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Head and neck (HN) squamous cell carcinomas (SCCs) originate from the epithelial cells of the mucosal linings of the upper aerodigestive tract, which includes the oral cavity, the pharynx, the larynx, and the sinonasal cavities. There are many associated risk factors, including alcohol drinking coupled with tobacco use, which accounts for 70% to 80% of HNSCCs. Human papilloma virus (HPV) is another independent risk factor for oropharyngeal SCC, but it is only a minor contributor to oral cavity SCC (OSCC). Betel quid chewing is also an established risk factor in southeast Asian countries. However, OSCC, and especially oral tongue cancer, incidence has been reported to be increasing in several countries, suggesting risk factors that have not been identified yet. This review summarizes the established risk factors for oral cavity squamous cell carcinomas and examines other undemonstrated risk factors for HNSCC.

Background Despite the development of anterior skull base surgery, the anatomy of the nasal bone and anterior cribriform plate remains unclear. A recent study confirmed 2 distinct foramina in the anterior part of cribriform plate: the ethmoidal slit (ES) and the cribroethmoidal foramen (CF). The aim of this study was to specify their content, their anatomic relationship to the frontal sinus and skull base, and their potential value in skull base surgery. Methods Dissections were performed on 36 cadaver heads. Macro- and microscopic examinations were carried out. Microcomputed tomography scans contrasted with osmium were performed to identify vessels and nerves. Histology with neural, meningeal, or luteinizing hormone-releasing hormone immunomarkers was performed on the content of the foramina. Finally, endonasal surgical dissections were carried out. Results The ES and the CF were observed in all cases. They measured a mean of 4.2 and 1.6 mm, respectively. The ES contained dura mater, arachnoid tissues, lymphatics, and the terminal nerve. The CF contained the anterior ethmoidal nerve and artery. This foramen continued forward with the cribroethmoidal groove, which measured a mean of 2.5 mm. This groove was under the frontal sinus and in front of the skull base. We also described a "cribroethmoidal canal" and a "nasal bone foramen." Conclusion The clinical applications of this new anatomic description concern both cribriform plate and frontal sinus surgeries. Identifying the terminal nerve passing through the ES is a step forward in understanding pheromone recognition in humans.

International audience; Objectives: To assess the factors associated with long-term quality of life (QoL) and patient concerns in elderly oral or oropharyngeal cancer (OOPC) patients after oncologic surgery and free-flap reconstruction. Methods: Patients aged over 70 years who were still alive and disease-free at least 1 year after surgery were enrolled in this cross-sectional multicentric study. Patients completed the EORTC QLQ-C30, -H&N35 and -ELD14 QoL questionnaires, and the Hospital Anxiety and Depression Scale (HADS). Patient needs were evaluated using the Patient Concerns Inventory (PCI). Factors associated with these clinical outcomes were determined in univariate and multivariate analysis. Results: Sixty-four patients were included in this study. Long-term QoL, functioning scales and patient autonomy were well-preserved. Main persistent symptoms were fatigue, constipation and oral function-related disorders. Salivary and mastication/swallowing problems were the main patient concerns. The mean number of patient concerns increased with the deterioration of their QoL. Psychological distress (HADS score ≥ 15) and patient frailty (G8 score

To assess patient needs and concerns after head and neck squamous cell carcinoma (HNSCC) treatment and their possible correlations with long-term quality of life (QoL) and to examine the potential impact of psychological distress on these results.Alive and disease-free HNSCC patients at least 1 year after treatment were enrolled in this cross-sectional multicentric study and completed the EORTC QLQ-C30 and HN35 QoL questionnaires, the head and neck cancer-specific patient concerns inventory (PCI-HN) questionnaire and the hospital anxiety and depression scale (HADS). Correlations between QoL outcomes and patient needs and concerns were investigated using Spearman's correlation tests.Seventy-two patients were enrolled in the study. Fear of cancer recurrence was the main patient concern followed by dental, salivary, fatigue, speech, and eating problems. The leading patient needs in terms of consultation were to be referred to the surgeon, the speech, and swallow therapist and the oral rehabilitation team. The number of patient concerns correlated negatively (r .40) with functioning scales score and positively (r .40) with general and head and neck symptoms. Psychological distress was the main determinant of QoL outcomes (p .0001). We found a significant impact of gender (p = .002) on the number of patient concerns, and of patient age (p = .003) on the number of staff members selected by patients.Identification of patient needs and concerns along with multidisciplinary management of persistent symptoms and psychological distress seem essential steps towards improving QoL of HNSCC patients.

