ski1,2 1Foniatric Clinic of Institute of Physiology and Pathology HP 103 of Hearing, Warsaw, Poland Surgical treatement of T3 and T4 laryngeal carcinoma 2Academy of Music, Warsaw, Poland Vladimir Djordjevic, Jovica Milovanovic, Zeljko Petrovic, Zoran Dudvarski, Vladimir Nesic, Anton Mikic Objective: This investigation was undertaken for perceptual and Institute of Otorhinolaryngology and Maxillofacial Surgery, acoustic analysis of voice in patients with Reinke’s oedema treated Clinical Centre of Serbia, Belgrade with laser microsurgery. Material: Material of the study included 45 patients at the age of Objective: The aim of the study was to establish today’s results of 23 to 65 presenting to Foniatric Clinic with dysphonia in Reinke’s the surgical treatement of patients with T3 and T4 laryngeal oedema. Patients were divided into three groups according to the malignoma. Remacle’s classification of Reinke’s oedema. All patients were Method: The study was retrospective and included the group of treated with the CO2 laser microsurgery. Voice assessment was 1,054 patients who had total laryngectomy during the eight years made subjectively with the GRBAS scale and objectively, using period (1994–2001) at our institution. multidimensional voice parameters analysis (MDVP). The exam- Results: The postoperative complications were: faryngocutaneous ination was undertaken preoperatively, 1 week after operation fistulas (16%), haemorrhage (7%), tracheal stenosis in 6 and and four weeks after an operation. oesophageal stenosis in six cases. The five-years survival rate Results: The results of our study show relationship between established in the group of patients who had primary total lar- quality of voice after surgery and the stage of evolution of Re- yngectomy is 308/794 (39%); in the patients group where total inke’s oedema according to the applied classification. The best laryngectomy was salvage surgery after radiotherapy, the 5-years quality of voice was presented by young patients (up to the age of survival rate is 47/172 (27%); in the group where total laryngec- 30) with 1st stage of Reinke’s oedema.

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HP 106 geal sphincter. The first at the level of junction of posterior and Predisposing factors, management, and outcomes middle one-third of the soft palate passing through soft palate left lateral pharyngeal wall, posterior pharyngeal wall, right lat- of major anastomotic dehiscence after crico-tracheal eral pharyngeal wall and the soft palate. The second was at resection and anastomosis 3 mm in front of the latter. The surgical technique was described C. Piazza, G. Peretti, P. Nicolai in details. Department of Otolaryngology, University of Brescia, Spedali Results: Before surgery five patients (83.3%) had severe hyper- Civili, Piazza Spedali Civili 1, 25123 Brescia, Italy nasality (rating scale 3). After the cerclage operation and speech therapy four patients (66.6%) significantly improved to normal Objective: Crico-tracheal resection and anastomosis (CTRA) is nasality (rating scale 0) and the remaining two patients improved applied to benign and neoplastic stenoses of the crico-tracheal to mild and moderate hypernasality (rating scale 1 and 2), junction. Aim of this paper is to describe predisposing factors, respectively (P-value = 0.02). By endoscopy the closing activity management, and outcomes of major anastomotic dehiscence was (rating scale 3) in five patients (83.3%) and (rating scale 2) in (MAD), the most feared CTRA’s complications. one patient (18%). After the cerclage operation and speech ther- Methods: Between 1996 and 2007, 92 patients received CTRA for apy five patients (83.3%) changed significantly to complete clo- inflammatory (61) or neoplastic (31) stenoses. A charts review sure (rating scale 0) and to (rating scale 1) in one patient (P- identified eight (9%) MAD: four after CTRA for post-intubation value = 0.01). and four for neoplastic stenoses. Conclusions: Endoscopic guided Cerclage sphincter pharyngoplasty Results: MAD occurred 2–20 days after surgery (mean, 8). Extent is a new procedure designed by the author in VFI. It helps the velo- of resection was considered the main predisposing factor in two pharynx to function physiologically in 3D patterns without depen- patients (5 and 5.5 cm resections). In one patient, an epileptic dency on the type of closure. Also it is an easy technique; without crisis caused anastomotic rupture, while emesis was encountered tissue flaps transfer, upper airway obstruction or hyponasality. in two. Concomitant thyroidectomy with central compartment neck dissection in three, tracheo-oesophageal fistula closure in two, and preoperative RT in two were responsible for MAD in the HP 108 others (three patients had an association of two or more predis- Endolaryngeal/-tracheal surgery in tubeless posing factors). Univariate analysis by Fisher or Pearson Chi superimposed high frequency jet ventilation (SHFJV) Squared test showed statistically significant association between MAD and length of resection equal or superior to 5 cm Doris-Maria Denk-Linnert1, A. Rezaie-Majd2, M. Burian3, (P = 0.007), preoperative RT (P = 0.02), and postoperative W. Bigenzahn1, A. Aloy2 emesis (P = 0.007). MAD required total laryngectomy with 1Division of Phoniatrics and Speech Pathology, forearm free flap for oesophageal closure in one case and per- ENT Department, manent tracheostomy in another (both neoplastic stenoses after Medical University of Vienna, Wa¨ hringer Gu¨ rtel 18-20, A-1090 RT); 75% achieved a patent airway (after redo-CTRA in five and Vienna, Austria Dumon prosthesis insertion in one). Overall decannulation rate 2Department of Anesthesiology and Intensive Care Medicine, was 97%. Medical University of Vienna, Austria Conclusions: Besides length of resection, other factors predispose 3 Division of General ENT, ENT Department, Medical University to MAD. Preoperative RT should be considered a contraindica- of Vienna, Austria tion to CTRA for neoplastic stenoses. Management of these pa- Objective: In endolaryngeal and -tracheal surgery, the transla- tients must include aggressive anti-emetic therapy in the ryngeal tube interferes with a free operating field. Therefore, the postoperative course. supraglottic tubeless superimposed high frequency jet ventilation (SHFJV) was developed by Aloy et al. 1990 and has since been HP 107 used and studied prospectively in our department. Methods: In 1,515 consecutive patients transoral laryngotracheal Endoscopic guided cerclage sphincter pharyngoplasty: surgery was performed in SHFJV. 158 of the patients operated a new technique for velopharyngeal insufficiency were children (newborn to 14 years), 139 suffered from a laryngeal Ahmed Ragab* / tracheal stenosis, and in 312 patients transoral laser surgery was ORL Department, Menoufiya University Hospital, Egypt carried out. For ventilation an air/oxygen mix was used. Anes- thesia was administered intravenously. The larynx was exposed by Objective: Several surgical techniques are available for the treat- the ENT surgeon using a specially designed jet laryngoscope. ment of velopharyngeal insufficiency (VFI). Each method has its Results: In 1,512 patients (99.8%) an adequate ventilation and own complications and non-dynamic roles. The aim of this study oxygenation was achieved so that SHFJV was successfully per- was to present a novel physiological surgical technique designed formed without any complications. Three patients suffering from by the author for reconstruction of the velopharyngeal sphincter severe obesitas and laryngeal stenosis or pulmonary disease nee- in VFI. ded tracheal intubation for anesthesiological reasons. An impor- Methods: This prospective study included six patients with VFI tant benefit of the studied technique is the avoidance of (two males and four females) with ages from 5 to 20 years (mean tracheostomy in the management of patients with severe lar- 12.50 years). Speeches, nasopharyngeal and oral endoscopies for yngeal/tracheal stenosis. Due to it´ s minor invasiveness, SHFJV velopharyngeal valve closure were measured according to a 5- proved especially useful in children. Limitations were insufficient point scale where 0 was equivalent to normal and 4 meant a exposure of the airway with the jet laryngoscope, systemic infec- severe (constant) deviation. They were scheduled for cerclage tious diseases, severe obesitas and endolaryngeal bleeding. sphincter pharyngoplasty after failure of appropriate speech Conclusions: SHFJV offers a free access to the operating field as therapy. Under general anaesthesia and the patient in semi- well as an adequate ventilation and oxygenation. Our experiences Fowler’s position; two level cerclages (1-0 polypropylene suture show that SHFJV is a safe, effective and useful method for en- materials) were inserted behind the muscles of the velopharyn- dolaryngeal/tracheal surgery.

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HP 109 HP 111 Cervical actinomycosis: a review of the literature The use of ligasure in otolaryngology: head and neck and description of a case surgery Ja´ nos Szikszai, Csongor Gyo¨ rgy Lengyel, Judit Bakk, Ibolya Emmanuel Prokopakis, Vassilios Lachanas, Nikolaos Hadzakis, Elek, Erzse´ bet Fu¨ le Alexander Karatzanis, Emmanuel Helidonis, George Velegrakis Department of Otolaryngology Head & Neck Surgery, Jo´ sa Department of Otolaryngology, University of Crete School of Andra´ s County Hospital, Nyı´ regyha´ za, H-4400, Szent. I. u. 68., Medicine, 7110 Heraklion, Crete, Greece Nyı´ regyha´ za, Hungary Objective: To evaluate the role of LigasureTM Vessel Sealing Objective: Cervicofacial actinomycosis usually presents as a sub- System (LVSS) in Otolaryngology–Head and Neck Surgery. mandibular mass. The aim of the article is to report of our case Emphasis was given to the duration of the procedure, efficacy of and review of the literature. haemostasis, and relevant postoperative complications. Methods: Boy, 9, previously well, reported a painful mass in the left Methods: A prospective study was conducted, on patients under- neck of 5-day duration. A tender, hard mass measuring 3 · 4cm going thyroidectomy, laryngectomy, neck dissection, parotidec- was present in the region of the thyroid and multiple smaller, non- tomy, and tonsillectomy procedures with the use of LVSS device tender nodes both side in the supraclavicular and axillary regions. as the primary means of ligation. All patients’ records were placed Ultrasound revealed a conglomerate in continuity with the left in a database. Efficacy of haemostasis, operation time and post- thyroid lobe (3 · 3 · 3.5 cm). His laboratory findings were normal. operative complications were assessed. Results were compared to Aspiration of the mass suggested autoimmune thyreoiditis, later previous surgical procedures done by our team when the LVSS bacterial thyreoiditis. Parenteral antibiotic therapy was iniciated was not available. (augmented Amoxicillin and Metronidazole, later Tazobactam) but Results: LVSS proved effective in providing ligation and haemo- during the first weeks the conglomerate largely increased in size stasis in 120 total thyroidectomies, 19 total laryngectomies with (7 · 5 · 4.5 cm). A CT scan revealed an enormous mass com- unilateral radical neck dissection, 41 superficial parotidectomies, pressing and displacing the whole length of the pharynx and and 201 tonsillectomies. There was a mean reduction in operating extending to the mediastinum suggesting an inflammation or a time of 23 min in total thyroidectomies, 30 min in total laryn- malignant lymphoma. After 3 weeks, the mass decreased in size, and gectomy with unilateral radical neck dissections, and 52 min in was excised by surgery. Histology revealed actinomyces filaments. superficial parotidectomies compared to our historical control Results: A 3-week parenteral, followed by a postoperative 5-week group. Postoperative complications did not differ statistically of oral treatment could eradicate the organism. The patient re- compared to previous surgical procedures done when the LVSS mained completely symptom-free. was not available. Conclusions: Surgery for actinomycosis is considered mainly of Conclusions: LVSS proved quite a reliable and safe device in diagnostic use, because Actinomyces is not known to be resistant otolaryngology head and neck surgery procedures, providing to penicillin. In this case, needle aspiration did not facilitate the sufficient haemostasis and reducing operative time. diagnosis. Our case illustrates that despite the antibiotic treat- ment, the mass was capable of enormous increase in size. HP 112 ‘‘One-stop’’ head and neck clinic: does it make HP 110 a difference? Trends in ENT surgery in the UK: are we operating P. Anand, A. H. Sadr, E. Gruber, D. J. Courtney less than we used to? Department of Head and Neck Surgery, Derriford Hospital, Samuel MacKeith, David D. Pothier Plymouth, UK ENT Department, Royal United Hospital, Combe Park, Bath, Objective: To evaluate the efficacy of One Stop Head and Neck UK, BA1 3NG clinic in terms of costs, patients’ satisfaction and accuracy of Objective: To analyse trends in Otorhinolaryngological surgery in diagnosis in patients with suspected head and neck lumps. the National Health Service (NHS) Hospital Episode Statistics Methods: We conducted a prospective study of 277 patients attend- (HES) from 1998 to 2005. ing the clinic over a period of 10 months. The clinical examination, Methods: HES statistics were downloaded from the Department Ultrasound scan, FNA, and cytology results were examined. Patient of Health website. Data were imported into SPSS and trends were satisfaction was also assessed using a satisfaction questionnaire. analysed. Results: Average cost of seeing a patient in this clinic was £78 Results: Rates of insertion of ventilation tubes and tonsillectomy compared to £56 for a normal clinic. 30% of patients were dis- have decreased by 38.9 and 24.5%, respectively over the 7 year charged on the first visit. Findings included: malignancy (17.3%), period. Rates of septoplasty and turbinate surgery have decreased cysts (3.6%), Lipoma (5.4%), salivary gland tumours (14.1%), by 10.6 and 25.6%, respectively. Not only were absolutes numbers Thyroid disease (11.6%), benign lymphadenopathy(42%) and no of operations reduced, but the frequency ranking of the proce- abnormality in (6%). 50.2% of patients had an FNA during the dures has dropped consistently over the time period when com- visit. 6.5% had inconclusive cytology results. 95.3% had an USS pared to procedures performed by other specialties. Despite a with a 100% sensitivity in diagnosing malignancy. FNA results 6.6% reduction in diagnostic laryngoscopies, levels of major lar- yield rose from 50 to 90% by using USS thus reducing the number yngeal surgery have increased by 0.9%. Rates of major otological of follow up visits and the overall costs (£14122 annually).87.9% procedures have dropped. of responders were confident that they were given a diagnosis on Conclusions: The volume of simple ‘bread and butter ENT surgery the day and 100% of them preferred the one stop clinic. seems to be decreasing rapidly, but rates of more complex lar- Conclusions: USS guided FNA increases the adequacy of cytology. yngeal and otological surgeries remain constant. This will have a One stop clinic results in better communication and more accurate significant effect on service provision and training within the NHS diagnosis. Based on our experience, this service is cost effective in and independent sector. long term and brings higher patient satisfaction.

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HP 113 Results: Sarcoidosis presenting features are protean, ranging Lipoid proteinosis: a rare entity with significant ENT from asymptomatic but abnormal findings on chest radiography in many patients to progressive multiorgan failure in a minority. involvement It predominantly affects the respiratory tract with preference for George Patrikakos, Christina Sophia Nousia, Vasilios Mitsios, the lower. Most patients report acute or insidious respiratory and Konstantinos Karentzos problems, variably accompanied by symptoms affecting the skin, Department of Otorhinolaryngology, Ioannina General Hospital, eyes, or other organs. Non-caseating granuloma holds the key to Ioannina, Greece the diagnosis. It is strongly recommended that all suspected cases must be confirmed by biopsy to exclude infection or malignant Objective: Lipoid proteinosis is a rare, autosomal recessive geno- conditions. The disease is usually self limiting with spontaneous dermatosis in which there is deposition of a hyaline material rich resolution, although in a few patients there is progressive in proteins, lipids and carbohydrates in extra-cellular spaces in downhill course, culminating in irreversible fibrosis and severe and around the walls of blood vessels. impairment of organ function. Corticosteroids remain the Methods: We present a case of a 23-year old male suffering from mainstay of therapy. lipoid proteinosis, exhibiting typical dermatological, biochemical, Conclusions: Even though manifestations from the upper respi- histological and radiological features caused by deposits of hya- ratory tract are most uncommon in Sarcoidosis, presenting linelike material in skin, mucosa, and viscera. features of granulomatous inflammation in the nose, paranasal Results: Skin appeared waxy, thickened, and yellowish, with pap- sinuses or larynx should always alert the Otorhinolaryngologist ules, plaques, and nodules arising on patient’s face, axillae, and to include Sarcoidosis in the differential diagnosis. Lower scrotum. Various sites within the oral mucosa (lip mucosa, tongue respiratory tract estimation and biopsies are considered the and gingival) were involved. The patient complained about basic steps for diagnosis and consequent appropriate manage- hoarseness and dysphagia due to infiltration of the larynx, vocal ment. cords, and surrounding structures. Radiographic findings included bilateral, intracranial, bean-shaped suprasellar calcifications in the temporal lobe. Polymerase chain amplification and direct nucleo- tide sequencing of the ECM1 gene together with skin biopsy of HP 115 affected cutaneous or mucosal sites confirmed the diagnosis. Relapsing polychondritis: case report and review Conclusions: Lipoid proteinosis is a chronic disease that can in- of literature volve many organ systems. The disease follows a stable, chronic course but may fluctuate in intensity. No uniformly successful D. Lefantzis, M. Artopoulos, Z. Antonopoulou, V. Tzavara, treatment is available. Consultations with the appropriate spe- G. Papazoglou cialists, depending on the system involved, are indicated. Life span ENT Department ‘‘RED CROSS’’ Hospital, Athens, Greece is usually normal unless altered by laryngeal obstruction or epi- lepsy. Patients with significant airway compromise may require Objective: Relapsing polychondritis(RP) is a chronic multisystem permanent tracheostomy. Parents should be educated about the disease, most likely of autoimmune etiology, characterized by a risk of having affected offspring. variety of manifestations which are caused by recurrent episodes of inflammation of cartilaginous tissues. But most important, relapsing polychondritis is a disease whose diagnosis is very HP 114 challenging for the otolaryngologist. Sarcoidosis presenting with upper respiratory tract Methods: A case of a 35-year-old woman who came to our manifestations hospital reporting pain and redness of both ears and a history of severe rhinitis with nasal cartilage inflammation and several Christina Sophia Nousia, George Patrikakos, Vasilios Mitsios, episodes of bronchitis the last few months. Laboratory studies Kostantinos Karentzos were made and the patient received treatment consisted of iv. Dept of Otorhinolaryngology, ‘‘G. Hatzikosta’’ General Hospital administrated prednisone. Her symptoms were remitted from of Ioannina, Greece the first day of administration. Objective: Sarcoidosis is a systemic disorder of unknown cause, Results: The patient’s diagnosis of RP was made primarily on the characterized by non-caseating granulomatous inflammation of basis of her clinical manifestations and her response to systemic the organs involved. Upper respiratory tract manifestations are corticosteroids. considered rare. Conclusions: The most important step in the diagnosis of relapsing Methods: We report the rare case of a young woman with Sar- polychondritis is made once the otolaryngologist suspects this coidosis, which was first manifested with upper respiratory tract diagnosis. Laboratory studies and biopsy are very helpful, but in clinical disorders. Upper respiratory was the only field clinically the end the diagnosis of RP is clinical. The cooperation of a affected from the disease, with lesions mainly focused in the nose rheumatologist may often be valuable especially in the manage- and the supraglottic region of the larynx. ment of additional systemic manifestations.

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HP 116 Objective: The Asiatic black bear lives in the mountainous areas Arteriovenous malformation of lower lip on the main island of Japan. The bear is an omnivorous animal eating insects, fruits and nuts, with weights reaching up to 70– Umit Taskin, Ozgur Yigit, A. Volkan Sunter 150 kg weight. Recently injuries by bear’s attacks are increasing in Istanbul Training and Research Hospital, ENT department, Akita prefecture in Japan. We studied the pattern and charac- Istanbul teristics on head and neck injuries from a view point of planning Vascular malformations can be categorized into low-flow lesions and treatment procedure. high-flow lesions according to blood flow volume. Arteriovenous Methods: Six head and neck injury cases attacked by Asian malformation (AVM) kind of arterial lesions is high-flow vascular black bear which occurred in the past 12 years, were analized. anomalies consisting of a nidus or a network of abnormal vascular Results: There are four men and two women with ages ranging channels between feeding arteries and draining veins. Incidence of from 47 to 76 years old (means 65.7 years old). Of six cases, four AVM in the oral and maxillofacial region is rare but potentially life cases were attacked by the bear while picking up edible wild threatening vascular lesion. They have a high propensity to bleed, plants. Two cases were attacked while working in a vegetable which maybe life-threatening. Angiography is most important patch. One case was attacked while working in woods. Multiple diagnostic technique for determination of location and flow char- wide severe injuries were found with their head, eye, face, and oral acteristics of vascular lesions. Total resection of lesion is the only cavity by the bear’s hand, teeth and claws. Tracheostomy was treatment that could result in radical cure, and at the same time total performed in all cases. In three cases additional operations were resection is quite hard to perform for AVM in the head and neck performed because of sever defects of the skin tissues. because the lesion some times invades deep tissues, and lesions may Conclusions: Injuries by Asiatic black bear attack usually are not have several feeding arteries that are directly derived from the fatal, although some cases suffered from defect of tissues of head internal or external carotid artery, this could cause uncontrollable and neck. In most cases team approach might be needed to obtain bleeding during surgery. In our case, lesion was in right lower lib the best result. extending to chin. First of all, lesion was diagnosed with angiogra- phy showed AVM supplied from mainly right facial artery, slightly from contralateral facial artery. Main suppliying artery was em- bolized and than total excision of lesion was done. During surgery, HP 119 to minimize cosmetic defect, submandibular skin incision was done Hydatid cyst of maxillofacial region with blindness to reach and resect right facial artery, than lesion was excised totally presentation intraorally. Remaining small feeding arteries was cauterized in- traorally. So we did not need for closure of defect with local flap. Nasrin Yazdani*, J. Yazdani*, M. Hossein Dadgarnia**, There was no cosmetic problem and recurrence after surgery. M. Saeidi* *Tehran University of Medical Sciences HP 117 **Yazd Shahid Sadughi University of Medical Sciences Aneurysms of the facial artery; an unusual Objective: Hydatid cyst is a common disease in the endemic re- presentation of neck lump gions, especially in the Middle East. Liver and pulmonary involvement is very common but primary hydatid cyst of the James Barraclough, Harpreet Uppal, Janet O’Connell maxillofacial region is very rare. Birmingham City Hospital, UK Patient and methods: A 13-years-old child presented with exoph- Objective: We present a case of a 78-year-old female who presented with thalmia of right eye and visual loss since 10 days ago. Physical a slowly enlarging neck lump in the right submandibular triangle. There examination showed limitation of eye movements, and visual was no associated history of trauma to the face, no risk factors for acuity was hand motion. In the past history, she had history of cardiovascular disease and otorhinolaryngological examination was multiple brain hydatid cysts and seizure 8 years ago who has unremarkable. The lump was firm and non-pulsatile. underwent craniotomy. Paranasal sinus CT scan showed cystic Methods: The lump was investigated initially with fine needle mass in the right maxillary sinus eroding the inferior orbital wall aspiration which revealed blood only. She then went on to have a and compressing the orbit. Sonography from liver and surpris- computed tomography (CT) scan with intravenous contrast. ingly chest-X ray were normal. The patient underwent surgery and Results: The CT scan revealed a 2.2 cm aneurysm of the right three hidatid cysts were removed from right maxillary sinus by facial artery just below the mandible. There was calcification of standard Caldwell-Luc approach. Pathology report confirmed the wall and thrombus formation within the lumen. In theatre, the hydatid cyst. 4 month after surgery in physical examination, vi- aneurysm was dissected open and feeding vessels were identified sual acuity and eye movements were normal. and ligated. She made a good post-operative recovery. Results: Hydatosis is a well known disease for general surgeons Conclusions: This case is unique as the lesion was identified using but it may present diagnostic difficulties for otolaryngologist or computed tomography scanning due to the unusual presentation. The maxillofacial surgeons, because hydatid cyst is very rare in the vast majority of aneurysms of the head and neck have a traumatic head and neck region. Therefore, we must be to think about aetiology giving rise to false aneurysms: true aneurysms are extremely this rare disease until can diagnose and apply appropriate rare. We discuss the implications of such a lesion and its management. treatment. Conclusions: Hydatid cyst should be considered in differentiated HP 118 diagnosIs of any cystic mass in the patient who living in the en- demic areas. With due attention to that there is no effective Head and neck injuries by Asiatic black bear attacks medical treatment in cases of head and neck hydatid cysts, total Kohei Honda, Wenghoe Wong, Teruyuki Sato, Takashi Saito, excision of cysts is the treatment of choice. Naoko Fukui, Kazuo Ishikawa Division of Otorhinolaryngology, Head and Neck Surgery, Department of Sensory Medicine, Akita University, School of Medicine, 1-1-1, Hondo, Akita, Japan

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HP 120 thyroid. FNAB from the thyroid was benign. Surgery was indi- The ‘‘Mini-packer’’ syndrome. An unusual case cated. of oesophageal foreign body Results: Total thyroidectomy and partial parathyroidectomy was performed. Subsequent histological examination confirmed pres- Anastasia Konstantinou ence of parathyroid adenoma and revealed papillary carcinoma in ENT Department, General Hospital of Halkis, Greece the right thyroid lobe, 0.15 cm in diameter, and sarcoid reaction in adjacent lymph nodes. Concerning the size of the carcinoma Objective: Body stuffer, sometimes called ‘mini-packer’, is the surgery itself was an adequate therapy. The patient showed no definition of someone who admits to, or is strongly suspected of other supporting evidence for systemic sarcoidosis and was refered ingesting illegal drugs in order to escape detection by authorities, to a pneumologist. and not for recreational purposes or to transport the drug across Conclusions: Anamnesis and detailed examination is mandatory borders. Cocaine is the drug most commonly involved in the body but in case of coincidence of more diagnoses individual symptoms stuffer syndrome. may superpose thereby complicate the establishment of diagnosis Methods: This report describes the successful oesophagoscopic and consequent therapy. retrieval of a cocaine balloon after ingestion. A 42-year-old Gipsy Acknowledgments: This study was supported by the IGA MZ CR presented himself in the Emergency Room with anxiety, com- No. NR9049-3, and the MSMT No. 2B06106. plaining of dysphagia. There was no stridor. Even if body-packers are often dishonest historians, he admitted swallowing a single bag of cocaine in order to avoid police detection. Results: At oesophagoscopy, a small yellow, intact balloon visu- HP 122 alized at 30 cm, was removed. Toxicological analysis of the bal- loon contents found cocaine. The packaging used was not A case of oral-facial-digital syndrome type sophisticated. The powder was packed inside a condom without II-diagnosis and treatment extra covering. Djordje Kravljanac1, Radoje Simic1, Aleksandar Vlahovic1, Conclusions: The description of the case is followed by a short Vladan Subarevic2 review of the literature, mainly focused on the possible complica- 1Department of plastic and reconstructive surgery, Institute for tions of ingested drug packets and possible methods of removal. mother and child health care of Serbia, St. R. Dakic 6-8, Belgrade, Reported cases of body stuffer deaths are rare, however while drug Serbia packets are inside the body, they can leak or rupture causing acute 2Department of otorhynolaryngology, Institute for mother and substance toxicity. Body packers usually present to health care child health care of Serbia, St. R. Dakic 6-8, Belgrade, Serbia providers for one of three reasons: drug-induced toxic effects, intestinal obstruction, or medical assessment after detention or Objective: Oral-facial-digital (OFD) type II or Mohr syndrome is arrest. Hospital physicians may neglect this type of gastrointestinal characterized by facial deformities, midline cleft of the upper lip, foreign body if they are not aware of the body packer syndrome. high arched or cleft palate, tongue hamartomas, hand and feet deformities. We report the child with clinical features of OFD syndrome type II associated with trigonocephaly. HP 121 Methods: A 4-year-old girl born at term was first time admitted Sarcoidosis associated with PTC and parathyroid in Institute during her neonatal period. The diagnosis of OFD adenoma syndrome was based on clinical and radiological findings. Sur- gical treatment was performed in several stages. Zuzana Jandova´ 1, Jan Plza´ k1, 2, 3, Vladimı´ r Zeman4, Jaromı´ r Astl1 1 Results: On physical examination the patient was found to have: Department of Otorhinolaryngology and Head and Neck Sur- trigonocephaly, hypertelorism, broad nasal root, incomplete gery, 1st Faculty of Medicine, Charles University, Faculty Hos- cleft palate, lobulate tongue with papilliform outgrowths, lop- pital Motol, V U´ valu 84, 150 06 Prague 5, Czech Republic 2 ped and low set ears, mandibular hypoplasia, bilateral hand Institute of Anatomy, 1st Faculty of Medicine Charles Univer- syndactily of the index and middle finger, right hand syndactily sity, U nemocnice 3, 128 00 Prague 2, Czech Republic 3 of the ring and small finger, polydactily of the both feet and Center for Cell Therapy and Tissue Repair, 2nd Faculty of muscular hypotonia. Radiographs of the head, hands and feet ´ Medicine, Charles University, Faculty Hospital Motol, V Uvalu confirmed clinical findings and substantiated the diagnosis of 84, 150 06 Prague 5, Czech Republic 4 OFD syndrome. Surgical treatment started at the age of seven Department of Pathology and Molecular Medicine, 2nd Faculty days by excision of accessories digits of the feet. Surgical of Medicine, Charles University, Faculty Hospital Motol, V correction of trigonocephaly was performed at the age of ´ Uvalu 84, 150 06 Prague 5, Czech Republic 6 and 5 months later reconstruction of the cleft palate was Objective: A coincidence of papillary carcinoma of the thyroid, done. Bilateral hand sindactily was corrected at the age of parathyroid adenoma and sarcoidosis is rare. The importance of 18 months. detailed histological examination is pointed out in this report. Conclusions: ORD type II or Mohr syndrome is rare autosomal Methods: We present a case of 64-years-old woman suffering from recessive inherited disorder. Early diagnosis is important, because dorsalgia with diagnosed hypercalcemia and hyperparathyroid- of genetic counseling. Management requires a multidisciplinary ism. Ultrasonography and MIBI scan detected parathyroid ade- approach. Surgical correction of all anomalies causing functional noma in the right inferior parathyroid gland and nodules in the impairment is mandatory.

