Acta otorhinolaryngologica Italica: organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale (Acta Otorhinolaryngol Ital)

Publications in this journal

• Article: Potential applications of human saliva as diagnostic fluid.

  Castagnola M, Picciotti PM, Messana I, Fanali C, Fiorita A, Cabras T, Calò L, Pisano E, Passali GC, Iavarone F, Paludetti G, Scarano E
  Acta otorhinolaryngologica Italica: organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale 12/2011;
• Article: Surgical treatment of recurring preauricular sinus: supra-auricular approach.

  G Leopardi, G Chiarella, S Conti, E Cassandro
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  ABSTRACT: Congenital preauricular sinus is a malformation of the preauricular soft tissues with an incidence ranging between 0.1 and 0.9% in Europe and the United States. It presents a high risk of recurrence when treated by a standard surgical technique (simple sinectomy), the incidence of which is reported to be between 19% and 40%. The supra-auricular approach, proposed by Prasad et al. in 1990, is easier to perform and presents a lower recurrence risk. Personal experience is presented in the treatment of congenital preauricular sinus with the supra-auricular approach as first choice or in the case of recurrence following previous standard surgery. This report includes a short review of the literature in order not only to focus on the supra-auricular approach and check the efficacy as far as concerns reduction of recurrence risk but also to contribute to a more widespread use of this method.
  Acta otorhinolaryngologica Italica: organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale 01/2009; 28(6):302-5.
• Article: Extranasopharyngeal angiofibroma of nasal septum. A controversial entity.

  I Tasca, G Ceroni Compadretti
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  ABSTRACT: The term extranasopharyngeal angiofibroma has been applied to vascular, fibrous nodules occurring outside the nasopharynx. The maxillary sinus is the most common site involved, while the nasal septum represents an extremely rare localization. Computerized tomography scan and magnetic resonance imaging are used to determine the tumour site and its extension. Surgical excision of the mass is the treatment of choice, and recurrence is rare. Typically, clinical characteristics of extranasopharyngeal angiofibromas do not conform with that of nasopharyngeal angiofibromas and, for this reason, these tumours must be regarded as a separate entity. Due to these different features, extranasopharyngeal angiofibromas can present a diagnostic challenge and a meticulous evaluation with a high index of suspicion is essential in establishing the correct diagnosis and treatment. We report the case of a 57-year-old female with a 1-year history of a slowly progressing right nasal obstruction due to the presence of a whitish mass adhering to the posterior nasal septum. The patient was succesfully treated surgically. Histopathological findings were compatible with a diagnosis of angiofibroma. Extranasopharyngeal angiofibroma must be taken into consideration in the differential diagnosis of nasal vascular tumours and nasal septum should be regarded as a potential, though exceptional, localization of these neoplasms.
  Acta otorhinolaryngologica Italica: organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale 01/2009; 28(6):312-4.
• Article: Converting apogeotropic into geotropic lateral canalolithiasis by head-pitching manoeuvre in the sitting position.

  L Califano, M G Melillo, S Mazzone, A Vassallo
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  ABSTRACT: Liberatory treatment of lateral canalolithiasis is more effective for the geotropic, than for the apogeotropic forms and, therefore, it is worthwhile attempting to convert the apogeotropic forms into the geotropic forms. In 36 cases of apogeotropic lateral canalolithiasis, one to five Head-Pitch Manoeuvres were performed in the sitting position (Head-Pitch Test) in the attempt to transform apogeotropic into geotropic lateral canalolithiasis. The Head Pitch Test was performed by a quick 60 degrees forward-flexion and a slow maximal backward-extension of the head. The Head-Pitch Test was effective in 36.1% of cases, less than the repeated Head-Rolling in the supine position, but it was always well tolerated by patients. The quick 60 degrees forward-flexion of the head can evoke a horizontal nystagmus beating towards the healthy side in apogeotropic lateral canalolithiasis and towards the affected side in geotropic lateral canalolithiasis (Bow Nystagmus). Slow backward-extension of the head can evoke a horizontal nystagmus beating towards the affected side in apogeotropic lateral canalolithiasis and toward the healthy side in geotropic lateral canalolithiasis (Lean Nystagmus). Conversion from apogeotropic to geotropic lateral canalolithiasis by the Head-Pitch Test was effective when Bow and Lean Nystagmus changed directions or when the Head-Pitch Test evoked Bow Nystagmus toward the affected side and Lean Nystagmus toward the healthy side. Conversion occurred in 10 patients during the 60 degrees forward-flexion of the head. In contrast, in 3 patients, it occurred during extension of the head, when a "Lean Nystagmus" toward the healthy side appeared. In addition, Pseudospontaneous Nystagmus and Positioning Nystagmus that arose when the patient moved from the sitting to the supine position changed direction or were evoked ex-novo, both directed toward the healthy side. In all cases, Pagnini-McClure diagnostic manoeuvre confirmed the transformation with a Positional Paroxysmal Horizontal Geotropic Nystagmus, which was more intense when the affected ear was brought down. The Head-Pitch Test can be used as the method of choice to transform apogeotropic into geotropic lateral canalolithiasis. However, anterior flexion of the head in the geotropic forms must be avoided since involuntary and harmful transformations from the geotropic into the apogeotropic form can occur, moving otoliths towards the anterior arm and cupula.
  Acta otorhinolaryngologica Italica: organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale 01/2009; 28(6):287-91.
• Article: Radiotherapy alone for local tumour control in esthesioneuroblastoma.

