Voice rehabilitation after total laryngectomy using the Newvox voice prosthesis.

OBJECTIVES: To evaluate the anatomy, as well as the probability of restoring voice (study of the methods of vocal recovery) with the Newvox voice prosthesis. MATERIAL AND METHODS: This study relates to 225 patients having undergone a total laryngectomy and a Newvox voice prosthesis (one or more prosthesis) between April 1979 and November 2003. All the cases were followed up for 2 years. During evolution the complications were noted. All the valves removed were sent for microbiological analysis, including culture. The Statistical Analysis were carried out on the cohort of patients defined as having benefited from one or more voice prostheses after undergoing total laryngectomy. The lifespan of the implants has been described by the median duration (corresponding to the duration above which 50% of the implants lasted) the first quartile (corresponding to the duration above which 75% of the implants lasted) and the third quartile (corresponding to the duration above which 25% of the implants lasted). RESULTS: No infection by candida albicans was found. Complete removal of the Newvox voice prosthesis for local problems was necessary only in 20 cases (8.9% of the cases). The general lifespan (on 225 patients) of the 1st implant corresponded to a median of 252 days (8.4 months) with a first quartile of 452 days (1.2 year). The statistical analysis of the lifespan of the Newvox voice prosthesis made it possible to study the impact of radiotherapy on the quality of the results. The time to onset of satisfactory phonation was studied: The general median (time above which includes 50% of the patients) was three weeks. After two weeks, 25% of the patients obtain a satisfactory voice. CONCLUSION: On the whole, out of 185 documented cases, a satisfactory voice was obtained in 84% of patients, either by the voice prosthesis or by oesophageal voice. The absence of infection by candida albicans of the Newvox voice prosthesis is one of the factors which probably account for it being so well tolerated and having a significantly longer lifespan compared with other prostheses.

[Pneumoparotid: a case report and review of the literature]. / Pneumoparotide: à propos d'un cas, revue de la littérature.

This article reports a case of peneumoparotid in a ten-year-old girl. This pathology is caused by insufflation of air into the acini of the parotid gland via Stensen's duct. A review of the literature shows that it has many aetiologies but more frequently it presents as an occupational hazard among glassblowers and wind instrumentalists. It may also occur by auto-insufflation in adolescence who often have psychological problems. The diagnosis is made from the history and imaging. The treatment is aetiologic and symptomatic.

[Loss of visual acuity caused by ethmoidal mucocele cured after endonasal surgery: report of a case]. / Perte d'acuité visuelle par mucocèle ethmoïdale résolutive après chirurgie endonasale. A propos d'un cas.

A posterior and/or ethmoidal mucocele remains a rare occurrence. The condition usually follows a past history of sinonasal surgery. Extension of the lesion may have ophtalmological implications, with the possibility of causing visual impairment. The predilection for a site of origin in the posterior sinuses explains the frequent absence of nasal symptoms, and the usual pattern of discovery by the ophtalmologist. Modern imaging techniques, especially scanning, allows the diagnosis to be made immediately after the first orbital symptoms. By the same token, recent techniques of endoscopic endonasal surgery have radically changed the treatment. Early complete surgical removal holds out hope for remission of the symptoms that led originally to discovery of the mucocele. We report here a case of posterior ethmoidal mucocele causing a visual field defect which reversed completely after endoscopic treatment.

Postintubation interarytenoid adhesion.

Interarytenoid fibrous adhesion is a poorly recognized complication of intubation and is frequently confused with bilateral vocal cord paralysis. Early diagnosis and treatment is essential for optimal management. Otolaryngologists should constantly remain alert for interarytenoid fibrous scar to establish the diagnosis as early as possible, optimizing the probability of restoring normal breathing and quality of life and avoiding an unnecessary tracheotomy. Surgical laser reduction is appropriate in all cases when other miscellaneous laryngeal injury lesions are eliminated. Direct laryngoscopy with careful examination of the posterior commissure and laryngeal electromyography are the 2 main clinical diagnostic aids contributing to establish the diagnosis.

