Cervical anatomy of phrenic nerve roots in the rabbit. European Group for Research on the Larynx.

The cervical anatomy of the different nerve contributions that constitute the phrenic nerve (phrenic nerve roots and accessory phrenic nerve) were studied in rabbits. In 55 dissections, 6 main root arrangement types were observed. The roots that issued from the fourth and fifth cervical nerves (C4 and C5 roots) were constant. The C4 root was either short or long. The C6 root was at times absent, or sometimes double. An accessory phrenic nerve was present in 43% of the right and 28% of the left dissections. The distribution of the phrenic nerve roots often displayed left-right asymmetry. We conclude that a better knowledge of the cervical anatomy of the phrenic nerve is useful both in physiological studies involving diaphragm denervation and in experimental laryngeal reinnervation.

Experimental reinnervation of a strap muscle with a few roots of the phrenic nerve in rabbits.

In order to compare application of the roots of the phrenic nerve to the ansa hypoglossi for laryngeal muscle neurotization, 1 or more roots from the phrenic nerve were implanted into the right sternothyroid (RST) muscle of rabbits (n = 36). Controls were intact animals (in which RST innervation is provided by the ansa; n = 6) and denervated ones (n = 6). At 66 +/- 2 days (mean +/- SE) after neurotization, during quiet breathing, inspiratory electromyographic activity and isometric contraction force were observed in all reinnervated RST muscles (n = 24). During maximal inspiratory effort, electromyographic activity and force increased. In animals reinnervated by the C4 root alone, forces (46.22 +/- 7.8 g) were significantly higher than in intact animals (10.83 +/- 5.0 g). Retrograde labeling proved the phrenic origin of the neurotization. Electromyography of the diaphragm was recorded. We conclude that in rabbits, neurotization of a strap muscle by 1 or 2 roots of the phrenic nerve allows inspiratory contraction, even during quiet breathing. Such inspiratory activity is not observed in sternothyroid muscles of intact animals innervated by the ansa hypoglossi.

Hamartoma of the middle ear: a case study.

Hamartomas and teratomas are rare tumors in children. Its location in head and neck is quite exceptional. An unusual case of hamartoma in the middle ear is reported in a 5-month-old child. The tumor was isolated without associated malformation. Definitive diagnosis was made after surgery and based on histological results. At 2 years follow-up, no recurrence was observed. CT-scan is useful in order to reach a final diagnosis. Although rare, this type of tumor should be considered in the differential diagnosis of a middle ear mass during childhood.

Normal vestibular responses to air caloric tests in children.

One hundred and forty normal children, divided into four age-groups (2-3, 4-5, 6-7, 8-10 years old) have been submitted to a vestibular examination by caloric tests with air, and the responses were recorded. This technique is sure and easily reproducible. Frequency of nystagmus, and maximum eye speed in slow phase of nystagmus (M.E.S.) were examined during 30 sec after caloric stimulation. Frequency of nystagmus increases, and M.E.S. decreases as the children become older. A significant difference between the 2-3 and 4-5 year old groups is also noticed. Normal variations are fixed for each age group. A quantitative relation between frequency, M.E.S. and height is established.

Infiltrating lipoma of the head and neck: a report of one pediatric case.

Infiltrating lipomas are rare benign tumors. Several cases have previously been reported in the oral cavity but only three cases have been reported to date in children. We report a case of a 7-year-old child with an infiltrating lipoma of the neck and a posterior extension to the fourth and fifth cervical roots and the vertebral artery. The absence of any neurological signs, negative clinical and radiological examination results, as well as, the surgical risk of total removal and high rate of recurrence suggested a period of watchful waiting. After 5 years, the patient's clinical and radiological characteristics remain stable. A review of the literature regarding this pathology in the head and neck area, in both children and adults is also presented.

[Benign sub-periosteal osteoblastoma of the nasal cavity. histological and ultrastructural study of a case]. / Ostéoblastome bénin sous-périosté de la cavité nasale. Etude histologique et ultrastructurale d'une observation.

