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Metabolic images from Positron Emission Tomography (PET) are used routinely for diagnosis, follow-up or treatment planning purposes of cancer patients. In this study we aimed at determining if radiomic features extracted from 18 F-Fluoro Deoxy Glucose (FDG) PET images could mirror tumor transcriptomics. In this study we analyzed 45 patients with locally advanced head and neck cancer (H&N) that underwent FDG-PET scans at the time of diagnosis and transcriptome analysis using RNAs from both cancer and healthy tissues on microarrays. Association between PET radiomics and transcriptomics was carried out with the Genomica software and a functional annotation was used to associate PET radiomics, gene expression and altered biological pathways. We identified relationships between PET radiomics and genes involved in cell-cycle, disease, DNA repair, extracellular matrix organization, immune system, metabolism or signal transduction pathways, according to the Reactome classification. Our results suggest that these FDG PET radiomic features could be used to infer tissue gene expression and cellular pathway activity in H&N cancers. These observations strengthen the value of radiomics as a promising approach to personalize treatments through targeting tumor-specific molecular processes.

An aberrant course of the internal carotid artery, such as a carotid loop or kinking, is a rare type of malformation. These malformations are typically asymptomatic, their occurrence is unpredictable, and they can exacerbate clinical disorders such as heart failure. We report the case of a seven-year-old child who died consecutively to cardiac arrest during otologic surgery for a cholesteatoma. After rapid and effective cardiorespiratory resuscitation, the child was transferred to a paediatric intensive care unit. In the following days, pronounced cerebral hypoperfusion led to the death of the child. The autopsy revealed a right carotid loop and a left carotid kink that presumably led to the cerebral hypoperfusion., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: The prognosis of advanced nodal (N3) squamous cell carcinoma of the head and neck (HNSCC) is poor. We investigated whether surgery or radiotherapy of early (T1-2) primary stage HSNCC is preferable to limit the overall morbidity after upfront neck dissection (uND) for N3 disease., Methods: This retrospective multicentric Groupe d'Étude des Tumeurs de la Tête Et du Cou study included patients undergoing uND and surgery or radiotherapy of their primary. Prognostic factors were evaluated using propensity score matching to account for biases in performing surgery depending on primary site and stage., Results: Of 189 T1-2, N3 HNSCC patients, 70 (37.0%) underwent uND: 42 with surgery of their primary and 28 with radiotherapy only. Radiotherapy alone was more frequent in patients with hypopharyngeal primaries. All local (N = 3) and regional (N = 10) relapses (included 2 locoregional relapses) occurred within the first 2 years. There were 16 distant metastatic failures. Five-year locoregional relapse and survival incidences were 15.7% and 66.5% and were similar regardless of the treatment of the primary. The overall morbidity rate was 65.2% and was similar after weighting by the inverse propensity score (p = 0.148). The only prognostic factor for morbidity was the radicality of the uND. Prolonged parenteral feeding was not more frequent in patients only irradiated to their primary (p = 0.118). Prolonged tracheostomy was more frequent after surgery of the primary., Conclusions: In patients with T1-2, N3 HNSCC undergoing uND, radiotherapy and surgery of the primary yield similar oncological outcomes. Morbidity was related to the extent of neck dissection.

Background: The incidence of cancer during pregnancy is low but is slightly increasing. Data on incidence and etiology of head and neck (HN) cancers in pregnant women are rare. We evaluated the frequency, tumor type, associated factors, and specific biomarkers in HN cancers occurring in pregnant (and peripartum) women., Methods: A systematic literature search was performed on PubMed, for any HN tumor site occurring in pregnant women., Results: Sixty cases of HN cancers occurring during pregnancy were identified. Most of them were oral cavity cancers. Relationships with oncogenic viruses, hormonal disturbance, and shift in maternal immunity profile were identified., Conclusion: Carcinogenesis of HN cancers in pregnant women may be led by different cancer type-specific hallmarks. Relevance of these etiological factors with respect to treatments and birth control recommendations is being investigated by the REFCOR in an ambispective study., (© 2019 Wiley Periodicals, Inc.)

Background: Sinonasal undifferentiated carcinoma (SNUC) is a very rare entity with a poor prognosis. Due to the lack of studies on the subject, evidence is lacking concerning its management., Methods: A multicenter collaborative study was conducted to assess treatment strategy, oncological outcome, and prognostic factors., Results: Definitive analyses focused on 54 patients with a majority of advanced stage; the 3-year overall survival (OS) and 3-year recurrence-free survival (RFS) rates were, respectively, 62.4% and 47.8%. During the follow-up, 18 patients (33.3%) died, 10 (18.5%) developed metastases, 7 had lymph-node involvement (13%), and 12 (22.2%) showed recurrence or local progression. In univariate analyses, treatment modalities associated with improved RFS were induction chemotherapy (p = 0.02) and intensity-modulated radiotherapy (p = 0.007). In the multivariate analyses, only induction chemotherapy (p = 0.047, hazard ratio [HR] = 0.39) was significantly associated with improved RFS., Conclusion: Multimodal therapies including induction chemotherapy and intensity-modulated radiotherapy may improve the prognosis of SNUC; surgery might improve local control. Further multicenter studies are required., (© 2018 ARS-AAOA, LLC.)

