RESUMEN
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.
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Trasplante Óseo/métodos , Carcinoma/cirugía , Mandíbula/cirugía , Neoplasias de la Boca/cirugía , Procedimientos de Cirugía Plástica/métodos , Colgajos Quirúrgicos , Humanos , Procedimientos Quirúrgicos Orales/métodos , Satisfacción del Paciente , Resultado del TratamientoRESUMEN
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.
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Neoplasias Faríngeas/diagnóstico , Neoplasias Faríngeas/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
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.
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Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/cirugía , Neoplasias de la Boca/patología , Neoplasias de la Boca/cirugía , Disección del Cuello/métodos , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/mortalidad , Femenino , Estudios de Seguimiento , Francia/epidemiología , Humanos , Incidencia , Escisión del Ganglio Linfático , Ganglios Linfáticos/patología , Metástasis Linfática , Masculino , Registros Médicos , Persona de Mediana Edad , Neoplasias de la Boca/mortalidad , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias , Pronóstico , Estudios Retrospectivos , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
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.
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Epistaxis/terapia , Planificación de Atención al Paciente , Telangiectasia Hemorrágica Hereditaria/terapia , Enfermedad Aguda , Enfermedad Crónica , Embolización Terapéutica , Humanos , Coagulación con Láser , Arteria Maxilar , Mucosa Nasal/irrigación sanguínea , Soluciones Esclerosantes/uso terapéutico , Escleroterapia , Tampones QuirúrgicosRESUMEN
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.
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Carcinoma Papilar/diagnóstico , Espectroscopía de Resonancia Magnética , Neoplasias de la Tiroides/diagnóstico , Estudios de Evaluación como Asunto , Humanos , TiroidectomíaRESUMEN
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.
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Aspergilosis/patología , Carcinoma de Células Escamosas/patología , Neoplasias Laríngeas/patología , Recurrencia Local de Neoplasia/patología , Biopsia , Carcinoma de Células Escamosas/radioterapia , Humanos , Neoplasias Laríngeas/radioterapia , Laringe/patología , Laringe/efectos de la radiación , Masculino , Persona de Mediana Edad , NecrosisRESUMEN
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.
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Adenoma/patología , Nasofaringe/patología , Neoplasias Hipofisarias/patología , Adenoma/diagnóstico , Adulto , Diagnóstico Diferencial , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Nasofaríngeas/diagnóstico , Invasividad Neoplásica , Neoplasias de los Senos Paranasales/diagnóstico , Neoplasias Hipofisarias/diagnósticoRESUMEN
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.
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Quistes/patología , Enfermedades de las Paratiroides/patología , Anciano , Quistes/complicaciones , Femenino , Humanos , Persona de Mediana Edad , Enfermedades de las Paratiroides/complicaciones , Enfermedades de la Tiroides/complicaciones , Enfermedades de la Tiroides/patología , Factores de TiempoRESUMEN
The authors describe an exceptional case of aspergillosis from sphenoidal sinus showed by oculomotar palsy its follow up simulates a malignant tumour.
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Aspergilosis/diagnóstico , Oftalmoplejía/etiología , Seno Esfenoidal , Anciano , Aspergilosis/complicaciones , Aspergilosis/terapia , Biopsia , Diagnóstico Diferencial , Femenino , Humanos , Nervio Oculomotor , Enfermedades de los Senos Paranasales/complicaciones , Enfermedades de los Senos Paranasales/diagnóstico , Enfermedades de los Senos Paranasales/terapia , Neoplasias de los Senos Paranasales/diagnóstico , Radiografía , Seno Esfenoidal/diagnóstico por imagen , Seno Esfenoidal/patologíaRESUMEN
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.
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Otitis Media con Derrame/diagnóstico , Enfermedad Aguda , Corticoesteroides/administración & dosificación , Animales , Antibacterianos/administración & dosificación , Ensayos Clínicos como Asunto , Humanos , Mediadores de Inflamación/metabolismo , Depuración Mucociliar/inmunología , Otitis Media con Derrame/tratamiento farmacológico , Otitis Media con Derrame/inmunología , RecurrenciaRESUMEN
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.
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Asma Inducida por Ejercicio/diagnóstico , Ejercicio Físico , Enfermedades de la Laringe/etiología , Adolescente , Asma Inducida por Ejercicio/complicaciones , Errores Diagnósticos , Disnea/etiología , Femenino , Humanos , Enfermedades de la Laringe/diagnóstico , Enfermedades de la Laringe/patología , LaringoscopíaRESUMEN
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.
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Sinusitis/tratamiento farmacológico , Adolescente , Adulto , Amoxicilina/uso terapéutico , Combinación Amoxicilina-Clavulanato de Potasio , Niño , Preescolar , Ácidos Clavulánicos/uso terapéutico , Ensayos Clínicos como Asunto , Quimioterapia Combinada , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Sinusitis/etiologíaRESUMEN
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.
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Trastornos de Deglución/fisiopatología , Esófago/fisiopatología , Faringe/fisiopatología , Adulto , Anciano , Trastornos de Deglución/cirugía , Esófago/cirugía , Femenino , Humanos , Masculino , Manometría , Persona de Mediana Edad , Faringe/cirugíaRESUMEN
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.
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Estenosis Traqueal/congénito , Humanos , Pronóstico , Estenosis Traqueal/clasificación , Estenosis Traqueal/cirugíaRESUMEN
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.
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Farmacología Clínica , Glándula Tiroides/citología , Amiodarona/farmacología , Anestésicos/farmacología , Animales , Células Cultivadas , Humanos , Propranolol/farmacología , Tiroglobulina/análisis , Glándula Tiroides/efectos de los fármacos , Tiroxina/análisis , Toxicología , Triyodotironina/análisisRESUMEN
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.
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Respiración Artificial/efectos adversos , Estenosis Traqueal/etiología , Broncografía , Broncoscopía , Cateterismo , Femenino , Humanos , Lactante , Recién Nacido , Recien Nacido Prematuro , Masculino , Neumotórax/etiología , Atelectasia Pulmonar/etiología , Enfisema Pulmonar/etiología , Estenosis Traqueal/diagnóstico , Estenosis Traqueal/terapiaRESUMEN
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.
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Neoplasias de Cabeza y Cuello/diagnóstico , Espectroscopía de Resonancia Magnética , Tumor Glómico/diagnóstico , Humanos , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Neuroma Acústico/diagnóstico , Neoplasias de los Senos Paranasales/diagnóstico , Pólipos/diagnóstico , Neoplasias Craneales/diagnósticoRESUMEN
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.
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Seno Maxilar , Enfermedades de los Senos Paranasales/cirugía , Adulto , Humanos , Enfermedad Iatrogénica , Masculino , Enfermedades de los Senos Paranasales/etiología , Enfermedades de los Senos Paranasales/patologíaRESUMEN
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.