Supracricoid laryngectomy with cricohyoidoepiglottopexy (CHEP) in the management of laryngeal carcinoma: oncologic results. A 35-year experience.

To evaluate the long-term oncologic results of supracricoid laryngectomy with cricohyoidoepiglottopexy (CHEP) for laryngeal cancer. A 35-year retrospective study concerning 291 patients treated by supracricoid laryngectomy with CHEP for laryngeal cancer was performed. The following postoperative data were studied: recurrence rates (lymph node and laryngeal), distant metastases and second cancer. The mortality rate and overall survival were estimated by the Kaplan-Meier method. The postoperative mortality was 1.03 %. 23 patients were lost to follow-up. The 3-year survival rate was 84 % and the 5-year survival rate was 80 %. 12 patients developed distant metastasis. 31 patients developed a second cancer. The local (laryngeal) control rate was 93.94 % and the regional (cervical lymph node) control rate was 92.05 %. In multivariate analysis, the occurrence of a second non-ENT cancer and metastasis as well as margins involvement were reliable to mortality. Supracricoid laryngectomy with CHEP appears to be associated with very good long-term oncologic results and still has a place in the management of T1, T2 and selected T3 glottic cancers.

[Preoperative corticosteroid treatment and nasal polyposis]. / Corticothérapie préopératoire et polypose naso-sinusienne.

OBJECTIVES: Impairment of the surgical view by bleeding in endoscopic ethmoidectomy for chronic rhinosinusitis with nasal polyps (CRSwNP) contributes to the risk of skull base injuries. The aim of this study was to investigate the effect of a short course of a systemic corticoid treatment on bleeding and surgical field quality during endoscopic ethmoidectomy for CRSwNP. METHODS: A prospective study was conducted on 40 patients. Before surgery, 21 of them (group B) were treated with 1 mg/kg per day of prednisolone for seven days. They were compared with the 19 other patients (group A) on intraoperative blood loss and surgery duration. RESULTS: The two groups shared identical clinical features (Lidholdt endoscopic grading). There was no statistical difference in terms of bleeding, although the Lund-Mackay CT score was higher in group B (19/24 vs. 21/24, p=0.05). The surgical procedure was shorter in group B (72 min vs. 85 min, p=0.05). CONCLUSION: Preoperative treatment with systemic corticosteroids does not seem to reduce surgical blood loss. However, we noted a decrease in the procedure's duration. By reducing mucous inflammation, this treatment could improve the local conditions and help the surgeon in the mucous eradication.

Salvage radical prostatectomy for radiorecurrent prostate cancer: indications and results.

AIMS: A rise in the incidence of radiorecurrent prostate cancer is to be expected, since approximately one third of early prostate cancer cases are nowadays treated with a radiotherapy modality. One possibility in treating radiorecurrent prostate cancer is salvage prostatectomy. Our objective was to look into our own experience with salvage radical prostatectomy and to analyse outcome and morbidity. METHODS: A computer search through our hospital database identified 11 patients who underwent a salvage radical prostatectomy for radiorecurrent cancer over the last 15 years. All data were retrospectively analysed and confronted with the literature. RESULTS: Although the surgery was mostly difficult, there were no intraoperative complications. Bladder neck stricture is the most common postoperative complication (18%). Continence rates are worse than in classical radical prostatectomy. All patients lost potency, since no attempt was made to spare the neurovascular bundles. With a mean follow-up of 6.9 years, biochemical disease-free survival rates was 55%, while overall and cancer-specific survival was 91%. CONCLUSION: While most patients with radiorecurrent prostate cancer will be treated by many experts with hormonal therapy, a salvage radical prostatectomy can give a second chance for cure in carefully selected patients.

[Use of fast neutrons in the treatment of tumors of the salivary glands: rationale, review of the literature and experience in Orleans]. / Utilisation des neutrons rapides dans le traitement des tumeurs des glandes salivaires: rationnel, revue de la littérature et expérience d'Orléans.

