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Key points: ICA coil extrusion (ICA‐CE) occurs most frequently in the nasopharyngeal/sinonasal site.Evaluating the ICA coils stability, through an angiography, is of primary importance.ICA‐CE management needs to be decided based on the patient's symptoms and general status. [ABSTRACT FROM AUTHOR]

This article discusses a study on fungal sinus aspergilloma (FSA), a rare condition characterized by the presence of fungal growth in the sinuses. The study included six patients with FSA and found that the frontal sinus was involved in one patient, while bilateral infection was reported in another case. The most common symptom was headache. The study also compared the incidence of bone erosion in FSA with other types of fungal sinusitis and found that FSA had a higher incidence of bone erosion. The authors suggest that recognizing the radiological features of FSA and obtaining tissue samples for analysis are important for accurate diagnosis and treatment planning. [Extracted from the article]

Key points: Nasoseptal flap with extended pedicle dissection is a low morbidity and high success rate flap.It is a flap that can be applied to reconstruct a wide range of ipsilateral skull base defects. [ABSTRACT FROM AUTHOR]

Key Points Intralesional cidofovir injections in combination with surgery is an effective treatment for recurrent multifocal sinonasal exophytic papilloma. No malignant transformation has been observed in our experience. Anosmia is a potential side effect that patients should be aware of. [ABSTRACT FROM AUTHOR]

Background: Iatrogenic cerebrospinal fluid leak (iCSF-L) is a major complication of endonasal surgeries whose occurrence is always a potential adverse event due to anatomical variation/asymmetry of the skull base (SB). The aim of this manuscript is to provide a topographical map of iCSF-L and to investigate the role of SB asymmetry in iCSF-L occurrence. Methods: In this retrospective study, the location of iCSF-L dural defect was studied and compared to patients affected by spontaneous and post-traumatic CSF-L. Considering only iCSF-L, after having collected the SB asymmetry data, the Keros, Gera, distance of the anterior ethmoidal artery from the SB, frontal sinus pneumatization, and Thailand–Malaysia–Singapore score classifications were compared to a control group of patients. Results: A total of 153 CSF-Ls (103 spontaneous, 37 iatrogenic, and 13 traumatic) were included. A significant association was noted (p < 0.001) between the nature of the CSF-L and the areas involved. Considering iCSF-Ls, only the Gera classification was significantly different (p < 0.05) and the most reliable in predicting the risk of dural transgression (AUC = 0.719). Conclusions: ICSF-Ls present peculiar regional SB involvement with the cribriform plate, with the ethmoidal roof being the most involved. After having assessed the asymmetry of the SB, the Gera classification was the most reliable one. [ABSTRACT FROM AUTHOR]

Inversion of time‐lapse electrical resistivity tomography is an extension of the conventional electrical resistivity tomography inversion that aims to reconstruct resistivity variations in time. This method is widely used in monitoring subsurface processes such as groundwater evolution. The inverse problem is usually solved through deterministic algorithms, which usually guarantee a fast solution convergence. However, the electrical resistivity tomography inverse problem is ill‐posed and non‐linear, and it could exist more than one resistivity model that explains the observed data. This paper explores a Bayesian approach based on data assimilation, the ensemble smoother multiple data assimilation. In particular, we apply an adaptive approach in which the inflation coefficient is chosen based on the error function, that is the ensemble smoother multiple data assimilation restricted step. Our inversion approach aims to invert the data acquired at two different times simultaneously, estimating the resistivity model and its variation. In addition, the Bayesian approach allows for the assessment of the posterior probability density function needed for quantifying the uncertainties associated with the results. To test the method, we first apply the algorithm to synthetic data generated from realistic resistivity models; then, we invert field data from the Pillemark landfill monitoring station (Samsø, Denmark). Inversion results show that the ensemble smoother multiple data assimilation restricted step can correctly detect the resistivity variation both in the synthetic and in the field case, with an affordable computational burden. In addition, assessing the uncertainties allows us to interpret the reconstructed resistivity model correctly. This paper demonstrates the potential of the data assimilation approach in Bayesian time‐lapse electrical resistivity tomography inversion. [ABSTRACT FROM AUTHOR]

