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V Jouffre

Publications and source records attributed to V Jouffre.

At least 19 recordsLinked to original sources
PubMed1998

Complications and functional outcome after supracricoid partial laryngectomy with cricohyoidoepiglottopexy.

We present a review of the postoperative course, complications, and functional outcome of 190 patients consecutively treated with supracricoid partial laryngectomy with cricohyoidoepiglottopexy. The average times until removal of the tracheostomy and nasogastric feeding tubes were 9 and 16 days, respectively. The postoperative mortality rate was 1%. Major complications included pneumonia from aspiration, cervical wound infection, symptomatic laryngocele, ruptured pexis, laryngeal chondroradionecrosis, and laryngeal stenosis in 8.5%, 4.2%, 3.1%, 1%, 0.5%, and 0.5% of the patients, respectively. Completion total laryngectomy, permanent gastrostomy, and permanent tracheostomy were requested in 0.5% of the patients. Normal swallowing without gastrostomy and respiration without tracheostomy was achieved by the first postoperative year in 98.4% (187/190) of the patients. This article presents a univariate analysis of the potential correlation between various variables and the duration of tracheostomy and the length of time the nasogastric feeding tubes were inserted, the mortality incidence and causes, the incidence and type of the various complications, and the duration of hospitalization. Comparison of our data with the reported functional results after vertical partial laryngectomy suggested that supracricoid partial laryngectomy with cricohyoidoepiglottopexy does not result in an increased rate of postoperative complications.

Deglutition↗
PubMed1996

Tracheal resection with end-to-end anastomosis for isolated postintubation cervical trachea stenosis: long-term results.

A 20-year experience with end-to-end tracheal resection and anastomosis for isolated postintubation stenosis of the cervical trachea, in a consecutive series of 32 adult patients, has been reviewed. Surgical death was never encountered. The overall incidences for superficial wound infection, pneumonia, and inferior left laryngeal nerve paralysis were 6.2%, 3.1%, and 3.1%, respectively. One-, 3- and 5-year actuarial anastomosis success rates were 96.7%, 93.3%, and 93.3%, respectively. Successful revision tracheal end-to-end anastomosis was performed once, resulting in an overall 96.9% success rate in our series. None of the following variables-sex, age, cause for intubation, intubation type (laryngotracheal and/or tracheotomy) and duration, delay from initial injury, presence of an open stoma, number of tracheal rings resected, and type of sutures used-were statistically related to the anastomosis success rate or the incidence of complications.

Adult↗
PubMed1996

[Supra-cricoid partial laryngectomy extended to the anterior arch of the cricoid with tracheo-crico-hyoido-epiglottopexy. Oncologic and functional results].

21 patients with glottic carcinoma presenting anterior infraglottic extent of tumor, classified T2-T4, were offered and extended supracricoid partial laryngectomy with tracheocricohyoidoepiglottopexy (TCHEP) between 1979 and 1994 at our department. The technique for the procedure, the duration of tracheotomy tube, naso-gastric feeding tube, and hospital stay are presented. Postoperative complications and management were described. The 5-year actuarial survival, local control, nodal recurrence, distant metastasis, and metachroneous second primary tumor estimate was 74.7%, 88.9%, 11.1%, 22.4% and 15%, respectively. Overall a 95.2% (20/21) local control rate was achieved with a 90.5% (19/21) laryngeal preservation rate.

Actuarial Analysis↗
PubMed1996

[Surgery of primary malignant melanomas of the mucosa of the nasal fossa and facial sinuses].

A retrospective analysis of 22 patients with primary malignant melanoma of the nasal fossa and/or paranasal sinuses consecutively managed with surgery at our department from 1975 to 1993 was conducted. Fifteen patients had negative margins of resection. Neoadjuvant chemotherapy and post-operative radiation therapy was associated in 4 and 5 of these 15 patients, respectively. Four patients had positive margins. Adjunctive treatment was chemotherapy and postoperative radiation therapy in 2 and 3 of these 4 patients, respectively. The remaining 3 patients were managed with palliative treatment (debulking surgery and chemotherapy). No patients were lost to follow up. A 3-year follow-up was always achieved. In patients in whom surgical resection achieved negative margins, the 5-year actuarial survival, and local control estimate was 17.9%, and 26.9%, respectively. None of the variables under analysis were statistically related to local recurrence or survival. Death always occurred within 24 months from initial diagnosis in all 7 patients but one in whom surgical resection with negative margins was not achieved or debulking surgery was performed.

Aged↗
PubMed1995

[Long-term results of total conservative parotidectomy for pleomorphic adenoma].

