Philippe Eloy

The use of injectable collagen to correct velopharyngeal insufficiency.

The use of Gax® collagen is proposed for correcting velopharyngeal insufficiency with posterior pharyngeal wall augmentation. The indications for this procedure are velopharyngeal insufficiency that remains after surgery and treatment by a speech pathologist. The procedure is also valuable after velum paralysis.

Actual concepts in rhinosinusitis: A review of clinical presentations, inflammatory pathways, cytokine profiles, remodeling, and management

Rhinosinusitis (RS) is a heterogeneous group of diseases. It is a significant and increasing health problem that affects about 15% of the population in Western countries. It has a substantial impact on patients’ health-related quality of life and daily functioning and represents a huge financial burden to society and the health care system as a result of the direct and indirect costs. In addition, RS is not well-understood, and little is known about the etiology and pathophysiology. In the past decade, many papers have been published that have changed our understanding of RS. RS is commonly classified into acute and chronic RS based on symptom duration. In acute RS, an inflammatory reaction initiated by a viral infection characterizes most uncomplicated, mild to moderate cases. Therefore, the first line of treatment for these cases are intranasal steroids and not antibiotics. In severe and complicated cases, antibiotics combined with topical steroids remain the treatment of choice. On the other hand, chronic RS is actually subdivided into two distinct entities (chronic rhinosinusitis with and without polyps), as growing evidence indicates that these entities have specific inflammatory pathways and cytokine profiles. The authors review recent data regarding the clinical presentations, cytokine profiles, tissue remodeling, and modalities of treatment for each form of RS.

Genetic evidence for a role of IL33 in nasal polyposis

To cite this article: Buysschaert ID, Grulois V, Eloy P, Jorissen M, Rombaux P, Bertrand B, Collet S, Bobic S, Vlaminck S, Hellings PW, Lambrechts D. Genetic evidence for a role of IL33 in nasal polyposis. Allergy 2010; 65: 616–622.

The silent sinus syndrome

Silent sinus syndrome is a rare clinical entity typically characterized by spontaneous and progressive enophthalmos and hypoglobus caused by an alteration of the normal orbital architecture and function from maxillary collapse in the setting of the chronic maxillary sinus hypoventilation. The authors report an unusual case revealed by mild dental pain, present the imaging (before, during and after the development of the disease), discuss the different theories related to pathogenesis and comment the treatment.

Pediatric endonasal endoscopic dacryocystorhinostomy

Dacryocystorhinostomy (DCR) in children is indicated in cases of common congenital nasolacrimal duct obstruction (CNLDO) unresponsive to medical therapy, probing or intubation. The purpose of this manuscript is to evaluate the effectiveness of endonasal endoscopic pediatric DCR. The authors present a series of eight children (seven boys and one girl) who underwent a pediatric endonasal DCR between September 2007 and December 2008. The mean age was: 4.3 years (range: 8 months to 9 years old). Three children had a craniofacial abnormality. There were ten primary DCRs and one revision DCR. In nine cases, the indication was a pure primary low mechanical obstruction persistent after one or more probings. In the 10th case there was also a stenosis of the inferior canaliculus diagnosed during the DCR. The revision DCR was indicated because of the closure of the stoma created 3 years ago. A silicone intubation was put in place only in two cases: in case of a stenosis of the inferior canaliculus (3 months) and the other in case of revision DCR (1 month). The follow-up for primary DCRs was 10.5 months (range: 6-15) and for revision surgery 6 months (after the retrieve of the stent). In primary DCRs, there was a complete resolution of symptoms in nine out of 10 cases. The 10th case experienced a transient slight epiphora during a viral rhinitis. In case of revision DCR, the child was free of symptoms. In conclusion pediatric DCR is a very effective and safe procedure for the treatment of a low mechanical obstruction of the lacrimal pathway in children unresponsive to previous probings. Stenosis of the inferior canaliculus can give some slight intermittent epiphora despite a wide and patent stoma. Moreover craniofacial abnormalities are more common in children than in adults undergoing a DCR.

