Transoral robotic styloidectomy for Eagle syndrome: A systematic review.

OBJECTIVES: The aim of the study is to conduct a systematic review of the existing literature on styloidectomy performed through transoral robotic surgery (TORS) in Eagle syndrome (ES). DESIGN AND SETTING: Two independent reviewers (RC and AC) conducted a systematic review of PubMed and Embase databases, seeking articles on TORS performed for ES treatment. The search was conducted in July 2023. The review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PARTICIPANTS: The review included a total of 17 adult patients, comprising 12 females and 5 males, with an average age of 52.2 years, all diagnosed with ES. MAIN OUTCOME MEASURES: For each patient, we assessed the overall length of the styloid process, the affected side, total intervention duration, hospitalization duration, pre and postoperative Visual Analogue Scale (VAS) scores, and the presence of minor and major complications. RESULTS: We identified 4 articles describing 17 instances of TORS as a surgical treatment for ES in the literature, totaling 18 styloidectomies. The mean age of the patients was 52.2 years, with 12 females and 5 males. The average operation time, inclusive of the docking phase, was 68.8 minutes. Sixteen patients (94.1% of the total) experienced complete symptom disappearance or near-complete resolution after surgery. One patient (5.9%) showed improvement categorized as 'non-meaningful.' Only one case of minor complication was reported among the 17 procedures (5.9%).

Sleep position and obstructive sleep apnea (OSA): Do we know how we sleep? A new explorative sleeping questionnaire.

PURPOSE: Positional obstructive sleep apnea (POSA) has been defined as a difference of 50% or more in Apnea-Hypopnea Index (AHI) between supine and non-supine position. Sleep position is fundamental in the evaluation of obstructive sleep apnea syndrome (OSAS) severity but most tools used in the diagnosis of OSAS are not free from potential bias in the evaluation of usual sleep positions. The aim of this investigation was to evaluate a novel sleep questionnaire with the purpose of exploring sleep habits and evaluating if sleep assessment can identify the usual body position assumed for sleep. MATERIALS AND METHODS: The questionnaire was administered to patients recruited from October to November 2018. Questions concerned sleeping positions and conditions that could influence sleeping positions. Patients who had previously undergone polysomnography (PSG) were asked how they slept during the study night. Whenever present during the examination, the patient's bed partner was also asked about the patient's usual body positions during sleep. RESULTS: Of 315 patients (211 men) enrolled, 35% were affected by OSAS and 69% of patients with OSAS had POSA. POSA was more prevalent among men (75%) compared to women (43%). The new questionnaire provided a discordant result from PSG recordings about sleeping positions and revealed a difference between usual sleeping position and the position during PSG recording. Reported sleep quality was much worse on PSG than at home suggesting that the "first night effect" is real and may lead to over-estimation of POSA cases. CONCLUSIONS: Information about sleeping positions is fundamental to the assessment of OSAS severity. Knowledge gained from the new questionnaire as described may represent a valuable addendum to develop a more detailed polygraphic report. Such a tool may be used in practice with the aim of better identifying patients with true positional OSAS. Such patients may benefit from targeted positional therapy.

Transoral Robotic Surgery (TORS) for Bilateral Eagle Syndrome.

Eagle syndrome is a rare and poorly understood clinical condition caused by an elongated or disfigured styloid process. The possible managements of Eagle syndrome include conservative medical treatment or surgical intervention. The surgical removal of the elongated styloid process may be efficiently achieved either by an intraoral or a transcervical approach. An effective styloidectomy may be either total or partial, provided the bony residue's length is within the range of normality. Here, we report our experience with a bilateral robotic-assisted styloidectomy in a young female patient. Our experience showed that this procedure is a safe alternative to traditional surgical approaches, granting an excellent view and a safe manipulation by robotic arms, and, thereby, avoiding iatrogenic damage to neurovascular structures. Moreover, transoral robotic surgery could represent the gold standard for the treatment of bilateral Eagle syndrome cases allowing a quick and safe single-time surgery.

