SAMCEP Society consensus on the treatment of upper facial lines with botulinum neurotoxin type A: A tailored approach.

BACKGROUND: The safety and efficacy of botulinum neurotoxin type A (BoNTA) treatments are well established, but injection techniques, target muscles, and toxin doses continue to evolve, with each refinement producing improvements in treatment outcomes. The recommendations in this consensus move away from standard templates and illustrate how to tailor treatments to individual patterns and strengths of muscle activity, and patient preferences. METHODS: Seventeen experts in the fields of plastic surgery, dermatology, ophthalmology, otorhinolaryngology, and neurology convened in 2022 to develop consensus-based recommendations for the use of botulinum toxin A for the treatment of horizontal forehead lines, glabellar frown lines, and crow's feet lines that reflect current clinical practice. The focus was on how to tailor injections to individual patients to optimize treatment outcomes. RESULTS: For each upper face indication, consensus members describe how to perform a dynamic assessment to optimize the dose and injection technique for each patient. A tailored treatment protocol is presented for commonly observed patterns of dynamic lines. Units of Inco are defined and the precise location of injection points, illustrated with the use of anatomical images. CONCLUSION: This consensus provides up-to-date recommendations on the tailored treatment of upper facial lines based on the latest research and collective clinical experience of the expert injectors. Optimal outcomes require thorough patient evaluation, both at rest and during animation, using both visual and tactile cues; detailed understanding of facial muscular anatomy and how opposing muscles interact; and use of a BoNTA with high precision to target identified zones of excess muscle activity.

Modern lipostructure: the use of platelet rich fibrin (PRF).

OBJECTIVES: To evaluate the interest of growth factors adjonction during lipostructure. MATERIALS AND METHODS: Between May 2005 and June 2012, 232 patients benefited from this modern approach of lipostructure with concentrate of platelets. The technique evolves on the simplification way. RESULTS: All the patients were satisfied with the result with minimal associated resorptions. No massive resorption requiring a resumption of lipostructure was noted. CONCLUSION: By offering a matricial support to angiogenesis and by stimulating the proliferation of pre-adipocytes, the PRF could have a beneficial role on the cicatrization and the consolidation of an adipocyte graft.

[Botulinum toxin and rejuvenation of the eye]. / Toxine botulique et rajeunissement du regard.

AIM OF THE STUDY: Treatments with botulinum toxin in the forehead and periorbital areas may induce disappointing or even paradoxical results. Our study, focused on this area aimed at refining injection techniques by analyzing muscular balances and comparing the effect according to injection doses and topography. METHODS: This experimental study has been carried out in the form of 2 session workshops, with volunteers duly informed of the study contents and giving their informed consent. It was conducted by physicians and surgeons members of SAMCEP* (Société Avancée de Médecine et Chirurgie Esthétique et Plastique). The botulinum toxin was onabotulinumtoxin A. Results were evaluated 15 days after treatment, in regard to global eyebrow position, eyebrow head and tail position; muscle interactions; lines above the eyebrow. Eleven case reports and their results are shown and discussed. CONCLUSION: Our study underlines two important insights: muscle balances and "border areas", between orbicularis oculi and corrugator, key features for eyebrow head, and between frontalis and orbicularis oculifor eyebrow tail.

New trends in rhinoplasty.

Rhinoplasty is one of the most interesting and complex aesthetic surgeries. It's main aesthetic and artistic goal is to enhance beauty by creating a harmonious natural looking face. There isn't one and only standard rhinoplasty procedure, but as many rhinoplasties as there are individual patients. Everyone seeks for more wellbeing and self-confidence in the quest of beauty. Along with facial aesthetic, rhinoplasty aims to improve the nasal breathing function, another important factor for patients. Rhinoplasties have evolved in much the same way as other plastic surgeries: more radical; more preserving of the function; and more simple both in concept and in procedure. Rhinoplasty procedures are simplified with the objective of reducing surgical trauma and optimising down time. It remains a surgical act, but newer fields of aesthetic medicine modify its philosophic and technical approach. Furthermore, approaches which propose an external approach and large dissection are now becoming less common. The developpement of aesthetic medicine is also one of the most recent and important "evolution corner" in the indication strategy. We can now modifiy and "sculpt" the nose by using fillers, with or without the use of botulinum toxin. In this article, the author describes his personal surgical strategies and the position of non-surgical solutions in the modification of the nose appearance.

