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Pirola F, Di Santo D, Turri-Zanoni M, Chabrillac E, Fradeani D, Sionis S, Carta F, Lambertoni A, Malvezzi L, Galli A, Giordano L, Puxeddu R, Castelnuovo P, Mercante G, Spriano G, Ferreli F. Squamous Cell Carcinoma of the Nasal Vestibule: A Multi-Centric Observational Cohort Study. Laryngoscope 2023. [PMID: 38158584 DOI: 10.1002/lary.31251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 11/21/2023] [Accepted: 12/15/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES Squamous cell carcinoma of the nasal vestibule (NV-SCC) is a rare but challenging entity, due to the complex anatomy of the region. Consensus on the best treatment strategy is still lacking, as well as a dedicated staging system. Our aim was to analyze oncological outcomes of surgically treated patients and to investigate possible prognostic factors. METHODS We performed a retrospective multi-centric observational study including six Academic Hospitals over a 10-year period, including only patients who underwent upfront surgery for primary NV-SCC. Patients were staged according to all currently available staging systems. The Kaplan-Meier method was used to compute overall, disease-free, and disease-specific survival. Logistic regression models were used to correlate between survival outcomes and clinical and pathological variables. RESULTS Seventy-one patients with a median follow-up of 38 months were included in the study. Partial and total rhinectomy were the most commonly performed procedures, respectively, in 49.3% and 25.4% of cases. Neck dissection was performed on 31% of patients, and 45.1% of them underwent adjuvant radiotherapy. Three years overall, disease-specific and disease-free survival were, respectively, 86.5%, 90.3%, and 74.2%. None of the currently available staging systems were able to effectively stratify survival outcomes. Factors predicting lower overall survival on multivariate analysis were age (p = 0.021) and perineural invasion (p = 0.059), whereas disease-free survival was negatively affected by age (p = 0.033) and lymphovascular invasion (p = 0.019). CONCLUSION Currently available staging systems cannot stratify prognosis for patients who underwent surgery for NV-SCC. LEVEL OF EVIDENCE 4 Laryngoscope, 2023.
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Affiliation(s)
- Francesca Pirola
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Davide Di Santo
- Head and Neck Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - Mario Turri-Zanoni
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
- Head and Neck Surgery & Forensic Dissection Research center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Emilien Chabrillac
- Department of Surgery, University Cancer Institute Toulouse-Oncopole, Toulouse, France
| | - Dario Fradeani
- Department of Ear, Nose and Throat Surgery, Sheffield Teaching Hospitals Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - Sara Sionis
- Department of Ear, Nose and Throat Surgery, Sheffield Teaching Hospitals Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - Filippo Carta
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Cagliari, Italy
| | - Alessia Lambertoni
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
- Head and Neck Surgery & Forensic Dissection Research center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Luca Malvezzi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Andrea Galli
- IRCCS Ospedale San Raffaele; Department of Otolaryngology-Head and Neck Surgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
- Università Vita-Salute San Raffaele, Milan, Italy
| | - Leone Giordano
- IRCCS Ospedale San Raffaele; Department of Otolaryngology-Head and Neck Surgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
- Università Vita-Salute San Raffaele, Milan, Italy
| | - Roberto Puxeddu
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Cagliari, Italy
| | - Paolo Castelnuovo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
- Head and Neck Surgery & Forensic Dissection Research center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Giuseppe Mercante
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Giuseppe Spriano
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Fabio Ferreli
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
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Rampi A, Tettamanti A, Bertotto I, Comini LV, Howardson BO, Luparello P, Di Santo D, Bondi S. Atypical Tongue Abscesses Mimicking Submucosal Malignancies: A Review of the Literature Focusing on Diagnostic Challenges. Cancers (Basel) 2023; 15:5871. [PMID: 38136415 PMCID: PMC10741429 DOI: 10.3390/cancers15245871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/06/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023] Open
Abstract
Tongue abscesses are rare conditions that usually follow mucosal disruption due to mechanical trauma or foreign body impaction. They typically manifest abruptly as a rapidly growing, hard mass or swelling in the context of tongue muscles; the patient frequently complains of pain, difficulties in swallowing or speaking, and fever. Nonetheless, the features of its presentation, together with accurate clinical evaluation, blood tests, and appropriate imaging tests, are usually sufficient to easily discern a tongue abscess from a malignancy. However, in rare cases, they may occur with slowly progressing and subtle symptoms, nuanced objective and laboratory findings, and inconclusive radiological evidence, leading to difficult differential diagnosis with submucosal malignancy. Herein, we review the literature, available on Pubmed, Embase, and Scopus, on publications reporting tongue abscesses, with atypical presentation suggesting an oral tumor. Our review confirms that tongue abscesses may manifest as a slowly growing and moderately painful swelling without purulent discharge and minimal mucosal inflammation; in this case, they may constitute an actual diagnostic challenge with potentially severe impact on correct management. Atypical tongue abscesses must therefore be considered in the differential diagnosis of tongue malignancy with submucosal extension, even when other diagnostic elements suggest a neoplasia; in this case, a deep biopsy under general anesthesia is essential for differential diagnosis, and simultaneous drainage of the necrotic and abscessual material may resolve the condition.
