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This update aimed to evaluate surgical indications in the management of chronic rhinosinusitis with nasal polyps (CRSwNP). It was conducted and reported according to the criteria stipulated by the Synthesis Without Meta-analysis (SwiM) guidelines. From the PubMed-National Library of Medicine database, 1098 articles were identified for the period 2006–2021 using the key words "nasal polyps" and "surgery". After screening and analysis, 39 publications were selected. The efficacy of surgery on functional improvement in CRSwNP, measured by the specific quality-of-life score SNOT-22, is established, and improvement in olfactory function is expected in 50% of patients. The rate of surgical revision is at least 10–15% at 4 years, but the disease can be controlled for several years, with the interval between primary surgery and symptomatic recurrence exceeding 10 years in some cases. The criteria for surgery are not clearly defined in the literature. However, several authors consider failure of ≥ 8 weeks' well-conducted local medical treatment and use of more than 2 courses of systemic corticosteroids as a reliable indication. No studies or meta-analyses are currently available to determine the superiority of one surgical technique over another. [ABSTRACT FROM AUTHOR]

To determine the indications, anesthesiological and surgical procedure and interest of drug-induced sleep endoscopy in the treatment of adult obstructive sleep apnea syndrome. A redactional committee of 17 experts was set up. Conflicts of interest were disclosed and followed up throughout the process of drawing up the guidelines. The work received no funding from any firm dealing in health products (drugs or devices). The GRADE (Grading of Recommendations Assessment, Development and Evaluation) method was applied to assess the quality of the data on which the guidelines were founded. It was stressed that strong recommendations should not be made on the basis of poor-quality or insufficient data. The committee studied 29 questions on 5 topics: indications and contraindications, anesthetic technique, surgical technique, interpretation and reporting of results, and management guided by results. Expert review and application of the GRADE method led to 30 guidelines: 10 with high level of evidence (Grade 1+ or 1−), 19 with low level (GRADE 2+ or 2−) and 1 expert opinion. Experts fully agreed on the strong guidelines formalizing the indications and modalities of drug-induced sleep endoscopy for adult obstructive sleep apnea syndrome. [ABSTRACT FROM AUTHOR]

Posterior parotid lithiasis may in some cases require a combined surgical approach associating sialendoscopy to an external intraoral or transfacial approach. This single-center retrospective study describes the surgical technique for parotid lithiasis extraction by a combined external and sialendoscopic approach with the help of CT-navigation. Five patients were included between November 2014 and July 2020. The sialolith was extracted in 100% of cases. Navigation and transillumination localizations matched consistently. No patients showed postoperative facial paresis. At 2 to 21 months' follow-up, there was no recurrence of sialolithiasis. Navigation can be a complement to transillumination, improving surgical comfort and safety, but does not replace first-line sialendoscopy. Visual control is required whenever possible after extraction. In combined procedures, it enables accurate identification of parotid sialoliths. In case of impassable stenosis, it could be a therapeutic alternative to parotidectomy. [ABSTRACT FROM AUTHOR]

To describe the diagnostic performance of Narrow Band Imaging (NBI) combined with White Light Imaging (WLI) in the diagnosis of mucosal lesions at each location of the upper aerodigestive tract, for detection of primary tumor in case of carcinoma of unknown primary, for determination of intraoperative resection margins, and to describe its main diagnostic pitfalls. A PubMed search was carried out according to the PRISMA method. Four hundred and seventy-seven articles published between 2007 and 2020 were identified, 133 of which met the study inclusion criteria and were assessed. The current literature seems to support the use of NBI in diagnosis and/or follow-up of (pre-)malignant head & neck tumors, and in the determination of intraoperative resection margins. [ABSTRACT FROM AUTHOR]

Le syndrome du nez vide (SNV) est une entité clinique de description récente regroupant l'ensemble des symptômes ressentis par un patient après éxérèse complète ou sub-totale des cornets inférieurs. Ces symptômes associent à des degrés divers des signes fonctionnels rhinologiques et des anomalies de l'examen endoscopique. Le retentissement psycho-fonctionnel est parfois très important avec une altération marquée de la qualité de vie de ces patients. La prise en charge du syndrôme du nez vide est complexe. Elle repose avant tout sur une prise en charge symptomatique et un suivi psychologique. De nouvelles techniques de réhabilitation donnent actuellement des résultats encourageants. Empty nose syndrome has been recently described. It represents a disease consisting of a number of symptoms following radical inferior turbinectomy that include nasal inspiratory disorders, sometimes loss of smell and changes in mood and behaviour. Naso-endoscopy is essential for diagnosis. Treatment generally involves nasal douche, topical steroids or antibiotics and psychological care. New rehabilitation techniques are currently giving encouraging results. [ABSTRACT FROM AUTHOR]

