Sergio Motta

CO2 laser surgery in the treatment of glottic cancer

The aim of the study was to assess the effectiveness of CO2 laser endoscopic surgery in the treatment of glottic carcinoma limited to the true vocal cords or involving the adjacent regions.

T1-T2-T3 Glottic Tumors: Fifteen Years Experience with CO2 Laser

This research aims at reporting the results of endoscopic treatment of glottic carcinomas by CO2 laser. The cases cited concern 516 patients with glottic T1-T2-T3 carcinomas. The patients have been divided into 5 groups: a) T1a: 194 patients with monolateral carcinoma involving the true vocal cord who underwent simple cordectomy; b) T2a: 104 patients with monolateral cordal carcinoma involving the ventricle and the false cord; c) T1b: 127 cases of monolateral or bilateral carcinoma involving the anterior commissure; d) these patients underwent bilateral cordectomy; T2b: 54 cases of monolateral or bilateral carcinomas involving the anterior commissure and extending to the hypoglottic or supraglottic region; in these patients a bilateral extended cordectomy was performed; e) T3: 37 selected cases of monolateral or bilateral cordal carcinoma with fixed vocal cord, fixity was due to the substantial size of the tumor or to the infiltration of the paraglottic space; these patients underwent a monolateral or bilateral extended cordectomy. The following are the results at 5 years: group a: overall observed survival rate (OSR) was 79% and the adjusted survival rate (ASR) 94.5%; group b: OSR 67% and ASR 77%; group c: OSR 88.4% and ASR 96.5%; group d: OSR 82% and ASR 90%; group e: OSR 55% and ASR 67%. The above data are evidence of the fact that our surgical techniques offer similar or better advantages in terms of survival rate compared to the traditional procedures. It must be noted that endoscopic surgery of glottic tumors carried out by CO2 laser offers relevant benefits when compared with traditional surgery: i) rapidity of operation and reduced surgical trauma; ii) the possibility of avoiding tracheotomy; iii) the respect of the integrity of the cartilaginous skeleton; iv) short postoperative course and low incidence of complication; v) better functional results; vi) a shorter stay in hospital with positive psychological effects on the patients and lower social costs.

Olfactory groove meningioma with paranasal sinus and nasal cavity extension: removal by combined subfrontal and nasal approach

A very unusual case of olfactory groove meningioma with recurrence extending into the paranasal sinuses and nasal cavities, 15 years after the first transcranial operation, is described. The patient was successfully treated by a combined subfrontal and nasal approach. Large downward extension of an olfactory groove meningioma into the nasal cavities is a rare event, with no or isolated cases reported even in large series of these tumours. The nasal extent of these meningiomas is more often asymptomatic, although signs of sinus obstruction and epistaxis have been described. Although small paranasal sinus extensions of the meningioma may be removed by the transcranial route, a combined subfrontal and nasal approach is necessary in cases with large tumour masses extending into the nasal cavities, as in our own one.

Occult Lymph Node Metastases in Supraglottic Cancers of the Larynx

Occult cervical lymph node metastases may often be associated with cancers of the supraglottic larynx. The aims of this investigation were: (1) to determine the incidence of occult lymph node metastases in patients with cancer of the larynx; (2) to assess whether the presence of such metastases was related to the extent of the primary tumor (T) and its grading (G); and (3) to discuss which therapeutic approach should be followed in treating clinically occult lymph node metastases. Our investigation included 97 patients who underwent supraglottic horizontal laryngectomy and elective cervical lymph node dissection. The incidence of occult lymph node metastases in the series considered was 27%. Based on the preoperative staging of the tumor, 14% of the cases had metastatically involved lymph nodes in the T1 tumors, 21% in the T2 tumors, 35% in the T3, and 75% in the T4. In the statistical analysis, a significant difference was shown to exist when T1 + T2 and T3 + T4 (P = 0.04) were compared. In terms of grading, occult metastases were found in 16% of the G1 tumors, 27% of the G2, and 42% of the G3. The statistical analysis demonstrated a significant difference between G1 and G3. In brief, the incidence of occult metastases was higher for the less differentiated tumors and for the ones with a higher T value; the effects of both factors are combined thereby increasing the rate of occult metastases (P = 0.05).

A multicenter trial of specific local nasal immunotherapy

Objective: To assess the efficacy and safety of specific local nasal immunotherapy (LNIT) in powder form in patients with allergic rhinitis, using subjective and objective parameters.

CO2 Laser Treatment of Bilateral Vocal Cord Paralysis in Adduction

This study presents results obtained from 83 patients with bilateral vocal cord paralysis in adduction treated between 1982 to 2001, with CO2 laser microlaryngoscopy. In relation to the different types of surgery followed, three distinct treatment groups were included: group 1 (1982–1984) included 5 patients treated with vaporization of the vocal process of the arytenoid and the homolateral posterior third of the true vocal cord. Group 2 (1983–1990) contained 19 patients who were treated with arytenoidectomy and removal of the homolateral posterior half of the true vocal cord and group 3 (1990–2001), including 59 patients who were treated with arytenoidectomy and removal of the homolateral posterior half or two thirds of both the true and false vocal cord. Functional results were assessed by means of spirometry, spectrography and aerophonic examinations performed at 5, 90, 180, and 240 days postoperatively. The results show that removal of the posterior third of the true vocal cord and false vocal cord, combined with arytenoidectomy, is the surgical treatment of choice to resolve respiratory insufficiency in these patients.

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.