Service dORL et de chirurgie cervico faciale

Clamart, France

Service dORL et de chirurgie cervico faciale

Clamart, France
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Eyermann C.,Service dORL et de chirurgie cervico faciale | Raguin T.,Service dORL et de chirurgie cervico faciale | Hemar P.,Service dORL et de chirurgie cervico faciale | Debry C.,Service dORL et de chirurgie cervico faciale
European Annals of Otorhinolaryngology, Head and Neck Diseases | Year: 2017

Introduction: Liposarcoma of the hypopharynx is extremely rare, as only 28 cases have been reported in the literature. The cardinal symptom of liposarcoma is progressively worsening dysphagia. Case report: The authors report the case of a 71-year-old man who presented with dysphagia, marked weight loss over several weeks and an episode of exteriorization of a solid mass from the mouth during an episode of vomiting. Imaging revealed a fat density intra-oesophageal mass. Panendoscopy and upper gastrointestinal endoscopy visualized the pedunculated tumour in the left piriform sinus, which was able to be exteriorized via the mouth. The tumour was then resected endoscopically at its hypopharyngeal insertion pedicle. Histological examination of the operative specimen concluded on well-differentiated benign liposarcoma. Discussion: Well-differentiated liposarcoma is the most common form of liposarcoma, but is only exceptionally reported in the hypopharynx. The main symptoms are related to compression of adjacent structures. Imaging findings are nonspecific. Only histological examination can distinguish liposarcoma from other benign oesophageal tumours. Standard treatment consists of wide, complete resection, which is not always possible in the neck. Long-term follow-up of these patients is essential in order to rapidly detect recurrence. © 2017 Elsevier Masson SAS.

Lefaucheur J.-P.,University Paris Est Creteil | Brugieres P.,Service de neuroradiologie | Guimont F.,Aix - Marseille University | Iglesias S.,University Paris Est Creteil | And 3 more authors.
Neurophysiologie Clinique | Year: 2012

Objective: Repeated transcranial magnetic stimulation (rTMS) of auditory cortex has been proposed to treat refractory chronic tinnitus, but the involved mechanisms of action remain largely unknown. The purpose of this pilot study was to evaluate the impact of rTMS on auditory cortex activity in a series of tinnitus patients, using for the first time both functional magnetic resonance imaging (fMRI) of the brain and auditory evoked potentials (AEPs). Method: In six patients with chronic, lateralized refractory tinnitus, we performed five sessions of neuronavigated rTMS delivered at 1. Hz over the secondary auditory cortex (defined on morphological MRI), contralateral to tinnitus side. The effects of rTMS were assessed on clinical scales, fMRI, and AEPs (N1 and P2 components). Results: The clinical impact of rTMS on tinnitus was good for three patients (25-50% improvement of tinnitus severity compared to baseline), moderate for two patients (15% improvement), and null for one patient who had the most severe tinnitus at baseline. The changes induced by rTMS on fMRI data varied with the baseline level of auditory cortex activation before rTMS. This baseline level of activation was itself related to the severity of tinnitus. Thus, cortical stimulation increased auditory cortex activation in patients who had less severe tinnitus and low level of activation before rTMS, whereas it decreased auditory cortex activation in patients who had more severe tinnitus and higher level of activation before rTMS. Regarding AEPs, rTMS decreased N1 amplitude in all patients, except in the patient who had the most severe tinnitus at baseline and showed no improvement after rTMS. Conversely, P2 amplitude decreased after rTMS only in patients with severe tinnitus, at least for auditory stimulation contralateral to tinnitus, but increased in patients with less severe tinnitus. Conclusions: The changes produced by rTMS in auditory cortex activity, as assessed by fMRI and AEPs, appeared to depend on a process of disease-related homeostatic cortical plasticity, regardless of the therapeutic impact of rTMS on tinnitus. © 2011 Elsevier Masson SAS.

