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Objectives There are emerging reports of the effectiveness of in-office awake vocal-fold corticosteroid injection in the treatment of exudative vocal-fold lesions. The aim of this study was to review this therapy and specify indications, practical modalities and outcomes. Study design Systematic review of the literature without meta-analysis. Methods A systematic review by PubMed search for the period January 2000 to December 2018 was carried out. Results Nine articles were included, for a total of 502 lesions: nodules (46.4%), polyps (31.7%), and Reinke's edema (21.9%). Submucosal injection of low-dose triamcinolone acetonide (0.1 to 0.3 mL) was transoral, transcutaneous or transnasal via flexible endoscope with operating channel. Lesion volume was significantly reduced in more than 90% of cases, with significant vocal improvement in all studies. Relapse rates ranged between 4% and 31%, with time to relapse of 1 to 40 months. Conclusions First-line treatment of exudative glottic lesions by submucosal corticosteroid injection provides at least transient significant reduction in lesion volume and vocal improvement. It is consensually reserved to moderate-sized mainly exudative lesions without fibrosis. In-office injection provides an immediate therapeutic response in case of vocal impairment, enabling surgery under general anesthesia to be postponed.

Management of oropharyngeal cancer depends on several factors. Immediate surgery or radiotherapy may be considered. If the patient is operable, the choice depends on the extent of the disease, the contributing factors, and the expected functional results. For HPV-positive cancers, studies show comparable efficacy between surgery and radiotherapy. For early-stage cancers, unimodal treatment should be preferred. For HPV-negative cancers, the results of retrospective and observational studies are in favor of surgery. These studies have some limitations. In observational and/or retrospective studies, reclassification biases and the applicability of propensity scores weaken the validity of studies showing differences in management. Tumor and patient comparability are others majors interpretation biases. It is precipitate to conclude that surgery is superior for HPV-negative oropharyngeal cancers. Toxicity, therefore, becomes a criterion of choice for treatment. Unimodal management by surgery allows limited toxicity for the early stages. Surgery has less impact on salivation. Radiotherapy is rather less deleterious for swallowing in the early stages. For the advanced stages of HPV-induced tumors, the non-superiority of surgery should lead to the choice of radiochemotherapy. For oropharyngeal cancers, the possible benefit of surgery in HPV-negative oropharyngeal cancers must be confirmed in randomized studies. For the early stages of oropharyngeal cancer with unimodal treatment, management could be decided by shared decision making.

Resume Introduction Les auteurs exposent les recommandations de la Societe francaise d’oto-rhino-laryngologie et de chirurgie de la face et du cou (SFORL) concernant le bilan clinique et d’imagerie d’une adenopathie cervicale d’allure kystique sans porte d’entree chez l’adulte. En majorite, il s’agit de metastase d’un carcinome des voies aerodigestives superieures, le plus souvent oropharynge, plus rarement d’un carcinome differencie de la thyroide ou d’un carcinome non keratinisant du nasopharynx. Objectif Un groupe de travail multidisciplinaire a ete charge de realiser une revue de la litterature scientifique concernant le bilan etiologique a effectuer en presence d’une adenopathie cervicale d’allure kystique chez l’adulte, comprenant les donnees cliniques et d’imagerie conventionnelle (echographie, TDM, IRM) et metaboliques. Les recommandations ont ete redigees a partir de ces textes et de l’experience de chacun puis classees en grade A, B, C ou accord professionnel selon un niveau scientifique decroissant. Resultats Il est recommande de realiser un examen clinique oriente, une echographie cervicale et thyroidienne, une TDM cervicothoracique injectee chez un adulte presentant une adenopathie cervicale d’allure kystique sans porte d’entree. La TEP-TDM est recommandee avant l’endoscopie pour rechercher la tumeur primitive. Conclusion La realisation d’un bilan clinique et d’imagerie est essentielle pour le diagnostic etiologique d’une adenopathie cervicale kystique de l’adulte et sera associe aux examens cytologiques avant prise en charge therapeutique.

