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Biomedical subjects

M Zanaret

Publications and source records attributed to M Zanaret.

At least 37 records · Page 2Linked to original sources
PubMed2002

[Venous malformations of the parotid in adults. Report of two cases and review of the literature].

Parotid vascular malformation in the adult is a very rare and benign tumor; only 47 cases were described in the world literature. This vascular malformation, mostly of venous origin is, on the opposite of the clinical, histological and evolution features of parotid hemangiomas in children, which are more frequent. Some clinical and radiological elements are pathognomonic allowing preoperative diagnosis. We present 2 cases of intraparotid venous malformation in adults, and based on an exhaustive study of the world literature discuss frequency, diagnosis and treatment of this disease.

Adult↗
PubMed2001

Diagnosis and treatment of juvenile nasopharyngeal angiofibroma.

The aim of this retrospective study was to compare clinical and radiological findings and discuss optimal surgical approach in patients with juvenile nasopharyngeal angiofibroma (JNA). Forty-three cases of JNA were treated at our institution from 1975 to 1999. Thirty-three male patients aged between 8 and 25 years (mean 15.3) were included. Twenty-nine patients underwent primary surgical treatment at our institution and four were treated for recurrence following primary surgery elsewhere. Tumors were staged according to Fisch's staging. Preoperative embolization was performed in 22 cases. Surgical techniques consisted of the transantral approach, lateral rhinotomy approach, transmaxillary via midfacial degloving approach, and the subtemporal preauricular infratemporal fossa approach. Tumors were classified stage I in seven cases, stage II in 11, stage III in 13 and stage IV in two. The mean delay between the initial symptom and surgery was 14 months overall, 18 months for stage I, 14 for stage II, 13 for stage III and 12 for stage IV. The transantral approach was used in 11 patients, lateral rhinotomy approach in 11 cases, transmaxillary via midfacial degloving approach in three patients, and pre-auricular infra-temporal approach in eight patients. Mean follow-up after surgery was 56 months. Six patients had recurrent tumors. Surgery is the gold standard for treatment of JNA. Modern imaging techniques allow accurate diagnosis and staging of JNA. Our experience and a review of the literature shows that the surgical approach should be selected according to tumor stage.

Adolescent↗
PubMed2001

Partial frontolateral laryngectomy with epiglottic reconstruction for management of early-stage glottic carcinoma.

OBJECTIVES: The aim of this study was to demonstrate that partial frontolateral laryngectomy with epiglottic reconstruction (PFLER) is an effective therapeutic option for treatment of T1 and T2 glottic carcinoma. STUDY DESIGN: Retrospective study. METHODS: Between 1982 and 1997, we treated 127 cases of early glottic carcinoma with PFLER. Early glottic carcinoma was staged using the Union Internationale Contre le Cancer TNM classification as either T1N0M0 (62 cases) or T2N0M0 (65 cases). Selection criteria, depending on the limits of exeresis, must remain glottic carcinoma with less than 0.5 cm of anterior subglottic involvement, with no involvement of the supraglottic space or laryngeal side of the epiglottis, with involvement of only one arytenoid, and with good mobility of both arytenoids even if vocal cord mobility is decreased. RESULTS: Postoperative recovery was uneventful in all cases, and all patients but one were able to breath and eat normally. The failure involved a patient with a permanent gastrostomy. As with other partial laryngectomy techniques, the main drawback of PFLER was deterioration of voice quality. All patients presented hoarseness and weakness of the voice. Five-year survival rates calculated according to the Kaplan-Meier method were 91% (standard error, 5%) in the T1N0M0 group and 86% (standard error, 5%) in the T2N0M0 group. No recurrence was observed in the T1N0M0 group. Local control was successful in 92% in the T2N0M0 group after a median follow-up of 5 years. CONCLUSION: These findings show that PFLER is an effective therapeutic option in selected cases of early T1N0M0 or T2N0M0 glottic carcinoma.

Carcinoma, Squamous Cell↗
PubMed2001

[Reconstruction of the palate vault by free forearm cutaneous flap in oncology].

