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Aim To evaluate the surgery program strategy adopted in an adult otorhinolaryngology and head and neck surgery department in an area badly affected by the Covid-19 epidemic peak. The main objective was to analyze the reasons for not cancelling surgeries and the postoperative course of operated patients. The secondary objective was to assess the situation of postponed patients. Material and Methods A single-center observational study carried out during the COVID-19 period in France included 124 patients scheduled for surgery during the period March 21-May 20, 2020. The number and nature of operations, both performed and postponed, were reviewed. Results A total of 54.0% patients were operated on during the COVID period and 46.0% were postponed. Operations were maintained in urgent or semi-urgent cases. The operated patients did not show any signs of infection during their hospital stay. A total of 29.8% of postponed patients were lost to follow-up and 49.1% were rescheduled. Conclusion The application of national and international recommendations minimized the risk of loss of chance for operated patients without increasing the risk of contamination. The postponement of canceled operations resulted in considerable loss to follow-up. Intensified follow-up is necessary for these patients.

Objective To analyse tracheostomies after intubation for SARS-Cov-2 infection performed by otorhinolaryngologists in 7 university hospitals in the Paris area of France during the month March 24 to April 23, 2020. Material and methods A multicentre retrospective observational study included 59 consecutive patients. The main goals were to evaluate the number, characteristics and practical conditions of tracheostomies, and the COVID-19 status of the otorhinolaryngologists. Secondary goals were to analyse tracheostomy time, decannulation rate, immediate postoperative complications and laryngotracheal axis status. Results Tracheostomy indications were for ventilatory weaning and extubation failure in 86% and 14% of cases, respectively. The technique was surgical, percutaneous or hybrid in 91.5%, 3.4% and 5.1% of cases, respectively. None of the operators developed symptoms consistent with COVID-19. Postoperative complications occurred in 15% of cases, with no significant difference between surgical and percutaneous/hybrid techniques (P = 0.33), although no complications occurred after percutaneous or hybrid tracheostomies. No procedures or complications resulted in death. The decannulation rate was 74.5% with a mean tracheostomy time of 20 ± 12 days. In 55% of the patients evaluated by flexible endoscopy after decannulation, a laryngeal abnormality was found. On univariate analysis, no clinical features had a significant influence on tracheostomy time, decannulation rate or occurrence of laryngeal lesions. Conclusion The main findings of the present retrospective study were: absence of contamination of the surgeons, heterogeneity of practices between centres, a high rate of complications and laryngeal lesions whatever the technique, and the specificities of the patients.

This technical note documents an easily reproducible technique to improve velar competency after transoral lateral oropharyngectomy extending to the velum.

European Annals of Otorhinolaryngology, Head and Neck Diseases - Vol. 138 - N° 4 - p. 229

Resume But Analyse des caracteristiques des tumeurs de la thyroide revelees par une paralysie laryngee unilaterale (PLU). Materiel et methodes Etude retrospective d’une cohorte de 30 patients avec une PLU revelant une affection tumorale thyroidienne (groupe A) et comparaison avec une cohorte de 99 patients avec une PLU revelant une affection tumorale non thyroidienne (groupe B). Resultats Le groupe A se composait de 66,6 % de femmes avec un âge median de 69 ans. La comparaison entre les deux groupes notait que le sexe etait plus souvent feminin au sein du groupe A (66,6 % vs 17,1 %, p Conclusion Cette etude confirme que la PLU n’est pas un element clinique qui permet d’orienter de facon formelle vers le caractere benin ou malin d’une tumeur thyroidienne et souligne l’importance d’une surveillance au long cours en l’absence de recuperation de la mobilite laryngee chez les patients operes d’une tumeur thyroidienne benigne ipsilaterale.

