Aldo Zupi

Mandibular lengthening by external distraction: an experimental study in the rabbit.

OBJECTIVE To observe the development of bone at different times during the period of mandibular lengthening by external distraction using Ilizarovs transosseous osteosynthesis technique. MATERIALS AND METHODS Fifteen rabbits, 2 to 3 kg in weight, were used for this experiment. The left side of the mandible was exposed and a corticotomy was performed with a water-cooled drill. After 12 hours, distraction was started and continued 1 mm per day for 2 weeks. Plain radiography and three-phase bone scan scintigraphy were performed on the 1st, 7th, and 14th postoperative days. The mandibles were then either removed for immediate histologic evaluation or after 2, 5, or 8 weeks of postdistraction fixation. RESULTS Elongation of up to 11 mm was achieved. Radiographic and scintigraphic evaluation suggested a residual inflammation on the 7th day and definite ossification on the 14th day. Histologic observations of the distraction site showed a gradual change from an amorphous matrix to a fibrous matrix and, finally, an osseous-like tissue. CONCLUSION Bone lengthening by gradual distraction is commonly used in tubular bones. To achieve mandibular lengthening it is necessary to resolve many problems. Morphologic, radiographic, scintigraphic, and histologic observations confirm that mandibular lengthening by external distraction is possible, with the formation of new bone tissue.

Accuracy of fine needle aspiration biopsy in head and neck tumors

PURPOSE Fine-needle aspiration biopsy (FNAB) is frequently used in the diagnosis of lesions occurring in the head and neck region. This study evaluated the correlation between the findings on FNAB and the histological findings observed after surgery. MATERIALS AND METHODS A review of 218 patients who underwent FNAB of a head or neck tumor was performed. Cytological reports were classified into the following diagnostic categories: negative or positive for malignant cells and unsatisfactory. False-positive, false-negative, true-positive (sensitivity), and true-negative (specificity) rates were calculated. RESULTS Twelve specimens did not allow an adequate diagnosis (5.5%). Among benign tumors, 96.2% of the cases were correctly diagnosed, and 3.8% were nondiagnostic specimens. Among malignant tumors, 86.4% of cases were correctly identified. There were two (3.4%) false-negatives and six (10.2%) nondiagnostic specimens, with a total false-negative rate of 13.6%. CONCLUSIONS Sampling errors present a minor problem with FNAB. Most nondiagnostic or incorrect specimens were caused by nonhomogenous lesions, with poor placement of the needle and an insufficient amount of aspirated material. FNAB is a useful modality for the diagnosis of head and neck masses.

Accuracy in the diagnosis of mandibular involvement by oral cancer

Cancer of the mandibular region usually has a poor prognosis; this is particularly correlated to invasion of the mandible. To reduce the consequences of poor therapeutic planning, careful preoperative assessment of bone infiltration is necessary. We have examined the records of 50 patients evaluated by clinical examination, conventional radiography, computed tomography (CT), bone scintigraphy with 99mTc and magnetic resonance imaging (MRI). The highest sensitivity (100%) was attained by scintigraphy; the highest values of specificity (96.3%) were reached by CT scan and MRI. A CT scan showed the highest predictive positive value (95.4%) and efficiency (94%), this plus MRI have good values and the associated sensitivity and efficiency are higher than when these techniques are used alone.

Lymph-node metastasis in squamous cell carcinoma of the lip A retrospective analysis of 105 cases

During 1975-87, 105 patients with squamous cell carcinoma (SCC) of the lip were surgically treated. All patients underwent radical resection of the tumor. Only the patients with palpable lymph nodes had a simultaneous neck dissection. All patients were followed up for at least 5 years. Of the 80 patients without palpable lymph nodes, only three developed lymph-node metastasis. Of the 25 patients with palpable lymph nodes who underwent modified neck dissection, four had recurrence of lymph-node metastasis at a different level. The over-all 5-year survival rate was 97%. The survival rate for patients with lymph-node metastasis was 88%.

