[Functional anatomy of the facial nerve]. / Anatomie fonctionnelle du nerf facial.

Embryologic individualization of the facial nerve primordium occurs early and emphasizes trigeminofacial connections and variations in the transitional zone (TZ). In the brainstem, the specific nuclei of the facial nerve are located within five columns corresponding to the main functions. Three-quarters of the fibers are of the special visceral efferent group (SVE). Central connections of the facial motonucleus are numerous, particularly with the trigeminal complex but also the cochlear nerves. Only endoneurium surrounds facial nerve fibers in the cerebellopontine angle; central nervous system tissue offers a small extracellular space, lacking collagen and funicular plexus, without epiperineurium: nerve fibers are therefore more susceptible to injury. The segment of a nerve that reveals both CNS and PNS components is referred to as the transition zone. It should be regarded as a "locus minor resistae" because of poor vascularization and CNS myelin deficiency. The acousticofacial reflex is often absent in patients with hemifacial spasm. Early (R1) and late (R2) responses of the trigeminofacial reflex (blink reflex) in patients with hemifacial spasm are of major interest in understanding both peripheral and central mechanisms.

[Surgery for vertigo]. / Chirurgie des vertiges.

Spontaneous recovery or central compensation makes surgical procedures rare in patients with vertigo. Surgery for vertigo proposed after pharmacological or physical therapy fails to eliminate Ménière's disease and some very rare cases of paroxystic positional vertigo. The main target in treating Ménière's disease is to promote vestibular compensation, which is possible only with a nonprogressive and stable deficit leading to readjustment of vestibular reflexes. Surgical procedures can be classified as nondestructive (endolymphatic sac decompression, vestibular nerve decompression, patching of perilymphatic fistulas), selectively destructive (middle fossa or retrosigmoid vestibular neurotomy, lateral semi-circular plugging) and destructive (labyrinthectomy). Surgical indications essentially concern incapacitating vertigo and depend mainly on hearing status. In Ménière's disease, vestibular neurotomy can be regarded as the gold standard considering its good results on vertiginous episodes; however, scoring with functional and quality-of-life scales bring out residual deficiency in some cases.

[Unilateral paralysis of the lower cranial nerves caused by lesion of the internal carotid artery]. / Paralysie unilatérale des derniers nerfs crâniens par lésion de l'artère carotide interne.

We report two cases of unilateral, isolated lower cranial nerves (IX, X, XI and XII) palsy: both were due to a lesion of the internal carotid artery in the para-pharyngeal space (a dissection and a pseudoaneurysm). The diagnosis was based upon magnetic resonance imaging and selective angiography. The normality of the external carotid artery on angiography led to the hypothesis of a direct compression of the lower cranial nerves in the para-pharyngeal space, rather than an ischemia of these nerves.

[Fixed retraction pockets and cholesteatoma in children. Authors' experience with 199 cases]. / Poches de retraction fixées et cholestéatomes de l'enfant. Notre expérience à propos de 199 cas.

Cholesteatoma is more destructive in the child than in the adult, but few studies have examined the outcome as a function of age. The authors evaluated retrospectively their experience in 199 cases of cholesteatomas or uncontrollable fixed retraction pouches in children under the age of 15. Mean follow-up was 2 and a half years and the anatomic and functional results are detailed. Reasons for performing first intention or second intention canal wall up or down procedures were analyzed as a function of age. Residual cholesteatomas were particularly frequent in whatever the initial surgical procedure. Cholesteatomas and retraction pouches in the child under 5 (n = 24) were particularly aggressive and destructive, often requiring a canal wall down operation. Residual cholesteatomas were also very frequent and involved both bony and functional element of the petrus. The clinical course of cholesteatoma in the young child appears to be very different, becoming less destructive as the child reaches adulthood.

[Value of the monitoring of the facial nerve in the evaluation of facial function in translabyrinthine surgery for acoustic neuroma]. / Intérêt du monitoring du VII sur la fonction faciale dans la chirurgie translabyrinthique des neurinomes de l'acoustique.

