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Maniaci A, Ferlito S, Bubbico L, Ledda C, Rapisarda V, Iannella G, La Mantia I, Grillo C, Vicini C, Privitera E, Coco S, Cammaroto G, Lechien JR, Magliulo G, Pace A, Meccariello G, Cocuzza S. Comfort rules for face masks among healthcare workers during COVID-19 spread. Ann Ig 2021; 33:615-627. [PMID: 33797548 DOI: 10.7416/ai.2021.2439] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background The outbreak of Coronavirus disease 2019 (COVID-19) made imperative the use of protective devices as a source control tool. As there is no definite antiviral treatment and effective vaccine, the only efficient means of protecting and mitigating infectious contagion has been the use of personal protective equipment, especially by healthcare workers. However, masks affect the humidification process of inhaled air, possibly leading to a basal inflammatory state of the upper airways. Study design This is a single-center observational study conducted at the University Hospital of Catania from April 1, 2020, to June 31, 2020. Methods We analyzed the role of protective masks on the elimination of upper airways complaints in healthcare workers of the University Hospital of Catania. We evaluated 277 subjects through a self-administered 17 item questionnaire based on respiratory, work performance and health-related quality of life domains. Results A higher prevalence of nasal and ocular symptoms, perceived reduced work performance, difficulty in concentrating, and sleep disorders were found. After two weeks adhering to a list of good practices that we recommended, significant reversibility of the symptoms investigated and work performance enhancement were observed. Conclusions Despite clinical complaints related to personal protective equipment, effective amelioration through usage rules is easily obtained. Given the essential use of protective masks, healthcare workers have to adhere to appropriate work and safety prevention rules.
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Affiliation(s)
- A Maniaci
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia," ENT Section, University of Catania, Catania, Italy
| | - S Ferlito
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia," ENT Section, University of Catania, Catania, Italy
| | - L Bubbico
- Department of Sensorineural Disability INAPP/Italian Institute of Social Medicine, Rome, Italy
| | - C Ledda
- Department of Clinical and Experimental Medicine, Occupational Medicine, University of Catania, Catania, Italy
| | - V Rapisarda
- Department of Clinical and Experimental Medicine, Occupational Medicine, University of Catania, Catania, Italy
| | - G Iannella
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy.,Department of Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - I La Mantia
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia," ENT Section, University of Catania, Catania, Italy
| | - C Grillo
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia," ENT Section, University of Catania, Catania, Italy
| | - C Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy.,Department ENT and Audiology, University of Ferrara, Ferrara, Italy
| | - E Privitera
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia," ENT Section, University of Catania, Catania, Italy
| | - S Coco
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia," ENT Section, University of Catania, Catania, Italy
| | - G Cammaroto
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - J R Lechien
- Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium
| | - G Magliulo
- Department of Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - A Pace
- Department of Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - G Meccariello
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - S Cocuzza
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia," ENT Section, University of Catania, Catania, Italy
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2
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Capaccio P, Montevecchi F, Meccariello G, D’Agostino G, Cammaroto G, Pelucchi S, Vicini C. Transoral robotic surgery for hilo-parenchymal submandibular stones: step-by-step description and reasoned approach. Int J Oral Maxillofac Surg 2019; 48:1520-1524. [DOI: 10.1016/j.ijom.2019.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 05/20/2019] [Accepted: 07/02/2019] [Indexed: 11/29/2022]
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3
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Meccariello G, Montevecchi F, D'Agostino G, Iannella G, Calpona S, Parisi E, Costantini M, Cammaroto G, Gobbi R, Firinu E, Sgarzani R, Nestola D, Bellini C, De Vito A, Amadori E, Vicini C. Trans-oral robotic surgery for the management of oropharyngeal carcinomas: a 9-year institutional experience. ACTA ACUST UNITED AC 2019; 39:75-83. [PMID: 31097824 PMCID: PMC6522856 DOI: 10.14639/0392-100x-2199] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 05/16/2018] [Accepted: 09/15/2018] [Indexed: 12/11/2022]
Abstract
Trans-oral robotic surgery (TORS) has changed surgical management
of patients with oropharyngeal squamous cell carcinomas (OPSCC). In
this study we present surgical and oncologic outcomes of patients with
oropharyngeal squamous cell carcinomas, treated using TORS, with and
without an adjuvant therapy. Sixty patients with oropharyngeal
squamous cell carcinomas treated with TORS between January 2008 and
December 2017 have been retrospectively evaluated considering
clinicopathologic features, disease characteristics, adjuvant
treatments and oncological outcomes. TORS was performed for OPSCC to
the base of tongue in 41.7%, tonsils in 46.7%, soft palate and
posterior pharyngeal wall in 3.3% and 5%, respectively. Neck
dissection was performed in 43.3% of patients. Management strategies
included surgery alone in 30%, TORS and adjuvant radiotherapy in
33.3%, and TORS plus adjuvant chemotherapy in 36.7%. The 5-year
overall survival of the total group was 77.6%, the 5-year disease-free
survival rate was 85.2%, and the 5-year local recurrence-free survival
rate was 90.6%. Finally, in selected patients TORS appears to yield
similar oncologic outcomes and functional outcomes to traditional
techniques and non-operative treatment with a possible benefit on
long-term quality of life. The future offers exciting opportunities to
combine TORS and radiotherapy in unique ways. However, further
research is urgently needed to clarify the indications for adjuvant
therapy following TORS resections.