If low LET radiation therapy (photons, electrons), following radical microscopically and complete surgery can improve results in term of local control from 34 to 74% for salivary gland tumors, local control is more difficult to achieve in advanced tumors and only palliative treatment is usually attempted. In this survey, all the patient series treated worldwide were reviewed. They show an overall control rate of 31% with photon vs 64% with neutron therapy. A prospective randomised trial sponsored by the RTOG and the MRC published in 1988 and reviewed in 1993 showed an overall locoregional complete tumor clearance of 67% for neutrons and 17% for photons (P < 0.005), with 68% and 25% survival at two years for neutrons and photons respectively. This study was closed for ethical reasons. In Orleans, since 1987, 59 patients have been treated. At five years the persistent local control probability was 69.5%, the five-year crude survival probability 66% and the five-year tumor free survival probability was 64.5%. This review provides evidence that surgical treatment for salivary gland tumors should be limited to patients presenting a high likelihood of negative surgical margin and a small risk of facial nerve damage. Others patients should receive neutron radiation therapy alone as definitive treatment.

[Paranasal sinuses: postoperative imaging]. / Imagerie des sinus opérés.

Radiologic assessment after sinus surgery requires not only a good knowledge of the primary disease, but also a mandatory understanding of every surgical technique and approach. After having described these techniques, we will illustrate immediate, possible but rare, post-operative complications. The various pathologies responsible for a delayed recurrence will also be illustrated. A chapter will be dedicated to paranasal sinuses malignant tumors follow up after surgery.

[Nasal fossae hemangiopericytoma revealed by acute dacryocystitis]. / Hémangiopéricytome des fosses nasales révélé par un épisode de dacryocystite aiguë

We report a 42-year-old woman with a hemangiopericytoma tumor located in nasal fossae, revealed by acute dacryocystitis. Clinical rhinoscopic examination and orbitofacial tomodensitometry showed tumefaction of the lacrimal sac and nasolacrimal duct. We removed the tumor by endonasal surgery. The anatomopathology examination confirmed the diagnosis of hemangiopericytoma. The internal canthus area and the maxillary sinus roof were treated with complementary irradiation.

[Surgery of inflammatory and neoplastic tracheal stenosis. Apropos of 38 cases]. / Chirurgie des sténoses inflammatoires et tumorales de la trachée. A propos de 38 cas.

This is a retrospective study of 38 patients who were operated on for inflammatory (31) or tumoral tracheal stenosis. A cervical approach was possible in 20 cases; a sternotomy was required in 8 cases and a thoracotomy in 5 cases. Per-operative ventilation was satisfactory for all patients. There were 2 deaths in patients suffering from chronic airflow obstruction. There were 2 immediate and 13 late post-operative stenosis; 9 of these were symptomatic and required treatment which was successful in 7 cases. 25 of the 30 patients (among 33 survivors) who were followed-up were symptomless; 4 patients who had operations for a tumour had a larger than 3 years survival.

[Endoscopic treatment of post-intubation tracheal stenosis. Apropos of 58 cases]. / Traitement endoscopique des sténoses trachéales post-intubation. A propos de 58 cas.

Over a period of 6 years, 58 patients aged between 55 +/- 16 years have been treated for post-intubation tracheal stenosis (STPI). These patients were characterised by their frequency of an underlying respiratory or cardiac failure, a duration of intubation which was sometimes short and a delay between the extubation and the detection of stenosis which was les than one month in about one half of the cases. Thirty of the 58 patients presented with respiratory distress on admission. All the stenoses were treated initially by mechanical dilatation using a rigid bronchoscope. Radial incisions using an Nd-Yag laser were performed when necessary to facilitate the dilatation. The great majority of stenoses which were not fitted up with a tracheal endoprosthesis (EPT) at the first attempt recurred, leading to repeated therapeutic bronchoscopies (221 sessions in all). Fitting an EPT (Dumon prosthesis) was necessary in 35 cases on 12 occasions at the first attempt with the first bronchoscopy, and 23 times following a recurrence. Amongst the recurring stenoses a stabilisation was obtained at the price of repeated dilatations (4.3 sessions on average in only nine patients). Seven patients finally had a surgical resection and anastamosis of the trachea, of whom four had a transitory instillation of an EPT for the stenosis. The removal of the EPT was later attempted in 11 patients. Four did not present with any symptomatic recurrence. The secondary migration of the EPT is in practice one of the main inconveniences of the silicon prosthesis (8 cases now experienced). Our approach, which used to favour the mechanical dilatation has lead to a relatively high number of failures and thus to repeated bronchoscopies. This has lead us to re-define our therapeutic approach. The current schema which we propose is in the course of being validated in which we use EPT and surgical repair of the trachea more often. Only short stenoses (less than 1 cm) with a diaphragm are treated by dilatation and laser. The others are fitted initially with an EPT. The final management is guided by the progress in the stenosis, the tolerance of the endoprosthesis and the operability of the patients.

