Evaluation of robotic surgery for transoral resection of T1-2 squamous cell carcinoma of the tonsillar fossa Publication date: Available online 24 September 2019 Source: European Annals of Otorhinolaryngology, Head and Neck Diseases Author(s): K. Shenouda, F. Rubin, D. Garcia, C. Badoual, P. Bonfils, O. Laccourreye Abstract Goal To evaluate transoral robotic surgery (TORS) for isolated previously untreated squamous cell carcinoma (SCC) of the tonsillar fossa classified as T1-2. Method Retrospective analysis of two cohorts of isolated untreated T1-2 tonsillar fossa SCC consecutively operated on by a transoral approach, with (R = 21) and without (NR = 24) robotic assistance, in the period 2006–2014. Three main (survival, local control, and operative morbidity) and three secondary (pathologic data, incidence and duration of tracheotomy and nasogastric intubation, and hospital stay) endpoints were compared between groups. The significance threshold was set at P <  .005. Results Three- and five-year actuarial survival estimates were 80.2% and 74.5% respectively in group R, and 91.5% and 82.5% respectively in group NR (NS: P = .34). Three- and five-year actuarial local control estimates were 90% and 90% respectively in group R, and 95.8% and 91% respectively in group NR (NS: P = .81). There were no significant differences in morbidity, tracheotomy/nasogastric intubation time, or hospital stay. Positive resection margins (R1) were noted in 38.1% and 16.7% in groups R and NR, respectively (NS: P = .05) without significant impact on 5-year actuarial local control (P = 0.78). Conclusion Robotic assistance in transoral lateral oropharyngectomy for T1-2 tonsillar fossa SCC did not significantly impact oncologic or functional outcome.

Day-surgery in otology: Impact study of a dedicated organizational model Publication date: Available online 20 September 2019 Source: European Annals of Otorhinolaryngology, Head and Neck Diseases Author(s): D.S. Lazard, F. Donné, J.B. Lecanu Abstract Aim Day surgery (DS) in otology in France is insufficiently implemented compared to other countries of comparable socio-economic level. The aim of the present study was to evaluate changes in surgical practice in “major otology” cases in a hospital center after launching a dedicated ENT DS unit. Material and methods This new unit, designed in collaboration with the surgeons, was inaugurated in 2014. Number of procedures, patient demographics, surgery durations, and rates of crossover from DS to conventional management were recorded prospectively for the year before and the year after the launch. All otologic surgery procedures with at least tympanomeatal flap elevation were included; minor surgeries such as grommet insertion were excluded. Results Between the two time periods, major otology day cases increased from 106 to 153 procedures (+43%). In 2013, the DS rate was 27%, versus 56% in 2015. Otosclerosis surgeries represented 7% in 2013 and 15% in 2015, and type II and III tympanoplasties 3% and 24% respectively. Difference in patient age between DS and conventional surgery was lower in 2015. Crossover rates were 10% in 2013 and 21% in 2015, mainly due to nausea/vertigo (56%) and surgery ending too late in the day (33%). Conclusion Major otologic cases are suitable for DS. Launching this dedicated unit with its specific organization enabled a very significant increase in DS rates, probably due to greater patient satisfaction and surgeons’ growing confidence. The main pitfall was in scheduling, with surgery ending too late in the day for discharge home; this has since been corrected.

Laryngology in the mirror of its eponyms Publication date: Available online 19 September 2019 Source: European Annals of Otorhinolaryngology, Head and Neck Diseases Author(s): A. Werner, C. Holsinger, S. Guiquerro, R. Guttierez-Fonseca, O. Laccourreye Abstract From a reading of various sources (scientific articles, books, dictionaries and websites), this article documents eponyms in the field of laryngology (other than those related to anatomy or therapeutics), memorializing certain notable events in this subspecialty of otorhinolaryngology and in the life of our illustrious forebears.

