Publications by authors named "Giuseppe Mercante"

60 Publications

Preliminary Functional Outcomes and Quality of Life after Tongue Reconstruction with the Vastus Lateralis Myofascial Free Flap.

Facial Plast Surg 2021 Apr 26. Epub 2021 Apr 26.

Otorhinolaryngology Unit, IRCCS Humanitas Clinical and Research Center, Rozzano, Milan, Italy.

The aim of the present study is to report our preliminary experience with the vastus lateralis myofascial free flap (VLMFF) for tongue reconstruction according to tongue and donor site functional outcomes. Twelve consecutive patients (F: 5; median age: 54.0 years, interquartile range or IQR 42.75-69.0) were included. The validated European Organization for Research and Treatment of Cancer of the Head and Neck 35 Quality of Life Questionnaire (EORTC QLQ-H&N35) and the performance status scale for head and neck cancer (PSS-HN) questionnaires were used to assess the health-related quality of life (HRQOL). The lower extremity functional scale (LEFS) was used to self-report the donor area function. All patients were successfully treated, and no VLMFF failure was detected during a median follow-up period of 10.5 months (IQR: 6.5-33.0). The HRQOL showed a median EORTC QLQ-H&N35 score of 56.0 (IQR: 50.0-72.5). The median PSS-HN score was 80.0 (IQR: 45.0-95.0), 75.0 (IQR: 62.5-100.0), 75.0 (IQR: 62.5-100.0) for "Normalcy of Diet," "Public Eating," and "Understandability of Speech," respectively. The self-reported function of the lower extremities (donor area) showed a median LEFS of 59.0 (IQR: 32.5-74.0). This study reports optimistic data regarding the functional and quality of life outcomes after tongue reconstruction using VLMFF. Prospective controlled studies are needed to demonstrate advantages and disadvantages when compared with other reconstructive techniques.
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http://dx.doi.org/10.1055/s-0041-1726445DOI Listing
April 2021

Applying the Exoscope to Lacrimal Surgery: Preliminary Experience.

ORL J Otorhinolaryngol Relat Spec 2021 Mar 18:1-6. Epub 2021 Mar 18.

Department of Otorhinolaryngology and Head and Neck Surgery, Humanitas Clinical and Research Hospital IRCCS, Milan, Italy.

Purpose: The aim of the study was to investigate the role of the exoscope as an assisting tool in endoscopic dacryocystorhinostomy (e-DCR).

Materials And Methods: In this observational retrospective study, the application of the VITOM® exoscope was studied in a group of 21 patients undergoing mono- or bilateral DCR. The primary endpoint was to evaluate resolution of symptoms (epiphora/dacryocystitis) at the 6-month follow-up and time for surgery. Qualitative features of the exoscope (intraoperative view of the surgical field) and comparison with the typical setting for DCR were analyzed as secondary endpoints. A questionnaire was administered to surgical team members (ENT surgeon, ophthalmologist, and scrub nurse) to evaluate the perceived quality of this new technology (12 items valued as "good" = 2, "acceptable" = 1, and "not acceptable" = 0). A questionnaire score of 24 out of 24 was valued as "completely approved," score 20-23 as "moderately approved," and score ≤19 as "weakly approved." Patients were divided into 3 consecutive groups, and questionnaire scores by each team member were analyzed for tendencies. Statistical analysis was performed to test significance at p < 0.05. Local Ethical Committee approval was obtained.

Results: No significant differences were found between exoscope-set DCR and classic setting for concerned patient outcomes (failure rate: 3.2 vs. 3.8%, respectively, p = 0.896) and mean time for surgery (20' vs. 23', respectively, p = 0.091). The exoscope was valued by surgical team members as "completely approved" in 55.5% of cases, "moderately approved" in 39.7%, and "weakly approved" in 4.8%. Questionnaire scores by the ENT, ophthalmologist, and scrub nurse showed an average increase in the 3 consecutive groups (p = 0.119, p = 0.024, and p < 0.001, respectively).

Conclusions: The exoscope is a new tool that may support e-DCR. It has no effects on symptom outcomes (epiphora/dacryocystitis) and time for surgery compared to classic DCR. Based on self-perception, this new technology was accepted by all team members.
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http://dx.doi.org/10.1159/000513529DOI Listing
March 2021

Trigeminal features in COVID-19 patients with smell impairment.

Int Forum Allergy Rhinol 2021 Mar 16. Epub 2021 Mar 16.

Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.

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http://dx.doi.org/10.1002/alr.22796DOI Listing
March 2021

The worst adverse event for an endoscopist after esophageal stent placement: an aortoesophageal fistula.

Endoscopy 2021 Mar 5. Epub 2021 Mar 5.

Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center - IRCCS, Rozzano, MI, Italy.

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http://dx.doi.org/10.1055/a-1368-3677DOI Listing
March 2021

HPV Infection in Middle Ear Squamous Cell Carcinoma: Prevalence, Genotyping and Prognostic Impact.

J Clin Med 2021 Feb 12;10(4). Epub 2021 Feb 12.

