Lymphangioma is a benign vascular malformation of the lymphatic vessels. In 90% of cases it is diagnosed during the first 2 years of life. As seen in 75% of cases, the head and neck region are the ...preferred location. This report represents an original case of lymphatic malformation (LM) in a 15-year-old patient discovered during an unscheduled postoperative symptomatology of third molar germectomies. Two biopsies, one non-contributory, were required to make the diagnosis. Lymphangiomas are classified as LM. They are usually non-regressive. Their etiology remains controversial.
BACKGROUND:A calcium alginate dressing (ALGINATE) and negative pressure wound therapy (NPWT) are frequently used to treat wounds which heal by secondary intention. This trial compared the healing ...efficacy and safety of these 2 treatments.
METHODS:This randomized, non-inferiority trial enrolled patients who underwent skin excision (>30 cm), which was left open to heal by secondary intention. They received ALGINATE or NPWT by a centralized randomization. Follow-up was performed weekly until optimal granulation tissue was obtained. The primary outcome was time to obtain optimal granulation tissue for a split thickness skin graft take (non-inferiority margin4 days). Secondary outcomes were occurrence of adverse events (AEs) and impact of the treatments on the patient’s daily life.
RESULTS:ALGINATE and NPWT were applied to 47 and 48 patients, respectively. The mean time to optimal granulation was 19.98 days (95% CI, 17.7–22.3) with ALGINATE and 20.54 (95% CI, 17.6–23.5) with NPWT. Between group difference was −0.56 days (95% CI −4.22 to 3.10). The non-inferiority of ALGINATE versus NPWT was demonstrated. No AE related to the treatment occurred with ALGINATE versus 14 AEs with NPWT. There was no difference in the impact of the treatments on the patient’s daily life.
CONCLUSION:This trial demonstrates that ALGINATE has a similar healing efficacy to that of NPWT and that is markedly better with regard to patient safety.
•The STEREOPOSTOP-GORTEC-2017–03 phase 2 trial evaluates postoperative SBRT in case of high risk margins for pT1-T2/N0 oropharyngeal and oral cavity tumors.•On the 10 first patients treated on ...Novalis, adding non-coplanar arcs resulted in better dosimetric outcomes.•Acute toxicity appears acceptable.•The most common acute toxicity was grade 2 and 3 mucositis.
The STEREO POSTOP GORTEC 2017–03 phase 2 trial (NCT03401840) evaluates postoperative stereotactic body radiotherapy (SBRT) in case of high-risk margins for pT1-T2/N0 oropharyngeal and oral cavity tumors. The present ancillary study aimed to compare the dosimetric impact of adding non-coplanar arcs to the volumetric modulated arc therapy (VMAT) technique and to evaluate acute toxicities on the first patients included in this trial.
Ten patients were included. Patients were treated with Novalis TX®. The total dose was 36 Gy (100 % isodose line) in 6 fractions, treated every other day. Two treatment plans were created for each patient: one plan using 2 coplanar arcs only (VMATc) and one plan using coplanar and 3 non-coplanar arcs (VMATc + nc). Acute toxicity was evaluated according to NCI CTCAE criteria V4.03.
Median age was 62 years. Localization of tumor was the mobile tongue for 6 patients, floor of mouth for 2, cheek for 1, and gingiva for 1. Six patients had pT2N0 tumors (AJCC 7th edition) and 4 had pT1N0. Mean CTV and PTV volumes were 36.4 and 56.1 cc respectively. Mean PTV coverage by the 36 Gy isodose was 98.2 % for both techniques (p = ns), with comparable conformity indexes (1.1 for VMATc vs 1.07 for VMATc + nc; p = 0.23). VMATc + nc had a significantly better gradient index (3.45 vs 2.97; p = 0.01), resulting in a significantly better sparing of most organs at risk. For example, mean Dmean to the oral cavity, lips, and homolateral parotid were respectively of 16.8 Gy, 11.1 Gy, and 10.4 Gy for VMATc vs 14.8 Gy (p = 0.005), 8.1 Gy (p = 0.001), 6.5 Gy (p = 0.04) for VMATc + nc. No grade ≥ 4 or higher acute toxicity was reported. The most common acute toxicity was grade ≥ 2 mucositis.
