[Treatment of head and neck squamous cell carcinoma of an unknown primary (HNCCUP): oncologic analysis of 35 cases]. / Traitement des adénopathies cervicales malignes en apparence primitive (AMAP): résultats carcinologiques à propos de 35 cas.

OBJECTIVE: The aim of our study was to perform an oncologic analysis of patients treated for head and neck squamous cell carcinoma of an unknown primary (HNCCUP). PATIENTS AND METHODS: 35 cases were included in our monocentric restrospective study (1999-2010). All patients had a complete clinical exam as well as head, neck and chest CT scans. The primary tumour remained undetected after panendoscopy 25 patients underwent a routine tonsillar biopsy ipsilateral to the lymphadenopathy. In 9 cases (36%), an invasive squamous cell carcinoma was detected on pathological examination. These patients were excluded from further study. Kaplan-Meier method was used for survival analysis. Univariate and multivariate analysis were also performed using Cox's regression model. RESULTS: The therapeutic management of patients' majority (73%) consisted of lymphadenectomy with frozen section examination which confirmed the presence of an invasive squamous carcinoma in the resected lymph node(s). This was followed by ipsilateral neck dissection and radiotherapy or radiochemotherapy. Patients with unresectable lymph node(s) underwent exclusive radiochemotherapy. Specific survival rates at 1, 3 and 5 years were respectively 77%, 52% and 47%. The median survival time was 3 years. The comparison of univariate and multivariate survival curves confirmed that the lymph node status is an important factor for survival (HR 8.3 [2.03-33.96]). CONCLUSION: Our results are consistent with those found in the medical literature. HNCCUP has a poor prognosis which correlates with the lymph node status.

[Complications after insertion of a totally implantable venous access port in patients treated with chemotherapy for head and neck squamous cell carcinoma]. / Complications d'un dispositif intraveineux implantable pour chimiothérapie dans les cancers des voies aérodigestives supérieures.

OBJECTIVES: To review the occurrence of early and delayed complications after insertion of a totally implantable venous access port (Tivap) in patients treated with chemotherapy for head and neck squamous cell carcinoma. MATERIAL AND METHODS: Monocentric prospective study (2005-2008) undertaken in a tertiary referral center. In all cases, the inserted Tivap was a Celsite ST301 (Braun) model. The insertion procedure was performed in operating room conditions under local anesthesia using a surgical cut-down method. No antibiotic prophylaxis or long-term anticoagulant medications were administered. Two groups were made between experienced and in-training surgeons. All complications occurring from the date of Tivap insertion to the date of its removal or until the closure of the study were included. RESULTS: The study comprised of 122 patients including 103 males and 19 females; the patients' mean age was 58.5 years (range, 36-80). Twelve (9.8%) had a tracheotomy or tracheostomy and 41 (33.6%) underwent cervical radiotherapy before Tivap insertion. In 63 cases (51.6%), the procedure was performed by a senior surgeon. The inserted vessel was the cephalic vein (84.4%), the external jugular vein (11.5%) or the internal jugular vein (2.5%). Overall, the total number of days of Tivap implantation was 51,403. Altogether, 11 complications (9%) were listed: two (1.6%) early complications and nine (7.4%) delayed complications. We did not uncover a significant statistical relation between complication onset and experience of the operating surgeon, sex, implanted side, tracheotomy, previous radiotherapy, or number of days of Tivap port. CONCLUSION: Our study suggests that: (1) complications are rare provided careful implantation and manipulation methods are followed by health personnel; (2) surgical cephalic cut-down is a very reliable method; and 3) antibiotic prophylaxis or long-term anticoagulant medications are not mandatory.

[Lateral transmandibular route for deep-lobe parotid tumor excision]. / Abord transmandibulaire latéral pour l'exérèse des tumeurs du lobe profond de la parotide.

The parapharyngeal space may be a site for tumors, especially for those developed in the deep parotid lobe. The surgical route to parapharyngeal space tumors is a challenge because of neighbor anatomic structures and the specific risk of mandibular nerve damage. The aim of this study was to describe an original lateral transmandibular route, setting aside the mandible angle and preserving the mandibular nerve.

Giant osteoma of the maxillary sinus--diagnosis and management.

