[Rejuvenation of the eye: combined techniques]. / Rajeunissement du regard: techniques combinées.

To show that adjuvant techniques to traditional blepharoplasty: Fat graft, phototherapy, radiofrequency must be offered in combination with cosmetic eyelid surgery for rejuvenation and embellishment of the orbital and peri-orbital regions.

[Endoscopic fronto-temporo-malar face lift. Technique and results apropos of 18 cases]. / Lifting fronto-temporo-malaire par voie endoscopique. Technique et résultats à propos de 18 cas.

Endoscopy was recently introduced into facial cosmetic surgery in 1992 following the work by O. Ramirez and N. Isse. Endoscopic facelift is not only a surgical approach, but also represents a new pathophysiological concept. The creation of a new balance between levators and depressors of the eyebrow allows ascension of the eyebrow and reduction of hypertonicity of the frontalis muscle, responsible for horizontal wrinkles. Based on a series of 18 patients operated at the Pitié-Salpêtrière hospital over the last 2 years, the authors describe the technique, the complications and define the indications.

Clear cell sarcoma of the pre-parotid region: an initial case report.

An unusual case of clear cell sarcoma (CCS) found in the parotid region of a 75-year-old man with a long history of chronic lymphoid leukemia is reported. Treatment of the patient included a total parotidectomy with preservation of the facial nerve. The tumor was pathologically consistent with a clear cell sarcoma. Since CCS originates from the neural crest and is melanin producing, we suggest that this particular tumor originated from the superficial musculo-aponeurotic system (SMAS). To our knowledge, this is the first case of CCS that has been reported in the parotid region.

[Demonstration and electrophysiological analysis of the blinking reflex in the rat. Value of the animal model]. / Mise en évidence et analyse électrophysiologique du réflexe de clignement chez le rat. Intérêt de ce modèle animal.

The authors have developed an animal model for the electrophysiological investigation of the blink reflex. The justification for such investigations and the experimental protocol were presented. The authors studied the blick reflex with electromyographic recordings obtained after the stimulation of the supra orbital nerve (V1) in the awake rat and in the anaesthesized rat. Two components of the reflex, R1 and R2 were observed. The early component, R1 was ipsilateral to the stimulus. It was observed whatever the degree of anaesthesia. The R2 component came later and was only observed in awake or weakly anaesthesized rats. It appeared to be isolated and unprecedented by an R1 component when the contralateral supra orbital nerve was stimulated. The R1 responses were facilitated by prior ipsilateral or contralateral stimulation of V1.

[Electrophysiological study of hemifacial spasm]. / Exploration électrophysiologique de l'hémispasme facial.

Hemifacial spasm is characterized by intermittent involuntary contractions of one or several groups of muscles innervated by the facial nerve. The possible causal mechanisms have been the subject of numerous publications. The pre-eminent work of Moller and Jannetta implicates the compression of the facial nerve at its point of entry into the central nervous system, the Root Entry Zone, while the physiopathology is poorly understood, two principle hypotheses emerge: 1) ephaptic transmission between injured fibers; 2) hyper excitability of the facial motor nucleus. Using standard electromyographic techniques and blink reflex studies, we were able to demonstrate hyperexcitability of the facial nucleus. The cause of this hyperexcitability remains unexplained. It could be the result of a permanent antidromic stimulation from a peripheral ectopic center of excitation.

Redirection of the hypoglossal nerve to facial muscles alters central connectivity in human brainstem.

Functional motor control requires perfect matching of central connectivity of motoneurones with their peripheral connections. However, it is not known to what extent central circuitry is influenced by target muscles, either during development or following a lesion. Surgical interventions aimed at restoring function following peripheral nerve lesions provide an opportunity for studying this interaction in the mature human nervous system. We have followed 8 patients in whom the hypoglossal nerve was anastomosed into a lesioned facial nerve, allowing voluntary contractions of the previously paralyzed muscles. We show that, in addition to replacing the facial neurons at peripheral synapses, a new short-latency trigemino-hypoglossal reflex, of the R1 blink reflex type, can be demonstrated in patients showing recovery, implying a sprouting of trigeminal neurons towards hypoglossal motoneurones, over a distance of at least 0.5 cm. These surprising results show an unexpected influence of the periphery in remodelling central connectivity in man.

[Mouth and pharyngeal hyperalgesic syndromes in AIDS]. / Syndromes hyperalgiques bucco-pharyngés observés au cours du SIDA.

