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International audience; Background: To describe the characteristics of the largest European study of MEC of salivary glands and to determine the prognostic factors for overall and disease free survival.Patients and methods: Patients with MEC were prospectively included in the Réseau d'Expertise Français sur les Cancers ORL Rares (REFCOR, French Network of Rare Head and Neck Tumors) database between 2009 and 2015.Results: A total of 292 patients were included. Tumors were classified as low grade in 175 cases (60%), intermediate in 39 (13%) and high grade in 78 (27%). Median follow-up was 26 months. The 5-year OS and DFS rates were respectively 83% and 69%. In multivariate analysis, age (p = 0.004), diabetes (p = 0.02) and advanced stage (p = 0.03) were found to have a significant negative impact on OS. Diabetes (p = 0.001), alcohol consumption (p = 0.003) and advanced stage (p = 0.001) were found to have a significant negative impact on DFS. Compare to low grade, high grade tended to have a negative impact on OS (p = 0.05) and had a significant effect on DFS (0.002) while intermediate grade had no significant influence on survival. The surgical treatment had a positive impact on both OS (p = 0.00005) and DFS (p = 0.0005). Postoperative radiotherapy had no impact in multivariate analysis.Conclusion: Advanced clinical stage, high grade tumor, high age, the impossibility of carrying out a complete surgical resection, and diabetes are the main prognostic factors in this prospective series of patients with MEC. Such findings open new research perspectives on the influence of these components on initial patient care.

Resume Introduction Les schwannomes nasosinusiens sont rares, et particulierement au niveau du sinus frontal. Cas clinique Nous rapportons le cas d’une patiente atteinte d’un schwannome du sinus frontal gauche decouvert lors d’une complication a type de sinusite frontale avec complications orbitaire et oculaire. Le geste a consiste en une exerese tumorale par voie endonasale et un drainage par voie externe. Discussion L’origine des schwannomes du sinus frontal sont multiples avec des expressions clinico-radiologiques variees, rendant leur diagnostic difficile leur exerese etant par ailleurs complexe.

International audience; BACKGROUND:Head and neck mucosal melanoma (HNMM) is aggressive and rare, with a poor prognosis because of its high metastatic potential. The two main subtypes are sinonasal (sinonasal mucosal melanoma [SNMM]) and oral cavity (oral cavity mucosal melanoma [OCMM]). Consensual therapeutic guidelines considering the primary tumour site and tumour-node-metastasis (TNM) stage are not well established.MATERIAL & METHODS:Patients with HNMM from the prospective national French Rare Head and Neck Cancer Expert Network database between 2000 and 2017 were included. Clinical characteristics, treatment modalities, outcomes and prognostic factors were analysed.RESULTS:In total, 314 patients were included. The 5-year overall survival (OS) and progression-free survival (PFS) rates were 49.4% and 24.7%, respectively, in the surgery group; no long-term survivors were observed when surgery was not feasible. Moreover, even after surgery, a high recurrence rate was reported with a median PFS of 22 months. In multivariate analysis, Union for International Cancer Control (UICC) stage and tumour site correlated with PFS and OS. Postoperative radiotherapy (PORT) improved the PFS but not OS in patients with small (T3) SNMM and OCMM tumours. Nodal involvement was more frequent in patients with OCMM (p < 10-4), although, as in SNMM, it was not a significant prognostic predictor.CONCLUSION:Even early HNMM was associated with poor oncologic outcomes due to distant metastases despite surgical resection with clear margins. Lymph node metastases had no impact on the prognosis, suggesting treatment de-escalation in cervical node management. PORT might be useful for local control.

Fibrous dysplasia of bone is a benign, uncommon, sporadic, congenital skeletal disorder resulting in deformity. This disease arises from activating somatic mutation in GNAS which encodes the α subunit of the G stimulatory protein associated with proliferation of undifferentiated osteogenic cells resulting in marrow fibrosis, abnormal matrix production, and stimulation of osteoclastic resorption upon overproduction of IL-6 observed in dysplastic cells. Fibrous dysplasia may be monostotic or polyostotic. This mutation affecting many tissues, cafe au lait skin macules and endocrinopathies (precocious puberty, hyperthyroidism, growth hormone excess, Cushing syndrome) may be associated in McCune-Albright syndrome, but also myxoma in Mazabraud syndrome or phosphate diabetes. Diagnosis of craniofacial fibrous dysplasia should be considered in the presence of headache, neuralgia, sensory disorders (vision, hearing, balance, smelling), functional disorders (nasal obstruction, nasolacrimal duct obstruction, non-matching occlusion), infectious complications (sinusitis, otitis, mastoiditis). Such symptoms should lead to perform craniofacial CT scan completed with MRI. Bone biopsy is not systematic. Surgical treatment is discussed in cases of nervous complication, facial deformity or active lesions. In case of pain resistant to conventional analgesics, intravenous bisphosphonates can be proposed. In non-responder patients, several case reports suggest the efficacy of a monoclonal antibody directed against the IL-6 receptor which requires to be confirmed by randomized studies.

Introduction Nasal sinus schwannomas are rare tumors, particularly in the frontal sinus. Case report The authors report the case of a woman with left frontal sinus schwannoma discovered in a context of frontal sinusitis with orbital and ocular complications. The surgical procedure consisted of endonasal tumor resection and external drainage. Discussion The pathogenesis of frontal sinus schwannomas remains unclear. These tumors can present with a wide range of clinical and radiological signs, making them difficult to diagnosis. Surgical resection of these tumors is also complex.

Resumen La rinitis aguda es la afección rinológica más frecuente. El costo económico de los tratamientos y el absentismo laboral que provoca esta patología tienen una repercusión socioeconómica muy importante. En su forma habitual, de etiología viral, esta afección se resuelve espontáneamente en varios días. Las recidivas son frecuentes y la evolución puede agravarse, sobre todo en caso de sobreinfección o cuando la infección viral se presenta en pacientes de riesgo (recién nacidos, pacientes ancianos o inmunodeprimidos). Los mecanismos fisiopatológicos implicados en la inflamación nasal de la rinitis aguda, no se conocen aún perfectamente y son motivo de numerosos estudios; se han encontrado citocinas proinflamatorias y quimiotácticas y receptores celulares a los virus implicados en esta infección. Probablemente, estos descubrimientos permitirán, en un futuro próximo, tener terapéuticas específicas; de momento, el tratamiento de las rinitis se basa fundamentalmente en la prevención, disminuyendo los riesgos de contaminación, y en la prescripción de medicamentos sintomáticos.

