Osseointegrated implants in patients with auricular defects: a case series study.

Several surgical solutions have been proposed for reconstruction of the auricle in patients whose ear is missing as a result of a traumatic accident, cancer resection, or a congenital condition. These include insertion of an autogenous rib cartilage framework or a porous polymeric material into an expanded postauricular pocket. Reconstruction with rib cartilage has given good results, but requires more than one surgical step and adverse events can occur at both the donor and acceptor site, while cases of prosthesis rejection have been described following application of polymeric prostheses with the expanded postauricular pocket technique. The use of a titanium dowel-retained silicone prosthetic pinna, fixed to temporal bone, has recently been proposed. This surgical technique is particularly indicated after resection of the pinna in cancer patients and in cases of traumatic auricular injury. Bone-anchored titanium implants provided the 15 patients in this study with a safe, reliable, adhesive-free method of anchoring auricular prostheses. The prostheses allowed recovery of normal appearance and all patients were completely satisfied with their reconstructions. No surgical complications, implant failures, or prosthetic failures were encountered.

Solitary fibrous tumour of the laterocervical spaces.

Solitary fibrous tumours are rare mesenchymal neoplasms usually arising in the pleura. Extra-pleural locations are uncommon although some cases of head and neck involvement have been reported in the recent literature. In such cases, nose, paranasal cavities and parapharyngeal spaces are the most frequently affected sites. The Authors present a case of a solitary fibrous tumour involving the laterocervical spaces. The histological diagnosis of solitary fibrous tumours gives rise to significant problems since parameters for determining their aggressiveness are still controversial. Immunohistochemical techniques are considered to provide a decisive identification. Follow-up plays a crucial role, as recurrences can occur even after several years. Usually, complete surgical excision is adequate whilst curative and radiochemotherapy may be indicated if complete resection of the tumour mass is impossible.

Management of nasal septal perforation using silicone nasal septal button.

Nasal septal perforation may present with various symptoms: epistaxis, crusting, secondary infection, whistling and nasal obstruction. Perforation may be treated by conservative pharmacological treatment or closed by surgical approach. A useful alternative is mechanical obturation, achieved inserting a prosthesis. The present report refers to a study on 15 patients (10 male, 5 female, mean age 38.5 years) treated by insertion of a one-piece or two-piece silicone septal button (Xomed). In the follow-up period, insertion of the nasal button reduced epistaxis, eliminated whistling during inspiration, and reduced nasal obstruction and crusting around the margin of the perforation. Contraindications are presence of acute infection with osteitis, chronic septal disease (Wegener), neoplasia and extremely large perforations. The latest buttons appear to be superior to the conventional type on account of plasticity and adaptability which offer greater conformity to the septum. This study also reveals that the new septal button is well tolerated by patients.

Parathyroid cysts: description of two cases and review of the literature.

Parathyroid cysts are a relatively rare cause of neck swelling, and their anatomo-pathological and clinical features are still under debate. Two types of parathyroid cysts have been recognized: the non-functioning or essential forms, which are more frequent, and the adenomatous or functioning parathyroid cysts, which are rarer and cause hyperparathyroidism. Two cases of parathyroid cysts are reported and the treatment is described bearing in mind the various therapeutic procedures proposed in the literature. Attention is focused on pre-operative differential diagnosis from other masses, in the same area, and, to this end, the importance is stressed of assaying parathyroid hormone levels in the cystic fluid, obtained by fine-needle aspiration, and correlating these values with serum levels of the hormone.

The role of positron emission tomography (PET) in the management of cervical lymph nodes metastases from an unknown primary tumour.

Cervical lymph node metastases may be the initial manifestation of occult cancer. Despite a very exhaustive search, the primary site of approximately 2-10% of these tumours remain undetected. Evaluation of the patient includes: detailed physical examination of skin, upper airways (fiberoptic endoscopy), salivary glands and thyroid; fine-needle biopsy, multiple endoscopic biopsies, and imaging studies (ultrasonography, computed tomography scan or magnetic resonance imaging). Recently, positron emission tomography scan has been demonstrated to be a useful diagnostic imaging study in these patients. The records of 11 patients were reviewed. End-points were the usefulness of positron emission tomography in the detection of an unknown primary tumour and/or distant metastatic disease. In 5 patients, positron emission tomography detected a primary lesion, confirmed pathologically and revealed distant metastases in 2 patients. Two cases were false-positive and 1 false-negative. In 3 patients no primary tumour was found after 3 years follow-up. In conclusion, positron emission tomography was not of any significant advantage in detecting occult primary tumour vs. computed tomography scan or magnetic resonance imaging. Positron emission tomography, as "ab initio" total body examination, is important in detection of unsuspected distant diseases.