Purpose: Inverted papilloma of the sphenoid sinus (IPSS) is a rare tumor with debated surgical management due to its proximity to vital structures. The aim of this manuscript is to highlight the role of a transpterygoid approach (TPA) and pedicle-orientated strategy in case of involvement of critical structures in IPSS and compare it with data from the literature. Methods: Patients with primary IPSS between January 2000 and June 2021 were included. Pre-operative CT/MRI were analyzed to classify the pneumatization of the SS and predict the insertion point of the inverted papilloma. All patients were treated with a trans-sphenoidal approach which was combined with a TPA in case of lateral insertion point. A systematic search was also performed to summarize the available literature. Results: Twenty-two patients were treated for IPSS. By CT, the SS was categorized with type III pneumatization in 72.8% of cases. Eleven patients (50%) were treated with a TPA with a statistical association with the insertion point on the SS lateral wall (p = 0.01), rather than a SS pneumatization (p = 0.63). The overall success was 95.5% after a mean follow-up of 35.9 months. For the literature, 26 publications were included on 97 patients and described a trans-sphenoidal approach with a success rate of 84.6% after a mean follow-up of 24.5 months. Conclusion: IPSS is generally treated with a sphenoidotomy approach, although in selected cases, a TPA should be preferred to expose the whole SS lateral wall though allowing a complete pedicled oriented resection of the tumor. [ABSTRACT FROM AUTHOR]

Keywords: chronic rhinosinusitis; endoscopic sinus surgery; maxillectomy; paranasal sinus diseases EN chronic rhinosinusitis endoscopic sinus surgery maxillectomy paranasal sinus diseases 1051 1054 4 05/29/23 20230601 NES 230601 INTRODUCTION Transnasal endoscopic medial maxillectomies (EMMs) are widely used to treat inverted papilloma of the maxillary sinus (IPMS). Chronic rhinosinusitis, endoscopic sinus surgery, maxillectomy, paranasal sinus diseases The aim of this study was to compare the postoperative pain, nasal symptoms burden, and complications in patients treated with EMM or EPLA for IPMS. [Extracted from the article]

(1) Background: In head and neck squamous cell carcinoma, tumor hypoxia has been associated with radio/chemoresistance and poor prognosis, whereas human papillomavirus (HPV)-positive status has a positive impact on treatment response and survival outcomes. The aim of this study was to evaluate the expression and the potential prognostic value of hypoxia-induced endogenous markers in patients treated for squamous cell carcinoma of the nasal cavity and paranasal sinuses (SNSCC), and their correlation with HPV status. (2) Methods: In this monocentric study, patients treated in a curative intent for a SNSCC were screened retrospectively. Protein expression of CA-IX, GLUT-1, VEGF, VEGF-R1, and HIF-1α was determined by immunohistochemical staining, scored, and then correlated with overall survival (OS) and locoregional recurrence free survival (LRRFS). HPV status was assessed and correlated with hypoxic markers. (3) Results: 40 patients were included. A strong expression of CA-IX, GLUT-1, VEGF, and VEGF-R1 was detected in 30%, 32.5%, 50%, and 37.5% of cases, respectively. HIF-1α was detected in 27.5% of cases. High CA-IX expression was associated in univariate analysis with poor OS (p = 0.035), but there was no significant association between GLUT-1, VEGF, VEGF-R1, and HIF-1α expression, and OS/LRRFS. There was no correlation found between HPV status and hypoxia-induced endogenous markers (all p > 0.05). (4) Conclusions: This study provides data on the expression of hypoxia-induced endogenous markers in patients treated for SNSCC and underlines the potential role of CA-IX as a prognostic biomarker for SNSCC. [ABSTRACT FROM AUTHOR]

Aims: The aim of the present study is to evaluate the clinical applicability of laser energy during an oro-nasal endoscopic approach (ONEA) in the management of the anterior maxillary sinus wall. Methods: An experiment on three adult human cadavers was performed to study the nasal cavities with angled rigid scopes and using the ONEA technique. In order to evaluate the effectiveness of laser energy on the bone, the drilling effect was compared to laser energy (1470 nm diode laser, continuous wave, power 8, 9 and 10 W). Results: Compared to a rigid angled scope, the ONEA technique allowed complete visualization of the anterior wall of the maxillary sinus. Microscopic analysis of frontal bone revealed similar bone Exeresis with high-speed drilling (270.28 μm) and laser approaches (285.73–456.6 μm). Conclusions: The laser ONEA technique is an innovative, mini-invasive, and safe approach to the anterior wall of the maxillary sinus. Additional study is warranted to further develop this technique. [ABSTRACT FROM AUTHOR]

