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Advances in Minimally Invasive Otolaryngology: Precision Techniques and Functional Outcomes
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Advances in Minimally Invasive Otolaryngology: Precision Techniques and Functional Outcomes

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Otolaryngology".

Deadline for manuscript submissions: 20 January 2027 | Viewed by 5973

Editors

Dr. Giovanni Colombo

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Guest Editor
Otorhinolaryngol Head & Neck Department, Legnano Hospital, ASST Ovest Milanese, Legnano, 20025 Milan, Italy
Interests: otolaryngology; sinus surgery; skull base surgery; otoneurosurgery; exoscope; endoscopic surgery; nasal polyposis
Dr. Matteo Di Bari

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Guest Editor
Otorhinolaryngol Head & Neck Department, Legnano Hospital, ASST Ovest Milanese, Legnano, 20025 Milan, Italy
Interests: otolaryngology; otoneurosurgery; ear surgery; exoscope; cholesteatoma; otosclerosis; cochlear implant

Special Issue Information

Dear Colleagues,

Otolaryngology has entered a new era of technological and conceptual innovation. Rapid progress in surgical platforms and tools, imaging modalities, and functional rehabilitation strategies is transforming patient care across ear, sinonasal, and head and neck disorders. These developments reflect the growing need for precision, safety, and measurable improvements in quality of life.

This Special Issue aims to showcase recent advances and future directions in otolaryngology, highlighting how novel techniques and functional outcome monitoring contribute to more effective and patient-centered care. By encouraging interdisciplinary contributions, the Special Issue will provide a broad yet focused overview of the evolving landscape of surgical and non-surgical management in our specialty.

In this Special Issue, original research articles and reviews are welcome. Research areas may include (but are not limited to) the following:

  • New surgical and diagnostic techniques in otology, rhinology, and head and neck surgery;
  • Emerging technologies such as endoscopic, exoscopic, and robotic platforms;
  • Novel implants and grafts in otology, rhinology, and skull base surgery;
  • Functional outcome monitoring, including hearing, olfaction, swallowing, voice, and sleep disorders.

We look forward to receiving your contributions.

Dr. Giovanni Colombo
Dr. Matteo Di Bari
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • advances in otolaryngology
  • endoscopic surgery
  • head and neck surgery
  • functional outcomes
  • quality of life

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Published Papers (5 papers)