International audience; PurposeEthmoidal slit (ES) and cribroethmoidal foramen (CF) have been poorly studied, without any radiological description. They may ease cribriform plate’s diseases. The objective was to describe the frequency, size, and computed tomography (CT) appearance of these foramina.MethodsA two-part anatomoradiological study was performed: first on dry skulls using a surgical microscope and CT, second on patients CT scans. For each, foramina were searched for, described, and measured when possible.ResultsThirteen dry macerated skulls were studied. The orbitomeatal plane was relevant for studying ES. With microscope, ES and CF were identified in, respectively, 92% and 100% of cases. Using CT, all ES and CF were visible, with a mean length and width of, respectively, 3.9 ± 1.7 mm and 0.9 ± 0.3 mm for ES and 1.6 ± 1 mm and 0.9 ± 0.3 mm for CF. CT scans from 153 patients were reviewed. ES and CF were identified in, respectively, 80% and 91% of cases, with a mean length and width of, respectively, 3.9 ± 0.8 mm and 0.8 ± 0.2 mm for ES.ConclusionLarge-sized ES was found frequently, and were clearly visible in patients CT scans. CF was markedly smaller, but seen in most patient scans. ES and CF could be areas of least resistance in the anterior part of the cribriform plate. CT might be helpful in understanding their pathological implications.

International audience; Introduction: "Sociability" is defined as the range of experiences linking the subject to others. This is the first study to focus specifically on the impact of head and neck cancer on the sociability of patients' partners. Method: Data were collected via a dedicated questionnaire sent to patients' partners. The main endpoint was partner's self-assessment of the impact of the patient's disease on the partner's everyday life. The impact on sociability was analyzed with respect to: the circle of friends (friendship environment), unknown environment, known outside environment, necessary environment, and solitary activities. Results: Two hundred and seventy partners responded. Their everyday activities were impacted by the patient's disease in 71.5% of cases. The friendship environment was badly affected in 46.4% of cases. The unknown environment was affected in 44.0% of cases. Social practices related to the known outside environment were affected in 67.8% of cases, and the necessary environment in 26.0%; the number of solitary activities increased in 35.6% of cases. Social impact on patients' partners was thus considerable.

Ethmoidal slit (ES) and cribroethmoidal foramen (CF) have been poorly studied, without any radiological description. They may ease cribriform plate's diseases. The objective was to describe the frequency, size, and computed tomography (CT) appearance of these foramina.A two-part anatomoradiological study was performed: first on dry skulls using a surgical microscope and CT, second on patients CT scans. For each, foramina were searched for, described, and measured when possible.Thirteen dry macerated skulls were studied. The orbitomeatal plane was relevant for studying ES. With microscope, ES and CF were identified in, respectively, 92% and 100% of cases. Using CT, all ES and CF were visible, with a mean length and width of, respectively, 3.9 ± 1.7 mm and 0.9 ± 0.3 mm for ES and 1.6 ± 1 mm and 0.9 ± 0.3 mm for CF. CT scans from 153 patients were reviewed. ES and CF were identified in, respectively, 80% and 91% of cases, with a mean length and width of, respectively, 3.9 ± 0.8 mm and 0.8 ± 0.2 mm for ES.Large-sized ES was found frequently, and were clearly visible in patients CT scans. CF was markedly smaller, but seen in most patient scans. ES and CF could be areas of least resistance in the anterior part of the cribriform plate. CT might be helpful in understanding their pathological implications.

Nutritional care improves quality of life (QOL) in head and neck cancer patients treated with radiotherapy. The aim of our study was to determine whether intensive nutritional care (INC) would further improve QOL. In addition to a control group based on European and American guidelines, patients included in the INC group received six meetings with a dietitian. QOL was measured after radiotherapy using the EORTC QLQ-C30. We performed a meta-analysis to determine the best nutritional care. In the 87 patients, the QOL scores, weight, energy, and protein intakes were similar between the INC group (n = 43) and the control group (n = 44). The meta-analysis revealed no heterogeneity and significant differences in QOL (three studies) (p = 0.46) or weight changes after radiotherapy (four studies) (p = 0.06). The nutritional care specified in the European and American guidelines is composed of well-defined recommendations, and appears sufficient to maintain QOL without further intervention.

