Reconstruction of lateral defects of the tip and supratip less than 1.5 cm in diameter.

The authors describe the surgical technique as well as the indications and limitations of the East-West flap for repair of lateral defects of the tip/supratip of the nose less than 1.5 cm in diameter. This easy and reliable technique is based on the use of skin from the lower third of the nose to repair the defect. This tissue presents the same thickness and colour characteristics, which limits excessive thickness, distortion and dyschromia phenomena.

Guidelines of the French Society of Otorhinolaryngology (SFORL), short version. Extension assessment and principles of resection in cutaneous head and neck tumors.

Cutaneous head and neck tumors mainly comprise malignant melanoma, squamous cell carcinoma, trichoblastic carcinoma, Merkel cell carcinoma, adnexal carcinoma, dermatofibrosarcoma protuberans, sclerodermiform basalioma and angiosarcoma. Adapted management requires an experienced team with good knowledge of the various parameters relating to health status, histology, location and extension: risk factors for aggression, extension assessment, resection margin requirements, indications for specific procedures, such as lateral temporal bone resection, orbital exenteration, resection of the calvarium and meningeal envelopes, neck dissection and muscle resection.

[Reconstruction of nasal cartilage defects using a tissue engineering technique based on combination of high-density polyethylene and hydrogel]. / Reconstruction du cartilage nasal par ingénierie tissulaire à base de polyéthylène de haute densité et d'un hydrogel.

AIM OF THE STUDY: Nasal reconstruction remains a challenge for any surgeon. The surgical indications for nasal reconstruction after oncologic resection, trauma or as part of cosmetic rhinoplasty, are steadily increasing. The current attitude for reconstruction is the use of autologous cartilage grafts of various origins (septal, ear or rib) trying to restore a physiological anatomy but their quantity is limited. Thus, in order to produce an implantable cartilaginous model, we developed a study protocol involving human nasal chondrocytes, growth factors and a composite biomaterial and studied at the molecular, cellular and tissue level the phenotype of the chondrocytes cultured in this model. MATERIALS AND METHODS: After extraction of chondrocytes and their amplification on plastic, the cells were cultured for 15 days either in monolayer or within an agarose hydrogel or a composite biomaterial (agarose/high density polyethylene: Medpor(®)) in the presence or not of a cocktail of soluble factors (BIT): bone morphogenetic protein-2 (BMP-2), insulin and triiodothyronine (T3). The quality of the chondrocyte phenotype was analyzed by PCR, western blotting and immunohistochemistry. RESULTS: During their amplification in monolayer, chondrocytes dedifferentiate. However, our results show that the BIT cocktail induces redifferentiation of chondrocytes cultured in agarose/Medpor with synthesis of mature chondrogenic markers. Thereby, chondrocytes associated with the agarose hydrogel will colonize Medpor and synthesize an extracellular matrix characteristic of nasal cartilage. CONCLUSION: This nasal cartilage tissue engineering protocol provides the first interesting results for nasal reconstruction.

Deep cervical granular cell tumor: an atypic location suggestive of neurogenic origin.

INTRODUCTION: Granular cell tumor (GCT), or Abrikossoff's tumor, is usually benign, with predominantly head-and-neck locations. Putative Schwann-cell origin is controversial. Treatment is surgical, due to risk of malignancy. CASE REPORT: A 41-year-old man presented with benign GCT in one of the deep cervical plexus roots, suggesting neurogenic origin. DISCUSSION: Surgical resection is important. Preoperative diagnosis is hindered by the ubiquity of the lesions and the poor specificity of imaging. Pathologic and immunohistochemical analysis is essential for definitive diagnosis.

Saddle nose: classification and therapeutic management.