Otorhinolaryngology Unit, Ospedali Riuniti Padova Sud "Madre Teresa di Calcutta" Hospital, 35043 Monselice, Italy.

Middle ear squamous cell carcinoma (MESCC) is rare. Human Papilloma Virus (HPV) infection has been found in a significant number of cases of MESCC. Despite the emerging role of HPV in oncogenesis, its role in the pathogenesis and prognosis of MESCC is not known. This study aims to identify the prognostic impact of alpha and beta HPV in MESCC and its correlation with p16 protein. We retrospectively investigated 33 patients with MESCC surgically treated between 2004 and 2016. HPV DNA was ascertained by polymerase chain reaction (PCR) and P16INK4a detection was performed. Disease-specific survival (DSS) and cumulative incidence of recurrence were calculated in relation to HPV presence and genotype. p16 sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) in predicting HPV infection were calculated. HPV was detected in 66.7% of patients (36.4% alpha HPV, 63.6% beta HPV). Five-year DSS was 55.0% and was not statistically related to HPV presence ( = 0.55) or genotype ( = 0.87). Five-year cumulative incidence of recurrence was 46 %, and was not statistically related to HPV presence ( = 0.22) or genotype ( = 0.44). p16 sensitivity, specificity, PPV, and NPV in predicting HPV infection were 27.3%, 36.4%, 46.2%, and 20.0%, respectively. In our experience, beta HPV was more frequent than alpha HPV in MESCC. Neither HPV presence nor HPV genotypes relate to DSS or cumulative incidence of recurrence. p16 expression was not predictive for HPV infection in MESCC. The role of HPV infection in oncogenesis, maintenance, and prognosis of MESCC seems to be different from that in oropharynx and skin cancer.
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http://dx.doi.org/10.3390/jcm10040738DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7918549PMC
February 2021

Sudden neck swelling with rash as late manifestation of COVID-19: a case report.

BMC Infect Dis 2021 Feb 27;21(1):232. Epub 2021 Feb 27.

Department of Diagnostic Radiology, Humanitas Clinical and Research Center IRCCS, Via Alessandro Manzoni 56, 20089 Rozzano, Milan, Italy.

Background: Although there are reports of otolaryngological symptoms and manifestations of CoronaVirus Disease 19 (COVID-19), there have been no documented cases of sudden neck swelling with rash in patients with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection described in literature.

Case Presentation: We report a case of a sudden neck swelling and rash likely due to late SARS-CoV-2 in a 64-year-old woman. The patient reported COVID-19 symptoms over the previous three weeks. Computed Tomography (CT) revealed a diffuse soft-tissue swelling and edema of subcutaneous tissue, hypodermis, and muscular and deep fascial planes. All the differential diagnoses were ruled out. Both the anamnestic history of the patient's husband who had died of COVID-19 with and the collateral findings of pneumonia and esophageal wall edema suggested the association with COVID-19. This was confirmed by nasopharyngeal swab polymerase chain reaction. The patient was treated with lopinavir/ritonavir, hydroxychloroquine and piperacillin/tazobactam for 7 days. The neck swelling resolved in less than 24 h, while the erythema was still present up to two days later. The patient was discharged after seven days in good clinical condition and with a negative swab.

Conclusion: Sudden neck swelling with rash may be a coincidental presentation, but, in the pandemic context, it is most likely a direct or indirect complication of COVID-19.
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http://dx.doi.org/10.1186/s12879-021-05911-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7912866PMC
February 2021

Anatomical-based classification for transoral base of tongue resection.

Head Neck 2021 May 13;43(5):1604-1609. Epub 2021 Feb 13.

Depatment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.

Background: To propose a classification of transoral base of tongue (BOT) procedures able to provide uniform terminology in order to better define postoperative results.

Methods: The classification resulted from the consensus of the different authors and is based on anatomical and surgical principles.

Results: The classification comprises three types of BOT resections: type 1 is the resection of the entire lingual tonsil to the muscular plane; type 2 is performed by removing the entire lingual tonsil and part of BOT muscles; type 3 is performed by removing the entire lingual tonsil and the entire BOT muscles. Based on the extension of the dissection, we can use the suffix A (contralateral BOT), B (supraglottic larynx), C (lateral oropharynx), and/or D (oral tongue).

Conclusion: The proposed classification could allow us to easily compare data from different centers.
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http://dx.doi.org/10.1002/hed.26628DOI Listing
May 2021

High-definition three-dimensional exoscope for head and neck reconstruction: Prospective analysis of 27 consecutive patients.

Head Neck 2021 May 4;43(5):1574-1580. Epub 2021 Feb 4.

Department of Biomedical Sciences, Humanitas University, Pieve Emanuele - Milan, Italy.

Purpose: To analyze the advantages and disadvantages of a three-dimensional (3D) operating exoscope (OE) in head and neck free flap reconstruction.

Methods: Twenty-seven consecutive patients (females: 8; mean age: 57.0) were included. After each procedure, both surgeon and nurse were asked to fill out a tailored questionnaire on a three-point Likert scale including 12 items.

