Background Anterior commissure (AC) carcinoma is in close proximity to the thyroid cartilage. Our objective was to evaluate risk factors for thyroid cartilage invasion. Methods This was a retrospective study of tumors involving the AC treated by open surgery. Tumor stage, extensions, vocal fold (VF) mobility, CT scan, and pathologic cartilage status were recorded. Results Ninety-four patients with clinical T (cT) classifications cT1b (44%), cT2 (50%), and cT3 (6%) were included. The incidence of thyroid cartilage invasion was 8.5%, significantly related to VF mobility, with invasion in 31% versus 5% with normal mobility (p = .002). Sensitivity, specificity, and positive and negative predictive values for decreased VF mobility were 50%, 90%, 31%, and 95%, respectively. After a median follow-up of 49 months, there was no difference in local control between tumors with or without cartilage invasion. Conclusions For these tumors involving the AC, VF mobility was the only significant factor related to thyroid cartilage invasion and should be taken into consideration when planning surgery. (c) 2011 Wiley Periodicals, Inc. Head Neck, 2011

La dermatomyosite (DM) est une pathologie inflammatoire multi-organe dont les manifestations cutanées et musculaires sont au premier plan. La physiopathologie est encore très mal comprise, mais il s’agit d’un dérèglement de l’immunité humorale et cellulaire. Le diagnostic de DM est basé sur cinq critères : une faiblesse des muscles proximaux des membres, une élévation des enzymes musculaires sériques, des anomalies musculaires histopathologiques visibles sur la biopsie musculaire, des anomalies électromyographiques, et des manifestations cliniques inflammatoires dermatologiques (éruption héliotrope, poïkilodermie et lésions inflammatoires au niveau des mains et en regard des articulations). La DM s’observe fréquemment au cours de certains cancers, et peut apparaître avant le cancer, en même temps que le cancer ou après le diagnostic de cancer. L’incidence de DM associée avec les carcinomes nasopharyngés est de l’ordre d’un pour 1000 cas de cancer nasopharyngé. Le traitement est fondé sur les immunosuppresseurs non sélectifs même en cas de cancer, et en particulier sur les corticoïdes par voie générale à long cours. Cependant, le développement de thérapies ciblées pourra modifier cette approche thérapeutique dans un avenir proche. Malgré l’immunosuppression iatrogène, le pronostic des cancers nasopharyngés associés à la DM paranéoplasique n’est pas modifié. Notre rapport a pour objectif de rapporter un cas à titre d’illustration d’une évolution paranéoplasique (évoluant en même temps que le cancer) et de faire une mise au point des connaissances actuelles concernant la DM paranéoplasique dans ces cancers.

Dermatomyositis (DM) is a multisystem inflammatory disorder primarily affecting the skin and muscles. Its pathophysiology is still very poorly understood, but humoral and cellular immune dysregulation is apparent. Diagnosis of DM is based on five criteria: proximal limb muscle weakness, serum muscle enzyme elevation, histopathologic muscle abnormalities on muscle biopsy, electromyographic abnormalities, and clinical inflammatory dermatological manifestations (heliotrope rash, poikiloderma, and inflammatory lesions on the hands and facing joints). DM is frequently associated with certain cancers, and may appear before, concurrent with, or after diagnosis of cancer. DM has been reported to be associated with approximately one per 1000 cases of nasopharyngeal carcinoma. Treatment is based on long-course nonselective immunosuppression, particularly corticosteroids, by general route, even when malignancy is present, but new-targeted therapies may modify the treatment strategy in the near future. Despite iatrogenic immunosuppression, the prognosis of nasopharyngeal cancer is not worse in patients with paraneoplastic DM. We report one case as an illustration of this paraneoplastic course (evolving in parallel with the cancer), and to make an update on the state of knowledge on paraneoplastic DM in such cancers.

OBJECTIVES/HYPOTHESIS:Determine the incidence and risk factors for thyroid cartilage invasion in early and midstage laryngeal cancer.STUDY DESIGN:Retrospective review.METHODS:A retrospective review was carried out of tumors treated by open surgery with at least partial resection of thyroid cartilage from 1992 to 2008. Preoperative laser, radiation therapy, or chemotherapy were excluded. Tumor stage, anterior commissure involvement, vocal fold (VF) mobility, computed tomography (CT) scan, and pathological cartilage status were recorded.RESULTS:Three hundred fifty-eight patients were treated for tumors staged cT1 (32%), cT2 (53%), and cT3 (15%) by vertical (26%), supracricoid (62%), or supraglottic partial laryngectomy (12%). The thyroid cartilage was invaded in 8.9% of cases. Abnormal VF mobility was significantly related to thyroid cartilage invasion (Fisher exact test, P = .0002). Neither anterior commissure involvement nor CT scan were related to cartilage invasion.CONCLUSIONS:Thyroid cartilage invasion was rare but increased if VF mobility was impaired. This has implications for transoral resection, which unlike open surgery avoids unnecessary cartilage resection.

