Palmitoylethanolamide is a disease-modifying agent in peripheral neuropathy : pain relief and neuroprotection share a PPAR-alpha-mediated mechanism

Peer reviewedPublisher PD

Risk Factors for Multiple Malignancies in the Head and Neck

Original research articl

Tonsillectomy and residents: a safe match?

Letter to the Edito

Effectiveness and pitfalls of elective neck dissection in N0 laryngeal cancer

The aim of the study was to evaluate the efficacy and potential pitfalls of selective neck dissection of levels II-IV in controlling occult neck disease in clinically negative neck (cN0) of patients with laryngeal squamous cell carcinoma. Charts of 96 consecutive cN0 laryngeal cancer patients undergoing 122 neck dissections at the University of Florence from January 2000 to December 2004 were reviewed. N0 neck was defined with contrast enhanced computed tomography scan. Occult neck disease rate was 12.5%, involvement per level was: 47.6% at level II, 38.1% at level III, 9.5% at level IV. Six patients developed neck recurrence (6.25%) after selective neck dissection of levels II-IV within the first two years after treatment. In conclusion, selective neck dissection of levels II-IV is effective in N0 laryngeal squamous cell carcinoma; posterior limits of surgical resection are missing therefore if post-operative radiation is required, the field should be extended beyond the dissected levels. The low incidence of occult neck disease indicates the need to refine treatment strategy, restricting elective neck dissection only to supraglottic T2 with epilaryngeal involvement, supraglottic T3-4 and glottic T4 tumours, and considering a "wait and see" protocol implemented with imaging techniques and cytological assessments for other lesions

Tobacco exposure and complications in conservative laryngeal surgery.

Smoking is an important risk factor in the development of head and neck cancer. However, little is known about its effects on postoperative complications in head and neck cancer surgery. We performed a retrospective analysis on 535 consecutive laryngeal cancer patients submitted to open partial laryngectomy at the Otolaryngology-Head and Neck Surgery Department of Florence University to evaluate a possible correlation between smoking and surgical complications. Patients were grouped in non smokers and smokers and evaluated for airway, swallowing, local and fistula complications by multivariate analysis: 507 (95\%) patients were smokers, 69\% presented supraglottic, 30\% glottic and 1\% transglottic cancer. The most common operation was supraglottic horizontal laryngectomy in 58\%, followed by supracricoid partial laryngectomy in 27\% and frontolateral hemilaryngectomy in 15\% of cases. The incidence of overall complications was 30\%, airway complications representing the most frequent (14\%), followed by swallowing (7\%), local (6\%) and fistula complications (3\%). Smokers developed more local complications (p = 0.05, univariate, p = 0.04, multivariate analysis) and pharyngocutaneous fistula (p = 0.01, univariate, p = 0.03, multivariate analysis)

Spontaneous internal carotid artery rupture during neck dissection in osteogenesis imperfecta patient.

Several connective tissue disorders are associated with vascular wall abnormalities, including spontaneous dissection of the cervical arteries. Osteogenesis imperfecta (OI) is a hereditary disorder, with rare neurovascular complications, which potentially lead to life-threatening events.We presented a case of spontaneous internal carotid artery (ICA) rupture that occurred in a 52-year-old-woman, suffering from OI type I, and who underwent a bilateral modified radical neck dissection (mRND) plus total thyroidectomy for a T4aN1b thyroid cancer. During mRND, an ICA's spontaneous rupture occurred.Histopathologic report suggested a structural defect of the arterial wall without cancer infiltration. The patient did not experience any neurologic complications.Head and neck surgeons have to be aware about early clinical recognition of possible cervical vascular abnormalities, in patients with connective tissue disorders, potentially responsible for dramatic vascular rupture during cervical surgical procedures

Allergic fungal rhinosinusitis infiltrating anterior skull base and clivus.

Bone erosion and skull base invasion are often suggestive of a malignant mass in paranasal and nasal cavities. Nevertheless, forms of chronic rhinosinusitis, such as allergic fungal rhinosinusitis (AFRS), could mimic malignant features. Here, we report AFRS patient with orbital, anterior cranial fossa, Turkish saddle and clivus erosion. A 48-year-old Caucasian female with history of drug-resistant headache, nasal obstruction and anosmia was referred to our institution. Imaging showed hyperdense featureless tissue with signs of medial orbital wall, cribiform lamina and clivus erosions and encasement of right internal carotid artery. Massive amounts of thick and grayish mucoid material were evacuated during surgery. In case of bony erosion, malignancy should always be excluded. Often the correct diagnosis will be obtained only by operative specimens. AFRS could usually be managed endoscopically. Appropriate medical management of the AFRS should be administered in order to prevent relapses