Objectives The authors present the guidelines of the French Society of Otorhinolaryngology - Head and Neck Surgery Society on diagnostic procedures for lymphadenopathy in case of a cervical mass with cystic aspect. Methods A multidisciplinary work-group was entrusted with a review of the scientific literature on the topic. Guidelines were drawn up, then read over by an editorial group independent of the work-group, and the final version was drawn up. Guidelines were graded as A, B, C or expert opinion, by decreasing level of evidence. Results In adults presenting a cystic cervical mass, it is recommended to suspect cervical lymphadenopathy: in order of decreasing frequency, cystic metastasis of head and neck squamous cell carcinoma, of undifferentiated nasopharyngeal carcinoma, and of thyroid papillary carcinoma (Grade C). On discovery of a cystic cervical mass on ultrasound, architectural elements indicating a lymph node and a thyroid nodule with signs of malignancy should be screened for, especially if the mass is located in levels III, IV or VI (Grade A). Malignant lymphadenopathy should be suspected in case of cervical mass with cystic component on CT (Grade B), but benign or malignant status cannot be diagnosed only on radiological data (CT or MRI) (Grade A), and 18-FDG PET-CT should be performed, particularly in case of inconclusive ultrasound-guided fine needle aspiration biopsy (Grade C).

International audience; Background: To describe the characteristics of the largest European study of MEC of salivary glands and to determine the prognostic factors for overall and disease free survival.Patients and methods: Patients with MEC were prospectively included in the Réseau d'Expertise Français sur les Cancers ORL Rares (REFCOR, French Network of Rare Head and Neck Tumors) database between 2009 and 2015.Results: A total of 292 patients were included. Tumors were classified as low grade in 175 cases (60%), intermediate in 39 (13%) and high grade in 78 (27%). Median follow-up was 26 months. The 5-year OS and DFS rates were respectively 83% and 69%. In multivariate analysis, age (p = 0.004), diabetes (p = 0.02) and advanced stage (p = 0.03) were found to have a significant negative impact on OS. Diabetes (p = 0.001), alcohol consumption (p = 0.003) and advanced stage (p = 0.001) were found to have a significant negative impact on DFS. Compare to low grade, high grade tended to have a negative impact on OS (p = 0.05) and had a significant effect on DFS (0.002) while intermediate grade had no significant influence on survival. The surgical treatment had a positive impact on both OS (p = 0.00005) and DFS (p = 0.0005). Postoperative radiotherapy had no impact in multivariate analysis.Conclusion: Advanced clinical stage, high grade tumor, high age, the impossibility of carrying out a complete surgical resection, and diabetes are the main prognostic factors in this prospective series of patients with MEC. Such findings open new research perspectives on the influence of these components on initial patient care.

Introduction The authors present the guidelines of the French Society of Otorhinolaryngology (SFORL) for clinical and radiological assessment of cystic neck lymphadenopathy of unknown primary in adults. Most cases concern head and neck carcinoma metastasis, often in the oropharyngeal area, or less frequently differentiated thyroid carcinoma or non-keratinizing nasopharyngeal carcinoma. Methods A multidisciplinary task force was commissioned to carry out a review of the literature on the etiological work-up in cystic neck lymphadenopathy in adults: clinical examination, conventional imaging (ultrasound, CT, MRI) and metabolic imaging. Guidelines were drafted based on the articles retrieved, and graded A, B, C or expert opinion according to decreasing level of evidence. Results Oriented clinical examination, cervical and thyroid ultrasound scan and contrast-enhanced neck and chest CT scan are recommended in the assessment of cystic neck lymphadenopathy of unknown primary in adult patients. PET-CT is recommended prior to panendoscopy, to identify the primary tumor. Conclusion Clinical and radiological assessment is fundamental for etiologic diagnosis of cystic neck lymphadenopathy in adult patients, and should be completed by cytological examination before in initiating treatment.