Lazard D.S.,French Institute of Health and Medical Research | Giraud A.-L.,French Institute of Health and Medical Research | Gnansia D.,MXM Neurelec | Meyer B.,Service dOrl et de Chirurgie Cervico faciale | And 3 more authors.
European Annals of Otorhinolaryngology, Head and Neck Diseases | Year: 2012

The cochlear implant (CI), by enabling oral communication in severely to profoundly deaf subjects, is one of the major medical advances over the last fifty years. Despite the globally very satisfactory results, individual outcomes vary considerably. The objective of this review is to describe the various factors influencing the results of CI rehabilitation with particular emphasis on the better understanding of neurocognitive mechanisms provided by functional brain imaging. The following aspects will be discussed: 1. Peripheral predictors such as the degree of preservation of nerve structures and the positioning of the electrode array. 2. The duration of auditory deprivation whose influence on brain reorganization is now becoming more clearly understood. 3. The age of initiation of hearing rehabilitation in subjects with pre-lingual deafness influencing the possibility of physiological maturation of nerve structures. 4. The concepts of sensitive period, decoupling and cross-modality. 5. In post-lingually deaf adults, brain plasticity can allow adaptation to the disability induced by deafness, subsequently potentiating CI rehabilitation, particularly as a result of audiovisual interactions. 6. Several studies provide concordant evidence that implanted patients present different phonological analysis and primary linguistic capacities. The results of CI rehabilitation are dependent on factors situated between the cochlea and cortical associative areas. The importance of higher cognitive influences on the functional results of cochlear implantation justify adaptation of coding strategies, as well as global cognitive management of deaf patients by utilising brain plasticity capacities. © 2011 Elsevier Masson SAS.

Leboulanger N.,Service dOrl et de Chirurgie Cervico faciale | Fauroux B.,Service de Pneumologie Pediatrique | Fauroux B.,French Institute of Health and Medical Research
European Annals of Otorhinolaryngology, Head and Neck Diseases | Year: 2013

Introduction: Obstructive diseases of the upper airways are common in children and sometimes difficult to manage. Non-invasive positive-pressure ventilation (NPPV) consists of delivering continuous positive pressure during all or part of the respiratory cycle via a non-invasive interface (face mask or nasal mask, or nasal prongs). NPPV is the treatment of choice for severe obstructive sleep apnoea in children and should be considered prior to tracheotomy and is also indicated in the case of persistent sleep-disordered breathing following surgical treatment, a frequent situation in children with a malformation of the head and neck or upper airways. Discussion: A simple ventilator, able to deliver continuous positive airway pressure, is sufficient is most cases in otolaryngology. The interface represents the major technical limitation of NPPV, especially in infants for whom no appropriate commercial interface is available. A sleep study before and after initiation of NPPV, followed by regular follow-up examinations, is essential to confirm correction of gas exchanges and sleep quality in response to NPPV. Conclusion: Finally, NPPV must be performed in a specialized paediatric centre with specific expertise in this field. © 2012 Elsevier Masson SAS. All rights reserved.

Mortuaire G.,Service dOrl et de Chirurgie Cervico faciale | Vandeville S.,Service dOrl et de Chirurgie Cervico faciale | Assaker R.,Clinique de Neurochirurgie | Chevalier D.,Service dOrl et de Chirurgie Cervico faciale
European Annals of Otorhinolaryngology, Head and Neck Diseases | Year: 2012

Objectives: This study analysed the factors influencing the risk of recurrence following endoscopic repair of CSF leaks of the anterior and middle skull base after endonasal skull base tumour resection. Patients and methods: A retrospective review was conducted on 17 patients operated between May 2007 and December 2010 by endonasal endoscopic resection of anterior or middle skull base tumour who presented an intraoperative CSF leak. Epidemiological data (body mass index [BMI], age, gender) and type of leak (site, size) were studied. Results: CSF leaks involved the roof of the ethmoid sinus (one patient), cribriform plate (three), posterolateral wall of the sphenoid sinus (six) or the sella turcica (seven). The CSF leak recurrence rate after the first endoscopic procedure was 29.4% (5/17). Failures were not influenced by gender, age, BMI or size of the leak. All recurrences involved the sella turcica or the lateral wall of the sphenoid sinus. The success rate after a second endoscopic procedure was 88.2%. Conclusion: Endonasal endoscopic repair of anterior and middle skull base meningeal injuries after tumour resection is a minimally invasive and effective technique. The main challenge of this method consists of ensuring effective control of the postoperative defect after tumour resection in the sphenoidal region, as this region was the only potential risk factor for recurrence identified in this study. © 2011 Elsevier Masson SAS.

