Acute smell and taste loss in outpatients: all infected with SARS-CoV-2?

During SARS-CoV-2 pandemic, our region (Alsace, East of France) became a Covid-19 cluster quite early in Europe. Loss of smell and taste was quickly flagged by the Ears-Nose and Throat scientific community as a potential warning signs of SARS-CoV-2 infection (1). Many patients and medical/paramedical workers with mild to moderate form of SARS-CoV-2 infection complained about their loss of sense of smell and taste to our ENT department. The aim of our study was to compare the characteristics of loss of smell and taste between patients with a clinical diagnosis of SARS-CoV-2 infection to patients with a RT-PCR diagnosis.

Imaging sphenoid diseases.

In this review we provide comprehensive analysis of the imaging features of diseases affecting the sphenoid sinus, including a large and heterogeneous spectrum of pathologies such as sinusitis, pseudotumours, bony pathologies, and tumours. Clinical symptomatology related to sphenoid pathologies is often non-specific and patient clinical examination and endoscopic investigations are not definitive; thus, radiological imaging is mandatory for diagnosis. Strengths and limitations of both morphological and functional imaging methods such as computed tomography (CT), magnetic resonance imaging (MRI), and combined positron-emission tomography/computed tomography (PET/CT) have been considered and integrated into a well-defined clinical context in order to recognise specific imaging features and to underline their clinical relevance for an early and accurate diagnosis. An overview of several sphenoid conditions is herein selected with a didactic objective including both common and less common diseases.

Induction chemotherapy before surgery for unresectable head and neck cancer.

OBJECTIVE: To preoperatively reduce tumour size in patients with locally advanced and/or non-resectable squamous cell carcinoma with induction chemotherapy in order to achieve surgical excision with clear margins and preserve quality of life. METHODOLOGY: In this study, 16 patients with locally advanced and/or non-resectable squamous cell carcinoma underwent induction chemotherapy with docetaxel, cisplatin, and 5-fluorouricil or paclitaxel, carboplatin, and cetuximab. RESULTS: Over 80% of patients responded to induction chemotherapy. Histological examination of the 14 surgical specimens showed a total absence of residual cancer cells in 37.5% of cases. CONCLUSION: Concurrent radiation and chemotherapy is the standard treatment for locally advanced head and neck squamous cell carcinoma; however, induction chemotherapy may be beneficial in select patients.

Transcaruncular anterior ethmoidal artery ligation.

Recurrence of epistaxis after ligation or embolization of the sphenopalatine artery may require ligation of the ipsilateral anterior ethmoidal artery, which cannot be embolized because of the risk to the ophthalmic artery. We describe a transconjunctival transcaruncular approach that allows reliable low-risk access to the anterior ethmoidal artery. This technique offers a minimally invasive approach to the surgical site, without unsightly scar.

Inferior turbinate lateralization.

Inferior turbinate lateralization via an endonasal approach is a reliable low-risk procedure to correct inferior turbinate hypertrophy resistant to medical treatment. This well-established technique provides nasal comfort while conserving the mucosal membrane and physiology of the inferior turbinate, minimizing the postoperative complications (empty nose syndrome) besetting turbinoplasty involving mucosal or submucosal reduction.

[Balloon catheter dilatation for frontal sinus ostium stenosis: surgical technique and preliminary report]. / Technique de dilatation ostiale par ballonnet ("balloon Sinuplasty") dans les obstructions du canal naso-frontal: expérience préliminaire et notes techniques.

OBJECTIVES: To report early clinical experience with balloon dilation of the frontal recess ("Balloon Sinuplasty"), to describe surgical technique, to assess its feasibility and effectiveness. MATERIAL AND METHODS: This prospective, multiinstitutional case series describes all patients who underwent balloon sinuplasty for frontal sinus ostium stenosis from May 2011 to December 2011. RESULTS: Eight adult patients underwent a total of 11 frontal balloon sinuplasty in the clinical setting. The mean age was 46 +/- 12. All procedures were performed under general anesthesia. No complications occurred. Six of the eight patients were deemed cured with a follow-up range of 1-7 months. For 2 patients the procedure was unsuccessful. CONCLUSIONS: Balloon dilatation of the frontal recess is a safe and feasible technique with a comparable efficacy to conventional surgical treatment modalities. There is a need for randomised controlled trials and cost-effectiveness studies.

