Electrical stimulation of the superior laryngeal nerve (SLN) can elicit reflex responses in the c... more Electrical stimulation of the superior laryngeal nerve (SLN) can elicit reflex responses in the cricothyroid (CT) and thyroarytenoid (TA) muscles. We made bilateral recordings of the responses evoked in these muscles in piglets by the stimulation of either the right or the left superior laryngeal nerve (SLN). The stimulus intensity was gradually increased to study the "persistence" of the responses. We observed a direct, ipsilateral response in the CT muscle, and reflex, ipsilateral and crossed responses in both CT and TA muscles. The ipsilateral or contralateral responses obtained in TA muscles, following stimulation of the left SLN, were significantly delayed in comparison with those evoked by stimulation of the right SLN. This delay cannot be explained by the difference in length between the right and the left recurrent laryngeal nerves, but rather by an asymmetry in the sensory afferent pathway. The functional significance of this observation remains to be determined.
Purpose: To evaluate prospectively autologous fat injection as a treatment for leakage around tra... more Purpose: To evaluate prospectively autologous fat injection as a treatment for leakage around tracheoesophageal puncture. Patients and Methods: For ten patients who exhibited leakage of saliva or liquid around their tracheoesophageal puncture, autologous fat injection was carried out into the tracheoesophageal wall around the maintained prosthesis. Short-term success was evaluated at one month, and long-term follow-up was continued as long as the patients remained alive. The effectiveness of the procedure was evaluated based on the presence or absence of leakage around the puncture as the patient swallowed methylene blue liquid. Patients were adjudged completely improved when no leakage of blue liquid was observed, partially improved when a slight stasis was evident, or unimproved when a marked leakage of blue liquid was noted. Results: Short-term success was achieved for 6 patients, 2 patients partially improved, and the procedure failed for 2 others. Long-term success (from 10 to 65 months) was achieved in all 4 of the completely improved patients who were free of disease, including 1 patient who required an additional injection. Removal of the puncture was later carried out in the 2 others for cervical node metastases or tracheal tumor. Definitive or transitional puncture closure or removal of the prosthesis was required in 3 partially or unimproved patients, whereas 1 partially improved patient died of lung metastasis 3 months later. Conclusions: Fat injection around a voice prosthesis is a procedure that may be conducted as an alternative to other conservative techniques to decrease the size of the puncture. Close endoscopic observation is required however to eliminate secondary tumor that might expand the size of the puncture. (Am J Otolaryngol 2002;23:345-350. Copyright 2002, Elsevier Science (USA). All rights reserved.)
International journal of cancer. Journal international du cancer, Jan 26, 2015
A fraction of oropharyngeal cancer (OPC), especially in the tonsil, is caused by human papillomav... more A fraction of oropharyngeal cancer (OPC), especially in the tonsil, is caused by human papillomavirus (HPV), mainly HPV16. Non-invasive diagnostic methods to detect precancerous lesions in the tonsil would be useful, e.g., liquid-based cytology (LBC). However, ill-characterized precancerous lesions may be hidden in the depth of the tonsillar crypts. We therefore conducted a study on HPV and tonsillar precancerous lesions to evaluate, among other things, the utility of LBC obtained by deep brushing of the crypts. Two hundred non-paediatric patients (mean age: 30.3 years) who underwent tonsillectomy for infection-related conditions (69%) or other conditions (mainly obstructive sleep apnoea, 31%) were included. An ultra-sensitive Luminex bead-based platform was used to test for the DNA of 21 mucosal HPV types. 56% of slides were unsatisfactory due to low number of squamous epithelial cells or the masking effect of a large number of lymphocytes. Three patients (1.5%; 95% CI: 0.5-4.3) sh...
The Annals of otology, rhinology, and laryngology, 2000
This study was performed to evaluate the ability of a dual-head gamma camera with 18fluoro-2-deox... more This study was performed to evaluate the ability of a dual-head gamma camera with 18fluoro-2-deoxy-glucose coincidence detection emission tomography (FDG-CDET) to detect primary tumors in patients with cervical lymph node metastases of head and neck squamous cell carcinoma from an unknown origin. From 60 patients with untreated head and neck squamous cell carcinoma, we selected 4 in whom no evidence of the primary's origin was found by the conventional methods used for the evaluation of head and neck tumors. In addition to the panendoscopy, chest radiography, a computed tomography (CT) scan, and FDG-CDET were performed. Both FDG-CDET and the CT scan located cervical lymph node metastases. In addition, FDG-CDET located the primary tumor in 3 of the 4 patients, and the tumors were confirmed with histopathologic findings. In contrast, the CT scan detected the primary tumor in none of them. FDG tomography performed on a coincidence gamma camera appears to be a successful new tool in...
