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Recurrent respiratory papillomatosis (RRP) is a benign disease of the upper aerodigestive tract caused by human papillomavirus (HPV) types 6 and 11. The clinical course is unpredictable and some patients, especially younger children, experience a high rate of recurrence with a significant impact on their quality of life. The molecular mechanisms of HPV infection in keratinocytes have been extensively studied throughout the years, with particular regard to its role in causing malignant tumors, like cervical cancer and head and neck carcinomas. A minor but not negligible amount of the literature has investigated the molecular landscape of RRP patients, and some papers have studied the role of angiogenesis (the growth of blood vessels from pre-existing vasculature) in this disease. A central role in this process is played by vascular endothelial growth factor (VEGF), which activates different signaling cascades on multiple levels. The increased knowledge has led to the introduction of the VEGF inhibitor bevacizumab in recent years as an adjuvant treatment in some patients, with good results. This review summarizes the current evidence about the role of VEGF in the pathophysiology of RRP, the molecular pathways activated by binding with its receptors, and the current and future roles of anti-angiogenic treatment.

ObjectiveThe local spread of oral tongue squamous cell carcinoma (OTSCC) follows pathways of dissemination along areas of lesser resistance. In more advanced scenarios, the tumor can extend beyond the hemi-tongue of origin, by passing through the lingual septum and following the fibers of the transverse muscle. This can lead to the invasion of the contralateral extrinsic muscles, the first being the genioglossus and more laterally the hyoglossus. An anatomically guided surgical resection of the tumor can be planned to ensure both oncological safety and an acceptable functional outcome. This approach aims to preserve the hyo-styloglossus unit (HSU) whenever feasible.MethodsBetween January 2019 and November 2022, six patients received extended glossectomy Type B (EG Type B), with preservation of the HSU. Preliminary oncological results and functional results in terms of swallowing (FOIS score) and quality of life (MDADI) are presented.ResultsFive out of the six patients are alive and disease-free, while one patient died due to other causes. All patients who were candidates for an EG Type B underwent a swallowing assessment prior to surgery and followed daily postoperative swallowing training. At discharge, the patients continued swallowing training in an outpatient clinic. Five out of the six patients reached a full oral diet within 1 year of follow-up.ConclusionThe oncological results confirm the safety of this technique. The importance of preserving the HSU, the minimal functional unit, shows very encouraging results in terms of swallowing rehabilitation.

Introduction: The planning of oral reconstruction after tumor resection is a pivotal point for head and neck surgeons. It is mandatory to consider two aspects: the size of the surgical defect and the complexity of the oral cavity as an anatomical region. We offer a review of the literature that focuses on four types of locoregional flaps that can be profitably used for such reconstruction: infrahyoid (IF), nasolabial (NF), platysma (PF), and submental (SF). Methods: The study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. This systematic review was carried out according to the PICOS acronym through a comprehensive electronic search on PubMed/MEDLINE, Cochrane Library, and Google Scholar databases. For each selected article, we extrapolated eight main parameters, of which all mean values were compared through an ANOVA test. The dimensions of the oral defects were referred to as "small" (<7 cm2), "medium" (7–50 cm2), or "large" (>50 cm2). Results: A total of 139 articles were selected with a total of 5898 patients. The mean ages for each type of flap were not statistically significant (p = 0.30, p > 0.05). Seven sublocations of oral defects were reported: The most common was the tongue (2003 [34.0%] patients), followed by the floor of the mouth (1786 [30.4%]), buccal mucosa (981 [16.6%]), cheek (422 [7.2%]), hard palate (302 [5.1%]), alveolar ridge (217 [3.7%]), and retromolar trigone (187 [3.2%]). The defects were mainly medium-sized (4507 [76.4%] patients), and fewer were small-sized (1056 [17.9%]) or large-sized (335 [5.7%]). Complications were noted, the most frequent of which was flap necrosis, seen in 0.57% of cases. The functional and esthetical results were mainly positive. Conclusions: Locoregional flaps represent a good alternative in medium-sized defects as well as a fairly good alternative in small- and large-sized defects when other options are ruled out. [ABSTRACT FROM AUTHOR]

L’intervento prende in esame due casi di studio dell’Appennino tosco-emiliano: l’ospedale intitolato a San Benedetto e a Sant’Antonino delle Alpi, detto anche di Prato del Vescovo, e l’ospedale della Croce Brandegliana. Erano entrambi ospedali di valico posti su due delle principali strade che collegavano Pistoia ai territori emiliani. Particolarmente interessanti appaiono le vicende due e trecentesche di questi due enti (sorti a fine XI secolo), che conobbero il passaggio dalla giurisdizione ecclesiastica a quella comunale, l’ampliamento delle funzioni espletate, la progressiva riduzione della comunità ospedaliera fino al trasferimento in città o alla sua scomparsa. Nel tentativo di comprendere le ragioni di queste evoluzioni, nel contributo ci si sofferma sul significato assunto dalla costituzione di una rete ospedaliera per la colonizzazione ecclesiastica della zona; sulle conseguenze nell’indirizzamento militare delle attività ospedaliere derivante dall’affermazione del comune come forza politica; e infine sugli effetti di fenomeni di carattere climatico, fazionario e religioso nella configurazione del paesaggio assistenziale.

Il volume costituisce uno dei prodotti del PRIN 2015 Alle origini del welfare (XIII-XVI secolo). Radici medievali e moderne della cultura europea dell’assistenza e delle forme di protezione sociale e credito solidale, coordinatrice Gabriella Piccinni. In questa occasione, studiose e studiosi presentano contributi utili ad affrontare in maniera comparativa la storia degli enti ospedalieri di montagna, soffermandosi su casi di studio di area italiana, francese e iberica. Gli scavi documentari e orografici su un tema finora molto poco esplorato della storia ospedaliera medievale hanno consentito di ridefinire la fisionomia degli ospedali di montagna – che si sono rivelati essere non solo ospizi e rifugi, ma anche santuari, fortezze, aziende, locande – e di rivedere alcune convinzioni storiografiche: la funzionalità di questi enti è apparsa infatti dipendere maggiormente dalle esigenze di coloro che vissero, lavorarono, controllarono le aree di montagna, che dai bisogni dei viaggiatori occasionali, come i pellegrini. Il volume si presta dunque a contribuire in maniera originale e significativa alla ricostruzione dei paesaggi storici e delle strutture economiche, politiche, sociali, oltre che dei quadri culturali e religiosi, dei territori medievali.

Primary tumors of the airways in the pediatric population are very rare entities. For this reason, little is known about the pathogenesis of these neoplasms. Understanding the biology has different practical implications: for example, it could help in the differential diagnosis, have a prognostic significance, or may lead to the development of a targeted therapy. The aim of this article is to present the current knowledge about pediatric airways tumors, focusing on the molecular mechanisms that cause the onset and progression of these neoplasms. After a brief introduction of epidemiology and clinical presentation, the tumorigenesis of the most frequent pediatric airways tumors will be described: Juvenile-onset recurrent respiratory papillomatosis (JORRP), Subglottic Hemangiona (SH), Rhabdomyosarcoma (RMS), and Mucoepidermoid carcinoma (MEC).