[Mandibular reconstruction for the treatment of oral carcinomas: state of the art and perspectives]. / Reconstruction mandibulaire en cancérologie: état actuel et perspectives.

INTRODUCTION: Mandibular reconstruction in head and neck oncology uses a number of techniques whose results are inconsistent and whose indications do not benefit from consensus. MATERIALS AND METHODS: A review of the literature allowed us to assemble the available knowledge on current mandibular reconstruction techniques, their functional results, and the research perspectives. RESULTS AND DISCUSSION: Marginal resections lead to dental rehabilitation problems, which can be palliated by alveolar enhancement techniques but whose results have not been validated in cases subjected to irradiation. Reconstruction of segmental substance loss is warranted by the repercussions on the vital prognosis when it is anterior and on the quality of life when it is posterior. The ideal means of reconstruction is the free fibular flap, which is limited by cost, morbidity of the donor site, and selection of the patient's surgical team. For these reasons, it may be necessary to turn to pedicled osteo-myocutaneous flaps, abandoned because of their reputedly very high failure rate, but few have been reported in the literature. CONCLUSION: Poor functional results of mandibular reconstruction plates make this a last-resort solution. Tissue engineering is currently the most promising line of research. It runs counter to the principles of oncology itself because postoperative radiotherapy reduces the osteoinduction potential of the biomaterials proposed.

[Parapharyngeal tumors: diagnosis and treatment]. / Tumeurs parapharyngées: diagnostic et traitement.

OBJECTIVES: Parapharyngeal space tumors are rare and usually benign. Their treatment is surgical and many approaches have been described. We report our experience in managing these neoplasms. Two points are developed more fully: the correlation between imaging and surgical observation and the reliability of the cervical approach. MATERIAL AND METHODS: A retrospective review of primary parapharyngeal space tumors treated at the Rennes University Hospital between 1992 and 2004 is presented. Nine patients were included, all treated surgically with a cervical approach without parotidectomy. RESULTS: Eight MR imaging and seven CT scans were done. Two retrostyloid tumors and six prestyloid tumors, all independent of the deep lobe of the parotid gland, were found. They were benign in all cases (five salivary tumors and four schwannomas). Two patients treated for a pleomorphic adenoma presented recurrence and were reoperated successfully. The average follow-up was 66 months. None of the patients died. Definitive postoperative complications occurred only for neurogenic tumors. CONCLUSION: The cervical approach is safe and allows the surgical excision of retrostyloid and prestyloid tumors, independent of the deep lobe of the parotid gland. Large tumor (8cm in our study) excision can be done with few complications. An attentive study of preoperative imaging is necessary to choose the best surgical approach.

[Neck dissection for stage N0 oral cavity carcinoma]. / Evidement cervical dans les carcinomes de la cavité orale classes N0.

OBJECTIVES: The management of N0 neck remains controversial. The purpose of this study was to evaluate the efficacy of selective neck dissection (SND) in managing N0 neck of oral cavity carcinomas. MATERIAL AND METHODS: A retrospective chart review of 77 previously untreated patients with squamous cell carcinomas of the oral cavity with N0 neck from 1988 to 2001 was performed. Cervical treatments were "wait and see" policy in 7 cases, neck dissection in 56 cases, radiotherapy alone in 14 cases. 77 neck dissections were performed in which 62 were selective and 15 were radical modified. RESULTS: On pathologic examination, the average number of lymph nodes was 10.7 per neck. Occult disease (cN0pN+) was detected in 32.5%, and occult extracapsular spread (cN0pN+R+) was detected in 7.8%. The median follow-up was 43 months. The overall neck recurrence rate in patients with controlled primary disease was 2.4%. Recurrent disease developed in 2.9% of the cNOpN0 neck. Regional control rate of the dissected neck was 94%. No cervical recurrence occurred in 11 patients treated with SND alone. There was no survival or recurrence rate difference in T1T2pN0 patients with or without post-operative radiotherapy. Post-operative radiotherapy could be avoided in 27% of the dissected neck. One, 3 and 5 years overall survival rate were 89.3%, 77.7% and 63.2%. CONCLUSIONS: SND is an effective procedure for staging and treating the clinically negative neck of oral cavity cancer.

