Melanoma of the external auditory canal: case report and systematic literature review.

Melanoma of the external auditory canal (EAC) is particularly rare and poorly understood, with limited available data on management and survival. This systematic review aims to analyze existing data and provide insights into the management and prognosis the beginning of EAC melanoma. It is conducted using Pubmed and Scopus databases from the beginning to July 2023 and it follows the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 guidelines. Searches are performed using the search string "(melanoma) AND (external auditory canal)".The review includes a total of 30 patients diagnosed with EAC melanoma, supplemented by an additional case from the authors' clinical experience. The role of Breslow thickness as a determining factor for the choice of surgery remains inconclusive due to limited available data. Sentinel lymph node biopsy and adjuvant therapy are sparingly employed, indicating the need for standardized guidelines. Patients in the study demonstrate a 50% overall survival rate at 5 years.EAC Melanoma is a rare and aggressive malignancy with limited therapeutic guidelines. Surgical interventions, including wide local excision and lateral temporal bone resection, are the primary treatment options for patients without distant metastases.

Outcome of Salvage Therapy in Isolated Regional Recurrence in Head and Neck Squamous Cell Carcinoma.

OBJECTIVES/HYPOTHESIS: Head and neck squamous cell carcinoma (HNSCC) has a high tendency for regional lymphatic spreading. Nevertheless, isolated regional lymph node recurrences are rare, and only limited data regarding its management are available. The aim of this study was to describe treatment modalities and outcomes, and to identify prognostic factors. Study Design Retrospective cohort study. METHODS: The records of all patients (n = 498) with tumor persistence or recurrence after curatively intended treatment for HNSCC were retrospectively reviewed. Patients with synchronous secondary tumors at initial presentation, tumor persistence, local or locoregional recurrence, and systemic metastases were excluded. RESULTS: A total of 76 patients were included. The rate of occult additional metastasis in radiologically uninvolved neck compartments during salvage neck dissection was 25%. The salvaged patients showed a 37.5% 5-year recurrence-free survival (RFS). Multivariate analysis revealed initial stage IVA-B (hazard ratio [HR]: 4.16, P < .01), extracapsular spread (HR: 3.71, P = .04), higher involved/total lymph node ratio (HR: 6.79, P < .01), and soft-tissue infiltration (HR: 3.27, P < .01) as independent adverse prognostic factors for RFS. Moreover, univariate data analysis identified recurrent stage rcN2-3; clinical involvement of the neck levels IV, V and/or VI; and smoking as adverse risk factors for RFS. CONCLUSIONS: This study identifies initial stage IVA-B, extracapsular spread, higher involved/total lymph node ratio, and soft-tissue infiltration as independent adverse prognostic factors for RFS following isolated regional recurrences. The incidence of occult additional metastasis of radiologically uninvolved levels during salvage neck dissections was high (25%). Therefore, superselective or selective neck dissection would not have been the adequate type of salvage surgery. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:67-72, 2021.

Early experience in tracheostomy and tracheostomy tube management in Covid-19 patients.

In Italy, we have experienced Europe's first and largest coronavirus outbreak. Based on our preliminary experience, we discuss the challenges in performing tracheotomy and tracheostoma care in the setting of a new pathogen.

Clinical features and management of Luc's abscess: Case report and systematic review of the literature.

OBJECTIVES: Luc's abscess is a rare complication of acute otitis media, with a challenging diagnosis and a controversial surgical treatment. The aim of the present study was to review the published literature in order to clarify the clinical features and the surgical management of those patients. METHODS: A systematic review of the literature was carried out for published reports or case series in English language, describing a temporo-zygomatic (or Luc's) abscess which complicated an acute or chronic otitis media and/or mastoiditis, confirmed through CT scan or MRI of the petrous bone. The collected clinical and radiological data were merged and critically appraised. RESULTS: Eighteen reports of Luc's abscess were included. Adding our case report, a total of 21 cases were included in the analysis. Abscess drainage plus myringotomy alone vs. abscess drainage plus myringotomy and mastoidectomy were the two surgical management approaches described in the literature. Patients undergoing first line mastoidectomy were successfully treated in all cases, while among those undergoing a more conservative approach, one failure required subsequent mastoidectomy. CONCLUSIONS: The clinical features of Luc's abscess are rather constant and help in rising the suspicion before the radiological diagnosis. Although cases with associated intra-cranic complications have been reported, the limited existing data do not permit to advocate the mastoidectomy over a more conservative surgical approach. However, the decision to avoid mastoidectomy as the first line surgical treatment should be based on the clinical and radiologic assessment, after an accurate counseling, particularly in the case of a pediatric patient.

