Efficacy and safety of early G-CSF administration in patients with head and neck cancer treated by docetaxel-cisplatin and 5-fluorouracil (DCF protocol): a retrospective study.

BACKGROUND: Induction chemotherapy with docetaxel-cisplatin and 5-fluorouracil (DCF) for locally advanced head and neck cancers (HNC) is associated with a high risk of severe neutropenia or febrile neutropenia (FN). We conducted a retrospective study to evaluate the efficacy and safety of administering granulocyte colony-stimulating factor (G-CSF) on day 3 (D3) during chemotherapy (early G-CSF stimulation) versus after the end of chemotherapy, as per current guidelines (i.e., after the end of 5-FU perfusion; D7), and its impact on patient outcomes. PATIENTS AND METHODS: Patients ≥19 years old, with advanced HNC who received DCF induction chemotherapy (D and P 75 mg per meter squared (mg/m(2)) on day 1 and 5-FU 750 mg/m(2)/day from D1 to D5), were included in the analysis. RESULTS: Data of 70 patients were analyzed from 01 January 2003 to 01 December 2010. Mean age was 56 years (range 45 to 77 years). Thirty-six patients (51.4 %) received pegfilgrastim on D7, and 28 (40 %) started G-CSF prophylaxis during chemotherapy; 12 (17.1 %) had daily filgrastim and 16 (22.9 %) pegfilgrastim on D3. Overall response rate (ORR) was 89.6 % (three early deaths due to infectious complications; 4.3 %). The 3-year overall survival (OS) rate was 72.8 %. FN rate was 14.3 % and chemotherapy delay was 12.9 %. In the D7 G-CSF arm, incidence of grade 3-4 neutropenia (p = 0.023), FN (p = 0.029), and cycle delays (p = 0.006) was statistically higher than the "early" G-CSF arm. A decrease of OS was observed at 2 years (from 85.1 to 63.5 %) of chemotherapy discontinuation or FN (p = 0.0348). DISCUSSION: Early administration of G-CSF is safe and seems to be more effective than D7. Future prospective trials are required to confirm our results.

Rehabilitation following total laryngectomy: Oncologic, functional, socio-occupational and psychological aspects.

GOAL: To review rehabilitation following total laryngectomy by an analysis of epidemiological, oncologic and functional data. MATERIALS AND METHODS: This retrospective observational study focused on patients having undergone total laryngectomy or pharyngolaryngectomy between January 1, 2005 and December 31, 2016. Oncologic data notably comprised survival and relapse and predictive factors. The impact of the procedure on quality of life and the voice was analyzed by self-administered questionnaires (EORTC QLQ-C30 and H&N35, VHI 30). A satisfaction questionnaire was also sent to patients. RESULTS: One hundred and thirty three patients were included. Overall specific 5-year survival was 65%. The relapse rate was 32%. Factors influencing survival were WHO performance status ≥2 (P<0.05), tumor location (P=0.07), metastatic lymphadenopathy (P=0.017) and positive resection margins (P=0.01). Quality of life was moderately degraded (global EORTC QLQ-C30 status: 61.4±23.9). Type of rehabilitation (P=0.03), tube feeding (P=0.03) and relapse (P<0.01) influenced quality of life. There were no differences in voice quality according to rehabilitation method, and no predictive factors for failure of voice rehabilitation. More than 90% of patients were satisfied with their hospital stay; 43%, however, were not satisfied with community caregiver training for laryngectomy patients. CONCLUSION: Rehabilitation of laryngectomized patients is a current therapeutic challenge. A therapeutic education tool was designed to better meet patient expectations.

Anatomical and functional rehabilitation after total bilateral maxillectomy using a custom-made bone-anchored titanium prosthesis.

Surgical reconstruction after a total maxillectomy remains challenging. The standard treatment is the microvascular free flap. In cases of surgical contraindication, oral rehabilitation is usually performed with a palatal obturator prosthesis (PAP). Acceptable anatomical and functional outcomes in terms of speech, mastication, aesthetic appearance, stability, and comfort are not often achieved with a PAP. This technical note describes a technique for reconstruction after total bilateral maxillectomy involving the implantation of a custom-made bone-anchored titanium prosthesis obtained by 3D printing. Good functional and anatomical outcomes were achieved with this technique. It combines the advantages of the obturator prosthesis (short duration of surgery and hospitalization, low morbidity) and free flap (aesthetic/anatomical reconstruction and irremovable comfortable functional rehabilitation). This technique constitutes a new therapeutic alternative for the restoration of large defects after total maxillectomy when free flaps are contraindicated.

