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Urbanelli A, Nitro L, Pipolo C, Maccari A, Albera A, Fadda GL, Felisati G, Albera R, Pecorari G, Fuccillo E, Saibene AM. Therapeutic approaches to sinonasal NUT carcinoma: a systematic review. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08489-0. [PMID: 38329527 DOI: 10.1007/s00405-024-08489-0] [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: 12/19/2023] [Accepted: 01/16/2024] [Indexed: 02/09/2024]
Abstract
PURPOSE Sinonasal nuclear protein in testis carcinoma (SNUTC) is a rare, aggressive malignancy caused by genetic rearrangements in the NUTM1 gene. The prognosis of SNUTC ranks among the most unfavorable within the naso-sinusal district, with an overall survival of 9.7 months. This systematic review aimed to determine the best therapeutic strategy for SNUTC. METHODS We reviewed eligible articles for patient demographics, TNM and stage at presentation, best response after primary treatment, disease-free survival and overall survival (OS) times, other following therapy lines, and final outcomes. RESULTS Among 472 unique citations, 17 studies were considered eligible, with reported treatment data for 25 patients. Most studies (n = 12) were case reports. The most frequently administered treatment regimen was surgery as primary treatment and combined radiochemotherapy as second-line or adjuvant treatment. Four patients were alive at follow-up. CONCLUSION Basing on the existing literature, a standardized line in the treatment of SNUTC is not yet well delineated. A self-personalized strategy of therapy should be drawn on each patient affected by SNUTC.
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Affiliation(s)
- Anastasia Urbanelli
- Department of Surgical Sciences, Otorhinolaryngology Unit, University of Turin, Via G. Verdi, 8, 10124, Turin, Italy.
| | - Letizia Nitro
- Department of Health Sciences, Otorhinolaryngology Unit, Santi Paolo e Carlo Hospital, University of Milan, Milan, Italy
| | - Carlotta Pipolo
- Department of Health Sciences, Otorhinolaryngology Unit, Santi Paolo e Carlo Hospital, University of Milan, Milan, Italy
| | - Alberto Maccari
- Department of Health Sciences, Otorhinolaryngology Unit, Santi Paolo e Carlo Hospital, University of Milan, Milan, Italy
| | - Andrea Albera
- Department of Surgical Sciences, Otorhinolaryngology Unit, University of Turin, Via G. Verdi, 8, 10124, Turin, Italy
| | - Gian Luca Fadda
- Otorhinolaryngology Unit, San Luigi Gonzaga University Hospital, University of Turin, Turin, Italy
| | - Giovanni Felisati
- Department of Health Sciences, Otorhinolaryngology Unit, Santi Paolo e Carlo Hospital, University of Milan, Milan, Italy
| | - Roberto Albera
- Department of Surgical Sciences, Otorhinolaryngology Unit, University of Turin, Via G. Verdi, 8, 10124, Turin, Italy
| | - Giancarlo Pecorari
- Department of Surgical Sciences, Otorhinolaryngology Unit, University of Turin, Via G. Verdi, 8, 10124, Turin, Italy
| | - Emanuela Fuccillo
- Department of Health Sciences, Otorhinolaryngology Unit, Santi Paolo e Carlo Hospital, University of Milan, Milan, Italy
| | - Alberto Maria Saibene
- Department of Health Sciences, Otorhinolaryngology Unit, Santi Paolo e Carlo Hospital, University of Milan, Milan, Italy
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Fadda GL, Urbanelli A, Petrelli A, Trossarello M, Nitro L, Saibene AM, De Corso E, Gned D, Panfili M, Cavallo G. Type IV optic nerve and Onodi cell: is there a risk of injury during sphenoid sinus surgery? Acta Otorhinolaryngol Ital 2024; 44:36-41. [PMID: 38165204 PMCID: PMC10914358 DOI: 10.14639/0392-100x-n2462] [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] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 06/13/2023] [Indexed: 01/03/2024]
Abstract
Objective This study aims to determine the prevalence and types of Onodi cells through computed tomography and investigate the relationship between Onodi cell and the surrounding structures, paying particular attention to the risky proximity to the optic nerve canal. Methods In this study, 430 computed tomography scans of paranasal sinuses were analysed to establish the prevalence and different types of Onodi cells. Furthermore, the relationship between Onodi cell and different patterns of sphenoid sinus pneumatisation and surrounding structures were investigated. Special attention was paid to the relationship between Onodi cell and the optic nerve canal, particularly in cases when the optic nerve canal was bulging by more than 50% into the Onodi cell (Type IV). Results The Onodi cell was detected in 21.6% of cases, with the most common being Type I (48.5% right, 54.3% left). Type IV bulging of the optic nerve canal into the Onodi cell was observed in 47.1% of cases on the right side, 41.2% on the left side and bilateral in 11.7% of cases. Conclusions In our series, we observed a high prevalence of Type IV optic nerve bulging into the Onodi cell. For this reason, we suggest that clinicians should always try to identify it in a pre-operative setting with computed tomography to avoid catastrophic consequences during endoscopic sinus surgery approaching the sphenoid area.
