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The role of prophylactic central neck dissection (pCND) in differentiated thyroid cancer (DTC) is still controversial.In a cohort of 274 DTC cN0 patients with a high rate of tumour recurrence, who underwent total thyroidectomy with or without pCND, clinical and histopathological features were retrospectively analysed.In our cohort, no clinical or histopathological features are able to predict the presence of central lymph node metastases (CLNM) at diagnosis, which instead represents the only variable significantly associated with a higher risk of long-term tumour relapse, independently from age, sex, BMI and radioiodine treatment (OR=1.03, CI95% 1.002-1.074, p0.05). Moreover, our study demonstrates that pCND does not significantly increase the risk of post-surgical complications.In our setting, pCND could have a key role in the management of DTC. The risks and benefits of pCND should be evaluated for each population to make the most appropriate therapeutic choice.

Papillary thyroid microcarcinoma (mPTC) is defined as a papillary thyroid cancer sized 10 mm or less. Despite their generally indolent clinical course and good prognosis, a subset of mPTCs shows potentially aggressive behaviour. To search for predictors of clinical outcome of mPTCs, we retrospectively evaluated the genetic tumour profile of 100 patients (23 M/77 F, mean age ± SD 53.8 ± 13.4 years) with histologically confirmed mPTCs through analysis of BRAF, NRAS and TERT promoter mutations as well as RET/PTC translocations. Mean follow-up period was 8.4 ± 3.6 years. In 55 cases, mPTC were detected incidentally after surgery. Capsular invasion, bilateralism and multifocality were found in 11/100, 17/100 and 24/100 cases, respectively, while lymph-nodes metastases were present at diagnosis in 9/100 cases. After 3.5 ± 2.0 years, tumour relapse occurred in 6/100 cases and was locoregional in five (two in the thyroid bed, three in laterocervical lymph-nodes), while lung metastasis occurred in one case. Biochemical persistence of disease was seen in 1/100 case. Mutations occurred in 55/100 cases; BRAFV600E was the most frequently detected (49/100) and was associated with higher tumour size, bilateralism and follicular variant but not with capsular invasion. RET/PTC rearrangements were found in 2/100 cases, NRASQ61R in 4/100, while no mutations of TERT promoter gene were detected. Despite the observed association between BRAFV600E mutation and unfavourable histopathological features, we found no direct association with tumour recurrence, distant metastases and mortality. In our study, the search for the most frequent genetic alterations as prognostic markers in mPTCs would not have changed the therapeutic strategy.

Lymphangiomas are relatively uncommon head and neck region lymphatic malformations. Although surgery can be still considered the mainstay of treatment, sclerotherapy by OK-432 is becoming a widespread treatment option. The aim of this article is to present and discuss the management and outcomes of a series of cases of lymphangiomas. All patients with lymphangiomas who were treated from 2010 to 2018 were reviewed. The following data were recorded: age, gender, subtype, staging, type of treatment, outcome, and recurrence. Fifteen patients (9 females, 6 males) were included with 2 microcystic and 13 macrocystic lymphangiomas. Six patients underwent surgery with excision (5 with a complete success, one with a fair success), whereas the remaining 9 subjects underwent sclerotherapy by OK-432 (6 with a complete success, 3 with a fair success). No postoperative complications were observed. All modes of treatment are important in properly selected patients affected by lymphangiomas. OK-432 therapy is a safe and effective option in the treatment of head and neck lymphangiomas.