Purpose: To compare international and regional guidelines for prescription and monitoring of response to biologics in chronic rhinosinusitis with nasal polyps (CRSwNP). Methods: A literature review was performed to identify publications reporting indications for biologic therapy in CRSwNP. A full-text reading identified specific issues for comparison: prior surgery, evidence of type 2 inflammation (T2I), smell function, comorbidities, use of systemic corticosteroids, impact on quality of life, and endoscopic and CT findings were compared for the prescription, while the monitoring of the treatment was described in relation to timing, classification of response and criteria for withdrawal. Results: Ten publications were found. Prior surgery was strictly necessary in five guidelines, while in all the remaining it was variably recommended. A confirmation of T2I was considered necessary in one publication, unnecessary in two, and recommended or constituted only one of the factors to consider in seven. All the other issues analyzed were variably considered. Reevaluation was suggested at 4–6 months and 1 year, mostly assessing improvement in the same criteria used for prescription. Conclusions: A combination of subjective and objective findings is used for the identification of patients with CRSwNP who are indicated for biologic therapy. Major debate has developed on the need for previous surgery, which is generally recommended, or strictly necessary for some authors. Confirmation of T2I is generally suggested, but compulsory only in a minority of guidelines. Smell function, use of systemic corticosteroids, and the impact on quality of life are the other factors most frequently considered. [ABSTRACT FROM AUTHOR]

Purpose: Biological therapies are gaining relevance in the management of CRSwNP with few adverse events reported. Among these, dupilumab, an anti-IL4-Ra monoclonal antibody, is frequently associated with hypereosinophilia (HE) which usually remains silent and progressively resolves, although some cases of systemic involvement occurs. The aim of this paper is to describe our experience and propose a management flowchart for HE during therapy with dupilumab. Methods: Patients with CRSwNP who satisfied EPOS2020 criteria for biological therapies were included in this prospective study. Each case was discussed in a multidisciplinary meeting with subsequent prescription of dupilumab; all patients were candidates to follow-up bi-monthly for 6 months, while additional blood tests were scheduled in the event of HE. Results: A total of 21 patients with a mean age of 48.4 years were enrolled. Of these, 15 of 21 presented an asthma comorbidity and 9 of 21 ASA sensitivity. Four patients (19%) developed HE with AEC > 1.5 × 109/L, whereas it occurred in 9.5% (two patients) if considered AEC > 3 × 109/L. No cases of hypereosinophilic syndrome were recorded. Following our decision-making flowchart, two patients received short-term corticosteroid therapy, whereas the other two were only eligible for closer follow-up. Conclusions: During dupilumab therapy, HE may occur and should be considered benign when < 3 × 109/L in the absence of organ involvement. Conversely, in case of HE ≥ 3 × 109/L, an empirical approach with short-term corticosteroid therapy should be considered to debulk the blood from eosinophils and prevent potential organ involvement. [ABSTRACT FROM AUTHOR]

This article is a response to a letter discussing the potential use of cidofovir in the treatment of sinonasal squamous papillomas. The authors acknowledge the promise of topical drug approaches in the field of rhinology and highlight other topical treatments that have been explored for various sinonasal conditions. They note that while the case presented in the letter is interesting, longer follow-up is needed to assess the long-term efficacy of topical treatment. Overall, the article provides valuable insights into the potential use of topical cidofovir and emphasizes the need for further research in this area. [Extracted from the article]

This document is a reply to a letter discussing the potential use of topical cidofovir for the treatment of sinonasal papillomas. The authors acknowledge the promising results presented in the letter but emphasize the need for longer follow-up to assess the long-term efficacy of topical treatment. They also mention other topical applications that have been explored for various sinonasal conditions. The authors provide their contact information for further correspondence. [Extracted from the article]

