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We defined a standardized approach to surgery of sinonasal inverted papillomas (IP) for adequate and safe resection. A cohort of 65 patients treated from January 1995 to December 2005 at a single institution was retrospectively analyzed (mean follow-up: 28 months; range 1-132). The extension of the tumor was evaluated on clinical findings and computed tomography (CT) scan and/or resonance magnetic imaging (RMI). External and endoscopic surgical approaches were compared according to tumor extension, rate of local recurrence. Univariate analysis was used to review the impact on disease-free survival of factors related to the histopathological findings and the treatment. Endoscopic (alone or combined with transantral approach) and external surgery were used in 46 patients (71%) and 19 patients, respectively. Endoscopic approach (34/46) was performed to control IP in the nasal fossa, the ostiomeatal complex, the sphenoid sinus. It was combined with Caldwell-Luc procedure (12/46) for tumor extent into the lateral part of the maxillary sinus. The mean time for recurrences to occur was 19 months with range of 5-35 months. The rate of local recurrence was 17.6% (6/34) in endoscopic approach alone, 8.3% in endoscopic approach combined with a Caldwell-Luc procedure and 15.8% (3/19) in external approach. Tumor extension, excision with safe margins, associated malignancy or dysplasia have no significant impact on disease-free survival regardless of surgical procedure. On the basis of imaging evaluation and peroperative view of tumor extent, we propose a surgical strategy in which endoscopic approach could be used on the first attempt by trained surgeons. RMI is very useful to determine acute extent of the disease.

From 1980 to 1998, 65 patients whose glottic lesions were classified T1 or T2 were operated with a reconstructive anterior frontal laryngectomy with epiglottoplasty such as described by Tucker (Arch Otolaryngol Head Neck Surg 115:1341-1344). This procedure consists of resection of the two vocal cords, in some cases one arytenoid, the anterior commissure with a part of the thyroid cartilage, the anterior part of both false vocal cords, and of 1 cm of the subglottis. The epiglottis is grasped downward to close the larynx. There were no per or postoperative deaths. Our functional results confirm those reported in the previous publications. The mean time of removal of the nasogastric tube was about 12 days and the patients were generally satisfied about their residual voice. Decannulation was performed after satisfactory peroral feeding, generally about 2 weeks postoperatively. Three patients only required subsequent procedures which can be considered due to functional failures. There were four recurrences, which means a 5-year actuarial local control rate of 94%. This operation takes place as part of our surgical treatment policy of laryngeal carcinomas, considering that this surgery is like an extensive frontolateral laryngectomy. In case of an infiltrating tumor or in case of invasion to the arytenoid cartilage, we perform a supracricoid partial laryngectomy with crico-hyoido-epiglottopexy (the Majer-Piquet's procedure).

If low LET radiation therapy (photons, electrons), following radical microscopically and complete surgery can improve results in term of local control from 34 to 74% for salivary gland tumors, local control is more difficult to achieve in advanced tumors and only palliative treatment is usually attempted. In this survey, all the patient series treated worldwide were reviewed. They show an overall control rate of 31% with photon vs 64% with neutron therapy. A prospective randomised trial sponsored by the RTOG and the MRC published in 1988 and reviewed in 1993 showed an overall locoregional complete tumor clearance of 67% for neutrons and 17% for photons (P < 0.005), with 68% and 25% survival at two years for neutrons and photons respectively. This study was closed for ethical reasons. In Orleans, since 1987, 59 patients have been treated. At five years the persistent local control probability was 69.5%, the five-year crude survival probability 66% and the five-year tumor free survival probability was 64.5%. This review provides evidence that surgical treatment for salivary gland tumors should be limited to patients presenting a high likelihood of negative surgical margin and a small risk of facial nerve damage. Others patients should receive neutron radiation therapy alone as definitive treatment.

Transoral laser surgery (TLS) is a safe, time and cost-effective method of treatment for early stage glottic squamous cell carcinoma. This technique is more controversial in case of local extension to other subsite or in case of limited mobility.

Chondronecrosis of the cricoid cartilage is a rare complication of intubation. The records of two children were reviewed. An 8-month-old girl with myelomonocytic leukaemia developed chondronecrosis 10 days after a 2-day period of ventilation. A 4-year-old girl comatose after poisoning by the histamine antagonist, alimemazine, developed chondronecrosis after a 2-day period of intubation. The complication was suspected when extubation led to dyspnoea owing to laryngeal stridor and was confirmed by direct laryngoscopy. We review the development of the condition, the causative factors, treatment and prevention.

