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Annales Francaises d'Oto-Rhino-Laryngologie et de pathologie cervico-faciale - Vol. 124 - N° 6 - p. 309-313
Research Interests: Iconography and Art
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Purpose To develop a European White Paper document on oropharyngeal dysphagia (OD) in head and neck cancer (HNC). There are wide variations in the management of OD associated with HNC across Europe. Methods Experts in the management of... more
Purpose To develop a European White Paper document on oropharyngeal dysphagia (OD) in head and neck cancer (HNC). There are wide variations in the management of OD associated with HNC across Europe. Methods Experts in the management of specific aspects of OD in HNC across Europe were delegated by their professional medical and multidisciplinary societies to contribute to this document. Evidence is based on systematic reviews, consensus-based position statements, and expert opinion. Results Twenty-four sections on HNC-specific OD topics. Conclusion This European White Paper summarizes current best practice on management of OD in HNC, providing recommendations to support patients and health professionals. The body of literature and its level of evidence on diagnostics and treatment for OD in HNC remain poor. This is in the context of an expected increase in the prevalence of OD due to HNC in the near future. Contributing factors to increased prevalence include aging of our European po...
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La chirurgie de l'otospongiose a connu une etape majeure en 1956 avec la stapedectomie. Les progres de cette chirurgie ont permis de diminuer les complications sans les faire disparaitre et de donner un taux de satisfaction tres... more
La chirurgie de l'otospongiose a connu une etape majeure en 1956 avec la stapedectomie. Les progres de cette chirurgie ont permis de diminuer les complications sans les faire disparaitre et de donner un taux de satisfaction tres eleve. L'alternative a la chirurgie pour les surdites moderees que sont les aides auditives a beneficie de progres considerables. L'implantation cochleaire permet d'ameliorer l'audition dans les formes d'otospongiose evoluees lorsque l'association de la chirurgie stapedienne et d'une aide auditive s'avere inefficace. Ces progres ont des repercussions sur les indications operatoires.
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OBJECTIVE To develop and assess the feasibility, repeatability, and safety of an ultrasound-guided technique to stimulate the first cervical nerve (FCN) at the level of the alar foramen of the atlas of horses. ANIMALS 4 equine cadavers... more
OBJECTIVE To develop and assess the feasibility, repeatability, and safety of an ultrasound-guided technique to stimulate the first cervical nerve (FCN) at the level of the alar foramen of the atlas of horses. ANIMALS 4 equine cadavers and 6 clinically normal Standardbreds. PROCEDURES In each cadaver, the FCN pathway was determined by dissection, and any anastomosis between the first and second cervical nerves was identified. Subsequently, each of 6 live horses underwent a bilateral ultrasound-guided stimulation of the FCN at the alar foramen 3 times at 3-week intervals. After each procedure, horses were examined daily for 5 days. RESULTS In each cadaver, the FCN passed through the alar foramen; a communicating branch between the FCN and the accessory nerve and anastomoses between the ventral branches of the FCN and second cervical nerve were identified. The anastomoses were located in the upper third of the FCN pathway between the wing of the atlas and the nerve's entry in the ...
