The diagnosis of head and neck squamous cell carcinoma is usually made by visual identification. Searching for a non-invasive optical diagnostic method with the ability to detect the precancerous lesions or second primary tumors earlier in high-risk populations led to the development of photodiagnosis by autofluorescence (AF) endoscopy. The aim of the present study was to evaluate and discuss the diagnostic potential of autofluorescence videoendoscopy as a complementary visual aid in the routine endoscopic diagnosis of head and neck cancers. In a prospective study, 48 patients underwent white light (WL) videoendoscopy followed by AF technique at the Institute of Gustave-Roussy from November 2001 to August 2002. Of 48 patients, 30 had suspected precancerous or cancerous laryngeal lesions, 7 presented benign laryngeal lesions, while 8 showed pharyngeal and 3 oral tumors. All detected lesions were evaluated by histological examination. AF was induced by filtered blue light of a xenon short arc lamp and processed by a CCD camera system (D-Light AF System; Storz, Tuttlingen, Germany). Normal laryngeal mucosa displayed a typical green fluorescence signal. Moderate and severe epithelial dysplasia, carcinoma in situ and invasive carcinoma showed a diminished green fluorescence and presented a marked reddish-blue color. In case of hyperkeratosis a bright white color was detected. Some benign lesions, such as granulomas, polyps and papillomas also displayed altered green fluorescence. Autofluorescence videoendoscopy for photodiagnosis of head and neck squamous cell carcinomas has proved to be a method of high specificity and good sensitivity. Two additional precancerous lesions that were invisible at the WL examination but detected with the AF technique show its potential role in the regular screening procedure or follow-up examination in a high-risk population. It was a very helpful complementary visual aid for the intraoperative control of the surgical margins after per oral endoscopic resection.

The present prospective study was designed to analyze the results achieved with intracordal autologous fat injection for aspiration in a series of 20 patients with recurrent laryngeal nerve paralysis. Swallowing was documented by having each patient swallow puréed food colored with methylene blue during nasofibroscopy. No laryngeal adverse effects were associated with the intracordal injection of fat. One patient developed an abdominal hematoma at the donor site. The intracordal injection of autologous fat after 1 year resulted in an 85% successful rehabilitation of swallowing. One of the three patients who failed the initial rehabilitation of swallowing was managed successfully with reinjection of autologous fat, resulting in a 90% definitive successful rehabilitation of swallowing. In all patients, speech and voice were immediately improved after the intracordal injection of autologous fat. Objective acoustic recordings documented the improvement in selected speech and voice parameters when compared with pretreatment data. Our presented experience shows that the intracordal autologous fat injection is a safe and valuable treatment option in patients with aspiration after recurrent laryngeal nerve paralysis.

Although many reports can be found in the literature about temporal bone holders for postgraduate temporal bone surgery courses, the author did not find any kind of suitable description of a larynx holder for laryngomicrosurgery courses. A cadaver larynx holder is presented, made by the author himself for individual and postgraduate teaching courses. This simple model has been proved already to be a unique and a very useful tool for a practising course on laryngomicrosurgery during two training courses and the instructional session of the IIIrd EUFOS Congress in Hungary in 1996.

The authors performed a retrospective review of their 10-year experience of carotid artery resection with vascular reconstruction for advanced squamous cell carcinoma of the neck. From 1986 to 1997, four patients underwent elective and one patient acute carotid artery resection with revascularization at the Department of Otolaryngology, Albert Szent-Györgyi Medical University, Szeged, Hungary. Primary lesions were three laryngeal and two hypopharyngeal squamous cell carcinomas. All five resected specimens had metastatic invasion by tumor of the carotid adventitia on pathological examination, while only four specimens exhibited tumorous destruction of the arterial wall. No cerebrovascular accident occurred in any patient, although one patient died postoperatively from cardiac failure. The four remaining patients died of local-regional recurrences or metastatic disease within 17 months after their carotid artery resections. Our findings show that carotid artery resection with replacement is superior to ligation alone in avoiding neurological complications. This approach can provide local control of tumor, but may fail to achieve significant disease-free survival.