J. Hohlfeld

Treatment of velopharyngeal insufficiency by autologous fat injection.

Velopharyngeal insufficiency (VPI) is a structural or functional trouble, which causes hypernasal speech. Velopharyngeal flaps, speech therapy and augmentation pharyngoplasty, using different implants, have all been used to address this trouble. We hereby present our results following rhinopharyngeal autologous fat injection in 18 patients with mild velopharyngeal insufficiency (12 soft palate clefts, 4 functional VPI, 2 myopathy). 28 injections were carried out between 2004 and 2007. The degree of hypernasal speech was evaluated pre- and postoperatively by a speech therapist and an ENT specialist and quantified by an acoustic nasometry (Kay Elemetrics™). All patients were exhaustively treated with preoperative speech therapy (average, 8xa0years). The mean value of the nasalance score was 37% preoperatively and 23% postoperatively (pxa0=xa00.015). The hypernasality was reduced postoperatively in all patients (1–3 degrees of the Borel-Maisonny score). There were no major complications, two minor complications (one hematoma, one cervical pain). The autologous fat injection is a simple, safe, minimally invasive procedure. It proves to be efficient in cases of mild velopharyngeal insufficiency or after a suboptimal velopharyngoplasty.

Propranolol treatment for subglottic haemangioma.

A 1-month-old child was referred to our department for numerous cutaneous infantile haemangiomas (figure 1). Two weeks later, he developed a stridor during breast feeding. The laryngeal dyspnoea was investigated by an endoscopic examination (figure 2). Propranolol was then started. The cutaneous haemangiomas regressed rapidly (figure 3). Endoscopy at 2 months showed a regression of the laryngeal haemangioma (figure 4). The baby was treated …

Rhinopharyngeal autologous fat injection for treatment of velopharyngeal insufficiency in patients with cleft palate

AbstractnPatients with cleft palate are prone to velopharyngeal insufficiency. In minor cases or when hypernasal speech does not resolve after velopharyngoplasty, an augmentation pharyngoplasty with autologous fat can be proposed. The aim of the present study is to evaluate the short-term (within 2xa0months) and long-term efficiency (during the 24xa0months following the procedure) of our procedure in the setting of velopharyngeal insufficiency related to a cleft palate. Twenty-two patients with cleft palate related velopharyngeal insufficiency were included in this retrospective study. All patients were operated following the same technique, in the same institution. The pre- and postoperative evaluations included a nasometry, a subjective evaluation using the Borel-Maisonny score, and a nasofibroscopy to assess the degree of velopharyngeal closure. Scores of Borel-Maisonny and nasometry were compared before, shortly after the procedure (within 2xa0months) and long term after the procedure (within 24xa0months). Forty-one procedures in 22 patients with a cleft palate performed in our institution between October 2004 and January 2012 were included in the study. Nine patients had a previous velopharyngoplasty with persistent rhinolalia despite intensive speech therapy. In 14 patients the procedure was repeated because of recurrent hypernasal speech after the first injection. The average number of procedures per patient was 1.8. Postoperative nasometry and Borel-Maisonny scores were statistically significantly improved and remained stable until the end of the follow-up (median 42xa0months postoperative) in most patients. Complications were rare and minor. Autologous fat injection is a simple procedure for treatment of minor velopharyngeal insufficiencies in patients with cleft palate, with good long-term results and few complications.

Brûlure chez l’enfant : évaluation en surface et profondeur

1.1. Étendue : pourcentage de la surface corporelle Selon l’âge de l’enfant, la surface des brûlures peut être calculée selon le tableau I. Une évaluation rapide met en relation la surface brûlée avec la paume de la main de l’enfant qui représente 1 % de sa surface. Mais la relation entre les surfaces corporelles varie avec l’âge : par exemple, plus l’enfant est petit, plus la surface cutanée du scalp est grande par rapport à celle des membres inférieurs. La règle des « 9 » s’applique dès l’âge de 10 ans (cf colonne adulte).

Brûlure chez l’enfant : évaluation en surface et profondeur: Soins primaires : pansements

1.1. Étendue : pourcentage de la surface corporelle Selon l’âge de l’enfant, la surface des brûlures peut être calculée selon le tableau I. Une évaluation rapide met en relation la surface brûlée avec la paume de la main de l’enfant qui représente 1 % de sa surface. Mais la relation entre les surfaces corporelles varie avec l’âge : par exemple, plus l’enfant est petit, plus la surface cutanée du scalp est grande par rapport à celle des membres inférieurs. La règle des « 9 » s’applique dès l’âge de 10 ans (cf colonne adulte).

CL149 - Thérapie foetale : analyse biomécanique musculaire sur un modèle de souris

Objectif La reconstruction musculaire tissulaire permet de reconstruire du muscle suite a un traumatisme ou une brulure. Nous utilisons de cellules musculaires fœtales humaines sur un support de collagene pour une reparation tissulaire. Nos cellules fœtales peuvent integrer un muscle de souris sans rejet immunitaire. Le but de cette etude est d’analyser sur un modele de souris les proprietes mecaniques d’un muscle blesse et traite par des cellules fœtales. Methodes Les muscles jumeaux de femelles de souris C57BL/6 ont ete blesses avec un punch de 4 mm. Des cellules musculaires fœtales humaines (1×105) associees a un support de collagene ou un support de collagene seul ont ete transposes dans ces muscles. Les muscles jumeaux controlateraux ont servi de controle. A differents temps, une analyse de force isometrique puis une tetanisation ont ete enregistes grâce a un modele d’analyse dynamique de la contraction musculaire. Resultats et conclusions Nos resultats preliminaires montrent que le taux de recrutement des unites motrices obtenu dans nos muscles blesses est plus faible en comparaison a celui obtenu a partir de muscles non blesses. L’utilisation de cellules fœtales transposees dans ces muscles leses ameliore le recrutement de fibres musculaires.