[Positron emission tomography (PET) with 18-fluorodeoxyglucose (FDG) in the diagnosis and preoperative staging of head and neck tumors: a prospective study]. / Ruolo diagnostico della tomografia ad emissione di positroni (PET) con 18-fluorodesossiglucosio (FDG) nella stadiazione preoperatoria dei tumori del capo-collo: studio prospettico.

To evaluate the effectiveness of PET with FDG in the preoperative identification of loco-regional lymph node metastases in patients with head and neck tumors a total of 24 consecutive patients coming to the E.N.T. Center were studied. In all cases staging was made using CT and/or MRI and by PET with FDG. All patients then underwent surgery performed by one single team and the histopathological findings were evaluated every time by the same pathologists. The sensitivity (87.5% vs. 53.1%), specificity (99% vs. 87.8%) and diagnostic precision (98.2% vs. 85.3) achieved by PET with FDG proved significantly better than the radiological imaging methods. In particular, given that in the present study PET showed a negative predictive value of 99%, when planning a functional lymphadenectomy this technique can be suggested as a preoperative guide in mapping out lymph node metastases.

Vaciamiento microquirúrgico transnasal de los senos paranasales / Transnasal microsurgery draining of paranasal sinus

La poliposis nasosinusal es una enfermedad muy antigua cuya etiologia aun no es bien conocida. Se sabe que está relacionada con factores alergicos, infecciosos, inmunologicos y mecánicos, entre otros. Su tratamiento continua siendo controversial; siempre debe intentarse primero mejorar la sintomatologia con terapia medicamentosa, recurriendo a la cirugia en caso de fracaso del tratamiento medico. Se presenta una serie de 82 pacientes con maxipoliposis rinosinusal bilateral tratados mediante vaciamiento microquirurgico transnasal de los senos paranasales en los años 92, 93 y 94. Se describe la tecnica quirurgica y se presentan los resultados de los hallazgos operatorios y evolucion clinica

Microsurgery in juvenile nasopharyngeal angiofibroma: a lateronasal approach with nasomaxillary pedicled flap.

Thirty-four consecutive juvenile nasopharyngeal angiofibromas, mainly stage II or III, were removed using a transnasomaxillary approach with good tumor control and without complications or sequelae. A pedicled nasomaxillary osteomucocutaneous flap is lifted through a lateronasal skin incision, and reflected laterally to open the nasal fossa and the maxillary sinus. This approach is an improvement on the conventional approach of lateral rhinotomy, which entails nasomaxillary skeletal loss. The approach ensures early and direct exposure of the root of the tumor and its vascular peduncle and also allows removal of tumors with intracranial extradural extensions.

[Surgery of the base of the skull]. / La chirurgia della base del cranio.

This is a review of the current status of the surgery of the skull base with special reference to the otolaryngological districts. The main topics are as follow: classification of pathology review of the clinical and surgical anatomy clinical and neuroradiological diagnosis surgical management of the pathology in the occipito-temporal area and in the rhinobase principles of management and operative approaches to the skull base in Neurosurgery principles of management and operative approaches to the skull base in Maxillo-Facial Surgery.

Vidian nerve surgery revisited.

With microsurgical dissection of 30 nasosinusal blocks, the author has followed the steps of various techniques that have been proposed for vidian neurectomy. The anatomical information obtained leads to the conclusion that each of these techniques has shortcomings if the surgical steps are respected.

Microsurgery in nasal polyposis transnasal ethmoidectomy.

Transnasal ethmoidectomy is a current treatment in selected cases of nasal polyposis, and with its complicated anatomy offers a proper opportunity for microsurgery. Ten years' experience of microsurgical ethmoidectomy in 155 patients with nasal polyposis is reported. The surgical anatomy of the ethmoid sinus is reviewed with attention to the requirements of the microsurgical approach, and the operative procedure is described. The microsurgical approach is discussed both as a part of the treatment of nasal polyposis and as a new development in rhinologic surgery. Advantages of the technique are the objective safety against risks of the ethmoid area and enhanced sense of security for the surgeon.

The ethmoid labyrinth: an anatomical and comparative radiological study.

After an osteologic description of the ethmoid labyrinth, the radiologic techniques which best display the ethmoidal cell topography, relationships and configuration are examined. On the basis of these observations it is concluded that standard radiographic tests cannot give a clear anatomic-radiologic representation of the ethmoid cells and that they must be supplemented with tomography.

Behavior of cancer at the anterior commissure of the larynx.

The present research is concerned with the behavior of the vestibular cancer with respect to the portion of the anterior commissure of the larynx which the authors have named the "x-space." The research is based on the analysis of semiseriated vertical sections showing cancers of the vestibule in stages T1 and T2 with histological gradings 1 and 2. The specimens show that, at least in the early stages of the neoplastic spread, the fibrous structures of the x-space act as a fairly effective barrier to deep diffusion of the tumor. This fact enables the surgeon to estimate macroscopically the lower borders of the tumor growth on the basis of the superficial spread of the cancer in the zone of the x-space.

The ethmoid labyrinth. An anatomical and radiological study.

After an osteological description of the ethmoid labyrinth, the authors examine the radiological techniques which best display the topography, interrelation and configuration of the ethmoid cells. On the basis of their observations they conclude that standard radiographic examinations cannot provide an adequately clear anatomical-radiological representation of these cells and must therefore be supplemented with polytomography and computerized tomography.

Morphological study of the laryngeal anterior commissure with regard to the spread of cancer.

This morphological study, done on larynges from male cadavers from 40 to 60 years of age, sectioned horizontally and dye-stained, shows that in the anterior commissure, at the level of the upper surface of the vocal cords, there is a structure which could be of cancerological interest, termed the X-space by the authors. This structure, 1.5-2.0 mm long, is composed of a homogeneous layer of dense fibrous connective tissue located between the dihedral angle of the thyroid cartilage and the laryngeal mucosa. Vascular and glandular formations penetrate the segments above and below this point, making the connective layer less homogeneous. As the X-space is a point of greater resistance to the deep spread of the tumor, the dissemination of cancer at this level is more likely to occur along the mucosa: this allows the surgeon to ascertain the exact margins of the tumor.

Transnasal microsurgical ethmoidectomy in nasal polyposis.

A technique of microsurgical ethmoidectomy by a nasal route was devised for and applied to the treatment of nasal polyposis. A description of the operative procedure and the results in 30 cases with a 3-5 years of follow-up are reported.