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Affiliation(s)
- G Meccariello
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - F Montevecchi
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - G D'Agostino
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - G Iannella
- Department of Organs of Sense, Ear, Nose, and Throat Section, University of Rome "La Sapienza," Italy
| | - S Calpona
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola (FC), Italy
| | - E Parisi
- Radiotherapy Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola (FC), Italy
| | - M Costantini
- Department of Surgical Pathology, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - G Cammaroto
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy.,Department of Otolaryngology, University of Messina, Italy
| | - R Gobbi
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - E Firinu
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - R Sgarzani
- Department of Emergency, Burn Center, Bufalini Hospital, Azienda USL della Romagna, Cesena, Italy
| | - D Nestola
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - C Bellini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - A De Vito
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - E Amadori
- Radiology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola (FC), Italy
| | - C Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
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4
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Meccariello G, Montevecchi F, Sgarzani R, Vicini C. Defect-oriented reconstruction after transoral robotic surgery for oropharyngeal cancer: a case series and review of the literature. ACTA ACUST UNITED AC 2019; 38:569-574. [PMID: 30623902 PMCID: PMC6325658 DOI: 10.14639/0392-100x-1473] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 10/24/2016] [Accepted: 06/06/2017] [Indexed: 11/23/2022]
Abstract
Transoral robotic surgery (TORS) is a fascinating new technique that has been shown to be a safe and feasible treatment for selected oropharyngeal cancers. Furthermore, TORS might offer some advantages in selected locoregionally advanced cancers. Thus, the patient selection is the keypoint for the useful application of TORS. However, the reconstruction of large oropharyngeal defects is challenging due to the restoration of velopharyngeal competency and swallowing. Moreover, the absence of mandibular splitting increases the difficulties faced by reconstructive surgeons. The paradigm for oropharyngeal reconstruction has undergone changes paralleling reflecting the overall change in the trend of the treatment alternatives over the last few decades. Flap choice and harvesting should be tailored to obtain significant advantages both in functional terms and for easy insetting. In this review, we analyse the strengths and weaknesses of the various flaps used in TORS framework with particular regards on our preliminary experience.
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Affiliation(s)
- G Meccariello
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - F Montevecchi
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - R Sgarzani
- Department of Emergency, Burn Center, Bufalini Hospital, Azienda USL della Romagna, Cesena, Italy
| | - C Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
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5
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Meccariello G, Georgalas C, Montevecchi F, Cammaroto G, Gobbi R, Firinu E, De Vito A, Vicini C. Management of idiopathic epistaxis in adults: what's new? ACTA ACUST UNITED AC 2019; 39:211-219. [PMID: 30933179 PMCID: PMC6734206 DOI: 10.14639/0392-100x-2155] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 03/18/2018] [Accepted: 05/27/2018] [Indexed: 11/25/2022]
Abstract
Epistaxis is one of the most common complaints presenting to emergency departments. The aim of this study is to systematically review and critically evaluate the evidence relating to treatment of idiopathic epistaxis for guiding best practice. A comprehensive review of the English language literature was performed using PubMed, Embase, Cochrane Library and Central electronic databases. The inclusion criteria were: retrospective or prospective or randomised controlled clinical trials which included outcomes in the management of idiopathic epistaxis. Twenty-three articles met inclusion criteria and were reviewed. Nasal packing still represents the first-line approach to epistaxis, although, at present, it appears that there is clear evidence in the literature to suggest that it is less effective and associated with more admissions and longer hospital stays than endoscopic electrocoagulation-based management of epistaxis. In conclusion, cauterisation should be the first-line approach for its high cost-effectiveness rate and low risk of complications. Further research is urgently needed to assess the efficacy of new biomaterials.
