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Francesco MATTIOLI

Professore Associato
Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell'Adulto

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Pubblicazioni

2023 - Endoscopic closure with double stenting and autologous fascia lata graft of large tracheo-esophageal fistula [Articolo su rivista]
Mattioli, Francesco; Serafini, Edoardo; Andreani, Alessandro; Cappiello, Gaia Francesca; Marchioni, Daniele; Pinelli, Massimo; Tonelli, Roberto; Clini, Enrico; Marchioni, Alessandro
abstract

Introduction: Radiotherapy and esophageal stenting are usually employed to manage esophageal localization of distant cancer. However, they are also related to the occurrence of an increased risk of tracheoesophageal fistula. Tracheoesophageal fistula management in these patients involves dealing with poor general conditions and short-term prognosis.This paper presents the first case in literature of bronchoscopic fistula closure through an autologous fascia lata graft placement between two stents. Case report and aim: A 67-years-old male patient was diagnosed with pulmonary squamous cell carcinoma in the inferior lobe of the left lung with mediastinal lymph node metastasis. After a multidisciplinary discussion, bronchoscopic repair of tracheoesophageal fistula with autologous fascia lata was decided without the removal of the esophageal stent due to the high risk on the esophagus possibly related to such a procedure. Oral feeding was progressively introduced without the development of aspiration symptoms. Videofluoroscopy and esophagogastroduodenoscopy were performed at seven months showing no signs of tracheoesophageal fistula patency. Conclusion: This technique might represent a low risks viable option for patients unsuitable for open surgical approaches.

2023 - Molecular biology and therapeutic targets of primitive tracheal tumors: focus on tumors derived by salivary glands and squamous cell carcinoma. [Articolo su rivista]
Marchioni, Alessandro; Tonelli, Roberto; Samarelli, ANNA VALERIA; Cappiello, Gaia; Andreani, Alessandro; Tabbì, Luca; Livrieri, Francesco; Bosi, Annamaria; Nori, Ottavia; Mattioli, Francesco; Bruzzi, Giulia; Marchioni, Daniele; Clini, Enrico
abstract

2023 - Paraglottic Space Invasion in Glottic Laryngeal Cancer: A Clinical-Pathological Study [Articolo su rivista]
Fermi, M.; Lo Manto, A.; Di Massa, G.; Gallo, G.; Lupi, M.; Maiolo, V.; Montrone, G.; Lovato, L.; Presutti, L.; Mattioli, F.
abstract

Objective: This study aims to prospectively compare endoscopic, radiological, and pathological features of a cohort of patients with glottic laryngeal squamous cell carcinoma (LSCC) undergoing open partial horizontal laryngectomy (OPHL) type II/III or total laryngectomy to better understand the reliability of preoperative endoscopy and computed tomography (CT) to predict the inferior paraglottic space (iPGS) involvement. Methods: We prospectively compared the endoscopic, radiological, and pathological findings in patients with glottic LSCC who underwent OPHL II/III, or total laryngectomy. Results: Endoscopy achieved a diagnostic accuracy of 87.2% for the anterior iPGS (iPGSa) and 86.1% for the posterior iPGS (iPGSp). There was no statistically significant difference in terms of histopathologic iPGSa involvement between reduced (85%—17/20 pts) and absent (92%—24/26 pts) vocal cord mobility (p = 0.39). CT alone did not improve the diagnostic performance of the endoscopy, reaching a diagnostic accuracy of 62.9% and 73.7% for the iPGSa and iPGSp, respectively. When endoscopy and CT were combined, the diagnostic performance improved for the iPGSp, achieving a sensitivity (Se), specificity (Spe), positive predictive value (PPV), and negative predictive value (NPV) of 100%, 89.8%, 68.7%, and 100%, respectively. On the contrary, the combination of CT and endoscopy improved only the Se and NPV for the iPGSa with respect to the sole endoscopic assessment. Conclusions: Whenever motility impairment is present, a histopathologic invasion of the iPGS should be suspected. Endoscopic assessment of laryngeal motility achieved a satisfactory value of Se, Spe, PPV, and NPV in predicting the involvement of the iPGS. CT scan is still the mainstay imaging technique in the clinical staging of patients with LSCC. Level of Evidence: IV Laryngoscope, 2022.

2023 - The role of adjuvant therapy in pT4N0 laryngectomized patients: Multicentric observational study [Articolo su rivista]
Mattioli, F.; Serafini, E.; Lo Manto, A.; Mularoni, F.; Abeshi, A.; Lionello, M.; Ferrari, M.; Paderno, A.; Lancini, D.; Mattavelli, D.; Confuorto, G.; Marchi, F.; Ioppi, A.; Sampieri, C.; Mercante, G.; De Virgilio, A.; Petruzzi, G.; Crosetti, E.; Pellini, R.; Giuseppe, S.; Giorgio, P.; Piazza, C.; Molteni, G.; Bertolin, A.; Succo, G.; Nicolai, P.; Alicandri-Ciufelli, M.; Marchioni, D.; Presutti, L.; Fermi, M.
abstract

Background: To retrospectively evaluate oncological outcomes in two groups of patients with pT4aN0 glottic SCC treated with total laryngectomy (TL) and neck dissection (ND) who underwent postoperative radiotherapy or exclusive clinical and radiological follow-up. Methods: It includes patients with pT4N0 glottic SCC who underwent TL and unilateral or bilateral ND with or without PORT. Divided in two comparison groups: the first group underwent adjuvant RT (TL-PORT); the second group referred to clinical and radiological follow-up (TL). Results: PORT was associated with a better OS while no differences were found in terms of DSS. A better local control is achieved when PORT is administered while no differences in terms of regional and distant control rates were found. Bilateral ND positively impacts on the regional control while the PNI negatively impact the regional control. Conclusions: A tailored PORT protocol might be considered for pT4N0 glottic SCC treated with TL and ND, both considering the ND's extent and presence of PNI.

2022 - Endoscopic Bronchopleural Fistula Repair Using Autologous Fat Graft [Articolo su rivista]
Marchioni, Alessandro; Mattioli, Francesco; Tonelli, Roberto; Andreani, Alessandro; Cappiello, Gaia Francesca; Serafini, Edoardo; Stefani, Alessandro; Marchioni, Daniele; Clini, Enrico
abstract

Bronchopleural fistula (BPF) represents a not rare catastrophic complication of pulmonary resection with high mortality rates. While surgical treatments of BPF are often technically difficult and can only be tolerated by a limited number of patients, less invasive endoscopic approaches showed variable success rates, mainly related to the size of the fistula. With this report, we describe for the first time the successful treatment of large BPF by means of endoscopic autologous fat implantation and we discuss the surgical technical details of the procedure.

2022 - Extensive tracheal injuries: a reasoned multi-step approach to guarantee mechanical ventilatory support developed during COVID-19 pandemic. [Articolo su rivista]
Mattioli, F; Martone, A; Andreani, A; Cappiello, G; Tonelli, R; Clini, E; Marchioni, A.
abstract

COVID-19 pandemic has notably increased the need for prolonged mechanical ventilation (MV) in patients with respiratory failure. This has increased the risk of extensive tracheal injuries (ETI) associated with life-threatening complications in very complex patients. Furthermore, tracheal injury treatment in COVID-19 patients has not been described yet. Three COVID-19 patients with ETI who required MV treated between April and November 2020 were included. A multi-step approach was performed in order to restore tracheal integrity with a custom remodeled stent and tracheostomy tube placement to allow ventilatory support. Efficient MV with no residual air leaks was obtained in all cases. One patient died six weeks after the procedure due to COVID-19 lung damage. Two patients have completely been weaned from MV. This multi-step procedure could be used in order to maintain ventilatory support in case of ETI, working as a bridge to subsequent surgery when clinical conditions improve.

2022 - Management of parapharyngeal space tumors with transparotid–transcervical approach: analysis of prognostic factors related with disease-control and functional outcomes [Articolo su rivista]
Fermi, M.; Serafini, E.; Ferri, G.; Alicandri - Ciufelli, M.; Presutti, L.; Mattioli, F.
abstract

Purpose: Different therapeutic strategies have been developed to improve surgical and functional outcome of parapharyngeal space (PPS) neoplasms. The transparotid–transcervical approach (TTa) is a valid surgical option to manage most PPS tumors. Its short- and long-term disease control and cranial nerve (c.n.) function outcomes have not been discussed extensively. Methods: All patients who underwent TTa over a 10-year period at a tertiary academic center were retrospectively reviewed. Data about preoperative imaging, clinical presentation, tumor’s size, location and histology, and postoperative oncological and functional results were registered and analyzed. Results: Sixty patients matched the inclusion criteria. Most of the lesions were benign (71.7%), involved the prestyloid PPS (63.3%) and measured more than 30 mm (75%). Fifty-two (86.7%) lesions were resected en-bloc. Clear margins were achieved in 91.7% of the cases, with positive margins solely associated with malignancy (p = 0.008). Post-operative c.n. function was satisfactory, with X c.n. function significantly associated with the retrostyloid location (p =.00) and neurogenic tumors (p = 0.02). Local disease-control was achieved in 96% of the cases after a median follow-up of 46 (± 19.7–82.0 IQR) months. Conclusions: The TTa was safe and effective, achieving a satisfactory local control rate. Nevertheless, malignancies maintain a higher rate of positive margin due to their infiltrative nature and the complex anatomy of the PPS. In such cases, multiportal approaches might be more effective. However, post-operative c.n. function remained satisfactory, irrespective of lesions’ size and histopathologic behavior. A higher X c.n. deficit rate was observed in retrostyloid and neurogenic lesions.

2022 - Microsurgical training using an ex-vivo model: microscope vs 3D exoscope [Articolo su rivista]
Molteni, G.; Ghirelli, M.; Sacchetto, A.; Fermi, M.; De Rossi, S.; Mattioli, F.; Presutti, L.; Marchioni, D.
abstract

Objective. The aim of this study is to evaluate the feasibility of the 3D exoscope in a mi-crovascular anastomosis training setting and compare it with the gold-standard technique using the operating microscope (OM). Methods. Participants were recruited among otorhinolaryngology head and neck surgery (OHNS) residents of two tertiary care hospitals. Trainees were asked to complete 4 micro-vascular end-to-end anastomoses on chicken thighs with the OM and VITOM 3D exoscope. The performances were scored by experienced microvascular surgeons; an objective evaluation of the anastomosis and a subjective assessment of the workload were conducted. Results. 8 OHNS residents were recruited. Considering the amount of time needed to complete (TTC) the anastomosis, an improvement was shown by all the participants throughout the training program. The objective evaluation of the anastomosis did not show a significant difference. No significant differences were found by analyzing the subjective workload with the different tools. Conclusions. This article represents the first attempt to compare the use of the OM and the 3D exoscope during training for microsurgery. The results of our study demonstrate the noninferiori-ty of microsurgical training obtained using the 3D exoscope compared to that offered by the OM.

2022 - Molecular Mechanisms and Physiological Changes behind Benign Tracheal and Subglottic Stenosis in Adults [Articolo su rivista]
Marchioni, Alessandro; Tonelli, Roberto; Andreani, Alessandro; Cappiello, Gaia Francesca; Fermi, Matteo; Trentacosti, Fabiana; Castaniere, Ivana; Fantini, Riccardo; Tabbì, Luca; Andrisani, Dario; Gozzi, Filippo; Bruzzi, Giulia; Manicardi, Linda; Moretti, Antonio; Baroncini, Serena; Samarelli, ANNA VALERIA; Marchioni, Daniele; Pinelli, Massimo; DE SANTIS, Giorgio; Stefani, Alessandro; Mattioli, Francesco; Clini, Enrico
abstract

Laryngotracheal stenosis (LTS) is a complex and heterogeneous disease whose pathogenesis remains unclear. LTS is considered to be the result of aberrant wound-healing process that leads to fibrotic scarring, originating from different etiology. Although iatrogenic etiology is the main cause of subglottic or tracheal stenosis, also autoimmune and infectious diseases may be involved in causing LTS. Furthermore, fibrotic obstruction in the anatomic region under the glottis can also be diagnosed without apparent etiology after a comprehensive workup; in this case, the pathological process is called idiopathic subglottic stenosis (iSGS). So far, the laryngotracheal scar resulting from airway injury due to different diseases was considered as inert tissue requiring surgical removal to restore airway patency. However, this assumption has recently been revised by regarding the tracheal scarring process as a fibroinflammatory event due to immunological alteration, similar to other fibrotic diseases. Recent acquisitions suggest that different factors, such as growth factors, cytokines, altered fibroblast function and genetic susceptibility, can all interact in a complex way leading to aberrant and fibrotic wound healing after an insult that acts as a trigger. However, also physiological derangement due to LTS could play a role in promoting dysregulated response to laryngo-tracheal mucosal injury, through biomechanical stress and mechanotransduction activation. The aim of this narrative review is to present the state-of-the-art knowledge regarding molecular mechanisms, as well as mechanical and physio-pathological features behind LTS.

