[Glomangioma or "glomus tumor" of the nasal cavity: apropos of a new case and review of the literature]. / Glomangiome ou "tumeur glomique" des cavités nasales: à propos d'un nouveau cas et revue de la littérature.

Glomangioma, or "glomic tumour" is a benign soft tissue tumour appearing most commonly at the distal extremities, in the nailbed and subcutaneous tissue. This is a vascular tumour, rare for the dermatologist, and exceptional in an ENT site. We describe here what is, as far as we can tell from the literature, the eighteenth case. The problem is the diagnosis of a vascular tumour, arising usually from the septal mucosa, which has to be distinguished histopathologically from a haemangiopericytoma. Radiological investigation will define the extent of the tumour and guide the treatment plan, which is purely surgical and consists of wide excision to avoid the possibility of a local recurrence.

Management of facial paralysis resulting from temporal bone fractures: Our experience in 115 cases.

OBJECTIVE: The goal of this study was to review decision factors and overall results regarding surgical and nonsurgical management of post-traumatic facial nerve paralysis (FP). STUDY DESIGN: A retrospective study and literature review were performed. METHODS: Between 1984 and 1990, 115 cases of post-traumatic FP were handled. Patients were evaluated through clinical, audiologic, radiologic, and electromyogram assessment. Depending on examination results, patients were treated either medically or surgically through total facial nerve decompression. RESULTS: Forty-nine of the 50 medically treated patients experienced a normal or subnormal facial function recovery (grade I-II). Of the 65 (56.5%) surgically treated patients, 52 (80%) had immediate, 2 had delayed, and 11 (17%) had unknown delay-associated FP. The approaches chosen were middle fossa and transmastoid (75.3%), translabyrinthine (10.7%), or pure transmastoid according to facial nerve nonmotor branch evaluation, hearing, location of the fracture line, and the patient's general condition. Lesions were predominantly found in the geniculate ganglion area (66.2%). A nerve gap was found in only 13.8% of the cases. At 2 years after surgery, 93.8% had a grade I to III recovery. None had grade V or VI. CONCLUSION: The rarity of severe nerve lesions encountered in surgically treated patients raises the question of better selection of candidates for surgery. Surgery is clearly indicated when FP is total, is of immediate onset, and is associated with a bad prognosis electromyogram pattern. In other settings, decisions are to be made based on high-resolution CT data and electromyogram results, thanks to a clinical survey and second electromyogram evaluation.

[Abnormal trajectory of the internal carotid artery in the middle ear. Report of a case]. / Trajet aberrant de l'artère carotide interne dans l'oreille moyenne. A propos d'une observation.

The authors report a case with an aberrant course of the internal carotid artery within the middle ear--a rare abnormality with only about fifty cases so far reported in the literature. The combination of pulsatile tinnitus and a retro-tympanic mass calls for a precise anatomical investigation of the temporal bone before any surgery is undertaken. The role of the various complementary investigations is discussed. A high resolution CT scan is the key investigation, and is sufficient to give the diagnosis in the majority of cases. Angio-MRI currently affords the possibility of confirming this vascular malpositioning in a non-invasive way. Arteriography should be used only when there is remaining doubt about the possibility of a glomus tumour, or before treatment by clamping. The most logical course to adopt would seem to us to be to abstain from treatment once this diagnosis has been made, given the risk of major haemorrhage and the potential neurological complications.

[Facial paralysis: treatment with an acyclovir-methylprednisolone combination, preliminary results]. / Paralysies faciales a frigore: traitement par l'association Aciclovir-Methylprednisolone, résultats préliminaires.

RATIONALE: Many actual data suspect a viral etiology to Bell's palsy. Herpes viridae are more and more incriminated. On these basis, we have studied the efficacity of parenteral association of 30 mg/Kg/j of Aciclovir and 1 mg/Kg/j of Methylprednisolone in the treatment of Bell's palsy with less than 12 days of evolution. METHOD: The evaluation concern 53 patients. We also evaluated the functional motor result (using House and Brackmann staging) and search prognostic factors in clinic and paraclinic data. A viral investigation have been made in most of the cases. RESULTS: Only one of our patients treated with Aciclovir keeps some sequeles (stage III of House and Brackmann classification). We didn't found any deleterious effect. Statistically, the electromyography is the only one test with a prognostic value. But we feel that delay between the starting and the treatment of the palsy is important. Viral tests show sometime abnormal Ig against the Herpes viridae group. CONCLUSIONS: These promising results are lightened with a review of the literature. A multicentric investigation is already in place for a stronger statistic effect.