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Affiliation(s)
- G Meccariello
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - C Georgalas
- Department of Otolaryngology, Hygeia Hospital, Athens, Greece & Leiden University Hospital, Leiden, The Netherlands
| | - F Montevecchi
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - G Cammaroto
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy.,Department of Otolaryngology, University of Messina, Italy
| | - R Gobbi
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - E Firinu
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - A De Vito
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - C Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
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6
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Meccariello G, Montevecchi F, D'Agostino G, Zeccardo E, Al-Raswashdeh MFH, De Vito A, Vicini C. Surgical site infections after parotidectomy: management and benefits of an antibiotic prophylaxis protocol. ACTA ACUST UNITED AC 2018; 39:139-144. [PMID: 30632521 PMCID: PMC6536030 DOI: 10.14639/0392-100x-1768] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 05/26/2017] [Accepted: 11/03/2017] [Indexed: 12/15/2022]
Abstract
The use of perioperative prophylactic antibiotics in uncontaminated head and neck surgery is still controversial. The aim of this study was to assess the efficacy of an institutional antibiotic prophylactic protocol in preventing surgical site infection after parotidectomy. The medical charts of 448 patients who underwent parotidectomy were reviewed. Patients were divided in two groups according the use of perioperative administration of intravenous cefazolin or post-operative week course of antibiotics. Surgical site infection was registered in 29 (6.5%) cases, 16 (5.7%) within the group before the application of the perioperative protocol and 13 (7.9%) within the antibiotic prophylaxis protocol group. The univariate and multivariate logistic regression analyses showed that predictors for surgical site infection were the amount of drain output ≥ 50 ml in the first post-operative 24 hours (OR: 4.86; 1.59-14.82 95% CI; p < 0.01) and history of a previous parotid acute infection (OR: 13.83; 5.31-36 95% CI; p < 0.01). The majority of post-surgical infections (82%) were treated with intravenous antibiotic therapy. The remnants were treated surgically. Perioperative antibiotic treatment is recommended for patients undergoing parotid gland surgery and intravenous antibiotics during the post-operative course are highly suggested in case of history of previous acute parotid infection and drain output ≥ 50 ml in first 24 hours.
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Affiliation(s)
- G Meccariello
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì and degli Infermi Hospital, Faenza, Azienda USL della Romagna, Italy
| | - F Montevecchi
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì and degli Infermi Hospital, Faenza, Azienda USL della Romagna, Italy
| | - G D'Agostino
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì and degli Infermi Hospital, Faenza, Azienda USL della Romagna, Italy
| | - E Zeccardo
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì and degli Infermi Hospital, Faenza, Azienda USL della Romagna, Italy
| | - M F H Al-Raswashdeh
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì and degli Infermi Hospital, Faenza, Azienda USL della Romagna, Italy
| | - A De Vito
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì and degli Infermi Hospital, Faenza, Azienda USL della Romagna, Italy
| | - C Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì and degli Infermi Hospital, Faenza, Azienda USL della Romagna, Italy
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7
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Cammaroto G, Montevecchi F, D'Agostino G, Zeccardo E, Bellini C, Meccariello G, Vicini C. Palatal surgery in a transoral robotic setting (TORS): preliminary results of a retrospective comparison between uvulopalatopharyngoplasty (UPPP), expansion sphincter pharyngoplasty (ESP) and barbed repositioning pharyngoplasty (BRP). Acta Otorhinolaryngol Ital 2018; 37:406-409. [PMID: 28530254 PMCID: PMC5717986 DOI: 10.14639/0392-100x-1321] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [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: 06/25/2016] [Accepted: 10/18/2016] [Indexed: 11/28/2022]
Abstract
It has become increasingly clear in the past decade that surgical management of obstructive sleep apnoea hypopnoea syndrome (OSAHS) is most successfully managed with multilevel surgery. We evaluated the outcomes of multilevel interventions comparing three different palatal techniques added to TORS: uvulopalatopharyngoplasty (UPPP), a modified expansion sphincter pharyngoplasty (ESP), inspired by the Pang expansion sphincter pharyngoplasty technique and the latest barbed repositioning pharyngoplasty (BRP). Thirty patients were retrospectively evaluated. Ten patients underwent UPPP by Fairbanks, 10 BRP and 10 a modified ESP already described. All patients underwent TORS, tonsillectomy and septo-turbinoplasty. For all cases, the following data were retrieved and revaluated: preoperative and postoperative apnoea-hypopnoea index (AHI), preoperative and postoperative Epworth Sleepiness Scale (ESS), pain visual analogue scale (VAS; 0–10) for the first 5 days postoperatively, palatal operative time for each surgical technique, discharge date and complication types and rate. Both BRP and ESP resulted in better postoperative AHI values and higher surgical success rates in comparison with UPPP. On the other hand, BRP was not more effective than ESP. ESP surgery time was significantly higher than UPPP, while BRP was the quickest procedure. In summary, ESP and BRP seem to be more effective than UPPP in a multilevel surgical robotic setting. However, being quicker, easy to learn and with a low rate of complications, BRP is a safe, effective and promising option for treatment of OSAHS patients.