2022 - SARS-CoV-2 tracheitis in laryngectomised patients: A consecutive case-series study [Articolo su rivista]
Fernandez, I. J.; Spagnolo, F.; Valerini, S.; Mattioli, F.; Molteni, G.; Marchioni, A.; Lucidi, D.
abstract

2022 - STenting veRsus balloOn dilatation in patients with tracheal BEnign stenosis – the STROBE trial. [Articolo su rivista]
Marchioni, A; Andrisani, D; Tonelli, R; Andreani, A; Cappiello, G; Ori, M; Gozzi, F; Bruzzi, G; Baroncini, S; Nani, C; Femino', R; Manicardi, L; Mattioli, F; Fermi, M; Fantini, R; Tabbi', L; Castaniere, I; Presutti, L; Clini, E.
abstract

Background- It is well known that benign tracheal stenosis represents an obstacle to open surgery, and that its treatment could be challenging. Two endoscopic techniques have so far been adopted to restore tracheal patency: balloon dilatation (BA) through laryngoscopy, and tracheal stenting (ST) with rigid bronchoscopy.  The main objective of this study was to compare the efficacy of BA and ST to cure treat benign tracheal stenosis not eligible for surgery. We also compared the rate of adverse events in the two treatment groups. Methods- A retrospective, observational cohort study was carried out at the University Hospital of Modena (Italy) from November 2012 to November 2017 in two separate departments. Patients were considered to be “stabilized” (primary outcome) if they did not report significant respiratory symptoms, or re-stenosis in the long-term(2 years) following the endoscopic procedure. Results- Sixty-six patients were included in the study (33 in the BA and 33 in the ST group, respectively). Unadjusted Kaplan-Meier estimates showed a greater therapeutic effect of ST compared to BA at 2 years (HR=3.9 95%CI [1.5-9.8], p=0.01). After adjusting for confounders, stratified analyses showed that this effect was significant in patients with complex stenosis, idiopathic etiology, and degree of stenosis >70%. Compared with BA, ST showed a higher rate of adverse events (p=0.01). Conclusions- Compared to balloon dilatation, tracheal stenting seems to be more effective in achieving stabilization of tracheal patency in complex benign tracheal stenosis, although burdened with a significantly higher number of adverse effects. These findings warrant future prospective study for confirmation.

2022 - Surgical Training on Ex Vivo Ovine Model in Otolaryngology Head and Neck Surgery: A Comprehensive Review [Articolo su rivista]
Fermi, M.; Chiari, F.; Mattioli, F.; Bonali, M.; Molinari, G.; Alicandri-Ciufelli, M.; Anschuetz, L.; Fernandez, I. J.; Presutti, L.
abstract

Background: Nowadays, head and neck surgical approaches need an increased level of anatomical knowledge and practical skills; therefore, the related learning curve is both flat and long. On such procedures, surgeons must decrease operating time as much as possible to reduce the time of general anesthesia and related stress factors for patients. Consequently, little time can be dedicated for training skills of students and young residents in the operating theater. Fresh human cadavers offer the most obvious surrogate for living patients, but they have several limitations, such as cost, availability, and local regulations. Recently, the feasibility of using ex vivo animal models, in particular ovine ones, have been considered as high-fidelity alternatives to cadaveric specimens. Methods: This comprehensive review explores all of head and neck otolaryngology applications with this sample. We analyzed studies about ear surgery, orbital procedures, parotid gland and facial nerve reanimation, open laryngeal and tracheal surgery, microlaryngoscopy procedures, laryngotracheal stenosis treatment, and diagnostic/operative pediatric endoscopy. For each different procedure, we underline the main applications, similarities, and limitations to human procedures so as to improve the knowledge of this model as a useful tool for surgical training. Results: An ovine model is easily available and relatively inexpensive, it has no limitations associated with religious or animal ethical issues, and it is reliable for head and neck surgery due to similar consistencies tissues and neurovascular structures with respect to humans. However, some other issues should be considered, such as differences about some anatomical features, the risk of zoonotic diseases, and the absence of bleeding during training. Conclusion: This comprehensive review highlights the potentials of an ex vivo ovine model and aims to stimulate the scientific and academic community to further develop it for other applications in surgical education.

2021 - COVID-19 in the tonsillectomised population [Articolo su rivista]
Capriotti, V.; Mattioli, F.; Guida, F.; Marcuzzo, A. V.; Manto, A. L.; Martone, A.; Molinari, G.; Fabbris, C.; Menegaldo, A.; Calvanese, L.; Latini, G.; Cingolani, C.; Gradoni, P.; Nata, F. B.; De Sisti, C.; Selle, V.; Leone, G.; Indelicato, P.; Pilolli, F.; Mevio, N.; Roncoroni, L.; Papi, S.; Meschiari, M.; Tominz, R.; D'Ascanio, L.; Dragonetti, A.; Torelli, L.; Trenti, L.; Spinato, G.; Boscolo-Rizzo, P.; Bussi, M.; Cossarizza, A.; Presutti, L.; Tirelli, G.
abstract

Objective. Interactions between SARS-CoV-2 and pharyngeal associated lymphoid tissue are thought to influence the manifestations of COVID-19. We aimed to determine whether a previous history of tonsillectomy, as a surrogate indicator of a dysfunctional pharyngeal associated lymphoid tissue, could predict the presentation and course of COVID-19. Methods. Multicentric cross-sectional observational study involving seven hospitals in Northern and Central Italy. Data on the clinical course and signs and symptoms of the infection were collected from 779 adults who tested positive for SARS-CoV-2, and analysed in relation to previous tonsillectomy, together with demographic and anamnestic data. Results. Patients with previous tonsillectomy showed a greater risk of fever, temperature higher than 39°C, chills and malaise. No significant differences in hospital admissions were found. Conclusions. A previous history of tonsillectomy, as a surrogate indicator of immunological dysfunction of the pharyngeal associated lymphoid tissue, could predict a more intense systemic manifestation of COVID-19. These results could provide a simple clinical marker to discriminate suspected carriers and to delineate more precise prognostic models.

2021 - Chronic thyroiditis in lateral ectopic thyroid mimicking cervical metastasis of thyroid cancer [Articolo su rivista]
Pederzoli, S.; Salviato, T.; Mattioli, F.; Di Massa, G.; Brigante, G.
abstract

We present the case of a 45-year-old Caucasian woman who attended the Endocrinology Unit for a left cervical mass discovered during follow-up for autoimmune chronic thyroiditis. The ultrasound-guided fine-needle aspiration biopsy of the lesion was consistent with a metastasis of follicular thyroid carcinoma. The sonographic neck evaluation revealed no thyroid nodules but three markedly hypoechoic and highly vascularized areas, with irregular margins and hyperechoic spots. In the clinical suspicion of primary thyroid neoplasm, ultrasound-guided fine-needle aspiration biopsy of two of the three areas was performed, but both cytological reports were non-diagnostic, revealing only colloid and blood. Subsequently, the patient underwent surgical removal of the cervical mass, with the intra-operatory consultation with frozen section examination suggesting follicular-like neoplasia. For this reason, thyroidectomy with both central and lateral neck dissection was performed. Surprisingly, the final histologic examination revealed chronic thyroiditis in the thyroid specimen and no evidence of metastasis in the left neck mass. Consequently, the pathological revision of the frozen section assessment led to the final diagnosis of chronic thyroiditis on the lateral ectopic thyroid. This case represents an uncommon example of lateral ectopic thyroid tissue with coexisting normally located thyroid tissue both affected by chronic thyroiditis. Learning points: •• Ectopic thyroid must be considered in the diagnostic work-up of lateral neck mass. •• Even if rare, ectopic thyroid tissue can be found lateral to the carotid sheath and with coexisting normally located thyroid tissue. •• As the orthotopic tissue, lateral ectopic thyroid tissue can be affected by chronic thyroiditis, which may complicate the diagnosis both on ultrasound and cytology.

2021 - Clear cell sarcoma-like/malignant gastrointestinal neuroectodermal tumor of the tongue: a clinicopathologic and molecular case report [Articolo su rivista]
Sbaraglia, M.; Zanatta, L.; Toffolatti, L.; Spallanzani, A.; Bertolini, F.; Mattioli, F.; Lami, F.; Presutti, L.; Dei Tos, A. P.
abstract

Malignant gastrointestinal neuroectodermal tumor (M-GNET) and clear cell sarcoma (CCS) of soft tissue represent closely related, extremely rare, malignant mesenchymal neoplasm of uncertain differentiation. Both entities are characterized genetically by the same molecular alterations represented by the presence of EWSR1-ATF1 and, more rarely, EWSR1-CREB1 fusion genes. The latter translocation seems to be more represented in M-GNET that, despite significant morphologic overlap with CCS, tends to lack overt features of melanocytic differentiation. Most M-GNET occur in the lower gastrointestinal tract, whereas occurrence in the upper tract has been reported only exceptionally. The differential diagnosis represents a major challenge, and accurate diagnosis impact significantly on therapeutic planning. We herein report the clinicopathologic features of a molecularly confirmed M-GNET that arose at the base of the tongue and review the pertinent literature.

2021 - Could the replacement of a tracheotomy tube be potentially fatal? [Articolo su rivista]
Ghirelli, M.; Molinari, G.; Livio, P.; Mattioli, F.
abstract

2021 - Gynecological malignancy mimicking a thyroid lymph node metastasis. [Articolo su rivista]
Pederzoli, S.; Spaggiari, G.; Bernardelli, G.; Mattioli, F.; Baldessari, C.; Maiorana, A.; Rochira, V.; Santi, D.
abstract

We present the case of a 69-year-old woman who attended the Endocrinology Unit of Modena for a suspicious lymph node in the left cervical compartment discovered during the follow-up of a recurrent gynecological malignancy. At neck ultrasonography, a thyroid goiter was detected, and the further cytological examination was inconclusive for thyroid nodule and compatible with a localization of an adenocarcinoma with papillary architecture for the lymph node. The histological examination after a left neck dissection confirmed the presence of an intracapsular metastasis of a papillary carcinoma immunohistochemically focally positive for thyroid transcription factor 1 and paired box 8 and negative for thyroglobulin. Subsequently, in the suspicion of a thyroid primitiveness, a total thyroidectomy was performed, revealing an intraparenchymal follicular variant of papillary thyroid carcinoma of 2 mm in the right lobe. During the follow-up, the appearance of a suspected cervical metastatic lesion led to another neck dissection, histologically compatible with a papillary carcinoma localization, immunohistochemically focally positive for thyroid transcription factor 1 and paired box 8, and negative for thyroglobulin. The histological revision of surgical specimens suggests the cervical recurrence of the prior gynecological cancer, rather than a thyroid carcinoma metastasis. The case described shows how carefully the cytological, histological and immunoistochemical results must be evaluated in oncological management, considering the whole patient’s history.