Fibrous dysplasia of bone is a benign, uncommon, sporadic, congenital skeletal disorder resulting in deformity. This disease arises from activating somatic mutation in GNAS which encodes the α subunit of the G stimulatory protein associated with proliferation of undifferentiated osteogenic cells resulting in marrow fibrosis, abnormal matrix production, and stimulation of osteoclastic resorption upon overproduction of IL-6 observed in dysplastic cells. Fibrous dysplasia may be monostotic or polyostotic. This mutation affecting many tissues, café au lait skin macules and endocrinopathies (precocious puberty, hyperthyroidism, growth hormone excess, Cushing syndrome) may be associated in McCune-Albright syndrome, but also myxoma in Mazabraud syndrome or phosphate diabetes. Diagnosis of craniofacial fibrous dysplasia should be considered in the presence of headache, neuralgia, sensory disorders (vision, hearing, balance, smelling), functional disorders (nasal obstruction, nasolacrimal duct obstruction, non-matching occlusion), infectious complications (sinusitis, otitis, mastoiditis). Such symptoms should lead to perform craniofacial CT scan completed with MRI. Bone biopsy is not systematic. Surgical treatment is discussed in cases of nervous complication, facial deformity or active lesions. In case of pain resistant to conventional analgesics, intravenous bisphosphonates can be proposed. In non-responder patients, several case reports suggest the efficacy of a monoclonal antibody directed against the IL-6 receptor which requires to be confirmed by randomized studies.

OBJECTIVE Acute maxillary rhinosinusitis (AMRS) is a pathology in which the pain is often severe and requires appropriate treatment. Although the use of antibiotics is widely documented, the interest of short cycles of corticosteroids in the treatment of the functional manifestations of AMRS is based on professional experience. The aim of this study was to assess the efficacy and tolerance to prednisone administered for 3 days in addition to antibiotherapy in patients presenting with an AMRS. METHOD This was a double blind, randomised study in parallel groups and controlled versus a placebo, involving patients aged over 18, presenting with an AMRS confirmed by X-ray and endoscopy, having developed less than 5 days and complaining of spontaneous pain assessed as >or=50 millimetres on a visual analog scale (VAS). Together with cefpodoxime, the patients received either prednisone (0.8 to 1.2 mg/kg) for 3 days or a placebo. The primary efficacy endpoint was the mean of the differences versus the baseline value of pain (MPID - mean pain intensity difference) assessed on the VAS from Day 1 to Day 3. The secondary endpoints assessed were the mean of the differences in intensity of nasal obstruction, assessed in the same way as the MPID, the time lapse before the orally expressed relief of the pain (PRID - pain reflief intensity difference) and the administration of paracetamol during the first 3 days. RESULTS 289 patients (placebo 147, prednisone 142) were assessable for analysis in intent-to-treat (ITT). The global spontaneous pain on inclusion, measured by a VAS was of 73.0 +/- 14.1 mm. The assessments made during the first 3 days of treatment showed a statistically significant difference in favour of the prednisone group regarding MPID: - 4.82 mm (CI 95% -9.25; -0.40) (p=0.03), nasal obstruction - 5.0 mm (CI 95% -9.1; -0.8) (p=0.02) and consumption of paracetamol (p=0.03). There was no difference between the two groups after the end of the antibiotherapy. The tolerance measured throughout the study was comparable between the two groups. CONCLUSION This study clearly showed the efficacy of a short course of oral prednisone (3 days), versus a placebo, in the treatment of the functional signs of acute maxillary rhinosinusitis with severe pain in adults in addition to an appropriate antibiotic treatment.

Resume Propos. – Les surdites brusques idiopathiques sont des surdites neurosensorielles sans cause declenchante reconnue au moment de leur installation. L’atteinte neurosensorielle est habituellement cochleaire, mais certaines lesions retrocochleaires (tumorales de l’angle pontocerebelleux, degeneratives, ou ischemiques du nevraxe) peuvent se reveler ainsi. La prise en charge vise a rechercher une cause et a instaurer un traitement en urgence. Lorsqu’aucune cause n’est trouvee, on pose le diagnostic de surdite brusque idiopathique. Habituellement l’atteinte est cochleaire. La physiopathologie de cette atteinte sensorielle est encore inconnue. Il est tres probable que plusieurs causes soient possibles, leur point commun etant une alteration de la boucle de retrocontrole de l’organe de Corti. Actualites et points forts. – Il est fort probable que parmi les causes, une reactivation de virus neurotropes et/ou une ischemie cochleaire soient frequentes. Quelle que soit la cause, le traitement doit etre instaure en urgence et comprendre une corticotherapie a forte dose. Tout autre traitement n’a jamais prouve formellement son efficacite. On cherche ensuite, dans un second temps moins urgent, a eliminer une atteinte retrocochleaire, telle qu’une tumeur de l’angle pontocerebelleux, notamment chez le sujet jeune. Perspectives et projets. – Un des objectifs actuels est de pouvoir determiner les cas d’ischemie cochleaire de facon mini-invasive, notamment par velocimetrie laser doppler, afin d’optimiser le traitement. Sur le plan therapeutique, la protection acoustique precoce est benefique en cas d’ischemie cochleaire, au moins chez l’animal. Son efficacite en cas de surdite brusque, toute etiologie confondue, est en cours d’evaluation, dans un projet multicentrique.