Osteomas are rare, slow-growing, benign bone tumors that preferentially develop in the paranasal sinuses. We report a case of a giant osteoma of the left maxillary sinus in a 29-year-old man which was diagnosed by imaging and endoscopy and treated surgically because of the patient's symptoms and maxillary sinus distortion. Given the large volume and location of the osteoma, resection was performed through an external sublabial approach, according to the Rouge-Denker technique. There were no postoperative complications. There was no sign of recurrence at 5 years follow-up. A review of the literature for maxillary sinus osteomas was performed. Indications for surgery and the different surgical approaches available are discussed.

Non-traumatic nasal septal abscess due to acute spheno-ethmoiditis.

Non-traumatic nasal septal abscesses (NSAs) are rare and those associated with acute sinusitis are even rarer. We report a case of a 12-year-old female child with NSA and complicating acute spheno-ethmoiditis that was diagnosed by physical examination and computed tomography (CT) scan. The NSA was treated by surgical incision and drainage of the abscess, endoscopic aspiration of pus from the spheno-ethmoidal recess, systemic antibiotic therapy, and nasal cleansing.

[Therapeutic management of glottic tumours: about a series of 41 cases of subtotal laryngectomy with cricohyoidoepiglottopexy (CHEP)]. / Stratégie de prise en charge des tumeurs du plan glottique a partir de l'etude d'une série de 41 laryngectomies subtotales avec CHEP.

OBJECTIVES: 1) To analyse the oncological and early functional results of partial supra-cricoid laryngectomy with crico-hyoido-pexy performed as a primary treatment modality on patients diagnosed with glottic squamous cell carcinoma involving the anterior commissure; 2) To propose a therapeutic management. PATIENTS AND METHODS: This is a retrospective study conducted over a period of 10 years (1995-2005). Inclusion criteria included: 1) Squamous cell carcinoma of the vocal cords reaching the anterior commissure; 2) Absence of previous treatment for the glottic lesion; 3) Minimum follow-up period of 24 months. The functional results were evaluated according to duration of hospitalization, and the time elapsed before decanulation and realimentation. Statistical analysis was performed using the stat-view software. RESULTS: Forty-one patients underwent partial supra-cricoid laryngectomy. All patients had a tumour stage I or II. Mean follow-up was of 88 months. Tumour resection was complete in 95% of cases. The rate of lymph node involvement was 7.3%. Four patients (9.8%) developed local recurrence 13 months, on average, postoperatively. Three patients (7.3%) developed a metachronous lesion 14 months, on average, postoperatively. Three patients (7.3%) died during the follow-up period (2 cases related to the cancer). The specific survival and recurrence-free survival rates were 95% and 84.7% respectively. There was no statistically significant difference in survival rates between patients with stage I and stage II tumours. The mean duration of hospitalization was 24 days. The mean time intervals to decanulation and realimentation were 21 and 15 days respectively. CONCLUSION: Partial supra-cricoid laryngectomy with crico-hyoido-pexy is one surgical option in laryngeal conservative surgery. This surgical procedure allows for adequate oncological control and good functional results as long as the indications are well respected and the surgical techniques are well mastered.

[A radiological case of sinusology: a schwannoma localized in the sinuses]. / Un cas radiologique de sinusologie: un schwannome de localisation rhinosinusienne.

INTRODUCTION: In daily practice, the otorhinolaryngologist may face cases of facial tumors of sinonasal origin. Their diagnosis remains difficult based on clinical findings alone. Therefore, imaging techniques can guide the surgeon toward the correct diagnosis. METHODS: A 14-year-old male presented with a history of headaches and nasal obstruction. Physical examination revealed a mass in the right nasal fossa. RESULTS: A computed tomography scan showed an isodense lesion in the posterior half of the right nasal fossa, extending into the maxillary sinus, orbital floor, pterygopalatine fossa, and infratemporal fossa. Magnetic resonance imaging showed great enhancement upon gadolinium administration. The diagnosis of schwannoma was suggested after angiography was performed. The tumor was then resected via a transfacial approach with maxillozygomatic osteotomy. Pathologic examination confirmed the diagnosis of schwannoma. CONCLUSION: The definite diagnosis of a sinonasal tumor can be confirmed only histologically. However, preoperative radiological data can direct the surgeon toward the correct diagnosis and above all the most appropriate surgical approach.

[Diffuse cervical cellulites and descending necrotizing mediastinitis]. / Cellulites cervicales extensives et médiastinite descendante nécrosante.

