Adult rhabdomyosarcoma (RMS) represents an uncommon entity with an incidence of less than 3% of all soft tissue sarcomas (STS). Consequently, the natural history and the clinical management of this ...disease are infrequently reported. In order to fill this gap, we investigated the molecular biology of an adult RMS case series. The expression of epithelial mesenchymal transition-related gene and chemoresistance-related gene panels were evaluated. Moreover, taking advantage of our STS translational model combining patient-derived primary culture and 3D-scaffold, the pharmacological profile of an adult head and neck sclerosing RMS was assessed. Furthermore, NGS, microsatellite instability, and in silico analyses were carried out. RT-PCR identified the upregulation of
,
,
,
,
and
, representing promising biomarkers for this disease. Pharmacological profiling showed the highest sensitivity with anthracycline-based regimen in both 2D and 3D culture systems. NGS analysis detected
in frame gene rearrangement and
mutation; microsatellite instability analysis did not detect any alteration. In silico analysis confirmed the mutation of
as a promising marker for poor prognosis and a potential therapeutic target. We report for the first time the molecular and pharmacological characterization of rare entities of adult head and neck and posterior trunk RMS. These preliminary data could shed light on this poorly understood disease.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Trans Oral Robotic Surgery (TORS) is a modality in the management of oropharyngeal squamous cell carcinoma(OPSCC). This study was conducted to show the rates of peri-operative complications after ...TORS for OPSCC in our experience. Single centre retrospective analysis of consecutive OPSCC treated with TORS. The surgical complication severity was recorded according to Clavien-Dindo criteria (CDC). Eighty-seven OPSCC were operated with TORS. According to CDC, grade I, grade II and IIIb were registered in 8%, 4.6% and 11.5% of cases, respectively. The postoperative pain, registered with visual-analogue scale (VAS) score, was 8 ± 1.2 for the secondary healing wounds and 6.2 ± 1.5 for the flap reconstructions (
p
< 0.01). The impact on swallowing function was not significant between secondary healing and flap reconstructions(
p
= 0.96). Any major or life-threatening intraoperative complications have not been recorded. Only one patient had postoperative bleeding into the neck whilst 13.3% of patients had postoperative bleeding from the primary tumor. No total local or free flap failure were registered. The mean duration of tracheostomy use was 7.4 ± 2.6 days, and nasogastric tube 14.3 ± 6.9 days. Only one patient, who had also reconstruction with flap, experienced a postoperative severe dysphagia with severe aspiration, needing a permanent tracheostomy tube and percutaneous endoscopic gastrostomy feeding. TORS for OPSCC showed less morbidity, lower risk of severe complication and mortality. Thus, this treatment modality could be offered as first line treatment in selected cases.
The nose is a central component of the face, and it is fundamental to an individual's recognition and attractiveness. The aim of this study is to present a review of the last twenty years literature ...on reconstructive techniques after oncological rhinectomy.
Literature searches were conducted in the databases PubMed, Scopus, Medline and Google Scholar. "Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA)" for scoping review was followed.
Seventeen articles regarding total rhinectomy reconstruction were finally identified in the English literature, with a total of 447 cases. The prostheses were the reconstructive choice in 213 (47.7%) patients, followed by local flaps in 172 (38.5%) and free flaps in 62 (13.8%). The forehead flap (FF) and the radial forearm free flap (RFFF) are the most frequently used flaps.
This study shows that both prosthetic and surgical reconstruction are very suitable solutions in terms of surgical and aesthetic outcomes for the patient.
Objective Adenoid cystic carcinoma of the salivary glands has a propensity for perineural invasion, which could favor spread along the major cranial nerves, sometimes to the skull base and through ...the foramina to the brain parenchyma. This study evaluated the relationship between neural spread and relapse in the skull base. Study Design During surgery, we performed multiple biopsies with extemporaneous examination of the major nerves close to the tumor to guide the surgical resection. Results The percentage of actuarial local control at 5 years for patients with a positive named nerve and skull base infiltration was 12.5%, compared with 90.0% in patients who were named nerve–negative and without infiltration of the skull base ( P = .001). Conclusions Our study shows that local control of disease for patients who are named nerve–positive with skull base infiltration is significantly more complex compared with patients who are named nerve–negative without infiltration of the skull base.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
The purpose of this pictorial essay is to clarify and propose a novel positioning technique for raising the free flaps on the peroneal system with the aim of obtaining optimal exposure of the ...operating field, good stabilization of the inferior limb with high comfort for the surgical teams without the need of a third assistant during the harvest or closure. A review of the literature, focusing on the exact position of the patient during the harvest of the peroneal system flaps, was made and no key publications were found. In February 2007, the Maxillofacial group at the Bufalini Hospital of Cesena and the University of Sassari Hospital switched from putting the patient in a standard Gilbert’s technique with the use of a second assistant to a novel positioning technique in the supine position with the use of the orthopedic-derived supports in order to hold the leg during the harvest. A broad literature review was also performed, revealing very little literature on this topic. A shared guideline for standardized positioning of the patient in FFF harvesting can decrease the potential risk for gravitational-related injuries on the operating table and thus the legal complaints as well. We think that our novel positioning technique can be useful for all residents in maxillofacial, plastic and ENT Departments, improving the time spent in the operating room and for all the more skilled senior colleagues who carry out this type of intervention to facilitate their task and make it more comfortable. Level of evidence: level V, therapeutic study
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Background
We review here our substantial experience in using Alexis Carrel’s technique with a geometrical optimization for microsurgical end-to-end anastomoses.
