Inferior turbinate lateralization.

Inferior turbinate lateralization via an endonasal approach is a reliable low-risk procedure to correct inferior turbinate hypertrophy resistant to medical treatment. This well-established technique provides nasal comfort while conserving the mucosal membrane and physiology of the inferior turbinate, minimizing the postoperative complications (empty nose syndrome) besetting turbinoplasty involving mucosal or submucosal reduction.

Transcaruncular anterior ethmoidal artery ligation.

Recurrence of epistaxis after ligation or embolization of the sphenopalatine artery may require ligation of the ipsilateral anterior ethmoidal artery, which cannot be embolized because of the risk to the ophthalmic artery. We describe a transconjunctival transcaruncular approach that allows reliable low-risk access to the anterior ethmoidal artery. This technique offers a minimally invasive approach to the surgical site, without unsightly scar.

3D-printed simulator for nasopharyngeal swab collection for COVID-19.

OBJECTIVES: Diagnosis of COVID-19 is essential to prevent the spread of SARS-CoV-2. Nasopharyngeal swabs (NPS) remain the gold standard in screening, although associated with false negative results (up to 30%). We developed a 3D simulator of the nasal and pharyngeal cavities for the learning and improvement of NPS collection. PATIENTS AND METHODS: Simulator training sessions were carried out in 11 centers in France. A questionnaire assessing the simulator was administered at the end of the sessions. The study population included both healthcare workers (HCW) and volunteers from the general population. RESULTS: Out of 589 participants, overall satisfaction was scored 9.0 [8.9-9.1] on a scale of 0 to 10 with excellent results in the 16 evaluation items of each category (HCWs and general population, NPS novices and experienced). The simulator was considered very realistic (95%), easy to use (97%), useful to understand the anatomy (89%) and NPS sampling technique (93%). This educational tool was considered essential (93%). Participants felt their future NPS would be more reliable (72%), less painful (70%), easier to perform (88%) and that they would be carried out more serenely (90%). The mean number of NPS conducted on the simulator to feel at ease was two; technical fluency with the simulator can thus be acquired quickly. CONCLUSION: Our simulator, whose 3D printing can be reproduced freely using a permanent open access link, is an essential educational tool to standardize the learning and improvement of NPS collection. It should enhance virus detection and thus contribute to better pandemic control.

Laryngeal spasm and tracheostomy after hydroxyapatite injection laryngoplasty.

INTRODUCTION: Adductor spasmodic dysphonia (Ad-SD) is usually treated by botulinum toxin injection into the thyroarytenoid muscles. In older patients, atrophy of these muscles is responsible for glottic leak, causing presbyphonia and is managed by vocal fold medialization using autologous fat or hydroxyapatite (HA). We report the first case of uncontrollable laryngeal spasm requiring tracheostomy after hydroxyapatite injection laryngoplasty in a patient with spasmodic dysphonia and presbyphonia. CASE REPORT: An 83-year-old man had been treated for Ad-SD by botulinum toxin injections every six months for 14 years. Due to severely disabling glottic leak, autologous fat injection laryngoplasty was then successfully performed. Six months later, following recurrence of severe hypophonia, hydroxyapatite injection was performed, subsequently complicated by immediate acute respiratory distress secondary to adductor laryngeal spasm requiring reintubation and tracheostomy. The postoperative course was marked by gradual recovery of vocal fold mobility with decannulation on day 12. DISCUSSION: This case allows a discussion of the possible pathophysiological mechanisms responsible for adductor laryngeal spasm. Vocal fold medialization procedures should be performed with caution in patients with Ad-SD.

Acute smell and taste loss in outpatients: all infected with SARS-CoV-2?

During SARS-CoV-2 pandemic, our region (Alsace, East of France) became a Covid-19 cluster quite early in Europe. Loss of smell and taste was quickly flagged by the Ears-Nose and Throat scientific community as a potential warning signs of SARS-CoV-2 infection (1). Many patients and medical/paramedical workers with mild to moderate form of SARS-CoV-2 infection complained about their loss of sense of smell and taste to our ENT department. The aim of our study was to compare the characteristics of loss of smell and taste between patients with a clinical diagnosis of SARS-CoV-2 infection to patients with a RT-PCR diagnosis.

Iatrogenic meningoencephalocele after traumatic perforation of the cribriform plate during nasal intubation of a preterm infant.