[Involvement of the nasal sinuses in sarcoidosis. A prospective study of 63 patients]. / Atteinte nasosinusienne au cours de la sarcoïdose. Etude prospective chez 62 patients atteints de sarcoïdose.

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.

[Laryngectomy with Tucker's epiglottoplasty]. / Laryngectomie avec épiglottoplastie de Tucker.

From 1980 to 1987, 37 patients were operated with a reconstructive anterior frontal laryngectomy including epiglottoplasty such as described by Tucker. These patients presented with epidermoid carcinomas of the glottis. The carcinological results are satisfactory, with a survival rate of 33 of 37 patients at 3 years and 22 of 25 patients at 5 years. However, the control of the paraglottic space still is insufficient after this type of surgery, and we reserve it for the tumors confined to the glottic level, without impairment of mobility. The anterior frontal laryngectomy performed is extensive and frontolateral. It is used for a few of its former indications, as showed by the comparison of the periods before and after 1980.

[Partial surgery of laryngeal vestibule cancer]. / La Chirurgie partielle des cancers du vestibule laryngé.

A retrospective study was conducted of 141 cases of laryngeal vestibule cancer treated by partial surgery between 1968 and 1977. Patients underwent either subglottic laryngectomy (105 cases) or subtotal laryngectomy with cricohyoidoplexy (36 cases). Operative mortality was 6.5 p. 100. Overall survival rate was 63 p. 100 at 3 years, with lymph node invasion in 32 p. 100 of cases, and a 3 year survival rate for group N of 71 p. 100 as against 50 p. 100 for group N+.

[Endonasal plasmocytoma: diagnosis and management]. / Diagnostic et prise en charge du plasmocytome endonasal: à propos d'un cas.

UNLABELLED: Plasmocytomas are either medullary (disseminated form) or extramedullary with or without bone infiltration (located form). Plasmocytoma is not a common tumor but extramedullary forms mostly occur in the upper respiratory tract without specific manifestations. OBJECTIVE: The aim of this study is to discuss the management (diagnostic and therapeutic) and the follow-up of extramedullary nasal plasmocytoma. MATERIAL AND METHODS: We report a case of a 71-year-old patient with unilateral nasal obstruction manifestation. RESULTS: Endonasal biopsy concluded plasma cell tumor without extension on CT scan. Treatment consisted of external nasal surgery and radiotherapy. CONCLUSION: Diagnosis of solitary extramedullary plasmocytoma can only be confirmed when the presence of systemic disease is excluded by performing clinical, biological (marrow bone biopsy) and radiological investigations. The treatment should be based on surgery with complementary radiotherapy if there is a skull base erosion. Long term follow-up is necessary because of the high risk of diffuse marrow involvement (multiple myeloma) which may occur after a long delay.

[Subtotal laryngectomy in the treatment of extensive tumors of the larynx]. / La laryngectomie sub-totale dans le traitement des tumeurs étendues du larynx.

The authors assess the possibility to perform subtotal laryngectomy for extensive tumors of the endolarynx. They describe a particular variety of T3/T4 tumor extending anteriorly to the thyroid cartilage or to the pre-epiglottic space. Such tumors do not affect the arytenoid cartilages posteriorly, which makes functional subtotal laryngectomy with CHP or CHEP possible. This surgery was performed in 28 patients from 1972 to 1985, with 20 patients still living after 5 years, ie. 72% of all cases.

[Value of coral implant in the treatment of functional failure after subtotal laryngectomy with crico-hyoid fixation]. / Intérêt de l'implant de corail dans le traitement des échecs fonctionnels après laryngectomie subtotale avec crico-hyoido-pexie.

Subtotal laryngectomy with CHP have prolongated post operative care because aspiration. In 16% of cases a new surgical procedure is necessary. The authors have used a implant of madreporic coral placed in the base of the tongue just behind the hyoid bone to achieve a total closure of the larynx during swallowing. This operation has stopped aspiration in 2 cases very quickly.

[Treatment of bilateral laryngeal abductor paralysis (author's transl)]. / Le traitement des paralysies laryngées bilatérales en fermeture.

