Techniques of Endoscopic Ossiculoplasty

The utilization of endoscopes in modern otology has evolved from diagnostic purposes to the development of exclusive endoscopic ear surgery. This technique offers a panoramic view of the middle ear and provides an optimal magnification of the oval window region, the stapes' suprastructure, and the footplate, allowing great precision in prosthesis positioning during ossiculoplasty (OPL). Various techniques for ossicular chain reconstruction have been described in the literature. Either autologous or synthetic materials can be used for reconstruction. The use of a patient's own tissue minimizes the risk of implant rejection or extrusion of the prosthesis through the tympanic membrane. On the other hand, synthetic materials like titanium are light and rigid and do not require time-consuming prosthesis remodeling. The main objective of this article is to present a comprehensive step-by-step guide that serves as a surgical manual for exclusive endoscopic OPL. This guide will explain various forms of OPL using synthetic and autologous materials. The goal is to provide a comprehensive understanding of the various surgical techniques and support the integration into clinical practice.

HER2-targeted therapies for salivary gland cancers

Salivary gland cancers (SGCs) are a heterogeneous group of rare tumors including various histological subtypes with different molecular profiling. Human epidermal growth factor receptor 2 (HER2) is one of the most intriguing and studied molecular alterations with prognostic and predictive roles. Indeed, HER2 overexpression is commonly correlated with aggressive histological subtypes and poorer prognosis. However, HER2 may represent the target of personalized treatment. We performed a literature review of use of anti-HER2 targeted agents for treatment of recurrent or metastatic SGCs. The efficacy and safety of anti-HER2 were firstly evaluated in patients affected with other solid tumors, mostly breast and gastric cancers. For SGCs the literature is mainly comprised of case reports or case series and small clinical trials. The most common used drug is trastuzumab in combination with chemotherapy (i.e. taxanes, capecitabine, carboplatin, eribulin) or with another anti-HER2 targeted agent (i.e. pertuzumab). The use of anti-HER2 therapies induces improvement in clinical responses, which are mostly durable. Besides, new anti-HER2 drugs such as antibody-drug conjugates (ADC) (i.e. trastuzumab emtansine, trastuzumab deruxtecan) have been introduced in this setting inducing further therapeutic advances. Anti-HER2 treatment strategy is emerging as potentially effective in selected HER2 overexpressing SGCs. However, prospective and multicentric clinical trials are needed to evaluate the efficacy of these therapeutic regimens within larger cohorts and to assess the most appropriate treatment sequence strategy.

Features Associated With High Risk of Recurrence in Saccular Laryngeal Cysts: A Systematic Review and Qualitative Synthesis

INTRODUCTION

Saccular cysts are rare benign anomalies of the larynx (1.5% of laryngeal anomalies) determined by dilatation of the laryngeal saccule. They can be congenital or acquired. Clinical manifestation depends on the site of the cyst and the age of the patient. Children frequently have stridor and dyspnea, while adults usually complain of dysphonia.The therapeutic approach can be surgical or nonsurgical (needle aspiration or drainage).However, guidelines on the management of this disease are lacking in the literature.This systematic literature review was conducted through an interferential analysis with the aim of detecting the association between clinical, diagnostic, and operative factors and the recurrence of saccular cysts.

MATERIALS AND METHODS

This systematic literature review was evolved following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 checklist statement Papers published up to August 2023 containing relevant clinical data were searched in Embase/PubMed, Web of Science, Scopus, and Cochrane database. Full texts lacking information on the patient's data, clinical, radiological, and/or histological diagnosis of saccular cysts of the larynx were excluded. Articles with follow-up inferior to 6 months and not reporting any treatment of the cyst were excluded, too. Data concerning signs and symptoms, cyst characteristics, and the type of treatment were described, and the risk of recurrence was studied in association with these features. A qualitative synthesis of the results was performed.

RESULTS

Ninety-eight articles were screened. One hundred two patients were involved in the analysis. The articles with low or intermediate risk of bias were 22 (8 case reports and 14 case series) and they were included in the statistical analysis. Median age was 25 years (range 0-81). Saccular cysts were congenital (46/102, 45%) of cases acquired (56/102, 55%). Relying on the available data, all patients were symptomatic, with stridor as the main symptom (59%). Surgical approach was performed in 85% of cases, while drainage or needle aspiration of the cyst was the treatment of choice in the remaining 25% of cases. Twenty-four percent of patients had recurrence of the disease within 3 months. Median age at recurrence was 9 years. Cysts characteristics, preoperative management, and type of treatment were associated with an increased risk of disease recurrence (P < 0.05).

CONCLUSIONS

Saccular cysts are rare congenital or acquired laryngeal diseases. Data regarding their management and factors associated with the risk of recurrence are still limited. Congenital cysts treated conservatively have a higher risk of recurrence than acquired cysts treated by open surgical techniques or by microlaryngoscopy. A better knowledge of factors associated with a higher risk of recurrence could help choose the best treatment.