Prevalence and characterisation of vocal fold motion impairment (VFMI) in patients with Multiple system atrophy compared with Parkinson's disease.

INTRODUCTION: Multiple system atrophy (MSA) is a neurodegenerative disorder in which vocal fold mobility can be affected, sometimes leading to life-threatening situations. Our aim was to know if laryngeal examination could help differentiate MSA from Parkinson's disease (PD). MATERIALS AND METHODS: Between 2004 to 2014, all consecutive patients diagnosed with probable MSA were included in this retrospective, monocentric study. Flexible laryngoscopy was obtained in 51 MSA patients and compared with 27 patients with Parkinson's disease (PD). Laryngeal muscles EMG was available in 6 MSA patients. RESULTS: Vocal fold motion impairments (VFMI) was found in 35 (68.6%) MSA patients: 15 (29.4%) had uni- or bilateral vocal fold abnormal movement (VFAM), 13 (25.5%) had uni- or bilateral vocal fold abductor paresis (VFABP), 4 (7.8%) had uni- or bilateral vocal fold adductor paresis (VFADP), 10 (19.6%) had bilateral vocal fold paralysis (BVFP). VFMI was found in 13 PD patients (48.1%) all of whom had VFADP. Presence of BVFP was found associated with stridor (P<0.001) and dysphagia (P=0.002). In all muscles examined in 6 MSA patients, the EMG showed neuropathic patterns. CONCLUSIONS: Our data support that VFMI may be encountered in two-thirds of MSA with a variable degree of gravity. Laryngological examination should be considered as a supplementary tool for the diagnosis and prognosis of MSA. VFMI in particular VFAM, VFABD and BVFP should be discussed as an additional possible red flag even at an early stage of MSA and could help discriminate MSA from PD.

[Facial rejuvenation: rationale use of lasers and thermal systems]. / Le rajeunissement du visage: techniques de complément ou de substitution à la chirurgie. Apport des lasers et systèmes à effets thermiques.

The methods additional or substitution for the surgery of facial skin ageing are dramatically rising before 40 years. These methods are addressed more to the wrinkles and others signs of aging skin. They can constitute a door of entry in the aesthetic treatments and needs a professional approach. These noninvasive methods (within the meaning of the incision) can present complications this the more so as the tendency is with the vulgarizing and with under considerations of the initial diagnosis and the treatment itself. The devices of thermal effects consist of lasers, pulsed flashlamps and radiofrequency. The objective of this development is to consider the bonds, which link the initial diagnosis and the proposal for a treatment by considering side effects and complications of each method.

Transconjunctival approach in lower eyelid blepharoplasty.

AIM: To specify interest and indications of the transconjunctival approach in lower-eyelid plastic surgery. MATERIALS AND METHODS: Twenty-three cases of inferior blepharoplasty performed through a transconjunctival approach are reported. The authors describe the surgical technique, its indications and results. RESULTS: The transconjunctival approach provides excellent access to the inferior fatty chambers and is cutaneous scar free. It has a lower complication rate than the classic transcutaneous approach, and no case of cyclid retraction has been reported. CONCLUSION: In our 'cosmetic society', the inferior blepharoplasty through a transconjunctival approach has taken a significant place in the armamentarium of the esthetic surgeon. Juvenile palpebral lipoptosis without skin excess constitutes the best indication for this technique. It is also indicated in secondary blepharoplasty and in patients presenting with a cicatricial risk or with orbital septum distention.

OBJECTIF: Préciser l'intérêt et les indications d'une approche transconjonctivale pour la plastie de la paupière inférieure. DOCUMENTATION ET MÉTHODOLOGIE: Vingt-trois cas de blépharoplastie exécutés selon l'approche transconjonctivale sont présentés. Les auteurs décrivent la technique chirurgicale, ses indications et ses résultats. RÉSULTATS: L'approche transconjonctivale assure un excellent accès aux cavités graisseuses et évite les cicatrices cutanées. Elle présente un taux de complications plus faible que la approche transcutanée classique, et aucun cas de rétraction de la paupière n'a été déclaré. CONCLUSION: Dans notre société « esthétique ¼, la blépharoplastie inférieure par approche transconjonctivale a pris une place de choix dans l'arsenal du plasticien. Une lipoptose palpébrale juvénile sans excès cutané représente la meilleure indication pour privilégier cette technique. Elle est également indiquée en cas de blépharoplastie secondaire et chez les patients présentant un risque de cicatrice ou de distension de la cloison orbitaire.

[Essential parathyroid cysts: a misleading lesion]. / Le kyste parathyroïdien essentiel: une affection trompeuse.

Though a rare lesion, non-functioning parathyroid cyst is of clinical significance because it usually mimics a thyroid nodule. The cyst can be ectopic in location and therefore constitutes a differential diagnosis to a bronchial or thymic cyst. Two recent cases of non-functioning parathyroid assay are reported. Needle puncture with estimation of the level of parathyroid hormone in the aspirate allows the diagnosis to be made before surgery.

