Management of Early Glottic Cancer Treated by CO2 Laser According to Surgical-Margin Status: A Systematic Review of the Literature

Abstract Introduction Transoral laser microsurgery (TLM) is the treatment of choice for Tis-T2 squamous cell glottic carcinomas due to its advantages compared with open surgery and radiotherapy. However, the CO2 laser beam causes changes and damage on the specimens, making the histological assessment of resection margins, the gold standard for confirming radical tumor resection, sometimes difficult. Objective To assess the different ways to manage patients depending on the status of the histopathological margin according to recent studies to detect the most commonly shared therapeutic strategy. Data Synthesis We analyzed the literature available on the PubMed and Web of Science databases, i…

Sleep-disordered breathing:Evaluation of dynamic patterns of the upper airways in obese subjects

Melanotic Oncocytic Metaplasia of the Nasopharynx: An Unusual Case Report

Introduction: Melanotic oncocytic metaplasia of the nasopharynx is an uncommon disease, usually asymptomatic, that could be misdiagnosed for melanoma, because of its macroscopic features. For this reason, is necessary to know it thoroughly and to take it into account in the differential diagnosis.   Case Report: A 69-year-old Italian woman presented to our Otorhinolaryngology Clinic with a 1-month history of sore throat. She has been a smoker for several years. During the nasopharyngoscopic examination, grey-brown, irregular and slightly elevated lesions, measuring few millimetres, were found near the right Eustachian tube opening. The preliminary diagnostic hypothesis was malignant disease…

Sinonasal respiratory epithelial adenomatoid hamartoma: A report on three cases

Respiratory Epithelial Adenomatoid Hamartoma (REAH) is a rare benign lesion that may occur in the nasal cavity and paranasal sinuses. Histology is essential for the differential diagnosis with other lesions that could affect the sinonasal region. Our report focuses on three cases of male patients that were 46, 66 and 73 years old, diagnosed with REAH of the sinonasal region. All cases presented a nasal obstruction and hyposmia, and in one case cephalalgia. The definitive diagnosis of REAH was supported by the endoscopic, radiological and histological examinations. The patients underwent surgical excision with an endoscopic approach and did not experience a local recurrence at the time of wr…

Surgical treatment of choanal atresia with transnasal endoscopic approach with stentless single side-hinged flap technique: 5 year retrospective analysis

Abstract Introduction: Choanal atresia is a rare congenital malformation of the nasal cavity characterized by the complete obliteration of the posterior choanae. In 67% of cases choanal atresia is unilateral, affecting mainly (71%) the right nasal cavity. In contrast to the unilateral form, bilateral choanal atresia is a life-threatening condition often associated with respiratory distress with feeding and intermittent cyanosis exacerbated by crying. Surgical treatment remains the only therapeutic option. Objective: To report our experience in the use of a transnasal endoscopic approach with stentless single side-hinged flap technique for the surgical management of choanal atresia. Methods:…

Oncological Outcomes of Primary vs. Salvage OPHL Type II: A Systematic Review

Background: Open partial horizontal laryngectomy type II (OPHL type II) has two main aims: oncological radicality and laryngeal preservation. The aim of this review is to define and emphasize the oncological efficacy of OPHL type II, both as primary and salvage surgery, by analyzing the latest literature. Methods: The research was carried out on Pubmed, Scopus and Web of Science databases, by using strict keywords. Oncological outcomes were evaluated by the following parameters: overall survival, disease-specific survival, disease-free survival, local control, laryngeal preservation, local recurrence. Results: The review included 19 articles divided into three groups: (1) primary OPHL type …

Functional Nasal Surgery and Use of CPAP in OSAS Patients: Our Experience.

The surgical correction of nasal obstruction is definitely effective and recommended in patients with poor CPAP compliance, often secondary to the high pressures that need to be given in patients with nasal sub stenosis. For this reason, the objective of this study is the evaluation of the effectiveness and effects of the functional nose surgery on adherence to CPAP- therapy in patients (with moderate to severe OSAS with indication of ventilation therapy) poorly compliant with CPAP. The study was performed on a sample of 52 patients, 40 male and 12 female, aged between 29 and 72 years followed by the Otolaryngology Unit of the University Palermo in the period between January 2015 and Januar…

Thyroid cartilage involvement in patient affected by IgA multiple myeloma: case report.

