How to classify the stylohyoid complex syndrome in the ICHD

We have read the International Classification of Headache Disorders, third edition (beta) (ICHD-3 beta), and for the first time headaches are attributed to inflammation of the stylohyoid ligament (SL). It is included among the secondary headaches in “Headache or facial pain attributed to disorder of the cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cervical structure.

Pathophysiology and therapy of systemic vasculitides

Systemic vasculitides represent uncommon conditions characterized by the inflammation of blood vessels that can lead to different complex disorders limited to one organ or potentially involving multiple organs and systems. Systemic vasculitides are classified according to the diameter of the vessel that they mainly affect (small, medium, large, or variable). The pathogenetic mechanisms of systemic vasculitides are still partly unknown, as well as their genetic basis. For most of the primary systemic vasculitides, a single gold standard test is not available, and diagnosis is often made after having ruled out other mimicking conditions. Current research has focused on new management protocol and therapeutic strategies aimed at improving long-term patient outcomes and avoiding progression to multiorgan failure with irreversible damage. In this narrative review, authors describe different forms of systemic vasculitides through a review of the literature, with the aim of highlighting the current knowledge and recent findings on etiopathogenesis, diagnosis and therapy

Laser microsurgery versus radiotherapy versus open partial laryngectomy for T2 laryngeal carcinoma: a systematic review of oncological outcomes

The aim of the current systematic review is to update the pooled survival outcome of patients with T2 glottic carcinoma treated with either laser surgery (CO2 transoral laser microsurgery [CO2 TOLMS]), radiotherapy (RT), or open partial laryngectomy (OPL)

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

The prognostic value of adding narrow-band imaging in transoral laser microsurgery for early glottic cancer: a review

Background and Objectives Transoral laser microsurgery (TLM) is a universally recognized safe and minimally invasive approach for early glottic cancer. Narrow band imaging (NBI) is an optical technique working with a filtered light that reveals superficial mucosal abnormalities through the neoangiogenic pattern. The aim of this systematic review is to demonstrate the role of intraoperative NBI during TLM for early glottic cancer to better evaluate tumor extension and for more precise margin resection. Study Design/Materials and Methods A systematic review of the literature following the PRISMA guidelines was performed. A literature search was performed using the following keywords: TLM, NBI, and early glottic cancer. Two independent authors evaluated the extracted data. Data regarding status of surgical margins after TLM, local recurrence, recurrence-free survival, and need of additional samples following NBI were collected. Results Five articles met inclusion criteria with a total of 577 patients undergoing TLM with intraoperative NBI. A significant reduction of positive superficial margins was found in patients treated with (52%) and without (28.6%) intraoperative use of NBI (P < 0.05) Conclusions Routine use of intraoperative NBI increases the accuracy of neoplastic superficial spreading evaluation and accuracy of mass resection during TLM for early glottic cancer. The significant reduction of superficial positive margins dramatically decreases the number of patients at risk and improves clinical outcomes. Lasers Surg. Med. (c) 2019 Wiley Periodicals, Inc

Laryngeal cancer, HPV DNA vs E6/E7 mRNA test: a systematic review

OBJECTIVE: The reported range of involvement of human papillomavirus (HPV) in laryngeal squamous cell carcinoma (SCC) is wide because of the methods used to detect HPV. DATA SOURCES: A computerized Medline study was carried out using the following as key words: "Papillomavirus Infections"[Mesh] and "Laryngeal Neoplasms"[Mesh]. MATERIALS AND METHODS: Studies that were included were written in English and reported results of HPV DNA with RNA in laryngeal SCC. RESULTS: There were six reported HPV mRNA extraction. Among these studies, Lewis et al reported that out of the 31 cases analyzed, only 2 were HPV DNA+ and of these only 1 was mRNA HPV+ (3%). Halec et al reported 102 cases of which 32 were HPV DNA+ cases and of which only 6 were mRNA+ (5%). Chernock et al reported 76 cases of which 13 were HPV DNA+ cases and of which 4 were mRNA+ (5%). Masand et al reported 8 cases of which 1 was HPV DNA+ case and none was mRNA+. Gheit et al reported 43 cases of which 4 were HPV DNA+ cases and of which 2 were mRNA+ (4%). Castellsagné et al reported 1042 cases of which 59 were HPV DNA+ case and of which 51 were mRNA+ (4.8%) CONCLUSIONS: When determining the role of HPV in laryngeal SCC, evidence of HPV DNA warrants further examination for E6/E7 mRNA as simple assays such as p16 are nonspecific in laryngeal SCC. Further studies of HPV and its role in laryngeal SCC are warranted

Transoral laser microsurgery for Tis, T1, and T2 glottic carcinoma: 5-year follow-up.

