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Objectives: Define endoscopic landmarks through cadaveric dissection for an optimal harvesting of the septal flap, pedicled on the septal branch of the anterior ethmoidal artery, for surgical closure of small anterior septal perforations. Materials and Method: Twelve nasal cavity dissections were performed on seven human cadavers, after latex injection of the external and internal carotid arteries, respectively in black and red. Twelve mucoperichondrial flaps pedicled on the anterior ethmoidal artery were dissected according to the Castelnuovo method. Macroscopical and microscopical study of the flap’s vascular network were carried out. Results: The origin of the anterior ethmoidal artery’s septal branch was found at 6.75 ± 2.57 mm posterior to the septal projection of the middle turbinate’s anterior insertion. It had a tangential course 3.67 ± 1.03 mm below the skull base. The nasal floor was exclusively vascularized by the external carotid territory. Conclusion: The design of the anterior ethmoidal artery pedicled flap is based on a simple and reproducible technique. We recommend its use for small anterior septal perforations closure. The first septal incision should be vertical, close to the posterior edge of the septal perforation followed by another vertical septal incision starting at least 1 cm posteriorly to the septal projection of the middle turbinate’s anterior insertion and extended to the posterior nasal spine of the palatine bone. The vertical incisions should be at least 5 mm below the skull base. The third incision is horizontal, connecting the two previous incisions, without nasal floor mucosa harvesting.

BACKGROUND Exercise-induced laryngeal obstruction (EILO) is an exercise-dependent dyspnoea, linked to a laryngeal closure during physical effort. It may concern from 5% to 7% of adolescents and young athletic adults. EILO is a quite recently described condition: standardized diagnostic criteria and consensual management are still to come. Formal diagnosis of EILO requires a continuous laryngoscopy during exercise (CLE). This test allows visualization of laryngeal abnormalities during an effort but is only accessible in specialized centres. AIMS We wanted to assess performance of a simplified CLE (sCLE) procedure for EILO diagnosis in everyday practice. MATERIAL AND METHODS The procedure consisted in a continuous flexible videolaryngoscopy during a cycloergometre cardio-pulmonary exercise test. Screening questionnaire and visual scoring of laryngeal abnormalities were performed. Patients clinically suspected of EILO were included from 2018 to 2020. RESULTS Seventeen consecutive subjects had an indication for sCLE. Fifteen patients underwent sCLE, and EILO-linked significative abnormalities were observed in 80% of them, thus confirming the diagnosis. CONCLUSIONS CLE can be done successfully in a simple way. Due to its simplicity, tolerance and contribution in EILO diagnosis, this simplified version of CLE may promote its widespread use in ENT and pulmonology practices, as an affordable confirmation test.

Resumen La traquea es la porcion cervicotoracica de las vias respiratorias entre la laringe y los bronquios. Es un conducto fibromusculocartilaginoso en forma de U que sirve de paso para el aire inspirado y espirado. Esta formada por 15-20 anillos cartilaginosos incompletos, abiertos hacia atras y cerrados por el musculo traqueal. Sigue a la laringe a la altura de la 6.a vertebra cervical y se divide en dos bronquios principales en el mediastino a la altura de la 5.a vertebra toracica. La traquea se relaciona con el esofago por la parte posterior, lo que explica la presencia de algunas patologias como las fistulas traqueoesofagicas. Por delante, al nivel cervical se relaciona con la glandula tiroidea y al nivel toracico con los elementos vasculares del torax, en particular con el cayado aortico a la altura de T4. Por su estructura fibromusculocartilaginosa, la traquea resiste el colapso durante la respiracion y adapta su diametro gracias al musculo traqueal. La traquea tambien desempena funciones inmunitarias a traves de su aparato mucociliar, que permite el drenaje y la eliminacion de las particulas inhaladas hacia la faringe, pero tambien a traves de las acumulaciones linfoides parietales que forman el tejido linfoide asociado a los bronquios (BALT). Hay muchas maneras de explorar la traquea. La endoscopia flexible o rigida es una herramienta muy interesante para el diagnostico, en particular de las lesiones tumorales, pero tambien permite efectuar procedimientos terapeuticos, como la extraccion de cuerpos extranos o el tratamiento de una estenosis. La prueba de imagen de referencia de la traquea es la tomografia computarizada, aunque las radiografias simples pueden proporcionar datos utiles.

Bilateral laryngeal reinnervation can be a promising procedure for reanimation of laryngeal muscles, but currently not yet standardized. Besides patient conditions some intraoperative anatomical pitfalls need to be solved. Twelve human head and neck specimens (24 sides) have been studied using microdissection and histological serial sections of the nerves. The surgical anatomy of the dual reinnervation procedure according to JP Marie was investigated notably the branching pattern of the phrenic nerve (PN), the Ansa cervicalis (AC) and the recurrent laryngeal nerve (RLN). Despite variations of the AC, a prominent inferior common trunk for sterno-hyoid and sterno-thyroid muscles can be used in more than 90% of the specimens. If the AC is missing because of previous surgery, the tiny nerve of the thyro-hyoid muscle can be used preferred. The PN display a double roots pattern from C3 to C4 cervical plexus in 50% of the specimens. A single root pattern can be found and an end-to-lateral neurorraphy can be used. Intra-laryngeal nerves pattern of the RLN display tiny collaterals which cannot be selected for abduction–adduction activity. Direct implantation of the Y-shape great auricular nerve within the posterior crico-arytenoid muscles can be a reliable method leading to challenging mechanical and functional conditions. Several anatomical pitfalls, including intra-operative choices and variants of the donor nerves, but also the challenging intra-laryngeal dissection of the inferior laryngeal nerve need to be solved. A successful laryngeal reinnervation still needs further studies for a simplified procedure.

Resume Objectifs L’objectif principal etait d’evaluer le taux de satisfaction de patients operes d’une lobo-isthmectomie thyroidienne sous hypnosedation et de comparer les resultats a ceux des patients operes sous anesthesie generale (AG). Methodes Il s’agit d’une etude retrospective ayant inclus 100 patients operes de lobo-isthmectomie thyroidienne. Un groupe de 50 patients operes sous hypnosedation a ete compare a un groupe temoin de 50 patients operes sous anesthesie generale. Un questionnaire de satisfaction a ete soumis entre trois et six mois apres la chirurgie. Nous avons egalement compare des criteres secondaires tels que la duree de l’intervention, les pertes sanguines, le confort peroperatoire, la douleur postoperatoire (echelle EVA), le taux de complications postoperatoires et le delai de reprise des activites quotidiennes apres la chirurgie dans les deux groupes. Resultats Notre etude montrait une bonne satisfaction globale des patients operes sous hypnosedation pour une securite operatoire et un taux de complication equivalents a l’anesthesie generale. Pour une consommation en antalgiques equivalente, les douleurs postoperatoires etaient moindres dans le groupe « Hypnose », la difference n’etant pas significative. Le taux de nausees et vomissements etait significativement plus faible chez les patients du groupe « Hypnose » (p Conclusion L’hypnosedation constitue, en chirurgie thyroidienne, une alternative efficace a l’anesthesie generale dans la mesure ou elle place le patient au centre des attentions de l’equipe soignante. Sa participation active est indispensable lors du procede et apporte une dimension nouvelle aux soins, benefique pour le patient. Elle doit cependant etre reservee a des interventions peu invasives dont l’organisation est anticipee en complete collaboration au sein d’equipes chirurgicales et anesthesiques disponibles et experimentees.