[Advantages of combined therapies in cosmetic medicine for the treatment of face aging: botulinum toxin, fillers and mesotherapy]. / Intérêt des thérapies combinées en médecine esthétique pour le traitement du vieillissement du visage: toxine botulique, fillers et mésothérapie.

Non surgical cosmetic medicine procedures for the face are developing considerably, as they deliver good results using simple, non invasive, atraumatic and reproducible techniques. Aesthetic mesotherapy, also known as anti-aging mesotherapy, uses intra-dermal injections of a nutritive and moisturizing solution to improve brightness, skin hydration and tonus, and also smooth out superficial wrinkles. Subcutaneous filler injections enable to fill wrinkles and folds; by using high density products it is also able to provide genuine facial volumetric reconstruction. Finally, botulinum toxin acts by reducing certain muscle contractions to smooth out expression lines and folds induced by facial dynamics. In this article, we explore the concept of combined therapy and describe our experience associating anti-aging mesotherapy (NCTF-135HA, Filorga, Paris, France), hyaluronic acid based fillers (X-HA3 and X-HA-Volume, Filorga, Paris, France) and botulinum toxin (Vistabel, Allergan, Irvine CA, USA). A therapy combining anti-aging mesotherapy, botulinum toxin and filler injections, offers full treatment of the 3 biological levels of the covering tissues. This non-invasive therapeutic strategy brings patient satisfaction through a global approach to facial aging.

[The relevance of Choukroun's Platelet-Rich Fibrin (PRF) during middle ear surgery: preliminary results]. / Place des facteurs de croissance (Platelet-Rich Fibrin de Choukroun) dans la chirurgie de l'oreille moyenne: résultats préliminaires.

OBJECTIVES: To evaluate the relevance of Leucocyte- and Platelet-Rich Fibrin (L-PRF, Choukroun's technique) Concentrates during tympanoplasty. MATERIALS AND METHODS: 152 myringoplasties (including 2 cases with bilateral tympanic perforations) were treated by the senior surgeon in 150 patients, 63 women and 87 males aged between 25 and 55-years-old, between december 2004 and june 2008. These patients showed non marginal tympanic perforations, sized from punctiform to subtotal. For the smallest perforations, a PRF cylinder was used alone to fill the perforation without preparing a tympanomeatus flap (Champagne plug technique). For perforations largest than the third of the tympanic surface, temporal aponeurosis graft in underlay was preferred, and optimized by the lateral application of a PRF membrane (hamburger technique). RESULTS: 6 failures were recorded in this case series, with tympans showing residual microperforations, after a minimum follow-up of 6 months. The success rate was thus close to 96%. The mean success rate without PRF is normally 85%. All failures were recorded on large non marginal lesions. CONCLUSION: PRF will never save an inadequate surgical procedure, but it offers both mechanical and inflammatory protection to the tympanic graft and accelerates cell proliferation and matrix remodelling. Moreover, this autologous biomaterial induces no undesirable tissue reaction, is easy, quick and cheap to produce and is easily manipulated during the surgical procedure. It seems a precious help for the otologist, in order to improve tympanic healing. PRF potential applications in the middle-ear surgery seem numerous.

[Medical rhinoplasty: rationale for atraumatic nasal modelling using botulinum toxin and fillers]. / La rhinoplastie médicale : de l'usage de la toxine botulique et des produits de comblement pour un remodelage atraumatique du nez.

