Primary epithelioid angiosarcoma of the thyroid: A case report.

Angiosarcoma of the thyroid is a rare and aggressive primary malignant tumour of the thyroid. We report the case of a 69-year-old woman who presented with a red and sore skin area at the right-anterior region of the neck. Ultrasound examination and computed tomography scan showed a non-homogeneous mass in the right thyroid lobe. Fine needle aspiration cytology was suggestive of atypical vascular proliferation and so the patient underwent right thyroid lobectomy. The specimen measured 6 × 5 × 2.5 cm, and a reddish nodule was found, including a whitish central area of maximum 4 cm in diameter. Immunohistochemistry showed CD31 and ERG positivity, while thyroglobulin, calcitonin and TTF-1 expression were negative, indicating a diagnosis of angiosarcoma.

Personal protective equipment for ENT activity during COVID-19 pandemic.

BACKGROUND: In the COVID-19 era physicians have to face with need to perform office procedures maintaining the maximum safety for both the patient and the Doctor himself. The purpose of this paper was to suggest some equipment useful to perform outpatient visits in an ENT setting. METHODS: A simple modification of the standard headlight used during an ENT visit provides the operator a better face protection without any impairment in vision and comfort. In addition, in order to perform a safer ENT examination, a droplet protective barrier has been adapted to the patient's chair. RESULTS: Both the devices have been texted with success during a period of 2 months in our ENT clinic. No cases of contamination have been registered among physicians. CONCLUSION: A simple modification to a device used in the routine ENT activity implemented its protective efficacy with low costs. On the other hand, a more structured tool permitted to obtain a more protected environment during patient examination.

Nasal growth after pediatric septoplasty at long-term follow-up.

BACKGROUND: Septoplasty in children is still a matter of open discussion, because it is thought that a surgical procedure on a developing structure might produce some adverse effects on normal nasal growth. The goal of this retrospective study is to evaluate the effects of pediatric nasal septum surgery in a long-term follow-up by anthropometry. METHODS: Forty-four Italian patients, 25 male patients and 19 female patients, who had undergone septoplasty during childhood using the endonasal approach, were reassessed after a mean follow-up of 12.2 years. Anthropometric recordings were used to identify any growth retardation due to the operation by a comparison with previously published age-specific normative data of North American white subjects. Nasal measurements consisted of five linear parameters, three angular parameters, and three proportional index. RESULTS: There were no significant differences in any of the measures between the sample and controls (p > 0.1) with regard to gender, with the exception of the nasolabial angle measurement. Indeed, the nasolabial angle of the female patients was significantly reduced compared with controls (p = 0.04), whereas that of the male patients was reduced compared with controls (p = 0.08). This measurement seems to be influenced by the type of operation, because it has been noted that the nasolabial angle of patients treated surgically by extracorporeal septoplasty were significantly lower than those of patients treated surgically by conservative septoplasty. CONCLUSION: Pediatric septoplasty may be indicated in selected cases of obstructing nasal septum deformities. The operation, performed via endonasal approach, does not interfere with the normal growing nasal process.

Closure of nasal septal perforation via endonasal approach.

OBJECTIVE: We report our experience in nasal septum perforation surgery using the endonasal approach. The role of rhinomanometry and nasal endoscopy in the management of septal perforation repair is also discussed. STUDY DESIGN AND SETTING: We reviewed a sample of 30 patients with septal perforation. Patients underwent preoperative and postoperative nasal endoscopy and rhinomanometry. They were all treated using the Cottle technique with the backward extraction-reposition of nasal septum and inverted sliding flap suture technique. RESULTS: Closure rate for small-sized and middle-sized perforations was 94% and 75%, respectively. It was 86.6% if calculated for all patients. Preoperative nasal resistances was normal in patients with isolated septum perforation, and high in patients with associated septum deformity or hypertrophic turbinates. CONCLUSION: The Cottle technique is a viable procedure for the closure of small- and middle-sized perforations. Endoscopy and rhinomanometry help provide a correct and complete understanding of this nasal alteration.

Nasal airway measurements in children treated by rapid maxillary expansion.

BACKGROUND: Rapid maxillary expansion is an orthodontic procedure that is commonly used to widen the maxilla. It is generally admitted that this technique is effective to correct palate narrowing, whereas there has not been agreement on the effect of this procedure in nasal parameters. The availability of a reliable and objective technique to assess the geometry of nasal cavities, such as acoustic rhinometry, stimulated the present investigation. METHODS: Twenty-seven children, undergoing rapid maxillary expansion, were evaluated by rhinomanometry and acoustic rhinometry. Postero-anterior radiographs were taken in 15 patients for cephalometric measurements. Examinations were performed before expansion treatment and after 12 month follow-up and compared to the measurements obtained from an untreated control group. RESULTS: With regard to rhinomanometry, we recorded a significant reduction in nasal airway resistance (NAR) after the orthodontic procedure only in decongestion. Using acoustic rhinometry, we found a significant increase in total minimum cross-sectional areas (TMCA) and total nasal volume (TNV) after the expansion both in basal and decongested conditions. Also, nasal cavity width and interzygomatic distance had a significant mean increase after the treatment. Comparison of measures between the control group and the treated group showed that the increase in TMCA and TNV, as well as the decrease in NAR, were significantly greater in the treated group in both basal and decongested conditions. CONCLUSION: We demonstrated that rapid maxillary expansion is an effective procedure in widening nasal cavities with respect to an untreated control group and that the reported improvement in nasal breathing after palatal expansion, is a consequence of an increase in nasal size.

