RESUMO
The authors report a case of a neurinoma of the third portion of the facial nerve, revelated by a progressive palsy completed four months later (but the muscle of the stapes was still working). After removing the neurinoma which was in the middle of the mastoïde an anastomosis between the XII and the VII nerves was performed and successful. The authors emphasize two facts: --The possibility of active reinervation by this method of the facial muscles even after a long delay of complete interruption of the facial nerve. --The advantage of performing the micro-anastomosis as close as possible to the myo-neural synapsis (just before the bifurcation of the facial nerve.
Assuntos
Neoplasias dos Nervos Cranianos/cirurgia , Nervo Facial , Neurilemoma/cirurgia , Nervo Facial/cirurgia , Humanos , Nervo Hipoglosso/cirurgia , Masculino , Pessoa de Meia-IdadeRESUMO
The treatment of severe laryngo-tracheal stenosis raises complex problems and we remain far from having found a universally agreed solution for all of them. The authors describe here their attitude to severe laryngo-tracheal damage without suggesting that this should be applied from the outset or to all cases seen. It consists of an operation faithful to the principle of that of Rethi as greatly improved by P. aboulker and to which we ourselves have remained faithful whilst in our turn suggesting a certain number of technical modifications which whilst in no way changing its principle simplify the performance with a teflon tube equipped with a detachable tip with a teflon diaphragm momentarily occluding the lower airway. We also suggest the use of steel wire sutures in order to hold the two hemi-larynxes and the fragments of tracheal rings apart when the degree of damage suggests the danger of postoperative trachemalacia or in the presence of recurrence of stenosis, a far from rare possibility in the late course following this type of surgery.
Assuntos
Laringoestenose/cirurgia , Estenose Traqueal/cirurgia , Humanos , MétodosAssuntos
Neoplasias/diagnóstico , Otorrinolaringopatias/diagnóstico , Feminino , Humanos , Neoplasias Laríngeas/diagnóstico , Masculino , Doenças da Boca/diagnóstico , Neoplasias Bucais/diagnóstico , Neoplasias/epidemiologia , Otorrinolaringopatias/epidemiologia , Paris , Neoplasias Faríngeas/diagnóstico , Neoplasias Cutâneas/diagnósticoRESUMO
Cholesteatoma, defined by Muller in 1830, has not benefited by any means to the same extent as other otological conditions from therapeutic progress. Its histological nature has been defined on information supplied by the electric microscope. It remains puzzling and the manner in which it invades the inner ear cavities imperfectly reproducing the epidermis remains very much a mystery. In spite of a certain ultra-structural unity, it would appear that there is not just one, but many cholesteatomas and if this protean condition is to be understood treated, a primary requisite is a nosological break-down which takes into account the topography of the lesions and their macroscopic appearance. From this attempt at a classification which groups together the most frequently encountered possibilities, operative indications which have to take into account several contradictory preoccupations can be arrived at. It is essential to: -- eradicate the lesions as thoroughly as possible; -- avoid damaging those structures of the middle ear which are still functional or which may be made serviceable again; -- leave open the possibility of surveillance of the cavities so as to detect relapses. These contradictory requisites can be reconciled in a great number of cases and justify the hope that a cure will go hand in hand with an appreciable gain in function. As examples, a few audiograms of patients operated on are included to show the sort of results that it is possible to obtain.