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To determine the indications and modalities for resection in the management of primary sublingual and minor salivary gland cancer, and the specific features of each primary location. The French Network of Rare Head and Neck Tumors (REFCOR) formed a steering group who drafted a narrative review of the literature published on Medline and proposed recommendations. The level of adherence to the recommendations was then assessed by a rating group, according to the formal consensus method. Histological evidence (submucosal biopsy) is recommended before surgical treatment of minor salivary gland carcinoma. Surgical treatment is recommended, with optimal oncologic margins, adapted to anatomical factors, histologic type and grade and functional consequences, with reconstruction if necessary. Treatment of primary minor salivary and sublingual gland cancer is surgical, with wide resection margins. The modalities of resection and reconstruction are highly dependent on tumor location, extension and histologic type. [ABSTRACT FROM AUTHOR]

To determine the therapeutic indications for systemic medical treatment in the management of adenoid cystic carcinoma (ACC) according to the clinical situation. The French Network of Rare Head and Neck Tumors (REFCOR) formed a steering group, which drafted a narrative review of the literature published on Medline and proposed recommendations. The level of adherence to the recommendations was then assessed by a rating group, according to the formal consensus method. ACCs are rare tumors and there is currently insufficient evidence to indicate chemotherapy at the localized stage. At the metastatic stage, progression is often slow. In case of oligometastatic ACC, local treatment should be discussed. The most often indolent nature of polymetastatic ACC can allow management by active surveillance. Molecular screening is recommended, for abnormalities potentially accessible to targeted therapy. ACCs are rare tumors for which there are currently few effective medical treatments. It is therefore recommended to include patients in clinical trials. [ABSTRACT FROM AUTHOR]

To determine the therapeutic indications for systemic medical treatment in the management of salivary gland carcinoma (excluding adenoid cystic carcinoma) according to the clinical situation. The French Network of Rare Head and Neck Tumors (REFCOR) formed a steering group who drafted a narrative review of the literature published on Medline and proposed recommendations. The level of adherence to the recommendations was then assessed by a rating group, according to the formal consensus method. Salivary gland carcinoma is rare and there is currently insufficient evidence to indicate chemotherapy at the localized stage. At the metastatic stage, initial management can be based on a phase of monitoring for indolent disease. Some histological subtypes (salivary duct carcinoma and adenocarcinoma) are more aggressive and require systemic treatment from the outset. To guide systemic treatment, it is recommended to perform immunohistochemistry and molecular biology analyses (overexpression of HER2 and androgen receptors, NTRK fusion, next-generation sequencing). Salivary gland carcinoma is a rare tumor for which there are currently few effective medical treatments. It is therefore recommended to include patients in clinical trials. [ABSTRACT FROM AUTHOR]

To determine the indications for radiotherapy in salivary gland cancer and to specify the modalities and target radiation volumes. The French Network of Rare Head and Neck Tumors (REFCOR) formed a steering group which drafted a narrative review of the literature published on Medline and proposed recommendations. The level of adherence to the recommendations was then assessed by a rating group, according to the formal consensus method. Postoperatively, radiotherapy to the primary tumor site ± to the lymph nodes is indicated if one or more of the following adverse histoprognostic factors are present (risk > 10% of locoregional recurrence): T3–T4 category, lymph node invasion, extraglandular invasion, close or positive surgical margins, high tumor grade, perineural invasion, vascular emboli, and/or bone invasion. Intensity-modulated radiation therapy (IMRT) is the gold standard. For unresectable cancers or inoperable patients, carbon ion hadrontherapy may be considered. Radiotherapy in salivary gland cancer is indicated in postoperative situations in case of adverse histoprognostic factors and for inoperable tumors. [ABSTRACT FROM AUTHOR]

To determine the indications for neck dissection in the management of parotid, submandibular or minor salivary gland cancers depending on the clinical situation: i.e., clinical lymph node involvement (cN+) or not (cN0); low or high risk of occult nodal metastasis; diagnosis of malignancy before, during or after surgery. The French Network of Rare Head and Neck Tumors (REFCOR) formed a steering group which drafted a narrative review of the literature published on Medline and proposed recommendations. The level of adherence to the recommendations was then assessed by a rating group according to the formal consensus method. In cN+ salivary gland cancer, ipsilateral neck dissection is recommended. In cN0 salivary gland cancer, ipsilateral neck dissection is recommended, except for tumors at low risk of occult nodal metastasis. If definitive pathology reveals a high risk of occult nodal involvement, additional neck treatment is recommended: ipsilateral neck dissection or elective nodal irradiation. The rate of occult lymph node involvement, and therefore the indication for elective neck dissection, depends primarily on the pathologic grade of the salivary gland cancer. [ABSTRACT FROM AUTHOR]

To determine the frequency and modality of post-treatment monitoring of primary salivary gland cancer. The French Network of Rare Head and Neck Tumors (REFCOR) formed a steering group who drafted a narrative review of the literature published on Medline and proposed recommendations. The level of adherence to the recommendations was then assessed by a rating group, according to the formal consensus method. Clinical monitoring should be adapted to the risk of recurrence: initially every 3 months and progressively spaced out, becoming annual after 5 years. Post-treatment head and neck and chest imaging is recommended at 3 months. Local and regional monitoring can then be carried out yearly or twice yearly with contrast-enhanced head and neck imaging. An annual chest CT scan is recommended for high-grade tumors. For lesions at high risk of late recurrence, very prolonged annual surveillance (up to 15 years) is recommended, including screening for pulmonary metastases. Given the wide range of malignant salivary gland tumors, the modalities and frequency of post-treatment monitoring must be adapted to the expected course of the disease. [ABSTRACT FROM AUTHOR]

To determine the role of surgery of the primary tumor site in the management of primary major salivary gland cancer. The French Network of Rare Head and Neck Tumors (REFCOR) formed a steering group, which drafted a non-systematic narrative review of the literature published on Medline, and proposed recommendations. The level of adherence to the recommendations was then assessed by a rating group, according to the formal consensus method. Treatment of salivary gland tumor is mainly surgical. The gold standard for parotid cancer is a total parotidectomy, to obtain clear margins and remove all intraparotid lymph nodes. For low-grade tumors, partial parotidectomy with wide excision of the tumor is acceptable in the case of postoperative diagnosis on definitive histology. In the event of positive margins on definitive analysis, revision surgery should be assessed for feasibility, and performed if possible. Treatment of primary major salivary gland cancer is based on surgery with clear resection margins, as far away as possible from the tumor. The type of surgery depends on tumor location, pathologic type and extension. [ABSTRACT FROM AUTHOR]

