Andrea Achena

Purpose Sinonasal intestinal-type adenocarcinoma (ITAC) is a rare malignancy with high recurrence rates and significant morbidity. This study evaluates survival outcomes and prognostic factors—particularly the impact of tumor stage (pT category), histologic grade, and resection margins—in a contemporary institutional series. Methods A retrospective analysis included 30 patients treated for histologically confirmed sinonasal ITAC at a single centre from July 2010 to July 2024. Patient demographics, tumor characteristics, treatment strategies (including surgical approach and perioperative therapies), and outcomes were reviewed. Kaplan–Meier analyses were used to estimate overall (OS), disease-specific (DSS), and disease-free survival (DFS). Results The study cohort comprised predominantly male patients (86.7%), with a mean age of 66 years. Advanced disease (pT3 and pT4) occurred in 66.7% of patients. The median follow-up was 53 months. Five-year OS was 58.6%, DSS 75.3%, and DFS 65.3%. Early-stage tumors (pT1 and pT2) demonstrated superior outcomes, achieving 100% five-year OS and DSS compared to 41.7% OS and 62.9% DSS for advanced stages (p < 0.05). Conclusion Pathological T category remains a key prognostic determinant in sinonasal ITAC. Endoscopic resection, including transnasal craniectomy when necessary, coupled with risk-adapted radiotherapy, yields favorable survival outcomes even in advanced cases.

Purpose Frontal sinus osteomas are benign tumors that often require surgical resection due to their proximity to critical anatomical structures. The surgical approach can vary significantly depending on the size, location, and extent of involvement of these structures. Currently, no universally accepted classification system exists to guide the surgical management of frontal sinus osteomas. This study proposes a classification system based on these factors, with the objective of providing a standardized approach for selecting the most appropriate surgical techniques. Methods A retrospective analysis was conducted on all patients who underwent surgical resection of frontal sinus osteomas at a single institution from 2012 to 2024. Osteomas were categorized into three grades (I, II, and III) based on size, location, and anatomical features. Surgical outcomes were analyzed in relation to the osteoma classification. Results Fifty-two patients were included in the study. Of these, 41 (78.8%) patients were treated using an endoscopic approach, 7 (13.5%) with an open approach, and 4 (7.7%) with a combined approach. According to the classification, 25 (48.1%) osteomas were categorized as grade I, 14 (26.9%) as grade II, 13 (25.0%) as grade III. Grade I osteomas were predominantly managed with endoscopic techniques, while grade II osteomas required extended endoscopic approaches. Grade III necessitated open or combined approaches. Conclusion This classification system provides a structured approach for determining the optimal surgical method for frontal sinus osteomas, aiming to reduce variability in treatment and improve patient outcomes.

Background/Objectives: Stapes surgery is a well-established treatment for conductive hearing loss caused by otosclerosis, with the choice of prosthesis playing a pivotal role in audiological outcomes and safety. Heat-activated and superelastic nitinol prostheses are widely used, but their comparative effectiveness and complication profiles remain debated. This systematic review and meta-analysis aimed to evaluate the audiological outcomes, complication rates, and overall performance of these two prosthesis types. Methods: A systematic review was conducted following PRISMA guidelines. Seven studies involving 273 patients were included. Data on mean air–bone gap (ABG) reduction, complication rates, and follow-up outcomes were extracted. Meta-analyses were performed using a random-effects model, and odds ratios (OR) with 95% confidence intervals (CI) were calculated for comparative analysis. Results: The pooled mean ABG reduction was 20.2 dB (95% CI: 19.47–20.95), indicating substantial and comparable improvements in hearing for both prosthesis types. Heat-activated prostheses achieved slightly higher ABG reduction in individual studies, while superelastic prostheses offered advantages in procedural simplicity. Complication rates were 6.0% for heat-activated and 5.6% for superelastic prostheses. The most common complications included sensorineural hearing loss (2.0–2.4%) and incus-related issues such as necrosis and lateralization. Conclusions: Both prosthesis types provide comparable audiological outcomes and surgical success rates. However, the slightly lower complication rate observed with superelastic prostheses emphasizes their safety and predictability. The choice of prosthesis should be guided by patient anatomy, surgeon expertise, and procedural considerations. Future studies should prioritize long-term outcomes and standardized reporting to further refine prosthesis selection.

Introduction: The planning of oral reconstruction after tumor resection is a pivotal point for head and neck surgeons. It is mandatory to consider two aspects: the size of the surgical defect and the complexity of the oral cavity as an anatomical region. We offer a review of the literature that focuses on four types of locoregional flaps that can be profitably used for such reconstruction: infrahyoid (IF), nasolabial (NF), platysma (PF), and submental (SF). Methods: The study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. This systematic review was carried out according to the PICOS acronym through a comprehensive electronic search on PubMed/MEDLINE, Cochrane Library, and Google Scholar databases. For each selected article, we extrapolated eight main parameters, of which all mean values were compared through an ANOVA test. The dimensions of the oral defects were referred to as “small” (50 cm²). Results: A total of 139 articles were selected with a total of 5898 patients. The mean ages for each type of flap were not statistically significant (p = 0.30, p > 0.05). Seven sublocations of oral defects were reported: The most common was the tongue (2003 [34.0%] patients), followed by the floor of the mouth (1786 [30.4%]), buccal mucosa (981 [16.6%]), cheek (422 [7.2%]), hard palate (302 [5.1%]), alveolar ridge (217 [3.7%]), and retromolar trigone (187 [3.2%]). The defects were mainly medium-sized (4507 [76.4%] patients), and fewer were small-sized (1056 [17.9%]) or large-sized (335 [5.7%]). Complications were noted, the most frequent of which was flap necrosis, seen in 0.57% of cases. The functional and esthetical results were mainly positive. Conclusions: Locoregional flaps represent a good alternative in medium-sized defects as well as a fairly good alternative in small- and large-sized defects when other options are ruled out.

