[Spontaneous posterior sphenoid sinus fistula]. / A propos d'un cas de brèche spontanée de la paroi postérieure du sinus sphénoïdal.

OBJECTIVE: Describe a rare localization of spontaneous cerebrospinal fistula. CASE REPORT: A 75-year-old women was admitted for bacterial meningitis arising from a sinus infection. She had not experienced facial or head trauma. The CT-scan revealed pneumocephaly and a defect in the posterior part of the sphenoid sinus. DISCUSSION: Spontaneous cerebrospinal fistula is uncommon. The exact etiology remains unknown.

[The pedicled musculo-cutaneous latissimus dorsi flap]. / Le lambeau musculo-cutané pédiculé du grand dorsal.

The pedicled musculo-cutaneous latissimus dorsi flap presents many advantages and merits to be used more frequently in head and neck surgery because a large musculo-cutaneous pallet with an excellent vitality can be obtained. The flap reaches easily the inferior third of the face thanks to its rotation arc, leading to a discreet aesthetic scar. For this reason, its use is interesting especially for women. The aim of this article is to focus on the fundamental points of the technique we use and to emphasize the importance of the postoperative patient's arm positions to obtain a good result.

[An unusual tumor of the larynx: malignant fibrous histiocytoma. Apropos of a case. Review of the literature]. / Une tumeur exceptionnelle du larynx: l'histiocytome fibreux malin. A propos d'une observation et revue de la littérature.

On the basis of one case, the authors report about an exceptional tumor of the larynx: malignant fibrous histiocytoma. This tumor, belonging to the soft-tissue sarcomas, usually develops in the limbs. The histological diagnosis is still difficult, in spite of the help provided by immunocytochemistry and fine structural analysis. A histological grading associated to other deciding prognostic factors, such as the size and depth of the tumor and the quality of exeresis, would demonstrate a prognostic correlation. The evolution is characterized by frequent local recurrence and metastases. The treatment is mainly surgical, with as extensive an exeresis as possible at once. Radiation therapy and chemotherapy, though often associated, have not decisively proven their value.

[The scapular osteocutaneous flap. Technic, indications in cervicofacial surgery]. / Le lambeau ostéocutané scapulaire. Technique--indications en chirurgie cervico-faciale.

The authors describe 10 cases of mandibular reconstruction following transmandibular buccopharyngectomy, using scapular osteocutaneous flaps. Repair of mandibular substance loss due to neoplastic surgery becomes a problem. Composite bone resections are associated with mucous and muscular defect formation. There is dual advantage in using this type of flap: on the one hand, reliability is great, independently of the case (revisions or other types of surgery) because of the presence of constant elements in the vascular pedicle; on the other hand, the cutaneous flap and the bone transplant are independent from each other, such plasticity affording equally successful symphyseal and lateral repair.

[Spheno-ethmoidectomy in recurrent nasal polyposis. Technic, indications, results]. / La sphéno-ethmoïdectomie dans la polypose nasale récidivante. Technique, indications, résultats.

Spheno-ethmoidectomy can be legitimately included within the therapeutic schema for nasosinusal polyposis causing incapacity and resistant to medical treatment. Benefiting from recent technical progress, a very precise medical therapeutic framework and improved knowledge of ethmoid surgical anatomy, a marked reduction in complications of this operation has been observed. Results of a series of 175 ethmoidectomies performed in 90 patients confirm the good results reported in the literature, even though follow up is still insufficient.

[Requisite selection of surgical technics in the treatment of cancer of the larynx]. / La nécessaire sélection des techniques chirurgicales dans le traitement du cancer du larynx.

