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The primary aim of this study was to illustrate the prevalence of facial skeletal discrepancy in an Italian sample. Another aim was to evaluate the effectiveness of the sagittal skeletal discrepancy classification in order to establish a morphologic pattern of growth useful for diagnosis and prediction of therapeutic results. The authors considered a sample of 732 patients (426 females and 306 males) aged between 6 and 17 years old. Cephalometric parameters were evaluated in order to establish a relationship between sagittal skeletal discrepancy and the classification of facial rotations (Lavergne and Petrovic). Facial types with neutral mandibular growth direction were the most prevalent, and were most observed in classes I and II; the latter was more represented than others in our sample. Facial types with posterior mandibular growth direction were the most prevalent in class III. Sagittal skeletal discrepancy classification is not able to establish a specific facial type or predict an individual responsiveness to treatment.Studio retrospettivo epidemiologico delle tipologie rotazionali mandibolari in pazienti con malocclusione.L’obiettivo principale di questo studio è stato quello di definire la prevalenza delle asimmetrie cranio-facciali nella popolazione italiana. Obbiettivo secondario è stato quello di valutare l’efficacia della classificazione delle asimmetrie scheletriche sul piano sagittale al fine di stabilire il pattern morfologico di crescita, utile per la diagnosi e la previsione dei risultati terapeutici. Gli autori hanno analizzato retrospettivamente 732 pazienti (426 donne, 306 maschi), di età compresi tra 6 e 17 anni. Sono stati quindi effettuati i vari tracciati cefalometrici per stabilire i rapporti scheletrico sagittali e la classificazione delle rotazioni facciali sec Lavergne e Petrovic. Le tipologie con la più alta prevalenza sono risultate essere quelle con una direzione neutrale di crescita mandibolare. Tali tipologie sono state quelle più frequentemente osservate sia in classe I sia in classe II (la classe malocclusiva maggiormente rappresentata). In classe III, invece, è stata osservata la più alta prevalenza di tipologie facciali con direzione posteriore di crescita mandibolare. In conclusione la classificazione delle asimmetrie craniofacciali non è in grado di stabilire una specifica tipologia rotazionale e predire la risposta individuale al trattamento.

For survivors of severe COVID-19 disease, having defeated the virus is just the beginning of an uncharted recovery path. What follows after the acute phase of SARS-CoV-2 infection depends on the extension and severity of viral attacks in different cell types and organs. Despite the ridiculously large number of papers that have flooded scientific journals and preprint-hosting websites, a clear clinical picture of COVID-19 aftermath is vague at best. Without larger prospective observational studies that are only now being started, clinicians can retrieve information just from case reports and or small studies. This is the time to understand how COVID-19 goes forward and what consequences survivors may expect to experience. To this aim, a multidisciplinary post-acute care service involving several specialists has been established at the Fondazione Policlinico Universitario A. Gemelli IRCSS (Rome, Italy). Although COVID-19 is an infectious disease primarily affecting the lung, its multi-organ involvement requires an interdisciplinary approach encompassing virtually all branches of internal medicine and geriatrics. In particular, during the post-acute phase, the geriatrician may serve as the case manager of a multidisciplinary team. The aim of this article is to describe the importance of the interdisciplinary approach––coordinated by geriatrician––to cope the potential post-acute care needs of recovered COVID-19 patients.

