[Apparently primary cerebrospinal rhinorrhea. Apropos of 4 cases]. / Rhinorrhées cérébro-spinales apparemment primitives. A propos de 4 cas.

While rhino-liquorrhea is a severe condition, its incidence is not exceptionally rare, and it raises problems, namely etiopathogenic, diagnostic and therapeutical ones, which call for the close collaboration of ENT doctors, neuroradiologists and neurosurgeons. 4 relatively recent cases are reported here, whereby the diversity of the problems encountered is made apparent. ENT specialists must be aware of those when faced with refractory aqueous rhinorrhea, often triggered by forward head motion, Valsalva's maneuver... Screening for rhinorrhea is readily achieved by biochemical tests, or simply using a Labstix-type diagnostic strip. Rhinoscopic examination should be accurate and carried out optically to check for any congenital malformation (meningocele). Most of the times, but not always, a thorough radio-neurological workup (isotopic analysis, CT-scan with contrast medium, MR imaging) will provide precise data regarding the infraction site and its possible cause, invariably warranting surgical management. Surgery should be case-adapted (CSF derivation, filling of the gap via the extra- or intracranial approach).

[Endoscopy and cophosurgery]. / Endoscopie et cophochirurgie.

Certain fixed adherent retraction pockets especially in the posterior aspect of the tympanic cavity and certain cholesteatomas are difficult to treat even after a posterior tympanotomy has been performed. Using 70 degrees and especially 30 degrees optical systems can be of great value as the lesions can be perfectly visualised and endoscopic copho-surgery itself can even be carried out. Study of 27 cases of fixed retraction pockets and 14 cholesteatomas which underwent microscopic surgery but with optical verification of the operative cavity demonstrated the value of this technique. The safety of the method even allows the exclusive use of the endaural route in cases which have up to now required a posterior approach and posterior tympanotomy.

[Cholesteatoma and labyrinthine fistula]. / Cholestéatome et fistule labyrinthique.

43 cases of large labyrinthic fistulas caused by a cholesteatoma of the middle ear were studied (33 External Semi-circular Canal fistulas, 4 External Semi-circular Canal amputations with opening of the vestibule, 3 of the promontory, 2 of the oval window, 1 of the Semi-circular Canal). The audiometric, preoperative, radiological data was analyzed. The radiological exam is often disappointing for the average-sized fistulas. Preoperative labyrinthization is moderate for External Semi-circular Canal fistulas and even for certain vestibular amputations; it is often incomplete in the other locations. Systematic exeresis of the cholesteatoma matrix is recommended by the authors, at least for the External Semi-circular Canal fistulas as it is not generally accompanied by aggravation of the bony curve. In the other locations, surprising auditory preservations were observed. In conclusion, the presence of External Semi-circular Canal fistulas should not be a counter-indication for carrying out a ossiculoplasty.

[Peroperative radiotherapy and cancer of the base of tongue. Technic, indications and preliminary results]. / Radiothérapie per opératoire et cancer de la base de langue. Technique, indications et résultats préliminaires.

This study involved 15 patients suffering from large volume squamous carcinomas of the base of the tongue, who were likely to benefit from curative therapy (tumours graded T3, T4, N0, N1, N2, TNM UICC 1987). In 13 patients, treatment included transmaxillary bucco-pharyngectomy (TMBP) carried out either as first intention (10 cases), or as a second stage procedure after radiotherapy (3 cases). 2 patients underwent total laryngectomy with secondary basi-glossectomy. Per-operative radiotherapy was performed on the basi-lingual resection site, delivering a boost of 15 to 20 Gy using adapted localisers. A pectoralis major musculo-cutaneous flap procedure was carried out for the TMBP. Post-operative external radiotherapy to the tumour zone for patients treated as first intention was limited to 50 Gy with a boost of 15 Gy to the cervical lymphatic clearance wound in the event of capsular rupture. The aim of this method was to deliver an elective basi-lingual boost allowing better loco-regional control, while reducing the complications of high dose external oro-pharyngeal irradiation. The technique (reliability-tolerance) and the preliminary results are presented.

[Intrapetrous cholesteatoma. Apropos of 42 cases]. / Les cholestéatomes intrapétreux. A propos de 42 cas.

Cholesteatomas of the temporal bone are lesions which exceed the classical limitations of cholesteatoma middle ear. Certain raise the problem on their acquired or congenital origin. All require delicate but obligatory surgical treatment using various techniques and approach of oto-neurosurgery. Forty-two cases are studied here, bringing together the series from the Grenoble University Hospital.

[Reconstructive laryngectomies. Technical and functional aspects]. / Les laryngectomies reconstructives. Aspects techniques et fonctionnels.

Technical aspects are described of the reconstructive laryngectomy used between 1982 and 1986 to treat 59 patients with endolaryngeal epidermoid carcinoma. Both "conservative" techniques (Tücker's laryngectomy, total endolaryngeal functional evidement) and "non-conservative" techniques (cricohyoidopexy, cricohyoidoepiglottopexy, cricobasiglossopexy) as well as their functional outcome are described. Results of surgical review of endolaryngeal spaces (paraglottic space, hyothyroepiglottic space) are analyzed for each method, and a schema for their use proposed.

[Trepanation of the labyrinth and congenital malformations]. / Trépanation labyrinthique et malformation congénitale.

Labyrinthine trepanation was performed in the majority of 16 patients with minor agenesis of middle ear involving either stapedovestibular ankylosis or absence of fenestra vestibuli. Preoperative findings are discussed, as well as the prevention and treatment of labyrinthine geysers and the possibility of obtaining a functioning labyrinthine opening. Results were good in simple cases but poorer in more complex lesions, for which the indication for use of this procedure is debatable.