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1.
J Laryngol Otol ; 137(9): 997-1002, 2023 Sep.
Article in English | MEDLINE | ID: mdl-34823628

ABSTRACT

OBJECTIVE: To report the outcome of 18 patients with a tracheostomy secondary to bilateral vocal fold immobility, who were managed using reconstructive transoral laser microsurgical techniques. METHODS: A retrospective review was conducted of the surgical outcome of 18 patients with bilateral vocal fold immobility and a tracheostomy resulting from different aetiologies. Follow-up duration ranged from one to five years. RESULTS: A total of 18 patients had a tracheostomy at presentation because of bilateral true vocal fold immobility and stridor. All cases were treated using reconstructive transoral laser microsurgery with arytenoidectomy and vocal fold lateralisation. All patients were successfully decannulated by eight weeks after surgery. CONCLUSION: Reconstructive transoral laser microsurgery using partial arytenoidectomy with vocal fold lateralisation is minimally invasive, feasible, safe and effective for airway reconstruction in patients who present with stridor due to bilateral true vocal fold immobility.


Subject(s)
Airway Obstruction , Vocal Cord Paralysis , Humans , Vocal Cords/surgery , Vocal Cord Paralysis/surgery , Respiratory Sounds , Arytenoid Cartilage/surgery , Airway Obstruction/etiology
2.
Eur Ann Otorhinolaryngol Head Neck Dis ; 138(6): 479-482, 2021 Dec.
Article in English | MEDLINE | ID: mdl-33622626

ABSTRACT

The diagnosis of exercise-induced laryngeal obstruction (EILO) should be suspected when exercise triggers inspiratory stridor. EILO is common in adolescent populations and has a significant impact on sports. Identification of laryngeal obstruction during continuous laryngoscopy during exercise (CLE) is the gold standard diagnostic tool for this disorder, which is not widely known in France. The challenge faced by otolaryngologists is to identify, among patients referred by pulmonologists or sports physicians, those with exercise-induced inspiratory symptoms or poorly controlled exercise-induced asthma, in whom a diagnosis of EILO is strongly suspected. Laryngoscopy at rest may reveal a laryngeal, glottic or supraglottic abnormality predictive of obstruction at increased inspiratory airflow. When pulmonary function tests are normal or in the case of failure of treatment of exercise-induced asthma, the otolaryngologist must complete the examination by a CLE test to confirm the diagnosis of EILO and identify the site of obstruction. This examination is well tolerated, minimally invasive and allows identification of the site of airflow obstruction, allowing specific conservative or surgical treatment. This technical note describes in detail clinical examination and CLE testing in patients with suspected EILO.


Subject(s)
Airway Obstruction , Asthma, Exercise-Induced , Laryngeal Diseases , Adolescent , Airway Obstruction/diagnosis , Airway Obstruction/etiology , Airway Obstruction/surgery , Dyspnea , Humans , Laryngeal Diseases/diagnosis , Laryngeal Diseases/etiology , Laryngeal Diseases/surgery , Laryngoscopy
3.
Eur Ann Otorhinolaryngol Head Neck Dis ; 138(3): 183-185, 2021 May.
Article in English | MEDLINE | ID: mdl-32654988

ABSTRACT

INTRODUCTION: Polydimethylsiloxane (VOX Implant®) injection into the larynx is a surgical technique used to restore volume to paralysed or atrophic vocal folds. We present a case series that demonstrates the feasibility of explantation of this non-resorbable material in the event of complications secondary to this injection. DESCRIPTION: We report four cases of VOX Implant® explantation. In every case, explantation was performed following complications such as dysphonia and/or dyspnoea secondary to injection of this material. VOX Implant® explantation was performed via cordotomy using transoral lasermicrosurgical techniques. DISCUSSION: VOX Implant® explantation improved voice and breathing parameters in all patients. Explantation can be performed by transoral microsurgery in the presence of complications related to polydimethylsiloxane injection.


Subject(s)
Laryngoplasty , Laser Therapy , Dimethylpolysiloxanes , Humans , Lasers , Microsurgery , Vocal Cords/surgery
4.
Eur Ann Otorhinolaryngol Head Neck Dis ; 138(1): 53-55, 2021 Jan.
Article in English | MEDLINE | ID: mdl-32651083

ABSTRACT

We describe an endoscopic-guided, suspension laryngoscopy-assisted percutaneous dilatational tracheostomy technique, which can be performed by all otolaryngologists and is suitable for any patient requiring tracheostomy. It can be performed in the context of elective surgery or as an emergency procedure. This technique was developed using suspension laryngoscopy and ENT endoscopy equipment, as well as a percutaneous dilatational tracheostomy kit. It has the advantage of ensuring optimal control of the patient's ventilation and haemostasis throughout the procedure. The good quality endoscopic vision and easy access to the airway provided by suspension laryngoscopy allow tracheostomy to be performed under optimal safety conditions.