Resume L’electrophysiologie laryngee peroperatoire est une methode fiable et non deletere d’analyse anatomo-fonctionnelle des nerfs du larynx pendant et a l’issue d’une thyroidectomie. La mise en place selective d’electrodes bipolaires intramusculaires dans les muscles thyro-arytenoidiens et crico-thyroidiens autorise lors d’une stimulation vagale un controle precis des trajets du nerf recurrent et de la branche externe du nerf larynge superieur. Si une reponse musculaire significative (> 100 μv) est obtenue, la valeur predictive d’une mobilite laryngee preservee est de 100 % ; si aucune reponse musculaire n’est observee, la valeur predictive d’une mobilite laryngee alteree est de 70 %. La sensibilite de la procedure est de 100 % et sa specificite de 98 %. Une stimulation vagale enregistre une reponse musculaire thyro-arytenoidienne uniquement ipsi-laterale a la stimulation, avec une latence plus courte a droite (ecart moyen des latences droite-gauche de 2,30 ms). Une reponse musculaire simultanee thyro-arytenoidienne et crico-thyroidienne est notee dans plus de 70 % des cas lors de la stimulation vagale ou de la branche externe du nerf larynge superieur.

Intraoperative neuromonitoring of the laryngeal nerves during thyroidectomy is a reliable method to assess nerve function. After identification of the cricothyroid ligament, a bipolar electrode is selectively inserted through the ligament into the thyroarytenoid muscle (TAM) and cricothyroid muscle (CTM). Vagus nerve stimulation then allows precise monitoring of the recurrent laryngeal nerve and the external branch of the superior laryngeal nerve (EBSLN) in the TAM and CTM, respectively. A significant muscle response (greater than 100 μV) is 100% predictive of preserved laryngeal mobility, while the absence of a muscle response is 70% predictive of vocal fold paralysis with 100% sensitivity and 98% specificity. A significant thyroarytenoid muscle response is only recorded ipsilateral to the stimulation with a shorter latency on the right side. A concomitant TAM and CTM response to vagus nerve stimulation or EBSLN stimulation is observed in more than 70% of cases.

Positron emission tomography/computed tomography (PET/CT) has shown prognostic significance in head and neck cancer patients. The underlying pathologic features that could explain the mechanisms associated with this observation are not clear. To analyze the correlation between 18-F-fluoro-2-deoxy-D-glucose (18F-FDG) uptake assessed by PET/CT in head and neck cancer and histopathologic prognostic factors. Ninety-nine patients with laryngeal and pharyngeal squamous cell carcinoma were retrospectively reviewed for pretreatment PET/CT measurements, namely standardized uptake value (SUV), metabolic tumor volume (MTV), and total lesion glycolysis (TLG). The corresponding histologic material was evaluated for tumor stroma-related prognostic factors such as the amount and type of stroma, lymphocytic response, tumor budding activity, and size of tumor cell nests in the tumor core area and tumor front. TLG and MTV were associated with tumor localization, as they were higher in oropharyngeal tumors. These values were also associated with tumor cell nest size in the tumor core with higher values corresponding to tumors with smaller nests. MTV40% was marginally associated with fibroblastic stroma type and higher budding activity. SUVmax was not associated with the histological factors in the whole sample, but higher values trended with higher tumor budding activity and stroma-rich tumors of the oropharynx. 18F-FDG PET measurements in head and neck squamous cell carcinomas are associated with prognostic histopathologic factors and suggest a possible correlation of glucose metabolism to epithelial-to-mesenchymal transition.

A classification of olfactory sensory neuron (OSN) markers, a simple and robust technique of immunostaining on flat-mounted olfactory epithelium (OE) and a reliable quantification of the density of mature and immature OSNs are three crucial tools to study the pathophysiology of olfactory dysfunction. Using the rat model, we first categorized the main OSN markers by immunohistochemistry (IHC) on cross sections of OE. The OSN markers were divided into 3 groups: mature OSNs (OMP), immature OSNs (Tuj-1, DCX, OLIG2) and both (N-cadherin, LHX2, PGP9.5). The subcellular localization of each marker was also described. Tuj-1, OMP, DCX, PGP9.5 and N-cadherin were selected for immunostaining on flat-mounted OE because of their staining of OSN dendrites. We were able to successfully label OE with all the 5 markers using a simple technique for flat-mounted OE. In addition, this technique allowed the first mapping of the OE directly on the ethmoid turbinates. Finally, we quantified the mature (OMP+, Tuj-1-), immature (OMP-, Tuj-1+), transitory (OMP+, Tuj-1+) and total OSN density which were respectively 42080 ± 11820, 49384 ± 7134, 14448 ± 5865 and 105912 ± 13899 per mm2 (mean ± SD). The transitory population was quantified for the first time.

Background/aim In metastatic head and neck squamous cell carcinoma (HNSCC) the metastatic tumor does not always keep the same gene expression profile as the parental tumor, which may influence the course of the disease. The aim of this study was to compare the expression of genes implicated in HNSCC carcinogenesis between the primary tumor and the corresponding lymph node metastasis. Materials and methods Eighteen HNSCC, their corresponding node metastases and non-neoplastic tissues were studied by RT-qPCR for the expression of EGFR, VEGF, claudin7, maspin, survivin and SCCA. The levels of expression were correlated with histological characteristics and patients' prognosis. Results All genes except for survivin displayed different expression in node metastasis compared to the primary tumor. The expression of EGFR, survivin, maspin, and claudin7 in node metastasis and SSCA in the primary tumor affected the prognosis. SCCA expression is associated with the expression of claudin7 and maspin. P16-positive tumors expressed low levels of VEGF and SCCA, while keratinizing tumors over-expressed VEGF. Conclusion Differential gene expression levels in node metastases compared to the primary tumor is linked to the prognosis of HNSCC patients. The histological/immunohisto-chemical characteristics of the tumor are associated with these genes expression changes.

