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Introduction Informed consent for any surgical intervention is necessary, as only well-informed patients can actively participate in the decision-making process about their care, and better understand the likely or potential outcomes of their treatment. No consensus exists on informed consent for suspension microlaryngoscopy (SML). Materials and methods Informed consent procedures in nine countries on five continents were studied. Results Several risks can be discerned: risks of SML as procedure, anesthesiologic risks of SML, specific risks of phonosurgery, risks of inadequate glottic exposure or unexpected findings, risks of not treating. SML has recognized potential complications, that can be divided in temporary (minor) complications, and lasting (major) complications. Conclusion SML is a safe procedure with low morbidity, and virtually no mortality. Eleven recommendations are provided.

International audience; Background: To analyze worldwide practices regarding the initiation of oral feeding after total laryngectomy (TL).Methods: Online survey.Results: Among the 332 responses received, 278 from 59 countries were analyzed. Our results showed that 45.6% of respondents started water and 45.1% started liquid diet between postoperative days 7 and 10. Semi-solid feeds were initiated between days 10 and 14 for 44.9% of respondents and a free diet was allowed after day 15 for 60.8% of respondents. This timing was significantly delayed in cases of laryngo-pharyngectomy and after prior radiotherapy (p < 0.001). A greater proportion of respondents in Africa and Oceania allowed early oral feeding before day 6 as compared with the rest of the world (p < 0.001).Conclusion: Despite increasing number of publications, there is still a lack of evidence to support early oral feeding. The majority of respondents preferred to delay its initiation until at least 7 days after surgery.

Objectives Neck dissection is a controversial surgical procedure in patients with squamous cell carcinoma of the Larynx free of any node metastasis detected in preoperative staging. The aim of this study was to investigate the distributions of lymph node metastases in laryngeal squamous cell carcinoma and improve the rationale for elective treatment of N0 neck. Material and methods Retrospective single-center series of Seventy-eight successive patients with laryngeal squamous cell carcinoma who underwent neck dissection between 2008 and 2015. Results Surgery was first-line treatment in 37 patients (47%) and for recurrent disease in 41 (53%). The rate of occult nodal metastasis was 14% (n = 11): levels IIa and/or III were affected in 9 cases (11.5%) compared with single cases of IIb and IV involvement (1.3% each). The rate of occult nodal metastasis was significantly lower among patients operated on for recurrent disease after radiotherapy than in patients who never had any radiotherapy of the cervical lymph nodes (0% vs. 16.7%, P = 0.03). Conclusions Selective cervical lymph node dissection in levels IIa and III sparing levels IIb and IV seems to be ideal in total laryngectomy in patients with cN0 laryngeal squamous cell carcinoma. Omitting lymph node dissection altogether may be considered in total laryngectomy on a cN0 patient showing recurrence after radiotherapy.

International audience; Background: The objective of this study was to evaluate the impact of early oral hydration on the incidence of pharyngocutaneous fistula (PCF) after total laryngectomy (TL) or total pharyngolaryngectomy (TPL).Methods: A prospective series of 25 patients operated on between October 2017 and March 2019 who received early oral hydration starting 2 days after surgery were compared to a retrospective cohort of 28 patients who did not receive any early oral hydration. These are two consecutive series including all operated patients.Results: There was no significant difference between the two groups in terms of risk factors for PCF. In univariate and multivariate analysis, early oral hydration was significantly associated with a decreased risk of PCF: 50% vs 20% (odds ratio [OR], 0.25; 95% confidence interval [95% CI], 0.07-0.85; P = .03, vs OR, 0.24; 95% CI, 0.07-0.85; P = .02).Conclusion: Early oral hydration after TL or TPL reduces the risk of PCF.

Purpose Infectious agents, such as SARS-CoV-2, can be carried by droplets expelled during breathing. The spatial dissemination of droplets varies according to their initial velocity. After a short literature review, our goal was to determine the velocity of the exhaled air during vocal exercises. Methods A propylene glycol cloud produced by 2 e-cigarettes' users allowed visualization of the exhaled air emitted during vocal exercises. Airflow velocities were measured during the first 200 ms of a long exhalation, a sustained vowel /a/ and varied vocal exercises. For the long exhalation and the sustained vowel /a/, the decrease of airflow velocity was measured until 3 s. Results were compared with a Computational Fluid Dynamics (CFD) study using boundary conditions consistent with our experimental study. Results Regarding the production of vowels, higher velocities were found in loud and whispered voices than in normal voice. Voiced consonants like /3/ or /v/ generated higher velocities than vowels. Some voiceless consonants, e.g., /t/ generated high velocities, but long exhalation had the highest velocities. Semi-occluded vocal tract exercises generated faster airflow velocities than loud speech, with a decreased velocity during voicing. The initial velocity quickly decreased as was shown during a long exhalation or a sustained vowel /a/. Velocities were consistent with the CFD data. Conclusion Initial velocity of the exhaled air is a key factor influencing droplets trajectory. Our study revealed that vocal exercises produce a slower airflow than long exhalation. Speech therapy should, therefore, not be associated with an increased risk of contamination when implementing standard recommendations., European Archives of Oto-Rhino-Laryngology, Springer Verlag, 2020

Background Vocal fold (VF) scarring, caused by surgery or inflammation, often results in severe voice problems or aphonia. Effective lasting treatment is lacking. Previous in vitro and in vivo animal studies reported positive effects on VF scar resolution with mesenchymal stromal cell (MSC) implantation. The principal aim of this study was to examine safety aspects and secondly treatment efficacy vocal fold function in patients with VF scarring and severe voice problems. Methods In this open-label phase I/II study, 16 patients were treated with surgical scar resection followed by injection of autologous MSCs (0.5–2 × 106 MSCs/patient). Patients were monitored 1 year for serious adverse events (SAE) or minor complications. Therapeutic efficacy on treated VFs was evaluated by measurement of VF vibrations using high-speed laryngoscopy (HSL) and phonation pressure threshold (PTP) for elasticity and VF function. Patients self-reported voice change using the Voice Handicap Index (VHI). Results No SAE or minor side effects were reported. Video ratings of VF vibrations and digitized analysis of HSL and PTP were significantly improved for 62–75% of the patients (depending on parameter). Two patients showed deteriorated VF vibrations, but improved PTP. VHI was significantly improved in 8 patients, with the remaining experiencing no significant change. Conclusions The results indicate that local injection of autologous MSC into scarred VFs with severe voice problems may offer a safe and feasible therapeutic option. VF vibration and elasticity were improved in approximately two thirds of treated patients. This clinical study is registered in clinicaltrials.gov (ID: NCT01981330). Retrospective registration of first patient (20130511). https//: register.clinicaltrials.gov/.