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Affiliation(s)
- Gian Luca Fadda
- Department of Otorhinolaryngology, University of Turin, “San Luigi Gonzaga” Hospital, Orbassano (TO), Italy
| | - Anastasia Urbanelli
- Department of Otorhinolaryngology, University of Turin, “San Luigi Gonzaga” Hospital, Orbassano (TO), Italy
| | - Alessio Petrelli
- National Institute for Health, Migration and Poverty (INMP), Rome, Italy
| | - Marta Trossarello
- Department of Otorhinolaryngology, University of Turin, “San Luigi Gonzaga” Hospital, Orbassano (TO), Italy
| | - Letizia Nitro
- Otolaryngology Unit, “Santi Paolo e Carlo” Hospital, Department of Health Sciences, University of Milan, Milan, Italy
| | - Alberto Maria Saibene
- Otolaryngology Unit, “Santi Paolo e Carlo” Hospital, Department of Health Sciences, University of Milan, Milan, Italy
| | - Eugenio De Corso
- Otorhinolaryngology, “A. Gemelli” Unversitary Hospital IRCCS, Rome, Italy
| | - Dario Gned
- Department of Diagnostic Imaging, University of Turin, “San Luigi Gonzaga” Hospital, Orbassano (TO), Italy
| | - Marco Panfili
- Unit of Radiology, “A. Gemelli” University Hospital Foundation IRCCS, Rome, Italy
| | - Giovanni Cavallo
- Department of Otorhinolaryngology, University of Turin, “San Luigi Gonzaga” Hospital, Orbassano (TO), Italy
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De Corso E, Ottaviano G, Pipolo C, Cantone E, Mattavelli D, Alicandri-Ciufelli M, Lucidi D, Caminati M, Senna G, Cavaliere C, Ghidini A, Gallo S, Macchi A, Torretta S, Seccia V, Garzaro M, Fadda GL, Trimarchi M, Pasquini E, Pagella F, Canevari FR, Preti A, La Mantia I, Galli J. Chronic Rhinosinusitis with Nasal Polyps: A Survey on Routine Management and Evaluation of Disease Control in Practice. J Pers Med 2023; 13:1531. [PMID: 38003847 PMCID: PMC10672031 DOI: 10.3390/jpm13111531] [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: 09/22/2023] [Revised: 10/19/2023] [Accepted: 10/24/2023] [Indexed: 11/26/2023] Open
Abstract
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a disease with a significant impact on quality of life. The overall goal of CRSwNP management, as with other chronic conditions, is to achieve "disease control", and for that reason, a definition of control of disease is pivotal in deciding the best treatment strategy. Although many staging systems have already been developed to evaluate the disease, disease control is not yet to be standardized, and a specific tool that is consistently applied and accepted by all practitioners is still missing in daily clinical practice. To gain an overview of the implementation and limitations of existing guidelines and to shed light on real-life definitions of control and disease severity, we conducted a nationwide survey of otorhinolaryngologists routinely treating CRSwNP to identify unmet clinical needs in Italy. The results showed homogeneous responses regarding the knowledge contained in international guidelines while highlighting the difficulty of their implementation in day-to-day practice. Respondents called attention to the importance of clinical symptoms, giving more weight to the patient's perspective. Among the symptoms to be considered, respondents emphasized nasal obstruction, followed by loss of sense of smell and rhinorrhea. Others also believe that the physician's perspective should be considered, and the inclusion of endoscopy as a measure of control was warranted by many. The need for a specific tool that is able to unequivocally ascertain disease control is increasingly pivotal in this new era of biologics for treating CRSwNP.
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Affiliation(s)
- Eugenio De Corso
- Otolaryngology, Head and Neck Surgery, Rhinology, A. Gemelli University Hospital Foundation, IRCSS, 00168 Rome, Italy;
| | - Giancarlo Ottaviano
- Department of Neurosciences, Otolaryngology Section, University of Padova, 35122 Padova, Italy
| | - Carlotta Pipolo
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy
| | - Elena Cantone
- Department of Neuroscience, Reproductive and Odontostomatological Sciences-ENT Section, University of Naples 29 Federico II, 80131 Naples, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, 25123 Brescia, Italy
| | - Matteo Alicandri-Ciufelli
- Department of Otorhinolaryngology Head and Neck Surgery, Azienda Ospedaliero-Universitaria Policlinico di Modena, 41124 Modena, Italy
| | - Daniela Lucidi
- Department of Otorhinolaryngology Head and Neck Surgery, Azienda Ospedaliero-Universitaria Policlinico di Modena, 41124 Modena, Italy
| | - Marco Caminati
- Department of Medicine, University of Verona and Verona University Hospital, 37134 Verona, Italy
| | - Gianenrico Senna
- Department of Medicine, University of Verona and Verona University Hospital, 37134 Verona, Italy
| | - Carlo Cavaliere
- Department of Sense Organs, Sapienza University of Rome, 00185 Rome, Italy
| | - Angelo Ghidini
- ENT Department, Azienda USL Reggio Emilia-IRCCS, 42123 Reggio Emilia, Italy
| | - Stefania Gallo
- Otorinolaryngology Unit, Head and Neck Department, ASST Sette Laghi and UPLOAD Research Center, University of Insubria, 21100 Varese, Italy; (S.G.); (A.M.)
| | - Alberto Macchi
- Otorinolaryngology Unit, Head and Neck Department, ASST Sette Laghi and UPLOAD Research Center, University of Insubria, 21100 Varese, Italy; (S.G.); (A.M.)
| | - Sara Torretta
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Veronica Seccia
- Otolaryngology, Audiology and Phoniatric Operative Unit, Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, 56124 Pisa, Italy;
| | - Massimiliano Garzaro
- Department of Otorhinolaryngology, Rhinology Unit, Eastern Piedmont University-Maggiore Hospital, 28100 Novara, Italy
| | - Gian Luca Fadda
- Department of Otorhinolaryngology, San Luigi Gonzaga Hospital, University of Turin, 10043 Orbassano, Italy;
| | - Matteo Trimarchi
- Otorhinolaryngology Unit, Head and Neck Department, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Ernesto Pasquini
- Otorhinolaryngology Unit, Dip Chirurgie Specialistiche, Ospedale Bellaria AUSL BO, 47814 Bologna, Italy
| | - Fabio Pagella
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Frank Rikki Canevari
- Otorhinolaryngology Unit, IRCCS Policlinico San Martino Genova, Dipartimento 1 DISC Università di Genova, 16124 Gernova, Italy;
| | - Andrea Preti
- Department of Otorhinolaryngology, Ospedale San Giuseppe IRCCS Multimedica Milan, 20099 Milan, Italy
| | - Ignazio La Mantia
- Department of Medical-Surgical Sciences and Advanced Technologies-“G.F. Ingrassia” Director of E.N.T. Unit P.O. “G. Rodolico” University of Catania, 95123 Catania, Italy;
| | - Jacopo Galli
- Department of Head, Neck and Sensory Organs, Catholic University of The Sacred Heart, 00168 Rome, Italy
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De Corso E, Pasquini E, Trimarchi M, La Mantia I, Pagella F, Ottaviano G, Garzaro M, Pipolo C, Torretta S, Seccia V, Cantone E, Ciofalo A, Lucidi D, Fadda GL, Pafundi PC, Settimi S, Montuori C, Anastasi F, Pagliuca G, Ghidini A, Cavaliere C, Maffei M, Bussu F, Gallo S, Canevari FRM, Paludetti G, Galli J. Dupilumab in the treatment of severe uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP): A multicentric observational Phase IV real-life study (DUPIREAL). Allergy 2023; 78:2669-2683. [PMID: 37203259 DOI: 10.1111/all.15772] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [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: 01/30/2023] [Revised: 04/08/2023] [Accepted: 05/01/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyps (CRSwNP) is associated with significant morbidity and reduced health-related quality of life. Findings from clinical trials have demonstrated the effectiveness of dupilumab in CRSwNP, although real-world evidence is still limited. METHODS This Phase IV real-life, observational, multicenter study assessed the effectiveness and safety of dupilumab in patients with severe uncontrolled CRSwNP (n = 648) over the first year of treatment. We collected data at baseline and after 1, 3, 6, 9, and 12 months of follow-up. We focused on nasal polyps score (NPS), symptoms, and olfactory function. We stratified outcomes by comorbidities, previous surgery, and adherence to intranasal corticosteroids, and examined the success rates based on current guidelines, as well as potential predictors of response at each timepoint. RESULTS We observed a significant decrease in NPS from a median value of 6 (IQR 5-6) at baseline to 1.0 (IQR 0.0-2.0) at 12 months (p < .001), and a significant decrease in Sino-Nasal Outcomes Test-22 (SNOT-22) from a median score of 58 (IQR 49-70) at baseline to 11 (IQR 6-21; p < .001) at 12 months. Sniffin' Sticks scores showed a significant increase over 12 months (p < .001) compared to baseline. The results were unaffected by concomitant diseases, number of previous surgeries, and adherence to topical steroids, except for minor differences in rapidity of action. An excellent-moderate response was observed in 96.9% of patients at 12 months based on EPOS 2020 criteria. CONCLUSIONS Our findings from this large-scale real-life study support the effectiveness of dupilumab as an add-on therapy in patients with severe uncontrolled CRSwNP in reducing polyp size and improving the quality of life, severity of symptoms, nasal congestion, and smell.
