Predictors of unanticipated admission within 30 days of outpatient sinonasal surgery.

OBJECTIVES: To identify predictive factors of readmission after day-case rhinologic surgery. METHODS: A 2-year retrospective chart review of patients scheduled for ambulatory sinonasal surgery in a tertiary medical center was conducted. The operating room and the anesthetic files were screened to identify demographic data, types of procedure, comorbidities and post-operative complications. RESULTS: From January 2014 to January 2016, 924 outpatient sinonasal procedures were identified. The overall readmission rate within the 30-postoperative days was 5.1% (2.9% for overnight hospital stay, 2.2% for unplanned post procedure visit to the hospital via the emergency room, or directly to the surgical unit within 30 days of discharge). Age at least 50 years, surgical duration at least 80 min, endoscopic sinus surgery procedures and postoperative nasal packing were identified as negative predictive factors of readmission. CONCLUSION: Careful scheduling of those higher-risk patients undergoing sinonasal surgery and appropriate postoperative observation should be implemented to improve healthcare quality in an outpatient setting.

Supracricoid laryngectomy with cricohyoidoepiglottopexy (CHEP) in the management of laryngeal carcinoma: oncologic results. A 35-year experience.

To evaluate the long-term oncologic results of supracricoid laryngectomy with cricohyoidoepiglottopexy (CHEP) for laryngeal cancer. A 35-year retrospective study concerning 291 patients treated by supracricoid laryngectomy with CHEP for laryngeal cancer was performed. The following postoperative data were studied: recurrence rates (lymph node and laryngeal), distant metastases and second cancer. The mortality rate and overall survival were estimated by the Kaplan-Meier method. The postoperative mortality was 1.03 %. 23 patients were lost to follow-up. The 3-year survival rate was 84 % and the 5-year survival rate was 80 %. 12 patients developed distant metastasis. 31 patients developed a second cancer. The local (laryngeal) control rate was 93.94 % and the regional (cervical lymph node) control rate was 92.05 %. In multivariate analysis, the occurrence of a second non-ENT cancer and metastasis as well as margins involvement were reliable to mortality. Supracricoid laryngectomy with CHEP appears to be associated with very good long-term oncologic results and still has a place in the management of T1, T2 and selected T3 glottic cancers.

Respiratory epithelial adenomatoid hamartomas of the sinonasal tract.

We report the clinicopathologic features of two cases of respiratory epithelial adenomatoid harmartoma (REAH) of the sinonasal tract. Hamartomas are rare in the nasal cavity. Histologically, these lesions were characterized by a glandular proliferation lined by ciliated respiratory epithelium originated from the surface epithelium. The two patients were evaluated by a gastroenterologist to assess intestine colocalization. The treatment was a complete surgical resection through limited approach. We should be aware of this entity as a differential diagnosis for inverted papilloma and well-differenciated adenocarcinoma. Fine histopathological analysis is necessary to avoid aggressive surgery for this benign lesion.

[Ossicular reconstruction with autograft in type III]. / La réparation ossiculaire par autogreffe en type III.

OBJECTIVE: The prostheses known as biocompatible are usually proposed for columellar repair in absence of stapes but at which cost and which long-term tolerance? It appeared useful to study the possibilities of autograft ossicular reconstruction (incus and cortical bone) in absence of suprastructure of the stapes. MATERIAL AND METHODS: Retrospective study for 82 operated patients for cholesteatoma with lysis of the cruras of the stapes. Columellar repair was obtained by prosthesis, columella of cortical mastoid bone, and more often autograft of incus (54 cases). The technique of Autogreffe Tympanum-Cartilage-Os-Platinum (ATCOP) (Autograft Tympanum-Cartilage-Bone-Footplate is described: tympanic repair by fascia and cartilage from the concha is made at the first surgical step. Type III ossiculoplasty is performed at the second look. The distance tympanum-footplate is then lower than 6 mm and the body of the incus, preserved as a spare ossicle in the mastoid, has a sufficient length to be interposed in between new drum and footplate. RESULTS: 78% of the patients have final air bone gap less or equal than 30 decibels. The average post op air bone gap is 23 decibels with incus while it was 42 decibels before surgery. Average gain is 19 decibels. The cost of autograft is null and tolerance is excellent. CONCLUSION: Patient's incus is usable in type III ossiculoplasty thanks to a cartilage graft of the tympanic membrane. Patient's ossicle is a material of choice for columellar repair even in absence of the suprastructure of the stapes. Prostheses in biomaterial appear justified in case of absent or destroyed incus.

[Parapharyngeal synovial sarcoma]. / Synovialosarcome parapharyngé.

A parapharyngeal biphasic synovial sarcoma arising in a 38-year-old man is reported. The rarity of this tumor in the head and neck and its multitude of histopathologic features are responsible for frequent initial misdiagnosis. The purpose of this report is to highlight the differential diagnosis with other cervical tumors.

[Labyrinthine fistulae and cholesteatoma]. / Fistules labyrinthiques et cholestéatome.

The case notes of 33 patients with labyrinthine fistulae have been studied; they have been found in 10% of cholesteatomas. The usual site is the lateral semicircular canal. Only 17 patients experienced vertigo, 2 had total deafness, and 14 others had a mixed deafness. Scanning with fine cuts in both the axial and coronal planes demonstrates the lesion definitively in 70% of cases, but the fistula may be discovered only at operation, either in the lateral semicircular canal, or especially at the level of the oval window (5 cases). The authors usually use the closed technique (26 cases), and always seek to remove the matrix in its entirety, followed by the use of bone powder to close the fistula. In 2 patients there was a loss of hearing on bone conduction at 4 and 8 KHz, and only one had total loss of hearing. No patients had vertigo persisting after 6 months. The indications and results are compared with those found in the literature. It now seems unusual to experience postoperative sensory-neural hearing loss provided that the presence of a fistula is recognised early on, and that the covering of squamous epithelium is removed completely atraumatically at the last part of the operation.