George A. Velegrakis

Objectives: We present the clinical outcome and long-term survival in patients with medullary thyroid carcinoma treated in a tertiary center. A thorough review of published series and current therapeutic approaches is also addressed. Study Design: A retrospective review Setting: An Academic Tertiary center Subjects/Methods: An analysis of oncologic outcomes from 25 patients treated in our department for medullary thyroid carcinoma is performed, together with a comparison of relevant studies over the literature. Results: The incidence of patients alive free of disease and the 5-year survival rate has been noticed to be slightly higher than the rate reported in most series. Conclusions: Total thyroidectomy and neck dissection remains the gold standard in the treatment of medullary thyroid carcinoma. Early diagnosis and aggressive surgical treatment lead to lower rates of recurrence and invasiveness. Tyrosine-kinase inhibitor, especially vantetanib, appears to be a promising target for treatment.

Background: Management of advanced laryngeal cancer is complex and ideal strategy is yet to be defined. This study evaluates the experience of a single head and neck oncologic centre in the management of T4 laryngeal cancer. Methods: Retrospective assessment of cases primarily treated for T4a squamous cell carcinoma of the larynx, between 1980 and 2007, at a tertiary referral center. Results: A total of 384 cases were studied. Five-year disease specific survival was 56.2% and local control 87.4%. Regional and distal control estimates were 90.3% and 88.3% respectively. Prognosis was significantly superior for cases treated with primary surgery compared to cases solely managed with non-surgical modalities. Positive surgical margins and regional disease worsened prognosis. Conclusion: This study suggests that primary surgery remains a key element in the treatment of advanced laryngeal cancer. The need for well-designed, prospective, randomised studies in order to further evaluate the remaining role of primary surgery in the modern management of locally advanced laryngeal lesions is emphasized.

Recurrent laryngeal nerve (RLN) palsy is one of the most important complications after thyroid and parathyroid surgery. There is controversy in the literature regarding whether or not intraoperative nerve monitoring decreases the risk of injury. We report our experience using Nerve Integrity Monitoring (NIM) system in cases of revision thyroidectomy, providing clear indications for its use. A series of 97 patients who underwent revision thyroidectomy with and without intraoperative NIM alternately was evaluated. There were 121 RLN patients at risk. Use of NIM during revision thyroidectomy was not statistically significant compared to revision operation without monitoring (p value = 0.059). Furthermore, comparison of operative times either with or without NIM showed that use of NIM led to statistically significant prolonged operation time (p value <0.001). There is no strict indication to use RLN monitoring during thyroid surgery, especially as there is no statistical evidence that the use of this technique decreases the incidence of RLN palsy, although there is a trend especially in difficult revision cases.

Ectopic internal carotid artery (ICA) is a very rare variation. The major congenital abnormalities of the ICA can be classified as agenesis, aplasia and hypoplasia, and they can be unilateral or bilateral. Anomalies of the neck artery may be vascular neoplasms or ectopic position. Carotid angiograms provide absolute confirmation of an aberrant carotid artery, while EcoColorDoppler (ECD) gives also important information about the evaluation of carotid vassels. Nevertheless Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) of the neck provide spatial information about the adjacent pharyngeal anatomy and are less invasive than angiogram. Injuries to the ICA during simple pharyngeal surgical procedures can be catastrophic due to the risk of massive bleeding. We report a case of a 56 year-old male patient suffering from dysphagia associated with aberrant ICA manifesting itself as a pulsative protruding of the left lateral wall of the oropharynx.

Laryngomalacia (LRM), is the most common laryngeal abnormality of the newborn, caused by a long curled epiglottis, which prolapses posteriorly. Epiglottis prolapse during inspiration (acquired laryngomalacia) is an unusual cause of airway obstruction and a rare cause of obstructive sleep apnea syndrome (OSAS). We present a minimally invasive technique where epiglottis on cadaveric larynx specimens was treated with CO2 laser. The cartilage reshaping effect induced by laser irradiation was capable of exposing the glottis opening widely. This technique could be used in selected cases of LRM and OSAS due to epiglottis prolapse as an alternative, less morbid approach.