Amongst the 62 patients operated for acoustic neuroma using a translabyrinthine approach, the authors study post operatory results at one month of the facial function according to the "House-Brackmann" classification. The analysis consists in 2 homogeneous and comparable series of 34 and 28 patients having benefited or not of a per operatory monitoring of the facial nerve with "NIM 2" neuro monitor. Without distinction of the tumoral sizes 76% of patients show a good facial result when monitorized against 60.7% when not. According to the tumoral size monitoring becomes more interesting: also you will find better results in the monitorized serial (71%) against 29% without. Other factors concerning the facial post operatory functions are also analysed by authors. To the very important part of per operatory monitoring, the anatomical status, microvascularization and physiological state of the nerve al as well as the operator's experience are to be added. All above factors must be considered when evaluating the final post operatory facial result.

[Painful ophthalmoplegia caused by chronic sphenoid sinusitis. Contribution of imaging]. / Ophtalmoplégie douloureuse par sinusite sphénoïdale chronique. Apport de l'imagerie.

Sphenoid sinusitis is a rare, often misdiagnosed, potentially lifethreatening infection. We report two cases of chronic sphenoid sinusitis presenting as painful ophthalmoplegia. We emphasize the difficulty of the diagnosis due to the deep-seated position of the cavity. The availability of CT and MRI should allow an early diagnosis. Attention has to be paid to the sphenoid sinus on every cranial image. In the chronic as well as in the acute form, the treatment is an emergency. Surgery procedures should be considered when antibiotics are inefficient. Sphenoid sinusitis must be considered in the diagnosis of painful ophthalmoplegia.

[A cause of neonatal respiratory distress: cerebral tissue heterotopia in the cavum]. / Une cause de détresse respiratoire néonatale: hétérotopie de tissu cérébral dans le cavum.

BACKGROUND: Brain heterotopia can be reflected in disturbances of the oropharynx during the neonatal period, such as acute upper airway obstruction. The main differential diagnosis is encephalocele, which must be recognized before undertaking any surgical procedure. CASE REPORT: A boy, aged 5 days, with a cleft palate and bifid uvula, was admitted for respiratory distress. The distress initially occurred during bottle-feeding, but later became permanent. A solid mass, seemingly implanted in the superior wall of the pharynx, was successfully removed by forceps. A later CT scan showed the absence of any defect in the cribriform plate, thus excluding diagnosis of encephalocele. Histological, examination of the mass showed glial tissue without neurons. CONCLUSION: The presence of a pharyngeal mass in a newborn signals three possibilities: teratoma, heterotopic brain tissue or encephalocele. Encephalocele must by ruled out by a preoperative CT scan with a water soluble contrast agent in order to avoid CSF leakage and meningitis. Respiratory distress should be treated by oral endotracheal intubation to allow time for CT scan investigation.

Indications of the carbon dioxide laser in tracheobronchial pathology of the infant and young child: 14 cases.

Fourteen children aged between 6 months and 7 years (mean age = 3.5 years) were treated by CO2 broncholaser in the ENT Department of Trousseau Hospital. Three groups of diagnostic indication were identified: 1. Granulomas treated after mucosal trauma (tracheotomy, foreign body). 2. Granulomas due to pulmonary and/or lymph node tuberculosis. 3. Adhesions and stenosis secondary to neonatal ventilation. The operative and anesthetic technique is described in detail, together with any possible adverse events. The CO2 broncholaser appears to be a technique of choice in this age group, in which the narrowness of the airways makes any endoscopic procedure difficult. The broncholaser allows the early treatment of obstructive tracheobronchial pathology with its risks of severe ventilatory sequelae.

[Protracted otitis and subacute mastoiditis in children. A prospective study apropos of 118 cases]. / Otites traînantes et mastoïdites subaiguës de l'enfant. Etude prospective à propos de 118 cas.

Antibiotherapy has lead to a substantial decrease in the number of infants with acute mastoiditis or complications thereof. However, the non-negligible incidence of protracted otitis currently observed has caused one to raise several pathogenid hypotheses, among which subacute mastoiditis figures as one needing to be detected early. This prospective study was conducted on 118 children treated for protracted otitis in the ENT Service at Hopital Trousseau, during the period from january 1987 to december 1988. It allowed us to develop diagnostic and therapeutic strategies to cope with the difficult problem of protracted otitis, taking into account bacteriologic findings and risk factors, among other things.

[Emergency tracheobronchoscopy in children with burns]. / Trachéo-bronchoscopie en urgence chez les enfants brûlés.