Synchrotron radiation imaging revealing the sub-micron structure of the auditory ossicles.

PURPOSE: Synchrotron-based X-ray Phase Contrast Imaging (SR X-PCI) allows, thanks to a highly coherent and powerful X-ray beam, the imaging of surface and cross-sectional tissue properties with high absorption-contrast. The objective of this study is to investigate the sub-micron structure of the ossicular chain. The understanding of its morphological properties at sub-micron scale will help to refine the understanding of its structural properties. The investigation of intact, non-decalcified and unstained ossicular bones allows to study the spatial relationship between surface properties, internal structure and tomographical slides. MAIN RESULTS: The tomography datasets with a pixel size of 0.65 µm were reconstructed and 3D volume rendering models of all specimens were analyzed. Based on surface models, the surfaces of the articulations, the insertion of the tensor tympani and stapedial muscle tendons and the nutritional foramina, where the vessels penetrate the ossicles, were visualized. Moreover, a branched network of inner channels could be represented and its connection to the nutritional foramen was demonstrated. Looking at the tomographic structure of the three ossicles a mineralization pattern for every auditory bone was described, indicating a considerable variation throughout the bones. CONCLUSIONS: This study investigates the submicron-structure of the auditory ossicles at a pixel size of 0.65 µm, which is to the best of our knowledge the highest resolution reported in the investigation of the human auditory system so far. The provided data helps in the further understanding of the anatomical conformation of the ossicular chain.

Clinical Applicability of a Preoperative Angular Insertion Depth Prediction Method for Cochlear Implantation.

OBJECTIVE: Evaluation of the accuracy and clinical applicability of a single measure cochlear implant angular insertion depth prediction method. BACKGROUND: Cochlear implantation outcomes still vary extensively between patients. One of the possible reasons could be variability in intracochlear electrode array placement. For this reason, single measure methods were suggested to preoperatively predict angular insertion depths. Based on a previously performed accuracy study in human temporal bones, we were interested in determining the extent to which the method could be applied in a clinical setting. METHODS: A retrospective analysis was performed on pre- and postoperative radiographic images of 50 cochlear implant recipients. Preoperatively predicted angular insertion depths were compared with angular insertion depths measured on postoperative ground truth. The theoretical prediction error was computed under the assumption that all achieved insertions were matching the preoperatively assumed linear insertion depth. More importantly, the clinical prediction error was assessed using two different software tools performed by three experienced surgeons. RESULTS: Using the proposed method we found a theoretical prediction error of 5 degrees (SD = 41 degrees). The clinical prediction error including the cases with extracochlear electrodes was 70 degrees (SD = 96 degrees). CONCLUSIONS: The presented angular insertion depth prediction method is a first practical approach to support the preoperative selection of cochlear implant electrode arrays. However, the presented procedure is limited in that it is unable to predict the occurrence of insertion results with extracochlear electrodes and requires user training.

Long-term functional outcome after laryngeal cancer treatment.

BACKGROUND: The functional outcome after the treatment of laryngeal cancer is tightly related to the quality of life of affected patients. The aim of this study is to describe the long-term morbidity and functional outcomes associated with the different treatment modalities for laryngeal cancer. METHODS: Retrospective chart review of 477 patients undergoing curatively intended treatment for laryngeal cancer at our tertiary referral center from 2001 to 2014: Details on patient and disease characteristics, diagnostics and treatment related functional outcomes were analyzed. RESULTS: With a median follow-up of 51 months, the crude rate of functional larynx preservation was 74.6%. Radiotherapy +/- chemotherapy was the dominant treatment modality (n = 359-75.3%), whereas 24.7% (n = 118) underwent primary surgery, with 58.5% (69) receiving adjuvant treatment. The 5-year laryngectomy-free survival was 57% (95% CI, 48-66%) after surgery vs. 69% (95% CI, 64-75%) after chemoradiotherapy (p < 0.01). In stage III-IVB, these rates were 26% (95% CI, 16-39%) vs. 47% (95% CI, 36-59%), respectively (p < 0.01). Aspiration occurred in 7%, tracheostomy was necessary in 19.8% and feeding tube placement in 25.4%. Feeding tube and tracheostomy necessity was higher in the initially surgically treated group. Primary surgery (HR: 1.67, 95% CI: 1.19-2.32; p < 0.01), stage III-IVB (HR: 4.07, 95% CI: 2.97-5.60; p < 0.01) and tumor recurrence (HR: 3.83, 95% CI: 2.79-5.28; p < 0.01) remained as adverse factors for laryngectomy-free survival. CONCLUSIONS: Preserving the laryngeal function after cancer treatment is challenging. Advanced tumor stages, primary surgery and recurrence are related to a poor functional outcome. Therefore, the criteria for initial decision-making needs to be further refined.