Oral cavity cancers are frequent: 6,600 cases per year are diagnosed in France. Age of occurrence... more Oral cavity cancers are frequent: 6,600 cases per year are diagnosed in France. Age of occurrence is around 60. Tobacco is the main risk factor, especially when associated with alcohol. They occur de novo or by evolution of a precancerous lesion. Diagnosis is late in 70% of cases. They must be treated in specialized centers. Pretreatment check-up has to be done according to national guidelines. Treatment often implies primary surgery. Reconstructive surgery progresses allow for wide excisions and still acceptable quality of life. Radiotherapy, eventually potentialized, is usually performed post-operatively. Induction chemotherapy still needs to be evaluated in oral cancers, especially in an organ preservation purpose.
Oral cavity and pharyngeal cancers account for 75% of head and neck cancers and are the fourth mo... more Oral cavity and pharyngeal cancers account for 75% of head and neck cancers and are the fourth most spread cancer in men. Their incidence has decreased since 1980 in men (incidence from 2011 gives 13,930 for lip, oral cavity, pharyngeal and laryngeal carcinomas) but has increased in women, linked to the more recent smoking or alcohol intoxication in women. In addition to the smoking or alcohol consumption risk factors, the EBV role in nasopharyngeal carcinomas, HPV in the oropharyngeal carcinomas and professional exposures in paranasal sinuses cancers are recognized. Head and neck cancers are the fifth most common cancer in men mortality in France. Extended anatomical sites reflect the diagnostic's complexity specific to some locations (sinuses, nasopharynx), possible therapies and prognosis depending on the affected site.
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2007
Prospectively evaluate the impact of fluorodeoxyglucose-fluorine-18 positron emission tomography ... more Prospectively evaluate the impact of fluorodeoxyglucose-fluorine-18 positron emission tomography (FDG-PET) in the management of recurrence of advanced head and neck squamous cell carcinoma during the first year after treatment. Seventy patients were followed-up every 6 to 8 weeks during the first year after initial combined curative therapy. FDG-PET, together with conventional imaging and endoscopy were performed systematically at 1 year (group A) or prompted earlier in case of clinically suspicious recurrence (group B). The referring physician evaluated the impact of FDG-PET on the patient's management. Another clinician checked the pertinence of decisions. FDG-PET had a therapeutic impact in 8 of 43 group A patients and in 16 of 27 group B patients; the overall rate was 34%. This change was pertinent in 5 of 8 and 14 of 16 cases, respectively. Overall pertinence rate of decisions was 90% versus 70% without FDG-PET. FDG-PET had a significant overall therapeutic impact; the indu...
The Annals of otology, rhinology, and laryngology, 2002
A prospective study was performed on 18 adults to analyze disturbances of voice and respiratory f... more A prospective study was performed on 18 adults to analyze disturbances of voice and respiratory function in unilateral vocal fold paralysis and the role of medialization in the improvement of breath control. In addition to physical examination, an acoustic and aerodynamic analysis, as well as patient self-assessment, were performed both before and after medialization (14 fat injections, 4 thyroplasties) to evaluate voice and both phonatory breath control and respiratory function outcome. Preoperative and postoperative results, at short, middle, and long term, were compared to data from 14 control subjects and evaluated by statistical analysis. Preoperative acoustic and aerodynamic parameters were significantly disturbed in comparison to controls. Independently of the pulmonary status, medialization induced an improvement in most of the parameters at short and long terms, whereas a diminished effect was observed at middle term. Phonatory breath control, as evaluated by maximum phonat...
The Annals of otology, rhinology, and laryngology, 2002
This prospective study was performed to evaluate the ability of a dual-head gamma camera with flu... more This prospective study was performed to evaluate the ability of a dual-head gamma camera with fluorine-18 fluorodeoxyglucose coincidence detection emission tomography (FDG-CDET) to detect primary tumor and cervical lymph nodes in head and neck squamous cell carcinoma (HNSCC), and to show the response of the carcinoma to chemotherapy. The findings were compared with those of physical examination, computed tomography (CT), and histopathology, before treatment in 61 patients, and after induction chemotherapy in 34 of them. Before treatment, the primary was detected in 93%, 79%, and 95% of cases on panendoscopy, CT, and FDG-CDET, respectively. After chemotherapy, 34 patients were evaluable for response of the primary tumor. Surgical resection was performed in 23 of them: agreement with histopathologic results for response to treatment was 74%, 69%, and 78% for panendoscopy, CT, and FDG-CDET, respectively. No surgical resection was performed in 11 of the 34 patients, but biopsies were pe...