3D-printed simulator for nasopharyngeal swab collection for COVID-19.

OBJECTIVES: Diagnosis of COVID-19 is essential to prevent the spread of SARS-CoV-2. Nasopharyngeal swabs (NPS) remain the gold standard in screening, although associated with false negative results (up to 30%). We developed a 3D simulator of the nasal and pharyngeal cavities for the learning and improvement of NPS collection. PATIENTS AND METHODS: Simulator training sessions were carried out in 11 centers in France. A questionnaire assessing the simulator was administered at the end of the sessions. The study population included both healthcare workers (HCW) and volunteers from the general population. RESULTS: Out of 589 participants, overall satisfaction was scored 9.0 [8.9-9.1] on a scale of 0 to 10 with excellent results in the 16 evaluation items of each category (HCWs and general population, NPS novices and experienced). The simulator was considered very realistic (95%), easy to use (97%), useful to understand the anatomy (89%) and NPS sampling technique (93%). This educational tool was considered essential (93%). Participants felt their future NPS would be more reliable (72%), less painful (70%), easier to perform (88%) and that they would be carried out more serenely (90%). The mean number of NPS conducted on the simulator to feel at ease was two; technical fluency with the simulator can thus be acquired quickly. CONCLUSION: Our simulator, whose 3D printing can be reproduced freely using a permanent open access link, is an essential educational tool to standardize the learning and improvement of NPS collection. It should enhance virus detection and thus contribute to better pandemic control.

Osteosclerotic bone dysplasia in siblings with a Fam20C mutation.

Raine syndrome is an autosomal recessive disorder caused by mutations in the FAM20C gene. FAM20C codes for the human homolog of DMP4, a dentin matrix protein highly expressed in odontoblasts and moderately in bone. DMP4 is probably playing a role in the mineralization process. Since the first case reported in 1989 by Raine et al. 21 cases have been published delineating a phenotype which associates dysmorphic features, cerebral calcifications, choanal atresia or stenosis and thoracic/pulmonary hypoplasia. Kan and Kozlowski suggested the name of Raine syndrome to describe this new lethal osteosclerotic bone dysplasia. All the cases described were lethal during the neonatal period except for the last two reported patients aged 8 and 11 years who presented severe mental retardation. Here we describe two sisters, with an attenuated phenotype of Raine syndrome, who present an unexpectedly normal psychomotor development at ages 4 and 1, respectively. Identification of a homozygous mutation in the FAM20C gene confirmed the Raine syndrome diagnosis, thus contributing to the expansion of the Raine syndrome phenotype. This case report also prompted us to revisit the FAM20 gene classification and allowed us to highlight the ancestral status of Fam20C.

Laryngeal spasm and tracheostomy after hydroxyapatite injection laryngoplasty.

INTRODUCTION: Adductor spasmodic dysphonia (Ad-SD) is usually treated by botulinum toxin injection into the thyroarytenoid muscles. In older patients, atrophy of these muscles is responsible for glottic leak, causing presbyphonia and is managed by vocal fold medialization using autologous fat or hydroxyapatite (HA). We report the first case of uncontrollable laryngeal spasm requiring tracheostomy after hydroxyapatite injection laryngoplasty in a patient with spasmodic dysphonia and presbyphonia. CASE REPORT: An 83-year-old man had been treated for Ad-SD by botulinum toxin injections every six months for 14 years. Due to severely disabling glottic leak, autologous fat injection laryngoplasty was then successfully performed. Six months later, following recurrence of severe hypophonia, hydroxyapatite injection was performed, subsequently complicated by immediate acute respiratory distress secondary to adductor laryngeal spasm requiring reintubation and tracheostomy. The postoperative course was marked by gradual recovery of vocal fold mobility with decannulation on day 12. DISCUSSION: This case allows a discussion of the possible pathophysiological mechanisms responsible for adductor laryngeal spasm. Vocal fold medialization procedures should be performed with caution in patients with Ad-SD.

Wegener's granulomatosis of the temporal bone and skull base that mimicked an inflammatory myofibroblastic tumour: a case report.

