Guidelines of the French Society of ENT (SFORL): Drug-induced sleep endoscopy in adult obstructive sleep apnea syndrome.

OBJECTIVES: To determine the indications, anesthesiological and surgical procedure and interest of drug-induced sleep endoscopy in the treatment of adult obstructive sleep apnea syndrome. DESIGN: A redactional committee of 17 experts was set up. Conflicts of interest were disclosed and followed up throughout the process of drawing up the guidelines. The work received no funding from any firm dealing in health products (drugs or devices). The GRADE (Grading of Recommendations Assessment, Development and Evaluation) method was applied to assess the quality of the data on which the guidelines were founded. It was stressed that strong recommendations should not be made on the basis of poor-quality or insufficient data. METHODS: The committee studied 29 questions on 5 topics: indications and contraindications, anesthetic technique, surgical technique, interpretation and reporting of results, and management guided by results. RESULTS: Expert review and application of the GRADE method led to 30 guidelines: 10 with high level of evidence (Grade 1+ or 1-), 19 with low level (GRADE 2+ or 2-) and 1 expert opinion. CONCLUSION: Experts fully agreed on the strong guidelines formalizing the indications and modalities of drug-induced sleep endoscopy for adult obstructive sleep apnea syndrome.

[Supraglottic laryngectomy with arytenoidectomy]. / Laryngectomie supra-glottique avec aryténoïdectomie.

Relearning to swallow is frequently difficult after supraglottic laryngectomy requiring arytenoid cartilage resection. We propose a surgical procedure in which a local flap is used to close the pharyngeal defect without approximating the laryngeal remnants and the base of tongue. The procedure opens the median raphe and cuts the hyoid bone along the midline. The strap muscles, the perichondrium from the thyroid cartilage and thyroid lobe on the ispilateral side to the tumor are retracted laterally to be used to close the mucosal defect. Sixty-eight patients with T1-T3 carcinomas of the laryngeal margin with extension to an arytenoid in all cases and limited extension to the medial wall and/or anterior angle pyriform fossa in 33 underwent this surgical procedure. Only 5 patients had local recurrence and 8 a lymph node recurrence. Visceral metastases occurred in 21 patients (33%) and second primary tumors were diagnosed at the time of surgery or during follow-up in 19 patients (28%). Three and 5-year actuarial survival rates were 57 and 51%, respectively. Despite post operative radiotherapy, functional success was obtained in 50 patients (75%). This technique provided good tumor control and a high rate of satisfactory functional results in patients with tumors of lateral margin extended to one arytenoid.

[T3 and T4 cancer of the oral cavity, surgical treatment with oral tongue resection]. / Cancers T3 et T4 de la cavité buccale, traitement chirurgical par amputation de la langue mobile.

Amputation of the oral tongue is required to treat T3 and T4 bilateral tumors of the anterior two third of the tongue with or without extension to the floor of the mouth. This partial glossectomy was performed initially for 27 patients and as salvage therapy for 35 patients with recurrent diseases. The reconstruction required a flap in all cases, including 8 microvascular free flaps. Two months after surgery, two third of patients had a satisfactory swallowing hability. The functional results were worst for patients operated after radiotherapy. Actuarial survival rates were 37.5% and 22.1% at 3 and 5 years respectively. The survival rate of patients who had surgery as primary modality of treatment was significantly better as compared with those who had radiotherapy before surgery (p=0,018). This surgery offers a perfect control of tumors of the anterior floor and oral tongue and good rehabilitation provided by the conservation of the posterior tongue.

[Cranialization of the frontal sinus]. / La cranialisation des sinus frontaux. A propos de 19 cas.

UNLABELLED: In the surgery of frontal sinus exclusion, the place of cranialization is still controversial. Our aims were to describe the operative technique, report our results and discuss its indications. PATIENTS AND METHODS: Nineteen patients were operated according to this technique between 1984 and 1997. Cranialization was performed in the first place for tumors, osteitis, traumatisms and benign tumors or mucoceles with a special location. In patients with chronic sinusitis or mucocele, it was performed in the second place when functional surgery was considered as failure and because sinus obliteration seemed to be inappropriate. RESULTS: There was no mortality nor anosmia linked to the procedure. Postoperative sequelae were related to the disease or to the surgical approach. After a median follow-up of 29 months, no disease recurrence was observed. CONCLUSION: Cranialization of frontal sinus gives good results in selected patients, with low morbidity. Even though its indications are infrequent, this technique has its place in the surgical exclusion of frontal sinus.

[Retro-pharyngeal and pharyngeal-laryngeal lipomas]. / Lipomes rétro-pharyngés et du pharyngo-larynx.

Pharyngeal and laryngeal lipoma are uncommon mesenchymal tumors. This report discusses the clinical and pathological features of five cases and a review of the literature. Symptoms included dysphagia, throat discomfort and airway obstruction in three patients. These complaints occurred over several years. One patient had a recurrent fibrolipoma and had experienced several surgical procedures. Surgery is the treatment of choice including conservative procedures but for large tumors open surgical approaches rather than endoscopic techniques should be employed. Recurrent tumor may be a sign of incomplete excision but also of a well-differentiated liposarcoma.

[Orbital complications of sinusitis in adults]. / Complications orbitaires des sinusites de l'adulte.

Orbital complications of sinusitis are rare in adults but delayed diagnosis is vision and life threatening. We report our experience in 6 patients to present clinical history, bacteriology and discuss the modality of treatment. There were 4 young men and 2 women, aged from 16 to 79 years old. Only one patient had an immunocompromised underlying condition (HIV infection). Four patients had preseptal abscesses and three post septal cellulitis or abscess (one patient had preseptal abscess and post septal abscess and hematoma). Two patients had a complete unilateral loss of light perception. Pathogens encountered were Streptococcus species: 4, strict anaerobes: 1, Pseudomonas aeruginosa: 1 (patient with AIDS). Patients recovered from infection with antibiotics in 6 and surgery in 5 but sequellar blindness occurred in 2 patients. Our experience emphasizes the necessity of antibiotic treatment in bacterial sinusitis and importance of early diagnosis and appropriate management of complications.

[Value of MRI and computerized tomography scanner in oro-buccopharyngeal cancers with bone invasion]. / Apport de l'IRM et du scanner dans les cancers oro-buccopharyngés avec envahissement osseux.

The purpose of this prospective study was to assess the impact of Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) in the surgical management of carcinomas with mandibular bone invasion. Thirty-five patients with squamous cell carcinoma of oral cavity or oropharynx, with mandibular spread, were studied with both imaging methods before surgical treatment. We compared the radiographic findings with histologic examination. Sensitivity of CTScan and MRI was respectively 25% and 80% to identify bone invasion. CTScan was found less effective in the assessment of bone invasion before mandibular resection and was considered more radiologist dependent. MRI is becoming the imaging method of choice for these cancers, despite inherent disadvantages including limited availability and increased cost over CTScan. MRI is accurate in large oropharyngeal tumors with extension of base of tongue and pterygoid muscle, and to study bone invasion before surgery in oral cavity tumors.

[Sebaceous carcinoma of the parotid gland]. / Carcinome sébacé de la parotide.

Sebaceous carcinoma is a rare tumor, from the adnexal epithélium of the sebaceous glands. Usually, lesions arise in meibonian glands of the eyelid. However, extraocular lesions within head and neck have been reported. We report a case of recurrent sebaceous carcinoma of the parotid gland without metastases.