SUMMARYFine-needle aspiration cytology guided by ultrasound imaging is a widely used diagnostic tool to evaluate neoplastic or inflammatory lesions of salivary glands. From February 2002 to February 2008 all the parotid lesions removed surgically in our Unit of Otolaryngology were reviewed. Study focused on sensitivity, specificity, accuracy, predictive values, likelihood ratios, and Kappa statistics for fine-needle aspiration cytology vs histological diagnosis in 176 cases. Fine-needle aspiration cytology sensitivity and specificity were 81% and 99%, respectively. Accuracy for malignancy was 97%, accuracy for benignity was 83%; positive and negative predictive values were 93% and 98%, respectively; likelihood ratio of positive and negative test results were 100.3 and 0.19, respectively ("positive" was used to define "malignant"). The prevalence of malignancy was 0.114. Kappa statistics for the degree of agreement between fine-needle aspiration cytology and histological results were 0.85 (95% CI = 0.71-0.99). Pre-operative fine-needle aspiration cytology diagnosis improves surgical treatment of parotid masses.

Esistono numerose strategie terapeutiche per il trattamento del carcinoma glottico in stadio iniziale (Tis/T1/T2): la laringectomia parziale a cielo aperto, la radioterapia e la chirurgia endoscopica condotta mediante laser CO2. In particolare quest’ultimo approccio ha gradualmente, ma inesorabilmente, acquisito un ruolo sempre più centrale nel management del cancro laringeo. In questo lavoro presentiamo la nostra esperienza in materia di chirurgia endoscopica laser-assistita delle neoplasie glottiche in stadio iniziale. è stata realizzata un’analisi retrospettiva su un campione di 72 pazienti affetti da carcinoma glottico in classe T1-T2 trattati con cordectomia laser endoscopica nel periodo compreso tra il 2006 e il 2012. Tutti i pazienti avevano almeno 36 mesi di follow-up. La disease-specific survival, la disease-free survival (DFS) e il tasso di preservazione laringea rilevati con il presente studio sono stati rispettivamente del 98,6%, 84,7% e 97,2%. Analizzando l’influenza sull’outcome oncologico a lungo termine di alcune tra le principali caratteristiche della malattia o del trattamento eseguito, abbiamo riscontrato come il coinvolgimento da parte del tumore della commissura anteriore e lo staging patologico della neoplasia (pT) correlino significativamente con un aumentato tasso di recidiva locale (p = 0,021 e p = 0,035) e con una ridotta DFS (p = 0,017 e p = 0,023). Gli altri parametri presi in esame, come staging clinico, tipo di cordectomia, coinvolgimento di altre specifiche sottosedi laringee e stato dei margini di resezione, non si sono dimostrati, invece, correlare significativamente con gli endpoint oncologici stabiliti. La chirurgia endoscopica laser-assistita è quindi una tecnica estremamente affidabile per il trattamento dei tumori glottici in stadio iniziale in termini di outcome oncologico. Il tasso di recidiva risulta significativamente influenzato dal coinvolgimento della commissura anteriore e dal pT.

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POSTERSResults: Fifty neck dissections (ND) were performed in 28 patients (positive nodes in 47.7%). The NM occurred in 22.2%, 60%, 70%, and 66.6% of patients with esophageal, pyriform sinus, retrocricoid, and laryngeal carcinomas, respectively. The number of neck nodes averaged 22.8 to 27.5 nodes per ND (positive in 12.5%) and was concentrated in levels II, III, and IV (84.3%). Extra capsular invasion (IE) occurred in 80.9%. Eighteen (48.6%) out of 37 patients had MM. MM occurred in 16.6%, 47.2%, and 64.2% of the patients with laryngeal, hypopharyngeal, and esophageal Ca, respectively. MD yielded 222 nodes, positive in 17%. EI occurred in 33%. Conclusion:A high number of ND was done with positive nodes in most therapeutic ND and nearly 50% of selective ND. EI was high (80.9%). Selective ND may suffice in esophageal carcinomas (NM in 22.2%). MM was significant, cervical esophageal carcinomas (64.2%) occurrence of MM in 47.2% of hypopharyngeal was disturbing. Head and Neck Surgery Method:We describe the surgical approach to a submandibular mass in a young boy. Results:The patient had a preoperative evaluation with a ultrasound examination that showed a well-defined, disomogeneous lesion of 50 × 36 × 36 mm of the left submandibular region. Magnetic resonance imaging showed a lesion of the submandibular space, extended to the left parapharyngeal space. This lesion had disomogeneous enhancement and a diameter of 6 cm. The patient underwent a fine needle aspiration cytology of the lesion that resulted compatible with a pleomorphic adenoma.The patient underwent the surgical excision of the lesion.The lesion occupied the left parapharyngeal space. The histological examination defined the lesion as a neurinoma of the parapharyngeal space. Conclusion:A neurinoma of the parapharyngeal space should be considered in the evaluation of the submandibular masses. Method: Present a series of 7 cases from the past year at a single academic institution where ultrasound was used in a novel way to enhance patient care. Compare the ultrasound images obtained with other imaging modalities. Head and Neck SurgeryResults: Three patients underwent ultrasound-guided fineneedle aspiration (FNA) of tongue base tumors, which avoided the necessity of a tracheotomy in 1 patient with a difficult airway. Two patients underwent ultrasound-guided FNA of supraglottic tumors through the thyrohyoid membrane, which obviated the need for biopsy with general anesthesia. One noncancer patient had a highly metabolic enlarged lymph node on PET/CT though it demonstrated benign characteristics on ultrasound. Both ultrasound-guided FNA and incisional biopsy confirmed the lymph node's benignity. One patient had a vallecular foreign body seen on ultrasound but not on flexible laryngoscopy, and it was retrieved in the operating room. Conclusion:Ultrasound can be used to guide FNA for tissue diagnosis from tongue base and larynx tumors. Ultrasoundguided FNA may eliminate the need for biopsy under general anesthesia for some patients. Ultrasound has an expanding a...

frequency so that soft tissue (nerve, vessel, dura mater, etc) will not be damaged even on accidental contact with the cutting tip; this renders the piezoelectric device suitable for bone surgery. Rhytidectomy Approach to the Excision of a Branchial CystLucia Oriella Piccioni, MD (presenter); Daniela Sarandria, MD; Pietro Limardo, MD; Mario Bussi, MD OBJECTIVE: Branchial cysts are congenital anomalies of the branchial apparatus related to the partial obliteration of a branchial sulcus. They are usually located anterior to the sternocleidomastoid muscle. The treatment is complete surgical excision. The traditional surgical approach is a horizontal incision in the neck. This technique is easy and radical but it produces a cervicotomy scar with aesthetic results sometimes unsatisfactory. In this work we present a novel application of the rhytidectomy approach to the excision of branchial cysts. METHOD: A 28-year-old man with a right laterocervical cyst. This lesion was surgically removed with a rhytidectomy approach. We evaluated the operating time and the aesthetic and functional results. The incision was conducted in the retroauricular sulcus and extended to the hairline. We preserved the great auricular nerve, the spinal accessory nerve, jugular vein, and carotid artery. RESULTS: Operating time was 90 minutes. The patient had no nerve deficits and 3 months after surgery, he was satisfied with the aesthetic result. CONCLUSION: The use of rhytidectomy in treatment of a branchial cyst improves aesthetic results with hidden scar, allowing no nerve or vasal injuries instead of a minimum additional operating time.