A comparative prospective study between the outcomes of one-stage Pelnac reconstruction and full thickness skin graft on donor site healing in the radial forearm and fibula flaps.

OBJECTIVES: Dermal substitutes are classically used in a 2-stage procedure followed by skin graft for wound healing. This study aims to evaluate the possibility to use an alternative technique for radial forearm and fibula donor sites coverage using one-stage Pelnac reconstruction. MATERIALS AND METHODS: 21 patients who underwent radial forearm and fibula flaps harvest for reconstruction of head and neck defects after oncological surgery were enroled in the study. 13 patients were treated by one-stage Pelnac reconstruction of the donor site defect, 8 patients underwent full thickness skin graft. The Vancouver Scar Scale was used to evaluate the scar quality. RESULTS: Most patients treated with one-stage Pelnac reconstruction showed good healing of the flap donor site, with minor complications, scar quality comparable to other treatment options and unimpaired function of the implicated limb. One patient had wound dehiscence at the radial forearm site, which was treated with secondary full thickness skin graft. In the group treated with FTSG we had three patients that developed complications, such as dehiscence of the graft and seroma. Overall, we reported comparable satisfaction with donor sites both for aesthetic and functional outcomes, in both groups of patients. CONCLUSION: The use of Pelnac without a following skin graft provides a viable method for the reconstruction of radial forearm and fibula flaps donor site. A longer postoperative care is needed, but the long-term aesthetic and functional results are satisfactory in comparison with full thickness skin graft.

Orbital metastasis or idiopathic orbital pseudotumor? A case report from a patient previously diagnosed with primary breast cancer.

INTRODUCTION: Cancer metastatic to the orbit may be difficult to distinguish from idiopathic orbital pseudotumor at clinical and radiological examination. This case report describes clinical, radiological features, differential diagnosis, and treatment options for orbital neoplasms of unknown origin. PRESENTATION OF CASE: A 63-year-old woman presented to our Unit because of orbital swelling, ocular pain, globe displacement, conjunctival chemosis, and progressive vision loss. The patient had been seen by an ophthalmologist at another hospital. The initial diagnosis was idiopathic orbital pseudotumor. Steroid therapy did not resolve clinical symptoms. Her medical history held decisive clues: ten years before this presentation she had been diagnosed with double primary breast cancer, invasive lobular breast carcinoma, and invasive ductal breast carcinoma. Orbital biopsy was performed for differential diagnosis. DISCUSSION: Considering the rapid onset and severity of symptoms, the radiological features of the orbit, and the patient's medical history of breast cancer, orbital metastasis should have been the most likely diagnosis. Orbital biopsy was performed because of the history of multiple primary cancers and because metastatic origin had to be determined to define the best treatment strategy. CONCLUSION: Biopsy is necessary under specific circumstances in the diagnosis of orbital metastasis, especially when presentation is ambiguous and when differential diagnosis is challenging. A patient's medical history may hold vital clues to correct diagnosis.

Temporomandibular Disorders Management-What's New? A Scoping Review.

Temporomandibular disorders include various conditions that impact the masticatory system, affecting its structure, function, or physiology. Clinicians face a complex array of therapeutic options when treating this group of diseases, emphasizing the importance of evaluating the current evidence to guide decisions in patient care. The main objective of this article is to conduct a scoping review on the available treatment approaches to manage temporomandibular disorders (TMDs). An extensive search of the literature was performed on Scopus, Pubmed, Embase, and Web of Science. Systematic reviews published in the last 5 years were considered. Out of the 2183 publications identified, 109 studies were included in this review. Among them, 39 articles focused on the non-invasive approach, while 120 delved into the minimally invasive approach, and 15 explored the surgical approach. Non-invasive or conservative approaches like cognitive-behavioral therapy, physical therapy, and acupuncture offer effective pain management and functional improvements in TMDs. Emerging treatments offer promising alternatives for treating these disorders. Surgery should be reserved for severe cases, with conservative therapies used in conjunction with invasive procedures for optimal patient outcomes.

The role of artificial intelligence in training ENT residents: a survey on ChatGPT, a new method of investigation.

Objective: The primary focus of this study was to analyze the adoption of ChatGPT among Ear, Nose, and Throat (ENT) trainees, encompassing its role in scientific research and personal study. We examined in which year ENT trainees become involved in clinical research and how many scientific investigations they have been engaged in. Methods: An online survey was distributed to ENT residents employed in Italian University Hospitals. Results: Out of 609 Italian ENT trainees, 181 (29.7%) responded to the survey. Among these, 67.4% were familiar with ChatGPT, and 18.9% of them used artificial intelligence as a tool for research and study. In all, 32.6% were not familiar with ChatGPT and its functions. Within our sample, there was an increasing trend of participation by ENT trainees in scientific publications throughout their training. Conclusions: ChatGPT remains relatively unfamiliar and underutilised in Italy, even though it could be a valuable and efficient tool for ENT trainees, providing quick access for study and research through both personal computers and smartphones.