Introduction: Head and neck squamous cell carcinoma (HNSCC) treated by radio-chemotherapy have a significant local recurrence rate. It has been previously suggested that 18F-FDG PET could identify the high uptake areas that can be potential targets for dose boosting. The purpose of this study was to compare the location of initial hypermetabolic regions on baseline scans with the metabolic relapse sites after radio-chemotherapy in HNSCC., Results: The initial functional tumor volume was significantly higher for patients with proven local recurrence or residual disease (23.5 cc vs. 8.9 cc; p = 0.0005). The overlap between baseline and follow-up sub-volumes were moderate with an overlap fraction ranging from 0.52 to 0.39 between R40 and I30 to I60., Conclusion: In our study the overlap between baseline and post-therapeutic metabolic tumor sub-volumes was only moderate. These results need to be investigated in a larger cohort acquired with a more standardized patient repositioning protocol for sequential PET imaging., Methods: Pre and post treatment PET/CT scans of ninety four HNSCC patients treated with radio-chemotherapy were retrospectively reviewed. Follow-up 18F-FDG PET/CT images were registered to baseline scans using a rigid body transformation. Seven metabolic tumor sub-volumes were obtained on the baseline scans using a fixed percentage of SUV max (I30, I40, I50, I60, I70, I80, and I90) and were subsequently compared with two post-treatment sub-volumes (R40, R90) in 38 cases of local recurrence or residual metabolic disease. Overlap fraction, Dice and Jaccard indices, common volume/baseline volume and common volume/recurrent volume were used to determine the overlap of the different estimated sub-volumes., Competing Interests: CONFLICTS OF INTEREST The authors declare that they have no conflict of interest.

Fungal rhinosinusitis (FRS) has a worldwide distribution, comprises distinct clinical entities but is mostly due to Aspergillus among which Aspergillus fumigatus plays a major role in European countries. Although, there is accumulating evidence for the emergence of environmentally acquired-azole resistance in A. fumigatus (such as TR 34 /L98H) in various clinical settings, there is few data for patients with FRS. In this study, we aimed to investigate the prevalence of A. fumigatus azole resistance due to TR 34 /L98H in a multicentre cohort of patients with FRS. One hundred and thirty-seven patients with FRS admitted between 2002 and 2016 at four French medical centres were retrospectively enrolled. Clinical and mycological findings were collected. Aspergillus fumigatus and the TR 34 /L98H alteration conferring azole resistance were investigated directly from clinical samples using the commercial CE-IVD marked MycoGENIE ® A. fumigatus real-time PCR assay. Fungal ball was the more frequent clinical form (n = 118). Despite the presence of fungal hyphae at direct microscopic examination, mycological cultures remained negative for 83 out of the 137 patients (60.6%). The PCR assay proved to be useful allowing the identification of A. fumigatus and etiological diagnosis in 106 patients (77.4%) compared with 44 patients (32.1%) when using culture as the reference method. Importantly, neither TR 34 nor L98H alterations were evidenced., (© 2017 Blackwell Verlag GmbH.)

