Infrahyoid myocutaneous flap in head and neck reconstruction: a systematic review and meta-analysis.

The aim of this systematic review and meta-analysis was to analyse the literature on the infrahyoid myocutaneous flap (IHMCF) and evaluate its clinical outcomes. The MEDLINE, Embase, Web of Science, Cochrane Library, and Scopus databases were searched (inception to December 31, 2021). Meta-analyses were then conducted to estimate the overall rates of partial flap loss, total flap loss, salivary fistula, and surgical revision. The 21 studies that met the inclusion criteria included 768 patients undergoing head and neck reconstruction with 773 IHMCF. The oral cavity (77.7%) and oropharynx (13.0%) were the most reconstructed sites. The meta-analyses estimated a pooled partial flap loss rate of 10.4% (99% confidence interval (CI) 5.4-16.7%), total loss rate of 1.8% (99% CI 0.8-3.2%), salivary fistula rate of 3.0% (99% CI 1.3-5.3%), and surgical revision rate of 1.9% (99% CI 0.7-3.7%). Fast flap harvesting and low donor site morbidity were other flap features. Previous thyroid surgery or neck dissection and advanced lymph nodal stage were considered contraindications to IHMCF reconstruction by most authors, while prior neck radiotherapy was reported as a relative contraindication. This pedicled cervical flap is a versatile and reliable reconstructive option for medium-sized head and neck defects. Careful preoperative assessment of the neck condition allows for its safe use.

Surgery of thyroid cancer: twelve years' personal experience.

Diagnosis and treatment of thyroid carcinoma require a multidisciplinary approach. The close and long-standing collaboration between the Otorhinolaryngology, Pathological Anatomy and Nuclear Medicine Departments of Legnano Hospital has led to a precise diagnostic and therapeutic protocol in thyroid patients. In the 1990-2002 period, 131 patients underwent total thyroidectomy after diagnosis of thyroid cancer at the Otorhinolaryngology--Head and Neck Surgery Department. Patients submitted to lobectomy for differentiated thyroid cancer were excluded from the present study. The patient population is composed of 96 females (73%) and 36 males (27%) aged between 22 and 85 years. Of the 131 patients, 115 (87%) presented papillary carcinoma, 13 (10%) follicular carcinoma, 2 (2%) medullary carcinoma and one (1%) undifferentiated carcinoma. Two patients (2%) suffered from a preoperative monolateral recurrent nerve palsy. Total thyroidectomy was performed in all 131 patients. Selective neck dissection was performed only in patients with positive lymph nodes for papillary (37/115, 32%) and follicular carcinoma histotype (2/13, 15%) and, in both patients with medullary carcinoma (100%). Of the 131 patients, 15 (11%) did not undergo routine follow-up and were, therefore, excluded from the study, the remainder completed a mean follow-up of 47 months. During follow-up, the incidence of the two most frequent complications of thyroid surgery were evaluated: recurrent nerve paralysis and permanent hypoparathyroidism (exceeding the postoperative 6 months). Results of treatment have been evaluated considering the incidence of local and/or distant recurrences and patient survival rate. As far as concerns papillary and follicular histotype, we have considered as healed (absence of signs suggesting loco regional and distant recurrence) only those patients presenting both negligible levels of plasma thyroglobulin and a negative total-body 131I scintigraphy. Briefly, in 3 cases (3%), all papillary carcinomas, local recurrence occurred; 9 (8%), all with papillary carcinoma, developed lateral neck recurrence; 6 (5%), 5 with papillary carcinoma and one with follicular carcinoma, developed distant metastases, of which 3 pulmonary, 2 bone and 1 hepatic. Serum thyroglobulin values were considered during the last control visit in 95/113 patients (84%). Of these, 86 (91%) with negligible thyroglobulin levels and negative 131I scintigraphy, were considered healed. All 113 patients with differentiated thyroid carcinoma were alive at the last control visit. Both patients with medullary carcinoma are alive with no sign of illness at the last follow-up control. The patient presenting undifferentiated carcinoma died 2 months after surgery. In conclusion, at the last follow-up control, 1 (1%) patient has died, 5 patients (4%) are alive with disease (2 of whom suffered from multiple recurrences) and the remaining 110 (95%) patients are alive without evidence of disease. As far as concerns complications of surgery, iatrogenic recurrent palsy and permanent hypoparathyroidism are present in 2 (2%) and 10 patients (8%), respectively.

