Chemotherapy alone in laryngeal squamous cell carcinoma.

AIMS: To evaluate the results of chemotherapy alone in patients with invasive squamous cell carcinoma of the larynx who have achieved a complete clinical response after an induction chemotherapy protocol. METHODS: A comparison of results in a group of complete responders managed with a chemotherapy alone protocol, matched with those of an incomplete responder group managed with conventional modalities. RESULTS: The survival rate of the complete responder group was significantly higher than that of the incomplete responder group. No statistically significant difference was noted between the two groups in terms of local failure and nodal recurrence. CONCLUSION: Our results confirm the fact that chemotherapy alone is a viable option in selected patients with carcinoma of the larynx who have achieved a complete clinical response after an induction chemotherapy protocol. This therapeutic approach allows surgery and/or radiation therapy to be reserved for the management of metachronous second primary tumours.

U-shaped free jejunal transplantation: improved technique and indications.

Reconstruction of the oropharynx and the hypopharynx is difficult due to their wide diameters. We report eight cases of circumferential pharyngolaryngectomies for epidermoid carcinomas of the hypopharynx extended to the oropharynx and classified T4. Reconstruction was performed with a U-shaped free jejunal transplantation. This specific technique consists of a side to side anastomosis between two loops of jejunum. It facilitates reconstruction at the level of the oropharynx and diminishes postoperative complications.

[Sebaceous carcinoma of the parotid gland]. / Carcinome sébacé de la parotide.

Sebaceous carcinoma is a rare tumor, from the adnexal epithélium of the sebaceous glands. Usually, lesions arise in meibonian glands of the eyelid. However, extraocular lesions within head and neck have been reported. We report a case of recurrent sebaceous carcinoma of the parotid gland without metastases.

[U-shaped free jejunum transplant]. / Le transplant libre de jéjunum en U.

Reconstruction of the oro and hypopharynx has specific difficulties due to their wide diameters. Seven patients underwent reconstruction with a free U-shaped jejunal transplant, after circular pharyngolaryngectomy for hypopharyngeal cancer invading the oropharynx. This transplant included a side-to-side anastomosis between the two limbs of the jejunal loop. This transplant allowed reconstruction of the upper digestive tract after wide carcinologic resection of the pharynx. The U-shaped jejunal transplant facilitated the upper anastomosis, especially at the upper part where the resection involved the oropharynx. It formed a reservoir behind the tongue, and avoided nasal reflux. The best indications are large resections involving the oropharynx.

[Clinical, etiologic and therapeutic aspects of chronic sphenoid opacities]. / Aspects cliniques, étiologiques, et thérapeutiques des opacités sphénoïdales chroniques.

A series of 23 patients with sphenoid disease were seen between 1992 and 1997. The most common symptom was headache. This headache was found to be nonspecific. Cranial nerve abnormalities were found in two patients. The different types of radiolographic images were analyzed, and compared with the surgical diagnosis. Twenty-one patients underwent surgical exploration by intranasal endoscopic sphenoidotomy. This approach allowed drainage and inspection of the sinus.

[Uncommon tumor and pseudotumor lesions of the submandibular fossa]. / Lésions pseudo-tumorales ou tumorales inhabituelles de la loge sous-mandibulaire.

The histological examination of the salivary gland tumors is a very important step in the diagnostic approach of the lesions, on which depends the success of therapeutic outcome. Some surprises may occur; four examples were reported. In one case the lesion was not a tumor but a tuberculous lymphadenitis; another showed a Destombes Rosai Dorfman syndrome. Two other cases were found to be unusual tumors: a carcinosarcoma of the submandibular gland and a metastasis of a Merkel carcinoma in the submandibular gland.

[Malignant tumors of the parotid gland. Apropos of 60 cases]. / Les tumeurs malignes de la parotide. A propos de 60 cas.

Among a series of 520 parotidectomies performed between 1975 and 1995, we observed 88 cases of malignancy (17%). For this study, we excluded skin cancers which had invaded the parotid and glandular metastases of squamous cell carcinoma, malignant melanoma or kidney cancers, retaining only tumors with a glandular origin and lymphomas. Thus defined, our series comprised 60 patients, i.e. 12% of the operated parodids (31 confirmed cancers, 18 tumors with intermediary malignancy, including several in which the pathology report confirmed malignancy, and 11 lymphomas). We examined therapeutic management by histology and compared the outcomes. Relation with the facial nerve are discussed. Prognosis depends on histology, tumor stage and treatment.

