Medical analysis of the contribution of sialendoscopy in managing non-tumoral main salivary gland pathology in Reunion Island: Observational study following STROBE guidelines.

GOALS: To perform a medical analysis of the contribution of sialendoscopy in the treatment of non-tumoral pathologies of the main salivary glands, in Reunion Island, a French overseas territory. MATERIAL AND METHOD: A multicenter retrospective observational study was conducted for an 8-year period, before and after introduction of sialendoscopy (2011-2014 and 2015-2018), following STROBE guidelines. OBJECTIVES: To compare populations treated before (period A) and after (period B) the introduction of sialendoscopy in terms of clinical characteristics, and analyze the characteristics of patients treated by sialendoscopy. RESULTS: Two hundred and sixty-five patients were included: 74 in 2011-2014 and 191 in 2015-2018; 139 had sialendoscopy. Populations A and B were comparable except for the proportion of parotids treated (9% vs. 31%, respectively; P<0.0001), and smaller stones (11mm vs. 7.4mm, respectively; P=0.003). One hundred and ten pure sialendoscopies and 29 combined routes (20.8%) were performed: 63% submandibular and 37% parotid. Median age was 46 years. The M/F sex ratio was 0.96. Thirty-seven patients presented stenosis. There were 10 cases of papillary catheterization failure (7.1%), and 16 false routes or creation of false channels (11.5%), including 9 during the learning period. The rate of crossover to gland resection decreased: 10.45% for 2015-2016 and 5.56% for 2017-2018. CONCLUSION: Although follow-up ranged between 12 and 55months (median, 30months), sialendoscopy appeared to be a useful and reliable technique, with a role in therapeutic strategy for the management of non-tumoral salivary pathologies in Reunion Island.

Economic analysis of the contribution of sialendoscopy in managing non-tumoral principal salivary gland pathology in the Réunion Island: Economic evaluation following the CHEERS methodology.

GOALS: Cost analysis of the contribution of sialendoscopy in the treatment of non-tumoral pathologies of the main salivary glands, in Réunion Island, a French overseas territory. OBJECTIVES: Calculation and comparison of median pricing (i.e., median payment to the healthcare establishment) per patient before and after the introduction of sialendoscopy, in the only regional establishment practicing sialendoscopy and in the whole of Réunion Island. Material and method A multicenter retrospective cost study was conducted over an 8-year period, before and after the introduction of sialendoscopy (period A: 2011-2014 and period B: 2015-2018), according to the CHEERS guidelines for economic studies, and included inpatients with non-tumoral pathology of the main salivary glands, whether treated by sialendoscopy or not. RESULTS: Two hundred sixty-five patients were included, 139 of whom were treated by sialendoscopy: 74 in 2011-2014 and 191 in 2015-2018. Between the two periods, median pricing in the only center practicing sialendoscopy did not vary significantly: €3468 vs. €3368 (i.e., +2.9% (P=0.1)). In the Island as a whole, pricing increased significantly: €598 vs. €2332, (i.e., +390% (P<0.0001)). CONCLUSION: Sialendoscopy is cost-effective in France in the public healthcare sector if outpatient management is optimal, but significantly increases the public health budget. It makes it possible to recruit and manage previously untreated patients (small stones, salivary strictures, etc.).

Speech restoration with tracheoesophageal prosthesis after total laryngectomy: An observational study of vocal results, complications and quality of life.

OBJECTIVES: To study voice prosthesis survival, complications, efficacy and impact on quality of life. METHODS: A single-center observational study was performed in patients treated for squamous cell carcinoma of the larynx or hypopharynx by total (pharyngo)-laryngectomy between 2010 and 2015. Study data comprised: maximum phonation time (sec), number of and reasons for prosthesis exchanges (leakage through or around the prosthesis, expulsion or inclusion of the prosthesis), plus 2 quality of life questionnaires (QLQ-C30, QLQ-H&N35) and the Voice Handicap Inventory (VHI 30). RESULTS: Forty-nine patients were included. The most common causes of prosthesis exchange were leakage through (73.2%) or around the prosthesis (18.5%). The median time between exchanges was 4 months. Global quality of life status on the QLQ-C30 was 63.5. Mean maximum phonation time was 7.4sec. Mean VHI was 46/120; 10 patients had a mild voice handicap, 12 moderate and 10 severe. No relation emerged between the number of prosthesis exchanges per year and quality of life. Voice handicap significantly decreased quality of life, with QLQ-C30 72.3 for the 22 patients with mild to moderate voice handicap and 44.2 for the 10 patients with severe voice handicap (P=0.001). CONCLUSION: Voice restoration by tracheoesophageal prosthesis after total (pharyngo)-laryngectomy is a reliable technique that decreases voice handicap and, despite potentially serious complications, has little negative impact on quality of life.

Epidemiological features of cancers of the oral cavity, oropharynx, hypopharynx and larynx cancer in Réunion Island.

INTRODUCTION: This study had two objectives: firstly, to identify and compare characteristics of cancer of the oral cavity, oropharynx, hypopharynx and larynx in Réunion Island, a tropical French overseas territory in the southern hemisphere; and secondly, to discuss how incidence of these cancers is presented in the international literature. MATERIAL AND METHOD: A retrospective study included 599 patients diagnosed with cancer of the oral cavity, oropharynx, hypopharynx or larynx between 2009 and 2013 in Réunion Island. Demographic characteristics and data on alcohol consumption, smoking habits and HPV infection were analyzed. Standardized incidences were calculated for the worldwide population for both genders. RESULTS: Sex ratio was 7.7 and mean age was 60 years. Cancer consisted of squamous cell carcinoma in 99.1% of patients. Three hundred and forty over 375 patients (81.25%) showed alcohol abuse; 309/359 (86.1%) were smokers; 31/184 (16%) had HPV infection. On the International Agency for Research on Cancer (IARC) anatomic classification, the incidence of "other pharynx" locations was 9.3/100,000 for men and 0.7/100,000 for women, and incidence of "larynx" locations was 6.4/100,000 for men and 0.4/100,000 for women. CONCLUSION: Réunion Island features some particularities in terms of incidence: women are less than half as likely as in Metropolitan France to develop any type of cancer, whereas incidence in males is among highest in France. The presentation of results in cancer registries could be improved in line with everyday practice in head and neck surgery.

[Peak Nasal Inspiratory Flow: learning curve for the measurement method and reproducibility]. / Peak Nasal Inspiratory Flow: apprentissage de la méthode de mesure et reproductibilité.

OBJECTIVES: A prospective study on the learning curve and reproducibility of PNIF measurement with 18 different operators. MATERIAL AND METHODS: Five hundred twenty-eight patients in two groups were prospectively enrolled in this study from September 2003 to April 2004. The learning curve of the technique was monitored after five patients had been measured. Reproducibility was evaluated with all patients after two consecutive measurements. RESULTS: The technique was acquired by all operators after the fifth patient. The mean PNIF measurements in controls and patients were 86.02+/-36.96 l/min and 89.59+/-41.97 l/min, respectively. Reproducibility (PNIF2-PNIF1=5.51+/-24.93 l/min) was obtained for all operators, whatever the number of measurements taken. CONCLUSIONS: The study confirms the good reproducibility and the easy training in PNIF measurement.