Publications by authors named "Karma Lambercy"

13 Publications

  • Page 1 of 1

Intubation Related Laryngeal Injuries in Pediatric Population.

Front Pediatr 2021 10;9:594832. Epub 2021 Feb 10.

Head and Neck Surgery Department, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.

Laryngeal intubation related lesions (LIRL) in pediatric patients cause extreme morbidity in both elective and emergency settings. It has a wide range of presentations from minor laryngeal edema to a life-threatening airway obstruction. We report here our units' experience with LIRL in neonates, infants, and small children. This is a retrospective monocentric cohort study between January 2013 and April 2019. Thirty-nine patients with intubation lesions were included in the study. We looked at the lesions type, characteristics, management, and outcome. Half the patients were premature and having comorbidities. Main LIRL were subglottic stenosis (31%), ulcers (26%), granulations (18%), retention cysts (18%), posterior glottic stenosis (13%), and vocal cords edema (5%). Unfavorable lesions causing airway stenosis were associated with an intubation duration of over 1 week and were an important factor in causing airway stenosis ( < 0.05). The endoscopic treatment performed for these lesions was lesion and anatomical site-specific. Tracheostomy was needed in five patients, and was avoided in another two. Seven patients (18%) received open surgery prior to their decannulation. LIRL management is challenging and stressful in the pediatric population and optimal treatment could avoid extreme morbidity in them. Intubation duration and associated comorbidities are important factors in deciding the severity of these lesions. Protocols to prevent the formation of these lesions are critical.
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http://dx.doi.org/10.3389/fped.2021.594832DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7902727PMC
February 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

[Atypical neck pain: an example of a little-known syndrome].

Rev Med Suisse 2020 Oct;16(709):1891-1893

Service d'oto-rhino-laryngologie, CHUV, 1011 Lausanne.

Eagle's syndrome is an unknown disease. Its suspicion is first and foremost clinical and his symptoms are diverse. The diagnosis is confirmed by imaging. Its management is surgical: resection of the styloid process by trans-oral or trans-amygdala route. Patients often consult several specialists and there are many investigations before the right diagnosis is made.
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October 2020

[Obstructive sleep apnea syndrome : CPAP or Mandibular Advancement Device?]

Rev Med Suisse 2020 Oct;16(709):1865-1869

Service d'oto-rhino-laryngologie et chirurgie cervico-faciale, CHUV, 1011 Lausanne.

Obstructive sleep apnea syndrome (OSAS) is a respiratory disorder affecting up to 49 % and 23 % of middle to older aged men and women respectively. CPAP (continuous positive airway pressure) is the gold-standard treatment for severe apneas. In mild and moderate forms of OSAS, mandibular advancement devices (MAD) are equally a first line of treatment. Both CPAP and MAD have their advantages and side effects. Patient tolerance to these two therapies varies according to different patient-parameters. In order to guide physicians and patients in choosing between these two treatments, we present a description of both treatment modalities.
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October 2020

A new endoscopic surgical approach to the larynx, hypopharynx, and neck lymphatics: The robotic-assisted extended "Sistrunk" approach (RESA).

Head Neck 2020 09 13;42(9):2750-2756. Epub 2020 Jun 13.

Department of Otolaryngology - Head and Neck Surgery, CHUV, University of Lausanne, Lausanne, Switzerland.

Background: We report on the feasibility of a novel robotic-assisted extended "Sistrunk" approach (RESA) to the larynx, hypopharynx, and lateral neck lymphatics.

Methods: Studies were performed using the da Vinci Xi and SP system on three cadavers comprising of three supraglottic laryngectomies, one partial hypopharyngectomy, and four lateral level II to IV neck dissections.

Results: In all resections at first a central common working space overlying the hyoid bone was created. The da Vinci Xi system was used with two vestibular and two submental ports for laryngeal/hypopharyngeal resections, and an additional port through a facelift incision for level II to IV neck dissections. The da Vinci SP system was used with only one submental port.

Conclusions: We describe herein a novel endoscopic robotic approach to the larynx, hypopharynx, and neck based on the traditional "Sistrunk" procedure. The technique should help improving exposure of the primary lesion and reduce access-related morbidity to the neck.
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http://dx.doi.org/10.1002/hed.26273DOI Listing
September 2020

[New therapy for sleep apnea at CHUV: hypoglossal nerve stimulation].

Rev Med Suisse 2019 Oct;15(665):1760-1764

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

Neurostimulation of the hypoglossal nerve is a new alternative treatment to CPAP (Continuous Positive Airway Pressure) for patients with moderate-to-severe OSAS (Obstructive Sleep Apnea Syndrome) with anteroposterior pharyngeal obstruction visualized during a Drug Induced Sleep Endoscopy (DISE). Implantation and follow-up are performed at the CHUV with the collaboration between the SAOS-ronchopathie unit, the maxillofacial and dental surgery division and the center for investigation and research on sleep (CIRS). In this article, we present the technique, its indication and the outcomes through a recent review of the literature. This new device has been used for five years, mainly in the United States and Europe.
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October 2019

Role of Unilateral Vocal Cord Palsy in Causing Recurrent Tracheobronchial Foreign Bodies.