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Affiliation(s)
- Eugenio De Corso
- Otorhinolaryngology Unit, A.Gemelli University Hospital Foundation IRCCS, Rome, Italy
| | - Ernesto Pasquini
- Otorhinolaryngology Unit, Ospedale Bellaria Dip Chirurgie Specialistiche AUSL, Bologna, Italy
| | - Matteo Trimarchi
- Otorhinolaryngology Unit, Head and Neck Department, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Ignazio La Mantia
- Department of Medical-Surgical Sciences and Advanced Technologies, E.N.T. Unit, P.O. "G. Rodolico", University of Catania, Catania, Italy
| | - Fabio Pagella
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Giancarlo Ottaviano
- Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy
| | - Massimiliano Garzaro
- Department of Otorhinolaryngology, Rhinology Unit, Eastern Piedmont University, Maggiore Hospital, Novara, Italy
| | - Carlotta Pipolo
- Otorhinolaryngology Unit, Department of Health Sciences, ASST Santi Paolo e Carlo Hospital, Università degli Studi di Milano, Milan, Italy
| | - Sara Torretta
- Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico", University of Milan, Milan, Italy
| | - Veronica Seccia
- Otolaryngology, Audiology and Phoniatric Operative Unit, Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Elena Cantone
- Department of Neuroscience, Reproductive and Odontostomatological Sciences-ENT Section, Head and Neck Department-ENT Section, University of Naples Federico II, AOU Federico II, Naples, Italy
| | - Andrea Ciofalo
- Rhinology Unit, Department of Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Daniela Lucidi
- Department of Otolaryngology-Head and Neck Surgery, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Gian Luca Fadda
- Department of Otorhinolaryngology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Pia Clara Pafundi
- Epidemiology and Biostatistics Core Facility, Gemelli Science and Technology park, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Stefano Settimi
- Department of Head, Neck and Sensory Organs, Catholic University of The Sacred Heart, Rome, Italy
| | - Claudio Montuori
- Department of Head, Neck and Sensory Organs, Catholic University of The Sacred Heart, Rome, Italy
| | - Francesca Anastasi
- Otorhinolaryngology Unit, Ospedale San Giovanni Evangelista, Tivoli, Italy
| | - Giulio Pagliuca
- Otolaryngology University Unit, "S. M. Goretti Hospital", Latina, Italy
| | - Angelo Ghidini
- ENT Department, Azienda USL Reggio Emilia-IRCCS, Reggio Emilia, Italy
| | - Carlo Cavaliere
- Department of Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Marianna Maffei
- Otolaryngology Head and Neck Surgery Unit, AORN Ospedali della Colli, Naples, Italy
| | - Francesco Bussu
- Division of Otorhinolaryngology, Department of Medicine, Surgery and Pharmacy, Azienda Ospedaliera Universitaria di Sassari, University of Sassary, Sassari, Italy
| | - Stefania Gallo
- Otorinolaryngology Unit, Head and Neck Department, ASST Sette Laghi and UPLOAD Research Center, University of Insubria, Varese, Italy
| | | | - Gaetano Paludetti
- Department of Head, Neck and Sensory Organs, Catholic University of The Sacred Heart, Rome, Italy
| | - Jacopo Galli
- Department of Head, Neck and Sensory Organs, Catholic University of The Sacred Heart, Rome, Italy
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Fadda GL, Petrelli A, Urbanelli A, Castelnuovo P, Bignami M, Crosetti E, Succo G, Cavallo G. Risky anatomical variations of sphenoid sinus and surrounding structures in endoscopic sinus surgery. Head Face Med 2022; 18:29. [PMID: 36057720 PMCID: PMC9440488 DOI: 10.1186/s13005-022-00336-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 04/20/2022] [Accepted: 08/23/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose This study aimed to examine the relationship between the sphenoid sinus (SS) and surrounding vital structures such as the internal carotid artery (ICA) and optic nerve canal (ONC) as well as the types of attachment of the sphenoidal septa onto these structures. Methods In total, 230 computed tomography (CT) scans were reviewed to study the type of sphenoid sinus pneumatization (SSP), the protrusion and dehiscence of the ICA and ONC, the relationship between the sphenoidal septa and surrounding vital structures as well as pterygoid recess pneumatization (PRP). Results The most common SSP was sellar type (58.7%). The rates of protrusion and dehiscence of the ICA were 26.3 and 0.4%, and for the ONC, they were 13 and 1.5%, respectively. The ICA and ONC were most protruded and dehiscent in more extensive SSP. In 21.6% of patients, the intersphenoidal septa (IS) were attached to the wall of the ICA and in 8.6% they were attached to the wall of the ONC. The attachment of IS to the ICA correlated statistically significantly (p < 0.0001) with protrusion of the ICA. Accessory septa were detected in 30.4% of cases with various sites of attachment. Conclusion To reduce the risk of injury and complications during endoscopic sinus surgery (ESS), surgeons should consider using CT to identify possible bulging and dehiscence of the ICA/ONC and their relationship to the extent of SSP and also to establish the presence of deviation of the sphenoid septum, and the presence of accessory septa.
