•Initial standard curative treatments considered equivalent in LA-HNSCC are exclusive (chemo)radiotherapy or surgery.•But this paradigm is currently challenged by several studies showing a significant improvement in overall survival with surgery.•This work is another argument for inferiority of (chemo)radiation as curative treatment compared to surgery and/or induction chemotherapy.

Supplementary Figure S2 from Tumor-Specific Methylation in Saliva: A Promising Biomarker for Early Detection of Head and Neck Cancer Recurrence

I paragangliomi rappresentano lo 0,6% dei tumori della testa e del collo. Derivano embriologicamente dalla cresta neurale. Sono benigni nel 95% dei casi. Esistono forme familiari legate a mutazioni dell’enzima succinato deidrogenasi. A livello cervicale, i due principali siti anatomici di questi tumori sono il nervo vago e il corpuscolo carotideo. Possono essere uni- o bilaterali. La valutazione preterapeutica ha fatto molti progressi, in particolare nel campo dell’imaging morfologico o metabolico. L’ottimizzazione della valutazione preterapeutica ha permesso di migliorare la scelta del tipo di trattamento e la qualità dell’asportazione chirurgica di questi tumori, che deve essere adattata alla localizzazione e alle dimensioni tumorali. La scelta del trattamento chirurgico dipende dalle condizioni generali e dalla storia del paziente. Per quanto riguarda le vie d’accesso, queste dipendono dal sito del tumore e dalla sua estensione. In generale, il trattamento di questi tumori richiede una collaborazione tra i chirurghi cervicofacciali, i chirurghi vascolari e i rianimatori anestesisti.

BACKGROUND:Given the particularities of olfactory neuroblastoma (ONB) and the lack of studies on the subject, a multicenter collaborative study was conducted to assess treatment strategy. METHODS:Fifty-three patients with ONB were included from the French Rare Head and Neck Cancer Expert Network (REFCOR) database: 16T1, 8T2, 19T3, and 10T4. All cases were treated endoscopically with skull base removal and repair in 26 cases (49%) and without external craniotomy. RESULTS:The overall survival (OS) and disease-free survival (DFS) rates at 5 years were 87% and 71%, respectively, with mean follow-up of 45.4 ± 26.5 months. The complication rate was 18.8% with 4 cases of meningitis. Pathological analysis showed positive margins in 26.8%, notably on the dura-mater and periorbita, without impairment of OS or DFS. Forty-eight patients received adjuvant radiotherapy on T ± N. Ten patients had a recurrence (18.9%). Six patients died of their disease. Prophylactic neck irradiation seemed to reduce the recurrence rate. CONCLUSION:Exclusively endoscopic treatment proved efficient and reliable in a large controlled series.

CONCLUSIONS:Conventional radiotherapy with concurrent cisplatin is significantly superior to induction cisplatin fluorouracil chemotherapy followed by radiotherapy in terms of laryngeal preservation in patients with T3 hypopharyngeal carcinoma. Despite a high rate of laryngeal preservation no survival benefit was recorded in this selected population.OBJECTIVES:To compare conventional radiotherapy with concurrent cisplatin to induction chemotherapy with cisplatin fluorouracil followed by conventional radiotherapy. The primary end point was the preservation of the larynx. The secondary end points included toxicity, causes of death, and survival rates.PATIENTS AND METHODS:Seventy-one adult patients with previously untreated resectable T3 pyriform sinus squamous cell carcinoma were enrolled in the multicenter prospective randomized phase III trial. They were evaluated for organ preservation, survival rates, and toxic reactions.RESULTS:The rates of laryngeal preservation at 2 years were 68% for the induction chemotherapy (IC) group and 92% for the chemoradiotherapy (CR) group (p = 0.016). At 2 years, the event-free survival rates were 36% and 41% for the IC group and CR group, respectively.