Background: The aim of this retrospective study is to evaluate the results obtained with CO2 TOLMS in patients with Tis, T1, and T2 glottic tumors at our Department from 2004 to 2016 treated with CO2 TOLMS. Methods: One hundred eighty-five patients having a median age of 67 years (range 42–88) were included in the present analysis. The tumor stages of the patients included 134 pTis-T1a, 12 pT1b, and 39 pT2 cases. Median duration of follow-up for the whole study cohort was 55 months (range 24–108 months) Results: At 5-year follow-up, local control was 91%, 83%, and 79.4% for T1a, T1b, and T2 respectively. Disease-specific survival was 95.5%, 91.6%, and 92.3%. Overall survival was 73.8%, 91.6%, and 82%, and larynx preservation was 96.2%, 83%, and 84.6%. The overall outcomes are resumed in figure 1. Conclusion: This study confirms that CO2 TOLMS is a safe and standard therapy for selected T1 and T2 glottic carcinoma, and our review on T2 glottic cancer suggests that CO2 TOLMS represents a reliable option in terms of overall survival, disease-specific survival, and laryngeal preservation. However, patients with anterior commissure involvement and T2 cancer should be evaluated with a preoperative MRI in order to exclude the infiltration of the laryngeal framework and to quantify the neoplastic involvement of para-glottic space

Orofacial pain and stylohyoid complex syndrome

In the introduction of the manuscript entitled ‘nigrostriatal dopaminergic depletion produces orofacial static mechanical allodynia’ the authors suggest that nigrostriatal dopamine depletion could cause atypical facial pain. The purpose of this letter is to underline that the stylohyoid complex syndrome (SHCS) induces a part of orofacial pain that should not be confused, as often is the case, with the atypical idiopathic orofacial pain and Dopamine depletion. The term orofacial pain refers to pain that originates from hard and soft tissues of the head and neck. It may also originate from the central nervous system or it can express a psychological disorder. A classification of orofacial pain considers the origin and the onset of pain: dental, oropharyngeal–laryngeal mucosal, neurovascular and atypical idiopathic. SHCS is a rare disease which is not well known. Unfortunately, it is underestimated and is misdiagnosed as atypical idiopathic orofacial pain

La chirurgia sub-totale della laringe: problematiche ancora aperte

.Il carcinoma della laringe rappresenta il 2-3% di tutte le neoplasie; il sesso maschile è nettamente quello più colpito mentre solo il 5-8% dei casi è riscon- trabile nel sesso femminile. Il picco di incidenza è intorno ai 65 anni; in Europa, il 60% dei nuovi casi di carcinoma della laringe si riscontra in pazienti oltre i 65 anni di età. In Italia l’incidenza è massima tra i 65 e i 75 anni (fig. 1). Attualmente si registrano in Italia circa 5500 nuovi casi di cancro della laringe ogni anno, di cui 5 000 circa nel solo sesso maschile. La storia naturale dei car- cinomi squamocellulari della laringe è caratterizzata dalla crescita locale e dalla diffusione regionale e negli stadi avanzati, a distanza. I carcinomi della laringe si sviluppano con maggiore frequenza sul piano glottico, e appaiono nella maggior parte dei casi come lesioni leucoplasiche e/o eritroplasiche con uno sviluppo su- perficiale, seguendo le barriere anatomiche nelle fasi iniziali

Pathophysiology and therapy of systemic vasculitides

Systemic vasculitides represent uncommon conditions characterized by the inflammation of blood vessels that can lead to different complex disorders limited to one organ or potentially involving multiple organs and systems. Systemic vasculitides are classified according to the diameter of the vessel that they mainly affect (small, medium, large, or variable). The pathogenetic mechanisms of systemic vasculitides are still partly unknown, as well as their genetic basis. For most of the primary systemic vasculitides, a single gold standard test is not available, and diagnosis is often made after having ruled out other mimicking conditions. Current research has focused on new management protocol and therapeutic strategies aimed at improving long-term patient outcomes and avoiding progression to multiorgan failure with irreversible damage. In this narrative review, authors describe different forms of systemic vasculitides through a review of the literature, with the aim of highlighting the current knowledge and recent findings on etiopathogenesis, diagnosis and therapy