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.

[Interest of the cervical gland dissection after radiotherapy with or without chemotherapy]. / Intérêt du curage ganglionnaire cervical après radio +/- chimiothérapie.

OBJECTIVES: The aim of this study was to evaluate the necessity and morbidity of neck dissection after radiation therapy within organ preservation treatment. PATIENTS AND METHODS: We present a retrospective study of 64 patients, treated initially by radiotherapy with or without chemotherapy for squamous cell carcinoma of head and neck with cervical metastases (> 2 cm), who underwent post-radiation neck dissection between January 1992 and August 2000. Eight (13%) patients were classified T1, nineteen (30%) T2, twenty (31%) T3, eleven (17%) T4 and six (9%) Tx. Eleven patients had N1 neck disease (17%), fifteen patients N2a (24%), eleven patients N2b (17%) and twenty-seven patients N3 (42%). RESULTS: Follow-up ranged from 3 to 86 months with a mean of 39 months. The average length of time between neck dissection and the end of treatment was 60 days. Complications were recorded in 21 patients (33%). Forty-four (68%) of 64 patients had microscopic residual disease. Eight (72%) of 11 patients with N1 neck disease and 17 (63%) of 27 patients with N3 neck disease had pathology. Initial N status was not a predictive factor of microscopic residual disease (p = 0.51). There was no significant relationship between clinical residual adenopathy and microscopic residual disease (p = 0.53). Fourteen patients are still alive without recurrent disease. Eight (57%) of these 14 patients had a positive pathology at the time of neck dissection. The mean follow-up time of these patients is 32.6 months, with a follow up longer than 2 years for half of them (n = 7). CONCLUSION: Neck dissection after radiation was planned for all patients with an initial node > 2 cm in diameter regardless of clinical response in the neck. We confirm that neck dissection appears to be safe after radiotherapy and is necessary because it improves quality of life and prevents fatal evolution with uncontrollable neck disease.

[Adenoid cystic carcinoma of the head and neck: a review of 30 cases]. / Carcinomes adénoïdes kystiques de la tête et du cou. Etude rétrospective a propos de 30 cas.

OBJECTIVES: To evaluate treatment results and identify prognostics factors which determine local and regional treatment failure and crude survival in adenoid cystic tumours (ACT) in the head and neck. METHODS: A retrospective study (1984 to 2001) of 30 cases of adenoid cystic tumour. The mean age was 56.9 years, with a sex ratio female to male of 2:1. Tumours of all sites were encountered, most (26.7%) being in the nose and sinuses and major salivary glands (26.6%). Tumours at the T4 stage were found in 14 cases, mainly situated in the nose and sinuses (50%). No patient had cervical lymphadenopathy, while two patients (6.7%) had bony metastases at the time of diagnosis. Two patients (6.7%) were treated by surgery alone, for T1 and T2 tumours; four patients (13%) had radiotherapy alone, and 24 patients (80%) had surgery with post-operative radiotherapy with a mean dose of 60.3 Grays (56-65 Grays). RESULTS: Local recurrence occurred in 30.8% (nine cases) after a mean interval of 43 months (1 to 10 years). Treatment of these recurrences was by revision surgery in six cases, leading to local control in one case, but in a patient with pulmonary metastases. No cases of lymph node recurrence were observed. 30% of patients developed metastases; these were pulmonary in 44% and bony in 33.3%. Mean follow-up was five years. Crude survival at 3 years was 91%, at 5 years 86%, and at 10 years 50%. The percentage tumour-free survival was 70% at 3 years, and 57% at 5 years. 22 patients (73.3%) are still alive, 17 of them recurrence-free. Analysis of the prognostic factors has shown tumour to be more aggressive in the nose and sinuses when they presented at an advanced stage (T4); recurrence was more common when excision was incomplete, or if there was peri-neural spread. Tumours of "massive" histological type carried a poorer prognosis than those of cribrigorm type (60% death compared with 10%). The development of metastases is independent of local recurrence. Metastases to bone appear to be more rapidly aggressive than pulmonary metastases, which may remain asymptomatic for some time. CONCLUSION: Combined radiotherapy and surgery have allowed improved local control of ACT, but the therapeutic challenge remains the multiply recurrent ACT, or those with symptomatic metastases, and this despite new research techniques (neutral therapy, immuno-histochemistry, molecular biology). ACT are rare tumours, whose prognosis remains poor.

[Spontaneous cervical emphysema: a case report]. / Emphysème cervical spontané: à propos d'un cas.

Spontaneous cervical subcutaneous emphysema, without any aetiology found in the clinical history, is far less common than subcutaneous cervical emphysema following trauma, surgery, or infectious cervical processes. In this recent case report, the authors describe a young woman who developed a cervical subcutaneous emphysema. No responsible factor had been found. Radiological investigations revealed a pneumomediastinum, which is an uncommon but a serious complication of cervical emphysema. The CT-scan highlighted a rupture of the crico-thyroid membrane, from which the air had followed the fascial planes up to the neck and the mediastinum. The authors describe the treatment and clinical course. They put forward an embryological hypothesis regarding the spontaneous crico-thyroid membrane rupture. A congenital fragility of this area could exist which could explain its breach. The pathogenesis and management of spontaneous cervical emphysema are discussed in the light of diverses articles about this subject. The radiological or surgical explorations which may be used in this aetiological diagnosis and treatment are given.

[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.