Human papillomavirus infection and non-oropharyngeal head and neck cancers: an umbrella review of meta-analysis.

OBJECTIVE: The causative and prognostic roles of human papillomavirus (HPV) in non-oropharyngeal squamous cell carcinoma of the head and neck are uncertain. This umbrella review assessed the strength and quality of evidence and graded the evidence derived from published meta-analyses on this subject. DATA SOURCES: MEDLINE, Embase, and the Cochrane Library were searched. Meta-analyses of observational studies and randomized trials were included. REVIEW METHODS: Evidence of association was graded according to the established criteria: strong, highly suggestive, suggestive, weak, or not significant. RESULTS: 15 meta-analyses were evaluated. The association with HPV was highly suggestive of oral (OR = 2.40, [1.87-3.07], P < 0.00001) and nasopharyngeal cancers (OR = 17.82 [11.20-28.35], P < 0.00001). Improved survival emerged only in hypopharyngeal carcinoma and was confirmed in studies in which only p16 + cancers were considered. CONCLUSION: HPV infection may increase the risk of oral cavity and nasopharyngeal cancer. However, the prognosis was not influenced, except in hypopharyngeal carcinoma.

Comparison of different treatments for HPV+ oropharyngeal carcinoma: a network meta-analysis.

INTRODUCTION: Treatment of human papillomavirus (HPV)-related head and neck squamous cell carcinoma (HNSCC) is rapidly evolving. Despite either surgery or radiotherapy (RT), with or without chemotherapy (CT), being acceptable in intermediate and locally advanced diseases, there is uncertainty regarding the best treatment option for these patients. Therefore, we performed a network meta-analysis (NMA) to compare the relative efficacy of different treatments for HPV+ oropharyngeal carcinoma. MATERIAL AND METHODS: Randomized clinical trials that enrolled adults with non-metastatic HPV+ oropharynx cancer and provided data about overall survival (OS) and/or progression-free survival (PFS) and/or locoregional control and distant metastases (LRC and DM) were included. Fixed- or random-effects models were fit using a Bayesian approach to NMA. Between-group comparisons were estimated using hazard ratios (HRs) with 95% credible intervals (CrIs). The primary outcome was OS. RESULTS: A total of 844 citations were screened; 11 randomized clinical trials were included (HPV+ stage III-IV cancer, mainly oropharynx carcinomas). Nine treatment arms were compared. Radiotherapy (altered or standard fractionation) + triweekly cisplatin (HR 3.8; 95% CrIs 0.29-65 and 0.3; 95% CrIs 0.03-2.51) was superior to RT in term of OS (P score = 0.42 and 0.16). Radiotherapy with low and high cisplatin doses appeared similar (HR 1.57; 95% CrIs 0.19-12.72). Altered fractionation or standard RT + 3-weekly cisplatin are the 2 highest-ranked options in terms of PFS (P score = 0.35 and 0.34). CONCLUSIONS: This meta-analysis confirms the role of cisplatin added to RT as the best option for HPV+ oropharyngeal carcinoma. RT+ 3-weekly cisplatin is likely to be the best radical treatment in terms of OS and PFS.

A novel integrated platform for the identification of surgical margins in oral squamous cell carcinoma: results from a prospective single-institution series.

BACKGROUND: The optimal surgical margins assessment is capital in oral squamous cell carcinoma (OSCC) management. We evaluated the clinical benefits of integrating intraoperative macroscopic margin (MM) assessment and narrow band imaging (NBI). METHODS: Sixteen OSCC patients eligible for surgery were prospectively enrolled. For each patient, 2 to 6 bioptic samples of MM and NBI margins were obtained and histologically analyzed for the presence of dysplasia and lymphocytes. Microvessel density was investigated by CD34 immunohistochemistry. RESULTS: Taken together, 104 specimens were analyzed, including 15% tumors, 33% MM, 33% NBI margins, and 19% MM-NBI overlapping margins. The NBI margins were closer to the lesion in 50% cases, while the same number of MM were more conservative than NBI, irrespective of the tumor site. The rate of histologically positive margins was similar among the two methods, akin to the microvessel density. CONCLUSIONS: MM assessment should be integrated but not replaced with the NBI technology to allow for more conservative surgery.

