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Rubenstein E, Henneton P, Rivière S, Casanova ML, Broner J, Arnaud E, Oziol E, Quintrec ML, Moranne O, Jorgensen C, Combe B, Bourdin A, Fontaine C, Schiffmann A, Fraison JB, Hallé O, Fraisse T, Veysseyre F, Taieb G, Aerts C, Crampette L, Alovisetti C, Guis L, Mehlal S, Papinaud L, Le Quellec A, Guilpain P, Mahr A. Prevalence of anti-neutrophil cytoplasmic antibody-associated vasculitis in the south of France, using the capture-recapture method. Rheumatology (Oxford) 2023:kead557. [PMID: 37819770 DOI: 10.1093/rheumatology/kead557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/25/2023] [Accepted: 10/02/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVES This study aimed to estimate the prevalence of ANCA-associated vasculitis (AAV), ie granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA) and eosinophilic granulomatosis with polyangiitis (EGPA), in Southern France in 2018, and evaluate differences among Europeans and non-Europeans. METHODS This population-based, cross-sectional study used four sources (hospitals, community-based physicians, laboratories, National Health Insurance) to identify adults ≥ 15 years diagnosed with GPA, MPA or EGPA, living in Hérault and Gard in 2018. Cases were defined using the ACR/EULAR classification criteria, and if necessary, the European Medicines Agency algorithm. Prevalence estimates were standardised to the world population and capture-recapture analysis was used to assess the comprehensiveness of the estimation. The influence of geographical origin was evaluated. RESULTS 202 patients were selected, with 86 cases of GPA (42.6%), 85 cases of MPA (42.1%), and 31 cases of EGPA (15.3%). The standardised prevalence estimates per million inhabitants for 2018 were: 103 (95%CI 84 - 125) for AAV, 48 (95%CI 35 - 64) for GPA, 39 (95%CI 28 - 53) for MPA and 16 (95%CI 9 - 26) for EGPA, 36 (95%CI 25 - 50) for anti-PR3 positive AAV, 46 (95%CI 34 - 61) for anti-MPO positive AAV, and 16 (95%CI 9 - 26) for ANCA-negative AAV. The global estimation of comprehensiveness by capture-recapture analysis was 80.5%. The number of AAV cases was higher for non-European residents (P=0.001), particularly for MPA (P<0.0001). CONCLUSION We provide a new estimate of AAV prevalence in France and show a higher prevalence of MPA in non-European patients.
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Affiliation(s)
- Emma Rubenstein
- Department of infectious diseases, Saint-Louis Hospital, Paris, France
| | - Pierrick Henneton
- Department of vascular medicine, Saint-Eloi University Hospital, University of Montpellier, Montpellier, France
| | - Sophie Rivière
- Department of internal medicine and multi-organic diseases, Referral center for systemic and autoimmune diseases, Saint-Eloi University Hospital, Montpellier, France
| | | | - Jonathan Broner
- Department of internal medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Erik Arnaud
- Department of internal medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Eric Oziol
- Department of internal medicine, Béziers Hospital, Béziers, France
| | - Moglie Le Quintrec
- Department of nephrology-transplant, Lapeyronie University Hospital, University of Montpellier, Montpellier, France
| | - Olivier Moranne
- Department of nephrology-dialysis-apheresis, Carémeau University Hospital, IDESP, University of Montpellier, Nîmes, France
| | | | | | - Arnaud Bourdin
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France
| | | | - Aurélie Schiffmann
- Department of internal medicine and multi-organic diseases, Referral center for systemic and autoimmune diseases, Saint-Eloi University Hospital, Montpellier, France
- Department of internal medicine, Saint Jean Clinic, Montpellier, France
| | | | - Olivier Hallé
- Department of internal medicine 2, Alès Hospital, Alès, France
| | | | - Frederic Veysseyre
- Department of internal medicine, Saint Jean Clinic, Saint Jean de Vedas, France
| | - Guillaume Taieb
- Department of neurology, Gui de Chauliac University Hospital, Montpellier, France
| | - Cécile Aerts
- Department of neurology, Beau Soleil Clinic, Montpellier, France
| | - Louis Crampette
- Department of otorhinolaryngology, Gui de Chauliac University Hospital, Montpellier, France
| | - Caroline Alovisetti
- Department of otorhinolaryngology, Carémeau University Hospital, Nîmes, France
| | - Laurence Guis
- Laboratoire Eurofins Biomnis, Auto-immunité, Ivry sur Seine, France
| | - Souad Mehlal
- Laboratoire Cerba, Biochimie spécialisée, immunologie et pharmacotoxicologie, Saint-Ouen, France
| | | | - Alain Le Quellec
- Department of internal medicine and multi-organic diseases, Referral center for systemic and autoimmune diseases, Saint-Eloi University Hospital, Montpellier, France
| | - Philippe Guilpain
- Department of internal medicine and multi-organic diseases, Referral center for systemic and autoimmune diseases, Saint-Eloi University Hospital, Montpellier, France
- IHU IMMUN4CURE, Saint Eloi University Hospital, Montpellier cedex, France
- Inserm U1183, Institute for Regenerative Medicine and Biotherapy (IRMB), Saint-Eloi University Hospital, Montpellier, France
| | - Alfred Mahr
- ECSTRRA Research Unit, Centre of Research in Epidemiology and Statistics, Sorbonne Paris Cité Research Center UMR 1153, Inserm, Paris, France
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Favier V, Charriot J, Crampette L, Bourdin A, Ahmed E. What place will tezepelumab hold in the treatment paradigm in chronic rhinosinusitis? Expert Rev Clin Immunol 2023; 19:821-825. [PMID: 37194702 DOI: 10.1080/1744666x.2023.2215986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/16/2023] [Indexed: 05/18/2023]
Affiliation(s)
- Valentin Favier
- Department of ENT Surgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Jérémy Charriot
- Department of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France
- PhyMedExp, Univ Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, France
| | - Louis Crampette
- Department of ENT Surgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Arnaud Bourdin
- Department of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France
- PhyMedExp, Univ Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, France
| | - Engi Ahmed
- Department of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France
- PhyMedExp, Univ Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, France
- Laboratory of Immunoregulation and Mucosal Immunology, VIB-UGent Center for Inflammation Research, Ghent, Belgium
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Moser PO, Favier V, Raingeard I, Crampette L, Rigau V, Boetto J. Primitive pituitary perivascascular epithelioid cell tumor: A challenging diagnosis of melanocytic pituitary lesion. Neurochirurgie 2023; 69:101394. [PMID: 36502879 DOI: 10.1016/j.neuchi.2022.101394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/24/2022] [Accepted: 09/28/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Perivascular Epithelioid cell tumors (PEComa) are rare mesenchymal tumors. They generally occur in the gynecologic or digestive tract. The diagnosis of Central Nervous System PEComa is exceptional and challenging. CASE DESCRIPTION We report the case of a 46-year-old woman, with no particular medical history, who presented a secondary amenorrhea and a slight hyperprolactinemia. She was diagnosed on MRI with a pituitary tumor showing spontaneous hypersignal in T1-weighted images. After failure of medical treatment with cabergoline, surgical resection was required due to progressive tumor growth. Macroscopic aspect and initial immunohistochemical features were in favor of a primitive hypophyseal melanocytoma. However, molecular and transcriptional study through targeted exome- and RNA-sequencing led to the exceptional diagnosis of pituitary Perivascular Epithelioid Cell Tumor (PEComa). Three-years of postoperative radio-clinical follow-up showed an asymptomatic non-evolutive small remnant. CONCLUSION PEComa is an exceptional diagnosis among pituitary tumors. It should be evoked as a potential differential diagnosis in case of primitive melanocytic lesion of the pituitary gland. Specific molecular analysis is mandatory to confirm the diagnosis and exclude differential diagnosis.
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Affiliation(s)
- P-O Moser
- Department of neurosurgery, Montpellier University medical center, Gui-De-Chauliac Hospital, Montpellier, France.
| | - V Favier
- Department of ENT, Montpellier University medical center, Gui-De-Chauliac Hospital, Montpellier, France
| | - I Raingeard
- Department of endocrinology, Montpellier University medical center, Lapeyronie Hospital, Montpellier, France
| | - L Crampette
- Department of ENT, Montpellier University medical center, Gui-De-Chauliac Hospital, Montpellier, France
| | - V Rigau
- Department of pathology, Montpellier University medical center, Gui-De-Chauliac Hospital, Montpellier, France
| | - J Boetto
- Department of neurosurgery, Montpellier University medical center, Gui-De-Chauliac Hospital, Montpellier, France
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Boetto J, Joitescu I, Raingeard I, Ng S, Le Corre M, Lonjon N, Crampette L, Favier V. Endoscopic transsphenoidal surgery for non-functioning pituitary adenoma: Learning curve and surgical results in a prospective series during initial experience. Front Surg 2022; 9:959440. [PMID: 35983556 PMCID: PMC9379140 DOI: 10.3389/fsurg.2022.959440] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background To report the initial experience of surgery for non-functioning pituitary adenoma (NFPA) from a neurosurgeon in a dedicated residency training endoscopic transsphenoidal (ETS) program, and detail the surgical and clinical outcomes during this period. Methods A prospective series of all patients operated for NFPA, using an ETS approach, during the three first years of experience of a newly board-certified neurosurgeon was analysed. Clinical, radiological and peri-operative data were collected. Extent of resection (EOR) was determined by formal volumetric analysis. Impact of the learning curve and predictive factors of gross total resection (GTR) were determined. Results Fifty-three patients with NFPA were included in this prospective cohort which was divided in two periods of time (“First period”: 30 first cases, and “second period”: 23 following cases). Baseline characteristics of the patients in the two periods were similar. Overall occurrence of complication was 22% and was not significantly different in the two periods of time. No patient had severe neurological complication. Gross total resection was achieved in 70% of patients. Mean Extent of resection was 96%. In a multiple linear regression model, a higher EOR was positively correlated with experience (p = 0.018) and negatively correlated with Knosp Score equal to 4 (p < 0.001). Predictive factors for GTR were Higher Knosp grade (p = 0,01), higher pre-operative volume (p = 0.03), and second period of time (p = 0.01). Conclusion NFPA surgery can be safe and efficient during the learning period. Dedicated intensive learning, careful patient selection and multidisciplinary work are key to shorten the learning curve and achieve satisfactory results.
