Retropharyngeal liposarcoma: A rare cause of dysphagia.

INTRODUCTION: Liposarcoma is a rare malignant mesenchymal tumour. Very few cases of retropharyngeal liposarcoma have been reported in the literature. SUMMARY: A 30-year-old woman with no notable history reported swallowing disorders for the past year associated with dysphonia. Nasal endoscopic examination demonstrated a tumour arising from the left lateral pharyngeal wall, ascending as far as the junction of the free margin of the epiglottis, aryepiglottic fold, and pharyngoepiglottic fold and obliterating the ipsilateral pyriform sinus with preservation of cord mobility. The rest of the physical examination was normal. The preoperative assessment was completed by gadolinium-enhanced MRI of the neck. Open surgery was performed. Definitive histological examination concluded on dedifferentiated liposarcoma with negative resection margins. Following staging chest computed tomography that did not reveal any metastases, the multidisciplinary consultation meeting decided to deliver adjuvant volumetric modulated arc therapy. No recurrence was observed nine months post-treatment. DISCUSSION: Retropharyngeal liposarcoma is a rare tumour. The authors report the first case of a dedifferentiated histological subtype in this site. A review of the literature completes this case report by providing a description of prognostic factors and the various treatments.

[Preliminary results of percutaneous tracheotomies]. / Résultats préliminaires des trachéotomies percutanées.

OBJECTIVES: Percutaneous tracheotomy (PT) is an alternative to surgical tracheotomy (ST). We describe our procedure and discuss the current status of PT through a retrospective study of our first 30 cases. MATERIAL AND METHODS: Thirty patients had a PT between October 2006 and March 2008 in the intensive care units of Caen University Hospital (France). Twenty-eight were done with the Ciaglia Blue Rhino (CBR) and two with the Percutwist. Each PT was endoscopically guided. We retrospectively collected preoperative data and most of the intraoperative as well as early postoperative complications. RESULTS: No death was reported with the PT application. Twenty-two (73.3%) PTs had neither preoperative nor early postoperative complications. Eight complications were observed, half preoperative and half early postoperative. The most frequent complication was minor bleeding in three cases (10%), the most important one was the intraoperative appearance of a tracheoesophageal fistula with the CBR. DISCUSSION: The principal advantages of PT are safety attributable to simultaneous endoscopic guidance as well as shorter operative time and lower cost in comparison with the ST technique. CONCLUSION: PT is a safe and valid alternative procedure to ST. Initially performed by intensivists, it should be part of the ENT/head and neck surgeon's repertory as the upper airway specialist.

[Otologic sequels in velopalatine clefts. Analysis and management]. / Séquelles otologiques dans les fentes palatovélaires. Analyse et prise en charge.

As early as in 1878, medical teams managing children born with a velopalatine cleft had noted the prevalence of middle-ear pathologies largely related to anatomic and inflammatory Eustachian tube dysfunction. The aim of this study was to describe otologic sequels related to a velopalatine cleft and to suggest an adapted management. These sequels are evolving presentations of chronic serous otitis; they worsen the functional prognosis (hypoacousia) and more rarely the vital prognosis (cerebral or infectious complications of cholesteatoma). We must stress the importance of prevention: during the initial management, by Eustachian tube rehabilitation, and by ENT (Ear, Noseand Throat) follow-up allowing to prevent these sequels and to bring hearing to normal as soon as possible, so as to support cognitive development, language skills, and sociofamilial integration of the children.

[Detection of the sentinal node in squamous-cell carcinoma of the oral cavity and oropharynx. Preliminary study]. / Détection du ganglion sentinelle dans les carcinomes épidermoïdes de la cavité buccale et de l'oropharynx. Etude préliminaire.

