Rééducation orthophonique post myoplastie d’allongement du temporal : une étude de trois patients

La myoplastie d’allongement du temporal est une chirurgie qui vise à restaurer le sourire chez les patients ayant une paralysie faciale périphérique irréversible. Le muscle temporal est détaché dans sa partie haute et rattaché à la commissure labiale. À la suite de la chirurgie, une rééducation orthophonique est nécessaire pour atteindre un sourire fonctionnel. Cette rééducation vise à automatiser le sourire pour le rendre spontané, ainsi qu’à optimiser le sourire pour rendre le mouvement de la commissure opérée symétrique à celui du côté sain. Parmi les moyens utilisés dans cette rééducation, un logiciel reproduisant l’hémiface saine permet de créer un effet-miroir, en offrant un biofeedback visuel positif aux patients. Les objectifs de la présente étude de cas multiples étaient 1) de mesurer les effets de la rééducation orthophonique après la myoplastie d’allongement du temporal et 2) de mesurer l’adhérence au traitement. Trois patients présentant une paralysie faciale périphérique droite secondaire à une résection de tumeur et ayant subi une myoplastie d’allongement du temporal ont été recrutés. Ces patients ont tous été évalués avant la chirurgie, ainsi qu’avant et après la rééducation, à l’aide de l’échelle Sunnybrook. Les résultats ont confirmé qu’à la suite de la rééducation orthophonique, le sourire des trois patients avait progressé.Compte tenu des résultats prometteurs obtenus avec cette rééducation, il serait intéressant d’en valider l’efficacité sur un plus grand nombre de patients.Lengthening temporalis myoplasty is a surgical procedure to restore the smile in patients with irreversible facial nerve paralysis. The temporalis muscle is detached from its upper end and attached to the labial commissure. Following surgery, facial rehabilitation by speech-language pathologists is necessary to achieve a functional smile. More specifically, this rehabilitation aims to automate the smile to make it spontaneous, as well as to optimize the smile to make the movement of the commissure operated on symmetrical to that of the healthy side. Among the means used in this rehabilitation, a software program reproducing the healthy hemiface allows for the creation of a “mirror effect” by giving the patients positive visual biofeedback. The objectives of this multiple case study were (a) to measure the effects of facial rehabilitation after lengthening temporalis myoplasty and (b) to measure adherence to treatment. Three patients with right facial nerve paralysis secondary to tumour resection that had lengthening temporalis myoplasty were enrolled. These patients were all assessed before surgery, and before and after rehabilitation, using the Sunnybrook scale. The results confirmed that following facial rehabilitation, the smiles of the three patients had improved. Given the promising results obtained from this rehabilitation, it would be interesting to validate its effectiveness on a larger number of patients

Reconstruction of medium-size defects of the oral cavity: radial forearm free flap vs facial artery musculo-mucosal flap

Abstract Background The radial forearm free flap (RFFF) is the most commonly used flap for defects of the oral cavity. The facial artery musculomucosal (FAMM) is a safe and effective method to reconstruct medium sized defects of the oral cavity. No comparison exists between the FAMM flap and RFFF. Methods 1) Retrospective chart review from 2007 to 2016. 2) Cost difference analysis. Results Thirteen FAMM flap cases and 18 RFFF met inclusion criteria. The FAMM flap showed a tendency to lower rates of return to the operating room (p = 0.065) as well as lower rates of complications not requiring return to the OR with 1 complication in 1 patient as opposed to 10 patients with 15 complications (p = 0.008). Also, FAMM flap had shorter operative times compared to the RFFF group (7.2HR and 8.9 HR respectively, p = 0.002). The average operative room related costs for a FAMM flap were 6510 CAD vs 10,703 CAD for RFFF (p  0.05). Conclusion The FAMM flap can be used for reconstruction of medium-size defects of the oral cavity with functional outcomes similar to the RFFF while decreasing the associated costs and morbidity. Graphical Abstrac

Quantification and visualization of aerosols in ear, nose, and throat exam and flexible laryngoscopy

OBJECTIVE: To measure and visualize aerosol generation during ear, nose, and throat (ENT) exam and flexible laryngoscopy, as safety recommendations are currently to defer routine and low‐priority examinations. METHODS: Aerosols generated during ENT examination and flexible laryngoscopy were quantified by laser aerosol spectrometry and visualized live by high‐speed imaging during those procedures for three participants who were tested three times for each test. RESULTS: Routine ENT examination and flexible laryngoscopy produce aerosols at levels comparable to normal breathing and speech. CONCLUSION: During ENT examination and flexible laryngoscopy, the practitioner should wear a surgical mask and potentially contaminated surfaces should be cleaned after the procedure. For flexible laryngoscopy, it is recommended in addition that the patient wear a mask over the mouth in case the procedure induces a sneeze. The time during which the patient is unmasked should be minimized. In these settings, the risk to the practitioner is minimal unless the patient is sneezing or symptomatic. LEVEL OF EVIDENCE:

Free versus pedicled flaps for reconstruction of head and neck cancer defects: a systematic review

