Two-sided dorsal plus ventral oral graft bulbar urethroplasty: long-term results and predictive factors.

OBJECTIVE: To evaluate long-term outcomes of the 2-sided dorsal plus ventral oral graft (DVOG) urethroplasty by preserving the narrow urethral plate in tight bulbar strictures and investigate which factors might influence long-term outcomes. METHODS: This is a single-center retrospective study of 166 patients who underwent DVOG urethroplasty for tight bulbar strictures by a single surgeon (E.P.) between 2002 and 2013. The strictured urethra was opened ventrally; the exposed urethral plate was incised in the midline and augmented dorsally and ventrally using 2 oral grafts. Outcome was considered a failure when any postoperative instrumentation was needed. According to stricture length, patients were classified in 3 groups as follows: ≤1.5 cm (group 1), >1.5 and ≤3.9 cm (group 2), and ≥4 cm (group 3). Time to failure was analyzed using Kaplan-Meier estimates and Cox regression. RESULTS: Median follow-up was 47 months (interquartile range, 33-95.5 months). Of the 166 patients, 149 (89.8%) were successful and 17 (10.2%) were failures. Most of the failures (90%) were observed during the first 5 years of follow-up; afterward, the success rate remained stable. The stricture length was a significant predictor of surgical outcome (odds ratio, 1.743 per cm; confidence interval, 1.2-2.5; P <.001); patients with a urethral stricture ≥4 cm presented a higher risk of late failure. Age, stricture etiology, and previous treatment were not significant predictors of surgical outcome. CONCLUSION: With long-term follow-up, the treatment of tight bulbar strictures using a 2-sided DVOG urethroplasty showed a high success rate. The stricture length is an independent predictor of failure.

Transoral robotic geniohyoidpexy as an additional step of transoral robotic tongue base reduction and supraglottoplasty: feasibility in a cadaver model.

PURPOSE OF THE STUDY: To evaluate the feasibility of including an additional step of transoral geniohyoidpexy in the transoral robotic tongue base reduction (TBR) and supraglottoplasty (SGP) procedure in order to better reproduce the classic Chabolle operation with expected similar outcomes but possibly with far less invasivity. PROCEDURE: A da Vinci surgical system was used in 2 cadavers. Dissection was carried out via a transoral approach in the same setting of TBR and SGP, after completing the basic tongue base and supraglottic steps. RESULT: A complete geniohyoidpexy was performed transorally. After identification, the hyoid bone body was rapidly dissected free from the suprahyoid muscles near the midline to the inferior border. CONCLUSION: A transoral robotic access to the hyoid bone was demonstrated. The procedure proved to be feasible in the same robotic setting of TBR and SGP.

Endoscopic surgery for the treatment of pediatric subperiosteal orbital abscess: a report of 10 cases.

INTRODUCTION: The pediatric subperiosteal abscess is considered an infectious process characterized by an abscess pocket localized between the lamina papiracea and the periorbita. Usually the surgical management is used to drain the collection of pus. METHODS: Between January 2006 and January 2009, 10 patients of age under 18-year-old underwent through a transnasal endoscopic approach at the University of Bologna, Sant'Orsola Malpighi Hospital for the treatment of a subperiosteal orbital abscess. All these patients were taken to the operative room in order to drain the abscess only after that the CT scan was accomplished and it demonstrated the presence of a subperiosteal orbital abscess. RESULTS: The transnasal endoscopic approach was used alone in 9 cases while it was associated with an external approach in one case for the treatment of a superolateral based subperiosteal orbital abscess. In all cases the exudate was obtained during the surgical procedure for the microbiological examination, although only 2 out of 10 cases had positive abscess cultures for Streptococcus pneumoniae. CONCLUSIONS: The transnasal endoscopic approach is an effective surgical treatment to drain the collection of pus in all medially based subperiosteal orbital abscess, while it can be associated with an external approach for the treatment of a superolateral based subperiosteal orbital abscess.

Abordaje endoscópico endonasal para el tratamiento del carcinoma adenoide quístico de fosas nasales con afección de la fosa pterigopalatina y basiesfenoides / Endonasal Endoscopic Approach for the Treatment of Adenoid Cystic Carcinoma Involving the Pterygopalatine Fossa and Basisphenoid

La utilidad de los abordajes endoscópicos para el tratamiento del carcinoma adenoide quístico del basiesfenoides y fosa pterigopalatina, solos o combinados con abordajes transorales, y la reconstrucción de los defectos creados constituyen un nuevo desafío para conseguir unos mejores resultados con una baja morbilidad. Se analiza 4 casos de carcinoma adenoide quístico abordados mediante técnica endoscópica o combinada y con un seguimiento que oscila entre 6 meses y 2 años. Todos los pacientes están libres de tumor en el período de seguimiento, las reconstrucciones realizadas han resultado efectivas y la morbilidad fue mínima, con una reducción de la estancia hospitalaria muy significativa. Se pone de manifiesto la utilidad del abordaje endoscópico para el tratamiento del carcinoma adenoide quístico del basiesfenoides y fosa pterigopalatina, la posibilidad de combinar la técnica con abordajes transorales y la reconstrucción con colgajos de músculo temporal para conseguir unos resultados funcionales excelentes (AU)

The utility of endoscopic approaches for the treatment of adenoid cystic carcinoma of the pterygopalatine fossa and basisphenoid, whether alone or combined with transoral approaches, as well as the reconstruction of resulting defects, represent a new challenge to achieve improved results with low morbidity. The present article describes four cases of adenoid cystic carcinoma treated through the endoscopic approach, alone or combined, with a follow-up ranging from 6 months to 2 years. All four patients remained tumorfree during the follow-up period and the reconstructions performed were effective. Morbidity was minimal and length of hospital stay was significantly reduced. We stress the utility of the endoscopic approach for the treatment of adenoid cystic carcinoma of the pterygopalatine fossa and basisphenoid and the possibility of combining this technique with transoral approaches and reconstruction with a temporalis muscle flap to achieve excellent functional results (AU)