Comparison of needle aspiration versus incision and drainage under local anaesthesia for the initial treatment of peritonsillar abscess.

PURPOSE: The treatment of peritonsillar abscess (PTA) is still controversial regarding the best method of drainage to perform. This study aims to compare effectiveness and safety of needle aspiration versus incision and drainage under local anaesthesia for the initial treatment of PTA. METHODS: A retrospective review of patients (age > 15 years) admitted in two tertiary medical centres for a PTA between November 2010 and October 2016 was performed. Patients were divided into two groups according to the type of drainage: needle aspiration or incision and drainage, under local anaesthesia. The primary outcome was the length of hospital stay; the need to repeat the procedure or to go to the operating room was also assessed. Complications or adverse events were listed in each group to assess safety. RESULTS: Over a 6-year period, 182 patients were admitted for a PTA and included in the analysis, with 82 patients in the aspiration group and 100 patients in the incision group. Mean age was 36.3 years, with a sex ratio of 1.33. The length of hospital stay ranged from 1 to 7 days (mean 2.7 days, median 2 days) with a median length of stay of 3.0 days (interquartile range 2-4) in the aspiration group versus 2.0 days (IQR 2-3) in patients who underwent incision and drainage (p = 0.009). A repetition of the needle aspiration was made for 46.3% of patients versus 10% of repetition of the procedure in the incision group (p = 0.0001). 12 patients (14%) of the aspiration group and 4 patients (4%) of the incision group required an additional drainage under general anaesthesia (p < 0.001). We found no differences regarding safety in both groups. CONCLUSION: Our study showed a significant decrease in the length of hospital stay in patients admitted for a PTA who underwent an initial incision and drainage under local anaesthesia, compared to needle aspiration, as well as a lower risk of repeating the procedure. A well-designed prospective and randomized study on a larger sample of patients is required to support these findings.

Variability in facial-muscle innervation: A comparative study based on electrostimulation and anatomical dissection.

Facial-nerve palsy is the most common complication during facial surgery. However, there are few detailed reports on the distribution of the terminal branches of the facial nerve to the mimetic muscles. This also applies to the communicating branches. The aim of our study was to assess the variability of communicant and terminal branches of the facial nerve in humans. This prospective study involved anatomical dissections and intraoperative electric stimulation of facial nerves. We first performed 30 dissections to define the branching patterns of the extracranial facial nerve, with particular focus on the penetrating points into the mimetic muscles. We then studied and compared these preliminary data with 14 operative facial stimulations conducted during parotidectomies. Each trunk and branch received systematic electrostimulation. The electrostimulation and facial-and-neck movements were analyzed by two independent reviewers. The peripheral branching and intercommunication of the facial branches were highly variable. Combining electrostimulation and dissections, the frontalis muscle, the depressor labii inferioris and the platysma showed little nerve recuperation whereas the sphincter muscles (orbicularis ori and oculi) were anatomically protected. Facial-muscle innervation differed among individuals. We found complex variations in the facial branching mode. Our study highlights the branches and corresponding areas that could be considered anatomically risky. Clin. Anat. 32:169-175, 2019. © 2018 Wiley Periodicals, Inc.

Ultrasound-guided fine-needle capillary cytology of parotid gland masses coupled with a rapid-on-site evaluation improves results.

OBJECTIVE OF THE STUDY: To test whether a direct-on-site microscopic examination of fresh, unstained puncture slides by the radiologist decreases the rate of false-negative cases on ultrasound-guided fine-needle cytology of parotid gland masses. PATIENTS: Thirty parotid gland masses from 28 patients were punctured under ultrasound guidance. The same group was used as its control group. METHODS: After one or two passes, the material was spread on slides and air-dried (control group, without microscopic examination). For the study group, it was thus analyzed unstained under the microscope. A sample was considered adequate if at least six clusters of parotid cells were found per slide on at least two slides. For the study group, new punctures were obtained and slides prepared until this condition was fulfilled. RESULTS: Of the 30 evaluated masses, 100% benefited from a cytological diagnosis after microscopy. Twenty-four were adequate in the control group, while 30 were adequate in the study group. The maximum number of punctures to obtain an adequate sample was six. On-site direct microscopy significantly increased the number of adequate specimens by 20% (P=0.03, CI [1.63-20%]). CONCLUSION: Direct and systematic examination of slides by a radiologist avoided the risk of false-negative results caused by having insufficient sample material.

