Double-handed endoscopic myringoplasty with a holding system in children: Preliminary observations.

OBJECTIVES: Endoscopic transcanal myringoplasty is a newly-introduced technique for reconstruction of tympanic membrane perforation that offers the advantage to obviate postauricular incision. The objective of this study was to evaluate the feasibility of a double-handed endoscope holder transcanal myringoplasty in children. This technique permits bimanual execution of the procedure and allows the surgeon to overcome the two significant issues of single-handed endoscope surgery, i.e. easy domination of a bloody field and smooth introduction of the graft. METHODS: A prospective non-randomized study of 10 consecutive primary endoscope holder-aided myringoplasties was performed; 3 mm or 4 mm 0° rigid endoscopes were used. A xenograft, biologic soft tissue, was applied in all cases. RESULTS: All procedures were performed successfully. Duration of surgery was faster than with a single-handed procedure and varied between 20 and 60 min. The tympanic membrane healed successfully in all patients. CONCLUSIONS: In this preliminary experience in children, a bimanual endoscopic holder-aided myringoplasty technique offers the possibility to overcome the obstacles encountered in a single-handed technique, since it can replicate the same concept of a bimanual microscopic approach and allow for easy management of a bloody field and introduction of the graft in the middle ear.

Inner ear function following underlay myringoplasty.

INTRODUCTION: Inner ear function can be modified by middle ear surgery. OBJECTIVES: This study aimed to describe bone threshold conduction changes after myringoplasty. DESIGN: Prospective study. MATERIALS AND METHODS: Determination of preoperative and 6- to 12-month postoperative bone conduction thresholds for patients consecutively treated by primary underlay myringoplasty. RESULTS: The mean bone conduction threshold improvement was 1 +/- 6 dB (p = 0.006). There were significant differences in bone conduction threshold changes by surgical approach and for patients with tympanosclerosis. There were no 'dead ears' following intervention, and only a 1% risk of impairment. CONCLUSIONS: Anatomically successful myringoplasty can partially improve bone conduction with minimal risk of impairment.

[Salvage surgery in squamous cell carcinoma of the oral cavity]. / Chirurgia di salvataggio nel carcinoma squamocellulare del cavo orale.

The objective of this work was to evaluate the results of salvage surgery in squamous cell carcinoma of the oral cavity. In the period 1983-1998, 127 patients consecutively underwent surgical treatment. Of these, 80 cases had not been treated previously (Group I), while 47 patients had come under our observation after radiotherapy alone or other treatment had failed (Group II). Local recurrence was observed in 29 cases, local/regional in 10 cases, and exclusively regional in eight cases. In both groups, the surgical T-approach was prevalently transoral (55 cases in Group I and 24 in Group II). A transmandibular approach was taken in most of the remaining patients (22 cases in Group I and 16 in Group II). One hundred patients (65 in Group I and 35 in Group II) underwent laterocervical neck dissection. The neoplasms in group I were staged as follows: pT1, 29%; pT2, 37.5%; pT3, 12.5%; pT4, 21%. In group II, the neoplasms were stages as: pT0, 17%; pT1, 21%; pT2, 38%; pT3, 13%; pT4, 11% (Group II). The overall 5-year survival rate was 38% and the overall determinate 5-year survival rate was 45%, distributed as follows in the two groups: 51% of the patients in Group I, 36% of the patients in Group II (p = 0.01). Restricting the analysis to Group II, the difference in the three year survival rate was 54% among the patients at stages I-II and 25% among the patients suffering from a recurrence at stages III-IV (p = 0.04). In patients whose recurrence was limited to the primary tumor, survival at 3 years was 49%; in those whose recurrence also had nodal involvement, survival was 27% (p = 0.05). Lastly, the 5-year survival rate was 45% in the patients whose recurrence had been diagnosed late and only 24% in the 24 patients whose recurrence had been diagnosed within a year of prior treatment (p = 0.09). In conclusion, the life expectancy of patients undergoing salvage surgery for squamous cell carcinoma of the oral cavity is significantly less with respect to patients undergoing first round treatment. This difference appears significant only in patients with a recurrence that was diagnosed at an advanced stage. In accordance with the previously published data, an early recurrence (within a year) and the presence of a recurrence in the neck are unfavorable prognostic factors.