Giovanni Bastanza

Oncologic results of the surgical salvage of recurrent laryngeal squamous cell carcinoma in a multicentric retrospective series: Emerging role of supracricoid partial laryngectomy

Several studies in the last decade evaluated conservative surgical procedures and, in particular, supracricoid operations as an alternative to total laryngectomy for the salvage of recurrences of laryngeal squamous cell carcinoma (SCC) after a first attempt of organ preservation.

Oncological results of the surgical salvage of recurrent laryngeal SCC in a multicentric retrospective series. The emerging role of supracricoid partial laryngectomy

Several studies in the last decade evaluated conservative surgical procedures and, in particular, supracricoid operations as an alternative to total laryngectomy for the salvage of recurrences of laryngeal squamous cell carcinoma (SCC) after a first attempt of organ preservation.

Drug-induced sleep endoscopy as a selection tool for mandibular advancement therapy by oral device in patients with mild to moderate obstructive sleep apnoea

SUMMARY Nowadays oral appliance therapy is recognised as an effective therapy for many patients with primary snoring and mild to moderate obstructive sleep apnoea (OSA), as well as those with more severe OSA who cannot tolerate positive airway pressure (PAP) therapies. For this reason, it is important to focus on objective criteria to indicate which subjects may benefit from treatment with a mandibular advancement device (MAD). Various anthropometric and polysomnographic predictors have been described in the literature, whereas there are still controversies about the role of drug-induced sleep endoscopy (DISE) and advancement bimanual manoeuvre as predictor factors of treatment outcome by oral device. Herein, we report our experience in treatment of mild moderate OSA by oral appliance selected by DISE. We performed a single institution, longitudinal prospective evaluation of a consecutive group of mild moderate patients with obstructive sleep apnoea syndrome who underwent DISE. During sleep endoscopy, gentle manoeuvre of mandibular advancement less than 5 mm was performed. In 30 of 65 patients (46.2%) we obtained an unsuccessful improvement of airway patency whereas in 35 of 65 patients (53.8%) the improvement was successful and patients were considered suitable for oral device application. Because 7 of 35 patients were excluded due to conditions interfering with oral appliance therapy, we finally treated 28 patients. After 3 months of treatment, we observed a significant improvement in the Epworth medium index [(7.35 ± 2.8 versus 4.1 ± 2.2 (p < 0.05)], in mean AHI [(21.4 ± 6 events per hour versus 8.85 ± 6.9 (p < 0.05)] and in mean ODI [(18.6 ± 8 events per hour to 7 ± 5.8 (p < 0.05)]. We observed that the apnoea/hypopnoea index (AHI) improved by up to 50% from baseline in 71.4% of patients selected after DISE for MAD therapy. In the current study, mandibular advancement splint therapy was successfully prescribed on the basis not only of severity of disease, as determined by the subjects initial AHI, but also by DISE findings combined with results of gentle mandibular advancement manoeuvre allowing direct view of the effects of mandibular protrusion on breathing spaces in obstruction sites, and showing good optimisation of selection of patients for oral device treatment.

Clinical history, prognostic factors, and management of facial nerve in malignant tumors of the parotid gland.

Objectives We analyzed the outcomes following clinical management of parotid masses that were determined to be malignant tumors after parotidectomy. Methods We evaluated data from 70 patients with parotid malignancies between November 1994 and December 2005. Results Among salivary histotypes (n=49), the most significant prognostic parameter was cT4 stage at diagnosis (P=0.0055, log-rank) both for clinical involvement of the facial nerve and for invasion of other structures. The main cause of cancer-related death was a distant metastasis. Conclusion The present series confirms that the main prognostic parameter in salivary parotid malignancies was cT4 classification at diagnosis, often due to clinical involvement of the facial nerve. The oncological outcome of salivary malignancies was influenced by distant metastasis more than most other head and neck sites. We recommend dissecting and preserving the functioning VIIth cranial nerve during surgery for parotid malignancies.

