Limits of ENT surgery: when a multidisciplinary approach is required in skull base, orbit, dental pathologies and head-neck tumours involving skin. Introduction| ACTA Otorhinolaryngologica Italica

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I really thank the Italian Society of Otorhinolaryngology and Head & Neck Surgery for assigning me such a difficult task. Our specialty has experienced a profound change over the last twenty years, by refining the knowledge about the spectrum of ENT diseases and improving our surgical performance with an increasing number of surgical treatment modalities. This new wave of innovation changed our way of working, driving us to exceed our limit and going beyond the line of the standard ENT anatomic fields. In this scenario, great efforts have been made in order to cope with the risks of a new extended surgical approach, requiring an integrated collaboration with other head and neck surgical specialists.

We are witness of an epochal change, consisting of an evolutionary significance, never seen before. I first-hand experienced, during my very long ENT activity, the importance of an increasing multidisciplinary surgical approach to several ENT pathologies. The official report of the Italian Society of Otorhinolaryngology and Head & Neck Surgery for this year, essentially aimed to focus the attention on this topic, by outlining the complementarity between the different surgical specialties that share the head and neck district as the main field of action. The overlapping surgical practice by several surgeon in the same anatomic region may represent a prickly issue; this situation, in fact, if well-handled could guarantee better surgical outcomes, which could significantly improve the quality of life of patients; on the other hand, the relationship with other specialists may not always be simple, and close cooperation and mutual trust are essential to ensure higher levels of care. Moreover, it is important from a medico-legal point of view, in order to reduce the number of troubles, to strictly follow updated guidelines and other specialists’ expertise.

Cooperation between the ENT surgeon and other specialists is crucial, since all of the different anatomic areas affected by pathologies have distinctive characteristics and the best results in terms of life expectancy and patients’ quality of life can only be achieved through a synergic surgical approach. The cooperation between specialists should always start from the early diagnosis of different pathologies that involve shared field of action and should continue along the all diagnostic work-up, in order to achieve the best therapeutic strategy. This kind of tailored management, takes into account the needs of each patient, driving step by step to the correct therapeutic approach by involving several surgeons, each of them with a different expertise but with a complementary action.

Herewith, in our report we focused the attention on the modalities of cooperation between surgeons during the surgical management of complex disease, involving borderline anatomic sites. We underlined how other specialists’ expertise allows to manage difficult situations and their potential complications, in the light of a decreasing rate of surgical failures. In particular, the communication between the ENT surgeon and other surgeons (such as ophthalmologist, neurosurgeon, dentist and reconstructive surgeon) is critical and time-sensitive for a successful treatment with high success rate. In this report, we have intentionally excluded the discussion about the lateral skull base, as it was the central topic of the official report of 2019, and about the medical diseases in the ENT domain in which cooperation with other specialists is needed (neurologists, immunologists, etc.).

I am finally profoundly grateful to all the Authors who contributed to this official report. All this work was carried out hoping that it could be subject of debate and an instrument for the enrichment of all the readers.