Refractory lymphorrhoea of the neck treated with etilefrine.

BACKGROUND: Intraoperative injury of the thoracic duct is an uncommon complication of head and neck surgery, which is difficult to manage and associated with serious consequences. We report a case of lymphorrhoea of the neck refractory to all the usual treatments that resolved in response to a treatment strategy described in thoracic and visceral surgery: use of a sympathomimetic drug, etilefrine. To our knowledge and after review of the literature, this is the first reported case of lymphorrhoea of the neck treated by etilefrine. CASE REPORT: Our patient presented massive lymphatic fluid leakage following left neck dissection as part of the management of oropharyngeal cancer with lymph node metastases. The treatments usually proposed, such as intraoperative repair and appropriate dietary and drug management, were not effective, resulting in multiple, severe complications. After evaluation of the benefit-risk balance, treatment with etilefrine was introduced at the dosages proposed in the literature for the management of chylothorax. This treatment allowed complete resolution of the lymphatic fluid leak after one week. DISCUSSION: Etilefrine can therefore be added to the treatment options for the management of lymphatic fluid leaks refractory to the usual treatments.

Use of a navigation system in endonasal surgery: Impact on surgical strategy and surgeon satisfaction. A prospective multicenter study.

OBJECTIVES: Surgical navigation systems (SNS) are now widely used in endoscopic endonasal surgery. Benefit, however, has not been fully studied. The objective of this study was to evaluate the impact of an SNS in terms of performance of the surgical procedure and of surgeon satisfaction, in a prospective multicenter study. MATERIALS AND METHODS: A multicenter prospective study included patients undergoing endoscopic endonasal surgery using the electromagnetic DigiPointeur® (DGP) SNS in 16 French hospitals. An observation form, completed by the surgeon immediately at end of procedure, included type of procedure, and any changes in strategy or extent of surgery related to use of the SNS. Surgeon satisfaction was rated on an analog scale, with self-assessment of stress experienced during the procedure. RESULTS: The study included 311 patients operated on by 36 surgeons in 16 French hospitals. Ethmoidectomy was the most frequent procedure (90%); tumor resection was performed in 5.1% of cases. The SNS enabled more extensive surgery in 81% of cases, in particular by identifying and opening additional cells (57% of cases). Mean satisfaction was 8.6/10; surgeons reported decreased surgical stress thanks to the SNS in 95% of cases. CONCLUSION: In this observational study, the use of an SNS increased the extent of surgery in 81% of cases, and had a positive impact on the stress perceived by the surgeon in 95% of cases.

[Acute acoustic trauma, a retrospective analysis about 225 military cases]. / Traumatismes sonores aigus: analyse rétrospective de 225 cas militaires.

OBJECTIVES: Studying the epidemiology, the evolutionary audiometric profile and the after-effects of acute acoustic trauma managed in military environment. Assessing the influence beyond the audiometric recovery of earplugs, precocity of the treatment and hyperbaric oxygen therapy. MATERIALS AND METHODS: This retrospective cohort gathered 225 military cases of acute acoustic trauma hospitalized between 2003 and 2008. The cochlear supportive therapy associated intravenous methyl-prednisolone and pentoxyfilline, completed sometimes with hyperbaric oxygen therapy. The evolution was appreciated with pure-tone audiometry at the admission, at the end of hospitalization and one month after. Perceptive deafness and recovery shifts were statically calculated on 109 ears. RESULTS: On the 225 cases, 90% were males, middle-aged of 23 years. Initially 95% of the patients complained about tinnitus, associated with hearing loss felt for 71%. The left ear was more frequently affected. The initial audiometric loss was average of 34 dB HL, concentrated on 4000 and 6000 Hz frequencies. The therapy allowed an average recovery of +18,3 dB in a month. The audiometric sequela concerned 40% of the cases, and residual tinnitus a third. These rates were significantly higher with people whose initial hearing loss average exceeded 40 dB HL. Concerning the audiometric recovery and the after-effects, no significantly difference was found between the groups treated before or after 12 hours. There were either no difference with the earplugs and hyperbaric oxygen groups. CONCLUSION: Despite the effectiveness of early corticotherapy, after-effects of acute acoustic trauma remain frequent and invalidating. Its prevention suffers from non-observance and malposition of earplugs.