[Trans-labyrinthine approach for the resection large and giant acoustic nerve neuromas]. / Abordaje translaberíntico para resección de neurinomas de gran tamaño y gigantes del nervio acústico.

The standard translabyrinthine approach for acoustic neuromas removal was introduced by W. House in 1964. After several years of experience the original translabyrinthine approach has been progressively modified into the current "enlarged" approach by extending the area of bone removal. This increased surgical field has made the translabyrinthine approach suitable for the removal of tumours of all sizes. We present our serie of 71 large (52) and giant (19) neuromas of the VIIIth nerve removed through a translabyrinthine approach between 1993 and 1998 at the ENT Department of Legnano.

Abordaje translaberíntico para resección de neurinomas de gran tamaño y gigantes del nervio acústico / Translabyrinthine approach for the resection large and giant acoustic nerve neuromas

El abordaje translaberíntico clásico para la exéresis de neurinomas del acústico fue introducido por William House en 1964. En el curso de los años el abordaje translaberíntico original ha sido progresivamente modificado hacia el actual abordaje "ampliado", extendiendo el área de resección ósea. Esta modificación permite la exéresis de tumores prácticamente de cualquier tamaño del ángulo pontocerebeloso. Se presentan los resultados de 71 neurinomas del nervio acústico grandes (52) o gigantes (19) operados entre los años 1993-1998 por abordaje translaberíntico en el Servicio de Otorrinolaringología del Hospital de Legnano. (AU)

The standard translabyrinthine approach for acoustic neuromas removal was introduced by W. House in 1964. After several years of experience the original translabyrinthine approach has been progressively modified into the current «enlarged» approach by extending the area of bone removal. This increased surgical field has made the translabyrinthine approach suitable for the removal of tumours of all sizes. We present our serie of 71 large (52) and giant (19) neuromas of the VIIIth nerve removed through a translabyrinthine approach between 1993 and 1998 at the ENT Department of Legnano (AU)

[Petrous bone cholesteatoma: surgical strategy]. / I colesteatomi della rocca: strategia chirurgica.

Petrous bone cholesteatoma is a rare pathology which grows slowly and is often asymptomatic. This work presents a series of 25 cases of Petrous bone cholesteatoma and discusses the diagnostic impact, the surgical approach, the results and the complications. Currently our surgical orientation favors translabyrinthine and transcochlear approaches which, better than other ones, allow both radical excision of the lesion and preservation of the main neuro-vascular structures. Out of the 25 patients undergoing surgery, 22 were treated with the translabyrinthine (6 cases) or transcochlear (16 cases) approaches, in 1 case an infratemporal type A approach was used while the remaining 2 were treated with a median cranial fossa approach. Paralysis of the facial nerve is the most dreaded complication, particularly when a deficit is already present prior to surgery. In just a few cases did the hearing justify an attempt at preservation but in no case should this compromise radical removal of the cholesteatoma.

[Ablation therapy with gentamycin in the treatment of Meniere's disease]. / La terapia ablativa con gentamicina nel trattamento della malattia di Ménière.

