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.

Sclerosing polycystic adenosis of the parotid gland: diagnosis and management.

OBJECTIVE: To describe diagnostic and therapeutic management of a rare parotid lesion: sclerosing polycystic adenosis. PATIENT AND METHOD: We report a case of persistent right intraparotid tumefaction. RESULTS: A 68-year-old man was referred with a right parotid nodule of 2 years' evolution. Cytology diagnosed pleomorphic adenoma, verified on MRI. Conservative subtotal parotidectomy diagnosed sclerosing polycystic adenosis. Over 1 year's regular follow-up, there were no signs of local recurrence. CONCLUSION: Sclerosing polycystic adenosis of the parotid gland is a rare and recently described entity presenting several analogies to the much more frequent cystic mastitis. Although benign and well-delimited, it requires complete exeresis of the parotid, due to a non-negligible risk of recurrence.

Supraglottic laryngeal paraganglioma.

INTRODUCTION: Laryngeal paraganglioma is a rare, mainly supraglottic, tumor. CLINICAL CASE: A 67-year-old woman was operated on in June 2009 for supraglottic laryngeal paraganglioma, with simple postoperative course. DISCUSSION: Anatomopathologic features, malignant paraganglioma and the various possible treatments are presented and discussed. Surgical exeresis with an external approach should in our opinion remain the reference treatment, for optimal control of exeresis of this potentially hemorrhagic tumor with risk of recurrence in case of incomplete exeresis.

[Comparison between external radiotherapy and laser microsurgery for the treatment of TisT1N0 glottic carcinoma: Clinical modelling and cost-minimization study from the French national health insurance payer's point of view]. / Place de l'analyse médico-économique dans la décision thérapeutique en cancérologie ORL. L'exemple du cancer limité de la corde vocale (Tis, Tla). Comparaison entre la radiothérapie externe et l'exérèse laryngoscopique laser CO2. Création d'un modèle clinique et étude de minimisation de coûts suivant la perspective de l'Assurance Maladie.

OBJECTIVES: The excellent effectiveness of both treatment modalities (radiotherapy, endoscopic laser surgery) for early glottic carcinoma (Tis, TlaN0) is similar (carcinologic, functional and QoL results). This is part of an evidence-based medicine policy, which is to choose the cheapest of various treatment modalities known as equally effective and equally morbid. Is analytical economic approach useful and efficient to guide decision making? The aim of this study is to perform a costminimization analysis using an objective clinical modeling. MATERIAL AND METHODS: For each modality, probabilities of various events were recorded from review of literature. Only local recurrences which constitute the major end-point affecting survival were considered. French national Health insurance's point of view (as the payer's point of view), with a 100% case-mix based payment system was used. Results of cost-minimization between laser endoscopic surgery and external radiation therapy are: Global Cost of laser endoscopic surgery is about 2613.01 euro. Without (90% of cases) and with recurrence it is about 1700.36 euro and 10826.87 euro respectively. Global Cost of external radiation therapy is about 4490.88 euro. Without (90% of cases) and with recurrence it is about 3578.23 euro and 12704.74 euro respectively. CONCLUSION: Cordectomy by CO2 laser seems to be an efficient cost-effective alternative to radiotherapy for early glottic carcinoma management from the French national Health insurance perspective.

[Endostenting using a Y-stent for hematoma after thoracic aorta surgery]. / Endostenting par prothèse en Y sur hématome après chirurgie de l'aorte thoracique.

OBJECTIVE: To describe the diagnostic and therapeutic management of extrinsic tracheobronchial compression after thoracic aorta surgery. PATIENT AND METHODS: We report the case of a female patient with Marfan syndrome. RESULTS: A 27-year-old woman with Marfan syndrome presented respiratory distress after type III dissecting aneurysm of the descending aorta from extrinsic compression (hematoma) of the lower third of the trachea and the left bronchial stump. We placed a Y-stent (Y-Tracheobronxane, Novatech SA, France), thus restoring a satisfactory channel. A few days later, the patient developed right congestive heart failure from compression of the left pulmonary artery secondary to the progression of the hematoma. Medical treatment for this cardiological complication and the progressive resorption of the hematoma made it possible to remove the stent after 21 days with no dyspneic recurrence. CONCLUSION: Placing a Y-stent is possible and effective and has few iatrogenic consequences in cases of extrinsic tracheobronchial compression from a hematoma occurring during heavy thoracic vascular surgery. With surgical revision impossible given the risks, stent placement allows progressive resorption of the hematoma, thus ending the compression of the bronchial tree.

[Inflammatory pseudotumor of the larynx in children]. / Tumeur pseudo-inflammatoire du larynx chez l'enfant.