Rules for functional surgery of cancer of larynx are defined by means of a detaited analysis of results of 43 cases of reconstructive anterior frontal laryngectomy, 17 cases of crico-hyoide-epiglottopexy and 32 cases of crico-hyoidopexy. The carcinologic features of this surgery are discussed, and emphasis placed on the importance of the paraglottic space and its functional conditions in the light of recent physiologic data. Surgical procedures used are outlined with, for each of them, the neoplastic localization suitable for treatment and a critical analysis of postoperative functional results. Carcinologic follow up is still insufficient for several techniques used, preventing any precise conclusions to be drawn, but the authors consider it is justifiable to perform 66% of partial as against 34% of total laryngectomies.

[Total circular pharyngolaryngectomy. A method of reconstruction with a free forearm skin flap]. / Pharyngo-laryngectomie totale circulaire. Méthode de reconstruction par un lambeau cutané libre d'avant-bras.

The reconstruction of the digestive tube after total circular pharyngo-laryngectomy continues to pose a number of problems. Fistulae and delayed healing of the mucosa are common problems after musculo-cutaneous flaps. They are due, on the one hand, to a spring effect of the flap which interferes with tubulisation and, on the other hand, to the problematical suture of the thick thoracic wall skin to the fine oesophageal mucosa. Free visceral plasties give first intention repairs with rapid return of eating, but they carry a mortality of 10 to 15%. The free ante-brachial plasty with a radial pedicle seems to be a satisfactory alternative due to the quality of the oesophageal reconstruction and the absence of mortality. The technique of forming the flap and the operative procedure are described. Five cases are presented. There were no failures and oral feeding could be re-commenced by the 21st day, on average.

[Value of thallium scintigraphy in thyroid pathology]. / Intérêt de la scintigraphie au thallium en pathologie thyroïdienne.

The value of thallium 201 (Tl 201) scintigraphy was investigated in 45 patients with thyroid affections. Scintigrams were performed with both technetium 99 m (Tc 99 m) and Tl 201. Of the 27 patients with 43 thyroid nodules confirmed histologically (16 patients were operated upon and needle puncture cytology conducted in 11 cases), all cold nodules to Tc 99 m and Tl 201 were found to be benign. Of the 28 hot nodules to Tl 201, cancer was demonstrated in 8 cases, equivalent to 72 p. 100 of false positives against the 47 p. 100 of all cases reported in the literature. In benign affections, thyroid topography to Tl 201 can now be obtained in patients with plummer's toxic nodules without the need for Quérido's test and without iodine saturation of the thyroid. Gonadal toxicity of Tl 201 prevents its routine use in patients under 35, who were excluded from this study.

[Role of musculocutaneous flaps in pelvibuccopharyngectomy]. / La place des lambeaux musculo-cutanés dans les pelvi-bucco-pharyngectomies.

Musculocutaneous flaps were used for reconstruction after excision of large base of tongue or lateral oropharyngeal wall tumors in 50 patients, the most frequently employed flap in both regions being one from pectoralis major. Results showed marked reliability for these types of flaps for repair in these two areas, and they have now supplanted conventional single pedicle skin flaps. Various flaps supplying different useful surfaces are required, the platysma or sternocleidomastoid muscles being used for small areas, the pectoral or trapezius muscles for medium sized gaps and the latissimus dorsi for extensive repairs. Postoperative and functional results were improved both after initial or repeat operations. The possibility of more extensive excisions should improve prognosis of these tumors, their severity being partly related to local recurrence. It is too early to conclude definitely in their use in initial surgery, but they are valid procedures following failure of radiotherapy, enabling certain patients to be treated again after 3 years in the absence of any other therapy.

[Glottic reconstruction with a flap of thyroid perichondrium]. / Les reconstructions glottiques par lambeau de périchondre thyroïdien.

Laryngoplasty was performed using the perichondrium of the thyroid cartilage or a sternohyoid muscle flap. Techniques and results are described using this method, applied for glottic reconstruction after vertical partial laryngectomy of the frontolateral type and after cordectomy. Anatomic and functional results in 15 cases are described, ultrasound imaging showing in all cases an improvement in basic laryngeal function, and in the timbre and strength of the voice.