VMATc + nc had better dosimetric outcomes than VMATc and has become the standard technique for patients treated in the STEREO POSTOP GORTEC 2017–03 trial (NCT03401840) in our institution. Acute toxicity appears acceptable.
Repairing surgical defects of the nose is still challenging due to its tridimensional shape and its aesthetic concern. Difficulty in reconstructing nasal subunits lies in their contour, skin texture ...and limited availability of adjacent skin. For lower nasal dorsum and supra-tip regions, we design a new combined local flap as existing local flaps may give disappointing results. This combination flap was performed on two patients for reconstruction of the lower nasal dorsum area after basal cell carcinoma excision. Size of the excision ranged from 20 to 25 mm diameter and safe margins were obtained. The defects were reconstructed with a local flap that combined a rotation nasal flank flap and a V-Y advancement nasolabial flap. Excision and reconstruction were performed in a one-stage surgery under intravenous sedation and local anesthesia. There were no postoperative complications and no flap loss occurred. Aesthetic and functional results after 6 months postoperatively were satisfying without modification of nasal shape. This flap is reliable and offers interesting functional and aesthetic outcomes. It can be considered as a new reconstruction alternative for supra-tip and lower nasal dorsum skin defects performed in a one-stage procedure under local anesthesia.
Eyelid basal cell carcinoma (BCC) is usually cured by surgery. However, for a minority of patients, extensive disease progression and recurrence contraindicate surgery or radiotherapy because of ...severe ocular morbidity. The hedgehog signaling pathway inhibitor vismodegib is becoming the key treatment for this specific form.
The aim of this review was to define the role of surgery after vismodegib treatment.
A literature search of the PubMed, Cochrane Library, ScienceDirect, and Embase databases was conducted for all articles published up to March 2021 to identify studies that examined treatment of BCC of the eyelid by vismodegib.
Level 1 evidence was found for the use of vismodegib as neoadjuvant therapy in locally advanced eyelid BCC contraindicated to surgery and/or radiotherapy with a rather good tolerance of treatment. Level 3 evidence was found for the role of surgical excision of residual clinically suspicious lesions as for the indication of eyelid reconstruction after mapping or during residual tumoral resection if frozen sections or Mohs surgery were performed.
Vismodegib is a well-tolerated treatment for advanced periorbital BCC. The hedgehog signaling pathway inhibitor vismodegib is a potential treatment option in patients with these challenging tumors.
The age of closure of skull base synchondroses has never been analyzed in a homogenous population of children with Crouzon syndrome.
A retrospective case-control study was performed on 30 Crouzon ...children (17 male, 13 female) aged 1 month to 12.48 years with Fibroblast Growth Factor Receptor type 2 mutation. Eleven synchondroses were analyzed on millimetric computed tomodensitometric slices before surgery. Syndromic patients were compared with a series of 235 healthy children previously published.
Synchondrosis closure follows a global pattern that occurs earlier in Crouzon syndrome than in controls (P ≤ 0.002). Synchondrosis fusion starts at 10 months of age with posterior intraoccipital synchondroses and lambdoid sutures, followed by occipitomastoid synchondroses between 1.85 (right) and 2.27 years (left) and anterior intraoccipital synchondroses at approximately 2.80 years. Time to complete fusion varies considerably according to the synchondroses. Spheno-occipital and petro-occipital synchondroses fuse last, at approximately 3 years old.
In children with Crouzon syndrome, synchondrosis closure occurs prematurely, with a time course specific to each synchondrosis.