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HP 123 questionnaires voluntarily. The results were analyzed according to Treatment of deep phlegmona of the neck-our the 100 cc-ses. expirience Results and conclusion: Eighty-six (86%) percent of patients in this study showed oral etiology, 7% ENT etiology, 5% un- Anton Mikic, Ivica Pendjer, Aleksandar Trivic known etiology, 2% intestitional etiology of halitosis. In pa- Institute of Otorhinolaryngology and Maxillofacial Surgery, tients with oral etiology of halitosis, tongue coating were found Clinical Center of Serbia, Belgrade, Serbia to be the main factor. 86.6% of the patients with oral etiology of halitosis had lower level of socioeconomic status. In this In preantibiotic era, deep phlegmona of the neck and para- research we found that 81% of patients with 25 years age or pharyngeal space, caused by expansion of pathological process older and 90% of patients younger than 25 years old showed form the teeth, tonsils and peritonsillar abscess were very dra- higher prevalence of oral factor etiology of halitosis.This study matic and ended in lethal outcome. At that time, the only mode shows no meaningful relationship between sex and oral etiology of treatment was wide surgical incision and abscess drainage. of halitosis but pharynx, intestitional, and unknown factor were The use of antibiotics considerably reduced the incidence of more common in male gender. Nasal factor showed to be more disease and lethal outcome, but even today, the surgery holds prevalent in females comparing to males.In oral etiology sub- an important place in treatment of these life-threatening com- group, tongue coating is the main factor.This study shows oral plications. The authors present the results of surgical treatment factor has lower prevalence in elderly but other etiologies have of deep phlegmona of the neck at the Institute of Otorhino- higher prevalence in elderly comparing to normal population. laryngology and Maxillofacial surgery, Clinical Center of Ser- In group with oral factor etiology increasing in socioeconomic bia, in the period November 1991 to November 2005. In this status showed to have no meaningful relationship with preva- period, 59 patients with deep phlegmona of the neck and pa- lence of halitosis but prevalence of tennyivitis showed a sig- rapharyngeal space, caused by anaerobic and aerobic flora were nificant increase in prevalence in patients with higher treated in our Institute. The significance of multidisciplinary socioeconomic status diagnostics and team work were highlighted. Modern approach to surgical management of cervical phlegmon was emphasized, using the deep multiple incisions and regular lavage of the in- HP 125 fected region by Hydrogen 3%, Acidum borici 3% and Riv- anoli solutions. Such surgical approach and exposure of all Complex pharyngeal soft-tissue defects: cervical spaces, along with high doses of broad-spectrum anti- Pre-operative, intra-operative and postoperative biotics, provide high percentage of survival, specifically in our management series 89.93%. The authors particularly stress out the signifi- cance of timely referring of patients to treatment and point to Christiane Motsch, B. Freigang the value of preventive measures. Medizinische Fakulta¨ t Keywords: Deep phlegmon of the neck, Surgical drainage, Irrespective of the approach adopted, whether conventional or by Conservative treatment laser surgery, loss of more than 50% of a functional unit entails in both the oral cavity and the pharynx complex soft-tissue defects that cannot be closed immediately or left to secondary granula- HP 124 tion. Hence, resection of advanced oropharyngeal carcinomas has Prevalence and type of halitosis and perception only been possible as plastic surgery became established for the closing of defects. In everyday clinical practice, much importance Hamed Hatefi has been attached to routine application of microsurgically re- Department of otolaryngology H&N surgury shohaday kargar vascularised tissue transfer, with preference given to antebrachial hospital fasciocutaneous graft. The outcome of surgery with respect to Introduction: Halitosis is a common disorder in general popula- both prognosis and the functions—breathing, swallowing, voice tion. But there is not accessible exact data about prevalence of and speech—does not depend on the surgical technique alone; key halitosis in our society. This study is designed to measure the aspects include an accurate diagnosis, comorbidity and the pa- prevalence of different types of halitosis. tient’s distinctive characteristics, as well as the therapeutical Patients, materials and methods: Sampling was based on Cross management including postoperative rehabilitation and intensive Sectional method and questionnaire was given to the patients care. The strategy to diagnosis and therapy that has been expe- coming to the ENT Clinics of Kargar Shohada Hospital during rienced to be successul in 320 patients with advanced carcinomas 2003–2004. One hundred (100) patients were informed completely of the oral cavity and the pharynx during the 1994–2006 period is about the purpose of this research and accepted to fill out the described.

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HP 126 fected. Laryngopharyngoscopy revealed complete remission after Syphilitic lymphadenopathy: return of an old foe 4 hours. Except a local skin irritation at the injection site, no other side effects were noticed. Alexandra Roper, Iain Bruce, S. L. Gayed, M. Dabrwski, Conclusions: Icatibant showed a rapid onset of symptom relief in Pradeep Morar the treatment of acute, life-threatening HAE attacks with laryn- East Lancashire NHS Trust gopharyngeal and lingual manifestations. Objective: Review of the case of a 38-year-old man who presented to the ENT department with a persistent sore throat and cervical HP 128 lymphadenopathy. Methods: Flexible pharyngolaryngoscopy was normal. The only Head and neck localisation of sarcoidosis positive features on examination were sloughing of the left tonsil Olfa Ben Gamra, Sarra Zribi, Samia Ayari, Ines Hariga, and a non-specific rash. A biopsy of the tonsil was performed Chiraz M’barek, Abdelkader El Khedim which was subsequently reported as showing non-specific ENT department Habib Thameur Hospital Tunis Tunisia inflammation. Upon review with the histopathology result, the skin rash had progressed to a non-pruritic, erythematous rash Objective: To presise clinical, paraclinical and theraputic aspects affecting his torso, palms and feet (Figs. 1, 2). At review, he of head and neck sarcoidosis. complained of a sore tongue and examination revealed a lesion the Patients and methods: The authors report a retrospective study of midline of the posterior third of the tongue (Fig. 3). A sexual and eight cases of head and neck sarcoidosis diagnosed over a period lifestyle history was taken, indicating a somewhat ‘promiscuous’ of 10 years (1997–2006). The mean age is 41 years. The sex-ratio is lifestyle. 0.6 (3 men, 5 women). We repport six patients with isolated sar- Results: Subsequent virology testing, found that he tested positive coidosis of the nose and the sinuses; one case localisated in parotid for syphilis.He was commenced on doxycycline. He made a good gland and one cervical node localisation. recovery, with his rash, lymphadenopathy and chancre resolving Results: None of these patients was found to have a pulmonary completely. illness or any other extrapulmonary manifestation of sarcoidosis. Conclusions: It would be unusual for a history of syphilis to be The diagnosis was based on clinical and histological confronta- elicited in the ENT outpatient clinic unless it was directly sus- tion. pected (3). Its presentation to the otolaryngologist is rare, but Conclusion: Sarcoı¨ dosis is an ubiquitary disease, which can infil- such are the implications of non-diagnosis to the patient and their trate all tissues. The most frequents localisations are cutaneous, sexual partner(s), that diagnosis must not be missed. The rapid ophthalmologic and thoracique. The otorhinolaryngologic local- increase in the incidence of syphilis is likely to translate into an isation are rare. They can be isolated or associated with systemic increase in head and neck presentations. The latest generation of manifestations. The treatment was based on local and general otolaryngologists need to be forewarned if this old adversary is to corticotherapy. The evolution was favorable for all patients with be promptly identified and treated. 3 years average following up.

HP 127 HP 129 HAE in the head and neck-region Parapharyngeal space abscesses: report of 15 consecutive cases J. Greve1, N. Mansour1, M. Bas1, G. Kojda2, H. Bier1, T. K. Hoffmann1 S. Vlachou, C. Diplas, G. Leondis, V. Bakas, P. Kanakis*, 1Department of Otorhinolaryngology, Heinrich-Heine-University, C. Christidis, G. Papazoglou Du¨ sseldorf, Germany ENT Department, Red Cross Hospital, Athens, Greece 2Institute for Pharmacology and Clinical Pharmacology, *Maxillofacial surgery unit, Red Cross Hospital, Athens, Greece Heinrich-Heine-University, Du¨ sseldorf, Germany Objective: The purpose of the present study was to present our Objective: Hereditary angioedema (HAE) are caused by increased data on parapharyngeal space abscesses. bradykinin-production due to the lack of functional C1-esterase Methods: We report 15 cases diagnosed and treated in our inhibitor. Affected patients experience recurrent angioedema of department. The patients were 5 women and 10 men, 25 to the dermis or mucosa. Laryngopharyngeal and lingual manifes- 60 years old, with fever, pharyngeal pain, odynophagia, neck tations may lead to hoarseness, dysphagia, and dyspnoea as well swelling and trismus. Four cases were due to oropharyngeal as suffocation in individual cases. In these particular emergency infections, while the rest were odontogenic. All patients were cases, a fast acting and effective treatment is necessary. admitted, clinically examined, and submitted to laboratory Methods: During an ongoing open label study (FAST-2) we workup, including neck CT scan. The patients received iv broad treated 6 HAE-patients with Icatibant, a specific bradykinin-B2- spectrum antibiotics. receptor-antagonist, which is applied subcutaneously. So far, we Results: Four patients were treated conservatively. Eleven patients have administered Icatibant during 10 acute life-threatening HAE were operated on, nine of whom immediately and two after some attacks of the laryngopharyngeal (n = 8) region or the tongue days because of an acute deterioration of their condition. One (n = 2). Further 13 attacks involved other head-neck-regions (5· patient was operated twice. Eight patients were submitted to lips, 2· face, 6· neck). Symptom score by patient, documentation tracheostomy before surgery. All patients underwent an external of time for the onset of symptom relief measured by a visual approach to the parapharyngeal space, and drainage of the ab- analog scale and time to complete resolution of symptoms were scess. Their post-operative course was uneventful and one stayed the main assessments. in the ICU for 3 weeks Results: Following treatment with Icatibant, first symptom relief Conclusion: Parapharyngeal space abscess present still a clinical was reported by patients after 37 ± 22 min in patients with lin- entity which has to be treated with care. The evaluation using CT gual edema, 79 ± 13 min in laryngopharyngeal manifestations scan along with timely intervention appear to be the critical fac- and 91 ± 11 min when other head and neck regions were af- tors in the successful management of these patients.

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HP 130 neck, face, back of the head. The problem of etiology and Endoscopic removal of foreign bodies in the lung recurrences is still in discussion. with optical fibers. A case study. Ippokratio Hospital Methods: Authors present three case reports: all were male pa- tients who came to the hospital for giant tumoral masses sur- of Thessaloniki rounding the neck and face. One of them presents with Athanasios Skouras, Spiridon Gougousis, George Kontzoglou moderate to severe dispnea, and one of them with swallowing E.N.T Department of Ippokratio General Hospital of Thessaloniki difficulties. Results: All patients were carefully examinated and investigated. Objective: The purpose of this paper is to demonstrate that the use We decide that surgical excision is the best option for all these of rigid endoscope with optical fibers in removing foreign bodies patients presenting with giant fatty masses. from the lungs is considered revolutionary not only because it Conclusions: Complete excision is very difficult because of the increases the surgeon’s visibility but guarantees the safety of the hemorrhagic risk and also because of the fact that the adipose operation. tissue is surrounding important anatomic elements, like carotid Methods: It was presented the last decade and has been a challenge arteries, larynx or thyroid gland. This rare disease is not only the due to its obvious advantages. In our hospital we exercised this cause of aesthetic changes, but can also give respiratory or ali- method in 246 cases there was speculation of foreign body. In 174 mentary troubles. One can recognize and differentiate aerodiges- cases it was found and removed. tive symptoms from the symptoms of malignancy of head and Results: In the majority of cases we were able to remove the for- neck. eign bodies. In two cases a second effort was needed, whereas in three cases an open thoracotomy was used to remove the foreign body from the lung. HP 133 Conclusion: The results of our survey have declared the use of rigid Evaluation of the necessity of a practical teaching endoscope with optical fibers an advanced method, safe and more of otolaryngology in a Brazilian Medical School efficient than the traditional method with rigid bronchoscope. Lisandre Fraza˜o Brunelli Foti1, Osmar Clayton Person1,2, Renata Ribeiro de Mendonc¸ a Pilan1, Priscila Bogar Rapoport1 1Faculty of Medicine of ABC, Sa˜o Paulo, Brazil HP 131 2 Centro Universita´ rio Sa˜o Camilo, Sa˜o Paulo, Brazil Case report: secondary lingual tuberculosis resembling lingual cancer with lung metastasis Introduction: The graduation curriculum of the medical schools has been a target for improvement of the formation of a generalist Kursat Ceylan, Hulya Bayiz, Ahmet Yavanoglu, Zeynep and humanity doctor to attend the basic necessities of a popula- Kizilkaya, Huseyin Ustun, Erdal Samim, Hasmet Kılıc tion. In otolaryngology, practically there are no evaluations about Ministry of Health Ankara Research and Training Hospital Ear it in Brazil. Nose and Throat Department, Ulucanlar Cad. No:1 Mamak Objective: The purpose of this study was to evaluate the necessity Ankara, Turkey of a practical teaching of otolaryngology in the medical gradua- tion of the ABC Medical School (Sa˜o Paulo, Brazil). Material and Objective: We present a case of secondary lingual tuberculosis method: for that, 87 students of the last period of the course of the with disseminated lesions in lungs and with ulceration and infil- ABC Medical School answered a survey analyzing cases and tration of the tongue. clinical situations in ENT (questionnaire), classifying in order of Method: Case report and world literature concerning secondary an urgent assistance by a generalist doctor, an urgent assistance by lingual tuberculosis are presented. an otolaryngologist or not urgent. Results: Tuberculosis of the tongue is a rare condition that is Results: In 80% of the cases the answers were appropriatte; in usually associated with pulmonary tuberculosis. We present a case 16% inappropriatte and in 4% they were suitable, but not the best of secondary lingual tuberculosis in a 51-year-old man, heavy answer. The main difficulties appeared in cases that envolved a cigarette smoker, an alcoholic, with disseminated lesions in lungs practical knowledge of the otolaryngology. and with ulceration and infiltration of the tongue. Treatment with Conclusion: The practical basic teaching of otolaryngology in the antibiotics was ineffective. He was admitted to the otolaryngo- ABC Medical School can aid in the formation of a generalist logical department because of suspicion of the tongue cancer. The doctor. clinical manifestations, diagnosis and the response to the antitu- berculosis treatment are considered. Conclusion: The clinicians should be alert of the possibility of TBC in the differential diagnosis of atypical lesions of the oral cavity, HP 134 including those appearing as ulcerated and/or granular lesions in a Cutaneous self-extrusion of a foreign body lingual location. from the upper aero-digestive tract Hong Juan Han, Alvin Kah Leong Tan, Pon Poh Hsu, HP 132 Peter Lu Madelung disease: case reports Changi General Hospital, 2 Simei Street 3, Singapore 529889 Migrated ingested foreign bodies from the upper digestive tract Raluca Grigore1, S. V. G. Bertesteanu1, D. Mirea1, have the potential to cause life-threatening complications. Cases R. C. Popescu1 of spontaneous expulsion to the skin of the neck are very rare. 1ENT, Head and Neck Surgery Clinic, Coltea Clinical Hospital, We present an unusual case of an ingested foreign body that Bucharest, Romania migrated out of the upper digestive tract and self-extruded via Objective: Madelung disease is a rare disorder of fat metabolism the skin of the neck. An approach to the safe management of that results in an unusual accumulation of fatty tissue around the such seemingly innocuous foreign bodies is discussed.

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HP 135 Objective: In accordance with UK National Health Service Tortuous internal carotid artery narrowing piriform guidelines, we operate a ‘two week wait’ fast track referral system for suspected head and neck malignancy from primary care sinus: two cases practitioners as well as other sources. The aim of this study was to K. M. Ozcan*, I. Ozcan*, A. Selcuk*, L. Pasaoglu**, assess referrals under this system and evaluate the frequency of G. Hatipoglu**, H. Dere* cancer diagnoses. *Ankara Numune Education and Research Hospital 4th ENT Methods: A retrospective review of all 2 week wait referral case Clinic, Turkey notes for the calendar year 2005–2006 was performed. The **Ankara Numune Education and Research Hospital Radiology appropriateness and timeliness of referral was assessed. The Clinic, Turkey number of positive cancer diagnoses was evaluated via SNOMED. Results: During the study period 423 patients were referred with Objective: An elongation of the internal carotid artery should be suspected head and neck cancer. A total of 63 patients were classified as a tortuosity or a kink. Tortuosity of the carotid artery subsequently diagnosed with cancer (15%). Three hundred and is rarely seen in otolaryngologic practice. twenty patients were referred by local GPs via the 2 week wait Methods: Fifty-three and 54-year-old women presenting with rule. In this group, 31 patients (10%) were diagnosed with cancer. foreign body sensation in throats were seen in otolaryngology Also in this group 49 patients (15%) were inappropriately referred clinic. In videolaryngoscopic examination bilateral piriform sinus according to two week wait guidelines. One hundred and three narrowing revealed in one patient and unilateral piriform sinus patients were referred via other sources (GPs not via two week narrowing revealed in the other patient. wait system, emergencies, inpatient referrals) and were subse- Results: Computerized tomography scans showed tortuous inter- quently ‘upgraded’ to the two week wait system if this were nal carotid artery in both patients. No treatment offered. deemed appropriate. In this group, 32 patients (31%) had a Conclusions: Awareness of the possible internal carotid artery diagnosis of cancer. tortuosity is very important to prevent serious complications Conclusions: Our results demonstrate a relatively low yield for during laryngeal and pharyngeal surgical procedures. cancer diagnosis following fast track referral. A large proportion of patients from general practitioners are inappropriately referred whereas those referred via other sources have a higher rate of HP 136 cancer diagnosis. A high referral rate and low yield is preferable to Surgical management of branchial cysts missed or late diagnosis of cancer. However, we suggest referral N. Salemis1, K. Nazos2, I. Psarommatis2, N. Bollas1, criteria should be modified. This will be most effective in con- E. Tsohataridis1 junction with improved education of referring practitioners. 12nd Department of Surgery, Army Veterans General Hospital NIMTS, ‘‘P & A Kyriakou’’, Athens, Greece 2Children’s Hospital, Athens, Greece HP 138 Objective: The aim of this study is to evaluate the clinical pre- Cervical lymph node tuberculosis: 12-years experience sentation, diagnosis and management of patients who underwent Ines Hariga, Olfa Ben Gamra, Rabie Ben Hammouda, surgical operation due to a branchial cyst at our institution. Sarra Zribi, Chiraz M’barek, Abdelkader El Khedim Materials and methods: Between January 2000 and December ENT department Habib Thameur Hospital Tunis Tunisia 2006, 21 patients with branchial cysts were admitted to our department. There were 13 (61.9%) men and 8 (38.1%) women, Objective: The clinical problem of a neck mass in general and ranging in age from 18 to 46 years (mean age 28 years). Seventeen lymph nodes in the neck in particular may present a diagnostic patients (81%) presented with an asymptomatic swelling, while dilemma. This retrospective study was conducted to highlight four had clinical manifestations of an infected cyst. Diagnostic clinical presentation, management, and outcome. evaluation included full blood count, biochemical analysis, Methods: We retrospectively studied 169 cases of lymph cervical ultrasonography, computerized tomography scans (CT) and node tuberculosis confirmed by pathology from 1994 to 2006 in magnetic resonance imaging (MRI) where indicated. our hospital. Results: Patients with infected cysts were initially treated with Results: The mean age of the patients at diagnosis was 37 years. It intravenous antibiotics. No surgical intervention at that stage was was more common in females (119 females, 70% and 50 males, required. Resection followed 2 months later. All other patients 30%). Young adults were most frequently involved (49.5%). The underwent complete resection of the cyst at the time of admission patients’ main presenting problems were palpable masses (97.1%). with thorough exploration for a possible sinus tract presence. The diameter of the cervical nodes ranged between 1.5 and 5 cm. There were no perioperative complications and the mean hospital The neck mass was fixed in (29.1%) cases. Erythrocyte sedimen- stay was 2.1 days. tation rate was accelerated in 68.8 and 77.1% of tuberculin skin Conclusions: Branchial cysts should always be considered in the testing was positive. All patients had chest radiographs, one pa- differential diagnosis of neck swellings especially in young adults. tient had concomitant pulmonary tuberculosis and their chest Patients with clinical manifestations of an infected cyst should be radiographs showed typical tuberculous lesions. The ultrasound initially treated with intravenous antibiotics. FNA cytology is examination was systematic. The sensitivity of fine-needle aspi- recommended. ration cytology in the diagnosis was 28.8%.Ninety-eight percent of patients had a cervicotomy explorative with histopathological examination. Patients received antituberculous drugs after histo- HP 137 logical confirmation. The standard regimens were 8 months. Effectiveness of fast track referrals in head and neck Recurrent disease was observed in six patients (4%). surgery Conclusion: Mycobacterial infections have been shown to be increasing in number worldwide. The histopathological examina- Paul Stimpson, Alwyn D’Souza tion was necessary for the diagnosis. The treatment was medical University Hospital Lewisham and surgical. 123 S112 Eur Arch Otorhinolaryngol (2007) (Suppl 1) 264:S5–S151

HP 139 ation of this chemoradiotherapy modality in locally advanced Surgical approaches for oropharyngeal tumors SCCHN patients. N. Salemis1, K. Nazos2, I. Psarommatis2, N. Bollas1, E. Tsohataridis1 HP 141 12nd Department of Surgery, Army Veterans General Hospital 3D power Doppler analysis of the vascularization NIMTS, ‘‘P & A Kyriakou’’, Athens, Greece in tumours of the oral cavity 2Children’s Hospital, Athens, Greece Janez Rebol Objective: In this study is reported the value of the four main Department of Otorhinolaryngology, Maribor Teaching Hospital, approaches to oropharyngeal tumors: transoral, transoral/trans- Ljubljanska 5, 2000 Maribor, Slovenia cervical, transpharyngeal and mandibular splitting approaches. Methods: Both surgical approach and chemoradiotherapy have Objective: The aim of this study was to determine the volume and been used to 80 patients with oropharyngeal tumors in our vascularization of tumours by 3D power Doppler ultrasound in department during the last 5 years. Fifty-three patients presented patients with oral cavity tumours. malignant forms and 27 patients benign lesions. A selective local Methods: 3D power Doppler ultrasound investigation was per- resection of the tumor was done in the 33, 7% of our patients with formed pre-operatively on 49 patients with oral cavity carcinomas. benign tumor and an extended dissection of the tumor and neck Digitally-stored data were analysed with 3D View program soft- lymph nodes (modified radical neck dissection or radical neck dis- ware, a part of which is the ‘‘VOCAL-Imaging program’’. By section) was performed in 66, 3% of our patients with malignancy. using VOCAL, the borders of a structure (tumour) can be deter- Results: Most oropharyngeal tumors are operable. The tumors are mined and its volume calculated. The vascularization of the tu- normally resected with 1–2 cm border of grossly normal tissue. mour was determined by analysing 3D colour histograms, and the Oropharyngeal cancers can be resected through four main surgical vascularization indices were calculated. approaches. The choice of approach depends on the size and loca- Results: Vascularization indices VI and VFI were significantly tion of the tumor and if a related neck dissection is planned. Visual higher in patients with neck metastases. The differences between inspection and palpation are the most accurate ways for determin- the vascularization indices in N+ and N0 neck were statistically ing the dimension of the tumor in the oral pharynx. Determination significant (P < 0.05). The flow index (FI) values between N+ of bony involvement can be difficult preoperatively, so imaging and N0 neck were not statistically different. studies such as CT or MRI should be considered. In cases with Conclusions: The volume of oral cavity tumours and their vascu- palpable nodes or if the primary is large, a modified radical neck larization could be determined effectively by 3D power Doppler dissection or radical neck dissection may be necessary. ultrasound. Tumour vascularization is higher in metastatic than in Conclusions: It is important for the surgeon in order to select the non-metastatic tumours. proper approach to consider the type, size, and location of the tumor which is going to be excised, as well as to follow the best chemoradiotherapy postoperatively. HP 142 Basaloid type of the squamous cell carcinoma HP 140 B. Vukomanovic-Djurdjevic1, R. Kozomara2, A. Peric3, Chemoradiotherapy with CDDP, 5-FU, MTX and LV N. Baletic3, M. Jovic1 for head and neck cancer 1Military Medical Academy, Institute for Pathology, Crnotravska 1,2 3 17, Belgrade Hideaki Katori , Mamoru Tsukuda 2 1 Military Medical Academy, Clinic for Maxillofacial and Oral Otolaryngology, Yokohama City Minato Red Cross Hospital, Surgery, Crnotravska 17, Belgrade 3-12-1 Shin-Yamashita, Naka-ku, Yokohama 231-8682, Japan 3 Military Medical Academy, Clinic for Otorhinolaryngology, 2 Otolaryngology, Yokohama City University Medical Center, Crnotravska, Belgrade 4-57 Urafune-chou, Minami-ku, Yokohama 232-0024, Japan 3Otolaryngology, Yokohama City University School of Medicine, Objective: Basaloid squamous cell carcinoma is rare variant tumor 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; of uper aerodigestive tract. This tumor have more aggressive biological maner and poor prognosis. Objective: The aim of this study was to evaluate the efficacy and Methods: Clinical examination, ultrasonography, radiography, toxicity of concurrent chemoradiotherapy using CDDP, 5-FU, operation, histopathology analysis. MTX and LV (PFML) in locally advanced squamous cell carci- Results: Female, 60 years old, had egsophytic tumor on the lateral noma of the head and neck (SCCHN). margin of the tongue. Tumor was sesile and without pain and Methods: Seventy-seven patients with previously untreated stage without erosion of the mucosa above the tumor. Ultrasonography III-IV SCCHN were included in this trial. Patients received two of the neck and radiography of the lung and heart did not present cycles of chemotherapy repeated every 4 weeks. The chemother- metastasis. Surgical excision of the tumor was done with margin apy regimen consisted CDDP (60 mg/m2, day 4), 5-FU (600 mg/ of the normal tissue. On the hystopathology examination, tumor m2 given over 24 h for 5 days, days 1–5), MTX (30 mg/m2, day 1), had two areas of cells. Basaloid cells had numerous mitoses and and LV (20 mg/m2, days 1–5). Radiation was targeted to begin on many comedo- necrosis. Althout, there was areas with tipical the starting day of chemotherapy, day1. The total radiation dose squamous cell carcinoma with keratinisation as well as keratini- to the primary site and neck lymph nodes was 70.0 Gy. sation in basaloid patterns. Musosa above the tumor had high Results: The overall clinical response rate and the pathological degree of displasion. Immunohystochemical staining and this complete response (CR) were 94% (72/77) and 71% (55/77). The mycroscopical picture determinated dyagnosis of the basaloid primary site CR and neck lymph node CR were 79% (61/77) and type of the squamous cell carcinoma. 85% (44/52), and 3-year survival rate was 73%. Conclusion: It is necessary continous examination of patient with Conclusions: This concurrent chemoradiotherapy with PFML was basaloid type of the squamous cell carcinoma, because aggressive safe and well tolerated. The high CR rate justifies further evalu- nature of the tumor.

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HP 143 immunosuppression by the leukaemia, but an exacerbation from Lymphoma of nasolacrimal drainage system chemotherapy cannot be excluded. 1 1 2 3 D. Marev , N. Sapundzhiev , I. Krasnaliev , M. Alamo HP 145 1Department of Oto-rhino-laryngology, St. Marina University hospital – Varna, Bulgaria Epidemiological study of skin tumors of the head 2Department of General and Clinical Pathology, St. Marina and neck University hospital – Varna, Bulgaria Evdoxia Gerostergiou1, Georgia Vergou1, Christos Ganohoritis3, 3Department of Radiology, St. Marina University hospital – Dimitrios Batzakakis1, Ioannis Tsitiridis1, Ioannis Bardanis2, Varna, Bulgaria Georgios Vrionis4, Panagiotis Karagounis1 Introduction: Primary lymphoma of the lacrimal drainage system 1ENT Clinic General Hospital of Larissa (LDS) presents an extremely rare condition. 2ENT Clinic General Hospital of Ikaria Case report: A 70-year old female preseneted at the Department of 3General Practitioner Health Center of Gonoi oto-rhino-laryngology with complains of a palpable mass over 4Opthalmologist General Hospital of Larissa right median eye angle with local pain and epiphora since approximately 3 months. The mass was approximately 2.5 cm Objective: Facial skin tumors can be benign or malignant.The with no signs of fluctuation or inflammatory changes in the differential diagnosis is based on the biological behavior and the overlying skin. Head CT scan revealed solid tumoral mass without histological type as defined after their surgical excision. In this osteolytic changes and no involvement of the eyeball and orbital survey, we tried to define the most common types of benign and fat pad. After the complete surgical resection the specimen was malignant skin tumors located on the head and neck, the corre- stained with H&E and an immunohistochemical panel with anti- lation between the age and the appearance of the tumors and the bodies directed against CD3 and CD20 was applied. B-cell non- frequency of tumors in males-females the period 2003–2005 in the Hodgkin’s lymphoma (NHL) was diagnosed. Further staging by ENT Clinic of Larissa’s General Hospital. CT and sonography revealed no enlarged lymph nodes or other Method: During the years 2003–2005, 432 patients underwent bulky tumor, but bone marrow examination showed massive surgical excision and biopsy of skin tumors located on the head infiltration with NHL cells (stage IV HNL). Ttreatment with the and neck. All the tumors were sent for histological examination. CHOP protocol was started. Results: From the whole of the cases 235 persons were male Conclusion: Primary involvement of LDS by NHL is extremely rare. (54.4%) and 197 were female (45.6%). The age range in both sexes The most cases described in the literature are of the B-cell type, the was 20–92 years. The tumors were diagnosed as malignant in T-cell type being extreme rareness. As only of patients with LDS 65.74% of the patient and as benign in 34.24%. Basal cell carci- involvement the incidence of NHL is estimated at 1/2000. noma is the most common malignant skin tumor (47.92%) and it is located at the nose area in the 36% of the patients. The area of HP 144 the lips was the most common location of benign skin tumors. Conclusions: Men are most frequently affected of skin tumors than Head and neck SCC in chronic lymphocytic women. The 2/3 of the cases suffered from malignant skin tumors, leukaemia: a high risk group? which are most commonly a basal cell carcinoma, so that surgical excision and biopsy is imperative in all tumors with suspicious Annabelle Leong, Leonard Liew, John Shotton, Nicholas Rowell behavior. Department of Head and Neck Surgery and Oncology, Kent Oncology Centre, Maidstone Hospital, UK HP 146 The increased incidence of second cancers in CLL has been doc- Gigantic laterocervical tumor: case report umented. Although there is little specific data focusing on the behaviour of head and neck squamous cell cancers (HNSCC) in Daniel Mirea, Serban Vifor Gabriel Bertesteanu, Raluca Grigore, CLL patients, it has been suggested that these tumours are more Cristian Radu Popescu aggressive and carry a poor prognosis. ENT Department, Coltea Clinical Hospital, 1st IC Bratianu Blvd, Bucharest, Romania Objective: Study the natural history of HNSCC in CLL patients. Methods: A retrospective review of all patients with concurrent Objective: The authors present a rare case of a gigantic latero- diagnoses of CLL and HNSCC who had attended the Multidis- cervical tumor. The difficulties of surgical treatment and hysto- ciplinary Head and Neck Clinic at a regional oncology centre over pathological findings were the most important particularities of 10 years (1996–2006). Demographics, site of SCC, stage of dis- this case. ease, CLL management, treatments and outcomes were studied. Method: A 66-years-old female was admitted in our department Results: Thirteen patients with CLL and HNSCC were identified for enlarging painless soft tissue mass located in the left latero- (0.7% of total HNSCC referrals in this period). They presented as cervical region. Tumor dimension at the time of admission was 13/ cutaneous primaries (6 pinna, 1 post-auricular, 1 scalp, 1 eyebrow, 18 cm. MRI was useful to appreciate tumor extension. A needle 1 nasal columella, 1 lower lip), or head and neck primaries (1 biopsy was performed shown the presence of malignant cells. parotid and 1 unknown- metastatic cervical lymph nodes). Pa- Possible distant metastasis were not found. tients were treated with surgery and/or radiotherapy but 7 of 13 Results: Tumor excision was very difficult because tumor relapsed. CLL treatment encompassed chlorambucil, fludarabine, dimenssions and proximity of the great neck vessels. Hysto- or cyclophosphamide, while 5 of 13 had no treatment. Survival pathological examination, including imunohistochemistry, times from time of primary HNSCC diagnosis ranged from 3 to showed the presence of a malignant fibrous histiocytoma. 62 months (mean 19.3, median 22). Conclusions: Diagnosis of this gigantic laterocervical mass was Conclusions: Prognosis for HNSCC is worse for patients with possible after its removal. Immunohistochemistry was useful to CLL. Close monitoring is advised for development of second tu- eliminate other types of sarcomas (liposarcoma). Prognosis is mours, as more aggressive treatment may be needed. The in- poor because tumor dimensions, despite the absence of distant creased susceptibility to second cancers is thought to be due to the metastasis.