International audience; Objective. To analyze the range of values of the contact pressure between the membranous vocal folds with Reinke’s edema and to compare it to those observed in the absence of such a lesion.Methods. Two human larynges were separately tested on the experimental bench, one of them with a bilateral loose swelling of the vocal folds. Once in a glottal prephonatory configuration, airflow was increased until achievement of self-sustained oscillations while recording aerodynamic, acoustic, electroglottographic data, and contact pressure between the folds.Results. We observed well-documented variations in acoustical parameters, as the decrease of the fundamental frequency and the increase of the phonation threshold pressure. The results of the study also point to a significant increase in the amplitude of the contact pressure in presence of the Reinke’s edema, and a lower degree of harmonicity of the produced sounds.Conclusion. This is the first report of ex vivo study of a larynx with Reinke’s edema. It highlights the increase in the contact pressure during phonation, which possibly contributes to sustain the lesion once it appeared.

International audience; Purpose: To propose, in patients presenting a difficult laryngeal exposure, a surgical innovation allowing to perform a transoral laser cordectomy for cancers reaching the anterior commissure or the anterior third of vocal folds (according to the European Laryngological Society classification of laryngeal endoscopic cordectomies).Methods: Our surgical technique consisted of adding to conventional cordectomies a modified relaxation thyroplasty proposed by Isshiki (type III), also called relaxation thyroplasty by a medial approach in the European Laryngological Society classification system. The anterior commissure retrusion is usually employed in the management of high-pitched voice disorders, but can also allow a better exposure of the anterior commissure.Results: We described here this surgical innovation through the example of our first two patients. For both patients, the definitive histologic analysis showed negative microscopic margins and there was no post-operative complication. There was no need for a tracheostomy. They were allowed to take a normal diet after 2 days and were discharged after 4 days. The voice was breathy and hoarse as expected in case of extended cordectomy.Conclusions: This surgical innovation corresponding to the addition of an anterior commissure retrusion by a bilateral thyrotomy could be useful in the ELS classification of endoscopic cordectomies. It should allow surgeons to carry out a transoral CO2 laser cordectomy in patients with a T1 and sometimes T2 glottic carcinoma, even with a difficult laryngeal exposure.

Vocal fold microstructure is complex and can be affected by laryngeal microsurgery, inducing scarring that prevents mechanical uncoupling of epithelium and muscle, leading to vibration disorder and disabling dysphonia. Treatment options presently are few, and often without efficacy for vibration, having only an impact on volume to reduce glottal closure defect. The present review of the literature had two aims: (i) to report the current state of the literature on cell therapy in vocal fold scarring; and (ii) to analyze the therapeutic interest of the adipose-derived stromal vascular fraction in the existing therapeutic armamentarium. A PubMed® search conducted in September 2016 retrieved English or French-language original articles on the use of stem cells to treat vocal fold scarring. Twenty-seven articles published between 2003 and 2016 met the study selection criteria. Mesenchymal stem cells were most widely used, mainly derived from bone marrow or adipose tissue. Four studies were performed in vitro on fibroblasts, and 18 in vivo on animals. End-points comprised: (i) scar analysis (macro- and micro-scopic morphology, viscoelastic properties, extracellular matrix, fibroblasts); and (ii) assessment of stem cell survival and differentiation. The studies testified to the benefit of mesenchymal stem cells, and especially those of adipose derivation. The stromal vascular fraction exhibits properties that might improve results by facilitating production logistics.

International audience; Objectives: To evaluate the prevalence of obstructive sleep apnoea syndrome (OSAS) in a population of patients treated for an advanced oropharyngeal cancer (AJCC Stage III or IV), depending on treatment strategy, and to evaluate its impact on quality of life.Design: Prospective cohort study.Setting: University Teaching Hospital of La Conception, Marseille, France.Participants: Fifty-one disease-free patients were included. Forty-one patients received a combined chemoradiotherapy, while 10 patients were treated by surgery followed by chemoradiotherapy.Main outcome measures: Every patient underwent a formal sleep consultation and was asked to complete the Epworth Sleepiness Scale and EORTC QLQ C-30 and the EORTC H&N 35 questionnaires. A home overnight respiratory polygraphy was performed in every subject.Results: The mean time between the end of cancer treatment and the OSAS analysis was 54.04 months [20; 84]. An OSAS was found in 25.49% of our patients. There was no significant difference between patients treated with either surgery (30%) or CRT (24.39%), P=.79. The EORTC QLQ C-30 questionnaire showed a significant difference between positive and negative OSAS groups in the Global Health Status Scale (50.64 vs 67.11, P=.02) and in the fatigue item (35.04 vs 17.25, P=.03).Conclusions: Our population with advanced oropharyngeal cancer, whatever the treatment strategy it may be, was at risk of developing OSAS with negative impact on quality of life. A routine screening and treatment of OSAS seems necessary to improve the quality of life of patients treated for advanced oropharyngeal cancer.

The objective of the study was to analyze temperament and character in females with vocal nodules (VN) compared to a vocally healthy control population. 61 females were examined over a 17-month period for dysphonia with VN (mean age 46 years, duration of vocal complaints from 2 months to 6 years). 71 control females were recruited in their environment (mean age 34 years). The validated French Version of the Temperament and Character Inventory (TCI) was used. Patients with VN had significantly (p

Aim Providing head and neck cancer patients with adequate information is essential to their confidence and satisfaction regarding medical care. The aims of this study were to evaluate patient perceptions of the information received, the predictive factors of such perceptions and their potential correlation with patient quality of life (QoL). Methods We conducted a prospective multicentric study using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-INFO25 and QLQ-C30 questionnaires before and after surgery. Results This study enrolled 200 patients, 149 men and 51 women, mean age 63.5 ± 10.3 years. Before and after treatment, global QLQ-INFO25 scores were 39.3 and 42.5, respectively, whereas satisfaction with the information received scores were 69.9 and 58.1, respectively. Regarding EORTC QLQ-INFO25 scores, between the pre- and post-treatment periods, we observed a significant increase in three scales/items (information about other services, information about different places of care and information about things you can do to help yourself) and a significant decrease in two scales/items (satisfaction with the information received and overall the information has been helpful). Before and after treatment, global QoL scores were 62.7 and 61.0, respectively. Overall, we found low correlations between QLQ-INFO25 and QLQ-C30 scores. Patient age and education level, centre of care, tumour site and treatment characteristics had a significant impact on QLQ-INFO25 scores. Conclusion Perceived information was satisfactory in the perioperative period for head and neck cancer patients. Several demographic and clinical factors were identified as significant predictors of QLQ-INFO25 scores.

