Maurizio Bignami

Università degli Studi dell'Insubria, Varese, Lombardy, Italy

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Publications (71)124.19 Total impact

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    ABSTRACT: After traumatic events (accidental or surgical), the respiratory tract activates specific and prolix repairing mechanisms which tend to claw back the primitive differentiated state. The attempt of reactivation of the normal tissue functions is called 'remodeling' and its aim is to reinstate the modeling mechanisms that existed before the damaging event or the pathology's establishment. Endoscopic sinus surgery represents the gold standard treatment for inflammatory, malformative, benign, and, in selected cases, malignant diseases. The surgical technique is commonly described as minimally invasive as the nostrils are used as an access route and therefore does not leave any external scars. Currently, the surgical procedures, even though minimally invasive regarding the way in, are in fact widely destructive towards the surgical target. The healing process and re-epithelialization will depend on the amount of bony tissue that has been exposed and it will be important to stratify the different surgical typologies in order to foresee the increasing difficulty of mucosal healing process. As far as upper inflammatory diseases are concerned, recent studies demonstrated how intranasal hyaluronic acid can positively regulate mucosal glands secretion and modulate inflammatory response, being a useful tool for the improvement of remodeling after endoscopic sinus surgery. Acid has shown to be able to regulate mucosal glands secretion and modulate the inflammatory response. © The Author(s) 2015.
    International journal of immunopathology and pharmacology 04/2015; DOI:10.1177/0394632015582316 · 2.51 Impact Factor
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    ABSTRACT: Background Nowadays the endoscopic approach represents a useful alternative to traditional surgical approaches in the treatment of cholesterol granulomas (CGs) of the petrous apex (PA). Recently the nasoseptal flap (NSF) has been employed to permit long-term patency of drainage site. The purpose of this study is to report our experience with the NSF in the endoscopic management of CG and to analyze the advantages, limitations, and outcomes of the technique.MethodsA retrospective analysis was carried out on 10 patients affected by CG of the PA who had been treated endoscopically, using the NSF.ResultsAn endoscopic transpterygoid approach was used for 6 patients and the remaining 4 were treated using the transclival approach. A NSF was used in all 10 cases. In 6 cases the flap was ipsilateral to the lesion whereas in 4 it was contralateral. In 90% of our patients no evidence of disease was observed after a mean follow-up period of 35.7 months, with resolution of their symptoms. One patient presented a recurrence because of a technical error (inadequate placement of the flap in the cavity), and has been retreated endoscopically.Conclusion The pedicled NSF seems to be helpful in avoiding the concentric growth of the granulomatous cyst epithelium while assuring ventilation and drainage of the cyst. However, bigger studies with longer-term follow-up are needed to confirm these findings. Correct and meticulous placement of the flap inside the cystic cavity is the most critical issue for the success of the procedure.
    International Forum of Allergy and Rhinology 03/2015; DOI:10.1002/alr.21521 · 2.37 Impact Factor
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    ABSTRACT: To evaluate the necessity of reconstructing the eroded bony boundaries after mucocele marsupialization when the mucoperiosteum has been spared. Retrospective review of 308 patients treated for a sinonasal mucocele. Of these, 116 showed areas of bone reabsorption in their preoperative computed tomography (CT) scan. Of 116 patients showing one or more areas of bone reabsorption who underwent marsupialization of the mucocele, whether using a purely endonasal endoscopic approach or a combined approach, the common factor was that the mucoperiosteum of the paranasal sinus had always been spared and the eroded bone had never been reconstructed. After rigorous selection, 12 adult patients were enrolled to undergo a postoperative CT scan in order to verify what had happened to the eroded bone at least 3 years following the surgical marsupialization of the mucocele. In 66,6% of patients, the postoperative CT scan showed complete self-reconstruction of bone that had previously been eroded by the mucocele. No enophthalmus, meningocele, or other facial deformities were noted in our selection group, despite not having undergone surgical reconstruction of the bone. Even taking into account the small number of patients enrolled in the present study, indications are that there is no need to reconstruct the eroded bone, as would appear from our results that sparing the mucoperiosteum is enough to enable the bone to regenerate. Nevertheless, larger scale studies of the subject are merited. 4. Laryngoscope, 2015. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.
    The Laryngoscope 02/2015; DOI:10.1002/lary.25157 · 2.03 Impact Factor
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    ABSTRACT: Dermoids of the Eustachian tube are rare benign developmental tumours that typically occur in female children. General consensus of classification and nomenclature has still not been reached. The treatment of choice consists of a radical surgical excision. Several approaches have been described and few cases are reported in literature. A gross total resection is now safely achievable through an endoscopic mini-invasive approach.
