S Sionis

Sialoendoscopy with and without holmium:YAG laser-assisted lithotripsy in the management of obstructive sialadenitis of major salivary glands

Obstructive sialadenitis is a major cause of dysfunction of the salivary glands, and increasingly sialoendoscopy is used in both diagnosis and treatment. At present the limit of the endoscopic approach is the size of the stone as only stones of less than 4mm can be removed. Endoscopic laser lithotripsy has the potential to treat many stones larger than this with minimal complications and preservation of a functional salivary gland. The holmium:YAG laser has been widely and safely used in urology, and its use has been recently proposed in salivary lithotripsy for the removal of bigger stones. We describe our experience with sialoendoscopy for stones in the parotid and submandibular glands and assess the feasibility and the efficacy of holmium:YAG laser lithotripsy. We have used the procedure 50 times for 43 patients with obstructive sialadenitis; 31 patients had sialolithiasis, 15 of whom (48%) had stones with diameters between 4 and 15mm (mean 7). Total extraction after fragmentation was possible in 14 of the 15 patients without complications. Intraductal holmium:YAG laser lithotripsy is effective and safe, and allows the treatment of large stones in Stensens and Whartons ducts.

Enhanced contact endoscopy for the detection of neoangiogenesis in tumors of the larynx and hypopharynx.

Image‐enhanced endoscopy, such as narrow band imaging and the Storz Professional Image Enhancement System, have been increasingly used in patients with suspect lesions of the larynx and hypopharynx during preoperative and intraoperative assessment.

Endoscopic management of adult-type rhabdomyoma of the glottis: case report and review of the literature.

while glottic lesions are extremely rare, and only22 cases have been reported up to now. With this article we anadditionalcaseofglotticadult-typerhabdomyoma reviewthepertinentliterature,withtwoaims:(I)assess standard ofcare this pathology, to avoid inadequate and (II) increase its knowledge among surgeons pathologists.

Balloon catheter sialoplasty: a safety and feasibility pilot study.

Obstructive sialoadenitis is the most common non-neoplastic disorder of the salivary glands. With advances in the use of diagnostic and interventional sialoendoscopy in the major salivary glands, operations can often be less invasive and treatment can spare the gland and restore normal function. By using an expandable balloon catheter to dilate ductal stenosis during sialoendoscopy it is possible to dilate a stenotic duct and remove large stones with or without a basket. However, the use of different angiocatheters or dedicated balloons is still empirical. In this pilot study we assessed the feasibility and safety of balloon dilatation of the submandibular gland (Whartons duct). We did balloon catheter sialoplasty on four ducts from two fresh adult cadavers. We used a non-compliant dilating balloon catheter 6mm in diameter at a pressure of 12 × 10(5)Pa for a total of three minutes and then examined the ducts histologically. There was no damage to the wall of Whartons duct. Although this is a small study, we have shown the safety of balloon catheter sialoplasty for the first time as assessed histologically after dilatation of the duct. By virtue of the technique histological assessment is not possible after dilatation in patients. Long-term follow up is clearly required in this rapidly evolving area of surgery.

Congenital remnants as a cause of neonatal respiratory impairment

Neonatal respiratory distress is a potentially life-threatening condition, representing a diagnostic and therapeutic challenge for physicians, especially when it is caused by rare pathologies. Head and neck remnants are benign congenital neoplasms rarely observed in newborns. Teratoma is the most common congenital tumor in childhood, while head and neck epithelial and mesenchymal hamartomas are uncommon. We report three cases of pharyngeal congenital remnants presenting with neonatal airway obstruction. We observed a 9-month-old, 35-day-old, and 15-hour-old patients, who have been referred to our Department of Otorhinolaryngology with acute airway distress. All the patients showed a pharyngeal benign lesion, since teratomas originated from the left lateral wall of the pharynx in two cases and one “fibrovascular” hamartoma originated from the base of the tongue. Timely surgical excision through transoral CO 2 laser microsurgery was curative in all the cases. Dyspnoea in newborns is a challenging condition and must be managed, when possible, by a well-trained paediatric team. When clinicians face obstructive airway congenital remnants, a timely and radical surgical excision is necessary to avoid potentially lethal asphyxia.