Dental plaque microbiota sequence counts for microbial profiling and resistance genes detection.

Shotgun metagenomics sequencing experiments are finding a wide range of applications. Nonetheless, there are still limited guidelines regarding the number of sequences needed to acquire meaningful information for taxonomic profiling and antimicrobial resistance gene (ARG) identification. In this study, we explored this issue in the context of oral microbiota by sequencing with a very high number of sequences (~ 100 million), four human plaque samples, and one microbial community standard and by evaluating the performance of microbial identification and ARGs detection through a downsampling procedure. When investigating the impact of a decreasing number of sequences on quantitative taxonomic profiling in the microbial community standard datasets, we found some discrepancies in the identified microbial species and their abundances when compared to the expected ones. Such differences were consistent throughout downsampling, suggesting their link to taxonomic profiling methods limitations. Overall, results showed that the number of sequences has a great impact on metagenomic samples at the qualitative (i.e., presence/absence) level in terms of loss of information, especially in experiments having less than 40 million reads, whereas abundance estimation was minimally affected, with only slight variations observed in low-abundance species. The presence of ARGs was also assessed: a total of 133 ARGs were identified. Notably, 23% of them inconsistently resulted as present or absent across downsampling datasets of the same sample. Moreover, over half of ARGs were lost in datasets having less than 20 million reads. This study highlights the importance of carefully considering sequencing aspects and suggests some guidelines for designing shotgun metagenomics experiments with the final goal of maximizing oral microbiome analyses. Our findings suggest varying optimized sequence numbers according to different study aims: 40 million for microbiota profiling, 50 million for low-abundance species detection, and 20 million for ARG identification. KEY POINTS: • Forty million sequences are a cost-efficient solution for microbiota profiling • Fifty million sequences allow low-abundance species detection • Twenty million sequences are recommended for ARG identification.

Forensic value of soft tissue detachments from the hyoid bone in death due to strangulation asphyxia.

BACKGROUND: There are no unequivocal histopathological findings for the diagnosis of fatal asphyxia due to neck compression. From the observation of a series of asphyxiation cases, we noted, during microscopic analysis, a high frequency of "detachment" of soft tissues from the hyoid bone. This specifically refers to the presence of an optical space between the surface of the hyoid bone and soft tissues. OBJECTIVES: We aimed to evaluate the detachment of soft tissues from the hyoid bone as specific histological evidence of death due to strangulation asphyxia. MATERIAL AND METHODS: Ten blocks were taken from deaths due to external mechanical compression of the neck (strangulation asphyxia, group A), 22 blocks were taken from deaths for other causes without trauma to the neck (group B), and 38 blocks were obtained from living subjects that have undergone laryngectomies (group C). The presence/absence of detachments were compared between the 3 groups (A, B and C) using Fisher's exact test. RESULTS: The detachment of soft tissues from the hyoid bone was observed in 5 cases (50%) in group A, 6 cases (27.2%) in group B, and 17 cases (44.3%) in group C. The sensitivity and specificity of the presence of the detachment in group A were 0.5 (95% confidence interval (95% CI): 0.38-0.62) and 0.57 (95% CI: 0.45-0.69), respectively. The comparison between the 3 groups and the presence/absence of soft tissue detachment showed no statistically significant differences between the groups (p = 0.329), clarifying that soft tissue detachment is a nonspecific variable for all 3 situations. CONCLUSIONS: Detachment of soft tissues has poor value as a single element to favor the diagnosis of asphyxia due to violent compression of the neck and should be interpreted as an artifactual finding, unrelated to the neck injury or injury vitality.

Subtotal Petrosectomy: Pictorial Review of Clinical Indications and Surgical Approach.

Subtotal petrosectomy (STP) is characterized by obliteration of the middle ear and occlusion of the external auditory canal. The advent of the endoscope has allowed a reduction in morbidity for some conditions such as cholesteatoma and other middle ear disorders, but STP still plays an important role. A retrospective review of medical records and videos of patients who had undergone STP was performed. Perioperative data and images were collected from various clinical cases who had undergone subtotal petrosectomy at our tertiary referral university hospital in Verona. We confronted our experience with a review of the literature to present the main indications for this type of procedure. STP allows a variety of diseases to be managed effectively as it offers the possibility of a definitive healing with radical clearance of temporal bone. Moreover, it can be safely combined with other procedures with a very low complication rate. Although the endoscope represents a revolution in ear surgery, STP, when indicated, is nowadays a surgical option that should be included in the otosurgeon's portfolio.