Altered immune responses have been reported in head and neck cancer, and some of these responses have been associated with poor clinical outcomes. A multiple-array technology platform was used to simultaneously evaluate the levels of 25 cytokines. Pre-treatment serum levels were evaluated in 31 HNSCC patients and 6 healthy controls. The levels of 8 cytokines, specifically IL-1ra, IL-2, IL-5, IL-6, IL-8, IL-17, IFN-γ and IP-10, were significantly higher in patients than in controls. Among cancer patients we observed lower levels of IFN-γ and IL-7 in cases with nodal metastases compared to those with cN0 disease. We observed increases in the levels of some serum cytokines in HNSCC patients, as well as reductions in selected cytokines associated with regional progression. These findings provide an intriguing perspective on the development and validation of novel markers for follow-up evaluations and predictions of regional spreading in HNSCC patients.IFN-γ e altre citochine sieriche nei carcinomi squamocellulari della testa e del collo.È noto che nelle neoplasie della testa e del collo vi siano delle alterazioni della risposta immune, ed alcune di tali alterazioni sono state associate ad un peggioramento prognostico. Abbiamo utilizzato una piattaforma con una tecnologia multi-array per valutare simultaneamente i valori di 25 citochine nel siero di 31 pazienti, affetti da carcinomi squamosi della testa e del collo prima del trattamento, e di 6 controlli sani. I livelli di 8 citochine, IL-1ra, IL-2, IL-5, IL-6, IL-8, IL-17, IFN-γ ed IP-10, sono risultati significativamente più elevati nei pazienti che nei controlli. Tra i pazienti i casi con metastasi linfonodali mostravano livelli significativamentre inferiori di IFN-γ ed IL-7 rispetto ai casi cN0. Pertanto alcune citochine tendono ad essere più elevate nei soggetti affetti da carcinomi squamocellulari della testa e del collo, ma nel contesto di tale gruppo di pazienti si osserva un calo specifico di alcune citochine in caso di metastasi linfonodali. Tali dati aprono prospettive interessanti soprattutto ai fini di una miglior definizione del rischio di metastasi/recidive linfonodali con implicazioni sia in termini di impostazione terapeutica che di follow up.

Nowadays oral appliance therapy is recognised as an effective therapy for many patients with primary snoring and mild to moderate obstructive sleep apnoea (OSA), as well as those with more severe OSA who cannot tolerate positive airway pressure (PAP) therapies. For this reason, it is important to focus on objective criteria to indicate which subjects may benefit from treatment with a mandibular advancement device (MAD). Various anthropometric and polysomnographic predictors have been described in the literature, whereas there are still controversies about the role of drug-induced sleep endoscopy (DISE) and advancement bimanual manoeuvre as predictor factors of treatment outcome by oral device. Herein, we report our experience in treatment of mild moderate OSA by oral appliance selected by DISE. We performed a single institution, longitudinal prospective evaluation of a consecutive group of mild moderate patients with obstructive sleep apnoea syndrome who underwent DISE. During sleep endoscopy, gentle manoeuvre of mandibular advancement less than 5 mm was performed. In 30 of 65 patients (46.2%) we obtained an unsuccessful improvement of airway patency whereas in 35 of 65 patients (53.8%) the improvement was successful and patients were considered suitable for oral device application. Because 7 of 35 patients were