Resume Objectif Le but de cette etude etait d'evaluer la place de la tomodensitometrie dans le suivi des patients chez lesquels se developpent des lesions pleuropulmonaires au cours d'une granulomatose de Wegener. Materiels et methodes Il s'agissait d'une etude retrospective de dix patients dont le suivi a ete en moyenne de 23 mois, avec des extremes de 4 a 61 mois. Resultats Au stade initial, les lesions qui dominaient etaient les nodules (90% des patients) et les condensations alveolaires (100% des patients). Les nodules ont disparu en 6 mois chez 60% des patients ayant beneficie d'une tomodensitometrie de controle et avaient completement disparu chez tous les patients en 12 mois. Les nodules sous-pleuraux ont regresse en laissant des opacites lineaires de traction cicatricielle. Ces nodules sous-pleuraux pouvaient, lorsqu'ils etaient excaves, se compliquer de pneumothorax. Les condensations alveolaires ont disparu dans 44% des cas le plus souvent dans les 4 mois. Lorsqu'elles persistaient, elles laissaient des infiltrats alveolaires associes a des bronchectasies et des opacites lineaires. Le mode d'expression des rechutes etait similaire a celui des lesions initiales dans 40% des cas. Conclusion Cette etude a montre une disparition sans sequelle de tous les nodules medullaires et corticaux sous traitement. Les nodules sous-pleuraux qui apparaissaient frequents ont ete remplaces par des epaississements cicatriciels. Les condensations alveolaires ont eu une evolution plus variable. Lorsque leur regression etait incomplete, une image de condensation retractile pouvait eventuellement permettre de les differencier d'une complication pulmonaire infectieuse ou d'une rechute de la granulomatose de Wegener dont l'aspect tomodensitometrique le plus evocateur etait nodulaire. La tomodensitometrie a permis de depister des complications souvent meconnues en radiographie standard comme le pneumothorax.

Resume Introduction De nombreuses localisations extrapulmonaires de la tuberculose ont ete decrites. La localisation linguale est rare et le plus frequemment secondaire a une atteinte pulmonaire ou plus rarement ganglionnaire. Observation Un homme de 64 ans, tabagique chronique souffrait d'une ulceration linguale chronique s'accompagnant d'une anorexie et d'une perte de poids importante. Une biopsie profonde de cette lesion a mis en evidence un granulome epithelioide et gigantocellulaire sans necrose caseeuse, sans bacille acido-alcooloresistant a l'examen direct. Les examens complementaires (radiographie thoracique, scanner thoracoabdominopelvien) montraient des signes de tuberculose disseminee confirmee par la positivite des cultures des prelevements pulmonaires, sanguins et urinaires. L'introduction d'un traitement anti-tuberculeux a permis la disparition rapide de l'ulceration linguale, evitant ainsi une evolution defavorable, voire fatale. Conclusion Une ulceration linguale d'origine tuberculeuse doit etre differenciee d'une lesion cancereuse, traumatique, d'un aphte ou d'un chancre syphilitique. Le diagnostic de l'origine tuberculeuse est difficile mais important a poser du fait de l'amelioration generalement rapide de la lesion apres introduction d'un traitement antituberculeux.

Introduction et but de l’etude La denutrition est frequente en pathologie neoplasique ORL et s’aggrave avec les traitements, rendant indispensable son depistage et sa prise en charge precoce. Actuellement, les criteres les plus utilises pour le diagnostic de denutrition sont la perte de poids et les scores composites tels que le NRI, prenant en compte a la fois la perte de poids et l’albumine-mie.Des techniques de mesure de composition corporelle telles que la bioimpedancemetrie et plus recemment la mesure de la surface musculaire sur coupe tomodensitometrique en L3 pourraient completer l’evaluation de l’etat nutritionnel, avec une mesure de la masse maigre, compartiment corporel directement relie aux complications de la denutrition. Egalement, des scores de fragilite tels que le Short Physical Performance battery (SPPB), score de performance physique, pourraient apporter un interet pour l’evaluation du retentissement fonctionnel et ainsi preciser la severite de la denutrition. Cette etude a pour but d’evaluer la performance de ces differentes techniques en comparaison au NRI pour le depistage de la denutrition chez des sujets atteints de neoplasie ORL avant traitement par chirurgie et/ou radiochimiotherapie Materiel et methodes 90 patients atteints d’un premier cancer ORL ont ete evalues, avant traitement, sur le plan nutritionnel. Cette evaluation comportait le NRI, une mesure de la composition corporelle par bioimpedancemetrie, une mesure de la surface musculaire squelettique sur une coupe en L3 par tomodensitometrie, a l’aide du logiciel Slice-O-Matic®. L’equation utilisee pour le calcul de la masse maigre (MM) a partir de la bioimpedancemetrie etait l’equation de Kyle. Celle pour le calcul de la masse musculaire squelettique (MS) etait l’equation de Janssen. La surface musculaire squelettique en L3, la MM et la MS etaient ensuite rapportees a la taille au carre pour obtenir l’indice de masse musculaire en L3, l’indice de masse maigre (IMM) et l’indice de masse musculaire squelettique (IMS). Etaient consideres comme criteres de denutrition, un NRI ≤ 97,5, un IMM ≤ 17 kg/m2 chez l’homme et ≤ 15 kg/ m2 chez la femme, un IMS ≤ 10,8 kg/m2 chez l’homme et ≤ 6,8 kg/ m2 chez la femme, un indice de surface musculaire squelettique en L3 ≤ 52,4 cm2/m2 chez l’homme et ≤ 38,5 cm2/m2 chez la femme. Egalement, le SPPB etait realise et considere comme critere de denutrition pour un score ≤ 8/12 Resultats et Analyse statistique La population est decrite par des pourcentages pour les donnees qualitatives et par des moyennes ± ecart-type pour les donnees quantitatives. La concordance entre les differents marqueurs a ete evaluee a l’aide d’un coefficient de Kappa. Toutes les analyses ont ete realisees en formulation pour un risque de 1re espece bilateral de 5 % sous STATA® (version 12, College Station, Texas, USA). 90 patients ont ete evalues. L’âge moyen etait de 61,4 ± 11,7 annees, l’IMC moyen etait de 24,6+/-5,4 kg/m2, le sex ratio etait de 13 femmes pour 77 hommes. La prevalence de la denutrition selon le NRI etait de 53,9 %. La prevalence de la denutrition etait sous-estimee lorsque l’on utilisait comme critere l’IMM avec seulement 17 % de denutris. Lorsque l’on regardait la prevalence de la denutrition selon l’IMS, la prevalence etait de 44,3 % avec une concordance de 56,3 % par rapport au NRI(Kappa = 0,134;p = 0,1). L’indice de surface musculaire squelettique en L3 detectait 57,7 % de denutris avec une concordance de 66,2 % par rapport au NRI (Kappa = 0,32 ; p = 0,002). Le SPPB identifiait 18,4 % de sujets fragiles. Tous ces sujets etaient identifies comme denutris selon le NRI Conclusion L’evaluation de masse musculaire a l’aide du scanner permet de detecter une prevalence de la denutrition proche du NRI, avec une concordance de 66,2 %. Cette technique de depistage de la denutrition semble surpasser l’evaluation par l’impedancemetrie. L’association du NRI et de l’indice de surface musculaire squelettique en L3 permettrait de depister plus de sujets a risque nutritionnel et apparaissent complementaires. L’utilisation du SPPB indique la severite de la denutrition et donne une information supplementaire sur le risque nutritionnel

