Odontogenic Sinusitis with Oroantral Communication and Fistula Management: Role of Regenerative Surgery.

Objective: The aim of this study is to show our experience with the correct management of patients suffering from odontogenic sinusitis with oroantral communication and fistula. Methods: According to the inclusion criteria, 41 patients were enrolled in this retrospective study with a diagnosis of odontogenic sinusitis with oroantral communication and fistula; 1 patient with pre-implantological complication, 14 with implantological complications, and 26 with classical complications. Results: Two patients were treated with a fractioned combined approach, 13 patients were treated with an oral approach only, and 26 patients were treated with a combination. There was a complete resolution of the symptoms and closure of the fistula in all the patients enrolled. Conclusions: In our study, in all 41 patients, there was a surgical success. The best option is to use a multidisciplinary approach for patients suffering from odontogenic sinusitis.

Multiple-access versus telemedicine home-based sleep apnea testing for obstructive sleep apnea (OSA) diagnosis: a cost-minimization study.

PURPOSE: The aim of the present study was to compare two clinical pathways: the multiple-access outpatient pathway versus the telemedicine pathway. METHODS: The multiple-access outpatient pathway and the telemedicine pathway were both performed with WatchPAT and implemented in a real-life healthcare scenario, adopting a cost-minimization approach. A cost-minimization analysis was undertaken to assess the economic impact of the two alternatives. The cost analyses were performed in euros for the year 2021 adopting the patient, the hospital, and the societal perspectives. Given the chosen perspectives, direct medical costs, direct nonmedical costs, and indirect costs were considered. In addition, a univariate sensitivity analysis was conducted. RESULTS: From a hospital perspective, the telemedicine approach was estimated to cost €49 more than the multiple-access alternative. Considering the patient perspective, the telemedicine approach was estimated to cost €167 less than the multiple-access pathway. Considering the societal perspective, the telemedicine approach is estimated to cost €119 less than the multiple-access pathway. CONCLUSION: The adoption of telemedicine home sleep apnea testing could improve the efficiency of the healthcare processes if considering the direct and indirect costs incurred by patients and not only by healthcare providers.

No-cutting remodelling intra-pharyngeal surgery can avoid CPAP in selected OSA patients: myth or reality?

INTRODUCTION: Oropharyngeal surgery for Obstructive Sleep Apnea (OSA) has evolved from a radical excision of "redundant" soft tissue for the enlargment of the airway to a minimally invasive reconstruction to fulfill both preservation of pharyngeal function and improvement of sleep apnea. Recently, Alianza surgical technique has been successfully introduced as a new, non-resective procedure aimed to treat concentric pharyngeal collapse at the velum using Barbed Sutures. The aim of this study was to show the effectiveness and safety of Alianza technique as standalone surgical treatment in selected patients with moderate-severe OSA and concentric pharyngeal collapse that refused or did not tolerate Continuous Positive Airway Pressure therapy. MATERIALS AND METHODS: Effectiveness of the surgical procedure was assessed by means of the Epworth Sleepiness Scale (ESS), Home Sleep Test, and a 0-10 snoring VAS. RESULTS: At the end of our selection process, 26 patients were enrolled, with a mean age of 52.7 ± 9.2 years, that undergone Alianza tecnique. There was a statistically significant reduction in mean post-operative apnea-hypopnea indexes (34.1 ± 11.5-16.3 ± 10.3; p <0.01), mean oxygen desaturation index (29.0 ± 14.5-13.1 ± 9.2; p < 0.01), and mean ESS scores (12.1 ± 5.8 and 5.8 ± 4.4; p < 0.01).There was also a significant decrease in mean post-operative snoring VAS scores (7.85 ± 1.23 vs 3.2 ± 1.7, p < 0.01). There were no major complications. CONCLUSIONS: Our preliminary results suggest that Alianza technique is a safe and repeatable surgery. Further studies on a larger scale are needed to confirm these encouraging data supporting the role of Alianza alone or in OSA multilevel surgery in selected OSA patients.