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19 pages, 472 KB  
Article
Extracapsular Enucleation Versus Partial Superficial Parotidectomy and Extracapsular Dissection in Warthin’s Tumor: A Retrospective Matched Cohort Study
by Michael Kostares, Evangelos Kostares, Maria Kakazani, Marina Karaiskou, Matilda Chatzipanagiotou, Maria Kantzanou, Paul Stampouloglou, Maria Piagkou and Spiridon Laskaris
J. Clin. Med. 2026, 15(8), 3026; https://doi.org/10.3390/jcm15083026 - 15 Apr 2026
Viewed by 858
Abstract
Background/Objectives: Warthin’s tumor (WT) is a benign parotid neoplasm increasingly managed with tissue-preserving surgical approaches to reduce postoperative morbidity. Partial superficial parotidectomy (PSP) and extracapsular dissection (ECD) are commonly performed, whereas extracapsular enucleation (EN) remains less systematically evaluated. This study compared postoperative morbidity [...] Read more.
Background/Objectives: Warthin’s tumor (WT) is a benign parotid neoplasm increasingly managed with tissue-preserving surgical approaches to reduce postoperative morbidity. Partial superficial parotidectomy (PSP) and extracapsular dissection (ECD) are commonly performed, whereas extracapsular enucleation (EN) remains less systematically evaluated. This study compared postoperative morbidity among EN, PSP, and ECD in a matched cohort of patients with unifocal WT. Methods: A retrospective matched cohort study was conducted at a single tertiary referral center, including patients with histologically confirmed, unifocal WT treated between 2009 and 2023. A total of 360 patients were organized into 120 matched triplets (EN, PSP, ECD), with exact matching on age group and sex and balancing for smoking status, body mass index, and alcohol use. To enable comparison under technically uncomplicated conditions, cases with documented intraoperative capsular rupture or tumor spillage were excluded. The primary endpoint was overall postoperative morbidity, defined as the occurrence of at least one predefined complication. Associations between surgical technique and morbidity were assessed using conditional logistic regression, with estimation of odds ratios (ORs), absolute risk differences (RDs), and numbers needed to treat (NNT). Results: Overall complication rates were 8.3% after EN, 29.2% after ECD, and 32.5% after PSP (p < 0.001). EN was associated with lower odds of postoperative complications compared with ECD (OR 0.23, 95% CI 0.10–0.50) and PSP (OR 0.18, 95% CI 0.08–0.41). Adjusted absolute risks were 8.3% for EN, 29.3% for ECD, and 32.4% for PSP, corresponding to absolute risk differences of 21% and 24% and numbers needed to treat of 4.8 and 4.2, respectively. Conclusions: In this selected cohort of unifocal, anatomically favorable Warthin’s tumors without intraoperative capsular violation, ΕΝ was associated with lower observed postoperative morbidity compared with ECD and PSP. These findings are context-dependent and reflect outcomes achieved under strict selection and technical conditions. Therefore, they should not be extrapolated to anatomically complex, inflamed, or diagnostically uncertain lesions. Prospective multicenter studies with standardized selection criteria are warranted to better define the role of EN in contemporary WT management. Full article
(This article belongs to the Special Issue Advances in Minimally Invasive Otolaryngology: Precision Techniques and Functional Outcomes)
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14 pages, 1192 KB  
Article
Global Variations in Surgical Techniques and Postoperative Care for Radial Forearm Free Flap (RFFF) in Head & Neck Surgery: A Cross-Sectional International Survey
by Elena Russo, Andrea Costantino, Giannicola Iannella, Filippo Marchi, Antonio Greco, Luca Calabrese, Antonella Polimeni, Remo Accorona, Armando De Virgilio and RFFFSurv Collaborative
J. Clin. Med. 2025, 14(22), 8023; https://doi.org/10.3390/jcm14228023 - 12 Nov 2025
Viewed by 1401
Abstract
Objective: This cross-sectional survey aimed to comprehensively gather data on radial forearm free flap (RFFF) utilization and practices in head and neck reconstructive surgery. Methods: An online questionnaire was organized into seven sections: demographics, surgeon experience, harvesting techniques, microsurgical considerations, postoperative [...] Read more.
Objective: This cross-sectional survey aimed to comprehensively gather data on radial forearm free flap (RFFF) utilization and practices in head and neck reconstructive surgery. Methods: An online questionnaire was organized into seven sections: demographics, surgeon experience, harvesting techniques, microsurgical considerations, postoperative care, flap monitoring, and outcomes. It was distributed by email to 216 head and neck reconstructive surgeons who attended the International Federation of Head and Neck Oncologic Societies (IFHNOS) congress in Rome (21–25 June 2023) using the congress mailing list. Responses were collected from 54 surgeons (25% response rate), representing 15 countries across Europe, Asia, the Americas, and Oceania, underscoring the international scope of the survey between 5 February and 25 March 2024. The questionnaire was not formally piloted or validated. Missing data were managed on a per-question basis. Descriptive statistics were used, and 95% confidence intervals (CIs) were calculated for key surgical outcomes to indicate estimate precision. Associations between categorical variables were analyzed using Pearson’s χ2 test with Cramér’s V as an effect size, and relationships between continuous variables were examined using Spearman’s rank correlation (ρ) with 