OBJECTIVES: To give a report on the progress in physical examination, investigations and treatment of diffuse cervical cellulites (DCC) associated with descending necrotizing mediastinitis. MATERIALS AND METHODS: A Retrospective study (1995-2005) of patients presenting DCC with mediastinitis was made. All had a cervical and thoracic Computed tomography (CT) scan. The references were collected by a Medline search. RESULTS: Six men and 2 women, average ages 53 years were treated. Four had an immunodeficient status. Two had had an anti-inflammatory drug treatment without antibiotic treatment. The average for diagnosis and treatment was 4 days. In 2 cases we found a dental origin and in 6 cases a pharyngeal origin. The most frequently identified germs were streptococcus beta haemolytic group A and Prevotella. In 4 cases, no physical sign of mediastinitis was noted. The diagnosis of mediastinitis was made thanks to the thoracic CT scan. All the patients were treated by broad-spectrum antibiotic therapy. All had cervical and thoracic surgical drainage. Mediastinal drainage was made by cervical way in 3 cases and by thoracotomy in 5 cases. One patient died. CONCLUSIONS: The DCC with mediastinum extension are serious infectious emergencies with a high mortality rate. Clinical diagnosis of mediastinitis is difficult. A thoracic CT scan should be performed systematically. Performing thoracotomy best controls mediastinal drainage.

Spontaneous perforation in the upper oesophagus resulting from ulcer in heterotopic gastric mucosa.

Heterotopic gastric mucosa (HGM) can be found throughout the entire gastrointestinal tract, more frequently in the cervical oesophagus. Macroscopic HGM is named inlet patch (IP). The great majority of IPs are asymptomatic and discovered incidently during oesophageal endoscopy performed for another pathology. However, complications can occur. Among these, perforation is extremely rare. We report a case of a 27-year old man who presented with a perforation of an upper oesophageal ulcer arising from an IP. The diagnosis was made during endoscopy and confirmed with biopsy of the tissue surrounding the perforation, showing histologic modifications consistent with heterotopic gastric mucosa. Medical treatment using a proton pump inhibitor and antibiotics delivered with a gastric tube was advocated. The perforation was closed at day 7 and plasma Argon coagulation of the inlet patch was performed two months later. Annual endoscopy has been normal for three years.

[Outcome of surgical and adjuvant radiotherapy treatment of T3-T4 squamous cell carcinoma of the floor of the mouth: evaluation of oncological control and treatment related morbidity]. / Traitement par chirurgie et radiothérapie des carcinomes epidermoïdes T3-T4 du plancher buccal: résultats carcinologiques et etude de la morbidité liée au traitement.

OBJECTIVE: The aims of this study were to evaluate the therapeutic outcome and morbidity associated with management of squamous cell carcinoma (SCC) T3-T4 of the floor of the mouth. PATIENTS AND METHODS: This was a retrospective study (1993 and 2005). Inclusion criteria were: 1) Presence of a locally advanced (T3-T4) lesion of the floor of the mouth; 2) Pathological confirmation of SCC; 3) No previous treatment of the floor of the mouth; 4) Absence of any synchronous lesions at the primary endoscopic work-up; 5) Absence of distant metastasis outside the aero-digestive tract; 6) Karnofsky performance index > 70. All patients were treated by surgery and adjuvant radiotherapy. The statistical analysis was conducted using the stat-view software; categorical variables were compared using the Fisher's exact test; analysis of recurrence-free survival rate was done following the Kaplan-Meier method, and the log-rank test was used for the comparison of survival graphs. RESULTS: Fourty-seven patients were included in this study (42 men), of a mean age of 53.3 years. The majority of patients (93.6%) presented with a stage IVa tumour and no clinical evidence of cervical lymphadenopathy in 60% of cases. All patients underwent bilateral neck dissection adapted to the cervical lymph node status. Forty-one (87%) patients underwent partial mandibulectomy with fibula free-flap reconstruction in 32 cases (78%). Early local complication rate was of 32%. The mean duration of hospitalization was 34 days. Late local complication rate was of 17%. The immediate post-operative death rate was 2%. The rate of survival and recurrence free survival was of 47.5% and 47% respectively. The 3 survival-influencing factors were age (p = 0.02), margins of surgical resection (p = 0.002), and histologic cervical lymph node status (p = 0.03). CONCLUSION: T3-T4 tumours of the floor of the mouth are managed by surgical resection and adjuvant radiotherapy. There is a high rate of treatment-associated complications. The prognosis of locally advanced tumours of the floor of the mouth remains humble.

[Schwannomas of the neck. About 3 cases, and literature review]. / Schwannomes du cou. A propos de 3 cas, revue de la littérature.

