Role of 18F-FDG PET/CT in evaluating lymph node status in patients with head and neck squamous cell carcinoma.

Objective: The presence of cervical lymph node metastases (CLNM) at diagnosis is one of the most relevant negative prognostic factors in patients with head and neck squamous cell carcinoma (HNSCC). The aim of this study was to analyse 2-deoxy-2[18F]fluoro-D-glucose (FDG) PET/CT findings for the identification of primary tumours and CLNM in a sample of patients affected by HNSCC. Moreover, a maximum standardised uptake value (SUVmax) threshold for the detection of CLNM was estimated. Clinical variables (i.e. smoking and alcohol habits), and tumour features (i.e. EBV and HPV positivity) were also evaluated in relation to FDG PET/CT findings. Methods: We retrospectively analysed patients who underwent FDG PET/CT for HNSCC staging between 2015-2020 at the University Hospital of Ferrara. All patients had cytological or histological confirmation of suspected cervical lymph nodes. Results: In total, 65 patients were enrolled (53 males, 12 females, median age 65.7 years). CLNM of patients with smoking habit had significantly higher SUVmax values than those of patients with previous smoking habit and non-smokers (p = 0.04). p16 positive HNSCC demonstrated a trend for higher SUVmax values on CLNM, in comparison to p16 negative tumours (p = 0.089). ROC curve analysis identified 5.8 as the best cut-off value of SUVmax for the detection of CLNM (AUC = 0.62, sensitivity 71.4% and specificity 72.7%). Conclusions: FDG PET/CT is a useful tool to evaluate CLNM in patients with HNSCC, particularly in those with smoking habit and p16 positive disease. A SUVmax cut-off of 5.8, combined with the use of conventional radiological investigations, may represent a useful tool in the identification of CLNM.

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.

Diagnosis of SARS-CoV-2 by RT-PCR Using Different Sample Sources: Review of the Literature.

OBJECTIVE: The most widely used diagnostic technique for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is real-time reverse transcriptase-polymerase chain reaction (RT-PCR). It can be done on different samples: nasopharyngeal swabs (NPS) or oropharyngeal swabs (OPS), and self-collected saliva. However, negative findings do not rule out infection. METHODS: A review was conceived to discuss advantages and limitations of the available diagnostic modalities for nonserologic diagnosis of SARS-CoV-2 based on RT-PCR; the article also proposes some practical suggestions to improve diagnostic reliability. RESULTS: A total of 16 papers (corresponding to 452 patients) of the 56 initially identified were included. Most of the papers describe findings from different samples obtained in limited case series; comparative studies are missing. CONCLUSIONS: Diagnostic accuracy of NPS and OPS is suboptimal and the risk of contaminated aerosol dispersal is not negligible. The SARS-CoV-2 RNA can be found in self-collected saliva specimens of many infected patients within 7 to 10 days after symptom onset. There is an urgent need for comparative trials to define the diagnostic modality of choice. Adequate education and training of health care personnel is mandatory.

Literature in the time of COVID-19: The "phase two".

The sudden onset of the COVID-19 pandemic has put a strain on the whole scientific world. We assisted to a tremendous effort by researchers with the final goal of achieving a better management of COVID-19 patients. The world of otorhinolaryngology, likewise, has not been exempt from this commitment to research. In this commentary we perform a bibliometric review of the available academic literature about COVID-19 in the top 20-ranked ENT journal, with the goal of providing an overview of what has been published to date and encouraging a shift towards quantitative research.

Submandibular gland excision: From external surgery to robotic intraoral and extraoral approaches.

Submandibular gland excision is generally performed through a transcervical approach, a safe procedure that, however, carries few neurological, functional and aesthetic drawbacks. Intraoral approach to the submandibular gland has been described many years ago but it has been newly proposed in recent years thanks to endoscope-assisted and robot-assisted surgical procedures. The main purpose of intraoral approaches is to avoid cosmetic sequelae and to reduce the risk of marginal nerve injury although the recent introduction of retroauricular, postauricular, facelift and transhairline neck incisions has overcome the need for an alternative to traditional transcervical approach. Different surgical approaches (transoral versus transcervical) to the submandibular gland as well as different type of cutaneous incisions will be illustrated and discussed in the light of advancement of endoscope-assisted and robot-assisted procedures.

Lateral pharyngoplasty techniques for obstructive sleep apnea syndrome: a comparative experimental stress test of two different techniques.

PURPOSE: To show the different effects of expansion sphincter pharyngoplasty (ESP) and barbed reposition pharyngoplasty (BRP) on muscle tension and muscle fiber tearing using a comparative experimental stress test with a frog thigh muscle model. METHODS: Frog thigh muscle was used for this experimental study. A Barbed suture was used to simulate the BRP pharyngoplasty whereas a Vicryl 3-0 suture was used to simulate the ESP technique. The other extremity of the suture was attached to traction scales. The traction scales were used to measure the weight relative to the amount of force required to obtain muscle breaking. Both surgical techniques were simulated on the frog muscle. Traction was performed until muscle breaking was observed, measuring the value of force needed to obtain muscle rupture. RESULTS: Specimen muscle breakdown in the ESP simulation occurred with an average value of 0.7 kg of traction force. Contrarily, specimen muscle breakdown in the BRP simulation with Barbed suture occurred with an average value of 1.5 kg of traction force CONCLUSION: During simulation of the ESP technique, specimen muscle breakdown occurred with an average value of traction force lower than in the BRP technique. During traction the multiple lateral sustaining suture loops of BRP could ensure greater stability then the single pulling tip suture of ESP with minor risk of muscle fiber damage.

Transnasal Endoscopic Approach for the Treatment of Medial Orbital Wall Fractures.

The aim of this study is to report a case series of blowout fractures of the medial orbital wall that were treated endoscopically. Isolated fractures of the medial orbital wall are uncommon and can be asymptomatic. Various surgical methods for repairing medial orbital wall fractures have been described. The standard approach for the treatment of medial orbital wall fractures is the transcutaneous approach or the transconjunctival with retrocaruncular approach. In the last years, the attention on the use of minimally invasive techniques such as transnasal endoscopic approach is growing. This was a retrospective study of six cases completely managed endoscopically. In the presented case series, the endoscopic endonasal approach represented a safe and effective procedure for the reduction of medial wall orbital fractures.