Cancer of the larynx and laryngopharynx, which is accessible to visual and instrumental examination, remains the most relevant and complicated problem among head and neck malignances as before. Investigations show that the incidence of cancer at these sites in Russia in the last decade has risen from 4.5 to 9.67 %. This is a severe and poor prognostic form of cancer, which is characterized by its nonspecific early clinical manifestations, complex anatomic and topographic structure, and a high rate of regional metastases. The mainstay of treatment for head and neck cancer involves 3 components: surgery, chemotherapy, and radiotherapy (RT), which are performed alone or in combination. The most commonly used technique is combined, frequently crippling due to organ-removing operations. The clinical introduction of current radio modifiers, local and deep hyperthermia systems, is a promising approach to improving the results of treatment, to enhancing the radiation damage of RT, and to achieving the tumor regression sufficient for surgical intervention without augmenting the early and late toxicity inherent in chemoradiation treatment. The results of the performed study of 35 patients with T2–3N0–2M0 laryngeal and laryngopharyngeal cancer proved the high efficiency of local hyperthermia in treating malignancies in this region during both preoperative (grades III– IV therapeutic pathomorphism) and radical beam RT.

Objective. To minimize surgical trauma in patients with head and neck tumors during microsurgical plasty with visceral autografts.

Subjects and methods. Clinical experience has been gained in the treatment of 53 patients with locally advanced craniofascial (n = 27) and oropharyngeal (n = 36) cancers. Abdominal organs were used for plastic closure of extensive defects after surgical resection. Paraumbilical incision allowing for an adequate approach into the abdominal cavity with minimal external trauma in the anterior abdominal wall was chosen as an access procedure. Video-assisted techniques were used to excise the midline aponeurosis. Donor organs, such as the omentum, greater curvature of the stomach, transverse colon, small intestine) were taken through a mini-laparotomic incision to the anterior abdominal wall, then the vascular pedicle was exposed and a visceral autograft was made. After forming and cutting off the autograft, organ anastomoses were created extracorporeally.

Results. Mini-access surgery could be completed in 50 of the 53 cases (4 patients had previously undergone abdominal interventions). Omental (n = 26), colo-omental (n = 15), gastro-omental (n = 7), and entero-omental (n = 5) flaps were made and prepared for autografting. No intra- or postoperative abdominal complications were found.

Conclusion. Minimally invasive technologies used to create visceral authografts for head and neck tissue repair can minimize surgical trauma and reduce treatment duration. The indications for this access are the debilitating state of a cancer patient or the young age of a patient who does not wish to have an additional scar in the donor region.

Despite broad current diagnostic capabilities, most (60–70 %) patients with larynx cancer seek medical advice only when they have stages III and IV. Until the present time, laryngectomy has remained the most common treatment option for cancer of the larynx and laryngopharynx. Tracheoesophageal shunting with endoprosthesis replacement is one of the most important surgical vocal rehabilitation techniques after laryngectomy. According to different authors» data, the mean lifetime of voice prostheses is 6–12 months. The long-term use of voice prostheses in patients after laryngectomy with tracheoesophageal shunting with endoprosthesis replacement was the object of our investigation.

Patient G., aged 34 years was admitted to the Department of Head and Neck Tumors, Oncology Clinical Dispensary (OCD) One, Moscow Healthcare Department, with a diagnosis of larynx cancer spreading to lymph nodes (LN) (T3N1M0) in the left neck on September 16, 2010. Surgery involving laryngectomy with tracheoesophageal shunting and implantation of a Russian voice prosthesis, as well as radical fascial excision of LN and fat in the neck on the left side were performed on September 21, 2010. During the 4-year use of the voice prosthesis, his voice was sonorous and good. The voice prosthesis was removed in November 2014. Antifungal therapy was used; a new voice prosthesis was implanted. His speech was fluent and his voice was sonorous and good.

Patient M., aged 54 years was admitted to the Department of Head and Neck Tumors, OCD One, Moscow Healthcare Department, with a clinical diagnosis of laryngopharynx cancer (T4N1M0) and an aftereffect of gamma-therapy with a summary focal dose of 42 Gy on November 18, 2003. Surgery involving laryngectomy with laryngopharyngeal resection, tracheoesophageal shunting, and endoprosthesis replacement with implantation of a Russian voice prosthesis, as well as radical fascial excision of LN and fat in the neck on the right side were performed on November 25, 2003. The voce prosthesis was removed in December 2014. Antifungal therapy was performed. A new Russian prosthesis was implanted in the tracheoesophageal shunt. His voice was sonorous and good.

