Head and neck lymphatic malformation and treatment: Clinical study of 23 cases.

OBJECTIVES: Head and neck lymphatic malformation is a rare benign tumor, mainly affecting children under 1 year of age. Total resection is often difficult, and recurrence is frequent. Functional and esthetic sequelae are a major issue. MATERIALS AND METHODS: A single-center retrospective study recruited patients with head and neck lymphatic malformation managed surgically, with or without associated sclerosis by alcohol, bleomycin or aetoxisclerol, between January 1, 2004 and December 31, 2013. Local control, recurrence and complications rates were analyzed, as were swallowing disorder, tracheostomy and impaired phonation. RESULTS: Twenty-three patients, with a mean age of 15.80 years, were included. Location was suprahyoid in 17 cases (73.91%) and infrahyoid in 6 (26.09%). There were 11 macrocysts (47.82%), 2 microcysts (8.70%) and 10 mixed lesions (43.48%). Three patients showed spontaneous resolution; 12 patients (52.17%) underwent a single surgical procedure, 2 (8.7%) multiple procedures, 2 (8.7%) 1 surgical procedure and 1 sclerosis, 2 (8.7%) 1 surgical procedure and multiple scleroses, and 2 (8.7%) multiple procedures and multiple scleroses. The local control rate was 69.56%. There were 8 recurrences (34.78%), all in suprahyoid microcystic or mixed lesions. There were 2 complications (8.7%): 1 severe upper cervical edema following sclerosis of the floor of the mouth, and 1 postsurgical palsy of the marginal mandibular branch of the facial nerve. In 1 case (4.35%), a nasogastric tube was required for 6 days, without tracheostomy. CONCLUSION: Recurrence was frequent, with non-negligible functional and esthetic impact, especially in case of suprahyoid and microcystic lesion.

[Nasal tumours of the threshold and vestibule]. / Les tumeurs du seuil et du vestibule narinaire.

The nasal vestibule tumors are not very frequent. The pronostic can be severe if the first treatment is not effective. The authors present a personnal nine pateints' serie. They point out the clinical aspect, the evolutivity of these tumors and more specially the local extension which can produce recurrencies. The differents aspects of the treatment are analysed and more specially the surgical reconstruction procedures. reconstruction.

[A new look on septoplasties: an anatomo-clinical study and surgical procedures of the 4 main septoplasties]. / Les septoplasties revisitées: étude anatomo-clinique et technique chirurgicale des 4 principales septoplasties.

The aim of a nasal septum surgery is functional and aesthetic aims. With a semiologic study the authors analyse four kinds of septoplasties which allows to correct the main septal deviations: erndoscopic septoplasty for posterior nasal obstruction, Cottle's septoplasty for septum's luxation and deviation on the premaxilla area, septoplasty with spreader grafts for dorsum cartilage deviations, extracorporeal septoplasty with a new septum cartilage frame for the complex deviations. The authors emphasize on the help given by videoendoscopy during the surgical procedures.

Bilateral paranasal sinus mucopyoceles in a child with cystic fibrosis.

Mucoceles of the paranasal sinuses are well-described complication of chronic sinusitis in adults. They are extremely rare in children and the main predisposing factor is cystic fibrosis (CF). We report a case of bilateral ethmoid and maxillary sinus mucopyoceles, associated with CF occurring in a six months old boy. The main symptom was a complete nasal obstruction. The marsupialization of mucocele was performed by endoscopic surgery. One year follow-up showed no recurrence.

[Induction chemotherapy and laryngeal preservation in pharyngolaryngeal carcinomas. Study of a 124 serie's patients and patient's follow up with laryngeal preservation]. / Chimiothérapie d'induction et préservation laryngée dans les cancers du pharyngolarynx. Etude d'une série de 124 patients et suivi des patients en préservation laryngée.

