[Peak Nasal Inspiratory Flow: learning curve for the measurement method and reproducibility]. / Peak Nasal Inspiratory Flow: apprentissage de la méthode de mesure et reproductibilité.

OBJECTIVES: A prospective study on the learning curve and reproducibility of PNIF measurement with 18 different operators. MATERIAL AND METHODS: Five hundred twenty-eight patients in two groups were prospectively enrolled in this study from September 2003 to April 2004. The learning curve of the technique was monitored after five patients had been measured. Reproducibility was evaluated with all patients after two consecutive measurements. RESULTS: The technique was acquired by all operators after the fifth patient. The mean PNIF measurements in controls and patients were 86.02+/-36.96 l/min and 89.59+/-41.97 l/min, respectively. Reproducibility (PNIF2-PNIF1=5.51+/-24.93 l/min) was obtained for all operators, whatever the number of measurements taken. CONCLUSIONS: The study confirms the good reproducibility and the easy training in PNIF measurement.

[Four-layer laryngotracheoplasty to repair an anterior tracheal wall defect induced by a Montgomery T-tube]. / Réparation par laryngotrachéoplastie cutanéochondromyocutanée d'une perte de substance trachéale antérieure induite par un tube de Montgomery.

A 37-year old patient was referred in 2000 for reconstruction of the anterior tracheal wall eroded by a Montgomery T-tube. A four-layer laryngotracheoplasty was proposed to the patient. The endotracheal plane was reconstructed by a bilateral random pattern quadrangular skin hinge flap raised from both sides of the defect. The chondral plane was realized with conchal cartilage. This cartilage graft was covered with an inferiorly based sternocleidomastoid flap. The fourth layer was a mesh split-thickness skin graft. Satisfactory and lasting results were observed during a three-year follow-up. Few articles deal specifically with tracheal reconstruction after anterior wall erosion induced by a Montgomery-T tube. We found no mention of the described four-layer flap in the literature.

[Treatments of hereditary hemorrhagic telangiectasia of the nasal mucosa]. / Indications et stratégies thérapeutiques des épistaxis dans la maladie de Rendu Osler.

UNLABELLED: Hereditary Hemorrhagic Telangiectasia is a systemic autosomal dominant disorder involving blood vessels. The most common symptom is recurrent epistaxis. The treatments of these epistaxis are numerous but such treatments are often symptomatic and their effects are often not sustained. Some of these treatments may be complicated by visceral vascular malformations. The aim of this study is to propose a treatment plan for these patients with hierarchical organisation of therapeutic options taking into account of their previous therapy. METHOD: H. Plauchu organized in Paris, december 2002 a meeting with any medical specialists of this disease. They have analysed variety of therapies that have been proposed for epistaxis control in Hereditary Haemorrhagic Télangiectasia. RESULTS: Most common use packing of nasal fossa and then hyperselective embolization of the internal maxillary and facial arteries for severe epistaxis. For chronic epistaxis, best treatment use sclerotics products (Ethibloc) and laser. After discussion, primary embolization could be useful to reduce vascularization of nasal fossa. CONCLUSION: Treatment of epistaxis in Hereditary Haemorrhagic Telangiectasia could increase in few years. Use of an index card of for epistaxis in the disease of Rendu-Osler could help to find treatment of choice.

[Retropharyngeal and lateral pharyngeal abscesses in children]. / Abcès rétro- et latéropharyngés chez l'enfant.

OBJECTIVE: Review of the diagnostic and management of retropharyngeal and lateral pharyngeal abscesses in children. PATIENTS AND METHODS: Retrospective study of 5 children's cases hospitalized during year 2003. RESULTS: Diagnosis included CT scan which is often helpful to differentiate cellulitis from abscesses. First medical management consists in an intravenous broad-spectrum antibiotics. Surgical drainage may be considered in cases of failure or clinical aggravation. Closed observation is mandatory in all cases to prevent major complication. CONCLUSION: Retropharyngeal and lateral pharyngeal abscesses in children are life-threatening infectious. Therapeutic consists in intravenous broad-spectrum antibiotics associated, if necessary, with surgical drainage in cases of persistent abscess.

[Epistaxis and hospitalization: a retrospective observational study over 4 years of 260 patients]. / Epistaxis et hospitalisation: étude rétrospective observationnelle sur 4 ans à propos de 260 patients.

