[A post-styloid mass revealing a parapharyngeal schwannoma]. / Une masse rétro-stylienne révéatrice d'un schwannome parapharyngé.

INTRODUCTION: The schwannoma of the glossopharyngeal nerve is a rare etiology among the tumor masses developed in the parapharyngeal space. CASE REPORT: We report the case of a 33 years old woman in whom a large schwannoma of the left glossopharyngeal nerve was discovered incidentally on a brain MRI. Respiratory evolutionary prognosis imposed trans-oral surgical treatment. DISCUSSION: We discuss the diagnostic and therapeutic strategy for the benign tumors of the parapharyngeal space. CONCLUSION: The schwannoma of the glossopharyngeal nerve is a benign rare lesion. The difficulty lies on the surgical strategy and the choice of the approach. The functional suites are marked by difficulty swallowing and require intensive speech therapy.

[Preliminary analysis of sentinel node detection during surgical treatment of head and neck melanoma]. / Etude préliminaire de la détection du ganglion sentinelle dans la prise en charge chirurgicale des mélanomes cervico-faciaux.

OBJECTIVE: The aim of this study was to define reliability of the sentinel lymph node technique in head and neck N0 melanoma. Identification of the sentinel node, which is the first evidence of melanoma metastasis, enables selective node dissection. MATERIALS AND METHODS: Twelve patients with untreated localized cutaneous or mucous N0 melanoma of the head and neck were included in this study. After resection of the sentinel lymph node, type III neck dissection was performed during the same operative time in all twelve patients. RESULTS: The sentinel node was successfully located by preoperative lymphoscintigraphy and confirmed at surgery in eleven patients. Five of these patients had evidence of metastatic node disease, always in the sentinel node. No other metastatic node were found in the neck dissection specimens. For the six other patients with a negative sentinel node, no other metastatic node was found in the neck dissection specimens. CONCLUSION: These preliminary results are promising. The sentinel node can be mapped and identified in most patients. No metastatic node was noted in patients with a negative sentinel node. If these results are confirmed, complete node dissection should only be performed in patients with a positive sentinel node in order to achieve more conservative surgical cure of head and neck melanoma.

[Comparison of magnetic resonance imaging with histopathological correlation in laryngeal carcinomas]. / Comparaison dans les cancers du larynx entre l'imagerie par résonance magnétique et les coupes histologiques après laryngectomie.

Apart from a clinical examination including direct laryngoscopy and biopsy, pretherapeutic staging for local extension of laryngeal carcinoma requires computed tomography. The role of magnetic resonance imaging (MRI) remains controversial. The aim of this study was to determine its value for detecting invasion of the main laryngeal structures. Histological findings were compared with axial MRI slices to remain in the same plane. A double-blind study of 10 areas of the larynx was performed: vocal muscle, anterior and posterior paraglottic spaces, anterior and posterior laryngeal commissures, anterior and posterior subglottic area, arytenoid, thyroid, and cricoid cartilages. MRI appeared to be the method of choice to detect neoplastic cartilage, and subglottic and commissural invasion. MRI allows a treatment strategy adapted to the areas involved by the laryngeal carcinoma.

[15 years experience with microvascular free tissue transfert for repair of head and neck cancer defects]. / Expérience de 15 ans d'utilisation des lambeaux libres en cancérologie cervico-faciale.

We present the modalities and results obtained with free flap reconstruction of head and neck cancers defects. This retrospective review of 165 free transfers performed between 1984 and 1999 included 89 radial forearm flaps (54%), 38 latissimus dorsi flaps (23%), 28 osteomyocutaneous flaps (17%), 6 omentum flaps (4%), 2 jejunum flaps, and 2 cutaneous scapular flaps. Indications were orobuccopharynx (34%), hypopharynx (24%), mandible (17%), craniofacial (15%) and skin (10%) defects. Flap failure rate was 9%. Reconstruction of a radiated site was a statistically significant indicator of flap failure. Four types of free flaps were preferred for reconstruction of head and neck cancer defects. The radial forearm flap was used as a lap flap for the orobuccopharynx, the tubuled radial forearm flap for reconstruction of the digestive tract after total pharyngolaryngectomy, the osteomyocutaneous free fibular flap for pelvimandibulectomy, especially for the anterior arch, the latissimus dorsi flap to fill craniofacial defects, and the free omentum flap for craniofacial complications after radiotherapy.

