Near-infrared fluorescence imaging-guided surgery improves recurrence-free survival rate in novel orthotopic animal model of head and neck squamous cell carcinoma

International audienceBackground. Appropriate animal models are required to test novel therapeutics for head and neck squamous cell carcinoma (HNSCC) such as near-infrared (NIR) imaging-guided surgery. Methods. We developed an optimized animal model of orthotopic HNSCC (in female athymic NMRI (Naval Medical Research Institute) nude mice) with a prolonged survival time. Resection of the orthotopic tumors was performed 30 days after implantation with or without the aid of a minia-turized clinical grade NIR optical imaging device, after systemic administration of a fluorescent RGD-based probe that targets a v b 3 integrin. Results. NIR optical imaging-guided surgery increased the recurrence-free survival rate by 50% through the detection of fluorescent cancer residues as small as 185 mm; these fragments could remain unidentified if resection was performed exclusively under unaided visual guidance. Conclusion. NIR optical imaging-guided surgery showed an improved HNSCC tumor resection quality in our optimized orthotopic animal model

[A radiological case of sinusology: a schwannoma localized in the sinuses]

International audienceINTRODUCTION: In daily practice, the otorhinolaryngologist may face cases of facial tumors of sinonasal origin. Their diagnosis remains difficult based on clinical findings alone. Therefore, imaging techniques can guide the surgeon toward the correct diagnosis. METHODS: A 14-year-old male presented with a history of headaches and nasal obstruction. Physical examination revealed a mass in the right nasal fossa. RESULTS: A computed tomography scan showed an isodense lesion in the posterior half of the right nasal fossa, extending into the maxillary sinus, orbital floor, pterygopalatine fossa, and infratemporal fossa. Magnetic resonance imaging showed great enhancement upon gadolinium administration. The diagnosis of schwannoma was suggested after angiography was performed. The tumor was then resected via a transfacial approach with maxillozygomatic osteotomy. Pathologic examination confirmed the diagnosis of schwannoma. CONCLUSION: The definite diagnosis of a sinonasal tumor can be confirmed only histologically. However, preoperative radiological data can direct the surgeon toward the correct diagnosis and above all the most appropriate surgical approach

Mise en place et diffusion d’un campus numérique en milieu hospitalo-universitaire : l’exemple de l’oto-rhino-laryngologie (ORL)

Contexte : Le campus numérique d’ORL est issu d’un projet de modernisation de l’enseignement suite aux appels à projets « Campus numériques français » lancés entre 2000 et 2002 par le ministère de l’Education nationale. Matériels : Réorganisation du contenu pédagogique du deuxième cycle des études médicales dans l’optique de la formation aux épreuves nationales classantes des étudiants en médecine, avec mise à disposition sur une plate-forme librement accessible, gérée par le collège français d’ORL et de chirurgie cervico-faciale (CFORL). Application par une plate-forme spécifiquement dédiée à l’apprentissage à distance (Acol@d, Université Louis Pasteur, Strasbourg) pour les pays francophones avec tutorat synchrone et asynchrone. Buts : 1) actualisation et modernisation des contenus pédagogiques ; 2) homogénéisation de ceux-ci au niveau national sous l’égide du collège français d’ORL et de chirurgie cervico-faciale (CFORL) ; 3) diffusion des connaissances labellisées par le CFORL par l’Université Médicale Virtuelle Francophone (UMVF) ; 4) mise en place d’une formation annuelle à distance destinée aux pays de langue française et anglaise, avec sanction par un diplôme d’université. Conclusion : La concrétisation sur une période de trois ans de ces objectifs justifie l’éligibilité initiale du projet et permet à notre spécialité d’entrer dans une phase de diffusion des connaissances sur le plan international. Cette phase initiale fondatrice doit être prochainement évaluée du point de vue des enseignants et des étudiants

Spontaneous perforation in the upper oesophagus resulting from ulcer in heterotopic gastric mucosa.