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Affiliation(s)
- Julien Boetto
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
- IGF, Université de Montpellier, CNRS, INSERM, Montpellier, France
- Correspondence: Julien Boetto
| | - Irina Joitescu
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Isabelle Raingeard
- Department of Endocrinology, Lapeyronie Hospital, Montpellier University Medical Center, Montpellier, France
| | - Sam Ng
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
- IGF, Université de Montpellier, CNRS, INSERM, Montpellier, France
| | - Marine Le Corre
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Nicolas Lonjon
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Louis Crampette
- Department of ENT Surgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Valentin Favier
- Department of ENT Surgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
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Peters AT, Soler ZM, Kern RC, Heffler E, Maspero JF, Crampette L, Fujieda S, Lane AP, Zhang H, Nash S, Khan AH, Siddiqui S, Jacob-Nara JA, Rowe P, Deniz Y. Improvement in patient-reported "taste" and association with smell in dupilumab-treated patients with severe chronic rhinosinusitis with nasal polyps from the SINUS-24 and SINUS-52 trials. Clin Exp Allergy 2022; 52:1105-1109. [PMID: 35775319 PMCID: PMC9545952 DOI: 10.1111/cea.14194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 06/24/2022] [Accepted: 06/26/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Anju T Peters
- Allergy-Immunology Division and the Sinus and Allergy Center, Feinberg School of Medicine, Northwestern University Chicago, IL, USA
| | - Zachary M Soler
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Robert C Kern
- Department of Otolaryngology - Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Enrico Heffler
- Personalized Medicine, Asthma & Allergy - Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Jorge F Maspero
- Allergy and Respiratory Medicine, Fundación CIDEA, Buenos Aires, Argentina
| | - Louis Crampette
- Department of Otorhinolaryngology - Head and Neck Surgery and Maxillofacial Surgery, University Hospital of Montpellier, Montpellier, France
| | - Shigeharu Fujieda
- Department of Otorhinolaryngology - Head/Neck Surgery, University of Fukui, Fukui, Japan
| | - Andrew P Lane
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Haixin Zhang
- Medical Affairs, Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | - Scott Nash
- Medical Affairs, Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | - Asif H Khan
- Global Medical Affairs, Sanofi, Chilly-Mazarin, France, USA
| | - Shahid Siddiqui
- Medical Affairs, Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | | | - Paul Rowe
- Global Medical Affairs, Sanofi, Bridgewater, NJ, USA
| | - Yamo Deniz
- Medical Affairs, Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
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6
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Dahan LS, Giorgi R, Vergez S, Le Taillandier de Gabory L, Costes-Martineau V, Herman P, Poissonnet G, Mauvais O, Malard O, Garrel R, Uro-Coste E, Barry B, Bach C, Chevalier D, Mouawad F, Merol JC, Bastit V, Thariat J, Gilain L, Dufour X, Righini CA, Moya-Plana A, Even C, Radulesco T, Michel J, Baujat B, Fakhry N, Albert S, Andry G, Babin E, Bach C, Badet JM, Badoual C, Baglin A, Banal A, Barry B, Baudin E, Baujat B, Bensadoun R, Bertolus C, Bessède JP, Blanchard D, Borel C, Bozorg-Grayeli A, Breheret R, Breton P, Brugel L, Calais G, Casiraghi O, Cassagnau E, Castillo L, Ceruse P, Chabolle F, Chevalier D, Chobaut J, Choussy O, Cosmidis A, Coste A, Costes V, Crampette L, Darrouzet V, Demez P, Dessi P, Devauchelle B, Dolivet G, Dubrulle F, Duflo S, Dufour X, Faivre S, Fakhry N, Ferron C, Floret F, de Gabory L, Garrel R, Geoffrois L, Gilain L, Giovanni A, Girod A, Guerrier B, Hans S, Herman P, Hofman P, Housset M, Jankowski R, Jegoux F, Juliéron M, Kaminsky MC, Kolb F, St Guily JL, Laccoureye L, Lallemant B, Lang P, Lartigau E, Lavieille JP, Lefevre M, Leroy X, Malard O, Massip F, Mauvais O, Merol JC, Michel J, Mom T, Morinière S, de Monès E, Moulin G, Noel G, Poissonnet G, Prades JM, Radulesco T, de Raucourt D, Reyt E, Righini C, Robin YM, Rolland F, Ruhin B, Sarroul N, Schultz P, Serrano E, Sterkers O, Strunski V, Sudaka A, Tassart M, Testelin S, Thariat J, Timochenko A, Toussaint B, Coste EU, Valette G, Van den Abbeele T, Varoquaux A, Veillon F, Vergez S, Wassef M. Mucoepidermoid carcinoma of salivary glands: A French Network of Rare Head and Neck Tumors (REFCOR) prospective study of 292 cases. Eur J Surg Oncol 2021; 47:1376-1383. [DOI: 10.1016/j.ejso.2020.11.123] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/31/2020] [Accepted: 11/13/2020] [Indexed: 12/18/2022] Open
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Villerabel C, Makinson A, Jaussent A, Picot MC, Nègre-Pagès L, Rouvière JA, Favier V, Crampette L, Morquin D, Reynes J, Le Moing V, Tuaillon E, Venail F. Diagnostic Value of Patient-Reported and Clinically Tested Olfactory Dysfunction in a Population Screened for COVID-19. JAMA Otolaryngol Head Neck Surg 2021; 147:271-279. [PMID: 33410887 DOI: 10.1001/jamaoto.2020.5074] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Importance Recent studies have suggested that olfactory dysfunction and gustatory dysfunction are associated with coronavirus disease 2019 (COVID-19). However, olfaction has been evaluated solely on reported symptoms, after COVID-19 diagnosis, and in both mild and severe COVID-19 cases, but rarely has it been assessed in prospectively unselected populations. Objective To evaluate the diagnostic value of a semiobjective olfactory test developed to assess patient-reported chemosensory dysfunction prior to testing for the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in patients attending a COVID-19 screening facility. Design, Setting, and Participants This prospective diagnostic study with participants and observers blinded to COVID-19 status was conducted in a COVID-19 screening center of a tertiary university hospital in France from March 23 to April 22, 2020. Participants were 854 consecutively included health care workers or outpatients with symptoms or with close contact with an index case. Exclusion criteria were prior chemosensory dysfunction, testing inability, or contraindications (n = 45). Main Outcomes and Measures Participants were interviewed to ascertain their symptoms and then underwent Clinical Olfactory Dysfunction Assessment (CODA), an ad hoc test developed for a simple and fast evaluation of olfactory function. This assessment followed a standardized procedure in which participants identified and rated the intensity of 3 scents (lavender, lemongrass, and mint) to achieve a summed score ranging from 0 to 6. The COVID-19 status was assessed using reverse transcriptase-polymerase chain reaction to detect the presence of SARS-CoV-2 in samples collected via nasopharyngeal swab (reference standard) to calculate the diagnostic values of patient-reported chemosensory dysfunction and CODA. Results Of 809 participants, the female to male sex ratio was 2.8, and the mean (SD) age was 41.8 (13.0) years (range, 18-94 years). All participants, if symptomatic, had mild disease at the time of testing, and 58 (7.2%) tested positive for SARS-CoV-2. Chemosensory dysfunction was reported by 20 of 58 participants (34.5%) with confirmed COVID-19 vs 29 of 751 participants (3.9%) who tested negative for COVID-19 (absolute difference, 30.6% [95% CI, 18.3%-42.9%]). Olfactory dysfunction, either self-reported or clinically ascertained (CODA score ≤3), yielded similar sensitivity (0.31 [95% CI, 0.20-0.45] vs 0.34 [95% CI, 0.22-0.48]) and specificity (0.97 [95% CI, 0.96-0.98) vs 0.98 [95% CI, 0.96-0.99]) for COVID-19 diagnosis. Concordance was high between reported and clinically tested olfactory dysfunction, with a Gwet AC1 of 0.95 (95% CI, 0.93-0.97). Of 19 participants, 15 (78.9%) with both reported olfactory dysfunction and a CODA score of 3 or lower were confirmed to have COVID-19. The CODA score also revealed 5 of 19 participants (26.3%) with confirmed COVID-19 who had previously unperceived olfactory dysfunction. Conclusions and Relevance In this prospective diagnostic study of outpatients with asymptomatic or mild to moderate COVID-19, systematically assessed anamnesis and clinical testing with the newly developed CODA were complementary and specific for chemosensory dysfunction. Olfactory dysfunction was suggestive of COVID-19, particularly when clinical testing confirmed anamnesis. However, normal olfaction was most common among patients with COVID-19.
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Affiliation(s)
- Charles Villerabel
- Department of Otorhinolaryngology-Head and Neck Surgery and Maxillofacial Surgery, Hospital and University of Montpellier, Montpellier, France
| | - Alain Makinson
- Department of Infectious Diseases, Hospital and University of Montpellier, Montpellier, France.,INSERM U1175, Montpellier, France
| | - Audrey Jaussent
- Clinical Research and Epidemiology Unit, Department of Medical Information, Hospital and University of Montpellier, Montpellier, France
| | - Marie-Christine Picot
- Clinical Research and Epidemiology Unit, Department of Medical Information, Hospital and University of Montpellier, Montpellier, France.,INSERM CIC 1411, Montpellier, France
| | - Laurence Nègre-Pagès
- Clinical Research and Epidemiology Unit, Department of Medical Information, Hospital and University of Montpellier, Montpellier, France
| | | | - Valentin Favier
- Department of Otorhinolaryngology-Head and Neck Surgery and Maxillofacial Surgery, Hospital and University of Montpellier, Montpellier, France
| | - Louis Crampette
- Department of Otorhinolaryngology-Head and Neck Surgery and Maxillofacial Surgery, Hospital and University of Montpellier, Montpellier, France
| | - David Morquin
- Department of Infectious Diseases, Hospital and University of Montpellier, Montpellier, France.,INSERM U1175, Montpellier, France
| | - Jacques Reynes
- Department of Infectious Diseases, Hospital and University of Montpellier, Montpellier, France.,INSERM U1175, Montpellier, France
| | - Vincent Le Moing
- Department of Infectious Diseases, Hospital and University of Montpellier, Montpellier, France.,INSERM U1175, Montpellier, France
| | - Edouard Tuaillon
- INSERM U1058-Pathogenesis and Control of Chronic Infections, Hospital and University of Montpellier, Montpellier, France
| | - Frédéric Venail
- Department of Otorhinolaryngology-Head and Neck Surgery and Maxillofacial Surgery, Hospital and University of Montpellier, Montpellier, France.,INSERM U1051-Institute for Neurosciences of Montpellier, Montpellier, France
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8
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Favier V, Crampette L, Gergelé L, De Cristofaro G, Jouanneau E, Manet R. Should the Impact of Postural Change of Intracranial Pressure After Surgical Repair of Skull Base Cerebrospinal Fluid Leaks Be Considered? A Preliminary Survey. Acta Neurochir Suppl 2021; 131:329-333. [PMID: 33839869 DOI: 10.1007/978-3-030-59436-7_63] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
INTRODUCTION Managing skull base cerebrospinal fluid (CSF) leaks is often challenging. Postoperative care, especially regarding postural restrictions and bedrest recommendations, is variable and continues to be based on empirical habits. METHODS An electronic survey was submitted to French experts in skull base surgery to evaluate current practice of postoperative postural recommendations in patients treated for skull base CSF leaks. RESULTS Thirty-nine experts completed the survey. Postoperative recommendations were heterogenous. They depended on the size of defects: half of the surgeons did not recommend any constraints of posture for small defects; 84% recommended bed rest for large defects. The most preferred bed-rest modality was Fowler's position (20°-30° tilt). Standing/walking during short periods was allowed in up to 73%. From a physiological viewpoint, head elevation decreases ICP and thus limits the risk of recurrence of CSF leak. However, ICP can fall below 0 in the standing position, favouring pneumocephalus. DISCUSSION These results confirmed that postural recommendations for patients surgically treated for skull base CSF leaks remain variable. Recommendations should take into consideration the postural change in ICP. Fowler's position may represent the best compromise between risk of recurrence of CSF leak and the risk of pneumocephalus in large CSF leaks.
