Background/Objectives: Narrow Band Imaging (NBI) endoscopy is a relatively novel optical biological endoscopic method that enables improved visualization of microvascular patterns and thus, earlier detection of vocal cord cancer. The purpose of this instructional course is to present the diagnostic value of NBI and compare the most commonly used classifications of microvascular patterns.

Methods: The literature was reviewed and our own clinical experience in the use of NBI and enhanced contact endoscopy using NBI were incorporated with an emphasis on Ni's classification and the classification of the European Laryngology Society (ELS) and Puxeddu’s classification.

Results: NBI allows for the precise visualization of mucosal and submucosal vessels and the detection of pathological microvascular patterns associated with malignant transformation. Ni's classification offers a detailed, but complex classification that requires a high level of training. The ELS classification is simpler, based on the dichotomous division of vascular changes into longitudinal and perpendicular ones, allowing for the effective and straightforward differentiation between benign and malignant changes as well as rapid learning. Puxeddu’s classification is intended for use with contact endoscopes coupled to NBI device and high-resolution monitors. Although complex, it provides highly informative clinical data.

Conclusions: NBI is a non-invasive, swift, reliable endoscopic method for the early detection of vocal cord cancer. For optimal results, both profound understanding of microvascular patterns and two-step endoscopic diagnostic procedure are of paramount importance.

Background & Aim:

The pharyngocutaneous fistula (PCF) is the most common complication following a laryngectomy (LE) with a wide range of incidence and various potential risk factors. This study aimed to analyse the variability in the incidence and to identify the underlying causes for fluctuations in incidence rates.

Material & Methods:

In the retrospective study, the annual PCF incidence data and comprehensive clinicopathologic data from 540 patients who underwent TLE between January 2004 and December 2022 were reviewed. Distinct periods of both high and low PCF incidence were identified. Within these periods, patients were categorized into groups with PCF (study groups) and without it (control groups). These groups were statistically compared based on potential risk factors for PCF development. The high-incidence periods were specially analysed for recurring risk factors and the corresponding corrective measures were reviewed.

Results:

The analysis revealed four high-incidence periods with an overall PCF incidence of 37.61%, along with three low-incidence periods in between with an overall incidence of 19.38%. Surgical wound infection (SWI) and a history of head and neck cancer alongside their related treatments were repeatedly identified as independent risk factors during high-incidence periods, with SWI being the most consistent predictor of PCF development.

Conclusions:

Continuous monitoring of PCF incidence is crucial, as it allows for the identification of emerging risk factors and the immediate implementation of corrective measures to mitigate these newly identified risk factors.

Background & Aim:

Pharyngocutaneous fistula (PCF) is the most common complication following salvage laryngectomy (SLE). The preventive use of a pectoralis major flap (PMF) is one strategy to reduce the incidence of PCF. The aim of this study was to evaluate whether the use of PMF in SLE reduces the incidence of PCF.

Material & Methods:

In this retrospective study, patients who underwent SLE were divided into two groups according to the presence or absence of PCF. The groups were compared with respect to the use of PMF using the chi-square and Fisher’s exact tests.

Results:

PCF developed in 39.3% of patients after SLE. Overall, a PMF was used in 34 patients (23.3%), including seven cases (20.6%) in which it was applied prophylactically. The use of PMF did not significantly reduce the incidence of PCF (p = 0.407). Furthermore, no significant differences were found between prophylactic and reconstructive use of PMF (p = 0.427 and p = 0.353, respectively).

Conclusions:

In our series, the preventive use of PMF in SLE did not reduce the incidence of PCF. However, the literature largely supports the effectiveness of vascularized flaps in preventing PCF; therefore, when risk factors are carefully considered, routine use of PMF remains justified.