Aims: To evaluate the impact of human papillomavirus (HPV) status, tobacco smoking and initial treatment approach on progression-free survival (PFS) and overall survival (OS) for oropharyngeal cancer (OPC) in France, a country where smoking declines started late (1990s)., Methods: 340 OPC patients (median age: 60years) from 14 French hospitals were followed up (median 26.7months). PCR-based positivity for both HPV DNA and E6/E7 mRNA was used to distinguish HPV-positive OPC (27.1%). Hospital-stratified hazard ratios (HR) and corresponding 95% confidence intervals (CI) were used to compare PFS and OS according to HPV and other prognostic factors in hospital-stratified unadjusted and multivariate models. The combined effect of HPV status with either smoking, stage, or initial treatment on PFS was also evaluated., Results: PFS in multivariate analysis was better in HPV-positive patients (HR=0.42; 95% CI: 0.24-0.73) and worse in older patients (HR for 5-year age increase=1.12) and those having had firstly radiotherapy (HR=1.86; 95% CI: 1.19-2.92) or induction chemotherapy (HR=1.73; 95% CI: 1.08-2.79) instead of upfront surgery. Findings for OS were similar. Loco-regional recurrences were less frequent in HPV-positive (10.5%) than HPV-negative patients (26.0%) but distant recurrences were similarly frequent. HPV status did not modify the influence of smoking or stage on PFS but the impossibility to perform upfront surgery may be more relevant for HPV-negative patients., Conclusions: HPV-positive OPC patients fare better than HPV-negative OPC and may benefit from toxicity-sparing. Whether HPV-negative patients responded less well to radiation and chemotherapy because of more severe genomic damage or bulkier tumours is unclear., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: Epistaxis is the most frequent and disabling manifestation of hereditary hemorrhagic telangiectasia (HHT). The efficacy of intravenous bevacizumab (an anti-vascular endothelial growth factor monoclonal antibody) for epistaxis has been shown. However, the efficacy of intranasal bevacizumab has yet to be evaluated., Objective: To evaluate the efficacy of 3 different doses of bevacizumab administered as a nasal spray in a repeated manner for the duration of nosebleeds in patients with HHT., Design, Setting, and Participants: Randomized, multicenter, placebo-controlled, phase 2/3 clinical trial with dose selection at an intermediate analysis and prespecified stopping rules (nonbinding stopping for futility). Patients aged 18 years or older with a diagnosis of HHT were recruited from 5 French centers from April 2014 to January 2015 with a 6-month follow-up after the end of treatment. Participants had a history of self-reported nosebleeds with a monthly duration of more than 20 minutes in at least the 3 months prior to inclusion corroborated by epistaxis grids completed during the same preinclusion period., Interventions: Eighty consecutive HHT patients were randomized and treated in the phase 2 study, with 4 parallel groups in a 1:1:1:1 ratio. One group received placebo (n = 21); the other 3 received bevacizumab nasal spray. Each bevacizumab group received a different dose of the drug (25 mg [n = 20], 50 mg [n = 20], or 75 mg [n = 19] per treatment) in 3 doses 14 days apart for a total treatment duration of 4 weeks, resulting in a total dose of 75 mg, 150 mg, and 225 mg in each treatment group., Main Outcomes and Measures: Mean monthly epistaxis duration for 3 consecutive months immediately after the end of the treatment., Results: Of the 80 patients who were randomized (mean age, 60.47 [SD, 10.61] years; 37 women [46.25%]), 75 completed the study. Mean monthly epistaxis duration measured at 3 months was not significantly different in the 59 patients receiving bevacizumab in comparison with the placebo group (P = .57) or between the bevacizumab groups. The mean monthly epistaxis duration was 259.2 minutes (95% CI, 82.1-436.3 minutes) in the 25-mg group, 244.0 minutes (95% CI, 81.8-406.2 minutes) in the 50-mg group, 215.0 minutes (95% CI, 102.8-327.2 minutes) in the 75-mg group, and 200.4 minutes (95% CI, 109.3-291.5 minutes) in the placebo group. Toxicity was low and no severe adverse events were reported. This study was terminated prior to phase 3 for treatment futility after interim analysis on the recommendations of an independent data monitoring committee., Conclusions and Relevance: In patients with HHT, a bevacizumab nasal spray treatment of 3 administrations at 14-day intervals with doses of 25 mg, 50 mg, or 75 mg per spray, compared with a placebo, did not reduce monthly epistaxis duration in the 3 consecutive months immediately after the end of treatment., Trial Registration: clinicaltrials.gov Identifier: NCT02106520.

Weapon injuries with spear gun are rare. The aim of this case report is to report the emergency and surgical management when this event occurs. A 35-year-old man attempted suicide with a spear gun. The entry of the shaft was localized through the submental area without an obvious exit point. The projectile passed through the tongue and palatal bone. A tracheotomy was performed. Preoperative cranial computed tomography (CT) showed the harpoon was gone upward through the submental area, the oral cavity, the ethmoid paranasal sinus, the cribriform plate, and the frontal region without vessel damages. Under general anesthesia, the harpoon was pulled out in order to extract the shaft tip and the articulated wishbone. Osteo-meningeal defect of the ethmoid roof was closed using a middle turbinate flap. There were no neurologic deficit and no cerebro-spinal rhinorrhea at his 3-year follow-up visit. The trajectory of the shaft is different between attempted suicide and accident. Cranial CT scan is helpful to show the trajectory of the shaft. Angiogram can be helpful to see the relations between the tip shaft and the vessels. The knowledge of the shaft tip and the imagery findings are important to decide the best surgical approach.

