[Acute pseudo-membranous laryngitis in epidermolysis bullosa acquisita]. / Laryngite pseudo-membraneuse sévère dans le cadre d'une épidermolyse bulleuse acquise.

Epidermolysis bullosa acquisita is a rare entity belonging to the auto-immune cutaneous blistering disorders of the dermo-epidermal junction. Clinical manifestations are generally cutaneous including the development of sub-epidermal blisters. Mucosal manifestations should be systematically looking for, but laryngeal involvement remains uncommon. We report an 81-year-old woman who presented with dysphagia, dyspnea and dysphonia as the presenting features of laryngeal involvement of an epidermolysis bullosa acquisita. This is the tenth reported case in the literature. We describe our diagnostic approach and the therapeutic management, comparing them with the literature.

[Sphenoid arachnoidocele: report of one case]. / Arachnoïdocèle sphénoïdale : à propos d'un cas.

OBJECTIVES: To define a diagnostic strategy of a sphenoid sinus lesion and the management of CSF fluid leak in the case of a sphenoid arachnoidocele. MATERIALS AND METHODS: A 70-year-old woman exhibited a sphenoidal sinus opacity which was discovered on the assessment of chronic headaches. It was labelled sphenoid mucocele. A cerebrospinal fluid leak occurred when the marsupialization was made. After an assessment of additional imaging (MRI, CTscan), the diagnosis of sphenoid arachnoidocele was retained. RESULTS: The leak was repaired by navigated endoscopic endonasal surgery. We used a multilayer reconstructive technique with autologous materials (abdominal fat, fascia of muscle, middle turbinate) and fibrin glue. With a decline of eighteen months no rhinorrhea was noted. CONCLUSION: Sphenoid arachnoidocele is a rare disease. This case shows that it's essential to know the differential diagnosis sphenoid sinus lesions and how to repair an osteomeningeal leak.

[Partial allotransplantation of the face including the mandible: a feasibility study]. / Allotransplantation partielle de face incluant l'os mandibulaire: étude de faisabilité.

OBJECTIVE: Facial grafts are useful in that they allow the repair of severe facial defects in one step in contrast to the actual available techniques which require staged procedures with limited cosmetic and functional results. The aim of our study was to determine whether it would be possible to include part of the mandible in a partial allotransplant of the face. MATERIAL AND METHODS: An anatomical study on the arterial and venous vascularisation of the face and the mandible was performed on 7 heads. Then nine heads were used to describe an anatomical model of harvesting two-thirds of the lower face. RESULTS: The study determined that a graft could be viable with a facial artery, inferior dental artery and two veins facial. Thus, a reliable method for harvesting hemi-mandible and total mandible is developed. The average sampling time was 4 hours and thirty minutes. Harvesting a total mandibular graft was more tedious because of the loss of joint laxity caused by the absence of mandibular osteotomy. CONCLUSION: Partial allotransplant of the face including the mandible is feasible. In such transplantations, functional difficulties related to the temporo-mandibular joint and orthognathic problems need to be overcome.

[Management of cervical cellulitis with and without mediastinal extension: report of 17 cases]. / Prise en charge des cellulites cervicales avec on sans extension médiastinale: à propos de 17 cas.

OBJECTIVES: Cervical cellulitis is infrequent but serious. The aim of our study was to describe the way we care and to identify certain factors that promote the development of such a condition. PATIENTS AND METHODS: We conducted a retrospective study covering the period 2004 to 2009 and included patients with cervical cellulitis with or without mediastinal extension surgically supported by ENT department of the University Hospital of Dijon. Data were collected clinical, radiological, treatment, type of surgery and complications. RESULTS: Seventeen patients met our inclusion criteria, four of which had a form associated with mediastinitis. Eight patients had taken NSAIDs and/or corticosteroids and fifteen patients antibiotics before their hospitalization. All have benefited from surgery with an average of 1.35 interventions (range 1 to 3) and support postoperative resuscitation. In both cases the outcome was unfavourable. CONCLUSION: The use of NSAIDs and/or corticosteroids was a factor in promoting this type of infection. In the context of surgical treatment, it does not seem necessary to surgically reoperate systematically.

