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Background Hypoparathyroidism is a recognised complication following laryngectomy; it is associated with significant short-and long-term morbidity. This study aimed to further characterise this condition, identify risk factors and describe preventative and management strategies in a large cohort. Materials and methods This was a retrospective study at a tertiary referral centre for head and neck cancers. All consecutive patients who had total laryngectomy over an eight-year period were included. Results A total of 140 patients were included. Rates of transient and long-term hypoparathyroidism were 14.3% and 10.1%, respectively. The following factors were significantly associated with transient post-surgical hypocalcaemia or hypoparathyroidism: total thyroidectomy (relative risk, RR, 4.33; 95% confidence interval, CI, 1.86–10.10), oesophagectomy (RR 6.05; 95% CI 2.92–12.53) and female sex (RR 3.23; 95% CI 1.45–7.19). In addition, total thyroidectomy (RR 5.89; 95% CI 1.94–17.86), central neck dissection (RR 3.97; 95% CI 1.42–11.10), oesophagectomy (RR 9.38; 95% CI 4.13–21.3), pharyngectomy (RR 7.14; 95% CI 2.08–24.39) and female sex (RR 5.52; 95% CI 1.95–15.63) were risk factors for long-term hypoparathyroidism. There was variability in the use of preventative measures, monitoring and management of hypocalcaemia and hypoparathyroidism following total laryngectomy. Conclusions Transient hypocalcaemia and long-term hypoparathyroidism occur in a significant proportion of patients after laryngectomy. A standard protocol is required to improve care.

Adenosquamous carcinoma of the head and neck is a rare cancer associated with poor prognosis. Histologically, it is identified through the presence of both adenocarcinoma and squamous cell carcinoma, although it may be difficult to diagnose from initial endoscopic biopsies. We report a case of adenosquamous carcinoma of the glottis in an 82-year-old female patient who presented with progressive hoarseness of voice and in whom initial biopsies had shown only moderate to severe dysplasia. This is the first case in the literature of a primary adenosquamous carcinoma of the glottis managed successfully with a CO2 laser left type Va cordectomy. The patient remained disease-free 28 months postoperatively.

This study aims to analyse the oncological outcomes of total rhinectomy (TR) for squamous cell carcinomas (SCCs) involving the nasal vestibule, and to identify prognostic factors for disease recurrence. A retrospective single-centre study was conducted between September 2003 and February 2021 including all patients who underwent a TR for a SCC involving the nasal vestibule. 23 patients were included in the study. Tumours originated from the anterior septum (n = 12), vestibule (n = 8) or skin (n = 3). Six TRs (26.1%) were salvage procedures, after primary radiotherapy or partial rhinectomy. Seven patients had a concurrent neck dissection and 17 patients (73.9%) received adjuvant treatment (14 patients had radiotherapy and 3 had chemoradiotherapy). After a median follow-up of 32 months, six patients (26.1%) presented with tumour recurrence. Three patients (13%) had nodal-only recurrence. The estimated 5-year overall survival, disease-free survival and disease-specific survival were 67.5%, 66.3% and 80.7%, respectively. Positive excision margins were a predictive factor for tumour recurrence (p = 0.0401). For SCCs involving the nasal vestibule that are not amenable to limited surgical resection, TR along with adjuvant radiotherapy provide good oncological outcomes and should be considered the main treatment option.