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Affiliation(s)
- Valentin Favier
- Department of ENT-Head and Neck Surgery, Gui de Chauliac Hospital, University Hospital of Montpellier, Montpellier, France
| | - Louis Crampette
- Department of ENT-Head and Neck Surgery, Gui de Chauliac Hospital, University Hospital of Montpellier, Montpellier, France
| | - Laurent Gergelé
- Intensive Care, Ramsay Générale de Santé, Hôpital Privé de la Loire, Saint Etienne, France
| | - Generoso De Cristofaro
- Department of Mental and Physical Health and Preventive Medicine, ENT Unit of University of Campania "Luigi Vanvitelli"-University Hospital "Luigi Vanvitelli", Naples, Italy
| | - Emmanuel Jouanneau
- Skull Base Unit, Department of Neurosurgery B, Neurological Hospital Pierre Wertheimer, University Hospital of Lyon, Lyon, France
| | - Romain Manet
- Skull Base Unit, Department of Neurosurgery B, Neurological Hospital Pierre Wertheimer, University Hospital of Lyon, Lyon, France.
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9
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Favier V, Najaf Y, Damecourt A, Subsol G, Captier G, Boetto J, Crampette L. Three-dimensional printing to compare endoscopic endonasal surgical approaches: A technical note. Clin Otolaryngol 2020; 46:106-109. [PMID: 32865888 DOI: 10.1111/coa.13641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/24/2020] [Accepted: 08/23/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Valentin Favier
- Department of Otolaryngology-Head and Neck Surgery and Maxillofacial Surgery, Gui de Chauliac Hospital, University Hospital of Montpellier, Montpellier, France.,Aide à la Décision Médicale Personnalisée, EA 2415, Montpellier University, Montpellier, France
| | - Yaser Najaf
- Department of Otolaryngology-Head and Neck Surgery and Maxillofacial Surgery, Gui de Chauliac Hospital, University Hospital of Montpellier, Montpellier, France
| | - Arnaud Damecourt
- Department of Otolaryngology-Head and Neck Surgery and Maxillofacial Surgery, Gui de Chauliac Hospital, University Hospital of Montpellier, Montpellier, France
| | - Gérard Subsol
- ICAR Team, Montpellier Laboratory of Informatics, Robotics and Microelectronics (LIRMM), French National Centre for Scientific Research (CNRS), Montpellier University, Montpellier, France
| | - Guillaume Captier
- Aide à la Décision Médicale Personnalisée, EA 2415, Montpellier University, Montpellier, France
| | - Julien Boetto
- Department of Neurosurgery, Gui de Chauliac Hospital, University Hospital of Montpellier, Montpellier, France
| | - Louis Crampette
- Department of Otolaryngology-Head and Neck Surgery and Maxillofacial Surgery, Gui de Chauliac Hospital, University Hospital of Montpellier, Montpellier, France
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Favier V, Le Corre M, Segnarbieux F, Rigau V, Raingeard I, Cartier C, Crampette L, Boetto J. Endoscopic subperichondrial transseptal transsphenoidal approach is safe and efficient for non-extended pituitary surgery. Eur Arch Otorhinolaryngol 2020; 277:1079-1087. [PMID: 31960129 DOI: 10.1007/s00405-020-05790-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 01/06/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE To report the results of a series of patients undergoing the endoscopic subperichondrial transseptal (STRAS) approach for pituitary surgery and to evaluate the efficiency and the safety of this approach. METHODS This is a single-centre retrospective study including all patients undergoing pituitary lesion resection through the STRAS approach from January 2002 to December 2017 by a multidisciplinary surgical team (ENT and neurosurgeon). Demographic data, tumour type, complication rate and pre- and post-operative visual, endocrine and tumour status were retrospectively analysed. RESULTS 119 patients were included in the study, 80 (67%) presenting macroadenoma, 24 (20%) microadenoma (20%) and 6 (5%) giant adenoma. 61 (51%) patients had secreting adenoma and 51 (42%) patient had non-functioning adenoma. The STRAS approach allowed a good visualization of intrasphenoidal and intrasellar anatomical landmarks in all cases and no patient needed turbinate resection. No patient died or had neurological deficit. Endocrine remission or control was achieved in 90.5% of hormone-secreting microadenomas and in 84.2% of hormone-secreting macroadenomas. Gross-total resection was achieved for 39 patients (48.8%) of the 80 macroadenomas. Nasal complication rate was very low, with no septal perforation and two epistaxis (1.7%) medically treated. CONCLUSION The STRAS approach is an elegant approach to the sphenoid sinus that enables a good exposure of the intrasphenoidal anatomical landmarks with a maximal preservation of the nasal mucosa. This approach allows an intrasellar work with great comfort and safety for the surgeon using a two-hand or a four-hand technique.
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Affiliation(s)
- Valentin Favier
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Montpellier, 80 Avenue Augustin Fliche, 34090, Montpellier, France.
| | - Marine Le Corre
- Department of Neurosurgery, University Hospital of Montpellier, Montpellier, France
| | - François Segnarbieux
- Department of Neurosurgery, University Hospital of Montpellier, Montpellier, France
| | - Valérie Rigau
- Department of Pathology, University Hospital of Montpellier, Montpellier, France
| | - Isabelle Raingeard
- Department of Endocrinology, University Hospital of Montpellier, Montpellier, France
| | - César Cartier
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Montpellier, 80 Avenue Augustin Fliche, 34090, Montpellier, France
| | - Louis Crampette
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Montpellier, 80 Avenue Augustin Fliche, 34090, Montpellier, France
| | - Julien Boetto
- Department of Neurosurgery, University Hospital of Montpellier, Montpellier, France
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de Gabory L, Verillaud B, Rumeau C, Herman P, Jankowski R, Michel J, de Kermadec H, Coste A, Mortuaire G, Righini C, Reyt E, Choussy O, Trévillot V, Crampette L, Serrano E, Tsaranazy A, Bastier PL, Vergez S. Multicenter assessment of exclusive endoscopic endonasal approach for the treatment of 53 olfactory neuroblastomas. Head Neck 2018; 40:1000-1007. [PMID: 29356209 DOI: 10.1002/hed.25064] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 09/22/2017] [Accepted: 11/28/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Given the particularities of olfactory neuroblastoma (ONB) and the lack of studies on the subject, a multicenter collaborative study was conducted to assess treatment strategy. METHODS Fifty-three patients with ONB were included from the French Rare Head and Neck Cancer Expert Network (REFCOR) database: 16T1, 8T2, 19T3, and 10T4. All cases were treated endoscopically with skull base removal and repair in 26 cases (49%) and without external craniotomy. RESULTS The overall survival (OS) and disease-free survival (DFS) rates at 5 years were 87% and 71%, respectively, with mean follow-up of 45.4 ± 26.5 months. The complication rate was 18.8% with 4 cases of meningitis. Pathological analysis showed positive margins in 26.8%, notably on the dura-mater and periorbita, without impairment of OS or DFS. Forty-eight patients received adjuvant radiotherapy on T ± N. Ten patients had a recurrence (18.9%). Six patients died of their disease. Prophylactic neck irradiation seemed to reduce the recurrence rate. CONCLUSION Exclusively endoscopic treatment proved efficient and reliable in a large controlled series.
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Affiliation(s)
- Ludovic de Gabory
- Otorhinolaryngology, Head and Neck Surgery Department, University Hospital Pellegrin, Bordeaux, France
| | - Benjamin Verillaud
- Otorhinolaryngology, Head and Neck Surgery Department, University Hospital Lariboisière, Paris, France
| | - Cécile Rumeau
- Otorhinolaryngology, Head and Neck Surgery Department, University Hospital of Nancy, France
| | - Philippe Herman
- Otorhinolaryngology, Head and Neck Surgery Department, University Hospital Lariboisière, Paris, France
| | - Roger Jankowski
- Otorhinolaryngology, Head and Neck Surgery Department, University Hospital of Nancy, France
| | - Justin Michel
- Otorhinolaryngology, Head and Neck Surgery Department, University Hospital, Marseille, France
| | - Héloïse de Kermadec
- Otorhinolaryngology, Head and Neck Surgery Department, University Hospital Creteil, France
| | - André Coste
- Otorhinolaryngology, Head and Neck Surgery Department, University Hospital Creteil, France
| | - Geoffrey Mortuaire
- Otorhinolaryngology, Head and Neck Surgery Department, University Hospital Charles Nicolle, Lille, France
| | - Christian Righini
- Otorhinolaryngology, Head and Neck Surgery Department, University Hospital Grenoble, France
| | - Emile Reyt
- Otorhinolaryngology, Head and Neck Surgery Department, University Hospital Grenoble, France
| | - Olivier Choussy
- Otorhinolaryngology, Head and Neck Surgery Department, University Hospital Charles Nicolle, Rouen, France
| | - Vincent Trévillot
- Otorhinolaryngology, Head and Neck Surgery Department, University Hospital Guy de Chauliac, Montpellier, France
| | - Louis Crampette
- Otorhinolaryngology, Head and Neck Surgery Department, University Hospital Guy de Chauliac, Montpellier, France
| | - Elie Serrano
- Otorhinolaryngology, Head and Neck Surgery Department, University Hospital Rangueil-Larrey, Toulouse, France
| | | | - Pierre-Louis Bastier
- Otorhinolaryngology, Head and Neck Surgery Department, University Hospital Pellegrin, Bordeaux, France
| | - Sebastien Vergez
- Otorhinolaryngology, Head and Neck Surgery Department, University Hospital Rangueil-Larrey, Toulouse, France
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12
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Favier V, Zemiti N, Caravaca Mora O, Subsol G, Captier G, Lebrun R, Crampette L, Mondain M, Gilles B. Geometric and mechanical evaluation of 3D-printing materials for skull base anatomical education and endoscopic surgery simulation - A first step to create reliable customized simulators. PLoS One 2017; 12:e0189486. [PMID: 29252993 PMCID: PMC5734742 DOI: 10.1371/journal.pone.0189486] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 11/27/2017] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Endoscopic skull base surgery allows minimal invasive therapy through the nostrils to treat infectious or tumorous diseases. Surgical and anatomical education in this field is limited by the lack of validated training models in terms of geometric and mechanical accuracy. We choose to evaluate several consumer-grade materials to create a patient-specific 3D-printed skull base model for anatomical learning and surgical training. METHODS Four 3D-printed consumer-grade materials were compared to human cadaver bone: calcium sulfate hemihydrate (named Multicolor), polyamide, resin and polycarbonate. We compared the geometric accuracy, forces required to break thin walls of materials and forces required during drilling. RESULTS All materials had an acceptable global geometric accuracy (from 0.083mm to 0.203mm of global error). Local accuracy was better in polycarbonate (0.09mm) and polyamide (0.15mm) than in Multicolor (0.90mm) and resin (0.86mm). Resin and polyamide thin walls were not broken at 200N. Forces needed to break Multicolor thin walls were 1.6-3.5 times higher than in bone. For polycarbonate, forces applied were 1.6-2.5 times higher. Polycarbonate had a mode of fracture similar to the cadaver bone. Forces applied on materials during drilling followed a normal distribution except for the polyamide which was melted. Energy spent during drilling was respectively 1.6 and 2.6 times higher on bone than on PC and Multicolor. CONCLUSION Polycarbonate is a good substitute of human cadaver bone for skull base surgery simulation. Thanks to short lead times and reasonable production costs, patient-specific 3D printed models can be used in clinical practice for pre-operative training, improving patient safety.