Objective. To investigate the prognostic value of the apoptotic markers (p53) and vascular endothelial growth factor (VEGF) in evaluating the clinical course of juvenile nasopharyngeal angiofibroma (JNA).

Subjects and methods. The investigation enrolled 43 patients with primary JNA (a study group) and 20 with its relapses (a control group). The expression of VEGF and mutant p53 (mtp53) gene was immunohistochemically determined using DAKO kits (Denmark). The results of reactions with antibodies to VEGF-A and mtp53 located in the nuclei and membranes were expressed as percentages in terms of stained cell counts per 100 cells examined in different visual fields.

Results. An associative analysis showed that both study and control group patients with high mtp53 gene expression in the tumor cells had clinical stages IIIA–B and IV and those in whom the expression of this gene in the tumor cells was weak or absent were found to have clinical stages I and II. The high (3+) and moderate (2+) mtp53 gene expressions suggest that the disease is severe. Consequently, this is of prognostic value and a poor predictor and the absence of mutations or the decreased expression of this gene is associated with a favorable disease outcome.

Our investigations indicated that the high expression of the VEGF gene was detected in none of the tumor specimens. In the study group, the tumor cell expression of this gene was found to be moderate (2+) in 18 (41.9 %) patients, weak in 6 (13.9 %) and absent in 19 (44.2 %) of the 43 patients. In the control group, the absence of VEGF gene expression in the tumor specimens was 9 times lower than that in the study group.

A comparison with the clinical characteristics of the patients demonstrated that in both the study and control groups, the VEGF expression was observed to be moderate, or weak and absent in those with clinical stages IIIA–B and IV or in those with stage II and I, respectively.

Conclusion. The associative analysis showed that both study and control group patients with high tumor cell mtp53 expression had clinical stages IIIA–B and IV.

Background. Thyroid cancer (TC) is one of the common oncological disease of the head and neck. However, its treatment is sharply restricted in a locally advanced and metastatic cancer process. In the past decade, there have been fundamental changes in the understanding of the molecular bases of thyroid carcinogenesis, resulting in the design of novel targeted drugs aimed at disseminated and refractory TC control. Multikinase inhibitors that are able to block the processes of proliferation, invasion, and neoangiogenesis are being intensively studied worldwide. Performed placebo-controlled trials have culminated in the registration of the antitumor drugs that is highly active against disseminated medullary and differentiated TC, which will make a change in the situation in treating radioactive iodine-refractory differentiated TC in the near future.

Objective: to review recent advances in the targeted therapy of TC with particular emphasis on lenvatinib, a multikinase inhibitor.

Postsurgical survival is considered to be indicators of treatment efficiency in most cases. However, the sociomedical rehabilitation of patients in this group is no less important; not only life expectancy, but also functional rehabilitation and quality of life are in the lead in patients with Stage III–IVA due to their low 2-year and much lower 5-year survival. The main efficiency criterion is patients, quality of life as compared to antitumor treatment programs in the absence of differences in survival.

As the only chance of cure or life prolongation in most cases, multicomponent surgery for locally advanced and recurrent oropharyngeal cancer may be refused by a patient for fear of being lost to society. Identification of surgical treatment-induced changes in quality of life in patients may be used as a criterion for assessing the performed operations.

The body's changes in a patient with otopharyngeal cancer are associated with impairment of basic physiological functions (deglutition, mastication, and breathing), sensitivity (taste, olfaction, and hearing), and individual characteristics of a human being (for example, appearance and voice). The quality of life is integral characteristics of the physical, psychological, emotional, and social functioning of a patient, which is based on his subjective perception. The methods for studying the quality of life include first of all questionnaires that are classified as general and special ones.

The general questionnaires are intended to assess the quality of life of both healthy individuals and patients regardless of their disease; the special questionnaires are used to study that in certain categories and groups of patients. The general questionnaires allow the comparison of patients with a population of healthy people. Account must be also taken of the fact that the quality of life varies with age and comorbidities. A great deal of procedures for measuring the quality of life in different groups of people determine whether it is expedient to use the most extensively studied method to adequately assess the findings and to compare with previously performed studies.

Examination of changes in the quality of life after saving surgery is a promising line in the study of this disease and may be a success criterion for performed surgical treatment, including palliative care.

Objective. To evaluate the impact of oral hygiene on the development of oropharyngeal malignancies.

