Surgical treatment of T1-T2 glottic carcinomas.

Transoral laser surgery (TLS) is a safe, time and cost-effective method of treatment for early stage glottic squamous cell carcinoma. This technique is more controversial in case of local extension to other subsite or in case of limited mobility.

Cricohyoidoepiglottopexy for glottic carcinoma with fixation or impaired motion of the true vocal cord: 5-year oncologic results with 112 patients.

The medical charts and operative files of 112 patients (combined inception cohort) with well to moderately differentiated invasive glottic squamous cell carcinoma presenting fixation (22) or impaired motion (90) of the true vocal cord (TVC) consecutively treated with cricohyoidoepiglottopexy (CHEP) at our institutions from 1972 to 1989 were retrospectively reviewed. A minimum 5-year follow-up was always achieved. The Kaplan-Meier 5-year actuarial survival, local recurrence, nodal recurrence, distant metastasis, and metachronous second primary tumor estimate for the entire group of patients were 84.7%, 5.4%, 6.4%, 1.2%, and 10.8%, respectively. The 5-year absolute and cause-specific survival rates were 85.5% and 94.1% for patients with fixation of the TVC and 81.3% and 96% for patients with impaired motion of the TVC. The 5-year actuarial local control rates for patients with fixation or impaired motion of the TVC were 95.4% and 94.4%, respectively. Local recurrence was statistically more likely in patients with positive margins (p = .007). Nodal recurrence was statistically more likely in patients with local recurrence (p = .005). Permanent tracheostomy related to postoperative laryngeal stenosis was requested in 2 patients. Aspiration-related completion total laryngectomy and/or permanent gastrostomy were never requested. Overall, local control and laryngeal preservation were achieved in 97.3%, and 95.5% of patients, respectively. At our institutions, the change from the conservative treatment modalities of radiotherapy and vertical partial laryngectomy to CHEP has brought about an increase in long-term survival, local control, and laryngeal preservation rates when compared to historical controls using vertical partial laryngectomy or radiotherapy.

Supraglottic hemilaryngopharyngectomy plus radiation for the treatment of early lateral margin and pyriform sinus carcinoma.

BACKGROUND: Supraglottic hemilaryngopharyngectomy is a functional procedure suitable for the treatment of carcinoma of the upper part of the pyriform sinus and carcinoma of the lateral laryngeal margin. It consists of resection of the supraglottic hemilarynx and ipsilateral pyriform sinus. METHODS: Forty-nine patients underwent this procedure from 1979 through 1994. The median age was 51 (40-72). The data were collected by a review of patients' records. RESULTS: Two patients died in the postoperative period. The average time of removal of the nasogastric tube was 14 days. The survival rate at 3 years was 52% and at 5 years, 47%. The local recurrence rate was 2%, the overall neck recurrence was 15%, metastasis occurred in 15% of cases. CONCLUSIONS: Indications for this procedure are carcinoma of the upper part of the pyriform sinus and carcinoma of the laryngeal margin with normal vocal cord mobility.

Sequential evaluation of pulmonary function and bronchial hyperresponsiveness in patients with nasal polyposis: a prospective study.

Nasal polyposis (NP) is commonly associated with nonspecific bronchial hyperresponsiveness (BHR) and/or asthma. The aim of this prospective study was to investigate the changes of pulmonary function and BHR in patients with nasal polyposis. Forty-four consecutive patients with NP were included in the study and were followed for 12 mo. Nonspecific BHR was assessed by a carbachol challenge test to determine the provocating dose (PD20) necessary to decrease FEV1 by 20% from baseline values; 17 of 22 patients who demonstrated BHR also exhibited asthma. Spirometric measurements and carbachol challenge were performed before initiating any treatment and 12 mo later. All patients were treated first with beclomethasone (600 microg/d). Intranasal ethmoidectomy was performed in 23 patients who did not improve when treated with topical steroids alone (nonresponders); in contrast, 21 patients were successfully treated with beclomethasone alone (responders). PD20 significantly decreased in the group of nonresponders (p = 0.018), whereas it remained unchanged in responders (p = 0.95). FEV1 (% pred) and FEF25-75 (% pred) significantly decreased in nonresponders (p < 0.001), whether BHR existed or not, whereas no significant change was observed in responders. Our results demonstrate that nonresponders who required nasal surgery exhibited an enhancement of BHR and a slight but significant decrease of FEV1 and FEF25-75 values. However, no change in pulmonary symptoms and/or asthma severity occurred. Clinical and functional follow-up of these patients should assess the long-term evolution of these parameters and their clinical relevance.