"Barbed snore surgery" simulator: a low-cost surgical model.

BACKGROUND: "Barbed snore surgery" (BSS) represents one of the last innovation for obstructive sleep apnea syndrome (OSAS) surgical management. Although this technique represents an effective and minimally invasive surgery, it is not still widespread in many ENT centers. The aim of our study was to develop an inexpensive surgical simulator useful to expedite the surgical learning curve for BSS in untrained ENT surgeons. MODEL ASSEMBLY: The simulator is a simple model composed of a manually shaped silicone palate (3 × 4 × 1 cm) fixed on a resin skeleton (21 × 16 × 12 cm) using a transparent silicon rubber. The mandible is fixed bilaterally with the aid of two screws allowing for modular inter-incisive distance. SIMULATION: Barbed anterior pharyngoplasty (BAPh) was readily performed on the simulator to show the feasibility of this BSS model. All surgical steps were carried out determining a lift and a shortening of the palate as in real surgery. CONCLUSIONS: This is the first surgical model that provides a realistic, easily repeatable training in the performance of BSS. Our BSS surgical model is very inexpensive with a cost of approximately 19.25$ dollars and it is manufactured to facilitate a worldwide diffusion of this promising palatal surgery for OSAS.

Odontogenic Sinusitis from Classical Complications and Its Treatment: Our Experience.

Odontogenic sinusitis (ODS) refers to the maxillary sinus infection, which is secondary to either adjacent infectious dental pathologies or procedures. The aim of this retrospective study is to report the experiences of the department of integrated therapies in otolaryngology (Campus Bio-Medico Foundation, Rome, Italy) in classifying and treating patients that are affected by odontogenic sinusitis derived from "classic complications". A total of 68 patients responding to the criteria and to the definition as a classical odontogenic complication were included. The surgical therapy consisted of a combined oral and nasal simultaneous approach for 28 patients (43%), a combined non-simultaneous approach for 4 patients (6%), a nasal only approach for 14 patients (21%), and an oral only approach for 20 patients (30%). All the patients presented a complete resolution of the symptoms. The choice of performing a nasal, oral, or combined approach is based on the presence of anatomical elements that facilitate sinusitis and reinfection occurrence, such as deviated nasal septum, concha bullosa, or obstructed osteo-meatal complex. The correct use of validated classification, the pre-operative CT scan, a multidisciplinary approach, and an appropriate presurgical examination are the necessary elements to obtain a good success rate.

A New Lighting System for Surgical Vision Optimization in Barbed Pharyngoplasty for OSA.

Obstructive sleep apnea (OSA) surgery is now a viable solution in selected patients and the "remodeling" palatopharyngeal surgery is the most common one. Recently, it has become less invasive with the introduction of barbed sutures (BS). An optimization of surgical techniques is represented by barbed pharyngoplasty (BP), which requires surgical precision and needs efficient and precise oropharyngeal visualization. Consequently, the lighting system is of pivotal importance in BP. The aim of this work is to describe the first experience on the use of a new lighting system, called KLAROTM in BP for OSA. We evaluated the KLARO™ system in 15 consecutives BP for OSA in comparison with conventional headlamp illumination. The visualization of palatopharyngeal muscle in the bottom of the tonsillar fossa, entry and exit needle, such as needle tip, were statistically better with KLAROTM than headlamp illumination for both the surgeon and resident (p < 0.05). No significant differences for the visualization of the posterior pharyngeal wall and uvula were reported. The KLAROTM lighting system allows a satisfied illumination of oral cavity and oropharynx in the majority of cases. We encourage the use of KLAROTM not only in BP for OSA, but in all oral and pharyngeal surgeries, including tonsillectomy and oncological surgery.

Could nasal irrigation and oral rinse reduce the risk for COVID-19 infection?

