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PURPOSE: The overall survival of laryngeal squamous cell carcinoma (LSCC) hasn't changed significantly in the last decades, leading to a negative prognosis in advanced stages. So, the immunotherapy takes space with the inhibition of PD-1/PD-L1 checkpoint, involved in suppression of immune response. METHODS: A prospective study was conducted on LSCC patients, selected according to strict criteria. The study was approved by the ethics committee of our Hospital. Parameters were: sex, age, smoking and alcohol habits, C-reactive protein (CRP) level in the serum, laryngeal subsite involved, differentiation-based histopathologic grading of tumor, neck node involvement, tumor stage, expression levels of PD-L1 (as Combined Positive Score - CPS). P-value < 0.05 was statistically significant. RESULTS: 58 patients were included: 31.03% were females, mean age 63.55±10.09. A statistically significant correlation between CPS and smoking habits and N stage was found. CRP resulted increased in 44.83% of patients with a statistically significant correlation with CPS. The most cases were glottic cancers (46.55%). 75.86% of tumors were moderately-differentiated, without correlation with CPS. CONCLUSION: PD-L1 expression levels are variables independent of sex, age, alcohol consumption, differentiation degree of LSCC. A statistically significant correlation between PD-L1 expression levels and smoking habits, neck node status and CRP was found. This last finding demonstrates the involvement of PD-1/PD-L1 checkpoint in immune response in case of cancer. However, these results need further studies to detect the best patients tailored for treatment with anti-PD-1/PD-L1 blocking antibodies.
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BACKGROUND: Smoking and alcohol are the main risk factors for head and neck cancer. Despite the significant psychological impact, many patients continue to smoke and drink alcohol after diagnosis of cancer. This study aims to analyze the patients' behavior post diagnosis and treatment of head and neck cancer. METHODS: An observational retrospective study was conducted on patients suffering from head and neck cancer. Their smoking and alcohol habits before and after diagnosis of cancer were studied. RESULTS: A total of 85 patients were recruited: 80â¯% males, mean age 61.77±9.30 years. Among smokers, 35.80â¯% continued smoking post-diagnosis. A statistically significant correlation was found between smoking habit after diagnosis of cancer and type of treatment and tracheostomy. Among drinkers, 65.52â¯% continued to consume alcohol after diagnosis of cancer. A statistically significant correlation was found between alcohol consumption post-diagnosis and sex. CONCLUSIONS: Patients undergoing more invasive treatments are more likely to quit smoking and/or drinking alcohol, suggesting the strong psychological impact of cancer and its therapy. Many patients continue smoking and consuming alcohol due to unawareness, depression, or addiction. However, most patients reduced cigarette smoking and alcohol consumption. Comprehensive care, including psychological support, is essential for these patients.
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INTRODUCTION: Difficult intubation is the situation when a skilled anesthetist has difficulties to manage airway using face mask, laryngoscopy, supraglottic device, tracheal intubation, surgery. Videolaryngoscope and flexible fibroscope (FFS) represent valid alternatives for difficult airway management, with some limitations. However, literature lacks of studies about the efficacy of the combined use of videolaryngoscope and FFS. CASE REPORT: We report a case of a man, with glottic lesion, who needs surgery under general anesthesia. Anesthesiologic pre-operative evaluation revealed that he's a difficult intubation case. So, in a supine position, intubation was performed on first attempt by videolaryngoscope combined with FFS. On post-op, no signs of injuries due to intubation have been found. DISCUSSION: In 2022, the American Society of Anesthesiologists defined the guidelines to manage difficult intubation: based on patient' anatomical and clinical feature and anesthetist' skills, several intubation procedures could be used. Each procedure has pros and cons. CONCLUSION: It's the first case of anticipated difficult intubation in adult man that was intubated under general anesthesia by using videolaryngoscope combined with FFS. We demonstrated that this procedure is safe and useful in case of difficult airway and recommended in case of laryngeal lesions that hinder the visualization of glottic plane.