[Thyroplasty by external approach with silastic prosthesis in the treatment of laryngeal paralysis]. / Thyroplastie par voie externe avec prothèse en silastic dans le traitement des immobilités laryngées.

From August 1995 to January 1997 8 phonosurgical procedures were performed to correct glottal incompetence. There were 4 men and 4 women, the median age was 42 years. The most common indication for thyroplasty was recurrent or vagal nerve injury (6/8 cases). In 7 cases the paralyzed vocal cord was unilateral and in 1 case bilateral after oesophagectomy. Two patients were previously treated by endoscopic injection without success. The procedure was conducted under general anaesthesia. A window in the thyroid ala was created and silastic implant inserted. This technique was indicated to correct large glottal incompetence or in case of failure after endoscopic treatment. There have been no complications. Improvement of post operative voice was noted. The maximum phonation duration, intensity and objective voice measurements were improved in all cases.

[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.

[Is endoscopy of the respiratory-digestive tract under general anesthesia useful in the screening for cancer of the superior respiratory-digestive tract synchronous with lung cancer?]. / L'endoscopie des voies aéro-digestives sous anesthésie générale est-elle utile au dépistage des cancers des voies aéro-digestives supérieures synchrones des cancers bronchiques?

The frequency of lung cancers associated with synchronous head and neck malignancies can be evaluated between 1.5 to 2%. The purpose of our work was to determine if complete endoscopic head and neck examination performed under general anesthesia was superior than clinical head and neck examination for the diagnosis of these synchronous additional tumors. From july 1991 to august 1992, we realised a prospective study on 58 consecutive patients suffering from pulmonary removable lung cancers. All the patients had a clinical head and neck examination during the preoperative period. Immediately before thoracotomy a complete endoscopy of head and neck aerian and digestive tract was performed. During this last examination 18 new macroscopical lesions were discovered in 13 patients: benign lesions (n = 17), oral cavity and laryngeal dysplasia (n = 1). The one gingivolingual sulcus carcinoma, already discovered by the clinical examination, was confirmed. This study suggests that complete head and neck endoscopy is not superior than clinical examination for the diagnosis of synchronous malignancies before lung cancers removal.

[Endonasal ethmoidectomy in the treatment of nasal sinus polyposis]. / L'ethmoïdectomie endonasale dans le traitement de la polypose naso-sinusienne.

Endonasal surgery of paranasal polyposis. Two hundred and fifty one microscopical sphenoethmoidectomies with a major complication rate of 2.6% are reported. Long term results are analysed. Nasal obstruction disappears in 96% and persists in 70% of the cases 5 years later. Through topical steroid therapy and surgical experience polyp recurrence rate is reduced to 30%.

Subtotal laryngectomy with cricohyoidopexy for supraglottic carcinoma: review of 61 cases.

BACKGROUND: Subtotal laryngectomy with cricohyoidopexy is a functional laryngectomy suitable for treatment of supraglottic carcinomas. This procedure consists of resection of the thyroid cartilage, the paraglottic space, the epiglottis, and the entire pre-epiglottic space. The cricoid cartilage, the hyoid bone, and at least one arytenoid cartilage are spared. METHODS: Between 1973 and 1990, we used subtotal laryngectomy with cricohyoidopexy to treat 61 successive patients with supraglottic carcinomas. The data were collected by a review of patient records. The cancers were stages T1 (2), T2 (41), T3 (14), and T4 (4), according to the 1979 American Joint Committee on Cancer staging criteria. RESULTS: No patient died postoperatively. Forty-nine (80%) were able to eat normally before the 28th day. A follow-up analysis showed survival rates of 83% at 3 years and 79% at 5 years. CONCLUSION: We propose subtotal laryngectomy with cricohyoidopexy for the surgical treatment of supraglottic carcinomas extending to the true vocal cord, the ventricle, and the posterior third of the false vocal cord.