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Affiliation(s)
- Valentin Favier
- Montpellier Laboratory of Informatics, Robotics and Microelectonics (LIRMM), ICAR team, French National Centre for Scientific Research (CNRS), Montpellier University, Montpellier, France
- ENT department, University Hospital of Montpellier, Gui de Chauliac Hospital, Montpellier, France
| | - Nabil Zemiti
- LIRMM, DEXTER team, CNRS, Montpellier University, Montpellier, France
| | | | - Gérard Subsol
- Montpellier Laboratory of Informatics, Robotics and Microelectonics (LIRMM), ICAR team, French National Centre for Scientific Research (CNRS), Montpellier University, Montpellier, France
| | - Guillaume Captier
- Anatomy laboratory, School of Medicine, Montpellier University, Montpellier, France
| | - Renaud Lebrun
- Evolutionary Sciences Institute of Montpellier, MRI-ISEM, University of Montpellier, Montpellier, France
| | - Louis Crampette
- ENT department, University Hospital of Montpellier, Gui de Chauliac Hospital, Montpellier, France
| | - Michel Mondain
- ENT department, University Hospital of Montpellier, Gui de Chauliac Hospital, Montpellier, France
| | - Benjamin Gilles
- Montpellier Laboratory of Informatics, Robotics and Microelectonics (LIRMM), ICAR team, French National Centre for Scientific Research (CNRS), Montpellier University, Montpellier, France
- AnatoScope SA, Montpellier, France
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Sasso M, Barrot A, Carles MJ, Griffiths K, Rispail P, Crampette L, Lallemant B, Lachaud L. Direct identification of molds by sequence analysis in fungal chronic rhinosinusitis. J Mycol Med 2017; 27:514-518. [PMID: 28827018 DOI: 10.1016/j.mycmed.2017.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 06/20/2017] [Accepted: 07/17/2017] [Indexed: 11/30/2022]
Abstract
Fungi are widely implicated in chronic rhinosinusitis. Direct microscopic examination (DME) is used to confirm the biological diagnosis of fungal rhinosinusitis (FRS). Diagnostic sensitivity of DME is better than culture, however DME does not allow fungal species identification. In this study, we included 54 sinus samples demonstrating hyphae on DME. Direct sequencing was compared to culture for the identification of the fungal species. Sequence analysis identified fungi in 81.5% of cases while culture was positive in only 31.5%. The most common genus was Aspergillus and the identified species belonged to section Fumigati or to section Flavi. Among other fungi identified by sequence analysis, Schizophyllum commune was present in three samples attesting to the importance of this Basidiomycetes in FRS. Our results clearly demonstrate the superiority of sequencing compared to culture when performed on specimens with hyphal elements at DME, and contributes to the epidemiological knowledge of fungi involved in FRS.
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Affiliation(s)
- M Sasso
- Laboratoire de parasitologie-mycologie, CHU de Nîmes, place du Pr-Debré, 30029 Nîmes cedex 9, France; Faculté de médecine de Montpellier-Nîmes, université de Montpellier, Montpellier, France
| | - A Barrot
- Laboratoire de parasitologie-mycologie, CHU de Nîmes, place du Pr-Debré, 30029 Nîmes cedex 9, France; Faculté de médecine de Montpellier-Nîmes, université de Montpellier, Montpellier, France
| | - M-J Carles
- Laboratoire de virologie, CHU de Nîmes, Nîmes, France
| | - K Griffiths
- Service biostatistique et technologies de l'information et de la communication, AP-HM, hôpital de la Timone, Marseille, France
| | - P Rispail
- Département de parasitologie-mycologie, CHU de Montpellier, Marseille, France
| | - L Crampette
- Faculté de médecine de Montpellier-Nîmes, université de Montpellier, Montpellier, France; Service d'otorhinolaryngologie, CHU de Montpellier, Marseille, France
| | - B Lallemant
- Faculté de médecine de Montpellier-Nîmes, université de Montpellier, Montpellier, France; Service d'otorhinolaryngologie, CHU de Nîmes, Nîmes, France
| | - L Lachaud
- Laboratoire de parasitologie-mycologie, CHU de Nîmes, place du Pr-Debré, 30029 Nîmes cedex 9, France; Faculté de médecine de Montpellier-Nîmes, université de Montpellier, Montpellier, France.
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Mortuaire G, Michel J, Papon JF, Malard O, Ebbo D, Crampette L, Jankowski R, Coste A, Serrano E. Specific immunotherapy in allergic rhinitis. Eur Ann Otorhinolaryngol Head Neck Dis 2017; 134:253-258. [PMID: 28684084 DOI: 10.1016/j.anorl.2017.06.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Allergic rhinitis is a common condition, with significant impact on quality of life depending on severity and quality of control. Allergen-specific immunotherapy (allergen-SIT) is the only known treatment able to alter the natural course of allergic rhinitis. Although well known to allergologists, it has yet to be fully adopted by the ENT community. This review, based on the most recent meta-analyses and clinical studies, shows that SIT significantly reduces symptoms and medication requirements (nasal corticosteroids, H1-antihistamines) in allergic rhinitis. It can reduce the risk of progression to asthma and, if initiated early enough, of developing new sensitizations. Immunobiological analysis shows an altered inflammatory profile following SIT, with immune tolerance involving T-regulatory lymphocyte induction and IgG production. Sublingual SIT with drops is as effective as subcutaneous SIT and is simpler to use, with less anaphylactic risk. Standardization of trial protocols in terms of treatment response assessment and side effect grading is recommended to improve comparative studies. Sublingual SIT with tablets has recently been introduced, providing a good opportunity for ENT practitioners to adopt the SIT approach in rhinitis triggered by allergy to pollens and, in the near future, to house dust mites.
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Affiliation(s)
- G Mortuaire
- Inserm U995, service d'ORL et de chirurgie cervicofaciale, Lille Inflammation Research International Center, université de Lille, hôpital Huriez, CHU de Lille, 59000 Lille, France.
| | - J Michel
- Service d'ORL et de chirurgie cervicofaciale, CHU Hôpital La Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France
| | - J F Papon
- Service d'ORL et de chirurgie cervicofaciale, Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - O Malard
- Service d'ORL et de chirurgie cervicofaciale, CHU de Nantes, 44000 Nantes, France
| | - D Ebbo
- Groupe hospitalier Paris-Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - L Crampette
- Service d'ORL et de chirurgie cervicofaciale, CHU de Montpellier, 34090 Montpellier, France
| | - R Jankowski
- Service d'ORL et de chirurgie cervicofaciale, CHU Nancy, 54500 Vandœuvre-lès-Nancy, France
| | - A Coste
- Service d'ORL et de chirurgie cervicofaciale, CHU de Créteil, 94000 Créteil, France
| | - E Serrano
- Service d'ORL et de chirurgie cervicofaciale, CHU de Toulouse, 31059 Toulouse, France
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Bequignon E, Vérillaud B, Robard L, Michel J, Prulière Escabasse V, Crampette L, Malard O, Malard O, Crampette L, Achache M, Alaoui Lamrani Y, Ardillon L, Babin E, Bal Dit Sollier C, Bequignon E, Borsik M, Castillo L, Coste A, Debry C, Dessi P, Drouet L, Dufour X, Dupuis-Girod S, Faure F, Gallet P, Guldman R, Houdart E, Jankowski R, Jegoux F, Leble S, Michel J, Mortuaire G, Mouchon E, Page C, Prulière Escabasse V, Robard L, Roux A, Saint Maurice J, Sarlon G, Strunski V, Trevillot V, Vérillaud B, Vironneau P. Guidelines of the French Society of Otorhinolaryngology (SFORL). First-line treatment of epistaxis in adults. Eur Ann Otorhinolaryngol Head Neck Dis 2017; 134:185-189. [DOI: 10.1016/j.anorl.2016.09.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Escabasse V, Bequignon E, Vérillaud B, Robard L, Michel J, Malard O, Crampette L, Malard O, Crampette L, Achache M, Alaoui Lamrani M, Ardillon L, Babin E, Bal Dit Sollier C, Bequignon E, Borsik M, Castillo L, Coste A, Debry C, Dessi P, Drouet L, Dufour X, Dupuis-Girod S, Faure F, Gallet P, Guldman R, Houdart E, Jankowski R, Jegoux F, Leble S, Michel J, Mortuaire G, Mouchon E, Page C, Pruliere Escabasse V, Robard L, Roux A, Saint Maurice J, Sarlon G, Strunski V, Trevillot V, Verillaud B, Vironneau P. Guidelines of the French Society of Otorhinolaryngology (SFORL). Managing epistaxis under coagulation disorder due to antithrombotic therapy. Eur Ann Otorhinolaryngol Head Neck Dis 2017; 134:195-199. [DOI: 10.1016/j.anorl.2016.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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17
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Michel J, Prulière Escabasse V, Bequignon E, Vérillaud B, Robard L, Crampette L, Malard O, Malard O, Crampette L, Achache M, Alaoui Lamrani M, Ardillon L, Babin E, Bal Dit Sollier C, Bequignon E, Borsik M, Castillo L, Coste A, Debry C, Dessi P, Drouet L, Dufour X, Dupuis-Girod S, Faure F, Gallet P, Guldman R, Houdart E, Jankowski R, Jegoux F, Leble S, Michel J, Mortuaire G, Mouchon E, Page C, Pruliere Escabasse V, Robard L, Roux A, Saint Maurice J, Sarlon G, Strunski V, Trevillot V, Verillaud B, Vironneau P. Guidelines of the French Society of Otorhinolaryngology (SFORL). Epistaxis and high blood pressure. Eur Ann Otorhinolaryngol Head Neck Dis 2017; 134:33-35. [DOI: 10.1016/j.anorl.2016.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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18
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Akkari M, Lassave J, Mura T, Gascou G, Pierre G, Cartier C, Garrel R, Crampette L. Atypical presentations of sinonasal inverted papilloma: Surgical management and influence on the recurrence rate. Am J Rhinol Allergy 2016; 30:149-54. [PMID: 26980397 DOI: 10.2500/ajra.2016.30.4288] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Sinonasal inverted papilloma (SNIP), classically, is a unilateral benign tumor of the nasal lateral wall. Numerous variations have been observed, depending on location, bilateral presentation, or association with nasal polyposis. OBJECTIVE The aim of this work was to describe atypical presentations of SNIPs with their management specificities and to assess their influence on the recurrence rate in a large case series. METHODS A retrospective single center study of 110 patients treated for SNIP. Atypical inverted papillomas were identified according to the following criteria: (1) unusual location (frontal, posterior, anterior), (2) bilateral involvement, and (3) association with nasal polyposis. Surgical management was detailed, and the influence of each atypical group on recurrence was assessed by using Kaplan-Meier survival curves and the log-rank test. RESULTS Distribution of atypical presentations was as follows: frontal sinus localization (10.9%); posterior localization, including sphenoid sinus (9%); nasal anterior localization (3.6%); bilateral involvement (3.6%); and nasal polyposis association (10%). The surgical approach was endoscopic (74.5%), external (5.5%), or combined endoscopic and external (20%). Except for nasal anterior localization, all the groups were associated with a higher recurrence rate, without reaching statistical significance. CONCLUSION Recurrence rates for these atypical presentations arise from their specific surgical challenges. The choice of the surgical technique is guided by tumor location and extension, and by the surgeon's experience; the main objective is a complete resection. The endoscopic endonasal approach is the most frequent procedure.
