[Esthesioneuroblastoma: general review about three new cases (author's transl)]. / Les esthésioneuromes olfactifs. Revue générale à propos de trois nouvelles observations.

The authors report three new cases of olfactory esthesioneuromas. They emphasise, both the surgical and radiotherapeutic methods used, and staging according to Kadish. Very localized forms may be treated either by surgery or radiotherapy. Less localized forms require association of surgery and radiotherapy, with a craniofacial combined approach when extension goes beyong the lamina cribosa.

[Tracheo-bronchial granular cell tumors. Apropos of 4 cases]. / Les tumerus trachéo-bronchiques à cellules granuleuses. A propos de quatre observations.

We have seen four cases of granular cell tumor (Abrikossoff's tumour) and it is recalled that these tumours are most often discovered fortuitously by bronchoscopy in the tracheo-bronchial region because they have a non specific clinical presentation. The cytological and histological characteristics enable an accurate diagnosis but there are problems posed as to the histogenesis of these tumours. With a tumour with a slow progression regular surveillance with regular biopsies seems preferable as in certain cases the tumour regresses spontaneously or disappears after ablation with the forceps. A good alternative approach is destruction of the tumours with a laser in certain complicated forms which enables one to avoid surgical excision.

[Value of the pectoralis major musculocutaneous flap in the repair of the posterior wall of the pharynx and the lateral wall of the hypopharynx]. / Intérêt du lambeau musculo-cutané du grand pectoral dans la réparation de la paroi postérieure du pharynx et latérale de l'hypopharynx.

Two further indications for the use of a musculocutaneous flap from pectoralis major are reported: mucosal reconstruction after posterior pharyngectomy and vertical hemi-laryngopharyngectomy. This method was used in 7 cases, after previous surgery in 6 of these patients. Caution is necessary when interpreting carcinologic results because of the lack of long-term follow up results, but postoperative course was uncomplicated and tube removal and subnormal feeding was possible within 3 to 6 weeks.

[Retrospective study of the treatment of piriform sinus cancers. Apropos of 97 cases]. / Etude rétrospective du traitement des cancers du sinus piriforme. A propos de 97 cas.

Results of a retrospective analysis of case-reports of 97 patients treated for piriform sinus cancer showed a high frequency of large tumors and adenopathies providing an explanation for the very poor prognosis of these cancers. Therapy of choice for T1-T2 tumors is still radiotherapy. However, recently obtained results and data from the literature demonstrate the increased benefits of partial surgery with monoblock curettage followed by radiotherapy in cases with an ulcerous tumor, a mobile larynx and adenopathy of 3 cm or more. For T3-T4 cases the best treatment is by total pharyngolaryngectomy and postoperative radiotherapy.

[Laryngotracheal stenosis treated by the Rethi operation : anatomical and functional (respiratory and vocal) results (author's transl]. / Sténoses laryngo-trachéales traitées par opération de Réthi : résultats anatomiques et fonctionnels (respiratoires et vocaux).

On the basis of 25 cases of laryngotracheal stenosis of mescellaneous etiology, the authors report their experience of Rethi's operation carried out in 14 cases, 8 patients having received medical and instrumental treatment, 1 undergoing surgery for resection and anastomosis according to Pearson's technique and 3 receiving symptomatic treatment by tracheotomy because of inoperable stenosis. The frequency of postop-operative complications of Rethi's operation was analysed (essentially infectious, but also as a result of obstruction of the calibration prosthesis which represents a definite vial risk). Functional results were also assessed, being relatively satisfactory from a respiratory functional standpoint, but less good from a phonetic standpoint. The authors then define their present therapeutic attidude which leans, in the case of pure sub-glottal and sub-glotto-tracheal stenosis, towards a direct approach with resection anatomosis according to Pearson's technique rather than calibration procedures which remain the treatment ofa choice for glotto-sub-glottal stenosis.

[Cervical branchiomeric paraganglioma. Report of 21 cases]. / Paragangliomes branchiomériques cervicaux. A propos de 21 cas.

Over the last 24 years the authors operated 21 branchiomeric paragangliomas in 18 patients. They emphasize the difficulty of making the diagnosis and the importance of completing a thorough work-up before deciding surgery. Adequate imaging is particularly important (neck sonography, computed tomography, arteriography) to avoid making the diagnosis by exploratory neck dissection and to assess the vascular risk. Biological studies have regained importance, especially in the context of complex neuro-cristopathy. Treatment is essentially surgical and must be considered with prudence in patients with bilateral lesions. The surgical removal of branchiomeric paragangliomas necessitates preparation of a small saphenous vein bypass in case it is not possible to avoid sacrificing the internal carotid artery.

