ENT pathologies

acute external otitis, catarrhal otitis media in adults and children, perforations of the tympanic membrane, loop ear ("protruding") hearing loss, presbycusis (deafness in the elderly), tinnitus (ringing of the ear)

acute and chronic tonsillitis and adenoiditis of pediatric and adulthood acute and chronic pharyngitis pharyngitis from gastroesophageal reflux neoplasms of the oropharynx

(submaxillary sublingual, parotid)
salivary stones acute and chronic sialadenitis cysts, benign and malignant tumors

total and partial thyroidectomies, parathyroidectomy

A tumor or neoplasm of the oral cavity is any malignant lesion affecting the mucous membrane of the tongue, cheeks, gums, hard palate or lips. Often they originate from persistent wounds or ulcers of the oral mucosa, which do not heal after 15-20 days of local therapy. The doctor who most frequently encounters this type of injury is the dentist during periodic dental hygiene visits. In particular, it will be the dentist who specializes in pathologies of the oral cavity who will recognize, biopsy and treat precancerous lesions, ie those dyskeratotic lesions that have superficially modified the mucosa without having yet transformed into carcinoma. When a neoplasm of the oral cavity is identified in 90% of cases it is squamous cell carcinoma, that is, a tumor that originates from squamous epithelial cells; its incidence in Italy is 3-4 new cases per year per 100,000 inhabitants and clearly prevails in adult men between 60 and 70 years. The main risk factors are the consumption of alcohol and the habit of smoking cigarettes, cigars or pipes, the presence of chipped, decayed teeth or poorly positioned prostheses that cause continuous trauma to the oral mucosa (especially lingual). Poor oral hygiene, chewing tobacco or betel leaves (common in the peoples of the Indian subcontent) can also favor the onset of this neoplasm. Exposure to the sun's rays for long periods can instead favor the formation of lip carcinomas. Finally, the presence of the HPV 16-18 virus, integrated in the cells of malignant lesions, does not seem to have a certain role in the carcinogenesis of oral cancers. The main symptoms that prompt the patient to visit are persistent pain, bleeding, swelling, difficulty swallowing and reflex otalgia; however, even indolent lesions of the oral cavity must be subjected to the evaluation of an experienced physician. The otolaryngologist is in fact the doctor who will have to evaluate during the visit, through inspection and palpation, any changes in the mucous membrane of the oral cavity and in the motility of the tongue. Any suspected lesion of the oral cavity must be subjected to a biopsy examination. The next step involves the staging of the tumor, ie the execution of radiological tests that allow to define the extent of the tumor, the possible involvement of the lymph nodes in the neck and the possible presence of distant metastases. Carcinomas of the oral cavity require magnetic resonance imaging of the oral cavity and neck as the first radiological examination. Alternatively, it is possible to perform a CT scan of the neck and oral cavity with contrast medium, especially if the patient is elderly, edentulous or uncooperative. In the presence of advanced stage cancer (in size or in the presence of laterocervical lymph nodes) it is always advisable to study with PET to assess the presence of distant metastases. The treatment of these neoplasms primarily involves surgery, while radiotherapy and chemotherapy are used as adjuvant therapies (therefore after surgery) only in advanced-stage neoplasms. The prognosis is highly variable and depends on the size of the tumor and the presence of metastatic lymph nodes; in particular, the five-year survival is 80-90% in the early stages and between 25-70% in the advanced stages. The latter data is very variable in relation to the presence of pathological lymph nodes in capsular rupture. The surgical treatment of oral carcinomas requires careful pre-operative planning, to propose a radical surgery but at the same time respectful of the function of fundamental organs such as the tongue, necessary for eating and speaking. In small tumors it is in fact possible to perform a partial resection of the organ of the disease and to associate the search for the sentinel lymph node; then only the first lymph node draining the tumor will be removed and analyzed and in case of positive disease, a second surgical time will follow for complete emptying of the neck lymph nodes. On the other hand, in the case of advanced tumors of the oral cavity, it will be necessary to propose a largely demolitive surgery with emptying of the lymph nodes in the neck and contextual reconstruction of the removed area (eg tongue, jaw, cheek) with free revascularized or pedunculated flaps. In fact, reconstructive surgery makes it possible to restore organ function by transplanting tissues taken from other parts of the body (eg fibula, skin of the thigh, skin of the forearm). In relation to the therapeutic aggressiveness that these tumors impose, prevention based on abstention from smoking, the limited use of alcoholic beverages and the annual schedule of dental check-ups is essential, especially in subjects over 60 years of age.

