Mucoceles of the frontal sinus. Clinical and therapeutical considerations.

BACKGROUND: Mucocele is an epithelial lined mucus-containing sac completely filling a paranasal sinus and capable of expansion by virtue of a dynamic process of bone resorption and new bone formation. It is the most common lesion causing expansion of the paranasal sinuses. Even though mucoceles of paranasal sinuses are increasingly treated by endoscopic surgery, the external approach with or without the obliteration of the sinus still remains a useful and sometimes the only tool in the treatment of this disease. METHODS: The results obtained in seven patients observed at the ENT Department of the University of Ferrara (Italy) in the period ranging from 1989 to 1999 are presented; they were affected by massive fronto-ethmoidal mucoceles and treated with the external approach alone or combined with an endonasal approach and osteoplastic flap. They were five males and two females, with a mean age of 56.5 years. Locations were bilateral in one mucocele, while in six patients only one side was involved, with a prevalence of the left frontal sinus (4:2). RESULTS: No patient showed any local or general complication in the postoperative period. The follow-up showed no recurrence of the disease. CONCLUSIONS: Since the osteoplastic flap was introduced one hundred years ago, it still remains the optimal surgical treatment for fronto-ethmoidal mucoceles. Even though, today, endoscopic surgery represents the new horizon in the management of the sinonasal disease, mucoceles need a surgical treatment which allows the total vision of the cavity to obtain radical treatment and any recurrence of disease.

Tracheostomal recurrences after laryngectomy.

A clinicopathologic study of 681 laryngectomies performed at the Otorhinolaryngology Clinic of the University of Ferrara forms the basis here of a discussion of the etiopathogenesis of the postsurgical tracheostomal recurrence. Special attention is paid to the much debated etiopathogenetic role of preoperative tracheotomy. In all classes of material analyzed, tracheostomal recurrence was more frequent in patients with preoperative tracheotomy, though the percentages varied depending on the class. Morphological analysis of original tumor specimens from preoperatively trachetomized patients who later had tracheostomal recurrence, revealed tumors in 4 out of the 11 usable specimens. Of these, two had submucosal infiltration in a peripheral digitation of the tumor; in the other two cases, no contact was observed between the neoplastic infiltration and the outer border of the original tumor. The authors also reviewed the case histories of patients in whom conservative surgery was followed by total laryngectomy because of endolaryngeal recurrence. The high rate of tracheostomal recurrence in this category of patients suggests that the pathogenetic mechanism may be analogous in the two situations: preoperative tracheotomy/tracheostomal recurrence and inadequate conservative surgery/tracheostomal recurrence.