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Eugenia Allegra,1 Ignazio La Mantia,2 Maria Rita Bianco,1 Gaetano Davide Drago,3 Maria Cristina Le Fosse,1 Alfio Azzolina,4 Calogero Grillo,2 Vincenzo Saita41Otolaryngology, Department of Health Science, University of Catanzaro, Catanzaro, Italy; 2Otolaryngology, "G.F Ingrassia" Department, University of Catania, Catania, Italy; 3Grand Hôpital de l’Est Francilien, Jossigny, France; 4Otolaryngology Unit, Cannizzaro Hospital, University of Catania, Catania, ItalyIntroduction: Total laryngectomy has important psychophysical and social consequences for patients’ quality of life because of the functional changes resulting from the removal of the larynx. Voice deprivation is perhaps the most relevant limiting factor in social relationships, increasing feelings of solitude and tending to drive individuals into social isolation. Multiple voice rehabilitation methods after total laryngectomy are available. This study aimed to determine the acoustic quality of the rehabilitated voice achieved with esophageal speech (ES) and tracheoesophageal speech (TES), and acoustic quality impacts on patients’ perceptions of their quality of life.Materials and methods: The patient inclusion criterion was the completion of a speech rehabilitation course with ES or TES at least 6 months after total laryngectomy. The voice acoustic analysis was carried out automatically by using the Multidimensional Voice Program. The following parameters were extracted: fundamental frequency (F0), Jitter% (Jitt), Shimmer% (Shim), and noise-to-harmonic ratio (NHR). Subjective voice evaluation was performed by using the following questionnaires: Voice Handicap Index (VHI), Voice-related Quality of Life (V-RQOL), and Voice Performance Questionnaire (VPQ).Results: The acoustic analysis showed a difference between ES and TES patients on all acoustic parameters; this difference was significant for F0 (133.09±2.4 and 119±3.3, respectively; p

Eugenia Allegra,1 Vincenzo Saita,2 Alfio Azzolina,2 Massimo De Natale,2 Maria Rita Bianco,1 Domenico Michele Modica,3 Aldo Garozzo1 1Otolaryngology, Department of Health Sciences, University of Catanzaro, Catanzaro, Italy; 2Otolaryngology Unit, Cannizzaro Hospital, Catania, Italy; 3Otolaryngology Unit, University of Palermo, Palermo, Italy Background: Laryngeal early glottic tumors can benefit from different treatment modalities, including transoral laser microsurgery, open partial horizontal laryngectomy (OPHL), and radiotherapy. However, the treatment of early glottic tumors with the involvement of the anterior commissure remains controversial. The studies about the role of anterior commissure involvement in oncologic outcomes in patients with early glottic cancer treated with supracricoid laryngectomy (SCL) are very few. For this reason, we conducted a retrospective study to evaluate local recurrence-free survival and specific survival in patients with and without involvement of the anterior commissure who underwent SCL with cricohyoidoepiglottopexy.Methods: This retrospective study has been carried out on patients with T1b–T2 glottic squamous cell carcinoma submitted to SCL with cricohyoidoepiglottopexy. The patients’ demographic and clinical data were collected, and the histological findings of the surgical specimens were reviewed to identify patients who had involvement of the anterior commissure.Results: A total of 72 patients were included in the study; two of them were female and 70 were male. The mean age at diagnosis was 61.5±8.0 SD years. In 26 of the 72 (36.2%) patients, anterior commissure was not pathologically involved (group A), while in 46 (63.8%) patients, it was involved (group B). The 5-year local recurrence-free survival rate was 96.1% and 93.48% in groups A and B, respectively, P=0.09. The 5-year disease-specific survival rate was 92.31% and 95.65% in groups A and B, respectively, P=0.057.Conclusion: SCL with cricohyoidoepiglottopexy seems to be an adequate treatment modality, even for T1b–T2 glottic tumors with anterior commissure involvement. Keywords: open partial horizontal laryngectomy, laryngeal cancer, supracricoid laryngectomy, cricohyoidoepiglottopexy