[Reconstruction by free jejunal transplant after circular pharyngolaryngectomy (functional results and survival)]. / Reconstruction par transplant libre de jéjunum après pharyngolaryngectomie circulaire (résultats fonctionnels et survie).

One hundred and ninety seven patients with cancer of the hypopharynx underwent after circular resection, reconstruction with a free jejunal graft. The quality of free jejunal grafts is controlled by many investigations: clinical examination, radiography, electromyography, fibroscopy with biopsy. These investigations show that technically jejunal grafts must be short and linear to give the best functional results. Average resumption of oral intake was 14 days. Oral feeding was possible in 92% of cases. The free jejunal grafts with microsurgery are one of the more reliable procedures for reconstruction of pharynx and cervical esophagus after resection for cancer. (2 post-operative deaths and 8 grafts necrosis on 197 cases). The cumulative survival rate of 5 years was 35% for free jejunal graft. Survival depends on selection of the patients for local and nodes invasion. The quality of survival has improved. This operation must be reserved for the hypopharyngeal cancers which need a circular resection and do not invade the esophagus. The surgery is performed for a curative aim. The distant follow up of the patients is imperative: consultation every four months and then every six months: clinical examination, endoscopic, E.N.T., bronchial, and esophageal investigation. Chemotherapy and radiotherapy have specific indications.

[Partial surgery in cancer of the upper respiratory and digestive tracts]. / La chirurgie partielle dans les cancers des voies aérodigestives supérieures.

Partial or functional surgery for cancers of the upper aerodigestive tract essentially concerns the larynx and the pharyngolaryngeal area. The aim of this surgery is to preserve voice and deglutition. Therefore fundamental anatomical structures such as the cricoid cartilage or at least one arytenoid cartilage must be spared, pointing the limitations of the techniques. Based on these principles, many authors have divided partial surgical procedures ranging from the simplest (cordectomy) to reconstruction on near-total laryngectomy. Cancers of the hypopharynx can benefit from similar techniques always founded on reconstruction by muscle and aponeurosis or by a free flap. Carcinologic results after partial surgery for cancer of upper aerodigestive tract are better than those obtained after total laryngectomy. This fact could be explained by the nature of these cancers that are limited. The carcinologic and functional success of this surgery needs a precise clinical indication and a perfect approach of the various surgical techniques.

[Cervicofacial cancerology: complications of implantable systems of venous access. Prospective study]. / Cancérologie cervico-faciale: complications des systèmes d'accès veineux implantables. Etude prospective.

OBJECTIVE: Implantable systems for venous access are widely used in cervicofacial cancer. We prospectively evaluated complications related to this type of venous access in our cancer patients. METHODS: From September 1991 to September 1993, an implantable system for venous access was installed in 164 patients with epidermoid carcinoma of the upper respiratory and digestive tracts. The systems were implanted in the subclavian vein by 20 different operators (mean number of implants per operator = 8.2). All catheters were tunnelized. Chemotherapy was a combination of 5 fluorouracil and cisplatinum. RESULTS: Immediate complications included impossible implantation (n = 12, 7.3%), pneumothorax (n = 5), false passage (n = 4), haematoma (n = 3), arterial puncture (n = 2) and abscess of the thoracic wall (n = 1). During use, complications included extravasation (n = 4), catheter thrombosis (n = 2), venous thrombosis (n = 2) and infection at the site of implantation, desinsertion of the catheter from the chamber, haematoma at the site of implantation and septicaemia (n = 1 each). The rate of complications was related to implantation (17% of the implantations) or to use (8%). CONCLUSIONS: The rate of complications due to implantable venous access systems is relatively low, suggesting that these systems are acceptable for ambulatory chemotherapy.

[Technique of intraoperative treatment of a retro-mandibular defect after parotidectomy. Use of a blot clot]. / Technique de comblement per-opératoire de la dépression rétromandibulaire après parotidectomie. Utilisation d'un caillot sanguin.