Surgical reconstruction after partial superior maxillectomy raises a major functional challenge and postoperative recovery implies difficult prosthetic rehabilitation. Between 1989 and 2000, 23 free radial forearm flap reconstruction were performed for palate defects. Twenty-two patients were treated for cancer-related defects and one patient for a non-malignant tumor. Immediate reconstruction was performed in 21 cases and delayed reconstruction in 2. Radiation therapy had been given prior to surgery in 7 patients, Flap necrosis occurred in 2 patients who had surgery alone. Deglutition and phonation outcome was satisfactory in all patients. Trismus was the most frequent complication (7 cases). The free radial forearm flap is the gold standard surgical treatment for superior maxillary defects. In these patients, and exclusive skin flap enables complete reconstruction.

Adult↗
PubMed2000

Radiological follow-up of inverted papilloma.

The aim of this study was to describe cross-sectional imaging features of recurrent papilloma of the nasal fossa and paranasal sinuses and to evaluate the role of MR and CT in the postoperative follow-up of this lesion. Magnetic resonance imaging and CT of ten patients who presented recurrence of inverted papilloma were reviewed and correlated to initial imaging, endoscopy, and surgical reports. Imaging patterns of recurrent inverted papilloma are identical to those of initial tumors and recurrence location is closely related to the site of the former lesion. Magnetic resonance is more efficient than CT for the diagnosis and evaluation of extensions. Magnetic resonance supplies the deficiencies of endoscopy in case of extensions to the frontal sinus or the lateral recess of the antrum, especially if mucosal hyperplasia or sinusitis is associated. Magnetic resonance imaging is the first imaging modality to perform in the follow-up after removal of inverted papilloma.

Adult↗
PubMed2000

[The pectoralis myofascial flap in oropharyngeal and pharyngolaryngeal reconstruction in salvage surgery].

BACKGROUND: The pectoralis major myofascial (PMMF) flap is rapidly mobilized, reliable in a number of clinical situations calling for vascularized soft tissue coverage in the head and neck. Salvage surgery after radiation failures produce salivary fistula, skin flap necrosis, vascular rupture. Use of PMMF improves healing in such cases. METHODS: A retrospective review performed at the university hospital, Marseille, between August 1987 and August 1999, was undertaken in two groups of salvage surgery. Groupe 1: protection of great vessels and fistula prevention after total laryngectomy (TL) and pharyngolaryngectomy (PL). Groupe 2: intra oral and pharyngeal defects reconstruction. Outcomes were classified in three types: type 1 - no complications; type 2 - delayed healing; type 3 - complicated healing. In groupe 2, in six cases the amount of flap contraction was analysed by C.T. scan. RESULTS: 83 PMMF was performed. Groupe 1, 57 cases (TL 28 cases, PL 26 cases); groupe 2, oral cavity défect 9 cases; oropharyngeal défects; 17 cases. There was no flap necrosis or vascular rupture. The donor site complications rate was 9.2%. The overall complications follow up was; groupe 1; type 1: 66%; type 2: 32%; type 3: 2%. In the groupe 2, type 1: 81%; type 2: 19%; type 3: 0%. The flap contracture was 30%. The use of PMMF in salvage surgery must be indicated in all cases after TL or PL, and is an excellent alternative from soft tissue coverage of oropharyngeal defects.

Adult↗
PubMed1999

Nonlinear behavior of vocal fold vibration: the role of coupling between the vocal folds.

Coupling between the vocal folds is one of the nonlinear mechanisms allowing regulation and synchronization of mucosal vibration. The purpose of this study was to establish that modulations such as diplophonia and abnormalities observed in vocal signals that may be observed in some cases of laryngeal pathology can be considered as nonlinear behavior due to the persistence of some physical interaction (coupling). An experimental model using excised porcine larynx was designed to create tension asymmetry between the vocal folds and to obtain vocal signals with modulations. Signals were analyzed by spectral analysis and the phase portrait method. Results were compared with computer-generated synthetic signals corresponding to nonlinear combinations of sinusoid signals. Under these conditions, evidence of nonlinear behavior was detected in 85% of experimental signals. These findings were interpreted as a demonstration of vocal fold interaction. Based on these findings, the authors conclude that (1) coupling must be taken into account in physical models of laryngeal physiology, and that (2) methods of nonlinear dynamics may be used for objective voice analysis.

Animals↗
PubMed1999

Clinical experience with Gore-Tex for vocal fold medialization.

