Browsing by Author "Dimitrijević, Milovan (25642808400)"

Introduction. Late metastases of malignant tumors in the temporal bone are very rare lesions. They can be asymptomatic for a long time and usually manifest themselves in the form of hearing loss, dizziness, tinnitus, and paralysis of the facial nerve. Modern radiological diagnostics and explorative surgery with biopsy are essential for diagnosis. Case report. We present a rare and unusual case of a 66-year-old female patient with facial nerve paralysis that appeared as the first sign of metastatic breast cancer in the temporal bone 10 years after treatment. A sudden hearing loss and dizziness occurred six months later, and the value of CA 15-3 was elevated. Scintigraphy pointed to susceptible metastatic deposits of the axial skeleton without lesions in the temporal bone. Finally, repeated computed tomography revealed osteolytic changes in the temporal bone six months after that. Immunohistochemical analysis of mastoid tissue samples confirmed that it was a breast cancer metastasis. One year after palliative radiotherapy and oral hormone therapy, a patient had a good general condition with a better function of the facial nerve. Conclusion. A high degree of clinical suspicion sometimes requires repeated radiological diagnostics in order to detect osteolytic metastatic changes in the temporal bone but also in other bone structures within the hematogenous dissemination of the malignant disease. © The Author(s) 2022.

Introduction. Metastatic head and neck carcinoma (HNC) from an unknown primary tumor is defined as a metastatic disease in the neck's lymph nodes without evidence of a primary tumor after appropriate investigation. Multiple na-tional guidelines recommend taking essential steps in diag-nostic protocols which involve a detailed clinical exam with radiological imaging, fine-needle aspiration (FNA) biopsy of the cervical tumor, esophagogastroduodenoscopy (EGD) with palatine and lingual tonsillectomy, immunohistochemi-cal staining, and human papillomavirus (HPV) detection. Treatment of HNCs of unknown primary origin involves surgery (neck dissection) with radiotherapy (RT), while some authors recommend chemo-radiotherapy in cases of advanced regional disease. Case report. A 44-year-old male was referred to the tertiary medical center because of a large ulcero-infiltrative cervical mass on the right side. Examina-tion of the head and neck and flexible nasopharyngolaryn-geal endoscopy was conducted, followed by computed to-mography (CT) of the head, neck, and thorax with intrave-nous contrast. The primary localization of the tumor was not confirmed by these diagnostic methods. An open biop-sy of the neck mass established a histopathology diagnosis of metastatic squamous cell carcinoma (SCC). Results of EGD with biopsies and bilateral tonsillectomy were nega-tive for malignancy. Treatment included extended radical neck dissection with reconstruction and postoperative ipsi-lateral RT. The patient presented with an extensive pharyn-golaryngeal tumor five years after the first surgery. Biopsy with histopathology examination confirmed the diagnosis of SCC. Conclusion. A structured step-by-step diagnostic ap-proach to identifying the primary site of the metastatic HNC is mandatory. Substantial advances in diagnostics and operative techniques have increased the likelihood of prima-ry tumor identification and detection of the disease's region-al and systemic spread. The purpose of adherence to guide-lines results in higher overall survival and longer regional disease-free survival in these patients. © 2022 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

Introduction. The reconstruction of columella defects is still regarded as a challenging procedure due to the very specific anatomy of the columella and limited local and regional flap options. Furthermore, the texture and color of columella tis-sue pose difficulties in choosing the right method of recon-struction. Case report. The report presents a patient who un-derwent reconstruction of a complex columella defect using a Schmid-Meyer flap. Schmid-Meyer flap represents a tubular flap with an internal supraciliary pedicle which allows the transposition of the temporal skin with the addition of ear carti-lage on the tip of the nose or the ala nasi. The integration of the flap was complete. During the five-year follow-up period, the cosmetic and functional results were satisfying. Conclu-sion. Schmid-Meyer flap may be one of the best options for the reconstruction of complex defects of the columella. © 2022 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

Intraoperative bradycardia (IOB) is one of the most common cardiac arrhythmias observed in clinical anaesthetic practice. Controlled hypotension, as a strategy of lowering patient’s blood pressure during anesthesia has been practiced for decades in head and neck surgery. The aim of our study was to determine the incidence and the risk factors for intraoperative bradycardia in maxillofacial, ear, nose and throat surgery, as well as to determine whether controlled hypotension affects the occurrence of IOB. The retrospective study included 2304 patients who underwent maxillofacial, ear, nose or throat surgery. We studied the influence of: sex, age, comorbidity, type of surgery, duration of anesthesia and controlled hypotension on the occurrence of IOB. IOB was registered in 473 patients (20.5%). Patients with controlled hypotension had IOB significantly more often than patients without controlled hypotension (33.9 vs 15.1%) (p = 0.000). The significant predictors of IOB were: age (OR = 1.158; 95% CI = 1.068–1.256; p = 0.000), sex (OR = 0.786; 95% CI = 0.623–0.993; p = 0.043), ischemic heart disease (OR = 2.016; 95% CI = 1.182–3.441; p = 0.010); ear surgery (OR = 1.593; 95% CI = 1.232–2.060; p = 0.000), anesthesia duration, (OR = 1.006; 95% CI = 1.004–1.007; p = 0.000) and controlled hypotension (OR = 2.204; 95% CI = 1.761–2.758; p = 0.000). IOB is common in maxillofacial, ear, nose and throat surgery, particularly in male, older age and patients with ishemic heart disease. The ear surgery, longer anesthesia duration and controlled hypotension raise the risk for occurrence of IOB. © 2017, Springer-Verlag GmbH Germany, part of Springer Nature.

Background/Aim. The oral cavity and oropharyngeal cancers are among the most common cancers worldwide with the multifactorial etiology. The aim of this study was to determine the major risk factors among patients with oral cavity and oropharyngeal tumors in Serbia. Methods. A total of 63 patients with biopsy proven malignant (33 patients) or benign (30 patients) oral cavity or oropharyngeal lesions were included in this study. The data about gender, age, smoking habits and alcohol consumption were obtained from the routine medical files. The detection and genotyping of human papillomavirus (HPV) was done in paraffin embedded tissue samples using in situ hybridization. Results. Malignant lesions were more frequent in men, smokers and patients who consume alcohol with a statistically significant difference compared to the patients with benign lesions. The prevalence of HPV infection was higher in patients with malignant lesions compared to patients with benign lesions, but without statistically significant difference. High risk genotypes were detected only in patients with malignant lesions of tonsils and base tongue cancer, while low risk types were demonstrated in patients with benign lesions with a highly statistically significant difference. Conclusion. The results point to the significant association of tobacco smoking, alcohol consumption and high risk HPV genotypes as risk factors for oral cavity and oropharyngeal carcinomas in Serbian patients. © 2020 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.