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Introduction: The alveolar capillary bed, which appears essential for the maintenance of alveolar septa, is altered in pulmonary emphysema. Until recently, techniques that allow its analysis in vivo in spontaneously breathing conditions... more
Introduction: The alveolar capillary bed, which appears essential for the maintenance of alveolar septa, is altered in pulmonary emphysema. Until recently, techniques that allow its analysis in vivo in spontaneously breathing conditions were lacking. Fibered confocal fluorescence microscopy (FCFM) is a new technique that enables distal lung microstructures imaging in vivo. FCFM can be coupled with I.V fluorescein injection to image the pulmonary capillary network. The aim of this study was to assess the lung microcirculation in vivo using FCFM and I.V fluorescein in rats with experimental emphysema. Results: In vivo pulmonary microcirculation imaging was possible in 7/7 elastase animals and in 6/7 controls. Using FCFM, intercapillary distances and alveolar facets diameters were found significantly higher in the elastase group compared with controls (49.5 vs. 41.8 µm p < 0.001, and 118.5 vs. 95.1 µm p < 0.001, respectively). Ex vivo mean interwall distance (MIWD) was correlated with the alveolar facets diameters measured in vivo (rs = 0.65 ; p = 0.016). Methods: 14 Sprague-Dawley rats were assigned to intratracheal instillation of porcine pancreatic elastase (n = 7) or saline (n = 7). The subpleural microcirculation was assessed using FCFM in spontaneously breathing rats, through a 2mm thoracic window using a continuous aspiration system, after I.V. injection of fluorescein-dextran. FCFM sequences were recorded and the image analysis was performed separately by two observers, blindly to the animal group. Fluorescence intensity (FI), maximal intercapillary distances, and alveolar facets diameters measured with FCFM were compared between groups, and to ex vivo lung morphometric measurements (MIWD). Conclusion: FCFM allows the quantitative assessment of the microcirculation alterations due to emphysema in vivo.
Research Interests: Pathology, Biology, Microcirculation, Confocal Microscopy, Lung, and 3 moreIn Vivo, Confocal, and Elastase
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Research Interests: Medicine, Humans, Female, Male, Electromagnetic Fields, and 15 moreAbdominal Muscles, Electromyography, Medical Physiology, Digestive System, Adult, Esophagus, Contraction, Healthy Subjects, Muscle Activity, Hydrostatic Pressure, Glottis, Constriction, Deglutition, Cardiovascular medicine and haematology, and Electric stimulation
To evaluate the biomechanical properties of the principal prosthetic materials currently used in genital prolapse surgery. Based on an animal model of incisional abdominal hernia, 40 adult rabbits were implanted. Four 2.5 cm x 2.5 cm... more
To evaluate the biomechanical properties of the principal prosthetic materials currently used in genital prolapse surgery. Based on an animal model of incisional abdominal hernia, 40 adult rabbits were implanted. Four 2.5 cm x 2.5 cm parietal defects, were created in the abdominal fascia and muscles while respecting the peritoneum. For each rabbit, the defect was repaired by four different large pore size prostheses which varied according to the material used: two with monofilament of heavy (75 g/m(2)) or low (38 g/m(2)) weight polypropylene (PP), and two with multifilament of heavy (115 g/m(2)) or low (59 g/m(2)) weight polyethylene-terephthalate (PET). Animals were sacrificed in groups of 10 after 14, 30, 90 and 180 days to evaluate contraction, solidity and elasticity of the prostheses. PP and PET retracted, independently of their weight, in 81.25% and 20% respectively. Intensity of contraction was not predictable but median value of retracted surface was 14% with PP, none with PET. Contraction settled quickly after tissue integration and did not subsequently occur. Heavyweight PET was considered the most solid material (70 N cm(-1)), low-weight PP the most fragile (20 N cm(-1)). Heavy forms of PP or PET resisted better to the rupture than the light forms which were sometimes insufficient to resist the extreme values of the human abdominal pressure (16 N cm(-1)). PP was more flexible than PET, but PET was the only form which was able to support extreme values of the abdominal pressure and remain in the elastic range. Duration of implantation did not modify solidity or elasticity of the prostheses. In our abdominal rabbit model, as regards mechanical properties, heavyweight PET seems to be the optimal biomaterial.
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Objectives The aim of this study was to review the different types of genetic deafness. Methods We describe syndromic and isolated sensorineural deafness and transmission deafness. Results Genetic sensorineural syndromic deafness... more
Objectives The aim of this study was to review the different types of genetic deafness. Methods We describe syndromic and isolated sensorineural deafness and transmission deafness. Results Genetic sensorineural syndromic deafness represents 30% of cases of genetic deafness. A frequent cause is Pendred syndrome, which associates congenital sensorineural deafness with goitre and malformations of the inner ear which can be identified on computed tomography scan. Isolated deafness which is responsible for 70% of cases of genetic deafness is then outlined. Among the different types of isolated deafness, 80% are autosomal recessive disorders. A frequent form of autosomal recessive deafness is due to mutations in the connexin 26 gene. Lastly, we detail transmission deafness dominated by aplasia. Major aplasia is characterized by a malformation of the external ear associated with malformations of the middle ear whereas, minor aplasia corresponds to a malformation of the middle ear, sometimes associated with minor external ear malformations. Conclusion For each type of deafness we propose a systematic assessment.
