Alberto Grammatica

The role of early voice therapy in the incidence of motility recovery in unilateral vocal fold paralysis

Abstract Objectives. Vocal fold paralysis can have a significant impact on a patients quality of life. The aim of this study was to analyze, in terms of vocal improvement and motility recovery, the post-vocal treatment results of patients with unilateral vocal fold paralysis (UVFP) who underwent early voice therapy. Study design. A 7 years prospective study of patients with an UVFP who underwent our multidimensional diagnostic-therapeutic assessment. Material and Methods. Seventy-four patients with UVFP were included in the study. All patients underwent a voice therapy based on forcible exercises supplemented by manipulations and maneuvers. A pre and post-treatment objective voice evaluation and self-assessment was made. Results: Out of 74 patients with UVFP, 51 (68.9%) recovered vocal fold motility. In 23 (31.1%), UVFP persisted after voice therapy. In this group of patients, a complete glottal closure was seen in 5 before voice therapy and in 13 after; An important and significant (p <0.0001) reduction in fundamental frequency (Fo) was found; a manifest improvement was seen for the mean values of Jitter (Jitt%; p = 0.001), Shimmer (Shim%; p <0.0001) and noise-to-harmonic ratio (NHR) (p <0.0001). The same statistical comparisons calculated for male patients alone was not significant for Jitt% (0.102), Shim% (0.112) and NHR (0.155), as a result of the reduced number of patients in this group. Voice Handicap Index (VHI) values showed a clear and significant improvement and mean maximum phonation time (MPT) increased significantly. Conclusion. Early voice therapy based on an energetic approach, combined with patient co-operation, motivation and understanding through educated participation in the voice restoration process, strengthen the idea that patients with UVFP have a good chance of recovering vocal fold motility or improving their voice quality.

Ultrasound-guided percutaneous laser ablation in treating symptomatic solid benign thyroid nodules: Our experience in 45 patients.

Laser ablation may be useful in debulking of benign thyroid nodules.

Free Flaps in Head and Neck Reconstruction after Oncologic Surgery Expected Outcomes in the Elderly

Objective To provide surgeons and clinicians with a critical review of microvascular reconstructive options and their expected outcomes after head and neck cancer resection in the elderly. Data Sources Medline, Isiweb, and Cochrane databases. Review Methods A literature search was performed in May 2014 and included studies published between 2000 and 2014. Keywords were used for articles identification, and inclusion criteria were defined for consideration in the present review. Conclusions Evaluation of the pertinent literature is hampered by a number of biases, such as a lack of general consensus of a definition of “elderly,” differences among scales used to quantify comorbidities, and subjective evaluation of flap-related and systemic complications. However, our findings showed no differences in terms of free flap success, surgical complications, or mortality rate between older and younger patients. Moreover, recipient site complications do not seem to be affected by age. Implication for Practice Microvascular reconstruction in the elderly can be performed with high success rates, even though medical complications can occur more frequently compared to younger patients. Minor and major surgical complications in the elderly appear to be comparable to those in the younger population and do not affect final outcome or the perioperative mortality rate. Flap outcome does not seem to be significantly affected by age. Careful preoperative assessment and postoperative monitoring are mandatory to prevent adverse events, and prompt management is warranted whenever present.

Voice and swallowing after partial laryngectomy: Factors influencing outcome

The purpose of this study was to assess the factors influencing swallowing and phonatory results after partial laryngectomy.

Pyramidal eminence and subpyramidal space: An endoscopic anatomical study

To describe retrotympanic endoscopic anatomy, especially the pyramidal eminence and contiguous spaces.