To report the known data on the functional consequences of cochlear ischemia and the tools available to detect them.Review of the main integrated in vivo models described in mammals.The main integrated models of cochlear ischemia use laser doppler velocimetry to measure the degree of ischemia. Cochlear function can be effectively monitored during cochlear ischemia through the cochlear potentials and otoacoustic emissions, each of these signals giving specific information. The cochlea appears to be particularly resistant to several minutes of reversible ischemia. Indirect monitoring of cochlear ischemia can be achieved through distortion-product otoacoustic emissions during surgical procedures to the cerebellopontine angle. It is still impossible to directly and noninvasively detect cochlear ischemia in nonsurgical clinical practice.Integrated models of cochlear ischemia have contributed greatly to our knowledge of the functional behavior of the cochlea in this specific situation. Clinical practice now needs to be able to detect cochlear ischemia early and noninvasively, for example in cases of sudden hearing loss.

To determine the clinical, histological, epidemiological and occupational data related to exposure to wood dust in a series of 100 nasal sinus malignant tumors.We conducted a retrospective and descriptive study of cases diagnosed between 1st January 1981 and 31 December 2000, in the Auvergne region of France. Individual, medical, and occupational data were collected from a questionnaire completed by the patient (or the patient's family in case of death) and from the medical documents available.Forty-six cases (46 men), with an average age of 63+/-9.2 years [range, 43-82], had been exposed to occupational wood dust before the diagnosis. Fifty-four cases (30 men, 24 women), with an average age of 64.3+/-8.7 years [range, 40-96], had never been exposed. The average annual incidence increased, either for the total population or for the two subgroups distinguished on the basis of occupational exposure to wood dust. The majority of the patients presented different functional symptoms at the time of the diagnosis. For the 46 patients exposed to wood dust, the tumors were primarily ethmoid adenocarcinomas (92%). For the 54 non-exposed patients, the tumors observed were mainly epidermoid carcinomas (57%), then adenocarcinomas (15%). On the 46 patients exposed to wood dust, 85% were carpenters or cabinetmakers. For the majority of the patients, wood dust exposure started before the age of 20 (average age: 17+/-4.5) and the longest exposure began before 1981. The exposure time to wood dust before diagnosis was in the majority of cases greater than 20 years (mean exposure time: 37 years+/-11.4). Only 15% were exposed at the time of the diagnosis (mean time between the end of the exposure to the diagnosis was 11 years+/-2.8). Of the 54 non-exposed patients, no professional risk factor was evidenced.Epidemiologic data, such as the increasing incidence, and clinical and professional data, such as the occupational exposure to wood dust, were in agreement with the French and European literature. It is still probably too early to appreciate the effectiveness of prevention, established in France since 1980, on nasal sinus tumor incidence.

Report a case of tracheopathia osteoplastica and describe from a literature analysis the main clinical, radiological, and therapeutic features of this rare disease based on literature review.A 74-year-old patient suffering from a nasal polyposis that had been repeatedly operated was admitted for surgery of the frontal sinus. The day of surgery, the difficult intubation required a laryngotracheoscopy, which found a dystrophic trachea, with a sprinkling of whitish nodules, and hard swelling. The pathologic exams of a large biopsy specimen using a rigid bronchoscopy provided the diagnosis of tracheopathia osteoplastic. A complementary workup to search for the etiology was undertaken. The risk and the difficulty of the intubation led to suspending the surgery.The CT scan as well as the histological, bacteriological, and immunological tests showed nothing specific. The etiopathogenic hypothesis was the association of chronic disease of the upper airways such as the ozena or the chronic inflammation of the respiratory tract, an endocrine factor, dermatomyositis, exposure to toxic substances such as silica, or tracheobronchial amyloidosis. The bronchial microbiology test is positive in more than 50% of patients, and often Klebsiella ozaenae or Pseudomonas aeruginosa is found.Tracheopathia osteoplastica is a rare tumor, with unknown etiology and physiopathology. The discovery is most often incidental. Progession is slow and it does not compromise the vital prognosis. The treatment is symptomatic. Few surgical tracheal operations are described in the literature.

To report a case of laryngeal tuberculosis and to consider tuberculosis management in ENT practice.A 44-year-old man, a smoker with pulmonary sarcoidosis experienced dysphonia with dysphagia. Laryngeal fibroscopy revealed an ulcerated epiglottic lesion. Direct laryngoscopy was performed to detect carcinoma, laryngeal sarcoidosis or tuberculosis. The histologic study revealed granulomatosis with giant cells and caseous necrosis. Tissue culture identified Mycobacterium tuberculosis.Antituberculosis therapy decreased dysphonia and dysphagia. Isolated ulceration disappeared at three months. Pulmonary infiltration decreased in radiography. The discovery of this case of laryngeal tuberculosis instigated hospital and community tuberculosis surveillance.The ENT specialist should be aware of laryngeal tuberculosis in suspicious lesions. Mandatory declaration of such cases can motivate setting up tuberculosis surveillance.

