Prevalence of obstructive sleep apnoea syndrome following oropharyngeal cancer treatment: A prospective cohort study.

OBJECTIVES: To evaluate the prevalence of obstructive sleep apnoea syndrome (OSAS) in a population of patients treated for an advanced oropharyngeal cancer (AJCC Stage III or IV), depending on treatment strategy, and to evaluate its impact on quality of life. DESIGN: Prospective cohort study. SETTING: University Teaching Hospital of La Conception, Marseille, France. PARTICIPANTS: Fifty-one disease-free patients were included. Forty-one patients received a combined chemoradiotherapy, while 10 patients were treated by surgery followed by chemoradiotherapy. MAIN OUTCOME MEASURES: Every patient underwent a formal sleep consultation and was asked to complete the Epworth Sleepiness Scale and EORTC QLQ C-30 and the EORTC H&N 35 questionnaires. A home overnight respiratory polygraphy was performed in every subject. RESULTS: The mean time between the end of cancer treatment and the OSAS analysis was 54.04 months [20; 84]. An OSAS was found in 25.49% of our patients. There was no significant difference between patients treated with either surgery (30%) or CRT (24.39%), P=.79. The EORTC QLQ C-30 questionnaire showed a significant difference between positive and negative OSAS groups in the Global Health Status Scale (50.64 vs 67.11, P=.02) and in the fatigue item (35.04 vs 17.25, P=.03). CONCLUSIONS: Our population with advanced oropharyngeal cancer, whatever the treatment strategy it may be, was at risk of developing OSAS with negative impact on quality of life. A routine screening and treatment of OSAS seems necessary to improve the quality of life of patients treated for advanced oropharyngeal cancer.

[Choice of surgical technic for correcting the nose tip]. / Le choix de la technique de la chirurgie correctrice de la pointe du nez.

The surgical approach should be adapted to the type of correction needed. There is no room of standard technics. The various selection criteria that have to be considered are: the structure of the alar cartilages and the infra-and suprastructural characteristics thereof, determining the upper triangle of the lobule; the relative incidence of the abnormalities encountered in rhinoplastic practice; an analysis of the failures leading to secondary rhinoplastic operations, among which the most frequent are lobule and/or irregularities and drooping apex or insufficient projection thereof. Currently, the authors' conclusions are that: Most of the times, the upper triangle of the lobule is overdeveloped: reduction is carried out by resecting a superior strip laterally, while additionally trimming the cupulae, if necessary. Much more rarely, a globally hypertrophied lobule will be found that requires management by section-reconstruction of the cupulae. In case of a "normal", excessively projected lobule, the technic of choice is apex retraction. Primary apex projection defects should be recognized and treated with molding grafts. The nose tip should be prevented from drooping by means of columellar supporting grafts.

[Results of surgery of acoustic neuroma via translabyrinth and suprapetrous approaches. Development of a classification by House and Brackmann based on facial function]. / Résultats de la chirurgie du neurinome de l'acoustique voies trans-labyrinthique et sus-pétreuse. Aménagement de la classification de J.W. House et D.E. Brackmann sur la fonction faciale.

Two studies were conducted consecutively on two series of post-operative acoustic neurinoma patients. The first one included 104 patients over a period spanning from January 1982 through April 1986; the second one bore on 75 cases enrolled between October 1985 and April 1988. Post-operative complications, sequelae, and findings were analyzed. As far as facial function was concerned, this was assessed on the basis of a classification worked out by J.W. House and D.E. Brackmann. For the first series (93 patients tested, 86 followed up and 7 who completed and returned a form arranged from Brackmann's questionnaire), the following results were obtained: 94% with anatomically intact nerves, including 50.0% grade I; 8.6% grade II; 10.7% grade III; 12.8% grade IV; 4.3% grade V, and 2.2% grade VI cases. 10 nerve sections pertaining to grade III and grade IV surgical repair cases including 10 hypoglossofacial anatomoses were reported. In the second series, 75 patients were followed up for at least 2 years. The facial nerve condition was recorded at the end of the operation, corresponding to the beginning of the nerve recuperation period. A very tight relationship was noted between the nerve condition and the end result as reflected by facial function; such correlation was also found to exist between facial function and tumor size. Likewise, end-point facial function was strictly dependent upon the incipient recuperation phase, whenever palsy had been complete or partial post-operatively. That is to say, if recovery started out after the third month following surgery, the affected hemiface would never retrieve its normal or subnormal function (grade I and II as per J.W. House and D.E. Brackmann). In this series, facial function was restored in 45%, 15%, 21%, 11%, 1%, and 0 cases corresponding to grade I, II, III, IV, V and VI, respectively. Five grade III and IV nerve sections were repaired via five hypoglossofacial anastomosis operations. We propose a slight modification be brought to the House-Brackmann classification. The aim of this study was to accurately assess the complications and sequelae secondary to surgical ablation of unilateral acoustic neurinoma by an otoneurosurgical team utilizing almost exclusively the broadened translabyrinthic (B.TL) and medial cerebral fossa or supra-petrous (SP) approaches Despite achievements realized since W.F. House [23] described those, the main problem encountered has been-excluding major complications which are fortunately rare, remains the preservation of normal or subnormal facial function.