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Affiliation(s)
- Andrea Rampi
- Otorhinolaryngology Unit, Division of Head and Neck Department, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (A.R.); (A.T.); (B.O.H.)
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Alberto Tettamanti
- Otorhinolaryngology Unit, Division of Head and Neck Department, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (A.R.); (A.T.); (B.O.H.)
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Ilaria Bertotto
- Radiology Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, 10060 Turin, Italy;
| | - Lara Valentina Comini
- Otorhinolaryngology Unit, Head and Neck Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, 10060 Turin, Italy; (L.V.C.); (P.L.); (D.D.S.)
| | - Bright Oworae Howardson
- Otorhinolaryngology Unit, Division of Head and Neck Department, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (A.R.); (A.T.); (B.O.H.)
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Paolo Luparello
- Otorhinolaryngology Unit, Head and Neck Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, 10060 Turin, Italy; (L.V.C.); (P.L.); (D.D.S.)
| | - Davide Di Santo
- Otorhinolaryngology Unit, Head and Neck Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, 10060 Turin, Italy; (L.V.C.); (P.L.); (D.D.S.)
| | - Stefano Bondi
- Otorhinolaryngology Unit, Head and Neck Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, 10060 Turin, Italy; (L.V.C.); (P.L.); (D.D.S.)
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Di Santo D, Bramati C, Festa BM, Pace GM, Comini LV, Luparello P, Cascardi E, Galizia D, Galli A, De Virgilio A, Giordano L, Bondi S. Current evidence on diagnosis and treatment of parotid gland lymphomas: a systematic review. Eur Arch Otorhinolaryngol 2023; 280:5219-5227. [PMID: 37638999 DOI: 10.1007/s00405-023-08206-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 08/19/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND AND PURPOSE Parotid gland lymphoma (PGL) is a rare and challenging diagnosis. Different lymphomas can develop in the parotid gland, with the most common being the mucosa-associated lymphoid tissue (MALT) lymphoma, which originates directly from the glandular parenchyma. Other histologic subtypes arise from both intraglandular and extraglandular parotid lymph nodes. A consensus on diagnosis and treatment of PGL is still lacking, and published data is scarce and heterogeneous. METHODS We performed a systematic review of the literature, including studies published after 2001, when the WHO classification of lymphoid tumours was introduced. RESULTS Twenty retrospective studies were included in the analyses, eight of which focused exclusively on MALT lymphomas. Final analysis included 612 cases of PGL, with a 1.68:1 F/M ratio. MALT lymphoma was the most common histology, followed by follicular and diffuse large B-cell lymphoma. Most cases were low stages (IE/IIE acc. Ann Arbour, 76.5%) and only 10% of patients presented with symptoms, most commonly pain (4.8%) and B symptoms (2.2%). A high prevalence of associated autoimmune diseases was found, particularly Sjögren's syndrome, that affected up to 70% of patients with MALT lymphoma. In most cases diagnosis was achieved through parotidectomy (57.5%), or open biopsy (31.2%). Treatment strategies were either surgical, non-surgical or a combination of modalities. Surgery as a single-modality treatment was reported in about 20% of patients, supposing it might be a valuable option for selected patients. CONCLUSIONS Our review showed that the diagnosis and treatment of PGLs is far from being standardized and needs further, more homogeneous reports to reach consensus.
