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References 1. Silver CE, Beitler JJ, Shaha AR, Rinaldo A, Ferlito A. Current trends in initial management of laryngeal cancer: the declining use of open surgery. Eur Arch Otorhinolaryngol 2009; 266: 1333-52. 2. Casper JK, Colton RH. Clinical manual for laryngectomy and head and neck cancer rehabilitation. San Diego, California: Singular Publishing Group, INC.; 1993. p. 55-78. 3. Hočevar Boltežar I, Šmid L, Žargi M, Župevc A, Fajdiga I, Fischinger J, et al. Factors influencing rehabilitation in patients with head and neck cancer. Radiol Oncol 2000; 34: 289-94. 4

Abstract

Background and objectives: Laryngectomy with extensive extirpational neck dissection is still the treatment of choice for patients with advanced laryngeal cancer. During the initial part of laryngectomy – tracheostomy, there is a significant upper airway obstruction, caused by the cancer process itself and worsened by surgical pressure and manipulation during creation of tracheostomy. This study aims to make comparative assessment of the patient’s hemodynamic parameters, operated using three of the most popular approaches during tracheostomy: local anesthesia with preserved spontaneous ventilation; general anesthesia with ventilation by endotracheal intubation and general anesthesia with ventilation by laryngeal mask airway.

Methods: A prospective cohort study was conducted in a tertiary referral center. Sixty patients with advanced laryngeal cancer appointed for total laryngectomy, were enrolled in the study. They were randomly assigned into three groups, according to the ventilation method used during the tracheostomy.

Results: Patients who underwent tracheostomy under local anesthesia displayed statistically the highest levels of SAP, DAP, MAP and heart rate intraoperatively. The group of patients who underwent tracheostomy with endotracheal intubation, also displayed significantly higher levels of hemodynamic parameters during the procedure compared with the group with laryngeal mask airway ventilation, despite the fact that both groups were under general anesthesia.

Conclusions: To our knowledge, this is the first study to demonstrate that laryngeal mask ventilation during tracheostomy improves intraoperative hemodynamic stability in patients undergoing total laryngectomy compared to endotracheal intubation.

Abstract

BACKGROUND. Even if it is a rare variant growth pattern of squamous cell carcinoma, sarcomatoid carcinoma seems to have almost the same clinical manifestations and risk factors as conventional squamous cell carcinoma.

CASE REPORT. This paper presents a complex case of a 59-year-old female patient known with laryngeal papillomatosis, who presented in our Department for moderate to severe inspiratory dyspnea associated with dysphonia and difficulty in swallowing. We mention that the patient had been previously evaluated by a pneumologist for apnea, snoring and daytime sleepiness and diagnosed and treated for sleep apnea syndrome. Clinical, laboratory, imaging and pathologic examinations revealed the association of upper airway obstruction with laryngeal cancer. Surgical intervention consisted in total laryngectomy and selective neck dissection associated with permanent tracheotomy. The microscopic appearance was that of a bilateral transglottic sarcomatoid squamous cell carcinoma without metastasis in the right lymph node.

CONCLUSION. It is important to evaluate the clinical and imagistic status of patients with laryngeal tumors in order to make a correct decision concerning their treatment policy. We emphasize that cooperation between multiple departments is absolutely necessary in order to adequately resolve, explore, diagnose and treat patients with laryngeal pathology.

Background. Treatment planning for head and neck (H&N) cancer is complex due to the number of organs at risk (OAR) located near the planning treatment volume (PTV). Distant OAR must also be taken into consideration. Intensity-modulated radiotherapy (IMRT) and three-dimensional conformal radiotherapy (3D-CRT) are both common H&N treatment techniques with very different planning approaches. Although IMRT allows a better dose conformity in PTV, there is much less evidence as to which technique less dose to OAR is delivered. Therefore, the aim of the study was to compare IMRT to 3D-CRT treatment in terms of dose distribution to OAR in H&N cancer.

Patients and methods. This was a prospective study of a series of 25 patients diagnosed with stage cT3-4N0-2 laryngeal cancer. All patients underwent total laryngectomy and bilateral selective neck dissections. In all cases, patients were treated with IMRT, although a 3D-CRT treatment plan was also developed for the comparative analysis. To compare doses to specific OAR, we developed a new comparative index based on sub-volumes. Results. In general, IMRT appears to deliver comparable or greater doses to OAR, although the only significant differences were found in the cerebellum, in which 3D-CRT was found to better spare the organ.