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INTRODUCTION: Hemangiomas are the most common benign tumors of the head-neck region in children and mainly affect the face, oral mucosa, lips, and tongue. The base of tongue is an extremely rare site of involvement. The incidence is higher in women and occur more frequently in infants and childhood. PRESENTATION OF CASE: We present a rare case of cavernous hemangioma of the base of tongue in a 70-year-old male patient surgically removed by Transoral Ultrasonic Surgery (TOUSS). 1-year follow up didn't show sign of recurrence. DISCUSSION: Hemangiomas are benign proliferations of endothelial cells common in the head and neck. The etiology is uncertain: an imbalance in angiogenesis related to substances such as vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (BFGF) with uncontrolled proliferation of vascular elements is proposed. It can be asymptomatic or, when affecting the tongue, lead to difficulty swallowing, pain, bleeding and dyspnea. CONCLUSION: This case report aims to stress that hemangioma should be considered in differential diagnosis in case of richly vascularized tongue base lesion, also in adult population. It would like to highlight the role of transoral ultrasonic surgery (TOUSS), which is able to achieve the same advantages as TORS with lower costs and shorter learning curve.
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Laryngeal squamous cell carcinoma (LSCC) is the second most common cancer among head and neck cancers. Despite a lower incidence of laryngeal carcinoma, new diagnostic techniques, and more targeted therapies, the overall survival has not changed significantly in the last decades, leading to a negative prognosis in advanced stages. Recently, several studies have focused on the identification of biomarkers that may play a critical role in the pathogenesis of LSCC. Reviewing the literature on the main databases, this study aims to investigate the role of some biomarkers in LSCC that are correlated with oxidative stress and inflammation: heat shock proteins; metallothioneins; nuclear factor erythroid 2-related factor 2; heme oxygenase; cyclooxygenase-2; and micro ribonucleic acids. This review shows that biomarker expression depends on the type, grade of differentiation, stage, and site of carcinoma. In addition, the role of these biomarkers in LSCC is still little-known and little-studied. However, the study of biomarker expression and the detection of a possible correlation with patients' epidemiological, clinicopathological, and therapeutics data may lead to better awareness and knowledge of the tumor, to the identification of the best therapeutic strategy, and the most proper follow-up protocol tailored for each patient. In conclusion, the achievement of these goals may improve the prognosis of LSCC patients.
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Background and Objectives: Hypo/anosmia is a characteristic symptom of COVID-19 infection. The aim of this study is to investigate the time of smell recovery and to identify a possible order of perception recovery of different odors in COVID-19 patients. Materials and Methods: A prospective observational study was conducted on not hospitalized COVID-19 patients, selected according to eligible criteria. The study was approved by the Ethical Committee. A questionnaire formulated by our team was submitted to patients in order to know the duration of the hypo/anosmia and hypo/ageusia and the order of odor recovery: vanillin (mixed olfactory/gustatory substances), phenyl ethyl alcohol (rosewater) (pure olfactory substances), eucalyptol (mixed olfactory/trigeminal substances), and eugenol (mixed olfactory/trigeminal/gustatory substances). Results: 181 patients were included. Hypo/ageusia and hypo/anosmia lasted on average 10.25 (±8.26) and 12.8 (±8.80) days, respectively. The most frequent odor recovery sequence was: (1) phenyl ethyl alcohol; (2) eucalyptol; (3) vanillin; and (4) eugenol. In COVID-19 patients, hypo/anosmia occurs more often in women and at a young age. Conclusions: This preliminary investigation highlighted novel data: there is a chronological order in perception recovery of different olfactory substances and, therefore, in the restoration of the various sensitive nerve pathways involved in the sense of smell.