Temporary and permanent facial nerve dysfunctions can be observed after parotidectomy for benign and malignant lesions. Intraoperative nerve monitoring is a recognised tool for the preservation of the nerve, while the efficacy of the operative microscope has been rarely stated. The authors report their experience on 198 consecutive parotidectomies performed on 196 patients with the aid of the operative microscope and intraoperative nerve monitoring. 145 parotidectomies were performed for benign lesions and 53 for malignancies. Thirteen patients treated for benign tumours experienced temporary (11 cases) or permanent facial palsy (2 cases, both of House-Brackmann grade II). Ten patients with malignant tumour presented with preoperative facial nerve weakness that did not improve after treatment. Five and 6 patients with malignant lesion without preoperative facial nerve deficit experienced postoperative temporary and permanent weakness respectively (the sacrifice of a branch of the nerve was decided intraoperatively in 2 cases). Long-term facial nerve weakness after parotidectomy for lesions not directly involving or originating from the facial nerve (n = 185) was 2.7%. Patients treated for benign tumours of the extra facial portion of the gland without inflammatory behaviour (n = 91) had 4.4% facial nerve temporary weakness rate and no permanent palsy. The combined use of the operative microscope and intraoperative nerve monitoring seems to guarantee facial nerve preservation during parotidectomy.I pazienti sottoposti ad intervento chirurgico di parotidectomia per lesioni benigne e maligne possono presentare disfunzioni temporanee o permanenti del nervo facciale. Il monitoraggio intraoperatorio della motilità facciale è uno strumento ampiamente riconosciuto per la sua utilità nella preservazione del nervo, mentre l’efficacia del microscopio operatorio è stata raramente discussa. Gli autori riportano la loro esperienza su 198 parotidectomie consecutive eseguite su 196 pazienti con l’ausilio del microscopio operatorio e del monitoraggio intraoperatorio del nervo facciale. Centoqurantacinque interventi sono stati eseguiti per lesioni benigne e 53 per neoplasie maligne. Tredici pazienti operati per lesioni benigne hanno presentato un deficit della funzionalità del nervo facciale: 11 hanno sofferto di paralisi temporanea e 2 di paralisi permanente (entrambe di secondo grado). Dieci pazienti affetti da patologia maligna presentavano un interessamento preoperatorio del nervo facciale. Cinque e sei pazienti affetti da patologia maligna senza interessamento preoperatorio del nervo hanno presentato un deficit rispettivamente temporaneo e definitivo (in 2 casi il sacrificio di un ramo del nervo macroscopicamente infiltrato dalla neoplasia fu deciso solo durante la procedura chirurgica). L’incidenza di paralisi definitiva di una singola branca del nervo facciale dopo interventi eseguiti per lesioni che non originavano dal nervo facciale o che non lo infiltravano macroscopicamente (n = 185) è stata del 2,7%. I pazienti trattati per tumori benigni non flogistici del lobo superficiale della ghiandola parotide (n = 91) hanno presentato una paralisi facciale postoperatoria temporanea nel 4,4% dei casi e nessun deficit permanente. L’uso combinato del microscopio operatorio e del monitoraggio intraoperatorio del nervo sembra garantire la preservazione del nervo facciale nei pazienti sottoposti a parotidectomia.

The autosomal dominant Birt–Hogg–Dube syndrome is known to be associated with skin, lung and kidney lesions. It is caused by heterozygous germline mutations in the folliculin gene and has a high penetrance. We report the case of a 51 year old woman with Birt–Hogg–Dube syndrome who presented with a laryngeal mass. Imaging confirmed a mass centered on the piriform sinus and following excision histological examination confirmed the lesion was composed of polygonal cells with abundant eosinophilic cytoplasm consistent with a rhabdomyoma. Laryngeal rhabdomyoma is rare condition and has not been previously described in association with Birt–Hogg–Dube. In patients with Birt–Hogg–Dube syndrome who develop upper aerodigestive tract symptoms secondary to mass lesion an adult-type rhabdomyoma might be considered as a differential, with endoscopic excision being the treatment of choice.

