G Motta

CO2 laser treatment of supraglottic cancer.

The aim of the study was to evaluate the effectiveness of endoscopic CO2 laser microsurgery in the management of supraglottic cancer.

Functional vocal results after CO2 laser endoscopic surgery for glottic tumours.

INTRODUCTION Vocal results after endoscopic cordectomy have not yet been well defined. The aim of this study was to assess the vocal function of patients who had undergone CO2 laser cordectomy. DESIGN Retrospective, observational and control group study, conducted in a tertiary care medical department. METHODS One hundred and thirty-five male patients (age range 36-83 years) underwent different types of endoscopic cordectomy. Forty age-matched, euphonic male subjects were selected as controls. Patients were classified according to the main site of the phonatory neo-glottis. Outcome measures were maximum phonation time, vocal intensity and harmonic/noise ratio. Mann-Whitney and rank Spearman tests were used for statistical analysis. RESULTS Findings indicated statistically significant differences for all parameters, comparing patients and controls (p<0.001), and a direct positive relation between type of functional compensation and outcome measures in the study patients (p<0.001). CONCLUSIONS The results indicate that functional compensation and outcome measures were related, and that no functional compensation enabled the study patients to achieve a voice quality comparable with that of controls.

Chondroid chordoma of the lateral skull base

A rare case of chondroid chordoma of the lateral skull base with laterocervical extension is reported. Clinical, radiological and pathological features of the tumor are described. This unusual location of chondroid chordoma enabled total resection of the neoplastic tissue through a combined laterocervical and far lateral transjugular approach.

Effects of guidelines on adeno-tonsillar surgery on the clinical behaviour of otorhinolaryngologists in Italy

BackgroundSeveral guidelines on adeno-tonsillar disease have been proposed in recent years and some discrepancies in relation both to clinical manifestations and indications for surgical treatment have emerged. The aim of the study was to verify what influence (adeno)-tonsillectomy guidelines have had on the clinical behaviour of ENT specialists in Italy. Our study is a retrospective and multi-centre case series with chart review.MethodsThe survey involved 14,770 children, aged between the ages of 2 and 11, who had undergone adeno-tonsillar surgery between 2002 and 2008 in fourteen Italian tertiary and secondary referral centres. Anova test was used for the statistical analysis, assuming p < 0.05 as the minimum statistical significance value.ResultsThe frequency of adeno-tonsillar surgeries did not change significantly (p>0.05) during the study period and following the Italian policy document publication. Overall, adeno-tonsillectomy was the most frequent intervention (64.1%), followed by adenoidectomy (31.1%) and tonsillectomy (4.8%). The indications for surgery did not change significantly for each of the operations (p>0.05), with the exception of adeno-tonsillectomy in case of feverish episodes due to acute recurrent tonsillitis ≥ 5 without nasal obstruction (decreased p= 0.010) , even when the feverish episodes due to acute recurrent tonsillitis were < 5 over the last year. Nasal obstruction was associated with feverish episodes due to acute recurrent tonsillitis in 65.2% of operated cases, while otitis media had been diagnosed in 43.3% of the patients studied.ConclusionsThe recommendations first developed in Italy in a 2003 policy document and then resumed in guidelines in 2008, were not implemented by ENT units involved in the survey. The study highlights the fact that the indications for adeno-tonsillar operations are based on the overall clinical presentation (comorbidity) rather than on a single symptom. Guidelines are necessary to give coherent recommendations based on both the findings obtained through randomized controlled trials and the data collected from observational studies.

CO 2 -laser treatment of laryngeal amyloidosis

Four consecutive female patients (age: 14-47 years) with laryngeal amyloidosis, treated with endoscopic CO(2)-laser surgery, entered the study. All patients underwent periodic microlaryngoscopies following surgery to confirm the adequacy of the surgical resection. Recurrences or suspected lesions were resected and fibrin deposits were removed to prevent the formation of synechiae or healing adhesions. After two negative microlaryngoscopies, performed two months apart, the patients were followed-up approximately every six months over a period from six months to 18 years, with no evidence of recurrences. The endoscopic CO(2)-laser technique is highly effective in the treatment of localized laryngeal amyloidosis.

Surgical treatment of acute recurrent throat infections in children

OBJECTIVE The purpose of this study was to define the contribute of surgery and watchful waiting in the treatment of feverish episodes and other clinical manifestations related to acute recurrent throat infections in children. METHODS An observational, retrospective and multi-centric study was carried out on 407 subjects, aged 2-11, with a minimum two-year follow-up. Chi square test and Fishers test were used for the statistical analysis. RESULTS Watchful waiting prevented, similarly to surgery, recurrences of feverish episodes, but did not favourably impact on other clinical manifestations (respiratory obstruction, otitis media, group A beta hemolyticus streptococcus positive laboratory findings) as compared to surgery (p<0.001). CONCLUSIONS The higher effectiveness of surgical treatment, as compared to watchful waiting, was documented in the study patients, considering all the clinical manifestations related to acute recurrent throat infections.

Association between Kaposi's sarcoma and squamous cell carcinoma of the larynx.

i d v v o D a m T f s T a a c c t t t w t o s n w f H D F t t he laryngeal location of Kaposi’s sarcoma (KS) is xtremely rare. To our knowledge, there are no previus reports on the coexistence of a KS of the larynx and squamous cell carcinoma at this site. The observation f a clinical case characterized by this association arises ome questions about the interference of different athogenetic mechanisms on the onset and evolution of S of the larynx.