The French way of voice rehabilitation post total laryngectomy: current clinical practices and tendencies

BACKGROUND

Vocal rehabilitation post total laryngectomy (TL) lacks clinical guidelines, especially with the presence of multiple modalities.

OBJECTIVES

To describe the tendencies of vocal rehabilitation post TL in France and compare it with other countries. We try to identify the most practiced modalities and recognize statistically significant influencing factors.

MATERIALS AND METHODS

An electronic anonymous survey was answered by 75 ENT surgeons from France. The survey outlined the common practiced vocal rehabilitation modalities and had two versions depending on if the participant practices the tracheoesophageal speech (TES) or not.

RESULTS

96% use TES in their practice. Single modality TES and double modality TES with esophageal speech (ES) are the two most practiced modalities. 99% agreed that there is no age limit for the TES. Single modality ES was offered 92% more when more than 10 TL were performed per year (p < .05). No influencing factors found for single modality TES or double modality TES with ES (p > .05).Conclusion: In line with tendencies from other countries, the TES is the most practiced modality of vocal rehabilitation coupled or not with the ES. TES has no age limit as per our participants. The least practiced modality is the singe modality ALS.

Characterization of human oxidoreductases involved in aldehyde odorant metabolism

Oxidoreductases are major enzymes of xenobiotic metabolism. Consequently, they are essential in the chemoprotection of the human body. Many xenobiotic metabolism enzymes have been shown to be involved in chemosensory tissue protection. Among them, some were additionally shown to be involved in chemosensory perception, acting in signal termination as well as in the generation of metabolites that change the activation pattern of chemosensory receptors. Oxidoreductases, especially aldehyde dehydrogenases and aldo-keto reductases, are the first barrier against aldehyde compounds, which include numerous odorants. Using a mass spectrometry approach, we characterized the most highly expressed members of these families in the human nasal mucus sampled in the olfactory vicinity. Their expression was also demonstrated using immunohistochemistry in human epitheliums sampled in the olfactory vicinity. Recombinant enzymes corresponding to three highly expressed human oxidoreductases (ALDH1A1, ALDH3A1, AKR1B10) were used to demonstrate the high enzymatic activity of these enzymes toward aldehyde odorants. The structure‒function relationship set based on the enzymatic parameters characterization of a series of aldehyde odorant compounds was supported by the X-ray structure resolution of human ALDH3A1 in complex with octanal.

Nasal Odorant Competitive Metabolism Is Involved in the Human Olfactory Process

Within the peripheral olfactory process, odorant metabolizing enzymes are involved in the active biotransformation of odorants, thus influencing the intensity and quality of the signal, but little evidence exists in humans. Here, we characterized the fast nasal metabolism of the food aroma pentane-2,3-dione in vivo and identified two resulting metabolites in the nasal-exhaled air, supporting the metabolizing role of the dicarbonyl/l-xylulose reductase. We showed in vitro, using the recombinant enzyme, that pentane-2,3-dione metabolism was inhibited by a second odorant (e.g., butanoic acid) according to an odorant-odorant competitive metabolic mechanism. Hypothesizing that such mechanism exists in vivo, pentane-2,3-dione, presented with a competitive odorant, both at subthreshold concentrations, was actually significantly perceived, suggesting an increase in its nasal availability. Our results, suggesting that odorant metabolizing enzymes can balance the relative detection of odorants in a mixture, in turn influencing the intensity of the signal, should be considered to better manage flavor perception in food.

Salvage total glossectomy and total glosso-laryngectomy: Are they worth it? A GETTEC French multicenter study

BACKGROUND

Salvage total glossectomy (TG) or total glosso-laryngectomy (TGL) remain controversial, as highly morbid procedures. The objective was to describe oncological and functional outcomes after salvage TG or TGL.

METHODS

We performed a multicenter retrospective study, including patients with previous neck irradiation undergoing TG or TGL for squamous cell carcinoma involving the base of tongue.

RESULTS

We included 42 patients: 27 in the TG group and 15 in the TGL group. For the entire cohort, median OS and DFS were estimated at 19 months (95% IC [14-44]) and 10 months (95% IC [7-13]) respectively, with no difference between the two groups. After a median follow-up of 90 months, 10 patients (24%) were alive and free of disease. Att he end of follow-up, we noted a gastrostomy dependency of 89% and 87 %respectively in the TG and TGL group, and 48% of patients in the TG group had a tracheotomy.