International audience; BACKGROUND:Head and neck mucosal melanoma (HNMM) is aggressive and rare, with a poor prognosis because of its high metastatic potential. The two main subtypes are sinonasal (sinonasal mucosal melanoma [SNMM]) and oral cavity (oral cavity mucosal melanoma [OCMM]). Consensual therapeutic guidelines considering the primary tumour site and tumour-node-metastasis (TNM) stage are not well established.MATERIAL & METHODS:Patients with HNMM from the prospective national French Rare Head and Neck Cancer Expert Network database between 2000 and 2017 were included. Clinical characteristics, treatment modalities, outcomes and prognostic factors were analysed.RESULTS:In total, 314 patients were included. The 5-year overall survival (OS) and progression-free survival (PFS) rates were 49.4% and 24.7%, respectively, in the surgery group; no long-term survivors were observed when surgery was not feasible. Moreover, even after surgery, a high recurrence rate was reported with a median PFS of 22 months. In multivariate analysis, Union for International Cancer Control (UICC) stage and tumour site correlated with PFS and OS. Postoperative radiotherapy (PORT) improved the PFS but not OS in patients with small (T3) SNMM and OCMM tumours. Nodal involvement was more frequent in patients with OCMM (p < 10-4), although, as in SNMM, it was not a significant prognostic predictor.CONCLUSION:Even early HNMM was associated with poor oncologic outcomes due to distant metastases despite surgical resection with clear margins. Lymph node metastases had no impact on the prognosis, suggesting treatment de-escalation in cervical node management. PORT might be useful for local control.

Resume Objectif Le diagnostic des cancers de l’oropharynx lies a HPV repose en pratique clinique sur l’immunohistochimie de p16 et la detection de l’ADN viral par PCR (PCR-HPV). L’objectif principal de cette etude etait d’evaluer la concordance entre ces 2 tests diagnostiques. L’objectif secondaire etait d’etudier les caracteristiques cliniques de ces patients. Materiels et methodes Il s’agissait d’une etude prospective monocentrique realisee entre fevrier 2010 et juillet 2012. Une analyse immunohistochimique de p16 et une PCR-HPV ont ete realisees sur des prelevements biopsiques de la tumeur. La concordance a ete evaluee selon le coefficient kappa de Cohen et interpretee selon l’echelle de Landis et Koch. Les donnees cliniques des patients ont ete analysees en fonction des resultats des tests. Resultats Soixante et onze patients ont ete inclus. La prevalence de HPV etait de 43,7 % selon la p16 et 31 % selon la PCR. L’etude de la concordance retrouvait un coefficient kappa a 0,615. Une localisation amygdalienne ou basi-linguale etait retrouvee dans 100 % des cas p16+/PCR-HPV+. L’intoxication ethylique et tabagique etait significativement moindre pour les patients HPV+ quelle que soit la methode de detection. L’âge de ces patients etait plus eleve et les tumeurs de grade histologique de differenciation plus faible. Conclusion L’immunohistochimie de p16 ou la PCR-HPV utilisees seules semblent insuffisantes. Ces resultats confirment la haute prevalence des CEOP lies au virus HPV et les specificites cliniques et histologiques deja rapportees excepte l’âge. Il parait essentiel que les etudes cliniques soit a l’avenir stratifiees en fonction de l’intoxication tabagique et du statut HPV des tumeurs, et que ce dernier soit defini au moyen d’outils virologiques fiables ciblant l’ARNm de E6/E7 et non plus la simple positivite au marqueur p16 comme c’est souvent le cas. L’avenement de nouveaux tests realisables en routine est souhaitable.

Summary Objectives The French Society of Otorhinolaryngology (SFORL) set up a work group to draw up guidelines for initial staging of head and neck squamous cell carcinoma. Locoregional and remote extension assessment are dealt with in two separate reports. The present part 3 deals with the assessment of frequent associated symptoms and pathologies, requiring early treatment and the collection of data on a certain number of clinical and paraclinical parameters for therapeutic decision-making in the multidisciplinary team meeting. Materials and methods A multidisciplinary critical analysis of the literature was conducted. General assessment here covers screening, assessment and initial management of the following: usual risk factors (smoking, alcohol, HPV), the most frequent medical comorbidities, nutritional status, social and psychological status, dental status, pain and possible anemia. As oncologic management frequently associates surgery, radiation therapy and chemotherapy, the underlying examinations should be early, as part of initial staging. The levels of evidence for the examinations were estimated so as to grade guidelines, failing which expert consensuses were established. Results The high rates of pain, malnutrition and anemia call for systematic screening and early management, especially as rapidly effective treatments exist. Assessing comorbidity and social and psychological status enables general health status to be assessed, along with possible contraindications to the usual treatments. Tracheal intubation problems may require intubation under flexible endoscopy or jet-ventilation by inter-cricothyroid catheterization from the diagnostic endoscopy stage. Assessment and adapted dental care should be conducted if radiation therapy is likely or certain. Conclusion Early management of symptoms and comorbidity and anticipation of subsequent treatment are intended to shorten initial staging time and to collate the data needed for therapeutic decision-making. This assessment should be performed at the same time as the locoregional and remote extension assessment, and is obviously to be adapted according to tumoral extension stage and the possible treatment options.

