Purpose To develop a clinical practice guideline for treatment of laryngeal cancer with the intent of preserving the larynx (either the organ itself or its function). This guideline is intended for use by oncologists in the care of patients outside of clinical trials. Methods A multidisciplinary Expert Panel determined the clinical management questions to be addressed and reviewed the literature available through November 2005, with emphasis given to randomized controlled trials of site-specific disease. Survival, rate of larynx preservation, and toxicities were the principal outcomes assessed. The guideline underwent internal review and approval by the Panel, as well as external review by additional experts, members of the American Society of Clinical Oncology (ASCO) Health Services Committee, and the ASCO Board of Directors. Results Evidence supports the use of larynx-preservation approaches for appropriately selected patients without a compromise in survival; however, no larynx-preservation approach offers a survival advantage compared with total laryngectomy and adjuvant therapy with rehabilitation as indicated. Recommendations All patients with T1 or T2 laryngeal cancer, with rare exception, should be treated initially with intent to preserve the larynx. For most patients with T3 or T4 disease without tumor invasion through cartilage into soft tissues, a larynx-preservation approach is an appropriate, standard treatment option, and concurrent chemoradiotherapy therapy is the most widely applicable approach. To ensure an optimum outcome, special expertise and a multidisciplinary team are necessary, and the team should fully discuss with the patient the advantages and disadvantages of larynx-preservation options compared with treatments that include total laryngectomy.

American Society of Clinical Oncology Clinical Practice Guideline for the Use of Larynx-Preservation Strategies in the Treatment of Laryngeal Cancer

Delineation of the primary tumour Clinical Target Volumes (CTV-P) in laryngeal, hypopharyngeal, oropharyngeal and oral cavity squamous cell carcinoma: AIRO, CACA, DAHANCA, EORTC, GEORCC, GORTEC, HKNPCSG, HNCIG, IAG-KHT, LPRHHT, NCIC CTG, NCRI, NRG Oncology, PHNS, SBRT, SOMERA, SRO, SSHNO, TROG consensus guidelines.

A classification of laryngeal endoscopic cordectomies, which included eight different types, was first proposed by the European Laryngological Society in 2000. The purpose of this proposal of classification was an attempt to reach better consensus amongst clinicians and agree on uniformity in reporting the extent and depth of resection of cordectomy procedures, to allow relevant comparisons within the literature when presenting/publishing the results of surgery, and to recommend the use of guidelines to allow for reproducibility amongst practicing laryngologists. A total of 24 article citations of this classification have been found through the science citation index, as well as 3 book chapters on larynx cancer surgery, confirming its acceptance. However, on reflection, and with the passage of time, lesions originating at the anterior commissure have not been clearly described and, for that reason, a new endoscopic cordectomy (type VI) for cancers of the anterior commissure, which have extended or not to one or both of the vocal folds, without infiltration of the thyroid cartilage is now being proposed by the European Laryngological Society Committee on Nomenclature to revise and complete the initially reported classification.

/pdf/proposal-for-revision-of-the-european-laryngological-society-16u651woci.pdf

Proposal for revision of the European Laryngological Society classification of endoscopic cordectomies

Purpose of reviewTransoral laser microsurgery has developed in recent years into a surgical method that combines a minimally invasive approach with the surgical precision of laser and microscope. The outcomes of laser microsurgical treatment of laryngeal carcinomas are reviewed and compared with the

The role of laser microsurgery in the treatment of laryngeal cancer.

Background
Transoral CO2 laser surgery has been accepted as a valuable therapeutic option for glottic cancer.

Methods
This was a retrospective analysis of 595 patients. Five-year overall and disease-specific survivals, local control with laser, locoregional, regional control, and organ preservation rates were calculated. The impact of different variables was calculated by univariate analysis.

Results
Overall, disease-specific and disease-free survivals, local control with laser, locoregional, regional control, and organ preservation rates were 87.5%, 99%, 81.3%, 92.7%, 98.9%, 98.2%, and 97.1%, respectively. Univariate analysis showed a significant impact of pT category on local control with laser, organ preservation, locoregional and regional control, of endoscopic re-treatment for positive deep surgical margins on local control with laser and organ preservation, and recurrence after endoscopic re-treatment on local control with laser and organ preservation.

Conclusion
This series confirms the good oncologic outcomes of endoscopic laser surgery for Tis, T1, and selected T2 and T3 glottic tumors. © 2009 Wiley Periodicals, Inc. Head Neck, 2010

Transoral co2 laser treatment for tis―t3 glottic cancer: the university of brescia experience on 595 patients

Radiotherapy contends with endoscopic surgery for the role of treatment of choice for Tis-T1 glottic cancer. The amount of vocal cord to be surgically removed logically depends on the surface and deep extension of the neoplasm. Thus, a prerequisite for proper management includes an analysis of the voice changes after each of the progressive types of cordectomy described in the European Laryngological Society Classification. Between January 1998 and December 2000, 89 patients with glottic cancer (8 Tis, 63 T1a, 18 T1b) underwent different types of endoscopic cordectomy. Perceptual analysis (GRBAS scale); objective analyses of jitter, shimmer, and noise-to-harmonics ratio; and subjective (Voice Handicap Index) evaluation of voice were performed in 51 patients. Statistical evaluation of preoperative and postoperative objective results by analysis of covariance, as well as perceptual and subjective data, showed significant voice improvement after type I and II cordectomies, with the voice attaining nearly normal parameters. By contrast, after type III, IV, and V cordectomies, the vocal outcome was not significantly different from the preoperative pattern. It can therefore be concluded that type I and II resections, whenever indicated, are adequate procedures even for professional voice users. By contrast, accurate counseling is mandatory before type III, IV, and V cordectomies.

