Search

The objective of this manuscript was to review the indications, efficacy, and safety of a 585 nm pulsed dye laser (PDL) in non-malignant laryngeal lesions. Following the PRISMA statement recommendations, three independent authors searched for articles published in PubMed/MEDLINE, the Cochrane Library, Google Scholar, Scielo, and Web of Science. A bias analysis was performed following NICE guidance tools. From the 506 identified publications, 19 observational studies met the inclusion criteria. The PDL improves vocal quality objectively and subjectively in vascular lesions ( p < 0.005) and improves vocal quality in patients with dysplasia/leukoplasia without changing the natural history of the disease compared to other treatments. Reinke's edema and granulomas require an average of 1.5 PDL sessions for resolution. Treatment of recurrent respiratory papillomatosis requires multiple sessions, with complete remission achieved in 50-70% of patients. Regardless of the lesion, the tolerance of the procedure under local anesthesia is exceptional (84-97%), and the results in terms of regression and vocal quality are promising. The complication rate is minimal, and the procedure does not interfere with other treatment alternatives. There is no consensus on laser settings. The lack of consistent use in evaluating vocal outcomes, whether objective or subjective, prevents the comparability between studies. The 585 nm pulsed dye laser appears to be an effective and safe therapeutic option in patients with non-malignant laryngeal pathology. Future controlled studies are needed to compare the 585 nm pulsed dye laser with other lasers or cold instrument procedures.

Pseudoankylosis of the temporomandibular joint is a rare, extra-articular form of ankylosis of the jaw. It is characterised by limited mandibular movement caused by an extrinsic condition of the joint leading to fusion between the coronoid process and temporal, zygomatic or maxillary bone. Pseudoankylosis is less frequent than the intracapsular form. Extracapsular ankylosis can be congenital or acquired; approximately 70% of cases are associated with trauma. A CT scan is usually requested to achieve a diagnosis. CT can detect bony fusion, thus differentiating pseudoankylosis from true ankylosis. Once symptomatic bone ankylosis is diagnosed, surgery with postoperative physiotherapy is the recommended treatment. The ankylotic bone is removed together with the coronoid process and the mouth is forced open under general anaesthesia. Two cases of post-traumatic pseudoankylosis of the jaw treated with bilateral coronoidectomy and postoperative physiotherapy are described., (2015 BMJ Publishing Group Ltd.)

A 45-year-old woman with left facial palsy presented to our department. She developed the condition after radical resection of a neurinoma of the homolateral VIII cranial nerve 2 years prior. On physical examination, a complete palsy of the lower third of the face was reported. Electromyographic examination showed no fibrillation potentials in mimic muscles. A latissimus dorsi muscle free flap (6 cm × 3 cm), split into two bellies linked by their own neurovascular pedicle, was used to restore full-mouth smile. Ten years after surgery, the patient showed a near-natural smile without need of any ancillary procedure., (2015 BMJ Publishing Group Ltd.)

Warthin's tumour is the second most common benign neoplasm to affect the salivary glands. It virtually affects the sole parotid gland. A sudden increase in a tumour's size is usually due to a malignant transformation of the tumour. The transformation of the lymphoid stroma into malignant lymphoma is relatively common, while an epithelial malignancy is extremely rare. In this paper, the authors present a case of squamous cell carcinoma arising in Warthin's tumour. The patient underwent enucleoresection of the tumour. Intraoperative frozen section revealed the presence of a cystic component associated with the squamous cell carcinoma areas. In consideration of the result of the intraoperative consultation, the surgeons decided to enlarge the previous resection by removal of a 30×25 mm cuff from the surrounding parotid tissue. Close follow-up was carried out and 12 months after surgery there was no evidence of recurrence or metastatic neoplasm., (2014 BMJ Publishing Group Ltd.)