Congenital Pyriform Sinus Fistula: Management of an Extra-Delayed and Atypical Case.

Clinical presentations of pyriform sinus fistulas vary, and this sometimes leads to a delay in diagnosis and treatment. Recently, we experienced a case of recurrent cervical abscesses occurring after thyroidectomy in an adult affected by a bifidus pyriform sinus fistula. The diagnostic dilemma was related to the timing of events, with a single episode of acute suppurative thyroiditis having occurred 16 years before the onset of the more recent clinical scenario. An endoscopic approach allowed effective management of this clinical case.

Oncocytic papillary cystadenoma of the larynx: a case report.

BACKGROUND: Cystadenoma of the salivary glands is a rare benign clinical condition affecting both major and minor salivary glands equally. It constitutes approximately 2% of total neoplasms and 4.2-4.7% of benign formations in minor salivary glands. Typically presenting as a slow-growing, painless neoplasm, it can be distinguished from Cystadenolymphoma (Whartin's Tumor) by the absence of lymphoid elements in histological examination. While mostly located in the oral cavity and oropharynx, it can also be found in sinonasal mucosa, and rare cases have been identified in the larynx. CASE PRESENTATION: A 75-year-old Caucasian woman presented to the ear, nose, and throat department with complaints of dysphonia and headaches persisting for several months. Dysphonia had developed months after an unspecified vocal cord surgery elsewhere. Flexible laryngoscopy identified a left-sided cystic swelling affecting the supraglottic space, leading to respiratory obstruction and dysphonia. Head and neck computed tomography confirmed a 1.9 × 1.7 cm bilobed cystic mass originating from the left Morgagni ventricle. Microlaryngoscopy with CO2 laser excision and biopsy revealed a histopathological diagnosis of oncocytic papillary cystadenoma. Post-surgery, the patient fully recovered from dysphonia, with no significant complications noted. Long-term clinical surveillance was advised to detect potential recurrences promptly. CONCLUSION: Ectopic minor salivary gland tumors, both benign and malignant, should be taken into consideration as potential differential diagnosis for any swelling arising within the upper digestive tract mucosa. Ears, nose, and throat clinical examination completed by videolaryngoscopy can easily point out the location of the mass. Imaging is mandatory for differential diagnosis and for surgical planning. Surgical excision can provide both diagnosis and definitive cure.

Oncological features and outcomes of laryngeal cancer surgery: a multicentric study.

BACKGROUND: Laryngeal cancer (LC) is among of the most frequent head and neck cancers, associated to a high social impact and mortality. Unfortunately, the current treatment outcomes of LC are often scant, with different factors affecting patient's prognosis (i.e., advanced age, advanced disease stage, lymph node involvement, tumor pathological features, type of intervention). The aims of the present study were: 1) to evaluate the epidemiological and clinical features of patients affected by LC; and 2) to focus on tumor risk factors affecting patient's overall survival (OS) and recurrences. METHODS: A retrospective analysis of all patients affected by LC and surgically treated at two different hospital settings has been performed. RESULTS: Two hundred twenty-five patients were enrolled in the present study; of these 189 were males (84%) and 36 (16%) were females. The most frequently performed surgery was total laryngectomy. Thirty-two (14.2%) patients experienced local recurrence, while 15 patients (6.6%) had regional recurrence and 15 distant metastases. Multivariate analysis showed that locoregional recurrence was associated to the occurrence of distant metastases (P=0.002, HR=25,35). Analyzing OS, the only statistically significant factor that correlated with an increased risk of mortality (P<0.015, HR=2,45) was locoregional recurrence. CONCLUSIONS: The present study confirms the literature data about age and sex distribution of LC, about tumors localization, lymph nodes metastasis and distant metastasis incidence and OS rate, based on T and N stage. Interestingly, within this series, the presence of locoregional recurrence or distant metastasis is related to a worst prognosis and a lower overall survival rate.