Conclusions. Organs located outside of the IMRT beam (i.e., distant organs) are generally thought to be well-spared. However, the results of this study show that, in the case of the cerebellum, this was not true. This finding suggests that larger studies should be performed to understand the effects of IMRT on distant tissues. Anthropomorphic phantom studies could also confirm these results.

References 1. Addams GL, Maisel RH. Malignant tumors of the larynx and hypopharynx. In: Cummings WC, Flint PW, Harker LA, editors. Otolaryngology - head & neck surgery. Philadelphia: Elsevier Mosby; 2005. p. 2222-83. 2. Barr GD, Robertson AG, Liu KC. Stomal recurrence: a separate entity? J Surg Oncol 1990; 44: 176-9. 3. Griebie MS, Adams GL. “Emergency” laryngectomy and stomal recurrence. Laryngoscope 1987; 97: 1020-4. 4. Halfpenny W, McGurk M. Stomal recurrence following temporary tracheostomy. J Laryngolo Otol 2001; 115: 202-4. 5. Campbell AC, Gleich LL, Barret

., Williamson P., Conboy P., Penney S., Wood H. - Pre-treatment clinical assessment in head and neck cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol., 2016;130(Suppl 2):S13-S22. 15. Haubner F., Ohmann E., Pohl F., Strutz J., Gassner H.G. - Wound healing after radiation therapy: Review of the literature. Radiat Oncol., 2012;7:162. doi: 10.1186/1748-717X-7-162. 16. Clark J.H., Feng A.L., Morton K., Agrawal N., Richmon J.D. - Neck incision planning for total laryngectomy with pharyngectomy. Otolaryngol Head Neck Surg., 2016;154(4):650-656. 17

. Morland B, Cox G, Randall C, Ramsay A, Radford M. Synovial sarcoma of the larynx in a child: case report and histological appearances. Med Pediatr Oncol 1994; 23: 64-8. 15. Ferlito A, Caruso G. Endolaryngeal synovial sarcoma. An update on diagnosis and treatment. J Otorhinolaryngol Relat Spec 1991; 53: 116-9. 16. Pruszczynski M, Manni JJ, Smedts F. Endolaryngeal synovial sarcoma: case report with immunohistochemical studies. Head Neck 1989; 11: 76-80. 17. Quinn HJ Jr. Synovial sarcoma of the larynx treated by partial laryngectomy. Laryngoscope 1984; 94

N.M., Frisch T., von Buchwald C. - Postoperative improvement in acoustic rhinometry measurements after septoplasty correlates with long-term satisfaction. Rhinology, 2013;51(2):171-175. doi: 10.4193/Rhino12.163. 5. Dinis P.B., Haider H. - Septoplasty: long-term evaluation of results. Am J Otolaryngol., 2002;23(2):85-90. 6. Skoloudik L., Vokurka J., Zborayova K., Celakovsky P., Kucera M., Ryska A. - Cytology of the nasal mucosa after total laryngectomy. Acta Otolaryngol., 2009;129(11):1262-1265. doi: 10.3109/00016480802654398. 7. Holmström M. - The use of objective

-3016(02)02712-8 Eisbruch A Lyden T Bradford CR Dawson LA Haxer MJ Miller AE Objective assessment of swallowing dysfunction and aspiration after radiation concurrent with chemotherapy for head and neck cancer Int J Rad Oncol Biol Phys 2002 53 23 8 10.1016/S0360-3016(02)02712-8 13 Ward EC, Bishop B, Frisby J, Stevens RM. Swallowing outcomes following laryngectomy and pharyngolaryngectomy. Arch Otolaryngol Head Neck Surg 2002; 128: 181-6. 10.1001/archotol.128.2.181 Ward EC Bishop B Frisby J Stevens RM Swallowing outcomes following laryngectomy and pharyngolaryngectomy Arch Otolaryngol

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 published recording containing pronunciations of polish surnames and proper names), and  above all the various aspects of diagnosis and therapy of speech recognition and production:  diagnosis and rehabilitation of  the speech of  laryngectomy patients  (including  the use of  a prototype artificial larynx), diagnosis of defects in children’s pronunciation, early detec- tion and rehabilitation of hearing disorders in children, and the use of speech visualisation  as a tool for the revalidation of deaf people. a confirmation and supplementation of the diversity of the