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ABSTRACT: Parotid gland tumours account for 80% of all salivary gland neoplasms, 20% of these are malignant, but in daily clinical practice most parotid masses are operated on before obtaining the final histological diagnosis. This clinical setting further complicates the critical point of parotid surgery, which is the management of the facial nerve. In the present study, data were evaluated referring to 540 patients who underwent parotidectomy for a mass which was discovered to be a benign (470 cases) or a malignant (70 cases) neoplasm, between November 1994 and December 2007, at our Institution. The most significant single parameter in this series of malignancies regarding disease specific survival was the clinical involvement of the facial nerve at diagnosis (p = 0.006). Also for this reason, as there is no evidence that liberal VIIth nerve sacrifice improves prognosis, when it is not clinically involved, every attempt is made to dissect and preserve it. At present, the most complicated situation concerning nerve preservation may be, on the other hand, recurrence of a benign tumour, in particular pleomorphic adenoma, which, in our series, has a higher incidence (8.3%) of permanent facial dysfunction, than surgery with nerve preservation for malignancy (3.7%).
Acta otorhinolaryngologica Italica: organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale 06/2011; 31(3):135-43. · 0.86 Impact Factor
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ABSTRACT: It is estimated that about 92,000 new cases of oral cavity and pharyngeal cancer occurred in Europe in 2008. During the past 30 years in the USA and Western Europe, the prognosis for oral cancer has clearly improved thanks to the possibility of reconstruction with microvascular free flaps, resulting in broader and safer resections. The anterolateral thigh flap is now being increasingly employed for this goal. The aim of the present work is to evaluate the anterolateral thigh free flap in the reconstruction of oral cavity defects.
Between July 2004 and February 2009, we harvested 73 free flaps for the reconstruction of soft tissue defects in the oral cavity of 70 patients at our institution. The oncological and functional results in these 70 patients were evaluated, particularly in those patients reconstructed with anterolateral thigh (ALT) free flap. We also evaluated the quality of life using the FACT-H&N questionnaire.
We observed no significant differences in functional and oncological results between patients reconstructed by ALT and patients reconstructed with other flaps. Swallowing may be more difficult in patients who undergo adjuvant irradiation.
In our opinion, the very low morbidity at the donor site, great versatility, and very long pedicle make the ALT free flap the first choice for reconstructing soft tissue defects in the oral cavity (particularly mobile tongue).
B-ENT 01/2011; 7(1):19-25.
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ABSTRACT: Pharyngocutaneous fistula is the most common non-fatal complication following total laryngectomy. To start oral feeding and exclude the presence of a pharyngocutaneous fistula, a subjective test and instrumental assessments using videofluoroscopy, have been described. The aim of this study was to evaluate the effectiveness of oral-pharyngo-oesophageal scintigraphy as an objective and non-invasive tool to establish presence, site and dimensions of the fistula. Observations were performed on 3 male patients, mean age 65 years, who underwent total laryngectomy and mono or bilateral neck dissection after failure of radiotherapy in 2 cases and of conservative laryngeal surgery in the third case, complicated by post-operative pharyngocutaneous fistula. Oral-pharyngo-oesophageal scintigraphy dynamic study with sequential images were obtained during the swallowing phases. In case 1, the test showed a wide pharyngocutaneous fistula the internal orifice of which was at the level of the base of the tongue: on the scintigraphic images, the radiomarked water bolus, from the fistulous orifice, descended along the stoma walls and only a small part reached the oesophagus. In the other two patients, the pharyngocutaneous fistula was small and the internal fistulous orifice was detected in the lower part of T-suture line. In conclusion, scintigraphy offered the possibility to precisely identify presence of pharyngocutaneous fistula and location of its internal orifice and to monitor its spontaneous closure. Therefore, important information could be obtained regarding the suture line status and the possibility of deciding whether to remove the nasogastric tube or to leave it in place. Finally, these data showed that oral-pharyngo-oesophageal scintigraphy could be performed in the early post-operative period to optimize starting safe oral feeding.