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HP 147 Results: The initial clinical symptoms of the primary sinonasal Castelman’s disease located in neck: case report NHL—nasal obstruction, rhinorrhea, epistaxis—are non-specific and mostly found in benign nasal disease. It may mimic a Besim Boci, Emirjona Vajushi chronic rhinosinusitis and the histopathology proves the Department of Otorhinolaryngology–Ophtalmology; University unexpected result: non-Hodgkin’s lymphoma. Demonstrating Hospital Center of Tirana ‘‘Mother Theresa’’ Albania these cases and with a review of literature we tried to identify Castelman’s disease is a rare disorder charecterized of a non some specific signs in the clinical and radiological manifesta- cancerogenic growth of lymph nodes all over the human body. tions, and we have found that in the early stage there is no There are two histologic variants of this disease: the hyaline-vas- evident sign to settle the correct diagnosis, which can delay the cular type (90% of cases) and the plasmacellular type. The hya- appropriate treatment. We underline that in case of any mass in line-vascular type and plasmacellular type. We report a case of a the nasal cavity the surgical biopsy to the early diagnosis is male patient with the hyaline–vascular type of Castelman’s disease essential. located in neck. Conclusions: The primary sinonasal NHL is a rare entity, and it is Materials and methods: A 37 year old male-patient S.H. was difficult to distinguish from benign diseases or other malignancies. admitted to our hospital with a history of 7 months of an mass in The initial symptoms are not specific, and the key for the diag- right posterior triangle of neck. The patient underwent surgical nosis and optimal treatment is the biopsy. excision. Results: Cervical CT revealed a 8 · 5 cm well-defined homogenous solid mass that fixes contrast. The mass has close contact with the HP 149 posterior wall of internal jugular vein, does not infiltrate it but Parapharyngeal hemangiopericytoma: clinical case moves it. The histological examination showed a lymph nodular structure with little follicles and sclero-hyaline changes highly S¸ erban Vifor Gabriel Bertesteanu, Daniel Mirea, Raluca Grigore, indicative of Castleman’s disease. Immunohistochimic examination Cristian Radu Popescu revealed production of polyclonal Ig from plasmocytes and increase ENT Department of Coltea Clinical Hospital, 1st I.C. Bratianu of T-suppressor cells in interfollicular regions. Blvd., Bucharest, Romania Conclusions: This report presents a rare disease of lymph nodes Objectives: Hemangiopericytomas account for only 1% of blood located in neck with dimension 80 mm which is larger than re- vessel tumor and 3% soft tissue sarcomas. Hemangiopericytomas portes in literature (literature reports cases of about 20 mm). in the region of the head and neck pose special problems in Patient is in good health and under recurrent checkup. diagnosis. We want to present an uncommon tumor of the para- pharyngeal space. Tumors of the parapharyngeal space are rare, HP 148 approximately 0,5% of the head and neck tumors. Primary sinonasal non-Hodgkin’s lymphoma: case Methods: The authors present a case of 62-year-old with right report parapharyngeal space tumor. CT scan is not specific but angi- ograms show a characteristic picture. The tumor is very inter- Istva´ n Bartku, Ibolya Elek, Erzse´ bet Fu¨ le, Ja´ nos Jako´ * esting for the differential diagnosis. The histopathological and Department of Otorhinolaryngology-Head and Neck Surgery, imunohistochemical aspect was specific for hemangioperyci- Jo´ sa Andra´ s County Hospital, Nyı´ regyha´ za, Hungary toma. We used the surgical approach for the removal of the *Department of Hematology, Jo´ sa Andra´ s County Hospital, tumor with postoperative radiation therapy (44 Gy) and che- Nyı´ regyha´ za, Hungary motherapy. Results: After surgery the patient was followed up for 5 year. The Objective: Non-Hodgkin’s lymphomas of the nasal cavity and evolution was good, without recurrences. paranasal sinuses are uncommon manifestations of malignant Conclusions: The radical surgery with postoperative radiotherapy lymphomas. This study was performed to report two cases, to is required in less well-differentiated hemangiopericytomas. Usu- discuss the primary NHL of the sinonasal tract and to remind us ally metastasis becomes apparent within a period of 5 years after of the importance of histopathological examination. the initial diagnosis, but late metastases occurring 10 or more Methods: Presenting two cases (age, clinical symptoms, site years after the initial diagnosis are not uncommon. We must involvement, stage, histological type, imaging, treatment, prog- follow up the patients for minimum 5 years. nosis) and a review of literature.

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HP 150 average area of skin 5 (1.1) cm2 in size to achieve macroscopic Esophageal Lugol staining in head and neck cancers: clearance. There was a need for a local flap or skin graft to reconstruct the defect in approximately half (49%) the cases. The is it worthwhile? excision margin was positive in 10% of cases, with re-excision P. Komı´ nek1,P.Vı´ tek2, O. Urban3, P. Vantuch1, P. Matousek1 most commonly required for squamous cell carcinomas. There 1Faculty Hospital Ostrava, Czech Republic was no perioperative mortality and minimal morbidity. During 2City Hospital Fry´ dek-Mı´ stek, Czech Republic the follow-up period, there were 4 local and 10 regional recur- 3Vı´ tkovice Hospital Ostrava, Czech Republic rences, which were treated by re-excision, neck dissection, radio- therapy or combination therapy. There was only one disease- Objective: Patients with squamous-cell carcinoma in the head and specific mortality (distant metastasis from merkel cell carcinoma). neck (HNSCC) often develop second primary esophageal squa- Conclusion: We present a large series of head and neck skin can- mous-cell carcinomas (ESCC). Widespread epithelial oncogenic cers treated at a regional referral center. The current study pro- alterations are frequently observed in the esophagus and can be vides important data on their site predilection and pathological, made visible as multiple lugol-voiding lesion (multiple LVL) by surgical and reconstructive characteristics. Lugol chromoendoscopy. Methods: Since 2004 44 patients with HNSCC have been exam- ined with esophagoscopy with chromoendoscopy (3% Lugol HP 152 solution). The iodine in the solution rapidly stains glycogen in Preoperative embolization in the management normal squamous mucosa brown, and area of dysplasia or early cancer are unstained (LVL). The biopsy specimens were obtained of hypervascular tumors of the head and neck from the unstained streaks. Ihar Belatsarkouski, Uladzimir Akinfeyeu Results: LVLs were identified in 18 cases (41%). One detected N.N. Alexandrov’s Research Institute of Oncology and Medical esophageal SCC was also visible macroscopically, not only chro- Radiology, Minsk, Belarus moendoscopically. Low grade dysplasia was detected 1·, hyper- keratosis 1·, hyperplasia 1·. Nonspecific mucosal inflammatory Objective: To study results of surgical treatment and preoperative changes were detected in the other cases. The reflux esophagitis embolization of neck paragangliomas and juvenile nasal angiofi- was detected in 17 cases (39%). bromas (JNA). Conclusion: Lugol chromoendoscopy should be carried out in Methods: A retrospective analysis of treatment results of 48 pa- patients with primary HNSCC to detect synchronnous early tients treated since 1996 till 2006 was performed. Patients were esophageal carcinomas. devided in two groups. First group consisted of 38 patients (11 M/ 27 F, mean age 44 years) with neck paragangliomas. There were 32 (85%) carotid body tumors (CBT) and 6 (15%) vagal para- HP 151 gangliomas. Second group consisted of 10 male adolescents with Surgical and reconstructive characteristics of head JNA. Preoperaive embolization was performed in nine patients in and neck skin cancer in a regional referral center the first group and in all the patients of second one. In the first group subadventitial tumor removal was performed in 26 (68%) L. G. McClymont, M. Dhiwaker of cases (20- CBT, 6-vagal paraganglioma). Tumor removal with ENT Department, Raigmore Hospital, Inverness, UK external carotid artery resection was applied in 9 (24%) cases. Objective: To determine the demographic, pathologic and surgical Tumor removal with resection of external and internal carotid characteristics of a large cohort of patients undergoing surgical arteries with autovenous grafting was performed in 3 (6%) of removal of head and neck skin cancers. cases. In the second group tumor removal was performed using a Methods: All cases of head and neck skin cancers (excluding Denker or Weber-Ferguson rhinotomy approach. malignant melanoma) undergoing surgical resection in a re- Results: 1st group: Total tumor devascularization after embo- gional referral center over a 10-year period were retrospectively lization was achieved in six cases and subtotal in 3. Surgical reviewed. A total of 463 patients (638 cases) were eligible for complications was noticed in 19 patients (including two cases of inclusion. brain ischemia). Mean intraoperative blood loss was 150 ml Results: The male to female ratio was 2.3:1. The majority of le- among embolized patients comparing with 400 ml without sions were basal cell carcinoma (68%), followed by squamous cell embolization. 2nd group: No complications of embolization was carcinoma (27%). Nose, cheek and ear in descending order of noticed. Mean intraoperative blood loss was 200 ml. frequency were the commonest sites of incidence. Most (78%) Conclusions: Preoperative embolization should be considered as lesions were amenable to local anaesthetic excision. The mean size useful method to prevent intraoperative blood loss in patients with of lesions (±SD) was 1.2 (±1.5) cm2, warranting excision of an paragangliomas and JNA.

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HP 153 ment on CT. Nodes were evaluated sonographically, by cytology Sentinel lymph node biopsy: a new prospective and histopathology. in parotid gland carcinoma? Results: With ultrasound of high resolution 84% enlarged lymph nodes were considered malignant by size, in 64% by shape and Ivo Sta´ rek1, Pavel Koranda2 69% by vascularity. USgFNAC had a high diagnostic accuracy of 1ENT Clinic, Faculty Hospital, I.P.Pavlova 30, Olomouc, 99% for detection metastatic nodal disease. Czech Republic Conclusion: USg FNAC should be used for preoperative staging 2Clinic of Nuclear Medicince, Faculty Hospital, I.P.Pavlova 30, and for follow up on the status of the neck in cancer of the head Olomouc, Czech Republic and neck carcinoma. In the present managed care environment, it proves cost-effective. Objective: Indications for elective neck dissection in N0 staged patients with parotid gland carcinomas are inconsistent. A pilot study was performed to test the feasibility and efficacy of radio- HP 155 guided sentinel lymph node biopsy (SLNB) in these tumors. Aesthetic aspects of pectoralis major flap Methods: In seven consecutive N0 patients with parotid gland in reconstruction of head and neck region carcinoma preoperative lymphoscintigraphy, followed by paroti- dectomy and elective neck dissection with radio-guided identifi- A. L. Klochihin, M. A. Klochihin cation of sentinel lymph nodes (SLNs) was performed. The Yaroslavl Regional Oncological Hospital histopathological status of particular SLNs was then compared to Objective: Alongside with radical removal of the tumour in that of the remaining lymphatic basin. modern ENT oncology, an important part is improvement of Results: The SLNB exactly reflected the positive and negative aesthetic correction of postsurgical defects. histopathological status of the remaining lymphatic basin in three Methods: Sixty-nine patients undergone expanded resections of and four patients, respectively. There was no case of false nega- ENT organs with simultaneous or delayed reconstruction using tivity of the SLN. myo-cutaneous or myo-facial pectoralis major flap. Classical Conclusions: The study suggests that SLNB could provide reliable technique with slanting section of skin in a thoracoacromialis information on the status of regional lymph nodes, making it possible projection and carrying it above the clavicle was performed at 59 to base the neck dissection on the actual presence of the microme- patients (control group). The base group consisted of 10 patients tastases. Before this method can be used in everyday practice, an where preparation of the flap was performed from two horizontal extended and ideally multicentric and long-term trial will have to be incisions appropriative to relaxed skin tension lines and recon- performed. struction of defects was carried out by pectoralis major flap passing it below the clavicle. Results: This technique of preparation of the flap had not affected HP 154 negatively on healing of wounds. At 9 of 10 (90%) patients of base The role of ultrasound guided fine needle aspiration group healing was primary. Failure in one case, in our opinion, can be explained by formation of not enough width of tunnel cytology (USgFNAC) in detection of occult below the clavicle, where the pedicle was wide and mastering of metastases in cancer of head and neck subcutaneous surgical approach from two horizontal incisions. Sewing the skin with release of tension, parallel to tension lines, Ljiljana Cvorovic, Zoran Milutinovic, Aleksandar Oroz, Ljubo- allowed us to apply continuous intracutaneous suture. Occasion- mir Pavicevic* ally it was necessary to sever the pedicle. That arose only in Department of Otorhinolaryngology, Head and Neck Surgery, control group after reconstruction of middle and upper third of University Hospital Zemun, Belgrade, Serbia the face, when there were problems with head motion, unaesthetic *Department of Otorhinolaryngology, Head and Neck Surgery, appearance. There was no sectioning of the pedicle in the basic Military Academy, Belgrade, Serbia group, as it was long enough and was less appreciable on a neck in Objective: To evaluate US and USgFNAC criteria based on nodal connection with passing it below the clavicle. size, shape, vascularity and cytology findings with respect to their Conclusions: Displacement of the muscle below the clavicle al- value for comparative determination of metastatic lymph nodes in lowed us to increase the length of flap by 2–5 cm and decrease it head and neck carcinoma. visualization that enables to decline of it severing. Mobilization of Method: A prospective study was performed in 50 patients with pectoralis flap below the clavicle from two horizontal sections head and neck squamous cell carcinoma without node enlarge- parallel to tension lines of a chest gave good aesthetic results.

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HP 156 geal vascular lesions including nasopharyngeal angiofibroma. Correlation of human papillomavirus with oral cavity Exact diagnosis of adenoid hypertrophy is done with histo- pathological examination of biopsy specimen. But also radio- and oropharyngeal carcinoma logical and endoscopical examinations are indicative for P. Jeremic, M. Dimitrijevic, T. Jovanovic, Z. Vujicic,V. Djukic, nasopharyngeal mass but not distinguish malign and benign G. Bjelogrlic form. In our study, 62 adults diagnosed as nasopharyngeal mass Institut for otorhinolaryngology and maxillofacial surgery, with complaints of nasal obstruction, neck masses, otological Clinical Centre of Serbia, Pasterova 2, 11000 Belgrade, Serbia problems, epistaxis were evaluated. All patients were examined endoscopically and radiological confirmation was done with Aims: Human papillomavirus (HPV) is the cause of some benign nasopharyngeal computed tomography in malign expected lesions as papillomas, but some types, especially HPV 16, has been group. If any nasopharyngeal mass, mucosal hypertrophy, associated with SCC of the head and neck and it is an area of mucosal irregularity was detected endoscopically, punch biopsies intensive investigation. The aims of this study were to investigate were taken from different part of nasopharyngeal masses under the presence and type of HPV in SCC tissue of oral cavity and topical anesthesia and histopathological examination was done. oropharynx and determinate their correlation-association. The pathological findings showed a non specific inflammation in Methods: We examined 33 paraffin-embedded SCC tissues of head 15 (24.1%) cases, predominant follicular hyperplasia in 32 and neck, including 29 men and 4 women. Twenty of the tumors (51.6%) cases, nasopharyngeal carcinoma in 10 (16.1%) cases. were located in the oral cavity and 13 in the oropharynx. As Our study described that the adenoid can be persistent in later control group we used 30 benign paraffin-embedded tissue sam- years of life. Furthermore, it may present as a nasopharyngeal ples from the oral cavity and oropharynx. In situ Hybridization mass causing obstructive symptomatology and necessitating technique was used for the detection and typing of the HPV. diagnostic biopsy. Results: HPV was detected in 15.15% of the 33 SCC samples. HPV was detected in 38.46% of tonsil SCC samples while HPV was not detected in none of the oral cavity SCC samples. HPV types 16 and 18 were detected in 3 of the 5 positive carcinoma HP 158 samples while in the remaining two samples HPV 16 was detected Possibility of the extended radical neck dissection in one and mixed type 16 + 18 + 6/11in the other carcinoma on account of metastasis of the squamous cell sample. In the control group HPV was detected in 6,6% of benign carcinoma of the head and neck lessions. Conclusion: Our results reveal that there is no statisticaly signifi- A. L. Klochikhin, S. V. Movergoz, V. V. Vinogradov cant difference between the experimental and control group Yaroslavl Regional Clinical Oncological Hospital, Head and regarding the detection of HPV. The results also reveal that HPV Neck Center, Octyabrya av., 67, Yaroslavl, Russia, 150040 16 and 18 may have a significant correlation with the SCC of the Objective: Extended tumors of head and neck is an urgent prob- tonsil, while its correlation with the SCC of the oral cavity is less lem in ENT and oncology. Aim of the study is to improve the significant results of treatment of patients with head and neck cancer with extensive regional metastasis. HP 157 Methods: The study is based on the results of treatment of 36 patients with head and neck cancer, treated in Yaroslavl Head and Pathologic evaluation of nasopharyngeal masses Neck Center from 2000 to 2006, mean age 59 years old, males 31 in adults (86%), females 5 (14%). In primary tumor localization oropha- ryngeal cancer prevailed, 15 patients (42%). Squamous cell car- Ilker Cavusoglu, Ozgur Yigit, Umit Taskin cinoma of high differentiation prevailed, 76%. All of the patients Istanbul Training and Research Hospital, ENT department, had extensive regional metastasis, corresponding N . In the Istanbul 3 majority of the cases extension of the dissection was in wide Adenoid hypertrophy in adults is uncommon and most of them resection of soft tissues of the neck with reconstruction of the are misdiagnosed because of difficulty of examination of naso- defect with musculocutanious pectoralis major flap, 19 cases. The pharynx and most of them are asymptomatic. With use of en- other structures which were resected in addition to standard vol- doscopies, diagnosis of adenoid hypertrophy in adult are ume of radical neck dissection were: common carotid artery, increased. Cause of enlargement of adenoid hypertrophy is hyoid bone, thyroid gland, parotid gland, scalenus muscles, bra- mostly multifactorial including viral and bacterial nasopharyn- chial plexus, n. vagus, flour of the mouth, temporal bone. geal infections, exposure with external irritants like smoking, Results: Three years survival was 17% (6 patients). A recurrence chemicals. Adenoid hypertrophy causes nonspecific symptoms in on the neck was in 23 patients (64%), which was mortal. The adults, so it should be in mind always especially in patients with worth prognosis was in the cases of tumor invasion into scalenus headaches, nasal obstructions, nasal bleeding, postnasal bleed- muscles and common carotid artery. ing, aural fullness, postnasal dripping, cervical masses. Differ- Conclusion: It is possible to perform extended radical neck dis- ential diagnosis of nasopharyngeal masses in adults includes section in the cases of absence of tumor invasion into scalenus nasopharyngeal carcinomas, nasopharyngeal cysts, nasopharyn- muscles and common carotid artery.

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HP 159 were diagnosed as having intracranial extension of JNA. All the Clinical analysis of the minor salivary gland tumor patients were males in age ranged from 9 to 20 years with mean of 14.8 years. Many of them (9 of 10) were secondary patients in the oral cavity and pharynx (operated earlier). Satoshi Nakamura, Kazuhiko Takeuchi, Yuichi Majima Results: All patients underwent combined surgery with cranio- Department of Otorhinolaryngology-Head and Neck Surgery, facial approach as first stage. Above mentioned approach in- Mie University Graduate School of Medicine, Tsu, Mie, Japan cluded resection of the orbitozygomatic complex and the floor of the middle cranial fossa. By doing this it was possible to Objective: To elucidate prognostic factors of the minor salivary mobilize the tumor in the infratemporal fossa of the cranium in gland tumor in the oral cavity and pharynx. cases of intracranial extension. In all cases but one there was Methods: A retrospective study in our otorhinolaryngology de- extradural resection. In one case there was intracerebral exten- partment of a university hospital. sion and we used subdural resection. All the tumors were com- Results: Of a total of 23 patients suffering from the minor salivary pletely resected. There were no serious complications during gland tumor in the oral cavity and pharynx experienced between postoperative period. No recurrence was found in a follow-up 1986 and 2005, 12 (six men and six women) had benign tumors, all period of 36–54 months. of which were pleomorphic adenoma. The other 11 (8 men and 3 Conclusions: Combined craniofacial approach is an effective women) cases were of malignant tumor. There were three patients treatment for large and advanced JNA that significantly reduce with stage I, four with stage II, one with Stage III, two with stage recurrence rate. IVA and one with IVB. All patients underwent surgical therapy. Five cases in early stages remains cancer free. In four of them, postoperative pathologic examination confirmed complete resec- tion of cancer. However, five case (in advanced stages) died due to HP 161 local recurrence of the cancer (n = 1) or distant metastasis Nasopharyngeal angiofibroma (n = 2). Their surgical resection margins were found insufficient by postoperative pathologic examination. Although three of the Gheorghe Iovanescu, Stan Cotulbea, Stelian Lupescu, five underwent postoperative irradiation, two of them could not Alin Horia Marin survive for five years. E.N.T. Department, University of Medicine and Pharmacy Conclusions: Completeness of surgical resection of the tumor is ‘‘Victor Babes’’ Timisoara critical to good prognosis of the minor salivary gland cancer in the Objective:Nasopharyngeal angiofibroma (NAF), occurring mostly oral cavity and pharynx. in young men, is histologically a benign tumor with aggressive clinical behavior that includes repeated epistaxis and intractable nasal obstruction. HP 160 Methods: This paper reviews our experience regarding clinical Craniofacial Resection of Juvenile Nasopharyngeal features and the treatment of NAF at E.N.T. Department-Ti- misoara. Nineteen patients with diagnosis of NAF from 1984 to Angiofibroma 2006 were included, and their clinical presentations, imaging D. Zabolotnyi, G. Timen, O. Palamar, D. Zinchenko studies, treatments and outcomes were retrospectively analyzed. Institute of Otolaryngology of Academy of Medical Sciences of The duration of symptoms in the current study was 8–9 months. Ukraine, Kiev, Ukraine The current treatment modality was in all cases surgery. All pa- tients underwent combined transpalatal or retropalatal and lateral Objective: The medical records of 225 patients treated for Juvenile rhinotomy approach. Nasopharyngeal Angiofibroma (JNA) between the years 1985 and Results: In present series there were three recurrences due to 2005 at our Institute were examined. The surgical approaches failure in complete removing of the tumor. They were all reop- mainly consisted of the traditional Denker procedure and lateral erated by lateral rhintomy approach and they are now free of rhinotomy. The recurrence occurred in 10.2% cases that encour- disease. The follow up period was at least 18 month for all pa- aged us for further search of optimal surgical approach to large tients, even for recurrences and advanced JNA. Conclusions: Contemporary radiographic methods (C.T., M.R.I.) Aim: To investigate the efficacy of combined craniofacial resection improve the evaluation of the patients, and provide essential of large and advanced JNA. information for the surgeon regarding the approach to use, and Method: Ten patients suffered from JNA with stage III or IV improve the postoperative results. according to the Fisch classification were studied. Five patients

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HP 162 tracapsular spread; no correlation between T and presence of Tongue base cancer: transhyoid pharyngotomy occult metastases; a high predicitivity of the GS obtained from G and ICG. approach Conclusions: Elective neck dissection is mandatory in N0 neck Stelian Lupescu, Stan Cotulbea, Gheorghe Iovanescu, Alin Horia disease of T1-T2 oral/oropharynx carcinomas with ICG ‡ 13 and Marin, Horatiu Stefanescu GS ‡ 9. ENT Department, University of Medicine and Pharmacy ‘‘Victor Babes’’ Timisoara Objective: There is an aprox. 1/4 incident rate between malign HP 164 tumors of the tongue base and the malign tumors of the tongue’s A giant mixed tumor in soft palate mobile part. Methods: The study was made in the ENT Clinic Timisoara, for a Ylli Sallavaci, Tahsin Demi, Bledi Nini, Sonil Mone, Igli Zhilla, period of 10 years. It presents the therapy of 30 patients treated for Suela Sallavaci neoplasm with tongue-base localization. Clinically positive cervical University Hospital Centre ‘‘Mother Teresa’’, Department node at the initial visit was found in 26 (86.66%) of those patients at of ENT, Rr. Dibra Nr.372, Tirana, Albania the moment of examination. Treatment for all patients was initial Methods: The patient V.M, 70 years old was presented on april surgery followed by postoperative radiation. Surgical procedures 2006. She got a tumor in soft palate, since 15 years which was performed (1) tongue base tumor removal trough transhyoid increased too much last year. pharyngotomy approach (2) tongue base tumor removal + epi- Clinically: Dysphagia, dysphonia, compensated dyspnea. glottectomy (3) tongue base tumor removal + horizontal supra- Inspection: A tumor, same measures with a large egg, soft and glottic laryngectomy. mobile, originated from soft palate. Results: The post-operative evaluation factors were: resection Results: The tumor was removed, the palatoplasty was performed. borders healthiness, postoperative complications, level of post- Histologically: Giant mixed tumor of soft palate. operative disfagia. Long term evaluation after surgical treatment. Actually she is healthy. At 25 of 30 patients the post-operative evolution was positive without signs of loco-regional or ganglionar recidivae. One patient died after one and a half-year from the operation. Death was caused by an abdominal tumor. Another patient died after eight HP 165 month with local recurence. One patient presented a pharyngeal Lip reconstruction following lip cancer resection: fistula which necessitated pharyngoplasty with latissimus dorsi. our experience The nasophageal nutrition catheter was suppressed after three weeks for all the patients. None of the cases required postopera- Sever Pop, Marcel Cosgarea, Constantin Iencica, Alma Maniu, tive gastrostoma. Magdalena Chirila, Violeta Necula Conclusions: The resections of the neoplasms using the trans- ‘‘Iuliu Hatieganu’’ University of Medicine Cluj-Napoca, Romania hyoidian approach is a useful procedure that permits postopera- ENT Clinic, Clinicilor street, nr 2-4, Cluj-Napoca, Romania tive deglutition and comparable rate of the tumor control for a Objective: Several factors should be considered when planning a long time, with lower postoperative morbidity. resection and reconstruction for a patient with lip carcinoma. Reconstructive algorithms are based on the proportion of lip re- sected. In this paper we present our experience in lip reconstruc- HP 163 tion following lip carcinoma resection. Histopathological parameters of neck metastases Methods: A number of 22 patients underwent surgery for lip of oral/oropharynx carcinomas cancer in our clinic between 2001 and 2006. Besides tumor 1 1 1 resection, lip reconstruction and neck dissection, the management Giancarlo Tirelli , Giacomarra Vittorio , Barbara Cutrera , of these patients involved collaboration with the oncologist. Ledia Papanikolla1, Rossana Bussani2 Results: Male–female ratio was 10:1, and the mean age was 68.5 1ENT Clinic, University of Trieste 2 (50–86). All cancers were located on the lower lip (100%), and Anatomical Pathology Department, University of Trieste all were squamous cell carcinomas (100%). The surgical pro- Objective: To predict the presence of occult metastases in oral/ cedures consisted of: vermillionectomy in two cases (9.09%), oropharynx cancer by correlation between tumor (T) and related standard V excision followed by primary closure in nine cases parameters. (40.9%), wide excision followed by reconstruction in 11 cases Methods: Evaluation of four parameters: tumor size (T), Broder’s (50%). The reconstructive methods included the Abbe-Estlander grading of histologic differentiation (G), invasive cell grading flap in five cases (22.73%), the Karapandzic flap in five cases (ICG) and thickness in (a) occult metastases in N0 neck disease (b) (22.73%) and the Gillies fan-flap in one case (4.54%). metastases independently from node (N) class, (c) extracapsular Complications: Sutures dehiscence in six cases (27.27%), micro- spread. Considering previous results, we gave a score to each stomia in three cases (13.63%), loco-regional recurrence in five parameter and we compared the predicitivity of metastases of cases (22.72%). single parameters to the sum of them (global score, GS) in 61 Conclusions: Lip reconstruction remains one of the most chal- patients, who underwent T and N surgery. lenging tasks for the head and neck surgeon. The use of various Results: A high correlation between G, ICG and presence of oc- flaps allows a wider resection within safety limits and enables an cult metastases; a strong correlation between ICG ‡ 13 and ex- appropriate restoration of facial aesthetics.

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HP 166 vapour lamp equipped with filter sets designed to detect pre- Treatment of tongue cancer with NSC 631570: dominantly tryptophan, NADH, FAD. Inclusion of simulta- neously recorded white light remission spectra into the analysis case report enabled the calculation of ‘‘intrinsic’’ fluorescence spectra. Spec- Aleksejus Mickonas1, Gedrius Shalkus2, Romualdas Meshkauskas2, troscopy results were then compared to histopathological findings Jolita Rimiene2 of the subsequently excised lesions. 1Oncology Institute of Vilnius University, Lithuania Results: Quantitative results analysis indicated intrinsic fluores- 2National Center of Pathology. Lithuania cence spectra of endogenous fluorophores of (pre)malignant mucosa to present significant intensity differences compared to Objective: To present a case report of a woman with advanced healthy tissue. NADH- and FAD-modes in particular showed cancer of tongue (T3N0M0), successful treated with NSC 631570. tumour specific fluorescence intensity profiles whereas for tryp- Patient and method: A 48-year-old woman presented with a 6- tophane-mode no distinct spectral differences were observed. month history of progressive canker, pain and discomfort in the Mucosa of healthy controls yielded similar spectral patterns as tongue. The tumor infiltrated the middle third of the right side of did macroscopically intact tissue of patients presenting with the tongue, more than 4 cm in size without obvious boundaries. neoplasia. Biopsy showed poorly differentiated squamous cell carcinoma Conclusions: The results of this study suggest MFA, in conjunc- (G3). Resection of the half of the tongue and concomitant che- tion with an adequate screening method (e.g. autofluorescence moradiotherapy was not acceptable for the patient because of imaging), to be a suitable tool for the discrimination of neoplastic speech disorder and fear to loose job. The patient consumed changes in oral mucosa. 400 mg of the drug (NSC 631570) until the surgery. Results: After 2 month therapy an organ save resection of the tongue was possibility. Pathological examination revealed 2.5 cm diameter encapsulated mass of the tongue. Microscopically tumor HP 168 is moderately differentiated squamous cell carcinoma. Tumor Oncological value of modified radical dissection shows focal moderate desmoplastic stromal reaction. After 1 and of the neck in cervicofacial cancers 2 months of follow-up, the patient remained free of disease, and ultrasound control was normalized without residual tumor. Aleksandar Trivic, Sanja Krejovic-Trivic, Zeljko Petrovic, Conclusion: Treating with NSC 631570 the tumor gradually de- Vojko Djukic, Anton Mikic, Zlatko Vujicic creased and tumor border has become more obvious, therefore an Institute of Otorhinolaryngology and Maxillofacial Surgery, organ save surgery was possible to perform with high functional Clinical Center of Serbia, Belgrade, Serbia results. Speech and swallowing function did not suffer and did not Objective: Modified radical dissection removes ‘‘en bloc’’ the influence the career of the patient. Treatment with NSC 631570 same lymph nodes and lymphatics as radical dissection, but was used instead of resection of the half of the tongue and/or preservation of one or more non-lymphatic structures. aggressive chemoradiotherapy treatment. Tumor resection speci- Methods: The study was conducted at the Institute of Otorhino- men showed higher degree of lymphoid infiltration and fibrosis laryngology and Maxillofacial Surgery, Clinical Center of Serbia, comparing to biopsy, possibly reflecting enhanced immune re- Belgrade. It involved 319 patients who were operated on in the sponse of the patient. period January 1, 1995 to December 31, 1997, and followed up 5 years after surgery by doctors’ consultation board. Results: It was found that the recurring metastases developed in HP 167 57/319 (17.86%) of subjects. Immediately after the operation, Multiple fluorophore-analysis (MFA) for qualitative in the first three postoperative months, the recurrences occurred tissue diagnosis in oral cavity in one-seventh of patients, in the first 12 months in 2/3 of pa- 1 2 2 2 1 tients, and in 24 months in almost 90% of patients. The recurred M. Havel , R. Pauli , H. Stepp , R. Sroka , A. Leunig ,C.S. metastases by N categories found that the largest number of Betz1 1 recurrence belonged to N1 and N2 categories. It could be Department of Otorhinolaryngology, Head & Neck Surgery, expected since N1 category was the most prevalent, accounting Ludwig Maximilian University, Munich, Germany 2 for 42.94% in the overall series of patients; in addition, the Laser-Research Centre, Ludwig Maximilian University, Munich, majority of unilateral cervical dissections was done in this cate- Germany gory, 137/291 (47.08%), while modified radical dissections were Introduction: Early detection of head and neck tumours is usually on the first place. achieved via surgical tissue biopsy. The measurement of specific Conclusions: Highly significant difference of the incidence of autofluorescence of endogenous fluorophores with tumour-spe- subjects with recurred metastases was found in relation to pri- cific distributions might represent a non invasive method to assess mary tumor localization (P < 0.01), where the incidence of tissue dignity (‘‘optical biopsy‘‘). laryngeal and pharyngeal localizations was significantly higher Materials and methods: We performed fluorescence measurements (P < 0.01). There was highly significant difference of fre- of oral mucosa tissue on 22 subjects with a clinical aspect of quency of recurred metastases in relation to N categories. The malignant lesion, as well as on seven healthy controls. The exci- incidence of N3 and N0 tumors was significantly lower, while it tation and spectroscopic detection was achieved with mercury was highly significant within N1 and N2 categories (P < 0.01).