Purpose: Vocal fold scar is one the most challenging benign laryngeal pathologies. The purpose of this paper is to propose a classification that will allow for a common description of this entity between laryngologists, prevent discrepancies in interpretation, allow for comparison of related studies, and offer a training tool for young laryngologists. Methods/Results: Based on the depth and laterality of scarring, we propose 4 types: type I, characterized by atrophy of lamina propria with/without affected epithelium; type II, where the epithelium, lamina propria, and muscle are affected; type III, where the scar is located on the anterior commissure; type IV, which includes extended scar formation in both anteroposterior and rostro-caudal axis with significant loss of vocal fold mass. Conclusion: We believe that our proposal is comprehensive and encompasses all existing iatrogenic and non-iatrogenic etiologies in a simple and concise manner. It also serves its purpose as a descriptive, comparative, and training tool.

Providing cancer patients with adequate information is essential to their confidence and satisfaction regarding medical care. The aims of this study were to evaluate the information given to patients undergoing total pharyngolaryngectomy (TPL) as well as the evolution and predictors of patient quality of life (QoL). We conducted a prospective multicentric study on patients undergoing TPL for a locally advanced laryngeal/hypopharyngeal cancer. All patients completed the EORTC QLQ-INFO25, QLQ-C30, and QLQ-H&N35 questionnaires, before and after surgery. This study enrolled 46 patients. Between the pre- and post-therapeutic periods, we observed no significant changes in the global QLQ-INFO25 and QLQ-C30 scores. However, we found a significant deterioration in 4 QLQ-INFO25 scales/items and in social functioning, as well as an increase of sense, speech, and social contact problems. N-stage and professional activity were significant predictors of preoperative QLQ-INFO25 scores. Younger age was significantly associated with financial difficulties, whereas professional activity and lower education level were significant predictors of xerostomia and swallowing problems, respectively. In patients undergoing TPL, we observed significant changes in QLQ-INFO25 scores between the pre- and post-treatment periods and, particularly, a deterioration of patient satisfaction with the information received. Several clinical factors were identified as significant predictors of QLQ-INFO25 and QoL scores.

International audience; Objectives To develop an experimental protocol to study the vocal effort generated by introducing barriers to communication, and its relationship with certain personality traits. Material and methods The experimental protocol consisted of an interactive game in which the subject gave an investigator instructions to adopt various body positions (semi-directed communication situation). The Control situation included no constraints on communication. Then a Distance Constraint (increased distance between subject and investigator) and a Time Constraint (generation of performance stress by putting the subject in competition with others) were introduced. The vocal parameters studied comprised vocal intensity and fundamental frequency in the middle of the vowel of 3 target phonemes. Subjects also took the NEO FFI-R personality test. Results The study included 41 women aged between 18 and 52 years. Vocal intensity and fundamental frequency increased significantly with the introduction of the constraints ( P < 0.05), intensity passing from 75.5 dB to 81.8 dB and frequency from 249.4 Hz to 335.8 Hz. No correlations were found between these changes and results for the various personality traits. Conclusions This ecological protocol enables the impact of both physical and emotional obstacles to communication to be studied. No correlations between vocal effort and personality traits emerged. A larger-scale study would be necessary to analyze the continuum between vocal effort and vocal forcing, to improve speech therapy for dysfunctional dysphonia.

International audience; Patients with scarred vocal folds (congenitally or following phonosurgery) are currently difficult to treat and present a dysphonia, often disabling in daily life. Several therapies are available on the market but the results of these are often disappointing. The autologous adipose-derived stromal vascular fraction (ADSVF) is recognized as an easily accessible source of cells with angiogenic, anti-inflammatory, immunomodulatory, and regenerative properties. We present here the case of a 43-year-old woman who had a severe dysphonia associated with scarred vocal folds after a phonosurgery and was resistant to conventional medical and surgical treatments. She received a local administration of autologous ADSVF. The protocol involved, on the same day, adipose tissue extraction, ADSVF preparation, and then local injection (0.45ml of ADSVF in each vocal fold, for a total of 12.2 million ADSVF viable cells). No serious adverse events have been described. One year following the surgery, the laryngoscopic aspect and the majority of voice parameters had improved, in particular the Voice Handicap Index decreasing from 75 to 9. The perceptual analysis found the voice to be less hoarse and more stable, without breathiness. The case of this patient highlights the therapeutic potential of ADSVF for such applications (trial registration, ClinicalTrials.gov NCT02622464; registered 4 December 2015).

Objectives: To evaluate the prevalence and distribution of lymph-node metastasis after total laryngectomy or total pharyngolaryngectomy. Material and methods: Retrospective single-center series of 136 successive patients undergoing total laryngectomy or total pharyngolaryngectomy with neck dissection for squamous cell carcinoma of the larynx or hypopharynx. Results: The primary site was laryngeal in 110 cases and hypopharyngeal in 26. In 63 patients, surgery was first-line treatment; 73 were operated on for recurrence. The lymph-node metastasis rate, confirmed on histology, was 44.8% regardless of primary site. Hypopharyngeal location was a risk factor for lymph node metastasis (73.1%, P = 0.002) as was the supraglottic subsite (64.3%, P = 0.039). Levels Ha and III were invaded in 28.7% and 25.7% of cases, respectively. Level VIb lymph-node involvement was 23.8% in patients who underwent level VIb neck dissection. Lymph-node recurrence rate was 10.3% in levels II to IV and 13.2% in VIb. Conclusions: Whatever the tumor site, levels Ha and III were most frequently invaded. The high rate of histological involvement of level VIb and of recurrence argues for systematic elective bilateral neck dissection of these territories in some primary sites. (C) 2017 Elsevier Masson SAS. All rights reserved.

International audience; Objective and Hypothesis: Vocal effort in loud voice is produced with increased subglottal pressure during vowels and increased supraglottal pressure during consonants. In the paper, our main objective is to check whether it was supported by a parallel increase in the airflow resistance of the laryngeal articulator and of the supralaryngeal articulator, here the lips. Study Design and Method: For this comparison, our choice fell on the fricative consonants, as their production allows perfectly synchronous air pressure and airflow measurements. Also, the calculation of the real instantaneous aerodynamic resistance is possible with fricatives-as it is with vowels-whereas it is not possible with plosives. The present feasibility study on a healthy subject is based on direct subglottal and intraoral pressures and airflow measured for /f/ or /v/ and from the contiguous vowel produced in VCVCV non sense words at different levels of intensity. Results and Conclusion: The results support that the airflow resistances at the lips and that at the larynx are quite parallel. The airflow resistance at the lips during labial fricative production could provide a good picture of the laryngeal resistance during the production of continuous speech. This suggests clinical applications using both non invasive inferred measurements of subglottal pressure variation and direct non inferred airflow measurements from more natural speech production tasks.