2021 - Open laryngeal surgery training on ex-vivo ovine model: Development and dissection experience [Articolo su rivista]
Fermi, M.; Mattioli, F.; Ghirelli, M.; Maccarrone, F.; Molteni, G.; Presutti, L.; Alicandri-Ciufelli, M.
abstract

Objectives: To develop and validate an ex-vivo dissection model suitable for open laryngeal surgery (open partial laryngectomy and total laryngectomy) training. Methods: A fresh ex-vivo 6-months old ovine model was tested by experienced laryngologists and validated during two international dissection courses on open laryngeal surgery held in December 2018 and 2019. Each participant completed a survey to subjectively evaluate the dissection experience. Likewise, four experienced laryngologists rated their experience. Statistical comparison of these ratings was performed. Results: The suitability of the ex-vivo ovine model for open laryngeal surgery was assessed among 28 head and neck surgeons with a mean experience of 6.3 years and 4 expert laryngologists. The feedback from all the participants was excellent with a mean overall impression of 9.5 (± 0.7 SD) and a mean recommendation score of 9.6 (± 0.6 SD) for further use. No statistically significant differences were found comparing neither the overall grade (p= 0.63) nor the recommendation rating (p= 0.24), testifying that even for expert laryngologists this remains a viable model for open laryngeal surgery training. Conclusions: The complexity of open laryngeal surgery makes simulation an attractive option for developing skills that are transferrable to operating setting. Due to the anatomic resemblance with the human, the ex-vivo ovine model is herein proposed as a training model for open laryngeal surgery. Validation among beginners and expert laryngologists revealed its suitability as effective teaching means in laryngectomies.

2021 - Post-intubation tracheal stenosis in COVID-19 patients [Articolo su rivista]
Mattioli, F.; Marchioni, A.; Andreani, A.; Cappiello, G.; Fermi, M.; Presutti, L.
abstract

2021 - Prelaminated flaps in head and neck cancer reconstructive surgery: A systematic review [Articolo su rivista]
Fermi, Matteo; Bassano, Edoardo; Molinari, Giulia; Alicandri-Ciufelli, Matteo; Scarpa, Alfonso; Presutti, Livio; De Santis, Giorgio; Mattioli, Francesco
abstract

Prelamination is a reconstructive technique providing fasciomucosal or composite flaps with low donor-site morbidity. We conducted a systematic review of retrospective studies to assess the application of prelaminated flaps in reconstructive surgery of head and neck cancer patients, and to evaluate the advantages and disadvantages of this technique.

2021 - Salvage neck dissection for isolated neck recurrences in head and neck tumors: Intra and postoperative complications [Articolo su rivista]
Molteni, G.; Comini, L.; Le Pera, B.; Bassani, S.; Ghirelli, M.; Martone, A.; Mattioli, F.; Nocini, R.; Santoro, R.; Spinelli, G.; Presutti, L.; Marchioni, D.; Mannelli, G.
abstract

Background and Objectives: The current evidence regarding complications after salvage neck dissection (ND) for isolated regional recurrences (IRRs) in head and neck cancers is poor. The aim of this study is to evaluate the incidence and differences in complication rates of salvage ND after primary surgery, radiotherapy, chemoradiotherapy, or combined treatments. Methods: This was a multicentric retrospective study on 64 patients who underwent salvage ND for IRR in three Italian institutes between 2008 and May 2020. Results: Complications were detected in 7 of the 34 patients (20.8%) and surgeons described difficult dissection in 20 patients (58.82%). Accidental vascular ligations or nervous injury during surgery were never detected. None of the variables analyzed were statistically significant in predicting the risk of complications, disease-free survival, or overall survival. Conclusions: IRR represents a rare entity among total relapses. The incidence of complications after salvage ND for IRR is higher than after primary surgery but at an acceptable rate in experienced hands. However, an adequate balance between functional and oncological outcomes is mandatory.

2021 - Second primary tumors in head and neck cancer patients: The importance of a “tailored” surveillance [Articolo su rivista]
Bertolini, F.; Trudu, L.; Banchelli, F.; Schipilliti, F.; Napolitano, M.; Alberici, M. P.; Depenni, R.; D'Angelo, E.; Mattioli, F.; Rubino, L.; Presutti, L.
abstract

Objective: Head and neck cancer survivors have increased risk of developing second primary tumors compared to overall population. Because second primary represents a major cause of morbidity and mortality in this population, early detection is fundamental. Materials and Methods: In this 10-year single-institution study, we investigated the following: incidence, clinical-pathological risk factors, and survival of patients with second primary tumor. We included all patients with diagnosis of squamous cell carcinoma of the head and neck seen at the Modena University Hospital from 2008 to 2018. Results: Among 1,177 patients included, 222 (18.9%) developed second primary tumor; its survival probability at 5 years was 40.6%. Alcohol consumption (p =.0055) and index cancer in oropharynx (p =.0029), supraglottic larynx (p =.0000), glottic larynx (p =.0222) were associated with higher risk of second primary. The most common second primary sites were head and neck district and lung (70, 31.5%, and 67, 30.2%, respectively). Head and neck district were more common in oral cavity (18, 43%) and oropharynx index cancer (20, 31%); lung second primary in hypopharynx (4, 40%), supraglottic larynx (17, 43%), and glottic larynx index cancer (23, 35%). Conclusion: Head and neck cancer survivors developing a second primary tumor have dismal prognosis. Tailored surveillance is recommended.

2021 - Siblings with Acquired Tracheocele: Possible Hereditary Etiopathogenesis? [Articolo su rivista]
Botti, C.; Maccarrone, F.; Bernardelli, G.; Lupi, M.; Presutti, L.; Mattioli, F.
abstract

Tracheocele is a herniation of the tracheal mucosa through a defect in the tracheal wall. Familiar and/or genetical factors have never been taken into consideration in the etiopathogenesis of acquired tracheocele. Acquired tracheocele occurred in a brother and a sister from India. CT scan of the neck showed an air cyst next to the right tracheal wall. They underwent surgical excision through a transverse cervical incision. Histopathology of the lesion revealed a fibrous sac lined by a pseudostratified columnar respiratory epithelium in both patients. They had no recurrence of tracheocele at 12 months follow up. Genetic counseling did not evidence any significative associated abnormalities. No previous cases of familiar acquired tracheocele have been reported in the literature. Given the rarity of the lesion occurring in more than one member of a family, hereditary factors could be supposed as contributing factors in the etiopathogenesis of acquired tracheocele.

2021 - Supraclavicular artery fascial flap (SAFF): a valuable tool in salvage total laryngectomy and hemipharyngolaryngectomy [Articolo su rivista]
Mattioli, F.; Fermi, M.; Martone, A.; Ghirelli, M.; Giordano, L.; Di Santo, D.; Bussi, M.; Presutti, L.
abstract

Objective. To describe the surgical technique of the supraclavicular artery fascial flap (SAFF) and outcomes in neopharyngeal covering with overlay technique during salvage total laryngectomy for residual or recurrent carcinoma after chemo/radiation treatment. Methods. Chart review of patients treated between October 2018 and February 2019 at two tertiary care hospitals. Variables extracted from patient records were age, gender, history of chemo/radiation therapy, neck dissection, surgical and postoperative complications. Outcomes measured were surgical time, postoperative complications and flap failure, oral intake start and patient discharge. Results. Ten male patients were included. Median age was 64 years. All patients underwent salvage total laryngectomy and neopharyngeal covering with SAFF. Mean flap harvest time was 25 minutes. No surgical complications or flap failure were recorded. Oral intake was started on a median of post-operative day 10. No cases of pharyngocutaneous fistula were encountered. Conclusions. SAFF is a reliable, easy and quick to harvest flap, which provides a good al-ternative to other pedicled and free flaps for hypopharyngeal coverage in laryngeal salvage surgery. Donor site morbidity is almost null and postoperative complications are very rare.

2021 - Surgical management of benign cervical tracheoesophageal fistulas: A single-tertiary academic institution experience [Articolo su rivista]
Fermi, M.; Lo Manto, A.; Ferri, G.; Ghirelli, M.; Mattioli, F.; Presutti, L.
abstract

Purpose: Despite improvements of diagnosis and management, acquired benign tracheoesophageal fistulas (AB-TEFs) remain a challenging clinical problem and a life-threating condition. In the present study, we reviewed the early results and the long-term outcomes after surgical treatment of cervical AB-TEFs treated in our institution during the last 9 years. Methods: This retrospective study included patients who underwent transcervical repair of benign cervical AB-TEFs. Patients were identified from a prospectively filled electronic database which included patients' demographics, medical history, disease presentation, prior treatments, operative report, morbidity and mortality, hospital stay, postoperative results and follow-up information. Results: A total of 13 patients affected by cervical AB-TEF were treated. Most of the patients (91%) in our series were treated with a lateral cervicotomic approach with interposition of either sternocleidomastoid muscle flap (72.7%) or pectoralis major myocutaneous flap (9.1%) or infrahyoid muscle flap (9.1%). The univariate analysis of showed that the etiology and surgical technique were significantly associated with immediate postoperative outcome. Esophageal diversion was removed in all patients but 3 due to their neurological status, which was the only significant factor related to post-operative oral-intake (p =0.016). We experienced 2 (18.2%) failures of the reconstruction, which occurred in patients previously treated with chemoradiation for head and neck malignancies. None of the remaining patients (72.8%) relapsed after a long-term follow-up restoring a normal oral diet was restored. Conclusion: The lateral cervicotomic approach with sternocleidomastoid flap interposition showed its effectiveness and safety in the treatment of AB-TEFs in our single-institution experience.

2021 - Surgical rehabilitation of swallowing with polydimethylsiloxane injections after open partial horizontal laryngectomy: Long-term functional results and quality of life [Articolo su rivista]
Mattioli, F.; Fernandez, I. J.; Bassano, E.; Luppi, M. P.; Bonali, M.; Ghidini, A.; Trebbi, M.; Bergamini, G.; Presutti, L.; Botti, C.
abstract

Background: Swallowing disorders are common problems after partial laryngectomy. The aim of this study is to illustrate the long-term functional results of rehabilitation of swallowing by polydimethylsiloxane (PDMS) injection. Methods: Twenty-eight patients with dysphagia after partial laryngectomy who underwent injection of PDMS for rehabilitation of swallowing were included in the study. Impairment of swallowing and quality of life (QoL) were investigated with questionnaires: M. D. Anderson Dysphagia Inventory (MDADI) and Performance Status Scale for Head and Neck Cancer (PSS-HNC). Functional results at fiberoptic endoscopic evaluation of swallowing (FEES) were analyzed using a modified penetration-aspiration scale. Results: Mean follow-up was 8.5 years. Twenty-six patients showed an improvement at questionnaires (p < 0.001). Median improvement was 6 (p < 0.001) in the modified penetration-aspiration scale. Total laryngectomy was required in one patient. Conclusions: PDMS injection is a good option for rehabilitation of swallowing in case of dysphagia after partial laryngectomy. It improves QoL and the results persist after a long follow-up period.

2021 - The effect of tracheostomy on swallowing function in open partial horizontal laryngectomies: Preliminary experience [Articolo su rivista]
Lucidi, D.; Botti, C.; Fermi, M.; Luppi, M. P.; Alicandri-Ciufelli, M.; Presutti, L.; Mattioli, F.
abstract

Objective. Tracheostomy is required to ensure a safe airway in open partial horizontal laryngectomies. The presence of the tracheostomy tube can contribute to post-operative dysphagia. This study aimed to evaluate the effects of a circumferential tracheostomy technique on swallowing. Methods. Aretrospective study was conducted of patients who underwent open partial horizontal laryngectomies between April 2018 and June 2019. Patients were divided into two groups based on the tracheostomy technique: group 1hadtwo stitches from the inferior tracheal ring to the skin; group 2hadcircumferential fixation of the trachea to the skin. Demographic information, surgical data, post-operative rehabilitation course and complication details were collected and analysed. Results. Twenty-four patients were enrolled. Patients in group 2 had significant improvement in the initial phases of swallowing rehabilitation. Conclusion. Tracheostomy with anchorage of the trachea to the skin by circumferential stitches could allow early removal of the tracheal tube, with a betters wallowing outcome.

