[Parapharyngeal mixed tumour. One case (author's transl)]. / Tumeur mixte parapharyngée. A propos d'un cas.

A parapharyngeal tumour discovered at the end of tonsillectomy was removed secondarily by enucleation. It was a mixed tumour with cylindromatous plaques, raising a triple problem of diagnosis, prognosis and treatment.

[The surgical treatment of carcinomas of the opening of the oesophagus. Personal experience. Selection of a technique of oesophagoplasty (author's transl)]. / Le traitement chirurgical des cancers de la bouche oesophagienne. Expérience personnelle. Choix d'une technique d'oesophagoplasties.

The authors describe the principles relating to the excision of carcinomas involving the opening of the oesophagus. They emphasize the need for low section of the oesophagus, or even total oesophagectomy by virtue of the frequent submucosal spread of the tumour process. The need for resection of this type eliminates the possibility of repair by the Bakamgian flap type and involve the need for a long intestinal segment with a difficult digestive anastomosis in the middle of the thorax if a free intestinal transplant is selected. The authors themselves carry out oesophagoplasty using the transverse colon which in common with the majority of other authors, they feel to be the technique of choice. However, on the basis of their brief experience, they wish above all to discuss the criteria of operability, rarely discussed elsewhere, and concerning spread to the membranous trachea and the possibility of perivisceral tumour spread which cannot be detected by classical techniques. They suggest the use of a prior mediatinoscopy incision in order to attempt to assess any such possible spread.

[Laryngeal trauma and laryngo-tracheal rupture during road accidents. Current concepts (author's transl)]. / Fracas du larynx et désinsertion laryngo-trachéale au cours des accidents de la voie publique. Aspects actuels.

The authors review 6 cases of laryngeal trauma and 2 cases of laryngotracheal rupture which were seen after road accidents. They note that increasingly, as a result of the intervention of emergency medical ambulance teams, such injured patients are intubated at the site of the accident. Closed laryngo-tracheal rupture corresponds completely with cases described in the literature, forming a clinical picture which is a source of grave error by virtue of its latent nature. The management at the time of admission of the patient obviously is altered if intubation has already been performed, since the tube should never be removed for the purposes of clinical assessment before tracheotomy has been performed. If the patient is not intubated, the presence of respiratory distress necessitating emergency therapy reflect major lesions which therefore require surgical exploration. Rather than primary tracheotomy, the authors prefer intubation using a rigid bronchoscope which facilitates subsequent tracheotomy.

[The management of allergic rhinitis (author's transl)]. / Conduite à tenir dans les rhinites allergiques.

The diagnosis of allergic rhinitis varies in difficulty and is based upon evaluation of all information provided essentially by clinical examination and skin test, it being essential that responses to the latter should be not only local but focal in order to be valid. With regard to laboratory examinations, in particular measurement of IgE, they offer significant confirmation in difficult cases. Diagnostic and therapeutic problems differ according to whether the problem is one of seasonal rhinitis, aperiodic rhinitis, longstanding rhinitis and forms in the child. The secret of complete cure of allergic rhinitis remains to be found. The multitude of clinical types is such that no single form of therapy may be proposed. Amongst the many solutions offered, treatment carried out by the oto-rhino-laryngologist may be effective, but an essential rule is to be satisfied with fulfilling the desires of the patient without seeking to exceed them.

[Benign angiomatous pediculated tumour of the oesophagus. Treatment via endoscopy (author's transl)]. / Tumeur pédiculée angiomateuse bénigne de l'oesophage. Traitement par voie endoscopique.

A pediculated tumour of the oesophagus which was missed by radiological examination and an initial fibroscopy performed for a hiatal hernia was discovered by chance 25 centimeters from the teeth during a second fibroscopy. Histologically, this consisted of a benign polypoid angiomatous structure. The patient's anxiety made operation necessary, the latter being carried out using a rigid oesophagoscope. The benign nature of the tumour was confirmed. Both the operative procedure and post-operative course were completely satisfactory.

[The conception of rhinoplasty on the basis of different skin types (author's transl)]. / Conception des rhinoplasties à partir des différents types de peau.

During X Rays carried out after fractures of the nose or rhinoplasty, it has been noted that there is often absence of superimposition between bony displacement and the esthetic state of the nose. The author studies the course of this difference and draws the conclusion that it is related to an important parameter: skin type. Thus, during rhinoplasty osteo-cartilaginous resection should be adapted to different skin types, rather than the contrary.

[Progress in oesophagoscopy. The role of the conventional oesophagoscope as against the supple fibroscope (author's transl)]. / Evolution de l'oesophagoscopie. La place de l'oesophagoscope conventionnel face au fibroscope souple.