  G Benfari, M Fusconi, A Ciofalo, A Gallo, G Altissimi, T Celani, M De Vincentiis
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  ABSTRACT: Esthesioneuroblastoma is an uncommon tumour. Due to its low incidence, this neoplasm is difficult to evaluate and its treatment remains a matter of debate. Although the role of post-operative radiation is relatively well-defined, little is reported regarding the role of radiotherapy as the only treatment modality. A retrospective analysis of the literature has been conducted. With reference to the treatment of esthesioneuroblastoma, 55 patients submitted only to radiotherapy have been selected from publications of internationally indexed literature between 1979 and 2006. According to the Kadish classification, 6 patients were in stage A, 12 in stage B, and 37 in stage C. Response to therapy for each stage was assessed. There was no evidence of disease in: 6/6 stage A patients with a median follow-up period of 103.6 months, 7/12 stage B patients with a median followup period of 120 months, and 7/37 stage C patients with a median follow-up period of 77.3 months. A total of 27 patients died due to tumour-related causes and 5 due to intercurrent disease, while 3 patients were alive with disease (local recurrence and cervical lymph node metastasis). In conclusion, esthesioneuroblastoma is a malignant tumour which grows both locoregionally and distantly. For this reason, despite the satisfying results regarding response to radiotherapy alone in stage A patients, irradiation should be used only in early lesions arising below the cribriform plate, whereas all other cases require aggressive and multimodal therapy.
  Acta otorhinolaryngologica Italica: organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale 01/2009; 28(6):292-7.
• Article: Congenital dacryocystocele: diagnosis and treatment.

  S Cavazza, G L Laffi, L Lodi, G Tassinari, D Dall'Olio
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  ABSTRACT: Five children were diagnosed with congenital dacryocystocele; in all cases, the cystic lesion was unilateral; age ranged from 7 to 60 days (mean 29 days). The mean ultrasonography diameter of the cyst, at the time of the diagnosis, was 11.51 mm. Topical and systemic antibiotics and massage were prescribed. One patient had no recurrence of the dacryocystocele but 4 showed no improvement with medical treatment; they were submitted to successful probing in the first months of life under general anaesthesia. Nasal endoscopy revealed a nasolacrimal cyst in one patient. True dacryocystocele is relatively rare: ultrasound is a simple, non-invasive method that can reliably distinguish dacryocystocele from other pathological conditions. Several reports have described a variable natural course of these lesions but there are controversial opinions regarding their management. Initially, we treated this congenital anomaly with digital massage, and topical and systemic antibiotics. Probing under general anaesthesia was performed in the event of dacryocystitis or lack of resolution after a short trial period with digital massage. Particular attention was paid to nasal bilateral endoscopy to exclude a nasal obstruction caused by cystic swelling of the nasolacrimal duct. When performed, the probing procedure was successful in all patients.
  Acta otorhinolaryngologica Italica: organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale 01/2009; 28(6):298-301.
• Article: Isolated sinonasal sarcoidosis with intracranial extension: case report.

