[Rehabilitation of the paralyzed face by hypoglossal-facial nerve anastomosis. An analysis of 7 cases]. / Réhabilitation de la face paralysée par anastomose hypoglosso-faciale. Analyse de sept cas.

After facial nerve injury, in cerebello-pontine tumors surgery, hypoglossal-facial anastomosis is the most common procedure, to rehabilite a paralysed face, if direct facio-facial graft is not possible. This procedure must be done, in a second time, during the next year and followed with a specific reeducation. In seven patients operated between 1985 and 1996, we performed clinical evaluation and electrophysiological examination. The best evaluation is the clinical evaluation using the G. Freyss's facial testing. Best results are seen in early, specific and continued reeducation. All our patients have a good recovery of facial nerve function, but clinical examination and electrophysiological results are not correled with an objective video performance. The management of such patients needs efficient oto-neurosurgical team and specific trained physiotherapists.

Otologic features and teachings of a bombing attempt.

The authors present 13 casualties observed after the bombing attempt in Djibouti (March 1987). All of them suffered blast injury to the ear. The scene and the circumstances of the explosion are described. A correlation is sought between the location and position of each casualty and the lesions he presented, with reference to animal experiment data, namely the shock waves propagation conditions. The otologic lesions are commented on with reference to acute acoustic trauma, and the need for a special study of vestibular outcome of blast injuries is emphasized.

Study of the distribution of oral ciprofloxacin into the mucosa of the middle ear and the cortical bone of the mastoid process.

This multicentre study evaluates the distribution of ciprofloxacin into the tissue structures of the middle ear following multiple dosing of one 500 mg tablet every 12 h. The samples were taken perioperatively from adult patients due to undergo surgery for chronic otitis. Administration of ciprofloxacin was instigated 9 days prior to the operation. The samples were taken at different intervals after the last dose in order to evaluate variations in concentration with time. The average peak concentrations recorded and the time taken to reach these concentrations were as follows: middle ear mucosa (n = 16): 5.54 +/- 3.46 micrograms/g (3-4 h): cortical bone of the mastoid process (n = 21): 1.07 +/- 1.29 micrograms/g (4 h). The measurements carried out 12 h after the last dose show that concentrations of ciprofloxacin in the middle ear mucosa were still at least as high as the minimum inhibitory concentration for this antibiotic for most of the pathogens implicated in acute exacerbations of chronic otitis. These results suggest that, administered as an oral dose of 500 mg every 12 h, ciprofloxacin may be an effective agent for the treatment of chronic suppurative otitis. These results now need to be backed up by clinical trials.

[Cervical cystic lymphangiomas in adults]. / Lymphangiomes kystiques cervicaux de l'adulte.

Cystic hygromas, infrequent in children, are even rarer in adults where they are generally unexpected operative findings. Now, with the progress in modern medical imaging, the diagnosis can be suggested before operation. Analysis of the embryogenesis helps to explain the different anatomical and clinical forms and the relations of the cystic hygroma with neighboring tissues, particularly of venous origin. 9 cases of cystic hygroma of the neck in adults are reported and discussed with 26 other well documented cases from the literature. The diagnosis can be confirmed only after operation and histological examination. Surgical removal is technically less difficult in adults than in children and recurrences are rare.

[Cervical cystic lymphangioma in adults]. / Lymphangiomes kystiques cervicaux de l'adulte.

Cystic hygromas, infrequent in children, are even rarer in adults where they once were generally an unexpected operative findings. Now, with the progress in modern medical imaging the diagnosis can be suggested before operation. Analysis of the embryogenesis helps to explain the different anatomical and clinical forms and the relations of the cystic hygroma with neighboring tissues, particularly of renous origin, grases of cystic hygroma of the neck in adults are reported and discussed with 26 other well documented cases from the literature. The diagnosis can be confirmed only after operation and histological examination. Surgical removal is technically less difficulté in adults than in children and recurrences are rare.

[Noise and hearing]. / Bruit et audition.

