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Capaccio P, Lazzeroni M, Lo Russo F, Torretta S, Di Pasquale D, Conte G, Firetto MC, Nicolino G, Gaffuri M, Carrafiello G. MR sialographic assessment of the masseter muscle and the ductal kinking in patients with recurrent parotitis. Radiol Med 2024:10.1007/s11547-024-01802-1. [PMID: 38512620 DOI: 10.1007/s11547-024-01802-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 02/15/2024] [Indexed: 03/23/2024]
Abstract
Dysfunction of the masseter muscle may cause pathological kinking of the parotid duct leading to parotitis; MR sialography is a non-invasive radiological examination that allows to evaluate dynamically the ductal system of the parotid glands. In the present study we aimed to assess the relationships between Stensen's duct and masseter muscle and their implications in the aetiopathogenesis of recurrent parotitis secondary to masseter muscle dysfunction. Forty-one patients with recurrent unilateral parotitis and nine with bilateral recurrent parotitis, all with a clinical suspicious of masseter muscle hypertrophy due to bruxism were enrolled. They underwent ultrasonography as a first line examination and then MR sialography and sialendoscopy. Different anatomical features were studied. Involved parotid glands had a wider duct compared to contralateral unaffected parotid glands of patients with recurrent parotitis (p = 0.00134); male subjects with parotitis had a longer duct compared to the salivary glands of healthy patients (p = 0.00943 for affected glands and p = 0.00629 for the contralateral). A concordance between the evidence of an acute duct angle during sialendoscopy and a wider duct in patients with parotitis was observed although not statistically significant. These initial findings suggest that the masticatory muscle dysfunction related to bruxism seems to condition alteration of parotid duct course and anatomy thus favouring the occurrence of recurrent parotitis. A specific diagnostic iter based on clinical evaluation, dynamic ultrasonography and MR sialography, is therefore, mandatory to confirm the relationship between masseter muscle anatomy and parotid duct anomalies; this is the premise for an adequate therapeutic approach to underlying masticatory muscle disorder.
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Affiliation(s)
- Pasquale Capaccio
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Matteo Lazzeroni
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy.
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
| | - Francesco Lo Russo
- Neuroradiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sara Torretta
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Daniele Di Pasquale
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Giorgio Conte
- Neuroradiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Cristina Firetto
- Operative Unit of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Di Milano, 20122, Milan, Italy
| | - Gabriele Nicolino
- Breast Unit, Fondazione IRCCS San Gerardo Dei Tintori, Via G. B. Pergolesi 33, Monza, Italy
| | - Michele Gaffuri
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Gianpaolo Carrafiello
- Operative Unit of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Di Milano, 20122, Milan, Italy
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Gaffuri M, Battilocchi L, Neri S, Fraccaroli F, Tosini D, Gaini LM, Cantarella G, Pignataro L. 3D-4K Exoscope-Assisted CO 2 Laser Supraglottoplasty for Severe Laryngomalacia in a Pediatric Patient. Laryngoscope 2024; 134:1359-1362. [PMID: 37610287 DOI: 10.1002/lary.30972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/01/2023] [Accepted: 07/24/2023] [Indexed: 08/24/2023]
Abstract
Laryngomalacia is the most frequent congenital laryngeal anomaly. Surgery is possible by means of cold knife, carbon dioxide (CO2 ) laser, microdebrider and coblation, traditionally under microscopic view. We here describe the use of the 3D-4K exoscope assisted CO2 laser supraglottoplasty in tubeless general anesthesia in spontaneous breathing in a 5 month-old patient with severe laryngomalacia. Laryngoscope, 134:1359-1362, 2024.
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Affiliation(s)
- Michele Gaffuri
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Ludovica Battilocchi
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Simona Neri
- Unit of Pediatric Anesthesiology and Intensive Care, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesca Fraccaroli
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Davide Tosini
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Lorenzo Maria Gaini
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanna Cantarella
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Lorenzo Pignataro
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Gaffuri M, di Lullo AM, Trecca EMC, Russo G, Molinari G, Russo FY, Albera A, Mannelli G, Ralli M, Turri-Zanoni M. High-Definition 3D Exoscope in Pediatric Otorhinolaryngology: A Systematic Literature Review. J Clin Med 2023; 12:6528. [PMID: 37892666 PMCID: PMC10607561 DOI: 10.3390/jcm12206528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 10/03/2023] [Accepted: 10/07/2023] [Indexed: 10/29/2023] Open
Abstract
This PRISMA-compliant systematic review aimed to investigate the use of and the most common procedures performed with the novel 3D 4K exoscope in surgical pediatric head and neck settings. METHODS Search criteria were applied to PubMed, EMBASE and the Cochrane Review databases and included all studies published up to January 2023 reporting 3D 4K exoscope-assisted surgeries in pediatric patients. After the removal of duplicates, selection of abstracts and full-text articles, and quality assessment, we reviewed eligible articles for number of patients treated, age, surgical procedures, and outcomes. RESULTS Among 54 potentially relevant records, 5 studies were considered eligible and included in this systematic review, with reported treatment data for 182 patients. The surgical procedures belong to the otologic field (121 cases), head and neck surgery (25 cases) and transoral surgery (36 cases). Exoscopy allowed high quality visualization of anatomical structures during cochlear implantation and during reconstruction in head and neck surgery; moreover, it improved the surgical view of surgeons, spectators and ENT students. CONCLUSIONS The use of 3D 4K exoscopy has shown promising potential as a valuable tool in pediatric ORL-head and neck surgery; nevertheless, further validation of these encouraging outcomes is necessary through larger-scale studies specifically focused on pediatric patients.
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Affiliation(s)
- Michele Gaffuri
- Research Group of Pediatric Otorhinolaryngology of the Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery, Italy
- Department of Otolaryngology—Head and Neck Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Antonella Miriam di Lullo
- Research Group of Pediatric Otorhinolaryngology of the Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery, Italy
- Division of Otolaryngology-Head and Neck Surgery, Department of Neuroscience, Reproductive and Odontostomatologic Sciences, University of Naples Federico II, Pansini Street n.5, 80131 Naples, Italy
- CEINGE—Advanced Biotechnology, Salvatore G. Street n.486, 80131 Naples, Italy
| | - Eleonora M. C. Trecca
- Research Group of Pediatric Otorhinolaryngology of the Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery, Italy
- Department of Maxillofacial Surgery and Otolaryngology, IRCCS Research Hospital Casa Sollievo della Sofferenza, San Giovanni Rotondo, 71013 Foggia, Italy
- Department of Otolaryngology, University Hospital of Foggia, 71100 Foggia, Italy
| | - Gennaro Russo
- Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery, Italy
- Otolaryngology Unit, AORN dei Colli, V. Monaldi Hospital, 80131 Napoli, Italy
| | - Giulia Molinari
- Research Group of Pediatric Otorhinolaryngology of the Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery, Italy
- Department of Otolaryngology—Head and Neck Surgery, IRCCS Azienda Ospedaliero—Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum—Università di Bologna, 40138 Bologna, Italy
| | - Francesca Yoshie Russo
- Research Group of Pediatric Otorhinolaryngology of the Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery, Italy
- Department of Sense Organs, ENT Department, Sapienza University of Rome, 00185 Rome, Italy
| | - Andrea Albera
- Research Group of Pediatric Otorhinolaryngology of the Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery, Italy
- Department of Surgical Sciences, University of Turin, 10124 Turin, Italy
| | - Giuditta Mannelli
- Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery, Italy
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Firenze, Italy
| | - Massimo Ralli
- Research Group of Pediatric Otorhinolaryngology of the Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery, Italy
- Department of Sense Organs, ENT Department, Sapienza University of Rome, 00185 Rome, Italy
| | - Mario Turri-Zanoni
- Research Group of Pediatric Otorhinolaryngology of the Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery, Italy
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, 21100 Varese, Italy
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Gaffuri M, Battilocchi L, Pignataro L, Capaccio P. Image-guided and sialendoscopy-assisted transoral approach for parotid duct stenosis and megaduct. J Laryngol Otol 2023:1-3. [PMID: 37807900 DOI: 10.1017/s0022215123001731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
OBJECTIVE The aim of this communication was to introduce a novel combined image (magnetic resonance and computed tomography-guided and sialendoscopy-assisted transoral approach for the treatment of a parotid duct stenosis with megaduct. METHODS A 46-year-old woman was referred to our department for recurrent infections of the right parotid gland following unsuccessful multiple transoral surgical approaches for a Stensen's duct stricture with megaduct. An image (magnetic resonance and computed tomography)-guided and sialendoscopy-assisted transoral sialodochoplasty was planned and performed. RESULTS No complications occurred. The patient was discharged 2 days after surgery. No more swelling or infections occurred. The patient is currently symptom-free after a follow up of 11 months. CONCLUSION Although imaging navigation means more technical effort and costs, this novel approach can be considered a viable surgical opportunity for distal and mid-third parotid duct stenosis with concomitant megaduct, particularly in cases of persistent inflammation or iatrogenic scars due to previous surgery.
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Affiliation(s)
- Michele Gaffuri
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Ludovica Battilocchi
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Lorenzo Pignataro
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Pasquale Capaccio
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
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Trecca EM, Gaffuri M, Molinari G, Russo FY, Turri-Zanoni M, Albera A, Miriam di Lullo A, Russo G, Mannelli G, Ralli M. Impact of the COVID-19 pandemic on paediatric otolaryngology: a nationwide study. Acta Otorhinolaryngol Ital 2023; 43:352-359. [PMID: 37519138 PMCID: PMC10551727 DOI: 10.14639/0392-100x-n2452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 04/10/2023] [Indexed: 08/01/2023]
Abstract
Objective The COVID-19 pandemic profoundly modified the work routine in healthcare; however, its impact on the field of paediatric otorhinolaryngology (ORL) has been rarely investigated. The aim of this study was to assess the impact of COVID-19 on paediatric ORL. Methods A questionnaire was developed by the Young Otolaryngologists of the Italian Society of ORL-Head and Neck Surgery (GOS). The questionnaire consisted of 26 questions related to workplace and personal paediatric ORL activities. The link was advertised on the official social media platforms and sent by e-mail to 469 Italian otolaryngologists. Results The questionnaire was completed by 118 responders. During the pandemic, the main reduction was observed for surgical activity (78.8%), followed by outpatient service (16.9%). The conditions that were mostly impacted by a delayed diagnosis were respiratory infections in 45.8% of cases and sensorineural hearing loss in 37.3% of cases. Conclusions Paediatric ORL was highly impacted by the COVID-19 pandemic, with a significant reduction of surgical and outpatient activities and a delay in time-sensitive diagnosis. Therefore, the implementation of new strategies, such as telemedicine, is recommended.