The authors report on their treatment of 39 patients with bilateral laryngeal abductor paralysis, observed over a 10-year period. Medical treatment was given in 5 cases, and tracheotomy was performed in 5. Ten patients underwent endoscopic surgery with very good results in 7. Arytenoidopexy was carried out by the extra-laryngeal route in 19 cases with 16 excellent results.

[Results of the surgical treatment of cancers of the supraglottic area]. / Les résultats du traitement chirurgical des cancers de l'étage sus-glottique.

The authors report a retrospective analysis of the results of surgery in 169 patients with supraglottic cancer referred to the Lille ENT clinic from 1976 to 1985. Partial surgery was performed in 53% of patients versus total laryngectomy in 47%. The 5 year survival rates in the patient groups treated by supraglottic laryngectomy and supracricoid laryngectomy with cricohyoidopexy were similar, 69.4% and 75.2%, respectively. The 5 year survival rate in the patient group treated by total laryngectomy or by total laryngectomy extended to the base of tongue was 62.8%.

[Extracartilaginous glottectomy. Operative technic, indications and results]. / La glottectomie extra-cartilagineuse. Technique opératoire, indications, résultats.

Cancer developing on a chronic laryngitis or bilateral superficial cancer of vocal cords still pose management problems to surgeons. Double cordectomy presents the inconvenience of opening the larynx in the median line and the need for insertion of a dilating piece removed during a second stage. These disadvantages can be avoided by an extracartilaginous glottectomy by median opening of thyroid cartilage, monoblock ablation of both vocal cords and immediate closure of larynx by lowering of ventricular bands. A wide larynx is obtained with a loud but veiled voice.

[Laser endoscopic treatment of cysts of the larynx and laryngoceles]. / Le traitement endoscopique au laser des kystes du larynx et des laryngocèles.

Twelve patients (8 with appendicular laryngeal cysts and 4 with laryngoceles) were treated in the ENT Unit, Lille between 1980 and 1983. Therapy was by laser through endoscopic guidance, and consisted of resection of the ventricular band to allow marsupialization of the cyst or mixed laryngocele in the endolarynx. Treatment was effective in all cases with restoration of a normal larynx within 2 to 3 months, even in patients with external laryngoceles. This method is of particular interest in bilateral lesions.

[Our experience with the pectoralis major musculocutaneous flap. Apropos of 57 cases]. / Notre expérience du lambeau musculo-cutané de grand pectoral. A propos de 57 cas.

One of the most important technical advances in cervicofacial plastic surgery over the last few years is undoubtedly the use of the musculocutaneous flap from pectoralis major. A review of its application in 57 cases showed the flap to be of excellent viability (5% total necrosis of flap), and to offer multiple possibilities during primary surgery or that following radiation. Indications and excision limits can be extended, particularly in buccopharyngeal surgery, providing and appreciable functional gain (particularly disappearance of pain), even though long-term carcinologic advantages are deceiving.

[Reoperation and recurrence of pleomorphic adenoma of the parotid. A propos of 62 cases]. / Les reprises et récidives d'adénome pléomorphe de la glande parotide. A propos de 62 cas.

Between 1967 and 1994, 344 patients were treated with total conservative parotidectomy for benign pleomorphic adenoma of the parotid gland. Our retrospective study focuses on a sixty-two patients group treated for recurrence after biopsy, enucleation or total parotidectomy. Twenty-two patients underwent a systematic total parotidectomy after biopsy (n = 7) or enucleation (n = 15). Twenty-nine patients were treated with total parotidectomy for local recurrence after enucleation. The mean time before this treatment was 8 years-9 months. In the third group, 11 patients, (7 patients from our institution), were surgically treated for recurrence after total parotidectomy. After enucleation, the recurrence rate was high and insufficient margins were found in 27% of the cases. In this group, a multicentric recurrence was found in 45% of the cases. In our own experience, recurrence after total parotidectomy was noted in 2.4%. The surgical salvage was performed with enucleation after identification of the branches of the facial nerve. The operative microscope was usefull. In 1 case, a second recurrence occured, and in 1 case iterative recurrence was noted. The local control rate after total parotidectomy was 99.6% (292/293). Total conservative parotidectomy is, for us, the treatment of choice for pleomorphic adenoma of the parotid gland.