INTRODUCTION: The understanding and treatment of saddle nose have always been a surgical challenge. The authors propose a three-stage classification of this deformity as well as a treatment strategy adapted to each case. MATERIALS AND METHODS: A retrospective study was carried out on 25 patients with saddle nose. After defining the three stages of saddle nose: minimal, moderate and major, the authors describe the treatment protocol adopted for each stage. RESULTS: This series comprised 3 cases of minimal saddle nose, 17 cases of moderate saddle nose and 5 cases of major saddle nose. Minimal saddle nose was treated by extracorporeal rhinoplasty, an inverted U-shaped conchal graft was used to treat moderate saddle nose, and costal cartilage was used to reconstruct major saddle nose. Surgical approaches varied according to the technique adopted. Surgical revision was never required. CONCLUSION: Saddle nose is a classical condition in facial reconstructive surgery. The proposed treatment strategy is based on detailed analysis of the clinical signs, resulting in a graduated solution adapted to each clinical case according to the severity of the deformity.

Efficacy and safety of photodynamic therapy with temoporfin in curative treatment of recurrent carcinoma of the oral cavity and oropharynx.

Therapeutic options for recurrent carcinoma of the upper aérodigestive tract (UADT) are limited. The prognosis of these tumours remains poor with significant rate of recurrence and a lower median survival time. Photodynamic therapy (PDT) is a relatively new therapeutic alternative which combines the use of a photosensitising agent and light to induce a cytotoxic effect on the tissues. This is a retrospective single-centre study carried out in patients with a recurrence of an oral cavity or oropharyngeal carcinoma or a second appearance of tumour in a previously irradiated area. There were no metastases in lymph nodes or other organs. Laser treatment was carried out 96 h after temoporfin (Foscan(®)) injection. In our series we had 14 cases with a complete response, 1 partial response. Overall survival at 1 year was 72 % and 36 % at 5 years. Disease-specific survival at 1 year was 82 % and 45 % at 5 years. Recurrence-free survival at 1 year was 52 % and 34 % at 5 years. Side effects mainly described are pain in the area of illumination, well controlled. PDT with Foscan(®) gives useful results in terms of survival and improvement in quality of life with few adverse events or severe complications. The fact that it has low toxicity and that treatment sessions can be repeated mean it should be considered in the therapeutic armamentarium for recurrent carcinoma of the UADT.

Thulium-YAG laser sialendoscopy for parotid and submandibular sialolithiasis.

OBJECTIVE: To evaluate the efficacy and safety of thulium-YAG laser in sialendoscopic fragmentation of salivary lithiasis. DESIGN: Retrospective, interventional case series. MATERIAL: Sixty-three patients treated by interventional sialendoscopy with thulium-Yag laser fragmentation between 2003 and 2010 at Edouard Herriot Hospital were included in the study. The laser was used for non-floating or large lithiasis (>4 mm). METHODS: The sialendoscopic thulium fiber laser was used in a pulsed mode with an average power output of 2-8 W to fragment and facilitate extraction of salivary stones. Several variables were studied: success rate, total number of procedures, total energy per procedure, size and number of salivary stones removed, and complications. RESULTS: Our series of 63 cases includes 40 cases of parotid lithiasis and 23 cases of submandibular lithiasis. In nine cases, two sessions of laser were performed. Stone size was evaluated pre-operatively by ultrasound and varied between 2 and 18 mm. Laser fragmentation was possible in every case. Complete extraction of the lithiasis was possible in 51 cases (73.9%) and partial extraction in eight cases (12.6%). Extraction failed in four cases (6.3%). Mean stone size was 5.4 mm (5.7 mm for parotid glands and 5.0 mm for sub-mandibular glands) and mean energy per procedure was 1,450 J (range: 1,400-1,800 J). Ductal perforations were observed in 12.7% of the cases. 65.1% of patients were free of symptoms with a mean follow-up of 18 months. CONCLUSION: Thulium-YAG laser appears to be an effective and safe technique in the treatment of salivary lithiasis.

Localized nasopharyngeal amyloidosis.

OBJECTIVES: To illustrate, via a case report, how a differential diagnosis of amyloidosis is to be suspected in case of a nasopharyngeal mass. CASE REPORT: A 59-year-old woman presented with bilateral nasal obstruction with associated episodic tubal dysfunction. Physical examination found a mass occupying the entire nasopharynx, initially suggestive of tumor. DISCUSSION: Amyloidosis was diagnosed on histopathologic study of the biopsy and surgical specimens. Exploration for systemic disease proved negative. The localized amyloidosis was managed conservatively. At 9 months' follow-up, there was no recurrence. CONCLUSION: Localized amyloidosis, however rare, should be considered as differential diagnosis in any case of nasal obstruction with tubal dysfunction, even if bilateral. ENT physicians need to recognize and understand this pathology for adapted diagnostic and treatment planning.

