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51. [Features of tomodensitometry in the development of pleuropulmonary lesions related to Wegener's granulomatosis]

Author

C, Courthaliac, O, Aumaître, M, André, J L, Kémény, H, Janicot, L, Gilain, and J L, Michel

Subjects
Adult, Lung Diseases, Male, Time Factors, Granulomatosis with Polyangiitis, Humans, Female, Middle Aged, Tomography, X-Ray Computed, Lung, Aged, Follow-Up Studies, Retrospective Studies
Abstract

The aim of this study was to determine CT scan value for the follow-up of patients with pleuropulmonary lesions related to Wegener's granulomatosis.Retrospective study of ten patients who were diagnosed with diffuse Wegener's granulomatosis including lung involvement and for whom mean follow-up was 23 months (range 4-61).During early stages of the disease, the most common finding was the existence of either nodules (90% of the patients) or consolidations (100% of the patients). CT scan controls showed that nodules disappeared within 6 months in 60% of patients and had completely resolved after 12 months. Linear opacities relating to traction developed, replacing subpleural nodules. A pneumothorax occurred in two patients who had excavated subpleural nodules. Consolidations disappeared in 44% of the patients, most frequently within 4 months. When consolidations persisted, they were replaced by alveolar infiltrates accompanied by bronchiolectasies and linear opacities. Regarding either nodules or consolidations, CT features related to relapse were similar to those of initial lesions in 40% of the cases.The main features of pleuropulmonary lesions relating to Wegener's granulomatosis were subpleural nodules that either disappeared with, however, subsequent linear opacities sequelae, or were complicated by the occurrence of pneumothorax.

Published
1999

52. [Postoperative pain assessment in head and neck cancer surgery: benefit of patient controlled analgesia (PCA)]

Author

P, Bost, F, Commun, E, Albuisson, C, Guichard, T, Mom, A, Eschalier, and L, Gilain

Subjects
Adult, Male, Pain, Postoperative, Morphine, Analgesia, Patient-Controlled, Equipment Design, Middle Aged, Analgesics, Opioid, Treatment Outcome, Head and Neck Neoplasms, Acute Disease, Preoperative Care, Humans, Aged, Pain Measurement, Retrospective Studies
Abstract

Acute postoperative pain has seldom been assessed in head and neck cancer surgery. The estimation of actual pain is more difficult when communication is impaired by tracheotomy or tracheostomia. The aim of the present prospective study was the assessment of analgesia level during the first 48 postoperative hours after head and neck cancer surgery. The analgesic procedure involved intra-venous morphine injected by means of a PCA pump (Patient controlled analgesia). Thirty patients were thus treated after cancer surgery of the larynx or the oropharynx. The protocol included during 48 hours the assessment of pain, using a visual analogic scale (VAS) every fourth hour, while recording the total injected dose of morphine, the localisation of pains, as well as the occurrence of side-effects. The control of postoperative pain was shown to be satisfactory, with a VAS grade smaller than 3 at time zero and kept below this value during 48 hours. At the end of this period, the mean total dose of morphine injected was 38 mg. No case of respiratory depression was even seen. It can be concluded that PCA seems to be an efficient procedure for controlling postoperative pain in head and neck cancer surgery. This technique proved to be better than delivering analgesia on requirement.

Published
1999

53. [Parapharyngeal tumors. Apropos of 6 cases]

Author

C, Guichard, P, Bost, S, Boudet, D, Advenier, E, Fargeix, and L, Gilain

Subjects
Adult, Carotid Artery Diseases, Male, Adolescent, Epidermal Cyst, Adenoma, Pleomorphic, Aneurysm, Magnetic Resonance Imaging, Parotid Neoplasms, Diagnosis, Differential, Humans, Cranial Nerve Neoplasms, Female, Tomography, X-Ray Computed, Carotid Artery, Internal, Glossopharyngeal Nerve, Neurilemmoma, Aged
Abstract

We conducted a retrospective study of six patients presenting a parapharyngeal tumor and an analysis of data of the literature and recall classification of these tumors and their anatomo-clinics characters, therapeutic and diagnostic problems highlighting. These tumors are rare and have various origins, their treatment is almost always surgical by cervical approach which can be undertaken only after a rigorous exploration, systematically associating computed tomography scan and magnetic resonance imaging. Transoral resection is strongly advised against as it is potentially harmful.

Published
1999

55. Epithelial cell proliferation, apoptosis, and apoptosis inhibition in inverted papillomas

Author

L. Brugel, G Piron, C Guichard, L Gilain, I Abd-Al Samad, Estelle Escudier, and André Coste

Subjects
Adult, Male, Pathology, medicine.medical_specialty, Nose Neoplasms, Apoptosis, Biology, Malignant transformation, Nasal Polyps, Proliferating Cell Nuclear Antigen, medicine, Humans, Aged, Papilloma, Inverted, Hyperplasia, Cell growth, Epithelial Cells, Middle Aged, medicine.disease, Immunohistochemistry, Epithelium, Proliferating cell nuclear antigen, medicine.anatomical_structure, Otorhinolaryngology, Proto-Oncogene Proteins c-bcl-2, Dysplasia, biology.protein, Cancer research, DNA fragmentation, Female, Cell Division
Abstract

Inverted papillomas (IPs) are rare benign tumors of nasal epithelium with high recurrence rates and malignant transformation potential. Their etiology is still uncertain, and the mechanism of their growth has not yet been fully described. The purpose of this study was to detect, quantify, and compare cell proliferation, apoptosis, and apoptosis inhibition in hyperplastic epithelium from IPs and in inflammatory nasal polyps (NPs). IP samples were obtained after surgical removal of tumor in 13 patients, and NPs were sampled during endoscopic ethmoidectomy in 10 patients with nasal polyposis. Cell proliferation and apoptosis inhibition, respectively, were assessed by immunohistochemical identification of the proliferating cell nuclear antigen (PCNA) and the oncoprotein Bcl-2. Apoptosis was evaluated by analyzing the DNA fragmentation. Cell proliferation and apoptosis were significantly higher in IPs than in NPs (P = .0002 and P = .043, respectively), while apoptosis inhibition was significantly lower in IPs than in NPs (P = .001). Concerning IPs, cell proliferation was significantly higher than apoptosis (P = .0029) and apoptosis inhibition (P = .0015). The increase in epithelial cell proliferation seemed to be greater in IPs with dysplasia than in IPs without dysplasia. Increased epithelial cell proliferation, but not apoptosis and apoptosis inhibition, seems to be involved in the development of IP.

Published
1998

57. Modified epithelial cell distribution in chronic airways inflammation

Author

F. Verra, L. Gilain, C. Chapelin, André Coste, Estelle Escudier, and F. Poron

Subjects
Pulmonary and Respiratory Medicine, Adult, Male, Pathology, medicine.medical_specialty, Cell, Population, Inflammation, Cell Count, Biology, Giemsa stain, Epithelium, Tubulin, medicine, Humans, Cilia, Respiratory system, education, Rhinitis, education.field_of_study, Immunohistochemistry, Nasal Mucosa, medicine.anatomical_structure, Chronic Disease, Respiratory epithelium, Female, medicine.symptom
Abstract

Although airway epithelium is known to be modified during chronic respiratory diseases, epithelial cells have rarely been precisely quantified. We therefore intended to evaluate epithelial cell distribution in inflammatory airways, using a cytological approach. Nasal airway cells in 12 patients with nonallergic chronic rhinitis were sampled by brushing, quantified after cytocentrifugation and compared to those from eight controls. Cell populations were quantified after May-Grunwald Giemsa staining and alpha-tubulin immunolabelling to demonstrate ciliary differentiation. When compared to controls, rhinitis patients exhibited lower percentages of ciliated cells (59 +/- 4 versus 32 +/- 2%, respectively), and higher percentages of goblet (24 +/- 3 versus 37 +/- 2%) and basal cells (9 +/- 1 versus 18 +/- 2%). After tubulin immunolabelling, positive staining was specifically detected in cells with cilia (LC+), and in the cytoplasm of some small round cells without obvious cilia (LC-). Fewer immunolabelled cells were detected in rhinitis patients than in controls (with significantly lower percentages of LC+ and higher percentages of LC-). Nasal brushing is an effective technique for quantification of airway epithelial cells. Tubulin immunolabelling is useful to detect ciliated cells and distinguishes another cell population, possibly preciliated cells. These cytological findings suggest the presence of modifications of epithelial differentiation and proliferation, possibly related to local chronic inflammation.