Resume Objectifs La Societe francaise d’otorhinolaryngologie (SFORL) a organise un groupe de travail charge de la redaction de recommandations pour le bilan initial des carcinomes epidermoides des voies aerodigestives superieures (VADS). Le bilan d’extension locoregional et a distance est traite dans deux autres publications. Cette troisieme partie aborde l’evaluation de symptomes ou de pathologies frequentes chez ces patients et dont la prise en charge precoce est necessaire, ainsi que le recueil d’un certain nombre de parametres cliniques ou paracliniques necessaires a la prise de decision therapeutique en reunion de concertation pluridisciplinaire. Materiels et methodes Lecture critique multidisciplinaire de la litterature. Le champ de ce bilan general comprenait le depistage, l’evaluation et la prise en charge initiale des points suivants : les facteurs de risque habituels (tabac, alcool, HPV), les comorbidites medicales les plus frequentes, le statut nutritionnel, le statut social et psychologique, l’etat de la dentition, l’existence de douleurs, la recherche d’une anemie. Le traitement de ces cancers associant souvent une intervention chirurgicale, une radiotherapie et une chimiotherapie, les auteurs ont estime que les examens necessaires a ces traitements devaient etre realises precocement et faisaient donc partie du bilan initial. Le niveau de preuve des etudes a ete estime, permettant de grader le niveau des recommandations. Le cas echeant, des avis d’experts ont ete proposes. Resultats La frequence des douleurs, de la denutrition et de l’anemie impose leur depistage systematique et leur prise en charge precoce, d’autant plus que des traitements rapidement efficaces existent. L’evaluation des comorbidites et du statut social et psychologique permet d’evaluer l’etat de sante general du patient, et de depister d’eventuelles contre-indications aux traitements habituellement proposes. Les difficultes d’intubation tracheale peuvent necessiter le recours a une intubation sous controle fibroscopique ou une jet-ventilation par catheter inter-cricothyroidien des l’endoscopie diagnostique. Le bilan et les soins dentaires adaptes seront realises si une radiotherapie est certaine ou fortement probable. Conclusion La prise en charge precoce des symptomes et des comorbidites et l’anticipation des traitements ont pour but de reduire la duree du bilan initial et de rassembler les elements necessaires a la prise de decision therapeutique. Ce bilan doit etre realise en meme temps que le bilan d’extension locoregional et a distance. Ce bilan sera evidemment adapte en fonction du stade d’extension tumorale et des options therapeutiques potentielles.

Resume Objectifs Ce travail presente les recommandations de la SFORL pour la recherche de metastases a distance et d’un second cancer synchrone lors du bilan initial des cancers epidermoide des VADS. Materiels et methodes Revue exhaustive de la litterature analysee par un groupe de travail multidisciplinaire. Resultats Le thorax constitue la localisation la plus frequente des metastases a distance et des seconds cancers synchrones hors VADS. Le scanner thoracique est preconise chez tous les patients en premiere intention (grade B). Une TEP-TDM au 18-FDG est preconisee en cas d’image thoracique douteuse ou de risque metastatique eleve pour la detection des metastases a distance non pulmonaires (grade B). Une exploration de l’œsophage est recommandee pour les patients a risque significatif de cancer synchrone de l’œsophage (tumeur de l’hypopharynx et de l’oropharynx, intoxication alcoolique chronique) (grade B). L’examen de reference est la fibroscopie digestive haute (grade B). Conclusions Ces recommandations de grade B permettent de rationnaliser la place des differents examens radiologiques et endoscopiques realises en premiere intention pour la recherche des metastases a distance et des seconds cancers synchrones. Cette rationalisation devrait permettre de limiter le nombre d’examens realises et ainsi reduire le temps necessaire au bilan initial.

