Marilia Simonelli

CO2 laser cordectomy for early-stage Glottic carcinoma: A long-term follow-up of 156 cases

Objectives To define when laser resection of early‐stage glottic carcinoma is indicated and to compare the results obtained by laser surgery with other therapeutic options.

Evolution of precancerous laryngeal lesions: A clinicopathologic study with long-term follow-up on 259 patients

A wide spectrum of lesions ranging from dysplasia to in situ carcinoma have to be considered when dealing with laryngeal precancerous conditions. Recently the concept of laryngeal intraepithelial neoplasia (LIN) was introduced.

Ectopic Lingual Thyroid as Unusual Cause of Severe Dysphagia

Ectopic lingual thyroid is an uncommon embryological aberration characterized by the presence of thyroid tissue located in a site different from the pretracheal region as in the normal. Lingual thyroid is the most frequent ectopic location of the thyroid gland, although its clinical incidence varies between 1:3000 and 1:10,000. We present the case of a 26-year-old woman who presented severe dysphagia caused by a mass located on the base of the tongue in the midline. An endoscopic partial removal of the ectopic tissue allowed her to rapidly regain her swallowing capacity. The literature regarding the incidence and diagnosis of lingual thyroid is reviewed and the possibilities of treatment discussed.

Swallowing ability and chronic aspiration after supracricoid partial laryngectomy

Objective: Sporadic episodes of aspiration may occur after supracricoid partial laryngectomy. To prevent risks of pulmonary consequences, a limitation of oral intake of food or a “nothing by mouth” regimen has been suggested. The objective of this study was to evaluate the long-term swallowing and pulmonary status of patients after supracricoid partial laryngectomy. Study Design: Case series with chart review. Setting: Tertiary University Hospital Policlinico “Umberto I” and Santa Lucia Foundation, Rome, Italy. Subjects and Methods: The swallowing status of a selected group of 116 patients who recovered functional deglutition after supracricoid partial laryngectomy was analyzed during follow-up consultation. Swallowing evaluation included clinical observation, fiberoptic endoscopic evaluation of swallowing, and a videofluoroscopy. When aspiration was confirmed by videofluoroscopy, a high-resolution computed tomography (CT) of the chest was performed in order to assess the radiological manifestations of aspiration. A group of 45 patients with chronic obstructive pulmonary disease and normal deglutition was used as a control. Results: Seventy-nine patients out of 116 showed a fiberoptic endoscopic evaluation of swallowing suggestive for aspiration; only 45 patients had aspiration confirmed by videofluoroscopy. No significant differences in radiological findings were noted in the patients affected by postoperative chronic aspiration compared to the control group. Conclusion: Patients with functional deglutition after supracricoid partial laryngectomy show a mild and well-tolerated degree of chronic aspiration and do not require a limitation of oral intake of food.

Prognostic value of resection margins in supracricoid laryngectomy

Objectives The objective was to assess the prognostic value of surgical margin involvement in patients treated for squamous cell carcinoma of the larynx.

Carcinoma Cuniculatum: Verrucous Carcinoma of the Skin of the Face

Carcinoma cuniculatum, a form of low-grade squamous cell verrucous carcinoma of the skin, was first described by Aird et al in 1954 as epithelioma cuniculatum. The tumor usually presents as an ulcerated, bulky, exophytic mass that grows slowly and is painful. On the surface of the lesion, there are numerous sinus tracts that exude foul-smelling greasy matter when pressure is applied. These numerous crypts and sinuses on the tumor mass resemble rabbit burrows, thus the term “cuniculatum” was coined (from the Latin “cuniculus” meaning rabbit burrow) and due to the uncertain nature and history of the lesion, the term “epithelioma” was initially used. However, the slow but continuous growth of the tumor and its capacity to erode bone and metastasis to the lymph nodes have brought it to be considered a squamous cell carcinoma, so the term “carcinoma cuniculatum” a verrucous carcinoma of the skin is therefore preferable. http://www.entnet.org/journal/casereports/OTO-05.pdf/