OBJECTIVE: To try and determine the value of chemotherapy and its subsequent effect on laryngeal preservation in patients presenting with laryngeal and pharyngeal carcinomas. One group was initially treated with surgery and radiotherapy. The second group was treated with chemotherapy and subsequent salvage surgery and/or radiotherapy. Their survival rates and laryngeal preservation rates were compared. PATIENTS AND METHODS: From 251 patients the authors have retrospectively studied 124 patients with induction chemotherapy. The survival rate has been compared with a control group of 127 patients who was treated by initial surgery and radiotherapy. RESULTS: The survival rate at 5 years for the patients initially treated by surgery and radiotherapy was 64.1%. The survival for patients with a total clinical response following chemotherapy was 49.8% at 5 years. Survival with no total clinical response following chemotherapy treated by secondary radiotherapy was 25.7% at 3 years. The initial rate of laryngeal preservation is 32.2% but this rate fell to 22% after local recurrencies. CONCLUSION: The group with total clinical response after induction chemotherapy with laryngeal preservation have a non significantly difference in their survival compared with the group initially treated by surgery and radiotherapy. In contrary patients with non complete clinical response have a survival of 25.7% at 3 years. The rate of local recurrency of patients with laryngeal preservation is 32.5% and gives a finally rate of laryngeal preservation of 21%. These recurrencies decrease the survival rate.

[Adult laryngeal cavernous hemangioma: a case report]. / Malformation veineuse laryngée de l'adulte: à propos d'un cas.

We describe a case of laryngeal venous malformation, discovered by dysphonia. This malformation has a different histology and evolution compared to infant laryngeal hemangioma. The histological exam shows large and multiple vessels lined by regular endothelium. There is no spontaneous regression; this malformation can be stable or increase and induce a laryngeal obstruction. Although inconstant, a bluish colour, seen at endoscopy, suggests the presence of venous malformation. The diagnostic is confirmed by MRI, which shows local extension. We propose regular clinical and radiological supervision for asymptomatic venous malformations. Treatment is recommended only for symptomatic patients usually by laryngeal microsurgery or cervicotomy. Per cutaneous sclerosis is an interesting alternative therapy alone or prior to surgery. Regular follow-up is essential in order to detect frequent recurrences.

[Lymph node metastasis of cutaneous epidermoid carcinomas of the head and neck: prognostic factors and therapeutic strategies. Apropos of a series of 13 cases]. / Métastases ganglionnaires des carcinomes épidermoïdes cutanés cervico-faciaux. Facteurs pronostiques et modalités thérapeutiques. A propos d'une série de 13 cas.

UNLABELLED: Squamous cell skin carcinoma has a relatively low rate of metastasis (0.5 to 16%), but the prognosis of these metastases is poor (22% of survival at 5 years). PATIENTS AND METHODS: from a series of 243 patients, we studied 13 patients who were found initially to have metastases or who developed metastases later. Fifty-four percent (54%) of the patients presented initially with regional lymph node and parotid involvement in 54%. RESULTS: All patients underwent surgery with removal of the skin cancer and a neck dissection. Radiotherapy was performed later in 92% of the cases. The 2 years survival rate was 62% and mean survival by Kaplan Meier curve was 47 months. DISCUSSION: Poor criteria of these cutaneous tumors are defined: tumor size, histologic differentiation, perineural spread. Patients with severe criteria must have a neck dissection to control the first lymph node. Along the anatomic area of the cutaneous tumor, a parotidectomy, a submaxillary control or a neck dissection will be performed. Its involvement will be followed by a neck dissection. A comparative study of the literature is made. Poor prognostic criteria of these cutaneous tumors are defined, in addition to the initial management of the cervical and parotid lymph nodes.

Reliability and validity of the Turkish version of the Hamilton Depression Rating Scale.

The aim of the study was to examine the reliability and validity of the Turkish version of the Hamilton Depression Rating Scale (HDRS). Ninety-four patients with major depression/depressive mood disorders and 40 healthy controls participated in the study. The severity of depression was assessed with the HDRS, Beck Depression Inventory (BDI), and Clinical Global Impression score (CGI). The test-retest reliability coefficient of the HDRS was based on a 5-day interval was.85, with a Cronbach alpha coefficient of.75 and a split-half reliability coefficient of.76. Interrater reliability coefficients based on the independent ratings of four assessors were between.87 and.98. The correlation between the HDRS and BDI scores was.48, and between the HDRS and CGI it was.56. Principal Components Analysis yielded six factors. The correlation (-.13) between the control and patient groups indicates that the HDRS assesses depression very well.

[Adenoid cystic carcinomas invading the skull base. Apropos of 4 cases and review of the literature]. / Carcinomes adénoïdes kystiques envahissant la base du crâne. A propos de 4 observations et revue de la littérature.