[Persistent stapedial artery with otosclerosis]. / Artère stapédienne persistante et ankylose stapédovestibulaire.

OBJECTIVES: A persistent stapedial artery is a rare vascular malformation. This diagnosis is based on CT scan and intraoperative findings. MATERIAL AND METHODS: The case of a 19-year-old woman with a persistent stapedial artery found during stapes surgery is reported. This vascular malformation was explored with a CT scan showing the bilaterality of this anatomical variation and signs of associated otosclerosis. RESULTS: This malformation was successfully coagulated with laser allowing the stapedotomy to be completed. CONCLUSIONS: A persistent stapedial artery is not a contraindication to stapedotomy because it can be safely coagulated during the same procedure.

[Transoral resection of thyroid cancer metastasis to retropharyngeal lymph node]. / Abord transoral d'une adénopathie rétropharyngée métastatique d'un carcinome thyroïdien papillaire.

OBJECTIVES: Retropharyngeal lymph node metastasis from papillary thyroid carcinoma is uncommon. Traditional extirpative procedures include cervical, cervical-parotid, and transmandibular approaches. The authors report the case of a patient with a retropharyngeal node metastasis originating from papillary carcinoma of the thyroid gland that was successfully removed by a transoral approach. METHOD: A 49-year-old man presented for removal of a retropharyngeal lymph node metastasis measuring 21 mm x 27 mm from papillary thyroid carcinoma. Surgical excision was performed through a transoral approach using a surgical navigation system to assess the location of the node precisely. RESULT: The postoperative course was uneventful with return to a normal diet on the first postoperative day and hospital discharge on the second postoperative day. Three months after surgery, TSH-stimulated thyroglobulin was undetectable. CONCLUSION: The transoral approach to retropharyngeal space is a reliable procedure with low morbidity compared to other approaches. The limited surgical access provided by this approach should limit its use to removal of well-circumscribed lesions not invading adjacent structures.

Importance of malnutrition and associated diseases in the management of Zenker's diverticulum.

OBJECTIVES: To study the impact of malnutrition on a population treated for Zenker's diverticulum and to look for the causes of persistence or recurrence of dysphagia after endoscopic surgery. MATERIAL AND METHODS: This retrospective study included 30 patients with Zenker's diverticulum treated by endoscopy. All swallowing disorders and manifestations of malnutrition and postoperative improvement in and/or recurrence of symptoms were noted. RESULTS: Nutritional status was evaluated for 26 patients. Before surgery, 54% suffered from malnutrition, which was severe in 31%; 28.6% of the cases with malnutrition showed postoperative complications, versus 8.3% of cases without baseline malnutrition. Ninety percent of patients (n=27) declared complete resolution of symptoms. Nine patients presented recurrence of dysphagia, including 6 with recurrence of Zenker's diverticulum and 3 with, respectively, inclusion body myopathy, esophageal hypertonia and central disease. CONCLUSION: Malnutrition should be quantified and treated before and after surgery for Zenker's diverticulum to prevent complications and decrease mortality. Associated pathologies should be systematically screened for, especially in case of recurrence of swallowing disorder without recurrence of Zenker's diverticulum.

[Pediatric reversible acute velar palsy: A case report]. / Paralysie vélaire aiguë réversible de l'enfant : à propos d'un cas.

INTRODUCTION: Approximately 40 cases of acute idiopathic velopharyngeal reversible paralysis in the pediatric population have been reported in the literature. OBSERVATION: We present the case of a 12-year-old boy who had consulted in pediatric emergency departments for symptomatology including rhinolalia, nasal regurgitation, and deviation of the labial commissure. Paraclinical explorations helped diagnose rhombencephalitis with enterovirus. The introduction of oral corticosteroids was followed by rapid clinical improvement in 3 days. Monitoring 1 month later showed complete regression of symptoms. DISCUSSION: Similar cases in the literature describe the occurrence of nasal regurgitation and rhinolalia, sometimes associated with other cranial nerve impairment. The pathogenesis is rarely highlighted and the imaging results are always normal. Ad integrum recovery with or without corticosteroids is the rule. In light of this literature review, it is possible to conclude that the occurrence of such a suggestive clinical picture should limit the often costly and unnecessary additional tests.

Bronchogenic cyst of the tip of the tongue: report of two cases.