[Surgical treatment of traumatic facial paralysis]. / Le traitement chirurgical des paralysies faciales traumatiques

Facial paralysis caused by cranial traumatism often needs surgical treatment / 28 operations were carried out on a group of 47 paralysed patients. Direct lesion of the facial nerve was in fact common / 10 compressions or contusions, 4 sections. Associated kophosis was frequent (15 cases). Conductive deafness was not uncommon (11 cases). Transverse fractures (5 cases) and complicated fractures (4 cases), true to their reputation for seriousness, all needed surgery and span the four nerve sections observed. Surgery is often delayed due to extensive cranio-cerebral lesions requiring prolonged neuro-surgical nursing care / 16 patients were operated on between the 4th and 8th weeks, 9 patients after the 8th week. The operation was usually carried out through the mastoid. Posteiror lympanotomy enabled the bend and the second portion to be reached and later enabled the ossicular chain to be reconstructed. In two cases involving kophosis, the three portions of the nerve were tackled through the labyrinth. The choice depends on the audiometric, radiological and operative findings. Surgical indications depend on clinical, elecromyographic, audiometric and radiological results. A check was carried out by means of muscular tests in 23 out of 28 cases: --20 decompressions / 15 recuperations of more than 50 p. 100 of which 7 were above 75 p. 100; --3 grafts or sutures / 3 recuperations of 30 p. 100.

[The role of anastomosis resection in the treatment of stenosis of cervical trachea after resuscitation]. / La place de la résection anastomose dans le traitement des sténoses de la trachée cervicale après réanimation

The authors describe a group of 9 resection anastomoses with end-to-end sutures of the cervical portion of the trachea after resuscitation. The operative results are analyzed first: in 8 cases the trachea recovered almost normal function in a very short time; one failure occurred : this was with a patient with considerable neuro-psychic sequelae following serious cranial traumatism. These results are then compared with 7 laryngo-tracheal plasties carried out according to the principles of Rethi's operation; it emerges from this study that circumferential resection followed by end-to-end anastomosis is still the ideal form of treatment for tracheal stenoses in view of the quality and consistency of the results. Operative technique is then described and, in giving their operative indication, the authors stress the need for medical and endoscopic treatment during the asphyxial crisis; this treatment is then suggested for removing the tube in open tracheal stenoses and in order to allow resection anastomosis with the trachea closed several weeks later.

[Selective laryngeal re-innervations in the dog by nervous microsutures of branches of the recurrent laryngeal nerve]. / Réinnervations laryngées sélectives chez le chien par micro-sutures nerveuses des branches de division du nerf récurrent.

INTRODUCTION: This work has been carried out to investigate in an animal model, the possibility of surgical selective reinnervation of the larynx following destruction of the laryngeal branch of the vagus nerve. MATERIAL AND METHODS: In ten dogs, on the right side of the neck only, the recurrent laryngeal nerve was identified, cut and section of the nerve removed. Following this the hemi-larynx on the operated side was reinnervated in the following manner. Using a microsurgical suture (described in the text) the motor nerves from extra-laryngeal muscles were anastomosed onto the nerves supplying the intrinsic abductors and adductors of the larynx. The nerve to sterno-thyroid was anastomosed onto the nerve supplying the posterior crico-arytenoid muscle (vocal cord abductor). Similarly the nerve supplying thyrohyoid was anastomosed onto the cut distal end of the adductor division of the recurrent laryngeal nerve. Clinical, electromyographical and histological evaluations have been used to prove the reinnervation. RESULTS: In the nine surviving animals successful re-innervations, as defined by the return of normal function, has been achieved for posterior crico-arytenoid and 7 adductor muscles. CONCLUSION: This study has demonstrated the feasibility of laryngeal reinnervation after surgical section of the recurrent laryngeal nerve, and give some cause for optimism for its ultimate application in man.

[Non-Hodgkin's malignant lymphoma with cervicofacial expression. Modulation of the radiotherapy-chemotherapy combination according to the cytological class]. / Lymphomes malins non hodgkiniens à expression cervico-faciale. Modulation de l'association radio-chimiothérapique par la classe cytologique.

