[Diagnostic value of needle biopsy and frozen section histological examination in the surgery of primary parotid tumors]. / Valeur diagnostique de la cytoponction et de l'examen histologique extemporané dans les tumeurs parotidiennes primitives opérées.

The necessity of fine-needle aspiration biopsy (FNAB) in the diagnosis and treatment of parotid gland lesions is still controversial. We examined the accuracy of cytology and histology in a review of 128 parotid gland tumors who underwent surgery with FNAB, n = 102 and/or frozen section examination (FS), n = 94. The diagnostic sensibility and specificity for malignant or benign lesions was respectively 81.5% and 97.5% for FNAB and 75% and 100% for FS as compared with definite histology (110 tumors were benign and 18 malignant). Insufficient material for FNAB evaluation was found in 12 patients mainly with small tumors (p = 0.043) or with tumors located in the deep process of the parotid gland (p = 0.029). Surgery was inappropriate (superficial lobe resection for malignant tumor) because of 4 false negative FS diagnoses. FNAB offers valuable information in the diagnosis of nonsurgical lesions and permits to avoid FS if FNAB identify a benign lesion. FS remains mandatory if FNAB evaluation is not possible or suggests a neoplastic tumor.

[Supraglottic laryngectomy with arytenoidectomy]. / Laryngectomie supra-glottique avec aryténoïdectomie.

Relearning to swallow is frequently difficult after supraglottic laryngectomy requiring arytenoid cartilage resection. We propose a surgical procedure in which a local flap is used to close the pharyngeal defect without approximating the laryngeal remnants and the base of tongue. The procedure opens the median raphe and cuts the hyoid bone along the midline. The strap muscles, the perichondrium from the thyroid cartilage and thyroid lobe on the ispilateral side to the tumor are retracted laterally to be used to close the mucosal defect. Sixty-eight patients with T1-T3 carcinomas of the laryngeal margin with extension to an arytenoid in all cases and limited extension to the medial wall and/or anterior angle pyriform fossa in 33 underwent this surgical procedure. Only 5 patients had local recurrence and 8 a lymph node recurrence. Visceral metastases occurred in 21 patients (33%) and second primary tumors were diagnosed at the time of surgery or during follow-up in 19 patients (28%). Three and 5-year actuarial survival rates were 57 and 51%, respectively. Despite post operative radiotherapy, functional success was obtained in 50 patients (75%). This technique provided good tumor control and a high rate of satisfactory functional results in patients with tumors of lateral margin extended to one arytenoid.

[T3 and T4 cancer of the oral cavity, surgical treatment with oral tongue resection]. / Cancers T3 et T4 de la cavité buccale, traitement chirurgical par amputation de la langue mobile.

Amputation of the oral tongue is required to treat T3 and T4 bilateral tumors of the anterior two third of the tongue with or without extension to the floor of the mouth. This partial glossectomy was performed initially for 27 patients and as salvage therapy for 35 patients with recurrent diseases. The reconstruction required a flap in all cases, including 8 microvascular free flaps. Two months after surgery, two third of patients had a satisfactory swallowing hability. The functional results were worst for patients operated after radiotherapy. Actuarial survival rates were 37.5% and 22.1% at 3 and 5 years respectively. The survival rate of patients who had surgery as primary modality of treatment was significantly better as compared with those who had radiotherapy before surgery (p=0,018). This surgery offers a perfect control of tumors of the anterior floor and oral tongue and good rehabilitation provided by the conservation of the posterior tongue.

[Retro-pharyngeal and pharyngeal-laryngeal lipomas]. / Lipomes rétro-pharyngés et du pharyngo-larynx.

Pharyngeal and laryngeal lipoma are uncommon mesenchymal tumors. This report discusses the clinical and pathological features of five cases and a review of the literature. Symptoms included dysphagia, throat discomfort and airway obstruction in three patients. These complaints occurred over several years. One patient had a recurrent fibrolipoma and had experienced several surgical procedures. Surgery is the treatment of choice including conservative procedures but for large tumors open surgical approaches rather than endoscopic techniques should be employed. Recurrent tumor may be a sign of incomplete excision but also of a well-differentiated liposarcoma.

[Value of MRI and computerized tomography scanner in oro-buccopharyngeal cancers with bone invasion]. / Apport de l'IRM et du scanner dans les cancers oro-buccopharyngés avec envahissement osseux.

