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Giorgio Peretti

Publications and source records attributed to Giorgio Peretti.

At least 19 recordsLinked to original sources
PubMed2006

Cervical spondylodiscitis: a rare complication after phonatory prosthesis insertion.

BACKGROUND: Tracheoesophageal puncture has excellent voice rehabilitation after total laryngectomy. However, despite its easy insertion and use, severe complications have been reported. METHODS: We report a case of cervical spondylodiscitis, occurring in a 67-year-old woman submitted to phonatory prosthesis insertion. After 1 month, she complained of severe cervicalgia associated with fever. Spondylodiscitis involving C6, C7, and the intervening vertebral disk with medullary compression was detected by means of imaging studies. RESULTS: A right cervicotomy with drainage of necrotic tissue was performed, and a de-epithelialized fasciocutaneous deltopectoral flap was interposed between the neopharynx-esophagus and the prevertebral fascia to protect the neurovascular axis. MR performed 1 month later showed a complete resolution of the infectious process. CONCLUSIONS: Severe neck pain after tracheoesophageal puncture should alert the physician about the possibility of a cervical spondylodiscitis. MR is the most useful imaging technique for preoperative and postoperative evaluation. When neurologic symptoms are detected, surgical exploration of the neck is mandatory.

Aged↗
PubMed2006

A new insight into postsurgical objective voice quality evaluation: application to thyroplastic medialization.

This paper aims at providing new objective parameters and plots, easily understandable and usable by clinicians and logopaedicians, in order to assess voice quality recovering after vocal fold surgery. The proposed software tool performs presurgical and postsurgical comparison of main voice characteristics (fundamental frequency, noise, formants) by means of robust analysis tools, specifically devoted to deal with highly degraded speech signals as those under study. Specifically, we address the problem of quantifying voice quality, before and after medialization thyroplasty, for patients affected by glottis incompetence. Functional evaluation after thyroplastic medialization is commonly based on several approaches: videolaryngostroboscopy (VLS), for morphological aspects evaluation, GRBAS scale and Voice Handicap Index (VHI), relative to perceptive and subjective voice analysis respectively, and Multi-Dimensional Voice Program (MDVP), that provides objective acoustic parameters. While GRBAS has the drawback to entirely rely on perceptive evaluation of trained professionals, MDVP often fails in performing analysis of highly degraded signals, thus preventing from presurgical/postsurgical comparison in such cases. On the contrary, the new tool, being capable to deal with severely corrupted signals, always allows a complete objective analysis. The new parameters are compared to scores obtained with the GRBAS scale and to some MDVP parameters, suitably modified, showing good correlation with them. Hence, the new tool could successfully replace or integrate existing ones. With the proposed approach, deeper insight into voice recovering and its possible changes after surgery can thus be obtained and easily evaluated by the clinician.

Diagnosis, Computer-Assisted↗
PubMed2006

Comparison of functional outcomes after endoscopic versus open-neck supraglottic laryngectomies.

OBJECTIVES: Endoscopic supraglottic laryngectomy (ESL) by carbon dioxide laser for selected T1-T3 supraglottic squamous cell carcinomas is a sound procedure with oncological results comparable to those obtained by open-neck supraglottic laryngectomy (ONSL). The aim of this study was to retrospectively evaluate functional outcomes after ESL in comparison with ONSL. METHODS: We performed perceptual voice evaluation by GRBAS (grade, roughness, breathiness, asthenicity, strain), subjective analysis by Voice Handicap Index, objective analysis with the Multidimensional Voice Program, swallowing evaluation with the M. D. Anderson Dysphagia Inventory, video nasal endoscopic examination of swallowing, videofluoroscopy, and analysis of hospitalization time, need for and duration of feeding tube and tracheotomy, and complication and aspiration pneumonia rates in a group of 14 patients treated with ESL. These results were compared to those obtained in a historical group of 14 patients matched for T category who were treated with ONSL at the same institution. Statistical analysis was performed with the Mann-Whitney U and Pearson chi(2) tests. RESULTS: Comparison of comprehensive voice analysis, M. D. Anderson Dysphagia Inventory, and complication and aspiration rates showed no statistically significant differences between the two groups. However, significant differences were found for video nasal endoscopic examination of swallowing (p = .03), videofluoroscopy (p = .03), hospitalization (p = .0001), feeding tube duration (p = .0001), and tracheotomy duration (p = .0001). CONCLUSIONS: Endoscopic supraglottic laryngectomy had a significantly lower functional impact on swallowing than ONSL, even though it was not subjectively perceived by patients, and was associated with less morbidity and a shorter hospitalization time.

