Voice modulation, self-perception and motor branch of the superior laryngeal nerve.

OBJECTIVES: Vocal morbidity resulting from damage to the motor branch of the superior laryngeal nerve (SLN) after endocrine surgery is well known, but diagnosis is often delayed. The present study aimed to quantify these vocal changes acoustically (main objective), and correlate this with the vocal complaints of patients with suspected SLN motor impairment (secondary objective). MATERIAL AND METHODS: Thirty females patients with suspected injury of the SLN cricothyroid branch (CT-) were compared to 30 patients without postoperative vocal impairment (CT+) and to 30 control subjects. Mean, minimal and maximal fundamental frequencies (F0mean, F0min and F0max) and vocal range were measured on /e/ at high frequency, sirens (glissandi), a reading text, and minimal intonation pairs. Subjective vocal impairment was evaluated on the Voice Handicap Index (VHI). RESULTS: A lowering of F0mean associated with vocal range reduction by one fifth (in the reading text) seemed to be specific to CT- patients. Production of questions was affected, with differences in melodic curve and attack. Thyroidectomy within 2 months in itself (without suspected SLN cricothyroid branch injury) also affected these parameters, but to a lesser degree. CT- patients reported greater voice impairment than CT+ patients or controls (P=0.0004). CONCLUSION: Alterations in speech intonation, quantified on minimal pair test, and self-assessed vocal handicap (VHI) are tools that can easily be used in daily practice to screen for SLN motor branch lesion.

Radiological-audiological correlation in type II tympanoplasty with glass ionomer cement.

AIM: To assess the CT scan aspect of cement bridges used to repair incudostapedial joint discontinuity (ISD) and correlate these observations to audiometric data over time. MATERIAL AND METHODS: A retrospective study in 12 patients with cement rebridging for ISD compared pre- and post-operative pure-tone average thresholds, Hounsfield units (HU), and bridge size and position on postoperative CT scans. RESULTS: Mean pre- and post-operative air-bone gap (ABG) was 24.5 and 16dB, respectively. HU did not vary over time post-surgery, with no significant correlation between HU and time to postoperative CTnscan up to 24months (p=0.219). However, a "suggestive" correlation was found between postoperative ABG and HU (p=0.004, r=-0.7). High cement density correlated with good functional outcome: HU <500 indicating functional failure and >1000 indicating ABG closure. CONCLUSION: Immediate cement polymerization quality (high HU) was stable over time and a marker of ossiculoplasty success, correlating with good functional outcome. Particular care should be taken in preparing the cement, and solidification needs to be on dry mucosa-free ossicles.

Day-surgery in otology: Impact study of a dedicated organizational model.

AIM: Day surgery (DS) in otology in France is insufficiently implemented compared to other countries of comparable socio-economic level. The aim of the present study was to evaluate changes in surgical practice in "major otology" cases in a hospital center after launching a dedicated ENT DS unit. MATERIAL AND METHODS: This new unit, designed in collaboration with the surgeons, was inaugurated in 2014. Number of procedures, patient demographics, surgery durations, and rates of crossover from DS to conventional management were recorded prospectively for the year before and the year after the launch. All otologic surgery procedures with at least tympanomeatal flap elevation were included; minor surgeries such as grommet insertion were excluded. RESULTS: Between the two time periods, major otology day cases increased from 106 to 153 procedures (+43%). In 2013, the DS rate was 27%, versus 56% in 2015. Otosclerosis surgeries represented 7% in 2013 and 15% in 2015, and type II and III tympanoplasties 3% and 24% respectively. Difference in patient age between DS and conventional surgery was lower in 2015. Crossover rates were 10% in 2013 and 21% in 2015, mainly due to nausea/vertigo (56%) and surgery ending too late in the day (33%). CONCLUSION: Major otologic cases are suitable for DS. Launching this dedicated unit with its specific organization enabled a very significant increase in DS rates, probably due to greater patient satisfaction and surgeons' growing confidence. The main pitfall was in scheduling, with surgery ending too late in the day for discharge home; this has since been corrected.

Correlation between the rate of asymmetry volume of maxillary sinuses and clinical symptomatology in the silent sinus syndrome: A retrospective study about 13 cases.

OBJECTIVES: The "silent sinus syndrome" (SSS) also known as imploding antrum syndrome or chronic maxillary sinus atelectasis consists of painless enophthalmos and inward retraction of the ipsilateral maxillary sinus walls. The aims of the present study were: i) to look for a correlation between the level of volume asymmetry of the maxillary sinuses and the presence of ophthalmological and rhinosinusitis signs, ii) to determine the benefits of a middle meatal antrostomy in SSS cases, and iii) to evaluate the preventive role of neuronavigation surgery in the morbidity of this specific surgery. MATERIALS AND METHODS: We retrospectively analyzed the data of 13 patients operated on for a SSS by middle meatal antrostomy, with the aid of neuronavigation in 7 cases. The median follow up was 30 months. No reconstruction of the orbital floor was performed. Morphometric analysis and modeling of the sinus volume from the preoperative CT scanners were performed to assess the impact of the loss of sinus volume on the symptoms. RESULTS: all patients displayed a retraction of the orbital floor. There was a significant correlation between the magnitude of the decrease in sinus volume and clinical manifestations. Surgical treatment allowed rhinosinusitis symptom disappearance in 53% of patients. Ophthalmological symptoms did not decrease, but stayed stable after the surgical treatment. When neuronavigation surgery was performed, no complications were observed. CONCLUSION: SSS symptoms correlated with the reduction of volume of the maxillary sinuses. This measure may be related to the severity of the disease. The middle meatal antrostomy seemed sufficient to stop the evolution of the SSS, avoiding the occurrence of severe enophthalmos. Neuronavigation surgery helped preventing serious eye complications.

