Educational video to improve memorization of preoperative information in parotidectomy: A randomized controlled study.

AIM: To compare the number of risks memorized by patients before parotid surgery for benign tumor after receiving standard oral and written information versus the same information with an additional educational video, in France. MATERIAL AND METHODS: A single-center prospective controlled randomized study was conducted from July 2017 to October 2019 with 69 patients operated on for a-priori benign parotid tumor. Median age was 52 years (range, 20 to 87 years). Mean interval from preoperative consultation to surgery was 100 days. The cohort was randomized between two groups: without (control group) and with (experimental group) additional audiovisual information. The main endpoint was the number of risks remembered, out of seven listed. Results were expressed as median with interquartile range. The secondary endpoint was the impact on memorization of age, gender, education level, interval to surgery, and type of planned surgery. RESULTS: Twenty-nine patients were analyzed in the control group and 27 in the experimental group. The number of risks remembered ranged from zero to five and was significantly greater in the experimental group: median 2 [IQR, 2-3] versus 1 [0-2] (P<0.005). The best remembered was transient facial palsy (41 patients). In the control group, one third of the patients did not remember any risks. There were no significant correlations between individual factors and memorization. CONCLUSION: Although subject to many methodological biases, our study showed that additional audiovisual information improved memorization of the risks associated with parotidectomy.

Vertebral artery (V2) pseudo-aneurysm after surgery for cervical schwannoma. How to prevent it and a review of the literature.

STUDY DESIGN: Case report and review of the literature. OBJECTIVE: To prevent and manage a suspected iatrogenic vertebral artery injury during a cervical spine anterior approach. SUMMARY OF BACKGROUND DATA: The anterior spine approach is a common surgery with few complications. One of the rare but significant risks is vertebral artery injury. Consequences of vertebral artery injuries are often delayed. Therefore, it is essential to prevent this complication and to know how when exploring after a suspected vertebral artery injury. METHODS: Report of a case and review of the literature. A 61-year-old woman presented with a cervical schwannoma involving the C5-C6 foramen. She had undergone surgery 22 years before by the posterior approach. We performed an anterior cervical approach. After 12 days, a vertebral artery pseudo-aneurysm occurred. Our review of the literature is focalized on vertebral artery injuries during cervical surgery by the anterior approach. RESULTS: The patient was treated by coil embolization with a good outcome. To our knowledge, only 6 cases of vertebral artery pseudo-aneurysm after surgery have been reported in the literature. CONCLUSION: According to the literature, vertebral artery pseudo-aneurysms resulting in anterior cervical approach are rare but their consequences could be severe. Prevention begins by detailed surgical planning. Peroperative imaging is helpful. Any suspected vertebral artery injury should postpone a contralateral approach before angiographic imaging.

Study of the concordance between p16 immunohistochemistry and HPV-PCR genotyping for the viral diagnosis of oropharyngeal squamous cell carcinoma.

OBJECTIVE: The diagnosis of HPV-related oropharyngeal cancer in clinical practice is based on p16 immunohistochemistry and PCR detection of viral DNA (HPV-PCR). The primary objective of this study was to evaluate the concordance between these 2 diagnostic tests. The secondary objective was to study the clinical characteristics of these patients. MATERIALS AND METHODS: This single-centre prospective study was conducted between February 2010 and July 2012. Immunohistochemical analysis of p16 and HPV-PCR were performed on tumour biopsies. Concordance was evaluated according to Cohen's kappa coefficient and was interpreted according to the Landis and Koch scale. The patients' clinical data were analysed as a function of the diagnostic test results. RESULTS: Seventy-one patients were included in this study. The prevalence of HPV was 43.7% according to p16 and 31% according to HPV-PCR. The concordance study revealed a kappa coefficient of 0.615. A tumour of the tonsil or base of the tongue was detected in 100% of p16+/HPV-PCR+ cases. Smoking and alcohol abuse were significantly less frequent among HPV+ patients regardless of the method of detection. These patients were older and presented tumours with a lower grade of histological differentiation. CONCLUSION: p16 immunohistochemistry or HPV-PCR used alone appear to be insufficient. These results confirm the high prevalence of HPV-related oropharyngeal squamous cell carcinoma (OSCC) and the previously reported specific clinical and histological features, apart from age. It appears essential for future clinical trials to be stratified according to smoking and tumour HPV status, defined by means of reliable virological tests targeting E6/E7 mRNA and no longer a simple positive response to the p16 marker, as is frequently the case at the present time. New tests suitable for use in routine practice therefore need to be developed.