    Auris Nasus Larynx 01/2015; DOI:10.1016/j.anl.2014.10.015 · 1.00 Impact Factor
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    ABSTRACT: Post-traumatic optic neuropathy (TON) is a rare, but very much feared event. It is a traumatic injury of the optic nerve at any level along its course (often inside the optic canal), with partial or total loss of visual acuity, temporarily or permanently. Until now, an univocal treatment strategy does not exist. The clinical records of 26 patients, treated from 2002 to 2013, were reviewed. The most frequent cause of injury was road traffic accident (63 %), followed by iatrogenic damage, work injuries, sport or home accidents. All patients underwent pre-operative ophthalmological evaluation, neuro-imaging (angio-CT or angio-MRI scans) and systemic corticosteroid therapy. All patients required a surgical treatment, due to poor response to medical therapy; it consisted of an endonasal endoscopic decompression of the intracanalicular segment of the optic nerve, performed by removing the bony wall of the optical canal and releasing the perineural sheath. Improvement of visual acuity was reached in 65 % of cases. No minor or major complication occurred intra- or post-operative, with a maximum follow-up time of 41 months. An improvement in visual acuity was achieved, although very limited in some cases, when surgery was performed as close as possible to the traumatic event. In the literature, there is no evidence-based data evaluating both of the two main treatment options (medical therapy versus surgical decompression), to state which is the gold standard in the treatment for TON. We discuss the pro and cons of our protocol: medical endovenous steroid treatment, within 8 h of injury, and endoscopic surgical decompression within 12-24 since the beginning of medical therapy, represent the best solution in terms of risk-benefit ratio for the patients.
    Archiv für Klinische und Experimentelle Ohren- Nasen- und Kehlkopfheilkunde 12/2014; DOI:10.1007/s00405-014-3408-5 · 1.61 Impact Factor
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    ABSTRACT: Data from several centers worldwide have demonstrated that transnasal endoscopic surgery performed with or without a transcranial approach is capable of achieving radical resection of selected sinonasal malignancies. We report our experience with endoscopic management of sinonasal cancers, with emphasis on naso-ethmoidal malignancies encroaching on the anterior skull base. Major series reporting results concerning the endoscopic endonasal approach with or without craniectomy for treatment of sinonasal and anterior skull base cancers were reviewed. Preoperative work-up, indications and exclusion criteria, surgical techniques, postoperative management, and adjuvant therapy are reported. In the 2 largest series analyzed, the most common malignancies were adenocarcinoma (28%), olfactory neuroblastoma (14.5%), and squamous cell carcinoma (13.5%). The 5-year disease-specific survival rate ranged from 81.9%-87%, with no major differences in the mean follow-up time (34.1 months vs. 37 months). Endoscopic endonasal resection performed with or without a transcranial approach, when properly planned and in expert hands, has an accepted role with precise indications in the surgeon's armamentarium for the treatment of sinonasal and skull base malignancies. Copyright © 2014 Elsevier Inc. All rights reserved.
    World Neurosurgery 12/2014; 82(6S):S22-S31. DOI:10.1016/j.wneu.2014.07.021 · 2.42 Impact Factor
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    ABSTRACT: Background Respiratory epithelial adenomatoid hamartomas (REAHs) are rare benign tumors and may manifest as either isolated lesions or in association with sinonasal polyposis. The aim of this study is to report our experience in the management of patients with REAH and to analyze the long-term results of the endoscopic endonasal approach. MethodsA retrospective analysis of a database dedicated to patients with REAH treated between May 2003 and December 2012 was performed. Clinical presentation, demographic, histologic and radiographic features, operative findings, and follow-up data were examined. ResultsTwenty-seven patients with REAH, 14 males and 13 females, with a mean age of 51 years, underwent endoscopic sinus surgery (ESS). The most frequent reported symptoms were nasal obstruction (80%), headache (12%), mucous rhinorrhea (20%), and hyposmia (40%). Seventeen cases (first group) were present as isolated masses, 10 cases (second group) were associated with nasal polyposis. The first group with a preoperative diagnosis of REAH was submitted to a more aggressive resection with subperiosteal dissection and drilling of the underlying bone. The patients in the second group, because of the unrevealed diagnosis of REAH and due to the presence of nasal polyposis, underwent standard ESS. No evidence of recurrence in either of the subgroups after a mean follow-up of 61.2 months. ConclusionREAH is a benign well-defined pathological entity but is still unfamiliar. REAH should be kept in mind as a differential diagnosis from more aggressive lesions to avoid unnecessary surgical procedure. A complete but conservative endoscopic resection appears to be curative.