Simple Summary In contrast to normal notochords, autophagic factors are often present in chordomas. Furthermore, PD-L1+ immune cells also express LC3B, suggesting the need for further investigations between autophagy and the immune microenvironment. Abstract Chordomas are notably resistant to chemotherapy. One of the cytoprotective mechanisms implicated in chemoresistance is autophagy. There are indirect data that autophagy could be implicated in chordomas, but its presence has not been studied in chordoma tissues. Sixty-one (61) chordomas were immunohistochemically studied for autophagic markers and their expression was compared with the expression in notochords, clinicopathological data, as well as the tumor immune microenvironment. All chordomas strongly and diffusely expressed cytoplasmic p62 (sequestosome 1, SQSTM1/p62), whereas 16 (26.2%) tumors also showed nuclear p62 expression. LC3B (Microtubule-associated protein 1A/1B-light chain 3B) tumor cell expression was found in 44 (72.1%) tumors. Autophagy-related 16‑like 1 (ATG16L1) was also expressed by most tumors. All tumors expressed mannose-6-phosphate/insulin-like growth factor 2 receptor (M6PR/IGF2R). LC3B tumor cell expression was negatively associated with tumor size, while no other parameters, such as age, sex, localization, or survival, were associated with the immunohistochemical factors studied. LC3B immune cell expression showed a significant positive association with programmed death-ligand 1 (PD-L1)+ immune cells and with a higher vascular density. ATG16L1 expression was also positively associated with higher vascular density. Notochords (n = 5) showed different immunostaining with a very weak LC3B and M6PR expression, and no p62 expression. In contrast to normal notochords, autophagic factors such as LC3B and ATG16L1 are often present in chordomas, associated with a strong and diffuse expression of p62, suggesting a blocked autophagic flow. Furthermore, PD-L1+ immune cells also express LC3B, suggesting the need for further investigations between autophagy and the immune microenvironment.

Introduction Le lambeau supra-claviculaire est un lambeau fascio-cutane axial a vascularisation directe par l’artere supra-claviculaire, decrit par Lamberty en 1979. Le pedicule, constant, emerge au niveau du triangle cervical posterieur. L’angiosome, dans la region supra-claviculaire, mesure 10 × 22 cm, avec un arc de rotation de 180°. Materiel et methode Nous decrivons l’anatomie du lambeau supra-claviculaire et sa technique de prelevement par la dissection de 6 corps formoles et 2 corps utilisant le Simlife. Nous presentons ensuite une serie de cas utilisant le lambeau supra-claviculaire pour les reconstructions de pertes de substances cervico-faciale. Resultats Le pedicule vasculaire est retrouve au niveau du triangle cervical posterieur, 3 cm au-dessus de la clavicule et a 2 cm du bord posterieur du muscle sterno-cleido-mastoidien. L’artere supra-claviculaire est issue de l’artere cervicale transverse. La veine se draine dans la veine cervicale transverse ou la veine jugulaire externe. Le pedicule est accompagne d’une branche nerveuse issue du plexus cervical profond. La dissection realisee en subfaciale est aisee, mais necessite une desepithelialisation de la palette en cas de tunnelisation. Ce lambeau a pu etre utilise pour 8 patients ayant une perte de substance cervico-faciale. Nous deplorons un cas de necrose totale et un de necrose de la pointe, ayant necessite pour les deux une reprise chirurgicale. Conclusion Ce lambeau est fiable, facile a prelever, dans un territoire souvent non irradie, avec une peau fine et glabre, utilisable pour un grand nombre de perte de substance cervico-faciale.

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.

Background While middle antrostomy (MA) is the most common approach to the maxillary sinus (MS), it is known for not allowing to fully inspect the whole MS, especially in its inferior and anterior portions. To overcome this limitation, alternative approaches have been proposed, such as inferior antrotomy (IA) and canine fossa accesses (CFA). Objective Given the lack of studies on the MS floor visualization with different accesses, our study aims, in a cadaver lab setting, to systematically compare three different approaches (MA, IA and CFA) in these regards. Methods Eight cadaver heads, previously submitted to CTscan, were prepared inserting fixtures corresponding to teeth 2, 4, 6, 11, 13 and 15 and into the canine fossae. Three approaches were prepared: a wide MA, an IM and a CFA. We endoscopically evaluated, for each specimen, side, access type and scope angle (0°, 30°, 45°, and 70°), which fixtures were visible on the maxillary sinus floor and whether the canine fossa fixture was visible (MA and IA only). Results IA allowed to visualize all fixtures in nearly all cases (14/16 with 70° endoscope), while MA showed poor visualization results (3/16 with 70° endoscope); CFA failed to gain full visualization in most specimens (7/16 with 70°endoscope). Such difference was statistically significant. MA proved unable to visualize the canine fossa fixture in most cases while IA showed excellent possibilities. All differences were statistically significant (p Conclusions Our data show that the IA grants a statistically significant superior surgical field vision when compared to MA and CFA, though in vivo validation of these results is still required.

Background Tumors lymphocytic infiltration has prognostic and predictive value. However, the mechanisms involved in lymphocyte recruitment remain poorly characterized. High endothelial venules (HEV) are blood vessels specialized in lymphocyte recruitment, recently showing prognostic significance in some types of cancer. Their implications in laryngeal or pharyngeal cancer is largely unknown. Aim of the study To investigate the possible presence of HEVs in head and neck cancer. Material and Methods Oropharyngeal (n = 61), hypopharyngeal (n = 53) and laryngeal (n = 21) squamous cell carcinomas were immunohistochemically studied with the MECA-79 antibody, which specifically recognizes HEVs. Histological and clinical factors were correlated with HEVs’ presence. Results HEVs were present in 34% of tumors, showing significant correlations with oropharyngeal localization, higher lymphocytic response, lower tumor budding, lower T status, absence of distant metastases and better overall and progression-free survival. Conclusion HEVs represent an important prognostic factor in head and neck cancer.

The study objective was to compare patient satisfaction after thyroid lobo-isthmectomy under hypnoanesthesia versus general anesthesia.A retrospective study included 100 patients undergoing lobo-isthmectomy. A group of 50 patients under hypnoanesthesia was compared to a control group of 50 patients under general anesthesia. Satisfaction was assessed on questionnaire between three and six months after surgery. We also compared secondary criteria: procedure time, blood loss, intraoperative comfort, postoperative pain, postoperative complications and time to resumption of daily activities.Our study showed good overall satisfaction in patients operated under hypnoanesthesia, for equivalent operative safety and complications rate compared to general anesthesia. For comparable analgesia, postoperative pain was lower, but not significantly, in the Hypnosis group, while the rate of nausea and vomiting was significantly lower (p0.05). Postoperative convalescence was shorter in the Hypnosis group: 3.7 versus 9.2 days (p0.001).In thyroid surgery, hypnoanesthesia has real advantages over general anesthesia in that it places the patient at the center of the care team's attention. His or her active participation is essential during the process, bringing a new dimension to care, beneficial for the patient. However, it must be reserved for minimally invasive procedures in which organization is anticipated in full collaboration within teams that are willing and experienced.

