Bilateral secondary syphilis of the tonsil.

A patient with bilateral tonsillar enlargement secondary to syphilis is presented. Clinical appearance, histological findings and serological tests permitted a correct diagnosis to be obtained, ruling out the suspicion of cancer.

[Algodystrophic syndrome of the temporo-mandibular joint: a clinical experience]. / La sindrome algo-disfunzionale dell'articolazione temporomandibolare. Nostra esperienza clinica.

Algo-dysfunctional syndrome (ADS) of the temporo-mandibular joint (TMJ) is frequently encountered and, since its clinical expression is extremely polymorphic, it is often misdiagnosed. As there are many causes for ADS, even in a single patient, in line with the most recent interpretations found in the literature, an attempt was made to determine how important the lack of muscular coordination is in the onset of clinical symptoms. The study was conducted on 48 patients (32 females, 16 males, age range 17-68 years, average age 41.7 years) with ADS, clinically diagnosed according to the criteria defined by Rendell et al. The patients belonged to three distinct groups: -Group 1: patients with ADS of articular origin (9 cases); -Group 2: patients with ADS of dental and/or periodontal origin (18 cases); -Group 3: patients with ADS for which there was no apparent cause (21 cases). All patients were treated with a rehabilitation protocol aimed at eliminating the muscle spasm and restoring correct coordination. The results obtained showed that conservative treatment to resolve the muscle spasm gave positive results in 69% of the cases. The patients with concomitant articular pathology proved the least responsive to treatment. It was, therefore, considered likely that the main cause for clinical expression of this pathology is the muscle spasm itself. On this basis it can be concluded that muscular rehabilitation of the TMJ is valid in the treatment of ADS as it has proved able to break the vicious cycle of symptoms at the base of this pathology.

[Presumed physiopathology of the nasal wall surgery and contemporary techniques of the inferior turbinates surgery]. / Presupposti fisiopatologici della chirurgia della parete laterale del naso ed attuali tecniche della chirurgia dei turbinati inferiori.

The lateral wall of the nasal cavity is anatomically complex and covers several nasal functions: ventilation, conditioning of the air, protection. This region also plays a prime role in maintaining nasal-sinus homeostasis through dynamic regulation of the two-way exchange between the nasal cavity and paranasal sinuses. In light of the most recently acquired information, physio-pathological aspect of the lateral wall are discussed in terms of ventilation mechanisms and mucociliary clearance of the paranasal sinuses. In this light, the key to nasal-sinus physiology is clearly the perviousness of the side wall ostium and, above all, the status of the structures making up the "ostiomeatal complex". The anatomo-functional integrity of the lateral wall is fundamental for sinus ventilation 90% of which depends on passive diffusion of air through ostium. It is also a key to mucociliary clearance, always directed toward the main ostium. This rationale provides the basis for the so-called functional surgery of the lateral wall aimed at restoring ostium permeability. One structure in the lateral wall is a key to nasal physiology: the lower turbinate. Anatomical or functional alterations of the lower turbinate is one of the major causes of nasal stenosis. Pharmacological treatment of this pathologies is not always satisfactory, hence one leans toward surgical treatments. Nevertheless, the wide range of techniques available attests to the fact that there is still great deal of uncertainty in this regard. After having analysed the data available in the literature, the authors propose a comparison of some of the most frequently used forms of surgery: electrocauterization, cryotherapy, laser therapy, submucosal decongestion with or without luxation, turbinectomy. Follow-up based on rhinomanometric evaluation, rhinometry, TTMC, IgA assay and symptom scoring has been performed for 4 years. The results show that the submucosal decongestion technique, particularly the variation with lateral luxation, is considered most effective in resolving obstruction while respecting nasal physiology.

Cirugía reconstructiva de la laringe: resultados oncológicos y funciones / Reconstructive surgery of larynge: oufcome oncology and function

En los últimos años el manejo quirúrgico del cáncer de la laringe ha tomado derroteros extraordinarios. El objetivo de la cirugía parcial es la preservación de las funciones de la laringe: lamentablemente este tipo de cirugía ha tenido indicaciones muy restringidas. La restauración quirúrgica de la voz después de la laringectomía total (LT) encara sólidamente uno de los muchos problemas que la investigación encaminada a mejorar la calidad de vida de los pacientes afectos en cáncer de laringe trata de resolver. La reconstrucción subtotal pretende por otro lado recuperar todas las funciones de la laringe y los cirujanos hoy día pueden efectuar esta operación en sujetos que presentan tumores relativamente avanzados. Los autores pretenden que este es el camino correcto a seguir en el futuro y presentan una revisión de la literatura cerca de las intervenciones cuyo objetivo es la reconstrucción. Esta revisión se refiere a la posibilidad de extender más y más las indicaciones oncológicas en especial, permitiendo abandonar las intervenciones destructivas clásicas paso a paso

Un abordaje racional para la rehabilitación de la voz después de la laringectomia total / Rational attack for the rehabilitation of the voice after total laryncectomy

La rehabilitación quirúrgica protésica de la voz después de la laringectomía serealiza en la actualidad mediante el uso de prótesis exclusivamente. Las prótesis vocales son fáciles de insertar y son satisfactorias, tanto para el paciente como para el cirujano: por lo que su colocación ha tenido cada vez mayor aceptación. A pesar de esto, las prótesis fonatorias presentan aspectos desfavorables, tales como: altos costos, dependencia del paciente respecto al cirujano, en cuanto a cambio y reposición dela prótesis. Los autores discuten acerca de la intervención quirúrgica para rehabilitación de la voz después de la laringectomía total sin prótesis, y los problemas de deglución en pacientes con dispositivos intraoperatorios. La colocación de prótesis por consiguiente se ha restringido a aquellos pacientes en quienesla intervención quirúrgica como único procedimiento, ha fallado para el desarrollo de producción de la voz