In the history of endoscopy, laryngologists have played an important role in knowledge of the oesophagus. For those familiar with gastroscopy, the supple fibroscope represents a diagnostic instrument which may be used for observation of the oesophagus with the exception of natural or pathological areas of stenosis. It offers considerable possibilities in the photographic documentation of lesions. It is relatively easy to perform though not completely harmless. The rigid oesophagoscope remains an effective method of investigation of the whole oesophagus, including the oesophageal opening. It remains the best method for the performance of endoscopic surgery and in particular the extraction of foreign bodies. It is not dangerous in the hands of a competent and trained operator. Rather than opposing each other, the two instruments may be seen to be complementary.

[Chondronecrosis of the cricoid after prolonged intubation (author's transl)]. / Les chondronécroses du cricoïde après intubation prolongée. A propos de 4 observations.

On the basis of 4 cases of partial chondronecrosis of the cricoid after prolonged intubation, the authors review the literature which contains very few similar cases. With regard to pathogenesis, in the light of experimental studies and clinical findings, they emphasize the importance of two lesional factors: excessive diameter of the intubation tube and excessive deflection of the patients' head. All of these factors increase the pressure applied by the tube to the region inferior to the posterior commissure. These parameters would appear to be more important than the duration of intubation itself. The prognosis of these lesions is related to the extent of necrosis: poor when the latter involves the major part of the chaton, generally good when it is limited to partial lysis of the cartilage which may be associated with arytenoid sequestration. Calibration procedures were used in each case. It should be borne in mind that such methods are inadequate for the treatment of massive chondronecrosis which requires repeated operation.

[Oesophageal strictures after surgery (author's transl)]. / Les sténoses oesophagiennes post-opératoires.

Oesophageal strictures after surgery of all kinds on the oesophagus are the unusual but still relatively frequent. The underlying pathogenetic cause is peptic disease. The diagnosis is made by conventional rigid oesophagoscopy which also allows the stricture to be gauged and dilatation treatment to be starded. This dilatation constitutes the main basis of treatment. The surgical cure of the reflux from the stomach increase the efficacity of these dilatations, which should be done immediately after the postoperative period and continued for a long time. This procedure has allowed patients with gastrostomies, thought to be forever, to be closed. The case of strictures after oesophageal surgery is more complex. The etiological causes are varied. The strictures may be associated with and need to be distinguished from kinds and disorders of motility. They may be due to the original disease which continues to progress, or to the surgical technique. Curative treatment is always difficult. The solution is to prevent complications by discussion between the laryngologist and the surgeon before operation.

[The management of corrosive oesophagitis (author's transl)]. / Attitudes devant une oesophagite corrosive.

Regardless of the treatment used against corrosive oesophagitis, the laryngologist must play a role from the beginning and throughout the course. The fibroblasts and collagen fibres which results are the natural agents of healing but, at the same time, are responsible for virtually inexorable stenosis if the corrosion has passed through to the muscular layers. Infection is constant and contributes to stenosis. The effectiveness of antibiotics is certain. They must be used from the beginning and continued for as long as necessary. As far as fibroiss is concerned, dilatations remain the basic treatment, their application requiring great experience and much patience and tenacity. Replacement surgery is attractive. It comes up against the stenosing perioesophageal inflammatory process which tends to die down in time but remains active for a long period. The nENT specialist must therefore pay careful attention from the very end of the postoperative period onwards. The gravity of oesophageal burns justifies intensification of preventive measures. Since it impossible to complete eliminate corrosive oesophagitis, efforts must be directed towards the discovery of substances capable of inhibiting collagen synthesis. Corticosteroids used in the treatment of shock do not prevent stenosis. In the laboratory, B.A.P.N. has shown its effectiveness in the rat. Also in the rat, particularly difficult experiments are in progress using penicillinamine. Although such methods have as yet to be extended to human clinical use, there are nevertheless grounds for hope.

[Preventive treatment in caustic stenosis of the oesophagus (author's transl)]. / Les traitements préventifs des sténoses caustiques de l'oesophage.

The authors review the varioux forms of treatment used experimentally and clinically in an attempt to prevent oesophageal stenosis following ingestion of caustic substances. Corticosteroid therapy is still used by certain authors though its effectiveness is far from obvious. However, promising results have been obtained experimentally using substances such as amino-nitriles, which alter the properties of newly formed collagen.

[Experimental model for the study of caustic stenoses of the oesophagus. Trial of d-penicillamine (author's transl)]. / Modèle expérimental d'étude des sténoses caustiques de l'oesophage et de leur prévention.

The aim of this article is above all to describe a new experimental protocol of caustic stenosis of the oesophagus in the rat, a protocol leading to regular stanoic scarring and offering and experimental model for the trial of anti-collagen substances. Initial research with d-penicillamine appears to offer encouraging results which justify its continuation.