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Biomedical subjects

P Rombaux

Publications and source records attributed to P Rombaux.

At least 37 records · Page 2Linked to original sources
PubMed2000

Surgery of inverted papillomas under endoscopic control.

Six centers cooperated in a retrospective study on endoscopic surgical resection of Papillomas of the nose and paranasal sinuses in order to assess both the efficiency and the safety of this kind of surgical approach. From 1991 till march 2000, 87 cases of Papillomas resections under--at least partially--endoscopic control were gathered, among which 85 were Inverted Papillomas (IP), 2 were Exophytic Papilloma (EP) and one was IP coexisting with Collumnar Cell Papilloma (CCP). Malignant transformation was found out in 3 cases of IP. Regarding the 85 patients with IP demographics are as follows: 61 males, 24 females, with a mean age of 58.4 years (STDV: 13.96) in a range from 27 to 92 years. The mean follow-up was of 41.9 months with range of 1-120 months. Fifteen recurrences occurred that were treated by revision surgery either under endoscopic control or by limited external approach. The mean time for recurrences to occur was 8.07 months with range of 1-24 months. The three patients with malignant transformation underwent postoperative radiation therapy. All of the patients are free of recurrence, however for some of them the follow-up is too short to definitely assess their free of disease status. The role of modern diagnostic tools in medical imaging--CAT and MRI--in order to assess clearly the limits of the tumors and to enhance the efficiency and the safety in the choice of a surgical approach is pointed out. The stress is put on the need for radical excision under endoscopic control which can be combined with the Caldwell-Luc transantral approach or with frontal trepanation for the cure of tumors impossible to be reached under endoscopic control only. Irrespective of the tumor extent and of the approaches that was used for excision a close endoscopic follow-up still remain mandatory, by trained surgeons, in the long term management of IP. Biopsies, CAT and/or MRI must be performed in any case with recurrence suspicion.

Adult↗
PubMed2000

Endoscopic endonasal ligation in treatment of severe posterior epistaxis.

The technique and indications of an endonasal endoscopic technique for treatment of posterior epistaxis are presented. Three cases were successfully treated in our department in 1999. The posterior vascularisation of the nose is reviewed with emphasis on surgical anatomy. Endoscopic endonasal ligation of posterior nasal arterial vascularisation is compared with other treatment choices in posterior epistaxis. The technique is save and efficient. Since it is also a minimally invasive technique, it has become our first choice surgical procedure for posterior epistaxis.

Adult↗
PubMed2000

Transcanalicular diode laser assisted dacryocystorhinostomy.

AIM OF THE STUDY: To assess the validity of transcanalicular diode laser assisted dacryocystorhinostomy (TLADCR) in the treatment of distal obstruction of the lachrymal pathways. MATERIAL AND METHOD: Between June 1999 and February 2000, 29 TLADCR were performed in the ENT department on 26 patients. Surgical indications included chronic dacryocystitis in 19 cases and dacryostenosis in 10 cases. In all cases but one, the surgery was carried out under a standard general anesthetic. The diode laser was used with a power setting of 10 watts. RESULTS: Seventeen out of 29 TLADCR were regarded as having successful outcomes. 2 out of 29 TLADCR had a little persisting tearing regarded as non debilitating and much less than which was present preoperatively. In 10 out of 29 TLADCR, the procedure was deemed a failure. These failures included 4 out of the 10 primary dacryostenosis and 6 out of the 19 chronic dacryocystitis. Two patients refused further treatment. In the other 8, surgical revision was undertaken via the traditional endonasal approach. In 7 of these cases, the lachrymal system was full of purulent secretions. COMPLICATIONS: Two patients developed a partial stenosis of one canaliculus that was diagnosed during the surgical revision. Another patient had a small fistula between the canalicular system and the skin of the corner of the eye that disappeared after the revision surgery. In one other case, the superior canaliculus was cauterised by the denudated portion of a resculpted laser fibre. Two bicanalicular nasal stent required reinsertion. Three patients developed a granuloma around the stent. Four patients developed an episode of infection whilst the stent was still in situ. CONCLUSION: Transcanalicular diode laser assisted dacryocystorhinostomy (TLADCR) performed with a 600-micron contact fibre is a relatively simple, elegant and effective procedure when used in conjunction with nasal endoscopy, to treat distal obstruction of the lachrymal pathways. But, the cost, the high prevalence of minor complications and the currently higher reported failure rate would favour external or endonasal approaches over this approach.

Adolescent↗
PubMed2000

Transnasal endoscopic orbital decompression and Graves' ophtalmopathy.