Maxillary sinus fungal infection by Acremonium.

OBJECTIVE: To illustrate by this case report that Acremonium must now be considered as a differential diagnosis in cases of maxillary fungus balls. CASE REPORT: Seventy-seven-year-old woman consulted for persistent pain of the right maxillary sinus, with rhinorrhea and nocturnal coughing. Computed tomography (CT) of the sinuses showed a heterogeneous opacification of the right maxillary sinus with well-defined hyperdense foci suggesting aspergillosis. She underwent a middle meatus antrectomy by an endonasal approach. Six months after the surgery, her symptoms were gone and had not recurred. Mycological examination found Acremonium. DISCUSSION/CONCLUSION: Acremonium is a genus of saprobic fungi that rarely cause disease in humans. Infection with Acremonium has recently been described in immunocompromised patients. We describe the first case of fungal maxillary sinusitis caused by Acremonium in an immunocompetent person. Clinically and radiologically, the initial diagnosis was aspergillosis. Acremonium must be considered together with aspergillosis in all situations of fungus ball chronic sinusitis.

Glioblastoma multiforme mimicking a frontal abscess after surgery for a large vestibular schwannoma.

OBJECTIVES: Routine vestibular schwannoma surgery can result in serious and potentially lethal infectious complications. A high degree of vigilance is necessary to diagnose these uncommon infections and in case of postoperative neurological symptoms, brain magnetic resonance imaging should be performed to eliminate a brain abscess. In some cases, the final diagnosis is not the expected one. CLINICAL PRESENTATION: A 39-year-old man presented three months postoperatively after a vestibular schwannoma removal by translabyrinthin approach with a rapid and progressive history of headaches, confusion, and left hemi paresis with fever. The brain CT and MRI were in favour of a delayed postoperative frontal abscess. TECHNIQUE: A biopsy under stereotactic guidance was performed. Histopathologic examination revealed WHO grade 4 glioblastoma multiforme. CONCLUSION: Symptoms and signs of glioblastoma multiforme are congruent with brain abscess. Its rapid evolution, the normality of the first magnetic resonance imaging, and its radiological aspect made it a differential diagnosis of a postoperative brain abscess and should be systematically researched.

[Importance of a molding nasolabial flap in the reconstruction of mobile nose defects, a review of 25 cases]. / Intérêt du lambeau nasogénien (LNG) modelant dans la reconstruction des pertes de substances du nez mobile à propos de 25 cas.

INTRODUCTION: Mobile nose reconstruction, because of its location, its anatomy and its functional role is a surgical challenge. We describe throughout this article the surgical technique and the importance of the nasolabial flap in a single-step procedure for repairing mobile nose defects. MATERIALS AND METHODS: We present 25 cases of mobile nose defects secondary to an oncologic etiology, affecting the supratip, the alar margin and the columella. Patients benefited from a superiorly pedicled molding nasolabial flap harvested in a one-step procedure under local anesthesia. RESULT: Aesthetic result of each repair was evaluated according to 5 criteria and was considered as very satisfactory by the surgeons. No complication such as necrosis or infection was recorded. DISCUSSION: A molding nasolabial flap allows optimum repair of the mobile nose. It represents reliability, elasticity at the price of minimal scarring. We find it an important tool in the therapeutic armamentarium in patients with tissue loss in mobile nose.

Twenty-four hours in the life of Zingel asper.

For the first time, radio-tracking observations were made over 24 h cycles during the growing season to quantify the habitat use and home range of Zingel asper, a critically endangered fish species, endemic to the Rhône River with a high risk of extinction (IUCN). New advances in radio telemetry with regard to the size of tags provided an opportunity to collect behavioural and habitat use information while remaining non-lethal. Zingel asper was characterized by small ranges of habitat use and, contrary to previous assumptions, the species was diurnal as illustrated by a smaller home range during the night than during daytime.