Traumatic iatrogenic meningoencephaloceles infants are rare and there is no consensus on management in the literature. This article presents a case of a meningoencephalocele diagnosed 15 months after a traumatic perforation of the cribriform plate due to a difficult intubation of a preterm infant that was treated by an endoscopic endonasal surgery. A close collaboration between pediatricians and ENT surgeons appears essential for early diagnosis and management. Endoscopic endonasal approach for meningoencephalocele management has several advantages and is a safe procedure when performed by an experienced surgeon.

The Grisel's syndrome: A non-traumatic subluxation of the atlantoaxial joint.

INTRODUCTION: Grisel's syndrome consists in rotational subluxation of C1-C2 following ENT infection or surgery. There is no consensus on management. We present 2 cases requiring surgical treatment in our center. CASE REPORTS: Two 10-year-old patients presented torticollis with cervical pain resistant to medical treatment, with onset a few months after tonsillectomy. In both cases, radiological assessment, comprising CT scan and MRI, showed Fielding-Hawkins type-3 C1-C2 rotational subluxation, without ligament lesion. After failure of conservative treatment, posterior reaming, realignment, C1-C2 arthrodesis using lateral masses and pars interarticularis screws and bone graft achieved good fusion and immediate spinal stability in all planes of the atlantoaxial complex. DISCUSSION: Grisel's syndrome consists in non-traumatic subluxation of the atlantoaxial joint with intact atlantoaxial ligaments. Initial pharyngeal inflammation spreads to the prevertebral fascia via direct connections between the periodontoidal venous plexus and pharyngovertebral veins, inducing fasciitis that leads to abnormal relaxation of the atlantoaxial ligaments and reactional muscle contraction with ankylosis. This phenomenon, appearing gradually and insidiously over a period of a few weeks, creates a frozen joint with ankylosis. Medical treatment with NSAIDs, muscle relaxants, and immobilization is usually sufficient; cervical traction may be needed. Surgical treatment by C1-C2 arthrodesis is indicated in case of failure of medical management or onset of neurologic signs. CONCLUSION: Close collaboration between pediatricians, ENT surgeons and neurosurgeons is essential for early diagnosis and management, which is the main prognostic factor for successful medical treatment, avoiding surgery.

Dysphagia 27 years after cervical disc arthroplasty.

INTRODUCTION: Dysphagia is a frequent postoperative symptom after anterior cervical disc arthroplasty. However, onset of dysphagia and neck pain a long time after surgery should suggest a diagnosis of prosthesis dislocation. CARE REPORT: A 65-year-old man with a history of cervical disc arthroplasty 27 years previously consulted for rapidly progressive dysphagia with no other associated symptoms. Physical examination and CT scan confirmed the diagnosis of anterior dislocation of the prosthesis with no signs of perforation. Surgical extraction via a neck incision allowed resolution of the symptoms. DISCUSSION: Prosthesis dislocation should be considered in a patient with a history of cervical disc arthroplasty presenting with dysphagia and neck pain. The clinical and radiological assessment confirmed the diagnosis and early surgical management allowed resolution of the symptoms and avoided complications such as pharyngo-oesophageal perforation.

Imaging sphenoid diseases.

In this review we provide comprehensive analysis of the imaging features of diseases affecting the sphenoid sinus, including a large and heterogeneous spectrum of pathologies such as sinusitis, pseudotumours, bony pathologies, and tumours. Clinical symptomatology related to sphenoid pathologies is often non-specific and patient clinical examination and endoscopic investigations are not definitive; thus, radiological imaging is mandatory for diagnosis. Strengths and limitations of both morphological and functional imaging methods such as computed tomography (CT), magnetic resonance imaging (MRI), and combined positron-emission tomography/computed tomography (PET/CT) have been considered and integrated into a well-defined clinical context in order to recognise specific imaging features and to underline their clinical relevance for an early and accurate diagnosis. An overview of several sphenoid conditions is herein selected with a didactic objective including both common and less common diseases.

Daratumumab: Therapeutic asset, biological trap!

OBJECTIVES: Recently, daratumumab has been included in the therapeutic strategies for myeloma patients. This molecule is an antibody directed against CD38, strongly expressed on plasma cells. Nevertheless, as CD38 is also present on erythrocyte membrane, daratumumab interferes with immunohaematological tests, complicating the selection of compatible blood. METHODS: A total of 14 patients treated by daratumumab have been followed in our transfusion laboratory. Among them, 11 have been transfused. Dithiotreitol (DTT) has been used to inhibit the daratumumab's interference, in the pre-transfusion tests (irregular antibody screening and cross-match). RESULTS: The red blood cell treatment with DTT has been very efficacious to inhibit the daratumumab's interference in 13 patients out of 14. Some precautionary measures had to be taken into account, especially the pH and the storage conditions. An extended pheno/genotype was an additional security element in the selection of compatible blood. To simplify and to optimize the laboratory practices, a decisional flow chart has been written. CONCLUSION: DTT red blood cell treatment is very useful and efficacious in the pre-transfusion tests of patients treated with daratumumab. It allows to avoid the selection of blood bags only on the basis of an extended pheno/genotype, what is more secure and more ethical with respect to other at higher risk patients. A clear decisional flow chart allows a quality assurance gait. Collaboration with physicians is essential.

