No abstract

The transcanal endoscopic approach to the ST is indicated in ST of Types A and B. In ST of Type C, it is not always possible to have good control of the ST; in these cases, a posterior retrofacial approach is suggested.

4.

The round window region is a critical area of the middle ear; the aim of this paper is to describe its anatomy from an endoscopic perspective, emphasizing some structures, the knowledge of which could have important implications during surgery, as well as to evaluate what involvement cholesteatoma may have with these structures. Retrospective review of video recordings of endoscopic ear surgeries and retrospective database review were conducted in Tertiary university referral center. Videos from endoscopic middle ear procedures carried out between June 2010 and September 2012 and stored in a shared database were reviewed retrospectively. Surgeries in which an endoscopic magnification of the round window region and the inferior retrotympanum area was performed intraoperatively were included in the study. Involvement by cholesteatoma of those regions was also documented based on information obtained from the surgical database. Conformation of the tegmen of the round window niche may influence the surgical view of round window membrane. A structure connecting the round window area to the petrous apex, named the subcochlear canaliculus, is described. Cholesteatoma can invade the round window areas in some patients. Endoscopic approaches can guarantee a very detailed view and allow the exploration of the round window region. Exact anatomical knowledge of this region can have important advantages during surgery, since some pathology can invade inside cavities or tunnels otherwise not seen by instrumentation that produces a straight-line view (e.g. microscope).

A selective epitympanic dysventilation syndrome is hypothesized; normal ET function seems to be insufficient for complete ventilation of the middle ear, and an open tympanic isthmus or an incomplete tensor fold may be necessary for epitympanic recess ventilation. The selective epitympanic dysventilation syndrome would consist of the contemporary presence of the following four conditions: attic retraction pocket or cholesteatoma, normal tubal function tests, complete epitympanic diaphragm, and isthmus blockage.

OBJECTIVE The aim of this study was to describe the first case series in which an exclusive endoscopic transcanal transpromontorial approach (EETTA) was used to treat small vestibular schwannomas (VSs) and meningiomas of the internal auditory canal (IAC). METHODS The authors performed a retrospective review of patients who had undergone surgery using an EETTA to the IAC at 2 university tertiary care referral centers during the period from November 2011 to January 2015. RESULTS Ten patients underwent surgery via an EETTA for the treatment of VS in the IAC at the University Hospital of Modena or the University Hospital of Verona. The patients had Koos Grade I or II tumors and American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) Class D hearing status preoperatively. Gross-total resection was achieved in all patients. No major complications such as cerebrospinal fluid leakage or hemorrhage were reported. In 7 of 10 (70%) patients, facial nerve function was normal immediately after surgery (Rough Grading System [RGS] Grade I). Two patients presented with a transitory facial palsy immediately after surgery (RGS Grade II-III) but experienced complete recovery during the follow-up period. The mean follow-up was 10 months. CONCLUSIONS The EETTA proved to be successful for the removal of VS or meningioma involving the cochlea, fundus, and IAC, with possible lower complication rates and less invasive procedures than those for traditional microscopic approaches. The potential for the extensive and routine use of this approach in lateral and posterior skull base surgery will depend on the development of technology and surgical refinements and on the diffusion of skull base endoscopic skills among the otolaryngological and neurosurgical communities.

In total, 56 patients were selected and all were observed over a 3-year follow-up period. We identified two groups: group A, 34 patients (60.71%) affected by nasal polyposis who underwent endoscopic surgery with the conservation of middle turbinate; group B, 22 patients (39.29%) affected by nasal polyposis who underwent more radical endoscopic sinus surgery. Analyzing the entire study group, during the 3-year follow-up, 20 (35.71%) of the 56 patients had a relapse of nasal polyposis. Analyzing time to relapse curves in the allergic and non-allergic patients, we obtained a p value of 0.0589, i.e. at the limit of statistical significance. The comparison between preoperative and postoperative Cologne test in the whole study group was statistically significant for a symptomatic improvement (p < 0.001). Trends within the two groups were also evaluated: there was a statistically significant difference in behavior upon time to relapse of the patients in group B vs group A (p = 0.0102). The patients in group A developed nasal recurrence more frequently during the follow-up periods. In patients affected by allergy vs patients not affected by allergy in group A, a statistically significant difference was noted (p = 0.0074); the allergic patients developed nasal recurrence more frequently during the follow-up period. We could not find a statistically significant difference between those patients affected by allergy and those not affected by allergy, as regards the number of relapses in patients in group B.

The aim of this systematic review is to evaluate the definition of close margin in head and neck squamous cell carcinoma (HNSCC), and its possible prognostic significance. An appropriate string was run on PubMed to retrieve articles discussing the 'close' surgical margin issue in HNSCC. A double cross-check was performed on citations and full-text articles retrieved. In total, 348 articles were identified. Further references were included by using the option "Titles in your search terms" option in PubMed. 15 papers were finally included for qualitative synthesis. In vocal cord surgery of HNSCC, a close margin could be considered to be ≤1 mm, in the larynx ≤5 mm, in the oral cavity ≤4 mm, and in the oropharynx ≤5 mm. In each patient, the choice of extent of close margin should be balanced against general condition, tumor stage, and functional issues to indicate appropriate adjuvant therapy.