2021 - Tip of the Tongue Reconstruction with Prelaminated Fasciomucosal Radial Forearm Free Flap [Articolo su rivista]
De Santis, G.; Mattioli, F.; Pinelli, M.; Martone, A.; Starnoni, M.; Fermi, M.; Presutti, L.
abstract

Summary: Tongue cancer is the most common malignant neoplasm of the oral cavity. Occurrence in the tip of the tongue (TOT) is rare. We describe a case report of a TOT tumor excision and reconstruction with a prelaminated fasciomucosal radial forearm free flap. A 41-year-old white man was referred to our department for a squamous cell carcinoma of the tip of the tongue. The patient worked as an air traffic control official; therefore, conservation of speech intelligibility, both in Italian and English language, was of paramount importance. A transoral excision of TOT, bilateral selective neck dissection, and reconstruction with prelaminated fasciomucosal radial forearm free flap were performed. Adjuvant radiotherapy was necessary. The patient was completely re-established as an air traffic control officer. Successful tongue reconstruction of smaller defects depends on thinness, pliability of flap, and conservation of tongue mobility. Surgical options for TOT reconstruction are facial artery muscolomucosa flap, Zhao flap, radial forearm free flap, or primary suture. In the authors' opinion, a fasciomucosal prelaminated RFFF offers a series of advantages for TOT reconstruction. The absence of subcutaneous tissue makes the PFRFFF much thinner than fascio-cutaneous flaps. Compared with mucosal loco-regional flaps, prelaminated flaps allow the preservation of oral mucosa lining while providing adequate bulk and reduced scar formation for optimal func- tional recovery. In our case report, the fasciomucosal flap allowed an adequate reconstruction of TOT volume with good functional and aesthetic outcomes. The flap's added bulk and its minimal scar retraction granted free tongue movement and optimal speech intelligibility.

2021 - pT3 N0 Laryngeal Squamous Cell Carcinoma: Oncologic Outcomes and Prognostic Factors of Surgically Treated Patients [Articolo su rivista]
Mattioli, F.; Fermi, M.; Molinari, G.; Capriotti, V.; Melegari, G.; Bertolini, F.; D'Angelo, E.; Tirelli, G.; Presutti, L.
abstract

Objectives/Hypothesis: To assess the disease control, survival rates, and prognostic factors of exclusive surgical treatment for patients with pT3 N0 laryngeal squamous cell carcinoma (LSCC). Study Design: Multicentric retrospective cohort study. Methods: Multicentric retrospective case series of previously untreated patients with pT3 R0N0 LSCC, who received exclusive surgery between 2011 and 2019. Tumor location; subsite involvement; grading; and lymphatic, vascular, and perineural invasion were reported. Overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) were measured. Results: Fifty-four patients (mean age 67.1; male sex 83.3%; mean follow-up period 37 months) underwent total laryngectomy (48.1%) or partial laryngectomy (51.9%). Ipsilateral or bilateral neck dissection was performed in 46 (85.2%) cases. Perineural invasion was more frequent in case of supraglottic involvement than glottic involvement (85.7% vs. 14.3%, P =.03). Five (9.3%) patients experienced recurrence (3 local recurrences, 1 nodal recurrence, 1 distant recurrence). Rate of recurrence differed between glottic (0%), supraglottic (80%), and transglottic (20%) tumors (P =.01), with a lower risk yielded by glottic involvement (odds ratio [OR], 0.05, 95% confidence interval [95% CI], 0.01–0.56, P =.01). A higher risk was recorded in case of perineural invasion (OR, 66.0, 95% CI, 1.41–3085.3, P =.03). The OS, DSS, and DFS were 79.6%, 96.3%, and 90.7%, without differences regarding the type of surgery. The DFS was lower in case of supraglottic involvement when compared to purely glottic LSCC (83.9% vs. 100%, P = 0.02). Conclusions: Exclusive surgery is a safe option for patients with pT3 R0N0 LSCC. Adjuvant treatments or closer follow-up monitoring might be considered in case of supraglottic involvement or perineural invasion. Level of Evidence: 4 Laryngoscope, 131:2262–2268, 2021.

2020 - A conservative transnasal endoscopic and intraoral approach in a case of a maxillary dentigerous cyst [Articolo su rivista]
Consolo, Ugo; Bellini, Pierantonio; Mattioli, Francesco; Lizio, Giuseppe
abstract

The transoral approach for enucleation of a voluminous odontogenic lesion involving the maxillary sinus is considerably invasive and can cause irreversible damage to the ciliated mucosa with definitive loss of the normal bone morphology. Functional endoscopic sinus surgery (FESS), which increases the patency of the osteomeatal complex (OMC), involves the use of a direct approach to the lesion, facilitating the drainage of secretions and improving the ventilation. Nevertheless, FESS cannot completely enucleate large odontogenic cystic lesions, particularly dentigerous cysts associated with dislocated teeth. Accordingly, a combined transnasal endoscopic and transoral approach is desirable. Here, we report the successful use of FESS combined with a conservative intraoral approach for the treatment of a voluminous dentigerous cyst that completely occupied the maxillary sinus. In a single surgery, FESS was used to enlarge OMC and open the cystic compartment into the nasal cavity, while an intraoral approach involving the removal of a bony lid from the anterolateral wall of the maxillary sinus facilitated minimal removal of the cystic wall associated with the dislocated tooth. The bony lid was repositioned and fixed with titanium plates. Computed tomography performed at 6 months showed that the original cystic compartment, which maintained communication with the nasal cavity through the enlarged OMC, was absent, and that the sinus had recovered its healthy morphology. Computed tomography at 27 months showed the maintenance of this status with no signs recurrence. We recommend this approach to eradicate such pathology while preserving the sinus structure and function.

2020 - Correlation of Radiologic Versus Endoscopic Visualization of the Middle Ear: Implications for Endoscopic Ear Surgery [Articolo su rivista]
Bonali, M.; Fermi, M.; Alicandri-Ciufelli, M.; Mattioli, F.; Villari, D.; Presutti, L.; Anschuetz, L.
abstract

OBJECTIVES: To determine the limits of visualization during transcanal endoscopic ear surgery (EES) by correlating the relationship between radiologic and endoscopic anatomy using angled optics. METHODS: Radiology and endoscopic visualization of tensor fold, protympanum, facial sinus (FS), sinus tympani (ST), subtympanic sinus (STS), hypotympanum, and aditus ad antrum were analyzed using a transcanal approach in 30 human temporal bones specimens with different angled endoscopes (0 degree, 45 degrees, 70 degrees) to check for the full visualization of these regions. High-resolution computed tomography (CT) was performed prior to dissection to classify retrotympanic anatomy. According to previously published descriptions, FS, ST, and STS were classified into types A, B, and C depending on their morphology relative to the mastoid segment of the facial nerve. These radiologic findings were compared to endoscopic visualization of these same structures using a Chi-squared test. RESULTS: Visualization of the posterior wall of three different retrotympanic areas was significantly associated (FS p < 0.01; ST p < 0.01; STS p = 0.02) with the radiologic classification and endoscopic optical angle. Angled endoscopy improved visual access to the other subsites, especially the aditus ad antrum and the tensor fold (>70% with 45 degrees and 70 degrees). CONCLUSION: Complete visual access to the hidden recesses of the middle ear can be achieved using angled endoscopes (45 degrees and 70 degrees). We observed a statistically significant association of endoscopic visualization to radiologic description of the retrotympanum on CT and the optical angle used. The prediction of the endoscopic exposure of the retrotympanum from the preoperative CT is possible. Even with the use of 70 degrees lens, retrotympanum is not fully visualized on transcanal endoscopy if a type C retrotympanic recesses (posterior and medial to the facial nerve) is present. This represents a technical limit of exclusive transcanal EES.

2020 - Ex Vivo Porcine Larynx Model for Microlaryngoscopy Laryngeal Surgery: Proposal for a Structured Surgical Training [Articolo su rivista]
Ghirelli, M.; Mattioli, F.; Federici, G.; Ferri, G.; Malagoli, A.; Trebbi, M.; Presutti, L.
abstract

Purpose: Microlaryngoscopy laryngeal surgery (MLS) is a highly specialized and delicate surgical procedure performed by a single operator. The aim of this study is to report the initial development of a validated and codified training program on ex vivo porcine larynx, allowing residents to obtain the basic skills of the MLS. Methods: Two residents without previous MLS experience were tested with four different exercises on 10 larynxes, one side at a time. The time needed for each exercise was noted. A skilled surgeon performed the same procedure, and this was considered to be the gold standard. Videos of the training exercise were evaluated by the two expert surgeons in a random, blinded sequence, using a modified global rating scale (GRS) to evaluate specific surgical skills. Results: The median execution times and GRS scores were calculated for both residents. Execution times and surgical skill scores were subsequently analyzed. For each exercise, a Spearman test between observations and time was performed to evaluate a significative increasing or decreasing trend in time execution. Execution times and surgical skills were also compared between the two subjects. Wilcoxon rank-sum test was used to evaluate any significant differences between them. A P value ≤0.05 was considered statistically significant. The results showed a significant improvement of the execution times for each resident (P value < 0.01). While the GRS scores for the exercises have remained between 3.0 and 5.0 from the first to the last procedure. Conclusion: MLS training on a porcine ex vivo model is useful, repeatable, and low cost. The work showed that, after only 10 training sessions, two residents without experience in MLS could quickly improve their execution times without statistically significant decrease of the visual analysis of surgical skills.

2020 - Giant hemangioma involving the tongue: A surgical strategy to improve quality of life [Articolo su rivista]
Ferri, G.; Fermi, M.; Maccarrone, F.; Mattioli, F.; Presutti, L.
abstract

Backgroud: Hemangiomas are the most common benign vascular tumors which most frequently occurs in newborns and infants. The skin of head and neck district is often involved, whereas the oral cavity and oropharynx do not. There are many different strategies for the management of head and neck hemangiomas, including wait and see policy, drug therapy, sclerotherapy, cryotherapy, radiotherapy, laser therapy and surgery. The treatment plan must consider aspects such as size, location, lesion hemodynamics and patient's age. Case presentation: We describe a case of a 38-years-old male complaining dysphagia, dyslalia and dyspnea, moreover, the patient referred episodic bleeding from the oral cavity. At clinical examination a giant vascularized lesion involving the tongue and occupying almost all the oral cavity and oropharyngeal space was observed. Surgical approaches for macroglossia can be considered in case of benign vascular lesion of the tongue when other therapies have failed and/or patient's clinical condition requires early intervention. Conclusions: The aim of this case report is to describe our surgical strategy to manage a giant vascular malformation of the tongue and improve quality of life through a median glossectomy with trapezoidal wedge resection of the tongue, as previously described for surgical management of macroglossia.

2020 - Improvement of Swallowing Function After Surgical Treatment of Diffuse Idiopathic Skeletal Hyperostosis: Our Experience [Articolo su rivista]
Mattioli, F.; Ghirelli, M.; Trebbi, M.; Silvestri, M.; Presutti, L.; Fermi, M.
abstract

Objective: To investigate the swallowing improvement in patients who underwent a transcervical prevascular retrovisceral approach for symptomatic cervical diffuse idiopathic skeletal hyperostosis (DISH), by means of the 10-item Eating Assessment Tool (EAT-10) questionnaire. Methods: Retrospective observational study of 21 patients treated with a transcervical anterior prevascular retrovisceral approach for symptomatic DISH with dysphagia as the primary symptom. All patients underwent videofluoroscopic study of swallowing before surgery and the EAT-10 questionnaire before and after the surgical procedure. Results: A statistically significant (P < 0.001) improvement in the postoperative EAT-10 score was reported. Sixteen out of 21 patients (76.2%) had their symptoms completely resolved, with an EAT-10 score less than 3. These results were not influenced by age and sex nor by presence of tracheostomy. The preoperative EAT-10 score was consistently related to postoperative outcome. Patients with mild and moderate dysphagia had better Δ in EAT-10 scores than patients with severe and very severe dysphagia (P = 0.02). Conclusions: Surgical management seems to be effective in resolving swallowing disorders related to this disease in a consistent percentage of patients. This evidence is supported by the statistically significant improvement in EAT-10 scores after treatment. Moreover, it might be postulated that early intervention can guarantee a higher success rate because patients with severe and very severe dysphagia had significantly smaller improvement.

