Computer Assisted Endoscopic Sinus and Skull Base Surgery

The surgical anatomy of the paranasal sinuses and the skull base is considered to be one of the most complex anatomies of the human body, with great morphological differences among individuals. The development of technology in endoscopic sinus and skull base surgery can be divided in two directions. On the one hand, they are increasingly developing powered instruments that make surgery easier and faster, but also make it potentially more dangerous. On the other hand, there is improvement in the devices that enhance the security by better visualization and orientation within the operative field. Among them, computer-assisted navigation (CAN) is particularly important. Originally developed for neurosurgery, CAN was rapidly accepted by endoscopic sinus and skull base surgeons. Thus, by 2010, it became available in the USA to almost all otorhinolaryngologists dealing with this branch of surgery. The main reason for using CAN is the reduction of operative risks and complications, especially reduction of major and orbital complications. It should be noted that CAN also serves as a great educational tool for young surgeons, but one should be aware that it cannot replace surgical skills and knowledge. CAN has no absolute contraindications other than the lack of surgical experience and training. Our experiences with CAN, which we have routinely used for over 10 years, are also presented

Stupanj metilacije gena ASC/TMS1 i MyD88 u uzorcima zdravog tkiva i tkiva karcinoma pločastih stanica grkljana

Laryngeal Cancer is the most frequent Head and Neck Cancer comprising high mortality rate. Almost 90% of all Laryngeal Cancers develop due to genetical and epigenetical changes caused by lifestyle and environmental factors. More than 95% of all laryngeal cancers are Squamous Cell Carcinoma. To date there are no established biomarkers to facilatate the diagnosis, prognosis and treatment of patients suffering from this malignant disease. Recent studies showed that inadequate control of inflammation and presence of infection are tightly related with developing and promotion of the cancer. Innate immue system has a very important role in the control of inflammation. Innate immunity defense mechanisms activate pattern recognition receptors (PRRs) and adaptor molecules play the key role in all signalling pathways. In this study, we hypothesized that the changes in the methylation status of promotor regions of ASC/TMS1 and MyD88 genes, responsible for activation and regulation of inflammation, in healthy and laryngeal cancer tissue might be related with development and progression of cancer. The aim of this study is to investigate is there a difference in the methylation status of this genes in healthy and tumor tissue and does it correlate with protein expression. In recent literature the methylation status of this genes has still not been analyzed in Laryngeal Cancer and the pyrosequencing method in methylation status determination as performed in this study has not been used in other cancers. Results of this study show that the overall methylation level of the promotor region of MyD88 gene is statistically significantly higher in healthy laryngeal tissue in relation to cancer tissue and this finding correlate with protein expression level. The overall methylation level of promotor region of ASC/TMS1 gene is unchanged in Laryngeal Cancer and healthy laryngeal tissue. The protein expression level of ASC/TMS1 is statistically significantly higher in cancer in relation to healthy laryngeal tissue. Taking into account there is no difference in the overall methylation level of the promotor region of ASC/TMS1 gene in healthy and tumor tissue we assume that the observed difference in ASC/TMS1 protein expression (higher expression in tumor tissue) is the outcome of other posttranscriptional regulation mechanisms. We consider that the results of this study in the future may lead to earlier detection, treatment and follow-up of Laryngeal Squamous Cell Carcinoma and reveal new scientific discoveries of the role of ASC/TMS1 and MyD88 genes

Silicon foil patching for blast tympanic membrane perforation: a retrospective study

Aim: To establish whether covering the tympanic membrane perforation after war blast injury with silicon foil can enhance the ear drum healing rate and to determine the appropriate timing of silicon patching. ----- Methods: We retrospectively analyzed the charts of 210 patients wounded during the Homeland War in Croatia 1991-1995, with 315 blast tympanic membrane perforations. In 44 patients (61 perforations), the eardrum perforation was covered by silicon foil, whereas in 166 patients (254 perforations) it was left to heal spontaneously. The patients who underwent the patching procedure were divided in two groups according to the time period between the blast injury and the procedure: 38 perforations were treated within 3 days and 23 perforations were treated 4 to 6 days after the blast injury. ------ Results: The rate of tympanic membrane healing in the silicon foil patching group was significantly higher (91.8%) than that in the group of perforations left to heal spontaneously (79.9%, P = 0.029). The healing rate was significantly higher in the group treated within 3 days after the blast injury (97.4%) than in the group treated 4 to 6 days after the injury (82.6%, P = 0.042). ----- Conclusion: Covering the perforation after the war blast injury with silicon foil significantly improves the rate of tympanic membrane healing. To obtain the best healing outcome, the procedure should be performed within the first 72 hours after the trauma

Overview of 100 patients with voice prosthesis after total laryngectomy--experience of single institution [Pregled 100 bolesnika sa govornom protezom nakon totalne laringektomije]