[Surgical treatment of snoring and sleep apnea syndromes. Results apropos of 59 cases]. / Traitement chirurgical du ronflement et des apnées du sommeil. Résultats à propos de 59 patients.

From 1991 to 1993, 59 patients underwent surgical cure for snoring. Polysomnography was performed 47 times when history taking and clinical signs revealed diurnal and nocturnal manifestations. Sleep apnea was confirmed in 20 patients with a mean apnea-hypnea index of 34.1. Treatment was based on surgery of the velum palatinum in 59% of the cases, the palatine tonsils in 39% and the basilingual tonsils in 1 patient. Snoring disappeared in 24 patients (40%) and improved for 75% satisfaction in 22 patients (37%).

[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.

[Hyo-sub-glosso-epiglottectomy in the surgical treatment of tumors of the vallecula and anterior laryngeal margin]. / La hyo-sub-glosso-épiglottectomie dans le traitement chirurgical des tumeurs de la vallécule et de la margelle antérieure.

Hyo-sub-glosso-epiglottectomy was performed in 56 patients with a tumour of the vallecula or the anterior laryngeal margin. Tumour classification in most of the patients was T2 and N0-N1. Survival rate at 3 years was 54% and 40% at 5 years. Major impairment of deglutition occurred in 5.4% of the cases. This operation is indicated for limited tumours of the vallecula and the anterior laryngeal margin.

[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%.

[Laser and glottis excision]. / Laser et exérèse glottique.

The CO2 laser is being used in several department for primary treatment of limited vocal cord carcinoma. The surgical resection is not the same in several department. One speaks of vaporisation, laser excision, cordectomy, deep cordectomy. The purpose of this paper is to definitive 3 types of laser surgery for glottic cancer = partial cordectomy, cordectomy with exposition, enlarged cordectomy. This classification allow to know with precision the importance of the surgical resection in each case.

[Sphenoidal aspergillosis in a seed-shop keeper]. / Aspergillose sphénoïdale chez une grainetière.

Human infections due to Aspergillosis Fungi are unusual and occur preferentially in defenseless patients. Nonetheless, our patient, a seed-shop owner, was not immuno-depressed and became infected by inhaling or chewing the seeds. Moreover, the aspergillosis was situated in the sphenoidal sinus, which is extremely unusual. In fact, the initial pseudo tumoral and misleading appearance justified a surgical biopsy which revealed a black "truffle" suggestive of aspergillosis and was confirmed by anatomo-pathology.

[Midline congenital fistula of the nose]. / Les fistules congénitales médianes du dos du nez.

Midline congenital fistulae of the nose requires early diagnosis to avoid infectious complications. This dermoid cyst of the nose may have intracranial extension and is the consequence of an anterior neural tube closure abnormality. The authors report 2 cases revealed by ophthalmic complications. Computed tomographic scan or magnetic resonance imaging provides precise information concerning the extent. Surgical treatment is always necessary.

[Our experience of meatotomy in the treatment of paranasal sinus diseases]. / Notre expérience des méatotomies dans le traitement des affections sinusiennes.

Results are presented of patients treated by endonasal microsurgery in the ORL clinic of the Lille UCH between January 1986 and July 1990. The principal affections treated were: chronic sinusitis, aspergillosis and Killian's polyp. The objective of the technique employed, which has evolved progressively, was in each case to eradicate the infectious focus or its cause, and to maintain satisfactory ventilation and drainage of the maxillary sinus. The technique used is described, and results presented based on the responses received from a questionnaire sent to 164 patients.