Il tutore endolaringeo nelle stenosi laringo-tracheali

Viene illustrato lL'impiego del tutore endolaringeo nelle stenosi laringo-tracheali

Magnetic Resonance Imaging in Primary and Secondary Septorhinoplasty

The authors emphasize the importance of MRI as a means to functionally evaluate patients in primary (PR) and secondary (SR) rhinoseptoplasty. Forty-eight subjects were appraised who underwent various types of corrective nose surgery: 31 PR, 12 SR, 4 introgenic perforations, and 1 dermoid cyst of the nasal dorsum. MRI allows the nasal structures at the level of the valve to be visualized, as well as the medial and lateral walls of the nasal fossa in all of its components. MRI studies improve pre-surgical evaluation (alar cartilages, iaterdomal distance, and valvular configuration), and the exam of structures and anomalies which are hard to evaluate by the rhinoscopy (turbino-septal-synchias, perforations, losses of bone-cartilaginous substance). Moreover, through MRI the nasal respiratory surface (NRS) is determined and used by the authors to quantify the improvement of the postsurgical nasal respiratory function. All of these points gain importance during the planning of primary, secondary, and/or corrective surgery

ECochG, CNAP and ABR monitoring during vestibular Schwannoma surgery

Identification of the specific pathophysiological processes and correlation with post-operative hearing are the prerequisites for utilizing electrophysiological audiomonitoring techniques in preventing damage to auditory structures during vestibular Schwannoma (VS) surgery. The present paper compares the value of auditory brainstem responses (ABRs), electrocochleography (ECochG) and directly recorded cochlear nerve action potentials (CNAPs) in detecting damage to auditory structures during VS surgery and predicting postoperative hearing. Eighteen consecutive patients operated on for VS, in an attempt at hearing preservation, participated in the investigation. The ipsilateral hearing level (pure tone average (PTA) 0.5-3 kHz) ranged from 10 to 50 dB HL (mean: 30.7 dB HL), with a speech discrimination score equal to or better than 50 per cent. CNAPs furnished the highest predictive score for post-operative hearing. In particular, when a permanent loss of CNAPs occurred the sensitivity and specificity were 100 per cent. The discrepancies between the ECochG and CNAP findings were attributable to high prevalence of cochlear nerve damage, capable of 'disconnecting' the ear from the central auditory pathways, causing persistence of peripheral auditory function and no propagation of the neural input. ABR monitoring was highly sensitive in detecting auditory damage but its prognostic utility was marred by its poor specificity

En-block removal of small to medium sized Acoustic Neuromas with Retrosigmoid transmeatal Approach

Abstract Surgery of acoustic neuroma (AN) has significantly refined over the past years due to a series of advances in diagnostics and surgical technique. Electrophysiologic investigation performed during surgery has greatly contributed to this progress, increasing the surgeon's understanding of the mechanism of damage and suggesting various changes in his or her surgical strategy.In this context, the advantages of the retrosigmoid "en-bloc" removal of small to medium size ANs have been examined in the present study. At the ENT Department of the University of Verona, 103 subjects with AN were operated on, from January 1990 to December 1995, with a retrosigmoid-transmeatal approach. Eighteen subjects (17.4%) presented pure a intracanalar (IC) tumor and 85 (82.6%) had both IC and extracanalar (EC) involvement. All the IC tumors (n = 18) and 70 of the IC-EC neuromas with an EC size less than 25 mm are reported in this paper for a total of 88 patients. The first 48 patients were operated on via the classic procedures described in the literature, characterized by removal of the tumor after "debulking" and limited exposure of the internal auditory canal (IAC). The following 40 subjects were operated on according to the technique of "en-bloc" removal of the tumor and wide exposure of the IAC.In the "en-bloc" group the tumor was first detached from the cerebellar flocculus and the pons, when necessary. The tumor was not debulked to preserve the anatomic relationship with the nerves and to facilitate identification, cleavage and dissection of the tumor from the neural structures. Thereafter, the posterior wall of the IAC was drilled out and opened in a circumferential range from 180 to 270 degrees . The IAC dura was subsequently opened, and the distal end of the AN along with the vestibular nerves were identified. The vestibular nerves were sectioned in the distal portion of the IAC and dissected with the tumor from the underlying facial and cochlear nerves. Dissection continued medially to the IAC porus. The AN was progressively dissected from the cochlear and facial nerves in the cerebellopontine angle (CPA) with multiple direction maneuvers, as required by the characteristics and degree of adherence to the neural structures.The anatomic and functional results obtained with this new procedure ("en-bloc" removal) were compared with the classic "debulking" technique. The statistical analysis shows an improvement in postoperative outcome for both auditory and facial nerve function. The "en-bloc" removal procedure along with the wide exposure of the content of the IAC and electrophysiologic monitoring of the seventh and eighth cranial nerves are, in our experience, the recommended strategies for improving outcomes in small to medium size ANs