Head and neck adenoid cystic carcinomas may invade the adjacent skull base by bone lysis and/or by perinervous and perivascular spread within the skull base foramina. Neurosurgical decision making is not well defined regarding the extent of intracranial tumor component removal, as neurosurgical expertise is limited for this peculiar type of tumors. The issue is to decide whether a radical supposedly locally curative surgery should be attempted, or if a large non disfigurating surgery is mandatory, keeping in mind the frequency of local recurrences and of distant metastases. Over a 13-year period, four adenoid cystic carcinomas invading the skull base were operated on at our institution: two tumors originated in the parotid gland, one in the sphenoid sinus, and one in the ethmoid sinus. Surgical removal was total in one case, subtotal in three cases. Post-operative irradiation was delivered in the four patients (two neutron irradiation, two conventional). One patient with advanced metastatic disease was submitted to chemotherapy. Three patients died from local tumor progression and distant metastases within three years after the intracranial tumor extension has been diagnosed. The patient with an ethmoid tumor is still alive seven years after surgery without any evidence of local tumor progression nor distant metastases. Surgery remains the gold standard treatment for adenoid cystic carcinomas invading the skull base. However, in our opinion a large tumor removal, without or with bone osteotomies, but without sacrifice of cranial nerves, cavernous sinus, internal carotid artery, and of the orbit allows patient survival with an acceptable comfort and absence of psychological distress due to disfigurating surgery nor surgically induced neurological functional deficit. Post-operative irradiation may sometimes stabilize locally the lesions. The place of chemotherapy has, yet, to be determined.

The validity of diagnosis of melancholic depression according to different diagnostic systems.

BACKGROUND: Melancholic versus nonmelancholic depression dichotomy is perhaps the most widely accepted distinction in categorization of depression. This research aims to compare RDC, DSM-III, DSM-III-R, DSM-IV and ICD-10 melancholic/endogenous/somatic and nomelancholic/nonendogenous/nonsomatic depressive patients with regards to biological variables thyroid stimulating hormone (TSH), basal and post dexamethasone cortisol levels, age, age of onset of depression, psychosocial stressors, and severity of depression. METHODS: Sixty-five patients who had been diagnosed as having major depression according to DSM III-R, using SCID were included in this study. Patients were divided into melancholic and nonmelancholic subtypes using RDC, DSM-III, DSM III-R, DSM-IV and ICD-10 criteria and groups were compared on the basis of biological variables, as well as age, psychosocial stressors and the severity of depression. RESULTS: RDC endogenous depressives were older, more severely depressed and had higher cortisol levels then RDC nonendogenous depressives. DSM III-R melancholics were older, more severely depressed, reported fewer numbers of psychosocial stressors and had lower levels of TSH than nonmelancholics. DSM-IV melancholics were more severely depressed, had higher basal and post dexamethasone cortisol levels and lower TSH levels. The ICD 10 somatic depression group contained more severe, older depressives with lower TSH levels. CONCLUSION: The results of this research show that different criteria may identify different groups of patients as having melancholic depression. They also partly support the hypothesis that endogenous or melancholic depression have a biological basis. LIMITATIONS OF STUDY: The study involved a relatively small sample size from a single centre and the results are based on this relatively small sample.

[Closure of esotracheal fistula after phonation implants. Technique and results of tracheal ascension]. / Fermeture des fistules oesotrachéales après pose d'implant phonatoire. Technique et résultat de l'ascension trachéale.

Enlarging tracheoesophageal fistula after tracheoesophageal prosthesis for voice rehabilitation remains a major challenge. The authors analyze the results of treatment of 15 severe enlarging tracheoesophageal fistulas among 28 cases (52%) of tracheoesophageal voice rehabilitation which occurred during a 4 years period of time. Among these 15 cases, a spontaneous closure occurred in 3 cases (20%), a two layers closure was performed in 4 cases (26%) and a closure using a tracheal ascension associated with the design of a new tracheostoma was performed on 8 cases (53%). The authors describe the surgical technique and discussed the advantages of surch technique.

["Conservative" transmandibular buccopharyngectomy]. / La bucco-pharyngectomie trans-mandibulaire "conservatrice".

Tumors of the amygdaline region were up until now most often treated by transmandibular buccopharyngectomy (TMBP) with a systematic sacrifice of the mandibular angle. This exercise justified by wide carcinological imperatives, a larger surgical facility and simple immediate postoperative follow-up, in fact systematically shows a substantial esthetic and functional prejudice. This principle was reinforced by the occurrence of osteitis during the first attempts of osseous reconstruction using steel wires opposite the mandibular angle (Dargent, Charachon, 1963). In 1989, Gehanno and Beauvillain published a mandibular conservation technique by vertical paramedian osteotomy, right in front of the mental nerve, shifted from the future field of radiation, with osteosynthesis by titanium plates. This technique appeals to us because it is easy to use, reliable and carcinologically safe. We have currently adopted it with satisfaction for 8 of our patients over an 18-month period, without any case of osteitis and with both good esthetic and functional results.