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Affiliation(s)
- Mohamed Akkari
- Department of Ear, Nose and Throat and Head and Neck Surgery, University Hospital Gui de Chauliac, University of Montpellier, Montpellier, France
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Verillaud B, Robard L, Michel J, Pruliere Escabasse V, Béquignon E, Crampette L, Malard O. Guidelines of the French Society of Otorhinolaryngology (SFORL). Second-line treatment of epistaxis in adults. Eur Ann Otorhinolaryngol Head Neck Dis 2016; 134:191-193. [PMID: 27765622 DOI: 10.1016/j.anorl.2016.09.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The authors present the guidelines of the French Oto-Rhino-Laryngology - Head and Neck Surgery Society (Société Française d'Oto-Rhino-Laryngologie et de Chirurgie de la Face et du Cou: SFORL) on second-line treatment of epistaxis in adults, after failure of anterior and/or anterior-posterior nasal packing. METHODS A multidisciplinary work group was entrusted with a review of the scientific literature on the above topic. Guidelines were drawn up, based on the articles retrieved and the group members' individual experience. They were then read over by an editorial group independent of the work group. The final version was established in a coordination meeting. The guidelines were graded as A, B, C or expert opinion, by decreasing level of evidence. RESULTS Arterial embolization should be performed by an experienced interventional neuroradiologist with adequate technical facilities, to reduce the risk of complications. Cerebral and supra-aortic vessel CT angiography should be performed in case of post-traumatic epistaxis with suspected internal carotid injury. In case of persistent bleeding despite endoscopic hemostasis of the sphenopalatine artery, anterior ethmoidal artery hemostasis should be performed via a medial canthal incision, with endoscopic assistance as needed. In case of persistent epistaxis despite the usual surgical and neuroradiological procedures, surgical exploration of the sinonasal cavities should be performed, with elective coagulation in case of bleeding from secondary branches, and/or ethmoidectomy in case of diffuse bleeding. A decision-tree was drawn up for the management of second-line treatment of epistaxis.
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Affiliation(s)
- B Verillaud
- Service d'ORL, Hôpital Lariboisière, AP-HP, Université Paris 7, 2, Rue Ambroise Paré, 75010 Paris, France.
| | - L Robard
- Service d'ORL, CHU Côte de Nacre, Caen, France
| | - J Michel
- Service d'ORL, APHM CHU Timone, Université d'Aix-Marseille, Marseille, France
| | - V Pruliere Escabasse
- Service d'ORL, Hôpitaux H. Mondor (Assistance Publique Hôpitaux de Paris) et Centre Hospitalier Intercommunal de Créteil, Paris, France
| | - E Béquignon
- Service d'ORL, Centre Hospitalier Intercommunal de Créteil, Université Paris Est Créteil, Créteil, France
| | - L Crampette
- Service d'ORL, CHU Gui de Chauliac, Montpellier, France
| | - O Malard
- Service ORL, CHU de Nantes, Nantes, France
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Garrel R, Jouzdani E, Costes V, Makeieff M, Crampette L, Guerrier B. About the Existence of a Foraminal Laryngeal Cyst. Otolaryngol Head Neck Surg 2016; 133:641. [PMID: 16213950 DOI: 10.1016/j.otohns.2004.09.079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2004] [Accepted: 09/21/2004] [Indexed: 10/25/2022]
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Garrel R, Jouzdani E, Gardiner Q, Makeieff M, Mondain M, Hagen P, Crampette L, Guerrier B. Fourth Branchial Pouch Sinus: From Diagnosis to Treatment. Otolaryngol Head Neck Surg 2016; 134:157-63. [PMID: 16399198 DOI: 10.1016/j.otohns.2005.05.653] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2004] [Indexed: 11/26/2022]
Abstract
BACKGROUND: Fourth branchial pouch sinus (FBPS) is rare and frequently unknown to clinicians. Misdiagnosis is common and definitive surgery is often made difficult by previous episodes of infection and failed attempts at excision. The purpose of this paper is to clarify the diagnostic criteria and the methods used for the surgical management of FBPS. MATERIALS AND METHOD: From a series of 265 head and neck cysts and fistulae, 7 cases of FBPS were retrospectively reviewed. The surgical technique is detailed. RESULTS: Six cases were located on the left side and one on the right. CT scanning showed an air-filled structure on both sides of the lesser horn of the thyroid cartilage in 2 cases out of 4, and barium swallow found a FBPS in 1 case out of 3. Direct pharyngoscopy allowed confirmation of the diagnosis in all cases and permitted catheterization of the tract with the spring guidewire of a vascular catheter which helped surgical location and subsequent dissection. The recurrent laryngeal nerve was systematically dissected to avoid inadvertent damage. A hemi-thyroidectomy was performed in one case. A transient laryngeal paralysis (lasting 9 months) was noted in a 3-week-old newborn operated on. None of the 7 cases had a recurrence after complete resection of the FBPS (3.7 years average follow-up). CONCLUSION: Symptoms on the right side do not exclude the diagnosis of a FBPS. Endoscopy is the key investigation. It allows confirmation of the diagnosis and catheterization of the tract, which aids the surgical dissection. Total removal of the sinus tract tissue with dissection and preservation of the recurrent laryngeal nerve is recommended. EBM rating: A-1
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Affiliation(s)
- Renaud Garrel
- Department of Otolaryngology-Head and Neck Surgery "A", CHU Gui de Chauliac, 34295 Montpellier, France.
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Garrel R, Bartolomeo M, Makeieff M, Crampette L, Guerrier B, Cartier C. Interest of video-assisted minimally invasive surgery in primary hyperparathyroidism. Eur Ann Otorhinolaryngol Head Neck Dis 2016; 133:247-51. [PMID: 27133292 DOI: 10.1016/j.anorl.2016.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Surgery is the only radical and definitive treatment for primary hyperparathyroidism. Exploration of the four parathyroid sites is giving way to minimally invasive techniques. The present study sought to compare two minimally invasive parathyroidectomy techniques, by classical cervicotomy (MIP-C) and by video-assistance (MIP-VA), in terms of success rate, complications rate, operating time, and patient and community physician satisfaction. MATERIALS AND METHOD A non-randomized retrospective comparative study included 112 patients presenting with primary hyperparathyroidism with identified parathyroid adenoma, operated on between January 2005 and October 2010. The two groups were constituted according to the surgeons' habitual practice: 54 cases of MIP-VA and 58 of MIP-C. RESULTS Results for MIP-VA and MIP-C were respectively: success, 96.3% vs. 100% (P=0.09); mean scar size, 1.47 vs. 3.43cm (P<0.01); hypocalcemia, 2 vs. 3 cases (P=0.1); theater time, 94.25 vs. 76min (P=0.02); and postoperative stay, 1.08 vs. 1.37 days (P=0.07). Patient satisfaction was comparable between groups, while 93.3% of community physicians found MIP-VA preferable to MIP-C, although only 39.3% had known the MIP-VA technique. CONCLUSION With efficacy, morbidity and patient satisfaction comparable to classical surgery, MIP-VA significantly reduced cervicotomy size and hospital stay. Community physicians considered it to be preferable to MIP-C.
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Affiliation(s)
- R Garrel
- Département d'ORL et CCF, Hôpital Guide-Chauliac, Pôle Neuroscience Tête et Cou, CHRU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 05, France.
| | - M Bartolomeo
- Département d'ORL et CCF, Hôpital Guide-Chauliac, Pôle Neuroscience Tête et Cou, CHRU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 05, France
| | - M Makeieff
- Département d'ORL et CCF, Hôpital Guide-Chauliac, Pôle Neuroscience Tête et Cou, CHRU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 05, France
| | - L Crampette
- Département d'ORL et CCF, Hôpital Guide-Chauliac, Pôle Neuroscience Tête et Cou, CHRU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 05, France
| | - B Guerrier
- Département d'ORL et CCF, Hôpital Guide-Chauliac, Pôle Neuroscience Tête et Cou, CHRU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 05, France
| | - C Cartier
- Département d'ORL et CCF, Hôpital Guide-Chauliac, Pôle Neuroscience Tête et Cou, CHRU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 05, France
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Akkari M, Gascou G, Trévillot V, Bonafé A, Crampette L, Machi P. Endovascular management of a carotid aneurysm into the sphenoid sinus presenting with epistaxis. Interv Neuroradiol 2015; 21:660-3. [PMID: 26494406 DOI: 10.1177/1591019915609164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 08/09/2015] [Indexed: 11/17/2022] Open
Abstract
Non-traumatic cavernous internal carotid artery (ICA) aneurysms are rare, and favour the occurrence of massive recurrent epistaxis, which is associated with a high mortality rate. We report the case of a 67-year-old woman presenting a ruptured ICA aneurysm extending into the sphenoid sinus, revealed by epistaxis. Selective coil embolization of the aneurysm was performed. Flow-diverter stents were deployed in order to utterly exclude the aneurysm and prevent revascularization. Anti-platelet treatment was provided to lower the risk of in-stent thrombosis. A left frontal hematoma associated with a subarachnoid haemorrhage occurred at day 2. Outcome was favourable with no neurological sequelae, and no clinical recurrence of epistaxis occurred. A 4 months follow-up digital subtraction angiography showed a complete exclusion of the aneurysm. In addition, a magnetic resonance cerebral angiography at 16 months showed stable results. Thus, this two-stage endovascular procedure has proven its effectiveness in preventing epistaxis recurrence while preserving the ICA patency.
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Affiliation(s)
- Mohamed Akkari
- ENT and Head and Neck Surgery Department, University Hospital Gui de Chauliac, University of Montpellier, France
| | - Grégory Gascou
- Neuroradiology Department, University Hospital Gui de Chauliac, University of Montpellier, France
| | - Vincent Trévillot
- ENT and Head and Neck Surgery Department, University Hospital Gui de Chauliac, University of Montpellier, France
| | - Alain Bonafé
- Neuroradiology Department, University Hospital Gui de Chauliac, University of Montpellier, France
| | - Louis Crampette
- ENT and Head and Neck Surgery Department, University Hospital Gui de Chauliac, University of Montpellier, France
| | - Paolo Machi
- Neuroradiology Department, University Hospital Gui de Chauliac, University of Montpellier, France
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Prulière-Escabasse V, Michel J, Percodani J, Serrano E, Gilain L, Crampette L, Jankowski R, Stoll D, de Gabory L. Consensus document for prescription of nebulization in rhinology. Eur Ann Otorhinolaryngol Head Neck Dis 2014; 131:371-374. [DOI: 10.1016/j.anorl.2014.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 07/31/2014] [Indexed: 10/24/2022]
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Vergez S, du Mayne MD, Coste A, Gallet P, Jankowski R, Dufour X, Righini C, Reyt E, Choussy O, Serrano E, Crampette L, Debry C, de Gabory L. Multicenter study to assess endoscopic resection of 159 sinonasal adenocarcinomas. Ann Surg Oncol 2013; 21:1384-90. [PMID: 24264517 DOI: 10.1245/s10434-013-3385-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Indexed: 11/18/2022]
Abstract
PURPOSE This study was designed to assess the efficacy and morbidity of the endoscopic endonasal approach for the treatment of sinonasal adenocarcinomas. METHODS This was a retrospective, multicenter study of nine French tertiary referral centers, including untreated patients. All patients were operated by an endoscopic approach. Tumors were classified according to the UICC 2002. Demographic, therapeutic, histological, morbidity data, and the course of the disease were recorded. Survival rates were obtained using the Kaplan-Meier method. RESULTS A total of 159 patients were included with a mean age of 69 years. There were 19T1, 62T2 (1M1), 36T3 (1N1), 26T4a, and 16T4b (1N2a-1N2c). The mean duration of hospitalization was 4.4 days. The histologic outcomes showed that the olfactory cleft, the posterior and anterior ethmoid sinus, and the sphenoid, maxillary, and frontal sinuses were invaded in 95, 64, 55, 19, 7, and 3 % of cases, respectively. Histologic margins were positive in 17 % (1T1, 4T2, 3T3, 2T4a, and 8T4b). In total, 130 patients received adjuvant radiotherapy on the primary tumor site (58 Gy), 24 cases were not irradiated, and 5 refused treatment. The mean follow-up was 32.5 ± 24 months. The complication rate was 19 %: 6 epistaxis, 3 meningitis, 6 CSF leaks, 2 dacryocystitis, and 8 septoplasties. The recurrence rate was 17.6 % (28 cases) within 23 ± 21 months. Eleven patients underwent a second surgical procedure. Nine patients died of their disease (3T2, 2T3, 4T4b). The global and disease-specific, recurrence-free survival rate at 3 years was 74 and 84 % respectively. CONCLUSIONS The endoscopic approach seems to be efficient to remove sinonasal adenocarcinoma with low morbidity.