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Affiliation(s)
- Davide Di Santo
- Head and Neck Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, TO, Italy
| | - Chiara Bramati
- Otorhinolaryngology Unit, Division of Head and Neck Department, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy.
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
| | - Bianca Maria Festa
- Otolaryngology-Head and Neck Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Gian Marco Pace
- Otolaryngology-Head and Neck Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | - Paolo Luparello
- Head and Neck Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, TO, Italy
| | - Eliano Cascardi
- Pathology Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, TO, Italy
| | - Danilo Galizia
- Multidisciplinary Oncology Outpatient Clinic, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, TO, Italy
| | - Andrea Galli
- Otorhinolaryngology Unit, Division of Head and Neck Department, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Armando De Virgilio
- Otolaryngology-Head and Neck Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Leone Giordano
- Otorhinolaryngology Unit, Division of Head and Neck Department, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Stefano Bondi
- Head and Neck Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, TO, Italy
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Ferreli F, Pirola F, Di Santo D, De Virgilio A, Spriano G, Mercante G. A critical analysis of the classifications of squamous cell carcinoma of the nasal vestibule. Oral Oncol 2022; 129:105880. [DOI: 10.1016/j.oraloncology.2022.105880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 04/19/2022] [Indexed: 11/29/2022]
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Giombi F, Di Santo D, Spriano G, Mercante G, Ferreli F, Colombo G. Applications of Co 2 laser in endoscopic surgery for sinonasal neoplasms. Am J Otolaryngol 2022; 43:103281. [PMID: 34895761 DOI: 10.1016/j.amjoto.2021.103281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/22/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of the study is to assess safety, effectiveness, and potential advantages of CO₂ fiber laser during endoscopic endonasal surgery for the resection of sinonasal neoplasms. We present text, images, and videos to show our experience with this new device recently introduced in endoscopic endonasal surgery and as a potential tool for educational purpose. METHODS Six patients affected by benign or malignant sinonasal tumors who underwent endoscopic resection between January and May 2021 were enrolled in the study. Surgical approach was conducted via standardized centripetal endonasal technique. During the surgery we evaluated instrument ergonomics, quality in section on both healthy tissue and tumor, coagulation, and bleeding control from major vessels. RESULTS In our experience, CO₂ fiber laser has proved to have good ergonomics, as well as to be a safe and effective tool for the resection of both neoplastic and healthy tissues. Cauterization was efficient only in vessels with average diameter lower than 1 cm. Prolonged procedural time, costs, and necessity of learning-curve and expertise are possible drawbacks. CONCLUSION Co2-fiber laser is an effective tool which can aid the surgeon during endoscopic endonasal approach to sinonasal neoplasms.
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Affiliation(s)
- Francesco Giombi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy; Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy.
| | - Davide Di Santo
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy; Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy.
| | - Giuseppe Spriano
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy; Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy.
| | - Giuseppe Mercante
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy; Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy.
| | - Fabio Ferreli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy; Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy.
| | - Giovanni Colombo
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy; Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy.
