The Carcinologic Handicap Index (CHI): A disability self-assessment questionnaire for head and neck cancer patients.

INTRODUCTION: The present prospective study sought to draw up and validate a self-assessment questionnaire for disability following head and neck cancer treatment. MATERIAL AND METHOD: The Carcinologic Handicap Index (CHI) was designed empirically based on the Voice Handicap Index. It comprises 9 dimensions, self-assessed by the patient: pain, swallowing, feeding, respiration, phonation, hearing, vision, olfaction-gustation, and psychosocial. For each dimension, 4 items are scored in terms of frequency, providing dimension and global scores. The CHI was tested on 86 head and neck cancer patients (pathologic group: male predominance; mean age, 59 years) and 18 control subjects, for validation. RESULTS AND DISCUSSION: Global internal coherence was 0.905 (Cronbach alpha); content validity (r, between questionnaire scores and corresponding visual analog scales) ranged between 0.6 and 0.8 except for the vision dimension and for total score compared to general health rating on VAS (r≤0.5: i.e., the pathology did not directly impair vision and was only one factor among others affecting general health status); temporal validity was satisfactory (r>0.7; P<0.0001) except on the respiration dimension (r=0.624, probably due to fluctuation in pulmonary congestion). Impact on swallowing, feeding and respiration varied with lesion site. There were no significant differences between patients and controls on the pain, hearing and vision dimensions. CONCLUSION: The CHI showed acceptable psychometric qualities and can be considered as an authentic clinical tool for health professionals, assessing the impact of ENT pathology on quality of life, mainly in the functional domains directly affected by the pathology or treatment.

Lymph node management in clinically node-negative patients with papillary thyroid carcinoma.

AIMS: Systematic lymph node dissection in patients with papillary thyroid carcinoma (PTC) remains controversial. The objective of this study was to study the pattern of lymph node spread in patients with PTC clinically node-negative and then to propose a lymph node management strategy. METHODS: We retrospectively reviewed the records of patients who had undergone total thyroidectomy and a systematic central neck dissection (CND) and lateral neck dissection. Ninety patients with PTC without lymph nodes metastases (LNM) detected on preoperative palpation and ultrasonographic examination were included. RESULTS: Forty-one patients (45.5%) had LNM. Twenty-eight patients (31%) had a central and a lateral involvement. Thirteen patients (14.5%) had only a central involvement. All the patients without LNM in the central compartment were also free in the lateral compartment. There was no correlation between LNM status and TNM staging. The largest LNM in the central compartment was smaller than or equal to 5mm in 66% of the cases, and that could explain the lack of sensitivity of the preoperative ultrasonographic examination. CONCLUSION: CND could be considered at preoperative or intraoperative diagnosis of PTC whereas lateral neck dissection should be performed only in patients with preoperative suspected and/or intraoperatively proven LNM. Systematic CND allows an objective evaluation of lymph node status in this central cervical area where the LNM are particularly small and difficult to detect preoperatively.

Surgical management of maxillary sinonasal inverted papilloma.

OBJECTIVE: The extent of the surgery required when sinonasal inverted papilloma (IP) originates in the maxillary sinus is still the subject of debate. The principal aim of the study was to evaluate the efficacy of exclusive endoscopic removal or when combined with a limited vestibular anterior antrostomy of the maxillary IP. METHODS: A retrospective analysis was carried out of 64 patients with IP treated in our university tertiary referral center from 1993-2007. Endoscopic removal of the IP was done for all patients, either exclusively or combined with an open approach. All patients were followed up for more than 1 year and the local control rate has been compared between patients with maxillary IP and others, and with both approaches. RESULTS: The overall recurrence rate was 14% (9/64), for a mean follow up of 48 months (12-120 months). Twenty-three patients (23/64) had maxillary IP. Ten of them had endoscopic resection alone, 13 had a combined approach (1 with lateral rhinotomy). There were 4 recurrences (17%) three of which had had endoscopic surgery alone. We did not perform a medial maxillectomy in the first instance. There were no cases of epiphora or atrophic rhinitis. conclusion: We showed that the combined method (endoscopic assisted by a minimal vestibular approach) was an efficient and safe method to treat maxillary sinus IP. This approach could preserve the lacrimal duct and the inferior turbinate when these structures were not involved, even when there was a large maxillary sinus extension of the disease.

[Ruptured pexis after supracricoid partial laryngectomy: a series of 5 cases]. / Les lâchages de pexie dans les laryngectomies partielles supracricoidiennes: à propos de 5 cas.

