Pseudo-aneurysm of the external carotid artery: report of a case

The authors report a case of left otorrhagia in a 1-year-old male infant in the presence of a mass involving the parotideal and upper cervical regions, which had appeared after an infection of the upper airways. Non-invasive techniques, such as echography and CT scan, provided useful but contradicting information. Surgery allowed us to define the diagnosis of mycotic aneurysm of the external carotid artery. The authors, after pointing out the extreme rarity of such a pathology, discuss the ethiopathogenetic theories, the clinical features, the diagnosis and the surgical and medical treatment of the disease. Concerning surgery ligation of the external carotid artery is the treatment of choice, since distally the blood flow is provided by a conspicuous collateral circle and because a possible postoperative septic dissemination is avoided

Impact of COVID-19 and post-infectious course on the olfactory function: "Restitutio ad integrum" or permanent deficit?

The experience of our center with patients who, after having overcome the SARS-CoV19 infection, manifested olfactory disorders includes 1952 patients who were evaluated, according to the protocol established in multidisciplinary agreement with internal medicine and infectious disease specialists, through ENT physical examinatio, questionnaires, olfactometry and gustometry (before and after treatment). Our goal was to evaluate: the prevalence of smell and taste disorders in patients affected by SARSCoV19, the resolution of the mentioned disorder based on the treatment protocols and eventually a possible correlation with patients not affected by the SARS-CoV19 infection. Our evaluation method included: Chemosensory Complaint Score, three VAS scales for olfactory and gustatory dysfunction and nasal obstruction symptoms, full ENT evaluation (rhinoscopy, oropharyngoscopy, evaluation of larynx and tympanic membranes). In the context of the DH PostCovid, an olfactory deficit was observed in 24.3% of cases; the questionnaire submitted to the patients during the acute phase of the infection tended to overestimate the incidence of the symptoms, but this data is likely related to the psychological impact of the disease itself during the early stages of the pandemic. In a period ranging from 2 to 9 months (M 5.5 months), we found a subjective and olfactometrically detected recovery of the olfactory function in almost all patients (98.6%); in only one case the recovery was obtained 13 months after the first evaluation. Among these patients, 65% of them regained the olfactory function during the first 3 months of therapy. Our therapy protocol consisted of: either topical use of glyceritic acid plus mannitol for topical use in case of inflamed nasal mucosa or crosslinked ialuronic acid for topical use in case of atrophic rhinitis together with citicoline 1000mg per os and olfactory rehabilitation. Once having obtained these data, and keeping in mind that the therapy was personalized and modulated on the basis of the conditions found at the physical evaluation for each patient (presence or absence of significant nasal dryness, allergic rhinitis, etc.), and although the "unpredictability" of this pandemic imposes a certain caution on us, we can affirm that it is not frequent, in our series of cases, the persistence of the olfactory deficit in patients with previous SARS-CoV19 infection and that indeed the restitutio ad integrum is the most frequent of the eventualities

Oncological and functional outcome of conservative surgery for primary supraglottic cancer

The aim of this study was to verify the oncological and functional outcome of conservative surgical treatment of primary supraglottic squamous cell carcinoma (SGSCC) and related neck disease in order to verify the effectiveness of supraglottic laryngectomy (SL) and the validity of an "observation" policy in the control of clinically negative (NO) necks. Of a total of 252 consecutive patients affected by primary SGSCC seen between 1975 and 1990 at the Department of Otolaryngology of the University of Perugia (1975-1987) and the Catholic University of the Sacred Heart of Rome (1988-1990), a subset of 132 patients treated with classical SL was evaluated after presenting sufficient clinicopathological data and a follow-up period of at least 5 years. Tumors were staged according to the 1992 UICC TNM classification and grouped into stages I-II (n = 94) and III-IV (n = 38). Comprehensive neck dissections were performed only in the clinically positive (N+) necks (25/132 cases), while in the clinically NO ones (107/132 cases) an "observation" policy under strict follow-up conditions was adopted. After primary surgery, the 5-year relapse-free survival (RFS) was 74%. The RFS was 80% for T1-2 disease and 65% for T3. The RFS was 80% for stages I-II tumors and 71% for stages III-IV. The actual 5-year overall survival (OS) was 89% for T1-T2 tumors and 67% for T3 disease or 93% for stages I-II and 69% for stages III-IV. The OS was 89% for NO neck and 73% for N+. The 5-year-metastasis-free survival (MFS) was 83% for NO patients, 74% for N+, 84% for T1-T2 NO, 71% for T1-T2 N+, 81% for T3 NO and 68% for T3 N+. In all, SL was found to be highly effective in the management of primary SGSCC. In the presence of clinically NO neck "observation" under strict follow-up with therapeutic comprehensive neck dissection for delayed nodal recurrence, SL was suitable for controlling the neck cancer, as well as for salvaging recurrent disease. Bilateral elective, selective or functional neck dissection in every instance of supraglottic cancer was best performed only in those SGSCC patients who were more likely to have occult nodal disease on the basis of biological factors and imaging data

