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Differentiated thyroid carcinomas, particularly papillary carcinoma, are the tumors with good prognosis, but sometimes have a tendency to spread into the surrounding tissue. The spread of these tumors usually involves muscle, cartilage and upper aerodigestive tract. During two years (2008-2009) at the Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Center Zagreb, 233 patients with differentiated thyroid carcinoma were treated. Among them there were 23 cases of locally invasive papillary thyroid carcinoma. In this paper we present our experience in treating 23 patients with locally invasive papillary thyroid carcinoma with special reference to extrathyroid spread, surgery and postoperative treatment. Our recommendations for the treatment of such patients are total thyroidectomy and selective neck dissection, removal of macroscopically visible tumors, radical surgery for tumors with intraluminal expansion in the upper aerodigestive tract and postoperative adjuvant therapy.

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Renal transplantation is associated with increased incidence of cancer. We reviewed a large series of renal transplant recipients to determine the incidence and outcome of patients with malignant changes located at the head and neck. A total of 1232 renal transplant recipients have been followed at Department of Dialysis University Hospital Centre Zagreb from 1972 to 2009. Demographic data, localization and disease outcome were evaluated in patients who developed cancer. Twenty one patients (1.7%) developed 27 head and neck malignancies. The average time from transplantation to development of cancer was 56.8 months. The mean length of follow-up was 9.4+/-4.8 years. Eighteen malignancies were cutaneous in origin and 9 were noncutaneous. Of cutaneous malignancies, 88.9% were basal cell carcinoma; one patient had Merkell-cell carcinoma and one patient developed squamous cell carcinoma. Six cases of basocellular skin cancer were recorded in one fair-skin patient. Noncutaneous malignancies involved the oral cavity (2 cases of Kaposi's sarcoma and one pharyngeal cancer) and the thyroid gland in 3 patients each. Two patients had post-transplant lymphoproliferative disorder occurring at the head and neck. One patient had brain tumor. Radical surgery, radiation, and/or chemotherapy were necessary in 33.3% of patients. Immunosuppression was reduced in all patients, and 12 patients were switched from the calcineurin-based immunosuppression to sirolimus. They all have stable graft function. None of the patients died from cancer. Immunosuppression was ceased in one patient with Kaposi's sarcoma who returned to dialysis and died 10 years later from heart failure. An increased incidence of cancer occurring in the head and neck was recorded. Careful skin examination and oral examination is mandatory for discovering cancer before dissemination. Sirolimus is safe alternative to calcineurin-based immunosuppression in patients who developed head and neck malignancies.

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We present the management of a series of petrous bone cholesteatomas. We performed a retrospective analysis on 28 patients with petrous bone cholesteatoma who underwent surgery between 1991 and 2008 at Lariboisiere Hospital, Paris, France. Main outcome measures included age of patients, surgical approaches, complications, and recurrence. The mean age was 47 years. Five were congenital cholesteatomas and 23 were acquired ones. Seventeen patients had undergone previous mastoid surgery elsewhere. Ninety-six percent of patients presented with hearing loss and 37.5% with facial nerve palsy. The surgical approaches varied according to the classification. Postoperatively, four patients developed facial nerve palsy; two patients, XII nerve paresis; one patient, X nerve paresis; and eight patients, deafness. The mean follow-up was 5 years. Twenty patients had no long-term recurrence. Two cases of petrous apex cholesteatoma presenting with double vision were removed by an endoscopic transsphenoidal approach. Control of the lesion was satisfactory in both cases. However, a minor pontic stroke resulted in transient hemiparesis in the case with dehiscent dura around the petrous bone cholesteatoma. Petrous bone cholesteatoma surgery is difficult. Lateral transtemporal and middle fossa approaches are classically used to remove petrous bone cholesteatoma. Recent progresses in endoscopic surgery, using image guidance system, allow removal of the petrous apex cholesteatoma by an endoscopic transsphenoidal approach with minimal morbidity.