OBJECTIVES: Evaluation of the long-term results (10 and 15 years) achieved with total conservative parotidectomy for pleomorphic adenoma. METHODS: A retrospective analysis of the files of 127 patients with pleomorphic adenoma of the parotid gland consecutively treated with a total conservative parotidectomy at our department from 1970 to 1985. Actuarial analysis (Kaplan Meier method) of survival and local recurrence, as well as overall estimation of immediate and definite postoperative facial paresis and paralysis was performed. RESULTS: Ten- and fifteen-year survival and local control estimations were 90.8% and 99.1%, respectively. Immediate and permanent facial paresis and paralysis overall estimates were 64.6% and 6.3% and 2.1% and 0%, respectively. CONCLUSION: Total conservative parotidectomy for pleomorphic adenoma results in a very high long term local control associated with a very low rate of facial dysfunction.

Adenoma, Pleomorphic↗
PubMed1995

[Exclusive chemotherapy in T1-T3N0 cancers of the vocal cord with complete clinical response after neoadjuvant treatment with a cisplatin-fluorouracil combination].

OBJECTIVES: Evaluation of cisplatin-fluorouracil exclusive chemotherapy for invasive squamous cell carcinoma of the glottis staged as T1-T3N0 with a complete response after cisplatin-fluorouracil neo-adjuvant chemotherapy. METHODS: A retrospective analysis of the files of 69 patients with a well-differentiated untreated invasive squamous cell carcinoma, staged as T1-T3N0 with a complete response after cisplatin-fluorouracil neo-adjuvant chemotherapy is presented. Actuarial analysis (Kaplan Meier method) of survival and local failure is presented among the group of 25 patients treated with exclusive chemotherapy and the group of 44 patients in whom the local treatment (partial laryngeal surgery or radiation therapy) initially planned was maintained. RESULTS: Three-year survival and local control estimate was 91.8% and 69.3%, respectively after exclusive chemotherapy and 92.5% and 97.2% if the local treatment was performed as initially planned. Patients with local recurrence after exclusive chemotherapy were always salvaged with partial laryngeal surgery or radiation therapy resulting in an overall 100% local control and laryngeal preservation rate. CONCLUSION: Exclusive chemotherapy for T1-T3N0 glottic carcinomas with a complete response after cisplatin-fluorouracil neo-adjuvant chemotherapy should be considered especially in patients in whom preservation of voice is of utmost importance.

Adult↗
PubMed1995

Evolution of speech and voice following supracricoid partial laryngectomy.

The evolution of voice and speech parameters following supracricoid partial laryngectomy (SCPL) has been evaluated in a prospective fashion over an 18-month period of time in three patients using the Computerized Speech Lab (from Kay Elemetrics). Preliminary results demonstrate the post-operative instability of voice parameters. Speech parameters remain stable with time. Our data stresses that voice is attained post-operatively even if one arytenoid cartilage is disarticulated at time of resection.

Aged↗
PubMed1995

Acoustic parameters and speech analysis after supracricoid hemilaryngopharyngectomy.

Selected characteristics of speech and voice were compared in 10 patients who had undergone supracricoid hemilaryngopharyngectomy (SCHLP) and 20 normal adult laryngeal (NAL) speakers. Durational features of tape-recorded speech samples were measured using a stopwatch. Frequency features were analyzed with the Computerized Speech Lab and the multidimensional voice program. SCHLP speech proved comparable to NAL speech in average fundamental frequency, speech rate, and group phrasing. SCHLP speech and voice were statistically less efficient than NAL speech in fundamental frequency range, jitter, shimmer, noise-to-harmonic ratio, and maximum phonation time. Age, associated cricopharyngeal myotomy, postoperative radiation therapy, and time elapsed from SCHLP completion were not statistically related to the speech and voice parameters of SCHLP speakers.

Adult↗
PubMed1995

[Dysfunction of the facial nerve following total conservative parotidectomy for pleomorphic adenoma].

Two hundred and forty seven previously untreated pleomorphic adenoma of the parotid gland were operated with a total conservative parotidectomy between 1965 and 1992. The overall incidence for temporary facial nerve paresis and paralysis was 63.1% and 5.2%, respectively. None of the following variables sex, age, tumor size, tumor location, tumor contact with the facial nerve, degeneration of the pleomorphic adenoma, inadvertent tumor spillage, use of Surgical, and postoperative hematoma were statistically related to facial nerve dysfunction. Kaplan-Meier actuarial analysis demonstrated that facial nerve dysfunction recovery was noted until the 18th postoperative month. The use of the linear regression model with Pearson correlation underscores that the recovery time of facial nerve function significantly statistically increased with the patient's age (p = .0017). The overall incidence for permanent facial paresis and paralysis was 3.6% and 0%, respectively. Implications of these findings are discussed together with a review of the medical literature.

Adenoma, Pleomorphic↗
PubMed1994

A clinical trial of continuous cisplatin-fluorouracil induction chemotherapy and supracricoid partial laryngectomy for glottic carcinoma classified as T2.