The Annals of otology, rhinology, and laryngology, 1999
Deficits of the lower cranial nerves (nerves IX, X, XI, and XII) occurring after treatment of sku... more Deficits of the lower cranial nerves (nerves IX, X, XI, and XII) occurring after treatment of skull base tumors may cause disabling swallowing disorders. To assess the mechanisms of swallowing disorders involved in such cases, we performed functional examinations: a videoendoscopic swallowing study and simultaneous manometry and videofluoroscopy in 7 patients. This study shows that the main mechanism of the swallowing disorders was a disturbance of the pharyngeal stage, including a decrease of pharyngeal propulsion, reduced laryngeal closure, and cricopharyngeal dysfunction, which led to aspiration. Decreased pharyngeal propulsion was found in 6 patients, with a very high correlation between fiberoscopy and simultaneous manometry-fluoroscopy. The responsibility of the upper esophageal sphincter in swallowing disorders was more difficult to assess. The role of the upper esophageal sphincter and pharyngeal propulsion in the onset of the problem is discussed in regard to the cricophary...
Temporary tracheotomies are commonly performed in head and neck cancer surgery. The aim of this s... more Temporary tracheotomies are commonly performed in head and neck cancer surgery. The aim of this study was to propose a minimum peak inspiratory flow (PIF) as a standardized simple tool for successful decannulation after surgery. Prospective review between January 2011 and June 2013 in a university teaching hospital. Fifty-six patients after head and neck cancer surgery requiring tracheotomies were included. Decannulation failure was defined as the need to recannulate patients within 24 hours. PIF values did not influence the decisions to decannulate or recannulate. Pre- and postdecannulation PIF values, measured with a handheld PIF meter (In-Check Dial), were registered until definitive decannulation. A total of 67 decannulation attempts were performed, with 47 positive and nine negative decannulations at the first attempt. Of the latter, seven were positive at the second attempt and two at the third. All patients were decannulated (mean, 6.3 days). PIF values of 40 L/min appear to ...
Electrical stimulation of the superior laryngeal nerve (SLN) can elicit reflex responses in the c... more Electrical stimulation of the superior laryngeal nerve (SLN) can elicit reflex responses in the cricothyroid (CT) and thyroarytenoid (TA) muscles. We made bilateral recordings of the responses evoked in these muscles in piglets by the stimulation of either the right or the left superior laryngeal nerve (SLN). The stimulus intensity was gradually increased to study the "persistence" of the responses. We observed a direct, ipsilateral response in the CT muscle, and reflex, ipsilateral and crossed responses in both CT and TA muscles. The ipsilateral or contralateral responses obtained in TA muscles, following stimulation of the left SLN, were significantly delayed in comparison with those evoked by stimulation of the right SLN. This delay cannot be explained by the difference in length between the right and the left recurrent laryngeal nerves, but rather by an asymmetry in the sensory afferent pathway. The functional significance of this observation remains to be determined.
Purpose: To evaluate prospectively autologous fat injection as a treatment for leakage around tra... more Purpose: To evaluate prospectively autologous fat injection as a treatment for leakage around tracheoesophageal puncture. Patients and Methods: For ten patients who exhibited leakage of saliva or liquid around their tracheoesophageal puncture, autologous fat injection was carried out into the tracheoesophageal wall around the maintained prosthesis. Short-term success was evaluated at one month, and long-term follow-up was continued as long as the patients remained alive. The effectiveness of the procedure was evaluated based on the presence or absence of leakage around the puncture as the patient swallowed methylene blue liquid. Patients were adjudged completely improved when no leakage of blue liquid was observed, partially improved when a slight stasis was evident, or unimproved when a marked leakage of blue liquid was noted. Results: Short-term success was achieved for 6 patients, 2 patients partially improved, and the procedure failed for 2 others. Long-term success (from 10 to 65 months) was achieved in all 4 of the completely improved patients who were free of disease, including 1 patient who required an additional injection. Removal of the puncture was later carried out in the 2 others for cervical node metastases or tracheal tumor. Definitive or transitional puncture closure or removal of the prosthesis was required in 3 partially or unimproved patients, whereas 1 partially improved patient died of lung metastasis 3 months later. Conclusions: Fat injection around a voice prosthesis is a procedure that may be conducted as an alternative to other conservative techniques to decrease the size of the puncture. Close endoscopic observation is required however to eliminate secondary tumor that might expand the size of the puncture. (Am J Otolaryngol 2002;23:345-350. Copyright 2002, Elsevier Science (USA). All rights reserved.)