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Affiliation(s)
- Gian Luca Fadda
- Department of Otorhinolaryngology, University of Turin, San Luigi Gonzaga Hospital, Regione Gonzole 10, Orbassano, 10043, Turin, Italy.
| | - Alessio Petrelli
- National Institute for Health, Migration and Poverty (INMP), Rome, Italy
| | - Anastasia Urbanelli
- Department of Otorhinolaryngology, University of Turin, San Luigi Gonzaga Hospital, Regione Gonzole 10, Orbassano, 10043, Turin, Italy
| | - Paolo Castelnuovo
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy
| | - Maurizio Bignami
- Department of Otorhinolaryngology, Head & Neck Surgery, University of Insubria, Como, Italy
| | - Erika Crosetti
- Department of Otorhinolaryngology, University of Turin, San Luigi Gonzaga Hospital, Regione Gonzole 10, Orbassano, 10043, Turin, Italy
| | - Giovanni Succo
- Oncology Department, Head & Neck Surgery, University of Turin, Turin, Italy
| | - Giovanni Cavallo
- Department of Otorhinolaryngology, University of Turin, San Luigi Gonzaga Hospital, Regione Gonzole 10, Orbassano, 10043, Turin, Italy
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Allevi F, Fadda GL, Rosso C, Martino F, Pipolo C, Cavallo G, Felisati G, Saibene AM. Treatment of Sinusitis Following Dental Implantation: A Systematic Review and Meta-Analysis. Am J Rhinol Allergy 2022; 36:539-549. [PMID: 35244478 DOI: 10.1177/19458924221084484] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Implantological procedures aimed at rehabilitating upper jaw edentulous patients (dental implant placement and/or maxillary sinus grafting) can sporadically result in sinusitis. In these patients, endoscopic sinus surgery is the most commonly employed treatment, but clinical scenarios and comprehensive management strategies are extremely heterogeneous across studies. OBJECTIVE We sought to systematically define treatment strategies and related success rates for sinusitis following dental implantation, detailing different current treatment choices and concepts. METHODS Adopting a PRISMA-compliant review framework, systematic searches were performed in multiple databases using criteria designed to include all studies published until November 2020 focusing on the treatment of human sinusitis following dental implantation. We selected all original studies, excluding case reports, specifying treatment modalities with objective treatment success definitions. Following duplicate removal, abstract and full-text selection, and quality assessment, we reviewed eligible articles for treatment modalities and success rates, which were pooled in a random-effects meta-analysis. RESULTS Among 581 unique citations, eight studies (181 patients) were selected. Seven studies were retrospective case series. All studies relied on endoscopic sinus surgery, often coupled with intraoral accesses, and assessed therapeutic success endoscopically. The pooled treatment success rate was 94.7% (95% confidence interval, 91.5%-98%). Failures were treated in seven of 15 cases with further antibiotic therapies and in another seven cases with surgical revision. A single patient was lost to follow-up. CONCLUSIONS Endoscopic sinus surgery appears to be the most frequent treatment of choice for sinusitis following dental implantation, with excellent success rates. The protean clinical picture drawn from the selected studies calls for the standardization of diagnostics and definitions in this field to enable direct comparisons between the results of different studies. The role of postoperative antibiotic therapies, which have been employed unevenly across studies, should also be prospectively investigated.
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Affiliation(s)
- Fabiana Allevi
- Maxillofacial Surgery Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
- ISGOS, the Italian Study Group on Odontogenic Sinusitis
| | - Gian Luca Fadda
- ISGOS, the Italian Study Group on Odontogenic Sinusitis
- Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, Università degli Studi di Torino, Turin, Italy
| | - Cecilia Rosso
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Federica Martino
- Unit of Otorhinolaryngology, Department of Clinical Sciences and Translational Medicine, University of Tor Vergata, Rome, Italy
| | - Carlotta Pipolo
- ISGOS, the Italian Study Group on Odontogenic Sinusitis
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Cavallo
- ISGOS, the Italian Study Group on Odontogenic Sinusitis
- Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, Università degli Studi di Torino, Turin, Italy
| | - Giovanni Felisati
- ISGOS, the Italian Study Group on Odontogenic Sinusitis
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Alberto Maria Saibene
- ISGOS, the Italian Study Group on Odontogenic Sinusitis
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
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Fadda GL, Galizia A, Maugeri L, Canevari RF, Crosetti E, Cavallo G. Efficacy of omalizumab in an atopic young adult with asthma and eosinophilic chronic rhinosinusitis with nasal polyps. Eur Rev Med Pharmacol Sci 2022; 26:3320-3324. [PMID: 35587084 DOI: 10.26355/eurrev_202205_28751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Chronic rhinosinusitis (CRS) presents a multifactorial etiology due to interactions between the immune host system and external agents. It can be classified into two phenotypes based on the presence or absence of polypoid neoformation (respectively CRSwNP and CRSsNP). According to EPOS2020, CRS is now classified into two endotypes, eosinophilic (ECRS) and non-eosinophilic (non-ECRS), based on eosinophil tissue count (more than 10 eosinophils per High Power Field, HPF). CASE PRESENTATION We present the case of a 31-year-old man affected by recalcitrant ECRSwNP and asthma. RESULTS He was treated with a combination of omalizumab and endoscopic sinus surgery. This combination led to a reduction in blood eosinophils, modified Lund-Kennedy endoscopic score, Lund-Mackay score, and Sino-Nasal Outcome Test (SNOT-22), almost 6 months after surgery. CONCLUSIONS In this clinical case, omalizumab regulated nasal symptoms for more than a year and with good control of the recalcitrant pattern when combined with ESS.
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Affiliation(s)
- G L Fadda
- Department of Otolaryngology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy.
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Nitro L, Pipolo C, Fadda GL, Allevi F, Borgione M, Cavallo G, Felisati G, Saibene AM. Distribution of cocaine-induced midline destructive lesions: systematic review and classification. Eur Arch Otorhinolaryngol 2022; 279:3257-3267. [PMID: 35138441 PMCID: PMC9130192 DOI: 10.1007/s00405-022-07290-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 12/09/2021] [Accepted: 01/24/2022] [Indexed: 11/04/2022]
Abstract
Purpose Intranasal cocaine is known to potentially lead to midline destructive lesions. The present systematic review was undertaken to systematically define the localization of cocaine-induced midline destructive lesions and their prevalence and to propose a practical classification of these lesions. Methods A PRISMA-compliant systematic review was performed in multiple databases with criteria designed to include all studies published until March 2021 providing a precise definition of cocaine-induced midline lesions in humans. We selected all original studies except case reports. After duplicate removal, abstract and full-text selection, and quality assessment, we reviewed eligible articles for lesion localization, patients’ demographics, exposure to cocaine, and relationship with external nose destruction. Results Among 2593 unique citations, 17 studies were deemed eligible (127 patients). All studies were retrospective case series. The destructive process determined a septal perforation in 99.2% of patients. The distribution prevalence decreased from the inferior third of the sinonasal complex (nasal floor and inferolateral nasal wall, respectively, 59% and 29.9% of patients) to the middle third (middle turbinate and ethmoid, 22.8% of patients), and ultimately to neurocranial structures (7.9% of patients). Nasal deformities were inconsistently reported across reviewed studies. Cocaine use duration, frequency, and status were reported only occasionally. Conclusion Based on the distribution prevalence observed, we propose a four-grade destruction location-based classification. Future prospective studies following the evolution of cocaine-induced lesions are needed to validate our classification, its relationship with lesion evolution, and whether it represents a reliable tool for homogeneous research results reporting.
