SAMCEP Society consensus on the treatment of upper facial lines with botulinum neurotoxin type A: A tailored approach

BACKGROUND

The safety and efficacy of botulinum neurotoxin type A (BoNTA) treatments are well established, but injection techniques, target muscles, and toxin doses continue to evolve, with each refinement producing improvements in treatment outcomes. The recommendations in this consensus move away from standard templates and illustrate how to tailor treatments to individual patterns and strengths of muscle activity, and patient preferences.

METHODS

Seventeen experts in the fields of plastic surgery, dermatology, ophthalmology, otorhinolaryngology, and neurology convened in 2022 to develop consensus-based recommendations for the use of botulinum toxin A for the treatment of horizontal forehead lines, glabellar frown lines, and crow's feet lines that reflect current clinical practice. The focus was on how to tailor injections to individual patients to optimize treatment outcomes.

RESULTS

For each upper face indication, consensus members describe how to perform a dynamic assessment to optimize the dose and injection technique for each patient. A tailored treatment protocol is presented for commonly observed patterns of dynamic lines. Units of Inco are defined and the precise location of injection points, illustrated with the use of anatomical images.

CONCLUSION

This consensus provides up-to-date recommendations on the tailored treatment of upper facial lines based on the latest research and collective clinical experience of the expert injectors. Optimal outcomes require thorough patient evaluation, both at rest and during animation, using both visual and tactile cues; detailed understanding of facial muscular anatomy and how opposing muscles interact; and use of a BoNTA with high precision to target identified zones of excess muscle activity.

Hybrid quantum systems with high-T[Formula: see text] superconducting resonators

Superconducting microwave resonators are crucial elements of microwave circuits, offering a wide range of potential applications in modern science and technology. While conventional low-T[Formula: see text] superconductors are mainly employed, high-T[Formula: see text] cuprates could offer enhanced temperature and magnetic field operating ranges. Here, we report the realization of [Formula: see text] superconducting coplanar waveguide resonators, and demonstrate a continuous evolution from a lossy undercoupled regime, to a lossless overcoupled regime by adjusting the device geometry, in good agreement with circuit model theory. A high-quality factor resonator was then used to perform electron spin resonance measurements on a molecular spin ensemble across a temperature range spanning two decades. We observe spin-cavity hybridization indicating coherent coupling between the microwave field and the spins in a highly cooperative regime. The temperature dependence of the Rabi splitting and the spin relaxation time point toward an antiferromagnetic coupling of the spins below 2 K. Our findings indicate that high-Tc superconducting resonators hold great promise for the development of functional circuits. Additionally, they suggest novel approaches for achieving hybrid quantum systems based on high-T[Formula: see text] superconductors and for conducting electron spin resonance measurements over a wide range of magnetic fields and temperatures.

Complications associated with bone marrow sampling in dogs and cats

OBJECTIVES

To evaluate the prevalence of complications during bone marrow sampling and associated patient and procedural factors in dogs and cats.

MATERIALS AND METHODS

Retrospective cohort study, records were evaluated to identify dogs and cats that had bone marrow sampling between 2012 and 2019. Data including signalment, the presence of specific clinicopathological findings, anatomical site of bone marrow sampling, number of attempts, diagnostic quality of sampling, analgesia protocol and complications postprocedure were recorded.

RESULTS

A total of 131 dogs and 29 cats were included in the study. Complications were recorded in 22 of 160 (14%) of cases. Pain was the most common complication of bone marrow sampling in 20 of 22 (91%) of cases with bruising reported in the remaining patients. A local anaesthetic block was used in 98 of 160 (61%) of patients.

CLINICAL SIGNIFICANCE

Excluding pain, complications associated with bone marrow sampling were rare and no clear association were detected between patient or procedural variables. Haemorrhage and infection are rare complications in dogs and cats when thrombocytopenia and neutropenia are present. Peri-procedure analgesia is strongly recommended to minimise complications.

Phthalocyanine–titanate nanotubes: a promising nanocarrier detectable by optical imaging in the so-called imaging window

TiONts–phthalocyanine nanohybrids (150 nm long, 450 Pc per TiONts) combine an efficient optical probe and a promising nanovector. The organic coating was covalently attached onto TiONts in a step-by-step approach with a thorough characterization at each step.

Brain copper elevation and neurological changes in north ronaldsay sheep: a model for neurodegenerative disease?

