Neuropathic pain at diagnosis of head and neck squamous cell carcinoma.

OBJECTIVE: To assess the prevalence and characteristics of neuropathic pain (NP) at diagnosis of head and neck squamous cell carcinoma (HNSCC) and its impact on nutritional status and treatment tolerance. MATERIALS AND METHODS: Patients treated for HNSCC between January 1, 2018 and January 30, 2019 were included. Pain was assessed prospectively on the DN2 and NSPI scales. Epidemiological characteristics, nutritional status and treatment tolerance were collected. Two groups were distinguished according to absence or presence of neuropathic pain (NP-, NP+). RESULTS: Sixty patients were included. NP prevalence at diagnosis was 54%, mainly involving locally advanced oral cavity and oropharyngeal tumors. There was a significant intergroup difference in nutritional status, with 62% malnutrition in NP+ versus 32% in NP- (p=0.0321). There was no such difference in tolerance. CONCLUSION: NP is frequent at diagnosis of HNSCC. Early diagnosis on a simple validated score can help improve quality of life and nutritional status.

Epistaxis complicating treatment by anti-vitamin K and new oral anticoagulants.

OBJECTIVES: To assess any differences in severity and management of epistaxis when complicating treatment by anti-vitamin K (AVK) or by new oral anticoagulants (NOAC). MATERIALS AND METHOD: All patients admitted to the ENT department of a University Hospital Center for epistaxis under oral anticoagulation therapy between January 2010 and June 2015 were included in a retrospective study. Severity was assessed in terms of management and of hemoglobin level at admission. Two groups were distinguished: treatment by AVK or by NOAC. RESULTS: One hundred and thirty-four patients were included: 126 under AVK and 8 under NOAC. There was a significant difference in mean hospital stay: 4.5 days for AVK versus 3.5 days for NOAC (P=0.019; 95% CI [0.1921; 0.8907]). There were no significant differences for the other severity criteria. None of the patients died. CONCLUSION: Admission rates for epistaxis complicating NOAC therapy was low, and much lower than in case of AVK. Bleeding severity was equivalent with both treatments. NOACs significantly reduce hospital stay. Contrary to the study hypothesis, epistaxis is less serious when complicating NOAC than AVK therapy.

Polymyalgia rheumatica and vagal paraganglioma.

INTRODUCTION: Vagal paraganglioma are rare tumors that are mostly asymptomatic. We report a case of vagal paraganglioma associated with paraneoplastic polymyalgia rheumatica and review the literature on benign paragangliomas of the head and neck associated with paraneoplastic syndrome. CASE REPORT: A 53-year-old man presented with atypical polymyalgia rheumatica. MRI revealed a tumor that was then surgically excised. Histological examination confirmed the diagnosis of benign vagal paraganglioma. Rapid, complete and permanent resolution of all rheumatological symptoms were observed postoperatively, confirming the diagnosis of paraneoplastic polymyalgia rheumatica. CONCLUSION: Paraganglioma of the neck associated with paraneoplastic syndrome remains exceptional. A predisposing gene mutation must be systematically investigated. Long-term surveillance must be ensured due to the risk of local recurrence, second tumors or metastasis.