Cytologic and Functional Alterations of Nasal Mucosa in Smokers Temporary or Permanent Damage

Objective Tobacco smoke is a significant risk factor for respiratory diseases. The purpose of this study is to analyze the cytologic and functional features of nasal mucosa in smokers, nonsmokers, and ex-smokers to evaluate if nasal alterations in smokers are permanent or reversible conditions after smoking cessation. Study Design Case series with planned data collection. Setting University medical center. Subjects and Methods Ninety healthy volunteers recruited from the staff of Alfredo Fiorini Hospital, Sapienza University of Rome, were enrolled in this prospective study from October to November 2013. We divided the cases according to smoking habits (smokers, nonsmokers, ex-smokers). Each group was composed of 30 subjects. Cytologic features of nasal mucosa and effectiveness of nasal mucociliary clearance were studied, focusing on 4 parameters: (1) nasal mucociliary clearance, assessed by saccharin nasal transit time; (2) ratio between the number of ciliated cells and goblet cells, analyzed by microscopic observation of cytologic specimens of nasal mucosa that had undergone May Grunwald Giemsa staining; (3) evaluation of ciliary motility; and (4) time of ciliary movement of ciliated cells analyzed by phase-contrast microscopy. Results All parameters were significantly reduced in the smokers compared to the nonsmokers. There were no statistically significant differences between the nonsmoker and ex-smoker groups. Conclusion Cigarette smoking causes cytologic modifications of nasal mucosa that influence the effectiveness of mucociliary clearance. Our preliminary study suggests that these changes are not permanent and that nasal mucosa of ex-smokers recovers normal cytologic and functional features.

Clinical findings of laryngeal aspergillosis

mycosis because it is usually a significant cause of morbidity and mortality only in the immunocompromised host. More than 80% of cases involve the lung, followed by the brain, the gastrointestinal tract, and the kidneys. Head and neck manifestations include nasal, paranasal, and otologic diseases. Aspergillosis of the larynx is uncommon and is usually secondary to pulmonary involvement. Primary laryngeal involvement by Aspergillus has been reported but is extremely rare. Felty’s syndrome is a clinical variant of rheumatoid arthritis. Herein we report the clinical appearance of the first case of primary aspergillosis of the larynx in a patient with Felty’s syndrome.

Effect of Radiofrequency Thermal Ablation Treatment on Nasal Ciliary Motility A Study with Phase-Contrast Microscopy

Objective To investigate the efficacy of nasal ciliary motility after radiofrequency ablation treatment in patients with isolated inferior turbinate hypertrophy and to clarify how long until normal ciliary function is restored. Study Design Prospective, single-group, pretest-posttest design. Setting Academic tertiary care medical center. Subjects and Methods This study involved 34 adult patients affected by nasal obstruction due to inferior turbinate hypertrophy who underwent radiofrequency ablation treatment between June and December 2014. Diagnosis was assessed according to clinical history, nasal endoscopy, and active anterior rhinomanometry. Cytologic samples were collected by nasal scraping before surgery and 1, 2, and 3 months after surgery. Ciliary motility was evaluated by nasal cytology with phase-contrast microscopy. Functional aspects of nasal mucosa were studied, with a focus on 3 parameters: (1) nasal mucociliary clearance, assessed by saccharin nasal transit time test; (2) percentage of ciliated cell motility, measured as the ratio between cells with motility and cells without motility; and (3) efficacy of ciliary motility, measured as the ratio between cells with valid motility and cells with hypovalid motility. Results Ciliary motility and ciliary efficacy showed a significant reduction after 1 and 2 months from surgery, returning to normal values within 3 months. No significant changes in saccharin nasal transit time were recorded during the follow-up. Conclusions The outcomes of this study suggest that radiofrequency ablation treatment causes ciliary motility changes of nasal mucosa that are completely restored after at least 3 months after surgery. These cytologic abnormalities do not affect nasal functionality.