The contribution of selective dysventilation to attical middle ear pathology

Epitympanic primary cholesteatoma represents a challenge for ENT surgeons. Its exact pathogenesis is still unknown because of the very complex anatomy of this region. Until now, only a few authors have described this region and tried to hypothesize the causes that could lead to cholesteatoma genesis. We hypothesize the existence of a selective dysventilation of the epitympanic region based on the presence of various mucosal folds occluding air ventilation from the middle ear to the epitympanum, through the epitympanic isthmus, causing a negative epitympanic pressure and consequently cholesteatoma formation. All the anatomic findings were obtained with the aid of 0° and 45° angled surgical endoscopes. From our findings, patients affected by an epitympanic cholesteatoma often have a total isthmus blockage that completely isolates the whole epitympanum from the middle ear, causing a deficit of oxygenation of the mucosa that normally should be guaranteed by the Eustachian tube and which always works physiologically in these patients. This is confirmed by the tympanogram test where we observed how the pressure at the level of the tympanic cavity was normal, whereas the epitympanic pressure was selectively negative. In conclusion, selective epitympanic dysventilation syndrome consists of the concomitant presence of a series of complete or incomplete epitympanic diaphragms and ME isthmus blockage causing negative epitympanic pressure, and leading to the formation of a retraction pocket or cholesteatoma associated with normal Eustachian tube function.

Supracricoid Partial Laryngectomy in the Management of T3 Laryngeal Cancer

Objective To evaluate the oncologic results only in T3 glottic and supraglottic cancers regarding supracricoid partial laryngectomy (SCPL) not requiring total laryngectomy and to assess functional results by self-evaluation by the patient. Study Design Case series with medical record review. Setting Single tertiary care center. Subjects and Methods Thirty-two patients with laryngeal squamous cell carcinoma, previously untreated, who underwent SCPL with cricohyoidopexy or cricohyoidoepiglottopexy were reviewed. Results At 1, 3, and 5 years, the disease-free survival rates were 96.9%, 89.4%, and 78.2%; overall survival rates were 96.9%, 93.2%, and 87.3%; local control and locoregional control rates were 100%, 96.2%, and 96.2%; and distant metastasis–free survival rates were 100%, 100%, and 88.2%, respectively. Aspiration pneumonia was the most common complication observed. The 3 laryngeal functions (speech, swallowing, and breathing) were spared in 83.9% of patients. Conclusion Supracricoid partial laryngectomy for selected glottic and supraglottic T3 tumors has excellent oncologic and functional results.

Tympanoplasty: an up-to-date pictorial review

The indications for tympanoplasty are mainly chronic ear pathologies, such as cholesteatoma, atelectasis and chronic tympanosclerotic otitis. Usually, modification of the mastoid and temporal tissues in general mostly involves bone work, which means bone removal by burs or appropriate bone curettes. It is for this reason that, in both the pre- and postoperative periods, the computed tomography (CT) scan is the primary radiological tool for studying the middle-ear, and temporal bone structures and pathologies. The aim of this review is to illustrate the most up-to-date postoperative results for tympanoplasty, including the emerging endoscopic techniques. The present work focuses on the five types of tympanoplasty that are likely to be encountered by the radiologist: radical surgery; open tympanoplasty; closed tympanoplasty; closed endoscopic tympanoplasty; and open endoscopic tympanoplasty. Understanding and interpreting temporal bone images in relation to the different types of surgery are important, especially at the postoperative stage, because of the high risk of recurrence of middle-ear pathologies, and a good working knowledge of surgical changes is fundamental for distinguishing iatrogenic bone demolition from complications and new pathological foci.

Lateral endoscopic approach to epitympanic diaphragm and Prussak’s space: a dissection study

IntroductionUntil now, anatomic descriptions of the epitympanic diaphragm and Prussak’s space have been performed using a microscope. The aim of this study is to thoroughly describe and review the epitympanic diaphragm and the anatomy of Prussak’s space from an endoscopic point of view.Study designCadaver dissection study.SettingTertiary referral university center.Materials and methodsThe anatomy of four temporal bones dissected using an endoscope was studied. The most important findings were noted and described.ResultsEndoscopic cadaveric dissection of the middle ear allows a very good visualization of the epitympanic diaphragm, Prussak’s space and middle ear anatomy in general.ConclusionEndoscopic exploration and thorough knowledge of the complex fold anatomy may improve ‘functional’ interventions in middle ear inflammatory pathology during middle ear surgery, particularly in the case of selective dysventilation.

Microvascular head and neck reconstruction in the elderly: The University of Brescia experience

Microvascular reconstruction in head and neck surgery is increasing in the elderly because of prolonged life expectancy. The purpose of this study was to evaluate the impact of age on outcomes after microvascular reconstruction.