OBJECTIVE: Describe the management of laryngeal pseudotumor in a young boy with exclusive endoscopic resection with laser CO2 resection. MATERIAL AND METHOD: Case report. RESULTS: We report a rare case of a laryngeal pseudotumor in a child that was successfully treated with endoscopic resection with laser CO2 vaporization. The last follow-up at 12 months revealed no evidence of recurrence and no voice sequelae. This is the first case reported that was successfully treated after a single procedure. It is the second one where tracheotomy was avoided. CONCLUSION: Endoscopic resection with laser CO2 vaporization is a safe and effective treatment in cases of limited laryngeal inflammatory pseudotumor in a pediatric population, but close follow-up is necessary because of the risk of local recurrence.

[Bilateral hypopharyngocele]. / Hypopharyngocèle bilatérale.

OBJECTIVE: Describe the management of bilateral hypopharyngocele in a trumpet player. MATERIAL AND METHOD: Case report of a professional trumpet player suffering from bilateral hypopharyngocele. RESULTS: A professional trumpet player was referred for an ORL consultation after he noticed that a bad sound was produced while he was playing associated with cervical pain. A CT scan demonstrated an asymmetric bilateral hypopharyngocele with no other abnormality. Because of the mild symptoms and the professional context, a successful conservative approach was used with antireflux medications. He was advised to seek professional instruction in order to improve his technique. On follow-up examination 6 months later, he had had no further problems since adopting the corrected techniques. CONCLUSION: Pharyngoceles are rare and easily misdiagnosed. Because of the mild symptoms and the professional context, a conservative medical approach should be proposed (antireflux medications) combined with specific orthophonic and physical therapy to modify breathing and trumpet playing techniques.

Identification of transcripts overexpressed during airway epithelium differentiation.

Human airway epithelium, the defence at the forefront of protecting the respiratory tract, evacuates inhaled particles by a permanent beating of epithelial cell cilia. When deficient, this organelle causes primary ciliary dyskinesia, and, despite numerous studies, data regarding ciliated cell gene expression remain incomplete. The aim of the present study was to identify genes specifically expressed in human ciliated respiratory cells via transcriptional analysis. The transcriptome of dedifferentiated epithelial cells was subtracted from that of fully redifferentiated cells using complementary DNA representational difference analysis. In order to validate the results, gene overexpression in ciliated cells was confirmed by real-time PCR, and by comparing the present list of genes overexpressed in ciliated cells to lists obtained in previous studies. A total of 53 known and 12 unknown genes overexpressed in ciliated cells were identified. The majority (66%) of known genes had never previously been reported as being involved in ciliogenesis, and the unknown genes represent hypothetical novel transcript isoforms or new genes not yet reported in databases. Finally, several genes identified here were located in genomic regions involved in primary ciliary dyskinesia by linkage analysis. In conclusion, the present study revealed sequences of new cilia-related genes, new transcript isoforms and novel genes which should be further characterised to aid understanding of their function(s) and their probable disorder-related involvement.

[Misplacement of a central femoral catheter in the urinary conduit of a renal transplant]. / Migration extravasculaire d'un cathéter veineux fémoral dans les cavités excrétrices d'un rein transplanté.

Femoral vein catheterization is often carried out during resuscitation and in critical care units. Thrombosis and infections are the most current reported complications. Catheter malpositions have been reported. We described the inadvertent cannulation of the urinary tractus in a patient with a right iliac renal transplant.

Thyroid alar cartilage graft in paediatric laryngotracheal reconstruction.

OBJECTIVE: To evaluate the potential indications of thyroid alar cartilage (TAC) graft in the paediatric laryngotracheal reconstruction (LTR) population based on observations obtained in a case series of 27 consecutive infants referred to our tertiary care center. METHODS: Thyroid alar cartilage grafting was performed for limited Myer grade II and grade III subglottic stenosis requiring a single-stage laryngoplasty and for laryngeal enlargement after translaryngotracheal resection of endolaryngeal tumors. The evolution of the grafted area was evaluated prospectively during endoscopic follow-up. RESULTS: Twenty-five patients (92.5%) were successfully extubated after a mean of 5.1 days. No perioperative or postoperative complications were observed. The mean duration of graft harvesting was 7.7 min. Follow-up of the grafted area revealed one case of partial necrosis without prolapse into the lumen. The mean duration of graft epithelialization was 18.1 days (range: 12-30 days). Development of granulation tissue was observed in eight patients (32%) with a mean duration of granulation tissue persistence of 61.5 days (range: 7-155 days). Endoscopic follow-up did not demonstrate any pharyngolaryngeal asymmetry or feeding difficulties. CONCLUSION: This study demonstrated that the use of thyroid alar cartilage grafting is feasible for pediatric laryngotracheal reconstruction. The indications of thyroid alar cartilage graft should be reserved for moderated subglottic stenosis. The use of TAC reduced the operative time and cosmetic sequelae significantly. The healing of the grafted area was similar to those obtained with other types of graft. The TAC removal did not induce laryngeal deformation but longer follow-up is necessary to confirm this.

