An unusual case of acute periorbital swelling.

Periorbital swelling is frequently encountered in ear, nose, and throat practices and, as it may be secondary to acute sinusitis, delayed diagnosis may lead to significant morbidity. We describe the case of a 24-year-old man with acute ethmoid-maxillary sinusitis and ipsilateral facial swelling particularly involving the periorbital area. We also discuss the workup that led to the formulation of an unusual diagnosis.

Extracorporeal shock wave therapy in musculoskeletal disorders: a review.

Regenerative therapy is one of the most challenging and intriguing branches of modern medicine. Basic research has demonstrated the effectiveness of extracorporeal shockwaves (ESWT) in stimulating biological activities that involve intra-cell and cell-matrix interactions. These interactions are at the basis of the current clinical applications, and open the horizons to new applications in tissue regeneration. It is also feasible that shock waves could be used to treat various orthopaedic pathologies, removing the need for surgery. However, suitable translational studies need to be performed before ESWT can become a valid alternative to surgery.

Transoral robotic surgery in the management of head and neck tumours.

The article reviews the use of robotic technology for head and neck tumours. The authors discuss the development of transoral robotic surgery (TORS), the current status of the technology, and the set-up in the operating room. The article provides a review of the literature, highlighting the applications, advantages, functional outcomes, and disadvantages of TORS for each anatomic subsite (oropharynx, hypopharynx, larynx, parapharyngeal space, and skull base). New challenges related to reconstruction are also presented. Overall early functional and oncologic outcome data are promising; further long-term prospective trials are still needed to confirm the oncological safety of TORS.

The effects on bone cells of metal ions released from orthopaedic implants. A review.

The increasing use of orthopedic implants and, in particular, of hip and knee joint replacements for young and active patients, has stimulated interest and concern regarding the chronic, long-term effects of the materials used. This review focuses on the current knowledge of the adverse biologic reactions to metal particles released from orthopaedic implants in vivo and in vitro. More specifically, the purpose of this article is to provide an overview of the current literature about the adverse effects of metal particles on bone cells and peri-implant bone.

Carbon dioxide-enriched water inhalation in patients with allergic rhinitis and its relationship with nasal fluid cytokine/chemokine release.

BACKGROUND AND AIMS: Allergic rhinitis is characterized by eosinophil infiltration and accumulation in the nasal mucosa mainly due to IL-3, IL-5, and eotaxin activities. We undertook this study to investigate a possible in vivo effect of carbon dioxide-enriched water inhalation in patients with allergic rhinitis. METHODS: Twenty five consecutive patients inhaled carbon dioxide-enriched water at Fonti di Rabbi Spa Centre (Trento, Italy). Symptom scores for nasal obstruction, itching and sneezing were obtained before and after treatment. Nasal lavage was collected, and IL-3, IL-5, and eotaxin levels were assessed using the quantitative sandwich enzyme immunoassay technique. Cytometric analysis was performed on samples to measure total cell count, CD45+ cells, and percentages of polymorphonucleates and lymphocytes. RESULTS: There were statistically significant differences in chemokine levels and in cell populations between patients and healthy controls before treatment. After carbon dioxide-enriched water inhalation, we observed statistically significant improvements in symptom scores, chemokine levels, and percentages of cell populations. CONCLUSIONS: Our results seem to confirm the role of IL-3, IL-5, and eotaxin in the pathophysiology of allergy and the beneficial effect of carbon dioxide-enriched water inhalation in patients affected by allergic rhinitis.

Cochlear implantation in adolescents with prelinguistic deafness.

OBJECTIVE: The aims of this study were to examine auditory function in a group of adolescents with prelingual deafness who received cochlear implants (CI) and to identify poor-outcome predictors in order to define reliable prognostic indicators useful in selecting patients for CI. STUDY DESIGN: Prospective study. SETTING: The study was conducted in the Audiology Unit of Cà Granda Ospedale Maggiore Policlinico, Milan, Italy. SUBJECTS AND METHODS: The study involved 45 adolescents (mean age at implantation: 13.4 +/- 2.6 years, range: 11-18) with profound congenital hearing impairment with a follow-up of three years. Preimplantation and postimplantation auditory performance and speech perception were evaluated using the mean score of three hearing and speech perception tests (vowel-consonant-vowel [VCV], identification of disyllabic words, and recognition of short sentences) performed in auditory-only listening conditions. RESULTS: Significant improvements in all speech perception tests were observed after CI. However, 15 cases were considered "poor performers" (i.e., the auditory performance of these patients was less than 30 percent). The diagnosis of deafness in these subjects was significantly delayed (18.07 +/- 6.25 and 34.4 +/- 10.26 months in good and poor performers, respectively, P = 0.006), and their hearing threshold was significantly lower than in the good users group. The mean age at CI was 12.8 +/- 2.33 and 14.53 +/- 2.70 years in good and poor performers, respectively (P = ns). CONCLUSION: CI was shown to be a useful device with the ability to reverse the adverse consequences of hearing loss, particularly for prelingual adolescents who receive implantation early in life and who present a hearing threshold of 100 dB or better both at diagnosis and at surgery.