International audience; OBJECTIVES: This report presents the French Society of ORL (SFORL) guidelines for exploration for remote metastasis and synchronous second cancer in initial staging of head and neck squamous cell carcinoma. MATERIALS AND METHODS: An exhaustive literature review was analyzed by a multidisciplinary work-group. RESULTS: The thorax is the most frequent location of remote metastases and synchronous second cancer outside of the upper aerodigestive tract. Thoracic CT is recommended as first-line examination in all cases (grade B). 18-FDG PET/CT is recommended when the thoracic CT image is doubtful or in case of high metastatic risk (grade B), for the detection of non-pulmonary remote metastasis. Esophageal exploration is recommended in case of significant risk of synchronous esophageal cancer (hypopharyngeal or oropharyngeal tumor, chronic alcohol intoxication) (grade B). The reference examination is flexible endoscopy of the upper digestive tract (grade B). CONCLUSION: The present grade B recommendations rationalize the roles of the various first-line radiological and endoscopic examinations for remote metastasis and synchronous second cancer, so as to limit the number of examinations performed, thereby reducing the time needed for initial staging.

Resume Objectifs Les auteurs proposent d’exposer les recommandations de bonne pratique concernant le bilan d’extension locoregional des cancers epidermoides des voies aerodigestives superieures (VADS) : cavum, fosses nasales et sinus exclus. Materiels et methodes Lecture critique multidisciplinaire de la litterature concernant le bilan d’extension locoregional des cancers epidermoides des VADS selon les niveaux de preuve scientifique en accord avec le guide d’analyse de la litterature publie par l’HAS en janvier 2000. Conclusion A partir du niveau de preuve des articles selectionnes et de facon collegiale au sein du groupe de travail, des recommandations ont ete proposees et gradees concernant le bilan d’extension locoregional clinique, endoscopique et iconographique des cancers des VADS.

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 Tete 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. © 2012 Society of Surgical Oncology.

Objectif de l’etude La sarcopenie, ou perte de masse musculaire, est frequente en cancerologie, et est associee a la survie dans certaines etudes retrospectives. L’objectif etait d’evaluer la sarcopenie avant et apres la radiotherapie chez les patients traites pour un cancer de l’oropharynx et son impact sur la survie. Materiel et methode Tous les patients irradies dans le centre hospitalier universitaire de Bordeaux pour un cancer de l’oropharynx tumeur en place, avec une tomographie par emission de positons (TEP) avant et apres la radiotherapie, ont ete inclus. Pendant la radiotherapie, la variation du poids et de l’indice de masse musculaire squelettique a ete etudiee en fonction de la nutrition per os, enterale preventive ou curative. L’indice de masse musculaire squelettique a ete evalue la sarcopenie par la formule surface musculaire en L3/taille2, a partir la scanographie des TEP avant et apres la radiotherapie. Les taux de survie globale et sans recidive ont ete evalues par la methode de Kaplan–Meier en fonction de la sarcopenie avant et apres la radiotherapie ainsi que du type de nutrition. Resultats Parmi 124 patients inclus de 2011 a 2017, 116 (93 %) ont recu une chimioradiotherapie. Le suivi median etait de 18,2 mois. Au moment diagnostic, 55 patients (44 %) etaient sarcopeniques contre 80 (65 %) trois mois apres la radiotherapie (p Conclusion L’evaluation de la sarcopenie est pertinente dans les cancers de l’oropharynx. La nutrition enterale preventive est associee a une moindre diminution de masse musculaire or la sarcopenie apres la radiotherapie est pronostique des survies globales et sans recidive.

