[Basic principles for managing and post-operative follow-up in phono-surgery]. / Principes de la prise en charge et du suivi post-opératoire en phono-chirurgie.

The management of the voice in patients with benign lesions of the larynx causing chronic dysphonia follows certain simple rules, on which depend the final functional result. It also requires the closest collaboration between the voice surgeon and the speech therapy team. The indication for surgery rests on the most precise diagnosis of the condition, after examination of the larynx with the rigid endoscope and video-stroboscopy of the cord movements. When a final decision for surgery has been taken, it is essential that the patient should be thoroughly prepared for surgery if the post-operative phase is to pass smoothly, which is the criterion for a good functional recovery. The surgery must be both precise and thorough, with due respect to the structural elements of the vocal folds, and must involve the minimum of resection. Afterwards, a period of complete voice rest is mandatory, before the voice rehabilitation can commence. Finally, post-operative follow-up will be the best guide for selecting the appropriate speech therapy, which will allow the patient to overcome the anatomoical and functional changes brought about by surgery, to recover the potential qualities of his voice, and to resume his vocal and professional activity under the best conditions.

[Results of six years experience using an injection of autologous fat into the vocal cord]. / Bilan de six ans d'utilisation de la technique d'injection intra-cordale de graisse autologue.

Several techniques are available for medialising the vocal cord or for compensating for glottic air escape. The authors have used the technique of injection of autologous fat into the vocal cord over a six year period for various indications, in a total of 124 patients (65 having unilateral palsy, and 59 glottic air escape). The later results depend on the initial problem, but in general demonstrate a notable reduction in air escape.

["Bamboo nodes": a clinical study of 19 cases]. / "Bamboo nodes": étude clinique à propos de 19 cas.

This is an account of 19 cases undergoing surgery for submucosal deposits on the cords of a particular type, 8 of the 19 cases having an auto-immune disorder. The nineteen patients were operated and followed up between December 1986 and December 2001, the main symptom being dysphonia. Stroboscopy demonstrated a yellowish appearance, often transverse, of the middle third of the cord, giving the characteristic appearance of a bamboo node. Suspension microlayngoscopy was performed in all cases. Cordotomy was invariably required. Examination of the case notes of these patients has shown either a pre-existing auto-immune disorder or the development of suggestive pointers in 8 of these female patients. Histological examination necessarily demonstrates the common characteristics of these deposits, and may be able to show features which have predictive value in the absence of known auto-immune pathology.

[Anatomy and anatomopathology of benign vocal cord lesions]. / Anatomie et anatomopathologie des lésions bénignes des cordes vocales.

After 30 years of experience comprising more than 3000 suspension laryngoscopies, we are putting forward a classification of the main benign lesions of the vocal cords. Among the acquired group, we make a distinction between those caused by vocal overuse and abuse and those with a cause within the vocal cord. Congenital lesions are certainly more common than is usually thought. The hypothesis of a congenital origin would certainly justify a larger prospective study.

[Dysphonia in adults caused by unilateral pseudohypertrophy of the ventricular band with deformation of the thyroid cartilage. Apropos of three cases]. / Dysphonie de l'adulte par pseudo hypertrophie unilatérale de la bande ventriculaire avec déformation de l'aile thyroïdienne. A propos de trois cas.

The association of dysphonia appearing in adulthood with unilateral bulging of the false cord associated with a convex deformation of the overlying thyroid cartilage is to be remarked in three cases. The origin, which was presumably acquired by gradual deformation of the thyroid cartilage with age, is discussed in the light of the literature and the clinical history. A past traumatic cause can also be implicated (1 case). CT-Scan is essential for the diagnostic of the cartilage deformation and eliminates laryngeal tumors. In one of the cases reported, we were able to demonstrate the possibility of treatment by CO2 laser resection of the false cord hypertrophy.

[Otosclerosis: stapedectomy or stapedotomy. A long-term comparative study. Apropos of 1279 cases]. / Otospongiose: platinectomie ou platinotomie. Etude comparative a long terme. A propos de 1279 cas.

The authors report 1279 surgical operations of otosclerosis performed between 1980 and 1992 in 959 operated patients. They chose the autegenous vein or perichondrium interposition TeflonR piston; however this technique has improved over the past few years. The size of the stapedectomy has been diminishing; from total, then partial stapedectomy, at last to 0.8 mm across stapedotomy. The graft has become exclusively from venous origin and the diameter of the piston has been reduced from 0.8 to 0.6 then to 0.4 mm. Seven groups of patients have been examined according to the size of the incision for stapedotomy or stapedectomy and the size of the piston. The audiometric study was realized after one month, one year, three years, fine or even ten years after surgery. Comparative tests were made considering the sex and the age of the patient, the thinness of the graft, and surgical revisions. The audiometric study lied not only upon the audiometric Rinne's closing but also upon the bone conduction variation (postoperative bc-preoperative bc) in the course of time. The evolution of tinnitus, of vertigo has been, as well, the subject of a careful study in time according to the surgical techniques. The study shows that the audiometric results (Rinne's closing, bc evolution) are statically much better with total stapedectomy, then with partial stapedectomy, at last with stapedotomy in the first three postoperative years. The best audiometric results are obtained with wider pistons (0.8 mm diameter) and venous approach. The results regarding tinnitus and vertigos are dissimilar especially during the first operative year. After three years of evolution, the significant audiometric differences tend to reduce and the audiometric results become the same (no significant difference) whatever the surgical technique may be. After three years, simple, calibrated stapedotomy without interposition statically gives similar results in literature. However, each surgical technique may, though rather infrequently, produce some incidents or complications that undoubtedly influence the operator as for the choice of the surgical technique to use.

Microsurgical treatment of benign vocal fold lesions: indications, technique, results.

This report summarises the joint experience of a surgeon and a phoniatrician, working as a team over a period of 20 years, carrying out 2,552 microsurgical operations on 2,334 patients with benign vocal fold lesions. The authors first present their procedure and then examine indications for surgery, surgical technique, postoperative follow-up and results for each pathology concerned. Phonosurgery with children (191 cases) and singers (128 cases) is given separate consideration. This work demonstrates the great interest of teamwork between phoniatrician and surgeon in phonosurgery.

[Modes of appearance of vocal cord polyps]. / Mode d'apparition des polypes des cordes vocales.

A certain number of polyps of the vocal folds result from violent, intense and unaccustomed physical activity. The development of these polyps is certainly linked to high subglottal pressure and the abrupt reduction of the same.

Epidermoid cysts, sulci, and mucosal bridges of the true vocal cord: a report of 157 cases.

Presented is a summary of our experience with 157 patients having a diagnosis of epidermoid cyst, glottic sulcus, or mucosal bridge of the true vocal cord. Each patient in this group was diagnosed and treated jointly by a phoniatrist and microlaryngoscopist and then evaluated for results of surgical and phoniatric therapy. Included in the discussion are methods of examination and diagnosis, microanatomy and histopathology of the lesions, methods of treatment, and results of treatment. An argument for a common etiology for these lesions is advanced.