[Exposure of the facial nerve in the masseteric region during parotid surgery. Technical aspects and value]. / Exposition du nerf facial dans la région massétérine lors de la chirurgie parotidienne. Aspects techniques et intérêts.

With an accurate understanding of facial soft-tissue anatomy, deep plane rithydectomy can be performed in safe and precise fashion. We report our experience of 19 cases of parotidectomy using this superficial musculo-aponeurotic system mobilization anterior to the gland. In all cases (two recurrences), it was thus possible to safely expose at least two terminal branches of the lower facial nerve in the masseteric area without jeopardizing the facial nerve. During a second operation for recurrent tumor or in the case of some lesions as inferior and anterior intraglandular cyst, the distant branches of the nerve can be uncovered by a backward dissection. The easiest to identify seems to be the terminal branches in the masseteric area, as it is directly accessible after cutaneous undermining in an area generally not dissected during previous operations and with preserved anatomic relations. In other cases this technique enables one to expose the parotid gland completely and facilitates anterograde facial nerve dissection by its terminal exposure. The superficial musculo-aponeurotic system dissection allows its backward transposition, in the absence of any contraindication, so as to prevent retromandibular depression following a parotidectomy.

[Use of polyglactin 910 mesh with collagen in the prevention of pharyngostomes]. / Utilisation du filet de polyglactine 910 avec collagène dans la prévention des pharyngostomes.

The use of the collagen-coated Polyglactine 910 mesh is proposed as a preventive treatment of pharyngostomes in extensive pharyngolaryngectomies for necrotized hypopharyngeal tumors. The good results obtained in this series of 12 cases may be explained by a distribution of stress in the pharyngeal sutures, associated to a decrease in the stress exerted on the tight mucosal suture, as well as a sliding-rotating effect of the pharyngeal muscular suture, which is thus displaced relative to the plane of the mucosal suture. This original technique seems to be fully effective during the first two postoperative weeks, and may greatly help in the prevention of the dangerous pharyngostomes during the postoperative period following extensive pharyngeal resections.

[Cancer of the larynx and computed x-ray tomography: exploration of the hypothyroepiglottic area and paraglottic space]. / Cancer du larynx et examen tomo-densitométrique: exploration de la loge hyo-thyro-épiglottique et de l'espace para-glottique.

Twenty patients with laryngeal cancer were explored by tomography and a CT scan. Results were compared between cases and, for operated patients, with histosurgical findings. Results of this study and a review of the literature suggest that the CT scan is the most adapted examination for exploration of the paraglottic and hypothyroepiglottic spaces, but that caution should be exercised when assessing results.

Menière's disease, petrous bone tomography. A new radiographic sign?

Direct measurements on tomograms of the petrous bone in Menière's disease revealed a decreased thickness of the retrolabyrinthine part of the petrous bone. This could help to confirm previous theories that the cause of Minière's disease is developmental.