Dysplasia and squamous cell carcinoma of the upper aerodigestive tract show significant neoangiogenesis appearing as subepithelial and epithelial microvascular irregularities that can be detected by Image-Enhanced Endoscopy such as Narrow Band Imaging and Storz Professional Image Enhancement System. In the present study, the most advanced endoscopic enhancement systems were coupled with Contact Endoscopy (Enhanced Contact Endoscopy). This original method improved the identification and the understanding of the neoangiogenetic changes of the chorion in 42 patients with leukoplakia, erythroplakia, and leuko-erythroplakia of the oral cavity and oropharynx. The physiologic and pathologic mucosa was described in five obvious vascular patterns observed at Enhanced Contact Endoscopy ranging from normal to squamous cell carcinoma, passing through inflammation, hyperplasia, and dysplasia. Each vascular pattern was then compared to histology, showing that the microvascular architectural changes seen with Enhanced Contact Endoscopy are almost constant. Sensitivity, specificity, positive predictive value, and negative predictive value in the differentiation between healthy mucosa and inflammation versus pathologic hyperplasia, dysplasia, and carcinoma were, respectively, 96.6, 93.3, 98.2, 87.5, and 95.9 %. Sensitivity and specificity were 100 % in differentiation between non-malignant lesions versus squamous cell carcinoma. Our preliminary experience shows that accuracy of Image-Enhanced Endoscopy in the diagnosis of precancerous lesions and squamous cell carcinoma of the oral cavity and oropharynx can be increased if associated to Contact Endoscopy.

Objectives/Hypothesis Image-enhanced endoscopy, such as narrow band imaging and the Storz Professional Image Enhancement System, have been increasingly used in patients with suspect lesions of the larynx and hypopharynx during preoperative and intraoperative assessment. Study Design In the present study, a contact endoscope was coupled with the systems of image-enhanced endoscopy, as to precisely distinguish the peculiar neoangiogenetic changes in inflammation, and precancerous and cancerous lesions of the larynx and hypopharynx. Methods We performed a single-blind study with this original approach of a series of 44 patients with different lesions of the larynx and hypopharynx. Results We observed five obvious vascular patterns matching the diagnosis in 41 patients out of 44, with accuracy in the differential diagnosis between normal tissue and hyperplasia versus mild dysplasia and carcinoma of 97.6%. Conclusions Enhanced contact endoscopy allows for predicting histologic changes of laryngeal and hypopharyngeal lesions from inflammation to cancer on based on fine evaluation of the neoangiogenetic changes of the chorion. This innovative procedure can be considered an important tool during diagnosis, treatment, and follow-up of patients with precancer and cancer of the larynx and hypopharynx. Level of Evidence 1b. Laryngoscope, 125:1600–1606, 2015

Sebbene le tecniche scialoendoscopiche abbiano assunto un ruolo fondamentale nel trattamento delle patologie ostruttive dei dotti salivari, in letteratura sono riportati pochi studi multicentrici sull’argomento. Questo studio basato sull’esperienza di 9 centri italiani è stato con-dotto su 1152 pazienti (553 donne, età media di 50 anni) per un totale di 1342 procedure scialoendoscopiche, il 44,6% delle quali a carico della ghiandola parotide. Il 12% dei pazienti è stato sottoposto a più interventi. I calcoli salivari sono risultati essere la principale causa di ostruzione (55%), seguiti dalle stenosi e altre malformazioni duttali (16%), dai tappi mucosi (14,5%) e dalla scialodochite (4,7%). La procedura endoscopica è stata portata a termine in 1309 casi mentre in 33 casi è stata interrotta, principalmente a causa della presenza di stenosi duttali complete (21 casi). Dopo una o più procedure il successo terapeutico è stato ottenuto nel 92,5% dei pazienti. Complicanze peri-operatorie e post-operatorie sono state riscontrate nel 5,4% dei casi trattati. La scialoendoscopia rappresenta quindi una procedura efficace e sicua nella diagnosi e nel trattamento delle principali patologie ostruttive dei dotti salivari. Interventional sialendoscopy has become the predominant therapeutic procedure for the management of obstructive salivary disorders, but only a few multicentre studies of large series of patients with a long-term follow-up have been published. This Italian multicentre study involved 1152 patients (553 females; mean age 50 years) who, after at least a clinical and ultrasonographic evaluation, underwent a total of 1342 diagnostic and interventional sialendoscopies, 44.6% of which involved the parotid gland. 12% (n = 138) of patients underwent multiple treatments. The procedure was successful in 1309 cases. In 33 cases (2.4%) the procedure could not be concluded mainly because of complete duct stenosis (21 cases). Salivary stones were the main cause of obstruction (55%), followed by ductal stenosis and anomalies (16%), mucous plugs (14.5%) and sialodochitis (4.7%). Complete therapeutic success was obtained in 92.5% of patients after one or more procedures, and was ineffective in < 8%. Untoward effects (peri and postoperative complications) were observed in 5.4% of cases. Sialendoscopy proved to be an effective, valid and safe procedure in the diagnostic and therapeutic management of non-neoplastic obstructive salivary gland diseases.