[Acute group A beta-hemolytic streptococcus membranous laryngotracheobronchitis in an adult]. / Laryngotrachéobronchite aiguë membraneuse à streptocoque bêta-hémolytique du groupe A de l'adulte.

OBJECTIVE: To describe the first case of a group A beta-hemolytic streptococcus laryngotracheobronchitis as well as the other possible etiologies in a case of acute dyspnea. METHODS: We report the case of a 46-year-old woman with a doubtful vaccination status who presented clinical features of croup (laryngotracheobronchitis). She developed respiratory distress and required endotracheal intubation. RESULTS: The endoscopy demonstrated a great deal of crust and pseudomembrane detachment. Bacterial culture grew group A beta-hemolytic streptococcus. Progression was good with antibiotics and corticosteroid treatment. CONCLUSION: Bacterial acute pseudomembranous croup (laryngotracheobronchitis) is rare. We must search for the most frequent diagnoses such as diphtheria and epiglottitis. This is the first case to be reported in the literature.

[Zenker's diverticulum: technique and results of endoscopic treatment with Endo-GIA 30 stapler]. / Diverticule de Zenker : technique et résultats du traitement endoscopique a la pince GIA 30.

OBJECTIVES: The purpose of this project was to analyze the endoscopic management of Zenker diverticulum using an Endo-GIA stapler inserted transorally to perform an oesophageal diverticulostomia. PATIENTS AND METHODS: Between January 97 and December 2006, 30 consecutively treated symptomatic patients (13 men; median age 67 years; range 45-91) with Zenker's diverticulum were enrolled into this retrospective study. Ninety six percent complained about dysphagia with slimming in 33%. The diagnosis of Zenker's diverticulum is based on anamnesis and radiological examinations with applied contrast medium of the upper digestive tract. RESULTS: Twenty-six patients had the endoscopic approach. A patient profited in same time from a resection by external cervical approach following a tearing of the mucous membrane after installation from staled diverticulotomy. Finally 3 patients failed endoscopic exposure. On the 26 patients operated by strict endoscopic treatment, the average duration of intervention was 29 minutes. Overall, an onset of liquid intake on 2.3 postoperative days and the average length of stay was 6 days. Mean follow-up was 40 months. A recurrency was noted in the 2 cases, one was reoperated with the same technique. CONCLUSION: This endoscopic technique using an Endo-Gia stapler is an efficient, safe and minimally invasive method for the treatment of Zenker's diverticulum. With a low rate of morbidity, it is a good technique especially for patients with impaired of health or associated diseases.

[Revision ossiculoplasty: anatomical and functional results]. / Reprise des échecs d'ossiculoplastie: résultats anatomiques et fonctionnels.

OBJECTIVES: To analyse the anatomical and functional results after second-look ossiculoplasty using Titanium (TI) and Hydroxyapatite (HA) prosthesis and to study the prognostic factors for good functional results. PATIENTS AND METHODS: Forty nine patients (19 men and 30 women) with an average age of 36 years were included in this study. The patients presented with anatomical and/or functional failures after a first ossiculoplasty and had a second-look intervention. The status of the first prosthesis and also the anatomical status of the middle ear and the remaining ossicular chain were described intra operatively. The functional and anatomical results were assessed 2 months after the second ossiculoplasty and during the most recent out patient clinic. Postoperative air conduction gain (ACG) and air bone gap (ABG) were calculated in average values using four frequencies: 0.5, 1, 2 and 4 kHz. The variables used in statistical analysis were the following: Tympanic membrane and preoperative middle ear status, the type of prosthesis (partial or total) and its material (TI and HA). RESULTS: The average time to second-look operation was 18 months. The postoperative ABG did not show any significant statistic improvement and in several patients auditory function deteriorated in the operated ear The predictive factors for good functional results were: The integrity of the tympanic membrane, chronic otitis media without cholesteatoma, total prosthesis and HA prosthesis. If three of these factors were present, the postoperative ABG would always be less than 20 dB. CONCLUSION: When selecting patients for second look ossibuloplasty it is important to understand the predictive facctors for good results. This will allow a full discussion of options, risks and morbidity with the patient.