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Affiliation(s)
- Eleonora M.C. Trecca
- Correspondence Eleonora Maria Consiglia Trecca IRCCS Casa Sollievo della Sofferenza, Department of Maxillofacial Surgery and Otolaryngology, viale Cappuccini 1, 71013 San Giovanni Rotondo (FG), Italy E-mail:
| | - Michele Gaffuri
- Research group of Pediatric Otorhinolaryngology of the Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giulia Molinari
- Research group of Pediatric Otorhinolaryngology of the Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery
- Department of Otolaryngology-Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
- Department of Experimental Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Francesca Yoshie Russo
- Research group of Pediatric Otorhinolaryngology of the Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery
- Department of Sense Organs, ENT Department, Sapienza University of Rome, Rome, Italy
| | - Mario Turri-Zanoni
- Research group of Pediatric Otorhinolaryngology of the Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Andrea Albera
- Research group of Pediatric Otorhinolaryngology of the Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Antonella Miriam di Lullo
- Research group of Pediatric Otorhinolaryngology of the Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery
- ENT Unit- Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Gennaro Russo
- Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery
- Otolaryngology Unit, AORN dei Colli, V. Monaldi Hospital, Napoli, Italy
| | - Giuditta Mannelli
- Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Massimo Ralli
- Research group of Pediatric Otorhinolaryngology of the Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology-Head and Neck Surgery
- Department of Sense Organs, ENT Department, Sapienza University of Rome, Rome, Italy
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Gaini LM, Battilocchi L, Conte G, Gaffuri M, Zanetti D, Pignataro L, Torretta S. Bilateral Sensorineural Hearing Loss Related to a Skull Base Spontaneous Cerebrospinal Fluid Leak: A Case Report and Literature Review. Ear Nose Throat J 2023:1455613231191372. [PMID: 37551677 DOI: 10.1177/01455613231191372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023] Open
Abstract
Spontaneous intracranial hypotension (SIH) is a rare condition characterized by orthostatic headache, pulsatile tinnitus, vertigo, nausea, and fluctuating hearing loss; this latter seems to be due to the development of cochlear endolymphatic hydrops following negative cerebrospinal fluid (CSF) pressure transmitted to the perilymphatic space through a patent cochlear aqueduct. We here describe a case of bilateral progressive sensorineural hearing loss (SNHL) due to intracranial hypotension caused by an undiagnosed spontaneous CSF leak from a skull base defect in a middle-aged woman. To the best of our knowledge, this is the first report describing a SNHL in a patient affected by SIH secondary to sphenoidal CSF leak.
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Affiliation(s)
- Lorenzo Maria Gaini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Otolaryngology and Head and Neck Surgery, Milan, Italy
| | - Ludovica Battilocchi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Otolaryngology and Head and Neck Surgery, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giorgio Conte
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neuroradiology Unit, Milan, Italy
- University of Milan, Department of Medical-Surgical Physiopathology and Transplantation, Milan, Italy
| | - Michele Gaffuri
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Otolaryngology and Head and Neck Surgery, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Diego Zanetti
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Audiology Unit, Milan, Italy
| | - Lorenzo Pignataro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Otolaryngology and Head and Neck Surgery, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Sara Torretta
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Otolaryngology and Head and Neck Surgery, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Saibene AM, Rosso C, Felisati G, Pignataro L, Schindler A, Ghilardi G, Colletti G, Gaffuri M, Mozzanica F. Sirolimus treatment for paediatric head and neck lymphatic malformations: a systematic review. Eur Arch Otorhinolaryngol 2023; 280:3529-3540. [PMID: 37115326 PMCID: PMC10313583 DOI: 10.1007/s00405-023-07991-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023]
Abstract
PURPOSE This PRISMA-compliant systematic review aimed to assess risks and benefits of sirolimus treatment for paediatric lymphatic malformations by focusing not only on treatment efficacy but also on possible treatment-related adverse events, and treatment combinations with other techniques. METHODS Search criteria were applied to MEDLINE, Embase, Web of Science, Scopus, Cochrane Library, and ClinicalTrials.gov databases and included all studies published up to March 2022 reporting paediatric lymphatic malformations treated with sirolimus. We selected all original studies that included treatment outcomes. After the removal of duplicates, selection of abstracts and full-text articles, and quality assessment, we reviewed eligible articles for patient demographics, lymphatic malformation type, size or stage, site, clinical response rates, sirolimus administration route and dose, related adverse events, follow-up time, and concurrent treatments. RESULTS Among 153 unique citations, 19 studies were considered eligible, with reported treatment data for 97 paediatric patients. Most studies (n = 9) were case reports. Clinical response was described for 89 patients, in whom 94 mild-to-moderate adverse events were reported. The most frequently administered treatment regimen was oral sirolimus 0.8 mg/m2 twice a day, with the aim of achieving a blood concentration of 10-15 ng/mL. CONCLUSION Despite promising results for sirolimus treatment in lymphatic malformation, the efficacy and safety profile of remains unclear due to the lack of high-quality studies. Systematic reporting of known side effects, especially in younger children, should assist clinicians in minimising treatment-associated risks. At the same time, we advocate for prospective multicentre studies with minimum reporting standards to facilitate improved candidate selection.
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Affiliation(s)
- Alberto Maria Saibene
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università Degli Studi di Milano, Via Antonio di Rudinì, 8, 20142, Milan, Italy.
| | - Cecilia Rosso
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università Degli Studi di Milano, Via Antonio di Rudinì, 8, 20142, Milan, Italy
| | - Giovanni Felisati
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università Degli Studi di Milano, Via Antonio di Rudinì, 8, 20142, Milan, Italy
| | - Lorenzo Pignataro
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università Degli Studi di Milano, Milan, Italy
| | - Antonio Schindler
- Department of Biomedical and Clinical Sciences, Università Degli Studi di Milano, Milan, Italy
| | - Giorgio Ghilardi
- Clinica Chirurgica Generale, Department of Health Sciences, Università Degli Studi di Milano, Milan, Italy
| | - Giacomo Colletti
- Cranio Maxillo Facial Surgery, Università Degli Studi di Modena e Reggio Emilia, Modena, Italy
| | - Michele Gaffuri
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università Degli Studi di Milano, Milan, Italy
| | - Francesco Mozzanica
- Department of Clinical Sciences and Community Health, San Giuseppe Hospital, Università Degli Studi di Milano, Milan, Italy
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Fraccaroli F, Tosini D, Lerario G, Battilocchi L, D'Onghia A, Cantarella G, Pignataro L, Neri S, Gaffuri M. A misdiagnosed laryngeal foreign body causing recurrent wheezing in a pediatric patient: Case report. Clin Case Rep 2023; 11:e7476. [PMID: 37397573 PMCID: PMC10307997 DOI: 10.1002/ccr3.7476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 04/07/2023] [Indexed: 07/04/2023] Open
Abstract
Key clinical message The recurrence of respiratory symptoms without a clear clinical reason in children can be secondary to the presence of an unknown foreign body of the airways. In such cases, endoscopy of the airways is always necessary, regardless of the patient's age. Abstract The management of foreign bodies of the pediatric airway can be challenging. The clinical presentation may vary and, in case of recurrent respiratory symptoms without a clear clinical cause, the presence of a foreign body of the airway should be suspected. We describe the case of a 13-month-old patient, weight 11 kg, with a misdiagnosed subglottic foreign body causing dysphonia and worsening respiratory distress, removed by means of a direct laryngotracheoscopy in tubeless general anesthesia in spontaneous breathing.
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Affiliation(s)
- Francesca Fraccaroli
- Department of Otolaryngology and Head and Neck SurgeryFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
- Department of Clinical Sciences and Community HealthUniversità degli Studi di MilanoMilanItaly
| | - Davide Tosini
- Department of Otolaryngology and Head and Neck SurgeryFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
- Department of Clinical Sciences and Community HealthUniversità degli Studi di MilanoMilanItaly
| | - Giorgia Lerario
- Department of Otolaryngology and Head and Neck SurgeryFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
- Department of Clinical Sciences and Community HealthUniversità degli Studi di MilanoMilanItaly
| | - Ludovica Battilocchi
- Department of Otolaryngology and Head and Neck SurgeryFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
- Department of Clinical Sciences and Community HealthUniversità degli Studi di MilanoMilanItaly
| | - Alessandra D'Onghia
- Department of Otolaryngology and Head and Neck SurgeryFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Giovanna Cantarella
- Department of Otolaryngology and Head and Neck SurgeryFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
- Department of Clinical Sciences and Community HealthUniversità degli Studi di MilanoMilanItaly
| | - Lorenzo Pignataro
- Department of Otolaryngology and Head and Neck SurgeryFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
- Department of Clinical Sciences and Community HealthUniversità degli Studi di MilanoMilanItaly
| | - Simona Neri
- Unit of Paediatric Anaesthesiology and Intensive CareFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Michele Gaffuri
- Department of Otolaryngology and Head and Neck SurgeryFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
- Department of Clinical Sciences and Community HealthUniversità degli Studi di MilanoMilanItaly
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9
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Capaccio P, Gaffuri M, Canzi P, Pignataro L. Recurrent obstructive salivary disease after sialendoscopy. A narrative literature review. Acta Otorhinolaryngol Ital 2023; 43:S95-S102. [PMID: 37698106 PMCID: PMC10159639 DOI: 10.14639/0392-100x-suppl.1-43-2023-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/12/2023] [Indexed: 09/13/2023]
Abstract
Over the last 20 years, interventional sialendoscopy has become the therapy of choice for the management of obstructive salivary disorders, favouring a significant reduction in the number of patients undergoing traditional sialadenectomy. The overall success rate of sialendoscopy is around 90% as reported by the largest case series published; recurrence is expected in about 10% of cases, and the patient should be informed about the possibility to undergo further conservative procedures to improve symptoms. Adequate pre-operative assessment, based on ultrasonography, cone beam 3D CT and MR-sialography, is mandatory to reduce the risk of unsuccessful procedures and, therefore, recurrence of obstructive sialadenitis; moreover, in case of recurrence, the surgeon should be experienced enough to manage these cases and be able to perform additional interventions, such as transoral/transfacial sialendoscopy-assisted procedures and imaging-assisted procedures in case of difficult anatomical situations. Botulinum toxin injection and traditional sialadenectomy would be considered as possible salvage treatments in case of failure of all conservative approaches.
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Affiliation(s)
- Pasquale Capaccio
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Italy
| | - Michele Gaffuri
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Pietro Canzi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Lorenzo Pignataro
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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10
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Gaffuri M, Battilocchi L, di Furia D, Neri S, Cantarella G, Pignataro L. Endoscopic surgery under tubeless anesthesia and spontaneous breathing for a congenital laryngeal web in an infant: A case report. Congenit Anom (Kyoto) 2023; 63:83-86. [PMID: 36916226 DOI: 10.1111/cga.12511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/20/2023] [Accepted: 02/28/2023] [Indexed: 03/16/2023]
Abstract
Congenital laryngeal webs are rare and are defined as thick epithelium-covered fibrous tissue lying between the vocal folds; the anterior glottis is the most common site of involvement, with possible extension to the subglottic region. The association with chromosome 22q11.2 deletion syndrome has also been reported. Symptoms have been abnormal or absent crying and airway obstruction since birth. Management strategies range from endoscopic division using cold instruments to open surgery for severe webbing. In endoscopic surgery, the need for tubeless anesthesia and spontaneous breathing is fundamental for obtaining the best surgical outcome. Here, we describe the case of a 4-month-old female patient affected by a type II glottic web according to Cohen, who was treated by simple endoscopic division in spontaneous breathing.
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Affiliation(s)
- Michele Gaffuri
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Ludovica Battilocchi
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Domenico di Furia
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Simona Neri
- Unit of Pediatric Anesthesiology and Intensive Care, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanna Cantarella
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Lorenzo Pignataro
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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11
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Gaffuri M, Capaccio P, Torretta S, Daga M, Zuccotti GV, Pignataro L. An Unusual Retained Choanal Foreign Body: A Possible Complication of COVID-19 Testing With Nasopharyngeal Swab. Ear Nose Throat J 2023; 102:NP136-NP139. [PMID: 33634718 DOI: 10.1177/0145561321993933] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Testing for coronavirus disease 2019 is critical in controlling the pandemic all over the world. Diagnosis of severe acute respiratory syndrome coronavirus-2 infection is based on real-time polymerase chain reaction performed on nasopharyngeal swab. If not adequately performed, the viral specimen collection can be painful and lead to complications. We present a complication occurred during a nasopharyngeal swab collection performed in a noncooperative patient where the plastic shaft of the swab fractured during the procedure, resulting in swab tip retention deep into the nasal cavity. The foreign body was found endoscopically, stuck between the nasal septum and the superior turbinate tail at the upper level of the left choana and removed under general anesthesia in a negative pressure operating room with the health care personnel wearing personal protective equipment. Unpleasant complications like the one described can happen when the swab is collected without the necessary knowledge of nasal anatomy or conducted inappropriately, especially in noncooperative patients. Moreover, the design of currently used viral swabs may expose to accidental rupture, with risk of foreign body retention in the nasal cavities. In such cases, diagnosis and treatment are endoscopy-guided procedures performed in an adequate setting to minimize the risk of spreading of the pandemic.