Results: All microvascular anastomoses were successfully completed, and no related complications were detected with a final free flap survival rate of 100% (mean follow-up of 5.6 months, SD: 3.1 months). The ergonomics, the ease of use, and the possibility to share the view among all the OR members were the best-rated items by the surgeons, while the luminance of the surgical field and the eye strain determined by the 3D glasses can still be improved.

Conclusion: Further comparative clinical studies are needed to clarify its real value in substitution to a conventional operating microscope.
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http://dx.doi.org/10.1002/hed.26623DOI Listing
May 2021

Different Surgical Strategies in the Prevention of Frey Syndrome: A Systematic Review and Meta-analysis.

Laryngoscope 2021 Jan 27. Epub 2021 Jan 27.

Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele - Milan, Italy.

Objective/hypothesis: To define the best surgical technique able to reduce Frey syndrome (FS) incidence after parotidectomy.

Study Design: Systematic review and network meta-analysis.

Methods: An arm-based network analysis was conducted using a Bayesian hierarchical model. The primary and secondary outcomes were the incidence of subjective (clinical) and objective (positive starch-iodine test result) FS, respectively.

Results: A total of 3830 patients with a median age of 50.35 years (n = 2323; IQR 44.25-54.18) were included for six interventions [temporoparietal fascia (TPFF), free fat graft (FFG), acellular dermal matrix (ADM), sternocleidomastoid muscle (SCM) flap, and superficial musculoaponeurotic system (SMAS) flap]. If compared to no treatment, the greatest reduction of subjective (clinical) FS incidence was measured for the TPFF (OR: 0.07, CI: 0.004-0.57), the ADM (OR: 0.09, CI: 0.02-0.35), and the FFG (OR: 0.11, CI: 0.03-0.42) techniques. However, a significant difference was measured also for the SCM flap (OR: 0.38, CI: 0.18-0.73) and for the SMAS flap (OR: 0.42, CI: 0.19-0.97). All treatments showed a significant reduction of the objective FS incidence if compared to no treatment (FFG, OR: 0.06, CI: 0.002-0.62; TPFF, OR: 0.07, CI: 0.01-0.33; ADM, OR: 0.11, CI: 0.03-0.44; SMAS, OR: 0.36, CI: 0.17-0.71; SCM, OR: 0.40, CI: 0.19-0.74).

Conclusions: TPFF, ADM, and FFG seem to be the best treatment strategies to prevent FS after parotidectomy. Further randomized controlled trials comparing these techniques should be conducted to define specific indications. Laryngoscope, 2021.
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http://dx.doi.org/10.1002/lary.29414DOI Listing
January 2021

Prognostic Features in Intermediate-Size Supraglottic Tumors Treated With Open Supraglottic Laryngectomy.

Laryngoscope 2021 06 5;131(6):E1980-E1986. Epub 2021 Jan 5.

Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France.

Objectives/hypothesis: We investigated growth patterns and pathological features in intermediate-size laryngeal carcinoma amenable to supraglottic laryngectomy.

Study Design: Retrospective cohort study.

Methods: We reviewed patients who underwent an open partial horizontal laryngectomy (OPHL) type I. We analyzed pathological data, tumor sizes, overall survival, disease-specific survival, local control, and laryngeal preservation. Results were stratified between three groups: group I comprised patients with endolaryngeal carcinoma, group II comprised patients with anterior epilaryngeal carcinoma who underwent an OPHL type I + base of tongue (BOT), group III comprised patients with lateral epilaryngeal carcinoma who underwent an OPHL type I + pyriform sinus (PIR).

Results: Sixty-eight patients were analyzed. The 5-year rates of overall survival, disease-specific survival, local control, and laryngeal preservation were 68.4%, 83.7%, 91.6%, and 98.3%, respectively. The tumor sizes at pathological examination were similar between the three groups (mean 27 mm, P = .80) and were associated with pathological features, notably pre-epiglottic space (PES) invasion (24.9 mm vs. 32.2 mm, P = .01), occult invaded lymph nodes (22.6 mm vs. 29.9 mm, P = .03), and trends for margins status (26.5 mm vs. 29.3 mm, P = .45). The risks of PES invasion, occult lymph nodes, and positive margins, respectively, predominated in group I (41.7%), group II (56.3%), and group III (23.3%).

Conclusion: In intermediate-size tumors amenable to supraglottic laryngectomy, pathological features are associated with tumor size according to group stratification based on tumor location.

Level Of Evidence: 4 Laryngoscope, 131:E1980-E1986, 2021.
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http://dx.doi.org/10.1002/lary.29367DOI Listing
June 2021

Accuracy of fine-needle aspiration cytology in detecting cervical node metastasis after radiotherapy: Systematic review and meta-analysis.

Head Neck 2021 Mar 9;43(3):987-996. Epub 2020 Nov 9.

Otorhinolaryngology Unit, Humanitas Clinical and Research Center IRCCS, Rozzano (MI), Italy.