International audience; There is a growing need for evaluation tools allowing the quantification of the outcome after voice surgeries. Since the end of the 1990s, multiple unfruitful attempts have been made to reach a consensus, including the Dejonckere protocol for the European Laryngological Society in 2001. This suggested to perform objective and quantifiable measures in the following domains: perception, acoustic, aerodynamic, self-evaluation by the patient and videolaryngostroboscopy. But in a PubMed® search with the keywords “Voice Assessment” and “Voice Outcome” since 2001 retrieving 452 articles, only 33 of them were using methods taking into account the first four dimensions proposed by Dejonckere. To elaborate a new and simpler protocol, we chose to focus on unilateral vocal fold paralyses (UVFP), which represents a homogeneous disease in terms of physiology. This protocol was elaborated on the basis of a review of the literature and of the database and experience of the IFOS panel members. In summary, our group recommends the use and implementation of the ELS “basic protocol” with some minor modifications. Voice audio recordings are an indispensable prerequisite, and may even have medico-legal implications. We recommend the systematic use of the Voice Handicap Index (VHI). Perceptual analysis must be performed by using Hirano's GRB scale and voice breathiness has to be prioritized. Currently, acoustic analysis remains optional given the lack of data to support clinical usefulness. Aerodynamic studies should include at a minimum an evaluation of the Maximum Phonation Time, calculated in seconds following multiple trials in order to obtain a recording representing the patient's best possible glottis closure.

The aim of this study was to evaluate the practices of ENT surgeons for the management of early glottic cancers affecting only one vocal cord, i.e. classified T1a. A questionnaire was sent to different surgeons managing cancers of the larynx in France, Belgium and Switzerland. A descriptive and comparative analysis of practices across centers was performed. The decision-making parameters of the therapeutic strategy were analyzed. Sixty-nine surgeons completed the questionnaire (58 in France, 10 in Belgium and one in Switzerland). In the example of a 50-year-old man with active tobacco use and no oncologic history presenting a squamous cell carcinoma of the middle third of the vocal cord classified T1aN0M0, and with easy glottic exposition by laryngoscopy, 91 % of surgeons proposed endoscopic surgery laser, 2 % radiotherapy and 7 % proposed one of these two treatments without any preference. Therapeutic strategies were not influenced by the sex (p = 1.00), the smoking status (p = 0.58) or the age of the patient (more or less than 80 years, p = 0.27). A significant change was observed in the therapeutic strategy for tumors non-exposable by laryngoscopy (p = 0.032), tumors reaching the anterior commissure (p = 0.001) and patients using their voice professionally (p = 0.0003). The management strategy of T1a glottic carcinomas, in our series, is mainly surgical. The choice of therapeutic strategy seems to be based, in our series, on criteria such as the risk of a second location, cost, and duration of treatment.

Summary Objective The authors present the guidelines of the French Society of Oto-Rhino-Laryngology and Head and Neck Surgery (SFORL) on patient information ahead of thyroid surgery. Methods A multidisciplinary medical team was tasked with a scientific literature review on this topic. The texts retrieved were analyzed by an independent committee. A joint meeting drew up the final guidelines. The strength of the recommendations (grade A, B or C) was based on levels of evidence. Results It is recommended that the results of preoperative exploration and the indications for surgery should be explained to the patient. Patients should be informed as to the type of surgery, surgical objectives, risks and consequences. It is mandatory to obtain the patient's written consent before surgery. Conclusion Appropriate medical information is a critical step in patient management.

The objective of this study was to evaluate the surgical and long-term outcomes of a series of patients aged over 80 years, operated on for parotid neoplasms. Among 614 parotidectomies for neoplasms performed between 1998 and 2008, 34 patients (5.5%) aged over 80 years were identified retrospectively. Pathological examination showed a malignant tumour in 24 and a benign tumour in 10 cases. Overall survival (OS) and disease-free survival (DFS) were determined by Kaplan–Meier analysis. A search for parameters that could influence the postoperative complication rate and long-term outcomes was carried out by univariate analysis. There was no postoperative death. Eight patients (24%) had postoperative complications. Malignant histopathology ( P =0.05) and radical resection ( P =0.033) were found to have a significant negative impact on the postoperative course. Focusing on malignant tumours, only histopathological type (metastasis vs primary tumour) was found to have a negative impact on OS. The 2- and 5-year OS rates were 86% and 86%, respectively, for primary tumours, and 67% and 29%, respectively, for metastasis ( P =0.05). Malignant or benign histopathology had no impact on OS. Our results showed acceptable clinical and long-term oncological outcomes in very elderly patients operated on for parotid tumours, including malignant tumours.

SummaryObjectivesTo describe our experience in the management of vascular malformations of the parotid area.Materials and methodsThis was a retrospective study. Among 614 parotidectomy performed between 1998 and 2008 at our institution, 10 cases (1.6%) of vascular malformations have been identified. Clinical features and management of these patients were analyzed.ResultsClinical presentation was usually related to that of a benign, slow-growing and asymptomatic tumor. There was a marked female predominance (90%). In any case, the diagnosis of vascular malformation could be obtained with certainty preoperatively. Surgical excision was performed most often referred to diagnosis. Sixty percent of vascular malformations were located in the superficial lobe of the parotid gland. On the histological we found a classic look with benign vascular proliferation of endothelial cells in the walls. The vessel lumen was either the head of a congestion or thrombosis or calcification (phleboliths).ConclusionVascular malformations of the parotid gland, rare disease, are mainly venous. The terminology is based on clinical data, scalable, histological and hemodynamic as classified by the International Society of Study of Vascular Anomaly (ISSVA). Despite advances in imaging including MRI they remain difficult to diagnose. The treatment of reference is surgical excision.

Place: Germany; INTRODUCTION: The objective of this paper was to identify the determining factors of the glottal prephonatory configuration from the point of view of the resulting muscular actions (i.e., arytenoids adduction, membranous vocal fold adduction, and tension). MATERIALS AND METHODS: 21 human non-embalmed excised larynges (12 females and 9 males) were studied. Experiment A (11 larynges) studied four conditions of adduction of the vocal folds and arytenoids. Experiment B (10 larynges) studied the effect of cricothyroid approximation on the vocal fold length and the cricothyroid angle. RESULTS: Experiment A: The mean glottal area significantly decreased from 41.2 mm(2) mean with no adduction, to 10.2 mm(2) mean with arytenoid adduction, to 9.2 mm(2) with membranous vocal fold adduction, and down to 1.1 mm(2) with the combination of arytenoid and membranous adduction. The effect of the task was statistically significant. Experiment B: The length of vocal folds increased from 13.61 mm median to 14.48 mm median, and the cricothyroid angle decreased of 10.05 median along with cricothyroid approximation. DISCUSSION: The results of experiment A emphasize the sub-division of adductor intrinsic muscles in arytenoids adductors (i.e., LCA and IA), and membranous vocal fold adductor (i.e., TA). The results of experiment B quantify the effect of cricothyroid approximation on the vocal folds length. The implications of these results can be useful in both clinical practice and experimental studies.