As noticed in our experience, cosmetic results, after total parotidectomy, were better if the patient presented an hematoma. The author got the idea to fill the retro-mandibular defect with a clot. The technique is presented in detail. Fifty four patients had a total parotidectomy between January 1992 and May 1993. A clot was used in 39 of these 54 cases. Were excluded malignant tumors, superficial parotidectomies or the presence of a general pathology (diabetes, cirrhosis). The result was excellent in 31 cases even if a local treatment was necessary due to a secondary hematoma. There was no infectious complication. The follow-up of this series is insufficient, but by analogy with spontaneous hematoma, the results should be persistent. This technique is simple, does not increased the time of the surgical procedure and does not induced injury on any donor site.

[Scopulariopsis brevicaulis otomycosis after tympanoplasty]. / Otomycose à scopulariopsis brevicaulis après tympanoplastie.

We report a case of otomycosis due to Scopulariopsis brevicaulis in a patient who has undergone tympanoplasty 3 months before. Mycological finding led us to consider this fungus as the causative agent. Whereas in vitro studies show a better efficiency of azole derivatives, cure was obtained with nystatine after two treatment failures in our patient.

[Reoperation of tumors of the parotid gland, surgical approach and consequences for the 7th cranial nerve. Apropos of 42 cases]. / Reprises chirurgicales des tumeurs de la parotide, approche technique et conséquences pour le VII. A propos de 42 cas.

Second or more surgical procedures on parotid are usually difficult and may induce injury on the facial nerve. The authors report their experience about 42 patients. The choice between a total parotidectomy or a surgical excision of a tumor depends on the number of surgical procedure, the type of initial procedure and the histological type of the tumor. Second surgical procedures for a wrong initial diagnosis (11 cases) were always a total parotidectomy with facial nerve preservation. The risk of a partial or total facial palsy is higher after several recurrences (3 of 8 cases). The facial nerve had to be resected in 3 of 9 cases of malignant tumors recurrences. The initial treatment of a tumor of the parotid must be radical so it can prevent for further surgical procedures and then avoid a facial nerve injury.

[Reoperation of tumors of the parotid gland. Technical approach and consequences for the 7th cranial nerve. Apropos of 22 cases]. / Reprises chirurgicales des tumeurs de la parotide approche technique et conséquences pour le VII. A propos de 42 cas.

Second or more surgical procedures on parotid are usually difficult and may induce injury on the facial nerve. The authors report their experience about 42 patients. The choice between a total parotidectomy or a surgical excision of a tumor depends of the number of surgical procedure, the type of initial procedure and the histological type of the tumor. Second surgical procedures for a wrong initial histological diagnosis (11 cases) were always a total parotidectomy with facial nerve preservation. The risk of a partial or total facial palsy is higher after several recurrences (3 of 8 cases). The facial nerve had to be resected in 3 of 9 cases of malignant tumors recurrences. The initial treatment of a tumor of the parotid must be radical so it can prevent for further surgical procedures and then avoid a facial nerve injury.

[Screening of deafness in the young child. Value, techniques and initial results of products of acoustic distortion]. / Dépistage de la surdité du jeune enfant. Intérêt, modalités techniques, résultats préliminaires des produits de distorsion acoustique.

Distortion-product otoacoustic emissions are otoacoustic emissions evoked by two pure tones called primaries and proposed in order to provide a frequency specific investigation of the cochlea. This paper first reports complete input-output functions of distortion-product otoacoustic emissions for conventional audiometric frequencies in a population of 35 neonates without any risk for cochlear function. Distortion-product otoacoustic emissions could be useful, in association with evoked otoacoustic emissions and comportemental audiometry, to precisely evaluate the peripheral auditory system in infants and neonates.

[Does the use of nasal vasoconstrictor agents change tomodensitometric images of nasosinusal polyposis?]. / L'application de vasoconstricteur nasal modifie-t-elle les images tomodensitométriques des polyposes naso-sinusiennes?

This study compared the results of the CT scan of the paranasal sinuses in nasal polyposis patients before and after a topical vasoconstrictor application on the nasal mucosa. No change have been observed either on the maxillary and ethmoidal sinuses, or the middle meatus. On the other hand, an important retraction was observed on the nasal mucosa, in particular on the inferior turbinate. Then, the application of a topical vasoconstrictor on the nasal mucosa does not seem necessary in order to explore the sinuses in patients with nasal polyposis.