ABSTRACT
Twenty five cases of malignant tumors of the petrous bone are presented. Prognosis depends on the histology and on the local invasion which dictate the possibility of curative surgery. Squamous cell carcinoma of the middle ear and other invasive tumors have a bad prognosis, and in spite of the progress of modern image technology, the peripetrous extension of the tumors are often underestimated. Actuarial two years survival for squamous cell carcinoma was 38%. Total excision needs at least a subtotal petrous resection with, in some cases meningal and internal carotid resection. In all cases, surgery was followed by radiation. Low grade malignant tumors had a better prognosis and required a more limited resection. In these cases, when necessary, facial nerve can be repaired by a cable graft at the time of initial surgery.
Subject(s)
Carcinoma, Squamous Cell/therapy , Petrous Bone , Skull Neoplasms/therapy , Adolescent , Adult , Aged , Carcinoma, Squamous Cell/diagnosis , Child , Combined Modality Therapy , Diagnostic Imaging , Facial Paralysis/etiology , Female , Humans , Male , Middle Aged , Neck Dissection , Prognosis , Skull Neoplasms/complications , Skull Neoplasms/diagnosis , Survival RateABSTRACT
Enlarging tracheoesophageal fistula after tracheoesophageal prosthesis for voice rehabilitation remains a major challenge. The authors analyze the results of treatment of 15 severe enlarging tracheoesophageal fistulas among 28 cases (52%) of tracheoesophageal voice rehabilitation which occurred during a 4 years period of time. Among these 15 cases, a spontaneous closure occurred in 3 cases (20%), a two layers closure was performed in 4 cases (26%) and a closure using a tracheal ascension associated with the design of a new tracheostoma was performed on 8 cases (53%). The authors describe the surgical technique and discussed the advantages of surch technique.
Subject(s)
Larynx, Artificial , Tracheoesophageal Fistula/surgery , Adult , Aged , Humans , Laryngectomy/rehabilitation , Middle Aged , Pharyngectomy/rehabilitation , Trachea/surgery , Tracheoesophageal Fistula/etiology , TracheostomyABSTRACT
A disorder of the internal ear of unknown origin, Menière's disease is not characterised by vertigo but rather by the associated auditory symptoms and a chronic course. The first differential diagnosis is the acoustic neurinoma. Study of auditory evoked potentials, which is reliable and inexpensive, can preclude the use of more expensive imaging techniques. Menière's disease can be invalidating in patients who are often young and active. Treatment remains symptomatic and empiric. Destructive surgery can be a solution if it respects audition. Overall management remains the basis of treatment.
Subject(s)
Meniere Disease , Adult , Child , Chronic Disease , Female , Humans , Male , Meniere Disease/diagnosis , Meniere Disease/etiology , Meniere Disease/therapy , Time FactorsABSTRACT
Forty women, average age of 54, have been treated in first intention or after the failure of a previous treatment, for a squamous cell carcinoma of the tongue. Eighteen (45%) had no risk factors and 9 were under forty years of age. The oral tongue was the most frequent localisation in the group of patient without risk factors. Nineteen local failures were observed. Actuarial three-years survival was 36%. We believe that the poor prognosis of female tongue squamous carcinoma requires aggressive treatment with combined surgery and brachytherapy on the primary lesion and prophylactic neck dissection even in patients without palpable cervical nodes.
Subject(s)
Carcinoma, Squamous Cell , Tongue Neoplasms , Actuarial Analysis , Adult , Age Factors , Aged , Aged, 80 and over , Carcinoma, Squamous Cell/mortality , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/therapy , Combined Modality Therapy , Female , Humans , Lymph Node Excision , Middle Aged , Neoplasm Staging , Prognosis , Sex Factors , Survival Rate , Tongue Neoplasms/mortality , Tongue Neoplasms/pathology , Tongue Neoplasms/therapyABSTRACT
Tumors of the amygdaline region were up until now most often treated by transmandibular buccopharyngectomy (TMBP) with a systematic sacrifice of the mandibular angle. This exercise justified by wide carcinological imperatives, a larger surgical facility and simple immediate postoperative follow-up, in fact systematically shows a substantial esthetic and functional prejudice. This principle was reinforced by the occurrence of osteitis during the first attempts of osseous reconstruction using steel wires opposite the mandibular angle (Dargent, Charachon, 1963). In 1989, Gehanno and Beauvillain published a mandibular conservation technique by vertical paramedian osteotomy, right in front of the mental nerve, shifted from the future field of radiation, with osteosynthesis by titanium plates. This technique appeals to us because it is easy to use, reliable and carcinologically safe. We have currently adopted it with satisfaction for 8 of our patients over an 18-month period, without any case of osteitis and with both good esthetic and functional results.