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Familiari M, Di Santo D, Galli A, Danè G, Giordano L, Mellone R, Bussi M. Spontaneous extracapsular parathyroid adenoma hemorrhage: when surgery is required? Endocrine 2022; 75:575-582. [PMID: 34554413 DOI: 10.1007/s12020-021-02876-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 09/12/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Spontaneous bleeding is a rare but serious complication of parathyroid adenomas and few cases were reported in the literature. Clinical manifestations and treatment may vary but sometimes an immediate surgery is required. In other cases a conservative approach can be preferred based on clinical stability and patients' conditions. The purpose of this work is to describe our case and to carry out a review of the current literature on this topic. METHODS We reported a case of a parathyroid adenoma hemorrhage in an elderly patient describing its management. Moreover, a literature review of 57 cases was carried out, with the aim of collecting data about the most involved parathyroid gland and identifying the most correct management based on clinical manifestations and chosen treatments. RESULTS The patients had an age between 29 and 81 years (mean 56.9 ± 16.4 years). Forty-four patients were females (77.2%), whereas 12 were males (21.8%). Based on clinical severity, age, comorbidities and calcemic status, three possible scenarios were identified, each with a recommended management. CONCLUSIONS In parathyroid adenoma hemorrhages a careful clinical assessment is crucial to identify emergency conditions requiring immediate intubation, tracheostomy or neck exploration. Elderlies and comorbid patients have a higher risk of perioperative complications and indication for surgery should be evaluated case by case: whenever feasible, a conservative approach should be preferred in these subjects, especially in those with a stable course and without hypercalcemia-related symptoms.
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Affiliation(s)
- Marco Familiari
- Department of Otolaryngology-Head and Neck Surgery, Scientific Institute of Hospitalization and Care San Raffaele Hospital, Vita-Salute University, Milan, Italy.
| | - Davide Di Santo
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, via Manzoni 56 Rozzano, 20089, Milan, Italy
| | - Andrea Galli
- Department of Otolaryngology-Head and Neck Surgery, Scientific Institute of Hospitalization and Care San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Giulia Danè
- Department of Otolaryngology-Head and Neck Surgery, Scientific Institute of Hospitalization and Care San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Leone Giordano
- Department of Otolaryngology-Head and Neck Surgery, Scientific Institute of Hospitalization and Care San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Renata Mellone
- Department of Radiology, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Mario Bussi
- Department of Otolaryngology-Head and Neck Surgery, Scientific Institute of Hospitalization and Care San Raffaele Hospital, Vita-Salute University, Milan, Italy
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Galli A, Colombo M, Prizio C, Carrara G, Lira Luce F, Paesano PL, Della Vecchia G, Giordano L, Bondi S, Tulli M, Di Santo D, Mirabile A, De Cobelli F, Bussi M. Skeletal Muscle Depletion and Major Postoperative Complications in Locally-Advanced Head and Neck Cancer: A Comparison between Ultrasound of Rectus Femoris Muscle and Neck Cross-Sectional Imaging. Cancers (Basel) 2022; 14:cancers14020347. [PMID: 35053512 PMCID: PMC8774237 DOI: 10.3390/cancers14020347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/20/2021] [Accepted: 11/26/2021] [Indexed: 12/15/2022] Open
Abstract
Simple Summary Skeletal muscle mass (SMM) depletion is gaining popularity as independent predictor of postoperative complications in many surgical scenarios, even in the field of head and neck oncology. In this study, we demonstrate the value of ultrasound scans of the rectus femoris muscle together with the neck CT/MRI at C3 level in terms of estimation of SMM (through muscle cross sectional area), the identification of sarcopenic patients and as a predictor of major surgical morbidity in a cohort of locally-advanced head and neck cancer patients submitted to surgical treatment. This provides important tools for the on-going re-assessment of patients with regards to any pre-habilitation strategy aimed at reducing postoperative complications. Abstract Skeletal muscle mass (SMM) depletion has been validated in many surgical fields as independent predictor of complications through cross-sectional imaging. We evaluated SMM depletion in a stage III-IV head and neck cancer cohort, comparing the accuracy of CT/MRI at C3 level with ultrasound (US) of rectus femoris muscle (RF) in terms of prediction of major complications. Patients submitted to surgery were recruited from 2016 to 2021. SMM was estimated on CT/MRI by calculating the sum of the cross-sectional area (CSA) of the sternocleidomastoid and paravertebral muscles at C3 level and its height-indexed value (cervical skeletal muscle index, CSMI) and on US by computing the CSA of RF. Specific thresholds were defined for both US and CT/MRI according to ROC curve in terms of best prediction of 30-day major complications to detect sarcopenic subjects (40–53%). Sixty-five patients completed the study. At univariate analysis, major complications were associated to lower RF CSA, lower CSA at C3 level and lower CSMI, together with previous radiotherapy, higher ASA score and higher modified frailty index (mFI). At multivariate analysis RF CSA (OR 7.07, p = 0.004), CSA at C3 level (OR 6.74, p = 0.005) and CSMI (OR 4.02, p = 0.025) were confirmed as independent predictors in three different models including radiotherapy, ASA score and mFI. This analysis proved the value of SMM depletion as predictor of major complications in a head and neck cancer cohort, either defined on cross-sectional imaging at C3 or on US of RF.