Introduction/Objectifs Le developpement de la chirurgie endoscopique de la base du crâne necessite des reperes anatomiques precis. Aussi, la lame criblee anterieure reste une region incompletement decrite. Une etude preliminaire retrouvait l’existence de deux foramens appeles « fente ethmoidale » et « trou ethmoidal », ne contenant pas de filets olfactifs et mesurant respectivement 4,1 et 1,8 mm. L’objectif de notre etude a ete de preciser le contenu de ces foramens et leurs rapports pour la chirurgie. Materiels/Patients et methodes Nous avons effectue une etude cadaverique sur 36 specimens, analyses selon quatre techniques : – etude osteologique (12 crânes) : les foramens ont ete mesures par voie endonasale et endocrânienne ; – etude histologique (12 crânes) : sur corps frais apres decalcification pour analyse en coloration standard, immunohistochimie, immunofluorescence et microscopie electronique ; – etude radiologique (2 crânes) : micro-scanner. Deux d’entre eux ont ete contrastes au tetroxyde d’osmium avec reconstruction en 3 dimensions ; – etude chirurgicale endonasale (10 crânes) : avec injection et reperage des elements vasculo-nerveux. Resultats La « fente ethmoidale » et le « trou ethmoidal » ont ete retrouves dans 100 % des cas. Leur longueur moyenne etait respectivement de 4,2 (1,9) mm et 1,6 (0,7) mm. La fente ethmoidale contenait de la dure-mere, des granulations arachnoidiennes ainsi qu’un nerf ganglionnaire amyelinique correspondant au nerf terminal. Le trou ethmoidal contenait l’artere ethmoidale anterieure et le nerf ethmoidal anterieur. Ce trou se poursuivait en avant par une gouttiere que l’on a appele « gouttiere du trou ethmoidal », mesurant en moyenne 2,5 mm de long et qui constitue un nouveau repere en chirurgie endonasale. Conclusions Cette etude confirme l’existence de la fente ethmoidale et du trou ethmoidal au niveau de la lame criblee anterieure, en precisant leur contenu et leurs rapports. Les applications cliniques de ces nouvelles donnees concernent autant la chirurgie de la lame criblee que celle du sinus frontal.

Objectif Les fentes ethmoidales et trous ethmoidaux sont des foramens de la partie anterieure de la lame criblee de l’ethmoide. Ils n’ont, a notre connaissance, jamais ete etudies en imagerie. L’objectif etait de verifier leur visibilite en scanner, de les decrire, de trouver un plan d’examen reproductible des fentes. Methodes Etude de correlation anatomo-radiologique (scanner conventionnel, parametres d’acquisition de routine) de 13 crânes secs. Resultats Vingt-quatre cotes etaient analysables pour les fentes et pour les trous. Les fentes ethmoidales avaient une configuration « classique » (dessins de Gray [1] ) : caractere unique de chaque cote, forme ovalaire, sans cloison, dans 83 % des cas (20/24 cotes). Pour 2 cotes, une cloison separait la fente en deux parties, anterieure et posterieure. Pour 2 autres cotes, les fentes n’etaient pas identifiees. Lorsqu’elles etaient presentes, elles etaient toutes bien visibles au scanner, en particulier dans les plans orbito- et supraorbito-meataux. Elles mesuraient en moyenne 3,9 ± 1,7 mm de longueur, 0,9 ± 0,3 mm de largeur (dans le plan orbito-meatal). Les trous ethmoidaux etaient presents dans tous les cas, et toujours visibles au scanner. Ils mesuraient en moyenne 1,6 ± 1 mm de longueur, 0,9 ± 0,3 mm de largeur. De petites subdivisions des trous ethmoidaux etaient visibles au scanner dans 58 % des cas. Conclusion Fentes ethmoidales et trous ethmoidaux sont frequemment presents, et souvent bien visibles sur des scanners de crânes secs. Leurs tailles moyennes ont ete calculees, proches des valeurs retrouvees par deux etudes anterieures [2] , [3] . Leur visualisation scanographique chez des patients ainsi que leurs eventuelles implications pathologiques (rhinorrhees cerebrospinales, voies d’extensions tumorales, traumatismes chirurgicaux) restent a demontrer.