Objectif de l’etude Devant une tumeur des voies aerodigestives superieures de stade T1 ou T2 associee a une adenopathie de stade N3 non metastatique, le pronostic est lie au stade N3. Le choix entre une chirurgie de la tumeur primitive lorsque cela est possible et une chimioradiotherapie pourrait impacter la morbidite a taux de controle local au moins equivalent. Nous avons evalue les pratiques dans cette situation. Materiel et methode Onze centres francais ont collige leurs cas de cancers des voies aerodigestives superieures de stade T1-2 N3 M0, entre 2008 et 2017 retrospectivement. Resultats Au total, les dossiers de 210 patients atteints d’un cancer des voies aerodigestives superieures de stade T1-2 et N3 clinique ont ete inclus. Une chirurgie de la tumeur primitive suivie d’une chimioradiotherapie a ete realisee dans 21 % des cas, un traitement dissocie par curage cervical seul suivi d’une chimioradiotherapie dans 12 %, une chimioradiotherapie dans 39 %, une chimiotherapie neoadjuvante par docetaxel, cisplatine et 5-fluoro-uracile (TPF) dans 21 %, et un autre protocole de chimiotherapie dans 7 % ; 22 % des patients ont ete operes a un moment de la prise en charge de la tumeur primitive, et 43 % des aires ganglionnaires Il n’existait pas de difference significative de survie globale en cas de chirurgie du site tumoral primitif ou d’abstention chirurgicale (p = 0,16). En analyse unifactorielle, la survie etait correlee avec la resecabilite ganglionnaire, la localisation oropharyngee et la realisation du curage ganglionnaire. En analyse multifactorielle, la survie globale etait impactee par la realisation ou non du curage cervical (p = 0,022). Pour les patients operes de la tumeur primitive, on retrouvait une tendance a l’augmentation du taux de tracheotomie (p = 0,07) et il existait une augmentation du taux d’epaule douloureuse (p = 0,004), egalement correle avec le curage. Conclusion En cas de tumeur de stade T1 ou T2, associee a une adenopathie de stade N3, le pronostic est lie au traitement ganglionnaire, lui-meme lie a la resecabilite ganglionnaire. La morbidite etait augmentee en cas de chirurgie de la tumeur primitive. La morbidite pourrait etre limitee, a taux de controle local identique, en n’operant pas la tumeur primitive, qui sera incluse dans les volumes cibles de la radiotherapie.

Pre-irradiation dental care depends on teeth health, fields and dose of irradiation, compliance to fluorides, cessation of tobacco and psychosocial cofactors. Dental care aims at preventing complications and preserving the quality of life (eating, speech and aesthetics). Approximately 11% of patients do not require any pre-irradiation dental care. Dental complications vary from slight colorations of the teeth to major complication such as osteoradionecrosis. Osteoradionecrosis rates vary from 1 to 9%, and may be decreased by using a 21-day delay between extractions and irradiation, provided that it does not postpone cancer treatment, with a dose-dependent risk ( or =20% if >60 Gy). Osteoradionecrosis occurs spontaneously (35%), mostly involves the mandibula (85%).

Pre-irradiation dental care depends on teeth health, fields and dose of irradiation, compliance to fluorides, cessation of tobacco and psychosocial cofactors. Dental care aims at preventing complications and preserving the quality of life (eating, speech, and aesthetics). The role of hyperbaric oxygenotherapy for the prevention of osteoradionecrosis after teeth removal on the mandibula in areas receiving 50 Gy or more is still controversial. Medical treatments may be sufficient for early stages of osteoradionecrosis (antibiotics, pain killers, non-steroidal anti-inflammatory drugs as well as clodronate, vitamin E, pentoxifyllin). However, reconstructive surgery should not be delayed in advanced stages of osteoradionecrosis. New irradiation techniques are changing dose distributions and therefore require close collaboration between odonto-stomatologists and radiation oncologists to define the best dental care.

The optimal timing and extent of neck dissection in the context of chemoradiation for head and neck cancer remains controversial. For some institutions, it is uncertain whether neck dissection should still be performed upfront especially for cystic nodes. For others, neck dissection can be performed after chemoradiation and can be omitted for N1 disease as long as a complete response to chemoradiation is obtained. The question is debated for N2 and N3 disease even after a complete response as the correlation between radiological and clinical assessment and pathology may not be reliable. Response rates are greater than or equal to 60% and isolated neck failures are less than or equal to 10% with current chemoradiation protocols. Some therefore consider that systematic upfront or planned neck dissection would lead to greater than or equal to 50% unnecessary neck dissections for N2-N3 disease. Positron-emission tomography (PET) scanning to assess treatment response and have shown a very high negative predictive value of greater than or equal to 95% when using a standard uptake value of 3 for patients with a negative PET at four months after the completion of therapy. These data may support the practice of observing PET-negative necks. More evidence-based data are awaited to assess the need for neck dissection on PET. Selective neck dissection based on radiological assessment and peroperative findings and not exclusively on initial nodal stage may help to limit morbidity and to improve the quality of life without increasing the risk of neck failure. Adjuvant regional radiation boosts might be discussed on an individual basis for aggressive residual nodal disease with extracapsular spread and uncertain margins but evidence is missing. Medical treatments aiming at reducing the metastatic risk especially for N3 disease are to be evaluated.

