Giancarlo Tirelli

Benign Positional Vertigo Without Detectable Nystagmus

Objectives To demonstrate that for treatment of benign positional vertigo it is not necessary to identify a positional nystagmus.

A systematic review of therapeutical approaches in bisphosphonates-related osteonecrosis of the jaw (BRONJ)

OBJECTIVES The clinical management of bisphosphonate-related osteonecrosis of the jaw (BRONJ) remains controversial. Since universally accepted guidelines have not been released yet, clinicians usually chose the type of treatment according to position papers based on expert opinion, or on empirical experience. The aim of this systematic review is to identify different therapeutical approaches for BRONJ that have been described in literature and to describe their effectiveness. MATERIALS AND METHODS A Medline via Pubmed and Scopus database literature search was conducted and all publications fulfilling the inclusion and exclusion criteria were included in eligibility assessment. The full texts of 146 retrieved articles were then screened and 40 studies were included in the quality assessment process. RESULTS After quality assessment, 22 full text articles were selected for the final review. 14 articles out of 22 were screened for stage-related outcomes. The overall outcome results and results for every disease stage were the highest when patients were treated with extensive surgery or extensive laser assisted surgery.

Prognostic indicators of occult metastases in oral cancer.

Objective We evaluated the importance of several tumor factors related to predicting the presence of occult metastases in the oral cavity.

360-Degree canalith repositioning procedure for the horizontal canal.

OBJECTIVES: To evaluate the efficacy of modifications to the standard canalith repositioning procedure (CRP) in the treatment of benign positional vertigo (BPV) of the horizontal semicircular canal (HSC). STUDY DESIGN AND SETTING: Prospective trial of 72 patients with BPV of the HSC treated with a modified 360-degree CRP. RESULTS: 51 of the 62 patients treated for canalolithiasis made a complete recovery (82.2%) after a single 360-degree CRP. CONCLUSIONS AND SIGNIFICANCE: It is proposed a full 360-degree rotation of the HSC involved. It is essential to begin rotation of the patient departing from the affected side towards the healthy side, especially for canal side cupulolithiasis and for canalithiasis of the ampullar branch of the HSC. The head resting on the chest at angle of 30-degree during rotating encourages free-floating debris in the HSC to move into the utricle. Instead of using an oscillator for oscillation of the mastoid bone the head is shaken manually.

Modified Particle Repositioning Procedure

Objectives To evaluate the efficacy of modifications to traditional particle repositioning maneuvers in the treatment of benign paroxysmal positional vertigo.

External osteotomy in rhinoplasty.

Objectives To compare external and internal lateral osteotomy in rhinoplasty.

Telomere shortening in mucosa surrounding the tumor: Biosensor of field cancerization and prognostic marker of mucosal failure in head and neck squamous cell carcinoma

OBJECTIVES The aim of the present study was to investigate the pattern of telomere length and telomerase expression in cancer tissues and the surrounding mucosa (SM), as markers of field cancerization and clinical outcome in patients successfully treated for with head and neck squamous cell carcinoma (HNSCC). MATERIALS AND METHODS This investigation was a prospective cohort study. Telomere length and levels of telomerase reverse transcriptase (TERT) transcripts were quantified by real-time PCR in cancer tissues and SM from 139 and 90 patients with HNSCC, respectively. RESULTS No correlation was found between age and telomere length in SM. Patients with short telomeres in SM had a higher risk of mucosal failure (adjusted HR=4.29). Patients with high TERT levels in cancer tissues had a higher risk of regional failure (HR=2.88), distant failure (HR=7.27), worse disease-specific survival (HR for related death=2.62) but not mucosal failure. High-risk patients having both short telomeres in SM and high levels of TERT in cancer showed a significantly lower overall survival (HR=2.46). CONCLUSIONS Overall these findings suggest that telomere shortening in SM is a marker of field cancerization and may precede reactivation of TERT. Short telomeres in SM are strongly prognostic of mucosal failure, whereas TERT levels in cancer tissues increase with the aggressiveness of the disease and are prognostic of tumor spread.

Harmonic Scalpel and Electrothermal Bipolar Vessel Sealing System in Head and Neck Surgery A Prospective Study on Tissue Heating and Histological Damage on Nerves

Objectives: Define and compare the thermal nerve injury caused by 3 different vessel sealing and dissection devices: the harmonic scalpel (HS), the electrothermal bipolar vessel sealing system (EBVS), and the bipolar electrosurgery unit (BE). Methods: First we recorded the heating variations in pig tissue caused by a BE unit, HS, and EBVS after an activation for 5, 10, and 15 seconds at minimum and at maximum power. In the second part, we evaluated the histological damage caused by HS and EBVS on 20 in vivo human nerves, 10 per device. The 2 scalpels were placed and activated at 3 different distances from the nerve (1, 3, and 5 mm). The extension and the degree of the nerve lesion was then calculated. Results: The instrument determining the highest rise in temperature was the BE unit, followed by HS and then EBVS. Comparison between the extension and degree of nerve injury caused by the 2 scalpels showed no statistically significant differences. Based on these evaluations, we established a relative safety limit at 3 mm and an absolute safety limit at 5 mm for both scalpels. Conclusions: Our data suggest EBVS and HS can be considered valid and safe devices for ENT surgery.

Surgical treatment of tracheostomal stenosis.

Hypothesis Stenosis of the tracheostome is a frequent complication following total laryngectomy; the problems created by tracheostomal stenosis are the result of reduced airflow and consequent turbulence. Many authors have studied etiological factors for the onset of stomal stenosis, and a number of procedures have been recommended for the surgical correction of such stenosis.

Is NBI-Guided Resection a Breakthrough for Achieving Adequate Resection Margins in Oral and Oropharyngeal Squamous Cell Carcinoma?

Objectives: Obtaining free resection margins is the main goal of oncological surgeons. Narrow-band imaging (NBI) has been recently used to help define resection margins in transoral laser microsurgery for laryngeal carcinoma. The aim of this study was to evaluate the effect of intraoperative NBI in defining the surgical resection margins of oral and oropharyngeal cancers. Methods: Between January 2014 and March 2015, NBI was used intraoperatively after an initial definition of resection margins with white light in 26 patients (group A). The rate of superficial positive margins at definitive histology was compared with that of a historical cohort of 44 patients (group B) previously managed without the use of intraoperative NBI. Results: A statistically significant reduction in the rate of positive superficial margins was observed at definitive histology in group A (P = .028). NBI helped to identify the presence of dysplasia and cancer around the visible tumor not otherwise detectable with visual examination alone. Conclusions: NBI could be a useful tool for obtaining free resection margins in oral and oropharyngeal carcinoma.