SUMMARY Medical simulation enables trainees to learn procedural skills in a tailored, non-threatening, controlled environment that can provide feedback and educational experiences. The goals of this study are to describe the set-up and execution of an educational intervention (SimORL) in Ear Nose and Throat (ENT) simulation, to report confidence in performing basic ENT procedures before and after the event and investigate whether participants would find it useful and educationally effective. SimORL was a two-day formative event held at SIMNOVA - Eastern Piedmont Simulation Centre, Italy. The event was open to ENT trainees from any Italian ENT training program; participants were divided into 5 teams and rotated around 10 different simulation stations over two days. Stations included: high-fidelity, skill trainer, computer based, wet lab and dissection. Stations were: virtual otoscopy (OtoSim®), simulated clinical cases with high-fidelity mannequin (e.g. epistaxis) or standardised patients (e.g. vestibular neuronitis), robotic surgery (Da Vinci®), human anatomy (zSPACE AIO®), surgical tracheostomy (wet model), cadaveric sino-nasal endoscopy (wet model), crisis resource management (team exercise), surgical sutures (Limbs&Things SkinPad®), surgical set station and team building exercises. Participants were asked to complete a pre- and post-test that queried previous experience and confidence using 10-item unanchored semantic scales. Results are presented as median (25-75 percentile). Satisfaction was assessed by a validated 5-item Likert Simulation Experience Scale (SSES). Twenty-three ENT trainees attended SimORL 2018. Only 3 participants reported limited previous simulation experience. Pre-post confidence significantly improved between before and after the event. Overall satisfaction with Simulation Experience Scale (SSES) was very high with a median of 4.5 of 5. Regarding simulation evaluation, the most appreciated station was nasal endoscopy (10/10), while the least appreciated was otoscopy (6/10). SimORL proved to be a highly rated and useful educational tool to improve junior ENT trainees’ confidence in performing basic ENT procedures.

Introduction A variety of surgical techniques of septoplasty have been described. The aim of the present study was to assess the feasibility of endoscopic septoplasty as a routine approach both alone and during other sinonasal – skull base endoscopic procedures. Methods A retrospective study of all patients admitted for endoscopic septoplasty that were performed between January 2011 and December 2017 was conducted. Patients that performed septoplasty either alone or in combination with sinus surgery or skull base surgery were included. Data regarding postoperative major complications such post-operative hemorrhage, synechiae, and septal tears or perforation were collected. Results 647 patients were included. Postoperative hemorrhage was observed in 0,3% of patients, synechiae in 5,2% of cases, and septal tears and/or perforations in 6,2% of the whole study population. An incomplete septal correction was observed in 27 patients (4,2%). Conclusions The endoscopic technique provides a better visualization allowing to observe fewer complications. It can also be considered as an excellent and effective teaching tool.

BaCKgrOUND: the COViD-19 pandemic caused a diagnostic delay in various conditions, including sudden sensorineural hearing loss (SShl). the aim of this study was to investigate whether during the COViD-19 emergency period patients with a diagnosis of SShl received a late diagnosis and if any delay resulted in a worse post-therapy outcome. MEthODS: a retrospective study was conducted. Patients who received a diagnosis of SShl during COViD-19 period and in the same period of the previous year were identified (control group);demographic and clinical data, values of the tonal threshold at the time of diagnosis (T0) and after therapy (t1) and the recovery rate were collected. rESUltS: Sixteen patients of group 1 (control group) and 11 of group 2 (COViD-19 period) met the inclusion criteria. Diagnosis and therapy were performed on average after 1.69 days in group 1, after 5.45 days from the onset of symptoms in group 2 (P=0.0025). after therapy, the audiometric control examination showed an average threshold recovery of 26.77 dB in group 1 and 20.53 dB in group 2 (P=0.048). in group 1, 62.5% experienced recovery of the hearing threshold while in group 2 only 36.4% (P=0.252). CONClUSiONS: Despite therapy starting time was inevitably different in analyzed groups, diagnostic delay during COViD-19 emergency period resulted in a reduced improvement in the mean tonal threshold after therapy. Our data seems to confirm the hypothesis that early diagnosis and treatment are associated with a higher probability of auditory recovery. © 2020 EDiZiONi MiNErVa MEDiCa

Purpose: COVID-19 pandemic transformed the health system response worldwide. The aim of this study is to report changes about numbers and reason for ENT consultations in emergency department (ED) during COVID-19 pandemic comparing with those occurred the previous year (2019). Methods: Data about patients admitted to adult and pediatric ED were collected from March 1 to May 31, 2019 and 2020. Patients referred for urgency from general practitioners were excluded from the study. Results: Global ED admission (except for dyspnea or COVID-19–related symptoms) dramatically decreased during pandemic (−50.9% among adults and −71.4% among pediatrics). At the same time, ENT consultancy significantly reduced too, by 71.5% ( P < .01) among adults and 45.1% ( P < .01) for pediatrics. Among adults, it was reported a statistically significant decrease in consultation for ear problems (−88.5%, P = .0146). Reduction in ENT referral for bone fracture (−40%, P = .059), vertigo (−77.8%, P = .637), and tonsillitis (−87.5%, P = .688) was consistent, but not significant. Among pediatric patients, it was observed an increase by 25% about foreign bodies (12 vs 15, P < .01). A reduction in numbers of consults for ear problem (−90.8%; P = .045), epistaxis (−80%; P = .196), and nasal fracture (−70%; P = .36) was also observed. Conclusion: Fear of infection and the forced lock down caused a significant decrease in the number of ED accesses and in ENT consultancy. These data may suggest that some ED referral usually could be deferred, but on the other hand, pandemic will cause a great diagnostic delay.

