The pectoralis myofascial flap in pharyngolaryngeal surgery after radiotherapy.

Pharyngocutaneous fistula after total laryngectomy remains a hardly inevitable complication. The predisposing factors are not clearly identified, but prior radiotherapy seems to increase the risk of fistulae. The purpose of this retrospective study was to determine the value of the pectoralis myofascial flap in pharyngeal reconstruction in post-radiotherapy total laryngectomy in order to decrease the risk of fistula formation. The charts of 60 consecutive patients who had undergone total laryngectomy or pharyngolaryngectomy after radiotherapy were analyzed. Twenty-one variables were recorded for each patient. The overall rate of fistula formation was 38% (23% when a pectoralis myofascial flap was used to cover the pharynx and 50% when no flap was used, P = 0.06). The flap-related complications were exceptional. In the subgroup of patients with diabetes mellitus, a history of vascular disease or a poor nutritional status, the use of a flap reduced the fistula formation from 73 to 13% (P = 0.018). The pectoralis myofascial flap covering the pharyngeal sutures in postradiotherapy laryngectomy is particularly useful in a selected group of patients (with diabetes mellitus, history of vascular disease or poor nutritional status).

[Surgical and/or endoscopic treatment of acquired tracheal stenosis in adult patients]. / Prise en charge chirurgicale et/ou endoscopique des sténoses trachéales acquises non tumorales de l'adulte.

OBJECTIVES: Retrospective survey (over 13 Years) of the surgical treatment of 46 acquired tracheal stenosis, in adult patients. Our goals were to study their epidemiology, changes in the surgical technique with the cervical or endoscopic approach, and the recent contribution of endoprotheses. MATERIALS AND METHODS: Sixty-six therapeutic procedures were performed for 46 tracheal stenoses. Most of stenoses were post-intubation and/or post-tracheotomy and were fixed in 50% of the cases. We used 21 sleeve resections with end-to-end anastomoses, 9 tracheal stents, 27 dilations, 6 calibrations, and 3 electro-coagulations. RESULTS: The sleeve resection gave 91% success (1 failure and 1 death). The endoscopic treatments were less efficient: 79% for tracheal stents (2 mobilizations), 50% success for iterative dilations. The respiratory tests were meaningfully improved with a mean follow-up of 18 Months. CONCLUSION: Sleeve resection remains the gold standard treatment. For all temporary or definitive contraindications to open surgery, tracheal stents would be an excellent alternative to avoid often inefficient iterative dilations.

[Surgical strategy in paranasal sinus mucoceles]. / Stratégie chirurgicale des mucocèles sinusiennes.

INTRODUCTION: The aim of this retrospective study is to describe the surgical management of paranasal sinus mucoceles. MATERIALS & METHODS: In the period from 1981 through 2000, 45 patients were treated for symptomatic mucoceles. The mucoceles were most frequently found in the anterior ethmoidofrontal system. 13 patients were operated via a bicoronal transfrontal extradural approach. A complete marsupialization under endonasal endoscopic control was performed in 21 cases. Eleven patients were operated via a trans-facial approach. RESULTS: The follow up period was 4.7 years (2 to 15 years) on average for endonasal approaches and 11 years on average (2 to 20 years) for the other approaches. All patients were free of complaints immediately after the operation. Nine cases were lost to follow-up. Cysts recurred in 5 patients. CONCLUSION: We recommend an endoscopic approach to the treatment of mucoceles as the surgical procedure of choice. In high and lateral extended frontal mucoceles, a trans-frontal extradural approach is still recommended. Long term follow-up is necessary to obtain an accurate assessment of the results.

[Transmandibular buccopharyngectomy after radiotherapy for orpharyngeal cancer]. / La buccopharyngectomie transmandibulaire (BPTM) après échec de la radiothérapie dans les cancers de l'oropharynx.

MATERIALS & METHODS: We present a retrospective study of 95 patients with recurrence of oropharyngeal carcinoma after exclusive radiotherapy. The treatment consisted in a salvage composite resection in all cases. RESULTS & DISCUSSION: Since the use of muscular flaps, the post-operative complications have been relatively minimised but the carcinologic results were disappointing: only 20% of patients were alive free of disease at 5 years. The main prognostic factors for overall survival were the stage rT of the relapse, the histologic invasion of the nodes and the quality of the resection. The anatomic site of relapse did not influence the survival. CONCLUSION: Our serie confirms the high frequency of second primary tumors in oropharyngeal cancers. Rigorous selection of patients for exclusive radiotherapy is mandatory to decrease the number of relapses and might avoid salvage surgery.

[Methods of identification and localization of ethmoid and sphenoid osteomeningeal breaches]. / Méthodes d'identification et de localisation des brèches ostéo-méningées ethmoïdo-sphénoïdales.

The accurate localization of cerebrospinal fluid (CSF) fistula presenting as rhinorrhea is an essential requirement for successful dural repair, in order to eliminate unsuccessful surgical exploration, and to achieve a definitive closure of the osteo-dural defect. The authors report their experience in 22 patients, and propose a simplified attitude: realization of high resolution CT scan in all cases, in first choice, and a MRI with MR cysternography sequences, in second choice, in case of negative CT scan.