The hyoid bone, with its complex system of connected muscles, ligaments and membranes, provides a highly resistant anchor point in all cases of larynx tumour surgery requiring a "pexy" to reconstruct the upper respiratory tract. This bone can also be important in reconstructive cervical surgery employing myocutaneous flaps, especially after extensive tissue removal, such as in locally advanced larynx tumours (primary T4 lesions or recurrences after partial or subtotal operations) and some primary or recurring malignant cancers of the thyroid, parathyroid or pharyngoesophageal tract involving the larynx. In this study the importance is underlined of preserving the hyoid bone in all cases of cervical surgery in which a strong anchor is needed for repair, due to the radical nature of intervention. The clinical-surgical data are reported of 39 patients, 38 of whom affected with epidermoid carcinoma of the larynx with various degrees of differentiation and 1 with "tall cell" papilliferous thyroid carcinoma, observed and treated over the last three years. In horizontal supraglottic laryngectomy (HSL), but particularly in subtotal larynx surgery with cricohyoidoepiglottopexy (CHEP) and cricohyoidopexy (CHP), the hyoid bone allows a sort of anastomosis to be performed, using residual cartilage to make a "neo-larynx". In reconstructive cervical surgery after extensive tissue removal, such as in forward widened total laryngectomy (FWTL), the hyoid bone offers an excellent anchor for myocutaneous pedunculate "repair" flaps, which may be thoraco-dorsal or free revascularized, to ensure continuity between the muscle tissue of the base of the tongue and of the flap itself. The hyoid bone and connected structures thus provide a real support apparatus whose great versatility, due to its resistance and extreme mobility, makes it particularly useful during the reconstructive phase of cervical surgery.
The recurrent or chronic “non specific pharyngitis” is one of the most common complaints of adults treated in an outpatient setting and it is a disease without a certain aetiology, but with many probable causes which can be of bacterial or viral nature, but incidence of atypical microorganism infection, such as Chlamydia trachomatis (Ct), Mycoplasma hominis (Mh) and Ureaplasma urealyticum (Uu) is believed to be on the rise. The increase is correlated above all to sexual behavior and to diffusion of new microbiological diagnostic methods, such as PCR. From 840 patients affected by recurrent episodes of chronic pharyngeal phlogosis and examined from 2006 to 2008, we selected 67 patients, 37 women and 30 men. On the basis of molecular and cultural analysis, 85.07% of patients were positive to Ct, and 89.55% were positive to Mollicutes (Mh+Uu), showing a vast overlapping of co-infections of Uu and Mh. Our data indicated a higher rate of infection by atypical microorganism in selected patients affected by chronic pharyngitis. It is important to suspect this aetiology during recurrent chronic pharingitis because patients with these oropharingeal infections, must be considered as carriers and the correct treatment, only possible after exact diagnosis, is above all necessary to prevent fearful complications in other body areas.
Cranio-facial osteomas are frequent in the nasal and paranasal sinuses, particularly in fronto-ethmoidal sites; other sinus cavities are more rarely affected. Although various theories (embryogenetic, traumatic and inflammatory) have been advanced to explain the pathogenesis, it is difficult to establish a specific cause-effect relationship. Nasal and paranasal osteomas are generally asymptomatic and are diagnosed on the basis of X-rays performed for other conditions, the onset of sinusitis-like symptoms or the appearance of complications due to sinus diseases. These cases require surgical removal to avoid the risk of short- or long-term complications or to solve any that may already exist. Herein, a rare case of osteoma of the maxillary sinus is described and the possible aetiopathogenetic role of traumatic and inflammatory factors described. The main clinical and therapeutic data concerning this lesion are examined.
The authors present a rare case of primary non-Hodgkin lymphoma (NHL) of the mandible in an 81-year old woman. The location of this NHL caused problems in making a differential diagnosis between periodontal and tumoral disease as they have similar symptoms (i.e. dental pain, swelling, ulceration and radiologically detected rarefaction). The present work emphasizes how important correct diagnosis and staging of the primary NHL are to good therapy. The patient was treated with a combination of chemotherapy and radiotherapy and is alive and disease-free 12 months after treatment.
Since very little is understood about the exact aetiology of tinnitus, this has made treatment of the condition difficult. Even though approximately 10-15% of the general population suffer from tinnitus, only 2% consider it serious enough to warrant any treatment. The main problem arising from tinnitus is the disturbance it causes not only in day to day life but also in sleep, leading to fatigue and general discomfort. The present study focused on the effect of Melatonin in conjunction with Sulodexide as a treatment method for tinnitus. Overall, 102 patients suffering from tinnitus were evaluated in a prospective randomised controlled study conducted in a tertiary care ENT department. After randomisation, 34 patients were treated with Melatonin and Sulodexide, another 34 were treated with Melatonin alone, while the remaining 34 (control group) were managed without treatment in order to evaluate spontaneous variations in the quality of tinnitus. Patients were assessed prospectively with the Tinnitus Handicap Inventory and Acufenometry, both pre- and post-treatment. Among the patients studied, better results with both Tinnitus Handicap Inventory and Acufenometry were found in the group who received Melatonin and Sulodexide compared to those receiving Melatonin alone. No improvement was observed in the control group. In conclusion, Melatonin in combination with Sulodexide is, in our opinion, a viable treatment option for patients suffering from central or sensorineural tinnitus.
The high incidence of second primary malignant neoplasms in patients under treatment for head and neck tumors has been well documented in literature. In these cases the second primary reappears still in the upper aero-digestive tract or in distant organs (lung, esophagus, stomach, skin,....). The Authors report a case of a male, 64 year old patient, a moderate drinker and smoker, with two distinct simultaneous laryngeal malignant neoplasms. One tumor, which arose on the laryngeal face of the epiglottis, was a verrucous carcinoma (Ackerman's tumor); the other neoplasm, on the right vocal cord, was a well differentiated squamous cell carcinoma. Microlaryngeal examinations and TC-scans revealed a normal, uninvolved right false vocal cord and the Morgagni's ventricle. After surgical therapy, serial laryngeal samples were removed and underwent immunohistochemical studies. Microscopic examination revealed that the anterior commissure, the pre-epiglottic and paraglottic spaces were intact, furthermore, monoclonal antibody studies proved that the two simultaneous laryngeal cancers were independent. In the discussion the Authors report some clinical considerations, a review of literature concerning multiple simultaneous laryngeal tumours and emphasize the concept of "field cancerization", first described with regard to the oral cavity by Slaughter.