Subject(s)
Laryngoscopy , Tracheostomy , Dilatation , Endoscopy , Humans , Lung
5.
Eur Ann Otorhinolaryngol Head Neck Dis ; 137(3): 167-169, 2020 May.
Article in English | MEDLINE | ID: mdl-32307265

ABSTRACT

Tracheostomy post-tracheostomy care are regarded as at high risk for contamination of health care professionals with the new coronavirus (SARS-CoV-2). Considering the rapid spread of the infection, all patients in France must be considered as potentially infected by the virus. Nevertheless, patients without clinical or radiological (CT scan) markers of COVID-19, and with negative nasopharyngeal sample within 24h of surgery, are at low risk of being infected. Instructions for personal protection include specific wound dressings and decontamination of all material used. The operating room should be ventilated after each tracheostomy and the pressure of the room should be neutral or negative. Percutaneous tracheostomy is to be preferred over surgical cervicotomy in order to reduce aerosolization and to avoid moving patients from the intensive care unit to the operating room. Ventilation must be optimized during the procedure, to limit patient oxygen desaturation. Drug assisted neuromuscular blockage is advised to reduce coughing during tracheostomy tube insertion. An experienced team is mandatory to secure and accelerate the procedure as well as to reduce risk of contamination.


Subject(s)
Coronavirus Infections/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Tracheostomy/methods , Tracheostomy/standards , Betacoronavirus/isolation & purification , COVID-19 , Consensus , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/surgery , France/epidemiology , Humans , Infection Control/methods , Infection Control/standards , Intubation, Intratracheal/instrumentation , Intubation, Intratracheal/methods , Intubation, Intratracheal/standards , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/surgery , Postoperative Care/methods , Postoperative Care/standards , SARS-CoV-2 , Ventilation/methods , Ventilation/standards
6.
Eur Ann Otorhinolaryngol Head Neck Dis ; 137(5): 399-404, 2020 Nov.
Article in English | MEDLINE | ID: mdl-32001196

ABSTRACT

Vocal-fold leukoplakia and dysplasia are together designated "epithelial hyperplastic laryngeal lesions" (EHLL). Work-up and follow-up are founded on optical examination with high-definition imaging, stroboscopy and narrow-band imaging. Diagnosis is based on pathology, using the new 2017 WHO classification, dichotomizing "low grade" and "high grade". Statistically, the risk of cancerous progression is 20% within 5 to 10 years of diagnosis, or more in over-65 year-old males; risk for any given patient, however, is unpredictable. Research focuses on the genetic criteria of the lesion and characterization of the tumoral microenvironment. Treatment is exclusively microsurgical. Resection depth is adjusted according to infiltration. EHLL is a chronic disease, necessitating long-term follow-up, which may be hampered by residual dysphonia and surgical sequelae in the vocal folds. Sequelae need to be minimized by good mastery of microsurgical technique and indications. When they occur, biomaterials such as autologous fat and hyaluronic acid can be useful. Tissue bio-engineering is a promising field.


Subject(s)
Laryngeal Diseases , Otolaryngology , Aged , Humans , Laryngeal Diseases/diagnosis , Laryngeal Diseases/therapy , Leukoplakia , Male , Narrow Band Imaging , Tumor Microenvironment , Vocal Cords
7.
Eur Ann Otorhinolaryngol Head Neck Dis ; 136(3): 219-221, 2019 Jun.
Article in English | MEDLINE | ID: mdl-30420321

ABSTRACT

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


Subject(s)
Arytenoid Cartilage/surgery , Laryngoscopy/methods , Vocal Cord Paralysis/surgery , Vocal Cords/surgery , Anesthesia, General , Humans , Larynx/surgery , Suture Techniques
8.
Eur Ann Otorhinolaryngol Head Neck Dis ; 135(6): 449-451, 2018 Dec.
Article in English | MEDLINE | ID: mdl-30072286

ABSTRACT

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


Subject(s)
Arteritis/complications , Carotid Artery Diseases/complications , Infarction, Middle Cerebral Artery/etiology , Maxillary Sinusitis/complications , Carotid Artery, Internal , Child , Female , Humans , Infarction, Middle Cerebral Artery/diagnostic imaging , Magnetic Resonance Imaging , Maxillary Sinusitis/diagnostic imaging
9.
Eur Ann Otorhinolaryngol Head Neck Dis ; 135(3): 205-207, 2018 Jun.
Article in English | MEDLINE | ID: mdl-29661610