Parotid Masson's tumor: case report

Masson’s tumor, also known as ‘Masson’s vegetated intravascular hemangioendothelioma’, is a papillary hyperplasia of the endothelial vascular cells that generally develops in medium-sized veins, but may also be observed in all-sized veins and, less frequently, in arteries.1 Pierre Masson in 1923 first described this tumor in inflamed hemorrhoidal plexus and explained its pathogenesis as a primary endothelial proliferation of endothelial cells into the vessel lumen due to obstructive thrombosis, followed by degeneration and necrosis.2 Currently, it is considered a reactive vascular proliferation secondary to vascular stasis3 that can develop in tendons, head and neck, skin, intracranial, aero-digestive tract, intra-abdominal areas, genital tract, and fallopian canal; it is generally endovascular, but Pins et al.4 reported 13 patients presenting with a rare extravascular form. Corio et al. in 19825 reported 14 cases of head and neck Masson’s tumor, only one found in the parotid gland; clinical features were not detailed. To the best of our knowledge, this is the first well documented reported case of a Masson’s tumor of the parotid gland. The authors want ENT surgeons and pathologists to be aware of this entity.

Surgery for Otosclerosis: Results on 508 Patients

Objective: The objective of our paper is to evaluate the hearing results after surgical treatment of otosclerosis from a retrospective analysis of 649 procedures performed by the same surgeon (484 stapedotomies, 69 total stapedectomies, 26 partial stapedectomies, and 70 revisions). We also evaluated the hearing improvement in patients with far-advanced otosclerosis. Method: We conducted a retrospective study on 649 operations performed on 508 patients between 1998 and 2005. The approach was endoaural under local anesthetic. Audiological evaluation has been performed according to the Committee on Hearing and Equilibrium–AAO-HNS guidelines. Results: We found results better after stapedotomy than stapedectomy with a postoperative ABG within 10 dB in 89.67% after stapedotomy, in 85.51% after total stapedectomy, and in 84.62% after partial stapedectomy. Stapedotomy was most reliable in the variation of the BC for high tones; we had a worsening of BC in 17.56% after stapedotomy and in 21.74% after stepedectomy. After revision surgery the outcomes were worse than primary surgery, with an ABG within 10 dB in 85.36% after revision of stapedotomy and in 82.76% after revision of stapedectomy. In far advanced otosclerosis, we obtained a mean postoperative ABG within 10 dB in 86.32%. Conclusion: This study confirmed stapes surgery allows for a good restoration of hearing function in a high percentage of cases with slightly better results after stapedotomy. Time of surgery is fundamental for recovery of hearing function since the outcomes are better in patients without sensorineural hearing loss.

Universal newborn hearing screening: preliminary experience at the University Hospital of Cagliari

Bilateral congenital or acquired sensorineural hearing loss is a pathological condition affecting 1-2 children per 1,000 live births; it represents a major issue in public health because its late identification can negatively affect speech and language development. The aim of hearing screening is to obtain diagnosis and management of hearing loss as soon as possible; in fact early diagnosis and treatment allow children with congenital hearing impairment to acquire adequate linguistic competence. The present study reports our preliminary experience in newborn hearing screening at Neonatology services of University of Cagliari (Italy). During the first semester of surveillance, between January 2012 and June 2012, hearing screening was performed on a total of 901 babies using two different methods, TEOAEs in healthy neonates and automated ABR in high-risk babies. All infants were screened prior to hospital discharge; in some cases, especially for preterm infants of Neonatal Intensive Care Unit and Puericulture Institute, the screening was performed after discharge, to achieve a possible better global and acoustic maturation; 5 cases of hearing impairment were found. In the present study the Authors confirmed that it is possible to start a universal hearing screening in a relatively short time reaching the percentages suggested by Joint Committee on Infant Hearing.