    International Forum of Allergy and Rhinology 11/2014; 4(12):961-965. DOI:10.1002/alr.21372 · 2.37 Impact Factor
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    ABSTRACT: The palatovaginal or pharyngeal artery is a small branch of the internal maxillary artery supplying the nasopharynx. Bleeding from this artery is exceptional and only one case of traumatic epistaxis from this artery has been reported previously. We report a case of a 66-year-old male presenting with right recurrent posterior epistaxis. Endoscopic dissection of the pterygopalatine fossa and direct visualization of the palatosphenoidal canal permitted to identify the origin of bleeding, and coagulation of the pharyngeal artery solved the epistaxis. Although rare, intractable posterior epistaxis may arise from the pharyngeal artery. The anatomical knowledge of this artery and of the palatosphenoidal canal is of outmost importance in endoscopic transpterygoid and nasopharyngeal procedures, to identify the vidian canal, evaluate nasopharyngeal cancer spread in the pterygopalatine fossa, reduce bleeding during surgery of the nasopharynx, and harvest adequately the pedicle of the nasoseptal flap.
    Archives of Oto-Rhino-Laryngology 10/2014; 271(10):2839-2843. DOI:10.1007/s00405-014-3111-6 · 1.61 Impact Factor
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    ABSTRACT: Background: the aim of this study was to evaluate the clinical behaviour of oncocytic Schneiderian papillomas in relation to the rate of malignant transformation and recurrences and to report the long-term results of the endoscopic endonasal treatment. Methods: a retrospective analysis was carried out on patients with oncocytic papilloma, endoscopically managed over the past 20 years, at two university centres following a uniform policy. Results: thirty-three patients were treated between November 1991 and December 2010. The mean follow-up period was 62 months. We observed 2 cases of persistence (6%) at maxillary sinus level. Both of these patients underwent endoscopic surgical revision. Squamous cell carcinoma was observed in one patient (3%). Conclusion: the endonasal endoscopic technique proved to be a safe and effective approach for the treatment of oncocytic papillomas. An oncocytic papilloma is not to be considered a negative prognostic factor in terms of malignant transformation or recurrence. Head Neck, 2013.
    Head & Neck 05/2014; 36(5):624-630. DOI:10.1002/hed.23341 · 3.01 Impact Factor
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    ABSTRACT: Despite advances in endoscopic approaches, instrumentations and imaging guidance systems, the management of frontal sinus is still challenging. Failure of the endoscopic procedure and restenosis of the newly formed ostium have been demonstrated even with large frontal sinusotomy. We describe a newly designed double nasoseptal flap to cover the bare bone after endoscopic modified Lothrop procedure (EMLP). Five fresh, double-injected cadavers were dissected through an endoscopic endonasal approach. Posteriorly based nasoseptal flap on one side and laterally based nasoseptal flap on the other side were harvested before performing wide EMLP. Feasibility of the procedure, versatility of the flap, coverage area and measurements were calculated. Harvesting the mucoperichondrial/mucoperiosteal flap over the septectomy site was straightforward step. Two different designed flaps (one on each side) are more practical to avoid torsion of the flap. The flap measures 2 × 3 cm on average that was able to cover the bare bone of the anterior and posterior wall of frontal sinus. Osteoneogenesis and progressive osteoplastic activity after EMLP plays a major role in restenosis of frontal sinus. Vascularized nasoseptal flap helps in preventing closure of the newly formed ostium. Applying these flaps over the bare bone enhances the healing process and minimizes the crust formation.
    Archives of Oto-Rhino-Laryngology 03/2014; 271(11). DOI:10.1007/s00405-014-2961-2 · 1.61 Impact Factor
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    ABSTRACT: The treatment of skull base malignancies has evolved significantly during recent decades, requiring the contribution of multidisciplinary teams. Surgery, which plays a pivotal role, ranges from traditional external procedures to endoscopic endonasal approaches (EEA). Recent reports have demonstrated that EEA is feasible, safe, and able to achieve the radical resection of selected lesions, while minimising the morbidity in patients. At the present time, the major criticisms that are made focus on oncologic outcomes, in view of the limited number of patients studied and the short/intermediate follow-up of larger series, which have grouped together different histologies associated with different prognoses. An extensive review of the pertinent literature is addressed here in order to analyse the endoscopic surgical techniques employed, the evolution of indications and the oncologic outcomes. The promising results that have emerged seem to indicate that EEA, when properly planned and performed by experienced surgeons, has nowadays acquired an accepted role with precise indications in the whole armamentarium available for the treatment of skull base malignancies.