Venous Thrombosis in Airborne Viral Infections: Is Coronavirus Disease 2019 now Any Different from Influenza?

One of the hallmarks of coronavirus disease 2019 (COVID-19), particularly in complicated cases (i.e., requiring hospitalization or intensive care support), is persistent hemostasis activation, which may be associated with a vast array of thrombotic episodes involving both the arterial and venous systems. The renewed emphasis on the relationship between viral infections and venous thrombosis paves the way for determining whether a more common and often underestimated infection disease, such as influenza, may also be associated with a significant burden of venous thrombotic episodes, and how this eventual thrombotic risk compares to that seen in COVID-19, both in the past and with newer variants. Our review of studies comparing the burden of venous thromboembolism (VTE) in patients with COVID-19 or influenza revealed that the thrombotic risk appears to be significantly higher in patients with COVID-19 but remains certainly not meaningless in those with influenza, particularly in subjects infected by highly virulent strains (i.e., H1N1), in those who develop pneumonia and require intensive care support. In these specific clinical settings, the adoption of tailored thromboprophylaxis may be indicated though more studies are compellingly needed on this matter. As COVID-19 variants emerge, there is a possibility that the VTE burden of COVID-19 will decrease, and progress to that of other respiratory viruses.

Hearing rehabilitation in children with malformed ears: The endoscopic-assisted approach for cochlear implantation.

BACKGROUND: Cochlear implantation (CI) in children with malformed ears can be challenging through the standard surgical technique. Several alternative approaches have been described. The endoscopic-assisted approach can be chosen as an effective and safe surgical technique, overcoming the drawbacks of the traditional approach. MATERIAL: We further describe a combined technique based on a limited mastoidectomy with no posterior tympanotomy and an endoscopic transmeatal approach to the round window (RW): the electrode is driven from the mastoid to the middle ear through the attic. RESULTS: The concomitant endoscopic assistance allows for improved surgical vision, reducing the risk of major complications. The main advantages of this technique are related to better visualization of the RW for safe insertion of the electrode; avoidance of damage to the facial nerve (FN), due to direct visualization, and sparing the posterior tympanotomy; avoidance of subtotal petrosectomy, if not necessary. CONCLUSION: The purpose of this article, supported with a video file, is to describe step by step this endoscopic-assisted procedure in a patient with middle ear malformation.

Red blood cell distribution width (RDW) is a significant predictor of survival in laryngeal cancer patients: Systematic literature review and meta-analysis.

Background: This systematic literature review and meta-analysis investigated whether the red blood cell distribution (RDW) may predict survival outcomes in laryngeal cancer patients undergoing curative treatment. Methods: We conducted an electronic search in Medline and Scopus using the keywords "red blood cell distribution width" OR "RDW" AND "laryngeal cancer" OR "larynx cancer" OR "laryngeal carcinoma" OR "larynx carcinoma," without time or language restrictions (up to February 2023), for identifying studies investigating the prognostic value of RDW in patients with any form of laryngeal cancer and with a primary endpoint that was set as survival rate and/or disease-free survival between 1 and 10 years after curative treatment. The research was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 reporting checklist.

From Hype To Reality: A Narrative Review on the Promising Role of Artificial Intelligence in Larynx Cancer Detection and Transoral Microsurgery.

Early larynx cancer detection plays a crucial role in improving treatment outcomes and recent studies have shown promising results in using artificial intelligence for larynx cancer detection. Artificial intelligence also has the potential to enhance transoral larynx microsurgery. This narrative review summarizes the current evidence regarding its use in larynx cancer detection and potential applications in transoral larynx microsurgery. The utilization of artificial intelligence in larynx cancer detection with white light endoscopy and narrow-band imaging helps improve diagnostic accuracy and efficiency. It can also potentially enhance transoral larynx microsurgery by aiding surgeons in real-time decision-making and minimizing the risk of complications. However, further prospective studies are warranted to validate the findings, and additional research is necessary to optimize the integration of artificial intelligence in our clinical practice.

Step-By-Step Surgery for Diffuse Idiopathic Skeletal Hyperostosis (DISH) of the Cervical Spine.

Diffuse idiopathic skeletal hyperostosis (DISH) is a disease that can lead to relevant ENT symptoms such as dysphagia or dyspnea. Surgical treatment for this disease offers good results and outcomes, allowing patients to restore fundamental functions such as swallowing or phonation. Laryngoscope, 2023.

