E. Reyt

Assessment of nutritional status at the time of diagnosis in patients treated for head and neck cancer

OBJECTIVE To evaluate the nutritional status at the time of diagnosis of patients treated for head and neck cancer. MATERIAL AND METHODS Single-centre prospective study. Nutritional assessment comprised: clinical interview, physical examination, and a laboratory work-up. Clinical interview assessed: reference weight, diet, calorie intake, causes of weight loss, use of dietary supplements. A subjective global assessment of nutritional status (Detsky index) was established on the basis of clinical interview. The patients height and weight were determined and serum albumin was assayed. Weight loss, body mass index, and Buzby index were then calculated. Two groups of malnourished patients were distinguished: moderately malnourished (group 1), severely malnourished (group 2). Variables were compared between the two groups by Chi(2) test. RESULTS One hundred and sixty-nine patients were included in the study: 145 had a history of smoking and alcohol abuse, 82 (48.5%) were malnourished and 47 of them were classified in group 1. All patients of group 1 had a normal or pureed diet. 21 (69%) patients of group 2 had a pureed or liquid diet. The mean daily calorie intake was 31kcal/kg/24h for group 1 and 20kcal/kg/24h for group 2. The main causes of weight loss were pain and dysphagia. Dietary supplements were not used by any of the patients in group 1 and by four (13%) patients in group 2. The concordance between the Detsky index and objective nutritional status was 92% for the overall population. Malnutrition was significantly more frequent among males (P=0.01), alcohol users (P=0.02), elderly subjects (P=0.01), patients with pharyngeal tumour (P=0.03), and patients with advanced tumour stage (P=0.01). CONCLUSION The prevalence of malnutrition among patients with head and neck cancer is high. Assessment of nutritional status and appropriate management must be part of the initial work-up of these patients.

An original submandibular approach technique sparing the cervical branch of the facial nerve.

Many articles and anatomy textbooks accurately describe the anatomy and anatomical variations of the marginal mandibular branch of the facial nerve (VII). This is not, however, true for the cervical branch, damage to which results in paralysis of the platysma and, because of its insertions at the lower lip and labial commissure, in disfigurement, especially when smiling. This may be mistaken for paralysis of the marginal mandibular branch of the facial nerve. Precise anatomical description of the cervical branch of the facial nerve allows certain technical safeguards to be determined which, if adhered to, should reduce the risk of injury, especially during surgical excision of the submandibular gland on a transcervical approach.

Thyroglossal duct surgery. Sistrunk procedure

Midline cysts of the neck are the most common congenital malformations of the neck. They arise along the thyroglossal duct. The presence of a fistula is the result of either spontaneous (suppuration) or surgical fistulisation (simple incision or incomplete excision). The cyst and/or fistula are located between the base of the tongue and the thyroid gland, predominantly adjacent to the hyoid bone. This midline site can be explained by embryological development of the thyroid gland. Treatment is surgical. Many techniques have been described, but Sistrunck procedure (described in 1920), based on embryological studies, remains the reference technique with a recurrence rate of less than 3%, provided surgery is performed correctly, comprising resection of the body of the hyoid. Risk factors for recurrence are: surgery during the inflammatory phase, cyst rupture during dissection, multiple thyroglossal ducts and a technical error during the surgical procedure.

Role of near-infrared fluorescence imaging in the resection of metastatic lymph nodes in an optimized orthotopic animal model of HNSCC

OBJECTIVES To study the role of near-infrared fluorescence imaging in the detection and resection of metastatic cervical lymph nodes in head and neck cancer. MATERIALS AND METHODS CAL33 head and neck cancer cells of human origin were implanted in the oral cavity of nude mice. The mice were followed up after tumor resection to detect the development of lymph node metastases. A specific fluorescent tracer for αvβ3 integrin expressed by CAL33 cells was injected intravenously in the surviving mice between the second and the fourth month following tumor resection. A near-infrared fluorescence-imaging camera was used to detect tracer uptake in metastatic cervical lymph nodes, to guide of lymph-node resection for histological analysis. RESULTS Lymph node metastases were observed in 42.8% of surviving mice between the second and the fourth month following orthotopic tumor resection. Near-infrared fluorescence imaging provided real-time intraoperative detection of clinical and subclinical lymph node metastases. These results were confirmed histologically. CONCLUSION Near infrared fluorescence imaging provides real-time contrast between normal and malignant tissue, allowing intraoperative detection of metastatic lymph nodes. This preclinical stage is essential before testing the technique in humans.

Hoarseness revealing a rare pathology

European Annals of Otorhinolaryngology, Head and Neck Diseases - Vol. 130 - N° 2 - p. 103-106

Optimal enlargement of the frontal sinus approach

After recalling the main anatomical characteristics of the frontal sinuses, the authors describe the frontal craniotomy surgical procedure and its variants. A bicoronal skin incision is performed. An inferior-based pericranial flap is created, with its limits situated away from the osteotomies. Osteotomies are performed with an oscillating saw. The inferior osteotomy is horizontal, tangentially following the supraorbital margin as far as the lateral limit of each sinus. The osteotomy is continued medially as far as the nasion, passing an average of 3mm above the floor of the medial part of the sinuses, immediately above the frontonasal ducts. The superior osteotomy is performed in a vertical coronal plane through the summit of the sinuses. It is arc-shaped, concave downwards, joining the lateral extremities of the inferior osteotomy. The posterior wall of the sinus can be resected to perform frontal sinus cranialization, allowing access to the midline anterior cranial fossa. The posterior wall of the sinus is removed with a high-speed burr in the same way as the anterior wall. At the end of the procedure, the bone flap is sutured with nylon suture material and the pericranium is sutured over the bone flap.

Thyroid abscess: A case report.

European Annals of Otorhinolaryngology, Head and Neck Diseases - Vol. 132 - N° 6 - p. 357-359

A false nasal septum deviation.

European Annals of Otorhinolaryngology, Head and Neck Diseases - Vol. 130 - N° 6 - p. 359-361

Résultats fonctionnels de la prise en charge des aspergilloses parasinusiennes par voie endonasale

Conclusion/Discussion.— Il existe une corrélation statistiquement significative (CSS) entre RCS spontanée et surpoids, pneumatisation sinusienne importante, selle turcique vide et dilatation de la gaine du nerf optique. Pas de CSS avec l’obésité. Cela pourrait être dû au faible effectif et une puissance statistique basse en cas d’obésité. Malgré le fait que le test bilatéral soit idéal pour les petits effectifs, il faudra dans le futur un plus grand nombre de patients pour confirmer nos résultats préliminaires dans cette pathologie rare.

A dermatologic affection that can be readily diagnosed by an ENT specialist

European Annals of Otorhinolaryngology, Head and Neck Diseases - Vol. 129 - N° 6 - p. 334-338