Objective: Petrous apex cholesterol granuloma (PACG) is a lesion that can give rise to different symptoms, and correlations with etiopathology are ambiguous. The aim of this study is to analyze the association between PACG symptoms and radiological findings at presentation, in order to establish a reproduceable pre-operative radiological evaluation and guide the surgical indication. Methods: PACG patients were collected in two tertiary care hospitals. All cases underwent CT/MRI to evaluate the cyst localization and erosion of surrounding structures. Typical and atypical symptoms were then analyzed and compared to radiologic findings established in accordance with the literature. Results: Twenty-nine patients were recruited; the most common symptoms were headache (69%), diplopia (20.7%) and fainting (24.1%), an atypical clinical manifestation related to jugular tubercle involvement. Significant associations between symptoms and radiologic findings were noted in terms of headache and temporal lobe compression (p = 0.04), fainting and jugular tubercle erosion (p < 0.001), vestibular symptoms and internal auditory canal erosion (p = 0.02), facial paresthesia and Meckel's cave compression (p = 0.03), diplopia and Dorello canal involvement (p = 0.001), and tinnitus and cochlear basal turn erosion (p < 0.001). All patients were treated via an endoscopic–endonasal approach, in which extension was tailored to each case. At a median follow-up of 46 months, 93.1% of patients experienced resolution of symptoms. Conclusions: This clinico-radiological series demonstrates associations between symptoms and anatomical subsites involved with PACG. Hence, it may guide the surgeon at the time of surgical decision, since it asserts that typical and atypical symptoms are actually related to PACG. [ABSTRACT FROM AUTHOR]

Casting a geophysical inverse problem into a Bayesian setting is often discouraged by the computational workload needed to run many forward modelling evaluations. Here we present probabilistic inversions of electrical resistivity tomography data in which the forward operator is replaced by a trained residual neural network that learns the non‐linear mapping between the resistivity model and the apparent resistivity values. The use of this specific architecture can provide some advantages over standard convolutional networks as it mitigates the vanishing gradient problem that might affect deep networks. The modelling error introduced by the network approximation is properly taken into account and propagated onto the estimated model uncertainties. One crucial aspect of any machine learning application is the definition of an appropriate training set. We draw the models forming the training and validation sets from previously defined prior distributions, while a finite element code provides the associated datasets. We apply the approach to two probabilistic inversion frameworks: A Markov chain Monte Carlo algorithm is applied to synthetic data, while an ensemble‐based algorithm is employed for the field measurements. For both the synthetic and field tests, the outcomes of the proposed method are benchmarked against the predictions obtained when the finite element code constitutes the forward operator. Our experiments illustrate that the network can effectively approximate the forward mapping even when a relatively small training set is created. The proposed strategy provides a forward operator that is three orders of magnitude faster than the accurate but computationally expensive finite element code. Our approach also yields the most likely solutions and uncertainty quantifications comparable to those estimated when the finite element modelling is employed. The presented method allows solving the Bayesian electrical resistivity tomography with a reasonable computational cost and limited hardware resources. [ABSTRACT FROM AUTHOR]

Purpose: Endoscopic endonasal balloon-assisted dacryoplasty is a minimally invasive surgical approach that can be applied after failure of dacryocystorhinostomy with recurrence of distal acquired lacrimal obstruction. Methods: At the Department of Otolaryngology, San Raffaele Hospital, Milan (Italy), from December 2016 to October 2020, 14 patients underwent trans-nasal balloon-assisted dacryoplasty after a failed dacryocystorhinostomy (both external and endoscopic endonasal). The routinary pre-operative work-up included multidisciplinary study of the lacrimal disease, which consisted in primary ophthalmological and otorhinolaryngological visits associated with nasal endoscopy, in which a radiological exam was added if needed. The surgical approach includes pneumatic enlargement of the stenotic rhinostomy, created during the primary dacryocystorhinostomy, using a high-pressure trans-nasal balloon catheter. Anatomical success was considered when the ostium was patent upon irrigation, while functional success was considered as resolution of epiphora or free lacrimal flow on functional test. Results: Among 14 patients included and after a mean follow-up of 19.5 months (range 13–51 months), anatomic success was achieved in 100% of patients and functional success was achieved in the 85.7% (12/14). Operative time ranged from 9 to 28 min (mean 18 min) and no complications were reported. Conclusion: Trans-nasal balloon-assisted dacryoplasty is a mini-invasive surgical approach to treat failed dacryocystorhinostomies with reliable and stable outcomes in the long term. The absence of post-surgical complications, high success rate and short operative time are the main features of this innovative procedure. [ABSTRACT FROM AUTHOR]