OBJECTIVES: Supracricoid partial laryngectomies have a rare but a specific complication which is the rupture of the pexy. After cricohyoidoepiglottopexy or cricohyoidopexy, a separation can appear between the hyoid bone and the cricoid cartilage. Our objective was to define how to treat and to prevent this complication. METHODS: One hundred and one supracricoid partial laryngectomies were performed in our department between 1980 and 2006. A retrospective analysis of the medical charts and operative files revealed that 5 patients have had a ruptured pexy. A review of the diagnosis, management, and outcome of these five cases is presented and discussed in this paper. RESULTS: The diagnosis was done in the first post-operative month for all cases. Delay in decannulation time, swallowing disorders, local infection were associated with the rupture of the pexy. The separation between the hyoid bone and the cricoid cartilage was also suspected at neck palpation and in endoscopy. Lateral plain Xrays of the neck or CT scans were used to confirm the diagnosis. A medical treatment, a completion total laryngectomy and three revisions of the pexis were performed. CONCLUSIONS: In our series, an antecedent of radiation before surgery appears to be a risk factor for the development of this specific complication. A revision of the pexis procedure is advocated in case of a major ruptured pexis.

Endoscopic resection of sinonasal adenocarcinomas.

OBJECTIVE: To evaluate the outcome and morbidity of endoscopic resection of sinonasal adenocarcinomas. METHODS: This is a case series of 17 patients diagnosed with sinonasal adenocarcinoma that were resected endoscopically between 1999 and 2008. RESULTS: The surgery constituted the first line of treatment for all patients. Five anterior skull base reconstructions were done. Post-operative meningoencephalitis and minimal epistaxis were the complications reported. The mean follow-up was 3 years [6-107 months]. To date, there have been two local recurrences at 6 months of an insufficient resection of a tumour classified pT4 and 25 months of a pT2 resected with safe margins. Another patient presented an unique metastasis in the parietal lobe 42 months after the resection of tumour pT4 extended to the frontal lobe. Two deaths unrelated to the disease were reported while thirteen patients remained free of disease (76.5%). CONCLUSION: The endoscopic approach is a safe and effective treatment in selected cases of sinonasal adenocarcinomas. This procedure is less invasive than conventional surgery but requires an optimal preoperative imaging protocol and an experienced surgical team. These encouraging results have to be confirmed by a larger cohort and a longer follow-up.

[Endonasal endoscopic approach in the treatment of sino-nasal inverted papillomas]. / Voie endonasale endoscopique dans le traitement des papillomes inversés naso-sinusiens.

INTRODUCTION: Sino-nasal inverted papilloma is a rare benign tumor of the nasal fossa and the paranasal sinuses for which the successful surgical treatment by an endonasal approach has been corroborated in the literature. Nevertheless, the authors aim in this study to evaluate the advantages and the limits of this approach, to analyse its failures and its recurrences, and to define the indications for using it with the external or dissimulated approach. MATERIAL AND METHODS: 42 patients presenting with a sino-nasal inverted papilloma and treated surgically over a ten year period were included in this retrospective study. The operative technique was chosen as a function of the endonasal and radiological examination results (CT scan and MRI). Follow-up was over one year for all patients. RESULTS: Twenty eight patients were operated exclusively through an endoscopic endonasal approach. Fourteen patients were operated using a combined approach, associating either a vestibular (9 cases), a paralateral nasal (3 cases) or a fronto-orbital (2 cases) approach with endonsal endoscopy. In two cases, an associated squamous cell carcinoma was found. We observed a recurrence in 9.5% of the all cases and in 14.2% of the patients treated using a combined approach. CONCLUSIONS: Endoscopic endonasal surgery is a validated surgical approach for the treatment of sino-nasal inverted papilloma in that total tumor removal is possible. This approach is particularly indicated in medially-situated papillomas without frontal or maxillary extension. In all other cases, associating an external or dissimulated approach is usually necessary.

[Pseudoaneurysm of the internal carotid artery revelated by epistaxis: report of two cases]. / Pseudo-anévrysmes de l'artère carotide interne révélés par une epistaxis. A propos de deux cas.

OBJECTIVES: Pseudoaneurysms of the carotid artery are a rare but serious cause of epistaxis. They can be rapidly life-threatening. Usually resulting of a surgery or a traumatism, pseudoaneurysms can express themselves by recurrent epistaxis. Management of these epistaxis is discussed. METHODS: The authors present two cases and effect a review of the literature. RESULTS: The first patient presented with a pseudoaneurysm few days after a transsphenoidal surgery. The second patient presented with a pseudoaneurysm fourteen years after a radio-surgical treatment of an ethmoidal and frontal epidermoid carcinoma. Diagnosis was suspected during nasal endoscopy and confirmed in both cases with angio-CT and arteriography. The first patient underwent a selective embolization. The second patient had to have a carotid occlusion due to a sudden severe haemorrhage, resulting from a pseudoaneurysm rupture following the embolization attempt. CONCLUSION: Review of the literature confirms the indication of endovascular intervention. The optimal management is carotid occlusion, provided the patient can tolerate carotid test occlusion and the circle of Willis is satisfactory. In some cases, a preservative treatment may be possible, which could be either pseudoaneurysm embolization or the placement of a covered stent.

