Romain Kania

Surgical management of inverted papilloma: Approaching a new standard for surgery

Inverted papilloma surgery is currently performed primarily with an endoscopic approach, a technique that has a recurrence rate of 12%. However, a recent study reported a recurrence rate of 5% with a strategy based on subperiosteal dissection of the tumor, with limited indications for using an external approach. The aim of this work was to evaluate whether different teams using the same surgical concepts could reproduce the excellent results that were recently reported.

Early laryngeal injury and complications because of endotracheal intubation in acutely poisoned patients: a prospective observational study

Objective.u2002Tracheal intubation may represent a life-saving supportive measure in many acutely poisoned patients. Although considered as a safe procedure, intubation may rapidly damage laryngeal mucosa. The incidence and nature of short-duration intubation-associated laryngeal injuries are unknown in the population of poisoned patients.u2003Methods.u2002We designed a prospective clinical investigation to study intubation-related laryngeal complications in poisonings. All consecutive intubated poisoned patients admitted over a 20-month period in our toxicological intensive care unit in a teaching hospital were included in this study. Daily clinical observation and laryngeal fiberscopic evaluation were performed to assess intubation-related laryngeal complications.u2003Results.u2002We included 266 consecutive poisoned patients who had been intubated [116M/150F; age 41 years (31–53); median (25–75% percentiles); simplified acute physiology score II 43 (32–51); intubation time 24 h (13–52)]. Intubation was mainly performed at the scene (69%) and depended on the level of coma (89%). Complications included postextubation laryngeal dyspnea (9%) requiring mandatory reintubation (2%). Laryngoscopy was performed in 209 patients (79%) within 24 h after extubation. Eighty percent of patients presented significant initial laryngeal lesions. Stepwise logistic regression showed that two variables were predictive of injuries: female gender (odds ratio: 2.6; 95% confidence interval: 1.3–5.3) and intubation time ≥72 h (odds ratio: 6.4; confidence interval: 1.5–27.6). Overall, injuries were independent of age, severity of illness, coma level, vital signs, intoxicants, and intubation modalities. The most severe injuries were significantly associated with intubation time (p < 0.001) and simplified acute physiology score II (p = 0.04). Within 24 h following extubation, persistent dysphonia (p < 0.0001), dysphagia (p < 0.0001), or pharyngeal pain (p = 0.02) were predictive of laryngeal injury.u2003Conclusions.u2002Despite short-duration intubation, poisoned patients are at high risk of initial laryngeal injury.

Outcomes of endoscopic ethmoidectomy performed on a day-case basis: a prospective bi-centric study

Evaluation of endoscopic ethmoidectomy performed as a day-case in terms of security, quality, and satisfaction of the patient. This prospective observatory bi-centric study over 1xa0year included 74 patients undergoing an ethmoidectomy respecting the eligibility criteria of ambulatory care. We recorded patients’ demographic data, operative details, satisfaction, postoperative course, and follow-up results. Nasal symptoms were evaluated by SNOT-22 on preoperative appointment and postoperatively at D30. No non-absorbable nasal packing was used, eventually in the case of preoperative-bleeding absorbable gelatine packing. The postoperative follow-up took place at D1 by phone call and at D10 and D30 to assess complications, Visual Analogue Scale, and state of ethmoidal corridors by endoscopic exam. Patients benefited of bilateral ethmoidectomy in 82.4xa0% cases associated with septoplasty in 42xa0%. The majority (95xa0%) was discharged on the same day. Only one patient had bleeding at D0 and was kept in standard hospitalization, such as three other patients for medical or organizational reasons not related to surgery. At D1, 23xa0% described postoperative light bleeding but needed no revisit and pain was estimated at 1.3 (VAS). No readmission was observed, and no major complication was noted. SNOT-22 decreased successfully by 56xa0%, statistically related to postoperative treatment of corticosteroids and in the case of Samter triad. 97xa0% of patients were satisfied of the ambulatory care. These results suggest that within an experienced and dedicated day-case medical and paramedical team, ethmoidectomy can be safely performed on a day-case basis with high quality of taking care and satisfaction of patients.