Use of fluorescent in-situ hybridisation in salivary gland cytology: A powerful diagnostic tool.

OBJECTIVE: Salivary gland cytology is challenging because it includes a diversity of lesions and a wide spectra of tumours. Recently, it has been reported that many types of salivary gland tumours have specific molecular diagnostic signatures that could be identified by fluorescent in-situ hybridisation (FISH). The aim of the present study was to demonstrate the feasibility and efficiency of FISH on routine cytological salivary gland smears. METHODS: FISH was conducted on 37 cytological salivary gland smears from 34 patients. According to the cytological diagnosis suspected, MECT1/MAML2 gene fusion and rearrangements of PLAG1, MYB, or ETV6 were analysed. The presence and percentages of cells that had gene rearrangements were evaluated. Results were compared with the histological surgical samples, available from 26 patients. RESULTS: The PLAG1 rearrangement was observed in 12/20 (60%) cases of pleomorphic adenoma. MECT1/MAML2 gene fusion was observed in 1:2 mucoepidermoid carcinomas but was not observed in five other tumours (two pleomorphic adenomas, one Warthin's tumour, one mammary analogue secretory carcinoma [MASC] and one cystic tumour). MYB rearrangement was observed in 4/4 adenoid cystic carcinomas. ETV6-gene splitting identified one MASC. CONCLUSION: Overall, FISH had a specificity of 100% and a sensitivity of 66.7%. When FISH and cytological analyses were combined, the overall sensitivity was increased to 93.3%. It can thus be concluded that when the FISH analysis is positive, the extent of surgery could be determined with confidence pre-operatively without needing a diagnosis from a frozen section.

Transoral robotic surgery for squamous cell carcinomas of the posterior pharyngeal wall.

Posterior pharyngeal wall squamous cell carcinomas (SCCs) are rare and have an associated poor prognosis. Progress in transoral resection techniques, in particular, transoral robotic surgery (TORS), have renewed the role of surgery in their treatment. This article presents the oncological and functional results obtained by the French Group of Head and Neck Robotic Surgery for TORS for posterior pharyngeal wall SCC-curative surgery. This retrospective, multicentre study presents data collected between September 2009 and November 2013 for patients treated with TORS for posterior pharyngeal wall SCCs. Analysis of patient characteristics, tumour and treatment details were completed. Kaplan-Meier analysis was used to calculate overall survival rates and recurrence-free survival rates. Student's t test and Chi2 test were also calculated. 23 patients were included (mean age of 62 years). 12 patients had a prior HNSCC. Ten patients had pT1 cancers. The overall two-year survival rate was 59%, but 89% for pT1 compared to 28% for pT2-T3 (p = 0.01). It was noted that TORS was simple to perform, but generated significant post-operative dysphagia. Two cases of spondylodiscitis were reported as specific post-operative complications of TORS. In conclusion, TORS is a treatment solution for selected posterior pharyngeal wall SCCs. It provides a possible alternative to medical treatment for early pT1 lesions and is often the only remaining curative solution in patients previously treated with radiotherapy. In cases of bulky resection, or when there is a past medical history of radiotherapy, a tissue reconstruction by forearm free-flap may be indicated.

Long-term carcinologic results of advanced esthesioneuroblastoma: a systematic review.

