B. Vairel

Long-term oncological outcome after endoscopic surgery for olfactory esthesioneuroblastoma

Abstract Conclusions: Endoscopic techniques seem to be safe approaches for the treatment of esthesioneuroblastomas (ENBs). However, they are intended for selected patients and require extensive experience in base of the skull surgery. Objectives: ENB is a rare tumor of the nasal cavity. The craniofacial approaches remain the gold standard of treatment in multiple centers. Endoscopic endonasal approaches were progressively developed. The main objective of this work was to study the overall survival and recurrence-free period for patients with ENB who underwent endoscopic resection. Methods: We performed a retrospective study from 1996 to 2014, reviewing the patients treated by endonasal endoscopic surgery for ENB. Results: Eight patients benefited from endoscopic surgical resection. According to the Kadish classification, one patient was stage A, three patients were stage B, and four patients were stage C. According to the Dulguerov classification, one patient was stage T1, five patients were stage T2, and two were stage T4. Reconstruction of the base of the skull was performed in three patients. No postoperative complications were noted. The mean follow-up period was 95 months. The 5-year overall survival was 87.5% and the 5-year recurrence-free survival was 75%. To date, there have been no local recurrences but two patients had lymph node recurrences. Seven patients are disease-free and one is deceased.

Possible role of anti-inflammatory drugs in complications of pharyngitis. A retrospective analysis of 163 cases.

OBJECTIVES Complications of pharyngitis (peritonsillar abscess, retropharyngeal abscess, and cervical cellulitis) are rare, but appear to be on the increase over recent years and many of these patients have been treated by anti-inflammatory drugs prior to admission. The purpose of this study was to review the current epidemiological data concerning these complications and investigate a possible correlation with anti-inflammatory drug use. MATERIAL AND METHODS A single-centre retrospective review of epidemiological, clinical and microbiological data was performed on the medical charts of patients hospitalised for peritonsillar abscess, retropharyngeal abscess or cervical cellulitis between 2005 and 2010. RESULTS Over a six-year period, 163 patients were hospitalised for complications of pharyngitis, with a sex-ratio of 1.82 (104/57). The number of cases of peritonsillar abscess (PTA) increased from 13 to 28 cases per year from 2005 to 2010 and the number of cases of retropharyngeal abscess increased from three to six cases per year over the same period. The number of cases of cellulitis remained stable with an average of 1.82 cases per year. Each year, significantly more patients with an abscess were admitted to our unit with a history of anti-inflammatory drug use (13.3 ± 4.6) than without anti-inflammatory drug use (7.8±4.3) (P<0.01). Micro-organisms were identified in 80% of cases, with mixed strains in 73% of cases, Streptococcus in 72% of samples and Streptococcus pyogenes in 19% of cases of PTA. A favourable outcome was observed in all patients in response to medical and surgical treatment. CONCLUSION In line with the literature, we observed an increasing incidence of complications of pharyngitis. The present series comprised significantly more patients admitted for PTA with a history of anti-inflammatory drug use. A multicentre prospective controlled study in Nantes on a large cohort is currently underway and will probably confirm these preliminary results.

Variability in facial-muscle innervation: A comparative study based on electrostimulation and anatomical dissection: Variability in facial-muscle innervation

Facial‐nerve palsy is the most common complication during facial surgery. However, there are few detailed reports on the distribution of the terminal branches of the facial nerve to the mimetic muscles. This also applies to the communicating branches. The aim of our study was to assess the variability of communicant and terminal branches of the facial nerve in humans. This prospective study involved anatomical dissections and intraoperative electric stimulation of facial nerves. We first performed 30 dissections to define the branching patterns of the extracranial facial nerve, with particular focus on the penetrating points into the mimetic muscles. We then studied and compared these preliminary data with 14 operative facial stimulations conducted during parotidectomies. Each trunk and branch received systematic electrostimulation. The electrostimulation and facial‐and‐neck movements were analyzed by two independent reviewers. The peripheral branching and intercommunication of the facial branches were highly variable. Combining electrostimulation and dissections, the frontalis muscle, the depressor labii inferioris and the platysma showed little nerve recuperation whereas the sphincter muscles (orbicularis ori and oculi) were anatomically protected. Facial‐muscle innervation differed among individuals. We found complex variations in the facial branching mode. Our study highlights the branches and corresponding areas that could be considered anatomically risky. Clin. Anat. 32:169–175, 2019.

Chirurgia endoscopica delle ghiandole salivari

Le tecniche di chirurgia endoscopica delle ghiandole sottomandibolari e parotidi hanno significativamente modificato la gestione delle patologie salivari ostruttive e infiammatorie croniche. L’esplorazione endoscopica dei dotti salivari, spesso sotto sedazione o anestesia locale, puo consentire una diagnosi di litiasi, di stenosi duttale o altro. In queste situazioni, puo essere possibile una gestione chirurgica endoscopica. Nelle sialoendoscopie interventistiche, spesso in anestesia generale, sono attuate la dilatazione delle stenosi e l’asportazione di calcoli, dopo un’eventuale frammentazione. Lo sviluppo delle tecniche chirurgiche endoscopiche salivari limita il ricorso alle parotidectomie e alle submandibulectomie in queste situazioni infiammatorie in cui la morbilita di questi gesti, in particolare nervosa, e aumentata.

Cirugía endoscópica de las glándulas salivales

Las tecnicas de cirugia endoscopica de las glandulas submandibular y parotida han modificado considerablemente el tratamiento de las patologias salivales obstructivas e inflamatorias cronicas. La exploracion endoscopica de los conductos salivales, a menudo bajo sedacion, incluso con anestesia topica, puede proporcionar el diagnostico de litiasis, de estenosis ductal o de otro tipo. En estas situaciones, se puede realizar un tratamiento quirurgico endoscopico. En las sialoendoscopias intervencionistas, a menudo bajo anestesia general, se realiza la dilatacion de las estenosis y la reseccion de litiasis, en ocasiones tras su fragmentacion. El auge de las tecnicas quirurgicas endoscopicas salivales reduce la realizacion de parotidectomias y submandibulectomias en estas situaciones inflamatorias, donde la morbilidad de estos procedimientos, sobre todo de tipo nervioso, es mayor.

Patologías salivales de tratamiento médico

El termino de patologias salivales de tratamiento medico engloba todas las afecciones funcionales, inflamatorias e infecciosas cuyo tratamiento no es quirurgico. Por lo tanto, quedan excluidas las patologias tumorales, mientras que se incluyen sobre todo las sialitis y las sialosis. Las sialitis son inflamaciones de las glandulas salivales y se subdividen en sialoadenitis (inflamaciones del parenquima salival, infecciosas o no) y sialodoquitis (inflamaciones de los conductos excretores relacionadas posiblemente con una litiasis). Las sialosis son enfermedades no inflamatorias y no tumorales, que se subdividen en sialoadenosis (trastornos nutricionales, distrofias) y sialosis relacionadas con enfermedades sistemicas (Sjogren, sarcoidosis, etc.). Por lo tanto, existen numerosas patologias salivales de tratamiento medico, el cual es multidisciplinario. La aportacion de las tecnicas innovadoras de endoscopia y de imagen (como la sialorresonancia magnetica) es determinante en el diagnostico y tratamiento de estas afecciones.