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.

Malignant fibrous histiocytoma of the pharynx.

Malignant fibrous histiocytoma (MFH) is the most common soft-tissue sarcoma of late adult life, but is relatively uncommon in the head and neck region. That region has been reported to be the origin of malignant fibrous histiocytoma in 3-10% of cases. Only one case of the tumor occurring in the pharynx has been reported. Histologically it is sometimes hard to distinguish this tumor from some sarcomas and pleomorphic carcinomas. The treatment of choice is a large surgical resection, while radiotherapy and chemotherapy are reserved for recurrences. The authors present a case of oropharyngeal malignant fibrous histiocytoma. The patient complained dysphagia and dyslalia progressively worsening in six months. Pharyngo-laryngoscopy revealed a mass of the left lateral wall of oro and hypopharynx. CT scan examination showed a capsuled mass which displaced but not involved the neck neurovascular structures; there was no evidence of linphonodal involvement. Transoral surgical excision of the mass was performed with the preservation of speech and swallowing. For more than 1 year postoperatively, there has been no evidence of the disease or metastasis.

Color Doppler imaging and plasma levels of endothelin-1 in low-tension glaucoma.

Endothelin-1 (ET-1) is a potent vasoconstrictor peptide produced by vascular endothelin cells There are reports in the literature that ET-1 plasma levels are raised in low tension glaucoma (LTG). ET-1 plasma concentration and Color Doppler Imaging (CDI) evaluation in ophthalmic and posterior ciliary arteries were measured in 15 LTG patients and in 15 healthy subjects. The blood flow index recorded for the ophthalmic artery in normal subjects was a PSV of 36.646 +/- 6.611 cm/sec with RI of 0.717 +/- 0.019 while in the LTG patients it was 32.961 +/- 3.045 cm/sec (p < 0.003) with RI of 0.789 +/- 0.018 (p < 0.001). For the posterior ciliary arteries in the same two groups, we obtained a PSV of 13.878 +/- 4.149 cm/sec vs 8.720 +/- 1.645 cm/sec (p < 0.001) and an RI of 0.679 +/- 0.039 vs 0.722 +/- 0.024 (p < 0.001). The plasma ET-1 level in normal subjects was 1.720 +/- 0.174 pg while in LTG patients it was 2.947 +/- 0.217 pg (p < 0.001). On the basis of our experience, we think that GON and the visual field damage found in LTG can be attributed to an alteration in the endothelial self-regulating sections and consequent vascular insufficiency, particularly pronounced in the posterior ciliary arteries which, since it is these that provide the blood supply to the optic nerve head, leads to irreversible functional damage.

[Color Doppler ultrasonography in retinitis pigmentosa. Preliminary study]. / Echo-Doppler couleur dans la rétinopathie pigmentaire. Etude préliminaire.

PURPOSE: Retinitis pigmentosa is a bilateral retinal degeneration. The primary disorder is still debated. METHODS: We performed a prospective investigation of the ocular circulation directly by color Doppler imaging (CDI). A total of 28 eyes of 14 patients (8 men and 6 women, affected with retinitis pigmentosa) were recruited for this study. For each case were evaluated protosystolic velocity and the resistive index of the ophthalmic artery, central retinal artery, posterior ciliary arteries and choroid. These values, furthermore, have been compared with a control group. RESULTS: The results of the CDI in the group of RP and in the CG were: in the OA: PSV 31.177 +/- 5.119 cm/sec vs 36.700 +/- 3.152 cm/sec (p < 0.007); RI 0.713 +/- 0.058 vs 0.717 +/- 0.019 (p < 0.0839); in the CRA PSV 7.075 +/- 1.611 cm/sec vs 12.710 +/- 2.795 cm/sec (p < 0.001); RI 0.560 +/- 0.062 vs 0.550 +/- 0.051 (p < 0.234); in the PCA: PSV 8.569 +/- 3.408 cm/sec vs 14.100 +/- 2.571 cm/sec (p < 0.001) with RI 0.634 +/- 0.090 vs 0.681 +/- 0.045 (p < 0.145). In the CHO: PSV 12.312 +/- 2.327 cm/sec vs 16.170 +/- 1.846 cm/sec (p < 0.001) with RI 0.581 +/- 0.072 vs 0.638 +/- 0.050 (p < 0.065). CONCLUSION: Our results suggest that in the affected eyes there is a statistically significant reduction in blood flow in ophthalmic and ciliary arteries. These data offer new views on the retinitis cause of pigmentosa and possible therapeutics to be studied.