Acoustic rhinometric measurements in children undergoing rapid maxillary expansion.

OBJECTIVE: To evaluate geometric changes of nasal cavities in children undergoing rapid maxillary expansion and to assess the effect of this procedure on nasal airway size by means of acoustic rhinometry. METHOD: We recruited 14 mouth-breather children (mean age 8.2 years) presenting constricted maxillary arches and scheduled for rapid maxillary expansion in the orthodontics department of our hospital. Clinical history did not reveal any allergic diseases and ENT examination was completely normal with a well-aligned nasal septum. Nasal measurements were obtained using acoustic rhinometry, which was performed before the expansion treatment and after 1-year follow-up. A postero-anterior radiograph of the skull was also performed in all patients for cephalometric analysis before and 3 months after the treatment. RESULTS: We observed a satisfactory increment in the transverse dimension of the maxilla in all patients but one who manifested a relapse after 4 months from the treatment and required a second procedure. Similarly, acoustic rhinometric measurements and cephalometric tracings showed a statistically significant increase respectively in decongested total nasal volumes (p=0.047) and in binasal cavity width (p=0.001). However, only eight children switched their respiration from oral to nasal breathing mode. CONCLUSIONS: Rapid maxillary expansion is an effective method for increasing the width of narrow maxillary vault and it is also associated with a significant increment in nasal volumes and in the transverse diameter of the maxilla. With regard to breathing posture, the role of this procedure still remains debatable. To date this is the first study aimed at analysing the effects of rapid maxillary expansion on nasal dimensions by means of acoustic rhinometry.

Sudden sensorineural hearing loss in lupus erythematosus associated with antiphospholipid syndrome: case report and review.

Systemic lupus erythematosus is a disease of unknown cause that manifests with tissue and cellular alterations due to the deposition of antibodies and pathogenic immune complexes. The disease can be associated with anticardiolipin antibody syndrome, a disorder of recurrent vascular thrombosis and thrombocytopenia associated with a persistent anticardiolipin test positivity. In this report, we describe the case of a young woman affected by lupus erythematosus and positive for anticardiolipin antibodies who was brought to our observation for a sudden sensorineural hearing loss in the right ear. The patient was successfully treated with osmotic therapy and, 13 months after the initial symptom, is now in good clinical condition with no recurrence of the hearing loss and normal bilateral hearing. Together with a critical review of the pertinent literature, this rare clinical case led us to formulate some original comments.

Immediate correction of nasal septum dislocation in newborns: long-term results.

BACKGROUND: The authors present the results of a long-term follow-up after an immediate reduction of nasal septum luxation in newborn infants. METHODS: Forty-nine children, who underwent a treatment for septal dislocation within 48 hours after birth, were reexamined in 2002 at a mean age of 13.2 years (range, 10-17 years). The examination was performed through inspection of the nasal pyramid, anterior rhinoscopy, nasal endoscopy, rhinomanometry, and acoustic rhinometry. RESULTS: Anatomic and functional findings showed satisfactory results for all children affected by septal dislocation. Three patients presenting irreplaceable septal-pyramidal deformity had no spontaneous reduction at 7-, 10-, and 11-year follow-ups and thus required surgical intervention. CONCLUSIONS: Considering the simplicity and the safety of the reduction maneuver, the importance of early detection and treatment of neonatal septal dislocations is stressed. This is the longest follow-up study reported in international literature to date.

Isolated tonsillar sarcoidosis manifested as asymmetric palantine tonsils.

Sarcoidosis is a chronic systemic granulomatous disease of unknown etiology. Isolated sarcoidosis of palatine tonsils in the absence of other systemic localizations is very rare, and only a few cases have been described in literature. We report a case of a 69-year-old woman presenting an asymptomatic unilateral enlargement of palatine tonsils. The pathologic report of the tonsillectomy specimen revealed the presence of noncaseating granulomatous lesions compatible with sarcoidosis. The research of acid-fast bacilli on the biopsy material using the Ziehl-Neelsen stain was negative, and no cultural growth was documented. Further investigations confirmed the diagnosis and excluded other systemic localizations of the disease. In our experience, asymmetric tonsils caused by sarcoid disease should be taken into consideration for the differential diagnosis in tonsillar enlargement. With this report, we underline the possibility of an isolated localization of sarcoidosis in palatine tonsils manifested as asymmetric enlargement, and we point out the value of histopathologic examination after tonsillectomy in selected cases. Once sarcoid lesions are found in tonsillar specimens, further investigations are mandatory to confirm the diagnosis, to detect an eventual multisystemic disease, and to exclude a possible association with malignancy.

Endoscopy-assisted rhinoplasty.

In nasal surgery some surgical steps are done without the aid of direct vision. In these situations, surgeons must use their experience and judgment. I have adapted techniques used in endoscopic sinus surgery to perform some of the surgical steps of functional and aesthetic rhinoplasty. Between September 1999 and February 2000, 11 patients underwent endoscopic-assisted septorhinoplasty, and 18 patients underwent traditional closed rhinoplasty. The following parameters were compared: surgical bleeding, postoperative edema and ecchymosis, dorsum irregularity, and operative time for each technique. The following steps were clearly visualized with the endoscope: raising the periosteum from the nasal bone, resecting the nasal hump, and rasping the nasal bones. The use of endoscopic instruments does not change the surgical steps required. Rather, it allows direct vision of steps previously not viewable.