Published
1996

58. Acquired ciliary abnormalities of nasal mucosa in marrow recipients

Author

C, Cordonnier, L, Gilain, F, Ricolfi, L, Deforges, F, Girard-Pipau, F, Poron, M C, Millepied, and E, Escudier

Subjects
Adult, Immunosuppression Therapy, Male, Metaplasia, Transplantation Conditioning, Anemia, Aplastic, Graft vs Host Disease, HLA-DR Antigens, Middle Aged, Microtubules, Epithelium, Nasal Mucosa, Risk Factors, Hematologic Neoplasms, Acute Disease, Chronic Disease, Humans, Female, Cilia, Prospective Studies, Sinusitis, Respiratory Tract Infections, Bone Marrow Transplantation
Abstract

Respiratory symptoms are frequent after bone marrow transplantation (BMT). Most studies focus on lesions of the lower respiratory tract. However, sinusitis is also common in this setting, especially after allogeneic BMT. The nasal respiratory epithelium is the first line of airway defense and is very similar to the bronchial epithelium, especially in terms of ciliary beat frequency and ultrastructural pattern of ciliated cells. We have prospectively studied the nasal respiratory epithelium of 20 marrow recipients (four autologous, 16 allogeneic) with or without sinusitis, by brushing and biopsy of the median turbinate between 2.5 and 148 months after transplant. Samples were studied for ciliary beat frequency, cytology, ultrastructural pattern and HLA-DR expression. We found that 17 of our 20 patients had abnormalities of their nasal epithelium, mainly consisting of either squamous metaplasia or heterogeneous axonemal defects of peripheral and central microtubules. No relationship between these findings and the presence of acute or chronic sinus infection, previous irradiation, graft-versus-host disease or immunosuppressive therapy could be demonstrated in this preliminary study. These abnormalities probably have multiple causes. Prospective studies are needed to determine the respective roles of treatments, infections and immune disorders associated with BMT in these abnormalities, and to know their natural evolution over time and their impact on the occurrence of upper or lower respiratory tract infections.

Published
1996

59. [Postoperative pain evaluation in the surgery of head and neck cancers]

Author

T, Mom, F, Commun, C, Derbal, C, Dubray, A, Eschalier, P, Bost, P, Avan, J E, Bazin, and L, Gilain

Subjects
Adult, Male, Pain, Postoperative, Analgesia, Patient-Controlled, Laryngectomy, Middle Aged, Anxiety Disorders, Tracheostomy, Head and Neck Neoplasms, Humans, Prospective Studies, Tracheotomy, Aged, Pain Measurement
Abstract

Postoperative pain has rarely been assessed after ENT surgery for cancer. Its evaluation is difficult because of the frequent lack of speech after this type of surgery.to assess postoperative pain after pharyngeal and laryngeal surgery for cancer.prospective study in 13 men (38-71 ans) operated on by total laryngectomy with or without partial pharyngectomy. A standardised treatment using propacetamol and nalbuphine was systematically prescribed. Pain, anxiety and relief were assessed with the help of visual analogue scales (VAS). Heart rate, mean blood pressure and respiratory rate were evaluated too.mean postoperative pain was maximal just after recovery (6,64 +/- 2,14 cm) then decreased regularly. Initial mean score of anxiety was 3,14 +/- 3 cm and then was decreasing too. Anxiety and pain did not correlate except in 2 cases. None of the 3 objective parameters correlated with pain.postoperative pain can be assessed reliably after pharyngolaryngeal cancer surgery and is probably underrated. Its high initial score indicates that efforts must be focused on pre-emotive analgesia. Its high individual variability let us hypothesise that PCA systems should be effective.

Published
1996

61. [Evaluation of the brushing technique in nasal cytology]

Author

L, Gilain, C, Chapelin, M, Boucherat, R, Peynegre, and E, Escudier

Subjects
Adult, Nasal Mucosa, Evaluation Studies as Topic, Cytological Techniques, Humans, Cell Count
Abstract

Analysis of nasal cytology provides useful information for the diagnosis of rhinitis. This analysis represents an interesting tool for objective assessment of nasal pathology. The purpose of this study was to describe the brushing method for obtaining nasal cytologic specimen. Samples were carried out from nine adult patients with chronic nasal obstruction. In all cases, the cytologic specimen had a good amount of well-preserved cells, easy to identify on morphological criteria. A differential cell count was performed on the different epithelial cell types present in the specimen and the results are reported in the present study. In conclusion, brushing method is non invasive and allows to precisely evaluate both epithelial and inflammatory cells present in the nasal mucosa.

Published
1994

63. Nasal epithelial cell culture as a tool in evaluating ciliary dysfunction

Author

Denis Pierrot, L. Gilain, E. Puchelle, J.M. Zahm, R. Peynegre, and C Fuchey

Subjects
Adult, Pathology, medicine.medical_specialty, Mucous membrane of nose, Biology, Nasal Polyps, Culture Techniques, medicine, Methods, Humans, Nasal polyps, Cilia, Respiratory system, Cells, Cultured, Primary ciliary dyskinesia, Kartagener Syndrome, Cilium, General Medicine, medicine.disease, Epithelium, Nasal Mucosa, medicine.anatomical_structure, Otorhinolaryngology, Cell culture, Ciliary Motility Disorders, Female
Abstract

Cultures of respiratory epithelial cells were obtained from nasal polyps collected in patients with and without primary ciliary defect. The ciliary beating frequency and the ciliary beating heterogeneity were determined on native and cultured tissues. We observed a significantly higher (p < 0.01) ciliary beating frequency of cultured ciliated cells, when compared with ciliated cells from the native tissue. The ciliary beating frequency of the cultured ciliated cells from the patient with primary defect (7.9 +/- 2.1 Hz) was significantly lower when compared with the beating frequency of the ciliated cells from the control subject (12.4 +/- 2.0 Hz). In addition, the percentage of ciliated cells characterized by a beating frequency lower than 8 Hz was 90.7% in the native tissue and 47.5% in the cultured tissue from the patient with ciliary primary defect. In the patient without ciliary primary defect, 90% of the cultured ciliated cells had a homogeneous ciliary beating, whereas in the patient with primary ciliary defect, only 47% of the ciliated cells had a homogeneous ciliary beating. These results suggest that the culture of respiratory cells associated with the functional activity measurement of the ciliated cells represent another way of precisely determining the extent of the primary ciliary dyskinesia defect.

Published
1993

64. [Oral manifestations of zona. Apropos of a case]

Author

J, Eury, L, Gilain, and R, Peynegre

Subjects
Maxillary Nerve, Acyclovir, Humans, Pain, Female, Child, Mouth Diseases, Herpes Zoster, Cranial Nerve Diseases
Abstract

Oral manifestations of herpes zoster are very less common than cutaneous. Only a few cases of oral herpes zoster in children had been already described. Authors report a case of maxillary superior nerve's herpes zoster. Oral lesions are encountered in case of viral disease of the second and third branch of trigeminal nerve (VII, VIII). Dental pain is usually the first sign and can induce misdiagnosis. The diagnosis is based on the specific ulcerative lesions, strictly unilateral, developed in the field of sensitive innervation of the maxillary nerves. The use of antiviral drugs seems to be actually the best treatment.

