[Lysis of the incus long process and incudostapedial rebridging ossiculoplasty: comparative study of titanium-gold angle prosthesis Plester-type versus Martin Incudo prosthesis hydroxylapatite]. / Lyse de la branche descendante de l'enclume et rétablissement de la continuité incudo-stapédienne: étude comparée des prothèses angulées en titane-or type Plester versus Martin incudo prosthesis hydroxylapatite.

OBJECTIVES: We report two surgical techniques devised to restore a disrupted incudostapedial joint. MATERIAL AND METHODS: Thirty patients underwent rebridging of distal portion of incus long process in the ENT Department of University of Grenoble and Saint-Etienne, between October 1998 and September 2002. Two types of ossicular prostheses were used: A titanium-gold angle prosthesis according to Plester Winkel Kurz (n = 16 patients), and a hydroxylapatite prosthesis as Martin Incudo Prosthesis (n = 14 patients). RESULTS: The average hearing gain in short term is of 8.30 dB for the Martin-Incudo group. It is of 5.23 dB in the Winkel group. Seven and three cases of failures (Residual Rinne > 20 dB) were noticed respectively in the groups Martin-Incudo and Winkel. Seven and four cases of labyrinthisation were observed respectively in the groups Martin-Incudo and Winkel. The average hearing gain in long term is 3.43 dB in the Martin-Incudo group; and 2.85 dB among patients with Winkel Kurz prosthesis. Average residual Rinne is higher than 20 dB in the Winkel group. The hearing gain is not statistically significant between the two groups (p > 0.05). CONCLUSION: The titanium partial prosthesis did not give good functional results. In the case of a limited lysis (< 2 mm) of the distal portion of incus, we use the cement or cartilage interposition. When ossicular chain cannot be preserved entirely, we privilege incus transposition or a titanium PORP. The Martin-Incudo prosthesis seems interesting in the event of lysis of 2 mm of the long process of incus, nevertheless engineering changes are necessary in order to make rigid the incudostapedial joint.

Cholesterol granuloma of the middle ear invading the cochlea.

OBJECTIVES: To report a second case of cholesterol granuloma of the middle ear invading the cochlea. MATERIAL AND METHODS: A 54-year-old woman, who had undergone right-side tympanoplasty with stapedectomy, complained of intermittent right-side otorrhea associated with cophosis. Otomicroscopy found anterior eardrum perforation with mucopurulent effusion. Computed tomography (CT) showed a lesion filling the tympanic cavity, exposing the tympanic facial nerve, with destruction of the ossicles; the vestibule and cochlea were ossified except for the basal turn. The petrous apex was normal. Magnetic resonance imaging (MRI) showed invasion of the cavity and basal turn of the cochlea by a mass in heterogeneous hypersignal on T-1 weighted images, non-enhanced by gadolinium injection, and hyperintensity on T2-weighted images. Cholesterol granuloma of the middle ear was suspected, with surgery indicated due to the facial nerve exposure and cochlear invasion. RESULTS: A brownish-yellow compressive mass invading the basal turn of the cochlea, suggestive of cholesterol granuloma, was removed. Histologic examination confirmed diagnosis. CONCLUSION: Direct invasion of the otic capsule by cholesterol granuloma is extremely unusual. Surgery is indicated in such cases, to avoid onset of neurologic complications.

[The cricopharyngeal muscle and the laryngeal nerves: contribution to the functional anatomy of swallowing]. / Le muscle cricopharyngien et les nerfs laryngés supérieur et inférieur : contribution à l'anatomie fonctionnelle de la déglutition.

OBJECTIVES: The aim of our study has been to describe the cricopharyngeal muscle and its nerve supply from the recurrent laryngeal nerve and from the superior laryngeal nerve. METHODS: Six normal adult human pharynges (12 sides) obtained from cadavers were studied. Micro-dissections were carried out thanks to a Leica microscope. Measures were obtained with a micro-digital caliber. RESULTS AND CONCLUSION: The morphological feature of the cricopharyngeal muscle (CPM) showed three different muscular bundles: superior oblique muscle fibers are joining the inferior pharyngeal constrictor muscle, horizontal circular muscle fibers are 11 to 12mm high, and 3mm thick, inferior oblique muscle fibers are joining external layer of the superior oesophagus. The recurrent laryngeal nerve through its dorsal branch supplies the posterior part of the muscular bundles of the CPM. The superior laryngeal nerve by its lateral branch supplies the anterior part of the CPM. So this double vagal innervation of the CPM from superior and inferior laryngeal nerves participates in the laryngo-pharyngeal coordination specially for swallowing.