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Nonsquamous carcinomas of the larynx are very rare and present a diverse group of diseases. Timely recognition of these tumors is extremely important for their different origin, appearance, and approach in the treatment and prognosis. Polypoid and submucosal lesions of the larynx are characteristic findings in these tumors, and probably the reason for late diagnosis even in the presence of symptoms. According to cell origin, nonsquamous carcinomas are classified into secretory, connective tissue, lymphoreticular, melanoma, or metastatic carcinoma. In this study, 771 laryngeal carcinomas treated during a 15-year (1990-2005) period at the Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Center Zagreb, were reviewed to yield 11 cases of nonsquamous carcinoma, including one case of neuroendocrine carcinoma, leiomyosarcoma, fibrosarcoma, rhabdomyosarcoma, adenoid cystic carcinoma, and plasmacytoma, 2 cases of chondrosarcoma, and 3 cases of high-grade mucoepidermoid carcinoma. Our experience and treatment results for these tumors are presented.

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A case of massive rhinophyma that produced significant functional and cosmetic difficulties was treated using electrosurgery and carbon dioxide laser. Minimal bleeding occurred during the operative procedure despite grotesque enlargement and high degree of vascularity of the skin and soft tissue. Using this technique, restoration of normal function and excellent cosmetic effect was achieved without any complication.

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The objective of this study is to evaluate the efficacy of the Harmonic ACE, Harmonic FOCUS and harmonic scalpel with 5-mm curved blade in head and neck surgery. During a 15-month period, we performed 295 thyroidectomies, 23 parotidectomies and 45 tonsillectomies using the harmonic scalpel. Control group consisted of 106 thyroidectomies, 9 parotidectomies and 30 tonsillectomies performed with the use of conventional hemostatic techniques. The use of both Harmonic ACE and Harmonic FOCUS scalpel reduced the time of thyroid and parotid surgery by 20-25%. The use of Harmonic ACE reduced the mean time of tonsillectomy, while the use of 5-mm curved blade had no significant effect. Postoperative pain and complication rate were comparable for both the groups. In conclusion, the use of both Harmonic ACE and Harmonic FOCUS devices significantly reduces operative time in the head and neck procedures and enables a smaller neck skin incision in thyroidectomy.

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Sacral perineurial (Tarlov) cysts are rare lesions. Over a seven year period 4000 patients underwent surgery for lumbar disk herniation. In three patients neurological symptoms were caused by large sacral perineurial cysts. Methods of choice for diagnosis of Tarlov cysts are lumbosacral magnetic resonance imaging and computerized tomography myelography. The majority of Tarlov cysts are asymptomatic. In case of large (> or = 1.5 cm) and symptomatic perineurial cyst, as in three patients reported in this article, microsurgical treatment was successful. Although rare, perineurial (Tarlov) cysts must be taken into consideration when approaching to patient with low back and radicular pain. Authors review the medical literature, pathological and pathophysiological features and treatment options of sacral perineurial cysts.

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This article reports a case of an intranasal basal cell adenoma, which is an extremely rare tumor and comprises only 1 to 3% of salivary gland neoplasms. The tumor was removed by intranasal excision with the small alar rhinotomy to facilitate the access. Immunohistochemically the diagnosis of basal cell adenoma was confirmed. There was no recurrence after 24-month follow up. This location of basal cell adenoma has not yet been described in the recent literature.

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With the exception of moderately differentiated neuroendocrine carcinoma of the larynx, neuroendocrine carcinomas are very rare head and neck malignancies. We report a case of a small cell neuroendocrine carcinoma in the petrous apex of the temporal bone. This unusual site for this tumour has not yet been reported in the literature. We confirmed the location and extent of the primary tumour by positron-emission tomography scan. The final histopathological diagnosis was of small cell carcinoma, and this was confirmed by immunohistochemistry. We treated this patient with surgery followed by radiotherapy and chemotherapy. After the treatment was completed there was subtotal remission of the tumour, with no distant metastases.

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