Neoplasms originating from plasma cell are rare in the head and neck region. A correct clinical evaluation is very important in order to formulate a differential diagnosis as well as to distinguish local from metastatic disease. We report a case of larynx involvement by an IgA multiple myeloma in a 69-year-old female diagnosed in October 2004 and treated with chemotherapy; the 1 year control do not show progression of disease and the laryngeal lesion is unchanged. We highlight the radiological findings and clinical features to suspect plasma cell tumors in cases with a similar presentation.

Glut-3 expression in laringeal carcinoma: is really a prognostic indicator?

Analysis of visually guided eye movements in subjects after whiplash injury

Abstract Objective The aims of present research were to analyze the visually guided eye movements of subjects suffering from the consequences of whiplash injury and the possibility to differentiate patients from feigning subject. We analyzed the role of video-nystagmography for clinical and forensic aspects. Methods It was a prospective case–control study. Detailed history was taken and patients were thoroughly investigated. Smooth pursuit and saccadic eye movements were assessed in 33 patients affected by imbalance following a whiplash injury. A control group of 20 subjects was also evaluated. All tests were executed in neutral neck position and after left and right trunk rotation. Results…

Surgical treatment of choanal atresia with transnasal endoscopic approach with stentless single side-hinged flap technique: 5 year retrospective analysis

Introdução: A atresia de coanas é uma malformação congênita rara da cavidade nasal caracterizada pela obliteração completa da coana posterior. Nos 67% dos casos a atresia coanal é unilateral, acometendo principalmente (71%) a cavidade nasal direita. Diferentemente da forma unilateral, a atresia coanal bilateral é uma condição com risco de vida, frequentemente associada a angústia respiratória com alimentação e cianose intermitente exacerbada pelo choro. O tratamento cirúrgico permanece como a única opção terapêutica. Objetivo: Relatar a nossa experiência no uso de uma abordagem endoscópica transnasal com a técnica de retalho articulado de um lado só sem colocação de stent para o tratamento …

NBI and Laryngeal Papillomatosis: A Diagnostic Challenge: A Systematic Review.

Narrow-band imaging (NBI) represents a valid aid in laryngeal squamous cell carcinoma (LSCC) diagnosis for detecting vascular changes. However, LSCC and laryngeal papillomatosis (LP) show similar vascular patterns that may lead to misdiagnosis and improper treatment. This review aims to deepen this NBI limit in order to stress a careful preoperative evaluation of laryngeal lesions. The research was carried out on PubMed, Web of Science and Scopus databases using specific keywords. The topic of research was assessed by these parameters: accuracy, sensitivity, specificity, and positive and negative predictive values. This review included only five articles: they demonstrated that NBI is bette…

Quality of Life with Voice Prosthesis after Total Laryngectomy.

Introduction: The loss of voice after total laryngectomy is one of the main impairments in personal and social life. In order to prevent potential psycho-social consequences in the patient and his family, the restoration of phonatory function is the main objective of post-laryngectomy rehabilitation. The aim of this study was to assess quality of life in patients who received prosthetic voice after total laryngectomy. Materials and Methods: Over a one-year period, 51 patients with voice prostheses after total laryngectomy were recruited. 32 patients (62.74%) were administered radiation therapy and 9 patients (17.64%) underwent to surgical reconstruction with flaps. Each patient was administ…

Pleomorphic adenoma of the lateral nasal wall: case report.

Pleomorphic adenoma is the most common tumour of the salivary glands. However, it is extremely rare for these to originate in the nose and even when they do so, it is most commonly in the nasal septum. It is important to be aware of the paucity of presenting symptoms (nasal obstruction and epistaxis), as the lesion may not be recognized immediately. Growth is generally restricted locally and the tumour is not known to spread to the neighbouring structures. Surgical resection is the treatment of choice. Recurrences and evolution to malignancy are not frequent, but long-term follow-up is recommended. The case is presented of pleomorphic adenoma arising from the lateral wall of the right nasal…

Treatment of bilateral vocal cord paralysis following permanent recurrent laryngeal nerve injury.