INTRODUCTION: The sentinel lymph node is defined as the first relay of the lymphatic drainage of the tumor. Isotopic detection of the sentinel lymph node and absence of its metastatic invasion should theoretically be predictive of total drainage of the tumor. The goal of this study was to evaluate sentinel lymph node detectability by lymphoscintigraphy in N0 and/or N1 squamous-cell carcinoma of oral cavity and oropharynx and to determine its negative predictive value. MATERIAL AND METHOD: Lymphoscintigraphy was used for sentinel lymph node detection. The procedure required peritumoral injection of technicium-labeled colloids to enable anatomical and cutaneous location of the sentinel lymph node. A one-way Tyco-Mallinckrodt probe was used for intraoperative detection of the sentinel lymph node. This prospective study included 21 patients with N0 or N1 squamous-cell carcinoma of the oral cavity and the oropharynx. The surgical attitude based on T and N was not modified in this prospective study without direct individual benefit for the patient. Neck dissection was achieved without difficulty. RESULTS: The sentinel lymph node was identified in 20 out of 21 subjects. The sentinel lymph node was not identified in one patient with recurrence T2N0M0 squamous-cell carcinoma of the oropharynx radiated 3 years earlier. The percentage of false-negatives was 12.5% (1 false-negative out of 8 positive patients), giving a sensibility of the detection method of 87.5% (IC (95%)=[47.35-99.68]). This false-negative patient had a T3N0M0 squamous-cell carcinoma of the oropharynx with a sentinel lymph node removed in territory III. Neck dissection revealed 1 N + R- in the sub-mandibular territory associated with 27 N-R-. The probability of not finding a metastatic node at neck dissection when the sentinel lymph node is not metastatic (negative predictive value) was 92.3% (12/13) (IC (95)=[63.97-99.81]). The specificity of the method was 100%, as was the positive predictive value, because no sentinel node was diagnosed positive wrongly on frozen sections among patients without true histological node metastasis. DISCUSSION: For routine care of patients with squamous-cell carcinoma of the oral cavity and the oropharynx detection of the sentinel lymph node is proposed primarily for patients with T1T2N0 staging. Larger tumors can modify the architecture and flow within the lymphatic ducts, and consequently even the concept of a sentinel lymph node. Systematic neck dissection is required or T3T4, even when N0. Our series of T1T2N0 tumors is too small to enable statistically significant conclusions. A low level of false-negative in a larger series would be necessary to propose this technique instead of convention neck dissection for T1T2 tumors of the oral cavity and oropharynx.

[Interest of PET/CT scan fusion to assess mandible involvement in oral cavity and oro pharyngeal carcinomas]. / Intérêt de la fusion TEP/TDM dans l'exploration de l'envahissement mandibulaire des cancers de la cavité orale et de l'oropharynx.

UNLABELLED: The aim of the study is to assess mandible involvement in oral cavity and oropharyngeal carcinomas. OBJECTIVE: To evaluate interest of fusion of Positron Emission Tomography (PET) with Computed Tomography scan (CT scan). METHOD: Eight patients were included in this prospective study. Each patient underwent PET and CT scan of the head and neck before surgery including tumorectomy and mandibulectomy. We compared results of PET- CT fusion with histologic examinations. RESULTS: Oral cavity (6), oropharyngeal (2) carcinoma: Mandibular invasion was suspected by PET-CT in 3 cases, but was confirmed in histological examination in only 2 cases. In 5 cases, PET-CT did not find mandibular invasion; this was confirmed in histological examination in all cases. Sensibility of PET-CT fusion was 100%, specificity was 83%. Positive predictive value was 66% and negative predictive value was 100%. DISCUSSION: PET-CT fusion provided maximal sensitivity. Specificity was better than for MRI but less than CT-scan. There were no false negatives and the false positive rate was 33%. CONCLUSION: PET-CT fusion is interesting to predict mandible involvement. Further studies are necessary to confirm these preliminary results.

[Surgery for hyperthyroidism on 43 patients]. / Chirurgie de l'hyperthyroïdie: à propos de 43 patients.

UNLABELLED: Treatment of hyperthyroidy uses surgery as well radioactive iodine and antithyroid agents. OBJECTIVES: The study analyses the modalities of hyperthyroidy surgery, describes its complications and the population undergoing surgical treatment. POPULATION AND METHODS: It is a retrospective study on 43 patients with hyperthyroidy treated by thyroidectomy from January first 1998 until 31 January 2002. RESULTS: The mean age is 48 years. The sex ratio showed a predominance of women (with 36 women and 7 men). The most frequent aetiology is Graves' disease and toxic multinodular goiter. Total thyroidectomy is applied to Graves' disease and toxic multinodular goiter while single toxic nodules are treated by loboisthmectomy. Surgery for hyperthyroidy have a low morbidity (1/43 haematoma, 0/43 hypoparathyoidy, 1/43 palsy of recurrent nerve). CONCLUSIONS: In this conditions, the hyperthyroidy surgery is fast, effective and does not need a heavy follow-up. Surgery seems to be a good alternative to antithyroid agents, which are constraining and often ineffective in the long term, and to radioactive iodine who leads to a long follow-up because of induced hypothyroidy.