Purpose: This study was designed to assess the efficacy and morbidity of the endoscopic endonasal approach for the treatment of sinonasal adenocarcinomas., Methods: This was a retrospective, multicenter study of nine French tertiary referral centers, including untreated patients. All patients were operated by an endoscopic approach. Tumors were classified according to the UICC 2002. Demographic, therapeutic, histological, morbidity data, and the course of the disease were recorded. Survival rates were obtained using the Kaplan-Meier method., Results: A total of 159 patients were included with a mean age of 69 years. There were 19T1, 62T2 (1M1), 36T3 (1N1), 26T4a, and 16T4b (1N2a-1N2c). The mean duration of hospitalization was 4.4 days. The histologic outcomes showed that the olfactory cleft, the posterior and anterior ethmoid sinus, and the sphenoid, maxillary, and frontal sinuses were invaded in 95, 64, 55, 19, 7, and 3 % of cases, respectively. Histologic margins were positive in 17 % (1T1, 4T2, 3T3, 2T4a, and 8T4b). In total, 130 patients received adjuvant radiotherapy on the primary tumor site (58 Gy), 24 cases were not irradiated, and 5 refused treatment. The mean follow-up was 32.5 ± 24 months. The complication rate was 19 %: 6 epistaxis, 3 meningitis, 6 CSF leaks, 2 dacryocystitis, and 8 septoplasties. The recurrence rate was 17.6 % (28 cases) within 23 ± 21 months. Eleven patients underwent a second surgical procedure. Nine patients died of their disease (3T2, 2T3, 4T4b). The global and disease-specific, recurrence-free survival rate at 3 years was 74 and 84 % respectively., Conclusions: The endoscopic approach seems to be efficient to remove sinonasal adenocarcinoma with low morbidity.

The treatment of carcinomas of unknown primary revealed by cervical lymphadenopathy is based on neck dissection and nodal and pan-mucosal irradiation to control the neck and avoid the emergence of a metachronous primary. The aim of this review was to assess diagnostic and therapeutic approaches and criteria that may be used for a customized selective approach to avoid severe toxicities of pan-mucosal irradiation. A literature search was performed with the following keywords: cervical lymphadenopathy, unknown primary, upper aerodigestive tract, cancer, radiotherapy, squamous cell carcinoma, variants. The diagnostic workup includes a head and neck scanner or MRI, ((18)F)-FDG PET CT, a panendoscopy and tonsillectomy. Squamous cell carcinoma represents over two thirds of cases. The number of metastatic cervical nodes, nodal level, and histological variant (associated with HPV/EBV status) may determine the primary site origin and might be weighted for the determination of radiation target volumes on a multidisciplinary basis. A selective customized approach is relevant to decrease radiation toxicity only if neck and mucosal control is not impaired. Although no recommendation can yet be made in the absence of sufficient level of evidence, the relevance of systematic pan-mucosal irradiation appears questionable in a number of clinical situations. Accordingly, a customized selective redefinition of target volumes may be discussed and be prospectively evaluated in relation to the therapeutic index obtained., (Copyright © 2013 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.)

Background: The management of the neck remains controversial in the definitive chemoradiation setting of advanced N2-3 head and neck squamous cell carcinoma. Most published data favor omission of neck dissection (ND) after complete response for N2-3 or selective ND for residual disease, Methods: We studied the patterns of care in the French-Belgian Groupe d'Etude des Tumeurs de la Tête Et du Cou (GETTEC) through a questionnaire-based survey., Results: Eighteen percent of institutions never performed up-front ND, 20% rarely, 40% sometimes, 14% often, and 8% systematically. Induction chemotherapy was indicated in 30% of the cases, and most ND were performed either between induction and radiation or after chemoradiation for residual disease. Response to chemoradiation was assessed by computed tomographic scan and positron emission tomography in 72% of cases. Selective ND was more common than radical ND., Conclusions: Omission of ND based on computed tomographic scan and positron emission tomography-based complete response to chemoradiation is the most common strategy for advanced nodal disease among centers. However, neck management strategies vary among institutions, and some institutions continue advocating systematic ND before irradiation. The new treatment options and the changing epidemiology, namely docetaxel-based induction chemotherapy and human papilloma virus-related head and neck squamous cell carcinoma having better response profiles and prognosis, are adding to the nonconsensual approach. The best therapeutic index in terms of neck management remains to be defined in this evolving context.