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Ageusia , COVID-19 , Alcohol Feniletílico , Humanos , Femenino , Olfato , Anosmia , Eucaliptol/uso terapéutico , Eugenol/uso terapéutico , COVID-19/complicacionesRESUMEN
INTRODUCTION: Solitary fibrous tumor is a rare neoplasm that can affect any part of the body, also head and neck region. Etiology is unknown. The incidence is slightly higher in males, the age ranges from 11 to 79 years. PRESENTATION OF CASE: It's the first case in our country of left parotid solitary fibrous tumor, removed by partial parotidectomy with facial nerve preservation. Histology examination showed diffuse spindle-shaped cells proliferation, moderate polymorphism, low mitotic index (<4 mitoses per 10 HPF), partially bordered by fibrous capsule. Immunohistochemistry showed STAT6, CD34, CD99 positivity. Six-months follow-up didn't show sign of recurrence. DISCUSSION: Solitary fibrous tumor is a mesenchymal spindle cell neoplasm with fibroblastic differentiation ubiquitous in soft tissues, that involved the head and neck region in 6 % of cases. Etiology is unknown. The possible pathogenesis is NAB2-STAT6 gene fusion. It's asymptomatic or symptoms are related to space-occupying mass. Diagnostic work up involves imaging, immunohistochemistry, histology. Radiographic finding may lead to incorrect assessment of the mass: the same imaging features are present in pleomorphic adenoma, the most frequent tumor of salivary glands. CONCLUSION: This case report aims to stress that, although rare, solitary fibrous tumor should be considered in differential diagnosis in case of indolent salivary gland mass, since it may require more invasive approach (e.g., total parotidectomy, adjuvant radiotherapy). It would like to highlight the role of multidisciplinary team to define the best therapy, tailored for the patient, as well as to give awareness to a rare but sometimes aggressive tumor.
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INTRODUCTION: Laryngeal carcinoma represents the 22nd most common cancer worldwide. Thyroid metastasis from laryngeal cancer is extremely rare. Overall, thyroid gland involvement by metastatic carcinoma represents about 1.1-2.1 % among thyroid malignant diseases. PRESENTATION OF CASE: A male in his 70s came to our Otolaryngology Unit with a laryngeal squamous cell carcinoma (cT3). Total laryngectomy and bilateral neck dissection were performed. Histological examination revealed a pT3 carcinoma with sub-massive metastasis of the Delphian node. The patient underwent close follow-up. After eight months, neck examination revealed a suspected nodule in the right thyroid lobe. A right thyroid lobectomy was performed, and histological assessment revealed a nodule with squamous carcinoma metastasis in the superior pole of the thyroid lobe. The remaining thyroid tissue was affected by multinodular macrofollicular goitre. The patient underwent adjuvant therapy. One year after the second surgery, he showed no signs of recurrence. DISCUSSION: Thyroid gland metastasis from laryngeal carcinoma is a very rare occurrence. In literature, we found only three articles that describes thyroid metastasis in overall 7 patients affected by laryngeal squamous cell carcinoma. Positive Delphian lymph node is usually related to poor prognosis: in 2007 a study reported tumour recurrence in 15 out of 25 patients with metastatic Delphian lymph node within the first two years of surgery. CONCLUSION: Thyroid gland metastasis from laryngeal carcinoma is rare; so close follow-up of oncologic patients is mandatory and, most of all, the positive Delphian node should not be underestimated for its predictive value.
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Abstract Introduction Laryngoceleisan air-filled dilatation of the laryngeal saccule that can be classified according to its extent (internal, external, or combined) and contents (laryngocele or laryngopyocele). To date, there is no consensus on the best treatment for laryngocele. Objective The present study aims to demonstrate for the first time the effectiveness of CO2 laser marsupialization for internal and combined laryngoceles. Methods A retrospective study was accomplished in our ENT Clinic of the University Hospital, from 2010 to today, recruiting patients according to strict criteria. All patients had internal or combined laryngocele/laryngopyocele treated with CO2 laser marsupialization. Results A total of 15 patients were enrolled for a total of 17 laryngoceles; 66.67% of the patients were males and the mean age was 54.4 (±14.12) years old. Internal laryngoceles accounted for 64.71% of the total, and only 7 cases were laryngopyoceles. At the 3-year follow-up, no signs of recurrence were found. Conclusion CO2 laser marsupialization is efficacious in the treatment of laryngocele or laryngopyocele, both internal and combined, in terms of efficiency, safety, and fast postoperative recovery, without need for tracheotomy or open surgery.
