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Biomedical subjects

M Hamoir

Publications and source records attributed to M Hamoir.

At least 19 recordsLinked to original sources
PubMed1999

Cost-minimization analysis of treatment options for T1N0 glottic squamous cell carcinoma: comparison between external radiotherapy, laser microsurgery and partial laryngectomy.

BACKGROUND AND PURPOSE: A cost minimization analysis of radiotherapy (RT), laser microsurgery (L) or partial laryngectomy (PL), which are equally effective options for T1N0 glottic SCC was carried out from the perspective of the National Health Care System. METHODS: For each modality, the various events associated with the diagnostic procedure, the primary treatment, the complications, and the salvage treatment were individualized. The charges of each of these events weighted for the frequency of occurrence were then determined using the 'fee for service' policy established by the National Health Insurance of Belgium. RESULTS: A total cost of 5172, 5847 and 11563 EURO were calculated for RT, L and PL, respectively. For L, cost included post-operative RT applied in case of positive margins (30%). For PL, the cost of the primary treatment accounted for 68% of the total cost whereas it only accounted for 50 and 43% for L and RT, respectively. For RT, L or PL, complications accounted for less than 10% of the total cost. The cost of salvage treatment reached 19, 14 and 8% of the total cost for RT, L and PL, respectively. A sensitivity analysis indicated that reduction of the duration of hospitalization decreases the costs without affecting the ranking between the three options. Also, the cost of L could be reduced even slightly below the cost of RT by decreasing the need for post-operative RT. CONCLUSIONS: RT and L have almost the same expected average cost for the treatment of T1N0 glottic SCC, whereas PL is twice as expensive.

Belgium↗
PubMed1999

Conservation surgery for laryngeal and hypopharyngeal cancer.

The charts of 173 patients treated by conservation laryngectomy and pharyngolaryngectomy were retrospectively reviewed. The patients treated by endoscopic laser resection were excluded of this study. Glottic carcinoma was diagnosed in 101 patients, supraglottic carcinoma in 44 patients, hypopharyngeal carcinoma in 24 patients and oropharyngeal carcinoma in 4 patients. The median follow-up period was 44 months, 84/101 glottic cancer, 34/44 supraglottic cancer, 23/24 hypopharyngeal cancer and 2/4 oropharyngeal cancer were staged as T1 and T2. A voice-sparing external approach was carried on in 20 patients with locally advanced tumor (T3-T4). At time of the last follow-up, 132 patients (77%) were alive when 41 patients (23%) died. Overall survival rates for patients treated for T1-T2 glottic cancer at 3, 5 and 10 years were 90, 90 and 78% respectively. Overall survival rates for patients treated for T1-T2 supralottic cancer at 3, 5 and 10 years were 73, 68 and 48% respectively. Overall survival rates for patients treated for T1-T2 hypopharyngeal cancer at 3 and 5 years were 74 and 37% respectively. The site of the primary tumor (glottic versus supraglottic or hypopharynx) showed significant impact on survival (P = 0.0025)). Regarding survival, T stage and N stage were not found statistically significant.

Carcinoma, Squamous Cell↗
PubMed1999

New challenges in head and neck bone and soft tissue reconstruction.

Emphasizing the major impact of reconstructive microsurgery on the treatment of head and neck tumors, the present paper makes a synthesis of the ideal transplants now commonly used to repair specific cephalic bone and soft tissue defects. It also explores and discusses the new perspectives actually developed to improve their present anatomical, functional and aesthetic results. By extending the use of chimaeric or prefabricated flaps, neurovascular allografts or dynamic transfers, all these new challenges combine the progresses made in surgical skill, conceptual inventivity and basic molecular biology.

Face↗
PubMed1998

Congenital fistula of the fourth branchial pouch.

Between 1986 and 1995, 128 patients were treated for various head and neck congenital malformations at Saint-Luc University Hospital, Louvain. We report three cases of fourth branchial pouch cysts requiring surgical removal. One of these cases presented with a third branchial pouch remnant on the same side and subsequently a fourth branchial pouch sinus. To our knowledge, this is the first case published in the literature. A fourth branchial pouch sinus tract can become manifest clinically by recurrent episodes of neck abscess or acute suppurative thyroiditis (especially in infants). The tract can be identified with a barium swallow during the period of latency and hypopharyngeal endoscopy under general anesthesia. Total excision of the fistula with dissection up to the pyriform sinus with or without a left thyroid gland lobectomy and isthmectomy is the treatment of choice.