This study in North Ronaldsay (NR) sheep showed that copper was elevated in both the liver and brain of older animals and that the elevation in these two sites was highly correlated. The accumulation of copper in the liver culminated in chronic active hepatitis. Evidence of tissue damage in the brain was equivocal, but the astrocytes showed strong immunoreactivity for metallothionein. The study suggested that the blood-brain barrier of NR sheep possesses unusual features in respect of the import of copper into the brain, and that NR sheep may provide a useful animal model for the investigation of brain copper homeostasis.

[Surgery of mucocele of the paranasal sinuses: report of 52 cases with a middle term follow up]

OBJECTIVE

To define indications and limitations of Functional Endoscopic Sinus Surgery (FESS) for mucoceles therapeutic management.

PATIENTS AND METHODS

52 cases of mucoceles were treated in our institution during the 8-year period 1993-2001. All patients underwent follow-up for a minimal period of 4 years, with a clinical (endoscopy) and imaging assessments, in order to diagnose recurrences.

OUTCOMES

Distribution of mucoceles location was: fronto-ethmoid sinus (25 cases), maxillary sinus (10 cases), anterior ethmoid sinus (3 cases), posterior ethmoid sinus (8 cases), sphenoid sinus (4 cases) and nasal cavity (2 cases). Thirty eight patients had undergone a nasal (1 septoplasty, 2 rhinoplasties) or sinusal surgery in their history. Recurrences were reported in 2 cases (3.8%). These 2 patients presented primarily with nasal polyps (nasal polyposis or cystic fibrosis) and both recurrences involved fronto-ethmoid sinuses.

DISCUSSION AND CONCLUSION

Mucoceles involve quite commonly the maxillary sinus and the frontoethmoid sinus. Exclusive FESS with large opening of the mucocele (marsupialization) is an efficient therapeutic procedure. FESS procedure should be a procedure of first choice for mucocele management as it is highly efficient and has a low morbidity. Nevertheless, latero-frontal sinus mucoceles might be difficult to cure with FESS. Recurrences most likely occur in patients with associated ethmoidal inflammatory diseases.

[The frontal pneumosinus dilatans: surgical management by modelling osteoplasty]

Pneumosinus dilatans is a rare disease that most commonly occurs in young men. It is characterized by an hyperpneumatization of sinus cavities. Its etiopathogenis remains unclear. The bony and mucosal structures are normal and there is no sinus disorders associated with. Most of patients with pneumosinus dilatans present with a cosmetic complaint.

CASE REPORT

We report a new surgical technique performed in a young male with bilateral frontal pneumosinus dilatans. A Bi-coronal incision makes it possible to largely expose the anterior wall of the frontal sinus. This wall is then weakened by drilling which should not be transfixiant. A soft impaction of the weakened wall of the sinus, by avoiding any effraction of the sinusal mucous membrane allows a reduction in volume of the frontal sinus with disappearance of the sus-orbital tumefaction. Cosmetic and functional outcomes, 18 months after surgery are good and stable.

CONCLUSION

This technique of impaction, without sinusal bone window nor osteosynthesis or bone grafting, preserves the integrity of the sinusal mucous membrane while guaranteeing a good cosmetic result.

[Aesthetic parotidectomy: face lift incision and SMAS flap]

INTRODUCTION

Traditional parotidectomy skin incision (bayonet-shaped incision) is adapted from an extirpative standpoint but not ideal cosmetically. There are three main drawbacks: Scar, retro-mandibular depression and Frey syndrome. The goal of this prospective study was to evaluate the feasibility of this facial incision for extirpative purposes and to define the clinical benefit in terms of scar and retromandibular depression.

METHOD

Ten patients with parotid tumors were included during the period 2005-2006. All patients had benign tumours: 5 males and 5 females. Mean age was 49 yrs. (42-67). Investigated parameters were: "retromandibular depression", "skin scar" and "Frey syndrome". Analogic visual satisfaction scale (1-10) was used by patients to assess these data postoperatively at 15 days, 1 month and 6 months.

RESULTS

This face lift approach allowed very good surgical exposure not only of the parotid area but the posterior submandibular region and over the sternocleidomastoid muscle. Postoperative lateral facial contour was symmetric and good in all cases. Six patients assessed this parameter 8/10 and 4 assessed 10/10. After removal of stitches the facial skin scar was considered good in 100% of cases. Six patients assed this parameter 9/10 and 4 assessed 10/10. No Frey syndrome was reported by any patients within 16 months postoperatively.

