[Reflections on percutaneous tracheotomy. Regarding a retrospective study of 106 cases with major burns]. / Réflexions sur la trachéotomie percutanée. A partir d'une étude rétrospective chez 106 grands brûlés.

About ten years ago, a new technique for tracheotomy was invented in the United States and has tended to replace the surgical technique in intensive care units. Percutaneous tracheotomy is performed by the intensive care unit physician working in the unit at the patient's bedside. Progressive expansion seems to be the method of choice. Physicians at the Center for burn victims at the Percy Army Hospital have used this technique since 1994. We performed a retrospective study of 106 cases, between 1994 and 1998, and reviewed the international literature. Percutaneous tracheotomies were performed via a vertical cutaneous discharge incision and appeared to be particularly interesting for patients with major burns who are difficult to transport and risk secondary infections. Three early and serious complications were observed, emphasizing the need of a peroperative endotracheal fiberoptic endoscopic control. Three tracheal stenoses were observed: however respiratory tract burns had occurred all three of these patients. In the literature, most of which has been written by intensive care physicians, it is rather surprising to note the enthusiasm for percutaneous tracheotomy based on the high risk of complications of the surgical technique. Moreover, possible late after effects of percutaneous tracheotomy remain unknown as few survivors have been seen again late after use of this recent technique.

[Comparison: tinnitus pain]. / Comparaison acouphène douleur.

After having recalled the different physiologic hypothesis of the tinnitus and those more documented of the pain, the authors noted certain parallelious in the therapeutical approaches of these tow subjectives sensations. They put the emphasis on the necessity, like with pain, to treat the tinnitus as fast as possible in order to avoid a centralisation by actionning of neuronal autonomized circuits.

[Inhalation burns: apropos of 198 cases. Incidence of laryngotracheal involvement]. / Les brûlures par inhalation: à propos de 198 cas incidence de l'atteinte laryngo-trachéale.

Inhalation burns and laryngotracheal involvement were studied in a retrospective series of 635 patients hospitalized for skin burns at the Center for Burn Treatment from January 1993 to January 1997. Inhalation burns were observed in 31.1% of the cases. Exclusive laryngeal involvement occurred in 19.6% of the inhalation burns. Both tracheobronchial and laryngeal burns were observed in 27.2%. Patients with inhalation burns also had facial burns (90.9%) and extensive (> 50%) or severe (UBS > 200) skin burns in 39.8% and 29.7% of the cases respectively. Mortality of skin burns was increased six-fold to 19.1% in patients who also had inhalation burns. Intubation was used alone in 60.1% and was followed by tracheotomy in 27.2%. The decision for tracheotomy was essentially based on the probable duration of ventilatory assistance. Tracheotomy was required in case of severe inhalation burns and the predictable duration of intubation was over 8 days. Laryngotracheal stenosis occurring after inhalation burns is complex and extensive, with great variability over time. Laryngotracheal calibration is indicated as first intention therapy.

[The unique trans-fronto-nasal approach. A new approach to benign expansive bone tumors of the anterior floor of the skull base]. / La voie unique trans-fronto-nasale. Un nouvel abord pour les tumeurs osseuses bénignes expansives de l'étage antérieur de la base du crâne.

We report our experience with a new access route for benign expansive bone tumors of the anterior floor of the skull. From 1991, we used a unique transfrontonasal route, adapted from Raveh's technique for trauma surgery of the anterior floor, to access all tumors in this region. The images presented here show the advantages of this technique: overall vision allows permanent intraoperative control. In addition, the absence functional or esthetic sequelae favor this route for benign tumors.

[Cervical cystic lymphangiomas in adults]. / Lymphangiomes kystiques cervicaux de l'adulte.