The wide spread of mobile communication since the late 1980 s raises questions about the effects of electromagnetic fields (EMFs) on the human body. Most studies have focused on the non-thermal effects of electromagnetic radiation (EMR). Low-energy EMFs seem to cause structural and functional changes in the cell membrane of different cell types, leading to abnormal cell response. Such changes within the central nervous system (CNS) and auditory system, which directly receive EMR during mobile phone use, are of particular interest. Various studies suggest that EMR directly affects neurons by reducing the neuronal reactivity, increasing the neural membrane conductivity and prolonging their refractory period. Furthermore, although it has been suggested that EMR is related with increased incidence of specific tumors and can interact with known carcinogenic agents, no conclusive evidence exists supporting its role in carcinogenesis. Therefore, no safe conclusions can be drawn regarding the potential harmful effects of mobile phone use. Experiments are underway by our laboratory to investigate possible effects of mobile phone use on the auditory system and the CNS. These along with other studies are expected to further clarify whether mobile phone use truly presents a health hazard.

Traumatic auricular amputation due to human bite is not a common event. Nonetheless, it constitutes a difficult challenge for the reconstructive surgeon. Microsurgery can be performed in some cases, but most microsurgical techniques are complex and their use can only be advocated in specialized centers. Replantation of a severed ear without microsurgery can be a safe alternative as long as a proper technique is selected. We present two cases, one of a partial and one of a total traumatic auricular amputation, both caused by human bites, that were successfully managed in our Department. The technique of ear reattachment as a composite graft, with partial burial of the amputated part in the retroauricular region, as first described by Baudet, was followed in both cases. The prementioned technique is described in detail, along with the postoperative management and outcome of the patients. In addition, a brief review of the international literature regarding ear replantation is performed. The Baudet technique has been used successfully in two cases of traumatic ear amputation due to human bites. It is a simple technique, without the need for microsurgery, and produces excellent aesthetic results, while preserving all neighboring tissues in case of failure with subsequent need for another operation.

Background: In Greece, primary care is still developing. The aim of this study was to define the epidemiologic profile of common otorhinolaryngological, head and neck disorders in order to help general practitioners to deal with them in a primary care future.Methods: A total of 6771 patients attended the Otorhinolaryngology emergency department of the University General Hospital of Heraklion (Crete), between January and December 2004. All cases were included in this retrospective study. The registry of the Otorhinolaryngology emergency department was analysed and age, sex, seasonality and clinical diagnosis were tabulated. All patients were evaluated by Otorhinolaryngologists. The classification of the cases was based on the main symptom or clinical sign that conditioned the reason for seeking care. Diagnoses were also coded according to the International Classification of Diseases (ICD-10).Results: The male to female ratio was 1:1. The mean age for females was 36.3 years standard deviation (SD): 21.1 and for males was 36.8 years (SD = 22.0). Eight hundred eighty six patients (13.1%) formed the paediatric sub-group. Over 60% of the cases were classified in ten major groups of diagnosis. Acute tonsillitis (12.3%) and acute pharyngitis (9.0%) were the most common causes of all medical visits, followed by otitis media (7.6%) and external ear canal obstruction by ear wax (6.2%). Oedema of the larynx was detected in 0.4%. A negative diagnosis of otorhinolaryngological, head and neck disorder was formulated in 553 patients (8.2%). Hospitalization rate was 5.2%. The highest rate of visits was registered in March.Conclusion: Most patients used the facility as a primary care service. Real emergencies were a minority. Recovering data about which areas of Otorhinolaryngology deserve more emphasis might help primary health care providers to diagnose and manage the common otorhinolaryngological, head and neck disorders properly.

Arteriovenous malformations of the head and neck are rare lesions with unclear pathogenesis. They usually present during childhood, growing proportionately to the child. Although preoperative superselective embolization followed by surgical resection is the treatment of choice, complete removal is often not feasible, leading to high recurrence rates. The case of a patient with an arteriovenous malformation of the floor of the mouth diagnosed late in her adulthood and its management are presented.

Keypoints: • The Ligasure^TM Vessel Sealing System (LVSS) provides haemostasis by denaturating collagen and elastin from the vessel wall and surrounding connective tissue.• LVSS is efficient for ligation of vessels of up to 7 mm in diameter, and these seals can withstand a minimum of three times normal systolic pressure.• LVSS delivers a precise amount of energy, according to the grasped tissue's density resulting in limited thermal injury to adjacent tissues.• We report the efficacy of the LVSS device in a case series of total laryngectomy and radical neck dissection procedures. LVSS has proved a reliable device, providing safe and time‐saving haemostasis during these procedures.