Objectives A systematic review of the literature on stylohyoid syndrome treatment was performed according to PRISMA guidelines. Material and methods Three hundred and forty-nine articles were retrieved in the PubMed and Cochrane databases using the search-terms “stylohyoid syndrome” and synonyms. Articles documenting treatment and outcome with more than 1 month's follow-up were selected. Treatment-related complications and rate of cure, defined as disappearance of symptoms and/or of revelatory complication, were analyzed. Overall analysis was performed for series and a mixed logistic regression model for case reports. Results Hundred and two articles (12 series, 90 case reports) were selected. The 12 series included 482 patients with pain syndrome managed by styloidectomy, with 84.2% and 73.7% cure rates for cervical and transoral approaches, respectively. There were no complications with the transoral approach, versus 1.2% transient facial paresis with the cervical approach. In the 90 case reports, 112 patients had pain syndrome (Group I) and 16 neurological deficit (Group II). Cure rate in Group I varied significantly (P = 0.005; OR 8.33, 95% CI [2.12–32.81]) from 64.3% following medical treatment (antiepileptics, muscle relaxants, analgesics, per os and/or locally injected anti-inflammatory drugs) to 91.8% following styloidectomy, without any significant impact of surgical approach (P = 0.1; OR 0.17, 95% CI [0.02–1.60]). In Group I, no complications occurred after medical treatment, versus 4.3% and 16.3% after transoral and cervical styloidectomy, respectively. In Group II, cure and complication rates were 87.5% and 6.2%, respectively. Due to the small sample size and heterogeneity of Group II, no statistical assessment of the contribution of styloidectomy to medical treatment (antiplatelet drugs, with or without stenting) was performed. Conclusion Styloidectomy appears to be the treatment of choice for stylohyoid syndrome. The surgical approach does not significantly influence the cure or complications rate.

Background The aim of our study was to document 10-year outcome after curative "exclusive" chemotherapy in N0M0 squamous cell carcinoma of the larynx and pharynx. Methods Retrospective nonrandomized analysis of an inception cohort of 191 patients. Platinum salt and 5-fluorouracil were used in all patients. Results The 3-, 5-, 10-year overall actuarial survival and local control estimates were 83.3%, 74.4%, and 55.4% and 62.1%, 62.1%, and 55.3%, respectively. Main causes of death were metachronous second primary cancer (n = 39) and intercurrent disease (n = 28). No clinical variables were associated with increased risk of local recurrence. Salvage treatment resulted in 94.7% ultimate local control and 88.4% organ preservation. "Exclusive" chemotherapy was considered "beneficial" in 62.3% and "detrimental" in 7.8% of cases. Conclusion The high rate of local recurrence may be thought not to justify this treatment. Nevertheless, many patients avoided surgery and remained free of disease. Therefore, this approach deserves further study in the era of immune checkpoints inhibitors.

As a key player in modern scientific methodology, statistics, the science of collecting, processing and analyzing data from observation of random phenomena (i.e., in which chance is a factor), is an essential part of the process of formulating a research hypothesis, choosing the study variables and research method, analyzing the results and drawing conclusions. In this technical note, the authors touch on the main notions to be mastered for optimal use of descriptive statistics in this process, facilitating publication of articles submitted to the European Annals of Otorhinolaryngology, Head and Neck Diseases.

Based on a review of the medical literature, the authors document the key technical points and pitfalls in type I thyroplasty with Montgomery® implant, and the main results and indications in unilateral laryngeal immobility.

Resume Objectif Evaluation de l’impact du premier mois de confinement lors de l’epidemie Covid 19 sur l’activite de chirurgie carcinologique des services universitaires d’otorhinolaryngologie en Ile-de-France. Materiel et methodes Etude observationnelle, prospective, multicentrique menee au sein de 6 services universitaires (Paris Centre, Nord, Est et Sorbonne) d’otorhinolaryngologie sur le mois precedant (Groupe A) et suivant (Groupe B) le confinement instaure le 17/03/2020. Objectif principal : evaluer l’impact sur l’activite carcinologique chirurgicale. Objectifs secondaires : evaluer les caracteristiques de la population, les modalites pratiques des interventions, les suites operatoires, l’evolution Covid des patients et des otorhinolaryngologistes et les effets nefastes. Resultats Deux cent vingt-quatre interventions etaient realisees. Une diminution de 10,9 % de l’activite etait notee, sans difference significative entre les services. Les carcinomes epidermoides et la localisation au niveau du larynx, de l’hypopharynx, de l’oropharynx, de la cavite buccale, des fosses nasales et sinus de la face predominaient, avec respectivement 79 % et 75,8 % des interventions, sans difference significative entre les groupes. Les tumeurs classees T3/4 et N2/3 etaient plus frequentes au sein du Groupe B (p = 0,002 et 0,0004). Il n’existait pas de difference significative entre les groupes en termes d’abord chirurgical, de modalites de reconstruction, de suites operatoires et de duree de sejour en soins intensifs ou en reanimation, de tracheotomie, de sonde nasogastrique et d’hospitalisation. Aucun patient n’etait teste positif pour la Covid 19 au sein du Groupe A pour trois au sein du Groupe B, sans effets nefastes. Les otorhinolaryngologistes qui participaient aux interventions ne developpaient pas de symptomes evocateurs d’une infestation par la Covid 19. Conclusion Cette etude souligne que l’epidemie Covid 19 et le confinement n’ont que legerement altere la chaine diagnostique et therapeutique chirurgicale des cancers pris en charge dans les services universitaires ORL d’Ile-de-France, conservant toutes les chances de survie, sans favoriser la diffusion du virus.

