Biomedical subjects
Publications and source records attributed to M Hamoir.
We report the case of a 25 year old male who presented with a well-circumscribed mass in the infratemporal fossa, without intracranial localisation. On histological examination, this tumor was a transitional type of meningioma. We review the literature and discuss the pathogenesis and the differential diagnosis.
Two distinct cases of maxillary actinomycosis and maxillary candidosis in immunocompetent hosts are reported; These infections are rare and similar to mycotic extramucosal non allergic sinusitis. Microbiology and microscopic examination are mandatory to prompt and successful management. Endoscopic endonasal surgery by middle meatotomy seems to be an adequate treatment for these particular entities.
Nocturnal oxymetry was recorded in ten otherwise healthy patients undergoing different types of nasal surgery with total nasal packing. Postoperative nocturnal oxymetry was worse than preoperative one in seven patients and judged as abnormal in four. These results indicate that in otherwise healthy subjects, nasal surgery and total nasal packing induce immediate significant changes in nocturnal breathing.
Although the pulsion diverticulum of hypopharynx was first described by A. Ludlow in 1964, the name of the German pathologist F.A. von Zenker is definitively associated with this diverticulum, probably because he was the first to publish a full description of its clinical and pathological aspects. Later, numerous techniques have been described to surgically treat Zenker's diverticulum. However optimal treatment remains controversial. Considering transcervical approaches, microendoscopic CO2 laser diverticulotomy offers comparable functional results. Moreover, this procedure offers the advantages of reduced morbidity, is very short-time consuming and requires a short hospitalization. These last issues should be seriously taken in consideration regarding medical cost. Subsequently, we advocate that microendoscopic CO2 laser diverticulotomy should be considered as first-line treatment option for patients suffering of Zenker's diverticulum.
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Head and neck anastomosis techniques present common aspects with any type of anastomosis but their localisation at the junction of the respiratory and digestive tracts makes them often delicate to perform. In the present article, we first review the different surgical indications and the laryngeal, tracheal, pharyngeal and oesophageal anastomosis techniques. The main types of flaps also used for this purpose are highlighted. We then review the cases observed during the 5 last years in our department, type and technique of surgery used. In this general review, we illustrate our stand point although aware of the multiple variants favoured by different schools.
Microendoscopic treatment of hypopharyngeal (Zenker's) diverticulum was performed in 31 patients during the period 1990-1995. The CO2 laser combined with the operating microscope has been used. 33 endoscopic procedures were performed (2 procedures were needed for 2 patients). The average age of the patients was 70.3 years (46-86 years). The average length of the general anesthesia was 48 minutes; the average length of the endoscopic procedure was 20 minutes. No major complication occurred for 32/33 cases (97%). Mediastinitis occurred for 1 case (3%) and was successfully treated by surgical and IV antibiotherapy. The average duration of hospitalization was 5 days (3-5 days) (patient with mediastinitis excluded): the average follow-up was 19 months (1-62 months). 28/31 patients (90.3%) were highly or fairly satisfied. Considering the external approach microendoscopic CO2 laser diverticulotomy offers comparable functional results. Moreover, this procedure is quick, requires a shorter hospitalization stay and is followed by a very low percentage of complications. Additionally, no visible scar is noted. Optimal management of Zenker's diverticulum remains controversial. However, we advocate that microendoscopic CO2 laser diverticulotomy should be considered as a first-line treatment option for patients with hypopharyngeal diverticulum.
The subjective effect of uvulo-palato-pharyngoplasty surgery (U.P.P.P) for snoring was evaluated in 31 patients. Results were obtained following a questionnaire sent to patients after a median follow-up of 10 months, as well as through follow-up visits. Seventy seven point five percent of the patients and their partners were satisfied with the operation. No major complications were noted. Minor complications included pain, transient pharyngonasal reflux and sensitvity problems of the posterior wall of the pharynx.
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We report vocal and respiratory results following endoscopic CO2 laser therapy for bilateral vocal fold immobility in adduction. Two techniques were used: posterior cordectomy (PC) and subtotal arytenoidectomy (SA). Respiratory improvement was demonstrated by the peak expiratory flow/peak inspiratory flow ratio (PEF/PIF, normal = 1), which was less than 2 for 83% of patients following PC and for 81% following SA. As for vocal results, there were no significant quantitative differences between the two techniques. Mean maximum phonation time (/a/) was 6.8 +/- 2.6 s after SA and 7.8 +/- 1.6 s following PC. The phonation quotient was 288 +/- 116 ml/s after SA and 304 +/- 92 ml/s after PC. Mean vocal intensity was 62 +/- 4 dB after SA and 59 +/- 3 dB after PC. Vocal quality was measured by high-resolution vocal frequency analysis, as represented by a histogram. Peaks corresponding to fundamental frequency and first harmonics were preserved in more than 60% of patients in the two groups. Vocal preservation is better when the paralyzed folds are in the paramedian position, with the possibility of adduction (Gerhardt syndrome). SA is performed in our procedure, though it is longer and more difficult to perform than PC. PC often requires two procedures to achieve satisfactory results.