[Reconstruction of the palate vault by free forearm cutaneous flap in oncology]. / Reconstruction de la voûte palatine par lambeau cutané anté-brachial libre en cancérologie.

Surgical reconstruction after partial superior maxillectomy raises a major functional challenge and postoperative recovery implies difficult prosthetic rehabilitation. Between 1989 and 2000, 23 free radial forearm flap reconstruction were performed for palate defects. Twenty-two patients were treated for cancer-related defects and one patient for a non-malignant tumor. Immediate reconstruction was performed in 21 cases and delayed reconstruction in 2. Radiation therapy had been given prior to surgery in 7 patients, Flap necrosis occurred in 2 patients who had surgery alone. Deglutition and phonation outcome was satisfactory in all patients. Trismus was the most frequent complication (7 cases). The free radial forearm flap is the gold standard surgical treatment for superior maxillary defects. In these patients, and exclusive skin flap enables complete reconstruction.

Partial frontolateral laryngectomy with epiglottic reconstruction for management of early-stage glottic carcinoma.

OBJECTIVES: The aim of this study was to demonstrate that partial frontolateral laryngectomy with epiglottic reconstruction (PFLER) is an effective therapeutic option for treatment of T1 and T2 glottic carcinoma. STUDY DESIGN: Retrospective study. METHODS: Between 1982 and 1997, we treated 127 cases of early glottic carcinoma with PFLER. Early glottic carcinoma was staged using the Union Internationale Contre le Cancer TNM classification as either T1N0M0 (62 cases) or T2N0M0 (65 cases). Selection criteria, depending on the limits of exeresis, must remain glottic carcinoma with less than 0.5 cm of anterior subglottic involvement, with no involvement of the supraglottic space or laryngeal side of the epiglottis, with involvement of only one arytenoid, and with good mobility of both arytenoids even if vocal cord mobility is decreased. RESULTS: Postoperative recovery was uneventful in all cases, and all patients but one were able to breath and eat normally. The failure involved a patient with a permanent gastrostomy. As with other partial laryngectomy techniques, the main drawback of PFLER was deterioration of voice quality. All patients presented hoarseness and weakness of the voice. Five-year survival rates calculated according to the Kaplan-Meier method were 91% (standard error, 5%) in the T1N0M0 group and 86% (standard error, 5%) in the T2N0M0 group. No recurrence was observed in the T1N0M0 group. Local control was successful in 92% in the T2N0M0 group after a median follow-up of 5 years. CONCLUSION: These findings show that PFLER is an effective therapeutic option in selected cases of early T1N0M0 or T2N0M0 glottic carcinoma.

Diagnosis and treatment of juvenile nasopharyngeal angiofibroma.

The aim of this retrospective study was to compare clinical and radiological findings and discuss optimal surgical approach in patients with juvenile nasopharyngeal angiofibroma (JNA). Forty-three cases of JNA were treated at our institution from 1975 to 1999. Thirty-three male patients aged between 8 and 25 years (mean 15.3) were included. Twenty-nine patients underwent primary surgical treatment at our institution and four were treated for recurrence following primary surgery elsewhere. Tumors were staged according to Fisch's staging. Preoperative embolization was performed in 22 cases. Surgical techniques consisted of the transantral approach, lateral rhinotomy approach, transmaxillary via midfacial degloving approach, and the subtemporal preauricular infratemporal fossa approach. Tumors were classified stage I in seven cases, stage II in 11, stage III in 13 and stage IV in two. The mean delay between the initial symptom and surgery was 14 months overall, 18 months for stage I, 14 for stage II, 13 for stage III and 12 for stage IV. The transantral approach was used in 11 patients, lateral rhinotomy approach in 11 cases, transmaxillary via midfacial degloving approach in three patients, and pre-auricular infra-temporal approach in eight patients. Mean follow-up after surgery was 56 months. Six patients had recurrent tumors. Surgery is the gold standard for treatment of JNA. Modern imaging techniques allow accurate diagnosis and staging of JNA. Our experience and a review of the literature shows that the surgical approach should be selected according to tumor stage.