CONCLUSION

Association of a face skin lift approach and a SMAS flap yields a very good cosmetic outcome after surgical parotidectomy. As aesthetic considerations are obvious in breast surgery, aesthetic considerations have a great place in parotid and head and neck surgery.

[Remodeling of the nasal lobule using cartilaginous grafts on tip projection]

OBJECTIVES

Nasal tip projetion and definition are essential parameters which should be considered in the preoperative rhinoplasty plan. Jonhson and Toriumi have defined a technique of rhinoplasty to restructure the lobule using columellar strut and tip grafts. The aim of this study was to define the influence of this procedure on nasal tip projection, using the Goode method (objective measurement of the tip projection).

METHODS

Forty patients underwent primary rhinoplasty, by open approach, with remodeling of the lobule using cartilagenous grafts, according to Jonhson and Torium technique. Goode ratio was calculated to assess tip projection preoperatively and postoperatively, based on photographic analysis. Moreover, postoperatively, all patients were clinically evaluated at 2, 4 and 6 months, and based on photographs of face at 2 and 6 months.

RESULTS

Five hypoprojected preoperative nasal tips (Goode ratio (GR): 0,45 to 0,51) had a normal nasal tip projection postoperatively (GR: 0,55 to 0,59). Among the eight normal projected preoperative nasal tips (GR: 0,56 to 0,60), six had a normal postoperative nasal tip projection while two showed a hyperprojection (GR: 0,62 and 0,63). Among the 27 hyperprojected preoperative nasal tips (GR: 0,62 to 0,75), 17 showed a normal projection of the nasal tip postoperatively while 10 remained hyperprojected despite a decreased Goode ratio.

CONCLUSION

Restructuration of the lobule, using cartilagenous grafts, is a reliable and reproducible technique allowing satisfying aesthetic results and objective measurements of the changes in nasal tip projection using the Goode method.

Intérêt de la TEP au 18FDG couplée à la TDM dans la surveillance post-thérapeutiquedes carcinomes épidermoïdesdes voies aérodigestives supérieures

OBJECTIVE

To evaluate the contribution of 18FDG positron emission tomography for the post treatment surveillance of head and neck carcinomas.

METHODS

: This prospective study included 61 patients with advanced squamous cell carcinoma of the upper airways and/or digestive tract and who underwent curative treatment. Patients underwent a standard workup (physical examination, CT scan and panendoscopy) and a PET/CT image fusion 3 months after the end of treatment. The follow-up was 6 months minimum in all patients after this workup. PET/CT was evaluated in terms of: primary tumor, cervical lymph nodes, metastases and overall patient assessment.

RESULTS

: For diagnosis of the primary tumor, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of PET/CT were respectively 86.7%, 82.6%, 62%, 95% and 83.6%. Values for cervical lymph nodes were: 100%, 98.2%, 80%, 100% and 98.3%. Values for metastases were: 100%, 92.2%, 66.7%, 100% and 93.2%. Values for overall patient assessment were: 88.8%, 78.1%, 64%, 94.1% and 81.4%. Performances of PET/CT were better than standard workup in 22% of patients.

CONCLUSION

PET/CT contributes useful information in this indication, particularly an excellent negative predictive value.

Cervical paragangliomas: neurovascular surgical risk and therapeutic management

Paragangliomas of the neck region arise most commonly in the carotid and vagal bodies. The goal of this retrospective study is to evaluate intraoperative vascular and neurological morbidity and to define the therapeutic strategy. During the period 1990-2004, 32 patients with 42 neck paragangliomas were referred to our institution (Head and Neck Service, Otolaryngology Federation, CHU La Timone, Marseilles, France). There were 29 carotid body tumors and 11 vagal body tumors. There were 14 men and 18 women. Forty paragangliomas were surgically excised. Mean age of patients with family history of paragangliomas was 34 years and that of patients without any familial history was 47 years. Only one patient had a malignant paraganglioma. A vascular repair procedure was performed in 10% and always occurred in carotid body tumors including the malignant one. Postoperative hypoglossal nerve deficit was reported in five cases (12.5%). Paralysis of vagus nerve was reported in 11 cases (27.5%), nine of whom were patients with vagal body tumors. Knowledge of number of paragangliomas and their location is of main importance and influences the therapeutic strategy. The goal of this strategy is to avoid major neurovascular morbidity and to optimize treatment of multiple or bilateral tumors. Early management of patients prevents progressive neurological deficit due to an enlarging tumor mass and minimizes neurovascular complications.