Obstructive sialoadenitis is the most common non-neoplastic disorder of the salivary glands. With advances in the use of diagnostic and interventional sialoendoscopy in the major salivary glands, operations can often be less invasive and treatment can spare the gland and restore normal function. By using an expandable balloon catheter to dilate ductal stenosis during sialoendoscopy it is possible to dilate a stenotic duct and remove large stones with or without a basket. However, the use of different angiocatheters or dedicated balloons is still empirical. In this pilot study we assessed the feasibility and safety of balloon dilatation of the submandibular gland (Wharton's duct). We did balloon catheter sialoplasty on four ducts from two fresh adult cadavers. We used a non-compliant dilating balloon catheter 6 mm in diameter at a pressure of 12 × 10 5 Pa for a total of three minutes and then examined the ducts histologically. There was no damage to the wall of Wharton's duct. Although this is a small study, we have shown the safety of balloon catheter sialoplasty for the first time as assessed histologically after dilatation of the duct. By virtue of the technique histological assessment is not possible after dilatation in patients. Long-term follow up is clearly required in this rapidly evolving area of surgery.

Objectives Branchial malformations are common congenital head and neck lesions usually diagnosed in childhood during the first decade of life. Acute presentation is usually managed with conservative protocols before a definitive surgical procedure although the risk of life-treating septic complications may influence the physician’s decision. Surgery is the treatment of choice with the removal of the lesion alone, nevertheless more aggressive approaches must be considered in complicated cases. Selective neck dissection including the removal of part of the thyroid lobe with the congenital lesion should be considered as the “ultima ratio” treatment to avoid recurrence. Methods We reviewed literature and report our experience concerning two patients with fourth branchial cleft sinus. Results A three-year-old child with a clinical history of recurrent neck abscess was referred to our department after several drainages performed in another centre. A three-year-old child referred to our department for a left side lower primary neck abscess. In both cases the diagnosis of a complicated fourth cleft remnant was confirmed by rigid endoscopic visualization of the mucosal orifice of the sinus in the pyriform fossa. Surgical management during acute presentation was challenging; in one patient the early fasciitis required an emergency procedure to remove the infected sinus that were strictly adherent to the deep vascular-nervous axis. Conclusion Surgery was the definitive treatment in both cases and at 12 and 25 months follow-up respectively no recurrences were observed.

Obstructive sialadenitis is a major cause of dysfunction of the salivary glands, and increasingly sialoendoscopy is used in both diagnosis and treatment. At present the limit of the endoscopic approach is the size of the stone as only stones of less than 4 mm can be removed. Endoscopic laser lithotripsy has the potential to treat many stones larger than this with minimal complications and preservation of a functional salivary gland. The holmium:YAG laser has been widely and safely used in urology, and its use has been recently proposed in salivary lithotripsy for the removal of bigger stones. We describe our experience with sialoendoscopy for stones in the parotid and submandibular glands and assess the feasibility and the efficacy of holmium:YAG laser lithotripsy. We have used the procedure 50 times for 43 patients with obstructive sialadenitis; 31 patients had sialolithiasis, 15 of whom (48%) had stones with diameters between 4 and 15 mm (mean 7). Total extraction after fragmentation was possible in 14 of the 15 patients without complications. Intraductal holmium:YAG laser lithotripsy is effective and safe, and allows the treatment of large stones in Stensen's and Wharton's ducts.

