[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.

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.

[Laryngotracheal widening surgical techniques by external approach]. / Tecniche di ampliamento laringo-tracheale per via cervicotomica.

Surgical approach to laryngo-tracheal stenosis can be divided into: immediate approach and delayed approach. The aim of the immediate approach is to restore breathing and to repair the damage produced by the trauma. Delayed approach (the most frequent approach to the laryngeal and tracheal stenosis) has the purpose to reconstruct larynx and trachea removing scar tissue and improving lumen of the respiratory tract. In this paper the surgical external techniques employed in the widening of the larynx and trachea after blunt and/or penetrating trauma with secondary stenosis are evaluated. For each technique indications, pitfall conditions and complications are considered. Long term results are discussed.

[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.

[Laryngeal T4 carcinomas. The possibility of conservative treatment. Long-term oncological and functional results]. / Carciomi T4 della laringe:P possiblitià di trattamento conservativo. Risultati oncologici e funzionali a distanza.

The term laryngeal T4 carcinoma is applied to a heterogeneous group of neoplasias which may be treated following various surgical approaches. The elective therapy in dealing with many of these tumours (minimal cartilage involvement, marginal hypopharyngeal extension, supra-glottic cancer with oro-pharyngeal extension) is that of a conservative approach. Our clinical experience with regard to 276 T4 laryngeal tumours is presented in this paper. Oncological and functional results with partial surgery are reviewed and discussed and long-term results obtained with widened total laryngectomy (plus Radio and/or Chemotherapy) are presented.

[Anterior commissure in the spreading of the glottic cancer: classification, prognosis and therapy]. / La commissura anteriore nell'evoluzione dei tumori del piano glottico: considerazioni classificative, prognostiche e terapeutiche.

Laryngeal tumors involving anterior commissure have a particularly aggressive behaviour. Prognosis and therapy of these tumors is quite different depending on the type and the extension of commissural involvement. In spite of these considerations, present TNM classifications (UICC/AJCC) of laryngeal tumors do not consider anterior commissure in the spreading of glottic cancer. To obviate this problem, Fini-Storchi (1993) proposed an anatomic-oncological definition of anterior commissure (AC) and, on it, a classification (additional to TNM system) of AC involvement (AC1-AC2-AC3). We marginally modified Fini-Storchi classificative criteria and, according to them, we performed e re-classification of laryngeal tumors with anterior commissure involvement, we observed in our Department between 1977 and 1991 (255 cases). In particular we treated 190 AC1 (74.5%), 40 AC2 (15.6%), 25 AC3 (9.8%). For each AC category, different therapeutical options are presented and discussed. Long term results (minimum follow-up: 38 months) are evaluated and efficacy of AC classification is checked.

Clinical experiences with surgical techniques and treatment results in patients undergoing subtotal laryngectomies.

After a period of critical evaluation, subtotal laryngectomies are now considered to be valuable additions to the surgical management of laryngeal neoplasms. It is now possible to obtain good functional and oncological results in treating clinical situations that until a few years ago appeared curable only by radical surgery. We now report our clinical experiences with Labayle and Majer-Piquet types of subtotal laryngectomies and discuss indications and contra-indications to such surgery. Our current preference is to use Labayle technique, since it permits better functional recovery and a shorter clinical course.

Clinical experiences with surgical therapy of cervical metastases from head and neck cancer.

Indications for the various techniques of neck dissection can undergo substantial variations according to the metastatic picture found, biological aggressiveness of tumor, nodal volume and personal philosophies of the attending clinician. In the present paper we report our clinical experience with radical neck dissections, "functional" neck dissections and selective neck dissections-in total, 1658 neck dissections carried out between 1976 and 1991. We discuss the indications and contra-indications of the various surgical techniques of neck dissection and evaluate the long-term results. Our current preference is to use the Suarez-Bocca "functional" technique of neck dissection for prophylactic treatment of the neck and for therapeutic treatment of the neck when intracapsular metastases already exist.

Efficacy and tolerability of brodimoprim in otitis.

Eighty adult patients affected by acute bacterial otitis media were selected and randomized into two balanced groups of treatment: 1) brodimoprim 200 mg tablets at the dosage of 2 tablets in single dose on the first day and one tablet on the following days; 2) josamycin 500 mg tablets at the dosage of 3 tablets/day. The average duration of treatment was 8 days: all patients completed the trial. The symptoms were evaluated by score method (on the 3rd, 7th and on the last day of therapy) and a thermometric curve was made daily. Microbiological examination of the exudate was performed in the patients with auricular discharge (28), at the beginning of the treatment and 7 days after the end of therapy. The tolerability was assessed through registration of side effects. Brodimoprim resulted more effective in the reduction of hypoacusis and tinnitus; other symptoms demonstrated higher percentage reductions in the group under brodimoprim therapy. Bacteriological exams were negative at the second checkup, except in 6 patients (3 per group). Side effects were reported in 5 patients (12.5%) treated with brodimoprim and in 9 (22.5%) treated with josamycin. Abnormal values in laboratory tests were not observed.

Adenoid-cystic carcinoma (cylindroma) of the pyriform sinus in pediatric age.

Adenoid cystic tumors or cylindromas are malignant tumors typical of salivary tissue which often develop in minor salivary glands and, according to some authors, also in common mucosa glands. In these cases such tumors are particularly malignant owing to the frequency in which they re-occur locally and develop distant metastases. The authors report a case of a cylindroma of the pyriform sinus in a young child. An accurate review of the literature did not reveal any previous reports of analogous cases of cylindroma in the pyriform sinus of such a young subject. This finding created notably difficult problems with regard to therapy planning. After discussion of problems, conservative surgery is indicated as the most suitable treatment in these cases, considering that chemotherapy and radiation therapy alone are not highly effective in treating cylindromas and, furthermore, they are contraindicated because of the young age of the patient.