ABSTRACT

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


Subject(s)
Botulinum Toxins, Type A/administration & dosage , Laryngoscopy , Neuromuscular Agents/administration & dosage , Voice Disorders/drug therapy , Humans , Injections, Intralesional/methods , Office Visits
10.
Eur Ann Otorhinolaryngol Head Neck Dis ; 135(3): 197-199, 2018 Jun.
Article in English | MEDLINE | ID: mdl-29338941

ABSTRACT

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


Subject(s)
Epiglottis/surgery , Laryngeal Neoplasms/surgery , Laryngectomy/methods , Laryngoscopy , Humans
11.
Eur Ann Otorhinolaryngol Head Neck Dis ; 135(2): 127-129, 2018 Apr.
Article in English | MEDLINE | ID: mdl-29269211

ABSTRACT

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


Subject(s)
Laryngoplasty/methods , Natural Orifice Endoscopic Surgery , Pharynx/surgery , Surgical Flaps , Aged , Humans , Laryngeal Neoplasms/pathology , Laser Therapy/methods , Male , Microsurgery/methods , Mouth , Natural Orifice Endoscopic Surgery/methods , Plastic Surgery Procedures/methods , Tracheostomy/methods , Treatment Outcome
13.
Acta Otorhinolaryngol Ital ; 37(3): 188-194, 2017 Jun.
Article in English | MEDLINE | ID: mdl-28516961

ABSTRACT

Glottic cancers discovered at an early stage (T1-T2) can be treated with either radiotherapy or surgery. The aim of our study is to analyse survival and functional results of supra-cricoid partial laryngectomy (SCPL) with crico-hyoido-epiglottopexy (CHEP) as surgical treatment for glottic carcinoma with anterior commissure involvement. We performed a retrospective study (1996-2013) which included patients who underwent SCPL-CHEP for glottic squamous cell carcinoma with involvement of the anterior commissure. Before surgery, all patients underwent staging including head, neck and chest CT-scan with contrast injection as well as suspension laryngoscopy under general anaesthesia. A total of 53 patients were included. The median follow-up period was 124 months. Tumour resection was complete in 96.2% of cases. The overall, specific and recurrence-free survival rates at 5 years were, respectively, 93.7%, 95.6% and 87.7%. The average period of hospitalisation was 18 days. The average time elapsed before decannulation and before restoration of oral feeding were 15 and 18 days, respectively. SCPL-CHEP is an important option for laryngeal surgical preservation. It allows adequate disease control as well as good functional results as long as the indications are well respected and the surgical techniques are mastered.


Subject(s)
Carcinoma, Squamous Cell/surgery , Glottis , Head and Neck Neoplasms/surgery , Laryngeal Neoplasms/surgery , Laryngectomy/methods , Adult , Aged , Carcinoma, Squamous Cell/mortality , Carcinoma, Squamous Cell/pathology , Cricoid Cartilage/surgery , Epiglottis/surgery , Female , Head and Neck Neoplasms/mortality , Head and Neck Neoplasms/pathology , Humans , Laryngeal Neoplasms/mortality , Laryngeal Neoplasms/pathology , Male , Middle Aged , Retrospective Studies , Squamous Cell Carcinoma of Head and Neck , Survival Rate , Treatment Outcome
16.
Eur Ann Otorhinolaryngol Head Neck Dis ; 133(5): 319-324, 2016 Nov.
Article in English | MEDLINE | ID: mdl-27297087

ABSTRACT

OBJECTIVE: The present consecutive case series reports our experience in the management of carotid body paraganglioma and aims to assess whether the Shamblin classification or tumor size are predictive of early and late postoperative neurovascular complications. MATERIAL AND METHODS: A retrospective study included 54 carotid body tumor resections in 49 patients, between 1980 and 2011. Data comprised early (<1month) and late (18 months) postoperative neurovascular complications. RESULTS: Early postoperative complications occurred in 31 cases, including 30 cases of cranial nerve deficit (56%). Cranial nerve deficit occurred in 83% of Shamblin III carotid body paragangliomas and was associated with significantly larger mean tumor size (4±1.4cm versus 2.9±1.3cm; P<0.01). Shamblin III tumor and tumor size>3.2cm emerged as predictive factors for early postoperative peripheral neurological complications. Eight patients (17%) showed no cranial nerve deficit recovery, even after 18 months' follow-up; no predictive factors could be identified for this. CONCLUSION: Surgical resection remains the only curative treatment in carotid body paraganglioma, with low vascular morbidity. However, early postoperative nerve deficit remains frequent (56%), although mostly temporary, with 17% definitive sequelae at 18 months. Tumor size and Shamblin classification are predictive of early neurovascular complications.


