Philippe Halimi

Corticosteroid treatment in nasal polyposis with a three-year follow-up period.

Objectives/Hypothesis The management of nasal polyposis is undoubtedly a controversial subject. The part played by surgery seems to be steadily growing, if the number of published reports dedicated to this approach is any yardstick. Although the medical treatment remains the undisputed therapeutic mainstay, trials dedicated to the long‐term assessment of its overall efficacy are scarce.

Correlation between Nasosinusal Symptoms and Topographic Diagnosis in Chronic Rhinosinusitis

Rhinitis and sinusitis concern roughly a quarter of the population in the Western world. They are associated with a wide range of symptoms: nasal obstruction, anterior and posterior nasal discharge, sneezing episodes, facial pain or congestion, and taste and smell disorders. The aim of this prospective study was to evaluate the clinical significance of these various symptoms as a function of the topographic diagnosis of chronic rhinosinusitis. The study involved 474 patients with signs of chronic perennial and persistent rhinosinusitis. The disorders of the nasal cavities and paranasal sinuses were classified into three main diagnostic categories: chronic rhinitis, localized sinusitis (mainly, anterior sinusitis), and diffuse rhinosinusitis (ie, nasal polyposis). A principal components analysis was performed. The symptom patterns of the three main clinical entities differed greatly. Most of the following clinical signs — nasal obstruction, anterior and posterior nasal discharge, sneezing, and facial congestion — are found in all diagnostic categories and hold no specific clinical significance. By contrast, four symptoms seem to have a substantial differentiating potential: anosmia and complete loss of flavor for diffuse rhinosinusitis, cacosmia for localized anterior sinusitis, and severe facial pain for localized sinusitis. This study proposes a new analysis of the relationship between symptoms of chronic rhinosinusitis and findings on a sinus computed tomography scan.

Use of single MRI and 18F-FDG PET-CT scans in both diagnosis and radiotherapy treatment planning in patients with head and neck cancer: Advantage on target volume and critical organ delineation

The use of a single MRI and 18F‐fluoro deoxyglucose positron emission tomography‐CT (18F‐FDG PET‐CT) was evaluated, both in diagnostic procedure and radiotherapy planning, in patients with head and neck cancer.

Cavernous Sinus Involvement from Recurrent Adenoid Cystic Carcinoma

DISCUSSION division of the right trigeminal nerve, a decreased right corneal reflex, and right mydriasis. The remainder of the findings on head and neck examination were unremarkable. A CT scan revealed right pterygopalatine fossa invasion (Fig lA). Enlargement of the right foramen rotundum, right vidian canal, and right inferior and superior orbital fissures was documented (Fig IB-D). Furthermore, the integrity ofthe right parasellar region was not clearly demonstrated (Fig IB). Magnetic resonance imaging (1.5-T unit Sigma General Electric using a three-dimensional Fourier transform gradient echo sequence with a repetition time of 36 milliseconds, an echo time of 5 milliseconds, a flip angle of 30°, a 1.5-mm slice thickness, and gadolinium diethylenetriamine pentaacetic acid intravenous administration) allowed for precise visualization of the tumor extent at the level of the right pterygopalatine fossa, right foramen rotundum, right inferior and superior orbital fissures, and right vidian canal (Fig 2A-C). Tumor extent along the right foramen ovale (Fig 2D) was detailed. Reformatted views in the coronal plane allowed for visualization of tumor spread along the mandibular division of the right trigeminal nerve (Fig 2D). Involvementofthe right cavernous sinus with enhancement ofthe inferior and anterior portions ofMeckels cave, and perfect visualization of the right internal carotid artery was documented (Fig 2A,C). The treatment was associated cisplatin and radiotherapy. Radiotherapy to thebaseofthe skull and the infratemporal fossa region delivered 60 Gy in 25 fractions. The treatment allowed for complete remission of signs and symptoms. The patientremains asymptomatic 12 months after radiotherapy. CASE REPORT

