Outcomes of interventional sialendoscopy for obstructive salivary gland disorders: an Italian multicentre study.

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.

Sialoendoscopy: state of the art, challenges and further perspectives. Round Table, 101(st) SIO National Congress, Catania 2014.

This draft of the Official Round Table held during the 101(st) SIO National Congress is an updated review on sialoendoscopy, a technique used for diagnosis and treatment of obstructive pathologies of salivary glands in a minimally invasive fashion. This review treats many aspects of salivary gland endoscopy, starting from anatomy to deal with the more advanced surgical techniques and analyses the main decisional algorithms proposed in the literature. In addition, particular attention was directed to the current limitations of this technique and to the potential developments that sialoendoscopy could have in the near future.

[Glottic-hypoglottic laryngectomy in the treatment of laryngeal tumors]. / La laringectomia glottico-ipoglottica nel trattamento dei tumori della laringe.

Subglottic cancers and glottic cancers with subglottic extension are considered extremely serious because they are not easily detected and are normally quite advanced when diagnosed. Furthermore these cancers spread rapidly beyond the larynx to the lymph nodes (cervical and recurrential chains). Total laryngectomy is elective surgery in the treatment of subglottic cancer. However, in selected cases, small tumors may also be treated successfully with partial glottic-subglottic laryngectomy. The aim of this paper is to present a personal experience with partial surgery in the treatment of subglottic cancer. The surgical operation consists of the resection of both vocal cords, the subglottic region and the cricoid cartilage with the proximal tracheal rings. The larynx is reconstructed through a tracheal-thyroid approach. The surgical technique is illustrated and the authors' experience discussed.

External versus endoscopic approach in the surgical treatment of glottic cancer.

Laryngeal carcinomas in the early stages of evolution can be treated by different therapies. In this paper we present our personal experience with T1 and small T2 laryngeal glottic cancer treated by conventional surgery and by endoscopic laser surgery. In the period 1983-1997, we saw 573 patients affected by T1 and limited T2 glottic tumours. In particular, we treated 325 case of T1a tumour, 185 T1b and 63 T2 (ventricle floor). As regards surgical techniques, we employed cordectomy by laryngofissure in 196 patients; laser cordectomy in 129 cases; widened laser cordectomy in 63 cases; fronto-lateral laryngectomies according to Leroux-Robert in 110 patients; laser cordo-commissurectomies in 37 cases; horizontal glottectomies according to Calearo-Teatini in 9 cases, and laser glottectomies in 29 patients. The average oncological results, considered for every stage and every surgical technique were 84.4% (484 cancers definitively controlled by primary surgery). For comparison of oncological and clinical results, we evaluated patients affected by tumours with similar extension that had been treated by different surgical techniques. Oncological results were similar in the two groups. In the group treated by laser surgery we found a shorter clinical course and the best possibility of salvage therapy in the case of local recurrence.

[Delayed diagnosis of benign paroxysmal vertigo: economic impact]. / Il ritardo diagnostico nella vertigine posizionale parossistica benigna: impatto economico.

Some time has passed since the early 1980's when a group of vestibologists with the same singular passion introduced in Italy the concept of Paroxysmal Positional Vertigo (PPV). Since then great advances have been made, but, despite the energy focused on improving and expanding the knowledge on this common disorder, PPV still frequently goes unrecognized. The direct consequence of delayed diagnosis is prolonged patient discomfort and the execution of useless, costly clinical examinations. Today, in most cases, delayed diagnosis is unjustified. Within the modern concept of health care economics, such delay is costly to the health care provider and has obvious psycho-physical repercussions for the patient who has to undergo a fruitless series of examinations and treatments of all types without reaping any benefits. In this light the Authors have performed a study to identify and quantify the relative costs of the most common errors made in the diagnosis of PPV. For a sample population of 100 patients, the clinical-instrumental tests performed before the disorder was correctly diagnosed were gathered and analyzed. Then the costs for the management of PPV patients diagnosed late were compared with those for patients whose diagnosis was reached early on. The results indicate that for each delay in PPV diagnosis the average cost was Euro 317.66 vs. Euro 64.04 for early diagnosis: a difference of Euro 253.06. The Authors underline how in this brief period of time (March-September 2000) the prescription of excessive testing led to a significant waste of money (Euro 10137.01).

[Acoustic rhinometry: proposal for the standardization of the examination method]. / Rinometria acustica: una proposta di standardizzazione della metodica d'esame.

Acoustic Rhinometry is a rhinological test essential to evaluate nasal fossae geometry. The test requires that the patient be positioned so that a 120 degrees angle is formed between the nasal adapter and the floor of the nasal fossa. The use of a craniostat ensures that the patient is actually in this condition and that the position remains unvaried throughout subsequent tests. The purpose of the present study has been to evaluate the reproducibility and reliability of craniostat-aided acoustic rhinometry in routine clinical practice. A total of 33 patients with hypertrophy of the lower turbinates were enrolled in the study. Rhinometry was performed in the basal conditions and after decongestion with a vasoconstrictor spray. Statistical analysis was performed on the sampling and showed that acoustic rhinometry performed with the craniostat was more reproducible and more reliable than those readings taken without the aid of the craniostat.

Neurogenic tumors of the head and neck in children.

Soft tissue tumors make up 63% of all tumors in children. Tumors of the sympathetic chain make up 7.4% of tumors arising in children (nine new cases a year for every million children in USA) while neurofibrosarcomas make up 3.4% (2.4 new cases per year for every million children). There is a certain difference between the frequency of benign forms (rather elevated) and that of malignant forms (rather low). Diagnosis is possible by echo-scan, computed tomography, magnetic resonance imaging and fine-needle aspiration biopsy. As regards therapy, surgical resection represents the treatment of choice. In our experience, 35 neurogenic tumors in pediatric patients (8-16 years), arising in head and neck spaces, were observed and treated in the period 1976 and 1995. Twenty-six cases were schwannomas, six were neurofibromas and three were olfactory neuroblastomas. All the patients underwent surgery. Sacrifice of the affected nerve was necessary in 12 cases (all neurofibromas and eight neurinomas). In one case of olfactory aesthesioneuroblastoma a combined approach (extra-intracranial approach) was employed. Two patients are alive and disease-free with 5 and 7 years follow-up. As regards dysfunctional pathology following surgical resection, we report definitive facial nerve palsy in two cases, permanent laryngeal palsy in six cases, tongue dysfunction in one case and cheek hypoaesthesia in one case.

[Inverted papilloma. Modality of treatment]. / Il papilloma invertito. Modalità di trattamento.

According to World Health Organization (WHO, 1991) papillomas of nasal cavity is subdivided in three main histopathological types: 1) Inverted papilloma; 2) exophytic papilloma; 3) vestibular papilloma. In particular, inverted papilloma represents 0.5%-4% of all nasal tumors and is characterized by local aggressivity and malignant evolution. During the years controversies arose about therapeutical treatment of inverted papilloma, with different results concerning conservative treatment (endoscopic resection; Caldwell-Luc operation) and an external approach resection (Weber-Fergusson approach). Our clinical experience is related to 33 patients submitted to surgery for inverted papilloma of nasal and paranasal cavity in the period 1982-1993. Diagnostic method was based on endoscopy and CT/RM integration in order to demonstrate local extension of tumor and to plan surgical approach. In particular 8 patients were submitted to endoscopic surgical approach (small and anterior papillomas). In 10 cases we performed a combined approach (endoscopic microsurgery plus Caldwell-Luc approach) and in 15 patients an external approach was carried out. Long-term results of the therapy are presented and discussed and a review of Literature is carried out.