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Affiliation(s)
- G Cammaroto
- Department of Otolaryngology, University of Messina, Italy
| | - F Montevecchi
- Department of Special Surgery, ENT and Oral Surgery Unit, Ospedale Morgagni Pierantoni, Forlì, Italy
| | - G D'Agostino
- Department of Special Surgery, ENT and Oral Surgery Unit, Ospedale Morgagni Pierantoni, Forlì, Italy
| | - E Zeccardo
- Department of Special Surgery, ENT and Oral Surgery Unit, Ospedale Morgagni Pierantoni, Forlì, Italy
| | - C Bellini
- Department of Special Surgery, ENT and Oral Surgery Unit, Ospedale Morgagni Pierantoni, Forlì, Italy
| | - G Meccariello
- Department of Special Surgery, ENT and Oral Surgery Unit, Ospedale Morgagni Pierantoni, Forlì, Italy
| | - C Vicini
- Department of Special Surgery, ENT and Oral Surgery Unit, Ospedale Morgagni Pierantoni, Forlì, Italy
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Paladini D, Pistorio A, Wu LH, Meccariello G, Lei T, Tuo G, Donarini G, Marasini M, Xie HN. Prenatal diagnosis of total and partial anomalous pulmonary venous connection: multicenter cohort study and meta-analysis. Ultrasound Obstet Gynecol 2018; 52:24-34. [PMID: 28926132 DOI: 10.1002/uog.18907] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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: 06/07/2017] [Revised: 08/31/2017] [Accepted: 09/12/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The aims of this study were to review systematically literature on and describe the sonographic features and associated anomalies of total (TAPVC) and partial (PAPVC) anomalous pulmonary venous connection and scimitar syndrome (SS). METHODS A retrospective cohort study was carried out of cases of TAPVC, PAPVC and SS that underwent comprehensive ultrasound examination, seen over a 20-year period at two tertiary referral centers. Assessed variables included TAPVC subtype, gestational age at diagnosis, area behind the left atrium, ventricular disproportion, vertical vein, pulmonary venous obstruction, mode of diagnosis, association with cardiac and extracardiac conditions, and pregnancy and fetoneonatal outcomes. The outcome was considered favorable if the individual was alive and well (no functional impairment from surgery or cardiac or extracardiac conditions). Cases associated with right isomerism were excluded from the analysis, as TAPVC in these cases was only one of several major cardiac anomalies affecting sonographic signs. A systematic review was performed in order to obtain a synthesis of characteristics associated with TAPVC, PAPVC and SS. The literature search of PubMed and EMBASE (1970-2016) included reviews, case series and case reports. A meta-analysis was conducted only for TAPVC. Random-effects models were used to obtain pooled estimates of the frequencies of clinical characteristics and sonographic features. RESULTS For TAPVC, a total of 15 studies involving 71 patients (including 13 from the current cohort study) were included in the systematic review and meta-analysis. The pooled estimate for the association of TAPVC with congenital heart disease was 28.3% (95% CI, 18.1-41.3%) and with extracardiac anomalies it was 18.5% (95% CI, 10.5-30.6%). Of TAPVC cases, obstructed venous return was observed in 34.1% (95% CI, 22.7-47.7%), a favorable outcome in 43.8% (95% CI, 24.0-65.8%), ventricular disproportion in 59.2% (95% CI, 45.1-72.0%), increased area behind the left atrium in 58.1% (95% CI, 41.1-73.5%) and a vertical vein in 59.3% (95% CI, 41.1-75.3%). Diagnosis was established by using color or power Doppler in 84.9% (95% CI, 67.3-93.9%) of cases. For SS, there were only three studies describing eight cases, to which the current study added another five. Ventricular disproportion was present in three out of nine SS cases for which data were available, but for two of these, there was a concurrent heart anomaly. Color Doppler was used for all SS diagnoses, and four-dimensional echocardiography was useful in two out of six cases in which it was used. Outcome for SS cases was generally good. For PAPVC, there were only five studies describing five cases, to which the current study added another two. Major cardiac anomalies were associated in four out of seven of these cases, and extracardiac anomalies in three out of six cases for which data were available. CONCLUSIONS TAPVC can be associated with other cardiac and extracardiac anomalies in a significant percentage of cases. Leading sonographic signs are ventricular disproportion, increased area behind the left atrium and the finding of a vertical vein. Color/power Doppler is the key mode for diagnosis of TAPVC. Obstructed venous return can be expected in roughly one-third of cases of TAPVC and outcome is favorable in less than half of cases. Data for SS and PAPVC are too few to synthesize. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- D Paladini
- Fetal Medicine & Surgery Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - A Pistorio
- Unit of Epidemiology and Biostatistics, Istituto Giannina Gaslini, Genoa, Italy
| | - L H Wu
- Department of Ultrasonic Medicine, Fetal Medical Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - G Meccariello
- Fetal Medicine & Surgery Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - T Lei
- Department of Ultrasonic Medicine, Fetal Medical Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - G Tuo
- Department of Pediatric Cardiology and Cardiac Surgery, Istituto Giannina Gaslini, Genoa, Italy
| | - G Donarini
- Fetal Medicine & Surgery Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - M Marasini
- Department of Pediatric Cardiology and Cardiac Surgery, Istituto Giannina Gaslini, Genoa, Italy
| | - H-N Xie
- Department of Ultrasonic Medicine, Fetal Medical Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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9
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Vicini C, Meccariello G, Cammaroto G, Rashwan M, Montevecchi F. Barbed reposition pharyngoplasty in multilevel robotic surgery for obstructive sleep apnoea. Acta Otorhinolaryngol Ital 2018; 37:214-217. [PMID: 28516964 PMCID: PMC5463511 DOI: 10.14639/0392-100x-1203] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 04/08/2016] [Accepted: 09/21/2016] [Indexed: 11/23/2022]
Abstract
The surgical treatment of obstructive sleep apnoea in patients who are non-compliant with continuous positive airway pressure therapy still represents a valid alternative. In recent years, the multilevel approach is becoming more diffuse in routine surgical practice, especially since the introduction of transoral robotic surgery. Barbed reposition pharyngoplasty in multilevel robotic surgery for OSA may represent a valid option to surgically approach the soft palate. Herein, we describe the technique and preliminary results of our experience.