It is hypothesized that real time objective measurement of the subglottic pressure could contribute to the choice of the implant's size (IS) in medialization thyroplasty (MT). A prospective study was conducted with patients with glottal insufficiency. Patients had a MT using a Montgomery implant(®) (Boston medical, Boston, USA). Peak direct subglottic pressure (PDSGP) was measured intraoperatively using a catheter inserted in the cricothyroid membrane. The implant's choice was based on the results of PDSGP measured prior and after placement of the implant and was compared to the surgeon's and patient's perception and fiber optic estimation of the glottis aperture. Six patients were included in the first part of the study. The PDSGP could be measured in all the patients without increasing the surgical time or patients' discomfort. The mean PDSGP before and after the placement of the implant was 15.2 (SD = 5) and 10.6 (SD = 4) cmH(2)O, respectively. In the second part of the study, five patients were included. The PDSGP varied with the size of the implant and the implant with the lowest pressure was chosen in 4/5 patients. Peroperative measurement of PDSGP is easy, feasible and might allow a more objective choice of the IS in MT. Level of evidence 2c.

Summary Objectives The small size of endoscopic laser cordectomy (ELC) specimens frequently leads the histopathologist to assess excision margins as pathologic. The present study sought to assess the prognostic value of margin status in terms of overall and of recurrence-free survival in a population of T1a glottic carcinoma operated on by ELC. Material and methods Sixty-four records of T1a squamous-cell carcinoma treated between 1996 and 2006 were retrospectively analyzed. Overall and recurrence-free survival for the group with negative margins (group 1) and with positive margins (group 2) were analyzed following Kaplan-Meier. The influence of resection margin histologic status was assessed on Log Rank test. Results Six female and 58 male patients were included. Forty (62.5%) had negative margins (group 1) and 24 (37.5%) positive margins (group 2). Overall five-year survival was 97% (95% in group 1 and 100% in group 2). Five-year recurrence-free survival was 94% (91.7% in group 1 and 95% in group 2). There was no significant difference in overall or recurrence-free survival according to resection margin histologic status. Conclusions The present results show that margins considered positive after laser resection do not significantly impact carcinologic course, while still requiring close surveillance. The most generally recommended attitude is control endoscopy with biopsy at 10 weeks.

Fluoropyrimidine drugs are widely used in head and neck cancer (HNC). DPD deficiency is a pharmacogenetics syndrome associated with severe/lethal toxicities upon 5-FU or capecitabine intake. We have developed a simple, rapid, and inexpensive functional testing for DPD activity, as a means to identify deficient patients and to anticipate subsequent 5-FU-related toxicities. We present here the impact of fluoropyrimidine dose tailoring based on DPD functional screening in a prospective, open, non-controlled study, both in term of reduction in severe toxicities and of treatment efficacy. About 65 patients with HNC (59 ± 9 years, 52M/13F, Prospective Group) were entered into the study. Screening for DPD deficiency was performed prior to the beginning of the chemotherapy or radiochemotherapy. DPD status was evaluated by monitoring U/UH2 ratio levels in plasma as a surrogate marker for enzymatic functionality. 5-FU doses were reduced according to the extent of the detected DPD impairment, and adjusted on the basis of age, general condition, and other clinical/paraclinical covariates, if required. Treatment-related toxicities and subsequent impact on treatment delay were carefully monitored next for comparison with a retrospective, Reference subset of 74 other patients with HNC (mean age: 59 ± 10, 58M/16F, Reference Group), previously treated in the same institute with similar schedule but using standard 5-FU dosage. Thirty-one out of 65 patients (48%) were identified as mildly (28%) to markedly (20%) DPD deficient. Subsequently, dose reductions ranging from 10 to 100% with 5-FU were applied in those patients. In this group, six patients (9%) experienced severe toxicities, none of them being life threatening, and no toxic death was encountered. In comparison, 16 out of 74 patients (22%) of the Reference Group displayed severe side effects after standard 5-FU administration, 13% being life-threatening toxicities (e.g., G4 neutropenia + sepsis). Moreover, one toxic death was observed in this Reference Group. No postponement or cancelation of forthcoming chemoradiotherapy courses occurred in the Prospective Group, whereas treatment had to be disrupted in six patients (8%) from the Reference Group. No difference in first-line therapy efficacy was evidenced between the two subsets (78 vs. 79% response, P = 0.790). Although non-randomized, this study strongly suggests that prospective determination of DPD status has an immediate clinical benefit by reducing the drug-induced toxicities incidence in patients treated with 5-FU, allowing an optimal administration of several courses in a row, while maintaining efficacy. Our preliminary results thus advocate for systematic DPD screening in patients eligible for treatment with fluoropyrimidine drugs in HNC.

Background Many authors have studied adult’s larynx modelization, but the mechanisms of newborn’s voice production have very rarely been investigated. After validating a numerical model with acoustic data, studies were performed on larynges of human fetuses in order to validate this model with aerodynamical experiments. Material and methods Anatomical measurements were performed and a simplified numerical model was built using Fluent ® with the vocal folds in phonatory position. The results obtained are in good agreement with those obtained by laser Doppler velocimetry (LDV) and high-frame rate particle image velocimetry (HFR-PIV), on an experimental bench with excised human fetus larynges. Results It appears that computing with first cry physiological parameters leads to a model which is close to those obtained in experiments with real organs.

Objectives: To gather information on the vocal and professional impact of supracricoid partial laryngectomy (SCPL). Study Design: Collection of quality of life data more than 12 months postsurgery, including expert-rated patient voice assessment (GRBAS [grade, roughness, breathiness, asthenia, strain] scale), self voice assessment, Voice Handicap Index (VHI), and socioprofessional data. Patients: Sixty-four patients were evaluated after SCPL. The surgical procedure had been conducted for initial stage T1b or T2 glottic carcinoma. All patients had no recurrence, were decanulated, and did not have any swallowing impairment. Thirty-three patients were less than 60 years old and were professionally active at the time of surgery. The mean age was 48.5 years old (42–59 years old). Fifteen patients were working in the communications sector, so use of their voice was obligatory. Professional impact and VHI measurements were evaluated. Results: For patients with professional activities before surgery, 15/33 (45%) continued their activities, whereas 55% had to withdraw from or modify these activities. For patients with communications activities, 6/15 (40%) continued their activities, 4 (26.6%) adapted, and 5 (33.3%) withdrew from their professional activities. The mean VHI value was 51.2. The mean VHI values according to the dysphonic grade (1, 2, and 3) were 36.3, 50.7, and 52.9, respectively. The mean VHI values were 45.6, 58.6, and 53.2, respectively, for patients who pursued their professional activities, withdrew from or adapted their activities, and had no professional activities. Correlations were obtained between VHI and the dysphonic grade (P = .043), cessation of professional activities (P = .034), and the time elapsed since surgery (P = .046). VHI emotional and physical subscale scores were significantly higher for patients who had withdrawn from their professional activities or adapted them. Conclusions: Supracricoid partial laryngectomy can have a marked social and professional impact. Many patients have to withdraw from professional activities in which vocal involvement is essential. The potential postsurgical social voice impact should be taken into consideration before proposing this surgery, and it is essential to estimate the possible impacts of the vocal handicap according to the patient's professional or other activities. Laryngoscope, 2009