2020 - Pharyngo-esophageal perforations after anterior cervical spine surgery: management and outcomes [Articolo su rivista]
Ghirelli, Michael; Molinari, Giulia; Rosini, Maria; De Iure, Federico; Gasbarrini, Alessandro; Mattioli, Francesco; Alicandri-Ciufelli, Matteo; Presutti, Livio
abstract

To report about the diagnosis, surgical treatment and post-operative management of pharyngo-esophageal perforations (PEP) after anterior cervical spine (ACS) surgery in 17 patients.

2020 - Reply to “Indications and timing for tracheostomy in patients with SARS CoV2‐related” by Ferri et al [Articolo su rivista]
Mattioli, F.; Marudi, A.; Ghirelli, M.; Molteni, G.; Sgarbi, N.; Valerini, S.; Girardis, M.; Presutti, L.; Fermi, M.
abstract

2020 - Salvage open partial horizontal laryngectomy after failed radiotherapy: A multicentric study [Articolo su rivista]
Bertolin, A.; Lionello, M.; Ghizzo, M.; Cena, I.; Leone, F.; Valerini, S.; Mattioli, F.; Crosetti, E.; Presutti, L.; Succo, G.; Rizzotto, G.
abstract

Objectives: The primary aim of the present study was to report our multi-institutional experience in surgical salvage with open partial horizontal laryngectomies (OPHL) after failed radiotherapy (RT) for laryngeal squamous cell carcinoma (LSCC). Secondary aims were to analyze the prognostic meaning of the main clinical and pathological parameters in relation to the oncologic outcome and to compare our results with the available literature. Study Design: A retrospective multicenter analysis of surgical oncological outcomes. Methods: We retrospectively review the clinical charts of 70 recurrent LSCC patients after primary RT failure undergone salvage OPHL. Results: At last follow-up, 46 patients (65%) were disease-free; six (9%) were alive with disease; nine (12%) died because of the disease; and nine (12%) died without evidence of disease. The final local control, overall survival, disease-specific survival, and laryngectomy-free survival were 87%, 75%, 87%, and 91%, respectively. Twelve patients (17%) experienced postoperative complications, whereas 18 patients (25%) experienced late sequelae. In five patients (7%), decannulation was not possible because of postoperative laryngeal stenosis. Conclusion: In selected patients, when proper selection criteria for conservation laryngeal surgery are adopted, OPHL can be considered for salvage after RT failure. Level of Evidence: 4 Laryngoscope, 130:431–436, 2020.

2020 - Tracheostomy in the COVID-19 pandemic [Articolo su rivista]
Mattioli, F.; Fermi, M.; Ghirelli, M.; Molteni, G.; Sgarbi, N.; Bertellini, E.; Girardis, M.; Presutti, L.; Marudi, A.
abstract

Purpose: The role of tracheostomy in COVID-19-related ARDS is unknown. Nowadays, there is no clear indication regarding the timing of tracheostomy in these patients. Methods: We describe our synergic experience between ENT and ICU Departments at University Hospital of Modena underlining some controversial aspects that would be worth discussing tracheostomies in these patients. During the last 2 weeks, we performed 28 tracheostomies on patients with ARDS due to COVID-19 infection who were treated with IMV. Results: No differences between percutaneous and surgical tracheostomy in terms of timing and no case of team virus infection. Conclusion: In our experience, tracheostomy should be performed only in selected patients within 7- and 14-day orotracheal intubation.

2019 - Central compartment revision surgery for persistent or recurrent thyroid carcinoma: analysis of survival and complication rate [Articolo su rivista]
Molteni, G.; Bonali, M.; Mattioli, F.; Ghirelli, M.; Fermi, M.; Ferri, G.; Malagoli, A.; Presutti, L.
abstract

Purpose: Locoregional recurrence of thyroid carcinoma is relatively common and reported rate are between 5 and 20%. Cervical nodes are usually involved, especially at the central compartment. The management of recurrent thyroid carcinoma at central compartment still remains challenging because of higher incidence of complication rate. The aim of the study is to evaluate the survival and complications rate after revision surgery. Methods: Retrospective cohort study on a group of patients that underwent revision surgery for persistent or recurrent thyroid carcinoma from January 1, 2003 to December 31, 2017. Survival outcomes were calculated using Kaplan–Meier method. Significant variables on univariate analysis were subjected to a Cox proportional hazards regression multivariate model. Results: Fifty-two patients involved, 22 male (40%) and 30 female (60%). Mean age was 54 years old (range 24–85). Mean follow-up was 79 months, median follow-up was 85 months, with a range between 8 and 153 months. The 5-year overall survival was 90.8% while at 10 years it was 69.8%. The 5-year disease-specific survival was 93.5%, while at 10 years it dropped to 77.9%. The rate of recurrent laryngeal nerve paralysis and persistent hypocalcemia in our series were 1.3% and 5.9%, respectively. No evidence of thoracic duct, esophageal or laryngeal and tracheal injury was found in this case series. Regarding prognostic factors, univariate and multivariate analysis highlighted as statistically significant: the aggressive histological variants, the presence extranodal extension or soft-tissue metastasis. Conclusion: The surgical option remains the gold standard in locoregional recurrences of thyroid carcinoma and should be performed by experienced surgeons to reduce postoperative complications.

2017 - An ovine model for exclusive endoscopic ear surgery [Articolo su rivista]
Anschuetz, Lukas; Bonali, Marco; Ghirelli, Michael; Mattioli, Francesco; Villari, Domenico; Caversaccio, Marco; Presutti, Livio
abstract

IMPORTANCE: With the international spread of exclusive transcanal endoscopic ear surgery, the need for a suitable and affordable surgical training model has grown during the past years. OBJECTIVE: To develop and validate an ex vivo animal model for exclusive endoscopic ear surgery. DESIGN, SETTING, AND ANIMAL MODELS: In an experimental study, we compared ovine and human middle ear anatomy in 4 specimens and assessed the lamb as a model for endoscopic ear surgery. After confirming its suitability, we developed a surgical training program for canaloplasty, myringoplasty, and ossiculoplasty. From March 1 to May 31, 2016, the ex vivo model was tested, assessing the time needed for dissection and complications. Each experience was subjectively validated on a scale from 1 (very poor) to 10 (excellent). MAIN OUTCOMES AND MEASURES: Suitability of the lamb model for training in exclusive endoscopic ear surgery. RESULTS: We assessed the suitability of our novel lamb model on 20 ovine middle ears. All interventions could be performed in a satisfactory manner. The mean (SD) time required to perform canaloplasty was 29.7 (13.2) minutes, for middle ear dissection was 7.7 (2.6) minutes, for myringoplasty was 7.7 (4.3) minutes, and for ossiculoplasty was 10.4 (2.7) minutes. The time required for canaloplasty and tympano-meatal flap elevation during dissection decreased from 46.4 minutes in the first 5 cases to 16.2 minutes in the last 5 cases, representing an absolute difference of 30.2 minutes (95% CI, 22.28-38.12). Subjective ratings revealed excellent values for tissue quality (8.9 points of 10), overall satisfaction (8.3 points), and the learning experience (8.8 points). CONCLUSIONS AND RELEVANCE: The ovine model is suitable for endoscopic ear surgery. We describe a novel, exclusively endoscopic approach in an ex vivo animal model for middle ear surgery. The proposed surgical program leads the trainee step by step through the main otologic procedures and is able to enhance his or her surgical skills.

2017 - Novel Dissection Station for Endolaryngeal Microsurgery and Laser Surgery: Development and Dissection Course Experience [Articolo su rivista]
Mattioli, Francesco; Presutti, Livio; Caversaccio, Marco; Bonali, Marco; Anschuetz, Lukas
abstract

Objective: We aimed to develop and validate an ex vivo dissection station for endolaryngeal surgery suitable for different kinds of laryngeal specimen and any type of operating technique (CO2laser, cold instruments by endoscopic or microscopic techniques). Study Design: Experimental construction and validation of a highly specialized dissection station. Setting: Laboratory and international dissection course. Methods: We designed a lightweight dissection station made of polycarbonate resin approved for use with a CO2laser. The cylindrical box hosts an articulated laryngeal support. The laryngoscope is positioned on an articulated arm, which is fixed on the construction’s footplate. Validation of the larynx box was performed during an international dissection course on laryngeal surgery held in January 2016. Results: We assessed the suitability of our novel dissection station among specialized laryngologists with a mean experience of 14 years. Feedback from the participants was very positive, with a mean general impression of 9.5 (out of 10 points) and a recommendation score of 9.6 for further use. Its utility in transforming the taught surgical steps into daily practice has been highly recognized, with a score of 9.5. Conclusion: The lightweight and transparent larynx box is suitable for any kind of laryngeal specimen, and any surgical intervention can be taught at reasonable cost. It is safe and suitable for use with CO2lasers. Validation among experienced surgeons revealed its suitability in the teaching of endolaryngeal microsurgery and laser surgery.

2017 - Polydimethylsiloxane Injection Laryngoplasty for Unilateral Vocal Fold Paralysis: Long-Term Results [Articolo su rivista]
Mattioli, Francesco; Bettini, Margherita; Botti, Cecilia; Busi, Giulia; Tassi, Sauro; Malagoli, Andrea; Molteni, Gabriele; Trebbi, Marco; Luppi, Maria Pia; Bergamini, Giuseppe; Presutti, Livio
abstract

Objectives To analyze the long-term objective, perceptive, and subjective outcomes after endoscopic polydimethylsiloxane (PDMS) injection laryngoplasty in unilateral vocal fold paralysis. Study design A retrospective study carried out between January 2008 and January 2012. Setting Head and Neck Department, University Hospital of Modena, Modena, Italy. Methods This was a retrospective analysis of 26 patients with unilateral vocal fold paralysis who underwent endoscopic injection of PDMS under general anesthesia. A voice evaluation protocol was performed for all patients, which included videolaryngostroboscopy, maximum phonation time, fundamental frequency, analysis of the harmonic structure of the vowel /a/ and the word /aiuole/, Grade of Dysphonia, Instability, Roughness, Breathiness, Asthenia, and Strain scale, and Voice Handicap Index. The protocol was performed before surgery, in the immediate postoperative period, and at least 3 years after surgery. The mean follow-up period was 73 months (range 39–119 months). Results The statistical analysis showed a significant improvement (P < 0.01) for all of the objective, perceptive, and subjective parameters by comparison between the preoperative and long-term follow-up data; moreover, no statistically significant difference was found between the postoperative and long-term follow-up data. This indicates that injection laryngoplasty with PDMS guarantees long-lasting effects over time. No complications were reported in our series. Conclusion Injection laryngoplasty with PDMS can be considered to be a minimally invasive and safe technique for the treatment of unilateral vocal fold paralysis. Moreover, it allows very good and stable results to be obtained over time, avoiding repeated treatments and improving the quality of life of the patients.

2016 - Atypical mycobacteriosis involving parotid and para-retropharyngeal spaces [Articolo su rivista]
Bonali, Marco; Mattioli, Francesco; Alicandri Ciufelli, Matteo; Presutti, Livio
abstract

The incidence of retro-parapharyngeal localization of cervical adenitis due to non-tuberculous mycobacteria is very rare. We present a case of an 18-months-old child with an involvement of parapharyngeal and retropharyngeal areas, right parotid and submandibular regions by atypical mycobacteriosis in the CT and MRI scan. The masses were surgically removed and the frozen-section histological exam upheld their atypical mycobacterial origin.

