D. Malinvaud

Sinus mucocele: Natural history and long-term recurrence rate

OBJECTIVEnTo define the natural history, clinical signs, treatment and the modalities of medium- and long-term follow-up of patients operated for sinus mucocele.nnnPATIENTS AND METHODnRetrospective study of all patients operated for sinus mucocele between January 1993 and December 2009 (n=68). Demographic data, symptoms, medical imaging findings, surgical treatment and results were recorded.nnnRESULTSnThe mean age of patients in this series was 53 years (range: 27-82 years, sex ratio: 3/2). The most common site was fronto-ethmoidal. Fifty-one patients (75%) had a history of sinus surgery, essentially for nasal polyposis. Only 15% of mucoceles occurred spontaneously. Presenting symptoms, in decreasing order of frequency, were facial pain or headache (38%), ocular or orbital complications (28%), while 20% of patients were asymptomatic. Surgery was performed by endonasal endoscopic sinus surgery (n=57, 84%) or via a combined, transfacial and endonasal approach, associated with navigation after January 2003. The mean follow-up was 7 years (range: 4 months-16 years). During this follow-up period, 23.5% of patients developed recurrence or a second mucocele after a mean interval of 4 years.nnnCONCLUSIONnThis study demonstrates the high recurrence rate of mucocele, particularly in multi-operated patients with chronic sinusitis. Long-term, regular, clinical and radiological follow-up is necessary to detect asymptomatic lesions prior to the onset of complications.

Trade-off between Survival and Laryngeal Preservation in Advanced Laryngeal Cancer: The Otorhinolaryngology Patient's Perspective

Objectives: We performed a prospective study to evaluate, from the patients perspective, the trade-off between speech and survival that individuals face when given a diagnosis of advanced-stage laryngeal cancer amenable to either total laryngectomy or a laryngeal preservation protocol using chemotherapy and radiotherapy. Methods: Volunteers (309) consecutively seen at the otorhinolaryngology clinic of a university teaching hospital in France completed an anonymous questionnaire designed to determine their position if they faced the diagnosis of an advanced-stage laryngeal cancer. Univariate analysis was performed for potential statistical relationships with various variables. Results: We found that 12.9% of patients were unable to determine their position regarding the two treatment options offered, and this group had a significant statistical relationship with four variables (age, education, professional status, and history of cancer among relatives). We found that 24.6% of patients made survival their main consideration and would not consider any trade-off. Among the 62.5% who considered the trade-off, the percentage of cure that patients were ready to lose in order to preserve their larynx varied from 5% to 100% (mean, 33%; SD, 23%). Aside from the undecided group, none of the variables analyzed was related either to the decision as to whether to consider a trade-off or to the percentage of cure that patients agreed to trade to preserve their larynx. Conclusions: In patients with advanced-stage laryngeal cancer, treatment should be initiated only after careful evaluation of the patients attitude toward both laryngeal preservation and survival.

Accidents domestiques chez 57 patients ayant une perte sévère de l’odorat

OBJECTIVEnTo assess the risk of home accidents related to severe hyposmia.nnnMETHODSnA questionnaire, completed by 57 hyposmic patients and 49 control subjects with a normal sense of smell, asked about four specific types of olfactory-related home accidents: undetected fires, undetected gas leaks, consumption of spoiled food, and incidents of food burning. Level of olfactory function was determined by olfactory testing (Biolfa).nnnRESULTSnOlfactory testing revealed that 60% of the patients were anosmic and 40% had severe hyposmia. They reported cooking-related accidents most often (63%), followed by eating spoiled food (51%), inability to detect a gas leak (47%) and inability to smell a fire (26%). All these accidents were significantly more frequent than in the control population (p<10(-4)).nnnDISCUSSION AND CONCLUSIONnThis paper, the first in the European literature and the second in the international literature, shows that patients with severely impaired olfaction are more likely to experience related accidents than those with normal olfactory function.

Conventional transoral surgery for stage I-II squamous cell carcinoma of the tonsillar region

The purpose of this study was to review the results of conventional transoral resection and neck dissection for stage I to II squamous carcinoma of the tonsillar region.

Immobilités laryngées unilatérales après chirurgie de la glande thyroïde

BACKGROUNDnThe authors studied a cohort of 154 patients with unilateral vocal cord paresis following thyroidectomy, analyzing the pathogenesis, symptomatology, spontaneous evolution, and management of this complication.nnnOBJECTIVEnThis retrospective study distinguished between vocal cord paresis due to recurrent laryngeal nerve injury or due to injury of the cricoarytenoid articulation. We assessed the influence multiple variables on therapeutic management. The results and complications of currently-employed surgical techniques to remedy unilateral vocal cord paresis were defined.nnnPATIENTS AND METHODSnInjury to the recurrent laryngeal nerve was the cause of vocal cord paresis in 98% of cases; injury to the cricoarytenoid articulation accounted for only 2% of cases. When the recurrent laryngeal nerve had not been actually transected, spontaneous recovery of vocal cord function occurred in 36% of cases. No spontaneous recovery was noted when the nerve had been divided. The interval to recovery of cord function ranged from 2 to 15 months (median: 4 months). Spontaneous recovery of vocal cord function had occurred in 90% of these patients by the 9th postoperative month. Three factors significantly influenced the decision to perform a median transposition of the injured vocal cord: known transection of the recurrent laryngeal nerve, the interval to consultation with an ENT specialist, and the severity of dysphonia. Medial transposition of the injured vocal cord resulted in an immediate improvement in the quality of voice and speech with no major complications.nnnCONCLUSIONnUnilateral vocal cord paresis occurring after thyroidectomy is not always symptomatic and is not uniformly due to injury of the recurrent laryngeal nerve. Management does not always require surgical reintervention. The practical and medico-legal consequences of these injuries are discussed.

Rhinorrhée cérébro-spinale non-traumatique d’origine sphénoïdale

Resume La paroi posterieure du sinus sphenoidal est rarement le siege d’une fistule spontanee de liquide cephalo-rachidien. Nous presentons un cas rare de rhinorrhee cerebro-spinale spontanee issue d’une telle localisation, comprenant l’etape diagnostique et le traitement endoscopique ayant permis la fermeture de la fistule.

Inverted papilloma of the middle ear.

INTRODUCTIONnInverted papilloma (IP) of the middle ear is a very rare lesion, as less than 20 cases have been reported in the literature.nnnCASE REPORTnThe authors report the case of a 73-year-old male with IP of the middle and external ear that had already been operated many times. Treatment consisted of creating a large resection cavity. No recurrence was observed on clinical examination or MRI with a follow-up of 2 years.nnnDISCUSSION AND CONCLUSIONnThis case is analysed in the light of a review of published cases with a discussion of the pathophysiological and treatment problems raised by these lesions.

Sudden deafness following a sternutatory attack

European Annals of Otorhinolaryngology, Head and Neck Diseases - Vol. 128 - N° 2 - p. 103-105

Cystic lesions of the pterygoid process

INTRODUCTIONnCystic lesions of the pterygoid process are rare: there are only four case reports in PubMed.nnnCASE REPORTnTwo new cases (one schwannoma and one cystic lymphangioma) are reported, with clinical, radiological and therapeutic aspects.nnnDISCUSSIONnA literature review presents the semiology, radiology and treatment of cystic lesions of the pterygoid process.