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Affiliation(s)
- Letizia Nitro
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, Via Antonio di Rudinì, 8, 20142, Milan, Italy
| | - Carlotta Pipolo
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, Via Antonio di Rudinì, 8, 20142, Milan, Italy.,ISGOS, the Italian Study Group on Odontogenic Sinusitis, Milan, Italy
| | - Gian Luca Fadda
- ISGOS, the Italian Study Group on Odontogenic Sinusitis, Milan, Italy.,Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, Università degli Studi di Torino, Turin, Italy
| | - Fabiana Allevi
- ISGOS, the Italian Study Group on Odontogenic Sinusitis, Milan, Italy.,Maxillofacial Surgery Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Mario Borgione
- Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, Università degli Studi di Torino, Turin, Italy
| | - Giovanni Cavallo
- Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, Università degli Studi di Torino, Turin, Italy
| | - Giovanni Felisati
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, Via Antonio di Rudinì, 8, 20142, Milan, Italy.,ISGOS, the Italian Study Group on Odontogenic Sinusitis, Milan, Italy
| | - Alberto Maria Saibene
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, Via Antonio di Rudinì, 8, 20142, Milan, Italy. .,ISGOS, the Italian Study Group on Odontogenic Sinusitis, Milan, Italy.
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9
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Fadda GL, Martino F, Andreani G, Succo G, Catalani M, Di Girolamo S, Cavallo G. Definition and management of invasive fungal rhinosinusitis: a single-centre retrospective study. ACTA ACUST UNITED AC 2021; 41:43-50. [PMID: 33746222 PMCID: PMC7982758 DOI: 10.14639/0392-100x-n0848] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 05/12/2020] [Accepted: 09/14/2020] [Indexed: 12/18/2022]
Abstract
Objectives The purpose of this study was to correlate acute invasive fungal rhinosinusitis (AIFRS) and chronic invasive fungal rhinosinusitis with underlying diseases, aetiological microorganisms, clinical symptoms, radiological findings, and surgical and medical treatment to determine the subset of patients who require more accurate diagnostic investigation and to prevent irreversible complications. Methods This retrospective monocentric study included 17 patients who underwent endoscopic sinus surgery evaluated by paranasal computed tomography and magnetic resonance imaging. Age, sex and symptoms, and location of the invasive fungal infection and the causative fungus were analysed. Results In total, 4 patients were affected by the AIFRS form, and 13 by the chronic form. Diabetes mellitus was reported in 41.17% of cases, and haematological diseases in 23.52%. The maxillary sinuses were involved in 47.05% of cases and sphenoidal sinuses in 52.94%; Aspergillus fumigatus was the fungus in 76.47% of cases, and Zygomycetes in 23.53%. Conclusions An understanding of the different types of fungal sinusitis and knowledge of their features play a crucial role in reaching prompt diagnosis and initiation of appropriate therapy, which is essential to avoid a protracted or fatal outcome.
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Affiliation(s)
- Gian Luca Fadda
- Department of Otolaryngology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Federica Martino
- Department of Otolaryngology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy.,Otorhinolaryngology Unit, Department of Clinical Sciences and Translational Medicine, Tor Vergata University, Rome, Italy
| | - Giacomo Andreani
- Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Giovanni Succo
- FPO IRCCS, Head & Neck Oncology Unit, Candiolo Cancer Institute, Turin, Italy.,Oncology Dept. University of Turin, Italy; 6 Department of Otolaryngology, Humanitas Cellini, Turin, Italy
| | - Maurizio Catalani
- Oncology Dept. University of Turin, Italy; 6 Department of Otolaryngology, Humanitas Cellini, Turin, Italy
| | - Stefano Di Girolamo
- Otorhinolaryngology Unit, Department of Clinical Sciences and Translational Medicine, Tor Vergata University, Rome, Italy
| | - Giovanni Cavallo
- Department of Otolaryngology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
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10
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Fadda GL, Petrelli A, Martino F, Succo G, Castelnuovo P, Bignami M, Cavallo G. Anatomic Variations of Ethmoid Roof and Risk of Skull Base Injury in Endoscopic Sinus Surgery: Statistical Correlations. Am J Rhinol Allergy 2021; 35:871-878. [PMID: 34039073 DOI: 10.1177/19458924211020549] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recent developments in endoscopic sinus surgery (ESS) have increased the need to investigate the complex anatomic variations in the ethmoid roof and skull base, to inform the surgeon about the risk of damaging these crucial areas during ESS. OBJECTIVE To offer a detailed description of sinus anatomy focusing on the key surgical landmarks in ESS and frontal recess surgery to standardize a systematic approach during the preoperative sinuses imaging evaluation.Methodology: A total of 220 computed tomography (CT) scans were reviewed to obtain six sets of measurements: the depth of the cribriform plate (CP); the length of the lateral lamella of the cribriform plate (LLCP); the angle formed by the LLCP and the continuation of the horizontal plane passing through the CP; the position of the anterior ethmoidal artery (AEA) at the skull base; the extent of frontal sinus pneumatization (FSP); the type of superior attachment of the uncinate process (SAUP). RESULTS The length of the LLCP was statistically significantly correlated with the different Keros classification types, the angle formed by the LLCP with the continuation of the horizontal plane passing through the CP, and with the AEA position at the skull base. The depth of the olfactory fossa was correlated with FSP. CONCLUSIONS According to the Keros and Gera classifications, the data obtained from these evaluations allow the assessment of anatomic-radiological risk profiles and can help identify those patients who are high risk for ethmoid roof injury.