Basaloid squamous cell carcinomas (SCC) are a rare variant of SCC of the head and neck. Their histological characteristics have been described by Wain in 1986 and are reported in the 2005 WHO classification. A poorer prognosis of BSCC has been reported. Two recent case-control studies have shown a higher rate of distant metastases (15-40%, mean over 30%). Conversely, BSCC have similar or better locoregional control rates, a relatively good radiosensitivity and locoregional control. The role of chemotherapy in the neoadjuvant, concomitant or adjuvant setting needs to be redefined due to high metastatic failure rates; chest CT or PET CT are recommended at baseline and every 6-month during follow-up. Some subgroups of BSCC (oropharynx in particular) are more likely to be associated with oncogenic human papilloma virus HPV16. The determination of BSCC head and neck subgroups by HPV status is critical for the prognosis. The basaloid sub-type of squamous cell carcinomas owing to its particular behavior, should be taken into account while deciding the optimal therapeutic strategy.

Resume Objectifs Decrire l’anatomie et la technique de prelevement du lambeau musculomuqueux de buccinateur de l’artere faciale (lambeau de FAMM), ainsi que ses indications dans la chirurgie reconstructrice cervicofaciale. Methodes Revue retrospective de notre experience et revue de la litterature. Resultats Decrit en 1992 par Pribaz et al. [Plast Reconstr Surg 90 (1992) 421–9], le lambeau de FAMM est pedicule sur l’artere faciale et la base peut etre superieure ou inferieure en fonction de la region a reconstruire. Le drainage veineux s’effectue generalement par les veinules du plexus buccal plutot que par la veine faciale. Dans notre experience, le lambeau de FAMM a ete utilise essentiellement pour des deficits muqueux au niveau de la cavite orale suite a l’exerese de cancers. D’autres indications ont ete le recouvrement de deficits localises dans l’oropharynx, la fosse nasale et l’orbite ainsi que pour recouvrir des zones d’osteoradionecrose mandibulaire. Conclusions La technique de prelevement du lambeau de FAMM est simple et fiable. Les possibilites de reconstruction sont variees dans la region cervicofaciale.

International audience; Transoral robotic assisted surgery (TORS) represents an innovative endoscopic therapeutic alternative in the treatment of head and neck tumors. Many publications favor this surgery, especially in terms of functional results. The aim of this study was to investigate the TORS morbidity and mortality and to identify the risk factors for complications. It is a multicenter retrospective study. All head and neck tumor patients treated by TORS were included in the study over a period of 5 years (2009-2014). The studied parameters were the intraoperative and post-operative complications including hemorrhage, fistula, tracheotomy, aspiration pneumonia and death. The parameters were correlated with age, tumor location, tumor stage, endoscopic exposure and patient's co-morbidities. 178 patients were included in the study. Malignant tumors classified as T1 were found in 169 cases (n = 51), T2 (n = 100), T3 (n = 16) and T4 (n = 2). The tumor locations were distributed as follows: larynx (n = 84), oropharynx (n = 51), and hypopharynx (n = 43). Fifty-three patients followed post-radiation therapy. We observed 12 intraoperative complications including 6 hemorrhage, 3 pharyngeal fistulas and 3 external surgical conversions. Postoperatively, we detected 33 hemorrhage, 27 aspiration pneumonia, 9 tracheostomy, 2 pharyngostomes, 2 cervical spondylitis and 2 deaths. The risk factors identified were (i) anticoagulant and/or antiplatelet therapy for hemorrhage, (ii) tumoral stage and the laryngeal location for aspiration pneumonia and (iii) laryngeal location for tracheostomy. Higher age over 65 years has been identified as a risk factor for all post-operative complications. TORS is a safe technique for the treatment of head and neck tumors. We identified some risk factors for complications which should systematically be studied in order to reduce its morbidity.