Based on a review of the medical literature, the authors document the key points regarding the tests available in France to screen for and diagnose of CoV-2 infestation.

Resume Objectif Analyse de l’impact du premier mois de confinement lie a l’epidemie SARS-CoV-2 sur l’activite de consultation des otorhinolaryngologistes liberaux de l‘ile de La Reunion. Methode Etude observationnelle, multicentrique, prospective analysant l’activite de consultation de douze praticiens. Objectif principal Evaluer le nombre, les caracteristiques et les modalites des consultations realisees. Objectifs secondaires : preciser les symptomes amenant les patients a consulter, les diagnostics evoques, les prescriptions instaurees, les eventuelles consequences nefastes et l’impact sur le chiffre d‘affaire. Resultats 693 consultations etaient realisees, dont 50 % etaient demandees en urgence. 57,9 % des consultations etaient realisees en presence du patient, 28,4 % etaient effectuees au telephone et 13,7 % et en teleconsultation. Lors des consultations presentielles, les otorhinolaryngologistes portaient des gants et un masque respectivement dans 53,8 % et 92,2 % des cas. Le masque porte etait de type chirurgical et de type FFP2 dans 71,6 % et 28,4 % de cas, respectivement. Les trois symptomes les plus frequents (48,5 % des cas) etaient l’otalgie, les troubles de l’audition et les vertiges. Les trois diagnostics les plus frequents (60,6 % des cas) etaient, les otites, les corps etrangers d’oreille (cerumen inclus) et les infections pharyngees. Les trois examens complementaires les plus prescrits (74,3 % des cas) etaient l’imagerie, l’audiometrie, et l’avis d’un specialiste medical. Les trois familles therapeutiques les plus prescrites (52,7 % des cas) etaient les gouttes auriculaires, les antibiotiques, et les lavages de nez et/ou sprays nasaux. L’incidence des consequences nefastes etait de 0,001 % et aucun des otorhinolaryngologistes ou des patients ne semblait avoir ete infecte par la Covid 19. Une baisse de 47,3 % a 91 % (mediane : 75,6 %) du chiffre d’affaire de consultation etait notee. Conclusion Cette etude souligne la disponibilite et l’adaptabilite des ORL reunionnais liberaux en contexte epidemique malgre un impact economique tres negatif.

Objective To analyze the impact of the first month of lockdown related to the 2020 SARS-Cov-2 epidemic on the consulting activity of private ENT physicians in Reunion Island. Material and methods A multicenter prospective study analyzed the consulting activity of 12 ENT physicians in full-time private practice. The main endpoints were the number, characteristics and conditions of consultations. Secondary endpoints comprised presenting symptoms, diagnosis, prescriptions, adverse effects, and progression of monthly consulting turnover. Results Six hundred and ninety three consultations were performed during the study period ( Appendix 1 ), with 50% emergency consultations. In 57.9% were face-to-face, 28.4% by phone and 13.7% video. In face-to-face consultation, the physician wore gloves in 53.8% of cases and a mask in 92.2%: surgical mask in 71.6% of cases and FFP2 in 28.4%. The three most frequent symptoms (48.5% of cases) were otalgia, hearing impairment, and vertigo. The three most frequent diagnoses (60.6% of cases) were otitis, intra-auricular foreign body (including wax), and pharyngeal infection. The three most frequently prescribed complementary exams (74.3% of cases) were imaging, hearing work-up, and specialist opinion. The three most frequently prescribed treatments (52.7% of cases) were intra-auricular drops, oral antibiotics, and nasal spray. The incidence of adverse effects was 0.001%. None of the physicians or patients seemed to have been infected by Covid-19 during the study period. There was a 47.3-91% (median, 75.6%) drop in monthly consultation turnover. Conclusion The present study underscored the availability and adaptability of ENT physicians in the Reunion Island in an epidemic context, although economic impact was detrimental.