Evaluation of the results of laryngeal transplantation (LT) in humans. Analysis of 3 bibliographic databases with the keywords "larynx, transplantation, autograft". In total, 626 abstracts were read and 25 articles selected. The main objective was to analyze the characteristics of laryngeal transplant patients. The accessory objectives comprised analysis of operative technique, immunosuppressive treatment and results. Four articles were selected for analysis. Two patients were transplanted after total laryngectomy for laryngeal carcinoma and 2 after laryngeal trauma. Three of the 4 patients had true transplantation with arterial, venous and neural microanastomosis. Two patients were decannulated and the tracheostomy tube was maintained in the other 2. Three of the 4 patients had good-quality phonation and could feed without a gastric tube. One patient died of carcinoma progression and 1 patient had to be explanted 14 years after transplantation. The number of LTs reported is too small for scientific determination of the place of this intervention in laryngology. The published results could, at first sight, suggest that the future of LT is uncertain. However, several elements, also suggest that otolaryngologists should continue to take an interest in this technique. [ABSTRACT FROM AUTHOR]

To determine the indications for fine-needle cytology and the modalities of frozen section pathological analysis in the management of salivary gland cancer. The French Network of Rare Head and Neck Tumors (REFCOR) formed a steering group who drafted a narrative review of the literature published on Medline and proposed recommendations. The level of adherence to the recommendations was then assessed by a rating group according to the formal consensus method. Fine-needle cytology is recommended as part of the diagnostic work-up for a major salivary gland tumor suspicious for malignancy. Fine-needle cytology should be performed after MRI to avoid artifacts. Frozen section analysis is recommended to confirm the malignant nature of the tumor, to adapt the extent of resection and to indicate neck dissection. Whenever possible, the entire tumor and adjacent salivary or periglandular tissue should be sent for frozen section analysis. Fine-needle cytology and frozen section analysis play an essential role in the management of salivary gland cancers. [ABSTRACT FROM AUTHOR]

To define the indications for each imaging modality in the screening, characterization, extension and follow-up of salivary gland tumors. The French Network of Rare Head and Neck Tumors (REFCOR) formed a steering group who drafted a narrative review of the literature published on Medline and proposed recommendations. The level of adherence to the recommendations was then assessed by a rating group, according to the formal consensus method. If a swelling of a salivary gland is palpable for 3 weeks, an ultrasound scan is recommended to confirm a tumoral lesion and rule out differential diagnoses. For a salivary gland tumor, MRI is recommended with diffusion-weighted and dynamic contrast-enhanced techniques. In the case of histologically proven malignancy or a highly suspicious lesion, a CT scan of the neck and chest is recommended to assess the tumor, lymph nodes and metastases. FDG-PET is not currently recommended in routine clinical practice for initial diagnosis, assessment of extension, evaluation of response to treatment, staging of recurrence, or follow-up of salivary gland tumors. Assessing salivary tumors is based on MRI. Extension assessment is based on neck and chest CT. [ABSTRACT FROM AUTHOR]

Too many articles are still rejected by scientific medical journals due to lack of preparation of the manuscript and of knowledge of the modern editorial rules that govern scientific medical writing. Therefore, the editorial board of the European Annals of Otorhinolaryngology Heads & Neck Diseases summarized studies published by its members since 2020 in the columns of the scientific journal of the French Society of Otorhinolaryngology and the International Francophone Society of Otorhinolaryngology and data from the PubMed indexed literature dedicated to scientific medical writing in otolaryngology in the 21st century. The authors hope that this review, in the form of a list of "Dos and Don'ts", will provide authors with a practical guide facilitating publication of rigorous, reproducible and transparent scientific studies, in accordance with the movement toward better science that society as a whole has been fighting for since the beginning of this century. [ABSTRACT FROM AUTHOR]

To evaluate reviewing and editorial decision for articles submitted to the European Annals of Otorhinolaryngology Head & Neck Diseases. A retrospective analysis was made of reviewers' comments on 1,133 scientific articles (700 original articles, 96 literature reviews, and 337 case reports), originating from 69 countries, consecutively submitted on-line between January 1st, 2020 and December 31st, 2021. The main objective was to document the acceptance rate and decision time. Accessory objectives were to synthesize the main comments and to screen for correlations between acceptance and the main characteristics of first authors, articles and reviewers' comments. In total, 4.1% of submitted articles were accepted. Median decision time differed significantly (P < 0.0001), at 1 month in case of refusal and 4 months in case of acceptance. Reviewers mentioned failure to adhere to the journal's authors' guide, to use the appropriate EQUATOR guidelines and to adopt the recommended P < 0.005 significance threshold in 94.8%, 54.2%, and 39.9% of cases, respectively. On multivariate analysis, 3 variables significantly impacted acceptance, which increased from 1.3% to 44.6% (P < 0.0001) when an appropriate EQUATOR guideline was used and from 0.3% to 57.4% (P < 0.0001) when the significance threshold was set at P < 0.005, and decreased from 10.5% to 1.1% (P = 0.0001) when the article did not originate from a French-speaking country (member of the Francophonie organization). Adhesion to modern scientific medical writing rules increased acceptance rates for articles in the European Annals of Otorhinolaryngology Head & Neck Diseases. Teaching modern scientific medical writing needs to be enhanced in otorhinolaryngology. [ABSTRACT FROM AUTHOR]

To determine the indications, anesthesiological and surgical procedure and interest of drug-induced sleep endoscopy in the treatment of adult obstructive sleep apnea syndrome. 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. 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. 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. Experts fully agreed on the strong guidelines formalizing the indications and modalities of drug-induced sleep endoscopy for adult obstructive sleep apnea syndrome. [ABSTRACT FROM AUTHOR]