International audienceHeterotopic gastric mucosa (HGM) can be found throughout the entire gastrointestinal tract, more frequently in the cervical oesophagus. Macroscopic HGM is named inlet patch (IP). The great majority of IPs are asymptomatic and discovered incidently during oesophageal endoscopy performed for another pathology. However, complications can occur. Among these, perforation is extremely rare. We report a case of a 27-year old man who presented with a perforation of an upper oesophageal ulcer arising from an IP. The diagnosis was made during endoscopy and confirmed with biopsy of the tissue surrounding the perforation, showing histologic modifications consistent with heterotopic gastric mucosa. Medical treatment using a proton pump inhibitor and antibiotics delivered with a gastric tube was advocated. The perforation was closed at day 7 and plasma Argon coagulation of the inlet patch was performed two months later. Annual endoscopy has been normal for three years

[Aberrant methylation of tumor suppressor genes in head and neck squamous cell carcinoma: is it clinically relevant?]

International audienceDuring malignant transformation, the malignant cell accumulates epigenetic abnormalities that do not alter the DNA sequence but are transmissible during divisions and modify genes expression. The methylation of CpG islands in the tumor suppressor genes (TS genes) promoters inhibits their transcription ; it is a mecanism of gene inactivation as frequent as allelic deletions. The methylation profile (or panel of methylated genes in a tumor), similarly to allelic deletions, varies with the tumor histology. Within head and neck squamous cell carcinoma (oral cavity, larynx and oropharynx), 19 genes have been analysed, among them 5 are frequently methylated, i.e. : p16, ECAD, DAPK, MGMT et TIMP3. The method of methylation analysis, based on a bisulfite treatment followed by a PCR amplification, is sensitive and specific enough to allow the detection of abnormalities in biological fluid that drain the tumor or in circulating tumoral DNA. In the head and neck squamous cell carcinoma, correlation between the methylation profile in tumor and paired saliva is excellent ; thus methylation analysis in saliva is a very promising approach for early cancer detection in high risk patients or for the post treatment follow up and rapid diagnosis of relapse. The methylation signature might also reflect the tumor prognosis and complete the histology to define the diagnosis. Finally, DNA methylation is reversible with demethylating agents, a new avenue for cancer therapy in association with conventional chemotherapy

[Parenteral nutrition in pharyngo-laryngeal oncologic surgery].

International audienc

Cervical cellulitis and mediastinitis following esophageal perforation: A case report

Chicken bone is one of the most frequent foreign bodies (FB) associated with upper esophageal perforation. Upper digestive tract penetrating FB may lead to life threatening complications and requires prompt management. We present the case of a 52-year-old man who sustained an upper esophageal perforation associated with cervical cellulitis and mediastinitis. Following CT-scan evidence of FB penetrating the esophagus, the impacted FB was successfully extracted under rigid esophagoscopy. Direct suture was required to close the esophageal perforation. Cervical and mediastinal drainage were made immediately. Naso-gastric tube decompression, broad-spectrum intravenous antibiotics, and parenteral hyperalimentation were administered for 10 d postoperatively. An esophagogram at d 10 revealed no leak at the repair site, and oral alimentation was successfully reinstituted. Conclusion: Rigid endoscope management of FB esophageal penetration is a simple, safe and effective procedure. Primary esophageal repair with drainage of all affected compartments are necessary to avoid life-threatening complications

Osteoplastic maxillotomy approach for infraorbital nerve schwannoma, a case report.