Well-differentiated, pedunculated liposarcoma of the hypopharynx.

INTRODUCTION: Liposarcoma of the hypopharynx is extremely rare, as only 28 cases have been reported in the literature. The cardinal symptom of liposarcoma is progressively worsening dysphagia. CASE REPORT: The authors report the case of a 71-year-old man who presented with dysphagia, marked weight loss over several weeks and an episode of exteriorization of a solid mass from the mouth during an episode of vomiting. Imaging revealed a fat density intra-oesophageal mass. Panendoscopy and upper gastrointestinal endoscopy visualized the pedunculated tumour in the left piriform sinus, which was able to be exteriorized via the mouth. The tumour was then resected endoscopically at its hypopharyngeal insertion pedicle. Histological examination of the operative specimen concluded on well-differentiated benign liposarcoma. DISCUSSION: Well-differentiated liposarcoma is the most common form of liposarcoma, but is only exceptionally reported in the hypopharynx. The main symptoms are related to compression of adjacent structures. Imaging findings are nonspecific. Only histological examination can distinguish liposarcoma from other benign oesophageal tumours. Standard treatment consists of wide, complete resection, which is not always possible in the neck. Long-term follow-up of these patients is essential in order to rapidly detect recurrence.

Diagnosis of primary ciliary dyskinesia: When and how?

INTRODUCTION: Primary ciliary dyskinesia (PCD) is a rare congenital disorder involving permanent ubiquitous structural and/or functional ciliary abnormalities. METHODS: A single-center retrospective study included 56 cases of PCD (respiratory form) out of a cohort of 280 patients with suspected PCD. The main features of history-taking and clinical examination were analyzed, to formulate a pragmatic diagnostic procedure, easy to implement in clinical practice. RESULTS: Chronic respiratory tract infectious symptoms are sensitive but non-specific for the diagnosis of PCD. Nasal brushing for phase-contrast microscopy study of ciliary morphology and activity proved to be a fast, easy, non-invasive, cost-effective and age-independent diagnostic method. In doubtful cases, depending on local availability, further tests are indicated: nasal nitric oxide level, electronic microscopy, genetic study and cell culture. CONCLUSIONS: In suspected PCD, there being no gold standard method of screening and early diagnosis, nasal brushing with ciliary study is contributive, alongside numerous other complementary tests, on condition that the clinician is experienced and results are interpreted in the light of clinical examination and history-taking.

Differentiation of vestibular schwannomas from meningiomas of the internal auditory canal using perilymphatic signal evaluation on T2-weighted gradient-echo fast imaging employing steady state acquisition at 3T.

BACKGROUND: Our aim was to confirm the usefulness of the perilymphatic signal changes on T2-weighted (T2W) gradient-echo sequence to differentiate vestibular schwannomas from internal auditory canal (IAC) meningiomas, through a compartmental analysis of inner ear fluids signal intensity. METHODS: A total of 203 patients with all criteria for typical vestibular schwannoma on T1-weighted contrast-enhanced sequences were retrospectively enrolled (190 schwannomas and 13 meningiomas). All patients underwent a T2W gradient-echo steady state free precession (SSFP) acquisition at 3T. Two radiologists analysed the signal intensity of the perilymph (cistern and cochlea) and endolymph (saccule and utricle) using a region of interest-based method for obtaining ratios between the analysed structures and the cerebrospinal fluid (CSF). RESULTS: Obstructive vestibular schwannomas showed a markedly decreased perilymphatic signal in both cistern and cochlea; the cistern/CSF ratio (Ci/CSF) was 0.62. The decrease was more moderate in IAC meningiomas (Ci/CSF = 0.81). For Ci/CSF > 0.70, the tumour was more likely a meningioma, with a 92% sensitivity and 83% specificity. No endolymphatic signal changes were observed. CONCLUSION: The pronounced decrease in perilymphatic signal on a T2W SSFP sequence in obstructive vestibular schwannoma provides a new tool to differentiate schwannomas from IAC meningiomas, which may be useful to overcome the insufficiencies of morphological analysis.

