B. Verillaud

Transcribriform and transplanum endoscopic approach for skull-base tumors

European Annals of Otorhinolaryngology, Head and Neck Diseases - Vol. 130 - N° 4 - p. 233-236

Guidelines of the French Society of Otorhinolaryngology (SFORL). Managing epistaxis under coagulation disorder due to antithrombotic therapy

OBJECTIVE The authors present the guidelines of the French Society of Otorhinolaryngology concerning the management of epistaxis during antithrombotic therapy. METHODS A review of the literature was performed by a multidisciplinary work group. Guidelines were drafted, then re-edited by a reading group independent of the work group to produce the final text. The proposed recommendations were graded A, B, C or expert opinion, on decreasing levels of evidence. RESULTS Before any decision to modify antithrombotic treatment, it is recommended to screen for overdose and assess the risk of thrombosis. In stented patients, dual antiplatelet therapy must be maintained during the month following stenting and, if possible, for 3 months. In epistaxis with antivitamin K (AVK) overdose controlled by packing, corrective measures are based on the International Normalized Ratio (INR). In uncontrolled epistaxis, it is recommended to stop AVK, administer antidotes and regularly monitor INR. In case of intravascular embolization, it is not recommended to alter anticoagulant treatment.

Exposure techniques in endoscopic skull base surgery: Posterior septectomy, medial maxillectomy, transmaxillary and transpterygoid approach

European Annals of Otorhinolaryngology, Head and Neck Diseases - Vol. 129 - N° 5 - p. 284-288

Unilateral vs bilateral sphenopalatine artery ligation in adult unilateral epistaxis: A comparative retrospective study of 83 cases

Though most authors agree that TESPAL (transnasal endoscopic sphenopalatine artery ligation) should be considered in case of epistaxis resistant to nasal packing, there is no consensus on the indication for a unilateral/bilateral procedure. In this retrospective study of 83 patients with spontaneous intractable unilateral spontaneous epistaxis, we compared the outcomes of unilateral (n=36) vs bilateral (n=47) TESPAL. The main outcome was failure, defined as bleeding recurrence requiring another therapeutic procedure under general anaesthesia. The success rate was higher with bilateral TESPAL (91.5%) than with unilateral TESPAL (75%), without any major complication (p=0.041). This retrospective study supports the rationale for bilateral rather than unilateral TESPAL, and paves the way for further prospective studies. This article is protected by copyright. All rights reserved.

Minimally invasive surgery for superior semicircular canal dehiscence: Results of a four fenestration technique in twenty-one adults

Superior canal semicircular dehiscence (SCCD) may cause vestibular and audiological symptoms that are sometimes debilitating. Computed tomography (CT) and the vestibular evoked myogenic potential (VEMP) test are essential for the diagnosis of SCCD. Various surgical techniques have been developed to manage SCCD but have many associated complications. Our technique uses an approach that otologists and surgeons are highly familiar with and that has other advantages, such as minimizing surgical trauma and preventing recurrences. Plugging the superior canal with bone wax and fascia after performing four fenestrations is safe and effective for the surgical treatment of SCCD syndrome This article is protected by copyright. All rights reserved.

Infratemporal fossa tumors: When to suspect a malignant tumor? A retrospective cohort study of 62 cases

OBJECTIVES Infratemporal fossa (ITF) tumors are rare and little is known about their general epidemiology, making it sometimes difficult for clinicians, who seldom encounter them, to distinguish between benign and malignant forms on the basis of the initial clinical and radiological work-up alone. The objectives of this retrospective study were: (i) to determine the respective prevalences of the various histologic types of ITF tumor, and (ii) to assess associations between certain clinical and radiological features and malignancy. METHODS A single-center observational study in a university hospital included all new consecutive cases of ITF tumor treated from January 2000 to December 2016. Histologic type, demographics, clinical presentation and imaging findings were analyzed. RESULTS In total, 62 patients were included. 74% of tumors were benign (n=46) and 26% malignant. Juvenile nasopharyngeal angiofibroma, adenoid cystic carcinoma and schwannoma were the most frequent histologic types, accounting for 47%, 16% and 10% of cases, respectively. The only clinical or imaging signs significantly associated with malignancy were trismus, facial pain, facial hypoesthesia and neural invasion on magnetic resonance imaging (all P-values<0.05). CONCLUSION This study provides general epidemiological data on ITF tumors, and identified several clinical and radiologic signs to help clinicians suspect malignancy.

Infectious arteritis of the internal carotid artery complicating retropharyngeal abscess

INTRODUCTION Retropharyngeal abscess is a well-known entity in children, but can also occur in adults. The two main vascular complications are vascular compression and pseudoaneurysm, while infectious arteritis of the internal carotid artery is exceptional. CASE REPORT The authors describe a case of a retropharyngeal abscess in an adult woman complicated by infectious arteritis of the internal carotid artery. This rare complication was treated by endovascular occlusion of the internal carotid artery and incision and drainage of the abscess in combination with antibiotic and anticoagulant therapy. The patient did not present any neurological sequelae and follow-up MRI did not reveal any signs of vascular or neurological complications. DISCUSSION This case highlights the importance of thorough examination of imaging performed in the context of deep neck space abscess to detect signs of vascular involvement. Treatment must be aggressive in view of the life-threatening risk of arterial rupture or septic embolism. This is the first reported case of infectious arteritis involving the internal carotid artery complicating retropharyngeal abscess.