An analysis was conducted in March 1983, after a mean follow up of 40 months, of cases of cervicofacial stages I and II non-Hodgkins malignant lymphoma in 3 children and 41 adults (mean age: 51 years, range: 6-90 years) treated between 1969 and March 1981. According to the Working Formulation malignancy was low in 4 cases, intermediate in 24 and high in 13; 3 cases could not ne classified retrospectively. Cytologic classification showed 13 of class 1 of low malignancy, 7 of class 2 of high malignancy with leukemic potential, and 16 of class 3 of high malignancy with a course leading to tumor formation. The cavum was involved in 10 cases, the tonsils in 9, the parotids in 1, the uvula in 1, isolated cervical adenopathies in 14, multiple unilateral adenopathies in 3 and bilateral cervical adenopathies in 5 cases. Therapy varied according to the series: in the first series (1969-1975) the 23 cases were treated by radiotherapy alone (40-55 Gy). In the second series (1976-1981) of 21 cases, chemotherapy was given as a function of the cytologic class: prophylactic chemotherapy for 6 months after radiation for classes 1 and 2, initial chemotherapy for 6 weeks, cerebral radiation and methotrexate intrathecally, and maintenance chemotherapy for 3 months in class 3. The failure rate for radiated zones was identical in the 2 series (less than 10%). Adjusted 5-year survival rate was 60% for series 1 against 70% for series 2 (p = 0.9), and adjusted remission rate was 43% against 64% (p = 0.8).

Anatomy of the larynx, study of the anterior branch of the recurrent laryngeal nerve.

These studies are based upon 60 dissections of the recurrent laryngeal nerve. The authors describe the branches destined for the intrinsic musculature of the larynx. This study is a working approach for the operations of selective laryngeal reinnervation in man.

[Primary and recovery transmaxillar buccopharyngectomy in buccopharyngeal cancers]. / La buccopharyngectomie transmaxillaire en première intention et en rattrapage dans les cancers buccopharyngés latéraux.

From january 1976 to december 1986, 78 patients were treated surgically for squamous cell carcinoma of the lateral buccopharyngeal junction without chemotherapy at first. 36 patients were treated by primary surgery with post-operative radiotherapy and 31 patients were treated by recovery surgery. Post-operative course was uncomplicated in 41% of cases (39% in primary surgery, 43% in recovery surgery); in 14% of cases serious local complications were observed (11% in primary surgery, 17% in recovery surgery). Carcinological failures appeared in 46% of cases in primary surgery and in 70% of cases in recovery surgery. Three years and five years actuarial survival rate were 45% and 39% respectively in recovery surgery. Prognostic factors are studied: resection quality, histological metastasis in lymph nodes. The authors emphasize on the best control of the big tumors in primary surgery and on the best results with small ulcerated infiltrant carcinoma.

[Malignant cervical epithelial adenopathy from unknown primary source. Apropos of a series of 54 cases]. / Les adénopathies cervicales malignes épithéliales en apparence primitives. A propos d'une série de 54 cas.

Fifty four patients with cervical lymph node metastasis from an unknown primary tumor underwent treatment from 1969 to 1988. Fourty five underwent radical neck dissection. 69% had node capsular effraction and 36% perinodal vascular embolism. Thirty four patients underwent postoperative radiotherapy including rhinopharynx, cervical oesophagus and all the bilateral cervical nodes. The primary tumor appeared after treatment in 7 cases. Total survival rate is 36% 5 years after treatment. Vascular embolism aggravates the prognosis. Radiosurgical association allow effective control of loco-regional cancer but does not improve survival rate. Prognosis is aggravated by metastases arising (18%).

[Cancers of the supraglottic larynx: results and therapeutic indications apropos of 124 cases]. / Les cancers du vestibule laryngé: résultats et indications thérapeutiques à propos de 124 cas.

The authors report their experience of the treatment of the supraglottic laryngeal carcinoma in a retrospective study of 124 patients primarily treated in the ENT department of Grenoble University hospital. Fourteen patients received only radiotherapy, the others 110 patients were treated by surgery: partial or reconstructive surgery in 47 cases, total surgery in 63 cases. The carcinological results demonstrate the good prognosis of the intra-laryngeal tumors. Their treatment allows a good loco-regional control (tumoral recurrences: 4%, regional recurrences: 2%). The main prognostic factor is the nodal involvement with capsular rupture which is responsible for the most locoregional and metastatic recurrences.