[Head and neck reconstructive surgery with free flaps and quality of life: a prospective study]. / Chirurgie reconstructive cervico-faciale par lambeaux libres et qualité de vie: étude prospective sur 1 an.

OBJECTIVE: The aim of this prospective study is to evaluate functional results and quality of life after head and neck reconstructive surgery with free flaps. MATERIAL AND METHODS: All patients who have beneficed of head and neck reconstructive procedures with free flaps during the year 2004 were included in this study. EORTC quality of life questionnaire (QLQ-C30/H&N35) was used before and 6 months after surgery. A head and neck functional evaluation was realized 6 months after surgery. RESULTS: Thirty four patients were examinate 6 months after surgery. Global quality of life remained at its preoperative level (61.3% VS 62.8%). Physical, role and social functioning decreased significantly (p = 0.05), but emotional and cognitive functioning remained stable. Pain decreased considerably after treatment in the head and neck area (p = 0.001). Oral (eating: p = 0.05, speaking: p = 0.008) and sensorial functions (p = 0.001) decreased after treatment. All patients except one have recovered sufficient oral intakes, an intelligible speech and a good cosmetic result. CONCLUSION: Functional and cosmetic results after head and neck reconstructive surgery are the key factors of quality of life. Free flaps are considered actually as an indispensable technique to achieve an optimal reconstruction.

[Oropharyngeal reconstruction with radial forearm free flap: functional results]. / Les reconstructions buccopharyngées par lambeau libre antebrachial: résultats fonctionnels.

OBJECTIVE: The aim of this retrospective study is to evaluate functional results of oral and oropharyngeal reconstructions with radial forearm free flap. MATERIAL AND METHODS: We present our experience with radial forearm free flap for reconstructing oral and oropharyngeal defect between 2000 and 2004. A total of 96 patients were included in this study. We analysed functional results (alimentation, elocution, mouth opening and cosmetic appearance) and researched the potentialy predictive factors of these results (age, comorbidity, preoperative irradiation...; Chi 2 test). RESULTS: The rate of free flap success was 97.9%. Good functional results (normal or quasi normal function) were obtained for alimentation, elocution, mouth opening and cosmetic appearance in respectively 92.6%, 64.9%, 81.9% and 84.1% of cases. Age (p = 0.05), preoperative irradiation (p = 0.005) and T stage (p = 0,02) had a negative effect on elocution, free flap failure on mouth opening (p = 0.03), preoperative irradiation (p = 0.05) and free flap failure (p = 0,02) on cosmetic appearance. CONCLUSION: Radial forearm free flap is considered as the flap of choice for oral and oropharyngeal reconstructions and allows excellent functional results.

[Mandibular reconstruction with osseous free flaps: functional results]. / La reconstruction mandibulaire par lambeaux libres osseux: résultats fonctionnels.

OBJECTIVES: The aim of this retrospective study is to evaluate functional results of oromandibular reconstruction with osseous free flaps. MATERIAL AND METHODS: A total of 67 patients who underwent oromandibular reconstruction with fibula (n=60) or scapular (n=7) free flap between 2000 and 2004 were included in this study. We analysed functional results (alimentation, elocution, mouth opening and cosmetic appearance) and researched the potentially predictive factors of these results (age, comorbidity, preoperative irradiation, type of defect...; Chi(2) test). RESULTS: The rate of free flap success was 89.6%. A functional result considered as normal or subnormal was obtained by more than 50% of patients. Oral alimentation (without tube feeding) and intelligible speech were recovered by 92.5% of patients. Through and through defects and free flap failures were determinant predictive factors of worse functional outcomes. CONCLUSION: Fibula free flap is considered as the flap of choice for oromandibular reconstruction and allows excellent functional results.

[Fibula free flap for reconstruction of extensive mandibular osteoradionecrosis]. / Lambeau libre de fibula pour la reconstruction des ostéoradionécroses mandibulaires évoluées.