excluded due to conditions interfering with oral appliance therapy, we finally treated 28 patients. After 3 months of treatment, we observed a significant improvement in the Epworth medium index [(7.35 ± 2.8 versus 4.1 ± 2.2 (p0.05)], in mean AHI [(21.4 ± 6 events per hour versus 8.85 ± 6.9 (p0.05)] and in mean ODI [(18.6 ± 8 events per hour to 7 ± 5.8 (p0.05)]. We observed that the apnoea/hypopnoea index (AHI) improved by up to 50% from baseline in 71.4% of patients selected after DISE for MAD therapy. In the current study, mandibular advancement splint therapy was successfully prescribed on the basis not only of severity of disease, as determined by the subject's initial AHI, but also by DISE findings combined with results of gentle mandibular advancement manoeuvre allowing direct view of the effects of mandibular protrusion on breathing spaces in obstruction sites, and showing good optimisation of selection of patients for oral device treatment.Il trattamento con dispositivi di avanzamento mandibolare (MAD) rappresenta un'efficace alternativa terapeutica per i pazienti affetti da roncopatia semplice, OSAS di grado lieve/moderato e in casi selezionati di OSAS grave con scarsa tollerabilità alla terapia ventilatoria con C-PAP. Pertanto è importante identificare dei criteri oggettivi per selezionare i pazienti che possono beneficiare del trattamento con i sistemi di avanzamento mandibolare (MAD). In letteratura sono stati descritti vari fattori predittivi sia antropometrici che polisonnografici, mentre esistono ancora controversie circa il ruolo della Sleep Endoscopy e della manovra di avanzamento mandibolare bimanuale durante lo stesso esame come fattori predittivi del successo terapeutico con MAD. In questo studio descriviamo la nostra esperienza nel management di pazienti affetti da OSAS lieve/moderata trattati con MAD e selezionati mediante "sleep endoscopy". Abbiamo eseguito una valutazione prospettica longitudinale di una serie consecutiva di pazienti giunti alla nostra osservazione con diagnosi di OSAS lieve/moderata e sottoposti a sleependoscopy. Durante il sonno indotto farmacologicamente è stata eseguita una delicata manovra di avanzamento mandibolare con escursione inferiore ai 5 mm e abbiamo riscontrato che in 30 dei 65 pazienti (46,2%) lo spazio respiratorio non migliorava in modo significativo a livello dei siti di ostruzione osservati, mentre in 35 dei 65 pazienti (53,8%) si osservava un miglioramento significativo tale da poter indicare terapia con MAD. In 7 dei 35 pazienti venivano riscontrate condizioni che ostacolavano l'applicazione del MAD per cui 28 dei 35 pazienti sono stati sottoposti a terapia con MAD. Dopo 3 mesi di trattamento abbiamo documentato un miglioramento significativo dell'indice di Epworth medio [(7,35 ± 2,8 vs 4,1 ± 2,2 (p0.05)], dell'AHI medio [(21.4 ± 6 eventi per ora verso 8,85 ± 6,9 (p0.05) ] e dell'ODI medio [(18.6 ± 8 eventi per ora versus 7 ± 5.8 (p0.05)]. Abbiamo inoltre osservato che l'AHI migliorava di almeno il 50% rispetto al basale nel 71.4% dei pazienti selezionati mediante sleep endoscopy. In questo studio, la terapia con i dispositivi di avanzamento mandibolare è stata prescritta con successo sulla base non soltanto dell'indice di apnea/ipopnea, ma anche dei reperti della sleep endoscopy e della manovra di avanzamento mandibolare, ottenendo una visione diretta degli effetti della protrusione mandibolare sullo spazio respiratorio in corrispondenza dei siti di ostruzione, e ottenendo una buona ottimizzazione della selezione dei pazienti per il trattamento con MAD.

