Arytenoidopexy for bilateral vocal fold paralysis in young children.

The purpose of this retrospective study was to describe and evaluate the results of arytenoidopexy performed by the external laterocervical approach in 15 consecutive children presenting bilateral vocal fold paralysis causing life-threatening airway compromise. Mean age at the time of surgery was 20 months and mean follow-up was 42 months. At the end of follow-up all patients were in good health and did not need special care for breathing. No abduction movement has been observed on the opposite vocal fold since arytenoidopexy. One failure subsequently required arytenoidectomy. The findings of this study suggest that arytenoidopexy is an effective surgical treatment for life-threatening bilateral vocal fold paralysis in young children.

[Bone anchored auditory prosthesis. Indications, clinical and audiometric results]. / La prothèse auditive à ancrage osseux (BAHA). Indications, résultats cliniques et audiométriques.

Fourteen patients with conductive or mixed hearing loss were fitted with 16 BAHA. Three patients had congenital malformation of the auditory canal. Eleven patients had sequelae after bilateral chronic otitis media. All implants were osseointegrated. In 81% of the patients, no skin reactions around the abutment occured. The subjective evaluation was investigated by means of a questionnaire. All patients preferred their BAHA to their previous hearing aid and 93% are globally satisfied. Patients were evaluated in sound field, preoperatively and postoperatively using warble tones (mean on the average pure tone threshold at 0.5 1 and 2 kHz of 51.5 dB unaided to 22.6 dB aided with BAHA), speech reception threshold (mean of 51.1 dB unaided to 21.9 dB aided with BAHA) and speech discrimination. In three cases, we find an "antenna" effect, an improvement in reception wearing the Titanium screw and the abutment without the hearing aid connected.

[CO2 laser in pediatric laryngology]. / Le laser CO2 en laryngologie infantile.

Carbon dioxide Laser is a recently developed instrument which has became essential in laryngology, especially in its pediatric applications. Authors report 86 cases of children with a laryngeal pathology treated by CO2 Laser at the Childrens Hospital of La Timone in Marseille. Four groups emerge from this study. They are composed of laryngomalacia (n = 34), subglottic angiomas (n = 12), laryngeal papillomatosis (n = 12) and laryngeal stenosis (n = 14). Other patients (n = 14) made up a miscellaneous population (granulomas, laryngeal paralysis, benign tumors). Post-operative data are analyzed and compared with those of literature. The result is that this therapeutic method, used within the limits of precise indications and, if necessary, with divided sequences, can offer rapid curative care with few complications.

[Orbito-maxillo-facial rehabilitation with osteointegrated prostheses]. / Réhabilitation orbito-maxillo-faciale par prothèses ostéo-intégrées.

This investigation was conducted to evaluate 20 cases of implant-retained prosthetic rehabilitation (mean follow-up of 35 months). Ear, nose, orbit and complex defects of the face have been restored. Our main indication was reconstruction in cancer patients after tumor surgery (n = 14). Rehabilitation was also performed in traumatic disorders (n = 3) and congenital aural malformations (n = 3). Fifty seven titanium fixtures have been implanted with an integration success rate of 98%. We also report 6 cases of maxillary or mandibulary functional rehabilitation. The use of osteointegrated implants to provide support for maxillo-facial prosthesis is a new and valuable technique when reconstructive plastic surgery is not envisageable.

[Laryngeal stenosis in children. Evaluation of 10 years of treatment]. / Les sténoses laryngées de l'enfant. Bilan de dix ans de traitement.

Over a 10 year period from 1984 to 1994, 98 children underwent curative treatment for sub-glottal stenosis of the larynx at La Timone Hospital in Marseille, France. Eighty-two patients were operated on via an external approach. An endoscopic procedure with the CO2 laser was used in 16 cases. The majority of the children had acquired stenosis (77%), with greater than 70% obstruction (65%), and were under 5 years of age (60%). The details of the different therapeutic techniques used are presented. The laryngotracheoplasty technique used to widen the larynx (n = 58) with an autologous rib cartilage (n = 53) is the most important current progress. The possibilities for laryngotracheofissure (n = 21) and cricotracheal resection (n = 3) are also discussed. After decannulation, 95% of the children could breath normally via the natural airways. The quality of the outcome was not dependent on the therapeutic method used. Perspectives for new methods or modifications of existing methods are discussed.