To systematically present and interpret the current literature on research and treatment perspectives for mandibular osteoradionecrosis (mORN) in the field of biomaterials. A systematic review of the literature using the "Synthesis without meta-analysis" (SWiM) methodology was performed on PubMed, Embase and Cochrane, focusing on the implantation of synthetic biomaterials for bone reconstruction in mORN in humans and/or animal models. The primary endpoints were the composition, efficacy on mORN and tolerance of the implanted synthetic biomaterials. Forty-seven references were obtained and evaluated in full-text by two assessors. Ten (8 in humans and 2 in animal models) met the eligibility criteria and were included for analysis. Materials most often comprised support plates or metal mesh (5 of 10 cases) in combination with grafts or synthetic materials (phosphocalcic ceramics, glutaraldehyde). Other ceramic/polymer composites were also implanted. In half of the selected reports, active compounds (molecules, growth factors, lysates) and/or cells were associated with the reconstruction material. The number of articles referring to implantation of biomaterials for the treatment of mORN was small, and the properties of the implanted biomaterials were generally poorly described, thus limiting a thorough understanding of their role. In preventing the morbidity associated with some reconstructive surgeries, basic research has benefitted from recent advances in tissue engineering and biomaterials to repair limited bone loss. [ABSTRACT FROM AUTHOR]

The aim of this historical vignette is to delve into the description and use of the first artificial larynx, developed by Carl Gussenbauer, and used after Theodor Billroth's first total laryngectomy, performed on December 31, 1873. [ABSTRACT FROM AUTHOR]

Posterior parotid lithiasis may in some cases require a combined surgical approach associating sialendoscopy to an external intraoral or transfacial approach. This single-center retrospective study describes the surgical technique for parotid lithiasis extraction by a combined external and sialendoscopic approach with the help of CT-navigation. Five patients were included between November 2014 and July 2020. The sialolith was extracted in 100% of cases. Navigation and transillumination localizations matched consistently. No patients showed postoperative facial paresis. At 2 to 21 months' follow-up, there was no recurrence of sialolithiasis. Navigation can be a complement to transillumination, improving surgical comfort and safety, but does not replace first-line sialendoscopy. Visual control is required whenever possible after extraction. In combined procedures, it enables accurate identification of parotid sialoliths. In case of impassable stenosis, it could be a therapeutic alternative to parotidectomy. [ABSTRACT FROM AUTHOR]

To describe the diagnostic performance of Narrow Band Imaging (NBI) combined with White Light Imaging (WLI) in the diagnosis of mucosal lesions at each location of the upper aerodigestive tract, for detection of primary tumor in case of carcinoma of unknown primary, for determination of intraoperative resection margins, and to describe its main diagnostic pitfalls. A PubMed search was carried out according to the PRISMA method. Four hundred and seventy-seven articles published between 2007 and 2020 were identified, 133 of which met the study inclusion criteria and were assessed. The current literature seems to support the use of NBI in diagnosis and/or follow-up of (pre-)malignant head & neck tumors, and in the determination of intraoperative resection margins. [ABSTRACT FROM AUTHOR]

The authors present the guidelines of the French Society of Otorhinolaryngology–Head and Neck Surgery (SFORL) for the diagnosis and treatment of pleomorphic adenoma (PA) of the salivary glands. A review of the literature was performed by a multidisciplinary task force. Guidelines were drafted based on the articles retrieved and the workgroup members' individual experience. Guidelines were graded A, B, C or expert opinion by decreasing level of evidence. In clinically suspected salivary gland PA, MRI should be performed, including head and neck lymph node levels. Fine needle aspiration cytology is particularly recommended for tumours difficult to characterise by MRI. Frozen section biopsy should be performed to confirm diagnosis and adapt the surgical procedure in case of intraoperative findings of malignancy. Complete resection of the parotid PA should be performed en bloc, including margins, when feasible according to tumour location, while respecting the facial nerve. Enucleation (resection only in contact with the tumour) is not recommended. For the accessory salivary and submandibular glands, complete en bloc resection should be performed. [ABSTRACT FROM AUTHOR]

The authors present the guidelines of the French Society of Otorhinolaryngology–Head and Neck Surgery (SFORL) for the management of recurrent pleomorphic adenoma (RPA) of the parotid gland. A review of the literature was performed by a multidisciplinary task force. Guidelines were drafted, based on the articles retrieved and the work group members' individual experience. There were then read and re-edited by an independent reading group. The proposed recommendations were graded A, B or C on decreasing levels of evidence. Complete resection under neuromonitoring is recommended in case of RPA. The risks of progression and malignant transformation, which are higher the younger the patient, have to be taken into consideration. The risk of functional sequelae must be explained to the patient. MRI is recommended ahead of any surgery for parotid RPA, to determine extension and detect subclinical lesions. Radiotherapy should be considered in case of multi-recurrent pleomorphic adenoma after macroscopically complete revision surgery at high risk of new recurrence (microscopic residual disease), in case of RPA after incomplete resection, and in non-operable RPA. [ABSTRACT FROM AUTHOR]

AQFThe authors present the guidelines of the French Society of ENT and Head and Neck Surgery (SFORL) regarding the management of Bell's palsy in adults. After a literature review by a multidisciplinary workgroup, guidelines were drawn up based on retrieved articles and group-members' experience, then read over by an independent group to edit the final version. Guidelines were graded A, B, C or "expert opinion" according to decreasing level of evidence. Thorough ENT and neurological clinical examination is recommended in all patients presenting with peripheral facial palsy to confirm diagnosis of Bell's palsy. MRI with gadolinium enhancement should explore the entire course of the facial nerve, if possible within the first month. ENMG should be performed to assess prognosis for recovery. In confirmed Bell's palsy, corticosteroid therapy should be implemented as early as possible (ideally within 72 h) at a dose of 1 mg/kg/day for 7–10 days. Antiviral therapy should be associated to steroids in patients with severe and early-onset disease and in Ramsay-Hunt syndrome. Isolated antiviral therapy is not recommended. To date, there is no evidence that surgical facial nerve decompression provides benefit. [ABSTRACT FROM AUTHOR]