OBJECTIVE:To assess the efficacy of radiotherapy in the treatment of nasoethmoidal adenocarcinoma.DESIGN:Multicenter, retrospective study.SETTING:Eleven French hospitals.PATIENTS:The medical records of 418 patients who presented with nasoethmoidal adenocarcinoma from January 1, 1976, through December 31, 2001, were evaluated. A total of 324 patients were treated with a combination of surgery and radiotherapy, and 55 were treated with surgery only.MAIN OUTCOME MEASURES:Survival rates, disease recurrence, and postoperative complications.RESULTS:The 5-year Kaplan-Meier survey revealed survival rates of 64.5% for the surgery-only group and 70.8% for the combined-treatment group. In the surgery-only group, 28 patients (51%) had disease recurrence (24 local, 2 regional, and 2 distant). Of the 55 patients in the combined-treatment group, 31 patients (56%) had disease recurrence (29 local, 1 regional, and 1 distant). Immediate postoperative complications in the combined-treatment group were hemorrhages in 2 patients, meningitis in 3 patients, and cerebrospinal fluid leakage in 4 patients, but no deaths occurred. In the surgery-only group, 1 patient had meningitis, 2 had cerebrospinal fluid leaking but no hemorrhage, and 5 died postoperatively.CONCLUSION:The results of this retrospective study suggest that radiotherapy can be used to treat nasoethmoidal adenocarcinoma, but its usefulness should be confirmed with further prospective studies.

Objective: To measure patient-reported quality of life before and after botulinum toxin A treatment of post-parotidectomy Frey's syndrome (gustatory sweating).Patients and methods: A questionnaire concerning functional, social and emotional aspects of Frey's syndrome (14 questions, with responses on a zero to three point scale) was administered to 17 patients (13 women and four men) before and one month after intradermal injection of botulinum toxin A. Parotidectomy had been performed one to 19 years previously, for benign (n = 10) or malignant (n = 7) tumours, with gustatory sweating occurring a median of 15 months after surgery (range: one month to 14 years). Pre- and post-treatment quality of life scores were compared using Wilcoxon's test (p < 0.05).Results: Patients' reported functional quality of life improved significantly (p = 0.0004). Their social and emotional scores were not significantly modified (p = 0.155 and 0.142, respectively). Seven patients (41 per cent) found the injections painful, but all patients said that the effects were beneficial, that they would undergo new injections if necessary and that they would recommend this treatment to other patients. The benefit lasted over 1.5 years for 60 per cent of patients. No correlation was found between duration of the effect and the extent of parotidectomy (p = 0.067).Conclusions: Botulinum toxin A significantly improved patients' functional quality of life, without significant improvement in their social or emotional quality of life, according to our questionnaire results. The duration of the effect was longer than the reported physiological effect of botulinum toxin A on acetylcholine receptors.

Los carcinomas del piso de la boca requieren un tratamiento quirúrgico en numerosas ocasiones, que debe incluir el lecho tumoral y las áreas ganglionares. El tratamiento del lecho tumoral consiste siempre en una fase de exéresis y, después, en una etapa de reparación. La fase de exéresis debe adaptarse a la extensión del tumor tanto a nivel de los tejidos blandos como del hueso. Si se produce una discontinuidad ósea, su reparación (sobre todo si es anterior), es indispensable para evitar secuelas morfológicas y funcionales muy graves.

Objective To report the efficacy of botulinum toxin A for radiation‐induced pain, trismus, and masticator spasm in head and neck cancer. Patients and Methods This prospective nonrandomized study included patients in complete remission with radiation‐induced pain and trismus with or without masticator spasms. Fifty units of Botox (Allergan) or 250 units of Dysport (Ipsen) were injected transcutaneously into the masseter muscles. Jaw opening was measured and patients answered 20 questions about jaw opening, pain, and cramps, before injection at 1 month. Results Nineteen patients (7 women, 12 men) were included. Median time after radiation therapy was 5 years (range, 11 months to 22 years). At 1 month, no significant increase in jaw opening was recorded. Improvement was noted in the functional domain ( P = 0.004), for pain ( P = 0.002) and cramps ( P = 0.004), but not in the social ( P = 0.83) or emotional ( P = 0.43) domains. No side effects occurred. Conclusions Botulinum toxin did not improve trismus but significantly improved pain scores and masticator spasms (oromandibular dystonia).