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Affiliation(s)
- Sebastien Vergez
- Otorhinolaryngology, Head and Neck Surgery Department, University Hospital Rangueil-Larrey, Toulouse, France
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Trévillot V, Sobral R, Dombre E, Poignet P, Herman B, Crampette L. Innovative endoscopic sino-nasal and anterior skull base robotics. Int J Comput Assist Radiol Surg 2013; 8:977-87. [PMID: 23568018 DOI: 10.1007/s11548-013-0839-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 03/25/2013] [Indexed: 11/24/2022]
Abstract
PURPOSE Design a compact, ergonomic, and safe endoscope positioner dedicated to the sino-nasal tract, and the anterior and middle-stage skull base. METHODS A motion and force analysis of the surgeon's movement was performed on cadaver heads to gather objective data for specification purposes. An experimental comparative study was then performed with three different kinematics, again on cadaver heads, in order to define the best architecture satisfying the motion and force requirements. RESULTS We quantified the maximal forces applied on the endoscope when traversing the sino-nasal tract in order to evaluate the forces that the robot should be able to overcome. We also quantified the minimal forces that should not be exceeded in order to avoid damaging vital structures. We showed that the entrance point of the endoscope into the nostril could not be considered, as in laparoscopic surgery, as a fixed point but rather as a fixed region whose location and dimensions depend on the targeted sinus. CONCLUSION From the safety and ergonomic points of view, the best solution would be a co-manipulated standard 6-degree of freedom robot to which is attached a gimbal-like passive remote manipulator holding the endoscope.
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Affiliation(s)
- Vincent Trévillot
- LIRMM, UMR 5506, CNRS-Université Montpellier 2, 161 Rue Ada, 34095 , Montpellier Cedex 05, France
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Makeieff M, Burcia V, Raingeard I, Eberlé M, Cartier C, Garrel R, Crampette L, Guerrier B. Positron emission tomography–computed tomography evaluation for recurrent differentiated thyroid carcinoma. Eur Ann Otorhinolaryngol Head Neck Dis 2012; 129:251-6. [DOI: 10.1016/j.anorl.2012.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Revised: 01/10/2012] [Accepted: 01/12/2012] [Indexed: 11/16/2022]
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Gari-Toussaint M, Lachaud L, Pihet M, Rispail P, Castillo L, Crampette L, Bouchara JP. Sinusite récidivante due à Schizophyllum commune . À propos de deux nouveaux cas. J Mycol Med 2011. [DOI: 10.1016/j.mycmed.2011.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Garrel R, Tripodi C, Cartier C, Makeieff M, Crampette L, Guerrier B. Cervical lymphadenopathies signaling thyroid microcarcinoma. Case study and review of the literature. Eur Ann Otorhinolaryngol Head Neck Dis 2011; 128:115-9. [PMID: 21333620 DOI: 10.1016/j.anorl.2010.11.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Accepted: 11/29/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND Some lateral cervical lymphadenopathies may lead to the discovery of papillary microcarcinomas (PMC) of the thyroid that are not radiologically apparent. This relatively rare clinical situation raises questions about the diagnostic approach to chronic cervical lymphadenopathy and the impact of lymph node metastasis on PMC prognosis. PURPOSE OF THE ARTICLE: To study the epidemiologic, clinical, and prognostic criteria of cases of lymphadenopathy that signaled PMC. PATIENTS AND METHODS A retrospective study of 167 consecutive cases of PMC compared with 13 cases where a cervical mass signaled other forms of PMC. RESULTS The mean age was 48.5 years, the ratio of men to women was 5:8, and the mean PMC size was 5.5mm. These data did not differently significantly from those of the other PMC cases. The preoperative imaging found fluid content in six cases, with microcalcifications in three cases. All cases were treated by modified radical neck dissection on the side with the lymphadenopathy and total thyroidectomy with central neck dissection. The lymphadenopathy included a ruptured capsule in five cases and was accompanied by central lymph node metastases in three cases. Thyroid capsule involvement was significantly more common in cases of PMC discovered due to lymphadenopathy than in other cases of PMC (69% versus 9.7%, respectively; p<0.001). The mean follow-up was 7.3 years. There were no deaths due to PMC signaled by lymphadenopathy. Two cases of lymph node recurrence after 8 and 10 years were controlled by another surgery and radioactive iodine treatment. CONCLUSION Any chronic cervical mass should suggest the possibility of thyroid origin, especially in cases with cystic content or microcalcifications in subjects with no particular risk factors. An ultrasound of the thyroid should be done, as well as a fine needle aspiration biopsy of the lymphadenopathy with a thyroglobulin assay. Treatment is the same as for any thyroid carcinoma, and results in a good oncological outcome, despite the possibility of lymph node recurrences.
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Affiliation(s)
- R Garrel
- Pôle Neuroscience Tête et Cou, Département ORL et Chirurgie Cervico Faciale, CHRU Gui-de-Chauliac, 34280 Montpellier, France.
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Trévillot V, Dombre E, Poignet P, Sobral R, Tempier O, Herman B, Garrel R, Crampette L. Primary step for endoscopic sinonasal tract and anterior skull base robotics. BIO Web of Conferences 2011. [DOI: 10.1051/bioconf/20110100090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Blumen M, Crampette L, Fischler M, Galet de Santerre O, Jaber S, Larzul JJ, Meyer B, Monteyrol PJ, Payen JF, Pételle B, Rugina M, Chabolle F. Traitement chirurgical du SAHOS. Rev Mal Respir 2010; 27 Suppl 3:S157-65. [DOI: 10.1016/s0761-8425(10)70021-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Makeieff M, Pelliccia P, Letois F, Mercier G, Arnaud S, César C, Garrel R, Crampette L, Guerrier B. Recurrent Pleomorphic Adenoma: Results of Surgical Treatment. Ann Surg Oncol 2010; 17:3308-13. [DOI: 10.1245/s10434-010-1173-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Indexed: 11/18/2022]
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Jouzdani E, Yachouh J, Costes V, Faillie JL, Cartier C, Poizat F, Pierre G, Burcia V, Makeieff M, Crampette L, Guerrier B, Garrel R. Prognostic value of a three-grade classification in primary epithelial parotid carcinoma: result of a histological review from a 20-year experience of total parotidectomy with neck dissection in a single institution. Eur J Cancer 2010; 46:323-31. [PMID: 19931448 DOI: 10.1016/j.ejca.2009.10.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Accepted: 10/09/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND The tumour grading of primary parotid cancers (PPCs) remains controversial. METHODS A 20-year standardised single centre treatment has been assessed retrospectively. The histological review of 155 consecutively treated parotid malignancies identified 96 suitable cases for univariate and multivariate survival analyses. RESULTS Treatment involved total parotidectomy, neck dissection and post-operative radiotherapy in, respectively, 91.7%, 83.3% and 70.4% of cases. The 5-year overall survival, disease-specific and recurrence-free survival rates were 79.4%, 83.5% and 70.8%, respectively. Univariate analysis confirmed the classical prognostic factors, i.e. age>60 years, male gender, facial palsy, hardness of the tumour, clinical stage, tumour grade, facial nerve invasion and lymph node metastases. Multivariate analysis identified a three-grade classification just after the clinical stage as the most important prognostic factor. CONCLUSION This study identifies the prognostic significance of intermediate grade tumours.
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Affiliation(s)
- Elham Jouzdani
- Head and Neck Surgery Department, Gui de Chauliac Hospital, Montpellier University Hospital Center, France
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Burcia V, Costes V, Faillie JL, Gardiner Q, de Verbizier D, Cartier C, Jouzdani E, Crampette L, Guerrier B, Garrel R. Neck restaging with sentinel node biopsy in T1-T2N0 oral and oropharyngeal cancer: Why and how? Otolaryngol Head Neck Surg 2010; 142:592-7.e1. [DOI: 10.1016/j.otohns.2009.12.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Revised: 12/05/2009] [Accepted: 12/08/2009] [Indexed: 10/19/2022]
Abstract
Objective: To evaluate the lack of accuracy in neck staging with the classical technique (i.e., neck dissection and routine histopathology) with the sentinel node (SN) biopsy in oral and oropharyngeal T1-T2N0 cancer. Study Design: Cross-sectional study with planned data collection. Setting: Tertiary center care. Subjects and Methods: In 50 consecutive patients, the pathological stage of sentinel node (pSN) was established after analyzing SN biopsies (n = 148) using serial sectioning and immunohistochemistry. Systematic selective neck dissection was performed. The pN stage was established with routine histopathologic analysis of both the non-SN (n = 1075) and the 148 SN biopsies. Results: The sensitivity and negative predictive value of pSN staging were 100 percent. Conversely, if one considers pSN staging procedure as the reference test for micro- and macro-metastasis diagnosis, the sensitivity of the classical pN staging procedure was 50 percent (9/1; 95% CI 26.9-73.1) and its negative predictive value was 78 percent (95% CI 61.9-88.8). Fifteen patients (30%) were upstaged, including nine cases from pN0 to pSN ≥ 1 and six cases from pN1 to pSN2. Two of the pN0-pSN1 upstaged patients died with relapsed neck disease. Conclusion: The SN biopsy technique appeared to be the best staging method in cN0 patients and provided evidence that routinely undiagnosed lymph node invasion may have clinical significance.
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Affiliation(s)
- Vincent Burcia
- Head and Neck Surgery Department, Gui de Chauliac Hospital, Montpellier University Hospital Center, Montpellier, France
| | - Valérie Costes
- Pathology Department, Gui de Chauliac Hospital, Montpellier University Hospital Center, Montpellier, France
| | - Jean Luc Faillie
- Medical Statistics Department, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, Montpellier, France
| | - Quentin Gardiner
- Department of Otolaryngology, Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Delphine de Verbizier
- Nuclear Medicine Department, Gui de Chauliac Hospital, Montpellier University Hospital Center, Montpellier, France
| | - César Cartier
- Head and Neck Surgery Department, Gui de Chauliac Hospital, Montpellier University Hospital Center, Montpellier, France
| | - Elham Jouzdani
- Head and Neck Surgery Department, Gui de Chauliac Hospital, Montpellier University Hospital Center, Montpellier, France
| | - Louis Crampette
- Head and Neck Surgery Department, Gui de Chauliac Hospital, Montpellier University Hospital Center, Montpellier, France
| | - Bernard Guerrier
- Head and Neck Surgery Department, Gui de Chauliac Hospital, Montpellier University Hospital Center, Montpellier, France
| | - Renaud Garrel
- Head and Neck Surgery Department, Gui de Chauliac Hospital, Montpellier University Hospital Center, Montpellier, France
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Poizat F, Gonzalez AM, Raynaud P, Baldet P, Garrel R, Crampette L, Costes V. [Adenocarcinomas of nasal cavities and paranasal sinuses: Diagnostic pitfalls in sinonasal glandular lesions]. Ann Pathol 2009; 29:286-95. [PMID: 19900634 DOI: 10.1016/j.annpat.2009.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Accepted: 07/22/2009] [Indexed: 01/05/2023]
Abstract
Among primitive adenocarcinoma of nasal cavity and paranasal sinus, the 2005 WHO classification distinguishes two main categories: intestinal type adenocarcinoma (ITAC) and low-grade non-intestinal adenocarcinoma, entities with different clinical and epidemiological characteristics. Low-grade adenocarcinoma shows a respiratory type phenotype (CK20-/CK7+/CDX2-/villin-) and ITACs, an intestinal type profile (CK20+/CK7-/CDX2+/villin+). Because of histological, ultrastructural and phenotypical similarities between ITAC and colorectal adenocarcinomas, several studies have discussed a possible common pathway in carcinogenesis. But the review of literature shows conflicting results, suggesting different pathways of pathogenesis. Differential diagnoses of sinonasal intestinal-type adenocarcinoma are mainly respiratory epithelial adenomatoid hamartomas, inverted schneiderian papillomas, salivary glands-type carcinoma and more rarely metastasis of adenocarcinoma.