[Pseudoaneurysm of the internal carotid artery revelated by epistaxis: report of two cases]. / Pseudo-anévrysmes de l'artère carotide interne révélés par une epistaxis. A propos de deux cas.

OBJECTIVES: Pseudoaneurysms of the carotid artery are a rare but serious cause of epistaxis. They can be rapidly life-threatening. Usually resulting of a surgery or a traumatism, pseudoaneurysms can express themselves by recurrent epistaxis. Management of these epistaxis is discussed. METHODS: The authors present two cases and effect a review of the literature. RESULTS: The first patient presented with a pseudoaneurysm few days after a transsphenoidal surgery. The second patient presented with a pseudoaneurysm fourteen years after a radio-surgical treatment of an ethmoidal and frontal epidermoid carcinoma. Diagnosis was suspected during nasal endoscopy and confirmed in both cases with angio-CT and arteriography. The first patient underwent a selective embolization. The second patient had to have a carotid occlusion due to a sudden severe haemorrhage, resulting from a pseudoaneurysm rupture following the embolization attempt. CONCLUSION: Review of the literature confirms the indication of endovascular intervention. The optimal management is carotid occlusion, provided the patient can tolerate carotid test occlusion and the circle of Willis is satisfactory. In some cases, a preservative treatment may be possible, which could be either pseudoaneurysm embolization or the placement of a covered stent.

[Nasal polyposis: long term functional results in 203 patients treated by ethmoidectomy combined with intranasal corticotherapy]. / Polypose naso-sinusienne: résultats fonctionnels à long terme chez 203 patients traités par évidement ethmoïdal et corticothérapie locale.

OBJECTIVE: Evaluate the long term quality of life in patients after ethmoidectomy associated with intranasal corticotherapy for nasal polyposis on the appreciation of the intensity of nasal symptoms. MATERIAL ET METHOD: The authors report their experience about 203 patients treated by endonasal endoscopic ethmoïdectomy intranasal followed by a long term intransal corticotherapy, with a mean follow up of six years. In this prospective study, each symptom was evaluated using an analogic visual scale and a questionnaire. The evolution of asthma after surgery and the patients global satisfactory rate were noted. RESULTS: There is a global improvement of the nasal symptoms with a mean postoperative individual scores calculated at 32% for nasal obstruction, at 34% for rhinorrhea and at 51% for anosmia. No impact on asthma or improvement of asthma was encountered in 92% of the patients. The patients global satisfactory rate of this medico-surgical approach of the disease is 93.6%. A positive correlation was found between the severity of the olfactory disorders and the oral corticosteroid therapy. CONCLUSION: Endoscopic endonasal ethmoïdectomy followed by intranasal corticotherapy represents a valuable protocol in treating patients with severe nasal polyposis.

[Value of of fine-needle aspiration cytology and MRI in parotid gland masses]. / Intérêt de la ponction cytologique et de l'IRM dans les tuméfactions parotidiennes.

