[Use of grafts for the olecranial crest in rhinoplasty]. / Utilisation des greffons de crête oléocrânienne dans la rhinoplastie.

On the basis of 30 cases of rhinoplasty utilizing an ulnar crest graft performed over the past few years, the authors review the various types of grafts used for rhinoplasty and describe the technique for sampling the ulnar crest graft in detail. They stress the merits of this procedure: --superficial, easily accessible donor site; --simple postoperative period; --minimal scars; --good-quality graft requiring minimum modeling.

[Mucocutaneous leishmaniasis. Report of 2 cases]. / La Leishmaniose cutanéo muqueuse. A propos de deux cas.

Two new cases of midfacial granuloma caused by leishmaniasis are reported. This disease is very rare in France but very frequent in South America, where it occurs in two forms called UTA and Espundia. These are described here as well as the means of diagnosis and treatment for this disease. A brief review of the cases published in France seems to indicate that the disease is underestimated in this country. The study of the cases published in other African or European countries shows that all species of Leishmania can produce a midfacial granuloma.

[Incidence of mandibular osteoradionecrosis in a series of 13 cases of carcinoma of the mouth floor]. / Incidence des ostéo-radio-nécroses mandibulaires sur une série de 13 cas de carcinomes du plancher buccal.

In a 13-case series of epithelioma of the floor of the mouth given cobalt-therapy irrespective of the selected therapeutic protocol, the authors recorded 5 cases of osteoradionecrosis. In this study, they review both risk and prevention factors linked with radionecrosis at the localization site of this particular type of tumor. They also stress the importance of adapting the treatments, when introducing so-called néo-adjuvant systemic chemotherapy, the high efficacy rate of which is likely to reduce the risks of radionecrosis. This can be achieved either by eliminating completely or limiting the surgical step, or by bringing modifications to the post-operative radiation regimen.

[Cardiac toxicity of 5-fluorouracil. Reflections on a case]. / Toxicité cardiaque du 5-fluoro-uracile. Réflexions à propos d'un cas.

The authors relate a case of spasm occurring during cisplatin and 6-fluorouracil combination chemotherapy. The cardiotoxicity of 5-F.U., and namely the risk of coronary spasm, has been known since 1969. However, few cases have been reported in France. Referring themselves to the case of interest and to literature sources, the authors review current pathogenic hypotheses and specify the precautions commanded by the prescription of any protocol that includes 5-F.U.

[Stapedovestibular otospongiosis beginning in the cochlea. Apropos of 3 cases]. / Otospongiose stapédo-vestibulaire à début cochléaire. A propos de trois cas.

Stapedovestibular ankylosis developed after a prolonged course of pure perception deafness in 3 patients, suggesting possible secondary fixation of the stapes from otospongiosis restricted to the cochlear up to that time. A precise diagnosis of pure cochlear otospongiosis is always difficult to make, its presence usually being supposed rather than confirmed in spite of clinical, audiometry and radiology data, except in those few cases where secondary ankylosis of the foot of the stapes occurs. These findings suggested the need for regular audiometric surveillance of all patients with perception deafness.

[Isolated fractures of the branches of the stapes. Apropos of 2 cases]. / Les fractures isolées des branches de l'étrier. A propos de deux cas.

Isolated fractures of the limbs of the stapes are relatively rare when compared with other traumatic lesions of the ossicula. Diagnosis, as in two recent cases, is suggested by the history of injury and the persistence of a recordable stapes reflex. Surgical re-establishment of transmission is simple but results are not always as spectacular as might be expected.

[Ototoxic potential of erythromycin]. / Potentiel ototoxique de l'érythromycine.

On the basis of a personal case and a review of the literature, the authors raise the problem of the potential ototoxicity of erythromycin in patients with renal failure. The cochlear toxicity of this antibiotic is very different from that of the aminoglycosides, as in all of the reported cases, hypoacusis appears very early and always resolved once the antibiotic was stopped. The actual mechanism of the cochlear damage has not been studied. Although this iatrogenic reaction is uncommon, the authors recommend caution when prescribing erythromycin to patients with renal failure.

[Giant mucocele of the maxillary sinus. Apropos of a case]. / Mucocèle géante du sinus maxillaire. A propos d'un cas.

A young woman presented with a very large primary mucocele of the right maxillary sinus having a tumoral appearance as it had destroyed the bony walls of the sinus. The various proposed etiopathogenic theories fort these mucoceles are discussed, emphasis being placed mainly on their possible inflammatory origin. The contribution of computed tomography for differential diagnosis is stressed, the quality of the images obtained and the data supplied being of invaluable assistance.

[Neurinoma of the third portion of the facial nerve. About a case cured after hypoglosso-facial anastomosis (author's transl)]. / Neurinome de la 3 portion du nerf facial. A propos d'un cas suivi d'une réhabilitation par anastomose hypoglosso-faciale.