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Affiliation(s)
- C Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - G Meccariello
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - G Cammaroto
- Department of Otolaryngology, University of Messina, Italy
| | - M Rashwan
- Department of Otolaryngology, Suez Canal University Teaching Hospitals, Ismailia, Egypt
| | - F Montevecchi
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
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Montevecchi F, Cammaroto G, Meccariello G, Hoff PT, Corso RM, Galletti C, Al-Rawashdeh MFH, Vicini C. Transoral robotic surgery (TORS): a new tool for high risk tracheostomy decannulation. Acta Otorhinolaryngol Ital 2018; 37:46-50. [PMID: 28374870 PMCID: PMC5384309 DOI: 10.14639/0392-100x-1134] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 03/05/2016] [Accepted: 04/06/2016] [Indexed: 11/23/2022]
Abstract
Tracheostomy decannulation has always been considered a procedure with an attendant risk, especially in patients with a reduced upper airway diameter as is commonly observed in the obstructive sleep apnoea (OSA) population. We report on 4 cases where transoral robotic surgery (TORS) helped in the management of long-term cannulated patients. The aims of our paper are: 1. To demonstrate how the otolaryngology team can help identify patients at high risk for decannulation failure; and 2. To demonstrate how TORS may aid in the decannulation process of patients at high risk for failure due to severe tongue base hypertrophy. From our experience, TORS appears to offer an effective option to aid in the decannulation of patients with a severe hypertrophy of the base of tongue and floppy epiglottis.
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Affiliation(s)
- F Montevecchi
- Head and Neck Department, ENT & Oral Surgery Unit, G.B. Morgagni, L. Pierantoni Hospital, Forlì, Infermi Hospital, Faenza, ASL of Romagna, Italy
| | - G Cammaroto
- Department of Otorhinolaryngology, University of Messina, Italy
| | - G Meccariello
- Head and Neck Department, ENT & Oral Surgery Unit, G.B. Morgagni, L. Pierantoni Hospital, Forlì, Infermi Hospital, Faenza, ASL of Romagna, Italy
| | - P T Hoff
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - R M Corso
- Emergency Department, Anaesthesia and Intensive Care Section, "GB Morgagni-L. Pierantoni" Hospital, Forlì, Italy
| | - C Galletti
- Department of Anaesthesiology, University of Messina, Italy
| | - M F H Al-Rawashdeh
- Head and Neck Department, ENT & Oral Surgery Unit, G.B. Morgagni, L. Pierantoni Hospital, Forlì, Infermi Hospital, Faenza, ASL of Romagna, Italy
| | - C Vicini
- Head and Neck Department, ENT & Oral Surgery Unit, G.B. Morgagni, L. Pierantoni Hospital, Forlì, Infermi Hospital, Faenza, ASL of Romagna, Italy
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Montevecchi F, Meccariello G, Firinu E, Rashwan MS, Arigliani M, De Benedetto M, Palumbo A, Bahgat Y, Bahgat A, Lugo Saldana R, Marzetti A, Pignataro L, Mantovani M, Rinaldi V, Carrasco M, Freire F, Delgado I, Salamanca F, Bianchi A, Onerci M, Agostini P, Romano L, Benazzo M, Baptista P, Salzano F, Dallan I, Nuzzo S, Vicini C. Prospective multicentre study on barbed reposition pharyngoplasty standing alone or as a part of multilevel surgery for sleep apnoea. Clin Otolaryngol 2017; 43:483-488. [PMID: 28981208 DOI: 10.1111/coa.13001] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of this study was to demonstrate in a prospective multicentre study that Barbed Reposition Pharyngoplasty (BRP) procedure is safe and effective in management of obstructive sleep apnoea/hypopnea syndrome (OSAHS) patients. DESIGN Prospective study. SETTING Multicentre study. PARTICIPANTS Patients suffering from obstructive sleep apnoea. MAIN OUTCOMES MEASURES Values of postoperative apnoea-hypopnea index (AHI), oxygen desaturation index (ODI), epworth sleepiness scale (ESS). RESULTS 111 Barbed Reposition Pharyngoplasty procedures standing alone or as a part of multilevel surgery for OSAHS, performed between January and September 2016, were analysed in 15 different centres. The average hospitalisation period was 2.5 ± 0.5 days. The mean patient age was 46.3 ± 10.5 years. The average body mass index at the time of the procedure was 27.9 ± 3.2, and the majority of the patients were men (83%). The mean preoperative and postoperative apnoea/hypopnea index was 33.4 ± 19.5 and 13.5 ± 10.3, respectively (P < .001). The mean preoperative and postoperative ESS score was 10.2 ± 4.5 and 6.1 ± 3.6, respectively (P < .001). The mean preoperative and postoperative ODI were 29.6 ± 20.7 and 12.7 ± 10.8, respectively (P < .001). CONCLUSIONS Patients undergoing BRP standing alone or as part of a multilevel approach for the treatment of OSAHS have a reasonable expectation for success with minimal morbidity.