Laryngomalacia and Obstructive Sleep Apnea in Children: From Diagnosis to Treatment.

The aim of this review is to investigate the state of the art among the association between Obstructive sleep apnea (OSA) and laryngomalacia, analyzing the epidemiology, the diagnostic tools, and the possible treatments available to affected patients. Laryngomalacia, characterized by the malacic consistency of the epiglottis with a tendency to collapse during inspiratory acts, producing a characteristic noise known as stridor, is a common condition in infants and particularly in those affected by prematurity, genetic diseases, craniofacial anomalies, and neurological problems. Congenital laryngomalacia, presenting with stridor within the first 15 days of life, is often self-limiting and tends to resolve by 24 months. OSA is not only a consequence of laryngomalacia but also exacerbates and perpetuates the condition. Currently, the treatments reported in the literature are based (i) on medical therapies (including watchful waiting) and (ii) on surgical treatments. Among the surgical techniques, the most described is supraglottoplasty, performed with the use of cold instruments, CO2 LASER, transoral robotic surgery, or the microdebrider.

Unraveling the Complexities of Oxidative Stress and Inflammation Biomarkers in Obstructive Sleep Apnea Syndrome: A Comprehensive Review.

BACKGROUND: Obstructive sleep apnea syndrome (OSAS), affecting approximately 1 billion adults globally, is characterized by recurrent airway obstruction during sleep, leading to oxygen desaturation, elevated carbon dioxide levels, and disrupted sleep architecture. OSAS significantly impacts quality of life and is associated with increased morbidity and mortality, particularly in the cardiovascular and cognitive domains. The cyclic pattern of intermittent hypoxia in OSAS triggers oxidative stress, contributing to cellular damage. This review explores the intricate relationship between OSAS and oxidative stress, shedding light on molecular mechanisms and potential therapeutic interventions. METHODS: A comprehensive review spanning from 2000 to 2023 was conducted using the PubMed, Cochrane, and EMBASE databases. Inclusion criteria encompassed English articles focusing on adults or animals and reporting values for oxidative stress and inflammation biomarkers. RESULTS: The review delineates the imbalance between pro-inflammatory and anti-inflammatory factors in OSAS, leading to heightened oxidative stress. Reactive oxygen species biomarkers, nitric oxide, inflammatory cytokines, endothelial dysfunction, and antioxidant defense mechanisms are explored in the context of OSAS. OSAS-related complications include cardiovascular disorders, neurological impairments, metabolic dysfunction, and a potential link to cancer. This review emphasizes the potential of antioxidant therapy as a complementary treatment strategy. CONCLUSIONS: Understanding the molecular intricacies of oxidative stress in OSAS is crucial for developing targeted therapeutic interventions. The comprehensive analysis of biomarkers provides insights into the complex interplay between OSAS and systemic complications, offering avenues for future research and therapeutic advancements in this multifaceted sleep disorder.

Clear-Cell Renal Cell Carcinoma Metastasis into Pterygomaxillary Fossa - A Case Report.

Rationale: The aim of this study is to describe a rare case of clear-cell renal cell carcinoma (ccRCC) metastasis to the pterygomaxillary fossa. Patient Concerns: A 54-year-old woman was referred to the Department of Otolaryngology due to right facial pain for the past six weeks. Diagnosis: ccRCC metastasis to the pterygomaxillary fossa. Treatment: The patient was treated by immunotherapy (Ipilimumab + Nivolumab) after multidisciplinary team evaluation. Outcomes: After 18 months, the patient is in good overall condition and the size of the skull base lesion has significantly reduced. Take-Away Lessons: ccRCC metastasis to the skull base and adjacent sites occur rarely. Most commonly, the presenting symptoms of these lesions are headache and diplopia for skull base metastases and epistaxis in case of sinusal involvement, according to the literature. When total resection of the metastasis is not feasible, tumour-targeted therapy may be used, as in the presented case. A multidisciplinary evaluation is recommended for the correct assessment and management of these patients.