The purpose of this prospective study was to assess the impact of Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) in the surgical management of carcinomas with mandibular bone invasion. Thirty-five patients with squamous cell carcinoma of oral cavity or oropharynx, with mandibular spread, were studied with both imaging methods before surgical treatment. We compared the radiographic findings with histologic examination. Sensitivity of CTScan and MRI was respectively 25% and 80% to identify bone invasion. CTScan was found less effective in the assessment of bone invasion before mandibular resection and was considered more radiologist dependent. MRI is becoming the imaging method of choice for these cancers, despite inherent disadvantages including limited availability and increased cost over CTScan. MRI is accurate in large oropharyngeal tumors with extension of base of tongue and pterygoid muscle, and to study bone invasion before surgery in oral cavity tumors.

[Endonasal endoscopic surgery in the treatment of spontaneous or post-traumatic cerebrospinal fluid (csf) leaks]. / La chirurgie endonasale sous guidage endoscopique dans le traitement des fuites de LCR spontanées ou post-traumatiques.

The incidence and the risk of meningitidis justify treatment in all cases of cerebrospinal fluid rhinorrhea with spontaneous etiology or after traumatic injury. Endonasal surgery with endoscopic instruments provides many advantages compared with transcranial or transfacial approach used by neurosurgeons. We report our experience and our surgical technique in the treatment of CSF leaks in 5 patients. Intrathecal injection of fluoresceine was very useful in all cases for detecting the CSF leak. Total or selected ethmoidectomy depended on the localization of the leakage. Wide sphenoidotomy enables detection and repair of CSF leaks from the sphenoid cavity. A free graft of inferior turbinal mucosal was used to repair the breache. This rapid low morbidity surgery offered secure closure of rhinorrhea in 4 cases after one procedure and in 1 case after two procedures with an average follow up of 22 months. Cerebrospinal fluid rhinorrhea can be managed in first line therapy with endoscopic intranasal surgical techniques when they are localized in the anterior ethmoid or in the sphenoid cavity.

[Intermaxillary immobilization using ring-screws in adults]. / Blocage intermaxillaire par pitons chez l'adulte.

We have been unsatisfied with the mandibular ligatures (binding) using Ivy type steel dental wire alone or with arch bars. The principal risks are: instability of ligature in patients with missing teeth AIDS, Hepatitis B and Hepatitis C infections periodental lesions We propose the use of anterior titanium implant screws or the monocortical "piton" which have been used up till now in maxillofacial bone reconstruction. Eight patients in one year have benefited from this procedure. This involved the implant of 32 "pitons" in fractured jaws and, for this study, in parasymphyseal areas

[Conservative trans-mandibular lateral pharyngectomy. Functional results in a series of 38 patients]. / La pharyngectomie latérale transmandibulaire conservatrice. Résultats fonctionnels sur une série de 38 patients.

The authors present their experience with conservative transmandibular lateral pharyngectomy used for access to oropharyngeal tumours of the buccal cavity. This study was conducted to evaluate both early results and later aesthetic and functional sequelae after a simplified operation using mini-plaques. This surgical route was used for 38 patients since 1985, including 9 for salvage operations. Surgical indications were tumours of the posterior wall of the pharynx (28), the posterior part of the tongue (8), the retromolar tigone (1), the intramaxillary commissure (2) and the pelvi-lingual region (2). Access via the mandibulotomy was always evaluated peroperatively on the basis of the cleavability of the periosteum of the medial mandibular table. Immediate follow-up was uneventful in 74% cases. Post-operative complications included two general decompensations due to the original lesion, four minor local complications (spontaneous by regressive non-unions) and four local complications requiring a second intervention (flap necrosis, 2; orostomy, 2). Five of the complications were directly related to the mandibulotomy, giving an overall rate of 13%; the rates for first intention and salvage surgery were 9% and 18% respectively. Functional capacity was considered excellent in 75% of the cases and the aesthetic results were good in 94%. The satisfactory post-operative course, the low rate of major complications both after first intention and salvage surgery, and the excellent functional and aesthetic results suggest that transmandibular bucco-pharyngectomy should be preferred whenever the state of the cancerous lesion does not require exeresis of the ramus.