OBJECTIVES: To describe the new techniques for medical rhinoplasty, associating fillers and botulinum toxin without invasive surgery, to evaluate their efficiency with a retrospective analysis on 85 patients for 2 years, and to discuss the adequate indications for this new approach. MATERIAL AND METHODS: Between january 2006 and january 2008, 85 patients were treated using a non surgical approach for aesthetic disorders of the nasal pyramid. 62 women and 23 men were included, with different indications: 32 primary rhinoplasties, 53 secondary rhinoplasty corrections. Fillers were used alone in 58 cases, botulinum toxin alone in 12 cases, and both products were used together in 15 cases. Botulinum toxin was always an A-type toxin. For fillers, reticulated hyaluronic acid was used in 56 cases, calcium hydroxyapatite in 11 cases, tricalcium phosphate in 2 cases, L-polylactic acid in 2 cases and polyacrylamid gel in 2 cases. Fillers were injected after application of anaesthetic gel, and placed in depth with osteocartilaginous contact following a retro-tracing movement. At the end of the procedure, the nose was manually modelled in order to improve the product distribution. Botulinum toxin injection was performed without anaesthesia following a specific protocol. Clinical results were evaluated by the patient and the physician immediately after treatment, after 15 days and after 1 month. The satisfaction index was based on 3 answers after 1 month: very satisfactory, satisfactory, insufficient. RESULTS: In this series of 85 cases, the satisfaction index was very high (66/85 patients, very satisfactory result), higher than the classical values obtained after other treatments of face wrinkles and defects (apart from botulinum toxin effects). The complication rate was very low, with only one reversible case in this series (infection of the tip on a multi-operated nose). The durability of results was dependent on the product: 4 months for botulinum toxin, 12 to 14 months after 2 injections for resorbable fillers. CONCLUSION: Medical rhinoplasty provides a large range of therapeutic solutions for minor corrections of nasal morphological or dynamic defects. The benefit/risk ratio for all aesthetic treatments must be high, what implies to reach the best result with the less complex, invasive and brutal protocol. This new approach for rhinoplasty fits in totally with actual patient expectations. The main inconveniences of this approach are the short durability of results and the cost of the procedure repetition.

[Influence of platelet rich fibrin (PRF) on proliferation of human preadipocytes and tympanic keratinocytes: A new opportunity in facial lipostructure (Coleman's technique) and tympanoplasty?]. / De l'influence du platelet rich fibrin (PRF) sur la prolifération des préadipocytes et keratinocytes tympaniques humains: une nouvelle opportunité pour la lipostructure faciale (technique de Coleman) et la tympanoplastie?

AIM: To analyze the effects of PRF (a platelet and immune autologous concentrate) on in vitro proliferation of human keratinocytes and preadipocytes, and to determine if these results may offer an opening on new clinical investigations, particularly in the improvement of tympanoplasties and facial lipostructures (Coleman's technique). MATERIALS AND METHODS: Human tympanic keratinocytes and preadipocytes are collected and cultured using the explant technique. 4 series of each type of cells are cultivated either in normal condition (control group) or with PRF (test group). The Petri dishes (of culture) are taken out on the 3rd, 7th, 14th and 21st day, for counting. Evolutions of cells' number are analyzed with a variance test. RESULTS: The number of cells in culture increases of more than 60% on the 7th day, and of almost 150% right from the 14th day when in presence of PRF. The daily proliferation peak occurs around the 14th day. The two cellular tested types react similarly. CONCLUSION: The PRF, considered as a healing biomaterial, could be used in tympanic and facial lipostructures surgeries, in order to improve the therapeutic result. Other applications in microsurgery and in plastic surgery may be possible, but specific clinical studies need to validate such protocols.

[Comparative study using AAO-HNS guidelines for conductive hearing loss and Glasgow Benefit Plot to evaluate results of stapes surgery for otosclerosis: results of 129 cases]. / Evaluation de la chirurgie stapédienne pour otospongiose par le score de bénéfice de Glasgow compare aux critères de l'AAO-HNS : résultats sur 129 cas.

AIM OF THE STUDY: For surgery of otosclerosis, broughting to the fore interest of crossing informations achieved by using AAO-HNS guidelines for conductive hearing loss and Glasgow Benefit Plot (GBP). Secondary aim: compare stapedotomy with and without veinous interposition. INSTITUTIONS: Referential otologic center in semi-country-side general hospital and private institution in urban zone. MATERIALS AND METHOD: retrospective bi-centric study comparing 129 cases of primary surgery for otosclerosis between 1998 and 2004. 3 groups: stapedotomy without veinous interposition (92 cases), stapedotomy with veinous interposition (27 cases), stapedectomy (10 cases). Results given following AAO-HNS guidelines and GBP. STATISTICAL ANALYSIS USED: variance analysis test and t-Student test (p < 0,05), graphic analysis of inter-aural difference before and after surgery. RESULTS: Main benefit in air conduction (AC) threshold is 23 to 25 dB, no statistical difference between both techniques of stapedotomy. Stapedotomy gives better results than stapedectomy in this serie. Stereophony is achieved in 75% of overall cases with stapedotomy but normal hearing is achieved in only 53% of unilateral pre operative hearing loss. COMMENTS: Stapedotomy is a more effective technique in this serie. Crossing informations achieved using AAO-HNS guidelines and GBP leads to give a more realistic and comprehensive understanding to patients who will undergo surgery for otosclerosis.

