Effects of mandibular advancement devices on the evolution of obstructive sleep apnea.

PURPOSE: Mandibular advancement devices (MADs) are a treatment for obstructive sleep apnea (OSA). Titration is a necessary component of proper fitting of MADs, yet little is known about what happens at each step of the titration. The objectives of this study were to determine the clinical and paraclinical evolution of OSA at every mm of MAD advancement. METHODS: Volunteers were fitted with MADs set to 50% of maximum advancement. MAD clinical and paraclinical results were recorded at every additional mm-titration, including apnea-hypopnea index (AHI), as well as symptoms of sleepiness and fatigue. RESULTS: In 20 volunteers with OSA, the MAD had a significant effect on every polygraphic parameter at the onset of use. The mean AHI with MAD fell by 15.2/h (p < 0.001). The mean Epworth Sleepiness Score and Pichot Fatigue questionnaire with MAD fell by 2.0 (p = 0.0687) and 2.4 (p = 0.1073) respectively. There was no proportionality between clinical gains (drowsiness and fatigue) and AHI improvements. CONCLUSIONS: MADs led to a significant improvement in AHI and other polygraphic parameters from the onset of use. The decrease of clinical symptoms (drowsiness and fatigue) was more complex to interpret because of the small decreases observed. The absence of concordance between AHI improvement and clinical symptoms was nevertheless objectively quantified and symptoms were alleviated with advancements. The findings suggest that it may be appropriate to use clinical symptoms as a main aim of titration, since the improvement in AHI is reached at the onset of MAD use.

A translation and validation of the French version of the Gothenburg Trismus Questionnaire 2 (F-GTQ-2).

BACKGROUND: Limitation of mouth opening, widely known as trismus, is a major symptom altering quality of life in individuals presenting from temporomandibular joint disorder or head and neck cancer. A French-language instrument addressing jaw opening limitation following treatment for head and neck cancer (HNC) or temporomandibular joint disorder (TMD) is lacking. OBJECTIVE: The aim of this study was to translate and validate the Gothenburg Trismus Questionnaire-2 (GTQ-2) into French. METHODS: A French translation of the GTQ-2 was performed according to established international guidelines, leading to the French-GTQ-2 (F-GTQ-2). The validation study included 154 participants with trismus (minimum interincisal opening of ≤35 mm) following treatment for TMD or HNC and 149 age-matched participants without trismus. All participants completed the F-GTQ-2 and participants with trismus completed additional health-related quality of life questionnaires to allow for analysis of convergent validity. RESULTS: The F-GTQ-2 demonstrated retained psychometric properties with Cronbach's alpha values above 0.70 for the domains, jaw-related problems, eating limitations, facial pain and somewhat lower for muscular tension (0.60). Mainly moderate correlations were found when comparing the F-GTQ-2 to other instruments, which was in line with the pre-specified hypotheses, indicating satisfactory convergent validity. Discriminant validity was found with statistically significant differences in all domains of the F-GTQ-2 between trismus and non-trismus participants. CONCLUSION: The F-GTQ-2 can be considered a reliable and valid instrument to assess jaw-related difficulties in individuals with trismus due to HNC or TMD.

Post-traumatic stress among COVID-19 survivors: A descriptive study of hospitalized first-wave survivors.

Introduction: The coronavirus Severe Acute Respiratory Syndrome Coronavirus Type 1 induces a severe respiratory disease, coronavirus disease 2019 (COVID-19). After Severe Acute Respiratory Syndrome Coronavirus Type 1 and Middle East Respiratory Syndrome infection, increased post-traumatic stress disorder (PTSD) rates were described. Methods: This single-centred, prospective study aimed to evaluate the rates of PTSD in patients who were hospitalized for COVID-19. Inclusion criteria were COVID-19 patients hospitalized in the intensive care unit (ICU) or in a standard unit with at least 2 L/min oxygen. Six months post-hospitalization, subjects were assessed for PTSD using a validated screening tool, the Post-Traumatic Stress Checklist-5 (PCL-5). Results: A total of 40 patients were included. No demographic differences between the ICU and non-ICU groups were found. The mean PCL-5 score for the population was 8.85±10. The mean PCL-5 score was 6.7±8 in the ICU group and 10.5±11 in the non-ICU group (P=0.27). We screened one patient with a positive PCL-5 score and one with a possible PCL-5 cluster score. Nine patients had a PCL-5 score of up to 15. Seven patients reported no symptoms. Seven patients accepted a psychological follow-up: one for PTSD, three for possible PTSD and three for other psychological problems. Discussion: The PCL-5 tool can be used by lung physicians during consultations to identify patients for whom follow-up mental health assessment and treatment for PTSD are warranted. Conclusion: Lung physicians should be aware of the risk of PTSD in patients hospitalized for COVID-19 and ensure appropriate screening and follow-up care.

