HPV-Positive Oral Squamous Cell Carcinoma

Head and neck malignancies represent the sixth most frequent type of cancer currently in worldwide statistics. Of these, oral and pharyngeal cancers have steadily increased, being linked with the increase in HPV infection pandemic. This rise is not due to one cause, but rather multiple factors such as lifestyle and sexual behavior pattern changes and globalization. Because of the anatomy of the oral cavity and oropharynx, the proper diagnosis is easily delayed, and patients present with advanced stage disease, which requires aggressive and extensive surgery along with neck dissection and chemoradiotherapy. Patients with advanced stage disease have a high recurrence risk with a low 5-year survival rate. Preventing the HPV infection is of course desirable, but right now, for adults which already are infected and have a higher risk of developing HPV-related neoplasias, as well as for our head and neck cancer patients, alternative treatment algorithms are necessary

Orbital complications of acute rhinosinusitis

Introduction. Rhinosinusitis is the infection and inflammation of at least one of the 4 paranasal sinuses (frontal, maxillary, ethmoid and sphenoid). Their correct diagnosis is generally determined by examining the patient clinically and by rhinosinusal endoscopic examination. There are also cases that show complications or continued evolution despite the correct treatment, and then we will use some imaging investigations to find out more about affection(radiography of anterior sinuses of the face, sinus computerized tomography, sinus magnetic resonance imaging). In particular, acute rhinosinusitis should be carefully managed to avoid complications such as the local ones: orbital cellulitis, orbital abscess, osteomyelitis, cavernous sinus thrombosis; and intracranial complications: meningitis, epidural abscess, subdural abscess, cerebral abscess.Materials and methods. There will be presented all orbital complications according to the cases treated in the ENT Clinic of the Coltea Clinical Hospital.Conclusions. Diagnosis of rhinosinusitis is largely clinical and endoscopic.When complications of the condition arise, these should be investigated imagistically to determine their exact extent and to institute the correct treatment as soon as possible. The complications of rhinosinusitis are medical and surgical life-threatening emergencies, which is why in order to diagnose and correct and quickly institute therapy requires a multidisciplinary approach

Pharyngocutaneous Fistulas Following Total Laryngectomy

Total laryngectomy is still the final therapeutic solution in cases of locally advanced laryngeal cancer, as well as in cases of therapeutic failure of organ-sparing surgery or radiation therapy. Following excision of the larynx, the remaining pharynx is reconstructed to obtain continuity of the upper digestive tract. One of the most common complications in these patients, despite constant refinement of the procedure, is the development of a pharyngo-cutaneous fistula. These fistulas prolong hospital stay and often require a second surgical procedure, increasing morbidity and cost for the patient, while diminishing his quality of life. Some risk-factors have been identified, but only some may be corrected before surgery to lower this risk. Managing the fistula once present depends on multiple factors, essential being the size of the fistula as well as the position and concomitant factors, with options ranging from conservative measures to aggressive reconstructive surgery with local miocutaneous flaps. Modern vocal rehabilitation with T.E.P. (tracheo-esophageal puncture) and vocal prosthesis placement presents a new challenge – because of the risk of developing a tracheo-esophageal fistula, with an even higher risk for the patient because of tracheal aspiration. Understanding healing mechanisms of these structures is key to proper management of this complication

Pharynx Reconstruction and Quality of Life

Patients who are diagnosed with squamous cell carcinoma of the pharynx have a first delayed presentation, with advanced stages of the disease. Therefore, they frequently require a multimodal approach—by surgery, radio, and chemotherapy. Due to anatomic spatial limits and particularities, therapy can imply large organ resection with difficulties in reconstruction. Nowadays, there is a paradigm shift in the management of this pathology, with significant first referral to oncology departments and initiation as the first line of treatment of radio/radio-chemotherapy. As a consequence, salvage surgery may be mandatory in some selected cases. The proposed chapter will address the oncological particularities of the pharynx, with a focus on the oro- and hypopharynx, ways of reconstruction after oncological ablative surgery of these segments, and impact on quality of life (QoL) index. Speech, respiratory, and deglutition rehabilitation of these patients is essential and will be a distinct topic. This paper will have the structure of a literature review with clinical examples of reconstruction from ENT and Head and Neck Surgery Department of Coltea Clinical Hospital, Bucharest. Reconstruction methods used in our clinic are regional flaps and biocompatible prostheses in advanced stages. QoL index in our clinic is assessed with questionnaires developed by the European Organization for Research and Treatment of Cancer – EORTC QLQ C30

The Impact of Laryngeal pathology on sleep disorders patients

Sleep disorders are a common disorder the most frequent being obstructive sleep apnea characterized by repetitive episodes of upper airway collapse and respiratory pause. It is associated with a significant cardiovascular morbidity and mortality and severely alters the quality of life .In many cases it can remain undiagnosed because of its symptoms that can be underestimated by both the patient and the doctor. Tobacco, alcohol abuse and obesity are amongst the most common risk factors but the most important ones are related to different anatomical structures that can stop the airflow.Treating this disorder sometime requires multilevel surgery depending on the structures involved the most common of them being palatal, oropharyngeal and tongue base. The development and increased usage of sleep endoscopy has somewhat changed the treatment options due to the fact that laryngeal collapse is almost always seen only on sleep endoscopy. The role of laryngeal pathology has to be taken into account especially in cases where CPAP and surgery have failed