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HP 169 year-old woman had suffered from 1-year difficulty in breathing Risk factors in the occurrence of nasopharyngeal through the nose, anosmia and headaches of different locations for 5 years. Examination revealed tumor in the left nasal cavity, carcinoma: an anamnestic study obstructing the posterior left choanae and deforming the nose. CT Vladimir Nesic1, Sandra Sipetic2, Zeljko Petrovic1, and MRI scans presented a large mass arising from ethmoid cells Svetlana Stosic1, Snezana Jesic1, Vladimir Djordjevic1 into the the left nasal cavity and anterior fossa. Finally histology 1Institute of Otorhinolaryngology and Maxillofacial Surgery, revealed a lesion with hypo- and hypercellular regions with a Clinical Centre of Serbia, Belgrade spindle-cells arranged in paternless fashion. Immunohistochemi- 2Institute of Epidemiology, School of Medicine, Belgrade cal studies finally confirmed SFT. The patient underwent left University lateral rhinotomy and craniectomy for total resection of the tu- mor. She has been followed up for 10 months with no sign of Objective: The aim of this study was to point out possible risk reccurence. SFTs located in the sinonasal tract cause some diag- factors that lead to the occurrence of undifferentiated carcinoma nostic difficulty. In these cases the diagnosis is often based not of nasopharyngeal type (UCNT). only on their histologic similarity to the pleural SFTs but also on Method: An anamnestic study was carried out in the period from exclusions others spindle cells lesions. This report pays attention 2001 to 2003. The study included 45 individuals, suffering from that SFT should be taken into consideration during diagnostic histologically verified UCNT and 90 controls (individuals with process of spindle-cell lesions of nasal cavity in order to avoid orthopaedic disorders and injuries). Only new patients with this some confusions. diagnosis were taken into consideration. The subjects and the controls were individually matched according to age (±3 years), sex, and place of residence. All subjects were polled by question- HP 171 naire by a single doctor and data were gathered about sociode- mographic characteristics, on-the-job exposure to harmful agents, TRANSORAL laser management of hypopharygeal habits, diet, individual anamnesis and family anamnesis. During low-grade malignant peripheral nerve sheet tumor the statistical analysis of the data, univariate (ULRA) and mul- (MPNST) tivariate (MLRA) logistic regression analyses were applied. Results: On the basis of the results of a MLRA, independent risk Zsolt Kasza´ s, Pe´ ter Poga´ ny, Gyo¨ rgy Lichtenberger factors for UCNT were found to be: passive ‘‘smoking’’ of to- Szent Ro´ kus Hosp. and Inst. Dept. of ORL-HNS, 1085 Budapest, bacco in the family during the childhood of the subjects suffering Gyulai P.u.2, Hungary from malignant tumours (RR = 4.04; CI = 1.10–14.85), exten- Objective: The study reports a case of a patient with an extremely sive use of industrially manufactured food additives for enhancing large hypopharyngeal low-grade malignant peripheral nerve sheet flavour (RR = 43.93; CI = 6.01–321.25), and frequent con- tumor (MPNST), causing severe dyspnoe and swallowing inability. sumption of white bread (RR = 1.63; CI = 1.07–2.49). Methods and results: The oval tumor filled the whole hypopharynx Conclusion: Passive ‘‘smoking’’ of tobacco in the family during and the entrance of the larynx. As the patient suffered from serious, childhood, daily consumption of industrially manufactured food life threatening dyspnoe, tracheostomy became mandatory. The additives for enhancing flavour, and more frequent consumption tumor recurred twice on slightly different localization in a 19-year of white bread, represent independent risk factors in the occur- period. The tumor appearance site varied from left aryepiglottical rence of UCNT. fold to left arytenoid region. We removed the tumor with laser. After removal of the tumor there was a constant diffuse bleeding. While the bleeding couldn’t be controlled by coagulation, we used HP 170 the transoral ligature-suture technique performed by Lichtenber- Solitary fibrous tumor of the nasal cavity, paranasal ger. It was not easy to set up the exact histological diagnosis of this sinuses and anterior fossa rare tumor. On the first two occasions the diagnosis was lipoma. Finally the exact histological diagnosis proved to be MPNST. From Marek Lukomski, Zbigniew Kozlowski, Katarzyna Dabrowska our point of view the MPNST corresponds much more with the Medical University of Lodz, Departament of Otolaryngology, patient’s clinical symptoms and case history than lipoma. After the Barlicki Hospital, Kopcinskiego 22, Lodz, Poland trans oral operation we preformed, the patient could be decanu- SFT is a rare mesenchymal neoplasm that usually arises in the lated. The patient has a one-year symptom free follow up since the pleura or less commonly is related to other serosal surfaces. There last surgery. were reported SFTs in some extrapleural locations. These loca- Conclusion: We would like to recommend to follow the patients tions cause diagnostic difficulties. Ethmoid sinuses, nasal cavity suffering from rare diseases like MPNST regularly, at least in and anterior fossa are rare site for SFTs. Such case is presented every 2 months, and in case of recurrence to perform immediate aiming to show the difficulty and importance of recognition. 33- transoral laser surgery preserving the delicate parts of larynx.

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HP 172 Results: Histological analysis showed fibrovascular tissue and Primary thyroid-like papillary adenocarcinoma skeletal muscle infiltrated by poorly differentiated invasive carci- noma, with no evidence of lymphoid tissue. of the nasopharynx Conclusions: Metastases to the tonsil cannot be ruled out by a Kai-Ping Chang1, Chia-Hsiang Fu1, Shir-Hwa Ueng2 history of tonsillectomy. 1Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan HP 174 2Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan Immediate reconstruction of the mandible with titanium plate and rib graft after a large Objective: To demonstrate a rare case with primary thyroid-like papillary adenocarcinoma of the nasopharynxy. segmental mandibulectomy due to multilocular Methods: An otherwise healthy 68-year-old male visited our clinic ameloblastoma in an edentulous patient and complained of only a globus sensation of his throat for Ahmet Kutluhan*, Sami Berc¸ in*, Go¨ khan Yalc¸ ıner*, 2 weeks. No nasal obstruction, epistaxis, tinnitus, or aural fullness Huseyin C¸ etin**, Hasan Mete Inanc_ ¸ lı* was noted. Physical examination of this individual revealed a *Ataturk Education and Research Hospital, ENT Department, pedunculated tumor with its stalk attaching to the roof of the Ankara, Turkey nasopharynx. A subsequent endoscopic biopsy revealed the **Ataturk Education and Research Hospital, Radiology presence of a papillary adenocarcinoma. No suspicious cervical Department, Ankara, Turkey lymph nodes were detected. Thyroid ultrasonography and sys- temic work-ups revealed negative results for any thyroid neoplasm Resection and the reconstruction with a titanium plate and a rib or distant metastasis. graft of an ameloblastoma of the mandible in an edentulous Results: The tumor was completely resected in an en-bloc fashion patient. by way of a facial translocation approach. Immunohistochemical studies revealed that this tumor was immunoreactively positive for TTF-1 and CK 7, but negative for thyroglobulin and CK 20. As HP 175 regards the association EBV, in-situ hybridization investigation Contact endoscopy in early diagnosis of oral and soft for the presence of EBER, and PCR amplification for EBV LMP- palate lesions 1 oncogene both revealed negative results. The postoperative course for this patient was uneventful and he remained free of Alberto Santos, Joaquim Amaral, Iuri Gaspar, Maria Joa˜o disease for 1 year until recent follow-up. Barros, Carlos Macor, O´ scar Dias, Ma´ rio Andrea Conclusions: We presented the clinicopathological manifestations Department of Otolaryngology, Voice and Communication Dis- of this rather rare case of a primary thyroid-like nasopharyngeal orders, Faculty of Medicine of Lisbon, Lisbon University, Santa papillary adenocarcinoma in order to remind clinicians that suf- Maria Hospital, Lisbon ficient attention and subsequent nasopharyngoscopic-assisted Objective: Contact Endoscopy allows the assessment in vivo and biopsy of the lesion are mandatory for the imminent management. in situ of epithelial cells, glandular ostia and microvascular net- work (60·, 150·). The authors describe the potentialities of con- tact endoscopy to perform real time histological diagnosis and/or HP 173 guided biopsies in an office setting. Breast cancer metastases to a tonsillar remnant Methods: The authors carried out a retrospective double blind study of a population of 86 patients with oral and soft palate Alexandra Roper, Iain Bruce, Pradeep Morar mucosal lesions which persisted after 3 weeks and were diagnosed East Lancashire NHS Trust by contact endoscopy and histology. Objective: Review of the case of a 54-year-old woman treated for Results: The examination made by contact endoscopy allowed, breast cancer who presented with dysphagia and foreign body with a similar accuracy as histological examination, to classify the sensation in the throat lesions in three groups: benign (n = 36), displasia (n = 23) and Methods: Fifty-four-year-old woman presented to the ENT malignant (n = 16). Carcinoma is characterized by a heteroge- department complaining of dysphagia and a foreign body sensa- neous tissue pattern and cells have a hyperchromatic nucleus with tion in the left side of her throat. She had been diagnosed with left increased and irregular dimensions. The vascular pattern is rep- breast carcinoma. Her breast carcinoma was T1 N1 M0 and she resented by a chaotic architecture made by vessels with atypical underwent a wide local excision and axillary node clearance nearly shape, ectasis, intravascular micro thrombosis and a vascular 3 years earlier. Unfortunately, she then developed a solitary brain fragility. Contact endoscopy is also important for follow up be- metastasis for which she received radiotherapy. At the time of cause it allows not only a macroscopic but also a microscopic referral, she had also developed multiple cutaneous lesions which observation in an office setting. had not been histologically diagnosed. Conclusions: In our study, contact endoscopy, a non-invasive She had undergone a tonsillectomy as a child but was found to technique, allowed to do a precise diagnosis in an office setting, have a 1–2 cm. lesions on the superior pole of the left tonsillar with similar effectiveness as histology. It was an important aid for fossa, extending on to the soft palate. The mass was excised under biopsy guiding and surgical excision limits and also allowed an general anaesthetic. improvement in follow up efficacy.

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HP 176 tion of a high-resolution may be usefull in the evaluation of Head and neck liposarcomas inconsiderable destruction of thin bone structures, which are not visible on conventional CT scans. 1 2 1 3 J. Kalhous , D. Musilova´ , R. Neubauer , K. Sultani , The aim: The aim of this study was to evaluate the usefulness of 1 K. st. Sla´ ma MPR CT reconstructons in the visualization of bone destructive 1Department of ENT and Head and Neck Surgery, Masaryk changes in the chosen pathologies of paranosal sinuses. Hospital, U´ stı´ nad Labem Materials and methods: In the 2004–2006 year, performed CT 2 Department of Radiation Oncology, Masaryk Hospital, U´ stı´ nad examinations of sinuses in 215 children. In 11 cases the changes of Labem the sinuses walls, suggesting bone destruction, were visualized on 3 Department of Pathology, Masaryk Hospital, U´ stı´ nad Labem conventional CT scans. In this cases, MPR CT reconstructions Liposarcomas are the second most common soft tissue sarcomas, were performed to confirm the presence of destruction and to but in the head and neck region they are rare. They were first de- estimate its range. All children were underwent surgical treatment, scribed by Virchow in 1857. Present WHO classification divides and the results of CT imagings were confirmed by histopatho- liposarcomas into six basic forms: well differentiated, myxoid, logical examinations. round-cell, pleomorphic, myxed-type and dedifferentiated. Myxoid Results: In MPR reconstructions were visualized changes of bone and well-differentiated are the most common types of liposarcoma. structure in seven children of analyzed cases: in two cases ob- Dedifferentiated liposarcoma is very rare in the head and neck re- served a bone sclerosis concomitant with chronic sinusitis, in one gion. Complete surgical excision with wide tumor-free margins is case visualized a destroing of bone structure as a result of post- the treatment of choise. Routine elective neck dissection is not traumatic osteitis, in four children observed a very aggressive bone recommended because regional lymph node metastases are rare. destruction as a result of intensive proliferation. Planning of adjuvant therapy depends on the size, grading and Conclusions: MPR CT reconstructions allow for definitive diag- resectability of the primary tumor. We present two cases of head and nosis of destructive changes in bones. MPR CT reconstructions neck liposarcomas. The first is a well-diferentiated liposarcoma of allow to point out on exact localization of bone destruction, the tongue, treated surgically, the second is a myxoid liposarcoma of what is useful in a delimitation of the range of a surgical the larynx, treated surgically and by adjuvant radiotherapy. intervention

HP 177 Schwannoma of vagus nerve: a case report HP 179 A modified technique for bypass of the external S. Triantos, P. Chaira, N. Gaitanakis, A Papadopoulou, D. Louverdis, G. Papazoglou carotid artery to the proximal middle cerebral artery ENT Department, Red Cross Hospital, Athens, Greece Kayhan Ozturk1, Sahika Liva Cengiz2, Aynur Emine Cicekci- basi3, Ahmet Salbacak3, Mehmet Erkan Ustun2 Objective: This paper presents a case of an unusual neck 1 neoplasm, a vagal schwannoma. Department of Otolaryngology, Meram Medical Faculty, Selcuk University, Konya, Turkey Methods: A 64-year-old patient presented with a 8-month history 2 of neck mass and dysphagia as the main symptom. The imaging Department of Neurosurgery, Meram Medical Faculty, Selcuk University, Konya, Turkey study (MRI) demonstrated a mass at the parapharyngeal space, 3 without specific characteristics. Department of Anatomy, Meram Medical Faculty, Selcuk University, Konya, Turkey Results: The patient was operated on and a total resection of the mass was performed. Intraoperatively, the tumor was found to Objective: We aimed to evaluate whether bypass of the external originate from the vagus nerve, which had to be sacrificed. carotid artery (ECA) to the middle cerebral artery (MCA) can be Conclusion: The possibility of a neurogenic tumor occurring in the established by a short saphenous vein graft in order to increase the parapharyngeal space has to be considered in the differential anastomosis patency. diagnosis of the tumors of the area. Materials and methods: The method was performed to five adult cadaver sides bilaterally. We described a modified technique for bypass of the ECA to the M2 segment of MCA. The diameters of HP 178 the vessels and graft length were measured by using an electronic Application of MPR CT reconstructions micrometer. in the imaging of pathological changes of paranasal Results: The mean diameter of the superior, middle and inferior sinuses, causing bones destruction trunks of the MCA with trifurcation were 1.7 ± 0.15, 2.2 ± 0.25 and 2 ± 0.2 mm, respectively whereas the mean 1 2 1 Emilia Ka˛tska , Ewa Dybiec , Grazyna_ Niedzielska , diameter of the superior and inferior trunks of the MCA with 2 Pawe Wieczorek bifurcation were 2.1 ± 0.2 and 2.3 ± 0.3 mm, respectively. The 1 Department of Paediatric Otolaryngology, Phoniatry and mean diameter of the ECA was 3.75 ± 0.4 mm. The mean length Audiology, Medical University of Lublin of the saphenous vein graft was 71.5 ± 3.9 mm. 2 Department of Paediatric Radiology, Medical University of Conclusions: The high-flow ECA to proximal MCA bypass using a Lublin short venous graft can supply enough blood flow to establish Introduction: The presence of bone structure damage is still the cerebral revascularization with a straighter route. most important criterion in the differantiation of benign and Keywords: Anterior circulation, Blood flow, Middle cranial fossa, malignant changes within paranasal sinuses. MPR CT examina- Vein graft

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HP 180 Introduction: The surgical treatment of oropharyngeal cancer A 10 year comparative study of FNAC and histology frequently necessitates radical surgical interventions, which may result in obvious functional impairment. Therefore, newer in head and neck lesions approaches, which include the combined use of interstitial James Benton, Sankalap Tandon, Samit Ghosh, Jonathon Sheard, brachytherapy and chemoradiation, are beginning to take their Terry Jones place in the treatment of locally advanced disease, in an effort to Department of Head and Neck Surgery, University Hospital achieve better quality of life for patients, without compromising Aintree, Lower Lane, Liverpool, L9 7AL, UK LRC and 5-year OSR. Materials and methods: Literature review from Medline and Objective: To assess the sensitivity, specificity, positive predictive database sources. Twenty randomised controlled trials, 5 con- value and negative predictive value for fine needle aspiration trolled clinical trials, 19 clinical trials, 2 prospective non-rando- cytology (FNAC) compared with histology for head and neck mised studies, 8 retrospective studies, 1 laboratory study, 3 meta- pathology in a tertiary referral centre. analyses, 1 practice guidelines and 13 systematic reviews met the Methods: All FNACs performed in the ten year period from defined criteria and were included in study selection. January 1996 to December 2005 at our institution were identified Data synthesis: Head and neck tumors are conventionally dealt from the head and neck and histopathology databases. From this with Ir192 LDR brachytherapy. HDR brachytherapy seems more list all patients who underwent formal histological evaluation of advantageous, by achieving better dose control, as also PDR the same lesion were identified. This group included benign and regimens. Chemoradiation improves both LRC and 5-year OSR. malignant pathology including lymphoma. Predominant ana- The timing of chemoradiation is crucial. Concurrent or alter- tomical sites were lymph node, salivary gland and thyroid gland. nating chemoradiotherapy seems more effective. There is also a Results: A total of 2,258 head and neck FNACs were performed in trend for brachytherapy treatment of certain cases with N+ the ten year period. Of these, 728 had corresponding histological neck disease. samples taken. Forty (5.5%) samples were inadequate and 45 Conclusion: The combination of interstitial brachytherapy and (6.2%) were non-diagnostic. Cytology and histology results were chemoradiation has proven a safe therapeutic modality, with compared and analysed by construct of a 4 · 4 table. From this satisfying results for selected patients with oropharyngeal carci- the overall sensitivity for FNAC was 93.7%; specificity was nomas; however, randomized control trials are needed, to deter- 96.6%. Positive predictive value was 97.0% and negative predic- mine the group of patients which would benefit the most from this tive value was 92.8%. Accuracy was 95.0%. combined approach. Conclusions: FNAC is still the primary modality for obtaining tissue diagnosis with a high degree of accuracy and certainty. Clinical suspicion should however always be borne in mind when HP 183 interpreting results of the cytology. Predictors of extracapsular spread in lymph node HP 181 metastases Case report: primary squamous cell carcinoma Kadir Imre, Ercan Pinar, Semih Oncel, Caglar Calli, of the nasal septum Bekir Tatar Ataturk Training and Research Hospital, Izmir, Turkey Zeynep Kizilkaya, Ilhan Unlu, Erdal Samim, Hakki Uzunkulao- glu, Kursat Ceylan, Hakan Gocmen, Unal Bayiz, Sedat Alagoz Objective: We investigated effect of clinical and pathologic Ministry of Health Ankara Research and Training Hospital Ear parameters on extracapsular spread(ECS) in patients with lymph Nose and Throat Department, Ulucanlar Cad. No:1 Mamak node metastases in laryngeal cancer. Ankara, Turkey Methods: 186 patients and 342 neck dissection were included in this study. Relationship between ECS and tumor location, T Objective: We report an extremely rare case of primary squamous stage, clinic and pathologic N stage, tumor differantiation, cell carcinoma of the nasal septum. number of metastatic lymph nodes, diameter of metastatic lymph Method: Case report and world literature concerning primary node and impact of presence ECS on contralateral neck metas- squamous cell carcinoma of the nasal septum are presented. tasis were evaluated. Results: Malign neoplasms of the nose and paranasal sinuses Results: Tumor location, clinic and pathologic N stage of the comprises 1% of the overall malign tumours of the head and neck. tumor, number of metastatic lymph node metastases, diameter of Primary carcinomas of the nasal septum are rare entities and positive node and contralateral neck metastases were significantly constitutes 9% of the malign neoplasms of the nasal cavity. In this associated with ECS (P < 0.05). Significant parameters were paper we report a case of primary squamous cell carcinoma of the included in multivariate logistic regression model. Only number of nasal septum in a 60-year-old male patient (‡3) lymph node metastases was independently related with ECS Conclusion: Importance of early diagnosis is emphasized with the (P < 0.05; OR:11.6). report of a rare case of primary squamous cell carcinoma of the Conclusion: Presence of ECS in lymph node metastases is believed nasal septum to be an indicator of poor prognosis. Physician should be paid more attention to patients who have an increased risk of ECS. HP 182 Bilateral neck dissection should be performed in patients with Cancer of the oropharynx: modern therapeutic approach ECS in positive nodes. P. Vlastarakos1, T. Nikolopoulos1, A. Tzagaroulakis1, K. Nazos2, N. Salemis3, E. Ferekidis1 1Hippokrateion General Hospital, Athens, Greece 2’’P & A Kyriakou‘‘, Children’s Hospital, Athens, Greece 32nd Department of Surgery, Army Veterans General Hospital NIMTS, Athens, Greece

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HP 184 tality rates as significant (v2 = 0.092; P > 0.05); in patients Multiple primary malignancies in patients with head with undetected primary tumor, death of recurrent metastases was the most frequent (79.4%), while among patients with pri- and neck cancer in our department mary tumor detected late, 75.0% died precisely because of such Hiroyoshi Iguchi, Makoto Kusuki, Taichi Uyama, Aki Nakam- tumor. ura, Akimori Kanazawa, Hisao Amatsu, and Hideo Yamane Conclusions: Highly significant differences of causes of death Department of Otolaryngology and Head and Neck Surgery, were found between group B1-1 of patients with cancer detected Osaka, City University Graduate School of Medicine, Osaka, late and B1-2 of patients with undetected primary cancer Japan, 1-4-3, Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan (v2 = 35.180; P < 0.001). In B1 group of patients, 75.0% of cases died due to development and evolution of primary cancer, Objective: It has recently been recognized that head and neck while in group B2, 79.4% them died for recurring metastases. cancers (HNC) frequently accompany other primary malignancies Cumulative probability of survival in group B1-1 was 30.43% especially those originating from the upper gastrointestinal tract. with an average length of survival probability of 34 months, We investigated multiple primary malignancies in patients with and in group B1-2, cumulative probability of survival was HNC in our department. 34.09% with an average length of survival probability of Methods: One hundred and nineteen patients with multiple pri- 39 months. No significant difference of cumulative probabilities mary malignancies other than malignant lymphoma out of 696 of survival was found between these groups (log rank = 0.38; patients with HNC treated in our department between September P > 0.05). 1997 and August 2005 were entered in this study. Results: The incidence of multiple primary malignancy was 17.1% (119/696). Double cancers developed in 91 patients, triple cancers in 27, and quintuple cancers in 1 patient, with 268 malignancies HP 186 altogether. The most frequently affected site of the head and neck Prognostic factors for nasopharyngeal carcinoma was the larynx (34.4%), followed by the hypopharynx (20.9%). The most frequent site of malignancies outside the head and neck Afgir Said, Ismaili Nabil, SbittiYassir, Errihani Hassan, region was the esophagus (29.1%), followed by the stomach Benjaafar Nourredine, K. ElGueddari Brahim (23.1%). In 51 patients with HNC as the initial malignancy, Service of Medical Oncology, National Institute of Oncology malignancies were subsequently detected in the esophagus (NIO) Rabat, Morocco (36.0%), stomach (16.4%), and lung (11.5%), in order of fre- Background: Nasopharyngeal carcinoma (NPC) is a distinct form quency. The incidence of HNC accompanying esophageal cancer of cancer of the upper respiratory or digestive tract in which the was 32.8% (39/119), and the hypopharynx was the most frequent epidemiologic features, origin, histopathologic types, treatment, site of HNC accompanying esophageal cancer. The interval and prognosis are different from those associated with other of detection of each malignancy was generally within one malignant neoplasms of this anatomical area. year because of our screening program for multiple primary Objective: To describe the survival of NPC patients in NIO, verify malignancies. the prognostic value of the revised (2002) Conclusions: The upper gastrointestinal tract needs to be carefully TNM staging system, and develop a multivariate prognostic examined in patients with HNC. Screening programs for multiple model for NPC. primary malignancies are required to manage such malignancies Methods: A retrospectively maintained database containing clin- as early as possible. ical and computed tomography scan data was used to reclassify 468 NPC patients treated between 1999 and 2001. Overall and stage specific survival were analyzed using the Kaplan-Meir HP 185 method and the log rank test. Univariate and multivariate cox Cervical metastases of cancer of unknown primary site proportional hazards regression analysis were used to obtain prognostic models. Sanja Krejovic-Trivic, Aleksandar. Trivic, Zeljko Petrovic, Vojko Djukic, Anton Mikic Results: 468 pts were enrolled: median age was 42 years (range 10– 83); histology subtype OMS 3 in 405 pts (86.5%); 380 (81%) were Institute of Otorhinolaryngology and Maxillofacial stage T3 T4; 319 (68%) N2N3 and 42 pts (9%) M1. With a Surgery, Clinical center of Serbia, Belgrade, Serbia median follow-up of 26 months (3–74) 128 pts (27.4%) are alive Objective: The largest number of metastases originates and free of disease. No differences between treatment arms were from primary cancer of the head and neck. found (P = 0.1). The 5-year survival rate was 26.6%. In univar- Methods: The study was carried out from January 1, 1990 to iate analysis, significant prognostic factors were: age December 31, 1999 at the Institute of Otorhinolaryngology and (P < 0.001), delay of consultation (P = 0.0015), node lymph Maxillofacial Surgery, Clinical Center of Serbia, Belgrade. The study status (P < 0.001) and metastasis (P < 0.001). After multi- included 67 patients with enlarged persistent cervical lymph nodes. variate analysis, independently prognostic factors were: lymph Results: The analysis of treatment outcome showed that 22 or node status (P = 0.0014) and metastasis (P < 0.001). 32.8% of cases survived and 45 or 67.2% died. Mortality rate in Conclusion: We confirm the need to determine the risk factors in primary tumors detected late was 69.6%, and in patients with patients with NPC, and we demonstrated long term survival. New undetected primary tumor it was slightly lower, 65.9% of pa- therapeutic approaches are warranted in order to improve the tients. Statistical tests failed to confirm the difference of mor- outcome of these patients.

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HP 187 Watch-PAT100. ED was measured in the morning using the Sleep apnea: snoring. New and alternative surgical Endo-PAT 2000. Apnea severity and ED were assessed after 3 months and 1 year on MAS treatment. techniques. Results: Mean apnea-hypopnea index (AHI) significantly im- P. Theodosis, D. Gourziotis, B. Gregoriou, S. Papaspyrou proved from a baseline (pre-treatment) of 29.7 ± 18.5/h to General Hospital Of Athens ’Eyaggelismos’ 17.7 ± 11.1/h after 3 months and to 19.6 ± 11.5/h after 1 year with MAS treatment (P < 0.005 for both). Endothelial func- Introduction: Sleep apnea is a disturbance of breathing, which can tioning improved significantly from a 1.77 ± 0.4 (baseline) to fluctuate from relatively innocent as snoring or severe obstructive 2.1 ± 0.4 (3 months) and 2.0 ± 0.3 (1 year). There was a sig- apneas, which, could lead to very serious lesions of the cardiore- nificant correlation between the improvement in AHI and endo- spiratory system. Diagnosis, differential diagnosis and the treat- thelial functioning (r = 0.55, P = 0.05). ment command the cooperation of many medical specialties: ENT Conclusions: These results indicate that the Herbst MAS may be surgeon, lung disease physician, maxillar surgeon, and dentist. an effective treatment in patients with OSA, at least for 1 year, The surgical treatment of the problem has been studied by ENT improving both breathing and endothelial function. The signifi- surgeons and different operative techniques have been suggested. cant correlation between the improvement in apnea indices and Most of them are focused on the reconstruction of the soft palate endothelial function suggest that the respiratory abnormality and the uvula combined or not with tonsillectomy or surgical causes the vascular abnormality. The fact that endothelial improvement of the rhinal respiration. function significantly improved to level similar to normal con- Materials and methods: In the last 4 years we have treated 78 cases trols without a complete elimination of apneic events suggests with sleep apnea. The patients firstly answered to a detailed that there is a threshold effect of OSA on endothelial function- questionnaire, which was followed by a clinical and laboratory ing. control. The treatment was personalized to every patient accord- ing to his symptoms, mainly using Laser CO2. Results: Seventy percent had exceptional decreasing symptoms, HP 189 15% had an improvement of the sleep, 15% showed alteration of Use of IDAS versus standard lasers in laser assisted LSAT, RDI, AL to satisfactory levels, 90% of the patients were uvulopalatoplasty for treatment of snoring treated with Laser CO2. Complications have not been notified. Conclusions: The multifactoral etiology of sleep apnea as well as Pavelec Vaclav, Slipka Jaroslav the majority of the therapeutic methods shows the difficulty of Charles University Hospital in Plzen, Czech Republic solving the problem. Keeping always in mind how easy the Objective:The aim of this study was to compare the effectiveness method can be performed and also the absence of complication, of five power lasers (CO , diode, KTP, ErCrYSGG, and IDAS) in the use of Laser CO is highly recommended. 2 2 laser assisted uvulopalatoplasty. Methods: This is a prospective study of 100 patients who were HP 188 treated for snoring by laser assisted uvulopalatoplasty with either CO2 (n = 21), diode (n = 19), KTP (n = 21), ErCr:YSGG One-year treatment with a Herbest mandibular (n = 21) or with IDAS laser (n = 18). advancement splint improves obstructive sleep apnea Results: Differences in sex ratios among the lasers were analyzed and endothelial function with the Chi-square test with the PROC FREQ procedure of SAS. Difference in snoring score among the lasers has been tested by S. Itzhaki, G. Clark, H. Dorcin, L. Lavie, P.Lavie, the Kruskal–Wallis test with the PROC NPAR1WAY procedure G. Pillar of SAS. Sleep laboratory, Rambam Medical Center and Technion – Israel The number of days of pain medication use and the time to return Institute of Technology, Haifa, Israel to normal diet were used as indicators of recovery from surgery. Objective: We sought for the first time to assess the effect of long- Pain medications were used on average for 10.1, 6.5, 6.5, 4.1 and term Herbst mandibular advancement splint (MAS) treatment on 4.9 days and the times to return to normal diet were on average obstructive sleep apnea (OSA) and on endothelial function (ED, a 8.6, 6.7, 6.8, 4.5 and 5.9 days in the CO2, diode, KTP, ErCrYSGG condition precedes ischemic heart disease). We hypothesized that and IDAS groups, respectively. both will improve with treatment, and that the magnitude of Conclusions: Differences in post op recovery were observed. Pro- improvement in ED will be correlated with the magnitude of bands treated with IDAS laser recovered more quickly than the improvement in OSA. diode, KTP and CO2 group, however more slowly than the Methods: Sixteen patients (11 m) aged 54.0 ± 8.3/year partici- ErCrYSGG group. IDAS laser is a suitable laser sytem for laser pated. Apnea severity was assessed by polysomnography and by assisted uvulopalatoplasty.