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Affiliation(s)
- Andrea Galli
- Department of Otorhinolaryngology, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; (C.P.); (F.L.L.); (L.G.); (S.B.); (M.T.); (M.B.)
- Correspondence: ; Tel.: +39-02-2643-8442
| | - Michele Colombo
- Department of Radiology and Experimental Imaging Center, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; (M.C.); (P.L.P.); (G.D.V.); (F.D.C.)
| | - Carmine Prizio
- Department of Otorhinolaryngology, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; (C.P.); (F.L.L.); (L.G.); (S.B.); (M.T.); (M.B.)
| | - Giulia Carrara
- Department of General Surgery, Ospedale Fatebenefratelli e Oftalmico, Piazzale Principessa Clotilde 3, 20121 Milan, Italy;
| | - Francesca Lira Luce
- Department of Otorhinolaryngology, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; (C.P.); (F.L.L.); (L.G.); (S.B.); (M.T.); (M.B.)
| | - Pier Luigi Paesano
- Department of Radiology and Experimental Imaging Center, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; (M.C.); (P.L.P.); (G.D.V.); (F.D.C.)
| | - Giovanna Della Vecchia
- Department of Radiology and Experimental Imaging Center, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; (M.C.); (P.L.P.); (G.D.V.); (F.D.C.)
| | - Leone Giordano
- Department of Otorhinolaryngology, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; (C.P.); (F.L.L.); (L.G.); (S.B.); (M.T.); (M.B.)
| | - Stefano Bondi
- Department of Otorhinolaryngology, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; (C.P.); (F.L.L.); (L.G.); (S.B.); (M.T.); (M.B.)
| | - Michele Tulli
- Department of Otorhinolaryngology, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; (C.P.); (F.L.L.); (L.G.); (S.B.); (M.T.); (M.B.)
| | - Davide Di Santo
- Department of Otorhinolaryngology, Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy;
| | - Aurora Mirabile
- Department of Medical Oncology, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy;
| | - Francesco De Cobelli
- Department of Radiology and Experimental Imaging Center, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; (M.C.); (P.L.P.); (G.D.V.); (F.D.C.)
| | - Mario Bussi
- Department of Otorhinolaryngology, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; (C.P.); (F.L.L.); (L.G.); (S.B.); (M.T.); (M.B.)
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Mattioli F, Fermi M, Martone A, Ghirelli M, Giordano L, Di Santo D, Bussi M, Presutti L. Supraclavicular artery fascial flap (SAFF): a valuable tool in salvage total laryngectomy and hemipharyngolaryngectomy. Acta Otorhinolaryngol Ital 2021; 41:523-529. [PMID: 34825667 PMCID: PMC8686805 DOI: 10.14639/0392-100x-n1152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 06/26/2021] [Indexed: 11/23/2022]
Abstract
Objective To describe the surgical technique of the supraclavicular artery fascial flap (SAFF) and outcomes in neopharyngeal covering with overlay technique during salvage total laryngectomy for residual or recurrent carcinoma after chemo/radiation treatment. Methods Chart review of patients treated between October 2018 and February 2019 at two tertiary care hospitals. Variables extracted from patient records were age, gender, history of chemo/radiation therapy, neck dissection, surgical and postoperative complications. Outcomes measured were surgical time, postoperative complications and flap failure, oral intake start and patient discharge. Results Ten male patients were included. Median age was 64 years. All patients underwent salvage total laryngectomy and neopharyngeal covering with SAFF. Mean flap harvest time was 25 minutes. No surgical complications or flap failure were recorded. Oral intake was started on a median of post-operative day 10. No cases of pharyngocutaneous fistula were encountered. Conclusions SAFF is a reliable, easy and quick to harvest flap, which provides a good alternative to other pedicled and free flaps for hypopharyngeal coverage in laryngeal salvage surgery. Donor site morbidity is almost null and postoperative complications are very rare.