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Introduction Laryngocele is an air-filled dilatation of the laryngeal saccule that can be classified according to its extent (internal, external, or combined) and contents (laryngocele or laryngopyocele). To date, there is no consensus on the best treatment for laryngocele. Objective The present study aims to demonstrate for the first time the effectiveness of CO2 laser marsupialization for internal and combined laryngoceles. Methods A retrospective study was accomplished in our ENT Clinic of the University Hospital, from 2010 to today, recruiting patients according to strict criteria. All patients had internal or combined laryngocele/laryngopyocele treated with CO2 laser marsupialization. Results A total of 15 patients were enrolled for a total of 17 laryngoceles; 66.67% of the patients were males and the mean age was 54.4 (±14.12) years old. Internal laryngoceles accounted for 64.71% of the total, and only 7 cases were laryngopyoceles. At the 3-year follow-up, no signs of recurrence were found. Conclusion CO2 laser marsupialization is efficacious in the treatment of laryngocele or laryngopyocele, both internal and combined, in terms of efficiency, safety, and fast postoperative recovery, without need for tracheotomy or open surgery.
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BACKGROUND: Sulcus vocalis (SV) is a longitudinal groove in the free edge of the true vocal cord. It may impair phonation with incomplete glottic closure, phonasthenia and hoarseness. This study aims to detect a correlation between benign vocal cord lesions and the incidence of the SV. METHODS: A retrospective study was carried out on patients who underwent transoral surgery due to benign vocal fold lesions and were selected according to strict criteria. Patients were divided into a group with sulcus vocalis (Group wSV) and a group without sulcus vocalis (Group w/oSV). The possible correlations between variables were assessed by the Pearson chi-square test (p < 0.05). RESULTS: The study included 232 vocal cord lesions in 229 patients: 62.88% were females whose mean age was 46.61 ± 14.04. The most frequent diseases were polyps (37.94%), nodules (18.53%) and Reinke's edema (21.12%). Statistically significant relationships were found between age and SV (p-value 0.0005) and between mild dysplasia and SV (p-value 0.03). CONCLUSIONS: This study did not detect a cause-effect relationship between SV and benign vocal fold lesions. SV within vocal fold lesions is more common in younger patients, suggesting a congenital nature of SV. In conclusion, in the case of a benign vocal fold lesion, a possible SV should be considered and researched to provide the patient the best healthcare.
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Enfermedades de la Laringe , Pólipos , Femenino , Humanos , Adulto , Persona de Mediana Edad , Masculino , Pliegues Vocales/patología , Pliegues Vocales/cirugía , Enfermedades de la Laringe/epidemiología , Enfermedades de la Laringe/patología , Enfermedades de la Laringe/cirugía , Estudios Retrospectivos , Fonación , Pólipos/epidemiología , Pólipos/patología , Pólipos/cirugíaRESUMEN
Introduction: Ranula is a limited mucus retention on the floor of mouth. Due to the young age of patients, over the years, attempts were made to find minimally invasive and effective surgical techniques. To date, however, there is still no gold standard. The modified micro-marsupialization is an effective and minimally invasive technique, with minimal risk of relapse, although there are very few reports about it. Case Report: A 12-year-old male presented to our ENT Clinic with a rounded swelling with regular and defined margins, measuring 4x3 cm, soft and painless, non-compressible and bluish. Clinical diagnosis of ranula was made and a modified micro-marsupialization was performed: eight interrupted sutures using silk 3-0 were placed perpendicularly to the major axis of the lesion, from one side of the lesion to the other, without reaching the underlying tissue. No sutures were lost during follow-up, no complications occurred. Complete healing was reached after removing sutures on the 30th postoperative day. At 6 months control no relapse was observed. Conclusion: Modified micro-marsupialization is strongly indicated and recommended, especially in pediatric patient, due to its low invasiveness and its very low relapse rate. The poor case history found in the literature is probably an indication of the lack of knowledge of modified micro-marsupialization which, in our opinion, could be considered the gold standard.