A case of periosteal benign osteoblastoma arising in the left nasal cavity is presented. The tumor develops on the surface of the middle turbinate without evidence of bone destruction. It has been locally excised and has not recurred in 3 1/2 years. The histological aspect is identical to that of the other cases of genuine osteoblastoma. The ultrastructure (the first of a periosteal osteoblastoma) is described. The osteoblasts resemble normal osteoblasts with a few exceptions: irregular nuclei, abundance of well-developed rough-surfaced endoplasmic reticulum and numerous fine filaments. The osteocytes and osteoclasts basically resemble their normal counterparts. The final diagnosis of benign osteoblastoma rests at the light microscopy level. The differential diagnosis are reviewed. Distinguishing histologic and ultrastructural characteristics between this tumor and other benign osteoblastic tumors are discussed.

[Experimental study of the ototoxicity of cisplatinum]. / Etude expérimentale de l'ototoxicité du cisplatinum.

Cisplatinum, used in numerous multiple chemotherapy regimens, provokes cochleovestibular toxicity. Two series of rats were treated with single or increasing fractionated doses, and audiometric consequences evaluated from modifications in auditory evoked potentials from brain stem and from electrocochleographic recordings. The ototoxic effect was found to be dose related with a cumulative effect. Fractionated doses were less ototoxic than single doses. The mechanism of production of this ototoxicity has not been determined but is probably similar to that of the aminoglycosides.

[Deafness and autoimmunity]. / Surdité et auto-immunité.

The etiology of a perception deafness cannot be determined in most cases. The autoimmune origin of some of them appears now to be increasingly possible, particularly when they form part of a disease affecting multiple systems. Three cases of this type are presented in an attempt, by analogy, to define the pathogenicity and criteria of the isolated "dysimmune" audiovestibular manifestations.

[The treatment of chronic cholesteatomatous otitis media in the child (author's transl)]. / Traitement de l'otite moyenne chronique cholestéatomateuse de l'enfant.

On the basis of 38 cases seen in the child, with a postoperative follow-up of more than 2 years, the authors note the special and early aggressive nature of cholesteatoma of the middle year at this age. Its development depends upon tubal factors which in general remain in an underlying position but involve the risk of inducing direct complications during the postoperative course. These reasons lead to the suggestion of a technique involving sacrifice of the osseous meatus and tympanoplasty which often saves hearing. Preservation of the osseous meatus is still to be recommended in limited forms and in the absence of any notable tubal factor, not encountered in this series.

[Radiological examination of the eustachian tube. Radiomanometry technique (author's transl)]. / Etude radiographique de la trompe d'Eustache. Interêt de la radiomanométrie tubaire. Etude préliminaire.

Radiomanometry is a modified technique for visualisation of the auditory tube. The contrast material is injected through a perforated tympanic membrane with control of injection pressure. Three positions are recommended: sub-mento-vertical, Worms, and modified Stenvers. The normal aspect of the tube is described with variations. Some pathological obstructtions are demonstrated. However, it must be underlined that many tubes with abnormal manometric test were not abnormal at the radiological evaluation: fonctionnal aspect is more important than anatomical one in the inflammatory pathology of the tube.

[Recurrent deforming juvenile nasosinusal polyposis and latent mucoviscidosis]. / Polypose naso-sinusienne juvénile déformante et récidivante, et mucoviscidose latente

Three children from a family of eight, had a cystic fibrosis diagnosed by Sweat test. Two of these had a nasal polyposis wigh widening of the nose, ethmoid and intercanthal distance. Every cases of this rare type of nasal polyposis in children observed since 1953 (Sweat test) and related in the litterature, had cystic fibrosis. It is concluded that cystic fibrosis may be the one only, cause of nasal polyposis with widening of the nose.

[Recurrent laterocervical suppurations. Role of fistulae and cysts of the 4th branchial pouch]. / Suppurations latéro-cervicales récidivantes. Rôle des fistules et kystes de la 4e poche branchiale.