An unusual cause of a parotid mass in an immunocompetent host: classic Kaposi's sarcoma.

Kaposi's sarcoma (KS) is a virally driven vascular tumor that usually has a multifocal origin, with multiple vascular nodules in the skin and other organs, particularly the gastrointestinal tract. Four variants of KS have been described: HIV-related, African, iatrogenic and classic. Primary classic KS of the head and neck is rare in any case, but KS arising in intraparotid lymph nodes, especially with no cutaneous involvement, is exceptionally rare. We report the case of an immunocompetent 71-year-old man who presented with a three-month history of a slowly progressive swelling in the right parotid region. After parotidectomy and histopathological diagnosis of lymph node localization of KS, a thorough dermatological examination did not reveal any skin lesions, and chest and abdominal computed tomography scans, esophagogastroduodenoscopy, and fecal occult blood test were all negative for visceral and other lymph node localizations. We here discuss the peculiarity of the presentation, the differential diagnosis, and the management strategy of such a rare disease.

Videosialoendoscopic assessment of bilateral atresia of the Wharton's duct orifice in an infant.

Atresia of the submandibular ducts (particularly the duct orifice) is a rare occurrence that is mainly observed in newborns or infants; moreover, its differential diagnosis with other anomalies of the oral floor is sometimes difficult. Given the lack of data concerning the differences between atresia of the orifice of Wharton's duct and other anomalies of the submandibular duct system, we describe here the findings of videosialoendoscopic assessment of the salivary duct system in an infant who underwent traditional surgery for bilateral atresia of the orifice of Wharton's duct. During sialoendoscopy, a trifurcation of the main duct, a normal variant of the more common bifurcation of the secondary branches of the salivary duct system, was observed bilaterally. No other ductal anomalies were encountered. Complete resolution of the symptoms and complete patency of both ducts at 19-month follow-up evaluation were observed. In conclusion, although spontaneous resolution of the disease during feeding is possible, minimal incision of the orifice of the imperforated submandibular duct together with diagnostic videosialoendoscopy of the main salivary duct system may be considered as part of the modern approach to salivary obstructive disorders in pediatric age as is currently the case for sialolithiasis and recurrent juvenile parotitis.

Glottic tuberculosis masquerading as early multifocal carcinoma.

The incidence of tuberculosis has progressively decreased in developed countries after the advent of antituberculous chemotherapy, but has recently been increasing again mainly due to migratory flows. Although common in the past and considered to be a prelethal event, laryngeal involvement has become a rarity. We report the case of a 52-year-old female smoker who complained of persistent aphonia. Videostroboscopy showed bilateral vocal fold erythroleukoplakias. A chest X-ray and CT scan aroused the suspicion of lung tuberculosis, which was confirmed by Ziehl-Neelsen staining for acid-alcohol-fast bacilli on bronchoalveolar lavage. Antituberculous chemotherapy rapidly improved the quality of her voice and led to complete disappearance of the vocal fold lesions. In conclusion, laryngeal tuberculosis may mimic an early glottic multifocal carcinoma and should therefore, despite its rarity, always be considered in the differential diagnosis of erythroleukoplakia-like lesions in order to avoid improper surgical treatment and voice damage.

Vertical platysma myocutaneous flap reconstruction for T2-staged oral carcinoma.

The surgical resection of tumour-affected oral soft tissue structures often leads to tissue defects. Various techniques can be used for reconstruction. Our experience of using a vertical platysma myocutaneous flap in a group of patients who underwent reconstruction after T2-staged oral cancer surgical resection associated with neck dissection is described. Only one patient required a surgical revision, due to flap detachment, with a pectoralis major myocutaneous flap. No other major complications, such as nerve lesions or orocutaneous fistulas, were observed. Satisfactory swallowing function was achieved within two weeks in all cases. A platysma myocutaneous flap is a versatile, easy-to-perform, one-stage procedure, and the outcome is best in adequately selected patients; it should not be adopted in patients who have undergone previous neck surgery or radiotherapy, or if radical neck dissection is planned. Care is required to preserve the external jugular vein and the submental artery, particularly when level I is dissected.

Bisphosphonate-associated osteonecrosis of the jaws: a therapeutic dilemma.

