Publications by authors named "Antoine Reinhard"

13 Publications

  • Page 1 of 1

Three-Dimensional Printed Nasal Prostheses After Oncologic Rhinectomies: Workflow and Patients' Satisfaction.

J Craniofac Surg 2021 Apr 5. Epub 2021 Apr 5.

Department of Otorhinolaryngology-Head and Neck Surgery, Lausanne University Hospital Department of Maxillofacial Surgery, Lausanne University Hospital, Lausanne, Switzerland.

Abstract: Reconstructions after oncologic full-thickness rhinectomies are often deferred from the ablative surgery. Definitive silicone prostheses are usually not used for transitional rehabilitation, and therefore, patients may deal with major facial defects for a long time before reconstruction. The aim was to develop a time- and cost-effective digital workflow to three-dimensional print temporary nasal prostheses and to assess patients' satisfaction. This prospective study enrolled all consecutive patients after full thickness ablative surgery and deferred reconstruction, from May 2018 to October 2019, at a tertiary care academic institution. With a dedicated software, the pre- and postoperative scans were three-dimensional processed to create the prosthesis and they were directly printed in elastic transparent resin. A cross-sectional survey was conducted 4 months after the rehabilitation to assess patients' satisfaction regarding comfort, aesthetics, and security of the retaining system. Seven patients were enrolled and they were all rehabilitated using this workflow. Mean time of design was 2h48 (SD 40 minutes), and mean printing time was 5h18 (SD 1 hour). Mean cost of production was 753 U.S. Dollars (SD 144 U.S. Dollars). Median scores of the visual analog scales were 8 out of 10 for each topic with interquartile range of 4 to 7 for aesthetics, 7 to 9 for comfort, and 7 to 10 for security of the retaining system. It has shown its feasibility in terms of costs and time of production. Patients were satisfied and it can be considered as a mean to help patients to deal with treatment sequelaes before definitive reconstruction.
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http://dx.doi.org/10.1097/SCS.0000000000007659DOI Listing
April 2021

Mucosal Melanoma of the Head and Neck: A Retrospective Review and Current Opinion.

Front Surg 2020 20;7:616174. Epub 2021 Jan 20.

ENT Department, CHUV, Lausanne, Switzerland.

Head and Neck Mucosal Melanoma (HNMM) is an uncommon malignancy that arises in decreasing order in the nasal cavity, the paranasal sinuses, and the oral cavity. Although radical surgery followed by eventual radiotherapy is acknowledged as the mainstay treatment, patients with advanced stages or multi-focal tumors benefit from new systemic therapies. We wish to share our experience with these treatments and review the current literature. We present a case review of every patient treated in our center for an HNMM over the past 10 years, including every patient treated in our center for an HNMM over the past 10 years. We analyzed clinical characteristics, treatment modalities, and outcomes. We included eight patients aged from 62 to 85 years old. We found six MM in the nasal cavity, one in the sphenoidal sinus, and one in the piriform sinus. Six patients underwent endoscopic surgery with negative margins, six underwent radiotherapy with variable modalities. Immunotherapy or targeted therapy was given in cases extensive tumors without the possibility of a surgical treatment or in two patient as an adjuvant treatment after R0 surgery. The three-year overall survival was 50%, and three patients (37.5%) are in remission. HNMM is associated with poor oncologic outcomes regarding the concerned patients of our review, as reported in the literature. New treatments such as immunotherapies or targeted therapies have not significantly changed the prognosis, but they may offer new interesting perspectives. Our small series of cases seems to confirm that surgical resection with negative margins improves overall survival.
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http://dx.doi.org/10.3389/fsurg.2020.616174DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7873938PMC
January 2021

[Chronic rhinosinusitis with nasal polyps : is there a place for monoclonal antibodies in 2020 ?]

Rev Med Suisse 2021 Jan;17(720-1):13-17

Service d'immunologie et allergie, CHUV, 1011 Lausanne.

Chronic rhinosinusitis with nasal polyps is a severe form of chronic rhinosinusitis, which has a strong negative impact on quality of life. Rhinoscopy is helpful for diagnosis, and initial management depends on intra-nasal corticosteroids and sometimes short-term oral corticosteroids (1 to 3 weeks). If well-conducted drug therapy fails, surgery is considered. In the event of post-surgery recurrence or in case of concomitant severe asthma, biologic therapies represent an interesting option. These drugs include dupilumab, mepolizumab, benralizumab and omalizumab. The choice of medication depends on the individual patient context, which includes the presence of atopic dermatitis, eosinophilia, or asthma.
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January 2021

[ENT management of head and neck cutaneous melanoma].