Introduction Many types of research have been performed to improve the diagnosis, therapy, and prognosis of oropharyngeal carcinomas (OP-SCCs). Since they arise in lymphoid-rich areas and intense lymphocytic infiltration has been related to a better prognosis, a TREM-1 putative function in tumour progression and survival has been hypothesized. Materials and methods Twenty-seven human papillomavirus (HPV) 16+ OP-SCC specimens have been analyzed to relate TREM-1 expression with histiocytic and lymphocytic markers, HPV presence and patients’ outcome. Results No differences have been shown between intratumoral and stromal CD4+ cells, while intratumoral CD8+ lymphocytes are higher with respect to the tumour stroma (p = .0005). CD68+ cells are more than CD35+ and TREM-1+; their presence is related to CD35± and TREM-1± histiocytes (p = .005 and .026, respectively). Intratumoral CD4+ lymphocytes are higher in p16+ cases (11/27) than in p16− (p = .042); moreover, p16 positivity correlates to a better survival (p = .034). CD4+, CD8+ and CD35+ cells have no impact on survival, while CD68 expression heavily influences progression and bad outcome (p = .037). TREM-1 positivity also leads to worst overall survival (p = .001): peritumoral expression and death-cause relationship are always significant, particularly when the cause is OP-SCC (p = .000). Conclusion While p16 shows to better stratify HPV16+ patients’ outcome, TREM-1+ macrophages suggest their key importance in HPV-related OP-SCCs progression.KEY MESSAGESTREM-1 positivity correlates to the worst overall survival of HPV16-positive OPSCCs-affected patients.p16-positive HPV16 related OPSCCs patients have a better prognosis with respect to p16-negative ones.

Introduction: Radiofrequency turbinate volume reduction (RFTVR) is an effective treatment of inferior turbinate hypertrophy. RFTVR can reduce epithelial cell alterations in nasal mucosa. The aim of this observational study was to evaluate the effects of RFTVR on nasal obstruction and cytology, stratifying for different types of rhinitis. Methods: Nasal cytology and subjective nasal obstruction were evaluated on 113 patients before RFTVR (T0) and after 3 months (T1). The patients were divided into groups on the basis of the underlying disease: allergic rhinitis, nonallergic rhinitis, rhinitis medicamentosa, and other diseases (e.g., hormonal-based turbinate hypertrophy). Results: Nasal cytology at T0 identified 42 patients with allergic rhinitis, 40 with nonallergic rhinitis, 19 with rhinitis medicamentosa, and 12 with other diseases. An improvement of nasal cytology at T1 was observed in 29.2% of cases. They mainly consisted of patients with nonallergic rhinitis with neutrophils, whose neutrophil infiltrate decreased. Only 2 cases (1.7%) showed a worsening of nasal cytology at T1. A statistically significant decrease in subjective nasal obstruction was observed for every group (p < 0.05). Higher differences of nasal obstruction between T0 and T1 were found in patients with rhinitis medicamentosa or other diseases. Conclusion: RFTVR represents a safe and effective treatment for turbinate hypertrophy of various etiology. It is not responsible for a worsening of inflammatory infiltrate of the nasal mucosa.