In old and frail patients, oncologic anterior skull-base surgery through an endonasal endoscopic approach avoids the morbidity incurred by transfacial and transcranial approaches, sometimes considered unreasonable, although surgery remains the gold standard treatment for sinonasal cancer. To assess the functional and oncologic results of this surgery in over-70 year-olds. A single-center retrospective study included all patients aged over 70 years at surgery, who underwent endonasal endoscopic oncologic resection and reconstruction of the anterior skull base, between October 2008 and October 2018. Fifteen procedures in 13 patients met the inclusion criteria. Mean hospital stay was 7 days. All resections were considered R0, apart from one case with positive dura-mater margins (6.7%). All patients had complete radio-surgical treatment, in accordance with the REFCOR recommendations. Two cases of meningitis were reported (13.3%). At a median follow-up of 27 months, 4 patients presented local recurrence, 1 of whom also had lung metastases. Two patients died of disease-related or treatment-related causes. This technique is a feasible treatment in patients aged over 70 years, providing good functional results, and acceptable oncologic outcome. [ABSTRACT FROM AUTHOR]

Abstract Introduction Obstructive sleep apnea syndrome (OSAS) is a major public health issue. Robotic tongue-base reduction surgery is being developed, but needs assessment. The present study reports clinical and polygraphic results at 6 months' follow-up. Method Single-center prospective study of 8 patients undergoing transoral robotic surgery (TORS) for severe OSAS. Results Mean age was 47 years. M/F sex ratio was 5:3. Initial body-mass index ranged from 18 to 35 kg/m2. Mean Epworth score was 12. Mean preoperative apnea-hypopnea index (AHI) was 47 (range, 36–60). At 6 months, only 1 patient did not meet usual success criteria (AHI < 20 with > 50% decrease); 2 patients had residual AHI between 10 and 20; the other 5 had non-significant event rates. Conclusion TORS tongue-base reduction showed promising results, which need confirmation on long-term multicenter studies. [ABSTRACT FROM AUTHOR]

Context Treatment of infected nasal polyposis. Material and methods Multicenter interventional prospective double-blind randomized study with matched groups: treatment with tobramycin aerosol versus isotonic saline aerosol. The study population included 55 patients: 23 receiving isotonic saline aerosol and 32 receiving tobramycin. A novel device (Easynose ® ) was used with an original principle limiting pulmonary deposition and ensuring homogeneous peripheral deposition in the nasal cavities. Objectives The principal objective was to compare bacteriological eradication between tobramycin 150 mg/3 ml versus isotonic saline, both administered by nebulization via the Easynose ® device. Results and conclusion Tobramycin aerosol administered via the Easynose ® device showed significantly better bacteriological eradication than isotonic saline. [ABSTRACT FROM AUTHOR]

Objectives Complications of pharyngitis (peritonsillar abscess, retropharyngeal abscess, and cervical cellulitis) are rare, but appear to be on the increase over recent years and many of these patients have been treated by anti-inflammatory drugs prior to admission. The purpose of this study was to review the current epidemiological data concerning these complications and investigate a possible correlation with anti-inflammatory drug use. Material and methods A single-centre retrospective review of epidemiological, clinical and microbiological data was performed on the medical charts of patients hospitalised for peritonsillar abscess, retropharyngeal abscess or cervical cellulitis between 2005 and 2010. Results Over a six-year period, 163 patients were hospitalised for complications of pharyngitis, with a sex-ratio of 1.82 (104/57). The number of cases of peritonsillar abscess (PTA) increased from 13 to 28 cases per year from 2005 to 2010 and the number of cases of retropharyngeal abscess increased from three to six cases per year over the same period. The number of cases of cellulitis remained stable with an average of 1.82 cases per year. Each year, significantly more patients with an abscess were admitted to our unit with a history of anti-inflammatory drug use (13.3 ± 4.6) than without anti-inflammatory drug use (7.8 ± 4.3) ( P < 0.01). Micro-organisms were identified in 80% of cases, with mixed strains in 73% of cases, Streptococcus in 72% of samples and Streptococcus pyogenes in 19% of cases of PTA. A favourable outcome was observed in all patients in response to medical and surgical treatment. Conclusion In line with the literature, we observed an increasing incidence of complications of pharyngitis. The present series comprised significantly more patients admitted for PTA with a history of anti-inflammatory drug use. A multicentre prospective controlled study in Nantes on a large cohort is currently underway and will probably confirm these preliminary results. [ABSTRACT FROM AUTHOR]