Determinate the different prognostic factors of survival in ethmoidal sinus adenocarcinomas (ADK).60 patients with ethmoidal sinus ADK. 59 men and one woman. Average of 62.2 years (41-82). Retrospective study between 1985 and 2005. The following data were analyzed: exposure time to wood dust, disease incidence, primary clinical symptoms and ASA score. Radiological data were recovered by tomodensitometry and magnetic resonance imaging. Histological groups were described. TNM classification according to UICC 2002 and Roux/Brasnu was established on clinical and radiological constatations. Different treatments used were analyzed. Estimate of survival rate and impact of different prognostic factors were based on Kaplan-Meier actuarial method and multivariate analysis.Incidence rate was 2.86 patients a year. Exposure average time to wood dust was 25.6 years (2-44). T3/T4 stages were predominant (66.7%). the survival rate was 46.5% at 5 years. The survival rate was significantly superior respectively in T1 and T2 stages than in T3 and T4 stages, and in T4a than in T4b stages. Extension of the lesion to the sphenoid sinus was revealed as a significant bad prognostic factor. The ASA score and the exposure time to wood dust were not identified as statistically significant prognosis factors.Survival factors of ethmoïd sinus ADK were T stage and the extension of the tumor to the sphenoid sinus. On the results of this study, we consider that extension in sphenoïd sinus could be include in TNM classification of ethmoïd sinus adenocarcinomas.

To report a case of adenoid cystic carcinoma of the external auditory canal with petrous involvement.A 50-year-old woman was referred to our department for the management of a necrotizing external otitis. Computed tomography and biopsy revealed an adenoid cystic carcinoma of the external auditory canal.The patient was treated by complete surgical excision. A radiation therapy completed the treatment. Follow-up time was 19 months without evidence of recurrence. Adenoid cystic carcinoma of the external auditory canal is a rare tumor. It's a special type of carcinoma developing from the ceruminous glands. Histogenesis is difficult and unsettled. The most important survival factor is removal of the tumor with histologically free margins.Lack of specific clinical and radiological signs makes the diagnostic challenging. The adenoid cystic carcinoma is a rare neoplasm of the external auditory canal. An initial aggressive wide "en bloc" surgical resection is mandatory.

Tuberculous lesions of the oral cavity are uncommon. Most of cases are secondary to pulmonary disease and the primary form is rare.We report the case of a 64 year-old man, smoker, presenting a chronic ulcer of the tongue, with anorexia and important weight loss. The biopsy of this ulcer showed granulomatous inflammation and Langhans type giant cells, without necrosis. Ziehl-Nielsen stain was negative. Pulmonary lesions were subsequently detected (chest X-ray, CT-scan) and the disseminated tuberculosis was confirmed by a positive culture with acid-fast bacilli in urine, blood, and pulmonary sample. Antituberculosis treatment resulted in the complete resolution of the oral lesion.Biopsy for histopathological diagnosis, acid-fast stains and culture, is essential to determine the exact nature of chronic oral ulceration to distinguish between oral malignancy, infectious (syphilis), traumatic, or aphthous ulcers. Tuberculosis of the tongue is a difficult diagnosis. However it should be searched for because treatment usually results in a rapid recovery.

To report a case of IgG4-related multifocal fibrosclerosis, revealed by a multifocal salivary involvement.A 59-year-old man, with chronic pancreatitis, was managed for fibrotic involvement of the 2 submaxillary glands and the 2 parotids. Clinical, radiological, and histologic features were retrospectively studied.Pathological features of submandibular gland revealed a chronic sclerosing sialadenitis. Retroperitoneal fibrosis in computed tomography and high rate of IgG4 are objectived. The diagnosis of IgG4-related multifocal fibrosclerosis is evoked. The patient's state improved with corticosteroid therapy.Salivary involvement in IgG4-related multifocal fibrosclerosis must be recognized in salivary medical pathology.

The purpose of the study was to report two cases of cervical and para-pharyngeal bone tumors.Patients were two 29 and 67-year-old men. Presentation of the lesions included respectively a right cervical mass and a left para-pharyngeal mass. Clinical features and radiological, anatomopathological and therapeutic characteristics of the tumors were retrospectively studied.A cervical approach was made in both cases. Tumor biopsies revealed a vertebral aneurismal cyst and a corporeo-pedicular chordoma respectively.Vertebral bone tumors with cervical expression are very uncommon entities. Diagnosis could be systematically evoked in patients with a cervical or para-pharyngeal tumor presenting vertebral lysis.

The purpose of this work was to evaluate the diagnostic strategy and outcome of patients treated for tympanic paraganglioma.Nine patients presented with tympanic paraganglioma were treated in our unit from 1996 to 2003. There were eight women and one man, mean age 65 years. Surgery was performed in all nine patients. This retrospective analysis focused on revealing signs, diagnostic tools, surgical procedure for tumor resection, and short-, mid-, and long-term functional outcome.The surgical procedure was well tolerated by all patients. There were no cases of postoperative mastoiditis. None of the patients experienced postoperative dizziness. Total tumor removal was achieved in seven patients. In one patient, incomplete tumor resection was decided in order to preserve facial motion. All patients but one were relieved from their tinnitus in the early postoperative period. In four patients, preoperative hearing levels were worsened by the surgical procedure, essentially through an alteration of preoperative conductive hearing loss.MRI is highly contributive to the diagnosis of tympanic paraganglioma, which should be evoked in patients with pulsatile tinnitus. Diagnosis should be established as early as possible to lower the postoperative morbidity. While surgery can provide cure and relieve tinnitus, there is a high risk of auditory deterioration.

To report a nasal leishmaniasis diagnosed by septal perforation biopsy.We report a case of septal perforation with crusty rhinosinusitis and nasal vestibulitis in a 54-year-old woman with cirrhosis.Mucocartilaginous biopsy revealed a mucosal leishmaniasis. Biological and radiologic findings were normal. Clinical follow-up with anti-parasitical treatment showed a regression of the patient's muco-cutaneous lesion and regression of her hepatic insufficiency.Biopsy of septal perforation is a useful diagnostic tool, advocated for differentiate infectious, neoplasic and inflammatory pathology. Leishmaniasis may be evoked in rhinologic pathology.

