Head-neck and mediastinal emphysema caused by playing a wind instrument.

INTRODUCTION: Etiology of head-and-neck emphysema is mainly infectious (cellulitis) or traumatic (rupture of the aerodigestive tract mucosa, usually in the larynx and trachea). CASE REPORT: We report a case of head-and-neck and mediastinal emphysema due to oral hyperpressure inducing parotid acini rupture. The aim is to highlight the importance of precise interview of patient and family so as to identify this mechanism. DISCUSSION: Pneumoparotid is a rare cause of swelling induced by insufflation into Stensen's duct. This reflux is caused by intra-oral hyperpressure, and can cause extensive subcutaneous emphysema induced by capsule rupture. The disorder is common in players of wind instruments and glass-blowers. Positive diagnosis is based on focused interview, looking for trigger factors, and on imaging assessment. Evolution is reported to be spontaneously favorable with simple antibiotherapy. Patient education is the best means of limiting recurrence. CONCLUSION: In case of cervical emphysema, it is important to determine the mechanism of onset and explore for pneumoparotid on CT, so as to adapt treatment and prevent possible recurrence.

[Pseudomembranous diphtheria caused by Corynebacterium ulcerans]. / Angine diphtérique pseudomembraneuse autochtone liée à Corynebacterium ulcerans.

INTRODUCTION: Pseudomembranous angina are classically caused by Corynebacterium diphtheriae. More rarely, it caused by Corynebacterium ulcerans, sometimes carrying the diphteric exotoxine. EXEGERIS: We report a new autochton case of pseudomembranous pharyngitis caused by C. ulcerans, carrying the diphteric exotoxine, transmitted by a dog, complicated of velopharyngitis and hypopharyngée paralysis, then of diphtheric polyneuritis. CONCLUSION: Although exceptional, diphteria must always be evoked in front of a pseudomembranous angina. The insolation of C. ulcerans must make seek diphteric toxin and its complications.

[Involvement of the nasal sinuses in sarcoidosis. A prospective study of 63 patients]. / Atteinte nasosinusienne au cours de la sarcoïdose. Etude prospective chez 62 patients atteints de sarcoïdose.

INTRODUCTION: Sarcoidosis is a diffuse granulomatous inflammatory disorder of unknown aetiology. Involvement of the nasal sinuses has been reported only rarely. METHODS: This multicentre prospective study was undertaken on patients suffering from histologically confirmed sarcoidosis between October 2001 and August 2002. It comprised a questionnaire for nasal symptoms, a nasal endoscopy and a CT scan of the nasal sinuses. RESULTS: Among the 62 patients enrolled 38 reported at least one nasal sinus symptom. An abnormality of the CT scan was present in 70% of cases. None were specific for sarcoidosis. Rhinoscopy revealed a mucosal lesion in 11 cases. The presence of mucosal nodules on the turbinates was suggestive of sarcoidosis and was proven histologically in 4 cases (6.5%). In these 4 cases there were symptoms of nasal sinus involvement and extensive CT changes. CONCLUSIONS: Involvement of the nasal sinuses is rare in the course of sarcoidosis. Anterior rhinoscopy allows diagnosis before the development of typical lesions and also the taking of guided biopsies.

[Nutritional status and clinical score of 95 patients examined by radiovideoscopy for deglutition]. / Etat nutritionnel et score clinique de 95 patients explorés en radiovidéoscopie de la déglutition.

Ninety five consecutive patients were examined. One performed swallowing videoradioscopy, swallowing clinical score calculation and nutritional assessment with four different methods: Body Mass Index (BMI), arm muscle circumference, dual frequency bioelectrical impedance analysis and serum albumin level. The easiest and the most reliable method for nutritional assessment, comparing to the others, was BMI, where only weight ant height were necessary to measure. So, the prevalence of protein-energy malnutrition was 24.2%, unlinked neither with the presence of videoradioscopy swallowing disorders nor with clinical swallowing score level. The score level was inversely correlated with the presence of videoradioscopy swallowing disorders, and correlated with feeding types: the highest for per os normal feeding, the lowest for patients with parenteral nutrition. The presence of videoradioscopy swallowing disorders was inversely correlated with feeding types. Swallowing clinical score was validated.

[Adenocarcinoma of the ethmoid sinus in woodworkers. Retrospective study of 25 cases]. / Adénocarcinomes de l'ethmoïde chez les travailleurs du bois. Etude rétrospective de 25 cas.

A retrospective oncological study was performed in 25 woodworkers, in whom an adenocarcinoma of the ethmoid sinuses was discovered between March 1985 and December 1993. All patients were males with a mean age of 57 years, and a mean duration of wood dust exposure of 24 years. Signs of nasal obstruction, drainage, and discomfort were present in all cases. Ophthalmological findings were a poor prognosis indicator. It was possible to precisely evaluate treatment and outcome in 23 cases. The majority of tumors were classified as T3 or T4 (72%), with extension beyond the ethmoid sinuses; all were in contact with the roof of the ethmoidal sinuses. Extension was predominantly into the orbital and intracranial cavities as compared with extension posteriorly or into the maxillary sinuses. Treatment was identical in the 25 patients: a) combined surgery including a paranasal and a neurosurgical approach, b) postoperative radiotherapy. Results were expressed in terms of morbidity related to surgery and the oncologic outcome. Operative morbidity and mortality were substantially reduced with reconstruction of the roof of the ethmoidal sinuses. Meticulous excision, in addition to postoperative radiotherapy, resulted in a decreased rate of local recurrence (26%). On the other hand, metastasis were encountered more frequently (30%). Radiotherapy was insufficient when macroscopic excision was incomplete. Chemotherapy was used as palliative treatment in the event of a recurrence and/or metastases. Survival rate was 68% at 3 years, and 48% at 5 years. Most complications and recurrences arose within the first two years. Exophthalmos, intracranial extension, incompleteremoval, and extensive class T4 tumors were associated with a poor prognosis. Optimal therapy for malignant tumors of the ethmoid sinuses requires combined transfacial and neurosurgical approaches that allow precise assessment of tumor extension and adequate excision, yielding an improved oncologic outcome. Followed by radiotherapy, this association can result in a remission. Patient prognosis depends essentially on management of the initial lesion.

[Hammock myringoplasty (technique, results)]. / Myringoplastie en Hamac (technique, résultats).

Since 1985, we have been using the so-called "hammock" technique in myringoplasty through the retro-auricular approach, with a temporal fascia graft positioned under what is left of the tympanum. The main feature of this technique lies in the creation of a cephaled tympano-meatal flap by a partial disinsertion of 4 to 5 millimetres of the cephalad part of the Gerlach annular labrurm, taking care to leave 2 millimetres of the labrum attached above the junction of the ephalad wall and the lower wall of the external auditory canal (anterior lower anchoring point). At the end of the operation, the graft is fixed both to the cephalad and to the caudad wall of the bony-external auditory canal like a hammock. This technique makes it possible to verify systematically the tympanic opening of the Eustachian tube. The use of biological glue is desirable, but not essential. The graft is stable enough for the implantation of Politzer's manoeuvre as from the seventh day and for Valsalva's manoeuvre from then on. Out of 213 operation, including all kinds of pathologies, 98% of good results were obtained as from the end of the first month, and 94.6% after three months.