Acta otorhinolaryngologica Italica: organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale 10/2009; 29(5):242-4. · 0.86 Impact Factor
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ABSTRACT: Personal experience is discussed in the use of botulinum neurotoxin injections into both parotids, performed in order to transiently reduce salivation in patients undergoing major ablative and ablative-reconstructive oncologic surgery for head and neck tumours. Overall, 8 adult patients (2 female, 6 male) have been treated. Six cases were affected by pharyngocutaneous fistulas, one by severe sialorrhoea and one recurrent sialocele. After the injection, patients were regularly observed at follow-up and asked to give their subjective assessment of salivary flow. Investigations concerning possible complaints, including side-effects, as well as complete examination of the head and neck area were performed. Follow-up periods ranged from 12 to 24 weeks (mean 20 weeks). Following botulinum neurotoxin injection, the fistula was dry after a mean period of 4.5 days (min 3 days, max 8 days) and was closed 6.6 days (min 5 days, max 8 days) later. The patient affected by severe hypersalivation reported subjective improvement in sialorrhoea 4 days post-treatment. The patient affected by recurrent sialocele, required only one aspiration of fluid two days after the treatment, after which there were no further problems. Post-operative saliva-related complications significantly increase patient morbidity and hospital stay after major tumour surgery. The easy, safe and effective treatment with botulinum neurotoxin injection, observed in our experience, suggest its significant role as a useful option in the post-operative saliva-related complications.
Acta otorhinolaryngologica Italica: organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale 03/2008; 28(1):13-6. · 0.86 Impact Factor
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ABSTRACT: Aim of this report is to introduce the use of a new high resolution magnifying endoscope in the endoscopic examination of the upper aerodigestive tract and discuss the usefulness of this tool in the diagnosis of laryngeal lesions. A total of 26 patients presenting various laryngeal disorders were examined by means of an electronic videoendoscope and a high resolution magnifying endoscope. The images obtained were examined and compared. High resolution high magnification endoscopic examination allowed a better description of the laryngeal lesions (colour, extension and thickness of the lesion, irregularities in surface and borders) with easy characterisation of aspect of neighbouring laryngeal mucosa especially in pre-malignant lesions. Furthermore, the optical magnifying zoom does not require a close approach to the laryngeal mucosa, therefore, local anaesthesia is not required. In conclusion, the high resolution magnified images obtained with this new tool provide important information on the characteristics of the laryngeal structures. This new endoscopic technology, as already occurred in gastric, oesophageal and colorectal disorders, could also be improved by using chromo-endoscopy and other vital stain techniques in order to provide useful information concerning pre-neoplastic lesions of the larynx.
Acta otorhinolaryngologica Italica: organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale 11/2007; 27(5):233-6. · 0.86 Impact Factor
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ABSTRACT: Our group has 25 years' experience in the use of molecular predictive markers in head and neck cancer, on a large patient population, enrolled from a single institution, with a long follow-up, and, most of all, homogeneous regarding histology (squamous cell carcinoma) and site (larynx). Among the most frequent malignancies in the US, cancers of the larynx and uterine corpus are the only types not showing an increase in 5-year Survival Rates over the last 30 years. As far as concerns laryngeal squamous cell carcinoma, we can identify several potential reasons for this failure, the most relevant probably lies in the neck. For this reason, a key issue in laryngeal oncology is to assess metastatic potential of squamous cell carcinoma at diagnosis. Nevertheless, the combination of clinical and histological parameters is not sufficiently reliable in the prediction of lymph node metastases. Molecular characterization, by the study of molecular predictive factors, is a clinical approach aimed to define homogeneous subgroups for clinical metastatic behaviour. Defining invasiveness by means of studies on selected molecular markers (among which the most reliable is probably Epidermal Growth Factor Receptor (EGFR)) may be useful in the choice of the most appropriate treatment on both T and on N.