95% confidence intervals (CIs). Given the exploratory design and limited sample size, no correction for multiple comparisons was applied, and the risk of both Type I and Type II errors was acknowledged. Results: Variations were observed in harvesting techniques, microsurgical preferences, and postoperative care protocols. Most surgeons initiated flap harvesting concurrently with tumor resection, primarily preserving superficial sensory nerves. Regarding venous outflow, 50% of respondents preferred the cephalic vein, 19% used comitant veins, and 29% utilized both systems when possible. Perioperative antibiotic use was standard practice, though anticoagulant preferences and flap monitoring methods varied. The study achieved a high success rate for RFFF procedures, exceeding 95%, with venous thrombosis identified as the main cause of flap failure. No significant correlations were found between flap failure rate and training method (p = 0.21), specialty (p = 0.37), annual number of RFFF procedures (p = 0.89), surgeon age (p = 0.42), or hospital type (p = 0.48). Effect sizes were small to moderate, indicating weak or negligible associations. Similarly, perioperative factors such as anticoagulant use (p = 0.84), preoperative antibiotics (p = 0.42), surgical instruments (p = 0.61), suture techniques (p = 0.51), and donor vein selection (p = 0.20) showed no statistically significant associations with flap loss. Patient satisfaction assessments were inconsistent, with only 39% of surgeons routinely performing them. Conclusions: The study provides valuable insights into current RFFF practices and outcomes across an international cohort of head and neck surgeons, highlighting patterns and variability in techniques, perioperative care, and monitoring strategies. Full article
(This article belongs to the Special Issue Advances in Minimally Invasive Otolaryngology: Precision Techniques and Functional Outcomes)
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14 pages, 686 KB  
Article
Submucosal Mitomycin C Injection in the Endoscopic Treatment of Laryngotracheal Stenosis: Experience of a Tertiary Center
by Elena Russo, Luca Canali, Luca Cerri, Giuseppe Mangiameli, Umberto Cariboni, Giuseppe Marulli, Giuseppe Spriano, Giorgio Maria Ferraroli and Armando De Virgilio
J. Clin. Med. 2025, 14(22), 8022; https://doi.org/10.3390/jcm14228022 - 12 Nov 2025
Cited by 1 | Viewed by 1587
Abstract
Background/Objectives: To assess the safety and efficacy of submucosal mitomycin C (MMC) injection as an adjunct in patients undergoing endoscopic treatment for laryngotracheal stenosis (LTS). Methods: All patients affected by LTS receiving endoscopic treatment with adjuvant MMC were screened and selected [...] Read more.
Background/Objectives: To assess the safety and efficacy of submucosal mitomycin C (MMC) injection as an adjunct in patients undergoing endoscopic treatment for laryngotracheal stenosis (LTS). Methods: All patients affected by LTS receiving endoscopic treatment with adjuvant MMC were screened and selected from a retrospective database spanning from May 2022 to July 2023 at IRCCS Humanitas Research Hospital (Rozzano, Italy). Demographic data, bronchoscopic findings, and treatment-related outcomes were recorded and analyzed. Results: A total of 16 patients were included in the study. Subglottic stenosis was the most common condition, occurring in 88.9% of cases. All procedures were completed safely without intraoperative or postoperative complications or conversion to open surgery. Re-stenosis occurred in 6 (37.5%) cases, with a median time to recurrence of 136.5 (±43.9) days, requiring additional treatments. At last follow-up, all included patients were asymptomatic, except for two who reported mild dyspnea. Conclusions: Submucosal MMC injections represent a safe and promising delivery method in the endoscopic treatment of LTS and may provide a more durable effect on the stenosis reducing the risk of recurrence. Further prospective studies are needed to evaluate MMC’s effectiveness and develop standardized treatment protocols. Full article
(This article belongs to the Special Issue Advances in Minimally Invasive Otolaryngology: Precision Techniques and Functional Outcomes)
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15 pages, 737 KB  
Systematic Review
Surgical Techniques and Materials Used in the Treatment of Complicated Otomastoiditis: A Systematic Review
by Maria Denisa Zica, Catalina Voiosu, Andreea Rusescu, Irina Ionita, Luana Maria Gherasie, Oana Ruxandra Alius, Alexandra Bizdu Branovici, Razvan Hainarosie and Viorel Zainea
J. Clin. Med. 2026, 15(10), 3911; https://doi.org/10.3390/jcm15103911 - 19 May 2026
Viewed by 587
Abstract
Background and Objectives: Complicated cholesteatomatous otomastoiditis includes a spectrum of inflammatory, suppurative, and destructive lesions affecting the temporal bone and surrounding critical structures, including the dura mater, labyrinth, facial nerve, sigmoid sinus, and skull base. The selection of appropriate surgical techniques and closure [...] Read more.