In old and frail patients, oncologic anterior skull-base surgery through an endonasal endoscopic approach avoids the morbidity incurred by transfacial and transcranial approaches, sometimes considered unreasonable, although surgery remains the gold standard treatment for sinonasal cancer. To assess the functional and oncologic results of this surgery in over-70 year-olds. A single-center retrospective study included all patients aged over 70 years at surgery, who underwent endonasal endoscopic oncologic resection and reconstruction of the anterior skull base, between October 2008 and October 2018. Fifteen procedures in 13 patients met the inclusion criteria. Mean hospital stay was 7 days. All resections were considered R0, apart from one case with positive dura-mater margins (6.7%). All patients had complete radio-surgical treatment, in accordance with the REFCOR recommendations. Two cases of meningitis were reported (13.3%). At a median follow-up of 27 months, 4 patients presented local recurrence, 1 of whom also had lung metastases. Two patients died of disease-related or treatment-related causes. This technique is a feasible treatment in patients aged over 70 years, providing good functional results, and acceptable oncologic outcome. [ABSTRACT FROM AUTHOR]

The purpose of this article is to give rhinologists advice on how to adapt their standard practice during the COVID-19 pandemic. The main goal of these recommendations is to protect healthcare workers against COVID-19 while continuing to provide emergency care so as to prevent loss of chance for patients. We reviewed our recommendations concerning consultations, medical prescriptions and surgical activity in rhinology. [ABSTRACT FROM AUTHOR]

Abstract Introduction Obstructive sleep apnea syndrome (OSAS) is a major public health issue. Robotic tongue-base reduction surgery is being developed, but needs assessment. The present study reports clinical and polygraphic results at 6 months' follow-up. Method Single-center prospective study of 8 patients undergoing transoral robotic surgery (TORS) for severe OSAS. Results Mean age was 47 years. M/F sex ratio was 5:3. Initial body-mass index ranged from 18 to 35 kg/m2. Mean Epworth score was 12. Mean preoperative apnea-hypopnea index (AHI) was 47 (range, 36–60). At 6 months, only 1 patient did not meet usual success criteria (AHI < 20 with > 50% decrease); 2 patients had residual AHI between 10 and 20; the other 5 had non-significant event rates. Conclusion TORS tongue-base reduction showed promising results, which need confirmation on long-term multicenter studies. [ABSTRACT FROM AUTHOR]

Tracheostomy post-tracheostomy care are regarded as at high risk for contamination of health care professionals with the new coronavirus (SARS-CoV-2). Considering the rapid spread of the infection, all patients in France must be considered as potentially infected by the virus. Nevertheless, patients without clinical or radiological (CT scan) markers of COVID-19, and with negative nasopharyngeal sample within 24 h of surgery, are at low risk of being infected. Instructions for personal protection include specific wound dressings and decontamination of all material used. The operating room should be ventilated after each tracheostomy and the pressure of the room should be neutral or negative. Percutaneous tracheostomy is to be preferred over surgical cervicotomy in order to reduce aerosolization and to avoid moving patients from the intensive care unit to the operating room. Ventilation must be optimized during the procedure, to limit patient oxygen desaturation. Drug assisted neuromuscular blockage is advised to reduce coughing during tracheostomy tube insertion. An experienced team is mandatory to secure and accelerate the procedure as well as to reduce risk of contamination. [ABSTRACT FROM AUTHOR]

Three-dimensional (3D) printing is booming in the medical field. This technology increases the possibilities of personalized treatment for patients, while lowering manufacturing costs. To facilitate mandibular reconstruction with fibula free flap, some companies propose cutting guides obtained by CT-guided moulding. However, these guides are prohibitively expensive (€ 2,000 to € 6,000). Based on a partnership with the CNRS, engineering students and a biomedical company, the authors have developed cutting guides and 3D-printed mandible templates, deliverable in 7 days and at a lower cost. The novelty of this project is the speed of product development at a significantly lower price. In this technical note, the authors describe the logistic chain of production of mandible templates and cutting guides, as well as the results obtained. The goal is to allow access to this technology to all patients in the near future. [ABSTRACT FROM AUTHOR]

Abstract Objective Circumferential pharyngolaryngectomy is performed for advanced pharyngeal tumor or in a context of postradiation recurrence. Several free or pedicle flaps have been described for pharyngeal defect reconstruction, with choice at the surgeon's discretion. The aim of this study was to evaluate long-term swallowing function according to the type of flap used for reconstruction. Material and method A multicenter retrospective study was conducted from January to September 2016 within the French GETTEC head and neck tumor study group. All patients in remission after circumferential pharyngolaryngectomy were included and filled out the Deglutition Handicap Index (DHI) questionnaire and underwent swallowing function fiberoptic endoscopy assessment. 46 patients (39 men, 7 women) were included. Reconstruction used a tubularized forearm free flap (FFF group) in 19 cases, pectoralis major myocutaneous flap (PMMF group) in 15 cases and free jejunum flap (FJF group) in 12 cases. Results Mean DHI was 24: 20 in the FFF group, 23 in the FJF group and 25 in the PMMF group, without significant differences. 27 patients had normal swallowing, 9 mixed diet, 8 liquid diet and 3 were fed by gastrostomy. On endoscopy, free flaps (FJF and FFF) were associated with significantly greater rates of normal swallowing of saliva and yogurt than in the PMMF group (P = 0.04). Conclusion Type of flap reconstruction after circumferential pharyngolaryngectomy had no significant impact on postoperative swallowing function assessed on the self-administered DHI questionnaire. [ABSTRACT FROM AUTHOR]

Treatment of symptomatic impacted and palpable submandibular lithiasis generally involves a combined transoral and sialendoscopic approach with an excellent success rate, and a low morbidity. Nevertheless, the approach of proximal or hilar lithiasis may in some cases represent a real challenge and cause major surgical discomfort, which could increase the risk of damage to the lingual nerve. This article details the surgical technique and advantages of submandibular lithiasis removal by transoral robotic surgery combined with sialendoscopy, together with a case video. [ABSTRACT FROM AUTHOR]