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Affiliation(s)
- Gian Luca Fadda
- Department of Otorhinolaryngology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Alessio Petrelli
- National Institute for Health, Migration and Poverty (INMP), Rome, Italy
| | - Federica Martino
- Otorhinolaryngology Unit, Department of Clinical Sciences and Translational Medicine, Tor Vergata University, Rome, Italy
| | - Giovanni Succo
- FPO IRCCS, Head and Neck Oncology Unit, Candiolo Cancer Institute, Turin, Italy.,Oncology Department, University of Turin, Italy
| | - Paolo Castelnuovo
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy
| | - Maurizio Bignami
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy
| | - Giovanni Cavallo
- Department of Otorhinolaryngology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
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11
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Fadda GL, Allevi F, Rosso C, Martino F, Pipolo C, Cavallo G, Felisati G, Saibene AM. Treatment of Paranasal Sinus Fungus Ball: A Systematic Review and Meta-Analysis. Ann Otol Rhinol Laryngol 2021; 130:1302-1310. [PMID: 33733891 DOI: 10.1177/00034894211002431] [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] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Paranasal sinus fungus ball is a common non-invasive mycosis with excellent long-term surgical treatment results. The present systematic review and meta-analysis were undertaken to define current treatment concepts and success rates in paranasal sinus fungus ball treatment. METHODS Systematic searches were performed in multiple databases with criteria designed to include all studies published until May 2020 focusing on paranasal sinuses fungus ball treatment in humans. We selected studies including at least 10 patients, specifying treatment modalities, providing a minimum 6-month follow-up, and objectivating treatment success. After duplicate removal, abstract and full-text selection, and quality assessment, we reviewed eligible articles for treatment modalities and success rates. Success rates were pooled in a random effect meta-analysis and compared according to the use of intraoperative sinus lavages and postoperative antibiotics. RESULTS Among 740 unique citations, 14 studies were deemed eligible. Most (n = 11) were retrospective case series. All studies relied on endoscopic sinus surgery. Intraoperative lavages were proposed in 10 studies and postoperative antibiotics in 7 (for all patients in 5 studies and for selected patients in 2). No significant heterogeneity was observed between results (Cochran's Q P = .639, I2 test = 0). Treatment success rate was 98.4% (95% confidence interval 97.4%-99.3%). Intraoperative sinus toilette and postoperative antibiotics didn't significantly improve the success rate. CONCLUSION Endoscopic sinus surgery shows excellent results in fungus ball treatment. Further prospective studies might help further reducing antibiotics prescriptions in these patients and improve their management.
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Affiliation(s)
- Gian Luca Fadda
- Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, Università degli Studi di Torino, Turin, Italy.,ISGOS, The Italian Study Group on Odontogenic Sinusitis
| | - Fabiana Allevi
- ISGOS, The Italian Study Group on Odontogenic Sinusitis.,Department of Health Sciences, Maxillofacial Surgery Unit, Santi Paolo e Carlo Hospital, Università degli Studi di Milano, Milan, Italy
| | - Cecilia Rosso
- Department of Health Sciences, Otolaryngology Unit, Santi Paolo e Carlo Hospital, Università degli Studi di Milano, Milan, Italy
| | - Federica Martino
- Department of Clinical Sciences and Translational Medicine, Unit of Otorhinolaryngology, University of Tor Vergata, Rome, Italy
| | - Carlotta Pipolo
- ISGOS, The Italian Study Group on Odontogenic Sinusitis.,Department of Health Sciences, Otolaryngology Unit, Santi Paolo e Carlo Hospital, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Cavallo
- Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, Università degli Studi di Torino, Turin, Italy
| | - Giovanni Felisati
- ISGOS, The Italian Study Group on Odontogenic Sinusitis.,Department of Health Sciences, Otolaryngology Unit, Santi Paolo e Carlo Hospital, Università degli Studi di Milano, Milan, Italy
| | - Alberto Maria Saibene
- ISGOS, The Italian Study Group on Odontogenic Sinusitis.,Department of Health Sciences, Otolaryngology Unit, Santi Paolo e Carlo Hospital, Università degli Studi di Milano, Milan, Italy
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12
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Fadda GL, Manca A, Testi F, Itri F, Nicoli P, Moratti G, Cavallo G, Guerrasio A. A Rare Case of Hodgkin Lymphoma of the Maxillary Sinus. Ear Nose Throat J 2021; 102:NP232-NP236. [PMID: 33734885 DOI: 10.1177/0145561321993599] [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] [Indexed: 11/16/2022] Open
Abstract
Hodgkin lymphoma (HL) is an uncommon B-cell malignant disease. It usually presents with mediastinal and/or laterocervical lymph node localization, while primary extranodal HL is a rare entity giving rise to diagnostic and therapeutic challenges. It rarely presents as just extranodal localization, so its presence within the maxillary sinus without any lymphadenopathy is exceptional. Given the rarity of this localization, there is no standard treatment for maxillary sinus HL. We present a case of a patient with extranodal HL of the right maxillary sinus treated with primary surgery followed by adjuvant sequential chemoradiation therapy.
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Affiliation(s)
- Gian Luca Fadda
- Department of Otorhinolaryngology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Andrea Manca
- FPO IRCCS, Head & Neck Oncology Unit, Candiolo Cancer Institute, Turin, Italy
| | - Francesca Testi
- Department of Otorhinolaryngology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Federico Itri
- Department of Clinical and Biological Sciences, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Paolo Nicoli
- Department of Clinical and Biological Sciences, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Giuseppe Moratti
- Department of Otorhinolaryngology, Galliera Hospital, Genova, Italy
| | - Giovanni Cavallo
- Department of Otorhinolaryngology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Angelo Guerrasio
- Departement of Clinical and Biological Sciences, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
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13
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Allevi F, Fadda GL, Rosso C, Martino F, Pipolo C, Cavallo G, Felisati G, Saibene AM. Diagnostic Criteria for Odontogenic Sinusitis: A Systematic Review. Am J Rhinol Allergy 2020; 35:713-721. [PMID: 33236664 DOI: 10.1177/1945892420976766] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Odontogenic sinusitis affects a significant proportion of patients with paranasal sinus infections. Nevertheless, no shared diagnostic criteria for this condition have yet been implemented and published studies differ in their definition of the disease. OBJECTIVE The present systematic review of the literature was undertaken to characterize and analyze the different diagnostic criteria currently employed for odontogenic sinusitis. METHODS Systematic searches for studies published between 2009 and 2019 were performed in Medline, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov databases. Search criteria were designed to identify all studies focusing, even partially, on odontogenic sinusitis. Human original studies except single case reports published in the English, French, German, Spanish, or Italian language were included. We removed duplicate abstracts and conducted full-text reads, data extraction, and quality assessment procedures (using the Oxford Centre for Evidence-based Medicine levels of evidence and National Heart Lung and Blood Institute Study Quality Assessment Tools). We reviewed articles for diagnostic criteria, both in terms of definition and etiology identification. RESULTS Among 1,000 unique citations, 63 studies were deemed eligible. Most articles (n = 45) were retrospective case series; a single randomized clinical trial was available. Only 49 studies reported diagnostic criteria, yet relied marginally on published guidelines (n = 10 articles) for identifying sinusitis, often choosing instead to develop their own clinical (n = 15 articles), endoscopic (n = 12 articles), and/or radiologic (n = 30 articles) criteria. For odontogenic focus identification, 14 papers required a multidisciplinary evaluation, 11 papers required a time relationship between dental procedures and sinusitis, 24 papers required oroscopy and/or dental evaluation, and 53 papers required computed tomography. CONCLUSIONS Current diagnostic criteria for odontogenic sinusitis are extremely heterogeneous. Establishing shared diagnostic criteria aimed at defining both sinusitis and related odontogenic foci would spur collaboration between investigators and support more comprehensive outcomes evaluations together with a better understanding of treatment options.