[Role of endoscopy and vascular decompression in the treatment of hemifacial spasm]. / Place de l'endoscopie et de la décompression vasculaire dans le traitement du spasme de l'hémiface.

Although it has long been hypothesized that hemifacial spasm could arise from a conflict between the nerve and the artery, it is very difficult to distinguish between a normal arterial loop and a pathological conflict leading to facial symptoms. Several new elements would help in the definition of the cause and allow less traumatic treatment of idiopathic hemifacial spasm. They include magnetic resonance imagery with CISS sequences, limited retrosigmoid approach, endoscopy of the cerebellopontine angle and monitoring the facial nerve. In our experience with 20 cases, retrosigmoid approach with a combined surgical and endoscopic procedure has led to total involution of the spasms in 80% of the cases.

[Rhinosinusal manifestations of cystic fibrosis]. / Les manifestations rhinosinusiennes de la mucoviscidose.

The generalized disorders which characterize cystic fibrosis often involve the nose and paranasal sinuses and may frequently lead to the development of nasal polyps. A retrospective study of 78 patients with cystic fibrosis, 3 to 28 years old, was undertaken in order to determine the incidence of nasal involvement and to define an approach to the treatment of disabling recurrent nasal polyposis. 65% of these patients presented chronic symptoms such as rhinorrhea, nasal obstruction and disturbances of smell. Nasal polyps were found in 50% of patients and were more frequent in adults than in children. Clinical symptoms were directly related to the extent of polyp development which could be classified according to 3 groups. CT scans showed maxillary sinus involvement in almost all patients. The incidence and extent of ethmoidal sinus involvement on CT scans was correlated to the grade of polyp development. Medical treatment of polyposis failed in all cases. Polypectomy was always followed by recurrence. Intranasal ethmoidectomy seems to be an interesting alternative, since 73% of patients undergoing this procedure had clinical improvement.

[Contribution of endoscopy of the cerebellopontine angle by retrosigmoid approach. Neuroma and vasculo-nervous compression]. / Apport de l'endoscopie de l'angle ponto-cérébelleux par voie rétro-sigmoïde. Neurinomes et conflits vasculo-nerveux.

An endoscopic approach to the cerebellopontine angle has been suggested by several authors over the last 20 years but it is only recently that the technical and operative conditions for successful endoscopy could be met. The retrosigmoid approach provides simple and direct access to the cerebellopontine zone. The endoscope, with its distal light source, provides excellent illumination of a wide visual field within an anatomical site particularly rich in neurovascular structures. Endoscopic and microsurgical techniques may be combined for the surgical management of acoustic neuroma with the advantage of assuring better exposure of structures adjacent to the tumor and better control of the quality of dissection of the fundus of the internal auditory canal. The addition of endoscopic techniques, during surgery for trigeminal neuralgia or unilateral facial spasm, makes it possible to accurately locate the site of neurovascular compression without either retraction of the cerebellum or unnecessary dissection.

[Comparative study of cartilaginous and synthetic laryngotracheoplasty. An experimental study in rabbits]. / Etude comparative des laryngotrachéoplasties cartilagineuse et synthétique. Travail expérimental chez le lapin.

The most significant advance in the treatment of laryngotracheal stenosis in children is the augmentative laryngotracheoplasty using a graft of autologous rib cartilage (ARC). In order to reduce the potential morbidity of this technique due to the additional surgical procedure, the use of a ceramic, hydroxyapatite (HA), implant was compared to ARC in a randomized experimental study in 99 New Zealand rabbits: 32 rabbits had ARC grafts, 33 had HA implants covered with a graft of perichondrium (HAP) and 33 had naked HA implants. At 3 months, immediately before necropsy, there was no significant clinical difference between the 3 groups of animals. Histological examination was performed in 81 animals. Implants were found in 54 specimens. More implants were found in the ARC group than in the HA groups (p < 0.003). No difference was noted between the 3 groups in the epithelial covering of the implant, the amount of inflammation, the analysis of the interface between the implant and the cricoid cartilage and in the viability of the graft. No implant was found in 27 animals. However, scar bands of approximately the same width as the implant were responsible for cricoid diastasis in 23 cases. Therefore, it seems that the missing implant played the role of spacer. While this experimental study does not eliminate HA as a augmentative implant in the subglottic region of the rabbit, the evolution of the scar bans must be followed for a longer period in rabbits before considering the clinical application of this technique.