  O Y Dessouky
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  ABSTRACT: The case is presented of a 20-year-old female who was incidentally diagnosed with isolated sarcoidosis in the form of a nasal mass involving the ethmoid sinuses with destruction of the cribriform plate and intracranial extension. The patient complained of cacosmia and nasal obstruction. Histopathologic examination of biopsies from the nasal mass led to a diagnosis of non-caseating granuloma, highly suggestive of sarcoidosis. No systemic manifestations were detected, and the patient was started on a regimen of systemic steroids. Over the 3 months following biopsy and commencement of systemic steroids, the patient showed improvement in symptoms, and computed tomography of the paranasal sinuses revealed complete resolution of the sinonasal mass. Follow-up for one year revealed no recurrence.
  Acta otorhinolaryngologica Italica: organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale 01/2009; 28(6):306-8.
• Article: Cavernous haemangioma of the left nasal cavity.

  M Archontaki, A K Stamou, J K Hajiioannou, M Kalomenopoulou, D P Korkolis, D E Kyrmizakis
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  ABSTRACT: Cavernous haemangioma of the nose is a rare lesion but it has to be added to the differential diagnosis of an intra-nasal bleeding mass. A high index of suspicion, upon computed tomography delineation of the extent of the mass, including the presence of bone remodelling plus histological evaluation can be usefully employed to define an accurate diagnosis. In the present case of an adult female with a huge cavernous haemangioma arising from the mucosa of the left middle nasal meatus, the two most interesting points were the rarity as a site of occurrence of this tumour and the successful extirpation of this lesion with the minimally invasive trans-nasal endoscopic technique. We recommend the minimal invasive trans-nasal endoscopic technique for adequate exposure, sufficient control of bleeding and for complete removal of a nasal haemangioma reaching the nasopharynx and paranasal sinuses.
  Acta otorhinolaryngologica Italica: organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale 01/2009; 28(6):309-11.
• Article: Thyroid cancer: possible role of telemedicine.

  G Gibelli, B Gibelli, F Nani
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  ABSTRACT: Telemedicine is extremely useful when distance could hinder diagnostic procedures, disease management, or when severe side-effects may occur in patients not within easy reach of medical care and requiring prompt action and specific therapies. Telemedicine has been successfully adopted in the management of chronic patients, particularly in those with cardiologic or oncologic diseases. In the treatment of differentiated thyroid cancer, requiring long-term check-ups and visits as well as administration of high doses of levothyroxine (TSH - thyroid-stimulating hormone - suppression), also in elderly patients, telemedicine seems particularly indicated. Moreover, these distant monitoring techniques could not only reduce long-term management costs but also considerably decrease cardiovascular risks associated with these patients. The present review aims to provide some general information on telemedicine and its possible fields of action with regard to distant monitoring of patients with differentiated thyroid carcinoma.
  Acta otorhinolaryngologica Italica: organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale 01/2009; 28(6):281-6.
• Article: Giant deep lobe parotid gland pleomorphic adenoma involving the parapharyngeal space. Report of three cases and review of the diagnostic and therapeutic approaches.

  B Sergi, A Limongelli, E Scarano, A R Fetoni, G Paludetti
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  ABSTRACT: Aim of the present report is to discuss and underline the diagnostic algorithm and the surgical approach to giant parotid pleomorphic adenomas arising in the deep lobe and growing in the parapharyngeal space. Three cases are described and a review is made of the international literature concerning giant deep lobe parotid gland pleomorphic adenoma. Diagnosis was based on imaging, computed tomography scan and magnetic resonance imaging and upon cytology, by means of fine needle aspiration biopsy. The surgical approach varied according to the location of the tumour. All patients were discharged without complications and no cases of permanent facial nerve palsy were observed. An exhaustive pre-operative diagnostic algorithm is required before approaching this lesion. Fine needle aspiration biopsy is, in our opinion, mandatory to avoid histological surprises. The surgical approach should provide excellent visibility with wide surgical exposure to secure local neurovascular structures.
  Acta otorhinolaryngologica Italica: organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale 11/2008; 28(5):261-5.
• Article: Role of the "rooming-in" on efficacy of universal neonatal hearing screening programmes.