Congenital cysts and fistulas of the neck.

This retrospective study describes a series of 191 children treated for congenital cysts and fistulas of the neck between 1984 and 1999 in the pediatric ORL Department of La Timone Children's Hospital. Preauricular fistulas and cystic hygromas were not included. The anomalies in this series were classified as either malformations of the midline or malformations of laterocervical region. Malformations of the midline included the thyroglossal duct cysts (n=102) and dermoid cysts (n=21). The most common malformations of the laterocervical region were cysts and fistulas of the second cleft (n=37) followed by those of the first cleft (n=20),those of the fourth pouch (n=7), and thymic cysts (n=4). Diagnosis of malformations of the midline is usually straightforward. However, diagnosis of malformation of the laterocervical region can be problematic. Misdiagnosis often leads to inadequate treatment with recurrence and functional as well as cosmetic sequelae.

[The pectoralis myofascial flap in oropharyngeal and pharyngolaryngeal reconstruction in salvage surgery]. / Applications du lambeau fascio-musculaire de grand pectoral dans la chirurgie de l'oro-bucco-pharynx et pharyngo-laryngé en rattrapage.

BACKGROUND: The pectoralis major myofascial (PMMF) flap is rapidly mobilized, reliable in a number of clinical situations calling for vascularized soft tissue coverage in the head and neck. Salvage surgery after radiation failures produce salivary fistula, skin flap necrosis, vascular rupture. Use of PMMF improves healing in such cases. METHODS: A retrospective review performed at the university hospital, Marseille, between August 1987 and August 1999, was undertaken in two groups of salvage surgery. Groupe 1: protection of great vessels and fistula prevention after total laryngectomy (TL) and pharyngolaryngectomy (PL). Groupe 2: intra oral and pharyngeal defects reconstruction. Outcomes were classified in three types: type 1 - no complications; type 2 - delayed healing; type 3 - complicated healing. In groupe 2, in six cases the amount of flap contraction was analysed by C.T. scan. RESULTS: 83 PMMF was performed. Groupe 1, 57 cases (TL 28 cases, PL 26 cases); groupe 2, oral cavity défect 9 cases; oropharyngeal défects; 17 cases. There was no flap necrosis or vascular rupture. The donor site complications rate was 9.2%. The overall complications follow up was; groupe 1; type 1: 66%; type 2: 32%; type 3: 2%. In the groupe 2, type 1: 81%; type 2: 19%; type 3: 0%. The flap contracture was 30%. The use of PMMF in salvage surgery must be indicated in all cases after TL or PL, and is an excellent alternative from soft tissue coverage of oropharyngeal defects.

[X-ray imaging in assessing the extent of laryngeal cancer]. / Imagerie radiologique et bilan d'extension des cancers du larynx.

Partiel surgery of the larynx for cancer should achieve the same carcinological control as total laryngectomy, while at the same time preserving the voice and swallowing. Establishing the extent of the tumour and its relationships with the anatomical structures of the larynx allows a treatment plan to be formulated. Decisions are taken in the light of investigation in which modern imaging plays a fundamental part. The authors have made a comparison of the relative value of CT scanning and MRI as a function of the area involved in the lesion. At present MRI is required only when there is uncertainly of the extent of the subglottic extension, or invasion of the cartilages. We give a prediction of the development of the technique of vitual endoscopy, which will yield a three-dimensional view of the relationships between the tumour and the cartilaginous structures.

Non linear behavior of vocal fold vibration in an experimental model of asymmetric larynx: role of coupling between the two folds.

One of the main factors involved in the laryngeal dynamic's non-linearity is the coupling between the two vocal folds. Evaluation of the different coupling elements requires various investigations. The present work evaluate the non-linearity effects in clinical situations such as unilateral laryngeal paralysis using Lyapunov's coefficients. It also demonstrate the coupling effects on excised larynx made experimentally asymmetrical, using a specially designed device to measure vibrations from each vocal fold (opto-reflectometer).