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Galli A, Tulli M, Vella A, Familiari M, Giordano L, Bondi S, Di Santo D, Biafora M, Bussi M. The importance of the patient's perspective in function-sparing parotid surgery for benign neoplasms: clinical reappraisal. Acta Otorhinolaryngol Ital 2021; 41:410-418. [PMID: 34734576 PMCID: PMC8569663 DOI: 10.14639/0392-100x-n1463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 03/03/2021] [Indexed: 11/23/2022]
Abstract
Objective Function-sparing surgery is the cornerstone for the treatment of benign parotid neoplasms. We assessed the incidences and determinants of the main postoperative complications, reappraising their influence on the patient’s quality of life (QoL). Methods Patients who underwent parotid surgery for benign neoplasms were reviewed (2016-2019). Parotidectomy Outcome Inventory-8 (POI-8) and condition-specific questionnaires were used to investigate the patient’s perspective. Results We enrolled 211 patients. Preservation of the posterior branch of the great auricular nerve (GAN) seemed to reduce early dysfunction (87% vs 96%, p = 0.053), but not the late one. Deep lobe dissection and resection of more than one parotid segment favoured first bite syndrome (FBS) and Frey’s syndrome (FS), respectively (16% vs 3%, p = 0.003; 37% vs 15%, p = 0.003). Neither GAN impairment, FBS, nor FS influenced patient QoL. Facial weakness affected 19 patients (9%), being more likely after total parotidectomy (23% vs 7%, p = 0.034). According to POI-8, QoL was mainly jeopardised by fear of revision surgery, especially in females (p= 0.005) and those experiencing early complications (p= 0.004). Conclusions Reappraisal of the patient’s perspective after functional parotid surgery is fundamental to tailor preoperative counselling.
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Affiliation(s)
- Andrea Galli
- Department of Otorhinolaryngology, San Raffaele Scientific Institute, Milan, Italy
| | - Michele Tulli
- Department of Otorhinolaryngology, San Raffaele Scientific Institute, Milan, Italy
| | - Adriana Vella
- Department of Otorhinolaryngology, San Raffaele Scientific Institute, Milan, Italy
| | - Marco Familiari
- Department of Otorhinolaryngology, San Raffaele Scientific Institute, Milan, Italy
| | - Leone Giordano
- Department of Otorhinolaryngology, San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Bondi
- Department of Otorhinolaryngology, San Raffaele Scientific Institute, Milan, Italy
| | - Davide Di Santo
- Department of Otorhinolaryngology, San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Biafora
- Department of Otorhinolaryngology, San Raffaele Scientific Institute, Milan, Italy
| | - Mario Bussi
- Department of Otorhinolaryngology, San Raffaele Scientific Institute, Milan, Italy
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Galli A, Bondi S, Canevari C, Tulli M, Giordano L, Di Santo D, Gianolli L, Bussi M. High-risk early-stage oral tongue squamous cell carcinoma, when free margins are not enough: Critical review. Head Neck 2021; 43:2510-2522. [PMID: 33893752 DOI: 10.1002/hed.26718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/15/2021] [Accepted: 04/14/2021] [Indexed: 12/11/2022] Open
Abstract
Oral tongue squamous cell carcinoma (OTSCC) is a quite peculiar disease from an anatomical and biological standpoint. An increasing amount of literature highlights the existence of a small subset of T1-T2N0 OTSCC, properly resected on a margin-dependent basis, which conversely proved higher than expected rates of loco-regional/distant failure and disease-specific mortality. These specific high-risk tumors might not have a margin-dependent disease and could possibly benefit from a more aggressive upfront loco-regional treatment, especially addressing the so-called T-N tract. Widespread adoption of a histopathological risk model would allow early recognition of these high-risk diseases and, consequently, intensification of the traditional treatment strategies in that specific niche. We reviewed the available knowledge trying to shed light on the potential determinants of the dismal prognosis of these high-risk OTSCC, with special reference to the role of overlooked T-N tract involvement and possible alternatives in terms of elective neck management and risk stratification.