Purpose: Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) is a common disease, which was previously approached with sinus surgery or systemic corticosteroids. The advent of biological therapies radically changed the approach to this disease. On the other hand, there is scarce scientific evidence of how specific subsets of patients respond to this treatment. Methods: this is a monocentric, prospective study investigating the long-term efficacy on biweekly 300 mg dupilumab therapy in CRSwNP, prescribed to 61 patients. Patients were evaluated at baseline and every 2 months for the first 6 months, then at 9, 12, 16, 20 and 24 months. Results: dupilumab proved to be an effective treatment, neatly improving both subjective and objective measurements in CRSwNP. The main finding of the study is the difference between specific subgroups of patients: while the overall response is similar, patients with Th2 comorbidities such as asthma and atopy tend to reach a stable response later, with the improvement ongoing even after 6 months of therapy, while non-asthmatic, non-atopic patients attain an earlier stability in response. Conclusions: dupilumab provides an excellent long-term control of CRSwNP, but the response in asthmatic and atopic patients appears to be different and delayed when compared to non asthmatic and non atopic ones. [ABSTRACT FROM AUTHOR]

Purpose: To describe and analyse functional treatment of temporal bone chondroblastoma (TBCh). Methods: From January 2000 to June 2019, at the Department of Otorhinolaryngology, Hôpital Lariboisière, Paris, France, patients with TBCh were enrolled in this study. All cases routinely performed pre-operatory work-up including evaluation of performance status, audio-vestibular function test, ear endoscopy, contrasted CT scan and MRI of head and neck region; in one case we also performed an angio-CT scan. All patients underwent resection of the tumour with a "functional" approach Results: Three male patients (mean age 46,6 years)—two primary tumours and one recurrence—were treated. In all three cases the tumour invaded the middle ear with a variable degree of hearing loss and infiltration of temporal bone structures. All surgeries were performed with a microscopic approach associated with open/endoscopic approach when necessary. Inner ear and facial nerve were speared in all cases and the TMJ was partially resected in 2 cases due to its moderate involvement. At present, after a mean follow-up of 103 months (range 40–225 months), only one case presented recurrence which has been successfully treated with radiotherapy. Conclusions: Our results of treatment suggest that functional surgery can be relevant in the management of TBCh since it is focused on both treatment of this pathology and maintenance of a good quality of life. [ABSTRACT FROM AUTHOR]

Endonasal balloon‐assisted dacryoplasty is a minimally invasive technique that uses a high‐pressure balloon catheter introduced into the lacrimal pathway through the nasal fossa into the neorhinostomy to treat recurrent epiphora after primary dacryocystorhinostomy. This procedure can be considered to be a reliable technique in patients unfit for general anesthesia. [ABSTRACT FROM AUTHOR]

Background: Epiphora is a common clinical sign whose primary cause is post‐canalicular lacrimal obstruction. Treatment is both surgical and non‐surgical. In the literature, there is some evidence to suggest that some treatments are superior to others, but there are no direct comparative data in this regard. Objective of review: To analyse the success rates of all available treatments to resolve post‐canalicular acquired lacrimal obstruction. Type of review: Systematic review and meta‐analysis. Search strategy: A literature search was conducted in the US National Library of Medicine (PubMed), EMBASE, SCOPUS and Cochrane databases with a final search performed in January 2020. Evaluation method: The search strategy identified articles published later than 2000 with at least 50 procedures performed both surgically (external dacryocystorhinostomy [EXT‐DCR], endoscopic dacryocystorhinostomy [END‐DCR] and transcanalicular laser dacryocystorhinostomy [TCL‐DCR]) and non‐surgically (balloon dacryoplasty [DCP], probing‐stenting [SP] and polyurethane stent [PoS]). The primary outcome was functional success, defined as symptom resolution or less than MUNK 2 scale; in addition to this, the influence of adjunctive treatments, such as application of mitomycin C and post‐procedural silicone stenting, was evaluated. Results: In total, 14 958 papers were selected, 440 of which were reviewed after screening; 55 were included after full‐text review, which involved 9337 procedures. Mean success rate was 48.9% (35.7%‐62.3%) for DCP, 54.4% (41.8%‐66.5%) for SP, 73.6% (59.7%‐84%) for PoS, 80% (75.1%‐84%) for TCL‐DCR, 89.8% (83.3%‐93.9%) for EXT‐DCR and 89.5% (87.2%‐91.5%) for END‐DCR. Among all procedures, a difference was noted between DCP and END‐DCR (P <.001), DCP and EXT‐DCR (P <.001), SP and END‐DCR (P <.001), SP and EXT‐DCR (P <.001), END‐DCR and PoS (P =.016), and END‐DCR and TCL‐DCR (P =.001); no differences were noted between END‐DCR and EXT‐DCR (P = 1.00), EXT‐DCR and PoS (P =.121) and EXT‐DCR and TCL‐DCR (P =.223). Considering surgical procedures, no differences were seen if a silicone stenting was applied, whereas, due to heterogeneity of the literature data, no statistical analysis was feasible for application of mitomycin C. Conclusions: Our analyses suggest that, among all procedures available, END‐DCR and EXT‐DCR should be considered as treatments of choice to resolve distal acquired lacrimal obstruction. [ABSTRACT FROM AUTHOR]