[Value of hyomandibulopexia in the surgical treatment of snoring in patients with sleep apnea]. / Intérêt de la hyomandibulopexie dans le traitement chirurgical des ronfleurs apnéiques.

The authors report their experience with hyomandibulopexia for lingual repositioning in patients with the sleep apnea syndrome. The technique was used 12 times in 11 men and 1 woman and a maximum follow-up of 3.4 years. Hypomandibulopexia was performed as first intention therapy 7 times with or without uvulo-palato-pharyngoplasty. Video-fibroscopy of the pharynx and cephalic magnetic resonance imagery revealed retrobasilingual narrowing in all 7 of these cases. Hyomandibulopexia was performed 5 times for recurrent sleep apnoea syndrome after prior surgery. In two cases, pre-operative evaluation did not reveal any topographic abnormality. Polysomnography studies showed clear improvement with a decreased apneic index and desaturation values. A second fixation of the hyoid was success fully in one case. Hyomandibulopexia is a simple and reliable technique which is useful in patients with sleep apnea syndrome with good to excellent medium term results.

[Asthma and polyposis. Efficacy and adverse effect of endonasal ethmoidectomy. Results apropos of 70 patients]. / Asthme et polypose. Efficacité et nocivité de l'éthmoïdectomie endonasale. Résultats à propos de 70 patients.

The authors report the efficacy and adverse effects of intranasal ethmoidectomy in 70 patients with asthma and persistent severe symptoms from nasosinal polyposis despite repeated prior treatment. The efficacy was defined according to the evolution of symptoms and endoscopic findings. Adverse effects were evaluated according to subjective clinical and therapeutic data in all 70 patients. In addition, 25 patients had complete pre and post-operative pulmonary function tests. The results confirm that intranasal micro-surgery does not increase the severity of asthma. On the other hand, no significant improvement in bronchial function was noted after ethmoidectomy. Finally, the authors emphasize the poorer results obtained in Widal's disease and the importance, after the failure of medical treatment, of using of sufficiently extensive surgical procedure in order to decrease the incidence of recurrences.

[Pharyngeal video-fibroscopy: value in the management of apneic snoring]. / La video fibroscopie pharyngée (V.F.P.): intérêt dans la prise en charge du ronfleur apnéïque.

The pharyngeal video fibroscopy (P.V.F.) should complete the classical diagnostical management of each snoring associated with obstructive sleep apnea. Easily made on a seated awake patient the P.V.F. is the one dynamical pharyngeal procedure. It also let see the snoring and reproduce the upper airway obstruction. The Müller test seats the level of this obstruction, helps the surgeon in the choice of the procedure and should reduce the failure rate.

[Benign adenoma of the middle ear]. / Adénome bénin de l'oreille moyenne.

Starting from one case, the authors review the recent literature data on this very rare lesion. Elements of clinical and histological diagnosis are discussed. Treatment is surgical and must be complete to prevent recurrence.

[Tumors of the cerebellopontine angle. Fortuitous association of meningioma and neurinoma]. / Tumeurs de l'angle ponto-cérébelleux. Association fortuite d'un méningiome et d'un neurinome.

The authors report the case of a totally accidental meningioma/neuroma association in the same internal auditory meatus, although no Recklinghausen's disease seems to be involved. In relation with this case and with the literature data, the authors review the frequency and diagnosis of meningiomas of the cerebellopontine angle. Lastly, this case helps avoiding a diagnostic error, since the imaging may lead to diagnose one tumor only.

[Nasosinusal polyposis. Indications. Results. Apropos of 222 ethmoidectomies]. / Polypose naso-sinusienne. Indications. Résultats. A propos de 222 ethmoïdectomies.

From 1984 to 1990, we carried out 222 endonasal ethmoidectomies in 116 patients with invalidating nasosinusal polyposis who had undergone multiple treatments. Out of these, 49 suffered from asthma and 17 from Widal's disease. We were able to follow up 109 patients with an average time lapse of 14.2 months, the extreme values being 3 months and 6 years. Complete ethmoidectomy was performed in all case, using a combination of surgical microscope and 30% rigid optics. The low number of complications, the high percentage of good results and the absence of respiratory functional aggravation currently give endonasal ethmoidectomy a place of choice for the management of patients with polyposis, in the absence of any true etiological treatment. We associate non-intolerant asthmatics, for whom we have obtained the best results, to the conventional indication. Conversely, Widal's disease is a more disputable indication, and its high percentage of failures justifies the continuation of basic research.

[Residual cholesteatoma: its prevention by surgery with endoscopic guidance]. / Cholestéatome résiduel: sa prévention par la chirurgie sous guidage endoscopique.

In comparing two series of 72 operated cholesteatomas covered by a systematic surgical second look between 12 and 18 months, the authors have observed a distinct regression of residual cholesteatomas since oto-endoscopy came into use (from 47.7% to 10.7%). This new approach, with a minimum amount of practice, makes it possible to perform true endoscopy-guided surgery of the entire tympanic cavity, and reduces the indications of later tympanotomy.