[The relevance of Choukroun's platelet rich fibrin (PRF) during facial aesthetic lipostructure (Coleman's technique): preliminary results]. / De l'intérêt du platelet rich fibrin (PRF) de Choukroun au cours de la lipostructure faciale esthétique de Coleman: résultats préliminaires.

OBJECTIVES: To evaluate the interest of fibrin PRF clots, a concentrate of platelets and immune factors, for the optimization of the adipocyte graft according to the technique of facial lipostructure described by S. Coleman. MATERIALS AND METHODS: Between May 2005 and June 2006, 32 patients (7 men and 25 women) benefited from a Coleman lipostructure with the use of PRF. The average age was 59 years (39 to 72 years). Lipostructure was used alone in 22 patients and associated with a face lift and/or a blepharoplasty in 10 patients. Before the adipocyte graft, a mixture of PRF and greasy supernatant (resulting from the purification of the sample of adipocytes) is deposited on the zones to be grafted in the same way as for lipostructure. For 2 patients, the pretreatment of the site to be grafted with PRF was unilateral. Patients were followed-up for one year. RESULTS: In this series, all the patients were satisfied with the result with minimal associated resorptions. No massive resorption requiring a resumption of lipostructure was noted. In the 2 patients treated with unilateral use of PRF, one notes a light asymmetry, the hemi-face treated with PRF appearing more stable than the side without PRF. No important residual oedema or echymosis were seen on the 3rd post-operative week. CONCLUSION: By offering a matricial support to angiogenesis and by stimulating the proliferation of pre-adipocytes, the PRF could have a beneficial role on the cicatrization and the consolidation of an adipocyte graft. Further studies are necessary to validate the interest of the PRF during aesthetic lipostructures. The potential uses in plastic surgery of such a biomaterial, easy and fast to produce, without any overcost and with no risk, are very numerous and require from now on to be tested and validated methodically.

[Surgical anatomy of the nose]. / Anatomie chirurgicale de la pyramide nasale.

A good anatomical knowledge is a pre-requisite to all surgeries. In rhinoplasty, where many steps are performed without visual control and are only guided by palpation, anatomy must be mastered. Based on classical static anatomy and dynamic surgical modifications of the nose, this study analyses anatomical and surgical correlation and reports their technical implications. Correction of the shape of the nose is to be able to conceptualize the underlying skeleton and to program adapted surgical procedure for each case.

[Rhinoplasty: morphodynamic anatomy of rhinoplasty. Interest of conservative rhinoplasty]. / La rhinoplastie : anatomie morpho-dynamique de la rhinoplastie. Intérêt de la rhinoplastie "conservatrice".

OBJECTIVES: To highlight the morphodynamic anatomical mechanisms that influence the results of rhinoplasty. To present the technical modalities of nasal dorsum preservation rhinoplasties. To determine the optimized respective surgical indications of the two main techniques of rhinoplasty: interruption rhinoplasty versus conservative rhinoplasty. MATERIALS AND METHODS: Based on anatomical dissections and initial morphodynamic studies carried out on 100 anatomical specimens, a prospective study of a continuous series of 400 patients operated of primary reduction rhinoplasty or septo-rhinoplasty by one of authors (YS) has been undertaken over a period of ten years (1995-2005) in order to optimize the surgical management of the nasal hump. The studied parameters were: (1) surgical safety, (2) quality of early and late aesthetic result, (3) quality of the functional result, (4) ease of the technical realization of a possible secondary rhinoplasty. The other selected criteria were function of the different nasal hump morphotypes and the expressed wishes of the patients. RESULTS: The anatomical and morphodynamic studies made it possible to better understand the role of the "M" double-arch shape of the nose and the role of the cartilaginous buttresses not only as a function but also the anatomy and the aesthetics of the nose. It is necessary to preserve or repair the arche structures of the septo-triangular and alo-columellar sub-units. The conservative technique, whose results appear much more natural aesthetically, functionally satisfactory and durable over the long term, must be favoured in particular in man and in cases presenting a risk of collapse of the nasal valve. CONCLUSION: The rhinoplastician must be able to propose, according to the patient's wishes and in view of the results of the morphological analysis, the most adapted procedure according to his own surgical training but by supporting conservation of the osteo-cartilaginous vault whenever possible.

