Total ossicular reconstruction: The "mushroom technique".

OBJECTIVE: The "Mushroom technique" is introduced in this paper as an alternative technique to reconstruct the total ossicular chain by using autologous grafts where it is not possible to use the patient's ossicles, and to seal a peri-lymphatic fistula (PLF) if present. MATERIALS AND METHODS: This non randomized retrospective study covers 18 patients aged between 26 and 72 years, operated between January 2006 and March 2012 by the same surgeon using a retro-auricular approach. There were 13 males and 5 females, 12 right ears and 6 left ears. The three ossicles were damaged in 18 patients, a PLF was associated in 3 cases, and a tympanum perforation was present in 2 ears. Postoperative follow-up period was a minimum of 6 months and up to 6.5 years. The origin of 18 patient's disease was; post traumatic in 11 patients and post removal cholesteatoma in 7 patients. The "mushroom technique" was performed for all patients. The average Air Bone Gap (ABG) of each patient was calculated (frequencies 500, 1000, 2000 and 4000 Hz) both pre and 6 months postoperatively. RESULTS: There were no extrusion of the composite graft. In the three cases of PLF; the leak was sealed. And in the two ears with tympanum perforation; the perforation was closed. The average post-operative ABG is 25 dB while it was 45 dB before surgery. Average gain is 20 dB. Non sensorineural hearing loss ocurred. CONCLUSION: This technique has several advantages: The mounting footplate-fascia-connective tissue-bone-cartilage-perichondrium-tympanum is solid and long lasting, the rate of leak closure in case of PLF is improved; This technique closes the leak, the hearing results are satisfactory, the cost of autograft is null and the tolerance is excellent. On the other hand, it might be time consuming since it is a delicate looking procedure.

Revascularized free scapular flaps in mandibular reconstruction. Report of 93 cases (April 1997 - October 2009).

OBJECTIVE: The aim of the present article is to demonstrate the relevance of revascularized free scapular flap in mandibular reconstruction in oncological cervicofacial salvage surgery. We will discuss the advantages and the disadvantages, indications and contraindications, together with possible complications and sequelae for this type of surgical flap. MATERIAL AND METHODS: Retrospective study of 93 revascularized free scapular flaps used to reconstruct segmental substance defects in the mandible from April 1997 to October 2009 (in 91 patients). All patients benefited from 10 months to 12 years follow-up surgical and functional results. Functional assessment following anatomic site restoration focused on the quality of feeding and deglutition. RESULTS: The anatomical success rate was 94.63% (5 complete necroses out of 93 flaps). Results were considered to be good (normal or close to normal function for feeding and deglutition) in the majority of patients (83% at 6 months, 91% at 18 months). On the donor site: Functional sequelae were moderate when post-operative reeducation was correctly performed. CONCLUSION: Vascularized free scapular flap bone graft is very interesting for the reconstruction of mandibular discontinuity, composite (soft tissue and cutaneous resection) or exclusively osseous defects (not in excess of 13 cm), secondary to oncologic or osteoradionecrotic resections.

Inferior turbinate hypertrophy radiofrequency management for children with cystic fibrosis.

OBJECTIVE: To evaluate, using radiofrequency techniques, the relevance and effectiveness of treatment of inferior turbinate hypertrophy in children with cystic fibrosis. MATERIALS AND METHODS: A study of patients with cystic fibrosis with hypertrophy of inferior turbinate who were being treated at Lisieux Hospital In-Patient Paediatric and ENT- Head and Neck Surgery Department. 41 patients were included in the study and followed over 2 years. We analyzed the postoperative phase and the effectiveness of treatment, through clinical and radiological examination. RESULTS: A clinical improvement of symptoms is observable from the third month after surgery in 100% of cases. However, we noted a loss in the effectiveness of radiofrequency on the turbinate tissue one year following operation, which worsens with time. However, the postoperative results remain satisfactory at 1 year and 2 years. CONCLUSION: Radiofrequency is, in our opinion, the treatment of choice for inferior turbinate hypertrophy in children with cystic fibrosis. It combines a simple and low-risk effect with effective preservative treatment. However, the benefits of radiofrequency fade with time. Nonetheless, this technique yields postoperative results that remain satisfactory beyond 2 years. It is often useful to consider a new session after this date.