2016 - Chronic and recurrent benign lymphadenopathy without constitutional symptoms associated with human herpesvirus-6B reactivation [Articolo su rivista]
Forghieri, Fabio; Luppi, Mario; Barozzi, Patrizia; Riva, Giovanni; Monica, Morselli; Bigliardi, Sara; Quadrelli, Chiara; Vallerini, Daniela; Maccaferri, Monica; Coluccio, Valeria; Paolini, Ambra; Colaci, Elisabetta; Goretta, Bonacorsi; Maiorana, Antonino; Sara, Tagliazucchi; Fabio, Rumpianesi; Mattioli, Francesco; Presutti, Livio; Gelmini, Roberta; Cermelli, Claudio; Giulio, Rossi; Patrizia, Comoli; Marasca, Roberto; Narni, Franco; Potenza, Leonardo
abstract

Chronic/recurrent behaviour may be encountered in some distinct atypical or malignant lymphoproliferations, while recurrences are not generally observed in reactive/benign lymphadenopathies. We retrospectively anal- ysed a consecutive series of 486 human immunodeficiency virus-negative adults, who underwent lymphadenectomy. Neoplastic and benign/reactive histopathological pictures were documented in 299 (61 5%) and 187 (38 5%) cases, respectively. Of note, seven of the 111 (6 3%) patients with benign lymphadenopathy without well-defined aetiology, showed chronic/ recurrent behaviour, without constitutional symptoms. Enlarged lymph nodes were round in shape and hypoechoic, mimicking lymphoma. Reac- tive follicular hyperplasia and paracortical expansion were observed. Human herpesvirus (HHV)-6B positive staining in follicular dendritic cells (FDCs) was documented in all seven patients. Serological, molecular and immunological examinations suggested HHV-6B reactivation. Among the remaining 104 cases with reactive lymphoid hyperplasia in the absence of well-known aetiology and without recurrences, positivity for HHV-6B on FDCs was found in three cases, whereas in seven further patients, a scanty positivity was documented in rare, scattered cells in inter-follicular regions. Immunohistochemistry for HHV-6A and HHV-6B was invariably negative on 134 lymph nodes, with either benign pictures with known aetiology or malignant lymphoproliferative disorders, tested as further controls. Future studies are warranted to investigate a potential association between HHV- 6B reactivation and chronic/recurrent benign lymphadenopathy.

2016 - Recurrent Massive Epistaxis from an Anomalous Posterior Ethmoid Artery [Articolo su rivista]
Greco, MARCO GIUSEPPE; Mattioli, Francesco; Alberici, MARIA PAOLA; Presutti, Livio
abstract

A 50-year-old man, with no previous history of epistaxis, was hospitalized at our facility for left recurrent posterior epistaxis. The patient underwent surgical treatment three times and only the operator's experience and radiological support ( cranial angiography) allowed us to control the epistaxis and stop the bleeding. The difficult bleeding management and control was attributed to an abnormal course of the left posterior ethmoidal artery. When bleeding seems to come from the roof of the nasal cavity, it is important to identify the ethmoid arteries always bearing in mind the possible existence of anomalous courses.

2015 - Analysis of risk factors for pharyngocutaneous fistula after total laryngectomy with particular focus on nutritional status [Articolo su rivista]
Mattioli, F; Bettini, M; Molteni, G; Piccinini, A; Valoriani, F; Gabriele, S; Presutti, L
abstract

Pharyngocutaneous fistula (PCF) is the most common complication following total laryngectomy and the most difficult to manage. It often causes increased morbidity, delays starting adjuvant therapy, prolongs hospitalisation, increases treatment costs and reduces the quality of life (QoL). The objective of this study is to analyse the predisposing factors and the most important nutritional parameters related to the development of PCF in patients undergoing total laryngectomy and to suggest medical alternatives that might improve results. We performed a retrospective study of 69 patients who underwent either primary or salvage total laryngectomy in our department between January 2008 and January 2012. Risk factors for fistula formation were analysed including tumour characteristics (histology, grading, AJCC stage), treatment (primary or salvage surgery, extent of resection, flap reconstruction, preoperative radiotherapy), comorbidity and nutritional status (preoperative haemoglobin, albumin and prealbumin levels and their changes during hospitalisation). Twenty-four patients developed a PCF (overall incidence 34.8%). Fistula formation was significantly higher in patients with diabetes, preoperative malnutrition (identified from low preoperative albumin and prealbumin levels). After specific nutritional evaluation and support, no patient developed a PCF. Risk factors for PCF formation are extensively treated in the literature but identification of high-risk patients is still controversial. Our study demonstrates that nutritional status of the patient, assessed by preoperative albumin, is also an important risk factor for PCF formation in addition to classical factors. Maintenance of a normal perioperative nutritional status can be helpful to avoid this complication.

2015 - Radiological assessment of the sinus tympani: temporal bone HRCT analyses and surgically related findings [Articolo su rivista]
Marchioni, Daniele; Valerini, Sara; Mattioli, Francesco; Alicandri Ciufelli, Matteo; Presutti, Livio
abstract

To evaluate the morphology of the sinus tympani (ST) based on computed tomography (CT) scans (axial view), describing the findings in a cohort of 148 patients (296 ears), and classifying the prevalence according to our ST classification. To evaluate the surgical prevalence based on the type of ST. To calculate the sensibility and positive predictive value (PPV) of high-resolution computed tomography (HRCT) scans for ST involvement by cholesteatoma.

2015 - Results of Early Versus Intermediate or Delayed Voice Therapy in Patients With Unilateral Vocal Fold Paralysis: Our Experience in 171 Patients [Articolo su rivista]
Mattioli, F; Menichetti, M; Bergamini, G; Molteni, G; Alberici, M P; Luppi, M P; Nizzoli, F; Presutti, L
abstract

Vocal fold paralysis can have an important impact on a patient's quality of life. The goal of this study was to compare, in terms of vocal improvement and motility recovery, the post-vocal treatment results of our patients with unilateral vocal fold paralysis (UVFP) when treatment was started early (within 4 weeks from injury) versus intermediate (from 4 to 8 weeks) or delayed (at least 8 weeks after injury) treatment.

2013 - Endoscopic anatomy of the retrotympanum [Articolo su rivista]
Nogueira, João Flávio; Mattioli, Francesco; Presutti, Livio; Marchioni, Daniele
abstract

This article presents the endoscopic anatomy of the retrotympanum and its relationship to other important anatomic landmarks in the middle ear to provide understanding of its importance and relevance during surgeries. A well-detailed tour of the retrotympanum, its associated structures, variability of anatomic structures, and surgical relevance is presented.

2013 - Endoscopic management of attic cholesteatoma: a single-institution experience [Articolo su rivista]
Marchioni, Daniele; Villari, Domenico; Mattioli, Francesco; ALICANDRI CIUFELLI, Matteo; Piccinini, Alessia; Presutti, Livio
abstract

At present, the main application of endoscopic surgery is in the surgical treatment of middle ear cholesteatoma; however, for definitive validation and acceptance by scientific community, results are needed regarding recurrent and residual rates of the condition. This article analyzes the single-institution experience from results of surgical treatment of attic cholesteatoma.

2013 - From external to internal auditory canal: Surgical anatomy by an exclusive endoscopic approach [Articolo su rivista]
Marchioni, D.; Alicandri-Ciufelli, M.; Mattioli, F.; Nogeira, J. F.; Tarabichi, M.; Villari, D.; Presutti, L.
abstract

Surgical approaches to the inner ear and internal auditory canal (IAC) are well known and well documented. The objective of this study is to analyze the morphology, and surgical and anatomic findings of an exclusive endoscopic transcanal approach (EETA) to the IAC. Cadaveric dissections were performed on 11 temporal bones, approaching the internal auditory meatus directly through the external ear canal and avoiding mastoidectomy. In all cases, it was possible to dissect the internal carotid artery and jugular bulb with a 0° endoscope, and with good control of these two structures. The medial wall of the bony labyrinth guaranteed good landmarks for IAC dissection, such as the spherical recess, and the labyrinthine tract of the facial nerve. The IAC can be thoroughly visualized in the cadaver using EETA, avoiding mastoidectomy, extensive temporal bone tissue removal and external incisions. Clinically based reports will be required in future to strengthen our preliminary results. © 2012 Springer-Verlag.

2013 - Prevalence of ventilation blockages in patients affected by attic pathology: a case-control study [Articolo su rivista]
Marchioni, Daniele; Mattioli, Francesco; ALICANDRI CIUFELLI, Matteo; Presutti, Livio
abstract

Using a retrospective video evaluation of exclusive endoscopic middle ear procedures, we analyzed the different anatomical and pathological findings between patients with attic disease or cholesteatoma and patients without attic disease.

2012 - Bronchial selective ventilation in a wide tracheocutaneous fistula [Articolo su rivista]
Marchioni, A.; Mattioli, F.; Piccinini, A.; Marchioni, D.; Alicandri-Ciufelli, M.; Monelli, M.; Presutti, L.
abstract

We present the treatment and management of a wide tracheocutaneous fistula after tracheotomy correlated with excessive cuff pressure in a 36-year-old woman with cerebral palsy since infancy in which persistent type II respiratory failure required continuous ventilatory support. We discuss the surgical treatment adopted for the management of this particularly wide lesion. At the end of surgery, mechanical ventilation through a tracheal cannula was hindered by the reduced length of the residual trachea below the tracheotomy. The need to guarantee mechanical ventilation to the patient led to the implementation of a cuff securing system in the two main bronchi. We describe the approach that may be attempted under extreme conditions, when traditional ventilation methods cannot be applied for anatomical reasons. © 2012.

2012 - Chronic/relapsing lymphadenopathy associated with HHV-6B infection: a new benign clinico-pathologic entity occurring in immunocompetent individuals [Abstract in Rivista]
Forghieri, Fabio; Potenza, Leonardo; Barozzi, Patrizia; Vallerini, Daniela; Riva, Giovanni; Zanetti, E; Quadrelli, C; Morselli, M; Leonardi, G; Maccaferri, M; Paolini, Ambra; Coluccio, Valeria; Colaci, Elisabetta; Pedrazzi, Letizia; Fantuzzi, Valeria; Bigliardi, Sara; Soci, Francesco; Bonacorsi, G; Zaldini, P; Rossi, G; Milani, M; Rivasi, Francesco; Gennari, W; Pecorari, M; Grottola, Antonella; Tagliazucchi, S; Rumpianesi, F; Mattioli, F; Presutti, Livio; Franzoni, Chiara; Gelmini, Roberta; Saviano, Massimo; Cermelli, Claudio; Marasca, Roberto; Narni, Franco; Luppi, Mario
abstract

Background. HHV-6 DNA sequences were disclosed in lymph node (LN) tis- sues of several patients with lymphoid malignancies, but a direct major role of HHV-6 in lymphoid malignant transformation has so far not been confirmed. In contrast, active HHV-6 infection has been associated to either infectious mononucleosis-like syndrome or acute lymphadenitis occurring in febrilepatients with systemic symptoms, or to Rosai-Dorfman disease in which viral antigens have been detected by immunohistochimical (IHC) analyses in both histiocytes and follicular dendritic cells (FDCs). Methods. We have retrospec- tively analyzed clinical and pathological data of 365 adult patients, consecutive- ly observed at our Institution over a period of 5 years (2006-2010), because of enlarged superficial lymph nodes and subsequently undergoing lymphadenec- tomy. In the benign/reactive cases in which well-recognized etiologies have been excluded, an involvement of HHV-6 active infection or reactivation was investigated by molecular and immunohistochemical examinations. Results. Malignant disorders, namely malignant lymphoproliferative disorders or solid cancer metastases, were found in 227 cases (62%), whereas in 138 cases (38%) benign/reactive pictures were documented on lymph node examination. Among these latter cases, a well-recognized etiology was demonstrated in 84 patients (61%), while in 54 cases (39%), a well-defined non-malignant reactive/infectious cause could not be documented. Immunohistochemical analyses resulted negative for both HHV-6A and HHV-6B in 38 of these latter lymph nodes (70%). In 7 patients (13%), a scattered, scanty and aspecific pos- itivity for HHV-6B late protein was documented in rare interfollicular plasma cells and histiocytes. Surprisingly, in 9 patients (17%), immunohistochemical analyses showed HHV-6B positive staining of FDCs, together with scattered positivity of interfollicular cells. These 9 HIV-negative adult patients (median age 42 years, range 18-76 years), with either localized or generalized LAP, were observed for a median follow-up of 38 months (range 28-166). Of note, six of them presented with recurrent LAP (one to 3 recurrences), without evolving into lymphoma. A common LN histological pattern at presentation showed florid fol- licular hyperplasia with concurrent mild paracortical expansion. Three cases also showed features consistent with PTGC. Constitutional symptoms were absent in all patients. The IHC reactions for both HHV-6A and HHV-6B, per- formed on further control cases, represented by 131 LN tissues from patients with either benign LAP induced by other known etiologies or lymphoma, were invariably negative. Serology was positive for both IgM and IgG with high avid- ity suggesting viral reactivation/reinfection. However, the molecular analyses failed to detect HHV-6 viremias in cell-free-serum samples of all the 9 patients with positive HHV-6B IHC staining, while positivity for HHV-6B DNA was dis- closed by PCR analyses in 7 out of the 7 LN tissues studied. Conclusions. We show for the first time that local reactivation/infection of HHV-6B should be con- sidered among the possible causes of chronic/relapsing benign LAP in immuno- competent individuals. IHC is the method of choice for investigating the pres- ence of HHV-6 infection in such cases. HHV-6B may indirectly modulate and trigger the proliferation of lymphocytes, by locally affecting FDCs and LN microenvironment. FDCs may indeed be involved in presenting HHV-6B anti- gens to other immune cells, mainly cortical B lymphocytes.