["Mini-rhinoplasty"]. / La mini-rhinoplastie.

OBJECTIVES: To define the interest of the so called "mini-rhinoplasty" in aesthetic nose surgery and to report the surgical technique. METHOD: The experience of the authors, based on more than 500 mini-rhinoplasty surgical procedures is reported. The surgical procedure such as technical tips are reported. RESULTS: Mini-rhinoplasty procedure is indicated in patients with small deformities, particularly in patients with nasal hump or hyper-projected noses, with no deviation. The nasal tip should be normal or slightly drooping. The surgical technique is safe and reproducible. Surgical aesthetic outcomes are excellent. This technique is also indicated in elderly patients willing a facial rejuvenation. CONCLUSION: Mini-rhinoplasty surgical technique is a minimal invasive procedure with no complication in the postoperative period. The postoperative management of patients undergoing this procedure is of main importance.

[Cervical liposuction: a reliable procedure to rejuvenate the face]. / Intérêt de la liposuccion cervicale dans le rajeunissement du visage.

Cervical liposuction belongs to aesthetic surgical procedures. It gives a new oval of the face, which is a characteristic of beauty and youth. The aim is the reduction of sub-mental and sub-maxillary fat accumulation. This procedure is reliable and not invasive. This article reports on the indications of this procedure, insisting on the physiopathology of fat tissue, technical procedures, results and complications, through the experience of authors.

[Temporal lift]. / Lifting temporal.

UNLABELLED: The temporal lift belongs to the traditional face lift which is in fact temporo-cervico-facial. It also forms part of the face lift "upper part of the face" which is in fact temporo-frontal. It is to say that it relates to a junction zone between the superior and inferior part of the face. OBJECTIVES: In a first part the authors recall the essential anatomical data including the eyebrow, the Charpy's fat pad, the galea and the temporoparietal fascia, the nerves (temporo-facial branch of the facial nerve and supra-orbital nerve) and the veins (sentinel vein). Then they expose the various surgical techniques (galeapexy, endoscopic temporal lift, brow lift, facial threads, standard fixing Endotine forehead, botulinic toxin. This makes it possible to define in a more precise way the indications and counterindications of the temporal lift. CONCLUSION: The indications of the temporal lift are the lateral ptosis of the tail of the brow. On the other hand, the total ptosis requires a frontal lift. In this case one can associate a concomitant blepharoplasty. The temporal lift is frequently carried out in a way combined with a cervico-cheek lift. The prospects for technical progress to improve perenniality of an isolated temporal gesture are large and will allow us to widen the indications.

Adipose graft: an original option in myringoplasty.

OBJECTIVE: To describe the fat graft as a reconstructive material in myringoplasty. METHOD: In a review of 45 patients conducted between 1993 and 1999, the authors analyzed their patients' outcomes after having myringoplasties with fat graft. Median follow-up was 2.5 years (range, 6 mo-6 yr). RESULTS: We achieved a success rate of 91.1%. Different features of the patient and the tympanic perforation were studied to demonstrate their role in the quality of the surgical closing. A review of the literature was done to compare our results with the results of other series using this type of graft as well as with studies of the temporalis fascia as a graft material. CONCLUSION: The high reliability of the fat graft and the technical simplicity of this procedure in anterior perforations, especially with the use of intraoperative endoscopy, make it an attractive technique.

Transconjunctival approach in lower eyelid blepharoplasty.

AIM: To specify interest and indications of the transconjunctival approach in lower-eyelid plastic surgery. MATERIALS AND METHODS: Twenty-three cases of inferior blepharoplasty performed through a transconjunctival approach are reported. The authors describe the surgical technique, its indications and results. RESULTS: The transconjunctival approach provides excellent access to the inferior fatty chambers and is cutaneous scar free. It has a lower complication rate than the classic transcutaneous approach, and no case of cyclid retraction has been reported. CONCLUSION: In our 'cosmetic society', the inferior blepharoplasty through a transconjunctival approach has taken a significant place in the armamentarium of the esthetic surgeon. Juvenile palpebral lipoptosis without skin excess constitutes the best indication for this technique. It is also indicated in secondary blepharoplasty and in patients presenting with a cicatricial risk or with orbital septum distention.