Metallic taste prevalence in patients treated for cancer: a systematic literature review and meta-analysis.

BACKGROUND: Metallic taste (MT) is a taste abnormality often reported by cancer patients. The aim of this systematic review was to exhaustively report MT incidences in cancer patients and to evaluate the risk of bias in the pertinent studies in accordance with a meta-analysis approach. METHODS: The research objective was to determine the prevalence of MT in patients treated for cancer. A literature search was conducted using PubMed, Web of Science, and Embase. The authors each screened articles and evaluated the eligibility and individual risk of bias for each article. Then, all of the results were compared. A meta-analysis was conducted on studies that specifically focused on MT evaluation. RESULTS: Very few articles have been published on the incidence of MT among taste and smell abnormalities in cancerology (22 of 1674, 1.3%), and the quality of the reports on MT was often low. The most common bias was the methodology used for MT evaluation. Pooling the results of the 22 studies led to an estimated MT incidence in the cancer patient population of 29% (95% CI [0.21; 0.39]) with high and significant heterogeneity observed among the studies. A heterogeneity analysis was performed to identify the causal factors of this heterogeneity. The specific impact of MT on nutritional status (two) and quality of life (five) studies were reported, respectively, and without a specific evaluation of MT. There was no mention of oral health in any of the studies. CONCLUSION: Although in clinical practice cancer patients often report MT, its incidence has only been reported in 22 studies, most of which have a moderate to severe risk of bias. Considering the rather high prevalence of MT, more research should be conducted in this field to better identify its causes and mechanisms.

Prevalence of radiotherapy, chemotherapy and access to supportive care in cancer in Brazil, China, France, Russia and the USA.

OBJECTIVES: The objective of this study is to assess the prevalence of treatment with radiotherapy and/or chemotherapy in the general adult population of five countries (Brazil, China, France, Russia and the USA) and to evaluate the use of different Supportive Care in Cancer (SCC) services. METHODS: A total of 11,100 individuals representing the general population over 18 years of age were recruited from the five countries via a rigorous quota sampling method. RESULTS: There are between 4.1% and 8.78% of respondents reported having undergone medical cancer treatment. Among these subpopulations, the use of at least one SCC was reported by 63% to 86% of respondents. The most commonly used SCC was psychological counselling in France, dietary counselling in Brazil and China, participating in a focus group in the USA and using alternative medicine in Russia. Alternative medicines were chosen by 50% to 61% of patients in every country. CONCLUSION: This study provides information on the prevalence of patients treated by chemotherapy and/or radiotherapy in representative populations from five countries. Among them, SCC was widely used. However, these uses varied both in proportion and choice, given the cultural differences in patients' and families' health beliefs and values, differences among organisations, in available resources and in ethics and policies among countries.

Creation of a tool to evaluate supportive care.