Acute maxillary rhinosinusitis (AMRS) is a pathology in which the pain is often severe and requires appropriate treatment. Although the use of antibiotics is widely documented, the interest of short cycles of corticosteroids in the treatment of the functional manifestations of AMRS is based on professional experience. The aim of this study was to assess the efficacy and tolerance to prednisone administered for 3 days in addition to antibiotherapy in patients presenting with an AMRS.This was a double blind, randomised study in parallel groups and controlled versus a placebo, involving patients aged over 18, presenting with an AMRS confirmed by X-ray and endoscopy, having developed less than 5 days and complaining of spontaneous pain assessed asor=50 millimetres on a visual analog scale (VAS). Together with cefpodoxime, the patients received either prednisone (0.8 to 1.2 mg/kg) for 3 days or a placebo. The primary efficacy endpoint was the mean of the differences versus the baseline value of pain (MPID - mean pain intensity difference) assessed on the VAS from Day 1 to Day 3. The secondary endpoints assessed were the mean of the differences in intensity of nasal obstruction, assessed in the same way as the MPID, the time lapse before the orally expressed relief of the pain (PRID - pain reflief intensity difference) and the administration of paracetamol during the first 3 days.289 patients (placebo 147, prednisone 142) were assessable for analysis in intent-to-treat (ITT). The global spontaneous pain on inclusion, measured by a VAS was of 73.0 +/- 14.1 mm. The assessments made during the first 3 days of treatment showed a statistically significant difference in favour of the prednisone group regarding MPID: - 4.82 mm (CI 95% -9.25; -0.40) (p=0.03), nasal obstruction - 5.0 mm (CI 95% -9.1; -0.8) (p=0.02) and consumption of paracetamol (p=0.03). There was no difference between the two groups after the end of the antibiotherapy. The tolerance measured throughout the study was comparable between the two groups.This study clearly showed the efficacy of a short course of oral prednisone (3 days), versus a placebo, in the treatment of the functional signs of acute maxillary rhinosinusitis with severe pain in adults in addition to an appropriate antibiotic treatment.

We describe a case of intraparotid facial nerve schwannoma. About sixty patients with intraparotid tumors have been reported in the literature.A 89-year-old female patient presented with a history of progressive facial palsy and a left intraparotid mass. The mass was removed by parotidectomy for definitive diagnosis and treatment. We reviewed the findings in comparison with data in the literature.The well-encapsulated tumor arose from the superior branch of the intraparotid facial nerve. As the tumor could not be dissected from the nerve, a segment of facial nerve was sacrificed and repaired by interposing a greater auricular nerve. The final pathological diagnosis was schwannoma arising from the facial nerve.This case illustrates the clinical and pathologic features of intraparatid facial nerve schwannoma and points out the pitfalls of diagnosis and treatment. Consensus has recognized total resection surgery with facial nerve sacrifice as the most reasonable treatment for these tumors. We discuss the currently accepted management approach as well as the different treatment modalities for recovering facial function.

The aim of this prospective study was to determine eosinophilia and ECP (Eosinophilic Cationic Protein) levels in blood and in nasal secretions of patients with nasal polyposis (NP).119 patients with NP were prospectively studied. The control group included 25 patients.They included: questionnaire about asthma and intolerance to aspirin; nasal endosopic grading; nasal symptoms scoring; allergy testing; measurements of serum and nasal values of eosinophilia expressed as a percentage; measurements of serum and nasal values of ECP expressed in ng/ml; the Spearman correlation test, the T series and Khideux tests were used in the statistical analysis.In NP group, 66 were asthmatic (As) and 53 non asthmatics (NAs), 40 were atopic (ATo), and 79 were non atopic (NAto). Values of nasal eosinophilia and nasal ECP in NP patients were significantly higher (respectively 40.7+/-35.6% and 22.8+/-48.0 ng/ml) than the control group (respectively 3.0+/-14% and 2.1+/-3.6 ng/ml). Nasal and serum eosinophilia values in asthmatic patients (As) (respectively 47+/-36% and 7.6+/-6.3%) were significantly higher (p0.05) than in non asthmatic patients (NAs) (respectively 32.6+/-33.8% and 4.6+/-3.1%). No difference was found in nasal and serum ECP values between asthmatic and non asthmatic patients. Nasal eosinophilia values were significantly correlated (p=0.02) with nasal scoring in NP patients. No correlation was found between nasal ECP and serum ECP values and clinical scoring.Nasal eosinophilia and nasal ECP values are significantly increased in NP. Nasal eosinophilia seems to be a relevant biological marker of clinical severity (association with asthma and a high clinical score) in NP patients. By contrast, nasal ECP cannot be consider as a marker of clinical severity.

Metastatic carcinoma involving the middle ear space is a rare entity that is little described in the literature. The number of cases seems to be increasing. It is usually recognized that palliative treatment as the most reasonable treatment for this tumors.A 59-year-old female patient presented with a history of a metastatic carcinoma involving the middle ear space and mastoid. This metastase occurred one year late in the course of a bladder cancer. Presentation of the lesion included otorrhea and facial palsy complicated by headache and bilateral visual loss in relation with lateral sinus thrombophlebitis and intracranial hypertension. Diffuses metastases in the skeletal system were demonstrated by pretreatment investigations. Treatment was only palliative chemotherapy. Outcome was fatal two months after onset of symptoms.This case illustrates the clinical and pathological features of this tumor and the pitfalls of diagnosis and treatment. We will discuss the current accepted management and the difference after diagnosis modalities for this type of metastatic tumor.

Wegener's Granulomatosis (WG) is a necrotizing granulomatous vasculitis that has a strong affinity for the upper respiratory tract.To retrospectively study the clinical features of otorhinolaryngological manifestations from 21 WG patients.Eleven men and 10 women were studied with respectively a mean age of 62.7 (23-79) and 63.9 (53-73).Otorhinolaryngological manifestations were recorded before and during the course of WG.Upper respiratory tract involvement occurred in 81% of cases (17/21 patients) and was isolated in 42.8% of cases (9/21 patients). Nasosinusal manifestations occurred in 71.4% of cases (15/21) before and at the time of GW diagnosis. They included bilateral sinusitis (7 cases), nasal crusting (6 cases), purulent rhinorrhea (5 cases), epistaxis (4 cases), nasal ulcers (2 cases), nasal congestion with obstruction (3 cases) and 4 cases of nose deformity (saddle nose or oedema). Otologic manifestations occurred in 28.5% of cases and were never isolated. They included otitis media (3 cases), sudden hearing loss (3 cases), tinnitus (1 case), facial palsy (1 case) and 2 cases of chondritis. Pharyngolaryngotracheal manifestations occurred in 33.3% of cases (7/21). Diagnosis of GW was based on positive ANCA test (95.2% of cases), presence of biologic inflammatory parameters (76% of cases) and histological features. 29 biopsies from nasosinusal lesions on 17 patients were made. 44.8% of the biopsies were contributive with at least one histologic feature of the combination including vasculitis, necrosis and granulomatous inflammation. The best contributive site of biopsy was the paranasal sinus.We report that otorhinolaryngological manifestations occurred in 81% of cases before and at the time of GW diagnosis. These findings indicate that otorhinolaryngologists have a central role to play in early diagnosis of the disease.

