ABSTRACT
INTRODUCTION: A multitude of treatment modalities have been proposed in management of early laryngeal squamous cell cancers(SCC). With the improvement of survival rates of these tumours, the degree of voice impairment after treatment became a deciding parameter in the choice of treatment modality. Many reports based on objective tools showed acceptable voice outcomes in patients treated with transoral laser microsurgery (TLM). This is a single centre study representing voice outcomes in patients treated with TLM using a patient-self assessment tool.PATIENTS AND METHODS: we retrospectively reviewed medical data of patients treated with TLM between 2012 and 2017. Voice outcomes were evaluated using the Arabic version of the voice handicap index (VHI). Thirty patients participated in the questionnaire.Scores were collected then studied following type of cordectomy, resection of one or both vocal cords, number of laser sessions and age.RESULTS: The mean age was 62 years. Sex ratio was 14:1. We performed 3 type III cordectomies, 10 type IV and 17 type Va (extended to the Anterior commissure). Local control was achieved since the first cordectomy in 27 cases, after 2 laser sessions in 2 cases and after 1 laser session in 1 case. The VHI score was realized in a mean delay of 29 months after surgery. The overall mean VHI was 47 (VHI-F= 15, VHI-P= 17 and VHI-E= 15). The handicap severity was considered mild in 2 cases (overall VHI<30), severe in 2 other cases (overall VHI> 60) and moderate in the remaining cases .The mean VHI following type of cordectomy was 26 ±6, 43 ±5 and 53 ±4 respectively in type III, IV and Va cordectomies. The mean overall VHI was 60 ±10 when the resection was extended to controlateral vocal cord (VC). However, it was 45 ±12 when the resection was limited to a single vocal cord. The mean overall VHI increased from 44 ±11 when a unique laser session was performed to 62 ±8 when extra laser sessions were needed. Older patients had a mean VHI equals to 46 ±14. In younger patients it was 48 ±10.CONCLUSION: The VHI is a reliable self assessment tool based on subjective perception of the quality of voice. TLM in well trained hands offers acceptable functional outcomes
Subject(s)
Glottis , Laryngeal Neoplasms , Laser Therapy , Tunisia , Vocal CordsABSTRACT
INTRODUCTION: A multitude of treatment modalities have been proposed in management of early laryngeal squamous cell cancers (SCC). With the improvement of survival rates of these tumours, the degree of voice impairment after treatment became a deciding parameter in the choice of treatment modality. Many reports based on objective tools showed acceptable voice outcomes in patients treated with transoral laser microsurgery (TLM). This is a single centre study representing voice outcomes in patients treated with TLM using a patient-self assessment tool.PATIENTS AND METHODS: we retrospectively reviewed medical data of patients treated with TLM between 2012 and 2017. Voice outcomes were evaluated using the Arabic version of the voice handicap index (VHI). Thirty patients participated in the questionnaire. Scores were collected then studied following type of cordectomy, resection of one or both vocal cords, number of laser sessions and age.RESULTS: The mean age was 62 years. Sex ratio was 14:1. We performed 3 type III cordectomies, 10 type IV and 17 type Va (extended to the Anterior commissure). Local control was achieved since the î¿rst cordectomy in 27 cases, after 2 laser sessions in 2 cases and after 1 laser session in 1 case. The VHI score was realized in a mean delay of 29 months after surgery. The overall mean VHI was 47 (VHI-F= 15, VHI-P= 17 and VHI-E= 15). The handicap severity was considered mild in 2 cases (overall VHI<30), severe in 2 other cases (overall VHI> 60) and moderate in the remaining cases .The mean VHI following type of cordectomy was 26 ±6, 43 ±5 and 53 ±4 respectively in type III, IV and Va cordectomies. The mean overall VHI was 60 ±10 when the resection was extended to controlateral vocal cord (VC). However, it was 45 ±12 when the resection was limited to a single vocal cord. The mean overall VHI increased from 44 ±11 when a unique laser session was performed to 62 ±8 when extra laser sessions were needed. Older patients had a mean VHI equals to 46 ±14. In younger patients it was 48 ±10. CONCLUSION: The VHI is a reliable self-assessment tool based on subjective perception of the quality of voice. TLM in well trained hands offers acceptable functional outcomes
Subject(s)
Glottis , Laryngeal Neoplasms , Laser Therapy , Tunisia , Vocal CordsABSTRACT
Introduction : Pendant plusieurs décennies, la pratique de septoplastie chez l'enfant était proscrite par la majorité des chirurgiens par crainte d'altération de la croissance craniofaciale. Actuellement, la septoplastie est de plus en plus indiquée chez l'enfant avec de bons résultats fonctionnels. Le but de ce travail est de révéler les particularités de la septoplastie chez l'enfant, de comparer les différentes techniques opératoires proposées etd'évaluer les résultats obtenus.Méthodes : Notre étude est rétrospective monocentrique transversale portant sur 34 enfants opérés de septoplastie sur une période de 15 ans [2000-2014].Résultats : L'âge moyen de nos patients était de 13 ans avec un sex-ratio de 5,8. Les antécédents d'adénoïdectomie ont été notés dans 9% des cas associés à une amygdalectomie dans 6% des cas. La déviation septale était posttraumatique dans 59% des cas.Elle était de siège antérieur dans 91% des cas. A côté de la déviation de la cloison nasale, nous avons noté une déviation de la pyramide nasale dans 32% des cas et un polype de Killian associé dans 3% des cas. L'indication opératoire était posée sur l'évaluation subjective de la gêne respiratoire et du degré de la déformation nasale. Une obstruction nasale sévère avec réduction importante du flux aérien a été retrouvée dans 73% des cas. Tous nos patients ont été opérés sous anesthésie générale. L'intervention était pratiquée selon la technique de Cottle dans 88% des cas et par voie endoscopique dans 12% des cas. Elle a consisté à une reposition simple de la cloison nasale dans 3% des cas, une dépose repose de la cloison dans 41% des cas, une résection sous muqueuse du cartilage dans 56% des cas. On n'a pas noté de complications majeurs post opératoires.Après un recul moyen de 22 mois, nous avons un bon résultat fonctionnel dans 88% des cas. La persistance de l'obstruction nasale a été notée dans 12% des cas et était en rapport avec la déviation septale dans 6% des cas. Une reprise chirurgicale était indiquée dans 6% des cas.Conclusion :La septoplastie de l'enfant doit être un geste conservateur limité à la zone pathologique. Le suivi post opératoire est clinique et prolongé
Subject(s)
Child , Nasal Septal Perforation/surgery , Otorhinolaryngologic Surgical Procedures , TunisiaABSTRACT
Les localisations ORL extra ganglionnaires de la tuberculose sont peu communes. La symptomatologie clinique est trompeuse; posant ainsi le probleme de diagnostic differentiel avec la pathologie tumorale. Nous rapportons 12 cas de localisations extra ganglionnaires de tuberculose; colliges au service ORL de l'EPS Fattouma Bourguiba de Monastir entre 1995 et 2009. L'age moyen de nos patients est de 38 ans. L'etude topographique a montre 3 localisations laryngees; 3 au niveau des glandes salivaires; 2 amygdaliennes; 2 rhinopharyngees; 2 rhino sinusiennes. Le diagnostic etait anatomopathologique dans tous les cas. Tous nos patients ont recu un traitement antituberculeux avec une bonne evolution