Methods
The technique used for ...microsurgical end-to-end anastomoses is described. We performed a retrospective analysis of head and neck free flaps where we used the described microsurgical anastomoses technique at Bufalini Hospital in Cesena, Italy. Patients’ demographic data, intraoperative findings, and postoperative progress, including complications, were accurately recorded. We also recorded the cases where vessel size discrepancy was observed intraoperatively, either arterial or venous.
Results
The described technique has been used in 300 consecutive flaps in the last 18 years, with an average of 16 free flaps per year. No significant problems were encountered using this simple technique. Comprehensive flap survival was 98%. We had 5 free flap failures, and in all cases, the main problem was not related to the microvascular anastomoses. Vessel size discrepancy was recorded in 25% of the total.
Conclusions
Alexis Carrel’s technique for microvascular end-to-end anastomoses is still a very efficient end safe technique. Our geometrical optimization of it is a useful trick to keep in mind for the microvascular surgeon, especially in hospitals with a small volume of microsurgical procedures per year.
Level of evidence: Level III, therapeutic study.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
The principles of nasal reconstruction include the need to reconstruct three tissue layers, the need to restore entire skin aesthetical units, and, possibly, the replacement with like tissues. ...Computer-aided design (CAD) and computer-aided manufacturing (CAM) technologies were applied to two total nasal reconstructions in male patients who underwent rhinectomy for cancer. Three-dimensional (3D) data were obtained from computerized tomography (CT) scan-derived DICOM files (Digital Imaging and Communications in Medicine), this allowed us to design the shape of the reconstructive nose in order to mimic the native nose and to plan dimensions and angles. A custom-made titanium plate was manufactured for the structure and a bi-dimensional template for the forehead flap was printed. The patients underwent a total nasal reconstruction in three layers: local flaps for the lining, custom-made titanium plate for the structure, and expanded forehead flap for the skin. Forehead flap pedicle was divided 3 weeks postoperatively under local anesthesia in an outpatient clinic, as well as further minor refinements. The patients underwent a 6-month post-operative CT scan in order to compare the result to the planned nose. No complications were reported. The superimposition demonstrated a 92% match in case 1 and 95% match in case 2 between the reconstructed nose and the planned one. Forehead flap is still the most favorable option for nasal reconstruction, CAD technology allows to implement the planning and makes the procedure easier; moreover, the use of a CAM plate for the structure allows to reconstruct a nose with the desired naso-frontal angle.
Level of evidence: level V, therapeutic study.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Trans Oral Robotic Surgery (TORS) has proved to be a safe and feasible treatment for oropharyngeal squamous cell carcinoma (OPSCC). The aim of this study is to analyse oncological outcomes of OPSCC ...patients treated with TORS.
This study involved 139 patients with OPSCC, treated with TORS between 2008 and 2020. Clinicopathological characteristics, treatment details and oncological outcomes were evaluated retrospectively.
The management strategies included TORS alone in 42.5%, TORS-RT in 25.2% and TORS-CRT in 30.9%. The ENE was noted in 28.8% of neck dissections. In 19 patients clinically classified as unknown primaries, the primary was found in 73.7%. Rates of local, regional relapses and distant metastasis were 8.6%, 7.2%, and 6.5%, respectively. The 5 year- Overall Survival and Disease Free Survival were 69.6% and 71.3%, respectively.
TORS fits well in the modern management of OPSCC. Although definitive CRT remains a milestone, TORS is proving to be a valid and safe treatment option. The choice of the therapeutic strategy requires evaluation by a multidisciplinary team.
•Transoral robotic surgery is a valid treatment for oropharyngeal carcinomas•Oncological outcomes are comparable to definitive chemoradiationtherapy•Multidisciplinary team should tailor the best treatment to single patient
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Objectives
This prospective study evaluated the accuracy of mandibular reconstruction using free fibular flaps (by comparing virtual plans to the three‐dimensional postoperative results), and the ...extent of bone‐to‐bone contact after computer‐assisted surgery.
Methods
We included 65 patients who underwent partial‐continuity mandibular resections from February 2013 to January 2017, and evaluated virtual planning, surgical techniques, and accuracy.
Results
Forty‐seven patients were analysed. A total of 112 fibular segments received 54 implants. We measured 227 distances between landmarks to assess the accuracy of reconstruction. Postoperative reconstruction accuracy ranged from 0.5 to 3 mm.
Conclusion
Virtual surgical planning very accurately translated simulation into reality, particularly in patients requiring large, complex mandibular reconstructions using multiple fibular segments.
Level of evidence
4 Laryngoscope, 131:E2169–E2175, 2021
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
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