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Affiliation(s)
- Michele Gaffuri
- 9339Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Otolaryngology and Head and Neck Surgery, Milan, Italy.,Department of Clinical Sciences and Community Health, 9304University of Milan, Italy
| | - Pasquale Capaccio
- 9339Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Otolaryngology and Head and Neck Surgery, Milan, Italy.,Department of Biomedical, Surgical and Dental Sciences, 9304University of Milan, Italy
| | - Sara Torretta
- 9339Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Otolaryngology and Head and Neck Surgery, Milan, Italy.,Department of Clinical Sciences and Community Health, 9304University of Milan, Italy
| | - Marco Daga
- 9339Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Otolaryngology and Head and Neck Surgery, Milan, Italy.,Department of Clinical Sciences and Community Health, 9304University of Milan, Italy
| | - Gian Vincenzo Zuccotti
- Department of Biomedical and Clinical Sciences Luigi Sacco, 9304University of Milan, Italy
| | - Lorenzo Pignataro
- 9339Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Otolaryngology and Head and Neck Surgery, Milan, Italy.,Department of Clinical Sciences and Community Health, 9304University of Milan, Italy
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12
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Gaffuri M, di Furia D, Battilocchi L, Torretta S, Accorona R, Pignataro L. Unilateral silent sinus syndrome: A case report. Clin Case Rep 2022; 10:e05794. [PMID: 35756393 PMCID: PMC9201464 DOI: 10.1002/ccr3.5794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/23/2022] [Indexed: 11/09/2022] Open
Abstract
Silent sinus syndrome (SSS) is a rare clinical condition, commonly unilateral, secondary to the obstruction of the osteomeatal complex, subsequent negative pressure in the maxillary sinus, and collapse of the orbit floor and sinus walls. We describe a case of unilateral SSS treated by means of functional endoscopic sinus surgery.
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Affiliation(s)
- Michele Gaffuri
- Department of Otolaryngology and Head and Neck Surgery Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milan Italy
- Department of Clinical Sciences and Community Health Università degli Studi di Milano Milan Italy
| | - Domenico di Furia
- Department of Otolaryngology and Head and Neck Surgery Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milan Italy
- Department of Clinical Sciences and Community Health Università degli Studi di Milano Milan Italy
| | - Ludovica Battilocchi
- Department of Otolaryngology and Head and Neck Surgery Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milan Italy
- Department of Clinical Sciences and Community Health Università degli Studi di Milano Milan Italy
| | - Sara Torretta
- Department of Otolaryngology and Head and Neck Surgery Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milan Italy
- Department of Clinical Sciences and Community Health Università degli Studi di Milano Milan Italy
| | - Remo Accorona
- Department of Otolaryngology and Head and Neck Surgery Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milan Italy
| | - Lorenzo Pignataro
- Department of Otolaryngology and Head and Neck Surgery Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milan Italy
- Department of Clinical Sciences and Community Health Università degli Studi di Milano Milan Italy
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13
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Capaccio P, Riva G, Cammarota R, Gaffuri M, Pecorari G. Minimally invasive transoral robotic surgery for hiloparenchymal submandibular stone: Technical note on Flex Robotic System. Clin Case Rep 2022; 10:e04529. [PMID: 35106157 PMCID: PMC8784954 DOI: 10.1002/ccr3.4529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/14/2021] [Indexed: 12/11/2022] Open
Abstract
Flex Robotic System allows a minimally invasive approach for transoral removal of submandibular salivary stones.
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Affiliation(s)
- Pasquale Capaccio
- Otorhinolaryngology UnitDepartment of Biomedical, Surgical and Dental SciencesUniversity of MilanFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Giuseppe Riva
- Otorhinolaryngology UnitDepartment of Surgical SciencesUniversity of TurinTurinItaly
| | - Raffaella Cammarota
- Otorhinolaryngology UnitDepartment of Surgical SciencesUniversity of TurinTurinItaly
| | - Michele Gaffuri
- Otorhinolaryngology UnitDepartment of Biomedical, Surgical and Dental SciencesFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Giancarlo Pecorari
- Otorhinolaryngology UnitDepartment of Surgical SciencesUniversity of TurinTurinItaly
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14
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di Furia D, Pignataro L, Gaffuri M, Osnaghi SG, Battilocchi L, Cantarella G. Surgical treatment of a congenital dacryocystocele by means of microdebrider marsupialization in a newborn. Clin Case Rep 2021; 9:e04886. [PMID: 34987806 PMCID: PMC8696236 DOI: 10.1002/ccr3.4886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 11/10/2022] Open
Abstract
Congenital dacryocystocele is a rare clinical condition, more commonly unilateral, secondary to the defective canalization of the nasolacrimal duct. In case of failure of conservative treatment, surgical marsupialization is recommended. We describe the case of a 40-day-old male newborn treated by means of microdebrider marsupialization.
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Affiliation(s)
- Domenico di Furia
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoDepartment of Otolaryngology and Head and Neck SurgeryMilanItaly
- Università degli Studi di MilanoDepartment of Clinical Sciences and Community HealthMilanItaly
| | - Lorenzo Pignataro
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoDepartment of Otolaryngology and Head and Neck SurgeryMilanItaly
- Università degli Studi di MilanoDepartment of Clinical Sciences and Community HealthMilanItaly
| | - Michele Gaffuri
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoDepartment of Otolaryngology and Head and Neck SurgeryMilanItaly
- Università degli Studi di MilanoDepartment of Clinical Sciences and Community HealthMilanItaly
| | | | - Ludovica Battilocchi
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoDepartment of Otolaryngology and Head and Neck SurgeryMilanItaly
- Università degli Studi di MilanoDepartment of Clinical Sciences and Community HealthMilanItaly
| | - Giovanna Cantarella
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoDepartment of Otolaryngology and Head and Neck SurgeryMilanItaly
- Università degli Studi di MilanoDepartment of Clinical Sciences and Community HealthMilanItaly
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15
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Cantarella G, Gaffuri M, Torretta S, Neri S, Ambrosini MT, D'Onghia A, Pignataro L, Sandu K. Outcomes of balloon dilation for paediatric laryngeal stenosis. ACTA ACUST UNITED AC 2021; 40:360-367. [PMID: 33299226 PMCID: PMC7726638 DOI: 10.14639/0392-100x-n0830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/28/2020] [Indexed: 02/02/2023]
Abstract
Objective Balloon dilation (BD) is a minimally invasive endoscopic treatment for paediatric laryngeal stenosis (LS) with reduced morbidity compared to open surgery. We retrospectively describe our experience in a cohort of children with chronic LS. Methods Fourteen children (median age: 28.5; range: 2-81 months) with chronic LS (multilevel in 8) were treated with tubeless total intravenous anaesthesia under spontaneous ventilation. Results Grade III LS was preoperatively detected in 12 children; the remaining 2 had grade IV stenosis. Six had prior tracheotomy, and one received it during the first intervention. Dilation laryngoplasty was the primary treatment in 11 children and was used as an adjuvant treatment in 3 after open reconstructive surgery. The median number of dilations was 2 (range: 1-6). There were no postoperative complications. At the end of the follow-up (median: 20.5; range: 2-46 months), detectable laryngeal lumen widening and/or respiratory improvement occurred in 12 children. Two of 7 patients with tracheostomy were decannulated. Conclusions Balloon laryngoplasty is a valuable therapeutic option to improve laryngeal patency in children with chronic multilevel LS, both as a primary and secondary adjuvant treatment after reconstructive surgery.
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Affiliation(s)
- Giovanna Cantarella
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Otolaryngology and Head and Neck Surgery, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Michele Gaffuri
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Sara Torretta
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Otolaryngology and Head and Neck Surgery, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Simona Neri
- Unit of Pediatric Anesthesiology and Intensive Care, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Teresa Ambrosini
- Unit of Pediatric Anesthesiology and Intensive Care, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandra D'Onghia
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Otolaryngology and Head and Neck Surgery, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Lorenzo Pignataro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Otolaryngology and Head and Neck Surgery, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Kishore Sandu
- Airway Sector; Department of Otolaryngology, Lausanne University Hospital CHUV, Switzerland
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16
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Gaffuri M, Libonati A, Ettori J, Torretta S, Pignataro L, Capaccio P. COVID-19 isolation drape for sialendoscopy-assisted transfacial approach to parotid gland. Clin Case Rep 2021; 9:e04197. [PMID: 34322234 PMCID: PMC8296138 DOI: 10.1002/ccr3.4197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 04/02/2021] [Indexed: 11/22/2022] Open
Abstract
Surgical procedures requiring close contact with saliva, such as salivary gland surgery, may determine the risk of spreading the SARS-CoV-2 infection. The use of PPE and isolation settings are mandatory to protect health workers.
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Affiliation(s)
- Michele Gaffuri
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoDepartment of Otolaryngology and Head and Neck SurgeryMilanItaly
- Università degli Studi di MilanoDepartment of Clinical Sciences and Community HealthMilanItaly
| | - Antonio Libonati
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoDepartment of Otolaryngology and Head and Neck SurgeryMilanItaly
- Università degli Studi di MilanoDepartment of Clinical Sciences and Community HealthMilanItaly
| | - Jacopo Ettori
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoDepartment of Otolaryngology and Head and Neck SurgeryMilanItaly
- Università degli Studi di MilanoDepartment of Clinical Sciences and Community HealthMilanItaly
| | - Sara Torretta
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoDepartment of Otolaryngology and Head and Neck SurgeryMilanItaly
- Università degli Studi di MilanoDepartment of Clinical Sciences and Community HealthMilanItaly
| | - Lorenzo Pignataro
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoDepartment of Otolaryngology and Head and Neck SurgeryMilanItaly
- Università degli Studi di MilanoDepartment of Clinical Sciences and Community HealthMilanItaly
| | - Pasquale Capaccio
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoDepartment of Otolaryngology and Head and Neck SurgeryMilanItaly
- Università degli Studi di MilanoDepartment of Biomedical, Surgical and Dental SciencesMilanItaly
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17
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Folino F, Fattizzo M, Ruggiero L, Oriano M, Aliberti S, Blasi F, Gaffuri M, Marchisio P, Torretta S. Nasopharyngeal Microbiota Analysis in Healthy and Otitis-prone Children: Focus on History of Spontaneous Tympanic Membrane Perforation. Pediatr Infect Dis J 2021; 40:16-21. [PMID: 33055502 DOI: 10.1097/inf.0000000000002895] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Recurrent acute otitis media (RAOM) is common in children, and it may result in spontaneous tympanic membrane perforation (STMP), management of which is often challenging. In the upper respiratory tract (URT), resident microorganisms play a pivotal role in otitis media pathogenesis and prevention, as they are able to inhibit the colonization process and otopathogens growth. In particular, Dolosigranulum spp. and Corynebacterium spp. have been associated with respiratory health in several studies. This study aims at comparing both nasopharyngeal microbiota of children with RAOM versus matched controls and nasopharyngeal microbiota of children with a history of RAOM with STMP. METHOD Nasopharyngeal swabs were collected from 132 children, median age 3.51 (2.13-4.72), including 36 healthy children, 50 with RAOM without STMP, and 46 with RAOM with STMP. Bacterial DNA was subsequently extracted and 16S rRNA gene V3-V4 regions were polymerase chain reaction amplified and sequenced using Illumina MiSeq technology. RESULTS A higher relative abundance of Dolosigranulum and Corynebacterium genera was detected in the nasopharynx of healthy children (16.5% and 9.3%, respectively) in comparison with RAOM without STMP (8.9% and 4.3%, respectively) and RAOM with STMP (5.2% and 2.8%, respectively). A decreasing pattern in relative abundance of these 2 pivotal genera through disease severity was detected. In all groups, the most abundant genera were Moraxella, Streptococcus and Haemophilus, followed by Dolosigranulum and Corynebacterium. CONCLUSIONS Our study provides a characterization of the URT microbiota in otitis-prone children with and without history of recurrent STMP, suggesting that the role of Dolosigranulum and Corynebacterium in regulating the healthy URT microbiota should be further studied.