Radiofrequency volumetric inferior turbinate reduction: long-term clinical results.

SUMMARY The aim of our study was to assess long-term results of radiofrequency volumetric tissue reduction of inferior turbinates (RVTR). We performed a prospective long-term longitudinal evaluation of 305 patients affected by rhinitis (114 allergic and 191 non-allergic) who were unresponsive to medical treatment and underwent RVTR (January 2004 - December 2010). Subjects were followed for a mean period of 39.70 ± 19.41 months (range 24-60). Patients completed the NOSE-scale questionnaire pre- and post-operatively after 1 month and yearly for 5-years. Recurrence was assumed if the post-operative total NOSE score increased by at least 75% during follow-up and the patient restarted medical treatments. Estimation of relapse over time was performed by Kaplan-Meyer analyses. We documented overall good satisfaction of patients regarding the procedure, with a good rate of pain control and a low rate of complications. Post-operatively there was a significant improvement in nasal stuffiness, nasal obstruction and mouth breathing (p < 0.05). We observed a worsening trend for symptoms after 36 months with progressive increasing rate of recurrences that were significantly higher in allergic than non-allergic patients (p < 0.05). We also observed a slight worsening trend of global satisfaction of patients. Our study confirms the minor discomfort and low risk of side effects of RVTR. Our data showed good efficacy of the procedure in the majority of patients for at least 36 months after surgery, and in fact in this time period the cumulative probability to remain relapse-free was up to 0.8. In the following 2 years, we observed a worse temporal trend in term of recurrence rate, and in particular in allergic patients with a significant difference vs non-allergic individuals (p < 0.05).

Clinical and prognostic features of lymphomas arising in the head and neck region: Our experience of preferential association of different histotypes with various sites of origin in ninety patients

neck region: Our experience of preferential association of different histotypes with various sites of origin in ninety patients Bussu, F.,* Hohaus, S., Bastanza, G.,* Bozzoli, V., Tisi, M.C., Martini, M., Paludetti, G.* & Almadori, G.* *Institute of Otolaryngology, Institute of Haematology, and Institute of Histopatology, Universit a Cattolica del Sacro Cuore, Policlinico Agostino Gemelli, Rome, Italy

Early definition of type, degree and audiogram shape in childhood hearing impairment

SUMMARY In the context of permanent childhood hearing loss, early audiological diagnosis is a prerequisite for activation of an adequate rehabilitation program to prevent or limit the known effects that auditory deprivation determines on language development and cognitive skills in neonates. Audiological diagnosis consists schematically of three phases: identification of subjects at risk, definition of hearing loss and/or children features, verification of appropriateness of diagnosis itself and a rehabilitation programme. Strategies and methods of audiological diagnosis are well defined and include an integration of data coming from objective methods with clinical and behavioural data. Although the substantial effectiveness of procedures and a general consensus on their use and interpretation have been defined, there are several critical issues concerning the achievement of this objective, which will be discussed in this paper.

