Alberto Schreiber

Juvenile Angiofibroma: Evolution of Management

Juvenile angiofibroma is a rare benign lesion originating from the pterygopalatine fossa with distinctive epidemiologic features and growth patterns. The typical patient is an adolescent male with a clinical history of recurrent epistaxis and nasal obstruction. Although the use of nonsurgical therapies is described in the literature, surgery is currently considered the ideal treatment for juvenile angiofibroma. Refinement in preoperative embolization has provided significant reduction of complications and intraoperative bleeding with minimal risk of residual disease. During the last decade, an endoscopic technique has been extensively adopted as a valid alternative to external approaches in the management of small-intermediate size juvenile angiofibromas. Herein, we review the evolution in the management of juvenile angiofibroma with particular reference to recent advances in diagnosis and treatment.

Intestinal type adenocarcinoma of the ethmoid: Outcomes of a treatment regimen based on endoscopic surgery with or without radiotherapy

The purpose of this study was to assess survival, prognostic factors, and complications in a cohort of patients with intestinal‐type adenocarcinoma (ITAC) treated with transnasal endoscopic surgery ± radiotherapy (RT).

IMMUNOSTAINING PATTERNS OF CD31 AND PODOPLANIN IN PREVIOUSLY UNTREATED ADVANCED ORAL/ OROPHARYNGEAL CANCER: PROGNOSTIC IMPLICATIONS

The objective of this study was to assess angiogenesis and lymphangiogenesis patterns in advanced oral/oropharyngeal cancer by immunohistochemical techniques.

Fibrous dysplasia of the sinonasal tract and adjacent skull base.

Purpose of reviewFibrous dysplasia is a rare condition characterized by replacement of normal bone by fibro-osseous connective tissue exhibiting varying degrees of osseous metaplasia, which can affect the craniofacial complex. This article reviews the recent literature with the intent to highlight the innovative information that has contributed to elucidate the pathophysiology, diagnostic criteria, and treatment principles of the disease. Recent findingsA mutation in the GNAS1 gene on chromosome 20 has been identified as the molecular hallmark of fibrous dysplasia. This finding is not present in ossifying fibroma, which has been traditionally included in differential diagnosis. The concept that asymptomatic patients do not require surgical treatment has been reinforced by a meta-analysis specifically addressing the issue of optic nerve decompression. SummaryA diagnosis of fibrous dysplasia can be achieved by combined assessment of clinical, radiologic, and pathologic findings. There is general agreement that, when the disease is not associated with symptoms, partial or radical resection is not indicated, but patients do require periodic radiologic evaluations. There is, however, an absolute need for prospective studies to identify factors predicting the possible late growth of the disease and to investigate the efficacy and side-effects of pharmacological treatment with biphosphonates.

Treatment strategies for primary early-stage sinonasal adenocarcinoma: A retrospective bi-institutional case-control study

To investigate different treatment strategies for primary early‐stage (pT1‐T2) sinonasal adenocarcinomas.

Modular Endoscopic Medial Maxillectomies: Quantitative Analysis of Surgical Exposure in a Preclinical Setting.

BACKGROUND The nomenclature adopted for endoscopic medial maxillectomies (EMMs) is exceedingly heterogeneous. The aim of this study was to objectively measure surgical exposure in a preclinical anatomic setting to validate a classification for modular EMMs. MATERIALS AND METHODS Computed tomography was used to scan 6 cadaver heads, and images were uploaded on dedicated software. A neuronavigation system was used to measure areas and volumes of surgical corridors during dissection. Differences of >10% of area exposed and >3 cm3 of volume were considered to define incremental types of EMM. Specific anatomic targets were assessed on the axial and sagittal planes. Influence of anatomic variants on surgical exposure was evaluated. RESULTS There were 4 types of EMMs (A-D), with a transseptal variant for each, identified. In the axial plane, type A exposed the vidian canal and foramen rotundum, type B exposed the foramen ovale and foramen spinosum, and transseptal type C or type D exposed the coronoid process. In the sagittal plane, type A exposed the vidian canal, and type B exposed the foramen ovale and styloid process. Transseptal type C exposed the pterygomaxillary fissure, and type D exposed the inferior border of the lateral pterygoid plate. The nasal floor limits the downward angle in transseptal approaches. The width of the piriform aperture independently influenced surgical volume of types B and C. CONCLUSIONS This modular classification of EMMs, based on quantitative analysis in a preclinical setting, should allow for better personalized preoperative surgical planning and provides standardization of nomenclature.

Angiogenesis and lymphangiogenesis in early-stage laryngeal carcinoma: Prognostic implications

Many studies have recently emphasized the role of tumor angiogenesis and lymphangiogenesis in regional and distant spread of disease. Although early laryngeal cancer has a favorable oncologic outcome after conservative surgery or radiation therapy, we observed few cases with poor prognosis in terms of locoregional relapse, organ preservation, and survival. The aim of our study was to evaluate the immunohistochemical expression of CD31 and podoplanin to define angiogenic and lymphangiogenic patterns and their possible prognostic implications in previously untreated T1–T2 glottic squamous cell carcinoma.

Middle Ear Effusion in Patients with Sinonasal Cancer Treated by Surgery with or without Radiotherapy

Objective To identify the prevalence and risk factors of eustachian tube dysfunction after surgery for sinonasal cancer by observing the occurrence of middle ear effusion. Study Design Historical cohort study. Setting Academic university hospital. Subjects and Methods Clinical records of 112 patients surgically treated for sinonasal cancer over a 16-year period were evaluated. Initial bivariate analysis was followed by a multivariate logistic regression model. Results The best model included 2 variables: posterior extension of surgical resection (nasopharynx, soft palate, eustachian tube, pterygomaxillary fossa, parapharyngeal space) with an odds ratio of 5.662 (95% confidence interval [CI], 1.877-9.447) and postoperative radiotherapy with an odds ratio of 8.691 (95% CI, 4.187-13.194). Conclusion Despite the limited number of patients, the study gives a prediction of middle ear effusion based on 2 well-defined factors: surgical resection of anatomic structures involved in tubal function and adjuvant radiotherapy.

Endoscopy-assisted iliotibial tract harvesting for skull base reconstruction: feasibility on a cadaveric model.

During the last years, multiple methods and a wide set of materials for skull base reconstruction have been described. In our experience, the ideal graft for duraplasty is the iliotibial tract due to its favorable characteristics in terms of thickness, pliability, and strength. In this report, we show the iliotibial tract-harvesting technique under endoscopic guidance with a minimally invasive approach using a cadaveric model. Two longitudinal incisions of 1 cm each were made at 4 cm down a line drawn between the anterior-superior iliac spine and the lateral margin of patella at the extremities of the middle third of the thigh. By using a set of instruments for endoscopic face-lifting, the graft was easily set up and harvested. The endoscopic approach is associated with less visible scars, but longer operative time in comparison with open traditional procedure. The pros and cons in terms of morbidity need to be evaluated by further studies on actual cases.

Agger-bullar classification (ABC) of the frontal sinus drainage pathway: validation in a preclinical setting.

The anatomy of structures surrounding the frontal sinus drainage pathway (FSDP) is extremely complex and challenging for endoscopic sinus surgeons. The anatomical nomenclature of this area reflects this complexity and lack of agreement regarding anatomical variants of this region is present in the literature. This work presents a new classification system of the air spaces surrounding the FSDP, called the agger‐bullar classification (ABC), and compares it with the most widely used anatomical classification of the frontoethmoidal region, the modified Bent and Kuhn classification (MBKC).