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Head and neck squamous cell carcinoma of the (HNSCC) represents approximately 5% of malignant tumours in Italy. HNSCC are commonly treated with surgery or radiotherapy, or a combination of such therapies. The objectives of treatment are maximum cure rate balanced with organ preservation, restoration of form and function, reduction of morbidities and improvement or maintenance of the patient's quality of life. Immediate reconstructive surgery: local, regional or free flaps are now widely advised in the treatment of these patients. Microsurgical transfer requires expertise, is time and resource consuming, and as a whole requires substantial costs. These considerations introduce some concerns about the wide or indiscriminate use of free flap reconstructive surgery. When considering cost-benefit outcomes of such treatment, the main objective is undoubtedly, survival. This data is underreported in the current literature, whereas functional outcomes of free flaps have been largely diffused and accepted. This study collects data from 1178 patients treated with free flap reconstructive surgery following ablation of HNSCC in a group of Italian tertiary hospitals, all members of the Head & Neck Group affiliated with the Italian Society of Microsurgery. According to many authors, free flap surgery for HNSCC seems to be a beneficial option for treatment even in terms of survival.

A pectoralis major myofascial flap (PMMF) is a simple variant of the pectoralis major myocutaneous flap (PMMC), and allows avoiding some of the disadvantages of Ariyan's technique while reducing well-known, overall complications. This is a retrospective analysis of 45 hypopharyngeal reconstructions (40 immediate reconstructions after subtotal pharyngolaryngectomy and 5 performed during revision surgery) using PMMF flap, performed from February 1995 to February 2008 in the Department of Otolaryngology at the "San Camillo- Forlanini" Hospitals in Rome, in collaboration with the Department of Plastic Surgery. In our series, we observed postoperative flap-related complications in 6.7% of cases. The incidence of major flap complications requiring surgical revision was 2.2%. Two minor complications were seen: hypopharyngeal stenosis and a salivary fistula, both of which were managed without surgery. Total or partial necrosis did not occur in any case. There were four postoperative deaths, but which were not related to flap complications in any case. In the remaining cases, oesophageal X-ray imaging showed the absence of fistulas and adequate calibre of the reconstructed tract; oral intake started within postoperative day 10-12, without swallowing problems of liquid or solid food. Postoperative radiotherapy performed in 30 patients was well tolerated. The PMMF flap is safe one-step procedure with low morbidity that is particularly useful for partial hypopharyngeal reconstructions, overcoming the disadvantages of the PMMC flap and offering comparable results to fasciocutaneous free flaps.

In spite of the amount of literature demonstrating the relationship between upper and lower airways, both from the anatomical, and pathophysiological point of view, little is known about the epidemiology, diagnosis and treatment of the Rhino-Bronchial Syndrome (RBS). After the publication, in 2003, of a Consensus Report defining the Rhino-Bronchial Syndrome, an interdisciplinary group of experts made up from the Italian ENT Society (SIO) and the Interdisciplinary Scientific Association for the Study of Respiratory Diseases (AIMAR) met again in 2005 in order to study a protocol which would have, as the main tasks, the analysis of RBS signs and symptoms and standardization of the diagnostic approach. A secondary endpoint was to characterize the most effective therapeutic options and to correct the great dyshomogeneity in the therapeutic approaches. With this aim, 9 ENT and Pneumology Centres were selected, based on the ability to multidisciplinary cooperation, availability of useful instrumentation and homogeneous distribution over the entire National territory. Overall, 159 patients were enrolled according to clinical history (major and minor symptoms of upper and lower airways) and inclusion/exclusion criteria. All underwent a two level diagnostic approach. In 116 patients, the diagnosis was confirmed on the basis of I level (rhinopharyngeal endoscopy and basal spirometry, respectively, for upper and lower airways) examination. Allergic and infectious diseases were significantly more frequent (37.9% vs 20.9% and 73.3% vs 46.55, respectively) in patients with a confirmed diagnosis for Rhino-Bronchial Syndrome. Nasal obstruction (93%), rhinorrhoea (75%), cough (96%) and dyspnoea (69%) were the more frequent symptoms. The presence of meatal secretions or polyps were the clinical findings significantly differing at endoscopy in the two groups. After 3 months of treatment, according to "good clinical practice" (inhaled steroids, antibiotics, nasal lavages), 96% of the patients recovered. On the basis of these results, a diagnostic flow-chart is proposed according to which the persistence of some symptoms (cough, dyspnoea, rhinorrhoea and nasal obstruction) should lead the patient to a multidisciplinary and multi-level diagnostic approach by an otorhinolaryngology and a pneumology specialist working together for a definitive diagnosis. The recovery rate of about 94% of patients after 3 months of treatment, stresses the importance of a correct diagnosis.

Microvascular free-flaps have been in clinical use for nearly 3 decades becoming the gold standard in oral and oropharyngeal reconstruction. In this study, a comparison has been made between the radial forearm fasciocutaneous flap with the thinned anterolateral thigh cutaneous flap (tALT), showing the advantage of the anterolateral thigh cutaneous flap in oral and oropharyngeal reconstruction. Between January 2003 and January 2007, 48 reconstructions were performed in patients submitted to surgery for oral and oropharyngeal carcinoma using, in 17 cases, a radial forearm fasciocutaneous flap and, in 31, an anterolateral thigh cutaneous flap. In patients treated with the radial forearm fasciocutaneous flap, results showed 94.1% flap survival; in cases treated with the anterolateral thigh cutaneous flap, 93.5% flap survival (p < 0.9). Functional results, at receiving site, were comparable in both groups. Functional results, at donor site, were less successful in the radial forearm fasciocutaneous flap group, with permanent forearm movement impairment in 35.3% of cases; in the anterolateral thigh cutaneous flap group, only transitory gait impairment occurred in 12.9% of patients. In conclusion, in our experience, the thinned anterolateral thigh cutaneous flap is comparable to radial forearm fasciocutaneous flap in terms of functional results at receiving site, but, having no limitation in availability of donor tissue, it allows a more extended resection of the tumour. Moreover, the donor site can be closed primarily with only an inconspicuous curvilinear scar left over the thigh and with significantly reduced functional impairment.

Allergic rhinitis is classically defined as an IgE-mediated inflammation of nasal mucosa, characterised by nasal obstruction, rhinorrhea, sneezing and nasal itching. It is certainly a high-prevalence disease and an important social and medical problem in many industrialised Countries, affecting about 20% of the general population; moreover, it is diagnosed with increasing frequency, both in adults and children in many developing countries. In view of the high medical and social costs, a correct diagnostic approach to allergic rhinitis is a fundamental need for the otorhinolaryngologist, also considering the severe complications (asthma, rhinosinusitis, rhino-otitis, rhinosinusal polyposis) which could develop if this disease is not recognised and adequately treated in its early phases. In order to evaluate not only the present epidemiological characteristics of allergic rhinitis in Italy but also the most commonly used diagnostic and therapeutic approaches in the management of this disease, 145 Italian otorhinolaringologists were selected to take part in the investigation. Each was invited to complete a questionnaire, divided into 8 different sections, to be answered according to their daily clinical practice. The significance of the results has been compared with those of the international samples comprised in the ARIA Document and in the epidemiologic survey of the Standing Committee on Rhinology and Allergy of the International Federation of Otorhinolaryngological Societies. A critical analysis of these data leads to some interesting epidemiological and therapeutic considerations.