Free-flap mandibular reconstruction is a highly specialized procedure associated with severe complications necessitating re-interventions and re-hospitalizations. This surgery is expensive in terms of health workers’ time, equipment, medical devices and drugs. Our main objective was to assess the direct hospital cost generated by osseocutaneous free-flap surgery in a multicentric prospective micro-costing study. Direct medical costs evaluated from a hospital perspective were assessed using a micro-costing method from the first consultation with the surgeon until the patient returns home, thus confirming the success or failure of the free-flap procedure. The mean total cost for free-flap intervention was 34,009€ (5151–119,604€), the most expensive item being the duration of hospital bed occupation, representing 30–90% of the total cost. In the event of complications, the mean cost increased by 77.3%, due primarily to hospitalization in ICU and the conventional unit. This surgery is effective and provides good results but remains highly complex and costly.

Objective Spontaneous cerebrospinal fluid rhinorrhea (SCSFR) might be the only clinical manifestation of idiopathic intracranial hypertension (IIH), which has been historically related to overweight. Our goal was to search for an association between SCSFR and increased body weight on the one hand and SCSFR and imaging findings suggestive of IIH on the other hand. Materials and Methods We retrospectively collected clinical and radiological data of patients operated on endoscopically for SCSFR in our institution from 1993 to 2013. Analyzed factors were body mass index (BMI), extended sphenoid sinus pneumatization on computed tomography, and empty sella and distention of the optic nerve sheath on magnetic resonance imaging. Results There were 15 patients: 8 females/7 males; mean age 50 years. Primary surgical success rate was 86.7%. Regarding body weight, 80% were overweight (BMI ≥ 25) versus 32% in the French general population (p < 0.001). Among patients with SCSFR, 20% were obese (BMI ≥ 30) versus 15% in French individuals without SCSFR (p = 0.483). Increased pneumatization of sphenoid sinuses was observed in 92.9 versus 27.5% in the general population (p < 0.0001). Empty sella was found in 46.2 versus 3% in the general population (p < 0.00001). Dilation of the optic nerve sheath was observed in 46.2 versus 15% in the general population (p < 0.01). Conclusion We found statistically significant associations between SCSFR and overweight, increased pneumatization of sphenoid sinuses, empty sella, and dilation of optic nerve sheath, but not with obesity, which did not have any additional impact of CSF leak than did overweight.

Glottic cancers discovered at an early stage (T1-T2) can be treated with either radiotherapy or surgery. The aim of our study is to analyse survival and functional results of supra-cricoid partial laryngectomy (SCPL) with crico-hyoido-epiglottopexy (CHEP) as surgical treatment for glottic carcinoma with anterior commissure involvement. We performed a retrospective study (1996-2013) which included patients who underwent SCPL-CHEP for glottic squamous cell carcinoma with involvement of the anterior commissure. Before surgery, all patients underwent staging including head, neck and chest CT-scan with contrast injection as well as suspension laryngoscopy under general anaesthesia. A total of 53 patients were included. The median follow-up period was 124 months. Tumour resection was complete in 96.2% of cases. The overall, specific and recurrence-free survival rates at 5 years were, respectively, 93.7%, 95.6% and 87.7%. The average period of hospitalisation was 18 days. The average time elapsed before decannulation and before restoration of oral feeding were 15 and 18 days, respectively. SCPL-CHEP is an important option for laryngeal surgical preservation. It allows adequate disease control as well as good functional results as long as the indications are well respected and the surgical techniques are mastered.

Objective: The present consecutive case series reports our experience in the management of carotid body paraganglioma and aims to assess whether the Shamblin classification or tumor size are predictive of early and late postoperative neurovascular complications.Material and methods: A retrospective study included 54 carotid body tumor resections in 49 patients, between 1980 and 2011. Data comprised early (< 1 month) and late (18 months) postoperative neurovascular complications.Results: Early postoperative complications occurred in 31 cases, including 30 cases of cranial nerve deficit (56%). Cranial nerve deficit occurred in 83% of Shamblin III carotid body paragangliomas and was associated with significantly larger mean tumor size (4 +/- 1.4 cm versus 2.9 +/- 1.3 cm; P < 0.01). Shamblin III tumor and tumor size > 3.2 cm emerged as predictive factors for early postoperative peripheral neurological complications. Eight patients (17%) showed no cranial nerve deficit recovery, even after 18 months' follow-up; no predictive factors could be identified for this.Conclusion: Surgical resection remains the only curative treatment in carotid body paraganglioma, with low vascular morbidity. However, early postoperative nerve deficit remains frequent (56%), although mostly temporary, with 17% definitive sequelae at 18 months. Tumor size and Shamblin classification are predictive of early neurovascular complications. (C) 2016 Elsevier Masson SAS. All rights reserved.