Changes in the edentate mandible in the elderly.

Resorption of alveolar bone is the best recognized feature of mandibular aging in the edentate subject. The other consequences of the loss of teeth in the elderly are less well known. An anthropometric study of the mandible by antero-posterior and lateral radiographs of subjects older than 70 years both dentate and edentate but without any maxillo-mandibular dysmorphosis has been done to demonstrate the differences, which exist between the dentate and edentate mandible. The edentate mandibles showed a diminution in the height of the symphysis and increase in the height of the mandibular incisure. A diminution in the height of the body and an increase in the gonial angle in the significant manner. No significant difference was seen for the height of the ramus and the length of the mandible, the minimum width of the ramus and the bigonial width. The diminution in the height of the mandibular symphysis and of the body is explained by the resorption of the alveoli part of the mandible. The increase in the mandibular angle and the diminution in the height of the mandibular incisure may be explained by disequilibrium between the elevator and depressor muscles of the mandible, as a function of the elevator muscles or by the absence of the molar buttress.

[Perioperative evolution of the nutritional status in head and neck surgical patients. Prospective and descriptive case series]. / Evolution périopératoire du statut nutritionnel en chirurgie carcinologique des voies aérodigestives supérieures. Etude prospective et descriptive.

AIM OF THE STUDY: To assess the perioperative evolution of the nutritional status of head and neck surgical patients. DESIGN: Prospective, descriptive case series. PATIENTS AND METHODS: Fifty-four patients candidates for total or partial laryngectomy for malignancy of the neck tract without a past of neck surgery. The nutritional status of all patients hospitalized for total pharyngolaryngectomy, total or partial laryngectomy was assessed by 1) clinical parameters including weight (W), weight variation (WV, percentage of loss), Body Mass Index (BMI), triceps skin fold measurement (T), midarm circumference (M), and 2) biological parameters such as serum albumin (SA), transthyretin (TTR), lymphocytes (Ly). These parameters were noted at the time of diagnostic laryngoscopy (T1), the day before surgery (T2), and 10 days afterward (T3) when patients were authorized to eat normally. All patients had enteral nutrition (EN) support (35 kcal/kg/day) starting at D1 and for 10 days afterward. Only complete data per patient were analyzed. RESULTS: 24 patients were excluded. During the 21 days [7-53] preoperative period (T1-T2), WV was (6.6% [-8,1-+20.0] [T2] vs. 4.7% [-12,9-+20.0] [T1], p<0.05) without difference in T and M. In the postoperative period (T2-T3), all parameters worsened, except T, with: WV (8.2% [-8,1-+20.0] [T3], p<0.05 vs T2), M (27.4 cm [20.0-37.0] [T3] vs 28.3 cm [20.5-39.0] [T2], p<0.05) et TTR (0.21 mg/l [0.09-0.36] [T3] vs. 0.27 mg/l [0.08-0.45] [T2], p<0.05). BMI was 22.9 [15.2-36.7] (T1) vs 22.9 [15.2-35.3] (T2), NS and 22.1 [15.0-34.9] (T3), p<0.05 vs (T2). CONCLUSION: The nutritional status in malignancy head and neck surgical patients seems to be best assessed by loss weight. It worsened mainly during the postoperative period even if a well-conducted EN was performed as defined by the French consensus conference.

[Severe laryngomalacia: surgical indications and results in 33 patients]. / Prise en charge chirurgicale des laryngomalacies sévères. Une série de 33 cas.

INTRODUCTION: Laryngomalacia is the most common course of stridor in children: with a 50% to 75% incidence. About 50% to 60% of congenital laryngeal anomalies that present with stridor are due to laryngomalacia. In most cases, the disease followed a benign course but the prognosis is less favorable in 10% to 15% of cases. These patients may require surgical intervention. MATERIALS AND METHODS: This prospective study included 33 patients referred to our institution from May 1998 to May 2003 for severe laryngomalacia. The diagnosis of severe laryngomalacia was based on clinical and if necessary paraclinical data. An endoscopic laser resection of arytenoid mucosal excess associated if necessary with suprahyoid epiglottectomy was performed in all patients. RESULTS: Mean age of the children was 7.5 Months (range, 2 weeks-4 Years). Ninety-six percent of the patients had complete resolution of symptoms before the fourth postoperative week. Ninety one percents of the patients had effective oral feeding within the first Month (48% immediately after surgery). The average hospital stay was 6 days (range, 3 to 14). Weight gains were found to be satisfactory in all cases since children were discharged the hospital. CONCLUSION: Endoscopic laryngeal surgery is an appropriate therapy for treatment of severe forms of laryngomalacia. It is a safe and effective surgical procedure.