A tumor or neoplasm of the oral cavity is any malignant lesion affecting the mucous membrane of the tongue, cheeks, gums, hard palate or lips. Often they originate from persistent wounds or ulcers of the oral mucosa, which do not heal after 15-20 days of local therapy. The doctor who most frequently encounters this type of injury is the dentist during periodic dental hygiene visits. In particular, it will be the dentist who specializes in pathologies of the oral cavity who will recognize, biopsy and treat precancerous lesions, ie those dyskeratotic lesions that have superficially modified the mucosa without having yet transformed into carcinoma. When a neoplasm of the oral cavity is identified in 90% of cases it is squamous cell carcinoma, that is, a tumor that originates from squamous epithelial cells; its incidence in Italy is 3-4 new cases per year per 100,000 inhabitants and clearly prevails in adult men between 60 and 70 years. The main risk factors are the consumption of alcohol and the habit of smoking cigarettes, cigars or pipes, the presence of chipped, decayed teeth or poorly positioned prostheses that cause continuous trauma to the oral mucosa (especially lingual). Poor oral hygiene, chewing tobacco or betel leaves (common in the peoples of the Indian subcontent) can also favor the onset of this neoplasm. Exposure to the sun's rays for long periods can instead favor the formation of lip carcinomas. Finally, the presence of the HPV 16-18 virus, integrated in the cells of malignant lesions, does not seem to have a certain role in the carcinogenesis of oral cancers. The main symptoms that prompt the patient to visit are persistent pain, bleeding, swelling, difficulty swallowing and reflex otalgia; however, even indolent lesions of the oral cavity must be subjected to the evaluation of an experienced physician. The otolaryngologist is in fact the doctor who will have to evaluate during the visit, through inspection and palpation, any changes in the mucous membrane of the oral cavity and in the motility of the tongue. Any suspected lesion of the oral cavity must be subjected to a biopsy examination. The next step involves the staging of the tumor, ie the execution of radiological tests that allow to define the extent of the tumor, the possible involvement of the lymph nodes in the neck and the possible presence of distant metastases. Carcinomas of the oral cavity require magnetic resonance imaging of the oral cavity and neck as the first radiological examination. Alternatively, it is possible to perform a CT scan of the neck and oral cavity with contrast medium, especially if the patient is elderly, edentulous or uncooperative. In the presence of advanced stage cancer (in size or in the presence of laterocervical lymph nodes) it is always advisable to study with PET to assess the presence of distant metastases. The treatment of these neoplasms primarily involves surgery, while radiotherapy and chemotherapy are used as adjuvant therapies (therefore after surgery) only in advanced-stage neoplasms. The prognosis is highly variable and depends on the size of the tumor and the presence of metastatic lymph nodes; in particular, the five-year survival is 80-90% in the early stages and between 25-70% in the advanced stages. The latter data is very variable in relation to the presence of pathological lymph nodes in capsular rupture. The surgical treatment of oral carcinomas requires careful pre-operative planning, to propose a radical surgery but at the same time respectful of the function of fundamental organs such as the tongue, necessary for eating and speaking. In small tumors it is in fact possible to perform a partial resection of the organ of the disease and to associate the search for the sentinel lymph node; then only the first lymph node draining the tumor will be removed and analyzed and in case of positive disease, a second surgical time will follow for complete emptying of the neck lymph nodes. On the other hand, in the case of advanced tumors of the oral cavity, it will be necessary to propose a largely demolitive surgery with emptying of the lymph nodes in the neck and contextual reconstruction of the removed area (eg tongue, jaw, cheek) with free revascularized or pedunculated flaps. In fact, reconstructive surgery makes it possible to restore organ function by transplanting tissues taken from other parts of the body (eg fibula, skin of the thigh, skin of the forearm). In relation to the therapeutic aggressiveness that these tumors impose, prevention based on abstention from smoking, the limited use of alcoholic beverages and the annual schedule of dental check-ups is essential, especially in subjects over 60 years of age.