BackgroundSensitive and reproducible detection of residual disease after treatment is a major challenge for patients with locally advanced head and neck cancer. Indeed, the current imaging techniques ...are not always reliable enough to determine the presence of residual disease. The aim of the NeckTAR trial is to assess the ability of circulating DNA (cDNA), both tumoral and viral, at three months post-treatment, to predict residual disease, at the time of the neck dissection, among patients with partial cervical lymph node response on PET-CT, after potentiated radiotherapy.MethodsThis will be an interventional, multicentre, single-arm, open-label, prospective study. A blood sample will be screened for cDNA before potentiated radiotherapy and after 3 months if adenomegaly persists on the CT scan 3 months after the end of treatment. Patients will be enrolled in 4 sites in France. Evaluable patients, i.e. those with presence of cDNA at inclusion, an indication for neck dissection, and a blood sample at M3, will be followed for 30 months. Thirty-two evaluable patients are expected to be recruited in the study.DiscussionThe decision to perform neck dissection in case of persistent cervical adenopathy after radio-chemotherapy for locally advanced head and neck cancer is not always straightforward. Although studies have shown that circulating tumour DNA is detectable in a large proportion of patients with head and neck cancer, enabling the monitoring of response, the current data is insufficient to allow routine use of this marker. Our study could lead to better identification of patients who do not have residual lymph node disease in order to avoid neck dissection and preserve their quality-of-life while maintaining their prospects of survival.Trial registrationClinicaltrials.gov: NCT05710679, registered on 02/02/2023, https://clinicaltrials.gov/ct2/show/ . Identifier with the French National Agency for the Safety of Medicines and Health Products (ANSM): N°ID RCB 2022-A01668-35, registered on July 15 th , 2022.
The aim of this study was to assess the medico-economic impact of the MACD Coupler™ system in comparison with HSA for end to end veno-venous anastomosis during free flap transfer. A retrospective ...case-control study was performed in an academic institution, from March 2019 through July 2021, to analyze medical and economic outcomes of patients managed for head and neck reconstruction with free flap transfer.
43 patients per group were analyzed. Rates of initial success, re-intervention, complications and flap transfer failure were not different between groups. Use of MACD increased the cost of medical devices between Coupler and Control groups with respectively K€ 0.7 0.5; 0.8 and K€ 0.1 0.5; 0.8 (p = 0.001) and decreased the cost for operating staff with respectively K€ 4.0 3.4; 5.2 and K€ 5.1 3.8; 5.4 (p = 0.03). The total management costs were not different between groups with respectively a total median cost of K€ 18.4 14.3; 27.2 and K€ 17.3 14.1; 23.7 (p = 0.03). In conclusion, the cost of the Coupler™ is significant but is partly offset by the decrease in operating staff costs. The choice of one or the other technique can be left to the discretion of the surgeon.
the objective of the study is to evaluate the interest of advanced computer technology, including virtual surgical planning, three-dimensional modeling and pre-bended titanium plate and mesh in the ...treatment of comminuted zygomaticomaxillary complex fractures.
A total of 19 patients were included. In the study group (n=6) surgery was combined with preoperative planning including mirroring and bending of the titanium plates and mesh on a 3D model. In the control group (n=13) plates and mesh were bended on the patient during the surgery. Patient characteristics, clinical outcomes, orbital volumes, zygoma projection and complications were recorded.
After surgery, the orbital volume and the zygoma projection variations between injured side and unaffected side were compared. Orbital volume variation was 2.1mL 1.5; 4.0 in the control group and 0.4mL 0.1; 1.0 in the study group. Zygoma projection variation was 0.2cm in the control group and 0.1cm in the study group. Orbital volume restoration (P=0.004) and zygoma symmetrisation (P=0.04) were significantly better when titanium plates and meshes were pre-bent on a stereolithographic model.
This study confirms the interest of surgical planification using 3D models to improve treatment of midface trauma.
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