[Address to the Society of Laryngology of the Paris Hospitals, January 15, 2005].
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Health Services↗
Biomedical subjects
F Chabolle
Publications and source records attributed to F Chabolle.
[Sleep apnea syndrome surgery in 2006].
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Algorithms↗
[Tracheal anastomosis: monofilament absorbable suture versus monofilament non-absorbable suture. Experimental study in rats].
OBJECTIVES: When tracheal stenosis is symptomatic, the treatment may consist of surgical resection and anastomosis. A multifilament absorbable suture is usually used. The aim of this experimental work on rats was to study the benefits of using a monofilament absorbable suture with high initial resistance. MATERIAL AND METHODS: We compared Ethilon, a nylon monofilament non-absorbable suture (MNA), with Monocryl, a polyglecaprone 25 (P25) monofilament absorbable suture (MA). The sutures were used for tracheal anastomosis on 16 rats. P25 has a high initial strength but its intra-tissular disappearance is fast. Animals were killed at 1, 2 and 3 months. Anastomoses were studied by optical microscopy and histological analysis. RESULTS: At 3 months no disunity or stenosis was seen with the MA. With the MNA, a modification of the tracheal transverse section and a stenosis were observed. The histological examination showed an initial important inflammatory cell reaction with the MA and at 3 months, a surgery-free like tracheal aspect. At 3 months the rats with MNA had a persistent foreign body cell reaction. CONCLUSION: Good results obtained by using P25 could be due to high initial resistance of the suture protecting the anastomosis. The semi-fast absorption of the suture avoided persistent inflammatory cell reaction. Confirmation of these results by working on larger animals and tracheal anastomosis under tension could allow the use of this suture on human beings, in this instance.
Adsorption↗
[Subcutaneous cervicofacial and mediastinal emphysema complicating tooth extraction: case report].
Subcutaneous emphysema is a rare and well-known complication of dental procedures. Many cases go unrecognized and resolve spontaneously, while others may require specific surgical management to prevent complications. We present a case of cervicofacial and mediastinal emphysema which occurred during a routine dental procedure and a review of the literature on differential diagnosis and management.
Adult↗
[Surgery and sleep apnea syndrome].
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Humans↗
Efficacy of fusafungine in acute rhinopharyngitis: a pooled analysis.
Upper respiratory tract infections are generally mild but they are associated with an enormous loss in productivity. Treatment consists of reduction of local symptoms e.g. local inflammation and prevention of potential superinfections. Besides its bacteriostatic activity against most micro-organisms involved in respiratory tract infections fusafungine displays original anti-inflammatory properties. To optimise nasal and throat deposition, a new fusafungine oro-nasal spray using HFA 134a was developed and its efficacy was evaluated in patients with acute rhinopharyngitis based on improvement of significant nasal symptoms. Three randomised double-blind placebo-controlled parallel-group studies with identical objectives design and dosage were performed and results were pooled for a better evaluation of treatment effect (532 patients). The percentage of responders (patients with nasal symptom score improvement from Day 0 to Day 4) was 61.5 +/- 2.9% with fusafungine vs 46.8 +/- 3.1% with placebo (p=0.009) with an odds ratio of 1.8 (p=0.01) in favour of fusafungine. The nasal symptom score distribution at Day 4 showed an odds ratio of 1.56 (p=0.011) also in favour of fusafungine. For patients treated early (onset of symptoms 1 pounds day) the percentage of responders was 65.9 +/- 4.1% with fusafungine vs 38.3 +/- 4.0% with placebo (p=0.022) with an odds ratio of 3.08 (p=0.033) in favour of fusafungine. Therefore fusafungine through its dual bacteriostatic and original anti-inflammatory properties is an effective treatment of acute rhinopharyngitis especially when administered early.
Acute Disease↗
Rehabilitation of the paralysed or lax lower eyelid using a graft of conchal cartilage.