OBJECTIVE: Epistaxis is a frequent emergency for which guidelines and treatment are well known. Nevertheless few studies have evaluated the factors that may influence the decision for hospitalisation. Through a retrospective study we have searched to define potential factors which lead to taking such a decision. METHODS: Retrospective analysis of charts of 260 patients hospitalized for epistaxis. For each patient we have reviewed several data including, age, associated pathologies, current treatment, duration of the stay, complications, recurrences etc... RESULTS: If the severity of the bleeding is one of the major factor, socio-economic factors are also taken into account and may influence the decision to hospitalize. Age, associated pathologies (hypertension, hemopathy) and their treatment (anti-coagulant) also play a role in this decision. Furthermore an obvious strategy in the choice of the different treatment may help to reduce the length of stay and the morbidity of each treatment. CONCLUSION: We propose some modifications to our strategy to improve the management of epistaxis. This includes the use of endoscopic techniques for diagnosis and treatment.

Frontal sinus irrigation: indications, results, and complications.

Management, diagnosis, and surgical treatment of the frontal sinus pathology remain a challenge for the rhinologist. Since the introduction of endoscopic instrumentation, the frontal recess may be reached easily and a variety of endonasal approaches have been rediscovered. Although the endoscopic technique allows direct visualization and manipulation, some problems remain, from localization of the frontal sinus ostium during the procedure to the management of the postoperative care to prevent stenosis. The frontal irrigation is suggested as a useful adjunct during the endonasal approach to locate the frontal drainage.

[Adenoid cystic carcinoma (CAC) of the naso-sinonasal cavities: report of 5 cases, review of the literature]. / Carcinome adénoïde kystique (CAK) des cavités naso-sinusiennes: à propos de 5 nouveaux cas, revue de la littérature.

Adenoid cystic carcinoma is a rare tumour which mainly affects the major and accessory salivary glands. We report 5 new cases affecting the nose and sinuses, and based on these review the literature to determine how this disorder can be better treated, given the significant morbidity and mortality of the condition.

[Rhino-sinus polyposis]. / Polypose rhino-sinusienne.

Nasal polyposis is a chronic inflammatory disease, involving mainly adults. Nasal obstruction and olfactory disorders are the main symptoms due to the presence of bilateral polyps in the nasal cavities. Association with asthma is frequently noted. Medical management is dominated by intranasal steroid. Recent studies lead to a better understanding of the pathophysiology of this pathology and to propose a better long term management including an information for the patient due to the chronicity of the disease.

Pneumosinus dilatans: a report of three new cases and their surgical management.

Pneumosinus dilatans is a rare pathology that primarily involves the frontal sinus. We report three new cases, with special attention given to the pathophysiology and histologic data. Surgical management is reported.

[Asthma and polyposis]. / Asthme et polypose.

For many years, the association between asthma and naso-sinus pathology has been noted in the literature. The role of sinus infections on the triggering or aggravation of asthma has been well established. More recently attention has been drawn to the association of the chronic inflammatory rhino-sinus pathologies such as polyposis, with asthmatic illness. Its research and identification are essential in care of the asthmatic patient, since recent work has shown the value of control of polyposis for the stability and improvement of the asthmatic illness. The authors report and analyse the diagnostic and therapeutic methods for polyposis in asthmatics.

[Laryngeal schwannoma. Diagnostic and therapeutic approach. Apropos of 2 cases]. / Le schwannome laryngé. Approche diagnostique et thérapeutique. A propos de deux cas.

Laryngeal schwannoma is an uncommon benign tumor. We report two clinical cases and discuss the different types of clinical symptoms revealing the tumor. Difficulties encountered in obtaining a histological diagnosis are presented. The contribution of imaging is also analyzed according to the different surgical techniques used to manage the tumor depending on its size and localization. We stress the importance of long-term follow-up as recurrences may occur several years after surgical removal.

Diffuse nasal polyposis: postoperative long-term results after endoscopic sinus surgery and frontal irrigation.