eAbstract Objective To evaluate the impact of the first month of lockdown related to the Covid-19 epidemic on the oncologic surgical activity in the Ile de France region university hospital otorhinolaryngology departments. Material and methods A multicenter prospective observational assessment was conducted in 6 university hospital otorhinolaryngology departments (Paris Centre, Nord, Est and Sorbonne) during the 1-month periods before (Month A) and after (Month B) lockdown on March 17, 2020. The main goal was to evaluate lockdown impact on oncologic surgical activity in the departments. Secondary goals were to report population characteristics, surgery conditions, postoperative course, progression of Covid status in patients and surgeons, and adverse events. Results 224 procedures were performed. There was 10.9% reduction in overall activity, without significant difference between departments. Squamous cell carcinoma and larynx, hypopharynx, oropharynx, oral cavity and nasal cavity and sinus locations were predominant, at 79% and 75.8% of cases respectively, with no significant differences between months. T3/4 and N2/3 tumors were more frequent in Month B (P = .002 and .0004). There was no significant difference between months regarding surgical approach, type of reconstruction, postoperative course, tracheotomy and nasogastric feeding-tube time, intensive care stay or hospital stay. None of the Month A patients were Covid-19-positive, versus 3 in Month B, without adverse events. None of the otorhinolaryngologists involved in the procedures developed symptoms suggesting Covid-19 infestation. Conclusion The present study underscored the limited impact of the Covid-19 epidemic and lockdown on surgical diagnosis and cancer surgery in the Ile de France university otorhinolaryngology departments, maintaining chances for optimal survival without spreading the virus.

Based on a review of the indexed scientific medical literature, the authors document the key technical points, the errors to avoid, the limitations, indications and main oncologic and functional results when performing transoral lateral oropharyngectomy in cancer originating from the tonsillar region.

Objectives:Sinonasal inverted papillomas (SIP) present a potential for recurrence years after the surgery, but most studies report short-term follow-up, and risk factors for recurrence are still debated. Furthermore, several classifications are described, and no consensus exists regarding which one should be used. The aims of this study were to report our long-term results, investigate for potential risk factors for recurrence, and compare the existing 8 staging systems.Methods:Over a 28-year period, 110 patients with a diagnosis of SIP were enrolled. The median follow-up time was 55.6 months.Results:In multivariate Cox regression modeling, history of previous surgery was the only variable associated with recurrence (hazard ratio = 4.91, 95% CI, 1.80-13.39). Recurrences occurred up to 60 months after the surgery. Among the 8 staging systems, none proved to be associated with recurrence.Conclusion:The only factor associated with recurrence of SIP was prior surgery, probably corresponding to an incomplete initial resection. Due to late recurrences, an extended follow-up of at least 5 years is mandatory. In the absence of a classification predicting prognosis, Krouse’s staging system should be used to homogenize studies’ report since it is the most widely used.

Based on a case of reconstruction after oncologic resection of the hard palate, the authors document the key technical points for harvesting a posterior-based buccinator myomucosal flap (Bozola's flap), and its limitations and indications after oncologic resection of tumors originating from the oral cavity and/oropharynx.

Inverted papilloma is a rare sinonasal tumor that mainly occurs in adults during the 5th decade. Three characteristics make this tumor very different from other sinonasal tumors: a relatively strong potential for local destruction, high rate of recurrence, and a risk of carcinomatous evolution. Etiology remains little understood, but an association with human papilloma virus has been reported in up to 40% of cases, raising the suspicions of implication in the pathogenesis of inverted papilloma. Treatment of choice is surgery, by endonasal endoscopic or external approach, depending on extension and tumoral characteristics. Follow-up is critical, to diagnose local relapse, which is often early but may also be late. The seriousness of this pathology lies in its association with carcinoma, which may be diagnosed at the outset or at recurrence during follow-up. It is important to diagnose recurrence to enable early treatment, especially in case of associated carcinoma or malignancy. A comprehensive review of the international literature was performed on PubMed and Embase, using the following search-terms: "sinonasal" [All Fields] AND ("papilloma, inverted" [MeSH Terms] OR ("papilloma" [All Fields] AND "inverted" [All Fields]) OR "inverted papilloma" [All Fields] OR ("inverted" [All Fields] AND "papilloma" [All Fields])). We reviewed all articles referring to sinonasal inverted papilloma published up to January 2015. The present article updates the state of knowledge regarding sinonasal inverted papilloma.