CONCLUSION

Although local control is difficult to achieve after salvage TG or TGL, these procedures are associated with acceptable survival and chance of cure for a last-resort situation. TG and TGL can be proposed in selected motivated patients after careful shared decision-making.

Oral tongue squamous cell carcinomas in young patients according to their smoking status: a GETTEC study

BACKGROUND

Incidence of oral tongue squamous cell carcinoma (OTSCC) is increasing, especially in young adults, despite decreasing tobacco and alcohol consumption.

METHODS

This multicentric retrospective study of 185 young adults with OTSCC (median follow-up 43 months), investigated risk factors, tumour characteristics and oncological outcomes according to the smoking status.

RESULTS

Overall, 38% of patients were smokers (S). Non-smokers (NS) were significantly younger than S. Sex ratios were 1.1 for N and 1.8 for S. NS patients were less frequently cannabis or alcohol users than S, but were more likely to have a history of leukoplakia. Second primaries were observed in NS (4.4%) and in S (12.7%). Despite more frequent local relapse in NS (p = 0.018), there was no difference in diagnostic stage and overall survival between groups.

CONCLUSION

OTSCC affects differently young S and NS patients suggesting the existence of a specific clinical entity of OTSCC in non-smoking young adults.

Evaluation of the quality of the information received during head and neck cancer announcement: Prospective two-center study

BACKGROUND

Providing patient with cancer with appropriate information following the disclosure of a cancer diagnosis has multiple benefits. The objective was to evaluate the quality of the information received during an announcement for head and neck cancer and to determine predictive factors.

METHODS

We conducted a prospective two-center study using self-questionnaires to assess the patient's perception of the quality of the announcement.

RESULTS

Satisfaction scores on the information provided about the overall disease were 7.7/10. The main positive predictors of quality were a satisfactory consultation setting (P = .004), assessment of pain by a physician (P = .04), physician availability (P = .003), accurate information about tumor stage, quality of information regarding the type (P < .0001) and purpose (P = .001) of treatment and its side effects (P = .006), and the interview with the oncology nurse coordinator (P < .05).

CONCLUSIONS

Patients who received the announcement of head and neck cancer perceived the information received during the pretherapeutic period as satisfactory.

Gangrenous cervicofacial cellulitis from odontogenic infection: two clinical cases

Introduction: Cervicofacial cellulitis resulting from common odontogenic infections is rare but serious, with life-threatening complications and potential general or local complications. Observation: Two cases are discussed here. The first observed case concerned a 32-year-old patient, affected by gangrenous cellulitis, following the avulsion of teeth number 38. The second observed case was of a chronic periapical infection being left untreated. The urgency of these two cases required the coordination of medical and surgical specialist teams to ensure a stable and successful treatment, involving surgical treatment, drug therapy, and reanimation. Discussion: The inadequate treatment or chronic dental infections, associated with immunosuppression and some cofactors (tobacco, alcohol, drugs, pregnancy, etc.), can lead to severe case of cellulitis. Medical and surgical management should be carried out as soon as possible to prevent the onset of serious complications such as mediastinitis, septic shock, and thrombophlebitis.

Impact of waiting time on nodal staging in head and neck squamous-cell carcinoma treated with radical intensity modulated radiotherapy

BACKGROUND AND PURPOSE

To evaluate the influence of delays for radiotherapy on survival, recurrence and upstaging for head and neck squamous-cell carcinoma (HNSCC) with no nodal involvement treated with intensity modulated radiotherapy (IMRT).

MATERIAL AND METHODS

This retrospective study included 63 consecutive patients with HNSCC located in the pharynx and larynx and treated with exclusive IMRT with or without chemotherapy. Survival, loco-regional or distant failure and upstaging were analyzed according to the waiting time.

