ACTA Otorhinolaryngologica Italica

Microsurgery in primary tumours of the parapharyngeal space: observational retrospective analysis of a series of consecutive cases

Antonio Mazzoni — 2025-06-25

Objective. To investigate safety and efficacy of the microsurgical approach to parapharyngeal space (PPS) tumour. A secondary goal was to evaluate the correspondence between preoperative and final histopathologic diagnosis after surgery.
Methods. A consecutive series of primary PPS tumours treated between 1985 and 2022 in 2 tertiary referral centres with a microsurgical cervico-parotid approach was considered. The sample included 97 tumours (88 benign and 9 malignant) in 94 patients, of which 11 affected by recurrent tumours when first diagnosed at our centres. The surgical approaches, planned on the presumptive preoperative diagnosis, were pericapsular and en bloc resections (including either conservative or radical resections of the PPS).
Results. Pericapsular and en bloc resections of the PPS achieved complete removal in 88 out of 97 tumours. Relapses after PPS microsurgery occurred only in 8 cases (4 pleomorphic adenomas, 2 malignant schwannomas, one melanoma, and one haemangiopericytoma). Four of the 8 relapsed cases were recurrent cases when first seen at our centres. A complete correspondence between preoperative diagnosis and final histology occurred only in the group of benign lesions classified as paraganglioma, schwannoma, or lipoma, submitted to pericapsular resection.
Conclusions. Microsurgery may support the transcervical-parotid approach, by enhancing the operative space through narrow surgical corridors, improving dissection on critical cleavage planes, vessels and nerves, and allowing the exposure of both caudal and cranial extent of the lesions. In our series, pericapsular and en bloc resections of the PPS were effective in most of the included patients. In high-grade malignancies, where the morbidity of a wider resection beyond the PPS walls may include vessels and nerves, the indication should be accurately balanced.

Airway assessment and management in head and neck cancer surgery

Chiara Mossinelli — 2025-06-25

Objectives. Head and neck cancer surgery (HNCS) is burdened by a great risk of difficult airway and adverse events during anaesthesia. This study describes our experience and provides a flowchart for airway management in HNCS.
Methods. We retrospectively reviewed 910 surgically treated patients (January 2022-January 2023, European Institute of Oncology, Milan, Italy). We selected malignant tumours of the upper airway and surgery performed under general anaesthesia. We report a descriptive analysis of the sample. The data collected were representative of our daily clinical practice and have been used to
draw up a proposal for airway management in HNCS.
Results. 200 consecutive patients (males 71.5%, females 28.5%), median age 67 years, were selected. The most represented sites were larynx (44.5%), oral cavity (30.5%), and oropharynx (20%). Airway management was obtained by orotracheal intubation (61%), nasotracheal intubation (15%), awake intubation under fibreoptic endoscopic control (15%), and tracheostomy under local anaesthesia (9%). In 3 cases we performed tracheostomy in an emergency setting (all patients affected by laryngeal cancer in a locally advanced stage).
Conclusions. Airway management in HNCS represents a topic of compelling interest that requires careful planning, well-defined options of strategies, and close communication between anaesthesiologists and surgeons.

Exploring the use of submental flap for parotid region reconstruction: a multicentric experience.

Luca Gazzini — 2025-06-25

Objectives. This study aims to evaluate the effectiveness and reproducibility of the submental island flap (SIF) for reconstructing defects in the parotid region after oncological surgery. The primary goals are to assess the flap’s impact on patient morbidity, its overall feasibility in complex head and neck reconstructions, and its potential for consistent outcomes across different cases.
Methods. A retrospective multicentric study was conducted across 6 tertiary centres in Northern Italy, reviewing cases from 2015 to 2023. Inclusion criteria encompassed adult patients undergoing parotid region reconstruction using the SIF, specifically for defects arising from parotid or associated skin tumours. Data on patient demographics, comorbidities, tumour characteristics, surgical
details, flap characteristics, complications, and long-term oncological outcomes were collected and analysed.
Results. The study included 30 patients with a mean age of 75.4 years, most of whom had significant comorbidities. The flap success rate was 93.3%, with minimal donor site morbidity. The aesthetic outcomes were favourable, with the flap providing a good match of colour and texture. Oncological safety was affirmed, with no nodal transfers observed.
Conclusions. The SIF is a reliable and aesthetically favourable option for parotid region reconstruction, particularly in elderly patients with multiple comorbidities. Its use minimises donor site morbidity and does not require microsurgical expertise. Careful patient selection is critical to avoid complications, particularly in those with a history of submental trauma, and to not risk metastatic lymph node transfer in advanced nodal disease. The SIF allows for effective reconstruction without compromising oncological outcomes, supporting its use as a standard approach in appropriate cases.

Surgical approaches to the management of the intrathoracic goiter – A systematic review

Cesare Miani — 2025-06-25

Objective. Intrathoracic goiters (ITGs) pose numerous challenges to head and neck surgeons due to the intricate relationships with major vessels and other mediastinal structures. Surgical excision remains the mainstay of treatment and we herein present an update on this topic.
Methods. A systematic review from 2017 to date was performed in the PubMed database and a total of 93 articles were identified and discussed, along with methodological issues and future directions in the research on ITGs.
Results. Transcervical excision is the commonest approach for treating ITGs, yet the potential need for a transthoracic approach must be always kept in mind. An acceptable rate of postoperative complications is expected if surgeries are carried out by experienced and dedicated surgical teams.
Conclusions. Surgical excision remains the principal treatment for ITGs and new less invasive techniques are being developed. Surgery for ITGs should be always carried out in specialist centres with experienced multidisciplinary teams.