Background. Appropriate animal models are required to test novel therapeutics for head and neck squamous cell carcinoma (HNSCC) such as near-infrared (NIR) imaging-guided surgery.Methods. We developed an optimized animal model of orthotopic HNSCC (in female athymic NMRI (Naval Medical Research Institute) nude mice) with a prolonged survival time. Resection of the orthotopic tumors was performed 30 days after implantation with or without the aid of a miniaturized clinical grade NIR optical imaging device, after systemic administration of a fluorescent RGD-based probe that targets alpha(v)beta(3) integrin.Results. NIR optical imaging-guided surgery increased the recurrencefree survival rate by 50% through the detection of fluorescent cancer residues as small as 185 mm; these fragments could remain unidentified if resection was performed exclusively under unaided visual guidance.Conclusion. NIR optical imaging-guided surgery showed an improved HNSCC tumor resection quality in our optimized orthotopic animal model. (C) 2015 Wiley Periodicals, Inc.

Après avoir rappelé les principales caractéristiques anatomiques des sinus frontaux, la technique, et ses variantes, utilisée pour réaliser une craniotomie frontale est décrite. L’incision cutanée est bicoronale. Un lambeau de péricrâne est confectionné, dont les limites restent à distance des ostéotomies. Les ostéotomies sont effectuées à la scie oscillante. L’ostéotomie inférieure est faite dans un plan horizontal. Elle suit tangentiellement le bord supra-orbitaire jusqu’à la limite latérale de chaque sinus. En dedans, elle est poursuivie jusqu’au nasion. Elle passe, en moyenne, 3mm au-dessus du plancher des sinus dans leur portion interne, immédiatement au-dessus des canaux nasofrontaux. L’ostéotomie supérieure est faite dans un plan vertical coronal. Elle passe par le sommet des sinus. Elle est arciforme, concave vers le bas, joignant les extrémités latérales de l’ostéotomie inférieure. L’ablation de la paroi sinusienne postérieure constitue une crânialisation des sinus frontaux. Elle permet l’accès à la partie médiane de la base antérieure du crâne. La découpe de la paroi postérieure est réalisée à la fraise rotative selon le même dessin que la paroi antérieure. En fin d’intervention, la synthèse du volet osseux est faite au fil nylon et le lambeau de péricrâne est rabattu en avant et suturé.

We studied whether there is a relationship between nausea and vestibular disorders in patients treated with intensity modulated radiation therapy (IMRT) for head and neck cancer.We performed a prospective single-centre study that enrolled 31 patients. A videonystagmography was carried out before and within 15 days after radiation therapy for each patient. Nausea was assessed at baseline, every week, and at the post-radiotherapy videonystagmography visit.Twenty-six patients had benefited from a complete interpretable videonystagmography. For 14 of these patients vestibular damage was diagnosed post-radiotherapy. During irradiation, six patients felt nauseous, but without dizziness. In univariate analysis, we found a relationship statistically significant between the average dose received by the vestibules and vestibular disorder videonystagmography (P=0.001, odds ratio [OR]: 1.08 [1.025-.138]), but there was no relationship between vestibular disorder videonystagmography and nausea (P=0.701).Irradiation of the vestibular system during IMRT does not seem to explain the nausea.

Midline cysts of the neck are the most common congenital malformations of the neck. They arise along the thyroglossal duct. The presence of a fistula is the result of either spontaneous (suppuration) or surgical fistulisation (simple incision or incomplete excision). The cyst and/or fistula are located between the base of the tongue and the thyroid gland, predominantly adjacent to the hyoid bone. This midline site can be explained by embryological development of the thyroid gland. Treatment is surgical. Many techniques have been described, but Sistrunck procedure (described in 1920), based on embryological studies, remains the reference technique with a recurrence rate of less than 3%, provided surgery is performed correctly, comprising resection of the body of the hyoid. Risk factors for recurrence are: surgery during the inflammatory phase, cyst rupture during dissection, multiple thyroglossal ducts and a technical error during the surgical procedure.