  D L Grasso, S Hatzopulos, P Cossu, F Ciarafoni, M Rossi, A Martini, E Zocconi
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  ABSTRACT: Sensorineural hearing loss is one of the most common congenital abnormalities in infants and it affects approximately one to two neonates in every 1000 births. Early identification of hearing loss in the newborn is the first step for a successful rehabilitation programme. The introduction of Otoacoustic Emission responses as a useful tool in hearing screening programmes, allowed the identification of hearing loss in the well-baby nursery and in targeted populations of the neonatal intensive care unit. Recently, a new concept of breastfeeding during hospitalization after birth has been developed. Indeed, the so-called "rooming-in" allows a mother to stay with her child in the same room, located in the nursery. This new trend has been developed to avoid any psychological adverse consequences of birth on the child-mother relationship. To enhance how "rooming-in" could affect the Universal Neonatal Hearing Screening (UNHS) programmes, an analysis has been made of the data coming from two maternity wards using different breastfeeding protocols. Data obtained demonstrate a worse performance on obtaining essential benchmark in the UNHS in the maternity ward where rooming-in is adopted (60% of newborns tested). UNHS programme efficacy could be affected by the wider adoption of the "rooming-in" regimen in the maternity wards and early detection of hearing loss revealed by UNHS could be vanished by dispersion of patients. In fact, more data are necessary to evaluate the impact of rooming, even though our data show a worsening in the UNHS results.
  Acta otorhinolaryngologica Italica: organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale 11/2008; 28(5):243-6.
• Article: Simultaneous pleomorphic adenoma of the parapharyngeal space and contralateral submandibular gland. Case report.

  V Pistorio, R Teggi, M Bussi
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  ABSTRACT: Herein the case is reported of a synchronous parapharyngeal space pleomorphic adenoma arising from the pharyngeal prolongation of the parotid gland and the contralateral submandibular gland, diagnosed in a young Caucasian female. Case reports and recent literature are presented. Upon physical examination, asymmetry of the lower part of the right side of the face with overlying intact skin, and a submucosal firm swelling, filling the ipsilateral side of the oropharyngeal wall, involving the right tonsillar bed which was medially displaced was immediately recognizable. The patient did not complain of dysphagia. Palpating the left submandibular region, a painless, mobile, rounded mass, 10 mm in diameter, apparently located in the submandibular gland, was detected. Magnetic resonance imaging showed that both lesions were well-defined and encapsulated. The surgical approach is discussed. Cytological diagnosis was that of a typical pleomorphic adenoma. To the best of our knowledge this is the second case report in the English literature of a concomitant pleomorphic adenoma located both in the parapharyngeal space and the submandibular gland.
  Acta otorhinolaryngologica Italica: organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale 11/2008; 28(5):257-60.
• Article: Paraclinical evaluation of side-effects of Taxanes on auditory system.

  M Sarafraz, K Ahmadi
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  ABSTRACT: Ototoxicity is one of the major causes of hearing loss and balance system disorders. Taxanes are a new group of anti-neoplastic agents used for chemotherapy; examples include Paclitaxel and Docetaxel. In this study, ototoxicity of these drugs has been evaluated in order to provide a means of adjusting the doses to avoid these complications. A prospective analytical study was carried out on 103 known cases of breast and ovarian cancer, during 2004 to 2006 (20 months), in the Otolaryngology, Head and Neck Surgery Department of Ahwaz University of Medical Sciences of Tehran. All patients (mean age 45 +/- 2.3 years) were treated with Taxanes. The first evaluation of hearing (using pure tone audiometery) was performed before starting treatment, the second in the middle of the treatment period and the last at the end of treatment. Results showed that nausea and vomiting were the most common side-effects of the drugs used. No significant side-effects of Taxanes, on the audiovestibular system, were observed. In conclusion, little information concerning the ototoxic effect of Taxanes has been reported in other studies, and, in the present investigation, no significant effect on the auditory system was found.
  Acta otorhinolaryngologica Italica: organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale 11/2008; 28(5):239-42.
• Article: Salivary gland diseases a challenge for GPs and surgeons.

  F Chiesa
  Acta otorhinolaryngologica Italica: organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale 11/2008; 28(5):256.
• Article: Parotid metastasis from renal cell carcinoma: a case report and review of the literature.

  R Spreafico, G Nicoletti, F Ferrario, R Scanziani, M Grasso
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  ABSTRACT: Renal cell carcinoma metastasis to the parotid gland after tumour nephrectomy is extremely rare. Herewith a review of the literature on this topic is discussed and a case report is presented of a 69-year-old man affected by parotid localization of renal clear cell carcinoma with neck lymph node metastases and involvement of the masseter muscle 2 years after nephrectomy. When an otolaryngologist encounters a parotid mass, diverse differential diagnoses have to be considered. A high level of suspicion of metastatic disease from the specific primary site will help in achieving correct diagnosis and evaluation of the extension of the disease. Surgical resection, even enlarged parotidectomy with neck dissection, should be considered as a therapeutic option for exclusive location of the disease in the head and neck.
  Acta otorhinolaryngologica Italica: organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale 11/2008; 28(5):266-8.
• Article: Parotid surgery in patients over seventy-five years old.