[Fractionated radiation therapy long-term effectiveness in the treatment of cerebello-pontine angle schwannomas: 12 years of experience in 30 cases]. / Efficacité à long terme de la radiothérapie fractionnée dans le traitement des schwannomes de l'angle ponto-cérébelleux : expérience de 12 ans sur 30 cas.

UNLABELLED: The purpose of this research was to evaluate long-term results of fractionated radiation therapy (RT) in the treatment of cerebello-pontine angle schwannomas. METHODS: from January 1986 to October 1995, 29 patients with stage III and IV scwhannomas were treated with external fractionated RT. One patient was irradiated on both sides and indication for RT was as follows: a) poor general condition or old age contraindicating surgery, 16 cases; b) hearing preservation in bilateral tumors after contralateral tumor removal, 6 cases; c) partial resection or high risk of recurrence after subsequent surgery for relapse, 5 cases; d) non surgical relapse, 3 cases. Most patients were irradiated with 6 to 10 MV photons. A three- to four-field technique with coplanar static beams and conformal blocks was used. Doses were calculated on a 95 % isodose and were given 5 days a week for a mean total dose of 51 Gy (1.8 Gy/fraction). RESULTS: Median follow-up from RT was 66 months (7 to 120); seven patients died, two with progressive disease, five from non tumoral cause. Two patients underwent total removal after RT (1 stable and 1 growing tumor). On the whole, tumor shrinkage was observed in 13 patients (43.3 %), stable disease in 14 (46.6 %), and tumor progression in three. Hearing was preserved in 4 out of 6 hearing patients (1 class A hearing, 2 class B and 1 class C). No patient experienced CN5 or CN7 neuropathy. CONCLUSION: long-term efficacy or fractionated RT is well documented in this series. Acute and delayed tolerance was excellent. Hearing can be preserved for a long time.

[Malignant or necrotizing otitis externa: experience in 22 cases]. / Otites externes "malignes" ou nécrosantes progressives.

Malignant or progressive necrotizing otitis extrema is an uncommon but severe infectious condition of the external auditory canal. Over a period of four years, we treated 22 patients: 60% had diabetes (1/4 insulin dependent) and 13% were immunodepressed. The causal germ was Pseudomonas aeruginosa in 87% of cases. The pretherapeutic work-up included a computed tomography scan and a technetium scintigraphy to confirm diagnosis and assess extension. Repeated scintigraphies with gallium were used to follow the course under treatment. Medical treatment was used in most cases (16/22) with parenteral antibiotic therapy using a third-generation cephalosporin (ceftazidime or ceftriaxone) and a fluoroquinolone (ciprofloxacin or ofloxacin) and, if there was no contraindication, hyperbaric oxygen. Surgery is not indicated in malignant otitis externa. We had a 95% cure rate with only 10% recurrence. We reviewed the data in the literature on malignant otitis externa and present the important diagnostic, imaging and therapeutic aspects.

Preference for the closed technique in the management of cholesteatoma of the middle ear in children: a retrospective study of 215 consecutive patients treated over 10 years.

OBJECTIVES: To evaluate clinical data, extensions, residual and recurrent lesion rates, and functional results in cases of cholesteatoma in pediatric patients. DESIGN: A retrospective study at a single tertiary care center over a decade. PATIENTS: In 199 children (mean age 9.6 years), 215 cholesteatomas were treated surgically, and the children were followed up for an average of 70 months (range 25-118 months). INTERVENTIONS: Therapeutic and rehabilitative surgical procedures were done, using either a closed technique (CT) or an open technique: tympanoplasty in open technique (TOT), radical mastoidectomy (RM), or Rambo's technique) MAIN OUTCOME MEASURES: Surgical findings, residual and recurrent lesions rate, and hearing assessment. RESULTS: The first surgical procedure was CT in 88% of cases, TOT in 10%, RM and Rambo's technique in 1%. Two operations were done in 61.8% of children; 21% had three operations and 4.5% had four. Residual lesions were observed in 21.5% of all children, 32.8% in those undergoing a planned second look. Recurrence rate was 9.8%. Surprisingly, residual and recurrent lesion rates were higher after TOT (23.8% and 19%) than after CT (20.5%, 8.9%), but TOT-treated children had much more extensive lesions. A speech reception threshold (SRT) <30 dB hearing loss (HL) was achieved in 63.7% of patients, and normal hearing was obtained in 12.1%; SRT was significantly better after CT (mean 26.7 dB) than after TOT (mean 37.4 dB), after type II (mean 27 dB) than after type III (35 dB). A high-frequency pure-tone hearing loss >10 dB was uncommon (7.6%). CONCLUSION: These results support the continued use of CT in most cases of cholesteatoma in children in developed countries.