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Affiliation(s)
- Flora Poizat
- Service d'anatomie et cytologie pathologique, hôpital Gui-de-Chauliac, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France.
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El Ayoubi A, Poizat F, Garrel R, Costes V, Guerrier B, Essakalli L, Kzadri M, Crampette L. Les adénocarcinomes nasosinusiens revisités. Intérêt pronostique de la classification histologique OMS 2005. ACTA ACUST UNITED AC 2009; 126:175-81. [DOI: 10.1016/j.aorl.2009.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Accepted: 06/04/2009] [Indexed: 11/28/2022]
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Cartier C, Jouzdani E, Garrel R, Makeieff M, Crampette L, Guerrier B. [Study of the platysma coli muscle vascularisation by the facial artery. Implication during the elevation of the musculo-cutaneous platysma coli muscle flap]. Rev Laryngol Otol Rhinol (Bord) 2009; 130:139-144. [PMID: 20345068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
AIM OF THE STUDY The purpose of this study was to assess the vascularity of the platysma muscle by the branches of the facial artery, in order to determine the best means of harvesting a musculo-cutaneous flap while ensuring maximum vascular security. PATIENTS AND METHODS Ten platysma muscles were dissected on 4 fresh specimens and one formaldehyde-preserved specimen. The dissection was performed after injection of the facial artery in 6 cases, while 4 muscles were dissected without any previous injection. RESULTS The vascular supply of the platysma muscle comes essentially from the branches of the submental artery and from branches descending straight from the facial artery. Other collateral branches contribute to this vascularization, but their importance is minor. All these arteries reach the muscle, entering its visceral aspect, then proceed to the sternal notch in a radial axis. CONCLUSION The size of the flap has to be defined within a quadrilateral figure with its base formed by the mandibular edge and its apex by the inferior limit of the flap. It is essential to preserve the maximum possible muscular thickness, especially on the medial side of the flap. If the facial artery needs to be ligated, this has to be done as it enters the submandibular space in order to protect most of the collateral branches destined to the muscle. The vascularization is then taken back by the homo- and contro-lateral facial vascularisation in an inverted flow in the remaining segment of the facial artery.
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Affiliation(s)
- C Cartier
- Hôpital Gui de Chauliac, Service O.R.L et Chirurgie Cervico-Faciale, Av Augustin Fliche, 34090 Montpellier, France.
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Abstract
CONCLUSION Endoscopic surgical management is recommended as a viable treatment option for sinonasal papilloma, with comparable results to those treated by an external approach. An external approach is still indicated in cases where the papilloma is not accessible endoscopically, or where there is extrasinus invasion. Long-term follow-up is essential for recurrence detection. OBJECTIVES The goal of this study was to highlight our experience with endoscopic surgery for the management of sinonasal papilloma. PATIENTS AND METHODS A retrospective study of all patients who underwent endoscopic surgery for the treatment of sinonasal papilloma over a 12 year period at the Gui de Chauliac Hospital, Montpellier, France. RESULTS A total of 55 patients were included in this study; 32 patients (58%) were treated exclusively by an endoscopic approach and 23 (42%) were treated by a combined approach. Minimal follow-up was 3 years. The overall recurrence rate was 7%. All recurrences occurred at the initial site and the average delay between surgery and recurrence was 30 months (14 months to 4 years).
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Garrel R, Costes V, Drommard M, Barbotte E, Cartier C, Makeieff M, Crampette L, Guerrier B, Maudelonde T, Boulle N. Evaluation of the diagnostic accuracy of RT-PCR quantification of cytokeratin mrna in the detection of sentinel lymph node invasion in oral and oropharyngeal squamous cell carcinoma: A comparison with immunohistochemistry. Radiother Oncol 2007. [DOI: 10.1016/s0167-8140(07)80074-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bozzo C, Garrel R, Meloni F, Stomeo F, Crampette L. Endoscopic treatment of antrochoanal polyps. Eur Arch Otorhinolaryngol 2006; 264:145-50. [PMID: 17013627 DOI: 10.1007/s00405-006-0175-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2006] [Accepted: 08/22/2006] [Indexed: 10/24/2022]
Abstract
The antrochoanal polyp (Killian polyp) is an infrequent, benign neoplasm, which arises from the maxillary sinus to reach the ipsilateral choana. The treatment of this disease is essentially surgical, by means of a wide antrostomy. The aim of the study was to compare the results obtained on 23 consecutive cases of antrochoanal polyps endoscopically treated between February 1997 and January 2000 with those reported in the literature, with particular regard to the surgical technique adopted, the histological features, the patterns of its development and the clinical outcomes. The histology revealed in most of the cases a cystic aspect surrounded by edematous stroma. In all cases the polyp emerged from the middle meatus, mostly starting from the upper-lateral (zygomatic) wall of the antrum. All patients were endoscopically followed-up for an average period of 39 months (17-61). We observed two recurrences, both in pediatric cases who evidently underwent an incomplete surgical removal of antral mucosa at its inferior aspect, probably due to the fear of damaging the teeth buds. We did not observe any postsurgical complication. Our data indicate the endoscopic middle meatal antrostomy as the optimal approach, also for the revision cases and in children.
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Affiliation(s)
- Corrado Bozzo
- Clinica ORL, Università degli Studi di Sassari, Sassari, Italy.
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Garrel R, Dromard M, Costes V, Barbotte E, Comte F, Gardiner Q, Cartier C, Makeieff M, Crampette L, Guerrier B, Boulle N. The Diagnostic Accuracy of Reverse Transcription-PCR Quantification of Cytokeratin mRNA in the Detection of Sentinel Lymph Node Invasion in Oral and Oropharyngeal Squamous Cell Carcinoma: A Comparison with Immunohistochemistry. Clin Cancer Res 2006; 12:2498-505. [PMID: 16638858 DOI: 10.1158/1078-0432.ccr-05-2136] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The main goal of sentinel lymph node (SLN) detection in head and neck squamous cell carcinomas is to limit neck dissections to pN+ cases only. However, intraoperative + diagnosis cannot be routinely done using the current gold standard, serial step sectioning with immunohistochemistry. Real-time quantitative reverse transcription-PCR (RT-PCR) is potentially compatible with intraoperative use, proving highly sensitive in detecting molecular markers. This study postoperatively assessed the accuracy of quantitative RT-PCR in staging patients from their SLN. EXPERIMENTAL DESIGN A combined analysis on the same SLN by serial step sectioning with immunohistochemistry and quantitative RT-PCR targeting cytokeratins 5, 14, and 17 was done in 18 consecutive patients with oral or oropharyngeal squamous cell carcinoma and 10 control subjects. RESULTS From 71 lymph nodes examined, mRNA levels (KRT) were linked to metastasis size for the three cytokeratins studied (Pearson correlation coefficient, r = 0.89, 0.73, and 0.77 for KRT 5, 14, and 17 respectively; P < 0.05). Histopathology-positive SLNs (macro- and micrometastases) showed higher mRNA values than negative SLNs for KRT 17 (P < 10(-4)) and KRT 14 (P < 10(-2)). KRT 5 showed nonsignificant results. KRT 17 seemed to be the most accurate marker for the diagnosis of micrometastases of a size >450 mum. Smaller micrometastases and isolated tumor cells did not provide results above the background level. Receiver operating characteristic curve analysis for KRT 17 identified a cutoff value where patient staging reached 100% specificity and sensitivity for macro- and micrometastases. CONCLUSION Quantitative RT-PCR for SLN staging in cN(0) patients with oral and oropharyngeal squamous cell carcinoma seems to be a promising approach.
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Affiliation(s)
- Renaud Garrel
- Departments of Head and Neck Surgery, Montpellier Teaching Hospital, Montpellier, France.
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Chevillard C, Rugina M, Bonfils P, Bougara A, Castillo L, Crampette L, Pandraud L, Samardzic M, Peynègre R. Evaluation of calcium alginate nasal packing (Algostéril) versus Polyvinyl acetal (Merocel) for nasal packing after inferior turbinate resection. Rhinology 2006; 44:58-61. [PMID: 16550952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Nasal packing is commonly used to control postoperative bleeding in patients undergoing endonasal surgical procedures. Bleeding and pain on packing removal are frequently reported. The principal objective of this study was to investigate the efficacy and safety of Algosteril to control post-operative nasal bleeding. The secondary objective was to assess nasal bleeding and pain on packing removal, and to evaluate the endoscopic appearance of nasal mucosa 9 days after the procedure. This open, multicenter, randomized, controlled study was conducted on 50 patients undergoing partial bilateral inferior turbinectomy, packed with Algosteril on one side versus Polyvinyl acetal tampon (Merocel) on the other side following a left/right randomization. Both nasal packs effectively prevented post-operative bleeding. However, bleeding on packing removal was statistically less frequent and less severe with Algosteril than with Polyvinyl acetal (p = 0.016). In addition, pain was statistically lower with Algosteril than with Polyvinyl acetal (p = 0.0001). A trend to a better healing of the wound on day 9 was observed with Algosteril, leading us to further investigations. Algosteril nasal packing is as effective as Polyvinyl acetal in preventing postoperative bleeding following partial inferior turbinate resection. Its removal, however, is less traumatic for the nasal mucosa and less painful for the patient, therefore improving patient's comfort.
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Abstract
OBJECTIVES Surgery of recurrent pleomorphic adenoma (RPA) is known to lead to a high facial nerve complication rate. The efficacy of the continuous facial nerve monitoring (CFNM) technique remains to be proven in RPA surgery. The goal was thus to evaluate facial nerve palsy rates and the recovery period after parotidectomy for RPA using CFNM by way of continuous electromyography and to compare these rates and the operation time with those of patients who had undergone surgery without facial nerve monitoring. DESIGN Cohort study. PATIENTS Forty-seven patients were referred for RPA (1981-2003). Among them, 32 (18 unmonitored and 14 monitored) patients displayed no preoperative facial palsy, and histologic analyses revealed evidence of recurrence. The operation time and the extent and duration of postoperative facial nerve palsy were examined in both groups (monitored vs. unmonitored). Both groups had a similar clinical appearance distribution. RESULTS Facial nerve paralysis was estimated using the House-Brackmann grading scale. CFNM reduced the intensity of facial nerve paralysis independently of the kind of surgery performed. The complete deficit rates were 0% for the monitored group and 5.6% for the unmonitored group. Postoperative facial nerve paralysis was significantly lower (P = .01) in the monitored group than in the unmonitored group. CFNM improved the duration of facial paralysis (P = .001) in the monitored group. The operation time was significantly lower in the monitored group than in the unmonitored group (P = .001). CONCLUSIONS Routine use of CFNM during RPA surgery improves the surgical outcome. The facial nerve deficit can be reduced, and the recovery of facial nerve function is faster.