Diffuse nasal polyposis remains a challenge despite recent improvements in endonasal surgery. The purpose of this study is to evaluate the results after a radical complete sphenoethmoidectomy with peroperative and postoperative frontal irrigation in cases of diffuse nasal polyposis. In this prospective study, we include 50 consecutive patients with diffuse nasal polyposis suffering from nasal obstruction, anosmia, and other symptoms of chronic sinusitis. All patients were refractory to medical therapy. In each patient an endoscopic complete sphenoethmoidectomy including total excision of all diseased ethmoid mucosa was performed. Preoperative and postoperative frontal irrigation was performed systematically. The patients were followed closely with serial endoscopic examination, and CT scanning was performed between 2 and 3 years after surgery. There were no complications. Thirty-nine of the 50 patients regained satisfactory olfaction. Partial nasal obstruction persisted in four of the 50 patients. Endoscopically, polyp recurrence was noted in 3% of posterior ethmoids, 23% of anterior ethmoids, and 50% of frontal recesses. We conclude that in cases of refractory and extensive nasal polyposis, a total sphenoethmoidectomy with perioperative frontal irrigation followed by long-term postoperative topical steroid therapy provides excellent improvement or cure with safety and reliability.

Functional endoscopic sinus surgery and 109 mycetomas of paranasal sinuses.

Mycetomas of paranasal sinuses are more frequently diagnosed with the widespread use of nasal endoscopy and computed tomography (CT). We present a series of 109 cases treated by functional endoscopic sinus surgery (FESS) with a mean follow-up of 29 months. All localizations were seen, and contrary to what was initially thought, seven cases presented in multiple sites. Several clinical presentations were found, from a pansinusal involvement to a simple mycetoma hanging in a superior meatus. A heterogeneous sinus opacity with microcalcifications on CT scan is very suggestive of the diagnosis, but a homogeneous opacity may be encountered even with bone lysis. FESS was performed in all cases to obtain a wide opening of the affected sinuses, permitting a careful extraction of all fungal material. In the postoperative period, no medical treatment is prescribed. With a mean follow-up of 29 months, only four recurrences were seen. This study reinforces the interest in FESS for cases of mycetoma of the paranasal sinuses.

Aspergillomas of the sphenoid sinus: a series of 10 cases treated by endoscopic sinus surgery.

We report our experience with 10 cases of sphenoidal aspergillomas treated by endoscopic sinus surgery (ESS). Chronic symptoms such as cough, post-nasal discharge, dysphonia and even facial pain can be encountered in the history. Computerised tomography and, occasionally, magnetic resonance imaging are of great help in the assessment of this disease, especially when extensive skull base involvement is present. The radiological presentation can vary from an heterogeneous to homogeneous opacity with or without bone lysis to a frank pseudotumoural appearance. Four diagnostic tools have been evaluated to confirm the diagnosis: histology, direct smear, fungal cultures, and serology for Aspergillus. ESS has been successfully carried out without morbidity in all cases. No recurrence of the disease is seen after a mean follow-up of 27 months.

[Unilateral choanal atresia and paranasal sinus growth]. / Atrésie choanale unilatérale et croissance sinusienne.

Mechanisms regulating sinus growth are poorly understood. We report a series of six cases of unilateral choanal atresia and discuss the role of nasal ventilation on sinus growth. The presence and the size of the sinus cavities are the main parameters. Our preliminary results suggest that sinus growth is independent of nasal ventilation.

[Dacryocystorhinostomy using Nd YAG laser by the intracanicular approach]. / Dacryocystorhinostomie au laser Nd YAG par voie endocanaliculaire.

Endocanalicular dacryocystorhinostomy is a recent surgical procedure for stenosis of the naso-lacrymal duct, thanks to a laser filter fitted into the heart of 800 mu diameter metallic pin constituting a rigid armed laser probe. We create a lacrymo-nasal orifice from inside the lacrymal bag towards the nose, using the laser fiber. The Nd YAG used is the solid state mobilisable Ophtalas sp 32 giving out infrareds at 1064 nm or green at 532 nm. The indications are the stenosis of the naso-lacrymal duct, the failed classical dacryocystorhinostomy, the conjunctivodacryocystorhinostomy and the stenosis of the common canaliculus. This surgical procedure compared to the classical surgical technics appears to the very promising due to its simplicity, innocuousness, time saving. Our results, still inferior to the classical technique for all indications (success rate: 70%) are very good for the idiopathic stenosis of the naso-lacrymal duct (success rate: 87.5%).

Endoscopic approach of the pterygopalatine fossa: report of one case.

We report one case of schwannoma of the pterygopalatine fossa. The pre-operative management and post-operative follow-up are presented. For this uncommon localization, we propose an endoscopic approach via the nasal fossa and the maxillary sinus. The advantages and limitations of this technique are discussed.