Intracochlear schwannomas are rare tumours. Diagnosis is based on high-resolution MRI, which should be used for accurate determination of the location of tumours. We report a case of a cochlear schwannoma that presented with profound hearing loss and intractable paroxysmal positional vertigo, which was diagnosed with gadolinium-enhanced MRI and removed using a transcanal minimally-invasive transotic approach.I neurinomi intracocleari sono tumori rari. La diagnosi si basa sulla RM, che fornisce accurate informazioni sulla loro localizzazione. Descriviamo un caso di neurinoma intracocleare manifestatosi con ipoacusia profonda e una intrattabile vertigine posizionale: la diagnosi è stata effettuata con la RM con gadolinio e il tumore rimosso mediante un approccio mini-invasivo transotico transcanalare.

Although the voice in a free field has an excellent recruitment by a cochlear implant (CI), the situation is different for music because it is a much more complex process, where perceiving the pitch discrimination becomes important to appreciate it. The aim of this study is to determine the music perception abilities among children with Cis and to verify the benefit of a training period for specific musical frequency discrimination. Our main goals were to prepare a computer tool for pitch discrimination training and to assess musical improvements. Ten children, aged between 5 and 12 years, with optimal phoneme recognition in quiet and with no disabilities associated with deafness, were selected to join the training. Each patient received, before training period, two types of exams: a pitch discrimination test, consisting of discovering if two notes were different or not; and a music test consisting of two identification tasks (melodic and full version) of one music-item among 5 popular childhood songs. After assessment, a music training software was designed and utilised individually at home for a period of six months. The results following complete training showed significantly higher performance in the task of frequency discrimination. After a proper musical training identification, frequency discrimination performance was significantly higher (p0.001). The same considerations can be made in the identification of the songs presented in their melodic (p = 0.0151) and full songs version (p = 0.0071). Cases where children did not reach the most difficult level may be due to insufficient time devoted to training (ideal time estimated at 2-3 hours per week). In conclusion, this study shows that is possible to assess musical enhancement and to achieve improvements in frequency discrimination, following pitch discrimination training.Gli attuali impianti cocleari forniscono buoni segnali temporali e grossolane indicazioni spettrali. In generale queste proprietà sono sufficienti per la percezione di un discorso in condizioni di quiete e per l'acquisizione del linguaggio nei bambini piccoli. Tuttavia esse risultano essere inadeguate per la trasmissione della moltitudine di pitch della musica. Lo studio si propone come obiettivi la determinazione delle abilità di percezione della musica nei bambini portatori di impianto cocleare e la verifica dei benefici di un periodo di training musicale specifico per la discriminazione frequenziale. In particolare abbiamo proposto un allenamento alla discriminazione delle note musicali, secondo un metodo da noi sviluppato attraverso un supporto computerizzato. Sono stati inclusi nello studio 10 bambini portatori di impianto cocleare di età compresa tra i 5 e i 12 anni senza disabilità associate alla sordità. Tutti i soggetti avevano un'ottima comprensione dei fonemi in ambiente silenzioso. Ogni paziente nel periodo precedente al Training è stato sottoposto a due tipi di esame: un test di discriminazione del pitch, che consiste nel riuscire ad identificare come differenti due note musicali pur in condizioni di crescente difficoltà (da 1 ottava ad 1 semitono), e un Music Test costituito da due prove di identificazione, Melodica e Strumentale completa. Il materiale del Music Test era costituito dai 5 canzoni popolari per l'infanzia, sintetizzate con il software Finale 2008™ (Makemusic Inc. Eden Prairie, MN). I brani, ciascuno della durata di 30 secondi, erano simili per il ritmo e venivano presentati in due modalità differenti: una versione melodica suonata al pianoforte senza accompagnamento orchestrale e parole cantate, ed una versione completa della canzone, che include l'accompagnamento dell'orchestra e le parole cantate. Il Training consisteva in un allenamento guidato da un programma che veniva fornito su supporto informatico ad ogni paziente, della durata di 6 mesi con allenamento almeno bisettimanale. I risultati ottenuti evidenziano che tutti i bambini sono migliorati nel training di discriminazione frequenziale (p0,0001). Per eliminare la possibilità che questo progresso potesse essere dovuto al caso o ad altri fattori si è applicata un'analisi statistica t-Student ad una coda per dati appaiati per verificarne la significatività. Le prestazioni al test di identificazione di item musicali sia nella versione melodica che in quella completa sono risultate significativamente superiori al livello casuale con un p0,05. I risultati ottenuti mostrano performance significativamente superiori nel compito di discriminazione frequenziale successivamente all'esecuzione del Training. Infatti prima del training 2 bambini si posizionavano al 1° livello (discriminazione frequenziale di 12 semitoni), 3 bambini al 2° livello (discriminazione frequenziale di 10 semitoni), 4 bambini al 3° livello (discriminazione frequenziale di 8 semitoni) e 1 bambino al 5° livello (discriminazione frequenziale di 4 semitoni), mentre dopo il training, 2 bambini si collocavano uno al 4° e uno al 5° livello, 5 bambini al 6° livello e i restanti 3 bambini al 7° ed ultimo livello. Dal nostro studio emerge quindi come sia possibile, in seguito ad un allenamento specifico con materiale dedicato, ottenere dei significativi miglioramenti nella discriminazione frequenziale permettendo anche ai soggetti impiantati di apprezzare meglio il mondo della musica.