BACKGROUND: Vertical partial laryngectomy (VPL) and radiation therapy (RT) are the recommended conventional conservative options for glottic carcinoma classified as T2. In series presenting more than 100 patients with a minimum 3-year follow-up, however, local recurrence rates were reported as 22-43.5%. The authors' experience with a new strategy based on continuous cisplatin-fluorouracil induction chemotherapy (IC) and supracricoid partial laryngectomy with cricohyoepiglottopexy (CHEP) is presented. METHODS: A retrospective analysis of 67 patients who presented with untreated moderately to well differentiated invasive glottic carcinoma classified as T2, managed from 1983 to 1991 with IC and CHEP, was conducted. Statistical analysis of survival, local control, nodal control, distant metastasis, and metachronous second primary tumor incidence was based on the Kaplan-Meier actuarial method. Univariate analysis was performed to analyze the relationships between various factors and survival, local recurrence, and nodal recurrence. Clinical response, histologic response, IC toxicity and postoperative course were reported. RESULTS: The Kaplan-Meier 5-year survival, local recurrence, nodal recurrence, distant metastasis, and metachronous second primary tumor estimate were 92.3%, 5.6%, 1.5%, 1.8%, and 5.6%, respectively. Overall laryngeal preservation was achieved in 65 patients (97%). Ultimate local control was achieved in all patients but one. Nodal recurrence was statistically more likely in patients presenting with a local recurrence. Analysis of the specimens demonstrated complete histologic response to IC in 25 (37.3%) patients. A strong statistical relation (P < 0.0001) was noted between complete clinical response after IC and complete histologic response. CONCLUSIONS: The change from the prevailing treatment modalities of RT and VPL to a new multimodal strategy (IC+CHEP) did not decrease survival and allowed for an increase in laryngeal preservation rate. The high rate (37.3%) of complete histologic response suggests that IC deserves further consideration in the management of patients with glottic carcinoma classified as T2. The favorable results achieved in this series, when compared with historic controls, should stimulate prospective clinical trials comparing the two surgical procedures (CHEP vs. VPL with or without IC) for resection of Stage II glottic carcinoma.

Adult↗
PubMed1994

Total conservative parotidectomy for primary benign pleomorphic adenoma of the parotid gland: a 25-year experience with 229 patients.

A 25-year experience with total conservative parotidectomy for primary benign pleomorphic adenoma (PBPA) of the parotid gland in a consecutive series of 229 patients has been reviewed. This study focuses on survival, morbidity, PBPA recurrence, postoperative facial nerve dysfunction, and Frey's syndrome. Surgical death was never encountered in this study. The overall incidence for postoperative hemorrhage, hematoma, seroma, skin necrosis, great auricular nerve schwannoma, and keloid scar was 1.7%, 6.1%, 4.8%, 0.9%, 15.7%, and 8.3%, respectively. Five-, 10-, 15-, and 20-year PBPA control actuarial rate was 99.6%. The overall incidence for temporary facial paresis and paralysis was 64.6% and 5.6%, respectively. Kaplan-Meier actuarial analysis demonstrated that paresis recovery was noted until the eighteenth postoperative month. The overall incidence for permanent facial paresis and paralysis was 3.9% and 0%, respectively. None of the following variables--sex, age, PBPA size, PBPA location, PBPA contact with the facial nerve, inadvertent PBPA spillage, or surgeon's experience--was statistically related to PBPA recurrence and facial nerve dysfunction. The overall incidence for Frey's syndrome was 65.9%. Kaplan-Meier actuarial analysis demonstrated the need for a minimal 5-year follow-up to assess Frey's syndrome incidence. The mean age was statistically lower in patients presenting with Frey's syndrome.

Adenoma, Pleomorphic↗
PubMed1994

[Computerized evaluation of acoustic parameters of voice and speech after partial supracricoid laryngectomy with cricohyoidoepiglottopexy].

Nineteen supracricoid porticol laryngectomy (SCPL) with cricohyoidoepiglottopexy (CHEP) speakers and 19 normal adult laryngeal (NAL) male speakers took part in this prospective study. Computed analysis of the voice and speech parameters was performed using the Computed Speech Lab from Kay Elemectrics. Parameters recorded for voice analysis were the average fundamental frequency, the fundamental frequency standard deviation, the jitter, the shimmer, the noise to harmonic ratio and the degree of voiceless. Parameters recorded for speech analysis were the maximum phonation time of the /a/ vowel, the phrase grouping and number of words read per minute. Speech and voice parameters statistically differed among NAL and SCPL with CHEP speakers. Among SCPL with CHEP speakers, none of the following factors (age, cricopharyngeal myotomy, piriform sinus tension, associated ipsilateral neck dissection, speech rehabilitation therapy) were statistically related to the frequential and durational variables. Jitter of SCPL with CHEP speakers was reduced as time elapsed from CHEP completion increased (p = .002). Maximum phonation time was reduced if one arytenoid cartilage was resected (p = 0.025).

