Paolo Marchesi

Rhabdomyoma of the Parapharyngeal Space Presenting with Dysphagia

Rhabdomyoma is an exceedingly rare soft tissue benign tumor of skeletal muscle origin classified into cardiac and extracardiac types based on location. Extracardiac rhabdomyoma is further classified into adult, genital, and fetal type depending on the degree of differentiation. Adult rhabdomyomas are rare, but morphologically characteristic, benign mesenchymal tumors with mature skeletal muscle differentiation that in 90% of cases arise in the head and neck region, mainly in the mucosa of the oropharynx, nasopharynx, and larynx, from the branchial musculature of third and fourth branchial arches. Most patients are between 40 and 70 years old, with a mean age of 60 years with a male predominance. Usually presenting symptoms include upper airway obstruction, Eustachian tube dysfunction, and mucosal or neck mass, but rarely does it arise as pure dysphagia. This article presents a case of parapharyngeal rhabdomyoma presenting with only progressive dysphagia.

Minimally invasive video-assisted submandibular sialoadenectomy: a preliminary report.

Open-field sialoadenectomy is the first-choice treatment for submandibular disease. Conventional surgery is based on the transcervical approach. The present study aims to demonstrate the feasibility of a minimally invasive video-assisted sialoadenectomy and to describe a new technique to perform it. A 52-year-old man affected by chronic sialoadenitis underwent minimally invasive video-assisted sialoadenectomy under general anesthesia. The ultrasound scanning of the submandibular gland showed a 6.5-cm hypertrophic gland with dilatated intraglandular ducts and a 2-cm long intraglandular sialolith. After surgery, no static or dynamic nerve deficiencies were detected, but slight temporary deficiency of the marginalis mandibulae nerve recovered in 15 days. Cosmetic results satisfied the patient. Minimally invasive video-assisted submandibular sialoadenectomy can be a feasible and safe procedure, which could be a valid choice to conventional surgery if performed on selected cases. More experience must be collected to analyze the cost-effectiveness.

Carcinoma of the buccal mucosa metastasizing to the talus.

Head and neck squamous cell carcinomas (HNSCCs) are tumors with propensity mostly for locoregional spread. Most frequent sites of metastasis from cancer of the oral cavity include lung, bone, liver, adrenal, heart, and kidney. The advent of newer surgical techniques and an improved understanding of head and neck cancer have further improved control of cancer above the clavicles. Furthermore, the overall survival rate in patients with advanced head and neck cancer has not improved significantly. This has been partly because of the emergence of second primary cancers and the development of distant metastasis defined as cancer deposits below the clavicles. Authors reported a case of a 60 years-old man affected by squamous cell carcinoma of the oral cavity treated with surgery and adjuvant radiochemotherapy that developed a metastatic lesion to the left talus 10 months after primary treatment. In conclusion, bone is a rare metastatic site for HNSCC, much rarer in case of sites distal to the knee. Owing to paucity of the literature on this, no definite predisposing factor is identifiable. Because of the rarity of these lesions, bone scintigraphy remains not indicated in case of HNSCC, but attention has to be paid to eventual symptoms, also if frequently sensitive for advanced lesions.

Active middle ear implant after lateral petrosectomy and radiotherapy for ear cancer.

Background Tumor of the temporal bone is a rare disease with a very poor prognosis. Surgery and postoperative radiotherapy are usually the recommended treatments for squamous cell carcinoma (SCC) of the external and middle ear, which may cause conductive hearing loss. The purpose of this study was to evaluate the audiologic results and compliance of active middle ear implant (AMEI) and establish the feasibility of the procedure in a patient treated for middle ear cancer. Methods A 73-year-old patient treated with lateral petrosectomy, neck dissection, reconstruction/obliteration by pedicled pectoralis major myocutaneous flap, and postoperative full dose radiotherapy for external and middle ear SCC was selected for AMEI. Preoperative audiometric and speech audiometry tests were performed on both ears before and after the activation. Main Outcome Measures Pure tone free field audiometry. Binaural free field speech audiogram. Results Aided pure tone free field audiometry AMEI results show an increase in air conduction. Speech audiogram showed better discrimination scores in AMEI-aided situations. No complications were observed. Conclusion AMEI after surgery followed by radiotherapy for middle ear cancer is feasible. Acoustic results in obliterated ear are satisfactory.

Vastus lateralis myofascial free flap in tongue reconstruction.

SUMMARY In the last decade, the antero-lateral thigh free flap (ALT) has become the most popular free flap for tongue reconstruction because of less donor site morbidity and better cosmetic outcomes. However, fascio-cutaneous ALT may be insufficient to reconstruct major tongue defects, while its muscular-cutaneous variant (using the vastus lateralis muscle) may be too bulky. The present study describes our preliminary experience of tongue reconstruction with vastus lateralis myofascial flap, which could potentially offer unique advantages in head and neck reconstruction including adequate bulk when needed, optimal functional results and obliteration of dead space thus preventing fistulas and infections with minimal morbidity.