Subjects and methods. The data of a prospective study of dental health indicators were analyzed in 586 patients (there were 76.4 % men and 23.6 % women) with oropharyngeal malignancies. In the examinees, the sites of oropharyngeal neoplasms were as follows: the tongue in 195 (33 %) cases, mouth floor in 147 (25 %), oropharynx in 139 (24 %), maxilla in 36 (6 %), buccal mucosa in 21 (4 %), soft palate in 18 (3 %), retromolar area in 14 (2 %), mandibula in 12 (2 %), and nose in 4 (1 %). The patients, examination employed routine dental examinations, determination of oral hygiene index, CFE index (a sum of carious, filled, and extracted teeth), and assessment of a patient, s skill and desire to perform individual oral hygiene. The patient hygiene performance (PHP) index (Podshadley, Haley, 1968) was used to estimate his/her baseline ability. The rates of initial visits made by patients with oropharyngeal tumors to physicians of different specialties were also analyzed.

Results. In the patients with oropharyngeal malignancies, the CFE index was high and amounted to 15 ± 0.4 с with a preponderance of carious and extracted teeth in the pattern; the PHP index was 1.4 ± 0.1, which corresponded to a satisfactory index. Thus, among the comparison group patients, satisfactory oral cavity sanitation was noted in only 4.8 % of the patients having a sanitation certificate. Consequently, 95.2 % of the patients were unready for specialized treatment. Out of the examinees, 176 (30 %) made an initial visit for complaints to a dentist, 155 (26.5 %) to an oncologist, 107 (18.3 %) to an ENT doctor, 103 (17.7 %) to a local therapist, and 43 (7.5 %) to a surgeon. The collected history data also revealed that 59.2 % of the patients had self-treatment before going to specialists (according to them). Self-treatment or treatment by a noncancer specialist was ascertained to take an average of 1 to 3 months, 4 to 6 months, and 6 months to 1 year in 52.4 %, 28.6 % and 19 %, respectively. This factor is responsible for the visits made by patients with stages III–IV cancer to oncology facilities.

Conclusion. It is concluded that the level of oral hygiene practices is low; the state of oral organs and tissues is generally unsatisfactory in the patients with oropharyngeal neoplasms; their dental visits are irregular, and they had mainly self-treatment. Irregular dental visits for oral prophylaxis and an untimely dental search for oral problems lead to the fact that the patients of this category are hospitalized to a specialized institution when they have mainly stages III–IV cancer, which accordingly determines further specialized treatment policy and long-term prognoses. The dentist should make a significant contribution to the diagnosis of maxillofacial malignancies.

After surgical treatment for locally advanced oral tumors with resection of soft tissues, mucosal membrane, and facial skeletal structures, there are penetration combined defects, removal of which is a challenge for reconstructive surgeons. Mandibular repair is one of the problems in the correction of combined oral defects. Surgeons use different grafts to remove mandibular defects. One-flap transplantation does not always solve all reconstruction problems and ensure the repair of the mucosal membrane, a soft-tissue component, skin integuments, and facial skeleton.

The authors describe a clinical case of successful single-stage correction of penetration combined orofacial defect after resection of the tongue, mouth floor, en bloc resection of the lower jaw and mental soft tissues, bilateral cervical supramyochoroidal lymphadenectomy, stage LCL CM mandibular defect formation after J. Boyd, by using two microsurgical autografts (a peroneal skin-muscle-skin autograft and a radial skin-fascia one) in a 39-year-old female patient clinically diagnosed with carcinoma of the left mandibular alveolar ridge mucosa, Stage IVA (T4аN0M0).

The Department of Microsurgery, P.A. Herzen Moscow Oncology Research Institute, Ministry of Health of Russia, has gained experience in comprehensively correcting extensive combined maxillofacial defects with two or more grafts in 27 patients who underwent autografting with a total of 73 flaps. The most functionally incapacitating and life-incompatible defect was removed at Stage 1 of reconstructive treatment. Delayed reconstruction was made after a complex of specialized antitumor therapy and assessment of treatment results in the absence of progressive growth. A great problem during multi-stage defect correction is presented by the lack of recipient vessels after cervical lymphadenectomy, the presence of soft tissue scar changes, trismus, temporomandibular joint ankylosis, contractures and displacement of the edges of the resected mandible, and autografting into the chronically infected area.

Single-stage repair, including that using a few microsurgical autografts, is the operation of choice for adequate anatomic and functional rehabilitation, permits the promptest recovery of patients, reduces a postoperative period, and allows them to undergo an antitumor treatment cycle. However, the repair is possible, when the risk of disease progression is low, in specialized centers and when there are trained head and neck surgery and reconstructive microsurgery specialists and anesthesiologists.