    12/2013; 1(4). DOI:10.1007/s40136-013-0028-3
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    The Laryngoscope 11/2013; 123(11):2639-42. DOI:10.1002/lary.24170 · 2.03 Impact Factor
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    ABSTRACT: Object For several decades, the exclusive purpose in the management of anterior skull base malignancies has been to increase survival rates. Recently, given the improved prognosis achieved, more attention has been focused on quality of life (QOL) as well. Producing data on QOL in anterior skull base cancers is hampered by the rarity of the neoplasm and the lack of specific questionnaires. The purpose of this study was to assess health-related QOL in a large and homogeneous cohort of patients affected by anterior skull base cancers who had undergone endoscopic endonasal resection. Methods The authors conducted a retrospective review of patients treated for sinonasal and skull base cancers via an endoscopic endonasal approach at two Italian tertiary care referral centers. All patients were asked to complete the Anterior Skull Base Surgery Questionnaire to evaluate their QOL before and 1 month and 1 year after surgical treatment. To assess which parameters affect QOL, the study population was divided into subgroups according to age, sex, stage of disease, surgical approach, and adjuvant therapy. Results One hundred fifty-three patients were enrolled in this study according to the adopted inclusion criteria. Overall QOL started at a score of 4.68 for the preoperative period, sharply decreased as far as a score of 4.03 during the 1st postoperative month, and rose again to a score of 4.59 over the course of 1 year after treatment, with a significant difference among the 3 values (p < 0.05). The specific symptoms and physical status domains registered poorer results at the 1-year assessment (4.00 and 4.71, respectively) than at the preoperative assessment (both domains 4.86), with a statistically significant reduction in scores (p < 0.05). Worse outcomes were associated with several variables: age > 60 years (difference of 0.21 points between the preoperative and 1-year period, p < 0.05), expanded surgical approaches with transnasal craniectomy (decrease of 0.20 points between the preoperative and 1-year period, p < 0.05), and postoperative radiotherapy (score of 4.53 at the 1-year period vs 4.70 in patients without any adjuvant treatment, p < 0.05). No statistically significant differences were found when analyzing the study population according to sex (p > 0.1) and T classification of disease at presentation (p > 0.05). Conclusions Radical endoscopic endonasal resection led to either complete or at least partial recovery of patient QOL within the 1st postoperative year.
    Journal of Neurosurgery 09/2013; 119(6). DOI:10.3171/2013.8.JNS13296 · 3.15 Impact Factor
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    ABSTRACT: Objectives: Describe the endoscopic transnasal approach to the infratemporal fossa (ITF) and upper parapharyngeal region (UPR), and analyze the indications and outcomes of this surgical technique in the management of the tumors localized in this critical area.
    Otolaryngology Head and Neck Surgery 08/2013; 149(2 Suppl):P62-P62. DOI:10.1177/0194599813495815a88 · 1.72 Impact Factor
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    ABSTRACT: Objectives: 1) Review the management of Non-Functioning Pituitary Adenoma (NFPA) invading the cavernous sinus (CS), currently in balance between radiotherapy, surgical decompression of neural structures, and wait-and-see policy. 2) Report our experience in the surgical removal of these lesions through an endoscopic endonasal trans-sphenoidal approach (EETSA).
    Otolaryngology Head and Neck Surgery 08/2013; 149(2 Suppl):P48-P48. DOI:10.1177/0194599813495815a48 · 1.72 Impact Factor
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    ABSTRACT: Objective To describe the different surgical techniques for nasopharyngeal endoscopic resection (NER) and to support the efficacy of the endoscopic endonasal approach in the management of selected primary and locally recurrent nasopharyngeal tumors (NPTs).Study DesignCase series with chart review.SettingPatients affected by NPTs who underwent NER from 1997 to 2011 at two Italian referral centers.Subjects and MethodsNER was tailored to the NPT extension and classified as follows: type 1 NER, resection of the posterior nasopharyngeal wall; type 2 NER, resection superiorly extended to the sphenoid; type 3 NER, trans-pterygoid approach to the postero-lateral nasopharynx with removal of pterygoid plates and Eustachian tube, under control of parapharyngeal-petrous-cavernous segments of the internal carotid artery.ResultsThirty-six consecutive patients with primary (9 cases) or locally recurrent (27 cases) NPTs were enrolled. The lesions were staged as follows: stage I, 16 (44.4%); stage II, 3 (8.4%); stage III, 15 (41.6%); and stage IVA, 2 (5.6%). Type 1 NER was performed in 6 cases, type 2 NER in 12, type 3 NER in 16, and bilateral-extended type 3 NER in 2. No perioperative mortality or major complications were observed. Postoperatively, 11 patients received intensity-modulated radiotherapy, with or without chemotherapy. Follow-up ranged from 2 to 173 months (mean: 38 months). Five years overall, disease-specific, and disease-free survivals were 75.1% ± 9.13%, 80.9% ± 7.79%, and 58.1% ± 14.8%, respectively.ConclusionNER is a feasible and minimally invasive surgical approach for the management of selected primary and locally recurrent NPTs. Our preliminary outcomes are promising, with local control rates comparable to those of conventional procedures. Larger case series and longer follow-up are needed to validate the reproducibility and efficacy of the technique.
