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G, Hornung J, Roedel C, et al. Squamous cell carcinoma of the oropharynx: Ki-67 and p53 can identify patients at high risk for local recurrence after surgery and postoperative radiotherapy. Int J Radiat Oncol Biol Phys 2000; 48: 1041-50. 19. Otero-Garcia J E, Youssef E, Enamorado I, Du W, Yoo G H, Merati K, et al. Prognostic significance of p53 and FHIT in advanced oropharyngeal carcinoma Am J Otolaryngol 2004; 25: 231-9. 20. Ribeiro DA, Nascimento FD, Fracalossi ACC, Gomes TS, Oshima CT, Franco MF. Expression profiling of cell cycle regulatory proteins in


Background: The proteins p16, p53, Bcl-2, and Bax are important cell cycle and apoptotic regulators involved in carcinogenesis and found to have prognostic significance in various cancers. However, the data for squamous cell carcinoma of oral cavity (OSCC) and of oropharynx (OPSCC) are conflicting.

Objective: We sought to determine if expression of p16, p53, Bcl-2, and Bax expression are associated with 5-year overall survival (OS) of patients with OSCC and OPSCC.

Methods: One-hundred thirty-seven cases of OSCC and 140 cases of OPSCC diagnosed from January 2002 to December 2004 at Songklanagrind Hospital, Songkhla, Thailand, were analyzed using a Cox proportional hazards model for 5-year OS in relation to immunohistochemical detection of Bcl-2, Bax, p53, and p16 proteins.

Results: The frequencies of p16, p53, Bcl-2, and Bax expression in OSCC were 13%, 45%, 4%, and 66%, and in OPSCC were 18%, 53%, 22%, and 75%, respectively. In univariate analysis, clinical variables including T stage, N stage and treatment were significantly associated with survival. In multivariate Cox regression, Bax overexpression was significantly associated with poor survival both in OSCC (HR 1.77, 95% CI 1.04-3.01) and in OPSCC (HR 2.21, 95% CI 1.00-4.85). We found no significant association of p16, Bcl-2, and p53 expression with survival.

Conclusion: The expression pattern of p16, p53, Bcl-2, and Bax are similar in OSCC and OPSCC. Only Bax expression has prognostic significance for both tumor sites.


Malignancies in the ENT (Ear, Nose, and Throat) area are mostly manifested by dysphagia, dysphonia, dyspnea, throat swelling, and other “traditional” head and neck symptoms. Sporadically, a primary tumor or metastasis can reach such a size and it can be localized in such an area in which it can cause the pathology of the brachial plexus. If this appears first, differential diagnosis may be more difficult.

In this article the authors review current literature knowledge and present the case of this unusual sign of a head and neck cancer at the Clinic of Otorhinolaryngology and Head and Neck Surgery, Jessenius Faculty of Medicine, Comenius University, and Martin University Hospital, Martin, Slovakia.

analysis system: reliability and validation. J Clin Periodontol , 2001; 28:1158-1162. 13. Chatzigianni A, Halazonetis DJ . Geometric morphometric evaluation of cervical vertebrae shape and its relationship to skeletal maturation. Am J Orthod Dentofacial Orthop , 2009; 136:481.e1-9. 14. Taylor M, Hans MG, Strohl KP, Nelson S, Broadbent BH . Soft tissue growth of the oropharynx. Angle Orthod , 1996; 66:393-400. 15. Linder-Aronson S, Leighton BC . A longitudinal study of the development of the posterior nasopharyngeal wall between 3 and 16 years of age. Eur J Orthod

L . Kent Evidence for Cigarette Smoking as a Major Risk Factor for Periodontitis. J Periodontol , 1993; 64(1):16-23. 13. de Graeff A, de Leeuw JRJ, Ros WJG, Hordijk GJ, Blijham GH, Winnubst JAM . A prospective study on quality of life of patients with cancer of the oral cavity or oropharynx treated with surgery with or without radiotherapy. Oral Onc , 1999; 35(1):27-32 14. Khalili J . Oral cancer: risk factors, prevention and diagnostics. Exp Oncol , 2008; 30:259-264. 15. Radoi L, Luce D . A review of risk factors for oral cavity cancer: the importance of a

cancers among cervical cancer patients and their husbands. Eur J Cancer Prev 2000; 9: 433-7. 20. Ryerson AB, Peters ES, Coughlin SS, Chen VW, Gillison ML, Reichman ME, et al. Burden of potentially human papillomavirus-associated cancers of the oropharynx and oral cavity in the US, 1998-2003. Cancer 2008; 113: 2901-9. 21. Grulich AE, Jin F, Conway EL, Stein AN, Hocking J. Cancers attributable to human papillomavirus infection. Sex Health 2010; 7: 244-52. 22. von Doersten PG, Cruz RM, Rasgon BM, Quesenberry CP Jr, Hilsinger RL Jr. Relation between age and head and


The case presented is one extremely rare of giant tonsil teratoma with oropharynx localization, with palatine left tonsil origin, inducing respiratory failure, swallowing and phonetic disorders.