[Nasal polyposis: long term functional results in 203 patients treated by ethmoidectomy combined with intranasal corticotherapy]. / Polypose naso-sinusienne: résultats fonctionnels à long terme chez 203 patients traités par évidement ethmoïdal et corticothérapie locale.

OBJECTIVE: Evaluate the long term quality of life in patients after ethmoidectomy associated with intranasal corticotherapy for nasal polyposis on the appreciation of the intensity of nasal symptoms. MATERIAL ET METHOD: The authors report their experience about 203 patients treated by endonasal endoscopic ethmoïdectomy intranasal followed by a long term intransal corticotherapy, with a mean follow up of six years. In this prospective study, each symptom was evaluated using an analogic visual scale and a questionnaire. The evolution of asthma after surgery and the patients global satisfactory rate were noted. RESULTS: There is a global improvement of the nasal symptoms with a mean postoperative individual scores calculated at 32% for nasal obstruction, at 34% for rhinorrhea and at 51% for anosmia. No impact on asthma or improvement of asthma was encountered in 92% of the patients. The patients global satisfactory rate of this medico-surgical approach of the disease is 93.6%. A positive correlation was found between the severity of the olfactory disorders and the oral corticosteroid therapy. CONCLUSION: Endoscopic endonasal ethmoïdectomy followed by intranasal corticotherapy represents a valuable protocol in treating patients with severe nasal polyposis.

Endoscopic sinus surgery for sinonasal haemangiopericytomas.

Haemangiopericytomas are rare peri-vascular tumours with variable malignant potential. The nasal cavity and the paranasal sinuses are most often involved in the head and neck. Five cases of haemangiopericytomas treated by a strict endonasal endoscopic approach are presented. Bleeding and nasal obstruction are the most frequent symptoms. Computed tomography (CT) scan and magnetic resonance imaging (MRI) allowed pre-operative assessment. Angiography with embolization was needed in two of the five cases. None of our patients presented with malignant histology. Our five cases were operated on, and a total tumour excision was performed through the endoscopic endonasal approach. We had one recurrence with a mean follow-up of 4.5 years. We suggest that when the tumour is purely intranasal or strictly located in the ethmoid or sphenoid sinus, it can be removed via an endonasal approach under endoscopic guidance in experienced hands.

[Allergic rhinitis in children]. / Rhinite allergique chez l'enfant.

The diagnosis of allergic rhinitis (AR) in children is mainly based upon history which leads to distinguish between seasonal (periodic or intermittent) pollinic AR and perrenial (permanent or chronic) AR. The consequences of an AR can be severe with major nasal discomfort, repercussion on quality of life and school attendance, and impact on facial bone growth. In addition it can be complicated by asthma. Specific desensitization is the only treatment which may modify the immune response towards allergens. However it must be compared with the other treatments including local or general antihistaminic drugs and intranasal corticosteroids, the choice resting upon the severity of the symptoms, the respiratory repercussion, and the age of the child.

Value of investigation in the diagnosis of allergic fungal rhinosinusitis: results of a prospective study.

The authors report a prospective study in which the aim was to analyse the usefulness of different criteria in optimizing the diagnosis of allergic fungal rhinosinusitis. From 1995 to 1998, 165 patients were operated on for chronic rhinosinusitis. Investigations used in this study for the diagnosis of allergic Aspergillus rhinosinusitis consisted of an analysis of clinical, radiological, immuno-allergic criteria. Fourteen patients presented with allergic Aspergillus rhinosinusitis. One hundred and fifty-one patients did not present any of the necessary criteria for the diagnosis of allergic Aspergillus rhinosinusitis. The results show that the characteristic macroscopic appearance, the maxillary sinus localization, and the presence of positive specific IgE to Aspergillus fumigatus are arguments that reinforce the diagnostic certitude of allergic fungal sinusitis. No specific clinical or radiological criteria orients a diagnosis of chronic rhinosinusitis toward that of allergic fungal rhinosinusitis. The other immuno-allergic tests do not contribute to the diagnosis of allergic fungal rhinosinusitis. pathological, mycological, and

[Allergic rhinitis]. / Rhinites allergiques.