OBJECTIVE: To compare two potential diagnoses of a temporal bone pseudotumour: an inflammatory myofibroblastic tumour and Wegener's granulomatosis. METHODOLOGY: A case of Wegener's granulomatosis that mimicked an inflammatory myofibroblastic tumour is reported. The clinical presentation, staging of the disease, histology, and follow-up are analysed. RESULTS: Histopathology of the temporal bone failed to provide an accurate diagnosis, even after immunocytochemical analyses. The diagnosis of Wegener's granulomatosis was suspected after biopsy of a pulmonary mass and was confirmed by the presence of anti-neutrophil cytoplasmic antibodies in blood samples. CONCLUSION: Irrespective of the aetiology, a pseudotumour of the temporal bone should always be investigated by biology and radiology. Radiological investigations will allow staging of the disease and specific localisation for biopsies.

[Replacement of the trachea using surgical reconstruction: current state of research]. / Remplacement de trachée par reconstructions chirurgicales: état actuel de la recherche.

OBJECTIVE: To review the main studies and the recent surgical procedures in tracheal reconstruction. MATERIAL AND METHOD: The literature search was conducted using the key words "tracheal reconstruction", "grafts", and "tissue engineering" and by selecting references from the articles reviewed as well as the experience of the authors in this field. RESULTS: Surgical reconstruction for tracheal replacement without using biomaterials involves tissue grafts (auto- or allografts) and tissue engineering. Among the many procedures already described, three new techniques have emerged these past few years employing autologous mesenchymal stem-cell-derived chondrocytes, autologous cultured epithelial cells, and a matrix derived from tracheal graft; costal cartilage, recipient mucosa, and local or free flaps, and an aortic graft. These procedures have been proposed in humans with apparently good results but with a still limited follow-up. CONCLUSIONS: Tracheal reconstruction techniques have recently progressed and replacing a long segment of trachea can be envisaged for the future. Moreover, these reconstructions, in conjunction with biomaterial development, would facilitate the design and the implantation of a laryngeal prosthesis.

Iatrogenic meningoencephalocele after traumatic perforation of the cribriform plate during nasal intubation of a preterm infant.

Traumatic iatrogenic meningoencephaloceles infants are rare and there is no consensus on management in the literature. This article presents a case of a meningoencephalocele diagnosed 15 months after a traumatic perforation of the cribriform plate due to a difficult intubation of a preterm infant that was treated by an endoscopic endonasal surgery. A close collaboration between pediatricians and ENT surgeons appears essential for early diagnosis and management. Endoscopic endonasal approach for meningoencephalocele management has several advantages and is a safe procedure when performed by an experienced surgeon.

Pathology of the facial nerve.

A good examination in facial nerve imaging (CT or MR imaging) depends on a good knowledge of anatomy. Two clinical situations must be considered: imaging of patients with or without facial palsy. CT and MR imaging are very useful when the symptoms are atypical or progressive: MR imaging gives very good information about the facial nerve inflammation but may also discover a schwannoma, a hemangioma, a meningioma, or a primitive or secondary cholesteatoma. In malignant tumors of the parotid gland, a study of the fallopian canal must always be performed to delineate an extension in the mastoid, tympanic, or intrameatic parts. In some rare cases, a metastasis in the temporal bone may occur, especially in the region of the geniculate ganglion. Particular attention must be paid to children with facial palsy, considering the possibility of a histiocytosis or metastasis of a neuroblastoma.

[CT imaging of the anterior ethmoidal artery: anatomic correlation]. / Imagerie tomodensitométrique de l'artère ethmoïdale antérieure: confrontation radio-anatomique.

PURPOSE: To identify the anterior ethmoidal artery (AEA) of a skull specimen on CT prior to transnasal endoscopic surgical management of anterior epistaxis. MATERIALS AND METHODS: From a medial canthotomy approach, the AEA was located and a marker placed on 9 skull specimens (18 AEA). CT with 2D reformations was then performed. The AEA were then dissected using an endoscopic anterior ethmoidectomy approach. The presence of AEA procidence was recorded. RESULTS: Correlation between CT and surgical findings allowed identification of 2 criteria predictive of AEA procidence: 1) presence of an ethmoid bulla above the AEA canal 2) AEA canal located below (not within) the ethmoid roof, anterior to the bulla. CONCLUSION: High resolution CT depiction of the AEA provides information regarding its accessibility for endoscopic ligation in patients with severe anterior epistaxis as an alternative to external ligation while demonstrating the upper limit of the anterior ethmoid.