Subject(s)
Carotid Body Tumor/surgery , Cranial Nerve Diseases/etiology , Postoperative Complications , Adult , Carotid Body Tumor/pathology , Disease Progression , Female , Follow-Up Studies , Humans , Male , Middle Aged , Neoplasm, Residual , Retrospective Studies
17.
Cancer Radiother ; 20(4): 255-60, 2016 Jun.
Article in French | MEDLINE | ID: mdl-27318553

ABSTRACT

PURPOSE: We studied whether there is a relationship between nausea and vestibular disorders in patients treated with intensity modulated radiation therapy (IMRT) for head and neck cancer. PATIENTS AND METHODS: We performed a prospective single-centre study that enrolled 31 patients. A videonystagmography was carried out before and within 15 days after radiation therapy for each patient. Nausea was assessed at baseline, every week, and at the post-radiotherapy videonystagmography visit. RESULTS: Twenty-six patients had benefited from a complete interpretable videonystagmography. For 14 of these patients vestibular damage was diagnosed post-radiotherapy. During irradiation, six patients felt nauseous, but without dizziness. In univariate analysis, we found a relationship statistically significant between the average dose received by the vestibules and vestibular disorder videonystagmography (P=0.001, odds ratio [OR]: 1.08 [1.025-.138]), but there was no relationship between vestibular disorder videonystagmography and nausea (P=0.701). CONCLUSIONS: Irradiation of the vestibular system during IMRT does not seem to explain the nausea.


Subject(s)
Dizziness/etiology , Head and Neck Neoplasms/radiotherapy , Nausea/etiology , Radiotherapy, Intensity-Modulated/adverse effects , Dose-Response Relationship, Radiation , Female , Humans , Male , Middle Aged , Prospective Studies , Radiotherapy Dosage , Semicircular Canals/radiation effects , Vestibular Function Tests , Vestibule, Labyrinth/radiation effects , Video Recording
18.
Eur Ann Otorhinolaryngol Head Neck Dis ; 133(5): 349-353, 2016 Nov.
Article in English | MEDLINE | ID: mdl-27183818

ABSTRACT

After recalling the main anatomical characteristics of the frontal sinuses, the authors describe the frontal craniotomy surgical procedure and its variants. A bicoronal skin incision is performed. An inferior-based pericranial flap is created, with its limits situated away from the osteotomies. Osteotomies are performed with an oscillating saw. The inferior osteotomy is horizontal, tangentially following the supraorbital margin as far as the lateral limit of each sinus. The osteotomy is continued medially as far as the nasion, passing an average of 3mm above the floor of the medial part of the sinuses, immediately above the frontonasal ducts. The superior osteotomy is performed in a vertical coronal plane through the summit of the sinuses. It is arc-shaped, concave downwards, joining the lateral extremities of the inferior osteotomy. The posterior wall of the sinus can be resected to perform frontal sinus cranialization, allowing access to the midline anterior cranial fossa. The posterior wall of the sinus is removed with a high-speed burr in the same way as the anterior wall. At the end of the procedure, the bone flap is sutured with nylon suture material and the pericranium is sutured over the bone flap.


Subject(s)
Craniotomy/methods , Frontal Sinus/surgery , Frontal Sinus/anatomy & histology , Humans , Mucous Membrane/surgery , Osteotomy/methods
20.
Eur Ann Otorhinolaryngol Head Neck Dis ; 133(2): 133-6, 2016 Apr.
Article in English | MEDLINE | ID: mdl-26725753

ABSTRACT

Midline cysts of the neck are the most common congenital malformations of the neck. They arise along the thyroglossal duct. The presence of a fistula is the result of either spontaneous (suppuration) or surgical fistulisation (simple incision or incomplete excision). The cyst and/or fistula are located between the base of the tongue and the thyroid gland, predominantly adjacent to the hyoid bone. This midline site can be explained by embryological development of the thyroid gland. Treatment is surgical. Many techniques have been described, but Sistrunck procedure (described in 1920), based on embryological studies, remains the reference technique with a recurrence rate of less than 3%, provided surgery is performed correctly, comprising resection of the body of the hyoid. Risk factors for recurrence are: surgery during the inflammatory phase, cyst rupture during dissection, multiple thyroglossal ducts and a technical error during the surgical procedure.


Subject(s)
Thyroglossal Cyst/surgery , Humans , Otorhinolaryngologic Surgical Procedures/methods
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