Acta otorhinolaryngologica Italica: organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale 01/2007; 26(6):326-34. · 0.86 Impact Factor
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ABSTRACT: A correlation between laryngo-pharyngeal reflux and laryngeal carcinoma is currently debated. Chronic inflammation is a mutagen factor confirmed in the cancerogenesis of various tumours. Aim of the present study was to evaluate, in an objective and consecutive way, with 24h multi-electrode pH-metry the presence of proximal and distal oesophageal reflux in patients presenting pre-cancerosis or squamous cell laryngeal and/or pharyngeal carcinomas. From our data, a strict correlation emerged between laryngo-pharyngeal reflux and neoplasias of the upper airways, documented through multi-electrode pH-metry. Data emerging from this study would seem to support the theory that the protracted exposure (> 20 years) to biliary reflux would represent a statistically significant added risk factor in the precancerous lesions and squamous pharyngo-laryngeal carcinoma as it occurs at oesophageal level. Moreover, a significant statistical association (p < 0.0001) emerged between laryngeal carcinoma and previous gastro-resection (odds ratio 3.8).
Acta otorhinolaryngologica Italica: organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale 10/2006; 26(5):260-3. · 0.86 Impact Factor
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ABSTRACT: 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 results obtained and the degree of satisfaction were evaluated in 90 patients with clinical visits, as well as by telephone interview. 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 patients 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 intensive care. The importance of clinical and radiological pre-operative diagnosis is stressed as well as the choice of the most suitable therapeutic approach for the different types of fractures, considering recent tendencies towards minimally invasive 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.
Acta otorhinolaryngologica Italica: organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale 09/2003; 23(4):265-73. · 0.86 Impact Factor
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ABSTRACT: The personal experience with the surgical treatment of reduction and fixation of comminuted fractures of the anterior wall of the frontal sinus is reported. Cosmetic results were examined with regard to patients' degree of satisfaction on a 0 to 2 scale and nasal function assessed via rhinoscopy and nasal endoscopy during clinical follow-up, in the course of which the integrity and functionality of the supraorbitary and facial nerves were evaluated. All patients were satisfied, on the whole, with the aesthetic result, with 0-degree satisfaction (no deformity compared with their condition prior to the injury). The operations were performed between the 2nd and 7th post-injury day. The importance of the preoperative clinico-radiological work-up is stressed, with particular regard to the detection of simultaneous involvement of the inferior and/or posterior wall, and to the choice of surgical approach. The evolution of the surgical techniques in the treatment of frontal sinus fractures is discussed. With reference to the new means of fixation, in cases of comminuted fractures of the anterior wall, titanium mesh is preferred. In the Authors' opinion it combines excellent fixation with easy adaptability (cosmetic results are good) without requiring in the majority of cases, autologous bone grafts.
Acta otorhinolaryngologica Italica: organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale 03/2003; 23(1):21-5. · 0.86 Impact Factor
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ABSTRACT: The Authors report on their experience of 18 patients with isolated fractures of the zygomatic arch who were treated via intraoral approach. The procedures were performed between the 2nd and 8th post-trauma day and the results obtained were evaluated via post-operative CT scan and periodic follow-up visits for six months. In describing the surgical technique, the Authors recommend that the fracture be reduced with the patient's mouth open, in order to overcome the anatomical obstacle constituted by the coronoid process of the mandible and avoid, as far as possible, external approaches and osteosynthesis with screws or miniplates, which often give rise to unaesthetic results and localized pain. In conclusion, this approach is seen to be the method of choice in the treatment of isolated zygomatic arch fractures in that it is simple, effective and substantially free from complications.
Acta otorhinolaryngologica Italica: organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale 11/2002; 22(5):280-3. · 0.86 Impact Factor
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ABSTRACT: At present, main factors considered responsible for the onset of squamous cell carcinoma are tobacco smoking, alcohol abuse, and exposure to viral and toxic agents. In last years, great interest has been focused on gastroesophageal reflux as independent carcinogenic factor and co-carcinogen in association with smoking and alcohol assumption.
Initially, the aim of this study was to objectively evaluate the presence of distal and proximal esophageal reflux with multielectrode pH measurement in patients with cancer of the larynx and/or hypopharynx (group A). However, in the course of the study, pharyngolaryngeal cancer was also observed in 4 patients with achlorhydria; therefore, the hypothesis that alkaline reflux might be involved in the onset of laryngeal cancer was tested (group B).
