Bone-Anchored Titanium Implants in Patients with Auricular Defects: Three Years and 27 Patients' Experience.

Different surgical solutions have been proposed for reconstruction of the auricle following loss of the pinna through traumatic injury or neoplastic disease or in patients with congenital defects. Surgical treatment may involve the insertion of an autogenous rib cartilage framework or the use of a porous polymer material inserted into an expanded postauricular flap. Reconstruction with rib cartilage has yielded good results but requires more than one surgical step, and adverse events can occur both at the donor and at the acceptor site; cases of prosthesis rejection have also been described following application of the polymeric prosthesis. The use of a titanium, dowel-retained silicone prosthetic pinna, fixed to the temporal bone, has recently been proposed. This useful surgical approach is indicated particularly after resection of the pinna caused by neoplastic disease or in traumatic auricular injury. Osseointegrated titanium implants used in 27 patients in this study provided them with a safe, reliable, adhesive-free method of anchoring the auricular prostheses. The prostheses allowed recovery of normal physical appearance and all the patients reported that they were completely satisfied with the outcome of the surgical reconstruction. No surgical complications, implant failures, or prosthetic failures were encountered over six months to three years.

Osseointegrated Implants: An Alternative Approach in Patients with Bilateral Auricular Defects due to Chemical Assault.

Acid attacks committed as crimes of passion are unfortunately becoming far from infrequent occurrence. The injuries sustained in such attacks mainly involve the face and trunk, with the acid causing cutaneous and subcutaneous tissue burns that can result in permanent scarring, loss of the nose or external ear, and severe visual impairment. Different surgical solutions have been proposed for reconstruction of the auricle following loss of the ear through traumatic injury or cancer or in patients with congenital defects: surgical reconstruction may involve the insertion of an autogenous rib cartilage framework or the use of a porous polymer material inserted into an expanded postauricular flap. Reconstruction with rib cartilage has given good results but requires more than one surgical step and may be associated with adverse events involving both the donor site and the recipient site, while rejections of polymeric prostheses have been reported following their insertion into expanded postauricular flaps. The use of a titanium dowel-retained silicone prosthesis, in which the dowel is anchored to the temporal bone, is a surgical possibility, indicated particularly in cases of pinna resection due to tumour or auricular scarring following traumatic injury.

Osseous choristoma of the tongue: a review of etiopathogenesis.

Osseous choristoma is a normal bone tissue in an ectopic position. In the oral region lingual localization occurs more frequently and the mass is generally localized on the dorsum of the tongue. Definitive diagnosis is obtained only after histopathologic examination. The etiology remains already debatable. The treatment of choice is surgical excision. In this paper we present a case of tongue osseous choristoma and a review of the literature.

Unusual esophageal foreign body: a table fork.

The presence of an esophageal foreign body (EFB) is a medical emergency requiring urgent evaluation and treatment. Swallowing of foreign bodies is most common in children aged between 6 months and 6 years, in whom it usually occurs during games. In adults, foreign bodies tend to be ingested accidentally together with food. The authors report an unusual case of EFB (a table fork) in an adult and briefly report the clinical presentation and the therapeutic procedures adopted in this case and similar cases.

Effects of guidelines on adeno-tonsillar surgery on the clinical behaviour of otorhinolaryngologists in Italy.

BACKGROUND: Several guidelines on adeno-tonsillar disease have been proposed in recent years and some discrepancies in relation both to clinical manifestations and indications for surgical treatment have emerged. The aim of the study was to verify what influence (adeno)-tonsillectomy guidelines have had on the clinical behaviour of ENT specialists in Italy. Our study is a retrospective and multi-centre case series with chart review. METHODS: The survey involved 14,770 children, aged between the ages of 2 and 11, who had undergone adeno-tonsillar surgery between 2002 and 2008 in fourteen Italian tertiary and secondary referral centres. Anova test was used for the statistical analysis, assuming p < 0.05 as the minimum statistical significance value. RESULTS: The frequency of adeno-tonsillar surgeries did not change significantly (p>0.05) during the study period and following the Italian policy document publication. Overall, adeno-tonsillectomy was the most frequent intervention (64.1%), followed by adenoidectomy (31.1%) and tonsillectomy (4.8%). The indications for surgery did not change significantly for each of the operations (p>0.05), with the exception of adeno-tonsillectomy in case of feverish episodes due to acute recurrent tonsillitis ≥ 5 without nasal obstruction (decreased p= 0.010) , even when the feverish episodes due to acute recurrent tonsillitis were < 5 over the last year. Nasal obstruction was associated with feverish episodes due to acute recurrent tonsillitis in 65.2% of operated cases, while otitis media had been diagnosed in 43.3% of the patients studied. CONCLUSIONS: The recommendations first developed in Italy in a 2003 policy document and then resumed in guidelines in 2008, were not implemented by ENT units involved in the survey. The study highlights the fact that the indications for adeno-tonsillar operations are based on the overall clinical presentation (comorbidity) rather than on a single symptom. Guidelines are necessary to give coherent recommendations based on both the findings obtained through randomized controlled trials and the data collected from observational studies.

Hemangioma of the tympanic membrane: a case and a review of the literature.

Hemangiomas of the external auditory canal, involving the posterior bony canal and the adjacent tympanic membrane, although rare, are considered a specific disease entity of the human external auditory canal. Hemangiomas of the tympanic membrane and/or external auditory canal are rare entities; there are 16 previous case reports in the literature. It is a benign vascular tumor. It generally occurs in males in the sixth decade of life. Total surgical excision with or without tympanic membrane grafting appears to be effective in the removal of this benign neoplasm. The authors present a case and a review of the literature discussing diagnostic and surgical approaches.

Multiple symmetric lipomatosis: a review of 3 cases.

Multiple symmetrical lipomatosis, or Madelung's disease, is a rare disease of unknown etiology. It is characterized by the presence of loose adipose tissue deposits localized in the cervical region and in the upper body. The neoformations grow slowly and their initial consequence is purely esthetic. They can, however, lead to compression of the laryngotacheal area and of the esophagus. This disease usually affects middle-aged males from the Mediterranean area with a history of alcohol abuse. Although most cases have been sporadic, a few authors have indicated that the disorder may be hereditary. It is thought that this pathology originates from an alteration in lipid metabolism. Since the patients were asymptomatic temperance and diet was proposed, surgical removal of the lipomatose mass is the treatment of choice in case of complications due to fat mass compression on upper aerodigestive tract. The authors present three cases of Madelung's disease with different and particular manifestations.

Unusual cases of cervical nerves schwannomas: phrenic and vagus nerve involvement.

Benign neurogenic tumors (neurilemmoma) arising from the cervical phrenic or vagus nerve are relatively rare. These lesions are benign, asymptomatic and incidentally found. We describe two cases considering different surgical techniques adopted. In the case of phrenic nerve schwannoma we performed a total excision of the tumor including the maternal nerve fiber to prevent tumor recurrence, also in regard to the already present hemidiaphragm palsy. On the other hand in second case, in which the vagus nerve was involved, we proposed a microsurgical approach by monitoring nerve function in order to minimize nerve damage.