Function evaluation of laryngeal reconstruction using infrahyoid muscle after partial laryngectomy in 37 patients Publication date: Available online 17 September 2019 Source: European Annals of Otorhinolaryngology, Head and Neck Diseases Author(s): O. Vella, D. Blanchard, D. de Raucourt, J.P. Rame, E. Babin Abstract Treatment of small laryngeal cancerous lesions (T1 and T2) is based on partial endoscopic or open surgery and radiotherapy. In addition to the oncological imperative, these techniques must optimally preserve the functions of breathing, swallowing and phonation. Objective To analyze the above functions in patients treated with supracricoid laryngectomy and reconstruction using infrahyoid muscle. Materials and methods Breathing, swallowing and phonation were analyzed in 37 patients treated in two institutes between 2005 and 2015. All patients undergoing the above type of reconstruction with a minimum 1 year's follow-up were included. Respiratory study noted any tracheotomy and measured peak inspiratory flow. Preservation of cricoarytenoid units and nasogastric intubation time, and DHI-30 self-administered questionnaire results were collected to analyze swallowing function. Phonation was assessed on the VHI-30 self-administered questionnaire. Results The rate of primary surgery without tracheotomy was 64.9% (13 patients), with rapid resumption of oral feeding (mean intubation time, 13 days). Mean VHI score was 28.3 and mean DHI 30 score 2.7. Mean peak inspiratory flow was 203.3 mL/min. Conclusion Supracricoid laryngectomy with reconstruction using subhyoid muscle is an alternative technique for the treatment of small laryngeal cancerous lesions, providing uncomplicated functional outcome.

French scientific medical journals confronted by developments in medical writing and the transformation of the medical press Publication date: Available online 17 September 2019 Source: European Annals of Otorhinolaryngology, Head and Neck Diseases Author(s): O. Laccourreye, H. Maisonneuve Abstract The present review article details developments in medical writing and the ongoing transformation of the scientific medical press. With these twin revolutions, French-language scientific medical journals are at a crossroads: are they going to become vehicles of teaching, of popularization, of liaison between members of medical societies, of general public information contributing to decision-making in the field of public health? Or will they maintain their scientific status? Under certain conditions, a move toward French/English bilingualism could be the solution to maintain and advertise their scientific level, while contributing to the quality of medical teaching in French and to the worldwide influence of the French language.

Contribution of drug-induced sleep endoscopy to the management of pediatric obstructive sleep apnea/hypopnea syndrome Publication date: Available online 16 September 2019 Source: European Annals of Otorhinolaryngology, Head and Neck Diseases Author(s): F. Blanc, T. Kennel, F. Merklen, C. Blanchet, M. Mondain, M. Akkari Abstract Objectives The role of drug-induced sleep endoscopy (DISE) in the management of obstructive sleep apnea/hypopnea syndrome (OSAHS) is not precisely defined in children. The primary objective of this study was to describe DISE-induced revision of airway obstruction site location and the ensuing treatment changes in children with OSAHS. Secondary objectives were to analyze the correlation of number of obstruction sites found on DISE with apnea-hypopnea index (AHI) and with type of OSAHS. Material and methods A retrospective single-center study included 31 children (mean age: 5.5 ± 2.6 years) undergoing DISE for management of OSAHS between 2015 and 2018. Revisions of airway obstruction site location and in treatment were noted. The correlation of number of obstruction sites with AHI and with type of OSAHS was analyzed. Results Airway obstruction site location was reconsidered in 77% of children (n = 24), modifying treatment in 45.2% (n = 14). There was no significant correlation between number of obstruction sites and AHI: Spearman coefficient 0.20 (P = 0.26). Patients with type-III OSAHS did not show more obstruction sites than others: respectively, 2.0 versus 1.8 (P = 0.40). Conclusion DISE induced significant revision of the location and change in treatment of obstruction sites in children with OSAHS. Systematic implementation, especially in type-I OSAHS, would allow more precise pre-therapeutic classification and treatment adapted to actual airway obstruction.

