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The clinical usefulness of 2-deoxy-2-[F-18]fluoro-D-glucose-positron emission tomography (FDG-PET) in head and neck squamous cell carcinoma (HNSCC) is now well-documented. However, its sensitivity is greater than its specificity due to false-positive results in inflammatory or infectious lesions, which are frequent in this area, in particular after treatment by surgery and/or radiotherapy. O-2-fluoro-(18F)-ethyl-L-thyrosine (FET) has been reported not to be taken up by such lesions, and a preliminary study indicated that this may be clinically useful in HNSCC. We performed a prospective study to compare the diagnostic performances of FDG and FET PET/CT in the different settings of HNSCC. Twenty-seven patients (20 men and seven women, aged 48–76, among 30 patients included) and 69 suspected cancer sites are now evaluable on basis of postsurgical histology and/or follow-up greater than 6 months; 15 patients were referred for initial staging and 12 during posttherapy follow-up, a recurrence being suspected in eight of them. FDG and FET PET/CT were performed on two different days, the patient fasting for 6 h, 1 h after injection of 5 MBq/kg of body mass of each radiopharmaceutical. Both PET/CT examinations were blind read more than 6 months after the end of inclusions in a random order for each tracer and with a time interval greater than 1 month between FDG and FET PET/CT blind readings. Overall diagnostic performances, derived from blind reading: FDG PET/CT on a per patient basis: sensitivity 100%, specificity 71%, accuracy 93%; FDG PET/CT on a per site basis: sensitivity 95%, specificity 63%, accuracy 83%; FET PET/CT on a per patient basis: sensitivity 70%, specificity 100%, accuracy 78%; FET PET/CT on a per site basis: sensitivity 64%, specificity 100%, accuracy 78%. At site level, sensitivity was significantly greater with FDG (p

I tumori benigni della laringe costituiscono un gruppo eterogeneo di tumori, rari nella maggior parte dei casi, in grado di provocare una sintomatologia di disfonia, dispnea e disfagia. Essi pongono prima di tutto un problema di diagnosi, che deve essere istologica, e un problema di trattamento, in cui la chirurgia conservatrice, in particolare endoscopica, ha un ruolo di primo piano.

Resume Les troubles de la deglutition concernent tout ce qui altere le processus physiologique amenant le contenu buccal a l’œsophage puis a l’estomac tout en assurant la protection des voies respiratoires. Les atteintes des temps initiaux concernant le passage du carrefour aerodigestif et du sphincter superieur de l’œsophage correspondent aux dysphagies hautes. Les tumeurs de l’axe pharyngo-œsophagien et les affections neurologiques sont des causes majeures de ces troubles qui les revelent frequemment. Devant un trouble de la deglutition revelateur, l’examen oto-rhino-laryngologique et la fibroscopie œsophagienne sont les deux examens etiologiques qui permettent de detecter une tumeur. L’examen neurologique permet de detecter une maladie neurologique. L’exploration fonctionnelle repose avant tout sur l’observation de la deglutition, la nasofibroscopie au cours de la deglutition et le radiocinema quand l’observation du sphincter superieur de l’œsophage est necessaire. Les manometries ont une place dans les troubles moteurs du corps de l’œsophage mais explorent mal le temps pharynge et le sphincter superieur. Les traitements disponibles sont la dietetique pour adapter les textures des aliments, la reeducation, les techniques d’alimentation non orale, les chirurgies a visee fonctionnelle (myotomie du cricopharyngien) ou palliatives.

Los tumores benignos de la laringe constituyen un grupo heterogeneo, son infrecuentes en su mayor parte y susceptibles de provocar sintomas como disfonia, disnea y disfagia. De entrada, plantean un problema de diagnostico, que debe ser anatomopatologico, y otro terapeutico, para el que la cirugia conservadora, sobre todo endoscopica, tiene un papel principal.