INTRODUCTION: Schwannomas of the neck are rare. Their diagnosis remains difficult despite the evolution of imaging techniques. The goals of our study were to review the diagnostic and therapeutic approach for these tumors. MATERIALS AND METHODS: Retrospective study (1998-2005) concerning 3 cases of schwannoma in rare localizations: superior laryngeal nerve, ansa cervicalis and deep cervical plexus. These 3 patients were operated on in our ENT head and neck department. We made a review of the literature using the Medline database. RESULTS: The mean delay between symptomatology and treatment was 5 years. In all cases, the schwannoma presented with a slowly-growing cervical mass. In only one case, the diagnosis of schwannoma was maded preoperatively. All 3 patients were treated surgically and the involved nerve was sacrificied. There were no postoperative complications. The mean follow-up duration was 3.5 years, with no recurrence. DISCUSSION-CONCLUSION: To establish a diagnosis of neck schwannoma, ultrasound is the least sensitive imaging tool. Fine needle aspiration is especially useful to rule out other conditions. The most relevant diagnostic tools are CT-scan and especially MRI. Treatment is surgical; it should include sacrifice of the involved nerve. Surgical exploration of the neck and tumor resection could be performed at the same operation in the informed patient aware of the sequelae of nerve sacrifice, or otherwise be performed in two steps in the uninformed patient.

Supracricoid partial laryngectomy with crico-hyoido-epiglottopexy for glottic carcinoma with anterior commissure involvement.

Glottic cancers discovered at an early stage (T1-T2) can be treated with either radiotherapy or surgery. The aim of our study is to analyse survival and functional results of supra-cricoid partial laryngectomy (SCPL) with crico-hyoido-epiglottopexy (CHEP) as surgical treatment for glottic carcinoma with anterior commissure involvement. We performed a retrospective study (1996-2013) which included patients who underwent SCPL-CHEP for glottic squamous cell carcinoma with involvement of the anterior commissure. Before surgery, all patients underwent staging including head, neck and chest CT-scan with contrast injection as well as suspension laryngoscopy under general anaesthesia. A total of 53 patients were included. The median follow-up period was 124 months. Tumour resection was complete in 96.2% of cases. The overall, specific and recurrence-free survival rates at 5 years were, respectively, 93.7%, 95.6% and 87.7%. The average period of hospitalisation was 18 days. The average time elapsed before decannulation and before restoration of oral feeding were 15 and 18 days, respectively. SCPL-CHEP is an important option for laryngeal surgical preservation. It allows adequate disease control as well as good functional results as long as the indications are well respected and the surgical techniques are mastered.

[Lemierre's syndrome: literature review]. / Syndrome de Lemierre: revue de la littérature.

OBJECTIVES: Our aim was to recall the pathogenesis, clinic aspects and therapeutic options for Lemierre's syndrome. PATIENTS AND METHODS: This was a retrospective study (1998-2005) of 4 patients, 3 males and 1 female, average age 22 years (18-30). Bacteriological samples, a chest radiograph and a cervical and thoracic CT-scan with injection were available for all patients who were given broad spectrum antibiotic therapy for 3 to 6 weeks. Surgical treatment was necessary for 3 patients. A review of the literature from Medline was performed. RESULTS: Three patients had a peritonsillar abscess. All of them exhibited thrombophlebitis of the internal jugular vein or one of its tributary branches. In all patients, metastatic infections were noted. In one, arthritis and mediastinitis were associated. The causal microorganism was Fusobacterium (necrophorum--2, nucleatum--1) in three patients. In one, bacteriological samples were negative. Transfer to an intensive care unit was necessary for one patient. There were no deaths. CONCLUSIONS: Lemierre's syndrome is a rare but acute medical condition which concerns young immunocompetent people. The pathogenesis consists of the development of infectious thrombophlebitis in the internal jugular vein or one of its tributary branches caused by a focal sepsis, localized in most the cases in the oropharynx, leading to metastatic infections, generally to the lung. Treatment is medical but surgery is sometimes required.

[Sphenoid sinus mucocele of unusual aetiology and location]. / Une mucocèle sphénoïdale atypique de par son étiologie et sa localisation.