2012 - Nipple trauma in infants? Bednar aphthae. [Articolo su rivista]
Tricarico, Antonella; Molteni, G.; Mattioli, F.; Guerra, A.; Mordini, B.; Presutti, Livio; Iughetti, Lorenzo
abstract

INTRODUCTION: Bednar aphthae are infected wounds caused by trauma, localized to the hard palate in infants. They do not require specific treatment because they regress spontaneously in a few days. They often remain undiagnosed; other times, because of the pain they caused, they may worsen the nursing.CASE REPORT: We describe the clinical case of a healthy infant of 2 months, fed with formula, who has 2 aphthous lesions in the oral cavity associated with irritability and inconsolable crying during feeding. We excluded the influence of infectious factors or underlying diseases. The hypothesis of a traumatic factor was supported by the anatomical features of aphthae and then confirmed by the gradual resolution of lesions after some advices on breastfeeding.CONCLUSIONS: Our intent is to provide a photographic record of Bednar aphthae, which are quite common but often misdiagnosed also because of lacking of photographic material. Improved knowledge of this condition helps physicians in the differential diagnosis of a traumatic condition that is not as unusual as it seems in newborns.

2012 - Radiology quiz case 1. Diagnosis: Cholesteatoma of the frontal sinus [Articolo su rivista]
Gioacchini, FEDERICO MARIA; Mattioli, Francesco; Todeschini, Alessandra; Presutti, Livio
abstract

g

2011 - Horizontal glottectomy: is it an out-of-date procedure? [Articolo su rivista]
ALICANDRI CIUFELLI, Matteo; Monzani, Daniele; Presutti, Livio; Molteni, Gabriele; Mattioli, Francesco; Bergamini, Giuseppe; Tassi, Sauro; D'Angeli, Ilaria; Izzo, Paolo; Izzo, Luciano
abstract

Purpose: The aim of the study is to illustrate our experience with horizontal glottectomy (HG), reviewing the indications and results of this uncommon partial laryngectomy. Materials and Methods: It is a retrospective study. We completed a chart review of patients who underwent partial laryngectomy between May 2003 and June 2010. Patients who underwent HG were included in the study. Data obtained were collected and analyzed. Results: Seven male patients were included in the study (mean age was 78 years; range, 69-88 years). In all cases, the TNM classification was pT1bN0M0 apart from one patient who had pT1N1MO. Three patients had a moderately differentiated neoplasm (G2), whereas 4 patients had a well-differentiated tumor (G1). Tracheotomy tube removal, oral feeding, and voice analysis have been evaluated and reported in the study. Mean follow-up was 16 months. Conclusions: Horizontal glottectomy might be a worthwhile treatment option in selected patients nowadays. In older patients with anterior commissure involvement, this procedure guarantees adequate functional and good oncological results. This study may possibly help surgeons dealing with glottic cancer involving the anterior commissure because we believe that some patients could benefit from HG, even in this radiotherapy and transoral laser surgery "era." (C) 2011 Elsevier Inc. All rights reserved.

2011 - Radiology quiz case 2. Giant rhinosinusal empty mucocele [Articolo su rivista]
Mattioli, Francesco; ALICANDRI CIUFELLI, Matteo; Trebbi, Marco; Molteni, Gabriele; Presutti, Livio
abstract

ab breve dell'art

2011 - The role of early voice therapy in the incidence of motility recovery in unilateral vocal fold paralysis [Articolo su rivista]
Mattioli, Francesco; Bergamini, Giuseppe; ALICANDRI CIUFELLI, Matteo; Molteni, Gabriele; Luppi, Maria Pia; Nizzoli, Federica; Grammatica, Alberto; Presutti, Livio
abstract

OBJECTIVES. Vocal fold paralysis can have a significant impact on a patient's quality of life. The aim of this study was to analyze, in terms of vocal improvement and motility recovery, the post-vocal treatment results of patients with unilateral vocal fold paralysis (UVFP) who underwent early voice therapy. Study design. A 7 years prospective study of patients with an UVFP who underwent our multidimensional diagnostic-therapeutic assessment. MATERIAL AND METHODS. Seventy-four patients with UVFP were included in the study. All patients underwent a voice therapy based on forcible exercises supplemented by manipulations and maneuvers. A pre and post-treatment objective voice evaluation and self-assessment was made.

2010 - Endoscopic evaluation of middle ear ventilation route blockage [Articolo su rivista]
Marchioni, D.; Mattioli, F.; Alicandri-Ciufelli, M.; Molteni, G.; Masoni, F.; Presutti, L.
abstract

Objectives: To describe middle ear ventilation route blockage, relieved during middle ear endoscopic surgery, and to analyze its association with mastoid hypopneumatization/sclerotization. Study design: Prospective case series with intraoperative analyses, and with a case-control computed tomographic scan comparison. Methods: Intraoperative findings during endoscopic middle ear surgery are described. Patients with middle ear ventilation route blockage were included in the study group (22 patients), while patients without middle ear ventilation route blockage were included in the control group (16 patients). An intra-patient and inter-group comparison of evaluated mastoid pneumatization was performed from the preoperative computed tomographic scans. Results: Middle ear ventilation route blockage was classified into three types (A, B, C) according to intraoperative findings. Intrapatient and intergroup comparisons showed that the presence of blockages of middle ear ventilation trajectories is associated with a statistically significantly higher prevalence of hypopneumatization/ sclerotization of the mastoid in the study group, a typical sign of middle ear dysventilation pathologies. Conclusions: Intraoperative evaluation of the middle ear anatomy during endoscopic surgery for inflammatory pathology allows us to clearly visualize the presence of anatomic blockages of the middle ear ventilation trajectories. These blockages might provoke a sectorial dysventilation of the middle ear, with consequent reduction of pneumatization of the mastoid. Further studies will be able to clarify to what extent selective dysventilation phenomena could be a principal factor in influencing middle ear pressure homeostasis. © 2010 Elsevier Inc. All rights reserved.

2010 - Lateral endoscopic approach to epitympanic diaphragm and Prussak's space: a dissection study [Articolo su rivista]
Marchioni, D.; ALICANDRI CIUFELLI, Matteo; Grammatica, A.; Mattioli, F.; Genovese, Elisabetta; Presutti, Livio
abstract

Introduction Until now, anatomic descriptions of the epitympanic diaphragm and Prussak’s space have been performed using a microscope. The aim of this study is to thoroughly describe and review the epitympanic diaphragm and the anatomy of Prussak’s space from an endoscopic point of view. Study design Cadaver dissection study. Setting Tertiary referral university center. Materials and methods The anatomy of four temporal bones dissected using an endoscope was studied. The most important findings were noted and described. Results Endoscopic cadaveric dissection of the middle ear allows a very good visualization of the epitympanic diaphragm, Prussak’s space and middle ear anatomy in general. Conclusion Endoscopic exploration and thorough knowledge of the complex fold anatomy may improve ‘functional’ interventions in middle ear inflammatory pathology during middle ear surgery, particularly in the case of selective dysventilation

2010 - Pyramidal eminence and subpyramidal space: An endoscopic anatomical study [Articolo su rivista]
Marchioni, D.; Alicandri-Ciufelli, M.; Grammatica, A.; Mattioli, F.; Presutti, L.
abstract

Objectives/Hypothesis: To describe retrotympanic endoscopic anatomy, especially the pyramidal eminence and contiguous spaces. Study Design: This was an anatomical study on a prospective case series. Methods: The anatomy of the retrotympanum was studied by endoscopy in nine patients affected by cholesteatoma who underwent tympanomastoid surgery and in six temporal bone dissections. Results: Pneumatization of the sinus tympani and posterior tympanic sinus or both, noted in 12 ears out of 15, may give rise to a recess beneath the pyramidal eminence, which we have called the subpyramidal space. This space can manifest with a variable degree of depth, shape, or extent depending on the shape and dimensions of the pyramidal eminence. Conclusions: Endoscopic exploration of the middle ear may guarantee a very good exposure of retrotympanic structures, allowing detailed anatomical descriptions of hidden areas. Improvement in our knowledge of the anatomy may decrease the possibility of residual disease during cholesteatoma surgery. © 2009 The American Laryngological, Rhinological and Otological Society, Inc.

2010 - Radiology quiz case 2. Bilateral tortuous internal carotid arteries (ICAs) [Articolo su rivista]
ALICANDRI CIUFELLI, Matteo; Piccinini, Alessia; Marchese, Caterina; Mattioli, Francesco; Presutti, Livio
abstract

carotid artery

2009 - "Collision" metastasis from unknown primary squamous cell carcinoma and papillary microcarcinoma of thyroid presenting as lateral cervical cystic mass [Articolo su rivista]
Mattioli, F; Masoni, F; Ponti, Giovanni; Rossi, G; Masoni, Francesco; ALICANDRI CIUFELLI, Matteo; Presutti, Livio
abstract

We report an unusual case of "collision metastasis". In a single lymph node, we found a metastatic mass composed of two immunohistochemically distinct components originating from two primary tumors: a papillary microfollicular thyroid cancer and an unknown primary squamous cell carcinoma. The clinical features and immunohistochemical profile are reported. Collision phenomena in oncology are extremely rare and pose diagnostic and management challenges which are discussed.

2009 - CT morphological evaluation of anterior epitympanic recess in patients with attic cholesteatoma [Articolo su rivista]
Marchioni, Daniele; Mattioli, Francesco; Cobelli, Milena; Todeschini, Alessandra; ALICANDRI CIUFELLI, Matteo; Presutti, Livio
abstract

The objective of this study is to analyze the possible variations in size and shape of the AER in the ear affected by acquired cholesteatoma versus the healthy ear in the same patient. A total of 22 patients affected by acquired cholesteatoma were included in our study. A CT morphological evaluation of both ears (pathologic and non-pathologic) was made. Measures of the AER were done, on axial plane, parallel to incudomalleal axis for the deepest anterior-to-posterior (AP) diameter and perpendicular to this line for the maximum transverse (T) diameter, selecting the most inferior cut that showed the Cog in its entirety. A third superior-inferior (SI) measure was done, on coronal plane from the tegmen tympani to the cochleariform process. Comparisons between the mean of AP, T and SI in affected ears versus non-affected have been carried out using a paired t test. The AER measurement was considerably smaller in affected ears than in the non-affected ones. Mean AP +/- DS was 5.1 (1.46) versus 3.1 (0.90), P values <0.0001. Mean T +/- DS was 4.1 (0.74) versus 3.2 (0.74), P values <0.0014. Mean SI +/- DS was 4.0 (1.01) versus 2.0 (0.82), P values <0.0001. In conclusion, based on our results, the AER in an affected ear seems smaller than in a non-affected one. Whether a hypovolumetric AER could be a congenital morphological condition predisposing cholesteatoma despite adequate aeration of the epitympanic compartment, on the contrary the presence of membranous and/or ligamentous folds could exclude the AER from the posterior epitympanic space and from the protympanum, predisposing it for attical dysventilation, should be clarified in further studies.