Published
1993

65. [Value of hyperbaric oxygen therapy in the treatment of malignant otitis externa. Apropos of a case]

Author

L, Gilain, M, Labroue, D, Aidan, M P, Ragu, X, Planquart, and R, Peynegre

Subjects
Male, Hyperbaric Oxygenation, Diabetes Mellitus, Type 1, Facial Paralysis, Humans, Gallium Radioisotopes, Otitis Externa, Magnetic Resonance Imaging, Aged, Anti-Bacterial Agents
Abstract

The authors report the case of a 75 years old insulin dependent diabetic man presenting a malignant otitis externa with facial nerve paralysis. Despite prolonged, adequate parenteral antibiotic therapy, the patient's clinical status did not improve. The addition of hyperbaric oxygen as a complementary treatment was followed by the regression of clinical signs and the resolution of infection. Based upon a review of the literature, the authors discuss the indications for this therapy and the problems involved in defining the criteria of cure in malignant otitis externa.

Published
1993

66. [Human papillomavirus and nasosinusal inverted papilloma]

Author

L, Gilain, M, Favre, X, Planquart, I, abd el Samad, G, Le Lièvre, and R, Peynegre

Subjects
Adult, Male, Papilloma, Inverted, Genotype, Nose Neoplasms, Middle Aged, Polymerase Chain Reaction, Blotting, Southern, Humans, Female, Papillomaviridae, In Situ Hybridization, Paranasal Sinus Neoplasms, Aged
Abstract

Eight inverted papillomas were evaluated for the presence of human papillomavirus (HPV) DNA. The techniques used were Southern Blot Hybridization in five cases and Polymerase Chain Reaction (PCR) in three cases. All eight lesions contained the characteristic features of inverted papillomas. Two lesions showed areas of dysplastic change and one lesion contained koilocytes. In three patients, invasive squamous cell carcinomas were found. The presence of HPV was noted in one of these specimen of inverted papilloma with squamous cell carcinoma. Specific testing for HPV types 6, 11, 16, 18 and 33 on this specimen was negative, thus indicating that the specimen is associated with a different HPV type. The results of this study, with only one case of positive HPV testing, leads us to question the precise role of HPV as an etiological agent in nasal inverted papillomas. The fact that this single positive case did not test positive for the HPV type 16 suggest that this is not the only "high risk" HPV type associated with the progression of inverted papilloma to a carcinoma.

Published
1993

67. [Nasal and sinusal polyposis. Semiology and values of magnetic resonance imaging]

Author

M, De Pressigny, P, Bonfils, L, Gilain, P, Halimi, N, Schlegel, G, Frija, R, Peynègre, and J, Trotoux

Subjects
Adult, Male, Adolescent, Echo-Planar Imaging, Gadolinium, Middle Aged, Magnetic Resonance Imaging, Ethmoid Bone, Nasal Polyps, Polyps, Ethmoid Sinus, Humans, Female, Paranasal Sinus Neoplasms, Aged
Abstract

Twelve patients with nasal polyposis were examined with magnetic resonance imaging (MRI) prior to surgical ethmoidectomies (20 ethmoidectomies). MRI signal was analyzed in correlation with surgical findings in order to define the semiology of nasal and sinuses polyps. One of the most important point of this semiology is based on the analysis of sequences after administration of gadolinium. MRI seems an interesting method for analysing the extension of nasal polyposis and could be useful for ENT surgeons before an endoscopic nasal surgery.

Published
1992

68. [Brush technique in cytological analysis of the nasal mucosa. A critical and comparative analysis]

Author

L, Gilain, E, Escudier, C, Chapelin, M, Boucherat, V, Faulcon, and R, Peynègre

Subjects
Adult, Inflammation, Microscopy, Nasal Mucosa, Adolescent, Biopsy, Child, Preschool, Cytodiagnosis, Humans, Epithelial Cells, Child
Abstract

The cytological study of the nasal mucosa is one the essential steps toward a better understanding of the physicopathological mechanisms involved in chronic affections of the nose. The development of a reliable, reproducible noninvasive technique to obtain cells in the prerequisite for this analysis. The brush technique is based on the use of a small cylindric nylon brush which is rotated as it is moved back and forth across the nasal mucosa to harvest the various cell types present on the surface of the mucosa. The specimen obtained is centrifuged and examined under an optical microscope. A semi-quantitative analysis is carried out to determine the relative richness of the specimen in epithelial cells (ciliated, qoblet and basal cells) and in inflammatory cells (neutrophils, basophils, eosinophils, lymphocytes, and monocytes). A precise differential cell count is then performed. According to the results obtained, an immunologic marker study of lymphocyte subsets may also be done using the same specimen. This technique may be used in both children and adults and permits cell harvest from various sites within the nasal fossa. Already tested in the study of the activity of cilia, this method is promising for the cytological study of the nasal mucosa. The brush method and other techniques of cell harvest are described and compared.

Published
1992

69. [Diagnostic strategy of acoustic neuroma. Evaluation of efficacy of auditory evoked potentials. Apropos of a series of 50 neuroma cases]

Author

L, Gilain, D, Bouccara, I, Jacquier, J, Achouche, J M, Casteran, G, Freyss, and P, Tran Ba Huy

Subjects
Predictive Value of Tests, Evoked Potentials, Auditory, Humans, Neuroma, Acoustic, Middle Aged, Tomography, X-Ray Computed, Hearing Disorders, Magnetic Resonance Imaging, Reflex, Acoustic, Retrospective Studies
Abstract

The authors carry out a retrospective study of the diagnostic procedures used in a series of 50 acoustic neuromas. AEP were performed for thirty-four neuromas at some stage of their history. The findings were perfectly normal for eight of them, which represents a sensitivity level of 76%. Various elements likely to account for this are put forward, then the role of AEP and MRI in the diagnostic strategy for neuroma is discussed in the light of this study. Finally, the authors emphasize the necessity to regularly evaluate the diagnostic methods in order to guarantee their quality and reliability.

Published
1991

70. [Recurrent pseudothyroiditis and cervical abscess. The fourth branchial pouch's role. Apropos of 16 cases]

Author

P, Contencin, C, Grosskopf-Aumont, L, Gilain, and P, Narcy

Subjects
Male, Thyroiditis, Adolescent, Fistula, Infant, Newborn, Infant, Pharyngeal Diseases, Thyroiditis, Suppurative, Abscess, Diagnosis, Differential, Hypopharynx, Recurrence, Child, Preschool, Humans, Pharynx, Female, Child, Neck, Retrospective Studies
Abstract

Among the causes of inflammatory swelling of the neck in children, the "cysts" and ducts joining in the hypopharynx deserve being individualized. This unrecognized pathology is indeed responsible for suppurative pseudothyroiditis or cervical abscesses relapsing in spite of adequate antibiotic treatment and incision-drainage. X-ray films may help as they often show the fistula. Diagnosis relies on hypopharyngoscopy. This investigation only may assess the origin of this "internal fistula" by showing the mucous opening of the bottom of the pyriform sinus, from which sometimes springs some pus when pressing the neck. The clear left predominance of this canal and its junction between the superior and inferior laryngeal nerves suggest that its origin could be the 4th branchial pouch. Its treatment consists of complete surgical excision, which avoids relapses.