[Interest of peri-operative immunonutrition in head and neck cancers]. / Intérêt de l'immunonutrition péri-opératoire en carcinologie cervico-faciale.

OBJECTIVE: Authors reported the results of a study on the application of immunonutrion in peri-operative (pre and postoperative) in head and neck cancer for all patients malnourished or not. In preoperative we used an oral treatmentand in postoperative an enteral one. MATERIALS AND METHODS: Prospective study concerning 78 patients (47 malnourished versus 31 not) having had heavy head and neck curative cancerology surgery. The mean follow up was of 10 months (from 7 to 16 month). They peri-operative immuno-enriched diet consisted, in pre-operative of 1000 kcal/j during 7 days of oral immunonutrition (Impact), and in post-operative, 1500 kcal/j during 10 days of enteral immunonutition (Crucial). The nutritional state was evaluated in pre-operative by simple clinical and biological parameters (size, weight, CMI "Corporal Mass Index", albumin, NRI "Nutritional Risk Index"), and in post-operative by the evolution of the weight and the CMI. The palatability of the product used in pre-operative and the patients' compliance to the treatment are studied using the satisfaction's multiple choice question paper. RESULTS: The study showed an improvement of the patients' nutritional and general state (regain appetite, less marked asthenia) and of the quality of life. The product used in preoperative was well tolerated, this oral supplementation led to the same beneficial effects of the enteral's. At eight days in preoperative, the average weight was 62.35 kg, the average CMI was 20.93, and the average NRI was 94.12. In post-operative the patients' nutritional state improved: at eight days, the average loss of weight was 2.82 kg, the average CMI was 22.2. At one and six months after respectively the average gain of weight was 2.17 kg and 6.11 kg, the average CMI was 23.71 and 25.16. The application of this protocol decreased the post-operative complications (13% reduction of the infectious complications and 6% diminution of the fistulas). The time of hospitalization is then reduced (1.7 days), and the life's longevity is improved. CONCLUSION: The results produced by this study, demonstrate the necessity to apply a peri-operative immuno-enriched diet systematically for all the patients with and without a degraded nutritional state, undergoing a heavy head and neck curative cancerology surgery.

Mandibular reconstruction following cyst removal by the autologous cancellous bone and marrow grafts.

This article presents the surgical technique of using the autologous cancellous bone and marrow grafts for filling defects following cyst removal in the mandible, and reports long-term results.

[Tinnitus: first symptom of chronic myeloid leukemia]. / L'acouphène: signe d'appel d'une leucémie myéloïde chronique.

In this article, we present a 53 year old patient who had an acute tinnitus that led to the diagnostic of chronic myeloid leukemia(CML). This symptom allowed an early diagnostic of the disease and a more favorable pronosis. This case demonstrates the inportance of blood tests for every patient who presents a tinnitus of unknown origin.

[The protocol of postop monitoring after endonasal endoscopic procedure: patient care]. / Protocole be surveillance post-operatoire apres chirurgie endo- nasale endoscopique--a l'attention du personnel soignant.

TITLE: A protocol for post-operative follow-up after endoscopic sinus surgery. A guide for nursing staff. SUMMARY: Endoscopic sinus surgery requires rigorous postoperative care by the nursing staff. There is a risk of complications in this surgery with a serious outcome if the postoperative care is defective. To be certain that this monitoring is done regularly the authors propose a card of evalation which is filled dice the arrival of the patient in recovery room and then with regular intervals. This card is the guarante of a recognition of the problem by the surgeon but also by the nursing staff. It facilitates the fast installation of the treatment in case of need.

Otoplasty for prominent ears in children. The technique adopted in the Portmann Institute.

The Otoplasty technique adopted in the Portmann Institute is a simple rapid technique that maintains the natural contours of the auricle with minimal risk of infection. The technique involves excision of a large ellipse of skin from the mastoid surface of the auricle and reflection of remaining skin to the edge of the helix. The subcutaneous and muscular tissues on the mastoid bone are excised and the mastoid surface of the auricular cartilage scored with monopolar diathermy. After haemostasis, the wound is closed using continuous long-term absorbable sutures. A dressing and bandage are applied and the child is monitored for 10 days. A head bandage is applied at night for one month with use of a sun-screen cream on the scar at daytime.