OBJECTIVE: Treatment of mandibular osteoradionecrosis is always a therapeutic challenge. The aim of this article is to evaluate the interest of fibula free flap for mandible reconstruction after radical excision of osteoradionecrotic lesions. MATERIAL AND METHODS: Six consecutives cases of extensive osteoradionecrosis of the mandible were treated with fibula free flap reconstruction. We report a meticulous analysis of the cosmetic and functional results. RESULTS: All vascularized fibula osteocutaneous flaps transplanted were successful. Median hospital stay was 32 days. At 6 months, functional results (swallowing, mouth opening and speech) were good. All patients had sufficient oral intake and a comprehensible speech with just two patients requiring a soft diet and 1 patient retaining a moderate trismus. DISCUSSION: Extensive mandibular osteoradionecrosis requires a radical surgical treatment. Fibula free flap is the best solution for mandible reconstruction in this situation. This technique allows good functional results. CONCLUSION: Fibula free flap is the method of choice for mandible reconstruction after radical treatment of osteoradionecrosis.

[Evaluation of rhinologic manifestations of gastro-oesophageal reflux]. / Evaluation des signes rhinologiques liés au reflux gastro-oesophagien.

OBJECTIVE: As well as other usually irritative factors, the acidity of gastro-oesophageal reflux (GOR) has many medical consequences that are not well known at the present time. The aim of this study is to describe the rhinologic signs caused by this common disease. MATERIALS AND METHODS: Prospective study; two groups (GOR proved by pH-metry and control) of 20 patients (10 men and 10 women) were formed. Individual patient status was evaluated by questionnaire, visual analogue scale (AVS), clinical examination and rhinomanometry. RESULTS: Nasal resistance, nasal obstruction and posterior rhinorrhea evaluated by AVS are significantly higher in the GOR group as compared to the control group (Mann-Whitney test; total nasal resistance: p < 0.01, uninasal resistances: p < 0.001, nasal obstruction: p < 0.00001, posterior rhinorrhea: p < 0.00001). DISCUSSION: The control group was completely free from rhinologic signs, so we used it to confirm the normal values of nasal resistance. Nasal obstruction and posterior rhinorrhea are two new signs which should be researched in patients affected by GOR. CONCLUSION: GOR is an important irritative factor for nasal mucosa responsible for nasal obstruction and posterior rhinorrhea. (full article translated in english available on www.ent-review.com).

Gallbladder torsion. A case report.

Gallbladder torsion is a rare condition causing acalculus cholecystitis. Its preoperative identification is difficult with current radiological means and it is generally diagnosed at surgery. A case of gallbladder torsion due to an extremely rare anomaly consisting of partial fixation of the fundus to a fore-shortened liver bed is reported. The etiology, diagnosis and treatment of this condition are discussed.

Traumatic neuroma of the cystic duct with biliary obstruction. Report of a case.

A case of amputation neuroma of the biliary tract occurring 12 years after a cholecystectomy is reported. The patient, a 81 year-old man, presented with obstructive jaundice due to a stricture of the extrahepatic biliary tract. The stricture was resected and biliary reconstruction was achieved with a Roux-en-Y jejunal loop. The diagnosis of neuroma was obtained only at histology that showed hyperplastic nerve bundles, positive for protein S 100. The patient is well one year and six months after surgery without signs of recurrence of the stricture. Although the amputation neuroma of the biliary tract has already been reported, it seems worthwhile to emphasise this further report. This lesion is an unusual cause of benign stricture of the biliary tract that may pose difficult diagnostic problems.

[Nonrecurrent inferior laryngeal nerve: review of 13 cases]. / La non-récurrence du nerf laryngé inférieur.

OBJECTIVE: This study reviews a rare and poorly understood anatomic anomaly of the thyroid region: non-recurrence of the inferior laryngeal nerve. METHOD: We describe thirteen cases of non-recurrence of the laryngeal nerve observed during 2128 surgical procedures on the thyroid gland. RESULTS: The malformation was right-sided in all thirteen patients (11 women, 2 men) and occurred at a frequency of 0.4% of all of the nerves explored. Only two complications were noted in this series of 13 cases: one case of temporary paresis and one case of irreversible vocal cord paralysis. CONCLUSION: A rare although not exceptional occurrence, non-recurrence of the inferior laryngeal nerve is an anomaly that Head and Neck surgeons should be familiar with so as to avoid nerve damage that can result in irreversible vocal cord paralysis.