The injuries induced by noise to auditory system affect above all the inner ear. Thus the hair cells forming the most fragile structures of the sensorial neuro-epithelium will suffer from hair disturbances. As a result these lesions will reduce hearing acuity and sensitivity leading to noise induced hearing loss. There are two types of hearing loss. The sudden hearing loss, called acute sonorous trauma, or the insidious one due to industrial-like noises. On the other hand, noisy environments may have some effects on the intelligibility known as effects on the recognition of speech. To conclude, the epidemiological studies carried on all sections of the population, including teen-agers, revealed a worrying yielding of their hearing performances, probably resulting from excessive level of noisy surroundings as supposed some years ago by Glorig.

[Maxillary Aspergillus sinusitis. Comments apropos of 20 cases]. / Les sinusites maxillaires aspergillaires. Commentaires à propos de 20 cas.

About a series of 20 aspergillus maxillary sinusitis, the correlation between this pathology and previous dental treatments is emphasized. In some cases such as sinusitis can occur without any dental pathology and/or in absence of foreign body on the X-rays. C.T. findings are the basis of the diagnosis. Surgical treatment, using endonasal micro surgery, has been performed in all cases.

[Petrous surgical approaches in tumors of the cerebellopontine angle]. / Les voies d'abord pétreuses des tumeurs de l'angle ponto-cérébelleux.

Three petrous incisions, performed by an ENT-neurosurgery team, can be used for the resection of tumours of the cerebellopontine angle: transpetrosal incisions (posterior translabyrinthine and transcochlear) which provide large access to the IAM and the posterior surface of the petrous bone, but they sacrifice hearing. The suprapetrosal incision (reserved for tumours in the meatus) and the mastoidoretrosigmoid incision (for tumours less than or equal to 20 mm) preserve the labyrinth in an attempt to preserve hearing. The principal objectives of surgical resection of tumours of the cerebellopontine angle (85% of which are acoustic neuromas) are total resection (to preserve the vital prognosis) and preservation of facial nerve function. Attempts to preserve hearing must be confined to cases selected by a complete clinical otological and audiometric examination.

[Surgery of the parotid gland. Indications. Review of the anatomy]. / Chirurgie de la parotide. Indications, rappels anatomiques.

The surgical division of the parotid gland in three parts or "lobes" in relation to facial nerve is a practical custom. After revising the surgical anatomy, the indications and operative technique of total parotidectomy with preservation of the facial nerve (TPP) are described. The discussion is open for pleomorphic adenomas of the superficial lobe, between some authors in favour of a superficial parotidectomy and others who perform a systematic TPP. Other surgical operations are total parotidectomy (TP) without preservation of the facial nerve, TP associated with a neck dissection, at lastly extensive or partial parotidectomies. Trans-parotid surgery uses the parotid region as an approach to neighbouring structures or regions.

[Evaluation of the prognosis of facial paralysis after surgery of acoustic neurinoma by an early Hilger's test]. / Evaluation du pronostic des paralysies faciales après chirurgie du neurinome de l'acoustique par la pratique précoce du test de Hilger.

Surgery for acoustic neuroma is highly risky for the facial nerve. This is why we have tried to assess immediate postoperative facial impairment by performing Hilger's test within the first few hours. Further evolution of the facial function showed the predictive value of Hilger's test as regards facial recovery. Indeed, a difference greater than 2 mA as compared with the opposite side indicates a lack of facial recovery at the 3rd postoperative month. In addition, facial muscle testing performed within the first postoperative 72 hours makes the prognosis of facial function recovery possible. Lack of facial recovery at the 3rd postoperative month was observed for neuromas with a diameter exceeding 2 cm. Preoperative assessment of the risk of facial sequellae is fundamental and essentially depends on the size of the tumor and on the surgical approach. Intraoperative facial monitoring allows better ensuring the preservation of the VIIth cranial nerve and consequently improves postoperative function.

[Isolated sphenoidal aspergillosis presenting as an optic neuropathy]. / Aspergillose sphénoïdale isolée révélée par une neuropathie optique.

Aspergillosis fixation in the sphenoidal sinus is an exceptional occurrence when isolated. The clinical feature is misleading and the diagnosis often difficult; local and regional complications are dreadful. The authors report a case, presenting as an optic neuropathy, and the literature data.

