ACTA Otorhinolaryngologica Italica

Endoscopic transnasal approach to remove an intraorbital bullet: systematic review and case report

2024-09-30T13:27:49+00:00

Introduction. Intraorbital foreign bodies (IOFBs) represent a clinical challenge: surgical management can be controversial and different strategies have been proposed. When removal is recommended, depending on the location and nature of the IOFB both external and endoscopic approaches have been proposed, with significantly different surgical corridors to the orbit and different morbidities.
Methods. We performed a literature review of cases of IOFBs that received exclusive endoscopic transnasal surgical treatment to evaluate the role of this surgery in these occurrences. We also present a case of an intraorbital intraconal bullet that was successfully removed using an endoscopic transnasal approach with good outcomes in terms of ocular motility and visual acuity.
Results. A limited number of cases of IOFBs have been treated with an exclusive endoscopic transnasal approach. When in the medial compartment, this approach appears to be safe and effective. In our case, two months after surgery the patient showed complete recovery with no significant long-term sequelae.
Conclusions. When feasible, an endoscopic transnasal approach for intraorbital foreign bodies represents a valid surgical technique with optimal outcomes and satisfactory recovery.

Management and prognosis of iatrogenic perforations of the cervical oesophagus and hypopharynx

2024-10-14T07:53:11+00:00

Objective. The study aimed to identify factors affecting the management and prognosis of iatrogenic cervical oesophageal and hypopharyngeal perforations (iCEHPs).
Methods. We retrospectively analysed 24 patients treated for iCEHP between 2004 and 2021 at a tertiary university medical centre. Data on demographics, clinical features, imaging, management and outcomes were collected. Factors associated with primary management and patient outcome were assessed.
Results. The most common management approach was surgical neck exploration (15 patients, 62.5%). Surgical management was used in 93% of uncontained perforations compared to 11% of contained perforations (p < 0.001). Surgically-treated patients had higher levels of C-reactive protein (CRP) than conservatively-treated patients (median, 18.3 vs 4.8 mg/dL; p = 0.001). Delayed diagnosis (≥ 24 hours) was associated with increased mortality (100 vs 5%; p = 0.011). The mortality rate was significantly higher in patients who had a history of neck irradiation than in patients who did not (67 vs 5%; p = 0.032).
Conclusions. Early diagnosis of iCEHP improves outcomes. The appropriate management should be carefully selected on the basis of CRP level and imaging findings. Prior neck radiation is a poor prognostic factor.

Squamous cell carcinoma metastatic to the lymph nodes of the parapharyngeal space: case series and systematic review

2024-09-30T13:27:51+00:00

Objective. Parapharyngeal space (PPS) is a rare and unusual site of head and neck squamous cell carcinoma (SCC) metastases. Treatment strategy for PPS metastases is still not well defined. This research aims to investigate the clinical implications and oncological outcomes of SCC metastases in PPS.
Material and methods. A systematic review was conducted according to PRISMA criteria. The authors considered only articles reporting the history and treatment of patients with PPS SCC metastases. A retrospective chart review was conducted in two tertiary referral academic centers collecting data of patients with diagnosis of PPS SCC metastases between 2010 and 2023 to study their outcome based on clinical presentation and treatment strategy.
Results. The retrospective chart review showed that the oropharynx was the most frequent primary tumour site. The advanced stage at the time of diagnosis was related to poorer survival and higher recurrence rates. A significant difference in 2-year overall survival in the subgroup of patients who experienced PPS metastases within the primary treatment and those who experienced PPS metastases as regional recurrence (66.7 vs 30.8%) was observed. Similar low survival rates were reported in the literature review with a mean overall and disease-free survival of 19.8 and 8.6 months, respectively.
Conclusions. PPS metastases are associated with a dismal prognosis, especially when diagnosed as regional recurrence after primary treatment, due to patients’ poor general conditions and difficulty of treatment.

Recurrent respiratory papillomatosis: comparing in-office and operating room treatments

2024-09-30T13:27:52+00:00

Objective. We report the management of recurrent respiratory papillomatosis (RRP) employing a protocol that includes both office-based (OB) and general anaesthesia (GA) procedures. Quality of life (QoL) outcomes in the OB cohort were compared to those obtained from an historical cohort treated only under GA.
Methods. Patients affected by RRP from 2019 until 2023 (“new protocol”) and from 2012 to 2019 (“historical protocol”) were enrolled. In both groups the Derkay site score (DSS) was calculated. In patients adhering to the new protocol, questionnaires measuring QoL were prospectively administered (voice handicap hindex-10 [VHI-10] along with a specific questionnaire to measure the tolerance to the OB procedures). A cost analysis was also performed.
Results. In all, 35 patients composed the new protocol cohort and 13 the historical. In the first group, patients underwent a median of 4 treatments. At 2 years, 68% of patients were treated ex-clusively in the office. Overall, for the new protocol, median DSS and VHI-10 after one year were both significantly lower than those at baseline [2 vs 4 and 3 vs 14, respectively; p < 0.001]. No differences were found between the new and the historical protocol cohorts considering DSS over time.
Conclusions. Treatment of RRP may be conducted successfully in an office-based setting reducing healthcare costs.

