[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.

[Surgical anatomy of the parathyroid glands. Apropos of 200 cases. Practical implications]. / Anatomie chirurgicale des glandes parathyroïdes. A propos de 200 cas. Implications pratiques.

An operative procedure aimed at decreasing the risk of post-surgery hypothyroidism was proposed on the basis of parathyroid gland surgical anatomy described from a retrospective study of 200 thyroidectomies performed by the same operator It is almost always possible to visualize 1 or parathyroids during thyroid procedures. This fact makes it possible to reduce the rate of definitive hypoparathyroidism to less than 5% in surgery for invasive cancer of the thyroid and to 1% for non-invasive cancers requiring total thyroidectomy and uni or bilateral mediastinorecurrent curettage.

[Cholesteatoma of the middle ear in children. Apropos of 80 cases and review of the literature]. / Le cholestéatome de l'oreille moyenne chez l'enfant. A propos de 80 observations et revue de la littérature.

Cholesteatoma occurs in 10% of cases of chronic otitis in children. In most children, the clinical form is very similar to acquired cholesteatoma in the adult. However, we observed certain clinical variations in our retrospective series of 80 cases seen in our unit over the past 8 years. In most all cases, otorrhoea and hypoacousia were the presenting signs. The tympanic membrane was fully intact in 10% of the cases raising the possibility of congenital pathogenesis. An analysis of the correlations between per-operative observations and tomodensitometric results was conducted. Closed tympanoplasty, with a second operation 11 months later, was performed in 84% of the cases. Residual cholesteatoma was observed in 41% of the second operations and relapse occurred in 16%. These anatomic and functional findings, compared with those in the literature, demonstrate that no major difference in the published series. Presently the most important point is to separate acquired and congenital forms, which differ in terms of pathogenesis and clinical presentation, but are treated in the same manner. Progress in the treatment of cholesteatoma of the middle ear in children will come from prevention through earlier diagnosis of pathological manifestations in the ear nose and throat, in particular blocked Eustachian tubes, and through follow-up and treatment of pre-cholesteatomous states, as well as further advances in fundamental research.