[Preservation of auditory function in the excision of acoustic neuroma]. / Conservation de l'audition dans l'exérèse des neurinomes de l'acoustique.

Selection criteria for the preservation of auditory function during excision of acoustic neurinoma have been defined for a long time, and the means for a successful achievement of such a goal are widely known. Recruitment of special patients, for whom maintenance of an even deeply altered hearing capacity constitutes a requisite for continuation of professional work has lead us to extend indications for the pre- and retrosigmoid approaches recommended by J.M. Sterkers. The authors present a series of 16 patients, in which a single case of cophosis was deplored.

[Tympanoplasty in the treatment of sequelae of blast injuries of the ear]. / Les tympanoplasties dans le traitement des séquelles des blasts auriculaires.

This study deals with 40 clinical files relating to auricular blast injury patients with ensuing eardrum perforation, managed either by tympanoplasty or by placement of a healing support. An analysis of the functional symptoms, the size and localization of the perforation; determination of the presence or lack of immediate post-injury infection, and of the degree and type of hearing loss suffered, permits to define the characteristics of postoperative ear status. A comparison of the study results with published data provides for specifying surgical indications and sheds light on the long-term evolution pattern in such patients.

[Effects of loud music on the Garde Républicaine musicians]. / Effets de la musique de forte intensité chez les musiciens de la Garde Républicaine.

The authors report their observations on the auditory status of 76 musicians belonging to a Republican Guard brass band, and give their interpretation of abnormal findings, as they compare percussion with wind instruments and make reference to literature data. Accompanying signs, such as ear fatigue, noise intolerance, tinnitus, ear-aches, disturbance of sleep, psychic disorders, and disturbances of equilibrium are also taken into account as predisposing factors. Lastly, an attempt is made to bring out some of the characteristics that are specific to each instrument.

[A severe form of external otitis: necrosing diabetic otitis]. / Une forme grave d'otite externe: l'otite nécrosante des diabétiques.

Otitis externa are of usual observation in inter-tropical regions. Pseudomonas aeruginosa is responsible generally. But, when immunodeficiency is associated or on diabetic diathesis, such an otitis externa can be extremely dangerous: extensive osteitis of the base of the skull, paralysis of the last pairs of cervical nerves rapidly creeping, built a clinical identity called malignant external otitis, leading to death in 50% of the cases.

[Laryngeal lesions caused by explosions (laryngeal blasts)]. / Les lésions laryngées par explosion (blasts laryngés).

Laryngeal lesions due to explosions are termed laryngeal blast injuries when they result exclusively from the shock wave effects on laryngeal structures. Their experimental study is very recent and physical and physiopathologic bases for these lesions are discussed in relation to two cases. It is essential to identify these lesions early in all victims of an explosion since their presence may indicate the existence of pulmonary or abdominal blast injuries, detected at a later stage and affecting vital prognosis.

[Blue tympanic membrane. Apropos of 3 cases]. / Tympans bleus. A propos de trois observations.

A CT scan allowed simple diagnosis of the affection in three patients with the blue tympanic membrane syndrome. Lesions included prolapse of the internal jugular vein sinus into the tympanic cavity, an aberrant trajectory of the internal carotid artery in the middle ear and a tympano-jugular glomus tumor. Angiographic investigation of the latter lesion was performed more as a pre-treatment procedure rather than for diagnostic purposes, since it served as a guide to surgery, consisting usually of embolization.

[Blast injuries of the ear. Current status and study of 200 cases]. / Les lésions auriculaires par blast. Aspects actuels et étude de 200 cas.

Clinical case-reports of 200 patients with blast-induced lesions are used as a basis for a review of physical and physiopathologic factors. Otologic aspects of injuries due to high-intensity shock waves are discussed and clinical and histopathologic features described. The place of post-traumatic pressure induced injuries to ear in catastrophy medicine is emphasized.

[Lightning injury of the ear]. / Fulguration d'oreille.

Three cases of auricular fulguration are described and used as a basis for a review of physical characteristics and histopathologic consequences of lightning strikes. Cases are presented and discussed in relation to these fundamental and experimental data.