Atypical neoglottis after supracricoid laryngectomy: a morphological and functional analysis.

The objective of this study was to analyze atypical neoglottis after supracricoid subtotal laryngectomy (SSL) from a morphological and functional point-of-view using retrospective case series reviewin a Tertiary university referral center setting. From May 2003 until January 2010, 106 patients underwent SSL (CHEP, CHP, THEP, THP) for laryngeal cancer, in the Otolaryngology Department of the University Hospital of Modena. We performed a retrospective analysis of recorded videos in our database of patients who underwent SSL. Patients with atypical neoglottis were included in the study. Six patients with atypical neoglottis were identified and morphologically evaluated. The functional outcomes were collected and analyzed. Atypical neoglottis may form after SSL, in particular in the case of CHEP. In most cases, these atypical conformations are due to anomalous positioning of the epiglottis, or involvement of the lateral pharyngeal wall in the sphincteric and vibratory function of the neoglottis. Atypical neoglottis formation seems to guarantee adequate functional outcomes in terms of vocal and swallowing performance.

Forestier disease: single-center surgical experience and brief literature review.

OBJECTIVES: We describe the experience of our otolaryngology department in the treatment of Forestier disease, particularly regarding the diagnostic process, surgical treatment, and postoperative outcomes. METHODS: The charts of 12 patients who underwent surgical treatment of Forestier disease between January 1, 2003, and January 1, 2009, were analyzed. All patients were subjected to clinical, radiologic, and endoscopic evaluation that confirmed the presence of cervical osteophytes. All patients were treated by a right-sided prevascular transcervical approach to remove cervical osteophytes. A literature review on Forestier disease was also carried out. RESULTS: One case of immediate postoperative hemorrhage was reported. During the postoperative follow-up, ranging from 1 to 5 years, all patients underwent cervical radiography and fiberoptic laryngoscopy that confirmed no evidence of recurrence, and all patients remained asymptomatic. CONCLUSIONS: A prevascular transcervical right-sided approach seems to be an effective treatment for surgical removal of hyperostosis in Forestier disease, with an acceptable rate of complications and recurrence.

The Impact of the Transcanal Endoscopic Approach and Mastoid Preservation on Recurrence of Primary Acquired Attic Cholesteatoma.

OBJECTIVE: We aim to investigate the factors associated with recurrent disease following surgery for primary acquired attic cholesteatoma. We hypothesize that minimal invasive, mucosal sparing operation techniques have beneficial effects on the outcome in terms of recurrence. STUDY DESIGN: Retrospective study. SETTING: Tertiary referral center. PARTICIPANTS: A total of 110 patients presenting with primary acquired attic cholesteatoma were enrolled in the study. Patients undergoing revision surgery or a canal wall down procedure, as well as patients with residual disease were excluded from the study. MAIN OUTCOME MEASURES: During follow-up recurrence was assessed and classified into normal, self-cleaning retraction pockets, or recurrent cholesteatoma requiring revision surgery. RESULTS: We observed during follow-up statistically significant decrease (p = 0.036) in the occurrence of retraction pockets and recurrence in patients operated by the transcanal endoscopic approach (n = 55, 11% re-retraction, 9% recurrence) compared with those who underwent a canal wall up procedure (n = 55, 16% re-retraction, 22% recurrence). However, the multivariate model did not demonstrate statistically significant predictors regarding the outcome. Moreover, the preservation or direct reconstruction of the ossicular chain had a beneficial effect on the outcome. We observed 11% re-retraction and 9% recurrence in cases with preserved or reconstructed ossicular chain versus 18% re-retraction and 24% recurrence (p = 0.011) in cases of nonpreserved or non-reconstructed ossicular chain. A score was established according to the intraoperative mucosal damage and correlated to the occurrence of recurrence (p = 0.02). The risk of recurrence increased by 23.6% (95% confidence interval: 3.22-48.1) with each additional mucosal damage site. CONCLUSION: Transcanal endoscopic approaches that preserve the mastoid may play an important role in preventing recurrence and underscores the importance of the mucosa and mastoid air cells on middle ear homeostasis.

Clinical findings and surgical results of middle ear cholesteatoma behind an intact tympanic membrane in adults.

BACKGROUND AND AIM: Cholesteatoma usually arises in the middle ear by the formation of a retraction pocket or a tympanic membrane perforation. In some cases, cholesteatoma presents behind an intact tympanic membrane (ITMC) and the underlying mechanism of its development is controversial. The aim of this study was to describe clinical features, pathogenesis and surgical results in a series of adult patients affected by ITMC. METHODS: We analyzed retrospectively 27 adult patients (age > 18 years) diagnosed with ITMC who underwent surgery between 1994 and 2013. We investigated the demographic data, presenting symptoms, otoscopic findings, disease location, surgical technique, postoperative complications and outcomes. RESULTS: Diagnosis was made on the basis of a white mass seen through the tympanic membrane in 24 cases and on explorative surgery in the remaining 3 patients. In 16 cases cholesteatoma was related to an acquired cause, while in 11 ears a congenital origin was supposed. Hearing loss was the chief complaint and it was present in 19 (70.3%) subjects. Cholesteatoma was managed by purely endaural or retroauricular transcanal tympanoplasty in 12 cases, by planned staged canal wall up mastoidectomy in 10 cases (37%), by canal wall down mastoidectomy in 3 cases, and by modified Bondy technique in 2 cases. A recurrent cholesteatoma was observed in one ear; one patient experienced a postoperative profound sensorineural hearing loss. CONCLUSIONS: ITMC in adults may have both congenital and acquired origin. It may grow silently over many years and develops into a massive size before being detected. Each patient's management should be tailored to clinical findings.

Otolaryngology fantastica: the ear, nose, and throat manifestations of Munchausen's syndrome.

OBJECTIVES/HYPOTHESIS: Munchausen's syndrome (MS) is a form of severe, chronic, factitious disorder with physical symptoms. Some essential features define MS, such as recurrent, feigned, or simulated illness; peregrination (traveling or wandering); pseudologia fantastica; and drug abuse. Munchausen's syndrome by proxy (MSBP) classically involves a parent or other caregiver who inflicts injury or induces illness in a child. The aim of the present study was to summarize and study the main ear, nose, and throat (ENT) manifestations of MS and MSBP. STUDY DESIGN: A systematic literature review carried out in a tertiary university referral center. METHODS: An appropriate string was run on PubMed to retrieve articles dealing with ENT manifestations of MS and MSBP. A double cross-check was performed on citations and full-text articles found using selected inclusion and exclusion criteria. RESULTS: In total, 24 articles were finally included in the study, describing 30 cases of MS or MSBP involving the ENT region; 15/30 (50%) cases involved the face, most often presenting as facial pain or facial swelling; and 7/30 (23.3%) cases presented with symptoms involving the ear. Six cases out of 30 (20%) were MSBP. CONCLUSIONS: MS and MSBP may present with symptoms involving the head and neck area, particularly the face and external ear canal. The ENT specialist should suspect MS in patients with strange and long-lasting symptoms, so as to avoid misdiagnosis and unnecessary treatments that waste time and money in the healthcare sector.