OBJECTIVES/HYPOTHESIS: Present clinical experience with vocal fold medialization under local anesthesia using a Gore-Tex implant. The procedure consists of placing the implant into a pocket formed by dissection of the inner perichondrium of the thyroid cartilage through a small window made in the thyroid ala. STUDY DESIGN: During 2 years, we used this technique preferentially in 13 of the 16 cases of vocal fold medialization (three patients underwent Teflon injection because of a contraindication to local anesthesia). Follow-up was longer than 3 months in 11 cases (mean, 13 mo). METHODS: Vocal result was analyzed by the means of perceptual analysis and by the measurement of jitter factor. Glottal leakage was evaluated perceptually using videolaryngoscopy, and oral airflow was measured during the production of a vowel. In cases with preoperative aspiration, videofluoroscopy was performed. RESULTS: Implantation was successful in all but one patient in whom extrusion of the implant material occurred. In the latter case, the implant was removed and the patient recuperated his preoperative voice without any other complication. In the 10 other cases, voice improvement assessed by perceptual and objective evaluation was satisfactory. CONCLUSIONS: Results compare favorably with those of endoscopic techniques using Teflon or collagen and laryngeal frame surgery techniques using silicone or cartilage. We conclude that Gore-Tex implantation is a simple, reproducible, and minimally invasive procedure for management of selected cases of vocal fold unilateral paralysis in the abductory position.

Adult↗
PubMed1999

[The use of calvarial bone in nasal reconstruction].

Twenty-seven nasal reconstructions with parietal bone graft performed between January 1989 and January 1995 were analyzed retrospectively. No complications involving parietal bone were observed. After a 2-year follow-up there have been no cases of shifting, extrusion or resorption of the rhinoplasty. Our experience shows that calvarial bone is an ideal material for nasal reconstruction bone grafts.

Adolescent↗
PubMed1999

[X-ray imaging in assessing the extent of laryngeal cancer].

Partiel surgery of the larynx for cancer should achieve the same carcinological control as total laryngectomy, while at the same time preserving the voice and swallowing. Establishing the extent of the tumour and its relationships with the anatomical structures of the larynx allows a treatment plan to be formulated. Decisions are taken in the light of investigation in which modern imaging plays a fundamental part. The authors have made a comparison of the relative value of CT scanning and MRI as a function of the area involved in the lesion. At present MRI is required only when there is uncertainly of the extent of the subglottic extension, or invasion of the cartilages. We give a prediction of the development of the technique of vitual endoscopy, which will yield a three-dimensional view of the relationships between the tumour and the cartilaginous structures.

Humans↗
PubMed1999

[Extensive rhinectomy. Apropos of 7 cases].

We report our experience in reconstructive surgery after total rhinectomy. Reconstructive surgery is performed after large excision and negative marginal biopsy results. The three layers of the nose (mucosal, osteocartilagineous and cutaneous) are restored by mucosal and cutaneous flaps and osteocartilaginous grafts. Carcinologic and cosmetic results are satisfactory but functional results may yet be improved.

Adult↗
PubMed1999

[Intralesional injection of vinblastine in treatment of laryngeal Kaposi sarcoma associated with AIDS].

Kaposi's sarcoma (KS), is the most frequent malignant neoplasm associated with acquired immunodeficiency syndrome (AIDS). Classically arising in the skin, mucosal lesions are seen in 50 percent in oral cavity. KS rarely involves the larynx (37 cases have been reported in the world literature), when KS occurs in the larynx airway compromise can be a serious threat and immediate treatment is necessary. We report one case of KS of the supraglottic larynx, and intralesional injections were performed. A complete response was noted eleven months later. Although several modes of treatment are available (radiation therapy, systemic chemotherapy) to manage KS, intralesional injections with vinblastine sulfate may after an effective therapeutic alternative.

Acquired Immunodeficiency Syndrome↗
PubMed1999

[Extramedullary plasmocytoma of the nasal cavity: a case report].

PURPOSE OF STUDY: To establish a diagnosis and therapeutic management in patients with extramedullar plasmocytomas. METHOD: There is no consensus concerning extramedullar plasmocytoma treatment. One patient with a nasal cavity tumor location and a review of literature are reported. RESULTS: Extramedullar plasmocytoma is a rare tumor that occurs most frequently in the upper respiratory tract. The most common location is the nasal cavity. Diagnosis can only be made after histological and immunohistochemical examinations. Localized tumors are treated by radiation therapy, combined or not with surgery. Disseminated diseases are treated by chemotherapy. CONCLUSION: Diagnosis can only be confirmed after the exclusion of a systemic disease (multiple myeloma).