RATIONAL: The absence of a specific tool to evaluate the impact of supportive care in general and socioesthetics (SE) in particular is undoubtedly at the origin of the lack of published research based on scientific standards. OBJECTIVE: We developed a supportive-care, patient-reported outcome questionnaire using the multistep methods, following COSMIN recommendations. METHODS: The Patient Centricity Questionnaire (PCQ) was developed using the standardized methodology for designing patient-reported outcome (PRO) questionnaires according to the following steps: elaboration of the questionnaire, measurement properties of the questionnaire, internal and external validation, test-retest validation and translation, cross-cultural adaptation, and cognitive debriefing. A multidisciplinary work group was designed including professionals, such as physicians, public health experts, sociologists, supportive-care experts, and socioestheticians. RESULTS: Our questionnaire includes 11 items. It is scored by adding each Visual Analogue Scale [VAS], making it range from 0 to 110, with a higher benefit when the score is higher. The Cronbach's α coefficient is 0.88 for the entire questionnaire. As the questionnaire is a reflection of the patient's feelings, it is quite natural that the name "Patient Centricity Questionnaire" (PCQ) was retained and validated by the Scientific Committee. The PCQ correlated negatively and moderately with the Perceived Stress Scale [PSS], positively and moderately with the mental dimension of the Short Form-12, and poorly with the Well Beng 12 [WB12], the physical dimension of the SF-12, and the satisfaction VAS. CONCLUSION: Constructed according to the recommendations, the PCQ meets the prerequisite for this type of questionnaire. Its short format and simplicity of use allow it to be used by a large number of people. The PCQ is a simple, reliable, easy-to-use, and validated tool for research teams, making it possible for randomized studies to prove the impact of supportive care in general and SE in particular, on the patient's quality of life.

[Quantitative and qualitative evaluation of a specific grid of head and neck post-cancer with user healthcare professionals]. / Évaluation quantitative et qualitative d'une grille spécifique de l'après-cancer des voies aérodigestives supérieures auprès des professionnels de santé utilisateurs.

INTRODUCTION: The post-cancer period is a delicate one, as it does not necessarily mean good health and/or a return to life as it was "before". Over the past twenty years, a number of initiatives have been launched to improve support for people after cancer. We have created a post-cancer care pathway for patients with head and neck cancer, based on a nursing interview and the use of a post-cancer grid. MATERIALS AND METHODS: The steps involved in creating the pathway and the grid, the fruit of a working group involving the educational team, five patient associations and two expert patients, with the support of a health promotion engineering resource association, were explained. A quantitative and qualitative evaluation of the use of the grid was carried out. RESULTS: Sixty-five patients benefited. Individual interviews with the nurses involved in the post-cancer process showed that the grid was complete, easy to follow and based on the semi-directive interview model, but that care had to be taken not to follow it to the letter, so as not to impair the quality of the interview. CONCLUSION: Our post-cancer approach for upper aerodigestive tracts, anchored in a dedicated grid, highlights the often underestimated significance of this crucial phase in patients' journeys. While the grid is a valuable tool in development, its use requires caution, with further research needed to confirm its effectiveness. We encourage adaptation by teams, respecting fundamental principles.

[Encouragement of adapted physical activity for three months after the end of treatment in patients with head and neck cancer: A pre-post interventional study]. / Encouragement à l'activité physique adaptée pendant trois mois après la fin des traitements de patients atteints de cancer des VADS : étude interventionnelle pré-post.

CONTEXT: In our institution, patients with upper aero-digestive tract cancer receive adapted physical activity (APA) awareness training as part of their holistic oncology care program. The main aim of this study was to show that raising awareness of APA helped to increase self-reported PA levels, as assessed by questionnaire. METHOD: This retrospective study included 67 patients with localized Head and Neck cancer. The intervention consisted of an APA teacher; a face-to-face consultation before the start of oncological treatment, four monthly telephone interventions in the three months following the end of treatment. The pre-post evaluation focused on self-reported APA practices before and three months after the end of oncology treatment. RESULTS: APA awareness training significantly increased average total PA, average moderate PA intensity, average weekly walking frequency, average walking intensity, and significantly reduced daily sitting time. The search for correlations between body composition or type of treatments and changes in PA levels showed no significant results. CONCLUSION: This study showed that a basic APA awareness training integrated into a holistic oncology care program could increase patients' self-reported PA levels. The next step will be to verify the objectivity of the increase in self-reported PA, and then to assess its effect on quality of life and survival.

Paclitaxel and cetuximab combination efficiency after the failure of a platinum-based chemotherapy in recurrent/metastatic head and neck squamous cell carcinoma.