[Treatments of hereditary hemorrhagic telangiectasia of the nasal mucosa]. / Indications et stratégies thérapeutiques des épistaxis dans la maladie de Rendu Osler.

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.

Evaluation of human thyroid tumors by proton nuclear magnetic resonance.

Proton nuclear magnetic resonance (NMR) was used in a study of 40 patients with thyroid tumors following partial or total thyroidectomy. Three patient groups were considered: those with nodules showing increased uptake, those with solitary nodules with decreased uptake, and those with multinodular goiters. Spin-lattice and spin-spin relaxation times (T1 and T2) were measured on samples of nodular and extranodular tissue from each patient. Increased T1 and T2 were observed for benign cold nodules, an increase in T1 alone for nodules with increased uptake, and a wide fluctuation in T1 and T2 for multinodular goiters. The four cancers in the series did not show a distinctive proton NMR pattern in comparison with the other nodular structures studied. The results point to the feasibility of applying NMR techniques to the detection of thyroid disease.

Primary aspergillosis of the larynx and squamous cell carcinoma.

Primary laryngeal aspergillosis is exceptionally rare, and only five cases have been reported in the literature. We present here two cases of invasive laryngeal aspergillosis without tracheobronchopulmonary extension and without any generalized immune deficit. Aspergillosis developed after local radiotherapy for a squamous cell carcinoma and preceded a recurrence of the tumor. The relationships between the clinical features, the histopathology, and the etiology of laryngeal aspergillosis and squamous cell carcinoma are discussed. We recommend that following treatment of laryngeal aspergillosis, these rare patients should systematically be investigated for a squamous cell carcinoma or a recurrence thereof.

Pituitary adenomas with infra-sellar extension into the nasopharynx.

Three cases of pituitary adenomas with infra-sellar extension into the nasopharynx and the nasal cavities are reported. The clinical signs were epistaxis, nasal obstruction, painful sinuses and purulent rhinorrhoea. The initial diagnostic hypothesis was that of a carcinoma of the nasopharynx or the sinuses in all three cases. The diagnosis was made by histological examination and measurement of plasma hormone levels. These cases highlight the difficulty in the diagnosis of such tumours due to their misleading clinical, radiological and histological features.

[Latent forms of parathyroid cysts. Report of two cases]. / Les formes latentes des kystes parathyroïdiens. A propos de deux cas.

The authors report two cases of non functional parathyroid cyst both found by a systematic clinical examination in two women of 56 and 67 years. In the first case, the cyst was associated to a thyroid dystrophy; the other patient had a history of thyroid dystrophy but also of pituitary prolactin adenoma.

[Aspergillosis from sphenoidal sinus (author's transl)]. / Aspergillose pseudo-tumorale du sinus sphénoïdal (ou l'étiologie d'une paralysie unilatérale du III).

The authors describe an exceptional case of aspergillosis from sphenoidal sinus showed by oculomotar palsy its follow up simulates a malignant tumour.

[Inflammation and seromucous otitis]. / Inflammation et otite séromuqueuse.