L’anatomie de la surface olfactive nasale est decrite dans de nombreux ouvrages anatomiques. Toutefois, la taille exacte de cette surface olfactive reste assez meconnue, evaluee entre 1 et 3,7 cm2. De meme, sa disposition exacte reste sujet a controverse ; certains auteurs decrivant une zone olfactive s’etendant jusqu’au cornet moyen, d’autres se limitant au cornet superieur [1] , [2] . De nombreux auteurs s’attachent egalement a expliquer les pertes olfactives par une metaplasie de l’epithelium olfactif en epithelium respiratoire [3] , [4] . Le premier objectif de ce travail a ete de faire une revue de la litterature concernant les marqueurs immunohistochimiques permettant d’identifier au sein d’un tissu les cellules olfactives. Puis, ces marqueurs ont pu etre testes sur des biopsies de la surface olfactive realisees chez le rat au niveau des cornets ethmoidaux, sur corps humain au niveau du cornet superieur et de la partie haute de la muqueuse septale. Les marqueurs immunohistochimiques connus dans la litterature ont ainsi pu etre testes et notamment l’olfactory marker protein (OMP) considere comme caracteristiques des cellules olfactives [5] . Les trois biopsies realisees sur le tissu humain preleve au niveau du cornet superieur n’ont pas ete marquees par l’OMP alors que des cellules comme les cellules de l’iris ont montre un marquage par l’OMP. Deux de ces biopsies ont egalement montre un marquage par le protein gene product (PGP 9.5), marqueur neuronal. Des marquages ont egalement pu etre realises chez le rat permettant de mettre en evidence une zone de transition entre le tissu olfcatif et le tissu respiratoire. Le marquage et la detection des cellules olfactives matures reste dont difficile. Les marqueurs largement utilises dans la litterature n’apparaissent pas toujours specifiques. Il est donc necessaire de developper la detection de ces cellules afin de determiner l’anatomie de la surface olfactive et ne pas conclure trop rapidement a une metaplasie de l’epithelium olfactif en epithelium respiratoire chez les patients atteints de troubles olfactifs.

The aim of this study was to validate a procedure to identify and preserve the external branch of the superior laryngeal nerve (EBSLN) during thyroid surgery. The present study also aimed to analyze the EBSLN and the vagus nerve activities after stimulation and demonstrate an operative association between all the laryngeal muscles. Dissection of the cervical region was performed bilaterally in four adult cadavers. In a second step, 144 patients undergoing total thyroidectomy were included. Intraoperative stimulations of the cervical vagus nerve and the EBSLN in the sternothyroid–laryngeal triangle were performed bilaterally. Potentials in the thyroarytenoid muscle and the cricothyroid muscle were registered on each side using the NIM3 Medtronic System. EBSLN was identified according to Cernea’s classification as type 1 in 62.5%, type 2a in 25%, and type 2b in 12.5% of cadaver’s dissection. According to Friedman’s classification, 50% of EBSLN were classified type 1, 25% type 2 and 25% type 3. The EBSLN was identified in 267 cases out of 288 peroperative dissections (92.7%). Direct stimulation (1 mA) of this branch led to a recordable contraction of the cricothyroid muscle with a mean latency of 1.42 ± 0.66 ms on the right side and 1.43 ± 0.61 ms on the left side. The stimulation of the EBSLN also led to a recordable contraction of the thyroarytenoid muscle in 211 cases (73.3%) with the same latencies. A contraction of the cricothyroid muscle was also recorded when the vagus nerve was stimulated in 219 cases (76.0%). The sole visual identification of the EBSLN during thyroid surgery is not a reliable method to prevent nerve injury. Direct stimulation of the EBSLN in the sternothyroid–laryngeal triangle is a simple and rapid procedure to detect and preserve the nerve during surgery. Functional associations between vagus nerve and EBSLN in laryngeal muscles’ contractions were also identified.

Resume Le but de ce travail est de definir le corps adipeux parapharynge (CAP) et ses rapports anatomiques initialement decrits par P. Sebileau en 1892 afin d’evaluer les implications cliniques potentielles. Materiel et methodes Sept cadavres frais congeles ont ete utilises dont 3 apres injection de latex neoprene colore dans le reseau arteriel cervicocephalique. Une IRM a ete conduite chez 10 patients indemnes de pathologie cervicale. L’analyse a ete faite sur des coupes frontales et transversales en ponderation T1. Resultats Le CAP, qui est une formation graisseuse jaunâtre, remplit l’espace paratonsillaire. Il mesure en moyenne 4,8 cm (de 4,5 a 5,2 cm) de longueur et 1,2 cm (de 1,1 a 1,5 cm) de largeur pour des individus de taille et de sexe variables. Sa vascularisation arterielle est essentiellement assuree par l’artere palatine ascendante, branche precoce de l’artere faciale. Une symetrie gauche–droite a ete retrouvee sur les analyses d’IRM quel que soit le sexe ou l’âge. Il est retrouve dans tous les cas en position mediale et ventrale par rapport au prolongement pharyngien de la glande parotide en hypersignal homogene T1. Conclusion Le CAP est une structure graisseuse constante. Sa vascularisation depend surtout de l’artere palatine ascendante. Par son association avec les espaces graisseux peripharyngiens, il pourrait constituer, sur le plan fonctionnel, un espace de glissement. En imagerie, il peut etre utile dans l’interpretation des images tumorales du prolongement pharyngien de la glande parotide.

Resume Objectifs Il existe peu de donnees concernant l’efficacite de la radiotherapie en modulation d’intensite volumetrique par arc therapie (VMAT), delivree dans le cadre du traitement des cancers epidermoides (CE) ORL. L’objectif etait d’etudier les resultats et les modes de recidive des patients traites par VMAT a l’encontre d’un CE ORL localement avance. Methodes Les donnees de tous les patients, traites en intention curative par VMAT a l’encontre d’un CE ORL stade III ou IV, ont ete retrospectivement etudiees. Resultats Entre 2010 et 2013, 130 patients furent traites pour un CE localement avance de l’oropharynx ( n = 55 ; 42 %), de l’hypopharynx ( n = 38 ; 29 %), du larynx ( n = 22 ; 17 %), ou de la cavite buccale ( n = 15 ; 12 %). L’âge median etait de 60 ans (39–85). La duree de suivi mediane etait de 18,1 mois (0–43,7). A la fin du suivi, 60 patients etaient decedes (46 %). La survie sans progression (SSP) et la survie globale (SG) a 2 ans etaient de 63,6 % et 77,3 % pour les tumeurs laryngees, 60 % et 60 % pour les tumeurs de la cavite buccale, 52,6 % et 57,6 % pour les tumeurs oropharyngees, et 38,8 % et 54,7 % pour les tumeurs hypopharyngees. La plupart des recidives etaient situees dans les champs, ou en bordure de champs de la radiotherapie. Conclusion Cette analyse retrospective est, a notre connaissance, la plus large etude s’interessant a l’efficacite du VMAT dans les CE ORL. Les resultats et les modes de recidive constates semblent concorder avec ceux rapportes en radiotherapie conformationnelle par modulation d’intensite (IMRT).