The addition of cetuximab (CTX) to the combination of cisplatin and 5-fluorouracil increases the overall survival (OS) in recurrent/metastatic head and neck squamous cell carcinoma. Only a few patients are eligible for this treatment because of its toxicity. The combination of CTX and paclitaxel (TXL) could be included in sequential treatment strategies. Patients were treated with CTX (400/250 mg/m) and TXL (60-80 mg/m) weekly until disease progression or unacceptable toxicity. Efficacy and safety outcomes were determined retrospectively. A total of 42 patients were included in this analysis. The overall response rate was 38% [95% confidence interval (CI); 23-53%]. The disease control rate with TXL and CTX combination was 74%. Seven (17%) patients progressed before the first evaluation. The median progression-free survival was 3.9 months [95% CI; 3.1-4.7 months] and the median OS was 7.6 months [95% CI; 5.3-9.9 months]. Neurotoxicity and skin rash were the most frequent grade≥2 toxicities, reported in 17 and 12% of patients, respectively. Previous chemotherapy seems to be associated with a lower response rate and progression-free survival but not with the OS. The combination of CTX and TXL was an active and well-tolerated treatment in this series of patients with a poor prognosis and who were mostly symptomatic.

[Early integration of physical tests for the diagnosis of under-nutrition in head and neck cancer]. / Intégration précoce de tests d'évaluation de la condition physique pour le diagnostic de dénutrition en cancérologie des voies aérodigestives supérieures.

INTRODUCTION: The French National Authority for Health has modified the criteria for the diagnosis of malnutrition by integrating measures of muscle strength and endurance. The main objective of this study was to determine whether the diagnoses of under nutrition made by the dietician and the adapted physical activity teacher were complementary or redundant. METHOD: Since July 2020, we have integrated an adapted physical activity teacher into our therapeutic education program. All patients (n=40) with head and neck tract cancer who received a physical assessment before their cancer treatment in our department from July 1st 2020 to September 30th 2021 were retrospectively included. The mean age was 66years. Among them, 27 were less than 70 years old, a necessary criterion to use the assessment of muscle strength and endurance in the diagnosis of malnutrition. RESULTS: Seven patients were undernourished at the time of their head and neck cancer diagnosis (25.9%). Three diagnoses of malnutrition were made by the dietician and the adapted physical activity teacher and one by both methods. The physical assessment increased the diagnosis of under nutrition, these methods were therefore complementary and not redundant. In addition, the physical activity level of the 40 patients with head and neck cancer was low in 85% of them. DISCUSSION: The early integration of the skills of an adapted physical activity teacher improved the diagnosis of malnutrition compared to an isolated dietary assessment. These two methods are therefore complementary and must be carried out concomitantly at an early stage. It is necessary to consider specific and innovative pathways for these patients given the stakes.

Well-being treatments in cancer care: patient benefits.

OBJECTIVES: Well-being care is widely offered and delivered in patients with cancer. However, very few studies have rigorously evaluated its benefits. The objective of this study was to evaluate the impact of four well-being treatments (foot reflexology, socio-aesthetics, sophrology and singing) provided in a healthcare facility. METHODS: Three hundred and seventy-four patients with cancer were offered a well-being treatment and agreed to evaluate the type of treatment received, the benefits felt as a result, and numerical evaluation scales for pain and well-being before and after the session. RESULTS: The distribution of well-being treatments provided was as follows: foot reflexology: 19.0%, socio-aesthetics: 63.9%, sophrology: 6.7%, singing: 10.4%. The average gain in pain relief was 1.01 on a scale of 0-10 (p<10-5) and on well-being 6.97 on a scale of -10 to +10 (p<10-5). One patient (0.3%) experienced pain induced by a foot reflexology session and one patient (0.3%) experienced a deterioration in well-being following a singing session. CONCLUSION: The well-being treatments studied provided significant pain relief and increased well-being in patients with cancer after their completion.

Transoral minimally invasive robotic surgery for carcinoma of the pharynx and the larynx: a new approach.