Purpose: To define the accuracy of fine-needle aspiration cytology (FNAC) in diagnosing persistent or recurrent neck metastases in previously irradiated patients.

Methods: The study was performed according to the PRISMA-DTA guidelines.

Results: A total of 382 FNACs were used for calculation of diagnostic accuracy parameters. The overall pooled sensitivity and specificity in detecting malignant nodes were 69.1% (95% CI: 56.3%-80.7%; I = 79.5%) and 84.2% (95% CI: 71.8%-93.5%; I = 87.0%), respectively. Cumulative diagnostic odds ratio (DOR) was 16.54 (95% CI: 4.89-38.99; I = 65.8%), while cumulative positive and negative likelihood ratio (PLR and NLR) were 5.4 (95% CI: 2.3-11.2) and 0.37 (95% CI: 0.22-0.54), respectively.

Conclusions: FNAC alone could not guide the decision to perform a salvage neck dissection in previously irradiated patients, but its results should be assessed in relation to the specific clinical context.
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http://dx.doi.org/10.1002/hed.26536DOI Listing
March 2021

3D 4K VITOM-assisted transoral removal of distal stone in the Wharton's duct.

Am J Otolaryngol 2021 Mar-Apr;42(2):102821. Epub 2020 Oct 31.

Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, MI, Italy; Otorhinolaryngology - Head and Neck Department, Humanitas Clinical and Research Center, IRCCS, Via Alessandro Manzoni 56, Rozzano, 20089, Milan, Italy.

Background: The aim of this study was to describe the potential advantages of the transoral 3D 4K exoscope-assisted removal of calculus of the Wharton's duct.

Methods: A 24-year-old female with swelling in the left oral pelvis was diagnosed of sialolithiasis of distal Wharton's duct. A CT scan confirmed the lithiasic formation and a transoral removal in local anesthesia was planned through the 3D 4K exoscope (VITOM 3D, Karl Storz).

Results: A high-quality magnification of the oral pelvis was obtained, with an easy identification of the entrance of the left submandibular gland's duct and the calculus. After blunt dissection the Wharton's duct was incised and the calculus removed. An angiocatheter (20G) was carefully inserted in the duct and removed after 3 days. No postoperative complications occurred. At 7 days post-operative follow-up the patient had developed a neo-ostium 5 mm from the papilla. The exoscope provided a better involvement in the surgery and more interactions of all operating room personnel, residents and students, that had access to the same field of view of the first surgeon with the perception of the depth of the surgical field with 3D technology.

Conclusions: The exoscope could represent a valid option for transoral removal of calculi, allowing for precise surgical dissection of the oral floor, thus reducing the risks for iatrogenic lesion of the lingual nerve. It showed also a high potential for training and educational purposes.
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http://dx.doi.org/10.1016/j.amjoto.2020.102821DOI Listing
October 2020

Regional disease control in sinonasal mucosal melanoma: Systematic review and meta-analysis.

Head Neck 2021 02 5;43(2):705-715. Epub 2020 Nov 5.

Otorhinolaryngology Unit, IRCCS Humanitas Clinical and Research Center, Via Manzoni 56, Rozzano (MI), Italy.

Purpose: To systematically analyze the regional disease control after sinonasal mucosal melanoma (SNMM) primary treatment.

Methods: The study was performed according to the PRISMA guidelines searching on Scopus, PubMed/MEDLINE, Cochrane Library, and Google Scholar databases.

Results: A total of 15 studies with 936 patients (median age: 68.0 years, IQR 65-71) were included. Overall, the cumulative regional recurrence rate (RRR) was 18.4% (n = 917, 99% CI: 14.0%-23.4%), with a median follow-up of 30.0 months (n = 765, IQR 22.0-37.0). The RRR in clinical node negative patients was 17.0% (99% CI: 12.2%-22.5%), with a median follow-up of 22.0 months (n = 327, IQR 21.5-31.5).

Conclusions: The RRR of SNMM after primary treatment is not to be neglected. Further prospective studies should be encouraged to clarify if elective treatment of the neck could be recommended at least in a subgroup of patients.
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http://dx.doi.org/10.1002/hed.26537DOI Listing
February 2021

Clinical presentation at the onset of COVID-19 and allergic rhinoconjunctivitis.

J Allergy Clin Immunol Pract 2020 Nov - Dec;8(10):3587-3589. Epub 2020 Aug 18.

Department of Biomedical Science, Humanitas University, Pieve Emanuele, Milan, Italy; Otorhinolaryngology Unit, Humanitas Clinical and Research Center, IRCCS, Milan, Italy.

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http://dx.doi.org/10.1016/j.jaip.2020.08.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7431330PMC
November 2020

Transoral robotic surgery and intensity-modulated radiotherapy in the treatment of the oropharyngeal carcinoma: a systematic review and meta-analysis.

Eur Arch Otorhinolaryngol 2021 May 21;278(5):1321-1335. Epub 2020 Jul 21.

Otorhinolaryngology Unit, IRCCS Humanitas Clinical and Research Centre, Via Manzoni 56, 20089, Rozzano, MI, Italy.