AIM OF THE STUDY: To assess the validity and the limits of endoscopic endonasal orbital decompression for Graves' ophtalmopathy resistant to the medical theapy. MATERIAL AND PATIENTS: Between September 1994 and May 1998, 16 patients with Graves' ophtalmopathy resistant to the medical treatment underwent an orbital decompression transnasally. 27 orbits were decompressed. The surgery was bilateral in 11 patients. In the 5 remaining cases, the surgery was unilateral. It was carried out on the left side in 2 cases and on the right side in 3 cases. RESULTS: Preoperatively, the average visual acuity was 8/10. Postoperatively, the visual acuity was 9.5/10. The average preoperative exophtalmometry measurement was 25.04 mm and the average postoperative measurement was 21.83 mm. The average retrodisplacement was 3.17 mm (range: 2-8). Preoperatively, 3 patients had mild diplopia whereas 5 others had moderate to severe extraocular muscle dysfunction. Postoperatively, 6 patients had mild diplopia whereas 10 patients required squint surgery for moderate to severe extraocular muscle dysfunction. CONCLUSION: Endoscopic orbital decompression improve all the symptoms of Graves' ophtalmopathy but one: the extraocular muscle dysfunction. Its cardinal indication is the treatment of compressive optic neuropathy whereas this surgical approach provides an excellent control of the medial wall of the orbit and the orbital apex. But the average reduction of proptosis of 3.17 mm is not high enough to propose this approach alone for the treatment of disfiguring proptosis. In such cases, a 2 or 3 wall orbital decompression should be performed to get marked cosmetic and functional improvement. In all cases, the patient should be informed about the risk of postoperative diplopia.

Adult↗
PubMed2000

Endoscopic endonasal surgery in choanal atresia.

Twenty-seven cases of choanal atresia operated between 1979 and 2000 have been reported from 4 different institutions (19 females, 8 males, age of first surgical procedure ranging from 2 days to 35 years). Of these 27 cases, 22 were previously untreated. The outcomes for 19 of these new cases were available for the present report. Bilateral atresias were somewhat more frequent (15 versus 12) and associated anomalies were present in 10 out of 27 patients. Details about the types of atresia, associated anomalies, surgical techniques, duration of stenting and outcomes are given together with a theoretical review on choanal atresia.

Adolescent↗
PubMed2000

Endoscopic sinus surgery for juvenile nasopharyngeal angiofibroma.

Juvenile nasopharyngeal angiofibroma is a rare tumour of the head and neck with very specific characteristics: adolescent males, choana-nasopharynx, pterygomaxillary fossa widening, specific and intense vascularisation. Staging is very important in the decision of the surgical approach. Endoscopic management of juvenile nasopharyngeal angiofibroma is technically possible after preoperative embolisation. Up to now 13 angiofibroma have been treated using the endonasal endoscopic sinus surgery approach in Belgium (Leuven 8; Mont-Godinne 2; Ghent 1; Liege 1; Woluwe 1). In smaller tumors endoscopic resection has been successful in four cases without any recurrence. Five larger tumors, extending in the pterygomaxillary fossa, were also successfully resected. Extension into the infratemporal fossa or the cavernous sinus can be endoscopically removed, but recurrences may occur as they do after classical, external approaches. In conclusion, the endoscopic approach is an acceptable alternative in small to middle sized juvenile nasopharyngeal angiofibroma.

Adolescent↗
PubMed2000

Secondary ciliary dyskinesia in upper respiratory tract.

The system of mucociliary clearance has the important task to remove from the airways inhaled substances and locally formed secretions. Inborn disorders of the mucociliary transport are due to ciliary dysfunction (Primary Ciliary Dyskinesia) (PCD) or of increased viscosity of the bronchial secretions (Cystic Fibrosis). To differentiate PCD from the ultrastructural abnormalities found during or after injuries such as respiratory infections, the name of Secondary--or acquired--Ciliary Dyskinesia (SCD) was created. In controls, less than 4% of the cilia may show ultrastructural abnormalities. The most frequent of these are the compound cilia and the peripheral microtubular abnormalities. Compound cilia often appear after infection and therefore are thought to arise secondarily. Secondary ultrastructural abnormalities of cilia include also blebs of the axoneme membrane, ciliary disorientation, and absence of axoneme membrane. No increase in ultrastructural ciliary abnormalities has been found in a variety of respiratory disorders: smoking, asthma and allergic rhinitis, chronic rhinitis and sinusitis, chronic bronchitis, cystic fibrosis, and lung carcinoma. But severe modifications of the respiratory epithelium can be seen. Important for the secondary ciliary disorders is their local and reversible character. To distinct from ultrastructural images between primary and secondary ciliary dyskinesia is often uneasy because some of the findings in secondary ciliary dyskinesia obviously mimic those dedicated to primary ciliary dyskinesia.

Bacterial Infections↗
PubMed2000

Cervical lymphadenitis and cat scratch disease (CSD): an overlooked disease?

