[Giant pleomorphic adenoma of the deep lobe of the parotid gland: role of MRI and nerve monitoring in facial nerve localization]. / Adénome pléiomorphe géant du lobe profond de la glande parotide : intérêt de l'IRM et du monitoring nerveux dans la localisation du nerf facial.

INTRODUCTION: Describe, from a clinical case, the usefulness of MRI and nerve monitoring in facial nerve and the interest of the MRI in detecting the position of the facial nerve. REPORT OF THE CASE: A 73 year-old woman has been supported for a huge tumour of the right parotid gland. Clinical examination and preoperative imaging were consistent with a pleomorphic adenoma located in the superficial lobe, with a facial nerve repressed deeply. Resection was performed using a facial nerve monitoring. The nerve was stretched and repressed in superficial position by the tumour. Parotid tissue was repressed by the tumour and the nerve branches were located in subcutaneous position. Tumour resection was achieved in full, without capsular break and without injury to the facial nerve branches. DISCUSSION/CONCLUSION: Despite recent technological developments, imaging, particularly MRI, can not accurately locate the facial nerve in all cases. A careful search of facial nerve during surgical procedure is always necessary to avoid accidental injury of the nerve. In difficult cases, nerve monitoring is an important technical assistance.

[Osteointegrated cranio-facial implants: 49 patients report]. / Implants ostéointégrés cranio-faciaux. A propos de 49 patients.

OBJECTIVES: To analyze the results obtained in the total implanted population in Strasbourg, in order to assess the reliability of this technique over the long-term, especially in children and in irradiated patients. METHODS: This is a retrospective study including all the cases of cranio-facial epitheses implanted in the department of Otorhinolaryngology, head and neck surgery at the University Hospital of Strasbourg since 1992, date of the first epithesis implantation. The results (rate of osseo-integration, cutaneous complications, degree of satisfaction) are presented according to the site of implantation and the antecedent of irradiation. The results obtained in children (16 years of age and less) are specified. RESULTS: The study involved 50 patients (including 11 children), that is 51 epitheses, auricular, orbito-palpebral or naso-maxillary. 142 implants were fixed, including 49 in irradiated patients. The average rate of osseo-integration was 95.7% in the absence of irradiation, and 81.6% following irradiation, with significant differences according to the site of the implant (worse in the nasal site). Radiotherapy being a factor which reduces the rate of osseo-integration. The success rate in children was comparable to the one obtained in adults. CONCLUSION: The extraoral osseous implantology has made it possible for the facial epitheses to be considered as a forerunner in the strategies of rehabilitation in facial loss of substance, with the surgical rehabilitation techniques. It is particularly interesting in oncology, as it allows easy clinical monitoring of the operation site.

[ENT Resident Activity in the Strasbourg Hospital ENT Emergency Clinic]. / Activité de l'interne d'ORL durant la garde au CHU de Strasbourg.

OBJECTIVES: We present an original study about ENT resident activity in an emergency ENT clinic. MATERIALS AND METHODS: The emergency unit's activity was analyzed over a seven-Month period from December 1, 1999 to June 30, 2000. ENT residents reported patient age, gender, duration of consultation, symptoms, and care delivered as well as the level of emergency and referral (general practitioner, emergency unit, other clinic, direct). RESULTS: A total of 147 emergency days were analyzed. During the study period, 1237 patients were examined, representing 8.4 patients per day and 26.5% of the ENT clinic outpatient activity. Mean patient age was 31.8 Years; 58% of the patient were male. Most of the cases did not correspond to true emergencies (53%). Half of the patients were not referred by a general practitioner. Emergency care was more justified when the patients were referred by a general practitioner or another emergency unit. The predominant pathological situations managed were acute external and middle ear otitis, epistaxis, angina, vertigo, and facial injuries. CONCLUSION: Over half of the patients came to the emergency clinic spontaneously, presenting minor problems. These data can be explained by the fact that residents are permanently present at the ENT emergency clinic. It would be interesting to conduct a similar study in ENT emergency care units where the resident is not permanently present.