RESULTS

Mean waiting time for treatment was 62.5 days for the hypopharynx subgroup (range = 37-102), 63 days for the larynx subgroup (range = 19-128) and 58.5 days for the oropharynx subgroup (range = 29-99) (p = 0.725). Nine patients (14%) experienced upstaging. Loco-regional or distant failure occurred in 18 patients. Beyond a delay of 50 days, 19% of patients had local failure, 17% nodal recurrence and 11% distant failure. Within a delay of 50 days, no nodal or distant failure was observed and only 1 patient experienced local recurrence. Upstaging and overall survival were not significantly affected by an increased waiting time.

CONCLUSION

For N0 patients treated with IMRT for HNSCC, waiting time around 50 days after the diagnosis was not significantly associated with an excessive risk of upstaging or recurrence.

A multi-generational study on low-dose BPA exposure in Wistar rats: effects on maternal behavior, flavor intake and development

Bisphenol A (BPA) is a common endocrine disruptor found as an environmental and food contaminant. It exerts both developmental and behavioral effects, mainly when exposure occurs in early life. The aim of this study was to determine the multi-generational effects of chronic, human-relevant low-dose exposure to BPA on development, maternal behavior and flavor preference in Wistar rats. BPA was orally administered at a daily dose of 5 μg/kg body weight to F0 pregnant dams from the first day of gestation (GD 1) until the last day of lactation (LD 21), and then to F1 offspring from weaning (PND 21) to adulthood (PND 100). F2 offspring were not exposed. Development and clinical signs of toxicity were assessed daily. Maternal behavior was evaluated by observing nursing and pup-caring actions, as well as "non-maternal" behaviors in F0 and F1 dams from parturition until LD 8. The flavor preferences of F1 and F2 offspring were evaluated based on the intake of sweet, salt and fat solutions using the two-bottle choice test on PND 21-34 and PND 86-99. BPA exposure: 1) decreased maternal behavior in F1 dams, 2) caused developmental defects in both F1 and F2 offspring, with a noticeable decrease in anogenital distance in male rats, and 3) did not affect flavored solution intake in F1, but induced changes in sweet preference in F2 juveniles and in salt and fat solution intakes in F2 adults, and 4) induced a body weight increase in the F2 generation only, whereas food intake and water consumption did not change. Taken as a whole, our findings showed that both gestational (F0) and lifelong (F1) exposures to a human-relevant dose of BPA could induce multi-generational effects on both development and behavior. These results suggest possible selective neuroendocrine defects and/or epigenetic changes caused by BPA exposure.

[Management of cervical cellulitis with and without mediastinal extension: report of 17 cases]

OBJECTIVES

Cervical cellulitis is infrequent but serious. The aim of our study was to describe the way we care and to identify certain factors that promote the development of such a condition.

PATIENTS AND METHODS

We conducted a retrospective study covering the period 2004 to 2009 and included patients with cervical cellulitis with or without mediastinal extension surgically supported by ENT department of the University Hospital of Dijon. Data were collected clinical, radiological, treatment, type of surgery and complications.

RESULTS

Seventeen patients met our inclusion criteria, four of which had a form associated with mediastinitis. Eight patients had taken NSAIDs and/or corticosteroids and fifteen patients antibiotics before their hospitalization. All have benefited from surgery with an average of 1.35 interventions (range 1 to 3) and support postoperative resuscitation. In both cases the outcome was unfavourable.

CONCLUSION

The use of NSAIDs and/or corticosteroids was a factor in promoting this type of infection. In the context of surgical treatment, it does not seem necessary to surgically reoperate systematically.

[Partial allotransplantation of the face including the mandible: a feasibility study]

OBJECTIVE

Facial grafts are useful in that they allow the repair of severe facial defects in one step in contrast to the actual available techniques which require staged procedures with limited cosmetic and functional results. The aim of our study was to determine whether it would be possible to include part of the mandible in a partial allotransplant of the face.

MATERIAL AND METHODS

An anatomical study on the arterial and venous vascularisation of the face and the mandible was performed on 7 heads. Then nine heads were used to describe an anatomical model of harvesting two-thirds of the lower face.

RESULTS

The study determined that a graft could be viable with a facial artery, inferior dental artery and two veins facial. Thus, a reliable method for harvesting hemi-mandible and total mandible is developed. The average sampling time was 4 hours and thirty minutes. Harvesting a total mandibular graft was more tedious because of the loss of joint laxity caused by the absence of mandibular osteotomy.