An old drug for a new application: Carbazochrome‐sodium‐sulfonate in HHT

To the Editor, Hereditary hemorrhagic teleangiectasia (HHT, RenduOsler-Weber Syndrome) is a dominantly inherited genetic vascular disorder in which epistaxis is the most frequent manifestation, responsible for high morbidity and very poor quality of life. Unfortunately, management of epistaxis in this disorder has no standard care and local treatments such as laser procedures, septodermoplasty intervention, or surgical closure of the nostrils are often aggressive. Therefore, the efforts in the approach to management are typically directed to minimize bleeding, as well as administration of blood transfusions avoiding invasive procedures as much possible. In this setting, blood transfusions bound with hormone therapy and antifibrinolytic treatment are used with unclear efficacy. Recently, experimental studies utilizing antiangiogenic drugs are reported as ongoing, but their efficacy has also not been proven. We report a collection of HHT patients showing a good response during treatment with an old hemostatic drug with capillary stabilizing action, carbazochromesodium-sulfonate, never tested before in such patients. Carbazochrome-sodium-sulfonate is used clinically for the treatment of hemorrhage due to capillary fragility. Its mechanism of action is unknown, but it may modulate fibrinolysis through alteration of endothelial cell function. Carbazochrome had various applications in bleeding disorders. With ethics committee approval and after written informed consents, we treated, orally, 10 HHT patients (3 male, 7 female; median range age of 42.8) who had carbazochrome-sodium-sulfonate 50mg twice per day for 2 months. Patients were administered the epistaxis severity score (ESS) questionnaire preand posttreatment. We observed a reduction in the ESS score in all subjects and, in particular, the pretreatment mean score (6.4 2.1) vs. post-treatment score at 1 month (4.9 1.8) and at 2 months (3.4 1.3) showed a statistically, significant difference (P< .05) compared to baseline (9.0 1.6) at both time points. Furthermore, the mean hemoglobin level increased at 1 month (9.9 gr/dL 1.3) compared to baseline (9.0 gr/dL 1.6) and at 2 months (10.9 gr/dL 1.15) statistical analyses showed significance (P< .05) at both time points (Table 1). To our knowledge, this is the first report on the potential beneficial effect of carbazochrome-sodiumsulfonate in treating HHT. Moreover, this observation may relate to an effect on endothelial barrier dysfunction through inhibition of agonist-induced phosphoinositide hydrolysis that may be involved in the pathogenesis of HHT-related epistaxis and these results may lead to further research that may determine safety and The Journal of Clinical Pharmacology 2015, 55(5) 601–602

Evaluation of pharyngeal muscle activity through nasopharyngeal surface electromyography in a cohort of dysphagic patients with acute ischaemic stroke

SUMMARY Oro-pharyngeal dysphagia is frequently present during the acute phase of stroke. The aim of the present study was to evaluate whether the recording of surface EMG using a nasopharyngeal (NP) electrode could be applied to evaluation of pharyngeal muscle activity in acute stroke patients and if this neurophysiological measure is related with clinical assessment of swallowing. Patients were examined and clinical severity was assessed with the National Institute of Health Stroke Scale (NIHSS) score; dysphagia was evaluated through bedside screening test using the Gugging Swallowing Scale (GUSS). Extension of the ischaemic lesion was measured by quantitative score, based on CT scan [Alberta Stroke Programme Early CT Score (ASPECTS)]. We analysed 70 patients; 50 were classified as dysphagic (Dys+), and 20 as non-dysphagic (Dys–). Each participant underwent a surface NP EMG recording performed with a NP electrode, made of a Teflon isolated steel catheter, with a length of 16 cm and a tip diameter of 1.5 mm. The electrode was inserted through the nasal cavity, rotated and positioned approximately 3 mm anteroinferior to the salpingo-palatine fold. At least four consecutive swallowing-induced EMG bursts were recorded and analysed for each participant. Swallowing always induced a repetitive, polyphasic burst of activation of the EMG, lasting around 0.25 to 1 sec, with an amplitude of around 100-600mV. Two parameters of the EMG potentials recorded with the NP electrode were analyzed: duration and amplitude. The duration of the EMG burst was increased in Dys+ patients with a statistically significant difference compared to Dys- patients (p < 0.001). The amplitude was slightly reduced in the Dys+ group, but statistically significant differences were not observed (p = 0,775). Nevertheless, the burst amplitude showed a significant inverse correlation with NIHSS [r(48) = –0.31; p < 0.05] and ASPECTS scores [r(48) = –0.27; p < 0.05], meaning that the burst amplitude progressively reduced with an increase of clinical severity (NIHSS) and topographic extension of brain lesions in CT (ASPECTS). These results suggest that NP recordings can give a semi-quantitative measure of swallowing difficulties originating from pharyngeal dysfunction, in fact, electromyographic findings suggest reduced pharyngeal motility.