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HP 190 index value.We should like to show the fact that the patients Laser-assisted uvulopalatoplasty shows substantial from the same group, meaning with the same AHI value, there are really different ESS values probably caused by some sec- improvement in obstructive sleep apnea ondary factors. The patients were divided in four groups by the Yves Kamami1, Mario Olszakier2, Giora Pillar3. AHI index values. Poligraphic registration were made to these 1Otolaryngology Department, Hoˆpital Saint-Cloud, Paris, patients, with ENT examination followed by a self evaluation France through completing the ESS questionnaire. The study was 2Itamar Medical, Caesarea, Israel completed by following the influence of the ENT diseases 3Sleep laboratory, Rambam Medical Center and Technion school associated with the respiratory pathology during the sleep. The of Medicine, Haifa, Israel daily activity is in strong relationship with the sleeping quality and influenced by the associated ENT diseases. So this is why Objective: UvuloPapatoPharyngoPlastic surgery (UPPP) and la- the treatment of the respiratory disturbances during sleep ser-assisted-uvulopalatoplasty (LAUP) have been suggested as achieved by solving the ENT problems, contribues to the raising treatments for obstructive sleep apnea (OSA). Unlike UPPP, of the life quality by reducing the diurnal sleepnes times and LAUP is performed in the office using only local anesthesia, with improving the ESS values. fewer side-effects and complications, and shorter recovery time. We have recently shown that improving OSA, even without completely abolishing it, results in a substantial potential protec- HP 192 tion from cardiovascular complications. Methods: Nine males aged 59 ± 7 years with a diagnosis of OSA CPAP compliance of OSA patients in Singapore (2 with mild OSA - Respiratory Disturbance Index; RDI < 15, 2 Alvin Tan, Pon Poh Hsu, Peter Kuo Sun Lu with Moderate OSA, and 5 with severe OSA - RDI > 30/h) Department of Otolaryngology, Changi General Hospital, 2 Simei underwent a LAUP by the same surgeon. All underwent a pre Street 3, Singapore 529889 treatment ambulatory sleep study (Watch-PAT100; Itamar-Med- ical, Caesarea, Israel), followed by the same study performed on Objective: To investigate the compliance rate of CPAP usage in the average 2.2 months following treatment. OSA patients in Singapore. To investigate if self-payment of Results: Following treatment, mean RDI decreased from 35 ± 18/ CPAP affects compliance rate h to 21 ± 17/h (P < 0.0001). In 5 (56%) of the patients (2 severe) Methods: Prospective study conducted in 2004 to 2006 looking treatment was clearly considered successful (reduction of RDI by into all patients with OSA who were sent for CPAP treatment. at least 50% and under 20, or to below 10/h). Mean Oxygen De- Emphasis placed on the number of patients who eventually saturation Index (ODI) decreased from 22 ± 16/h to 12 ± 12/h ended up purchasing CPAP after the trial period and the sub- (P < 0.003). Subjectively, patients reported substantial sequent compliance of CPAP usage. Investigate the main rea- improvement in snoring, quality of sleep and daytime alertness. sons why some patients do not purchase CPAP and why the There were minimal side effects including oral candidiasis and mild rest do. pain. Body mass index did not change with treatment. Results: The percentage of patients who have been referred for Conclusions: We conclude that the laser-assisted ablation of the CPAP treatment and eventually end up buying CPAP is low. soft palate may significantly improve OSA, and should be offered However, for those who eventually end up buying CPAP, there is for patients, especially when refusing CPAP. We also conclude a high compliance rate. that the WP100 system is a convenient and easy method to Conclusions: Medical coverage of patients is important in influ- quantify their OSA in their home. encing the take-up rate of CPAP and compliance is strongly influenced by whether the patient pays for the CPAP personally. HP 191 The relationship between Epworth sleepnes scale HP 193 values and the grade of the obstructive sleep apneea Simple snoring: diode laser treatment Neagos Adriana1, Muehlfay Georg2 Michel Jakobowicz, Fre´ de´ ric Tanke´ re´ , Elizabeth.Vitte 1Emergency County Hospital, ENT Department Tg. Mures, ENT Department Pitie´ -Salpeˆtrie` re-Paris, France Romania 2 Objective: Amelioration of quality of respiration, sleep and University of Medicine and Pharmacy, ENT Department Tg. snoring. Mures, Romania Methods: After an exploration of OSAS, patients in sitting posi- The life quality is affected by the obstructive sleep apneea, fact tion were treated under local anaesthesia, with Diode Laser, first, which has remained unexplored in many situations during the on turbinate, three sessions and secondly, on velum, three to six examinations made in laboratories. In appreciation of the life sessions. If necessary, we ask patients for: loosing weight, stopping quality there are used questionnaires through which diurnal hypnotics, tobacco and alcohol. sleepnes grades are evaluated. The Epworth Sleepnes Scale Results: Six hundred and twenty patients were treated since 1998 (ESS) represents an own questionnaire for measuring the risk of with the following results: 62.5% (very good); 25% (good); 8.5% falling asleep of the patient in everyday situations. The marks (failures) and 4% missing. are situated on a 0–24 scale which can be correlated with the Conclusion: 87.5% of amelioration without pain using Diode OSAS severity. The aim of the study is to demonstrate the way Laser 940 nm. This laser induces deep retractile scare and the in which the ESS value is being or not influenced by the AHI results are stable in time.

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HP 194 Objective: To assess the static and dynamic upper airway mor- Laser-assisted uvulopalatoplasty in treatment phological changes in patients with obstructive sleep apnea (OSA) who underwent modified uvulopalatoflap (UPF) and to derive of snoring and obstructive sleep apnea syndrome predictors of surgical outcomes from these changes. Rita Blotsky, Alexsandr Blotsky Methods: A prospective study of pre- and post-operative video- Amur State Medical Academy, Blagoveshchensk, Russia endoscopic computer assisted measurements (CAM) of upper airway parameters of 22 subjects with OSA between the period of Last 10 years snoring and obstructive sleep apnea syndrome May 2004 till January 2006 was undertaken. Measurements were (OSAS) are considered as a public health problem. We have performed at the retropalatal and retrolingual areas during quiet developed several of Laser Uvulopalatoplasty (LUPP) performed respiration and Mueller’s maneuvers. with Nd:YAG laser in contact mode and continious wave. The Results: Patients who underwent modified UPF surgery increased first type of the procedure consists of 5–7 mm long incisions with the retropalatal area by 66%, widened the transverse and longi- laser on the mucosa of the soft palate without damage of mucosal tudinal diameters of the retropalatal area by 28 and 39%, pharyngeal surface of soft palate, if necessary, 2/3 of the uvula respectively. There was a significant decrease in palatal collaps- may be excised. The second type consists of two steps. First, ibility and an overall improvement in AHI postoperatively. contours for forthcoming resection are made with subsequent Conclusions: Modified uvulopalatoflap and lateral pharyngoplasty resection of soft palate mucosa duplication 5–7 mm wide. In third is an effective surgical technique for the treatment of OSA patients LUPP type we have preserved about 1.5 cm of soft palate with a with predominantly retropalatal and lateral pharyngeal collapse. creation of new uvula. We evaluated the functional results of the With the aid of CAM, improvements in post-operative anatomical surgery by the repeated polysomnography in 4 weeks after LUPP dimensions can be quantified in a static and dynamic manner. with simultaneous registration of snoring frequency. It appears that contact Nd:YAG laser is highly comfortable in use, allows to provide LUPP, contribute to soft palate wrinkling because of scarring, increases pharyngeal air volume and decreases the HP 197 number of apnea/hypopnea episodes in patients suffered from Comorbidities in patients with obstructive sleep apnea OSAS. T. Chimona1, E. Proimos1, G. Perogamvrakis1, M. Tzanakakis1, E. Theodoraki1, E. Michelaki2, C. Papadakis1 1ENT Department, General Hospital of Chania, Greece HP 195 2Pulmonary Department, General Hospital of Chania, Greece Coblation assisted Uvulo-palatoplasty (CAUP) Objective: Obstructive sleep apnea (OSA) is a complex disease process with multifactorial etiology. The objective of this study is Huw Williams, Neela Mouli Doddi to find out diseases or conditions that coexist with moderate and ENT Department, Royal Glamorgan Hospital, Ynysmaerdy, severe OSA. Llantrisant, CF72 8XR, UK Methods: Four hundred and twenty-four adults with OSA were Objective: To know the efficacy of CAUP in treating snoring and referred to our clinic after polysomnography from January 2005 to compare our results of CAUP with those of Laser assisted to August 2006. Ninety-four patients had mild OSA with Apnea Uvulopalatoplasty (LAUP) in literature. Hypopnea Index (AHI) < 15/h and were excluded from the Methods: It is a retrospective study of 35 cases between 2003 and study. Two hundred and two patients suffered from moderate 2006 at the Pontypridd and Rhondda NHS Trust. The data was OSA (AHI) = 15–30/h, whereas 128 patients suffered from severe collected from the patient’s case notes in the Medical records OSA (AHI > 30/h). Full patients’ history related with cardio- department. vascular or lung diseases and medication was obtained. All Results: Snoring was totally abolished in 32 patients. Two patients patients underwent clinical examination, Mueller’s maneuver, snored less while one patient showed no improvement in snoring. Body Mass Index (BMI) calculation and abdominal perimeter Conclusions: CAUP when compared to LAUP is equally effective measurement. Furthermore, blood pressure measurement was but has the added advantages of a less. Painful recovery, low obtained as well as, serum fibrinogen, glucose, CRP, cholesterol postoperative morbidity and faster healing. Moreover the learning and triglycerides. curve is less, operative theatre need not be setup like in laser and is Results: Sixty per cent of patients with moderate OSA had Sleep economical. Hence CAUP is our preferred choice of palatal sur- Disordered Breathing (SDB) score >8. In the same group 56% gery. were hypertensives, 23% had high glucose levels and 48% were dyslipidemic patients. High fibrinogen and CRP levels were found in 33.6 and 38%, respectively. In the group with severe OSA 82% HP 196 of the patients had SDB score >8, 78% were hypertensives, 75% Quantitative analysis of anatomical improvements had high glucose levels and 83% were dyslipidemics. Forty-eight following modified UPF and lateral pharyngoplasty per cent of patients presented with high fibrinogen levels and 42% had high CRP levels. Pon Poh Hsu, Alvin Kah Leong Tan, Eng Cern Gan, Conclusions: Obstructive sleep apnea syndrome seems to be a Peter Kuo Sun Lu systematic disease which presents common parameters with met- Department of Otolaryngology, Changi General Hospital, 2 Simei abolic syndrome. The more severe the OSA, the greater is the risk Street 3, Singapore 529889 for atherosis and thromboembolic episodes.

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HP 198 Methods: Forty-one patients complaining of snoring and sleep Clinical parameters in obstructive sleep apnoea: apnea were investigated with a portable data logger at home. Five subjects did not tolerate the placement of the nasal probe. The are there any correlations? following parameters were recorded for six consecutive sleeping Jiun Thong, Kenny Pang hours: oxygen saturation, esophageal and pharyngeal pressure, Department of Otorhinolaryngology, Tan Tock Seng Hospital, body position, nasal and oral airflow, snoring events. The Singapore obstruction level was found by analysing pressure amplitudes. Results: The mean apnea hypopnea index was 18.2 with an Objective: To assess the correlation between clinical symptoms average minimum oxygen saturation of 82.2%. Thirty out of 41 and examination findings with severity of obstructive sleep apnoea patients had an AHI > 5, defined as OSAS. Seventy-three percent (OSA). of the patients presented an upper level obstruction, while 27% Methods: A prospective study was conducted on patients referred to showed a lower or multilevel obstruction. the Sleep clinic with a suspected diagnosis of OSA. Clinical exam- Conclusions: Ambulant EPPM is useful to distinguish central from ination documented the Epworth sleepiness score (ESS), body-mass obstructive breathing disorders as a screening method. In addition index (BMI), tonsil size, modified Mallampati index (MMP), to other devices it indicates the obstruction level. It still has to be Muller’s manoeuvre score and reflux finding score (RFS). All pa- proven if this information can increase operative success rates. tients underwent Level 1 overnight polysomnography. Regression Limitations arise from a 12% intolerance rate. analysis was performed to assess relationships between patient characteristics and various aspects of symptoms and signs with polysomnographic measures relating to the severity of OSA. A P HP 200 value of less than 0.05 was considered statically significant. Microtia: technique and results of auricular Results: Eighty patients (14 female, 66 male) with a mean age of 42.9 years (range 22–66) were included in the study. Mean BMI was reconstruction with autogenous rib cartilage 27.6 (range 20–39). Correlation was found between ESS and ante- R. Staudenmaier roposterior pharyngeal wall collapse at level of soft palate during ENT-Department, Klinikum rechts der Isar, Technical University Muller’s manoeuvre (r = 0.3,P = 0.02). BMI was significantly Munich, Germany associated with a history of hypertension (r = 0.3,P = 0.01), MMP (r = 0.3,P = 0.001) and lateral wall collapse at level of soft Introduction: Their are various ways treating the classic microtia, palate during Muller’s manoeuvre (r = 0.4,P = 0.0001). OSA the so called peanut ear. Apart a prosthesis the most common way severity correlated significantly with the male gender (P = 0.02), of auricualr reconstruction is the use of autogenous rib cartilage. history of hypertension (r = 0.5, P < 0.0001), BMI (r = 0.2, This technique requires two to three operations. P = 0.03), MMP (r = 0.3, P = 0.003) and upper airway collapse Technique and results The first step is to harvest the rib cartilage during Muller’s manoeuvre. from the 6th to the 9th rib. The base of the framework is the 6th Conclusions: Clinical findings in patients with OSA do correlate and 7th rib cartilage which is taken under preservation of the with severity of OSA and polysomnographic findings. Degree of synchondrosis. To create a satisfactory 3D structure the triangular upper airway collapse during Muller’s manoeuvre correlates well fossa and scapha are carved into the baseplate and the 8th rib is with AHI severity. Accuracy in predicting presence and severity of fixed as helical rim on top. After optimizing the framework with OSA allows for greater cost-effectiveness in screening patients additionell pieces of cartilage it is placed in a subcutanous pocket prior to polysomnography. on the mastoid plane. After 3 months the auriculocephalic ankle is built with a cartilage wedge which is placed under the baseplate and covered by a temporalis fascia flap and split thikness skin HP 199 graft from the hairbearing skull. Commonly a third step is rec- Outpatient esophagopharyngeal pressure monitoring ommended for minor corrections. Discussion: At the moment autogenous rib cartilage seems to be Martin Patscheider; Alfred Dreher; Christine Klemens; the ideal available material for ear reconstruction, despite the Robert Bodlaj; Richard de la Chaux improvements in tissue engineering. The harvesting of the carti- ENT-Department, Ludwig-Maximilians-University, lage causes a specific donor-site morbidity. Operations improving Marchioninistrasse 15, 81377 Munich, Germany hearing ability by building up the external ear canel and middle Objective: Esophagopharyngeal pressure monitoring (EPPM) is ear are mainly done in cases of bilateral microtia. helpful in the topodiagnosis of primary snoring, to determine the Conclusion: Following our own experience with more than 100 obstruction level in patients suffering from obstructive sleep ap- cases of total ear reconstruction with autogenous rib cartilage its noea syndrome (OSAS) as well as for the diagnosis of the upper possible to produce replicable aesthetic results from about the age airway resistance syndrome (UARS). We report about our expe- of 8. rience with the first portable screening device. Keywords: Ear deformity, Microtia, Auricle reconstruction

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HP 201 the oral cavity revealed solid, smooth, painless mass in the neck. Nasal septal teratoma in a Nigerian child The mass caused mechanical obstruction and difficulties with swallowing. CT scan showed solid tumor mass arising from the Titus S. Ibekwe1, Daniel D. Kokong1, Betrand A. Ngwu2, soft tissue of the right side of the neck narrowing the pharyngeal Oluwole A. Akinyemi3, Onyekwere G. Nwaorgu1, lumen. AT the child’s eight day of age total excision of tumor was Effiong E. Akang2 performed. Pathology report described solid tumor measuring 1Department of Otorhinolaryngology, University College Hospi- 4 · 3 · 2 cm, with histogical and immunohistochemical features tal, Ibadan, Nigeria of neuroblastoma of differentiating subtype. Tumor was com- 2Department of Pathology, University College Hospital, Ibadan, pletely covered by pseudocapsule (stage 1). There was no MYCN Nigeria amplification and DNA content was in the hypo-triploid range. 3Department of Anaesthesia, University College Hospital, Result: There was no intraoperative complication. Iatrogenic Ibadan, Nigeria Horner syndrome was arised postoperatively, but with sponta- Teratoma is an uncommon developmental neoplasm that arises neous regression after three months. According to standard SIOP from totipotential tumor stem cells. Some cases had been recorded protocol chemo and radiotherapy was not administrated. The in head and neck which constitutes about 10% of all cases. child is now eight years old and in good health, controlled by Objective: To present a rare tumour (teratoma) with an unusual oncologist and surgeons. site of presentation (nasal septum) and outline the management/ Conclusions: Cervical localization of neuroblastoma is wery rare. outcome. Prognosis is better for this than for all other localizations, espe- Method: Case report. cially in range I and II in infants under 6 months of age. Decision on the management should be made in agreement by pediatric Results: We report a case of mature teratoma, arising from the surgery, otorhinolaryngology, oncology and pathology teams. nasal septum into the left nasal cavity, in an 18-month-old Nigerian female. She had total surgical excision of the lesion which which was confirmed histologically as mature teratoma. The patient remained free of recurrence 31 months after. HP 203 Conclusion: This is the first reported case in Africa and second in Indication for pediatric tracheotomy the world literature (Medline search) and both cases were man- ˇ aged similarly with good outcome. Therefore, the prognosis for K. Stankovic´ ,V.Subarevic´ , R. Simic´ , P. Vasiljevic´ , Z.Dudvarski benign teratoma is good with total excision. Pediatric Otorhinolaryngology Center, Mother and Child Health care Institute of Serbia ‘‘Dr Vukan Cupic’’, Belgrade, Serbia HP 202 Pediatric tracheotomy is a life saving procedure when it is per- formed with in appropriate indication and surgical technique. A Parapharyngeal neuroblastoma in newborn-case percentage of pediatric tracheotomy and indcations had shown a report slight decrease because of endotracheal intubation, which is a very R. Simic1, A. Vlahovic1, V. Subarevic2, S. Djuricic3 good solution for disease which was treated with tracehotomy 1Department of Pediatric surgery, Institute for Mother and Child 20 years ago.We wont to report our experience during 15 years in Health care of Serbia, Radoja Dakica street 6-8, Belgrade, Serbia Pediatric Otorhinolaryngology Department in the Institute for 2Department of Otorhinolaryngology, Institute for Mother and Mother and Child health care Serbia ‘‘Dr Vukan Cupic‘‘ in Bel- Child Health care of Serbia, Radoja Dakica street 6-8, Belgrade, grade. A retrospective study included 86 children with traheos- Serbia tomy between 1991 and 2006. The youngest child with 3Department of Pathology, Institute for Mother and Child Health tracehotomy was 3 days old, and the oldest was 11 years old. care of Serbia, Radoja Dakica street 6-8, Belgrade, Serbia Fifty-six (65.1%)patients were younger than 12 months. The most common indication for pediatric tracheotomy was airway Objective: Neuroblastoma is the most common malignant con- obstruction because of congenital anomaly of the upper respira- genital tumor. It is rare in cervical localization (2–5% of all tory organs, head and neck. Fifty-one (59.3%) patient had con- neuroblastoma in childhood). Cervical neuroblastoma in in the genital anomaly of upper respiratory organs and 12 (13.9%) had newborn is of special significance for hed and neck surgeons. It is congenital anomaly of the head and neck organs. Other indica- often misdiagnosed as lymphatic malformation, branchial cleft tions that were treated with tracheotomy, as only possible solu- cyst, or infectious adenitis. Patients having these conditions may tion, were prolonged intubation because of the respiratory be present with severe feeding and respiratory difficulties. insufficiency: eight (9.3%) children with neurological diseases, Case report: Three-day old female newborn was admitted to the six(7%) children with muscular diseases, four (4.6%) with Institute’s intensive care unit (ICU) with oral intubation and malignant head and neck tumors, three (3.5%) with cardiopul- nasogastric tube for feeding because of the tumor mass on the monary diseases and two (2.4%) with traumatic lesions. The right parapharyngeal localization. Prenatal history was unre- pediatric surgeons dealing with this procedure should be aware of markable. At the day of delivery the child was sent to the regional the tracheotomy care problems, fatal complications and the need medical center because of stridor and cyanosis. Examination of for reconstructive surgery.

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HP 204 HP 206 Lower airway papillomatosis in children Congenital midline cervical cleft Lidia Zawadzka-Glos, Anna Jakubowska, Micha Brzewski, Radoje Simic, Aleksandar Vlahovic, Djordje Kravljanac, Mieczysaw Chmielik Vladan Subarevic ENT Paediatric Department of Medical University of Warsaw Institute for Mother and Child Health Care of Serbia, New Belgrade, 8 Radoje Dakic Str. Objective: Laryngeal papillomatosis in children is a frequent disease caused by human papilloma virus (HPV) type 6 or type 11. In some Congenital midline cervical cleft (CMCC) is a rare cervical dis- cases papilloma may affect the lower levels of the respiratory tract. order clinically evident at birth. Usually it is initially evaluated In this study among 90 patients treated for laryngeal papillomatosis by pediatrician or surgeons for adults who misinterprets CMCC in four children papilloma of trachea, bronchi and lung tissue were as a thyroglossal duct cyst (TDC) or branchial cleft deformity. detected in endoscopic and radiological examination. During the past 10 years, five cases of CMCC were treated at Methods: Papilloma of the larynx, trachea and bronchi were our hospital. They were 3 females and 2 males with age ranged recognised during laryngotracheobronchoscopy. All children had from 1 month to 8 years. For three infants, with typical CMCC, ultrasonography of the larynx and chest X-ray. (two were 1 and one was 2 months old) treatment entails com- Results: Multiple papillomatomies had indicated a progression of plete surgical excision of the cleft, fibrous cord, skin protuber- papillomatous changes in the trachea and bronchi and the fre- ance and sinus tract with closure via multiple Z-plasties. The quency of surgery was increased. Three children died at the 13th, female infant was misdiagnosed and treated as TDC by the 9th and 7th year of age due to chronic respiratory insufficiency. plastic surgeon in another hospital. Anterior cervical contracture One patient is now 24 years old and 4 years ago had tracheotomy persisted and girl was cured many years after primary operation because of massive growth of papilloma and progressive respira- by removal of the underlying cord and Z-plasties. Five months tory insufficiency. old infant had lower lip cleft hemangioma, associated with cleft Conclusions: Recurrent pneumonia in children with recognised of the mandible, sternum and flexion neck contracture. This type laryngeal papillomatosis may suggest the spread of the disease to of the CMCC was treated after excision of the hemangioma and lung tissue. All children with recognised laryngeal papillomatosis cheiloplasty by excision of the underlying fibrotic tissue and should be given chest X-rays. multiple Z-plasties. All patients did not develop secondary con- tracture. CMCC is a rare developmental abnormality that may be isolated or associated with a spectrum of midline defects. HP 205 Treatment of CMCC consists of excision of the midline cleft Rare forms of children’s respiratory papillomatosis with a Z-plasty repair to avoid a vertical scar and subsequent duration cicatricial contracture. V. N. Bakumov, I. V. Konovalova, V. V. Reznikov ORL-Clinic Of Volgograd Region HP 207 Gullet papillomatosis is not difficult to diagnose and cure. Earlier Neuroendocrine carcinoma of the tongue in a child: we have not observed cases with rapid growth of papillary tumors, so we found it interesting to supervise a 7-year old patient with a case report large gullet papilloma that has appeared in the period between 1.5 D. Martu, Luminita Radulescu, Loreta Ungureanu, C. M. Martu, and 2 months. The child has gone though a medical examination B. Cavaleriu about 1.5 months prior to the diagnosis, and no pathology was University of Medicine and Pharmacy ‘‘Gr.T.Popa’’ Iasi, revealed. Registered illness’ symptoms included rhinolalia clausa, Romania dysphagia caused by the papilloma (size 2.5 · 2 · 2.5 cm) located Neuroendocrine carcinomas arising outside the appendix are ex- between palatine glands. The tumor originated from the soft tremely rare in the pediatric population. palate. Under endotracheal narcosis the gullet papilloma was re- moved with the help of CO2-laser. The patient was supervised Objective: We present a case of neuroendocrine carcinoma of the during 2 years after the surgery, and no recurrence was revealed. base of the tongue. The uniqueness of this case is in the rapid growth and substantial Method: In a 7 years old male child presented with some other size of the child’s papilloma. Another patient with such diagnosis complains, the examination of the oropharynx revealed a smooth, is 13 years old and has been under medical observation for 8 years large mass in the middle of the base of the tongue. Excision of the due to recurrent papillomatosis of the right side of nose and tra- tumor and bilateral neck dissection followed by histological chea on the level of I-II rings. Relapses occurred every 6– examination and immunohistochemical analyses confirmed the 9 months and were accompanied by trachea stenosis, which forced neuroendocrine nature of the tumor. The surgery was followed by annual (sometimes more often) removals of papillomas. During chemotherapy. No other primary or secondary site was identified. last 2 years no recurrence of the disease was observed in the right Results: The evolution of the child is good 3 years after the side of nose. However, papillomas continue to grow in the trachea diagnosis. with the same localization with no tendency to deeper trachea Conclusions: The neuroendocrine carcinoma of the base of the expansion or upwards to the larynx. This case confirms the fact of tongue is an extremely rare tumor so recognition of this site is the most common localization the human papilloma virus lesions. important so that proper management can be initiated.

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HP 208 radiotherapy. From functional aspect, these two methods have Is there a need for cross-training between paediatrics advantage over open chordectomy. and otolaryngology? Paul Goodyear, Samit Ghosh, Krishna Reddy HP 210 Department of Otolaryngology, North Cheshire Hospitals NHS Acoustic parameters of voice and quality Trust, Warrington Hospital, Lovely Lane, Warrington, UK of life in bilateral vocal cord paralysis Objective: To evaluate the need for cross-training between the two W. Harnisch1, S. Brosch1, R. Hagen1 specialties paediatrics and otolaryngology. 1Univ. -ENT-Clinic Wuerzburg, Germany Method: A confidential telephone enquiry of on call otolaryn- gology and paediatrics trainees in NHS trusts in the UK, between Objectives: The aim of this study was to evaluate the long-term September 2005 and November 2005. Otolaryngology trainees effect of surgical treatment on acoustic parameters of voice and were asked whether they felt teaching by paediatricians would be related quality of life in patients with bilateral vocal cord paral- beneficial. If yes, they were asked to clarify whether it was lec- ysis. tures/rounds, clinics or rotation. What areas they perceive would Methods: Ten patients underwent acoustic assessment (comput- be important for relating to paediatrics. Similarly, paediatricians erized voice analysis: Go¨ ttingen Hoarseness Diagramm (GHD), were asked the same questions. voice range profile, expert evaluation of roughness, breathiness, Results: One hundred and sixty-four on call Otolaryngology hoarseness) at least 6 months after glottal surgery. The voice trainees were contacted, 155 of these completed the survey handicap index (VHI) was used to assess patient’s voice related (94.5%).On average they saw five paediatric patients per week. quality of life. Indirect microlaryngostroboscopy was performed 130 (84%) trainees said that they don’t receive any formal to reveal residual vocal fold movement and mucosal wave. training by paediatricians. The majority felt that paediatric Results: In five patients minimal vocal fold movement was pre- clinical experience either through clinics (38.9%), lectures served. Seven patients showed uni- or bilateral mucosal wave (32.2%), rotation (22.5%) or paediatric courses (12.9%) would movement, indicating residual recurrent nerve functioning. Voice be beneficial. Formal teaching on resuscitation, dealing with range was reduced in all patients. The irregularity component of sick child was considered beneficial. 144 on call paediatric the GHD (perturbation parameters) as well as voice range were trainees were contacted 124 responded (86.1%). 85 (68.5%) said correlated with residual recurrent nerve function. High breathi- they will see five patients with ENT problems per week. ness (noise component of the GHD) and maximal phonation time n = 118 (95.1%) said that they do not receive any formal lead to increased VHI scores. training in ENT. Similar responses were observed from the Conclusions: Microlaryngostroboscopic findings did not neces- paediatric trainee responses. sarily correspond to subjective vocal complaints. VHI scores Conclusions: This study has demonstrated that otolaryngology tended to be correlated with computerized voice analysis. and paediatric trainees feel cross-training is important. This ulti- mately impacts on patient care. HP 211 The new approaches in the voice disorder diagnostics HP 209 Phoniatric treatment results of patients with initial E. V. Osipenko Federal Research Clinical Centr of ENT of Russia glottic cancers Objective: The purpose of research is to study the coefficient V. Djukic, P. Stankovic, A. Ugrinovic, Z. Dudvarski accommodation (CA) of the patients who suffer from functional and Institute of Otorhinolaryngology and Maxillofacial Surgery, organic voice disorder. CA indicates of the accommodative ability of Clinical Center of Serbia, Belgrade nerve and allows to estimate a degree of the muscular innervation. Objective: Comparative analysis of values of relevant vocal param- Methods: Two hundred and fifty-six patients have been examined eter before and after therapy, for different therapeutical modalities. (214 women and 42 men). They were divided into 4 groups: I Methods: Laser chordectomy was done in 82 patients; 85 patients group consists of the patients who suffer from functional voice were operated through laryngofissure by open chordectomy; 84 disorder (n = 117), II group one consists of the patients who patients were treated by primary radiotherapy. Out of 251 pa- suffer from unilateral laryngeal paralysis (n = 61); III group with tients, 24 were females and 227 males, with different age (ranging acute laryngitis (n = 53); IV group is the control one (n = 25). from 30 to 71 years). Using the computer analysis of the voice, CA (a) was determined in the conditions of videostrobolaryn- before surgery and after 6 months of treatment, the following goscopy with the device ’’VOCASTIM‘‘. Plane electrodes in a parameters were tested: maximum phonation time (s), modal monopolar mode were used in the projection of the larynx. intensity (dB), intensity range (dB), fundamental frequency (Hz), Results: Having analysed the received data we have found out that Jitter (%) and Shimmer (%). a = 1.5–2 is in I group; a = 0–1 is in II group; a  1.5 is in III Results: Longer maximum phonation time was most pronounced group; a 2.2–2.5 is in IV group. after primary radiotherapy. Higher mean values of fundamental Conclusions: (1) the definition of CA is the objective method of frequency, Jitter, Shimmer, harmonic-to-noise ratio and intensity research of the quantitative changes in the nervous-muscular part range were most marked after laser chordectomy. Phonation was of the larynx and allow differentiate the degree of innervation’s much better after primary radiotherapy than upon open chor- violation. (2) the most serious innervation’s violations up to dectomy. Laser surgery resulted more frequently in moderate denervation were typical of the patients suffered from laryngeal hoarseness than primary radiotherapy, as well as in higher level of paralysis. The denervation was typical of the patients who were ill fundamental frequency of speech voice. more than for 6 months; (3) the data of the CA is the basis for Conclusions: Analysis of relevant voice parameters revealed that selection of the appropriate parameters of the current for electrical there was no essential difference of laser surgery and primary nervous–muscular stimulation of phonation.