Vallecular acinic cell carcinoma in a 9-year-old girl: report of an unusual case.

An unusual case of acinic cell tumour of the vallecula is presented. Acinic cell carcinoma occurs usually in the major salivary glands. Minor salivary gland location is unusual and vallecular origin exceptional. This peculiar histologic tumour should now be classified as an low grade carcinoma and adequate treatment has to be initiated. The patient, a 9-year-old girl, had undergone a suprahyoid access for total tumor removal with a bilateral neck exploration. Postsurgical radiotherapy has to be done in case with perineural invasion, invaded margins, node invasion or high grade tumor. The clinical and histopathological findings are discussed in the light of the literature.

[Uvular edema. Diagnostic, etiologic and therapeutic management]. / Oedème uvulaire. Prise en charge diagnostique, étiologique et thérapeutique.

Acute oedema of the uvula is relatively rare, and often idiopathic. None the less, possible causes should be excluded, such as allergy, infection, trauma or mechanical. Hereditary angioneurotic oedema should be excluded when there are identical recurrent episodes. Although three of our patients had a recent herpetic viral infection, it does not seem likely that this was the cause. Treatment consists mainly or antihistamines, steroids, antibiotics, or specific treatment for hereditary angioneurotic oedema. The clinician must always bear in mind the potential seriousness or this condition as a cause of obstruction of the upper airway. In the light of four recent cases, the authors discuss the diagnosis, cause and treatment of this particular condition.

[Otolaryngological manifestations of sarcoidosis. Report of 10 cases and review of the literature]. / Manifestations ORL de la sarcoïdose. A propos de 10 cas. Revue de la littérature.

Sarcoidosis is a systemic chronic granulomatous condition of unknown aetiology. Although the mediastino-pulmonary type is the commonest, the condition may affect the head and neck in a significant number of cases, obliging the practising ENT surgeon to be familiar with the condition. The diagnosis is made by a combination of clinical, biochemical, radiological and histopathological features. We present 10 cases of sarcoidosis with exclusively cervico-facial features which have passed through the department between 1985 and 1996, including a typical nasal case with combined features, and a very rare pharyngeal case. The definitive diagnosis, always with histological confirmation, was sometimes made only after some delay, demonstrating the polymorphic nature of the clinical features, which are rarely pathognomonic. Special investigations, carried out virtually routinely once the diagnosis of ENT sarcoidosis was made, demonstrated only one case of associated pulmonary disease. Treatment was reserved for the symptomatic cases (4 out of 10), and consisted of systemic steroids whose dose and duration was determined by the clinical response.

[A prospective study of ENT complication following surgery of the cervical spine by the anterior approach (preliminary results)]. / Etude prospective des complications ORL de la chirurgie du rachis cervical par voie antérieure (résultats préliminaires).

In order to evaluate complications due to cervical spine surgery using the anterior cervical approach a prospective study was conducted on 125 patients. ENT examination with the fibroscope was employed for all the patients before the procedure. The patients were operated on under general anesthesia and were intubated with an armoured tube, and then were placed in an intensive care unit for 24 hours. Assessment of deglutition and an ENT examination were performed the day after surgery. Before surgery, two cases of vocal cord paralysis were noted. 111 patients (88.8%) presented with subjective disorders: problems such as sore throat, odynophagia, dysphagia, dysphagia with overspill and hoarseness were respectively noted in 55 (44%), 34 (27.2%), 32 (25.6%), 11 (8.8%) and 13 (10.4%) cases. Dyspnoea was found in 2 cases (1.6%). 117 patients (93.6%) presented postoperative anomalies which were found on the posterolateral pharyngeal wall, on the arytenoids and on posterior third of the vocal cords. Inflammatory and/or swollen lesions were slight, moderate, significant or very significant in respectively 22.4%, 22.4%, 15.2% and 1.6% of cases. Very significant circumferential swelling of the pharyngeal wall and of the arytenoids was responsible for two cases of respiratory distress, and the patients required reintubation and return to theatre. Severe pharyngeal lesion correlated with duration of surgery (r = 0.20; p < 0.05), with the number levels of fusion (r = 0.02; p < 0.02) and with the age of the patient (p < 0.02). Six patients presented problems of mobility of the vocal cords: 3 had a right vocal cord paresis which was temporary and 3 had paralysis, also on the right but which persisted. There were no other complications. It is concluded that (i) ENT complications are frequently found in postoperative cervical spine surgery using the anterior cervical approach, some of them being severe. An ENT examination must be performed before the procedure for legal reasons. It is also recommended in the postoperative period in the case of discomfort; (ii) patients need to be placed in an intensive care unit during for the first 24 hours (iii). This study needs to be attended over more patients (iv) comparison with a control group of patients having non cervical surgery and intubated in the same way is needed to differentiate lesions related to surgery or intubation.