We present a rare case of a 47-year-old woman admitted to our maxillofacial surgery department for a large cervicofacial venous malformation. The patient underwent fluoroscopy-guided intralesional foam sclerotherapy with sodium tetradecyl sulfate and air under general anaesthesia. On awakening, after 48 h of endotracheal intubation, she displayed dysarthria and dysmetria. Her brain CT scan showed no haemorrhagic lesions. A chest CT scan ruled out a potential pulmonary embolism. Suspicion for a paradoxical embolism was high and echocardiography confirmed a patent foramen ovale, which acted as a passageway for the embolus. Transcranial ultrasound showed mild right-to-left heart shunting. The dysarthria and dysmetria disappeared gradually over 48 h, thus confirming a reversible ischaemic neurological deficit. A brain MRI performed 1 week later showed no ischaemic or haemorrhagic lesions. The patient recovered completely. She was advised cardiosurgical follow-up and discharged., (2014 BMJ Publishing Group Ltd.)

Patients affected by facial palsy suffer from failure to fully close the eyelids; the resulting eye exposure can lead to dry eye syndrome, loss of epithelial integrity, corneal ulceration and infections. Corneal anaesthesia exacerbates risk of corneal damage in these patients. Eyelid paralysis-associated corneal lesions may induce severe visual impairment, for which the ideal treatment is corneal transplantation, a procedure contraindicated in patients with corneal sensitivity and inadequate eyelid closure. We present the case of a patient affected by unilateral facial palsy associated with corneal anaesthesia, due to seventh and fifth cranial nerve damage following homolateral eighth cranial nerve surgery. The patient underwent surgery to re-establish eyelid and corneal competence, and then received a corneal graft with consequent amelioration of visual acuity. This is the first case of associated corneal anaesthesia and facial palsy that was comprehensively treated with a set of surgical procedures, including a corneal transplant., (2014 BMJ Publishing Group Ltd.)

The case of a recurrent phosphaturic mesenchymal tumour of the maxillary sinus 10 years after the first surgical excision is reported. The neoplasm first presented with paraneoplastic osteomalacia causing a pathological femur fracture. A right maxillary sinus tumour was identified and treated thereafter. The patient had no local symptoms and serum electrolytes returned to normal after surgical removal of the tumour. However, 10 years later, the patient's urine Ca and P levels increased and an octreoscan detected a new tumour in the right maxillary sinus. Early diagnosis prevented the effects of the paraneoplastic activity of the neoplasm. This case emphasises the importance of specific, close follow-up, because the neoplasm rarely produces local signs indicating its position. To our knowledge, this is the first reported case of a late relapse presenting without relevant symptoms (local pain or swelling or pathological fractures)., (2014 BMJ Publishing Group Ltd.)

'Clown nose' (CN) is the common medical term referring to a reddish-brown bulge involving the tip of the nose, reminding of a clown's fake red nose. Reports about these tumours are scarce. Most reports refer to metastatic skin manifestation of systemic malignancies: this condition has been rarely described as a primary skin neoplasm. We report a case of a 31-year-old patient with a giant cutaneous squamous cell carcinoma of the nose which evolved into a CN. After ruling out genetic or immune risk factors, the patient was treated with surgical excision of the lesion and local reconstruction with good aesthetic outcome and no recurrence over a 2-year follow-up.

In 2009, a 57-year-old man was referred to our maxillo facial surgery department for the appearance of a reddish-purplish swelling on his right helix. The lesion was more than 1 cm in length and did not show changes for 3 months. He was otherwise healthy, without any predisposing factors. The patient denied smoking, alcohol misuse and intravenous drug use. He had no family history of similar lesions or Kaposi's sarcoma . The lesion was completely excised and the surgical defect reconstructed with a local flap. In 2011 the same patient returned to our attention because of the appearance of a new lesion, similar to the first one on the other auricle. The lesion was completely removed. The same situation recurred in September 2012, when the patient presented a new little reddish-purplish swelling of 3 mm on the left helix. The lesion was excised. The patient has not reported further lesion at present.