Friedrich Trendelenburg's tracheal tampon-cannula.

The aim of this historical vignette is to analyze the role of Friedrich Trendelenburg's tracheal balloon cannula in the development of laryngeal surgery in the early 1870s. The purpose of this cannula was to prevent bleeding into the airway in cases of extensive laryngeal surgery requiring a tracheostomy.

Hypopharyngeal reconstruction with gastro-omental free flap.

Three types of reconstruction are possible following total laryngopharyngectomy (TLP) for advanced hypopharyngeal cancer: locoregional tubularized island flaps, gastric pull-up and free flaps. Gastro-omental free flap (GOFF) is rarely used in this setting. However, because of its composite nature, this flap has the advantage of being able to restore digestive continuity and reconstruct part of the skin of the neck when it needs to be sacrificed because of tumour invasion or poor trophicity. The GOFF is a reliable and robust flap particularly indicated in hostile environments: repeated neck surgery, atrophic and devascularized skin after radiotherapy, sepsis in the context of fistula and/or pharyngostomy. It requires the collaboration of two or even three surgical teams. In this article, we describe the flap harvesting technique and the complications and functional outcome.

Guidelines of the French Society of Otorhinolaryngology-Head and Neck Surgery (SFORL), part II: Management of recurrent pleomorphic adenoma of the parotid gland.

INTRODUCTION: The authors present the guidelines of the French Society of Otorhinolaryngology-Head and Neck Surgery (SFORL) for the management of recurrent pleomorphic adenoma (RPA) of the parotid gland. METHOD: A review of the literature was performed by a multidisciplinary task force. Guidelines were drafted, based on the articles retrieved and the work group members' individual experience. There were then read and re-edited by an independent reading group. The proposed recommendations were graded A, B or C on decreasing levels of evidence. RESULTS: Complete resection under neuromonitoring is recommended in case of RPA. The risks of progression and malignant transformation, which are higher the younger the patient, have to be taken into consideration. The risk of functional sequelae must be explained to the patient. MRI is recommended ahead of any surgery for parotid RPA, to determine extension and detect subclinical lesions. Radiotherapy should be considered in case of multi-recurrent pleomorphic adenoma after macroscopically complete revision surgery at high risk of new recurrence (microscopic residual disease), in case of RPA after incomplete resection, and in non-operable RPA.

Guidelines of the French Society of Otorhinolaryngology-Head and Neck Surgery (SFORL), part I: Primary treatment of pleomorphic adenoma.

INTRODUCTION: The authors present the guidelines of the French Society of Otorhinolaryngology-Head and Neck Surgery (SFORL) for the diagnosis and treatment of pleomorphic adenoma (PA) of the salivary glands. METHOD: A review of the literature was performed by a multidisciplinary task force. Guidelines were drafted based on the articles retrieved and the workgroup members' individual experience. Guidelines were graded A, B, C or expert opinion by decreasing level of evidence. RESULTS: In clinically suspected salivary gland PA, MRI should be performed, including head and neck lymph node levels. Fine needle aspiration cytology is particularly recommended for tumours difficult to characterise by MRI. Frozen section biopsy should be performed to confirm diagnosis and adapt the surgical procedure in case of intraoperative findings of malignancy. Complete resection of the parotid PA should be performed en bloc, including margins, when feasible according to tumour location, while respecting the facial nerve. Enucleation (resection only in contact with the tumour) is not recommended. For the accessory salivary and submandibular glands, complete en bloc resection should be performed.

Endoscopic lateralization of the vocal fold.

Vocal fold paralysis in adduction can result in significant breathing difficulties. Techniques such as vocal fold lateralization and/or arytenoidopexy help to improve respiratory function in this setting. These techniques require open approach or specific instruments. The authors describe an original vocal fold lateralization technique performed exclusively via an endoscopic approach. This technique helps to enlarge the glottic aperture, while preserving laryngeal architecture, and permanently improves respiratory function in patients with vocal fold paralysis in adduction.

Maxillary sinusitis complicated by stroke.

INTRODUCTION: Neurological complications of acute sinusitis are exceptional, but potentially serious. CASE REPORT: The authors report the case of a 6-year-old diabetic girl who presented with middle cerebral artery ischemic stroke secondary to inflammatory arteritis of the left internal carotid artery in a context of bilateral acute maxillary sinusitis. MRI confirmed ischaemic stroke associated with carotid arteritis and complete obstruction of the maxillary sinuses. A favourable outcome was observed after endoscopic drainage of the sinuses associated with broad-spectrum antibiotic therapy. DISCUSSION: This complication was probably due to spread of an infectious inflammatory reaction of the intrapetrosal carotid artery and its branches via the pterygoid venous plexus. To our knowledge, this is the first published case report of maxillary sinusitis complicated by stroke.

Office-based endoscopic botulinum toxin injection in laryngeal movement disorders.

INTRODUCTION: Botulinum toxin injection is widely used for the treatment of laryngeal movement disorders. Electromyography-guided percutaneous injection is the technique most commonly used to perform intralaryngeal botulinum toxin injection. OBJECTIVE: We describe an endoscopic approach for intralaryngeal botulinum toxin injection under local anaesthesia without using electromyography. TECHNIQUE: A flexible video-endoscope with an operating channel is used. After local anaesthesia of the larynx by instillation of lidocaine, a flexible needle is inserted into the operating channel in order to inject the desired dose of botulinum toxin into the vocal and/or vestibular folds. CONCLUSION: Endoscopic botulinum toxin injection under local anaesthesia is a reliable technique for the treatment of laryngeal movement disorders. It can be performed by any laryngologist without the need for electromyography. It is easy to perform for the operator and comfortable for the patient.

Epiglottoplasty technique in endoscopic partial laryngectomy.

The main advantage of endoscopic laser surgery for laryngeal cancer is to allow tumour resection, while limiting functional sequelae, thereby improving the postoperative course. In this type of surgery, the epiglottis is often partially resected, leaving a raw zone without any reconstruction. The surgical technique described here involves endoscopic reconstruction of the epiglottis after partial resection. The sectioned edge of the epiglottis is sutured to the base of the tongue to create a neoepiglottis and to reconstruct the vallecula, thus resembling preoperative anatomy, allowing improvement of postoperative swallowing.

Endoscopic pharyngolaryngoplasty: A case report.

INTRODUCTION: Any technique that allows decannulation of tracheostomy-dependent patients relieves their discomfort and reduces health costs. CASE REPORT: We present the case of a 70-year-old tracheostomy-dependent patient with pharyngolaryngeal stenosis and a history of radiation therapy for laryngeal cancer in remission for 13years and multiple decannulation failures. Endoscopic pharyngolaryngoplasty was performed using reconstructive transoral laser microsurgery techniques, allowing permanent decannulation. Endoscopic sutures secured by clips were performed to remodel the pharyngolarynx and prevent recurrence of synechiae. DISCUSSION: Endoscopic surgery of the pharynx and larynx was initially developed for resection of small tumours. Reconstructive transoral laser microsurgery has been developed more recently. One of the objectives of this surgery is to reconstruct the pharyngolarynx to treat functional sequelae following surgery and/or radiation therapy for head and neck cancer. It allows reconstruction of the upper airways to restore mouth breathing in tracheostomy-dependent patients, thereby facilitating permanent decannulation.