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L'apparition d'une dyspnee inspiratoire chez une patiente operee plusieurs annees auparavant d'une thyroidectomie totale pour maladie de Basedow, a revele un trouble de la mobilite cordale bilaterale avec syncinesies... more
L'apparition d'une dyspnee inspiratoire chez une patiente operee plusieurs annees auparavant d'une thyroidectomie totale pour maladie de Basedow, a revele un trouble de la mobilite cordale bilaterale avec syncinesies laryngees. La deterioration de l'etat ventilatoire, a distance d'une arytenoidectomie suivie de cordotomie transverse posterieure controlaterale, a fait proposer l'injection de toxine botulique dans les muscles thyroarytenoidiens et interarytenoidiens. L'amelioration obtenue, sans alteration de la phonation justifie la presentation de cette observation inhabituelle.
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La simple suture d'un nerf larynge ne permet pas la rehabilitation fonctionnelle d'un hemilarynx paralyse. C'est la neurotisation separee des muscles larynges qui permet experimentalement de parvenir a cet objectif. Le... more
La simple suture d'un nerf larynge ne permet pas la rehabilitation fonctionnelle d'un hemilarynx paralyse. C'est la neurotisation separee des muscles larynges qui permet experimentalement de parvenir a cet objectif. Le transplant nerveux phrenique est adapte a la reinnervation du muscle abducteur de la corde vocale (CAP). Dans ce travail nous avons etudie ses possibilites d'utilisation, tout en preservant la fonction diaphragmatique. Apres avoir fait le point de la litterature sur la rehabilitation des fonctions laryngees (reinnervation et stimulation e��lectrique) ainsi que sur la transplantation de cet organe , nous avons detaille le role des differentes portions du diaphragme et les consequences de sa denervation unilaterale. Puis nous avons presente nos travaux sur ce sujet. Apres avoir realise chez le chien la reinervation experimentale d'un hemilarynx pas e nerf phreniqe et une branche du nerf grand hypoglosse (XII) , nous avons etudie chez le lapin queles ...
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Objectifs: le bilan des lesions glottiques necessite un scanner et une endoscopie. L'etude des atteintes tumorales et notamment cartilagineuse, element majeur de la decision therapeutique, semble amelioree par l'imagerie par... more
Objectifs: le bilan des lesions glottiques necessite un scanner et une endoscopie. L'etude des atteintes tumorales et notamment cartilagineuse, element majeur de la decision therapeutique, semble amelioree par l'imagerie par resonance magnetique. Notre but etait de determiner l'examen, scanner ou IRM, le plus performant pour le diagnostic de l'extension tumorale. Materiel et methodes: une etude prospective realisee entre octobre 2006 et mars 2008 a inclus 7 patients atteints d'un cancer glottique operable (T1-T2 clinique). Les donnees des 2 examens d'imagerie etaient comparees aux resultats anatomopathologiques des pieces d'exerese chirurgicale. Resultats: les 2 examens sont performants mais plus specifiques (90 %) que sensibles (74 %). Les regions anatomiques difficiles a interpreter sont la commissure anterieure, les ventricules, la sous-glotte, les cartilages thyroide et arytenoides, Conclusion: le scanner reste l'examen de reference. L'IRM est...