Background : The aim of our multicenter retrospective study was to evaluate the long-term complications associated with primary and secondary tracheoesophageal puncture (TEP) in patients who underwent total laryngectomy (TL) for laryngeal cancer and were subsequently rehabilitated to phonatory function with tracheoesophageal speech (TES). Materials and Methods : To evaluate the long-term outcomes and complications of TEP, the following data were collected: mean time of prosthesis replacement, mean time of onset of complications, type of complications, and type of failure. Results : Complications occurred in 18 out of 46 patients (39.2%) with primary TEP and in 10 out of 30 patients (33.4%) with secondary TEP, out of a total of 76 enrolled patients. Common complications included prosthesis leakage, fistula leakage, granulation, and prosthesis extrusion. Prosthesis replacement due to fistula leakage or prosthesis extrusion was observed exclusively in the group of patients with primary TEP. Among the 28 patients (35.7%) who experienced complications, rehabilitation with TEP failed in 10 cases, primarily due to abandonment and spontaneous fistula closure. Conclusions : TEP, both primary and secondary, represents a valid option for vocal rehabilitation in patients undergoing TL. However, identifying prognostic factors that could influence the success of TEP would be beneficial to allow a targeted rehabilitation process.

Objective: In recent years, the number of open preservation surgeries for the treatment of laryngeal Cancer has increased. This surgery aims to maintain laryngeal function and ensure oncological radicality, thereby avoiding a total laryngectomy (TL) that could significantly impact the patient's quality of life. The purpose of this study was to assess the oncologic results of OPHL I and II and to identify prognostic factors that could impact patient survival and local failure rates. Methods: This study was conducted on 182 patients with laryngeal squamous cell carcinoma treated with OPHLs between 2005 and 2015. The survival rates of a group of patients treated with TL between 2004 and 2014 were taken into consideration to compare survival outcomes. Results: The disease-specific survival in pT2 and pT3 tumors in relation to the type of surgery showed no statistically significant difference between OPHLs and TL ( P  = .54 and P  = .63, respectively). The 5-year T-recurrence-free survival showed that pT4 tumors, perineural/vascular positive invasion, and OPHL IIb + ARY-treated tumors were associated with a higher risk of tumor recurrence ( P  < .0001, P  = .0005 and P  = .016 respectively). Conclusions: OPHLs represent an excellent alternative to TL considering the characteristics of the tumor and the general conditions of the patient., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: This study aimed to evaluate olfactory function in patients rehabilitated with oesophageal (ES) voice or tracheo-oesophageal (TES) prosthesis to further verify whether there were differences in smell alterations depending on voice rehabilitation modality., Methods: A total of 40 patients who had undergone total laryngectomy participated in the study. Speech rehabilitation was achieved through TES in 20 patients (Group A) or ES in 20 patients (Group B). Olfactory function was evaluated using the Sniffin' Sticks test., Results: At olfactory evaluation, in Group A, 4/20 patients (20%) were anosmic, whereas 16/20 patients (80%) were hyposmic; in Group B, 11/20 patients (55%) were anosmic whereas 9/20 patients (45%) were hyposmic. A significant difference (p = 0.04) was found at global objective evaluation., Conclusions: The study shows that the rehabilitation with TES contributes to maintaining a functioning, albeit limited, sense of smell., (Copyright © 2023 Società Italiana di Otorinolaringoiatria e Chirurgia Cervico-Facciale, Rome, Italy.)

Objectives: Alteration of smell and taste has been reported in patients with coronavirus disease 2019 (COVID-19). The incidence and clinical-symptomatic manifestation of COVID-19 is different between northern and southern Italy. This study aims to evaluate the onset of alteration of smell and taste in asymptomatic and symptomatic patients in Sicily (extreme south of Italy)., Methods: This prospective cross-sectional study was performed on asymptomatic and symptomatic COVID-19 patients tested for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) from May 1 to May 15, 2020. A questionnaire was used for evaluating the prevalence of smell and taste disorders in COVID-19 patients before performing nasopharyngeal swab., Results: Of the total 292 patients, 242 (83.2%) were negative for SARS-CoV-2 and 50 were positive (16.8%). Twenty-six of the 50 (52%) SARS-CoV-2 positive patients reported smell/taste disorders. Twenty-eight of the 50 (57.1%) SARS-CoV-2 positive patients were hospitalized (group A), and 22 (42.9%) were nonhospitalized (group B). The mean age in group A and group B was 45.4 ± 13.7 years and 57.0 ± 15.0, respectively ( P = .007). The symptoms reported by hospitalized patients were fever (71.4%), cough (64.2%), fatigue (82.1%), and dyspnea (100%), while in nonhospitalized patients, the most reported symptoms were sore throat (72.7%), rhinorrhea (77.2%), and altered smell (81.8%). Anosmia/hyposmia reported in group A and group B was 28.5% and 81.8%, respectively ( P = .001)., Conclusion: These preliminary results indicate that the majority of SARS-Cov-2 positive patients in southern Italy did not require hospitalization and presented with milder symptoms or no symptoms and the alterations in smell and taste occurred.