Background and Objectives: Complicated cholesteatomatous otomastoiditis includes a spectrum of inflammatory, suppurative, and destructive lesions affecting the temporal bone and surrounding critical structures, including the dura mater, labyrinth, facial nerve, sigmoid sinus, and skull base. The selection of appropriate surgical techniques and closure materials is decisive for long-term outcomes, functional preservation, and prevention of life-threatening complications. This systematic review and meta-analysis evaluates the evidence base for surgical approaches, intraoperative technologies, and autologous and synthetic closure materials used in the management of iatrogenic and disease-related fistulas in otomastoid surgery. Materials and Methods: A PRISMA 2020-compliant search was conducted across PubMed, Cochrane Library, Embase, and Scopus (2000–2024). The review was registered in PROSPERO (CRD420261370406). After the systematic screening process, 56 eligible studies involving 4218 patients were selected for inclusion. The primary outcome measures analysed were infection rates, fistula recurrence, preservation of function, and long-term integrity of the closure. Limitations include the predominance of observational studies and the absence of prospective registration prior to data extraction. Results: Autologous materials demonstrated consistently low infection rates (<10%) in contaminated operative fields and therefore remain the preferred first-line option for the reconstruction of small to moderate defects. In contrast, synthetic materials exhibited superior mechanical durability in large sterile defects, achieving closure integrity rates of 85–92% at two-year follow-up. Hybrid reconstructive constructs provided the most favourable overall outcomes, with pooled closure integrity reaching 91.6%, suggesting a synergistic advantage when combining biologic and synthetic components. Furthermore, the adjunctive use of combined microscopic–endoscopic surgical techniques was associated with a significant reduction in residual cholesteatoma rates (OR 0.56, 95% CI 0.38–0.82), supporting the growing role of endoscopic assistance in middle ear and mastoid surgery. When biologic closure strategies were appropriately selected according to defect characteristics and contamination status, functional preservation rates exceeded 90–95%, underscoring the importance of tailored reconstructive approaches. Conclusions: The durability of long-term outcomes is most strongly influenced by complete pathological clearance and by the strategic alignment of biomaterial properties with defect dimensions, contamination status, and surrounding anatomical structures. In response to these findings, an evidence-based algorithmic framework is proposed to facilitate rational intraoperative material selection. Full article
(This article belongs to the Special Issue Advances in Minimally Invasive Otolaryngology: Precision Techniques and Functional Outcomes)
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31 pages, 918 KB  
Systematic Review
The Evolving Role of the Endoscopic Endonasal Transplanum–Transtuberculum Approach in the Management of Craniopharyngiomas: A Systematic Review of Outcomes, Reconstruction, and Surgical Evolution
by Omar Alomari, Ali Ozan Yazıcı, Tuğçe Gültepe Zorlu, Aylin Ateş, Cem Çelik, Beyzanur Güney and Gulpembe Bozkurt
J. Clin. Med. 2026, 15(8), 3072; https://doi.org/10.3390/jcm15083072 - 17 Apr 2026
Viewed by 747
Abstract
Background: Craniopharyngiomas are histologically benign but clinically aggressive epithelial tumors that pose significant surgical challenges due to their proximity to the hypothalamic–pituitary axis. While traditional transcranial approaches are well-established, the endoscopic endonasal transplanum–transtuberculum approach (EETTA) has emerged as a specialized corridor offering direct [...] Read more.
Background: Craniopharyngiomas are histologically benign but clinically aggressive epithelial tumors that pose significant surgical challenges due to their proximity to the hypothalamic–pituitary axis. While traditional transcranial approaches are well-established, the endoscopic endonasal transplanum–transtuberculum approach (EETTA) has emerged as a specialized corridor offering direct midline access. This systematic review evaluates the surgical efficacy, functional outcomes, and complication profiles of the EETTA over two decades of clinical evolution. Methods: Following PRISMA guidelines, a systematic search was conducted across five databases. Eligible studies included patients of all ages undergoing EETTA for craniopharyngioma. Data on the extent of resection (EOR), visual and endocrine outcomes, and CSF leak rates were extracted. Quality was assessed using NIH/JBI tools, and evidence was graded via AANS/CNS criteria. Results: Fifty-one studies (677 patients) were included. The cohort had a mean age of 43.4 years and predominantly suprasellar tumors (mean diameter 2.9–4.0 cm). Gross total resection (GTR) was achieved in 66.4% of cases (364/548). Postoperative visual improvement was reported in 79.8% of patients, while 7.1% experienced deterioration. Endocrine morbidity remained significant, with 120 patients developing new-onset diabetes insipidus and 105 developing new anterior pituitary deficits. The pooled CSF leak rate was 9.2%, with contemporary series frequently reporting 0% due to advanced multilayer reconstruction with nasoseptal flaps. The pooled recurrence rate was 7.8% over a mean follow-up of 37.4 months. Conclusions: The EETTA is a safe and effective primary strategy for suprasellar and retrochiasmatic craniopharyngiomas, offering more favorable visual outcomes and resection rates in this specific cohort. While endocrine dysfunction remains a pervasive challenge inherent to the tumor’s location, technical refinements in skull base reconstruction have successfully addressed historical concerns regarding CSF leaks. These findings support the use of the EETTA at high-volume centers with multidisciplinary expertise. Full article
(This article belongs to the Special Issue Advances in Minimally Invasive Otolaryngology: Precision Techniques and Functional Outcomes)
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