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Bilateral vocal fold immobility is a challenging life-threatening problem involving multiple treatment options and nuanced clinical decision making. We aim to provide relevant background on the etiology, diagnosis, and management of... more
Bilateral vocal fold immobility is a challenging life-threatening problem involving multiple treatment options and nuanced clinical decision making. We aim to provide relevant background on the etiology, diagnosis, and management of bilateral vocal fold movement impairment (BVFMI). Over the last 20 years, the management of bilateral vocal fold immobility has advanced significantly with the addition of multiple endoscopic approaches as well as procedures with the goal of returning dynamic function to the larynx, among them: selective reinnervation. Chemodenervation has also demonstrated promising results as a temporizing procedure in appropriately selected patients with BVFMI. Tracheostomy remains the mainstay of emergent treatment for airway obstruction secondary to bilateral vocal fold immobility. However, recent advances in endoscopic approaches allow for avoidance of tracheostomy in many patients. Developments in dynamic procedures with the aim of restoring laryngeal function all...
Phoniatricians usually have the key role when dealing with a voice disorder, supported by logopedists/speech-language pathologists. Cooperation with other medical or non-medical disciplines may contribute when needed. Fundamentals,... more
Phoniatricians usually have the key role when dealing with a voice disorder, supported by logopedists/speech-language pathologists. Cooperation with other medical or non-medical disciplines may contribute when needed. Fundamentals, general goals and the structure of voice therapy are followed by a survey of specific methods and techniques. No matter what kind of technique is used, treatment strategy is inevitably based on pathophysiological mechanisms of a disorder and the patient’s state as a whole. Voice therapy is a dynamic process and not an application procedure for a stable phonatory pattern or a list of exercises for every patient. This integrative model for treatment of voice disorders includes additional skills and knowledge of mechanisms of applications, stages of behavioural treatment, phases of motor learning, stages of voice therapy and steps of a given technique. Functional disorders of the singing voice (dysodia) require additional and specific expertise, especially i...
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Background: Posttraumatic facial paralysis is a disabling condition. Current surgical management by faciofacial nerve suture provides limited recovery. To improve the outcome, the authors evaluated an add-on strategy based on a syngeneic... more
Background: Posttraumatic facial paralysis is a disabling condition. Current surgical management by faciofacial nerve suture provides limited recovery. To improve the outcome, the authors evaluated an add-on strategy based on a syngeneic transplantation of nasal olfactory stem cells in a rat model of facial nerve injury. The main readouts of the study were the recording of whisking function and buccal synkinesis. Methods: Sixty rats were allocated to three groups. Animals with a 2-mm facial nerve loss were repaired with a femoral vein, filled or not with olfactory stem cells. These two groups were compared to similarly injured rats but with a faciofacial nerve suture. Olfactory stem cells were purified from rat olfactory mucosa. Three months after surgery, facial motor performance was evaluated using video-based motion analysis and electromyography. Synkinesis was assessed by electromyography, using measure of buccal involuntary movements during blink reflex, and double retrograde labeling of regenerating motoneurons. Results: The authors’ study reveals that olfactory stem cell transplantation induces functional recovery in comparison to nontransplanted and faciofacial nerve suture groups. They significantly increase (1) maximal amplitude of vibrissae protraction and retraction cycles and (2) angular velocity during protraction of vibrissae. They also reduce buccal synkinesis, according to the two techniques used. However, olfactory stem cell transplantation did not improve axonal regrowth of the facial nerve, 3 months after surgery. Conclusions: The authors show here that the adjuvant strategy of syngeneic transplantation of olfactory stem cells improves functional recovery. These promising results open the way for a phase I clinical trial based on the autologous engraftment of olfactory stem cells in patients with a facial nerve paralysis.
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Prior to selective bilateral laryngeal reinnervation there must be no inspiratory PCA laryngeal EMG activity. The only way to properly assess for cricoarytenoid joint ankylosis and interarytenoid synechiae is under deep paralysis. Use... more
Prior to selective bilateral laryngeal reinnervation there must be no inspiratory PCA laryngeal EMG activity. The only way to properly assess for cricoarytenoid joint ankylosis and interarytenoid synechiae is under deep paralysis. Use respiratory auscultation to confirm paradoxical inspiratory adduction versus purposeful adduction.