Aged↗
PubMed2005

Penetrating foreign body mimicking supraglottic carcinoma.

Penetrating trauma to the neck is a rare observation. We report the first case of laryngeal myofibroblastic tumor due to a persistent splinter of glass in the preepiglottic space, which presented with recurrent mild hemoptysis and cough, and mimicked supraglottic carcinoma. The clinical and imaging evaluations are herein reported. Finally, medical and surgical options in the management of this unusual observation are discussed.

Aged↗
PubMed2005

Endoscopic treatment of cT2 glottic carcinoma: prognostic impact of different pT subcategories.

OBJECTIVES: The cT2 glottic squamous cell carcinomas are a heterogeneous group of lesions in terms of superficial and deep extension. As a consequence, they differ greatly in treatment indications and prognosis. The aim of the present study was to divide cT2 glottic tumors into subcategories according to radiologic and postoperative histopathologic information, in order to identify risk factors connected with determinate survival, local-regional control, and laryngeal preservation rates. METHODS: We retrospectively analyzed 55 cT2 glottic lesions treated at a single institution by carbon dioxide laser with at least 2 years of follow-up. Clinical, radiologic, surgical, and histopathologic data were reviewed, and the tumors were accordingly divided into 5 subcategories: I, or pT2 with lateral supraglottic extension (19 patients); II, or pT2 with lateral subglottic extension (6 patients); III, or pT2 with supracommissural and/or subcommissural extension (10 patients); IV, or pT2 with deep vocal muscle infiltration (14 patients); and V, or pT3, for superior and/or inferior paraglottic space invasion lateral to the thyroarytenoid muscle not detected before operation by computed tomographic scan (6 patients). RESULTS: The disease-free survival, ultimate local control with laser alone, and laryngeal preservation rates were compared for each subcategory. Statistically significant differences were found only for the pT3 subgroup (2-year rates of 16.7%, 16.7%, and 16.7% for pT3 versus 5-year rates of 80.5%, 84.7%, and 93.3% for the entire pT2 group). CONCLUSIONS: Endoscopic treatment of cT2 glottic tumors can be considered effective when the pT2 stage has been confirmed. In cT2/pT3 patients, after the first endoscopic resection that allows the correct pT staging, additional treatment should always be considered.

Adult↗
PubMed2004

Diagnostic accuracy of magnetic resonance imaging in the assessment of mandibular involvement in oral-oropharyngeal squamous cell carcinoma: a prospective study.

OBJECTIVE: To evaluate the sensitivity, specificity, accuracy, and predictive values of magnetic resonance imaging (MRI) in the assessment of mandibular involvement in oral-oropharyngeal squamous cell carcinoma. DESIGN: Prospective study. SETTING: University hospital. PATIENTS: Forty-three patients with oral or oropharyngeal squamous cell carcinoma undergoing marginal or segmental mandibulectomy between January 1, 1994, and January 31, 2003. INTERVENTIONS: Indications for mandibulectomy were MRIs suggestive of bony invasion, tumor involving the retromolar trigone or the alveolar ridge, recurrent or persistent lesion, or intraoperative suspicion of periosteal invasion. Detection of tumor signal replacing the hypointense cortical rim was considered the main radiologic finding for mandibular invasion. MAIN OUTCOME MEASURES: The MRI findings were subsequently compared with histopathologic data of surgical specimens with reference to the presence of cortical and/or medullary mandibular involvement. RESULTS: Sixteen patients had MRI findings suggestive of mandibular involvement. Segmental mandibulectomy was performed in 15 cases and marginal resection in the remaining case. In 14 patients, bony invasion was confirmed. All of the other 27 patients who underwent marginal or segmental mandibulectomy with negative MRI findings had no histopathologic evidence of mandibular involvement, except in 1 patient: on histopathologic examination, despite cortical integrity, neoplastic vascular embolization into the bony lacunae was detected. Sensitivity of MRI in detecting mandibular involvement was 93%; specificity, 93%; accuracy, 93%; and negative and positive predictive values, 96% and 87.5%, respectively. CONCLUSIONS: Magnetic resonance imaging is commonly considered the technique of choice for treatment planning in advanced oral and oropharyngeal squamous cell carcinoma because of its accuracy in depicting soft-tissue involvement. This study demonstrates the additional diagnostic value of MRI in detecting bone invasion.

Adult↗
PubMed2004

Carbon dioxide laser salvage surgery after radiotherapy failure in T1 and T2 glottic carcinoma.