Kolski C.,Service dORL et de chirurgie cervico faciale
European Annals of Otorhinolaryngology, Head and Neck Diseases | Year: 2014

The efficacy of neonatal screening in lowering age at diagnosis and treatment in congenital hearing loss should not mask the limitations due to the fact that hearing loss often appears or is detected after birth. Early diagnosis of secondary or progressive postnatal hearing loss is nevertheless necessary and justifies systematic screening of hearing disorder in all children seen in consultation, for whatever reason. Screening bilateral hearing loss in under-2 year-olds in a community context is feasible, using simple means: parent interview, clinical observation, and acoumetry using the voice and sound-emitting toys. In case of abnormality detected or suspected on screening, children of whatever age should be referred to an ENT specialist for complete audiometric assessment. Behavioural audiometry is feasible in very young children, and indispensable to diagnosis. The parents will only be reassured after specialized hearing examinations have been performed. © 2014 Elsevier Masson SAS. All rights reserved.

Maire R.,Service dORL et de Chirurgie Cervico faciale | Meylan P.,Institute Of Microbiologie
Revue Medicale Suisse | Year: 2011

The clinical significance of facial palsy hinges on its psychosocial consequences. While its causes are very numerous, several infections account for a majority of cases: Lyme disease, geniculate zoster (Ramsay Hunt syndrome), while the role of HSV-1 in essential (Bell's) palsy remains controversial. Essentials of facial palsy management are discussed, including the importance of the functional grading of palsy, the complexity of Lyme disease serological diagnosis, and its treatment using doxycycline, antiviral and steroids treatment of geniculate zoster, while regarding essential facial palsy, only steroids, but not antiviral have been shown to improve functional recovery.

Mortuaire G.,Service dOrl et de Chirurgie Cervico faciale | De Gabory L.,Service dOrl et de Chirurgie Cervico faciale | Francois M.,Service dOrl et de Chirurgie Cervico faciale Pediatrique | Masse G.,Cabinet de Medecine Generale | And 4 more authors.
European Annals of Otorhinolaryngology, Head and Neck Diseases | Year: 2013

Introduction: Systemic and topical nasal decongestants are widely used in otorhinolaryngology and general practice for the management of acute rhinosinusitis and as an adjuvant in certain forms of chronic rhinosinusitis. These products, very effective to rapidly improve nasal congestion, are sometimes available over the counter and can be the subject of misuse, which is difficult to control. The Société Française d'ORL has recently issued guidelines concerning the use of these decongestants in the doctor's office and the operating room. Materials and methods: The review of the literature conducted by the task force studied in detail the concepts of "rebound congestion" and "rhinitis medicamentosa" often reported in a context of misuse, particularly of topical nasal decongestants. The clinical and histopathological consequences of prolonged and repeated use of nasal decongestants have been studied on animal models and healthy subjects. Results: Discordant results have been obtained, as some authors reported a harmful effect of nasal decongestants on the nasal mucosa, while others did not identify any significant changes. No study has been able to distinguish between inflammatory lesions induced by chronic rhinosinusitis and lesions possibly related to the use of nasal decongestants. Discussion: The task force explained the rebound congestion observed after stopping nasal decongestant treatment by return of the nasal congestion induced by rhinosinusitis and rejected the concept of rhinitis medicamentosa in the absence of scientific evidence from patients with rhinosinusitis. Conclusion: Nasal decongestants are recommended for the management of acute rhinosinusitis to reduce the consequences of often disabling nasal congestion. They are also recommended during rhinoscopic examination and for preparation of the nasal mucosa prior to endonasal surgery. © 2012 Elsevier Masson SAS.

Reinhard A.,Service dORL et de chirurgie cervico faciale | Maire R.,Service dORL et de chirurgie cervico faciale
Revue Medicale Suisse | Year: 2013

Vestibular neuritis is a sudden unilateral peripheral vestibular deficit of unknown origin without associated hearing loss. It is the second cause of peripheral vertigo after Benign Paroxysmal Positional Vertigo (BPPV). The etiology remains unclear and some treatments are still controversial. The prognosis is good. The differential diagnosis of the disease mainly includes an acute vertigo of central origin. This article summarizes the management and prognosis of vestibular neuritis.

Juilland N.,Service dOrl et de Chirurgie Cervico Faciale | Pasche P.,Service dOrl et de Chirurgie Cervico Faciale
Revue Medicale Suisse | Year: 2012

Microtia is a uncommon pathology that is defined by a hypoplasia of the pinna. Multiple reconstructives surgeries have been developed. Nowadays, autologous rib cartilage reconstruction and Medpor implant reconstruction are the most widely used techniques. The authors present these two alternatives that significantly improve the quality of life of young patients with this visible abnormality.

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