Bilateral vocal cord paralysis is a serious illness requiring emergency intervention to resolve the potentially life-threatening respiratory distress. Several surgical procedures were proposed to help improve the airway and to eliminate the tracheostoma in those patients with permanent paralysis. All the procedures have their own advantages and disadvantages. We conducted a retrospective study of 30 patients affected by bilateral vocal cord paralysis following total thyroidectomy. All the patients underwent total thyroidectomy for benign thyroid pathology. In 26 patients (86.6%), cord paralysis occurred during the perioperative stage; and in the remaining 4 cases (13.3%), it occurred within…

Trattamento chirurgico endoscopico della paralisi ricorrenziale in adduzione

Sindrome dell'acquedotto vestibolare largo e ossigenoterapia iperbarica.

Familial occurrence of warthin tumour: Our experience and review of the literature

The tumour of Warthin (WT) is the second parotid tumour for frequency after the pleomorphic adenoma, it represents about 2% to 15% of all parotid tumors. The pathogenesis of familial Warthin Tumour is unknown, even if cytogenetic abnormalities have been identified in Warthin Tumour. Among the inducing factors there is the smoke which has an important role. Familial occurrence of Warthin Tumour is rare, only five reports in the literature. Two of them were reported in brothers, two in a mother and son and one in monozygotic twins. We quote a case of familiar Warthin Tumour arisen in two brothers and we present a review of the Literature.

Modified fronto-lateral laryngectomy in treatment of glottic T1(a-b) cancer with anterior commissure involvement

Abstract Objective Evaluation of clinical and oncological safety of the modified fronto-lateral laryngectomy in the treatment of T1a-b glottic cancer. Methods Retrospective review of charts of patients managed with classical fronto-lateral laryngectomy or with our modified technique using a cervical fascia flap and a false cord flap to reconstruct the defect. Results No recurrence of cancer was observed in the present series and slight dysphonia was present in all cases. The patients managed with classical technique required a revision surgery for granulations or anterior synechia in 4 cases; those managed with modified technique did not need a second intervention. Conclusion The fronto-lat…

Management of nasal septal abscess in childhood: our experience.

Summary A nasal septal abscess is usually the result of an infected hematoma of the septum. A secondary septal abscess may be the result of infections extending from any of the neighbouring tissues. The necrosis of septal cartilage may lead to nasal deformities and severe impairment of nasal patency and growth. Objectives: Assess if the drainage of the abscess and the immediate reconstruction of the destroyed nasal septum in the acute phase is the best treatment to prevent short- and long-term effect on nasal and midface growth. Methods: Three pediatric patients treated with drainage and immediate implantation of homologous bank cartilage prior to 1990 and four treated with mosaic plastic u…

Il linfoma non-Hodgkin del seno piriforme: case report e revisione della letteratura

Sindrome dell'acquedotto vestibolare largo ed ossigeno-terapia iperbarica (HBO): caso clinico

The Impact of Narrow-band Imaging on the Pre- and Intra- operative Assessments of Neoplastic and Preneoplastic Laryngeal Lesions. A Systematic Review

Abstract Introduction Narrow-band imaging is an endoscopic diagnostic tool that, focusing on superficial vascular changes, is useful to detect suspicious laryngeal lesions, enabling their complete excision with safe and tailored resection margins. Objectives To analyze the applications and benefits of narrow-band imaging in detecting premalignant and malignant laryngeal lesions through a comparison with white-light endoscopy. Data Synthesis A literature search was performed in the PubMed, Scopus and Web of Science databases using strict keywords. Then, two authors independently analyzed the articles, read the titles and abstracts, and read completely only the relevant studies according to c…

Failure of OPHL type IIb due to undiagnosed Eagle syndrome

A 52-year-old man with glottic-supraglottic tumour underwent open partial horizontal laryngectomy (OPHL) IIb. On the 12th day postoperative, laryngoscopy showed necrotic tissue at the level of pexy and an increased distance between tongue base and neoglottis; the neck CT showed cricoid arch rupture and rupture of the pexy. By re-examining the preoperative CT images, the ossification of stylohyoid ligament (Eagle syndrome) was detected and supposed as the possible cause of cricoid rupture due to its traction on the hyoid bone and therefore on the pexy. The stylohyoid ligaments were cut at their insertion on the hyoid bone and a tracheohyoidopexy was performed. Two months after surgery, the p…