Nasal Septal Perforations: Modern Diagnostic Work-Up, Management and Surgical Strategy

The closure of septal perforations is a challenging procedure in nasal reconstructive surgery, both for the surgeon and the patient, since postoperative care is just as important as the surgical procedure used to obtain the best outcome. The first objective is to restore the nasal function and, in the meantime, to rebuild, as possible, the anatomical integrity of the nasal structures, to have long-lasting results. The surgical success rate depends on a precise definition of aetiology, state of nasal mucosa, size and location of the defect, and on a correct postoperative management

Linfomi del tessuto linfatico associato alle mucose (MALT) delle ghiandole salivari. Descrizione di un caso in un paziente con infezione da virus C dell'epatite e revisione della letteratura

We describe a 68-year old woman affected by chronic hepatitis C virus infection; hypertransaminasemia was first observed at the age of 46 years, when the patient was diagnosed uterus carcinoma. Since 1994 she had complained of xerostomia, xerophtalmia, pain at the left parotid and laterocervical adenomegaly. Neck ultrasound examination revealed enlarged intraglandular, submandibular and laterocervical lymph nodes. Fine-needle aspiration of both left parotid and laterocervical lymph nodes was not diagnostic. The histologic examination of the surgical biopsy of the left parotid and the right submandibular salivary gland allowed to diagnose mucosa-associated lymphoid tissue lymphoma (MALT lymphoma). The patient was given alpha-interferon obtaining a clinical remission of the lymphoma and transitory normalization of transaminase level. The authors review the literature about some aspects of MALT lymphomas: a) the etiopathogenesis of MALT lymphomas and the mechanisms suspected to be involved in the evolution from a "benign" lymphoepithelial infiltrate to a neoplastic disorder; b) the relationship between chronic inflammatory diseases as Sjögren's syndrome and chronic C virus infection and MALT lymphomas, particularly MALT lymphomas of the salivary glands; c) the significance of the evidence of a B-cell clonality in the context of a lymphoepithelial lesion; d) diagnostic and therapeutic aspects of MALT lymphomas of the salivary gland

HPV-related papillary squamous cell carcinoma of the tonsil during treatment with fingolimod

Fingolimod is a commonly used treatment for highly active relapsing-remitting multiple sclerosis (MS). We describe the case of a 50-year old man on fingolimod since 2011 who presented, in April 2017, with a voluminous swelling of the left tonsil. A left tonsillectomy was performed, and histological exam disclosed a papillary squamous cell carcinoma of the palatine tonsil, with an in situ hybridization positive for human papillomavirus (HPV)-16 DNA. Neither lymph nodes involvement nor other metastases were detected. Fingolimod was stopped as a precautionary measure in May 2017, and the patient currently continues his follow up at our Department. Immunocompromised patients are at risk for developing HPV-related malignancies probably in light of the suppression of T-cell immunity, therefore an increased risk for HPV activation in MS patients treated with disease modifying therapies (DMTs) characterized by a more pronounced immunosuppressant activity cannot be excluded. Given the absence of studies on larger cohorts of MS patients exposed to DMTs, additional monitoring for HPV infection during fingolimod treatment is not currently recommended. However, vigilance for this possible association is warranted