Lateral semicircular canal plugging: a simple and effective surgical treatment against incapacitating Menière's disease.

OBJECTIVES: To present lateral semicircular canal plugging (LCP) technique and late results dedicated to patients with incapacitating Menière's disease. METHOD: In a prospective case-controlled baseline study, patients with unilateral incapacitating Menière's disease were treated either by LCP (n = 11) or by vestibular neurotomy (VN) (n = 11). LCP was performed by retro auricular approach, vestibular neurotomy by retro sigmoid approach. According to Menière's disease therapeutic evaluation guidelines, disability and hearing loss were assessed before and after both surgical treatments, with a 2 years followup at least. After LCP, a CT and MRI scan analyse was performed on the inner ear RESULTS: LCP was effective (A or B class) in 82% of cases (n = 9/11), 91% after VN (n = 10/11). When treatment was effective, 100% of patients regained a normal life after LCP (postoperative functional level I or 2, n = 9/9), versus 50% after VN (n = 5/10). After LCP, postoperative hearing level was unchanged in 82% of cases, n = 9/11 (73% after VN, n = 8/11), and decreased of about 30 dB in 18% (n = 2/11). There was no surgical complication. The endolymph interruption area was well visualized on MRI, allowing determining the optimal plugging area to be as far as possible from the ampulla. CONCLUSION: LCP is a simple and safe new treatment that could be very useful to control vertigo in Menière's disease. Early and late tolerance are excellent. This prospective study will go on to evaluate the potential of this innovating treatment: LCP could be recommended as an alternative to VN or chemical labyrinthectomy, except in case of drop attacks.

[Reconstruction of the anterior mandibule using a porous titanium implant: a case report]. / Reconstruction de la symphyse mandibulaire par implant de titane poreux: à propos d'un cas.

OBJECTIVE: Anterior mandibular arch reconstruction. PATIENT AND METHOD: A 55-year-old immuno-depressed female underwent resection of the lower third of the face subsequent to extensive mucormycosis-related necrosis. Reconstruction of the anterior part of the mandible and adjacent soft tissue was carried out with a mandibular prosthesis and a latissimus dorsi flap. The mandibular prosthesis was made of titanium T40 micro-beads, consolidated by two parallel plates of titanium. The porous structure is intended to enhance cellular and bone integration. RESULTS: The tolerance of the prosthesis was still excellent after 36 months. Labial continence was restored in a second procedure. Unrestricted diet was allowed from the third month. Radiological investigations confirm the good stability of the prosthesis. CONCLUSION: This original prosthesis design offers an alternative to the reconstruction of an anterior mandibular arch by plate or by vascularised free osseous tissue transfer that is sometimes associated with significant morbidity.

[Cine-MRI contribution to assess swallowing mechanism and oro-pharyngeal dysphagia]. / Etude de la déglutition et des dysphagies oro-pharyngées par ciné-IRM.

OBJECTIVE: This study aimed at evaluating the performance of Cine-MRI to assess swallowing in patients previously treated for head and neck cancer. MATERIALS AND METHODS: 10 healthy control subjects and a cohort of 10 patients with 8 partial glossectomies, 1 total laryngectomy and 1 glossolaryngectomy underwent imaging from October 2005 to February 2007. The MRI examinations were performed on a 1.5 Tesla system (Siemens Avanto), with True-Fisp sequences (TR = 170 ms, TE = 1 ms, slice thickness = 10 mm) at a rate of 8 pictures per second, during dry swallowing. RESULTS: Results are relevant for real-time spatial resolution from lips to larynx and dynamic motions analyses of tongue, velum, posterior pharyngeal wall and larynx during dry swallowing. Oro-pharyngo-laryngeal occlusion deficiency induces aspiration in case of partial glossectomy. Total laryngectomy modifies tongue, velum and pharynx landmarks. CONCLUSION: Cine-MRI i) provides functional insight from the oral cavity to the larynx, ii) gives accurate informations about impairments due to the pathology and its treatment, iii) completes others investigations like fiberoptic endoscopy or transit time, iiii) allows a precise analysis of the muscular movements involved in the deficient swallowing mechanism, in order to optimize rehabilitative strategies and results.