Surgical procedures, especially total laryngectomy, used for treatment of advanced laryngeal carcinoma, have a profound adverse effect on the patient's physical, functional, and emotional health, and almost always decrease quality of life. There are three main types of voice rehabilitation after surgery. They are: esophageal speech techniques, the use of artificial larynx devices and tracheoesophageal puncture with the insertion of various types of voice prostheses. Voice prosthesis was inserted in 100 patients in the ENT Department, University Hospital Center Zagreb, from January 2004 until February 2011, and 91 of these patients were included in our study. The prosthesis was inserted secondary at 71 patients, while in other 20 it was inserted primary, i.e. immediately after laryngectomy as a part of the same procedure. Voice rehabilitation was initiated 10th day after primary insertion and 1st-3rd day after secondary insertion. The postoperative voice quality was compared with a five degree scale, which was taken from Hilger's retrospective study (2000). The rehabilitation was successful in 75.8% of our patients. Early complication rate was 4.4%, and 10.9% of patients had late complications. Statistical analysis didn't show significant differences regarding the complications rate and success rate of rehabilitation between groups of patients, formed according to age, irradiation status and timing of prosthesis insertion

Izraženost markera maligne transformacije u invertnom papilomu sinusa

Invertni papilom je dobroćudni sinonazalni tumor koji čini 0,5–4% svih primarnih tumora u nosu i paranazanim sinusima. Invertni papilom ima sposobnost širenja u okolno tkivo, veliku tendenciju recidivima i mogućnost maligne alteracije. Povezanost invertnog papiloma s planocelularnim karcinomom je dobro proučena i prema dostupnim podacima u literaturi iznosi između 10 i 20%. EGF je čimbenik rasta koji ima važnu ulogu u regulaciji rasta stanica, njihovoj proliferaciji i diferencijaciji. Također označava i povećani rizik nastanka malignih tumora. VEGF je homodimerni glikoprotein koji je najvažniji čimbenik angiogeneze, jer stimulira sintezu proteaza, te migraciju i proliferaciju endotelnih stanica. U tumorskom rastu i metastaziranju tumora, angiogeneza je pokretačka snaga koja omogućava metabolizam tumorskih stanica. Cilj ovoga istraživanja je bio odrediti izraženost EGFR i VEGR u 52 bolesnika podijeljena u tri skupine – primarni invertni papilom, recidiv i karcinom nastao na osnovi invertnog papiloma u području cilindričnog, metaplastičnog, pločastog i displastičnog epitela. Utvrđena je statistički značajna razlika u izraženosti EGFR između skupina bolesnika s primarnim invertnim papilomima u odnosu na skupine bolesnika s recidivom i karcinomom u području pločastog i displastičnog epitela, kao i u području metaplastičnog epitela između skupine bolesnika s primarnim invertnim papilomima i karcinomima. Utvrđena je statistički značajna razlika u izraženosti VEGF između skupina bolesnika s primarnim invertnim papilomima u odnosu na skupine bolesnika s recidivom i karcinomom u području pločastog i displastičnog epitela. Dobiveni rezultati upućuju na zaključak da je razlika u izraženosti EGFR i VEGF, kao markera maligne transformacije, važna u razumijevanju patogeneze invertnog papiloma i karcinoma nastalog na osnovi invertnog papiloma. Na osnovi navedenih podataka može se reći da recidiv invertnog papiloma predstavlja „međufazu“ u tumorskoj transformaciji između benigne lezije invertnog papiloma prema karcinomu. To također potvrđuje tezu da je bolesnike s invertnim papilomom potrebno pojačano pratiti, poglavito u slučajevima recidiva koji se mogu pojaviti i godinama nakon primarnog tumora, jer postoji realna opasnost od nastanka karcinoma. Kao rezultat ovoga istraživanja u obzir dokazi i eventualna primjena ciljane terapije (novi „pametni“ lijekovi - monoklonska protutijela, koji ciljano djeluju na tumorske stanice), u bolesnika s recidivom i karcinomom u odnosu na bolesnike s primarnim invertnim papilomom sinusa

Poremećaji glasa u dječjoj dobi

Poremećaji glasa u dječjoj dobi česti su i zahtjevaju što raniju dijagnostiku i liječenje, jer ukoliko se zakasni s liječenjem prelaze u kroničnu promuklost koja dovodi do poremećaja komunikacije u vrlo osjetljivom razdoblju školovanja djeteta. Pristup takvom djetetu ostvaruje se putem multidisciplinarnog tima koji čine ORL liječnik, logoped i psiholog. U našem izlaganju prikazali smo istraživanje koje je obuhvatilo 120 bolesnika, u razdoblju od siječnja 2018. do siječnja 2020. godine, od toga 80 dječaka i 40 djevojčica u dobi od 4 do 18 godina. Dječje glasnice vizualizirane su putem fiberendoskopije i videostroboskopije, a svaki bolesnik procijenjen je od strane logopeda i psihologa. Kod gotovo svih bolesnika provedena je logopedska glasovna rehabilitacija. Od 120 bolesnika s poremećajima glasa, 104 ih je imalo stečeni, funkcionalni poremećaj, dok je 16 bolesnika imalo primarno organsku promjenu na glasnicama, od čega 7 cista glasnica i 8 juvenilnih papilomatoza larinksa. U zaključku možemo reći da najveći broj bolesnika ima stečeni, funkcionalni poremećaj glasa i zahtijeva logopedsku glasovnu rehabilitaciju, dok je prema našem iskustvu kirurško liječenje indicirano u 13% bolesnika