Multidisciplinary management of anemia behind epistaxis in HHT

HHT affects one in 5000 people and occurs in all the ethnic groups and areas. It is also known as the Rendu-Osler-Weber disease and it is an inherited autosomal dominant genetic disorder, characterized by vascular abnormalities. Epistaxis, specifically recurrent and spontaneous nosebleeds, has been assessed as one of the most common, if not the most common clinical manifestation in HHT patients. The burden related to this manifestation has both psychological and physical consequences, especially since the treatment options follow a ladder that might bring to surgery and more invasive therapies. The EQ-VAS questionnaire allows us to adequately assess and classify HHT patients based on the intensity and type of epistaxis-related symptoms. This same questionnaire, which is submitted to patients during each evaluation for the benefit of anamnestic supplementation, includes both a question about the presence or absence of anemia and one about whether a red cell transfusion has been performed in the past months or since the last outpatient visit. As a matter of fact, chronic nosebleed, although mild to moderate, can lead to anemia within months or years and, in general, to a poor quality of life. Patients who have to undergo iron supplementation treatments often face the almost inevitable side effects that this therapy entails (diarrhea, constipation, nausea, persistent metallic taste, abdominal pain, etc.). Although numerous treatment options are available for patients with epistaxis phenotype, from topical to surgical, we believe, based on the successes achieved in the follow up of HHT patients at our center, that a multidisciplinary collaboration is essential to identify the patients who can benefit most from each treatment

Midfacial fractures: our experience.

Authors report their experience in the treatment of midfacial fractures in 201 patients, 177 of whom underwent surgery for reduction and fixation of the fracture. Since no functional or aesthetic deficits were present, surgery was not performed in the remaining 24 cases. Of the 177 patients, the maxillary complex was involved in 70 (classified as central and centro- lateral fractures), the zygomatic-maxillary-orbital complex in another 70, isolated fractures of the orbital floor blow-out in 18, and. isolated fractures of the zygomatic arch in 19. The re- sults obtained and the degree of satisfaction were evaluated in 90 patients with clinical visits, as well as by telephone inter- view. A total of 88 patients expressed complete satisfaction with the results of the surgical outcome, while the remaining 2 patients were not satisfied with the aesthetic outcome. All pa- tients were operated within 24-48 hours post-trauma in the case of incarceration of extrinsic ocular muscles, and within 10 days in other types of trauma, even in those patients in inten- sive care. The importance of clinical and radiological pre-op- erative diagnosis is stressed as well as the choice of the most suitable therapeutic approach for the different types of frac- tures, considering recent tendencies towards minimally inva- sive procedures to achieve better cosmetic results. The latest developments in fixation techniques with reference to titanium mini- and/or micro-plates that may eventually be substituted with absorbable materials are discussed

Study on normal and otosclerotic bone cell cultures: an advance in understanding the pathogenesis of otosclerosis