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Affiliation(s)
- Fabiana Allevi
- Department of Maxillo-Facial Surgery, Santi Paolo e Carlo Hospital, Milan, Italy.,Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.,Italian Study Group on Odontogenic Sinusitis, Italy
| | - Gian Luca Fadda
- Italian Study Group on Odontogenic Sinusitis, Italy.,Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, Università degli Studi di Torino, Turin, Italy
| | - Cecilia Rosso
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.,Department of Otolaryngology, Santi Paolo e Carlo Hospital, Milan, Italy
| | - Federica Martino
- Unit of Otorhinolaryngology, Department of Clinical Sciences and Translational Medicine, University of Tor Vergata, Rome, Italy
| | - Carlotta Pipolo
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.,Italian Study Group on Odontogenic Sinusitis, Italy.,Department of Otolaryngology, Santi Paolo e Carlo Hospital, Milan, Italy
| | - Giovanni Cavallo
- Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, Università degli Studi di Torino, Turin, Italy
| | - Giovanni Felisati
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.,Italian Study Group on Odontogenic Sinusitis, Italy.,Department of Otolaryngology, Santi Paolo e Carlo Hospital, Milan, Italy
| | - Alberto Maria Saibene
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.,Italian Study Group on Odontogenic Sinusitis, Italy.,Department of Otolaryngology, Santi Paolo e Carlo Hospital, Milan, Italy
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14
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Fadda GL, Galizia A, Galizia G, Castelnuovo P, Bignami M, Cavallo G. Multiparametric Analysis of Factors Associated With Eosinophilic Chronic Rhinosinusitis With Nasal Polyps. Ear Nose Throat J 2020; 101:NP256-NP262. [PMID: 33023335 DOI: 10.1177/0145561320960357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Previous studies have reported a diverse range of threshold values for blood eosinophilia. In addition, a single predictive biomarker for eosinophilic chronic rhinosinusitis (CRS) with nasal polyps (ECRSwNP) has not yet been identified. OBJECTIVES The aim of this study is to compare the clinical characteristics of ECRSwNP and non-ECRSwNP to evaluate the preoperative risk of tissue eosinophilia of chronic rhinosinusitis with nasal polyps (CRSwNP) through a multiparametric statistical analysis. METHODS One hundred ten patients with evidence of chronic polypoid rhinosinusitis were included in this study and clinical records were retrospectively reviewed. Eosinophilic CRSwNP was diagnosed based on the presence of at least 10 eosinophils per high-power field. The demographic and clinical features of ECRSwNP and non-ECRSwNP are described. The values of blood eosinophilia as predictors of tissue eosinophilia have been identified using receiver operating characteristic curves. As the predictive value of the identified cutoff through regression analysis was low, we evaluated whether other risk factors could be statistically associated with ECRSwNP, and from this, a new predictive model was proposed for the identification of eosinophilic nasal polyps before surgery. RESULTS We found that the best method for predicting ECRSwNP is based on a model having asthma, blood eosinophil percentage, posterior ethmoid value in Lund-Mackay score, and modified Lund-Kennedy score as explanatory variables. CONCLUSIONS This study provides new data for a better understanding of the polypoid CRS endotypes, and the proposed model allows the endotype to be identified preoperatively.
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Affiliation(s)
- Gian Luca Fadda
- Department of Otorhinolaryngology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Andrea Galizia
- Department of Otorhinolaryngology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Giuseppe Galizia
- Department of Otorhinolaryngology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Paolo Castelnuovo
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy
| | - Maurizio Bignami
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy
| | - Giovanni Cavallo
- Department of Otorhinolaryngology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
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15
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Fadda GL, D'Eramo A, Gned D, Succo G, Galizia A, Cavallo G. An unusual case of complicated rhinosinusitis of the sphenoid sinus involving the cavernous sinus and skull base: Endoscopic sinus surgery and medical therapy. SAGE Open Med Case Rep 2019; 7:2050313X19852885. [PMID: 31205718 PMCID: PMC6537237 DOI: 10.1177/2050313x19852885] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 04/09/2019] [Accepted: 05/03/2019] [Indexed: 11/21/2022] Open
Abstract
Isolated sphenoid sinus diseases are generally asymptomatic and relatively uncommon with the potential for serious complications. Patients with this condition should be monitored closely and treated aggressively and either diagnostic or therapeutic intent is often indicated. In the management of a complex, life-threatening condition that involves many different fields of expertise, the otolaryngologist plays a key role in orchestrating different specialists and gaining direct access to the affected area, thus taking the first and essential step towards diagnosis and therapy. Because of the superiority of computed tomography in defining the bony margins and the superior soft tissue resolution of magnetic resonance imaging, these two techniques should be used in a complementary manner in the evaluation of isolated sphenoid sinus disease in addition to mapping the lesion better and identifying intracranial and intraorbital extent. We report an unusual case of isolated rhinosinusitis of the sphenoid sinus involving the cavernous sinus, pterygoid fossae and masticatory space in an immunocompetent patient.
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Affiliation(s)
- Gian Luca Fadda
- Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, University of Turin, Turin, Italy.,ENT Department, San Luigi Gonzaga University Hospital, Turin, Italy
| | - Anna D'Eramo
- Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, University of Turin, Turin, Italy
| | - Dario Gned
- Department of Radiology, San Luigi Gonzaga University Hospital, University of Turin, Turin, Italy
| | - Giovanni Succo
- Head and Neck Oncology Service, Candiolo Cancer Institute-FPO IRCCS, Turin, Italy
| | - Andrea Galizia
- Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, University of Turin, Turin, Italy
| | - Giovanni Cavallo
- Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, University of Turin, Turin, Italy
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16
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Abstract
Chondrosarcoma of the larynx is a rare tumor; worldwide only about 250-300 cases have been described in the literature. We present a clinical case of laryngeal chondrosarcoma manifesting as a swollen mass of 10 x 7 x 6 cm in the infrahyoid and left lateral cervical region. The patient underwent total laryngectomy, thyroidectomy and bilateral neck dissection. A review of the literature on this disease is also reported.