[Lateral cervical chemodectoma]. / Les chémodectomes latéro-cervicaux.

Diagnostic and surgical features of lateral cervical chemodectomas are discussed in relation to a personal series of 13 patients with carotid body tumors and 7 with tumors of the intravagal glomus. Clinically, these affections are poor in symptomatology, those of the carotid glomus presenting as an isolated cervical tumor, intravagal glomus tumors as parapharyngeal masses of the retrostyloid type. Arteriographic findings are discussed in detail, as they constitute the only pathognomonic signs, enable differentiation between the two tumor sites, and supply essential pre-operative data: location of the pedicles, possible invasion of arterial walls, and the limits of the tumor. Surgical approach should be wide to enable control of the distal end of the internal carotid artery, if necessary under the base of the cranium, excision of the tumor usually being possible by employing the subadventitial resection technique.

[Evaluation of cochlear and vestibular functions of patients treated by dibekacin in an E.N.T. unit]. / Evaluation des fonctions cochléaires et vestibulaires chez des malades traités par la dibékacine en milieu ORL.

Cochlear and vestibular ototoxicity of dibekacin was evaluated in 27 patients treated with aminoglycoside after surgery on head and neck cancer. The treatment was administered intramuscularly or intravenously during 13 days at the schedule of 3 mg/kg per day. Cochlear and vestibular functions were tested by audiometry and electronystagmography before the administration of the antibiotic and on the 14th, 30th day, and for certain patients on the 4th month after the start of the treatment. No cochlear ototoxicity was found after the dibekacin treatment. On the other hand, the dibekacin treatment produced minor abnormalities of ENG (irritative pattern).

[Results of rhinoplasties. A computer study of 351 medical records]. / Résultats de rhinoplasties. Etude informatique de 351 dossiers.

The authors studied the cosmetic results of 1380 rhinoplasties carried out over a period of 10 years by two surgeons, Professor A. Pech and Professor M. Cannoni. They used a classical reduction rhinoplasty technique. Different procedures were used for the tip of the nose depending on the individual indications, and the development of ideas over a period of time. Only 351 files, complete with pre- and post-operative photographs have been selected. The photographs have been analyzed on the basis of 70 criteria by an independent, young female ENT specialist, and the results of her analysis were fed to the computer. The study provides three types of answer. Firstly, the results were good in 69% of cases, and the greater the experience of the surgeon, the greater the success. Secondly, the different techniques for correcting the tip of the nose are analysed with good scores for Cinelli's technique (69%). The tip modeling procedures of Converse and of Lipsett have been abandoned owing to the high frequency of round tips. Finally, the different types of anomalies encountered are listed: 42% round tips, 20% asymmetrical tips, 17% residual humps, 11% of wide nasal bones, hooked noses and postoperative deviations. The authors then comment on the results, focusing on following points: the frequency of incomplete files (70%); the general improvement in the results with the gaining of experience, the decline in the proportion of hooked noses, also in line with experience, from 24% in the first 5 years to 7% after 10 years; the development of ideas concerning the techniques to be used in correcting the tip of the nose with an evergrowing place for those sacrificing the dome of the alar cartilages, such as the "Hockey stick" and a personal procedure derived from Pollot; wide nasal bones and failures in the tracing of the naso-frontal angle (64%) for which no solution is suggested; and, finally, postoperative nasal deviations. Since undertaking this study, the authors have successfully avoided this defect by using the external approach.

[Reconstructive anterior frontal laryngectomy (author's transl)]. / La laryngectomie frontale antérieure reconstructive.

Sliding epiglottoplasty was employed for reconstruction of the glottis after subtotal laryngectomy. Technical aspects are described, and the indications and limitations of this reconstructive partial laryngectomy procedure are discussed from the anatomic and carcinologic points of view. Its advantages include lack of postoperative complications, the very good functional results obtained, and the fact that it can be conducted following radiotherapy and in debilitated patients. It has a limited but definite place among partial laryngectomy procedures.