Allergic rhinitis is one of the commonest diseases. The main allergens responsible are respiratory allergens. Pollinic or seasonal allergic rhinitis is currently distinguished from perannual or nonseasonal rhinitis, generally related to sensitization to allergens of the home environment. The diagnostic approach of allergic rhinitis is based on a careful clinical examination, in order to eliminate other causes of nasal dysfunction, and on complementary investigations, most importantly allergic skin tests. Several types of drugs, topically or systemically administered are currently available to treat allergic rhinitis. Surgical techniques should be reserved to patients who resist to medical treatment or to correct nasal architectural abnormality.

[Does allergic fungal sinusitis exist? Preliminary results of a prospective study]. / La sinusite aspergillaire allergique existe-t-elle? Résultats préliminaires d'une étude prospective.

Allergic aspergillar sinusitis is a very controversial clinical feature. We present results of a prospective study aimed at evaluating the reality of allergic aspergillar sinusitis in a nosologic and clinical point of vue. During a 5 months period, 31 patients underwent surgery: 21 sino-nasal polyposis, 5 chronic sinusitis without polyposis, 5 chronic sinusitis with radiologic images evocative of mycosis. The study was carried out using clinical criteria (per-operative discovery of glue-like, thickened and viscous aspect of the secretions), pathologic criteria (the presence of elements consitutive of allergic mucin), mycological criteria (direct examination and culture), and immunoallergic criteria (specific IgE for Aspergillus fumigatus, serology for Aspergillus fumigatus and Aspergillus flavus (IgM, IgG), skin tests for Aspergillus fumigatus). In three cases we suspect an allergic aspergillar sinusitis (one patient presenting a bilateral chronic sinusitis and two patients presenting a sinonasal polyposis). In two patients presenting a sinonasal polyposis, a allergic fungal sinusitis was suspected, fungal identification was not possible.

Nasopharyngeal tuberculosis.

Rhinopharyngeal tuberculosis is a rare pathological condition. It is most often associated with lymph node and pulmonary lesions, but it may be an isolated finding. The authors report a recent case of an isolated rhinopharyngeal tuberculosis in a 64-year-old female. A review of the literature is presented. They emphasize the clinical presentation, that, in all aspects, may resemble a malignant tumour of the nasopharynx, as well as the difficulty of obtaining a pathological and bacteriological diagnosis.

[Adenoid cystic carcinoma of the larynx. A case report and review of the literature]. / Carcinome adénoïde kystique du larynx. Revue de la littérature à propos d'un cas.

Laryngeal adenoïd cystic carcinoma (ACC) is a rare disease due to the poor distribution of the accessory salivary glands in this area. The authors describe a case of ACC arising from the sus glottic area and underline the difficulty of such a diagnosis, which is in fact an histologic finding. The signs of discovery of a laryngeal ACC are not different from other tumors of the area, except pain frequently evoked in these tumors. Laryngeal ACC arises exceptionally before the age of 20 years and no risk factor is known. The most frequent localization is in the sub-glottic area, but sus glottic and glottic localizations have been reported. Evolution is marked by the onset of cervical lymph adenopathies and systemic metastasis most often located in the lung. The treatment comprises wide surgical exerisis followed by radiotherapy. Other reports seem to indicate that the pronostic of the laryngeal location of this disease is worse than in other areas of the head and neck.

[Bilateral closure of the nasal cavity. An original surgical technique of treatment of severe recurrent epistaxis in Rendu-Osler disease]. / La fermeture bilatérale des fosses nasales. Une technique chirurgicale originale du traitement des épistaxis récidivantes graves de la maladie de Rendu-Osler.

In the Rendu Osler disease, epistaxis are seen in 80 to 90% of patients, and the multiple treatments that have been proposed have each shown their failure to achieve satisfactory results. We propose, in the case of abundant epistaxis, a bilateral closure of the nasal cavity. This technique has been initially described by Young in 1967 in the treatment of chronic atrophic rhinitis. This operation was carried out in two patients who presented with serious daily epistaxis, poorly tolerated, and refractory to several treatments. Neither of these patients has presented a post-operative bleeding episode with a one year and six months follow-up respectively. Anatomically, the results are satisfactory in both patients, with total closure of the nasal cavity. Functionally, both patients are satisfied, with an appreciable improvement in the quality of life despite total nasal obstruction.

The holmium:YAG laser for treatment of inferior turbinate hypertrophy.

Chronic hypertrophic rhinitis is sometimes refractory to local, as well as general, medical treatment. Before undertaking surgical reduction of the inferior turbinates, there is indisputably a place for cauterization or laser vaporization of the inferior turbinate mucosa. The authors present a study of 46 patients treated by the holmium:YAG laser for chronic hypertrophic rhinitis. The results after only one laser session are satisfactory in 89.1% at 6 months' follow-up and in 52.2% with mean follow-up of 16.2 months. No major secondary effects were observed.