Early management in oncology is based on coordination and high-quality exchange between the various health-care partners. The present guidelines are based on a literature search with levels of evidence. Treatment waiting time can be optimized by performing assessment as early as possible (Expert opinion), to limit the interval (ideally, less than 4 weeks) between first consultation and data collection. In the first specialist consultation, diagnostic work-up should be scheduled and the data required for management should be determined (Grade B). Work-up may be conducted on a day-care basis or with conventional admission (Expert opinion). The patient's medico-social context should be taken into account from the outset, with social work involvement whenever necessary (Expert opinion). Pain and nutritional management should be planned for (Grade A) and realistic therapeutic education be provided (Expert opinion). Community-hospital teamwork for supportive care should be optimized (Expert opinion). Management should be early and multidisciplinary, to shorten delay between diagnosis and treatment initiation. [ABSTRACT FROM AUTHOR]

Objectives Complications of pharyngitis (peritonsillar abscess, retropharyngeal abscess, and cervical cellulitis) are rare, but appear to be on the increase over recent years and many of these patients have been treated by anti-inflammatory drugs prior to admission. The purpose of this study was to review the current epidemiological data concerning these complications and investigate a possible correlation with anti-inflammatory drug use. Material and methods A single-centre retrospective review of epidemiological, clinical and microbiological data was performed on the medical charts of patients hospitalised for peritonsillar abscess, retropharyngeal abscess or cervical cellulitis between 2005 and 2010. Results Over a six-year period, 163 patients were hospitalised for complications of pharyngitis, with a sex-ratio of 1.82 (104/57). The number of cases of peritonsillar abscess (PTA) increased from 13 to 28 cases per year from 2005 to 2010 and the number of cases of retropharyngeal abscess increased from three to six cases per year over the same period. The number of cases of cellulitis remained stable with an average of 1.82 cases per year. Each year, significantly more patients with an abscess were admitted to our unit with a history of anti-inflammatory drug use (13.3 ± 4.6) than without anti-inflammatory drug use (7.8 ± 4.3) ( P < 0.01). Micro-organisms were identified in 80% of cases, with mixed strains in 73% of cases, Streptococcus in 72% of samples and Streptococcus pyogenes in 19% of cases of PTA. A favourable outcome was observed in all patients in response to medical and surgical treatment. Conclusion In line with the literature, we observed an increasing incidence of complications of pharyngitis. The present series comprised significantly more patients admitted for PTA with a history of anti-inflammatory drug use. A multicentre prospective controlled study in Nantes on a large cohort is currently underway and will probably confirm these preliminary results. [ABSTRACT FROM AUTHOR]

Observational studies conducted in the 1970s, including that by Bernard Guerrier, cited by Bocca et al. [1], and subsequent studies published in the literature [2], have shown that neck dissection must be systematically performed in operable stage T1-T2N0 oral and oropharyngeal squamous cell carcinoma (OC) in order to diagnose and treat occult micrometastases [3]. This randomized ENT health economics study, called SentiMEORL, which included 307 patients, 152 in the neck dissection arm and 155 in the SNB arm in 9 French centres, concluded on the oncological equivalence in terms of lymph node control, recurrence-free survival and overall survival between the neck dissection and SNB arms. In particular, 2- and 5-year neck node recurrence-free survival was 89.6% (95%CI: 0.83-0.94) in the neck dissection arm and 90.7% (95%CI: 0.84-0.95) and 89.4% (95%CI: 0.82-0.94), respectively, in the SNB arm. [Extracted from the article]

Summary: Objectives: The French Society of Otorhinolaryngology (SFORL) set up a work group to draw up guidelines for initial staging of head and neck squamous cell carcinoma. Locoregional and remote extension assessment are dealt with in two separate reports. The present part 3 deals with the assessment of frequent associated symptoms and pathologies, requiring early treatment and the collection of data on a certain number of clinical and paraclinical parameters for therapeutic decision-making in the multidisciplinary team meeting. Materials and methods: A multidisciplinary critical analysis of the literature was conducted. General assessment here covers screening, assessment and initial management of the following: usual risk factors (smoking, alcohol, HPV), the most frequent medical comorbidities, nutritional status, social and psychological status, dental status, pain and possible anemia. As oncologic management frequently associates surgery, radiation therapy and chemotherapy, the underlying examinations should be early, as part of initial staging. The levels of evidence for the examinations were estimated so as to grade guidelines, failing which expert consensuses were established. Results: The high rates of pain, malnutrition and anemia call for systematic screening and early management, especially as rapidly effective treatments exist. Assessing comorbidity and social and psychological status enables general health status to be assessed, along with possible contraindications to the usual treatments. Tracheal intubation problems may require intubation under flexible endoscopy or jet-ventilation by inter-cricothyroid catheterization from the diagnostic endoscopy stage. Assessment and adapted dental care should be conducted if radiation therapy is likely or certain. Conclusion: Early management of symptoms and comorbidity and anticipation of subsequent treatment are intended to shorten initial staging time and to collate the data needed for therapeutic decision-making. This assessment should be performed at the same time as the locoregional and remote extension assessment, and is obviously to be adapted according to tumoral extension stage and the possible treatment options. [Copyright &y& Elsevier]

Summary: Objective: To study quality of life in patients treated for advanced hypopharyngeal or laryngeal cancer, with laryngeal conservation or laryngectomy. Patients and methods: A retrospective 2-center study included 100 patients in remission from squamous cell carcinoma, treated between 1998 and 2009. Seventy patients (24 hypopharynx, 46 larynx) were treated by total (pharyngo-) laryngectomy followed by external radiation therapy, and 30 (13 hypopharynx, 17 larynx) underwent an organ-conservation protocol with concurrent radiochemotherapy or with induction chemotherapy using platin-5FU or taxan-platin-5FU followed by radiation therapy. All patients responded to the quality of life questionnaires (EORTC QLQ-C30 and QLQ-H&N35). Results: Advanced tumor stages IVa and IVb were significantly more frequent in the surgery groups (hypopharynx: 71.6% vs. 45.9%, p =0.01; larynx: 72.4% vs. 37.5%, p <0.01). In pharyngeal cancer, the only significant difference between surgical treatment and laryngeal conservation was for “sensory disorder” (taste and odor), with better results in case of laryngeal conservation (p <0.0001). For the other items, there was a trend for quality of life to appear better in patients with laryngeal conservation (p =NS). In laryngeal cancer, the only significant difference was for “dry mouth”, which was significantly less invalidating with surgical treatment (p <0.001). The impairment of the other quality of life items did not differ between surgical and conservative treatment. Conclusions: Quality of life is impaired in all patients treated for pharyngeal or laryngeal cancer. The type of treatment, surgical or conservative, affects differently various aspects of quality of life. [ABSTRACT FROM AUTHOR]