International journal of cancer. Journal international du cancer, Jan 26, 2015
A fraction of oropharyngeal cancer (OPC), especially in the tonsil, is caused by human papillomav... more A fraction of oropharyngeal cancer (OPC), especially in the tonsil, is caused by human papillomavirus (HPV), mainly HPV16. Non-invasive diagnostic methods to detect precancerous lesions in the tonsil would be useful, e.g., liquid-based cytology (LBC). However, ill-characterized precancerous lesions may be hidden in the depth of the tonsillar crypts. We therefore conducted a study on HPV and tonsillar precancerous lesions to evaluate, among other things, the utility of LBC obtained by deep brushing of the crypts. Two hundred non-paediatric patients (mean age: 30.3 years) who underwent tonsillectomy for infection-related conditions (69%) or other conditions (mainly obstructive sleep apnoea, 31%) were included. An ultra-sensitive Luminex bead-based platform was used to test for the DNA of 21 mucosal HPV types. 56% of slides were unsatisfactory due to low number of squamous epithelial cells or the masking effect of a large number of lymphocytes. Three patients (1.5%; 95% CI: 0.5-4.3) sh...
The Annals of otology, rhinology, and laryngology, 2000
This study was performed to evaluate the ability of a dual-head gamma camera with 18fluoro-2-deox... more This study was performed to evaluate the ability of a dual-head gamma camera with 18fluoro-2-deoxy-glucose coincidence detection emission tomography (FDG-CDET) to detect primary tumors in patients with cervical lymph node metastases of head and neck squamous cell carcinoma from an unknown origin. From 60 patients with untreated head and neck squamous cell carcinoma, we selected 4 in whom no evidence of the primary's origin was found by the conventional methods used for the evaluation of head and neck tumors. In addition to the panendoscopy, chest radiography, a computed tomography (CT) scan, and FDG-CDET were performed. Both FDG-CDET and the CT scan located cervical lymph node metastases. In addition, FDG-CDET located the primary tumor in 3 of the 4 patients, and the tumors were confirmed with histopathologic findings. In contrast, the CT scan detected the primary tumor in none of them. FDG tomography performed on a coincidence gamma camera appears to be a successful new tool in...
Oral cavity cancers are frequent: 6,600 cases per year are diagnosed in France. Age of occurrence... more Oral cavity cancers are frequent: 6,600 cases per year are diagnosed in France. Age of occurrence is around 60. Tobacco is the main risk factor, especially when associated with alcohol. They occur de novo or by evolution of a precancerous lesion. Diagnosis is late in 70% of cases. They must be treated in specialized centers. Pretreatment check-up has to be done according to national guidelines. Treatment often implies primary surgery. Reconstructive surgery progresses allow for wide excisions and still acceptable quality of life. Radiotherapy, eventually potentialized, is usually performed post-operatively. Induction chemotherapy still needs to be evaluated in oral cancers, especially in an organ preservation purpose.
Oral cavity and pharyngeal cancers account for 75% of head and neck cancers and are the fourth mo... more Oral cavity and pharyngeal cancers account for 75% of head and neck cancers and are the fourth most spread cancer in men. Their incidence has decreased since 1980 in men (incidence from 2011 gives 13,930 for lip, oral cavity, pharyngeal and laryngeal carcinomas) but has increased in women, linked to the more recent smoking or alcohol intoxication in women. In addition to the smoking or alcohol consumption risk factors, the EBV role in nasopharyngeal carcinomas, HPV in the oropharyngeal carcinomas and professional exposures in paranasal sinuses cancers are recognized. Head and neck cancers are the fifth most common cancer in men mortality in France. Extended anatomical sites reflect the diagnostic's complexity specific to some locations (sinuses, nasopharynx), possible therapies and prognosis depending on the affected site.