Summary: Study Purpose: For ten years the market for resorbable fillers has seen a large increase. A CE mark is sufficient for its placing on the market, they do not require AMM because they are not considered drugs. The Macrolane® is a hyaluronic acid NASHA gel-based technology, available on the French market since 2007 as filler used in all areas of the body except face and breasts. It is highly crosslinked, which slows its resorption, leaving in place long-term waste. At end of 2008, Macrolane® received a CE mark for breast augmentation. The aim of this paper is to review current scientific knowledge on the Macrolane™ and list the many uncertainties regarding its recent breast indication. Materials and methods: We reviewed the PubMed literature and study levels of evidence on Macrolane®. All AFFSAPS communication and correspondence with the SOFCPRE on hyaluronic acids and particularly Macrolane™ were collected. Results: At the moment there is no scientific study of high level of evidence which has studied the effects of Macrolane® on breast parenchyma in terms of carcinogenesis or the disruption of radiological monitoring of the breast. The subglandular method of injection remains complex and uncertain especially about the risk of wrong passage. Conclusions: The Macrolane® is proposed as an alternative less invasive than breast implants. Nevertheless the lack of scientific data on this product led to its non approval by the Food and Drug Administration in the United States. Currently there remains too much uncertainty on this filler for reasonable use plebiscite. It would therefore be preferable to return to the manufacturer the burden of proof of Macrolane® safety and security and limit its use in clinical trials yet. [ABSTRACT FROM AUTHOR]

A 67-year-old woman with no notable history presented with features of subacute right anterior sinusitis refractory to several courses of antibiotics, including intravenous antibiotics adapted to antibiotic susceptibility testing. Nasal sinus CT scan revealed high-density opacification of the right maxillary sinus, diffuse opacities in all of the right paranasal sinuses with osteolysis of the turbinates (Fig. 1 Preoperative sinus CT scan: high-density opacification of the right maxillary sinus, diffuse opacities in all right paranasal sinuses, osteolysis of the turbinates. [Extracted from the article]

Mr R., 49years old, attended the emergency department with sudden onset of severe neck pain, present for 36hours. Answer 2: In the presence of low-grade fever, odynophagia and the low-density image on CT, the differential diagnoses of retropharyngeal abscess and spondylodiscitis must be excluded [2]. 3 D.J. Artenian, J.K. Lipman, G.K. Scidmore, Acute neck pain due to tendinitis of the Longus Colli: CT and MRI findings. [Extracted from the article]

Summary: Submental skin and fat excess are common with aging. Real cutaneous crop in pronounced forms, may be felt with difficulty by patients, which leads them to consult. The proposal of a conventional face-lift is not always suitable or accepted by a predominantly male population. Therefore, an anterior medial cervicoplasty with elliptical excision of excess skin and a medial platysmaplasty will be an interesting alternative. The authors offer a new description of this technique by simplifying, compared to the previously described techniques. Two clinical cases are reported, with both types of recommended incisions. This procedure is performed under local anesthesia. The results obtained by this technique were considered good to excellent by all operated patients in our unit. The final scar that may appear significant and sometimes unacceptable for some surgeons remains in fact very inconspicuous. The anterior medial cervicoplasty is an easy technique that allows responding gracefully to a frequent request, with good cosmetic results and few complications. [Copyright &y& Elsevier]

Summary: Study purpose: High-pressure injections (HPI) in the hand are rare and their prognosis is often tragic, some authors report up to 48% of amputations. Poorly standardized, their management is often too late and inadequate. The HPI of paint results in inoculation of toxic particles in depth that are particularly difficult to remove surgically. The persistence of this foreign material maintains local inflammation and increases the risk of infection. We wanted to simulate in rats, the physiopathology of HPI with paint. The aim of this study is to authenticate an advantage to achieve consistently a second surgical debridement at 48–72 hours in HPI with paint. Materials and methods: Six rats were injected with 200 bars of white glycerophtalic paint in the leg. At six hours and then every 24 hours for four days, we did a debridement and a surgical washing, then at the end of intervention a tissue sample was analyzed by histology. Results: Despite surgical debridement and thorough washing, at each step we found the persistence of painting in the intermuscular septa by light microscopy. From 24 hours, a necroinflammatory process is set up with an influx of neutrophils, organizing themselves into micro-abscesses. It will be very deleterious, initially by encouraging risk of sepsis, and then facilitating the formation of extensive fibrosis, which is the cause of functional impairment. Conclusion: We established the kinetics of tissue under HPI with paint using an animal model. It appears that single emergency surgery is insufficient to manage this “septic compartment syndrome”. Therefore, we recommend a systematic surgical “second look” at 48–72 hours to complete the debridement of residual inoculum and necrotic tissue without wound closure. [ABSTRACT FROM AUTHOR]