Background: Supraglottic hemilaryngopharyngectomy is a functional procedure suitable for the treatment of carcinoma of the upper part of the pyriform sinus and carcinoma of the lateral laryngeal margin. It consists of resection of the supraglottic hemilarynx and ipsilateral pyriform sinus., Methods: Forty-nine patients underwent this procedure from 1979 through 1994. The median age was 51 (40-72). The data were collected by a review of patients' records., Results: Two patients died in the postoperative period. The average time of removal of the nasogastric tube was 14 days. The survival rate at 3 years was 52% and at 5 years, 47%. The local recurrence rate was 2%, the overall neck recurrence was 15%, metastasis occurred in 15% of cases., Conclusions: Indications for this procedure are carcinoma of the upper part of the pyriform sinus and carcinoma of the laryngeal margin with normal vocal cord mobility.

Acquired laryngotracheal stenosis is a serious long term complication of tracheal intubation with an incidence of 0.7 to 8% in intubated children. We report five cases of subglottic stenosis over a 4.5-year period and review the pathology and pathogenesis of the condition. A diagnosis of subglottic stenosis was suspected when extubation failed due to the onset of dyspnoea or laryngeal stridor. An incidence of 0.9% of all intubated children was observed. We conclude that the main components contributing to stenosis are pathologies with decreased mucosal capillary perfusion pressure and intubation conditions.

Between 1967 and 1994, 344 patients were treated with total conservative parotidectomy for benign pleomorphic adenoma of the parotid gland. Our retrospective study focuses on a sixty-two patients group treated for recurrence after biopsy, enucleation or total parotidectomy. Twenty-two patients underwent a systematic total parotidectomy after biopsy (n = 7) or enucleation (n = 15). Twenty-nine patients were treated with total parotidectomy for local recurrence after enucleation. The mean time before this treatment was 8 years-9 months. In the third group, 11 patients, (7 patients from our institution), were surgically treated for recurrence after total parotidectomy. After enucleation, the recurrence rate was high and insufficient margins were found in 27% of the cases. In this group, a multicentric recurrence was found in 45% of the cases. In our own experience, recurrence after total parotidectomy was noted in 2.4%. The surgical salvage was performed with enucleation after identification of the branches of the facial nerve. The operative microscope was usefull. In 1 case, a second recurrence occured, and in 1 case iterative recurrence was noted. The local control rate after total parotidectomy was 99.6% (292/293). Total conservative parotidectomy is, for us, the treatment of choice for pleomorphic adenoma of the parotid gland.

Endonasal surgery of paranasal polyposis. Two hundred and fifty one microscopical sphenoethmoidectomies with a major complication rate of 2.6% are reported. Long term results are analysed. Nasal obstruction disappears in 96% and persists in 70% of the cases 5 years later. Through topical steroid therapy and surgical experience polyp recurrence rate is reduced to 30%.

Subtotal laryngectomy with CHP have prolongated post operative care because aspiration. In 16% of cases a new surgical procedure is necessary. The authors have used a implant of madreporic coral placed in the base of the tongue just behind the hyoid bone to achieve a total closure of the larynx during swallowing. This operation has stopped aspiration in 2 cases very quickly.

Hyo-sub-glosso-epiglottectomy was performed in 56 patients with a tumour of the vallecula or the anterior laryngeal margin. Tumour classification in most of the patients was T2 and N0-N1. Survival rate at 3 years was 54% and 40% at 5 years. Major impairment of deglutition occurred in 5.4% of the cases. This operation is indicated for limited tumours of the vallecula and the anterior laryngeal margin.

The authors report a retrospective analysis of the results of surgery in 169 patients with supraglottic cancer referred to the Lille ENT clinic from 1976 to 1985. Partial surgery was performed in 53% of patients versus total laryngectomy in 47%. The 5 year survival rates in the patient groups treated by supraglottic laryngectomy and supracricoid laryngectomy with cricohyoidopexy were similar, 69.4% and 75.2%, respectively. The 5 year survival rate in the patient group treated by total laryngectomy or by total laryngectomy extended to the base of tongue was 62.8%.

The authors assess the possibility to perform subtotal laryngectomy for extensive tumors of the endolarynx. They describe a particular variety of T3/T4 tumor extending anteriorly to the thyroid cartilage or to the pre-epiglottic space. Such tumors do not affect the arytenoid cartilages posteriorly, which makes functional subtotal laryngectomy with CHP or CHEP possible. This surgery was performed in 28 patients from 1972 to 1985, with 20 patients still living after 5 years, ie. 72% of all cases.

This is a retrospective study of 38 patients who were operated on for inflammatory (31) or tumoral tracheal stenosis. A cervical approach was possible in 20 cases; a sternotomy was required in 8 cases and a thoracotomy in 5 cases. Per-operative ventilation was satisfactory for all patients. There were 2 deaths in patients suffering from chronic airflow obstruction. There were 2 immediate and 13 late post-operative stenosis; 9 of these were symptomatic and required treatment which was successful in 7 cases. 25 of the 30 patients (among 33 survivors) who were followed-up were symptomless; 4 patients who had operations for a tumour had a larger than 3 years survival.