Adult↗
PubMed1994

[Results of the treatment of spontaneous widening of tracheo-esophageal punctures after laryngeal implant].

Vocal rehabilitation by tracheosophageal puncture procedure and voice prosthesis was employed in a series of 68 patients (64 men and 4 women). The mean age was 68.4 years and ranged from 39 to 78 years. Enlarging tracheoesophageal fistula and leakage occurred in 31 patients. One or several conservative treatments were employed in 23 patients. Surgical closure of the tracheoesophageal fistula was performed in 5 patients (closure without muscular interposition: 3 patients, closure with sternomastoid muscle interposition: 2 patients). Leakage around the prosthesis was noted 8 days to 39 months postoperatively (mean: 11 months). Successful rates of conservative treatments were as following: prosthesis replacement with a small gauge catheter for several days followed by a prosthesis replacement: 9/17 (52.9%), replacement of prosthesis: 4/12 (33%), Gax Collagen injection: 3/9 (33%), cauterization of the tracheoesophageal tract: 0/1. Surgical closure was successful in all cases. Repuncture and prosthesis replacement was successful in one patient. Conservative treatment is initially recommended including prosthesis replacement with a small gauge catheter for several days and followed by a prosthesis replacement. Surgical treatment with muscular interposition is recommended in case of failure of conservative treatments.

Adult↗
PubMed1994

[Inverted nasosinusal papilloma and lateronasal rhinotomy].

The authors report about 18 cases of inverting papillomas treated between 1972 and 1992. (17 men and 1 woman). The minimum follow-up was of 30 months. The mean age was 55 years with ages ranging from 26 to 85 years. The most frequent symptom encountered was unilateral nasal obstruction. A synchronous carcinoma occurred in 2 patients. Treatment was always surgical: lateral rhinotomy and total ethmoidectomy. A local recurrence occurred in 1 on 16 benign inverting papillomas (6.2%). No local recurrence occurred in malignant inverting papillomas treated by surgery and followed by postoperative radiation. A metachronous malignant papilloma never occurred. Because of the high risk of recurrence and malignant transformation and after analyzing the literature, the authors recommend a lateral rhinotomy and total ethmoidectomy with as limited after effects as possible.

Adult↗
PubMed1994

[Cisplatin-fluorouracil chemotherapy in epidermoid cancers of glottic origin staged as T2].

A retrospective analysis of 94 patients presenting well-differentiated untreated invasive glottic squamous cell carcinomas, staged as T2 according to the 1987 Union Internationale contre le Cancer staging classification system, managed at our institution from March 1982 to April 1991 with cisplatin-fluorouracil neo-adjuvant chemotherapy, was conducted. Following neo-adjuvant chemotherapy, partial laryngeal surgery, and radiation therapy were performed in 85.1% (80/94) and 4.2% (3/94) of cases, respectively. Perioperative chemotherapy (fluorouracil) and postoperative chemotherapy (cisplatin-fluorouracil) was performed in 68.7% (55/80) and 63.7% (51/80) of patients who underwent surgery, respectively. Following neoadjuvant chemotherapy, one patient (1.1%) refused any form of treatment, and "exclusive" chemotherapy was performed in 9.6% (9/94) of cases. A 3-year follow-up was always achieved and 66 patients (70.2%) presented with a 5-year follow-up. A complete clinical response was achieved in 32.9% of cases following neo-adjuvant chemotherapy. A complete histological response was noted in 31.2% (25/80) of patients treated with partial laryngeal surgery following neo-adjuvant chemotherapy. A strong statistical relation was noted between complete clinical response and complete histological response (p < .0001). Chemotherapy related death never occurred in our series however chemotherapy related toxicity lead to reduction in the drug dosages and chemotherapy arrest in 14.3% and 3.6% of cases, respectively. The Kaplan-Meier 5-year survival, local recurrence, nodal recurrence, distant metastasis, and second primary estimate was 84.9%, 8.4%, 1.1%, 2.2%, and 10%, respectively. The overall local recurrence rate varied from 25% following neo-adjuvant chemotherapy and radiotherapy, to 33.3% following "exclusive" chemotherapy, and 3.7% following neo-adjuvant chemotherapy and partial laryngeal surgery. Overall local control and laryngeal preservation was achieved in 98.9% and 97.8% of patients respectively. Our data suggests that the use of neo-adjuvant cisplatin-fluorouracil induction chemotherapy deserves further consideration in the management of glottic carcinomas staged as T2.

Adult↗