Psychological profile of laryngectomized patients

Larynx cancer is one of the most susceptible form of cancer susceptible to induce alteration of the patient’s psychological profile due to the social role that the larynx has in communication. Oral communication is severely impaired even after voice rehabilitation of the laryngectomized patients, so that the social rehabilitation is somewhat not only a medical but also a social problem. The psychological profile of these patients is altered in a way that dealing with the disease is sometimes neglected and the interaction with the outside world in terms of oral communication is totally abandoned. The starting point for depression in these cases is the acknowledgement of the disease and is, in some cases, the entire medical environment. Facial scarring, the inability to verbally interact with other human, as well as the presence of the tracheostoma, are all deciding factors in the presence of a low self-esteem for these particular patients. Psychological counseling is a mandatory approach for laryngectomized patients, in order to improve their ability to cope with cancer and providing better recovery chances

Differences Between Men and Women with Total Laryngectomy

The larynx is one of the organs that is usually involved in the tumor growth in the head and neck region and it is the second site of malignant neoplasia of the respiratory tract after the lungs. It is a well-known fact that larynx cancer is more often present in male population, with a ratio of 3:1 male/female because of the higher rate of tobacco and alcohol use. The issues related to total laryngectomy are the loss of voice, swallowing rehabilitation, reeducation of breathing through the tracheostomy, psychological alterations and social pressure. Women tend to be more affected by the presence of the tracheostomy, since general physical aspect is a major concern for modern women. Also, the emotional status of women is a plays a major role for the adherence to the therapy plan. The response to total laryngectomy by men and women is similar with slight differences in physical aspect and social reinsertion

Natural Compounds for Wound Healing

Many plants or plant-derived compounds with high levels of antioxidants and anti-inflammatory, immunomodulatory, and antimicrobial properties could be of great benefit for wound healing. Several studies have documented the use of plant extracts for the development of bioactive wound dressings. The purpose of this chapter is to give an update about the vegetal and bee products, which can be used as bioactive substances in wound dressings or in other formulations for wound healing. The adverse effects of plant and bee extracts, such as contact allergies, are also presented. In order to better exploit the huge reservoir of pharmacologically active plant-derived compounds and extracts, standardized methodology and clinical trials are necessary to give more concrete evidence supporting the use of traditional medicine in wound management

Quality of life challenges for larynx cancer patients

Laryngeal cancer continues to raise challenges for specialists all over the world even if there has been improvement in its diagnosis, therapeutic options and comprehensive view of the malignant tumor process. The decision of the oncological committee is not subject to the preferences of the patient, since in terms of therapy, this is the role of the specialist treating the patient. It is very important that the patient should know the implications of total surgery and that the patient has a poorer quality of life after total laryngectomy. The quality of life of these patients has been assessed by means of European quality of life questionnaires in terms of physical status and symptoms, social integration and psychoemotional status. The absence of voice, the impairment in swallowing, the esthetic impairment, the family and social reintegration need to be addressed by the oncological team so that the quality of life of these patients be at optimal levels. The specific questionnaires for the quality of life evaluation need to be used for any patient with laryngeal cancer and key points need to be addressed individually to meet each patient's expectations

Molecular pathways and targeted therapies in head and neck cancers pathogenesis

The substantial heterogeneity exhibited by head and neck cancer (HNC), encompassing diverse cellular origins, anatomical locations, and etiological contributors, combined with the prevalent late-stage diagnosis, poses significant challenges for clinical management. Genomic sequencing endeavors have revealed extensive alterations in key signaling pathways that regulate cellular proliferation and survival. Initiatives to engineer therapies targeting these dysregulated pathways are underway, with several candidate molecules progressing to clinical evaluation phases, including FDA approval for agents like the EGFR-targeting monoclonal antibody cetuximab for K-RAS wild-type, EGFR-mutant HNSCC treatment. Non-coding RNAs (ncRNAs), owing to their enhanced stability in biological fluids and their important roles in intracellular and intercellular signaling within HNC contexts, are now recognized as potent biomarkers for disease management, catalyzing further refined diagnostic and therapeutic strategies, edging closer to the personalized medicine desideratum. Enhanced comprehension of the genomic and immunological landscapes characteristic of HNC is anticipated to facilitate a more rigorous assessment of targeted therapies benefits and limitations, optimize their clinical deployment, and foster innovative advancements in treatment approaches. This review presents an update on the molecular mechanisms and mutational spectrum of HNC driving the oncogenesis of head and neck malignancies and explores their implications for advancing diagnostic methodologies and precision therapeutics

Implications of oral dysbiosis and HPV infection in head and neck cancer: from molecular and cellular mechanisms to early diagnosis and therapy