In past years, external dacryocystorhinostomy has been considered the gold standard in terms of functional outcome for treatment for nasolacrimal duct obstruction. In comparison, interest in the use of the recently developed endonasal dacyocystorhinostomy procedure has been rekindled because of advances in instrumentation. For the past 10 years, differences in the outcomes between the two techniques have been reduced; thus, currently, the choice of the type of surgery is associated with the experience of the surgeon, resources available in the healthcare system and patient preferences.In passato la dacriocistorinostomia per via esterna (EXT-DCR) è stata considerata il gold standard in termini di risultato funzionale nel trattamento delle ostruzioni del dotto naso lacrimale. L'innovazione della strumentazione ha recentemente incrementato l'interesse per la dacriocistorinostomia endoscopica per via endonasale (EES-DCR). Negli ultini 10 anni le differenze in termini di risultati tra le due tecniche chirurgiche sono andate riducendosi; la scelta del tipo di tecnica chirurgica è attualmente legata all'esperienza del chirurgo, alle risorse economiche del sistema sanitario e alle preferenze del paziente.

The objective of our studies was to document the presence of bacterial biofilms in recurrent and chronic infectious diseases of the upper airways (UA) (adenoiditis, tonsillitis, chronic rhinosinusitis) and to assess the association between the presence of biofilm and the maintenance of a chronic inflammation.16 surgical samples of tonsils and adenoids from patients with UA infections and 24 samples of ethmoid mucosa from patients who underwent endoscopic sinus surgery for chronic rhinosinusitis (CRS) were cultured using conventional methods and subjected to scanning electron microscopy (SEM) to detect evidence of biofilm.Bacterial biofilms were observed in 57.5% of chronically infected UA mucosa; in 41.7% of ethmoid mucosa of CRS patients they were significantly (p0.001) associated with a marked destruction of ciliated epithelium.Our studies confirm that biofilm formation plays a role in UA infections, it not only explains the resistance of these infections to antibiotic therapy, but also represents an important element that contributes to the maintenance of a chronic inflammatory reaction.

Contemporary research efforts have provided new insight into the processes underlying common hearing impairments include aging, genetic defects, and environmental stress such as excessive noise (NIHL) or chemotherapeutic drugs. The primary cause of hearing impairment involves the death of sensory cells (hair cells) and neurons in the cochlea which are irreplaceable in mammmals. Rehabilitative measures have traditionally been based on technical solutions: hearing aids and cochlear implants that can minimize the social impact of impairment, however the challenge for a successful hearing rehabilitation is definitely the prevention of cell death or regeneration of the sensorineural cells and neurons after cochlear damage. Addressing experimentally the first issue, we have shown that noise exposure and ototoxic drugs lead to apoptosis and by using neurotrophic factors and anti-apoptotic drugs as well as antioxidants, we have developed several therapeutic approaches of protection thus limiting the damage to the inner ear [1-3]. One of the most exciting areas involving hair-cell regeneration concerns regeneration of hair cells with the use of stem cells. The discovery of both adult and embryonic stem cells in the cochlea and evidence that they can be converted into hair cells raise hope for the development of stem-cell based treatment regimes to regenerate damaged cochlear components. Potential cell sources for inner ear transplantation include fetal dorsal root ganglion cells, neural progenitor cells, stem or progenitor cells isolated from inner ear, immortalized auditory neuroblast cells, embryonic stem cells (ESCs) and their derived neuronal cells, and marrow stromal cells and finally stem cells arising from amniotic fluid and placenta and olfactory progenitors [3,4]. Principal obstacles for the clinical application remain the effects of immunosuppression, induced-carcinogenesis and teratoma formation observed in the experimental models [3,4].