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HP 212 directed for endoscopic research of a throat in case of stridor. Ten The homeopathic drug in mutation dysphonia children had various disorders of breath and phonation; 2 had the diagnosis of congenital stridor; other children displayed the teenagers symptoms at later age. The ‘‘frame-accurate’’ (time lapse) tech- E. Yu. Radtzig, M. R. Bogomilsky nique has been used for examination. Russia State medical University, Moscow, Russia Results: All 16 infants had basic complaints of ’’squelching‘‘ sounds on inhale, noisy or heavy breathing (which amplified Objective: Mutation dysphonia(MD)-not so often disputable greatly during physical activity), hoarseness. At three cases the medical problem. Teenagers complain on voice quality changes complaints occurred due to inflammatory diseases of a respi- very rare themselves and do not understand necessity voice and ratory path, at one case-due to vaccination. At the moment of breathing exercises. That is why complex homeopathic drugs are endoscopic examination stridor has been noted at four cases. interest for ENT for MD treatment. Laryngomalacia has been diagnosed with 15 children. One case Methods: The Homeovox efficiency estimation as monotherapy of larynx papyllomatosis has been revealed. None of children (28–56 days in recommended doses) in MD teenagers. The had attributes of respiratory insufficiency, gastroesophageal re- hoarseness reason was revealed after complex investigation (sub- flux, inflammatory throat diseases and neurologic semiology. jective and objective voice analysis, endoscopy and stroboscopy). Conclusions: From our point of view endoscopic research of a Results: 30 MD teenagers were examined. Before treatment severe throat should be performed at the first and unique case of im- dysphonia were in 3 cases, moderate in 14, mild in 13. After paired phonation (stridor, hoarseness) or breath. Equipping ENT 28 days Homeovox usage normal voice were in 4 cases, severe doctors’ workplaces with endoscopic technics (outfit?) would al- dysphonia were in 2, moderate in 4, mild in 20. After 56 days low performing screening already at the out-patient stage. Homeovox usage normal voice were in 19 cases, severe dysphonia were in 1, moderate in 2, mild in 8. Conclusions: The complex homeopathic drugs can used in proto- col treatment hoarseness children as monotherapy. HP 215 A comparison of findings between HP 213 videolaryngostroboscopy and digital high-speed The voice quality in laryngeal paresis children videolaryngoscopy: a case report E. O. Viazmenov, E. Yu. Radtzig, M. R. Bogomilsky Thomas Woellner1, Andreas Krenmayr2, Katrin Baumbusch1, Russia State medical University, Moscow, Russia Markus Rungger1, Patrick Zorowka1 1Clinical Department of Hearing, Voice and Speech Disorders; Objective: Our main aim was the voice quality estimation in lar- Innsbruck Medical University, Anichstr. 35, A-6020 Innsbruck, yngeal paralysis (LP) children during the conservative treatment. Austria Methods: Under our observation were 10 children with peripheral 2 laryngeal paresis: unilateral in 7 cases, bilateral in 3. The reasons Christian Doppler Laboratory for Active Implantable Systems, were: trauma in 3 cases, prolonged intubation in 4, in 1 perinathal Institute for Applied Physics hypoxic encephalopathia and 1 children-recurrent subglottic ste- Objective: This casereport compares the investigation of vocal nosis. All of them had breathing and voice disorders: hoarseness folds by means of videolaryngostroboscopy (VLS) and high-speed (severe in 4, moderate in 3) and aphonia in 3 cases. videolaryngoscopy (HSV). Results: The conservative treatment includes lidaza and prozerin Methods: A 77-year-old female patient with persistent dysphonia electrophoresis on laryngeal region, prednizolon (intramuscu- one year after surgery of a Reinke-edema, treated gastro- larly), acupuncture, alkaline ultrasound inhalations and lasts 1– esophageal reflux disease (GERD), and age-related atrophy of 2 months. After treatment normal voice was in 3 cases, hoarseness the vocal folds underwent a 5-days intensive-voicetherapy in our still presented in 7 cases (severe in 3, moderate in 1, mild in3). clinic. Recordings of the vocal fold vibration were made prior Conclusions: The LP conservative treatment in children is very and after the therapy, both with a standard VLS-unit and a difficult and actual problem. The reasons are increasing congenital digital HSV-unit, capable of taking 4,000 greyscale images per laryngeal abnormalities frequency, numerous operations in head second. The HSV-datasets were analyzed according to an and neck region. The searching of new conservative therapy algorithm which computes amplitude and phase of vocal fold possibilities are necessary. vibration by means of Fourier analysis, resulting in false-color images. These single images allow diagnosis of vibration HP 214 amplitude, glottal insufficiency, and phase relationships along and between the vocal folds. Endoscopic screening: diagnostics of congenital stridor Results: The findings in the false-color images computed from the in infancy HSV datasets are in complete agreement with the conventional stroboscopic results and partially outperform the standard Elena Radtzig method due to the straightforward display of vibration properties Moscow of the vocal folds. Objective: The objectives of this study are to present the technique Conclusions: This work shows the clinical value of false-color and results of Endoscopic screening- diagnostics of congenital images to display functional properties of the vocal folds, as as- stridor in infancy. sessed with high-speed videolaryngoscopy. The method has the Methods: The authors conducted a retrospective case analysis clear advantage of generating plain images, which can be easily consisting of 16 infants in the age from 2 months to 6 years old filed in the patient’s records.

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HP 216 used for diagnosis of mandibular fractures. However, the choice Applying fourier analysis to high-speed laryngoscopy: of imaging for diagnosis of mandibular fractures is controversial. Present study compares the accuracy of the three most common applications and limitations imaging methods in mandibular fracture diagnosis; panoramic Andreas Krenmayr1, Thomas Woellner2, Katrin Baumbusch2, radiography, coronal CT and axial CT scan. Patrick Zorowka2 Methods: This cross sectional diagnostic study was performed on 1Christian Doppler Laboratory for Active Implantable Systems, 45 patients a clinical diagnosis of post traumatic mandibular Institute for Applied Physics, University of Innsbruck, Techni- fracture at the ENT department of Shaheed Sadoughi hospital, kerstraße 25, 6020 Innsbruck, Austria Yazd patients underwent panoramic radiography and CT scan 2Clinical Department of Hearing, Voice and Speech Disorders, (both axial and coronal) Then, all were operated for reduction of Innsbruck Medical University, Austria fracture (either closed or open) and Fixation done with arch bar and MMF in combination with or without rigid internal Fixation. Objective: This talk presents a method which combines endoscope The physical examination and observation during operation was motion compensation and an algorithm for displaying functional considered as the exact diagnosis. The radiological findings were properties of the vocal fold vibration, applicable to digital high- reported by three different radiologists. Finally, the accuracy and speed laryngoscopy. A special focus is put on interpretation and sensitivity of each method was compared with the other methods. possible artefacts of the resulting images. Results: There was no significant difference between the accuracy Methods: For high-speed laryngoscopy we use the HS-ENDO- of panoramic radiography and coronal. CT scan in all of the CAM 5560, which is capable of taking 4,000 greyscale images per regions, but the accuracy of axial CT was significantly less that second. The resulting images are then segmented in glottal area coronal CT in certain regions. and environment, thus providing a framework for the subsequent Conclusion: The accuracy of panoramic radiography and coronal endoscope motion compensation. Currently the compensation CT scan in diagnosis of mandibular fractures is the same or higher algorithm is restricted to translational endoscope movements in than axial CT scan. Additionally, panoramic radiography is more the transversal plane. Fourier analysis of the time series of grey accessible and less expensive that coronal CT scan. Therefore, this values yields phase information and a criterion to decide which study recommends oral panoramic radiography as the first parts of the vocal folds participate in the oscillatory movement. Radiologic test for diagnosis and localization of mandibular This information is then projected as hue and saturation into a fracture. single image of the vocal folds. Results: The resulting false colour images of the vocal folds are suitable for displaying phase relationships between or along the vocal folds as well as for displaying glottal insufficiency. HP 218 Conclusions: Although some of the patterns found in the false Advancement in the minimally invasive management colour images can readily be matched to distinct functional of parotid duct calculus: the intracorporeal properties of the vocal folds, the significance of some other pat- terns, especially subtle phase differences, is harder to determine. electrokinetic lithotripsy option Compared to videolaryngostroboscopy, this method has the clear Prince Cheriyan Modayil1, Vinay Jacob2, George Manjaly1, advantage of producing single images which present morpholog- Graham Watson3 ical as well as functional information at one glance. 1Department of Otorhinolaryngology, Eastbourne DGH, East Sussex, UK HP 217 2The Queen Victoria Hospital, East Grinstead, West Sussex, UK Comparison of the accuracy of panoramic 3Urology Department, Eastbourne DGH, East Sussex, UK radiography, coronal and axial Ctscan in diagnosis Objective: Modify existing techniques of sialolith lithotripsy to of mandibular fractures avoid injury to the duct or to any of the local structures by direct application of the shock wave to the stone under direct vision. Payman Dabirmoghadom1, Mohammed Hossein Baradaranfar2, 3 4 Method: The beneficial effects of the endoscopically controlled Shabnam Azari , Fatemeh Ezoddinni-Ardakan , electrokinetic lithotripsy which is normally used for the treat- Abdorreza Sadr-Arhami5, Hamid reza Mansourian5 1 ment of the lower ureteric stone has been applied to the Assistant Professor of Otolarnygology and Head and Neck sur- treatment of the parotid duct calculus to minimize concomitant gery, Tehran University of Medical sciences 2 tissue damage. Associated Professor of Otolarygology and Head and Neck Result: Application of the shock wave to the stone under direct surgery, Yazd University of Medical sciences 3 vision avoided injury to the duct or to any of the local structures. Otolanygologyist, Charmehal Bakhtiary University of Medical The patient had an uneventful post procedure recovery and has sciences been asymptomatic at 18 months. 4Professor of Marxillofacial, Yazd University of Medical sciences 5 Conclusion: Continuous endoscopically monitored electrokinetic Assistant professor of Radiology, Yazd University of Medical lithotripsy with good irrigation gives a well illuminated field for an sciences absolute delivery of the energy to the target. It avoids side effects Introduction: Mandibular fracture is the most common facial bone of the shock wave to the parotid duct and the adjacent anatomical fracture due to facial trauma. A variety of imagings have been structures, thereby making it a safer procedure.

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HP 219 incidence of the different types of tumours and their age and sex Investigations on chemical dissolution of salivary distribution. calculi Results: In our study the benign tumours were more common (73%) than the malignant tumours (27%) in the parotid gland. A Robert Schatton1, Ajit-Joe Pothen2, Gerhard Rettinger1, higher prevalence was observed in the male sex (female /male ratio: Helmut Schatton3 1/1.32) and in the 4th to 7th decade of life (98.25%). The incidence 1Department of Otorhinolaryngology, University of Ulm, Ulm, in childhood was rather low (0.43%) with haemangioma the pre- Germany dominant histological type. Pleomorphic adenoma was the most 2Department of Otorhinolaryngology, Alfried-Krupp-Hospital, common benign tumour (42.5%), followed by Warthin’s tumor Essen, Germany (41.9%) in adults. Metastatic carcinoma (30.6%) and adenoid 3Hydrometallurgical Engineering, Lu¨ nen, Germany cystic carcinoma (19.4%) were the most prevalent histological types in the malignant neoplasms in adults, followed by mucoep- Objective: Only little information is available about chemical idermoid carcinoma (12.9%) and adenocarcinoma NOS (8.12%). dissolution of salivary calculi. The purpose of this study was to Superficial parotidectomy was performed approximately in 84%, look for a solvent usable for sialolitholysis in vitro. near-total (subtotal) parotidectomy in 10% and total parotidec- Methods: Since sialoliths contain 50–80% inorganic material with tomy in 6%. In cases with facial nerve preservation the incidence of hydroxyapatite (HP) as the main component, we used HP powder temporary facial nerve dysfunction was approximately 1.2%. and algae-derived HP granules as model substances. Amounts of Conclusions: Malignant tumours were more common in the elderly 50 mg HP were treated with 150 ml diluted acetic acid, lactic acid, than in young patients and in our experience the most common citric acid, tartaric acid (all at pH 2,78), diluted NaOH, NaOH histological types were the metastatic carcinoma and the adenoid combined with cesium carbonate or sodium carbonate (all at pH cystic carcinoma. 12.85) and EDTA (at pH 9), for 30 min. at 36C. Phosphate in solution was photometrically analyzed and used to calculate the amount of dissolved HP. The best dissolution agent was selected for litholysis of seven salivary calculi, each with 300 ml solvent for HP 221 three hours at 36C. Sialolithiasis in ent department: our experience Results: The most effective agent to dissolve HP was acetic acid Evdoxia Gerostergiou1, Ioannis Panaras1, Dimitrios Batzakakis1, (39.2 mg HP powder, 8.9 mg HP granules). The mean weight Ioannis Bardanis2, Panagiotis Karagounis1 reduction of salivary calculi was 6.8% after litholysis with acetic 1General Hospital of Larissa, ENT Department acid, corresponding to an increase of phosphate in solution. 2General Hospital of Ikaria, ENT Department Conclusions: Carbonic acids, especially acetic acid, are potent solvents of HP, the main inorganic component of salivary cal- Objective: Sialolithiasis is one of the most common diseases of the culi. Used for chemical dissolution in vitro, diluted acetic acid salivary glands. With this retrospective analysis we report our can reduce the weight of sialoliths. Further investigations experience and diagnostic findings in a large group of patients comparing other approaches should be done. suffering from sialolithiasis. Methods: Eighty-seven patients with typical symptoms of sialoli- HP 220 thiasis, were collected and analyzed to look for location of stones, size or number of stones, and possible risk factors between 2004 Parotid gland tumours: a retrospective study and 2006 in the Department of Otorinolaryngology, General of 286 patients Hospital of Larissa, Greece. Results: Sixty-one of all stones were detected in the submandibular E. Kyrodimos, A. Varsamis, A. Varsamakidou, M. Tanasidis, duct and 26 were in the ducts of the parotid gland. The sublingual I. Thomaides, Th. Sidiras or other smaller salivary glands were not affected. The predomi- Department of Otolaryngology-Head and Neck Surgery, nated age was between 25 and 55 years with a small predilection ‘‘Theagenio’’ Cancer Hospital, Thessaloniki, Greece to male. Seven patients were found with more than one stone and Objective: Parotid gland benign and malignant tumours constitute one simultaneous stone of the urinary tract occurred in a male. In a highly heterogeneous group in human oncological pathology. three cases the stone was seen only by X-ray and not by ultra- They show different clinical, epidemiological, histopathological sonography. and evolutionary characteristics. Conclusions: Diagnosis of sialolithiasis demands careful consid- Study design: Retrospective chart review at a tertiary referral centre. eration of patient histories and clinical examination. Even if the Methods: We have tried to identify the epidemiological charac- sonography is the first choice of imaging, with X-ray we can have teristics of 286 patients, treated surgically from 1995 to 2005, for a good results. Pathogenesis of sialolithiasis seems to be based to benign or a malignant tumour in the parotid gland, to evaluate the local factors within the salivary glands.

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HP 222 There were 18 females and 5 males with the average age of A case of bilateral submandibular gland agenesis 46 years. Histopathology confirmed pleomorphic adenoma in 17, adenolymphoma 3, Sialolithiasis 2, and one with cat scratch dis- Taichi Uyama, Hiroyoshi Iguchi, Makoto Kusuki, Aki Nakam- ease. ura, Akimori, Kanazawa, Hisao Amatsu, Hideo Yamane Results: Facial nerve was identified in every case and complete Department of Otolaryngology and Head & Neck Surgery, Osaka tumour excision was obtained in all patients. There were no major City University Graduate School of Medicine, 1-4-3, Asahi- complications. Well hidden scars were obtained in all patients and machi, Abeno-ku, Osaka, 545-8585, Japan contour deformities were minimal. No patients have reported Objective: Congenital absence of the major salivary glands is an Frey’s syndrome to date. All patients reported a high level of extremely rare disorder. We present a case of bilateral aplasia of cosmetic satisfaction. the submandibular glands associated with left submandibular Conclusions: Rhytidectomy incision is safe and confers a signifi- hemangioma. cant cosmetic advantage over traditional parotidectomy ap- Materials and methods: A 62-year-old woman came to our proaches. In addition, it provides excellent training opportunity to department complaing of a 10-year history of hydrodispsia. She surgeons interested in face lift surgery. We advocate the use of had noted left submandibular swelling 3 years previously, and rhytidectomy incision routinely in parotid surgery. subsequent gradual enlargement. We performed left sub- mandibular tumor extirpation. HP 224 Results: On preoperative examination including computed tomography and ultrasonography, lack of the right sub- Solitary fibrous tumor of submandibular gland mandibular gland and a 2-cm left submandibular mass with Kai-Ping Chang1, Chia-Hsiang Fu1, Shir-Hwa Ueng2 calicification were demonstrated. We suspected that she had 1Department of Otolaryngology-Head & Neck Surgery aplasia of the right submandibular gland and left sub- 2Department of Pathology, Chang Gung Memorial Hospital and mandibular gland tumor. During the operation, it was found Chang Gung University, Taipei, Taiwan that both the right and left submandibular glands were missing and a left submandibular tumor was present. The left subu- Objective: Solitary fibrous tumor is a rare disease entity in head mandibular tumor was smooth and soft. Postoperatively, we and neck neoplasms. We demonstrate a rare case with solitary diagnosed bilateral aplasia of the submandibular glands asso- fibrous tumor of submandibular gland. ciated with left submandibular hemangioma. The calcification in Methods: A 31-year old man presented with a left neck painless the left submandibular mass was found to be a venous stone. mass with progressive enlargement noted for one month. He had Conclusions: Bilateral submandibular gland agenesis associated no other clinical manifestations in the head and neck region, nor with submandibular hemangioma is rare. Retrospectively viewed, symptoms such as odynophagia, dyspnea, weight loss, night radiological examinations suggested that the submandibular mass sweats, or fever. No significant personal or family medical history was a hemangioma. was noted. Physical examination revealed a 5 · 3 cm, elastic, immobile, non-tender mass in the left submandibular triangle. Fine-needle aspiration cytology showed some epithelial cell nests HP 223 with myxoid stroma in a bloody background and no definite diagnosis could be made. Computed tomography demonstrated Optimising outcomes of parotidectomy using the presence of a well-defined tumor in proximity to the left rhytidectomy incision submandibular gland with mild contrast enhancement and with- Paul Stimpson, Alwyn D’Souza out associated adjacent lymph nodes. University Hospital Lewisham Results: The tumor was completely resected in an en-bloc fashion by way of a transcervical approach. Histopathological examina- Objective: In the current climate successful surgical outcome is tion revealed a well-circumscribed tumor composed of oval to dictated by both functional and cosmetic parameters in addition spindle cells with irregular cellularity and thin-walled branching to optimal treatment. Traditional parotidectomy incision has vessels. Immunohistochemistry showed that the tumor cells were the drawback of an obvious scar in the neck, often disliked by diffusely positive for O13 (CD99) and CD34, and negative for patients. This may be addressed by the use of Rytidectomy S100 protein and smooth muscle actin (SMA). The patient re- approach which is not commonly used by otolaryngologists. In mained free of disease after 2-year regular follow-up. this study we address various aspects of parotid surgery Conclusions: We presented the clinicopathological manifestations including training benefits from this approach and advocate its of this rather rare case of solitary fibrious tumor of sub- use routinely. mandibular gland in order to remind clinicians of sufficient Methods: A total of 23 patients underwent parotidectomy per- attention and subsequent management for this rare neoplasm in formed via a rhytidectomy approach over a period of 30 months. the head and neck region.

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HP 225 Methods: We report a total of 26 cases, 21 located in the par- In vitro lithotripsy of salivary calculi with FREDDY otid, 3 in the submandibular and 2 in the minor salivary glands, diagnosed and treated in our Department within 10 years. The and Ho:YAG-Laser patients were 14 women and 12 men, 22 to 76 years old, who V. Siedek1, V. Hecht2, M. Vogeser3, C. Betz1, R. Sroka2, presented mainly with neck swelling. The patients were sub- A. Leunig1 mitted to clinical examination, imaging evaluation using CT, 1Klinik und Poliklinik fu¨ r Hals-Nasen-Ohren Heilkunde, MRI, Echo, Nuclear scanning or Pet scanning and FNA. The Mu¨ nchen, Germany patients underwent superficial parotidectomy, total parotidec- 2LIFE-Center Laser-Research-Laboratory, Mu¨ nchen, Germany tomy, surgery of submandibular or minor salivary gland, RND, 3 MND, SND, radiation therapy, chemotherapy or combined Institut fu¨ r Klinische Chemie, Klinikum-Großhadern der therapy. Ludwig-Maximilians-Universita¨ tMu¨ nchen, Marchioninistr 15, 81377 Mu¨ nchen, Germany Results: The histological examination revealed the following tumor types: Malignant mixed tumors 3, Carcinosarcoma 1, Objective: This in-vitro study investigates laser parameters of Squamous cell carcinomas 3, Epithelial-myoepithelial carcino- FREDDY- and Ho:YAG-Laser for fragmentation, as both lasers mas 4, Undifferentiated carcinomas 7, Undifferentiated lym- promise a good fragmentation rate combined with a minimal risk phoepithelial carcinomas 2, Oncocytic carcinoma 1, Sarcoma 1, of soft tissue damage. Metastatic Tumors 3, Myoepithelial and adenocarcinoma. 1. Methods: The fragmentation capability of the lasers was investi- Local recurrence was found in 3 patients, nodal metastases in 1, gated on 15 salivary calculi. The FREDDY-laser emitted light distal metastases in 1 and paralysis of n.VII in 1 patient. pulses of 120–160 mJ/pulse, the Ho:YAG pulses of 300–800 mJ/ Conclusion: The treatment of choice and the biological behavior of pulse, both fed into a fibre (230 lm) positioned in front of each each tumor is related to its histological type. stone. For fragmentation each stone (n = 8 FREDDY, n =7 Ho:YAG) was placed on a garting (mash-diameter 0.1–0.3 mm). The fragmentation rate was calculated to mg(stone-fragment)/J. HP 227 Stone fragments were analysed spectrographically. Furthermore the laser impact applied from short distance or in contact on human Simultaneous sublingual sialolithiasis salivary duct mucosa was examined histologically (HE-staining). and rhinolithiasis Results: Spectrographic composition showed difference in varia- Kayhan Ozturk, Bahar Keles, Hamdi Arbag tion of protein content from 5 to 25% besides carbonatappatit. Department of Otolaryngology, Meram Faculty of Medicine, Using the Ho:YAG all stones could be vaporized (fragmentation Selcuk University, Konya, Turkey rate 0.2–1 mg/J) while by means of the FREDDY-Laser frag- mentation looks like cracking stones and failed in three cases. A Sialolithiasis is a common disease of the salivary glands. dependency on the stone composition could not be found. Pulse Sialolithiasis occurs mainly in the submandibular gland (80– effects on soft tissue were limited to the mucosa. 90%) and to a lesser extent in the parotid gland (5–20%). The Conclusion: While the Ho:YAG vaporises the calculi in a more sublingual gland and the minor salivary glands are rarely af- milling and soft sense, the FREDDY shows a more cracking and fected. Rhinolithiasis is mineralized, calcareous concretions explosive destruction. Although, both laser systems showed little resulting from calcification of an endogenous or exogenous ni- direct risk to the surrounding tissue, it has to be proven whether dus within the nasal cavity. Rhinolithiasis is a rare pathology in cracked and accelerated particles could insure soft tissue in the case adult. In the study, we present the first case with rhinolithiasis of the FREDDY-laser is used. With respect to this further in-vitro and sublingual sialolithiasis. A 20-years-old girl suffered from studies are needed and clinical treatments will proof these results. recurrent diffuse swelling and pain on the right submandibular area admitted to the our department. During the otolaryngo- logical examination, a rhinolithiasis was found in the floor of HP 226 the left nasal cavity, incidentally. Panoramic graphy showed Rare malignant tumors of the salivary glands. simultaneous rhinolithiasis and sialolithiasis at the same case. Presentation of 26 cases During surgery, sublingual sialolithiasis was determinated in the anteromedial part of submandibular gland after dissection of G. Mireas, S. Triantos, D. Louverdis, G. Plessas, M. F. Graikou, submandibular gland. Submandibular and sublingual glands S. Vlachou, G. Papazoglou and rhinolithiasis were removed. Surgical removing for the ENT Department, Red Cross Hospital, Athens, Greece sialolithiasis and rhinolithiasis is offered for treatment. Simul- taneous rhinolithiasis and sublingual sialolithiasis should be Objective: The purpose of the present study was to present our suspected in adult patients. data on rare malignant tumors of the salivary glands.

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HP 228 lesions. The patient died about 12 months later despite of inten- Peptidomic analysis of selected parotid sive chemotherapy. and submandibular/sublingual gland secretions b c b Fanali Chiara , Cabras Tiziana , Inzitari Rosanna , HP 230 Passali Giulio Cesarea, Picciotti Pasqualina Mariaa, Scarano Emanuelea, Calo` Leaa, Messana Irenec , Fine-needle aspiration cytology of parotid gland Castagnola Massimob masses aInstitute of Otolaryngology, Catholic University, Rome b M. Naderpour*, N. Shahidi*, M. Hossein Dadgarnia** Institute of Biochemistry and Clinical Biochemistry, Catholic *Tehran University of Medical Sciences University, Rome **Yazd Shahid Sadughi University of Medical Sciences cDepartment of Sciences Applied to Biosystems, Cagliari University, Italy Objective: Differentiating benign from malignant tumors of par- otid gland preoperatively is very important from the point of Objective: The aim of this study is to investigate the differences in treatment planning. We design this study to evaluate the useful- peptide secretion of human parotid (Pr) and submandibular/ ness and accuracy of fine-needle aspiration cytology (FNAC) in sublingual (Sm/Sl) glands. the diagnosis of parotid gland masses. Methods: Selected saliva from parotid was collected either by a Materials and methods: In a descriptive-case series study the re- Lashley’s cup or by small plastic aspirators at the duct exit. Saliva sults of FNAC of 124 parotid masses were analyzed and com- from Sm/Sl glands was collected by a small aspirator at the duct pared with corresponding histopathological diagnosis. exit. Samples were immediately added with aqueous TFA (0.2%) Results: The cytological findings were no diagnostic in 2 (1.6%), in 1/1 (v/v) proportion. Solution was centrifuged at 10,000g for true—negative in 84 (67.7%), true- positive in 24 (19.4%), false- 5 min (4 C) and the acidic supernatant was immediately analysed negative 13 (10.5%), and false—positive in 1 (0.8%) cases in by HPLC-MS apparatus or stored at –80 C. detecting malignant tumors. The sensitivity and specificity in Results: Basic proline-rich peptides (bPRP) are parotid gland- detecting malignant tumors were 64.8 and 98.8%, respectively. specific, while salivary cystatins (S, S1, S2, SA, SN) are almost Conclusions: Fine-needle aspiration cytology is a valuable completely Sm/Sl gland-specific. Conversely, all the isoforms of adjunct to preoperative assessment of parotid masses. Preoper- acidic-PRP, histatins, statherin and PB peptide are secretion ative recognition of malignant tumors may help prepare products of both glands. The analysis of the post-translational both the surgeon and patient for an appropriate surgical pro- modification of different salivary peptides evidenced: (1) higher cedure. kinase activity in the parotid gland, (2) higher convertase activity in Sm/Sl glands, (3) sulfation of histatin-1 is Sm/Sl gland-specific. Conclusions: This study evidenced sensible differences between peptides secreted by the two glands and their post-translational HP 231 modifications, strongly suggesting specific roles in different dis- Case report: cystic clear cell myoepithelioma tricts of the oral cavity. of parotid gland Zeynep Kizilkaya, Hatice Emir, Kursat Ceylan, Hakan Gocmen, HP 229 Mu¨ zeyyen Astarci, Erdal Samim, Mehmet Metin, Sedat Dogan Metastatic myoepithelial carcinoma arising from Ministry of Health Ankara Research and Training Hospital Ear Nose and Throat Department, Ulucanlar Cad. No:1 Mamak recurrent pleomorphic adenoma of the parotid gland Ankara, Turkey Shin-ichi Ohba, Masato Fujimori, Hiroyuki Takayanagi, Objective: We report an extremely rare case of cystic clear cell Masateru Hata, Katsuhisa Ikeda myoepithelioma of parotid gland. Department of Otorhinolaryngology, Juntendo University School Method: Case report and world literature concerning cystic clear of Medicine, Tokyo, Japan cell myoepithelioma of parotid gland are presented. A myoepithelial carcinoma, arising in recurrent or pre-existing Results: Myoepitheliomas are rare but well-characterized group of pleomorphic adenoma of the parotid gland is an extremely rare tumours, among which myoepithelioma of the salivary glands is salivary gland malignancy. General speaking, the biological nat- the best known. In this paper a cystic clear cell variant of the ure arising in association with a pleomorphic adenoma is known parotid gland is reported in an 80-year old male patient presenting to be a low grade malignancy unlike to de novo in the literature. with a slow growing mass and treated surgically with superficial We report a case of myoepithelial carcinoma arising in recurrent parotidectomy. To our knowledge this is the first case of cystic pleomorphic adenoma, which showed a higher metastatic poten- clear cell myoepithelioma ever reported in the parotid gland. The tial. A 53-year-old man, who had undergone superficial lobectomy histopathological features, immunohistochemical profile and of the pleomorphic adenoma of the parotid gland 2 years before, clinical behaviour were discussed. presented a recurrent parotid swelling with multiple coin lesions in Conclusion: Cystic clear cell myoepithelioma should be kept in the lung. The total parotidectomy with a biopsy of lung lesion mind in the differential diagnosis of the cystic neck masses in the under bronchoscopy revealed myoepithelial carcinoma of both parotid region.