Partial laryngectomy is an old but well-accepted surgical treatment for selected carcinomas of the larynx. Actually, the transcervical approach remains the most popular even if the transoral laser approach is useful in some cases. Transoral robotic surgery is a new promising surgical procedure in head and neck oncology as an alternative to conventional surgery with decreased morbidity. The aim of this study is a description of the state of the art by a review of the literature. We emphasize limits and future prospects on this topic with a special focus on dependability.

Determination of predictive factors of tracheobronchial prosthesis removal: stent brands are crucial.

OBJECTIVES: We sought to describe in a retrospective study our experience in the endoscopic management of tracheobronchial stenoses over 20 years and to determine prognostic factors of stent removal. METHODS: We analyzed the medical records of 166 patients (111 male and 55 female) who underwent the placement of a prosthesis for all causes of tracheobronchial stenosis between 1990 and 2009. RESULTS: Overall, 34% of the patients had their stents removed. The incidence of complications for the first stent was 0.08 per patient-month. One hundred five patients (63%) had no complications. In univariate analysis, stent removal was significantly linked with the stent brand. In multivariate analysis, taking into account the causes of stenosis, the stent brand appeared to be the only factor that significantly influenced stent removal. Finally, stenosis with more than 1 stent replacement was most prone to repeat endoscopies. CONCLUSIONS: Even though endoscopic stent placement is a relatively safe and effective treatment for tracheobronchial stenoses, particularly in cases with malignancy, complications led to stent removal in about one third of cases. The type of stent chosen is crucial.

[Antalgic effects of socio-aesthetics in cancer patients]. / Effets antalgiques de la socio-esthétique chez les patients atteints de cancer.

INTRODUCTION: Socio-aesthetics is the delivery appropriate beauty care in a population weakened by a physical, psychological and/or social attack. It has found its place in indications in both medical (especially in oncology) and social settings. It offers many types of treatments including facials, foot beauty, make-up, wig tips, body massage, product advice, cosmetic manicure, varnishing… The main purpose of this study was to evaluate pain reduction as a result of socio-aesthetics. METHODS: One hundred and eighty patients were offered a socio-aesthetic session between 12/01/2018 and 11/30/2019. One hundred and fifty-seven (87,2%) accepted the care (56.7% of women/43.3% of men, regardless of the type of cancer) and all agreed to complete a questionnaire on the type of treatment received, the benefits felt and a Likert pain assessment scale before and after the treatment. RESULTS: No patient experienced an increase in pain after the socio-aesthetic care. In the general population, the mean pain evaluation was rated at 1.31/10 and 0.78/10 before and after the session respectively, p<10-5. By selecting patients experiencing pain before treatment (40 patients, 28.0% of the total population), the mean pain evaluation was 4.27/10 and 2.52/10 before and after the treatment respectively, p<10-5. Pain was significantly reduced by massage. No patient found the socio-aesthetic treatment unnecessary. CONCLUSION: Socio-aesthetics is definitely a supportive care in oncology as it is significantly analgesic. It is easily accepted by men and regardless of the type of cancer. Researchers should conduct more studies on its impact on the quality of life.

Predictive Factors for Efficacious Oral Appliance Therapy in Moderate to Severe Obstructive Sleep Apnea Patients.

OBJECTIVES/HYPOTHESIS: Oral appliances (OAs) are a treatment for obstructive sleep apnea hypopnea syndrome (OSAHS). The main objective of the study was to determine the predictive factors of OA efficacy. The secondary objective was to measure the efficacy rates and determine OAs' tolerance and dropout. STUDY DESIGN: Retrospective study. METHODS: Efficacy results of the OAs based on the apnea hypopnea index (AHI) reduction, complications, and dropout rates were retrospectively collected from 347 patients with a moderate to severe OSAHS treated by a retention OA. The procedure was entirely performed by otolaryngologists. RESULTS: The AHI with OA was more significantly reduced in patients with a higher initial AHI and a higher initial body mass index but reduction was not related to age and not proportional to the degree of mandibular advancement. The 50% AHI reduction rate after OA was 65.2%, the AHI ≤5/hr rate after OA was 26.1%, and the <50% AHI reduction and residual AHI > 10/hr rate was 50.1%. The OA significantly reduced the mean AHI (-14.9/hr, P < .0001). In 7.8% of patients, the AHI increased with OA. Seven patients (1.5%) experienced adverse effects. Thirty-seven (7.8%) patients stopped using OA mainly because of its ineffectiveness. Advancement can be considered beyond the initial maximal advancement. It can be effective sometimes; however, increasing advancement did not significantly reduce AHI. CONCLUSIONS: OA is an effective and well-tolerated treatment for moderate to severe OSAHS. This treatment was effective for reduction of the AHI ≥50% in two-thirds of cases studied and it should be considered in more cases. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E2089-E2096, 2021.