Front Pediatr 2019 24;7:282. Epub 2019 Jul 24.

ENT Head and Neck Surgery Department, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.

Foreign body (FB) aspiration in children is a frequent condition managed by ENT pediatric surgeons and pediatric pulmonologists. We present the case of a 20-months-old child who presented with three recurrent episodes of FB aspiration. At the time of FB removal, an initial dynamic examination of the larynx revealed a unilateral vocal cord palsy (UVCP). For recurrent tracheobronchial FB inhalation, we recommend a systematic dynamic airway endoscopy.
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http://dx.doi.org/10.3389/fped.2019.00282DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6668050PMC
July 2019

[Sleep apnea : diagnostic and therapeutic modalities in case of failure of the CPAP].

Rev Med Suisse 2018 Oct;14(621):1751-1754

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

Obstructive sleep apnea (OSA) is a sleep disorder that affects 49 % of men and 23% of women over 40 years old. CPAP is currently the treatment of choice for severe OSAS, but there are mild to moderate cases of OSAS with poor compliance or intolerance to CPAP, for which alternative treatments should be considered. In this article, we present a tool for evaluation of the upper airways, the DISE (Drug-induced sleep endoscopy), the OAM (mandibular advancement device), the bimaxillary advancement osteotomy, the hypoglossal nerve stimulation and the positional treatment.
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October 2018

Lamb larynx model for training in endoscopic and CO laser-assisted surgeries for benign laryngotracheal obstructions.

Eur Arch Otorhinolaryngol 2018 Aug 4;275(8):2061-2069. Epub 2018 Jun 4.

Department of Otolaryngology, Head and Neck Surgery, University Hospital of Lausanne (CHUV), Bugnon 46, 1011, Lausanne, Switzerland.

Purpose: With adequate indication and meticulous execution, endoscopic procedures can efficiently treat a subset of adult and pediatric benign laryngotracheal stenosis and obstructions, but these procedures are precise and very demanding. The difference between a successful and a failed surgery, with potentially debilitating side effects, resides in small details. The learning curve is long and very few centers worldwide have a sufficient case load making adequate training difficult. While indications and concepts of endoscopic procedures can be learned in books and by observing trained colleagues, the dexterity and the precise realization need to be practiced, ideally not initially on patients.

Methods: We describe here the lamb model system for the initial training in such procedures. We provide a step-by-step guide for endoscopic approaches intended to treat pathologies such as laryngomalacia, bilateral vocal fold paralysis, posterior glottic stenosis, and laryngotracheal clefts.

Conclusions: The lamb model system does not pose ethical issues, and it is easy to obtain and to handle. It was used during an international training course for laryngotracheal stenosis by novice and advanced airway surgeons. It was unanimously judged as relevant and useful by the participants.
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http://dx.doi.org/10.1007/s00405-018-5011-7DOI Listing
August 2018

Congenital pharyngeal webs: Treatment of a rare clinical entity by endoscopic CO laser approach.

Int J Pediatr Otorhinolaryngol 2017 Nov 3;102:123-126. Epub 2017 Aug 3.

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

Importance: Oesophageal inlet stenosis can promote dysphagia and aspiration. We report the cases of syndromic children with congenital pharyngeal webs successfully treated with endoscopic CO2 laser.

Observations: Pharyngeal webs were excised with CO2 laser (Ultrapulse mode) and resurfaced using mucosal advancement flaps to avoid restenosis and/or formation of secondary synechia. This led to a significant enlargement of the oesophageal inlet, which was documented immediately postoperatively and the clinical improvement of dysphagia and decreased aspiration persisted at distant follow-up.

Conclusion And Relevance: Pharyngeal webs are congenital anomalies that can be safely and effectively corrected with endoscopic treatment.
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http://dx.doi.org/10.1016/j.ijporl.2017.08.001DOI Listing
November 2017

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

[Retropharyngeal abscess in children].

Rev Med Suisse 2017 Oct;13(577):1698-1702

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

A retropharyngeal abscess is a collection of pus located behind the posterior pharyngeal wall. Main symptoms include torticoli, pyrexia and odynodysphagia. It can be secondary to upper airway infections, pharyngeal penetrating trauma or idiopathic. Complications are rare, but may be life-threatening due to airway obstruction or infection's spread to the surrounding structures. Surgery is conducted in case of abscess > 2 cm on CT scan images, complication or worsening of the symptoms. This article presents a clinical case with literature review.
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October 2017

[Otoscopic pitfall : the congenital cholesteatoma].

Rev Med Suisse 2016 Oct;12(533):1653-1656

Service d'oto-rhino-laryngologie et de chirurgie cervico-faciale, CHUV, 1011 Lausanne.

The congenital cholesteatoma is a rare benign tumor whose diagnosis is mainly made during childhood. Otoscopic examination shows a white retrotympanic collection with or without hearing loss. In case of a late diagnosis, the disease will spread to the surrounding structures, leading to ossicules destruction, facial palsy, sensorineural hearing loss and vestibular dysfunction. Surgery is the therapeutic gold-standard, with different techniques chosen based on the cholesteatoma's extension. Patient should benefit from a long term medical and radiological (MRI) follow-up.
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October 2016