CONCLUSION

Partial allotransplant of the face including the mandible is feasible. In such transplantations, functional difficulties related to the temporo-mandibular joint and orthognathic problems need to be overcome.

[Sphenoid arachnoidocele: report of one case]

OBJECTIVES

To define a diagnostic strategy of a sphenoid sinus lesion and the management of CSF fluid leak in the case of a sphenoid arachnoidocele.

MATERIALS AND METHODS

A 70-year-old woman exhibited a sphenoidal sinus opacity which was discovered on the assessment of chronic headaches. It was labelled sphenoid mucocele. A cerebrospinal fluid leak occurred when the marsupialization was made. After an assessment of additional imaging (MRI, CTscan), the diagnosis of sphenoid arachnoidocele was retained.

RESULTS

The leak was repaired by navigated endoscopic endonasal surgery. We used a multilayer reconstructive technique with autologous materials (abdominal fat, fascia of muscle, middle turbinate) and fibrin glue. With a decline of eighteen months no rhinorrhea was noted.

CONCLUSION

Sphenoid arachnoidocele is a rare disease. This case shows that it's essential to know the differential diagnosis sphenoid sinus lesions and how to repair an osteomeningeal leak.

[Acute group A beta-hemolytic streptococcus membranous laryngotracheobronchitis in an adult]

OBJECTIVE

To describe the first case of a group A beta-hemolytic streptococcus laryngotracheobronchitis as well as the other possible etiologies in a case of acute dyspnea.

METHODS

We report the case of a 46-year-old woman with a doubtful vaccination status who presented clinical features of croup (laryngotracheobronchitis). She developed respiratory distress and required endotracheal intubation.

RESULTS

The endoscopy demonstrated a great deal of crust and pseudomembrane detachment. Bacterial culture grew group A beta-hemolytic streptococcus. Progression was good with antibiotics and corticosteroid treatment.

CONCLUSION

Bacterial acute pseudomembranous croup (laryngotracheobronchitis) is rare. We must search for the most frequent diagnoses such as diphtheria and epiglottitis. This is the first case to be reported in the literature.

[Zenker's diverticulum: technique and results of endoscopic treatment with Endo-GIA 30 stapler]

OBJECTIVES

The purpose of this project was to analyze the endoscopic management of Zenker diverticulum using an Endo-GIA stapler inserted transorally to perform an oesophageal diverticulostomia.

PATIENTS AND METHODS

Between January 97 and December 2006, 30 consecutively treated symptomatic patients (13 men; median age 67 years; range 45-91) with Zenker's diverticulum were enrolled into this retrospective study. Ninety six percent complained about dysphagia with slimming in 33%. The diagnosis of Zenker's diverticulum is based on anamnesis and radiological examinations with applied contrast medium of the upper digestive tract.

RESULTS

Twenty-six patients had the endoscopic approach. A patient profited in same time from a resection by external cervical approach following a tearing of the mucous membrane after installation from staled diverticulotomy. Finally 3 patients failed endoscopic exposure. On the 26 patients operated by strict endoscopic treatment, the average duration of intervention was 29 minutes. Overall, an onset of liquid intake on 2.3 postoperative days and the average length of stay was 6 days. Mean follow-up was 40 months. A recurrency was noted in the 2 cases, one was reoperated with the same technique.

CONCLUSION

This endoscopic technique using an Endo-Gia stapler is an efficient, safe and minimally invasive method for the treatment of Zenker's diverticulum. With a low rate of morbidity, it is a good technique especially for patients with impaired of health or associated diseases.

Management of postcricoid and upper esophageal hemangioma

To discuss management of postcricoid and upper esophageal hemangiomas in infants. Four children presenting with progressive feeding and/or respiratory disturbance underwent endoscopy including systematic esophagoscopy revealing the hemangioma of the postcricoid area and extending to the lumen of the upper esophagus. In the three children with severe disturbance, systemic steroids were insufficient and open surgical excision brought the hemangioma under control. No significant stenosis occurred despite prolonged progressive oral feeding up to 1 month after surgery. The fourth child whose disturbance was moderate, was managed by intralesional steroids. Various solutions have been proposed for the treatment, i.e. conservative approach or partial or complete destruction or excision, management of postcricoid hemangioma by intralesional steroids or by open surgical excision. Indications will require greater series.