Public health measures are essential to protect against COronaVIrus Disease 2019 (COVID-19). The nose and the mouth represent entry portals for the COVID 19. Saline Nasal Irrigations (SNIs) can reduce the viral load in the nasal cavities. Oral rinse with antimicrobial agents is efficacious in reducing the viral load in oral fluids. We advocate the inclusion of SNIs and ethanol oral rinses as additional measures to the current public health measures, to prevent and control the transmission of any respiratory infectious disease, including COVID-19.

Image-guided endoscopic marsupialization technique for frontal sinus mucocele with orbital extension: A case report.

INTRODUCTION: Frontal sinus mucocele with intra-orbital extension represents a rare benign cyst-like lesion. Surgical management could be summarized in an open approach, an endoscopic marsupialization or a combined procedure. The present study reports a case of frontal mucocele with wide intra-orbital invasion treated with endoscopic marsupialization assisted by an image-guided navigation system. PRESENTATION OF CASE: A 34-year-old African male was referred to the otolaryngology clinic for unilateral supraorbital swelling and post-nasal drip. A clinical ophthalmic assessment showed normal ocular movement, the absence of diplopia and normal visual acuity. CT scan showed a large soft tissue density lesion originating from the right frontal sinus with a supero-medial orbital erosion. The mass invaded the orbital cavity compressing and dislocating the eyeball forward and laterally. An image-guided ESS was performed according to Draft type IIa. Frontal mucocele's inferior wall was open in order to drain muco-purulent content. No complications were detected and the patient was completely recovered with open frontal sinus drainage at 4 months follow-up visit. DISCUSSION: We have successfully treated a wide intra-orbital frontal mucocele with an endoscopic marsupialization thanks to image-guided navigation system support. This technology prevented an external approach with associated morbidity and longer hospitalization. CONCLUSION: Navigated assisted endoscopic approach with marsupialization can be considered a safe treatment for FM with orbital extension. In particular, the image-guided system could be useful if bony landmarks are missing, if orbital erosion is present, and to completely drain lateral and multi-cystic lesions.

Nasal Delivery Devices: A Comparative Study on Cadaver Model.

Nasal nebulization is a more effective method of delivering topical medication than nasal spray. The purpose of this study was to assess the deposition patterns of nebulization in delivering topical agents to the nasal cavities in the human cadaveric model using a color-based method. We have compared these following nasal devices: single-dose vial irrigation, syringe-irrigation, common nasal spray, Spray-sol, MAD nasal, and Rinowash nasal douche. Endoscopic images were recorded at six anatomical regions prior to and following each nasal device application and four reviewers evaluated the amount of surface area staining. At the nasal vestibule, the blue dye distribution achieved with Spray-sol was more extensive than nasal sprays. At inferior turbinate and nasal cavity floor, single dose vial, syringe, MAD nasal, Spray-sol, and Rinowash demonstrated a greater extent of dye distribution than nasal spray. At the middle turbinate, the average score of both Spray-sol and MAD nasal was significantly higher than other nasal investigated devices. At the nasopharynx, Spray-sol nebulization covers a surface significantly greater than other devices. Compared to traditional sprays, Spray-sol and MAD nasal provided a more effective method of delivering topical agents to the deeper and higher portions of the nasal cavities.

Topical Ectoine: A Promising Molecule in the Upper Airways Inflammation-A Systematic Review.