Preoperative and Postoperative Voice in Tis-T1 Glottic Cancer Treated by Endoscopic Cordectomy: An Additional Issue for Patient Counseling

u F s i e 54-year-old Caucasian male presented to the Deartment of Otolaryngology Service at the University f Brescia Hospital in December 2002 for a foreign ody sensation in his throat and slight dysphagia lasting or 2 weeks. In June 1999, he had been submitted to ight nephrectomy for renal cell carcinoma (RCC) taged as pT1N0M0G3. Between July 1999 and Noember 2000, he had undergone multiple bilateral lung etastasectomies and mediastinal lymphadenectomies or pulmonary metastases of RCC. When first seen in ur department, he was still under palliative chemotherpy for multiple hepatic and lung metastases. However, is general status was satisfactory and the rest of the linical history unremarkable for systemic diseases. Direct laryngoscopy under local anesthesia showed hypervascularized, pedicled, berry-like neoformation rising from the infrahyoid epiglottis, projecting into he laryngeal vestibule, in contact laterally with the left ryepiglottic fold and the false vocal cord below (Fig ). Due to the concern of further RCC metastases with high risk of bleeding from biopsy under local aneshesia, an “en bloc” excisional biopsy under direct icrolaryngoscopy by CO2 laser (Sharplan 1055 S) ith an Acuspot 712 micromanipulator (Sharplan, Tel viv, Israel) was performed after a full supraglottic xposure by the Lindholm laryngoscope. The resection as accomplished using the laser beam set on the uperpulse mode (3.5 watts, 270-micron spot size). The ostoperative course was uneventful and the patient as discharged the day after surgery with complete emission of symptoms. Histopathologic examination was suggestive for a etastasis of RCC: the mucosa appeared infiltrated by heets of polygonal and oval clear cells, forming a solid attern interrupted only by fibrous septae and thinalled vessels. There were scanty nuclear atypia and are mitoses.

Renal cell carcinoma metastatic to the larynx.

A27-year-old semiprofessional singer was referred to our department in February 2004 for progressive hoarseness with breathy and strained voice lasting 6 months. She denied any previous voice problem, recent upper respiratory infection, or pharyngodynia. Videolaryngostroboscopic examination showed the presence of a fusiform lesion covered by normal mucosa on the middle third of the right vocal fold surrounded by vascular ectasias. Moreover, laryngeal hyperemia, bilaterally reduced mucosal wave, and incomplete glottic closure during phonation with an oval-shaped gap were observed. Voice therapy was prescribed and scrupulously performed. At the end of the logopedic treatment, hoarseness was still present with minimal improvement of vocal fatigue. Endoscopic examination 2 months after the first videolaryngostroboscopy showed a substantially unchanged situation. Therefore, direct microlaryngoscopic examination with phonosurgical treatment of the right vocal cord lesion was scheduled. The patient was submitted to direct microlaryngoscopy under general anesthesia in April 2004. During palpation of the glottis by blunt instrumentation, two occult mucosal bridges on the right and one on the left vocal fold were detected (Fig 1). Excision of the mucosal bridges and detachment of the mucosal layer from the underlying vocal ligament were therefore bilaterally performed by cold instrumentation. Autologous abdominal fat was subsequently harvested, centrifuged, and bilaterally injected into the vocal muscle to reduce the residual glottic gap. A slight overcorrection was performed in consideration of the delayed partial resorption of the injected fat. The postoperative course was uneventful and the patient was discharged the day after surgery with recommendations for adequate voice rest. She subsequently performed further voice therapy with considerable improvement of voice quality, and began singing again 2 months later. At the last videolaryngostroboscopic examination, 30 months after surgery, complete glottic closure was observed, with restored bilateral mucosal wave.

Triple mucosal bridge of the glottis.

Special needs children presenting with dental problems were penalised during the Covid-19 pandemic due to the reduction of clinical activity and the risks of nosocomial infection. The aim of this study is to evaluate the impact of the pandemic on oral healthcare in paediatric special needs patients.We retrospectively assessed and compared the outpatient clinic activity and dental procedures performed under general anaesthesia in children with special needs at Brescia Children's Hospital (Italy) in 2019, 2020, and 2021. Any delay between expected waiting time based on assigned priority and surgery was recorded. The efficacy of the protocol adopted to reduce the spread of Covid-19 was evaluated by reporting any infections in patients, parents, and health care providers.In 2020, 270 outpatient visits were performed, and 40 patients were treated under general anaesthesia, with a 26% and 65% reduction, respectively, compared to 2019. In 2021, 362 visits were performed (similar to 2019) and 48 patients were treated under general anaesthesia (58% compared to 2019). The mean delay in the planned treatment was 1.0 month in 2019 (pre-pandemic period), 2.1 months in 2020, and 1.1 month in 2021. No cases of Covid-19 infection were reported in the cohort of patients and parents or among the operators related to nosocomial infection.The Covid-19 pandemic has profoundly reduced the activity of general anaesthesia in paediatric special need patients during 2020, with a gradual return to normal pre-pandemic activity in 2021. The adopted protocol prevented the spread of COVID-19 during hospitalisation. 

https://link.springer.com/content/pdf/10.1007/s40368-022-00770-2.pdf

Impact of Covid-19 pandemic on children with special needs requiring general anaesthesia for the treatment of dental disease: the experience of the Brescia Children’s Hospital, Lombardy, Italy

"La videochimografia”In: A. Ricci Maccarini, V. Di Nicola: Relazione Ufficiale del XXXVI Congresso Nazionale della Società Italiana di Foniatria e Logopedia “La valutazione dei risultati del trattamento logopedico delle disfonie. Il protocollo SIFEL”

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