Head and neck cancer is frequent worldwide and oropharyngeal locations are presently sharply on the increase, in relation with an increasing incidence of oropharyngeal infection by oncogenic type-16 human papillomavirus (HPV). The clinical and biologic profile of these patients is distinct from that of other oropharyngeal carcinoma patients, with earlier onset, cystic cervical nodes and basaloid carcinoma histopathology. Detection of intratumoral viral DNA is essential to confirm the role of HPV, and E6/E7 mRNA expression is the most relevant indicator for stratification. Several methods can reveal intratumoral oncogenic HPV DNA, but PCR with hybridization is the most sensitive and most widely used. According to several reports, prognosis in terms of survival and locoregional control is better in HPV-positive oropharyngeal carcinoma than in oropharyngeal carcinoma associated with smoking and alcohol consumption. The future lies in vaccination, but further studies will determine whether the rate of oropharyngeal carcinoma falls in women vaccinated against cervical cancer., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Objective: The study objective was to identify bacteria responsible for facial cellulitis of dental origin., Design: Adult patients, admitted for facial cellulitis of dental origin were included. The pus sample was taken by swabbing during the surgical incision and drainage performed under general anesthesia. The bacteriological diagnosis was performed by microscopic examination and bacterial culture in aerobic and anaerobic atmosphere., Results: Two hundred and seven bacterial species were isolated from 100 samplings, that is to say 2.07 bacterial species per sample. 19% of the samples contained only aerobic germs, 36% only anaerobic ones, and 45% contained mixed aerobic and anaerobic flora. Streptococcus (65.38%) and Capnocytophaga (11.54%) were the most frequently isolated aerobic bacteria. The anaerobic bacteria accounted for 62.32% of isolates and the most frequently isolated were Prevotella (55%) and Fusobacterium (16.28%). Bacterial species were not significantly different according to the age (P-value=0.06) and sex (P-value=0.584). There was a significant statistical association between aerobic or anaerobic bacteria and clinical symptoms such as cheek edema (P-value=0.03) and pus at tooth root (P-value=0.02). Patients previously treated by antibiotic therapy presented significantly more infections due to the same respiratory germ type (P-value=0.009)., Conclusions: Even though the bacterial flora responsible for facial cellulitis of dental origin is polymorphic, anaerobic bacteria were predominant., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Objective: A prospective study in a healthy French population to evaluate the normal range of PNIF., Material and Methods: In total, 234 subjects separated into 2 groups (group 1: patients with VAS >or= 8, n = 151 and group 2: patients with VAS < 8, n = 83) have been prospectively enrolled in this study from September 2003 to April 2004. For all participants, nasal obstruction was evaluated through a VAS and two PNIF measurements., Results: The mean PNIF measurements in group 1 and group 2 were 87.5 L/min and 84.7 L/min, respectively with a significant difference between male and female in both groups (p < 0.0001). The reproducibility in group 1 and group 2 was 5.1 L/min and 4.4 L/min respectively. A slight tendency to a reduction due to the age was observed except for patients over 60., Conclusion: This study confirms that the technique of PNIF measurement is reliable and simple. The normal range of PNIF in a healthy French population has been determined although our results show lower values than previous published reports from other countries. However, it remains an attractive method for the follow-up and survey of patients complaining of nasal obstruction.

Background: Primary involvement of the sphenoid sinus occurs in 2% of all paranasal sinus tumors and is associated with dismal prognosis. Optimal management remains debatable., Methods: A total of 23 patients were treated for a primary cancer of the sphenoid sinus from 1988 to 2004. Charts were reviewed for patient-, tumor-, and treatment-related parameters. Univariate and multivariate analyses were conducted to identify prognostic factors for locoregional control and survival., Results: Cranial neuropathies were present in 12 patients. Pathologic findings included adenoid cystic carcinoma, adenocarcinoma, lymphoma, squamous cell carcinoma, sarcoma, neuroendocrine carcinoma, melanoma, and malignant hemangiopericytoma. All but 2 patients had stages III to IV cancer. Radiotherapy was performed in 18 patients and chemotherapy in 12. Of 10 patients undergoing surgery, total excision with grossly negative margins was achieved in 4 patients and subtotal resection in 6. Median locoregional control and overall survival were 12 and 41 months, respectively. On multivariate analysis, cranial neuropathy was associated with worse locoregional control and survival. Surgery was rarely complete because of advanced stages at presentation, but it yielded better outcomes than other treatments without surgery in non lymphoma-cases., Conclusion: Early CT and MRI should be performed when facing aspecific, rhinological, or neuro-ophtalmological symptoms. Cranial neuropathies indicate a worse prognosis. Surgery, including debulking surgery, may be preferred to combined modality treatments without surgery. Its apparently favorable impact on prognosis would need to be tested in homogenous histological groups of patients, which is impossible because of the rarity of the disease. Highly conformal radiotherapy (adjuvant or definitive) should be encouraged and optimized with concurrent chemotherapy in advanced stages. Aggressive multidisciplinary management including surgery, chemotherapy, and radiotherapy should be encouraged and adapted on histology and tumor extensions. Progress is still warranted to improve outcomes.