Smoke inhalation affects the upper airways and lung parenchyma, causing the burn victims' death rate to increase substantially. Early diagnosis is hard to obtain, as clinical signs of complications will be delayed. However, both improved chances for survival and a lower incidence of sequelae depend on how soon treatment is initiated. The smoke inhalation syndrome suspectacle from the case history cannot be confirmed without due paraclinical investigations. The authors retrace their experience with 42 children hospitalized at the Hôpital Trousseau Burn Unit. They stress the importance of emergy ENT endoscopic assessment for obtaining the diagnostic and therapeutic data necessary for taking adequate measures.

[Congenital sensorineural deafness and associated syndromes]. / Surdités de perception congénitales et syndromes associés.

The etiology of perceptive deafness, especially the congenital variety, requires investigation. The presence of a variety of signs associated with deafness constitutes an "associated syndrome" and helps to define a possible genetic origin. These syndromes only represent a small percentage of overall causes of deafness in children, since at most they account for only 10% of cases. Certain syndromes are encountered more often or are well known, others are extremely rare or have only been described recently. The authors report six of these very rare syndromes discovered among their patients: a KID syndrome, a Leopard syndrome, a Norrie syndrome, a Jervell and Lange Nielsen syndrome, a recently described entity called CEE with deafness and an External Neuro-Cochleo-Pancreatic syndrome which would not appear to have been previously described.

[Development of tone curves in sensorineural deafness in children]. / Evolution des courbes tonales dans les surdités de perception de l'enfant.

The authors reviews 239 cases of child sensorineural deafness (478 ears studied both separately and in correlation with the controlateral ear) to try and identify the evolutionary trend of the tone curves throughout the follow-up period, which spanned nearly 20 years in some cases. The difficulties encountered in this study were due to several factors, namely the problem involving very accurate assessment in very young children, the high incidence of tubotympanal disease in the very young, the hard to obtain definition and quantitative evaluation of the notion of progressiveness, as well as the need to analyze the evolutionary patterns in global terms (mean hearing loss), from one frequency to the next and from one ear to the other, since such tone loss patterns are not always symmetric. The authors state their opinion derived from a large number of cases regarding a situation, which characterizes a relatively frequent (over 25% of cases) aggravation of perceptive hearing loss in children.

[The carbon dioxide laser in tracheobronchial diseases in children. A prospective study of 11 cases]. / Le laser CO2 dans la pathologie trachéo-bronchique de l'enfant. Etudeprospective à partir de 11 cas.

Carbon dioxide laser has been used in bronchology for over 15 years, primarily in adults and older children. With the recent development of appropriate bronchoscopes, one has now been able to extend its application to infants and small children. 11 patients, aged 10 months through 7 years, were treated by this technic at the ENT Service of the Hôpital Trousseau (Paris). Indications for broncholaser management at this age and the particularities thereof are specified, as well as the results obtained and the complications linked with its use. This new therapeutic tool appears to be reliable and effective in a certain number of cases, representative of which are circumscribed bronchostenoses, granulomas resulting from trauma or associated with tuberculosis, and benign tumors.

[The dilated vestibular aqueduct syndrome]. / Le syndrome de l'aqueduc du vestibule dilaté.

The authors analyse the clinical, radiological and audiometric findings in a population of 89 ears of 49 patients. There was no correlation between bone malformation and auditory deficit which was often profound. This anomaly occurs during the 7th week of embryogenesis and represents one facet of the dysplasia of Mondini.

Acute myeloblastic leukemia presenting as apparent acute otitis media.

Three cases of acute myeloblastic leukemia of FAB-M2 type revealed by an isolated otitis media are reported. This mean of revelation is valuable for early diagnosis and treatment of the disease. A karyotype was performed in two cases and showed an 8;21 translocation. As far as we know, these are the first acute myeloblastic leukemia cases with otitis media reported in which an 8;21 translocation was detected.

[Effect of the surgical treatment of cleft palate on pathology of the middle ear. Apropos of 49 cases]. / Influence du traitement chirurgical des fentes vélo-palatines sur la pathologie de l'oreille moyenne. A propos de 49 cas.

The presence of middle ear disease was analyzed in 49 patients with soft palate cleft, and more particularly the influence of surgical repair and early therapy. Clinical examination, impedancemetry and audiometry carried out preoperatively and at follow up more than 3 months after surgery showed that although surgical closure of cleft provokes some improvement (40% of cases) some degree of seromucous otitis persisted in most patients, with a very partial positive influence of early surgery. Other physiopathologic factors are involved in the genesis of seromucous otitis, which cannot be cured by early surgery for soft palate cleft alone.