Oropharynx squamous cell carcinoma (OPSCC) is a subtype of head and neck squamous cell carcinoma (HNSCC) arising from the base of the tongue, lingual tonsils, tonsils, oropharynx or pharynx. The majority of HPV-positive OPSCCs has a good prognosis, but a fraction of them has a poor prognosis, similar to HPV-negative OPSCCs. An in-depth understanding of the molecular mechanisms underlying OPSCC is mandatory for the identification of novel prognostic biomarkers and/or novel therapeutic targets. 14 HPV-positive and 15 HPV-negative OPSCCs with 5-year follow-up information were subjected to gene expression profiling and, subsequently, compared to three extensive published OPSCC cohorts to define robust biomarkers for HPV-negative lesions. Validation of Aldo-keto-reductases 1C3 (AKR1C3) by qRT-PCR was carried out on an independent cohort (n = 111) of OPSCC cases. In addition, OPSCC cell lines Fadu and Cal-27 were treated with Cisplatin and/or specific AKR1C3 inhibitors to assess their (combined) therapeutic effects. Gene set enrichment analysis (GSEA) on the four datasets revealed that the genes down-regulated in HPV-negative samples were mainly involved in immune system, whereas those up-regulated mainly in glutathione derivative biosynthetic and xenobiotic metabolic processes. A panel of 30 robust HPV-associated transcripts was identified, with AKR1C3 as top-overexpressed transcript in HPV-negative samples. AKR1C3 expression in 111 independent OPSCC cases positively correlated with a worse survival, both in the entire cohort and in HPV-positive samples. Pretreatment with a selective AKR1C3 inhibitor potentiated the effect of Cisplatin in OPSCC cells exhibiting higher basal AKR1C3 expression levels. We identified AKR1C3 as a potential prognostic biomarker in OPSCC and as a potential drug target whose inhibition can potentiate the effect of Cisplatin.

In this reply to a letter, the Authors discuss the raised points regarding the nomenclature and management of Lymphatic Malformations / Lymphangiomas.

Background As reported by increasing literature, a significant number of patients with SARS‐CoV‐2 infection developed smell/taste disorders. Aim of this study is to determine the prevalence and severity of these symptoms among laboratory‐confirmed SARS‐CoV‐2 patients. Secondary objective is to determine their onset/recovery time. Methods This cross‐sectional study was conducted from March 10 to 30, 2020 at Novara University Hospital during the COVID‐19 Italian outbreak. The 355 enrolled patients answered a questionnaire at 14th (or more) days after proven infection. Results The overall population prevalence of both smell/taste or one of the two disorders was 70%. They were first symptoms in 31 (8,7%) patients. Most patients reported a complete loss that in half of the cases (49.5%) was fully recovered after 14 days, with a median recovery time of 10 days. Conclusion This study confirms a high prevalence of smell/taste disorders in COVID‐19 infection with self‐recovery for half cases after about 2 weeks.

Clinical features and natural history of coronavirus disease 2019 (COVID-19) differ widely among different countries and during different phases of the pandemia. Here, we aimed to evaluate the case fatality rate (CFR) and to identify predictors of mortality in a cohort of COVID-19 patients admitted to three hospitals of Northern Italy between March 1 and April 28, 2020. All these patients had a confirmed diagnosis of SARS-CoV-2 infection by molecular methods. During the study period 504/1697 patients died; thus, overall CFR was 29.7%. We looked for predictors of mortality in a subgroup of 486 patients (239 males, 59%; median age 71 years) for whom sufficient clinical data were available at data cut-off. Among the demographic and clinical variables considered, age, a diagnosis of cancer, obesity and current smoking independently predicted mortality. When laboratory data were added to the model in a further subgroup of patients, age, the diagnosis of cancer, and the baseline PaO2/FiO2 ratio were identified as independent predictors of mortality. In conclusion, the CFR of hospitalized patients in Northern Italy during the ascending phase of the COVID-19 pandemic approached 30%. The identification of mortality predictors might contribute to better stratification of individual patient risk.