Rev Med Suisse 2020 Oct;16(709):1853-1859

Service d'ORL et de chirurgie cervico-faciale, CHUV, 1011 Lausanne.

A quarter of cutaneous melanomas occur on the head and neck. Despite close collaboration between the dermatology, oncology, pathology, nuclear medicine and otorhinolaryngology departments, the survival of patients presenting with this type of melanomas remains inferior to that of other parts of the body. The morbidity of head and neck surgery significantly alters the quality of life. Therefore, specific multidisciplinary expertise is required. We present here the specificities of ENT management.
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October 2020

[Anosmia and COVID-19].

Rev Med Suisse 2020 Apr;16(N° 691-2):849-851

Service d'ORL et chirurgie cervico-faciale, CHUV, 1011 Lausanne.

Anosmia associated or not with dysgeusia seems to be a frequent symptom in cases of infection with SARS-CoV-2 responsible for COVID-19. It can be the initial symptom of the disease or remain isolated in pauci-symptomatic patients. Waiting for scientific confirmation and in the context of the current pandemic, it seems essential to consider any patient with a new anosmia as being infected with SARS-CoV-2 until proven otherwise. These patients should therefore isolate themselves and remain alert to the occurrence of other symptoms suggestive of the infection and/or be tested. Topical and systemic corticosteroids and nose washes are contraindicated. The natural course of anosmia seems to be favorable in most cases.
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April 2020

Comparison of contemporary staging systems for oropharynx cancer in a surgically treated multi-institutional cohort.

Head Neck 2019 05 28;41(5):1395-1402. Epub 2018 Dec 28.

Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, Bern, Switzerland.

Background: Between the publication of the Union of International Cancer Control staging system (UICC) 7th and 8th editions, other staging algorithms for oropharyngeal squamous cell carcinoma (OPSCC) were proposed from Radiation Therapy Oncology Group (RTOG), MD Anderson Cancer Center (MDACC), and Yale University.

Methods: With C-statistics, the above-mentioned five staging algorithms were compared for overall and relapse-free survival endpoints in a multi-institutional cohort of OPSCC cases (n = 338) treated with primary surgery.

Results: Pathological UICC 8th ed yielded the highest C-indexes in the entire cohort and in the HPV- subset, whereas MDACC was superior for HPV+ OPSCC. RTOG was the simplest and holistic algorithm with a noninferior discriminatory power.

Conclusion: UICC 8th ed, MDACC, and RTOG offer moderate and comparable efficacy for staging in this OPSCC patient cohort undergoing surgical treatment. Notable discrepancy between clinical and pathological UICC 8th ed algorithms poses potential concerns in diagnosis, treatment, research, and data management.
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http://dx.doi.org/10.1002/hed.25574DOI Listing
May 2019

Eosinophilic Esophagitis: Relationship of Subepithelial Eosinophilic Inflammation With Epithelial Histology, Endoscopy, Blood Eosinophils, and Symptoms.

Am J Gastroenterol 2018 03 16;113(3):348-357. Epub 2018 Jan 16.

Swiss EoE Clinic, Praxis Römerhof, Olten, Switzerland.

Objectives: For technical reasons, the histologic characterization of eosinophilic esophagitis (EoE)-specific alterations is almost exclusively based on those found in the esophageal epithelium, whereas little is known about subepithelial abnormalities. In this study, we aimed to systematically assess the nature of subepithelial histologic alterations, and analyze their relationship with epithelial histologic findings, endoscopic features, and symptoms.

Methods: Adult patients with established EoE diagnosis were prospectively included during a yearly follow-up visit. Patients underwent assessment of clinical, endoscopic, and histologic disease activity using EoE-specific scores.

Results: We included 200 EoE patients (mean age 43.5±15.7 years, 74% males) with a median peak count of 36 intraepithelial eosinophils/hpf (IQR 14-84). The following histologic features were identified in the subepithelial layer: eosinophilic infiltration (median peak count of 20 eosinophils/hpf (IQR 10-51)), eosinophil degranulation (43%), fibrosis (82%), and lymphoid follicles (56%). Peak intraepithelial eosinophil counts were higher, identical, and lower when compared to the subepithelial layer in 62.5%, 7%, and 30.5% of patients, respectively. Anti-eosinophilic treatment at inclusion did not influence the relation between subepithelial and epithelial peak eosinophil counts. Subepithelial histologic activity correlated with epithelial histologic activity (rho 0.331, P<0.001), endoscopic severity (rho 0.208, P=0.003), and symptom severity (rho 0.179, P=0.011). Forty percent (21/52) of patients with <15 intraepithelial eosinophils/hpf had subepithelial peak counts of ≥15/hpf.