Purpose: To perform a meta-analysis evaluating trans-oral robotic surgery (TORS), and intensity-modulated radiation therapy (IMRT) in the treatment of oropharyngeal squamous cell carcinoma (OPSCC).

Methods: This study adhered to the PRISMA guidelines.

Results: A total of 5624 patients (IMRT, n = 4322; TORS, n = 1302) were included in this meta-analysis. The majority of patients in the IMRT cohort were treated with concurrent CT (n = 3433, 81.3%). On the other hand, the majority of patients in the TORS cohort was treated with an adjuvant treatment (n = 826, 67.8%). IMRT subgroup showed a cumulative survival rate of 83.6% (99% CI 76.9-89.3%), while it was 91.3% (99% CI 81.2-97.8%) in the TORS subgroup. Disease-free survival was significantly different between IMRT (79.6%, 99% CI 70.6-87.3%), and TORS (89.4%, 99% CI 82.7-94.5%). IMRT subgroup showed a feeding tube dependence rate of 4.0% (99% CI 1.1-8.4%), but it was not significantly different from the TORS subgroup (1.3%, 99% CI 0-4.9%). Tracheostomy dependence rates were similar among the two subgroups (IMRT, 0.7%, 99% CI 0-1.1%; TORS, 0.2%, 99% CI 0-1.1%).

Conclusions: TORS appears to be a consolidated effective surgical approach in the management of OPSCC, according to both oncologic and functional outcomes. Further RCTs comparing TORS and IMRT with homogeneous cohorts in terms of tumor staging and HPV status are advisable.
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http://dx.doi.org/10.1007/s00405-020-06224-zDOI Listing
May 2021

Present and Future of De-intensification Strategies in the Treatment of Oropharyngeal Carcinoma.

Curr Oncol Rep 2020 07 9;22(9):91. Epub 2020 Jul 9.

Department of Otorhinolaryngology, Humanitas Clinical and Research Center-IRCCS, Viale Manzoni 56, Rozzano, MI, Italy.

Purpose Of Review: The treatment of patients with squamous cell carcinoma of the oropharynx (OPSCC) remains controversial. HPV positivity is widely accepted as a favorable prognostic factor, and HPV+ OPSCC is considered a distinct pathological entity with dedicated NCCN guidelines and may deserve a more personalized therapeutic strategy. The possibility to reduce surgical invasiveness and acute and late toxicity of radiotherapy/chemotherapy has led to the new concept of de-escalation treatment strategies. In particular, several de-intensified approaches have been investigated with the aim to give patients less toxic treatments, while maintaining comparable results in terms of disease's control and survival. The aim of the present review is to systematically illustrate the current status of research in de-intensification surgical and non-surgical strategies in the treatment of the OPSCC.

Recent Findings: We categorized all completed and on-going trials on the basis of the specific de-escalated treatment protocol. Several de-intensified approaches have been investigated with the aim to give patients less toxic treatments, while maintaining comparable results in terms of disease's control and survival. Considering the conflicting results reported so far by preliminary studies, it is necessary to wait for the final results of the on-going trials to better clarify which is the best de-intensified strategy and which patients would really benefit from it.
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http://dx.doi.org/10.1007/s11912-020-00948-1DOI Listing
July 2020

Prevalence of Taste and Smell Dysfunction in Coronavirus Disease 2019.

JAMA Otolaryngol Head Neck Surg 2020 08;146(8):723-728

Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.

Importance: Early diagnosis of coronavirus disease 2019 (COVID-19) may help control the diffusion of the disease into the population.

Objective: To investigate the presence of sinonasal manifestations at the onset of COVID-19 to achieve an earlier diagnosis.

Design, Setting, And Participants: This retrospective telephone survey study investigated patients diagnosed with COVID-19 from March 5 to March 23, 2020, who were hospitalized or discharged from a single referral center. Patients who were unable to answer (intubated, receiving noninvasive ventilation, or deceased) or unreachable by telephone were excluded. Of 359 consecutive patients, 204 fulfilled the inclusion criteria; 76 were unable to answer, 76 were unreachable by telephone, and 3 refused.

Exposures: Sinonasal manifestations reported before COVID-19 diagnosis were studied with a validated questionnaire: Italian Sino-Nasal Outcome Test 22 (I-SNOT-22). If reduction of taste and/or smell was documented by item 5 of the I-SNOT-22, further inquiries were made to score them separately on a scale from 0 to 5, with 0 indicating no problem and 5 indicating problem as bad as it can be.

Main Outcomes And Measures: The prevalence of sinonasal manifestations preceding COVID-19 diagnosis.