La malattia metastatica in oncologia testa-collo.Il distretto testa e collo rappresenta una delle più comuni sedi di insorgenza di malattie oncologiche, con una percentuale di disseminazioni metastatiche elevata tanto a livello loco-regionale quanto a distanza. La prognosi di questi tumori è strettamente legata ad alcuni fattori principali: a) lo stadio della malattia; b) le recidive loco-regionali; c) le metastasi a distanza. Nei tumori della testa e del collo le metastasi a distanza sono presenti in circa il 10% dei casi al momento della prima diagnosi e si rendono evidenti nel corso della malattia in un ulteriore 20%-30% dei casi. Quando una metastasi a distanza a partenza da un tumore della testa e del collo si rende evidente, la prognosi viene usualmente considerata infausta, con una sopravvivenza media stimabile intorno ai 10 mesi. Scopo del presente lavoro è quello di fornire un up-todate aggiornato ed esaustivo in tema di metastasi a distanza in oncologia cervico-cefalica alla luce delle più recenti conoscenze. Concetti di recente acquisizione quali l’assetto molecolare dei tumori, le possibili interazioni tra cellule tumorali e tessuti, le peculiarità della malattia oligometastatica, il ruolo dell’immunoterapia… stanno profondamente cambiando l’approccio terapeutico in questi pazienti, con interessanti ricadute in tema di controllo di malattia. I primi capitoli sono dedicati alla storia naturale ed all’epidemiologia delle metastasi a distanza nei tumori della testa e del collo ed al loro inquadramento diagnostico anatomo-patologico e radiologico. Nei capitoli successivi vengono focalizzate le più rilevanti peculiarità cliniche con particolare attenzione agli argomenti di recente attualità quali le metastasi a distanza da tumori EBV ed HPV positivi ed il concetto di malattia oligometastatica. Ampio spazio viene destinato alle varie opzioni terapeutiche con particolare attenzione al sempre più rilevante ruolo dell’immunoterapia ed allo sviluppo di nuove tecnologie terapeutiche. In conclusione, vengono focalizzate le problematiche etico-cliniche legate al concetto di fragilità del paziente oncologico e le crescenti difficoltà di una sostenibile governance socio-economica.The head and neck district represents one of the most frequent sites of cancer, and the percentage of metastases is very high in both loco-regional and distant areas. Prognosis refers to several factors: a) stage of disease; b) loco-regional relapses; c) distant metastasis. At diagnosis, distant metastases of head and neck cancers are present in about 10% of cases with an additional 20-30% developing metastases during the course of their disease. Diagnosis of distant metastases is associated with unfavorable prognosis, with a median survival of about 10 months. The aim of the present review is to provide an update on distant metastasis in head and neck oncology. Recent achievements in molecular profiling, interaction between neoplastic tissue and the tumor microenvironment, oligometastatic disease concepts, and the role of immunotherapy have all deeply changed the therapeutic approach and disease control. Firstly, we approach topics such as natural history, epidemiology of distant metastases and relevant pathological and radiological aspects. Focus is then placed on the most relevant clinical aspects; particular attention is reserved to tumours with distant metastasis and positive for EBV and HPV, and the oligometastatic concept. A substantial part of the review is dedicated to different therapeutic approaches. We highlight the role of immunotherapy and the potential effects of innovative technologies. Lastly, we present ethical and clinical perspectives related to frailty in oncological patients and emerging difficulties in sustainable socio-economical governance.

Paragangliomas of the thyroid gland are rare and usually they originate from the inferior laryngeal paraganglia. In this case report, we describe the case of a 78-year-old woman who presented with an incidental finding of thyroid nodule dislocating the trachea. After a systemic and radiological evaluation, right lobo-isthmectomy was performed, and the definitive diagnosis of paraganglioma was reached. Diagnosis of these thyroidal lesions could be difficult due to their rarity, to their specific radiological aspects and the need of employing specific histological staining techniques. Once the definitive diagnosis is reached, patients should undergo a systemic and genetic evaluation. Surgery is the gold standard treatment; radiotherapy should be considered when aggressive behavior is suspected. Regular long-lasting follow-up should be proposed to these patients considering the unpredictable behavior of these lesions.

Background: Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by the ossification of entheses. When localized in the cervical paravertebral region, typical signs and symptoms include...

Endoscopic approach represents a valid alternative to conventional septoplasty. The aim of this study is to analyze the objective and subjective data on 276 patients, who underwent traditional (147) or endoscopic (129) septoplasty. This is a prospective observational study on 276 consecutive patients affected by deviated nasal septum (DNS), who underwent isolated septoplasty between 2011 and 2018. 147 of them were treated using an “open” approach, while 129 were treated with an endoscopic approach. The two groups were compared 3 months after surgery: the objective results (complications such as bleeding, hematoma, pain, synechiae, septal tears and incomplete correction), objective (rhinomanometric data) and subjective measurements (NOSE questionnaires). Both techniques are effective in decreasing nasal obstruction and discharge. Complications such as pain, synechiae, early postoperative bleeding, septal tears and incomplete correction are less frequent in the endoscopic group (p