Conclusions: There is a significant but modest correlation between subepithelial histologic activity and epithelial histologic activity, endoscopic severity, and symptom severity. The long-term clinical impact of assessing subepithelial alterations in EoE needs to be further elucidated.
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http://dx.doi.org/10.1038/ajg.2017.493DOI Listing
March 2018

Temporary tracheal stenting using endovascular prosthesis in the management of severe refractory stenosis following slide tracheoplasty.

Eur Arch Otorhinolaryngol 2018 Jan 26;275(1):275-280. Epub 2017 Oct 26.

Department of Otorhinolaryngology, Lausanne University Hospital, 1005, Lausanne, Switzerland.

Objectives: To evaluate the role of endovascular stents in temporary tracheal stenting and endoscopic treatment strategy for patients with severe refractory tracheal stenosis following slide tracheoplasty.

Methods: Two patients had severe tracheal stenosis after slide tracheoplasty for long segment congenital tracheal stenosis. Both these patients were managed endoscopically and an endovascular prosthesis was used to temporarily stent the trachea. Short and long term results were evaluated clinically and with repeated endoscopies.

Results: The 2 patients had an excellent recovery immediately after the stent placement and continue to have an optimal, age-appropriate stable tracheal diameter after stent removal.

Conclusion: Endovascular stents can be temporarily used to stent the trachea in the endoscopic treatment strategy to correct refractory severe tracheal stenosis following slide tracheoplasty.
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http://dx.doi.org/10.1007/s00405-017-4792-4DOI Listing
January 2018

Extraluminal biodegradable splint to treat upper airway anterior malacia: A preclinical proof of principle.

Laryngoscope 2018 02 16;128(2):E53-E58. Epub 2017 Sep 16.

Department of Otolaryngology, Head and Neck Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.

Objective: Upper airway malacia highly complicates the treatment of benign laryngotracheal stenosis, and no ideal option is available to date. We here explore the use of extraluminal biodegradable splints in an animal model of long-segment anterior tracheomalacia (TM). We show the efficacy, as well as the tissue tolerance, of a custom-made biodegradable extraluminal device surgically inserted around the trachea.

Study Design: Preclinical animal study.

Methods: Anterior TM was induced in rabbits through an anterior neck approach by removing eight consecutive anterior tracheal rings without damaging the underlying mucosa. Malacia was corrected during the same surgery by pexy sutures, suspending the tracheal mucosa to an experimental biodegradable device. Symptoms, survival, and tissue reaction were compared to healthy and sham surgery controls.

Results: The model induced death by respiratory failure within minutes. Ten animals received the experimental treatment, and those who survived the perioperative period remained asymptomatic with a maximum follow-up of 221 days. Histological studies at programmed euthanasia showed complete degradation of the prosthesis, with significant remnant fibrosis around the trachea. However, the tracheal stiffness of test segments was comparatively less than that of control segments.

Conclusion: Extraluminal biodegradable splints rescued animals with a condition otherwise incompatible with life. It was well tolerated, leaving peritracheal fibrosis that was not as stiff as normal trachea. The external tracheal stiffening was sufficient for the test animals to live through the phase of severe acute hypercollapsibility. This represents a valid option to help pediatric patients with laryngotracheal stenosis and associated cartilaginous airway malacia.

Level Of Evidence: NA. Laryngoscope, 128:E53-E58, 2018.
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http://dx.doi.org/10.1002/lary.26857DOI Listing
February 2018

Impact of human papillomavirus on outcome in patients with oropharyngeal cancer treated with primary surgery.

Head Neck 2017 10 10;39(10):2004-2015. Epub 2017 Jul 10.

Institute of Pathology, Kantonsspital St. Gallen, Switzerland.

Background: Knowledge about prognostic factors in surgically treated patients with oropharyngeal squamous cell carcinoma (SCC) is limited. The purpose of this study was to identify influential factors on survival in a large cohort of patients with surgically treated oropharyngeal SCC.

Methods: Retrospective analysis of survival estimates in patients with surgically treated oropharyngeal SCC using tumoral positivity for human papillomavirus (HPV) and risk-of-death categories according to a study from 2010 as stratification factors.

Results: The 5-year overall survival (OS) and disease-specific survival (DSS) rates after surgery alone were higher in HPV-associated oropharyngeal SCC (OS 80% vs 62%; P = .01; DSS 92% vs 76%; P = .03). Patients in the low-risk category had higher survival rates (OS 91%; DSS 99%) than patients in the intermediate-risk group (OS 63%; DSS 83%), and high-risk group (OS 61%; DSS 75%).