Objective: To determine risk factors and evaluate the treatment of ethmoid adenocarcinoma. Epidemiologic data were recorded and compared with the literature.Materials and Methods: A multicenter and retrospective study. The medical records of 418 patients who had presented with ethmoid adenocarcinoma at 11 French hospitals from 1976 to 2001 were analyzed to determine the clinical characteristics and treatment of the disease.Results: The gender ratio was 2.8 men per 1 woman. Toxic exposure was classic for this lesion, exposure to wood and leather for most cases. The mean age was 63 years (range 31-91). Symptoms were nonspecific and based on clinical rhinologic signs. Nasal endoscopy after mucosal retraction was found useful to evaluate the extension of the lesion and to perform biopsies. Computed tomography scan and magnetic resonance imagery must be carried out prior to treatment to define extra nasal extension. The survival rate was significantly influenced by the size of the lesion (T4, N+) and extension to brain or dura. Surgery with postoperative radiotherapy remains the treatment of choice. Total excision must be a major priority, as confirmed in our series.Conclusion: This retrospective study was, to our knowledge, the largest ever reported in the literature. This series confirmed the risk factor of this lesion as well as the lesion's influence on the survival rate. Surgery is the most important part of the treatment. Local recurrences were responsible for the poor prognosis of this lesion.

Annales Francaises d'Oto-Rhino-Laryngologie et de pathologie cervico-faciale - Vol. 118 - N° 1 - p. 26-34

I carcinomi del pavimento orale vengono trattati nella gran parte dei casi con un trattamento chirurgico. Questo trattamento chirurgico deve interessare il letto tumorale e le aree linfonodali. Il trattamento del letto tumorale comporta sempre un tempo di exeresi e successivamente un tempo di riparazione. Il tempo di exeresi deve essere adattato sia all’estensione del tumore sia ai tessuti molli e all’osso. In caso di interruzione ossea, la riparazione della continuità ossea, specialmente se l’interruzione è anteriore, è indispensabile per evitare gravi postumi morfologici e funzionali.

Annales Francaises d'Oto-Rhino-Laryngologie et de pathologie cervico-faciale - Vol. 124 - N° 5 - p. 244-251

Los cánceres del seno piriforme son frecuentes en algunos países de Europa. Cuando alcanzan cierto grado de desarrollo, invaden ampliamente la pared posterior de la hipofaringe y la boca esofágica. En estos casos, la única cirugía posible es la faringolaringectomía total circular, que requiere la reconstrucción del tubo faríngeo. Lo mismo ocurre con los cánceres de la región retrocricoaritenoidea y los de la boca esofágica. En los últimos 35 años han aparecido numerosas técnicas, aunque en la actualidad se emplean fundamentalmente cuatro: el colgajo musculocutáneo en U, el trasplante libre antebraquial tubulizado, la gastroplastia y el trasplante libre de yeyuno. Estas técnicas tienen como objetivo la obtención de un tubo faríngeo que permita la recuperación rápida de la deglución sin riesgo de estenosis tardía y con la mínima mortalidad y morbilidad. La elección de la técnica de reparación depende en gran parte de las costumbres de cada equipo y de la posibilidad de disponer o no de un cirujano experto en técnicas de microanastomosis. Resulta fundamental permitir que el paciente vuelva pronto a su domicilio, ya que el pronóstico de estos cánceres es reservado y después requieren radioterapia a corto plazo.

Aim: To report our experience in free flap reconstruction of the hard palate after malignant tumor resection, in terms of reconstruction method, immediate post-operative course and subjective functional results.Patients and methods: Files from 1988 to 1999 were reviewed for patients having undergone microvascular reconstruction of the hard palate. The immediate post-operative course (during the first month) was reviewed to determine the occurrence of complications. The surgeon's evaluation I year post-operatively was used to determine the intelligibility of speech, type of diet and the quality of nasal permeability.Results: Thirty eight patients (28 men and 10 women) with malignant tumors involving the hard palate had undergone surgical reconstruction using microvascular free flap techniques: free radial forearm flap (13 cases), scapular flap (24 cases) or fibular flap (five cases). Two different flaps were employed in two cases (scapula plus fibula). A second flap, was used with success in two cases of failure of the first flap, for a total of 42 free flaps for 38 patients. Complications occurred in seven cases, with two cases of flap necrosis. At 1 year. 33 patients achieved a normal diet and 35 normal or easily intelligible speech.Conclusions: Microsurgical reconstruction using free tissue transfer allows reconstruction of large defects of the hard palate, with low morbidity and an excellent functional outcome. We propose criteria for free flap reconstruction and choice of flap. (c) 2006 Elsevier Ltd. All rights reserved.