Cat Scratch Disease (CSD) is a benign disease characterized by regional lymphadenopathy affecting most frequently the head and neck region in children and young adults. In the present paper, the authors describe four cases of CSD focusing on clinical history, diagnostic management and therapy. The main germ responsible for this lymph node disease is Bartonella henselae. Diagnosis is based on history, serology and histological findings. Clinical evolution is generally favorable despite the fact that complications occur in about 5% to 13% of patients including encephalitis, hepatitis and Parinaud's oculoglandular syndrome. Antibiotic treatment is only considered for highly symptomatic patients. Surgical excision of the lymphadenopathy is useful to establish the diagnosis when serology is not available and/or when the adenopathy become fluctuating. The authors emphasize the increasing incidence of patients with CSD in the ENT population and the algorithm for CSD disease affecting the cervical lymph nodes.

Adolescent↗
PubMed1999

Conservation surgery for laryngeal and hypopharyngeal cancer.

The charts of 173 patients treated by conservation laryngectomy and pharyngolaryngectomy were retrospectively reviewed. The patients treated by endoscopic laser resection were excluded of this study. Glottic carcinoma was diagnosed in 101 patients, supraglottic carcinoma in 44 patients, hypopharyngeal carcinoma in 24 patients and oropharyngeal carcinoma in 4 patients. The median follow-up period was 44 months, 84/101 glottic cancer, 34/44 supraglottic cancer, 23/24 hypopharyngeal cancer and 2/4 oropharyngeal cancer were staged as T1 and T2. A voice-sparing external approach was carried on in 20 patients with locally advanced tumor (T3-T4). At time of the last follow-up, 132 patients (77%) were alive when 41 patients (23%) died. Overall survival rates for patients treated for T1-T2 glottic cancer at 3, 5 and 10 years were 90, 90 and 78% respectively. Overall survival rates for patients treated for T1-T2 supralottic cancer at 3, 5 and 10 years were 73, 68 and 48% respectively. Overall survival rates for patients treated for T1-T2 hypopharyngeal cancer at 3 and 5 years were 74 and 37% respectively. The site of the primary tumor (glottic versus supraglottic or hypopharynx) showed significant impact on survival (P = 0.0025)). Regarding survival, T stage and N stage were not found statistically significant.

Carcinoma, Squamous Cell↗
PubMed1998

Congenital fistula of the fourth branchial pouch.

Between 1986 and 1995, 128 patients were treated for various head and neck congenital malformations at Saint-Luc University Hospital, Louvain. We report three cases of fourth branchial pouch cysts requiring surgical removal. One of these cases presented with a third branchial pouch remnant on the same side and subsequently a fourth branchial pouch sinus. To our knowledge, this is the first case published in the literature. A fourth branchial pouch sinus tract can become manifest clinically by recurrent episodes of neck abscess or acute suppurative thyroiditis (especially in infants). The tract can be identified with a barium swallow during the period of latency and hypopharyngeal endoscopy under general anesthesia. Total excision of the fistula with dissection up to the pyriform sinus with or without a left thyroid gland lobectomy and isthmectomy is the treatment of choice.

Abscess↗
PubMed1998

Effects of Breathe Right on snoring: a polysomnographic study.

The nasal vestibule is a major site of resistance to airflow in healthy subjects. A high nasal resistance may increase snoring. Activation of the alae nasi and alar retraction reduce resistance to airflow and improve ventilation. The Breathe Right (BR) device has been proposed to reduce or eliminate snoring by improving nasal breathing. We assessed the efficacy of BR on sleep quality and snoring during 2 full-night polysomnographies, the first without and the second with BR. Ten non-apnoeic snorers were studied. Snoring was present during 22-98% of total sleep time during the control night. Ear-nose-throat examination disclosed a nasal valve anomaly in five subjects, objectivated by anterior and posterior rhinomanometry. Quality of sleep and snoring were not influenced by BR, even when different sleep stages were analysed separately. No difference in snoring index was found between snorers with or without nasal valve anomaly. We conclude that BR is ineffective in relieving snoring in non-apnoeic snorers.

Adult↗
PubMed1998

Meningioma of the infratemporal fossa: report of a case.

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.

Adult↗
PubMed1998

[Maxillary actinomycosis and maxillary candidiasis in the immunocompetent patient].

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.

Actinomycetales Infections↗
PubMed1998

[Schwannoma of the cervical esophagus: case report and clinical and pathological analysis].

Neurogenic tumors fo the head and neck are relatively rare and often mistaken for other disease processes. Schwannoma (neurinoma, neurilemoma, neurolemoma) is a tumour histologically characterized by the proliferation of schwann cells from the neural sheath of autonomic, cranial or peripheral nerves. We describe a case of schwannoma located in the muscular layer of the cervical esophagus. The clinical and radiological findings are highlighted allowing a retrospective preoperative presumption of schwannoma. Esophageal schwannoma is a very rare entity as only nine cases have been reported so far.

Adolescent↗
PubMed1998

Nocturnal oxymetry in patients with total nasal packing.

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.

Adult↗
PubMed1997

[Zenker's diverticulum. External or endoscopic surgery?].

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.

Endoscopy↗
PubMed1997

[Anastomoses and sutures in cervical laryngotracheal and pharyngoesophageal surgery].

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.

Anastomosis, Surgical↗