Published
1990

74. [Failure and complications of esthetic rhinoplasty. Apropos of 30 reoperations]

Author

L, Gilain, B, Bossard, J M, Juvanon, I, Delacour, G, Koskas, A, Bouaziz, and R, Peynègre

Subjects
Reoperation, Cartilage, Esthetics, Humans, Nose Deformities, Acquired, Female, Nose, Rhinoplasty
Abstract

Out of 150 rhinoplasties carried out over 3 years in a Surgical Department. 20% of cases had previously undergone one or several surgical procedures. Based on these cases, the authors analysed the principal factors producing failure in cosmetic rhinoplasties and proposed a preventive strategy. The osteocartilaginous dorsum and point of the nose are considered separately in this paper.

Published
1989

75. [Conservative surgery of cancer of the larynx. Cordectomy, hemilaryngectomy, supraglottic laryngectomy]

Author

C, Levy, F, Rivière, S, Berreby, D, Deffrennes, L, Gilain, F, Denoyelle, and J, Trotoux

Subjects
Adult, Aged, 80 and over, Male, Laryngectomy, Vocal Cords, Middle Aged, Postoperative Complications, Carcinoma, Squamous Cell, Humans, Female, Neoplasm Recurrence, Local, Laryngeal Neoplasms, Aged, Follow-Up Studies
Abstract

Of a total of 219 partial laryngectomies performed, 119 were cordectomies, 30 hemilaryngectomies and 70 supraglottic laryngectomies. Results of each type of operation are presented with emphasis on problems of local recurrences, evidence of validity of procedure selected and of its indications. Analysis of results, with the reservation that indications were sometimes wide but always reasonable, showed an extremely low incidence of recurrences, the quality of the resection (limited or insufficient) having finally little incidence on the latter, except perhaps in the supraglottic laryngectomies. It is suggested, therefore, that no attempt should be made to "recover" a histologically detected insufficient excision by complementary radiotherapy not required in principle. This assists follow up review and allows secondary therapy if an unfavorable course is noted.

Published
1986

76. [Endoscopic surgery of the turbinates. Preliminary results]

Author

R, Peynègre, B, Bossard, G, Koskas, M, Borsik, A, Bouaziz, and L, Gilain

Subjects
Nose Diseases, Humans, Endoscopy, Hypertrophy, Laser Therapy, Turbinates
Abstract

Turbinate surgery has become more precise thanks to miniaturisation and improvements in optical systems, therby allowing endoscopic surgery throughout the procedure including its posterior portion. Endoscopic turbinate surgery includes surgery of the hypertrophied middle turbinate "concha bullosa" which requires diagnosis for successful treatment (septoplasty, endonasal ethmoid surgery). Endoscopy has improved inferior turbinate cauterisation which has become more complete and precise especially for the posterior portion of the turbinate. It allows the use of new techniques: the YAG laser and the CO2 laser. Endoscopy allows good control during resection of the tail of the inferior turbinate and ensures hemostasis in the event of hemorrhage occurring during this procedure.

Published
1989

77. [Functional surgery of cancer of the hypopharynx. Hemilaryngopharyngectomy, posterior pharyngectomy by bilateral cervical approach]

Author

A, Florant, S, Berreby, L, Gilain, F, Denoyelle, B, Geoffray, M P, Morisseau, and J, Trotoux

Subjects
Adult, Male, Hypopharyngeal Neoplasms, Pharyngectomy, Lymphatic Metastasis, Carcinoma, Squamous Cell, Humans, Lymph Node Excision, Female, Laryngectomy, Pharyngeal Neoplasms, Middle Aged, Aged
Abstract

The authors report on 48 patients operated by hemi-laryngo-pharyngectomy for spinous carcinoma of the piriform sinus. They try to precise the indications by analysing the factors influencing survival and relapses. They compare surgery to the other methods. In a second part, they report 3 cases of posterior pharyngectomy by bilateral cervical incision.

Published
1986

78. The Prognostic Value of Olfactory Dysfunction in Patients with COVID-19: The COVIDORA Study.

Author

Hamel AL, Delbos L, Natella PA, Radulesco T, Alexandru M, Bartaire E, Bartier S, Benoite G, Bequignon E, Castillo L, Canouï-Poitrine F, Carsuzaa F, Corré A, Coste A, Couloigner V, Daveau C, De Boissieu P, De Bonnecaze G, De Gabory L, Debry C, Deraedt S, Dufour X, El Bakkouri W, Gilain L, Hans S, Hautefort C, Hermann R, Jankowski R, La Croix C, Lecanu JB, Malard O, Michel J, Nguyen Y, Nevoux J, Papon JF, Patron V, Prigent M, Pruliere-Escabasse V, Renaud M, Rumeau C, Salmon D, Saroul N, Serrano E, Nhung Tran Khai C, Tringali S, Truy E, Vandersteen C, Verillaud B, Veil R, and Fieux M

Abstract

Background: Among all studies describing COVID-19 clinical features during the first wave of the pandemic, only a few retrospective studies have assessed the correlation between olfac-tory dysfunction (OD) and the evolution of disease severity. The main aim was to assess whether OD is a predictive factor of COVID-19 severity based on the patient's medical management (outpa-tient care, standard hospital admission, and ICU admission)., Methods: A national, prospective, mul-ticenter cohort study was conducted in 20 public hospitals and a public center for COVID-19 screen-ing. During the first wave of the pandemic, from 6 April to 11 May 2020, all patients tested positive for COVID-19 confirmed by RT-PCR underwent two follow-up ENT consultations within 10 days of symptom onset. The main outcome measures were the evolution of medical management (out-patient care, standard hospital admission, and ICU admission) at diagnosis and along the clinical course of COVID-19 disease., Results: Among 481 patients included, the prevalence of OD was 60.7%, and it affected mostly female patients (74.3%) under 65 years old (92.5%), with fewer comor-bidities than patients with normal olfactory function. Here, 99.3% (290/292) of patients with OD presented with non-severe COVID-19 disease. Patients reporting OD were significantly less hospi-talized than the ones managed as outpatients, in either a standard medical unit or an ICU. Conclu-sions: As regards the clinical course of COVID-19 disease, OD could predict a decreased risk of hospitalization during the first wave of the pandemic.

Published
2024
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79. Early detection of pharyngocutaneous fistulae after total laryngectomy by cytokine in drainage: A pilot study (DEFILAC).

Author

Saroul N, Loukine M, Durand M, Pereira B, Rozand I, Becaud J, Martinez Q, Mom T, Gilain L, Evrard B, Puechmaille M, and Bonnet B

Subjects
Humans, Laryngectomy adverse effects, Interleukin-10, Pilot Projects, Cytokines, Prospective Studies, Retrospective Studies, Postoperative Complications epidemiology, Laryngeal Neoplasms surgery, Cutaneous Fistula diagnosis, Cutaneous Fistula etiology, Cutaneous Fistula epidemiology, Pharyngeal Diseases diagnosis, Pharyngeal Diseases etiology, Pharyngeal Diseases epidemiology
Abstract

Background: The determination of cytokines in the postoperative drainage (POD) fluid could be a method for early detection of the development of a pharyngocutaneous fistula (PCF)., Materials and Methods: We conducted a prospective two-center study involving 28 patients. PODs were collected on Day 1 (D1) and Day 2 (D2) postoperatively for determination of a cytokine panel and cytobacteriological examination., Results: Eleven (39%) patients presented with PCF on average 13 ± 5.5 days after surgery. Patients with PCF had higher IL-10 (121 vs. 40.3, p = 0.04, effect size (ES) = 0.98 [0.16, 1.79]) and TNFα level (21.2 vs. 2.2, p = 0.02, ES = 0.83 [0.03, 1.63]) on D2. An IL-10 threshold of 72 pg/mL on D2 was diagnostic of the occurrence of PCF with a sensibility of 70%, specificity of 88%., Conclusion: The determination of cytokines in POD fluid on D2 is a reliable tool for predicting the development of a PCF after total laryngectomy., (© 2023 Wiley Periodicals LLC.)