Chirurgia del fibroma nasofaringeo

Il trattamento di riferimento del fibroma nasofaringeo rimane l’exeresi chirurgica. I progressi compiuti nel settore della diagnostica per immagini, dell’embolizzazione selettiva e della strumentazione hanno permesso di ridurre notevolmente la morbilita legata alla chirurgia di questo tumore ipervascolarizzato. Anche le tecniche chirurgiche sono progredite. Attualmente, le vie d’accesso endoscopiche endonasali permettono, nella maggior parte delle situazioni, di ottenere un’exeresi di qualita, limitando al tempo stesso le sequele estetiche e funzionali. I tumori limitati alla fossa pterigopalatina e alla fossa nasale sono stati i primi a essere operati per via endonasale. I miglioramenti nel settore dell’esposizione (resezione del setto, maxillectomia mediale), delle vie transmascellari e delle vie transpterigoidee permettono di gestire dei tumori estesi alla fossa infratemporale, alla regione dell’apice petroso, al forame lacero e al clivus. Anche alcune estensioni intracraniche limitate (forame rotondo e ovale, planum sfenoidale, lamina cribrosa) sono accessibili a un’exeresi endoscopica. Un accesso esterno resta comunque indispensabile in alcune situazioni: invasione intracranica importante, inguainamento dell’arteria carotide interna, estensione molto laterale alla fossa temporale al di sopra dello zigomo ed estensione tumorale posteriormente o lateralmente al nervo ottico. Quando la resezione completa provoca una morbilita giudicata inaccettabile, puo, talvolta, essere lasciato in sede un frammento tumorale. In tutti i casi, il monitoraggio postoperatorio passa attraverso una diagnostica per immagini precoce, per individuare e trattare un eventuale residuo tumorale passato inosservato, poi attraverso un follow-up clinico e radiologico prolungato.

Cirugía del fibroma nasofaríngeo

El tratamiento de referencia del fibroma nasofaringeo sigue siendo la reseccion quirurgica. Los progresos realizados en el ambito de las pruebas de imagen, de la embolizacion selectiva y del instrumental han permitido reducir de forma notable la morbilidad relacionada con la cirugia de este tumor hipervascularizado. Las tecnicas quirurgicas tambien han evolucionado. En la actualidad, las vias de acceso endoscopicas endonasales permiten lograr una reseccion de calidad en la mayoria de las ocasiones, a la vez que restringen las secuelas esteticas y funcionales. Los tumores limitados a la fosa pterigopalatina y a la fosa nasal han sido los primeros en operarse por via endonasal. Los avances en el ambito de la exposicion (reseccion del tabique, maxilectomia medial), las vias transmaxilares y las vias transpterigoideas permiten tratar los tumores extendidos a la fosa infratemporal, a la region del vertice petroso, al agujero rasgado y al clivus. Algunas extensiones intracraneales limitadas (agujeros redondo y oval, yugo esfenoidal, lamina cribosa) tambien son accesibles a la reseccion endoscopica. Sin embargo, en algunas situaciones sigue siendo indispensable un acceso externo: invasion intracraneal extensa, tumor que rodea la arteria carotida interna, extension muy lateral a la fosa temporal por encima del cigoma, extension tumoral por detras o lateralmente al nervio optico. Cuando la reseccion completa provoca una morbilidad que se considera inaceptable, en ocasiones se puede dejar in situ un fragmento tumoral. En todos los casos, la vigilancia postoperatoria consiste en la realizacion precoz de pruebas de imagen, para detectar y tratar un posible resto tumoral que haya pasado desapercibido. Despues, debe llevarse a cabo un seguimiento clinico y radiologico prolongado.

Balle fongique isolée du sinus frontal : à propos d’un cas

quantitatifs ont représenté 24,72 %, les troubles qualitatifs, 41,57 % et les troubles mixtes, 33,71 %. Les explorations ont permis de rattacher ces troubles à des pathologies chez 93,25 % des patients. Il s’agissait principalement de : rhinosinusites infectieuses (60,25 %), rhinite allergique (16,87 %) et polypose nasosinusienne (14,46 %). Conclusion.— Les troubles de l’odorat sont fréquents. Des tests simples élaborés à partir d’essences culturellement connues du milieu permettent de classer le trouble. Les pathologies infectieuses et inflammatoires nasosinusiennes constituent les principales étiologies. L’interrogatoire, l’examen clinique, les tests physicochimiques et l’imagerie permettent dans 90 à 95 % des cas de retrouver l’étiologie.