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Affiliation(s)
- Francesco Folino
- From the Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Miriam Fattizzo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pediatrics, ASST Sette Laghi, Del Ponte Hospital, Varese, Italy
| | - Luca Ruggiero
- From the Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Martina Oriano
- From the Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Stefano Aliberti
- From the Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Blasi
- From the Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Michele Gaffuri
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Marchisio
- From the Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sara Torretta
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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18
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Torretta S, Capaccio P, Gaffuri M, Gaini LM, Borin M, Maruca A, Battilocchi L, Nitro L, Marchisio P, Pignataro L. ENT management of children with adenotonsillar disease during COVID-19 pandemic. Ready to start again? Int J Pediatr Otorhinolaryngol 2020; 138:110145. [PMID: 32499073 PMCID: PMC7253984 DOI: 10.1016/j.ijporl.2020.110145] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 05/25/2020] [Accepted: 05/25/2020] [Indexed: 01/29/2023]
Abstract
Clinical manifestations of COVID-19 in children are milder, but the real burden of disease is unknown. After the lockdown, in our Region Lombardia we have been requested to progressively resume medical services including outpatient assessment and priority surgery. Therefore, we screened surgical waiting lists with identification of 47 children candidates to priority surgery (among 358). No homogeneous national health surveillance/screening programs are ongoing or have been conceived to test susceptible population among children/healthcare workers in preparation of coming down to routinely daily activities, and diagnostic strategies are not completely accurate in children. So, restoring medical services now might be untimely.
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Affiliation(s)
- Sara Torretta
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
| | - Pasquale Capaccio
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Biomedical Surgical Dental Science, University of Milan, Milan, Italy
| | - Michele Gaffuri
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lorenzo Maria Gaini
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Borin
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Antonella Maruca
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Ludovica Battilocchi
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Letizia Nitro
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Paola Marchisio
- Pediatric Highly Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Lorenzo Pignataro
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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19
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Torretta S, Gaini LM, Gaffuri M, Pignataro L, Accorona R, Capaccio P. Looking at the day after COVID-19… what laryngeal sequelae should we expect? Acta Otorhinolaryngol Ital 2020; 40:466-468. [PMID: 32970048 PMCID: PMC7889259 DOI: 10.14639/0392-100x-n0884] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 06/09/2020] [Indexed: 12/04/2022]
Affiliation(s)
- Sara Torretta
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Università degli Studi di Milano, Department of Clinical Sciences and Community Health, Milan, Italy
| | | | - Michele Gaffuri
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lorenzo Pignataro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Università degli Studi di Milano, Department of Clinical Sciences and Community Health, Milan, Italy
| | - Remo Accorona
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Pasquale Capaccio
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Università degli Studi di Milano, Department of Biomedical Surgical Dental Science, Milan, Italy
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20
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Castellazzi ML, di Pietro GM, Gaffuri M, Torretta S, Conte G, Folino F, Aleo S, Bosis S, Marchisio P. Pediatric otogenic cerebral venous sinus thrombosis: a case report and a literature review. Ital J Pediatr 2020; 46:122. [PMID: 32883359 PMCID: PMC7470606 DOI: 10.1186/s13052-020-00882-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/17/2020] [Indexed: 12/18/2022] Open
Abstract
Background Cerebral venous sinus thrombosis in children is a rare but potentially fatal complication of acute mastoiditis, one of the most common pediatric infectious diseases. Due to its subtle clinical presentation, suspicion is essential for a prompt diagnosis and appropriate management. Unfortunately, no standard treatment options are available. To discuss the possible clinical presentation, microbiology, and management, we here report the case of a child with otogenic cerebral venous sinus thrombosis and perform a literature review starting from 2011. Case presentation The child, a 10-months-old male, presented clinical signs of right acute otitis media and mastoiditis. Brain computed tomography scan detected right sigmoid and transverse sinus thrombosis, as well as a subperiosteal abscess. Fusobacterium necrophorum and Haemophilus Influentiae were detected on cultural sampling. A multidisciplinary approach along with a combination of medical and surgical therapy allowed the patient’s full recovery. Conclusion Cerebral venous sinus thrombosis is a rare but severe complication of acute otitis media and mastoiditis. The management of this pathological condition is always challenging and an interdisciplinary approach is frequently required. Current therapeutic options include a combination of medical and surgical therapy. A patient-centered approach should guide timing and treatment management.
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Affiliation(s)
- Massimo Luca Castellazzi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Paediatric Emergency Department, Milan, Italy
| | | | - Michele Gaffuri
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Otolaryngology and Head and Neck Surgery and Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Sara Torretta
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Otolaryngology and Head and Neck Surgery and Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giorgio Conte
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neuroradiology Unit, Milan, Italy
| | | | - Sebastiano Aleo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Paediatric Highly Intensive Care Unit, Milan, Italy
| | - Samantha Bosis
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Paediatric Highly Intensive Care Unit, Milan, Italy.
| | - Paola Marchisio
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Paediatric Highly Intensive Care Unit, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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21
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Canzi P, Capaccio P, Marconi S, Conte G, Preda L, Avato I, Aprile F, Gaffuri M, Occhini A, Pignataro L, Auricchio F, Benazzo M. Feasibility of 3D printed salivary duct models for sialendoscopic skills training: preliminary report. Eur Arch Otorhinolaryngol 2019; 277:909-915. [DOI: 10.1007/s00405-019-05763-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 12/07/2019] [Indexed: 10/25/2022]
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22
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Gramegna A, Aliberti S, Seia M, Porcaro L, Bianchi V, Castellani C, Melotti P, Sorio C, Consalvo E, Franceschi E, Amati F, Contarini M, Gaffuri M, Roncoroni L, Vigone B, Bellofiore A, Del Monaco C, Oriano M, Terranova L, Patria MF, Marchisio P, Assael BM, Blasi F. When and how ruling out cystic fibrosis in adult patients with bronchiectasis. Multidiscip Respir Med 2019. [DOI: 10.4081/mrm.2018.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Bronchiectasis is the final result of different processes and most of the guidelines advocate for a careful evaluation of those etiologies which might be treated or might change patients’ management, including cystic fibrosis (CF). Main body: CFTR mutations have been reported with higher frequency in bronchiectasis population. Although ruling out CF is considered as a main step for etiological screening in bronchiectasis, CF testing lacks of a standardized approach both from a research and clinical point of view. In this review a list of most widely used tests in CF is provided. Conclusions: Exclusion of CF is imperative for patients with bronchiectasis and CFTR testing should be implemented in usual screening for investigating bronchiectasis etiology. Physicians taking care of bronchiectasis patients should be aware of CFTR testing and its limitations in the adult population. Further studies on CFTR expression in human lung and translational research might elucidate the possible role of CFTR in the pathogenesis of bronchiectasis.
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23
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Contarini M, Shoemark A, Rademacher J, Finch S, Gramegna A, Gaffuri M, Roncoroni L, Seia M, Ringshausen FC, Welte T, Blasi F, Aliberti S, Chalmers JD. Why, when and how to investigate primary ciliary dyskinesia in adult patients with bronchiectasis. Multidiscip Respir Med 2019. [DOI: 10.4081/mrm.2018.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Bronchiectasis represents the final pathway of several infectious, genetic, immunologic or allergic disorders. Accurate and prompt identification of the underlying cause is a key recommendation of several international guidelines, in order to tailor treatment appropriately. Primary ciliary dyskinesia (PCD) is a genetic cause of bronchiectasis in which failure of motile cilia leads to poor mucociliary clearance. Due to poor ciliary function in other organs, individuals can suffer from chronic rhinosinusitis, otitis media and infertility. This paper explores the current literature describing why, when and how to investigate PCD in adult patients with bronchiectasis. We describe the main PCD diagnostic tests and compare the two international PCD diagnostic guidelines. The expensive multi-test diagnostic approach requiring a high level of expertise and specialist equipment, make the multifaceted PCD diagnostic pathway complex. Therefore, the risk of late or missed diagnosis is high and has clinical and research implications. Defining the number of patients with bronchiectasis due to PCD is complex. To date, few studies outlining the aetiology of adult patients with bronchiectasis conduct screening tests for PCD, but they do differ in their diagnostic approach. Comparison of these studies reveals an estimated PCD prevalence of 1–13% in adults with bronchiectasis and describe patients as younger than their counterparts with moderate impairment of lung function and higher rates of chronic infection with Pseudomonas aeruginosa. Diagnosing PCD has clinical, socioeconomic and psychological implications, which affect patients’ life, including the possibility to have a specific and multidisciplinary team approach in a PCD referral centre, as well as a genetic and fertility counselling and special legal aspects in some countries. To date no specific treatments for PCD have been approved, standardized diagnostic protocols for PCD and recent diagnostic guidelines will be helpful to accurately define a population on which planning RCT studies to evaluate efficacy, safety and accuracy of PCD specific treatments.
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24
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Torretta S, Guastella C, Ibba T, Gaffuri M, Pignataro L. Surgical Treatment of Paediatric Chronic Rhinosinusitis. J Clin Med 2019; 8:jcm8050684. [PMID: 31096610 PMCID: PMC6571701 DOI: 10.3390/jcm8050684] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/26/2019] [Accepted: 05/13/2019] [Indexed: 11/16/2022] Open
Abstract
Rhinosinusitis (RS) is a common disease in children, significantly affecting their quality of life. Chronic rhinosinusitis (CRS) is frequently linked to other respiratory diseases, including asthma. Children affected by CRS may be candidates for surgery in the case of failure of maximal medical therapy comprising three to six weeks of broad-spectrum systemic antibiotics with adjunctive therapies. Although endoscopic sinus surgery (ESS) is the surgical treatment of choice in adult patients with CRS, different surgical procedures are scheduled for refractory paediatric CRS and include adenoidectomy, paediatric ESS (PESS), and balloon catheter sinuplasty (BCS). The present paper discusses the indications and limitations of each treatment option in children with CRS. Given the amount of current evidence, it is reasonable to suggest that, in young and otherwise healthy children with refractory CRS, an adenoidectomy (eventually combined with BCS) should be offered as the first-line surgical treatment. Nevertheless, this approach may be considered ineffective in some patients who should be candidates for traditional ESS. In older children, those with asthma, or in the case of peculiar conditions, traditional ESS should be considered as the primary treatment.
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Affiliation(s)
- Sara Torretta
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy.
| | - Claudio Guastella
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
| | - Tullio Ibba
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
| | - Michele Gaffuri
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
| | - Lorenzo Pignataro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy.