Published
2023
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81. Conditioned Media from Head and Neck Cancer Cell Lines and Serum Samples from Head and Neck Cancer Patients Drive Catabolic Pathways in Cultured Muscle Cells.

Author

Saroul N, Tardif N, Pereira B, Dissard A, Montrieul L, Sanchez P, Salles J, Petersen JE, Jakobson T, Gilain L, Mom T, Boirie Y, Rooyakers O, and Walrand S

Abstract

Background: The role of secreted factors from the tumor cells in driving cancer cachexia and especially muscle loss is unknown. We wanted to study both the action of secreted factors from head and neck cancer (HNC) cell lines and circulating factors in HNC patients on skeletal muscle protein catabolism., Methods: Conditioned media (CM) made from head and neck cancer cell lines and mix of sera from head and neck cancer (HNC) patients were incubated for 48 h with human myotubes. The atrophy and the catabolic pathway were monitored in myotubes. The patients were classified regarding their skeletal muscle loss observed at the outset of management., Results: Tumor CM (TCM) was able to produce atrophy on myotubes as compared with control CM (CCM). However, a mix of sera from HNC patients was not able to produce atrophy in myotubes. Despite this discrepancy on atrophy, we observed a similar regulation of the catabolic pathways by the tumor-conditioned media and mix of sera from cancer patients. The catabolic response after incubation with the mix of sera seemed to depend on the muscle loss seen in patients., Conclusion: This study found evidence that the atrophy observed in HNC patients cannot be solely explained by a deficit in food intake.

Published
2023
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82. Robotized Cochlear Implantation under Fluoroscopy: A Preliminary Series.

Author

Mom T, Puechmaille M, El Yagoubi M, Lère A, Petersen JE, Bécaud J, Saroul N, Gilain L, Mirafzal S, and Chabrot P

Abstract

It is known that visual feedback by fluoroscopy can detect electrode array (EA) misrouting within the cochlea while robotized EA-insertion (rob-EAI) permits atraumatic cochlear implantation. We report here our unique experience of both fluoroscopy feedback and rob-EAI in cochlear implant surgery. We retrospectively analyzed a cohort of consecutive patients implanted from November 2021−October 2022 using rob-EAI, with the RobOtol®, to determine the quality of EA-insertion and the additional time required. Twenty-three patients (10 females, 61+/−19 yo) were tentatively implanted using robot assistance, with a rob-EAI speed < 1 mm/s. Only three cases required a successful revised insertion by hand. Under fluoroscopy (n = 11), it was possible to achieve a remote rob-EAI (n = 8), as the surgeon was outside the operative room, behind an anti-radiation screen. No scala translocation occurred. The additional operative time due to robot use was 18+/−7 min with about 4 min more for remote rob-EAI. Basal cochlear turn fibrosis precluded rob-EAI. In conclusion, Rob-EAI can be performed in almost all cases with a low risk of scala translocation, except in the case of partial cochlear obstruction such as fibrosis. Fluoroscopy also permits remote rob-EAI.

Published
2022
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83. Prevention of cerebrospinal fluid leak after vestibular schwannoma surgery: a case-series focus on mastoid air cells' partition.

Author

Plainfossé O, Puechmaille M, Saroul N, Gilain L, Godey B, Pereira B, Khalil T, and Mom T

Subjects
Adult, Aged, Cerebrospinal Fluid Leak etiology, Cerebrospinal Fluid Leak prevention & control, Humans, Mastoid, Middle Aged, Petrous Bone surgery, Postoperative Complications etiology, Postoperative Complications prevention & control, Retrospective Studies, Neuroma, Acoustic surgery
Abstract

Background: Petrous bone pneumatization may be related to cerebrospinal fluid (CSF) leak secondary to vestibular schwannoma surgery., Objective: To assess the association between petrous bone pneumatization and CSF leak in vestibular schwannoma surgery., Methods: A retrospective study included 222 consecutive vestibular schwannoma patients treated via a retrosigmoid or translabyrinthine approach in a 17-year period in one University Hospital. Association of CSF leak and petrous bone pneumatization, as seen on CT scans, was assessed on ANOVA and Student's t or Chi-squared test in case of non-parametric distribution., Results: One hundred and 75 resections were performed on a retrosigmoid approach and 47 on a translabyrinthine approach. Mean age was 53.6 ± 12.9 years. Mean follow-up was 5 years 6 months. Twenty-six patients (11.7%) showed CSF leak and 8 (3.6%) meningitis. Approach (p = 0.800), gender (p = 0.904), age (p = 0.234), body-mass index (p = 0.462), tumor stage (p = 0.681) and history of schwannoma surgery (p = 0.192) did not increase the risk of CSF leak. This risk was unrelated to mastoid pneumatization (p = 0.266). There was a highly significant correlation between internal acousticus meatus (IAM) posterior wall pneumatization and CSF leak after retrosigmoid surgery (p = 0.008). Eustachian tube packing in the translabyrinthine approach did not decrease risk of CSF leak (p = 0.571)., Conclusion: Degree of petrous bone pneumatization was not significantly related to risk of CSF leak, but pneumatization of the posterior IAM wall increased this risk in retrosigmoid surgery. Eustachian tube packing in the translabyrinthine approach is not sufficient to prevent postoperative CSF leak. Both approaches had similar rates of CSF leaks, around 12%., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Published
2022
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84. Toxicity of induction chemotherapy in head and neck cancer: The central role of skeletal muscle mass.

Author

Lere-Chevaleyre A, Bernadach M, Lambert C, Cassagnes L, Puechmaille M, Mom T, Gilain L, Lapeyre M, Boirie Y, Biau J, and Saroul N

Subjects
Antineoplastic Combined Chemotherapy Protocols adverse effects, Cisplatin adverse effects, Docetaxel, Fluorouracil adverse effects, Humans, Muscle, Skeletal diagnostic imaging, Head and Neck Neoplasms drug therapy, Head and Neck Neoplasms etiology, Induction Chemotherapy adverse effects
Abstract

Background: To assess the impact of nutritional status on tolerance to induction chemotherapy by docetaxel, cisplatin and 5-fluorouracil (ICT) in head and neck cancer (HNC)., Methods: Ninety-two HNC patients were included. Toxicity was assessed according to common terminology criteria for adverse events. Nutritional status was assessed by body mass index (BMI), serum albumin, nutritional risk index (NRI), and CT scan (skeletal muscle mass index [SMI] at the first lumbar vertebral level)., Results: Before treatment, average BMI was 22.7 ± 4.6 kg/m 2 , serum albumin 38.7 ± 5.8 g/L, NRI 97.6 ± 10.6, and SMI 36.4 ± 7.9 cm 2 /m 2 . After treatment, BMI was 23 ± 4.5, serum albumin 30.2 ± 7.1, and NRI 88.1 ± 9.2. During ICT, 52 (62%) patients developed at least one toxicity ≥ Grade 3. Pre-treatment SMI was the only predictive factor of toxicity irrespective of BMI (p = 0.04)., Conclusion: Low skeletal muscle mass is a predictive factor of toxicity to ICT in HNC., (© 2021 Wiley Periodicals LLC.)

Published
2022
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85. Poor dental condition is a factor of imbalance of the nutritional status at the outset of management of head and neck cancer.