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Affiliation(s)
- F Montevecchi
- Head and Neck Department, ENT & Oral Surgery Unit, G.B. Morgagni - L. Pierantoni Hospital, Forlì - Infermi Hospital, Faenza - ASL of Romagna, Forli, University of Ferrrara, Italy
| | - G Meccariello
- Head and Neck Department, ENT & Oral Surgery Unit, G.B. Morgagni - L. Pierantoni Hospital, Forlì - Infermi Hospital, Faenza - ASL of Romagna, Forli, University of Ferrrara, Italy
| | - E Firinu
- Head and Neck Department, ENT & Oral Surgery Unit, G.B. Morgagni - L. Pierantoni Hospital, Forlì - Infermi Hospital, Faenza - ASL of Romagna, Forli, University of Ferrrara, Italy
| | - M S Rashwan
- Head and Neck Department, ENT & Oral Surgery Unit, G.B. Morgagni - L. Pierantoni Hospital, Forlì - Infermi Hospital, Faenza - ASL of Romagna, Forli, University of Ferrrara, Italy
| | - M Arigliani
- Department of Otolaryngology Head and Neck Surgery, Fazzi Hospital, Lecce, Italy
| | - M De Benedetto
- Department of Otolaryngology Head and Neck Surgery, Fazzi Hospital, Lecce, Italy
| | - A Palumbo
- Department of Otolaryngology Head and Neck Surgery, Fazzi Hospital, Lecce, Italy
| | - Y Bahgat
- Department of Otorhinolaryngology, Alexandria University, Alexandria, Egypt
| | - A Bahgat
- Department of Otorhinolaryngology, Alexandria University, Alexandria, Egypt
| | - R Lugo Saldana
- Department of Otorhinolaryngology, Grupo Medico San Pedro, Monterrey, Mexico
| | - A Marzetti
- Department of Otolaryngology, Fabrizio Spaziani Hospital, Frosinone, Italy
| | - L Pignataro
- Department of Otolaryngology, Department of Clinical Sciences and Community Health, Fondazione I.R.C.C.S. Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - M Mantovani
- Department of Otolaryngology, Department of Clinical Sciences and Community Health, Fondazione I.R.C.C.S. Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - V Rinaldi
- Department of Otolaryngology, Department of Clinical Sciences and Community Health, Fondazione I.R.C.C.S. Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - M Carrasco
- Department of Otorhinolaryngology, Doctor Peset University Hospital, Valencia, Spain
| | - F Freire
- Department of Otolaryngology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - I Delgado
- Department of Otolaryngology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - F Salamanca
- Department of Otolaryngology, S. Pio X Hospital, Milan, Italy
| | - A Bianchi
- Department of Otolaryngology, S. Pio X Hospital, Milan, Italy
| | - M Onerci
- Ear Nose Throat-Head and Neck Surgery Department, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - P Agostini
- Department of Otolaryngology, San Bassiano Hospital, Bassano del Grappa, Vicenza, Italy
| | - L Romano
- Department of Otolaryngology, San Bassiano Hospital, Bassano del Grappa, Vicenza, Italy
| | - M Benazzo
- Department of Otolaryngology Head Neck Surgery, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - P Baptista
- Department of Otolaringology, Campus Universitario, University of Navarra, Pamplona, Spain
| | - F Salzano
- Otorhinolaryngologic Unit, San Giovanni di Dio e Ruggi d' Aragona University Hospital, Salerno, Italy
| | - I Dallan
- First Otorhinolaryngologic Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - S Nuzzo
- Biostatistics Unit, G.B. Morgagni - L. Pierantoni Hospital, Forlì - ASL of Romagna, Forli, Italy
| | - C Vicini
- Head and Neck Department, ENT & Oral Surgery Unit, G.B. Morgagni - L. Pierantoni Hospital, Forlì - Infermi Hospital, Faenza - ASL of Romagna, Forli, University of Ferrrara, Italy
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De Vito A, Meccariello G, Vicini C. Narrow band imaging as screening test for early detection of laryngeal cancer: a prospective study. Clin Otolaryngol 2016; 42:347-353. [PMID: 27542069 DOI: 10.1111/coa.12728] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To analyse the specificity and sensibility of narrow band imaging illumination technology in the early detection of laryngeal cancer in the patients' population without previous diagnosis of laryngeal cancer in a screening setting. DESIGN Unicentre, prospective study. SETTING One tertiary medical centre. PARTICIPANTS A total of 158 patients completed all protocol steps. MAIN OUTCOME MEASURES Sensitivity, specificity, positive and negative predictive values of narrow band imaging (NBI) in detecting precancerous lesions and early laryngeal cancer. RESULTS The blind assessment of NBI patterns concurred in 90% of patients. In identifying laryngeal cancer and its precursor lesions, in-office NBI showed a high sensitivity of 97% (CI, 84.2%-99.9%), specificity of 92.5% (CI, 79.6%-98.4%), PPV of 91.4% (CI, 76.9%-98.2%), NPV of 97.4% (CI, 86.2%-99.9%) and accuracy of 94.5% but intra-operative NBI demonstrated a sensitivity of 97% (CI, 84.2%-99.9%), a slightly higher specificity of 95% (CI, 83.1%-99.4%), PPV of 94.1% (CI, 80.3%-993%), NPV of 97.4% (CI, 86.5%-99.9%) and accuracy of 95.9%. The comparative receiver operating characteristic curves confirmed a slightly higher performance for the intra-operative NBI evaluation without any statistical significance (P = 0.41). CONCLUSIONS Our results confirm the high values of sensitivity and specificity of NBI system in detecting pre-neoplastic laryngeal lesions or early laryngeal cancer in a patients' population selected only by means of risk factors exposure and confirmed the potential role of NBI evaluation as in-office screening tool.