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Abstract Introduction Transoral laser microsurgery represents the treatment of choice for early glottic cancer. Its use and effectiveness are mainly related to laryngeal exposure and deep extension of tumor. Histopathologic assessment of surgical margin presents a main issue about transoral laser microsurgery and complete oncological excision. Objective The aim was to analyze the impact of revision surgery on organ preservation and local disease control in patients with early glottic cancer treated by transoral laser microsurgery. Methods We carried out a retrospective study on a cohort of 153 patients with early glottic cancer (Tis, T1, T2) treated by transoral laser microsurgery. Resection margins were classified as follows: "free" if macroscopic margin-tumor distance was at least 2 mm, as "close" if it was less than 2 mm and "positive" if the margin was involved by carcinoma. Patients were divided into two groups: patients with free resection margins (Group A) and patients with positive, close or not-evaluable resection margins (Group B). Group A (36) underwent periodic followup. Group B (117) underwent a second look laser CO2 2 months after surgery. Fifteen patients of Group A with suspected persistence of carcinoma during followup underwent a second laser resection after a time interval of 4-8 months after first surgery. Overall survival, disease-free survival, disease-specific survival, ultimate local control with laser alone and organ preservation rates were estimated. Results Five-year overall survival rate and 5-year disease-specific survival were 100% in both groups. The five-year laryngeal preservation rate was 100% in Group A and 95.2% in Group B. Five-year disease-free survival was 92.15% and 5-year ultimate local control with laser alone in 92.15% of patients. Conclusion This study has demonstrated that revision Transoral Laser Microsurgery is able to confirm the oncological radicality in most cases, even in the case of positive, close or non-evaluable margins. Considering our results, according to our experience, the second look with CO2 laser is a therapeutic strategy to consider, even in the case of close or non-evaluable as well as positive margins.
Resumo Introdução A microcirurgia transoral a laser representa o tratamento de escolha para o câncer glótico inicial. Seu uso e sua eficácia estão relacionados principalmente à exposição laríngea e à profundidade da extensão do tumor. A avaliação histopatológica da margem cirúrgica representa uma das principais questões sobre a microcirurgia a laser transoral e excisão oncológica completa. Objetivo Analisar o impacto da cirurgia de revisão na preservação de órgãos e controle local da doença em pacientes com câncer glótico inicial tratados por microcirurgia a laser transoral. Método Fizemos um estudo retrospectivo em uma coorte de 153 pacientes com câncer glótico inicial (Tis, T1, T2) tratados por microcirurgia transoral a laser. As margens de ressecção foram classificadas da seguinte forma: livre, se a distância margem macroscópica-tumor fosse de pelo menos 2 mm; próxima, se fosse menor do que 2 mm; e positiva se a margem fosse afetada pelo carcinoma. Assim, os pacientes foram divididos em dois grupos: com margens de ressecção livres (grupo A) e com margens de ressecção positivas, próximas ou não avaliáveis (grupo B). O grupo A (36) foi submetido a seguimento periódico. O grupo B (117) foi submetido a uma cirurgia de revisão com laser de CO2 2 meses após a cirurgia. Quinze pacientes do grupo A com suspeita de persistência do carcinoma durante o seguimento foram submetidos a uma segunda ressecção a laser após um intervalo de 4 a 8 meses após a primeira cirurgia. A sobrevida global, a sobrevida livre de doença, a sobrevida doença-específica, o controle local final com laser isolado e as taxas de preservação de órgãos foram estimados. Resultados A taxa de sobrevida global em cinco anos e a sobrevida doença-específica em 5 anos foi de 100% em ambos os grupos. A taxa de preservação laríngea em cinco anos foi de 100% no grupo A e 95,2% no grupo B. A sobrevida livre de doença em cinco anos foi de 92,15% e o controle local final em 5 anos com laser isolado em 92,15% dos pacientes. Conclusões A revisão da microcirurgia transoral a laser é capaz de confirmar a radicalidade oncológica na maioria dos casos, mesmo em caso de margens positivas, próximas ou não avaliáveis. Considerando nossos resultados, de acordo com a nossa experiência, a cirurgia de revisão (second look) com laser de CO2 é uma estratégia terapêutica a ser pensada mesmo no caso de margens próximas ou não avaliáveis, bem como em margens positivas.