SINDROME DELL'ACQUEDOTTO VESTIBOLARE LARGO E OSSIGENO TERAPIA IPERBARICA. CASO CLINICO

GASTRO-ESOPHAGEAL REFLUX MANIFESTATIONS IN THE TREATMENT OF OSTEOARTHRITIS WITH NON STEROIDAL ANTI-INFLAMMATORY DRUGS

Management of naso-septal deformity in childhood: long-term results.

Abstract Objective The classical teaching advocates a conservative approach for children presenting with various naso-septal deformities. It may not be appropriate especially when it causes nasal obstruction to the growing child. This study has two main purposes: to contribute in identifying the correct selection criteria for surgical management of pediatric patients and in selecting the most appropriate surgical technique. Material and method We reviewed a series of 46 cases of post-traumatic septal and naso-septal deformity not managed promptly or with recurrence of nasal deviation, following bones fracture correction alone. The mean follow-up was 10 years. Results Patients with naso-sept…

Management of Naso-Septal Deformity in Childhood: Long Term Results

Swallowing Outcomes in Open Partial Horizontal Laryngectomy Type I and Endoscopic Supraglottic Laryngectomy: A Comparative Study

Background: Effective swallowing represents the main challenge in supraglottic laryngectomy. This study aimed to assess swallowing outcome comparing endoscopic supraglottic laryngectomy (ESL) and open partial horizontal laryngectomy type I (OPHL I). Methods: A retrospective study was carried out on 20 patients that underwent supraglottic laryngectomy from 2015 to 2021: 10 underwent ESL (group A) and 10 underwent OPHL I (Group B). Patients underwent fiberoptic endoscopic evaluation of swallowing (FEES) 3 months and 12 months after surgery and videofluoroscopy swallowing studies (VFSS) 12 months after surgery. A Swallowing Outcome After Laryngectomy (SOAL) questionnaire was administered to pa…

Tubercolosi laringea: caso clinico

Transoral laryngeal microsurgery for early-stage laryngeal basaloid squamous cell carcinoma

A 71-year-old man presented to our otolaryngology clinic with dysphagia and dyspnoea. He had a history of smoking for 40 years. Laryngoscopy showed an exophytic, round mass on the left aryepiglottic fold that was entirely excised by transoral laser CO2 microsurgery. Histological assessment revealed a pT1 basaloid squamous cell carcinoma (BSCC) with free-margin resection. He underwent close follow-up and after 3-year follow-up, the patient was free from disease. Laryngeal BSCC is a rare cancer with poor prognosis due to its late diagnosis and early neck node metastases. We report a rare case of early tumour treated by endoscopic surgery without complications or recurrence of disease. However…

Endoscopic treatment of maxillary sinus mucocele

Laryngeal manifestations of Crohn's disease

Crohn’s disease is a chronic inflammatory bowel disease. It should be considered a multisystemic disease due to its extra-intestinal manifestations found in 25-40% of patients with inflammatory bowel disease. Laryngeal involvement is very uncommon and the lesions in hypopharynx and larynx are edema, ulcerations and granulation tissue. Symptoms are dysphonia, dysphagia, odynophagia and airway restriction. Laryngeal manifestations of Crohn’s disease are usually successfully treated with oral steroids. We describe a 54-year-old woman who presented with dysphagia and odynophagia for 20 days. She had a history of Crohn’s disease for 6 years. Laryngoscopy revealed a cobblestone appearance of epig…

Important Biomolecular Indicators In Locally Advanced Laryngeal Squamous Carcinoma: P16 Mutations

Frontal sinus osteoma complicated by palpebral abscess: case report.