Excessive laxity of the tarso-ligamentous sling of the lower eyelid may be caused by inadequate muscular support (resulting from injury to the muscle, facial palsy or senile degeneration) or prolonged mechanical distension (exophthalmia). Numerous techniques have been devised for functional reconstruction of the distended lower eyelid, based upon the principle that restoring the lower eyelid to its anatomical position will improve lacrimal transit andre-establish its natural protective function. We now use an autologous conchal cartilage graft to treat the distended or atonic lower eyelid. We review our results in a retrospective study of 20 patients, and aim to identify the indications for this procedure and to evaluate its advantages and disadvantages relative to other existing methods. All of our patients reported functional improvement after the operation in terms of decreased dry-eye symptoms, less epiphora and a decline in keratitis and conjunctivitis. All patients also reported a visible cosmetic improvement postoperatively. The major drawback of this operation is the partial loss of the visual field when looking down, due to the limited lowering of the lower eyelid. The stability of our results compares favourably with that achieved using other currently available techniques. We conclude that autologous conchal cartilage grafting is an effective procedure for improving both the function and the appearance of the atonic lower eyelid.
Adult↗
[Laryngeal immobility after thyroidectomy].
One of the most common complications of surgery of the thyroid gland is vocal folds immobility. New advances in its management have been achieved over the last few years. Laryngeal electromyography, stroboscopy, and computerized analysis of the voice help guide diagnosis, allowing differentiation between recurrent nerve paralysis and glottis traumatism due to intubation, and further follow-up of recovery with relevant therapeutic decisions. In case of unilateral vocal fold paralysis, intrafold silicone or injection of autologous fat is more and more routinely used to obtain vocal rehabilitation. In case of bilateral vocal fold paralysis, to avoid tracheotomy, partial posterior cordectomy using laser surgery restores sufficient laryngeal airflow, with minimal vocal sequelae. Early management of these complications by teams of specialists should allow appropriate and less invasive surgery.
Aged↗
[Inverted papilloma: endoscopic versus external surgery. Apropos of 28 cases].
To evaluate the role of endoscopic versus external surgery in the treatment of inverted papillomas, the clinical courses of 35 patients over a period of 10 years were reviewed. 13 patients were treated endoscopically whereas 15 were treated with an external approach. 7 patients with a post operative follow up of less than 12 months were excluded from the study. Recurrences occurred in 4 patients, 2 patients had been treated by endoscopic surgery and 2 by medial maxillectomy by lateral rhinotomy. 3 patients were diagnosed with squamous cell carcinoma. Salvage surgery was performed by an external procedure or endoscopically depending on the extension of the recurrence. Late complications occurred in both groups: cosmetic complaints and epiphora were more frequently encountered after external treatment. Functional complaints were noted after endoscopic treatment. If there is no evidence of associated malignancy, if complete exposure of the tumor is possible and long term follow up is feasible, the authors propose endoscopic surgery as first line treatment to excise the body of the tumor, assess it's extension, and remove the root of the tumor. If this is not the case, medial maxillectomy by external approach should be performed.
Adolescent↗
[Cranialization of the frontal sinus].
UNLABELLED: In the surgery of frontal sinus exclusion, the place of cranialization is still controversial. Our aims were to describe the operative technique, report our results and discuss its indications. PATIENTS AND METHODS: Nineteen patients were operated according to this technique between 1984 and 1997. Cranialization was performed in the first place for tumors, osteitis, traumatisms and benign tumors or mucoceles with a special location. In patients with chronic sinusitis or mucocele, it was performed in the second place when functional surgery was considered as failure and because sinus obliteration seemed to be inappropriate. RESULTS: There was no mortality nor anosmia linked to the procedure. Postoperative sequelae were related to the disease or to the surgical approach. After a median follow-up of 29 months, no disease recurrence was observed. CONCLUSION: Cranialization of frontal sinus gives good results in selected patients, with low morbidity. Even though its indications are infrequent, this technique has its place in the surgical exclusion of frontal sinus.
Adolescent↗
[Obstructive sleep apnea syndrome and the upper airway muscles].
Pharyngeal muscles are prone to distorsion during inspiratory negative pressure. Some pharyngeal muscles, called pharyngeal dilatators, exhibit tonic and/or phasic inspiratory activity. At the velar level, tensor palatini, glossopharyngeus, palatopharyngeus and musculus uvula drive the airflow towards nasal or buccal breathing. Genioglossus and geniohyoid muscles exert a forward propulsion to the tongue. The contraction of the dilatators muscles precedes the diaphram contraction. These muscles show a poor endurance. In obstructive sleep apnea syndrome, they contract during unfavorable metabolic (hypoxia and hypercapnia) as well as mechanical (excentrical contraction) conditions. Histological changes occur in upper airway dilator muscles: muscle volume and proportion of type Ila fibers are increased. These changes, considered as compensatory mechanisms, are variable within the different studied pharyngeal muscles. The initial pharyngeal obstructive site, and its further extension, could be determined by the different strength and endurance properties of these muscles.