[Otogenic cavernous sinus thrombophlebitis. A case report]. / Thromboses otogènes du sinus caverneux. A propos d'un cas.

OBJECTIVES: Acquire knowledge concerning the diagnosis and treatment of otogenic cavernous sinus thrombophlebitis. PATIENT AND METHODS: We report a case of otogenic cavernous sinus thrombophlebitis (CST) in a 6-year-old boy. RESULTS: CST diagnosis was based on clinical signs (septic illness, ocular nerve palsy and chemosis), and neuro-imaging confirmed the diagnosis. Contrast-enhanced CT scan demonstrates different signs: (i) filling defect or heterogeneous enhancement of cavernous sinus, (ii) cavernous sinus enlargement with bulging of the lateral wall, (iii) intensive enhancement of lateral wall corresponding to enhancement of a collateral network replacing the thrombosed cavernous veins, (iiii) and sometimes indirect orbital signs (exophthalmus, densification of the retro-orbital fat, superior ophthalmic dilatation with partial or no enhancement in case of thrombosis extension). The bacteria most frequently found are Streptococci, Streptococcus pneumoniae, Staphylococcus aureus, Gram-negative rods and anaerobes combined. The therapeutic management of CST consists of intravenous administration of appropriate antibiotics combined radical mastoidectomy if medical therapy has failed. Anticoagulant therapy is controversial. CONCLUSION: Knowledge of early diagnosis of otogenic cavernous sinus is important because prior to the antibiotic era, CST was almost always fatal. Currently, therapeutic outcome is not always favorable due to high morbidity after aggressive treatment.

[Chondromas and low-grade chondrosarcomas of the larynx: a case report]. / Chondromes et chondrosarcomes de bas grade du larynx. A propos d'un cas.

OBJECTIVE: We report a case of cricoid chondroma, underlining the difficulty in establishing a precise differential diagnosis between chondroma and low-grade chondrosarcoma of the larynx. MATERIAL AND METHODS: A 48-year-old woman developed inspiratory dyspnea. The final diagnosis was cricoid chondroma. We reviewed our case and data in the literature on these cartilaginous tumors. RESULTS: The patient was treated with conservative surgery. At 18 months follow-up, no recurrence has been detected. DISCUSSION: These tumors are rarely found in an ENT location and have similar histological features. According to many authors, the clinical course alone enables a distinction between chondroma and low-grade chondrosarcoma. Surgical treatment is indicated and provides good phonatory function in the vast majority of the cases.

[Bronchial foreign bodies in children]. / Corps étrangers intra-bronchiques de l'enfant.

BACKGROUND: Tracheobronchial aspiration of foreign bodies in children is a rare event that can be serious. We report a 10-year retrospective study of tracheobronchial foreign body aspiration in children. METHOD: This retrospective analysis involved 87 patients who underwent endoscopy at the ENT unit of the Caen University Hospital. RESULTS: Foreign bodies were found in 34 of the 87 patients. Average age was 3 years, with a male predominance. Peanuts were the most common foreign bodies observed (16/34). Most of the foreign bodies were removed via the right main bronchus (17/34). Clinical and radiological signs depended on delay to admission and were found to be normal in 15% and 37.5% of the cases respectively. Twenty-four children out of 34 had a positive history of foreign body inhalation. All foreign bodies were removed during the endoscopy procedure. CONCLUSION: This work underlines the much-debated function of chest x-ray, the need for a rigorous technically correct endoscopy procedure and the importance of close cooperation between the anesthesiologist and the endoscopist.

[Utility and limitations of speech audiometry testing in the detection of occupational noise-induced hearing loss: a comparative study in two groups in the hospital setting]. / Intérêt et limites des indices audiométriques vocaux dans le dépistage des traumatismes sonores professionnels: à propos d'une étude sur deux groupes en milieu hospitalier.