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Demonstration of voice improvement and long‐term stability following nonselective unilateral laryngeal reinnervation (ULR) in patients with unilateral vocal fold paralysis (UVFP) and severe denervation. A subgroup of patients on whom ULR... more
Demonstration of voice improvement and long‐term stability following nonselective unilateral laryngeal reinnervation (ULR) in patients with unilateral vocal fold paralysis (UVFP) and severe denervation. A subgroup of patients on whom ULR was performed as a salvage technique following unsuccessful medialization was analyzed separately.
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A significant step forward in otosclerosis surgery was made in 1956 with the advent of stapedectomy. This led to a significant reduction in surgical complications and to a high level of patient satisfaction. Hearing aids are the... more
A significant step forward in otosclerosis surgery was made in 1956 with the advent of stapedectomy. This led to a significant reduction in surgical complications and to a high level of patient satisfaction. Hearing aids are the alternative to surgery, and have themselves undergone considerable technical improvements. In advanced otosclerosis, cochlear implants can improve hearing when stapes surgery and a conventional hearing aid are inadequate. These advances are modifying the surgical indications.
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Spinal cord injury (SCI) induces permanent loss of sensitive and motor functions below the injury level. To date, a wide variety of cells has been used as biotherapies to cure SCI in different animal paradigms. Specifically, olfactory... more
Spinal cord injury (SCI) induces permanent loss of sensitive and motor functions below the injury level. To date, a wide variety of cells has been used as biotherapies to cure SCI in different animal paradigms. Specifically, olfactory ensheathing cells (OECs) is one of the most promising. Indeed, OECs have been shown to enhance recovery in many animal studies. Moreover, OECs transplantation has been applied to a paraplegic patient and have shown beneficial effects. However, it has been reported that the significant level of recovery varies among different patients. Therefore, it is of primary importance to enhance the regenerative efficiency of OECs for better translations. Recently, it has been shown that inhibiting ADAMTS4 expression in glial cells in vitro increases their synthesis of neurotrophic factors. We hypothesized that the expression of neurotrophic factors secreted by OECs can be increased by the deletion of ADAMTS4. Taking advantage of ADAMTS4-/- mouse line we produce ADAMTS4 deficient primary OEC cultures and then we investigated their regenerative potential after SCI. By using Q-PCR, bioluminescence imaging, measurement of locomotor activity, electrophysiological studies and immunohistochemistry, our results show that ADAMTS4-/- bOECs primary cultures upregulate their trophic factor expression in vitro, and that the transplantation of ADAMTS4-/- bOECs in a severe SCI model increases functional recovery and tissue repair in vivo. Altogether our study reveals, for the first time, that primary bOEC cultures transplantation can be potentialized by inhibition of the expression of ADAMTS4.
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To evaluate the benefit of cetuximab (Cx) addition to platinum-based and 5-fluorouracil chemotherapy (PFU) in unselected recurrent and/or metastatic head and neck cancer patients (R/MHNC) according to KRAS-LCS6 variant status. All... more
To evaluate the benefit of cetuximab (Cx) addition to platinum-based and 5-fluorouracil chemotherapy (PFU) in unselected recurrent and/or metastatic head and neck cancer patients (R/MHNC) according to KRAS-LCS6 variant status. All patients who received at least two PFU ± Cx cycles from 2004 to 2014 were retrospectively included into to two distinct study periods according to Cx implementation: patients treated by PFU alone before 2009 and those treated by PFU + Cx from 2009. Primary objective was to evaluate the progression-free survival (PFS) between the two groups. Secondary objectives were to analyze the overall survival (OS) between the two groups and the prognostic impact of KRAS-LCS6 variant. Factors associated with survival were determined by a Cox multivariate analysis including age, WHO performance status (PS), type of treatment, KRAS-LCS6 variant, Charlson&#39;s score and p16 status. Overall, 134 patients were included: 59 (44%) in PFU group and 75 (56%) in PFU + Cx group. Baseline characteristics were well balanced including 30% of patients with 2-3 PS. Median PFS was significantly improved in PFU + Cx group compared to PFU group (6.1 vs 4.4 months, respectively, HR 0.68, p = 0.02) and with a trend for better OS. A KRAS-LCS6 variant was found in 27 (25%) of samples without prognostic impact neither in whole population nor according to treatment. In multivariate analysis, addition of Cx to PFU was the only factor significantly associated with a better PFS (p = 0.01, HR 0.6). Our results suggest that PFU + Cx combination may be effective in unselected population of R/MHNC regardless the KRAS-LCS6 variant status.