Terrorist attacks in Paris: Surgical trauma experience in a referral center

BACKGROUND On November 13th, 2015, terrorist bomb explosions and gunshots occurred in Paris, France, with 129 people immediately killed, and more than 300 being injured. This article describes the staff organization, surgical management, and patterns of injuries in casualties who were referred to the Teaching European Hospital Georges Pompidou. METHODS This study is a retrospective analysis of the pre-hospital response and the in-hospital response in our referral trauma center. Data for patient flow, resource use, patterns of injuries and outcomes were obtained by the review of electronic hospital records. RESULTS Forty-one patients were referred to our center, and 22 requiring surgery were hospitalized for>24h. From November 14th at 0:41 A.M. to November 15th at 1:10 A.M., 23 surgical interventions were performed on 22 casualties. Gunshot injuries and/or shrapnel wounds were found in 45%, fractures in 45%, head trauma in 4.5%, and abdominal injuries in 14%. Soft-tissue and musculoskeletal injuries predominated in 77% of cases, peripheral nerve injury was identified in 30%. The mortality rate was 0% at last follow up. CONCLUSION Rapid staff and logistical response, immediate access to operating rooms, and multidisciplinary surgical care delivery led to excellent short-term outcomes, with no in-hospital death and only one patient being still hospitalized 45days after the initial event.

Lymphocele after Neck Dissection

The current report documents a case of lymphocele after neck dissection and reviews the management and treatment options.

Medical Treatment of Stage I Nasal Polyposis over a 3-Year Follow-Up Period

Purpose: To determine the effects of a standardized therapeutic protocol (short-term oral administration of prednisolone and daily intranasal spray of beclometasone) on stage I nasal polyposis over a follow-up period of 3 years. Procedures: Assessments (evaluation of nasal function and drug consumption) were conducted at baseline and every 3 months on 54 consecutive patients with stage I nasal polyposis during 3 years. Results: Over the follow-up period of 3 years, this dual modality proved to be successful in 87% of the subjects; only 13% had to undergo surgery after its failure. The average symptom reduction reached an improvement rate varying from 66 to 94.8%, according to the symptom type. The daily dosage of prednisolone and beclometasone was progressively decreased, while the gain in nasal comfort was being preserved. Conclusion: Management of stage I nasal polyps should be primarily medical.

Computerized tomography of the glottis after intracordal autologous fat injection

According to the committee on speech, voice, and swallowing disorders of the American Academy of Otolaryngology-Head and Neck Surgery, various surgical methods such as laryngeal framework surgery, laryngeal re-innervation, and injection laryngoplasty might be used to palliate inferior laryngeal nerve paralysis. In the present case report we document the survival and exact location of the boluses of autologous fat in one patient in whom this material was used for injection laryngoplasty.

Atypical pseudotumoral osteomyelitis of the skull base

Typical osteomyelitis of the skull base (SBO) is initiated by ear infection, especially malignant otitis externa in diabetic and immunocompromised patients, whereas atypical SBO does not begin with otitis externa. Particular attention should be drawn to a rare form: the pseudotumoral form presenting as a mass of the skull base and/or a submucosal tumefaction of the nasopharynx that evokes the diagnosis of a malignant tumor of the nasopharynx or a metastatic disease in the skull base. Over the past 20 years, less than 20 such cases have been documented. A 56-year-old woman was referred complaining of dysphonia and swallowing impairment. The condition, with progressive left otalgia, severe temporal headache, and a 10-kg weight loss, had started 2 months earlier while the patient was on a boat trip. On clinical examination the patient had a left serous otitis media and a submucosal mass within the left nasopharynx together with paralysis of the IX, X, and XII cranial nerves. Otorrhea was not encountered. General biological workup revealed a previously unknown diabetes mellitus and moderate renal insufficiency. MRI was performed (Fig 1) and a lymphoma was suspected. Pathological analysis of the biopsy did not reveal any tumor. Fluid from the middle ear was sterile. Bacteriological culture from the nasopharynx revealed Pseudomonas pyocyaneus. Atypical SBO was diagnosed. The treatment associated ceftazidime (Fortum 3 g/d) and oral ciprofloxacin (Ciflox 750 mg/d). After an overall 5 months of antibiotic treatment, complete clinical recovery with a normal MRI was achieved. The patient is doing well 62 months from admission.

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.