Distant metastases of laryngeal carcinoma are rare and their diagnosis and management are still a challenge for the Otolaryngologist. We present a case of an 56-year-old man with a history of total laryngectomy and selective neck dissection (Level II, III) in the right side two years ago, who presented to our Hospital with a swelling, redness and pain on his left clavicle, without a history of trauma in the above area. Radiological examinations revealed a spontaneous fracture of the left clavicle. Patient underwent surgical procedure of the above area and biopsies were taken from the surgical field and the skin. Metastatic infiltration of the overlying skin cancelled the decision for postoperative radiotherapy or chemotherapy because the closure of the wound would be at risk. Patient discharged having only palliative treatment. We present the prognostic factors, location and management of distant metastases. Surgeons have to keep in mind an index of high risk for distant metastasis based on the previous surgical procedure, the histology and staging of the carcinoma. This could be useful for early diagnosis of metastatic disease in order to improve the quality of life of these patients.

OBJECTIVE:The patient selection for septoplasty usually relies on clinical judgement alone. It is not clear, if surgeons' selection criteria are able to accurately anticipate patients' long term satisfaction as only a few studies exist on the outcome of nasal septal surgery. In this study, we analyze patients' long term satisfaction following septoplasty based on their subjective opinion. MATERIALS AND METHODS:In this prospective study, 67 consecutive patients, who underwent septoplasty during one year in a District General Hospital, were included. We used the fairley nasal symptom questionnaire (FNQ) preoperativeiy and postoperatively and the Glasgow benefit inventory (GBI) postoperatively to assess the outcome. Patients were mailed two questionnaires 2-3 years postoperatively, to evaluate their perception of the procedure's long term results. As a criterion to measure the success of the operation we used the median postoperative FNQ score and patients were divided into two groups, consisting of patients with more and less successful result, respectively. RESULT:Fifty-one patients responded (76%). Analysis of the outcomes revealed significant improvement of total nasal symptom score (FNQ) postoperatively (from mean score 13.25 to 9.09) with significant benefit in the nasal obstruction, sore throat and the sense of smell but not for headaches. Significant improvement in nasal breathing was recorded mainly from patients with anterior septal deviation. Patients in the below criterion group (49%) had a mean GBI total score of 6.3, reporting no satisfaction after surgery, whereas patients in the above criterion group (51%) had a mean of 23.8, which is also not a satisfactory result. Social and physical components of GBI had no difference between groups having considerably low scores. CONCLUSION:The principal benefits of septal surgery are related to improvement in nasal symptoms. In this study GBI results did not reflect a significant change in health status from septoplasty even in the above criterion group. The significant percentage of patients who did not report satisfaction in the long term, questions the objectivity of surgeons' criteria regarding nasal septal surgery. It also indicates that positive evaluation by patients of septal surgery outcome tends to be attenuated with time.

OBJECTIVE:To assess the ability to smell and appreciate food in children with adenoid hypertrophy pre and post-adenoidectomy. METHODS:A total of 35 children with adenoid hypertrophy admitted for adenoidectomy (aged 5-9.3 years, mean age 5.9 years) were tested preoperatively. In a follow up appointment 3 months postoperatively, 28 of them returned and were tested again. The control group consisted of 30 healthy children (aged 5-10.2 years, mean age 6.1 years). Orthonasal olfactory function was assessed psychophysically using "Sniffin sticks" 12 item odor identification test. Retronasal olfaction was assessed using a collection of 12 grocery available powders applied to the oral cavity. RESULTS:Both orthonasal and retronasal olfactory function of the study group preoperatively were significantly lower in comparison with the results of the control group (p<0.0001). The difference in retronasal olfaction between groups was significantly higher in comparison with the difference in orthonasal odor identification (p=0.048). There is a strong correlation between adenoid hypertrophy grade and retronasal testing results (t=-5.461, p<0.0001), but not with the orthonasal results (t=-1.677, p=0.9). Significant improvement of orthonasal and retronasal olfaction was observed in the follow-up appointment (p<0.0001). Relative increase postoperatively was higher for the retronasal olfaction compared to orthonasal olfaction (p=0.0029). CONCLUSIONS:Children with adenoid hypertrophy have a reduced ability to smell, with retronasal olfactory function being more affected. Surgery had a greater impact on retronasal olfaction.

Solitary fibrous tumor (SFT) arises in the pleura and less commonly in extrapleural sites. SFT can be found in various head and neck sites. SFTs of the nasal cavity and paranasal sinuses are extremely rare with only ten previously reported cases in the world literature. This case report presents an additional case of SFT of the nasal cavity underlining the benign pattern and the bleeding tendency of nasal SFT, that surgeons managing these tumors should be aware of. Diagnostic procedure, clinical and histopathological findings as well as immunoreactivity of this tumor are discussed, with a review of the current literature.

Septorhinoplasty is the most difficult and complicated procedure in facial plastic surgery. Because of the complex interdependency of the anatomical parts, alteration of one may have an impact on another. Form and function are completely interwoven in septorhinoplasty. The selection of appropriate candidates involves an understanding of their expectations. Outcome research is a new concept in clinical medicine and its importance is increasingly recognized for the patient management and policy decisions. This study includes an analysis of patients' subjective opinion of the surgical outcome after septo-rhinoplasty, with the use of Glasgow Benefit Inventory (postoperatively) and the Nasal Symptom Questionnaire (pre- and postoperatively). In this study we analyze the patient subjective rating of benefit in 41 consecutive patients who underwent septo-rhinoplasty within the first 8 months of 2001, and had completed a follow up period of more than 6 months postoperatively. The early complication rate was recorded and analyzed along with data regarding the patient satisfaction rate using GBI and NSQ. The response rate was 80%, which is high. Patients had significant improvement in all subscales of GBI (General, Social, Physical) related with a decreased number of nasal symptoms postoperatively and a good aesthetic result.