[Microdebrider-assisted partial turbinoplasty: technique and results in perennial non-allergic rhinitis]. / Turbinoplastie endoscopique au microdébrideur: technique et résultats dans la rhinite vasomotrice primitive.

AIM OF THE STUDY: To assess objective and subjective outcomes in patients with perennial non-allergic rhinitis who had undergone endoscopic microdebrider-assisted inferior turbinoplasty. PATIENTS AND METHODS: Twenty patients (13 men and 7 women; age range, 15-64 years; mean age, 42.6 years) were included in a prospective study. Each patient had a perennial non-allergic rhinitis with substantial mucosal hypertrophy of the inferior turbinates, resistant to a 4- to 6-week course of nasal saline irrigations and nasal steroid spray. Then, they underwent endoscopic microdebrider-assisted inferior turbinoplasty with follow-up 6 months after surgery. This technique describes an elevator incorporated into a small microdebrider blade (2.0 mm). It provides a method for achieving the goals of volumetric reduction with mucosal preservation, with 0O endoscopic guidance, and minimal risk of complications. Objective outcomes were evaluated by peak nasal inspiratory flow (PNIF), an easy and highly reproducible measurement. Subjective symptoms were measured by a standard 10-cm visual analog scale, and analyzed before, at 1, 3 and 6 months after surgery. RESULTS: Preoperative PNIF measurement was 65 L/min, 98 L/min at 1 month, 123 L/min at 3 months and 126 l/min at 6 months. Statistical analysis (Wilcoxon signed rank test) showed significant improvement between preoperative and 1, 3 and 6 months. Subjective nasal obstruction improvement was statistically significant between preoperative and 1, 3 and 6 months. CONCLUSIONS: Our results suggest that microdebrider-assisted inferior turbinoplasty is effective for decreasing objective and subjective nasal in patients with perennial allergic rhinitis who have substantial nasal congestion.

[Evolution of facial nerve prognosis in vestibular schwannoma surgery by translabyrinthine approach]. / Evolution du pronostic du nerf facial dans la chirurgie du neurinome de l'acoustique par voie translabyrinthique.

OBJECTIVES OF THE STUDY: To evaluate our results on the postoperative facial function, its pre and preoperative predictive factors, and the application of the surgical technique to lesions of decreasing size. PATIENTS AND METHODS: A series of 248 patients operated of an unilateral vestibular schwannoma has been reviewed. We have compared the results gathered over two periods corresponding to the evolution of our surgical technique since 1998. RESULTS: Immediate and 1 year postoperative facial function is significantly better among patients operated after 1998 (satisfactory in 75 and 88% respectively). This trend marked by the improvement of the results since 1998 has to be discussed according to other predictive factors. One of predictive factor is the decrease of the size of the lesion during the same period. The other factors are the hearing level, deafness duration, trigeminal nerve involved, vestibular status and ABR desynchronization. CONCLUSION: The positive predictive factors are usually correlated with the size of the tumour This implies the necessity of an early diagnosis of the schwannomas. The second predictive factor of the facial function is the use of a soft surgical technique.

[Free temporoparietal osteomuscular flap for cranioplasty]. / Cranioplastie par lambeau libre ostéomusculaire temporo-pariétal.

PURPOSE: Advances in composite materials for craniofacial reconstruction surgery has tended to limit indications for osteomuscular free flaps which nevertheless must be used for certain septic patients. The purpose of this report was to illustrate the usefulness of the free temoroparietal osteomuscular flap in this particular situation. CASE REPORT: A 47-year-old man underwent surgical repair of an aneurysm of the anterior communicating artery complicated by acute hydrocephaly treated by external then ventriculoperitoneal bypass. The fronto-pteryonal approach was used. The early postoperative period was complicated by osteitis of the cranial piece requiring revision. The revision procedure, performed at the end of the septic period, involved cranioplasty with acrylic cement. Recurrent infection contraindicated any new attempt for prosthetic repair. The patient was treated with a controlateral free temporoparietal osteomuscular flap to achieve cranioplasty. The postoperative period was uneventful with no infection and satisfactory healing. Flap vitality was very satisfactory. The patient's neurological status improved and no further complication developed. DISCUSSION: In certain therapeutic situations, several diffent techniques may be required to overcome postoperative complications or manage particularly difficult cases. A free osteomuscular flap can be a useful alternative for cranioplasty. This technique is rarely used but can offer an optimal solution in selected patients, particularly for second intention revision after failure of prosthetic repair.