Introduction  The main modalities of surgical treatment for laryngeal cancer include transoral laser microsurgery (TLM), open preservation surgery, and total laryngectomy (TL). In the elderly, for the presence of comorbidities, the surgical approach more appropriate in many cases remains TL. The use of a stapler for the closure of the esophagus has been introduced to reduce surgical time and postoperative complications such as pharyngocutaneous fistula (PCF). Objective  In the present study, we have evaluated the effectiveness of the use of the horizontal mechanical pharyngoesophageal closure in patients who underwent TL. Methods  This nonrandomized study was performed on consecutive patients with histopathologically proven squamous cell endolaryngeal carcinoma. The TL was performed using a linear stapler to mechanically suture the pharyngotomy using the semiclosed technique. Results  A total of 33 patients underwent TL, and 13 of them underwent neck dissection. A total of 15 patients (45.4%) were ≤70 years old, and 18 were > 70 years old. Analyzing the results in relation to age, patients > 70 years old showed tumors at an earlier stage than those aged ≤70 years old. Furthermore, in this group there was a greater number of patients who had comorbidities ( p  = 0.014). In total, we had 2 (6%) cases of PCF in 6.6% in the group ≤70 years old, and in 5.5% of the group > 70 years old ( p  = 1.00). Conclusions  The use of the stapler for the horizontal closure of the pharyngoesophagectomy in the patients subjected to TL is proven to be useful and safe even when used in elderly patients.

Multiple myeloma is a lymphoproliferative disease that may involve the bone marrow as well as extramedullary soft tissues. However, laryngeal localization of multiple myeloma is extremely rare. We herein present the case of a 68-year-old male patient with a history of dyspnea, dysphonia and dysphagia. Laryngoscopic examination revealed a lesion involving the right glottis and right vestibular (false) vocal fold, with absence of ipsilateral laryngeal motility and constriction of the airway. Computed tomography and magnetic resonance imaging revealed a gross swelling infiltrating the right glottis and right false vocal fold, sized 33×19×33 mm, with sub-centimeter laterocervical lymph nodes bilaterally. Careful integration of the clinical manifestations with the radiological and pathological data led to the diagnosis of multiple myeloma. Given the rarity of this localization, the purpose of this study was to increase knowledge of this disease among ear, nose and throat specialists, in order to enable a more timely diagnosis.

Background: Microlaryngoscopy is the preferred and most widely used technique in phonosurgery for the treatment of benign and early malignant glottic lesions. However, the procedure may be technically difficult or impossible due to alterations of the cervical spine that may not allow hyperextension of the head or may present general anesthesia contraindications. The aim of this study is to evaluate the efficacy and safety of our surgical approach for lesions of the vocal folds in patients who are not suitable for phonosurgery by microlaryngoscopy. This approach applies videolaryngoscopy during conscious sedation, which combines local anesthesia with moderate analgosedation by using midazolam and fentanyl with premedication., Methods: A total of 235 patients affected by benign diseases or suspicious cancerous lesions of the vocal folds were retrospectively evaluated., Results: The method has shown a success rate of 95.5, 89, 52.3, and 86.7% in cases of polyps of the vocal folds, Reinke's edema, cysts of the vocal folds, and suspicious lesions of the larynx, respectively. Only 3 patients (1.27%) have been reported to experience adverse events., Conclusion: The results suggest that the method is an effective and safe procedure without relevant local and/or general complications., (© 2017 S. Karger AG, Basel.)