Surgical resection followed by radiotherapy can be considered like the optimal treatment modality for limited esthesioneuroblastoma. However, therapeutic management of locally advanced tumors remains a challenge. The aim of our study was to access and compare the oncologic results of the different treatment modalities in advanced esthesioneuroblastoma. We performed a systematic review using the Medline, and Cochrane database in accordance with PRISMA criteria and included all the cases of advanced esthesioneuroblastoma published between 2000 and 2013. We also retrospectively included 15 patients with an advanced esthesioneuroblastoma managed at our tertiary care medical center. Long-term survival rates defined as the time from diagnosis or randomization to the date of death or last follow-up were evaluated for each treatment with Kaplan-Meier survival curve analyses. 283 patients have been included. The mean follow-up was 78 months. Five-year highest survival rates were obtained in patients treated by surgery associated with radiotherapy. Ten-year highest survival rates were obtained in patients treated by the association of surgery, radiotherapy and chemotherapy (p = 0.0008). Within the surgical group, 5-year highest survival rates were obtained in patients treated by endoscopic resection (p = 0.003). Surgical resection combined with radiotherapy offers the gold standard of care. Adjuvant chemotherapy seems to improve the long-term survival in patients with locally advanced esthesioneuroblastoma. Endoscopic resection in advanced tumors should be discussed on a case-by-case basis.

Morphological concordance between CBCT and MDCT: a paranasal sinus-imaging anatomical study.

PURPOSE: Cone-beam computed tomography (CBCT) is an imaging technique, first developed for use during oral and pre-implant surgery. In sinonasal surgery, CBCT might represent a valuable tool for anatomical research given its high spatial resolution and low irradiation dose. However, clinical and anatomical evidence pertaining to its efficacy is lacking. This study assessed the morphological concordance between CBCT and multislice detector computed tomography (MDCT) in the context of sinonasal anatomy. METHODS: We performed an anatomical study using 15 fresh cadaver heads. Each head underwent both CBCT and MDCT. Two independent reviewers evaluated 26 notable anatomical landmarks. The primary outcome was the overall morphological concordance between the two imaging techniques. Secondary objectives included assessment of inter-rater agreement and comparison of the radiation doses received by different parts of the anatomy. RESULTS: Overall morphological concordance between the two imaging techniques was excellent (>98 %); the inter-rater agreement for CBCT was approximately 97 %, which is highly similar to MDCT, but achieved using a significantly decreased irradiation dose. CONCLUSION: Our preliminary study indicates that CBCT represents a valid, reproducible, and safe technique for the identification of relevant sinonasal anatomical structures. Further research, particularly in pathological contexts, is required.

The frontal branch of the facial nerve: can we define a safety zone?

PURPOSE: The temporal branch of the facial nerve, a particularly important branch in facial expression, is commonly exposed to surgical trauma. The frontal branch is the most important branch of the temporal branch in the clinical point of view. However, it does not really define in the international nomenclature. The objective of this study was to clearly identify this branch, to perform a cartography of the crossing areas of this branch; and therefore to define statistically a zone of safety within the fronto-temporal region. METHOD: We used 12 fresh cadavers to perform 24 facial nerve dissections. After the identification of the facial nerve, the branches of the temporofacial trunk were identified, dissected and followed till their penetration. We measured the relationship of the frontal branch with the zygomatic arch, temporal vessels and lateral border of the orbit. We conducted a statistical study to assess the risk of injury of this branch within the temporal region. RESULTS: We observed an important variability in the distribution of this branch in the temporal region. We defined three zones of decreasing safety at the level of three interest landmarks: at the level of the inferior part of the zygomatic arch, we estimated an elevated risk of nerve injury (>85%) from 22.6 to 26.06 mm in front of the tragus; at the level of the superior part of the zygomatic arch, we estimated an elevated risk of nerve injury (>85%) from 27.46 to 30.43 mm in front of the tragus; at the level of the lateral border of the orbit, we estimated an elevated risk of nerve injury (>85%) from 16.20 to 19.17 mm behind this landmark. CONCLUSIONS: There exists no real area of anatomical safety in the temporal region. It seems, however, possible to define areas of relative safety that would be of great help for the surgeon or the morphologist wishing to approach pathologies of this region.

Sialendoscopy learning curve: comparing our first and last 100 procedures.