Key points: In a limited subset of patients, dupilumab‐induced hypereosinophilia is persistent.Two‐month follow‐up eosinophil count may predict long‐lasting hypereosinophilia. [ABSTRACT FROM AUTHOR]

Electrical resistivity tomography (ERT) is an ill-posed and non-linear inverse problem commonly solved through deterministic gradient-based methods. These algorithms guarantee fast convergence toward the final solution but hinder accurate uncertainty assessments. On the contrary, numerical Markov Chain Monte Carlo algorithms provide accurate uncertainty appraisals but at the expense of a considerable computational effort. In this work, we develop a novel approach to ERT that guarantees an extremely fast inversion process and reliable uncertainty appraisals. The implemented method combines a Discrete Cosine Transform (DCT) reparameterization of data and model spaces with a Convolutional Neural Network. The CNN is employed to learn the inverse non-linear mapping between the DCT-compressed data and the DCT-compressed 2-D resistivity model. The DCT is an orthogonal transformation that here acts as an additional feature extraction technique that reduces the dimensionality of the input and output of the network. The DCT also acts as a regularization operator in the model space that significantly reduces the number of unknown parameters and the ill-conditioning of the inversion procedure, thereby preserving the spatial continuity of the resistivity values in the recovered solution. The estimation of model uncertainties is a key step of geophysical inverse problems and hence we implement a Monte Carlo simulation framework that propagates onto the estimated model the uncertainties related to both noise contamination and network approximation (the so-called modeling error). We first apply the approach to synthetic data to investigate its robustness in case of erroneous assumptions on the noise and model statistics used to generate the training set. Then, we demonstrate the applicability of the method through inverting real data measured along a river embankment. We also demonstrate that transfer learning avoids retraining the network from scratch when the statistical properties of training and target sets are different. Our tests confirm the suitability of the proposed approach, opening the possibility to estimate the subsurface resistivity values and the associated uncertainties in near real-time. • A convolutional neural network inversion approach applied to ERT. • Discrete Cosine Transform reparameterization of data and model spaces. • A Monte Carlo simulation framework for uncertainty assessment. • Synthetic and real data inversions demonstrate the applicability of the approach. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to describe the use of near-infrared autofluorescence (NIR-AF) to identify and preserve parathyroid glands (PGs) in a group of patients with advanced hypopharyngeal/laryngeal cancer undergone total (pharyngo)laryngectomy with hemi- or total thyroidectomy. Methods: At San Raffaele Hospital, Milan (Italy), from January 2021 to May 2021, 7 patients affected by cT4a laryngeal squamous cell carcinoma (SCC) underwent surgery using an autofluorescence detection system (Fluobeam–Fluoptics®). For proper surgical planning, the demolition phase envisaged extension of the intervention to 4 hemithyroidectomies and 3 total thyroidectomies associated, respectively, with homolateral or bilateral CCND. Serum calcium, ionized calcium, and parathyroid hormone (PTH) levels at post-operative day (POD) 1 and 2 and at 2 weeks after surgery were monitored. Finally, we compared the data obtained with a cohort of patients who underwent surgery without the adoption of NIR-AF. Results: With the use of NIR-AF, 18/20 PGs were identified, of which 7/18 were preserved exclusively thanks to the use of autoflorescence. The technique also made it possible to identify and isolate three PGs from the surgical specimen, which were subsequently transplanted only after intraoperative histological confirmation. On POD-1, 3/7 patients (42.8%) were hypocalcemic; on POD-2 and after 2 weeks only 1/7 patient (14.2%) was hypocalcemic. Comparing the two groups, we highlighted that the utilization of NIR-AF was related to a significant decrease of median serum (p = 0.026) and ionized calcium levels (p = 0.017) 2 weeks after surgery. Using this new technology, in no case did definitive histological examination reveal the presence of PGs in the surgical specimen, reaching an accuracy of 100%. Conclusions: In our cohort of patients who underwent total (pharyngo)laryngectomy with hemi- or total thyroidectomy, the use of near-infrared autofluorescence improved medium term postoperative hypocalcemia rates. This new technology helps to achieve a better calcemic outcome compared to the standard naked eye approach, since it helps the surgeon to identify and preserve parathyroid glandular tissue with a lower incidence of post-operative hypocalcemia. [ABSTRACT FROM AUTHOR]