OBJECTIVES: Recurrent glottic carcinoma after radiotherapy (RT) may be managed by open neck or endoscopic surgery. The impact of endoscopic treatment with CO(2) laser for recurrent glottic carcinoma after RT is reported. METHODS: We present the oncologic and vocal outcomes of a retrospective study based on a series of 16 patients with rT1 and rT2 glottic carcinoma who were endoscopically managed between February 1995 and December 1999 after RT failure. All patients were males with a mean age of 68.7 years (range, 50 to 87 years). Before RT, the lesions had been staged as T1 N0 in 11 patients and T2 N0 in 5, and after RT as rT1 N0 in 12 and rT2 N0 in 4. According to the European Laryngological Society classification, a total of 9 transmuscular, 3 total, and 4 extended cordectomies were performed. Mean follow-up was 45 months (range, 9 to 79 months). RESULTS: Endoscopic salvage surgery was successful in 14 patients. One of them developed a second recurrence and was definitively cured with an additional endoscopic procedure. Two of the 16 patients had recurrent disease after salvage laser surgery and died due to progression of disease. Ultimate local control with laser alone at 3 years was 87.1%, according to the Kaplan-Meier method. Laryngeal preservation was obtained in all survivors after endoscopic rescue surgery. Voice analysis showed a clear correlation between the amount of vocal cord tissue resected and decrease of the vocal outcome. CONCLUSIONS: The present series indicates that selected recurrences after primary RT for T1 and T2 glottic carcinoma are eligible for endoscopic salvage surgery with oncologic results comparable to those with open neck procedures but with a lower complication rate and a favorable functional outcome.

Aged↗
PubMed2004

Analysis of recurrences in 322 Tis, T1, or T2 glottic carcinomas treated by carbon dioxide laser.

An endoscopic approach to early glottic carcinoma is considered a sound treatment for both previously untreated lesions and selected recurrent lesions. Between January 1988 and December 2000, we treated 322 patients by CO2 laser at a single institution; 37 had Tis, 191 T1a, 55 T1b, and 39 T2 lesions (mean follow-up, 77 months; range, 6 to 180 months). Kaplan-Meier curves showed a 5-year overall survival rate of 88%, a determinate survival rate of 99%, a disease-free survival rate of 81%, a rate of ultimate local control with laser alone of 91%, and a laryngeal preservation rate of 97%. Univariate and multivariate analysis showed that the only factor that statistically affected endoscopic control was lateral extension of the tumor with involvement of the bottom of the ventricle (hazard risk ratio, 4.0; 95% confidence interval, 1.71 to 9.35). The 58 recurrences were classified according to their location compared with the site of the primary tumor as follows: 14 in the same area (group A), 27 in adjacent subsites with superficial spreading or multifocal distribution (group B), and 17 in adjacent sites by submucosal diffusion to the visceral spaces, cartilaginous framework, or extralaryngeal tissues (group C). For each group, we analyzed the rate of patients who underwent salvage by endoscopic or open neck procedures and the rate of laryngeal preservation. Recurrences in groups A and B were endoscopically treated in 86% and 74% of cases, respectively. By contrast, in group C no patient was endoscopically cured, and there was a low laryngeal preservation rate (47%). The pathways of spread in recurrent carcinoma are therefore the single most important factor in predicting its endoscopic curability.

Adult↗
PubMed2003

Thyroid metastasis from rectal adenocarcinoma involving the airway treated by crico-tracheal resection and anastomosis: the role of palliative surgery.

A 59-year-old woman underwent surgical removal of a pT3N3M0 rectal adenocarcinoma (RAC) through an abdominal-perineal approach followed by chemoradiotherapy (CHT-RT) in 1995. She underwent a right inferior lobectomy for a lung metastasis 3 years later, followed in 2000 by an additional intervention for a second metastasis that was treated by a left superior atypical lobectomy and CHT. The patient complained 1 year later of dysphagia and an anterior neck mass was found. US examination detected a multifocal lesion in the thyroid gland with involvement of the strap muscles, which was confirmed by FNAB to be a third RAC metastasis. A palliative course of RT was performed, but no regression of the lesion was observed. Crico-tracheal infiltration was also suspected after CT scan. The patient was in good general condition and strongly favored surgery. In August 2001 she underwent total thyroidectomy, total parathyroidectomy, strap muscles excision, central compartment neck dissection and crico-tracheal resection and anastomosis involving the anterior arch of the cricoid between the crico-thyroid joints and the first three tracheal rings. She was extubated at the end of the surgical procedure with no tracheotomy, started an oral diet the day after, and was discharged without complications 9 days later. She was followed up monthly by endoscopy and has undergone one CT and two MR scans at 6-month intervals. The patient had no RAC recurrence in the neck when last seen 26 months after surgery. During this time, she underwent four further lung metastasectomies followed by CHT.