To date, topical therapies guarantee a better delivery of high concentrations of pharmacologic agents to the mucosa of the upper airways (UA). Recently, topical administration of ectoine has just been recognized as adjuvant treatment in the Allergic Rhinitis (AR) and Rhinosinusitis (ARS). The aim of this work is to review the published literature regarding all the potential therapeutic effects of ectoine in the acute and chronic inflammatory diseases of UA. Pertinent studies published without temporal limitation were selected searching on MEDLINE the following terms: "ectoine" and "nasal spray," "oral spray," "upper respiratory tract infections," "rhinosinusitis," "rhinitis," "rhinoconjunctivitis," "pharyngitis," and "laryngitis." At the end of our selection process, six relevant publications were included: two studies about the effect of ectoine on AR, one study about ARS, one study about rhinitis sicca anterior, and two studies about acute pharyngitis and/or laryngitis. Due to its moisturizing and anti-inflammatory properties, topical administration of ectoine could play a potential additional role in treatment of acute and chronic inflammatory diseases of UA, in particular in the management of sinonasal conditions improving symptoms and endoscopic findings. However, these results should be viewed cautiously as they are based on a limited number of studies; some of them were probably underpowered because of their small patient samples.

Neck fat volume as a potential indicator of difficult intubation: A pilot study.

BACKGROUND: Direct laryngoscopy is the gold standard of the airway management in patients without predicted difficulties. If unpredicted difficulties are encountered instead, different algorithms to follow have been developed. To date, no single predictor is sufficiently valid. In clinical practice, it is used a combination of them to enhance the estimate, and despite the variety of parameters used, not all the difficult intubations are predicted. The aim of this work is to retrospectively analyze neck computed tomography scans of 37 patients who have had tracheal intubation and search for anatomic neck fat compartments that correlate with the intubation difficulty, and eventually find a suitable, clinical parameter that can potentially enhance the prediction of a difficult airway when used in combination of the preexisting scores. MATERIALS AND METHODS: the patients are divided by direct laryngoscopy view into two groups: Group A (n = 31): Normal airway, with a Cormack Lehane, Score I or II; Group B (n = 6): Difficult airway, with a Cormack Lehane Score III or IV. In the zone of interest, it was measured the neck volume parameter and other subparameters. RESULTS: Despite a positive trend is shown for anterior fat volume (AFV) (P = 0.23) and fat volume (FV) (P = 0.28), statistically significant differences (P < 0.05) were not found between Group A and B in any of the measurements acquired. CONCLUSIONS: According to the literature, our results confirmed that there is still no single element that can predict a difficult intubation. Although no statistical significance was found, the AFV and FV have shown to have a potential predictive role for difficult intubation. Further studies with bigger samples are advisable to confirm this encouraging result.

Mobile applications in otolaryngology for patients: An update.

OBJECTIVE: Recently smartphones and tablets have spread in developed countries, and healthcare-related apps are growing incredibly in different specialties. The aim of this study is to provide an up-to-date review of the current OtoHNS (otolaryngology-head and neck surgery) apps developed for patients. METHODS: This mobile applications review was conducted in September 2017. Relevant apps about OtoHNS were searched in the Apple Store and in the Google Play using various keywords. We included helpful apps for OtoHNS patients. Apps for medical students, physician (95 apps) and non-English apps (6 apps) were excluded. RESULTS: At the end of our selection process, 216 apps have been included for mobile applications review. The number of apps published per year in OtoHNS has increased each year. The most common apps were about hearing, in particular 63 of 216 (29%) were hearing test; 75 of 216 (35%) for tinnitus treatment; 10 of 216 (5%) for sounds measurement around the patients; and 7 of 216 (3%) to treat vertigo. One hundred thirty-seven of 216 (63%) apps were free of charge. Physicians were clearly involved in the app's development in only 73 of 216 (34%) apps. One hundred sixty-three of 216 (75%) had no user ratings. CONCLUSIONS: Apps are increasingly and easily accessible, although their use in clinical practice is not yet totally accepted. Our review showed that most apps have been created with no guidance from otolaryngologist. Further steps are needed to regulate apps' development. Hoping an "App Board," such as editorial board for scientific journal, to assess app quality, validity, and effectiveness before they can be fully incorporated into clinical practice and medical education. LEVEL OF EVIDENCE: N/A.

Could Music Minimize Discomfort and Pain During Office-Based ENT Surgery?