Goal To evaluate transoral robotic surgery (TORS) for isolated previously untreated squamous cell carcinoma (SCC) of the tonsillar fossa classified as T1-2. Method Retrospective analysis of two cohorts of isolated untreated T1-2 tonsillar fossa SCC consecutively operated on by a transoral approach, with (R = 21) and without (NR = 24) robotic assistance, in the period 2006–2014. Three main (survival, local control, and operative morbidity) and three secondary (pathologic data, incidence and duration of tracheotomy and nasogastric intubation, and hospital stay) endpoints were compared between groups. The significance threshold was set at P Results Three- and five-year actuarial survival estimates were 80.2% and 74.5% respectively in group R, and 91.5% and 82.5% respectively in group NR (NS: P = .34). Three- and five-year actuarial local control estimates were 90% and 90% respectively in group R, and 95.8% and 91% respectively in group NR (NS: P = .81). There were no significant differences in morbidity, tracheotomy/nasogastric intubation time, or hospital stay. Positive resection margins (R1) were noted in 38.1% and 16.7% in groups R and NR, respectively (NS: P = .05) without significant impact on 5-year actuarial local control (P = 0.78). Conclusion Robotic assistance in transoral lateral oropharyngectomy for T1-2 tonsillar fossa SCC did not significantly impact oncologic or functional outcome.

From a reading of various sources (scientific articles, books, dictionaries and websites), this article documents eponyms in the field of laryngology (other than those related to anatomy or therapeutics), memorializing certain notable events in this subspecialty of otorhinolaryngology and in the life of our illustrious forebears.

The present review article details developments in medical writing and the ongoing transformation of the scientific medical press. With these twin revolutions, French-language scientific medical journals are at a crossroads: are they going to become vehicles of teaching, of popularization, of liaison between members of medical societies, of general public information contributing to decision-making in the field of public health? Or will they maintain their scientific status? Under certain conditions, a move toward French/English bilingualism could be the solution to maintain and advertise their scientific level, while contributing to the quality of medical teaching in French and to the worldwide influence of the French language.

In the light of a case of sudden onset of diffuse, isolated oedema of the lips, the authors describe the key points of the diagnostic approach and the main epidemiological and clinical data.

European Annals of Otorhinolaryngology, Head and Neck Diseases - Vol. 136 - N° 2 - p. 61-62

The aim of the present study was to determine the prevalence of long-term mucocele development after functional endoscopic sinus surgery (FESS) for nasal polyposis, to search for a statistical relationship with preoperative variables and to analyze the management of this complication. A retrospective analysis of 153 patients who underwent FESS for nasal polyposis, with a minimum of 7 years of follow-up, was performed. Mucocele diagnosis was based on regular clinical and radiologic evaluation. Univariate and multivariate statistical analysis was performed. The postoperative mucocele rate was 13.1% (20 patients). The mean delay between surgery and mucocele diagnosis was 6.25 years. A high preoperative Lund-Mackay score (>19) was a risk factor for postoperative mucocele (p = 0.04). Asthma and aspirin intolerance did not increase the risk of this complication. Endoscopic marsupialization of mucoceles was successful in 19 patients, with only one recurrent frontal mucocele. One patient required external approaches for two frontal mucoceles. In conclusion, mucocele risk after FESS for nasal polyposis is significant, especially in case of a high preoperative Lund-Mackay score (>19). Long-term clinical follow-up is recommended, imaging being prescribed based on symptoms or abnormal findings on clinical examination. Endoscopic marsupialization is very effective, but frontal mucoceles are more likely to recur.

Only about ten articles devoted to operative reports have been published in the medical literature, but this document is essential, both medically and legally, to ensure optimal management of operated patients. In this technical note, based on published studies on this subject, the authors describe the key features of operating reports after otorhinolaryngology head & neck surgery and emphasize the need to write this document during the minutes after the end of the operation, the importance of standardization and its teaching role during surgical training.