Four cases of fistula of fourth branchial pouch are used as a basis for a description of the two possible clinical pictures: left cervical suppuration in a neonate with respiratory distress or recurrent cervical cellulitis in an older child or young adult usually diagnosed as a suppurative thyroiditis. Diagnostic features are outlined and emphasis placed on the need for an adapted surgical excision originating at the pharyngeal orifice of the fistula. In two of the four cases reported its trajectory was between muscle and mucosa planes and then in contact with the cricothyroid joint as a small cord, otherwise unidentifiable.

[Lower trapezius musculocutaneous flap for the repair of neoplastic loss of substance of the ear]. / Le lambeau musculo-cutané trapézien inférieur pour réparation des pertes de substance carcinologiques de l'oreille.

Large defects created by oncological resections of the auricular area require to fill and cover the gap to achieve their reconstruction. The lower trapezius myocutaneous island flap meets these two principles more easily and more reliably than previous loco-regional skin flaps. About two patients, who undergone resection of spread carcinoma of the external ear, the authors discuss the advantages and disadvantages of this flap, that appears seldom utilised; they point out some practical problems encountered when raising the flap.

[Use of fiber optics in difficult intubations in young children]. / Utilisation du fibroscope dans les intubations difficiles chez le jeune enfant.

Difficulties in performing laryngotracheal intubation may arise in patients with cervicofacial anomalies, particularly when young children are involved. Technical artifices usually employed in adults, mainly intubation under fibroscopic guidance, cannot be used in these cases. Intubation was performed in three children aged between 3 to 4 years by means of a guide-catheter previously introduced into the trachea by using the fibroscope working canal, a method that is particularly recommended, even in younger children. The type of anesthesia used must be adapted to these circumstances.

[Respiratory and swallowing difficulties after oesophageal atresia (author's transl)]. / Troubles respiratoires et de déglutition après cure chirurgicale de l'atrésie de l'oesophage.

The main reason for these problems is a tracheo-oesophageal fistula, either recurrence of the T.O. fistula, either persistance of a fistula which has been neglected during surgery. It has been observed in 7 infants from 19 operated atresias with such problems. These functionnal troubles may be produced by different other anomalies: oesophageal stenosis and or dyskinesia often observed, gastro-oesophageal reflux, associated anomalies of the larynx or trachea; laryngeal paralysis, tracheomalacia, tracheal epithelium metaplasia, tracheal compression by abnormal vessel, neurological dysmaturity, loss of swallowing reflex after a long postoperative course. Radiography and endoscopy are fundamental and complementary investigations. Endoscopy, under general anesthesia, must be minute (with optics), explore oesophageal and laryngo-tracheo-bronchic tract, and use several tests to demonstrate permeability of the fistula when it has been located. A special technique is presented. Several points must be outlined: 1--classical symptoms of persistant fistula are not reliable in authors' experience; any recurrent respiratory and swallowing problem requires investigations; 2--endoscopy and radiographic study have to be repeated sometimes to prove fistula; 3--responsability of some anomalies must be always discussed, because of their possible association with a fistula; several fistulas may also exist.

[Caustic burns of the esophagus in children. Apropos of initial endoscopy and routine sizing]. / Brûlures caustiques de l'oesophage chez l'enfant. A propos de l'endoscopie initiale et du calibrage de principe.

The advantages and indications for initial endoscopy in esophageal caustic burns in children are discussed in relation to 37 such cases, 13 of which were severe lesions. However, the procedure does not provide initial valid assessment of prognosis in severe 2nd and 3rd degree burns. The definite advantages of early and prolonged esophageal stenting in burns liable to provoke stenosis are emphasized: the esophagus is kept at rest and alimentation by the natural pathways can be maintained. Tubage also avoids gastrostomy or other early surgical procedure in the children, with a subsequent more satisfactory course during dilatations, their frequency thus being diminished. The usual inocuity of sodium hypochlorite after accidental ingestion does not justify endoscopic exploration but esophageal and gastric endoscopic examinations should be performed in all children after ingestion of major caustic agents (soda, acids), whether it is certain or simply suspected that ingestion has occurred, even when clinical signs are absent.