UNLABELLED: Mucoceles of the sphenoid sinnus are rare. 140 cases have been reported in the literature. PURPOSES: We review a case and discuss: 1) pathophysiology and diagnosis of mucoceles; 2) etiologies, anatomical variants, clinical manifestations and treatment of sphenoidal mucoceles. MATERIAL AND METHOD: Case report and literature review. CASE REPORT: An 18-year-old female, with no past medical history was hospitalized for right fluctuating monocular blindness. MRI and CT scan facilitated the diagnosis of right clinoid mucocele with compression of the optic nerve. Imagery also revealed fibrous dysplasia of the anterior skull base which probably induced the mucocele formation. The mucocele was successfully decompressed during endoscopic sinus surgery. Postoperative course was unremarkable. At four months post surgery there was no recurrence of ophtalmological symptoms. DISCUSSION-CONCLUSION: The pathophysiology of mucoceles remains uncertain. Diagnosis is based on imagery (CT scan, RMI). Imagery allows accurate location of the mucocele, defines any concomitant pathology and oulines important anatomical structures necessary for safe endoscopic sinus surgery. The association of fibrous dysplasia and an anterior clinoidal mucocele is exceptional. To our knowledge this is the only report in the literature. Ophtalmologic symptoms with a risk of blindness require urgent surgical treatment. Surgery involves decompression, ideally endoscopically.

[Combined induction chemotherapy and radiotherapy in case of undifferentiated carcinoma of nasopharynx tumours (UCNT)]. / Traitement par chimiothérapie d'induction et radiothérapie des cancers du cavum de type UCNT.

OBJECTIVE: The objectives of our study were to consider the morbidity and the effectiveness of combined induction chemotherapy and radiotherapy in the treatment of Undifferentiated Carcinoma of Nasopharynx Tumor (UCNT). PATIENTS AND METHODS: It was a retrospective study (1987-2002) of patients who had not received any previous treatment. Patients with distant metastases during initial assessment were excluded. Two types of chemotherapy were administered: The BAC regime (Bleomycin, Adriamycin, Cisplatinum) and the FUCIFOL regime (Fluorouracil, Cispaltinum, Elvorin). The protocol for radiotherapy was either radiotherapy alone or concomitant chemoradiotherapy. The survival rates were calculated with the nonparametric method of Kaplan-Meier and compared with logrank tests. The multivariate analysis were made with the regressive logistic method. RESULTS: Fourty four patients (32 males, 12 females), average age 46 years (14-77) were selected. On the whole, the tolerance of the treatment was good (chemotherapy 71%, radiotherapy 82%). Treatment mortality was null. The BAC regime was the most effective. At the end of the treatment, a total response was obtained in 82% of cases. The commonest cause of treatment failure was the emergence of metastases (64% of deaths). The overall disease free survival rates at 3 years were respectively 78% and 69%. With multivariate analysis, the independent variables inductive radiotherapy and the initial response to treatment were significantly linked to death with a respective p value of 0.02 and 0.0084. CONCLUSIONS: Combined induction chemotherapy and radiotherapy is efficient in the treatment of UCNT. The tolerance of treatment was good. Our results are comparable with those reported in the literature.

Optimal enlargement of the frontal sinus approach.

After recalling the main anatomical characteristics of the frontal sinuses, the authors describe the frontal craniotomy surgical procedure and its variants. A bicoronal skin incision is performed. An inferior-based pericranial flap is created, with its limits situated away from the osteotomies. Osteotomies are performed with an oscillating saw. The inferior osteotomy is horizontal, tangentially following the supraorbital margin as far as the lateral limit of each sinus. The osteotomy is continued medially as far as the nasion, passing an average of 3mm above the floor of the medial part of the sinuses, immediately above the frontonasal ducts. The superior osteotomy is performed in a vertical coronal plane through the summit of the sinuses. It is arc-shaped, concave downwards, joining the lateral extremities of the inferior osteotomy. The posterior wall of the sinus can be resected to perform frontal sinus cranialization, allowing access to the midline anterior cranial fossa. The posterior wall of the sinus is removed with a high-speed burr in the same way as the anterior wall. At the end of the procedure, the bone flap is sutured with nylon suture material and the pericranium is sutured over the bone flap.

Thyroglossal duct surgery. Sistrunk procedure.

Midline cysts of the neck are the most common congenital malformations of the neck. They arise along the thyroglossal duct. The presence of a fistula is the result of either spontaneous (suppuration) or surgical fistulisation (simple incision or incomplete excision). The cyst and/or fistula are located between the base of the tongue and the thyroid gland, predominantly adjacent to the hyoid bone. This midline site can be explained by embryological development of the thyroid gland. Treatment is surgical. Many techniques have been described, but Sistrunck procedure (described in 1920), based on embryological studies, remains the reference technique with a recurrence rate of less than 3%, provided surgery is performed correctly, comprising resection of the body of the hyoid. Risk factors for recurrence are: surgery during the inflammatory phase, cyst rupture during dissection, multiple thyroglossal ducts and a technical error during the surgical procedure.