Malignant sinonasal tumors are the most frequent facial malignancies in adults. Assessment of these tumors requires a multidisciplinary approach and imaging plays a major role to define the precise tumor location, volume and extension and to plan post-treatment follow-up. MRI provides superior differentiation between tumor and surrounding tissues and depiction of intracranial or perineural extension. CT is a useful complement to demonstrate bone erosion or extension into the skull base.

Objective: The purpose of this study is to describe the treatment of epistaxis in hospital emergency departments and to identify the principal risk factors for more severe episodes of bleeding., Study Protocol: Prospective cross-sectional epidemiological study, Material and Methods: This study was carried out in 23 hospital centres in France, most of them teaching hospitals. Every patient presenting non-traumatic epistaxis or else associated with hereditary hemangioma during two consecutive and separate 24-hour periods were included., Results: Fifty patients were included in the study. Nasal bleeding was stopped within 30 minutes for 47 patients. Fourteen patients were hospitalized. The risk factors for severe epistaxis included either copious bleeding or else bleeding for more than 6 hours or patients aged 65 and over. A history of repeated nasal packing and/or taking medication with a known hemorrhagic risk was associated with the amount and duration of bleeding (p < 0.05)., Conclusion: Risk factors for severe epistaxis should be identified as to improve patient care and avoid treatment failure or useless hospitalization.

Objective: Describe the profile of patients consulting a general practitioner or allergologist for seasonal spring-time allergic rhinitis (SAR) in France., Methods: 3.348 physicians (3.284 general practitioners and 64 allergologists) recruited in 4 monthly episodes from March to June 1998, 34.851 patients consulting for SAR. Using a questionnaire, demographical data concerning the practitioners consulted and all the patients were collected. For 12,420 patients the symptomatology, history of asthma and ongoing treatment for SAR were analysed by comparing the population consulting a general practitioner (A) or an allergologist (B)., Results: Mean age for all patients with suspected SAR was of 37.1 +/- 15.7 years with a majority of women (54.90%). For 1,441 patients, it was the first consultation for this disorder, notably with a general practitioner, (11.1 vs. 2.4%). Aqueous rhinorrhea, sneezing and nasal obstruction were the most frequent symptoms noted, without significant difference between the type of practitioner consulted. 5.711 patients had undergone previous allergy tests, with more skin tests in the group consulting an allergologist (78 vs. 44.9%). Association with history of asthma was similar in both groups (30%). Impact on daily life was almost identical, whether isolated or associated with past history of asthma (56 vs. 51.6%), but differed with regard to sleep (56.7 vs. 21.1%). During the consultation, 5.889 patients were already treated with antihistamines (83.2%), whatever the type of practitioner consulted., Conclusion: Seasonal spring-time allergic rhinitis is a frequent pathology, which significantly impairs quality of life. There is little difference in patients' profile whether they consult a general practitioner or an allergologist.

Objective: To analyze the surgical results after Functional Endoscopic Sinus Surgery (FESS) in patients with paranasal sinus fungus ball., Material and Methods: Retrospective analysis of the results of FESS performed in 175 patients suffering from paranasal sinus fungus balls., Results: All maxillary (n = 150), sphenoidal (n = 20), and ethmoidal (n = 4) locations have been treated exclusively by FESS to obtain a wide opening of the affected sinuses, allowing a careful extraction of all fungal material without removal of the inflamed mucous membrane. No major complication occurred. Postoperative care was reduced to nasal lavage with topical steroids for 3 to 6 weeks. Only 1 case of local failure have been observed (maxillary sinus, n = 1), and 6 cases of persisting of fungus ball (maxillary sinus, n = 4; frontal sinus, n = 2) with a mean follow-up of 5 years. No medical treatment (antibiotic, antifungal) was required., Conclusion: Surgical treatment of a fungus ball consists in opening the infected sinus cavity at the level of its ostium and removing fungal concretions while sparing the normal mucosa. No antifungal therapy is required. Finally, through this 175 patients study, FESS appears a reliable and safe surgical treatment with a low morbidity.

We have established an experimental model of fungal sinusitis in rabbits to analyze the chronology and the pathogenesis of the development of noninvasive fungal sinusitis due to Aspergillus fumigatus. Thirty-four Pasteurella-free New Zealand white rabbits divided into three groups were included in this study. In the first group (10 rabbits), A fumigatus was inoculated into the maxillary sinus. In the second group (10 rabbits), A fumigatus was inoculated into the maxillary sinus in the presence of a wound in the mucosa. In the third group (14 rabbits), A fumigatus was inoculated into the maxillary sinus in the presence of a blocked ostium. On days 15 and 30, endoscopic, histopathologic, bacterial, and mycological examinations of both maxillary cavities and mucous membrane were performed. The rabbits were painlessly sacrificed 30 days after inoculation; mucosal and bone biopsies of the maxillary sinus cavities were performed for histopathologic studies. We found that noninvasive fungal sinusitis had been induced in 2 rabbits of the second group and 8 rabbits of the third group. We conclude that introduction of fungi into a sinus with a blocked ostium induces fungal sinusitis. The present model of experimental fungal sinusitis seems to be reproducible and suitable for further studies of the development of fungal sinusitis.