Author

Devoize L, Dumas C, Lambert C, El Yagoubi M, Mom T, Farigon N, Gilain L, Boirie Y, and Saroul N

Subjects
Humans, Nutrition Assessment, Nutritional Status, Weight Loss, Head and Neck Neoplasms, Tooth Loss
Abstract

Objectives: To determine whether deterioration of dental condition at the outset of management of head and neck cancer (HNC) is a nutritional risk and whether social deprivation is a cause of the poor dental condition observed in HNC patients., Material and Methods: A nutritional assessment form (NAF) and the Nutrition Risk Index (NRI) were used to standardize the nutritional status of 108 patients at the outset of management of HNC (2017-2019). The NAF includes assessment of weight loss over the past 3 months, the amount and difficulty of food intake, and the presence of digestive disorders. Dental condition was assessed by the decayed, filled, and missing teeth acopre (DFM) index and the masticatory coefficient (MC). Dental status and social deprivation were correlated with the EPICES score., Results: A correlation was found between the extent of weight loss and dental condition. The MC was higher in absence of weight loss (46% vs. 27%, p = 0.03) and the DMF lower when weight loss was less than 5% (22.3 vs. 26.9 if > 5% loss of weight, p = 0.005). No correlation was found between dental status and nutritional status. Social deprivation was associated with a lower MC (26% vs. 50%, p < 0.001)., Conclusion: Dental condition is a risk factor for weight loss at the outset of management of HNC but is not a determinant of nutritional status. Clinical relevance Dental condition is no longer considered simply as a source of potential complications after radiotherapy but also as an important factor for nutritional status., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Published
2022
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86. Prognosis in Head and Neck Cancer: Importance of Nutritional and Biological Inflammatory Status.

Author

Saroul N, Puechmaille M, Lambert C, Hassan AS, Biau J, Lapeyre M, Mom T, Bernadach M, and Gilain L

Subjects
Aged, Female, Head and Neck Neoplasms blood, Humans, Lymphocyte Count, Male, Middle Aged, Monocytes, Neutrophils, Platelet Count, Prognosis, Retrospective Studies, Survival Rate, Head and Neck Neoplasms diagnosis, Head and Neck Neoplasms epidemiology, Inflammation complications, Nutritional Status, Social Status
Abstract

Objectives: To determine the importance of nutritional status, social status, and inflammatory status in the prognosis of head and neck cancer., Study Design: Single-center retrospective study of prospectively collected data., Setting: Tertiary referral center., Methods: Ninety-two consecutive patients newly diagnosed for cancer of the upper aerodigestive tract without metastases were assessed at time of diagnosis for several prognostic factors. Nutritional status was assessed by the nutritional risk index, social status by the EPICES score, and inflammatory status by the systemic inflammatory response index. The primary endpoint was overall survival., Results: In multivariable analysis, the main prognostic factors were the TNM classification (hazard ratio [HR] = 3.34, P = .002, for stage T3-4), malnutrition as assessed by the nutritional risk index (HR = 3.64, P = .008, for severe malnutrition), and a systemic inflammatory response index score ≥1.6 (HR = 3.32, P = .02). Social deprivation was not a prognostic factor., Conclusion: Prognosis in head and neck cancer is multifactorial; however, malnutrition and inflammation are important factors that are potentially reversible by early intervention.

Published
2022
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89. Failure of anterior skull base reconstruction for sinonasal carcinoma: consequence on the postoperative follow up. A multicentre evaluation of management.

Author

Saroul N, Rumeau C, Verillaud B, Patron V, Righini C, De Bonnecaze G, Daveau C, Mortuaire G, Mom T, Gilain L, Pereira B, and Montrieul L

Subjects
Adult, Aged, Aged, 80 and over, Cerebrospinal Fluid Leak therapy, Female, Follow-Up Studies, Humans, Male, Middle Aged, Postoperative Complications therapy, Retrospective Studies, Treatment Failure, Cerebrospinal Fluid Leak etiology, Paranasal Sinus Neoplasms surgery, Plastic Surgery Procedures adverse effects, Skull Base surgery
Abstract

Background: Numerous techniques for closure of the anterior skull base in cancer patients have a high success rate but management of failure is poorly documented., Objectives: To standardize the post-operative follow-up after reconstruction surgery of the anterior skull base after removal for sinonasal carcinoma., Materials and Methods: Retrospective review of failure of anterior skull base reconstruction between 2005 and 2018 in a multicenter setting., Results: Twenty four patients were included. Reconstruction failure was detected by a cerebrospinal (CSF) leak in 79.2%, by an infectious complication without CSF leak (i.e. meningitis) in 12.5%, and in 8.3% by extensive pneumocephalus. Failure was observed during the first week after surgery in 75% of patients, in the second week in 21%, and in 4% after day 15. The delay in discovery of the failure was associated with multilayer reconstruction ( p =.03). Failure was treated surgically in 54% of the patients and medically in 46%, with a similar success rate (85 vs. 100%)., Conclusion and Significance: After carcinologic resection of the anterior skull base, monitoring should be systematic during the first postoperative week. Surgical management of failure is not always necessary.

Published
2021
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90. Mucoepidermoid carcinoma of salivary glands: A French Network of Rare Head and Neck Tumors (REFCOR) prospective study of 292 cases.

Author

Dahan LS, Giorgi R, Vergez S, Le Taillandier de Gabory L, Costes-Martineau V, Herman P, Poissonnet G, Mauvais O, Malard O, Garrel R, Uro-Coste E, Barry B, Bach C, Chevalier D, Mouawad F, Merol JC, Bastit V, Thariat J, Gilain L, Dufour X, Righini CA, Moya-Plana A, Even C, Radulesco T, Michel J, Baujat B, and Fakhry N

Subjects
Adolescent, Adult, Age Factors, Aged, Aged, 80 and over, Alcohol Drinking adverse effects, Chemoradiotherapy, Adjuvant, Databases, Factual, Diabetes Complications complications, Disease-Free Survival, Follow-Up Studies, France, Humans, Lymphatic Metastasis, Middle Aged, Neck Dissection, Neoplasm Grading, Neoplasm Staging, Prospective Studies, Radiotherapy, Adjuvant, Survival Rate, Young Adult, Carcinoma, Mucoepidermoid secondary, Carcinoma, Mucoepidermoid therapy, Neoplasm Recurrence, Local pathology, Salivary Gland Neoplasms pathology, Salivary Gland Neoplasms therapy
Abstract

Background: To describe the characteristics of the largest European study of MEC of salivary glands and to determine the prognostic factors for overall and disease free survival., Patients and Methods: Patients with MEC were prospectively included in the Réseau d'Expertise Français sur les Cancers ORL Rares (REFCOR, French Network of Rare Head and Neck Tumors) database between 2009 and 2015., Results: A total of 292 patients were included. Tumors were classified as low grade in 175 cases (60%), intermediate in 39 (13%) and high grade in 78 (27%). Median follow-up was 26 months. The 5-year OS and DFS rates were respectively 83% and 69%. In multivariate analysis, age (p = 0.004), diabetes (p = 0.02) and advanced stage (p = 0.03) were found to have a significant negative impact on OS. Diabetes (p = 0.001), alcohol consumption (p = 0.003) and advanced stage (p = 0.001) were found to have a significant negative impact on DFS. Compare to low grade, high grade tended to have a negative impact on OS (p = 0.05) and had a significant effect on DFS (0.002) while intermediate grade had no significant influence on survival. The surgical treatment had a positive impact on both OS (p = 0.00005) and DFS (p = 0.0005). Postoperative radiotherapy had no impact in multivariate analysis., Conclusion: Advanced clinical stage, high grade tumor, high age, the impossibility of carrying out a complete surgical resection, and diabetes are the main prognostic factors in this prospective series of patients with MEC. Such findings open new research perspectives on the influence of these components on initial patient care., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to disclose., (Copyright © 2020 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)

Published
2021
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91. Inspiratory stridor of newborns and infants admitted to a paediatric ENT outpatient clinic: diagnostic approach and therapeutic outcome.

