33 research outputs found
In response to "On challenges of disproving inferiority of tumour bed margins"
No full textStrips‐and‐bowl FS are meticulously collected from the entire superficial and deep margins and consequently allow assessment of the entire resection margins. Conceptually, Kim and Chiosea's proposal to expand the initial resection and leave “strips‐and‐bowl” tissue with the main resection specimen from which to collect FS is not wrong; however, in such a scenario, FS would be collected from the resected specimen, and this, in our experience, makes it more difficult to relocate the site requiring intraoperative enlargement in the case of positive FS
Neck Metastasis From Burned-Out Tumor of the Testis: Diagnostic Pitfall for the Head and Neck Surgeon
No full textGerm cell neoplasms are relatively uncommon but highly curable when recognized and treated properly. They most commonly present as a testicular mass and have high tendency to hematogenous spread; thus, more than 70% of patients have metastases at the time of diagnosis. Usually they develop retroperitoneal lymph node metastasis, then spread into the thoracic region and reach the cervical region finally
Narrow-band imaging pattern classification in oral cavity
No full textNarrow-band imaging is widely used in the diagnostic work-up of oral lesions. Different oral subsites present three epithelial types (1, 2a and 2b), each with a different structure and function. The aim of this study was to analyse and describe the different vascular patterns seen on narrow-band imaging according to oral epithelial type and histology
Salivary bypass tube placement in esophageal stricture: A technical note and report of three cases
No full textHypopharyngeal and cervical esophageal strictures can be caused by advanced malignancies, ingestion of caustic materials, or can follow surgery or radiation therapy.
They cause marked dysphagia and consequently patients need nasogastric or gastrostomy tube feeding, with a remarkable impact on quality of life.
To restore oral feeding, the stenosis can be progressively dilated by using rubber bougies of increasing diameter, and a Montgomery® Salivary Bypass Tube can then be inserted to maintain the obtained calibre. However, while its flexibility makes it easy to tolerate, it has the drawback of making insertion difficult because the tube tends to bend.
The aim of this paper is to present a possible solution to this problem. A Montgomery® Salivary Bypass Tube was distally sutured to a Cook Airway Exchange Catheter® to simplify its initial insertion through a laryngoscope and following replacements. The catheter was then easily removed leaving the bypass tube in the correct position.
In our experience, this innovative approach proved effective in facilitating Montgomery® Salivary Bypass Tube insertion in three patients, without risks for the patient, additional operative time or increase in costs
Stretching stenoses of the external auditory canal: a report of four cases and brief review of the literature
No full textAcquired stenosis of the external auditory canal may be caused by a variety of insults, all sharing a common pathogenesis, namely a cascade of inflammatory changes leading to medial canal fibrosis. Previous surgery (canaloplasty or meatoplasty) and radiotherapy, especially if associated with a history of parotid surgery extended to the external auditory canal, have been implicated as possible causes. The literature offers advice on the management of stenosis consequent to otosurgery for congenital and acquired defects, but nothing on forms secondary to radiotherapy to the head and neck region. The proposed solutions are often cumbersome and difficult to fabricate, and therefore expensive. The aim of this paper, in which the cases of four patients are reported, is to present a new technique initially used for the most severe form - i.e. external auditory canal stenosis after surgery and radiotherapy - and then extended to forms due to different causes. This new technique involves the use of a series of surgical steel tubes of increasing dimension commonly used for tissue expansion in a body piercing practice called stretching and known as ear stretching tunnels or ear stretchers. This innovative approach proved effective in solving external auditory canal stenosis in our patients, with the least discomfort for the patient and the lowest cost. We consider this new solution to be feasible and practical and are convinced that it provides a new approach to an old problem. Further studies are needed to increase the number of clinical cases to verify how long the ear stretcher should be kept in place for the stenosis to stabilise, and to establish whether surgery is always necessary after ear stretcher application and, if so, the best timing for surgery
Narrow-band imaging with 4K technology in the head and neck: preliminary experience and technical settings
No full textN/
What’s behind Margin Status in Oral Cancer?
No full textIn the 2nd century AD, Galen argued that the failure to remove any single ‘root’ of a malignant tumor could result in a local relapse. After nearly 2 millennia, this problem appears to be even more challenging due to our increased understanding of the complexity of tumor formation and spread. Pathological analysis of tumor margins under a microscope remains the primary and only accepted method for confirming the complete tumor removal. However, this method is not an all-or-nothing test, and it can be compromised by various intrinsic and extrinsic limitations. Among the intrinsic limitations of pathological analysis we recall the pathologist handling, tissue shrinkage, the detection of minimal residual disease and the persistence of a precancerous field. Extrinsic limitations relate to surgical tools and their thermal damage, the different kinds of surgical resections and frozen sections collection. Surgeons, as well as oncologists and radiotherapists, should be well aware of and deeply understand these limitations to avoid misinterpretation of margin status, which can have serious consequences. Meanwhile, new technologies such as Narrow band imaging have shown promising results in assisting with the achievement of clear superficial resection margins. More recently, emerging techniques like Raman spectroscopy and near-infrared fluorescence have shown potential as real-time guides for surgical resection.
