Sexual health at 5 years after diagnosis of head and neck cancer.

PURPOSE: Sexual health (SH) is an emerging concern in the assessment of quality of life in patients surviving head and neck cancer (HNC). Using data from the French National Prospective VICAN Survey, this study aimed to assess SH deterioration five years after HNC diagnosis and related factors. METHODS: Using univariate and multivariate analyses were performed in the 241 HNC survivors. We studied the factors associated between the sexuality and intimate life of these patients with demographic and medical data from the national epidemiological survey VICAN 5. RESULTS: Sexuality and body image were altered in 78.8% for men and 79.2% for women. This alteration in sexual quality of life affects both men and women. Dissatisfaction with the frequency of sexual intercourse was associated with being treated with radiotherapy (p=0.024), as well as decrease of sexual desire in patients treated with chemotherapy (p=0.044). Fatigue (p=0.002), impaired physical health (p=0.049), and high disease stage (p=0.001) remained significantly associated, after multivariate analysis, with decreased sexual desire. Among these 3 factors negatively influencing sexual quality of life, two are treatable with appropriate management. CONCLUSION: Five years after the diagnosis of HNC, a decrease in sexuality and body image are frequent and significantly impact the quality of life of survivors. These observations imply an adaptation of the management of the professionals involved.

Cervical lymph node metastases and T1 squamous cell carcinoma of the lips.

OBJECTIVE: The occurrence of cervical lymph node metastasis is a major prognostic factor for head and neck squamous cell carcinoma (SCC) of the lip. This study focuses on patients with T1 stage tumours,in order to describe the prevalence of metastatic lymphadenopathies. METHODS: A multicenter retrospective study was performed in three tertiary care referral centers and included 59 patients surgically treated for T1 stage SCC of the lips from January 1996 to December 2006. This surgical treatment concerned the tumour, with cervical neck dissection when lymph node metastasis was suspected. RESULTS: Cervical lymph node metastasis was found and histologically proven in 7 patients (11.9% of the cases, pN+ group; 95% confidence interval, 3.6 to 20.2%) during follow-up, never at the time of diagnosis. Metastasis appeared 13.3 ± 7.9 months (min. 5.3 months, max. 29.1 months) after the initial treatment and involved the IB level in all cases. Tumour progression was significantly longer in the pN+ group compared to patients with no lymph node metastases (sN-group). The pN+ group also had a significantly higher proportion of poorly or moderately differentiated tumours, and a significant decrease in overall survival, disease-free survival, and disease-specific survival. CONCLUSION: Lymph node metastasis occurs in roughly 12% of T1 stage SCC of the lips, and the management of neck lymph node areas is necessary. A randomized trial is needed to determine the proportion of occult lymph node metastases in T1N0 patients and the impact of this therapeutic procedure on survival.

Retropharyngeal lipostructure in the treatment of velopharyngeal insufficiency: A prospective study and update.

INTRODUCTION: Retropharyngeal lipostructure is a recent procedure in velopharyngeal insufficiency (VPI), offering an effective alternative to heavier surgery. OBJECTIVES: To update and assess retropharyngeal lipostructure as a treatment for VPI in the University Hospital Center of Rouen (France). TYPE OF STUDY: Single-center prospective study, from May 2012 to May 2014. PATIENTS AND METHODS: Six patients (4 girls, 2 boys) presenting with VPI were treated by retropharyngeal lipostructure. Age at surgery ranged between 6 and 12 years. Four of the patients bore a 22q11 microdeletion. Treatment was indicated in case of Borel-Maisonny type 2b (n=2) or 2m (n=4) despite well-conducted speech therapy and of≥50% velopharyngeal sphincter closure on nasal endoscopy. Patients were assessed preoperatively and at 3 months, by a multidisciplinary team. Borel-Maisonny type was assessed by a speech therapist. Nasality was measured on assisted vocal evaluation (EVA®). Sphincter closure was assessed on dynamic MRI. RESULTS: Between 6 and 8cm3autologous fat was injected. At 3months, 4 children showed 1-grade improvement in Borel-Maisonny type. Nasality decreased systematically, from a mean 14.5% preoperatively to 10.5% postoperatively. MRI showed improvement in all cases, with complete closure in occlusive vowels in 3 children. CONCLUSION: EVA® and MRI provide precise objective assessment of VPI. Retropharyngeal lipostructure is a simple, relatively non-invasive, reproducible technique, providing good results in VPI.

