[Exposure of the facial nerve in the masseteric region during parotid surgery. Technical aspects and value]. / Exposition du nerf facial dans la région massétérine lors de la chirurgie parotidienne. Aspects techniques et intérêts.

With an accurate understanding of facial soft-tissue anatomy, deep plane rithydectomy can be performed in safe and precise fashion. We report our experience of 19 cases of parotidectomy using this superficial musculo-aponeurotic system mobilization anterior to the gland. In all cases (two recurrences), it was thus possible to safely expose at least two terminal branches of the lower facial nerve in the masseteric area without jeopardizing the facial nerve. During a second operation for recurrent tumor or in the case of some lesions as inferior and anterior intraglandular cyst, the distant branches of the nerve can be uncovered by a backward dissection. The easiest to identify seems to be the terminal branches in the masseteric area, as it is directly accessible after cutaneous undermining in an area generally not dissected during previous operations and with preserved anatomic relations. In other cases this technique enables one to expose the parotid gland completely and facilitates anterograde facial nerve dissection by its terminal exposure. The superficial musculo-aponeurotic system dissection allows its backward transposition, in the absence of any contraindication, so as to prevent retromandibular depression following a parotidectomy.

[Recurrent or familial facial palsy. Apropos of 6 cases and review of the literature]. / La paralysie faciale périphérique récidivante ou familiale. A propos de 6 cas et d'une revue de la littérature.

About 5 cases of recurrent facial palsy (1 case of familial récurrent facial palsy) and 1 case of non récurrent familial facial palsy, this work analyse the recent knowledges about this subject. Frequency of recurrent palsy is about 10% of the non traumatic facial palsies. A classification is proposed. The prognostic of a recurrence appears similar to the first palsy. Transmission of familial facial palsy seems autosomic dominant or multifactorial. Among the etiology, some like the alternobaric facial paralysis or Melkerson-Rosenthal syndrome could require special preventive or specific therapy.

[Primary cutaneous neuroendocrine carcinoma (Merkel tumor). Clinical and therapeutic update apropos of 4 cases]. / Carcinome neuroendocrine cutané primitif (tumeur de Merkel). Actualités cliniques et thérapeutiques à propos de quatre cas.

The clinical and pathological features of 4 cases of cutaneous neuroendocrine carcinoma are reported. There are unusual malignancies mostly observed in elderly, the prognosis is poor by loco-regional aggressivity and disseminated metastases. They are diagnosed by a pathologist: ultrastructural studies and immunohistochemistry support the diagnosis. A combination of a wild local excision, node dissection and post-operative radiation is recommended.

[Cancer arising in a cyst of the thyroglossal tract]. / Cancer sur kyste du tractus thyréoglosse.

Two new cases of thyroglossal cyst carcinoma are reported. Such cancers concern rather young women. The diagnosis must be suspected whenever a thyroglossal cyst is associated with cervical adenopathies. The most performing investigation seems to be fine-needle aspiration guided by echography. The malignant diagnosis is made during surgery by frozen section of the lesion, confirmed by histology. Two type of cancer must be distinguished: squamous cell carcinoma and carcinoma of thyroid type. The management of squamous cell carcinoma includes a large resection. For thyroid type carcinomas, total thyroidectomy and bilateral neck dissection are to be considered. Because of up-to-date insufficiency following, it is difficult to make a prognosis.

[Primary carcinoma of the external auditory canal and the middle ear. Apropos of 14 cases]. / Carcinomes primitifs du conduit auditif externe et de l'oreille moyenne a propos de 14 cas.

Fourteen carcinomas of the external auditory canal and middle ear are presented regrouping eleven squamous cell carcinomas, two adenocarcinomas and one adenoid cystic carcinoma. Results are analyzed according to the treatment employed: surgery and/or radiotherapy. Four local recurrences occurred, two after radiation as initial treatment and two after surgery completed by radiation. Tumors strictly limited to the skin of the auditory canal and treated surgically are free of disease. A new classification is proposed in order to simplify and clarify the therapeutic indications and prognosis.