[How I do it: salivary duct preservation in the excision of small oral tumors]

Benign tumors, in-situ carcinomas and small carcinomas of the anterior floor mouth or of the internal surface of the cheek may require resection of salivary duct papilla i.e. papilla of submandibular duct or Stensen's duct. If a lymph node dissection is not required, excision of submandibular or parotid duct which papilla is interested in the resection can be avoided using a surgical technique not reported. The authors present two cases illustrating a simple surgical proceeding of salivary duct resection/transposition. The present method can be used to keep a functional principal salivary gland with an optimal oncologic result.

Surgical-site infections and surgery of the salivary glands

OBJECTIVES

To determine the surgical-site infection (SSI) incidence rate targeted on salivary gland surgery over a 2-year period (from January 2007 to December 2008). Then identify any risk factors associated with SSI in all the patients operated with no antibiotic prophylaxis in accordance with French Anesthesiology Society guidelines.

POPULATION AND METHODS

Ninety-three patients were operated during the standard SSI surveillance period. A case-control (one case for five controls) study was then conducted aiming to identify risk factors.

RESULTS

The SSI incidence rate was 9.7%. The case-control study failed to identify any relevant risk factor with univariate analysis.

CONCLUSION

As no risk factors could be identified, we suggest that surgical antibioprophylaxis could be relevant in salivary glands surgery and should be evaluated in this setting.

Surgical management of maxillary sinonasal inverted papilloma

OBJECTIVE

The extent of the surgery required when sinonasal inverted papilloma (IP) originates in the maxillary sinus is still the subject of debate. The principal aim of the study was to evaluate the efficacy of exclusive endoscopic removal or when combined with a limited vestibular anterior antrostomy of the maxillary IP.

METHODS

A retrospective analysis was carried out of 64 patients with IP treated in our university tertiary referral center from 1993-2007. Endoscopic removal of the IP was done for all patients, either exclusively or combined with an open approach. All patients were followed up for more than 1 year and the local control rate has been compared between patients with maxillary IP and others, and with both approaches.

RESULTS

The overall recurrence rate was 14% (9/64), for a mean follow up of 48 months (12-120 months). Twenty-three patients (23/64) had maxillary IP. Ten of them had endoscopic resection alone, 13 had a combined approach (1 with lateral rhinotomy). There were 4 recurrences (17%) three of which had had endoscopic surgery alone. We did not perform a medial maxillectomy in the first instance. There were no cases of epiphora or atrophic rhinitis. conclusion: We showed that the combined method (endoscopic assisted by a minimal vestibular approach) was an efficient and safe method to treat maxillary sinus IP. This approach could preserve the lacrimal duct and the inferior turbinate when these structures were not involved, even when there was a large maxillary sinus extension of the disease.

Bronchopulmonary nematode infection of Capra pyrenaica in the Sierra Nevada massif, Spain

The present investigation examined the prevalence and abundance of bronchopulmonary nematodes in 213 randomly hunted Iberian ibexes (Capra pyrenaica) (87 females and 126 males) in the Sierra Nevada mountain range in Spain between 2003 and 2006. Post mortem examination revealed an overall prevalence of 72% for adult nematodes (Cystocaulus ocreatus 44%, Muellerius capillaris 44%, Protostrongylus sp. 40%, and Dictyocaulus filaria 4%). The abundances were 13.45+/-3.97, 5.18+/-2.49, 6.36+/-2.16, and 2.27+/-0.46, respectively. Protostrongylid adults showed similar infection rates, which were statistically different from that of D. filaria. 20% of the examined Iberian ibexes were infected by three protostrongylid nematodes species, 24% of C. pyrenaica were affected by two protostrongylid species, while infestations with only one protostrongylid species were detected in 20% of the examined animals. The overall prevalence of larvae nematodes in the examined animals was 100%, and the overall abundance (number of the first stage larvae per gram) was 86.45+/-20.63. There was a high correlation between the two sets of data (adults and larvae). Results of the present investigation provided foundation for the effective control of bronchopulmonary nematode infection in Iberian ibex.

Long-term study of fluticasone propionate aqueous nasal spray in acute and maintenance therapy of nasal polyposis

BACKGROUND

Topical steroids are first-line medication to control nasal polyposis (NP), a disease with long-term clinical course.

