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Objectives: To identify predictive factors of readmission after day-case rhinologic surgery., Methods: A 2-year retrospective chart review of patients scheduled for ambulatory sinonasal surgery in a tertiary medical center was conducted. The operating room and the anesthetic files were screened to identify demographic data, types of procedure, comorbidities and post-operative complications., Results: From January 2014 to January 2016, 924 outpatient sinonasal procedures were identified. The overall readmission rate within the 30-postoperative days was 5.1% (2.9% for overnight hospital stay, 2.2% for unplanned post procedure visit to the hospital via the emergency room, or directly to the surgical unit within 30 days of discharge). Age at least 50 years, surgical duration at least 80 min, endoscopic sinus surgery procedures and postoperative nasal packing were identified as negative predictive factors of readmission., Conclusion: Careful scheduling of those higher-risk patients undergoing sinonasal surgery and appropriate postoperative observation should be implemented to improve healthcare quality in an outpatient setting.

Objectives: To assess subjective improvement of olfactory function following endoscopic sinus surgery (ESS) in chronic rhinosinusitis associated with nasal polyps (CRSwNP) and to analyse factors of recovery with the European Test of Olfactory Capabilities (ETOC)., Methods: We carried out a prospective study of 30 patients with CRSwNP from November 2011 to April 2013. The ETOC was filled the day before surgery and in the short term follow-up. Sixteen suprathreshold odorants with a detection task and a forced choice verbal identification task were tested., Results: The mean composite score (MCS) improved at 3 and 6 months. The preoperative MCS was correlated to the Lund-Mackay score and to the olfactory cleft opacification on preoperative computed tomography (CT) scan. Multivariate linear regression modelling of patients with preoperative anosmia showed that the olfactory recovery at 3 months was predicted by the preoperative Lund-Mackay score and the age, and at 6 months by the preoperative Lund-Mackay score., Conclusion: With a convenient psychophysical test, we showed that olfactory cleft opacification and CT scan score could be predictive factors of olfaction disorder severity and improvement after ESS in CRSwNP. These results need to be strengthened in the long term with a larger panel of patients.

Objective: To assess the safety and efficacy of submucosal radiofrequency (RF) treatment for hereditary hemorrhagic telangiectasia (HHT) with mild or moderate epistaxis., Methodology: We carried out a prospective pilot study of 16 consecutive patients with HHT-related epistaxis from June 2010 to April 2012. Under local anesthesia, RF was applied to one or both sides of the nose from the columella beneath the septal mucosal (50 joules per puncture). Patients were sent a questionnaire at least six months after the procedure., Results: RF under local anesthesia was well tolerated, according to visual analog scale scores. Neither crusting nor pain was reported one week after the intervention. The frequency of epistaxis per day and per month was significantly lower after RF. The duration of bleeding also decreased from more than 10 minutes to less than 5 minutes in two thirds of patients. Thirteen of the 16 patients were satisfied with the technique and would request it for subsequent procedures to treat repeated bleeding., Conclusion: Submucosal RF treatment for HHT is a safe, well tolerated procedure with significant efficacy in the short term. It should be considered as an alternative technique for managing HHT-related epistaxis, although long-term results remain to be evaluated.

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., (Copyright © 2012. Published by Elsevier Masson SAS.)

We defined a standardized approach to surgery of sinonasal inverted papillomas (IP) for adequate and safe resection. A cohort of 65 patients treated from January 1995 to December 2005 at a single institution was retrospectively analyzed (mean follow-up: 28 months; range 1-132). The extension of the tumor was evaluated on clinical findings and computed tomography (CT) scan and/or resonance magnetic imaging (RMI). External and endoscopic surgical approaches were compared according to tumor extension, rate of local recurrence. Univariate analysis was used to review the impact on disease-free survival of factors related to the histopathological findings and the treatment. Endoscopic (alone or combined with transantral approach) and external surgery were used in 46 patients (71%) and 19 patients, respectively. Endoscopic approach (34/46) was performed to control IP in the nasal fossa, the ostiomeatal complex, the sphenoid sinus. It was combined with Caldwell-Luc procedure (12/46) for tumor extent into the lateral part of the maxillary sinus. The mean time for recurrences to occur was 19 months with range of 5-35 months. The rate of local recurrence was 17.6% (6/34) in endoscopic approach alone, 8.3% in endoscopic approach combined with a Caldwell-Luc procedure and 15.8% (3/19) in external approach. Tumor extension, excision with safe margins, associated malignancy or dysplasia have no significant impact on disease-free survival regardless of surgical procedure. On the basis of imaging evaluation and peroperative view of tumor extent, we propose a surgical strategy in which endoscopic approach could be used on the first attempt by trained surgeons. RMI is very useful to determine acute extent of the disease.