In a series of 12 patients suffering from an HIV infection, including 9 with confirmed AIDS, who complained about pharyngeal pain in a fixed site, having a progressive intensity and not relieved by antalgics and the specific treatments that were prescribed empirically, and for whom etiological investigation yielded negative results, Thalidomide proved to be the only effective means of healing the exulcerated, nail-mark lesions or the ulcerated, budding, neoplastic-like lesions, and of completely suppressing pain.

[Endocranial complications of chronic otitis in adults]. / Complications endo-crâniennes des otites chroniques chez l'adulte.

47 patients with intracranial abscess were admitted in the neurosurgical department of Professor Fohanno Pitié-Salpêtrière Hospital, between 1973 and 1989. Most often central abscesses were found. In 9 cases, the ear was the primary septic focus: 3 chronic otitis with cholesteatoma, 6 chronic otitis without cholesteatoma. In most cases, treatment included: Immediate drainage, Delayed surgery for the primary focus.

[The value of radiotherapy in the treatment of tympano-jugulare chemodectoma. Apropos of 18 cases]. / Intérêt de la radiothérapie dans le traitement des chémodectomes tympanojugulaires. A propos de 18 cas.

Surgery is the standard treatment of tympano-jugular chemodectomas. Radiation therapy is used only for inoperable forms. Since the tumor most often does not regress completely after irradiation, radiation therapy is generally considered as palliative. From 1979 to 1988, 18 patients with this rare tumor were referred to the Necker Hospital Tumor Center for radiation therapy. These patients have now been followed for 2 to 11 years. Tumors were extensive (Fish Stage C and D) in 75% of the patients and half of these patients showed cranial nerve involvement in addition to the usual otovestibular anomalies. Three patients were referred for recurrent tumors and 7 patients had undergone surgery just prior to radiation therapy. Among the 11 patients treated with the tumor in place, 7 had more or less complete regression of symptoms and radiologic signs, 3 had no further progression of symptoms and radiologic signs and 1 had tumor progression and expired as the result of the disease. No patient receiving post-operative radiation therapy developed clinical or radiological evidence of recurrent tumor. Among the 18 patients treated, 2 died of intercurrent disease. Our experience shows that a dose of 45 Gy is suffisant, leaves no trace, and does not prevent subsequent surgery. In an extensive review of the literature, tumor growth stopped or regressed after radiation therapy in 90% of the patients reported. Therefore, if incomplete surgery or neurological operative sequelae seem unavoidable, we prefer radiation therapy to surgical management of this tumor.

[Neurinoma of the 8th cranial nerve. Surgical indications in neurofibromatosis]. / Neurinome du VIII. Indications chirurgicales au cours des neurofibromatoses.

There are two types of neurofibromatosis, i.e. peripheral neurofibromatosis (type 1) and central neurofibromatosis (type 2). Neurinomas of the acoustic nerve are basically seen in central neurofibromatosis, in which case they are generally bilateral. Surgical indications for neurinoma are rare and 5 patients will be discussed: 2 of these underwent an operation on the neurinoma by the posterior route on several occasions, while 1 patient was operated by the trans-labyrinth route. Nuclear magnetic resonance remains the best means of monitoring.

[Severe lesions of the petrous bone caused by pseudomonas aeruginosa]. / Lésions pétreuses graves dues au pseudomonas aeruginosa.

Pseudomonas aeruginosa is often isolated in infections of the ear cleft. In some circumstances, this organism can cause serious petrous or peri-petrous lesions. Two pictures are seen: Malignant external otitis with severe headaches, signs of external otitis, and usually pseudomonas aeruginosa is isolated. This is usually seen in an elderly diabetic patient. Nerve paralysis is the main risk. The other complications, very grave in the past, are rare nowadays with the use of selective antibiotic treatment. Pseudomonas aeruginosa is also the causative organism in extensive osteitis of the skull base. Diagnostic problems are seen in case of specific infections or tumoral lesions. The treatment includes the same medications as for the malignant external otitis, as well as complete surgical excision.

[The temporomandibular joint: anatomy, physiology, clinical review]. / Articulation temporo-mandibulaire: anatomie, physiologie, rappel clinique.

The temporomandibular joint (TM joint) is a synovial joint with two condylar surfaces and an intra-articular cartilaginous disc. Its development has two origins. Its physiology is complex and intimately related to dental occlusion, which is why we talk about the temporomandibular and dental joint. Recent neurophysiological data allow a better approach to TM joint dysfunction. The lateral pterygoid muscle plays decisive role in the pathogenesis of TM joint dysfunction.