Cette étude de série de cas rapporte notre expérience dans la prise en charge des paragangliomes du glomus carotidien. L’objectif est de déterminer si la classification de Shamblin ou la taille tumorale sont des facteurs prédictifs de survenue des complications neurovasculaires postopératoires précoces ou tardives. Quarante-neuf patients opérés de 54 paragangliomes du glomus carotidien ont été inclus dans cette étude rétrospective sur la période allant de 1980 à 2011. Nous avons recensé les complications neurovasculaires postopératoires précoces (< 1 mois) et tardives (séquelles à 18 mois). Des complications postopératoires précoces sont survenues dans 31 cas ; il s’agissait d’un déficit neurologique crânien dans 30 cas (56 %). Ce déficit était retrouvé dans 83 % des cas lorsque le paragangliome du glomus carotidien était de stade III selon la classification de Shamblin et la taille tumorale significativement plus élevée (4 cm ± 1,4 versus 2,9 cm ± 1,3 ; p < 0,01). Un paragangliome du glomus carotidien de stade III selon la classification de Shamblin et de taille > 3,2 cm était un facteur prédictif de survenue de complications neurologiques périphériques précoces. Huit patients (17 %) présentaient un déficit neurologique périphérique permanent, avec des séquelles à 18 mois ; aucun facteur prédictif n’a été identifié. L’exérèse chirurgicale des paragangliomes du glomus carotidien est le seul traitement curatif avec une faible morbidité vasculaire. Cependant la survenue d’un déficit neurologique périphérique précoce reste fréquent (56 %), mais temporaire avec 17 % d’atteinte définitive à 18 mois. La classification de Shamblin et la taille tumorale sont des facteurs prédictifs de survenue des complications neurovasculaires postopératoires précoces.

Los tumores del carrillo son menos frecuentes que los de las otras localizaciones de la cavidad bucal, aunque son más frecuentes en los países asiáticos porque se asocian al tabaco de mascar (betel). Se clasifican en lesiones precancerosas o cancerosas de origen mucoso (carcinoma epidermoide) o glandular (adenocarcinoma o carcinoma adenoide quístico). Las lesiones precancerosas requieren una resección limitada para efectuar un análisis patológico detallado. En los tumores en los que se comprueba su malignidad, puede realizarse una resección quirúrgica limitada, pero ampliada a los músculos de la mejilla en profundidad. Si la resección yugal es limitada, la reparación tisular no es obligatoria. Las resecciones más extensas requieren una reconstrucción mediante colgajo muscular, miocutáneo, pediculado o no, e incluso colgajos compuestos que incluyan un elemento óseo, en particular si se realiza una resección mandibular. La resección se suele asociar a un vaciamiento ganglionar homolateral, debido a la linfofilia de estos tumores.

Purpose. - We studied whether there is a relationship between nausea and vestibular disorders in patients treated with intensity modulated radiation therapy (IMRT) for head and neck cancer.Patients and methods. - We performed a prospective single-centre study that enrolled 31 patients. A videonystagmography was carried out before and within 15 days after radiation therapy for each patient. Nausea was assessed at baseline, every week, and at the post-radiotherapy videonystagmography visit.Results. - Twenty-six patients had benefited from a complete interpretable videonystagmography. For 14 of these patients vestibular damage was diagnosed post-radiotherapy. During irradiation, six patients felt nauseous, but without dizziness. In univariate analysis, we found a relationship statistically significant between the average dose received by the vestibules and vestibular disorder videonystagmography (P=0.001, odds ratio [OR]: 1.08 [1.025-.138]), but there was no relationship between vestibular disorder videonystagmography and nausea (P=0.701).Conclusions. - Irradiation of the vestibular system during IMRT does not seem to explain the nausea. (C) 2016 Societe francaise de radiotherapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.