  A Croce, L D'Agostino, A Moretti, A Augurio
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  ABSTRACT: Malignant parotid tumours are generally rare but become more common in the last decades of life; this increased incidence concerns mainly secondary parotid space involvement from metastasis or direct invasion. During the past five years, we observed and operated upon 84 patients for parotid diseases, performing 86 parotidectomies (2 bilateral operations). The patients included 30 (35.7%) over 75 years old (2 subjects over 90), mean age 80.5 years, object of the present study. In these 30 patients 2 chronic infections were observed, 6 benign tumours and 22 malignant tumours with only 6 primary neoplastic lesions. Overall, 14 extended radical parotidectomies were performed, 13 conservative total parotidectomies, 2 superficial parotidectomies and 1 radical parotidectomy, a few associated with neck dissection and/or radiotherapy. Three patients died in the post-operative period from heart attack. Five patients died from disease (3 from melanomas--2 after 3 years and 1 after 2 years--and 2 from primary carcinomas--1 after 2 years and 1 after 1 year). Six patients died without disease from various causes (2 after 4 years, the others after 3, 2, 1 year and 8 months). Nine patients are alive, 8 NED and 1 with disease in the ethmoid after 2 years, the latter well under control with radiotherapy. This experience implies that surgical treatment of these secondary tumours, which are performed more frequently in old age, exposes the patient to the risk of serious complications (3 patients died in the immediate post-operative period) and stresses the importance of careful evaluation of general conditions. However, surgery seems to have been the treatment indicated also in the patients who subsequently died from the disease, but in whom at least two-year survival was achieved in almost all cases. Unfortunately, because of the advanced age of the patients, the final results are penalized by deaths from natural causes. It is, nevertheless, encouraging that over one third of the patients operated upon are free of disease.
  Acta otorhinolaryngologica Italica: organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale 11/2008; 28(5):231-8.
• Article: Simplified technique without skin flap for the bone-anchored hearing aid (BAHA) implant.

  R Bovo
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  ABSTRACT: Aim of this report is to present a new surgical technique for the BAHA system implant and to discuss the operational techniques and complications related to this type of surgery. The common technique for the positioning of the Bone-Anchored Hearing Aid (BAHA, Cochlear Limited, Englewood, CO, USA) titanium implant into the temporal bone is based on the use of either a free or a pedunculated skin flap. Reported complications of this type of surgery include skin flap necrosis with healing by second intention, infection of the flap, skin growth over the abutment, failure of osseointegration and implant extrusion. In order to reduce the incidence of these problems, different types of surgery have already been presented over the years. Herewith, a new technique is proposed for implanting a BAHA screw in the temporal bone, that is simple, rapid to perform, and does not require the use of a flap. This technique appears to offer two main advantages: i) the speeding up of the procedure; ii) the low risk of complications, such as infection and necrosis, within the skin surrounding the implant.
  Acta otorhinolaryngologica Italica: organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale 11/2008; 28(5):252-5.
• Article: Psychological aspects and treatment of patients with nasal septal perforation due to cocaine inhalation.

  L Di Rienzo Businco, M Lauriello, C Marsico, A Corbisiero, O Cipriani, G Coen Tirelli
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  ABSTRACT: Use of cocaine, by inhalation, is currently increasing in Western Countries and its use is superseding heroin in the rising generation. Young people of the third millennium use narcotics to avoid the negative conditions of daily life and to escape on "unreal" trips, as happened in the '60s and '70s for the heroin-addicted. Today, on the contrary, people addicted to cocaine want to be more competitive and "winners" and believe that cocaine can help them to reach this goal. A series of 104 patients (75 male, 29 female), aged between 16 and 54 yrs, all habitual inhaling cocaine users (> or = 10 times per month) have been observed for 2 years. Among them, 11 (10.5%) had nasal septal perforation, which is frequently related to cocaine use. Of these 11 patients, 8 (72.7%) had nasal septal perforation of the quadrangular cartilage, while in the other 3 (27.3%) the perforation involved also the bony tract (vomer-perpendicular ethmoidal lamina). Psychological analysis of these 104 patients is reported: 62 patients (59.6%) answered that they inhaled cocaine to improve endurance and to feel stronger and less tired; 34 patients (32.7%) in order to enjoy themselves more during parties and to communicate more effectively with other people; 5 patients (4.8%) to gain confidence and to overcome their shyness, 2 patients (1.9%) to improve their sexual performance and 1 patient (1%) to drink more alcoholic drinks for a longer time without feeling sleepy. All the patients underwent psychotherapeutic treatment, but the lack of compliance and constantly missing the scheduled follow-up visits resulted in complete therapy being performed in only 16 patients (15.3%). All the patients with nasal septal perforation underwent rhino-endoscopy, at T0, with 0 degrees, 45 degrees endoscopes, computed tomography scan of nose and paranasal sinuses and biopsy. At the time of the observational period, none of the 11 patients who presented nasal septal perforation agreed to stop cocaine abuse; therefore, a temporary solution has been offered to all the patients (accepted by 3 of them), i.e., the positioning of a silicone button to close the perforation and, thus, improve the air flow in the nose and reduce progression of local necrosis. Together with the button, the positioning is described, under local anaesthesia, of two layers per septal side of hyaluronic acid, at different levels of esterification, kept in site by the button as a "sandwich" in order to obtain better re-growth of the mucosa and fewer scabs and bleeding.
  Acta otorhinolaryngologica Italica: organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale 10/2008; 28(5):247-51.
• Article: Noise-induced hearing loss and hearing aids requirement.