This study was carried out using a transversal design. It aimed to investigate possible changes of the normal voice in children before mutation, to create a database for the parameters used in the study, and to examine the use of fractal dimension and the largest Lyapunov exponent (LLE) in the assessment of nonpathological phenomena. Two hundred twelve children were enrolled: 111 females and 101 males; and 9 six-year-olds, 24 seven-year-olds, 18 eight-year-olds, 25 nine-year-olds, 27 ten-year-olds, 55 eleven-year-olds, and 54 twelve-year-olds. Fundamental frequency (Fo) decreased with age and was lower in boys than in girls. Jitter and shimmer did not significantly differ with age or gender. Fractal dimension and LLE were significantly lower in boys; LLE decreased with age. The present series confirmed the established findings that Fo is lower in boys than in girls, even before mutation, and decreases with age; two other classical voice analysis parameters, jitter and shimmer, also showed the same behavior as described in the literature. The study of nonlinear parameters (fractal dimension and LLE) showed that laryngeal dynamics is more stable in boys than in girls, and that stability is correlated with age.

Voice of patient with unilateral laryngeal paralysis (ULP) shows a nonlinear behaviour with sudden octave jumps, bifurcations and chaos. Such a behaviour may be due to an increased number of freedom degrees in the glottal system. We hypothesized that voice intensity (with increasing sub glottal pressure) could improve vocal signal stability with less freedom degrees in vibrating system, and then a decrease of nonlinearities. A prospective study of 32 consecutive voices of patients with ULP and severe dysphonia was conducted. Jitter and Lyapunov exponent from vocal signals were compared at comfortable and loud voicing with Wilcoxon’s test. In 23 out of 32 patients, jitter significantly decreased from 5 (median) in normal voice to 1.2 in loud voice (P < 10−3), Lyapunov exponent decreased from 1,495 bit/s (median) to 708 bit/s (P < 10−4). Two patients had paradoxical results regarding jitter (higher in loud voice) and 2 regarding Lyapunov exponent. From the 23 cases of voice improvement, 15 cases showing a marked improvement of the acoustic analysis supported our hypothesis (65%). Nonlinear phenomena detected in vocal signals of ULP with severe dysphonia may be reduced in loud voice.

International audience; The purpose of this study was to develop and test a training protocol for the perceptual evaluation of dysphonia. A group of 38 inexperienced listeners participated in a three-phase experiment: a pretest to evaluate their initial performance on categorization of dysphonic voices, a training phase, and a posttest to detect training-related changes in performance. In parallel, a different group of 14 listeners who were experts in voice assessment took a test that was identical to the posttest taken by the inexperienced subjects. The corpus used for the tests was made up of recordings of 142 voices of women reading aloud, with a sampling of voice qualities ranging from normal to severely degraded. The learners' performance on judgments of moderate and severe dysphonia improved between the pretest and the posttest. No improvement was observed for normal voices, whose initial detection was already good, nor for slight dysphonias, which appear to be the most difficult to learn. The improvements were still present on a delayed posttest taken a week later. Unexpectedly, the inexperienced listeners' initial performance was similar to that of the experts. After the training phase, their scores for severely deteriorated voices were even better than the experts'. In conclusion, our training protocol seems to be effective and could therefore be proposed to voice therapists. However, judging intermediate degrees of dysphonia remains fragile and therefore needs to be reinforced by repeated training. Key Words: Perceptual evaluation of dysphonia

International audience; The aim of this study was to analyze the causal mechanisms of severe swallowing disorders after the treatment of oropharyngeal cancer. Twenty-six patients with severe swallowing disorders at ≥12 months after treatment for oropharyngeal cancer were analyzed retrospectively using videofluoroscopy. Fourteen patients (54%) had been treated with surgery (±postoperative radiotherapy), while 12 patients (46%) had been treated with (chemo)radiotherapy. Videofluoroscopy analysis showed a localized alteration in the surgical excision area resulting in impaired tongue root retraction in the surgical group (P=0.012), while general impairment of the pharyngeal, laryngeal, and upper oesophagus sphincter was found in the non-surgical group. Aspirations in the surgical group most often occurred after swallowing, while in the non-surgical group, they occurred during and after swallowing (P=0.039). This analysis by videofluoroscopy provides important insights into the mechanisms giving rise to swallowing disorders after the treatment of oropharyngeal cancer.

International audience; In this cross-language study, six Italian and six French voice experts evaluated perceptually the speech of 27 Italian and 40 French patients with dysphonia to determine if there were differences based on native language. French and Italian voice specialists agreed substantially in their evaluations of the overall grade of dysphonia and moderately concerning roughness and breathiness. No statistically signifi cant effects were found related to the language of the speakers with the exception of breathiness, a fi nding that was interpreted as being due to different voice pathologies in the patient groups. It was concluded that the perception of the overall grade of dysphonia and breathiness is not language-dependent, whereas the signifi cant difference in the perception of roughness may be related to a perception/adaption process.

International audience; Abstract The glottal geometry is a key factor in the aerosol delivery efficiency for treatment of lung diseases. However, while glottal vibrations were extensively studied during human phonation, the realistic glottal motion during breathing is poorly understood. Therefore, most current studies assume an idealized steady glottis in the context of respiratory dynamics, and thus neglect the flow unsteadiness related to this motion. This is particularly important to assess the aerosol transport mechanisms in upper airways. This article presents a clinical study conducted on 20 volunteers, to examine the realistic glottal motion during several breathing tasks. Nasofibroscopy was used to investigate the glottal geometrical variations simultaneously with accurate airflow rate measurements. In total, 144 breathing sequences of 30s were recorded. Regarding the whole database, two cases of glottal time-variations were found: “static” or “dynamic” ones. Typically, the peak value of glottal area during slow breathing narrowed from 217 ± 54 mm2 (mean ± STD) during inspiration, to 178 ± 35 mm2 during expiration. Considering flow unsteadiness, it is shown that the harmonic approximation of the airflow rate underevaluates the inertial effects as compared to realistic patterns, especially at the onset of the breathing cycle. These measurements provide input data to conduct realistic numerical simulations of laryngeal airflow and particle deposition.