Twenty-one consecutive patients with laryngeal or hypopharyngolaryngeal squamous cell carcinoma (group A) entered the study. Twenty-one patients without laryngo-pharyngeal diseases were used as control subjects. A validated questionnaire of the clinical history was completed by all patients who underwent 24-hour pH monitoring. Group B included 40 consecutive gastrectomized patients (28 males and 12 females) in whom biliary or alkaline reflux was directly consequent to Billroth I or Billroth II operation. The control group was composed of 40 non-gastrectomized dyspeptic patients. The clinical history was controlled and obtained; EDGS and ENT examination with videolaryngoscopy was performed in all patients.
In group A, pH measurement showed pathological reflux in 80.9% (17 of 21) of patients with no typical symptoms in 63.7% of them. The difference was significant with respect to the control group. In group B, 6 of 40 (15%) had preneoplastic lesions or a history of laryngeal tumor. The difference was significant with respect to the control group. A total of 7.5% of group B patients had previously undergone CO2 laser cordectomy for laryngeal squamous cell carcinoma and 7.5% had leukoplakia. We found a significantly higher incidence (<.05) of neoplastic and preneoplastic disease of the larynx in patients undergoing Billroth II and total gastrectomy than in those undergoing Billroth I and Roux-en-Y resection. We also found a significant increase (<.01) in ENT lesions in the group of patients who had undergone gastrectomy more than 20 years previously.
In agreement with literature reports, results obtained in group A confirmed that gastroesophageal reflux is often present in patients with neoplastic lesions of the pharynx and larynx. Furthermore, gastric resection is indicated for the first time as an additional risk factor or cofactor of precancerosis and squamous cell carcinoma of the pharynx or larynx. Further studies are necessary to establish the cause and effect relationship between biliary reflux and pharyngo-laryngeal tumors.
The Laryngoscope 10/2002; 112(10):1861-5. · 1.75 Impact Factor
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Clinical Nuclear Medicine 01/2002; 26(12):1054-7. · 3.67 Impact Factor
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ABSTRACT: This study was designed to add new data about laryngeal carcinogenesis, a multistep process in which chemical and/or viral agents induce and promote successive alterations in growth factor-linked signal transmission pathways, genetic instability, and mutations in key genes involved in cell growth control. Epidemiological evidence suggests that human papillomavirus (HPV) infection may be associated with the development of laryngeal cancer.
In this report, we have analyzed the prevalence of HPV infection and epidermal growth factor receptor (EGFR) expression in a series of 42 laryngeal squamous cell carcinomas by PCR with HPV consensus primers and by a radioligand receptor assay, respectively.
HPV DNA was detected in 15 of 42 (35.7%) tumors, and it belonged almost exclusively to the highly oncogenic HPV-16, HPV-18, and HPV-33 genotypes. At analysis by Mann-Whitney nonparametric statistical test, EGFR level was found to be significantly higher in HPV-infected than in HPV-negative cases (T = 440; P = 0.002). EGFR overexpression (EGFR-positive status >6 fmol/mg protein, the arbitrary cutoff value chosen) was found in 20 of 42 (47.6%) tumors, and it was associated with HPV infection in a statistically significant extent (chi(2) = 4.686; P = 0.03).
Viral oncoproteins have been shown to induce a perturbation of the cell response to signals for growth and differentiation; these findings confirm that enhanced EGFR expression and activation in laryngeal squamous cell carcinoma may occur also as a consequence of HPV infection and support the hypothesis of an involvement of HPV infection in laryngeal carcinogenesis.