This paper is based in a study case of a giant tonsil pediculous teratoma with slow evolution, with tolerancy, due to some diagnosis errors, developing respiratory failure and swallowing difficulties.


BACKGROUND. Drug-Induced Sleep Endoscopy (DISE) is a sleep apnea diagnostic procedure which allows direct view the obstruction while inducing sleep using analgosedation with propofol. Many studies highlighted the importance of DISE in finding the level of obstruction and choosing the specific treatment.

MATERIAL AND METHODS. We performed DISE under propofol sedation in 27 patients diagnosed with sleep apnea who addressed to our clinic for further investigation and treatment. We assessed the obstruction type and severity using the Fujita scale, VOTE (velum, oropharynx, tongue base, epiglottis) and NOHL (nose, oropharynx, hypopharynx, larynx). Finally, we correlated the DISE findings with the polysomnographic results.

RESULTS. We observed significant correlations between the obstruction severity seen at DISE and the polysomnographic results. Further, we could decide the appropriate treatment for our patients, whether surgical or not (continuous positive airway pressure - CPAP).

CONCLUSION. Sleep endoscopy represents a very important method in establishing the topographic diagnostic of sleep apnea patients, being useful for the therapeutic decision and the postoperative assessment. We recommend drug-induced sleep endoscopy as elective investigation regarding the diagnostic and treatment of sleep apnea patients.


Background. The increased incidence of accidental or non-accidental ingestion of corrosive substances or drug compounds leading to postcaustic esophagitis represents a major public health issue. The treatment of postcaustic esophagitides is difficult and long lasting, calling for a complex team trained in this borderline pathology: gastroenterologist, general surgeon, otorhinolaryngologist, anesthesiologist, psychiatrist. In cases when preventive treatment has failed, the only effective therapy remains the surgical one.

Material and methods. Our study involved an analysis of the cases treated and/or operated in the Department of General and Esophageal Surgery of the “Sfanta Maria” Hospital in Bucharest, between 1981-2014; respectively 195 patients who benefited from reconstructive esophageal interventions. Of the selected patients, 191 were operated for corrosive pathology produced by ingestion of caustic soda and only four cases by ingestion of acids. The lesion balance showed that, besides the esophagus, the oropharynx (28 patients), the larynx (7 patients) and the stomach (31 patients) had been affected by the corrosion process, requiring particular surgical solutions. The bypass reconstruction (preserving the esophagus) was the standard treatment, esophagectomy having been performed in only 4 patients.

Results. The main remote postoperative complaint was feeding inability, a consequence of various causes: cervical anastomosis stenosis, motor dysfunctions of the graft or of the laryngopharyngeal complex, over-time alteration of the graft, technical vices or the degradation of intra-abdominal assemblies, traumatic injuries of the presternal substituent.

Conclusion. One of the most important moments during the esophageal reconstruction surgery remains the duration of the cervical anastomosis, since the postoperative complication rate and the remote functional outcome depend on it. Minimizing postoperative risks and complications requires a complete mastery of surgical methods, of the small technical “artifices” and of the necessary therapeutic refinements adapted to each individual case.


Introduction: Due to the effect of radiation on both the tumor and the surrounding normal tissues, the side effects of radiation in normal tissues are expected. One of the important complications in the head and neck radiotherapy is the doses reached to the larynx and spinal cord of patients with non-laryngeal head and neck tumors.

Materials and Methods: In this study, CT scan images of 25 patients with non-laryngeal tumors including; lymph nodes, tongue, oropharynx and nasopharynx were used. A three-field and a four-field treatment planning with and without laryngeal shield in 3D CRT technique were planned for each patient. Subsequently, the values of Dmin, Dmean, Dmax and Dose Volume Histogram from the treatment planning system and NTCP values of spinal cord and larynx were calculated with BIOPLAN and MATLAB software for all patients.

Results: Statistical results showed that mean values of doses of larynx in both three and four-field methods were significantly different between with and without shield groups. Comparison of absorbed dose didn’t show any difference between the three and four field methods (P>0.05). Using Shield, just the mean and minimum doses of spinal cord decreased in both three and four fields. The NTCP of the spinal cord and larynx by three and four-field methods with shield in the LKB and EUD models significantly are less than that of the three and four fields without shields, and in the four-field method NTCP of larynx is less than three radiation field.

Conclusion: The results of this study indicate that there is no significant difference in doses reached to larynx and spinal cord between the treatments techniques, but laryngeal shield reduce dose and NTCP values in larynx considerably.