Prevalence and distribution of cervical lymph node metastases in HPV-positive and HPV-negative oropharyngeal squamous cell carcinoma.

OBJECTIVE: In oropharyngeal squamous cell carcinoma (OP-SCC), the prevalence and distribution of clinical and pathological lymph node metastasis in the neck have been extensively reported. It served as the basis for consensus recommendations on the selection of the lymph node levels in the neck requiring a treatment. The objective of the study is to compare the prevalence and distribution of neck node metastases in HPV+ and HPV- OP-SCC from a large series of patients with OP-SCC who underwent a cervical lymph-node dissection (LND) as part of their treatment. METHODS: The study concentrated on OP-SCC patients treated by various neck node dissection (LND) procedures from January 2014 to December 2018 in 3 French institutions. Patients with prior head and neck cancer, prior neck surgery, the use of induction chemotherapy, or patients with carcinoma of unknown primary were excluded. HPV-status was assessed by p16 immunohistochemistry. For each patient, the clinical and the pathological nodal status, as well as the distribution of the positive nodes in each neck level (from Ia to V) were reported. RESULTS: Two-hundred and sixty-three patients were included (126 p16-negative (p16-), and 137 p16-positive (p16+). The rate of clinical positive node (cN+) reached 54% and 88.3% in the p16- and p16+ groups, respectively (p < 0.001); the corresponding rate of pathological positive node (pN+) reached 61.9% and 91.2%, respectively (p < 0.001). Regarding the clinical lymph node distribution, in p16+ patients, more positive nodes were observed in the ipsilateral level IV (p = 0.003), and less positive nodes were observed in the contralateral levels III and IV (p = 0.003 and p = 0.045, respectively). Regarding the pathologic lymph node distribution in the ipsilateral neck, in the cN0 patients, no significant difference was observed between p16- and p16+ patients (p = 0.33 to 1); in the cN+ patients, the nodes were distributed in levels Ib, II, III, IV and V without differences between the p16- and the p16+ patients. In the contralateral neck of p16- patients, nodes metastases were mainly observed in levels II, III and IV, whereas for the p16+ patients, positive nodes were only observed in level II (p = 0.03). CONCLUSION: This study demonstrated the higher prevalence of cN+ and pN+ in p16+ OP-SCC patients, but without meaningful difference in the distribution of the lymph node drainage between p16- and p16+ OP-SCC. It indicates that no difference should be made between p16- and p16+ patients regarding the extend of neck treatment.

History of tonsillectomy and risk of oropharyngeal cancer.

OBJECTIVE: To investigate whether palatine tonsillectomy in youth influences the risk of oropharyngeal cancers (OPC) by assessing the association between history of tonsillectomy and risk of tonsillar, base of tongue (BOT) cancer, and other head and neck cancers (HNC). MATERIALS AND METHODS: RACKAM was a case-case study comparing frequency of tonsillectomy history in individuals diagnosed with HNC from 2013 to 2018 in 15 centers across France. History of tonsillectomy was defined using combined assessment of patients' recollections and surgeons' visualizations of tonsil area. OPC subsite-specific odds ratios (OR) of tonsillectomy were calculated using multinomial logistic regression with non-oropharyngeal HNC as reference. RESULTS: 1045 patients were included in the study. Frequency of tonsillectomy was 19.5% in patients with tonsillar cancer (N = 85), 49.3% in BOT (N = 76), 33.8% in other oropharyngeal cancers (N = 202) and 38.0% in non-oropharyngeal HNC (N = 682). History of tonsillectomy was inversely associated with tonsillar cancer (adjusted OR 0.4; 95% CI 0.2-0.8), and positively associated with BOT cancer (adjusted OR 1.8; 95% CI 1.1-3.1), but was not associated with all OPC combined (adjusted OR 1.1; 95% CI 0.8-1.4). Sensitivity analyses considering only patients' or surgeons' assessments of tonsillectomy provided comparable results. CONCLUSION: We confirm the long-term protective effect of tonsillectomy performed in youth on future risk of tonsillar cancer, and our study is the second to report a concurrent increased risk of BOT cancer. Our data suggest that tonsillectomy in youth shifts the site of the first diagnosed oropharyngeal tumor and has a limited impact on overall risk of OPC.