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Affiliation(s)
- Marc Makeieff
- Service ORL Chirurgie Cervico-Faciale, CHU Montpellier, Montpellier, France.
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Abstract
BACKGROUND Conservation of laryngeal function is a key surgical objective in cases of limited recurrence after previously irradiated T1b or T2 glottic carcinoma. Only a few articles have mentioned the use of supracricoid partial laryngectomies (SCPL) to treat recurrent T1/T2 tumors that cannot be managed with vertical partial laryngectomy. OBJECTIVES To evaluate oncologic and functional results of SCPL in selected cases of T1/T2 glottic carcinoma recurrence after primary irradiation therapy. METHOD Between 1986 and 2000, 23 selected patients (T1b, 12 cases; T2, 11 cases) underwent SCPL as salvage treatment: cricohyoidepiglottopexy (CHEP) in 18 cases and cricohyodopexy (CHP) in 5 cases. RESULTS The mean cannulation time was 28 (14-90) days. The mean nasogastric feeding tube time for CHP and CHEP was 55 (28-96) days and 21 (9-45) days, respectively. Four (17.4%) patients had major swallowing recovery problems. Three patients died in the postoperative period, one of intercurrent disease and two because of aspiration pneumonia. Six (26.08%) patients relapsed and underwent total laryngectomy. Three were subsequently controlled. The T stage was correlated with the onset of a new recurrence (P = .0258). The surgical margins were not correlated with recurrence (P = .0741). At 3 and 5 years, the global survival rate was 82.9% and 69.04%. The success rate for oncologic control and oncologic control with organ preservation was 74% and 66.6%, respectively. CONCLUSION In selected cases of limited recurrence after radiation therapy for T1/T2 vocal cord carcinomas, SCPL can be an alternative to total laryngectomy when partial vertical surgery appears unsuitable.
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Affiliation(s)
- Marc Makeieff
- Department of Otolaryngology-Head and Neck Surgery, Hopital Gui de Chauliac, University of Medecine, Montpellier 34295, France
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Babin E, Borsik M, Braccard S, Crampette L, Darrouzet V, Faure F, Fontanel JP, Houdart E, Jankowski R, Le Clech G, Malvezzi L, Morinière S, Perie S, Perret J, Pignat JC, Portier F, Serrano E, Plauchu H. [Treatments of hereditary hemorrhagic telangiectasia of the nasal mucosa]. Rev Laryngol Otol Rhinol (Bord) 2005; 126:43-8. [PMID: 16080648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
UNLABELLED Hereditary Hemorrhagic Telangiectasia is a systemic autosomal dominant disorder involving blood vessels. The most common symptom is recurrent epistaxis. The treatments of these epistaxis are numerous but such treatments are often symptomatic and their effects are often not sustained. Some of these treatments may be complicated by visceral vascular malformations. The aim of this study is to propose a treatment plan for these patients with hierarchical organisation of therapeutic options taking into account of their previous therapy. METHOD H. Plauchu organized in Paris, december 2002 a meeting with any medical specialists of this disease. They have analysed variety of therapies that have been proposed for epistaxis control in Hereditary Haemorrhagic Télangiectasia. RESULTS Most common use packing of nasal fossa and then hyperselective embolization of the internal maxillary and facial arteries for severe epistaxis. For chronic epistaxis, best treatment use sclerotics products (Ethibloc) and laser. After discussion, primary embolization could be useful to reduce vascularization of nasal fossa. CONCLUSION Treatment of epistaxis in Hereditary Haemorrhagic Telangiectasia could increase in few years. Use of an index card of for epistaxis in the disease of Rendu-Osler could help to find treatment of choice.
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Affiliation(s)
- E Babin
- CHU, Service ORL et de Chirurgie Cervico-Faciale, Avenue de la Côte de Nacre, F-14033 Caen Cedex 1, France.
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Venail F, Crampette L. [Management of chronic cough by the ENT specialist]. Ann Otolaryngol Chir Cervicofac 2004; 121:322-6. [PMID: 15711470 DOI: 10.1016/s0003-438x(04)95529-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Affiliation(s)
- F Venail
- Service ORL, CHU Gui de Chauliac, 34000 Montpellier
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Meybeck A, Just N, Heurtebise F, Chanez P, Crampette L, Darras J, Wallaert B. [Involvement of the nasal sinuses in sarcoidosis. A prospective study of 63 patients]. Rev Mal Respir 2004; 21:279-86. [PMID: 15211236 DOI: 10.1016/s0761-8425(04)71286-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Sarcoidosis is a diffuse granulomatous inflammatory disorder of unknown aetiology. Involvement of the nasal sinuses has been reported only rarely. METHODS This multicentre prospective study was undertaken on patients suffering from histologically confirmed sarcoidosis between October 2001 and August 2002. It comprised a questionnaire for nasal symptoms, a nasal endoscopy and a CT scan of the nasal sinuses. RESULTS Among the 62 patients enrolled 38 reported at least one nasal sinus symptom. An abnormality of the CT scan was present in 70% of cases. None were specific for sarcoidosis. Rhinoscopy revealed a mucosal lesion in 11 cases. The presence of mucosal nodules on the turbinates was suggestive of sarcoidosis and was proven histologically in 4 cases (6.5%). In these 4 cases there were symptoms of nasal sinus involvement and extensive CT changes. CONCLUSIONS Involvement of the nasal sinuses is rare in the course of sarcoidosis. Anterior rhinoscopy allows diagnosis before the development of typical lesions and also the taking of guided biopsies.
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Affiliation(s)
- A Meybeck
- Clinique des Maladies Respiratoires, Hôpital Albert Calmette, Lille, France
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Piette V, Bousquet C, Kvedariene V, Dhivert-Donnadieu H, Crampette L, Senac JP, Bousquet J, Demoly P. Sinus CT scans and mediator release in nasal secretions after nasal challenge with cypress pollens. Allergy 2004; 59:863-8. [PMID: 15230820 DOI: 10.1111/j.1398-9995.2004.00509.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Involvement of paranasal sinuses has been suggested in allergic rhinitis but not clearly demonstrated. AIMS To investigate the relationship between intermittent allergic rhinitis and computerized tomography (CT). METHODS Twenty patients with intermittent rhinitis and sensitized to cypress pollens underwent unilateral nasal provocation tests (NPTs) using increasing concentrations of cypress pollens out of the pollen season. Sinus CT-scans were carried out just before a NPT and 24 h later. Nasal lavage was carried out just before a NPT, 30 min after a positive challenge and again 24 h later. Leucotriene C4/D4, intracellular adhesion molecule-1 and eosinophil cationic protein were measured in nasal secretions. RESULTS Thirteen patients (65%) showed an alteration in their CT-scans after allergen challenge. Ten of them showed sinus changes controlateral to their allergenic provocation. Radiological changes mainly affected the osteomeatal complex and the ethmoid sinuses. Pre-existing abnormalities (13 of 20 cases) mainly concerned the maxillary sinuses. There was no correlation between CT-scan abnormalities and levels of mediators released in nasal secretions. CONCLUSIONS We have shown that nasal allergen challenge can produce radiological changes in the paranasal sinuses. This mainly concerned the ethmoid sinuses.
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Affiliation(s)
- V Piette
- Maladies Respiratoires, INSERMU454, IFR3, Hôpital Arnaud de Villeneuve, CHU Montpellier, 34295 Montpellier Cedex 5, France
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Raherison C, Montaudon M, Stoll D, Wallaert B, Darras J, Chanez P, Crampette L, Magnan A, Demessi P, Orlando JP, Didier A, Serrano E, Prud'homme A, Meurice JC, Klossek JM, Tunon-de-Lara JM. How should nasal symptoms be investigated in asthma? A comparison of radiologic and endoscopic findings. Allergy 2004; 59:821-6. [PMID: 15230813 DOI: 10.1111/j.1398-9995.2004.00487.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND To improve asthma control, the management of rhinosinusitis often leads the physician to perform sinonasal imaging and/or nasal endoscopy, but their respective contributions are still insufficiently understood. OBJECTIVE To evaluate the potential contribution of a symptoms questionnaire, sinus radiography (SR) and computed tomography (CT) scan to the diagnosis of nasal diseases in asthmatic patients when compared with ENT examination. METHODS A total of 124 patients completed a questionnaire on nasal symptoms administered by the chest physician. Then, they underwent ENT examination. On the same day, SR and CT scans were performed independently. RESULTS Patients (80.3%) had nasal symptoms during the month preceding the consultation. The ENT examination was normal in 8.1% (n = 10) and revealed rhinitis in 57.3% (n = 71), rhinosinusitis in 14.5% (n = 18) and nasal polyposis in 20.2% (n = 25). For rhinitis, the negative predictive value of bilateral nasal obstruction was 87.8%. Both SR and CT had low sensitivity and specificity. For rhinosinusitis, the negative predictive value of nasal symptoms varied from 85.4 to 95.2%. Sinus CT was at least as accurate as SR for the diagnosis of rhinosinusitis. In a multivariate analysis, only the CT scan (score > or =12) appeared to be significantly associated with the diagnosis of nasal polyposis. CONCLUSION In asthmatic patients, physicians need to enquire systematically about the existence of nasal symptoms by using this simple questionnaire which is sensitive for rhinitis, and has good negative predictive value for excluding rhinosinusitis and nasal polyposis.
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Affiliation(s)
- C Raherison
- Société de Pneumologie de Langue Française (SPLF) Working Group, CHU-Bordeaux, France
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Abstract
OBJECTIVE/HYPOTHESIS Descending necrotizing mediastinitis is caused by downward spread of neck infections and constitutes a highly lethal complication of oropharyngeal lesions. This infection previously had a much worse prognosis. In recent years, more aggressive management has been recommended. The aim of this study is to evaluate the results with the association of thoracotomy and cervicotomy, medical care in an intensive care unit, and daily washing of drained cervical and thoracic tissues. STUDY DESIGN Retrospective study of 17 patients treated from 1984 to 1998. METHOD Descending necrotizing mediastinitis was consecutive to pharyngitis (6 cases), peritonsillar abscess (3 cases), dental abscess (6 cases), foreign body infection (1 case), and laryngitis (1 case). Corticotherapy was reported in seven cases. Twelve patients had no particular medical history. Mean age was 42 years. Mean duration of signs before diagnosis was 6 days. Thoracotomy was associated with the cervical approach in 14 cases, whereas 3 patients were treated by cervicotomy only. RESULTS Fourteen patients of 17 (82.3%) were successfully treated. Three deaths occurred. The mean duration of hospitalization in the intensive care unit was 30 days, and the mean total duration of hospitalization was 45 days. CONCLUSION Descending necrotizing mediastinitis must be detected as soon as possible by computed tomography (CT) scanning in patients with persistent symptomatologia after treatment for oropharyngeal infections. Prompt surgical drainage with thoracotomy and cervicotomy in all cases of mediastinal involvement below the tracheal carena, use of CT scanning to monitor the disease evolution, and medical management in an intensive care unit significantly reduces the mortality rate to less than 20%.
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Affiliation(s)
- Marc Makeieff
- Otolaryngology Head and Neck Surgery Department, Gui de Chauliac Hospital, University of Medicine, Montpellier, France.
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