[Revision ossiculoplasty: anatomical and functional results]

OBJECTIVES

To analyse the anatomical and functional results after second-look ossiculoplasty using Titanium (TI) and Hydroxyapatite (HA) prosthesis and to study the prognostic factors for good functional results.

PATIENTS AND METHODS

Forty nine patients (19 men and 30 women) with an average age of 36 years were included in this study. The patients presented with anatomical and/or functional failures after a first ossiculoplasty and had a second-look intervention. The status of the first prosthesis and also the anatomical status of the middle ear and the remaining ossicular chain were described intra operatively. The functional and anatomical results were assessed 2 months after the second ossiculoplasty and during the most recent out patient clinic. Postoperative air conduction gain (ACG) and air bone gap (ABG) were calculated in average values using four frequencies: 0.5, 1, 2 and 4 kHz. The variables used in statistical analysis were the following: Tympanic membrane and preoperative middle ear status, the type of prosthesis (partial or total) and its material (TI and HA).

RESULTS

The average time to second-look operation was 18 months. The postoperative ABG did not show any significant statistic improvement and in several patients auditory function deteriorated in the operated ear The predictive factors for good functional results were: The integrity of the tympanic membrane, chronic otitis media without cholesteatoma, total prosthesis and HA prosthesis. If three of these factors were present, the postoperative ABG would always be less than 20 dB.

CONCLUSION

When selecting patients for second look ossibuloplasty it is important to understand the predictive facctors for good results. This will allow a full discussion of options, risks and morbidity with the patient.

[Pseudoaneurysm of the internal carotid artery revelated by epistaxis: report of two cases]

OBJECTIVES

Pseudoaneurysms of the carotid artery are a rare but serious cause of epistaxis. They can be rapidly life-threatening. Usually resulting of a surgery or a traumatism, pseudoaneurysms can express themselves by recurrent epistaxis. Management of these epistaxis is discussed.

METHODS

The authors present two cases and effect a review of the literature.

RESULTS

The first patient presented with a pseudoaneurysm few days after a transsphenoidal surgery. The second patient presented with a pseudoaneurysm fourteen years after a radio-surgical treatment of an ethmoidal and frontal epidermoid carcinoma. Diagnosis was suspected during nasal endoscopy and confirmed in both cases with angio-CT and arteriography. The first patient underwent a selective embolization. The second patient had to have a carotid occlusion due to a sudden severe haemorrhage, resulting from a pseudoaneurysm rupture following the embolization attempt.

CONCLUSION

Review of the literature confirms the indication of endovascular intervention. The optimal management is carotid occlusion, provided the patient can tolerate carotid test occlusion and the circle of Willis is satisfactory. In some cases, a preservative treatment may be possible, which could be either pseudoaneurysm embolization or the placement of a covered stent.

[Value of interventional video-endoscopy in the assessment of cancer of the upper airways and digestive system]

INTRODUCTION

The aim of our study was to evaluate the video fiberoscope with operator canal (FOC) in he diagnosis of head and neck carcinoma compared to direct laryngoscopy (DL).

METHODOLOGY

From August 2000 to May 2001, 82 patients were included in a prospective study. They were examined for pharyngolaryngeal cancer with the FOC, DL and a CAT-SCAN. The compared elements were the visualization of the different regions of the pharyngolarynx. A three dimensional description of the lesion, the presence of secondary localisations as well as the anatomo pathological results were obtained with FOC and DL.

RESULTS

Although the pharyngolarynx is less well visualized in FOC than in DL (p = 0.04), no statistically significant difference was found between the two methods in terms of visual diagnosis and assessment of the extent of the lesion. The sensitivity of the biopsies made with FOC is lower than those performed with DL (66% FOC, 97% DL). Moreover, we have noted that FOC is highly reliant on the experience and ability of the surgeon.

CONCLUSION

DL remains the most reliable technique for the exploration and diagnosis of the pharyngolarynx. If it is not possible to perform a DL or if it is not indicated (trismus, contra-indication to general anaesthesia) FOC should be considered as the examination of choice.