Abscess↗
PubMed1998

Comparison of external radiotherapy, laser microsurgery and partial laryngectomy for the treatment of T1N0M0 glottic carcinomas: a retrospective evaluation.

PURPOSE: The aim of this study was to retrospectively compare the efficacy and functional results of three treatment options for T1N0M0 glottic carcinomas applied in a single institution. MATERIALS AND METHODS: One hundred six charts of patients with biopsy-proven T1N0M0 glottic carcinomas treated between 1979 and 1995 were reviewed. There were 81 T1a and 25 T1b tumors. Forty-one patients were treated by radiotherapy (RT) (median dose of 64 Gy), 34 patients were treated by partial laryngectomy (PL) and 31 patients were treated by laser microsurgery (L) of which 10 received postoperative RT for positive margins. In 18 patients, a perceptual voice rating on a visual scale was performed by the patients themselves, three non-speech specialists and two speech therapists. RESULTS: With a median follow-up time of 63.5 months, the 5- and 10-year loco-regional control probabilities reached 91 and 87%, respectively, without any difference between the treatment groups. After salvage laryngectomy, the 5- and 10-year loco-regional control probabilities reached 97% without any difference between the treatment groups. For the whole population, overall survival reached 78 and 62.4% at 5 and 10 years, respectively. The actuarial incidence of second primary reached 19% at 10 years. Regarding the quality of voice, overall there was a trend towards a worse satisfaction index, more hoarseness and more breathiness after PL than after L or RT. CONCLUSIONS: Our data suggested that assuming proper selection of patients, RT and L yielded similar outcomes and functional results. Local recurrence can be adequately salvaged by surgery. On the other hand, PL appeared to yield similar loco-regional control probability but with a worse quality of voice.

Actuarial Analysis↗
PubMed1998

Meningioma of the infratemporal fossa: report of a case.

We report the case of a 25 year old male who presented with a well-circumscribed mass in the infratemporal fossa, without intracranial localisation. On histological examination, this tumor was a transitional type of meningioma. We review the literature and discuss the pathogenesis and the differential diagnosis.

Adult↗
PubMed1998

[Maxillary actinomycosis and maxillary candidiasis in the immunocompetent patient].

Two distinct cases of maxillary actinomycosis and maxillary candidosis in immunocompetent hosts are reported; These infections are rare and similar to mycotic extramucosal non allergic sinusitis. Microbiology and microscopic examination are mandatory to prompt and successful management. Endoscopic endonasal surgery by middle meatotomy seems to be an adequate treatment for these particular entities.

Actinomycetales Infections↗
PubMed1998

Nocturnal oxymetry in patients with total nasal packing.

Nocturnal oxymetry was recorded in ten otherwise healthy patients undergoing different types of nasal surgery with total nasal packing. Postoperative nocturnal oxymetry was worse than preoperative one in seven patients and judged as abnormal in four. These results indicate that in otherwise healthy subjects, nasal surgery and total nasal packing induce immediate significant changes in nocturnal breathing.

Adult↗
PubMed1997

[Zenker's diverticulum. External or endoscopic surgery?].

Although the pulsion diverticulum of hypopharynx was first described by A. Ludlow in 1964, the name of the German pathologist F.A. von Zenker is definitively associated with this diverticulum, probably because he was the first to publish a full description of its clinical and pathological aspects. Later, numerous techniques have been described to surgically treat Zenker's diverticulum. However optimal treatment remains controversial. Considering transcervical approaches, microendoscopic CO2 laser diverticulotomy offers comparable functional results. Moreover, this procedure offers the advantages of reduced morbidity, is very short-time consuming and requires a short hospitalization. These last issues should be seriously taken in consideration regarding medical cost. Subsequently, we advocate that microendoscopic CO2 laser diverticulotomy should be considered as first-line treatment option for patients suffering of Zenker's diverticulum.

Endoscopy↗
PubMed1997

[Use of CO2 laser in endoscopic treatment of Zenker's pharyngo-esophageal diverticula. Experience apropos of 33 cases].