Endonasal endoscopic resection of an ethmoidal solitary fibrous tumor

Solitary fibrous tumor (SFT) is an uncommon spindle cell tumor that typically arises at the level of the pleura in adults. However, SFT has also been reported in various extrapleural sites including orbit, meninges, liver, lung, salivary glands, retroperitoneum, mediastinum. In the head and neck region, SFT has been documented in the external auditory canal, larynx, thyroid, sublingual gland, tongue, parapharyngeal space and the infratemporal fossa. The nose and the paranasal sinuses are a rare site for SFT with only 14 publications in the world literature. We present an additional case of a SFT arising at the level of the right ethmoid sinus successfully removed in one piece endoscopically and review the corresponding literature.

A new technique for laser-assisted uvulopalatoplasty: decision-tree analysis and results.

Objective: Report a new technique of laser‐assisted uvulopalatoplasty (LAUP) for snoring performed as a one‐stage procedure. Study Design: A decision‐tree was used in a prospective study of 89 patients from April 1994 to May 1997. It included a fiberscopy and Midlers maneuver, rhinomanometry, pH monitoring, computed tomography scan to measure the pharyngeal lumen, pulse oximetry, and polysomnography in case of sleep apnea syndrome was suspected. Methods: The authors performed their LAUP technique on 43 patients (48.5%) whose snoring was mainly caused by the velum. This technique consists of scarifying the velum by vaporizing the mucosa and the submucosa along a rectangle extending from the palatal dimple to the uvula and having a width of 1.5 to 2 cm. Vaporization of the palatal arches follows without exceeding the junction of the anterior and posterior pillars in height. The uvula is cut if necessary, preserving a length of at least 0.5 cm. The other patients underwent different procedures according to the cause of snoring. Results: There was no significant difference between LAUP and uvulopalatoplasty (UPPP) regarding pain. No permanent phonatory disorders and no regurgitation occurred. Satisfaction evaluated on a scale ranging from 0 to 10 was equivalent for the two techniques: mean value = 7.68 (±2.18) for LAUP and 8.60 (±2.27) for UPPP. The mean follow‐up was 17 months (range, 1–37 mo). Satisfaction was also identical for all techniques. Conclusion: Our LAUP technique combined with other procedures according to a decision‐tree is efficient and safe.

Taste disorders after tonsillectomy: case report and literature review.

The authors describe a case of dysgeusia that occurred during the recovery period after a tonsillectomy. The cause was thought to be a lesion to the lingual branch of the glossopharyngeal nerve because of the location of the symptoms at the posterior region of the buccal cavity and because of the raised electrogustometric thresholds in the posterior region of one half of the tongue. Clarification of this type of case was made by a review of the literature from 1966 to June 2004, carried out with the aid of Medline. From a medicolegal standpoint, it is important to inform the patient of the risk of dysgeusia after tonsillectomy, especially if that patient has a profession in which taste plays an essential role.

Presence of olfactory event-related potentials predicts recovery in patients with olfactory loss following upper respiratory tract infection.

The aim of the present study was to evaluate the course of olfactory dysfunction in patients with olfactory loss following infections of the upper respiratory tract.

Sphenoid sinus fungall ball: A retrospective study over a 10-year period

A fungal ball consists of a dense conglomerate of fungal hyphae growing at the surface of the sinus mucosa without tissue infiltration. The maxillary sinus is by far the most commonly involved paranasal sinus cavity followed by the sphenoid sinus. The present study is a retrospective study of 25 consecutive cases treated during the last 10 years in the two hospitals be- longing to the Catholic University of Louvain (CHU Mont-Godinne and UCL Saint Luc). We report the symptomatology, the imaging and discuss the different surgical managements. We conclude that the clinician must have a high index of suspicion when dealing with a unilateral rhinosinusitis persisting despite a maximal and well conducted medical treatment. This is particularly so in elderly women when associated with facial pain and post nasal drip, particularly when the computed tomography shows an unilateral opacity of the sphenoid sinus with or without a sclerosis or an erosion of the bony walls, a polyp in the sphenoethmoidal recess or a hyperdensity mimicking a foreign body. An endonasal endoscopic sphenoidotomy is the treatment of choice in most cases, allowing good ventilation of the sinus and radical removal of all the fungal concretion. A biopsy of the sinus mucosa adjacent to fungal elements is of upmost important to confirm the non- invasiveness of the fungi within the tissue. Antifungal medication is not required in uncomplicated forms. All host factors producing some degree of immunosuppression must be corrected when present and must alert the clinician to rule out any forms of invasive disease.