[Vestibular disorders and nausea during head and neck intensity-modulated radiation therapy]. / Nausées et troubles vestibulaires lors de la radiothérapie conformationnelle avec modulation d'intensité de la tête et du cou.

PURPOSE: We studied whether there is a relationship between nausea and vestibular disorders in patients treated with intensity modulated radiation therapy (IMRT) for head and neck cancer. PATIENTS AND METHODS: We performed a prospective single-centre study that enrolled 31 patients. A videonystagmography was carried out before and within 15 days after radiation therapy for each patient. Nausea was assessed at baseline, every week, and at the post-radiotherapy videonystagmography visit. RESULTS: Twenty-six patients had benefited from a complete interpretable videonystagmography. For 14 of these patients vestibular damage was diagnosed post-radiotherapy. During irradiation, six patients felt nauseous, but without dizziness. In univariate analysis, we found a relationship statistically significant between the average dose received by the vestibules and vestibular disorder videonystagmography (P=0.001, odds ratio [OR]: 1.08 [1.025-.138]), but there was no relationship between vestibular disorder videonystagmography and nausea (P=0.701). CONCLUSIONS: Irradiation of the vestibular system during IMRT does not seem to explain the nausea.

Neurovascular complications following carotid body paraganglioma resection.

OBJECTIVE: The present consecutive case series reports our experience in the management of carotid body paraganglioma and aims to assess whether the Shamblin classification or tumor size are predictive of early and late postoperative neurovascular complications. MATERIAL AND METHODS: A retrospective study included 54 carotid body tumor resections in 49 patients, between 1980 and 2011. Data comprised early (<1month) and late (18 months) postoperative neurovascular complications. RESULTS: Early postoperative complications occurred in 31 cases, including 30 cases of cranial nerve deficit (56%). Cranial nerve deficit occurred in 83% of Shamblin III carotid body paragangliomas and was associated with significantly larger mean tumor size (4±1.4cm versus 2.9±1.3cm; P<0.01). Shamblin III tumor and tumor size>3.2cm emerged as predictive factors for early postoperative peripheral neurological complications. Eight patients (17%) showed no cranial nerve deficit recovery, even after 18 months' follow-up; no predictive factors could be identified for this. CONCLUSION: Surgical resection remains the only curative treatment in carotid body paraganglioma, with low vascular morbidity. However, early postoperative nerve deficit remains frequent (56%), although mostly temporary, with 17% definitive sequelae at 18 months. Tumor size and Shamblin classification are predictive of early neurovascular complications.

[Reconstruction after tumor resection of the anterior skull base with an of abdominal fat graft]. / Reconstruction après résection tumorale de la base antérieure du crâne par greffon graisseux abdominal.

OBJECTIVES: Reconstruction of the anterior skull base is a surgical stage as significant as tumor removal. The quality of the reconstruction is the primary determinant of postoperative mortality, morbidity. The aim of our work was to assess the results of a reconstruction process combining: 1) a pericranium graft held by biological glue to complete the dura mater; 2) an abdominal fat graft supported by a Silastic arch to maintain the neurological structures. PATIENTS AND METHODS: This was a retrospective study. 55 patients (44 men and 11 women), 59 mean age (14 - 78), were analyzed. 45 had a malignant tumor and 10 a benign tumor. 35 patients were treated using a mixed approach and 18 using a trans frontal-sinus approach alone. Forty-three patients treated for a malignant tumor underwent postoperative radiotherapy. Results were analyzed according to 3 periods: 1) immediate postoperative period (<25 days); 2) early postoperative period (25 days - 3 months); 3) late postoperative period (> 3 months). RESULTS: None of the patients were lost to follow-up. The average follow up was 84 months. All periods considered together, we had five (9.4%) graft infections, 6 (11.3%) CSF leaks and 1 (1.8%) cases of meningitis. CONCLUSION: We use a simple technique for reconstruction. Postoperative complications were exceptional, even after postoperative radiotherapy. Medium and long-term results are good and similar to those obtained with other processes used for reconstruction of the anterior skull base reconstruction.