Adult↗
PubMed1998

Postoperative follow-up of juvenile nasopharyngeal angiofibromas: assessment by CT scan and MR imaging.

The purpose of this study was to assess the radiological findings after surgical removal of juvenile nasopharyngeal angiofibromas (JNA). The postoperative CT and MRI scans of ten patients were reviewed. The cured group included six patients. The non-controlled group included six patients with eight recurrences. Two patients belonged to both groups as they were also followed and cured after surgery for relapse. Four recurrences were asymptomatic and diagnosed by imaging. The imaging patterns were matched to the patients clinical status and endoscopic findings. In the cured group, non-enhanced residual soft tissue masses were seen in all cases. In the non-controlled group, recurrence was always demonstrated on early postoperative CT or MR as a dramatically enhanced mass. The recurrence was located in the lateral or superior aspect of the nasopharynx (n = 3), deep to the fossa of Rosenmuller (n = 4) or out of the nasopharynx (n = 1). In two cases a remaining enhanced mass disappeared spontaneously on iterated examinations. Because of numerous asymptomatic relapses, a radiological workup is recommended four months after surgery, even in patients with normal endoscopy, to rule out posterolateral or extranasopharyngeal recurrences. Spontaneous evolution of residual masses must be appreciated on iterated imaging examinations.

Adolescent↗
PubMed1998

[Chondrosarcoma in nasal fossae and Maffucci's syndrome].

INTRODUCTION: Maffucci's syndrome is a congenital non-hereditary disease very similar to Ollier's disease and associates multiple cutaneous hemangiomas, dyschondroplasia and often enchondromas. EXEGESIS: We report a unique case involving synchronous localization of chondrosarcoma in nasal fossae and anterior chest wall, disclosing Maffucci's syndrome. CONCLUSION: Atypical chondrosarcoma localization must lead to further investigation of potential multiple enchondromatosis.

Adult↗
PubMed1998

[Geometric modeling and virtual endoscopy of the laryngo-tracheal lumen from computerized tomography images: initial applications to laryngo-tracheal pathology in the child].

Endoscopy is an essential stage in the management of laryngo-tracheal disorders in the infant, but remains a difficult procedure. CT scanning is used to confirm the abnormality and to estimate the degree to which the airway is compromised. The authors describe virtual endoscopy of the larynx and trachea based on a mathematical model, itself constructed from CT images. This work is based on a methodology developed at the Hôpital de la Timone for modelling the aorta. By applying this methodology to the study of laryngo-tracheal disorders, it is possible to establish the relevant pre-treatment measurements (length, diameter, degree of narrowing). This preliminary study has been carried out in 8 cases, in parallel with their clinical treatment. It has allowed us to single out the 3 typical examples which are presented in detail, and to show the advantages of this new approach: immediate and precise measurements, presentation which it is not possible to achieve with conventional techniques of 3-dimensional imaging, and demonstration of the degree of encroachment of the externe stenoses. When taken as part of the management of the patient, this technique complements the findings of real endoscopy, or replaces them, thus reducing the costs of hospital admission and the risks inherent in this procedure.

Adolescent↗
PubMed1998

[Selection of electrophysiological investigations for diagnosis in idiopathic facial palsy. Twenty years experience in an ENT department].

Electrophysiological exploration of the facial nerve requires different tests to differetciate the importance of the block, denervation and canal conduction. We must answer five questions: 1) Assessing the degree and the phase of the nerve lesion, 2) Deciding on the advisability of a facial decompression in the early stage of the palsy, 3) Evaluating the prognosis, 4) Choosing the best therapeutic approach, 5) Detecting facial hyperkinesis in an infraclinic period. In order to answer these questions, we select the following methods: 1) Quantified Electroneuronography should be applied as early as the 2nd day after onset, repeated on the 7th and 10th days. Unfortunately this is not always possible for practical reasons. In any case a minimum of two investigations should be performed during the 12 first days. 2) We add Computer EMG in order to control the evolution of the blocked fibers with regard to denervated fibers. 3) Blink reflex and Stapedius reflex are investigated from the 3rd day. After the acute phase of the palsy, recovery is detected by the reappearance of the blink and stapedius reflexes and the evolution of the computed EMG. These tests are sufficient for answering the five questions mentioned above without discomfort for the patient.

Electromyography↗