Clinical Cancer Research 12/2001; 7(12):3988-93. · 7.74 Impact Factor
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ABSTRACT: Epidermal growth factor receptor (EGFR) overexpression is an unfavorable prognostic marker in laryngeal squamous cell carcinoma (SCC). EGFR stimulates cyclooxygenase-2 (COX-2) expression in normal human keratinocytes and squamous carcinoma cells. Based on these observations a prognostic role of COX-2 expression in laryngeal SCC can be hypothesized. Consequently, COX-2 expression was studied in laryngeal SCC (median follow-up = 47 months; range: 2-87 months) by quantitative immunohistochemistry (n = 61) and EGFR by binding assay (n = 51). Well-differentiated regions of laryngeal SCC revealed strong COX-2 immunostaining, whereas histologically normal areas neighboring tumor as well as poorly-differentiated tumors were negative. Immunohistochemical results were confirmed by Western blot analyses. Cox's regression analysis showed that the combination of low levels of COX-2 integrated density and high levels of EGFR covariates provided strong prediction, at 5-year follow-up, of both poor overall survival (chi(2) = 12.905; p = 0.0016) and relapse-free survival (chi(2) = 9.209; p = 0.01). In vitro studies on CO-K3 cell line, obtained from an EGFR positive, COX-2 negative poorly-differentiated laryngeal SCC, revealed that EGF stimulation failed to induce COX-2 expression and PGE2 production suggesting a change in EGFR signaling pathway. These findings indicate that COX-2 is overexpressed in less aggressive, low grade laryngeal SCC, whereas its expression is lost when tumors progress to a more malignant phenotype.
International Journal of Cancer 12/2001; 95(6):343-9. · 5.44 Impact Factor
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Otolaryngology Head and Neck Surgery 05/2001; 124(4):473-4. · 1.72 Impact Factor
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Acta otorhinolaryngologica Italica: organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale 01/2001; 20(6):407-12. · 0.86 Impact Factor
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The Annals of otology, rhinology, and laryngology 09/2000; 109(8 Pt 1):787-90. · 1.05 Impact Factor
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ABSTRACT: We report the case of a patient with a laryngeal carcinoma in whom asymptomatic hyperparathyroidism was also detected during the preoperative work-up. A planar (201)Thallium/(99m)Tc-pertecnetate subtraction scintigraphy was performed in order to locate the suspected parathyroid adenoma. The study showed a single area of increased (201)Thallium uptake just above the thyroid isthmus, likely due to the laryngeal tumor. The scintigraphic study was repeated using (99m)Tc-Sestamibi and (99m)Tc-pertechnetate and employing the SPECT technique. Both SPECT studies made it possible to identify correctly the parathyroid adenoma, located inferiorly and in a posterior position to the lower third of the right thyroid lobe. The laryngeal tumor and parathyroid adenoma could be excised in a single surgery session. This case is of interest due to the rarity of the coexistence of two neck tumors and the clear advantage shown by the SPECT technique with (99m)Tc-Sestamibi over the planar technique with 201Thallium.
Revista Española de Medicina Nuclear 07/2000; 19(3):211-4. · 0.89 Impact Factor
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Otolaryngology Head and Neck Surgery 06/2000; 122(5):773-4. · 1.72 Impact Factor
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ABSTRACT: After underlining recent progress in nuclear medicine diagnostics, even in oncology, the authors describe the most important methods used and oncotropic capacity of some radiodrugs currently used in clinical practice: i.e. perfusion tracers. Then they present the results of a personal experience using Tc99m-SestaMIBI SPET in detail. Fifteen patients suffering from various primary head and neck neoplasms underwent systematic clinical evaluation, endoscopy, CT and/or MRI and Tc99m-SestaMIBI SPET. The authors then briefly describe the method and underline the fact that the literature lacks any homogeneous data on the use of Tc99m-SestaMIBI SPET in the study of head and neck neoplasms. The results indicate that the method is reliable in identifying both primary tumors and laterocervical metastases. Then, taking indication from the only case currently available on post-radiotherapy recurrence, the authors suggest an interesting field of application for this technique: the study of post-radio-chemotherapy and/or surgery recurrences. In conclusion, the authors underline the valid contribution this method currently offers both in diagnosis and follow-up as well as its future of ever expanding clinical applications.
Acta otorhinolaryngologica Italica: organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale 11/1999; 19(5):265-71. · 0.86 Impact Factor