    Otolaryngology Head and Neck Surgery 06/2013; 147(2 Suppl). DOI:10.1177/0194599813493073 · 1.72 Impact Factor
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    ABSTRACT: Background. Intestinal-type adenocarcinoma (ITAC) is a rare and locally-aggressive occupation-related tumour. Nowadays, endoscopic-assisted resection and advances in irradiation modalities (3D-CRT/IMRT) are emerging as an alternative to traditional open surgery and conventional radiotherapy. Methods. Retrospective analysis of 30 consecutive patients affected with sinonasal ITAC, primarily treated by an endoscopic approach followed by 3D-CRT/IMRT at a single Institution, from 2003 to 2010. Results. The 5-year overall, disease-specific, disease-free and recurrence-free survivals were 72.7±9.6%, 78±9.5%, 67.9±10.7% and 69.2±9.4%, respectively (mean follow-up, 48 months). No major complications or serious toxicities were observed. Prognostic factors were: stage of disease at diagnosis, development of recurrences, status of surgical margins, grading, tumoural pattern of growth and proliferative index (Ki67). Conclusion. The low morbidity of endoscopic approaches, the acceptable toxicity of modern irradiation modalities and this promising survival rates, indicate that this treatment strategy might be considered a safe, minimally-invasive and maximally-effective option for treating selected sinonasal ITAC. Head Neck, 2014.
    Head & Neck 04/2013; DOI:10.1002/hed.23660 · 3.01 Impact Factor
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    ABSTRACT: Actinomycosis is a chronic, suppurative, and granulomatous process caused by Actinomycetes, saprophytic bacteria normally residing in the oral cavity. It can involve any organ, but the cervicofacial disease is the most frequent. Pharyngolayngeal involvement is rare and usually occurs secondary to the oral or cervical disease. There are few cases of primary pharyngolaringeal actinomycosis described in the literature. A rare case of pharyngeal actinomycosis mimicking an ulcerative malignancy in a 63-year-old man is reported. The patient was treated successfully with long-term antibiotic therapy. The clinical and pathological features and the aspects of diagnosis and treatment of cervicofacial actinomycosis are discussed.
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    ABSTRACT: Actinomycosis is a chronic, suppurative, and granulomatous process caused by Actinomycetes, saprophytic bacteria normally residing in the oral cavity. It can involve any organ, but the cervicofacial disease is the most frequent. Pharyngolayngeal involvement is rare and usually occurs secondary to the oral or cervical disease. There are few cases of primary pharyngolaringeal actinomycosis described in the literature. A rare case of pharyngeal actinomycosis mimicking an ulcerative malignancy in a 63-year-old man is reported. The patient was treated successfully with long-term antibiotic therapy. The clinical and pathological features and the aspects of diagnosis and treatment of cervicofacial actinomycosis are discussed.
    03/2013; 2013:323210. DOI:10.1155/2013/323210
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    ABSTRACT: Actinomycosis is a chronic, suppurative, and granulomatous process caused by Actinomycetes, saprophytic bacteria normally residing in the oral cavity. It can involve any organ, but the cervicofacial disease is the most frequent. Pharyngolayngeal involvement is rare and usually occurs secondary to the oral or cervical disease. There are few cases of primary pharyngolaringeal actinomycosis described in the literature. A rare case of pharyngeal actinomycosis mimicking an ulcerative malignancy in a 63-year-old man is reported. The patient was treated successfully with long-term antibiotic therapy. The clinical and pathological features and the aspects of diagnosis and treatment of cervicofacial actinomycosis are discussed.

Publication Stats

628 Citations
124.19 Total Impact Points

Institutions

  • 2007–2015
    • Università degli Studi dell'Insubria
      • Department of Surgical and Morphological Sciences
      Varese, Lombardy, Italy
  • 2003–2013
    • Ospedale di Circolo e Fondazione Macchi Varese
      Varese, Lombardy, Italy
  • 2012
    • Università degli Studi di Sassari
      Sassari, Sardinia, Italy
  • 2001
    • University of Pavia
      Ticinum, Lombardy, Italy