Treatment options for severe CRSwNP are limited. Dupilumab is a safe, well‐tolerated, and effective alternative in patients with poor control of symptoms, corticosteroid‐dependent disease, and high rates of recurrence of nasal polyps after surgery. [ABSTRACT FROM AUTHOR]

• Surgical navigation (SN) can improve disease extension and margin status assessment. • The spatial error in the localization of anatomical structures approaches 1 cm. • This error could affect treatment precision and outcomes. • SN can potentially increase spatial precision and information sharing. Recent evidence supports the efficacy of surgical navigation (SN) in improving outcomes of sinonasal and craniofacial oncologic surgery. This study aims to demonstrate the utility of SN as a tool for integrating surgical, radiologic, and pathologic information. Additionally, a system for recording and mapping biopsy samples has been devised to facilitate sharing of spatial information. SN was utilized for biopsy mapping in 10 sinonasal/craniofacial oncologic procedures. Twenty-five raters with experience in anterior skull base oncology were interviewed to identify 15 anatomical structures in preoperative imaging, relying on topographical descriptions and surgical video clips. The difference in the localization of anatomical structures by raters was analyzed, using the SN-mapped coordinates as a reference (this difference was defined as spatial error). The analysis revealed an average spatial error of 9.0 mm (95 % confidence interval: 8.3–9.6 mm), with significant differences between surgeons and radiation oncologists (7.9 mm vs 12.5 mm, respectively, p < 0.0001). The proposed model for transferring SN-mapped coordinates can serve as a tool for consultation in multidisciplinary discussions and radiotherapy planning. The current standard method to evaluate disease extension and margin status is associated with a spatial error approaching 1 cm, which could affect treatment precision and outcomes. The study emphasizes the potential of SN in increasing spatial precision and information sharing. Further research is needed to incorporate this method into a multidisciplinary workflow and measure its impact on outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Accurate diagnosis and quantification of polyps and symptoms are pivotal for planning the therapeutic strategy of Chronic rhinosinusitis with nasal polyposis (CRSwNP). This pilot study aimed to develop an artificial intelligence (AI)-based image analysis system capable of segmenting nasal polyps from nasal endoscopy videos.Recorded nasal videoendoscopies from 52 patients diagnosed with CRSwNP between 2019 and 2022 were retrospectively analyzed. Images extracted were manually segmented on the web application Roboflow. A dataset of 342 images was generated and divided into training (80%), validation (10%), and testing (10%) sets. The Ultralytics YOLOv8.0.28 model was employed for automated segmentation.The YOLOv8s-seg model consisted of 195 layers and required 42.4 GFLOPs for operation. When tested against the validation set, the algorithm achieved a precision of 0.91, recall of 0.839, and mean average precision at 50% IoU (mAP50) of 0.949. For the segmentation task, similar metrics were observed, including a mAP ranging from 0.675 to 0.679 for IoUs between 50% and 95%.The study shows that a carefully trained AI algorithm can effectively identify and delineate nasal polyps in patients with CRSwNP. Despite certain limitations like the focus on CRSwNP-specific samples, the algorithm presents a promising complementary tool to existing diagnostic methods.Methods: Accurate diagnosis and quantification of polyps and symptoms are pivotal for planning the therapeutic strategy of Chronic rhinosinusitis with nasal polyposis (CRSwNP). This pilot study aimed to develop an artificial intelligence (AI)-based image analysis system capable of segmenting nasal polyps from nasal endoscopy videos.Recorded nasal videoendoscopies from 52 patients diagnosed with CRSwNP between 2019 and 2022 were retrospectively analyzed. Images extracted were manually segmented on the web application Roboflow. A dataset of 342 images was generated and divided into training (80%), validation (10%), and testing (10%) sets. The Ultralytics YOLOv8.0.28 model was employed for automated segmentation.The YOLOv8s-seg model consisted of 195 layers and required 42.4 GFLOPs for operation. When tested against the validation set, the algorithm achieved a precision of 0.91, recall of 0.839, and mean average