Author

Moreddu E, Montero M, Gilain L, Triglia JM, and Nicollas R

Subjects
Ambulatory Care Facilities, Child, Humans, Infant, Infant, Newborn, Prospective Studies, Treatment Outcome, Laryngomalacia complications, Laryngomalacia diagnosis, Laryngomalacia surgery, Respiratory Sounds diagnosis, Respiratory Sounds etiology
Abstract

The main objective was to analyse the use of rigid laryngotracheoscopy under general anaesthesia (GA) and endoscopic surgery in the management of inspiratory stridor in patients referred to a paediatric ENT outpatient clinic. The secondary objective was to analyse the aetiological diagnoses made and their therapeutic management. This is a prospective study including all newborns and infants, corresponding to 190 patients, presenting for the first time in consultation for inspiratory stridor from January 2015 to December 2017. A consultation form was filled out after each consultation and added to a database; a management algorithm was used to determine which patients required a rigid laryngotracheoscopy. A 17.9% (n = 34) of the patients required rigid laryngotracheoscopy, of whom 12.6% (n = 24) underwent concomitant endoscopic surgery. A 65.8% (n = 125) of the patients were diagnosed with laryngomalacia, 21.1% (n = 40) with isolated posterior excess of mucosa, 9.5% (n = 18) with another diagnosis and 3.7% (n = 7) with a normal examination. The presence of comorbidity was associated (p < 0.001) with the use of rigid laryngotracheoscopy and endoscopic surgery.Conclusion: Rigid laryngotracheoscopy under GA was required in one in five to six patients. Conservative management with strict follow-up may be appropriate in a large number of patients, especially those with laryngomalacia. What is Known: • Previous research has established that laryngomalacia is the main aetiology of stridor. • Comorbidities are linked with a poor tolerance of stridor. What is new: • About one in five to six patients seen in consultation for stridor will require a trip to the operative room (and one in eight will require endoscopic surgery). • Laryngomalacia and isolated posterior excess of mucosa account for 85-90% of the patients seen in consultation for stridor.

Published
2021
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92. Fluoroscopy guided electrode-array insertion for cochlear implantation with straight electrode-arrays: a valuable tool in most cases.

Author

Perazzini C, Puechmaille M, Saroul N, Plainfossé O, Montrieul L, Bécaud J, Gilain L, Chabrot P, Boyer L, and Mom T

Subjects
Adult, Cochlea surgery, Electrodes, Implanted, Fluoroscopy, Humans, Cochlear Implantation, Cochlear Implants
Abstract

Purpose: To highlight the advantages of real time fluoroscopy guided electrode-array (EA) insertion (FGI) during cochlear implants surgery., Methods: All surgical procedures were performed in a dedicated operating room equipped with a robotic C-arm cone beam device, allowing for intraoperative real time 2D FGI and postoperative 3D imaging. Only straight EAs were used. Patients were sorted out in three groups: ANAT, with anatomical concerns; HP, with residual hearing; NPR: patients with no particular reason for FGI. In all cases the angle of EA-insertion was measured. In the HP group pre and postoperative hearing were compared. The radiation delivered to the patient was recorded., Results: Fifty-three cochlear implantation procedures were achieved under fluoroscopy in 50 patients from November 2015 to January 2020 (HP group: n = 10; ANAT group: n = 13; NPR group: n = 27). In the ANAT group, FGI proved to be helpful in 8 cases (61.5%), successfully guiding the surgeon during EA -insertion. On average, the angle of insertion was at 424° ± 55°. In the HP group, a controlled smooth EA-insertion was carried out in all cases but one. The targeted 360° angle of insertion was always reached. Hearing preservation was possible with an eventual average drop of 30 ± 1.5 dB. In the NPR group, FGI helped control the quality of insertion in all cases and appeared very informative in five (17.8%): one EA-misrouting, three stuck EAs, and one case with hidden electrodes out of the cochlea in revision surgery. Final 3D cone beam CT scan double-checked the EA position in all adults. The radiation dose was equivalent to a bit less than four digital subtract radiographs., Conclusion: The FGI is a very useful adjunct in cochlear implantation in all cases of expected surgical pitfalls, in patients with residual hearing, and even in case without preoperative particular reason, with low irradiation.

Published
2021
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93. Management of cN0 low-grade mucoepidermoid carcinomas of salivary glands: Prospective multicentre study of 152 cases of the French Network of Rare Head and Neck Tumors (REFCOR).

Author

Saloner Dahan L, Giorgi R, Garrel R, Le Taillandier de Gabory L, Costes-Martineau V, Herman P, Poissonnet G, Mauvais O, Malard O, Vergez S, Uro-Coste E, Barry B, Bach C, Chevalier D, Mouawad F, Merol JC, Bastit V, Thariat J, Gilain L, Dufour X, Righini CA, Dessi P, Michel J, Radulesco T, Even C, Baujat B, and Fakhry N

Subjects
Adolescent, Adult, Aged, Aged, 80 and over, Carcinoma, Mucoepidermoid mortality, Carcinoma, Mucoepidermoid pathology, Combined Modality Therapy, Female, France, Humans, Lymph Node Excision, Lymphatic Metastasis, Male, Middle Aged, Neoplasm Grading, Neoplasm Staging, Prospective Studies, Salivary Gland Neoplasms mortality, Salivary Gland Neoplasms pathology, Survival Rate, Carcinoma, Mucoepidermoid therapy, Salivary Gland Neoplasms therapy
Published
2020
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94. Impact of nutritional status at the outset of assessment on postoperative complications in head and neck cancer.

Author

Caburet C, Farigon N, Mulliez A, Mom T, Boirie Y, Gilain L, and Saroul N

Subjects
Humans, Nutritional Status, Postoperative Complications epidemiology, Retrospective Studies, Head and Neck Neoplasms complications, Head and Neck Neoplasms surgery, Sarcopenia complications
Abstract

Objectives: Half of the patients presenting with head and neck tumor are malnourished at the outset of treatment. Muscle mass loss (sarcopenia) seems to be critical. The aim of the present study was to assess the impact of nutritional status and sarcopenia on postoperative complications in head and neck cancer., Materials and Methods: A retrospective study for the period November 2014 to May 2016 included 92 patients operated on for head and neck squamous cell carcinoma. Complications at 30 days were graded on the 5-level Clavien-Dindo classification. Nutritional status was assessed anthropometrically (weight), biologically (albuminemia and Nutrition Risk Index (NRI)), on CT (muscle mass index at 3rd lumbar vertebra) and functionally (Short Physical Performance Battery). Assessment was made at the outset of management, and nutritional treatment was initiated as appropriate. Potential risk factors for postoperative complications were assessed: performance status, prior radiation therapy, smoking and alcohol abuse., Results: 54% of patients were malnourished on the NRI. 41% had grade≥2 complications. The most frequent complications were infection and healing disorder. The risk of complications was higher in case of malnutrition (62% vs. 17%; P<0.001) and sarcopenia (56% vs. 22%; P<0.01), with 50% longer hospital stay (P=0.04)., Conclusion: Malnutrition and sarcopenia are independent risk factors for postoperative complications., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Published
2020
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95. Efficacy of pentoxifylline-tocopherol-clodronate in mandibular osteoradionecrosis.