BACKGROUND: Video-assisted endoscopic radiofrequency inferior turbinate volume reduction (RFVTR) is one of the most common surgical therapies for inferior turbinate hypertrophy (ITH). Despite all the technical and surgical advancement, it is advisable to reduce as low as possible the intraoperative discomfort. The aim of this study is to evaluate the role of music in reducing patient discomfort during RFVTR. MATERIALS AND METHODS: Twenty-three patients with chronic nasal obstruction due to ITH and candidate to RFVTR are included. Before the procedure each patient filled in a completed Italian version of the state anxiety questionnaire (State-Trait Anxiety Inventory), SNOT 22 questionnaire, VAS, and chose their favourite music to be played during RFVTR. All patients evaluate the intraoperative discomfort with a visual analog scale (VAS) and for each patient, vital parameters such as blood pressure and heart rate were recorded 15 minutes before the procedure, during and after RFVTR. RESULTS: The intraoperative VAS scores during listening to music (5.7 ± 2.42 vs 6.7 ± 1.97; p< 0.05) were significantly lower, such as systolic BP (133.5 ±17.2 vs 136.78 ±16.8; p< 0.05) and heat rate (80.3 ±14.9 vs 81.7 ±15.5; p NS). During our survey, most of the patients preferred listening to classical music and none preferred rock music. No correlation was found between STAI 1-2 and intraoperative surgical discomfort evaluated both with VAS and cardiac parameters (systolic BP and HR). CONCLUSIONS: Music can be useful as a complementary method to control anxiety and reduce perception of pain in an office-based procedure, such as the RFVTR. The patient is more relaxed and experiences less discomfort; thus the surgeon and nurse can work with more confidence.

"Canalolabyrinthine Schwannoma," A Rare Variant of Intralabyrinthine Schwannoma: A Case Report.

Canalolabyrinthine schwannoma is a rare subtype of neuroma. Only 1 case has been described in the literature. We report the clinical case of a 51-year-old Caucasian female with Meniere's disease-like symptoms. Magnetic resonance imaging showed right VIII cranial nerve schwannoma that had different characteristics from the classical described types. The peculiar features of our case of intralabyrithine canalolabyrinthine schwannoma directed the surgeon and radiologist to tailored considerations for follow-up and therapy.

Vestibular rehabilitation in benign paroxysmal positional vertigo: Reality or fiction?

The objective of this article is to systematically review the evidence on the effectiveness of vestibular rehabilitation (VR) in patients with benign paroxysmal positional vertigo (BPPV). Relevant published studies about VR in BPPV were searched in PubMed, Google Scholar and Ovid using various keywords. We included trials that were available in the English language and did not apply publication year or publication status restrictions. Studies based on the VR in other peripheral and/or central balance disorders are excluded. Primary outcome was the effect on vertigo attacks and balance. Of 42 identified trials, only 12 trials fulfilled our inclusion criteria and were included in this review. Three of them investigated the role of VR in patients with BPPV comparing with no treatment, two of them evaluated the efficacy of VR versus medications, seven of them have highlighted the benefits of the VR alone or in combination with canalith repositioning procedure (CRP) compared to CRP alone. The studies differed in type of intervention, type of outcome and follow-up time. VR improves balance control, promoting visual stabilization with head movements, improving vestibular-visual interaction during head movement and expanding static and dynamic posture stability. CRP and VR seem to have a synergic effect in patients with BPPV, especially in elderly patients. VR does not reduce the recurrence rate, but it seems to reduce the unpleasantness. So VR can substitute CRP when spine comorbidities contraindicate CRP and can reduce the uptake of anti-vertigo drugs post CRP. Further studies are needed to confirm these encouraging results.

Hyaluronic acid and upper airway inflammation in pediatric population: A systematic review.