Conclusion: Nonsmokers with HPV-positive oropharyngeal SCC have a better prognosis than smokers with HPV-positive oropharyngeal SCC and also than patients with HPV-negative tumors when treated by surgery alone.
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http://dx.doi.org/10.1002/hed.24865DOI Listing
October 2017

External bioresorbable airway rigidification to treat refractory localized tracheomalacia.

Laryngoscope 2016 11 12;126(11):2605-2610. Epub 2016 Mar 12.

Department of Otolaryngology, Head and Neck Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.

Objectives/hypothesis: Our study evaluates the efficacy of extraluminal bioresorbable plates to treat refractory localized airway malacia in patients undergoing corrective surgery for complex multilevel laryngotracheal stenosis.

Study Design: Retrospective case series.

Methods: Secondary malacic airway segments were characterized (severity, site, type) by a dynamic transnasal flexible laryngotracheobronchoscopy before surgery. Extraluminal bioresorbable plates were used to stabilize the malacic segment through a transcervical approach under intraoperative flexible endoscopic guidance. Results were evaluated subjectively and by a postoperative dynamic endoscopy. We report our experience in seven patients (6 children, 1 adult).

Results: External tracheal stiffening allowed complete or partial resolution of refractory proximal airway malacia in six of seven complex cases described (result in one case is awaited). It allowed quick decannulation in four of seven patients who experienced multiple previous failures. Decannulation failures were due to recurrence of stenosis. With up to 2 years of follow-up, we report no direct complications related to the presence of extraluminal bioresorbable plates around the airway.

Conclusion: Extraluminal biodegradable tracheal stiffening represents a valid therapeutic option in select cases of upper airway malacia. It can be highly useful in cases of complex multilevel airway obstructions. External stiffening needs to be planned on a case-to-case basis according to the type of malacia and must be performed under endoscopic guidance.

Level Of Evidence: 4. Laryngoscope, 126:2605-2610, 2016.
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http://dx.doi.org/10.1002/lary.25918DOI Listing
November 2016

Laser supraglottoplasty for laryngomalacia; a 14 year experience of a tertiary referral center.

Eur Arch Otorhinolaryngol 2017 Jan 13;274(1):367-374. Epub 2016 Aug 13.

Department of Otorhinolaryngology, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 21, 1011 Lausanne, Switzerland.

To review the outcomes of laser supraglottoplasty performed in children with symptomatic laryngomalacia and determine the factors influencing them. We retrospectively reviewed the medical records of patients who underwent laser supraglottoplasty for symptomatic laryngomalacia at the Lausanne University Hospital from November 2001 to November 2014. We examined the patient's demography, symptoms, comorbidities, type of laryngomalacia, synchronous airway lesions, and final outcomes. Seventy-nine patients were included in this study; median age at the time of surgery was 12.7 months. 55.7 % of the cases had comorbidities, 22.8 % of the patients were premature and synchronous airway lesions were present in 32.9 % of the cases. The different morphological types of laryngomalacia (I-III) were seen in 26.6, 62 and 11.4 % of the patients, respectively. Overall, operation specific success rate of laser supraglottoplasty was 86.1 %. Failures in 11 (13.9 %) of the 79 cases required 15 revision procedures. Success rates for patients with associated comorbidities, synchronous airway lesions, neurological disorders and prematurity were 81.8, 76.9, 69.2 and 66.7 %, respectively. Patients with type III laryngomalacia had a limited success rate (66.7 %) as compared to patients with morphological types I and II (90.5 and 87.8 %, respectively). Laser supraglottoplasty is an effective and safe treatment for symptomatic laryngomalacia. Patients with prematurity, type III LM, synchronous airway lesions and associated comorbidities are predisposed to surgical failure.
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http://dx.doi.org/10.1007/s00405-016-4252-6DOI Listing
January 2017

Endoscopic epiglottopexy using Lichtenberger's needle carrier to avoid breakdown of repair.

Eur Arch Otorhinolaryngol 2015 Nov 11;272(11):3385-90. Epub 2015 Jul 11.

Department of Otolaryngology, University Hospital, Lausanne, Switzerland.

Severe type III laryngomalacia LM is represented by a retroflexed epiglottis that touches the posterior pharyngeal wall and obstructs the laryngeal inlet. Endoscopic epiglottopexy is advised in such cases wherein pexy sutures are passed between the epiglottis and base of tongue. Using conventional needle carriers, it is difficult to pass such sutures that go deep enough into the tongue base. Such a pexy is prone to a break down. We describe a novel technique of placing these glossoepiglottic sutures using the Lichtenberger's needle carrier. We used this technique in three patients with excellent results and report no complications. We propose to use this technique in cases of epiglottic prolapse seen in severe LM and certain hypotonic conditions.
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http://dx.doi.org/10.1007/s00405-015-3707-5DOI Listing
November 2015