Airway Resistance↗
[Surgical treatment of severe sleep apnea syndrome by maxillomandibular advancing or mental tranposition].
Surgery of the facial skeleton or the tongue may be envisaged in case of failure of continuous positive pressure ventilation for severe sleep apnea syndrome defined by a apnea-hyponea index greater than 30/h. We present here our results in patients treated by maxillo-mandibular advancing and mental transposition. We define the surgical indications. Between January 1993 and June 1997, 41 patients, mean age 49 years, with severe sleep apnea syndrome (mean apnea-hyponea index =58.5/h) were treated by maxillo-mandibular advancing (21 cases) or mental transposition (20 cases) depending on the cephalometric work-up including lateral teleradiography and sagittal magnetic resonance imaging of the tongue. Functional outcome was good in both groups. Objective success (postoperative apnea-hyponea index <20) was 70.5 % after bimaxillary advancing (mean apnea-hypopnea index =17), but only 25 % after mental transposition (mean apnea-hyponea index =44.5). Maxillomandibular advancing is a major procedure which can be effective in sleep apnea patients with severe craniofacial skeletal anomalies. Its applications in apneic patients with no skeletal anomaly remains a subject of debate. Conversely, there would appear to be very few indications for mental transposition.
Adult↗
[Retrospective cephalometric analysis for surgically treated obstructive sleep apnea: therapeutic deductions].
PURPOSE OF THE STUDY: The goal of surgical treatment for severe sleep apnea syndrome is to alleviate the upper airway obstruction. The narrowing site must be precisely determined during the preoperative evaluation to ensure success. We suggest that cephalometric analysis using a lateral cephalic radiograph to evaluate bony structures combined with magnetic resonance imaging (MRI) to study soft tissues may achieve this goal. The purpose of this study was to determine the role of two different cephalometric analysis systems for determining surgical strategy and to underline factors predictive of success for different surgical procedures. MATERIALS AND METHOD: We prospectively studied 73 sleep apnea patients. The preoperative evaluation included MRI and two different cephalometric analyses on a lateral cephalic radiograph: Tweed's and Delaire's analyses. Three surgical techniques were performed: mandibular osteotomy and geni tubercule advancement, maxillo-mandibular advancement and tongue base reduction with hypoepiglottoplasty via a cervical approach. RESULTS: Tweed's analysis appeared to underestimate maxillo-mandibular deficiencies compared with Delaire's analysis; the later seemed to be more sensitive. MRI did not prove to be useful in predicting surgical outcome. MRI was non-contributive in our preoperative evaluation. DISCUSSION: We suggest a new surgical strategy using two procedures: maxillo-mandibular advancement and tongue base reduction. Indications are based on the results of two cephalometric analyses (Tweed and Delaire) and the measurement of the oropharyngeal surface.
Adult↗
[Treatment of snoring with controlled temperature radiofrequency: short- and mid-term tolerance and efficacy].
UNLABELLED: Uvulopalatopharyngoplasty and laser pharyngotomy can provide effective and definitive cure of snoring. These methods are however very painful. The ideal treatment would be not only effective but also pain free. MATERIAL AND METHODS: We assessed prospectively the efficacy and tolerance to temperature controlled radiofrequency (somnoplasty). This technique was applied to the velar palate in 15 snoring patients. Self assessment was used to evaluate outcome. The patients daily recorded: uneasiness, pain, drug use, and food intake. Their spouse scored snoring for 6 to 8 weeks after the end of treatment and more than 6 months after the last treatment session. RESULTS: We achieved 80% success after 2.1 sessions. Pain was minimal. A sensation of uneasiness was frequent and led to minimal drug use. After a mean 13 months, half of the patients experienced a recurrence or an aggravation of their snoring level. Overall satisfaction rate was 69%. CONCLUSION: These preliminary results suggest that radiofrequency is well tolerated and effective in the short- and mid-term for the treatment of snoring.
Adult↗
Tongue base reduction with hyoepiglottoplasty: a treatment for severe obstructive sleep apnea.