[Sarcoidosis of the ethmoid sinus. Apropos of a case]. / Ethmoïdite sarcoïdosique. A propos d'un cas.

We report the case of a 78 year old man with unilateral persistent headache and associated bilateral kerato-conjunctivitis and minor skin lesions. Chronic ethmoiditis was diagnosed on a CT scan, and endoscopically controlled endonasal ethmoidal biopsy gave the diagnosis of sarcoid and hence the treatment. A nodular type isolated pulmonary lesion, atypical for sarcoidosis, also disappeared on steroid therapy. A review of the literature showed this to be an exceptionally rare form of the disease.

[Septal deposition in difficult rhinoseptoplasties. Surgical techniques. Experience. Results]. / La dépose septale dans les rhinoseptoplasties difficiles. Techniques chirurgicales--Expérience--Résultats.

The authors describe their septoplasty technique of performing an extramucosal dissection with excision, revision and replacement of the cartilaginous septum during difficult rhinoplasties. They analyse the main septal deformations which may benefit from this technique and the functional and esthetic results.

[Naso-orbito-cerebral mucormycosis. A more & more common disease]. / Mucormycose naso orbito cérébrale. Une maladie de moins en moins exceptionnelle.

A typical case of naso-orbital-cerebral mucormycosis is described. This rare but serious disease mainly occurs in fragile patients, notably diabetics or those undergoing an immunosuppressant treatment. The cases recorded are therefore increasingly frequent. Mucorales, normally saprophytic, germinate in the nasal cavities due to an infection and then colonize the sinuses, the orbit, followed by the meninges. The diagnosis must be made before meningeal impairment when faced with a peri-orbital edema, the beginning of exophtalmy or oculomotor paralysis in high-risk patients with sinusal opacity. The diagnosis is based on the histology and the mucology which must be directed by the clinician: indeed, the histology of the naso-sinusal mucosa samples must be performed using special stains. The mycological samples must also be taken from special environments. Once the diagnosis is confirmed, the required treatment with high doses of intravenous Amphotericine B must be administered immediately, otherwise the evolution is fatal.

[New prospects in the treatment of vertigo]. / Nouvelles perspectives dans le traitement des vertiges.

Vertigo results from sensory conflicts that are usually intralabyrinthine or between two labyrinths. Symptomatic treatments rests on the reduction of these conflicts by vestibuloplegic drugs. However, this treatment should not last for more than 48 or 72 hours since in established vestibular lesions central compensation demands that the centres be informed. The use of sedative drugs in vertigo, therefore, should be reduced, and vestibular rehabilitation is recommended in most cases. Only Meniere's disease escapes this rule, being a self-limited process.

[Lateral musculocutaneous flap of the trapezius muscle. Anatomic study of the venous drainage]. / Lambeau musculo-cutané latéral du muscle trapèze. Etude anatomique du drainage veineux.

A right and left comparative study of the venous drainage of the lateral trapezius muscle musculocutaneous flap was performed on 16 cadavers. The variability of this drainage explains the precautions required in the use of this flap.

[Giant cell tumor of the temporal bone. Clinical study of a case. Histologic and therapeutic remarks]. / Tumeur a myéloplaxes de l'os temporal. Etude clinique d'une observation commentaires histologiques et thérapeutiques.

A case of giant cell tumor of the temporal bone is reported. The surgical difficulties encountered in this case are presented and therapeutic modalities for this tumor, consisting of radical surgery and post operatoire radiotherapy, one defined and discussed. Comments are made concerning this rare tumor location, its occurrence in young adults, and difficulties in establishing a histologic diagnosis.

[Repair of deglutition troubles after partial surgery of the pharyngolarynx with injection of collage. Apropos of 9 cases]. / Correction des troubles de déglutition après chirurgie partielle du pharyngo-larynx par injection de collagène. Etude de 9 cas.

The authors report their experience treating nine patients with swallowing disorders following partial surgery of the laryngo-pharynx. GAX collagen (Phonagel), resistant to collagenase was injected into the laryngeal structures to protect the trachea, yielding a satisfactory long term result. A description of the injection technique is given particularly with functional reconstructive laryngectomies and hemipharyngolaryngectomies. The results concerning functional improvement and weight gain are evaluated over a five month period.