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Human papillomavirus is a sexually transmitted virus that is responsible not only for uterine cervical cancer, but also for the oral and oropharyngeal cancers. In this latter case, the virus indiscriminately affects both sexes at any age. Vaccination plays a key role in preventing infection and its possible consequences. Therefore, this study aimed to assess the degree of awareness of papillomavirus infection and its possible prevention in the Sicilian population. A prospective observational study was carried out on the Sicilian population through a self-administered questionnaire, consisting of 10 multiple-choice questions. The survey lasted from June 2021 to December 2021. A total of 844 respondents were included: 60.90% were female and 53.55% were aged between 21 and 30 years. Most of the surveyed population knew about the virus and the existence of the vaccine, however, many of them did not know about virus's effects on the oral and oropharyngeal sites (49.17%), or about the indication for vaccination for males (39.69%). Oral and oropharyngeal papillomavirus-related cancers are an increasingly frequent finding, especially in young adults. Therefore, it is necessary and quite mandatory to educate the population about the risks that certain voluptuous habits may cause, with the help of general practitioners, schools, social media, and social networks.
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Alphapapillomavirus , Neoplasias Orofaríngeas , Infecciones por Papillomavirus , Vacunas contra Papillomavirus , Neoplasias del Cuello Uterino , Adulto , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Neoplasias Orofaríngeas/epidemiología , Papillomaviridae , Infecciones por Papillomavirus/epidemiología , Infecciones por Papillomavirus/prevención & control , Vacunas contra Papillomavirus/uso terapéutico , Neoplasias del Cuello Uterino/prevención & control , Vacunación , Adulto JovenRESUMEN
Benign tumours of salivary glands represent 2%-3% of all tumours and parotid gland is most often affected. Keratocystoma is a rare benign tumour with multilocular cystic lesions filled with keratin materials. Histologically, it is characterised by solid epithelium islands containing keratinised lamellae with multicystic spaces. We report a case of a woman in her mid-70s with painless mass in her left parotid gland which increased in size over 1 year. Ultrasound scan revealed a 38×20 mm diameter hypoanechoic mass. Neck CT with contrast medium and fine needle aspiration were performed with diagnostic hypothesis of Warthin tumour. So, extracapsular parotid dissection with no facial nerve damage was performed. Histological examination revealed a keratocystoma. The patient had a 16-month follow-up without signs of relapse or malignancy. Despite its rarity, keratocystoma must be considered among the possible differential diagnostic hypotheses when we find parotid masses, to ensure the best treatment to the patient.
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Adenolinfoma , Neoplasias de la Parótida , Adenolinfoma/diagnóstico , Femenino , Humanos , Recurrencia Local de Neoplasia/patología , Glándula Parótida/diagnóstico por imagen , Glándula Parótida/patología , Neoplasias de la Parótida/diagnóstico por imagen , Neoplasias de la Parótida/cirugía , Región Parotídea/patologíaRESUMEN
Narrow-band imaging (NBI) represents a valid aid in laryngeal squamous cell carcinoma (LSCC) diagnosis for detecting vascular changes. However, LSCC and laryngeal papillomatosis (LP) show similar vascular patterns that may lead to misdiagnosis and improper treatment. This review aims to deepen this NBI limit in order to stress a careful preoperative evaluation of laryngeal lesions. The research was carried out on PubMed, Web of Science and Scopus databases using specific keywords. The topic of research was assessed by these parameters: accuracy, sensitivity, specificity, and positive and negative predictive values. This review included only five articles: they demonstrated that NBI is better than white-light endoscopy in detecting LSCC and LP. They also reported that LP is frequently mistaken for LSCC, resulting in high rates of false positives using NBI. This is the first review that emphasized this NBI limitation in distinguishing between LP and LSCC in cases of a type V pattern of intraepithelial papillary capillary loop. Although NBI application increased the rate of early cancer detection, LP reduces NBI accuracy. This drawback may lead to misdiagnosis and improper treatment. Our advice is to be careful in cases of type V pattern on NBI and to research LP epithelial and clinical features because it could be a pitfall.