Results: Among the 204 patients enrolled (110 [53.9%] male; mean [SD] age, 52.6 [14.4] years), the median I-SNOT-22 total score was 21 (range, 0-73). I-SNOT-22 identified 116 patients (56.9%) with reduction of taste and/or smell, 113 (55.4%) with taste reduction (median score, 5; range, 2-5), and 85 (41.7%) with smell reduction (median score, 5; range, 1-5). Eighty-two patients (40.2%) reported both. Severe reduction of taste was present in 81 patients (39.7%), and severe reduction of smell was present in 72 patients (35.3%). Only 12 patients (14.8%) with severe taste reduction and 12 patients (16.7%) with severe smell reduction reported severe nasal obstruction. Severe reduction of taste and smell was more prevalent in female vs male patients (odds ratios, 3.16 [95% CI, 1.76-5.67] vs 2.58 [95% CI, 1.43-4.65]) and middle-aged vs younger patients (effect sizes, 0.50 [95% CI, 0.21-0.78] vs 0.85 [95% CI, 0.55-1.15]). No significant association was observed between smoking habits and severe reduction of taste (odds ratio, 0.95; 95% CI, 0.53-1.71) and/or smell (odds ratio, 0.65; 95% CI, 0.35-1.21).

Conclusions And Relevance: The findings of this telephone survey study suggest that reduction of taste and/or smell may be a frequent and early symptom of COVID-19. Nasal obstruction was not commonly present at the onset of the disease in this study. The general practitioner may play a pivotal role in identifying potential COVID-19 in patients at an early stage if taste and/or smell alterations manifest and in suggesting quarantine before confirmation or exclusion of the diagnosis.
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http://dx.doi.org/10.1001/jamaoto.2020.1155DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7303892PMC
August 2020

How to increase the SARS-CoV-2 detection rate through the nasopharyngeal swab?

Oral Oncol 2020 07 14;106:104802. Epub 2020 May 14.

Otorhinolaryngology Unit, IRCCS Humanitas Clinical and Research Center, Via Manzoni 56, Rozzano (MI), Italy; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele (MI), Italy.

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http://dx.doi.org/10.1016/j.oraloncology.2020.104802DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7221403PMC
July 2020

High definition three-dimensional exoscope (VITOM 3D) for microsurgery training: a preliminary experience.

Eur Arch Otorhinolaryngol 2020 Sep 7;277(9):2589-2595. Epub 2020 May 7.

Otorhinolaryngology Unit, IRCCS Humanitas Clinical and Research Center, Via Manzoni 56, 20089, Rozzano, MI, Italy.

Purpose: To assess the feasibility of a high definition 3D exoscope (VITOM) for microsurgery training in a cohort of naïve medical students.

Methods: Twenty-two consecutive medical students performed a battery of four exercises assessing basic microsurgical skills. The students were randomized in two different groups based on two different VITOM holding systems (VERSACRANE™ and ARTip™ cruise). Participants self-reported the VITOM system quality on a 4-point Likert scale (VITOM Quality Assessment Tool). The time needed to complete the exercises was analyzed.

Results: All students successfully completed the training, and no technical issues were raised during the simulation. The majority of the individual items were judged "good" or "very good" (n = 187; 94.4%), regardless of the two groups. "Image quality" (n = 21; 95%), "magnification rate" (n = 20; 91%), "stereoscopic effect" (n = 19; 86%), and "focusing" (n = 18; 82%) represented the best-rated items. No statistically significant difference between the two groups was measured in almost all items of the VITOM Quality Assessment Tool (p > 0.05). The time needed to perform each exercise showed a statistically significant difference between groups in two tests (p < 0.05).

Conclusion: This study demonstrated the feasibility of a VITOM-based microsurgery training. The students' subjective assessment of the VITOM 3D system was promising in terms of technological quality and technical feasibility. Further studies are recommended to define which VITOM holding system could be more appropriate for microsurgery training.
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http://dx.doi.org/10.1007/s00405-020-06014-7DOI Listing
September 2020

Trans-Oral Robotic Surgery in the Management of a Supraglottic Solitary Fibrous Tumor.

J Craniofac Surg 2020 Jul-Aug;31(5):e491-e493

Otorhinolaryngology Unit, IRCCS Humanitas Clinical and Research Center, Rozzano.

Trans-oral robotic surgery (TORS) has become increasingly widespread for the head and neck surgery procedures. In this paper, the authors describe the first reported TORS in the management of a laryngeal solitary fibrous tumor (SFT). A 77-year-old woman suffered from progressive dysphonia lasting 2 years and occasional dyspnea. A submucosal mass of about 4 cm in diameter involving the left supraglottis and left aryepiglottic fold was detected during the flexible fibre-optic laryngeal examination. Magnetic resonance imaging revealed a solid, well-demarcated mass (36 × 25 mm), hyperintense with nonhomogeneous contrast enhancement in T2-weighted sequences. The lesion was successfully removed en bloc using the daVinci Xi system (Intuitive Surgical, Sunnyvale, CA) equipped with 3 robotic arms (1 3-dimensional endoscopic arm, 1 monopolar cautery, 1 bipolar Maryland forceps). The postoperative course was regular, and the endoscopic examination at 1 month showed normal laryngeal morphology and function. Trans-oral robotic surgery has proved to be a good alternative to conventional trans-oral approaches in the treatment of laryngeal SFT. The lesion was completely removed without intraoperative complications, and postoperative morbidity was minimized. Further comparative studies are recommended to define if TORS could become the gold standard for the surgical treatment of laryngeal SFTs.
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http://dx.doi.org/10.1097/SCS.0000000000006555DOI Listing
October 2020

A systematic review of different treatment strategies for the squamous cell carcinoma of the posterior pharyngeal wall.

