Dario Marcotullio

Laryngopyocele : An atypical case

18672 described Morgagni’s appendix and called its saccular dilation a “laryngocele.” The dimensions of the laryngeal saccule are greater in newborns but diminish during the first few years of life. In 2% to 3% of the cases, this regression does not occur.3s4 The presence of a communication between the dilatated appendix and the lumen of the Morgagni’s ventricle differentiates a laryngocele from a saccular cyst. The saccular cyst is a mucus-filled5 dilatation of the saccule that does not communicate with the laryngeal lumen.6j7 Based on location, three types of laryngocele have been described. The internal laryngocele is confined to the interior of the larynx and represents one third of the cases, usually extending posterosuperiorly into the area of the false vocal cord and aryepiglottic fold through the thyroarytenoid muscle and the superior thyroarytenoid legament. The external laryngocele extends upward and protrudes through the thyrohyoid membrane to the laterocervical region, following the upper laryngeal peduncle or through a weakness between the middle and inferior constrictor muscles of the pharynx (Fig

Facial Reanimation: A Proposal to Reduce Postoperative Morbidity

INTRODUCTION In postoperative facial palsy during cerebellopontine angle surgery, end-to-end hypoglossal–facial nerve anastomosis is at present the most popular technique used in rehabilitation of facial function in cases with loss of the proximal stump of the facial nerve. However, this technique may be a source of additional morbidity such as swallowing or speech dysfunction because facial expression is recovered at the expense of glossal function. Other potential complications may be excessive facial muscle tone, spasms, and synkinesis. Several alternative techniques have been proposed to eliminate these disabilities caused by erroneous nerve regeneration processes. May et al., Terzis, Arai et al., Cusimano and Sekkar, Atlas and Lowinger, and Sawamura and Hiroshi have reported successful results with their techniques in preserving glossal function. May et al. suggested grafting of the great auricular nerve between the facial nerve and a partially incised hypoglossal nerve. Function of the tongue is well preserved using this method, but the face does not respond equally positively and the rehabilitation period is longer, probably as a result of a pronounced fibrosis caused by multiple anastomoses and by the need for jumping the grafted nerve. Other authors have preferred the “split hypoglossal-facial nerve anastomosis” technique, but this invariably implies that the axons of the seventh cranial nerve could be transected at various levels because anatomically the hypoglossal nerve is not multifasciculated and therefore cannot be subdivided into fascicles. This may cause varying degrees of hemiglossal atrophy. Atlas and Lowinger and Sawamura and Hiroshi contemporaneously presented an alternative technique of hypoglossal–facial nerve surgery that involves end-to-side facial–hypoglossal nerve anastomosis. This is performed by skeletonizing the facial nerve in the mastoid and tympanic segments and transposing it from the fallopian canal to the hypoglossal nerve. This method is particularly advantageous because it requires only one nervous anastomosis, ensuring a better preservation of tongue function. No matter which technique of hypoglossal–facial nerve anastomosis one decides to adopt, optimal facial function is regained as far as muscular tone is concerned, but symmetrical coordination of the facial expression is unsatisfactory. To overcome this problem, Terzis devised the “baby-sitter” technique that combines hypoglossal– facial nerve anastomosis and facial crossover technique. The latter of these, on its own, does not always produce a sufficient muscular tone to ensure valid contraction, even if it does permit a good recovery of the dynamic symmetry of the face. The “baby-sitter” technique combines the two methods of facial rehabilitation, preserving the respective advantages and eliminating the disadvantages. However, the twelfth–seventh nerve technique employed (split hypoglossal–facial nerve anastomosis) is, as stated previously, a questionable method as far as tongue function is concerned. The aim of the present report is to present a modification of the classic baby-sitter technique, substituting split hypoglossal–facial nerve anastomosis with the method proposed by Atlas and Lowinger in an attempt to reduce its potential morbidity.

Endoscopic vs Microscopic Approach in Stapes Surgery: Advantages in the Middle Ear Structures Visualization and Trainee's Point of View

OBJECTIVE Comparing the endoscopic and microscopic approaches in stapes surgery, and establishing the surgical approach that allows better results in terms of visualization of the middle ear structures and aids assistants training. MATERIALS AND METHODS Twenty-one residents from the first to the fifth year of training in Otolaryngology were enrolled in this prospective study. A questionnaire specifically designed to investigate the understanding of middle ear anatomy, the surgical steps, and a personal opinion about endoscopic stapes surgery was submitted to each resident. RESULTS Statistical differences between the endoscopic and microscopic approaches were evident about identification of stapes and long process of the incus (p=0.03) and stapes footplate and the oval window (p=0.03). No substantial difference between the two surgical approaches emerged regarding the visualization of the tympanic membrane and the other middle ear structures (p>0.5). A substantial difference in favor of the endoscopic approach emerged regarding the identification of the hole creation in the footplate of the stapes. CONCLUSION Endoscopic stapes surgery could favor an easier understanding of the surgical technique for assistants in training with little knowledge of the anatomy and surgical steps.