Laryngomucocele as an unusual late complication of subtotal laryngectomy. Case report.

We report an unusual case of laryngomucocele occurring after subtotal laryngectomy. Laryngoceles generally have a congenital origin in a long-preexisting saccule, and their association with laryngeal carcinoma is well known. Laryngocele is usually favored by the increase of intraglottic pressure caused by the laryngeal carcinoma. However, an iatrogenic secondary laryngomucocele occurring after a surgical procedure is uncommon. We report in detail the physiopathologic conditions leading to the creation of this lesion.

[Comparative intensity-pressure study of patients with a voice prosthesis]. / Etude comparative intensité-pression chez les patients porteurs d'implant phonatoire.

We have studied the qualities of the voice of the laryngectomized patients and theirs possibilities to modify the intensity depending to the pressure. During the measurement, it was necessary to explain to the patient how to use the material and it was an opportunity to help him in the way to product a voice prosthesis. Most of the patients produced a higher intensity with a higher pressure. However, some of them obtained high pressures without producing a voice. These patients modified the use of the prosthesis or could have an oedema for example. In conclusion, these measurements show that there is a relation between intensity and pressure but not absolutely in relation with a better voice quality.

Primitive pharyngeal dyskinesia associated with upper airway collapse in an infant.

We report a case of total collapse of the upper pharyngeal airway in a slightly premature baby, resulting in a noisy breathing disorder. Primary immaturity of the central nervous system contributing to pharyngeal muscle hypotonia has been implicated in association with the increase in nasal pressure. The infant experienced complete resolution of symptoms a few weeks after the placement of a nasopharyngeal tube. This case report demonstrates the difficulty in diagnosis and management. The developmental spectrum and exploration are reviewed.

Horizontal glottectomy: functional and oncological results.

The authors report on their experience with 25 cases of horizontal glottectomy and discuss the functional and oncological results of this operation. Indications for this procedure are T1a and T1b glottic carcinomas. The overall three-year and five-year survival was respectively 94 and 88 per cent. Distant metastasis appears to be the major long-term failure, three patients dying of lung carcinoma. Short functional rehabilitation was observed in all cases. Decannulation was achieved in 100 per cent of the cases and none of our patients had laryngeal stenosis. The average time of removal of the nasogastric tube was 11.8 days. Because of its high local control and reduced functional after effects, horizontal glottectomy appears to be a reliable and safe procedure for limited glottic carcinomas and must be included in their therapeutic management.

[Laryngeal tuberculosis: a diagnosis not to be forgotten]. / La tuberculose laryngée: diagnostic à ne pas oublier.

Tuberculosis of the larynx has become a rarity since the discovery of streptomycin in 1944. In this article a personal case history is described, together with a review of the literature and an analysis of the main clinical features of tuberculosis of the larynx. The pseudo-tumoural form of tuberculosis is often indicative of the presence of pulmonary tuberculosis, but may also occur in isolation. Histology is often the only definitive diagnostic test.

[Primitive extracranial meningioma: a case report of intratemporal and naso-sinusal localization]. / Méningiome extracrânien primitif: a propos d'un cas de localisation infratemporale et naso-sinusienne.

The authors report on the rare extracranial locations regarding a case of infratemporal fossa and paranasal sinus meningioma. These tumours formulate pathogenic questions, the hypothesis of which are exposed. Diagnosis gets difficult because of the atypical location of these meningiomas. Computerized tomography scan is the examination of choice for assessing the extension of these lesions. The only treatment is surgical.