Congenital pharyngolaryngeal band: report of an unusual case of respiratory distress.

Congenital pharyngolaryngeal band (PLB) is an extremely rare congenital abnormality, characterized by a fibrous web extending from the nasopharynx to the epiglottis. We report a case of unilateral pharyngolaryngeal band in a new-born who presented severe airway obstruction and feeding difficulties. The band extended from the right postero-inferior part of the nasopharynx to the right lateral margin of the larynx. Faucial pillars and tonsil were absent on this side. Endoscopic and radiological assessments excluded associated cervicofacial abnormality. Two endoscopic laser resection procedures were necessary to liberate the larynx from PLB. Clinical and radiological assessment advocated a second pharyngeal pouch development failure as the origin to PLB.

[Zenker's diverticulum in the elderly patient: evolution of endoscopic treatment using a CO2 laser]. / Le diverticule de Zenker chez le sujet âgé: évolution du traitement endoscopique au laser CO2.

OBJECTIVES: The authors report their experience in a retrospective study of 28 patients with symptomatic hypopharyngeal diverticulum. MATERIAL AND METHOD: The mean age was 70 years. Eight patients presented with severe dysphagia and nine with weight's loss. The delay before diagnosis was 17 months. All patients included were studied by an oesophageal barium swallow prior to any treatment. According to Van Overbeeck's classification, diverticula were medium sized in 11 patients, small in 8 and large in 7. All patients had endoscopic assessment of the diverticular pouch; 26 patients were treated by microendoscopic laser myotomy and 2 by resection. RESULTS: The average time for oral feeding was 4 days. None of the 28 cases had a postoperative complication. 25 patients had partial or complete relief of symptoms after their initial treatment. In 3 cases recurrence of symptoms occurred, of whom 2 underwent endoscopic revision and 1 underwent an open procedure. CONCLUSION: Endoscopic laser surgery for Zenker's diverticulum can be recommended as the treatment of choice for elderly patients. It is a useful procedure because it is swift, effective with a low rate of morbidity, even in cases with impaired of health or associated diseases.

[Endonasal plasmocytoma: diagnosis and management]. / Diagnostic et prise en charge du plasmocytome endonasal: à propos d'un cas.

UNLABELLED: Plasmocytomas are either medullary (disseminated form) or extramedullary with or without bone infiltration (located form). Plasmocytoma is not a common tumor but extramedullary forms mostly occur in the upper respiratory tract without specific manifestations. OBJECTIVE: The aim of this study is to discuss the management (diagnostic and therapeutic) and the follow-up of extramedullary nasal plasmocytoma. MATERIAL AND METHODS: We report a case of a 71-year-old patient with unilateral nasal obstruction manifestation. RESULTS: Endonasal biopsy concluded plasma cell tumor without extension on CT scan. Treatment consisted of external nasal surgery and radiotherapy. CONCLUSION: Diagnosis of solitary extramedullary plasmocytoma can only be confirmed when the presence of systemic disease is excluded by performing clinical, biological (marrow bone biopsy) and radiological investigations. The treatment should be based on surgery with complementary radiotherapy if there is a skull base erosion. Long term follow-up is necessary because of the high risk of diffuse marrow involvement (multiple myeloma) which may occur after a long delay.

[Sebaceous hamartoma of Jadasshon: trichoblastoma mimicking basal cell carcinoma?]. / Risques évolutifs de l'hamartome sébacé de Jadassohn.

The sebaceous hamartoma of Jadassohn is a congenital skin malformation usually appeared at birth or in early childhood. Many authors support the notion that early complete surgical excision is necessary to prevent the development of malignant neoplasms (especially basal cell carcinoma) after puberty. On the contrary, others in recent large series suggest that it is an histological misdiagnosis: the basal cell-carcinoma is in fact a trichoblastoma, basaloïd neoplasm, but non-malignant one. We have also asked anatomopathologist for proofreading slide previously described as basal cell carcinoma to research unknown trichoblastoma. During the period, 1982 to 1999, 80 sebaceous hamartoma of Jadassohn were excised and 19 basal cell carcinoma were found. The basal cell carcinoma diagnosis has been confirmed in two cases only. The others were pigmented trichoblastomas. So, trichoblastoma is the most common basaloïd tumor developed in sebaceous of hamartoma Jadassohn. Nevertheless, we should recommend surgical excision during the childhood because of best elasticity of tissue, especially on the scalp where it's mostly localized.