OBJECTIF: Préciser l'intérêt et les indications d'une approche transconjonctivale pour la plastie de la paupière inférieure. DOCUMENTATION ET MÉTHODOLOGIE: Vingt-trois cas de blépharoplastie exécutés selon l'approche transconjonctivale sont présentés. Les auteurs décrivent la technique chirurgicale, ses indications et ses résultats. RÉSULTATS: L'approche transconjonctivale assure un excellent accès aux cavités graisseuses et évite les cicatrices cutanées. Elle présente un taux de complications plus faible que la approche transcutanée classique, et aucun cas de rétraction de la paupière n'a été déclaré. CONCLUSION: Dans notre société « esthétique ¼, la blépharoplastie inférieure par approche transconjonctivale a pris une place de choix dans l'arsenal du plasticien. Une lipoptose palpébrale juvénile sans excès cutané représente la meilleure indication pour privilégier cette technique. Elle est également indiquée en cas de blépharoplastie secondaire et chez les patients présentant un risque de cicatrice ou de distension de la cloison orbitaire.

[An original case of laryngomucocele after Tucker surgery]. / Un cas original de laryngomucocèle après intervention de Tucker.

Although discovered since nearly 2 centuries, the cystic tumours of the laryngeal ventricle remain very badly known by otorhinolaryngologists. Air-containing or cystic, these lesions can be congenital or acquired. We present an original case of laryngomucocele, acquired after a partial laryngectomy of Tucker type for a laryngeal neoplasty. Through a review of the literature, we expose in the second time, the etiopathogenic mechanisms of these lesions. If this pathology contributes to mislay the diagnosis during the post-operative survey, small surgical details at the time of the initial intervention, can prevent the appearance of this lesion. The treatment is a surgical procedure, with an endoscopic way or a cervicotomy.

[Recurrent acoustic neurinoma after complete surgical resection]. / Les récidives des neurinomes de l'acoustique après exérèse chirurgicale.

BACKGROUND: Mortality of acoustic neurinoma surgery is currently very low, well below the figures reported by the first surgeons. Morbidity has also declined with attempts at preserving the facial function and more recently hearing function. Long-term follow-up has demonstrated the well-known risk of recurrence after partial resection, but also evidenced a risk after complete resection. PATIENTS AND METHODS: We reviewed two series of patients, the first including 40 patients treated and followed at the Timone Hospital since 1975 and the second including 97 operated patients who were followed by the ENT Federation over 8 to 16 years. We studied recurrence after partial and complete resection. RESULTS: Recurrence rate was 20% after partial resection and 9.2% after complete resection. DISCUSSION: The 20% recurrence rate after partial resection was similar to that reported in the literature. After total extirpation, our 9.2% recurrence rate appears well above the 1% reported by others. Although our series could have a bias due to the large number of patients lost to follow-up, the large population size and the fact that we had a majority of large tumors would suggest that recurrence rate is generally underestimated. An 8 to 10% rate appears to be closer to reality. Most recurrences were late, with a peak around 8 years. We did however observe recurrences as early as 1 year and as late as 20 years. Delay appears to be shorter after partial removal. A wide range of localizations were observed but two areas predominated: the internal auditory canal and the components of the acousticofacial pedicle, and to a lesser degree the brain stem. Most patients were asymptomatic. The principal manifestations were balance disorders or trigeminal nerve lesions, more rarely facial palsy. But these clinical signs came late and generally signaled a bulky tumor measuring more than 3 cm. CONCLUSION: These findings lead us to insist on the need for radiological monitoring of all operated neurinomas irrespective of the initial surgery. MRI appears to be more accurate than computed tomography. Images must be interpreted carefully due to possible postoperative remodeling. For us, these observations point to the need for prolonged follow-up of at least 8 years, longer for young subjects, for all patients undergoing surgical resection of an acoustic neurinoma.

[Essential parathyroid cysts: a misleading lesion]. / Le kyste parathyroïdien essentiel: une affection trompeuse.

Though a rare lesion, non-functioning parathyroid cyst is of clinical significance because it usually mimics a thyroid nodule. The cyst can be ectopic in location and therefore constitutes a differential diagnosis to a bronchial or thymic cyst. Two recent cases of non-functioning parathyroid assay are reported. Needle puncture with estimation of the level of parathyroid hormone in the aspirate allows the diagnosis to be made before surgery.