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Affiliation(s)
- A De Vito
- Head and Neck Department, Ear-Nose-Throat Unit, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - G Meccariello
- Head and Neck Department, Ear-Nose-Throat Unit, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - C Vicini
- Head and Neck Department, Ear-Nose-Throat Unit, Morgagni-Pierantoni Hospital, Forlì, Italy
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Vicini C, D'Agostino G, Meccariello G, De Virgilio A, Montevecchi F. Robotic-assisted surgery for the management of velopharyngeal insufficiency and nasopharyngeal stenosis. Clin Otolaryngol 2016; 42:1432-1434. [PMID: 26923571 DOI: 10.1111/coa.12633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2016] [Indexed: 10/22/2022]
Affiliation(s)
- C Vicini
- Department of Special Surgery, ENT and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - G D'Agostino
- Department of Special Surgery, ENT and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - G Meccariello
- Department of Special Surgery, ENT and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - A De Virgilio
- Department of Organs of Sense, ENT section, 'Sapienza University of Rome, Rome, Italy
| | - F Montevecchi
- Department of Special Surgery, ENT and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
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Mannelli G, Magnelli L, Deganello A, Busoni M, Meccariello G, Parrinello G, Gallo O. Detection of putative stem cell markers, CD44/CD133, in primary and lymph node metastases in head and neck squamous cell carcinomas. A preliminary immunohistochemical andin vitrostudy. Clin Otolaryngol 2015; 40:312-20. [DOI: 10.1111/coa.12368] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2014] [Indexed: 12/29/2022]
Affiliation(s)
- G. Mannelli
- First Clinic of Otorhinolaryngology Head and Neck Surgery; University of Florence; Azienda Ospedaliera Universitaria Careggi; Florence Italy
| | - L. Magnelli
- Department of Sperimental Pathology and Oncology Medical School; University of Florence; Florence Italy
| | - A. Deganello
- First Clinic of Otorhinolaryngology Head and Neck Surgery; University of Florence; Azienda Ospedaliera Universitaria Careggi; Florence Italy
| | - M. Busoni
- First Clinic of Otorhinolaryngology Head and Neck Surgery; University of Florence; Azienda Ospedaliera Universitaria Careggi; Florence Italy
| | - G. Meccariello
- First Clinic of Otorhinolaryngology Head and Neck Surgery; University of Florence; Azienda Ospedaliera Universitaria Careggi; Florence Italy
| | - G. Parrinello
- First Clinic of Otorhinolaryngology Head and Neck Surgery; University of Florence; Azienda Ospedaliera Universitaria Careggi; Florence Italy
| | - O. Gallo
- First Clinic of Otorhinolaryngology Head and Neck Surgery; University of Florence; Azienda Ospedaliera Universitaria Careggi; Florence Italy
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Nappi L, Meccariello G, Cazzato L, Barone I, Greco P. Spontaneous dichorionic diamniotic twin pregnancy in bicornis unicollis uterus. Eur J Obstet Gynecol Reprod Biol 2015; 191:142-3. [PMID: 26067451 DOI: 10.1016/j.ejogrb.2015.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 05/15/2015] [Indexed: 11/17/2022]
Affiliation(s)
- L Nappi
- Institute of Obstetrics and Gynaecology, University of Foggia, Via Luigi Pinto 1, 71100 Foggia, Italy
| | - G Meccariello
- Institute of Obstetrics and Gynaecology, University of Foggia, Via Luigi Pinto 1, 71100 Foggia, Italy.