Mandibular osteosclerotic lesion of a parotid salivary duct carcinoma: demonstration of the neural tropism of these tumors.

INTRODUCTION: Salivary duct carcinoma (SDC) is an uncommon entity of salivary gland cancers with a poor prognosis due to local aggressiveness or distant recurrences involving lymph nodes, lung, and long bones, in which secondary lesions are usually osteolytic. The authors report the first case of mandibular SDC, atypical due to its osteosclerotic presentation and its site, attributed to aggressive neural spread of the tumor along the trigeminal nerve. CASE STUDY: This asymptomatic osteosclerotic bone involvement was diagnosed based on pathological enhancement of the trigeminal nerve demonstrated on MRI and was accompanied by facial nerve involvement up to its third intracranial portion. Radical surgery ensured disease control with continued good quality of life at the 4-year follow-up visit. CONCLUSION: Nerve enhancement on MRI and determination of specific tumor markers (HER-2/neu and p53) should be taken into account to evaluate the prognosis of SDC and to propose appropriate surgical treatment.

Muco-ciliary differentiation of nasal epithelial cells is decreased after wound healing in vitro.

BACKGROUND: Epithelial damage and modifications of cell differentiation are frequent in airway diseases with chronic inflammation, in which transforming growth factor-beta1 (TGF-beta1) plays an important role. The aim of this study was to evaluate the differentiation of human nasal epithelial cells (HNEC) after wound healing and the potential effects of TGF-beta1. METHODS: Basal, mucus, and ciliated cells were characterized by cytokeratin-14, MUC5AC, and betaIV tubulin immunodetection, respectively. Their expression was evaluated in situ in nasal polyps and in an in vitro model of wound healing in primary cultures of HNEC after wound closure, under basal conditions and after TGF-beta1 supplementation. Using RT-PCR, the effects of TGF-beta1 on MUC5AC and DNAI1 genes, specifically transcribed in mucus and ciliated cells, were evaluated. RESULTS: In situ, high TGF-beta1 expression was associated with low MUC5AC and betaIV tubulin expression. In vitro, under basal conditions, MUC5AC expression remained stable, cytokeratin-14 expression was strong and decreased with time, while betaIV tubulin expression increased. Transforming growth factor-beta1 supplementation downregulated MUC5AC and betaIV tubulin expression as well as MUC5AC and DNAI1 transcripts. CONCLUSION: After a wound, differentiation into mucus and ciliated cells was possible and partially inhibited in vitro by TGF-beta1, a cytokine that may be involved in epithelial remodeling observed in chronic airway diseases.

[Tracheal anastomosis: monofilament absorbable suture versus monofilament non-absorbable suture. Experimental study in rats]. / Anastomose trachéale: fil monofilament résorbable versus non résorbable. Etude expérimentale chez le rat.

OBJECTIVES: When tracheal stenosis is symptomatic, the treatment may consist of surgical resection and anastomosis. A multifilament absorbable suture is usually used. The aim of this experimental work on rats was to study the benefits of using a monofilament absorbable suture with high initial resistance. MATERIAL AND METHODS: We compared Ethilon, a nylon monofilament non-absorbable suture (MNA), with Monocryl, a polyglecaprone 25 (P25) monofilament absorbable suture (MA). The sutures were used for tracheal anastomosis on 16 rats. P25 has a high initial strength but its intra-tissular disappearance is fast. Animals were killed at 1, 2 and 3 months. Anastomoses were studied by optical microscopy and histological analysis. RESULTS: At 3 months no disunity or stenosis was seen with the MA. With the MNA, a modification of the tracheal transverse section and a stenosis were observed. The histological examination showed an initial important inflammatory cell reaction with the MA and at 3 months, a surgery-free like tracheal aspect. At 3 months the rats with MNA had a persistent foreign body cell reaction. CONCLUSION: Good results obtained by using P25 could be due to high initial resistance of the suture protecting the anastomosis. The semi-fast absorption of the suture avoided persistent inflammatory cell reaction. Confirmation of these results by working on larger animals and tracheal anastomosis under tension could allow the use of this suture on human beings, in this instance.

[Is coincidence detection emission tomography (CDET) as reliable as positron emission tomography (PET) in head and neck cancer?]. / La tomographie d'emission en détection de coïncidence (CDET) est-elle aussi performante que la tomographie par emission de positons (TEP) en cancérologie ORL?

OBJECTIVE: Positron emission tomography (PET) is becoming more and more useful in head and neck tumour detection, guiding diagnostic and therapeutic decision. However, techniques, similar to PET, but using modified conventional tomography equipment, are used. The most commonly used is the dual-head positron emission tomography using coincidence detection (CDET). This study was aimed at searching if CDET could be as reliable as PET in some of its indications. PATIENTS AND METHODS: Between 1997 and 2001, 19 patients, with head and neck cancer, had a CDET, for 3 indications. We studied retrospectively sensitivity (Se) and specificity (Sp) rates for these 3 indications. RESULTS: 1 degree) Detection of unknown primary head and neck cancers with lymph node manifestation: Se = 100%, Sp = 66,7%. 2 degrees) Detection of body metastasis: Se = 50%, Sp = 33%. 3 degrees) Detection of local recurrent cancer: Se = 100%, Sp = 25%. CONCLUSION: CDET seems to be useful in finding unknown primary cancers with lymph node manifestation but is not reliable to look for metastasis and local recurrences. It cannot be used in all indications for PET. If no other tool is available, this investigation can be used, keeping in mind its limitations.