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Affiliation(s)
- Andrea Galli
- Department of Otorhinolaryngology, San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Bondi
- Department of Otorhinolaryngology, San Raffaele Scientific Institute, Milan, Italy
| | - Carla Canevari
- Unit of Nuclear Medicine, San Raffaele Scientific Institute, Milan, Italy
| | - Michele Tulli
- Department of Otorhinolaryngology, San Raffaele Scientific Institute, Milan, Italy
| | - Leone Giordano
- Department of Otorhinolaryngology, San Raffaele Scientific Institute, Milan, Italy
| | - Davide Di Santo
- Department of Otorhinolaryngology, San Raffaele Scientific Institute, Milan, Italy
| | - Luigi Gianolli
- Unit of Nuclear Medicine, San Raffaele Scientific Institute, Milan, Italy
| | - Mario Bussi
- Department of Otorhinolaryngology, San Raffaele Scientific Institute, Milan, Italy
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Di Santo D, Trimarchi M, Galli A, Bussi M. Columella reconstruction with an inferiorly-based philtral advancement flap in a cocaine abuser. Indian J Plast Surg 2019; 50:96-99. [PMID: 28615819 PMCID: PMC5469245 DOI: 10.4103/ijps.ijps_163_16] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Nasal columella defects can significantly impair aesthetic appearance. Columella reconstruction can be very challenging for surgeons, especially if due to cocaine abuse. The case of a 32-year-old male patient with subtotal columellar necrosis secondary to cocaine abuse is presented. An inferiorly based philtral advancement flap was performed to cover the defect. Aesthetic outcome was the primary goal of surgery. Reconstruction led to good aesthetic and functional results.
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Affiliation(s)
- Davide Di Santo
- Department of Otorhinolaryngology, San Raffaele Hospital and Vita-Salute University, Via Olgettina, Milan, Italy
| | - Matteo Trimarchi
- Department of Otorhinolaryngology, San Raffaele Hospital and Vita-Salute University, Via Olgettina, Milan, Italy
| | - Andrea Galli
- Department of Otorhinolaryngology, San Raffaele Hospital and Vita-Salute University, Via Olgettina, Milan, Italy
| | - Mario Bussi
- Department of Otorhinolaryngology, San Raffaele Hospital and Vita-Salute University, Via Olgettina, Milan, Italy
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Di Santo D, Bondi S, Giordano L, Galli A, Tulli M, Ramella B, Bussi M. Long-term Swallowing Function, Pulmonary Complications, and Quality of Life after Supracricoid Laryngectomy. Otolaryngol Head Neck Surg 2019; 161:307-314. [DOI: 10.1177/0194599819835189] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objectives Long-term effects of supracricoid laryngectomies are nowadays under discussion. The purpose of this study was to detect the prevalence of chronic aspiration and incidence of pulmonary complications, to investigate possible influencing factors, and to analyze dysphagia-related quality of life in a cohort of patients who recovered swallowing function after undergoing supracricoid laryngectomies. Study Design Retrospective observational study. Setting San Raffaele Hospital, Vita-Salute University, Milan, Italy. Methods A cohort of 39 patients who recovered swallowing function free of disease after a minimum 3-year follow-up period was retrospectively investigated between October and December 2017—clinically with the Pearson’s Scale and M. D. Anderson Dysphagia Inventory and instrumentally with fiberoptic endoscopic evaluation of swallowing. Results Chronic aspiration was demonstrated in a significant portion of patients (clinically in 33.3% and instrumentally in 35.9%). Aspiration was influenced by advanced age at surgery ( P = .020). Type of surgical procedure, resection of 1 arytenoid cartilage, postoperative rehabilitation with a speech-language therapist, radiotherapy, age at consultation, and length of follow-up did not influence the prevalence of aspiration. Pulmonary complications affected 5 patients; incidence of pulmonary complications was related to aspiration and was favored by poor laryngeal sensation/cough reflex. Aspiration significantly affected quality of life. Conclusions Chronic aspiration is frequent and affects patients’ quality of life. However, incidence of pulmonary complications is low; therefore, oral feeding should not be contraindicated for aspirating patients. Preservation of laryngeal sensation and cough reflex is mandatory to prevent pulmonary complications.