precision at 50% IoU (mAP50) of 0.949. For the segmentation task, similar metrics were observed, including a mAP ranging from 0.675 to 0.679 for IoUs between 50% and 95%.The study shows that a carefully trained AI algorithm can effectively identify and delineate nasal polyps in patients with CRSwNP. Despite certain limitations like the focus on CRSwNP-specific samples, the algorithm presents a promising complementary tool to existing diagnostic methods.Results: Accurate diagnosis and quantification of polyps and symptoms are pivotal for planning the therapeutic strategy of Chronic rhinosinusitis with nasal polyposis (CRSwNP). This pilot study aimed to develop an artificial intelligence (AI)-based image analysis system capable of segmenting nasal polyps from nasal endoscopy videos.Recorded nasal videoendoscopies from 52 patients diagnosed with CRSwNP between 2019 and 2022 were retrospectively analyzed. Images extracted were manually segmented on the web application Roboflow. A dataset of 342 images was generated and divided into training (80%), validation (10%), and testing (10%) sets. The Ultralytics YOLOv8.0.28 model was employed for automated segmentation.The YOLOv8s-seg model consisted of 195 layers and required 42.4 GFLOPs for operation. When tested against the validation set, the algorithm achieved a precision of 0.91, recall of 0.839, and mean average precision at 50% IoU (mAP50) of 0.949. For the segmentation task, similar metrics were observed, including a mAP ranging from 0.675 to 0.679 for IoUs between 50% and 95%.The study shows that a carefully trained AI algorithm can effectively identify and delineate nasal polyps in patients with CRSwNP. Despite certain limitations like the focus on CRSwNP-specific samples, the algorithm presents a promising complementary tool to existing diagnostic methods.Conclusions: Accurate diagnosis and quantification of polyps and symptoms are pivotal for planning the therapeutic strategy of Chronic rhinosinusitis with nasal polyposis (CRSwNP). This pilot study aimed to develop an artificial intelligence (AI)-based image analysis system capable of segmenting nasal polyps from nasal endoscopy videos.Recorded nasal videoendoscopies from 52 patients diagnosed with CRSwNP between 2019 and 2022 were retrospectively analyzed. Images extracted were manually segmented on the web application Roboflow. A dataset of 342 images was generated and divided into training (80%), validation (10%), and testing (10%) sets. The Ultralytics YOLOv8.0.28 model was employed for automated segmentation.The YOLOv8s-seg model consisted of 195 layers and required 42.4 GFLOPs for operation. When tested against the validation set, the algorithm achieved a precision of 0.91, recall of 0.839, and mean average precision at 50% IoU (mAP50) of 0.949. For the segmentation task, similar metrics were observed, including a mAP ranging from 0.675 to 0.679 for IoUs between 50% and 95%.The study shows that a carefully trained AI algorithm can effectively identify and delineate nasal polyps in patients with CRSwNP. Despite certain limitations like the focus on CRSwNP-specific samples, the algorithm presents a promising complementary tool to existing diagnostic methods. [ABSTRACT FROM AUTHOR]

Purpose: To describe our personal experience during aclassic complete thyroidectomy adopting both intraoperative neural monitoringand near-infrared autofluorescence. Methods: In October 2021, 20 patients underwent totalthyroidectomy for benign and malignant conditions: 13 patients were affected bymultinodular goiter, 2 by Graves' disease, and 5 by indeterminate lesions (3Tir-3B and 2 Tir-3A). For each patient, intraoperative neural monitoring of therecurrent laryngeal nerve and near-infrared autofluorescence were used. Results: Overall, 76/80 (95.0%) parathyroid glands weredetected: 34/76 (44.7%) were identified by the surgeon during the dissection,while 42/76 (55.3%) were detected by the near-infrared camera before thesurgeon saw them with naked eye. Indocyanine green angiography was adopted inall the patients, and in 2 cases, parathyroid gland autotransplantation wasperformed since 2 parathyroid glands resulted devascularized after dissection.Operative time ranged from 113 to 201 min (mean 156 min). Conclusion: Together with intraoperative neural monitoring,near-infrared autofluorescence is a reliable device in thyroid surgery. Furtherprospective studies are necessary to establish if the adoption ofautofluorescence may result in long-term benefit in terms of calcemia. [ABSTRACT FROM AUTHOR]