Sialendoscopy: a new diagnostic and therapeutic tool.

BACKGROUND: Sialendoscopy is a recently developed minimally invasive diagnostic and therapeutic procedure for the management of obstructive diseases of the salivary glands. This report describes our early experience with this new tool and compares our results with the literature data. MATERIAL AND METHODS: This was a retrospective analysis of the 33 first cases treated at a teaching hospital from October 2009 to June 2011. RESULTS: The success rate for diagnostic sialendoscopy was 94%. Sialolithiasis was found in 19 cases and salivary duct stenosis in 11; no canal anomaly was found in two cases. The success rate for stone removal was 79%, while treatment of strictures failed in four cases. Longer surgical experience led to shorter operating times and improved indications as well as better therapeutic outcomes. There were no complications. CONCLUSION: Sialendoscopy is a safe technique that can easily be learned by surgeons familiar with endoscopic surgery. However, practical experience is needed to reduce operating times, lower failure rates and determine its precise indications.

Management of voice prosthesis leakage with Blom-Singer large esophage and tracheal flange voice prostheses.

INTRODUCTION: Voice rehabilitation after total laryngectomy is a major socio-economic challenge. Voice rehabilitation can be achieved by voice prostheses, which provide rapid patient satisfaction. Enlarged tracheo-oesophageal puncture is a frequent complication and can be difficult to manage. MATERIAL AND METHOD: A prospective study was conducted from November 2010 to October 2011 on 28 Blom-Singer large oesophageal and tracheal flange voice prostheses placed in 18 patients with enlarged tracheo-oesophageal puncture causing leakage around the voice prosthesis. RESULT: Leakage around the voice prosthesis resolved in all patients with a mean prosthesis lifespan of 95 days. The patients considered voice quality to be similar to that obtained with the initial voice prosthesis. CONCLUSION: The Blom-Singer large oesophageal and tracheal flange voice prosthesis is a useful solution for the management of periprosthetic leakage ensuring similar voice quality and an identical lifespan to that of other voice prostheses.

[Cranial fasciitis of childhood]. / Fasciite crâniale.

OBJECTIVE: To describe the clinical and pathological features of cranial fasciitis of childhood, and to review and compare this case with those of international literature. METHODS: We report a case of cranial fasciitis of childhood located on the face of a 13-month-old boy. A complete review was performed from the database "Pub Med", looking for the key words "head and neck inflammatory myofibroblastic tumour", "nodular fasciitis", "cranial fasciitis of childhood". RESULTS: Cranial fasciitis is benign rapidly growing fibroblastic tumour, belonging to the group of nodular fasciitis, and has a predilection for the head and neck region of young children. This tumour is highly cellular and often show striking erosion of bone often misdiagnosed as a sarcoma. Surgery with adequate resection margin is the best treatment. There is no tendency for local recurrence. CONCLUSION: Positive pathological diagnosis of cranial fasciitis is uncommon and may be difficult.

The uses of computer-assisted surgical navigation in trans-nasal pituitary gland surgery.

OBJECTIVES: To examine the use of computer-assisted surgery in transnasal pituitary gland surgery. PATIENTS AND METHODS: Twenty cases of transnasal pituitary gland surgery using a computer-assisted navigation system, carried out between 2002 and 2004, were retrospectively studied. The subjects consisted of 7 men and 13 women aged between 27 and 77 years of ages. The pituitary tumours included 18 macroadenomas, a microadenoma and a craniopharyngioma. Ten of the cases presented with visual field and/or visual acuity disturbances. Seven of the cases presented with endocrine disorders. A computed tomography scanner destined for navigation purposes was carried out 24 hours before the operation. The computer-assisted system used was the Digipointeur (Collin ORL) based on a system of spatial localization in electromagnetic fields. RESULTS: Tumour removal was complete in 50% of cases and partial, as judged by MRI 3 months after the procedure, in 45% of the cases. In 40% of cases, the preoperative visual disturbances had completely disappeared at 3 months. A considerable clinical improvement was observed in all of the other cases. Peroperative complications were limited to two breaches of the meninges and one peroperative hemorrhage during the excision of a macroadenoma invading the cavernous sinus, necessitating the suspension of the operation. CONCLUSION: In our experience, the use of a computer-assisted system in transseptal pituitary surgery gives reliable millimetric surgical precision in the localization of vital internal anatomical structures, optimizes surgical resection and increases levels of safety.