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Objectives: To evaluate results and failure factors in endonasal surgery in a private outpatient setting in a tropical environment., Material and Method: A single-center observational study included 337 patients consecutively undergoing endonasal surgery in a private hospital on Réunion Island, a French overseas administrative Département in the Indian Ocean between 2019 and 2021. The main objective was to assess the success rate of the outpatient pathway. Secondary objectives comprised analysis of complications and identification and management of factors for failure of outpatient management. The study was conducted according to the STROBE editorial guideline., Results: The 337 surgeries notably comprised 112 septoplasties (37.5%), 104 meatotomies (30.3%), 15 unilateral total ethmoidectomies (4.6%), 48 bilateral total ethmoidectomies with sphenoidotomy (14.3%), and 18 Draf procedures (5.5%). Seventy-five percent of patients (252/337) were operated on as outpatients, with a success rate of 90% (227/252 patients). The rate of severe intraoperative complications was 1.5% (5/337). On multivariate analysis, 3 variables were identified as influencing risk of failure of the outpatient pathway: emergency analgesia in the operating room [odds ratio (OR): 91.61; 95% confidence interval (CI): 22.8-540.3], operating time (OR: 1.05; 95% CI: 1.01-1.09), and recovery room time (OR: 1.02; 95% CI: 1.01-1.03)., Conclusion: Our study in a tropical environment found eligibility and success rates for outpatient endonasal surgery similar to those in metropolitan France. This makes surgical and anesthesiological training a key factor in the success of outpatient care, while the location of the care structure and the climate seem to have little impact., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

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

Objective: To analyze the difference between the endolymphatic sac tumors (ELSTs) in sporadic cases and in von Hippel-Lindau (VHL) disease., Study Design: Retrospective case review in a tertiary referral center., Patients and Methods: Fourteen cases of ELST, occurring since 1998, were reviewed. We analyzed the initial symptoms, characteristics of the tumor, treatment, sequelae, and follow-up for each group., Results: The ELSTs were sporadic in 6 cases and associated with VHL disease in 8 cases. The mean age at the time of the first surgery was 26 years (range, 12-41). All except two of the patients presented with a unilateral tumor. The initial symptoms were hearing loss (n = 9), tinnitus (n = 7), and/or vertigo (n = 5). Hearing loss was more prevalent in the sporadic cases. Preoperative arteriography was performed for 4 patients, with embolization performed for 1 patient. The size of the tumor was significantly larger in the sporadic cases (31.7 mm) than in the cases of VHL disease (19.3 mm). The surgical approach was more extensive in the sporadic cases. The surgeons found 2 types of tumors. Cystic tumors with massive bleeding invading the surrounding structures (the dura mater or jugular bulb) were more common in the sporadic cases. Fibrous tumors that infiltrate the bone and have moderate bleeding were more common in the cases associated with VHL disease.Two patients with small lesions were not operated on but were followed for 6 years without tumor growth. They died of metastasis from gastric and kidney cancer. Four recurrences occurred during the 14 years of follow-up. Four facial palsies and 8 cases of profound deafness were encountered postoperatively., Conclusion: Sporadic tumors are more aggressive than those associated with VHL disease. Complete surgical resection should be the goal of treatment. Preoperative angiography with embolization is recommended. In some cases, embolization may be impossible, and preoperative or postoperative radiotherapy should be discussed.

Background: Acute posterior lingual abscess is rare, but may potentially compromise the airway acutely., Objective: Lingual abscesses call for prompt and aggressive management because they are potentially life-threatening infections. Anterior lingual abscess (the most common) and posterior third lingual abscess must be differentiated., Case Report: A young man who experienced the beginnings of dyspnea and total aphagia presented to the Emergency Department. A posterior lingual abscess was identified on computed tomography scan., Discussion: Multi-antimicrobial therapy is the cornerstone of treatment. Surgical drainage is also of critical importance for preventing deeper spread of the infection., Conclusion: We present this case to increase awareness among emergency physicians and head and neck surgeons of the clinical findings of acute abscess of the base of the tongue, which can be difficult to diagnose clinically. Imaging of the oral cavity and pharynx is the key to the diagnosis, and the key to choosing the best surgical strategy., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Computer-assisted navigation systems can now potentially guide the surgeon to the cochlea with a trajectory avoiding the facial nerve through a keyhole approach. Five temporal bone specimens, with 4 titanium screws placed in the mastoid cortex, were studied. Preoperative computed tomographic scan images were loaded on an electromagnetic computer-assisted surgery (CAS) system (Digipointeur, Collin, Bagneux, France). A drill was connected to the CAS to monitor its progression continuously. A conical approach passing through the facial recess and ending in the scala tympani was performed. A 0.5-mm wire was inserted into the cochlea. The keyhole approach was technically feasible in all cases. No facial nerve injury was observed on imaging and dissection control. The wire was positioned in the scala tympani and the position accuracy of the CAS was <0.76 mm on the target in all cases. The CAS system with fiducial markers yielded sufficient precision to allow a minimally invasive approach to the cochlea.

