[Bilateral and recurrent facial palsy due to lymphoma: a case report]. / Paralysie faciale périphérique à bascule et lymphome: à propos d'un cas.

OBJECTIVE: To discuss about management of facial paralysis reccurence and to highlight the ENT's important role in the diagnosis of systemic diseases. MATERIAL AND METHODS: This article presents a case report about a controlateral facial palsy recurrence, two months later in a fifty-two year's old woman. This cranial nerves involvement was due to non-Hodgkin lymphoma with neuro-meningeal spreading. The first palsy had completely recovered with steroids. The early recurrence of the palsy and the lymph nodes areas exam lead to the diagnosis. The patient was treated by chemotherapy with good neuromeningeal diffusion. The facial score rapidly improved, according to facial electromyography results. DISCUSSION: Specific biological and radiological explorations are usually carried out in recurrent facial palsy. Complete clinical examination and cerebrospinal fluid study are useful in this case. Moreover it should be preferable to do these explorations before steroid therapy. A diffuse meningeal enhancement on the MRI can complete sometimes clinical and biological data. CONCLUSION: Cranial nerves involvement is sometimes one of the first symptoms of neuro-meningeal lymphoma. Facial palsy reccurence has to conduce ENT pratician to do more specific explorations, of which CSF analysis is required.

[Facial paralysis after temporal bone trauma]. / Paralysies faciales après fracture de l'os temporal.

OBJECTIVES: To evaluate functional outcome in 64 cases of facial paralysis following temporal bone fracture and discuss decisive arguments leading either to medical treatment or surgical management. METHODS: Sixty-four patients suffering from post-traumatic facial paralysis were managed between 1995 and 2003: 38 (59%) were given medical treatment and 26 (41%) underwent surgery. A combined middle fossa and transmastoid approach was mostly used (58%). Electrophysiological testing and CT scan results were the main points of the decision algorithm. RESULTS: Electroneuromyography seems to be the most accurate exploration for guiding treatment. Good results (grades I to II on the House and Brackmann scale) were obtained in 63% of cases after medical management and in 39% of cases after surgical treatment. Grades III or IV were obtained in 13% of medically-treated patients and 42% of surgically-treated patients. CONCLUSION: Management of facial paralysis following temporal bone fracture in accordance with electrophysiological testing (evoked EMG) together with CT scan findings enabled accurate indications for surgical treatment. A good grade I or II result can be expected after medical management. A grade III is at best reached after nerve anastomosis.

[Spontaneous cervical emphysema: a case report]. / Emphysème cervical spontané: à propos d'un cas.

Spontaneous cervical subcutaneous emphysema, without any aetiology found in the clinical history, is far less common than subcutaneous cervical emphysema following trauma, surgery, or infectious cervical processes. In this recent case report, the authors describe a young woman who developed a cervical subcutaneous emphysema. No responsible factor had been found. Radiological investigations revealed a pneumomediastinum, which is an uncommon but a serious complication of cervical emphysema. The CT-scan highlighted a rupture of the crico-thyroid membrane, from which the air had followed the fascial planes up to the neck and the mediastinum. The authors describe the treatment and clinical course. They put forward an embryological hypothesis regarding the spontaneous crico-thyroid membrane rupture. A congenital fragility of this area could exist which could explain its breach. The pathogenesis and management of spontaneous cervical emphysema are discussed in the light of diverses articles about this subject. The radiological or surgical explorations which may be used in this aetiological diagnosis and treatment are given.

[Middle ear tuberculosis extended to the skull base in a teenager: a case report]. / Tuberculose auriculaire étendue à la base du crâne chez un adolescent: à propos d'un cas.

Tuberculosis of the middle ear and mastoid is a rare disease in our countries. Nevertheless, it still occurs and the diagnosis must be considered in the differential diagnosis, especially in particular populations, of acute or chronic ear drainage. Diagnosis is not always easy, as in this case report, where the disease is disseminated, involving the skull and the lung. The discussion highlights the difficulty of diagnosis, and the different actual aspects of treatment.

Facial nerve decompression for idiopathic Bell's palsy: report of 13 cases and literature review.

INTRODUCTION: The prognosis for cases of idiopathic facial palsy is usually good. However, some cases develop disabling sequelae, such as synkinesis or severe facial hemispasm, despite targeted medical treatment. OBJECTIVES: The authors try to achieve that electromyography is useful to identify patients with severe palsy and an unfavourable prognosis. These patients would probably benefit from facial nerve decompression. SETTING: The otolaryngology-head and neck surgery department of Pitié-Salpêtrière Hospital, Paris, a tertiary referral centre. PARTICIPANTS: Thirteen cases undergoing surgery between January 1997 and March 2007. MAIN OUTCOME MEASURES: We describe the electromyographic findings that led to surgery. All patients underwent surgery via a subpetrous approach, within four months of the onset of palsy. Decompression involved the first and second portions of the nerve and the geniculate ganglion. RESULTS: Recovery to House-Brackmann grade III was obtained in all cases at one year follow up. CONCLUSION: These results compared favourably with previous reports. A new therapeutic procedure may allow improved results.