Abstract: Aims: Systematic lymph node dissection in patients with papillary thyroid carcinoma (PTC) remains controversial. The objective of this study was to study the pattern of lymph node spread in patients with PTC clinically node-negative and then to propose a lymph node management strategy. Methods: We retrospectively reviewed the records of patients who had undergone total thyroidectomy and a systematic central neck dissection (CND) and lateral neck dissection. Ninety patients with PTC without lymph nodes metastases (LNM) detected on preoperative palpation and ultrasonographic examination were included. Results: Forty-one patients (45.5%) had LNM. Twenty-eight patients (31%) had a central and a lateral involvement. Thirteen patients (14.5%) had only a central involvement. All the patients without LNM in the central compartment were also free in the lateral compartment. There was no correlation between LNM status and TNM staging. The largest LNM in the central compartment was smaller than or equal to 5mm in 66% of the cases, and that could explain the lack of sensitivity of the preoperative ultrasonographic examination. Conclusion: CND could be considered at preoperative or intraoperative diagnosis of PTC whereas lateral neck dissection should be performed only in patients with preoperative suspected and/or intraoperatively proven LNM. Systematic CND allows an objective evaluation of lymph node status in this central cervical area where the LNM are particularly small and difficult to detect preoperatively. [Copyright &y& Elsevier]

Summary: Objectives: To determine the surgical-site infection (SSI) incidence rate targeted on salivary gland surgery over a 2-year period (from January 2007 to December 2008). Then identify any risk factors associated with SSI in all the patients operated with no antibiotic prophylaxis in accordance with French Anesthesiology Society guidelines. Population and methods: Ninety-three patients were operated during the standard SSI surveillance period. A case-control (one case for five controls) study was then conducted aiming to identify risk factors. Results: The SSI incidence rate was 9.7%. The case-control study failed to identify any relevant risk factor with univariate analysis. Conclusion: As no risk factors could be identified, we suggest that surgical antibioprophylaxis could be relevant in salivary glands surgery and should be evaluated in this setting. [ABSTRACT FROM AUTHOR]

In the context of the current pandemic, there is a need for specific advice concerning treatment of patients with Head and Neck cancers. The rule is to limit as much as possible the number of patients in order to reduce the risks of contamination by the SARS-Cov-2 virus for both patients and the caregivers, who are particularly exposed in ENT. The aim is to minimize the risk of loss of opportunity for patients and to anticipate the increased number of cancer patients to be treated at the end of the pandemic, taking into account the degree of urgency, the difficulty of the surgery, the risk of contaminating the caregivers (tracheotomy) and the local situation (whether or not the hospital and intensive care departments are overstretched). [ABSTRACT FROM AUTHOR]

Objectives The authors present the guidelines of the French Otorhinolaryngology – Head and Neck Surgery Society (SFORL) for patient pathway organization in head and neck cancer, and in particular for multidisciplinary team meetings. The present article concerns the therapeutic decision-making process. Methods A multidisciplinary work group was entrusted with a review of the scientific literature on the above topic. Guidelines were drawn up, based on the articles retrieved and the group members’ individual experience. They were then read over by an editorial group independent of the work group. The final version was established in a coordination meeting. The guidelines were graded as A, B, C or expert opinion, by decreasing level of evidence. Results It is recommended that: an organ specialist should contribute to all multidisciplinary meetings on head and neck cancer; all members of the multidisciplinary meeting should have specific knowledge in head and neck cancer; any referring physician who does not follow the multidisciplinary meeting's advice should justify that decision; there should be sufficient time to prepare, discuss and sum up the cases dealt with in the multidisciplinary team meeting. [ABSTRACT FROM AUTHOR]

Mr R., 49years old, attended the emergency department with sudden onset of severe neck pain, present for 36hours. Answer 2: In the presence of low-grade fever, odynophagia and the low-density image on CT, the differential diagnoses of retropharyngeal abscess and spondylodiscitis must be excluded [2]. 3 D.J. Artenian, J.K. Lipman, G.K. Scidmore, Acute neck pain due to tendinitis of the Longus Colli: CT and MRI findings. [Extracted from the article]

Abstract: Childhood rhinosinusitis is a frequent motive for consulting a physician. Given its recurrent character, the patient should be assessed for intrinsic as well as environmental factors. Intrinsic factors to search for include adenoid hypertrophy, allergies, gastroesophageal reflux, diabetes, immunity deficiency, a ciliary disorder, and cystic fibrosis. Among the environmental factors, passive smoking should be discouraged; community living, repeated viral infections, and pollution have also been implicated. [Copyright &y& Elsevier]

We present the update of the recommendations of the French society of radiotherapy and oncology on the indications and the technical methods of carrying out radiotherapy of sinonasal cancers. Sinonasal cancers (nasal fossae and sinus) account for 3 to 5% of all cancers of the head and neck. They include carcinomas, mucosal melanomas, sarcomas and lymphomas. The management of sinonasal cancers is multidisciplinary but less standardized than that of squamous cell carcinomas of the upper aerodigestive tract. As such, patients with sinonasal tumors can benefit from the expertise of the French expertise network for rare ENT cancers (Refcor). Knowledge of sinonasal tumour characteristics (histology, grade, risk of lymph node involvement, molecular characterization, type of surgery) is critical to the determination of target volumes. An update of multidisciplinary indications and recommendations for radiotherapy in terms of techniques, target volumes and radiotherapy fractionation of the French society of radiotherapy and oncology (SFRO) was reported in this manuscript. [ABSTRACT FROM AUTHOR]

