Biological conditions affecting chronic inflammation in upper airways in children.

PROBLEMS/OBJECTIVES: A child's immune system cannot depend on a memory-type immune response and it also induces cytokine responses less efficiently. Biological conditions like allergy or cystic fibrosis, immune deficiency or gastrooesophageal reflux can induce and maintain background inflammation in children's upper airways, making newborns and children more susceptible to upper airway infections and inflammations. This paper will describe in brief how allergy, cystic fibrosis, immune deficiency, nasal and paranasal anatomical variants, and gastro-oesophageal reflux (GOR) can affect the immune and inflammatory responses in upper airways and how they could interfere with immunity development and maturation in children. METHODOLOGY: Literature review. RESULTS: Chronic inflammation induced by infection, allergy, cystic fibrosis or immune deficiency is multifactorial in origin and is strongly influenced by physiological, immunological, anatomical, environmental and, above all, genetic parameters. Finally, the direct role played by nasal and paranasal anatomical variants and GOR is also discussed. CONCLUSIONS: These conditions should be screened systematically in all children presenting chronic clinical features of upper airway inflammation.

Endoscopic endonasal medial maxillectomy: case series.

INTRODUCTION: A medial maxillectomy (MM) consists of a complete resection of the medial wall of the maxillary sinus. Traditionally the surgery is performed via an open approach. With more familiarity and expertise in endoscopic sinus surgery the endonasal approach is feasible. OBJECTIVE: To expose the surgical technique and report the results of endonasal endoscopic MM in a series of 6 consecutive patients. MATERIALS AND METHODS: Between August 2006 and October 2009, 6 patients were operated with this procedure. All were men. The mean age was 62-year-old (range: 43-83). In 5 cases, the surgery was performed for inverted papillomas confined to the maxillary sinus. In one case it was a primary surgery whereas it was a revision surgery for the others. The sixth patient was operated for a solitary extramedullary plasmocytoma inserted on the intersinonasal wall persistent after an external radiation therapy. RESULTS: All the patients are free of disease at the time of writing with a mean follow-up of 18,2 months (range: 9-38). This has been confirmed by a nasal endoscopy and CT scans. There were no major per or postoperative complications. Patients suffered from crusting for at least 6 months postoperatively necessitating daily nasal douches. One patient is still complaining of intermittent epiphora when he is exposed to wind. CONCLUSION: Endoscopic MM can be successfully performed for the resection of expanding processes involving the maxillary sinus and/or the intersinonasal wall. Compared to open approaches, it seems to be as effective with less postoperative morbidity. An important technical point is to do the anterior osteotomy in front of the nasolacrimal duct in order to expose the prelacrimal recess that is typically an area for possible recurrence. Exact determination of the tumor attachment during the surgery is another key point for success.

[Post-operative complications and predictive factors in a series of 117 total thyroidectomies for substernal goiter]. / Complications post-opératoires et facteurs prédictifs dans une série de 117 thyroïdectomies totales pour goitre cervico-thoraciques.

OBJECTIVE: The recurrential nerve palsy (RNP), the hypocalcemy and bleeding are traditional complications of the thyroid surgery. The objective is to bring back the postoperative rates of complications and to compare them with the patient's history and the goiter features (CT-scan extensions and weight) in order to identify predictive factors of these complications. PATIENTS AND METHOD: One hundred and seventeen patients with a goiter below the subclavicular vessels on the cervicothoracic CT-scan and with a benign extemporane histopathology were operated between february 1997 and January 2004 and included in this retrospective study. The initial clinical assessment reports the respiratory and digestive functional signs, researches a palpable mass and studies the mobility of the vocal folds. The post-operative complications rates (RNP hypocalcemy and bleeding) are analyzed according to the patient's history and the goiter extensions in order to correlate these factors with the complications occurence. RESULTS: Five unilateral RNP occurred and two of them remained permanent, particularly for patients with thyroid surgery history (NS). The right/left or anterior/posterior extensions did not seem determining factors. Nevertheless the volume of the goiter suspected by the tracheal latero-deviation seems to play a role but without statistical confirmation. Among the thirty-four hypocalcemies, six were defined like permanent, without correlations with the surgical history nor the systematic identification of parathyroid glands. The volume and the younger age of the patient tend nevertheless to support the hypocalcemy. Three post-operative bleeding cases were reported, which one needed a reoperation, with a correlation with thyroid surgical history. None the factors among volume, extension or the age of the patient seem to play a role. CONCLUSION: The cervico-thoracic CT-scan is essential since echography does not manage to identify the lower pole of the gland. It helps to define the goiter and to analyze its extensions, very usefull to predict surgical difficulties in the preoperative information of the patient. Complications occurrence seems related on the volume and the thyroid surgical history.

[Clinical signs and correlation with radiological extent in a series of 117 retrosternal goitre]. / Signes cliniques et corrélations radiocliniques dans une série de 117 goitres cervico-thoraciques.