Partial frontolateral laryngectomy (PL) is performed to remove larynx tumor while preserving its main functions. So far, the speech changes induced by difficulties of voicing and the alterations to the vocal tract due to PL have been seldom addressed. The goal of our study was to make an acoustic analysis of regressive voicing assimilation (RVA) among patients after PL and to study the relationship with rates of speech. A retrospective study was conducted from January to April 2013. 11 subjects treated by partial frontolateral laryngectomy, and ten healthy subjects were included. Functional recordings of voice were analyzed and compared. For assimilation sequences we found a significant modification of voicing ratio in healthy subjects (p < 0.05) and PL patient at accelerated speaking rate only (p < 0.05). The vowel duration is significantly modified only for healthy subjects. For all subjects (PL patients and healthy) the duration of C1 consonant was not significantly modified. Our results highlight the presence of RVA in healthy subjects, but also in PL patients in the rapid speaking mode.

The aim of this study was to evaluate the practices of ENT surgeons for the management of surgical margins after endoscopic laser surgery for early glottic cancers. A questionnaire was sent to different surgeons managing cancers of the larynx in France, Belgium and Switzerland. A descriptive and comparative analysis of practices across centers was performed. Sixty-nine surgeons completed the questionnaire (58 in France, 10 in Belgium and 1 in Switzerland). In case of very close or equivocal resection margins after definitive histological examination, 67 % of surgeons perform close follow-up, 28 % further treatment and 5 % had no opinion. Factors resulting in a significant change in the management of equivocal or very close margins were: the country of origin (p = 0.011), the specialty of the multidisciplinary team leader (p = 0.001), the fact that radiation equipment is located in the same center (p = 0.027) and the access to IMRT technique (p = 0.027). In case of positive resection margins, 80 % of surgeons perform further treatment, 15 % surveillance, and 5 % had no opinion. The only factor resulting in a significant change in the management of positive margins was the number of cancers of the larynx treated per year (p = 0.011). It is important to spare, on one hand equivocal or very close margins and on the other hand, positive margins. Postoperative management should be discussed depending on intraoperative findings, patient, practices of multidisciplinary team, and surgeon experience. This management remains non-consensual and writing a good practice guideline could be useful.

Background: Supracricoid partial laryngectomy (SCPL) results in laryngeal preservation in more than 95% of patients with T2 glottic carcinoma. After surgery, glottis function is characterized by an absence of vocal cords and poor glottis closure. Voice is an important postSCPL quality of life factor. Objective: Enhance postSCPL vocal function. Obtain postsurgical acoustic and aerodynamic measurements and correlate multiple objective parameters with perceptual results. Method: Continuous speech voice samples from 61 patients who had undergone SCPL more than 1 year before were scored according to the global, roughness, breathiness, asthenia, and strain (GRBAS) scale by a jury of listeners. Acoustic and aerodynamic parameters were recorded: fundamental frequency (F0), intensity, jitter, shimmer, signal-to-noise ratio (SNR), signal-to-noise ratio greater than 1 kHz (SNR>1), oral airflow (OAF), maximum phonation time (MPT), and estimated subglottic pressure (ESGP). Nonparametric tests and logistic regression analysis were used to compare objective measurements and perceptual evaluations. Results: All patients had various degrees of dysphonia: grade 1, 4.9%; grade 2, 55.7%; and grade 3, 39.4%. Correlations between perceptual grades and objective parameters were obtained for jitter, shimmer, SNR, SNR>1, ESGP, and OAF. No correlations were obtained between the different parameters and age, number of arytenoids, and time elapsed since surgery (TESS). Logistic regression analysis of jitter, SNR, ESGP, and OAF parameters revealed 92.6% agreement with the perceptual evaluation results.

Objective voice analysis based on simultaneous aerodynamic and acoustic measurements is not common and there have been no reports dealing specifically with aerodynamic features of laryngeal performance after partial laryngectomy. The present study describes objective voice analysis after near-total laryngectomy using the Tucker technique (NTLT). We performed and compared acoustic and aerodynamic measurements in patients who underwent NTLT (n = 21) and normal controls (n = 10). Acoustic indexes of instability of frequency and intensity (jitter and shimmer) were always higher in patients. Oral airflow and estimated subglottic pressure (ESPG) were significantly greater in patients than in controls (400 vs. 169 cm3/s and 23 vs. 6.2 hPa, respectively). Poor closure of the glottis after surgery leads to a significant increase in glottal leakage in comparison with controls. Higher ESGP values observed in patients are probably related to two factors. The first involves compensation for glottal leakage in order to achieve sufficient air pressure to initiate vibration of the mucosa. The second factor is the poor vibratory quality of the residual mucosa, which may require higher pressure levels than the more compliant normal cord to initiate vibration. Our findings confirm the adverse effects of NTLT on the aerodynamic efficiency of the larynx due to glottal leakage and poor compliance of postoperative mucosa. Aerodynamic measurements could provide the basis for standardized objective evaluation of postoperative voice quality.

Joint Bone Spine - In Press.Proof corrected by the author Available online since mardi 30 decembre 2014

The aim of this study was to rank vocal exercises using semi-occluded vocal tracts (SOVT) as a function of their effect on subglottal pressure (SGP) and on transglottal pressure (TGP). Direct measurements were performed in two healthy females. The correct realization of vocal exercises was controlled by maintaining a constant airflow at the phonation onset. TGP varied from 1.8 to 5.9 hPa among SOVT, in the same range as phonation threshold pressure values. SGP varied among subjects from 19.4 for 2-mm straw to 3.2 hPa for closed vowel. SOVT could be ranked in voice rehabilitation from the greatest to the smallest effects on SGP as following: 1) 2-mm straw; 2) 5-mm straw and fricative /v/; 3) 8-mm straw and nasals /m/ and /n/; 4) vowel /i/.

Objectives The aim of this study was to demonstrate that partial frontolateral laryngectomy with epiglottic reconstruction (PFLER) is an effective therapeutic option for treatment of T1 and T2 glottic carcinoma. Study Design Retrospective study. Methods Between 1982 and 1997, we treated 127 cases of early glottic carcinoma with PFLER. Early glottic carcinoma was staged using the Union Internationale Contre le Cancer TNM classification as either T1N0M0 (62 cases) or T2N0M0 (65 cases). Selection criteria, depending on the limits of exeresis, must remain glottic carcinoma with less than 0.5 cm of anterior subglottic involvement, with no involvement of the supraglottic space or laryngeal side of the epiglottis, with involvement of only one arytenoid, and with good mobility of both arytenoids even if vocal cord mobility is decreased. Results Postoperative recovery was uneventful in all cases, and all patients but one were able to breath and eat normally. The failure involved a patient with a permanent gastrostomy. As with other partial laryngectomy techniques, the main drawback of PFLER was deterioration of voice quality. All patients presented hoarseness and weakness of the voice. Five-year survival rates calculated according to the Kaplan-Meier method were 91% (standard error, 5%) in the T1N0M0 group and 86% (standard error, 5%) in the T2N0M0 group. No recurrence was observed in the T1N0M0 group. Local control was successful in 92% in the T2N0M0 group after a median follow-up of 5 years. Conclusion These findings show that PFLER is an effective therapeutic option in selected cases of early T1N0M0 or T2N0M0 glottic carcinoma.