[Middle ear cholesteatoma in children. Criteria for surgical procedure in 57 cases]. / Le cholestéatome de l'oreille moyenne chez l'enfant. Critères de décision chirurgicale. A propos de 57 cas.

Fifty five children with 57 cholesteatomas (2 bilateral cholesteatomas) were operated on by the same surgeon. The median period of follow-up was 87 months. Fifteen cases were lost to follow-up (26%). An ossicular erosion was present in 76% of cases. In the first stage, an "intact canal wall technique" (ICWT) was carried out in 44% and a "canal wall down technique" (CWDT) in 56%. A planned second stage was carried out in 76% of ICWT and 56% of CWDT. The incidence of residual cholesteatoma was 29% and the incidence of recurrent cholesteatoma was 11%. A third stage was carried out in 6 cases (11%) without residual or recurrent cholesteatoma. Finally a CWDT was performed in 65% and a ICWT in 35%. The hearing results were significantly better with ICWT but this was due to a better preoperative hearing level. Whatever the surgical technique, the hearing results were better in the presence of an intact stapes. The surgery was individualized. Although ICWT is our priority technique, it was feasible, in our experience, only in a minority of cases because of difficult ablation, insufficient eustachian tube function and very advanced sigmoid sinus or very low lying tegmen plate. Minimal postoperative cavity problems were encountered, even in children where in our experience the mastoidal pneumatisation is limited.

[Role of gastroesophageal reflux in acute recurrent laryngeal dyspnea in children]. / Rôle du reflux gastro-oesophagien au cours des dyspnées laryngées aiguës récidivantes de l'enfant.

Recurrent laryngeal croup (RLC) in children is rarely discussed unless permanent laryngeal obstruction is involved or there is an allergic basis. An atypical case is described where gastro-esophageal reflux (GER) was not only associated with but was also directly related to the provocation of each period. A series of 15 patients with RLC were investigated for the presence of GER, and this was confirmed in 7 cases. These findings suggest that GER may be responsible for the onset of RLC, as is now admitted for numerous respiratory manifestations in children. Moreover, GER may be implicated in the course of various laryngeal obstructive lesions, particularly subglottic angioma.

[The treatment of laryngeal stenosis in the child. 156 cases (author's transl)]. / Traitement des sténoses laryngées chez l'enfant.

156 cases of laryngeal stenosis in the child were seen over a 10 year period. 40 were congenital and 116 acquired, chiefly after intubation. Congenital stenosis improved spontaneously in 60 % of cases. When tracheotomy was necessary, treatment was similar to that of acquired stenosis. For post-intubation stenosis analysis of the underlying pathology revealed the existence of risk factors: coma, cardiac surgery with extracorporeal circulation, laryngaeal pathology being responsible in 75 % of cases. Awareness of these risk factors was felt to be one of the essential elements in the prevention of post-intubation stenosis. Treatment varied in accordance with the degree of progression of the stenosis. In recent progressive forms medical and endoscopic treatment (51 cures without treacheotomy, 11 after tracheotomy for 2 to 10 weeks). In forms with scar tissue, tracheotomy associated with endolaryngeal calibration (21 cases) or laryngotracheal enlargement surgery (21 cases). A number of precautions are suggested in order to improve the prevention of stenosis with scar tissue. Indications of the various therapeutic methods are discussed according to whether the stenosis is due to scar tissue or is congenital. With regard to procedures involving laryngotracheal widening (28 in all : 21 for stenosis after intubation and 7 for congenital stenosis), emphasis placed upon the need to select amongst several types of operation according to the site and extent of the lesions.

[Ewing's sarcoma of the head and neck: a case report]. / Sarcome d'Ewing et localisations ORL: à propos d'un cas.

We report a case of Ewing's sarcoma located in the ethmoid sinus. The patient complained of facial pain, anosmia and visual defect. Diagnosis was established at microscopic examination with histoimmunochemistry and molecular biology. Treatment combined chemotherapy and surgical resection with skull base reconstruction and post-operative ratio and chemotherapy.