Barbed Hyoglossomandibulopexia: A Preclinical Study on Human Anatomic Models.

The retrobasilingual space is the one of the most frequent sites of obstruction in patients with severe obstructive sleep apnea hypopnea syndrome, and several multilevel surgical procedures have been developed. The authors tested by means a preclinical study the feasibility of a new experimental surgical procedure called barbed hyoglossomandibulopexia (B.Hy.G.M.P.) which aims at advancing the tongue base with the hyoid bone (hyo-glossopexia) by multiple plicatures at the oral floor muscles.B.Hy.G.M.P. was performed during cadaveric dissection on 12 human models. Retrobasilingual space enlargement was assessed by means of nasopharyngeal fiberendoscopy.A 25% to 50% enlargement in the retrobasilingual space was documented by means of nasopharyngeal fiberendoscopy in all the patients.The authors' preclinical study documents the feasibility of the B.Hy.G.M.P. procedure on human models, and suggests the possible usefulness of this approach in obstructive sleep apnea hypopnea syndrome patients with retrobasilingual collapse. Dedicated clinical studies on living subjects are needed to assess the effectiveness and safety of this technique.

Barbed Roman blinds technique for the treatment of obstructive sleep apnea: how we do it?

Retro-palatal obstruction is often involved in the pathogenesis of obstructive sleep apnea syndrome (OSAS), which is currently treated by means of various surgical procedures. The aim of this paper is to describe our preliminary results using a new, minimally invasive and non-resective procedure called the "barbed Roman blinds technique" (BRBT), which was used to treat severe OSAS due to retro-palatal obstruction. The apnea-hypopnea index (AHI), time with <90 % O2 saturation, and Epworth Sleepiness Scale (ESS) of 32 consecutive adult outpatients (mean age 47.3 ± 8.6 years) were compared before and after surgery. The tolerability of the procedure was assessed using a 0-10 visual analog scale (VAS). All of the treated patients experienced a clinical and subjective improvement as documented by the significant differences (P < 0.001) in their pre- and post-BRBT AHI, time with <90 % O2 saturation, and ESS scores. There were no minor or major adverse events, and the good tolerability of the procedure was documented by the short mean hospital stay (1.2 ± 0.5 days) and the mean VAS value of 4.3 ± 0.7. The mean follow-up period was 12.2 ± 2.0 months. The preliminary results indicate that the BRBT is safe and effective, but long-term follow-up and comparative studies of larger case series are needed to confirm these encouraging findings.

New low-cost magnifying device for temporal bone laboratory.

Temporal bone dissection has important role in educating and training oto and skull base surgeons. Mounting of a temporal bone laboratory is expensive. A dedicated magnifying system, such as a surgical microscope or an endoscopic equipment, represents one of the most significant costs. The aim of this study is to test and demonstrate the utility of a commercial USB as a low-cost solution to equip the laboratory with a good magnifying system and illumination.

Phenotype Profiling and Allergy in Otitis-Prone Children.