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25
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Gaffuri M, Torretta S, Iofrida E, Cantarella G, Borzani IM, Ciralli F, Calderini E, Leva E, Iurlaro E, Mosca F, Pignataro L. Multidisciplinary management of congenital giant head and neck masses: Our experience and review of the literature. J Pediatr Surg 2019; 54:733-739. [PMID: 30955589 DOI: 10.1016/j.jpedsurg.2018.09.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 09/23/2018] [Accepted: 09/25/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Large fetal head and neck (HN) masses can be life-threatening at birth and postnatally owing to airway obstruction. The two most frequent congenital masses that may obstruct the airway are lymphatic malformation (LM) and teratoma. The aim of this paper was to evaluate the results of our experience in the management of giant congenital HN masses and to conduct a literature review. METHODS The study involved a consecutive series of 13 newborns (7 females) affected by giant HN masses. Prenatal diagnosis was achieved by means of ultrasound (US) and fetal magnetic resonance imaging (MRI). Delivery was performed by means of EXIT procedure in case of radiological evidence of airway obstruction. In the postnatal period all feasible therapeutic options (surgery, sclerotherapy, medical therapy) were discussed and adopted by a multidisciplinary team. Twelve patients underwent surgery and one received Rapamycin for one month, with consequent surgical resection owing to increasing size of the mass. RESULTS The histopathological diagnosis was LM in 11 cases and teratoma in 2 cases. Airway obstruction was solved in 11 cases; 2 LM patients required a tracheotomy because of persistent airway obstruction. Major complications were flap necrosis (one patient) and facial nerve palsy (2 cases). Recurrence occurred in 5 patients. CONCLUSIONS The management of congenital HN masses is always challenging and necessarily requires an interdisciplinary approach. Current therapeutic options include surgery, sclerotherapy, medical therapy or a combination of them. When they are large enough to obstruct the airway, a patient-centered approach should guide timing and modality of treatment. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Michele Gaffuri
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.
| | - Sara Torretta
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Elisabetta Iofrida
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Giovanna Cantarella
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Irene Maria Borzani
- Radiology Unit Pediatric Division, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabrizio Ciralli
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy; Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Edoardo Calderini
- Pediatric Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ernesto Leva
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Enrico Iurlaro
- Department of Obstetrics and Gynecology 'L. Mangiagalli', Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabio Mosca
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy; Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lorenzo Pignataro
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
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26
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Torretta S, Gaffuri M, Ibba T, Capaccio P, Marchisio P, Maruca A, Bosis S, Pignataro L. Surgical treatment of non-tuberculous mycobacterial lymphadenitis in children: Our experience and a narrative review. Int J Immunopathol Pharmacol 2019; 32:2058738418806413. [PMID: 30354841 PMCID: PMC6202736 DOI: 10.1177/2058738418806413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Non-tuberculous mycobacterial lymphadenitis (NTML) accounts for about 95% of the cases of head-and-neck mycobacterial lymphadenitis, and its prevalence has been increasing in the Western world. The diagnostic work-up can be challenging, and differential diagnoses such as tuberculous and suppurative lymphadenitis need to be considered. It may, therefore, not be diagnosed until the disease is in a late stage, by which time it becomes locally destructive and is characterized by a chronically discharging sinus. The treatment options include a medical approach, a wait-and-see policy, and surgery, with the last being considered the treatment of choice despite the high risk of iatrogenic nerve lesions. The aim of this article is to provide an overview of pediatric, head-and-neck NTML based on the literature and our own experience, with particular emphasis on the impact and limitations of surgery.
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Affiliation(s)
- Sara Torretta
- 1 Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy.,2 Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Michele Gaffuri
- 2 Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Tullio Ibba
- 2 Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Pasquale Capaccio
- 2 Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,3 Department of Biomedical, Surgical and Odontoiatric Sciences, Università Degli Studi Di Milano, Milan, Italy
| | - Paola Marchisio
- 2 Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,4 Department of Pathophysiology and Transplantation, Università Degli Studi Di Milano, Milan, Italy
| | - Antonella Maruca
- 2 Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Samantha Bosis
- 2 Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lorenzo Pignataro
- 1 Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy.,2 Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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27
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Capaccio P, Bresciani L, Di Pasquale D, Gaffuri M, Torretta S, Pignataro L. CT Navigation and sialendoscopy-assisted transfacial removal of a parotid stone: A technical note. Laryngoscope 2018; 129:2295-2298. [PMID: 30585329 DOI: 10.1002/lary.27621] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 08/31/2018] [Accepted: 09/21/2018] [Indexed: 12/18/2022]
Affiliation(s)
- Pasquale Capaccio
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Lorenzo Bresciani
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniele Di Pasquale
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Michele Gaffuri
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sara Torretta
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lorenzo Pignataro
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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28
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Contarini M, Shoemark A, Rademacher J, Finch S, Gramegna A, Gaffuri M, Roncoroni L, Seia M, Ringshausen FC, Welte T, Blasi F, Aliberti S, Chalmers JD. Why, when and how to investigate primary ciliary dyskinesia in adult patients with bronchiectasis. Multidiscip Respir Med 2018; 13:26. [PMID: 30151188 PMCID: PMC6101078 DOI: 10.1186/s40248-018-0143-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Bronchiectasis represents the final pathway of several infectious, genetic, immunologic or allergic disorders. Accurate and prompt identification of the underlying cause is a key recommendation of several international guidelines, in order to tailor treatment appropriately. Primary ciliary dyskinesia (PCD) is a genetic cause of bronchiectasis in which failure of motile cilia leads to poor mucociliary clearance. Due to poor ciliary function in other organs, individuals can suffer from chronic rhinosinusitis, otitis media and infertility. This paper explores the current literature describing why, when and how to investigate PCD in adult patients with bronchiectasis. We describe the main PCD diagnostic tests and compare the two international PCD diagnostic guidelines. The expensive multi-test diagnostic approach requiring a high level of expertise and specialist equipment, make the multifaceted PCD diagnostic pathway complex. Therefore, the risk of late or missed diagnosis is high and has clinical and research implications. Defining the number of patients with bronchiectasis due to PCD is complex. To date, few studies outlining the aetiology of adult patients with bronchiectasis conduct screening tests for PCD, but they do differ in their diagnostic approach. Comparison of these studies reveals an estimated PCD prevalence of 1-13% in adults with bronchiectasis and describe patients as younger than their counterparts with moderate impairment of lung function and higher rates of chronic infection with Pseudomonas aeruginosa. Diagnosing PCD has clinical, socioeconomic and psychological implications, which affect patients' life, including the possibility to have a specific and multidisciplinary team approach in a PCD referral centre, as well as a genetic and fertility counselling and special legal aspects in some countries. To date no specific treatments for PCD have been approved, standardized diagnostic protocols for PCD and recent diagnostic guidelines will be helpful to accurately define a population on which planning RCT studies to evaluate efficacy, safety and accuracy of PCD specific treatments.
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Affiliation(s)
- Martina Contarini
- Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
| | - Amelia Shoemark
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Jessica Rademacher
- Department of Respiratory Medicine, Hannover Medical School and German Center for Lung Research (DZL), Hannover, Germany
| | - Simon Finch
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Andrea Gramegna
- Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
| | - Michele Gaffuri
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Luca Roncoroni
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Manuela Seia
- Medical Genetics Laboratory, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Felix C. Ringshausen
- Department of Respiratory Medicine, Hannover Medical School and German Center for Lung Research (DZL), Hannover, Germany
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School and German Center for Lung Research (DZL), Hannover, Germany
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
| | - Stefano Aliberti
- Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
| | - James D. Chalmers
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
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29
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Gramegna A, Aliberti S, Seia M, Porcaro L, Bianchi V, Castellani C, Melotti P, Sorio C, Consalvo E, Franceschi E, Amati F, Contarini M, Gaffuri M, Roncoroni L, Vigone B, Bellofiore A, Del Monaco C, Oriano M, Terranova L, Patria MF, Marchisio P, Assael BM, Blasi F. When and how ruling out cystic fibrosis in adult patients with bronchiectasis. Multidiscip Respir Med 2018; 13:29. [PMID: 30151190 PMCID: PMC6101074 DOI: 10.1186/s40248-018-0142-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Bronchiectasis is the final result of different processes and most of the guidelines advocate for a careful evaluation of those etiologies which might be treated or might change patients’ management, including cystic fibrosis (CF). Main body CFTR mutations have been reported with higher frequency in bronchiectasis population. Although ruling out CF is considered as a main step for etiological screening in bronchiectasis, CF testing lacks of a standardized approach both from a research and clinical point of view. In this review a list of most widely used tests in CF is provided. Conclusions Exclusion of CF is imperative for patients with bronchiectasis and CFTR testing should be implemented in usual screening for investigating bronchiectasis etiology. Physicians taking care of bronchiectasis patients should be aware of CFTR testing and its limitations in the adult population. Further studies on CFTR expression in human lung and translational research might elucidate the possible role of CFTR in the pathogenesis of bronchiectasis.
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Affiliation(s)
- Andrea Gramegna
- Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
| | - Stefano Aliberti
- Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
| | - Manuela Seia
- 2Medical Genetics Laboratory, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Luigi Porcaro
- 2Medical Genetics Laboratory, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Vera Bianchi
- 3UOSD Genetica Medica, Medical Genetics Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Carlo Castellani
- 4Centro Fibrosi Cistica, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Paola Melotti
- 4Centro Fibrosi Cistica, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Claudio Sorio
- 5Dipartimento di Patologia e Diagnostica, Università di Verona, Verona, Italy
| | - Enza Consalvo
- 2Medical Genetics Laboratory, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Elisa Franceschi
- Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
| | - Francesco Amati
- Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
| | - Martina Contarini
- Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
| | - Michele Gaffuri
- 6Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Luca Roncoroni
- 6Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Barbara Vigone
- 7Scleroderma Unit, Referral Center for Systemic Autoimmune Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, 20122 Milan, Italy
| | - Angela Bellofiore
- Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
| | - Cesare Del Monaco
- Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
| | - Martina Oriano
- Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy.,9Molecular Medicine Department, University of Pavia, Viale Taramelli 3/b, 27100 Pavia, Italy
| | - Leonardo Terranova
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Maria Francesca Patria
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Paola Marchisio
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Baroukh M Assael
- Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
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Gasperini G, Gaffuri M, Guanziroli E, Goffredo M, Puornajaf S, Galafate D, Russo E, Filoni S, Franceschini M, Molteni F. Recovery of gait function with a wearable powered exoskeleton in sub-acute stroke patients using SEMG for fine tuning: Preliminary results. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.198] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Capaccio P, Canzi P, Gaffuri M, Occhini A, Benazzo M, Ottaviani F, Pignataro L. Modern management of paediatric obstructive salivary disorders: long-term clinical experience. Acta Otorhinolaryngol Ital 2018; 37:160-167. [PMID: 28516980 PMCID: PMC5463525 DOI: 10.14639/0392-100x-1607] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 12/12/2016] [Indexed: 12/22/2022]
Abstract
Recent technological improvements in head and neck field have changed diagnostic and therapeutic strategies for salivary disorders. Diagnosis is now based on colour Doppler ultrasonography (US), magnetic resonance (MR) sialography and cone beam 3D computed tomography (CT), and extra- and intracorporeal lithotripsy, interventional sialendscopy and sialendoscopy-assisted surgery are used as minimally invasive, conservative procedures for functional preservation of the affected gland. We evaluated the results of our long-term experience in the management of paediatric obstructive salivary disorders. The study involved a consecutive series of 66 children (38 females) whose obstructive salivary symptoms caused by juvenile recurrent parotitis (JRP) (n = 32), stones (n = 20), ranula (n = 9) and ductal stenosis (n = 5). 45 patients underwent interventional sialendoscopy for JRP, stones and stenoses, 12 a cycle of extracorporeal shockwave lithotripsy (ESWL), three sialendoscopy-assisted transoral surgery, one drainage, six marsupialisation, and two suturing of a ranula. Three children underwent combined ESWL and interventional sialendoscopy, and seven a secondary procedure. An overall successful result was obtained in 90.9% of cases. None of the patients underwent traditional invasive sialadenectomy notwithstanding persistence of mild obstructive symptoms in six patients. No major complications were observed. Using a diagnostic work-up based on colour Doppler US, MR sialography and cone beam 3D TC, children with obstructive salivary disorders can be effectively treated in a modern minimally-invasive manner by extracorporeal and intracorporeal lithotripsy, interventional sialendoscopy and sialendoscopy-assisted transoral surgery; this approach guarantees a successful result in most patients, thus avoiding the need for invasive sialadenectomy while functionally preserving the gland.