Induction chemotherapy before surgery for unresectable head and neck cancer.

OBJECTIVE: To preoperatively reduce tumour size in patients with locally advanced and/or non-resectable squamous cell carcinoma with induction chemotherapy in order to achieve surgical excision with clear margins and preserve quality of life. METHODOLOGY: In this study, 16 patients with locally advanced and/or non-resectable squamous cell carcinoma underwent induction chemotherapy with docetaxel, cisplatin, and 5-fluorouricil or paclitaxel, carboplatin, and cetuximab. RESULTS: Over 80% of patients responded to induction chemotherapy. Histological examination of the 14 surgical specimens showed a total absence of residual cancer cells in 37.5% of cases. CONCLUSION: Concurrent radiation and chemotherapy is the standard treatment for locally advanced head and neck squamous cell carcinoma; however, induction chemotherapy may be beneficial in select patients.

[Congenital lacrimonasal duct cyst: Do not forget this radiological and clinical entity]. / Kyste lacrymonasal congénital: une entité radioclinique à ne pas méconnaître.

Although obstruction of the lacrimonasal duct is a fairly common finding in newborns, development of a dacryocystocele (nasolacrimal duct cyst) is uncommon and is caused by stenosis in the proximal and distal area of the nasolacrimal duct leading to a cystic dilatation. Its diagnosis remains difficult for the pediatrician, the ENT specialist, the ophthalmologist, and the radiologist. The study of six cases of dacryocystocele and the review of the literature led the authors to describe the clinical and radiological features of this uncommon entity. The symptomatology includes nasal obstruction and, when bilateral, significant respiratory distress in the newborn (obligate nose-breather) and dilatation of the lacrimal duct with blue cystic swelling inferior to the medial canthus or with an inflammatory aspect of the lacrimal duct in case of infection. A careful endoscopic examination of the nasal cavities and CT or MRI imaging reveals a cystic tumor, which arises in the inferior meatus, inferolateral to the inferior turbinate, and can partly or completely obstruct the endonasal space, uni- or bilaterally. CT and MRI are equally sensitive in detecting dacryocystocele and are also useful for differential diagnosis for other cystic or tumoral nasal lesions such as meningoencephalocele, dermoid cyst, and glioma. To avoid the risk of potential complications (respiratory distress or even sudden infant death, infectious ophthalmologic complications), this radiological and clinical entity should not be forgotten. Endoscopic marsupialization leads to immediate and definitive healing recovery.

VIIIth nerve cavernous hemangioma mimicking a stage 1 acoustic schwannoma.

OBJECTIVE: To report a case of VIIIth nerve cavernous hemangioma, a very rare differential diagnosis among the various pathologies presenting as small enhancing entities into the internal auditory canal. It is one of the most challenging when imaging is not able to differentiate it from an intrameatal vestibular schwannoma. METHODS AND RESULTS: We report a cavernous hemangioma extruding from the internal auditory canal, diagnosed after a left translabyrinthine resection in a 45-year-old man complaining of profound sensorineural hearing loss, with no facial paresis or dizziness. The preoperative differential diagnosis of a vestibular schwannoma was impossible, due to the absence of calcifications that usually characterize temporal bone hemangiomas. Clinical presentation, radiological features and treatment considerations are discussed along with up-to-date review of pertinent literature. CONCLUSIONS: When considering an apparent small intra-auditory canal schwannoma, otoneurologists should be aware of the rare possibility of a cavernous hemangioma. Early diagnosis and surgical treatment may improve the functional outcome, possibly preserving neural integrity.

BAHA implant: implantation technique and complications.

OBJECTIVES: BAHA implants have been shown to be effective in certain forms of conductive hearing loss, but the presence of the titanium abutment is responsible for sometimes severe skin reactions. The objective of this study was to compare two operative techniques: skin flap, and full-thickness skin graft. MATERIAL AND METHODS: Between January 2004 and January 2011, 72 patients were treated by BAHA implant and 32 of these patients (total of 41 implants) were included in the study. Two surgical techniques were used: full-thickness skin graft (n=21) and skin flap (n=20). RESULTS: Four types of skin complications were observed: necrosis, inflammation/infection, hypertrophic scar, and fixture loss due to inadequate osseointegration. Complications requiring surgical revision were observed in 20% of cases with the skin flap method and 38% of cases with the skin graft technique, with no significant difference between the two groups (P=0.31). CONCLUSION: The skin graft technique appears to be associated with a higher rate of major complications. The most common complication is hypertrophic scar. The apparently high complication rate in this series can be explained by a selection bias (exclusion of a large number of complication-free patients).