Transoral robotic surgery for supraglottic cancer. A review of oncological and functional outcomes compared to open surgery.

Objective: Supraglottic squamous cell carcinoma (SCC) represents a major surgical challenge in organ-preserving treatment. Type I open partial horizontal laryngectomy (OPHL I) is considered the most popular. To date, minimally-invasive approaches such as laser microsurgery and transoral robotic surgery (TORS) have gained increasing relevance. The aim of this narrative review is to obtain a descriptive comparison of functional and oncological outcomes from studies on patients with supraglottic SCC treated with OPHL I and TORS, respectively. Material and methods: A computerised search was performed using the Pubmed database for articles published from 2000 to 2023. A comparative analysis on functional and oncological outcomes of patients treated by TORS and OPHL I was performed. Results: The present narrative review shows a superiority of TORS compared to open surgery for supraglottic SCC in terms of functional outcomes, while maintaining comparable oncological outcomes. Conclusions: Although recently introduced in the treatment of laryngeal pathology, TORS has been shown to be a reliable technique not only for functional but also for oncological outcomes, ensuring good overall survival, disease-free survival, and disease control rates comparable to OPHL I.

Analysis of local, regional, and distant recurrence of disease in mucoepidermoid tumors of larynx: A systematic review.

The aim of this systematic review is to analyze epidemiology, clinical presentation, histopathological features, treatment and oncological outcomes in laryngeal mucoepidermoid cancer (MEC) in order to improve the knowledge on the management of such a rare malignant neoplasm. Specifically, authors highlight patients' and tumors' features about local, regional, and distant recurrence of disease. PRISMA 2020 guidelines were applied in this systematic literature review. A computerized search was performed using the Embase/Pubmed, Scopus, and Cochrane databases, for articles published from 1971 to December 2023. A descriptive and univariate analysis including selected papers with low or intermediate risk of bias was performed. Twenty-seven papers (11 case series and 16 case reports) were included in this review. Fifty-six patients were included in the analyses, with a mean age of 56.7 years; 84% of them were males. Most patients (86%) underwent a primary surgical approach. Clinical stage was reported as follows: early stage (26 patients) and locally advance and advanced stage (19 patients). Overall survival (OS) and disease-free survival (DFS) at 2 years was 80% and 78%, respectively. The mean time to local recurrence was 18.7 months (range 8-36 months). The survival after recurrence is about 85% and 70% at 5 years, respectively. The mean time of lymph node recurrence was 14.7 months (range 7-19 months). Finally, the mean time of distant recurrence was 15 months (range 7-36 months) with a poor prognosis: all patients died due to the disease in a range of 0-7 months after metastasis evidence. Laryngeal MEC is a rare neoplasm of minor salivary glands in the larynx. No guidelines or indications about the management of this neoplasm are reported in the literature. The lower incidence of regional recurrence of the disease and the better OS and DFS underline how the prognosis of MEC is more favorable respect to other malignant histotypes.

Features Associated With High Risk of Recurrence in Saccular Laryngeal Cysts: A Systematic Review and Qualitative Synthesis.

INTRODUCTION: Saccular cysts are rare benign anomalies of the larynx (1.5% of laryngeal anomalies) determined by dilatation of the laryngeal saccule. They can be congenital or acquired. Clinical manifestation depends on the site of the cyst and the age of the patient. Children frequently have stridor and dyspnea, while adults usually complain of dysphonia.The therapeutic approach can be surgical or nonsurgical (needle aspiration or drainage).However, guidelines on the management of this disease are lacking in the literature.This systematic literature review was conducted through an interferential analysis with the aim of detecting the association between clinical, diagnostic, and operative factors and the recurrence of saccular cysts. MATERIALS AND METHODS: This systematic literature review was evolved following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 checklist statement Papers published up to August 2023 containing relevant clinical data were searched in Embase/PubMed, Web of Science, Scopus, and Cochrane database. Full texts lacking information on the patient's data, clinical, radiological, and/or histological diagnosis of saccular cysts of the larynx were excluded. Articles with follow-up inferior to 6 months and not reporting any treatment of the cyst were excluded, too. Data concerning signs and symptoms, cyst characteristics, and the type of treatment were described, and the risk of recurrence was studied in association with these features. A qualitative synthesis of the results was performed. RESULTS: Ninety-eight articles were screened. One hundred two patients were involved in the analysis. The articles with low or intermediate risk of bias were 22 (8 case reports and 14 case series) and they were included in the statistical analysis. Median age was 25 years (range 0-81). Saccular cysts were congenital (46/102, 45%) of cases acquired (56/102, 55%). Relying on the available data, all patients were symptomatic, with stridor as the main symptom (59%). Surgical approach was performed in 85% of cases, while drainage or needle aspiration of the cyst was the treatment of choice in the remaining 25% of cases. Twenty-four percent of patients had recurrence of the disease within 3 months. Median age at recurrence was 9 years. Cysts characteristics, preoperative management, and type of treatment were associated with an increased risk of disease recurrence (P < 0.05). CONCLUSIONS: Saccular cysts are rare congenital or acquired laryngeal diseases. Data regarding their management and factors associated with the risk of recurrence are still limited. Congenital cysts treated conservatively have a higher risk of recurrence than acquired cysts treated by open surgical techniques or by microlaryngoscopy. A better knowledge of factors associated with a higher risk of recurrence could help choose the best treatment.

Expanded transcanal transpromontorial approach for acoustic neuroma removal.

Axial sections from preoperative magnetic resonance imaging without contrast, showing a cone-shaped lesion of the internal auditory canal, extending toward the most lateral part of the cerebello-pontine angle. (A) T1-weighted high-resolution isotropic volume excitation (THRIVE) sequence; (B) T1-weighted sequence; (C) Fluid attenuated inversion recovery (FLAIR) sequence. Laryngoscope, 133:282-286, 2023.

Surgical Training on Ex Vivo Ovine Model in Otolaryngology Head and Neck Surgery: A Comprehensive Review.

Background: Nowadays, head and neck surgical approaches need an increased level of anatomical knowledge and practical skills; therefore, the related learning curve is both flat and long. On such procedures, surgeons must decrease operating time as much as possible to reduce the time of general anesthesia and related stress factors for patients. Consequently, little time can be dedicated for training skills of students and young residents in the operating theater. Fresh human cadavers offer the most obvious surrogate for living patients, but they have several limitations, such as cost, availability, and local regulations. Recently, the feasibility of using ex vivo animal models, in particular ovine ones, have been considered as high-fidelity alternatives to cadaveric specimens. Methods: This comprehensive review explores all of head and neck otolaryngology applications with this sample. We analyzed studies about ear surgery, orbital procedures, parotid gland and facial nerve reanimation, open laryngeal and tracheal surgery, microlaryngoscopy procedures, laryngotracheal stenosis treatment, and diagnostic/operative pediatric endoscopy. For each different procedure, we underline the main applications, similarities, and limitations to human procedures so as to improve the knowledge of this model as a useful tool for surgical training. Results: An ovine model is easily available and relatively inexpensive, it has no limitations associated with religious or animal ethical issues, and it is reliable for head and neck surgery due to similar consistencies tissues and neurovascular structures with respect to humans. However, some other issues should be considered, such as differences about some anatomical features, the risk of zoonotic diseases, and the absence of bleeding during training. Conclusion: This comprehensive review highlights the potentials of an ex vivo ovine model and aims to stimulate the scientific and academic community to further develop it for other applications in surgical education.