After recalling the main anatomical characteristics of the frontal sinuses, the authors describe the frontal craniotomy surgical procedure and its variants. A bicoronal skin incision is performed. An inferior-based pericranial flap is created, with its limits situated away from the osteotomies. Osteotomies are performed with an oscillating saw. The inferior osteotomy is horizontal, tangentially following the supraorbital margin as far as the lateral limit of each sinus. The osteotomy is continued medially as far as the nasion, passing an average of 3mm above the floor of the medial part of the sinuses, immediately above the frontonasal ducts. The superior osteotomy is performed in a vertical coronal plane through the summit of the sinuses. It is arc-shaped, concave downwards, joining the lateral extremities of the inferior osteotomy. The posterior wall of the sinus can be resected to perform frontal sinus cranialization, allowing access to the midline anterior cranial fossa. The posterior wall of the sinus is removed with a high-speed burr in the same way as the anterior wall. At the end of the procedure, the bone flap is sutured with nylon suture material and the pericranium is sutured over the bone flap.

Les kystes de la partie médiane du cou sont les malformations congénitales les plus fréquentes de la région cervicale. Ils se développent le long du tractus thyréoglosse (TTG). La présence d’une fistule est la conséquence d’une fistulisation soit spontanée (suppuration), soit chirurgicale (incision simple ou une excision incomplète). Le kyste et/ou la fistule se situent entre la base de langue et la glande thyroïde, majoritairement à proximité de l’os hyoïde. Cette situation sur la ligne médiane du cou s’explique par le développement embryologique de la glande thyroïde. Le traitement est chirurgical. Plusieurs techniques ont été décrites, mais la technique décrite par Sistrunk en 1920, basées sur des études embryologiques, reste la technique de référence avec un taux de rechute inférieur à 3 %, à condition que la chirurgie soit correctement réalisée avec comme élément clé, la résection du corps de l’os hyoïde. Les facteurs favorisant la rechute sont : une intervention faite en phase inflammatoire, la rupture du kyste lors de la dissection, la multiplicité des tractus basilinguaux et un défaut technique dans la réalisation de la technique chirurgicale.

Objectives: To study the role of near-infrared fluorescence imaging in the detection and resection of metastatic cervical lymph nodes in head and neck cancer.Materials and methods: CAL33 head and neck cancer cells of human origin were implanted in the oral cavity of nude mice. The mice were followed up after tumor resection to detect the development of lymph node metastases. A specific fluorescent tracer for alpha v beta 3 integrin expressed by CAL33 cells was injected intravenously in the surviving mice between the second and the fourth month following tumor resection. A near-infrared fluorescence-imaging camera was used to detect tracer uptake in metastatic cervical lymph nodes, to guide of lymph-node resection for histological analysis.Results: Lymph node metastases were observed in 42.8% of surviving mice between the second and the fourth month following orthotopic tumor resection. Near-infrared fluorescence imaging provided real-time intraoperative detection of clinical and subclinical lymph node metastases. These results were confirmed histologically.Conclusion: Near infrared fluorescence imaging provides real-time contrast between normal and malignant tissue, allowing intraoperative detection of metastatic lymph nodes. This preclinical stage is essential before testing the technique in humans. (C) 2015 Elsevier Masson SAS. All rights reserved.

Le stenosi tracheali sono il punto di incontro tra la laringologia, la pneumologia, la diagnostica per immagini, l’endoscopia, la chirurgia cervicotoracica e la rianimazione. Queste stenosi possono essere congenite o acquisite. La stenosi può essere laringotracheale, cervicale e/o toracica. Le cause delle stenosi tracheali sono numerose, ma ampiamente dominate dai traumi legati alle diverse modialità di assistenza respiratoria. Se, dal punto di vista eziologico, clinico e diagnostico, i dati sono ben definiti nella letteratura, lo stesso non vale per il trattamento chirurgico, che resta ancora mal codificato. Il trattamento può essere condotto per via esterna, ma può essere anche endoscopico. Attualmente, i progressi dell’endoscopia interventistica tracheale portano degli elementi nuovi nella strategia di trattamento delle stenosi tracheali dell’adulto, in particolare nei soggetti più fragili. In uno stesso paziente, il trattamento può fare ricorso a diverse tecniche in funzione della localizzazione, del tipo di stenosi, dell’età, dello stato generale e dell’evoluzione nel tempo di alcuni di questi elementi. È, quindi, necessaria una gestione pluridisciplinare.