Objective: Review of the diagnostic and management of retropharyngeal and lateral pharyngeal abscesses in children., Patients and Methods: Retrospective study of 5 children's cases hospitalized during year 2003., Results: Diagnosis included CT scan which is often helpful to differentiate cellulitis from abscesses. First medical management consists in an intravenous broad-spectrum antibiotics. Surgical drainage may be considered in cases of failure or clinical aggravation. Closed observation is mandatory in all cases to prevent major complication., Conclusion: Retropharyngeal and lateral pharyngeal abscesses in children are life-threatening infectious. Therapeutic consists in intravenous broad-spectrum antibiotics associated, if necessary, with surgical drainage in cases of persistent abscess.

Introduction: Nasal polyposis is an inflammatory disorder which pathophysiology remains unclear. Several clinical associations are described according to co-morbidities (asthma, allergy...)., Objective: To analyze the efficacy of a standardized surgical procedure in 65 patients with nasal polyposis, enrolled in three categories according to the presence of co-morbidities (asthma, allergy...)., Study Design: Open prospective study of non-randomized cases from a single institution., Methods: An inception cohort of 65 consecutive patients with nasal polyposis observed from January 1994 to December 1997. The same surgical procedure was performed in all patients. At the end of the study, an evaluation was performed to collect all the information concerning nasal and bronchial symptoms, asthma conditions, and medical treatment., Results: 60 patients have finally completed the study. Polyposis was isolated in 29 patients, asthma was present in 21 patients, associated with aspirin intolerance in 10 patients (ASA Triad). Nasal obstruction and olfactory dysfunction was improved in 37 and 42 patients, respectively (p<0.0001), without a statistical significance between all groups. After surgery, topical treatment with steroids and local recurrences were more frequently observed in the ASA Triad group without statistical significance., Conclusion: Nasal polyposis appears to be less controlled in the ASA Triad group compared to isolated nasal polyposis, although such conclusion is not statistically significant.

Objective: To analyze the efficacy of a standardized surgical procedure in patients with nasal polyposis., Study Design: Prospective study of nonrandomized cases from a single institution., Methods: An inception cohort of 65 consecutive patients with nasal polyposis observed from January 1994 to December 1997. Presence of asthma, allergies, or aspirin intolerance, duration of nasal polyposis, previous surgery, and medical treatment were noted. Clinical symptoms were evaluated with a visual analogue scale (VAS), and a preoperative computed tomography scan was performed before the surgical procedure. At the end of the study, an evaluation was performed to collect all information concerning nasal symptoms, asthma conditions, quality of life, and patient's opinion about this type of surgery., Results: Sixty patients have completed the study. Polyposis was isolated in 29 patients (group A), asthma was present in 21 patients (group B), and aspirin intolerance in 10 patients (group C). Nasal obstruction (n = 53/60, 88.3%) and olfactory disturbances (n = 54/56, 96.4%) were the main preoperative complaints, according to the VAS, with a high degree of severity. No significant difference for nasal symptomatology was found between the three groups. Nasal obstruction and olfactory dysfunction was improved in 37 and 42 patients, respectively, without a statistical significance between the groups. A reduction of the antiasthmatic treatment was observed in 24 of 31 patients. A massive and anteriorly localized recurrence was noted in 3 and 19 patients, respectively., Conclusions: Endoscopic sphenoethmoidectomy is indicated for nasal polyposis refractory to intensive medical management with a good improvement of patient's quality of life.

Objectives: To determine the incidence of local control in patients with "advanced" moderately to well-differentiated endolaryngeal invasive squamous cell carcinoma classified as T3, treated with a supracricoid partial laryngectomy; to identify any statistical relationship; and to analyze the consequences of local recurrence., Design: Retrospective nonrandomized case series., Setting: A tertiary referral care center and university teaching hospital., Patients: An inception cohort of 118 patients. Tumor stage was T3 N0 M0 in 90 patients, T3 N1 M0 in 21 patients, T3 N2 M0 in 5 patients, and T3 N3 M0 in 2 patients., Interventions: All patients underwent supracricoid partial laryngectomy. A platin-based induction chemotherapy regimen was used in 100 patients. Postoperative radiotherapy was used for 24 patients., Main Outcome Measures: Local recurrence, nodal recurrence, distant metastasis, and survival; univariate and multivariate analysis of local recurrence., Results: Nine patients developed a local recurrence. The 1-, 3-, and 5-year actuarial local control estimates were 97.3%, 93.5%, and 91.4%, respectively. In a stepwise regression model, the presence of positive margins of resection was the only variable that statistically increased the risk of local recurrence (P =.008). Local recurrence resulted in a significant increase in nodal recurrence (P<.001) and distant metastasis (P<.001) and a significant decrease in survival (P =.03). An overall 89.8% laryngeal preservation rate and 98.3% local control rate were achieved., Conclusion: Supracricoid partial laryngectomies should be considered when an organ preservation strategy is discussed in patients with advanced endolaryngeal squamous cell carcinoma classified as T3.