[Contribution of 18-F-FDG PET for detection of head and neck carcinomas with an unknown primary tumor]

OBJECTIVES

To evaluate the usefulness of fusioning positron emission tomography with computed tomography (PET/CT) for the detection of head and neck carcinomas of unknown primary.

METHODS

This prospective study included 20 patients with cervical lymph node of squamous cell carcinoma of unknown primary after standard initial workup (nasofibroscopy and CT scan of the chest and head and neck). Patients underwent PET/CT and panendoscopy of the upper airways and upper digestive tract with PET/CT directed biopsies. The follow-up was 6 months minimum in all patients.

RESULTS

A potential primary tumor was found in 10 of the 20 cases and confirmed by histology in 7 cases (3 bases of tongue, 1 tonsillar pillar, 1 vallecula, 1 tonsillar fossa, 1 piriform sinus). Four of these seven patients presented a normal endoscopy (diagnosis was made with submucosal PET/CT directed biopsies). PET/CT was normal in 10 of 20 cases with 3 false negatives. The sensitivity of PET/CT was 70%, the specificity was 70% and the accuracy was 70%.

CONCLUSION

PET/CT seems to be of interest in the detection of head and neck carcinoma of unknown primary. PET/CT detected 15% of unknown primary tumors with treatment-related implications.

Polymeric nano/microcapsules of liquid perfluorocarbons for ultrasonic imaging: physical characterization

Ultrasonic imaging is a widely available, noninvasive, and cost-effective diagnostic modality, but vessels smaller than 200 mum in diameter are impossible to visualize. Commercial ultrasound contrast agents (UCAs), consisting of encapsulated gas microbubbles injected intravenously, enable only a qualitative visualization of the microvascularization for a short period of time since they are rather unstable. In a strategy to develop more stable UCAs, we designed a process to obtain nano/microcapsules with a single core of liquid perfluorocarbons within a biodegradable polymeric shell of homogeneous thickness. The polymer shell should improve the stability of the capsules as compared to UCAs stabilized by a monomolecular layer, while the acoustic impedance of the perfluorocarbons should ensure their echogenicity. These capsules have been optimized to encapsulate several liquid perfluorocarbons: perfluorohexane, perfluorodecalin, and perfluorooctyl bromide. The system is rather versatile: the mean size of the capsules can be adjusted between 70 nm and 25 microm and the thickness-to-radius ratio (T/R) can be easily modulated by simply modifying the polymer-to-perfluorocarbon ratio. T/R does not depend on the size of the capsules and is between 0.2 and 0.6. The dependence of the echogenic properties of the capsules with their size and their T/R has yet to be studied experimentally before this system can be evaluated in vivo.

Personality traits as correlates of suicidal ideation, suicide attempts, and suicide completions: a systematic review

OBJECTIVE

Involvement of personality traits in susceptibility to suicidality has been the subject of research since the 1950s. Because of the diversity of conceptual and methodological approaches, the extent of their independent contribution has been difficult to establish. Here, we review conceptual background and empirical evidence investigating roles of traits in suicidal behaviors.

METHOD

We selected original studies published in English in MEDLINE and PsycINFO databases, focusing on suicidal ideation, suicide attempts, or suicide completions, and using standardized personality measures.

RESULTS

Most studies focused on investigating risk for suicide attempts. Hopelessness, neuroticism, and extroversion hold the most promise in relation to risk screening across all three suicidal behaviors. More research is needed regarding aggression, impulsivity, anger, irritability, hostility, and anxiety.

CONCLUSION

Selected personality traits may be useful markers of suicide risk. Future research needs to establish their contributions in relation to environmental and genetic variation in different gender, age, and ethnocultural groups.

[Facial paralysis: functional and aesthetic rehabilitation techniques]

The diagnosis of a permanent facial paralysis can be devastating to a patient, because of the cosmetic, functional and psychological disorders. Our society places on physical appearance and leads to isolation of patients who are embarrassed with their paralyzed face. The objectives of the facial rehabilitation is to correct the functional and cosmetic losses of the patient. The main functional goals are to protect the eye and reestablish oral competence. The primary cosmetic goals are to create balance and symmetry of the face at rest and to reestablish the coordinated movement of the facial musculature. The surgeon should be familiar with the variety of options available so that an individual plan can be developed based on each patient's clinical picture. History of the facial paralysis, its etiology and the duration of the paralysis are of particular interest as they orientate the rehabilitation plan strategy.