Surgical anatomy of the sphenopalatine foramen and its arterial content.

The sphenopalatine artery is the end artery of the maxillary artery located within the pterygopalatine fossa and passes through the sphenopalatine foramen (SPF) on lateral nasal wall. Nasal bleeding from this artery is potentially life threatening and may urgently require endonasal endoscopic occlusion. The aims of the present study have been first to investigate the location of the SPF, secondly the pattern of the main branches of the sphenopalatine artery at the foramen. 12 adult dry skulls and 6 adult cadaver heads injected within Indian Ink have been analyzed under an operating microscope Leica. All measurements were assessed using a digital calliper. The inferior border of the SPF has been situated 18.27 mm (15.09-20.87 mm) above the horizontal plate of the palatine bone and 13.04 mm (9.01-14.85 mm) above the horizontal lamina of the nasal inferior turbinate. Endoscopically, the posterior wall of the maxillary sinus is located at the level or anteriorly within 10 mm to the anterior border of the SPF. In all cases, the anterior border of the SPF is characterized by an easy recognizable sharp bony crest at the narrow middle part of the hourglass shape foramen. The SPF is 6.13 mm high (5.24-6.84 mm), with deep grooves extended superiorly and inferiorly from the foramen in eight skulls (8/12). The posterior lateral nasal artery which courses inferiorly and vertically (diameter 1.80+/-0.20 mm) and the nasal septal artery which courses superiorly and vertically (diameter 1.30+/-0.30 mm) have been the two major branches just leaving the SPF. One or two smaller collateral branches (diameter less than 1 mm) to the superior and/or the middle turbinate can get out coming from the stem of the main branches or directly from the SPF. So, the success rate of sphenopalatine artery ligation during endoscopic surgical procedure needs selective dissection of the two main branches of the sphenopalatine artery close to the SPF.

[Parotid gland masses: diagnostic value of MR imaging with histopathologic correlations]. / Morphologie IRM des tuméfactions de la glande parotide. Corrélations histopathologiques.

BACKGROUND AND PURPOSE: The purpose of our study has been to describe the pre-operatively MR Imaging appearance of masses in the parotid gland which may be sources of clinical and radiological confusion. METHODS: Sixty-eight adults patients with a parotid mass (39 female, 29 male) has been prospectively investigated. T1-weighted, T2-weighted, diffusion-weighted and contrast-enhanced dynamic MR images were performed by using a 1.5 or 1 T MR Imaging unit (Philips Gyroscan Intera 1.5 T. Siemens Expert 1 T). All patients underwent a parotidectomy with histopathologic analysis. RESULTS-CONCLUSIONS: In case of pleomorphic adenoma (N=30) MR imaging sensibility, specificity and accuracy were respectively 87.5, 80.5 and 83%. In case of Warthin tumors (N=13) the same values were respectively 45.5, 93 and 85%. In case of malignant tumors (N=13) theses values were respectively 71, 89 and 87%. Our routine MR Imaging study appears excellent not only for assessing the type and extent of benign salivary gland tumors and the relationship to adjacent structures, but also for determining whether the tumor is benign or malignant.

[Abscess of the posterior cranial fossa. Report of 4 cases]. / Les abcès de la fosse cérébrale postérieure à propos de 4 cas.