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2007
Prospectively evaluate the impact of fluorodeoxyglucose-fluorine-18 positron emission tomography ... more Prospectively evaluate the impact of fluorodeoxyglucose-fluorine-18 positron emission tomography (FDG-PET) in the management of recurrence of advanced head and neck squamous cell carcinoma during the first year after treatment. Seventy patients were followed-up every 6 to 8 weeks during the first year after initial combined curative therapy. FDG-PET, together with conventional imaging and endoscopy were performed systematically at 1 year (group A) or prompted earlier in case of clinically suspicious recurrence (group B). The referring physician evaluated the impact of FDG-PET on the patient's management. Another clinician checked the pertinence of decisions. FDG-PET had a therapeutic impact in 8 of 43 group A patients and in 16 of 27 group B patients; the overall rate was 34%. This change was pertinent in 5 of 8 and 14 of 16 cases, respectively. Overall pertinence rate of decisions was 90% versus 70% without FDG-PET. FDG-PET had a significant overall therapeutic impact; the indu...
The Annals of otology, rhinology, and laryngology, 2002
A prospective study was performed on 18 adults to analyze disturbances of voice and respiratory f... more A prospective study was performed on 18 adults to analyze disturbances of voice and respiratory function in unilateral vocal fold paralysis and the role of medialization in the improvement of breath control. In addition to physical examination, an acoustic and aerodynamic analysis, as well as patient self-assessment, were performed both before and after medialization (14 fat injections, 4 thyroplasties) to evaluate voice and both phonatory breath control and respiratory function outcome. Preoperative and postoperative results, at short, middle, and long term, were compared to data from 14 control subjects and evaluated by statistical analysis. Preoperative acoustic and aerodynamic parameters were significantly disturbed in comparison to controls. Independently of the pulmonary status, medialization induced an improvement in most of the parameters at short and long terms, whereas a diminished effect was observed at middle term. Phonatory breath control, as evaluated by maximum phonat...
The Annals of otology, rhinology, and laryngology, 2002
This prospective study was performed to evaluate the ability of a dual-head gamma camera with flu... more This prospective study was performed to evaluate the ability of a dual-head gamma camera with fluorine-18 fluorodeoxyglucose coincidence detection emission tomography (FDG-CDET) to detect primary tumor and cervical lymph nodes in head and neck squamous cell carcinoma (HNSCC), and to show the response of the carcinoma to chemotherapy. The findings were compared with those of physical examination, computed tomography (CT), and histopathology, before treatment in 61 patients, and after induction chemotherapy in 34 of them. Before treatment, the primary was detected in 93%, 79%, and 95% of cases on panendoscopy, CT, and FDG-CDET, respectively. After chemotherapy, 34 patients were evaluable for response of the primary tumor. Surgical resection was performed in 23 of them: agreement with histopathologic results for response to treatment was 74%, 69%, and 78% for panendoscopy, CT, and FDG-CDET, respectively. No surgical resection was performed in 11 of the 34 patients, but biopsies were pe...
The Annals of otology, rhinology, and laryngology, 1999
Deficits of the lower cranial nerves (nerves IX, X, XI, and XII) occurring after treatment of sku... more Deficits of the lower cranial nerves (nerves IX, X, XI, and XII) occurring after treatment of skull base tumors may cause disabling swallowing disorders. To assess the mechanisms of swallowing disorders involved in such cases, we performed functional examinations: a videoendoscopic swallowing study and simultaneous manometry and videofluoroscopy in 7 patients. This study shows that the main mechanism of the swallowing disorders was a disturbance of the pharyngeal stage, including a decrease of pharyngeal propulsion, reduced laryngeal closure, and cricopharyngeal dysfunction, which led to aspiration. Decreased pharyngeal propulsion was found in 6 patients, with a very high correlation between fiberoscopy and simultaneous manometry-fluoroscopy. The responsibility of the upper esophageal sphincter in swallowing disorders was more difficult to assess. The role of the upper esophageal sphincter and pharyngeal propulsion in the onset of the problem is discussed in regard to the cricophary...
Temporary tracheotomies are commonly performed in head and neck cancer surgery. The aim of this s... more Temporary tracheotomies are commonly performed in head and neck cancer surgery. The aim of this study was to propose a minimum peak inspiratory flow (PIF) as a standardized simple tool for successful decannulation after surgery. Prospective review between January 2011 and June 2013 in a university teaching hospital. Fifty-six patients after head and neck cancer surgery requiring tracheotomies were included. Decannulation failure was defined as the need to recannulate patients within 24 hours. PIF values did not influence the decisions to decannulate or recannulate. Pre- and postdecannulation PIF values, measured with a handheld PIF meter (In-Check Dial), were registered until definitive decannulation. A total of 67 decannulation attempts were performed, with 47 positive and nine negative decannulations at the first attempt. Of the latter, seven were positive at the second attempt and two at the third. All patients were decannulated (mean, 6.3 days). PIF values of 40 L/min appear to ...
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