[Sinonasal hemangiopericytoma: a case report]

OBJECTIVE

To define clinical, histological and radiological features of sinonasal hemangiopericytoma (SNHPC) and to describe its therapeutic management.

PATIENTS AND METHODS

A case of SNHPC (47 year old man) of the left nasal cavity underwent endoscopic sinus surgery at our institution. This case is reported and discussed with a review of the literature.

DISCUSSION

SNHPC is a low grade malignant vascular tumour. The intra-nasal location is very rare. This unusual tumour of the nasal cavity has a specific clinical behaviour and prognosis. Diagnosis is confirmed by histological studies with immunohistochemical methods. Vimentin and SMA markers are reported positive in 98% and 92% of cases, respectively. Work up includes MRI and CT scan in order to assess the tumour extent. Angiography is useful to assess the vascularization and preoperative embolization reduces the intra-operative bleeding of large tumours. The gold standard treatment is surgery and the aim is to perform a wide excision with tumour free margins. Surgery can be performed by endoscopic techniques in patients without extra-nasal extension. Radiotherapy is advised for cases of suspect or positive margins. Post-treatment follow up focuses on lifelong endoscopic surveillance. Metastases are rare but recurrences can occur many years postoperatively. The treatment of recurrence is also surgical.

[Papillary thyroid carcinoma metastasis to parapharyngeal lymph nodes: interest of the PET scan]

Thyroid cancer rarely metastasizes to the parapharyngeal space. A inconsistent lymphatic drainage pathway is involved, as described by Rouvière.

OBJECTIVES

To demonstrate the interest of [18 F]-FDG PET in early diagnosis of metastasis and in the follow up of the patient.

MATERIAL AND METHOD

40 y.o. male with papillary carcinoma who had a secondary parapharyngeal metastasis. The diagnosis of recurrence was difficult, as the plasmatic thyglobulin was low, and the iodine scan was not informative. In this case, [18 F]-FDG PET-CT was informative (clear parapharyngeal fixation) and led to the diagnosis of recurrence.

CONCLUSION

It appears that 18F FDG PET has a good diagnostic value and that its sensitivity is better than CT scan and MRI. Some authors recommend the use of [18 F]-FDG PET and scintigraphy with Iodine 131 to screen patients with thyroid cancer recurrences.

[Saddle nose surgery: long term aesthetic outcomes of support grafts]

Saddle nose surgery requires support grafts to improve the aesthestic of the nose such as the functional ventilation. Many kind of graft are available: Calvarial bone graft, iliac crest, septal cartilage, conchal cartilage, nasal hump, bony inferior turbinate.

OBJECTIVES

To define the surgical strategy and long term aesthetic outcomes of rhinoplasty with support graft for saddle nose correction.

MATERIAL AND METHOD

Retrospective study during the period 1985-2005: 160 patients underwent rhinoplasty with support graft for saddle nose correction. Patients were divided into 3 groups depending on the deformation (group I: Minor saddle nose; group II: Intermediate saddle nose; group III: Major saddle nose). Long term results were analysed at least 5 years after surgery, in 70 patients.

RESULTS

An intranasal approach was performed in 92 cases, while an open approach was performed in 68 cases. A bony support graft was used in 85% of patients of group II and 94% of patients of group III. These grafts allowed a more rigid correction of the saddle nose than cartilage. For groups II and III patients, cartilage support grafts were not used because of the lack of quantity to correct the saddle nose.

CONCLUSION

Calvarial bone support graft has a great role in saddle nose surgery. The postoperative aesthetic outcomes are interesting and its absorption is low.

Microvascular radial forearm fasciocutaneous free flap in hard palate reconstruction

THE AIM OF THIS STUDY

To report the reconstruction of palatal defects by microvascular radial forearm fasciocutaneous free flap (RFFF) and to report patient's quality of life outcomes after this procedure.

MATERIAL AND METHODS

During the period 1990-2002, 30 cases of palatal defects were reconstructed using RFFF in our institution. RFFF allowed restoration of a vestibular sulcus to maintain dental prostheses. Outcome measurements included post-operative assessment of speech, swallowing and diet evaluation 6 months, 1 year and 2 years after reconstruction. Quality of life outcomes were measured 1 and 2 years post-reconstruction.