The authors report a case of a neurinoma of the third portion of the facial nerve, revelated by a progressive palsy completed four months later (but the muscle of the stapes was still working). After removing the neurinoma which was in the middle of the mastoïde an anastomosis between the XII and the VII nerves was performed and successful. The authors emphasize two facts: --The possibility of active reinervation by this method of the facial muscles even after a long delay of complete interruption of the facial nerve. --The advantage of performing the micro-anastomosis as close as possible to the myo-neural synapsis (just before the bifurcation of the facial nerve.

[The treatment of serve laryngo-tracheal stenosis (author's transl)]. / Traitement des sténoses laryngo-trachéales graves.

The treatment of severe laryngo-tracheal stenosis raises complex problems and we remain far from having found a universally agreed solution for all of them. The authors describe here their attitude to severe laryngo-tracheal damage without suggesting that this should be applied from the outset or to all cases seen. It consists of an operation faithful to the principle of that of Rethi as greatly improved by P. aboulker and to which we ourselves have remained faithful whilst in our turn suggesting a certain number of technical modifications which whilst in no way changing its principle simplify the performance with a teflon tube equipped with a detachable tip with a teflon diaphragm momentarily occluding the lower airway. We also suggest the use of steel wire sutures in order to hold the two hemi-larynxes and the fragments of tracheal rings apart when the degree of damage suggests the danger of postoperative trachemalacia or in the presence of recurrence of stenosis, a far from rare possibility in the late course following this type of surgery.

[Failures of surgical treatment of iatrogenic laryngotracheal stenosis (author's transl)]. / Les échecs du traitement chirurgical des sténoses laryngo-trachéales iatrogènes.

In the light of their experience involving almost 100 cases, the authors emphasize the most frequent causes of failure of the surgical treatment of laryngotracheal stenosis. Minimal procedures most including a combination of the two procedures of widening of the laryngeal lumen and conservation of this recalibration by an atraumatic tube, axial and well tolerated, run the risk of giving results which, if not poor, will be at least incomplete. The classical operation of Rethi would appear to be inadequate to ensure totally effective recalibration if stenosis is major and methods of anterior widening of the larynx, associated with the Rethi procedure or not, are more widely indicated.

[Two cases of haemangiopericytoma (author's transl)]. / A propos de deux cas d'hémangiopéricytomes O.R.L.

The authors report 2 cases of haemangiopericytoma, one cervical and the other endolaryngeal. They emphasise the value of precise histological study which is alone capable of confirming the diagnosis. But in fact the existence of transitory forms leaves many incertainties with regard to the prognosis of these tumours and it is difficult to adopt a coherent therapeutic attitude.

[Some enigmas concerning the pathogenic etiology of certain cases of sudden deafness (author's transl)]. / Quelques énigmes étiopathogéniques concernant certaines surdités brusques.

Some facts relating to the numerous uncertainties concerning sudden deafness, which is often attributed to vascular or viral causes without convincing proof. The possible role of a cochlear hydrops, electrolyte disturbances, or rupture of the fenestra. This critical study includes many observations but the list is not exhaustive.

[Chronic otitis in the one remaining functional ear: therapeutic problems and sequelae (author's transl)]. / Problèmes thérapeutiques de l'otite chronique et de ses séquelles sur oreille fonctionnellement unique.

What should one do when a patient presents with a potentially dangerous chronic otitis, and the other ear is absent? An analysis of such dangerous cases with a cholesteatoma, more especially those with a labyrinthine fistula. Responsibility has to be taken. Medico-legal problems are evoked.

[A case of laryngeal histoplasmosis (author's transl)]. / A propos d'un cas d'histoplasmose laryngée.

Report on a case of histoplasmosis with laryngeal symptoms only, affecting no other organ, especially the lungs, which is rare. Diagnosis was made by histological identification of the intracellular mycosis without culture. Immunological reactions were positive against American forms whereas the patient had lived in Africa. Healing occurred after intravenous amphotericin.

[Reflections on cholesteatoma]. / Réflexions sur le cholestéatome.

Cholesteatoma, defined by Muller in 1830, has not benefited by any means to the same extent as other otological conditions from therapeutic progress. Its histological nature has been defined on information supplied by the electric microscope. It remains puzzling and the manner in which it invades the inner ear cavities imperfectly reproducing the epidermis remains very much a mystery. In spite of a certain ultra-structural unity, it would appear that there is not just one, but many cholesteatomas and if this protean condition is to be understood treated, a primary requisite is a nosological break-down which takes into account the topography of the lesions and their macroscopic appearance. From this attempt at a classification which groups together the most frequently encountered possibilities, operative indications which have to take into account several contradictory preoccupations can be arrived at. It is essential to: -- eradicate the lesions as thoroughly as possible; -- avoid damaging those structures of the middle ear which are still functional or which may be made serviceable again; -- leave open the possibility of surveillance of the cavities so as to detect relapses. These contradictory requisites can be reconciled in a great number of cases and justify the hope that a cure will go hand in hand with an appreciable gain in function. As examples, a few audiograms of patients operated on are included to show the sort of results that it is possible to obtain.