OBJECTIVE: The objective of this study is the evaluation of the calculation of 100% intelligibility threshold and noise resistance index as a monitoring test in populations exposed to noise in their work environment. METHOD: This is a retrospective exposed-unexposed study as the exposure to the risk factors took place before the survey. The exposed subjects were chosen in principle on sonometric criteria and the unexposed subjects among employees whom we believe were not exposed. The exploration method included history taking, clinical examination, free field audiometry and speech audiometry with background noise. RESULTS: The exposed population has a 100% intelligibility threshold on average equal to 29.69 dB, significantly higher than in the unexposed population where it is calculated at 25.30 dB (p = 0.07). The noise resistance index varies with age (p = 0.04). CONCLUSION: Our study shows the existence of a significant hearing difference between two populations with different noise exposure. It demonstrates a relationship between a hearing loss risk factor such as noise and the occurrence of the "professional hearing loss" disorder. The calculation of the 100% intelligibility index and the noise resistance index advantageously complements tonal audiometry. These procedures provide a better approach to the social impact of hearing loss but were not useful in the detection of hearing loss.

[Parathyroid cysts]. / Les kystes parathyroïdiens.

Two cases of parathyroid cysts are described. One cyst was symptomatic, the other was discovered while performing thyroidectomy. In both cases, the cysts were non-functional. There have been reports of functional cysts occurring in a lesser proportion and causing primary hyperthyroidism. These benign cysts are rare (300 cases reported in the literature). Surgery is the treatment of choice in most cases.

[Intracranial complications of acute mastoiditis]. / Complications intra-crâniennes de la mastoïdite aiguë

We report a case of extradural abscess after acute mastoiditis in an 8-years-old boy. The clinic diagnostic of an intracranial complication is difficult. The most common present symptoms are fever, otalgia and otorrhea but are not specific. Neurologic symptoms are suggestive signs of an intracranial complication. We believe that, in acute mastoiditis performance of a CT scan of the brain and temporal bones with intravenous contrast, contribues to the diagnostic of intracranial complication. The diagnostic of thrombosis sinus sigmoid is evoked with slight contrast enhanced sinus sigmoid and failure to opacify. The characterisation of an epidural empyema is a hypodense epidural collection in a contrast-enhanced CT scan. The most common isolated organism are Streptococcus Pneumoniae, Staphylococcus aureus and Pseudomonas aeuginosa. The therapeutic management includes combination of intraveinous antibiotics, mastoidectomy and surgery of the intracranial complication.

[Voice rehabilitation with a voice prosthesis. Study of 62 patients with 5 years follow-up]. / Réhabilitation vocale par implant phonatoire. Etude de 62 patients ayant 5 ans de recul.

UNLABELLED: From December 1987 to February 1998, 270 patients underwent a total laryngectomy with voice restoration by a voice prosthesis. The analysis is focused on the 62 live patients with a 5 year follow-up. Tracheoesophageal speech had a success rate of 81% after 1 year and 73% after 5 years. The daily use of the voice prosthesis is only 68% after 1 year and 61% after 5 years. During the 5 year follow up (for all patients) 16 (26%) presented an enlarged fistula with leakage around the fistula and 17 (27%) needed a removal of the prosthesis. CONCLUSION: Tracheoesophageal speech with a voice prosthesis appears interesting for laryngectomized patients with: a high success rate, the quality and precocity of the voice obtained. However, it requires extensive care and the results deteriorate with time.

[Temporal fibrous dysplasia with labyrinthine involvement. Apropos of a case and review of the literature]. / Dysplasie fibreuse temporale avec atteinte labyrinthique. A propos d'un cas et revue de la littérature.

Craniofacial fibrous dysplasia manifests clinically with dysmorphic syndrome, ophtalmologic or otologic signs. We report a case of temporal polyostotic fibrous dysplasia with vertigo and sensorineural hearing loss. Sensorineural hearing loss, with no cholesteatoma associated, as described in our case is rarely described. We review the literature concerning main clinical, diagnostic and therapeutic aspects of this disease.

[A case of Kikuchi disease. Review of the literature]. / A propos d'un cas de maladie de Kikuchi. Revue de la littérature.

We report a case of Kikuchi's disease in a young man. It is a rare entity, described for the first time in 1972. It manifests clinically with cervical adenopathy and fever, often associated with other non-specific clinical signs. Laboratory tests are often normal. The diagnosis is established on the basis of histologic of lymph node excisional biopsy. Kikuchi's disease is likely to be misinterpreted as malignant lymphoma or systemic lupus erythematosus. It generally needs no treatment because it runs a spontaneously benign course with complete resolution of the symptoms within 6 months. Secondary systemic lupus erythematosus may develop. For this reason, regular follow-up of patients is recommended. The etiopathogenesis of this disease is still unknown, perhaps due to an immunologic phenomenon. It could be a hyperimmune reaction induced by various antigenic agents (infectious, neoplasic), or an autoimmune process.