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To describe the surgical technique of the supraclavicular artery fascial flap (SAFF) and outcomes in neopharyngeal covering with overlay technique during salvage total laryngectomy for residual or recurrent carcinoma after chemo/radiation treatment.Chart review of patients treated between October 2018 and February 2019 at two tertiary care hospitals. Variables extracted from patient records were age, gender, history of chemo/radiation therapy, neck dissection, surgical and postoperative complications. Outcomes measured were surgical time, postoperative complications and flap failure, oral intake start and patient discharge.Ten male patients were included. Median age was 64 years. All patients underwent salvage total laryngectomy and neopharyngeal covering with SAFF. Mean flap harvest time was 25 minutes. No surgical complications or flap failure were recorded. Oral intake was started on a median of post-operative day 10. No cases of pharyngocutaneous fistula were encountered.SAFF is a reliable, easy and quick to harvest flap, which provides a good alternative to other pedicled and free flaps for hypopharyngeal coverage in laryngeal salvage surgery. Donor site morbidity is almost null and postoperative complications are very rare.Lembo peduncolato di fascia sovraclaveare: utile strumento nella laringectomia ed emifaringolaringectomia totale di salvataggio.Descrivere la tecnica chirurgica del lembo SAFF e le sue applicazioni e risultati nella ricostruzione faringea durante laringectomia di salvataggio per SCC persistenti dopo trattamento chemio/radioterapico.Analisi retrospettiva di pazienti trattati fra 10/2018 e 02/2019 in due centri ospedalieri di terzo livello. Le variabili analizzate sono età, sesso, precedente chemio/radioterapia, svuotamento laterocervicale, complicanze intra e post-operatorie. I risultati valutati sono tempo chirurgico, complicanze post-operatorie, fallimento del lembo, tempo d’inizio dell’alimentazione per os e durata della degenza.Sono stati inclusi 10 pazienti maschi. L’età mediana era 64 anni. Il tempo mediano di allestimento del lembo è stato di 25 minuti. Non sono state registrate complicanze intra o post-operatorie. L’inizio mediano dell’alimentazione per os è stato in decima giornata post-operatoria. Non sono stati osservati casi di fistolizzazione faringo-cutanea.Il SAFF è un lembo affidabile, facile e rapido da allestire, che offre una valida alternativa ad altri lembi peduncolati e liberi per la copertura ipofaringea nella chirurgia laringea di salvataggio. La morbilità del sito donatore è praticamente nulla e le complicanze post-operatorie sono molto rare.

Purpose: To evaluate the role of selected modalities of Storz Professional Image Enhancement System (IMAGE1 S) in differentiating cholesteatoma during endoscopic ear surgery (EES); to assess the potential usefulness of IMAGE1 S in recognition of cholesteatoma residuals at the end of EES. Methods: A retrospective study on 45 consecutive patients who underwent EES for cholesteatoma between March 2019 and November 2019 at a tertiary referral center was performed. For each case, Spectra A and Spectra B filters were applied intra-operatively. When examining the surgical field, a switch from white light (WL) to IMAGE1 S was performed to detect cholesteatoma and differentiate it from non-cholesteatomatous tissue. When the IMAGE1 S pattern was suspicious for the presence of cholesteatoma, images of the field under both enhancement modalities were taken and the targeted lesions were sent for histologic analysis. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of IMAGE1 S were calculated. A final recognition of the surgical field using the selected filters was performed to detect any possible cholesteatomatous residuals. Results: Detection of cholesteatoma by IMAGE1 S selected filters revealed the following data: sensitivity 97%, specificity 95%, PPV 95%, NPV 97%. On three occasions, there was no correspondence between enhanced endoscopy and histology. In 5 out of 45 cases (11%), cholesteatoma residuals, which had not been identified at WL inspection at the end of the procedure, were detected by IMAGE1 S. Conclusion: Our results suggest a potential role for IMAGE1 S Spectra A and B filters in EES for cholesteatoma surgery. We propose the integration of IMAGE1 S as a final overview of the surgical cavity for recognition of cholesteatomatous residuals.

This systematic review aims to (a) define what instruments are available to measure quality of life (QoL) in patients undergoing tympanoplasty for chronic otitis media (COM) and what is the most commonly selected timing to do so; (b) compare outcomes from different surgical techniques; and (c) describe any reported correlation between subjective and functional results. This review was conducted following the PRISMA statement recommendations. Of the 151 articles screened, 24 were included. Most studies had a prospective design. The mean age at surgery was 44.5 years. A microscopic retroauricular approach was the most common surgical technique. Most articles included both primary and revision surgeries. The most commonly used questionnaire was the Glasgow Benefit Inventory (GBI), followed by the Chronic Ear Survey (CES), the Chronic Otitis Media Outcome Test 15 (COMOT-15) and the Zurich Chronic Middle Ear Inventory (ZCMEI-21). Questionnaires were administered about 12 months after surgery in most studies. Ten studies reported possible associations between hearing results and QoL. QoL assessment after COM surgery variably relies on disease-specific and non-specific questionnaires. Patients are usually evaluated 12 months after surgery, and this appears to be a suitable timing to contrast the possible bias effect of different tympanoplasty techniques associated with different healing times. A comparison between QoL outcomes in different surgical approaches cannot be made, as several influencing factors have not been detailed in the included studies. Few studies have investigated the correlation between subjective and objective outcomes of tympanoplasty for COM so far.