BACKGROUND: Inflammatory disease of upper airway in pediatric population represents a social problem for both the pharmaco-economic impact and a burden for the family. To date, the use of topical therapies represents a significant therapeutic progress because they are able to reduce mucosal inflammation and improve tissue healing. Topical Hyaluronic Acid (HA) is a promising molecule that has been recently proposed as adjuvant treatment in the inflammatory disease of the upper aerodigestive tract (UADT) infections. AIMS: The aim of our work was to review the published literature regarding all the potential therapeutic effects of HA in the inflammatory disease of upper airway in pediatric population and evaluate the effectiveness of HA, alone or in combination, in children affected by cystic fibrosis. METHODS: Relevant published studies about use of HA in UADT in pediatrics were searched in Pubmed, Google Scholar, Ovid using various keywords with no limit for the year of publication. Studies based on the use of HA with nasal packing and with invasive administration of HA were excluded. RESULTS: At the end of our selection process, four publications have been included: one of them in children with recurrent upper respiratory tract infections, one of them in children with bacterial acute rhinopharyngitis, two of them in children affected by cystic fibrosis. CONCLUSIONS: Topical administration of HA plays a pivotal role in all the children suffering from UADT inflammatory disease, and positive results are generally observed in children with cystic fibrosis.

A safe transoral surgical approach to parapharyngeal tumor arising from deep lobe of parotid gland.

The management of parapharyngeal tumor is surgical, but the approach remains a challenge. Attention should be paid to avoidance intra-operative bleeding or cranial nerves damage. We report a case of a 67-year-old male complaining of left-ear fullness. A submucosal mass arising from the lateral wall of oropharynx on the left side was observed. Magnetic resonance imaging detected a mass arising from the parotid gland, in particular from the deep lobe, and a fine needle biopsy was compatible with "Warthin tumor." We performed a mini-invasive transoral approach under magnification, previous isolation of homolateral vessels. The decision on which surgical approach to be used is determined by site, size vascularity, and histology of the tumor. A literature review of the main surgical approaches was performed. We performed a combined transoral dissection under magnification with cervicotomic exposure of the neck vascular bundle allowing to dissect the tumor and manage any intra-operative complications.

Unilateral Blepharoptosis from Renal Cell Carcinoma.

Blepharoptosis is the drooping or inferior displacement of the upper eyelid. Blepharoptosis can be either congenital or acquired. Tumour metastasis is one of the acquired causes of blepharoptosis. The lungs, locoregional lymph nodes, bone and liver are the usual sites of metastases of renal cell carcinoma (RCC); however, unusual locations of RCC have also been reported. Herein, we describe a case of a 47-year-old man with unilateral ptosis and blurred vision due to metastatic RCC. We describe the different causes of blepharopstosis, the path that led to the diagnosis, and how RCC can metastasize to unusual anatomical regions such as the orbit. Symptoms such as exophthalmos, lid edema, diplopia, ptosis, cranial nerve paralysis or blurred vision may mime a benign disease; however, they could also be the symptoms of a systemic malignancy.

Hyaluronic acid: Perspectives in dentistry. A systematic review.

To date, topical therapies guarantee a better delivery of high concentrations of pharmacologic agents to the soft periodontal tissue, gingiva, and periodontal ligament as well as to the hard tissue such as alveolar bone and cementum. Topical hyaluronic acid (HA) has recently been recognized as an adjuvant treatment for chronic inflammatory disease in addition to its use to improve healing after dental procedures. The aim of our work was to systematically review the published literature about potential effects of HA as an adjuvant treatment for chronic inflammatory disease, in addition to its use to improve healing after common dental procedures. Relevant published studies were found in PubMed, Google Scholar, and Ovid using a combined keyword search or medical subject headings. At the end of our study selection process, 25 relevant publications were included, three of them regarding gingivitis, 13 of them relating to chronic periodontitis, seven of them relating to dental surgery, including implant and sinus lift procedures, and the remaining three articles describing oral ulcers. Not only does topical administration of HA play a pivotal key role in the postoperative care of patients undergoing dental procedures, but positive results were also generally observed in all patients with chronic inflammatory gingival and periodontal disease and in patients with oral ulcers.