Objective Congenital nonvascular neck masses are a challenge in head and neck diagnosis and management. The aim of this study was to analyze the clinical and epidemiologic findings in patients who were diagnosed with congenital nonvascular neck masses. Study Design All cases of patients with congenital nonvascular neck masses who were treated between 1996 and 2018 were reviewed. The following data were recorded: age, gender, final pathologic diagnosis (thyroglossal duct cysts, branchial cleft cysts, dermoid cysts), side of the lesion, subtype according to branchial arch (for branchial cleft cysts), and need for second surgery. Results In total, 226 patients were included: 100 with thyroglossal duct cysts, 97 with branchial cysts, and 29 with dermoid cysts. Excision surgery was performed in all cases. Recurrence and subsequent second surgery was necessary in 5 cases. Conclusions Appropriate knowledge of clinical and epidemiologic data regarding congenital nonvascular neck masses is crucial. Surgical resection is the optimal choice of therapy. Early referral of these patients to a head and neck surgeon is crucial for timely treatment.

This study was designed to identify the physiological vocal parameters of Italian adult subjects by means of Praat software, differentiated by gender and age. The vocal parameters analyzed were mean pitch, Jitter local %, Jitter local absolute, Jitter rap, Jitter ppq5, Jitter ddp, Shimmer local %, Shimmer local dB, Shimmer apq3, Shimmer apq5, Shimmer apq11, Shimmer dda, Harmonicity Mean autocorrelation, Harmonicity Mean noise-to-harmonics ratio, Harmonicity Mean harmonics-to-noise ratio, and the maximum phonatory time. The volunteers were 123 (58 men and 65 women) and were recruited among students and employees of the University of Eastern Piedmont and of the University Hospital Maggiore della Carità Novara, among family members and researchers' acquaintances. The group of subjects was divided according to gender and age categories, ie, 18-30, 31-40, 41-50, 51-60, and 61-70 years. The voice samples were recorded in the same silent room to minimize the differences in background noise. The measurement was repeated twice on different days to evaluate the reproducibility of the vocal analysis with the Praat software. The comparisons of the vocal values obtained were carried out by stratifying the group of volunteers both by gender and age. After analyzing the variables for skewness, kurtosis, normality distribution through Shapiro-Wilk test, and the equality of variances by Levene test, parametric or nonparametric statistical tests were used when appropriated assuming a confidence level of 0.05. The Bland-Altman test has been used to evaluate the data reproducibility. The analysis of the stratified data for both gender and age showed a good repeatability of all the vocal parameters (except the maximum phonatory time in the age groups 18-30, 31-40, and 41-50 of the women where the Pvalue was less than 0.05). Gender differences were significant in all the vocal parameters, in particular, the variables related to the fundamental frequency and jitter local absolute were statistically significant in all categories. From the analysis of the data of the participants divided by age groups grouped there emerged a substantial difference among individuals belonging to different ages (with the exception of men aged between 18 and 50 years), thus making it impossible to compare and defining an important difference in vocal parameters throughout life.

Adult laryngeal hemangiomas are uncommon and often poorly symptomatic. The authors describe a laryngeal hemangioma with acute airway obstruction and radiologic findings suggesting a chondrosarcoma-like neoplasm, while pathologic features were consistent with an ossified hemangioma. The presence of fields of bone metaplasia into a classical cavernous hemangioma is an unusual phenomenon which, to our knowledge, was never previously described in the larynx. Difficulties concerning the differential diagnosis and modality of treatment are also discussed.

Skull base metastases are extremely rare. The authors report a case of a 65-year-old man who presented with a headache and diplopia secondary to a skull base metastasis from occult renal cell carcinoma. Since there were no other systemic metastases, radical nephrectomy and radiotherapy of the unresectable skull base location were performed. He subsequently received immunotherapy with sunitinib, everolimus, and sorafenib with local and systemic control of the disease after 53 months from surgery. When metastasis is unresectable radical nephrectomy and radiotherapy aimed at the metastasis may be of benefit improving quality of life. Immunotherapy may provide alternative treatment strategies improving the outcomes of patients affected by this rare pathology with historically poor prognosis.