Resume La trompe d’Eustache (tube auditif) et les cavites tympanomastoidiennes forment un ensemble anatomique et fonctionnel difficilement dissociable, d’ou l’appellation « systeme tubotympanique ». L’etude de ce systeme a fait l’objet de nombreux travaux dont les resultats complexes et parfois contradictoires rendent difficile une vue d’ensemble de son fonctionnement. L’objectif cet article est d’en synthetiser les connaissances actuelles, prealable indispensable a la comprehension de son dysfonctionnement et notamment de la genese de l’otite chronique. L’ensemble du systeme est tapisse par une muqueuse qui en assure la continuite, bien qu’elle comporte certaines particularites selon la zone concernee, et y joue un role primordial. Ainsi, dans des conditions physiologiques, la diffusion gazeuse a travers la muqueuse tympanomastoidienne assure l’essentiel de l’equilibre pressionnel regnant entre l’oreille moyenne (OM) et le monde exterieur, l’ouverture tubaire n’intervenant que tres peu. Lors des changements rapides et importants de la pression atmospherique, la fonction ventilatoire de la trompe est alors mise en jeu, sous l’effet d’un mecanisme reflexe. Le systeme possede en outre d’autres fonctions indispensables au bon fonctionnement de l’OM, une fonction de protection vis-a-vis des secretions et agents pathogenes en provenance du rhinopharynx, mais aussi de certains bruits physiologiques, une fonction de clairance des cavites de l’OM dependant du transport mucociliaire des pathogenes, liee en partie a la secretion des glandes sous-muqueuses et une fonction de defense immunitaire.

The anterior commissure (AC) of the human larynx is usually understood as an area of the glottis anteriorly situated between the two vocal folds inserting to the thyroid cartilage (TC). The pattern of spread of AC carcinoma could hypothesize that AC could include other structures of the ventral larynx as developmental anatomy could demonstrate. Ten adult larynx specimens from donation program cadavers and 15 selected fetal specimens (from 11 to 34 weeks of amenorrhoea) were studied using microdissection and histological serial sections stained with hematoxylin–eosin and reticuline. In adult specimens, internal perichondrium of the TC was easily detached from the entire lateral lamina but not from an intermediate lamina superiorly marked by the superior thyroid notch. On this median band of TC is inserted the ventral connective tissue of the three levels of the larynx: the ventral part of the vocal folds with the anterior macula flava, the Broyle’s epiglottic ligament, and the subglottic part of the conoid ligament. In young fetuses (11–12 weeks), intermediate lamina of TC joined at the glottic level but not at the supraglottic level; in fetuses at 22–25 weeks, a meshwork of bundles of connective fibers inserted to the intermediate lamina of TC. In fetuses at 33–34 weeks, organization is practically identical to adult specimens. According to the adult anatomical features and the organogenesis, the AC of the human larynx could be anatomically defined ventrally as being made up of the intermediate lamina of TC beneath the superior thyroid notch and dorsally the ventral insertions of vocal folds with macula flava, supraglottic Broyle’s ligament, and subglottic conoid ligament leading to a “developmental” AC definition which could better explain specific spreading of AC carcinoma.

Background FOXA1 is a major transcription factor involved in the action of human papilloma virus (HPV). However, it has been never studied in HPV-associated tumors. Aim of the study To investigate its expression in cervical and head and neck tumors. Material and methods 63 cervical carcinomas/dysplasias and 152 head and neck squamous cell carcinomas (HNSCC) were immunohistochemically studied for the expression of FOXA1. Results 63.1% of cervical SCC and 40.7% of endocervical adenocarcinomas strongly expressed FOXA1. Most (90%) pre-invasive lesions (CIN3 and in situ adenocarcinomas) strongly expressed FOXA1 and this difference from invasive lesions was statistically significant (p = 0.005). No association with clinicopathological factors was found. 51.3% of HNSCC expressed FOXA1. In these tumors, FOXA1 expression was associated with the non-keratinizing morphology but not with the HPV/p16 status neither other clinicopathological features. Of normal structures, salivary glands, endocervical glands and basal/parabasal cell layer of squamous epithelium of both uterine cervix and head and neck mucosa, all strongly expressed FOXA1. Conclusion FOXA1 is expressed by basal cells of squamous epithelium, pre-invasion lesions of the uterine cervix and the head/neck and almost half invasive cervical and head/neck carcinomas, supporting its possible implication in HPV pathogenesis.

// Georgia Karpathiou 1 , Francois Casteillo 1 , Jean-Baptiste Giroult 2 , Fabien Forest 1 , Pierre Fournel 4 , Alessandra Monaya 1 , Marios Froudarakis 3 , Jean Marc Dumollard 1 , Jean Michel Prades 2 , Michel Peoc'h 1 1 Department of Pathology, North Hospital, University Hospital of St-Etienne, St-Etienne, France 2 Department of Head and Neck Surgery, North Hospital, University Hospital of St-Etienne, St-Etienne, France 3 Department of Pneumonology, North Hospital, University Hospital of St-Etienne, St-Etienne, France 4 Oncology Institute Lucien Neuwirth, St-Etienne, France Correspondence to: Georgia Karpathiou, email: gakarpath@yahoo.gr Keywords: PD-L1, CTLA4, macrophages, dendritic cells Received: July 15, 2016 Accepted: December 02, 2016 Published: December 27, 2016 ABSTRACT Background: Immune system affects prognosis of various malignancies. Anti-immune pathways like PD-L1 and CTLA4 are used by the tumor to overcome immune system and they serve as immunotherapy targets. The immune microenvironment of head-and-neck squamous cell carcinoma (SCCHN) has not been sufficiently studied. Patients and Methods: 152 SCCHN were immunohistochemically studied for the expression of CD3, CD8, CD57, CD4, granzyme b, CD20, CD163, S100, PD-L1, CTLA4 and CXCR4. Results: CD3, CD8, CD57 and stromal S100 higher density is a good prognostic factor (p=0.02, 0.01, 0.02, 0.03 respectively). CTLA4 tumor expression is a poor prognostic factor (p=0.05). The rest immune cells do not affect prognosis. CD3 and CD8 density does not correlate with clinicopathological factors or p16/p53 expression, while CD57 and CD4 higher density is associated with the absence of distant metastases (p=0.03 and 0.07, respectively). Higher CD20 and S100 density is associated with lower T stage (p=0.04 and 0.03, respectively). PD-L1 expression is higher in CD3, CD8, and CD163 infiltrated tumors and in histologically more aggressive tumors. Response to neoadjuvant chemotherapy is better in highly CD3 infiltrated tumors and in tumors with less intraepithelial macrophages. Conclusion: Rich T-lympocytic and dendritic cell response is a good prognostic factor in SCCHN, whereas tumors expressing CTLA4 show poor prognosis. PDL1 expression does not affect prognosis, but it is expressed in histologically more aggressive tumors and in T-cells rich tumors. Response to induction chemotherapy is better in tumors less infiltrated by macrophages and mostly infiltrated by T cells.