Adenocarcinoma↗
PubMed2003

Pre- and intraoperative assessment of mid-cord erythroleukoplakias: a prospective study on 52 patients.

A pre- and intraoperative evaluation by videolaryngostroboscopy (VLS) and saline infusion (SI) into Reinke's space was prospectively applied to a cohort of 52 patients with mid-vocal cord erythroleukoplakias observed at our institution between January 1997 and June 1999. These tests were done to predict the invasion of the layered structure of the lamina propria and consequently determine the deep extent of the excisional biopsy to be carried out. According to the results of these examinations, carbon dioxide laser resections were performed as follows: 25 Type I, 17 Type II and 10 Type III cordectomies according to the European Laryngological Society Classification. Histopathologic diagnoses were keratosis without atypia in 13 patients, keratosis with mild, moderate or severe dysplasia in 8, 3 and 5, respectively, microinvasive carcinoma in 12 and invasive carcinoma in 11. By comparing the type of resection with the pathologic diagnosis obtained on the specimen and its surgical margins, we estimated the number of under- and overtreatments. In addition, an assessment was made on specificity, sensitivity, positive and negative predictive values and accuracy of VLS and SI, both independently and in combination. Thirty-eight patients (73%) received the correct type of resection, 1 patient (2%) an undertreatment and 13 (25%) an overtreatment. VLS and SI showed a specificity, sensitivity, positive and negative predictive values and accuracy of 82, 100, 94, 100, 97% and 90, 83, 86, 87 and 87%, respectively. The VLS/SI combination raised the values to 89, 100, 88, 100 and 94%. The 4-year overall and disease-free survival and ultimate local control with laser alone were 90, 94 and 100%.

Adult↗
PubMed2003

Head and neck intramuscular haemangioma: report of two cases with unusual localization.

Head and neck intramuscular haemangioma (IMH) is a benign, uncommon neoplasm arising most frequently in the masseter and trapezius muscles. It usually appears as an enlarging mass without specific clinical features and is therefore frequently misdiagnosed. We report two cases of IMH at unusual localizations: one involving the pterygoid muscles in a 30-year-old female and another one originating from the thyrohyoid muscles in a 38-year-old male. Preoperative evaluation included routine ENT examination, ultrasound (US) and CT scan. The preoperative clinical diagnoses were lymphangioma of the parapharyngeal space in the first case and atypical thyroid duct cyst in the second. Both patients were treated with open-neck approaches. The histopathologic diagnosis was capillary-type IMH in the first patient and cavernous-type IMH in the second. Postoperative courses were uneventful, and the patients were discharged within a few days. Clinical and US follow-ups were negative at 50 and 20 months, respectively. Preoperative diagnosis of head and neck IMH is rendered difficult by its rarity and non-specific clinical findings. Ample surgical excision is required for an adequate cure due to the frequent microscopically infiltrative pattern of diffusion of such a tumor into skeletal muscles, and long-term follow-up is mandatory to promptly treat any recurrence.

Adult↗
PubMed2003

Endoscopic management of laryngo-tracheobronchial amyloidosis: a series of 32 patients.

Between June 1983 and December 2002, 32 patients were treated for primary localized laryngo-tracheobronchial amyloidosis (LTBA) at our institution. For enrollment in this retrospective study, at least one positive biopsy with Congo red stain and a diagnostic test battery excluding systemic or secondary amyloidosis were mandatory. The most common presenting symptom was dyspnea, which was observed in 75% of cases. Endoscopic appearance was described as submucosal plaques and nodules with a cobblestone appearance in 44% of patients, tumor-like in 28% and circumferential wall thickening in 28% of cases. Tracheobronchopatia osteochondroplastica was associated with LTBA in 22% of patients, both at the first treatment (four cases) or during follow-up examinations (three). Synchronous or metachronous disease in the larynx and tracheobronchial tree was observed in 47% of cases, while only one patient showed lung involvement with extensive amyloidosis of the trachea and bronchi. All but two patients were endoscopically treated. One of these was affected by a tracheal amyloidoma cured by endoscopic debulking and further tracheal resection-anastomosis. The other patient presented massive laryngo-pharyngeal involvement and was therefore treated by total laryngectomy. A total of 58 endoscopic procedures (range: 1-7; mean: two per patient) were carried out, 11 with CO2 laser (for supraglottic, glottic and selected subglottic lesions) and 47 with Nd:YAG laser (for the most part of subglottic lesions and amyloid deposits located in trachea and bronchi). Four patients required a tracheotomy and three necessitated a T-tube stent during management, which was subsequently removed in all cases. One patient was lost to follow-up, nine were endoscopically controlled elsewhere (Group A) and 22 were followed at our institution (Group B). In Group A, the patient with tracheal amyloidoma is asymptomatic and free of additional LTBA localizations 8 years after surgery. The remaining eight are asymptomatic, but with persistent endoscopic signs of amyloidosis. In Group B, five patients died: one from heart failure and another one from pneumonia 3 and 4 days after surgery, respectively. In one case death was from unrelated causes, and in the two remaining patients it was from respiratory failure due to uncontrolled bilateral bronchial amyloidosis in the subsequent 5 to 6 years. One patient is completely cured 5 years after surgery, and 16 are asymptomatic with persistence of LTBA.

