Pharyngeal flap in velopharyngeal insufficiency: Proposal of an algorithm in a series of 31 patients.

This study evaluated the results of a reproductible protocol indicating the need for a pharyngeal flap in children with cleft palate and velopharyngeal insufficiency (VPI). A retrospective review of all patients operated for a pharyngeal flap between 2010 and 2019 in our center was conducted. After exclusion of patients with primary VPI or residual fistulas, 31 patients' data were analyzed. Our main outcome measure was the improvement of the Borel Maisonny Classification (BMC) by at least 1 rank. Further analysis was made to evaluate the impact of age, type of cleft, and BMC before surgery on the gain in the velopharyngeal function. Of the 31 patients, success was achieved in 29 (93.5%, p<0.005). There was no significant correlation between age and gain in the velopharyngeal function (p = 0.137). There was no significant correlation between type of cleft and gain in the velopharyngeal function (p = 0.148). There was a significant correlation observed between the starting classification and gain in velopharyngeal function. The gain observed was greater as the initial velopharyngeal function was worse (p = 0.035). The use of an algorithm combining clinical assessment with a standardized classification of the velopharyngeal function proved to be a reliable tool for the indication of surgery in patients with VPI. A close follow up is essential in a multidisciplinary team.

Measurement of quality of life in orthognathic surgery using an original questionnaire: About a series of 123 cases.

INTRODUCTION: The aim of this study was to measure changes in the quality of life of patients who had orthognathic surgery using an original questionnaire, designed for this purpose. MATERIAL AND METHOD: This single-center retrospective study included all patients who had orthognathic surgery in our center between 2014 and 2019. An original questionnaire comprising 13 items in 4 domains was sent to patients postoperatively by email after telephone contact and obtaining their consent. Items were scored on a 5-point scale ranging from (-1), worse than before surgery, to (+3), better than before surgery. RESULTS: All data were collected in a standardized way. In total, 123 patients responded. The mean score for all surgeries combined was +1.14, indicating an improvement in QOL considered to be "low to moderate". A total of 118 patients (95.9%) reported an improvement following surgery, including 18 patients (14.6%) who reported a marked improvement. The greatest improvement was observed for psychosocial aspects and morphology. CONCLUSION: This study shows a positive effect of orthognathic surgery on patients' QOL, including self-perception, relationships with others, or functional aspects as mastication and breathing. We propose an original tool that is easy to use by patients to measure quality of life following orthognathic surgery.

Short-term hearing outcome of malleus removal for surgery: An observational cohort study.

OBJECTIVES: The main goal of the present study was to assess hearing outcome for malleus removal in cholesteatoma surgery compared to a group with malleus conservation. The secondary aim was to compare the auditory involvement of the stapes between the two groups. MATERIAL AND METHODS: A single-center observational study included adult patients operated on by ossiculoplasty for acquired cholesteatoma between 2015 and 2019. Endpoints comprised improvement in pure-tone average air-bone gap (PTA-ABG) and air-bone gap (ABG) at conversational frequencies and, independently, per frequency. 136 patients were included: 95 with conserved malleus (M+) and 41 with malleus removal (M(). Mean time to audiometric follow-up was 9 months in both groups. RESULTS: The PTA-ABG improvement was 4.4±12.6dB for the M+ group and 3.8±13.4dB for the M- group, with no significant significance (P=0.8). Better results (not exceeding 7.5dB) were found for the M+ group at 2 and 8kHz (P=0.3 and P=0.052 respectively). Presence or absence of the stapes did not affect the results in either group. CONCLUSION: Those results suggest a negligible role of the malleus in early hearing outcome of tympanoplasty for cholesteatoma. A slight improvement was observed in the M+ group at 2 and 8kHz, but its interpretation remains uncertain.

Management of an extended bone-invasive basal cell carcinoma of the median forehead.

We report the case of a 35-year-old male patient managed for extended basal cell carcinoma of the median forehead, invading the frontal bone. Bone reconstruction was performed by a splitting of calvaria and skin reconstruction was performed using two frontal flaps dissected into complete vascular island, covering a skin defect of about 8cm in diameter (including safety margins). Wound healing was achieved after 4 weeks despite a median area of suffering and a temporary leak of cerebrospinal fluid of favorable evolution. The result at 5 years was excellent, with the patient's return to normal daily life and total satisfaction.

[HBsAg quantification: virological significance]. / Quantification de l'antigène HBs: signification virologique.

HBsAg is a classic marker of hepatitis B virus infection. Since the levels of serum HBsAg are correlated to those of intrahepatic cccDNA, HBsAg quantification indirectly reflects the number of infected hepatocytes. The kinetics of serum HBsAg decline seems to be a predictive marker for sustained virological response, and clearance of HBsAg. This new tool may be clinically relevant for the monitoring and optimization of hepatitis B treatments. To fulfill this objective, prospective studies are still warranted for the the spread of sensitive and standardized techniques standardization of the quantification assays and to define cut off values with clinical predictive values.