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Implantable systems for venous access are widely used in cervicofacial cancer. We prospectively evaluated complications related to this type of venous access in our cancer patients.From September 1991 to September 1993, an implantable system for venous access was installed in 164 patients with epidermoid carcinoma of the upper respiratory and digestive tracts. The systems were implanted in the subclavian vein by 20 different operators (mean number of implants per operator = 8.2). All catheters were tunnelized. Chemotherapy was a combination of 5 fluorouracil and cisplatinum.Immediate complications included impossible implantation (n = 12, 7.3%), pneumothorax (n = 5), false passage (n = 4), haematoma (n = 3), arterial puncture (n = 2) and abscess of the thoracic wall (n = 1). During use, complications included extravasation (n = 4), catheter thrombosis (n = 2), venous thrombosis (n = 2) and infection at the site of implantation, desinsertion of the catheter from the chamber, haematoma at the site of implantation and septicaemia (n = 1 each). The rate of complications was related to implantation (17% of the implantations) or to use (8%).The rate of complications due to implantable venous access systems is relatively low, suggesting that these systems are acceptable for ambulatory chemotherapy.

The pre-epiglottic space is located superficially at the junction of the larynx, oropharynx and hypopharynx. When it is invaded by a neighbouring cancer, the latter rises to stages 3 or 4 of the TNM classification. The space is explorable by percutaneous ultrasonic scanning of the neck. The present paper gives the first description of the normal sonographic anatomy of the pre-epiglottic space, based on 16 healthy volunteers. It also gives the first description of invasion of that space, based on 18 patients operated upon for ENT (ear, nose and throat) cancers. In 5 of these 18 patients, invasion of the pre-epiglottic space was proven at histology. There were 3 positive and no false negative results, but 3 false positive results were obtained at the beginning of the series. The accuracy of ultrasounds in this study was 83 per cent.