[The base of the piriform sinus in the surgical treatment of fistula of the 4th endobranchial pouch. Apropos of 8 cases]. / Le fond du sinus piriforme dans le traitement chirurgical des fistules de la quatrième poche endobranchiale. A propos de 8 cas.

Fistula of the fourth endobrachial pouch, a congenital malformation, can be defined as an abnormal persistence of the canal joining the base of the piriform sinus and the deep surface of the lateral lobe of the thyroid. These fistulae, which have been more clearly understood over the last ten years, still constitute a delicate surgical problem, which is rarely discussed in the literature, based on the detection of their tract at their origin, the piriform sinus. The 8 cases operated at Hôpital Necker since 1981 reveal the variability of their tract, which, according to the authors, warrants an anatomosurgical analysis.

[Tympanic reconstruction by molded grafts. Value and results. Apropos of experience in 158 cases]. / Reconstitution tympanique par greffes moulées. Intérêt et résultats. A propos d'une expérience de 158 cas.

Use of a moulded aponeurotic graft, shapened and then made rigid by heat and formalin, is a seductive method of tympanic reconstruction because of its simplicity and availability. Indications for and results of the application of this method are analyzed based on experience of 158 cases, with sufficient follow up in 90. The principal indication for use is large perforations, when it is possible to exteriorize the whole canal and almost all the tympanic remains, while doubt exists as to its advantages for treatment of small perforations. Its essential advantage is in fact the ease with which the graft can be positioned on external surface of malleus and inside the remains of tympanic membrane. Overall anatomical results were very satisfactory (83.5%) if one includes in failures of treatment the apparent lateralizations of graft. Functional results were poorer, with rarely complete recovery of hearing and a certain number of labyrinthizations possibly due to injury to handle of malleus or even perforation of canal. Secondary degradation of favorable results may develop because of some degree of lateralization of the newly formed tympanic membrane. These could perhaps be avoided by the technical artifices proposed by other authors.

[Functional surgery of cancer of the hypopharynx. Hemilaryngopharyngectomy, posterior pharyngectomy by bilateral cervical approach]. / La chirurgie fonctionnelle des cancers de l'hypopharynx. Hémi-laryngo-pharyngectomies, pharyngectomies postérieures par abord cervical bilatéral.

The authors report on 48 patients operated by hemi-laryngo-pharyngectomy for spinous carcinoma of the piriform sinus. They try to precise the indications by analysing the factors influencing survival and relapses. They compare surgery to the other methods. In a second part, they report 3 cases of posterior pharyngectomy by bilateral cervical incision.

[Functional radical neck excision. Evaluation of 10 years' experience. Apropos of 434 cases]. / Evidement fonctionnel du cou. Bilan d'une expérience de 10 ans. A propos de 434 cas.

A total of 434 functional évidements of neck were conducted in 313 patients, taking into account all primary localizations. Details of the procedure used are described while emphasizing the need for an évidement tending towards one as complete as a radical operation. Surgery was usually elective (89% of cases) but in 11% considered as essential. A high proportion of lymph nodes classified as no were, however, found to be invaded (22.8%, including 27.5% of these with capsule rupture). Despite this, glandular recurrence on the side of functional évidement was extremely low (less than 7%) even when recurrence was epithelial or involved a second localization. These findings emphasize the validity of functional évidement and confirm published data, known to be difficult to analyze. Although the value of this operation with respect to the cancer is well established, the actual functional interest, particularly in relation, to external branch of XI th nerve is debatable.