Head and neck cancer (HNC) is the sixth most common type of cancer, with more than half a million new cases annually. This review focuses on the role of oral dysbiosis and HPV infection in HNCs, presenting the involved taxons, molecular effectors and pathways, as well as the HPV-associated particularities of genetic and epigenetic changes and of the tumor microenvironment occurred in different stages of tumor development. Oral dysbiosis is associated with the evolution of HNCs, through multiple mechanisms such as inflammation, genotoxins release, modulation of the innate and acquired immune response, carcinogens and anticarcinogens production, generation of oxidative stress, induction of mutations. Thus, novel microbiome-derived biomarkers and interventions could significantly contribute to achieving the desideratum of personalized management of oncologic patients, regarding both early diagnosis and treatment. The results reported by different studies are not always congruent regarding the variations in the abundance of different taxons in HNCs. However, there is a consistent reporting of a higher abundance of Gram-negative species such as Fusobacterium, Leptotrichia, Treponema, Porphyromonas gingivalis, Prevotella, Bacteroidetes, Haemophilus, Veillonella, Pseudomonas, Enterobacterales, which are probably responsible of chronic inflammation and modulation of tumor microenvironment. Candida albicans is the dominant fungi found in oral carcinoma being also associated with shorter survival rate. Specific microbial signatures (e.g., F. nucleatum, Bacteroidetes and Peptostreptococcus) have been associated with later stages and larger tumor, suggesting their potential to be used as biomarkers for tumor stratification and prognosis. On the other hand, increased abundance of Corynebacterium, Kingella, Abiotrophia is associated with a reduced risk of HNC. Microbiome could also provide biomarkers for differentiating between oropharyngeal and hypopharyngeal cancers as well as between HPV-positive and HPV-negative tumors. Ongoing clinical trials aim to validate non-invasive tests for microbiome-derived biomarkers detection in oral and throat cancers, especially within high-risk populations. Oro-pharyngeal dysbiosis could also impact the HNCs therapy and associated side-effects of radiotherapy, chemotherapy, and immunotherapy. HPV-positive tumors harbor fewer mutations, as well as different DNA methylation pattern and tumor microenvironment. Therefore, elucidation of the molecular mechanisms by which oral microbiota and HPV infection influence the HNC initiation and progression, screening for HPV infection and vaccination against HPV, adopting a good oral hygiene, and preventing oral dysbiosis are important tools for advancing in the battle with this public health global challenge

RÉVISION ANATOMIQUE ET PRATIQUE EN CAS DE SAIGNEMENT VEINEUX AU NIVEAU DE L’ANGLE PONTO-CÉRÉBELLEUX

The ENT practitioner has a principal role for diagnosis, treatment and clinical recovery of vestibular schwanno-ma patients. These tumors require a special attention, concerning the treatment and the follow-up, because of their location in a deep anatomical region, very rich in vascular and neurological elements. If surgery is chosen as the best treatment modality, the vascular related complications, during surgery or immediately after surgery, can be disastrous for the patient. The surgeon must have the anatomical knowledge and appropriate skills. The anatomy of the venous system has an individual variability, with an impact to the procedure’s surgical risks. The objective of this publication is to synthetize the local venous anatomy and surgical practices in case of venous bleeding at the level of the pontocerebellar angle.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

CE QUE NOUS DEVONS SAVOIR SUR LES SCHWANNOMES NON-VESTIBULAIRES DE L’ANGLE PONTO-CÉRÉBELLEUX?

A patient with pontocerebellar pathology has complaints in the ENT field, like hearing loss, tinnitus, vertigo or facial pain The vestibular and non-vestibular schwannoma are the most frequent pathologies of this anatomical region, and because of their “mild“clinical manifestations, the diagnosis can be delayed during a regular follow-up. Improvement of differential diagnosis between vestibular schwannoma and non-vestibular schwannoma requires a detailed anam-nesis as well as radiological and electrophysiological exams. Nevertheless, the non-vestibular tumors are often misdiagnosed as vestibular tumors. The surgeon must have all the knowledge and skills in order to provide, case by case, the right diagnosis and the best care for his patient. The aim of this publication is to overview the most recent data related to pontocerebellar non-vestibular schwannoma.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Standard or individualized quality of life for larynx cancer patients?

Locally advanced larynx cancer benefits from curative surgery therapy. Clinical trials have been proposed for assessing the quality of life for patients with larynx malignant neoplasia who underwent radical surgery. The removal of the “voice box” is known to have great impact on the social reintegration of these patients as well as psychological distress. The presence of tracheostomy and voice impairment are two of the major issues that need to be thought of by patients that will have a total laryngectomy. The quality of life is a multi-dimensional subjective and personal concept which includes normal physical activity, looks, psychological status, somatic symptoms and, non the less, sexual activity. Cancer free survival intervals for patients with larynx cancer must be evaluated physical and psychological modifications with particular considerations to stress, anxiety and depression related symptoms and to functional rehabilitation adaptation regarding swallowing and speech. Oncology surgeons must consider that QoL is impaired in all patients with larynx cancer that benefit from total laryngectomy. However, there is evidence presented below that the difference in QoL parameters is small when comparing radical surgery, total laryngectomy, and larynx conservation by radio and chemotherapy