[Olfactory esthesioneuromas]. / Esthésioneuromes olfactifs.

Olfactory neuroblastomas are rare malignant tumours of the nose arising from the olfactory epithelium. In a retrospective series of 18 cases and a review of the literature, the authors establish the main features of this tumour. They emphasise the difficulties of histological examination, often requiring immuno-cyt-chemistery and electron microscopy. They point out the value of a new classification, and confirm treatments being radio-surgical, with use of the combined rhino-neurosurgical approach when there is extension to the cribriform plate. They report a 5-year survival of 91.5%, with 87.5% at 10 years. The high incidence of lymph gland metastases (16.6%) is greater than that of local recurrence (11%) especially in the more advanced cases. The question of prophylactic treatment of the neck nodes is one to be considered.

[Congenital cholesteatoma of the ear in the child. Clinical, follow-up and therapeutic analysis of a series of 34 cases]. / Cholestéatomes congénitaux de l'oreille chez l'enfant. Analyse clinique, évolutive et thérapeutique d'une série de 34 cas.

Long a subject of debate, congenital cholesteatomas of the middle ear appear to be a specific clinical entity different from the much more frequent classical acquired cholesteoma. Characteristic features of congenital cholesteatomas are young age at diagnosis, typical peroperative presentation, satisfactory mastoid air cells in almost all cases, and associated congenital malformations, which may involve the otology system or not. Diagnosis is a difficult task due to the long latency period with no clinical manifestations. These congenital cholesteatomas appear to be more aggressive in a mastoid with functioning air cells. Thus open excision does not appear to be appropriate and should be reserved for selected cases. For us, the closed technique with two procedures is more adapted but requires good cooperation with the family. The risk of recurrence is however significant and at least comparable to that of acquired cholesteatomas in children. Follow-up should be persuade as long as possible. Functional results have been encouraging even though ossicular destruction is frequent. The quality of the auditory tube appears to be a determining factor.

[Acute vertigo caused by ischemia of the postero-inferior cerebellar artery or PICA. Apropos of 2 cases]. / Vertige aigü par ischémie de l'artère cérébelleuse postéro-inférieure ou PICA. A propos de 2 cas.

Based on two cases and a review of the recent literature, we would like to draw attention to the fact that a cerebellar infarction, localised to the territory of the PICA, can present with just a single clinical feature-acute rotary vertigo. Cerebellar vascular accidents remain a little known cause of acute vertigo, often masquerading as a peripheral vestibular disturbance. The main differential diagnosis is vestibular neuronitis. The prognosis is usually good, but the risk of a late recurrence or of a further cerebro-vascular episode is difficult to predict. This uncommon aetiology should not be ignored because of the risk of progression towards a sort of pseudo-tumoral infarct, in which the risk of a fatal outcome remains ever present. In most cases, however, sequelae are few or absent.

[Cholesteatoma of the middle ear in children. Clinical, developing and therapeutic study in a series of 215 consecutive cases]. / Les cholestéatomes de l'oreille moyenne chez l'enfant. Analyse clinique, évolutive et thérapeutique d'une série de 215 cas consécutifs.