OBJECTIVE: To describe our experience in prevention and treatment of mandibular and maxillary osteonecrosis, an emerging complication of long-term intravenous administration of bisphosphonates. STUDY DESIGN: Between February 2004 and February 2006, 10 patients who had received zoledronic acid intravenously because of multiple bone myelomas or bone metastases were treated for mandibular and maxillary osteonecrosis in the Departments of Otorhinolaryngology and Maxillofacial Surgery of our institution. RESULTS: All of the patients underwent surgical sequestrectomies. More extensive surgery was necessary in 3 cases. There were no major complications, and the majority of the patients are alive with no signs of infection or bone exposure. CONCLUSIONS: Our experience confirms that bisphosphonate therapy contributes to the pathogenesis of mandibular and maxillary osteonecrosis. Surgery seems to be necessary in the majority of the patients, although the most adequate procedure is far from being standardized and prevention seems to play a pivotal role.

Cricoid chondrosarcoma coexisting with a thyroid mass: case report and review of the literature.

Laryngeal chondrosarcomas are rare cartilaginous tumors that usually present with hoarseness, dyspnea and, occasionally, dysphagia and dysphonia. We report the case of a low-grade chondrosarcoma of the cricoid cartilage coexisting with a right thyroid nodule, which presented with homolateral vocal fold paralysis. After a precautionary tracheotomy the patient underwent a laryngofissure in which the mass arising from the posterior plate of the cricoid cartilage was entirely enucleated. The histopathological analysis was compatible with a low-grade chondrosarcoma involving the posterior resection margin. For this reason, in agreement with the patient's wishes, a total laryngectomy and simultaneous right hemithyroidectomy were performed. We here discuss the peculiarity of the presentation and the therapeutic dilemma posed by this rare neoplasm.

An unusual cause of mechanical dysphagia: an agglomerate of calculi in a tonsillar residue.

We report the case of a 68-year-old man affected by severe oropharyngeal dysphagia for solid food, who had undergone tonsillectomy when he was 22 years old. Videolaryngoscopy revealed a smooth-surfaced, elongated overgrowth on the left lateral pharyngeal wall that protruded toward the left pyriform fossa and impeded the transit of solid boli. A computed tomography scan showed that the solid content of the lesion was markedly inhomogeneous and denser than the surrounding soft tissues. The mass was removed by means of direct pharyngoscopy under general anesthesia. It was found that it arose from the inferior pole of the left tonsillar fossa and had a central cavity filled with caseum and multiple calculi. Histopathologic examination showed that its soft tissue component consisted of lymphoid tonsillar tissue. The operation totally resolved the swallowing disturbance. This case report highlights that tonsilloliths in a tonsillar residue should be considered in the differential diagnosis of mechanical oropharyngeal dysphagia, even in tonsillectomized patients.

The fate of an amputated nose after replantation.

Traumatic amputation of the nose is a challenging management problem. We describe the case of a 69-year-old woman who had a dog-bite nasal amputation. The avulsed piece, including the lobule, and approximately half of the columella and alae, was replanted within 2 hours of the trauma. Hyperbaric oxygen therapy was administered for 12 daily sessions. Skin gradually necrosed, and the eschar was tangentially excised. Almost all of the mucosa and of the cartilage layers survived and the final defect was smaller than the original. A 3-stage repair was performed by a paramedian forehead flap to replace cover. Lining was by approximation of native tissues, whereas framework was reinforced by conchal and septal cartilage grafts. The outcome was functionally and aesthetically satisfactory. Our case confirms that replantation of an amputated nose as a composite graft is worthwhile. Although the skin necrosed and required reconstruction, most of the lining and of the cartilage support survived, greatly improving the ease of reconstruction, as well as nasal function.

Prognostic value of Delphian lymph node in T1b glottic carcinoma.

BACKGROUND: The published papers concerning Delphian lymph node (DN) involvement in laryngeal tumours generally consider advanced laryngeal and hypopharyngeal cancer. We investigated the role of DN in a selected group of patients with T1b glottic squamous cell carcinoma. MATERIALS AND METHODS: The study involved 53 patients with T1b glottic squamous cell carcinoma who underwent horizontal glottectomy. DN was isolated in 46 (86.8%). Histological evaluation of the isolated nodes revealed the presence of metastases in three cases (6.5%). RESULTS: Forty-six of the 53 patients (86.8%) are still alive and disease-free; four (7.5%) died because of their disease and three (5.7%) because of unrelated causes. The 3- and 5-year overall survival was, respectively, 94.3% and 90.6%. Both the 3- and 5-year disease-free survival was 92.5%. Two of the three patients with a metastatic DN died because of a recurrence: laterocervical lymph node metastases in one case and parastomal recurrence in the other. The frequency of local relapse was at the threshold of significance in the patients with a positive DN (p = 0.0540). Of the four patients who died of their disease, two were DN-positive. Mortality was statistically higher in the DN-positive patients (p = 0.0166). CONCLUSION: The presence of DN metastases was statistically associated with recurrence and overall survival in T1b glottic cancer.