TIM-3-driven macrophage polarisation is associated to recalcitrant chronic rhinosinusitis with nasal polyps

2024-09-30T13:27:53+00:00

Objective. This study evaluated the expression of TIM-3 and its influence on macrophage polarisation in recalcitrant chronic rhinosinusitis with nasal polyps (CRSwNP).
Methods. We detected TIM-3 expression in serum and tissue samples of healthy controls (HC), primary CRSwNP, and patients with recurrent CRSwNP. Macrophage markers were detected among three groups, and their correlations with TIM-3 levels were examined. Macrophages from circulating blood were collected and used to examine the impact of TIM-3 on polarisation in vitro.
Results. TIM-3 levels were enhanced in the CRSwNP group compared to the HC group. Tissue immunofluorescence revealed elevated TIM-3 expression in patients with CRSwNP, and patients with multiple recurrences exhibited higher TIM-3 levels compared to their first recurrence and baseline levels. Tissue CD163 and CD206 levels were higher in recurrent CRSwNP in comparison with primary cases and HCs, and had a positive correlation with TIM-3 levels. TIM-3 overexpression promoted M2 polarisation and enhanced TGF-β1 and IL-10 secretion.
Conclusions. TIM-3 expression was enhanced in patients with CRSwNP, especially in those undergoing revision surgeries. TIM-3 may be a novel biomarker for recalcitrant CRSwNP. TIM-3-driven M2 polarisation might be involved in the mechanisms of recurrent CRSwNP.

Management of frontal sinus and frontal recess inverted papilloma: our experience and systematic review

2024-09-30T13:27:53+00:00

Objective. For frontal sinus inverted papilloma (FSIP) management, an endoscopic endonasal approach (EEA) can be combined (or not) with an external approach by an osteoplastic flap (OPF) or with a more conservative open approach. The present study aims to describe our experience in the management of FSIP, focusing on disease-related and anatomical features influencing outcomes and recurrence.
Methods. This case series of FSIP investigated anatomical and disease-related predictors of recurrence associated with EEA or a combined EEA-OPF approach. A systematic review was also performed, selecting publications on IP with the insertion point in the frontal sinus or frontal recess.
Results. Among 30 patients included, 18 underwent EEA, while 12 received a combined EEA-OPF approach. During a median follow-up of 37 months, the frontal sinus was cleared of IP in all cases except 2 in the EEA group, who presented a complex posterior wall shape of the frontal sinus. From the systematic review, a combined EEA-OPF approach was associated with a lower risk of recurrence.
Conclusions. A correct indication for a combined EEA-OPF approach is paramount and should integrate all disease-related and anatomical features, including posterior wall shape.

Predicting excellent response to radioiodine in differentiated thyroid cancer using machine learning

2024-09-30T13:27:54+00:00

Objective. If excellent response (ER) occurs after radioactive iodine (RAI) treatment in patients with differentiated thyroid carcinoma (DTC), the recurrence rate is low. Our study aims to predict ER at 6-24 months after RAI by using machine learning (ML) methods in which clinicopathological parameters are included in patients with DTC without distant metastasis.
Methods. Treatment response of 151 patients with DTC without distant metastasis and who received RAI treatment was determined (ER/nonER). Thyroidectomy ± neck dissection pathology data, laboratory, and imaging findings before and after RAI treatment were introduced to ML models.
Results. After RAI treatment, 118 patients had ER and 33 had nonER. Before RAI treatment, TgAb was positive in 29% of patients with ER and 55% of patients with nonER (p = 0.007). Eight of the ML models predicted ER with high area under the ROC curve (AUC) values (> 0.700). The model with the highest AUC value was extreme gradient boosting (AUC = 0.871), the highest accuracy shown by gradient boosting (81%).
Conclusions. ML models may be used to predict ER in patients with DTC without distant metastasis.

Relationships of the vidian nerve and internal carotid artery: MRI and intraoperative surgical evaluation

2024-09-30T13:27:54+00:00

Objective. Skull base anatomy around the internal carotid artery (ICA) is extremely complex. Among anatomical landmarks studied, the vidian canal has been thoroughly evaluated, unlike the vidian nerve (VN). Our aim is to evaluate the VN-ICA relationships, and understand their role in terms of surgical planning.
Methods. Fifty MRI examinations of 100 healthy petro-spheno-clival regions were reviewed in order to evaluate the relationship between the vidian nerve axis (VNA) and the petrous ICA. Twentyseven cases of expanded endonasal approaches to petrous apex region were evaluated to check the VN-ICA relationship intraoperatively.
Results. MRI evaluations showed that, in 23% of cases, the VNA was below the edge of the ICA, in 45% it was at the edge of the ICA and in 32% it ended up above the edge of the ICA. Surgically speaking, in 9 of 28 petrous apex approaches, the VN ended above the inferior edge of the petrous carotid.
Conclusions. MRI evaluation adds useful information in planning the surgical approach to petro-spheno-clival regions, even if the identification of VNA, in these cases, may not be radiologically possible. Surgical experience confirms the importance of VN identification in guiding the surgeon in complex cases, and also outline the possible risks of relying only on this landmark.

A case of otoliquorrhoea secondary to immunotherapy response in head and neck cutaneous squamous cell carcinoma. When abrupt response may worry the physician

2024-09-30T13:27:55+00:00