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Neoplasias Laríngeas , Papiloma , Humanos , Neoplasias Laríngeas/diagnóstico por imagen , Laringoscopía/métodos , Imagen de Banda Estrecha/métodos , Papiloma/diagnóstico por imagen , Papiloma/patología , Sensibilidad y EspecificidadRESUMEN
Background: Effective swallowing represents the main challenge in supraglottic laryngectomy. This study aimed to assess swallowing outcome comparing endoscopic supraglottic laryngectomy (ESL) and open partial horizontal laryngectomy type I (OPHL I). Methods: A retrospective study was carried out on 20 patients that underwent supraglottic laryngectomy from 2015 to 2021: 10 underwent ESL (group A) and 10 underwent OPHL I (Group B). Patients underwent fiberoptic endoscopic evaluation of swallowing (FEES) 3 months and 12 months after surgery and videofluoroscopy swallowing studies (VFSS) 12 months after surgery. A Swallowing Outcome After Laryngectomy (SOAL) questionnaire was administered to patients to assess their life quality. Results: A naso-gastric tube was placed in two patients of Group A and in all patients of Group B. Tracheostomy was performed in two patients of Group A and in all patients in Group B and it has been closed in 100% of them. According to Donzelli's scale, FEES and VFSS showed better results in Group A at 3 months, while at 12 months they did not show statistically significant differences between ESL and OPHL I in terms of laryngeal penetration and aspiration. The SOAL questionnaire showed satisfactory life quality. Conclusion: Swallowing evaluation by FEES and VFSS did not demonstrate statistically significant differences at 12 months post-op between two surgeries, although ESL showed less cases of laryngeal penetration and aspiration at 3 months post-op. Anyway, good results of any surgery depend on careful patient selection and the surgeon's experience.
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Neoplasias Laríngeas , Trastornos Respiratorios , Deglución , Endoscopía , Humanos , Neoplasias Laríngeas/cirugía , Laringectomía/métodos , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Introduction: Zenker's diverticulum is an acquired sac-like outpouching of the mucosa and submucosa layers originating at the pharyngoesophageal junction. The predominant symptom of Zenker's diverticulum is dysphagia. Videofluoroscopy confirms the diagnosis. Forestier disease is a clinical entity characterized by ossification of anterolateral vertebral ligament and anterior osteophyte formation along the anterolateral spinal column. Its etiopathogenesis remains unknown and common symptoms are dysphagia, dysphonia and airway obstruction. The objective of this study is to identify a pathophysiological correlation between Forestier disease and the onset of Zenker's diverticulum. Materials and Methods: A retrospective observational study was conducted. The electronic database of our Radiology Unit was analyzed in order to identify patients with hypopharyngeal diverticulum and osteophytes at the cervical vertebrae level, from January 2010 to January 2021. The search was performed using precise keywords. Results: The computerized database search outlined 10 imaging exams: 5 videofluorographies and 5 computed tomography scans. In 100% of the cases, dysphagia was the main symptom that led to the diagnostic assessment; 30% of patients, on the other hand, reported dyspnoea. From the data analysis, the male / female ratio is 1: 1 and the average age of the patients is 64.8 (+/- 11.31) years. Conclusions: We assume that the anatomical abnormalities in Forestier disease may cause an increase of pharyngeal pressure and consequently support the development of the Zenker's diverticulum. Hence, it is always recommended to investigate the presence of Zenker's diverticulum in a patient with Forestier disease, especially for the life-threatening complications of Zenker's diverticulum.