20 research outputs found
FACIAL PLASTIC SURGERY - THE ITALIAN APPROACH II
No full textGUEST EDITOR IN E. TARDY AND T.R. BULL (EDS
Il tutore endolaringeo nelle stenosi laringo-tracheali
No full textViene illustrato lL'impiego del tutore endolaringeo nelle stenosi laringo-tracheali
Le Stenosi laringo-tracheali nell'infanzia. Esperienza personale mediante trattamento chirurgico endoscopico
No full textViene dettagliata l'esperienza personale acqusisita nel trattamento chirurgico endoscopicodelle stenosi laringo-tracheali nell'infanzia
En-block removal of small to medium sized Acoustic Neuromas with Retrosigmoid transmeatal Approach
No full textAbstract
Surgery of acoustic neuroma (AN) has significantly refined over the past years due to a series of advances in diagnostics and surgical technique. Electrophysiologic investigation performed during surgery has greatly contributed to this progress, increasing the surgeon's understanding of the mechanism of damage and suggesting various changes in his or her surgical strategy.In this context, the advantages of the retrosigmoid "en-bloc" removal of small to medium size ANs have been examined in the present study. At the ENT Department of the University of Verona, 103 subjects with AN were operated on, from January 1990 to December 1995, with a retrosigmoid-transmeatal approach. Eighteen subjects (17.4%) presented pure a intracanalar (IC) tumor and 85 (82.6%) had both IC and extracanalar (EC) involvement. All the IC tumors (n = 18) and 70 of the IC-EC neuromas with an EC size less than 25 mm are reported in this paper for a total of 88 patients. The first 48 patients were operated on via the classic procedures described in the literature, characterized by removal of the tumor after "debulking" and limited exposure of the internal auditory canal (IAC). The following 40 subjects were operated on according to the technique of "en-bloc" removal of the tumor and wide exposure of the IAC.In the "en-bloc" group the tumor was first detached from the cerebellar flocculus and the pons, when necessary. The tumor was not debulked to preserve the anatomic relationship with the nerves and to facilitate identification, cleavage and dissection of the tumor from the neural structures. Thereafter, the posterior wall of the IAC was drilled out and opened in a circumferential range from 180 to 270 degrees . The IAC dura was subsequently opened, and the distal end of the AN along with the vestibular nerves were identified. The vestibular nerves were sectioned in the distal portion of the IAC and dissected with the tumor from the underlying facial and cochlear nerves. Dissection continued medially to the IAC porus. The AN was progressively dissected from the cochlear and facial nerves in the cerebellopontine angle (CPA) with multiple direction maneuvers, as required by the characteristics and degree of adherence to the neural structures.The anatomic and functional results obtained with this new procedure ("en-bloc" removal) were compared with the classic "debulking" technique. The statistical analysis shows an improvement in postoperative outcome for both auditory and facial nerve function. The "en-bloc" removal procedure along with the wide exposure of the content of the IAC and electrophysiologic monitoring of the seventh and eighth cranial nerves are, in our experience, the recommended strategies for improving outcomes in small to medium size ANs
ECochG, CNAP and ABR monitoring during vestibular Schwannoma surgery
No full textIdentification of the specific pathophysiological processes and correlation with post-operative hearing are the prerequisites for utilizing electrophysiological audiomonitoring techniques in preventing damage to auditory structures during vestibular Schwannoma (VS) surgery. The present paper compares the value of auditory brainstem responses (ABRs), electrocochleography (ECochG) and directly recorded cochlear nerve action potentials (CNAPs) in detecting damage to auditory structures during VS surgery and predicting postoperative hearing. Eighteen consecutive patients operated on for VS, in an attempt at hearing preservation, participated in the investigation. The ipsilateral hearing level (pure tone average (PTA) 0.5-3 kHz) ranged from 10 to 50 dB HL (mean: 30.7 dB HL), with a speech discrimination score equal to or better than 50 per cent. CNAPs furnished the highest predictive score for post-operative hearing. In particular, when a permanent loss of CNAPs occurred the sensitivity and specificity were 100 per cent. The discrepancies between the ECochG and CNAP findings were attributable to high prevalence of cochlear nerve damage, capable of 'disconnecting' the ear from the central auditory pathways, causing persistence of peripheral auditory function and no propagation of the neural input. ABR monitoring was highly sensitive in detecting auditory damage but its prognostic utility was marred by its poor specificity
Magnetic Resonance Imaging in Primary and Secondary Septorhinoplasty
No full textThe authors emphasize the importance of MRI as a means to functionally evaluate patients in primary (PR) and secondary (SR) rhinoseptoplasty. Forty-eight subjects were appraised who underwent various types of corrective nose surgery: 31 PR, 12 SR, 4 introgenic perforations, and 1 dermoid cyst of the nasal dorsum. MRI allows the nasal structures at the level of the valve to be visualized, as well as the medial and lateral walls of the nasal fossa in all of its components. MRI studies improve pre-surgical evaluation (alar cartilages, iaterdomal distance, and valvular configuration), and the exam of structures and anomalies which are hard to evaluate by the rhinoscopy (turbino-septal-synchias, perforations, losses of bone-cartilaginous substance). Moreover, through MRI the nasal respiratory surface (NRS) is determined and used by the authors to quantify the improvement of the postsurgical nasal respiratory function. All of these points gain importance during the planning of primary, secondary, and/or corrective surgery
Recent progress in instrumental rhinological diagnosis/ Recenti progressi della diagnostica rinologica strumentale
No full textVengono illustrati i più recenti progressi della diagnostica strumentale nella moderna rinologia
Utility and safety of parotid gland biopsy in Sjogren's syndrome
No full textParotid gland biopsy was performed in 32 female patients affected by suspected Sjogren's syndrome. In all cases histologic findings were in agreement with this diagnosis and in two subjects led us to detect the malignant transformation into lymphoma. None of the patients developed relevant complications. Our study indicates that parotid gland biopsy in Sjogren's syndrome is a safe procedure and may be useful in performing diagnosis
Mucosa-associated lymphoid tissue (MALT) lymphoma of the salivary glands occurring in patients affected by Sjogren’s syndrome. Report of 6 cases
No full text