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Affiliation(s)
- P Capaccio
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
| | - P Canzi
- Department of Otorhinolaryngology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - M Gaffuri
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A Occhini
- Department of Otorhinolaryngology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - M Benazzo
- Department of Otorhinolaryngology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - F Ottaviani
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano Ospedale Fatebenefratelli San Giuseppe, Milano
| | - L Pignataro
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
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32
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Gallo A, Capaccio P, Benazzo M, De Campora L, De Vincentiis M, Farneti P, Fusconi M, Gaffuri M, Lo Russo F, Martellucci S, Ottaviani F, Pagliuca G, Paludetti G, Pasquini E, Pignataro L, Puxeddu R, Rigante M, Scarano E, Sionis S, Speciale R, Canzi P. Outcomes of interventional sialendoscopy for obstructive salivary gland disorders: an Italian multicentre study. Acta Otorhinolaryngol Ital 2018; 36:479-485. [PMID: 28177330 PMCID: PMC5317126 DOI: 10.14639/0392-100x-1221] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 06/19/2016] [Indexed: 12/18/2022]
Abstract
Interventional sialendoscopy has become the predominant therapeutic procedure for the management of obstructive salivary disorders, but only a few multicentre studies of large series of patients with a long-term follow-up have been published. This Italian multicentre study involved 1152 patients (553 females; mean age 50 years) who, after at least a clinical and ultrasonographic evaluation, underwent a total of 1342 diagnostic and interventional sialendoscopies, 44.6% of which involved the parotid gland. 12% (n = 138) of patients underwent multiple treatments. The procedure was successful in 1309 cases. In 33 cases (2.4%) the procedure could not be concluded mainly because of complete duct stenosis (21 cases). Salivary stones were the main cause of obstruction (55%), followed by ductal stenosis and anomalies (16%), mucous plugs (14.5%) and sialodochitis (4.7%). Complete therapeutic success was obtained in 92.5% of patients after one or more procedures, and was ineffective in < 8%. Untoward effects (peri and postoperative complications) were observed in 5.4% of cases. Sialendoscopy proved to be an effective, valid and safe procedure in the diagnostic and therapeutic management of non-neoplastic obstructive salivary gland diseases.
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Affiliation(s)
- A Gallo
- Department of Medico-surgical sciences and biotechnologies, ENT Section, Sapienza University of Rome, Italy
| | - P Capaccio
- Department of Biomedical, Surgical and Dental Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - M Benazzo
- Department of Otorhinolaryngology, University of Pavia, IRCCS Policlinico "S. Matteo" Foundation, Pavia, Italy
| | - L De Campora
- Department of Otorhinolaryngology, "Fatebenefratelli" Hospital, Roma, Italy
| | - M De Vincentiis
- Department of Sense Organs, ENT Section, Policlinico "Umberto I", Sapienza University of Rome, Italy
| | - P Farneti
- Department of Experimental, Diagnostic and Specialty Medicine, Dimes, Bologna University Medical School, Ear, Nose and Throat Unit of "Sant'Orsola-Malpighi" Hospital, Bologna, Italy
| | - M Fusconi
- Department of Sense Organs, ENT Section, Policlinico "Umberto I", Sapienza University of Rome, Italy
| | - M Gaffuri
- Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - F Lo Russo
- Department Experimental biomedicine and clinical neurosciences, Otorhinolaryngology Unit, University of Palermo; Italy
| | - S Martellucci
- Department of Medico-surgical sciences and biotechnologies, ENT Section, Sapienza University of Rome, Italy
| | - F Ottaviani
- Department of Clinical Sciences and Community Health, San Giuseppe Hospital, Università degli Studi di Milano, Milan, Italy
| | - G Pagliuca
- Department of Medico-surgical sciences and biotechnologies, ENT Section, Sapienza University of Rome, Italy
| | - G Paludetti
- Department of Head and Neck Surgery, Institute of Otorhinolaryngology, Università Cattolica del Sacro Cuore, Italy
| | - E Pasquini
- Ear, Nose and Throat Metropolitan Unit, Surgical Department, AUSL Bologna, Italy
| | - L Pignataro
- Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - R Puxeddu
- Department of Otorhinolaryngology, AOU, PO "S. Giovanni di Dio", University of Cagliari, Italy
| | - M Rigante
- Department of Head and Neck Surgery, Institute of Otorhinolaryngology, Università Cattolica del Sacro Cuore, Italy
| | - E Scarano
- Department of Head and Neck Surgery, Institute of Otorhinolaryngology, Università Cattolica del Sacro Cuore, Italy
| | - S Sionis
- Department of Otorhinolaryngology, AOU, PO "S. Giovanni di Dio", University of Cagliari, Italy
| | - R Speciale
- Department Experimental biomedicine and clinical neurosciences, Otorhinolaryngology Unit, University of Palermo; Italy
| | - P Canzi
- Department of Otorhinolaryngology, University of Pavia, IRCCS Policlinico "S. Matteo" Foundation, Pavia, Italy
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Carandini T, Longari V, Mendogni P, Gaffuri M, Ceriani E. Utility of PET scan in diagnosis and monitoring descending necrotizing mediastinitis complicating Lemierre's syndrome. Intern Emerg Med 2018; 13:129-131. [PMID: 28776174 DOI: 10.1007/s11739-017-1726-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 07/29/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Tiziana Carandini
- Department of Neurology, Neurodegenerative Diseases, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.
| | - Virgilio Longari
- Department of Nuclear Medicine, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Mendogni
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Michele Gaffuri
- Department of Otolaryngology, Head and Neck Surgery, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisa Ceriani
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
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Cantarella G, Mazzola RF, Gaffuri M, Iofrida E, Biondetti P, Forzenigo LV, Pignataro L, Torretta S. Structural Fat Grafting to Improve Outcomes of Vocal Folds’ Fat Augmentation: Long-term Results. Otolaryngol Head Neck Surg 2017; 158:135-143. [DOI: 10.1177/0194599817739256] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Evaluating the long-term outcomes of vocal fold structural fat grafting. Study Design Case series with chart review. Setting University hospital. Subjects and Methods Seventy-nine dysphonic patients (16-82 years; 55 with unilateral laryngeal paralysis and 24 with vocal fold scarring) underwent vocal fold fat injection. Fat was harvested by low-pressure liposuction and then processed by centrifugation. Refined fat aliquots were placed in the vocal fold and paraglottic space in multiple tunnels to enhance graft neovascularization. All patients were followed for 12 months, 15 for 3 years, and 5 for 10 years with videolaryngostroboscopy, maximal phonation time (MPT) measurement, Voice Handicap Index (VHI) questionnaire, and GRBAS (grade, roughness, breathiness, asthenia, strain) perceptual evaluation. Laryngeal computed tomography (CT) and/or magnetic resonance imaging (MRI) studies were performed in 16 patients 3 to 28 months postoperatively; MRI was repeated in 5 cases 12 to 18 months after the first radiological study. Results The voice quality of all patients improved after surgery, and long-term stability was confirmed by MPT, GRBAS, and VHI ( P ranging between .004 and <.001). The results achieved 1 year postoperatively remained stable at 3 and 10 years. Videolaryn-gostroboscopy showed improved glottic closure in all patients despite a limited amount of fat resorption. CT and MRI demonstrated survival of the fat grafts in all of the 16 examined cases. Serial MRI scans showed no change in graft size over time. Conclusions The reported clinical and radiological data demonstrate that fat is an effective filler for permanent vocal fold augmentation if the refined micro-aliquots are placed in multiple tunnels.
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Affiliation(s)
- Giovanna Cantarella
- Otolaryngology Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Riccardo F. Mazzola
- Otolaryngology Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Michele Gaffuri
- Otolaryngology Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Elisabetta Iofrida
- Otolaryngology Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Pietro Biondetti
- Radiology Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura V. Forzenigo
- Radiology Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lorenzo Pignataro
- Otolaryngology Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Sara Torretta
- Otolaryngology Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
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Pipolo C, Bianchini S, Barberi S, Landi M, D'Auria E, Fuccillo E, Gaffuri M, Marchisio P, Rosazza C, Saibene AM, Gelardi M, Torretta S. Nasal cytology in children: scraping or swabbing? Rhinology 2017; 55:242-250. [PMID: 28492610 DOI: 10.4193/rhin16.287] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Nasal cytology has become a valuable tool in the assessment of a multitude of nasal pathologies in children. Collection methods differ significantly and even though the use of the nasal curette is regarded as the most reliable in adults, most practitioners use the nasal swab in children. However, no studies have validated the reliability and supposed better tolerability of the latter. We have compared these two sampling methods regarding their tolerability and analysed the diagnostic accuracy of the cotton nasal swab (NSW) to identify nasal cytotypes and rhinitis phenotypes, using nasal scraping (NSC) for comparison. In a multicentric prospective study we recruited 208 children and performed nasal cytology by means of NSW and NSC. Microscopic evaluating of the nasal cytotypes was performed and tolerability of NSW and NSC was tested. Our data revealed a significantly inferior diagnostic accuracy of NSW compared to NSC regarding reliability and cell counts. Our study is the first to shed light on the role of the sampling tools for pediatric nasal cytology. We documented a poor diagnostic accuracy of NSW, thus suggesting using only the nasal curette in clinical practice. Furthermore, tolerability did not differ between the two, refuting the common thesis that swabs are to be preferred when doing nasal cytology in children.
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Affiliation(s)
- C Pipolo
- Otolaryngology Unit, Department of Health Sciences, ASST Santi Paolo e Carlo Hospital, Universita degli Studi di Milano, Milan, Italy
| | - S Bianchini
- Pediatric Highly Intensive Care Unit, Department of Maternal and Pediatric Sciences, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Universita degli Studi di Milano, Milan, Italy
| | - S Barberi
- Department of Pediatrics, ASST Fatebenefratelli, Sacco, Milan, Italy
| | - M Landi
- Gruppo pediatrico di cure primarie Asl To1, Turin, Italy
| | - E D'Auria
- Department of Pediatrics, Department of Health Sciences, ASST Santi Paolo e Carlo Hospital, Universita degli Studi di Milano, Milan, Italy
| | - E Fuccillo
- Otolaryngology Unit, Department of Health Sciences, ASST Santi Paolo e Carlo Hospital, Universita degli Studi di Milano, Milan, Italy
| | - M Gaffuri
- Otolaryngology Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Universita degli Studi di Milano, Milan
| | - P Marchisio
- Pediatric Highly Intensive Care Unit, Department of Maternal and Pediatric Sciences, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Universita degli Studi di Milano, Milan, Italy
| | - C Rosazza
- Pediatric Highly Intensive Care Unit, Department of Maternal and Pediatric Sciences, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Universita degli Studi di Milano, Milan, Italy
| | - A M Saibene
- Otolaryngology Unit, Department of Health Sciences, ASST Santi Paolo e Carlo Hospital, Universita degli Studi di Milano, Milan, Italy
| | - M Gelardi
- Otolaryngology Unit, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari Aldo Moro, Bari, Italy
| | - S Torretta
- Otolaryngology Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Universita degli Studi di Milano, Milan
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Capaccio P, Gaffuri M, Rossi V, Pignataro L. Sialendoscope-assisted transoral removal of hilo-parenchymal sub-mandibular stones: surgical results and subjective scores. Acta Otorhinolaryngol Ital 2017; 37:122-127. [PMID: 28516974 PMCID: PMC5463519 DOI: 10.14639/0392-100x-1601] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 12/12/2016] [Indexed: 11/23/2022]
Abstract
It has been suggested that a conservative trans-oral approach to proximal and hilo-parenchymal submandibular stones (HPSMS) is a valid alternative to the more frequently used sialadenectomy. The aim of this study was to evaluate the surgical, ultrasonographic and patients' subjective outcomes of results of the trans-oral removal of HPSMS. Between January 2003 and September 2015, sialendoscope-assisted trans-oral surgery was used to remove symptomatic, large (> 7 mm), fixed and palpable HPSMS from 479 patients under general anaesthesia. All patients were followed clinically and ultrasonographically to investigate symptom relief and recurrence of stones, and were telephonically interviewed to assess saliva-related subjective outcomes with a questionnaire. Stones were successfully removed from 472 patients (98.5%); the seven failures (1.5%) concerned pure parenchymal stones. One year after the procedure, 408 patients (85.1%) were symptom free, 59 (12.3%) had recurrent obstructive symptoms and 12 (2.6%) had recurrent infections. Of the 54 patients who developed a recurrent stone (11.2%), 52 underwent a second procedure: 29 interventional sialendoscopies, two sialendoscope-assisted intra-corporeal pneumatic lithotripsy, eight secondary transoral surgery to remove residual stones, six a cycle of extra-corporeal lithotripsy and seven submandibular sialadenectomy. Most patients (75.2%) reported mild surgery-related pain. The symptoms of 454 patients (94.8%) improved after adjunctive treatment and, at the end of follow-up, the affected gland was preserved in 98.5% of patients. A sialendoscope-assisted trans-oral removal of large HPSMS is a safe, effective, conservative surgical procedure, and functional preservation of the main duct and parenchyma of the obstructed gland allows sialendoscopic access through the natural ostium in case of recurrence. Combining a trans-oral approach with other minimally invasive, conservative procedures ensures symptomatic relief and salivary duct system clearance in the majority of patients.
