PubMed Health⌕ Search

Biomedical subjects

F Marzetti

Publications and source records attributed to F Marzetti.

31 records · Page 2Linked to original sources
PubMedDate not supplied

[Results of a national survey on the treatment of the facial nerve in malignant tumors of the parotid gland].

The rare diagnosis of parotid malignant tumors, the different clinico-biological behavior of each histological type and the lack of agreement concerning surgical procedures to be followed in treating the facial nerve led the Authors to carry out a national survey on malignant parotid tumors and their treatment. A questionnaire concerning problems inherent to facial nerve treatment in malignant tumors of the parotid gland was sent to 69 ENT Departments. Data on 139 patients (69 females and 70 males, mean age--59.9 years) were collected for this study. Facial nerve function deficits occurred in 25.9% of the patients, primarily in cases of adenoid cystic carcinoma, adenocarcinoma and undifferentiated carcinoma. Clinical findings were not a good guide in choosing the best surgical procedure to be used with the VII nerve. In fact, in 17% of the cases with no facial deficit, a neural infiltration was found intraoperatively. Total parotidectomy with facial nerve sacrifice (PTST or PTSP) was performed in 87.6% of the patients with complete facial deficit and in 80% of the patients with partial deficit. A more conservative approach was followed when the facial nerve was compressed but not infiltrated. Only 71.7% of the patients with facial nerve infiltration underwent post-operative radiotherapy, a fact which is probably explained by the few departments of radiotherapy in existence. While the functional results reported in Literature are good, facial nerve repairs were carried out in this study in only 9% of the cases. The present study, which supplies interesting data on the treatment of the facial nerve in parotid gland malignant tumors, confirms the need of a multidisciplinary approach and a more frequent use of neural repair techniques in order to preserve the aesthetic and functional aspects of the facial nerve.

Adenocarcinoma↗
PubMedDate not supplied

[Overtreatment in advanced tumors of the head and neck].

So-called "over-treatment" in the practical management of advanced head and neck tumors is a very important problem in terms of its professional, ethical, moral and legal implications, that involve the physician in the therapeutic decision he must make. After presenting the general aspects of the subject, the chairman, together with all those participating in the Round Table, deals with the most important points of the problem: the definition of overtreatment, the limits of treatment, nontreatment, passive euthanasia, informed consent and quality of life. The various aspects of the problem have been dealt with and discussed from the point of view of the surgeon, the expert in bio-ethics and the magistrate. After comparing the different opinions, the most important point, in terms of a therapeutic choice, should be the patient's quality of life, whose improvement justifies every therapeutic strategy. Given that the advances in surgery, either demolitive or above all reconstructive, have made almost every operation technically possible, attention has been concentrated on overtreatment in nonsurgical therapies. In extremely advanced tumors, radio- and chemotherapy are often burdened by side effects and sequelae that lead to a quality of life at the limits of biological supportability. The Round Table ends with the presentation of emblematic case reports, followed by a vivacious discussion, also with those in the audience, that was basically in agreement with the therapeutic choices made.

Adolescent↗
PubMedDate not supplied

[Total/near-total glossectomy for advanced carcinoma of the tongue].

Poor survival rates and the limited palliation afforded by radiotherapy alone, together with progress made in reconstructive surgery in restoring mucosal continuity after large resections, make total glossectomy reasonably indicated for treatment of advanced carcinoma of the tongue. The Authors reviewed 19 cases (17 males, 2 females, mean age 58.4 years) of total and near total glossectomy without laryngectomy treated at National Cancer Institute "Regina Elena" of Rome from 1990 to 1993 in order to evaluate oncological and functional results. All patients were reconstructed immediately, 16 with a pectoralis major flap, 2 with a nasolabial flap and 1 with a radial forearm free flap and were available for follow-up from 6 to 45 months (mean 29 months). There was no operative mortality and no patient needed total laryngectomy for aspiration. The rate of local recurrencies was 52.6%, most of them (75%) in patients who had undergone total/near total glossectomy for recurrence. Survival rate was 61.5% after 1 year and 20% after 2 years. 94% of patients resumed swallowing and independent oral alimentation (48% of them without any dysphagia); 84%; of the patients were decannulated and 48% produced easily intellegible speech. Data from our experience let us conclude that, in the light of the acceptable functional results obtained with reconstructive flaps, total glossectomy should be considered as the primary treatment modality in advanced carcinoma of the tongue (including T2 > 3 cm exceeding midline), and should not be reserved only for salvaging hopeless situations.

Adult↗
PubMedDate not supplied

[The recurrent multifocal pleomorphic adenoma].

Pleomorphic adenoma (P.A.), the most common tumor of the salivary gland, demonstrates a peculiar clinicopathological behaviour for numerous reasons: the high recurrence rate following primary surgery (up to 50%), the appearance of malignancy (2-9%), the reported number of distant metastases histologically identical to the primary P.A. From among 71 cases of benign parotid tumors treated from Nov. 89 to Nov. 92 in the ENT Department of "Regina Elena", the National Cancer Institute in Rome, six particular cases showed multiple force of P.A. recurring after primary surgery performed from 3 to 32 years previously and are object of discussion in this study. All of these six cases had multiple recurrences, usually manifest as nodular clusters in the parotid area, while in three cases appeared as well a recurrence in the soft tissue of the neck, far removed from the parotid space, with no involvement of neck nodes as was revealed through histological examination following neck dissection. A hypothetical mechanism of diffusion is discussed. The Authors agree with the opinion which holds the surgeon's inability to successfully eradicate primary tumors responsible for the high frequency of recurrences. The surgical technique of "enucleation" is, in fact, inadequate in P.A. excision owing the high risk of mishandling or rupturing the tumor capsule with a consequent seeding of the tumor onto the surgical bed. Lateral lobectomy, with identification of the facial nerve, or total conservative parotidectomy (for deep lobe adenoma) are correct techniques in treating primary P.A.. The Authors also discuss management of recurrent P.A. in relation to facial nerve involvement. Preservation of the seventh nerve with eventual post-operative radiation should be considered an alternative to nerve sacrifice in selected cases of recurrent pleomorphic adenoma.

Adenoma, Pleomorphic↗
PubMedDate not supplied

[Morbidity and the morphofunctional aspects of myocutaneous flaps used in the head and neck area].

The authors analysed the data obtained from their experiences in extensive head and neck resections as well as reconstructive treatments using myocutaneous flaps. They tried to evaluate the reconstructive approach in terms of morbidity and functional results. Sixty-nine patients, treated from January 90 to November 92 for advances intra-oral cancer, were considered in this study. The reconstructive procedure in 68 cases was the pectoralis major myocutaneous flap while in 5 cases the trapezius flap was utilized. Even though the oncological results were poor, the functional ones were quite encouraging. In fact, the assessment of speech and swallowing was extremely satisfactory in 83% of the cases. The morbidity related to both flap procedures was low and the patients' life quality was good. Indeed, the use of a free flap offers additional advantages, without necessarily compromising safety of the reconstruction. Free flaps in general allow greater leeway in flap design and donor-site choice than pedicled flaps. Several reports have already demonstrated the versatility, usefulness and reliability of these flaps, especially in intra-oral reconstruction. The intricate nature of microsurgery and the expense of microsurgical equipment inhibit this kind surgery in many institutions around the world where the standard myocutaneous flaps would be a more practical procedure. In conclusion, even those patients with a poor prognosis may be considered potential candidates for demolitive and reconstructive treatment with which satisfactory results may be obtained.

Adult↗