1. AN IMPORTANT RELATIONSHIP: There is a strong relationship between tubular dysfunction, tympanic depression and effusion of the tympanic cavity. 2. TWO IMPORTANT PHENOMENA: Increased secretory capacity of the mucosa and decreased mucociliary clearance subsequent to a reduction in the number of ciliated cells have an important impact. 3. CONTINUUM: Rhinopharyngeal infection, acute middle ear infection and seromucosal otitis constitutes a continuum demonstrated by the fact that PCR (polymerase chain reaction) studies reveal the same germs in the rhinopharynx, in the middle ear fluid, and in seromucous otitis (SMO) effusions. 4. BACTERIA AND VIRUSES: By producing toxin, bacteria and viruses induce severe inflammatory reactions in SMO, triggering the cascaded of inflammation mediators. 5. MEDIATORS: Several elements participating in the cascade of inflammatory events have been demonstrated in human patients and animal models of SMO despite the minimal number of elements producing inflammation mediators initially. Recurrent favoring factors have a primordial effect. 6. ALLERGY: The clinical and epidemiologic data are widely debated, but do not favor the hypothesis of an allergic reaction, yet several studies have demonstrated that mediators of the allergic response are present in SMO effusions. 7. ANTIBIOTICS: Used in short-term regimens, antibiotics have a favorable [not readable: see text] on SMO, but their duration of action is short due to the persistent inflammatory reactions. 8. ORAL CORTICOSTEROIDS: The beneficial effect of oral corticosteroids in SMO is generally short-lived with a rapid decline in efficacy after a few weeks. 9. LONG DURATION AND RELAPSE: SMO is usually a long-standing highly recurrent condition proscribing use of long-term systemic corticosteroids. It might be interesting to assess the contribution of local corticosteroid therapy after classical "acute" treatment associating antibiotics and a short course of oral corticosteroids. 10. OTHER OPTIONS: Clinical trials using other treatment options in SMO have not been conclusive for mucolytic, decongestant or antihistamine agents.

[Exercise-induced laryngomalacia]. / La laryngomalacie induite par l'exercice.

Exercise-induced laryngomalacia is a rare differential diagnosis of exercise-induced asthma. We report the case of a previously fit 14-year-old female patient who presented with dyspnoea on intense exertion and whose condition had not improved with treatment prescribed for a misdiagnosed exercise-induced asthma. A diagnosis of exercise-induced laryngomalacia was eventually made when a variable extra-thoracic airway obstruction on the flow-volume loops was obtained after an incremental exercise test. Flexible fiberoptic rhinolaryngoscopy confirmed this abnormality and demonstrated an anterior prolapse of the arytenoid region, partially obstructing the airway. The patient therefore underwent laser aryepiglottoplasty which produced a satisfactory anatomical outcome in the larynx but which only resulted in a partial functional improvement. Laryngomalacia is rare and its pathophysiology is not well understood. However, it should be considered in patients presenting with exertional dyspnoea, particularly if there is inspiratory embarrassment, who fail to improve with beta-2-adrenergic agonists. The diagnosis can be made from the flow-volume loop and direct laryngoscopy, before and after exercise.

[Results of a multicenter study of an amoxicillin-clavulanic acid combination in sinusitis in children and adults]. / Résultats d'une étude multicentrique de l'association amoxicilline-acide clavulanique dans les sinusites de l'enfant et de l'adulte.

Efficacy and safety of Augmentin were evaluated in 79 patients, 64 adults and 15 children, treated for sinusitis during a multicentric hospital trial. Pre-treatment meatal pus samples were examined for bacteriology: 37 of 39 strains (95%) isolated from adults were sensitive to Augmentin, and two beta-lactamase producing Haemophilus strains sensitive to Augmentin were isolated from the children. Adult dosage was usually 2 g per day as two divided doses over 8 to 10 days. Recovery was obtained at end of treatment in 92% of cases, side effects being reported in 56 patients, including 8 with benign digestive disorders. Usual dosage in children was 25 to 50 mg/kg/d over 8 to 10 days and treatment was effective in 13 cases. One child developed a skin rash, and there was no report of digestive disturbance.

[The value of pharyngo-esophageal manometry in the study of deglutition disorders]. / Intérêt de la manométrie pharyngo-oesophagienne dans l'étude des troubles de la déglutition.

Pharyngoesophageal manometry is an excellent tool for the study of pharyngeal swallowing disorders, and allows quantifying the various anomalies. The comparison of pre- and postoperative results allows better differentiation of the indications for myotomy or myectomy of the cricopharyngeal muscle. On the basis of a series of 10 cases with sufficient distance in time, the operation can be regarded as even more beneficial as the manometric anomalies are confined to the sole upper esophageal sphincter.

[Intrinsic congenital stenoses of the trachea]. / Les sténoses congénitales intrinsèques de la trachée.

