[Anatomy of nasal obstruction. The recognition of the role of septum. Its application to the surgical treatment of nasal obstruction]. / Obstruction nasale morphologique. Identification et rôle du septum. Application au traitement chirurgical de l'obstruction nasale.

A retrospective study of the records of 392 consecutive patients prospectively operated for non-vasomotor nasal obstruction, has allowed us to identify a syndrome that we would call morphological syndrome. This is caused by anatomical deformities of the nasal septum, inferior turbinate hypertrophy frequently found being the most often only a compensation for the septal deviation. This endonasal abnormality, which can be congenital or post-traumatic, is most frequently of developmental origin and therefore most often found in Caucasian men, whose facial and septal growth is considerable. This morphological syndrome comprises unilateral or bilateral nasal obstruction, noisy nocturnal breathing (20% of patients), a posterior nasal drip (38% of patients), frontal headaches (49% of patients) and recurrent viral or bacterial rhinosinusitis (36% of patients). Other associated symptoms include epistaxis, olfactory dysfunction (hyposmia) and the manifestations of eustachian tube dysfunction. That this syndrome exists is confirmed by the effectiveness of septoplastic operation, performed in our hospital according to the method of Cottle, but without any surgical associated intervention on the inferior turbinates. This operation is an effective treatment both in a global fashion (95% of good results) and in relation to each of the symptoms (except postnasal drip) and is stable in the longterm and well tolerated (minor associated morbidity). This study allow us to re-establish the almost exclusive role of the nasal septum in the genesis of morphological nasal obstruction.

[Our experience with percutaneous endoscopic gastrostomy in pharyngo-laryngeal surgery]. / Notre expérience de la gastrostomie percutanée endoscopique dans la chirurgie pharyngo-laryngée.

Percutaneous endoscopic gastrostomy (PEG), is an enteral feeding procedure, easy to tolerate and simple to perform. PEG appears to be an alternative to surgical gastrostomy. Used in ten patients with E.N.T. cancer, we only observe two minor complications. Advisable in a first time for the feeding of patients with palliative treatment, we propose PEG for patients in position to have a long and difficult rehabilitation of swallowing.

[An atypical case of Wegener's disease]. / Un cas atypique de Maladie de Wegener.

The authors report on a case of Wegener's syndrome diagnosed fortuitously by the discovery of a perforation of the nasal septum during a bronchial fibroscopy for monitoring of a pulmonary fibrosis. In addition to the late appearance of the nasal perforation, the clinical picture includes classic polyvisceral impairment with pulmonary fibrosis, polyarthralgias and renal insufficiency. After 21 months of treatment, a stabilization of the visceral lesions was recorded, with the all but total disappearance of the E.N.T. lesions.