[Value of of fine-needle aspiration cytology and MRI in parotid gland masses]

INTRODUCTION

The objective of our study was to discuss the valve of fine-needle aspiration cytology (FNAC) and magnetic resonance imaging (MRI) in the diagnosis and treatment of parotid gland masses.

MATERIALS AND METHODS

Forty patients were included in the prospective study. They had undergone clinical examination, FNAC and MRI before parotidectomy. The results of these examinations were compared with the corresponding histopathological diagnosis.

RESULTS

When it is positive, FNAC is a good examination of malignant tumours (sensitivity 67%, specificity 79%, positive predictive value 86%, negative predictive value 100%). The MRI allows a good assessment of the tumoural mass and its anatomical relationships (sensitivity 55%, specificity 86%, positive predictive value 89%, negative predictive value 75%). If the T2 sequence shows reduced density (p < 0.05) or in case of bad limitation (p = 0.004), a malignant character is strongly suspected.

CONCLUSION

In cases of parotid gland mass, where surgical intervention is necessary, there is no need of special investigations: however FNAC and MRI allow us to anticipate what operation will be required.

[Nasal polyposis: long term functional results in 203 patients treated by ethmoidectomy combined with intranasal corticotherapy]

OBJECTIVE

Evaluate the long term quality of life in patients after ethmoidectomy associated with intranasal corticotherapy for nasal polyposis on the appreciation of the intensity of nasal symptoms. MATERIAL ET METHOD: The authors report their experience about 203 patients treated by endonasal endoscopic ethmoïdectomy intranasal followed by a long term intransal corticotherapy, with a mean follow up of six years. In this prospective study, each symptom was evaluated using an analogic visual scale and a questionnaire. The evolution of asthma after surgery and the patients global satisfactory rate were noted.

RESULTS

There is a global improvement of the nasal symptoms with a mean postoperative individual scores calculated at 32% for nasal obstruction, at 34% for rhinorrhea and at 51% for anosmia. No impact on asthma or improvement of asthma was encountered in 92% of the patients. The patients global satisfactory rate of this medico-surgical approach of the disease is 93.6%. A positive correlation was found between the severity of the olfactory disorders and the oral corticosteroid therapy.

CONCLUSION

Endoscopic endonasal ethmoïdectomy followed by intranasal corticotherapy represents a valuable protocol in treating patients with severe nasal polyposis.

[Comparison of the cephalometric characteristics of snoring patients and apneic patients as a function of the degree of obesity. Apropos of 162 cases]

BACKGROUND

The purpose of our study was to compare cephalometric analysis of craniofacial features in normal weight or obese subjects who are habitual snorers or apneic. We conducted a retrospective comparison of their clinical and cephalometric features by degree of obesity.

PATIENTS AND METHODS

One hundred and sixty two male subjects with obstructive sleep apnea syndrome (OSAS) diagnosed by conventional polysomnography were included in the study. Patients were divided into four groups according to their body mass index (BMI) and their apnea/hypopnea index (AHI: Group 1 = normal-weight snorers (34 patients), Group 2 = normal-weight apneic subjects (40 patients), Group 3 = obese snorers (20 patients), Group 4 = obese apneic subjects (68 patients). Lateral cephalometry was performed in all patients. Intergroup comparisons (2/4, 1/2, 3/4) were made using 32 parameters to study the influence of the size of bone structures, their relationships, and size of the upper airways.

RESULTS

The four groups were comparable for age. AHI was higher for group 4 (obese apneic) compared with group 1 (normal-weight snorers). Compared with group 3 (obese snorers), group 1 (normal-weight snorers) had a retroposition of the mandible (smaller SNB and ANB angle), an accentuated facial divergence and a narrower pharyngeal space at the hyoid bone level. Compared with group 1 (normal-weight snorers), group 2 (normal-weight apneic) had a narrower pharyngeal space at different levels. Compared with group 3 (obese snorers), group 4 (obese apneic) had a lower hyoid bone evaluated with different cephalometric variables.

CONCLUSION

This study mainly shows that apneic patients exhibit craniofacial differences when divided into two groups according to their body mass index. Our findings are consistent with previous reports and could suggest a dual etiology of OSAS.