Myringotomy and ventilation tube placement are procedures usually indicated for middle ear effusion with persistent conductive hearing loss. Although tympanostomy tube placement is a well-known technique and is considered a simple and low-risk procedure, sometimes there can be significant complications associated with this approach, like otorrhea, displacement of the device, and persistent perforation of the tympanic membrane. The two main advantages of the endoscopic approach for myringotomy and ventilation tube positioning are the possibility to work better in case of stenotic or tortuous external auditory canal and the enhanced visualization that can allow us to identify vascular abnormalities medial to the tympanic membrane, avoiding critical complications.

BACKGROUND AND OBJECTIVES The current evidence regarding complications after salvage neck dissection (ND) for isolated regional recurrences (IRRs) in head and neck cancers is poor. The aim of this study is to evaluate the incidence and differences in complication rates of salvage ND after primary surgery, radiotherapy, chemoradiotherapy, or combined treatments. METHODS This was a multicentric retrospective study on 64 patients who underwent salvage ND for IRR in three Italian institutes between 2008 and May 2020. RESULTS Complications were detected in 7 of the 34 patients (20.8%) and surgeons described difficult dissection in 20 patients (58.82%). Accidental vascular ligations or nervous injury during surgery were never detected. None of the variables analyzed were statistically significant in predicting the risk of complications, disease-free survival, or overall survival. CONCLUSIONS IRR represents a rare entity among total relapses. The incidence of complications after salvage ND for IRR is higher than after primary surgery but at an acceptable rate in experienced hands. However, an adequate balance between functional and oncological outcomes is mandatory.

Interactions between SARS-CoV-2 and pharyngeal associated lymphoid tissue are thought to influence the manifestations of COVID-19. We aimed to determine whether a previous history of tonsillectomy, as a surrogate indicator of a dysfunctional pharyngeal associated lymphoid tissue, could predict the presentation and course of COVID-19.Multicentric cross-sectional observational study involving seven hospitals in Northern and Central Italy. Data on the clinical course and signs and symptoms of the infection were collected from 779 adults who tested positive for SARS-CoV-2, and analysed in relation to previous tonsillectomy, together with demographic and anamnestic data.Patients with previous tonsillectomy showed a greater risk of fever, temperature higher than 39°C, chills and malaise. No significant differences in hospital admissions were found.A previous history of tonsillectomy, as a surrogate indicator of immunological dysfunction of the pharyngeal associated lymphoid tissue, could predict a more intense systemic manifestation of COVID-19. These results could provide a simple clinical marker to discriminate suspected carriers and to delineate more precise prognostic models.COVID-19 nella popolazione tonsillectomizzata.Si ritiene che le manifestazioni dell’infezione da SARS-CoV-2 siano influenzate dalle interazioni tra il virus e il tessuto linfatico associato alla faringe. Obiettivo di questo studio è determinare se una pregressa tonsillectomia, come indicatore surrogato di disfunzione immunologica faringea, possa predire la presentazione e il decorso della COVID-19.Studio multicentrico trasversale osservazionale coinvolgente 7 centri italiani. Sono stati raccolti i dati su decorso, segni e sintomi dell’infezione da 779 adulti positivi al SARS-CoV-2, e analizzati in relazione a pregressa tonsillectomia, dati demografici e anamnestici.I pazienti con pregressa tonsillectomia hanno un maggior rischio di sviluppare febbre, raggiungere temperature oltre i 39°C, brividi e malessere generalizzato. Non si riscontrano differenze nel tasso di ospedalizzazione.Il dato anamnestico di pregressa tonsillectomia, come indicatore di disfunzione immunologica faringea, può predire una manifestazione sistemica più intensa nei pazienti affetti da COVID-19. Questi risultati possono fornire un marker clinico semplice per discriminare sospetti portatori del virus e delineare modelli prognostici più accurati.

The purpose of this study was to understand the use of interim assessment data to inform mathematics instruction. A qualitative case study methodology was used to analyze the use of interim assessment data in a suburban elementary school. Data sources included interviews with three teachers at varying levels of their profession and the principal; observations of teachers working with assessment data in teams or as part of a professional development setting; artifacts representing interim assessments, supporting materials, and analysis results. The study explored the type of culture that was developed around data use, the types of assessments that were used, how the data were analyzed, and teachers’ use of the data as a means to inform their instruction. The results from this research will inform the work of teachers and adminis-trators as they design systems to support students’ learning.

The importance of training as a determiner of a company’s performance is widely acknowledged: the “Canton Ticino” (Switzerland) has to demonstrate that the organisational decisions (such as whether or not to maintain a training programme) are based on a strategic learning process. The aim of this chapter is to illustrate the evaluation process of a training programme conducted for a group of Swiss public managers. In order to measure the impact of the training, the first three (Reaction, Learning, Behaviour) of the four levels identified in Kirkpatrick’s model (1994) were measured, using an ex-post analysis. In particular, the chapter is focused on the changes at behavioural level.

The authors (a) discuss the importance of alignment for facilitating proper assessment and instruction, (b) describe the three most common methods for evaluating the alignment between state content standards and assessments, (c) discuss the relative strengths and limitations of these methods, and (d) discuss examples of applications of each method. They conclude that choice of alignment method depends on the specific goals of a state or district and that alignment research is critical for ensuring the standards-assessment-instruction cycle facilitates student learning. Additional potential benefits of alignment research include valuable professional development for teachers and better understanding of the results from standardized assessments.

The Italcementi case is a paradigmatic example of how a technological innovation process can lead to overall change of a firm’s organizational and value creation model. The success of the process does not lie so much in the validity of the technological solution, but rather in the ability to manage the change process itself, the main pillars of which are the learning of new techniques and new business models, the correct management of power, the development of technological, financial and knowledge resources.