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Affiliation(s)
- P Capaccio
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Biomedical, Surgical, Dental Sciences
| | - M Gaffuri
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - V Rossi
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Biomedical, Surgical, Dental Sciences
| | - L Pignataro
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Italy
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37
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Cantarella G, Dejonckere P, Galli A, Ciabatta A, Gaffuri M, Pignataro L, Torretta S. A retrospective evaluation of the etiology of unilateral vocal fold paralysis over the last 25 years. Eur Arch Otorhinolaryngol 2016; 274:347-353. [PMID: 27455863 DOI: 10.1007/s00405-016-4225-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 07/19/2016] [Indexed: 02/04/2023]
Abstract
Previous studies have shown that the etiology of laryngeal paralysis has changed over the last decades, with an increase in the incidence of cases attributable to thyroid surgery. The aim of this study was to evaluate longitudinal changes in the etiology of unilateral vocal fold paralysis (UVFP) in a single institution over the last 25 years. This retrospective study analyzed the etiology of UVFP between 1990 and 2015 by comparing a cohort of patients treated in 1990-1992 with a cohort treated in 2013-2015. The final analysis was based on data concerning 356 patients (38.8 % males; mean age 55.3 ± 20.4 years): 113 in the 1990-1992 cohort, and 243 in the 2013-2015 cohort. The main cause of UVFP in the population as a whole was thyroidectomy (41.3 %), followed by an idiopathic origin (25.3 %) and thoracic surgery (12.1 %); this was confirmed in both intra-group analyses. There was a statistically significant association between etiology and the sub-group periods: the prevalence of post-thyroidectomy UVFP was highly significantly lower in the 2013-2015 cohort (35.4 vs 54.0 %), and the prevalence of idiopathic cases was higher (28.4 vs 18.6 %). Etiology significantly related to gender in both cohorts (p value ≤0.001). In the 2013-2015 cohort, there was also a statistically significant relationship between etiology and age classes (p value 0.017), and the left side was more frequently affected than the right (67.1 vs 32.9 %). Our findings document changes in the etiological pattern of UVFP over the last 25 years, with a considerable decrease in post-thyroidectomy UVFP, and a growing predominance of idiopathic and post-thoracic surgery UVFP.
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Affiliation(s)
- Giovanna Cantarella
- Otolaryngology Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan, Italy.
| | - Philippe Dejonckere
- University of Leuven and Federal Institute for Occupational Diseases, Brussels, Belgium
| | - Anna Galli
- Otolaryngology Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan, Italy
| | - Annaclara Ciabatta
- Otolaryngology Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan, Italy
| | - Michele Gaffuri
- Otolaryngology Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Lorenzo Pignataro
- Otolaryngology Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Sara Torretta
- Otolaryngology Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
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Torretta S, Marchisio P, Rinaldi V, Gaffuri M, Pascariello C, Drago L, Baggi E, Pignataro L. Topical administration of hyaluronic acid in children with recurrent or chronic middle ear inflammations. Int J Immunopathol Pharmacol 2016; 29:438-42. [PMID: 27481884 DOI: 10.1177/0394632016656012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 05/24/2016] [Indexed: 11/16/2022] Open
Abstract
Hyaluronic acid (HA) treatment has been successfully performed in patients with recurrent upper airway infections or rhinitis. The aim of this study was to assess the efficacy and safety of the topical nasal administration of an HA-based compound by investigating its effects in children with recurrent or chronic middle ear inflammations and chronic adenoiditis. A prospective, single-blind, 1:1 randomised controlled study was performed to compare otoscopy, tympanometry and pure-tone audiometry in children which received the daily topical administration of normal 0.9% sodium chloride saline solution (control group) or 9 mg of sodium hyaluronate in 3 mL of a 0.9% sodium saline solution. The final analysis was based on 116 children (49.1% boys; mean age, 62.9 ± 17.9 months): 58 in the control group and 58 in the study group. At the end of follow-up, the prevalence of patients with impaired otoscopy was significantly lower in the study group (P value = 0.024) compared to baseline but not in the control group. In comparison with baseline, the prevalence of patients with impaired tympanometry at the end of the follow-up period was significantly lower in the study group (P value = 0.047) but not in the control group. The reduction in the prevalence of patients with conductive hearing loss (CHL) (P value = 0.008) and those with moderate CHL (P value = 0.048) was significant in the study group, but not in the control group. The mean auditory threshold had also significantly improved by the end of treatment in the study group (P value = 0.004) but not in the control group. Our findings confirm the safety of intermittent treatment with a topical nasal sodium hyaluronate solution and are the first to document its beneficial effect on clinical and audiological outcomes in children with recurrent or chronic middle ear inflammations associated with chronic adenoiditis.
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Affiliation(s)
- Sara Torretta
- Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Paola Marchisio
- Department of Maternal and Pediatric Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Vittorio Rinaldi
- Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Michele Gaffuri
- Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Carla Pascariello
- Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Lorenzo Drago
- Clinical Chemistry and Microbiology Laboratory, IRCCS Galeazzi Institute, Milan, Italy LITA Clinical Microbiology Laboratory, L. Sacco Department of Clinical Science, Università degli Studi di Milano, Milan, Italy
| | - Elena Baggi
- Department of Maternal and Pediatric Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Lorenzo Pignataro
- Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
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Capaccio P, Gaffuri M, Pignataro L, Assandri F, Pereira P, Farronato G. Recurrent parotid swelling secondary to masseter muscle hypertrophy: a multidisciplinary diagnostic and therapeutic approach. Cranio 2016; 34:388-394. [PMID: 26892838 DOI: 10.1080/08869634.2016.1142694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To present a patient with an atypical recurrent parotid swelling due to masseter muscle hypertrophy and the diagnostic/therapeutic assessment to treat this condition. CASE REPORT A patient referring recurrent right facial swelling underwent a complete multidisciplinary assessment of the parotid region that revealed masseter muscle hypertrophy, confirmed by means of clinical (otolaryngological and gnathological evaluation), radiological (utrasonography, dynamic magnetic resonance imaging, and cone beam computed tomography), instrumental (electromyography to evaluate the right masseter muscle function and kinesiography to evaluate maximum right deflection - MaxRDefl and maximum opening - MaxMO) and sialendoscopy assessment where T0 indicates the pre-treatment values. All electromyographic and kinesiographic parameters were evaluated six months after the orthodontic application of a neuromuscular orthosis at T1. At T1, the effectiveness of the orthodontic therapy was demonstrated by the complete resolution of symptoms, and instrumental results documented more efficient muscle activity at rest and during clenching and a better mandibular position. At EMG T1, the resting and post-TENS values were, respectively, 1.2 and 1.8 microV. At kinesiography, MaxRDefl increased from 10.2 (T0) to 10.5 mm (T1); maxMO increased from 41.2 (T0) to 48 mm (T1). CONCLUSION The proposed multidisciplinary assessment based on otolaryngological, gnathological, and radiological evaluation may be useful in the case of recurrent parotid swelling secondary to masseter muscle hypertrophy to plan an appropriate management with a removable neuromuscular orthosis.
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Affiliation(s)
- Pasquale Capaccio
- a Department of Otolaryngology and Head and Neck Surgery , Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico , Milan , Italy.,c Department of Biomedical, Surgical and Dental Sciences , Università degli Studi di Milano , Milan , Italy
| | - Michele Gaffuri
- a Department of Otolaryngology and Head and Neck Surgery , Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico , Milan , Italy.,d Department of Clinical Sciences and Community Health , Università degli Studi di Milano , Milan , Italy
| | - Lorenzo Pignataro
- a Department of Otolaryngology and Head and Neck Surgery , Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico , Milan , Italy.,d Department of Clinical Sciences and Community Health , Università degli Studi di Milano , Milan , Italy
| | - Fausto Assandri
- b Department of Maxillofacial Surgery and Odontostomatology , Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico , Milan , Italy.,c Department of Biomedical, Surgical and Dental Sciences , Università degli Studi di Milano , Milan , Italy
| | - Pollyanna Pereira
- b Department of Maxillofacial Surgery and Odontostomatology , Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico , Milan , Italy.,c Department of Biomedical, Surgical and Dental Sciences , Università degli Studi di Milano , Milan , Italy
| | - Giampietro Farronato
- b Department of Maxillofacial Surgery and Odontostomatology , Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico , Milan , Italy.,c Department of Biomedical, Surgical and Dental Sciences , Università degli Studi di Milano , Milan , Italy
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Cantarella G, Gaffuri M, Pugni L, Pignataro L, Mosca F. Severe respiratory distress at birth caused by a hairy polyp of the Eustachian tube: Transoral endoscopy-guided treatment. Congenit Anom (Kyoto) 2015; 55:158-60. [PMID: 25483752 DOI: 10.1111/cga.12100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Accepted: 11/30/2014] [Indexed: 11/30/2022]
Abstract
Hairy polyps are rare developmental lesions, which present as masses mainly consisting of fatty tissue covered by skin, seldom localized in the nasopharynx, causing respiratory obstruction. We describe the case of a female newborn affected by a hairy polyp arising from the left Eustachian tube, who presented severe respiratory distress soon after birth. The polyp was successfully removed transorally under videoendoscopic guidance. This case highlights the importance of including hairy polyp in the differential diagnosis of respiratory distress at birth because this type of tumor can be lethal and requires prompt treatment. A transoral endoscopy-guided approach can allow successful and minimally invasive excision even in a newborn.
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Affiliation(s)
- Giovanna Cantarella
- Otolaryngology Department, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Michele Gaffuri
- Otolaryngology Department, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Lorenza Pugni
- Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Lorenzo Pignataro
- Otolaryngology Department, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Capaccio P, Gaffuri M, Pignataro L. Erratum to “Sialendoscopy-assisted transfacial surgical removal of parotid stones” [J Craniomaxillofac Surg 42 (2014) 1964–1969]. J Craniomaxillofac Surg 2015. [DOI: 10.1016/j.jcms.2014.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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42
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Mantovani M, Rinaldi V, Salamanca F, Torretta S, Carioli D, Gaffuri M, Pignataro L. Should we stop performing uvulopalatopharyngoplasty? Indian J Otolaryngol Head Neck Surg 2014; 67:161-2. [PMID: 25621277 DOI: 10.1007/s12070-014-0800-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 11/11/2014] [Indexed: 10/24/2022] Open
Abstract
Uvulopalatopharyngoplasty (UPPP) is still one of the most frequently performed procedures for snoring and obstructive sleep apnea syndrome (OSAS) in adults, with unsatisfactory results. In the era of the mini-invasive/conservative surgery, considering the increasing attention to the disregulation of the peripheral neuromuscular control of the upper airway contributing to pharyngeal collapse in OSAS, with the development of sophisticated treatments such as the neural stimulation of the upper-airway, which role should be reserved to a muscular resective procedure such as UPPP? Being aware of the uncertain results and the high postoperative morbidity of UPPP, we believe that we should re-evaluate the role of these procedures involving the resection of palatal/pharyngeal muscles and uvula.
