Role and Management of a Head and Neck Department during the COVID-19 Outbreak in Lombardy

The recent Italian outbreak of coronavirus disease 2019 led to an unprecedented burden on our health care system. Despite head and neck\u2013otolaryngology not being a front-line specialty in dealing with this disease, our department had to face several specific issues. Despite a massive reallocation of resources in the hospital, we managed to keep the service active, improving safety measures for our personnel, specifically during common otolaryngologic maneuvers known to produce aerosols. Furthermore, we strived to maintain our teaching role, giving residents an inclusive role in managing the response to the emergency state, and we progressively integrated our inactive specialists into other service rotations to relieve front-line colleagues\u2019 burden. Specific issues and management decisions are discussed in detail in the article

Adenoidal Disease and Chronic Rhinosinusitis in Children-Is there a Link?

Adenoid hypertrophy (AH) is an extremely common condition in the pediatric and adolescent populations that can lead to various medical conditions, including acute rhinosusitis, with a percentage of these progressing to chronic rhinosinusitis (CRS). The relationship between AH and pediatric CRS has been extensively studied over the past few years and clinical consensus on the treatment has now been reached, allowing this treatment to become the preferred clinical practice. The purpose of this study is to review existing literature and data on the relationship between AH and CRS and the options for treatment. A systematic literature review was performed using a search line for "(Adenoiditis or Adenoid Hypertrophy) and Sinusitis and (Pediatric or Children)". At the end of the evaluation, 36 complete texts were analyzed, 17 of which were considered eligible for the final study, dating from 1997 to 2018. The total population of children assessed in the various studies was of 2371. The studies were categorized as surgical-observational, microbiological, genetic-immunological, and radiological. The analysis of the studies confirms the relationship between AH and CRS and supports the existing consensus on medical and surgical therapy. Furthermore, these studies underline the necessity to adapt medical and surgical treatment considering age, comorbidities including asthma and, if present, the Computed Tomography (CT) score

Orbital medial wall fractures: Purely endoscopic endonasal repair with polyethylene implants

Our technique couples the stronger support granted by non-resorbable materials and the minimal invasiveness of the endoscopic approach without the need for long-term nasal packing

Fabry disease presenting with sudden hearing loss and otosclerosis : a case report

Introduction: Fabry disease is an X-linked lysosomal storage disorder resulting in a multiple-system disorder with a wide spectrum of physical signs and symptoms, predominantly affecting the central and peripheral nervous systems, skin, heart, kidneys, and eyes. Case presentation: We describe the case of a 26-year-old European Caucasian man who had Fabry disease and who presented with episodic sudden unilateral hearing loss and was treated with glucocorticoids, pentoxifylline, hyperbaric oxygen, and fluoride because of concomitant audiometric evidence of otosclerosis. This case demonstrates the partial and transient beneficial effect of standard treatment for sudden hearing loss not related to Fabry disease and analyzes the possible connection between typical Fabry disease inner-ear lesions and otosclerosis. Whereas hearing loss has been described in connection with Fabry disease, otosclerosis-associated hearing loss in Fabry disease has not yet been described. Conclusions: Although progressive hearing loss in patients with Fabry disease seems to be influenced by replacement therapy, few data concerning treatment of sudden hearing loss are available. The lack of literature concerning the pathogenesis of the otological involvement in Fabry disease makes it impossible to identify a connection between the latter and otosclerosis. Therefore, this report may help to reinforce the importance of a thorough evaluation of hearing in patients with Fabry disease and may be of help with therapeutic decisionmaking

Advanced Differentiated Thyroid Cancer. A Complex Condition Needing a Tailored Approach

Differentiated thyroid cancers (DTCs) are slow-growing malignant tumours, including papillary and follicular carcinomas. Overall, prognosis is good, although it tends to worsen when local invasion occurs with bulky cervical nodes, or in the case of distant metastases. Surgery represents the main treatment for DTCs. However, radical excision is challenging and significant morbidity and functional loss can follow the treatment of the more advanced forms. Literature on advanced thyroid tumours, both differentiated and undifferentiated, does not provide clear and specific guidelines. This emerges the need for a tailored and multidisciplinary approach. In the present study, we report our single-centre experience of 111 advanced (local, regional, and distant) DTCs, investigating the rate of radical excision, peri-procedural and post-procedural complications, quality of life, persistence, recurrence rates, and survival rates. Results are critically appraised and compared to the existing published evidence review

Long-term disease-free survival in surgically-resected oral tongue cancer: a 10-year retrospective study