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HP 232 department. There were 30 (46.2%) male and 35 (53.8%) female Purulent sinusitis due to a supernumerary tooth inside ranging in age from 38 to 69 years (mean age 54 years). Diag- nostic evaluation included full blood count, biochemical analysis, the sinus ultrasonography, computerized tomography scans (CT) and K. Nazos1, N. Salemis2 I. Psarommatis1, N. Bollas2, magnetic resonance imaging (MRI) where indicated. The most E. Tsohataridis2 common presentation was a painless swelling of the parotid 1‘‘P & A Kyriakou’’, Children’s Hospital, Athens, Greece region. 22nd Department of Surgery, Army Veterans General Hospital Results: Fifty-two patients were diagnosed with benign tumors. NIMTS, Athens, Greece The commonest pathology was pleomorphic adenoma (55.7%), while Warthin’s tumors had an incidence of 26.7%. Out of 13 Objective: This study is a very rare case report of purulent patients with malignant disease, 2 were diagnosed to have a non sinusitis caused by a supernumerary tooth in the sinus of an Hodgkin’s lymphoma (NHL). The most common surgical proce- adult patient. dure performed was total conservative parotidectomy (75.4%) Materials and methods: This case concerns a woman 42 years old followed by conservative superficial parotidectomy (21.5%). The in good condition, who came to our clinic complaining about patients with NHL underwent a biopsy. Overall postoperative having headaches in the right side of her head for two years, which morbidity was 13.8%. Three patients developed Frey’s syndrome. pain was reflecting on the whole face and on the right eye, as well Median hospitalization was 4 days. as feeling her face heavy while bending. After having X-ray Conclusions: Total conservative parotidectomy was the operation examination of the visceral cranium and brain tomography, severe of choice. This procedure is associated with a higher incidence of right sinus inflammation was detected, as well as, the existence of postoperative morbidity, but at the same time with lower recur- the supernumerary tooth. The patient mentioned that during the rence rates. Surgeon’s experience is so important in the total pa- recent years she had been taking antibiotics without any result. By rotidectomy since it can ensure the least complications and the using total anesthesia, we proceeded to surgical operation, during best results in the treatment of parotid tumors. which, we managed to dislodge and to open the sinus from which purulent liquid was came out. We drainaged carefully the sinus and pulled out the supernumerary tooth. Moreover, by following the Caldwell-Luc procedure, an enlargement of the inferior mea- HP 234 tus and a sizeable androrhinostomy were created. Non-hodgkin’s lymphomas of the parotid gland Results: The post-operative progress of the patient was totally 1 2 2 1 positive. N. Salemis , K. Nazos , I. Psarommatis , N. Bollas , 1 Conclusions: The foreign bodies inside the sinuses represent a rare E. Tsohataridis 1 cause of chronic sinusitis and particularly in adults. A high index 2nd Department of Surgery, Army Veterans General Hospital of suspicion and a proper imaging study are required for NIMTS Athens, Greece 2 successful diagnosis. Surgical removal of the foreign body, con- ‘‘P & A Kyriakou’’, Children’s Hospital, Athens, Greece ventionally or endoscopically, usually ensures definitive cure. Objective: The aim of the study is to present two patients who were admitted to our department with a painless parotid swelling and diagnosed to have Non Hodgkin’s parotid gland lymphoma. HP 233 Materials and methods: Both patients, aged 81 and 88 years, Total parotidectomy in the management of parotid respectively, presented with a relatively mobile and painless tumors swelling of 3–5 months duration. They underwent computed tomography scan, magnetic resonance imaging scan and fine N. Salemis1, K. Nazos2, I. Psarommatis2, N. Bollas1, needle aspiration cytology. E. Tsohataridis1 Results: Diagnosis was established in both patients with incisional 12nd Department of Surgery, Army Veterans General Hospital biopsies. With pathological examination and immunohistochem- NIMTS Athens, Greece ical analysis the disease was classified as follicle center cell Lym- 2‘‘P & A Kyriakou’’, Children’s Hospital, Athens, Greece phoma in the first patient and as a large b-cell Non Hodgkin’s Objective: The appropriate surgical procedure for the treatment of lymphoma in the second. Both patients were referred to the parotid tumors is often a matter of discussion. The aim of this medical oncology department for further investigation and stag- study is to present our experience in the diagnostic evaluation and ing. management of patients who were admitted with a parotid gland Conclusions: Although rare, Non Hodgkin’s Lymphoma should tumor. always be considered in the differential diagnosis of parotid gland Materials and methods: Between January 2000 and July 2006, 65 swellings especially in the elderly. Chemotherapy and radiother- patients with tumors of the parotid gland were admitted to our apy are the preferred therapeutic options.

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HP 235 significantly fewer patients with flurbiprofen required rescue dic- Benign tumours of the parotid gland: a retrospective lofenac suppository. Total dose of required rescue during the postoperative 12 h in subjects with flurbiprofen, however, was not analysis of 252 cases significantly different from that in subjects without flurbiprofen. D. Koutsimpelas, C. Herzog, W. J. Mann, B. M. Lippert There were no significant differences in any of the vital signs E.N.T Clinic Johannes Gutenberg University of Mainz during the postanesthetic period. Conclusion: Preoperative flurbiprofen suppressed immediate Objective: The aim of the present study was to review a single- postoperative pain after tonsillectomy. The analgesic effect, institution experience in the treatment of benign tumours of the however, disappeared in a few hours and was insufficient for parotid gland. overnight pain relief. Methods: We retrospectively reviewed 252 patients treated in our clinic for benign parotid gland tumours over the last 5 years. Demographic details, clinicopathological parameters, type of pa- HP 237 rotidectomie and postoperative complications were assessed. Antibiotic treatment of acute tonsillitis ulcero-necrotic Results: The most common tumour was Warthin tumour in 115 patients followed by pleomorphic adenom in 107 patients. All of forms the patients were subjected to ultrasound examination. Concern- Ivasi Ofelia, Popa Vladimir, Antohi Ion ing the localisation of the tumours, in 237 cases the tumour was State Medical and Pharmaceutical University localised in the superficial part of the parotid gland while in 15 the ‘‘Nicoale Testemitanu’’ deep lobe was involved. We performed 120 limited resections, 114 superficial parotidectomies, 3 enucleations, 14 near total paroti- Objective: To compare effectiveness of three antibiotics of differ- dectomies and one total parotidectomie with preservation of the ent classes and ways of administration in the conservative treat- facial nerve. Postoperative 10 patients developed transient partiel ment of acute tonsillitis ulcero-necrotic forms. facial nerve palsy, 15 salivary fistula, 22 Frey-Syndrome while Materials and methods: Where examined 50 patients comparable other complications including wound infection, haematoma or for age and sex, with diagnosis of ulcero-necrotic forms of acute seroma formation were observed in 17 patients. Local reccurence tonsillitis confirmed clinically, divided into three groups according was observed in one case of pleomorphic adenom. to empirically administered antibiotic during 7 days: Conclusions: In our opinion the ultrasound examination is a Group 1– Penicillin 1 mln · 4 in daily for adults and 250.000– valuable adjuncts to preoperative assessment. Superficial and 500.000 in pediatric patients. conservative parotidec-tomies demonstrate favourable results Group 2 – Augmentin 1.0 g · 2 in a day for adults in tablets, and with low perioperative and longterm morbidity, as well as very for pediatric patients in suspension. low risk for tumour relapse and they constitute the procedures of Group 3– Aksef–cephalosporin with broad spectrum, including choice for most benign tumor masses. beta-lactamasis producing . Administrated intramuscu- larly, single injection in a day for adults 750 and 300 mg for pediatric patients. HP 236 Evaluation criteria: odinophagia at the second day of the treat- Preoperative flurbiprofen for pain after tonsillectomy ment; fever after 2 days of treatment; recidives after 2–3 months after treatment; stable remission S. Nishiikea, T. Katob, M.Nagaib, A. Nakagawab, M. Konishib, Results: Y. Sakatab, F. Shimadac, H. Kidac, M. Otac, T. Haradaa a Department of Otolaryngology, Kawasaki Medical School, Criteria Group Group Group Kurashiki, Japan 1n = 15 2n = 10 3n = 25 bDepartment of Otolaryngology, Suita Municipal Hospital, Suita, Japan Odinophagia at 12 (80%) 7 (70%) 3 (12%) c Department of Anesthesiology, Suita Municipal Hospital, 2nd day Suita, Japan Fever after 2 5 (33.3%) 4 (40%) 2 (4%) Objective: This study investigated the analgesic efficacy of pre- Days of treatment operative flurbiprofen, an injectable non selective cyclooxygenase Recidives 10 (66.6%) 8 (80%) 4 (16%) inhibitor, on postoperative pain after tonsillectomy. Stable remission 5 (33.3%) 2 (20%) 21 (84%) Methods: Twenty-five participants undergoing tonsillectomy were recruited prospectively. After randomization, one group under- went tonsillectomy with preoperative intravenous 50 mg flurbi- Conclusions: Results of this preliminary study shows the priority profen, and the other group did without it. of Aksef in the treatment of tonsillitis, of severe forms Aksef has Results: The pain score at rest as well as at swallowing 0.5 h after the advantage of single dose administration in a day. During this tonsillectomy was significantly lower in subjects receiving flurbi- study we did not report any allergic reactions or intolerance to the profen than in those without. During the first postoperative 1.5 h, antibiotic.

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HP 238 Objective: The aim of this study was to investigate the clinical Gustatory function after tonsillectomy prediction criteria for group A beta hemolytic streptococcal (GABHS) pharyngitis in patients with upper respiratory tract Christian A. Mueller1, Saher Khatib1, Basile N. Landis2, Andreas infections (URTI). 1 3 F. P. Temmel , Thomas Hummel Methods: A total of 420 patients admitted to the outpatient clinics 1Department of Otorhinolaryngology, Medical University Vienna, with URTI complaints, were included to the study. The clinical Vienna, Austria findings of the patients were recorded and throat cultures were 2Clinique de Oto-Rhinologie-Laryngologie et de Chirurgie cervi- obtained. The clinical features of patients with positive throat co-faciale, Hopitaux Universitaires de Gene` ve, Switzerland cultures for GABHS were compared to those with negative culture 3Smell and Taste Clinic, Department of Otorhinolaryngology, results. University of Dresden Medical School, Dresden, Germany Results: Throat cultures were positive for GABHS in 95 Objective: Due to the anatomical course of the lingual branch of the (22.6%) patients. Significant differences between the groups glossopharyngeal nerve near to the tonsillar bed, taste sensitivity can with and without GABHS pharyngitis were noted for the be affected after tonsillectomy. However, the incidence of taste presence of sore throat (P < 0.001), tonsillar swelling disorders after tonsillectomy is not clear. The aim of the study was (P < 0.001), cough (P < 0.001), fever (P < 0.001), rhinor- the prospective assessment of taste function before and after surgery. rhea (P < 0,001), abdominal pain (P < 0,001) and cervical Methods: Sixty-five patients (42 women, 23 men, mean age lymphadenopathy (P = 0.001), but not for the presence of 28 years) were included. Taste function was investigated before fever, headache, tonsillar exudate, otalgia. tonsillectomy with four concentrations each of sweet, sour, salty, Conclusions: These symptoms and signs may be helpful in modi- bitter taste, respectively, on both sides of the front part and the fying estimates of probability of infection with GABHS. Throat back part of the tongue. Self-assessment of gustatory function was cultures in suspected patients remain necessary. performed by visual analogue scales. Thirty-two patients were re- tested 64–173 days after tonsillectomy. Thirty-three patients could not be re-tested after surgery, but were interviewed by telephone. HP 241 Results: Self-assessed taste function significantly decreased (P = 0.001). Importantly, none of the subjects complained of taste dys- Evaluation and comparison of results of bipolar function. Surgery had no major effect on taste test scores (P > 0.27). and cold Tonsillectomies Conclusions: Persisting taste dysfunction seems to be rare after Sami Berc¸ in, Ahmet Kutluhan, Veysel Yurttas, Go¨ khan Yalc¸ ıner, tonsillectomy. Kazım Bozdemir HP 239 *Ataturk Education and Research Hospital ENT Dept. Ankara, Turkey Does ketoprofen prevent postoperative nausea and vomiting in pediatric tonsillectomy? Objective: To compare the classical dissection tonsillectomy results with the bipolar couther dissection results in the pediatric Rana Altaf Ahmad, Amjad Rashid, Khalid A. Al-Mazrou age group. King Saud University, PO Box 245, Riyadh 11411, Saudi Arabia Study design: Prospective randomized clinical study. Objective: To compare and determine the efficacy of a single dose of Place: Ankara Atatu¨ rk Education and Research Hospital, E.N.T. and Head and Neck Surgery Clinic. intravenous ketoprofen, midazolam and dexamethasone on postop- erative nausea and vomiting (PONV) after tonsillectomy in children. Patients and methods: For this study 201 children patient had Methods: Randomized, double blind prospective study of 90 chil- tonsillectomy between 2004 and 2006 years who has suitable dren of age 4–12 year. ASA 1 and ASA 11 scheduled for tonsillec- conditions. Ninety-five (47.26%) of the patients underwent tomy. These were classified into three equal groups: dexamethasone bipolar couther tonsillectomy (group 1), 106 (52.74%) of the (group A), midazolam (group B) and ketoprofen (group C). The patients had classical dissection tonsillectomy. Bleeding amount anesthetic regimen and surgical procedures were standardized for during the tonsillectomy, operation duration, tonsil volumes, all patients. All patients were observed in post anesthesia care unit primary and secondary bleedings, postoperative first hour and and in the ward for PONV and postoperative pain. 10th day pain severity and first solid food intake time were compared. Results: Data from 90 patients were analyzed. The overall inci- dence of early as well as late vomiting was significantly less in Results: Operation durations, bleeding amount, postopera- tive pain scores and first solid food intake time compared be- dexamethasone (group A) as compared to midazolam(group B) and ketoprofen (group C) (P _0.05). Episode of early vomiting tween the groups and statistically significant differences were were significantly high when group C was compared to group A & found. B. Postoperative pain was significantly less in group C. Conclusion: Bipolar couther tonsillectomy is beneficial espe- Conclusion: Dexamethasone and midazolam in the given doses are cially for the patients who has to take short time anesthesia considered effective in postoperative nausea & vomiting. Keto- who has limited blood volume, children under 3 years of profen is not an effective drug for PONV. age and children with coagulopathy. But we recommend classical tonsillectomy technique for the children who has thin HP 240 body and disabilities of food intake also has poor wound healing. Valuable symptoms of group A beta hemolytic Keywords: Tonsillectomy, Bipolar couther, Cold (classic) dissec- Streptococcal pharyngitis in differential diagnosis tion, Hemorrhage, Pain Arzu Yasemin Korkut, Ebru Aktas, Nevin Cambaz, Ozgul Yigit, Betul Sezgin, Meryem Benzer, Emin Ozkaya Department of Otorhinolaryngology-Head and Neck Surgery, Department of Child Health and Disease, Vakıf Gureba Teaching and Research Hospital, Istanbul, Turkey

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HP 242 analyses were performed by Statistic for Windows and MEDC- Bilateral intratonsillar abscess: case report LAC. Results: The results of research show that there are significantly E. D. Andrianopoulos, D. Lefantzis, V. Nikolaidis, M. Artopoulos, differences between aerodynamic variables of friction S and Z on G. Papazoglou the first, seventh, and thirtieth day such as mean fundamental Department of Otorhinolaryngology, Hellenic Red Cross frequency and frequency oscillation on the first and seventh day Hospital, Athens, Greece after adenotonsillectomy. After adenoidectomy there was a sig- Objective: The purpose of this study is to report a very rare nificantly higher maximum phonation time of friction S and Z on condition of patient presented with bilateral intratonsillar abscess. the first, seventh, and thirtieth postoperative day. The significant Even unilateral intratonsillar abscess is a relatively rare process in differences were determined postoperatively for: pitch, loudness, which an abscess forms in the tonsil itself. Intratonsillar abscess vocal quality and nasal resonance. The correlation analysis may form either from extension from an obstructed tonsillar crypt showed statistically significant intercorelation between the vari- or from an intratonsillar rupture of a peritonsillar abscess. ables of the same group. Methods: A 18-year-old male without previous history of tonsillar Conclusions: The study implies that acustical, aerodynamic and disease, presented to our department with high fever, sore throat perceptive voice characteristics assessment are very useful to and difficulty in swallowing. The patient complained of severe evaluate the complex aspects of respiration, phonation and reso- odynophagia, dysphagia, and displayed moderate trismus. Oral nance process. exam revealed significant bilateral oedematous and erythematous tonsils Grade 4 that made laryngoscopy almost impossible. In HP 244 order to exclude the possible developing upper airway obstruction and to evaluate the parapharyngeal spaces a CT scan was per- The new adenotom for improvement of the visual formed that revealed the presence of purulent accumulation inside control over adenoidectomy the tonsils. V. S. Kozlov*, V. A. Karpov**. Results: Under local anesthesia, thick yellow pus was aspirated *ENT Department General Management Department under the from the tonsils and a wide spectrum antibiotic treatment was President of Russian Federation, Central Clinical Hospital initiated. The following days the patient reported that the fever is **ENT Department, Yaroslavl state medical academy, Russia gone, and he is swallowing without difficulty. After 4 days of hospitalization the patient was discharged and a follow-up Objective: Improving the effectiveness of the operation of examination was scheduled. adenoidectomy. Conclusions: Although bilateral intratonsillar abscess is a very rare Tasks: To compare the effectiveness of operations performed with condition with severe clinical presentation and symptoms, early Beckmann curette and with an curette of our design. diagnosis followed by drainage and antibiotic therapy could lead Methods: After endoscopy of nasopharinx some variants of the to rapid improvement of all symptoms without complications. position of adenoid tissue have been revealed: adenoid grows into choanae, adenoid is separated from torus tubarius, adenoid is contiguous to torus tubarius, adenoid covers torus tubarius. These HP 243 variants confirmed importance of the constant visual control over Quality of voice childrens after adenotonsillectomy operation. The adenoidectomy was performed under general anesthesia with Sˇekib Umihanic´ 1, Fuad Brkic´ 1, Nevzeta Salihovic´ 2, Selma Dzˇinic´ 1 1 a visual control through a laryngeal mirror for all patients. Both a ORL Clinic, University Clinical Center Tuzla, Bosnia and Beckmann adenoid curette and new curette were used. The middle Herzegovina 2 part of the new instrument is bent at a right angle. The curette is Faculty of Education and Rehabilitation, University of Tuzla, slightly unbent and has an additional bend at the distal part of the Bosnia and Herzegovina instrument like a Negus curette. These constructional peculiarities Objective: The aim of this study was to examine acoustical, aero- make the curette longer and enable the surgeon to extract the dynamic and subjective voice variables day before, first, seventh, adenoid tissue even from a narrow and long nasopharinx. and thirtieth day after adenoidectomy or adenotonsillectomy. Results: The patients complaints and endoscopic finds after sur- Methods: The patients were divided into two groups: (1) those gery showed the advantage and effectiveness of the new adenoid who have had an adenotonsillectomy (33 male and 27 females). (2) curette. Those that have had an adenoidectomy (37 male and 23 females). Conclusion: The use of the new adenotom gives a better oppor- With Cool Edit and EZ VoicePlus were analyzed the sustained tunity for a surgeon to see the surgery field through the laryngeal phonation of vowel A and friction of S and Z. The statistical mirror and makes the results of the surgery more effective.

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HP 245 Result: After adenotonsilectomy, respiratory parameters Adenotonsillectomy in children with obstructive sleep (Mean FVC, FEV1,PEF,FEF 25–75%, FEF 75%, FEV1/PEF, FEV1/FEV 0,5) have been improved statistically for all of apnea syndrome the patients. Much of this improvement has been seen in Felicia Manole patients who had tonsillar and adenoid hypertrophy in grade Faculty of Medicine, Oradea, Romania 2–3. Conclusion: Alongside the upper respiratory truct, lower respira- Introduction: The part played by grossly hypertrophic tonsils and tory truct should also be evaluated preoperatively and postoper- adenoids in the obstructive sleep apnea is most frequently found atively in children with adenotonsillar hypertrophy. At the in children with very large tonsils (meeting in the midline) and postoperative fallow-up process, any recurrence could be detected adenoids (obliterating the nasopharynx) is largely acknowledged early on and the treatment of the disease could be completed in practice. without any pulmonary dysfunction. Objective: The purpose of the study is to delineate how obstructive sleep apnea syndrome is cured by surgery—adenotonsillec- tomy—and to compare the quality of life of those patients before and after surgical treatment. HP 247 Methods: The reseach has been carried out on 186 patients (aged Comparision of cold dissection method and thermal between 3 and 6 years) diagnosed with chronic adenotonsillitis in the Pediatric Hospital of Oradea during 2005–2006. Only 52 welding system in tonsilectomy pediatric patients presented symptoms of chronic hypertrophy O. Yigit, E. Karaman, A. S. Sisman, Z. A. Cakir adenoids and tonsils associated with sleep apnea syndrome. A Istanbul_ Research and Training Hospital sleep questionnaire was completed by parents both before and after surgery. All children underwent adenotonsillectomy. Objective: Tonsillectomy is one of the most frequently applied Results: Thirty-eight percent of patients were considered by their and the oldest surgical procedures in otorhinolaryngology.While parents and pediatric doctor as having a developmental delay pre- cold dissection method (CDM) is the most frequent technique, operatively, where resolved in 62% post surgery. Clinical symptoms: new methods are improved in tonsilectomy. Thermal welding snoring, sleep apnea, frequent movements during sleep, mouth system (TWS) is one of the most recent surgical methods. In breathing and recurrent awakenings are resolved or improved sig- this prospective study TWS and CDM is compared with respect nificantly after surgery. Persisting or recurrence of some clinical to per/postoperative parameters under the light of current lit- signs were recorded in 12% patients three month after surgery. erature. Conclusion: Adenotonsillectomy is the mainstay treatment of Method: Fifty-four patients who had undergone tonsillectomy obstructive sleep apnea syndrome in children, although children were included in this study. Under general anesthesia we used with complex medical condition may require additional treatment. TWS in 24 of them, CDM in 30 patients for tonsilectomy. Quality of life in children with obstructive sleep apnea syndrome During surgery; operating time, intraoperative bleeding and does improve after adenotonsillectomy. after the surgery postoperative pain, return of the fonation activity and initiation time of oral intake are measured. Results: While mean operative time was 13.92 ± 3.66 minutes for HP 246 TWS, the time for CDM is 37.80 ± 14.13 minutes (P < 0.001). Clinical use pulmonary function tests in children Mean intraoperative blood loss was 6.33 ± 4.27 g for TWS and 30.17 ± 10.95 g for CDM (P < 0,001). In TWS group higher with adenotonsillar-hypertrophy pain scores (2.71) were observed relative to the CDM group (0.93) Fadullah Aksoy, O¨ zgu¨ r Yigit, Zeynep Alkan Cakir, Erkan Soylu, (P < 0.001). With this finding, mean time to recovery of normal Tolgar Kumral, Gu¨ lfidan Cakmak fonation activity was 5.42 ± 1.25 days for TWS and Istanbul_ Research and Training Hospital 2.37 ± 1 days for CDM group (P < 0.001). However time to recovery of normal oral intake activity was not significantly dif- Objective: Adenotonsillar hypertrophy which is the most common ferent between two groups (P > 0.05). cause of upper airway obstruction in children causes pulmonary Discussion: TWS provides a better intraoperative bleeding and function disorder. In this study pulmonary function tests in chil- operative time. However CDM offers better postoperative com- dren with adenotonsillar hypertrophy who don’t have any other fort. Because there isn’t enough publication about the issue, it is upper and lower respiratory truct disorder have been evaluated necessary to design new comparative studies between tonsillec- preoperatively and postoperatively. tomy techniques by means of postoperative bleeding and patient Method: Pulmonary function tests have been made preoperatively comfort. and at postoperative second month for 60 children who have adenotonsillar hypertrophy.

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HP 248 Results: Sixty-eight patients underwent tonsillectomy for Histological aspects of the chronical tonsillitis obstructive sleep apnea, whereas 22 children suffered from recurrent acute tonsillitis. Surgery time for cold knife tonsil- Elena Ionita˘*, Carmen Mogoanta˘*, Florin Anghelina*, lectomy was found to be significantly prolonged compared to Iulica˘Ionita˘**, Sorin Ciolofan**, Laurentiu Mogoanta˘*** radiofrequency excision (P < 0.001) and tissue welding tech- *ENT Department, University of Medicine and Pharmacy nique (P < 0.001). No significant statistical difference was of Craiova found comparing the surgery time between radiofrequency and **Emergency Hospital of Craiova tissue welding techniques (P = 0.21). Mean intraoperative ***Histology Department, University of Medicine and Pharmacy blood loss was 86.8 ml (max = 150 ml, min = 50 ml), 26.3 ml of Craiova (max = 50 ml, min = 10 ml), 20.3 ml (max = 40 ml, Objective: Chronical tonsillitis represents the most common min = 10 ml) for cold knife tonsillectomy, radiofrequency inflammatory lesions of the pharynx determining numerous local technique and tissue welding technique respectively. Postopera- or distant evolutive complications. We decided to study the his- tive bleeding presented in a child operated by cold dissection. tological and especially immunohistochemical expression of this Cold knife tonsillectomy caused less pain on the seventh post- pathology. operative day compared to radiofrequency (P < 0.001) and tissue welding technique (P < 0.001). No significant statistical Methods: We’ve studied 202 surgical samples representing tonsils difference was found at the 7th postoperative day comparing resected from 112 patients with chronical tonsillitis. The ton- the pain between radiofrequency and tissue welding techniques sillectomies were performed in the ENT Clinic of Craiova, be- (P = 0.234). tween 2005 and 2006. The processed histological samples were stained using hematoxilin-eosin, light green trichromic and Conclusions: Cold dissection tonsillectomy may be more suit- argentic impregnation. For the immunohistochemical study we able in adults who usually experience prolonged postoperative used LSAB method with CD 20 and CD 45 RO antibodies in pain, whereas radiofrequency and tissue welding techniques order to reveal and differentiate T and B lymphocytes. seem to have indications in patients with coagulopathies or peritonsillar abscess history and in children with small blood Results: In all samples we found hyperplasia and hypertrophia volumes. of the lymphoid follicle with excessive developing of the clear germinal center as a normal reaction to antigens presence. In some cases we remarked micro hemorrhages and hematic ex- travasations inside the follicles, probably due to the excessive HP 250 virulence of the pathogens causing endothelial lesions. Post-tonsillectomy hemorrhage: a 2-year prospective The conjunctive stroma was enriched in collagen fibers, in some study cases organized in strong fascicles with an obvious tendency to divide the tonsils in lobules. The young fibroblastic type cells were Milosevic Dusanka numerous. The specific reticulin fibers had a low representation ENT Clinic, Zvezdara University Hospital, Presevska 32, being disorganized. Belgrade, Serbia The immunohistochemical study proved that the clear center of The aim of this prospective study was to evaluate the incidence, the lymphoid follicles was occupied by B lymphocytes but the T intensity and time of post-tonsillectomy hemorrhage (PTH). lymphocytes were present in the cortical region of the follicles, The prospective study included 757 patients undergoing inpa- peri follicles and in the surface epithelium. tient tonsillectomy with or without adenoidectomy during a Conclusion: In some pathological cases the predominant cellular two-year period in ENT Clinic, Zvezdara University Hospital in population of the clear center was formed by T lymphocytes. Belgrade. Tonsillectomy was performed under endotracheal anesthesia using a standard technique of blunt dissection with snare. The severity of PTH was classified according to Wind- fuhr and Seehafer (2001) in grade 1 (spontaneous cessation), HP 249 grade 2 (infiltration anesthesia), grade 3 (treatment under Multiparametric comparison of tonsillectomy endotracheal anesthesia), grade 4 (ligature of the external car- techniques in children otid artery) and grade 5 (fatal outcome). The time of PTH was classified as primary (£24 h) and secondary (>24 h). The T. Chimona, G. Perogamvrakis, E. Proimos, E. Theodoraki, overall incidence of PTH was 3.96% (30/757). Grade 1 PTH M. Tzanakakis, C. Papadakis occurred in 21 of 757 patients (2.77%). Six patients (0.79%) ENT Department, General Hospital of Chania, Greece had grade 2 and three (0.40%) patients had grade 3 PTH. Objective: The aim of the present study is the evaluation of several Grades 4 and 5 bleeding were not recorded and no patient intraoperative and postoperative parameters of three tonsillec- received a blood transfusion. PTH was primary in 65% and tomy techniques. secondary in 35% of patients. PTH can be expected in a small Methods: Ninety children aged between 5 and 13 years were en- number of patients undergoing tonsillectomy. PTH is mostly rolled a prospective trial comparing cold knife tonsillectomy, ra- primary and rarely requires treatment under endotracheal diofrequency excision, and tissue welding tonsillectomy. anesthesia and a blood transfusion.

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HP 251 Results: One thousand and sixty-five adenoidectomies were per- Post-adenoidectomy hemorrhage: a 2-year prospective formed 573 male 491 female with a median age of 7 (Interquartile range 5–10). Adenoid curettage was used in at least 923 (87%) of study operations, 26 (2.8%) required diathermy for haemostasis. Pri- Milosevic Dusanka mary haemorrhage requiring surgical management was seen in 9 ENT Clinic, Zvezdara University Hospital, Presevska 32, (0.85%) cases and 2 (0.18%) had secondary haemorrhage Belgrade, Serbia requiring surgical management. Conclusion: Adenoidectomy is a common operation in a lower age The aim of this prospective study was to evaluate the incidence, group with a median age of 7. Haemorrhage requiring surgical severity and time of post-adenoidectomy hemorrhage (PAH). management is a rare at < 1% in a group predominantly made of The study included 1053 patients undergoing inpatient ade- cold steel techniques. This is the largest multi-centre study noidectomy with or without tonsillectomy during a two-year undertaken in Europe. period in ENT Clinic, Zvezdara University Hospital in Bel- grade. Adenoidectomy was performed under endotracheal anesthesia with an adenotome and hemostasis was accomplished HP 253 by nasopharyngeal packing. The severity of PAH was classified Actinomycosis in the etiology of recurrent tonsillitis according to Guida and Mattucci (1990) in grade 1 (mild and obstructive tonsillar hypertrophy: answer bleeding which stopped spontaneously), grade 2 (moderate from histopathological point of view bleeding which required intranasal vasoconstrictors) and grade 3 (severe bleeding which needed haemostatic control under Ozan Bagis Ozgursoy1, Ozgur Kemal1, Mustafa Rahmi Saatci1, endotracheal anesthesia). The time of PAH was classified as Ozden Tulunay2 primary (£24 h) and secondary (>24 h). 1Department of Otorhinolaryngology-Head and Neck Surgery, The overall incidence of PAH was 0.38% (4/1053). Two of pa- Ankara University Faculty of Medicine, Ibni Sina Hastanesi KBB tients (0.19%) had grade 1and 2 of patients (0.19%) had grade 3 AD, 06100, Ankara, Turkey PAH. Grade 2 was not recorded and no patient received a blood 2Department of Pathology, Ankara University Faculty of Medi- transfusion. PAH was primary in all of patients and it occurred cine, Ibni Sina Hastanesi KBB AD, 06100, Ankara, Turkey within the first six postoperative hours. Objective: The aim of the study was to investigate the histopath- PAH can be expected in a small number of patients undergoing ological profile and clinical presentation of tonsillar disease in the adenoidectomy. PAH has occurred mostly within the first six presence of Actinomycetes in children. postoperative hours and rarely requires treatment under endo- Methods: A qualitative and quantitative histopathological analysis tracheal anesthesia and a blood transfusion. of palatine tonsil was performed. Tonsillectomy specimens from patients underwent tonsillectomy or adenotonsillectomy were HP 252 searched for Actinomycetes. Four histologic compartments of tonsil including surface epithelium, reticulated crypt epithelium Multicentre study of demographics and incidence (lymphoepithelium), lymphoid tissue and interfollicular region of significant post-operative haemorrhage were examined. in adenoidectomy Results: The presence of Actinomycetes in the tonsillectomy specimens of patients with obstructive symptoms (32%) was more David Owens1, Carl Passant1, Wendy Harrison2, 2 2 3 prevalent than that of patients with recurrent tonsillitis (14.2). The Victoria Mcclure , Sue Harrison , Mark Temple , number of subjectively quantitated total lymphoid follicles, as well Alun Tomkinson1 1 as small and medium sized lymphoid follicles of the palatine tonsil University Hospital of Wales, Heath Park, Cardiff, Wales were significantly increased (P < 0.05) in patients demonstrating 2Centre for Disease Control (Wales), Abton House, Wedal Rd, ‘‘sulphur granules’’ in their crypts. Highly thick squamous meta- Cardiff, Wales plasia of the lymphoepithelium and dilatation of crypts were more Objective: To establish the level of serious postoperative haem- prevalent in tonsil tissue revealing Actinomycetes. orrhage and described the demographics of adenoidectomy Conclusions: The presence of Actinomycetes in the tonsillectomy (Without tonsillectomy). specimens does not indicate active tissue infection. However, the Methods: The patient characteristics and operative details of all histopathological outcome may indicate a possible etiologic role patients undergoing adenoidectomy (Without tonsillectomy) in of Actinomycetes in the development of prominent lymphoid Wales in all hospitals between May 2003 and February 2006 were hyperplasia and hypertrophy, in turn, obstructive tonsillar prospectively examined. hypertrophy.