Septorhinoplasty by disarticulation: early assessment of a new technique for morphological correction of crooked noses.

OBJECTIVE: This study was aimed to assess the early morphological results of a new septorhinoplasty technique based on disarticulation (SRD) between bony and cartilaginous nose structures. METHODOLOGY: A retrospective, multi-judge, blind comparison of pre- and post-operative photographs displayed on Google documents was designed. A nasal morphology analysis grid based on 10 items was fulfilled independently by 6 judges to assess pre- and post-operatively, two times with a 15 day interval, the severity of each deformity by a score between 0 and 2. The sum of all deformities in a single patient produced the individual global score of nasal deformity, which was set between 0 and 20 for each patient. Pre- and post-operative individual global scores were compared using Student`s t test on paired samples. Percentages of post-operative improvement and deterioration were calculated for each item. RESULTS: Thirty-five SRD were analyzed. Before surgery, 80% of noses were humped and 86% were crooked; three months after surgery, 64% of noses had a rectilinear nasal crest on profile and 57% on facial view. The mean global score of deformities drop- ped from 11.1 before surgery to 5.8 after surgery, an improvement of 47% . Improvement rates of 82% and 74.3% were obtained, respectively, for hump profiles and orbitonasal lines. DISCUSSION: The early morphological results of SRD allow to propose this technique as a possible solution to correct crooked noses with humps.

Management of the neck in the setting of definitive chemoradiation: is there a consensus? A GETTEC study.

BACKGROUND: The management of the neck remains controversial in the definitive chemoradiation setting of advanced N2-3 head and neck squamous cell carcinoma. Most published data favor omission of neck dissection (ND) after complete response for N2-3 or selective ND for residual disease METHODS: We studied the patterns of care in the French-Belgian Groupe d'Etude des Tumeurs de la Tête Et du Cou (GETTEC) through a questionnaire-based survey. RESULTS: Eighteen percent of institutions never performed up-front ND, 20% rarely, 40% sometimes, 14% often, and 8% systematically. Induction chemotherapy was indicated in 30% of the cases, and most ND were performed either between induction and radiation or after chemoradiation for residual disease. Response to chemoradiation was assessed by computed tomographic scan and positron emission tomography in 72% of cases. Selective ND was more common than radical ND. CONCLUSIONS: Omission of ND based on computed tomographic scan and positron emission tomography-based complete response to chemoradiation is the most common strategy for advanced nodal disease among centers. However, neck management strategies vary among institutions, and some institutions continue advocating systematic ND before irradiation. The new treatment options and the changing epidemiology, namely docetaxel-based induction chemotherapy and human papilloma virus-related head and neck squamous cell carcinoma having better response profiles and prognosis, are adding to the nonconsensual approach. The best therapeutic index in terms of neck management remains to be defined in this evolving context.

[A locally advanced intrathyroid metastasis of bronchial cancer]. / Métastase intrathyroïdienne localement avancée d'un cancer bronchique.

PURPOSE: To assess the characteristics, the diagnosis and the treatment of intrathyroid metastasis. METHOD: The authors report a case of a locally advanced intrathyroid metastasis of a bronchial cancer. RESULTS: A 60-year-old woman, treated seven years before for a well-differentiated bronchial adenocarcinoma, developed enlargement of the thyroid gland. Metastatic disease was confirmed by a surgical biopsy. Following incomplete radiochemotherapy, a palliative surgical debulking was performed, associating an isthmolobectomy with a large skin excision and closure with a pectoralis major myocutaneous flap. CONCLUSION: Intrathyroid metastases are rare and usually treated by surgery. Surgical management is decided taking into account the type and the kinetics of the primary tumor, the location of the thyroid metastasis, and the extension of the metastatic disease. Except for isolated intrathyroid metastasis of kidney cancer, prognosis remains poor.