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Introduction: With a view to simplifying surgical techniques for selective laryngeal reinnervation, we addressed the question of whether it is feasible to receive additional innervation by a partially denervated muscle using an infrahyoid... more
Introduction: With a view to simplifying surgical techniques for selective laryngeal reinnervation, we addressed the question of whether it is feasible to receive additional innervation by a partially denervated muscle using an infrahyoid muscle model. Methods: In 90 rats (6 groups of 15), phrenic nerve transfer was used to reinnervate the sternothyroid muscle. In some cases, residual innervation by the original nerve was present. Three months later we performed electromyographic studies, contraction strength measurements, histologic assessment, and retrograde labeling. Results: Muscles reinnervated by the phrenic nerve had a greater “dual‐response” rate (in terms of nerve latency, contraction strength, and retrograde labeling) than muscles in the control groups. Discussion: The phrenic nerve can impart its inspiratory properties to an initially denervated strap muscle—even when residual innervation is present. The preservation of contractile potential confirmed the feasibility of dual innervation in a previously injured muscle. Muscle Nerve 59:108–115, 2019
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The aim of this study was to assess the effect of submental sensitive transcutaneous electrical stimulation (SSTES) on pharyngeal cortical representation after the creation of an oropharyngeal cortical virtual lesion in healthy subjects.... more
The aim of this study was to assess the effect of submental sensitive transcutaneous electrical stimulation (SSTES) on pharyngeal cortical representation after the creation of an oropharyngeal cortical virtual lesion in healthy subjects. Motor-evoked potential amplitude of the mylohyoid muscles was measured with transcranial magnetic stimulation (TMS), the oropharyngeal cortex was mapped by cartography, and videofluoroscopic parameters of swallowing function were measured before and after SSTES (at the end of SSTES [0min] and at 30 and 60min), after the creation of a cortical virtual lesion (repetitive TMS, 1Hz, 20min on the dominant swallowing hemisphere). Nine subjects completed the study. After 20min of SSTES, motor-evoked potential amplitude increased (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05), as did swallow reaction time after repetitive TMS, as seen on videofluoroscopy, which was reversed after electrical stimulation. On cortical mapping, the number of points with a cortical response increased in the dominant lesioned hemisphere (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05), remaining constant at 60min (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05). SSTES may be effective for producing cortical plasticity for mylohyoid muscles and reverses oropharyngeal cortical inhibition in healthy subjects. It could be a simple non-invasive way to treat post-stroke dysphagia.
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Hypnotherapy is currently used for tinnitus therapy in our university hospital. The aim of this study was to evaluate its efficacy. This study was performed on 110 patients suffering from distressing tinnitus. They were treated during... more
Hypnotherapy is currently used for tinnitus therapy in our university hospital. The aim of this study was to evaluate its efficacy. This study was performed on 110 patients suffering from distressing tinnitus. They were treated during five sessions with hypnotherapy, supplemented by instruction on self-hypnotherapy. A subjective evaluation was done by the practitioner at the end of the sessions of hypnotherapy. Then a questionnaire on psychologic distress (Wilson 1991) was sent retrospectively to the patients. We received 65 responses which were used for this study. Before treatment, the mean value of the Wilson score was 54 (28-104). After treatment, it was: 31 (0-86). 69% of the patients felt an improvement &gt; or = 5 points Wilson score. These results were compared with the evaluation carried out by the practitioner at the end of the sessions of hypnosis. There was a &quot;significant correlation&quot; between the evaluation of the felt benefice, analyzed by the practitioner at the end of the sessions of hypnosis, and by the patient questioned long after the treatment. These results had significant correlation with the evaluation made by the therapist at the end of the five sessions of hypnotherapy. They show, how effective (68% improvement) this therapeutic approach can be. Hypnotherapy can be regarded as an effective treatment against distressing tinnitus.