Conclusion: The use of an invasive marker in the ipsilateral temporal bone with mid-facial skin contouring for registration improved the position accuracy (PA) to levels required for otological and neuro-otological procedures., Objective: The aim of this study was to compare the PA after skin contouring with the combination of anatomic landmarks or a local invasive marker and skin surface registration for intratemporal computer-assisted navigation., Patients and Methods: Thirty-three patients undergoing a lateral skull base procedure with the Digipointeur system (Collin, Bagneux, France) based on CT scan were included in this study. Registration was obtained by a mid-facial skin contouring. In the first protocol (n=8), PA was evaluated and the position corrected for three intratemporal landmarks before evaluation of the target (round window). In a second protocol (n=25), a titanium screw was placed in the ipsilateral mastoid region before imaging. PA was measured before and after screw registration for five intratemporal landmarks., Results: In the first protocol, PA did not improve after the registration of the landmarks, and PA of the target was evaluated as 4.9+/-0.64 mm. In the second protocol, PA was reduced after screw registration for all landmarks with a mean PA ranging from 0 to 2.3 mm.

Objectives: Report a case of tracheopathia osteoplastica and describe from a literature analysis the main clinical, radiological, and therapeutic features of this rare disease based on literature review., Material and Methods: A 74-year-old patient suffering from a nasal polyposis that had been repeatedly operated was admitted for surgery of the frontal sinus. The day of surgery, the difficult intubation required a laryngotracheoscopy, which found a dystrophic trachea, with a sprinkling of whitish nodules, and hard swelling. The pathologic exams of a large biopsy specimen using a rigid bronchoscopy provided the diagnosis of tracheopathia osteoplastic. A complementary workup to search for the etiology was undertaken. The risk and the difficulty of the intubation led to suspending the surgery., Results: The CT scan as well as the histological, bacteriological, and immunological tests showed nothing specific. The etiopathogenic hypothesis was the association of chronic disease of the upper airways such as the ozena or the chronic inflammation of the respiratory tract, an endocrine factor, dermatomyositis, exposure to toxic substances such as silica, or tracheobronchial amyloidosis. The bronchial microbiology test is positive in more than 50% of patients, and often Klebsiella ozaenae or Pseudomonas aeruginosa is found., Conclusion: Tracheopathia osteoplastica is a rare tumor, with unknown etiology and physiopathology. The discovery is most often incidental. Progession is slow and it does not compromise the vital prognosis. The treatment is symptomatic. Few surgical tracheal operations are described in the literature.

Objective: To report a case of laryngeal tuberculosis and to consider tuberculosis management in ENT practice., Material and Methods: A 44-year-old man, a smoker with pulmonary sarcoidosis experienced dysphonia with dysphagia. Laryngeal fibroscopy revealed an ulcerated epiglottic lesion. Direct laryngoscopy was performed to detect carcinoma, laryngeal sarcoidosis or tuberculosis. The histologic study revealed granulomatosis with giant cells and caseous necrosis. Tissue culture identified Mycobacterium tuberculosis., Results: Antituberculosis therapy decreased dysphonia and dysphagia. Isolated ulceration disappeared at three months. Pulmonary infiltration decreased in radiography. The discovery of this case of laryngeal tuberculosis instigated hospital and community tuberculosis surveillance., Conclusion: The ENT specialist should be aware of laryngeal tuberculosis in suspicious lesions. Mandatory declaration of such cases can motivate setting up tuberculosis surveillance.

Leptomeningeal carcinomatosis is rare in evolution of head and neck cancers. Prognosis is poor and treatment is through supportive care. We report an atypical rapid post-operative leptomeningeal carcinomatosis after skull base resection for an ethmoidal adenocarcinoma. The anterior skull base resection was near-total and we suspect a seeding of subarachnoid space either before surgery, either during surgical extirpation or from the residual intracranial nodule. It is the first description of rapid LMC after surgery (less than 1 month). Post-operative MRI diagnosed the LMC through the detection of contrast enhancing leptomeningeal nodules at bilateral second and eighth cranial nerves and at bilateral interpedoncular area. A strong index of suspicion along with clinical and radiological correlation is essential to arrive at a correct diagnosis. Otolaryngologists should be aware of the possibility of leptomeningeal carcinomatosis, before or after surgery, in a patient presents with an appropriate constellation of neurologic symptoms and a history of cancer.

Objectives: To report a case of adenoid cystic carcinoma of the external auditory canal with petrous involvement., Material and Methods: A 50-year-old woman was referred to our department for the management of a necrotizing external otitis. Computed tomography and biopsy revealed an adenoid cystic carcinoma of the external auditory canal., Results: The patient was treated by complete surgical excision. A radiation therapy completed the treatment. Follow-up time was 19 months without evidence of recurrence. Adenoid cystic carcinoma of the external auditory canal is a rare tumor. It's a special type of carcinoma developing from the ceruminous glands. Histogenesis is difficult and unsettled. The most important survival factor is removal of the tumor with histologically free margins., Conclusions: Lack of specific clinical and radiological signs makes the diagnostic challenging. The adenoid cystic carcinoma is a rare neoplasm of the external auditory canal. An initial aggressive wide "en bloc" surgical resection is mandatory.