RESULTS

RFFF surgery was successful in 28 cases. Six months after resection 28 patients reported satisfactory speech and swallowing. Two years after surgery, 92% (n=26) of patients resumed a normal diet. All patients underwent dental evaluation and 68% (n=19) of patients required dental rehabilitation over a post-operative period of 3-18 months. Patients self assessed their quality of life on a scale of 0-2. First year post-operatively, 21 patients reported a good quality of life (score=2). After the second year, 26 patients reported a good quality of life and the remaining two patients reported an intermediate quality of life (score=1) because they did not resume a normal diet.

CONCLUSION

RFFF for palatal reconstruction is a reliable technique and provides a definitive separation between oral and sinusonasal cavities. Furthermore, it improves quality of life by improving speech, swallowing and chewing. It should be considered an integral component of head and neck cancer therapy and rehabilitation.

[Antrochoanal polyps: diagnosis and management]

Antrochonal polyp is a unilateral and benign tumor of the maxillary sinus occurring in children. Its physiopathology remains unclear. Nasal presenting symptoms are unilateral obstruction and nasal discharge. In rare cases, presenting symptoms may be atypical. Radiographic examination with CT-scan and more rarely MRI helps the diagnosis. Surgery remains the mainstay of treatment and the endoscopic approach should be used in first intention. Double maxillary meatotomy by endoscopic approach procures a good exposure and permits a complete resection of the pedicle of the polyp. The insertion of the pedicule should be coagulated. In cases with recurrence or in cases of incomplete resection, an external approach (Caldwell-Luc) should be preferred.

Cancers primitifs de la parotide : approche anatomo-clinique

BACKGROUND

Carcinoma of the parotid gland presents a wide variety of clinical presentations, behaviors and prognoses. The aim of this study was to define the characteristic clinical presentations and the prognostic factors of these tumors.

MATERIAL AND METHOD

Sixty-six patients with carcinoma of the parotid gland seeing during the 1985-2003 period were included in this study. Mean patient age was 55 years; the sex-ratio was 1.

RESULTS

The most common histological types of this series were mucoepidermoid carcinoma and adenoid cystic carcinoma. Stage I tumors were reported in 59% the series while only 18% the patients of this series had stage III and IV disease. Pain was reported in 45% all patients. Facial nerve clinical involvement was reported in 11% all patients.

DISCUSSION

Both tumoral stage and histological grading are independent prognostic factors influencing the therapeutic strategy. Clinical course and tumor growth distinguished between malignant tumors with benign clinical behavior and malignant tumors with malignant clinical behavior. A preoperative workup with physical examination, fine needle cytology and MRI helps to define the preoperative diagnostic and to adapt the therapeutic strategy.

[A case of nasal septum schwannoma: endoscopic resection]

OBJECTIVES

To define clinical and radiological characteristics of nasal septal schwannoma, and to propose endoscopic surgery.

PATIENT AND METHODS

We report a case of an isolated schwannoma of the anterior part of the nasal septum, without involvement of any local structure. The only preoperative symptom was nasal obstruction. Imaging study included a CT scan and an MRI study.

RESULTS

Schwannoma is a sheath tumor originating from Schwann cells of peripheral nerves. It rarely occurs in nasal and paranasal sinuses and its development on the nasal septum is extremely rare. Complete removal of the tumor was performed by endoscopic sinus surgery technique. Limits of the excision were free of tumor and the histological type was Antoni type A Schwannoma. After a year of follow up, the patient is free of recurrence.

CONCLUSION

The Schwannoma of the nasal septum is a rare tumour whose clinical and radiological diagnosis by CT scan and IRM is relatively easy. Its treatment is surgical and the endoscopic surgery can be proposed in the forms slightly extensive.

Adénome pléomorphe parotidien

OBJECTIVES

Capsular ruptures play a major role in recurrences of parotid pleomorphic adenomas. The aim of this retrospective study was to define histomorphological characteristics of pleomorphic adenoma in order to define possible recurrence mechanisms and to set a clear surgical management.

MATERIAL AND METHOD

Histological study was performed after reviewing of slides originating from 100 patients with pleomorphic adenomas of the parotid gland. These patients were treated in our institution during the period May 1992 - November 2002.