Resume Objectifs La presence d’adenopathies metastatiques supracentimetriques est un facteur classique de mauvais pronostic pour les recidives locoregionales et la survie des patients atteints d’un carcinome des voies aerodigestives superieures (VADS). Ce lien de causalite est plus controverse pour les adenopathies metastatiques infracentimetriques. L’objectif de cette etude est d’evaluer l’incidence et la valeur pronostique des adenopathies cervicales metastatiques infracentimetriques. Materiels et methodes Une analyse a ete menee sur 243 curages cervicaux, correspondant a 150 patients atteints d’un carcinome epidermoide des VADS. L’anatomopathologiste a note de facon exhaustive le nombre et la taille de toutes les adenopathies de la piece operatoire. Resultats Dans 38 % des cas, les adenopathies metastatiques sont infracentimetriques. Leur taux de rupture capsulaire est alors de 72 % (contre 91 % pour les adenopathies supracentimetriques, p p = 0,14). Parmi les curages metastatiques, 53 % ne sont envahis que par des metastases supracentimetriques (contre 13 % pour les metastases infracentimetriques, p Conclusion Les adenopathies metastatiques infracentimetriques representent donc un facteur pronostic pejoratif pouvant traduire un processus invasif different et plus agressif. Nous preconisons par consequent la realisation systematique d’un curage cervical complet par le chirurgien et d’une recherche histopathologique exhaustive par l’anatomopathologiste (dont les resultats conditionnent le traitement complementaire). Une surveillance rapprochee des recidives devrait egalement etre instauree.

Background The impact of obesity on total thyroidectomy (TT) morbidity (recurrent laryngeal nerve palsy and hypocalcaemia) remains largely unknown. Methods In a prospective study (NCT01551914), patients were divided into five groups according to their body mass index (BMI): underweight, normal weight, overweight, obese, and severely obese. Preoperative and postoperative serum calcium was measured. Recurrent laryngeal nerve (RLN) function was evaluated before discharge, and if abnormal, at 6 months. Results In total 1310 patients were included. Baseline characteristics were similar across BMI groups except for age and sex. Postoperative hypocalcaemia was more frequent in underweight compared to obese patients but the difference was not statistically significant in multivariate analysis. There was no difference between groups in terms of definitive hypocalcaemia, transient and definitive RLN palsy, and postoperative pain. Conclusion Obesity does not increase intraoperative and postoperative morbidity of TT, despite a longer duration of the procedure.

Objectives: Induction chemotherapy (IC) is occasionally used in head and neck cancer, leading to less extensive surgery and reduced need for irradiation. Factors predicting the response to IC have not been determined. In this study, we investigated the clinical and histopathologic factors that predict the response to IC. Methods: Head and neck squamous cell carcinomas from 81 patients were analyzed; clinical factors, histologic parameters, and expression of p16 and p53 were correlated with response to chemotherapy and prognosis. Results: Factors predicting a good response to IC were the nonoropharyngeal localization, a rich lymphocytic tissue response, and a low platelet-to-lymphocyte blood ratio before treatment. Response to IC did not correlate with prognosis, whereas a low neutrophil-to-lymphocyte ratio (NLR), the absence of a desmoplastic reaction, a rich lymphocytic tissue response, and the overexpression of p53 were associated with better prognosis. Conclusions: Lymphocytic tissue response, NLR, and nonoropharyngeal localization are factors predictive of response to IC.

The aim of the present study was to evaluate the thyroarytenoid muscle response during bilateral thyroid surgery using vagal nerve stimulation. 195 patients (390 nerves at risk) underwent a total thyroidectomy. The recurrent laryngeal nerve’s function was checked by analyzing the amplitude and the latency of the thyroarytenoid muscle’s responses after a vagal nerve’s stimulation (0.5 and 1 mA) using the NIM3 Medtronic system. All patients were submitted to preoperative and postoperative laryngoscopy. 20 patients get no thyroarytenoid muscle response to the vagal nerve stimulation, and 14 postoperative recurrent laryngeal nerve palsies were confirmed (3.8 %). Two palsies were present after 6 months (0.51 %). All the patients with muscle’s response have normal mobility vocal fold. The test sensitivity was 100 % and the test specificity was 98 %. Physiologically, the mean latencies of the muscular potentials for the right RLN were, respectively, 3.89 and 3.83 ms (p > 0.05) for the stimulation at 0.5 and 1 mA. The mean latencies for the left RLN were, respectively, 6.25 and 6.22 ms for the stimulation at 0.5 and 1 mA (p > 0.05). The difference of the latencies between the right and the left nerve was 2.30 ms (1.75–3.25 ms) with a stimulation of 0.5 or 1 mA (p

The aim of this study was to determine the existence and the frequency of communicating branches between the spinal accessory nerve (SAN) and the C2, C3 and C4 roots of the cervical plexus. The present study also aimed to elucidate whether these branches contain motor fibers or not. Dissection of the cervical region was performed on twelve adult cadavers. A powered operating microscope was necessary to dissect the SAN and its branches and also to dissect C2, C3 and C4 nerve branches. In a second step, data from 13 patients who underwent 25 modified neck dissections under trapezius muscle's monitoring were collected. At the end of surgery, intraoperative stimulation on the SAN, C2, C3 and C4 nerve branches was performed. Registered potentials in the three parts of the trapezius muscle, using the NIM Medtronic system, were analyzed. During cadaver dissection, 18 (78 %) communicating branches were identified between the SAN and C2, 11 (48 %) between the SAN and C3, 12 (52 %) between the SAN and C4. Intraoperative stimulation of the SAN and its branch for the trapezius muscle provided a significant electroneurographic response in the three parts of the trapezius muscle in all subjects. Intraoperative stimulation of C3 led to recordable contractions of the trapezius muscle in 5 (20 %) modified neck surgeries, stimulation of C4 led to recordable contractions during 5 (20 %) modified neck dissections. One case of contraction was recorded after intraoperative stimulation of C2 (7 %). Although we were able to identify at least one communicating branch between the SAN and the roots of the cervical plexus in each cadaver dissection, the cervical plexus is not always involved in trapezius motor innervation. Intraoperative electroneurography demonstrated that a motor input from the cervical plexus to the trapezius muscle was provided in only 32 % of cases. Therefore, SAN trunk and C3-C4 roots should be carefully preserved during modified neck dissection to protect trapezius and shoulder functions.