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HP 254 peroperative procedure, surgical findings and histopathological Io PTH level is predictive of postoperative types were analysed. Statistical analysis were made using the Statistical Analysis System software. hypocalcemia and need for supplementation Results: The average follow-up was 21 months post-operative. in thyroid surgery Positive predictive value to localize the adenoma is almost 99% Balegh Hamdy, Mohamed El-Shafie, Mohamed Hegazy, when Ultrasonography (US) and sestaMIBI scintigraphy are Hisham Rizq, Samy Marouf concordant. Sensitivity of US and scintigraphy to localize the El Minia University Hospital, ENT Department, Egypt side of the lesion is respectively 46 and 79%. We had done 57% unilateral neck dissection (UND), 28% bilateral neck Objective: Evaluation of the occurrence of hypoparathyroidism dissection (BND) and 15% minimal invasive surgery. We have after thyroid surgery and the use of ioPTH levels to predict pa- found 95.2% adenomas and 4.8% multiple gland hyperplasia tients with risk of postoperative hypocalcaemia. disease. Patients with UND had less postoperative hypocalca- Methods: IoPTH and serum calcium were obtained during sur- emia than those who had BND. There is no significant statis- gery, 1st postoperative day, and after one month. The accuracy of tical difference between the surgical procedures. There were two ioPTH to predict patients at risk for postoperative hypocalcaemia treatment failures. was compared with calcium levels of less than 8 mg/dl on the 1st Conclusions: We specify the essential role of doing both of pre- postoperative day. operative localisation imaging in order to choose the best surgical Result: Ten patients had an ioPTH levels less than 10 pg/ml at procedure. Selected patients with pHPT due to single-gland dis- skin closure. These patients showed reduction in serum calcium ease and an unequivocally positive preoperative imaging can concentration measured on the 1st postoperative day. Patients safely and successfully be managed with a focused unilateral with an ioPTH level below reference range developed hypocalca- cervical exploration without either frozen section or IOPTH emia (P 0.001) compared to patients with normal range of ioPTH. monitoring. At the one month evaluation, 6 of these 10 patients required vitamin D supplementation because of persistent hypoparathy- roidism or hypocalcaemia (P 0.001). The remaining four patients with ioPTH levels less than 10 pg/ml at skin closure did not re- HP 256 quire vitamin D supplementation because they were asymptom- Lingual thyroid: a review of 3 cases atic and their PTH and SCa levels had normalized. None of the 35 patients with an ioPTH level greater than 10 pg/ml at skin closure Imre Fu¨ lo¨ p, Csongor Gyo¨ rgy Lengyel, Erzse´ bet Fu¨ le needed vitamin D supplementation at the one month follow-up Department of Otolaryngology Head & Neck Surgery, Jo´ sa evaluation. Andra´ s County Hospital, H-4400, Szent.I. u. 68., Nyı´ regyha´ za, Conclusion: An ioPTH level less than 10 pg/ml at skin closure is a Hungary strong predictor of hypoparathyroidism after bilateral thyroid Objective: Lingual thyroid gland is a rare clinical entity that is surgery. Patients with ioPTH levels below 10 pg/ml should be caused by the failure of the migration of the thyroid gland during given calcium postoperatively, and placed on vitamin D supple- embrional development. A lingual thyroid gland as an ectopic mentation after surgery to avoid symptomatic hypocalcaemia, thyroid tissue located on the midline of the base of the tongue can facilitating discharge on the first day after bilateral thyroidectomy. cause several problems for the patient, with symptoms of dys- phagia, dysphonia, upper airway obstruction or even hemorrhage. The aim of our study is to report of our illustrative cases of lingual HP 255 thyroid gland, and to give a review of the literature, regarding Primary hyperparathyroidism: surgical approach, diagnosis and appropriate therapy. lessons learned Methods: Three patients of lingual thyroid were presented (all female, aged between 37 and 70 years), their primary symptom Mayeul Lecoq, Nicolas Guevara, Jose´ Santini was dysphagia. Scintigraphic examination of the neck revealed no Nice University Hospital, ORL maxillo-facial and head and neck thyroid gland at the usual anatomical site in two patients and one Department patient an orthotopic thyroid. All the patients were managed Objective: To evaluate the way that we treat patient who have surgically by an external, transhyoid approach. A tracheostomy primary hyperparathyroidism, from the diagnosis and the pre- was not performed in any of the patients. operative localisation to the long-term follow-up, regarding to the Results: All the patients remained completely symptom-free, two international recommendations (French Endocrinology Society, patients were placed on thyroid hormone replacement therapy and National Institute of Health) and to propose surgical algorithm. was last reported as clinically euthyroid after more than 10 years. Method: A retrospective study was conducted on 188 cases treated Conclusions: We emphasize the importance of preoperative thy- between January 2000 and July 2005. All patients were asked by roid scintigraphy. The external approach is advisable, it has never mailing for new blood analysis. Preoperative imaging localisation, been hazardous and greatly facilitates vision.

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HP 257 firmed parathyroid adenoma. Post operation total calcium levels Secondary hyperparathyroidism: operative returned to normal limit. and postoperative findings Results: Although the majority of patients with primary hyperparathyroidism are asymptomatic and the disorder is de- F. Debruyne, P. Delaere, V. Vander Poorten, G. Geuens tected during health screening or coincidentally during medical Otorhinolaryngology-Head&Neck Surg., K.U.Leuven, Belgium examination, these patients may exhibit with cardiac sign and symptoms as hypertension, myocardial ischemia and left ven- Records of 189 patients undergoing subtotal parathyroidectomy tricular dysfunction which may be reversible after parathy- for secondary hyperparathyroidism (SHPT) were reviewed. In 75 roidectomy. patients PTH levels were measured during the first five postop- Conclusions: It has been estimated that approximately 90% of erative days. In 86% of the patients 4 or more parathyroid glands people with primary hyperparathyroidism remain undiagnosed. were visualised and removed. Less than four glands were found in The screening of serum calcium has been a particularly important 14%; some of them had previous thyroid surgery. In 82% of the factor leading to detection of patients with mild symptoms or no patients all resected glands were enlarged; in 18% we found one or symptoms, especially among postmenopausal women that the two normal parathyroid glands. Five patients had five parathyroid benefit of parathyroidectomy is most apparent. glands. There was no significant difference between right-left or superior-inferior location of the glands. On each location about 89% of the glands showed hyperplasia, 7% was normal and 4% HP 259 was not visualised. In 87% of the patients the lowest postoperative PTH value was less than 10 pg/dl, suggesting a successful inter- The value of fine needle aspiration cytology vention. However, in some of them less than four glands were in the management of a thyroid mass: a two centre identified. In 9% of the patients the lowest postoperative PTH retrospective study value remained above 30 pg/dl; they seem to have a higher risk for persistent or recurrent SPTH, although in some of them four Hiba Al-Reefy, Suresh Baboo, Mike Dilkes, Vikram Dhar, glands were removed. In surgery for SHPT the common course is Alistair Balfour the removal of four enlarged glands, followed by a very low PTH St. Bartholemew’s Hospital, London, UK level in the first postoperative days. This review of a larger series Objective: To evaluate the usefulness and accuracy of Fine Needle of operations shows how in a minority of patients the clinical Aspiration Cytology (FNAC) in diagnosis of thyroid gland mas- course can be different. ses. Retrospective review of patients notes who have undergone thyroidectomy. Methods: A retrospective review of patients notes who have HP 258 undergone thyroidectomy Between Jan. 2003 to Dec. 2005, 146 Parathyroid adenoma: an incidental finding Thyroidectomies were performed at WhippsCross University in a patient with heart disease Hospital NHS Trust, London. Of these, 98 patients underwent preoperative FNAC. The results of FNAC were analysed and M.Taghi Khorsandi*, M. Hossein Dadgarnia** compared with the corresponding histopathlogical diagnosis to *Tehran University of Medical Sciences determine whether the FNAC was useful in terms of influencing ** Yazd Shahid Sadughi University of Medical Sciences the management of each case. Objective: A number of seemingly asymptomatic patients may Results: Of the 98 patients with FNAC, histological evaluation manifest subtle or even silent sequels of hyperparathyroidism at revealed 15 malignant tumours and 83 benign lesions. The cyto- the time of presentation that would be eliminated by early diag- logical findings were true-negative in 79 (80%), true-positive in 9 nosis and appropriate surgical operation. (9.1%), false-negative in 6 (6.1%) and false-positive in 4 (4.1%) Patient and methods: The patient was a 60-year-woman which due cases, when trying to detect a malignant tumour. The sensitivity to hypertension and chest pain refers to a cardiologist. For eval- and specificity were 60 and 95%, respectively. uation of patient, cardiac thallium scan is requested which showed Conclusions: As a preoperative diagnostic tool for the surgical a suspicious uptake in right lower cervical region. Patient is re- excision of thyroid swellings FNAC is less reliable than is widely ferred to our clinic that in head and neck physical examination accepted. It should be used as an adjunct to clinical examination hadn’t any positive finding. In laboratory evaluation; patient had and experienced ultrasound, rather than as a definitive test. increased serum total calcium levels with high normal parathyroid Negative cytological results do not exclude more serious disease. hormone level. With diagnosis of primary hyperparathyroidism, One should take in to account the cost implications of repeated localization study by technetium-99 m sestamibi scintography was clinical attendances for review and aspiration, the potential accomplished which showed nuclear uptake in right lower cervical morbidity from aspiration and also the consequences of delayed region. Patient undergoes operation and pathologic result con- surgical treatment.

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HP 260 thyroid tissue in order to make a final diagnosis. With the correct Hemangiosarcoma of the thyroid gland decision making, the incidence of this occurring should be re- duced. 1,2 1,3,4 1 Petra Jerˇa´ bkova´ , Jan Plza´ k , David Vesely´ , Methods: A group of Consultants with an interest in thyroid 5 1 Vladimı´ r Zeman , Jaromı´ r Astl disease agreed to work towards a problem-solving flow chart, to 1Department of Otorhinolaryngology and Head and Neck Sur- keep thyroid lump investigation simple and easy to understand, gery, 1st Faculty of Medicine, Charles University, Faculty Hos- and to avoid unnecessary surgery. These consultants included pital Motol, V U´ valu 84, 150 06 Prague 5, Czech Republic specialists from radiology (head and neck ultrasound), pathology 2Institute of Physiology, 1st Faculty of Medicine, Charles Uni- (head and neck cytologist), endocrine (professor of endocrinol- versity, Albertov 5, 128 00 Prague 2, Czech Republic ogy) and ENT (head and neck surgeon). The main source of 3Institute of Anatomy, 1st Faculty of Medicine Charles Univer- referrals was patients presenting to the one-stop neck lump clinic, sity, U nemocnice 3, 128 00 Prague 2, Czech Republic where immediate ultrasound and FNA-cytology are performed. 4Center for Cell Therapy and Tissue Repair, 2nd Faculty of Over a series of one to one meetings and two open fora, an agreed Medicine, Charles University, Faculty Hospital Motol, V U´ valu protocol was reached. This protocol was then used in the one stop 84, 150 06 Prague 5, Czech Republic clinic. 5 Department of Pathology and Molecular Medicine, 2nd Faculty Results: The flow chart has been helpful in streamlining patient of Medicine, Charles University, Faculty Hospital Motol, V investigation, and helping in the decision making process. The U´ valu 84, 150 06 Prague 5, Czech Republic next stage is to audit thyroid surgery before the flow chart was Objective: Hemangiosarcoma of the thyroid gland is a very rare introduced, and after. entity. The therapy is difficult because of its locally aggressive and Conclusions: Multi-disciplinary team working in the area of thy- destructive behavior with a high recurrence rate. roid surgery may reduce the need for diagnostic thyroidectomy. Methods: We present a case of 60-years-old man with history of one month rapidly enlarging neck mass in the thyroid region and in levels II-III on the left side. HP 262 Results: Ultrasound examination and CT scan showed resistance Effect of imatinib on a papillary thyroid carcinoma: 7 · 5 · 7 cm arising from the left thyroid lobe displacing the tra- a case report chea. FNAC yielded only necrotically changed tumor mass without any cytological specification. Total thyroidectomy was indicated. Shigeru Nakai, Koichiro Yoshimoto, Kaichiro Ikebuchi, Invasion of the tumor mass into the surrounding tissues was found Masahiro Matsui, Hiroshi Nakano, Taketoshi Shimada, during the surgery. Therefore only left side hemithyroidectomy was Yasuo Hisa performed. Histopathology including histochemistry proved posi- Kyoto Prefectural University of Medicine, Department of tivity of factor VIII, fasciin, and CD31 in tumor cells characteristic Otolaryngology-Head and Neck Surgery, Kyoto, Japan of hemangiosarcoma. Immediately after the surgery the general Objective: To present the first reported case of the anticancer status of the patient was getting worse not allowing planned radio- effects of imatinib on papillary thyroid carcinoma. and chemotherapy. The patient died 2 months after the surgery Methods: Case report and review of the literature. because of massive bleeding from the tumor mass. Results: The patient was a 79-year-old man who underwent left Conclusions: The histological diagnosis is mostly difficult. The neck dissection and subtotal thyroidectomy for papillary treatment of the first choice for angiosarcoma is radical surgery. If thyroid carcinoma (T2N1aM0) in 1997. In 2000, the patient the tumor is not resecable radiotherapy, eventually chemotherapy developed a swelling on the left lateral wall of the mesophar- is indicated. The prognosis is not favorable and average 5 years ynx. CT confirmed the diagnosis of lymphadenopathy (diame- survival is nearly 2%. ter, 2.5 · 2 cm) of the left parapharyngeal space, and Acknowledgments: This study was supported by the IGA MZ CR fine-needle aspiration cytology revealed metastasis of papillary No. NR9049-3, and the MSMT No. 2B06106. thyroid carcinoma. The patient did not desire treatment, and underwent follow-up. In 2002, the patient also developed HP 261 chronic myelogenous leukemia, for which administration of imatinib 400 mg/day was initiated. A partial cytogenetic re- A flow chart to aid decision making in thyroid lump sponse was achieved after 6 months. After approximately assessment 1 month of imatinib therapy, the swelling of the mesopharynx began to resolve, and the metastatic lymph node was essentially H. M. Al-Reefy, V. Dhar, A. M. Balfour, M. G. Dilkes undetectable on CT after 6 months. Although thyroglobulin Department of Otolaryngology, St Bartholomew’s Hospital, level was abnormally high on peripheral blood tests conducted West Smithfield, London EC1A 7BE, UK prior to imatinib therapy, it decreased to normal levels after Objective: The management of thyroid neoplasia varies from 6 months. No further enlargement of the metastatic lymph node institution to institution, and from specialty to specialty. The was observed over the course of imatinib therapy. A resected majority of thyroid surgery nationally is performed by head and sample obtained from the previous thyroidectomy was exam- neck surgeons, whether ENT or Maxillofacial. There are a large ined using immunostaining. Overexpression of c-KIT and number of tests that can be performed in order to make the key PDGFR-a was observed, in addition to the primary thyroid decision: is this cancer? These tests include ultrasound, fine tumor and cervical metastatic lymph node. needle aspiration for cytology, core biopsy, CT or MRI scan- Conclusion:The main emphasis of this report is that if a papillary ning, PET scanning and technetium99 uptake scanning. Many thyroid carcinoma expresses c-KIT and/or PDGFR-a, there is a surgeons end up removing benign, essentially asymptomatic possibility that imatinib may inhibit the effects of the cancer.

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HP 263 Methodology: Clinical records of patients histologically confirmed Perforated rectus abdominis free flap for head to have nasopharyngeal carcinoma over a 7 year period, June 99 and May 2006, were retrieved and studied. and neck reconstruction Results: Fifty-six cases of nasopharyngeal carcinoma were re- C. Piazza, J. Cappiello, A. Bolzoni Villaret, B. Pedruzzi, viewed. The age range was between 16 and 85 years with a mean age A. Bizzoni, P. Nicolai of 44 years. Thirty-six 0f the cases occurred in males, with a male to Department of Otolaryngology, University of Brescia, Spedali female ratio of 1.8:1 Neck swelling 71.4%, Nasal obstruction Civili, Piazza Spedali Civili 1, 25123 Brescia, Italy 46.4%, Audiologic symptoms 42.8%, Epistaxis 35.7%, and occular symptoms 28.5% were the commonest symptoms. Objective: Perforated rectus abdominis free flap (PRAFF) has Conclusion: Most common presenting complaint was neck swell- been introduced from breast reconstructive surgery as an ing and 10.5% of these patients had prior lymph node biopsy done adjunctive tool for head and neck reconstruction. Aim of this by Gen. Surgeons, which led to increased morbidity in these cases. paper is to describe our experience in the use of this versatile and The role of lymph node biopsy in metastatic neck disease is thus minimally morbid fascio-cutaneous flap. discouraged. Fine-needle aspiration cytology may however be Methods: Between 2004 and 2006, 17 patients with oral cavity (7 useful. cases), orbito-maxillary (8), parapharyngeal (1), and skull (1) Keywords: Nasopharyngeal carcinoma, Presentation, Biopsy, malignancies received primary microsurgical reconstruction with Neck swelling PRAFF at the end of cancer resection. This flap represents 11% of the total number of free flaps harvested in that period at our Institution. A chart review was performed to collect clinical and HP 265 functional outcomes of PRAFF. Intravenous hydration can reduce pain following Results: Surgical defects encompassed half of the hard palate in eight patients (with associated ethmoid, orbital, and anterior skull tonsillectomy base defects in 7), subtotal glossectomy in 5, total glossectomy in Ruta Pribuisiene, Virgilijus Ulozas, Algis Babarskas 2, radical extended parotidectomy in 1, unilateral temporo-pari- Kaunas University of Medicine, Lithuania etal skin, bone and dura in 1. One patient (6%) developed total necrosis of the PRAFF and another (6%) had partial dehiscence Objective: To determine the benefit of intravenous hydration for requiring surgical revision for oral-cutaneous fistula. No compli- postoperative pain following tonsillectomy. cations at the donor site were observed. Normal oral diet and Methods: The study is consisting of two groups of patients fol- good speech intelligibility were resumed with minor limitations for lowing tonsillectomy performed in a university hospital. One two and three patients, respectively. group received adequate intravenous hydration during and after Conclusions: PRAFF is a valid alternative to the classic myo- operation while the other did not have and dehydration was cutaneous rectus abdominis free flap in the head and neck area, detected. 100 mm visual analogue scale (VAS) for detecting particularly when applied to complex maxillo-facial or tongue postoperative throat pain was used. Two-tailed unpaired Stu- major defects. Its greatest advantages, in spite of a more time- dent’s t-test was used to compare the two independent groups. consuming dissection of the perforator vessels, are represented by P < 0.05 was accepted as statistically significant. reduced donor site morbidity and more adjustable thickness of the Results: The total amount of the intravenous solutions was in skin paddle, particularly in the obese patients. mean: 1591.7 (SD 666.7) ml for male (weight 79.1 SD 10.5 kg), 1269.2 (SD 525.0) ml for female (weight 70.4 SD 12.7 kg), 1281.3 (SD 625.6) ml for boys (weight 52.1 SD 13.5 kg), and 1188.5 (SD HP 264 641.0) ml for girls (weight 45.1 SD 12.3 kg). The dehydration in 35 Nasopharyngeal carcinoma in benin city Nigeria: (76.1%) patients was detected. There were 19 adults (9 male, 10 an update female) and 16 children (5 boys, 11 girls) in this group. The hydration (H) group had significantly (P < 0.05) less postoper- N. E. Okolugbo ative pain compared with the dehydration (D) group. The mean M.B.B.S., FMCORL and F.O.OGISI DLO, FRCS, FMCORL, pain in H group was 21.4 (SD 17.5) VAS points and 36.5 FWACS; ENT Unit, Dept of Surgery, University of Benin (SD 21.1) points in D group, respectivelly. There was no age Teaching hospital, PMB 1111, Benin City, Nigeria dependence. Conclusions: Results of the current study suggest that adequate Aims and objective: To determine the common modes of presen- intravenous hydration can reduce postoperative pain in postop- tation of Nasopharyngeal carcinoma in Benin City Nigeria, to erative period following tonsillectomy in children and adults. make for early diagnosis and better management modalities.

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HP 266 Objective: Using Fibre-optic Endoscopic Evaluation of Swallow- Most frequent symptoms in patients with proved ing (FESS) and Video-fluroscopy (VF); aspiration and penetra- tion were studied in these cancers. laryngo-pharyngeal reflux disease Methods: Swallowing in 25 treated oro-pharyngeal cancers Marianne Vidojevic, Radmila Sladoje, Gordana Golubovic (squamous cell carcinoma) was Studied prospectively using FESS ENT Clinic ‘‘MKM’’, Belgrade, Serbia or VF on the ‘Swallowing Workstation’.Penetration (score 2–5) and aspiration (score 6–8) were assessed according to a previously Introduction: A large number of ENT patients has complaints validated 8-point scale. Eight patients had a neck dissection with like pharyngeal sensations, postnasal drip, excessive mucus radical radio-therapy to the primary site (Group A). Eight pa- production, globus pharyngeus, chronic cough a.o. However, tients underwent resection of the primary with reconstruction and these symptoms are manifestations of different diseases includ- post-operative RT (Group B). Nine patients received radical ing infections, allergy, LPR, etc. chemo-radiation alone (Group C). Objective: Point out the most frequent symptoms in patients Results: Twelve patients (48%) had penetration alone: 11 (92%) with already proved LPR, on base of which the practicing were identified with FESS and six (50%) by VF. Eight patients doctor will suspect reflux disease exists in the ENT region. (32%) were aspirating: four (50%), were identified by FESS and Methods: Frequency and kind of symptoms were retrospectively seven (88%) by VF. No. of patients (%) penetrating: Group A - 4 analysed in 39 patients with laryngo-pharyngeal reflux disease, (50%); Group B - 4 (50%); Group C - 4 (44%). No. of patients diagnosed using the ‘‘golden standard’’, 24 h pharyngo-esoph- (%) aspirating: Group A - 2 (25%); ageal pH-measuring. Before pH measuring some patients Group B - 2 (25%); Group C - 4 (44%). 3 of 14 (21%) of tonsil underwent microbiological testing, radiography of the paranasal and 5 of 11 (45%) of tongue base tumours aspirated. sinuses and/or lungs, allergy testing, pulmonal and neurologic Conclusions: For oro-pharygeal cancers: (1) Aspiration and pen- testing or exluding of ACE inhibitors). etration is high irrespective of type of treatment used. (2) Video- Results: We found hyperphlegmia and chronic throat clearing in fluroscopy appears to be more reliable at detecting aspiration than 74.35%, pharyngeal sensations and globus pharyngeus/pharyn- FESS. Risk of aspiration is higher with tongue base than tonsillar geal tightness in 71.79%, dysphonia and dyspnea in 53.85, tumours. chronic cough and stickiness of soft palate in 43.6%, postnasal drip and drawing back of it in 41%, nasal obstruction 41.02%, cervical dysphagia, choking,voice breaks, dry mouth, snoring in HP 268 28.2%, need to drink with meals 18.18%, strange taste in Objective, subjective evaluation of voice after partial 15.4%, glossopyrosis, tongue swelling and hyposmia in 10.25%, laryngospasmus in 10.25%, sensation of foreign body in throat laryngectomy in 10.25%,water brash 7.7%, otalgia 2.56%, retrosternal pyro- M. Kulekci, E. Gultekin, F. G. Guzelderen sis/squeezing/sternal heavy weight 33.3/5.12/10.25%, belching Taksim Egitim ve Arastirma Hospital, Istanbul, Turkey and bloating 35.9%, stomach ache or nausea in 10.25/10.25%. Discussion: These results enable the establishing of a reflux ques- Objective: To compare the voice outcomes of cordectomy, vertical tionnaire, which it self may already give a justified suspection of hemilaryngectomy, horizontal supraglottic, vertical frontoanterior reflux disease, and along with a detailed ENT examination leads and supracricoid laryngectomy by means of patient self assess- to the necessity of final diagnosing. In this way long-lasting and ment, perceptual analysis and acoustic analysis. unadequate treatment with antibiotics, antihistaminics, antimy- Methods: A total number of 27 male patients treated with partial cotics or sedatives will be avoided. laryngectomy were enrolled in this study. Twelve patients (44%) Conclusion: The clinical picture of patients with LPR empha- were treated with cordectomy, six (22%) were treated with hori- sizes the importance of aimed ENT reflux anamnesis. The zontal supraglottic laryngectomy, three (11%) were treated with complaints are usually periodic and/or chronic, lasting from a vertical frontoanterior laryngectomy, three (11%) were treated few months to a few years. Many patients do not have typical with vertical hemilaryngectomy and three (11%) were treated with GERD symptoms (heartburn, stomach swelling or belching), supracricoid laryngectomy. After surgery, all of the patients were which however does not exclude the necessity of further LPR evaluated by using a 0–3 scale and Voice Handicap Index-30 scale. diagnosing. For complete diagnosing application of the ‘‘golden Acoustic analysis were performed for the objective voice evalua- standard’’, 24 h pharyngo-esophageal pH measuring is tion. necessary, and it justifies the specific and often long-lasting Results: The means of perturbation measurements, harmonic to treatment. noise ratio, maximum phonation time and s/z ratio were signifi- cantly high in cordectomy and horizontal supraglottic laryngec- tomy than in vertical frontoanterior laryngectomy, vertical hemilaryngectomy and supracricoid laryngectomy (P < 0.05). HP 267 On the basis of perceptual evaluation by using a 0–3 scale and Oro-pharyngeal carcinoma: assessment of swallowing Voice Handicap Index-30, mean scores were found to be signifi- with fibreoptic endoscopic evaluation cantly higher in cordectomy and horizontal supraglottic laryn- and videofluroscopy gectomy than in vertical frontoanterior laryngectomy, vertical hemilaryngectomy and supracricoid laryngectomy (P < 0.05). S. H. Vyas, S. Gollins, S. Ford Conclusions: Voice quality after partial laryngectomy appears to Ankara Numune, Education and Research Hospital, be better in cordectomy and horizontal supraglottic laryngectomy. 4th ENT Clinic, Turkey Keywords: Partial laryngectomy, Voice quality, Acoustic analysis

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HP 269 sive, permits to achieve a high rate of success in these patients who ENT day case turnover in a UK district general are grateful to be part of the modern and functional management of salivary calculi. hospital Tom Pezier, Paul Stimpson, Rahul Kanegaonkar, David Bowdler HP 271 University Hospital Lewisham Malignization of laryngeal papilloma Objectives: In 2000 the NHS plan set a target of 75% of all sur- N. A. Daikhes, H. Sh. Davudov, I. I. Matela gical activity to be performed as day cases. ENT lends itself well to Federal Research Clinical Center of ENT of Russia a day case approach. We conducted a retrospective study to evaluate our day case operating rate, in particular otological Objectives: The aim of our research is to study immunological procedures, in relation to national guidelines. parameters of the peripheral blood of patients with laryngeal Methods: We retrospectively analysed all elective operations over papillomatosis during diagnostics of the illness and after a certain one calendar year from September 2005 to September 2006. period of time after the tumor ablation and also examination of Information was gathered via the GALAXY Theatre coding ablated tissues for human papilloma virus. Participants of the system software and matched to the patient information man- study are 49 patients with laryngeal papilloma: 34 men and 15 agement system (PIMS). women aged from 19 to 64. Malignization of the papilloma oc- Results: Two thousand five hundred and thirty eight elective oper- curred with 16 out of 49 patients. From adverse effects it is nec- ations were performed over the study period. All elective ENT essary to note that 12 patients developed laryngeal papillomatosis operations were included. There were 1,535 adult procedures and and its malignization on the background of smoking. 2 patients 1,003 paediatric procedures ( < 16 years). In the adult group 1,137 had malignization detected during pregnancy. procedures were performed as day cases (74%). Of the 1,003 pae- Methods: All patients were prescribed to have immunological, diatric operations, 730 were day cases (73%). A total of 580 ear histological study and the examination of the ablated tissues done operations were performed during the study period. 333 were per- for the papilloma virus of 6, 11, 16 and 18 types by polymerase formed on paediatric patients and 247 on adults. Overall 87.9% of chain reaction. adult procedures were day cases including mastoidectomy (n = 18, Results: On studying of the immunity level all patients showed 78% day cases), Tympanoplasty (incl. CAT) (n = 53, 87%) and different disturbances, for the most part, depression of T-cell Stapedectomy (n = 20, 100%). 93.4% of paediatric cases were chain of lymphocytes: reduction of Thelpers and natural killers, performed as day cases. Procedures included grommets (n = 172, several patients showed reduction and increase of IgA, IgG and 94%), tympanoplasty (incl. CAT) (n = 15, 80%). IgM and also depression of the functional activity of B and T Conclusions: Day case surgery is preferred by patients and has well lymphocytes. Five patients with the papilloma malignization had recognised clinical and economical advantages. ENT surgery is the human papilloma virus—18 type. In two cases laryngeal well suited to a day case approach and our figures show that day papillomatosis was developed from childhood in men, in the rest case rates approaching 75% of all elective operations are achiev- cases—malignization of flat cell papilloma. able in the district general hospital setting. Otology day case rates Conclusions: It is necessary to reveal the presence of 16 and 18 type exceeding national recommendations are achievable even when papillomavirus in samples of laryngeal papilloma and papillo- considering major ear surgery. matosis to suspect possibility of future malignization.

HP 272 HP 270 Monitoring vocal perturbations in running speech: Extracorporeal shockwave lithotripsy for salivary objectives—technical challenges—perspectives calculi Jean Schoentgen Pasquale Capaccio Universite´ Libre de Bruxelles, CP 165/51, 50, Av. F.-D. Roosevelt, Department of Otorhinolaryngological and Opthalmological B-1050 Brussels, Belgium Sciences - Policlinico Foundation I.R.C.C.S. University of Milan, Vocal perturbations refer to deviations of the glottal cycle lengths Italy from strict cycle-to-cycle periodicity. The causes include jitter, In the last 15 years the increasing public demand for minimally shimmer, and turbulence noise. Acoustic cues summarizing vocal invasive therapies and rapid development in medical technologies perturbations are correlates of perceived roughness and breathi- have made feasible different minimally invasive methods for the ness. Known difficulties are that existing analysis methods occa- removal of salivary calculi with preservation of the salivary gland. sionally fail to track vocal perturbations accurately, if these exceed a The long-term experiences acquired in almost four centres around critical size, as well as that the analysis is often restricted to stable the world, including mine, in the application of extracorporeal fragments of sustained speech sounds. An argument in favour of shockwave lithotripsy (ESWL) under ultrasonographic monitoring analyzing running speech is that the variable conditions under have stated that ESWL is the preferred minimally invasive therapy which vocal fold vibration must take place constitute a greater for all parotid stones and may be also chosen for intraductal sub- challenge to a speaker’s larynx. The presentation therefore concerns mandibular stones of less than 7 mm in young patients. The results speech analysis methods that accurately detect and measure vocal of the personal experience, began in 1992, based on 525 patients perturbations in any speech material, whatever the severity of the with parotid and submandibular stones will be compared with that disorder. Experiments have shown that the (Pearson) correlation of other centers with such a long-term experience. Thanks to the between perceived abnormality (grade) and acoustic cues that recent development of other minimally invasive or conservative quantify vocal perturbations is better than 0.8 for four matched methods, ESWL may be used not only as a primary unique modality sentences and vowels [a] produced by a corpus of dysphonic but also in combination or as a secondary modality after transoral speakers. The ability to track vocal perturbations in connected removal of submandibular stones; in this regard, the availability of speech as reliably as in sustained sounds offers novel opportunities, different modalities, though time-consuming and relatively expen- such as monitoring speakers at risk in their professional setting.

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