Rare and massive odontogenic parakeratotic cyst treated by endoscopic sinus surgery: a case report

IntroductionKeratocystic odontogenic tumors are benign neoplasms of odontogenic origin with a potential for aggressive and infiltrative behavior. Many different treatments for this type of lesion have been reported. However, no common consensus has emerged to date regarding the most effective therapeutic approach. Cases of maxillary sinus giant keratocystic odontogenic tumors completely excised by enucleation or marsupialization via endoscopic sinus surgery are extremely rare, and, to the best of our knowledge, only one case has been described in the literature since 2005.Case presentationWe report a case of a 24-year-old Italian man who came to our department with maxillary sinus region swelling, pain and left nasal obstruction. A massive keratocystic odontogenic tumor involving the right maxillary sinus and causing focal erosions of the bony walls was diagnosed. The keratocystic odontogenic tumor was removed as much as possible by a transnasal approach using endoscopic sinus surgery, which produced optimal surgical and prognostic outcomes. Follow-up is reported for an 8-year period.ConclusionConservative management in this case demonstrated good therapeutic efficacy with a low risk of recurrence. For injuries involving the maxillary sinus, the possibility of decompression or marsupialization by endoscopic sinus surgery should always be considered because it demonstrated the potential to lead to excellent results even after 8 years of follow-up in our patient. To our knowledge, no case report has described follow-up longer than 8 years for a maxillary sinus keratocystic odontogenic tumor treated with endoscopic sinus surgery.

Mucoepidermoid Carcinoma Associated with Osteosarcoma in a True Malignant Mixed Tumor of the Submandibular Region

Introduction. True malignant mixed tumor, also known as carcinosarcoma, is a rare tumor of the salivary gland composed of both malignant epithelial and malignant mesenchymal elements. Frequently carcinosarcoma arises in the background of a preexisting pleomorphic adenoma; however, if no evidence of benign mixed tumor is present, the lesion is known as carcinosarcoma “de novo.” We reported the first case of true malignant mixed tumor of the submandibular gland composed of high grade mucoepidermoid carcinoma associated with osteosarcoma. Case Presentation. A 69-year-old Caucasian male came to our department complaining of the appearance of an asymptomatic left submandibular neoformation progressively increasing in size over 3 months. We opted for surgical treatment. Histological examination confirmed the diagnosis of carcinosarcoma with the coexistence of high grade mucoepidermoid carcinoma and osteosarcoma. Conclusion. To the best of our knowledge, in the true malignant mixed tumor of the submandibular gland, mucoepidermoid carcinoma associated with osteosarcoma has never been previously reported.

Renal Clear Cell Carcinoma and Tonsil Metastasis

Renal cell carcinoma is the most common renal tumor in adults. Clear cell carcinoma represents 85% of all histological subtypes. In February 2012 a 72-year-old woman came to our department due to the appearance of massive hemoptysis and pharyngodinia. Previously, this patient was diagnosed with a renal cell carcinoma treated with left nephrectomy. We observed an exophytic, grayish, and ulcerated mass in the left tonsillar lodge and decided to subject the patient to an immediate tonsillectomy. Postoperative histology showed nests of cells with highly hyperchromatic nuclei and clear cytoplasm. These features enabled us to make the diagnosis of renal clear cell carcinoma metastasis. Only few authors described metastasis of renal cell carcinoma in this specific site.

Sebaceoma of the external auditory canal.

Sebaceoma is a benign cutaneous neoplasm that typically presents as a nodule or plaque on the face or scalp. Sebaceomas may be associated with the Muir-Torre syndrome, in which they may be multiple and associated with other sebaceous neoplasms of the skin and multiple adenomatous polyps (1). We present the case of a young man affected by a sebaceoma of the external auditory canal (EAC). To our knowledge, this is the third reported case of sebaceoma localized in the ear canal (1,2). The differential diagnosis and clinical implications are also discussed.