Acquired cholesteatoma in children: Strategies and medium-term results

SummaryObjectivesTo assess paediatric cholesteatoma surgical management strategies, residual disease and recurrence rates and especially the medium-term auditory impact.Material and methodsRetrospective study of 22 cases of acquired middle ear cholesteatoma selected from a series of 77 children under the age of 16 operated for cholesteatoma between 1st January 2000 and 31st December 2003 on the basis of the following criteria: first-line surgical management with postoperative follow-up greater than four years. Surgical strategies, preoperative and postoperative (at 1 year and at the final visit) audiograms and residual disease and recurrence rates were analysed.ResultsA canal wall up tympanoplasty was performed in 82% of cases as first-line procedure and a canal wall down tympanoplasty was performed in 32% of cases. Residual cholesteatoma was observed in 9% of cases and recurrent disease was observed in 18% of cases. The mean preoperative hearing loss was 26dB with an air-bone gap of 23dB with values of 26dB and 20dB respectively at the end of follow-up.ConclusionThe majority of children were operated by two-stage canal wall up tympanoplasty. Long-term hearing results remained stable and close to preoperative values. The recurrence rate (residual disease and relapse) was low (27%), as reported in the literature

Management of voice prosthesis leakage with Blom-Singer large esophage and tracheal flange voice prostheses

SummaryIntroductionVoice rehabilitation after total laryngectomy is a major socio-economic challenge. Voice rehabilitation can be achieved by voice prostheses, which provide rapid patient satisfaction. Enlarged tracheo-oesophageal puncture is a frequent complication and can be difficult to manage.Material and methodA prospective study was conducted from November 2010 to October 2011 on 28 Blom-Singer large oesophageal and tracheal flange voice prostheses placed in 18 patients with enlarged tracheo-oesophageal puncture causing leakage around the voice prosthesis.ResultLeakage around the voice prosthesis resolved in all patients with a mean prosthesis lifespan of 95 days. The patients considered voice quality to be similar to that obtained with the initial voice prosthesis.ConclusionThe Blom-Singer large oesophageal and tracheal flange voice prosthesis is a useful solution for the management of periprosthetic leakage ensuring similar voice quality and an identical lifespan to that of other voice prostheses

Morbidity and mortality revue of the French group of transoral robotic surgery: a multicentric study

International audienceTransoral robotic assisted surgery (TORS) represents an innovative endoscopic therapeutic alternative in the treatment of head and neck tumors. Many publications favor this surgery, especially in terms of functional results. The aim of this study was to investigate the TORS morbidity and mortality and to identify the risk factors for complications. It is a multicenter retrospective study. All head and neck tumor patients treated by TORS were included in the study over a period of 5 years (2009-2014). The studied parameters were the intraoperative and post-operative complications including hemorrhage, fistula, tracheotomy, aspiration pneumonia and death. The parameters were correlated with age, tumor location, tumor stage, endoscopic exposure and patient's co-morbidities. 178 patients were included in the study. Malignant tumors classified as T1 were found in 169 cases (n = 51), T2 (n = 100), T3 (n = 16) and T4 (n = 2). The tumor locations were distributed as follows: larynx (n = 84), oropharynx (n = 51), and hypopharynx (n = 43). Fifty-three patients followed post-radiation therapy. We observed 12 intraoperative complications including 6 hemorrhage, 3 pharyngeal fistulas and 3 external surgical conversions. Postoperatively, we detected 33 hemorrhage, 27 aspiration pneumonia, 9 tracheostomy, 2 pharyngostomes, 2 cervical spondylitis and 2 deaths. The risk factors identified were (i) anticoagulant and/or antiplatelet therapy for hemorrhage, (ii) tumoral stage and the laryngeal location for aspiration pneumonia and (iii) laryngeal location for tracheostomy. Higher age over 65 years has been identified as a risk factor for all post-operative complications. TORS is a safe technique for the treatment of head and neck tumors. We identified some risk factors for complications which should systematically be studied in order to reduce its morbidity

Guidelines of the French Society of Otorhinolaryngology (SFORL), short version. Diagnosis of local recurrence and metachronous locations in head and neck oncology.

International audienceSurveillance is fundamental to the management of head and neck cancer. The present guidelines of the French ENT society (SFORL) were drawn up by a group of experts in the field, and are intended to specify the modalities of management, based on a review of the literature and, where data are lacking, to provide expert opinion. The present paper deals with guidelines for the diagnosis of local and regional recurrence and metachronous head and neck locations. Locoregional recurrence usually occurs within 3 years of primary treatment and is mainly related to the characteristics of the primary tumor and the treatment measures taken. Laryngeal location, safe primary resection margins, low level of lymph node invasion, unimodal primary treatment and early diagnosis of recurrence are factors of good prognosis. Systematic imaging surveillance may be considered for patients for whom a curative technique exists and when surveillance is difficult. The role of PET-scanning remains to be determined. Metachronous locations are frequent, even in the late course; prolonged surveillance is appropriate. The best preventive measure is cessation of alcohol abuse and smoking. Patient education is primordia

Sentinel node biopsy stands the test of time and the proof of time

International audienceObservational studies conducted in the 1970s, including that by Bernard Guerrier, cited by Bocca et al. [1], and subsequent studies published in the literature [2], have shown that neck dissection must be systematically performed in operable stage T1-T2N0 oral and oropharyngeal squamous cell carcinoma (OC) in order to diagnose and treat occult micrometastases [3]