Adult↗
PubMed2003

Vocal outcome after endoscopic cordectomies for Tis and T1 glottic carcinomas.

A cohort of 101 patients with previously untreated glottic cancer (15 Tis, 66 T1a, and 20 T1b) who underwent endoscopic CO2 laser excision between January 1995 and December 1997 was prospectively analyzed. The depth and extension of the excision were graded according to the European Laryngological Society Classification including 5 types of cordectomy. All patients were subsequently examined every 2 months for a period ranging from 30 to 66 months (mean, 48 months). The rates of 5-year overall survival, disease-free survival, ultimate local control with laser alone, and laryngeal preservation were 85%, 87%, 93%, and 95%, respectively. Sixty-nine patients underwent, at least 1 year after surgery, videolaryngostroboscopy combined with perceptual and objective evaluation of the voice, and spirometry. Acoustic parameters were compared with those obtained in a matched control group by Kruskal-Wallis test. No statistically significant difference was found (p > .05) between patients submitted to subepithelial (type I) and subligamental (type II) cordectomies and controls.

Adult↗
PubMed2003

Preoperative and postoperative voice in Tis-T1 glottic cancer treated by endoscopic cordectomy: an additional issue for patient counseling.

Radiotherapy contends with endoscopic surgery for the role of treatment of choice for Tis-T1 glottic cancer. The amount of vocal cord to be surgically removed logically depends on the surface and deep extension of the neoplasm. Thus, a prerequisite for proper management includes an analysis of the voice changes after each of the progressive types of cordectomy described in the European Laryngological Society Classification. Between January 1998 and December 2000, 89 patients with glottic cancer (8 Tis, 63 T1a, 18 T1b) underwent different types of endoscopic cordectomy. Perceptual analysis (GRBAS scale); objective analyses of jitter, shimmer, and noise-to-harmonics ratio; and subjective (Voice Handicap Index) evaluation of voice were performed in 51 patients. Statistical evaluation of preoperative and postoperative objective results by analysis of covariance, as well as perceptual and subjective data, showed significant voice improvement after type I and II cordectomies, with the voice attaining nearly normal parameters. By contrast, after type III, IV, and V cordectomies, the vocal outcome was not significantly different from the preoperative pattern. It can therefore be concluded that type I and II resections, whenever indicated, are adequate procedures even for professional voice users. By contrast, accurate counseling is mandatory before type III, IV, and V cordectomies.

Aged↗
PubMed2002

Idiopathic subglottic stenosis: management by endoscopic and open-neck surgery in a series of 30 patients.

We describe our experience in the diagnosis and treatment of idiopathic subglottic stenosis (ISS), a rare pathological entity involving the subglottic larynx and the first tracheal rings and affecting virtually only females. Its diagnosis can be made only after the exclusion of all other known causes of subglottic stenosis. In a 17-year period, between January 1986 and June 2002, 30 patients were admitted and treated for ISS at the Department of Otolaryngology and/or the Center for Respiratory Endoscopy and Laser Therapy, the University of Brescia, Italy. Clinical, endoscopic and surgical records were retrospectively analyzed with particular emphasis on treatment (endoscopic versus open-neck procedures) and follow-up. Based on our experience, we can define endoscopic treatment by carbon dioxide or Nd:YAG laser-assisted dilatation and scar tissue resection with or without airway stenting as the treatment of choice for the initial management of ISS. After repeated endoscopic failures, open-neck surgery by laryngoplasty or laryngotracheal resection and anastomosis is strongly recommended, particularly for complex lesions longer than 1 cm.

Adult↗