OBJECTIVES: Sialendoscopy is a relatively new minimally invasive technique that permits direct salivary tree visualization and is important in obstructive sialadenitis management and treatment. The present study aimed to examine the sialendoscopy learning curve between March 2009 and March 2013. METHODOLOGY: We compared the first and last 100 sialendoscopies performed in our department with regard to anaesthesia type, operating time, success rate, technical difficulty, major complications, and clinical improvement. RESULTS: General anaesthesia rates were 63% and 38% (P = 0.0004) among the first and last 100 sialendoscopies, respectively. Among the first and last 100 procedures, respectively, average operating times were 39 and 25 minutes (P = 0.00055) for diagnostic sialendoscopies and 68 and 65 minutes (P = 0.35) for interventional sialendoscopies. Successful stone extraction rates were 65% and 90.2% (P = 0.0058) among the first and last 100 procedures, respectively, while the corresponding rates of successful stenosis dilation were 92.5% and 97.1% (P = 0.27). Technical difficulty was encountered in 25% and 17% (P = 0.164) of the first and last 100 sialendoscopies, respectively. Neither group experienced major complications. All patients tolerated the procedures well and had excellent outcomes. CONCLUSION: Progressive learning regarding sialendoscopy enabled more frequent operation under local anaesthesia, thus better meeting the requirements of a minimally invasive technique. We were able to decrease the operative time in diagnostic sialendoscopy. These two factors support the inclusion of diagnostic sialendoscopy into the diagnostic panel in obstructive glandular diseases.

Clinical outcomes of transoral robotic surgery for supraglottic squamous cell carcinoma: experience of a french evaluation cooperative subgroup of gettec.

BACKGROUND: Transoral, minimally invasive, organ preservation surgeries are increasingly used to treat laryngopharyngeal carcinomas to avoid the toxicity associated with combined chemoradiotherapy regimens. This study investigated the efficiency, safety, and functional outcomes of using transoral robotic surgery (TORS) to perform supraglottic laryngectomy (SGL). METHODS: This was a multicenter study using a case series with planned data collection from 2009 to 2012 for patients with supraglottic squamous cell carcinomas (SCC) who underwent SGL using TORS. RESULTS: Eighty-four (84) of 262 patients underwent TORS for supraglottic SCC. Within 24 hours of surgery, 24% of the patients started on an oral diet. The median use of a feeding tube was 8 days for 76% of other patients. Definitive percutaneous gastrostomy feeding was necessary for 9.5% of the patients. 24% of the patients did require a tracheostomy, and the median use was 8 days. One percent (1%) of the patients had a definitive tracheostomy. Aspiration pneumonia was observed in 23% of the patients during the postoperative course, and was responsible for the death of one patient. Postoperative bleeding occurred in 18% of the patients. Based on the pathology results, 51% of the patients received adjuvant radiation therapy. CONCLUSION: TORS for SGL in intermediate stage SCC is a safe procedure with good functional outcomes and fast recovery times. However, adverse events can occur. Consequently, this technique requires good patient selection criteria to reduce the risk of postoperative complications.

Cytopathological analysis of salivary gland cancer: REFCOR recommendations by the formal consensus method.

OBJECTIVE: To determine the indications for fine-needle cytology and the modalities of frozen section pathological analysis in the management of salivary gland cancer. MATERIAL AND METHODS: The French Network of Rare Head and Neck Tumors (REFCOR) formed a steering group who drafted a narrative review of the literature published on Medline and proposed recommendations. The level of adherence to the recommendations was then assessed by a rating group according to the formal consensus method. RESULTS: Fine-needle cytology is recommended as part of the diagnostic work-up for a major salivary gland tumor suspicious for malignancy. Fine-needle cytology should be performed after MRI to avoid artifacts. Frozen section analysis is recommended to confirm the malignant nature of the tumor, to adapt the extent of resection and to indicate neck dissection. Whenever possible, the entire tumor and adjacent salivary or periglandular tissue should be sent for frozen section analysis. CONCLUSION: Fine-needle cytology and frozen section analysis play an essential role in the management of salivary gland cancers.

Diagnostic imaging of salivary gland cancers: REFCOR recommendations by the formal consensus method.