The objective of this report was to study the clinical interest of estimated subglottic pressure (ESGP) with measurements of intraoral pressure according to the “airway interrupted method.” Twenty healthy female subjects and 27 dysphonic female patients were included and asked to produce sounds under different conditions of pitch and intensity. The ESGP increased with intensity and slightly with pitch in both patients and controls. a comparison between patients and controls showed significantly higher values of ESGP in patients under all conditions of intensity and pitch. For normal intensity and usual pitch, ESGP has been found to be 6.1 hectopascals (hPa) in control subjects and 8.25 hPa in patients (p = .002). Discriminant analysis of all the measured data showed that data recorded for low intensity (lowest possible intensity without whispering) and high pitch (9 semitones above the usual pitch) were the most discriminant. The authors concluded that ESGP allows good discrimination between dysphonic patients and control subjects and might be included in the basic clinical set of objective parameters.

Choice of voice sample material can influence perceptual judgments by a jury. The twofold purpose of this study was first to validate the pertinence of a sustained vowel for perceptual voice analysis in French speakers and second to test the hypothesis that use of only the stabilized portion of the vowel would lead to underestimation of dysphonia. Voice samples were recorded in 60 dysphonic patients and 20 normal controls. Three different sample materials were obtained for each subject, i.e. connected speech, a sustained vowel including both the initial and stable portion (complete sustained vowel), and a sustained vowel including only the stable portion (stabilized sustained vowel). The jury was composed of 7 experienced listeners. Jury consistency was measured as a percentage of agreeing judgments for the same subject. No difference in consistency was observed using the three sample materials. Judgments on stabilized sustained vowels were confirmed as less severe than judgments on connected speech. Judgments on complete sustained vowels were comparable to judgments on connected speech.

Scarring of the vocal folds leads to a deterioration of the highly complex micro-structure with consecutively impaired vibratory pattern and glottic insufficiency. The resulting dysphonia is predominantly characterized by a reduced vocal capacity. Despite the considerable progress in understanding of the underlying pathophysiology, the treatment of scarred vocal folds is still an unresolved chapter in laryngology and phonosurgery. Essential for a successful treatment is an individual, multi-dimensional concept that comprises the whole armamentarium of surgical and non-surgical (i.p. voice therapy) modalities. An ideal approach would be to soften the scar, because the reduced pliability and consequently the increased vibratory rigidity impede the easiness of vibration. The chosen phonosurgical method is determined by the main clinical feature: Medialization techniques for the treatment of glottic gap, or epithelium freeing techniques for improvement of vibration characteristics often combined with injection augmentation or implantation. In severe cases, buccal mucosa grafting can be an option. New developments, include treatment with anxiolytic lasers, laser technology with ultrafine excision/ablation properties avoiding coagulation (Picosecond infrared laser, PIRL), or techniques of tissue engineering. However, despite the promising results by in vitro experiments, animal studies and first clinical trials, the step into clinical routine application has yet to be taken.

The aim of the study was to evaluate swal- lowing using a reproducible objective methodology and to seek preoperative factors that could influence swallowing outcomes in patients operated on for partial laryngectomy. Twenty-four patients who underwent partial frontolateral laryngectomy with epiglottic reconstruction for T1bN0 or T2N0 glottic carcinoma between 2008 and 2012 were retrospectively evaluated. Using fiberoptic endoscopic and videofluoroscopic evaluation, early (15 days postopera- tively) and late (2 months postoperatively) scores were obtained for all patients to quantify their swallowing skills. Eighty-three percent of patients achieved at least partial oral feeding at time of hospital discharge and 87.5 % achieved exclusive oral feeding within 2 months postop- eratively. Early score was good or excellent in 50 %, average in 4.2 % and poor in 41.8 %. Regarding late scores, 63 % were classified as having a good or excellent late score, 7 patients (29 %) were classified as ''middle result'' because their time to recover was longer (i.e. between 1 and 2 months postoperatively), and two patients had a poor late score. Finally, at last follow-up, only one patient was partially fed by gastrostomy (180 days after surgery). T stage (p=0.04) was the only factor influenc- ing early swallowing outcomes and length of hospital stay was longer for poor scores than for good late results (p=0.02). Our findings show good outcomes in terms of postoperative swallowing. Objective assessment of deglu- tition is essential for a better understanding of the mecha- nisms of postoperative swallowing disorders and for patient selection.

This was a retrospective study of 33 patients treated for sinonasal squamous cell carcinoma between 1995 and 2008. Epidemiological, clinical, histological, and therapeutic aspects of this series of patients were analysed, and their impacts on overall survival and disease-free survival established using the Kaplan–Meier method. A search for prognostic factors was made using a log-rank test. There were 27 men. The average age at diagnosis was 64.7 years. Tobacco-smoking was found to be a risk factor in 24 patients (72.7%). The median follow-up was 66 months (range 0–99 months). Tumours were classified as T1 in 18.3%, T2 in 27.3%, T3 in 6%, and T4 in 48.5% of cases. Disease-free survival rates at 1 and 5 years were 58.5% and 46.1%, respectively, and overall survival rates were 70.3% and 40%, respectively. Overall survival was correlated to tumour status (TNM, American Joint Committee on Cancer) ( P =0.010) and involvement of key structures (skull base, dura mater, brain, orbit, cavernous sinus, infratemporal fossa, skin) ( P =0.049). Surgery followed by radiotherapy improved overall survival ( P =0.005) and disease-free survival ( P =0.028) when compared to other treatment modalities. When compared to surgery alone, it improved disease-free survival ( P =0.049) regardless of tumour stage.

The purpose of this study was to assess the prognostic value of the 3 staging systems found in the literature for sinonasal mucosal melanomas tumors: the Ballantyne staging system modified by Prasad (Ballantyne/Prasad staging system), the American Joint Committee on Cancer (AJCC) TNM classification for mucosal melanomas (mmTNM), and the 2009 AJCC TNM classification for carcinomas of the nasal cavity and sinuses (carTNM).A retrospective study of 35 patients treated between 1995 and 2010 was conducted for this study. Each patient was retrospectively staged using the Ballantyne/Prasad staging system, mmTNM, and carTNM.There were 20 women (57.1%) and 15 men (42.9%). Only carTNM was significantly correlated with overall survival (p = .012) and disease-free survival (p = .041). The other 2 classifications were not correlated with survival except for metastatic patients whose overall survival was lower (p = .032).On the basis of these findings, we believe that carTNM should be the primary staging system for patients with mucosal melanomas of the sinonasal tract