We report a case of Wegener's granulomatosis clinically mistaken for carcinoma in a 21-year-old girl presenting with an ulcerated mass of the nasopharynx associated with enlarged laterocervical nodes. The lesion was clinically suspected as malignant on the basis of clinical and radiological findings (namely, computed tomography scan and positron emission tomography). However, multiple biopsies were not conclusive for malignancy showing histological change suggestive of Wegener's granulomatosis. A serum determination of cANCA supported the diagnosis of Wegener's granulomatosis. Clinical findings and image studies suggested an erroneous diagnosis of malignancy whereas a definitive diagnosis of Wegener's granulomatosis was achieved only after repeated biopsies thus leading to a correct therapeutic approach. The Wegener granulomatosis must be added to the list of the differential diagnoses of the masses of the nasopharynx associated with or without enlarged laterocervical nodes.

Ameloblastomas are locally aggressive jaw tumours with a high propensity for recurrence and are believed to arise from remnants of dental lamina or odontogenic epithelium. Extragnathic ameloblastomas are unusual, and primary sinonasal tract origin is very uncommon with few cases reported in the literature. We herein report a case of primary sinonasal ameloblastoma presented in a 74-year-old male with nasal obstruction, rhinorrhoea, and sinusitis. Nasal endoscopy showed the right nasal cavity completely obstructed by a polypoid lesion attached to the lateral nasal wall. A preoperative CT scan was performed showing a solid lesion, measuring 2 cm in the maximum diameter, extending from the nasopharynx area with obstruction of the ostiomeatal unit and sphenoethmoidal recess into the lateral pharyngeal space, laterally to the parotid, without continuity with maxillary alveola and antrum. The tumour was completely excised endoscopically, and a final diagnosis of ameloblastoma was rendered. At the 12-month followup, there was no evidence of recurrence.

Laryngeal schwannomas are uncommon lesions with only few cases reported. Herein we present a further case of a schwannoma of the epiglottis, occurring in a 62-year-old with a clinical history of a cutaneous malignant melanoma and laryngeal glottic keratosis. The schwannoma was incidentally discovered as a small polypoid lesion located on the laryngeal surface of the epiglottis and was removed endoscopically. The procedure was uneventful and the patient is well six months later. Authors focus on the diagnostic and therapeutic options for this unusual lesion and discuss the differential diagnosis of the spindle cell proliferation of the larynx.

Impediment of breath through the nose because of turbinal hypertrophy is an often repeated symptom in chronic rhinitis. In the course of years several procedures for clear the nasal congestion, with more or less satisfactory outcomes, has been tested. The introduction of Nd:Yag laser has allowed a new treatment of the hypertrophic turbinates, thanks to the advantage of its conduction through the flexible optical fibers of the traditional optical devices, even connected to the video system. Treatment can be achieved in the outpatients department with local anesthesia. Results are favorable and forebode new horizons in the surgery of chronic hypertrophic rhinopathies.

The paper reports the case of a newborn affected by malformations of the middle parts of the face. The patient was described as cebophalus according to Kundrat's classification because he had a single nostril, hypotelorism and severe brain malformations. Prosencephalia is present in 0.5% of all aborted fetuses but is very rare in live births (0.006%). Survival is extremely short and in this case the patient lived for 12 months. A description of the malformations is given using CT scans.

The necessity for direct observation of the pharyngeal outlet of the normal or pathological eustachian tube has always stimulated research for suitable diagnostic instruments. As the result of various investigation procedures currently available, we performed a series of endoscopic screenings using both the Hopkins telescope and the fiberoptic rhinopharyngolaryngoscope. The present study aimed at evaluating and demonstrating the morphological and dynamic functional condition of the pharyngeal outlet of the tube. The present investigation was carried out on 60 males and females, ranging in age from 4 to 70 years. Inspection of the pharyngeal outlet of the tube and its adjoining region enabled us to document some of the various causes for tubal dysfunction. By visualizing tubal movements, endoscopy also made it possible to perform a dynamic study of tubal functions. However, the investigation procedure utilized did not allow us to record any significant differences between the two diagnostic instruments used, except that the fiberscope can be more easily handled, whereas the photographs taken with the telescope are of better quality.