Paranasal sinus mucocele is a benign pseudocystic lesion, which may originate from any of the sinus cavities. Although the diagnosis may be suggested by the clinical presentation, CT is necessary to accurately analyze the regional anatomy and extent of the lesion. MRI is helpful in defining the limited unusual lesions occurring in critical areas. Standard treatment is surgical marsupialization, through endonasal sinus surgery, which offers a conservative, minimally invasive approach, and respects the sinus architecture and natural drainage. Our long-term experience with the endonasal endoscopic approach for the treatment of mucoceles led us to subsequently expand our indications to include most mucoceles, either as the sole approach or associated with an external approach. Comprising the surgical experience of two collaborating universities, this paper describes the indications for the endonasal surgical approach and the long-term postoperative followup.

Background: Chronic invasive fungal rhinosinusitis is rare in the immunocompetent patient. Few cases have been published except for in a specific geographic area (Sudan, India)., Methods and Results: We reported two new cases of chronic invasive fungal rhinosinusitis due to Aspergillus, which was successfully treated, to analyze the different clinical, radiological, and mycological criteria., Conclusion: Through these two new clinical cases and the analysis of the literature, we suggested, in the absence of general agreement on the surgical and medical management, the current strategies available for this rare pathology. New antifungal drugs seem to be an efficient alternative to classic antifungal agents, especially those that require an extended course of oral therapy for the chronic invasive form.

Objective: Epistaxis is a frequent emergency for which guidelines and treatment are well known. Nevertheless few studies have evaluated the factors that may influence the decision for hospitalisation. Through a retrospective study we have searched to define potential factors which lead to taking such a decision., Methods: Retrospective analysis of charts of 260 patients hospitalized for epistaxis. For each patient we have reviewed several data including, age, associated pathologies, current treatment, duration of the stay, complications, recurrences etc..., Results: If the severity of the bleeding is one of the major factor, socio-economic factors are also taken into account and may influence the decision to hospitalize. Age, associated pathologies (hypertension, hemopathy) and their treatment (anti-coagulant) also play a role in this decision. Furthermore an obvious strategy in the choice of the different treatment may help to reduce the length of stay and the morbidity of each treatment., Conclusion: We propose some modifications to our strategy to improve the management of epistaxis. This includes the use of endoscopic techniques for diagnosis and treatment.

Adenoid cystic carcinoma is a rare tumour which mainly affects the major and accessory salivary glands. We report 5 new cases affecting the nose and sinuses, and based on these review the literature to determine how this disorder can be better treated, given the significant morbidity and mortality of the condition.

Pneumosinus dilatans is a rare pathology that primarily involves the frontal sinus. We report three new cases, with special attention given to the pathophysiology and histologic data. Surgical management is reported.

Laryngeal schwannoma is an uncommon benign tumor. We report two clinical cases and discuss the different types of clinical symptoms revealing the tumor. Difficulties encountered in obtaining a histological diagnosis are presented. The contribution of imaging is also analyzed according to the different surgical techniques used to manage the tumor depending on its size and localization. We stress the importance of long-term follow-up as recurrences may occur several years after surgical removal.

For many years, the association between asthma and naso-sinus pathology has been noted in the literature. The role of sinus infections on the triggering or aggravation of asthma has been well established. More recently attention has been drawn to the association of the chronic inflammatory rhino-sinus pathologies such as polyposis, with asthmatic illness. Its research and identification are essential in care of the asthmatic patient, since recent work has shown the value of control of polyposis for the stability and improvement of the asthmatic illness. The authors report and analyse the diagnostic and therapeutic methods for polyposis in asthmatics.

The authors report a case of facial hemiatrophy, secondary to linear scleroderma, and review the various possible causes of facial hemiatrophy. The various treatments proposed to correct facial hemiatrophy are described. The advantages and disadvantages of each technique together with their indications as a function of the severity of the lesions are then discussed. Free flap currently appears to be the treatment of choice in severe forms and the main question concerns the choice of flap. The authors prefer an inverted dermal fat flap because of its advantages (absence of long-term ptosis, better facial contours) and the absence of laparotomy.