[How to reconcile therapeutic patient education and care pathology in oncology: Application in head and neck neoplams]. / Comment concilier éducation thérapeutique des patients et parcours de soin en cancérologie : application pour les voies aérodigestives supérieures.

Therapeutic education is an educational approach that allows the patient and his entourage to acquire or maintain the skills necessary to manage their daily lives. It requires a global care of patients and caregivers and is much broader than a learning of technical gesture. While their development is encouraged in the plan cancer 2014-2018, few programs exist in cancer surgery because the process is very cumbersome to implement due to a very strict administrative framework. In the absence of permission from the Regional health agency, "therapeutic education" term should not be used under penalty of a fine. The aim of this article is to present the principles and rules of therapeutic education defined by the french « Haute Autorité de Santé ¼ and to illustrate them through the example of our therapeutic education program for patients with tracheostomy and/or gastrostomy. The patient pathway with the chronology, the speakers, the competency references, the possible interactions with the announcement scheme as desired by the French National Cancer Institute are specified. This information will facilitate the filling of the program authorization in order to participate in the development of therapeutic education in our specialty.

Management of tracheobronchial stenoses with endoprostheses: experience with 103 patients and 11 models.

OBJECTIVE: To describe in a retrospective study our experience in endoscopic management of tracheobronchial stenosis with 145 stents (11 different models). METHODS: We analyzed the medical records of 103 patients (67 males and 36 females) who underwent the placement of prosthesis for any causes of tracheobronchial stenoses between 1990 and 2005. RESULTS: A total of 145 prostheses were placed. Of these, 96.1% of the patients had a relief of dyspnea, and 73.8% had only one prosthesis. Stent removal and replacement were significantly linked with etiologies (more frequently in patients with an inflammatory component), but not with the type of stent. CONCLUSION: Endostenting is a safe and effective treatment for tracheobronchial stenoses. Removal and replacements were due to etiologies of the strictures, but not to the type of stent. Stenoses with an inflammatory component were prone to iterative stenting. Only benign diseases that are a contra-indication to open surgery should be treated by endoscopic stenting.

Larynx transplantation: laryngectomees' opinion poll.

BACKGROUND: In 1998, Strome et al. performed the first human larynx transplantation in a patient with larynx traumatism. L'Association Nationale des Mutilés de la Voix, a French association of laryngectomees, estimates that the number of laryngectomees in France has reached 20,000. The main goal of the study was to determine the potential number of patients ready to benefit from larynx transplantation in France. METHODS: We carried out a public opinion poll among 420 total laryngectomees in Rhone-Alpes, in the southeast of France. The questionnaire could be divided into three parts: demographic data; incapacities and deficiencies of the patients; and acceptability of larynx transplantation according to short-, medium-, and long-term implications. RESULTS: We received 205 answers from 420 questionnaires (48.8%). Sixty-three patients (i.e., 30.7%) would accept larynx transplantation, especially the younger patients. The patients more willingly accepted the medical constraints (e.g., medical follow-up, rehabilitation) than they did vital (after the operation or because of the treatments) or functional (risk of permanent canula, no guarantee of laryngeal voice, no guarantee of swallowing) risks. CONCLUSIONS: Even though this opinion poll has intrinsic bias and acceptance rate is low, by interpolation, larynx transplantation would interest many patients in France. Larynx transplantation is an intervention that should be proposed to a certain number of patients in the future with the help of new immunosuppressor treatments.