The aim of this narrative review is to provide valuable insights into the complex process of margin analysis and underscore the importance of interdisciplinary collaboration between pathologists, surgeons, oncologists, and radiotherapists to optimize patient outcomes in oral cancer surgery
Impact of intraoperative NBI on complete resections and recurrence in oral and oropharyngeal cancer
No full textPurpose: The aim of this study was to assess the number of complete resections and recurrence rates in oral and oropharyngeal squamous cell carcinoma treated with intraoperative narrow-band-imaging. Materials and methods: In this observational study, superficial resection margins of oral and oropharyngeal squamous cell carcinoma were intraoperatively defined using narrow-band-imaging. The number of complete resections was assessed. Patients were followed up for at least 5 years: disease free survival and the cumulative incidence of local recurrence were recorded. Results: 93 squamous cell carcinoma were considered. Surgical resection was complete in 84.9 % of cases. The 5-years disease free survival was 76.2 % (95%CI: 67.1 %–84.4 %). Cumulative incidence of local recurrence was 9.7 % (95%CI: 4.7 %–16.7 %), lower compared to previous literature: it was higher in patients over 68 years (14.3 %, 95%CI: 6.2 %–25.6 % vs 4.5 %, 95%CI: 0.8 %–13.8 %) although without statistically significance. Conclusions: In oral and oropharyngeal squamous cell carcinoma surgery, narrow-band imaging is a valuable tool for accurately identifying the true superficial extent of the tumor, facilitating complete resection and potentially reducing local recurrence
Predicting laryngeal exposure in microlaryngoscopy: External validation of the laryngoscore
No full textOptimal laryngeal exposure during transoral laryngeal surgery is fundamental. We aimed to evaluate the reliability of a recently proposed score (Laryngoscore) in predicting difficult laryngeal exposure (DLE) in an independent cohort of patients undergoing elective microlaryngoscopy. We also verified the relation between DLE, surgeon's expertise, and difficult intubation, and investigated possible areas for score improvement.
STUDY DESIGN:
Prospective validation study.
METHODS:
A total of 136 patients were preoperatively evaluated using the Laryngoscore. Patients were divided into three classes according to patient position, type of laryngoscope, and need for external counterpressure to expose the anterior commissure. Based on their mean scores, two groups were identified: good laryngeal exposure (GLE) and DLE. A receiver operating characteristic curve with the Youden index was used to calculate the optimal cutoff value. The χ2 and Fisher exact test were used to correlate GLE and DLE to the surgeon's expertise and difficult intubation. The intraoperative anatomical parameters underlying DLE were also recorded.
RESULTS:
The optimal cutoff value for differentiating GLE and DLE was 4, which identified 80.6% of DLE cases. No statistically significant difference in GLE and DLE distribution was found between surgeons (P = 0.43). The correlation between difficult intubation and DLE was statistically significant (P = 0.03). The intraoperative parameters determining DLE were epiglottis characteristics (floppy, tight, or short), bulky abdomen and chest, bulky tongue base, mobile teeth, and a narrow laryngeal aditus.
CONCLUSION:
The Laryngoscore is reliable for detecting DLE preoperatively. The inclusion of additional parameters may allow a more complete assessment and maximize its diagnostic accuracy
Hyaluronate effect on bacterial biofilm in ENT district infections: a review
No full textBacterial resistance is a growing phenomenon which led the scientific community to search for new therapeutic targets, such as biofilm. A bacterial biofilm is a surface-associated agglomerate of microorganisms embedded in a self-produced extracellular polymeric matrix made of polysaccharides, nucleic acids, and proteins. Scientific literature offers several reports on a biofilm's role in infections regarding various body districts. The presence of a bacterial biofilm is responsible for poor efficacy of antibiotic therapies along with bacterial infections in ear, nose, and throat (ENT) districts such as the oral cavity, ear, nasal cavities, and nasal sinuses. In particular, bacterial biofilms are associated with recalcitrant and symptomatically more severe forms of chronic rhinosinusitis. As of today, there are no therapeutic options for the eradication of bacterial biofilm in ENT districts. Hyaluronic acid is a glycosaminoglycan composed of glucuronic acid and N-acetylglucosamine disaccharide units. Its efficacy in treating rhinosinusitis, whether or not associated with polyposis, is well documented, as well as results from its effects on mucociliary clearance, free radical production and mucosal repair. This review's aim is to evaluate the role of bacterial biofilms and the action exerted on it by hyaluronic acid in ENT pathology, with particular attention to the rhinosinusal district. In conclusion, this paper underlines how the efficacy of hyaluronate as an anti-bacterial biofilm agent is well demonstrated by in vitro studies; it is, however, only preliminarily demonstrated by clinical studies