Effect of exercise across the head and neck cancer continuum: a systematic review of randomized controlled trials.

PURPOSE: This study aims to systematically explore the impact of physical exercise as supportive therapy for head and neck cancer. METHODS: A systematic search on PubMed/MEDLINE, Cochrane, and SPORTDiscus was conducted. Randomized controlled trials exploring the effects of a physical exercise intervention in comparison with usual care on outcomes in patients with head and neck cancer were selected. The RoB 2 tool was used to determine the study quality. The extracted data are reported as qualitative synthesis. RESULTS: Among the 527 records examined, nine studies were included. No trials investigating exercise as prehabilitation were found, whereas eight studies involving 452 patients with head and neck cancer were conducted during anticancer treatment. Most trials did not report improvements in body mass index or body composition, while 2/4 and 3/5 investigations found a significant increase in muscle strength and cardiorespiratory fitness, respectively. Regarding the patients' reported outcomes, 4 out of 7 studies observed enhancements in some domains of quality of life, and two trials out of 3 detected an amelioration in fatigue following the exercise intervention. Analyzing the exercise programs, it seems that combining aerobic and resistance training could be more beneficial compared to a single type of full-body exercise in counteracting physical decline and controlling symptoms in the anticancer therapy phase. One trial has investigated the effect of resistance exercise on patients who had terminated the anticancer treatments, reporting significant improvements in lean mass, muscle strength, and quality of life. CONCLUSION: Exercise may be a promising approach in patients with head and neck cancer. Future studies are needed to consolidate these results.

The Role of Fibrinogen, Homocysteine and Metabolic Syndrome's Alterations in Sudden Sensorineural Hearing Loss (SSHL): A Narrative Review.

Fibrinogen and homocysteine (HCY) are molecules known to play a role in vascular homeostasis, and their blood levels are often elevated in patients with metabolic syndrome. Recent evidence suggests that sudden sensorineural hearing loss (SSHL) may have a vascular origin. This has led many authors to advocate that fibrinogen, homocysteine, and metabolic syndrome (MetS) may play a direct role in SSHL. The aim of this brief review is to examine the role and influence of these molecules and MetS on the mechanisms of SSHL. Elevated fibrinogen levels have been associated with a worse prognosis in SSHL, possibly due to increased blood viscosity and decreased blood flow. Similarly, HCY has been associated with vascular damage, particularly in hyperhomocysteinemia, although the exact association with SSHL remains controversial. MetS has been demonstrated to function both as a causative factor and as a contributor to poorer recovery in cases of SSHL. However, although some studies suggest a possible role for these biomarkers and MetS in the prognosis and treatment of SSHL, specific therapeutic and preventive strategies based solely on these factors have yet to be developed. Given their potential role in prognosis and treatment and the global epidemic of metabolic syndrome, this issue needs to be analyzed comprehensively. Thus, further quality studies need to be conducted, even though it is difficult to determine the actual impact of MetS on the development of SSHL, as it is a multifactorial disease affecting multiple organs.

Vascularized fibular flap and custom-made synthesis in post-traumatic ulnar diaphyseal pseudarthrosis: a case report.

BACKGROUND: Although isolated fractures of the ulnar shaft are considered common and relatively benign injuries, numerous complications can arise especially in the context of suboptimal care pathways. For pediatric patients, however, there is no single indication of the surgical approach. In the context of the management of these complications, it is known that the vascularized fibular graft has numerous advantages and indications in the treatment of recurrent pseudarthrosis. However, in revision surgery the frequent occurrence of anatomical subversions requires the use of fixation means adapted to the individual patient. We present a clinical case of an adult patient suffering from post-traumatic ulnar pseudarthrosis treated with autologous vascularized fibula grafts and 3D-planned custom-made plate. CASE PRESENTATION: A 38-year-old Ivorian woman came to our attention with a painful nonunion of the ulnar shaft and significant dysmorphism of the left forearm, with shortening and flexion of the limb as an outcome of unspecified road trauma in childhood. No alterations of the nerve compartment were reported. As far as detectable, she had undergone autologous bone grafting and implantation of questionable synthetic means, without acute treatment. Since we evaluated the patient (2012), we have performed two debridement surgeries, associated with autologous avascular bone graft from the iliac crest and plate fixation (2012 and 2014). In both cases, rupture of the fixation media was observed. In 2021, the pseudarthrosis was treated with a vascularized fibular bone graft. The subverted radius and ulna anatomy and poor bone quality required patient-specific reconstruction of the pseudarthrosic ulna from a 3D scan and the production of custom-made plate and screws, supported by the creation of special guides for drilling and by optimizing the positioning of screws with preoperative digital models. In the postoperative period, regular follow-up visits with X-rays evaluations were performed at 1, 3 and 6 months after surgery. No inflammatory reactions or local rejection were found. The fibula graft healed at the proximal ulnar junction six months after the operation while it took eight months to heal at the distal junction. Functionally, we observed a pain reduction and a range-of-motion preservation. CONCLUSIONS: The multiple failures of diaphyseal reconstruction with avascular bone grafts have forced the indication to the vascularized fibular flap. This case is a unique experience but we believe that the association between vascularized bone graft and the potential for customization through 3D planning represents a valid surgical potentiality in complex cases of post-traumatic reconstruction.