Objective The diagnosis of HPV-related oropharyngeal cancer in clinical practice is based on p16 immunohistochemistry and PCR detection of viral DNA (HPV-PCR). The primary objective of this study was to evaluate the concordance between these 2 diagnostic tests. The secondary objective was to study the clinical characteristics of these patients. Materials and methods This single-centre prospective study was conducted between February 2010 and July 2012. Immunohistochemical analysis of p16 and HPV-PCR were performed on tumour biopsies. Concordance was evaluated according to Cohen's kappa coefficient and was interpreted according to the Landis and Koch scale. The patients’ clinical data were analysed as a function of the diagnostic test results. Results Seventy-one patients were included in this study. The prevalence of HPV was 43.7% according to p16 and 31% according to HPV-PCR. The concordance study revealed a kappa coefficient of 0.615. A tumour of the tonsil or base of the tongue was detected in 100% of p16+/HPV-PCR+ cases. Smoking and alcohol abuse were significantly less frequent among HPV+ patients regardless of the method of detection. These patients were older and presented tumours with a lower grade of histological differentiation. Conclusion p16 immunohistochemistry or HPV-PCR used alone appear to be insufficient. These results confirm the high prevalence of HPV-related oropharyngeal squamous cell carcinoma (OSCC) and the previously reported specific clinical and histological features, apart from age. It appears essential for future clinical trials to be stratified according to smoking and tumour HPV status, defined by means of reliable virological tests targeting E6/E7 mRNA and no longer a simple positive response to the p16 marker, as is frequently the case at the present time. New tests suitable for use in routine practice therefore need to be developed.

Describe the anatomy and the harvesting technique of the facial artery musculo-mucosal flap (FAMM) and precise its indications in head and neck reconstruction.Retrospective review of our experience and review of the literature.Described by Pribaz et al. [Plast Reconstr Surg 90 (1992) 421-9] in 1992, the FAMM flap relies on the facial artery and can be used with a superior or inferior base depending on the deficit to be reconstructed. Venous drainage is usually assured by buccal plexus veinules instead of the facial vein. In our experience, the FAMM flap has been used mainly for limited soft tissue defects of the oral cavity following cancer ablation. Other indications were coverage of oropharyngeal, intranasal and orbital defects. The FAMM flap has also been used to treat mandibular osteoradionecrosis.Harvesting of the FAMM flap is easy and safe. This flap shows versatility in head and neck reconstruction.

Topical applications of mitomycin C to the anterior glottis may prevent anterior glottic synechia (prevention group) or restenosis (treatment group).In the prevention group, six patients with glottic carcinoma involving the anterior commissure were treated by transoral laser surgery. Repeated procedures were performed in one patient. For the six patients in the treatment group, the anterior glottic synechia was secondary to frontolateral laryngectomy (three patients), transoral laser therapy for laryngeal papillomatosis (two patients) or bilateral glottic carcinoma (one patient). Mitomycin C (0.4 mg/ml) was used as a topical application on the anterior commissure for a duration of 4 minutes. Outcome was assessed clinically at three months using a visual scale: no synechia (success), micro-synechia (partial failure), and synechia (failure).In the prevention group, there were six successes and one partial failure. In the treatment group, there were two successes, three partial failures, and one failure. No side effects were noted.Topical application of mitomycin C was effective to prevent anterior glottic synechia after transoral laser surgery for glottic carcinoma involving the anterior commissure. It is an alternative to endolaryngeal keel in patients with sequellar synechia. These preliminary results should be further evaluated in a larger series.

To evaluate the oncologic results of glottic carcinoma in situ (CIS) treated with transoral carbon dioxide laser microsurgery.A retrospective review of 12 patients with glottic CIS previously untreated, treated with carbon dioxide laser transoral microsurgery between January 1990 and December 1999 was conducted.Initial and ultimate local control rates were 75%, and 100%, respectively. Three local failures occurred: two glottic CIS were treated by carbon dioxide laser transoral microsurgery, one squamous cell glottic carcinoma was treated by supracricoid partial laryngectomy with cricohyoidoepiglottopexy. The ultimate rate of laryngeal preservation rate was 100%.Based on the material of this study, recommended treatment for glottic CIS should be carbon dioxide laser transoral microsurgery. Difficulties in endoscopic exposure of the larynx is a contraindication. Further studies are necessary to confirm these preliminary results.

International audience; OBJECTIVES: To set out good practice guidelines for locoregional extension assessment of squamous cell carcinoma of the head and neck (excluding nasopharynx, nasal cavities and sinuses). MATERIALS AND METHODS: A critical multidisciplinary review of the literature on locoregional extension assessment of squamous cell carcinoma of the head and neck was conducted, applying levels of evidence in line with the French health authority's (HAS) literature analysis guide of January 2000. CONCLUSION: Based on the levels of evidence of the selected articles and on work-group consensus, graded guidelines are set out for clinical, endoscopic and imaging locoregional extension assessment of head and neck cancer.