The authors report two cases of superior mesenteric artery syndrome observed in 22 operations for severe spinal deformities. Medical, dietary and postural treatment enabled the situation to be resolved in one case; whereas an intestinal derotation according to Strong-Valdoni was successfully performed in the other. The various surgical alternatives are discussed.
Laser surgery represents the evolution of endoscopic surgery and, as far as concerns treatment of laryngeal tumours, CO2 laser cordectomy is considered a valid alternative to conventional surgery (laryngofissure cordectomy) and to exclusive radiotherapy for glottic carcinomas, classified as T1a, T1b and T2. The present report focuses on personal experience with CO2 laser cordectomy over the last 11 years, evaluating oncological and functional results. Between October 1990 and December 2001, micro-laryngoscopy has been performed with CO, laser, in 606 cases (benign and malignant lesions), of which 150 laser cordectomies, at the ORL Department, Eastern Piedmont University of Novara. An analysis is made of 63 patients (mean age 64.3 years) who underwent laser cordectomy for glottic carcinoma, observed at follow-up for at least 3 years. Vocal function has been studied on a sample of 20 patients. Of those who underwent CO2 laser cordectomy for T1a and T1s, 95.8% were disease free after a minimum of 3 years follow-up. Video-larynx-stroboscopic test highlighted the presence of a "satisfying" fibrous neocord in cases treated with Type III cordectomy. The speech compensation was of the "cord-neocordal" type (35%), false cordal (40%) and with arytenoideus hyperadduction (25%). The electro-acoustical analysis of the voice highlighted a "serious dysphonia" compatible with Type IV cases according to Yanagihara (70%) and moderate-severe dysphonia (30%). Mean values of vocal parameters were 5.8% for Jitter, 12.2% for Shimmer, 0.34 for NHR. CO2 laser cordectomy is first choice treatment for T1a glottic carcinoma, offering intra- and post-operative advantages: reduced traumatism, lack of tracheostomy, low bleeding, fast functional recovery (deglutition and speech), brief hospital stay, and low management costs. Dysphonia resulting from treatment, characterised by breathed voice, allows the patient to lead a normal life.
Background In 1727, Heister (Compendium anatomicum. Altdorf, Guill, Koleshii: editio tertia 1727: 134, table VIII and figs. 36–37) described the buccal fat pad (BFP) as an independent anatomic structure of the face; in 1801, Bichat (Anatomie generale appliquee a la physiologie et a la medecine. Paris, France: Brosson, Gabon et Cie Libraires, 1801:60) reported his fatty histologic finding. According to the literature, several pathologic tumorous conditions can arise from BFP, such as lipoma, lipoblastomatosis, liposarcoma, hemangioma, arteriovenous malformation, and nodular fasciitis; all of which are rare. After a revision of the English literature performed through PubMed between 1948 and 2008, we found 10 cases of lipomas arising from the BFP (7 cases are simple subtype, 2 are spindle cell lipoma, and 1 is fibrolipoma). The aims of this study were to introduce our clinical report of this rare pathologic entity, describe the surgical technique of the transoral approach, and discuss the potential pitfalls regarding the preoperative diagnosis and the close interrelation among the BFP, the facial buccal branches (FBBs), and the parotid duct (PD). Clinical Report A 43-year-old man was referred to the Maxillofacial Unit of the Novara Major Hospital with a 6-month history of a painless swelling in the right cheek. Clinical examination revealed a clearly visible, tender, slightly fluctuant mass, situated anterior to the masseter muscle and extended to the submandibular region. The patient underwent an ultrasound, a computed tomography, and a magnetic resonance imaging. Under general anesthesia with nasotracheal intubation, the patient underwent intraoral resection of BFP lipoma. Discussion The 2 major areas of discussion are the potential pitfall regarding the preoperative diagnosis and the close anatomic interrelation among the BFP, the FBB, and the PD. First, the spindle cell lipoma, one of the most common BFP lipoma variant, can be histologically and clinically similar to a well-differentiated liposarcoma, which can be recurrent and metastatic. This issue warrants that a careful workup of the tumorous mass of the buccal space and a BFP origin must be considered in every situation. Finally, according to the recent literature, the anatomic variations of the interrelation between the FBB and the BFP are classified into 2 groups: (1) FBB passing lateral to the BFP and (2) branches crossing inside the BFP. The anatomic variations of the interrelation between the PD and the BFP are classified into 3 groups: (1) PD passing lateral to the BFP, (2) PD crossing deep to the BFP, and (3) PD running along the superior border of the BFP.
Background: Voice alteration is a recognized complication of thyroid surgery, impacting the quality of life and communication for affected individuals. In this prospective observational study, the Acoustic Voice Quality Index (AVQI) was employed to assess vocal outcomes after thyroidectomy. Method: Between February 2018 and August 2022, 224 patients underwent Thyroid surgery in our department, of which 74 with differentiated thyroid carcinoma (DTC) were enrolled in accordance with the inclusion criteria. Endoscopic findings and AVQI scores were evaluated before and after surgery (voice analysis was conducted using the Praat software program version 6.0.33). Results: Vocal fold impairment was present in 6.76% of patients after surgery (T1), with full recovery within 3 months. During preadmission evaluation, an AVQI score > 2.35 indicating hoarseness was present in 37 patients (despite normal vocal cord motility). Of these, 25 (67.57%), 26 (70.27%), and 24 (17.76%) maintained this trend at T1, T2, and T3, respectively. No significant variation in mean AVQI values was observed based on gender, age, and central neck dissection. Conclusion: AVQI values did not show significant variations comparing pre- and postoperative values. Thyroid surgery for DTC performed by experienced surgeons does not seem to impact significantly on patients’ voice quality.
BACKGROUND: The COVID-19 pandemic caused a diagnostic delay in various conditions, including sudden sensorineural hearing loss (SSHL). The aim of this study was to investigate whether during the COVID-19 emergency period patients with a diagnosis of SSHL received a late diagnosis and if any delay resulted in a worse post-therapy outcome.METHODS: A retrospective study was conducted. Patients who received a diagnosis of SSHL during COVID-19 period and in the same period of the previous year were identified (control group); demographic and clinical data, values of the tonal threshold at the time of diagnosis (T0) and after therapy (T1) and the recovery rate were collected.RESULTS: Sixteen patients of group 1 (control group) and 11 of group 2 (COVID-19 period) met the inclusion criteria. Diagnosis and therapy were performed on average after 1.69 days in group 1, after 5.45 days from the onset of symptoms in group 2 (P=0.0025). After therapy, the audiometric control examination showed an average threshold recovery of 26.77 dB in group 1 and 20.53 dB in group 2 (P=0.048). In group 1, 62.5% experienced recovery of the hearing threshold while in group 2 only 36.4% (P=0.252).CONCLUSIONS: Despite therapy starting time was inevitably different in analyzed groups, diagnostic delay during COVID-19 emergency period resulted in a reduced improvement in the mean tonal threshold after therapy. Our data seems to confirm the hypothesis that early diagnosis and treatment are associated with a higher probability of auditory recovery.
A retrospective study was carried out on 79 patients with deep neck infections (DNI) admitted to our Department between 1990 and 2005 in order to review our experience with DNI and verify if diabetic and immunocompromised patients have more aggressive infections and poorer prognosis. Demographics, clinical presentation, etiology, site of infection, associated systemic diseases (26.6%-21/79), microbiology, treatment and complications were considered.