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Affiliation(s)
- A De Stefani
- Clinical Physiopathology Department, University of Turin, Italy
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17
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Fadda GL, Berrone M, Crosetti E, Succo G. Monolateral sinonasal complications of dental disease or treatment: when does endoscopic endonasal surgery require an intraoral approach? Acta Otorhinolaryngol Ital 2017; 36:300-309. [PMID: 27734983 PMCID: PMC5066466 DOI: 10.14639/0392-100x-904] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 11/02/2015] [Accepted: 01/10/2016] [Indexed: 11/23/2022]
Abstract
The widespread use of dental implants and reconstructive procedures for their positioning has led to an increase in sinonasal complications of dental disease and treatment (SCDDT). Diagnosis requires accurate dental and rhinological evaluation, including computed tomography (CT). The aim of this study is to investigate a multidisciplinary approach for the treatment of SCDDT by combining endoscopic endonasal surgery (EES) and an intraoral approach on the basis of a preliminary classification system already proposed by other authors. Moreover, we analysed the percentage of odontogenic maxillary sinusitis extending to the anterior ethmoidal sinuses and bacteria involved in the pathogenesis of SCDDT. Between January 2012 and August 2015, in our series of 31 patients, 16/31 patients (51.6%) were treated with EES, 3/31 patients (9.7%) with an intraoral approach and 12/31 patients (38.7%) with a combined approach. All patients reported improvement in sinusitis symptoms confirmed by clinical examinations and CT scan. No significant complications were recorded and revision surgery was not required. Finally, the results of this preliminary study suggest that a multidisciplinary approach to SCDDT from diagnosis to therapy allows more precise diagnosis and comprehensive therapy to achieve a rapid recovery and minimise the risk of recurrence.
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Affiliation(s)
- G L Fadda
- ENT Dept., San Luigi Gonzaga Hospital, University of Turin, Italy
| | - M Berrone
- Dept. of Oncology, Resident, PhD program in Experimental Medicine and Therapy, University of Turin, Italy
| | - E Crosetti
- ENT Dept., San Luigi Gonzaga Hospital, University of Turin, Italy
| | - G Succo
- ENT Dept., San Luigi Gonzaga Hospital, University of Turin, Italy
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18
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Albera R, Cavalot A, Musto R, Fadda GL, Staffieri A, Di Girolamo S. Tympanic membrane displacement analyser tracing modifications induced by glycerol in Menière's disease. Audiology 2001; 40:185-90. [PMID: 11521710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
The aim of the study was to detect inner ear fluid pressure changes induced by glycerol in Menière's disease (MD) by means of a tympanic membrane displacement analyser (TDA). The study group consisted of 25 MD patients. The Vi (maximum inward displacement of the tympanic membrane) and the Vm (mean displacement of the tympanic membrane) were measured at 10, 20 and 25 dB above the stapedial reflex threshold. Each patient received therapy based on glycerol. The control group consisted of 20 patients with non-hydropic sudden hearing loss. At 20 and 25 dB above stapedial threshold MD patients had lower Vi values before therapy. After glycerol, we observed a Vi increasing in the hydropic ears in 68-96 per cent of patients. Since a Vi improvement implies a reduction of perilymph pressure, our results confirm the effectiveness of Vi in detecting specific action of glycerol in MD.
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Affiliation(s)
- R Albera
- Department of Physio-pathology, University of Turin, Italy
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19
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Abstract
We report a case of glottic primary laryngeal lymphoma. Although the head and neck region is a frequent site of origin of extranodal non-Hodgkin's lymphomas, laryngeal involvement is exceptional. Including this case, about 90 primary laryngeal lymphomas have been reported in the literature. Microscopic study showed a diffuse malignant lymphoma of high-grade malignancy (WF sub-division H). A diffuse, large, B-cell-type NHL was diagnosed histopathologically. The patient was treated with combination chemotherapy, including cyclophosphamide, doxorubicin, vincristine and prednisolone (CHOP), which resulted in complete clinical remission after two courses. Four courses of combination chemotherapy were subsequently performed, making a total of six courses of combination chemotherapy. No recurrence has been observed during the 16-month follow-up period.
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Affiliation(s)
- A L Cavalot
- Department of Physiology, University of Turin, Italy
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Altera R, Cavalot A, Musto R, Fadda GL, Staffieri A, Di Girolamo S. Tympanic Membrane Displacement Analyser Tracing Modifications Induced by Glycerol in Menièrés Disease: El Analizador de Desplazamiento de la Membrana Timpánica: Seguimiento de las Modificaciones inducidas por el Glicerol en la Enfermedad de Ménière. Int J Audiol 2001. [DOI: 10.3109/00206090109073113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Primary non-Hodgkin's lymphoma of the nasal cavity is a disease more likely to affect men than women; it is characterized by a T cell immunophenotype and is often associated with involvement of the paranasal structures and with high recurrence rates. Many authors report that its extremely poor prognosis depends on tumour stage and extension into the paranasal sinuses. Patients with Ann Arbor stage IE limited to only one nasal cavity have better survival rates than those with the same stage but with tumour extension beyond the nasal cavity. Patients with stages IIE, IIIE and IV have a very poor prognosis that does not seem to be affected by the use of conventional chemotherapy. Optimal treatment for the disease is not yet known. The use of radiotherapy alone has been reported in initial stages of the disease; however, given that its prognosis is burdened by frequent local or systemic recurrence or both, combined modality therapy has been applied in all stages. In this case report we describe a case of primary non-Hodgkin's lymphoma of the nasal cavity localized at the middle turbinate, in combination with an updated literature review.
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Affiliation(s)
- A L Cavalot
- Department of Physiopathology, Second Chair of ENT, University of Turin, Italy
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Cavalot AL, Nazionale G, Albera R, Staffieri A, Fadda GL. [Maxillary ameloblastoma: a case report]. Acta Otorhinolaryngol Ital 1999; 19:283-7. [PMID: 10827803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Ameloblastoma is a neoplasm of odontogenic origin. Although it is considered a benign lesion it presents some peculiarities including a high local recurrence rate, particularly after conservative surgery, and a high loco-regional invasiveness. The present work describes a case of ameloblastoma of the left maxillary sinus bordering on the homolateral nasal fossa. The male patient was admitted to the E.N.T. Dept II of the University of Turin in May 1998 and underwent left radical maxillectomy. The authors also review the literature on the topic.
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Affiliation(s)
- A L Cavalot
- II Clinica Otorinolaringoiatrica, Università di Torino
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