Historically the therapy for untreatable Ménière's disease (Md) has been surgery: conservative (cochleosacculotomy and decompression or sacco-endolymphatic shunt) or radical (labyrinthectomy and vestibular neurectomy). A valid alternative to surgery is the use of ototoxic drugs such as aminoglycoside antibiotics based on the assumption that some of the drugs exert greater ototoxicity vs. the posterior labyrinth. The purpose of the present study was to verify a severe protocol for the intratympanic administration of gentamicin sulfate in the treatment of Md unresponsive to medical treatment. A total of 29 patients were recruited for the study, all suffering from monolateral Md with reduced or normal (i.e. not absent) vestibular reflectivity on the side involved. The protocol called for audiovestibular testing prior to the treatment cycle and then 7 days after the administration of each individual dose. The same treatment scheme was used in all patients: a weekly intratympanic injection of gentamicin, 16 mg/per dose, for a maximum of 2 or 3 treatments. Of these cases, 20 have been followed up for 2 or more years and these are described in the present study. The follow-up called for suspending treatment and then repeating the audiovestibular tests every six months. Equilibrium was fully controlled in 70% of the patients while control was substantial in 30%. Audiometry showed that the auditory threshold remained unchanged in 60% of the cases while it worsened in 20% and, surprisingly, improved in the remaining 20%. In two cases deafness arose after the second treatment. The vestibular tests showed an uncompensated areflexia on the treated side after the therapeutic cycle although, in all cases, this had been compensated by the time of observation at 24 months. Symptoms of deafness remained unchanged. In conclusion, with respect to other more invasive treatments, chemical labyrinthectomy is simpler to perform and has fewer side effects while producing analogous clinical results.

Pollen markers for gene-centromere mapping in diploid potato.

The utility of two pollen genetic markers for estimating the extent of meiotic recombination between the centromere and a marker gene was tested in 2n pollen of diploid potato clones. One of these markers was the distal locus amylose-free (amf) on chromosome 8 and the other was the isozyme locus alcohol dehydrogenase (Adh-1) on chromosome 4. In the case of the amf locus, the gene-centromere distance was estimated in a normal synaptic and a desynaptic genotype. In both cases the genetic analysis was confined to: (1) a direct estimation of the phenotypic (blue vs red) segregation ratios in FDR (first-division restitution) 2n pollen and (2) a classification of the 4 x progeny from 4x (nulliplex amf) x 2x (Amf/amf) crosses into duplex, simplex and nulliplex classes. The recombination frequency between the centromere and the amf locus in the normal synaptic genotype B92-7015-4 corresponded to a gene-centromere distance of 48.8 cM, whereas this distance amounted to 13.3 cM in the desynaptic genotype RS93-8025-1. Hence desynapsis reduced crossing-over by 73%. The observed genetic distance of 48.8 cM in the normal synaptic clone, B92-7015-4, is the highest gene-centromere distance reported so far in potato and this could be explained on the assumption of absolute chiasma interference. For the Adh-1 locus, it was found that heterozygous 2n pollen grains could be detected in pollen samples of the diploid clones, because of the occurrence of a heterodimeric band of the isozyme. Unlike the amf locus, the genecentromere distance for the Adh-1 locus was estimated only on the basis of the duplex, simplex and nulliplex classes in the progenies from 4x (nulliplex Adh-1 (2) )x B92-7015-4 (Adh-1 (1) /Adh-1 (2) )crosses and was found to be 19.4 cM. Because the accurate positions of centromeres in relation to other loci are not available in the existing genetic maps of potato, which are saturated with molecular markers, halftetrad analysis is a promising additional approach to the basic genetics of this crop.

Closed osteosynthesis with stabilised Küntscher nail in comminuted diaphyseal fractures of the femur and the tibia.

Comminuted fractures of the femur and tibia often pose difficult problems of reduction and stable fixation. Closed endomedullary fixation in which the fixation device is anchored to the main fragments by screws enables these difficult problems to be solved in the majority of cases. Fourteen fractures of the femur and nine of the tibia were treated by this method in just over a year. In the author's opinion, the results confirm the validity of the method, which, although known for some time, has only recently been reintroduced by Kempf et al. (1978).