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Affiliation(s)
- Mario Mantovani
- Department of Otolaryngology, Department of Clinical Sciences and Community Health, University of Milan, Fondazione I.R.C.C.S. Cà Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy
| | - Vittorio Rinaldi
- Department of Otolaryngology, Department of Clinical Sciences and Community Health, University of Milan, Fondazione I.R.C.C.S. Cà Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy
| | | | - Sara Torretta
- Department of Otolaryngology, Department of Clinical Sciences and Community Health, University of Milan, Fondazione I.R.C.C.S. Cà Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy
| | - Daniela Carioli
- Department of Otolaryngology, Department of Clinical Sciences and Community Health, University of Milan, Fondazione I.R.C.C.S. Cà Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy
| | - Michele Gaffuri
- Department of Otolaryngology, Department of Clinical Sciences and Community Health, University of Milan, Fondazione I.R.C.C.S. Cà Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy
| | - Lorenzo Pignataro
- Department of Otolaryngology, Department of Clinical Sciences and Community Health, University of Milan, Fondazione I.R.C.C.S. Cà Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy
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Torretta S, Marchisio P, Gaffuri M, Capaccio P, Esposito S, Pignataro L. Step-by-step iconographic description of a prolonged but still favourable course of orbital cellulitis in a child with acute rhinosinusitis: an iconographic case study. Ital J Pediatr 2014; 40:25. [PMID: 24594215 PMCID: PMC3995968 DOI: 10.1186/1824-7288-40-25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 02/27/2014] [Indexed: 11/10/2022] Open
Abstract
Orbital cellulitis is an infrequent complication of acute ethmoiditis possibly leading to life- or visual-threatening complications. Despite its natural history is well known, its clinical evolution may widely vary among patients, and even in the most favourable cases long-term sequelae may persist. We here provide a step-by-step iconographic description of a periorbital and orbital cellulitis occurring in a child with ipsilateral acute rhinosinusitis. Our report shows that an unusual long-term evolution of periorbital and orbital cellulitis is possible also in apparently favourable cases.
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Affiliation(s)
- Sara Torretta
- Department of Clinical Sciences and Community Health, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F, Sforza 35, 20122 Milano, Italy.
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44
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Torretta S, Gaffuri M, Recalcati S, Marzano AV, Cantarella G, Iofrida E, Pignataro L. Pharyngolaryngeal location of Kaposi's sarcoma with airway obstruction in an HIV-negative patient. Tumori 2013. [PMID: 24362871 DOI: 10.1700/1377.15316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Kaposi's sarcoma (KS) is a human herpes virus-8 (HHV-8)-associated angioproliferative disorder, and its occurrence may be favored by human immunodeficiency virus (HIV) infection and iatrogenic immunosuppression. It has also been postulated that a chronic inflammatory disease of the skin can pave the way to its development. KS generally involves mucosal and cutaneous sites, including the head and neck. An oropharyngeal location is quite common, but laryngeal involvement with possible upper airway obstruction and respiratory distress requiring tracheotomy is rare, and no hypopharyngeal locations have yet been reported. We describe the case of a 68-year-old male patient who developed KS after immunosuppressive treatment for pemphigus vulgaris, an autoimmune bullous disease presenting with blisters and erosions on the skin and the oral mucosa. KS was initially localized to the oral cavity and oropharynx, but subsequent involvement of the laryngeal and hypopharyngeal tract led to acute airway obstruction and the need for tracheotomy. This unique case of pharyngolaryngeal KS suggests that clinicians faced with purple nodular lesions should consider a differential diagnosis of KS in immunocompromised patients, even if they are HIV negative, and should carefully manage the patency of the upper airways.
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Abstract
Submandibular swelling is a common clinical disorder of the maxillo-facial region that may be one of the manifestation of several pathologic disorders including sialolithiasis. A 38-year-old woman experienced a recurrent painful swelling in the right submandibular region for seven years. The symptoms, not always meal-related, gradually became chronic and associated with dysphagia, odynophagia and fever. Ultrasonography of the salivary glands revealed a retained glandular structure and no ductal obstruction or dilatation, and orthopantomography showed the presence of a structure compatible with tooth, but these findings did not correlate with clinical scenario. Only CT dental scan identified the radiological image as a salivary stone. Sialolithiasis should always be considered in the diagnostic iter of painful submandibular swelling. A careful evaluation of recurrence and characteristics of signs and symptoms associated to the swelling can help in making the correct diagnosis and planning a proper therapeutic strategy.
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Affiliation(s)
- Pasquale Capaccio
- Department of Specialist Surgical Sciences, ENT Clinic, University of Milan, IRCCS Foundation Ca` Granda Ospedale Maggiore Policlinico, Milan, Italy
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46
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Torretta S, Gaffuri M, Recalcati S, Marzano AV, Cantarella G, Iofrida E, Pignataro L. Pharyngolaryngeal location of Kaposi's sarcoma with airway obstruction in an HIV-negative patient. Tumori 2013; 99:e208-10. [DOI: 10.1177/030089161309900514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Kaposi's sarcoma (KS) is a human herpes virus-8 (HHV-8)-associated angioproliferative disorder, and its occurrence may be favored by human immunodeficiency virus (HIV) infection and iatrogenic immunosuppression. It has also been postulated that a chronic inflammatory disease of the skin can pave the way to its development. KS generally involves mucosal and cutaneous sites, including the head and neck. An oropharyngeal location is quite common, but laryngeal involvement with possible upper airway obstruction and respiratory distress requiring tracheotomy is rare, and no hypopharyngeal locations have yet been reported. We describe the case of a 68-year-old male patient who developed KS after immunosuppressive treatment for pemphigus vulgaris, an autoimmune bullous disease presenting with blisters and erosions on the skin and the oral mucosa. KS was initially localized to the oral cavity and oropharynx, but subsequent involvement of the laryngeal and hypopharyngeal tract led to acute airway obstruction and the need for tracheotomy. This unique case of pharyngolaryngeal KS suggests that clinicians faced with purple nodular lesions should consider a differential diagnosis of KS in immunocompromised patients, even if they are HIV negative, and should carefully manage the patency of the upper airways.
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Affiliation(s)
- Sara Torretta
- Otolaryngology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Michele Gaffuri
- Otolaryngology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Sebastiano Recalcati
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan
| | | | - Giovanna Cantarella
- Otolaryngology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan
| | - Elisabetta Iofrida
- Otolaryngology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Lorenzo Pignataro
- Otolaryngology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Torretta S, Drago L, Marchisio P, Gaffuri M, Clemente IA, Pignataro L. Topographic distribution of biofilm-producing bacteria in adenoid subsites of children with chronic or recurrent middle ear infections. Ann Otol Rhinol Laryngol 2013; 122:109-13. [PMID: 23534125 DOI: 10.1177/000348941312200206] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Bacterial biofilms have been found in the adenoids of children with recurrent acute otitis media (AOM) and persistent otitis media with effusion (OME). However, the possible difference in biofilm-producing bacteria (BPBs) between the adenoid surface at the nasopharyngeal dome (ND) and near the ostium of the eustachian tube (ET) has not been investigated. This study aimed to assess the difference in BPBs between adenoid biopsy specimens of the ND and those taken near the pharyngeal ostium of the ET in children with chronic adenoiditis with recurrent AOM and/or persistent OME. METHODS We collected adenoid biopsy specimens from the ND and ET during transoral endoscopic adenoidectomy to assess BPB by means of spectrophotometric analysis. RESULTS We collected 135 adenoid biopsy specimens from 45 children. BPBs were detected significantly (p = 0.04) more frequently in the ET samples than in the ND samples, mainly Staphylococcus aureus. Although the prevalence of S aureus was slightly greater in the ND samples, and that of Streptococcus pneumoniae and Moraxella catarrhalis was slightly greater in the ET samples, these differences were not statistically significant. CONCLUSIONS The fact that BPBs were significantly more frequently located near the ostium of the ET suggests that the adenoids are a reservoir for bacteria and indicates that hypertrophic adenoids (particularly hypertrophy near the ostium of the ET) play a role in recurrent AOM and/or OME.
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Affiliation(s)
- Sara Torretta
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
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Rinaldi V, Cappadona M, Gaffuri M, Torretta S, Pignataro L. Chorda tympani nerve, may it have a role in stabilizing middle ear pressure? Med Hypotheses 2013; 80:726-7. [PMID: 23523289 DOI: 10.1016/j.mehy.2013.02.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 02/21/2013] [Accepted: 02/23/2013] [Indexed: 02/06/2023]
Abstract
The chorda tympani (ChT) is a mixed nerve, branch of the facial nerve, crossing the middle ear and containing the preganglionic parasympathetic axons that innervate the sublingual and submandibular glands. The maintenance of a correct middle ear pressure (MEP) is essential for normal ear functions; its regulation has a sophisticated neural control mainly provided by middle ear receptors (tympanic plexus, TP) and Eustachian tube (ET). The information provided by chemoreceptors and baroreceptors of the TP is transmitted to the nuclei of the solitary tract (NST) and then a neural circuit promotes the activation of ET muscles. We hypothesize that the information provided by the TP may modulate submandibular and sublingual glands activity through a neural pathway involving the NST, the superior salivatory nucleus (SSN) and finally the ChT. According to our hypothesis, sudden perturbations of the MEP may stimulate saliva production with consequent swallowing, opening of the Eustachian tube and endotympanic pressure rebalancing.
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Affiliation(s)
- V Rinaldi
- Division of Otolaryngology, Department of Clinical Sciences and Community Health, Fondazione I.R.C.C.S. Cá Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
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Torretta S, Gaffuri M, Cantarella G, Pignataro L. Narrow-band imaging in the diagnosis of vascular nasal lesions. Am J Otolaryngol 2013; 34:75-8. [PMID: 23218114 DOI: 10.1016/j.amjoto.2012.08.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 08/27/2012] [Indexed: 11/27/2022]
Abstract
The management of unilateral nasal lesions can sometimes be a challenge and an ordinary bioptic assessment should be avoided in order to prevent complications due to their possible vascular or meningoencephalic origin. Narrow-band imaging (NBI) endoscopy could improve the diagnosis of vascular nasal formations by enhancing the visualisation of the mucosal microvascular supply. We describe the case of a 68-year-old male patient who was brought to our attention because of a left nasopharyngeal mass that had elsewhere been unsuccessfully biopsied (with conspicuous bleeding) and assessed by means of traditional endoscopic and radiological techniques. NBI endoscopy revealed increased vasculature covering most of the mucosal surface without any features suggestive for malignancy. Subsequent angiography showed that the feeding vessel was the left sphenopalatine artery, which was embolised using 150-250 μm Contour embospheres. The mass was then completely removed surgically using an NBI-assisted endoscopic technique, and a histopathological examination revealed it was a hemangiopericytoma-like (HPCL) tumor. This case suggests the usefulness of NBI endoscopy in diagnosing unilateral vascularised nasal lesions and guiding the therapeutic approach before and during major surgery.
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Cantarella G, Baracca G, Forti S, Gaffuri M, Mazzola R. Etiology-Related Results of Vocal Fold Lipoinjection. Otolaryngol Head Neck Surg 2010. [DOI: 10.1016/j.otohns.2010.06.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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