RESULTS

The studied population was distributed into 3 histological subtypes for better analysis. Hypocellular (stroma rich) pleomorphic adenoma was reported in 56%, hypercellular pleomorphic adenoma was reported in 29% and "classic" in 15%. Thinness of capsule was significantly related to hypocellularity. Pseudopodias and satellite nodules were reported in 72% of this series.

CONCLUSION

Due to capsular characteristics, surgical excision should avoid dissection in the vicinity of the tumor in order to avoid capsular bare area, so minimizing the risk of surgical induced recurrence. According to these findings, enucleation surgery for pleomorphic adenoma should not be performed anymore. Parotidectomy techniques (total or lateral) constitute the surgical procedures of choice.

Preoperative diagnostic values of fine-needle cytology and MRI in parotid gland tumors

The aim of this retrospective study was to assess and compare the diagnostic value of fine-needle cytology and MRI for the prediction of malignancy in parotid tumors. During an 11-year period, 148 patients underwent preoperative fine-needle aspiration cytology in our institution. Eighty-seven patients underwent a preoperative MRI study, and 54 had both MRI and cytology. The study compares results of cytology and MRI with histological reports. The sensitivity, specificity and accuracy for detecting malignant lesions were 87, 94 and 93% respectively for MRI, 81, 95 and 92% respectively for cytology and 100, 88 and 91% respectively for both studies combined. Fine-needle cytology provided better information than MRI concerning precise histological diagnoses. Conversely, the proportion of non-diagnostic smears reached 10%. Fine-needle cytology and MRI are simple, well-tolerated diagnostic means with an impact on the management of salivary gland tumors. The associated anatomic information obtained by MRI imaging makes it the test of first choice in an optimal medical environment.

[Recurrences of pleomorphic adenomas of the parotid: development of concepts]

OBJECTIVES

The aim of this study was to examine the surgical and pathological factors that led to recurrent parotid pleomorphic adenomas. The study also tried to determine best practice for the treatment of recurrence. In addition the study looked at the correlation between fine needle cytology and definitive histology.

MATERIAL AND METHOD

Histological study was undertaken on 100 pleomorphic adenomas surgically removed from patients in our institution between 1992 and 2002. Study of diagnostic value of fine needle cytology aspiration and MRI for pleomorphic adenoma diagnosis was performed in 181 patients operated on for parotid tumors.

RESULTS

Hypocellular pleomorphic adenomas often have a thin capsule and constitute the most frequently encountered histological type in recurrence. Pseudopodias are considered as an additional factor in recurrence. In our series, cytological study had an excellent diagnostic value with a sensitivity of 92% and a PPV of 96%. MRI study had a sensitivity of 83% and a PPV of 89%.

CONCLUSIONS

According to these findings, enucleation surgery on a pleomorphic adenoma should not be performed anymore. Parotidectomy techniques (total or lateral) constitute the surgical treatment of choice. Fine needle aspirate cystology in a useful diagnostic procedure. Management of recurrences is based on surgery with total parotidectomy and facial nerve preservation. Role of radiotherapy is still indeterminate.

[Diagnosis management of Warthin tumour: clinical presentation, fine needle cytology and MRI]

OBJECTIVES

Warthin tumour is the second most frequent benign tumour of the parotid gland after pleomorphic adenoma. The aim of this retrospective study was to define clinical, cytological and MRI characteristics in order to work out a therapeutic strategy.

MATERIAL AND METHOD

During the period May 1991-January 2003, 53 patients with Warthin tumors were treated in our institution. Clinical data were reported from medical records reviewing. Histological diagnoses were compared with FNAB and MRI results.

RESULTS

Warthin tumours represented 13% of all parotid lesions of our series. Mean age of patients was 58 year-old. Sex ratio was 3.8 men and 1 woman. Sensitivity of FNAB for Warthin tumour diagnosis was 75% while positive predictive value was 71%. Six cases of false positive patients were reported: 2 acinic cells carcinomas, 2 pleomorphic adenomas, 1 dermoid cyst, 1 branchial cyst.

CONCLUSIONS

Surgical management is based on partial parotidectomy that may be adapted to the tumour location. Because of elderly patients, benign nature and low risk of malignant transformation of Warthin tumours, one might prompt to adopt a conservative strategy, avoiding surgery in some cases. Despite diagnosis of Whartin tumour on FNAB and MRI, one must be cautious in recommending conservative treatment in order to avoid ignoring a surgical tumour.