  C Giordano, M Garzaro, J Nadalin, G Pecorari, R Boggero, P Argentero, R Albera
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  ABSTRACT: Subjective disturbances, due to hearing loss, are auditory disability and handicap which can be evaluated with a questionnaire. The present study refers to a population of industrial workers affected by noise-induced hearing loss. Aim of the study is to identify the minimal level of hearing loss over which the patient felt changes in his quality of life, and the average auditory threshold at which the patient considered the application of a hearing aid useful or necessary. The sample comprised 180 males with noise-induced hearing loss. Each subject received a questionnaire designed for this study. Data show a correlation between disability, handicap and the degree of noise-induced hearing loss. The most relevant problems in noise-induced hearing loss are correlated with disability rather than handicap. 35 dB can be considered as the level above which these devices can be suggested to patients. Hearing aids can become a therapeutic instrument even in the presence of a low degree of hearing loss.
  Acta otorhinolaryngologica Italica: organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale 09/2008; 28(4):200-5.
• Article: Orbital exenteration in elderly patients: personal experience.

  A Croce, A Moretti, L D'Agostino, P Zingariello
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  ABSTRACT: Orbital exenteration is a disfiguring procedure which typically involves removal of the entire contents of the orbit including the periorbita, appendages, eyelids and, sometimes, a varying amount of surrounding skin. This operation is reserved for the treatment of potentially life-threatening malignancies arising from the orbit, paranasal sinuses or periocular skin. The marked increase in the average life span and resulting greater incidence of invasive malignant skin tumours of the face, typical of old age, is the reason for the increased rate of exenterations in elderly patients. The purpose of this report is to describe personal experience regarding 8 operations of orbital exenteration carried out on elderly patients, 6 males and 2 females, age range 66-85 years (mean 75), who came to our observation, from January 2002 to December 2007, on account of cancer (7 cases: 4 basal cell carcinomas; 1 squamous cell carcinoma; 1 fibrosarcoma; 1 melanoma) or infectious inflammatory disease (1 case of rhinocerebral mucormycosis) and were treated with type III orbital exenteration (2 cases) and type IV orbital exenteration (6 cases according to Meyer and Zaoli's classification). The methods used to reconstruct the eye-socket consisted of a full-thickness skin graft in 5 cases, pedicled myocutaneous flaps in 2 cases--a latissimus dorsi muscle flap alone, in one patient, and combined with a pectoralis major muscle flap in another - and a combined lateral-based frontal fasciocutaneous pedicled flap and full-thickness skin graft in the oldest patient. Regarding survival and the local clinical situation, 3 of the 4 patients with basal cell carcinomas are alive and disease-free after 6 years, 2 years and 20 months, respectively, while the oldest patient died of the disease after 10 months. The subject who underwent surgery for squamous cell carcinoma is alive and disease-free after 2 years. The patients with melanoma, fibrosarcoma and mucormycosis died. Although there are various options available for reconstruction, full-thickness skin graft or a pedicled muscolocutaneous flap provide the simplest solution in the elderly population with significant co-morbidities. The final outcome is, in our experience, comparable to that of more complex flap reconstruction, obtaining very good final results with minimal donor site morbility and a reduced operation time.
  Acta otorhinolaryngologica Italica: organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale 09/2008; 28(4):193-9.