Objectives To analyze histopathologic invasion of the anterior laryngeal commissure on surgical specimens from patients operated on for stage-2 squamous-cell carcinoma managed by supracricoid partial laryngectomy (SCL). Patients and methods Twenty-five patients with previously untreated stage-2 squamous-cell carcinoma were selected. Preoperative endoscopy confirmed anterior commissure involvement; CT found no cartilage lysis. SCL was performed in all cases: 15 anterior frontal SCLs with epiglottoplasty, 8 with cricohyoidepiglottopexy, and 2 with cricohyoidopexy. Histopathology analyzed resection margins ( 5 mm), cartilage extension and vascular embolism. Mean time to observation was 18 months (range, 12–36 months). Results Resection margins were 5 mm in 9 patients. Vascular emboli were found in 15 patients (60%). Twenty patients were free of medial thyroid cartilage involvement; 5 showed cartilage extension (20%), restricted to the internal cortical layer in 4 cases (stage T3) and transfixing in 1 (stage T4a). Mucosal extension appeared non-predictive of cartilage invasion. The T4a patient showed local laryngeal recurrence at 12 months. Conclusions In laryngeal commissure squamous-cell carcinoma, SCL enables pathologic analysis of the entire anterior commissure as organogenetically defined: medial thyroid wing, in which the three laryngeal regions are inserted. Microscopic cartilage invasion is poorly predicted by mucosal extension, and may affect 20% of initially T2 patients.

Resume Objectifs Analyser les modalites d’envahissement histopathologique de la commissure anterieure du larynx sur les pieces operatoires de patients operes d’un carcinome epidermoide de stade T2 interessant la region commissurale par laryngectomie partielle supracricoidienne (LSC). Patients et methodes Vingt-cinq patients porteurs d’un carcinome epidermoide non anterieurement traite classe T2 ont ete selectionnes. L’endoscopie pretherapeutique confirme l’atteinte de la commissure anterieure et la tomodensitometrie n’objective pas de lyse cartilagineuse. Une LSC a ete chaque fois realisee : 15 LSC frontale anterieure avec epiglottoplastie, 8 LSC avec crico-hyoidoepiglottopexie et 2 LSC avec cricohyoidopexie. L’histopathologie a analyse les marges d’exereses ( 5 mm), l’extension cartilagineuse, les emboles vasculaires. Le recul moyen d’observation est de 18 mois (12 mois–36 mois). Resultats Les marges d’exereses sont inferieures a 1 mm pour 7 patients (28 %), entre 1 et 5 mm pour 9 patients, superieures a 5 mm pour 9 patients. La presence d’emboles vasculaires est notee pour 15 patients (60 %). Vingt patients sont indemnes d’atteinte cartilagineuse thyroidienne mediane, mais 5 presentent une extension cartilagineuse (20 %), limitee a la lame corticale interne pour 4 patients (classes T3) ou transfixiante pour 1 patient (classe T4a). L’extension muqueuse ne parait pas predire l’envahissement cartilagineux. Une recidive locale laryngee a ete observee a 12 mois chez le patient T4a. Conclusions Vis-a-vis d’un carcinome epidermoide larynge commissural, une LSC permet l’analyse histopathologique de la totalite de la commissure anterieure du larynx definie par l’organogenese : lame thyroidienne mediane sur laquelle s’inserent les trois etages larynges. L’envahissement cartilagineux microscopique difficilement previsible par l’extension muqueuse peut atteindre 20 % des patients classes initialement T2.

Introduction Although Multidisciplinary Team Management (MDT) is integrated in most international head and neck cancer treatment guidelines, its applications and proceedings were rarely described. The present study explores a 6-year real-life experience in a French Comprehensive Cancer Care Center. Methods Patients, tumor and meeting characteristics of all consecutive cases discussed in head and neck MDT meetings between 2010 and 2015 were retrospectively reviewed. Results From 2010 to 2015, 1849 cases (accounting for 1786 patients) were discussed in 138 MDT meetings. Median age was 62 (range: 15–96). When reported (n = 310, 16.8%), performance status was ≥2 in 36.1% of patients. Tumors were mainly squamous cell carcinomas (n = 1664, 91.5%) of the larynx/hypo-pharynx (n = 630, 34.4%), oropharynx (n = 518; 28.3%) and oral cavity (n = 339; 18.5%). Tumors were diagnosed at a locally (n = 358, 25%), locally advanced (n = 946, 66%) or metastatic setting (n = 53, 3.7%). Mean number of discussed patients per MDT meeting was 16 (range: 3–32). Most patients were discussed once (n = 1663, 97%). Most patients (n = 969, 52%) underwent treatment before MDT meetings: mainly surgery (n = 709, 73.2%). The mean time between MDT meeting and first radiation course was 21 days (range: 1–116). Discussion Optimal multimodal treatment management is based on MDT meetings and results from the interaction and coordination of surgeons, medical and radiation oncologists. In the present series, most patients were discussed once despite the number of expected recurrences, suggesting that the management of tumor progression was not discussed in head and neck MDT meetings. Furthermore, most patients had surgery before MDT meeting, pointing out that MDT role and place still needs to be improved. Finally, the present population significantly differed from patients included in phase III clinical trials, with more advanced age and poorer condition. It calls for the necessity of a high-quality head and neck MDT meeting since evidence-based recommendations should be adapted to patient’s frailties.

Introduction/objectifs Le traitement chirurgical d’une diplegie laryngee chronique chez l’homme peut faire appel a une innervation provenant de nerfs donneurs du plexus cervical, telle proposee par J.P. Marie (2009) [1] : une racine accessoire du nerf phrenique pour les muscles abducteurs du larynx, et le nerf du muscle thyrohyoidien pour les muscles adducteurs. Les variabilites d’origine des nerfs donneurs et leur longueur imposent d’avoir une strategie adaptee [2] , [3] . Materiels/patients et methodes Les microdissections nerveuses ont porte sur 10 corps donnes a la science (20 plexus cervicaux) : les variabilites des branches du nerf phrenique, du nerf du muscle thyrohyoidien et de l’anse cervicale sont notees. Resultats La dissection du nerf phrenique revele une grande variabilite d’origine et la necessite d’un greffon nerveux d’interposition : origine unique dans 70 % des cas provenant de C2, C4 ou C5 ; l’origine peut etre double de C3 ou de C4, plus rarement triple de C3–C4–C5. La participation de C4 est notee dans 75 % des cas. Une origine unique peut imposer de choisir la racine anastomotique C3–C4 comme nerf donneur abducteur. La confirmation electrophysiologique in vivo est toujours imperative. La dissection des racines anterieure et posterieure de l’anse cervicale montre de nombreuses variations mais toujours une branche collaterale distale est presente notamment pour les muscles sternothyroidiens comme nerf donneur adducteur sans interposition de greffon nerveux. La dissection du nerf du muscle thyrohyoidien revele un nerf constant, grele et court (> 20 mm) qui impose l’interposition de greffon nerveux. Conclusion La variabilite d’origine du nerf phrenique demande une adaptation dans le choix morphologique du nerf donneur abducteur et en regle un greffon d’interposition du fait de la longueur limitee des racines disponibles. La variabilite d’origine de l’anse cervicale n’empeche pas le choix d’une collaterale distale sans greffon d’interposition comme nerf adducteur.