OBJECTIVES: To report, compare the clinical signs and the radiological signs of retrosternal goitre (cervico-thoracic goitre) and try to establish a correlation between clinical signs and radiological extent. PATIENTS AND METHOD: One hundred and seventeen patients with a goitre beyond the sub-clavian vessels in cervico-thoracic CT-scan and with a benign histopathology examination after thyroid surgery in the head and neck department, University Hospital, Amiens, France between February 1997 and January 2004 were included in this retrospective study. The initial clinical assessment includes the respiratory and swallowing functional signs, palpable mass and mobility of the vocal cords. A correlation is analyzed between the extent of the goitre, the anatomic relations with the trachea and oesophagus and clinical signs. RESULTS: Dyspnea is the commonest of the functional signs (39.3%) for young subjects (p < 0.05), due to tracheal compression regardless of the side of extension of the goitre. Dysphagia (16.2%) is not correlated with the extent of the goitre in this series. A cervical palpable mass is present in 69.2% of cases. CONCLUSION: The cervico-thoracic CT-scan is the key examination of the assessment of a retrosternal goitre making it possible to appreciate its features, its anatomic relations and its tracheal involvement sometimes announced by respiratory disorders, the presence of a dysphagia should alert to the possibility of posterior extension which can not be felt during the cervical palpation.

[Evolution of the thyroid surgical treatment to the total thyroidectomy. Study of about 735 patients]. / Evolution de la chirurgie thyroïdienne vers la thyroïdectomie totale.

OBJECTIVES: To study the place of the total thyroïdectomy compared to the sub-total thyroidectomy and the lobectomy in benign nodular thyroid pathology, about complications and prevention of the recurrence. PATIENTS AND METHODS: The evolution of the number and the type of thyroïdectomy among the total thyroidectomy, subtotal thyroidectomy and the lobectomy was analyzed in a retrospective study including 735 patients in the service of Head and Neck Surgery in the University Hospital in Amiens, France over a 12 years period, for a multinodular goiter, a toxic and a nontoxic solitary nodule. The post-operative transient and permanent recurrent nerve paralysis and hypocalcemia of the total thyroidectomies were studied and compared with the other surgical procedures of the study and in a review of the literature in order to study benefit and risks. RESULTS: Multinodular goiters were the most thyroid pathologies (80%). The total thyroidectomy became gradually the most frequent surgical procedure, from 17% to nearly 70% of the surgical procedures over 12 years, with depend on the currently abandoned subtotal thyroidectomy and the lobectomy. No significant difference appeared concerning the recurrent and parathyroid complications between the 3 procedures. CONCLUSION: The post-operative morbidity is not statistically different between the total thyroidectomy and the other procedures. The total thyroidectomy prevents moreover nodular recurrences whose surgical treatment is difficult without benefit of the L-thyroxine treatment prevention. It implies a substitute opotherapy that the other surgical techniques cannot nevertheless always avoid. Nowadays, the total thyroidectomy is the gold treatment for surgical treatment of multinodular benign goiters. Many factors must be considered concerning the solitary nodules: the size, the evolutivity, the fine needle aspiration the aspect of the contralateral lobe. In all the cases, the decision will have to be consensual between the patient, the endocrinologist and the surgeon.

[Fistulisation of a tubercular adenopathy in the oesophagus. About a paucisymptomatic form]. / Fistulisation d'une adénopathie tuberculeuse à l'oesophage. A propos d'une forme frustre.

The authors present the case of a cervico-mediastinal mass which disappeared spontaneously. The clinical presentation and the image of a fistula during the oesophagoscopy are in favour of the fistulisation of a tubercular adenopathy in the oesophagus. This pathology is rare. This observation is original by the delay of diagnosis due to a dysphagie summarizing the clinical signs and the spontaneously favorable evolution of the fistula.

[Vocal rehabilitation with tracheoesophageal prosthesis. Study of peri-prosthetic leakages]. / Les fuites péri-prothétiques après implant phonatoire.

OBJECTIVES: Peri-prosthetic leakages are a frequent complication of tracheoesophageal prosthesis used in the vocal rehabilitation of laryngectomized patients. The authors examine the effect of pre or post operative radiotherapy upon the incidence of this complication. MATERIALS AND METHOD: In a retrospective study of 67 patients rehabilited with a phonatory prosthesis between 1993 and 2002, pre or post-operative radiotherapy was carried out in 61 patients. RESULTS: A peri-prosthetic leakage occured in 38.8% of the cases. The pre or post-operative radiotherapy was not a statistically significant cause of leakage, as the age of the patient and the surgical procedure. CONCLUSION: Although not supported by the statistical study because of a lack of cases, the radiotherapy remains for the authors a factor determining in the mechanism of the peri-prosthetic leakages and bad forecast for their treatment. Realized before the surgery, it contra-indicates the phonatory prosthesis at the time of the tumor resection. In case of post-operative radiotherapy, the risks must be clearly explained to the patient.

[The lymphoepithelial carcinoma of the parotid gland: a rare tumor for an European patient]. / Le carcinome lymphoépithélial de la parotide: une tumeur rare chez un patient européen.

Lymphoepithelial carcinoma of the parotid is a rare and little known tumour The ethnic origin of the patients and the association with the Epstein-Barr virus are recognized but not invariable. The mechanism of the carcinogenesis thus remains an enigma. The authors report the observation of a patient which is remarkable because of his European origin and the positivity of serologies to the Epstein-Barr virus, and discuss the features of the lesion through the literature.