The posterior cerebral fossa is an uncommon location for cerebral abscess. In most cases diagnosis is made at the encapsulation stage with the risk of life-threatening tonsillar herniation. The purpose of this retrospective study was to describe our experience in the management of four cases of abscess located in the posterior cerebral fossa between January 2000 and December 2004. All patients benefited from clinical examination and radiological study (CT-scan). Surgical treatment performed in all cases consisted of trepano-puncture of the abscess. The minimum duration of post-operative follow-up was 6 months. Mean patient age was 38.75 years. All patients presented infectious syndrome and intracranial hypertension. The male:female sex ratio was 3:1. A history of chronic middle ear otitis was noted in two patients. Diagnosis of abscess in the posterior cerebral fossa was confirmed by CT-scan in 2 cases. Cholesteatoma and triventricular hydrocephaly were noted in 2 cases. All patients benefited from trepano-puncture of the abscess. Bacteriologic study of pus was positive for Staphylococcus aureus in 1 case, and Providencia Sp associated with Bactéroïdes fragilis in another. Second-stage radical mastoidectomy was performed in 2 cases. One patient died. The outcome was favorable in 3 cases. Because of the small size of the posterior cerebral fossa, abscess in that location requires emergency treatment. Delay can be life-threatening due to the risk of obstructive hydrocephaly and tonsillar herniation.

[Posterior cranial fossa abscess secondary to cholesteatoma]. / Cholestéatome compliqué d'abcès de la fosse postérieure.

OBJECTIVE: The intra cranial complications of chronic ear disease continue to pose a challenge in Senegal, despite advances in anti microbial therapy. Posterior cranial fossa abscesses are rare and continue to be associated with significant morbidity and mortality rates. We describe the presentation and management of a large cerebellar abscess secondary to cholesteatoma. METHODS AND RESULTS: A 11-year-old female presented with an inflammed fluctuant swelling of the right temporal region with ipsilateral otorrhoea. Examination demonstrated an auto atticotomy, large marginal perforation of the tympanic membrane associated with polyp. A diagnosis of otomastoiditis secondary to cholesteatoma was made. The abscess of the right temporal region was incised and drained and the patient was commenced on broad spectrum antibiotics. However the patients clinical status did not improve and there was a deterioration in her neurological status. CT brain and temporal bones demonstrated a large abscess in the cerebellum. 30 CC of pus were drained through a posterior fossa burr hole by the neurosurgeons. A radical mastoidectomy for extensive cholesteatoma of the right ear was subsequently carried out when the patients condition improved. CONCLUSION: Cerebellar abscess is a life threathning condition. In the presence of complicated chronic ear disease, clinical suspicion must be high as early symptoms and signs may be misleading. A low threshold for the performance of brain imagining will aid early diagnosis and allow prompt definitive treatment.

[Benign paroxysmal positional vertigo of the horizontal canal. Clinical features in 25 patients]. / Le vertige positionnel paroxystique bénin du canal horizontal.

OBJECTIVES: To review the clinical features of benign paroxysmal positional vertigo of the horizontal canal (HC-BPPV). PATIENTS AND METHODS: Retrospective study (September 1999 to March 2001) of 25 patients with HC-BPPV. Patients complained of positional vertigo associated with direction changing horizontal positional nystagmus, either geotropic or ageotropic. RESULTS: The horizontal nystagmus was triggered in all patients when rolled to either side in a supine position (head raised 30 degrees) and in 14 patients by the Dix Hallpike manoeuvre. The nystagmus was geotropic in 15 patients and ageotropic in 10. It varies in time in 4 patients with one change in 3 (from geotropic to ageotropic in 2 and ageotropic to geotropic in 1) and 4 changes in 10 days in another patient. In one patient with head trauma, the HC-BPPV was currently associated with ipsilateral posterior canal benign paroxysmal positional vertigo (PC-BPPV), and its characteristic rotatory-up beat nystagmus. Interestingly, 4 patients had a previous history of ipsilateral PC-BPPV and in 5 others an ipsilateral PC-BPPV occurred after the HC-BPPV. Although spontaneous recovery of HC-BPPV was common in most patients, a 270 degrees "barbecue rotation" or a "prolonged position on the healthy side" was effective in some patients. CONCLUSION: Patients with positional vertigo should undergo Dix Hallpike positioning and supine lateral head turns as this latter manoeuvre is more efficient to diagnose an HC-BPPV. Both the transformation of the positional horizontal nystagmus (geotropic-ageotropic) and the association with a PC-BPPV support the diagnosis of an HC-BPPV.

[Kartagener's syndrome: a case report]. / Syndrome de kartagener: à propos d'une observation.