OBJECTIVE

The aim of this study was to evaluate the efficacy and safety of fluticasone propionate aqueous nasal spray (FPANS) 200 microg twice a day (bd) after 1 month of treatment, and to compare FPANS 200 microg bd and FPANS 200 microg once a day (od) in maintenance and long-term treatment.

METHODS

Double-blind, placebo-controlled, 8-month study with three treatment periods (1-month acute period followed with 1-month maintenance period and 6-month follow-up period) was carried out. Group 1 received FPANS 200 microg bd, during acute, maintenance and follow-up periods, Group 2 received FPANS 200 microg bd during acute period and FPANS 200 microg od during maintenance and follow-up periods, and Group 3 received placebo during acute and maintenance periods and FPANS 200 microg bd during follow-up period. Endpoints were change from baseline in clinic peak nasal inspiratory flow (PNIF), domiciliary evening PNIF, intensity of symptoms and polyposis grade.

RESULTS

After acute period and maintenance periods, FPANS 200 microg bd was significantly more effective than placebo on all endpoints and more effective than FPANS 200 microg od after 1-month maintenance period on clinic PNIF, evening PNIF, obstruction, percentage of days with no sense of smell and percentage of nights with no disturbances. The two doses were similar on other endpoints. After the 6-month follow-up period, there was no difference between the two doses of FPANS at all efficacy endpoints. The safety profile of FPANS did not highlight any new or unanticipated adverse events.

CONCLUSION

The study demonstrated the efficacy of FPANS 200 microg bd in acute treatment and FPANS 200 microg od as a sufficient dose to maintain a long-term efficacy in the treatment for NP.

Endoscopic resection of sinonasal adenocarcinomas

OBJECTIVE

To evaluate the outcome and morbidity of endoscopic resection of sinonasal adenocarcinomas.

METHODS

This is a case series of 17 patients diagnosed with sinonasal adenocarcinoma that were resected endoscopically between 1999 and 2008.

RESULTS

The surgery constituted the first line of treatment for all patients. Five anterior skull base reconstructions were done. Post-operative meningoencephalitis and minimal epistaxis were the complications reported. The mean follow-up was 3 years [6-107 months]. To date, there have been two local recurrences at 6 months of an insufficient resection of a tumour classified pT4 and 25 months of a pT2 resected with safe margins. Another patient presented an unique metastasis in the parietal lobe 42 months after the resection of tumour pT4 extended to the frontal lobe. Two deaths unrelated to the disease were reported while thirteen patients remained free of disease (76.5%).

CONCLUSION

The endoscopic approach is a safe and effective treatment in selected cases of sinonasal adenocarcinomas. This procedure is less invasive than conventional surgery but requires an optimal preoperative imaging protocol and an experienced surgical team. These encouraging results have to be confirmed by a larger cohort and a longer follow-up.

[Ruptured pexis after supracricoid partial laryngectomy: a series of 5 cases]

OBJECTIVES

Supracricoid partial laryngectomies have a rare but a specific complication which is the rupture of the pexy. After cricohyoidoepiglottopexy or cricohyoidopexy, a separation can appear between the hyoid bone and the cricoid cartilage. Our objective was to define how to treat and to prevent this complication.

METHODS

One hundred and one supracricoid partial laryngectomies were performed in our department between 1980 and 2006. A retrospective analysis of the medical charts and operative files revealed that 5 patients have had a ruptured pexy. A review of the diagnosis, management, and outcome of these five cases is presented and discussed in this paper.

RESULTS

The diagnosis was done in the first post-operative month for all cases. Delay in decannulation time, swallowing disorders, local infection were associated with the rupture of the pexy. The separation between the hyoid bone and the cricoid cartilage was also suspected at neck palpation and in endoscopy. Lateral plain Xrays of the neck or CT scans were used to confirm the diagnosis. A medical treatment, a completion total laryngectomy and three revisions of the pexis were performed.

CONCLUSIONS

In our series, an antecedent of radiation before surgery appears to be a risk factor for the development of this specific complication. A revision of the pexis procedure is advocated in case of a major ruptured pexis.