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Affiliation(s)
- Davide Di Santo
- Department of Otorhinolaryngology–Head and Neck Surgery, San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Stefano Bondi
- Department of Otorhinolaryngology–Head and Neck Surgery, San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Leone Giordano
- Department of Otorhinolaryngology–Head and Neck Surgery, San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Andrea Galli
- Department of Otorhinolaryngology–Head and Neck Surgery, San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Michele Tulli
- Department of Otorhinolaryngology–Head and Neck Surgery, San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Barbara Ramella
- Department of Otorhinolaryngology–Head and Neck Surgery, San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Mario Bussi
- Department of Otorhinolaryngology–Head and Neck Surgery, San Raffaele Hospital, Vita-Salute University, Milan, Italy
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Di Santo D, Giordano L, Bertazzoni G, Galli A, Tulli M, Bussi M. Rupture of the extracranial carotid artery caused by misdiagnosed infected pseudoaneurysm during deep cervical abscess drainage: A case report. Auris Nasus Larynx 2016; 44:355-358. [PMID: 27346681 DOI: 10.1016/j.anl.2016.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 04/15/2016] [Accepted: 06/06/2016] [Indexed: 12/01/2022]
Abstract
Infected aneurysms or pseudoaneurysms of the extracranial carotid artery are extremely rare, but they can lead to lethal complications. In some cases, infected pseudoaneurysms can be masked by the excessive inflammation of surrounding tissues. Here we describe the case of a 69-year-old woman with several comorbidities, who presented with a rapidly enlarging left neck bulge. CT was suggestive of an abscess involving the left common carotid artery. Colour Doppler ultrasound did not document intralesional flow. Abscess drainage under ultrasonographic assistance was attempted unsuccessfully, with collection of creamy, purple material. Surgical drainage of the abscess was, therefore, decided. As soon as necrotic tissue debridement was started, a massive haemorrhage originating from the common carotid artery invaded the surgical field. The carotid artery was then repaired with a bovine pericardial patch and covered with a pectoralis major muscle flap. The patient recovered without any neurological consequences. Revision of CT imaging revealed a very small misdiagnosed infected pseudoaneurysm. With better preoperative surgical planning and a good suspicion index, such a life-threatening emergency could have been avoided.
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Affiliation(s)
- Davide Di Santo
- Otolaryngology Service, Head and Neck Department, "San Raffaele" Hospital, "Vita-Salute" University, Milan, Italy.
| | - Leone Giordano
- Otolaryngology Service, Head and Neck Department, "San Raffaele" Hospital, "Vita-Salute" University, Milan, Italy
| | - Giacomo Bertazzoni
- Otolaryngology Service, Head and Neck Department, "San Raffaele" Hospital, "Vita-Salute" University, Milan, Italy
| | - Andrea Galli
- Otolaryngology Service, Head and Neck Department, "San Raffaele" Hospital, "Vita-Salute" University, Milan, Italy
| | - Michele Tulli
- Otolaryngology Service, Head and Neck Department, "San Raffaele" Hospital, "Vita-Salute" University, Milan, Italy
| | - Mario Bussi
- Otolaryngology Service, Head and Neck Department, "San Raffaele" Hospital, "Vita-Salute" University, Milan, Italy
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