OBJECTIVE: To define the indications for each imaging modality in the screening, characterization, extension and follow-up of salivary gland tumors. MATERIAL AND METHODS: The French Network of Rare Head and Neck Tumors (REFCOR) formed a steering group who drafted a narrative review of the literature published on Medline and proposed recommendations. The level of adherence to the recommendations was then assessed by a rating group, according to the formal consensus method. RESULTS: If a swelling of a salivary gland is palpable for 3 weeks, an ultrasound scan is recommended to confirm a tumoral lesion and rule out differential diagnoses. For a salivary gland tumor, MRI is recommended with diffusion-weighted and dynamic contrast-enhanced techniques. In the case of histologically proven malignancy or a highly suspicious lesion, a CT scan of the neck and chest is recommended to assess the tumor, lymph nodes and metastases. FDG-PET is not currently recommended in routine clinical practice for initial diagnosis, assessment of extension, evaluation of response to treatment, staging of recurrence, or follow-up of salivary gland tumors. CONCLUSION: Assessing salivary tumors is based on MRI. Extension assessment is based on neck and chest CT.

Writing in the European Annals of Otorhinolaryngology Head & Neck Diseases. Dos and Don'ts!

Too many articles are still rejected by scientific medical journals due to lack of preparation of the manuscript and of knowledge of the modern editorial rules that govern scientific medical writing. Therefore, the editorial board of the European Annals of Otorhinolaryngology Heads & Neck Diseases summarized studies published by its members since 2020 in the columns of the scientific journal of the French Society of Otorhinolaryngology and the International Francophone Society of Otorhinolaryngology and data from the PubMed indexed literature dedicated to scientific medical writing in otolaryngology in the 21st century. The authors hope that this review, in the form of a list of "Dos and Don'ts", will provide authors with a practical guide facilitating publication of rigorous, reproducible and transparent scientific studies, in accordance with the movement toward better science that society as a whole has been fighting for since the beginning of this century.

Laryngeal graft after total laryngectomy in humans: A SWiM analysis.

Evaluation of the results of laryngeal transplantation (LT) in humans. Analysis of 3 bibliographic databases with the keywords "larynx, transplantation, autograft". In total, 626 abstracts were read and 25 articles selected. The main objective was to analyze the characteristics of laryngeal transplant patients. The accessory objectives comprised analysis of operative technique, immunosuppressive treatment and results. Four articles were selected for analysis. Two patients were transplanted after total laryngectomy for laryngeal carcinoma and 2 after laryngeal trauma. Three of the 4 patients had true transplantation with arterial, venous and neural microanastomosis. Two patients were decannulated and the tracheostomy tube was maintained in the other 2. Three of the 4 patients had good-quality phonation and could feed without a gastric tube. One patient died of carcinoma progression and 1 patient had to be explanted 14 years after transplantation. The number of LTs reported is too small for scientific determination of the place of this intervention in laryngology. The published results could, at first sight, suggest that the future of LT is uncertain. However, several elements, also suggest that otolaryngologists should continue to take an interest in this technique.

Surgical treatment options for maxillary sinus fungus balls.

OBJECTIVE: 1) To evaluate the effectiveness and side-effects of endoscopic surgical treatment for maxillary sinus fungus balls, and to describe approaches to limiting recurrence of the disease and surgical complications. 2) To compare the results of this nasal endoscopic treatment with the results of treatment using a vestibular approach to the anterior wall of the maxillary sinus as described in the literature. PATIENTS AND METHODS: An institutional retrospective review was conducted for patients undergoing treatment for a maxillary sinus fungus ball using endonasal surgery alone from January 2005 to December 2010. RESULTS: A total of 100 patients were included in the study (58 women and 42 men, average age 54 years). The median follow-up time was 32 months. Three patients had a recurrence after our team performed endonasal surgery. No patients experienced complications. CONCLUSION: Our results are consistent with previous findings, indicating that the postoperative complication rate for endonasal surgery is low by comparison with the vestibular approach. Both techniques have similar outcomes. The nasal endoscopic route offers similar rates of success with a negligible complication rate.

A case of laryngeal sialolipoma: pathology in focus.