Purpose To propose an algorithm for the preoperative management of patients with obstructive sleep apnea syndrome (OSAS) and review the surgical outcomes in such patients. Materials and Methods This prospective cohort study involved 71 patients with OSAS who underwent presurgical upper airway endoscopy and cephalometry before being assigned to treatment categories based on the site(s) of obstruction, the pattern of collapse, the characteristics of the soft tissue, the air space between the base of the tongue and the posterior wall of the pharynx, and the severity of OSAS. Six months after surgery, they were followed up using polysomnography and the Epworth Sleepiness Scale. The pre- and postsurgical data were compared using a paired Student t test. Results The mean preoperative apnea/hypopnea index of the 71 patients (61 male and 10 female) was 40.98 events/hour (range, 14.7 to 87.6 events/hr), and the mean postoperative apnea/hypopnea index was 13.96 events/hour (range, 0 to 20 events/hr). The difference was statistically significant ( P Conclusions This algorithm was developed on the principle that every patient with OSAS should be considered individually. In the authors' opinion, taking into account the number, site(s), pattern, and degree of the collapse/obstruction is a reasonable means of ensuring the correct diagnosis and treatment.

Pharyngitis is an inflammatory disease of the mucosal and submucosal structures of the throat. Infection may or may not be a component of the disease. Pharyngitis is one of the common illness for which patients visit primary care physicians. Most of them are diagnosed by clinical evaluation and usually respond to treatment with antibiotics, but exceptions occur when pharyngitis is caused by non bacterial inflammatory processes like virus, mycoses, reflux of gastric juices, tobacco or alcohol abuse. In these cases, as alternative and preventive, could be indicated the thermal therapy. For many centuries thermal waters have been used in the treatment of chronic inflammations of the upper respiratory airway, such as pharyngitis, with good results. Different thermal waters are currently used, in particular sulfur or sulfur- salty- bromine-, iodine- or sulfur-sulfate-bicarbonate-carbonate alkaline or sulfur-arsenical-ferruginous, normally utilized by inhalation or irrigation or aerosol-therapy. The principal pharmacological activity of these waters is connected to the concentrations of H2S, halogens (Iodine e Bromine), sulfates, arsenic and the level of radioactivity, concerning their antimicrobial power and the mucolytic effect of sulphur.

A retrospective study was carried out on 79 patients with deep neck infections (DNI) admitted to our Department between 1990 and 2005 in order to review our experience with DNI and verify if diabetic and immunocompromised patients have more aggressive infections and poorer prognosis. Demographics, clinical presentation, etiology, site of infection, associated systemic diseases (26.6%-21/79), microbiology, treatment and complications were considered.

Background and Aim: Juvenile nasopharyngeal angiofibroma (JNA) is a rare vascular and fibrous tumor that most commonly affects males in prepuberal and adolescent age. Traditionally, these tumors have been removed, after selective embolization, with the open surgical approach (degloving), but the interest in the endoscopic resection, especially for small tumors, has increased in recent years. To present our experience of JNA management, comparing the endoscopic approach and open/combined approach. Materials and Methods: We conducted a retrospective, cross-sectional, and descriptive study of 12 young men, ages between 9 and 19 years (mean: 13), suffering from nasopharyngeal angiofibroma and treated with open surgery (N = 6), with endoscopic excision (N = 5) or with combined approach (N = 1). We reviewed demographical data, clinical presentation, surgical approach as well as time of surgery, of hospitalization, need of blood transfusion during surgery, and complications occurred during hospitalization. Results: All JNA patients were male. The average age at diagnosis was 13.7 years (range 9–19 years). Approximately, 8.3% were classified as Onerci I, 41.7% as Onerci II, and 50.0% as Onerci III. Preoperative embolization was carried out in all patients. All patients were submitted to primary surgical resection, and 2 of them required intraoperative blood transfusion. The overall recurrence rate was 8.3% and the cure rate was 100%. Conclusion: This study confirmed that endoscopic approach gives excellent results in small and medium dimensions tumors, whereas open surgery remains a safe procedure for patients with larger tumors.

Hemangiopericytoma is a vascular tumor that is believed to arise from the Zimmermann's pericytes, smooth muscles cells localized around the blood vessels. This tumor presents as a slowly enlarging painless mass with a clear predilection for the musculoskeletal system. The aim of this work was to introduce a peculiar case of a tongue hemangiopericytoma managed by conservative surgical treatment.