The authors report a rare case of Kartagener's syndrome in 8 years old girl revelated by congenital cardiopathy with chronic bronchitis and severe heart failure. Incomplet endocardial cushion defect with single atrium was found and situs inversus suspected, confirmed by ultrasonography. She undergone cardiac surgery in Europe: atrial septation and mitralvalve repair. Surgery redux was neccessary formitral insufficency and residual shunt. Persistent atelectasia in lower inferior lobe indicated bronchoscopy. Lung biopsy confirmed Kartagener's syndrome. Now, she has no cardiac symptom, but bronchitis and chronic pansinusitis.

Les abces de la fosse cerebrale posterieure; a propos de 4 cas

L'abces de la fosse cerebrale posterieure est une localisation inhabituelle des abces encephaliques. Son diagnostic se fait generalement au stade d'encapsulation avec le risque possible d'engagement amygdalien mettant en jeu le pronostic vital. Nous rapportons notre experience dans la prise en charge des abces de la fosse cerebrale poste-rieure a travers une serie de 4 cas. Il s'agit d'une serie retrospective de 4 patients; colliges de Janvier 2000 a Decembre 2004. Tous les patients ont beneficie d'un examen clinique et d'une exploration radiologique (tomodensitometrie). L'intervention operatoire realisee dans tous les cas; a consiste en une trepano-ponction de l'abces. Le suivi post-operatoire a ete assure pour une duree minimale de 6 mois. L'age moyen etait de 38;75 ans. Le sex-ratio etait de 3/1. L'antecedent d'otite moyenne chronique a ete note dans 2 cas. Le syndrome infectieux et l'hypertension intra-cranienne etaient constants. Le syndrome cerebelleux a ete note dans 2 cas. La tomodensitometrie a permis de confirmer le diagnostic d'abces de la fosse cerebrale posterieure. Un cholesteatome et une hydrocephalie tri ventriculaire ont ete notes dans 2 cas. Tous les patients ont beneficie d'une trepano-ponction de l'abces. L'examen bacteriologique du pus a permis d'isoler un Staphylococcus aureus dans 1 cas; et un Providencia sp associe au Bacteroides fragilis dans un autre. Une mastoidectomie radicale a ete pratiquee a distance dans 2 cas. L'evolution a ete bonne dans 3 cas. Un cas de deces a ete enregis-tre. La localisation de l'abces dans la fosse cerebrale posterieure qui est une loge exigue; signe l'urgence de la prise en charge. Tout retard met en jeu le pronostic vital par le risque d'hydrocephalie obstructive et d'engagement amygdalien

Les abces de la fosse cerebrale posterieure; a propos de 4 cas

L'abces de la fosse cerebrale posterieure est une localisation inhabituelle des abces encephaliques. Son diagnostic se fait generalement au stade d'encapsulation avec le risque possible d'engagement amygdalien mettant en jeu le pronostic vital. Nous rapportons notre experience dans la prise en charge des abces de la fosse cerebrale posterieure a travers une serie de 4 cas. Il s'agit d'une serie retrospective de 4 patients; colliges de Janvier 2000 a Decembre 2004. Tous les patients ont beneficie d'un examen clinique et d'une exploration radiologique (tomodensitometrie). L'intervention operatoire realisee dans tous les cas; a consiste en une trepano-ponction de l'abces. Le suivi post-operatoire a ete assure pour une duree minimale de 6 mois. L'age moyen etait de 38;75 ans. Le sex-ratio etait de 3/1. L'antecedent d'otite moyenne chronique a ete note dans 2 cas. Le syndrome infectieux et l'hypertension intra-cranienne etaient constants. Le syndrome cerebelleux a ete note dans 2 cas. La tomodensitometrie a permis de confirmer le diagnostic d'abces de la fosse cerebrale posterieure. Un cholesteatome et une hydrocephalie tri ventriculaire ont ete notes dans 2 cas. Tous les patients ont beneficie d'une trepano-ponction de l'abces. L'examen bacteriologique du pus a permis d'isoler un Staphylococcus aureus dans 1 cas; et un Providencia sp associe au Bacteroides fragilis dans un autre. Une mastoidectomie radicale a ete pratiquee a distance dans 2 cas. L'evolution a ete bonne dans 3 cas. Un cas de deces a ete enregistre. La localisation de l'abces dans la fosse cerebrale posterieure qui est une loge exigue; signe l'urgence de la prise en charge. Tout retard met en jeu le pronostic vital par le risque d'hydrocephalie obstructive et d'engagement amygdalien