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The objective of this retrospective study was to present the authors&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; experience on the management of labyrinthine fistula secondary to cholesteatoma. 695 patients, who underwent... more
The objective of this retrospective study was to present the authors&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; experience on the management of labyrinthine fistula secondary to cholesteatoma. 695 patients, who underwent tympanoplasty for cholesteatoma, in a University Hospital between 1993 and 2013 were reviewed, to select only those with labyrinthine fistulas. 42 patients (6%) had cholesteatoma complicated by fistula of the lateral semicircular canal (LSCC). The following data points were collected: symptoms, pre- and postoperative clinical signs, surgeon, CT scan diagnosis, fistula type, surgical technique, preoperative vestibular function and audiometric outcomes. Most frequent symptoms were unspecific, such as otorrhea, hearing loss and dizziness. However, preoperative high-resolution computed tomography predicted fistula in 88 %. Using the Dornhoffer and Milewski classification, 16 cases (38 %) were identified as stage 1, 22 (52 %) as stage II, and 4 (10 %) as stage III. The choice between open or closed surgical procedure was independent of the type of fistulae. The cholesteatoma matrix was completely removed from the fistula and immediately covered by autogenous material. In eight patients (19 %), the canal was drilled with a diamond burr before sealing with autologous tissue. After surgery, hearing was preserved or improved in 76 % of the patients. There was no statistically significant relationship between the extent of the labyrinthine fistula and the hearing outcome. In conclusion, a complete and nontraumatic removal of the matrix cholesteatoma over the fistula in a one-staged procedure and its sealing with bone dust and fascia temporalis, with sometimes exclusion of the LSCC, is a safe and effective procedure to treat labyrinthine fistula.
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Las manifestaciones clinicas y el tratamiento de las paralisis laringeas son muy diferentes dependiendo de si la paralisis es unilateral o bilateral y de la posicion de la cuerda o cuerdas vocales paralizadas. Las diferentes... more
Las manifestaciones clinicas y el tratamiento de las paralisis laringeas son muy diferentes dependiendo de si la paralisis es unilateral o bilateral y de la posicion de la cuerda o cuerdas vocales paralizadas. Las diferentes intervenciones para las paralisis laringeas unilaterales se dirigen a mejorar la fonacion, pues la disfonia es el signo funcional predominante en estos casos. Las intervenciones para las paralisis laringeas bilaterales tienen como finalidad mejorar la respiracion, mientras que el resultado en terminos de calidad de la voz pasa al segundo plano. Las intervenciones han evolucionado para ser cada vez menos invasivas, gracias a las tecnicas endoscopicas y al uso del laser, pero tambien para lograr cada vez mejores resultados funcionales gracias a las tecnicas de reinervacion.
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Objective.Microbiological and histological evaluation of tonsillectomy specimens has been performed routinely at our department for many years. We designed the present study to evaluate this practice. Patients and methods.We... more
Objective.Microbiological and histological evaluation of tonsillectomy specimens has been performed routinely at our department for many years. We designed the present study to evaluate this practice. Patients and methods.We retrospectively reviewed 402 tonsillectomies done at the otorhinolaryngology depart- ment of the Rouen Teaching Hospital from January 1999 to April 2003. Data from adults and pediatric patients were analyzed separately. Results.
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Infiltrating lipomas are rare benign tumors. Several cases have previously been reported in the oral cavity but only three cases have been reported to date in children. We report a case of a 7-year-old child with an infiltrating lipoma of... more
Infiltrating lipomas are rare benign tumors. Several cases have previously been reported in the oral cavity but only three cases have been reported to date in children. We report a case of a 7-year-old child with an infiltrating lipoma of the neck and a posterior extension to the fourth and fifth cervical roots and the vertebral artery. The absence of any neurological signs, negative clinical and radiological examination results, as well as, the surgical risk of total removal and high rate of recurrence suggested a period of watchful waiting. After 5 years, the patient&#39;s clinical and radiological characteristics remain stable. A review of the literature regarding this pathology in the head and neck area, in both children and adults is also presented.