Dysphagia 27 years after cervical disc arthroplasty.

INTRODUCTION: Dysphagia is a frequent postoperative symptom after anterior cervical disc arthroplasty. However, onset of dysphagia and neck pain a long time after surgery should suggest a diagnosis of prosthesis dislocation. CARE REPORT: A 65-year-old man with a history of cervical disc arthroplasty 27 years previously consulted for rapidly progressive dysphagia with no other associated symptoms. Physical examination and CT scan confirmed the diagnosis of anterior dislocation of the prosthesis with no signs of perforation. Surgical extraction via a neck incision allowed resolution of the symptoms. DISCUSSION: Prosthesis dislocation should be considered in a patient with a history of cervical disc arthroplasty presenting with dysphagia and neck pain. The clinical and radiological assessment confirmed the diagnosis and early surgical management allowed resolution of the symptoms and avoided complications such as pharyngo-oesophageal perforation.

Well-differentiated, pedunculated liposarcoma of the hypopharynx.

INTRODUCTION: Liposarcoma of the hypopharynx is extremely rare, as only 28 cases have been reported in the literature. The cardinal symptom of liposarcoma is progressively worsening dysphagia. CASE REPORT: The authors report the case of a 71-year-old man who presented with dysphagia, marked weight loss over several weeks and an episode of exteriorization of a solid mass from the mouth during an episode of vomiting. Imaging revealed a fat density intra-oesophageal mass. Panendoscopy and upper gastrointestinal endoscopy visualized the pedunculated tumour in the left piriform sinus, which was able to be exteriorized via the mouth. The tumour was then resected endoscopically at its hypopharyngeal insertion pedicle. Histological examination of the operative specimen concluded on well-differentiated benign liposarcoma. DISCUSSION: Well-differentiated liposarcoma is the most common form of liposarcoma, but is only exceptionally reported in the hypopharynx. The main symptoms are related to compression of adjacent structures. Imaging findings are nonspecific. Only histological examination can distinguish liposarcoma from other benign oesophageal tumours. Standard treatment consists of wide, complete resection, which is not always possible in the neck. Long-term follow-up of these patients is essential in order to rapidly detect recurrence.

The Grisel's syndrome: A non-traumatic subluxation of the atlantoaxial joint.

INTRODUCTION: Grisel's syndrome consists in rotational subluxation of C1-C2 following ENT infection or surgery. There is no consensus on management. We present 2 cases requiring surgical treatment in our center. CASE REPORTS: Two 10-year-old patients presented torticollis with cervical pain resistant to medical treatment, with onset a few months after tonsillectomy. In both cases, radiological assessment, comprising CT scan and MRI, showed Fielding-Hawkins type-3 C1-C2 rotational subluxation, without ligament lesion. After failure of conservative treatment, posterior reaming, realignment, C1-C2 arthrodesis using lateral masses and pars interarticularis screws and bone graft achieved good fusion and immediate spinal stability in all planes of the atlantoaxial complex. DISCUSSION: Grisel's syndrome consists in non-traumatic subluxation of the atlantoaxial joint with intact atlantoaxial ligaments. Initial pharyngeal inflammation spreads to the prevertebral fascia via direct connections between the periodontoidal venous plexus and pharyngovertebral veins, inducing fasciitis that leads to abnormal relaxation of the atlantoaxial ligaments and reactional muscle contraction with ankylosis. This phenomenon, appearing gradually and insidiously over a period of a few weeks, creates a frozen joint with ankylosis. Medical treatment with NSAIDs, muscle relaxants, and immobilization is usually sufficient; cervical traction may be needed. Surgical treatment by C1-C2 arthrodesis is indicated in case of failure of medical management or onset of neurologic signs. CONCLUSION: Close collaboration between pediatricians, ENT surgeons and neurosurgeons is essential for early diagnosis and management, which is the main prognostic factor for successful medical treatment, avoiding surgery.