OBJECTIVE: To describe a surgical procedure for the treatment of severe obstructive sleep apnea syndrome (OSAS), the procedure's indications, and its results. STUDY DESIGN: A retrospective study of 10 male patients with OSAS treated by tongue base reduction with hyoepiglottoplasty (TBRHE) at the Foch Hospital (Suresnes, France) between 1994 and 1997. Patients had a mean body mass index (BMI) of 32 kg/m2, a mean respiratory disturbance index (RDI) of 70 events/h, and a mean minimal oxygen saturation of 78%. They had refused positive airway pressure therapy or wished to discontinue it. METHODS: Subtotal tongue base reduction preceded by lingual neurovascular bundle identification and derouting, epiglottal verticalization, mouth floor horizontalization, and hyoid bone repositioning was performed, associated in some cases to uvulopalatopharyngoplasty (UPPP). Indications were based on a site-related obstruction, on the absence of craniofacial deficiencies, and on the presence of hyolingual abnormalities determined by cephalometry and magnetic resonance imaging. RESULTS: TBRHE associated to UPPP in most cases had an 80% success rate, based on a postoperative RDI below 20 events/h and a reduction of the preoperative RDI of more than 50%. Snoring and excessive daytime sleepiness decreased or disappeared, respectively, in 100% and 90% of the cases. No neurovascular complications occurred. CONCLUSION: TBRHE is a safe procedure for the neurovascular bundle. Associated to a pharyngotomy, it is an effective treatment for severe OSAS attributable to tongue base obstruction. These results require confirmation in a larger series of patients.
Adult↗
[Hypoglossal nerve in its intralingual trajectory: anatomy and clinical implications].
There is little literature on the intralingual trajectory of the hypoglosal nerve. We performed an anatomical dissection on 6 cadavers and completed our study with histological examinations. The 12th cranial nerve enters the lower part of the tongue laterally, reaching the anterior border of the hypoglossal muscle where it follows the ascending lingual artery medially to terminate anteriorly to the lingual V. Its terminal branches spread out horizontally in each half of the tongue. There is a paramedial branch, found in all cases, which projects downwardly, posteriorly and medially at the basilingual portion of the genioglossal muscle. These anatomic findings indicate that basiglossectomy removing the entire base of the tongue can be performed without functional sequelae. A certain degree of somatotopy is also found with specific fibers reaching the protractor and retractor muscles. This nerve distribution supports attempts at selective electrical stimulation of the hypoglossal nerve with the aim of dilating the upper airways in patients with sleep apnea syndrome.
Aged↗
[Dilator muscles of the pharynx and their implication in the sleep apnea syndrome of obstructive type. Review of the literature].
Pathophysiology of the obstructive sleep apnea syndrome shows three components: intra and peripharyngeal obstacles, excessive pharyngeal wall compliance and upper airway dilator muscle dysfunction. The intent of this paper is to provide an overview of the anatomy, histology, physiology and pathophysiology of the upper airway dilator muscles based on previously published articles. The upper airway dilator muscles can be separated in three different systems, main and accessory dilators, local and regional. They act in synergy. Their contraction occurs at the beginning of inspiration, thus maintaining opened the pharyngeal lumen through inspiration. Their action is modulated by several chemo or physical stimuli. In some apneic patients, these muscles demonstrate a dysfunction: hyperactivity during wakefulness, electromyogram wave amplitude reduced, delayed contraction during sleep and abnormal response to stimuli. This dysfunction might be due to neuromuscular histological abnormalities, a "fatigue" phenomenon or a central nervous command abnormality. Current explorations underlining an upper airway dilator muscle dysfunction will enable practitioners to decide which treatment is best and understand therapeutical failures; it will also help develop new therapeutical techniques such as functional electrical stimulation of the hypoglossal nerve/upper airway dilator muscles.
Disorders of Excessive Somnolence↗
[Long-term results of surgical pharyngectomy (uvulo-palato-pharyngoplasty) versus office CO2 laser (L.A.U.P.) for the treatment of uncomplicated snoring].
Two treatments are habitually proposed for snoring without obstructive sleep apnea syndrome: the surgical pharyngotomy, and the treatment by laser done in the office. Our study analyses retrospectively, by telephone questionnaire, a group of 168 snorers, without obstructive sleep apnea syndrome, treated by pharyngotomy (n = 71) or CO2 laser (n = 97) between 1989 and 1993. Results after a mean follow-up of 5 years, with a minimal of 3 years, show for the two procedures the same efficacity, and an equivalent prevalence of side effects. The rate of satisfaction for the patient and her bed-partner is about 50%, in relation to a degradation of therapeutic effect in the long run. We propose to precisely the results and the indications of the surgery and the laser for treatment of uncomplicated rhonchopathy.
Adult↗