We are reporting a rare case of laryngeal sialolipoma in a 66-year-old male affected by Parkinson's disease. He was evaluated for dysarthria and swallowing disorders during which a swelling of the left ventricular fold, was always present and enlarged over a span of six months. Surgical removal of the left ventricular fold was performed. Microscopic examination, showed a circumscribed mass with organoid seromucous glands surrounded by numerous mature adipocytes, separated from the parenchyma and fatty tissue by dense fibrous tissue. This mass fulfilled the diagnostic criteria of sialolipoma. Sialolipomas can develop in a variety of sites in which there is both adipose and salivary gland tissue. To our knowledge, this is the first case of sialolipoma arising in the larynx.

[Two cases of primary malignant melanoma of the larynx: a rare pathology]. / Deux cas de mélanome primaire du larynx: une pathologie rare.

INTRODUCTION: Primary malignant melanoma of the larynx is a very rare entity. There are less than sixty cases described in the literature. Through both cases, we describe and discuss the clinical management of melanoma of the larynx. CLINICAL CASES: Two men aged 80 and 61 years were supported for MPL. The tumor was revealed by persistent dysphonia for the first. For the second, it was a second melanoma of laryngeal location. In both cases it was performed a total laryngectomy extended to the first tracheal rings with bilateral lymphadenectomy associated with adjuvant radiotherapy. DISCUSSION: Excision margins with oncological safety are necessary to except a curative surgery. Still controversial, the adjuvant radiotherapy seems to provide a benefit in terms of local control. The place of targeted therapies remains unclear. However, no prognostic factor is currently clearly identified for this disease. CONCLUSION: Rare tumor, the MPL is associated with a very poor prognosis. Resective surgery followed by adjuvant radiotherapy is for us the treatment of choice.

Carl Gussenbauer and the first artificial larynx after total laryngectomy.

The aim of this historical vignette is to delve into the description and use of the first artificial larynx, developed by Carl Gussenbauer, and used after Theodor Billroth's first total laryngectomy, performed on December 31, 1873.

Surgical approaches for pleomorphic adenoma of the parapharyngeal space.

OBJECTIVE: This study aimed to analyse the outcomes of surgery for pleomorphic adenoma of the parapharyngeal space in relation to the surgical approach. METHOD: This was a single-centre retrospective data analysis conducted from January 2008 to December 2020 on all patients who underwent operation for pleomorphic adenoma originating from the parapharyngeal space. RESULTS: Twenty-one patients with a mean age of 52.6 years were included. The transparotid-transcervical approach was the most common (52.4 per cent, n = 11) surgical approach, followed by transoral robotic surgery (28.6 per cent, n = 6) and conventional transoral surgery (19 per cent, n = 4). Post-operative complications included nine cases of transient partial facial nerve palsy and two cases of Frey's syndrome after the transparotid-transcervical approach and 2 cases of transient trismus and 1 pharyngeal wound dehiscence in the conventional transoral approach group. Complete macroscopic excision was always achieved, and no recurrence occurred during follow up. CONCLUSION: These three approaches can provide adequate tumour visualisation, a high rate of clear excisional margins and an acceptable morbidity.

Surgery of sublingual and minor salivary gland cancer: REFCOR recommendations by the formal consensus method.

OBJECTIVE: To determine the indications and modalities for resection in the management of primary sublingual and minor salivary gland cancer, and the specific features of each primary location. MATERIAL AND METHODS: The French Network of Rare Head and Neck Tumors (REFCOR) formed a steering group who drafted a narrative review of the literature published on Medline and proposed recommendations. The level of adherence to the recommendations was then assessed by a rating group, according to the formal consensus method. RESULTS: Histological evidence (submucosal biopsy) is recommended before surgical treatment of minor salivary gland carcinoma. Surgical treatment is recommended, with optimal oncologic margins, adapted to anatomical factors, histologic type and grade and functional consequences, with reconstruction if necessary. CONCLUSION: Treatment of primary minor salivary and sublingual gland cancer is surgical, with wide resection margins. The modalities of resection and reconstruction are highly dependent on tumor location, extension and histologic type.