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1.
Int. arch. otorhinolaryngol. (Impr.) ; 27(1): 117-122, Jan.-Mar. 2023. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1421692

ABSTRACT

Abstract Introduction For a long time, major surgical defects after oncological surgery have always been challenging cases for surgeons in terms of wound healing and covering technique. Objectives To demonstrate the feasibility of supraclavicular artery flap (SCAF) in the reconstruction of surgical defects in those "fragile" patients undergoing oncological surgery who could not possibly have endured the timeframes involved in using microvascular free flaps. Methods Between January 2018 and January 2019, at the Azienda Socio Sanitaria Territoriale (ASST) Bergamo Est Hospital (Bergamo, Italy), we reported the cases of 11 patients in whom the SCAF was used for surgical reconstruction after oncological surgery in our Otolaryngology Department. The median age of the 11 patients was 68.7 years old. Results The SCAF has proved, in almost all 11 cases in which it was used, to be very reliable and, above all, easy and quick to make in those "fragile" patients without the need for further intervention. There was only one case in which the resection involved the auricle entirely and a small area of perimeatal bone exposure occurred, which, anyway, healed by secondary intention. Conclusion The SCAF is an extremely versatile flap for head and neck surgery to be considered especially for fragile and vulnerable patients who cannot undergo prolonged surgical time. Moreover, this technique has also shown high feasibility in small hospitals where there is not a plastic surgery department and the surgeon may face the difficulty of practicing surgical reconstruction after enlarged resection.

2.
Int Arch Otorhinolaryngol ; 27(1): e117-e122, 2023 Jan.
Article in English | MEDLINE | ID: mdl-36714897

ABSTRACT

Introduction For a long time, major surgical defects after oncological surgery have always been challenging cases for surgeons in terms of wound healing and covering technique. Objectives To demonstrate the feasibility of supraclavicular artery flap (SCAF) in the reconstruction of surgical defects in those "fragile" patients undergoing oncological surgery who could not possibly have endured the timeframes involved in using microvascular free flaps. Methods Between January 2018 and January 2019, at the Azienda Socio Sanitaria Territoriale (ASST) Bergamo Est Hospital (Bergamo, Italy), we reported the cases of 11 patients in whom the SCAF was used for surgical reconstruction after oncological surgery in our Otolaryngology Department. The median age of the 11 patients was 68.7 years old. Results The SCAF has proved, in almost all 11 cases in which it was used, to be very reliable and, above all, easy and quick to make in those "fragile" patients without the need for further intervention. There was only one case in which the resection involved the auricle entirely and a small area of perimeatal bone exposure occurred, which, anyway, healed by secondary intention. Conclusion The SCAF is an extremely versatile flap for head and neck surgery to be considered especially for fragile and vulnerable patients who cannot undergo prolonged surgical time. Moreover, this technique has also shown high feasibility in small hospitals where there is not a plastic surgery department and the surgeon may face the difficulty of practicing surgical reconstruction after enlarged resection.

3.
Otolaryngol Head Neck Surg ; 157(6): 966-972, 2017 12.
Article in English | MEDLINE | ID: mdl-28675099

ABSTRACT

Objective Evaluate outcomes of the lengthening temporalis myoplasty in facial reanimations. Study Design Case series with planned data collection. Setting Ospedali Riuniti, Bergamo, and AOUC Careggi, Florence, Italy. Subjects and Methods From 2011 to 2016, 11 patients underwent lengthening temporalis myoplasty; demographic data were collected for each. Pre- and postoperative photographs and videos were recorded and used to measure the smile angle and the excursion of the oral commissure, according to the SMILE system (Scaled Measurements of Improvement in Lip Excursion). All patients were tested with the Facial Disability Index, and they also completed a questionnaire about the adherence to physiotherapy indications. Results All patients demonstrated a significant improvement in functional parameters and in quality of life. On the reanimated side, the mean z-line and a-value, measured when smiling, significantly improved in all patients: from 22.6 mm (95% CI, 20.23-25.05) before surgery to 30.9 mm (95% CI, 27.82-33.99) after surgery ( P < .001) and from 100.5° (95% CI, 93.96°-107.13°) to 111.6° (95% CI, 105.63°-117.64°; P < .001), respectively. The mean postoperative dynamic gain, passing from rest to a full smile at the reanimated side, was 3.1 mm (95% CI, 1.30-4.88) for the z-line and 3.3° (95% CI, 1.26°-5.29°) for the a-value. The Facial Disability Index score increased from a preoperative mean of 33.4 points (95% CI, 28.25-38.66) to 49.9 points (95% CI, 47.21-52.60) postoperatively ( P < .001). Conclusions The lengthening temporalis myoplasty can be successfully used for smile reanimation, with satisfying functional and quality-of-life outcomes.


Subject(s)
Facial Muscles/surgery , Facial Paralysis/surgery , Free Tissue Flaps , Otorhinolaryngologic Surgical Procedures/methods , Outcome Assessment, Health Care , Plastic Surgery Procedures/methods , Quality of Life , Aged , Aged, 80 and over , Facial Muscles/physiopathology , Facial Paralysis/physiopathology , Facial Paralysis/psychology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Retrospective Studies , Smiling , Surveys and Questionnaires
4.
Otol Neurotol ; 37(6): 787-92, 2016 07.
Article in English | MEDLINE | ID: mdl-26808555

ABSTRACT

OBJECTIVE: To determine how classification of petrous bone cholesteatomas (PBCs) using the 5-point Sanna classification can predict major structural involvement, facial nerve outcomes, hearing outcomes, postoperative complications, and disease recurrence. STUDY DESIGN: Retrospective case series. SETTING: Tertiary referral center in Bergamo, Italy. PATIENTS: Eighty-one sequential patients with radiologic and surgically confirmed diagnoses of PBC treated at a single tertiary referral center during a 20-year period. MAIN OUTCOME MEASURES: Major structural involvement, facial nerve outcomes, hearing outcomes, postoperative cerebrospinal fluid leak, and disease recurrence were evaluated on the basis of Sanna classification. RESULTS: Using the Sanna classification, 70% (57) were supralabyrinthine, 12% (10) infralabyrinthine, 7% (6) infralabyrinthine-apical, 5% (4) apical, and 5% (4) massive. Massive classification was statistically significantly associated with cochlear involvement (p = 0.009) and internal auditory canal involvement (p = 0.02). The infralabyrinthine-apical class was associated with carotid canal involvement (p = 0.03). Facial nerve interruption was observed in 35% of patients and most frequently in the apical group (75%). Neither hearing nor facial nerve outcomes were associated with Sanna classification. House-Brackmann score improved or was maintained postoperatively in 89% of patients. CONCLUSION: The Sanna classification provides anatomic detail on location of PBCs and is predictive of IAC, cochlear, and carotid artery involvement. However, classification systems for this rare condition continue to pose a challenge in being able to accurately predict facial nerve and hearing outcomes in surgical obliteration of PBC.


Subject(s)
Cholesteatoma/classification , Cholesteatoma/pathology , Petrous Bone/pathology , Cholesteatoma/complications , Female , Humans , Italy , Male , Prognosis , Recurrence , Retrospective Studies , Tertiary Care Centers
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