Primary tumours of the salivary glands account for about 5 to 10% of tumours of the head and neck. These tumours represent a multitude of situations and histologies, where surgery is the mainstay of treatment and radiotherapy is frequently needed for malignant tumours (in case of stage T3–T4, nodal involvement, extraparotid invasion, positive or close resection margins, histological high-grade tumour, lymphovascular or perineural invasion, bone involvement postoperatively, or unresectable tumours). The diagnosis relies on anatomic and functional MRI and ultrasound-guided fine-needle aspiration for the diagnostic of benign or malignant tumors. In addition to patient characteristics, the determination of primary and nodal target volumes depends on tumor extensions and stage, histology and grade. Therefore, radiotherapy of salivary gland tumors requires a certain degree of personalization, which has been codified in the recommendations of the French multidisciplinary network of expertise for rare ENT cancers (Refcor) and may justify a specialised multidisciplinary discussion. Although radiotherapy is usually recommended for malignant tumours only, recurrent pleomorphic adenomas may sometimes require radiotherapy based on multidisciplinary discussion. An update of indications and recommendations for radiotherapy for salivary gland tumours in terms of techniques, doses, target volumes and dose constraints to organs at risk of the French society for radiotherapy and oncology (SFRO) was reported in this article. [ABSTRACT FROM AUTHOR]

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. 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. 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. 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. • Head and neck mucosal melanoma is a rare neoplasm with poor prognosis due to its high metastatic potential. • Surgery remains the cornerstone of the therapeutic algorithm. • Postoperative radiotherapy is interesting for local control, both in oral cavity mucosal melanoma and sinonasal mucosal melanoma, even in early-stage tumours. • Nodal involvement is not a significant predictor of outcomes. • Combination with systemic therapies, such as anti–PD-1 immunotherapy, must be considered. [ABSTRACT FROM AUTHOR]

Résumé Introduction La place du curage cervical dans la prise en charge conservatrice des carcinomes épidermoïdes localement évolués des voies aérodigestives supérieures demeure largement débattue. L’objectif de cette étude était d’analyser les caractéristiques, les facteurs pronostiques et le suivi des patients qui ont bénéficié d’un curage cervical avant une irradiation exclusive (traitement dissocié). Patients et méthodes Soixante-trois patients chez qui une atteinte ganglionnaire volumineuse (de 3 cm ou plus) ou nécrotique a été mise en évidence lors de la scanographie initiale ont fait l’objet d’un traitement dissocié entre 2000 et 2012 à l’institut Claudius-Regaud (Toulouse, France). La lésion primitive était oropharyngée, hypopharyngée ou laryngée dans respectivement 63, 21 et 13 % des cas. Résultats Les taux de contrôle locorégional et de survie globale à 3 ans étaient de 88 % et 68 % avec un suivi médian de 4 ans. Un seul patient a été atteint d’une récidive ganglionnaire isolée. En analyse unifactorielle, les variables significativement associées à un allongement de la survie sans maladie étaient : la réalisation d’un curage fonctionnel par opposition à non conservateur, ( hazard ratio [HR] : 0,39 ; intervalle de confiance à 95 % [IC 95 %] : 0,16–0,94 ; p = 0,03) et l’indice de performance de l’OMS (1–2 contre 0 ; HR = 6,27 ; IC 95 % = 2,73–14,39 ; p < 0,0001). En analyse multifactorielle, seul l’indice de performance de l’OMS reste significatif. Conclusion La réalisation d’un curage cervical avant la réalisation d’une (chimio)radiothérapie exclusive permet un bon taux de contrôle locorégional malgré une atteinte ganglionnaire initiale importante et permet de s’affranchir de la complexité d’une chirurgie cervicale de rattrapage en territoire irradié tout en gardant l’avantage d’une approche conservatrice sur la lésion primitive. Purpose Optimal timing of neck dissection remains debated in the conservative management of patients with locoregionally advanced squamous cell carcinoma of the head and neck. Patients and methods The files of 63 patients with radiographic evidence of bulky or necrotic nodal metastases treated by up-front neck dissection and definitive radiotherapy between 2000 and 2012 at two institutions were retrospectively reviewed. Results The primary site was oropharyngeal, hypopharyngeal or laryngeal in 63%, 21% and 13% cases, respectively. Overall, 83% of the tumours were staged pN2b or more. Extracapsular spread was found in 48 cases (77%). After a 48-month median follow-up, the 3-year locoregional control and overall survival were 88% and 68%, respectively. Only one isolated failure occurred in the dissected neck. Conclusion This combination therapy provides a good locoregional tumour control. It should be considered as an option in laryngeal, hypopharyngeal or oropharyngeal squamous cell carcinomas with bulky or necrotic nodal metastases at presentation. [ABSTRACT FROM AUTHOR]

La prise en charge par radiothérapie avec modulation d'intensité des tumeurs du plan glottique reste controversée du fait du petit volume à irradier et de la mobilité de la cible. L'objectif de cette étude est de comparer le contrôle local, la survie et la toxicité tardive des patients irradiés en technique conformationnelle avec ou sans modulation d'intensité pour un carcinome épidermoïde T1N0 de corde vocale. La chirurgie représentant l'autre option thérapeutique de référence dans cette situation, nous avons également comparé le contrôle local et la survie des patients irradiés avec celui des patients opérés. Cent quatre-vingt-trois patients ont reçu un traitement à visée curative dans notre centre pour un carcinome épidermoïde du plan glottique, soit par irradiation conformationnelle avec modulation d'intensité (« goupe IMRT », n = 72), soit par irradiation conformationnelle tridimensionnelle (« groupe RTC », n = 47), soit par chirurgie (« groupe chirurgie », n = 64) entre 2005 et 2020. La dose médiane délivrée en radiothérapie quelle que soit la technique était de 66 Gy en 30 fractions de 2,2 Gy. Une radiothérapie guidée par l'image quotidienne était effectuée par kv/kv ou tomographie conique. Le suivi médian était de 27,37 mois (intervalle de confiance à 95 % [IC95 %] : 20,9–35,4 mois) pour le groupe IMRT, 87,8 mois (IC 95 % : 68,5–106,7 mois) pour le groupe RTC et 45,6 mois (IC95 % : 32,7–55,9 mois) pour le groupe chirurgie. Les taux de survie sans récidive locale à 2 ans et de survie globale à 2 ans étaient de 85,4 % et 89,2 % pour le groupe IMRT, 84 % et 89 % pour le groupe RTC, 90,5 % et 96,4 % pour le groupe chirurgie respectivement, sans différence significative entre les groupes. L'incidence de la toxicité tardive a été évaluée dans le groupe IMRT comparé au groupe RTC selon l'échelle CTCAE v4.3, avec une diminution significative des taux de fibrose cutanée de grade 1–2 (1,4 % contre 6,4 %, p = 0,0062), de dysphagie de grade 1–2 (0 % contre 2,1 %, p = 0,0265), de dysphonie de grade 1–2 (50 % contre 76,6 %, p = 0,0037) et de la toxicité sévère définie par la nécessité de trachéotomie ou de laryngectomie pour larynx radique (0 % contre 8,5 % p = 0,0225). En outre, le taux de dysphonie persistante à 1 an était significativement inférieur pour la radiothérapie conformationnelle avec modulation d'intensité comparé à la chirurgie (23,6 % contre 75 %, p < 0,0001). La radiothérapie conformationnelle en technique avec modulation d'intensité permet d'obtenir des résultats équivalents à la technique tridimentionnelle en termes de contrôle local, tout en diminuant de manière significative la toxicité tardive, notamment le risque de trachéotomie pour larynx radique. En outre l'implémentation de la radiothérapie conformationnelle avec modulation d'intensité dans cette indication permet de diminuer la dose délivrée aux carotides chez ces patients à haut risque cardiovasculaire. Par ailleurs, le contrôle local est équivalent entre la radiothérapie conformationnelle avec modulation d'intensité et la chirurgie. [ABSTRACT FROM AUTHOR]