Eur Arch Otorhinolaryngol 2020 Oct 2;277(10):2663-2672. Epub 2020 May 2.

Otorhinolaryngology Unit, IRCCS Humanitas Clinical and Research Center, Via Manzoni 56, 20089, Rozzano, MI, Italy.

Objective: To perform a systematic review of the literature available about the posterior pharyngeal wall squamous cell carcinomas, with a special focus on oncologic outcomes.

Methods: A comprehensive research was performed on PubMed/MEDLINE, Google Scholar, and Cochrane Library datasets for published studies meeting the established criteria. The last search was conducted on December 8, 2019.

Results: Eleven studies were included in the review, for a total of 534 patients (median age 60.4; male: n = 359, 67.2%). Six of the studies evaluated the oncologic outcomes of primary surgery, while three studies focused on results achieved through primary radiotherapy. Two studies evaluated both surgery and radiotherapy outcomes for the treatment of early or advanced posterior pharyngeal wall carcinoma.

Conclusions: Primary surgery associated with adjuvant radiotherapy would seem to ensure better oncologic outcomes, especially for locally advanced tumors. Moreover, this systematic review showed that oro- and hypo-pharyngeal wall tumors are similar in terms of clinical and biological behavior.
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http://dx.doi.org/10.1007/s00405-020-05990-0DOI Listing
October 2020

CORONA-steps for tracheotomy in COVID-19 patients: A staff-safe method for airway management.

Oral Oncol 2020 06 17;105:104728. Epub 2020 Apr 17.

Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy; Otorhinolaryngology Unit, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089 Rozzano, MI, Italy.

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http://dx.doi.org/10.1016/j.oraloncology.2020.104728DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7164878PMC
June 2020

COVID-19: Nasal and oropharyngeal swab.

Head Neck 2020 06 30;42(6):1303-1304. Epub 2020 Apr 30.

Department of Otolaryngology-Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy.

Performing a proper nasal and oropharyngeal swab procedure is essential in the screening of COVID-19 infection. The video illustration of nasal and oropharyngeal swab is presented (Video S1). To correctly perform the nasopharyngeal swab, the patient must be seated comfortably with the back of their head against the headrest. The swab is inserted in the nose horizontally, along an imaginary line between the nostril and the ear. Oropharyngeal sampling is easier to perform. The swab is directed toward the rear wall of the oropharynx and it is rotated a few times before removal. After taking the sample, it is necessary to insert both swabs in the same tube, breaking the rod with one swift and controlled movement. Finally, carefully reset the cap. It appears to be extremely important to properly collect nasopharyngeal and oropharyngeal swabs in order to minimize the false negative rate among COVID-19 positive patients.
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http://dx.doi.org/10.1002/hed.26212DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7267300PMC
June 2020

Who should perform the rhinopharyngeal swab in COVID-19 positive patients?

Head Neck 2020 06 24;42(6):1250-1251. Epub 2020 Apr 24.

Otorhinolaryngology Unit, Humanitas Clinical and Research Center-IRCCS, Milan, Italy.

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http://dx.doi.org/10.1002/hed.26194DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7264563PMC
June 2020

Pre-Clinical Experience With the VITOM 3D and the ARTip Cruise System for Micro-Laryngeal Surgery.

Laryngoscope 2021 01 16;131(1):136-138. Epub 2020 Apr 16.

Otorhinolaryngology Unit, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milano, Italy.

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http://dx.doi.org/10.1002/lary.28675DOI Listing
January 2021

"L" shape technique for endoscopic sinus surgery: An alternative method.

Am J Otolaryngol 2020 Sep - Oct;41(5):102471. Epub 2020 Apr 1.

Department of Otolaryngology - Head and Neck Surgery, Humanitas Clinical and Research Center-IRCCS, Via Alessandro Manzoni, 56, 20089 Rozzano, MI, Italy; Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, MI, Italy.

Background: Several techniques for performing ethmoidectomy have been reported. We describe a safe, effective and efficient technique during functional endoscopic sinus surgery (FESS). We present text, images and videos to illustrate our preferred technique during an antero-posterior ethmoidectomy and to provide a multimedia tool for educational purpose.

Methods: A description of the technique without prospective or retrospective data is reported. A complete ethmoidectomy with an L-shape approach is described step-by-step, using the backbiting circular and miniature cutting forceps, with safe exposure of the lamina papyracea (LP) and skull base.

Results: In our hands, the L-shape approach for chronic rhinosinusitis with or without polyposis, performed with punch circular cutting and miniature cutting forceps, allowed for a reliably safe and efficient ethmoidectomy.