Author

Dissard A, P Dang N, Barthelemy I, Delbet C, Puechmaille M, Depeyre A, Pereira B, Martin F, Guillemin F, Biau J, Mirafzal S, Mom T, Gilain L, and Saroul N

Subjects
Aged, Aged, 80 and over, Drug Combinations, Female, Humans, Male, Middle Aged, Prospective Studies, Treatment Outcome, Bone Density Conservation Agents therapeutic use, Clodronic Acid therapeutic use, Mandibular Diseases drug therapy, Osteoradionecrosis drug therapy, Pentoxifylline therapeutic use, Tocopherols therapeutic use
Abstract

Objectives/hypothesis: PENTOCLO treatment, associating pentoxifylline, tocopherol, and clodronate, resolves radiation-induced fibrosis. The main aim of the present study was to prospectively assess efficacy in mandibular osteoradionecrosis (ORN)., Study Design: Prospective cohort study., Methods: Twenty-seven patients with mandibular ORN were included in the Pentoclauvergne Study between January 2014 and February 2016. After an initial 28-day phase of antibiotic, antifungal, and corticosteroid therapy, they received the PENTOCLO association daily until cure or a maximum of 24 months. The main assessment criterion was exposed bone area (EBA); secondary criteria comprised the Subjective, objective, management, and analytic (SOMA) score., Results: Under PENTOCLO, EBA decreased by 28% at 2 months, 55% at 6 months, and 92% at 24 months; the SOMA score decreased by 23%, 38%, and 50%, respectively. A complete treatment course cured 76.5% of patients at a mean 9.6 months., Conclusions: PENTOCLO is a simple, well-tolerated, and effective treatment for mandibular ORN., Level of Evidence: 4 Laryngoscope, 130:E559-E566, 2020., (© 2019 The American Laryngological, Rhinological and Otological Society, Inc.)

Published
2020
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96. Very painful acute frontal sinusitis revealing granulomatosis with polyangiitis.

Author

Montero M, Mom T, Smets P, and Gilain L

Subjects
Adult, Antibodies, Antineutrophil Cytoplasmic blood, Diagnosis, Differential, Frontal Sinusitis surgery, Humans, Male, Myeloblastin immunology, Recurrence, Tomography, X-Ray Computed, Frontal Sinusitis diagnosis, Granulomatosis with Polyangiitis diagnosis, Pain etiology
Abstract

Introduction: Granulomatosis with polyangiitis (GPA) is a necrotizing vasculitis of small and medium-sized vessels comprising inflammation of the vessel wall and perivascular and extravascular granulomas, frequently presenting in the form of chronic sinusitis., Observation: We report the case of a 27-year-old man who presented with very painful acute frontal sinusitis that was managed medically and surgically. The symptoms rapidly recurred despite treatment and CT scan demonstrated diffuse thickening of the sinus mucosa. Anti-proteinase 3 ANCA were positive. Biopsy of a pulmonary nodule confirmed the diagnosis of GPA. The patient was treated with corticosteroids in combination with rituximab, resulting in improvement of the clinical, laboratory and CT signs., Discussion: In the presence of persistent, acute, localized sinusitis despite appropriate treatment, associated systemic signs and/or the presence of other signs suggestive of GPA, the ENT surgeon must request a targeted work-up. In the absence of treatment, GPA can be fatal within a few months. However, with currently available treatment, remission is obtained in 80% of cases with a 75% 10-year survival rate., (Copyright © 2019. Published by Elsevier Masson SAS.)

Published
2019
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97. [Acute ethmoid sinusitis complicated by a retrobulbar abscess in a 13-year-old child].

Author

Montrieul L, Bons O, Gilain L, and Saroul N

Subjects
Abscess diagnosis, Abscess drug therapy, Abscess microbiology, Acute Disease, Adolescent, Anti-Bacterial Agents therapeutic use, Ethmoid Sinusitis diagnosis, Ethmoid Sinusitis drug therapy, Ethmoid Sinusitis microbiology, Eye Infections, Bacterial diagnosis, Eye Infections, Bacterial drug therapy, Humans, Male, Orbital Diseases diagnosis, Orbital Diseases drug therapy, Orbital Diseases microbiology, Streptococcal Infections diagnosis, Streptococcal Infections drug therapy, Streptococcus constellatus isolation & purification, Tomography, X-Ray Computed, Abscess complications, Ethmoid Sinusitis complications, Eye Infections, Bacterial complications, Orbital Diseases complications, Streptococcal Infections complications
Published
2019
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98. Early corrected serum calcium value can predict definitive calcium serum level after total thyroidectomy in asymptomatic patients.

Author

Houette A, Massoubre J, Pereira B, Puechmaille M, Dissard A, Gilain L, Saroul N, and Mom T

Subjects
Adult, Aged, Female, Humans, Hypocalcemia diagnosis, Male, Middle Aged, Parathyroid Hormone blood, Postoperative Complications diagnosis, Predictive Value of Tests, Prospective Studies, ROC Curve, Time Factors, Calcium blood, Hypocalcemia etiology, Postoperative Complications etiology, Thyroid Diseases blood, Thyroid Diseases surgery, Thyroidectomy adverse effects
Abstract

Introduction: Hypocalcemia is the most common complication of thyroidectomy, requiring supplementation as well as prolonged hospitalization. Our study's objective was to determine a corrected calcium (CCa) level on day 1 after thyroidectomy predictive of no calcium and vitamin supplementation., Materials and Methods: A single-center prospective study conducted between January 2012 and July 2015 in 396 patients, consisting of 331 cases of total thyroidectomy, with seven completion surgeries. The data collected were age, sex, type of thyroid surgery, etiology, anatomical pathological analysis, and the need for calcium and vitamin supplementation therapy as well as its duration. CCa levels were analyzed 20 and 30 h after surgery then on days 2 and 3. To determine a cut-off value for CCa, a ROC curve analysis was performed. The population was described in terms of numbers and associated percentages for categorical variables, and mean., Results: Mean CCa on 20 h after surgery was 2.09 mmol/L (p < 0.001) and 30 h was 2.06 mmol/L p = 0.02. CCa of less than 2.13 mmol/L was predictive of calcium and vitamin supplementation with 56% sensitivity and 97% specificity. On the evening of day 1, the cut-off value for CCa was 2.06 mmol/L with 67% sensitivity and 65% specificity., Conclusion: This prospective study confirms that CCa on the first morning after surgery is reliable when it is more than 2.13 mmol/L. In total, analyzing CCa on day 1 after total thyroidectomy allows the discharge of 70% of patients on the first day after surgery, with no risk of hypocalcemia.

Published
2018
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99. "Tumulus" stabilization of a total ossicular replacement prosthesis.

Author

Mom T, Caburet C, Saroul N, Gilain L, and Gersdorff M

Subjects
Adolescent, Adult, Aged, Aged, 80 and over, Child, Female, Humans, Male, Middle Aged, Young Adult, Cartilage transplantation, Ossicular Prosthesis, Ossicular Replacement methods
Abstract

Functional failure of total ossicular replacement prostheses (TORP) is often due to secondary displacement, ranging from simple subluxation to prosthesis extrusion following recurrence of severe tympanic membrane retraction. Several surgical techniques have been proposed to stabilize a TORP, mostly using superimposed non-organic or resorbable heterologous materials. We describe a simple so-called "tumulus" surgical technique that limits prosthesis displacement and extrusion, regardless of the type of TORP, by using a few fragments of autologous cartilage that are always available and perfectly tolerated at no cost. Review of 31 cases treated by this technique did not reveal any cases of prosthesis displacement and only one case (3.2%) of prosthesis extrusion with audiometric results comparable to the best results reported in the literature., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Published
2018
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100. Frontal sinus schwannoma.

Author

Petersen J, Gilain L, Coutu A, and Saroul N

Subjects
Female, Humans, Middle Aged, Frontal Sinus, Neurilemmoma diagnosis, Neurilemmoma surgery, Paranasal Sinus Neoplasms diagnosis, Paranasal Sinus Neoplasms surgery
Abstract

Introduction: Nasal sinus schwannomas are rare tumors, particularly in the frontal sinus., Case Report: The authors report the case of a woman with left frontal sinus schwannoma discovered in a context of frontal sinusitis with orbital and ocular complications. The surgical procedure consisted of endonasal tumor resection and external drainage., Discussion: The pathogenesis of frontal sinus schwannomas remains unclear. These tumors can present with a wide range of clinical and radiological signs, making them difficult to diagnosis. Surgical resection of these tumors is also complex., (Copyright © 2018. Published by Elsevier Masson SAS.)

Published
2018
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