Oncological and Functional Outcomes for Horizontal Glottectomy: A Systematic Review

: Horizontal glottectomy (HG) is a particular type of partial laryngectomy indicated for exclusive glottic tumor with anterior commissure involvement. The purpose of this study is to systematically review the literature about functional and oncological outcome of HG. This systematic review adhered to the recommendations of the PRISMA (Preferred Reporting Items of Systematic Reviews and Meta-analysis) 2009 guidelines. Articles mentioning patients undergoing HG for laryngeal squamous cell carcinoma were included. A total of 14 articles were selected and reviewed from 19 identified. The whole study population consisted of 420 patients who underwent HG. Three hundred and thirty-nine patients out of 359 were staged as T1. The range of post-operative follow-up was 5 months to 10 years. Fifty-five recurrences were experienced, being local, regional and distant in 35, 12 and 8 patients, respectively. Laryngeal preservation rate was 93.6%. Nasogastrict tube was removed on average after 10.1 days. The tracheostomy was maintained for 11.3 days. Mean hospitalization lasted for 11.7 days. According to the results of this systematic review, HG is an oncologically safe surgical option for T1a-T1b glottic tumors with oncological outcomes comparable to other treatment. HG could be a good therapeutical choice whenever poor laryngeal exposure and/or patient's refusal of radiotherapy are encountered, or when patient's medical history represents a contraindication for radiation therapy

Suprameatal–transzygomatic root endoscopic approach to the geniculate ganglion: an anatomical and radiological study.

Purpose To describe the suprameatal–transzygomatic root endoscopic approach (STEA) to the geniculate ganglion (GG), the labyrinthine facial nerve (FN) and epitympanum. Methods The feasibility and limits of the STEA, maintaining the integrity of the ossicular chain, were analysed. Ten human cadaveric ears were dissected. Step-by-step description of the technique and relevant measurements were taken during the approach. The visualization and surgical working feld on the anterior and posterior medial epitympanum, GG, greater superfcial petrosal nerve, the labyrinthine FN and suprageniculate area were evaluated. The range of motion through the approach and the rate of the decompression of the GG and the labyrinthine portion of the FN were assessed as well. CT-scan measurements were compared with those obtained during the dissection. Results A complete exploration of the epitympanum was possible in every specimen. Decompression of the GG and frst portion of the FN was achieved without any trauma to the ossicular chain in nine ears. The endoscope movements were mainly limited by the distance between bony buttress–short process of the incus–tegmen. The working space, during GG and labyrinthine FN decompression, was limited by the distance between malleus head–medial epitympanic wall and malleus head–GG. Radiologic measurements were consistent with those obtained during the dissections. Conclusion The STEA is a promising minimally invasive approach for decompression of the GG and FN’s labyrinthine portion. The applications of this corridor include the exploration and surgery of the medial epitympanum, preserving the ossicular chain

Rural Architectural Intensificaton: a multidisciplinary planning tool

When approaching a composite territorial problem that involves different scales and disciplines, it is necessary to establish a precise logical framework. Every planning or design activity is an iterative process applied to a complex system; not linear relations among the entities that compose the system are numerous and it is problematic to spell out them.  Authors developed a framework that has a hybrid structure in which different classical tool such as Spatial Decision Support Systems, Knowledge Discovery and Data Mining (KDD), and Expert Systems (ES) converge. The method is not completely automatic and there is a continuous interaction between user and system. The main aim of the entire research group who participated to a national research (PRIN 2009) was to define an informed methodology for decision makers, stakeholders and public bureaus who have to (or want to) face the problem of improving and intensifying insediative activities in minor centers located in rural-urban context. In particular authors defined Rural Architectural Intensification (RAI) as a way to improve territorial features throughout a serie of interventions in small settlements and buildings. The explanation of the relations among different disciplines, different scales and different related methodologies is the key point of the paper. After an introduction and the description of RAI, authors introduce the main methodological structure; then each passage is detailed and specified considering the elements involved and the technical operations