Cervical ganglioneuroma: Report of a case☆

are rare entities, constituting only 6% of tumors in the pediatric age group. The primary tumor is typically located in the abdomen (65%-80%) or thorax (10%15%), whereas only 5% occurred in the neck.1 These tumors usually occur within the first months of life as an indolent mass in the cervical region or as acute obstruction of the airway.1,2 Clinically, signs and symptoms of cervical NTs are related to mass effect and nerve dysfunction. Hypertension and diarrhea may be present as a result of catecholamine or vasoactive intestinal peptide release.1,2 Imaging techniques and microscopic assays may be helpful in diagnosis. CT, radiography, ultrasonography, and MRI may reveal a cervical mass that displaces the trachea and esophagus. The tumor may involve the cranial nerves, the internal jugular vein, the external and internal carotid arteries, and the skull base.2 Fine-needle aspiration biopsy is very helpful and can provide a reliable preoperative diagnosis. Pathologically, NTs have different degrees of maturation. Neuroblastoma is the most primitive type of tumor, and it has the highest potential for metastasis. Ganglioneuroblastoma is an intermediate-grade tumor, and it has a lower metastatic rate. Ganglioneuromas, as in our case, represent the most differentiated variant and have no metastatic potential.1,3

Perineural invasion of the lower alveolar nerve by oral cancer: a follow-up study of 12 cases

Twelve previously untreated cases of oral cancer with perineural infiltration were studied retrospectively. Age, sex, site, clinical stage and outcome were evaluated. Management of the neoplasm in each case involved surgical removal and six patients required adjuvant radiotherapy. The most frequent site was the lip. At the time of diagnosis, five patients had sensory complaints and palpable lymphadenopathy was observed in three patients. The 5-year crude survival rate was 16.7%. In the cases with postoperative assessment of perineural infiltration, a median survival time of 30.8 months was observed; while in the case of preoperative assessment of nerve infiltration, extensive surgery was performed with a consequent median survival time of 44.5 months. The perineural infiltration of the lower alveolar nerve is more common (6.3%) than is generally thought. This frequency is due to the relationship with the lower lip and the mandibular region. In carcinoma of the lip, spread is generally limited to 10-15 mm along the lower alveolar nerve. In carcinoma of the mandibular region, spread is entirely dependent on the location of the tumour; the absence of clinical fixation to the bone and the small size of the carcinoma does not preclude the possibility of bone involvement. Neurological symptoms should be evaluated carefully, and a radiographic investigation of the nerve canal is mandatory.

Accuracy in the diagnosis of parotid tumours

Parotid lesions are often not easily classified. Important information is gathered by conventional and instrumental investigation. But these data are often insufficient to make a correct diagnosis. The authors have compared these techniques. In particular, they have evaluated their accuracy in identification of site and histology. 60 patients with parotid tumours underwent the same instrumental diagnostic techniques (echography, sialography, computed tomography and fine needle aspiration biopsy). In regard to the identification of the site, the highest percentage was achieved by computed tomography (98%). Echotomography has shown an accuracy of 83%, and sialography 87%. Fine needle aspiration biopsy has allowed the definition of the histiotype in 98% of cases. Computed tomography, echotomography and sialography have not allowed the definition of histiotype in malignant tumours, but in the case of benign tumours computed tomography has permitted a diagnosis in 29 cases (57% of benign tumours). Echotomography and sialography in 25 (49%) and 26 cases (51%), respectively.

Detection of latero-cervical metastases from oral cancer

In squamous cell carcinoma of the oral cavity, the presence of nodal metastases greatly influences prognosis. The evaluation of regional lymph nodal involvement is crucial in the correct management of these neoplasms. The records of 45 patients with oral cancer were reviewed retrospectively to evaluate the accuracy and prognostic value of the techniques used to detect lymph node metastasis in the neck (clinical examination, echo-colour-Doppler, computed tomography and magnetic resonance imaging). Echo-colour-Doppler was the most accurate procedure with a predictive positive value of 95.6% and the lowest false-negative rate. Therefore, a diagnostic preoperative study must include echo-colour-Doppler preferably associated with computed tomography to achieve the greatest diagnostic accuracy.

Surgical management of the neck in squamous cell carcinoma of the floor of the mouth

Nodal involvement in squamous cell carcinoma considerably lowers survival rate. Despite its importance, neck management has still not been adequately explored. The Authors have retrospectively reviewed the records of 112 cases. Unilateral N+ were treated with a homolateral therapeutic and a controlateral prophylactic neck dissection; bilateral N+ were treated with a bilateral therapeutic neck dissection. On first observation the majority of cases (66.1%) were T1-2, N+ patients accounted for 45.5%. Among N- patients, 21.3% of occult nodal metastases were observed. The 5-year survival rate was 52.7%. With N+ lesions, a radical neck dissection should be performed; the dissection should be performed bilaterally. With N- lesions a prophylactic modified radical neck dissection is recommended in T2-4 lesions.