Is There a Correlation between Endoscopic Sinus Surgery and Improvement in Erectile Dysfunction?

BACKGROUND: In recent years, the focus on respiratory disorders has increased, notably on chronic rhinosinusitis (CRS), an inflammatory condition of the upper airway that can significantly impact one's quality of life. Interestingly, CRS has emerged as a potential comorbidity in erectile dysfunction (ED). This study aims to assess the impact of endoscopic sinus surgery for CRS on sexual function. MATERIALS AND METHODS: The authors conducted a prospective study of patients who visited their clinics for chronic rhinosinusitis between June 2018 and June 2022. The study involved 53 patients aged between 40 and 70 years who were treated for CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). Preoperative and postoperative assessments were performed using the Nasal Obstruction Symptoms Evaluation Score (NOSE score) and the 5th International Index of Erectile Function Score (IIEF-5 score) to evaluate potential improvements in sexual function following endoscopic sinus surgery. RESULTS: Before surgery, the average NOSE score was 72.6, which decreased to 24.9 postoperatively. The average preoperative IIEF-5 score was 16.35, while the postoperative average increased to 19.52. Statistical analysis revealed a significant improvement in erectile function for penetration (p-value = 0.024) and overall satisfaction after intercourse (p-value < 0.001) regarding the degree of nasal obstruction. CONCLUSION: This study underscores the potential benefits of treating chronic obstructive upper airway diseases such as sinusitis in improving the sexual outcomes of patients clinically diagnosed with erectile dysfunction.

Secretory carcinoma of salivary glands with NTRK3 break-apart molecular rearrangement: Potential misdiagnosis with mucoepidermoid carcinoma.

A woman presented a right submandibular gland lesion with cytologic diagnosis of mucoepidermoid carcinoma. Patient underwent sialoadenectomy en bloc with supraomohyoid neck dissection. Positivity for ETV6-NTRK3 genes fusion on surgical sample led to final diagnosis of secretory carcinoma (SC). Secretory carcinoma has been renamed by WHO in 2017 from mammary-analogue-secretory carcinoma (MASC). Only 649 have been reported until 2019. While cytologic alteration are shared with other neoplasms as the acinic cell and mucoepidermoid carcinomas, ETV6-NTRK3 rearrangement is pathognomonic of SC. Although usually indolent and with low-stage presentation, SC has higher rate of local recurrences and nodal involvement than ACC. Surgical treatment represent the gold standard. Real prevalence of SC is probably underestimated due to the recent WHO 2017 reclassification. While cytologic analysis does not allow to discriminate SC from other malignancies, chromosomal examination is recommended. When low-grade SC is diagnosed, complete surgical resection assures good prognosis.

Proposal for Perioperative Pharmacological Protocol for the Reduction in Early Complications in Orthorhinoseptoplasty: Five Years of Experience.

Septorhinoplasty is a crucial intervention in functional and aesthetic facial surgery. Although rare and usually manageable, complications could lead to disfiguring consequences. There is no universal protocol for perioperative management in the literature. The aim of this article is to analyze the surgical complications in patients who underwent open rhinoseptoplasty and were treated in the perioperative period with the standardized protocol used in our department, in order to propose it as a standardized protocol for a more global application. METHODS: The patients included underwent rhinoplasty between 2017 and 2022 and were managed with the same treatment protocol. Perioperative and intraoperative data, as well as possible complications, were collected. RESULTS: A total of 129 patients were included, 73% of which reported either mild or no complications. Abnormal scar healing was the most frequent complaint (9%), followed by edema (6.2%), nasal dyspnea (3.9%), infection (2.3%), and bleeding (2.3%). No severe complications were reported. CONCLUSIONS: Our protocol appears to be effective in minimizing complications such as infection and bleeding, although it is very difficult to compare the results with the literature.