2009 - Critical literature review on the management of intraparotid facial nerve schwannoma and proposed decision-making algorithm [Articolo su rivista]
ALICANDRI CIUFELLI, Matteo; Marchioni, Daniele; Mattioli, Francesco; Trani, Margherita; Presutti, Livio
abstract

Management of intraparotid facial nerve schwannomas (IFNS) is very challenging because the diagnosis is often made intra-operatively and in most cases, resection could lead to severe facial nerve (FN) paralysis, with important aesthetic consequences. Articles in the English language focused on the management of FN schwannoma have been selected and critically reviewed. A decision-making algorithm is proposed. In the case of type A or B neoplasms, or in case of a pre-operative FN House-Brackmann (HB) grade IV or worse, the authors would favor a resection of the IFNS and (where necessary) a reconstruction of the nerve. In the case of pre-operative HB grade III or better and type C or D neoplasms, patients would undergo an intra-operative biopsy to rule out malignancy, and a possible conservative management could be adopted. Localization and adherences of IFNS, as well as pre-operative FN function are important factors that must be considered in the decision-making process for IFNS to optimize the functional outcomes.

2009 - Endoscopic approach to tensor fold in patients with attic cholesteatoma [Articolo su rivista]
Marchioni, D.; Mattioli, F.; Alicandri-Ciufelli, M.; Presutti, L.
abstract

Conclusion. The endoscopic approach to attic cholesteatoma allows clear observation of the tensor fold area and consequently, excision of the tensor fold, modifying the epitympanic diaphragm. This permits good removal of cholesteatoma and direct ventilation of the upper unit, preventing the development of a retraction pocket or attic cholesteatoma recurrence, with good functional results. Objectives. An isthmus block associated with a complete tensor fold is a necessary condition for creation and development of an attic cholesteatoma. During surgical treatment of attic cholesteatoma, tensor fold removal is required to restore ventilation of the attic region. Use of a microscope does not allow exposure of the tensor fold area and so removal of the tensor fold can be very difficult. In contrast, the endoscope permits better visualization of the tensor fold area, and this aids understanding of the anatomy of the tensor fold and its removal, restoring attic ventilation. Patients and methods. In all, 21 patients with limited attic cholesteatoma underwent an endoscopic approach with complete removal of the disease. Patients with a wide external ear canal were operated through an exclusively endoscopic transcanal approach; patients with a narrow external ear canal or who were affected by external canal exostosis were operated through a traditional retroauricular incision and meatoplasty followed by the endoscopic transcanal approach. Results. In 18/21 patients, the endoscope permitted the discovery of different anatomical morphologies of the tensor fold. Sixteen patients presented a complete tensor fold (one with an anomalous transversal orientation), one patient presented an incomplete tensor fold and one patient presented a bony ridge in the cochleariform region. In all 16 cases of complete tensor tympani fold, the fold was removed and anterior epitympanic ventilation was restored. The ridge bone over the cochleariform process was also removed with a microdrill. © 2009 Informa UK Ltd.

2009 - Giant retropharyngeal liposarcoma [Articolo su rivista]
Alicandri-Ciufelli, M.; Mattioli, F.; Molteni, G.; Trebbi, M.; Presutti, L.
abstract

2009 - Quality of life in patients treated with PDMS injection for swallowing disorders [Articolo su rivista]
Molteni, Gabriele; Ghidini, Angelo; Bergamini, Giuseppe; ALICANDRI CIUFELLI, Matteo; Mattioli, Francesco; Luppi, Maria Pia; Presutti, Livio
abstract

To document the efficacy of polydimethylsiloxane (PDMS) injections in patients with swallowing disorders after partial supracricoid laryngectomy; to assess the importance of quality-of-life (QOL) outcome in oncologic patients.

2009 - Tonsillar swelling: always a simple diagnosis? [Articolo su rivista]
Alicandri-Ciufelli, Matteo; Molteni, Gabriele; Villari, Domenico; Mattioli, Francesco; Presutti, Livio
abstract

2009 - Transcanal endoscopic approach to the sinus tympani: A clinical report [Articolo su rivista]
Marchioni, D.; Mattioli, F.; Alicandri-Ciufelli, M.; Presutti, L.
abstract

OBJECTIVES: To investigate the anatomic limitations of the endoscopic transcanal approach to sinus tympani (ST), in particular, how this approach might allow a complete visualization of the ST recesses and to propose a morphologic classification of the ST using computed tomography and to examine if this could be useful for the surgeon in preoperative planning to decide the type of approach to the ST. STUDY DESIGN: Case series. PATIENTS AND METHODS: Forty patients affected by middle ear disease with ST involvement were included in our study. All patients underwent a preoperative computed tomographic scan of the temporal bone. All patients underwent tympanomastoid surgery with intraoperative use of the endoscope. We assessed the variation in depth of the ST area, analyzing the posterior and medial extension of the medial boundary of the ST, and performing a radiomorphologic classification of the ST. RESULTS: Of the 40 patients, it has been possible to describe the detailed morphology of the shape of the ST in 38. We classified the depth of the ST into 3 types based on radiologic findings: Type A (a limited ST), Type B (a deep ST), and Type C (a deep ST with a posterior extension). Of 35 ST of Types A and B, there was good exposure of the medial boundary of the sinus using a transcanal endoscopic approach in 33 (94.2%), whereas in 3 (60%) of 5 patients of Type C, it was not possible to explore the complete depth of the sinus, especially the ST portion under and posterior to the facial nerve. CONCLUSION: 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. © 2009 Otology &amp; Neurotology, Inc.

2009 - Transnasal endoscopic treatment of cerebrospinal fluid leak: 17 years' experience [Articolo su rivista]
Presutti, Livio; Mattioli, Francesco; Villari, Domenico; Marchioni, Daniele; ALICANDRI CIUFELLI, Matteo
abstract

Aim of this report is to describe the long-term results of endoscopic endonasal repair of cerebrospinal fluid leak using a septal mucoperichondrial graft. A case series of 52 patients operated for cerebrospinal fluid rhinorrhea between 1990 and 2006 is presented. All patients underwent surgical treatment for endoscopic endonasal closure of a cerebrospinal fluid leak using a septal mucoperichondrial graft. No lumbar drain and fluorescein tests were used. The intra-operative localization of the fistula was aided by Valsalva's manoeuvre by the anaesthetist. The success rate, after the first attempt, was 88.5% (46/52 patients); for the remaining 11.5% (6/52 patients), a second attempt was necessary which proved successful in 5 cases, raising the overall success rate to 98.1% (51/52 patients). Relapse occurred in only one case (1.9%), after the second attempt. In conclusion, a free mucoperichondrial graft offered good results for cerebrospinal fluid leak repair. In the Authors' experience, a high success rate can be achieved without the use of intrathecal fluorescein and lumbar drain.

2008 - A case of syryngocystadenoma papilliferum (SCAP) involving middle ear, presenting with otomastoiditis and cerebral abscess [Articolo su rivista]
Presutti, L.; Alicandri-Ciufelli, M.; Mattioli, F.; Marchioni, D.; Costantini, M.
abstract

Syryngocystadenoma papilliferum (SCAP) is an uncommon cutaneous adnexal neoplasm of apocrine gland origin. Until now, fewer than 200 cases have been reported in international literature, of which 12 cases involved the external ear. No cases of SCAP involving the middle ear have been reported. We describe a case of SCAP of external and middle ear, presenting with otomastoiditis and cerebral abscess; this aggressive behavior, never reported for a benign adenoma of the external or middle ear, could lead to a differential diagnosis with cholesteatoma or malignancies. © 2007 Elsevier Ireland Ltd. All rights reserved.

2008 - Endoscopic management of acquired cholesteatoma: our experience [Articolo su rivista]
Presutti, Livio; Marchioni, Daniele; Mattioli, Francesco; Villari, Domenico; Alicandri-Ciufelli, Matteo
abstract

The purpose of this study was to examine the utility of using an endoscope in cholesteatoma surgery and to demonstrate how it allows a reduction in the incidence of residual disease.

2008 - Middle turbinate preservation versus middle turbinate resection in endoscopic surgical treatment of nasal polyposis [Articolo su rivista]
Marchioni, Daniele; ALICANDRI CIUFELLI, Matteo; Mattioli, Francesco; Marchetti, Alessio; Jovic, Gordana; Massone, Federica; Presutti, Livio
abstract

Relapse in patients affected by nasal polyposis and subjected to endoscopic surgery appears to be a relevant feature. Surgical treatment shows a significant increase in quality of life in all the patients aside from surgical technique used. Our results show a better control of relapse of nasal pathology in patients subjected to more radical surgery (group B) vs patients subjected to conservative surgery on middle turbinate (group A). Allergic patients in group B had a smaller number of relapses during the follow-up period compared with allergic patients in group A and this was statistically significant.

2008 - Wnt pathway, angiogenetic and hormonal markers in sporadic and familial adenomatous polyposis-associated juvenile nasopharyngeal angiofibromas (JNA) [Articolo su rivista]
Ponti, Giovanni; Losi, Lorena; Pellacani, Giovanni; G. B., Rossi; Presutti, Livio; Mattioli, Francesco; Villari, Domenico; L., Wannesson; ALICANDRI CIUFELLI, Matteo; P., Izzo; M., De Rosa; P., Marone; Seidenari, Stefania
abstract

Juvenile nasopharyngeal angiofibroma (JNA) is a rare, invasive, and locally destructive tumor of the nasopharynx. The Writ pathway, angiogenctic and hormonal factors are involved in the pathophysiology of JNA; it can result in an extracolonic manifestation of familial adenomatous polyposis (FAP) or in a sporadic tumor. All patients who underwent resection of JNA between 1991 and 2006 at the University of Modena and Reggio Emilia were studied to identify immunohistochemical markers of associated FAP syndrome. Paraffin-embedded JNA samples were analyzed immunohistochemically for the expression of adenomatous polyposis coli (APC), beta-catenin, E-cadherin, androgen receptor, and vascular endothelial growth factors receptor (VEGFR(2)). In one out of the 4 (25%) young patients affected by JNA the diagnosis of FAP syndrome linked to APC mutation was made. All of the sporadic and familial JNA tumors showed nuclear staining of beta-catenin, whereas altered APC expression was seen only in FAP-associated JNA. All cases were stained with VEGFR(2). A combined clinical, immunohistochemical, and biomolecular screening may be useful for the identification of FAP among patients with a diagnosis of JNA. The Writ pathway can be involved in the JNA pathogenesis either by somatic mutations of beta-catenin or by germline APC mutations. As the VEGFR has an important impact on the pathogenesis of JNA, we suggest that a targeted therapy with monoclonal antibodies against VEGFR might lead to a specific chemoprevention and treatment of these tumors and their recurrences.

2007 - Nasal septal perforations: Our surgical technique [Articolo su rivista]
Presutti, L.; Alicandri Ciufelli, M.; Marchioni, D.; Villari, D.; Marchetti, A.; Mattioli, F.
abstract

Objective: The aim of this paper was to describe our surgical technique for the treatment of nasal septal perforations. Study and design: We studied 31 patients with nasal septal perforation treated with an endoscope-assisted technique, based on a bilateral dissection of monopedicled mucosal flaps from the nasal fossa floor, sutured at the edge of the perforation previously unstuck, without any graft interposed between the two mucosal layers. Results: In our experience with 31 patients, the use of this technique led to the persistent closing (with follow-up for at least one year) of 96.3% of the perforations smaller than 3 cm. Conclusions: Our technique has the advantage of an endonasal approach, without any external incision, and the use of monopedicled flaps from the nasal fossa floor without any graft interposition, avoiding any other surgical procedure and morbidity in the donor site of the graft. The use of nasal endoscopy permits superior precision in all surgical steps. Significance: The high success rate in perforations smaller than 3 cm seems to confirm the effectiveness of this technique. © 2007 American Academy of Otolaryngology-Head and Neck Surgery Foundation.