The embryological, clinical and radiological features of an abnormal stylohyoid chain ossification is reviewed. The common embryological origin of the styloid apophysis, the styloid ligament and the lesser cornu of the hyoid bone allows the concept of a stylohyoid entity. The pathogenesis of the ossification of the stylohyoid chain enables us to distinguish Eagle's syndrome, the stylohyoid syndrome and the pseudo-stylohyoid syndrome. The choice between medical and surgical treatment particularly surgery by external approach, is discussed.
A case of subglottic fibrous histiocytoma of the larynx, is reported. Fibrous histiocytoma is uncommon in the head and neck region, and rare in the larynx. It is a tumor of mesenchymal origin consisting of two separate components: histiocytic and fibroblastic cells. The clinical behaviour and the degree of malignancy can not be predicted. Surgery is the treatment of choice.
Sixteen paragangliomas of the neck were reviewed. Lesions were found in the carotid body (n = 12), vagal nerve (n = 3) and larynx (n = 1). While paragangliomas were often misdiagnosed clinically, CT scanning defined the extent of the disease. MR was able to accurately characterize the tumors as highly vascular. Multiplanar imaging, exquisite tissue contrast and anatomic detail allowed better display of the relationship between these neoplasms and surrounding carotid sheath vessels and intracranial structures. MR constitutes the imaging modality of choice in carotid body tumor. Arteriography is necessary for definite diagnosis and presurgical embolization.
Fistula of the pyriform sinus apex is an often overlooked entity which generally manifests itself as acute suppurative thyroiditis or recurrent deep neck abscesses in children or young adults. Two cases are reported. Arguments in favor of a fourth pharyngeal pouch origin are stressed and the surgical management is described.
In a series of 51 children presenting with an accidental caustic burn, symptoms were analysed for their predictive value of significant i.e. necrotizing oesophageal lesions (grade II or III). For the whole group, the incidence of significant oesophageal lesions was 37%. Vomiting and/or respiratory distress were associated with high incidence of significant oesophageal burn (84% and 75% respectively). The particular location of each caustic burn was analysed for its association with caustic burns at other anatomical sites. Of the 18 patients with a laryngeal burn, 72% also had a grade II or III oesophageal burn. The 19 patients with a grade II or III oesophageal burn and the 18 patients with a laryngeal burn, all had lesions at other sites. In the group of 19 patients with a caustic lesion limited to one site, only 1 patient showed mild oesophagitis (grade I) without late sequelae.
Eighty-three patients (median age, 56 years and Karnofsky performance status greater than or equal to 70) were treated with carboplatin (Carbo) and fluorouracil (5Fu) for stage III and IV head and neck squamous cell carcinoma (HNSCC). 5Fu (1 g/m2/d) was administered from day 1 to 4 by continuous infusion. Carbo was given on day 1 and, in order to evaluate its maximum-tolerated dose (MTD), the dose level was progressively increased from 250 mg/m2 to 450 mg/m2. The effectiveness of this association and its potential role in local control were also evaluated. Three patients received Carbo at a dose of 250 mg/m2, 13 received 300 mg/m2, one received 330 mg/m2, 12 received 350 mg/m2, six received 375 mg/m2, 26 received 400 mg/m2, 18 received 420 mg/m2, and four received 450 mg/m2. Two (13 of 83) or three courses (64 of 83), repeated every 4 weeks, were administered. The overall (primary tumor and node) response and complete response (CR) rates were 33% and 14%, respectively. For primary tumor, the response rate (RR) was 57% with 32% CR and 18% pathologic complete response (PCR); the RR was higher for patients with oropharyngeal tumor (76%, P = .037) and for patients treated with Carbo greater than or equal to 350 mg/m2 (65%, P = .02); the tumor size (T1 + T2 v T3 + T4) was a good prognostic factor for RR (90% v 46%, P = .001), CR (65% v 20%, P less than .001), and PCR (45% v 8%, P less than .001). For nodes, the RR was 33% with 11% CR. Grade 3-4 neutropenia and thrombocytopenia were experienced by 17% and 28% of the patients treated with 420 mg/m2 of Carbo and by 50% of the patients treated with 450 mg/m2. The MTD can be fixed at 420 mg/m2 and the proposed dose at 400 mg/m2. Thirty-eight patients were treated with surgery plus radiotherapy, 33 with radiotherapy alone, and seven with surgery alone. The median follow-up is 12 months. The 18-month disease-free survival (DFS) is 78% for overall complete responders and 39% for the others (P = .04). There is no primary tumor recurrence among the 12 patients with a primary tumor PCR treated by radiotherapy alone for tumor control (median follow-up, 17.3 months). The association of Carbo-5Fu is a safe induction chemotherapy regimen for HNSCC. The proposed dose of Carbo for future treatment is 400 mg/m2.(ABSTRACT TRUNCATED AT 400 WORDS)
The tumors of the submaxillary gland are rare. The authors are reviewing 23 cases gathered from three Departments over ten years. The tumors of the submaxillary gland are malignant in as many as 50% of all cases! When the lesion is benign, pleiomorphic adenoma is the most frequent possibility. The authors emphasize the necessity of early and complete surgical treatment, requiring at least total submaxillectomy in case of benign tumor. Cervical mode dissection will be considered if the tumor is malignant.