Objective: The objective of our paper is to evaluate the hearing results after surgical treatment of otosclerosis from a retrospective analysis of 649 procedures performed by the same surgeon (484 stapedotomies, 69 total stapedectomies, 26 partial stapedectomies, and 70 revisions). We also evaluated the hearing improvement in patients with far-advanced otosclerosis.Method: We conducted a retrospective study on 649 operations performed on 508 patients between 1998 and 2005. The approach was endoaural under local anesthetic. Audiological evaluation has been performed according to the Committee on Hearing and Equilibrium–AAO-HNS guidelines.Results: We found results better after stapedotomy than stapedectomy with a postoperative ABG within 10 dB in 89.67% after stapedotomy, in 85.51% after total stapedectomy, and in 84.62% after partial stapedectomy. Stapedotomy was most reliable in the variation of the BC for high tones; we had a worsening of BC in 17.56% after stapedotomy and in 21.74% after stepedectomy. A...

But de la presentation La prise en charge chirurgicale par voie externe du cancer du larynx peut beneficier de techniques chirurgicales comme la laryngectomie partielle supracrycoidienne avec CHP ou CHEP. Les resultats oncologiques de ces techniques sont generalement satisfaisants mais des formes de cicatrisations exuberantes peuvent compromettre des resultats fonctionnels initialement encourageant. L’objectif de cette etude est d’evaluer si les limites donnees a cette indication dans notre centre sont reproductibles et satisfaisants du point de vue oncologique et de rapporter le plus frequentes complications fonctionnelles a long terme, en precisant notre protocole de gestion. Materiel et methodes Du 1er janvier 2002 au 31 decembre 2013, 50 patients ont ete operes de laryngectomie partielle supra crycoidienne avec CHP ou CHEP dans notre service pour carcinome larynge. Dans la meme periode 5 patients ont ete pris en charge pour complications tardives de ces techniques (4 ete operees dans notre centre). L’etude a porte sur le stade de la lesion primitive, l’analyse du controle de la maladie et la gestion des complications fonctionnelles a long terme. Resultats L’etude a interesse 48 hommes et 2 femmes. L’âge moyen au moment de la chirurgie etait de 64 ans. 42 patients ont necessite d’une laryngectomie partielle avec CHEP et 13 patients d’une laryngectomie partielle avec CHP. Selon la classification TNM il y avait 7 T1, 19 T2, 18 T3 et 6 T4. Une atteinte ganglionnaire a ete retrouve chez le 14 % des patients (n = 7). L’hospitalisation moyenne a ete de 25 jours. L’alimentation par os a ete possible chez le 75 % des patients dans le 40 jours postoperatoires et le 80 % des patients a repris une respiration par le voie naturelle dans le 90 jours post-operatoire. Le suivi moyen a ete de 44,6 mois (de 3 mois jusqu’a 120 mois). Le taux de recidive a ete de 12 % (n = 6). Selon la methode Kaplan-Meier la survie totale est de 92 % a 3 ans, 85 % a 5 ans ; le taux de recidive est de 94 % a 3 ans et a 5 an. 4 patients (8 %) ont souffert de dyspnee tardive (3 patients ont developpe une exuberance muqueuse et 1 patient a developpe une stenose de la neoglotte). Le traitement de ces complications a ete realise avec des techniques endoscopiques au laser CO2, dilatations et positionnement de T-tube, avec preservation de la respiration et de la deglutition par le voie naturelle dans 3 cas. 1 patient opere dans un autre centre a experimente une laryngectomie totale pour recidive sur laryngomucocele. Conclusion L’indication aux laryngectomies partielles supra crycoidienne avec CHP ou CHEP principalement retenue pour des lesions non controlables par voie endoscopique, sans envahissement majeure de la cartilage thyroide, de l’espace paraglottique posterieure ou de la loge HTE. Une cicatrisation exuberante a long terme avec retrecissement de la neoglotte est relativement frequent soit pour la formation de muqueuse exuberante soit pour stenose. La gestion de ces conditions est generalement possible avec des methodes conservatives et avec resultats encourageantes pour la preservation des fonctions respiratoires et de la deglutition par le voie naturelles du patient.