Disposable chlorine dioxide wipes for high-level disinfection in the ENT department: A systematic review

Abstract Background Nasopharyngoscope reprocessing methods should be effective, rapid and reproducible with moderate cost. Tristel Trio Wipes system (TTWS) is a manual reprocessing method based on chlorine dioxide that has lately emerged in ENT department. This review aims to collect evidence on this system. Methods The PubMed, Web of Science and Cochrane Library databases were searched for all the studies on TTWS or one of its components. Data were grouped according to the study type. Results Ten articles were included in the review. TTWS ensured high-level disinfection in laboratory and clinical setting. Although the limitations of the manual systems, TTWS proved to be faster than automat…

Impact of resection margin status and revision transoral laser microsurgery in early glottic cancer: analysis of organ preservation and local disease control on a cohort of 153 patients

Abstract Introduction Transoral laser microsurgery represents the treatment of choice for early glottic cancer. Its use and effectiveness are mainly related to laryngeal exposure and deep extension of tumor. Histopathologic assessment of surgical margin presents a main issue about transoral laser microsurgery and complete oncological excision. Objective The aim was to analyze the impact of revision surgery on organ preservation and local disease control in patients with early glottic cancer treated by transoral laser microsurgery. Methods We carried out a retrospective study on a cohort of 153 patients with early glottic cancer (Tis, T1, T2) treated by transoral laser microsurgery. Resectio…

Papel prognóstico da margem de ressecção em cirurgia oncológica aberta de laringe: análise de sobrevida de uma coorte de 139 pacientes com carcinoma de células escamosas

Introduction: The treatment of laryngeal squamous cell carcinoma needs accurate risk stratification, in order to choose the most suitable therapy. The prognostic significance of resection margin is still highly debated, considering the contradictory results obtained in several studies regarding the survival rate of patients with a positive resection margin. Objective: To evaluate the prognostic role of resection margin in terms of survival and risk of recurrence of primary tumour through survival analysis. Methods: Between 2007 and 2014, 139 patients affected by laryngeal squamous cell carcinoma underwent partial or total laryngectomy and were followed for mean of 59.44 ± 28.65 months. Rese…

Prognostic role of resection margin in open oncologic laryngeal surgery: survival analysis of a cohort of 139 patients affected by squamous cell carcinoma

Abstract Introduction: The treatment of laryngeal squamous cell carcinoma needs accurate risk stratification, in order to choose the most suitable therapy. The prognostic significance of resection margin is still highly debated, considering the contradictory results obtained in several studies regarding the survival rate of patients with a positive resection margin. Objective: To evaluate the prognostic role of resection margin in terms of survival and risk of recurrence of primary tumour through survival analysis. Methods: Between 2007 and 2014, 139 patients affected by laryngeal squamous cell carcinoma underwent partial or total laryngectomy and were followed for mean of 59.44 ± 28.65 mon…

Impact of resection margin status and revision transoral laser microsurgery in early glottic cancer: analysis of organ preservation and local disease control on a cohort of 153 patients

Abstract Introduction Transoral laser microsurgery represents the treatment of choice for early glottic cancer. Its use and effectiveness are mainly related to laryngeal exposure and deep extension of tumor. Histopathologic assessment of surgical margin presents a main issue about transoral laser microsurgery and complete oncological excision. Objective The aim was to analyze the impact of revision surgery on organ preservation and local disease control in patients with early glottic cancer treated by transoral laser microsurgery. Methods We carried out a retrospective study on a cohort of 153 patients with early glottic cancer (Tis, T1, T2) treated by transoral laser microsurgery. Resectio…

Surgical treatment of choanal atresia with transnasal endoscopic approach with stentless single side-hinged flap technique: 5 year retrospective analysis

Abstract Introduction: Choanal atresia is a rare congenital malformation of the nasal cavity characterized by the complete obliteration of the posterior choanae. In 67% of cases choanal atresia is unilateral, affecting mainly (71%) the right nasal cavity. In contrast to the unilateral form, bilateral choanal atresia is a life-threatening condition often associated with respiratory distress with feeding and intermittent cyanosis exacerbated by crying. Surgical treatment remains the only therapeutic option. Objective: To report our experience in the use of a transnasal endoscopic approach with stentless single side-hinged flap technique for the surgical management of choanal atresia. Methods:…