BACKGROUND Despite immune microenvironment of head and neck squamous cell carcinoma (HNSCC) has been studied, there are no sufficient data on the role of tumor stroma factors. The aim of the study was to explore the prognostic and predictive role of these factors in a large series of HNSCC. METHODS This is a retrospective study of 266 patients with laryngeal and pharyngeal SCC. Clinical data were correlated with the following histological parameters: tumor-stroma ratio (TSR), tumor budding activity (BA), cell nests size (CNS), and stroma type. RESULTS Stroma-rich tumors, tumor budding, smaller CNS at core and front area, and fibroblastic stroma type, were all adverse prognostic factors (P

It is well known that total thyroidectomy is feasible on elderly patients but is linked to complications because of their underlying comorbidities. In this study we analyzed the specific risks linked to surgery, hypoparathyroidism and recurrent nerve palsy.materials-methods:Prospective, multicentre trial conducted at 13 hospital sites. The primary endpoint was the percentage of patients with postoperative hypocalcaemia (albumin-corrected serum calcium level2 mmol/L at day 2). Secondary endpoints included recurrent nerve palsy rate at day 2, the percentage of patients with hypocalcaemia (serum calcium level2 mmol/L) and recurrent nerve palsy at month 6, operating durations and postoperative pain. Patients were separated in two groups:70 years and ≥70 years old.In total, 1329 patients who underwent total thyroidectomy were included (median age 51.17 years [18.10; 80.90], 80% women, and hyperthyroidism in 20%, 101 ≥ 70 years old). Rates of hypocalcaemia at day 2 and month 6 were 20.02% and 1.98% respectively. Nasofibroscopy showed postoperative abnormal vocal cord motility in 9.92% cases (hypo-motility 5.76% - immobility 4.16%) and 0.95% at month 6 (hypo-motility 0.48%, immobility 0.48%). Patients ≥70 years had a lower (but non-significant) postoperative and definitive hypocalcaemia rate than patients 70 years: 14.85% vs 20.44% at day 2 (p = 0.1773) and 0% vs 2.15% at month 6 respectively (p = 0.2557). Abnormal vocal cord motility rate was 12.00% in patients ≥70 years vs 9.75% in patients70 years at day 2 (p = 0.4702), and 2.06% in patients ≥70 years vs 0.86% at month 6 (p = 0.2340).Total thyroidectomy in patients ≥70 years is feasible and safe. Age does not increase the morbidity. The study is registered with ClinicalTrials.gov number NCT01551914.

Background The aim was to determine whether the anterolateral ligament (ALL) had a histological structure that defined it as a real ligament. Methods Histological examination of 30 ALL samples taken from fresh-frozen knees were performed. The ALL femoral insertion and its relationship with the lateral collateral ligament (LCL) were studied and the tibial insertion and its relationship with articular cartilage of the tibial joint surface were analyzed. For the ligamentous part, its histological structure and its differences with the articular capsule were studied. Results This connective tissue is composed of a dense fibrous core constituted by a network of oriented collagenous fibers. The periphery of this dense connective center is made up of loose fibrocollagenous tissue with vascular structures and focal deposits of adipose tissue. This part was in contact but different to the joint capsule. With a perpendicular orientation of the collagen fibers relative to the bone, a fibrocartilaginous zone with an unmineralized hyalinized aspect, a mineralization front, its bone insertions presented a typical ligamentous insertion. With a cleavage plane between ALL and LCL femoral insertion, the ALL appeared to have a femoral insertion distinct from the LCL. ALL tibial insertion was less characteristic with less organized connective tissue and was at a distance from the articular cartilage. Conclusion From its bony insertion to its tissue composition and organization, the ALL has all the histological characteristics of a ligamentous structure. Our study confirms that ALL can be considered a real and distinct ligament.

Resume Introduction L’hyperthyroidie recouvre differentes situations anatomo-cliniques. Le traitement chirurgical est volontiers propose apres l’echec d’un traitement medical. Le but de ce travail a ete l’analyse des indications et complications du geste chirurgical mais aussi des resultats endocriniens. Patients et methodes Cette etude retrospective a inclus les patients operes d’une hyperthyroidie entre 2004 et 2012. Des thyroidectomies totales ont ete realisees pour les maladies de Basedow, les goitres toxiques multinodulaires et les hyperthyroidies induites par l’amiodarone ; des lobo-isthmectomies pour les nodules toxiques. Ont ete analysees l’histopathologie des pieces de thyroidectomies, les complications postoperatoires et la guerison de l’hyperthyroidie. Resultats Deux cents patients, âges entre 15 et 83 ans, ont ete inclus : une chirurgie premiere a ete realisee pour 188 patients et en situation de recidive post-chirurgicale pour 12 patients (6 suite a une thyroidectomie subtotale pour goitre multinodulaire pratiquee 25 ans auparavant, et 6 suite a une hemi-thyroidectomie pour nodule solitaire pratiquee 15 ans auparavant). Il s’agissait de 82 patients avec un goitre multinodulaire toxique, 78 avec une maladie de Basedow, 35 avec un nodule toxique et 5 avec une hyperthyroidie induite par l’amiodarone. Les resultats histopathologiques retrouvaient 14 carcinomes papillaires (dont 11 microcarcinomes) et dans 34 cas une glande parathyroide saine (17 %). Les complications postoperatoires comprenaient 4 % de paralysie recurrentielle definitive (a un recul d’un an), 9 % d’hematome necessitant une reprise chirurgicale et 3 % d’hypocalcemie definitive. Deux recidives ont ete observees en rapport avec une exerese incomplete (une maladie de Basedow a 18 mois ; un nodule endothoracique toxique a 5 mois). Les complications etaient plus frequentes pour les goitres toxiques (23 %) que lors des maladies de Basedow (13 %) (difference non significative : p > 0,05). Conclusion La chirurgie des hyperthyroidies permet le controle endocrinien de la maladie si le geste chirurgical est complet. Les complications postoperatoires, notamment vocales, demandent une information honnete des patients. Une surveillance a long terme est necessaire car une recidive peut survenir au-dela de 20 ans apres une thyroidectomie partielle. La chirurgie seule permet de diagnostiquer precocement 12,5 % de carcinomes papillaires.