Subcutaneous emphysema as a complication of otorhinolaryngological surgical procedures.

INTRODUCTION: Subcutaneous emphysema (SE) represents, after bleeding and infections, a common complication in ENT surgery, given the intimate relationship between upper airways and anatomical area pertaining head and neck surgeon. Aim of this review is to analyze its characteristics, method of diagnosis and treatment to provide the specialist a useful tool for its early recognition. EVIDENCE ACQUISITION: A narrative review was carried out in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. A total of 164 articles were collected and most of them were case reports. EVIDENCE SYNTHESIS: Of 273 articles taken into consideration, only 164 met inclusion criteria. Review of all cases of SE in relation to surgical ENT procedures allow to classify each etiology on the surgical procedure that could be complicated with SE: laryngo-tracheal procedures, thyroid surgery, nasal and otological surgery, adenotonsillectomies. Moreover, traumatic orotracheal intubation, as well as alveolar rupture because of positive pressure ventilation or rupture of a preexisting abnormality, must be always taken into account. CONCLUSIONS: All ENT surgery can be complicated by SE. Diagnosis is simple and usually based only on physical examination, but correct and quick diagnosis is required. Treatment is in most of the time exclusively conservative, but SE could also represent a surgical emergency, given the possible evolution in pneumothorax/pneumomediastinum with serious consequences for patient's health.

Tapia's Syndrome: keep it in mind!

INTRODUCTION: The aim of this study was to revise the etiologic features about Tapia's Syndrome (TS), a condition to particularly consider in the era of the COVID-19 pandemic. EVIDENCE ACQUISITION: A systematic review was performed according to the PRISMA criteria. The Medline and Embase databases were searched from January 1, 1990, to December 31, 2020. Initially the search yielded 399 manuscripts, which were reduced to 50, upon the application of inclusion criteria. EVIDENCE SYNTHESIS: A total of 65 patients were included in the present review. Mean age was 44±17.5 (DS) years (15-95); M:F ratio was 2.3:1. TS involved mainly the left side (3:2) and was rarely bilateral. Only 2 TS reported cases were due to central causes. Peripheral causes were mainly due to postintubation edema (77%), extrinsic compression (15%), vascular disease (3%), other/not defined (5%). CONCLUSIONS: TS is a rare syndrome that has been related to a combined cranial nerve palsy; while TS due to central causes is very rare, it is mainly related to peripheral causes. A particular attention to TS should be given during the SARS-CoV-2 pandemic, either since the correlation between Tapia's syndrome, airway management and anesthetic procedures, since the possible implication of the viral infection itself.

Primary signet ring cell carcinoma of the pancreas A case report about an extremely rare variant of pancreatic carcinoma.

INTRODUCTION: Primary signet ring cell carcinoma of the pancreas (PSRCCP) is an extremely rare histologic variant of pancreatic carcinoma, which cells are characterized by large mucin vacuoles and peripheric nucleus that producing a signet ring aspect. CASE REPORT: We present a case about 66 years old man, with history of chronic pancreatitis and Wirsung stenosis of unknown origin, came to our attention for abdominal pain compatible with pancreatitis exacerbation. A TC scan showed a head of pancreas' neoformation, and a MRI showed numerous metastatic liver lesions confirming the presence of pancreatic lesion (52x46) mm. Fine needle aspiration biopsy of liver was suggestive of signet ring cell carcinoma. As second step, an ERCP was performed in order to get a biopsy of pancreatic lesion and drain the biliary tract. No surgical approach was possible as well as the progressive complications arised after diagnosis contraindicated chemotherapy. The patient died 3 month after diagnosis. CONCLUSION: PSRCCP is an aggressive malignancy with low survival rate, because of high metastatization rate. Only 9 cases are described in literature at December 2019, so we consider our work a precious contribute to knowledge. KEY WORDS: Pancreatic tumor, Pancreas, Pancreatic carcinoma, Primary signet ring cell carcinoma of the pancreas. Signet ring cell carcinoma.