The authors first reviewed the main theories concerning the pathogenesis of otosclerosis and studied the morphologic and functional characteristics of cell cultures derived from normal and otosclerotic bones. Light transmission and scanning electron microscopy did not permit definite identification of the cultured cells as predominantly osteoblasts, nor did these techniques show significant differences between cultured cells derived from normal and pathologic bone. Functional tests of the cell cultures proved more interesting. First, the bony nature of the cultured cells was demonstrated by studying the intracellular 45Ca++ uptake after stimulation with calcitonin and dybutryl-cAMP. Second, cell cultures derived from otosclerotic bone behaved differently from those derived from normal bone. Their peak uptake of calcium appeared later, and post-stimulatory values were higher, suggesting that cells derived from otosclerotic bone store a greater quantity of 45Ca++. Furthermore, after stimulation with calcitonin and propranolol, we observed an inhibition of the calcium uptake and decreased intracellular cAMP levels in normal bone cell cultures. In contrast, the cell cultures derived from otosclerotic bone exhibited an initial inhibition of calcium absorption followed by massive calcium penetration. The response of adenylate cyclase to the action of Mg++, Ca++, and F− ions was evaluated in cultures derived from normal bone, otosclerotic bone, and normal skin fibroblasts. The resulting data show that activation due to Mg++ is much lower in cultured cells derived from otosclerotic bone than in those from either normal bone or skin fibroblasts. No significant differences were found after Ca++ inhibition in any of the cell cultures. Moreover, in cell cultures derived from normal bone, F− ions induced a strong activation that was lower than the levels observed in cultures of otosclerotic bone or in normal fibroblasts. We hypothesize that an alteration at the calcitonin receptor site is responsible for the difference in calcium uptake and cAMP levels observed in the cells derived from otosclerotic bone as compared to those cultured from normal cells

Prognostic significance of epidermal growth factor receptor in laryngeal squamous cell carcinoma.

Epidermal growth factor receptor (EGFR) content was determined by a radioligand receptor assay in 140 primary laryngeal squamous cell carcinomas (median value of 8.4 fmol mg-1 protein, range 0-169.9 fmol mg-1 protein). Cox univariate regression analysis using EGFR as a continuous variable showed that EGFR levels are directly associated with the risk of death (chi 2 = 14.56, P-value = 0.0001) and relapse (chi 2 = 7.77, P-value = 0.0053). A significant relationship between EGFR status and survival was observed at the different arbitrary cut-off values chosen (8, 16 and 20 fmol mg-1 protein). The cut-off value of 20 fmol mg-1 protein was the best prognostic discriminator. In fact, the 5 year survival was 81% for patients with EGFR- tumours compared with 25% for patients with EGFR+ tumours (P < 0.0001). The 5 year relapse-free survival was 77% for patients with EGFR- tumours compared with 24% for patients with EGFR+ tumours (P < 0.010). When clinicopathological parameters and EGFR status were examined in the multivariate analysis, T classification and EGFR status retained an independent prognostic value. In this study we demonstrated that high EGFR levels single out patients with poor prognosis in laryngeal cancer

Sialoendoscopy: state of the art, challenges and further perspectives. Round Table, 101st SIO National Congress, Catania 2014

This draft of the Official Round Table held during the 101st SIO National Congress is an updated review on sialoendoscopy, a technique used for diagnosis and treatment of obstructive pathologies of salivary glands in a minimally invasive fashion. This review treats many aspects of salivary gland endoscopy, starting from anatomy to deal with the more advanced surgical techniques and analyses the main decisional algorithms proposed in the literature. In addition, particular attention was directed to the current limitations of this technique and to the potential developments that sialoendoscopy could have in the near future

Decision Making on Vestibular Schwannoma: Lessons from a Multidisciplinary Board

Background: Management of vestibular schwannoma (VS) is a complex process aimed at identifying a clinical indication for fractionated stereotactic radiotherapy (sRT) or radiosurgery, microsurgical resection, or wait and scan (WS). We describe the experience of our VS multidisciplinary team (MDT) at a tertiary university referral center created for diagnosis, treatment, and follow-up of VS patients. Methods: We conducted a retrospective study on 132 consecutive patients referred to the MDT and managed by observation (WS), microsurgery, or fractionated sRT. The analysis included patient age, tumor size, hearing level, facial nerve function, tumor control, complications, and quality of life questionnaires. Results: Among the patients, 21% were subjected to microsurgery, 10% to sRT, and 69% to WS. The median follow-up time was 30 months. Outcomes based on different management modalities are described. Statistically significant differences among groups were detected in terms of quality of life (physical domain). Conclusions: MDT may provide the best individualized therapy for VS patients compared with a single gold-standard strategy