Background: Otitis-prone children can present some distinctive clinical patterns and although a number of known risk factors for recurrent acute otitis media (RAOM) are known, no dedicated epidemiological models have been developed to explain clinical heterogeneity. Methods: A preliminary retrospective pilot study was planned to evaluate the possible effect of allergic disease in the development of different disease phenotypes in otitis-prone children aged 3-10 years, particularly the absence (simple RAOM), or presence of episodes of otitis media with effusion between acute infections (RAOM with OME). Results: Analysis was based on the data contained in 153 charts (55.6% males, mean age of 59.4 ± 16.4 months). 75.8% of children had a simple RAOM and 24.2% a RAOM with OME. Atopy or allergy were documented in respectively 47.7 and 41.3% of children considered as a whole. The prevalence of atopy or allergy was significantly higher in the children with a RAOM with OME (atopy: 73.0 vs. 39.5%, p < 0.001; allergy: 60.0 vs. 36.1%, p = 0.049), who also more frequently showed adenoidal hypertrophy (p = 0.016), chronic adenoiditis (p = 0.007), conductive hearing loss (p = 0.004), and impaired tympanometry (p < 0.001). Conclusions: These data suggest that children with a RAOM with OME are clinically different from children with simple RAOM, as they have a more complex clinical presentation that includes not only adenoidal disease and audiological impairment, but also an underlying allergy or atopy. The possibility that the factors mentioned above may be differently involved in the heterogeneous clinical manifestations occurring in otitis-prone children needs to be further investigated in ad hoc epidemiological studies.

Aneurysmal bone cyst in the inferior nasal turbinate in a pediatric patient: A case report.

Torretta S, Di Pasquale D, Carioli D, Guastella C, Ibba T, Marchision P, Pignataro L. Aneurysmal bone cyst in the inferior nasal turbinate in a pediatric patient: A case report. Turk J Pediatr 2018; 60: 747-750. Aneurysmal bone cysts (ABCs) are non-neoplastic, highly vascularised bone lesions that rarely involve the craniofacial complex. We describe the first case of an ABC involving the inferior turbinate in a 17-month-old boy who attended our Pediatric Emergency Department because of recurrent epistaxis, and discuss the diagnostic and therapeutic work-up in children with nasal masses.

Barbed snore surgery for concentric collapse at the velum: The Alianza technique.

Recently, new conservative and non-resective surgical techniques, including palatopharyngeal surgical lifting and suspension (the 'Roman blinds technique') and modular barbed snore surgery (MBSS), have been successfully introduced for the treatment of obstructive sleep apnea syndrome (OSAS). This pilot longitudinal study describes our preliminary experience with the 'Alianza technique' (the simultaneous use of Roman blinds and MBSS) in mild to moderate OSAS patients with concentric pharyngeal collapse at the velum, previously documented by means of drug-induced sleep endoscopy. Effectiveness of the surgical procedure was assessed by means of the Epworth sleepiness scale (ESS), overnight polysomnography, and a 0-10 snoring visual analogue scale (VAS); tolerability was assessed by means of a 0-10 pain VAS. The final analysis relating to 19 patients (18 males; 94.8%), with a mean age of 43.8 ± 8.8 years, showed a statistically significant reduction in mean post-operative apnea-hypopnea indexes (22.3 ± 5.1 vs 7.0 ± 9.4 events/hour; p-value = 0.002) and mean ESS scores (11.3 ± 5.4 vs 3.9 ± 4.0; p-value < 0.001). There was also a significant decrease in mean post-operative snoring VAS scores (9.5 ± 0.7 vs 2.1 ± 1.7; p-value < 0.001). Surgery was well tolerated in most patients (mean pain VAS scores on day seven: 2.4 ± 1.4), and there were no major complications. In experienced hands, the Alianza can be considered an effective and safe technique for the treatment of mild to moderate OSAS.

Should we stop performing uvulopalatopharyngoplasty?

Uvulopalatopharyngoplasty (UPPP) is still one of the most frequently performed procedures for snoring and obstructive sleep apnea syndrome (OSAS) in adults, with unsatisfactory results. In the era of the mini-invasive/conservative surgery, considering the increasing attention to the disregulation of the peripheral neuromuscular control of the upper airway contributing to pharyngeal collapse in OSAS, with the development of sophisticated treatments such as the neural stimulation of the upper-airway, which role should be reserved to a muscular resective procedure such as UPPP? Being aware of the uncertain results and the high postoperative morbidity of UPPP, we believe that we should re-evaluate the role of these procedures involving the resection of palatal/pharyngeal muscles and uvula.