[Syncopal neuralgia of the glossopharyngeal nerve caused by tumoral invasiveness. Therapeutic management. Apropos of 2 cases]. / Névralgie syncopale du glossopharyngien par envahissement tumoral. Conduite thérapeutique. A propos de deux cas.

Cases of glossopharyngeal neuralgia are relatively rare, and are occasionally secondary to an upper cervical carcinomatous invasion. The combination with syncopal episodes suggests the creation of a reflex pathway between the glossopharyngeal nerve and the vagus nerve by connections between the bulbar nuclei. The fact that the syncopal episode is systematically preceded by a neuralgic crisis enables its differentiation from other active vasomotor phenomena. Treatment is based essentially on pain-killers and occasionally, in the event of escape, by a neurosurgical resection of the root of the glossopharyngeal nerve and of the upper part of the vagus nerve. In the light of two recent cases, the authors recall the therapeutic management and the physiopathological mechanism of this particular form of neuralgia.

[Chondroma and chondrosarcoma of the larynx: apropos of 4 cases]. / Les chondromes et chondrosarcome du larynx: à propos de 4 observations.

Chondroma and laryngeal chondrosarcomas, tumours of variable malignancy, are rare but a source of concern given their location and the surgery involved. Their anatomical limits and classification are still difficult, to the extent that the diagnosis of chondroma is often questioned. Of the four cases reported, two presented a high degree of malignancy, including one with metastasis. Two required a total laryngectomy, and two a partial laryngectomy with a costal cartilage graft in one case.

[Vocal rehabilitation after total laryngectomy: 15 years' experience with phonation implant]. / Réhabilitation vocale aprés laryngectomie totale: 15 ans d'expérience avec l'implant phonatoire.

Progress in voice rehabilitation after total laryngectomy is probably the most significative event of the last 15 years. The first to realise this procedure in France, the authors describe the state of the art in this field with a study of 160 cases. The results are in the main very positive with approximately 85% of success with all rehabilitation technics used currently. The future is establishing total functional rehabilitation of the larynx with new techniques researched specially in Europe with several groups : GREL, EGFL, BIOMED I program of Europe "Artificial Larynx" and so on... The work goes on and we shall see whether the next 15 years will be as satisfying as the last 15 years.

[Treatment of severe cervicofacial hemangioma with interferon alpha-2b]. / Traitement d'un hémangiome cervicofacial grave par interféron alpha-2b.

BACKGROUND: Indications for active treatment of hemangiomas are those lesions which, by virtue of their size and site, compromise vital structures. The treatment of choice is oral or intravenous corticosteroids, but interferon alpha may represent alternative therapy. CASE REPORT: A 15-day-old girl was admitted for congenital hypothyroidism. She had a large cervicofacial hemangioma extending to periorbital and laryngeal areas. The patient was given systemic prednisone (2 mg/kg/day) and L-thyroxin without success. An episode of acute respiratory distress a few weeks later required tracheostomy while prednisone dosage was increased to 4 mg/kg/day. This drug was not tolerated and the hemangioma was treated by particle embolization that was followed by a partial decrease in the volume of the hemangioma. A second episode of cardiorespiratory distress at 7 1/2 months of age required interferon alpha, 3 million units/m2/day, that was progressively effective. After 11 months of treatment, the hemangioma disappeared, without relapse 6 months later. CONCLUSION: Interferon alpha is an interesting alternative therapy of infantile hemangiomas when they are resistant to steroid treatment.

[External injuries of the larynx in the adult: apropos of a case]. / Traumatismes externes du larynx de l'adulte: A propos d'un cas particulier.

Reporting one case of negliged laryngeal traumatism, the authors expose their laryngeal injuries attitude. They detail admitted classification and propose a management which is based on initial respiratory functions. In view of the case, as extreme situation, laryngeal subtotal surgery was the better management, because of association with polytraumatism, which not permitted earlier treatment.