Objective: The eligibility criteria for cochlear implant (CI) are constantly changing. The aim of the current study was to show our department’s cochlear implant indications and to evaluate the longitudinal performance outcomes for patients with different types and degrees of sensorineural hearing loss, treated with CI. Methods: Between 2007–2019, 73 cochlear implantations were performed. Current CI indications allow us to categorize patients based on the type and degree of hearing loss. These can be grouped as follows: 1) Bilateral symmetric sensorineural hearing loss (SHL); 2) Bilateral profound hearing loss for high frequencies while maintaining low frequencies (EAS); 3) Asymmetric hearing loss (AHL); 4) Single-sided deafness (SSD) with intensive tinnitus in the deaf ear. For each group we evaluated the pre and post-operative pure tone audiometry and speech perception test in silence and with background noise. The patients also completed the speech, spatial and qualities of Hearing questionnaire (SSQ). Results: The four subgroups achieved significant benefits after CI, both in terms of speech performance and SSQ. Conclusions: According to literature, our data confirm that CI is an effective treatment for patients with different types of hearing loss. Key Points: 1) The eligibility criteria for cochlear implantation have regularly changed following the continuous progress in technology. 2) Schematically we divided our patients in 4 subgroups: 1) SHL; 2) EAS; 3) AHL; 4) SSD with intensive tinnitus in the deaf ear. 3) The criteria for AHL and SSD are in line with definitions suggested by Vincent et al. 4) Asymmetric hearing loss (AHL) and single-sided deafness (SSD) were traditionally treated with a contralateral routing of a signal hearing aid (CROS-HA) or a bone conduction device (BCD), even though CI is the only device capable of restoring bilateral stimulation to the auditory system and decreasing severity and incidence of tinnitus. 5) By treating patients with AHL or SSD and associated tinnitus, we saw that CI could not only improve hearing, but also drastically reduce tinnitus in most of the patients.

Background: To compare the functional and anatomical results of two different types of grafts in type 1 tympanoplasty (TPL I). Methods: A retrospective comparative bicentric study was conducted on patients treated with TPL I using temporal fascia or tragal cartilage. We evaluated the functional and anatomical results with intergroup and intragroup analyses. Variables predicting long-term success were also evaluated. Results: A total of 142 patients (98 fascia graft vs. 44 cartilage) were initially assessed, with a mean follow-up of 67.1 ± 3.2 months. No significant differences were observed between the two groups on the intergroup analysis of age, gender, ear side, or pre-operative hearing data (all p > 0.05). At the intragroup analysis of auditory outcomes, both groups demonstrated a significant improvement in post-operative air conduction, with greater gain for the fascia group at 6 months follow-up (p < 0.001 for both); however, at long-term follow-up, cartilage demonstrated better stability results (p < 0.001). When comparing the pre-and post-operative air-bone-gap (ABG), both groups showed a significant gain (p < 0.001); the fascia group showed that at 6 months, a greater ABG increase was found, but the difference was not statistically significant (4.9 ± 0.9 dB vs. 5.3 ± 1.2 dB; p = 0.04). On the contrary, the cartilage group at long-term follow-up at 5 years maintained greater outcomes (10 ± 1.6 dB vs. 6.4 ± 2 dB; p < 0.001). Lower age (F = 4.591; p = 0.036) and higher size of perforation (F = 4.820; p = 0.030) were predictors of long-term functional success. Conclusions: The graft material selection should consider several factors influencing the surgical outcome. At long-term follow-up, the use of a cartilage graft could result in more stable audiological outcomes, especially in younger patients or in case of wider perforations.

Background: To assess the long-term outcomes and independent predictors of surgical success of a one-stage minimally invasive surgical procedure for congenital choanal atresia (C.C.A.). Methods: a retrospective multicentric study was conducted between 2010 and 2022. An endonasal endoscopic approach was performed in 38 unilateral or bilateral C.C.A. children. All the patients were clinically and radiologically assessed and followed for at least 2 years. Seven outcome measures were applied. Consequently, surgical success was correlated with all the independent variables reported. Results: 18/38 (47.36%) patients presented normal postoperative healing, 8/38 (21.05) had moderate restenosis (50%), requiring a surgical revision. No statistical significance was found for average hospital stay between stenosis >50% and p = 0.802) and postoperative pain (p = 0.075); instead, the severe restenosis group demonstrated a higher delay of breast suction (p < 0.001). Among the independent variables predictors of surgical success, the presence of Charge syndrome and rhinopharyngeal stenosis demonstrated higher risks for surgical revision (OR: 4.00, 95% CI: 0.57–28.01, and OR: 2.75, 95% CI: 0.55–13.69, respectively). On the contrary, the hypoplastic inferior turbinate and bilateral C.C.A. showed a lower risk for severe restenosis by a higher endoscopic surgical space and creating a single larger opening (OR: 0.88, 95% CI: 0.22–3.52, and OR: 0.45, 95% CI: 0.10–2.08). Conclusion: Several independent variables could influence the surgical success after C.C.A. endoscopic repair; however, more high-quality evidence is needed to generate an effective predictive model.