Microendoscopic treatment of hypopharyngeal (Zenker's) diverticulum was performed in 31 patients during the period 1990-1995. The CO2 laser combined with the operating microscope has been used. 33 endoscopic procedures were performed (2 procedures were needed for 2 patients). The average age of the patients was 70.3 years (46-86 years). The average length of the general anesthesia was 48 minutes; the average length of the endoscopic procedure was 20 minutes. No major complication occurred for 32/33 cases (97%). Mediastinitis occurred for 1 case (3%) and was successfully treated by surgical and IV antibiotherapy. The average duration of hospitalization was 5 days (3-5 days) (patient with mediastinitis excluded): the average follow-up was 19 months (1-62 months). 28/31 patients (90.3%) were highly or fairly satisfied. Considering the external approach microendoscopic CO2 laser diverticulotomy offers comparable functional results. Moreover, this procedure is quick, requires a shorter hospitalization stay and is followed by a very low percentage of complications. Additionally, no visible scar is noted. Optimal management of Zenker's diverticulum remains controversial. However, we advocate that microendoscopic CO2 laser diverticulotomy should be considered as a first-line treatment option for patients with hypopharyngeal diverticulum.

Aged↗
PubMed1997

Subjective results after uvulo-palato-pharyngoplasty.

The subjective effect of uvulo-palato-pharyngoplasty surgery (U.P.P.P) for snoring was evaluated in 31 patients. Results were obtained following a questionnaire sent to patients after a median follow-up of 10 months, as well as through follow-up visits. Seventy seven point five percent of the patients and their partners were satisfied with the operation. No major complications were noted. Minor complications included pain, transient pharyngonasal reflux and sensitvity problems of the posterior wall of the pharynx.

Adult↗
PubMed1996

Posterior cordectomy and subtotal arytenoidectomy for the treatment of bilateral vocal fold immobility: functional results.

We report vocal and respiratory results following endoscopic CO2 laser therapy for bilateral vocal fold immobility in adduction. Two techniques were used: posterior cordectomy (PC) and subtotal arytenoidectomy (SA). Respiratory improvement was demonstrated by the peak expiratory flow/peak inspiratory flow ratio (PEF/PIF, normal = 1), which was less than 2 for 83% of patients following PC and for 81% following SA. As for vocal results, there were no significant quantitative differences between the two techniques. Mean maximum phonation time (/a/) was 6.8 +/- 2.6 s after SA and 7.8 +/- 1.6 s following PC. The phonation quotient was 288 +/- 116 ml/s after SA and 304 +/- 92 ml/s after PC. Mean vocal intensity was 62 +/- 4 dB after SA and 59 +/- 3 dB after PC. Vocal quality was measured by high-resolution vocal frequency analysis, as represented by a histogram. Peaks corresponding to fundamental frequency and first harmonics were preserved in more than 60% of patients in the two groups. Vocal preservation is better when the paralyzed folds are in the paramedian position, with the possibility of adduction (Gerhardt syndrome). SA is performed in our procedure, though it is longer and more difficult to perform than PC. PC often requires two procedures to achieve satisfactory results.

Adolescent↗
PubMed1996

Stylohyoid chain ossification: choice of the surgical approach.

The embryological, clinical and radiological features of an abnormal stylohyoid chain ossification is reviewed. The common embryological origin of the styloid apophysis, the styloid ligament and the lesser cornu of the hyoid bone allows the concept of a stylohyoid entity. The pathogenesis of the ossification of the stylohyoid chain enables us to distinguish Eagle's syndrome, the stylohyoid syndrome and the pseudo-stylohyoid syndrome. The choice between medical and surgical treatment particularly surgery by external approach, is discussed.

Female↗
PubMed1993

[Fibrous histiocytoma of the larynx: report of a case].

A case of subglottic fibrous histiocytoma of the larynx, is reported. Fibrous histiocytoma is uncommon in the head and neck region, and rare in the larynx. It is a tumor of mesenchymal origin consisting of two separate components: histiocytic and fibroblastic cells. The clinical behaviour and the degree of malignancy can not be predicted. Surgery is the treatment of choice.

Adult↗