Two cases of internal carotid artery aneurysm arising within the petrous bone are described, bringing up to 56 the number of such cases reported to date in the medical literature scanned through Medline. The first case presented as a moderately bleeding tumor of the petrous apex, while the second was revealed by a massive otorrhage. In both cases a pulsatile nasopharyngeal mass was associated with otorrhage. The treatment required in both cases the aneurysm to be embolized in extreme emergency. One patient suffered transient hemiplegia and aphasia that completely recovered, while the second eventually died, although the carotid occlusion had been well tolerated in the first two weeks that followed this procedure. From their own experience and a literature review, we can emphasize the need for arterial extra-intracranial bypass before an aneurysm embolization be proposed, since the neurological issue following internal carotid occlusion cannot be predicted.

A perfect knowledge of the anatomy of the vestibuloacusticofacial pedicle is required to preserve hearing and facial functions during cerebellopontine angle surgery for vestibular schwannoma. A clarification of the anatomy of this pedicle, in particular of its blood supply, is presented here, based on a review of the available literature, as well as on the author's data issued from anatomical dissections on latex-injected fresh specimens, and from radiological images of the cerebellopontine angle. The blood supply to the vestibuloacusticofacial bundle arises from the meatal loop of the anterior inferior cerebellar artery most often exhibited at the porus of the internal acoustical meatus. The labyrinthine artery is particularly exposed to injury between the cochlear and facial nerves. In addition, dissection in between these two nerves is likely to sever vessels directed to these nerves even though the labyrinthine artery is not interrupted. Thus, aside from a direct injury to the labyrinth, auditory function can be impaired through two distinct ischemic lesion types. Although the facial nerve is supplied through three main arterial systems (from the labyrinthine, the middle meningeal, and the stylomastoid arteries), its labyrinthine portion is more likely to suffer from ischemic damage as it is only supplied by meatal arteries. A refinement of our anatomical knowledge of the vestibuloacusticofacial pedicle, from a functional point of view, could arise from laser Doppler measurements of labyrinthine and facial blood flow during surgery, in an attempt to improve our functional preservation rate during therapeutic procedures for vestibular schwannoma.

Nitric oxide (NO) is implicated in the pathophysiology of inflammatory airway diseases. It has been identified as a potential marker of airway inflammation.The purpose of the study was to assess the concentrations of nasal NO in upper and lower airways in nasal polyposis patients.18 nasal polyposis patients (14 men, 4 women) and 21 control subjects (7 men, 14 women), all non asthmatic non smokers, without respiratory infections were prospectively studied.They included nasal obstruction scoring, nasal endoscopic grading, allergy testing, nasal cytology, flow-volume spirometry and measurement of nasal (NNO) and exhaled NO (ENO) concentrations. NO was measured by a chemiluminescence NO Analyser (Sievers 280). NNO was analysed by aspiration with a constant flow of 3 l/mn. ENO was analysed during a slow expiration (50 ml/s) against a constant resistance of 10 cm H2O.NNO was significantly (p0,001) decreased in NP group (596.4 +/- 102.06 ppb) compared to control group (2 251.6 +/- 288.6 ppb). ENO was significantly (p0.05) increased in NP group (45.4 +/- 14.1 ppb) compared to control group (11.2 +/- 1.16 ppb). NNO and ENO were not significantly different between atopic and non-atopic NP patients. NNO concentrations was inversely correlated with the values of nasal endoscopic grading. No correlation was found between NNO concentrations and respectively nasal obstruction scoring and eosinophil count in nasal mucosa.Further studies are necessary to understand the pathophysiology of decreasing NNO and increasing ENO in nasal polyposis. In particular, ENO could be consider as a biologic marker of lower airway inflammation in nasal polyposis.

The meaning of facial nerve enhancement by gadolinium-enhanced magnetic resonanca imaging (MRI) in Bell's palsy is very discussed. Aim of our study was to define the radiological data in facial Bell's palsy and to correlate them with clinical data.34 patients with facial Bell's palsy were studied prospectively. Each patient had two gadolinium-enhanced MRI. The first MRI was realized during the first ten days. The second MRI was realized three months later. Two patients with facial nerve enhancement localized on the third portion was not clinically normalized at 3 months. Facial nerve enhancement and his precise location was noted.Facial nerve enhancement was noted in 71,5% on first MRI and in 30% on second MRI. Gadolinium-enhancement was predominantly noted on the Fundus. No patients with facial nerve enhancement persisting at three months was clinically normalized at one month.Facial nerve enhancement localized on the fundus and/or on the third portion, persisting at three months, could be consider as a negative landmark of fast clinical facial recuperation.

Sudden idiopathic deafness is a sensorineural hearing loss with no recognized causes at the time of onset. The impairment site is usually localized in the cochlea, but some cases of retrocochlear lesions (e.g., cerebellopontine angle tumors, degenerative neural diseases, neuraxial ischemic lesions) can induce sensorineural deafness. The medical management of patients presenting with sudden deafness aims at detecting a causal mechanism, and at administering emergency therapeutic drugs. The diagnosis of idiopathic sudden deafness can be definitely made when no causes are found. Usually, the impairing mechanism involves the cochlea. The pathophysiology of this sensorineural alteration is still unknown. It is most likely that several mechanisms are associated together, their common point being an impairment to the feedback loop of the organ of Corti.It is very likely that reactivation of neurotropic viruses and/or cochlear ischemia are frequent etiologies. Whatever the cause, the treatment is to be administered urgently, and consists of a high-dose corticotherapy at the least. Other treatments have never really proven to be effective. It is secondarily checked that no retrocochlear pathological processes, such as a cerebellopontine angle tumor, is present, in particular in young people.One of the current objectives is to determine when cochlear ischemia is involved, in a mini-invasive manner, such as with laser Doppler flowmetry, so that the treatment can be optimized. From a therapeutic point of view, early acoustic protection has been proven to be effective in cases of cochlear ischemia in small laboratory animals. Its efficacy in case of sudden deafness, non-exclusive of other causes than ischemia, is being assessed in a multicentric project.