Objectives: To report a case of IgG4-related multifocal fibrosclerosis, revealed by a multifocal salivary involvement., Material and Methods: A 59-year-old man, with chronic pancreatitis, was managed for fibrotic involvement of the 2 submaxillary glands and the 2 parotids. Clinical, radiological, and histologic features were retrospectively studied., Results: Pathological features of submandibular gland revealed a chronic sclerosing sialadenitis. Retroperitoneal fibrosis in computed tomography and high rate of IgG4 are objectived. The diagnosis of IgG4-related multifocal fibrosclerosis is evoked. The patient's state improved with corticosteroid therapy., Conclusion: Salivary involvement in IgG4-related multifocal fibrosclerosis must be recognized in salivary medical pathology.

Lymphadenopathy in a patient taking TNFalpha antagonist therapy may indicate lymph node tuberculosis or a hematological malignancy. Although histological evidence of granuloma suggests tuberculosis, many other infections responsible for granulomatous reactions have been reported in patients on TNFalpha antagonist therapy. We report a case of granulomatous lymphadenopathy due to Bartonella henselae in a patient taking etanercept to treat ankylosing spondylitis.

Objective: To report the first case of spontaneous intratumoral and brainstem hemorrhage in a patient with a vestibular schwannoma., Study Design: Case report and review of the literature., Setting: University-based, tertiary referral center., Patient: A 73-year-old woman with a vestibular schwannoma, anti-vitamin K overdose, and arterial hypertension experienced a rapid onset of headache, facial palsy, diplopia, and hoarseness., Interventions: The patient was admitted to the intensive care unit and treated with vitamin K and corticoids., Main Outcome Measures: Clinical and radiologic findings., Results: At admission, the magnetic resonance imaging and computed tomographic scans showed an intratumoral hemorrhage. The patient entered a coma 24 hours after the onset of the symptoms. At that time, the computed tomographic scan demonstrated a massive intratumoral and brainstem hemorrhage. The patient died 3 days later., Conclusion: Intratumoral, subarachnoid, and brainstem hemorrhages can occur in patients with vestibular schwannoma. Oral anticoagulant therapy is a risk factor for tumor-related hemorrhage.

Klebsiella pneumoniae subsp. ozaenae was isolated from the pharynx of a woman with laryngeal scleroma. K. pneumoniae subsp. ozaenae is rarely isolated from clinical infections and has never been reported in laryngeal scleroma, which is usually caused by K. pneumoniae subsp. rhinoscleromatis.

Objective: To report a case of labyrinthine hemorrhage with a sudden sensorineural hearing loss and vertigo. This is a rare mechanism of inner ear damage, which may be considered in patients with anticoagulant therapy., Material and Methods: We report a case of sudden sensorineural hearing loss and vertigo in a 73-year-old male on anticoagulant therapy for arrhythmia. An audiovestibular and imaging work-up was performed., Results: Audiometry showed a left profound hearing loss. Videonystagmography demonstrated a left labyrinthine deficit. Hemostasis assessment showed an INR at 7.5 MR imaging evidenced a high intralabyrinthine signal on T1-weighted images without gadolinium and on FLAIR T2-weighted images, suggesting labyrinthine hemorrhage. At clinical follow-up the vertigo regressed but the hearing function was not recovered., Conclusion: Labyrinthine hemorrhage should be evoked in the event of sudden sensorineural hearing loss in patients with anticoagulant therapy. MRI is a useful diagnostic tool in this case.

Objective: To report a nasal leishmaniasis diagnosed by septal perforation biopsy., Material and Methods: We report a case of septal perforation with crusty rhinosinusitis and nasal vestibulitis in a 54-year-old woman with cirrhosis., Results: Mucocartilaginous biopsy revealed a mucosal leishmaniasis. Biological and radiologic findings were normal. Clinical follow-up with anti-parasitical treatment showed a regression of the patient's muco-cutaneous lesion and regression of her hepatic insufficiency., Conclusion: Biopsy of septal perforation is a useful diagnostic tool, advocated for differentiate infectious, neoplasic and inflammatory pathology. Leishmaniasis may be evoked in rhinologic pathology.

Objective: We describe a case of intraparotid facial nerve schwannoma. About sixty patients with intraparotid tumors have been reported in the literature., Material and Methods: A 89-year-old female patient presented with a history of progressive facial palsy and a left intraparotid mass. The mass was removed by parotidectomy for definitive diagnosis and treatment. We reviewed the findings in comparison with data in the literature., Results: The well-encapsulated tumor arose from the superior branch of the intraparotid facial nerve. As the tumor could not be dissected from the nerve, a segment of facial nerve was sacrificed and repaired by interposing a greater auricular nerve. The final pathological diagnosis was schwannoma arising from the facial nerve., Discussion: This case illustrates the clinical and pathologic features of intraparatid facial nerve schwannoma and points out the pitfalls of diagnosis and treatment. Consensus has recognized total resection surgery with facial nerve sacrifice as the most reasonable treatment for these tumors. We discuss the currently accepted management approach as well as the different treatment modalities for recovering facial function.