Sopravvivenza libera da malattia a lungo termine nel tumore della lingua mobile operato: studio retrospettivo a 10 anni.PLAIN-LANGUAGE-SUMMARY: Early and loco-regionally advanced oral tongue squamous cell carcinoma (OTSCC) can be treated by surgery alone or followed by adjuvant radiotherapy or chemoradiotherapy. Nevertheless, up to 40% of patients develop tumour relapse. The aim of our study is to investigate the clinical and pathological features associated with reduced disease-free survival (DFS) in a cohort of surgically-resected OTSCC patients. One hundred and six patients surgically resected for OTSCC were retrospectively identified from clinical records. DFS was calculated according to the Kaplan\u2013Meier method and differences between variables were assessed with Log-Rank test. A multivariable Cox regression model was used to analyse the impact of different prognostic factors on DFS. After a median of follow-up of 8.9 years, 22 events, including 11 deaths, were observed. Overall, the 5-year DFS-rate was 87.4%. The presence of extra-nodal extension (p = 0.023) and perineural invasion (p = 0.003) were significantly correlated with shorter DFS (in univariate analysis). In multivariable analysis, extra-nodal extension and perineural invasion confirmed their role as independent prognostic factors associated with an increased risk of disease recurrence [hazard ratio (HR) 2.87, 95% CI 1.11-7.42, p = 0.03; HR 3.85, 95% CI 1.49-9.96, p = 0.006, respectively]. p16 and p53 expressions in tumour cells were detected in 12% (n = 9) and 46% (n = 40) of cases, respectively. No differences in DFS were observed between p16+ and p16- (p = 0.125) and between p53+ and p53- tumours (p = 0.213). In conclusion, radical surgery, eventually followed by adjuvant radiotherapy or chemo-radiotherapy, can achieve high cure rates in OTSCC. After long-term follow-up, perineural invasion and extra-nodal extension confirmed their role as prognostic factors associated with reduced DFS in OTSCC patients

Thermal water delivery in the nose: experimental results describing droplet deposition through computational fluid dynamics

Thermal water therapies have a role in treating various inflammatory disorders dating back to ancient Greece. Several studies have demonstrated beneficial effects of thermal water inhalations for upper respiratory disorders, such as improvement of mucociliary function and reduction of inflammatory cell infiltration. This experimental study describes the numerical investigation and clinical implications of thermal water droplet deposition in the nasal cavity of a single patient. To our knowledge, the numerical flow simulations described are the first investigations specifically designed for thermal water applications. To simulate nasal airflow, a patient-specific 3D computer model was created from a CT scan. The numerical approach is based on the Large Eddy Simulation (LES) technique and builds entirely upon open-source software. Deposition on mucosa was studied for two droplet sizes (5 and 10 µm diameter), corresponding to common thermal therapy applications (aerosol and vapour inhalation). The simulations consider steady inspiration at two different (low and moderate) breathing intensities. The results of this preliminary study show specific deposition patterns that favour droplet deposition in the middle meatus region to the inferior meatus, with particle size- and breathing intensity-related effects. These global data on particle deposition differ from findings related to the single-phase nasal airflow, which is more evenly distributed between the middle and inferior meatus. The potential clinical consequences of deposition data are discussed. The study furthermore provides evidence for the effectiveness of thermal aerosol and vapour inhalation therapies in reaching important areas of nasal mucosa with considerable clinical significance

Primary extra-cranial meningioma of head and neck : clinical, histopathological and immunohistochemical study of three cases

I meningiomi extracranici della regione testa-collo sono neoplasie rare, dal momento che la maggior parte di esse risulta essere una localizzazione secondaria di un tumore primitivo intracranico. Vengono di seguito descritti tre casi clinici di meningioma extracranico localizzati nel muscolo temporale, nella ghiandola parotide e nella cavit\ue0 nasale. L\u2019asportazione chirurgica \ue8 il trattamento di elezione e la prognosi di questo tipo di neoplasia \ue8 generalmente eccellente. Per la diagnosi differenziale istopatologica di queste neoplasie \ue8 necessario considerare i tumori pi\uf9 comuni della regione testa-collo. In particolare l\u2019esame istopatologico perioperatorio \ue8 molto utile nell\u2019indirizzare il trattamento chirurgico e dovrebbe essere sempre eseguito per escludere la natura maligna della lesione evitando un \u201cover-treatment\u201d. I nostri pazienti sono stati sottoposti ad intervento chirurgico e sono attualmente in buono stato di salute dopo il trattamento.Extracranial meningiomas of the head and neck region are rare neoplasms, the majority being a secondary location of a primary intracranial tumour. We herewith report three rare cases of extracranial meningiomas, located in the temporal muscle, parotid gland and nasal cavity, together with complete pathological, immunohistochemical and ultrastructural studies. Prognosis of this tumour is generally excellent. Surgical excision is the treatment of choice, with no need for further treatment; nevertheless, differential diagnosis must consider other more common tumours of the head and neck and be based on histopathologic examination and relative techniques, including examination of frozen sections. This procedure is particularly useful assessing surgical treatment and should be performed whenever possible to exclude the malignant nature of the lesion and avoid over-treatment. All three patients underwent surgery and are alive and disease-free