But de la presentation Evaluer l’etat nutritionnel de 45 patients, atteint d’un premier cancer des voies aero-digestives superieures, lors de leur prise en charge initiale. Materiel et methodes L’evaluation nutritionnelle reposait sur l’examen clinique (Indice de Masse Corporelle, Circonference Musculaire Brachiale et Short Physical Performance Battery (SPPB), l’impedancemetrie (indice de masse maigre selon la formule de Kyle et indice de masse musculaire selon la formule de Janssen), la biologie (albumine et pre-albumine), le scanner (indice de masse musculaire en L3) et le Nutrition Risk Index (N.R.I.) (1,519 × Albumine + 0,417 × poids actuel/poids habituel × 100) utilises comme mesure de reference de l’etat nutritionnel. Resultats L’âge moyen des patients etait de 63 ans pour un sex ratio de 0, 80 (4 hommes pour une femme). Le taux de patients denutris d’apres le N.R.I. etait de 49 %. Ce taux etait fortement variable selon l’outil de mesure utilise. Il etait de 62 % d’apres l’indice de masse musculaire en L3 calcule sur le scanner abdominal, de 45 % d’apres l’indice de masse musculaire calcule selon la formule de Janssen par impedancemetrie, de 37 % d’apres l’albumine, de 26 % d’apres la circonference musculaire brachiale, de 23 % d’apres le SPPB, de 19 % d’apres l’indice de masse maigre calcule selon la formule de Kyle par impedancemetrie, et de seulement 14 % d’apres la pre-albumine. Conclusion Il existe une grande variabilite dans l’evaluation nutritionnelle initiale, selon l’outil utilise. Le N.R.I., outil de reference, donne un taux de patients denutris superposable a la litterature (environ 50 %), au contraire des criteres biologiques pris individuellement. Les mesures anthropometriques donnent aussi des valeurs bien plus faibles. Les valeurs recueillies par l’impedance varient selon la methode de calcul. La formule decrite par Janssen donne un taux de patients denutris comparable au N.R.I. L’evaluation de l’indice de masse musculaire sur coupe scannographique en L3 donne le taux le plus eleve.

The aim of this study was to investigate the role of dispositional optimism (DO) as a predictor of health-related quality of life (HRQL) in a sample of upper aerodigestive tract cancer (UADT) patients. A prospective observational study design was used with a cohort of patients from one centre. DO was evaluated using a French version of the Life Orientation Test (the FLOT) translated and validated for this study. HRQL was evaluated using the EORTC QLQ-C30 prior to and 3 months following treatment. The association between FLOT ratings and HRQL was evaluated using linear multiple regression analysis and a two-way ANOVA with repeated measures. Baseline data were gathered on 101 subjects and follow-up data on 88 of these. The sample was dichotomized around the median FLOT score creating 'optimist' and 'pessimist' groups. Before treatment, optimists reported better role, cognitive and emotional function, less pain and fatigue and a better global rating of HRQL than did pessimists. Following treatment, optimists reported better role and cognitive functioning, less pain and better global HRQL than did pessimists. Pessimists reported a greater deterioration in the role domain following treatment than did optimists. At no point did pessimists rate HRQL better than optimists. The results suggest that optimism is associated with better HRQL in French UADT cancer patients.

The efficacy of systemic antibiotics on the treatment of ventilator-associated infectious maxillary sinusitis (VAIMS) is debated. The objective of this study was to determine the etiologic diagnosis of VAIMS in patients receiving antibiotics.Patients mechanically ventilated for more than or equal to 72 h, who had persistent fever while on antibiotics for more than or equal to 48 h, underwent computed tomography scan followed by transnasal puncture of involved maxillary sinuses. VAIMS was defined as follows: fever greater than or equal to 38 degrees C, radiographic signs (air fluid level or opacification of maxillary sinuses on computed tomography scan), and a quantitative culture of sinus aspirate yielding more than or equal to 103 colony-forming units/ml.Twenty-four patients had radiographic signs of sinusitis. The mean +/- SD prior durations of mechanical ventilation and antibiotic exposure were 9.5 +/- 4.7 days and 6 +/- 4 days, respectively. Six unilateral and nine bilateral VAIMS were diagnosed in 15 patients. The median number of etiologic organisms per patient was two (range, one to four). The bacteriologic cultures yielded gram-positive bacteria (n = 21), gram-negative bacteria (n = 22), and yeasts (n = 5). Forty percent of causative agents were susceptible to the antibiotics prescribed. Seven patients with VAIMS developed 10 concomitant infections: ventilator-associated pneumonia (n = 5), urinary tract infection (n = 3), catheter infections (n = 2). In all cases of ventilator-associated pneumonia, the implicated agents were the causative agents of VAIMS.In VAIMS patients on antibiotics, quantitative cultures of sinus aspirates may contribute to establish the diagnosis. The frequent recovery of microorganisms susceptible to the antimicrobial treatment administered suggests that therapy of VAIMS with systemic antibiotics may not be sufficient.

The aim of this study was to test the hypothesis that optimism is a predictor of quality of life (QOL) in a sample of upper aerodigestive tract (UADT) cancer patients.Consenting patients with squamous cell carcinoma of the UADT were included during the week following disclosure of the diagnosis of their illness, and before the start of treatment. QOL and optimism were evaluated by questionnaires presented to the patients before the start of treatment, after the treatment, and 6 and 12 months after the end of the treatment.92 patients were included. The average age was 58.7+/-11.4 years. Their QOL scores were significantly correlated, first with age (r =- 0.23, p =0.03) and second with degree of optimism (r =0.32, p =0.002). No correlation was found between QOL scores, degree of optimism, and sociodemographic and clinical data. Optimism was the sole variable significantly associated with QOL before treatment (F =4.1, p =0.002, r(2) =0.19). The difference between QOL scores before and after treatment was not significant.Continuation of the study and analysis of survival of the patients may help pinpoint new prognostic factors, both objective and subjective, that will facilitate an overall approach to patient care by allowing for their preferences.