From 1980 to 1987, 37 patients were operated with a reconstructive anterior frontal laryngectomy including epiglottoplasty such as described by Tucker. These patients presented with epidermoid carcinomas of the glottis. The carcinological results are satisfactory, with a survival rate of 33 of 37 patients at 3 years and 22 of 25 patients at 5 years. However, the control of the paraglottic space still is insufficient after this type of surgery, and we reserve it for the tumors confined to the glottic level, without impairment of mobility. The anterior frontal laryngectomy performed is extensive and frontolateral. It is used for a few of its former indications, as showed by the comparison of the periods before and after 1980.

Cancer developing on a chronic laryngitis or bilateral superficial cancer of vocal cords still pose management problems to surgeons. Double cordectomy presents the inconvenience of opening the larynx in the median line and the need for insertion of a dilating piece removed during a second stage. These disadvantages can be avoided by an extracartilaginous glottectomy by median opening of thyroid cartilage, monoblock ablation of both vocal cords and immediate closure of larynx by lowering of ventricular bands. A wide larynx is obtained with a loud but veiled voice.

One of the most important technical advances in cervicofacial plastic surgery over the last few years is undoubtedly the use of the musculocutaneous flap from pectoralis major. A review of its application in 57 cases showed the flap to be of excellent viability (5% total necrosis of flap), and to offer multiple possibilities during primary surgery or that following radiation. Indications and excision limits can be extended, particularly in buccopharyngeal surgery, providing and appreciable functional gain (particularly disappearance of pain), even though long-term carcinologic advantages are deceiving.

From 1970 through 1982, 106 patients with carcinoma of the tonsillar region were treated by trans-mandibular bucco-pharyngectomy (composite resection) in the ENT department of Prof. Piquet at Lille University. After a brief reminder of the surgical process, the authors study the group of the operated patients (localization and classification of the UICC 1979), present the oncological results (crude 3-year survival of 58% and 5 years as 35%) and analyse them. According to several other series, they specify their therapeutic attitudes.

A retrospective study was conducted of 141 cases of laryngeal vestibule cancer treated by partial surgery between 1968 and 1977. Patients underwent either subglottic laryngectomy (105 cases) or subtotal laryngectomy with cricohyoidoplexy (36 cases). Operative mortality was 6.5 p. 100. Overall survival rate was 63 p. 100 at 3 years, with lymph node invasion in 32 p. 100 of cases, and a 3 year survival rate for group N of 71 p. 100 as against 50 p. 100 for group N+.

Treatment of severe cricoid stenosis with fixed vocal cords is difficult, the often used Réthi operation producing 20 to 30% of unsuccessful results. Use of a hyoid bone pedicle flap allows anterior enlargement with cricoid ring reconstruction, in addition to the classical posterior enlargement, and was successful in 8 of 9 cases treated by this method.

A homogeneous series of 106 cases of malignant tumor of tonsillar region was treated by first intention surgery. Treatment proposed for these patients with ulcerated or infiltration tumors often extending to pillars or to tongue was transmandibular buccopharyngectomy with curettage of glands and postoperative radiotherapy. Unadjusted survival rate at 3 years was 62% (T2 and T3) and at 5 years 35%. Clinical glandular enlargement, detected in 50% of cases, resulted in poorer prognosis, which decreased from 48% at 5 years to 25% in patients with histologic metastasis in lymph nodes.

This study is based on 29 juvenile angiofibroma, treated in 16 years. The average of age is 16.3 years but 24% of patients are over 20 years old. Scanner is the best mean to known the extension to the base of the skull and pterygoïd fossa. Angiography is not yet necessary and may be dangerous. The surgical approach is transmaxillary in most cases, with a very low average of recurrence = 10% and 1 post operative death.

Operative technique for functional subtotal laryngectomy with cricohyoidopexy is described and results analyzed in 120 patients after follow up for more than 5 years. Actuarial survival was 61% for the vestibules and 79% for the cords. Indications for Majer-Piquet, Labayle cricohyoidopexies and cricohyoido-epiglottopexies are discussed.

Twelve patients (8 with appendicular laryngeal cysts and 4 with laryngoceles) were treated in the ENT Unit, Lille between 1980 and 1983. Therapy was by laser through endoscopic guidance, and consisted of resection of the ventricular band to allow marsupialization of the cyst or mixed laryngocele in the endolarynx. Treatment was effective in all cases with restoration of a normal larynx within 2 to 3 months, even in patients with external laryngoceles. This method is of particular interest in bilateral lesions.

The authors report their experience with 210 microsurgical ethmoidectomies carried out in 109 patients between 1980 and 1987. In 23 patients the anatomy was considerably modified due to previous surgery. Asthma was present in 56 patients and 25 patients suffered from Widal's syndrome. The complications noted included 1 case of meningitis cured by antibiotics and a case of transient diplopia. Patients were monitored for 1 to 6 years; In 69 cases no recurrence was noted (63% of cases), 31 patients (28%) only required minor local procedures for slight recurrence (28%). On the other hand, 6 patients (5.5%) required a second surgical procedure for recurrence between 3 and 6 years.