Montgomery Salivary Bypass Tube vs Self-Expandable Metal Stents for the treatment of esophageal strictures after total laryngectomy: a crossover study.

Objectives: Dysphagia affects 16% of patients undergoing total laryngectomy; of these, a third is due to pharyngoesophageal stenosis. Currently, the treatment is cyclic dilation of the stricture and Montgomery Salivary Bypass Tube (MSBT) application. The aim of this study is to assess whether using Self-Expandable Metal Stent (SEMS) may give better results after a non-durable response to repeated dilatation and application of MSBT. Materials and Methods: We verified whether using SEMS after at least 3 cyclic dilations and application of MSBT results in a longer dysphagia-free time in laryngectomized patients with pharyngolesopha-geal stenosis. Secondary outcomes were the duration of the procedures, radiation exposure and complications. Results: We enrolled 6 patients with a median age of 65 years (QR 62.5 - 75.75), of which 50% had undergone radiotherapy. Friedman's test for the duration of the dysphagia-free period did not show a statistically significant difference between the two groups (Friedman chi-squared = 2.6667, df = 1, p-value = 0.1025). The time required to implant the MSBT was significantly less than that required to implant the SEMS (Friedman chi-squared = 6, df = 1, p-value = 0.01431). Radiation exposure was absent for MSBT, while SEMS implant required an exposure to X-rays during the procedure and after 48 hours for placement verification. Two patients experienced short-term complications after SEMS implantation and one after two weeks from MSBT implantation; none of them had any health consequences. Conclusion: In patients who are already undergoing cyclic dilations and application of MSBT, switching to SEMS is not beneficial. Furthermore, MSBT has a significantly shorter implant procedure, does not expose the patient to X-rays, and, in the absence of complications, has a longer duration before removal.

Malignant degeneration of oral lichen planus: our clinical experience and review of the literature.

Lichen planus of the oral mucosa (OLP) is characterized by lymphocytic infiltrate in the epithelial layer and basal cells lysis. Some studies have suggested a high incidence of oral squamous cell carcinoma in patients with OLP that has been implicated as a premalignant lesion. We describe 19 cases of OLP, and the immunopathologic basis for OLP, its potential association with malignancy and the variable clinical pictures in patients with OLP are reviewed. Also, specific recommendations are given for treatment and follow-up of lesions.

Perilymphatic fistula following trans-tympanic trauma: a clinical case presentation and review of the literature.

The perilymphatic fistula is constituted by an anomalous connection between the perilymphatic space and the middle ear. The principal accuses are to be sought in the intracranial pressure increasement, cranial traumas, barotraumas, congenital anomalies, trans-tympanic traumas, etc. Stapes's dislocation in the vestibule and the fracture of the platina are the most frequent pathogenic mechanisms. In clinical practice, the diagnosis remains a problem rather debated, even if the clinical pattern, the laboratory investigations, the diagnostic images and the tympanic exploration, all together can confirm, in the majority of the cases, the diagnostic suspect. This article presents a clinical case of a transtympanic trauma with perilymphatic fistula caused by a foreign body. The peculiarity of this case must be set in relation with both the aetiopathogenesis of the labyrinthine lesion and the severity of the symptomatology caused by it.

[Dermoid cysts of the floor of the mouth: case report]. / Cisti dermoidi del pavimento orale: presentazione di un caso clinico.

Dermoid cysts are for the most part benign neoformations most likely deriving from ectodermic differentiation of totipotent cells. Although localization on the floor of the mouth has been described for more than a century it is still reported as rare and can give rise to problems in differential diagnosis. This work presents a case of dermoid cyst of the floor of the mouth in a 16-year-old patient and provides considerations on clinical approach, diagnosis and therapy for this type of lesion.