Objectives: First, establishment and validation of a novel questionnaire documenting the burden of xerostomia and sialadenitis symptoms, including quality of life. Second, to compare two versions regarding the answering scale (proposed developed answers Q3 vs. 0-10 visual analogue scale Q10) of our newly developed questionnaire, in order to evaluate their comprehension by patients and their reproducibility in time.Study Design: The study is a systematic review regarding the evaluation of the existing questionnaire and a cohort study regarding the validation of our new MSGS questionnaire.Materials and Methods: A Multidisciplinary Salivary Gland Society (MSGS) questionnaire consisting of 20 questions and two scoring systems was developed to quantify symptoms of dry mouth and sialadenitis. Validation of the questionnaire was carried out on 199 patients with salivary pathologies (digestive, nasal, or age-related xerostomia, post radiation therapy, post radioiodine therapy, Sjögren's syndrome, IgG4 disease, recurrent juvenile parotitis, stones, and strictures) and a control group of 66 healthy volunteers. The coherence of the questionnaire's items, its reliability to distinguish patients from healthy volunteers, its comparison with unstimulated sialometry, and the time to fill both versions were assessed.Results: The novel MSGS questionnaire showed good internal coherence of the items, indicating its pertinence: the scale reliability coefficients amounted to a Cronbach's alpha of 0.92 for Q10 and 0.90 for Q3. The time to complete Q3 and Q10 amounted, respectively, to 5.23 min (AE2.3 min) and 5.65 min (AE2.64 min) for patients and to 3.94 min (AE3.94 min) and 3.75 min (AE2.11 min) for healthy volunteers. The difference between Q3 and Q10 was not significant.Conclusion: We present a novel self-administered questionnaire quantifying xerostomia and non-tumoral salivary gland pathologies. We recommend the use of the Q10 version, as its scale type is well known in the literature and it translation for international use will be more accurate.

Background. RAS gene mutations have an impact on treatment response and overall prognosis for certain types of cancer. Objectives. To determine the prevalence and impact of K-RAS codons 12 and 13 mutations in patients with locally advanced HNSCC treated with primary or adjuvant chemo-radiation. Methods. 428 consecutive patients were treated with chemo-radiation therapy and followed for a median of 37 months. From these, 199 paraffin embedded biopsy or surgical specimens were retrieved. DNA was isolated and analyzed for K-RAS mutational status. Results. DNA extraction was successful in 197 samples. Of the 197 specimens, 3.5% presented K-RAS codon 12 mutations. For mutated cases and non-mutated cases, complete initial response to chemoradiation therapy was 71 and 73% (P = 0.32). LRC was respectively 32 and 83% (P = 0.03), DFS was 27 and 68% (P = 0.12), distant metastasis-free survival was 100 and 81% (P = 0.30) and OS was 57 and 65% (P = 0.14) at three years. K-Ras codon 13 analysis revealed no mutation. Conclusion. K-RAS codon 12 mutational status, although not associated with a difference in response rate, may influence the failure pattern and the type of therapy offered to patients with HNSCC. Our study did not reveal any mutation of K-RAS codon 13.

Background. HPV is a positive prognostic factor in HNSCC. We studied the prevalence and prognostic impact of HPV on survival parameters and treatment toxicity in patients with locally advanced HNSCC treated with concomitant chemoradiation therapy. Methods. Data on efficacy and toxicity were available for 560 patients. HPV was detected by PCR. Analysis was performed using Kaplan-Meier survival curves, Fisher's test for categorical data, and log-rank statistics for failure times. Results. Median follow-up was 4.7 years. DNA extraction was successful in 255 cases. HPV prevalence was 68.6%, and 53.3% for HPV 16. For HPV+ and HPV−, median LRC was 8.9 and 2.2 years (P = 0.0002), median DFS was 8.9 and 2.1 years (P = 0.0014), and median OS was 8.9 and 3.1 years (P = 0.0002). Survival was different based on HPV genotype, stage, treatment period, and chemotherapy regimen. COX adjusted analysis for T, N, age, and treatment remained significant (P = 0.004). Conclusions. Oropharyngeal cancer is increasingly linked to HPV. This study confirms that HPV status is associated with improved prognosis among H&N cancer patients receiving CRT and should be a stratification factor for clinical trials including H&N cases. Toxicity of CRT is not modified for the HPV population.

HIV is a recognized etiologic agent in the development of peripheral facial paralysis (PFP). In most cases, the paralysis appears in the acute phase of the HIV infection, and its prognosis is similar to Bell's palsy. Other etiologic agents are generally involved in the development of the paralysis in the later stages of the disease. Bilateral facial palsy is a rare clinical entity in HIV infection. Only 19 cases have been reported. A case of facial diplegia revealing AIDS is described in this review. To the best of our knowledge, this is the first report of such an advanced state of the disease in a previously asymptomatic patient.

A n otherwise healthy 58-year-old woman was referred to our clinic for a slowly progressive obstructing mass in her right ear canal that appeared 1 year prior to consultation. The patient also complained of right hearing loss and occasional bleeding. Physical examination revealed a pink heart-shaped nonulcerated tumor protruding from the ear canal, molding the conchal bowl ( Figure 1). The mass was nontender, solitary, rubbery, and not adherent to the canal walls. Facial nerve was intact. Computed tomography (CT) scan showed a soft tissue mass that filled the right middle ear and external auditory canal. Biopsy was consistent with a myxoma. Other diagnoses include hemangiomas, ceruminous neoplasms, squamous papillomas, and cutaneous malignancies. The patient underwent a canal wall-down tympanomastoidectomy. Intraoperative findings showed the mass originated from the middle ear cavity, had eroded the ossicles, and invaded the sinus tympani and the Eustachian tube. This study was approved by the ethics committee of the University of Montreal Hospital Center.Ear myxomas are extremely rare benign tumors. In the head and neck, myxomas arise mostly in the mandible 1 but can occur in the pinna, ear canal, middle ear, and temporal bone. 2 Metastases in the head and neck from other sites can also emerge (eg, heart myxomas). 2 Both genders are equally affected, and the tumors generally appear in patients in their 20s and 30s. 2 Myxomas can occur as well in Carney complex, an autosomal dominant disorder characterized by cardiac and cutaneous myxomas, endocrine tumors, and schwannomas. 2 Recognition of this disease is important because cardiac myxomas are potentially fatal. 3 Ear myxomas can be hypodense or isodense on CT scanning, and contrast enhancement is variable. 2 These tumors are generally unresponsive to radiotherapy, 2 and surgical resection is advocated. 4 En bloc excision is difficult because they are locally invasive. Up to 25% of tumors do recur after treatment. 2 Author ContributionsOlivier Abboud, substantial contributions to conception and design, acquisition and analysis of data, drafting the article, and final approval of the version to be published; Issam Saliba, substantial contributions to conception and design, acquisition and interpretation of data, revising the article critically for important intellectual content, and final approval of the version to be published.

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