INTRODUCTION: The objective of our study was to discuss the valve of fine-needle aspiration cytology (FNAC) and magnetic resonance imaging (MRI) in the diagnosis and treatment of parotid gland masses. MATERIALS AND METHODS: Forty patients were included in the prospective study. They had undergone clinical examination, FNAC and MRI before parotidectomy. The results of these examinations were compared with the corresponding histopathological diagnosis. RESULTS: When it is positive, FNAC is a good examination of malignant tumours (sensitivity 67%, specificity 79%, positive predictive value 86%, negative predictive value 100%). The MRI allows a good assessment of the tumoural mass and its anatomical relationships (sensitivity 55%, specificity 86%, positive predictive value 89%, negative predictive value 75%). If the T2 sequence shows reduced density (p < 0.05) or in case of bad limitation (p = 0.004), a malignant character is strongly suspected. CONCLUSION: In cases of parotid gland mass, where surgical intervention is necessary, there is no need of special investigations: however FNAC and MRI allow us to anticipate what operation will be required.

[Value of interventional video-endoscopy in the assessment of cancer of the upper airways and digestive system]. / Intérêt de la vidéo-endoscopie interventionnelle dans le bilan des cancers des voies aérodigestives supérieures.

INTRODUCTION: The aim of our study was to evaluate the video fiberoscope with operator canal (FOC) in he diagnosis of head and neck carcinoma compared to direct laryngoscopy (DL). METHODOLOGY: From August 2000 to May 2001, 82 patients were included in a prospective study. They were examined for pharyngolaryngeal cancer with the FOC, DL and a CAT-SCAN. The compared elements were the visualization of the different regions of the pharyngolarynx. A three dimensional description of the lesion, the presence of secondary localisations as well as the anatomo pathological results were obtained with FOC and DL. RESULTS: Although the pharyngolarynx is less well visualized in FOC than in DL (p = 0.04), no statistically significant difference was found between the two methods in terms of visual diagnosis and assessment of the extent of the lesion. The sensitivity of the biopsies made with FOC is lower than those performed with DL (66% FOC, 97% DL). Moreover, we have noted that FOC is highly reliant on the experience and ability of the surgeon. CONCLUSION: DL remains the most reliable technique for the exploration and diagnosis of the pharyngolarynx. If it is not possible to perform a DL or if it is not indicated (trismus, contra-indication to general anaesthesia) FOC should be considered as the examination of choice.

[Comparison of the cephalometric characteristics of snoring patients and apneic patients as a function of the degree of obesity. Apropos of 162 cases]. / Comparaison des caractéristiques céphalométriques de patients ronfleurs et apnéiques en fonction du degré d'obésité. A propos de 162 cas.

BACKGROUND: The purpose of our study was to compare cephalometric analysis of craniofacial features in normal weight or obese subjects who are habitual snorers or apneic. We conducted a retrospective comparison of their clinical and cephalometric features by degree of obesity. PATIENTS AND METHODS: One hundred and sixty two male subjects with obstructive sleep apnea syndrome (OSAS) diagnosed by conventional polysomnography were included in the study. Patients were divided into four groups according to their body mass index (BMI) and their apnea/hypopnea index (AHI: Group 1 = normal-weight snorers (34 patients), Group 2 = normal-weight apneic subjects (40 patients), Group 3 = obese snorers (20 patients), Group 4 = obese apneic subjects (68 patients). Lateral cephalometry was performed in all patients. Intergroup comparisons (2/4, 1/2, 3/4) were made using 32 parameters to study the influence of the size of bone structures, their relationships, and size of the upper airways. RESULTS: The four groups were comparable for age. AHI was higher for group 4 (obese apneic) compared with group 1 (normal-weight snorers). Compared with group 3 (obese snorers), group 1 (normal-weight snorers) had a retroposition of the mandible (smaller SNB and ANB angle), an accentuated facial divergence and a narrower pharyngeal space at the hyoid bone level. Compared with group 1 (normal-weight snorers), group 2 (normal-weight apneic) had a narrower pharyngeal space at different levels. Compared with group 3 (obese snorers), group 4 (obese apneic) had a lower hyoid bone evaluated with different cephalometric variables. CONCLUSION: This study mainly shows that apneic patients exhibit craniofacial differences when divided into two groups according to their body mass index. Our findings are consistent with previous reports and could suggest a dual etiology of OSAS.