Conclusion: The technique described can be added to the armamentarium of the endoscopic sinus surgeon.
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http://dx.doi.org/10.1016/j.amjoto.2020.102471DOI Listing
November 2020

Lateral cervical approach for salvage total laryngectomy without pharyngeal reinforcement with pedicled or free flaps: our preliminary experience in six patients.

Eur Arch Otorhinolaryngol 2020 Jun 31;277(6):1837-1841. Epub 2020 Mar 31.

Humanitas University, Via Rita Levi Montalcini, 4, 20090, Pieve Emanuele, MI, Italy.

Purpose: To analyze the surgical outcomes in terms of postoperative wound complications in a small case series of six patients treated with lateral cervical approach (LCA) for salvage total laryngectomy (STL) without prophylactic use of the pectoralis major myocutaneous flap (PMMF) or free flaps.

Methods: Between September 2018 and August 2019, six patients with recurrent/residual squamous-cell carcinoma after (chemo)radiotherapy [(C)RT] underwent STL with minimally invasive LCA with the anterior myocutaneous flap (AMCF), sparing the prelaryngeal tissue. Clinical records were retrospectively reviewed.

Results: Wound dehiscence and local complications were prevented in five cases. Pharyngocutaneous fistula (PCF) occurred in one case and the closure was achieved by medical dressing with spontaneous healing within 15 days. Oral intake of liquids started 2 weeks after surgery in the five patients without local complications, after 24 days in the patient with PCF.

Conclusion: STL through the LCA after [(C)RT] failure seems to be feasible and effective in terms of prevention of local complications as wound dehiscence and fistula. More large clinical series are needed to confirm whether the use of LCA reduced the rate of postoperative wound complications following STL without the prophylactic use of pedicled or free flaps.
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http://dx.doi.org/10.1007/s00405-020-05942-8DOI Listing
June 2020

Transoral Robotic Surgery in the Management of a Tongue Base Schwannoma.

J Craniofac Surg 2020 Jun;31(4):e411-e413

Department of Otolaryngology Head and Neck Surgery, Regina Elena National Cancer Institute, IRCCS, Rome.

Schwannomas are the most common benign tumors arising from the peripheral nerve sheath, and the intraoral location is very atypical, representing less than 1% of all cases. Surgical excision is the treatment of choice, and a variety of surgical approaches have been described. The authors report the first described case of tongue base schwannoma treated with transoral robotic surgery (TORS). A 47-years-old female patient complaining mild dysphagia and snoring, presented a submucosal swelling at the right side of the tongue base. MRI showed a large well-circumscribed solid mass, homogeneously isointense in T1WI and hyperintense on T2WI, with no lymph node metastasis. According to size, location and radiological characteristic of the mass a TORS approach was chosen. An extracapsular dissection was performed, and the lesion was completely removed with no intraoperative complications. The final diagnosis based on histopathological examination and IHC analysis (S-100 positive) was a schwannoma of the tongue base. The post-operative course was uneventful, and no recurrence was observed after 6 months of follow-up. This study demonstrates the feasibility of TORS in the treatment of a tongue base schwannoma. This is a valid alternative to the common transoral approach in order to avoid more invasive external approaches, and further studies are recommended in order to clarify if this approach could be proposed as the first line treatment in selected cases.
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http://dx.doi.org/10.1097/SCS.0000000000006417DOI Listing
June 2020

Trans-oral robotic surgery in the management of parapharyngeal space tumors: A systematic review.

Oral Oncol 2020 04 12;103:104581. Epub 2020 Feb 12.

Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele (MI), Italy; Department of Otorhinolaryngology Head and Neck Surgery, IRCCS Humanitas Clinical and Research Center, Via Alessandro Manzoni, 56, 20089 Rozzano (MI), Italy.

Purpose: To perform a systematic review of studies evaluating Trans-oral Robotic Surgery (TORS) in the treatment of parapharyngeal space (PPS) tumors.

Methods: A comprehensive electronic search was performed in PubMed/MEDLINE, Cochrane Library, and Google Scholar databases for appropriate published studies. The last search was conducted on November 9, 2019.

Results: Twenty-two studies were included for the systematic review which analyzed a total of 113 patients (median age 53.5, IQR 41.5-58.1). The most common PPS tumor treated with TORS was the pleomorphic adenoma (n = 66; 58.4%). All tumors were successfully resected. The median tumor size was 4.8 cm (n = 73; IQR 3.8-5.4). Combined transcervical (TORS-TC) and transparotid (TORS-TP) approaches were used in 13 (11.5%) and 5 (4.4%) patients, respectively. Capsule disruption was noted in 11 cases (14.5%), while tumor fragmentation was observed in 7 patients (10.3%). The median time of hospitalization was 3 days (n = 79; IQR 2-4.1). Oral diet was possible from the day after surgery in the majority of patients (n = 34, 68%). The most common complication was dysphagia (n = 5, 4.5%).

Conclusions: This systematic review confirms the safety and feasibility of TORS in the treatment of PPS lesions. Given the low quality of included studies, further evidence is needed in order to establish clinical guidelines.
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http://dx.doi.org/10.1016/j.oraloncology.2020.104581DOI Listing
April 2020