M 44 SM 1 7 Yes Yes Yes No No Yes F 34 SM 1 8 Yes No Yes No No Yes F 40 SM 1 6 Yes No Yes No No Yes F 38 SM 1 10 Yes No Yes No No Yes F 67 P 1 11 Yes Yes Yes No No Yes F 58 P 1 7 Yes Yes Yes Recurrence Washing Yes M 51 P 1 7 Yes No Yes Stricture Scialectomy M 78 P bil. 2 4–8.5 Yes Yes Yes Recurrence Ho:YAG Yes M 69 SM 1 15 No No Scialectomy 0 F 19 P 1 4 Yes Yes Yes No No Yes 1 M 40 SM 1 14 Yes Yes Yes No No Yes 2 F 65 P 2 4–1 Yes Yes Yes No No Yes 3 M 38 SM 2 8-6 Yes Yes Yes No No Yes 4 M 37 P 1 6 Yes Yes Yes No No Yes 5 M 39 SM 1 8 Yes Yes Yes No No Yes a Case No. 6 had 3 stones, only 1 of which needed lithotripsy.

Stent prosthesis is a high efficacious method with low complication rates. However, the ideal adjunctive therapy following stent implantation remains controversial. The authors compared the effectiveness and complication rates of aspirin-ticlopidine antiplatelet therapy vs anticoagulant therapy with acenocoumarol within 30 days following stent prosthesis. They prospectively studied 404 patients following stent prosthesis while randomly receiving anticoagulant (Group A: 201 patients) vs antiplatelet treatment (Group B: 203 patients). Groups A and B were similar in demographic data (age, gender) stent location, clinical presentation, indication of stenting, and type of implanted stent. Chi-square test, t test, and Wilcoxon test for two samples were used for statistical analysis of the results. Stent implantation was attempted in 434 cases. This was successful in 70/85 (82%) of the bailout, 122/135 (90%) of the suboptimal, and 212/214 (99%) of the elective cases. In 201 patients anticoagulant treatment with acenocoumarol was administered for 4 weeks (group A) while 203 received antiplatelet treatment with ticlopidine (group B). The need for reintervention was less and total cardiac events were fewer in group B than in group A: three (1.5%) and nine (4.4%) vs 18 (9%) and 29 (14.4%) p < 0.0008 and p < 0.006 respectively. Hemorrhagic complications and total noncardiac events were fewer in group B than in group A: six (3%) and six (3%) vs 18 (9%) and 19 (9.5%) p < 0.01 and p < 0.007 respectively. The length of hospital stay was shorter in group B than in A, p < 0.0001. In conclusion, in this study of intracoronary stenting the authors had a high success rate in 434 attempted cases. Antiplatelet therapy was accompanied by fewer cardiac and noncardiac 1 month events when compared with anticoagulant therapy, supporting its role as the adjunctive treatment of choice post-stenting for the time being.

habdomyomas are benign mesenchymal tumors composed f striated mature skeletal muscle cells, being no more than % of all striated muscle tumors,1 distinguished in cardiac nd extracardiac subtypes. Cardiac rhabdomyomas occur enerally in children and are considered hamartomatous esions, often associated with phacomatoses, such as tuberus sclerosis,1,2 and hamartomas of the kidney and other rgans.1 Extracardiac rhabdomyomas are clinically and morhologically subdivided in three subtypes: the vaginal, fetal nd adult variants. The vaginal-type is a rare tumor-like olypoid mass, found in the vagina and vulva of middleged women. The fetal-type, with the subordinated juvenile habdomyoma,3 is prevalent in head and neck areas in chilren. Adult extracardiac rhabdomyomas present generally s unifocal head and neck tumors in middle-aged patients,4,5 ultifocal in 14--26% of cases.6 Adult rhabdomyomas occur