Cystic hygromas, infrequent in children, are even rarer in adults where they are generally unexpected operative findings. Now, with the progress in modern medical imaging, the diagnosis can be suggested before operation. Analysis of the embryogenesis helps to explain the different anatomical and clinical forms and the relations of the cystic hygroma with neighboring tissues, particularly of venous origin. 9 cases of cystic hygroma of the neck in adults are reported and discussed with 26 other well documented cases from the literature. The diagnosis can be confirmed only after operation and histological examination. Surgical removal is technically less difficult in adults than in children and recurrences are rare.

[Cervical cystic lymphangioma in adults]. / Lymphangiomes kystiques cervicaux de l'adulte.

Cystic hygromas, infrequent in children, are even rarer in adults where they once were generally an unexpected operative findings. Now, with the progress in modern medical imaging the diagnosis can be suggested before operation. Analysis of the embryogenesis helps to explain the different anatomical and clinical forms and the relations of the cystic hygroma with neighboring tissues, particularly of renous origin, grases of cystic hygroma of the neck in adults are reported and discussed with 26 other well documented cases from the literature. The diagnosis can be confirmed only after operation and histological examination. Surgical removal is technically less difficulté in adults than in children and recurrences are rare.

[Mucocutaneous leishmaniasis in otorhinolaryngology]. / La leishmaniose cutanéo-muqueuse en ORL.

The authors present a case of mucocutaneous Leishmaniasis of the nose in a patient originally from French Guiana and review the characteristics of this parasitic disease and its importance in the differential diagnosis of lethal midline granuloma. Beyond the exotic pathology of this case, the review of the literature indicates that with the present extension of concomitant leishmaniasis and Hids, authentic autochtonal leishmaniasis may be responsible for otolaryngologic manifestations. The increased prevalence of leishmaniasis associated with AIDS, as well as the presence of mucosal lesions, seems to be underestimated.

[Cleft palate and inflammatory diseases of the middle ear]. / Division palatine et pathologie inflammatoire de l'oreille moyenne.

Based on a series of 57 children who were operated for velar clefts, the authors studied the different associated aspects of middle ear inflammatory pathology: physiopathology, occurrence, evolution, complications. Seromucous otitis was initially found in 87% of the cases. Three years after surgery, it persisted in 70% of the cases. These children should be monitored on a long-term basis for timely detection of any and all evolution towards chronic otitis or even cholesteatomas.

[Ophthalmological complications in ORL and maxillofacial surgery]. / Complications ophthalmologiques de la chirurgie ORL et maxillo-faciale.

E.N.T. and maxillo-facial surgery may sometimes cause dramatic eye damage. Following a brief summary of the eye's anatomy and its surrounding parts, the most frequent surgical acts which may cause orbital complications are described. Perfect knowledge of the eye and its surrounding parts enable us to offset the dramatic changes due to the pathology.

[Isolated fractures of the medial orbital wall, surgical indications in 5 cases]. / Fracture isolée de la paroi interne de l'orbite, indications chirurgicales à propos de cinq cas.

Isolated fractures of the medial orbital wall are always blowout fractures. They are usually diagnosed when horizontal diplopia occurs (lateral movements of the globe and Lancaster test). If the medial rectus muscle is encapsulated (forced ductions and CT-scan), the area of restriction has to be explored surgically.

[Epidemiology of dracunculosis in the Mandara Mountains (North Cameroon). Organization of a control campaign]. / Epidémiologie de la dracunculose dans les Monts Mandara (Nord-Cameroun). Organisation d'une campagne de lutte.

The map of the Mandara Mountains dracuntiasis focus showing the wells and water bodies, which are the transmission sites of the disease in the study area, shows that the focus is relatively well limited. The drilling of new wells, the protection of existing water bodies used for human consumption, the health education project and the treatment of water by temephos lead to ascertain that the number of Guinea worm cases seen is decreasing every year in the area where the project is meticulously performed. These encouraging results show that it is now possible to eliminate the Guinea worm from North Cameroon by extending the operations in progress to the comprehensive surface of the focus, including the remote areas in mountains and the satellite foci in the plain along the Nigerian border.