La chirurgie thyroïdienne endoscopique par techniques vidéo-assistées et totalement endoscopiques

R.E. Kania *, M. Parodi , A. Coste , P. Herman , P. Tran Ba Huy , J.-F. Papon b,c,d,e a CNRS, LNRS 7060, service d’ORL & CCF, pôle neurosensoriel tête et cou, hôpital Lariboisière, AP–HP, université Paris-Diderot Paris-7, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France b Service ORL & CCF, hôpital Intercommunal, 94010 Créteil, France c Service ORL & CCF, groupe hospitalier Henri-Mondor – Albert-Chenevier, AP–HP, 94010 Créteil, France d Inserm, U955, 94010 Créteil, France e UMR_S841, faculté de médecine, université Paris-12, 94010 Créteil, France

Ethmoidal adenocarcinoma treated by exclusive endoscopic approach: Focus on learning curve and modification of management

The purpose of this study was to investigate the outcome and recurrences for ethmoidal adenocarcinomas treated by exclusive endoscopic surgery in curative intent and investigate the role of the learning curve.

Author’s reply to “Letter to the editor on the article: Saccular measurements in routine MRI can predict hydrops in Menière’s disease by Simon F et al.”

This is an answer to the Letter to the Editor regarding our previously published article « Saccular measurements in routine MRI can predict hydrops in Menière’s disease ». We thank the authors for their interest in our article and their insightful comments. We would like to emphasise that our article was a preliminary study and to our knowledge the first published series establishing a correlation between measurements of saccular morphology in T2-weighed 3D CISS images and clinical definite Menière’s disease. Therefore, we agree with the authors of the Letter that verifying reproducibility is paramount for the technique to be widely used. Further studies should be conducted to investigate the risk of artefacts reducing the reliability of saccular width measurements and to confirm the clinical implications. We recommend the use of saccular height measurements which have higher reliability. Also, the goal of the study was to present a possible radiological alternative to the more established methods of endolymphatic hydrops visualisation. If accessible, we agree that the latter techniques should be preferred, but we find that they are unfortunately too often unavailable in routine clinical practice to ENT physicians.

The recurrent laryngeal nerve and the tubercle of Zuckerkandl

The tubercle of Zuckerkandl is the posterior and lateral projection of the thyroid gland. It was originally described by anatomists, and later became of interest to thyroid and parathyroid surgeons because of its close proximity to the recurrent laryngeal nerve and the superior parathyroid gland. It is more frequently found on the right side of the body, and when found bilaterally it is often larger on the right. It has been postulated that an enlarged tubercle of Zuckerkandl can cause symptoms of compression even in the absence of a large goiter, but it is clinically significant because of its use as a landmark for finding the recurrent laryngeal nerve and the superior parathyroid gland during surgery.

Petrous and sphenoid arachnoid cysts: Diagnosis and management

Intraosseous arachnoid cysts are rare and difficult to diagnose. The purpose of this study was to describe the clinical and radiological semiology of petrous and sphenoid arachnoid cysts and to propose a specific management strategy.

Vestibular schwannoma and cell-phones. Results, limits and perspectives of clinical studies

The widespread development of cell-phones entails novel user exposure to electromagnetic fields. Health impact is a public health issue and a source of anxiety in the population. Some clinical studies reported an association between cell and cordless phone use and vestibular schwannoma; others found none. A systematic review was performed of all published clinical studies (cohort, registry, case-control and validation studies), with analysis of results, to determine the nature of the association and the level of evidence. Cohort studies were inconclusive due to short exposure durations and poor representativeness. Registry studies showed no correlation between evolution of cell-phone use and incidence of vestibular schwannoma. Case-control studies reported contradictory results, with methodological flaws. Only a small number of subjects were included in long-term studies (>10 years), and these failed to demonstrate any indisputable causal relationship. Exposure assessment methods were debatable, and long-term assessment was lacking. An on-going prospective study should determine any major effect of electromagnetic fields; schwannoma being a rare pathology, absence of association will be difficult to prove. No clinical association has been demonstrated between cell and cordless phone use and vestibular schwannoma. Existing studies are limited by their retrospective assessment of exposure.