Transalar transsphenoidal meningoencephalocele presenting in the form of recurrent meningitis: Report of two cases and discussion of the diagnosis and treatment.

INTRODUCTION: Skull base meningoencephaloceles are rare congenital malformations. The two cases of transalar transsphenoidal malformation reported here differ from the classical transsphenoidal meningoencephalocele. CASE REPORTS: Case 1 was a three-and-a-half-year-old boy and case 2 was a 36-year-old man. Both cases presented with clinical features of recurrent meningitis. Surgical management of case 1 was performed via an intradural infratemporal fossa craniotomy with reoperation 2years later. In the second case, surgery was initially performed via an endonasal approach and then via pterional craniotomy. Reoperation via Sekhar's transpetrosal approach was also a failure. Only closure of the trigeminal-pontine angle via a suboccipital retrosigmoid approach allowed repair of the defect. DISCUSSION: Surgical access to the pterygopalatine fossa is complex due to its anatomical position and its anatomical relations with nerves and vessels. An endoscopic approach appears to be a valuable alternative to classical craniotomy. CONCLUSION: In the two cases reported here, neurosurgery allowed lasting closure of the defect.

Management of voice prosthesis leakage with Blom-Singer large esophage and tracheal flange voice prostheses.

INTRODUCTION: Voice rehabilitation after total laryngectomy is a major socio-economic challenge. Voice rehabilitation can be achieved by voice prostheses, which provide rapid patient satisfaction. Enlarged tracheo-oesophageal puncture is a frequent complication and can be difficult to manage. MATERIAL AND METHOD: A prospective study was conducted from November 2010 to October 2011 on 28 Blom-Singer large oesophageal and tracheal flange voice prostheses placed in 18 patients with enlarged tracheo-oesophageal puncture causing leakage around the voice prosthesis. RESULT: Leakage around the voice prosthesis resolved in all patients with a mean prosthesis lifespan of 95 days. The patients considered voice quality to be similar to that obtained with the initial voice prosthesis. CONCLUSION: The Blom-Singer large oesophageal and tracheal flange voice prosthesis is a useful solution for the management of periprosthetic leakage ensuring similar voice quality and an identical lifespan to that of other voice prostheses.

Involvement of the aero-digestive tract in swallowing-ventilation coordination: an animal study.

BACKGROUND: The precise coordination of swallowing and ventilation is considered an important mechanism for minimizing the risk of pulmonary aspiration. The aim of this study was to test the hypothesis that the aero-digestive tract is involved in swallowing-ventilation coordination in rats. METHODS: The goal of the first part of the study was to characterize swallowing events associated with ventilation signals obtained using a barometric plethysmograph. This was done in seven rats with the help of esophageal electromyograms. Thereafter, swallowing-ventilation coordination was assessed in 15 rats with right unilateral vocal cord paralysis and 10 rats following oropharyngeal anesthesia. KEY RESULTS: In healthy animals, 92 ± 11% of swallows occurred during expiration and 8 ± 11% during inspiration. Swallow frequency and swallowing characteristics based on ventilation did not change following unilateral laryngeal paralysis. Swallows during expiration decreased (71 ± 9%, P < 0.01) while swallows during inspiration increased (29 ± 11%, P < 0.01) following oropharyngeal anesthesia with lidocaine. CONCLUSIONS & INFERENCES: Our findings using a rat model need to be confirmed, however, they indicated that a rat model can be used to study oropharyngeal dysphagia and that laryngo-pharyngeal anesthesia alters swallowing-ventilation coordination.