Italian adaptation of Listening Effort Assessment Scale and Fatigue Assessment Scale questionnaires

Sara Ghiselli — 2025-06-25

Objective. The purpose of this study is to adapt linguistically and culturally the Listening Effort Assessment Scale (EAS) and Fatigue Assessment Scale (FAS) questionnaires into Italian (EAS-IT and FAS-IT) and to investigate the reliability and validity of these scales in normal hearing and hearing-impaired subjects.
Methods. The Italian adaptation of the EAS and FAS questionnaires was conducted based on back and forward translation methodology. Both questionnaires were administered to 101 normal hearing (NH) subjects and 88 hearing-impaired subjects including 19 hearing aid users (HA), 50 cochlear implant users (CI) and 19 affected by single-sided deafness (SSD).
Results. Both questionnaires showed a high reliability (Cronbach’s α was 0.953 for EAS-IT and 0.837 for FAS-IT). EAS-IT showed high internal consistency with item-rest correlations. The interitem correlation of the FAS-IT shows a difference in the internal consistency of item 4. A high significance between the NH group and the 3 hearing loss groups (HA, CI, SSD) was found for EAS-IT, but no significant difference was found between NH and the single hearing-impaired groups for FAS-IT.
Conclusions. EAS-IT showed good internal reliability and validity and is sensitive to hearing loss.

Anatomical basis of the elongated nasoseptal flap

Tor Chiu — 2025-06-25

Objective. The aim of this study was to elucidate the anatomical factors influencing elongation of the pedicle of the nasoseptal flap (NSF).
Methods. Dissections were conducted on tissue blocks taken from 61 embalmed half-heads. In the first group, 36 were microdissected to delineate the configuration of the third part of the maxillary artery (MA). In the second group, 25 other specimens were dissected using endoscopic instruments to determine the tethering points limiting the mobility of the NSF and to document the surgical manoeuvres required for release.
Results. The MA is coiled in the pterygopalatine fossa (PPF) into a variety of configurations that can be classified into single-looped (SL) or double-looped (DL) forms depending on the number of vessel loops. Up to 4.7 ± 0.5 cm of NSF pedicle elongation is possible in the more common (80.8%) DL forms. Elongation is limited to 2.6 ± 0.5 cm in the SL form; greater palatine artery transection is more important to pedicle elongation in the SL form. Posterior branches such as the pharyngeal and vidian arteries may hinder pedicle elongation.
Conclusions. The pedicle of the NSF may be elongated by up to 5 cm, greatly increasing its potential utility. The vessel length available for elongation is determined by the extent of MA looping, while the branch configuration, and particularly the origins of the posterior branches, determine how difficult the process will be.

Ostiomeatal complex preservation: submucosal inferior meatal antrostomy for maxillary sinus pathologies

Roee Landsberg — 2025-06-25

Objective. Endoscopic inferior meatal antrostomy (EIMA) is feasible for treating maxillary sinus pathologies. We describe submucosal inferior meatal antrostomy (SIMA), a new ostiomeatal complex (OMC) sparing technique based on EIMA.
Materials and methods. Medical records of patients who underwent SIMA for maxillary sinus pathologies were retrospectively reviewed. Data collected included age, gender, presenting symptoms, preoperative and postoperative endoscopic and computed tomography findings, early followup duration, and complications.
Results. Twenty-two operated maxillary sinuses, in 20 patients, were included. Pathologies included displaced dental implant (n = 4), odontogenic sinusitis (n = 6), retention cyst (n = 5), antrochoanal polyp (n = 5) and fungus ball (n = 2). SIMA provided excellent access and view, and the OMC and the inferior meatus mucosa remained intact. Nineteen patients were completely cured following a rapid recovery and needed no further intervention. No intra-operative or postoperative complications occurred, and recirculation was not observed. One case failed due to a persistent odontogenic infection.
Conclusions. SIMA provides an improved access and view when treating non-OMC-dependent maxillary sinus pathologies, while maintaining the integrity of the middle and inferior meatuses mucosa.

Granulomatosis with polyangiitis presenting as isolated ear involvement: a case series and literature review

Silvia Zorzi — 2025-06-25

Objective. To describe the clinical characteristics and outcomes of patients affected by granulomatosis with polyangiitis (GPA) presenting with isolated ear involvement.
Methods. A retrospective review of patients affected by GPA and treated at the University of Brescia, Italy, from 2002 to 2023 was conducted. Only patients with exclusive otologic manifestation as first presentation were included.
Results. Among 610 patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV) diagnosed and followed at our Institution, 6 (0.8%) presented with exclusive ear involvement as first presentation, all affected by GPA. Most frequently patients presented with otitis media with effusion, sensorineural or mixed hearing loss, and dizziness. Two patients developed systemic symptoms. All patients experienced at least a partial recovery of middle ear function after starting immunosuppressive therapy.
Conclusions. AAVs rarely show initial presentation as isolated ear involvement, and more commonly present as otitis media with hearing loss that is unresponsive to conventional therapy. Once an AAV is suspected, surgery should be avoided since further damage can be caused by local iatrogenic inflammation sustained by the underlying condition. Local improvement is generally seen after the start of immunosuppressive therapy.