[Unconventional transradicular implant placement to avoid invasive surgeries: toward a potential paradigm shift]. / Protocole non conventionnel de mise en place d'implants transradiculaires. Esquisse d'un changement de paradigme.

The authors had for aim to present a new minimally-invasive protocol to rehabilitate anterior maxillary edentulism due to an impacted tooth. The implant is placed without removing the impacted tooth, which intercepts the implant trajectory. The inclusion/exclusion criteria have not been defined yet but this protocol goes against the consensual concept that no implant surface other than implant-bone interface should be tolerated. New implant-tissue interfaces are created in addition to the usual one, but this does not seem to jeopardize the prognosis of implants. The risk analysis shows that there is a growing corpus of reliable clinical and histological data to support this unconventional protocol. The overall follow-up covers from a 6-month to an 8-year period. This protocol should be more broadly documented before it can be used routinely; nevertheless it suggests that some of the leading concepts in dental implantology may be revisited.

[Laryngeal immobility after thyroidectomy]. / Immobilité laryngée post-thyroïdectomie.

One of the most common complications of surgery of the thyroid gland is vocal folds immobility. New advances in its management have been achieved over the last few years. Laryngeal electromyography, stroboscopy, and computerized analysis of the voice help guide diagnosis, allowing differentiation between recurrent nerve paralysis and glottis traumatism due to intubation, and further follow-up of recovery with relevant therapeutic decisions. In case of unilateral vocal fold paralysis, intrafold silicone or injection of autologous fat is more and more routinely used to obtain vocal rehabilitation. In case of bilateral vocal fold paralysis, to avoid tracheotomy, partial posterior cordectomy using laser surgery restores sufficient laryngeal airflow, with minimal vocal sequelae. Early management of these complications by teams of specialists should allow appropriate and less invasive surgery.

[Corticotherapy in ENT. Subglottic laryngitis in children, acute sinusitis, naso-sinusal polyposis, sero-mucous otitis]. / La corticothérapie en O.R.L. Laryngites sous-glottiques de l'enfant, sinusites aiguës, polyposes naso-sinusiennes, otites séro-muqueuses.

Corticosteroid therapy is a key element in the treatment of acute subglottic laryngitis as well as certain types of sinusitis and seromucous otitis. Insufficient or lacking compensatory mechanism in the physiological regulation of the ENT mucosa favors the progression of these different conditions to chronic or life threatening situations, particularly for acute laryngitis. Corticosteroid therapy is one of the management steps; it should be adapted to each individual and of short duration. The goal of corticosteroid therapy is to decrease inflammation, provide pain relief and reestablish the physiological state of the ENT mucosa.

[Photochemotherapy in the treatment of carcinoma of the vocal cords of early stage (Tis, T1)]. / La photochimiothérapie dans le traitement des carcinomes du plan glottique à un stade limité (Tis, T1).

Photodynamic Therapy (PDT) is a treatment which can prove interesting in head and neck oncology for small squamous cell carcinomas. We studied 33 patients with vocal cord squamous cell carcinoma at an early stage who have been treated by Photodynamic Therapy from 1986 to 1992. We used a Dye Laser Aurora which produces light with a wavelength of 630 nm. The intervention was done under general anesthesia, 72 hours after the injection of hematoporphyrin derivative. The mean and the maximum follow-up was respectively 66 and 93 months. The local control after an exclusive PDT was 73% at 3 years, 5 years, 7 years. If this method fails, a conventional treatment may be used.

[Attic emptying in cholesteatoma and precholesteatoma states. Technique, indications and results]. / L'évidement attical dans les états cholestéatomateux et précholestéatomateux. Technique, indications, résultats.

A surgical procedure different from the open or closed technique is presented. The attic is emptied through the meatus after a retromeatal access to the antromastoidal cavities. By blocking the aditus ad antrum, the procedure produces an antrio-attic microcavity with no recessus. Results of resection of epidermal lesions are quite satisfactory with a low rate of residual pathology. Retraction pouches do not develop because the mastoid is excluded and no attic recessus is formed. Surveillance of the cavity is easy and the disadvantages of functional sequellae inherent in open techniques are avoided. The preliminary results would confirmed the quality of the procedure. In 22 cases, there were 3 residual perles on the windows and 2 retraction pouches (anterior and posterosuperior). This technique is indicated in precholesteatoma states with poor prognosis and cholesteatomas of the attic. For more advanced lesions, this technique is less reliable and the open procedure is required.

[Laser CO2 arytenoidectomy by endoscopic approach in bilateral laryngeal paralysis. Apropos of 45 cases]. / Aryténoïdectomie par voie endoscopique au laser CO2 dans les paralysies récurrentielles bilatérales. A propos de 45 cas.

Between 1980 and 1993, 45 patients with bilateral cord abductor paralysis were treated by carbon dioxide endoscopic laser arytenoidectomy. Thyroid surgery was the main cause of bilateral laryngeal palsy (67%). Seven patients, who were tracheotomised before treatment, were decanulated. Ninety-one percent of the patients recovered physiologic respiration. The follow up period lasted from one month to thirteen one-half years. Advantages and disadvantages of laser arytenoidectomy are compared with other techniques.

Use of photodynamic therapy in the treatment of vocal cord carcinoma.

The photodynamic therapy of superficial vocal cord carcinoma is a promising new technique. Patients were irradiated with 630 nm light from an Aurora dye laser under general anaesthesia 72 h after a haematoporphyrin derivative (HpD) injection. So far, 32 patients have been treated for small epidermoid carcinoma of the glottis without anterior commissure. There have been no undesired effects due to the photosensitizer or the dye laser. The results show seven failures and 25 positive responses, of which three patients were treated more than 4 years ago.