Abstract Objective The present review focuses on comparative studies of reconstruction with free flaps (FF) versus pedicled flaps (PF) after oncologic resection. Method A systematic review was developed in compliance with PRISMA guidelines and performed using the Pubmed, Medline, EMBASE, Amed and Biosis databases. Results A total of 30 articles were included. FF are associated with a longer operative time, a higher cost and a higher incidence of postoperative revisions compared to PF. FF are associated with a longer stay at the intensive care unit than the supraclavicular artery island flap (SCAIF) and with a more extended hospital stay compared to the submental island flap (SMIF). FF are associated with fewer infections and necrosis compared to the pectoralis major myocutaneous flap (PMMF). Conclusion The comparison of both type of flaps is limited by the inherent design of the studies included. In sum, FF seem superior to the PMMF for several outcomes. SMIF and SCAIF compare favorably to FF for some specific indications achieving similar outcomes at a lower cost

A pilot study on the Mirror Effect PLUS protocol : a standardized and adapted facial rehabilitation for acute Bell’s palsy

Combining early facial exercises with medication may help patients with acute Bell’s palsy recover significantly faster and better than patients treated with medication alone. To date, exercise therapy in acute Bell’s palsy consists mostly of transferring facial rehabilitation techniques that were developed for chronic Bell’s palsy, despite the differences between those stages. The aim of this pilot study was to estimate the efficacy of the Mirror Effect PLUS Protocol, the first facial rehabilitation protocol specifically designed for acute Bell’s palsy. Ten patients with acute moderate-to-severe, severe, and total Bell’s palsy were recruited and assigned randomly to the Mirror Effect PLUS Protocol group or the control group. Both groups received the recommended medications. In addition, patients in the rehabilitation group performed exercises that were completed using a computer that duplicated their healthy hemiface. Compared to controls, a greater number of patients in the Mirror Effect PLUS Protocol group presented better facial symmetry and greater satisfaction towards their facial function. There were no differences in recovery between the rehabilitation and control groups; however, for the subset of patients with severe palsy, the Mirror Effect PLUS Protocol improved and accelerated recovery. These preliminary results support the hypothesis that the Mirror Effect PLUS Protocol enhances the recovery of severe acute Bell’s palsy. However, replication of these results with larger samples is necessary. Additionally, the intervention’s precise mechanisms of action need to be investigated thoroughly to exclude the effect of spontaneous recoveryCombiner une rééducation orthophonique à la prise de médicaments pourrait favoriser un rétablissement plus rapide et optimal des patients présentant une paralysie de Bell en phase aiguë, comparativement à la prise seule de médicaments. Présentement, la rééducation qui est offerte aux patients présentant une paralysie de Bell en phase aiguë consiste principalement en l’utilisation de techniques ayant été développées pour les patients ayant une paralysie de Bell chronique, et ce, malgré les différences entre ces stades de la pathologie. L’objectif de la présente étude pilote était d’évaluer l’efficacité du protocole Effet Miroir Plus, un premier protocole de rééducation orthophonique spécifiquement conçu pour la paralysie de Bell en phase aiguë. Dix patients présentant une paralysie de Bell en phase aiguë de degré « modéré à sévère » ou « sévère », ou encore, pouvant être qualifiée de « totale » ont été recrutés. Ceux-ci ont été divisés aléatoirement dans deux groupes : un groupe de patients à qui le protocole Effet Miroir Plus a été administré et un groupe contrôle. Les deux groupes ont pris les médicaments recommandés dans le traitement standard de la paralysie de Bell. Les patients du groupe à qui une rééducation orthophonique a été offerte ont également effectué des exercices musculaires en utilisant un ordinateur qui dupliquait leur hémiface saine. Lorsque comparés aux patients du groupe contrôle, un plus grand nombre de patients du groupe Effet Miroir présentaient une meilleure symétrie faciale et une plus grande satisfaction à l'égard de leur fonction faciale. En termes de rétablissement, aucune différence n’a été notée entre les groupes, sauf pour le sousensemble de patients ayant une paralysie de degré « sévère ». Dans ce cas précis, le protocole Effet Miroir Plus a amélioré et accéléré le rétablissement. Ces résultats préliminaires soutiennent l’hypothèse que le protocole Effet Miroir Plus améliore le rétablissement des patients ayant une paralysie de Bell en phase aiguë de degré « sévère ». Il sera toutefois nécessaire de répliquer ces résultats avec des échantillons plus importants. Ajoutons qu’il sera également important d’investiguer de façon approfondie les mécanismes d’action précis de la rééducation orthophonique pour exclure l’hypothèse d’un rétablissement spontané

Cubane Cu 4 I 4 (phosphine) 4 Complexes as New Coinitiator for Free Radical Photopolymerization: Towards Aromatic Amine-Free Systems

International audienceThe investigation of copper-iodide cubane derivatives as new co-initiators for the free radical polymerization (FRP) of acrylate monomers under mild irradiation conditions is described for the first time here. These tetranuclear Cu(I)-based complexes have general formula Cu4I4(phosphine)4, where phosphine is triphenylphosphine (Cu1) or diphenylphosphine (Cu2). In the presence of commercial Type II photoinitiators such as isopropylthioxanthone (ITX) or camphorquinone (CQ), this class of co-initiators achieves high final conversions of the reactive functional groups. Comparison between the aromatic amine, such as ethyldimethylaminobenzoate (EDB) used as benchmark hydrogen donor, and these copper-based co-initiators are made, which demonstrates that the latter can be considered as a valid, environmental-friendly, alternative to toxic aromatic amines. Markedly, photoluminescent materials can be generated thanks to the presence of cubanes linked to the polymer network