Objectif de l’étude Devant une tumeur des voies aérodigestives supérieures de stade T1 ou T2 associée à une adénopathie de stade N3 non métastatique, le pronostic est lié au stade N3. Le choix entre une chirurgie de la tumeur primitive lorsque cela est possible et une chimioradiothérapie pourrait impacter la morbidité à taux de contrôle local au moins équivalent. Nous avons évalué les pratiques dans cette situation. Matériel et méthode Onze centres français ont colligé leurs cas de cancers des voies aérodigestives supérieures de stade T1-2 N3 M0, entre 2008 et 2017 rétrospectivement. Résultats Au total, les dossiers de 210 patients atteints d’un cancer des voies aérodigestives supérieures de stade T1-2 et N3 clinique ont été inclus. Une chirurgie de la tumeur primitive suivie d’une chimioradiothérapie a été réalisée dans 21 % des cas, un traitement dissocié par curage cervical seul suivi d’une chimioradiothérapie dans 12 %, une chimioradiothérapie dans 39 %, une chimiothérapie néoadjuvante par docétaxel, cisplatine et 5-fluoro-uracile (TPF) dans 21 %, et un autre protocole de chimiothérapie dans 7 % ; 22 % des patients ont été opérés à un moment de la prise en charge de la tumeur primitive, et 43 % des aires ganglionnaires Il n’existait pas de différence significative de survie globale en cas de chirurgie du site tumoral primitif ou d’abstention chirurgicale (p = 0,16). En analyse unifactorielle, la survie était corrélée avec la résécabilité ganglionnaire, la localisation oropharyngée et la réalisation du curage ganglionnaire. En analyse multifactorielle, la survie globale était impactée par la réalisation ou non du curage cervical (p = 0,022). Pour les patients opérés de la tumeur primitive, on retrouvait une tendance à l’augmentation du taux de trachéotomie (p = 0,07) et il existait une augmentation du taux d’épaule douloureuse (p = 0,004), également corrélé avec le curage. Conclusion En cas de tumeur de stade T1 ou T2, associée à une adénopathie de stade N3, le pronostic est lié au traitement ganglionnaire, lui-même lié à la résécabilité ganglionnaire. La morbidité était augmentée en cas de chirurgie de la tumeur primitive. La morbidité pourrait être limitée, à taux de contrôle local identique, en n’opérant pas la tumeur primitive, qui sera incluse dans les volumes cibles de la radiothérapie. [ABSTRACT FROM AUTHOR]

Objectif de l’étude Une approche médicale par (chimio)radiothérapie ou chirurgicale (chirurgie avec ou sans radiothérapie adjuvante) représente deux alternatives thérapeutiques curatives des cancers oropharyngés. Le choix de l’une ou de l’autre option reste controversé. La surexpression de p16 représente un facteur pronostique majeur pour ces patients, mais sa valeur prédictive n’est pas connue. Nous rapportons les résultats en termes de contrôle tumoral et de toxicité stratifiés sur le statut p16 d’une cohorte de patients traités par radio(chimio)thérapie ou (radio)chirurgie. Matériel et méthode il s’agit d’une étude rétrospective incluant l’ensemble des patients pris en charge à visée curative pour un carcinome épidermoïde oropharyngé entre 2009 et 2013 dans notre institution. Les toxicités tardives ont été gradées selon la Common Terminology Criteria for Adverse Events (CTCAE) v4.3 après un délai minimal de 6 mois de la fin de tout traitement en l’absence de récidive locorégionale. Une relecture centralisée du statut p16 en immunohistochimie a été effectuée. Résultats Parmi les 183 patients inclus, il y avait chez 89 (49 %) une surexpression de p16. Après un suivi médian de 4,7 ans, la probabilité de survie sans maladie à 3 ans variait selon les stratégies thérapeutiques, 66 % après (chimio)radiothérapie et 33 % après (radio)chirurgie ( p = 0,002) en l’absence de surexpression de p16 et 83 % contre 82 % en présence ( p = 0,48) pour les patients p16+. En présence d’une surexpression de p16, le taux de dysphagie tardive sévère (de grade 3 ou plus) était significativement plus important après le traitement chirurgical qu’après le traitement médical : 35 % contre 4 % ( p = 0,004). Conclusion Notre étude met en évidence des taux de survie significativement variables après traitement chirurgical ou médical en fonction du statut p16 des patients. Cette donnée aisément accessible dans la pratique clinique peut s’avérer utile à la décision thérapeutique. La valeur prédictive du statut p16 devra être validée par des données prospectives. [ABSTRACT FROM AUTHOR]