A retrospective study of 215 cases of cholesteatoma in 199 children operated on from 1985 to 1996 was conducted. Mean age of the children was 9.6 years. Bilateral cholesteatoma was present in 32 cases (8%). The cause was congenital in 32 cases (16%), iatrogenic in 24 cases (11%) and secondary or acquired in 63%. The surgical procedure was a closed technique in 88%, an open technique with or without ossiculoplasty in 10%, and exclusion of the ear using the Rambo technique in exceptional cases (1%). The facial nerve was exposed in 17%. A labyrinth fistula was discovered in 4%, and an intracranial suppuration in only 0.5%. A secondary open procedure was required in 5 cases (2.5%) and secondary exclusion 3 times (1.5%). The ossicular chain was interrupted in 24.2% of the cases and ossicular rehabilitation was performed in 68% of the cases (39% type II, 29% type III), including 49% during the first procedure. At least 2 operations were needed in 62% of the children and 21% had 3 operations. Residual cholesteatomas were observed in 21.5% of all children in the series, 33% in those with a second operation. Recurrence rate was 10%. Mean hearing loss was 28 dB for a mean gain of 4 dB. Post-operative hearing capacity was socially useful in 64% of the cases, including 12% who had normal hearing. Labyrinthization was observed in 15 cases, including 4 cases with total hearing loss. These result are in general agreement with data in the literature. Our strategy is based on a closed procedure for cholesteatomy and systematic re-evaluation at 1 year. The open technique is useful for very extensive lesion on a narrow mastoid, either as second intention procedure or more rarely as a first intention procedure. Management in children differs from that in adults since in adults the destruction has usually progressed further in a mastoid which accepts an open procedure more readily.

[Bacteriology of maxillary sinusitis among members of the 11th parachutist unit]. / Bactériologie des sinusites maxillaires au sein de la 11ème division parachutiste.

When sinusoscopic examinations of chronic maxillary are made, bacteriological samples are the most often carried out. We report results of thirty one cases among young soldiers 19 to 23 years old. Our bacteriological results are similar to those reported in literature. A bibliographic study reminds the recent bacteriological findings according to countries or type of patients where pathogen germs were researched.

[Thyroid surgery: risks and complications. Apropos of 134 cases]. / Chirurgie thyroïdienne: risques et complications. A propos de 134 cas.

From a retrospective covering 134 patients operated from the thyroid gland, the authors have tempted, over at least a year's survey, to clarify the incidence of the main post-operative complications. Recurrent laryngeal nerve paralysis and permanent hypoparathyroïdism are the two major risks, with a respective percentage of 2.25% and 7.4%. After a general review of publications the discussion is focused on the etiology of the different complications already found and on the possible means to avoid them or, at least, to minimize them.

[Nasal localization of a cicatricial pemphigoid: apropos of a case]. / Pemphigoide cicatricielle de localisation nasale: à propos d'un cas.

The authors reports the case of a 34 years old patient with a cicatricial pemphigoid whose diagnosis was made on a nasal symptomatology, isolated, persistent and with an increasing aggravation over the five last years. This auto-immune bullous disease is quite unusual and has got the trend of a synechia characteristic. The mucous membrane O.R.L. attacks are scarce not to say exceptional in their nasal aspect. The treatment based on Disulone has quickly allowed a progress over a trouble caused by the lesions but had to be interrupted for problems of tolerance.

[Sudden deafness: a randomized comparative study of 2 administration modalities of hyperbaric oxygenotherapy combined with naftidrofuryl]. / Surdités brusques: étude comparative randomisée de deux modes d'administration de l'oxygénothérapie hyperbare associée au Naftidrofuryl.

Hyperbaric oxygen therapy is one of the numerous therapies which have been proposed in the management of sudden deafness. It is presumptuous to claim the efficiency of any treatment in a pathology where both the origin and the actual rate of spontaneous recovery are unknown. The grounds of therapies are therefore empirical but the need of urgent therapy is dictated by ethics. This study compares the effects of hyperbaric oxygen therapy in two groups of patients; according ot their order in randomization the subjects were treated either at a rate of 1 session or 2 sessions per day. Hyperbaric oxygen therapy was associated with infusion of Naftidrofuryl to counteract the vasoconstrictive effect of increased oxygen pressure in blood. Steroids were also administered simultaneously to avoid, for the same reasons, cerebral oedema. Normovolemic hemodilution (Dauman et al. 1983) was systemically performed in all the patients preliminarily to hyperbaric oxygen therapy, in order to reduce the haematocrit and thus facilitate blood supply. The efficiency and the side effects were similar in the two groups, provided that some principles in the selection and the monitoring of the patients were respected. The rate of 2 sessions of hyperbaric oxygen therapy per day has obvious advantages in view of health policy, but it requires the hospitalization of the patient and should be restricted to the younger subjects.