Objectives: The authors report their experience in a retrospective study of 28 patients with symptomatic hypopharyngeal diverticulum., Material and Method: The mean age was 70 years. Eight patients presented with severe dysphagia and nine with weight's loss. The delay before diagnosis was 17 months. All patients included were studied by an oesophageal barium swallow prior to any treatment. According to Van Overbeeck's classification, diverticula were medium sized in 11 patients, small in 8 and large in 7. All patients had endoscopic assessment of the diverticular pouch; 26 patients were treated by microendoscopic laser myotomy and 2 by resection., Results: The average time for oral feeding was 4 days. None of the 28 cases had a postoperative complication. 25 patients had partial or complete relief of symptoms after their initial treatment. In 3 cases recurrence of symptoms occurred, of whom 2 underwent endoscopic revision and 1 underwent an open procedure., Conclusion: Endoscopic laser surgery for Zenker's diverticulum can be recommended as the treatment of choice for elderly patients. It is a useful procedure because it is swift, effective with a low rate of morbidity, even in cases with impaired of health or associated diseases.

The frequency of lung cancers associated with synchronous head and neck malignancies can be evaluated between 1.5 to 2%. The purpose of our work was to determine if complete endoscopic head and neck examination performed under general anesthesia was superior than clinical head and neck examination for the diagnosis of these synchronous additional tumors. From july 1991 to august 1992, we realised a prospective study on 58 consecutive patients suffering from pulmonary removable lung cancers. All the patients had a clinical head and neck examination during the preoperative period. Immediately before thoracotomy a complete endoscopy of head and neck aerian and digestive tract was performed. During this last examination 18 new macroscopical lesions were discovered in 13 patients: benign lesions (n = 17), oral cavity and laryngeal dysplasia (n = 1). The one gingivolingual sulcus carcinoma, already discovered by the clinical examination, was confirmed. This study suggests that complete head and neck endoscopy is not superior than clinical examination for the diagnosis of synchronous malignancies before lung cancers removal.

Objective The study was designed to assess the prevalence, management and survival of patients with simultaneous squamous cell carcinomas of the oral cavity and hypopharynx (OC/HP). Material and methods A multicenter, retrospective study (2 university hospitals) was conducted between 2003 and 2007 on a series of 96 patients with simultaneous squamous cell cancers of the OC/HP. Results A total of 88 men and 8 women were included in the study: 81 patients presented double sites, 14 presented triple sites and one presented quadruple sites. The tumour sites most frequently observed were: hypopharynx in 61% of cases (involving the pyriform sinus in 42% of cases) and the oropharynx in 59% of cases (involving the palatine tonsil in 30% of cases). Upper aerodigestive tract endoscopy under general anaesthesia revealed a simultaneous lesion not suspected on clinical examination in 45% of patients: the site discovered on endoscopy was hypopharyngeal in 2 out of 3 cases; the tumour was classified T1 or T2 in 95.5% of cases. Patients treated simultaneously for all sites had a better prognosis than patients in whom each tumour was treated separately. The 5-year specific survival was 34% and the 5-year overall survival was 28%. Conclusion The prevalence of simultaneous squamous cell carcinomas of the oral cavity and hypopharynx ranges between 1 to 7.4% in the literature and was 4.6% in the present series. A common treatment strategy for each of the patient's tumours appears to be superior to the current theoretical approach that consists of considering each tumour separately. [ABSTRACT FROM AUTHOR]

Congenital pharyngolaryngeal band (PLB) is an extremely rare congenital abnormality, characterized by a fibrous web extending from the nasopharynx to the epiglottis. We report a case of unilateral pharyngolaryngeal band in a new-born who presented severe airway obstruction and feeding difficulties. The band extended from the right postero-inferior part of the nasopharynx to the right lateral margin of the larynx. Faucial pillars and tonsil were absent on this side. Endoscopic and radiological assessments excluded associated cervicofacial abnormality. Two endoscopic laser resection procedures were necessary to liberate the larynx from PLB. Clinical and radiological assessment advocated a second pharyngeal pouch development failure as the origin to PLB. [Copyright &y& Elsevier]