Correlation between visual field and color Doppler parameters in chronic open angle glaucoma.

The authors evaluated, by means of colour Doppler imaging, the blood flow in ophthalmic artery and posterior ciliary arteries in subjects with chronic open angle glaucoma. On the basis of the visual field indices (MD, SF, CPSD) the patients' eyes were divided in two groups: group A with better indices and group B with great damage. At the posterior ciliary arteries they found these values: PSV 10.264 +/- 2.363 cm/s (group A) vs. 7.882 +/- 1.251 cm/s (group B) (p < 0.008); RI 0.615 +/- 0.065 (group A) vs. 0.695 +/- 0.064 (group B) (p < 0.009). These data highlight a correlation between the visual field damage and the reduced supply of optic nerve head.

[Neoplasms intrinsic to the cheek. Diagnostic and surgical approach]. / Neoformazioni intrinseche della guancia. Approccio diagnostico e chirurgico.

In the light of nineteen personal observations during the past ten years, the Authors remember at first the anatomy of the cheek then the diagnostic approach and the surgery management of this complex region. They specify the variety of cheek space lesions and the possibility of rare or malignant masses involving the cheek. They emphasize the aesthetic results with the different surgery approaches.

[Embryonal rhabdomyosarcoma of the middle ear: description of a case with long-term survival]. / Il rabdomiosarcoma embrionale dell'orecchio medio: descrizione di un caso con sopravvivenza a lungo termine.

A case is described of embryonal rhabdomyosarcoma (E.R.) of the middle ear in a 4-year-old child; survival has been over 9 years. R.E. is the most common malignant tumor of the auricular region in children and is most often fatal due to locoregional extensions or secondary metastases carried through the bloodstream and lymphatic systems. The basis for treatment is a multidisciplinary approach to the disease: surgery with as broad an exeresis as possible; radiotherapy with tumor-killing doses of 5,500/6,000 rads; and polychemotherapy (Vincristina, Endoxan, Methotrexate). Such "aggressive" treatment often results in a high rate of morbidity with complications involving the blood, bones, eyes and meninx often requiring temporary suspension of treatment and prolonged hospitalization.

[Neurofibroma of the laterocervical space: 4 cases from our experience]. / I neurofibromi delle logge laterocervicali: quattro casi personali.

Four cases of neurofibroma located in the lateral neck spaces are reported. All had come to light upon clinical examination during the course of a few months. The clinical aspects of each are described and the particular difficulties in diagnosis and pre-surgical treatment are stressed. In fact, solitary neurofibromas must be distinguished from von Recklinghausen neurofibromatosis. Modern radiology has made it possible for the authors to make a presumptive diagnosis in two of the four cases. Particularly in one case CT-scan confirmed the contemporary involvement of the intrarachidian space. This demonstrates that in such cases a multidisciplinary approach is desirable.

Ultrasonic patterns of parotid masses.

The aim of this study was to define sonographic patterns of expanding parotid lesions. Over a 2-year period, 39 parotid gland masses were examined. Gray-scale sonography with a static scanner using high frequency transducers (5 and 7.5 MHz) provided refined visualization of the normal structure of the gland and the space-occupying mass. There are different sonographic patterns for different types of mass. Lesion malignancy should always be suspected when there is a clearly echogenic mass, especially one with an irregular distribution of the echoes, posterior attenuation, and rough margins (these sonographic features are of no value for lymphomas). All benign lesions have regular margins and are sonolucent at normal gain settings. It is possible to obtain a characteristic sonographic pattern for each specific benign lesion by varying the gain.