Objectives/Hypothesis: The objective was to analyze the incidence and factors associated with facial nerve dysfunction after conservative parotidectomy with facial nerve dissection. Study Design: A retrospective unicentric study in a tertiary care center with prospective record of studied factors. Methods: Over a 10-year period, 131 patients with normal facial nerve function underwent a superficial or total conservative parotidectomy with nerve dissection performed by one surgeon for primary benign or malignant tumors. Facial nerve function was assessed on the first postoperative day and at 1 month and 6 months after the parotidectomy. Extent of surgery, histopathological findings, tumor size, close contact of tumor with facial nerve, and sex and age of the patient were reviewed. These variables were studied in a χ2 statistical univariate and stratified analysis to determine their association with postoperative facial nerve dysfunction. Results: Incidence of postoperative facial nerve dysfunction was 42.7% on the first postoperative day, 30.7% at 1 month after the parotidectomy, and 0% at 6 months after the parotidectomy. The most common dysfunction was paresis in a single nerve branch (48.2%), in particular, the marginal mandibular branch. Total parotidectomy was associated with a significantly higher incidence of facial nerve dysfunction during the first postoperative period (60.5% at day 1 and 44.7% at month 1) than superficial parotidectomy (18.2% at day 1 and 10.9% at month 1) (P < .001). In patients with total parotidectomy, close contact of the tumor with the facial nerve was found to have statistical causal relation with facial nerve weakness. In patients with superficial parotidectomy, inflammatory conditions were found as factors that increased postoperative facial nerve dysfunction. Conclusion: In the study series of conservative parotidectomies with facial nerve dissection, only extent of surgery and particular local conditions of nerve dissection, especially the close contact of tumor with facial nerve and inflammatory conditions, were found to be associated with postoperative facial nerve dysfunction.

Los trastornos de la deglucion comprenden todas aquellas alteraciones del proceso fisiologico encargado de llevar el contenido bucal al esofago y despues al estomago, asegurando siempre la proteccion de las vias respiratorias. Las alteraciones de la etapa inicial que afectan al paso de la laringofaringe y del esfinter esofagico superior constituyen las denominadas disfagias altas. Las principales causas de estos trastornos son los tumores del eje faringoesofagico y las afecciones neurologicas, que se observan con frecuencia. Ante un trastorno sintomatico de la deglucion, las dos exploraciones etiologicas que permiten la deteccion tumoral son la exploracion otorrinolaringologica y la fibroendoscopia esofagica. Por su parte, la exploracion neurologica permitira confirmar la existencia de enfermedad neurologica. La exploracion funcional se basa ante todo en la observacion de la deglucion, la nasofibroendoscopia durante la deglucion y la radiocinematografia cuando es necesario observar el esfinter esofagico superior. La manometria es una exploracion de gran valor para el estudio de los trastornos motores del cuerpo del esofago, pero explora mal la etapa faringea y el esfinter superior. Los tratamientos disponibles en la actualidad son los dieteticos para adaptar la textura de los alimentos, la rehabilitacion, las tecnicas de alimentacion no oral y la cirugia funcional (miotomia del cricofaringeo) o paliativa.

Prospectively evaluate the impact of fluorodeoxyglucose-fluorine-18 positron emission tomography (FDG-PET) in the management of recurrence of advanced head and neck squamous cell carcinoma during the first year after treatment.Seventy patients were followed-up every 6 to 8 weeks during the first year after initial combined curative therapy. FDG-PET, together with conventional imaging and endoscopy were performed systematically at 1 year (group A) or prompted earlier in case of clinically suspicious recurrence (group B). The referring physician evaluated the impact of FDG-PET on the patient's management. Another clinician checked the pertinence of decisions.FDG-PET had a therapeutic impact in 8 of 43 group A patients and in 16 of 27 group B patients; the overall rate was 34%. This change was pertinent in 5 of 8 and 14 of 16 cases, respectively. Overall pertinence rate of decisions was 90% versus 70% without FDG-PET.FDG-PET had a significant overall therapeutic impact; the induced decisions were either pertinent or just led to "futile" noninvasive examinations. Systematic FDG-PET had a significantly lesser impact in comparison with FDG-PET motivated by clinical suspicion.