Peripheral neck nerve tumor: A 73-case study and literature review Publication date: Available online 16 September 2019 Source: European Annals of Otorhinolaryngology, Head and Neck Diseases Author(s): K. Boumaza, G. Michel, C. Salaud, C. Bossard, F. Espitalier, O. Malard Abstract Objectives Peripheral neck nerve tumors are rare and mostly benign neoplasms. The exceptional malignant forms are very aggressive, and diagnosis is difficult. The objective of this study was to evaluate diagnostic and therapeutic management and identify possible predictive factors. Material and methods A retrospective study was conducted of 73 patients treated for peripheral neck nerve tumor between 1995 and 2015. Results Mean age was 44 years. The main presenting symptom was a cervical mass, isolated or associated with signs related to the affected nerve structure. Diagnosis was suspected by slow progression of a firm mass, featuring T1 hyposignal and T2 hypersignal on magnetic resonance imaging. Surgery was performed in 99% of cases, completed by adjuvant chemotherapy in case of malignant neuroblastic tumor. Type 1 neurofibromatosis and sudden increase in mass with or without associated pain suggested malignant transformation. Age below 10 years suggested neuroblastic tumor. Conclusion Neck nerve tumors are very often benign with low degenerative potential. Surgery is the treatment of choice after risk/benefit analysis. However, there is no clearly defined consensus regarding the timing of surgery for these lesions.

Spontaneous arytenoid dislocation and crico-arytenoid instability Publication date: September 2019 Source: European Annals of Otorhinolaryngology, Head and Neck Diseases, Volume 136, Issue 4 Author(s): P. Gallet, D.T. Nguyen, B. Toussaint, C. Rumeau Abstract Introduction Arytenoid dislocation is a rare occurrence, for which the pathophysiology is still unclear. Methods We report here an unusual case of spontaneous arytenoid dislocation, which casts doubts on the prevailing classical theory of hemarthrosis. Results and conclusions This case and a review of the literature suggest that arytenoid dislocation could be linked to congenital or acquired arytenoid instability, thus facilitating arytenoid dislocation after even minor trauma. Once the diagnosis is established, we recommend to first attempt reduction, followed by speech therapy, though underlying diseases should be researched.

Guidelines of the French Society of Otorhinolaryngology. Role of the ENT specialist in the diagnosis of childhood obstructive sleep apnea-hypopnea syndrome (OSAHS). Part 1: Interview and physical examination Publication date: September 2019 Source: European Annals of Otorhinolaryngology, Head and Neck Diseases, Volume 136, Issue 4 Author(s): J.C. Leclere, R. Marianowski, P.J. Monteyrol, M. Akkari, F. Chalumeau, P. Fayoux, N. Leboulanger, P. Franco, V. Couloigner, M. Mondain Abstract Objectives To present the 2017 Clinical Practice Guidelines of the French Society of Otorhinolaryngology concerning the role of the ENT specialist in the diagnosis of pediatric obstructive sleep apnea-hypopnea syndrome. This article focuses specifically on medical history and physical examination. Methods A multidisciplinary work-group drew up a first version of the guidelines, graded according to level of evidence following the GRADE grading system. The final version was obtained by including the suggestions and comments from the editorial group. Results At the end of the process, guidelines were established and graded regarding the following points: interview and analysis of the various interview scores recommended in the literature; clinical examination with awake upper-airway endoscopy; and indications for referral to non-ENT specialists.

Guidelines of the French Society of Otorhinolaryngology. Role of the ENT specialist in the diagnosis of obstructive sleep apnea-hypopnea syndrome (OSAHS) in children. Part 2: Diagnostic investigations apart from sleep studies Publication date: September 2019 Source: European Annals of Otorhinolaryngology, Head and Neck Diseases, Volume 136, Issue 4 Author(s): J.-C. Leclere, R. Marianowski, P.J. Monteyrol, M. Akkari, F. Chalumeau, P. Fayoux, N. Leboulanger, P. Franco, V. Couloigner, M. Mondain Abstract Objectives To present the 2017 Clinical Practice Guidelines of the French Society of Otorhinolaryngology concerning the role of the ENT specialist in the diagnosis of pediatric obstructive sleep apnea-hypopnea syndrome. This manuscript specifically focuses on diagnostic investigations apart from sleep studies. Methods A multidisciplinary work-group drew up a first version of the guidelines, graded according to level of evidence following the GRADE grading system. The final version was obtained by including the suggestions and comments from the editorial group. Results At the end of the process, guidelines were established and graded regarding diagnostic investigations apart from sleep studies, in particular respiratory functional tests, biological markers, and morphologic assessment under induced sleep (drug-induced sleep endoscopy (DISE) and cine-MRI).