Use of a scapular free flap for reconstruction of the cricoid cartilage in pharyngolaryngeal oncology.

A newly developed technique for cricoid reconstructive surgery is presented and discussed. This method allows us to increase the number of patients presenting with squamous cell carcinoma who may benefit from partial laryngectomy. The method is based on the transfer of a vascularized scapular flap to reconstruct half a resected cricoid. Two alternatives may be used whether anterior laryngectomy preserves the half posterior cricoid and both arytenoids or a hemilateral laryngectomy leaves one arytenoid and half the cricoid. Complementary radiotherapy may be performed after surgery. Satisfactory results are reported from an initial series of three patients.

[Undifferentiated osteogenic carcinoma of the thyroid]. / Carcinome indifférencié ostéogénique de la thyroïde.

A case of osteogenic thyroid carcinoma in a 68 years old male patient is reported. The WHO histopathological classification of such exceptional tumor is reminded. A review of the literature and the treatment modalities are discussed. Several etiological hypotheses are discussed.

[Mechanical sutures in ORL cancers, value, indications, techniques and results apropos of 30 cases]. / Les sutures mécaniques en carcinologie O.R.L., intérêt, indications, techniques, résultats à propos de 30 cas.

The authors report their experience in closure of the pharynx following total laryngectomy or total pharyngolaryngectomy by mean of the TA 55 instrument. The technique is described stressing the particular point of good presentation of the mucosa and the importance of the crossing of the lines of staples when two clips are used. An analysis of 30 cases studies is presented with the results as of the date of removal of the nasogastric catheter and the percentage of fistula. This technique appears to be rapid, safer than conventional methods of closure and less complications have been encountered in this series.

[An original technique of reconstruction of the cricoid cartilage by vitalized scapular flap. Application to pharyngolaryngeal carcinology]. / Technique originale de reconstruction du cartilage cricoïde par lambeau vitalisé de scapulaire. Application en carcinologie pharyngo-laryngée.

A personal technique for cricoid reconstructive surgery is presented and discussed. A transfert of a free living scapular flap by microvascular anastomoses is used for reconstructing half cricoid resection. We can with this technique increase the number of partial laryngectomy in patients with squamous cell carcinoma. Two techniques are possible: The half anterior laryngectomy conserves only the half posterior cricoid and the twice arytenoids. The half lateral laryngectomy conserves one arytenoid and a half cricoid.

[Reconstruction of the mandibular symphysis using a revascularized free flap of the scapula. Surgical technic]. / Reconstruction de la symphyse mandibulaire par lambeau libre revascularisé de scapulaire. Technique chirurgicale.

In cases of surgically removed mandibular symphysis malignancies, the bone and mouth floor were reconstructed using osteo-musculo-cutaneous flaps. In our experience, the latter provide the best results. Removed in dorsal decubitus, they allow floor replacement. During the dissection of the tumor site, we also preserve labial and chin structures, which favours a good restoration of phonation and swallowing.

[Reconstruction of the mandibular arch using free vascularized iliac and scapular grafts. Arguments in favor of using scapular grafts]. / Reconstruction de la symphyse mandibulaire par transferts osseux vascularisés libres iliaques et scapulaires. Arguments en faveur de l'utilisation du lambeau scapulaire.

In 12 cases of surgically removed mandibular symphysis malignancies, the bone and mouth floor were reconstructed using osteo-musculocutaneous flaps from the iliac crest or free osteo-cutaneous scapular flaps. In our experience, the latter provide the best results. Removed in dorsal decubitus, they allow floor replacement. During the dissection of the tumor site, we also preserve labial and clin structures, which favours a good restoration of phonation and swallowing.