INTRODUCTION: Lingual bronchogenic cyst is a rare congenital malformation, classified as a choristoma. It is lined by respiratory epithelium. Extrathoracic sites are rare and the tongue is an exceptional site. CASE REPORT: The authors report two cases of bronchogenic cyst of the tip of the tongue in newborn infants. These two initially asymptomatic lesions gradually increased in size, leading to feeding difficulties in one case. MRI demonstrated well-demarcated, solitary, unilocular cystic images. Surgical resection was easily performed and histological examination concluded on bronchogenic cyst. An aberrant right upper lobe tracheal bronchus was also present in one case. DISCUSSION: Lingual choristomas are rare and defined histologically according to the type of epithelium. The embryological origin of lingual bronchogenic cysts remains controversial. MRI is the imaging examination of choice to characterize these lesions, but the definitive diagnosis is based on histological examination. Early, systematic surgical enucleation of all congenital lingual cysts must be performed to prevent obstructive and infectious complications.

Bilateral semicircular canal aplasia.

INTRODUCTION: Bilateral semicircular canal aplasia is extremely rare; discovery, when the cochlear-vestibular system is normal and there is no hearing loss, is serendipitous. CASE REPORT: Bilateral semicircular canal aplasia was serendipitously discovered in a 24-year-old male during assessment of unilateral mixed hearing loss with subnormal contralateral hearing. The deformity was isolated, with no associated syndrome. DISCUSSION/CONCLUSION: Incidence of this isolated entity is unknown, but doubtless greatly underestimated due to the absence of associated symptomatology. To the best of our knowledge, this is only the second report of bilateral aplasia of the entire semicircular canal system involving unilateral hearing loss. A review of the literature focuses on the embryological and molecular aspects.

Adenocarcinoma of the ethmoid sinus: retrospective study of 42 cases.

OBJECTIVES: Retrospective analysis of the oncological results and morbidity of ethmoid sinus adenocarcinoma surgery, and identification of survival factors. MATERIAL AND METHODS: Forty-two patients were treated from 1990 to 2009. The study covered clinical presentation, medical imaging, histologic data, TNM grade, treatment, morbidity and overall recurrence-free survival. RESULTS: Forty-one men and one woman, with mean age at diagnosis of 61.5 years, were included. 85.7% had been exposed to wood dust. Twenty patients (47.6%) were graded T4 at diagnosis. Thirty-three (78.5%) were treated by surgery followed by radiation therapy; nearly half of these showed recurrence. Overall specific 5-year survival was 44.2% at 5 years and recurrence-free 5-year survival 46.4%. The factors of poor prognosis found were cerebromeningeal or orbital invasion and local recurrence. CONCLUSION: This series confirms the epidemiological literature on ethmoid adenocarcinoma and the influence of poor prognosis factors. Survival depended directly on local tumor control and seemed to be enhanced on an isolated transfacial approach.

Ultrasound-guided botulinum toxin injections for treatment of drooling.

OBJECTIVES: To evaluate the efficacy of treatment of drooling by ultrasound-guided botulinum toxin injection of the salivary glands and to determine the optimal modalities of this procedure. PATIENTS AND METHODS: This study is a retrospective review of patients treated for drooling by injection of 100 units of Botox(®) into the parotid and submaxillary glands between 2002 and 2008. Efficacy was evaluated by a quality of life questionnaire six weeks after the injections. RESULTS: One hundred and eleven injection sessions were performed in 70 patients aged one to 84 years with a beneficial effect in 66% of cases. The most effective protocol was injection of 20 units of botulinum toxin into each submaxillary gland and 30 units of toxin into each parotid gland. CONCLUSION: The treatment of drooling by Botox(®) injections into salivary glands is effective. The authors propose ultrasound-guided injection of both submaxillary glands and both parotid glands. These injections can be repeated in the case of recurrence of drooling.

Juvenile ossifying fibroma of the maxilla.

INTRODUCTION: Juvenile ossifying fibroma is a rare, benign fibro-osseous tumour. In the light of a clinical case, the authors review the diagnosis, treatment and histological classification of these tumours. CASE REPORT: A seven-year-old child presented with a naso-orbito-ethmoidal trabecular juvenile ossifying fibroma. Complete surgical resection via a transfacial approach was performed after a preoperative work-up comprising head and neck CT and MRI. DISCUSSION: A review of the literature reveals that treatment of this aggressive tumour must comprise complete surgical resection via an incision determined by local tumour extension. CONCLUSION: Patients with juvenile ossifying fibroma tumour require long-term follow-up due to the high recurrence rate.