The authors report about one case of intrinsic congenital stenosis of the trachea in a newborn. The prognosis of tracheal stenosis in infants is poor, more so when it is congenital and intrinsic, because it is often extensive and associated with other malformations, especially of the right mainstem bronchus and of the right lung. The prognosis of such extensive stenoses, for which surgery constantly resulted in death, has been improved by a new type of tracheoplasty (Kimura-Tsugawa, 1982). However, these children can only be operated with this procedure once they are through intensive care and acute respiratory distress, often in the neonatal period.

[Use of cultures of human thyroid cells in physiopathology and pharmacotoxicology]. / Utilisation des cultures de cellules thyroïdiennes humaines en physiopathologie et pharmacotoxicologie.

We reconstituted functional follicles from isolated cells, after embedding in a collagen matrix. Therefore we could carry out many investigations. We showed that the cells embedded in collagen reorganized into functional follicles secreting thyroglobulin (Tg) visualised in the intra-follicular compartment, and triiodothyronine (T3) after TSH stimulation. We used these reconstituted follicles for testing several drugs, amiodarone, propranolol and some anaesthetic drugs (thiopental, midazolam and ketamine). We observed that all these drugs inhibited partially or totally, according to the dose administered, the follicular production of Tg and T3. We also found that the follicles reconstituted from thyroid Grave's tissues gave an abnormal secretion of Tg and T3. Finally we created in Rennes a human thyroid model that permits the exploration of pathologic tissues and that may be used in pharmacotoxicology.

[Acquired tracheobronchial stenosis of the premature infant under artificial respiration. Value of bronchography and endoscopic balloon dilatation. Apropos of 7 cases]. / Les sténoses trachéo-bronchiques acquises du prématuré ventilé. Intérêt de la bronchographie et de la dilatation endoscopique au ballonnet. A propos de 7 cas.

The authors report about a series of 7 cases of acquired tracheobronchial stenosis in premature infants who were intubated as soon as they were born and ventilated. Two important points can be pointed out: the merits of bedside bronchography, which allows diagnosing the lesions, the merits of balloon dilatation during tracheobronchoscopy on the ENT operating theatre to treat the stenosis. This technique allowed improving ventilation and removing the tube in 6 of 7 cases.

[Magnetic resonance imaging of craniofacial pathology]. / Apport de l'imagerie par résonance magnétique en pathologie crânio-faciale.

Effectiveness of nuclear magnetic resonance imaging (MRI) was compared with that of the CT scan in several cases involving different lesions: intracranial, base of skull, facial sinuses, parapharyngeal spaces. MRI provided excellent contrast in soft tissues with good detection of tumors and their limits, the condition of neighboring tissues and any local or regional tumor extension. Vessels were also visualized. It was not influenced by dental artefacts, and allowed three-dimensional sections to be obtained simply without manipulation of patients. In contrast, bone structures were analyzed less clearly than by the CT scan. Marked progress in MRI technical features and results obtained can be expected in the very near future.

[Myospherulosis of the maxillary sinus]. / Myosphérulose du sinus maxillaire.

BACKGROUND: We present a case of a myospherulosis, describe the underlying cause and discuss ways of preventing its development. CASE REPORT: A 35-year-old man presented myospherulosis of the maxillary sinus caused by an antibiotic ointment placed in the sinus three years earlier during a Caldwell Luc procedure. The patient underwent a second Calwell Luc procedure. Outcome was uneventful and no recurrence was noted. DISCUSSION: Histological examination should be ordered at reoperation and petroleum-based ointments and packings should be avoided in sinus surgery.

[Cell culture in thyroid cancers]. / Cultures cellulaires en carcinologie thyroïdienne.

The authors studied the diagnostic interest of cell cultures in thyroid tumors. They cultivated 10 tumours (4 papillary carcinomas, 5 medullary carcinomas and 1 sarcoma-looking tumour). In 7 cases, cultures yielded nothing more than pathologic examination. Nonetheless the study allowed to detect a double secretion (calcitonin and thyroglobulin) in 2 medullary carcinomas which turned out to be mixed proliferations. It also detected a production of thyroglobulin by the sarcoma. They think that cell cultures may have a diagnostic interest besides pathologic examination, allowing precise study of secretory features of the tumors.