International audienceBACKGROUND: Extracranial schwannomas can readily occur in the head and neck region and rarely involve the trigeminal nerve. As a rule, their treatment is surgical and dictated by the location of the tumor and nerve of origin. METHODS: We describe a case of a 14-year-old boy with a mass invading right nasal fossa, maxillary sinus, orbital floor, pterygopalatine fossa, and infratemporal fossa. The diagnosis of a nerve sheath tumor was evoked after angiography showed no vascular blush. RESULTS: The tumor was removed through a Weber-Fergusson incision with subciliary extension followed by maxillozygomatic osteotomy. This approach showed the tumor to be coming from the infraorbital nerve and allowed complete tumor exposure and removal. Pathology confirmed the diagnosis of a schwannoma. CONCLUSION: We describe the osteoplastic maxillotomy approach which we felt most appropriate for removal of the infraorbital schwannoma and discuss other possible surgical options for this type of tumor

[Outcome of surgical and adjuvant radiotherapy treatment of T3-T4 squamous cell carcinoma of the floor of the mouth: evaluation of oncological control and treatment related morbidity]

International audienceOBJECTIVE: The aims of this study were to evaluate the therapeutic outcome and morbidity associated with management of squamous cell carcinoma (SCC) T3-T4 of the floor of the mouth. PATIENTS AND METHODS: This was a retrospective study (1993 and 2005). Inclusion criteria were: 1) Presence of a locally advanced (T3-T4) lesion of the floor of the mouth; 2) Pathological confirmation of SCC; 3) No previous treatment of the floor of the mouth; 4) Absence of any synchronous lesions at the primary endoscopic work-up; 5) Absence of distant metastasis outside the aero-digestive tract; 6) Karnofsky performance index > 70. All patients were treated by surgery and adjuvant radiotherapy. The statistical analysis was conducted using the stat-view software; categorical variables were compared using the Fisher's exact test; analysis of recurrence-free survival rate was done following the Kaplan-Meier method, and the log-rank test was used for the comparison of survival graphs. RESULTS: Fourty-seven patients were included in this study (42 men), of a mean age of 53.3 years. The majority of patients (93.6%) presented with a stage IVa tumour and no clinical evidence of cervical lymphadenopathy in 60% of cases. All patients underwent bilateral neck dissection adapted to the cervical lymph node status. Forty-one (87%) patients underwent partial mandibulectomy with fibula free-flap reconstruction in 32 cases (78%). Early local complication rate was of 32%. The mean duration of hospitalization was 34 days. Late local complication rate was of 17%. The immediate post-operative death rate was 2%. The rate of survival and recurrence free survival was of 47.5% and 47% respectively. The 3 survival-influencing factors were age (p = 0.02), margins of surgical resection (p = 0.002), and histologic cervical lymph node status (p = 0.03). CONCLUSION: T3-T4 tumours of the floor of the mouth are managed by surgical resection and adjuvant radiotherapy. There is a high rate of treatment-associated complications. The prognosis of locally advanced tumours of the floor of the mouth remains humble

[Schwannomas of the neck. About 3 cases, and literature review]

International audienceINTRODUCTION: Schwannomas of the neck are rare. Their diagnosis remains difficult despite the evolution of imaging techniques. The goals of our study were to review the diagnostic and therapeutic approach for these tumors. MATERIALS AND METHODS: Retrospective study (1998-2005) concerning 3 cases of schwannoma in rare localizations: superior laryngeal nerve, ansa cervicalis and deep cervical plexus. These 3 patients were operated on in our ENT head and neck department. We made a review of the literature using the Medline database. RESULTS: The mean delay between symptomatology and treatment was 5 years. In all cases, the schwannoma presented with a slowly-growing cervical mass. In only one case, the diagnosis of schwannoma was maded preoperatively. All 3 patients were treated surgically and the involved nerve was sacrificied. There were no postoperative complications. The mean follow-up duration was 3.5 years, with no recurrence. DISCUSSION-CONCLUSION: To establish a diagnosis of neck schwannoma, ultrasound is the least sensitive imaging tool. Fine needle aspiration is especially useful to rule out other conditions. The most relevant diagnostic tools are CT-scan and especially MRI. Treatment is surgical; it should include sacrifice of the involved nerve. Surgical exploration of the neck and tumor resection could be performed at the same operation in the informed patient aware of the sequelae of nerve sacrifice, or otherwise be performed in two steps in the uninformed patient