External or internal lateral osteotomy: why I choose the external percutaneous approach.

The authors present their surgical experience with the management of patients with dorsum deformities using a precise technique: the external percutaneous approach. The indications for this technique have still not been set out very clearly in the rhinological textbooks or manuals, and so novices (and not only novices) have difficulty in understanding and applying it. We therefore try to systematise and clarify these indications in brief, together with the technical details, providing a comparison with another technique that is in very widespread use at present: the internal lateral osteotomy. Although the external percutaneous approach is not used very often--in our experience in 30% of cases only--we find the results very satisfactory and we recommend it when it is required by the anatomic conditions.

Autologous costochondral cartilage implant in two cases of velopharyngeal insufficiency.

The velopharyngeal sphincter is critical in enabling the functions of speaking and swallowing. Velopharyngeal insufficiency (VPI) results in hypernasal speech and nasal regurgitation. A frequent cause of VPI is congenital cleft palate, but otolaryngologists sometimes encounter iatrogenic VPI after surgery. Treatment of VPI with prostheses is often successful but not always well tolerated. Many surgical procedures have been proposed to correct palatal length or to enlarge the posterior pharyngeal wall. We report two cases in which autologous costochondral cartilage was used as implant augmentation. This approach is indicated and efficient when the velopharyngeal deficit is less than 5 mm. An autologous costochondral cartilage implant procedure is safe and reversible and can be expected to incite minimal host reaction.

The antrochoanal polyp.

The different varieties of choanal polyps are reviewed by the authors according to their implantation pedicle. Their histology, possible pathogenesis, the various symptoms, steps in the diagnostic procedure and differential diagnoses are also described. Finally, the various modes of treatment are discussed, focussing in particular on the surgical methods and the new possibilities offered by developments in the field of endoscopy.

Surgery of inverted papillomas under endoscopic control.

Six centers cooperated in a retrospective study on endoscopic surgical resection of Papillomas of the nose and paranasal sinuses in order to assess both the efficiency and the safety of this kind of surgical approach. From 1991 till march 2000, 87 cases of Papillomas resections under--at least partially--endoscopic control were gathered, among which 85 were Inverted Papillomas (IP), 2 were Exophytic Papilloma (EP) and one was IP coexisting with Collumnar Cell Papilloma (CCP). Malignant transformation was found out in 3 cases of IP. Regarding the 85 patients with IP demographics are as follows: 61 males, 24 females, with a mean age of 58.4 years (STDV: 13.96) in a range from 27 to 92 years. The mean follow-up was of 41.9 months with range of 1-120 months. Fifteen recurrences occurred that were treated by revision surgery either under endoscopic control or by limited external approach. The mean time for recurrences to occur was 8.07 months with range of 1-24 months. The three patients with malignant transformation underwent postoperative radiation therapy. All of the patients are free of recurrence, however for some of them the follow-up is too short to definitely assess their free of disease status. The role of modern diagnostic tools in medical imaging--CAT and MRI--in order to assess clearly the limits of the tumors and to enhance the efficiency and the safety in the choice of a surgical approach is pointed out. The stress is put on the need for radical excision under endoscopic control which can be combined with the Caldwell-Luc transantral approach or with frontal trepanation for the cure of tumors impossible to be reached under endoscopic control only. Irrespective of the tumor extent and of the approaches that was used for excision a close endoscopic follow-up still remain mandatory, by trained surgeons, in the long term management of IP. Biopsies, CAT and/or MRI must be performed in any case with recurrence suspicion.

[Relations between vasculotensional disease, sudden deafness and benign paroxysmal postural vertigo: value of anticochlear antibodies]. / Relations entre la maladie vasculotensionnelle, la surdité brusque et le vertige positionnel paroxystique bénin: intérêt des anticorps anticochléaires.

Some vasculotensional diseases may be associated, at a certain point of their evolution, with occurrences of sudden deafness or of benign paroxysmal positional vertigo. It seems that the efficiency of the treatments of sudden deafness and benign paroxysmal positional vertigo is not modified by those associations of pathologies. On the other side, the search for anticochlear antibodies gives a positive result in 45% of the vasculotensional diseases. When the vasculotensional disease is associated with sudden deafness, this percentage increases. On the contrary, it is lower when the vasculotensional disease is associated with benign paroxysmal positional vertigo. The presence of anticochlear antibodies may lead to a corticotherapy in case of failure of the classical treatments.