Acute Invasive Fungal Rhinosinusitis in Immunocompromised Patients: Role of an Early Diagnosis.

Objective The aims of the present study were to evaluate the clinical significance of the delay for surgical treatment and the prognostic value of other clinical, pathologic, and microbiological variables among hematologic patients affected by acute invasive fungal rhinosinusitis (AIFRS). Furthermore, we propose our early diagnosis and treatment protocol, reporting its 10-year results. Study Design Monocentric retrospective analysis. Setting The study was conducted from 2001 to 2017 at the University Hospital of Bologna, Italy. Subjects and Methods The impact of time to treatment and clinical, pathologic, and microbiological variables were analyzed among patients with histologically and microbiologically proven AIFRS. The outcomes of patients treated before the introduction of the early diagnosis protocol were compared with those treated afterward. Results Nineteen patients affected by AIFRS were eligible for the study. Treatment delay >4 days ( P = .002), infection caused by Mucorales ( P = .015), and extension of the disease were negative prognostic variables ( P = .017). The application of our protocol significantly reduced the delay for diagnosis and appropriate treatment by an average of 7.3 days ( P = .02). Conclusion The promptness of the diagnosis and surgical treatment may play a significant role in the management of AIFRS, as it appears to be significantly associated with the disease outcome. Our protocol may help to reduce the time required for diagnosis of high-risk hematologic patients.

The Impact of the Transcanal Endoscopic Approach and Mastoid Preservation on Recurrence of Primary Acquired Attic Cholesteatoma.

OBJECTIVE: We aim to investigate the factors associated with recurrent disease following surgery for primary acquired attic cholesteatoma. We hypothesize that minimal invasive, mucosal sparing operation techniques have beneficial effects on the outcome in terms of recurrence. STUDY DESIGN: Retrospective study. SETTING: Tertiary referral center. PARTICIPANTS: A total of 110 patients presenting with primary acquired attic cholesteatoma were enrolled in the study. Patients undergoing revision surgery or a canal wall down procedure, as well as patients with residual disease were excluded from the study. MAIN OUTCOME MEASURES: During follow-up recurrence was assessed and classified into normal, self-cleaning retraction pockets, or recurrent cholesteatoma requiring revision surgery. RESULTS: We observed during follow-up statistically significant decrease (p = 0.036) in the occurrence of retraction pockets and recurrence in patients operated by the transcanal endoscopic approach (n = 55, 11% re-retraction, 9% recurrence) compared with those who underwent a canal wall up procedure (n = 55, 16% re-retraction, 22% recurrence). However, the multivariate model did not demonstrate statistically significant predictors regarding the outcome. Moreover, the preservation or direct reconstruction of the ossicular chain had a beneficial effect on the outcome. We observed 11% re-retraction and 9% recurrence in cases with preserved or reconstructed ossicular chain versus 18% re-retraction and 24% recurrence (p = 0.011) in cases of nonpreserved or non-reconstructed ossicular chain. A score was established according to the intraoperative mucosal damage and correlated to the occurrence of recurrence (p = 0.02). The risk of recurrence increased by 23.6% (95% confidence interval: 3.22-48.1) with each additional mucosal damage site. CONCLUSION: Transcanal endoscopic approaches that preserve the mastoid may play an important role in preventing recurrence and underscores the importance of the mucosa and mastoid air cells on middle ear homeostasis.

Management of orbital cellulitis and subperiosteal orbital abscess in pediatric patients: A ten-year review.

OBJECTIVE: Pediatric periorbital cellulitis represents a common disease complicating a nasal infection. METHODS: A ten-year retrospective review of fifty-seven children admitted to our institution with the diagnosis of periorbital cellulitis as a complication of sinus infections was carried out. RESULTS: The age varied from one month to eleven years (mean 3.9 years). Thirty-five were males (62%), while twenty-two were females (38%). Nine out of fifty-seven (15.8%) presented exophthalmos associated with eyelid erythema and edema, while the rest suffered mainly from eyelid erythema and edema. Twenty-two patients complaining of exophthalmos or not responding to medical therapy within 48 h were assessed with a computed tomography scan (38.6%). A subperiosteal orbital abscess was detected in nine cases and these patients underwent surgical drainage (15,8%). Recurrence of orbital infection occurred in three cases (5.3%). CONCLUSIONS: Medical management is the main treatment for both preseptal and postseptal orbital cellulitis. Nevertheless, there is no universally accepted guideline for the treatment of subperiosteal abscesses and each case should be treated accordingly. Urgent surgical drainage should be considered in cases not responding to adequate medical management, or those cases presenting visual deterioration.