| | - L Cazzato
- Institute of Obstetrics and Gynaecology, University of Foggia, Via Luigi Pinto 1, 71100 Foggia, Italy
| | - I Barone
- Institute of Obstetrics and Gynaecology, University of Foggia, Via Luigi Pinto 1, 71100 Foggia, Italy
| | - P Greco
- Institute of Obstetrics and Gynaecology, University of Foggia, Via Luigi Pinto 1, 71100 Foggia, Italy
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Santoro R, Bini B, Mannelli G, Meccariello G, Paiar F, Gallo O. Salvage surgery after unsuccessful radiotherapy in early glottic cancer. B-ENT 2014; 10:113-120. [PMID: 25090809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Surgery is the main therapeutic option to control recurrent laryngeal cancer after radiotherapy (RT) relapse. Most RT-recurred cancer is treated aggressively; although, conservative laryngeal surgery was attempted in selected cases. Here, we report our experiences with salvage laryngeal surgery for early glottic cancers that did not respond to RT. We analyzed files from 1980 to 2006 and selected 173 patients surgically treated for a RT-failed early glottic carcinoma (stage I-II according to 2010 TNM: 114 T1N0, 59 T2N0). Among them, 47 patients (27%) underwent a salvage partial laryngectomy (SPL) and 126 (73%) had a salvage total laryngectomy (STL). When compared with initial T staging, we found 61% of lesions were up-staged, 31% had the same staged lesion, and only 8% were down-staged (according to rTNM). No statistically significant differences were found in terms of disease-free survival and overall survival when SPL and STL patients were compared. Univariate analysis showed that T, rT, and rTNM were prognostic factors for overall survival (p = 0.045, p = 0.028, and p = 0.037, respectively); yet, these significances were lost in multivariate analysis. Our results suggest that salvage surgery is feasible in most cases of RT-recurred early glottic cancer; although, a conservative approach achieves good oncological and functional results only in select RT-recurred patients.
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Deganello A, Meccariello G, Busoni M, Parrinello G, Bertolai R, Gallo O. Dissection with harmonic scalpel versus cold instruments in parotid surgery. B-ENT 2014; 10:175-178. [PMID: 25675661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND The harmonic scalpel (HS) has been used successfully in several head and neck surgical procedures. Some authors highlighted its advantages in reducing operative time, blood loss, and damages to surrounding tissue. In our study, we compared the results obtained during parotidectomy using the HS with the traditional approach to determine the benefits of the HS. METHODS 130 patients with benign parotid tumors were enrolled and randomized into two groups for this prospective study. 63 patients underwent HS parotidectomy, and 67 patients received a parotidectomy using cold instruments and bipolar electrocautery hemostatic control (CI). 20 HS and 2 CI patients did not meet the inclusion criteria requirements, and were excluded. RESULTS The admission time was significantly shorter in the HS group than the CI group (3.9 ± 1.2 days and 4.7 ± 1.4 days, respectively, p < 0.01). In the early post-operative period, 84% of HS patients and 60% of CI cases showed no facial nerve impairment (p = 0.01). Significantly more CI patients than HS patients showed the onset of Frey's syndrome (29% and 9%, respectively, p = 0.01). Multivariate stepwise regression analysis confirmed the reduction in admission length (Odds Ratio (OR): 0.62; p = 0.02) and the lower risk of Frey's syndrome (OR: 0.29; p = 0.04) in HS compared to CI parotidectomies. CONCLUSIONS In parotid surgery, the HS is useful in preventing Frey's syndrome and reducing early transitory facial nerve dysfunction and admission times, and results in decreased medical costs and increased quality of life.
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Gallo O, Santoro R, Fiorini FR, Meccariello G, Laganà RM, Paiar F, Maio V. Prognostic role of internal jugular vein preservation in neck dissection for head and neck cancer. J Surg Oncol 2013; 108:579-83. [PMID: 24155132 DOI: 10.1002/jso.23436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 07/02/2013] [Accepted: 08/24/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVES Sparing internal jugular vein (IJV) in neck dissection for head and neck cancer is controversial. We aimed at evaluating the prognostic impact of IJV preservation. METHODS We examined 206 files of head and neck cancer patients who underwent radical or modified radical neck dissection at the Otolaryngology University of Florence. The site of primary tumor was larynx and hypopharynx in 44.66%, oropharynx in 25.24%, oral cavity in 23.3%, unknown in 4.85%, salivary glands and rhinopharynx in 0.97%. In 60.19% the IJV was resected, in 39.81% preserved. Prognostic impact of IJV preservation was assessed by Kaplan-Meier and multivariate analysis. RESULTS Neck recurrence occurred in 25.2%: the IJV was resected in 42.31%, in 57.69% preserved (P = 0.02). At multivariate analysis, neck recurrence resulted significantly associated to extracapsular spread (ECS) (P = 0.009), IJV preservation (P = 0.01), positive margins (P = 0.02). In ECS positive patients, a higher risk of neck recurrence was documented for IJV preservation (P = 0.012). A worse prognosis was observed for patients with IJV spared (P = 0.06). CONCLUSIONS IJV preservation is associated with an increased risk of neck failure and a worse outcome, mainly in patients with ECS of nodes.
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Affiliation(s)
- O Gallo
- Academic Clinic of Otolaryngology and Head and Neck Surgery, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
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Muratori E, Meccariello G, Deganello A, Mannelli G, Gallo O. Tonsillectomy and residents: a safe match? Clin Otolaryngol 2013; 38:279-80. [PMID: 23745541 DOI: 10.1111/coa.12122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2013] [Indexed: 11/30/2022]
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Mannelli G, Meccariello G, Deganello A, Maio V, Gallo O. PO-072: Subtotal Laryngectomy: New Surgical Devices Influence Techniques and Functional Results. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)34691-0] [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] [Indexed: 10/23/2022]
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