[Bamboo nodes of vocal folds: case report and review of literature]. / Bamboo nodes des cordes vocales: description d'un cas clinique et revue de La literature.

Bamboo nodes are sub mucous lesions localized in the vocal folds. Their aspect reminds of the nodes in a bamboo, which gives them their name. The diagnosis is made by laryngoscopy. Those lesions are always associated with autoimmune diseases: systemic lupus erythematosus, rheumatoid arthritis, Sjögren's syndrome, Hashimoto, progressive systemic sclerosis. The treatment is not clearly described in literature. It is recommended to start with systemic steroids and speech therapy. If the regression of laryngeal lesions is not suf- ficient, it is advised to complete with local steroid injections. Surgery should be consi- dered as the last treatment. We describe a clinical case of bamboo nodes and make a review of literature.

[Evaluation of dysphonia--a multiparametric approach]. / Evaluation des troubles de la voix--une approche multiparamétrique.

Voice evaluation is based on perceptive analysis of voice quality and on instrumental assessments, which comprise acoustic and aerodynamic sound measures. Even though perceptive evaluation is considered the gold standard for voice evaluation, it is biased by its subjective nature. Despite the fact that instrumental analysis is considered objective, it has limited reliability. This is why the integration of these two methods into a multiparametric analysis allows a more broad range diagnostic approach for dysphonia.

[Dysphonia as a manifestation of internal carotid artery dissection: a case report]. / Dysphonie et dissection carotidienne spontanée: à propos d'un cas.

We report a case of spontaneous internal carotid artery dissection in a young patient resulting in vagal (X) and accessory (XI) nerve palsies. Clinical examination revealed right shoulder and laryngeal paralysis, with preservation of velar function. This corresponds to Garel-Gignoux syndrome. However, this patient also had hemipharyngeal paralysis, which Gignoux did not report in his case.

[Description of complications after injection laryngoplasty with polydimethylsiloxane]. / Evolution défavorable de médialisation laryngée par polydimethylsiloxane.

The injection of polydimethylsiloxane for medialization of the vocal folds has been used for more than 15 years with satisfactory long-term results. However there is little in the literature with regard to the complications and their treatment. We present 2 cases (1 unilateral laryngeal paralysis and 1 bilateral vocal fold atrophy) with unsatisfactory results after PDMS injection. The first case had chronic granulomatous inflammation induced by the PDMS and the second a periprothetic fibrotic reaction causing cordal rigidity. A superior cordotomy and extraction of the PDMS was performed in the two patients. A significant improvement was observed in the first patient (with granuloma); on the other hand the PDMS removal in the second case couldn't modify the cordal rigidity and consequently the voice quality. In conclusion, PDMS injection laryngoplasty is an efficient intervention with possible complications: foreign body granuloma, periprothetic fibrosis. In case of chronic inflammation, an endoscopic removal is indicated. Where there is vocal fold rigidity due to fibrosis the surgical correction is more difficult. For this reason an injection in Reinke's space or an over-correction must be avoided.

[Gastroesophageal reflux: a possible cause of paroxysmal laryngeal dyspnea]. / La dyspnée laryngée paroxystique: une manifestation extra-oesophagienne peu connue du reflux gastro-oesophagien.

An important number of patients are referred to the ENT specialist because of extraoesophageal manifestations of gastroesophageal reflux. The most alarming symptom is a paroxysmal dyspnea secondary to a laryngospasm. The patients report a laryngeal choking sensation associated to an aphonia. We report three cases of laryngospasm secondary to acid gastric reflux. The diagnosis was made with the clinical history, a laryngeal examination and a 24-hour pH-monitoring enabled us to demonstrate a clear temporal relation between the reflux episodes and the choking episodes. In conclusion, the pharyngo-laryngeal reflux is a possible cause of laryngospasm. In our three patients, a high dose antiacid treatment was efficient to bring a lasting relief of the symptoms.

Endoscopic neck dissection in human cadavers.

OBJECTIVE: To evaluate the feasibility and efficacy of endoscopic neck dissection (END) in human cadavers. STUDY DESIGN: Experimental self-controlled study. METHODS: END on five human cadavers through three openings: one for the camera, one for the dissecting instrument, and one for a grasping one. The tissue specimens removed were divided into traditional neck groups (I to V). After the completion of END, open neck dissection was performed using standard surgical techniques and the remaining tissue within each neck group was retrieved. The important neck structures (carotid artery, internal jugular vein, cranial nerves X, XI, and XII, phrenic nerve) were evaluated for lesions. A pathologist evaluated each specimen, without knowing its exact origin in terms of neck group or side, and type of surgical technique used. For each specimen, the number of retrieved lymph nodes and their anatomic integrity was analyzed. RESULTS: Ten neck dissections were performed on 5 cadavers, without any major difficulty. An injury of the internal jugular vein occurred twice and once the phrenic nerve was cut. Little tissue was usually left for open surgical dissection. The average number of retrieved lymph nodes by endoscopy was 4.9 +/- 2.7 (mean +/- standard deviation). Completion open neck dissection retrieved an additional 0.5 +/- 0.5 lymph nodes. Efficacy of END was 92 +/- 10%. The majority of retrieved lymph nodes were intact but exhibited important postmortem autolysis artifacts. CONCLUSIONS: Endoscopic neck dissection is possible in human cadavers and is free of lesions to major structures. The majority of neck lymph nodes can be removed endoscopically.

Transient hemiageusia in cerebrovascular lateral pontine lesions.

Knowledge of human central taste pathways is largely based on textbook (anatomical dissections) and animal (electrophysiology in vivo) data. It is only recently that further functional insight into human central gustatory pathways has been achieved. Magnetic resonance imaging studies, especially selective imaging of vascular, tumoral, or inflammatory lesions in humans has made this possible. However, some questions remain, particularly regarding the exact crossing site of human gustatory afferences. We present a patient with a pontine stroke after a vertebral artery thrombosis. The patient had infarctions in areas supplied by the anterior inferior cerebellar artery and showed vertical diplopia, right sided deafness, right facial palsy, and transient hemiageusia. A review of the sparse literature of central taste disorders and food preference changes after strokes with a focus on hemiageusia cases is provided. This case offers new evidence suggesting that the central gustatory pathway in humans runs ipsilaterally within the pons and crosses at a higher, probably midbrain level. In patients with central lesions, little attention has been given to taste disorders. They may often go unnoticed by the physician and/or the patient. Central lesions involving taste pathways seem to generate perceptions of quantitative taste disorders (hemiageusia or hypogeusia), in contrast to peripheral gustatory lesions that are hardly recognised as quantitative but sometimes as qualitative (dysgeusia) taste disorders by patients.