This study aimed to evaluate audiological and vestibular involvement in Fabry disease and the effects of enzyme replacement therapy with human alpha-galactosidase A. The study population comprised 20 patients (11 males, 9 females) aged 15-69 years (mean 39.7). Patients underwent a complete clinical and instrumental evaluation before starting and during enzyme replacement therapy. Median follow-up was 51.5 months (range 25-73). Nine patients (45%) complained of hearing symptoms (hearing loss, tinnitus); for six of them the onset and/or progression of the hearing loss were sudden. Vertigo or dizziness was reported by 6 patients (30%). Audiological evaluation showed a sensorineural hearing loss in 18 ears (45%; 10 in male patients, 8 in females). The hearing thresholds for 0.5, 1, 2 and 4 kHz frequencies ranged from 10 to 65 dB HL. Hearing loss was unilateral in 8 cases (40%; 4 in male patients, 4 in females). Also high frequency hearing loss for 4 and 8 kHz was evaluated. No signs of retro-cochlear lesions were observed by means of otoacoustic emissions and auditory brainstem response. Vestibular examinations showed a functional impairment in 7 ears (17.5%, all male patients). During enzyme replacement therapy the auditory function showed some degrees of worsening but no significant changes were observed at statistical analysis. In conclusion involvement of the inner ear is common in men and women with Fabry disease. In this study, a high incidence of cochlear hearing loss was found, which was typically unilateral and showed onset and/or progression by sudden episodes. Vascular or hydropic mechanisms could be hypothesized to explain audiological findings. Vestibular involvement showed a lower incidence and different pattern, thus suggesting that several patho-physiological mechanisms could play a role in determining inner ear damage in Fabry disease. Results obtained show that enzyme replacement therapy may stabilize hearing function; however, further studies on the physiopathology of the inner ear damage are needed.

Aim of the present study was to identify bacterial biofilms in tissue samples obtained from paediatric patients undergoing surgical treatment, for chronic and recurrent adeno-tonsillitis, not responding to repeated cycles of selective medical antibiotic and anti-inflammatory treatment and to assay the ability of Haemophilus influenzae strains, most frequently identified in the culture examinations, to grow as biofilm in vitro. Overall, 25 surgical specimens (15 adenoids, 10 tonsils) were examined from the upper respiratory tract, from 15 paediatric patients (mean age 6 years). All patients were affected by recurrent and/or chronic adenoiditis and adenotonsillitis unresponsive to selective antibiotic and anti-inflammatory therapy. Tissues were cultured using conventional methods and subjected to scanning electron microscopy for detection of biofilm. Haemophilus influenzae strains, were cultured on 96-sterile well polystyrene microtitre plates (CELLSTAR-greiner bio-one) and stained with 1% crystal violet to quantify biofilm production. Bacterial cocci attached to the tissue surface and organized in colonies, with a morphology consistent with bacterial coccoid biofilms, were observed in all adenoid (15/15) and in 6/10 tonsil samples. Haemophilus influenzae isolates from 12/25 (48%) of our tissue samples scored a percent transmittance (%Tbloc) > 50, displaying a high capacity to form biofilms (level 4). In conclusion identification of bacterial biofilms in chronic and/or recurrent paediatric upper airway inflammatory processes and the capacity to produce biofilm in vitro, demonstrated by Haemophilus influenzae (the most frequently identified bacteria in our samples), could be related to the aetiopathogenic role of biofilms in chronic inflammatory mucosal reactions and to the resistance of these infections to selective antibiotic therapy.

Background The association between head and neck squamous cell carcinoma (HNSCC) and allelic variants of glutathione S-transferase M1 (GSTM1) and -T1 (GSTT1) is currently controversial. The present study investigates the prevalences of GSTT1 and GSTM1 polymorphism in a cohort of 100 head and neck cancer patients, 100 healthy donors and 200 controls with non-neoplastic head and neck diseases from Italian Lazio Region. Methods The patients with benign head and neck pathologies, as well as the healthy donors were matched for age, sex, cigarette smoke (yes/no) and alcohol consumption (yes/no). Molecular definition of GSTT1 and GSTM1 genotype has been performed by means of allele-specific PCR technique. Results A significant association between head and neck cancer and GSTM1 null genotype was observed both considering benign disease controls (p = 0.001, OR = 2.613; 95% C.I. = 1.48–4.62), and healthy donors (p = 0.0003, OR = 3.35; 95% C.I. 1.69–6.67) while no significant association was found with GSTT1 null genotype (p ≥ 0.14). No interactive association was observed when combining the different genotypes of the two polymorphisms. These results were confirmed after correction for daily number of cigarettes and period of tobacco exposure. Conclusions The present study confirms a role for genetic alterations of GSTM1 detoxifying enzyme as a risk factor for the development of HNSCC in patients from the Italian Lazio Region, independently of age, sex and other confounding variables.